Mc CY2003

WELL CONSTRUCTION RECORD 2. 8 4 2 ; ,, 0
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDWIM DUAI4NAE (pima) 7�Ili b • .T �1�!-% c' L CERTIFICATION t
WELL CONTRACTOR COMPANY NAME SI) ,2F1. C. E w e,Li . D r;t,G = Ng PHONE a ( )
STATE WELL CONSTRUCTION PERMTTI ASSOCIATED WQ PERMIT:
(if applicable) (ifappliable)
1. WELL USE (Check Applicable Boxk Residential VMumcipal/Public 0 Industrial 0 Agricultural 0
Monitoring 0 Rccovery ❑ Heat Pump Water Injection ❑ Other 0 If Other, List Usc
2 WELL LOCATIA - Phic/Land setting
f!1 'dfBKl ge ❑Slope [Valley ❑Flat
(clue& appropriate box)
latiarddlongitude of well location
Nearest Town: LLLt.r7t`J , County )AC n
W ed4- Yviebt.A.c- -.
(Suer Mare. Numbers, Community,
Subdivision, lot Na, Code)
3. OWNER: ` Cflt, 204) W)
Address 35/ rusk% )44..1
(Street or Rome Ito.)
2, int
Gryor own tin
a yip Cole
Alen rode- Phone number,
4. DATE DRILLED //' Z&t 3
5. TOTAL DEPTH: 2 9; j- �/-
6. DOES WELL. REPLACE EXISTING WELL? YES ra4ii ❑
7. STATIC WATER LEVEL Below Top of Casing G O It
(Ua"d'ifAbon Topofering)
8. TOP OF CASING IS 1 FT. Above Land Surface*
net of easing temehained Wsr below Ind m em egaies a
nrlaan Y ntd nee MS ISA NCAC 2C atlt
9_ YIELD(gpin): Z. METHOD OF TEST in%tc/Si<R)rkl
10. WATER ZONES (depth): 2 g fpy,. C / 9O
1 I. DISINFECTION: T
12. CASING:
Depth DiameterDiameterFrom U To ge Ft.
From WO To '3-o F
From To Ft
13. GROUT: Depth
From To
Material
ypeau7gta Amount h QZ 7;1
Wall Thickness
awes . tMt i i&
Ft.
Frotr(_42_ To '7./ FL 7f J
14. SCREEN: Depth D� Slot Size
From To Ft
From To
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
in. in.
in.
(dam)
Luis ddiongitude source:❑GPS❑Topographc map
Idle& box)
DEPTH DRILLING LOG
From To Formation Description
I) 1 mat
D- S0
164,-29
-C-
L
C-2 O
"
LOCATION SKETCH N y c
Show direction and distance in miles from atAIM
two State Roads or County Roads. lnctije ,`�' z
,pd
tanbacra and common road names. g �
16. REMARKS:
I DO HERESY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH I5A NCAC 2CjWPCs—
CONSTRUCTION STANDARDSD THATPY OF THIS RECORD HAS BEEN PROVIDED TO THE WEIL OWNER
1- t
RSON CONSTRUCTING THE WELL DATE::: _.
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center = scam NC
27699-1636 Phone No. (919) 7333221, within 30 days.
GW-i REV. 07/2001

WELL CONSTRUCTION RECORD
284219
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Sectionl1
WELL. '7
CONTRACTOR (INDIVIDUAL) NAME (print) 2/,ZIy a-� .0 Le rir l C+C CERTIFICATION 0-��/Tt
WELL CONTRACTOR COMPANY NAME 3SJ.` t r Cr; LOW_ ci r ; Lc.; /V r, PHONE # t= t %C V 's h
STATE WELL CONSTRUCTION PERMITS ASSOCIATED WQ PERMITS
(ifapplicabie) (if applicable)
1. WELL USE (Check Applicable Box): Residential lH' Municipal/Public 0 Industrial 0 Agricultural ❑
Monitoring ❑ Recovery 0 Heat Pump Water Injection ❑ Other ❑ If Other, List Use
2. WELL LOCATIO -
Nearest Town: iiv&Ab m<. county %/ sk/-de,
49).fic 41 ,01..«<;Ie /z ; 1,�/- /Sc9
(Street Name. Numbers, Community, Subdivision, Lot No p Code)
3. OWNER:
Address / y
,,y(Street or Route No.)
///�g,(1 , 4' c
City or Town State Zip Code
)- L1jy
Area code- Phone number
.2 ,Zw' FFo,-J
4. DATE DRILLED /J-Z5'6) 3
5. TOTAL DEPTH: .)' &13—
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO
7. STATIC WATER. LEVEL Below Top of Casing: et el FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS FT. Above Land Surface'
'Top of easing terminated at/er below land surface requires
variance in accordance w1tb ISA NCAC 2C .0118. n
9. YIELD (gpm): / METHOD OFTESTJ./kit;*2z
10. WATER ZONES (depth): /e/a c�>
1I. DISINFECTION: Type G 2!). ,/t%=' Amount e 6e
12. CASING: Wall Thickness
Depth Diameter or WeigfiVFt.
From 0 To 6$4. Ft. tir//d 4'c
From 57,2 To 53) Ft. '; �/s
From To Ft.
13. GROUT: Depth Material
From To FL
From /Z) To 7.0 FL
14. SCREEN: Depth Diamete( Slot Size Material
Material
Method
From To Ft. in.
From To Ft. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
16. REMARKS:
in.
in.
(depeedminutcdseconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DRILLING LOG
Formation Description
0 pit -/-
0
0 0
n�
c-1
n
C-1 c
f f rn
1—
Po
LOCATION SKETCH — 2^�
rnZ
Show direction and distance in miles trot rat Ietl z
two State Roads or County Roads. Include -the rp d
numbers and common road names.
I DO HEREBY CERTIFY THAT THIS WELL W CONSTRUCTED IN ACCORDANCE WITH ISA NCAC 2C,
CONSTRUCTION STANDARDS, AND THAT COPY OF THIS RECORL3711AS BEEN PROVIDED TO THE WELjMWNER
Z
✓ f2//liv�/�-F
SIGNATURE OF PESO ,
Topo d setting
❑Ridge ope [Walley ❑Flat
(check appropriate box)
Latitude/longitude of well location
DEPTH
From To
yf
elf gc
NSTRUCTING THE WELL DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center - Rpteigb, NC
27699-1636 Phone No. [phone], within 30 days. GW-1 REV. ((7/2001

WELL CONSTRUCTION RECORD
284248
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) ('�+�4i" �TC)S>�iC� CERTIFICATION # o2ls'a
7 ToC59'/C'E Wb/G 6ritLr/(k3 PHONE R ( "%L'/4 '9
wELL CONTRACTOR COMPANY NAME
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable) (if atnolitable)
1. WELL USE (Check Applicable Box): Residential EY 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: �t.
Nearest Town: CZt Fir+ county /%% "J7/ //
eft0&oa-k
(Street Name.. Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: C_..I�R"'cj gY.Z.gn_dm
Address tt». CX era CI �t. rrtj
Street or, Route No.)
G\ A V-0 1 c �NCICI (p .
ny Ior. Tow ) ta"tte 15Zip Code
Area cede- Phone number
4. DATE DRILLED /?2' '0 3
5. TOTAL DEPTH: '' jj/�
6. DOES WELL REPLACE WELL? YES NO 0
7. STATIC WATER LEVEL Below Top of Casing: /6- FT.
(Use"+" if Above Top of Casing)
8. TOP OF CASING IS / FT. Above Land Surface'
*Top of casing terminated at/or below land surface regains a
variance In accordance wltb 15A NCAC 2C .0118.
9. YIELD (gpm): /p METHOD OF TEST give
10. WATER ZONES (depth): (9..a% Q 7tx,'
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)
DEPTH DRILLING LOG
From To Formation Description
d ` //5- n,2ttcyr tc4
C7
rm
3L arC'
�,,��J LOCATION SKETCH O mr
11. DISINFECTION: Type CI'.MGf41 Amount 862 '7-'2 it Show direction and distance in miles from easC
12. CASING: Wall Thickness two State Roads of County Roads. Include Ott mail
Diameter or Weight/EL Matenal numbers and common road names.
From 0 (g . L
Depth
To /be Ft
From IDZ To /14 Ft.
From 12 Z To / 2 S% Ft.
13. GROUT: Depth
From To Ft
Material Method
Frow To Z0 FL -fittc'
14. SCREEN: Depth Diameter
From To Ft in.
From To Ft. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
,oameete
Slot Size Material
in.
in.
From To Ft.
/J
16. REMARKS:
1 DO HEREBY CERTIFY THAT IS WELL WAS CONSTRUCTED IN ACCORDANCE WITH I5A NCAC 2C, WELL
CONSTRUCTION STANDAR AND THAT ACQk?YOFTFJ+S tECORD HAS BEEN PROVIDED TOTHE WEILOWNER
RE OF RSON CONSTRUCTING THE WELL DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center - R deig)1, NC
27699-1636 Phone No. [phone], within 30 days. GW-1 REV. 07/2001

WELL CONSTRUCTION RECORD
284247
North Carolina - Department of Environment and N turarrl''Resources
'-1Division of Water Quality - Groundwater Section
WELL CON'TRACTOR(INDIVIDUAL) NAME (print)
�T'L istb / \ (i$I1t(� CERTIFICATION i'`,,,7j//J�13
WELL CONTRACTOR COMPANY NAME �J 0 S Y-t .d1C� ccdtac V �U-t��i PHONE a MCC 75 (9
STATE WELL CONSTRUCTION PERMITt ASSOCIATED WQ PERMITS
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential H 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: r?d
Nearest Town: eye_ n rC f 'f County
Lop / at-27A ) e4 44 t s /
(Street Name. Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: i `i7.-'Ciect >f/
Address 25/ 7 limit /- e m r %«
(Street or Route No.)
Zip Code
(ter ((f) . 9360
Area code- Plane number
4. DATE DRILLED/2' b
5 TOTAL DEPTH4'�
7. STATIC WATER LEVEL Below Top of Casing: /.S FT.
(Use "+" if Above Top craning)
8. TOP OF CASING IS / FT. Above Laud Surface"
'Top of casing terminated at/or blow land surface require a
variance in accordance with ISA NCAC 2C .0I15.
9. YIELD (gpm): e 6 METHOD OF TEST,%i
10. WATER ZONES (depth): (007".+, 32'a
i 1. DISINFECTION: Type Lt Lc12i4 c
12. CASING:
City or Town State
From 0
Depth Diameter
To %/ / Ft. (17 9
From i // To i/ ,3 FL E,,
From To Et.
13. GROUT: Depth Material
From 0 To Z ( FL f '7G/2t l ✓
From______To Ft. , ✓/
14. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in.
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Size Material
To Ft.
To Ft.
Amount Qze%moo
Wall Thickness
or Weight/FL
From
From
2»7CZ
Topographic/Land setting
❑Ridge ❑Slope ❑Valley ❑Fla
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds) f _
Latitude/longitude source:❑GPS❑Topograjhic map i j_
(check box)
DEPTH
From To
a7 (0 C}
6. DOES WELL REPLA E EXISTING WELL? YES ❑ NO (!- / dQ-
DRILLING----'-'
Formation Description
fig
t2 it
39s- 1...6.
C t-'
C—
Tzm
LOCATION SKETCH N o=ETm
Show direction and distance in miles from at leftt0
two State Roads or County Roads. Inclu 'r he h
num • - nd ". on road names. cn x
m�
n
Y
0
G
16. REMARKS:
I DO HEREBY CERTIFY THAT T 1S WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STAN DARED THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
A /
SIGNATURE
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

13. CASING:
North Carolina • Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
1636 Mail Service Center - Raleigh, N.C. 27699-1636-Phone [phone]
WELL CONSTRUCTION RECORD
275255
WELLCONTRACTOR• .1aMe,3 G (c, -(\
WELL CONTRACTOR CERTIFICATION#:
STATE WELL CONSTRUCTION PERMIT#:
1. WELL USE (Check Applicable Box): Residential Eh —Municipal ❑ Industrial ❑ Agricultural ❑ Monitoring ❑
Recovery El Heat Pump Water Injection ❑ Other If Other, List Use:
2. WELL LOCATION: (Snlhlpow sketch of the location below) /�/�
Nearest Town' : Jn County I `c'eo''w z U
ikcbbc O1` v\.e \--ckf i-e4- 3.5
(Road Name and N�urrbers, Community. or Subdivision and Lot No.) DRILLING LOG DEPTH
3. OWNER Hc5keS dont-ceder From To Formation Descriptiva
Address
1/4310 clA:es) 2
(� Street or Route No.
7t\acim AL C OS75Q
City or Town Stale Zip Code
4. DATE DRILLED Slag/ea
5. TOTAL DEPTH Ia0
6. CUTTINGS COLLECTED YES n NOD--
7. DOES WELL REPLACE EXISTING WELL? YES J NOI T
6. STATIC WATER LEVEL Below Top of Casing: y FT.
(Use'+' it Above Top of Casing)
9. TOP OF CASING IS \ 5 FT. Above Land Surface*
'Top of casing terminated at/or below land surface requires a variance In accor-
dance with 15A NCAC 2C .0118
10. YIELD (gpm): aee METHOD OF TEST �`�'c
11. WATER ZONES (depth) 00 ( w
12. CHLORINATION: Type I- % I} Amount \ \ D If additional space is needed use back of forrr rnz
O
w
CO
0
0
r r,
AD r.) --I
Wall Thickness LOCATION SKETCH �_
Depth n Diameter or WeighvFt. f4ta�Cl (Show direction and distance from at least two Stale
From m-"�� To \-, 7 Ft 62-25 rai. 1'
__s]_L_ 6-3� S c314s Roads, or other map reference points)
FromTo If Ft.
k fi1�o�L
From To Ft
14. GROUT: 1 1 ---
_ Depth Material Method
From Toe To 30 Ft aeon en?"
From To Ft
15.SCREEN:
Depth Diameter Slot Size Material
From To Ft in in.
From To Ft in in
From To Ft in in
16. SAND/GRAVEL PACK:
Depth Size Material
From To Ft
From To Ft
17. RE
Fc _� Lrke Ac
AS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
A C!PY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER.
49/03
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
t original to Division of Water Duality, Groundwater Section Within 30 days
GW-1 REV. 12/99

WELL CONSTRUCTION RECORD
28.1014
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL. CON'TRACTOR (INDIVIDUAL) NAME (prht) Y Tti'Zit? F CERTIFICATION /5-6
WELL CONTRACTOR COMPANY NAME
:2 SS (CC LZffi PHONE a Itaatc5W
STATE WELL. CONSTRUCTION PERMITS, ASSOCIATED WQ PERMITR
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential IW Municipal/Public 0 Industrial 0 Agricultural ❑
Monitoring ❑ Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION:
Nearest Town:
A iebt tVL County 4dtZeei. -
,UNg4-etc' Cjikc r' fANuy'
(Street Name. Num Gsmnunity, Subdivision, Lot No_ Zip Code)
3. OWNER: 6r'0r9of Y'5e " T»fi/ji9 S
Address ,Q,O'/ (,t/tiers- ied /ir-'
(Street or Route No.)
/vee.'a 6'
City or Town State Zip Code
�k )- (006 -- 3
Area code- Phone number
4. DATE DRILLED //-L/- C3
5. TOTAL DEPTH: &Q S
,Topographic/Land setting
dge ❑Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(demsesfmioutm/secmds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From To Formation Description
5'0— dw
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO O— 70-
7. STATIC WATER LEVEL Below Top of Casing: (e C) FT.
(Use "+" if Above Tap of Casing)
8. TOP OF CASING IS / FT. Above Land Surface`
*Top of casing terminated as or below land surface repaints a
variance i. aceterder, tee who ISA NCAC 2C Aii6. ' n
9. YIELD(gpm): 5m METHOD OF TEST 41 I'"
10. WATER ZONES (depth): 'c D 9 PpVI ( (°.O'
1 I. DISINFECTION: Type jLita
12. CASING:
Depth Diameter
From 0 To kj/ Ft C,Y9
From To
From To Ft.
13. GROUT: Depth Material
From To FL
From 0 To IG Ft. "'e /
14. SCREEN: Depth
From To Ft
From To Ft.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
Amount 1 oeeo
Wall Thickness J
or Weight/Ft. Material
SkeZ
Method
ter Slot Size rial
in. in.
in. in.
16. REMARKS:
7<- 7CP
76, 9S
f�6t�t/roc,*
e
LOCATION SKETCH
Show direction and distance in miles front at least
two State Roads or County Roads. Include the road
numbers and common road names. ^ Ida
4 4/c
frittill re.
66
I DO HEREBY CERTIFY THAT THIS WELL CONSTRUCTED IN ACCORDANCE WITH I5A NCAC _
CONSTRUCTION STANDARDS, AND THt)TCOPY OF THIS RECORD HAS BEEN PROVIDED TO THWryL O R�
n
cu
,3
SIGMA RE OF RSO
NSTRUCTING THE WELL
r�
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service CetiIe igh, (NC
27699-1636 Phone No. [phone], within 30 days. GW' f)tEV. Q7/2001 G
m
EiTT

WELL CONSTRUCTION RECORD
North Carolina - Department of Envirotunent and Natant Resources - Division of Water Quality - Groundwater Sn tlon
WELL CONTRACTOR (INDIVIDUAL) NAME (print) `J^/O2y je 1—/t CERTIFICATION 10/1—e rr))
WELLCOATRACIOR COMPANY NAME ) t.'y e-r CC Le e LC t r,c`•i.,ti PHONE a ( )
STATE WELL CONSTRUCTION PERMITS ASSOCIATED WQ PERMITS
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): ResidentialiE MumicipaUPublic 0 Industrial 0 Agricultural 0
Monitoring ❑ Recovery 0 Heat Pump Water Injection ❑ Other 0 If Other, List Use
2. WELL LOCATION: ,
Nearest Town: lilt', c ri County
N 4J itA &imp do eri r P 4
(Saect Name. Numbers, Community, Subdivision. Lot No., Tap Code)
3. OWNER: 11t
Address r .Ll24
(Street or Route No.)
M
City or Town State Zip Code
(?L')- ;It/ j -d5'u V
Area code- Phone number,
4. DATE DRILLED I Z- ((,7--0
5. TOTAL DEPTH: Lib ca
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO 0------.3 c , 965
7. STATIC WATER LEVEL Below Top ofCasinw 'I0 FT.
(Mee" if Above Tap ofCt
8. TOP OF CASING IS i \I t FT. Above Land Surfaces
*Tap ofea�ingtaui ea •chat below land arbor rare a
variance Is acwrdaaee with ISA NCAC 2C MIS.
9. YIELD (gpm): ' , METHOD OF TEST A 1 IR
to. WATER ZONES (depth): a-{ r r tin A 4 00 t
Amount l/ $ 0 2. Tf `%Show direction and distance in miles fronlea ' pn
12. CASING: Wall Thickness two State Roads or County Roads. Include*
rcpbg
Depth Diameter or Weight/FL Material numbers and common road names. 2
From To Ft N\ �, 2 I' 2 Z 1
From C3 L To 1 b I FL ( O co1? if G
From %D/ To /03 Ft. i bp 6Att oc
13. GROUT: Depth Material Method
From To Ft.
From ✓ To . -2, FL T Q tar ( ii )14
14. SCREEN: Depth Diameter Slot Size Material
From To FL in. in.
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
Topographic/Land setting
❑Ridge ❑Slope ❑Valley OcIat
(check appropriate box)
Latitude/longitude of well location
(dep ah ioatesheooads)
Latitude/longitude source:❑GPS❑TCpographic map
(check box)
DEPTH DRILLING LOG
From To Formation Description
c-20 frt
-_
11. DISINFECTION: Type 0..-1-Or (N�
boA
284246
16. REMARKS:
o<
IV 4r
LOCATION SKETCH-er
I DO HEREBY CERTIFY THAT IS WELL WAS CONSTRUCTED IN ACCORDANCE WITH I5A NCAC 2C,
CONSTRUCTION STAND ARQS,ANDTHAT JtCOPY RECORD HAS BEEN PROVIDED TO THE WELL
SICN�Ft1R�OF PERSON CONSTRUCTING THE WELL
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center - Rairdes NC
27699-1636 Phone No. [phone], within 30 days. GW-1 Rijn; 01N2001

WELL CONSTRUCTION RECORD 284245
North Carolina - Department of Environment and Nahat Resources - Division of Water Quality - Gmuodwaler Section
WELL CONTRACTOR (,NDW IDUAtat'NAME (_ C_' �� SI Sq- ?C." CER71FlCATONa Z/5°
WELL. CON-RACIOR COMPANY NAME 3u g 1/yew pfi&C;/v? Prone of lfit"-v SIQ
STATE WELL. CONSTRUCTION PERMrfa ASSOCIATED WQ PERMITS
(if applicable) ram)
1. WELL USE (Cited( Applicable Box): Residential 1/ Maricipal/Ptddic 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pomp Water InjMion 0 Other 0 If Other, List Use
2. WELL. LOCATION: h/
Nearest Town: A\(1 i,,,vV County UIIci�
`)Cit,�k'.LL
j,aCbr Sa Ca 0
(Sow Name. Numbers, Carwaaaity, Sth&aisian. Lot No.. Hp Code)
3. OWNER: ), 4 -' TS Cvrv-, (_cb.✓d .+u "t
Address 4'5'/U G nee TArte'S /Zrl
(Sneerer of Rome Na)
Cry or Town State tbde
( - ( 2-7_go7
Area made Phase weber,
4. DATE DRILLED / 5 G 3
5. TOTAL DEPTH: 2 GJ
6. DOES WELL REPLACE EXISTING WELL? YES O NO fY
7. STATIC WATER LEVEL Below Top ofCosier 20 FT.
Worn Above Top atheist
8. TOP OF CASING IS / FT. Above Lad Surfaces
*Tap .(c.Ssg bwmiswd Maw bor toad sorbs rsaabaa
vadaset a anardaaec wNe ISA NCAC 2C ana.
9. YIELD (gpm): 9 METHOD(OF TEST ,4i/Z.
10. WATER ZONES (depth): 19 (fl v —L"f Z 9) 0
11. DISINFECTION: Type ('L OIL N l
12. CASING:
Depth
Dnunter
From L To L/ 5 Ft
Fwm 6 __To CO F
From 9 1 To 4o? Ft. to Virg,
l3. GROUT: Depth Material
From To Ft
Fran_. _To 7. 2 FL -f y�C /
14. SCREEN: Depth Dom&er Sbt Size
From To Ft in. is
From To Ft in. is
l5. SAND/GRAVEL PACK
Depth See Material
Topographic/[an4aetdng
ORidge OSlopa Malley °flat ,
(text appmpdame hoot)
Latituddtoagitude of well location
aepeedaderne ssecos )
Latitude/longituderowccOGPSOTopographitrnap
(6xhboa)
DEPTH ARILLINOL O--
Frum To Formation Description
From To Ft.
From To Ft.
16. REMARKS:
U / 8 19;C,' 5 , (
C5
L
1,0
NT,
N
2C
G
m
LOCATION SKETCH rn
Amount % A L y3o2 Show direction and distance at miles foal at ISttst
Wall two State Roads of County Roads. lnclti thgoad
a Weight/Pt aamaLl Dumbaa and COMMOII road names.
co pvc
Z2(0 pal
Alt) r,US/
/Cv/
t DO HEREBY CERTIFY THAT THIS WAS CONSTRUCTED
INACCORDANCE RD B PWIT I SA NCAC THE 2C,
WELL OWNER
CONSTRUCTION STANDARDS, AND PY OF mils
SIGNA
PERSON CONSTRUCTING THE WELL DATE
Submit the original to the Division of Water Quality, Grouadwatrr Seetiou,1636 Mrl Service Center GW-I REV. 70 NC27699-1636 Phone Na [phone], within 30 days.

WELL CONSTRUCTION RECORD 284244
North Carolina - Department of Environment and Natural Resources - Division of Water Quality
WELL CONTRACTOR (INDIVIDUAL) NAME (pain) (5f r 1c;•/ c-�
'TO rife &LItS Pr; <civet
ASSOCIATED WQ PERMIT(
(if applicable)
WELL CONTRACTOR COMPANY NAME
STATE WELL. CONSTRUCTION PERMIT#
(if applicable) — /
I. WELL L USE (Check Applicable Box): Residential 0 MtnicipalPublt)t"c 0 Industrial Agricultural 0
Monitoring ❑ Recovery ❑ Heat Puinp Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION?n /+/ �.AA /
Nearest Town: '(' County /14 5:d oe Jew
H» "/Ay.i /yet:t At
(Street Name. Numbers. Caimanity, Subdivision, lot No., Zip Code)
3. OWNER: X /%') L%SfSf.'y5
Address %H5- /1r',+�✓� 77'ld&r z°- 2
(Street or Route No.) _
iNgr,4/1 //JC. 7i 75"Z
City or Town State Zip Code
( } YZy yoiQ
Area code- Plate root
4. DATE DRILLED / e - W "
5. TOTAL DEPTH:
6. DOES WELL REPLACE EXISTING WELL? YES I«NO ❑
7. STATIC WATER LEVEL Below Top°MCasing: Za FT.
(Use"+" if Above Teo of Casing)
8. TOP OF CASING IS / l(L FT. Above Land Surface`
'Top of easing terwioned valor below tad seam require •
•arince l userdaam with ISA NCAC 2C SITS.
9. YIELD (gpm): J70 METHOD OF TEST A /Z
10. WATER ZONES (depth): �v
11. DISINFECTION: Type C IOCF/1/l-
12. CASING:
Depth
irier
From 0 To 39 Ft. iO
Amount ?t h 2.
Wall Tbiiimess
or Weight/Ft. Material
- Groundwater Section
CERTIFICATION R 'SZ)
rRONE 1 f ) 72(-nsi
Topographic/Land setting
❑Ridge ❑Slope Malley ❑Flat
(check appropriate box)
Latitude/longitude of well location
Latitude/longitude sourc� opographic map '., l--_
(check box) �-----
DEPTH DRILLING LOG.
From To Formation Description
From Ta 7/ FL ,1/4' ?Pe
From 7) To 7 9 Ft. /0 %(j r/Effc Stad
13. GROUT: Depth Material Method
From To FL
From To jS FL i a /
14. SCREEN: Depth r Slot Size aterial
From To FL in.
From To Ft. in.
15. SAND/GRAVEL PACK:
Depth Size
From To Ft.
From To Ft.
in.
in
Material
no- 57 6-m-0*--(
c
m
a vo
LOCATION SKETCH 3
Show direction and distance in miles fromaleastn
two State Roads or County Roads. Include the rola''
nmmbera and common road names. 7c3- Z e, % 5
z
4S- 025'" ✓✓ter 491ic
10
(j ly„, r \
16. REMARKS:
I DO HEREBY CERTIFY THAT 5 WELL VMS CONSTRUCTED IN ACCORDANCE WITH I5A NCAC 2C, WELL
CONSTRUCTION STANDARDS u D THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
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. (9)9) 733-3221, within 30 days. GW-1 REV. 07/2001

WELL CONSTRUCTION RECORD
North Carolina - Department of Enviiownent and Natural Resources - Division of Water Quality - Groundwa=r Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) c 2L/�' - 0sf/eC CERTIFICATION
WELL CO,KTRACfOR COMPANY NAME r<.:jfic. LXJ(Sc LW/O1'a, PHONE (.4789-`,S;'
STATE WELL CONSTRUCTION PERMITS ASSOCIATED WQ PERMITt
(if applicable) (if applieebk)
284243
1. WELL USE (Check Applicable Box): Residential Mmneipal/Public ❑ Industrial ❑ Agricultural ❑
Monitoring 0 Recovery 0 Heat Pwup Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATIM M 5 L1
Nearest Town: ' 1 ,(. itt- - County
9 li2.nn t,5' ✓/ 3 u `C i (
(Street Name. N.nnbersn.. community. Subdivision. )at No., Zip Code)
3. OWNER: belie as (t Ale: rP
Addrcss 591 Lu/v.l-e X.fiY
(Sues or Rome No.)
✓)1LL(ic i (Je Z 7_52
City or Town State Zip Code
,2( )-
Area code- Phone number 4. DATE DRILLED i 0- 2 Z L_ 3i
5. TOTAL DEPTH: Yet �
6. DOES WELL REPLACE EXISTING WELL? YES IWNO 0
7. STATIC WATER. LEVEL Below Top ofCasing:_y%
(Use'W' if Above Tap of Casing)
8. TOP OF CASING IS j FT. Above Land Surfaces
*Top et casing terminated .Sr below bed ata requires •
rartance In accordance wkh ISA NCAC 2C AW1a.
9. YIELD (gpm): :1 METHOD OFTESTSff1/v
10. WATER. ZONES (depth): ,2,20;41 96)
11. DISINFECTION: Type C viz; we Amotme l? c 2 61712.
12. CASING:
Depth
From o To
From_77_To 73
From To
13. GROUT: Depth
From To
From_ _To;%ci
14. SCREEN: Depth
From To
From To
15. SAND/GRAVEL PACIC:
Depth Size Material
To FL
To Ft.
From
From
FL it)
Ft.
Ft.
Ft.
l
FL 4/q
Diameter
FL in.
Ft. in.
Wall ThicSess
Diameter mr WeighYFL
L..'jY / y,c, Syt=rL
Topog@rcaapphic/Land setting
ORidge BSlope OVailey OFIat"
(cheep appropriate boa)
Latitude/longitude ofwell location ' I
Latittddlongitude source OGPSOTopogt6�hic iriapi
(check box) •
DEPTH DRILLINb1:60--"" -�---
From To Formation Description
Material Method
Slot Sae Material
in.
in.
16. REMARKS:
E: - 50
LY.'/G�
tariy
, x!<,
c
o �
4.
a ?
rc:
LOCATION SKETCH N
Show direction and distance in miles fromjt left
two State Roads or County Roads. lncludetthe teal{
numbers and common road names. O
w
o
76 U✓
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH I5A NCAC 2C, WELL
CONSTRUCTION STANDARDS, A THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
S GNam IEEOF.P,�RSON 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

283431
WELL CONSTRUCTION RECORD
North Carolina - Department of Envimtlmeat and N pR�q agees�ivisioa of Water Quality - Groundwater Sectiioon
WELL CONERACTOR(INMVIDUAL) NAME (plat) �rY17 /ecC, ,P r2YrLYrcwnoNs rJ. 713
vent connAaoncoMrANY nAME PRICF WELL D4I LLt Tom, INC. PBora e{�2i 327 02ES
STATY WELL CONSTRUCTION PERMITS } SQCIATLD WQ PER6Crd
(if applicable) Cif appl�ieable)
1. WELL USE (Check Applicable Box): Residential L3�Mwicipal/Public ❑ Indutal O Agieu)nual 0
Monitoring ❑ Recovery ❑ Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION: n n
Nearest Town: 4,111/vl Coygty
Grcn t rant re)i
(Stan Name. . Commme//y..Sub/division. Lc No.. Dp Code)str 3q
3. OWNER:,//)7 -9- Xeci Qei 37� (droemenimaas/secmb)
Address C-Y,-" ` y`'�cn*c. '77 i?- Latitndellongilnde srnacerOGPSC epogaphic map
(Sant or Roues No.) (cheek box)
DRILLING LOG
I ith ¢ -fah Coy T S
Qlw„e Area coda Thom mwtber
(77 a-5E1-7Q" ft DATE DRILLED 7- "' 0 3
5. TOTAL DEPTH: /2 1,
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO Fd<
7. STATIC WATER. LEVEL Below Top of Casing:
rb, (Use "'" if Above Top of Cages)
8. TOP OF CASING IS a PP. Above Land Surfaces
'Top of assist tenWated seat below lead surface requires
vsrhace h armed tact 15A NCAC 2C .0111.
e W_FLP (gpm): :.MTFICD OF ?TEST
10. WATER ZONES (depth): 7 9e0 r7,
GLl �/ a Town Zip Code
S her", n (R3, ')- G 5 9— t-t
lo
D
F?o,i
r 0 6Or
con 750
r/4'61 AO
Qin Lino
c:�
clot,
}o aphic/Land setting
ge OSlope Malley Qftat
(cueck wen:prime boa)
Latitude/longitude of well location
c
m
Ot-It
CZ I,'
u.=
.n
LOCATION SKETCH -0 n
11. DISINFECTION: Type T h ie 4s Amount Show direstion and distance in miles from atttast
12. CASING: oeprh, Dtur Wan Thickness two State Roads or County Roads. Include *pad Cr_
From �3) To (OCR Ft (.' �� y- �L numbers and common mad names, y_X L /
From______ To Ft. / T
From To Ft "� 7 sc ( � to m
13. GROUT: Depth ►fitai+t
From /.- To .�G Ft &YAW/1t
From _ To
14. SCREEN: Depth
From To
a
Diameter Slot Size Martial
Ft, in. in.
From To FL m. in.
15. SAND/GRAVEL PACK
Depth
Froro__To Ft.
From, To Ft.
Sin Material
16. REMARKS:
(-1G %/$ /
l /g 7- /is 61,7 ,
Ay/f J� .4wr 9
o d
711
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH ISA NCAC 2C, WELL
CONSTRUC 1ON AND PY OF THIS RECORD HAS BEEN PROVIDED TO THE WETS.. OWNE12--
i�� 1 7r C)31
SIGNATURE OF 1ERS0[I CONSTRUCTING THE WELL DATE
Submit the original to the Division of Water Quay, Gremadwster Seelloa,1636 Man Service Center - Raleigh, N
27699-1636 Phone No. [phone], within 30 days. GW-1 REV. 0Q7/2 i l 1
,n„'.S L o f

283441
WELL CONSTRUCTION RECORD
North Carolina - Deparament of Envinomneat and Natural Resources • Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME(prtat) ,SttMJe t alV id Lashcr tan?ICAnor( f 3CbW0
watt coNrstAcrotcoMPANr nAME PRICY WELL DRILLING, INC. PRoNEa$2 327 02E2
STATE WELL CONSTRUCTION PERMITS tCOCTATZD WQ ?ERbtlT#
(if applicable) (if aopliablel
1. WELL USE (Check Applicable Box): Residential Municipal/Public 0 Industry 0 Agricultural 0
Monitoring O Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION:
Nearest TownV1
: fV c( r, t
4J,:dIP[L /tt
(Shea Name. Numbers, �Caota *y. Subdivtwoa. LotNe., Tip Code)
,SCPee -Of
3. OWNER:7/_ V Itm Ae r lfamc 13-I IC/rrs
� Address 0 9
(Aunty (tc Oc✓oi I
(Sent or Roues No.)
Mot- on n).C•
Caw or Tani State (gam-')- S-So-3os Zip Code
Atee cocks More number,
4. DATE MULLED
%-/ DR
5. TOTAL DEPTH: //) 9 C Tl
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO lir
7. STATIC WATER. LEVEL Below Top of Casing: '5 On FT.
(Use -+' if Above Top of Casing)
S. TOP OF CASING IS / (/.4 FT. Above Land Surface'
*Ter of tube tendaued auv below tad terrace regdres t
newt h aeeerda with 15A NCAC 2C.011R n -
Q Yi7LP (gpm): Lo Za THCD OF TEST IQ/ r /Own
10. WATER ZONES (depth): Q 5-6 A''
1l. DISINFECTION: Type S-+a,
12. CASING: G'rc%K,.(es
Diameter
From (') To 5. - Ft
Fromm_ To Ft.
From To Ft
13. GROUT: Depth
From. n To ,7t Ft
From To Ft
Amount /0PQj',
Wall Thickness
or Weight/Ft Material
F //q Pvc
Mammal ,
(lcncreI-c
Method
fc.vreel
14. SCREEN: Depth Diameter Slot Sim Material
Fron To Ft`vt. in.
From To FL in. in.
15. SAND/GRAVEL PACK
Depth Sine Material
From To Ft
From, To Ft.
16. REMARKS
,Topographic/Land setting
ge OSlope Malley OFlat
(cheek appreerimie bat)
Latitude/longitude of well location
teepemnaiewaMeroaaa)
Latitude/longitude smrce.OGPSOTopographic map
(ehede bex)
DEPIi4 jRILLInNGG `on
LOG
From 0 93 FtI.mMIOR ) , "-4 K
q-5 ciao Sirartift
Oen 3v0 G. nit; er
3t7u yov
toe -t oO
t7 c t) C cc)
< ecm;
• qaret
LCSC '700 /j run 1-et.
Quid 400 ('i✓r�,ath=
Gtc) :v87 Ltvu.t,
LOCATION SKETCR
Sbow direction and distance in miles from atYst o
two State Roads or County Roads. Include digjoad
numbers and common road names. ' `t
c7 c-_rn
.y7
f}cj�wcnc�^ Re'
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND 11JA-T A C9PY OP THIS RECORD HAS BEEN PROVIDED TO/ THE WELL OWN
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mall Service Center - Makin,
27699-1636 Phone Na (919) 7333221, within 30 days. GW-I REV. 07ao!tll.
TIT
?i

283435
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Orauodwater Section
vats eorrrawcTOR(nmIVIDUAL)NAMs (petit) SCjM cal DayI-n5 he r carrriCAnorr 3Oao
writ coNTRACrOR COMP ANT NAME PRICF WELL DPILLING, INC. ?Rarar(32i 327 02E2
STATE WELL CONSTRUCTION rERMITI
J cROQAfgD WQ PERbOTe
(if applicable) (if zp1'wble)
1. WELL USE (Check Applicable Box): Residential Cir Mimicipal/Public 0 Industrial ❑ Agricultural ❑
Monitoring ❑ Recovery 0 Heat Pwnp Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION: //��
N tTown: COr&e I.s County Mc laTc.vct(
KJ
hyCreeg Lo1 $-eaR ct-gq
(Street Nam, Nicobar. Commmity. Subdlvisioa Lot No., Zip code)
3. OWNER' Lc 15kr 4 JeVE) /.(7c�.v, .f
Address /7'rOs 1A%et/ rr640✓fur (a Cc
(Street or Rao No.)
Coyne (t`.J, N.C. 2SC23I
Canaan: Star ZipCale
agr)- 6/ 7-0 rqa -7Oy.- -5E, -6--no
Ars code- ?bome somber
4. DATE DRILLED 3 a 0-
5. TOTAL DEPTH: .3wes we Mit 5-cc in"
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO Ur
7. STATIC WATER. LEVEL. Below Top of Casing: E FI
(Use '4"if Above Top of Going)
8. TOP OF CASING IS 1 �el PT. Above Land Surface*
?op of min tenoMated alter below Lead surface requires
reduce Is secerduce glib ISA NCAC 2C.01IL A
Q YWU' (gpm): / v[ LfE1HCDOF TEST/1 r InOt�n
10. WATER ZONES (depth): '�'i S_r-t-
11. DISINFECTION: TypeSlni4ali(+ v
12. CASING: Cr-orwr10-8
Deptf Diameter
From To _) Ft E>
Froo_ FL
Front To Ft
13, GROUT: Depth
From L To To C' FL Covet'
Maoenal
Amount
Wall Thickness
or c (74f L
Malarial
From To Ft
14. SCREEN: Depth Diameter
From To
From To FL in.
15. SAND/GRAVEL PACK
Depth Sim Mnavl
From _To Ft.
F}om To Ft.
16. REMARKS: I'xn Orr e f U Cleric tAxvier fz.4
Slot Sim Material
is
in.
Topo$$p�pphic/Land setting
ElRidge Ij'51ope Malley QFlat
(cleat appropriate box)
Latitude/longitude of well location
(d greanaiamd/aecoode)
Latitude/longitude source OGPSOTopographic map
(cheek tea)
D EMI DRILLING LOG
From To Formation
0 5.5) D : rt t:,C;
SR iOc rr:yrfic
JOc :ROO rreni
cQoo Jco 6 rcvpt fC
100 - -I CO C cal rl i i-e
4/00 rni'(-c"
0
W
n
c
0
e� e
LOCATION SKEICR `-'"
Show direction and distance in miles from at least
two Stara Roads or County Roads. Inelude the -Toad r".-.
numbers an11 corsmn road names. .� tn)
I.
Onr; yh-1
`ry
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WFr r
CONSTRUCTION STANDARDS, 'I�iAT A COPY OP THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
2 tc�(lp.
-CV- c a
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Caster - Raleigh, NC
27699-1636 Phone No. (919) 7333221, within 30 days. GW-1 REV. 07/2001
=
1

283404
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAMA (print)iJ0.Yv126 1-J• Ca, 141.p ^��'r. CERTIFICATION NA/ 3S
WELL CONTRACTOR COMPANY NAME lAmLis e I l t Pup I p.r,TTri C PHONE # (g; 45:3' ! 3a'(
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential la,Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCAT ON:
Ne est 'own: v1 lfii
u).4\4 A A
(Sweet Name, umbers, C
3. OWNER:
Address
\'
County \Y` C \J (t.)-1/413./`
ity, Subdivision, Lot Nq., Zip Code)
(Street or l,outo No.)
City or Town Staten \ Zip Code
Area coda- Phone number
4. DATE DRILLED t\ • t \ O
5. TOTAL DEPTH: \1 O S
6. DOES WELL REPLACE EXISTING WELL? YE,S VNO 0
7. STATIC WATER LEVEL Below Top of Casing: "10 FT.
(Use '4" if Above Top of Casing)
8. TOP OF CASING IS 1 FT. Above Land Surfaces
*Top of casing terminated at/or below land surface requires a
variance In accord ce with 15A NCAC 2C .0118.
9. YIELD (gpm); ' 0..)....)"‘„TROD OF TEST 0..)....)"‘„
WATER ZONES (depth): ,1)-
Topogra,phic/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
Fro STY
o anon Description
5ij yU t r—lti]
i ate.
LOCATION SKETCH
11. DISINFECTION: Type C
12. CASING:
D From 0 To Y, U Ft
From__To Ft.
From To Ft.
X Amount c_I
Di
Wall Thickness
1 n'
Show direction and distance in miles fro UV least
two State Roads or County Roads. Includ4 the road
numbers d common road names.
a7neter of �'{el °hdFtted . al-
13. GROUT: Depth Material Methoqd
From 0 To 20 Ft.heat Cement- kavt,d
From To Ft.
14. SCREEN: Depth Diameter
From in.
To Ft.
From_ To Ft. in.
15. SAND/GRAVEL PACK:
Depth Size
From To Ft."
From To Ft.
16. REMARKS:
Slot Size Material
in.
in.
Material
�(ct�,YM (,\ cn
CSr
1 DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS CORD HAS BEEN PROVIDED TO THE WELL OWNER
S1 4ATURE OF PERSON CONSTRU INIGiyHE WIT 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

283402
WELL CONSTRUCTION RECORD.
North Carolina - Department of Environment and Natural--ru—Resources - Division of WaterWQuality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAMA (print)___on rue.s f�1i • Ca in ip `OT
WELL CONTRACTOR COMPANY NAME (J AAp5 ell `l Y U WIp l p • I Tei c
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
CERTIFICATIONIa # (3 9
PHONE # e�i1a�5! 45.'S' 23422
1. WELL USE (Check Applicable Box): Residential la' Municipal/Public ❑ Industrial ❑ Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATON:
NeareSf,'3'own: \�i\n 1t,1
M� c /L.
Countyl
(Street t=e, iNumbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: \�-(71 ; uni�
Address \Z .' Mti
(Street or Route No.)
tiM clAkttvN c D-c(-) s
City or Town State /� Zip Code
(r )- toS 1 _ L1aa c(
Area code- Phone number
4. DATE DRILLED AI - h D —L 3
5. TOTAL DEPTH: 2 es
6. DOES WELL REPLACE EXISTING WELL? YES IW'NO ❑
7. STATIC WATER LEVEL Below Top of Casing: IA h 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 accordanc with 15A NCAC 2C .0118. rn� ���
9. YIELD (gpm): METHOD OF TEST GolL
10. WATER ZONES (depth):
Topog8 �ypPhic/Land setting
DRidge gerSlope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic trap
(check box)
DEPTH DRILLING LOG
From , To� �ormat;pn Dekscrip 'on
J �1M
ysu I;kR� f ul
11. DISINFECTION: Type
12. CASING: Wall Thiclmess
Depth Dia(rreter or Weight/Ft. ten
From O To \ SO Ft. 9 ca,kJt. \
From To Ft. ,,\
From To Ft. 1
13. GROUT: Depth Material I_Method
From 0 To ,2D Ft. neat Cerneit�}— l haYk.d
From To Ft.
Depth Diameter Slot Size Material
Amount (�
LOCATION SKETCH
Show direction and distance in miles fro
two State Roads or County Roads. Includ
numbers and common road names.
Uu
14. SCREEN:
From in.
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Size Material
To Ft. in.
From To Ft.
From To Ft.
16. REMARKS:
to
1 DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS R,CORD HAS BEEN PROVIDED TO THE WELL OWNER
gyinta
S1 ATURE OF PERSON CONSTRUOTING
HE WELL DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center -Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. - GW-1 REV. 07/2001

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and N ural Resources - Divisioniv�of Water Quat
WELL CONTRACTOR (INDIVIDUAL) NAM (print) JL_� t— 4--
WELL CONTRACTOR COMPANY NAME
283397
ty - Groundwater Section CERTIFICATION tan
PHONE # 1 S�
STATE WELL CONSTRUCTION PERMIT,/ y/I__ASSOCIATED WQ PERhIITa
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential jl Municipal/Public 0 Industrial 0 Agricultural C
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION.
No- st own:22 -K.
(Street Name bitur—ffe=rmbers, ity, Subdivision, Lot No.., Zip Code)
3. O W NER:.///(_Nu/
Address ,.
(Street or Route No.)
City or Town State
County e of 7
.28.7.CE-
Zip Code
Area code- Pho^_e number
4. DATE DRILLED /4/71 o 3
.5 TOTAL DEPTH: ....TO S
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO 5!
7. STATIC WATER LEVEL Below Top of Casing: G Cz FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS Ati7 _ FT. Above Land Surface"
'Top of casing terminated nt/or below lead surface requires
variance In accordance with ISA NCAC 2C .011S. •
9. YIELD (gpm): 1 ETHOD OF TEST etas __
l O. WATER ZONES (depth): t
I I. DISINFECTION: Type Amount ip_sc et'
12. CASING: Wall Thickness
Depth Diameter so�r.Weight/Ft. Material
Frorn� To , bc,.
n _ Ft y i 90
From_ To Ft ---
From _ To Ft.
13. GROUT: Depth Material Method •
From. 0 To'&_D CAyietzbLL__
From To L WAY -Sy
-
14 SCREEN: Depth Diameter Slot Size Material
From. r Ft. in.
From Fr_ in. .---- it.
15. SAND/GRAVEL PACK:
Depth Size Material
',Toni
ro_ io Ft.
From_ -__To_ ___ _-- Ft. p ��_._� r/ /
16. REMARF:S:%7._ r,t— _Atty — 2.0,51� 4 2L
Topographic/Land setting
J1QRidge 0Slope ❑Valley DFlat
(check appropriate box)
Latitude/longitude of well location
(degrees/mimue:✓sa:ouds
Latitude/longitude source:LIGPS❑Topographic tn_ap__.
(check box) [[ r . - ➢..
12E�LI, DRILLING LOCI J `_�
From To FormationDecnphon __
j
TI
e
L UI
•N S,W
Show direction and distance
two State Roads or County
numbers and common ro
miles from at leas:
ris. include the roar
t_rt
C.0 p
"ter pr,) rr a-u , y
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDAN E WITH 15A NCAC 2C, \VEU
CONSTRUCTION STANDARDS, AND AT A COPY OF THIS RECORD HAS SEEN PROVIDED TO THE WELL OVOWNER
----
/V/-3
SI AT(JRE OF PERSON CONSTRUCTING THE WELL De\TP.
tt?m
O
ya
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. 07/200

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and N
WELL CONTRACTOR (INDIVIDUAL) NAME „(print)
WELL CONT RACIOR COMPANY NAME
Sr ATE WELL CONSTRUCTION PERMIT('
(if applicable)
ASSOCIATED WQ PERMIT#
(if applicable)
283396
Resources - Division of Water Quality - Groundwater SectionB
:Qfp 2
NAL- CERTIFICATION 7
PHONE # 1£cad'lhif—
N/AI
I. WELL USE (Check Applicable Box): Residential fif- Municipal/Public ❑ lndusniai ❑ Agricultural C
Monitoring 0 Recovery ❑ Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION.
Nest Tgym:
_ Cotmtty_/%1C�
s� $ S- -
(Street Nam/Numbers, Community, Subdivi9{6o. Lot No., Zip Code)
)
Aura code- Phone number
4. DATE DRILLED ��//S/D 3
5. TOTAL DEPTH: 3 043
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO jIG
7. STATIC WATER LEVEL Below Top of Casing: 7e) FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS �v� FT. Above Land Surface*
°'fop of casing terminated at/or below land surface requires
variance to acwrdance ltb ISA NCAC 2C.ti118. •
9. YIELD (gpm): 4 METHOD OF TEST 0t�
10. WATER ZONES (depth): 2Q l
11. DTSLNFECTION: Type_ Amount JD O2.
12. CASING: Wall Thickness
Depth D/iameter or Wei_t iVFt.Material
From_O— To_4.O Ft-Lpij *cal&" '!-
From To Ft_
From _To_ Fi.
) 3. GROUT: Depths Material � � �Me�thod
From % To Q Ft. Cents t LLL pS37e*
From To Et.
I . SCREEN: Depth Diameter Slot Size bateral
From _ _ Ft.
From To rc___in. is
(5. SAND/GRAVEL PACK:
[>e th Size Material
From To Ft.
From To Ft
I6. REMARK -
T000graphicfLand se 'thug
❑Ridge Xs lope ❑Valley ❑Flat
(check approprime box)
Latitude/longitude of well locanon
(dcgtesiavmusfsrcand.*
Latirude/longitude source:❑GPS❑Topographic map
DEPTH,
From To
(check box) __ . _'-_----__
MULLING Loa== j L_.
Formation Desch tom- 1-/C-
LOCATION SKETCH
Show direction and distance in mile
two State Roads or County Roads.
numbers and common road nam=
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARD. ND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
l
a
1=
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center - R:c)e
27699--1636 Phone No. [phone], within 30 days_ GW-1 REV. 0ii2001

283394
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and N ral Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME(print) DN4 /e 9/t.L
WELL CONTRACTOR COMPANY NAME rl
STATE WELL CONSTRUCTION PERMIT# //I�r ASSOCIATED WQ PERMIT#
(if applicable) if applicable)
CERTIFICATION 4$'77
PHONE #
ifairft
4/
1. WELL USE (Check Applicable Box): Residential 14 Municipal/Public ❑ Industrial 0 Agricultural Li
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION. /�� m i n
Nearest T Con: Qi/cedig.�. County_ 2(/
B7iL
Street Nuns Numbers, Community, Subdivision, Lot No., Zip CM.)
3. OWNER:O—""
Address r.z
(Strut or Route No.) ryry pv
City or Town Stale Zip Code
Area coda Phone number
4. DATE DRILLED ///a lv /D 3
5. TOTAL. DEPTH: .5"-
6. DOES WELL REPLACE EXISTING WELL.? YES 0 NO Ji4
7. STATIC WATER LEVEL Below Top of Casing: 4,2,5— FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS A .S FT. Above Land Surfaces
"Top of casing terminated at/or below land surface requires a
variance to accordance with I5A NCAC 2C .911S. •
9. YIEI.D (gpm): METHOD OF TESTT
10. WATER ZONES (depth): /-1.12
1!. DISINFECTION: Type Amount S
12. CASINO: Wall Thickness
// Depth Diameter oorrWWeight/Et. Material
[% From To _7p Ft. ._ run_From: To
From To EL _
ethod
13. From ,L Degih �r Maze,
al
From_ � ___ Ta-��_.. Ft_(yrn¢a�
From To
Ft.
14. SCREEN: Depth Diameter Slot Size Material
From o Ft. in. it;.
From To Ft. in. in
1.5. SAND/GRAVEL PACK.
Depth Size Material
From -o Ft.
From To Ft,
16. REMARKS'
Topographic/Land sestina
DRidge ❑Slope ❑Valley slat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutcs/secouctf,
Latitude/longitude Source:❑GPS❑Topographic snap
(cheek box)
DEPTB,
From To
Formatioq Description- )
LOCATION SKETCH
Show direction and distance in mil
two State Roads or Count; Ito
numbers and common road mar
road
1 DO HEREBY CERTIFY THAT THIS WFI I WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, A; HAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
S °NATURE OFF PERSON CONSTRUCTIN WELL
DATE
,ill
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Ctuier - Raleigh- NC
27699-1636 Phone No. (9/9) 733-3221, within 30 days. GW-I REV. 07/2001

283384
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Resources - Division of Water Quality - Groundwater Section �/
WETS. CONTRACTOR (INDIVIDUAL) NAME (print Arad,
- CERTIFICATION /#fX O / /
WELL CONTRACTOR COMPANY NAME ,.de mot" �G�6(/ PRONE # tYo7r t Dy&a
STATE WELL CONSTRUCTION PERMIT/0 �Y/ir ASSOCIATED WQ PERMTTa
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential lR MunicipaUPublic 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:
lite-d 167-7 ? DV 74 L
(Street Name, Numbers, Community, Subdivision, Lot No., Zap Code)
Coins// Ctieweda,
3. OWNER: 7
Address 542 f/a7 ,V 4 e1
(Street or Route No.)
City or Town State Zip Code
(Cott.)- /,lob'-yiM
Aron coda jlV O
4. DATE DRILR1L LET
5. TOTAL DEPTH: _ 3 0,
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO J$
7. STATIC WATER LEVEL Below Top of Casing: to 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): /OIsgTHOD OF TEST—rinto
10. WATER ZONES (depth): ?int eZ loS'
11. DISINFECTION: Type
12. CASING:
From P To Diameter
O Ft. (' Ira/ ®tee
From To Ft
From To Ft.
13. GROUT: Depth Material Method
From 0 To4 Q_ Ft (-t y
From To Ft.
14. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in.
From To Ft. in. in.
15. SAND/GRAVEL PACK:
th Size Material
From To Ft.
From To Ft.
16. REMARKS: 4/O -/%U j c la 7 Ft T 3
1 DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRULIED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
Amount z/O °Z'
Wall Thickness
Topographic/land setting
011Ridge ❑Slope ❑Valley ❑Fiat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH DRILL{NG-4796---- . ----
From To Formation iDescriptiok
Lni
i
rn
ATI• 31 CH F
or Weight/Ft. Material
Show direction and distancemiles f{ogt atRast
two State Roads or County Roads. IncC e th =ioed
numbers and common road . es.
c.o r
tap tp
01 -3
ico
J c.
6�OW/4;. 6adv i�r/y/,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

283381
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) //I [��1 G) L3�i�L L CERTIFICATION f/ 2t77
WELL CONTRACTOR COMPANY NAME tt-2e&
STATE WELL CONSTRUCTION PERMIT#
(if applicable)
/Y/4
ASSOCIATED WQ PERMTT#
(if ayplicable)
BONE
1 eV
1. WELL USE (Check Applicable Box): Residential $. Municipal/Public ❑ Industrial ❑ Agricultural 0
Monitoring 0 Recovery ❑ Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION:
Nearest TOWIE County 416 title,'
37 t,2 g
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNE
Address
(Street or Route No.)
J77l ttt- c A/. C.
City or Town State Zip Code
(��
Area code- Phone number
4. DATE DRILLED /o//3 Jo 3
5. TOTAL DEPTH: i2 b5
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO pi
7. STATIC WATER LEVEL Below Top of Casing: yo FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS / s FT. Above Land Surface'
'Top of casing terminated at/or below land surface requires
variance In accordance with ISA NCAC 2C .0118.
9. YIELD (gpm): /D METHOD OF TEST
10. WATER ZONES (depth): / WO
11. DISINFECTION: Type -Q aIG Amount 7*
12. CASING: !/ Wall Thickness
Depth Diameter or Weight/Ft. Material
From Ton Ft. /v t. i eVc
From. To. Ft. 7
From To Ft.
13. GROUT: DepthMaterial Method�•
From 0 To 2 Ft.� .� t . ) rfrty
From To FL
14. SCREEN: Depth Diameter Slot Size Material
From /To Ft. in. in.
From /_ To Ft. in. in.
15. SAND/GRAVEL PACK:
th Size Material
Topographic/Land setting
[Midge NISlope ❑Valley DFlat
(cheek appropriate box)
Latitude/longitude of well location
yea
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH DRILLIN9 LQ
From To Formation D scription r.---�-�
From /To Ft
From / To Ft.
16. REMARKS:
LOCATION . KETCH ` (_
Show direction and distance in miles ttorzrM-least—__j
two State Roads or County Roads. Include the road
numbers and common road names.
Tli
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH ISA NCAC 2C, WFI T.
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
eniedent; dal/ /10//.3/03
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-1 REV. 07/2001

283376
2. WELL LOCATION:
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Qulity - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) �•/nL/J� CERTIFICATION #,r2# /7
7
WELL CONTRACTOR COMPANY NAME a /4..2e i,11aaZ. Y. _PHONE a (bra)— L 5,4-dy%£fd
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ ERMIT#
(if applicable)
(if applicable)
1. WELL USE (Check Applicable Box): Residential Municipal/Public ❑ Industrial ❑ Agricultural ❑
Monitoring ❑ Recovery 0 Heat Pump Water Injection ❑ Other 0 If Other, List Use
Near t To ``: �� County )ii Cal mcde
utht) �J
(Street Name, N rs, Community, SubdiSubdivision,Lot No., Zip Cade)
3. OWNER: ��
Address aS
• (Street or Rome 166)
777av—. , C.
City or Town State
oLD/5-z__
Zip Code
( T:
Arta RILPhonE /&D/0 3 4. DATE DRH.LE
5. TOTAL DEPTH: .Z ys' '
6. DOES WELL REPLACE EXISTING WELL? YES.0) NO Al
7. STATIC WATER LEVEL Below Top of Casing: /f r FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS jC FT Above Land Surfaces
*Top of casing terminated at/or below land suture requires a
variance in accordan a with I5A NCAC 2C .0118. •
9. YIELD (gpm): METHOD OF TEST��Grtte
10. WATER ZONES (depth): /gs I S'50 t
11. DISINFECTION: Type ,/p2— Amount
9 OZ-
Topographic/Land setting
DRidge MIS1ope OValley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrecs/minutes/seconds)
Latitude/longitude source:OGPSOTopographic map
(check box)
Forma 'on Desc� h n3
DEPTH
From To
12. CASING: Wall Thickness
Depth Diameter or Weigbt/Ft. Material
From 0 ToA2 Ft. .#_,2,z_ id L
From To Ft
From To Ft.
13. GROUT: Depth Material Method
From 0 To o2 tD Ft. (tent/ t_ i-i Oily
From To Ft.
14. SCREEN: Depth Diameter Slot Size Material
From /T'o Ft in. in.
From / To Ft. in. in.
15. S AND/GRAVEL PACK.
h Size Material
From To _ Ft.
From To FL
16.REMARKS.
LOCATION SKEtCY
Show direc . on and distance in miles from at least
two State oar's or County Roads. Include the roa
numbers . d common road names.
0
CO
0
t-n
n
rn
J
Cit
0
0
I DO HEREBY CERTIFY THAT THIS WFI 1 WAS CONSTRUCTED IN ACCORDANCE WITH I5A NCAC 2C, WF1 T.
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
SIGNATURE OF PERSON CONSTRUCTING THE WELL
DATE
O
�(l)_
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
WELL CONTRACTOR (INDIVIDUAL) NAME (print)
WELL CONTRACTOR COMPANY NAME
STATE WELL CONSTRUCTION PERMITS
(if applicable)
283371
Resources -Division of Water Quality - Groundwater Section .l
�/..S�� CERTIFICATION #Koid/,
it_) /- dealePRONE gral,(
ASSOC1ATEDWQ PERMIT# ASS
(if applicable)
1. WELL USE (Check Applicable Box): Residential,Qi Municipal/Public 0 Industrial ❑ Agricultural ❑
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use
2. WELL LNeanntTOCATION:n / `' County 4 C
i� e,Num ' 777T/V. aty7 ,952- 94�J?",,
(Street Name, Nuunity, Subdivision, Lot No., Zip Code)
3. OWNER:�s..t.
Address V7
tiLQ..
f4 • (Street or Route No.)
nY N.C. if24 2-
City or Town State Zip Code
Am code- Phone number,
4. DATE DRILLED /D/J%/t 3
5. TOTAL DEPTH: a ()S'
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 f .S FT. Above Land Surface"
*Top of casing terminated at/or below land surface requires a
variance In accordance with ISA NCAC 2C .0118.
9. YIELD (gpm): --CD METHOD OF TESTr�.Gsscr
10. WATER ZONES (depth): / `SAS'
11. DISINFECTION: Type c__ Amount 7 °Z
12. CASING: Wall Thickness
or WeiFt.Material
i� L
Depth Diameter
Topographic/Land setting
❑Ridge IQSlope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/mites/seconds)
Latitude/longitude source:OGPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From To Formation Description
rri
cn
N
LOCATION SKETCI- To
Show direction and distance in mileo
r at tract
two State Roads or County Roads. nclude th ri
pa _ j
numbers and common road names. r •� _-r--
From 0 To ly Ft. b #i T ft) 1 ITN
From To Ft.
From To FL
13. GROUT: Depth ta Method •
_ From__L>To v2(A Ft. f• /
From To Ft.
14. SCREEN: Depth Diameter Slot Size Material
From Ft. in. in.
From To Ft. in. in.
15. SAND RAVEL PACK:
Depth Size Material
From o Ft.
Fro 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 THIS RECORD HAS EEN PROVIDED TO THE WELL OWNER
SIGNATURE OF PERSON CONSTRUCTING THE WELL
/D7/D.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
fnr�

283370
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and tural Resources - Division of Water Quality - Groundwater Section��r
WELL CONTRACTOR (INDIVIDUAL) NAME (print) 5 . //L Ln , I CERTIFICATION gxtt? v,,
WELL CONTRACTOR COMPANY NAME fjt as ' _gs4 St i PRONE # tvS LV/eove c+
STATE WELL CONSTRUCTION PERMIT# �r/ "n ASSOCIATED WQ PERMrr#
(if applicable) <rf applicable)
1. WELL USE (Check Applicable Box): Residential !$ Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use_
2. WELL LOCATION
Nearest T.swe:
Countyj%ic IILt/et%/
_jre /vo Jfl,z-
(Street Name, Numlijs, Community, Subdivision, Lot No., Zip Code)
3. OWNE _
Address /9D erA-�Q., Wet
eseen jar t or Roug No.)
t
City or Town State
Zip Code
( )-
Area code- Phone number, /
4. DATE DRILLED D/3be 3
5. TOTAL DEPTH: 0
6. DOES WELL REPLACE EXISTING WELL? YEE 0 NO ,L i
7. STATIC WATER LEVEL Below Top of Casing: n FT.
/ (Use "+" if Above Top of Casing)
3. TOP OF CASING IS A 7 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—Ctino
10. WATER ZONES (depth): / -—,Z A'
11. DISINFECTION: Type^
12. CASING:
Depth
Diameter
Frorn d To //O Ft
From To Et.
From To FL
13. GROUT: Depth ,Nlateriaall..,
From_ Tos2_2 FL_(_t>•
From To Ft.
14. SCREEN- Depth Diameter
From / ToFt. in.
From / To Ft. in.
15. SAND/GRAVEL PACK:
Depth
From To _ Ft.
From /To Ft.
Amount
Wall Thickness
-
or #4 t/Ft. /Material
/C,
16. REMARKS:
Method
Slot Size Material
in.
in.
Size Material
Topographic/Land setting
DRidge 6QSlope DValley I7Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:DGPSCTopographic map
(check box)
DEPTH DRILLING LOG
From To Formation Description
LOCATION SKETCFt
Show direction and distance in mile
two State Roads or County Roads.
numbers and common road names.
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED 1N ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
/0 30/a i__
SIGNATURE 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.
GW-1 REV. 07/2001

WELL CONSTRUCTION RECORD
293246
North Carolina - Department of Environment and Natural ResourcesuGroundwater - Division of Water Quality - Section
WELL CONTRACTOR(INDIVIDUAL)NAME (print) eV /U7 .I rUS4+C - CERT7flCATIONA.056
WELL CONTRACTOR COMPANY NAME US44t. E t..-) DJ 2 '0 tt., I , PHONE It62:6) %ZSr-'L., 4
STATE WELL. CONSTRUCTION PERMITS ASSOCIATED W8FERMITe
(if applicable) (if applicable)
1. W ELL USE (Check Applicable Box): Residential E Mwiicipal/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: j 710 - County %14 - Darr (F,
14-4
(Sweet Name, Numbers, Commodity, Subdivision, lot No., Zip Code)
3. OWNER: I Qht lj/2en"
Address / (O
(Street or Route No.) i i Z
/'11Gy)j.eL p
City or Town State Zip Code
(8Z8)- 7Zy'45"zc,
Area code- Place number
4. DATE DRILLED / 2- e/- 03
5. TOTAL DEPTH: G o r
6. DOES WELL REPLACE EXISTING WELL? YES Q'NO ❑
7. STATIC WATER LEVEL. Below Top of Casing: /); O FT.
(Use "+n if Above Top of Cann)
8. TOP OF CASING IS I FT. Above Land Surface'
'Top of easing terminated Wet bdow land surface requires •
variance la accordance with ISA NCAC 2C .011a.
9. YIELD (gpm): Vz. METHOD OF TESTSnild
I O. WATER ZONES (depth): t1.7 g p,✓t 4/ e fO '
11. DISINFECTION: Type dLOtt; /ram
12. CASING:
From O
Depth Di.
To 5-7 FL (n
From i% To, l f F
From To Ft.
13. GROUT: Depth
From To j,
Fro �To -ZZ FL I"/f
14. SCREEN: Depth
From To Ft.
From To Ft.
15. SAND/GRAVEL PACK:
Depth
From To Ft.
From To Ft.
16. REMARKS:
FL
Material
Amount is
Wall Thickness
or Weight/FL Material
('6
Method
Topographic/Land setting
❑Ridge ❑Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(depees/mindtdseconds)
Latitude/longitude source:❑GPS❑Topographic map
(duck box)
DEPTH DRILLING LOG
From To Formation Description
anyla
Diameter Slot Size Material
in. in.
in. in.
Size Material
D ' SO nt
4-0 - 3 Sth<
3 2- 4QS
v
r
-T
CO
LOCATION SKETCH N
Show direction and distance in miles from at lenr591
two State Roads or County Roads. Include the ad
numbers and coumton road names. OYL
V
fret
a
1 DO HEREBY CERTIFY THAT ' 1S WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDA: a .:, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL 0
SIG
CONSTRUCTING THE WELL
DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Marl Service Center - Raid
27699-1636 Phone No. [phone], within 30 days. GW-I REV
U/gtico -& clo

North Carolina • Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
1636 Mail Service Center - Raleigh, N.C. 27699-1636-Phone [phone]
WELL CONSTRUCTION RECORD WELL CONTRACTOR. /r� 5"
293222
WELL CONTRACTOR CERTIFICATION #:
STATE WELL CONSTRUCTION PERMIT#: 4 7 d a e'f-
1. WELL USE (Check Applicable Box): Residential ID ---Municipal ❑ Industrial ❑ Agricultural ❑ Monitoring ❑
Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use:
2. WELL LOCATION: (Show sketch of the location below) ,<�
Nearest Town: / /72lJP i 0 b.,County: /%%C- act Pit e /7
1UeR//1 /s)ctr✓c .mac4,�./L'J Jcia1
(Road Name and Numbers/Community. or Subdivision and lot No.) DRILLING LOG DEPTH
3. OWNER sr' it v-,c, Nc)A ..r/Pc/pNS From To Formation Description
nee Address eg tAJetc s /C/ , 2a/ n e - 5.00 e'tw'Z.
(Street or Houle No.)
Avale r A a/ /VC 7s'A
City or Town State Zip Code
4. DATE DRILLED .n/3-el
5. TOTAL DEPTH Sea
6. CUTTINGS COLLECTED YES Q NOQ-
o
7. DOES WELL REPLACE EXISTING WELL? YES ❑ NOB
8. STATIC WATER LEVEL Below Top of Casing: eat FT.
(Use'.' 8 Above Top of Casing)
9. TOP OF CASING IS / , FT Above Land Surface'
?op of easing terminated et/or below land surface requires a variance In accor-
dance with 15A NCAC 2C .0118
10. YIELD (gpm): METHOD OF TEST
11. WATER ZONES (depth)* /6 a
12. CHLORINATION: Type //YN 7'MAmount SS'
13. CASING:
Wall Thickness
<--1
•4- o
-r1 15Dz
to cm
1.) oG
>o
cnr
m
If additional space is needed use back of fofn `�+
N c�
LOCATION SKETCH
Depth Diameter or"W�eight/Ft. Material (Show direction and distance from at least two State
From�To Ft. �+— ry inci 71'c Roads, or other map r- erence points)
From To Ft
From To Ft
14. GROUT:
Depth ,Mates* I Method
From O To �Ft ' Oti//ar� /77,.x e
From To Ft
15. SCREEN:
Depth Diameter Slot Size Material
From To Ft in
From To Ft In
From To Ft. in
16. SAND/GRAVEL PACK:
Depth Size
From To Ft
From To Ft
17. REMARKS:
in
In
In
Material
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY 0 THIS RECORD H/1$ BEEN PROVIDED TO THE WELL OWNER.
G- .. .." rc....: `5 i T -1 fr
FOR OFFICE USE ONLY
Quad No:
Serial No.
SIGNATURE bf PERSON CONSTRUCTING THE WELL DATE
Submit original to Division of Water Quality, Groundwater Section within 30 days
GWI REV. 1

North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
1636 Mail Service Center - Raleigh, N.C. 27699-1636 - Phone [phone]
WELL CONSTRUCTION RECORD
292357
WELL CONTRACTOR. Dewey Wright Well Pump Co.. Inc.
WELL CONTRACTOR CERTIFICATION #• 2666
030587 STATE WELL CONSTRUCTION PERMIT#• Leslie Reece
1. WELL USE (Check Applicable Box): Residential I Xl Municipal
Recovery El Heat Pump Water Injection 0 Other
2. WELL LOCATION: (Show sketch of the location below)
Nearest Town: MARION County:
CANNON RD. OFF-IANKINS RD OFF BUSINESS 221 OFF
(Road Name and Numbers, Community, or Subdivision and Lot No
3. OWNER KENNETH R. BURLESON
Address 2610 HAWKINS RD. .
MARION (Street or Route No.( NC 2p8752
City or Town State Zip Code
Industrial 0
If Other, List Use.
4. DATE DRILLED 11/21/2003
5. TOTAL DEPTH 345
6. CUTTINGS COLLECTED YES 0 NO
7. DOES WELL REPLACE EXISTING WELL? YES 0 NO
8. STATIC WATER LEVEL Below Top of Casing: 5 FT
(Use "+" if Above Top of Casing}
9. TOP OF CASING IS 1 FT Above Land Surface*
*Top of casing terminated at/or below land surface requires a variance in accor-
dance with 15A NCAC 2C.0119
10. YIELD (gpm)• 1.5 METHOD OF TEST Air
11. WATER ZONES (depth)• 0.50 ppm 101-102 1.00ppm 289-290
0.00 ppm 0.00ppm
12. CHLORINATION: Type I[N Amount 89
DRILLING LOG
To
80 CLAY MUD SAND
From
0
G.RCUND,:.,G[F; SECTION
AS f FECIMIAl. QGHCE
DEPTH
Formation Description
80 101 GRANITE
101 102 QUARTZ
102 289 GRANITE
289 290 QUARTZ
290 345 GRANITE
4
m
Z c_
__ zm
"' VC
tD -<
If additional space is needed use bacFCSf forum
c-r
13. CASING: LOCATION SKETCH W —(
Wall Thickness Q%
Depth Diameter or Weight/Ft. Material (Show direction and distance from at least two ate
From 0 To 63 Ft 6 1/4 .188 GALV Roads, or other map reference points)
From To Ft
From To Ft
14. GROUT:
Depth
From' 0 To 20 Ft Cement
From To Ft
15. SCREEN:
Material
Method
Gravity Flow
Depth Diameter Slot Size Material
From To Ft in. in
From To Ft in in.
From To Ft in in.
16. SAND/GRAVEL PACK:
Depth Size Material
From To Ft
From To Ft
eszr
But,: lass oia-4
17. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER.
SIGNATURE OF PE ON CONSTRUCTING THE WELL DATE
Submit original to Division of Water Quality, Groundwater Section within 30 days
GW-1 REV. 12/99
FOR OFFICE USE ONLY
Quad No:
Serial No.

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality -
WELL CONTRACTOR (INDIVIDUAL) NAME
(print) a /MCt r k Alle n
WELL CONTRACTOR COMPANY NAME Ferrit.S'on Wei/ —AM 1 in) CO,
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
`'3'3638
Groundwater Section
CERTIFICATION # 3a' at
PHONE (ttIOn 6 $3- 51.y 4 9
1. WELL USE (Check Applicable Box): Residential a' MunicipaUPublic ❑ Industrial ❑ Agricultural ❑
Monitoring 0 Recovery 0 Heat Pump Water Injection ❑ Other 0 If Other, List Use
2. WELL LOCATION:v
fl Nearest Town: Pawl On County f" Do e II
gr,h Ar:Lot RI toe—R,fc/ 41 eitadcoS
(Street Name, pNumbers, Community, (Subdivision, Lot No., Zip Code)
3. OWNER: 1t' R 6,/d #nrv)�P—LS
Address 5'QO 5u.rr)n� 11 ?tve,
(Street or Route No.)
Srgttr.e. trre., NC 1511777
Cry or Town State Zip Code
(tat 'i to 5 ' 7016
Area code- Phone number
4. DATE DRILLED 7 - 3 — U3
5. TOTAL DEPTH: 3
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO
7. STATIC WATER LEVEL Below Top of Casing: SS FT.
(Use "+" if Above Top of Casing)
S. TOP OF CASING IS / FT. Above Land Surface*
*Top ofcasing terminated at/or below land surface requires a
variance in accordance with 15A NCAC 2C .0118. 9. YIELD (gpm): /%) METHOD OF TESTil341_
10. WATER ZONES (depth): .2/.5"
Topographic/Land setting
[Midge IZJRIope ❑Valley ❑Flat
(check appropriate box)
Latitudenong tude of well loc tion
s5/39//c4 1-Ov/552W
(degrees/minutes/second )
Latitude/longitude sou ce: IHGPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From To , Formation Description
Ai:-1-
on .shcx l.e
Nu-..,
e i run; k
II. DISINFECTION: Type /1/7-1- Amount .215.nS
12. CASING: Wall Thickness
Depth 1 Diameter or Weight/Ft. Material
From D To53 FL 6yaJD -DO a) PVC
From C To_clir Ft.
From To Ft.
13. GROUT: Depth Material Method
From 0 To 640i Ft. Cone.tle 1)7,a
From To Ft.
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.
o' at,
C7) ` OS '
ffG 5-3'
p
c G
t
�
LOCATION SKETCH 0
rn
Show direction and distance in miles from at Iet m
two State Roads or County Roads. Include the road u+?
numbers and commtn road names. �`,-b tPtellow�
WA- d7 O
16. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
7- 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. [phone], within 30 days.
GW-1 REV. 07/2001

i
North Carolina • Department of Environment and Natural Resources - Division of Water Quality • Groundwater Section
1638 Mall Service Center - Raleigh, N.C. 27699-1636-Phone [phone]
WELL CONSTRUCTION RECORD WELL CONTRACTOR. C- 706,441
WELL CONTRACTOR CER FICATION N: e p9
STATE WELL CONSTRUCTION PERMIT":
27291,
1. WELL USE (check Applicable Box): Residential CJ Municipal ❑ Industrial ❑ Agricultural ❑ Monitoring ❑
Recovery ❑ Heat Pump Water Infection ❑ Other ElII Other, List Use:
2. WELL LOCATION: Show sketch of the location below) -7/i.r 11 /
Nearest Town:
(Road Name a
3. OWNER
Address
Numbers, Co
/ S /Zt
nlly, or Subdivision and Lot No.)
• (Sreo or"" •o
Ciyor Tavel Slate
4. DATE DRILLED it - O. ?
5. TOTAL DEPTH `i b /`S:
6. CUTTINGS COLLECTED YES n NOV< 7. DOES WELL REPLACE EXISTING WELL? YES NOn 0.4
8. STATIC WATER LEVEL Below Top of Casing:..35 FT. o
(Use •+' if Above Top of Casing) -_ n
9. TOP OF CASING IS / FT. Above Land Surface' a c_c
•Top of casing terminated aUor below land surface requires a verlance In accor- -4 ^-'-`
dance with 15A NCAC 2C/ rl
0 10 I r' c
10. YIELD (gpm): / 0 METHOD OF TEST
11. WATER ZONES (depth)* on ,a74 JQ a mc�-.
rn
II additional space Is needed use back of form- nA
1
DRILLING LOG
From To
DEPTH
Formation Descdptlen
Zlp Code
12. CHLORINATION: Type[." Amoun
13. CASING:
t.0 Q
LOCATION SKETCH =
Wall Thickness
Depth D meter or Welght/Ft. aledal (Show direction and distance from at least two State
From ��4--- To '3 Ft ` ►9 Roads, or other ey �� U map
Qreference
?�points)
From To Ft Al -
From To Ft �i'
lifXj
14. GROUT: i/ / ,/Z�� /�L, `��
Uopll Ap '50-- A nal Method Zr�A,, /bpi'' Y�•Gi7 O
at C� Ft �- : l�i.e-Ji '
From To , AQ t�
From To Ft 1 t _ 1j (1A G%i�/J ' PI-
15. SCREEN: �T"� //„ r /ii'�d -�J it
Depth Diameter Slot Siz© Material rY�/�r✓v O'J"/
fro
From To Ft In In ���/�`'�'(j ci- n '
From To Ft In In i� l �% �(
From To Ft In In
16. SAND/GRAVEL PACK: (ill C�%�� -' /
Depth Size Malarial D
From To Ft
From To Ft
17. REMARKS:
1 DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPYF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER.
Jr:- 0.?
FOR OFFICE USE ONLY
Quad No:
Serial No
[ f llrjti\E$.L ', PATE
Submit odginal to Division of Water Quality. Groundwate cl ithin-80 days r
SIGNATURE OF PERSON CONSTRUCTI4
G'N-tREtl-1
I I

North Carolina - Department of Environment and Nalural Resources - Division of Water Quality - Groundwater Section
1636 Mall Service Center • Raleigh, N.C. 27699-1636-Phone [phone]
WELL CONSTRUCTION RECORD WELLCONTRACTOR• 71‘°ram e„tec WELL CONTRACTOR CERTIFICATION #: .Z /' nl
O 3
272813
STATE WELL CONSTRUCTION PERMIT#:
1. WELL USE (Check Applicable Box): Residential Er- Municipal 0 Industrial 0 Agricultural 0 Monitoring ❑
Recovery ❑ Heat Pump Water Injection ❑ Other [] I1 Other, List Use:
2. WELL LOCATION: S sketch Al the location below) '�y� ,/% .,/�_
Neaarrest Town: GX� �j..gdedf County / " 4€1
SiC/ ^ `� 3 L11 DRILLING LOG DEPTH
(Road Name an Numbers, C unity, or Subc7 and Lot No.)
3. OWNER
Address a -9 -
(Skeet or outs No.) 62,E4 rc, ,2 riG 2
City or Town Slate Zip Code
4. DATE DRILLED 3- 72- 6 3
5. TOTAL DEPTH ,6
6. CUTTINGS COLLECTED YES in NO[(
7. DOES WELL REPLACE EXISTING WELL? YES n NO[
8. STATIC WATER LEVEL Below Top of Casing: g7 Q FT.
(Usa •: if Above Top of Casing)
9. TOP OF CASING IS L FT. Above Land Surface'
'Top of casing terminated at/or below land surface requires a variance In accor-
dance with ISA NCAC 2C .0118
10. YIELD (gpm)• % METHOD OFT9��_L_✓J�`�'
11. WATER ZONES (depth)•
/71" -
AQA
From To Formation Description
_ G�'
12. CHLORINATION: Type ��s+-a'� Amount •
13. CASING:
Depth
From --To c— Ft
From To Ft.
From To Ft
14. GROUT:
Wall Thickness
DI meter or WeighVFI. Material
r�
IV r=
If additional space Is needed use back of form
LOCATION SKETCH
(Show direction and distance from at least Iwo State
Roads, or other map reference points)
P • ; � wit
b �m
iao
�m
*del
ma(fJ
ti
5L2t0rms. n.
Depth Material Method
From To R Ft
From To Ft
15. SCREEN:
Depth Diameter Slot Size
From To Ft In
From To Ft In
From To Ft In
16. SAND/GRAVEL PACK:
Depth Size
From To Ft
From To FI
17. REMARKS:
Material
In
In
In
Material
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY O THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER.
.d,- - y� j�
(cc
URE OF PERSON CONSTRUCTING lif w Le , , ^ [I DkTE l
Submit original to Division of Water Ouallly, Groundwater Se ow. hln 30 days
r .\,, GW4 REV. t-
H
FOR OFFICE USE ONLY
Quad No:
Serial No.
iLr�
). 1 La a 2003

i
North Carolina - Department of Environment and Natural Resources - Division of Water Duality - Groundwater Section
1636 Mall Service Center - Raleigh, N.C. 27699-1636-Phone [phone]
272812
WELL CONSTRUCTION RECORD WELLCONTRACTORF ✓ C -fir !!c l'
WELL CONTRACTOR CERTIFICATION 0: a 7D 3
STATE WELL CONSTRUCTION PERMIT#:
1. WELL USE (Check Applicable Box): Residential El- Municipal ❑ Industrial ❑ Agricultural ❑ Monitoring ❑
Recovery ❑ Float Pump Water Injection ❑ Other ❑ II Other, List Use:
2. WELL LOCATIO���ryi�,�ot/y sket f the location below) n,� `�a ijc. !/
Nearest Town• ""!' �` sky
r County• .L('
Si )2, 7 Grfja a Zit
(Road Name and Numbers, Community, or Subdivision and Lot No.) DRILLING LOG DEPTH
3. OWNER /0 a ICJ) 1C -/2( C. 4 ) From To Formation Description
Address .o y'7 u/ ; l 2,; c R�
ereel or Houle .) cr.,- 2 ,J7
itv or Town Slate Z'p Code
4. DATE DRILLED Z— `9— 63
5. TOTAL DEPTH / / g
6. CUTTINGS COLLECTED YES f NOl -r
7. DOES WELL REPLACE EXISTING WELL? YES f F NO n
8. STATIC WATER LEVEL Below Top of Casing: ,14 ,2, FT.
(Use'+' If Above Top of Casing)
9. TOP OF CASING IS 7 FT. Above Land Surface'
'Top of casing terminated at/or below land surface requires a variance In actor- b rn
dance with 15A NCAC 2C.011B I
10. YIELD (gpm)•2— 7 METHOD b TES .12 10 A
11. WATER ZONES (depth):
O n
W
12. CHLORINATION: Type C° 7 m h b ) Amount 44 1.
13. CASING:
Depth DI meter.
FromTo fo 2- Ft -
Crom To Ft
From To Ft
14. GROUT:
Depth
From L/ To a FI
From To Ft
15. SCREEN:
Depth Diameter Slot Size
From To Ft In
From To Ft. In
From To Ft In.
16. SAND/GRAVEL PACK:
Depth Size
From
Frorn
17. REMARKS:
To Ft
To Ft
Wall Thickness
or Weight/Ft. Material
Material Method
Material
in
In
In
Material
A
�rn
CO 'Si rn
'MP Cr,
� zm
If additional space Is needed use back of lore
rn
CS
%.D
LOCATION SKETCH
(Show direction and distance from et least two State
Roads, or other map reference points)) I2le
Jb".J c'7 / r �l �z
z.\ 4 —o---/ 0 � Al 0/ Q � e—e
FLQ t Q Cy'C. Jl
- JI
ttsk-
X+
0
CD
0
I DO HEREBY CERTIFY THAT TI1IS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY F THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER.
SIGNATURE OF PERSON CONSTRUCTING THE'M1jlELL PATS.
Submit original to Division of Water Duality, Groundwater S I
L.1
FSOR OFFICE USE ONLY
Quad No:
edal No.
y
GWd REV. 1
J
11
GROUP:_ir!',T R SECTION

07/29/2003 09:53 8287339169
BRASWELL WELL DRILL PAGE 02
e)
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water�/Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) erast.,C I( Loa el Pn11,
WELL CONTRACTOR COMPANY NAME _ero iSMe',1) easel' ii2; Ihr19
STATE WELL CONSTRUCTION PERMIT. ASSOCIATED WQ PERMIT#
ifapplicable) OOfapp)icable)
CERTIFICATION 3ON #2
PHONE . Int 7 ►T-74o2
I. WELL USE (Check Applicable Box): Residential el Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring ❑ Recovery 0 Heat Pump Water Injection 0 Other Q If Other, List Use___,,,
2. WELL LOCATION:
Nearest Town: MA f-Dne4 County//%pp“.rf
77cer. Tea' Rd-
(Street Nome. Numbers, Community, Subdivision, I.ot No., Zip Code)
3. OWNER: St-tjje R'GNSS%y
Address 7QA/ r't #,idgysn r5
151reel w RauteNv.)
City or Town State
( Area code- Pion number
4. DATE DRILLED 3- 72- On
5. TOTAL DEPTH: 2 "Q
6. DOES WELL REPLACE EXISTING WELL? YES 0 N0 I
7_ STATIC WATER LEVEL Below Top of Casing: FT
(Use''t" if Above Top ofCasing)
R- TOP OF CASING IS 1 FT. Above Land Surface*
'Top of using terminated atlw blow land surface requires a
variance in accordan a with ISA NCAC 2C .9118.
9. YIELD (gpm): METHOD OF TEST at cm, u
10. WATER ZONES (depth): ,222;
1I. DISINFECTION. Type 617# Amount 4' 7w8?PSr
l2_ CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
From 0 To .32. Ft. le % f Sal PLe
From-_. To Ft.
From To Ft.
]3. C'JROUT: Depth Material
From h To 2ri Ft. Cerstem+
From To Ft.
Zip Code
14. SCREEN: Depth Diameter
From To Ft. in.
From To Ft in
15. SAND/GRAVEL PACK:
Depth Size Material
Meth
/410 rB
Skirt Size Material
in.
in.
From To FL
Topographic/Land setting
❑Ridge (Slope 17Valley ❑Flat
(check appropriate box)
Lattudeflongitud o well location,2
34Se7./` /8.�i' Z
(degrees/ otes/seconds)
Latitude/longitude source::GPSOTopogtaphic map
(check box)
DRILLING LOG
Formation Description
(1EPTFj
From To
n - 27 D„^7c
27 - 28a f/.orCb.o,ear.,
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 c� Ft. �"'
16. REMARKS: SOIL' knck Stiffx Ai- tS0 �'r5^49 f {.,y
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH I5A NCAC 2C, WELL
CONSTRUCCTTIIOOONN /STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
3-22_-06
S(GNATWCE 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. 1919) 733-3221, within 30 days. GW- I REV. 07/200!
JUL 2 9 2;03
ASH. E
HOE

From: Scott Gantt To: Date: 3/6/2003 Time: 9:48:34 PM
Page 6 of 7
)3 0/S/2_
269704
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment, and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL)NAME (print) SCOTT GANTT CERTIFICATION#2584
WELL CONTRACTOR COMPANY NAME CAROLINA WELL DRILLERS, INC. PHONE # [phone]
STATE WELL CONSTRUCTION PERMIT # ASSOCIATED WQ PERMIT #
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box) : Residential ® Municipal ❑ Industrial ❑ Agricultural ❑ Monitoring ❑
Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use:
z. WELL LOCATION:
Nevest town: MARION
WILD WOOD ACRES LOT 14
County
ticDowe
MARION
(Street Name, Numbers, Community, Subdivision, Lot No,. Zip Code)
3. OWNER AMERIC.AS HOME PLACE
ADDRESS 1340.A PATTON AVE.
(Street or Route No.)
ASHVILLE NC
City or Town State
828-253-4161
Area Code - Phone Number
4. DATE DRILLED 2/11/03
5. TOTAL DEPTH 640
6. DOES WELL REPLACE EXISTING WELL?
7. STATIC WATER LEVEL Below Top of Casing'.
Zip Code
YES ❑ NO fEl
150 FT.
(L6c "+" IfAbove Top of Casing)
8 TOP OF CASING IS 2 FT. Above Land Surface*
Nop of casing terminated actor below land swface requires a variance un
aeon dance with 15A NCAC 2(0118
9. YIELD (2pm). 6 . METHOD OF TEST ARDM
to. WATER ZONES (depth): 635
Topographic/Land setting
❑ Ridge ❑ Slope ❑ Valley X Flat
Latitude/Longitude of well location
35.40.991 / 82.03.078
(degrees/minutes/seconds)
Latitude'ongitude source: ® GPS ❑ Topographic map
DEPTH DRILLING LOG
From To Formation Description
0 60 Clay
60 640 Consolidated Rock
rso tf y09/03
11. DISINFECTION: TYPE HYPOCHLORTTE Amount 15 Oz
l2. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
From 0 To 65 Ft. 6 1/4 " SDR 21 PVC
13. GROUT:
Depth Material Method
From 0 To 20 Ft. GRAVEL MIX GRAVITY
14. SCREEN
Depth Diameter Slot Size Material
From NA To Ft. i in.
15. SAND/GRAVEL PACK.
Depth Size Material
From NA 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.
HWY 70
RESISTO FLEX RD
GREENLEE RD
—t
WILD 1'DOD:
ACRE rn _-
m;c-
oo
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 I IAS BEEN PROVIDED TO THE WELL OWNER.
2/12/03
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 PIwlmlin (9-1.9).33- vithin 30 days.
1 ryI
GW-1 REV. 07/2001

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) Jeremy H. Bowman CERTIFICATION # 2809
WELL CONTRACTOR COMPANY NAME n Bnwmnn Wel 1 ilri l l inge Inn PHONE # f37H 757-7779
STATE WELL CONSTRUCTION PERMITS/ ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
276007
I. WELL USE (Check Applicable Box): Residential i( 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: Marion County McDowell
Honeycutt .Read
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3.OWNER: Tony Barber
Address 21228 Masters Circle
(Street or Route No.)
Ester^ P1nric9a
City or Town State
Zip Code
( )-
Area code- Phone number
4. DATE DRILLED 4 / 1 7 / 03
5.TOTAL DEPTH 580'
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO IX
7. STATIC WATER LEVEL Below Top of Casing: 1 00 F•f,
(Use "+" if Above Top of Cuing)
8. TOP OF CASING IS 1 .4 FT. Above Land Surface'
•Top or casing terminated at/or below land surface requires a
variance In accordance with ISA NCAC 2C .OIlg.
9. YIELD(gpm): 4 METHOD OFTEST .rotary air
10. WATER ZONES (depth): 400' • 575 r
3397Fs
Topographic/Land setting
❑Ridge ❑Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:OGPSOTopographic map
(check box)
DEPTH DRILLING LOG
From To Formation Description
11. DISINFECTION: Type tablet Amount 6
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
From .0 To 35 Ft..61 /8 Snh 8-0 Ayr
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,
I3. GROUT: Depth Material Method
From 0 To 20 Ft. concrete gravity flow
From To Ft.
14. SCREEN: Depth Diameter Slot Size Material
From To Ft in in.
From To Ft. in. in.
15, SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
CD
W
L
r
CO
c5
16. REMARKS:
I D0 HEREBY CERTIFYTHAT THIS WELL WAS CONSTRUL I ED IN ACCORDANCE WITH ISA NCAC 2C, WELL
f•L"� G: (CONSTRUCTION tSTA)rgq . kDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
DATE
J,
a✓
Submit the original to the
L-1Z6.99-1616 Pbanc Nn I(919)
iIUN
ASP' -. t - _ Cr[-ICE
SIGNATURE OF PERSON CONSTRUCTING THE WELL
Division of Water Quality, Groundwater Section, 1636 Mall Service Center -Raleigh, NC
33-3221, within 30 days. GW-1 REV. 07/2001
N

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and.Nytural Resources
- Division of Water Quality - Groundwater Section net/ WELL CONTRACTOR (INDIVIDUAL) NAME (print) e/I JJ 1?bOf Sall.)
WELL CONTRACTOR COMPANY NAME iS,?A cio it J<)n iI :1.0` II`
STATE WELL CONSTRUCTION PERMIT(' ASSOCIATED WQ PERMIT('
(if applicable)
(if applicable)
277024
CERTIFICATION 0 J I[1
PHONE ('$ 1`13J—areDCA
1. WELL USE (Check Applicable Box): Residential Fr Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other ❑ If Other, List Use !J't;v.a.le
2. WELL LOCATIOA
Nearest Town: ' 1 `•.< ` L County Plei (k
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: l'�J; J_' �iie
Address 0k'b (degrees/minutes/seconds)
`J Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From To Formation Description
/Topographic/Land setting
Ridge ❑Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
( tree[ orie No.)
`7cS'YrS7
Q�r City(or Tamn State i Zip Code
Area code- Phone number
4. DATE DRILLED S P2 —6,j,
5. TOTAL DEPTH:
6. DOES WELL REPLACE EXISING WELL? YES 0 NO 1ii-•"
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 or casing terminated at/or below land surface requires a
variance In accordance with 15A NCAC 2C Al.I8.
9. YIELD (gpm): ( METHOD OF TEST /T % 1
10. WATER ZONES (depth): )5Z-. y TO
11
12
Depth
/
FromTo /.LC
From To
From To
13. GROUT: Depth
From G To g0
From To
14. SCREEN• Depth
From To Ft.
From To Ft.
15. SAND/GRAVEL PACK:
DISINFECTION: Type CI [ORrtie Amount cCc5
CASING: Wall Thickness
Diameter or Weight/Ft. M terial
Ft.
Ft.
Ft.
Material Method
Ft. ict ri e
Ft.
Diameter
in.
in.
Slot Size Material
in.
in.
Depth Size Material
From To Ft.
From To Ft.
16. REMARKS:
Gi L
r—
LOCATION SKETCH — R.,_
Show direction and distance in miles frorr9t least.
two State Roads or County Roads. lncludeghe rice&;
numbers and common road names.
0
r--� 1'LRXHEREBY CERTIFY.THATT IS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
") 11 CONSTRUCTION yr:ANDA1 .I-Att1D TILT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
±< <
NATURE OF PERSON CONSTRUCTING THE WELL DATE
ubmit the original to thejDivis1on of Water Quality, Groundwater Section, 1636 Mail Service Center- Raleigh, NC
9'14`36 PftoniTio(0I9) 733-3^
1, within 30 days. GW-( REV. 07/2001

276627
WELL CONSTRUCTION RECORD
North Carolina- Department of Environment and Nat t al Resourccs - Division of Water Quality - Groundwater Section
WELL ('OS'I7LAC tOR (INDIVIDUAL) NAME (Print) r/�/Q /k Qr CERTIFICATION #251/ %
tvELLCO rRACIORCONIPANVNAME ' Yadkin Well Company Inc. PHONE N f33)6-468-4440
S I'A'I E \V r:l.l. CONSTRUCTION 1'EItM1IIT#
HI -applicable)
ASSOCIATED WI) 1'ERNIIT8
(if applicable)
I. WELL USE (Check Applicable Box): Residential Municipal/Public ❑ Industrial ❑ Agricultural 0
Monitoring ❑ Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
9s6
2. WELL LOCATION:
Nearest Town: Plat / n w County
old via /6 NtMy
IStrcc; Name. Numbers, Community, Subdivision, Lot No.. Zip Codc)
3. OWNER: (,r—V( �A �AS etI"t""e-P'/r rJ�
Address Pr2, 0ek d63
(Street or Route No.)
('ilv or Toti.m Stalc
- /sfl
Area code- Phone numb,
DATE DRILLED
Zip Code
r , s'Y 3'a ,
4. 03
5. TOTAL DEPTH: Q .2
6. DOES WELL REPLACE EXISTING WELL? YES,. NOMI
7. STATIC WATER LEVEL Below Top of Casing: e 0 FT.
(Use "+" if Above Top of Casing)
S. TOP OF CASING IS I FT. Above Land Surface"
`Tap of easing terminated at/or below land surface requires a
variance in accordance with ISA NCAC 2C .0118.
9. YIELD (gpnt): / Tj METHOD OF TEST air pump
10. WATER ZONES (depth): /,Si -/QQ 0
Amount /j Q"Np�
Wall Thickness
1 I. DISINFECTION: Type HTH
12. CASING:
From
Front
Front
Depth T�
To / DI Ft
To Ft.
To Ft.
Diameter or Weieht/Ft. Material
I�,iLS JDR-21 ,Pa&
13. GROUT: Depth nnMat ria�lby y,.
Front I o2 Ft. rer %�riry
From To Ft.
14. SCREEN: Depth Diameter
Prom To Pt. in.
From To Ft. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
16. REMARKS:
Slot Size
in.
in.
HMethod /
Material
44i7
Topo raphic/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)
DEPTH • DRILLING LOG
Front To Formation Description
o /DU Soil
Bit ser. # Size off
'30012V /6,0ay
LOCATION SKETCH
Show direction and distance in miles iron
two State Roads or County Roads. IncludeQ
numbers and common road
i'f 1
e w r_,.. r37
�rnuel-
s.eter
Sc/.ee1 Itd .
1 DO HEREBY C FEY THAT TEAS WELL WAS CONSTRUCTED 1 )1 02.DA.,YCE.WLTHJIA NR-14 2C; WELL
CONSTItU :b( TANDAI2DS. AND AT A�� PY OF THIS RECL 12011AS BEEN PROVIDED 1 O T#4F WifLL OWNER 9/f V� lh
4-t tYIn
yar es
SIGNA URE OF PERSON CONSTR CTING THE WELL DAT
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Scr%ieeCcnter- Raleigh, NC
27699-1636 Plume No. [phone], within 30 days.
G-W PREV. 07/2001

2'76459
North Carolina . Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
1636 Mail Service Center - Raleigh, N.C. 27699-1636-Phone [phone]
•
WELL CONSTRUCTION RECORD WELL CONTRACTOR• (�OI43-n--s . le- ,��i \\L'FY(j-
WELL CONTRACTOR CERTIFICATION #: 30 419
STATE WELL CONSTRUCTION PERMIT#: Igo
WELL USE (check Applicable Box): Residential Municipal ❑ Industrial ❑ Agricultural ❑ Monitoring
Recovery Heat Pump Water Injection I j Other ❑ If Other, List Use:
I
I
2 WELL LOCATION: IUr(Show sketch of the location below) y� (�
Nearest Town- en County f l vC DOLLY 11
%%b
(Road Name rid Nutnoers. Community, or Subdivision and Lot No ) DRILLING LOG DEPTH
3. OWNER esTec ���' R - .1)a-U� From To Fom'a9on °escop:o
Address A I"ltJ 1,M �^ y. r-�
(Svee: or Houle No.)
�`eho NIr, c'flhl
City or Town Stale Zip Code
4 DATE DRILLED
5. TOTAL DEPTH
6. CUTTINGS COLLECTED YES I I NOI2
7. DOES WELL REPLACE EXISTING WELL? YES I/ I NOD
8. STATIC WATER LEVEL Below Top of Casing: ,) 3 FT.
t (Use 4' it Above Top of Casing)
9. TOP OF CASING IS I o FT. Above Land Surface'
•Top of casing terminated atfor below land surface requires a variance In accor-
dance with 15A NCAC 2C .0110
lU. YiELD (gpm): aU T METHOD OF TESTgoIDe-,
1 t_ WATER ZONES (depth)'
W
0
r
CO
n
0
w 2
12 CHLORINATION: Type tiJ
)3. CASING:
Depth
Front To e) Ft
Fro'n To Ft
From _-- --To— Ft
14. GROUT:
Amount _I —Q b If additional space is needed use back of loan
Wail Thickness
Diameter or Weight/Ft. Material
Depth Material Method
Cram To F1
From To Ft
15. SCREEN:
Depth Diameter Slot Size Material
From To Ft in. in
Frorn To Ft in. in
From _ To Ft. in in.
16. SAND/GRAVEL PACK:
Depth Size Material
From _ To Ft
From To Ft
17. REMARKS:
LOCATION SKETCH
(Show direction and distance from al least two State
Roads, or Other map reterenCe points)
r` \
DO HEREBY CERTIFY I4-IATI THIS WELE WAS eeNBTRebTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STAN:PAH-D5 AND THAT A COPY OF THIS fiE3ORD HAS BEEN PROVIDED TO THE WELL OWNER.
FOR OFFICE USE ONLY
Quad No
Senat No
U
• SIGNATURE OF ER ON CONSTRUCTING THE WELL DATE
L _Submit original to Division of Water Quality. Groundwater Section Within 30 days
_— G'W'I HEV. 12/9'i

FROM : MORETZ WELL & PUMP
FAX NO. : 7244521322 Jul. 20 2003 07:35PM
276450
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resolve es - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) ASHLEY T. MORETZ
ETZ
CERTIFICATION # 2 S 6
%YELL CONTRACTOR COMPANY NAME MORETZ WELL O LLLNG PHONE # (7O4)462 -132 2
_SATE WELL CONSTRUCTION PERMI),TS=ii0Ol:ATSD WQ PERMIT:
;a lieabie) Y
I- WELL USE (Check Applicable Box): Residential "Muse al:Pub is 0 Industrial 0 Agricultural 0
Monitoring _3 Recovery El Heat Pwnp Water Injection Other 0 If Other, List Use
WELL LOCATION: ,1 Topogr d 'ct and setting
Nearer: Town: �BLr ' 0— Coun f OG o i�r'1 / CiRidge lope ❑Valley t]Fiat
Le- C/1/lq(Jt- C;iAQfa (check appropriate box)
(Sand Namc, Numbers, Community, Subdivision. Lot No., Zip Code) Latitude/ioagitude of well location
3. OWNER: arl d 114.5.e
Address 2 tC kt.9 4�--�
(Street op Rot No.) a�7d,/._
Cloy orTown
-�Starta:ee Zip Code
ArtS code- P4'ny :umber
4. DATE DRILLED
5. TOTAI, DEPTE: S"
5. DOES WELL P...EPLACE EXISTING WELL? YES L0 tlO
7. `STATIC ViATn L EVEL Below Top of Casing: ifs =_ .
(Use"+" if Above Top of Cs=:3j
S. TOP OF CASING IS / FT. Above L zra
'Top of castle eery na'.ed tit/or below land surface regcfro, £
?mina la accordance with I5A NCAC 2C .011S.
fTh YIELD (prri): _ ✓ © METHO?AF TEST/
1O. WATER ZONES (depth): METH'?
(dcgrece&minutes(se ands)
LatitTRICiriOngliode soaroe:DGPSDTopographic ttuo
(chri box)
DEPTH DRILLINGZAG
v ver, Formation DS 11 ttq n
ei
dial
'o
7- o-o3
�2'.
al 2
LOCATION SKETCU
I . DISINFEC a SON: Type ,/Y% �' _ Show direction and distance in milesfrom a$%as
Amount � t'J. __ t12. CASING: Wall Thickcess rc't Sate Roads or County Roads. Include thrroact
..:*.ccs ,LL (1 cornmon road names. ._
- r -'=_% Diyne+.er or Weih ^t.
Front -_. _o Ft
rou-t____ -: c Ft
... GROUT; Depth Material
From , J2 To 242 Ft. Cee.n"'- i a,,
From To Ft. 1
`. SCREEN: Depth Diameter Slot Site l!tt: L
F ors Ft. in. _
..am To in,
_-. SAND/GFA`.'ELPACK:
Depth Size Mated
From
7rem �' TO
uRaYCET dTIE
CGNSTRUCTIO\.'3LI
THAT THIS WELL WAS CONSTRUCTED T CCOlCADICE WITH 15ANCAC 2C, WELL
)ARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OW; IER
�- 4__-- j A0-03
SIONATYJRE OF PERSON C D: C ::dG 'SPX WELL DATE
Siikfo- rtre-0 4.21to�the Division of Water Quality, Gr- r<'. S,rd t, 155o Maii Service Center - Raleigh, NC
__ttO9 1635 Phrne_Ne. 019) 733-3221, within 30 days. GW-1 REV. 07/2003

r f'.Ci'1 . Ir1ORETZ WELL a PUMP
FAX NO. : 7244621322 Jul. 20 2003 07:35F:1
276449
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
was. CONTRA croa (INDIVIDUALNAME ) ° S , ., .Y .'72 CERTIFICATION # 276c•
) (print) l...ClLF� ETZ
WELL CONTfACOR COMPANY NAME MORETZ WELL DRILLING FRONE it j7O4)462-1322
STATE WELL CONSTRUCTION FERMIT#
(if a •.licab]meowas
. WELL USE (Check Applicable Box): Residential tV :v_
Nlovitorrg L7 Recovery ❑ Heat Pomp Water l jecti--. C
2. WELL LOCATION:
t
ad a1L'%aJ� ty Zrt r's
�c st Town: n Con s
�
•
..treet ti,tni udibms, Community, Subdivision, tNo., curio)
J
AdPO Jr
dres' f/V P 4dy K �(� fr.(
(Strict or Routo Na) /
City or oan a Smis Zip Code
(.�
Anra Mee. Phar.c number
4. DATE DRILLED (e 03
i. TOTAL DEPTH:
22d
6. IDOES WELL REPLACE EXISTING WELL? YES D NO
7. STATIC WATER LEVEL Below Top of Casing: 60 FT.
(Ilse "+" if Above Top of C9s_ 3)
S. TOP OF CASING IS % FT. Above Land S^—t, se-
' 1 op of c:.is1 3 ttne:inated at/or below land surface requires a
rarlarsoo:^;,ordn* with 15ANCAC 2C.011E. t _J ,
. z I L1) ( :r )- -.�':i 0 METHOOD�OJ TEST - •
10, ` .TATER ZONES (depth):
d
l �,.,, f�0 LOCATION SKETCH —
i I. DISINFECTION: Type /'a.t,v Amount i Show direction and distance in miles from atje ist __:.
-_. CASING: Wall Thickness *zc Srate Roads or County Roads. Include &road::: c-:
Depth 2 Di flier or W¢i �1"" Mat r : iv:inteis and .:orn.,ion road names. lye`- 2- <
- G _
•,:3SCC:'1ATED WQ PER.MiT#
13 aonlicebie)
t�_�rt•'
h'GDT�!
;AZ To P
L'I Industrial 0 Agricultural 0
If'it rs,Y i..t Use
T opo cfLand setting
DRidgc Slope DValley DFlat
(check appropriate box)
L atiraderionginide of well location
(dereesiminut. sseconds)
;uz1ili ngitude source:DG?SDTopographic reap
(chsk box)
DRILLING* LOG
Formation Despr, `io
,'0Ra.r. Anc..k
O
Prom `. To Ft
^...n .,, Ft.
33. GROUT Depth Mateial y Y t 1 3
r.orr 1-0 i To c O Pr. (t,'.etA-y
FroM ' To Ft.
.:. SCREEN: Depth Diameter Slot Size l azr_:
Finny
Flom_ To Ft
15. SAND/GRAVEL PACK!
Dept:
',tics_ 1 To
._- ..EMA RnS-
Size
Materiel
h'21'y /!'Jyc-/a1
,9
;Dye.__-__
1 I DO HEREBY Ce 2'TIFY IFI
CON TAUCTION
S WELL WASCONSTRUCrso Tx D:DANCE WITH ISANCAC 22C,WFIL
THAT A COPY OF TFIS RECORD 'HAS' BEEN PROVIDED TO THE WELL OWNER
/ -- ‘— 27— 03
JS NATtJRB OF PERSOIN CONS Ti.LC ING i HE WELL DATE
Salnut the oregir.31 to the Divi0n of Water Quality, Giv>=?_d -Secrion, 1636 M.afl Service Center -Raleigh, NC
27O55 ,a3o ph ie NO. (91.9)'733-3#21, within 30 days. GW-1 REV. 07/2001

WELL CONSTRUCTION RECORD
2'76425
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR(INDIVIDUAL) NAME (print) JamaS 'L Camp, Jr CERTIFICATION# 21 i$
WELL CONTRACTOR COMPANYNAME r'amp's Wall R Pnmp Cr>, Tnr PHONE #837Ri 45"1-7-1 22
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable)
(if applicable)
I. WELL USE (Check Applicable Box): Residential 12( 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'. nA . t.h . Countyt
Cik A� e z JL� AA)L
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: CI -by,. C `� At>kl
Address 1 i 5' (' a vh b ct icy rl A RA
(Soeet of R to No L,2 c)
�' I1 1 f F If�'. /
City or Towo State Zip Code
c )
Area code- Phone number
4. DATE DRILLED \p -
5. TOTAL DEPTH: ;Dy •l
„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)
DRILLING LOG
To F, rmati n De, cription
\t rA 'ALK
DEPTH
From
n
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO tij
7. STATIC WATER LEVEL Below Top of Casing: U 0 FT.
(Use "+" if Above Top of Casing)
S. TOP OF CASING IS 1 FT. Above Land Surface'
•Top of casing terminated at/or below land surface requires a
variance in accordance with ISA NCAC 2C .0118.
9. YIELD(gpm): ;5.. METHOD OFTEST Air
10. WATER ZONES (depth): % U
11. DISINFECTION: Type Ph l on nn Amount ‘. LL
12. CASING: Wall Thickness
Depth or Weight/Ft. Material
SDR21 PVC
Diameter
From p To \et Ft. 6 1 / 4
Froth To Ft.
From To Ft.
13. GROUT: Depth
Frorri_n To 2 0 Ft.
From To
14. SCREEN: Depth
From To
From To
15. SAND/GRAVEL PACK:
Depth
From To
From To
Material
Method
Not Cement Hand
Ft.
Diameter
Ft. in.
Ft. in.
Slot Size Material
in.
in.
Size Material
Ft.
Ft.
A1 A-4/1Al.
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. elude the road
numbers and common road names.
16. REMARKS:
DO HEREBY CERTIFY
�NJ ,?ausitucTION SSTAND
r,.
L
pbtnit the original to thA Divh
2/6 <Y '6.P h-iieNti.:(q 9) 733-3
IS WELL WAS CONSTRUC 1hD IN ACCORDANCE WITH 15ANCAC 2C, WELL
THAT A COPY 0 THIS RECORD HAS EEN PROVIDED TO THE WELL OWNER
a44 J, C / . i- lI-
SON DATE
e3
GNATURE OF PERCONSTRUCTING THE WELL /
ion of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
21, within 30 days. GW-1 REV. 07/2001

278191
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAM (print) -`T0. (m e 5 V- . (IX »7 i JP4i8pr. CERTIFICATION NA( 3 g
WELL CONTRACTOR COMPANY NAME Lawtps eI(t PL(mp CO. !Lc . PHONE N ) 453-73e12
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential [Y Municipal/Public ❑ industrial 0 Agricultural ❑
Monitoring 0 Recovery 0 Heat Pump Water Injection ❑ Other 0 If Other, List Use
2. WELL LOCATION:
Nearest Town: VAJ-4P" County 'Nt t it n14) r�
54 t,4.1 �2 9 9-8 a 3
(Street Name, Numbers, Community, Subdivision, Lot
{{N��o.,,.yyZip Code)
3. OWNER: /t k_A &tn
Address 1 k Sn ISj IVcsti%. �J�i QO^, Sk
(Sheet or Route No.)
\ \A (i,`', NOLA^'la'.ti tN Al C-
City or Town State ( Zip Code
(50-t0- 1 K %
Area code- Phone number
4. DATE DRILLED l -If)3
5. TOTAL DEPTH: L% u 6
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO EA
7. STATIC WATER LEVEL Below Top of Casing: V h FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS 1 FT. Above Land Surface'
t. *Top of casing terminated at/or below land surface requires a
variance In accordance with ISA NCAC 2C .0118.
9. YIELD (gpm): t U MFATHOD OF TEST fl A A
10. WATER ZONES (depth): 00
11. DISINFECTION: Type CXn Q
12. CASING:
Depth Diameter
From 0 To 1 DO Ft. (1 YS
From To Ft.
From______ To Ft.
13. GROUT: Depth Material " �Methg4d
From 0 To 2D Ft.)leat Cewteat y 4Y1/4a
From To Ft.
14. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in.
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Dcpth Size Material
From To Ft. r
From To Ft.
Topo phic/Land setting
DRidge CliSlope ❑Valley ❑Flat
(check appropriate box)
Latitude/longittde of well location
(degrees/minutes/scconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH DRILLING I,ofi
From To FRrm��JJ�� Description
it)101) l �attpn
lob 4-10c Al.(iAtA .I
LOCATION SKETCH
Amount j (LA"? Show direction and distance in miles front least
two State Roads or County Roads. Includetthe rad
Wall Thickness >a
or c) 2.\.Ft. ate al numbers and common road names.
59 � 1h\O• uu 0
I N
16. REMARKS:
0
n
CD
I DO HEREBY CERTIFY THAT THIS WFi I WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS R,CORD HAS BEEN PROVIDED TO THE WELL OWNER
S !�-a3
ATE
c_ aA-n -
SIC)WATURE OF PERSON CON
Submit the original to the Division of Water Quality, Grou$$lweF-Seetior0636-METSen'
27699-1636 Phone No. [phone], within 30 days.
ter - Raleigh, NC
-1 REV. 07/2001

278190
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAMFA (print) '`T0.lne 5 "" ' Ca. Wn P r .
WELL CONTRACTOR COMPANY NAME WpI"—De it `I pi,, 11'1 (D, I..!-11c
STATE WELL CONSTRUCTION PERMIT(' ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
CERTIFICATI�ON # a (3 g
PHONE itfZokI(453-93,12
1. WELL USE (Check Applicable Box): Residential Er MunicipallPublic 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATI N:
Neare Town: l‘J,.L(yr Countx( 1
.(s NA/Jl) IaC` �(n, ,0_,,
mutiny, Subdivision, Lot No., Zip Cole)
(Street Name, Numbers,
3. OWNER:. 3 NI
_OG
-2
Address , \ �;
VI c (Street or No.)
City or Town State
64A0- iofil
Area coda- Phone number
4. DATE DRILLED • n R
5. TOTAL DEPTH. f1 S
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO
7. STATIC WATER LEVEL Below Top of Casing: $O FT.
(Use "-1 if Above Top of Casing)
8. TOP OF CASING IS I FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordance with ISA NCAC 2C .0118.
9. YIELD (gpm): U METHOD OF TEST C .l
10. WATER ZONES (depth): L00
Zip Code
11. DISINFECTION: Type
12. CASING:
Amount G,,J
Wall Thickness
Dep11''{{,�,�]']'ll]]yy11//� Diameter orr eight/Ft. /t�vteate
From 0 To Ft. Ft. 1p zg �-�v,C 9 k. l AAN
From To Ft. 0
From_____ To Ft.
13. GROUT: Depth
From 0 To ,20
From To
14. SCREEN: Depth
From To
From To
15. SAND/GRAVEL PACK:
Depth
From To
Material Methopd
Ft. heat CevneKt kaytd
Ft.
Diameter Slot Size Material
Ft. in. in.
Ft in. in.
Size Material
Ft
From To Ft.
16. REMARKS:
Topographic/Land setting
❑Ridge EH glope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH PRILLING LOG
From To Formation Description
0 Wu
•
J.00ATION SKETCH
Show direction and distance in miles from at least r"
two State Roads or County Roads. Include � roa&
numbers and common road names.
O
cn
w
-1
0
1 DO HEREBY CERTIFY THAT THIS WFI I WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS CORD HAS BEEN PROVIDED TO THE WELL OWNER
SI ATURE OF PERSON CONSTRU It4'G HE WELL DATE
Submit the original to the Division of Water Quality, Groupdwater Section, 1636 Mail Service Center - Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. i -�� C} W-1 REV. 07/2001
J L\ '-'—' \

WELL CONSTRUCTION RECORD
278186
North Carolina - Department of Environment and Natural Resources - Division of
Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAM (print) ('T0. rv1 C'S kA-) C . h'� Qy r . CERTIFICATION(ti 3 e
WELL CONTRACTOR COMPANY NAME Camp..5 0e t PIAMf1 f_D.IrLC • PHONE R f$cZ/) 453-73)2
STATE WELL CONSTRUCTION PERMITS ASSOCIATED WQ PERMITS
(if applicable)
(if applicable)
1. WELL USE (Check Applicable Box): Residential l'MunicipaUPublic 0 industrial 0 Agricultural ❑
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION:
Nearest\\``o
t'Y4,t ,tVtm
(Street Name, Numbers, Community, Commuinty, Subdivision, Lot No., Zip Code)
A3. OWNERt SLQIv .rl�j (. D
Address k 11 �A � l
Countyla
1A
(Street Route No.) ���
V.0 Wnn IV LI
«ar )- or Iowa f,1 tate Zip Code
Area code- Phone numb£;
4. DATE DRILLED J - o ?- 0 3
5. TOTAL DEPTH: U () S
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO [54
7.
STATIC WATER LEVEL Below Top of Casing: 3 0 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS 1 FT. Above Land Surface`
'Top of casing terminated at/or below land surface requires a
variance In accordance with ISA NCAC 2C .0118.
9. YIELD (gpm): S MF,}THOD OF TEST U.AA
10. WATER ZONES (depth): pp ;5 Li
11. DISINFECTION: Type l V\I
12. CASING:
Depth Diameter
From_ To 1 4 Ft. _
From To Ft.
From To Ft.
13. GROUT: Depth
From 0 To 20
From To Ft.
14. SCREEN: Depth
From To
From To
15. SAND/GRAVEL PACK:
Depth . , Size
From To Ft.'
From To
Amount
Topographic/Land setting
❑Ridge Ip8%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 To FpErnatipn Description
0 15
Wall Thickness
orWeight/Ft. Da
SJ)R2�
Material MethoQd
Ft. heal Cewtevtt /10.1'1/4-d
Diameter Slot Size Material
Ft. in. in.
Ft. in. in.
16. REMARKS:
Ft.
Material
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common road names. o
c)
ro c-`
o
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUC1hD IN ACCORDANCE WITH 15A NCAC 2C, WF1 r
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS R,CORD HAS BEEN PROVIDED TO THE WELL OWNER
SI ATURE OF PERSON C
dN• ' Uo' I1{G, 'HE WELL;
/kO
DATE
v — ,
Submit the original to the Division of Water Quality, Gr4nt$V{ater Section, 1636 Mail Sert'icie enter - Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-1 REV. 07/2001

278180
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Divisionlof
Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAMA�F (print) .Tct_m,eS l.Amp V r. CERTIFICATIONI�#At3g
WELL CONTRACTOR COMPANY NAME Lanlris Del( `lLPPIAn
wtp I Di IL< . PHONE #'Rdl - 73,2
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential Cr Municipal/Public ❑ Industrial ❑ A�Axrt,cultural
4 ° ❑
Monitoring ❑ Recovery 0 Heat Pump Water Injection 0 Other ❑ If Other, List Use I je \\ VYh.I
2. WELL LOCATION:
Nearest Town: ��P, (g,�1.t yy`,'� County
1��1 e, ji �W17 (Street Name, Numbers, CommunityQS�idiP�
}-diNo., Zip Code)
3. OWNER: f-V`n/y'� + �`
Address iog IUQrVmesa4v ��
(Street or Route No.) 9--9 1 r
City o TowoSD trite).. Zip Code V
L1,
Area code- Phone number
4. DATE DRILLED I Al -
5. TOTAL DEPTH: s a S
6. DOES WELL REPLACE EXISTING WELL? YES iteN0 ❑
7. STATIC WATER LEVEL Below Top of Casing: as b FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS 1 FT. Above Land Surfaces
*Top of casing terminated at/or below land surface requires a
variance In accordance with 1SA NCAC 2C .0118.
9. YIELD (gpm): g METHOD OF TEST (:A.rk
10. WATER ZONES (depth): 1-0
11. DISINFECTION: Type Amount Ci.l.q
12. CASING: Wall Thickness
Depth D ameter or Wet ht/Ft. ate 'al
From__ To_-\ Q�. Ft.3( i t�
From To Ft.
From To Ft.
13. GROUT: 'Depth Material Methoqd
From 0 To 20 Ft.Yteat Cenlertt kick r-d
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 Malley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
pRILLTNG LOG
F?{natic r Description
DEPTH
From To
n `OD
1Ob S LC
LOCATION SKETCH
Show direction and distance in miles from at 1 ast
two State Roads or County Roads. Include th
numbers and common road names.
16. REMARKS:
1 DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCIED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RCORD HAS BEEN PROVIDED TO THE WELL OWNER
1 1 0. 0
�HH;WELL
SIGtiJATURE OF PERSON CONSTR
Submit the original to the Division of Water Quality, Ground
27699-1636 Phone No. [phone], within 30 days.
u
ction, 1636 Mail Servi7e-2
Raleigh, NC
REV. 07/2001

278179
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAM (print)` a II
e5 14 • 1 a In p. �. CERTIFICATION/�# At 3 g
WELL CONTRACTOR COMPANY NAME L IYt/),S Vt/ L' II RA MQ I D.r-i L C • PHONE # ($'oW) 45 - / 3�2
STATE WELL CONSTRUCTION PERMIT% I ASSOCIATED WQ PERMIT%
(if applicable)
(if applicable)
1. WELL USE (Check Applicable Box): Residential fr.-Municipal/Public ❑ Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION:
Nearest Town: (�.I.t 1 rvr- County
beiilaSali
l i a ZnY �P �
(Street Name, Numbers, Comvision, Lot No., Zip Code)
3. OWNER:
Address _
l7 \V (Street or Route No.)
`City or Towo State Zip Code
- �°5- aLi
Area coda- Phone number
4. DATE DRILLED • ¢ a- t) R
5. TOTAL DEPTH: .2 S
6. DOES WELL REPLACE EXISTING WELL? YES Ita'NO ❑
7. STATIC WATER LEVEL Below Top of Casing: 0 FT
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS I FT. Above Land Surface'
`Top of casing terminated at/or below land surface requires a
variance in accordance with ISA NCAC 2C .0118.
9. YIELD (gpm): \ 0 MfTHOD OF TEST 0 M.
10. WATER ZONES (depth): 6 no
11. DISINFECTION: Type CAmount (P
12. CASING: Wall Thickness
DepOr
Diameter or eight/Ft. 11�atei
FromQ_ To X \ Ft Y(t .> (r
From o
From
13. GROUT:
From 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
❑Ridge hope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH pRILLING LOG
From To Fo-matiog Description
0 g3
c3 Dt
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include t road;
numbers and common road names.
4 7)-
To Ft. CDt C>A 1 1 S iL ;UM^_'
To Ft.
Depth Material Meth d
To ,20 Ft. neat
.}- CC fl e, kA vvd.
Iv'C
16. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WFI I
CONSTRUCTION STANDARDS, AND THAT A COPY OF S CORD HAS BEEN PROVIDED TO THE WELL OWNER
SI ATURE OF PERSON CONS
Submit the original to the Division of Water Quality, Grou
27699-1636 Phone No. [phone], within 30 days.
HE wEa I f) I°�TE
r Scti eon,1636 Mail Sernue C� I er -Raleigh, NC
Ci-1 REV. 07/2001

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section.�rd
/n� CERTIFICATION 4a
\YELL CONTRACTOR (INDIVIDUAL) NAME (Print) %�2y SUS`f'(
,pp -
WELL COYFI(:\CTORCOMPAN\'NAME SV:ikl c6 £ cLt Uri LZ.I ti CT PHONE # Sf/2�7 2C/4f 5/e
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED \VQ PERMIT#
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential ❑ Municipal/Public I Industrial 0 Agricultural 0
Monitoring ❑ Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION:, lw.I�G���
Nearest Town: � Sc.te4
-4-
(Street Name. Numbers, Community, Subdivision. Lot No., Zip Code)
3. OWNER: &.472,/ SL'i.4fltic-- 1
Address Ufa L'\i-F�r.. �, i iC7.a r�c,(.rrl err
p S .gpr Rowe No.)
o L�( ee
City or Town State Zip Code
)-
Area code- Phone number ✓ / ,
4. DATE DRILLED Or / J
5 TOTAL DEPTH' 7z11:5
County //r bocdea-
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO IW
7. STATIC WATER LEVEL Below Top of Casing: 41 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS ,2'/Z 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 /bra
10. WATER ZONES (depth): 3o9p,4.e- l 74J
11. DISINFECTION: Typet t4c;,r
12. CASING:
Depth
From 0 To r
From To
From To
13. GROUT: Depth Material Method
From To Ft.
From D To S, Ft. fp,e.e. /
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.
Qiametcr
Ft. 27
Ft.
FL
Amount 2 - Soz. 732,
Wall Thickness
or Weight/Ft. Material
Wfru to ?)y,4/1/
Topographic/Land setting
DRidge Dope 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
0—.5c Z-arF ,tat eie
67.ztva-tZ
16. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH I5A NCAC 2C, WELL
CONSTRUCTION STANDARDS,ND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
Pu/s' e
278299
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.
SIGNAIUR
;rice
OF PERSON C
Submit the original to the Division of Water Quality, Gr
27699-1636 Phone No. [phone], within 30 days.
pterSCftracr63bivra Set p
DATE
nter - Raleigh, NC
W-I REV. 07/2001

278295
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and NaturalJResources - Division of Water Quality - Groundwater Section
/
WELL CONTRACTOR (INDIVIDUAL) NAME (print) Ag9 5CISfi' CERTIFICATION#_5i57:)
w'ELW. CONTRACTOR COMPANY NAME 50 Lott( DitizeiN 6 PHONE # tng7n-wg
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
I. WELL USE (Check Applicable Box): Residential 0 Municipal/Public fir' Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION
Nearest Town: 44 4 a' ° At County % iz
May•;o& T1tAuetec.Rz,4
(Street Name. Numbers. Community. Subdivision, Lot No., Zip Code)
3. OWNER:
Address
M W- 9wcL PLW-2-r4
5 o L t4'1t g iLc t2d
�j (Street or Route No.) d
/"ta'I�oN l"n.
ity or Town State Zip Code
(Z - 04441.
Area code- Phone number
4. DATE DRILLED 4.- 2E- 03
5. TOTAL DEPTH: 4/0.5
6. DOES WELL REPLACE EXISTING WELL? YES dNO 0
7. STATIC WATER LEVEL Below Top of Casing: Zc, 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 I5.A NCAC 2C .0118.
9. YIELD (gpm): ) O METHOD OF TEST A I is
10. WATER ZONES (depth): SO tasn(ri ,??O
11. DISINFECTION: TypeC'Ld/Z;N e
12. CASING:
Depth
From 6 To JAI Ft.
From 71 To 71 Ft.
From Zt To 93 Ft.
Amount Y302-e ,
Wall Thickness
D..3Tye er or Weight/Ft.
// (ip
13. GROUT: Depth Material
From Q To .,9.2 Ft.
From To Ft.
14. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in.
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
16. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH I5A NCAC 2C, WELL
CONSTRUCTION STANDARDS, A THAT A COPY OF THIS. RECORD HAS BEEN PROVIDED TO THE WELL OWNER
Topographic/Land setting
❑Ridge ❑Slope fd'Qalley ❑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- to D;rcf-
im 4 i (2.AM,
rJ
t_
LOCATION SKETCH
Show direction and distance in miles from at1Bast
two State Roads or County Roads. Include theme road"'; _J
numbers and common road names.
0
NJ
UI o
vtrii
SIGNATURE 0
ate aIAL
Method
PERSON CONS
Submit the original to the Division of Water Quality, Groun
27699-1636 Phone No. [phone], within 30 days.
tfiG THE WELL
Section, 1636 Mail Servic
TE
r - Raleigh, NC
I REV. 07/2001
f l( q!
GRfL t ]Cr Ftf .�r.,; r•CF
V'.,

1-()j a35v C2
i /•-'-
In r
278294
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) 41 343-fic CERTIFICATION Pc2Ard
WELL CONTRACTOR COMPANY NAME
`jdSt;c ca.eFo Or{ft-Gfk�
PHONE k ( ) 72y-4..5'j/�
SFATE \\'ELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable)
(if applicable)
I. WELL USE (Check Applicable Box): Residential 3' Municipal/Public ❑ Industrial ❑ Agricultural ❑
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use
2. WELL LOCATION: Q
Nearest Town: 6L 0 rail County / And{"
&1171„41.4 FU
(Street Name, Numbers, Communjty, Subdivision, Lot No., Zip Code)
3. OWNER: -
Address
1 9
City or Town State Zip Code
( )- f) r)- 79 3
4 S4 U �Strect or Route No.)
Topographic/Land g
DRidge ❑Slope alley ❑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 !')16'}/)3
5. TOTAL DEPTH: t 4/0-5-
6 DOES WELL REPLACE EXISTING WELL? YES ❑ NO 0�
7. STATIC WATER LEVEL Below Top of Casing: (00 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordance with L5A NCAC 2C .0118.
9. YIELD (gpm): /2 METHOD OF TEST A /
10. WATER ZONES (depth):
0- g0 pia fi
So- yes reAr{'o
/2 9,0en 60
I I. DISINFECTION: Type e�/ti.(i-C Amount O Z
12. CASING: Wall Thickness
Depth Dia ter or Weight/Ft. [Material
From p0 To �?d Ft. t: �U S/U .pVC
From ! d To //U Ft. (p V}'
From//0 To //2 Ft. (. *'9
13. GROUT: Depth Material Method
From To Ft. �y
From 0 To 2 9 Ft. Type Poree/
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 W 0
Show direction and distance in miles from Fat easC'::,
two State Roads or County Roads. Include t tp road2',2.
numbers and common road names.
e
q
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND TIAT A COPY OF THIS RECORI HAS BEEN PROVIDED TO THE WELL OWNER
SI(iN1UR OW PEI N CONST
Submit the original to the Division of Water Quality, Ground
27699-1636 Phone No. [phone], within 30 days.
Ion, 1636 Mail Service .
Raleigh, NC
REV. 07/2001
0
0

10. WATER ZONES (depth):
WELL CONSTRUCTION RECORD
278291
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) , 7A l2 � � l i tuff C j CERTIFICATION ty`� O /t /�
WELL CONTRACI'O12 COMPANY NAME O St c 1 LAJ a I D r 1 Lci M:7 PHONE # cR2€- /L q «v3 yi9
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential e Municipal/Public ❑ Industrial ❑ Agricultural ❑
Monitoring ❑ Recovery ❑ Heat Pump Water injection ❑ Other ❑ If Other, List Use
2. WELL LOCATI
Nearest Town: srrr��r 1 ,010
ShoId E4}LL
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
CC.graphic/Land setting
County tdge ❑Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitudc of well location
3. OWSj:: J0fleN /4 —�L,f NN.��.�-r]�
Address McKnnfa( t�r1. W^rcj`B t
,,,/I (Sncct or doyte No.) 2 es>1 y-7
`'n^r3Cittyyy or Towwn //�Smt�e Zip Code
Area code=neitutnber-
4. DATE DRILLED �.Z_7^°3 D ��
5. TOTAL DEPTH: Oh
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO
7. STATIC WATER LEVEL Below Top of Casing: 90 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
a,,z,b�7ct'
Amount POZ
Wall Thickness
or Weight/Ft. Material
11. DISINFECTION: Type
12. CASING:
Depth Diameter
From O
From 6From //©
(degreeshninutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From To Formation Description
To 90 Ft.
To Ft. /6
To Ft. 47ty /9l0 `yf/r0
m P.c
13. GROUT: Depth Material Method
From To _ Ft.
From D To 42:12 Ft.,ae /
14. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in.
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
16. REMARKS:
LOCATION SKETCH
Show direction and distance in miles from at (east
two State Roads or County Roads. Include the road
numbers and common road names.
O
CA.)
c_
O
CO
N
CFI
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCT
CONSTRUCTION STANDARDS I ND THAT A COP �tI F TH
IGNATUR
ON CONSTR
Submit the original to the Division of NVA1er Quality, Groun
27699-1636 Phone No. [phone], within 30 days.
DANCE WITH I5A NCAC 2C, WELL
HAS BEEN PROVIDED TO THE WELL OWNER
TE
r - Raleigh, NC
-1 REV. 07/2001
0
2J

ell2
Gdv to,
¢,7(.,2
Submit the original to the Division of Water Quality, Grugdwefr-Seetton56.
27699-1636 Phone No. [phone], within 30 days.
Onv
can
WELL CONSTRUCTION RECORD 2 7 8 2 8 9
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
G ettzl .cC i ci, CERTIFICATION II 2 (3-G
WELL CONTRACTOR (INDIVIDUAL)NAME (prima)( ) J-!��
WELL CONTRACTOR COMPANY NAME ?tt
ASSOCIATED WO PERMIT#
STATE WELL CONSTRUCTION PERM ITO (if applicable)
(if applicable) /
I. WELL USE (Check Applicable Box): Residential R/ MunicipaVPublic 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:
S4c t()Jed- D. r u' Y j PHONE a
County %)1-5tk-Q
r
(Street Name, Numbers. Community, Subdivision, Lot No., Zip Code)
3. OWNER: Za•5k C,
Address 17G -'
(Street or Route No.)
OLoFor f 1.3 C
City or Town State Zip Code
( )- 4H2- Ctlyei
Area code- Phone number
4. DATE DRILLED 4. -12 03
5. TOTAL DEPTH: Lk' C
6. DOES WELL REPLACE EXISTING WELL? YES i NO 0
7. STATIC WATER LEVEL Below Top of Casing: ter FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS 1 FT. Above Land Surface'
*Top of easing terminated athar below land surface requires a
variance in accordance with ISA NCAC 2C .0118.
9. YIELD (gpm): Z METHOD OF TEST /4 f YZ-
10. WATER ZONES (depth): nn 2 9 f/iv e 3U`
II. DISINFECTION: Type(l.G"-t[.tp Amount ?,01 073),
12. CASING: Wall Thiclatess
Depth Dia?i�mter or Weight/Ft. Material
From " To 26 Ft. (OY4' f
From G To V Ft. 6 Vs S
t A-e
From eke To y8 Ft. to lie/ /PP l
13. GROUT: Depth Material ethod
From To Ft.
From CJ To 2 5 Ft.
14. SCREEN: Depth Di ter Slot Size
From To Ft. in. in.
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth
• From To Ft.
Topographic/Landisening
DRidge ❑Slope 14alley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/secondt)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DRILLING LOG
Formation Description
DEPTH
From To
From To Ft.
atedal
Si2e 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. O
ca
lode l 113311.
RV
•
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
4- r
SIGNATURE OF P ON CONSTRUCTING THE WELL DATE
enter - Raleigh, NC
GW-I REV. 07/2001

WELL CONSTRUCTION RECORD 278288
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print)t �(27 ,,/�u S�'C6 -i22'' _ CERTIFICATION(�if 2/CM
WELL CONTRACTOR COMPANY NAME Tl)Jtli (/2 Crl .-QQ r PHONE O (2p � y'�f4'2
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED\WQ PERMITS
(if applicable) (if applicable)
I. WELL USE (Check Applicable Box): Residential unicipal/Public 0 Industrial 0 Agricultural ❑
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION: kit_ Nearest Town: 0 L!!0 County
93o W a.t, .c `v1
(Street Name. Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER:C2C dkudel
Address 52,q en✓L l2 d
e �] (Street or Route No.)
(Ja/-)- 7,5-6c'9 P e
City or Town State
Area code- Phase number
4. DATE DRILLED -7744° 3
5. TOTAL DEPTH: 2 7,
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO (3-
7. STATIC WATER LEVEL Below Top of Casing: 80 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS 1 FT. Above Land Surface*
"Top of easing terminated at/or below laud surface requires a
variance In accordance with ISA NCAC 2C .0I la.
9. YIELD (gpm): 70 METHOD OF TEST 4/ K-
10. WATER ZONES (depth): 30‘ o-sar 0 ec '
I I. DISINFECTION: Type[e La7%
12. CASING:
Depth
From To Ft.
Diameter
From tD To 7 Q FL J, I/u
From '18 To'� Ft. 67
13. GROUT: Depth Material
From To FL
From Q To 22 Ft. 7 Si/
Amount S 0 2.
Wall Thickness
or Weight/Ft. Material
I4. SCREEN: Depth
Method
Topographic/Land setting
Ct3R 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
Diameter Slot Size Material
From To Ft. in. in.
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft. R
From To Ft. V
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
c_;
numbers and common road names.
co-
16. REMARKS:
e Do(
oek-
t • ( rOf
V
IaDO HEREBY CERTIFY THAT T,� 11IS WELL WAS CONSTRUCTED 1N ACCaRDANCE 1 A NCAC ZC, WELL
7
CONSTRUCTION STANDARD$}AND THAT A COPY OF TH1 RECORD HAS BEEN PROVIDED TO THE WELL OWNER
O
(.J
7
GN UREQ VERSCONSTRUCTING THE WELL
Submit the original to the Division of Water Quality rruundwater Section, 1636)Nai4
27699-1636 Phone No. [phone], within 30 days. ,i 111I —.__-- ----�1I�
DATE
ce Center - Raleigh, NC
GW-1 REV. 07/2001
1

WELL CONSTRUCTION RECORD 279 C 96
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
�• (; r CERTIFICATION 0 �7._- /'
WELL CONTRACTOR (INDIVIDUAL) NAME (p.1.4 A'< PHONE it (Vlrtr �~G
ASSOCIATED W Q PERMITA
(if applicable)
WELL CONTRACTOR COMPANY NAME
STATE WELL CONSTRUCTION PERMIT I
(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_._—.----
TopograB IC/Land setting
ORidge R$tope OValley ❑Flat
(cheek appropriate box)
Latitudellongitude of well location
2. WELL LOCATION:
Nearest Town: 0 L b (off County
/(a 3 Cf a flhiea , / @24.4-)o -f
(Street Name. Numbers, Coand(munity, Subdivision, l.ot No., Zip Code)
ryl dbawr?(
{ (degrees/minuteshaonds)
3. OW Address 1 it) i t e �' e 5 kee Latitude/longitude source:OGPSOTopographic map
'%tp3 eetv�W�! ��r'�W� (check box)
(Street or Route NJ x2 P26( DEPTH DRILLING LOG
Zip Code
�Lf7 F From To Formation Description
City or TownState
(82S )- VIZ - 3 rd 03
Area code- Phone number
4. DATE DRILLED 67-4 - eJ 3
5. TOTAL DEPTH: 706
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO ��.;? f�- 7o5
7. STATIC WATER LEVEL Below Top of Casing. Pr FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS
/ FT. Above Land Surface"
of
'Tog of casing tvminated at/or below lead surface regains a
variance in ac��rdaaee with ISA NCAC 2C .0118.
9. YIELD (gpa): o a2 5 METHOD OF TESTS 'r/
IO.WATER ZONES (depth): or>76 /f itt 209
LOCATION SKETCH
11. DISINFECTION: Type ( lot N e Amount 93 O2C' 73<-7G 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 umb
ers and gommon road names.
1
Depth
From To FL
From To
Ft.
From 3t% To 39 Ft. (�yy
Material
13. GROUT: Depth
From To Ft.
From t1) To .2 3 FL.
14. SCREEN: Depth Diameter
From To Ft. in.
From_, To Ft. in.
I5. SAND/GRAVEL PACK:
Depth Size
From To Ft.
From To Ft.
16. REMARKS:
I DO HEREBY CER'�fF
CONSTRUCTION STA
1 `oi?
' L
ethod (7
?OnP)
Slot Size Material
in.
in.
Material
/14
•
THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
ARDS, AND TH -.4COP 'LOF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
RSON CONSTRUCTING THE WELL
Submit the original to the Division of Water Quality, Gro
27699-1636 Phone No. [phone], within 30 days.
DATE
er - Raleigh, NC
W-I REV. 07/2001

2 2s5
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section ))
T CERTIFICATION *�9(_ CQ
WELL CONTRACTOR (INDIVIDUAL) NAME (prtat) COY/:f1SJi�/�"� 7u-G. .R
WELL CONTRACTOR COMPANY NAME �as,l'e CTT uI e CG Ii Yl l l
PHONE * ( )._---
STATE WELL CONSTRUCTION (if applicable) PEILNIT* ASSOCIATED W PERMIT*
(if applicable)
1. WELL USE (Check Applicable Box): Residential la7/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: Topographic/Land setting
Nearest Town: For' f County "'� [Ridge WF31ope ❑Valley ❑Flat
(fJI
30 C`�PJ ruv( 15 vG 7� 1 ' \i n • (check appropriate box)
(� Latitude/longitude of well location
(Street Hanle. Numbers, Community, Subdivision, Lot No.. Zip Code)
3. OWNER: fe7frie e efAitel
Address 29ze 0/4kk Hz/ Lota
(Street or Route No.)
k15S,mnap /JL
City or Town State
ran- go7e
Area code- Phase number,. — / 0
4. DATE DRILLED 7 _5£1- 03 ,eo—i/e
5. TOTAL DEPTH: 1 Co S G-6. —
DOES WELL REPLACE EXISTING WELL? YES 0 NQ IO/ )
3
3y749'
Zip Code
(dcgrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DRILLING LOG
Formation Description
DEPTH
From To
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 atlor blow land surface require a
variancein 1'with ISA METHOD OF TEST gi
9. YIELDELD(gpm): a
10. WATER ZONES (depth): /o rb'"fin % /20
II. DISINFECTION: Type cLeyea'e Amount 5i02&259
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
From To FL
From 0 ToOf� Ft.
From_? To C:>:.y Ft.
13. GROUT: Depth Material
From To Ft. /
From f% To ZZ. Ft. 7.
14. SCREEN: Depth Diameter' Slot Size ' Material
From To Ft. in. in.
From To Ft in. in.
15. SAND/GRAVEL PACK: Material
Depth Size
/1L -
/Gf.c.%20c FC
fi /AA/i *-C
(�f U-e
dig R4.4
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.
es p/%C
e'nLti
Method
From To Ft.
From To Ft.
16. REMARKS -
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDAN E WITH I5A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
S4s; 4feAs
,Qll ivc
eic
'3C�IB.
c
co
—o
rr `,
N H ;
N
G4.w&.y
Pet_..
ti/
SIGNATURE 0
bidke,y
uiehy
ON CONSTRUCTING THE WELL
Submit the original to the Division of Water Quality, Gr
27699-1636 Phone No. [phone], within 30 days.
DATE
enter- Raleigh, NC
GW-I REV. 07/2001
IiI

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
9:QYLl CERTIFICATION aC.Ls-=-
\VELLCONTRACTOR (INDIYIDUAL)NAME (orbit PHONE It Ira7 Y' C
\d,rr�
WELL CONTRACTOR COMPANY NAME 1151
ASSOCIATED WO PERMITIt
(if applicable)
STATE WELL CONSTRUCTION PERMITS;
(ifapplicable)
1. WELL USE (Check Applicable Box): Residential I V Municipal/Public 0 industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
278284
2. WELL LOCATION: Q�
Nearest Town: O County e
(Street Name. Numbers, Community, Subdivision,
3 %
3. OWNER:
Address
)_aka Or
(Street or Route No.)
City or Town State Zip Code
O>
Area code- Phone number
4. DATE DRILLED S � 5
5. TOTAL DEPTH:
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO UV
7. STATIC WATER LEVEL Below Top of Casing:
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS Z 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 OFTEST
10. WATER ZONES (depth): 1/4
II. DISINFECTION: Type L?Llf`e
12. CASING:
Depth
From To Ft
From o To b'7 Ft. 410 a --
89 Ft. C9 c/ ,/88 y''"
From `DepthTMethod
13. GROUTT:: Material
From To Ft
'sN ci
From 0 To_1�_ FL 2.?/
14. SCREEN: Depth
Diameter Slot Size Material
To Ft. in. in.
From From To Ft. in. in
15. SAND/GRAVEL PACK: Material
Depth Size
Front To Ft. From To Ft.
cc'
Topographic/Land setting
°Ridge °Slope °Valley ❑Flat
(cheek appropriate box)
Latitude/longitude of well location
(dngrees/minutes/seewtds)
Latitude/longitude source:OGPSOTopographic map
(check box)
DEPTH DR NG LOG
From To Formation Description
Amount ,` a?.e717a
Wall Thickness
Diameter or Weight/Ft. Material
- 76
/3✓�� i/rlG _
v
OCATION SKET91 1" ll0 D it
Show direction and distance in miles from at least I
i.
two State Roads or County Roads. Include the road) ,t
numbers and common road names. e , Vi 1J�' I"
ift{
frog )7-1
16. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND AT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
TURF 7' ERSON CONSTRUCTING THEW WELL
DATE
Submit the original to the Division of Water Quality, Grotu $water Se Lion, I616 Mail Service Center - Raleigh, NC
�_� '"p9W-1 REV.07/2001
27699-1636 Phone No. [phone], within 30 days. n I '
1

WELL CONSTRUCTION RECORD
,
Division of Water Quality - Groundwater n,.
North Carolina - Department of Ernrirontrtent and Natural CERTIFICATION S Z/
�"`" 7Z�/ �159 9
WELL CONTRACTOR (INDIVIDUAL) NAME (prLtl_----r-��--PHONE 0 (r
WELL CONTRACTOR COMPANY NAME ASSOCIATED WQ PERMITS
(if applicable)
STATE WELL CONSTRUCTION PERMITS
(if icable) Mt-Municipal/Public 1. WELL USE (Check Applicable Box): Residential tW Municipal/Public 0 Industrial 0 Agricultural ❑
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other ° If Other, List Use
Topographic/Land setting
dge °Slope Malley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degremhoinutedsecmMs)
Latitude/longitude source:°GPS°Topographic map
(check boll
QKI I
Formation Description
2. WELL LOCATION: County 11AQ �`
ILC
Nearest Town: -i- j ln� d,
(Sued Name. Numbers, Community, Sabdrrrswn,
Lot Nei, VS Code)
3. OWNER:K%
Address
d 4 k4
City or Town State Zip Code
Area code- Phone number, -/ V - O.3
4. DATE DRILLED tot
5. TOTAL DEPTH: 70 r
6. DOES WELL REPLACE EXISTING WELL? YES ° NO
7. STATIC WATER LEVEL Below Top of Casing. _&—FT.
(Use'+ if Above Top of Casing)
S. TOP OF CASING IS
FT. Above Land Surfaces
of
*Top easing tvrniaalad at/or below land surface requires a
variant in accordance with ISA NCAC 2C .0110. car L�
9. YIELD (gpm): " METHOD OF "E r
10 WATER ZONES (depth):
QlC_T H
From To
OCATA ION SKETCH
M E Aunt OZ 6 Show direction and distance in miles from at least
11. DISINFECTION: ION: Typey�.: two State Roads or County Roads. Include the road
12. CASING: Wall eigbt!ess numbers and commc road names.
Depth Diameter to WdghJFL Material u
From Ft.
FromT66 To Ft.
Fronr11__To-4iR—. FL
13. GROUT: Depth Material
From To
14. SCREEN: Depth Diameter Slot Sim Material
FL
Method
--------- f From_Ce___TorC Ft.
From To Ft. in. n.
Frotrl_
To FL in. in.
15. SAND/GRAVEL PACK:
Depth
To_
To
From
From
FL
Ft.
Size
Material
e
16. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL ',CONSTRUCTED 1N ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THA r
•PYOFTHIS RECORD HAS BEa. ' • %EDTOTHE WELL OWNER
�t
SIGNA RE PE' '.N CO ''tom l NGTHE WELL DATE
Submit the original to the Division of Water Quality,icro, unnwnter Section,1636 Mail Service Center- Raleigh, NC
27699-1 636 Phone No. [phone], within 30 days.
1 FM GW-1 REV. 07/2001

City or Town State
Cow)- / � firm
Area code- Phone mother
4. DATE DRILLED S7/9/ p,S
5. TOTAL DEPTH: /gs
6. DOES WELL REPLACE EXISTING WELL YES 0 NO Pt
7. STATIC WATER LEVEL Below Top of Casing - S FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS /. 6— FT. Above Land Surface'
flop of casing terminated at/or below land surface requires a
variance In accordance with ISA NCAC 2C .0118.
9. YIELD (gpm): t-2 07 METHOD OF TEST L-en -P
10. WATER ZONES (depth): //OQ
11. DISINFECTION: Typegaerthfitc
12. CASING:
��ter
From To ° Ft. !O
Fromm_ To Ft
From To Ft.
13. GROUT: Depths) ^ Material
Fromer ToyFt. Canza s -
From To Ft.
Amount /o 02-
Wall Thickness
or Weight/Ft Mj,%ial
278349
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and rural Resources - Division of Water Quality - Groundwater Section //
WELL CONTRACTOR (INDIVIDUAL) NAM EyK (print �Q CERTIFICATION/
WELL. CONTRACTOR COMPANY NAME �L.u./?�iLr�fbO (.C��(A �L *PHONE JI 9 D [±
STATE WELL CONSTRUCTION PERMIT#T_ASSOCIATED WQ P
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery ❑ Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATIO rat.,
, NearesTo County2ne2oc eI
L4D.
576 $5—
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER:7nd* Li-4-Gc.a) /Vo)s'c+-GJ
Address 7,24/ # Jy 9C 90
(Street or Route No.)
Topographic/Land setting
❑Ridge ❑Slope ❑Valley J Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
,Mat.lin.".. / •C, pZ 2'76Z- DEPTH DRILLING LOG
Zip Code From To Formation Description
Method ,
fa tit /ICA/
14. SCREEN: Depth Diameter Slot Size Material
Fro Ft. in. in.
From To Ft in. in
15. SAND/GRAVEL PACK
Size Material
FromGTo Ft.
Fro To Ft.
16. REMARKS:St
LOCATION SKETCH at -a-
Show direction and distance in miles fro„ at least
two State Roads or County Roads. Inc . de the road
numbers and common road names.
1 DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH ISA NCAC 2C, WET T
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WWI OWNER
I y OF PERSON
a
SIGMA PERCONSTRUC
Submit the original to the Division of Water Quality, Groundwat
27699-1636 Phone No. [phone], within 30 days.
TEW 1L;
ion,1636 Mai -rvt - . 2 ! sigh, NC
V. 07/2001

27S2&2
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Sectiono7
WELL CONTRACTOR (INDIVIDUAL) NAME (print) 6e/�Y J �� L6 CERTIFICATION 26
\Y
ELL CONTRACTOR T
PANY NAME 7E.S4'(LE tJ€-& 19-(1C(-. fl PHONE # ( ) � SteteJ i`
STATE WELL CONSTRUCTION PERMIT*/ ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
I. WELL USE (Check Applicable Box): Residential «Municipal/Public ❑ Industrial ❑ Agricultural ❑
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use
2. WELL LOCATION: ra/oti C/�,,Xx
Nearest Town: {ii y Count /V2 t "
eg)MIS C,I4.4C Y
(Street Name. Numbers, Community, Subdivision, Lot No.. Zip Code)
3. OWNER:
Address
' 13341 fo 14�
(Street or Route No.)
141 W3 aw AJ +_ "2 t7 c?—
City or Town State Zip Code
(_)- (o74/-6-3/7
Area code- Phone number
4. DATE DRILLED (0'/2 O 3
5. TOTAL DEPTH: 4o r
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO
7. STATIC WATER LEVEL Below Top of Casing: PO FT.
(Use"+^ if Above Top of Casing)
8. TOP OF CASING IS / FT. Above Land Surface*
`Top of easing terminated at/or below land surface requires a
ici
variance in accordance with ISA NCAC 2C .0118.
9. YIELD (gpm): / METHOD OF TEST Ai S'f
10. WATER ZONES (depth): /gr." Ir5/ irce
p LOCATION SKETCH
11. DISINFECTION: Type a Amount u 62 &/ A, 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.
pographic/Land setting
dge ❑Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From To Formation Description
0- /0a
Qi2e'
From To Ft.
From U To-Wir Ft
From PO To /JZ Ft. 6
13. GROUT: Depth Material
From To Ft.
From el To 24- Ft.
14. SCREEN: Depth Diafeter (Slot Size Material
From To Ft. in. in.
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Size Material
Method
From To Ft.
From To Ft.
16. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL W
CONSTRUCTION STANDARDS, AND THA 'COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
co ING
WELL
Qpii
0
C)
SIGN
H���
ONSTRUCTED IN AC a RDANCE WITH 15A NCAC 2C, WELL
THE
ERS a,
Submit the original to the Division of Water Quality, Groun
27699-1636 Phone No. [phone], within 30 days.
DATE
- Raleigh, NC
1 REV. 07/2001

LOCATION SKETCH
Show direction and distance in miles from at (east
two State Roads or County Roads. Include the road
twmbers and common road dames. 6 j ai-Lt4 t ! ✓ .
0
CO
WAS CONSTRUCTED IN ACCORDANCE
PROVIDED WITH
NCAC
THE WELL OWNER
A COPY OF THIS RECO'
UCIING THE WELL
WELL CONSTRUCTION RECORD
tlsli Groundwater Section
Division of W atet Q ty J�Zj
North Carolina - pepartntent of Environment and Natural �R U CERTIFICATION tf� '
WELL CONTRACTOR (INDIVIDUAL) NAME (Print (,JX.Ut v r _-u` PHONE a ON
G
W E1.I. CONTRACTOR COMPANY NAME ASSOCIATED WQ PERMIT*
(if appticabie)
STATE WELL CONSTRUCTION PERMIT*
(if icable)
Applicable Box): Residential m Municipal/Public ❑ Industrial 0 Agricultural 0
1. WELL USE (CheckRecovery
Heat Pump Water Injection 0 Other ❑ If Other, List Use
Monitoring 0 Recovery 0
16graphic/Land setting
dge ❑Slope ❑Valley OFIat
(chat appropriate box)
Latitude/longitude of well location
(deareWminummecom m
Latitude/longitude source:OGPS❑Topographic map
(cLatbox)
DF DRILt_ t_ Ns G LOG
From To Formation Description
278281
2. WELL LOCATION:
Nearest Town: t \M,� - County
(Street Name. Numbers, Community, Subdivision, Lot No.. Tip Code)
3. OWNER:
Address
AYj 1)-S -- Zip Code
City or Town State
(_) 2, A' may°
Area code_ Phone nwnbei /^.// G ' O
4. DATE DRILLED
5. TOTAL DEPTH: 3 L$
6. DOES WELL REPLACE EXISTING WELL? YES 0
FT.
7. STATIC WATER LEVEL Below Top of Casing
11 (Use -4-- if Above Tap of Gains)
8. TOP OF CASING IS _ L— ET. Above Land Surface'
`Top of eaaing terminated tSr below land arfacerequires a
variance in accordance with ISA NCAC 2C .Ottt
9. YIELD (gpm):_ — METHOD OFT ST �"
10. WATER ZONES (depth): qJ oo
11. DISINFECTION: Type A "_ '=�"=- Amount
Wall T(atdmess
12. CASING: Depth Diameter or WeiWeight/R.Material
From To Ft.
Fromm —To JIQ Ft.
Froml/D____To41 Ft.
13. GROUT: Dept Ft
From To
From__ To Ft.
14. SCREEN: Depth Di r Slot Size serial
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 W
CONSTRUCTION STANDARDS, AND
SIGN
Center
REV. h, NC
Submit the original to the Division of Water Quality, Gf4rtRdwater Section, 1636 Mail Sergi }Center -Raleigh,
27699-1636 Phone No. (919) 733-322 t, within 30 days.
i 11
�LI
F
DATE

WELL CONSTRUCTION RECORD
North Carolina — Department of Environment And Natural Resources — Division of Water Quality — Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) DEAN SHEHAN CERTIFICATION # 2160
WELL CONTRACTOR COMPANY NAME PITTMAN WELL BORING, LLC PHONE # [phone]
STATE WELL CONSTRUCTION PERMIT # _ ASSOCIATED WQ PERMIT #
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential ® Municipal/Public ❑ Industrial ❑ Agricultural D
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use
2. WELL LOCATION:
Nearest Town: MARION
SEQUOIA DR. LOT #1
(Street Name, Numbers, Community, Subdivision, Lot No
3. OWNER: JEREMY TAYLOR
Address SEQUOIA DR
(Street or Route No.)
MARION NC 28752
City or Town State Zip Code
(828) — 6524406
Area Code Phone number
4. DATE DRILLED 07/16/03
5. TOTAL DEPTH: 365
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO
7. STATIC WATER LEVEL Below Top of Casing: 50 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS 1-1/2 FT. Above Land Surface*
'Top of casing terminated at/or below land surface requires a
variance in accordance with 15A NCAC 2C .0118.
9. YIELD (gpm): 3 METHOD OF TEST ARD
10. WATER ZONES (depth):
County MCDL
11. DISINFECTION: Type CHLORYTE Amount 9.5
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
From 0 To 60 Ft. 6-1/4" SDR.21 PVC
From To _ Ft. _
From _ To Ft.
13. GROUT: Depth Material
From 0 To 20 Ft. QUHCRETE
From To Ft.
14.SCREEN: Depth Diameter
From To _ Ft.
From To Ft.
15. SAND/GRAVEL PACK:
Depth Size Material
Method
POURED
Slot Size Material
in. _ in.
in. in.
From To Ft.
From To Ft.
16. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONS CTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
Topographic/Landsetting
❑ Ridge ❑ Slope ❑ Valley ❑ Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source: ❑ GPS ❑ Topographic map
(check box)
DEPTH
From To
DRILLING LOG
From To
LOCATION SKETCH
Show direction and distance in miles from at least
Two State Roads or County Roads. Include the road
number and common names
HWY. #226 N. FROM POLKVILLE. RT. ON
JACKTOWN RD. CROSS RR. RT. ON PARKERS
CHAPEL RD. GO 1/10 MILE & RT. ON SEQUOIA
DRLAST HOUSE ON LEFT
o
CO
CD
-70
SIGNATURE OF PERSON CONS
Zip Code)
fJ FING `tki$'-ALL
Submit the original to the Division of Water Quality, Groulygwafer Section, 1636 Mail Sei:vi
37699-1636 Phone No. [phone], within 30 days. II II�II f is
277640
DATE
enter — Raleigh, NC
1 REV. 07/2001

277638
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment And Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) DEAN SHEHAN CERI It !CATION # 2160
WELL CONTRACTOR COMPANY NAME PITTMAN WELL BORING, LLC PHONE # [phone]
STATE WELL CONSTRUCTION PERMIT # ASSOCIATED WQ PERMIT #
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential ® Municipal/Public ❑ Industrial ❑ Agricultural ❑
Monitoring 0 Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use
2. WELL LOCATION:
Nearest Town: MARION County MCDWL
HWY. #64
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: DONNIE YELTON
Address HWY. #64
(Street or Route No.)
MARION NC 28752
City or Town State Zip Code
(704) — 477-4247
Area Code Phone number
4. DATE DRILLED 07/10/03
5. TOTAL DEPTH: 365
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO
7. STATIC WATER LEVEL Below Top of Casing: 20 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS 1-1/2 FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordance with 15A NCAC 2C .0118.
9. YIELD (gpm): 3 METHOD OF TEST ARD
10. WATER ZONES (depth):
11. DISINFECTION: Type CHLORYTE Amount 9
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
From 0 To 30 Ft. 6-1/4" SDR2I PVC
From To _ Ft. _
From _ To Ft. _
13. GROUT: Depth Material
From 0 To 20 Ft. QUIKRETE
From To Ft.
14.SCREEN Depth Diameter
From _ To Ft.
From To Ft.
15. SAND/GRAVEL PACK:
Depth Size Material
Method
POURED
Slot Size Material
in. _ in.
in. in.
From To Ft.
From To Ft.
16. REMARKS:
Topographic/Land setting
❑ Ridge 0 Slope ❑ Valley ❑ Flat
(check appropriate box)
Latitude/longitude of well Location
(degrees/minutes/seconds)
Latitude/longitude source: ❑ GPS ❑ Topographic map
(check box)
DEPTH
From To
DRILLING LOG
From To
LOCATION SKETCH
Show direction and distance in miles from at least
Two State Roads or County Roads. Include the road
number and common names
HWY. #64 E. FROM RUTH. 1 MILE ON LEFT
AFTER CROSSING INTO MCDOWELL CTY. LOG
HOUSE BEHIND OLD WOOD BARN.
(v
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONS CTION STANDARDS D THAT A COP OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNERi,,,,_
7
Submit the original to the Division of Water Quality, Ground
27699-1636 Phone No. [phone], within 30 days.
er - Raleigh, NC
(REV.07/2001

277637
WELL CONSTRUCTION RECORD
North Carolina — Department of Environment And Natural Resources — Division of Water Quality — Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) RODNEY ROBBINS CERTIFICATION # 2785
WELL CONTRACTOR COMPANY NAME PITTMAN WELL BORING, LLC PHONE # [phone]
STATE WELL CONSTRUCTION PERMIT # _ ASSOCIATED WQ PERMIT #
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential ® Municipal/Public ❑ Industrial ❑ Agricultural ❑
Monitoring ❑ Recovery 0 Heat Pump Water Injection ❑ Other ❑ If Other, List Use
2. WELL LOCATION:
Nearest Town: OLD FORT
LAUREL MTN. RIDGE
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: JEFFREY RUMFELT
Address LAUREL MTN. RIDGE
(Street or Route No.)
OLD FORT NC 28762
City or Town State Zip Code
(828) — 668-1152
Area Code Phone number
4. DATE DRILLED 07/23/03
5. TOTAL DEPTH: 385
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO
7. STATIC WATER LEVEL Below Top of Casing: 80 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS 1-1/2 FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordance with 15A NCAC 2C .0118.
9. YIELD (gpm): 40 METHOD OF TEST ARD
10. WATER ZONES (depth):
County MCDL
11. DISINFECTION: Type CHLORYTE Amount 9.5
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
From 0 To 150 Ft. 6-1/4" SDR.21 PVC
From To Ft. _
From To Ft.
13. GROUT: Depth Material Mcthod
From 0 To 20 Ft. QUIKRETE POURED
From To Ft.
14.SCREEN: Depth Diameter Slot Size Material
From _ To _ Ft. _ in. _ in.
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth
From To
From To Ft.
16. REMARKS:
Size Material
Ft.
Topographic/Land setting
❑ Ridge 0 Slope ❑ Valley ❑ Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source: ❑ GPS ❑ Topographic map
(check box)
DEPTH
From To
DRILLING LOG
From To
LOCATION SKETCH
Show direction and distance in miles from at least
Two State Roads or County Roads. Include the road
number and common names
HYW. #40 W. FROM MARION. GET OFF AT
EXIT 73. GO LEFT ON BAT CAVE RD. LEFT ON
OLD FORT/SUGAR HILL RD. APPROX. 1/2 MILE.
RIGHT ON CAMPGROUND RD. TAKE 1ST RIGHT
ON LAUREL MTN. RIDGE. LEFT AT FORK. THE
LOT IS THE FIRST ONE ON THE LEFT.
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUC 1 ED IN ACCORDANCE WITH 15A NCAC 2C. WELL::
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
SIGNAT OF PERSON CONSTRUC 'WELL
Submit the original to the Division of Water Quality,
27699-1636 Phone No. [phone], within 30 days.
-2- .3 -IA-3
GWai, ' V. 07/2001

North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
1636 Mail Service Center - Raleigh, N.C. 27699-1636 - Phone [phone]
272328
WELL CONSTRUCTION RECORD WELL CONTRACTOR: Dewey Wright Well Pump Co., Inc.
WELL CONTRACTOR CERTIFICATION #: 268/
030027 STATE WELL CONSTRUCTION PERMIT#. Steve Reece
1. WELL USE (Check Applicable Box): Residential
Recovery [ I Heat Pump Water Injection
I1
Municipal n Industrial
Other If Other, List Use:
2. WELL LOCATION: (Show sketch of the location below)
Nearest Town: MARION County: MCDOWELL
3. OWNER
Address
FAWN DR. OFF SUNRISE OFF DEER RIDGE TRAIL OFF
(Road Name and Numbers, Community, or Subdivision and Lot No.)
JOHN SCHNEIDER
3107 DEW DROP COURT ,
Agricultural I I Monitoring
a/Slit
DRILLING LOG DEPTH
From To Formation Description
0 220 DIRT GP.A.NITE
MELBOURIVtorRouteNo.l FL 32940 220 230 GRAVEL
City or Town State Zip Code
4. DATE DRILLED 2/21/2003
5. TOTAL DEPTH 230
6. CUTTINGS COLLECTED YES I I NO
7. DOES WELL REPLACE EXISTING WELL? YES 0 NO 71
8. STATIC WATER LEVEL Below Top of Casing: 20 FT
(Use "+" if Above Top of Casing)
9. TOP OF CASING IS 1 FT Above Land Surface*
*Top of casing terminated at/or below land surface requires a variance in accor-
dance with 15A NCAC 2C.011B
10. YIELD (gpm)• 2 METHOD OF TEST Ar
0 Mom
11. WATER ZONES (depth)•O �um2`0-230 0 ppm
12. CHLORINATION: Type HTH Amount 44 If additional space is needed use back of form
3S°S2-' ill" / fI' (16'o6.6
13. CASING:
Wall Thickness
Depth Diameter or Weight/Ft. Material
From 0 To G1.2Ft S 1/d .188 GALV
From To Ft 4j
�L
From To Ft D /
14. GROUT: rat4� 1 M'
Depth Material Method 0fFiCc_ o-i 5C W.)From 0 To 20 Ft Cement Gravity Flow w W
From To Ft. _ r
LOCATION SKETCH
(Show direction and distance from at least two State
Roads, or other map reference points)
15. SCREEN:
Depth Diameter Slot Size Material
From To Ft. in in
From To Ft in in
From To Ft in in
16. SAND/GRAVEL PACK:
Depth Size Material
From To Ft
From To Ft
r
17. REMARKS: F
I DO HEREE G
CONSTRUCT] • STANDARDS, AND THAT
FOR OFFICE JSCQI NLY
Quad No:
Serial No.
C
v
NSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
Y OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER.
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
LF r.'FLs'{n t origir al to Division of Water Quality, Groundwater Section within 30 days
GW-1 REV. 12/99
AL ':ICE

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (prin0 Jeremy H. Bowman - CERTIFICATION 2809
WELL CONTRACTOR COMPANY NAME D Rnwman Well llri 11 in9 Tnn PHONE W R7A 2 5 7 — 7 7 7 9
276507
STATE WELL CONSTRUCTION PERMITS ASSOCIATED WQ PERMITS
(if applicable)
(if applicable)
1. WELL USE (Check Applicable Box): Residential D4 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: :Topographic/Land setting
Nearest Town: Old Fort County Mrflnwel1 )$Ridge 0Slope ❑Valley ❑Flat
Catawba Pal -1 s Snhr1 Arrarlia Fall S Way Lot #89 (check appropriate box)
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code) Latitude/Iongiitud of well location
.,S°3'F/f'%Pu R26/41.11.4"
3. OWNER: Julie Sasuari & Joan Maurice (degrees/ mutes/seconds)
Address 12_27 Snnth West 75th Ave Latitude/longitude source:❑GPS❑Topographicmap
(Street or Route No.) (check box)
Deerfield Beach, Florida 33442 PEPTi-[ PRILLING LOG
City or Town State Zip Code From To Formation Description
( )-
Area code• Phone number
4. DATE DRILLED 6/03/03
5. TOTAL DEPTH: 700'
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO IX
7. STATIC WATER LEVEL Below Top of Casing: 200' FT
(Use "+" if Above Top of Cuing)
8. TOP OF CASING IS 1 • 4 FT, Above Land Surface"
*Top of cuing terminated actor below land surface requires a
variance In accordance wlth ISA NCAC 2C .011S.
9. YIELD (gpm): 43 METHOD OF TEST ..-rotary air
10. WATER ZONES (depth)' 540' , 660'
ASP zoto/7 U
II. DISINFECTION: Type tablet Amount 6
12. CASINO:
Depth Diameter
From p To 77 Ft.81 /8 _ S
From To Ft,
From To Ft.
13. GROUT: Depth Material Method
From 0 To 20 Ft. concrete gravity flow
• From _ To Ft.
14. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in,
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
Wall Thickness
or Weight/Ft. Material
h g0 ➢vr
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, -`
ief4µ! nf�c r ,tea i
Be f LEFr', /fTiva
J-3
0
0
16. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH I5A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
SIGNATURE OF PERSON CONSTRUCTING THE WELL
4 03/03
DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mall Service Center- Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-1 REV: 0712001 --,!
ee

279797
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment And Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) RODNEY ROBBINS CERTIFICATION # 2785
WELL CONTRACTOR COMPANY NAME PITTMAN WELL BORING, LLC PHONE # [phone]
STATE WELL CONSTRUCTION PERMIT # _ ASSOCIATED WQ PERMIT #
(if applicable) (if applicable)
1.
WELL USE (Check Applicable Box): Residential ® Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery ❑ Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION:
Nearest Town: MARION
WORLEY RD.
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: LORI PRICE
Address 685 WORLEY RD.
(Street or Route No.)
MARION NC 28752
City or Town State Zip Code
(828) - 652-9572
Area Code Phone number
4. DATE DRILLED 09/25/03
5. TOTAL DEPTH: 165
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO
7. STATIC WATER LEVEL Below Top of Casing: 40 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS 1-1/2 FT. Above Land Surface*
'Top of casing terminated at/or below land surface requires a
variance in accordance with I5A NCAC 2C .0118.
9. YIELD (gpm): 30 METHOD OF TEST ARD
10. WATER ZONES (depth):
County MCDL
11. DISINFECTION: Type CHLORYTE Amount 3
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
From 0 To 80 Ft. 6-1/4" SDR21 PVC
From To _ Ft. _
From _ To Ft. _
13. GROUT: Depth Material
From 0 To 20 Ft. QUIKRETE
From To _ Ft.
14.SCREEN: Depth Diameter
From To _ Ft.
From To Ft.
15. SAND/GRAVEL
Depth
From To _
From To
Method
POURED
Slot Size Material
in. in.
in. in.
PACK:
Size Material
Ft.
Ft.
Topographic/Land setting
0 Ridge ❑ Slope 0 Valley 0 Flat
(check appropriate box)
Latitude/longitude of well locati
(degrees/minutes/seconds)
Latitude/longitude source: 0 GPS ❑ TO;'
(check box)
DEPTH
From To
DRILLING LOG
From To
phic map Ki
r.�
UU
L
LOCATION SKETCH f ( ��
Show direction and distance in miles [from at le sL_ i
Two State Roads or County Roads. Include the road —
number and common names
HWY. #226 N. FROM POLKVILLE. GET ON I-40
GOING WEST. EXIT OFF ON SUGAR HILL RD. GO
STRAIGHT ACROSS ON TO WORLEY RD. DRIVE
ON LEFT 6/10 MILE PAST STAMEY CHRYSLER
DEALERSHIP.
0
w
0
c-t
w
-D
w
w
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
2.
SIG
/cemn, r,
ATURE OF PERSON CONSTRUCTING THE L
9-a sr- a.
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 - IDivisiioon of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print)
AIN-y T04ft t-L CERTIFICAATION#Z5iv
WELL CONTRACTOR COMPANY NAME ,J U.S.) Ica" k(IJ 6 Li 0 R_t t1 1 1N+ ( PHONE
STATE \\'ELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential 131tMunicipal/Public 0 Industrial ❑ Agricultural ❑
Monitoring 0 Recovery ❑ Heat Pump Water Injection ❑ Other 0 If Other, List Use
2. WELL LOCATION:
Nearest Town: 6l. () ref+
c35 4zrc;✓-)1ILL
County ILA t—G-N.0(
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: �i 1).ue (ti) e it ('t 5 kl
Address 127 /i6L C ape [yeg o I.) : Aw'C-
(Street or Route Na)
eKIN1{oit• if5�.
City or Town State
12. CASING:
Depth Diameter or Weight/Ft.
From t' To •21) Ft. (4)y lio
From -)^ To 72- Ft. if) / 9`^
From To Ft.
13. .GROUT: Depth Material Method
From To Ft.
From t) To 2c Ft. rjf t' ( IIc:'lehVr
14. SCREEN: Depth Diameter Slot Size Material
Zip Code
(w'5)- YOb- f,g7 r
Area code- Phone number
4. DATE DRILLED ,$C'p / (/ 0 3
5. TOTAL DEPTH: 2 Q
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO QV
7. STATIC WATER LEVEL Below Top of Casing: C30 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 /LH rC-
10. WATER ZONES (depth): S 5"t ` (C), 2
280160
Topographic/Land setting
DRidge ❑Slope DValley ❑Plat
(check appropriate box)
Latitude/longitude of well location;:-
(degrees/minutes/seconds)
Latitude/longitude source: ❑GPS❑Topognaphi3n map
(check box)
DEPTH DRILLING LOG
From To Formation Description
� l td
-(o
[b- %ncri
/J (/L f / /2c6 IC
Go- Z'r5' 60AN—
OCATION SKETCH
1 L DISINFECTION: Type C-1N-r Nw Amount 9 z 4 f 22 c. how direction and distance in miles from at least
Wall Thickness two State Roads or County Roads. Include the road
Material numbers and common road names.
e_
hLtLe/C—
From To
From To
15. SAND/GRAVEL PACK:
Depth
From To Ft.
From To Ft.
16. REMARKS:
Ft. in. in.
Ft. in. in.
Size Material
f2
' A-
n
I cm
cv
o.�
�rn
0
/et,, 1 f K4-
{t.og Eda
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
IGNATUR� OF P ARSON
CON
STRUCTING NSTRUCTING 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 - '(D'ivisio1n of Water Quality - Groundwater Section C
WELL CONTRACTOR (INDIVIDUAL) NAME (print) YA Ft b ' c..) C3S t C C CERTIFICATION ttc /"�/'t //
WELL CONTRACTOR COMPANYN.AME TQS+ic r- WALL bK, LC; /VC __PHONE#�729-4S i7
S'I ATf; WELL CONSTRUCTION PERMIT# ASSOCIATED WO PERMIT#
(if applicable) (if applicable)
I. WELL USE (Check Applicable Box): Residential 07I unicipal/Public ❑ Industrial 0 Agricultural 0
Monitoring 0 Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use
2. WELL LOCATION:
Nearest Town: OLD FO/
G44,w a -I LOf 787
(Street Name, Numbers, Community,, Subdivision, Lot No., Zip Code)
3. OWNER: /DNM pi -Lc) `si"
Address 67/47 A-4L1/091-0/1.1 Ct $IGle
(Street or RouA No.)_ 26146,
W1eLbOOPNe I✓� 3
City or Town State Zip Code
`e55 7
Area code- Phone number
4. DATE DRILLED ri `l(/'03
5. TOTAL DEPTH: (0O5 (/0— 6e;
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO IJY
7. STATIC WATER LEVEL Below Top of Casing: W FT. 6D.- 665-
(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): / METHOD OF TESTS-fA-AJ
Typographic/Land setting i
Cell❑Valley 0F14..
(check appropriate box)
Latitude/longitude of well location t
(degrees/minutes/seconds)
Latitude/longitude source:OGPS❑Topogra
(check box) -'t
DEPTH DRILLING fY°q1 tj
From To Formation Desc(jiitioh---T...
r--
r _JC.
r
r
d� ICJ
10. WATER ZONES (depth): ) L'1 p 44 c 300
11. DISINFECTION: Type&Wgl LW_ Amount 62%0'
12. CASING:
From
13. GROUT: Method
from To Ft.
From__ To 2C) Ft. +1/� 1
14. SCREEN: Depth Diame[[er Slot Size Material
From To Ft. in. in.
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Size Material
countyte tJ6WC(-(-
�i Kaf " feeCk
LOCATION SKETCH
Show direction and distance in miles from at least
Wall Thickness two State Roads or County Roads. Include the road
or Weight/Ft. Material numbers and common road names.
vo rU e
'% (?7v �
Depth Diameter
From so To 70 FL._%L .
From 7p To 72 Ft.
To Ft.
Depth Material
From To Ft.
From To Ft.
16. REMARKS:
I DO HEREBY CERTIFY THAT THI
CONSTRUCTION STANDARD
280159
Egigtee
WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
D THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
P
-c
rya
o Fire-
0
DO
tin
�o
m
C,-I`s e/&
Z
NATURE IF Pr,FSON 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

280090
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
\
1636 Mail Service Center - Raleigh, N.C. 27699-1636-Phone [phone] // �eZpp )
c 7
WELL CONTRACTOR CERTIFICATION 0: 2
ra
STATE WELL CONSTRUCTION PERMIT#:
WELL CONSTRUCTION RECORD
WELL CONTRACTOR'
1. WELL USE (Check Applicable Box): Residentialer Municipal ❑ Industrial ❑ Agricultural ❑ Monitoring ❑
Recovery ❑ Heat Pump Water Injection ❑ Other E] II Other, List Use:
2. WELL LOCATI (Show sketch of the location below)
Nearest Town• �
�//��?c-) County. ¢
av
67/2(1?
Gil -Road Name a Numbers, Commuf �Ily, or Subdivision and Lot No.)
OWNER lr/-P-c.��
3.
Z+-cit�C/�� -
- (Sheol or to No.)
Address
DRILLING LOG
From To
City or Town Slate Zip Code
5. DATE DRILLED 5
---j5. TOTAL DEPTH c'
6. CUTTINGS COLLECTED YES f NO[9
7. DOES WELL REPLACE EXISTING WELL? YES O NO[
8. STATIC WATER LEVEL Below Top of Casing: FT.
(Use'+' If Above Top of Casing)
9. TOP OF CASING IS 2 FT Above Land Surface'
'Top of casing terminated at/or below land surface requires a variance In accor-
dance with 1SA NCAC 2C.01)0
10. YIELD (gpm): // METHOJR9F TEST
11. WATER ZONES (depth): tS
12. CHLORINATION: Type`
13. CASING:
DEPTH
Formation Description
Amount i! additional space Is needed use back of form
Wail Thickness
1111,�, Depth r J C Diameter or Weight/Fl.
From To 17 Ft 1, -3
From To Ft.
From To Ft
14. GROUT:
LOCATION SKETCH
Material (Show direction and distance from el least two State
` . PC, Roads, or other map reference points) r
L
O's � r.,
rn
m :..
0
Depth "ate dal Method
Frorn — To It i2,.
From To FI.
15. SCREEN:
Depth Diarnetor Slot Size
From — To Ft In In
From To Ft In In
From To FI. In. In
16. SAND/GRAVEL PACK:
Depth Size
From To Ft
From To Ft.
Material
A
0
Ca) o
z
17. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY
F THIS RECORD HAS BEEN PROVIDED TO THE WELL
OWNER.
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
Submit original to Divisional Water Quality. Groundwater Section within 30 days GW 1 REV. 12/99
FOR OFFICE USE ONLY
Ouad No:
Serial No

i
1J636 Mail Service Centerent of Environment and Natural Resources - Ral gh, N.C. 27699-1636-Phone [phone]�n of Water Quality -Groundwater Section
WELL CONSTRUCTION RECORD WELLCONTRACTOR' c - �G2 C�t)
WELL CONTRACTOR CE IFICATION 0: o2erb 3
STATE WELL CONSTRUCTION PERMIT#:
280089
1. WELL USE (Check Applicable Box): Residential Et' Municipal ❑ Industrial ❑ Agricultural ❑ Monitoring ❑
Recovery ❑ Heat Pump Water Injection ❑ Other 11 Other, List Use:
2. WELL LOCATIIO�OjjN:: _IONsketch of the location below) � �, e
Nearest Town: �/"�-�� Thal County' 'i
7.2L Coat `S_ // / DEPTH
(Road Name er� Numbers. Community. or rbdlvislon and Lot No.) DRILLING LOG
From To Formation Description
3. OWNER
Address
Cll-o.
City or Town J. Slate
4. DATE DRILLED 3
5. TOTAL DEPTH / -
6. CUTTINGS COLLECTED YES n NOI -{---
7. DOES WELL REPLACE EXISTING WELL? YES NOj--r
8. STATIC WATER LEVEL Below Top of Casing: /e _ FT.
/ (Use'+' II Above Top of Casing)
9. TOP OF CASING IS FT. Above Land Surface'
'Top of casing terminated et/or below land surface requires a v dance In scoor-
dance with -ISA NCAC 2C a ,/
10. YIELD (gpm): ( METHOD OF TEST *-�4-4,
11. WATER ZONES (depth): l--3 /ft
ree or outs No.)
Z!p Code
z
i
12. CHLORINATION: Type / Arnountt' /..Sti if additional space Is needed use back of tj,rm
13. CASING:
,,�� "" Depth Diameter
From �y To 7C' Ft ' r
From OO To Ft.
From To Ft
14. GROUT:
Depth M erlai
From tL— To El
From 1. To Ft.
15. SCREEN:
Depth
From To Ft In
From To Ft In
From To Ft In
16. SAND/GRAVEL PACK:
Depth Size
From To
FI
Ft
Wall Thickness
or Weight/Ft. Mateda
LOCATION SKETCH
(Show direction and distance from at least two State
Roads, or other map reference points)
e. p
hi-ft A) A-p
Y
Method
-Diameter Slot Size Mated at
in
in
In
y Material
Arm.
>-L 21 - K3
irO
0;9
tV o
z-
From To
17. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COOF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER.
FOR OFFICE USE ONLY
1
Quad No:
Serial No
Submit original to Division oI Water Quality, Groundwater Section within 30 days SIGNATURE OF PERSON CONSTRUCTING THE WELL DATEGW 1 REV. 12/99

Ft.
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources --+Division of Water Quality - Groundwater Section
WELL WELL CONTRACTOR (INDIVIDUAL) NAME (print) '!1 Av-„, sk-Is4 etc- CERTIFICATION #r))S
r
WELL CONTRACTOR COMPANY NAME 03}rC E WeiC (r) i.(1cN4 PHONE #(Vfn 224-4-00
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable) (if applicable) r_
280167
1. WELL USE (Check Applicable Box): Residential ly Municipal/Public 0 Industrial ❑ Agricultural 0
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other 0 If Other, List Use _
2. WELL LOCATION:
Nearest Town: Jr/ hir40
County PP; S.Dar CG
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code) G7 3. OWNER: CGz' ,24.--tifi-47-
Address ( .2r5 Ale 22-4
(Street or Route No.)
fil¢LGCy- AX V-t'-G
City or Town State Zip Code
(0)2b1- 9 — /5
Area code- Phone number
4. DATE DRILLED , 8 200
5. TOTAL DEPTH: /00
Topographic/Land setting
DRidge DSlope DValley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds) I -
Latitude/longitude source:❑GPS❑Topograjjhltt; n
(check box) ff
DEPTH DRILLING 1 0n
From To
0 — / Zo
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO EiV /Zo._ f yo
7. STATIC WATER LEVEL Below Top of Casing: Ye, FT.
(Use "+" if Above Top of Casing)
8. 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 .0119.
9. YIELD (gpm): 20 METHOD OF TEST 01/14-
10. WATER ZONES (depth): fob- /Va
11. DISINFECTION: Type e aeitee
12. CASING:
Depth
From d To //0 FL
From / le To / Zv ' Ft.
From To Ft.
13. GROUT: Depth
From To
From 0 To <1.0 Ft. /42
14. SCREEN: Depth Diarheter
From To Ft. in
From /00 To ./ ilk) Ft. in.
Diameter
Material
Amount
Wall Thickness
or Weight/Ft. M terial
mt$ Lth
Method
Slot Size Ma(erial
in.
in. CG-7tretvet
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
I6.REMARKS:
Formation Description
p
Ar
k r smJ
LOCATION SKETCH
8O, 0>.?% Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common rrad names.
°cot
/y�J� ru j0
1 DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15,MNCAC 2C, WELL
CONSTRUCTION STANDARDS ND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
Gta
IGNAT 1E Q$ 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
280164
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) / /ir1 r y I'34-i Cam' CERTIFICATION # 13-0
�1
WELL CONTRACTOR COMPANY NAME at'`';+r ccg We tL lea •r, .L; tl/ PHONE # {8 7Zq-Q5 /S
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable) ��^ (if applicable)
I. WELL USE (Check Applicable Box): Residential Ar Municipal/Public ❑ Industrial ❑ Agricultural ❑
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use
2. WELL LOCATIO :
Nearest Town: war. co
SJ-Ptctd j1;cc
(Street Name, Numbers, Cotunbnity, Subdivision, Lot No., Zip Code)
County /14 i cLLTPLL-
3. OWNER: Ci,f AC< AREA)
Address (E12/1 /4/1/-'61 ZZJ "s
(Street or rute No.) 9 P?52
City or Town State Zip Code
Q)- rv7'a-7
Area code- Phone numbe
4. DATE DRILLED "Z3--© 5
5. TOTAL DEPTH: l
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO ly-
7. STATIC WATER LEVEL Below Top of Casing: 6 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): l{ METHOD OF TEST A //Z
10. WATER ZONES (depth): I/GEM CV ??et
Topographic/Land setting ' Cyr
Ridge ❑Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location-- V:1
(degrees/minutes/seconds) '
Latitude/longitude source:❑GPS❑Topogr1Phicai p(
(check box) r.-.
DEPTH DRILLIN� 1 nr,
From To Formation Description
1I. DISINFECTION: Type( LOfrA'e Amount 42 De
12. CASING: Wall Thickness
Depth Dia eter or Weight/Ft. �M �t rial
From 0 To cry/ Ft. /�"� vCA96 �C
From9( To�_.Ft. 6' / /Sys (»QLG
From To Ft.
13. GROUT: Depth Material
From To Ft
From 0
14. SCREEN: Depth Diameter Slot Size Material �(u�
From To Ft. in. in. 3
From To Ft. in. in.
Method
e& - 4oY %+ti'A'u:
ToF. &X// c-/ f///✓1(eJ
15. SAND/GRAVEL PACK:
Depth Size s 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 comm.n road E W
pkectitattA
rn
0
CPI
r
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH I5A NCAC 2C, WELL
CONSTRUCTION STAND f,RD$, AND THAT A COPY OT -11S RECORD HAS BEEN PROVIDED TO THE WELL OWNER
raid
SIGNA/ RE
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
c
0
-m
oZrt
>0
yt7
Ho
ma
rn
m�
ra
.y
0

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
�
WELL CONTRACTOR (INDIVIDUAL) NAME (print) //Ot1 S�+1 Ct CERTIFICATION#
MO
2� p
WELL CONTRACTOR COM
PANY NAME S ')/� R PrigL(4.m-, PHONE # (.422P-vf L
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring ❑ Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION:
Nearest Town: f1'j 44O&J County MS De
ode
moS C4 Ai,,1,.Q I r
(Street Name,
,NNumbers,
,CCon nunity, Subdivision, Lot No., Zip Code)
3. OWNER: / eI
Address 77,2. MUSC.fr jle,Ve Or -
(Street or Route No.)
City or Town State
Zip Code
Area code- Phone number
4. DATE DRILLED .''r f' y/ ZOO lz
5. TOTAL DEPTH: S'OS
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO r'
7. STATIC WATER LEVEL Below Top of Casing: / 20 FT. L.
(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(/Z
10. WATER ZONES cpth):
Topographic/Land setting
DRidge ❑Slope ❑Valley
(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
3yp1n tt 3fh
11 DISINFECTION: Type efts--GGue
12. CASING:
Depth
From p To ,,3-0
From 60 To 5—
From To
13. GROUT: Depth
From To
From © To act'
14. SCREEN: Depth
From To Ft. in. in.
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
Amount 13% 80e-
Wall Thickness
Diam ter or� Ft. Ma cr'al
Ft.� 'e.
L /
F9i3 e(Ar1t
Ft.
Material
Method
Ft.
Ft. /gel tV nnfe(
Diamet r Slot Size Material
16. REMARKS:
yam,
280161
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-
V- /g1'476044
Cie
w~r
rn
Oi<
Q 4/ a .err,
.0 yo
? rn,
30
O
1 rt
cnr
--�
0
I DO HEREBY CERTIFY THAT THIS WELL
CONSTRUCTION STANDARDS, AND THA"
SIGN
�AS CONSTRUCTED IN ACCORDANCE WITH I5A NCAC 2C, WELL
A COPY OF TWS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
E OF PRSNST U TING THE WELL
DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center -Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-t REV. 07/2001

North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
1636 Mail Service Center - Raleigh, N.C. 27699-1636 - Phone [phone]
280265
WELL CONSTRUCTION RECORD
030038-2
WELL CONTRACTOR- Iwwry Wright Well Pump Co Inc
WELL CONTRACTOR CERTIFICATION #• 7887
STATE WELL CONSTRUCTION PERMITt Choy.. Rpprp
1. WELL USE (Check Applicable Box): Residential
Recovery D Heat Pump Water Injection
Municipal
Other
Industrial
If Other, List Use:
2. WELL LOCATION: (Show sketch of the location below)
Nearest Town: fviARION County: MCDOWELL
3. OWNER
Address
r',ao Raggcn Ty,N3giggo, Pi RoPEF HWY 221
WILUAM O. POWELL
905 GEORcegjAgJf2 DR_,
Icy or Town
ate - z,p 6otl0
4. DATE DRILLED 9/25/20n3
5. TOTAL DEPTH 120
6. CUTTINGS COLLECTED YES CI NO L1
7. DOES WELL REPLACE EXISTING WELL? YES 0 NO xi
8. STATIC WATER LEVEL Below Top of Casing: 60-- FT
(Use "+" if Above Top of Casing}
9. TOP OF CASING IS 1 FT Above Land Surface*
*Top of casing terminated at/or below land surface requires a variance in accor-
dance with 15A NCAC 2C.0118
10. YIELD (gpm): 1 METHOD OF TEST Air
11. WATER ZONES (depth)' 1 nn ppm An-C11 n nnnpm
n nn npm n n0npm
12. CHLORINATION: Type HTH Amount 12
13. CASING:
Wall Thickness
Depth Diameter or Weight/Ft. Material
From 0 To 78 Ft 6 'IM 188 GALL/
From To Ft
From To Ft
14. GROUT:
Depth Material Method
From - n To 7n Ft Compri firpvity Flnw
From To Ft
15. SCREEN:
Depth Diameter Slot Size Material
From To Ft in in
From To Ft in in
From To Ft in in
16. SAND/GRAVEL PACK:
Depth Size Material
From To Ft
From To Ft
17. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RECORD Hp BEEN PROVIDED TO THE WELL OWNER.
Agricultural 0
Monit»rind LJ
DRILLING LOG DEPTf_,`
From To Formation Deiepipijon
0 70 DIRT f ` a
70 90 LIMESTONE
90 03 MUD
93 110 U MECTOMG
110 114 MUD
114 120 LIMESTONE
If additional space is needed use back of form
LOCATION SKETCH
(Show direction and distance from at least two State
Roads, or other map reference points)
FOR OFFICE USE ONLY
/o-6-03
Quad No:
Serial No.
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
Submit original to Division of Water Quality, Groundwater Section within 30 days
GW-1 REV. 12/99

N nth Carolina - Department of Environment and Natural Resources • Division of Water Quality - Groundwater Section
1636 Mail Service Center - Raleigh, N.C. 27699-1636-Phone [phone]
WELL CONSTRUCTION RECORD WELL CONTRACTOR: SQmecN C ejesd N
WELL CONTRACTOR CERTIFICATION #: (,pip \
S1 ATE WELL CONSTRUCTION PERMIT#:
279533
1. WELL USE (check Applicable Box): Residential Er Municipal ❑ Industrial ❑ Agriculturally MonitorinT E)---
Recovery 0 Heat Pump Water Injection ❑ Other 0 If Other, List U 1 ----
2. WELL LOCATION: (Show sketch of the location below)
Nearest Town: Mi f i o
r^n County: N
'l\rv.,ye• II
ZSt�c (-A,
(Road (Road Name and Numbers, Community, or Subdivision and Lot No.) DRILLING LOG
3 . OWNER I,., o c' n Mi.)(
From To
Address
P;„<„,o,e\• c� c\, �a
(Street or Route o
rnOt;,r\ A)! JR7.Sa
City or Town State Zip Code
4. DATE DRILLED 11 \ 103
5. TOTAL DEPTH laO
6. CUTTINGS COLLECTED YES n NOFF
7. DOES WELL REPLACE EXISTING WELL? YES NOf
8. STATIC WATER LEVEL Below Top of Casing: S FT.
11 (Use'+' if Above Top of Casing)
9. TOP OF CASING IS l ' FT Above Land Surface'
-Top of cm log le,minet nt IUnr below lend' Aare requires a variance b ar or-
dam•e with 15A NCAC 2C 119
10. YIELD (gem): __$. _ f.tl-Tf l(ir ; )I II '.I 2{0e <
11. WATER ZONES (depth). 1S- 25 'D
12. CHLORINATION: Type _ R T F{ Amount I I to rV ri z
If additional space is needed use back of form- -
DEPTH
'--"
F ormalion Descdptiq.
O
rri
sD ��
3II--
13. CASING:
Depth Wall Thickness
p lDiameter or WeighVFt. '� a erial
From ) b
To f Q Ft 35 a7. G PVC
From To Ft.
From To Ft
14. GROUT:
Depth Material Method
From i— To 0 f Cernen+
From To f
15. SCREEN:
Depth Dirmeter Slot Size Material
From To Ft _ in in
From __ To - Ft in In
From To Ft In Ir{.
16. SAND/GRAVEL PACK:
Depth Size Material
From To Ft
From To Ft
17. REMARKS:
LOCATION SKETCH z
(Show direction and distance from at least two State
Roads, or other map reference points)
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF IS RECORD HAS BEEN PROVIDE„ QTO THE WELL OWNER.
S ATURE OF PERSON CONSTRUCTING THE WELL DATE
Submit origin Division of Water Quality, Groundwater Section within 30 days
FOR OFFICE USE ONLY
Quad No:
Social No.
GW-1 REV. 12/99

279513
WELL CONSTRUCTION RECORD
Notch Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
Q �/
/,
WELL CONTRACTOR (INDIVIDUAL) NAM�ij(priot) tf6N.q/ C /gL L _ - ».. CERTIFICATION as,�O
WELL CONTRACTOR COMPANY N
STATE WELL CONSTRUCTION PERMIT# % ASSOCIATED WQ PE
(if applicable) (if applicable)
HONE 0 4 woYQa
y//1
I. WELL USE (Check Applicable Box): Residential Municipal/Public ❑ Industrial ❑ Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION:
Neared Town: County e
i/ d40 7
(Street Name, Numbers,
�Cammuthty, Subdivision? lot No., Zip Code)
3. OWNER: TJI- Gf
Address .2 y.2 f��i�tnrt �d
City or Town �Sy�e Zip Code
crow- 66 f— r&lam
Area code- Phone
4. DATE DRILLED ./.? 5/o 3
5. TOTAL DEPTH: CD di'
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO 181
7. STATIC WATER LEVEL Below Top of Casing:.2/D 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 15A NCAC 2C .0118.
9. YIELD (gpm): LI ME OD OF TEST%Lsui
10. WATER. ZONES (depth): s d
11. DISINFECTION: Type
12. CASING:
Dep
From 0 To (pQ
From To
From To
13. GROUT: Depth
From_ To e.2.t
From To FL
14. SCREEN: Depth Diameter
o Ft. in.
To Ft. in.
GRAVEL PACK:
D�pth Size Material
From v Ft.
From //////// To Ft.
Amount /e2 2 64
Wall Thic cress
or Weight/Ft. Material
#.2/ iPdC
ameter
FL
FL
Ft.
Material
Ft. tfeas.,›i
Slot Size Material
in.
in
16. REMARKS:
Topographic/Land setting
-Vidge 0Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/mimdes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH PRILLING LOG
From To Formation Descripfion
o
W n
yr 7-�
rT `^
Ni co
>0
—O rn
3
LOCATION SICETCH tV m
Show direction and distance in miles from, Ieasv
two State Roads or County Roads. IncludoSie rcgl
numbers and common road names.
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCIhD IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND UjiAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
1� e--! a .9-��I�
SI ATURE OF PERSON ONSTRUCTING 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
=J

North Carolina - Department of Environment and WWI.; sources - Division of Water Duality • Groundwater Section
1636 Mail Service Center - Raleigh, N.C. 27699-16: S4 „ [phone]
WELL CONSTRUCTION RECORD WELL CONTRACTOR: L—SaP , E
WELL CONTRACTOR CERTIFICATION #: (9,(Q(p
STATE WELL CONSTRUCTION PERMIT#:
1. WELL USE (Check Applicable Box): Residential ❑ Municipal ❑ Industrial ❑ Agricultural D
Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use:
2. WELL LOCATION: (Show sketch of the lot all rn below)
Nearest Town: 11 \ttc f o n
County:
f\nr. DO, Jcty
VIN Rca\ona C -ate1 �1
(Road Name and Numbers, Community. or Subdivision and Lot No.) DRILLING LOG
3. OWNER or&v --bCyC< 1 n\ From To
110reet or outr)0 C1^r�Qe`
(Stp��o o.
Zip Code
Address
nie N.L
City or Town Stale
4. DATE DRILLED G-Dte-63
5. TOTAL DEPTH vat)
6. CUTTINGS COLLECTED YES n NO
7. DOES WELL REPLACE EXISTING WELL? YES NO
8. STATIC WATER LEVEL Below Top of Casing: (5 FT.
(Use'+' it Above Top of Casing)
9. TOP OF CASING IS \ 5 FT Above Land Surface'
•Tr o or casing terminated et/or below land surface requires a variance in accor-
der co with 15A NCAC 2C .0118
10. YIELD (gpm): \S METHOD OF TEST �ac,eC
11. WATER ZONES (depth): 9S _ ys
12 CHLORINATION: Type ttlAmount \��
12 CASING:
From
1'. GROUT:
From
From
15. SCREEN
Wall Thickness
Depth Diameter or Weight/Ft. txtaterial
To 4q Ft. C. 3C ,)-1- 4
To Ft. (^.a5 Occii
To Ft
5
DepthMaterial Method
To �Us
Ft (eivienl
To Ft
Depth Diameter Slot Size Material
From To Ft in in
From To Ft
From To Ft
16. SAND/GRAVEL PACK:
Depth
From To
From To
17. REMARKS:
in
In
Ft
Ft
In
y in
Size Material
279538
)EF
Fon lalior ,J[ir4ptibn
c
t —'m
If additional space is nee ded use back le n y
7 „�
rn�
n
17
a
LOCATI( N SKETCH N
(Show direction and distant from at least tv/-
Roads, or other map re nonce points) O
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCk : 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF IS RECORD HAS BEEN PROVIDED TOT 1E WELL OWNE 1.
r oA £ L,
ATURE OF PERSON CONSTRUCTING THE WELL I ,q
Submit oto Division of Water Quality, Groundwater Section withi t 30 days
FOR OFFICE USE ONLY
Quad No:
o _.03-d3
Serial No
GW. n v. 12/99

North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
1636 Mail Service Center - Raleigh, N.C. 27699-1636-Phone [phone] 279537
WELL CONSTRUCTION RE,CORD WELL CONTRACTOR: JCalYAPa E (Lesait\
WELL CONTRACTOR CERTIFICATION #:
STATE WELL CONSTRUCTION PERMIT#:
1. WELL USE (Check Applicable Box): Residential Ll Municipal Cl Industrial ❑
RecoveryAgricultural Mortoring ❑
❑ Heat Pump Water Injection ❑ Other If Other, List Use:
2. WELL LOCATION: (Show sketch of the location below) -
Nearest Town: /A(a c :::, (l �I r, ;�
County rv\Cv>w,IP 1`
(Road Name and Numbers, Communuy,or Sunbdivision and Lot No.) DRILLING LOG
3. OWNER ` \ . K IF DEPTH
VJ Y� <So r�
From To Formation DesCripgooi
Address i 111O0 c_ 1'\, R
�,n (Street or Fi utB�lb.)tt �1111
/ \as'..o'N AI C aP„7
Zip Code
FOR OFFICE USE ONLY
Ouad No:
Serial No.
From To Ft.
14. GROUT:
Depth
From I CC To ,; Ft
From
To Ft
15. SCREEN:
CityRTown/ SS1 le
4. GATE DRILLED /03
5. TOTAL DEPTH / &D
6. CUTTINGS COLLECTED YES I 1 NCI—Y.
7. DOES WELL REPLACE EXISTING WELL? YES n NOFTh
8. STATIC WATER LEVEL Below Top of Casing: 6 FT.
(Use'+it Above Top of Casing)
9. TOP OF CASING IS 1_5 FT. Above Land Surface'
'Top of casing terminated at/or below land surface requires a variance In accor-
dance with 15A NCAC 2C.0118
10. YIELD (gpm): Cgr METHOD OF TEST 2n Ace
11. WATER ZONES (depth): CI 0
I15 *La_
12. CHLORINATION: Type /-1 '— 4Amount
13. CASING:
0
O
E o,�
11 additional space is needed use back of for —
Wall Thickness LOCATION SKETCH
--��� Depth 2�ec Diameter or WeighVFt. Material (Show direction and distance from at least two State >—
From Depth
__�_3L. FL (•...25 �77.(r P�
�`jj �S Roads, or other map reference points) �% `)
From To Sal Ft. c . LS `ZInc k 1 D
Material Method
Ce MCrI`i
Depth Diameter Slot Size Material
From To Ft in. in
From To Ft in in
From __ To Ft in. in'
16. SAND/GRAVEL PACK:
Depth Size Material
From To Ft I HgrAccn, coV 71
From To Ft / T
17. REMARKS:
�f6e
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COfjY OF THIS RECORD HAS BE N PR VIDED TO THE WELL OWNER.
/ SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
Submit original to Division of Water Duality, Groundwater Section Within 30 days
GW-1 REV. 12/99

North Carolina - Department of Environment and Natural Resources - Division of Water Quality • Groundwater Section 279536
1636 Mail Service Center - Raleigh, N.C. 27699-1636-Phone [phone]
WELL CONSTRUCTION RE,CORD WELLCONTRACTOR• 0—a•Me5 E
WELL CONTRACTOR CERTIFICATION #: a 4 Lp\
STATE WELL CONSTRUCTION PERMIT#:
1. WELL USE (_Check Applicable Box); Residential Municipal El Industrial ElRecovery [--1 Flent Pump Wnlor Injection
❑ Other ❑ If Other, List Use:
2. WELL LOCATION: (Shog sketch of the location below)
Nearest Town: /' \QC ,
:or\ County: '1`\O:#\Kid(
From
14, GROUT:
Address Deec RAC
Street or Rout") No.)
sn tf e 1Do AI C cri \
City or Town State Zip Code
4. DATE DRILLED - 0
5. TOTAL DEPTH a
6. CUTTINGS COLLECTED YES n NO�
7. DOES WELL REPLACE EXISTING WELL? YES n NOrf
8. STATIC WATER LEVEL Below Top of Casing: 5`6 FT.
tees CcacY\ RcL
(Road Name and Numbers, Community, or Subdivision and Lot No.) DRILLING LOG DEPTH
3. OWNER F ( e w ; 1\ 'a M$ fio;n To Formation Descriptioo .!.
Agricultural ❑ Monitoring ❑ 1'_';=-;L_
(Use'+• If Above Top of Casing)
9. TOP OF CASING IS \-S FT. Above Land Surface'
•Tole of casing terminated aVor below land surface requires a variance In actor -
clan e with 15A NCAC 2C .01,10 p `
10. YIELD (gpm): d METHOD OF TEST ob0..1 QC
11. WATER ZONES (depth) 11S - FAO
12. CHLORINATION: Type IT 1 /T Amount 1 lb —
If additional space is needed use back of form
13. CASING:
Depth Diameter.
From To FL L.a5.
From C" To 90 Ft. L.DC
To Ft
Wall Thickness
or eighVFl.
Qk s
6
0
cnCn
rn on
N o�
l0 -cm
-O m�
(n z cn
rn�
LOCATION SKETCH p a
erial (Show direction and distance from at least two Sta1=zcLr a tl
Roads, or other map reference points)
Dee 9avk
�clet.s
T Depth Materi l Method
From olo To a0 Ft (emen+
From To Ft
15. SCREEN:
Depth Diameter Slot Size Material
From To Ft in. in
From __._ To _ _ Ft _ In. in
From To Ft In. in
16. SAND/GRAVEL PACK:
Depth Size Material
From To Ft
From To Ft
17. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COP OF THIS RECORD HAS BEEN PRPVIDED TO THE WELL OWNER.
FOR OFFICE USE ONLY Q rytedst �O C7w
Quad No: SIGNATURE OF PERSON CONSTRUCTING THE WELL
Su i1 riginal to Division of Water Quality, Groundwater Section Within 30 days
Serial No.
D/(DO /6 3
DATE
GW-1 REV. 12/99

North Carolina • Department of Environment and Natural Resources • Division of Water Quality • Groundwater Section
1636 Mail Service Center - Raleigh, N.C. 27699-1636-Phone [phone]
WELL CONSTRUCTION RECORD WELL CONTRACTOR. CTnmtS L
WELL CONTRACTOR CERTIFICATION #:
STATE WELL CONSTRUCTION PERMIT#:
279535
6Ui
1. WELL USE (Check Applicable Box): Residential ❑r Municipal ❑
Recovery ❑ Heat Pump Water Injection ❑ Other ❑ I(
2. WELL LOCATION: (Show sket of jhe location below)
Nearest Town: 6 rat County:
(oq 1a< y;ew Mr(Street or louto No.)
Q<.u1
ni
City or Town Staleto Zipp Code
Code
4. DATE DRILLED I 3
5. TOTAL DEPTH 10
6. CUTTINGS COLLECTED YES[l NOj-
7. DOES WELL REPLACE EXISTING WELL? YES n NO
8. STATIC WATER LEVEL Below Top of Casing: S5 FT.
pr (Use '+ if Above Top of Casing)
9. TOP OF CASING IS i -Z- FT. Above Land Surface'
-Top of casing terminated at/or below land surface requires a variance In accor-
dance with 1SA NCAC 2C .0118
10. YIELD (gpm): 00 METHOD OF TEST \.cutcC
11. WATER ZONES (depth)• �`i5- 9Sr
Industrial ❑
Other, List Use:
IDcl)awe11
,Dec \%jiev Le - E
(Road Name anad. umber , dor unity, or Subdivi ion and Lot No.) DRILLING LOG DEPTH
3. OWNER tlrarpilm� Q"i\ae(S From To Formation Description
Address C
Agricultural ❑
Monitoring ❑
12. CHLORINATION: Type 1/ % Y Amount I /in
13. CASING:
From
From
From
14. GROUT:
Depth Diameter
To 7° Ft. (,..25
To -is Ft. CO
To Ft
From 1i
From
15. SCREEN:
Wall Thickness
or Weelht/Ft.
Depth Materi I Method
To .--)6 Ft �rnen�
To Ft
Depth Diameter Slot Size Material
From To Ft in in
From To Ft in in
From To Ft in in
16. SAND/GRAVEL PACK:
Depth Size Material
From To Ft
From To Ft
17. REMARKS:
c
O
V O
c', 9
N
+L2
0
Do
If additional space is needed use back of foal rn
IV
LOCATION SKETCH
(Show direction and distance from at least two SMe
Roads, or other map reference points)
cn
r't
G
Lo�. 1�eC
iley
r wc((
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COP of THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER.
FOR OFFICE USE ONLY
Quad No:
Serial No.
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
original to Division of Water Duality. Groundwater Section Within 30 days
GW-1 REV. 12/99

3.
North Carolina • Department of Environment and Natural Resources - Division of Water Quality • Groundwater Section
1636 Mail Service Center - Raleigh, N.C. 27699-1636-Phone [phone]
WELL CONSTRUCTION RECORD WELL CONTRACTOR: f ame5
WELL CONTRACTOR CERTIFICATION N:
STATE WEL CONSTRUCTION PERMIT#:
279534
3.4Ut
1. WELL USE (Check Applicable Box): Rebidential frf Municipal [l Industrial ❑ Agricultural ❑ Monitoring D
Recovery ri Heat Pump Water Injection ❑ Other ❑ If Other, List Use:
2. WELL LOCATION: (Showsketchof thelocaiion below) ��
Nearest Town: OLt rbCCounty: 1 `\ ctawcJ'
-bees "(e.\e1 e,\
(Road Name a`�umbers, Community, or Subdivision and Lot No.) DRILLING LOG
Kos,AO\ (9,o,\..ecs
t Dlreet or Route No.)
OWNER
Address (o
II ' kt.0
City or Town State
4. DATE DRILLED 'l -- 02
5. TOTAL DEPTH j\0
6. CUTTINGS COLLECTED YES NOn-
7. DOES WELL REPLACE EXISTING WELL? YES NO1
8. STATIC WATER LEVEL Below Top of Casing: .5 FT.
(Use'- it Above Top of Casing)
9. TOP OF CASING IS 1 FT. Above Land Surface'
'Top of casing terminated at/or below land surface requires a variance In accor-
dance with 15A NCAC 2C .011t
10. YIELD (gpm): 1b METHOD OF TEST " a\Ae.0
11. WATER ZONES (depth)' O
I
a$iSZ
Zip Code
From To
12. CHLORINATION: Type I, T \\ Amount
13. CASING:
Depths
From (M1 To
From 5 To :5"-
From To
14. GROUT:
Diameter
Ft. Las
Ft G-as
Ft
Wall Thickness
or or Weight/Ft. alenal
\cJK Z*cc
— � Depth Materialf Method
���_ From To s_ Ft d ?Intl T
From To Ft
15. SCREEN:
Depth Diameter Slot Size Material
From To Ft in in
From To Ft in in
From To Ft In 'In
16. SAND/GRAVEL PACK:
Depth Size Material
From To
From To
17. REMARKS:
Ft
Ft
DEPTH'
Formation Description
L_.
n
W v
rn
-a
If additional space is needed use back of to}Ild
LOCATION SKETCH
(Show direction and distance from at least two u&l le
(.rl
O
Roads, or other map reference points)
r
Dc,ec Y21ey
1 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.
FOR OFFICE USE ONLY
Quad No:
Serial No
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
Submit original to Division of Water Quality, Groundwater Section within 30 days
GW-1 REV. 12199

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Na tt l Resources - Division of Water Quality - Groundwater Section WELL CONTRACTOR (INDIVIDUAL) NAM (print) (,//1�/5/AO, IC 13
.4L �Lp. _D CECERTIFICATIONW2_8 7/✓�
WELL CONTRACTOR COMPANY NAME, .. iCte &dat ! PHONE # o�dl n/is U9-698
STATE WELL CONSTRUCTION PERMIT# 447 ASSOCIATED WQ PERMIT# wad
(if applicable)
(if applicable)
279506
1. WELL USE (Check Applicable Box): Residential 181 Municipal/Public ❑ Industrial 0 Agricultural 0
Monitoring ❑ Recovery 0 Heat Pump Water Injection ❑ Other ❑ If Other, List Use
2. WELL LOCATION:
Nearest Town: Co C �f
-sod
(Street Name, Numbers, Comm , Subdivision, Lot No., Zip Code)
3. OWNER:
Address .5-
(9 / O erect or Route N6.)
/�y/cam. (.1E74 z—
City or Town Sure Zip Code
Am code- Phone camber
4. DATE DRILLED g/oi gl 0.3
5. TOTAL DEPTH: &QS
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO )8(
7. STATIC WATER LEVEL Below Top of Casing: /O FT.
(the "+^ if Above Top of Casing)
8. TOP OF CASING IS / < FT. Above Land Surface*
flop of casing terminated at/or below tad surface requires a
variance in accordance with 15A NCAC 2C .0118.
Gjd
9. YIELD (gpm): oZfl METHOD OF TEST7:cie fe
10. WATER ZONES (depth): 9?' /l r�
11. DISINFECTION: Type Amotmt R 8L.
12. CASING: Wall Thickness
Depth , w Diameter or Weight/Ft. Material
From_ To L/ Ft. G y 44s2 / ©ie
From To Ft.
From To Ft.
13. GROUT: Dcpth
Fromm To e2 D
From To
14. SCREEN: Depth
From o
From To
15. SAND/GRAVEL PACK:
th
From / To
From To
16. REMARKS:
Material ethod
FL air/a� !t�
Ft
Diameter Slot Size Material
Ft. in. in.
Ft. in. in.
Size Material
Ft.
Ft.
Topographic/Land setting
❑Ridge ❑Slope %Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(depea/mtm+tes/seamds)
Latitude/longitude source:❑GPSDTopogjaphif map
(check box) „
DEPTHLOG
From To Formation scription
I o
LOCATION SKETCH n�
Show direction and distance in miles frond lea; c
two State Roads or County Roads. Includt,Sie tua&
numbers and common road names. r o
CO
I DO HEREBY CERTIFY THAT THIS WFI I WAS CONSTRUC Ih1) IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A CQPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
SIGNATURE OF PERSON CONSTRUCTING THE WELL
t�'�.2tD
DATE
ve
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

279507
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Nnal Resources - Divisionis�of Water Quality - Groundwater Section
n �j
WELL CONTRACTOR (INDIVIDUAL) NAM (print) �H/n A/1�/1 /i i !.7 h'LOpL {/�1— CERTIFICATION ilos/!7/
WELL CONTRACTOR COMPANY NAME 2.J.ft ie t ZAS.I / •itme 9 zC.PHONE M (R22i G y 5"--6 yra
STATE WELL CONSTRUCTION PERMIT# n//* ASSOCIATED WQ PERMI1Yl el/
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential PC. Municipal/Public ❑ Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION:
Newt T oyied.a. pJ
(Street Name, Numbers, Community, Subdivision, Lot No., lip Code)
3. OWNER:7X---/ ,
Address /Y[) >6 l d
0S2Srect or Route No.)
City or Taw State tip Code
( --Y
Area code Phone mrmber,9
4. DATE DRILLED 737�0 3
5. TOTAL DEPTH: see DS" '
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO 181
7. STATIC WATER LEVEL Below Top of Casing: 3...2, FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS / .S FT. Above Land Surfaces
*Top of easing terminated at/or below land surface require a
variance la accordance with 15A NCAC 2C .0118. •
9. YIELD (gpm): /o MMf� THOD OF TEST
10. WATER ZONES (depth): /1/0
11. DISINFECTION: Type Amount t ta-
12. CASING: Wall Thickness
Depthtn ameter or Weight/Ft. �7Material
From 17 To 7 t. FL '.2/ y t/C
From To Ft.
From To Ft.
13. GROUT: Depth Method
From_0 To e2 0 Ft. U
From To Ft
14. SCREEN: Depth Diameter Slot Size Material
From �fo Ft. in. in.
From / To FL in. in.
15. SAND/GRAVEL PACK: y
Depth Size Material
From o Ft.
From To Ft.
Topographic/Land setting
[Ridge 11Slope ❑Valley ❑Flat
(cheek appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(cheek box) r; `-- .---_
RTLI G LOG �_)
DEPTH D
Ii - �,
From To Formation escriytioa �----- - —
16. REMARKS:
c
(/)
tV
-O m-
LOCATION SKETCH -SC r"
NZ
Show direction and distance in miles frork t 1 .r, 23
two State Roads or County Roads. Includit
es a tr.numbers and common road names.
d
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUC t El) IN ACCORDANCE WITH 15A NCAC 2C, WEI r
CONSTRUCTION STANDARDS, 921DTHAT A COPY OF THIS HAS BEEN PROVIDED TO THE N)rEI.LOWNER
SIGN TUR' E O_F PERSON GICONSTRUCTING THE WELL DATE
t
fio
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center -Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-1 REV. 07/2001

WELL CONSTRUCTION RECORD 2 9 3 0 6
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print)_ ASHLEY T. MORETZ CERTIFICATION # 258(2
WELL CONTRACTOR COMPANYNA_.M£ MORETZ WELL DRILLING PRONE # (7041462-1322
STATE WELL CONSTRUCTION PERMIT/1
main ar able)mnwa ai
a%ti.
J ASSOCIATED WQ PERMIT#
of apP!icably
I. WELL USE (Check Applicable Box): R;sidenti :i t Municipal/Public 0 Industrial C7 Agricultural ❑
Monitoring Cl Recovery 0 Heat Put ., 77as r Iz;i "rtion 0 Other C3 If Other, List Usc
2. WELL LOCATION;,,
Nearest Town: (Par 10A
As Awo 0 op
(Street Name, Numbers, Community, Subdisjsion, Lot No., it? Cock)
3. OWNER: "t A(A r
Address � di/ C� Pia
hle-d in (ram
(Street or Amite No.)
City or Town State Zip Code
Arca code- Phone enrolees
4. DATE DRILLED
5. TOTAL DEPTH' "r10
6. DOES WELL REPLACE EXISTING WELL vrS0 NO.�T
7. STATIC WATER LEVEL Below Top of Casing: _ ^�;�t,T,_, T:
('Tic..yr if A;-,4Top PC3sng)
8. TOP OF CASING IS / FT. Above Surface*Land
*Top of cuing terminated at/er blow 14ed 5u6hee
variance in accordant! I 15A NCAC 2C .0's�'..
1 (eP )
9. YIELD (gpm): ME -OP T0 EST1 I/ le
0. WATER ZONES d th :
Topoc/Land setting
❑Ridge lope C]Valley ❑Flat
(CRC[ appropriate box)
Latitude/longitude of well location
Oleg='minut¢c/scconds)
Latitude/longitude source:IJGPSDTopog aphic rnap
(check box)
DEPTH//iT�7 o�DRILLING LOG
/om Lio, er RS i li/hsciri
12 (i "- ICC 6 retr, 4-e..
11. DISINFECTION: Type ,j/ 771",
12. CASING:
DepthDiameter
Fror.;.J-f To /2 CFt.
From To Ft.
Frorn, - To Ft.
13. GROUT: Depth
From /oo To-/ Ft.
Front To Ft.
14. SCREEN: Depth
Fro To.
From Ft
15. SAND/GRAVEL PACK:
Depth
Fro Tof"
Fro Ft.
16. REMARKS-
Wall Thisic-ass
o,- iar'eiZ`ut ri. M2t ia1
blo.tod
ied
/r'1f
Slot Sirs Material
Sue '4rsc-;:1
O
O or`n
LOCATION SKETCH 3 rei o
Show direction and distance in miles from at keel)to z
rn al
two State Roads or CountyRoads. Include the Reid a
numbers and common road names. C„0 o
z
1 DO HEREBY CERTIFY THAT THIS WELL WAS CGNSTRUC 1 ED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, Af tD THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO/!EL
T/SHE WELL OVv R
03
SIGN' t' 6F ?c',SON R.. CONSIt5 ING 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..
Ed Wd8£:90 200E 81 'daS
Z?£LZ9170L : 'ON Xtid
dNOd a -1)J1911 Z13lOW : kDd._i

2792S7
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Sectionqq
WELL CONTRACTOR (INDIVIDUAL) NAME (print) £f9 I Triskcc CERTIFICATION %��//�\
)�7C!
WELL CONTRACTOR COMPANY NAME
JU.S?re Wes( 6r(LC PHONE #
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential hY 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: n,,
Nearest Town: inQ�-Clx-' County CD/12/-e e
a3 CAs*
(Street Naine, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: 4Oina Seitto
Address 1 j CA51- 4->
I7Ntiu
_ (Street or Route N6.)
A. MG
e9.S752
City or Town State Zip Code
Area code- Phone number
4. DATE DRILLED II - 25--O )
5. TOTAL DEPTH: b DS
6. DOES WELL REPLACE EXISTING WELL? YES MAO 0
7. STATIC WATER LEVEL Below Top of Casing: (p0 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS i FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordance with ISA NCAC 2C .0118.
9. YIELD (gpm): /2. METHOD OF TEST AOC
10. WATER ZONES (depth): /Zgf/r/ e ace
11
12. CASING:
DISINFECTION: Type
Depth Diameter
From 0 To 9z Ft. (.4
From To Ft /
From 82 To &Q Ft.
13. GROUT: Depth Material Method ✓
From O To Z Z Ft. /
7 / /O
From To Ft.
14. SCREEN: Depth Diameter
From To Ft. in
From To Ft. in
15. SAND/GRAVEL PACK:
Depth Size r Material
From To Ft.
From To Ft.
Amount eoz ez5R
Wall Thickness
or WeighUFt.
Material
qo ,?Yie
6/Q//%
Topoggra hic/Land setting
❑Ridge L1tTlope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From To Formation Description
Slot Size Material
in.
in.
16. REMARKS:
1 DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCOR
CONSTRUCTION STANDARDS, ANAT A COPY OF THIS REORD HAS B
SY
Aei-225
•
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
/112
u
URE OF 17ERS
023.
of
N
cn
zm
— o<
-3o
p rrl a
t aa
mull)
C.:.?
U1
z
N WITH 15A NCAC 2C, WELL
EN 'ROVIDED TO THE WELL OWNER
NSTRUCTING THE WELL
DATE
Na
C31
va
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center- Raleigh NCij;
27699-1636 Phone No. (919) 733-322I, within 30 days. GW-1 REV. 07IZ
001
I --
I
c
rr

279 86
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater SectionnC
WELL CONTRACTOR (INDIVIDUAL) NAME (print) c'�/9 30:134/ Ce CERTIFICATION #,a/S��/'/7
WELL CONTRACTORCOMPANY NAME JOS4/C� (.XpQQ F� si PHONE #AG+{707- 7L
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential Kl Municipal/Public ❑ Industrial ❑ Agricultural ❑
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use
2. WELL LOCATION: •
Nearest Town: �Ylriiuulei
(Street Name Numbers Community, Subdivision, Lot No., Zip Code)
County e/�6f✓ "
111
Topographic/Land setting
❑Ridge ❑Slope alley ❑Flat
(check appropriate box)
A -r' Latitude/longitude of well location
3. OWNER: -i�6`J �iSt
Address
rJ� oC Yo,t G /) / (degrees/minutes/seconds)
6ra Lattude/longitude source:❑GPS❑Topographic map
rt,IJC (check box)
761 DEPTH DRILLING LOG
zip Code From To Formation Description
City or Town State
( )-
Area code- Phone numbeL
DRILLED
5. TOTAL DEPTH: 1 66
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO q/
7. STATIC WATER LEVEL Below Top of Casing: t/0 FT.
)(L (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): 40 METHOD OF TEST A/C
10. WATER ZONES (depth): 5O9Zprm e /o r
4. DATE-3`n—°3
I1. DISINFECTION: TypeetZed/e-
12. CASING:
Depth
From I/ To to 2 Ft.
From 42 To , '1 Ft.
From To Ft.
13. GROUT: Depth
From To
From 0 To 2
14. SCREEN: Depth
From To
15
Diameter
097
Material
RJ- 53-
LOCATION SKETCH
Amount R OZ tw'%V % Show direction and distance in miles from at least
Wall Thickness two State Roads or County Roads. Include the road
or Weight/Ft. Material numbers and common road names. p s
T4 e o
(�fl dJd4�
Method
Ft.
Ft. type /
Diameter Slot Size Mate ial
Ft. in. in.
From To Ft. in. in.
SAND/GRAVEL PACK:
Depth Size y Material
From To Ft.
From To Ft.
16.REMARKS:
ttia0
&Pe
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL ;,
CONSTRUCTION STANDARDS, AND T TqA COPY OF THI RECORD HAS BEEN PROVIDED TO THE WELL OWNJER.
( SIGN RE OFOF PER
w
rn
rTl
N CONSTRUCTING THE WELL DATE
Submit the original to the Division of NVater Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NCI
27699-1636 Phone No. [phone], within 30 days. GW-I REV. Q7f2D9l

From
2.7r
Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
North Carolina - Dcpa `
..t CERTIFICATION �•
WELL CONTRACTOR (INDIVIDUAL) NAME (print PHONE # SI2Lea0 �.9
WELL CONTRACTOR COMPANY NAME PEMIIT#
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED (if IicWO O
able
(if a licable) /
I. WELL USE (Check Applicable Box): Residential D' Municipal/Public 0 Industrial 0 Agricultural
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
Topographic/Land setting
#Ridge DSlope Galley #Flat
(check appropriate box)
Latitude/longitude of well location
(degrteshninutes/seconds)
o Arl • 7 ZG - R Latitude/longitude source:OGPSOTopographic map
(check box)
(street or Roe No.) ��)7`2 nFPTH DRILL IT1G LOG
From To Formation Description
City or Town State ZipCCode J
�-- ✓
2. WELL LOCATION:
Nearest Town:
WELL CONSTRUCTION RECORD
��� r
)nA 140-4 County /'
(Street Name. Numbers, Community, Subdivision, Lot No., T.tp Code)
3. OWNER:
Address
6. �y�' FT.
7. STATIC WATER LEVEL BelowTop
" of Above of Casing)
8. TOP OF CASING IS / FT. Above Land Surface'
*Top of easing terminated atfor below land surface requires a
variance in accordance with ISA NCAC 2C .0118.
9. YIELD (gpm): J__ METHOD OF TEST / {
l0. WATER ZONES (depth):
/ rLt SON SKETCH
/y ,ry Show direction and distance in miles from at least
DISINFECTION: N: Typed>>�� Amount two State Roads or County Roads. Include the road
CASING: Wall Thickness numbers and ommon road names.
Material
Depth � �r�
2� FL
From f% To 7� FL
From& ._T0lZ Ft.
13. GROUT: Depth
From To_
From To
14. SCREEN: Depth
From To
From_ To
15. SAND/GRAVEL PACK:
Depth
From To
FromTo
Diameter a W -ghUFL
PTO
atcrial Method
Ft.
Fir
Diameteerr Slot Size Material
Ftin. in.
Ftin. in.
Ft..
Ft.
Size Material
.r_L22!%Qr-'
Area code- Phone number ! p
4. DATE DRILLED
5. TOTAL DEPTH:
DOES WELL REPLACE EXISTING WELL? YES 0 NO
resit
0
W
Gel
rrl
tD
0
16. REMARKS:
1 DO HEREBY CERTIFY THAT THIS WELL WASACONSTRUCTEDABA COR BEECE WITH 15A TO THE WELL OWNER
NCAC 2C, WELL
CONSTRUCTION STANDARDAND THAT / I
1X� I)DATE
SIGNATURE ER
ERSON CONSTRUCTING THE WELL
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh,
H)1e)ghNC
27699-1636 Phone No. [phone], within 30 days. GWrI Ral
!t

2r9.actioon
84
North Carolina - Dcpanment of Environment and Natural Resources - Division of Water Quality - Groundwater Se �.nPtcproN1<>F=—
<
l' M
WELL CONTRACTOR (INDIVIDUAW NAME (print)'�ru Lire r / PHONE g Iis'%7Z S 8
WELL CONTRACTOR COMPANY NAME ASSOCIATED WQ PERMITI{
STATE WELL fa CONSTRUCTION PERMITR (ifa licable)
(i[a licable)
1. WELL USE (Check Applicable icableBox):
Residential
tfipa iIndustrial
Agricultural ieulhtrdl 0
Monitoring 0 Recovery
cHat PmP Water Injection "'Municipal/Public
If Other, e
pographic/(.and setting
2. WELL LOCATION: i��0�-i=� jdge Slope t7ValteY Flat
_ _ Count (check appropriate box)
Nearest Town: ri ;vWO Y
N. Co. Latitude/longitude of well location
(Street Name, Numbers, Community, Subdivision. Lot No.. Zip Code) (degrees/minutes/seconds)
b tk) ' • ` "' Latitude/longitude source:OGPSOTopographic map
(check box)
DEPTH DRILLING G'
2 ��7 % From To Formation Description
i
At°''-- <s-'- L llj� S-
3. OWNER:
Address
�j,�City or Town
(r )-
Area code- Phone number __ZrO 7
4. DATE DRILLED;
5. TOTAL DEPTH:
7. DOES WELL REPLACEBelowEXISTING of Ca? �0 NO
FT ;cm
7. STATIC WATER LEVEL BeIowUse fA�bovTopofCasing) '^- Q)---1—_ __
8. TOP OF CASING IS / FT. Above Land Surface' i - cTJ �
`Top of casing terminated at/or below land surface requires a nn.
variance in accordance with ISA NCAC 2C .0118. / F� 7 Qj 7
METHOD OF TEST / r t,.
9. YIELD (gpm): .A — O 4 g ac ' ATION SKETC
IO. WATER ZONES (depth):
C tori Le Amount 8Q �-�3 j, Show direction and distance in miles from at least
11. CN: Type--- Wall Thickness two State Roads or County Roads. Include the road
12. CASING:
NG: Diameter or Weight/Ft. Material numbers and common road 'games.
Deed' _ \
From To
From. — To U Ft V(ir
From IUi__To act Ft.
13. GROUT: Depth
From To Ft.._--
From_ To- — Ft. �—
Diam ter Slot Size Matenal
14: SCREEN: Depth Ft in in
From_To
From TO Ft. in. in.
15. SAND/GRAVEL PACK: Size Material
Depth
To
To
WELL CONSTRUCTION RECORD
(Sirs/
veCt or Route No.)
From
From
Ft.
Ft.
Material
Method
tit'
totL
A
a CD
N2
rn�
� o(L c
16. REMARKS:
I DO HEREBY CERTIFYFTHAT TH SWELL T ABCONSTRUCTED
THIS RE ORD HAS BEEN PRIN ACCORDANCE OVIDED TO THE WELL OWNER
I5A NCAC 2C, WELL
CONSTRUCTION STANDARD THAT C •
_ RSON CONSTRUCTING THE WELL DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center- Raleigh,NC
NC Raleigh,
27699-1636 Phone No. [phone], within 30 days. GWrt REV.1

WELL CONSTRUCTION RECORD
279 s 83
North Carolina - Department of Environment and Nutt// l Resources - Division �o}fWater Quality - Groundwater ronn
WELL CONTRACTOR (INDIVIDUAL) NAME (print) C / �t)�I21 (�%�• 11'-4t I '.�• CERTIFICAATION#iytr l�/�
WELL CONTRACTOR COMPANY NAME SO l7 t c5 V..S PSL4 r• �+'� ti PHONE # Q`i-h ?c 7 5 ?S
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
I. WELL USE (Check Applicable Box): Residential I ' unicipal/Public ❑ Industrial ❑ Agricultural ❑
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use
2. WELL LOCATI
i �A^�
U Nearest Town:
L �,e) '/Coounty YL"` l)Lt+��
(Street Name. Numbers, Community, Lot No., Zip Code)
3. OWNER: Sienen PC SL.o
Address I O Z i ) G0 y-u.t.4-e-at lCe(
,� 1 (Street or Route No.)
OA a_AA,dY— .N c eo s 7S 2
ny oor JTown Mate q { Zip Code
Area code- Phone number
4. DATE DRILLED 8 -It?, 0-3
5. TOTAL DEPTH: a}75
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO WV--
7. STATIC WATER LEVEL Below Top of Casing: 20 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS I FT. Above Land Surface*
*Top of casing terminated aUw below land surface requires a
variance In aceordaawith 15A NCAC 2C .01111
9. YIELD (gpm): t ME'OD OF TEST 4 I
IrC-
I0. WATER ZONES (depth): . 5 pale. 200 e
Topographic/Land setting
❑Ridge ❑Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From To Formation Description
LOCATION SKETCH
I I . DISINFECTION: Type't,iUtt,WE Amount V9 026= iT / Show direction and distance in miles from at least
12. CASING: Wall Thickness two State Roads or County Roads. Include the road
numbers and common road names.
Depth
From 0 To / Ft
From 5 Tt Ft
Frog_ To
13. GROUT: Depth
From To
From U To
14. SCREEN: Depth
From To
From To
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
FL
Ft. j�f ( POfre/
Diame er Slot Size Material
Ft. in. in.
Ft. in. in.
Djameter or Weight/Ft. Mate631
From To Ft.
16. REMARKS:
I DO HEREBY CERTIFY THAT T
CONSTRUCTION STANDARD
New G(r1414 - sf,Z F2
W
0/09
ib
'rn
tnz
MM
jS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL —.
ND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER;
IGNAT
OFX7ERSON CONSTRUCTING THE WELL
DATE
Submit the original to the Division of Water Quality, Groundwater Section, I636 Mail Service Center - Raleigh,NCy
27699-1636 Phone No. [phone], within 30 days. GW-1 REV. 07/2001

WELL CONSTRUCTION RECORD
279281
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) CrAgy .T d_5#/ t-t CERTIFICATION # Z/✓ t
w'EL.L CONTRACTOR COMPANY NAME TV St/ C O /LW (.L Pr L Lt N/ PHONE # ([L'Jlf' 72%Yin
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential ❑ Municipal/Public liee Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection ❑ Other ❑ If Other, List Use
2. WELL LOCATION: ,
Nearest Town: /b11112u6N4 County w% C OOLtt.t <-
(oL/S Fist, 00-1-chrt./ b(aA.i
(Street Name, Numbers, Community, Subdivision, Lot/No.. Zip Code)
3. OWNER: NL )A/ii, Iltt RecS 7rte6
Address 664s f;54 NAtk(,re'r1 yQ
(Street or Route No.)
Mgr/nit) Jt1 C S7 Z-
City or Town State Zip Code
(aR )- rosi- _575— /
Topogra is/Land setting
❑Ridgee ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
COMM O/%(M , (degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
Arca code- Phone number
4. DATE DRILLED 7- /Li-O 3
5. TOTAL DEPTH: 305-
6. DOES WELL REPLACE EXISTING WELL? YES ifr O ❑
7. STATIC WATER LEVEL Below Top of Casing: <10 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING 15 / 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): /Z METHOD OF vTAinEST A/
tO.WATER ZONES (depth): /29fintv7 306
I I. DISINFECTION: TypeCiOKift
12. CASING:
From v
From 77
From/7 7
13. GROUT: Depth
From To
From 0 To /7)
Ft
Ft.
14. SCREEN: Depth
From To
From To
15. SAND/GRAVEL PACK:
From
From
Diameter
6
Material
Ft.
Ft. -/ypt/
Diameter
Ft. in.
Ft. in.
DEPTH
From To
©- /10
/7&- 3ns
(check box)
DRILLING LOG
Formation Description
LOCATION SKETCH
Amount R6Z497576 Show direction and distance in miles from at least__
Wall Thickness two State Roads or County Roads. Includeae ro
Material numbers and common road names. w o
0
or Weight/Ft.
crie
go
/SR
Depth Size
To Ft.
To Ft.
Slot Size Material
in.
in.
Material
cn
rrl
to
16. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
1-03
ERSON CONSTRUCTING THE WELL DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC ,
27699-1636 Phone No. [phone], within 30 days. GW-1 REV. 07`j OOE
I
I i
a_
7. L-'1

WELL CONSTRUCTION RECORD 279280
North Carolina - Department of Environment and Natural Resourcespp///-���Division of Water Quality - Groundwater Section <<�
WELL CONTRACTOR (INDIVIDUAL) NAME (print) � / A9- 9 u,C4 CERTIFICATION ✓ �/�/
WELL CON'IRACFORCOMPANY NAME S�S"/r(4 vv(✓`,c l�•'-�C.(i/Vl PHONE #(/ )' 72* r5v6'
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
I. WELL USE (Check Applicable Box): Residential n* 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: Oct £rtT- County /7% f b6k, f
mfL:1cncpr2
(Street Name. Numbers, Community, Subdivision, Lot No. Zip Code)
3. OWNER: 60-6- 6-0 is) friu/
Address ill 4— L ,tot f? 72
tbtreet� Route No.) ')7
VL0
C ZS‘,Z-
City or Town _ State Zip Code
(�)- ?ZS—U` Zi5
Area code- Phone number`'
4. DATE DRILLED 66 Flo' C7 3
5. TOTAL DEPTH: 7°5`
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO M
7. STATIC WATER LEVEL Below Top of Casing: 'SC 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): 3 64e METHOD OF TEST 5�j
10. WATER ZONES (depth): 4a iSe /%yfrofnv<fre-I
11. DISINFECTION: TypeC(O/2]i e
12. CASING:
Depth Diameter
From To Ft.
Topoggrphic/Land setting
❑Ridge I Scllope ❑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
6/1z1-fPL
LOCATION SKETCH
Amount rneZ Show direction and distance in miles froin at Ieasio
Wall Thickness two State Roads or County Roads. Include rot
or Weight/Ft. Material numbers and common road namesrA c>�
f'r'1 '^fn
cn
<
From To t. QC
From To FFt %y QC
13. GROUT: Depth
From To Ft.
From To Ft.
atcrial Method
14. SCREEN: Depth Diameter Slot Size
From To Ft. in. in.
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Size y Material
Prom To Ft.
From To Ft.
Material
16. REMARKS:
I DO HEREBY CERTIFY T
CONSTRUCTION STAND
•
6 / t't1,Aeis`usAct
AT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
RDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER;
TURE OF PERSON CONSTRUCTING THE WELL
DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center- RaleighNQ
27699-1636 Phone No. [phone], within 30 days. GW-I REV. i07/200I
17:

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section ii_
WELL CONTRACTOR (INDIVIDUAL)NAME (print)%�✓ s24V 0
G Jn(.�p%�G CERTIFIC�AjTyI�ON# ,//�,,.-
WELLCONTRACTORCOMPANYNAME S�/2 et/e era/ Al PHONE # f ZI?-7LTT196r
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable)
(if applicable)
279278
I. WELL USE (Check Applicable Box): Residential Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery ❑ Heat Pump Water Injection 0 Other D I f Other, List Use
2. WELL LOCATION: ,yI ,t,,
Nearest Town: /✓ r %i/ 0� County '0 1.�/C/Wea
2o74a$ Q Aaele-ccS
(Street Name. Numbers, Community, Subdivision, Lot No., Zip Code)
pographic/Land setting
Ridge ❑Slope DValley ❑Flat
(check appropriate box)
Latitude/longitude of well location
3. 0 W N ER: l 4-ter te (degrees/minutes/seconds)
Address qg 4/.< gee/42 12 e,'Je.eQ, ;,.: 0C1 Latitude/longitude source:❑GPS❑Topographic map
(Street or Route No.) YY(check box)
j _%(ie s287// DEPTH DRILLING LOG
From To Formation Description
City or Town State Zip Code
)- nto �>- ea/ 9 — 771, egg/
Area code- Phone number
4. DATE DRILLED VVLW 3— ZWZ
5. TOTAL DEPTH: L ,r
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO EY
7. STATIC WATER LEVEL Below Top of Casing: GO 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. A
9. YIELD(gpm): 30 METHOD OF TEST4(n.
10. WATER ZONES (depth): alpen4 2
LOCATION SKETCH
11. DISINFECTION: Typeakei bide Amount g02 & 7,77 Show direction and distance in miles from at leaste
12. CASING: Wall Thickness two State Roads or County Roads. Include roag
or Weight/Ft. Material numbers and common road names. C,
rl
>0
©- C z 11,17407 /z
spy- 24'S
Y4AN."--C
From
From
From 6G7
Depth Diameter
To Ft.
To 6 % Ft. %
To (0 9 Ft. iD
13. GROUT: Depth
From To Ft.
Ft. -f / PUa ed
Diame�er Slot Size Material
in.
in.
From Cl To 2 5
14. SCREEN: Depth
From To Ft. in.
From To Ft. in.
416
Material
15. SAND/GRAVEL PACK:
Depth
From To Ft.
From To Ft.
16. REMARKS;1
I DO HEREB
CONSTRUCT
Size
r Material
Method
Iy
O
cJ'7
a(1.-°
TIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH I5A NCAC 2C, WELL
TANDARDS, AND THAT A COPY OF THIS ' CORD HAS BEEN PROVIDED TO THE WELL OWNER.
E 2SON CO RUCTING THE WELL
DATE
Submit the original to the Division of Wad Quality, Groundwater Section, 1636 Mail Service Center - RaleigF,C
27699-1636 Phone No. [phone], within 30 days. GW-1 REV. 07/2001

WELL CONSTRUCTION RECORD 279379
North Carolina - Department of Environment and Natural Resources - Divisionnof Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAM (print) .r —' m e5 f�""' l0nt'r\ p Cr. CERTIFICATIONp(4If A(3g
WELL CONTRACTOR COMPANY NAME � Wt5 We 11 ± PIA vvtp I D. (�i1 C . PHONE # Ipadl 453-73a2
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT'S - — -
(if applicable) (if applicable) r— ,
LSI
rr
1. WELL USE (Check Applicable Box): Residential f.3 Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection ❑ Other 0 If Other, List Use
2. WELL LOCATION:
Nearest Town: jlia (104
rift (,61,<r ck, RA.
County 1 r" C pc kfle
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: \ Lt.��ia1 et tit( u (ii•c frk. Ct,.
Address 6 142T (icier( V e tJ J_ o op
(Street pr Route No.)
Nlatica N 2$r1512,
City or Too/A State Zip Code
Area code- Phone number
4. DATE DRILLED It - i 9 - C 3
5. TOTAL DEPTH: 5-o 6
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO X
7. STATIC WATER LEVEL Below Top of Casing:, FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS 1 FT. Above Land Surface'
t. *Top of cuing terminated atlor below land surface requires a
variance In accordance with 15A NCAC 2C .0118.
9. YIELD (gpm): METHOD OF TEST tt 1(
10. WATER ZONES (epth): 440
11. DISINFECTION: Type
12. CASING:
Depth Diameter
From D To 70 Ft. / ig
From To Ft.
From - To Ft.
Amount
Wall Thickness
or Weight/Ft. Material
sLRa1 PJc
13. GROUT: Depth Material
From O To 2D Ft. Cleat Cerne vkt
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. a
From To Ft.
Methppd
vvd
Slot Size
in.
in.
Material
16. REMARKS:
1 Topographic/Land setting
9Ridge ❑Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds) i '_t
Latitude/longitude source:❑GPS❑Topographirtnap.-- 1
(check box) 11 -1
DEPTH J)RILLISLOQ \1-_—/
From o Formation Description
0 _0 flirt, 1vKJel
rct-isaf,date A rock
Yf
CO 0
'moo
Orn
C.
yo
LOCATION SKETCH 3 Jr,
Show direction and distance in miles fro� at leas?'
two State Roads or County Roads. Includc(fie rt
numbers and common road names. C!1
s
co
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUC ihD IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS R CORD HAS BEEN PROVIDED TO THE WELL OWNER
htiYVLeA-- 14) L��1� t�J 3
SI ATURE OF PERSON CONSTRU IW'G HE WELL DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-I REV. 07/2001

279503
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and N Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAM,6 (print) D A/ /y/ G L7 /9L L CERTIFICATION #fl77 WELL CONTRACTOR COMPANY N HONE ' k S�J D v8?
STATE WELL CONSTRUCTION PERMIT#_1�,L, - ASSOCIATED WQ PERMIla lY/%91
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential pitMunicipal/Public 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
unty�i
s
parke
e n ccc,2 L° ezr, G L
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNE
Address
(street or Route No.)
o /V.C. bl97/ 2-
City or Town State Zip Code
( }
Area code- Phone number
4. DATE DRJLLED an
520 3
5. TOTAL DEPTH:
6. DOES WELL REPLACE EXISTING WELL'/ YES 0 NO J11
7. STATIC WATER LEVEL Below Top of Casing: .ZS 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 accordaa a with 15A NCAC 2C .0118. •
9. YIELD (gpm):.SO METhOD OFTESTt n-t n
10. WATER. ZONES (depth): /6 `.9^ %2GY)'
11. DISINFECTION: Type
12. CASING:
Depthh Diameter
From O To /0 Ft G Jr?
From__ To Ft.
From To Ft.
13. GROUT: Depth Material M cad
From T7 To a2 !) Ft. . -
To Ft la
From
sai
Amount (.1
D�
Wall Thickness
or Weight/FL Material
/r
14. SCREEN: Depth Diameter
Fro Ft. in.
From.T�o Ft. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From o Ft.
From To Ft.
Slot Size Material
in.
in.
16. REMARKS:
Topographic/Land setting
❑Ridge "'Slope ❑Valley ❑F1at
(check appropriate box)
Latitude/longitude of well location
(degrees/minion/seconds)
Latitude/longitude sou ce:❑GPS❑Topographirmap
(check box)
DEPTH pRILLINith Log
From To
Formation Description
W
-'O
7 rr,
o<
yc
^'o
Show direction and di a in miles from�kga� least,,
two State Roads or Coun , Roads. Include' Die r°
numbers and common ro:. names.
0 O
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WEI T
CONSTRUCTION STANDARDS, AND A COPY OF THIS RECORD HHAAASS BEEN PROVIDED TO THE WELL OWNER
•
SIGNATURE OF CONSaf t THE WELL S / D e,
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-1 REV. 07/2001

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and N Resources` - Division of Water Quality - Groumdwater Section_
WELL CONTRACTOR (INDIVIDUAL) NAM (print) %. `0 Al /v /G 48 M L. ,�% CERTIFICATION Nraw%7
WELL CONTRACTOR COMPANY NAME u .649 �' - ^'� PHONE #)ssai 4VY-°Via
1/ir
STATE WELL CONSTRUCTION PERMIT#
(if applicable)
44417 acgOC1ATED WQ PERMIT*
(if applicable)
279502
1. WELL USE (Check Applicable Box): Residentialt 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 To ;tee
(Street Name, Numbus,, Community, Subdivision, Lot No., Tip Code)
•
3. OWNER: a���1i/�(/4/4„Q7
Address %2S a3alec.cLee"+P (kg/
(Street or Rome No.)
C}ity or rows /v Sto / J Zip Code
Area code- Phone munber
4. DATE DRILLED -- `�-/ O 3
5. TOTAL DEPTH:
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO ;it
7. STATIC WATER LEVEL Below Top of Casing: 3_S' FT.
(We-9' if Above Top of Casing)
8. TOP OF CASING IS / S FT. Above Land Surface*
*Tap of easing terminated at/or below Laud surface requires a
variance In ■aordan jwnh 15A NCAC 2C .0118.
9. YIELD (gpm): _
10. WATER ZONES (depth):
Topographic/Land setting
KfRidge ❑Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well Location
(degrees/mimics/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check
PRILLING LOG
Formation Description
DEPTH
From To
31 7
N r —i
LOCATION SKETCH -a m c
11. DISINFECTION: Type jf% ` Amount 9. /i(C ° L Show direction and distance in miles froi St lea m
12. CASING: v Wall Thickness two State Roads or County Roads. Inclutkhe
"ter Weight/Ftnumbers and common road names. m
From 0 To �0D Ft. (P # 11
From To Ft.
From To Ft.
13. GROUT: Depth
From To 07 0 Ft.
From To Ft.
14. SCREEN: Depth Diameter Slot Size Material
FrontTo Ft.in. in.
From / To Ft in in.
15. SAND/GRAVEL PACK
Size Material
16. REMARKS:
MEMOD OFT ES -r-n-rd
ta/
Ft.
Ft.
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COI' F 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 g
9
North Carolina - Department of Environment and NMnal Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) (15. D NAf / e ,3A1.t- CERTIFICATION a,2'9 2%
WELL CONTRACTOR COMPANY NAME2 4.A2. �Q. ell- ,,QQI fi Li22/O 14.A.191.7 l4 PHONE a Sal LW: DQ$2
STATE WELL CONSTRUCTION PERMIT* litV _ASSOCIATED WQ PERMIT* Adhr
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential $ Municipai/Public 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery ❑ Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION: �4 �/
Nearest Town: /--JT?W Coun
7/o 7
(Street Name. NumbersCommunity, Subdivision Lot No-,ripCode)
Address
n �(speet or Rase No.)
b A�'. stv A/-•C, a S74 (--
City or Town State Zip Code
Area coda Phone
4. DATE DRILLED numbers,/ o -3
5. TOTAL DEPTH: //. S
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO WJ
7. STATIC WATER LEVEL Below Top of Casing: J' FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS j < FT. Above Land Surfaces
'Top of casing terminated at/or below land surface requires a
variance in accordance with 1SA NCAC 2C .0118. •
9. YIELD (gpm): e2 n METHOD OF TESTT2Gi -ti
10. WATER ZONES (depth): ADO
11. DISINFECTION: Type Amount "i
12. CASING: Wall Thickness
Depth From_ To «0 Ft. li Diameter
From To Ft.
From To Ft.
•
or Weight/Ft
13. GROUT: Depth Material
From To ea Cs Ft. La
From To Ft.
14. SCREEN: Depth Diameter Slot Size Material
Fro Ft. in. in.
Fro To Ft. in. in.
15. S /GRAVEL PACK ,
Depth Size Material
Fro Cr o Ft.
Fro To Ft.
16. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUC rt•.0 IN ACCORDANCE WR'H 15A NCAC 2C, WE1S6 —~
CONSTRUCTION STANDARDS, AND TiiAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
fftti/ 03
SIGNATURE OF PERSON CONSTRUCTING THE WFI l DATE
Topographic/Land setting
!Midge 0S1ope Malley 151F7at
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitudellongitude source:❑GPS❑Topographic map
(check box)
DEPTHDRILLING LOG
From To Formation Description
P
c: '
IV
aJ a a
Show directi • • and distance in miles front
two State Ro. • or County Roads. Includ a road
numbers an • common road names.
119
m
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-1 REV. 07/2001

North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section r_ .1. 8 8 2 0
1636 Mail Service Center- Raleigh. N.C. 27699-1636-Phone [phone] Q e/J
WELL CONSTRUCTION RECORD WELL CONTRACTOR' ✓L ,2 L) f12Mf-�' ��`t--"
WELL CONTRACTOR CERTIFICATION #: r.2 7Ry
STATE WELL CONSTRUCTION PERMIT#:
1. WELL USE (Check Applicable Box): Residential ® Municipal ❑ Industrial ❑ Agricultural ❑ Monitoring ❑
Recovery ❑ Heat Pump Water Injection 0 Other ❑ If Other, List Use:
2. WELL LOCATION: (Show sketch of the location below) 1
Nearest own:
(Roa ame and Numrmbe Co oily,, ubdivision and Lot No.) DRILLING LOG DEPTH
3. OWNER /,//--ei7 From To Formation Description
Address r 7#b et
o , u 4,
-�j� tareetor a o.i�
City or Town Staten
4. DATE DRILLED S./? 9/4'? 2
5. TOTAL DEPTH 3 9
6. CUTTINGS COLLECTED YES ❑ NO
7. DOES WELL REPLACE EXISTING WELL? laiS NO23
8. STATIC WATER LEVEL Below Top of Casing: Q FT.
. / (Use '+ a Above Top of Casing)
9. TOP OF CASING IS / FT. Above Land Surface*
'Top of casing terminated atior below land surface requires a variance In actor -
dance with ISA NCAC 2C .0318 .�-
10. YIELD (gpm): / METHOD OF TEST
11. WATER ZONES (depth)' i
12. CHLORINATION: Type T41 /$ Amount 3
13. CASING:
Wail Thickness
Depth r�, me ter or WeighVFt.
From 0To ,) rl Ft . Df 4)�f ht. 7_ ./
From To Ft.
From To Ft.
14. GROUT:
From
Depth,
0To r% Ft
From To Ft
15. SCREEN:
,1,5)73Y
Zip Code
From
From
From
Depth
To Ft
To / Ft.
To FL
Diameter Slot Slze
in in
In / in
In
16. SAND/GRAVEL PACK:
Depth Size
From To • Ft.
From / To / Ft.
17. REMARKS:
I DO HERE
CONSTRUC
en
LJAateriaL. M1d
e-rolere %4!
Material
in
Material
r-1
cib
0
If motional space Is needed use back of form
LOCATION SKETCH
(Show direction and distance from at Least two State --
Roads. or other map reference points)
It
t-c
O
ater
iie Reg'
ONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
RECORD HASB N PROVIDED TO THE WELL OWNER.
OF PERSON CON UCTING
67JJ
SIGNATURETHE WELL/ ATE
to Division of Water Oualily. Groundwater Section within 30 days
GW-1 REV. 12r99

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) JerelJty H. Bowman' CERTIFICATION It 2809
WELL CONTRACTOR COMPANY NAME D Rnwman Wp11 Dr 11 i ng, Tnr
`'78957
PHONE at .678 757-7779
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential (X 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: Mari nn County McDowell
Ricmar Subdivision Lot 22
(Street Name. Numbers, Community, Subdivision, Lot No., Zip Code)
1.OWNER: Sabrina Dyer
Address 2999 Zion Hill Road
(Street or Route No.)
Marion N!' 7R757
City or Town State Zip Code
(
Area code- Phone number
4. DATE DRILLED 7/28/03
5. TOTAL DEPTH: 240'
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 FRILLING LOG
From To Formation Description
6. DOES WELL REPLACE EXISTING WELL? YES O NO
7. STATIC WATER LEVEL Below Top of Casing: 80 FT.
(Use "+" if Above Top of Cuing)
8. TOP OF CASING IS 1 ' 4 FT. Above Land Surface'
'Top of casing terminated at/or below land surface req ulres a
variance In accordance with ISA NCAC 2C .0I18.
9. YIELD(gpm): 8 METHOD OF TEST rotary air
10. WATER ZONES (depth): 1 20' , 180, 200'
11 DISINFECTION: Type
12. CASING:
Depth
From 0 To hn
From To
From To
11. GROUT: Depth
From 0 To 20
From To
14. SCREEN: Depth
From To
From To
15. SAND/GRAVEL PACK:
Depth
From To
From To
tablet Amount 6
Wall Thickness
Diameter or Weight/Ft. Material
Ft.f1 /8 SC1La0 PVf
43 c
m ''
O ors
LOCATION SKETCH
Show direction and distance in miles from Fje as[co z
two State Roads or County Roads. Include Me roast)
numbers and common road names. to o
z
Ft.
Ft.
Material Method
R. concrete gravity flow
Ft.
Diameter
Ft. in.
Ft. in.
Size
Ft.
Ft.
Slot Size Material
in.
in.
Material
16. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH ISA NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
14 71,1 ._ ,O VID
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mall Service Center -Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. OW -I REV. 07/2001

WELL CONSTRUCTION RECORD 278956
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) Jeremy H. Bowman' CERTIFICATION 92809
WELL CONTRACTOR COMPANY NAME D Plowman Wel 1 Dri 11 1n0. Tnr` PHONEY 92A 252 — 7779
STATE WELL CONSTRUCTION PERMIT ASSOCIATED WQ PERMITM
(if applicable) (if applicable)
I. WELL USE (Check Applicable Box): Residential [R Municipal/Public O Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection ❑ Other 0 If Other, List Use
2 WELL LOCATION:
Nearest Town: n1 d Fort County McDowell
Feather Falls Trail T.nt 4c- ratamEna Falls
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: Larry Bundrick
Address 2522 Garth Rd , Smith Fact
(Street or Route No.)
Huntsville Alabama 35801
City or Town State Zip Code
( )-
Arca code- Phone number
4. DATE DRILLED 7/25/03
5. TOTAL DEPTH: 400'
Topographic/Land setting
❑Ridge ❑Slope ❑Valley ❑Flat
Preserv6heck appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:OGPSOTopographic map
(check box)
DEPTH DRILLING LOG
From To Formation Description
6 DOES WELL REPLACE EXISTING WELL? YES 0 NO DI
7. STATIC WATER LEVEL Below Top of Casing: 60 FT.
(Use "+" if Above Top of Cuing)
8. TOP OF CASING IS 1 • 4 FT. Above Land Surface'
'Top of casing terminated odor below land m rface requires a
variance In accordance with ISA NCAC 2C .0I18.
9. YIELD (gpm): 9 METHOD OFTEST'-rotary air
10. WATER ZONES (depth): 380' . 400'
JOCATION SKETCH
I I. DISINFECTION: Type tablet Amount 6 Show direction and distance in miles from at leai,:o
12. CASING: Wall Thickness two State Roads or County Roads. Includge rollc
Depth Diameter or Weight/Ft. Material numbers and common road names.
From(_ To 1_40' Ftfit /8 Sch_$0 Pvr
From To Ft. CO
O
W
s
O
i-0
From To Ft.
13. GROUT: Depth Material Method
From 0 To 20 Ft concrete gravity flow
From To Ft.
14 SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in.
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
r-
cr,
o-c
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 CONSTRUCTING THE WELL
DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mall Service Center -Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-I REV, 07/2001

280419
m air \Waxen K1Lltlite3 ..((iirn1111iiVOle�r ilnm.
Q1HtOltEC.sAi Mmia
�*ate'- -"„-J'
♦LL1. (-u�lR\[-i 0RCOM? ANN •l
ses _
.I YI6 Pt.1.l.(r)%s;Rt.0i ION i't.RM1ir Ca.. ___ - -- ..--- —
tiµy! �7t-0mnxipat'Public O Industrial 0 A nantoral 0
IN :j�,l bock .\pplicubla ll
lie:d': el)
as ,e.a"anam_ La
_ WI1.1 LocArl . .IoO cown�.
\ ,.rT.,,,n G_L2v.W p�1I)�g1U
4&.14'�-V_L.0 -- �-
�ir:•'t'ovuou„oi. sehuulaof. Lot No. LIP C.
_�� (�Y
> \ situ L C
.. ... ... 1..., oom. Lp Gavle
O.
TiT.\L DEPEH.__J.S3-.---------- NO
UOES WELL REPLACE EXISTING ELL-' ES 0 _F'T. _. —__.
7. NE NI IC WATER LEVEL Below Top g. ;`-. ----tD
odse ..tr♦MwsTap or Catmg'
_ If. Above Land Surface q,
I 11 Or CASING S bays. Ind swim requires a _ -- — _
ivy I 'to ay flraln.lwI at/ort•CA ' T---'
.eta. in auo d.c�ul�\'�C aC ZC �OF TEST -_—•(y„'12„��i 1j.1+1.___.—� _t
1 C�
Olta.
n 1n—� �
Lo \',ATbR ZONES ldcpth7�. — --i--1'S -.-_—.--- J 1,UC:Ai�tN_-S�—Ui ---E..
Amount _ Show iur_cuon and diSims, - m [nat•) tryoIat 1-a> i
�.t
....0 Stutc Roads or Counr, Roads .
nc
3a E DRILL l
WELL CONSTRUCTION RECORD
"assiibiL:Aiwa-aims - L)cp-" Eno nt of hn i1i,astusnl mnlii%tltuy[vf"��1
tw i tll • to n g as uC r[ 1R t l \ U I \' MUM." N�'W. (OEM
an
ASSOCCX CCJt+*antinomy
Box 1. Res .T I ListUse__ ------- .__
tal I'ID p Water l0jCZliO ❑ Olhc, 0 11 Other,
Topogra rc Land setting
❑Ridge -lope OVallcy ❑I'la'.
1ch ' k appear ll box!
�.. _._ Latitudulong-nuie at w>ld11.1tti.iumm
4.V1 •ei riot:t S 9wa+wst:
I_atir uJ longitude e[. ur:\.DG
ibta
L.v.
auaLu�atia I LOt.,
ttionmtwwi asap.+.'
uEprH
From To
!I DISINFECTION T)'pe.Irl-- _.
Wall Yhtckness
C C ASl\Ci
DiNn ern :tr W yht H Male! .:I numbers and cmninon. road names
Dcpl1��-C}' —'— i4Wt4 Z. Z.1
R.�
Dah ��� ,�te:ert c nte�.t.:
'
namely,[ ). Zi nt';<r Cl,
I. iiRI rti liel•'I' —
FI — c;
tr.
15 SANOOR.ACEl. P:\C'K.I:. Te m,..
zc
j do inc.
Utpn S \luterlal --
-
oar.
mz
Mar•. __— " -.. - ..
z
c \t 1� ,C, W't-LL
yy�slj. DARDS. A.'DTHA - ACOP OF i-HIS RECORD HAS Bt E PRO \ IDED 101HE WELL OW•E
! DO Ii1 REISV LE1111F1 Al r IS WELL W AS COAslftl'(TE(1!N AC UPr,AVcFWITH
si '.-:1TLRb U` I'hRSUN CONST HL('TIRC Ttii. WLLL.
' Section. Inl6 Moil Sees !QV C'cn[er - Raleigh. SC
er Quality, Grnundtt utel („\_1 Ra.ei.h� C
Submit thy nr'rgurt lu the 13- siol. .s tri of hin 30 (lass.
]"n9'l.i4yo 1'hun. N,t. IH1'll 7.i. - 3:
-
sca

281340
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) � � 4\..1nTn f,S la...0 n CERTIFICATION #
WELL CONTRACTOR COMPANY NAME �iCd1/4r' A)e'I ;fn PHONE # CeS)-3-14
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential 13 Municipal/Public ❑ industrial ❑ Agricultural ❑
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use
2. WELL LOCATION/h
Nearest Town: 11 'O,C
LSo ,V\n CceeK r1?�
County m r c54,02- I
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: E cnrr.O.rUe\ C uCC�
Address .Se U�\-• CceeK d.
k\Pi()(SttxtKCmeNo.) OR C1
City or Town State tip Code
Area coda Phone number
4. DATE DRILLED /Q �2 3 63
5. TOTAL DEPTH: )5�
6. DOES WELL REPLACE EXISTING WELL? YES NO ❑
7. STATIC WATER LEVEL Below Top of Casing: (a 5 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS \ ,e FT. Above Land Surface*
'Top of casing terminated at/or below land surface requires ■
variance in accordance with 1SA NCAC 2C .0I18.
9. YIELD (gpm): 1a- METHOD OF TEST
10. WATER ZONES (depth): (1S - /a)
135 -Ilk
11. DISINFECTION: Type
12. CASING:
Depth
Fro m1 Fa0 To 70 Ft
Fro To 75 Ft
From To Ft
H T H Amount II
13. GROUT: Depth
From To c)() Ft
From To Ft
Wall Thiclmess
Drjr
or Weight/Ft. rial
VC -
a) RhrK <@ tl
Material Method
14. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in.
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Topographic/Land setting
❑Ridge ❑Slope ❑Valley flat
(check appropriate box) cs r_cri
Latitude/longitude of well Ioca4 it
T'o
(degrees/minutes/seconds)
Latitude/longitude sozrec ;:CO-PCJu T c.y graphic m
(check box)
DEPTH DRILL
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.
e�
\\
C' L.S. rn
n
i
e 1 Depth Size Material (� GCJr () S i r.
From To Ft. r.l rc>_'-
From To Ft. o n "O
J c
16. REMARKS:
1 DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCIION 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. 07/2001

281339
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division` of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) CNN' S . ar,c .1 z i. CERTIFICATION # c `+' '
WELL CONTRACTOR COMPANY NAME
2ec s-. WL,\ Oc; ,.5 PHONE # (46) 1- 34-1
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential E MunicipalPublic ❑ Industrial 0 Agricultural
Monitoring 0 Recovery 0 Heat Pump Water Injection ❑ Other 0 If Other, List Use
2. WELL LOCATIO
Neare(gTown: oc tt'. County Me NQ \t
c2910 V. a\4 i' c�n\t/ Q r of
(Street Name, Manlier; Comm', Subdivision, Lot No., Zip Code)
3. OWNER:�bJ QC c,API
c\
Address t'il(', P y
(SheetnrRnuteNRoute d .)
fi\QC:P,r. kj„ 0C;1S�
City or Town State Zip Code
( —1-
Area coda Phone number
4. DATE DRILLED 1\ I 1.--:.- �/ h 3
5. TOTAL DEPTH: (05
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO -Er
7. STATIC WATER LEVEL Below Top of Casing: \4`i FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS 14 5 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): aS METHOD OF TEST e_ C
10. WATER ZONES (depth): U((3C ti5
rzS _' (tp' ION SKETCH
11. DISINFECTION: Type \ Amount \ \ \o Show directionon and and distance in miles from at least
Topographic/Land setting
❑Ridge ❑Slope ❑Valley
(check appropriate box) c, ,
Latitude/longitude of well 1oda604
(degrees/minutes/seconds) n'-,
Latitude/longitude source:❑GPS❑To Mra
(check box)
DEPTH DRILLING LOG'
From To Formation Description
12. CASING: Wall Thiclmess
_ Depth Diameter or Weigh(t/Ft. Material
Fro To <� Ft Co.3-5'� l -,o\Vn c\\tea.
From To Ft.
From To Ft.
13. GROUT: Depth Material Method
Fromc. To 3O Ft. ).ernes
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.
two State Roads or County Roads. Include the road
numbers and common road names.
70 \Ves\
0
16. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH I5A NCAC 2C, WELL
CONSTRUQFION STANDARDS, AND THAT A 9QPY O) THIS RECORD HAS BEEN PROVIDED TO THE)�VELL QWNER
SIGMA
(LAC, Ate]
PERSON CONSTRUCTING THE WELL
I 03 o3
DATE
Sub mii 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

281338
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and NaturaltualResources - Division/jof Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) V C2 MPS `11 r O nc cX . r CERTIFICATION # ter 6 (1( l�,
WELL CONTRACTOR COMPANY NAME (')nCS:c� \ALE'\1 PC\\\(n� PHONE # tCf'b(oS)-i 1
STATE WELL CONSTRUCTION PERMIT!' ASSOCIATED WQ PERMIT#
(ifapplicable) (if applicable) r _
1. WELL USE (Check Applicable Box): Residential Er Municipal/Public 0 Industrial ❑ Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION: (
Ne � st Town:,, �(—\\� t 1 County +\CC W t �\
Coss l,Cee
(Street Name, Nmnbbcrs, Community, Subdivision, Lot No., Zip Code)
3. OWNER: a vC 1c1P Y�\e C ,\c\PC
D Address aei eerp< Ra.
(Street & Route No.)
/Je �$�S�
City or Town State tip Code
(W)-cryt- a.a43
Area code Phone number
4. DATE DRILLED 11 13 L / ta
5. TOTAL DEPTH: ‘CO
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO Er-
7. STATIC WATER LEVEL Below Top of Casing: a LI FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS \ S FT. Above Land Surface'
*Top of casing terminated at/or below land surface requires a
variance In accordance with ISA NCAC 2C .0118.
9. YIELD (gpm): i S ME OD OF TEST ?.\eC
10. WATER ZONES (depth): ,, ff Id — �
11. DISINFECTION: Type ttM
12. CASING:
_ Depth // SS Diameter
Fro To t: (.2 3-5
To Cot Ft. („ S
From To Ft.
13. GROUT: Depth Material i Method
From Co? To v t FL Cern ent
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 \ 1b
Wall Thiclmess
or Weight/Ft. Material
L'
16. REMARKS:
Topographic/Land setting _ !,
❑Ridge ❑Slope ❑Valley ❑flat'
(check appropriate box)
Latitude/longitude of well loca6b t
(degrees/minutes/seconds)
L ititudeRon.. do e:DGPS❑Tcp
(check box)
DEPTH pRILLIIkio OG
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.
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONST&OCIION STANDARDS, AND THAT A DOPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL 0
IWbi/A ) 64
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
0
rn
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 281013
North Carolina - Department of Environment and N^atural Resources - Division of Water Quality - Groundwater Section 7
WELL CONTRACTOR (INDIVIDUAL) NAME (print) /512.y b. . f054-ICC CERTIFICATION # 2ISt
WELL CONTRACTOR COMPANY NAME J Lli 'iC e be, 5 r:t62.” PHONE a n 8
STATE WELL CONSTRLCTION PERMrF1t ASSOCIATED WQ PERMITS
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential Municipal/Public ❑ Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION: /
Nearest Town: MARION County /2 -4:- ae
174,7 gi yr/I eryiF1'ff GC?�
(Street Name Numbers, Community, Suldivishan, Lot No., Zip Coda)
3. OWNER: je.
Address .t/Q
el
(Street oyrdRoute No.)
Ajre
City or Town Slate Zip Code
d+.:34)- 01.c7— 47Z cig
Area code- Phone number
4. DATE DRILLED /i /j
5. TOTAL DEPTH: 4/65-
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO CI
7. STATIC WATER LEVEL Below Top of Casing: 60 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS ) FT. Above Land Surface*
*Top of easing terminated aUor below land surface requires a
variance in accordance with 15A NCAC 2C .0118.
9. YIELD (gpm): r2 METHOD OF TEST 4/e/SS.•7.'c/
10. WATER ZONES (depth): ct r
- „Topographic/Land setting
!Midge ❑Slope ❑Valley ❑Flat
(cheek appropriate box)
Latitude/longitude of well location
(depers/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(cheek box)
DEPTH DRILLING LOG
From To Formation Description
4/0 - G? en 61.11
(a 2/0S 0ii-C.1-L
1 I. DISINFECTION: Type C &o#C,/UQ Amount V b'02E'7'
12. CASING: Wall Thickness
From
From 0
From [L lc
13. GROUT:
From
From (J To %Z Ft. @Vet/
14. SCREEN: Depth Diame r Slot Size Ma(enal
From To Ft. in. in.
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth
From To Ft.
From To Ft.
Depth Diameter or Weight/Ft. Material
To (PO Ft. 62 , -910 »('c
To Ft. 6, S/ ,/.Qf eAaC/c
Depth Material Method
To FL
16. REMARKS:
Size Material
LOCATION SKETCH O --
25how direction and distance in miles fro . east,
two State Roads or County Roads. Includ - roil h4re)
numbers and qommon road names. SE F �;
224-
ec�,�
I DO HEREBY CERTIFY THAT THIS WE
CONSTRUCTION STANDARDS, AN
WAS CONSTRUCTED IN ACCORDANCE WITH I SA NCACCC, WSt-11---- -mot
TACOPY OFT�IISRECORD HAS .: ..,.VIDEDTOTF WELL OWNER
SIGNATURE OF PRSON CON j• UCTING THE WELL DAM
ni Iv
c)
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service nidee
27699-1636 Phone No. [phone], within 30 days.
Lti
Raleigh, NC
REVA7/200
EL.

WELL CONSTRUCTION RECORD
281015
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) (/ / +� US 4--t rid CERTIFICATION # O/ S4
WELL CONTRACTOR COMPANY NAME S US4-I Cs Li-)Celti0 Y :GI ; Ai 9 PHONE # ( 1 7 Z r/-e1.i`t!o"
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMITU
(if applinble) (if applicable)
t®s®
1. W ELL USE (Check Applicable Box): Residential IW'Municipal/Public ❑ Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATI ' ;tog
opographic/Land setting
Nearest Town: u r County`'%% � dge ❑Slope ❑Valley ❑Flat
(check appropriate box)
(Street Name. Numbers, Community, Subdivision, Lot No., tip Code) Latitude/longitude of well location
LQt-CsJepr t,#28
3. OWNER: ,Y/ VCf.... in�:7-4-eX
Address // _/ to 0 PZ A't '-C, Or
(Street or Route No.) _
MArtaN i\iL. 7e2asz-
City or Town State Zip Code
(521.t7- 55-g(vIt?
(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 //-2A D'O 3
5. TOTAL DEPTH: T
6. DOES WELL REPLACE EXISTING WELD YES 0 NO GY
7. STATIC WATER. LEVEL Below Top of Casing: (o 0 FT.
(the "+" if Above Top of Casing)
8. TOP OF CASING IS FT. Above Land Surface`
*Top of easing tnmiaated Wor below land surface require' a
variance fa acmrdaa with ISA NCAC 2C .0115.
9. YIELD (gpm): METHOD OF TEST 4 hZ
10. WATER ZONES (depth): ( c-c pi. !^ 3 {° O
I I. DISINFECTION: Type eLOYLC.Ft C Amount 02
12. CASING:
Depth Di
From 0 To 8 ( Ft. er
From 4Z \ To 913 Ft ke 1(r;
From To Ft.
13. GROUT: Depth
From To Ft
Wall Thickness
or Weight/Fr Mattxial
, 1 CAP _c
Material Method
From To 2- t Ft %t/re ( fi 1.,Ot� U y�
14. SCREE Depth Dpame[Er Slot Sim Material V . i !r' 7m
From To Ft in. in. PkAtkp(:c- 0 1, p
From To Ft. in. in.
Q L A �.%
15. SAND/GRAVEL PACK: .,,/� n
Depth Size Material "Fur" C'M 11' C/--.I
From To Ft. 1f� // -
From To Ft.
210-• .76 JI r/Yi iT4e1/07-
"VCR - Clot 9,eplw
LOCATION SKETCH r
Show direction and distance in miles fromdsbleas-
two State Roads or County Roads. Includeoe road
numbers and common road names.
E
16. REMARKS:
1 DO HEREBY CERTIFY THAT
CONSTRUCTION STANDAR
Zt/e_
IS WELL WAS CONSTRUCTED IN ACCORDANCE WITH ISA NCACgIL, WELL --
ND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO TVA, -BILL OWNER
_<_ -U
SIGNAT U OF P SON CONSTRUCTING THE WELL 134
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Culdei-
27699-1636 Phone No. [phone], within 30 days. GW1
=z
N
Raleigh!. NC
REVi7I200
I
Irom
Cs
LR
rn

*Top of easing teruivatd war below land surface rgaves a
vanace V accordant with tSA,/CAC 2C MIL9. YIELD (gpm): 5- METHOD OF TEST /412
10. WATER ZONES (depth): rj j/7m61 fit''
Amount'Bo( e73%
Wall Thickness
I I. DISINFECTION: Type dLdie,pz
12. CASING:
Depth
From 0 To ZI Ft
Fromlo O To I Ft.
From 1 1 To Az Ft
13. GROUT: Depth
From To
From 0 To 27 Ft-Gd$L1
Diandier Slot Size Material
FL in. in.
Ft. in. in.
Diameter to Weight/Ft Material
wJ4Lt Adelis_
(9Hq
10" Y4p VC
vy
Material Method
FL
14. SCREEN: Depth
From To
From To
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft. From To Ft.
16. REMARKS:
3. OWNER:
Address
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
CERTIFICATION,/ ,2 S b
%VELL CONTRACTORUNDIVIDUAL)NAME (print
WELL CONTRACTOR COMPANY NAME
STATE WELL CONSTRUCTION PERMIT,/
(if applicable)
281o16
t—Lf e Le 4JL ., PHONE I f ) zit-7 •r7 U
ASSOCIATED WQ PERMIT.
(if applicable)
1. WELL USE (Check Applicable Box): Residential (1Mu iicipaVPublic ❑ Industrial 0 Agricultural ❑
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION.
�� !!'' p
Nearest Town: /U4�(�t+�n— County /'4 t.Ln.i.rt°
!(!C -410 .Des 1->ak Ywko e�
(Street Name. Numbers, Community, Subdivision, tat No., rip Code)
LZ4SCr7C. (f ect-v
/ 470 fcv' pi%)
(Street or Rime Na)
MCt, Ne 6tis2
City Or Town State Zip Code
( )-
Area code- Plane number
4. DATE DRILLED II'/BO 0.3
5. TOTAL DEPTH: /
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO q/
7. STATIC WATER LEVEL Below Top of Casing: FT.
(Use'+" if Above Top of Casing)
8. TOP OF CASING IS $ FT. Above Land Surface
Topographic/Land ss.Wng
❑Ridge ❑Slope argley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degaiminutesheconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From To Formation Description
170 t/CS
ix"'
Ses.e, C erAter,
4. ry tsfi dGE' t
6-
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common road names.
fs eau
c4-•C' ^rZ7
tit 'n
ry
a
PO
0
r. i
id, r.
/, 0
I DO HEREBY CERTIFY THAT THIS ELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC
CONSTRUCTION STANDARDS, A AT A COPY OF THIS RECORD HAS BEEN PROVIDED TO TF
G .f
t `--�.%
--.aWEL[aWNEIC
Il-uf_
ATURE OSRSON CONSTRUCTING THE WELL
�` Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Co Os
27699-1636 Phone No. [phone], within 30 days.
rn
0
0
l�
r1
Raleigh, NC
REV? Q7/20(

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources-y- Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL.) NAME (print) (/' �) LS'f-/CC CERTIFICATION It /S-C
WELL CONTRACTOR COMPANY NAME TL S4i W E LC Or? tc kJ-) <1 PHONE # (QVr) 7Lef-y5-58
STATE WELL CONSTRUCTION PERMIT# - ASSOCIATED WQ PERMIT#
(if applicable) - (if applicable)
281010
1. WELL USE (Check Applicable Box): Residential 0 Municipal/Public ❑ industrial 0 Agricultural
Monitoring 0 Recovery 0 Heat Pump Water Injection ❑ Other 0 If Other, List Use
2. WELL LOCATION:
Nearest Town: oz.)1 Fars' County)# 1StWt'cc
LQ'/-H f2i veer. 14-ii
(Street Name. Numbers, Community, Subdivision, Lot No.. Zip Code)
3. OWNER: AxAfotn Fee
Address 19 03e/ eafezz t .tP. oft
(Street or Route No.)
CI) ?AAve /t/r ,l9762
, City or Jown State Zip Code
(9EC7)- )Q-gz5S
Area code- Phone number
4. DATE DRILLED /0' .i/-0 3
5. TOTAL DEPTH:
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 jik FT. Above Land Surface'
*Top of cuing terminated at/or Wow laud surface regains a
variance In accordance wlh 15A NCAC 2C.0I18. C A,
9. YIELD (gpm): I Iy METHOD OF TEST, )7 A &J r 11 d•
10. WATER ZONES (depth): fr p 0 .300 IV4 (its'
I I. DISINFECTION: Typtiit LO,' to
12. CASING:
in Depth Diameter
From V To 22 Ft.
From fl To ,g t% Ft 6 //41
From To Ft.
13. GROUT: Depth
From To Ft
Material
Topographic/fanAsetting
❑Ridge ❑Slope laValley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrecs/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From To Formation Description
O • / 7
/2 - ;1/36 vC71 t2
LOCATION SKETCH
Amount SO2 ey?J9,, Show direction and distance in miles from at (east
Wall Thickness two State Roads or County Roads. Include the road
or Weight/Ft Ma nafi numbers and common road names. , 17//e 5E i
Zt'O Per-C- O o
.lee &AdC ?too
From(_ To z.2 Ft. ripe/
14. SCREEN- Depth Diana ter Slot Size Ma coal
From To Ft in. in.
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
Method
16. REMARKS:
2 44,464
,t t)ett
rig
I DO HEREBY CERTIFY THAT HIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH I5A NCAC 2
CONSTRUCTION STANDAR , AND THA COPY THIS RECORD HAS BEEN PROVIDED TO THE
(/act
SIGNATURE
F PERSON CONSTRUCTING THE WELL DA
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Cente
27699-1636 Phone No. [phone], within 30 days. GW-

WELL CONSTRUCTION RECORD
281011
North Carolina - Department of Environment and Na((ttral Resourceses- vision of Water Quality - Groundwater Section
l74C9 ICI �U&bCl/ CERTIFICATION II f5�
WELL CONTRACTOR (INDIVIDUAL)NAME (Trio-qts' /l
WELL CONTRACTOR COMPANY NAME .) ) ",II Ct WC u` lar �'('`.�, PHONE # f 1 "2�T'e
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WO PERMIT#
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential s 'M-unicipal/Public 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Waterinjection ❑ Other 0 If Other, List Use
2. WELL LOCATION: Nq ' Jam/C/CNearest Tow :flt-o^"f County
& '.sJ k vet- vz d
(Street Name. Numbers,
,,Community, Subdivision, Loot No., Zap Code)
3.OWNER Veil)C /1>� (41I'tom
Topographic/Land setting
❑Ridge ❑Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
I'
Address tg S er f% j% IC (�? Lr ( Latitude/(ongitude source:❑GPS❑Topographic map
DEPTH
From To
(St Route No.
burl Co A N `2Cl to
City or TownState
Zip Code
Area code- Phone number
4 DATE DRILLED %a - - O - u 3
5. TOTAL DEPTH: 9 a
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO Cam- /ate '
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 atlor below land surface requires a
variance in accordance with ISA NCAC 2C .0118.
9. YIELD (gpm): q6 METHOD OF TEST n i%
10. WATER ZONES (depth): 70 2/7 1 e 900
11. DISINFECTION: Type aLfc-PfI1%Q_Amount t� 0C
12. CASING: Wall Thickness
From 0
From
From ?/
GROUT:
DepTo
To
Toil V
Depth
From To
FromjliTo E11
SCREEN' Depth
7 r or W,CjghUPL Mg(eriC
7 Vet/Ft.
5Iw C..
Material
Ft FL Iy
/10
Diameter Slot Size
Mete
C/ hiI .I
Material
From To Ft. in. in.
From To Ft. in. in.
SAND/GRAVEL PACK:
Depth
From To Ft.
From To Ft.
16. REMARKS:
Size Material
(check box)
DRILLING LOG
Formation Description
YOI
l -4 ,4/ JL
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common road names.
CD
chug
cn
CCI
frct
I DO HEREBY CERTIFY THAT THIS
CONSTRUCTION STANDARDS, AN
t 7
WAS CONSTRUCTED IN ACCORDANCE WITH I5A NCAC 2C, W LL ( J �;,r
T A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WE4. RATTER Inn
r„ 0
t=
SIGNATU O/ E .NCONSTRUCTINGTHE WELL
DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center -
27699-1636 Phone No. [phone], within 30 days. GW-I
t_
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07/29Q,I
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WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality
WELL CONTRACTOR (INDIVIDUAL) NAME (print) al icy .1 L'.f�IG
WELL CONTRACTOR COMPANY NAME
STATE WELL CONSTRUCTION PERMIT#
(if applicable)
281009
- Groundwater Section
CERTIFICATION # a'J/S
JJ.Sf/ c 6 k/EtL Pri L2_, (J PHONE Si age 7e9-y5-9.9
ASSOCIATED WQ PERMIT#
(if applicable)
I . WELL USE (Check Applicable Box): Residential E� M iicipal/Public 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection ❑ Other 0 If Other, List Use
2. WELL LOCATION:©_, _ /%/f
Nearest Town: q �" County K`�x�
l7,?ryruery /rrf
(Street Name. Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: Oda &l S rr
Address (02 51GV L..p' e d,. H-✓?
) (Street or Route No.)
Lit
City or Town State Zip Code
( )-
Area code- Phone number
4. DATE DRILLED /0' 25? 0 3
5. TOTAL DEPTH: 6o5-
6. DOES WELL REPLACE EXISTING WELL? YES fd NO ❑
7. STATIC WATER LEVEL Below Top of Casing: 80 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 O/JFJTEST --
Waittel
10. WATER ZONES (depth): /gpx b7 9'44
I I. DISINFECTION: Type!/halt.< Amount Pi 62
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
From To Ft.
From 0 To alo Ft.
From 90 To %Z Ft.
13. GROUT: Depth Material Method
From To Ft.
From 0 To f? Ft. 'Pyre i
14. SCREEN: Depth Diameter Slot Size
From To Ft. in. in.
From To Ft in. in.
I5. SAND/GRAVEL PACK:
Size Material
From
From
Depth
To Ft.
To Ft.
16. REMARKS:
Topogla d setting
❑Ridge ope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(dearees/minutesheconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From To Formation Description
0-70 th y5
70 - 00 S�e
go- jzt
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the roM
numbers and common road names. C
CO
0
FTl
C)
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2
CONSTRUCTION STAND S, AND THAT A COP OF THIS RECORD HAS BEAN PROVIDED TO THE
AP" -
WELL
3D
0
OWNER
-D
CTJti
Cs
SI NAT
OF PERSON CONSTRUCTING THE WELL
DA
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Cent
27699-1636 Phone No. [phone], within 30 days. GW
0
--D
G) �
er:
eigh,rlat
V. 07r4101
0
C

283214
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) Jarrlo5 w Camp, Jr.
CERTIFICATION# 71 3 R
WELLCONTRACTOR COMPANY NAME Campus Wa11 R Pnmfs fn Tnc PHONE#87R1 4S3-7322
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential ❑ Municipal/Public 0 Industrial 0 Agricultural let
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATIlO1N:
Nearest Town: '.VL (JttckhA County CLC
"))N` Ci n.rn-t;-• V<
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
t 3. OWNER: ) cr&
Address 10.1 Ik'M- ( Y -" tvk
k Akt"In (Street orRC to No.) 15 1
City or Town State Zip Code
C--)-
Area code- Phone number
4. DATE DRILLED 11.) - t}7 O rid
5. TOTAL DEPTH: Ci03
6. DOES WELL REPLACE EXISTING WELL? YEyS 0 NO 11
7. STATIC WATER LEVEL Below Top of Casing: FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS 1 FT. Above Land Surface'
*Top of casing terminated at/or below land surface requires a
variance In accordance with 15A NCAC 2C .0118.
9. YIELD (gpm): S 1) METHOD OF TEST 21 it
10. WATER ZONES (depth): , (? ()
11. DISINFECTION: Type r h 1 nr i n n Amount Li r�
Wall Thickness
or Wcight/Ft. Material
GDR21 PVC
12. CASING:
Depth
From Q To 11 ()
From To
From To
13. GROUT: Depth
From__ To 212 Ft.
Diameter
Ft. 6 1 / 4
Ft
Ft.
Material
Neat Cement
From To Ft.
14. SCREEN: Depth Diameter
From To Ft. in
From To Ft. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
Method
Hand
Slot Size Material
in.
in
Topographic/lad setting '-{
❑Ridge ❑S1opeValley ❑ "tat 'I
(check appropriate box)
Latitude/longitude of well locatidn j
(degrees/minutes/seconds) "
Latitude/longitude source:❑GPS❑Topograghid map
(check box)
DRILLIN O
Formatio
DEPTH
From To
n [`1O
—
J.00ATION SKETCH
Show direction and distance in miles from avast c7,
two State Roads or County Roads. Include thtxoad-;:,
numbers and common road names. a '
S•FGAPP.-
en
CS
16. REMARKS:
I DO HEREBY CERTIFY THAT THIS WFf i WAS CONSTRUCIbD IN ACCORDANCE WITH 15A NCAC 2C, WFI i
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
/ V V Y'LA iGNATURE OF PERSON CONSTRUCTING THE WELL
�D - /4 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-1 REV. 07/2001

c To: NC Dept cif Env. and Na Resour
4G3 Time: 9:14.26 PM
WELL CONSTRUCT IT
rn Carolina Department of Environment, and Natural Resources -
CON RAC FOR (INDIVIDUAL) NAME (print) SCOIT CAS
i, r LI C O\TRACTOR COMPANY NAME CAROLINA WELL Oi
T. }.LL C:i STRUCTION PERMIT #
Dot Residential Z Mlu.i.ba. _
GoatPump Water Injection D Other L.
County MCDOWE'.',
G.D. MARION, NC
.n1y Subd.ehioq Lot No,. Zip Coda)
Eliketio ). ?Ri1N
281940
)N RECORD
a:_ of Water Quality - Groundwater Section
CERTIFICATION a 258e
t4 S INC.. PHONE # [phone]
ASSOCIATED WQ PERMIT#
Cifapplicable)
Ei Agricultural L
NC
Sta:e
iN3 WELL'?
'
Top ofC
Yes ❑ NO td
60 04.
(Us: "*" lfAbavc Top of Casing)
_ Abosp Land Surface'
'e raec., :. v_s...n
: T0.OD04 TEST ARUM
325
Topo}aphic'Land settine
❑ Ridge ❑ Slope ❑ Valley
L atitude Longitude of well locaron
31.41.50552.03.240
(degrres:minute>§aeon's)
'ltul so- tie_ 0 GPS '�Te cos -1--
ER?TEi DRILLD _
To
43 Clay
l7
33C Ceticl.(1tas:_
HO rOCHLORITE Amount 9
Diameter
6 1.4
Wall Thickness
or Weight/Ft. Material
SDR 21 PVC
Diameter
Material Method
GRAVEL MIX GRAVITY
Slot Si7c Mate,ia!
in
Mamie
IiS WELL WAS CONSTRUCTED -
[)zRDS, AND THAT A COPY OF THIS RECC4
SIGNATURE OF PERSON CONS ,• EL_
Division of Water Quality, Groundwater S€ tat -
3r= i'_ `,0. (99) 733-3221, within 30 days.
LOCATION SKETCH
lien anti distance in miles from at 1.
Roads or Comity Roars. incluals the
ted common Fond n rues
CO
0
re
r
l
I Gird
a 1.111TA NC-C2C.1r91,
1_DEDTO THE ELL CAVIL:
-41 mz
10'17-C'
Date . - _
Ice center - Raleigh, N C

281822
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and tutal Resources - Division of Water Quality - Groundwater Section�l�7
WELL CONTRACTOR (INDIVIDUAL) NAM(S (paintp� "pp �L' /� CERTIFICATION�0027
WELL CONTRACTOR COMPANY NAMF .C3��/Li.i e�J LtJe1(49/244 2 PHONE # (Ka /o Y9 DRIB d
STATE WELL CONSTRUCTION PERMITS IV�/S1 _ASSOCIATED WQ PERMITS y/iv
(if applicable) (if applicable)
I. WELL USE (Check Applicable Box): Residential al Municipal/Public ❑ Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION
Nearest Town:
County?%,CLE LIJ/a
Jeg ?6 2_
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER:
Address
Laiatt
(tkeaClmittreetiy.Rroute. No.)
City or Town Stale tip Code
Area coda Phone number 9/V / o 3
4. DATE DRILLED
5. TOTAL DEPTH: So 3-
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO 8d
7. STATIC WATER LEVEL Below Top of Casing: / $ I) FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS /. S FT. Above Land Surface*
'Top of casing terminated at/or below land surface requires a
variance hi accordance with 15A NCAC 2C .0118. .
9. YIELD(gpm): u.2 THOD OF TESTrav-co
10. WATER ZONES (depth): YO
11. DISINFECTION: Type OF -kW— Amount /%/ n L
12. CASING: Wall Thickness
th
From To .1.G Ft. G y
From To Ft.
From To Ft.
13. GROUT: Depths. Maim? a
From P To ? 0 Ft. Ci'
From To Ft.
14. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in.
Fro To Ft. in. in
15. S /GRAVEL PACK
Depth Size Material
From�I'o Ft.
From--7To Ft.
Topographic/Land setting
kiRidge ❑Slope ❑Valley ❑Fiat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From To Formation Description
r �
LOCATION SKETCH rn
Show direction and distance in miles om at le.
two State Roads or County Roads. Incl
or Wei t/Ft. rnal numbers and common road names.
16. REMARKS:
6
650(1
w
0
0
N
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUC t:D IN ACCORDANCE WITH 15A NCAC 2C, WFt 1
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
g, r ti 641/ `/0 3
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
c_
0
n
c
rn
-^4 rn
o
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
IWU
riu

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and N
WELL CONTRACTOR (INDIVIDUAL) NAMJ, (print)
WELL CONTRACTOR COMPANY N
STATE WELL CONSTRUCTION PERMIT#
(if applicable)
281821
Resources - Division of Water Quality - Groundwater Section
'� "" ,� L /JL CERTIFICATION
W `F PcitA S' PRONE # Orli 4549-09P
/VIC ASSOCIATED WQ PERMIT#
(if applicable)
1. WELL USE (Check Applicable Box): Residential JCL MunicipallPublic 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION.
Neaicgst Town:
(Sheet N
3. OWNER:
Address -4, 53
(Street or Route N..,,
ZTa -4 4/.C• 07895-2
County ,,&& a-k
a .28752-
Numbers, Community, Subdivision, Lot No., Zip Code)
City or Tnwn State
M qd
Zip Code
606- 779- 8 y/G
Area coda Phone number
4. DATE DRILLED 9�3/0 -3
5. TOTAL DEPTH:
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO St
7. STATIC WATER LEVEL Below Top of Casing: .20 FT.
_ (Use "+" if Above Top of Casing)
8. TOP OF CASING IS /.3 FT. Above Land Surface*
'Top of casing terminated at/or below land surface requires a
variance in accordant, with ISA NCAC 2C .0118.
9. YIELD (gpm): 90 METHOD ODTEST etost F
10. WATER ZONES (depth): 7i r / S I
11. DISINFECTION: TypefiS Amount g 6z
12. CASING: Wall Thickness
Depth, I�rarttor Wei t/Ft. Material
From 0 To � Ft. le :�eter > .2 rya
From To FL
From To Ft.
13. GROUT: Depth ppMat M od
From(_ To. Ft f
From To Ft.
14. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in.
From �To Ft. in. in.
15. SAND/GRAVEL PACK:
Size Material
From To Ft.
From To Ft.
16. REMARKS:
Topographic/Land setting
❑Ridge ❑Slope Walley ❑Fiat
(check appropriate box)
Latitude/longitude of well location
(degreeshninutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DRILLING LOG
Formation Dexriptii_
DEPTH
From To
LOCATION SKETCH
Show direction and distance in miles #rom at le
two State Roads or County Roads. Include the road
numbers and common road names.
kit
1 DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUL1to 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
-?/-3/0 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

281814
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print)�Q�/ •/� L//�////� CERTIFICATION th 2P77
WELL CONTRACTOR COMPANY NAblEjacefier,itfJ�'.ft1Y?iltar. PHONE # (62,9)— ro 519 0 K0a
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ ERMrr#
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential a MunicipalPublic 0 Industrial 0 Agricultural 0
Monitoring ❑ Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION: ty/W ellk
Nearest Town-�`%Gr9-r1. Coum iw )v/,
L Y jL e MTAV xf d .Zg7S�
(Street Name, Numbers, Comm(unity, Subdivision, Loft No., ZipZiCode)
3. OWNER:Y0.)--tttlPal4e QL{YLo:
Address a n /y Loute t — t�
(Street or No.)
7zlllt,L,su 1y r, 9tY�s�
City or Town State Zip Code
Arca code- Phone numbers
4. DATE DRILLED ?Atli o 3
5. TOTAL DEPTH: a 05
6. DOES WELL REPLACE EXISTING WFI I ? YES 0 NO ,R
7. STATIC WATER LEVEL Below Top of Casing: S FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS /.,5 FT. Above Land Surface"
'Top of casing termtaated at/or below land surface requires a
variance In accordance with ISA NCAC 2C .611S.
9. YIELD (gpm): /..5 METHOD OF TEST f tend.
10. WATER ZONES (depth): //o r
11. DISINFECTION: Typepta--- Amount 9 47-^
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
From 0 To /0d Ft.44. #.1../ ®[/L
From To Ft.
From To Ft.
13. GROUT: Depth Material M�e(tho"'d' •
From 0 To .2 o Ft. (..nq?.� �
From To Ft.
i4. SCREEN: Depth Diameter Slot Size Material
From o Ft. in. in.
From / To Ft. _in. in.
15. SAND/GRAVEL PACK:
di Size Material
Frotn / 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❑Topographic map
(check box)
DEPTFI PRILLING LOG
From To
Formation Descrjption t
LOCATION SKETCH
Show direction and distance in [Hiles from atll..aat
two State Roads or County Roads. Include the road
numbers and common road names.
16. REMARKS.
t DO HEREBY CERTIFY THAT THIS WFI 1 WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WEI I OWNER
SIGNATURE OF PERSON CONSTRUCTING THE WELL
1s9-/n3
BATE
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

281813
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print)_ L.. CERTIFICATION #2277,7
WELL CONTRACTOR COMPANY NAME tr £4.209 tPt .#C€jr _PRONE # (82,9) — y4—dr/ffd
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ R,r1(T#
(if applicable)
(if applicable)
I. WELL USE (Check Applicable Box): Residential al Municipal/Public ❑ Industrial 0 Agricultural 0
Monitoring 0 Recovery ❑ Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL NeareLOCATION-
tyn ��
Town:Cotm m�
,2 (75-2
(Street Name, NumberKConummity, Subdivision, Lot No Zip Code)
3. OWNER:
Address f
arne
mo-fr icnse�r%
(Street or Route No.)
City or Town State Zip Code
Area A E DRILLED
ED�/.2 y/ o 3
4. DATE DRILLED
5. TOTAL DEPTH: ..2 OS'
6. DOES WELL REPLACE EXISTING WFI f ? YES 0 NO t2
7. STATIC WATER LEVEL Below Top of Casing: /O FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS / .S FT. Above Land Surface'
*Top of casing terminated at/or below land surface requires a
variance In accordance h ISA NCAC 2C .0118.
9. YIELD (gpm): /S IvW.THOD OF TESTT�G�r,
10. WATER ZONES (depth): YO • / IS '
11. DISINFECTION: Type`
12. CASING:
Amount 9 CZ"
Wall Thickness
Topographic/Land setting
❑Ridge ri4Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic man
(click box)
DRILLING LOG
DEPTH
From To
Depth Diameter or Weight/Ft. Material
From To «0 Ft /..-*L.2./ f t/C.
From To Ft
From To Ft.
13. GROUT: Depth ( Method
From O To ea 0 Ft. '^^)'`�"v- '7,
From To Ft
14. SCREEN: Depth Diameter Slot Size Material
Fronk /To Ft in. in.
From / To Ft in. in.
15. SAND/GRAVEL PACK:
th Size Material
From To Ft.
From To Ft
16. REMARKS:
Formation
escnptronl —tl
LOCATION SKETCH
Show direction and distance in mil
two State Roads or County Ro
numbers and common road
n
Ul
0
I DO HEREBY CERTIFY THAT THIS WFI I WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WFI I OWNER
f; /3a.1, 9/.y/.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

281812
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
L CERTIFICATION
WELL CONTRACTOR (INDIVIDUAL) NAM (print) [JLU iy_Ly ic�
WELL CONTRACTOR COMPANY NAME L.t.20,�
STATE WELL CONSTRUCTION PERMIT#
(if applicable)
02E27
_PHONE # cer - r%9 4,8-4
ASSOCIATED WQ PER.1IIT%
(if applicable)
1. WELL USE (Check Applicable Box): Residential 0 Municipal Public 0 Industrial 0 Agricultural ❑
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION: •
Near Town: Co.2f,y7C nt v
W, c tad s
(Stint Name,
/Numbers, Community, Subdivision, Lot No., tip Code)
3. OWNER:1i 4s '�`�j`e a
Address �Q5 ru��^ ett;t-sisa a'd
City or Town
Area code- Phone number
4. DATE DRILLED 4/o2, /D 3
5. TOTAL DEPTH:
(Street or Route No.)
•
State
57SZ
Zip Code
6. DOES WELL REPLACE EXISTING WELL? YES 0 „O p.'
7. STATIC WATER LEVEL Below Top of Casing: FT.
(Use "+" if Above Top of Casing)
S. TOP OF CASING IS lj FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance to accordance with ISA NCAC 2C .0118.
9. YIELD (gpm): .O METHOD OF TEST':ton,
10. WATER ZONES (depth):
11. DISINFECTION: Typef%
12. CASING:
Depth Diameter
From Q To./SD FL
From To Ft.
From To Ft.
Amount
Wall Thiclmess
or Weight/Ft. Material
Sid t-
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 PRITLING LOG
From To Formation Descriptic__..
13. GROUT: Depth Material
From 0 To Ft. aa-on_o.sW
From To FL
14. SCREEN: Depth Diameter
From /To Ft. in.
From / To Ft. in.
15. SAND/GRAVEL PACK:
th
From_... To Ft.
Method A •
'od
Slot Size Material
in.
in.
Size Material
From / To Ft.
16. REMARKS:
LOCATION SKETCH
Show direction and distance in miles from
two State Roads or County Roads. Include the road
numbers and common road names.
[NtrG
.?S'
Gi
S
at least
1
1 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
£nit t� e3Q/l/ 9/&3l D 3
SIGNATURE OF PERSON CONSTRUCTING THE WFI 1 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

281810
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and NNflrral Resources - Division of Water Quality - Groundwater Section
7
WELL CONTRACTOR (INDIVIDUAL) NAM (print)) /1 /7/��Vps/ l fin. L CERTIFICATION nyi D
WELL CONTRACTOR COMPANY NAMEdS .LLL t f%If (LP4./ 4.0 PHONE # W8) G ry O i/ O
STATE WELL CONSTRUCTION PERMIT# ell ASSOCIATED WQ PERMIT# A091
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential ® Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION:
Nearest Torn: %%7tt .i-u County "0 (' 62
7CLG— cq.Gcoc.Jerr—
(Street Name, Numbers, Community, Subdivision,%viojLot No., Tip Code)
JP"Gm�' ( G?�(9� 3. OWNER: L7
Address /.2 S/o `}d4r. c 4 t� Of i
(Street or Route No.)
7'f7at4toz 4/. c . J 17sz
City or Town State Zip Code
Area code- Phone number
4. DATE DRILLED V / 9/D .3
5. TOTAL DEPTH: y.ar
6. DOES WELL REPLACE EXISTING WELL? YES p� NO 1$
7. STATIC WATER LEVEL Below Top of Casing: /I?i FT. /
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS 2_5— FT. Above Land Surfaces
'Top of wing terminated at/or below land surface requires a
variance in accordant with ISA NCAC 2C .0118.
9. YIELD (gpm): METHOD OF TESTTCLnre
10. WATER ZONES (depth /t% i�9C
Topographic/Land setting
❑Ridge ❑Slope Malley rat
(check eppmpriate box)
Latitude/longitude of well location
(degrees/mimaes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From To Formation Description
11. DISINFECTION: Type /d--
12. CASING: v
Depth
From 0 To fGh Ft.
From To Ft.
From To Ft.
13. GROUT: Depth
From /i To '20 Ft.
Ft.
From To
14. SCREEN: Depth Diameter
From To Ft. in.
From To Ft. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
Fro To Ft.
Diameter
61-
Amount 42 a -
Wall Thickness
or Weight/Ft. Material
MateanLatrial
od
f,t fL[n�
Slot Size Material
in.
in.
16. REMARKS:
LOCATION SKETCH
Show direction and distance in miles fr
two State Roads or County Roads. Incl
numbers and common road names. tin
I DO HEREBY CERTIFY THAT THIS WFI I 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
ea/
9
SIGN TUBE & ESN CON UC THE WE.I t � DATE b
Inn
UV
c.1.,
+ Ain 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

281808
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
p
WELL CONTRACTOR (INDIVIDUAL) NAME (print) /y� / G I�f,n�L Z.—CERTIFICATION sic O // /
WELL CONTRACTOR COMPANY NAME !� ( �W _PHONE Y �— 4 v -O,v%Fi6
STATE WELL CONSTRUCTION PERMIT# /�/o% ASSOCIATED WQ1 1T# N/i7/e%�
(if applicable)
(if applicable)
1. WELL USE (Check Applicable Box): Residential 12. Municipal/Public ❑ Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION:
Nearest Town: 7z4.eez-c County fc eTZ0.G1,
,4t,2,z.6.Y 2 jai.' he ,v,C. „?S77.TI
(Street Name, Numbers, Community, Subdivision,pp�di�Lot No., Zip Code)
3. OWNER: 9l�/SH /1%C2ePe
Address ea/4 t 1,2 , A/
(Street or Enure No.)
City or Town // State Zip Code
((toot 7...s4 — 4/3�y3 6 /
Topographic/Land setting
4Ridge ['Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic reap
(check box)
DEPTH DRILLING ,LOC
From To Formation Description
Area code- Phone number
4. DATE DRILLED 9//7/O 3
5. TOTAL DEPTH: 3 'S
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO t$
7. STATIC WATER LEVEL Below Top of Casing: 7S' FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS //, 5 FT. Above Land Surfaces
'Top of casing terminated at/or below land surface requires a
variance la accordance with ISA NCAC 2C .011S. '
9. YIELD (gpm): /0 METHOD/OF TEST 7a
10. WATER ZONES (depth): .2 b 1
11. DISINFECTION: Type Amount 43, 4i
12. CASING: Wall Thickness
Depth/ Diameter or Weight/Ft. Material
From 0 ToJeQ 1c Ft -�. ,' tJJ tJ t/ C_
From To Ft. 7
From To Ft.
13. GROUT: Depth Material Method
From D To 02 D Ft. Lr i ii /11.1/1
From To Ft.
14. SCREEN: Depth Diameter Slot Size Material
From /To Ft. in. in.
From / To Ft. in. in.
15. SAND/GRAVEL PACK:
th 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.
tit
Nye
CD
CO
ToP09 Hi"' o
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
-2; r342-69
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
c
G

281805
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Na Resourcesu- Division of Water Quality - Groundwater Section
�i/�
WELL CONTRACTOR (INDIVIDUAL) NAMEDQ (print)q� ENO/4/�G�,�R MLL CERTIFICATION #e.Zd//
WELL CONTRACTOR COMPANY NAME,Xea,,� eu / iiA9 ✓ eJ7 ?.�ec PHONE # f %'/a yp dsfire
STATE WELL CONSTRUCTION PERMIT# N/ ASSOCIATED Q PERMIT# el
(if applicable)
(if applicable)
1. WELL USE (Check Applicable Box): Residential la Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION:
Ne&a�jT,� CotmtyAC tzt (
crew" cr7.5-7
(Street Name, Numbers, Community, S4Wvision, Lot No., Try Code)
3. OWNED__-__ �7
Address 3�' o/ /2QJ7rr-r2
• (Street or Route No.)
?Than-. iVe,-28'75-7
City or Town State Zip Code
Atcode-Phone numbe
4. DATE
DRILLED r// wa/ D 3
5. TOTAL DEPTH: . 3 VS
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO {Til
7. STATIC WATER LEVEL Below Top of Casing: /Po FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS / $ FT. Above Land Surface*
'Top of cuing terminated at/or below land surface requires a
variance 1n accordance with 15A NCAC 2C .0118.
9. YIELD (gpm): V N HOD OF TEST-
10. WATER ZONES (depth): Te ' 30
11. DISINFECTION: Type 9.4
12. CASING:
Amount // e><
Wall Thickness
Depth Diameter or Weight/Ft. Material
From 0 To i�0 Ft #.Z! Gnat
From To Ft
From To Ft.
From
13. GROUT: Depth Material M' LdJ
ID To e20 Ft. � �.i/
From To Ft.
14. SCREEN: Depth Diameter Slot Size Material
From /�To Ft. in. in.
From .. To Ft. in. in.
15. SAND/GRAVEL PACK:
th
To
Size
From Ft.
Material
FromTo Ft.
16. REMARKS:
I DO HEREBY CERTIFY THAT THIS WFr i 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
(y1ra &o��
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
Topographic/Land setting
❑Ridge ISSlope ❑Vailey ❑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
LOCATION SKETCH
Show direction and distance in miles
two State Roads or County Roads. Inc
numbers and common road names.
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

283227
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) Ja m n s Came, Tr CERTIFICATION # 2118
WELL CONTRACTOR COMPANY NAME ramp S Wpl 1 R Primp Cn, Tnr PHONE #3%7R) dSi-7322
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable)
(if applicable)
1. WELL USE (Check Applicable Box): Residential Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION: ,,pp
Nearest Town:
fi )Pg5anj Gzlr'E;6unty c))ott )1
(l y( 55t0
(Street Name, Nurhbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: p ( 3A-IL
Address / 70
( treA�qor Routq No.)
p)c0.5a k_, (>4velem-
4.
5.
6.
7.
Ks
C
City or Towo''// State Zip Code
(S�g)- �W7 goo4
Area code- Phone number
DATE DRILLED 20.- l C- 03
TOTAL DEPTH: -3 n c
DOES WELL REPLACE EXISTING WELL? YES 0 NO
STATIC WATER LEVEL Below Top of Casing: `J,2 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS 1 FT. Above Land Surface'
*Top of casing terminated at/or below land surface requires a
variance in accordance with 15A NCAC 2C .0118.
9. YIELD (gpm): 30 METHOD OF TEST A i r
10. WATER ZONES (depth): 31 0
11. DISINFECTION: Type rh l nri np Amount li cur
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
From p To /4-S Ft.6 a /4
From To Ft.
From To Ft.
DR21 PVC
13. GROUT: Depth Material Method
From_g To 20 Ft. Neat Cement— —
From To Ft.
14. SCREEN: Depth Diameter Slot Size Material
From To Ft. in in.
From To Ft. in. in.
15. SAND/GRAVEL PACK: 2
Depth Size Material
From To Ft.
From To Ft.
Topographic/Land setting
❑Ridge ❑Slope ❑Valley ❑Fiat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topogr
(check box)
DEPTH DRILLING
From To Formation Description
J /µ3 (girl-
/2) 3 3 nrr Con of, date Yo LK
bic map ;
�a.
0
LOCATION SKETCH
Show direction and distance in miles from atdeast 7=
two State Roads or County Roads. Include the3oad
-_
numbers and common road names. 3 .; T-1
—1
16. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WFI r
CONSTRUCTION STANDARDS, THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
C iVV mod_ li(/. (ft-itn-A
NATURE OF PERSON CONSTRUCT ,(VG TFyE 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

283221
WELL CONSTRTJCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) 3 mn s t.,- Camp, Jr CERTIFICATION 6 71 3R
WELL CONTRACTOR COMPANY NAME ('.amp' c Wn1 1 R ➢nrapz CrL Tnr
STATE WELL CONSTRUCTION PERMITU ASSOCIATED WQ PERMIT#
(if applicable) — (if applicable)
/
1. WELL USE (Check Applicable Box): Residential lid Municipal/Public 0 industrial 0 Agricultural 0 1
Monitoring 0 Recovery ❑ Heat Pump Water Injection 0 Other 0 If Other, List Use
PHONE p%,7R) 4S3-7322
2. WELL LOCATION: (�
Nearest Town a t' I o ✓ _ County Mc D0 UJe-4
th 4e LAke ILaIKe✓ R-ck. pooI site
(Street Name, Numbers, Commwiry, SubdivisiJ�on, Lot No., Zip dale)
3. OWNER: Greet jec l si%oV SI--
Address I) 7 Lautre) L&Ke5 tar KuJat/
(SECet or Route No.)
krLKe Lure lei L e29 141
Ciry or Town State / Zip Code
(44)- 2841 — 2 o 3 6
Area coda- Phone number ' I
4. DATE DRIJIFD IDI"T
5. TOTAL DEPTH: .305'
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO Piri
7. STATIC WATER LEVEL Below Top of Casing: 4' FT.
(Use "r" if Above Top of Casing)
8. TOP OF CASING 1S 1 FT. Above Land Surface`
'Top of casing terminated at/or below land surface requires a
variance In accordance with 15A NCAC 2C .0118.
9. YIELD (gpm): 30 METHOD OF TEST &i r
10. WATER ZONES (depth): R 75
11. DISINFECTION: Type r h 1 n r i n a
12. CASING:
Depth Diameter
From p To GS Ft 6 1 / 4
From To Ft.
From To Ft
13. GROUT: Depth Material Method
From o To -20 Ft. Neat Cement
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
Amount 1 Cal°
Wall Thic)mess
or Weight/Ft. Material
GDR?1 PVC
From To _ Ft.
From To Ft.
. 16. REMARKS:
Topographic/L setting
❑Ridge ❑Slope alley ❑Flat
(check appropriate box)
Latitude/longittde of well location.'
(degreeslminutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box) I
DEPTH D'I �d-.__
From To Formation De cription L i.,
n 6s eta..
v� 3Ds-
LOCATION SKETCH Iv
Show direction and distance in miles from at leas
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 0 THIS RECORD HAS BEEN PROVIDED TO THE WFI i OWNER
(t4 t&4
SIGNATURE OF PERSCIN CONSTRUCTING THE WELL
ID- 14 -G3
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
CO
s
tv ter=
-1

WELL CONSTRUCTION RECORD
283165
North Carolina - Department of Envin nment and Natural Resources - pDivisQion if Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NA' 1E (print) Deec:c% h aA-d'\ qo,. ya CERTIFICATION 1_3tG
WELL CONTRACTOR COMPANY NAME e-Ndea Se♦1-1`3CV 0 tavvtxP"'e PHONE # 6?2$31 GAS- Lcu
STATE WELL CONSTRUCTION PERMIT' ASSOCIATED WQ PERMIT#
(if applicable) - (ifapplcable)
s1111111•
I. WELL USE (Check Applicable Bo t): Residential ® Municipal/Public ❑ Industrial ❑ Agricul ural ❑
Monitoring ❑ Recovery ❑ He t Pump Water Injection ❑ Other ❑ If Other, List Use
2. WELL LOCATION:
Nearest Town: Mac : o rn County M C. QcwP \\
13."1% P\'Cy lr,ye- 28'152
(Street Name. Numbers, Con unity, Subdi ision, Lot No., Zip Code)
3. OWNER: f V- -\ -roe CtC V \\
Address \a'ls G''\ey 1NvC
(Street or Rode No.)
c*Aacto v\ (\C
City or Town State
(j'] )- Lk 33' LI2'1'i
Arca code- Phone number
4. DATE DRILLED 10-a-0%
5.-TOTAL DEPTH:
6. DOES WELL REPLACE EXISTIP
7. STATIC WATER LEVEL Below 1
(Ui
8. TOP OF CASING IS \
*Top of casing terminated at/or below la.
variance in accordance with ISA NCAC
9. YIELD (gpm): 020 METH(
10. WATER ZONES (depth):
oi8'l S T.
Zip Code
G WELL? YES ❑ NO l
op of Casing: oiD FT.
"+" if Above Top of Casing)
'T. Above Land Surface*
d surface requires a
C .0118.
D OF TEST fN ••
Topographic/Land setting
[]Ridge ,®Slop-. ❑Valey DFlat
(check appropriate E >x)
Latitude/longitude of wt 11 location
(degrees/minutes/sect ads)
Latitude, longitude source:❑GPS-7Topographi: nap
(check I ox)
DE'TH GRILLING LCG
From To ForrtationDeseriFtic-
}\ 4',Z bver ksx.er\na
I . DISINFECTION: Type f2 t\5
12. CASING:
Depth Dior eter
From .t.1 To 42 Ft. (Air
From To Ft.
From To Ft.
�rti`o nt:te
`o 'Cr"'
rJ itn:
LOCATION SKETCH O 0
Amount 6 Show di -ection and distance in re les fro at Igst
Wall Thickness two Stat, Roads or County Road . Include the"oa
or Weight/Ft. Material numbers and common rc ad name>.
Irk-2:c.
13. GROUT: Depth M rterial
From 0 To ?b Ft. Cemese)
Method
poUCCc\
From To Ft.
14. SCREEN: Depth Diame er Slot Size Material
From To Ft. in. in.
From To Ft. in. in.
15. SAND,/GRAVEL PACK:
Depth Siz, Material
From To Ft.
From To Ft.
16. REMARKS:
1 DO HEREBY CERTIFY THAT THIS WE..L WAS CONSTRUCTED IN ACCORDAN IT WITH ISA NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND TEAT A COPY OF THIS RECORD HAS BEE 1 PROVIDED TO THE WILL OWNER
b twin 7-I
SIGNAT JRE4F PERSON CONSTRUCTING THE V'EL.L DATE
IO_,2.O 3
Submit the original to the Division of dater Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
27699-1636 Phone No. [phone], wi: hin 30 days. GW-1 REV. 07/200I

WELL CONSTRUCTION RECORD
f
Division o Water Quality - Groundwater Section
282511
North Carolina - Department of Environnteld and Natural Resources
r / CERTIFICATION P��� /�O
��c-��
WELL CONTRACTOR (INDIVIDUAL) NAME (ptiat PHONE a l%g
WELL CONTRACTOR COMPANY NAME TED WQ PERMITS
STATE WELL CONSTRUCTION PERMIT* (if • •licable.
(if licable)
I. WELL USE (Check Applicable Box): Residential C MtnicipaVPublic 0 Industrial 0 Agricultural
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
Topographic/Land setti
(Ridge °Slope °ealle
(check appropriate
Latituddbngitude of well t
Town:
2. WELL LOCATION: T d� County a_
Nearest TTown:
(Street Name. Numbers, Community. Subdivision, tut No.. tip Code)
3.OWNER: at�l�S9' 5
Address
(Street or Route No.)
pops
City or Town slate
(_)• 7 '11
Area code- Phone number
4. DATE DRILLED
5. TOTAL DEPTH: .C. 0 NO
6 DOES WELL REPLACE EXISTING WELL?
YES 7. STATIC WATER LEVEL Below Top of Casing: J FT. —
(Use •`f" if Above Top of Casing) _ —_-
8. TOP OF CASING IS FT. Above Lend Surface'
*Top of casing terminated allot below Ind surface sequins a �—
variance lo accordance with 15A NCAC tC Alt
9. YIELD (gpm): 2 METHOD OF TEST
l0. WATER ZONES (depth): Z o^^ N SKETCH
�� N� mount ( 2 1v Show direction and distance in miles from at least
11. DISINFECTION: N: Type /! two State Roads or County Roads. Include the road
12. CASING:
WallThickness numbers and common road names.
Tao Code
(devour/minutes/seconds) r- �!
Latitude/longitude source:l7P OTo
bna
RI
Formatio
Liana'
From To
From
From O To
From `IZ To
13. GROUT: Depth
From To
From__ To 2`—Ft.
'14. SCREEN: Depth Di
From To Ft._
Fro, To Ft
IS. SAND/GRAVEL PACK:
Depth
From To Ft.
From To Ft.,
Depth Diameter or Weight/Ft. Material
To Ft.
Z Ft
Ft
Material
FL
16. REMARKS:
1 DO HEREBY CERTIFY THAT THIS WELL. WAS CONSTRUCTED IN ACCORDANCE WITH 15 CAC 2C, WELL
CONSTRUCTION STANDARDS, AND THA 1' COPY OF THIS RECORD HAS BEEN PROVID i TO THE WELL OWNER
DATE
Size
In.
in.
Method
Slot Size Material
_ in.
in.
Material
�• SIGNATU 0 PEa CONSTRUCTING THE WELL
'
Submit the original to the Division of Water Quality, Groundwater Section,1636 Mail Service Center Raleigh, NC 1
27699-1636 Phone No. [phone], within 30 days.

WELL CONSTRUCTION RECORD
282510
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) 0Fi1t7 T j'I/c CERTIFICATIION#._2J5e
WELL CONTRACTOR COMPANY NAME .f iC�if se U-b Cs/-L•ruj PHONE #
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential It�Municipal/Public 0 Industrial 0 Agricultural ❑L 1 J
Monitoring 0 Recovery ❑ Heat Pump Water Injection 0 Other 0 If Other, List Use I `' i r'-���,'
WELL LOCATION: ographic/Land setting
Nearest Town: eut.L.Ar,-- Count T� f Doc; 1
Y t dge ❑Slope ❑Valley G1FIat
(check appropriate box)
(Street Name, Numbers, /Commmuunity,, Subdivision,dLot No., ZZip Code) Latitude/longitude of well locakiga;
3. OWNER: P(.GCA-� / �°"-'�-�� •- Rik t 1ti.i (degrees/minutes/seconds) 'f - •
-
Address i�b 4av Ifre Latitude/longitude source:❑GPS❑TopP4apiic map
(Street or Rome No.) (check box)
2.
SC-a^ica-A (13 (_
2fr?7 B
DEPTH DRILLING LOG
City or Town State Zip Code From To Formation
)- 773-- / 5 7S
Arca code- Phone number
4. DATE DRILLED /o-9- 03
5. TOTAL DEPTH: 706
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO
19-. ;00 p.r.�.l' FS
705— <g/4.a.c
7. STATIC WATER LEVEL Below Top of Casing: 1/0 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): /S METHOD OF TEST"/+2
10. WATER ZONES (depth): /..S-Ve � e 275
LOCATION SKETCH
11. DISINFECTION: Type(; tOde.,;yt Amount SOO &736 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 Weieht/Ft. Material numbers and common road names.
From 0 Toe FL 619 4_ Pee /L14r:CCa.1
I'
From To/04 Ft. (Oli$ 8es J'i dC C 226
W
0
FromjOS To 70? Ft. 679 /RA ,S�t}? //,� c`
13. GROUT: Depth Material Method J 7c -c ={zcfciir >
From To FL n/� 'Q � /h„� I �"�
From To &ffi Ft. / i'oLL}e+X "L'd • e c
14. SCREEN: Depth Dia of r Slot Size Material -0 ni ^
From To Ft. in. in.` i-i
From To Ft. in. in. co
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft. P L., ��
From To FL o� X
16. REMARKS:
✓ 0
w
O O
1 DO HEREBY CERTIFY THAT IS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15ANCAC 2C, WELL
CONSTRUCTION STANDARDS D THAT A COPY OF THI RECORD HAS BEEN PROVIDED TO THE WELL OWNER
INA/fURE
ERSON CONSTRUCTING THE WELL DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-1 REV. 07/2001

282509
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources Division of Water Quality - Groundwater Section
\YELL CONTRACTOR (INDIVIDUAL) NAME (print) GAPS 5uS'#ICI CERTIFICATION
WELL CONTRACTOR COMPANYNAME 3 54-tcE PHONE #?A)22 u-QT3'
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT
(if applicable) (if applicable)
-�t
1. WELL USE (Check Applicable Box): Residential t9' Municipal/Public 0 Industrial 0 Agricultuty'k❑
Monitoring ❑ Recovery 0 Heat Pump Water Injection ❑ Other ❑ If Other, List Use
2. WELL LOCATION:
Nearest Town: inilig'0/4 County in %•kutin
/87 Pere Li) aa rU
(Street Name. Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: R1J-e P4 OI"—
Address
?o &cY 4y2
(Street or Route No.)
City or Town State Zip Code
(9LB )- z 73 - / ,r 7;
Area code- Phone number
4. DATE DRILLED
5. TOTAL DEPTH: ,? A5-
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO ®--""
7. STATIC WATER LEVEL Below Top of Casing: 9b FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS 1 FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordance with 15A NCAC 2C .0118.
9. YIELD (gpm): % j METHOD OF TEST J4 //Z
10. WATER ZONES (depth): /V55,41/2.. 27 2 VO
� �Topographic/Land s4ftiti
Ltfttoge ❑Slope ❑Vall4g,,* Flat
(check appropriate box?:".,
Latitude/longitude of well Fuca on
(degrees/minutes/secona.
Latitude/longitude source:❑GPS❑ o(w ira hie ma
(check bo
DEPTH D LLING L
From To Forma on rescnp ion
0- ge3
I L DISINFECTION: Type e (e, Pe Amount 13(52-6" a
12. CASING: Wall Thickness
Depth Di [deter or Weight/Ft. Material
From y0 To Ft. �� j!! i/ rt
From (P To Ft. 6 /89
From To Ft.
13. GROUT: Depth
From To Ft.
From tt5 To VD Ft. 2,l-t/ 1 _1
14. SCREEN: Depth Dia(neter Slot Size M erial
From To Ft. in. in.
From To Ft. in. in.
15. SAND/GRAVEL PACK
Depth Size Material
From To Ft.
Ft.
Material Method
From To
16. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH I5A NCAC 2C, WELL
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
nuumbersZnd common road names.
22
Main
fii 3
tu
CONSTRUCTION STANDARDS, A TH - SA COPY OF T y. RECORD HAS BEEN PROVIDED TO THE WELL OWNER
G
RE OF PERSON C
STRUCTING 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
FT

282508
WELL CONTRACTOR (INDIVIDUAL) NAME (print)
WELL CONTRACTOR COMPANY NAME \Cr➢ncE INtL C Or Cc.;/4 t2 PHONE # (a"e1729-45-4p
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
CERTIFICATION # 2C0
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential I9'Municipal/Public ❑ Industrial ❑ Agricultural
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use
2. WELL LOCATION:
Nearest Town: Mdricx.: County M Oufare2C
&Les..Hae'd COI% M .
(Street Name. Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: Fr A Al it; /2- IYI A-rLow't
Address Zti S (LC,u acol P r •
iiTL� (Street or Route No.)
itre.tl 1d C.-
City or Town State
)- 65-4- /923
Area code- Phone number
4. DATE DRILLED / O/ Z/I o 3
5. TOTAL DEPTH: 2 2 r
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO
7. STATIC WATER LEVEL Below Top of Casing: 6O 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 it in-
10. WATER ZONES (depth): fQ 2/Nu lc' 2 oc '
Amount ed o2
11. DISINFECTION: Type C tor/ Ate
12. CASING:
Depth
From To So Ft.
From 5 o To y0 Ft.
From!/0 To //L Ft.
13. GROUT: Depth
14. SCREEN;
.2, Mt
Zip Code
Wall Thickness
Diameter or Weight/Ft. Mat 1
r/q yo P
_hip__ PE'e
, Rfi 54-A t
Material
From To Ft.
From 0 To RO Ft. //0¢
From
Method
,p
Depth Dia eter 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.
16. REMARKS:
Topographic/Land_settiing
❑Ridge ❑Slope ®'Valley i3FJa
(check appropriate box)
Latitude/longitude of well loc tio4,
r r"
(degrees/minutes/seconds) _
Latitude/longitude source:❑GPS❑To r.
(check box)
DRIL
Formatio
DEPTH
From To
hic map
1
O Co D%s/F5 d
go• ego
fd'
130- t2C
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbe and co on roa names grel
IS Apt?
z
6Lb
tp111
I DO HEREBY CERTIFY THAT THIS WELL WA CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A OPY OF THIS RECORD AS BEEN PROVIDED TO THE WELL OWNER
(
SIGNATU O PER ON C NSTRUCTING 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

282504
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) f 7 f%toff TUS/ICC CERTIFICATION w+%Idt0
WELL CONTRACTOR COMPANY NAME Jtlsfla//////.c. a wt Pei f.Lf ttl4 PHONE #(aw)7ty-f599
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
I. WELL USE (Check Applicable Box): Residential Re-Municipal/Public ❑ Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use n
�C
2. WELL LOCATION: msyi
Neareswn: r 6 County in .16061ELL
iIun faietat
(Street Numbers, Community, Subdivision, Lot
Na o., Zip C e)
3. OWNER:LEN/ 5 ICOCk
Address P� 8 0 y / is
(Street or Route No.)
/UP.Ao Al G _ Z e n /
ny or Town Sui 5,, 9 Zip Code
itz
Area code- Phone number
4. DATE DRILLED d 3
5. TOTAL DEPTH: MS
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO Dr
7. STATIC WATER LEVEL Below Top of Casing: t;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 I5A NCAC 2C .0118.
9. YIELD (gpm): 30 METHOD OF TEST /i'/I'1-
10. WATER ZONES (depth): 70ytose eA ,3 540
11. DISINFECTION• Typa Amount er
12. CASING: Wall Thickness
Dep�1, Dia9;etter or Weight/Ft.
From V To 50 Ft. 4 g 0
From 0a! To ' 1 Ft.
From
To Ft.
13. GROUT: Depth
From To Ft.
From n To JQ Ft. Noel
14. SCREEN: Depth Diameter Slot Size Materiel
From To Ft. in. in.
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth
From To Ft.
Material
Method
ounytoe
Size Material
From To Ft.
Topo tc/Land s
❑Ridge ope ❑ValI; `
(check appropriate h&j,: vi
Latitude/longitude of wel
(degrees/minuleslsecondi
Latitude/longitude source:OGPS
(check bo: r
pRf LING L —, 1
Formation Descr
DEPTH
From To
PO- 75- a9n74
7S- 35lS
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.
"ot
CD
o '
ZZ6
—D
rn-
17, o 0
16. REMARKS:
I DO HEREBY CERTIFY THAT f
WELL WAS CONSTRUCTED IN ACCORDANCE WITH I5A NCAC 2C, WELL
CONSTRUCTION STANDARDSD THAT A COP IS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
NAT RE
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

284481
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) James 47 Camp Tr CERTIFICATION #71 3
WELL CONTRACTOR COMPANY NAME ramps s Wnl 1 & Pump Crc. Tnr PHONE #$7A) 4511=7272 r__ --
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT# (if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential &rMunicipaUPublic 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELLLOCATKQN:
Nearest Town: II \ Q 'U Airy— County C Q C,
`DM \u^%% S
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: t id m O.K
Address �j U � �`i/t.`
Go- ra (Sd .ls uk N
o
t
T
City or Tow [ Zip Code
(61 _ 213 et/5 9
Area code- Phone number
4. DATE DRILLED a - a 1. o 3
5. TOTAL DEPTH: )- S
6. DOES WELL REPLACE EXISTING WELL? YES iti410 ❑
7. STATIC WATER LEVEL Below Top pf Casing: S 0 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS 1 FT_ Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance In accord ce with 15A NCAC 2C .0118.
9. YIELD (gpm): O METHOD OF TEST_i r A
10. WATER ZONES (depth): 0L L
11. DISINFECTION: Type NI l nr i n p
12. CASING:
Depth Diameter
From p To Ft. 6 1 / 4
From_ To Ft.
From To Ft.
13. GROUT: Depth
From 0 To 2 0 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.
Amount ().J.�
Wall Thickness
or Weight/Ft. Material
SDR21 PVC
Material Method
Nit
Slot Size
Material
in.
in.
Material
16. REMARKS:
Topographic/Land setting
❑Ridge 19$1ope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic�;ma��.�_..
(check box)
DEPTH DRILLING LOG
From S rmn D crfMi2 Ruri
p
Sts r J +:'-t,c y ?.c
J
:2n
7
t ^n
LOCATION SKETCH to n
Show direction and distance in miles from atst .may
two State Roads or County Roads. Include thcroad1
numbers and common road names.
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUC 1ED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
S1GN\A1'URE 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

284480
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) Ja In e S w Canp, J-t
WELL CONTRACTOR COMPANY NAME
CAMEO Wa11
CERTIFICATION #r 2 1 3 R _ _
R primp Cr)._ TnC PHONE #$7R) d63-732r t_
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential If-Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION:
(�
N est oy(n �1Ik AJKa. ounty
� u1� C �C7Ul�
(Street Name, Numbers, Community_Subdivisiona.Lot No., Zip Code)
3. OWNER: JKI.k, Q f1�Q-'�/
Address kI?U �n/'t CArQN✓/
Y\ (0...).6 (Street orrRot llto P
City orT nJ S tet10 �• Zip Code
Area code- Phone number
4. DATE DRILLED (2 •
5. TOTAL DEPTH: b 5
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO EK
7. STATIC WATER LEVEL Below Top of Casing: 3 0FT.
(Use'-" if Above Top of Casing)
8. TOP OF CASING IS 1 FT. Above Land Surface'
`Top of casing terminated at/or below land surface requires a
variance In accordance with 15A NCAC 2C .0118.
9. YIELD (gpm): 2.(J M T OD OF TEST Air
10. WATER. ZONES (depth): U
11. DISINFECTION: Type C'h 1 nr i rip. Amount C 1 1 AO
12. CASING: Wall Thickness
Depth . Diameter or Weight/Ft. Material
From p To C Ft. 6 1/ 4
From To Ft
From To Ft.
13. GROUT: Depth Material
From_ To 3 p Ft.
From To Ft.
14. SCREEN: Depth Diameter Slot Size
From To Ft. in. in.
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
DR?1 PVC
Neat Cement
16. REMARKS:
Topographic/Land setting
❑Ridge ❑Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude Source:❑GPS❑Topograptit iiiap
(check box)
DEPTH DRILLING LOG
From To
Formation Description
L u S
t� ?m
7 rn
N v<
v rio
X
JOCATION SKETC$ n
r�
Show direction and distance in miles from oiliest E-4
two State Roads or County Roads. Include t1--o,
numbers and common road names.
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WFr r
CONSTR CTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO TILE WELL OWNER
- l©� oil
S►
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) James ur
WELL CONTRACTOR COMPANY NAME ("Amp' a
ramp, Jr
Wall R Pimp ('n Tnr
284479
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential It ' Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring ❑ Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
WE
2. N are t T wnTION4: -xt County C \C) rT1, 10)9
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: CADAP ()
Address \ 2CI\ 0 FQA. TK )Y.ANJ C\Ay
lyNo.)
City or Town StateZip Code
( )-
Area code- Phone number
4. DATE DRILLED ti- \5-03
5. TOTAL DEPTH: I( 0 S
6. DOES WELL REPLACE EXISTING WELL? YEy§ ❑ NO .S
7. STATIC WATER LEVEL Below Top of Casing: `4 0 FT.
(Usc "+" 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 accorda a with 15A NCAC 2C .0118.
9. YIELD (gpm): IsgTHQD OF TEST & it
10. WATER ZONES (depth):
Topographic/Land setting
kidge ❑Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map —
(check box)
DEPTH RILLING LOG
From To. ):prmapon Description
0
S (00 S At.flILIA
11. DISINFECTION: Type ch 1 nr i np Amount t C-U4
12. CASING: Wall Thickness
Depth, Diameter
From 0 To 2,5 Ft. 6 1/ 4
From To Ft.
From To Ft.
or Weight/Ft. Material
SDR2I PVC �
l
13. GROUT: Depth Material Method
From__q__To 20 Ft. N at Cement
From To Ft.
14. SCREEN: Depth Diameter Slot Size Materia
From To Ft. in. in.
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
c
O o
r
tli
cm
Show direction and distance in miles from af;}2ast m?
two State Roads r County Roads. Include tla-roat
numbers and co ad names. 0 0
LOCATION SKETCH
Nf
16. REMARKS:
1 DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WFI i
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
jitt 03
'IGNA F cEtSORNINSTRUCTING 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
CERTIFICATION # 21 4 R
PHONE #2R) 4S3-9'Y77=— `---
—;

WELL CONSTRUCTION RECORD
271738
North Carolina - Department of Environment and Natural�Resources - Division of Water Quality - Groundwater Section
V. C
ELL CONTRACTOR (INDIVIDUAL) NAME (print) //.cfr 'b J 054-i ce CERTIFICATION#9/-)t
\YELL CONTRACTOR COMPANY NAME \)VJTICa L e4 6: SCA ,Ai•
PHONE if ( ) E2Q 72V- 0 4&
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED \VQ PERMIT#
(if applicable) iF�p.Li able)Z l
WELL USE (Check Applicable Box): Residential Municipal/Pu Industrial ❑ Agricultural ❑
Monitoring ❑ Recovery ❑ Heat Pump Water Injection Other ❑ If Other, List Use
WELL. LOCATIOtE
1opograp h /Lan d setting
341 ke 5de Or.
tDg
Nearest Town: l^tOtCounty/2-DO LL ❑Ridge �ope
❑Valley ❑Elul
(check appropriate box)
Latitude/longitude of well location
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: 4 tA,C '/,Ind--ccj.',C L/ rT-
(degrees/minutes/seconds)
Address CAI,8 /'Get"r1rr -»r GA/ly8,t-A atitude/longitude source:❑GPS❑Topographic map
(Street Of Route No.)
filie / 041 lj l e_
e7sL- teoci tai EPTH (check DRILLING LOG
Cityor Town State Zip Code From To Formation Description
6.52- ✓' l r?
Area code- Phone number
4. DATE DRILLED .1-W63j
5. TOTAL DEPTH: 30S
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO I
7. STATIC WATER LEVEL Below Top of Casing: /CC FT.
(Use `+" if Above Top of Casing)
8. TOP OF CASING IS l 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 METHOD OF TEST %/%2
10.WATERZONES(depth): /470g©9r, /Ho S499,e,<c_
0 3o'p✓l/ 25?) eolpt
11. DISINFECTION: Type It) 1' e- Amount 026, nag
12. CASING: Wall Thickness
Diameter or \VeightlFt. Material
Depth
From To Ft.
From 0 To 6 Ft. G 11/ bc, Plr fl'.
From Lee* To Ft. 674 % ie 63441✓
13. GROUT: Depth Material Method
From _ To Ft.
From 0 To ).10
14. SCREEN_ Depth
From To Ft. in. in.
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Sizc Material
From To Ft.
From To Ft.
16.REMARKS:
Diameter Slot Sizc Mat riot
Ft. Ii,pe 1 '�
�' (`�o l
ILLX) MFRM,Y CEICTIFYT t4T
CONSTRUCTION STAN DAR°`.
-55" Dreg
55- 5 5" f~2nN:
LOCATION SKETCH
Show direction and distance in miles from at 'cast
two State Roads or County Roads. Include the road
numbers and common road names. o
S WELL WAS CONSTRUCTED II1ACCO
ATACOP OF THIS RE DH•,
H-
SG
Jyrbm t the original to Die Divis
7699-I636 Phone No. (919) '7337
TURE
•
F PE
•
i
N CONSTRUCTING THE WELL DATE
u
cn
c-.
0
NCE ITH 15A NCAC 2C, WELL
rtp_r_viDvo TO THE WELL OWNER
on of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
21, within 30 days. GW-I REV. 07/2001

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality
WELL CONTRACTOR (INDIVIDUAL) NAME (print) J am s w Camp, Jr
-
WELLCONTRACTORCOMPANYNAME ('ampI s WP11 R Primp ('n Tnr
280846„
- Groundwater Section
CERTIFICATION # 7 1 3 fi
PHONE #VP) d51-7322
STATE WELL CONSTRUCTION PERMIT,/ ASSOCIATED WQ PERMIT,/
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential & Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION: ^I �
Nearest To`� tN`MM
C10/1.UL1 _�.1,1.
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: AddressVP
\ "`111iii ,Xf
extort:
to No.)
cbe - Qex
County `rVIC�(NJ2 U
(qoy)-
Ciry nr Towa 30Srare 0 Zip Code
Ds 9
Area coda Phone number
4. DATE DRILLED a 5 • I) 4
5. TOTAL DEPTH:,S2.)l
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO it
7. STATIC WATER LEVEL Below Top of Casing: (.0 I) FT
(Use "+" if Above Top of Casing)
8. TOP OF CASING 1S -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): \ot)�' METHOD OF TEST kir
10. WATER ZONES (depth): 513
I1. DISINFECTION: Type C'h 1
12. CASING:
Depth
From p To I Ft.
FromTo Ft.
From To Ft.
13. GROUT: Depth
From._o To 20
From To
14. SCREEN: Depth
From To
Frum To
15. SAND/GRAVEL PACK:
Depth
From To
From To
—
. 16. REMARKS:
.Q nri na Amount 1 (IA
Wall Thiclosess
Diameter or Weight/Ft. Material
6
1/4 eDR21 PVC
Material Method
Ft. Neat Cement Hand
Ft.
Diameter Slot Size Material
Ft. in. in.
Ft. in, in.
Size . Material
Ft.
Ft,
Topographic/Land setting
ORidge ❑Slope 129a11ey OFlat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:OGPSOTopographic map -
(check box)
DEPTH DRILLING LOG
From To F rrr on Description '-
n TO `A
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common road natnes.
CL� l o
co
t-)
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUC IED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY 0 THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
O
0
lD 10-63
SIGNATURE OF PETN 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 Na
al Resour es - Division of
D
WELL CONTRACTOR (INDIVIDUAL) NAME (print) I �/
WELL CONTRACTOR COMPANY NAME
STATE WELL CONSTRUCTION PERMIT#
(if applicable)
Vf/materr Qyality - GroundwaterZV// // f%'CF.RTIFIC.\TIION/�%—��//./Za/1Q PHONE # �?Q (A�" r 'J Co�\P
ASSOCIATED WQ PE
( if applicable)
I. WELL USE (Check Applicable Box): Residential IV-Municipal/Public 0 Industrial 0 Agricultural ❑
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2
WELL LOCATION:
Nearest Town:
Coon
(Street Name, Numbers, Comm 'ty, Subdivision. Lot No., hip Code)
3. OWNER: I��&;C{ //(e/ n
Address JZZZJJJ,�',bo/y /lu/-zare �j
/d fir/
rRontee ,01/,A
City or T n Slice �✓✓//// Zip Code
- (o �o 77-3p
Area code- Phone number y
4. DATE DRILLED 1!—,I� 6 '1
5. TOTAL DEPTH: 93
6. DOES WELL REPLACE EXISTING WELL? YES NO f
7. STATIC WATER LEVEL Below Top of Casing: FT.
f (. se' • " if Above Top of Casing)
8. TOP OF CASING IS 1 FT. Above Land Surface*
*Top of casing terminated atror below land surface requires a
variance in accordance with ISA NCAC 2C .011g.
9. YIELD(gpm): / METHuOD OF TEST %U"Vl�er
10. WATER ZONES (depth){ 5 f
11. DISINFECTION: Type CA br'ktbj Amount c I -�
12. CASING:
Depth
Frain /5 To
From To R.
From To
�7 EL__ Altai
Wall Thickness
Diameter or WeightiFt.� �(aaterr�/ numbers and common road names.
Ft.
Topographic/Land setting
❑Ridge ❑Slope ['Valley at
(check appropriate box)
Latitude/longitude of well location
(deacesminutes/seconds)
Latitude longitude source:OGPSOTopomaphic map
(check box)
DEPTH DRILLING LOG
From To Fo nation Descnpt on
D Z C t oi, 5-tv&e_
�:2 ci 3 L3) CTf nTfc
13. GROUT: Depth Maley'
From t) To D Ft. /7Ctfir%Lf9Yl9
From To Ft.
Method -.4_
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road;
hftic� red lII�Irr
4
trrao) '"I I
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 tl7ti To 7 7 Et.
From To Et.
16. REMARKS:
3r ireiai r
a
4'
� r
/,.4 m 11
4'
9
a.3y
I DO (HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH ISA NCAC 2C, WELL
CONSTRUCTION STANDARDS, ATHAT f OPY OF THRECORD EEN PROVIDED TO TFIE WELL OWNER
SIGNATf(JRE OF PERSON CONRUCTING THE WELL DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mall Seni
27699-1636 Phone No. [phone], within 30 days.
GROUNDWATER SECTION
ASFIEVILLE REGIONAL OFFICE

277968
Depth
�)
() To 3
To
From To
13. GROUT: Depth
From 5 ToJa Ft.
From To Ft.
14. SCREEN: Depth D
From To Ft.
From To Ft.
15, SAND/GRAVEL PACK:
Depth A Size Material
From-�b To YHA Ft. tedi!
From To Ft.
From Ft. In J
From Ft.
Ft.
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and N
WELL CONTRACTOR (INDIVIDUAL) NAME ()print)
WELL CONTRACTOR COMPANY NAME e /if
Division of
al Resour es
t
uality - Groundwater Section �/
CERTIFICATION�6)�)0 cY64'/
5
PRONT, # S i�.4-3�/7�
STATE WELL CONSTRUCTION PERNIIT# ASSOCIATED WO RMIT#
(if applicable)
(if applicable)
1. WELL USE (Check Applicable Box): Residential yY b1unicipaUPublic 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATIO
Nearest Town: '/ ! County -
S2tatl C ± ; 1a 2I,C,
(Street Name,, Numbers, Community, Subdi ision, Lot No., Zip Code)
3. OWNER: 7 7117/7,I�/ VC'
Address ZioN WV 77 ///Dh! if
����// (Street or Route No.)
/!/%/lint fit f ia4
b//
(Y'4t)
CiweI3To Stine Zip Code
, ,t3t593
Area code- Phone number // y
4. DATE DRILLED y ,4J
5. TOTAL DEPTH: c3 Ff
6. DOES WELL REPLACE EXISTING WELL? YES B VO ❑
7. STATIC WATER LEVEL Below Top of Casing.: 51", FT.
([:se " if Above Top of Casin__)
8. TOP OF CASING IS ,/ FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordance with 15A NCAC 2C .0118.
9. YIELD (gpm): /d ME �D O EST l�r
ID. WATER ZONES (depth): �f
(17J4 ,6/ I
I L DISINFECTION: T e C f7 Amount ,%�� CJ
12. CASING: Wall Thickness
Diameter or Weight/Ft. Materhhat
Material
filOt all ire, 7I
16.
arneter
in.
in.
Slot Size
in.
in.
Material
REMARKS:
Topographic./Land setting.
❑Ridge ❑Slope ❑Valley llaricr
(check appropriate box)
Latitude/longitude of well location
(derees/minutes seconds)
Latitude/longitude source:❑GPS❑Topogr'aphic map
(check box)
DEPTH DRILLING LOG
From To Formatign Descyiption
v ti5
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.
1/ad
4
'r
.tJ.G 443ilrhtI�!'C cJe.SF I16mtle
c,.7w
v�
7
ltas
a ,s1Iarn` is
•
[ DO HEREBY CERTIFY THATTHIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH I5A NCAC 2C, WELL
CONSTRUCTION Sj4NDARDS,AND THAT COPY OF THI ORD HAS BEEN PROVIDED TO THE WELL OWNER
�.,LOb�OF�/Q
SIGNATURE OF PE ON CONSTRUCTING THE WELL DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Se
27699-1636 Phone No. [phone], within 30 days.
r - litaleig1t, NC r7..1/
*1;1 RRVJ'O7/" 001=1
e'JEn STON
i �, rr_inr,iAlECCIFT, CE

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Na ural Resources -Div
WELL CONTRACTOR (INDIVIDUAL) NAhIE ( riot
WELL CONTRACTOR COMPANY NANIE
a
n 7
f 9f
f watt' Quality - Groundwater Section
CERTIFICATION
PHONE #
0
STATE WELL CONSTRUCTION PERMIT# / 7 i { ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
1
2
WELL USE (Check Applicable Box): Residential Bi;lunicipaUPub(ic ❑ Industrial 0 Agricultural ❑
Monitoring ❑ Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
Coutu`ity
A'c ca.. :; rV / I .
(Street Name, Numbers,[[Community, Subdivision,, Lot No., Zip Code)
3. OWNER: lCo/d/7 5///l'Yii,'74
Address af%L.l,`C• rd
WELL LOCATION:�/
Nearest Town: 1/ (0) / n/7
(Sweet or m Na.) /� t254
�Z �j
OCintO/I Y
1 ity or Town$tate. Zip Code
fit' 5-//�.‘16
( )- -
ea code- Phone number �7
4. DATE DRILLED 3
5. TOTAL DEPTH: //O Ff-
6. DOES WELL REPLACE EXISTING WELL? YES 10.<0 ❑
7
STATIC WATER LEVEL Below Top of Casing.: c)46 ET.
(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 accords c with 15A NCAC 2C .0118.
r�"
i�`
YIELD (arpm): METHOD OF TEST /gel �
9
r
10. WATER ZONES (depth): /or
11. DISINFECTION:Type_C/r4ryrt�i1
12. CASING:
From
From To Ft.
From To Et.
13. GROUT: Depth
From 6 To 46 _ Ft.
From To Ft.
I4. SCREEN: Depth Diameter
From To Ft. in.
From To Et. in.
15. SAND/GRAVEL PACK:
Depth
From .-w To/ZD
Depth Diameter
0 To /60 Ft. G tt
Amount • /1 /r5
Wall Thickness
or WC1,gI1I1 L Mate i
Y fir' •
Matgial
/7607 e lYl&R7
Topographic/Land setting
❑Ridg.e 0Slope ❑Valley FdfLnt
(check appropriate box)
Latitude/longitude of well location
(dereesaninutesiseconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From To Formation Descripti
jU Gay v`6nnof
4U /Iv flfeel 'Nat?,ram4_
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common road names.
Method
*Heztj
Slot Size Material
in.
in.
Sae Material
Ft.
From To Ft.
16. REMARKS:
-/Hle/.Se 96 Et Pea
a
E— e
7
;7 1
I DO HEREBY CERTIFY THAT TIIIS WELL WAS CONS -ERUCTED IN ACCORDANCE WITIi I5A NCAC 2C, WELL
CONSTRU9ION ST DARDS, AND T 1T • • OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
SIGN ;4 URE OF PERSON CONSTRUCTING THE WELL DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 NV
27699-1636 Phone No. [phone], within 30 days.
lu
,ION
LUFFICE
YULE RE'l

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and N
WELL CONTRACTOR (INDIVIDUAL) NANIE,
((yrint) WELL CONTRACTOR COMPANY NANIE //O/ •`fF
27 971
'ater u lity - Groundwater Section 0 CERTIFICATION# ci/O�r>)e-
PHONE # fitVI /c-S//e
STATE WELL CONSTRUCTION PERMIT# . ASSOCIATED WQ PERNHT#
(if applicable)
(ifapplicable)
1. WELL USE (Check Applicable Box): Residential unicipavPublic ❑ Industrial 0 Agricultural ❑
Monitoring 0 Recovery ❑ Heat Pump Water Injection 0 Other 0 If Other, List Use
?. WELL LOCATION,:OF /
Nearest Town::On
OJ"/f- County
Lii/c ni.. oul. p),Q 621
(Street Name, Numbers, Community, Subdivision, Lot No.. Zip Code)
3. OWNER: / , / /i (kit";
//
4
5
6
7.
Address ()/ J 4 fet'N/ee
(Street or Rokte
OOilFc•r{- i,C , ,9g7 4
STATIC WATER LEVEL Below Top of Casim=: I y
icy o T wn State Zip Code
799- y776
Area code- Phone number
DATE DRILLED 3-�5=G3
TOTAL DEPTH: &:37
DOES WELL REPLACE EXISTING WELL? YES NO B'
FT.
(tse "r" if Above Top of Casing)
8. TOP OF CASING IS l FT. Above Land Surface*
'Top of casing terminated at/or below land surface requires a
variance in accordance with 15A NCAC 2C .0118. ��%% ,,yyI�
9. YIELD(gpm): / METHOD OF TEST&/47//cr-
10. WATER ZONES (depth): SO 7'
(/
yepographic/Land setting
tdge ❑Slope ❑Valley ['Flat
(check appropriate box)
Latitude/longitude of well location
(decrees; minutes/seconds)
Latitude/Longitude source:0GPSOTopographic map
(check box)
DRILLING LOG
Fnrmatio Description
DEPTH
From To
t 'SLY
13/cie tG g/tt t grant it -
LOCATION SKETCH
11. DISINFECTION: Type 6/7/r2bd'1 Amount a /a Show direction and distance in miles from at Least
12. CASING: Wall Thickness two State Roads or County Roads. Include the road
or Weight/Et:. Material/ numbers and commo nam�es. t��•
7 t°/C! ltil � d
Depth
From 0 To 33'
From To
From To
13. GROUT: Depth
From G To 4(..)From Ta
14. SCREEN: Depth
From To
From To
15. SAND/GRAVEL PACK:
Depth
From o20 To (33) Ft.
From To Et.
Ft.
Ft.
Ft.
Diameter Slot Size Materiat
Et. in. in.
Ft. in. in.
Ft. Di�retcr
e
Matcrjal I othod ) i
ikc42 toe/ire/ter
16. REMARKS:
Size
Material
Gfeen
(V
:JT
� -)
/e m
9'0I4
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORD
CONSTRUCTION STANDARDS, AN THAT A CD/Y OF THIS RECO
0
NCE WITH 15A NCAC 2C, WELL T
PROVIDED TO THE WELL OWNER ,yrifeci r../-
.55 63 d PI- 8e„
TING THE WELL DATE.
Submit the original to the Division of Water Quality, Groundwater Section, 1636 �Ail,er1ce Intel - R
27699-1636 Phone No. [phone], within 39 days. ll \��
I t
n ri.- OFHCL

North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section 3
1636 Mail Service Center - Raleigh, N.C. 27699-1636 - Phone [phone]
WELL CONSTRUCTION RECORD
WELL CONTRACTOR: Dewey Wright Well Pump Co
WELL CONTRACTOR CERTIFICATION #• 2687
030028-2 STATE WELL CONSTRUCTION PERMIT# Steve Reece
Inc.
WELL USE (Check Applicable Box): Residential ❑v Municipal
Recovery I I Heat Pump Water Injection ❑ Other I I
Industrial
If Other, List Use•
2. WELL LOCATION: (Show sketch of the location below)
Nearest Town: FINEQI q County Mrn0WELL
1
me and um emmunit o dt it oF'a fL
3. OWNER JACK ALFXpNDER
Address 1203 "'H'slrEeH10 L„F I
ty or Town
State
code
4. DATE DRILLED ora/2003
5. TOTAL DEPTH q64
6. CUTTINGS COLLECTED YES I I NO L.x
7. DOES WELL REPLACE EXISTING WELL? YES I I NO I XI
8. STATIC WATER LEVEL Below Top of Casing i29 FT.
(Use "+" if Above Top of Casing)
9. TOP OF CASING IS 1 FT Above Land Surface*
*Top of casing terminated at/or below land surface requires a variance in accor-
dance with 15A NCAC 2C.0118
10. YIELD (gpm). 15 METHOD OF TEST Air
11. WATER ZONES (depth)15 aom 300-Sf15 0 oom
Q aom 0 aom
12. CHLORINATION: Type HTH
13. CASING:
Amount 2E+
Wall Thickness
Depth Diameter or Weight/Ft. Material
From D To 76d Ft 6 1f^ 1RR (AI V
From To Ft
From To Ft
14. GROUT:
Depth Material
From 0 To 70 Ft rernanf
From To Ft
15. SCREEN:
Method
__fir::•ihj Platy
Depth Diameter Slot Size
From To Ft in in
From To Ft in in
From To Ft in in
Material
II
Agricultural ❑ Monitoring ❑
DRILLING LOG
From To
C 249
DEPTH
Formation Description
EDIRT'RDCK'` N TE
240 3n0 GRANITE
309 305 FHALFCI-4,
GRANITE
irrf� - v8/ r 3
3:,t SZr41.6 it
R7os.r 40.2•r
If additional space is needed use back of form
16. SAND/GRAVEL PACK: Iti%t
Depth Size Material t�a
From To Ft
From rho' 2 ylco
17. REMAR $ I iL l
I DO HEREBY C RTIFY-TKATTHISWale
CONSTRJCT]ON STANDARDS, AND TH
FOR OFFICE USE ONLY
Quad No: i
LOCATION SKETCH
(Show direction and distance from at least two State
Roads, or other map reference points)
TF
a. I
ti
CY °v
,
O -t'
"ONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
OPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER.
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
Submit o(iginal to Division of Water Quality, Groundwater Section within 30 days
GW-1 REV. 12/99
Serial No. `--

North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section 2 7 0 5 3 6
1636 Mail Service Center - Raleigh, N.C. 27699-1636 - Phone [phone] l)
WELL CONSTRUCTION RECORD
WELL CONTRACTOR. Dewey Wright Well Pump CO_ Inc.
WELL CONTRACTOR CERTIFICATION #• 2687
030028-1 STATE WELL CONSTRUCTION PERMIT# Steve Reece
1. WELL USE (Check Applicable Box): Residential
Recovery I I Heat Pump Water Injection
Municipal El Industrial
Agricultural Ili Monitoring El
Other If Other, List Use:
2. WELL LOCATION: (Show sketch of the location below)
Nearest Town: PI NPOI A County. MCnnwFI I
SFQIIAI IH CIRCI F OPF QCoNFF nR °FF HWY'71 OF
(Road Name and Numbers, Community, or Subdivision and Lot No.)
3. OWNER TACK Al FXANIIFR
Address ian? WHizmil%L N' tree[ or Duce o.
FPS h F
City or Town D Q 1 State C 2 iP ode
DRILLING LOG
From To
DEPTH
Formation Description
0 10 ni PT
10 280 - J 16AF4TQNFJfl ANIT
'440 inn MAt 1n
4. DATE DRILLED a/4/2nn? snn
5. TOTAL DEPTH ?20
6. CUTTINGS COLLECTED YES El NO
7. DOES WELL REPLACE EXISTING WELL? YES L E ��0 xi
8. STATIC WATER LEVEL Below Top of Casing 3'>R ‘FT.
(Use'+" if Above Top of Casing)
9. TOP OF CASING IS 1 FT Above Land Surface*
*Top of casing terminated at/or below land surface requires a variance in accor-
dance with 15A NCAC 2C.0118
10. YIELD (gpml' 0 METHOD OF TEST Air
1 A
11. WATER ZONES (depth)• 0 aom DRY HOLE 0 aom
0 apm 0 anm
12. CHLORINATION: Type HTH Amount
13. CASING:
From
From
From
Depth Diameter
0 To 84 Ft 19 1 /4
14. GROUT:
From
From
To Ft
To Ft
?e)n GRANITF
u Freetext
-
LNbP - OS124/6 3
3S2 sa' 40.E "
wi'ss' 40.4"
if additional space is needed use back oLfemt--
Wall Thickness
or Weight/Ft. Material
189 SAI V
Depth Material Method
0 To 20 Ft fnmenf Gravity Flow
To Ft
15. SCREEN:
From
From
From
Depth
To
To
To
Ft.
Ft
Ft
Diameter Slot Size Material
in
in
in
in
in
in
16. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft
.._... _
C.: LUu3
17. REMARKS. t
I DO HEREBY CERTIFY THAT THIS WELL WAS-yt
CONSTRUCTI N" STANDARDS, AND THAT A C(
2
FOR OFFICE USE ONLY
Quad No:
LOCATION SKETCH
11963
(Show direction and distance from at least two State
Roads, or other map reference points)
C:
f�STRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
PW OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER.
k- a7-03
Feria) Nn
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
Submitloiiginal fo Division of Water Quality, Groundwater Section within 30 days
GW-1 REV. 12/99

From: Scott Gantt To:
Date: 2/13/2003 Time: 11 21:20 PM Page 2 of 8
2FsRnf
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment, and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL)NAME (print) SCOTT GANTT CERTIFICATION # 2584
WELL CONTRACTOR COMPANY NAME CAROLINA WELL DRILLERS, INC. PHONE # [phone]
STATE WELL CONSTRUCTION PERMIT # ASSOCIATED WQ PERMIT #
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box) : Residential ® Municipal ❑ Industrial ❑ Agricultural ❑ Monitoring ❑
Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use:
2. WELL LOCATION:
Nearest town: MARION
NORTH WOODS SUBDIVISION LOT 5
County McDOWELL
(StreetName,Numbers, Community, Subdivision, Lot No, Zip Code)
3. OWNER PERRY MURPHY
ADDRESS 564 PARADISE CIRCLE
(Street or Route No.)
MARION NC
City or Town State
828-652-8764
Arca Code - Phone Number
4. DATE DRILLED 2/6/03
5. TOTAL DEPTH 300
6. DOES WELL REPLACE EXISTING WELL?
7. STATIC WATER LEVEL Below Top of Casing:
YES ❑ NO
60 FT.
(Usc "*" IfAbovc Top of Casing)
8. TOP OF CASING IS 2 FT. Above Land Surface'
'Top of casing tcn mated aabr below land surface requires a.mtancc ,n
accordance with 15A NCAC 2C.0118
9 YIELD (gpm): 6 ME I HOD OF TEST ARDM
10. WATER ZONES (depth). 150 285
28752
Zip Code
Topographic/Land setting
❑ Ridge ❑ Slope ❑ Valley 0 Flat
Latitude/Longitude of well location
35.39.090 / 81.55.451
(degreesfminurosheconds)
Latitude -longitude source: El GPS ❑ Topographic map
DEPTH DRILLING LOG
From To Formation Description
0 75 Clay
75 300 Consolidated Rock
11. DISINFECTION: TYPE HYPOCHLORITE Amount 7 Oz LOCATION SKETCH
12. CASING: Wall Thickness Show direction and distance in miles from at least
Depth Diameter or Weight/Ft. Material two State Roads or County Roads. Include the road
From 0 To 80 Pt 6 I/4" SDR 21 PVC numbers and common road names. O
W
U. GROUT: T
n
czl
Depth
From 0 To 20 FtGRAVEL MIX GRAVITY
14. SCREEN
Depth Diameter
From NA To Ft. in.
Material Method
Slot Size Material
in
15. SAND'GRAVEL PACK.
Depth Size Material
From NA To Ft.
16. REMARKS:
NORTH WOODS SUB
c
HARMONY GROVE fa r*+r
cn-t
cb n.11
0
N)
HWY 226
tV 9
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.
2/13/03
SIGNATURE OF PERSON CONSTRUCTING THE WELL Dale
t the Division of Wa er Quality, Groundwater Section, 1636 Mail Service center - Raleigh, NC
914636(,PlwrieNo4(9i9)73332
lin 30 days.
GW-1 REV. 07/2001

Ft. Neat Cement Hand
Ft.
Diameter
Ft. in.
Ft. in.
•, l.:O''STi(UCTION S'CANMR�Sh
Iu L!
Submit the original to the
24699-1636 Phone N0,,19i1 33-32
WELL CONSTRUCTION RECORD
268614
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) James m r'amr Tt CERTIFICATION It 21 RA
WELL CONTRACTOR COMPANY NAME Camp' c Wa11 R Pimp+ f'n TnC
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
PHONE #S2A1 /1C t-732,z
1. WELL USE (Check Applicable Box): Residential V 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: M0.7/0Pt I County McDoue//
KAt-y (red?' 028 Clearbibtter&y.
(Street Name`Nuumbers, CommunitSubdivision,y, ^ Lot No., Zip Code)
t/ O
3. OWNER: C61 NKre
Address /741 /.io`',AUe, fir. iVE At7f,33
HIC-kor?(Street or cute No.)
II
City or Town State Zip Code
aSGol
Area code- Phone number
4. DATE DRILLED"ag-03
5. TOTAL DEPTH: 41 S5'
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO X
7. STATIC WATER LEVEL Below Top of Casing: r,fl 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 METHOD OF TEST 'jr
10. WATER ZONES (depth): 46 C
11. DISINFECTION: Type Ch 1 nr i n a Amount ) cap
12. CASING: Wall Thickness
or Weight/Ft. Material
sn&.)1 PVC
Depth Diameter
From p To 78 Ft. 6 1/ 4
From To Ft.
From - To Ft.
GROUT: Depth Material Method
From_p To 3 0
From To
SCREEN: Depth Slot Size Material
From To in.
From To in,
SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
16. REMARKS:
Topographic/Land setting
❑Ridge Lailope [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 Fo tion Description
n 79 San rork
7P 2-1-OS"Consolidated rock,,
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common road names.
J
S WELL WAS CONSTRUCTED IN ACCORDANCE WITH I5A NCAC 2C, WFI I
THAT A COPY OF THIS RECORD HAS (SEEN PROVIDED TO THE WELL OWNER
a 1 w , (ay/
N CONSTRUCTING THE WELL d '4/ DATE
1-3-03
n of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
1, within 30 days. GW-1 REV. 07/2001

268613
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) JameS 4r CamP, Jr
CERTIFICATION # 21 3 R
WELL CONTRACTOR COMPANY NAME Camp' G Wa11 & Pnmp r'nL T n c PHONE #al9Rl 453-7322
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential Its" Municipal/Public 0 industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATIOtN: •
n
Nearest Town: Ma Ia Yl C y\ county c(/D iL'C/l
cet 4a K4ty NzvV 4
(Street Name, Numbers, Comm ity, Subdivision, Lot No., Zip Code)
3.OWNER: Cl)Ne5 �a1-nit
Address O flip X '/] (.,
(Snee[ Route No.)
n i�f .;N176. I
City or Town State Zip Code
( )-
Area code- Phone number
4. DATE DRILLED
5. TOTAL DEPTH: / S `7
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO f
7. STATIC WATER LEVEL Below Top of Casing: `i `i FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS 1 FT. Above Land Surface"
`Top of casing terminated at/or below land surface requires a
' variance In accordance with 15A NCAC 2C.0118.
9. YIELD (gpm): .90 METHOD OF TEST air
10. WATER ZONES (depth): 1 7o
11. DISINFECTION: Type rh 1 nr i nP
12. CASING:
Depth
From Q To (7
Diameter
Ft.6 1/4
From To Ft.
From To Ft.
Amount 1 Can
Wall Thickness
or Weight/Ft. Material
WR21 PVC
13. GROUT: Depth Material
From_o___To 20 Ft. Neat Cement
From To Ft.
14. SCREEN: Depth Diameter
From To Ft. in.
From To Ft. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
Method
Hand
Sint Size Material
in.
in
16. REMARKS.
Topott9fohicILand setting
❑Ridge lei 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
sa rtd ,
Cerro l(dAed fro EX
DEPTH
From To
n
'5.
tT- f,
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common road names.
*t a,rlt1-
ttc
fV
rV
-J
0
Y CERTIFY f r
TR JC ION STANI]zR�6,
S WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
ND THAT A COPY 0 THIS RECORD HAS EEN PROVIDED TO THE WELL OWNER
G 1/l C ,t. �— ID-o3
GNATURE OF PERS
CONSTRUCTING THE WELL
DATE
Submit the original.Mike.Division of Water Quality, Groundwater Section, 1636 Mall Service Center - Raleigh, NC
9-163A phone No 73 (9I!4N 3-3221, within 30 days. GW-1 REV. 07/2001
9
r

268619
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) James uL Carpn Tr CERTIFICATIONS 21 iR
WELL CONTRACTOR COMPANY NAME Camp. a Wall & Primp Co Tnr PHONE gffiifl) d51-7122
STATE WELL CONSTRUCTION PERMITS ASSOCIATED WQ PERMITS
(if applicable)
(if applicable)
1. WELL USE (Check Applicable Box): Residential 17VMunicipal/Public 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCAT N:
Nearest ToW
CA Cu
County 'N* (5:3 (R r U
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER:
Address s 1
M tp (Street or Route No.)
Nth -11"--
City or Town State
�a-
Area code- Phone number.
4. DATE DRILLED 1 ' 111- 0 3
5. TOTAL DEPTH: 414
S �,(
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO `(
7. STATIC WATER LEVEL Below Top of Casing: St FT.
(Usc'4" if Above Top of Casing)
8. TOP OF CASING IS 1 FT. Above Land Surface'
`Top of casing terminated at/or below land surface requires a
variance in accord e with 15A NCAC 2C .0118.
9. YIELD (gpm): METHOD OF TEST air
10. WATER ZONES (depth): 490
11. DISINFECTION: Type C'h 1 or i n
12. CASING:
Depth Diameter
From 0 To \ 35Ft. 6 1 / 4
From To Ft.
From - To Ft.
13. GROUT: Depth
From_0 To 2 0 Ft.
Amount
Wall Thickness
or Weight/Ft. Material
SDR21 PVC
Material
N at Cement
From To Ft.
14. SCREEN: Depth Diameter
From To Ft. in.
From To Ft. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
Slot Size
in.
in.
Topographic/Land setting /
❑Ridge ❑Slope ❑Valley Wlat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH PRILLING LOG
From To Forrnati nDescription
n t7,S' �A
\,a s IL\ b"s /�l urti J
J.00ATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common road [tames y'�
Method
W
16. REMARKS:
I r Y CERTIFY THAT U111
C:t4S UCTION STANDARD
SIC
h
h
Zip Code
WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
T A COPY 0 THIS RECORD HAS . EEN PROVIDED TO THE WELL OWNER
1RE OF PERSON CONSTRUCTING THE WELL d DATE
Submitjthe original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
211699-1614,1Wtte'No. (919): 723 21, witain 30 days. GW-1 REV. 07/2001
A° FuiL r't�- -ICE
C
cei

269425
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural $esources -Division of Water Quality - Groundwater Section
O
WELL CONTRACTOR (INDIVIDUAL) NAMF�,[(priut)�J nL,/JL� �/� CERTIFICATION #d 0 %%
WELL CONTRACTOR COMPANY NAME X L�%o zkie ' tat ZCSI PHONE # (rE7ZKA y9 Q VP)
!V/PT
STATE WELL CONSTRUCTION PERMIT#
/Y/Y
(if applicable)
ASSOCIATED WQ PE
(if applicable)
1. WELL USE (Check Applicable Box): Residential Municipal/Public 0 Industrial ❑ Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other ❑ If Other, List Use
2. WELL LOCATION:
Neargst Town:.
Countc
y��
It? le
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: 721,-/
Address At _3
�-, (Street or Route No.)
Cn�,G i
City or Town state Zip Code
Area code- Phone number
4. DATE DRILLED t t// /b 3
5. TOTAL DEPTH:
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO 131
7. STATIC WATER LEVEL Below Top of Casing: sip S FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS / FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance In accordance with 15A NCAC 2C .0118.
9. YIELD (gpm): / METHOD OF TESTt nt.O
10. WATER ZONES (depth): 7020
11. DISINFECTION: Type v OQ2aAmount I y or
12. CASING: Wall Thickness
Depth Diameter or Weigbttil
Weir/Ft. tt:rial
From�To 7D Ft G, ` 2.J t;
From To Ft.
From To Ft.
13. GROUT: Depth �� v Method .
From LiTo nlO Ft L.t? My
From To Ft.
14. SCREEN: Depth Diameter Slot Size Material
From / To Ft. in. in.
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From /To Ft.
To From Ft.
16. REMARKS:
fiER$BY CERtw /fi AT
cep STRUCTIONSTANDARDf
,
Topographic/Land setting
❑Ridge @(Slope 0Valley ❑Fiat
(check appropriate box)
Latitude/longitude of well location
(degreeslminuteslseconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From To Formation Description
TI'N S
Show direction and distance in
two State Roads or County Ro
numbers and common road
5
WFI T WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
et, ,:o C13c-4, able)3
ATURE OF PERSON CONSTRUCTING THE WELL DATE
Submit the Original to thq Tivisior of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
27699-1636 Phone No.019)i73a-3221 within 30 days. GW-1 REV. 07/2001

269396
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and NAtural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME
(print) Q Any/""L'�� oo 'r3nn4LL �Q CERTIFICATION 7�71
WELL CONTRACTOR COMPANY NAME A5L ) el '!a/ .a4f4 4 JHONE # B2d107-OV492I
STATE WELL CONSTRUCTION PERMIT#
(if applicable)
ASSOCIATED W PERMIT#
(if applicable)
I. WELL USE (Check Applicable Box): Residential ly1 Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
o t—
„7.9WEITLOCATION:
ige ci Town:
County /06
3.`_'-(StreettNuuName, NmbeQ Couununity,Subdivision, of No., Zip Code) QW1?IER:_ie-ife✓
_Add 'is //.2 !//I..lotiye 41/1
(Street or Route No.)
Ai", a87sz
=-D City or Town State Zip Code
B�>_ av/-s/3o
Area code- Phone number
4. DATE DRILLED J//a2 / D 3
5. TOTAL DEPTH: .2 95"
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO 21
7. STATIC WATER. LEVEL Below Top of Casing: VS FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS 2 .J FT. Above Land Surface'
'Top of casing terminated at/or below land surface requires a
variance 1n accordaa with 15A NCAC 2C .0118.
9. YIELD (gpm): e METHOD OF TEST clione
10. WATER ZONES (depth): y.s r b26D
11. DISINFECTION: Typer ' Amount 9 a2.
12. CASING: Wall Thiclmess
From Ft.
13. GROUT: 1
From 0 ty O Ft. CenzieJlit at t. rx ay
From Ft.
14. SCREEN: Diameter Slot Size Material
From --To Ft in. in.
From , To Ft. in. in.
15. SAND/GRAVEL PACK:
th Size Material
From o Ft.
T
From To Ft.
Topographic/Land setting
❑Ridge ❑Slope ❑Valley *Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From To Formation Description
y
LOCATIONS CH
Show direction and distance in miles from s jeasty,
two State Roads or County Roads. Include t t' mad%
numbers and common road names. o
Depth Diameter or Weight/Ft Material
From To (D Ft to, t.2/ !/e.
From To Ft l7
To
Depth Material Method
To
To
Depth
16. REMARKS:
r
s •
Ciyys1tu it?'�4 `
MAR
Submit the original to the I
27699-1636 Phone Noy p19) 7
T THIS WEr I WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
S, THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
TOF �
GNATURE
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

North Carolina - Department of Environment and Natural Resources - Division of Water Quality • Groundwater Section
1636 Mail Service Center - Raleigh, N.C. 27699-1636-Phone [phone]
WELL CONSTRUCTION RECORD WELL CONTRACTOR. `1flev-\PCn E
269707
e-EiC �1t1
WELL CONTRACTOR CERTIFICATION #: rQ Cr lk I
STATE WELL CONSTRUCTION PERMIT#:
1. WELL USE (Check Applicable Box): Residential ElMunicipal ❑ Industrial ❑ Agricultural ❑ Monitoring ❑
Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use:
2. WELL LOCATION: (Show sketch of the location below) {�
NeMarest Town' tAn.c.Y\ County " \ C 1 /c•1 ei t
1\i F\cP\\ec JOr 5
(Road Name and Numbers, Community, or Subdivision and Lot No.) DRILLING LOG
3. OWNER Jove �h�\PC l�vn,Aec From To
Address Dee( 1a k K
(StreetarF�ouC I�o.) ,e
City or Town State
4. DATE DRILLED I /jVO4
5. TOTAL DEPTH a1C
6. CUTTINGS COLLECTED YES (l NOE
7. DOES WELL REPLACE EXISTING WELL? YES NO
8. STATIC WATER LEVEL Below Top of Casing: 5 FT.
Zip Code
--1
r (Use'+' if Above Top of Casing)
9. TOP OF CASING IS I y-?- FT Above Land Surface'
•Top of casing terminated at/or below land surface requires a variance In accor-
dance with 15A NCAC 2C.411a
10. YIELD (gpm): a22 METHOD OF TEST `e
11. WATER ZONES (depth) 1.�5
DEPTH
Formation Description
12. CHLORINATION: Type b "V
13. CASING:
Amount \ If additional space is needed use back of form
Wall Thickness LOCATION SKETCH o
n Depth Diameter or Weight/Ft. Ma>lerial (Show direction and distance from at least two State°
From /c t' To C� Ft. G 13 rT, R. L r VC Roads, or other map reference points) ---4. '
From S. To %3 Ft. (, .0 5 g 4e k S� e L a
From To Ft cicn
I `_-
14. GROUT: 7.3
Depth Materi I Method \. 0 f ..;1: .77
From _""_To � Ft � Fmen� � s�;.� off?
5;
From To Ft »�r a1sow�� =,
IN)15. SCREEN: 1J c'6 5
Depth Diameter Slot Size Material
From To Ft in in
From To Ft in in
From To Ftin in.
16. SAND/GRAVEL PACK:
Depth Size Material
From To Ft
From To Ft.
17. REMARKS:
IDOHE ea RTIFYTNATTHIS WEL7,.
CONSTRITI f�-STANDARbS, AND -It IATI�
Ta,100Pnw
FOR OFFIEI USE ONLY
Quad No:
Serial No.
subrjlt od(i
ONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
Y OF THIS RECORD HAS BEEN PRpVIDED TO THE WELL OWNER.
CArtv1 4.9 /I4/03
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
bl to Division of Water Quality, Groundwater Section within 30 days
GW-1 REV. 12199

14. GROUT:
Depth Materia Method
From —`"'� To a /J Ft l .e Vi� z �
From To Ft
15. SCREEN:
Depth Diameter Slot Size Material
From To Ft in in.
From To Ft in in.
From To Ft. in in
16. SAND/GRAVEL PACK:
Depth Size Material
From To Ft
From To Ft.
17. REMARKS:
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
1636 Mail Service Center - Raleigh, N.C. 27699-1636-Phone [phone] ---��--
WELL CONSTRUCTION RECORD WELL CONTRACTOR. �la4T\ F
WELL CONTRACTOR CERTIFICATION #: ori(0\
STATE WELL CONSTRUCTION PERMITN:
269706
1. WELL USE (Check Applicable Box): Residential ErMunicipal ❑ Industrial ❑ Agricultural 0 Monitoring ❑
Recovery ❑ Heat Pump Water Injection ❑ Other n If Other, List Use:
2. WELL LOCATION: (Show sketch of the location below)
tTn
Nearest Town: MCkC ;0 n County' t"e. i7. a W e \l
Yncrv\;$e C:-C\E
(Road Name and Numbers, Comm,yva�y,P1r Subdivision and Lot No.) DRILLING LOG DEPTH
3. OWNER /V\ 1�\\on� From To Formation Description
Address ,.D.F'r1,ccc„ C;c(.\e_
(street or Route No.)
MOSNor. A).0 r�R75�
City or Town State Zip Code
4. DATE DRILLED e9-/5/03
5. TOTAL DEPTH ada
6. CUTTINGS COLLECTED YES n NOES
7. DOES WELL REPLACE EXISTING WELL? YES r— NO
8. STATIC WATER LEVEL Below Top of Casing: I O FT.
(Use': it Above Top of Casing)
9. TOP OF CASING IS \ -5 FT. Above Land Surface'
'Top of casing terminated atlor below land surface requires a variance In accor-
dance with 1SA NCAC 2C .0118
10. YIELD (gpm)• Q METHOD OF TESTns\ZC
11. WATER ZONES (depth).
ai5
12. CHLORINATION: Type R lePr Amount k. h
13. CASING:
Depth Diameter or Weight/Ft. lle/ri-I (Show direction and distance from at least two State
From. l To CRS Ft (� rq-7- (o t' `IC Roads, or other map reference points)
From To Ft �t// '
From - To Ft „
Ti-
Wall Thickness
If additional space is needed use back of form
LOCATION SKETCH
t o;c sle c w
I DO HEREBY CERTIFY
CONSTRUCTfOi T7tNDARDS,: AND THAT'A
STRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
F THIS RECORD HAS BEEN PROVVIDED TO THE WELL OWNER.
a/s/o3
tij4ATURE OF PERSON CONSTRUCTING THE WELL DATE
o Division of Water Quality, Groundwater Section within 30 days
GW-1 REV. 12/99

WELL CONSTRUCTION RECORD
269873
North Carolina - Department of Environment and I� tural Resources - Division of Water Quality - Groundwater Section
riot) V) 0##/l /3,QLL
WELL CONTRACTOR COMPANY NAME 7
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT #
(if applicable) (if applicable)
WELL CONTRACTOR (INDIVIDUAL) NAM
CERTIFICATION #n2/J 7,//v2
PHONE # tar GV,ze 0
1. WELL USE (Check Applicable Box): Residential N Municipal/Public 0 Industrial ❑ Agricultural 0
Monitoring ❑ Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION: G n o�
Neare o unty jig (J� 74,--
9
7
(Street Name, Numberrn Community,lSubth on, Lot No Tip Code)
3. OWNER: W4 G<24
Address ,2't9n Apr),"/�Ln,J V.P./ .
// (Street or Route No.) (/
IVC'. e2S77St"
City or Town State Zip Code
Area code- Phone number
4. DATE DRILLED // 7/D 3
5. TOTAL DEPTH: b5
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO 1a
7. STATIC WATER LEVEL Below Top of Casing: tit .3i FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS / S FT. Above Land Surface'
'Top of casing terminated at/or below land surface requires a
variance In accordance with ISA NCAC 2C .0118.
9. YIELD (gpm): /_S- METHOD OF TEST��ro
10. WATER ZONES (depth): 3/0 Fr
11. DISINFECTION: Type
12. CASING:
Amount /7 oZ
Depth
From O To 7 K Ft
From To Ft.
From To Ft.
Wall Thickness
Diameter or Weight/Ft. Material
#.2 d7//t
Topographic/Land setting
[Midge QQSIope ['Valley ❑Fla(
(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
13. GROUT: Depth Mat rial Method
From 0 To sal if) FL L� t){ My
From To Ft /
14. SCREEN: Depth Diameter Slot Size Material
From floo Ft_ in. in.
From / To Ft in. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From Ft.
From To Ft.
16. REMARKS:
I DCI HEREBY CERTIFY
[-CONSTRUCTION STAND
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common road names.
CD
CO
ass e
O r
co
/ 1//L
IS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WFI.I OWNER
/2/ 3
SIGNATURE OF PERSON CONSTRUCTING THE WFI T DATE
0
0
ILSubmitthe original toe Di I sion of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
9� 27699-1636 Phone .No::(19) 7333221, 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
•C4G
WELL CONTRACTOR (INDIVIDUAL) NAME (print) 6-1 i CERTIFICATION !1/""
1
1,.J,s �,,f rr--C PHONE It(
�
WELL CONTRACTOR COMPANY NAME
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
WELL USE (Check Applicable Box): Residential {d' Municipal!Public D Industrial 0 Agricultural ❑
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL 2 LOCATION:
Nearest Town: / 1/ /' libi-)
(Street Name. Numbers, Community, Subdivision, Lot No, hip Code)
4�Y
3. OWNER:C,ritr ri. r /'
Address 4.O.13or.'-ID3 f`igivi i{.'• 1Z�"
(Street or Route r/o.) r�i G
r�✓1Do �S'Z-
City or Town I State Zip Code
(70-7)- (i?.
Area code- Phone number
4. DATE DRILLED %t //,-O.L,
/r�County 0 (72`Cli:
5. TOTAL DEPTH: j MIS
269882
Topographic/Land setting
❑Ridge 0Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:DGPS❑Topographic map
(check box)
DRILLING LOG
Formation Description
DEPTH
From To
�� fir... ?"<'
6. DOES WELL REPLACE EXISTING WELL? YES Lyf NO ❑
7. STATIC WATER LEVEL Below Top of Casing: 4..9 ✓ 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): 9 METHOD OF TEST A / /
I0. WATER ZONES (depth): °!'e7 l=' P&L.'
L.' '
I I. DISINFECTION: Type IL LJ=,)
12. CASING:
Depth Diameter
From To Ft. ' �7
From 0 To 't(42- FL C-t/'7 tt'
From ' - To qd l Ft. icIft iY.?
13. GROUT: Depth
r
0
i
Amount �;b;� E '$how direction and distance in miles fromst
LOCATION SKETCH
Wall Thickness two State Roads or County Roads. Inc1u4Ihe r�t8d-
or Weight/Ft. Material numbers and common road names. c�a _ _
I
I
rJl
From To
From 0 `/f,• To 7
14. SCREEN: Depth
From To
From To
15. SAND/GRAVEL PACK:
Depth
To
To
From
From
16. REMARKS:
aterial
Ft.
Ft.
Diamet Slot Size
Ft. in. in.
Ft. in. in.
Ft.
Ft.
Size
Method
�j i Y•t�
Material
Material
I DO HEREBY CERTI�F OATCONSTRUCTION S�f Ntp1(RD
i
THIS WELL WAS CONSTRUCTED IN ACCORDANCE VAT
JD THAT A COPY OF THIS RECORD HAS BEEN PROVI
n
a ( c✓
SIGNATURE O PERSON CONSTRUCTING THE WELL DATE
Submit the original to the Division of Water Quality, Groundwater Section
27699-1636 Phone No. (919}733-3221, within 30 days.
r
Mail Service 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
WELL CONTRACTOR (INDIVIDUAL) NAME (print) 47Ary . 1O7`Y/1/, CERTIFICATION /1/42/`P,
0
SO54;'Z L.I(.•GL 7JYi c C/U& PHONE #
STATE WELLCONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
WELL. CONTRACTOR COMPANY NAME
WELL USE (Check Applicable Box): Residential S Municipal/Public 0 Industrial ❑ Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Usc
WELL LOCATION: rr
Nearest Town: OLQ !t: County
4/J senLLj'6i-
(Street Name. Numbers, Community, Subdivision, Lot No.. Zip Code)
3. OWNER: 43c 6_06 AJC
Address z.// S'/4-LL ' Co elf) if,
(Street or Route No.)
0 44- Are 2 , (.2
City or Town State Zip Code
( )- 463-,77l`7
Area code- Phone number
4. DATE DRILLED /� ZU }
5. TOTAL DEPTH: So,-
6 DOES WELL REPLACE EXISTING WELL? YES C�I�NO ❑
7. STATIC WATER LEVEL Below Top of Casing: /540 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 ISA NCAC 2C .0118.
9. YIELD (gpm): ' METHOD OF TEST iN
10. WATER ZONES (depth): 59ptrf E 'PI o
II
12. CASING:
From
From •74
Topogra is/Land setting
❑Ridge lope ❑Valley ❑FIaI
(check appropriate hox)
Latitude/longitude of well location
(degrees/ntinutes,'seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From To Formation Description
©-70
05
,0/2
&/jgsfi Cc�
LOCATION SKETCH _r,
DISINFECTION: Type ethier .6 Amount g OZ6"/7? how direction and distance in miles frog it leash:.
Wall Thickness two State Roads or County Roads. Include the r4
Depth Dia up�,t/oter or Weight/Ft. Material numbers and common road names. �"2
From 0 To lit Ft. (/ 7 0 Fee
. i—f/eirt'zCid Mrs,
y
To Ft.
To 75 Ft. i
13. GROUT: Depth terial N ethod
From To Ft.
From 0 To 2Ij Ft. -type
14. SCREEN: Depth Diadteter
From To Ft. in.
From To Ft. in.
15. SAND/GRAVEL PACK:
Depth Size Material
AlkftW
Slot Size Material
in.
in.
From To Ft.
From To Ft.
16. REMARKS:
.-'�it' I bO HEREBY CERTJF
f--Gob+SFRUCTION STAl
LSubmit the original la the 1'vision of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
S- 27699 1636 Phone Nit (919) 7 ,3-3221, within 30 days. CiW-1 REV. 07/2001
�nI
269883
T THIS WELL WAS CONSTRUCTED ]N ACCORDANCE WITH ]SA N AC 2C, WELL
S. ND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED 0 THE WELL OWNER
c
IGN RE
F ERSON CONSTRUCTING THE WELL DATE
6*,

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) C7/ ( SQ $'+C. CERTIFICATION #______U
•lic
WELL CONTRACTOR COMPANY NAME 5.05e- L&JeLLr -i LL:AJy°/ PHONE # ( ) 7>y-rts
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
269884
I. WELL USE (Check Applicable Box): Residential Ill- icipal/Public 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery ❑ Heat Pump Water Injection 0 Other ❑ If Other, List Use
2. WELL LOCATION: �/XiL�/eCC
Nearest Town: / �� %d /Li County
9,q /VitJvctJ ilyz
(Street Nar6e, Numbers, Community, Subdivision, Lot No, Zip Code)
3. OWNER: _)ein&.5' -tt,9
Address 3 a g &.i /J(ucc.( D/L
(Street or Route No.)
4, cit.' /V cl
City or Town State Zip Code
( )- yre- as z0
Area code- Phone number
4. DATE DRILLED / / 7 — 6
5. TOTAL DEPTH: 7c5-
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO Er
---
7 STATIC WATER LEVEL Below Top of Casing: 4/C' 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.
75-
9. YIELD (gpm): y-3 METHOD OF TEST /1`f d .RAW
10. WATER ZONES (depth): go & -V 50
11. DISINFECTION: Type/1/4/7/,t''e Amount /a c7 7 P70
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
From To Ft.
From 0 To 7. Ft. 6- tie Pe-L-
From 737 To 74- Ft. 6 /7 ./8S1 /a/
13. GROUT: Depth Material Method
From To Ft.
7 From t) To 70 5 Ft. 7/ • /17,9Ce'i
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:
DO 1-IEREBYCERTIPIr
CONSTRUCTION
TopograIopiclT.and setting
[Midge Metope ❑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 — 70 eerCfz-
70- 7v,-
LOCATION SKETCH
Show direction and distance in miles rom at least
two State Roads or County Roads. In lude the road
numbers and common road names.
8.20
ets6.
_)p�Lrici
till p r
Q3-70
AT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL a
DS, /pND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNEIF
/
C�� 1C.
GNAT(JRE PERSON CONSTRUCTING THE WELL DATE CCr7
O
Co
Submit the originalto thelDivision of Water Quality, Groundwater Section, 1636 Mail Service Center- Raleigh, NC
27699-1636 Phone No..[phone], within 30 days. GW-1 REV. 07/2001
-1
Cr

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (printt)r a Li J U S-1 f C (= CERTIFICATION# .42)5Z)
TF WELL CONTRACTOR COMPANY NAME )c^1 Cr La )p14.. 0 K.t LONG PHONE#( ) /Z1F4 We'
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential Q Municipal!Public 0 Industrial 0 Agricultural 0
Monitoring ❑ Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION: q/'
Nearest Town: tit /1/24!>Af County 4?: r OCCOe
yazip Uj zzi i✓
(Street Name. Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: A 0 f4EF &A,L/
Address 1/9 7r0 05 Z ZI/U
(Street or Route No.)
/))4/Z.rnN A%
City or Town Statc
P752
Zip Code
(-) 756-4/?nc,
Area code- Phone number
Topographic/Lamtsetting
❑Ridge ❑Slope C}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
Q ^ 2,/c 0 /R- e
4. DATE DRILLED / -H- e 3 t"p— Xs--
5. TOTAL DEPTH: ZGS'
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO tyi
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 easing terminated at/or below land surface requires a
variance in accordance with 1SA NCAC 2C .0118.
9. YIELD (gpm): 'ZU METHOD OF TEST /3/ a-
10. WATER ZONES (depth): 05-7,„w L+y_ �J -70
t 1. DISINFECTION: Type eloCAFe Amount A02 L: 79
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
From '� To ri5 Ft. /e
From Li{{ To -97 Ft. � 1/4;a/Pik (14/1-1
From To Ft.
13. GROUT: Depth
From To
Material Method
Ft.
From 6 To .1/ Ft. 1 24 / A1/47fid
14. SCREEN: Depth Diameter StotSize Material
From To Ft. in. in.
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
2""-'
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common road names.
Luetil ilt t/u
269885
Usl2(.IJ
o ),
16. REMARKS: l
•'
CONSTRUCTION STANhARDS, A THAT A COPY OF THISRECORD HAS BEEN PROVIDED TO THE WELL OWNER
1 DO HEREBY CERTIFtF T THIS ELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
cp
.i,Zi . W
ON CONSTRUCTING THE WELL DATE Cn —,
`
- Submit- the original. to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center -Raleigh, NC
- 27699-1636 Phone No: (919) 7,(33-3221, within 30 days. GW-I REV. 07/2001
SIGNATURE OF PE
r-,R

WELL CONSTRUCTION RECORD
269886
North Carolina - Department of Environment and Natural Resources7- Division of Water Quality - Groundwater Section
VEIL CONTRACTOR (INDIVIDUAL) NAME (print) (lb 7i ` / J C 94 C F CERTIFICATION# /XISU
WELL CONTRACTOR COMPANY NAME Jb5'Ii e G- L 0/2FLCrh)(- PRONE # ( ) 72Q-15-4/8
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
I. WELL USE (Check Applicable Box): Residential 6� Municipal!Public ❑ Industrial ❑ Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION:
Nearest Town: 1?7 RCic,"
L eAnno n C.C.) n n01
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Coda)
County_ %i%-
a curet
3. OWNER: 1S1IC1 S ,L
Address , it9 I5 Ron CcIPC`P_-nr V e
(Street or Route No.)
ra\ u, IJC 0._so31
City or Town State up Code
( )-
Area code- Phone number
4. DATE DRILLED % Z - j/-
Topograa c/Land setting
❑Ridge L351ope [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
/.,_ Be, Aitd-sRez-Jc
5. TOTAL DEPTH: 7R 6 S- gU -, £25
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO rce---
7. STATIC WATER LEVEL Below Top of Casing: 2/6' 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): y METHOD OF TEST //1 ✓L G/
10. WATER ZONES (depth): / .7/9n7
11. DISINFECTION: Type(/02//0 c
12. CASING:
Depth Diameter
From To Ft.
From 0 To
From rfy+7 To Ft. (oil'!
13. GROUT: Depth Material
From To Ft.
AmountWall Thickness
or Weight/Ft. Material
•
From C To 2° Ft. 2ti/
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
"get
Slot Size Material
in-
in -
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common road names.
c-n
16. REMARKS:
- JDO HFREBY CERTIFY THAT
ONSTRUCTION STANDARD
IS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
HAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
der/
URE OF PE SON CONSTRUCTING THE WELL DATE
Submit the original to the:tivisi of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
27699-1636 Phone No. (919)733-322 within 30 days. GW-I REV- 07/2001

From: Scott Gantt To:
Date: 3/6/2003 Time: 9:48:34 PM Page 7 of 7
269705
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment, and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL)NAME (print) SCOTT GANTT CERTIFICATION # 2584
WELL CONTRACTOR COMPANY NAME CAROLINA WELL DRILLERS, INC. PHONE # [phone]
STATE WELL CONSTRUCTION PERMIT # ASSOCIATED WQ PERMIT #
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box) : Residential ❑ Municipal ❑ Industrial ❑ Agricultural ❑ Monitoring ❑
Recovery [] Heat Pump Water Injection D Other ❑ If Other, List Use:
z. WELL LOCATION:
Nearest town: MARION
WILD WOOD ACRES LOT 10
/ /ck+ we
County M *MON
(Street Name, Numbers, Community, Subdivision, Lot No,Zip Code)
3. OWNER AMERICAS HOME PLACE
ADDRESS 1340A PATTON AVE.
(Street or Route No.)
ASIIVILLE NC
City or Town State
828-253-4161
Area Code - Phone Number
a. DATE DRILLED 2/12/03
5. TOTAL DEPTH 180
6. DOES WELL REPLACE EXISTING WELL?
7. STATIC WATER LEVEL Below Top of Casing'.
Zip Code
YES ❑ NO 0
90 FT.
(Use "+" If Above Top of Casing)
s_ TOP OF CASING IS 2 ET. 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): 10 METHOD OF TEST ARDM
10. WATER ZONES (depth): 180
Topographic/Land setting
❑ Ridge ❑ Slope ❑ Valley X Flat
Latitude/Longitude of well location
35.40.934 / 83.02.172
(degrees/minutes/seconds)
Latitude/longitude source: © GPS ❑ Topographic map
DEPTH DRILLING LOG
From To Formation Description
0 45 Clay
45 180 Consolidated Rock
II. DISINFECTION: TYPE HYPOCHLORITE Amount 3 or LOCATION SKETCH
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
From 0 To 52 Et 61/4" SDR 21 PVC
13. GROUT:
Depth Material Method
From 0 To 20 Et. GRAVEL MIX GRAVITY
14. SCREEN
Depth Diameter Slot Size Material
From NA To Ft. in. in.
15. SAND/GRAVEL PACK'.
Depth Size Material
From NA To Ft,
16. REMARKS:
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
n bers and common road names.
HWY 70
RESISTO FLEX RD
GREENLEE RD
W
WILD -WOOD
ACAS
co -a
-
I DO HEREBY CERTIFY TFIAT 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.
S bmitthugprigma o le; ore
277 951-1636 Phone No. (919) 7133-3
lc
2/12/03
SIGNATURE OF PERSON CONSTRUCTING THE WELL Dale
er Quality, Groundwater Section, 1636 Mail Service center- Raleigh, NC
thin 30 days.
GW-1 REV. 07/2001

From: Scott Gantt To: Date: 3/6/2003 Time: 9:48:34 PM
Page 2 of 7
269:'00
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment, and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (1NDIVIDUAL)NAME (print) SCOTT GANTT CERTIFICATION # 2584
WELL CONTRACTOR COMPANY NAME CAROLINA WELL DRILLERS, INC. PRONE # [phone]
STATE WELL CONSTRUCTION PERMIT # ASSOCIATED WQ PERMIT #
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box) : Residential ® Municipal ❑ Industrial ❑ Agricultural ❑ Monitoring ❑
Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use:
2. WELL LOCATION:
Nearest town: MARION County
WILD WOOD ACRES LOT 9
mmeteN
(Street Name, Numbers, Community, Subdivision, Lot No,. Zip Code)
3. OWNER AMERICAS HOME PLACE
ADDRESS 1340A PATTON AVE.
(Street or Route No.)
ASHVILLE
City or Town
828-253-4161
NC
State
Area Code - Phone Number
4. DATE DRILLED 2/13/03
e. TOTAL DEPTH 200
Zip Code
6. DOES WELL REPLACE EXISTLNG WELL? YES ❑ NO 0
7. STATIC WATER LEVEL Below Top of Casing: 150 FT.
(Use "+" If Above Top of Casing)
8. TOP OF CASINO IS 2 FT. Above Land Surface*
"Top of casing terminated at/or below land surface requires a variance in
aoeordance with 15A NCAC 2C.0118
9. YIELD (gpmY 10 METHOD OF TEST ARDM
10. WATER ZONES (depd0: 180
Topographic/Land setting
❑ Ridge ❑ Slope ❑ Valley X Flat
Latitude/Longitude of well location
35.40.934 / 83.03.139
(degrees/minutes/seconds)
Latitude/longitude source: 0 GPS 0 Topographic map
DEPTH DRILLING LOG
From To Formation Description
0 65 Clay
65 200 Consolidated Rock
xi. DISINFECTION: TYPE HYPOCHLORITE
12. CASING:
Depth Diameter
From 0 To 70 FL 6 1/4"
13. GROUT:
Depth
From 0 To 20 Ft
w. SCREEN
Depth
From NA To
15. SAND/GRAVEL PACK:
Depth
From NA To
16. REMARKS:
Amount 2
Wall Thickness
or Weight/Ft. Material
SDR 21 PVC
Oz
Diameter
Ft.
Ft,
Material Method
GRAVEL MIX GRAVITY
Slot Size Material
in. in.
Size
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.
HWY 70
CD
RESISTO FLEX RD
GREENLEE RD
I
A rn
WILD —WOOF_'
rn
rn �.
ACRE
I DO HEREBY CERTIFY THAT THIS WELL \VAS CONSTRUCTED IN ACCORDANCE WITH l5A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER.
2/13/03
SIGNATURE OF PERSON CONSTRUCTING THE WELL Dale
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.
ri. lc-
,11 r- f _�
GW-1 REV. 07/2001
Ain LOTION
ASHEVILLE RECiEitJAL OFFICE

270384
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) James U>
WELL CONTRACTOR COMPANY NAME
STATE WELL CONSTRUCTION PERMIT#
(if applicable)
ramp' c Wr 1 1
Camp, Jr.
CERTIFICATION # 2 1 3 R
R Pimp en Tnr PRONE #$2R) d53-7'122
ASSOCIATED WQ PERMIT#
(if applicable)
I. WELL USE (Check Applicable Box): Residential 0" Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATI011,} 1
Nearest Towns I ' (G Y I 0 VI- County MC DO lice
I-Fifl( N L-&Ve5 rff I)ys(l)iie
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Cdde)
3. OWNER: GreepOe0.+ Zyl5
Address 117 LAILre I 2-e,ke s 15tAr)(vett
f , (Suet[ or Route �pNo.) ('
f bU'E N� 76,
City or Town State Zip Code
( )-
Area code- Phone number
4. DATE DRILLED ` G
5. TOTAL DEPTH: 5.-f
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO
7. STATIC WATER LEVEL Below Top of Casing: 55 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS 1 FT. Above Land Surface'
`Top of casing terminated at/or below land surface requires a
variance In accordance with ISA NCAC 2C .0118.
9. YIELD (gpm): METHOD OF TEST p i r
10. WATER ZONES (depth): G 0
11. DISINFECTION: Type chi nr i n p
12. CASING:
Depth Diameter
From p To Ft.6 1/4 GDR)1 PVC
From To Ft
From To Ft.
13. GROUT: Depth Material Method
From_ p To 30 Ft. --Nmot C^ :ent Hand
From To Ft.
14. SCREEN: Depth Diameter Slot Size Material
From To Ft. in in.
Front To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
16. REMARKS:
Amount I /A 6_,2A
Wall Thickness
or Weight/Ft. Material
— ,,,Topographic/Land setting
fdRidge ❑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 IDD i(f-tick)/
Inc 5.2 5 vl15olidat(c )- ck
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common road names.
'J
r r
I DQ FIEREEY CERTIFY THAT T liS1 WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WFI r
CONSTRUCTION STANDARDS, ANlb'THAT A COPY 0 THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
111
i�led- Ui ,-03
SIGNATURE OF PER$ N CONSTRUCTING THE WELL DATE
CD
t)
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
•

U4/04; roU7 US: 4/
S1y-rlb-U583
NCDELCttrn wz l tr OJAL ra',t u1! vi
270231
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment anddNatural Resources - Division of Water Quality - Groundwater Section
� y
WELL CONTRACTOR (INDIVIDOCAL) NAME (prtat) I" 1 tee/ 194 v, • c/ /-47 ear CERT>PfCATION
WELL cont ToacOreANr NAME PRICF WELL DRILLII'1G, INC. raoNc s j2i 327 0262
STATE WELL CONSTRUCTION PERMED/ ASSOCIATED WQ PERMTT 1
(if applicable) (if applicable)
I. WELL USE (Check Applicable Box): Residential 0Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION: �I
Nearest Town: 0i rr CotmY,41cAn ode /7
qy0 tx 0ncf54 ti /) r
(Sava Name. Numbers, Comanalty7SubdIvlsice. Lot No.. Tap Code)
3. OWNER: L%U013/ J. Tayi
Address 3V// r 4,; e gri
Nebo (smtes' ) ,,87G /
CRP or Town State Zip Code
( t; 5--2 -4792 t
Atw code. Thom number
4. DATE DRILLED —'s— C3
5. TOTAL DEPTH: .570 o Art 1
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO Dil
7. STATIC WATER LEVEL Below Top of Casing. FT,
(Use `+" if Above Top of Cams)
8. TOP OF CASING IS 6.9 FT. Above Land Surface*
'Top of ale( terminated Wow below land amrhee regatra a
variance to mordant witb ISA NCAC ZC.OtlI
9. YIELD (gpm): (1 METHOD OF TEST
10. WATER ZONES (depth): f
/ Topographic/Land setting
Midge 0Slope Malley Mat
(check appropdae box)
LatitudeAongitude of well location
kkgreemeim+wamwarl
Latitude-fltmgitnde source0GPSQIopographic map
(ebedtbax)
DEEM pPJLLING LOG
From To c=atnt Description
1O Qc
a CI el PI lie Q`
LOCATION SKEIC$
Show direction and distance in miles from at least
two Save Roads or County Roads. Include the road
numbers and common road runes.
CO
N)
0
1 DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRON STANDARDS. AJJD THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WFI T OWNF
P
11. DISINFECTION: Type So,,,{n/icy Amount C✓ps
12. CASING: 6 ✓4A ins Wall Thickness
Depth Diameter or Weight/Ft Material
From. GI To C� Ft
From__ To Ft
From To Ft
13. GROUT: Depth Material
From C To /OD Ft Comore rr vrecl
From To Ft
14. SCREEN: Depth Diameter Slot Sim Mammal
From To FL .jn. in.
From To Ft in. in.
15. SAND/GRAVEL PACK: Sul
eC7 C'�
From/d(R
7 To SB0 Ft. > tDepth Size
,ny�
Front To Ft.
16. REMARKS: �/r ilo/e / and/iac/ /G /2P/occ./c ?jic Wei/
SIGNATURE OF PERSON CONSTRUCTING THE WELL
,2-5-c'3
DATE
Cf1
vision of Water Quality, Groundwater Section, 1636 Mall Service Center - Raleigh, NC
221, within 30 days. GW-I REV. 07/2001

U4/04; .UU U8:4i 91'3-rlti-Ub66
FICDL&t1NllaAItr LUaL . aL,t UL/U1
i
s;
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division off Water Quality - Groundwater Section
WELL CONTRACTOR (WDIVIDUAL) NAME (prim) `c/ Az/jot La ilntr crRWICATrona 30Z0
wILL coNTRAcroacoMPANY Matt PRICF WELL DRILLING, INC. raoras$2/i) 327 02E8
STATE WELL CONSRtVCTION PERMIT/ ecOC1ATW WQ PERM3TA
Of applicable) (ifwlicable)
1. WELL USE (Cbeck Applicable Box): Residential i 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 /o/ f—O r» County 141 c r-c
475b /a/000fs9n,�j Pr-
S Numbers � . Sllidfvisim, to
(tract rt . Cenmmay. No., Tip Code)
3. OWNER: Jctc y L. Tay/.:
Address .3` i F4/rvfrr✓ PcI
Are be tAl cc
(Bast a Rom NO
(f3-
Gtya 6S3 Taco —y4Swe
t*E
Ann code- Phone number
4. DATE DRILLED - 4-O
5. TOTAL DEPTH: 0- S- EXISTING
�
6. DOES WELL REPLACE WELL? YES 'NO 0
7. STATIC WATER LEVEL Below Top of Casing: Q Ff.
(Use "a" if Above Top of Casing)
S. TOP OF CASING IS (' FT Above Land Surfaces
'Tap of eating terndaated stfa below Iced surface requires s
variance In tecerduce Ida 15A NCAC 2C.011I.
9. YIELD (gpm): (1 METHOD OF TEST
10. WATER ZONES (depth): r7
r)CI 6 /
Zip Code
Topographic/Land setting
Midge EfSlope Malley ❑Flat
(cheek eppeoprinse box)
Latitudellongitude of well location
cdegme»nimm/aecoect
Latitude/longitude smace:❑GPSDTopographic map
(check box)
:DEPTH L*J LING LOG
From To - tion Description
O 55- it
3 S- ' rl
Oder iS /:nL�.'41.,
11. DISINFECTION: Type 5Gn )JFnl/ndi Amount C ✓�
12. CASING: Cj rro nine.) Wall Thickness
Depth Diameter or Weight/Ft. Material
From /� 0 To SO Ft. ,6 ( f✓G
From_ To Ft
From To Ft.
13. GROUT: Depth Material r Method /
From ei To �l' 5 Ft CO ve » fit.) ✓r-cC
From To Ft
14. SCREEN: Depth Diameter Slot Sim Material
From To Ft,_pt _ in.
From To Ft in. in.
15. SAND/GRAVEL PACK:
Depth Sim Material
Front To Ft.
From To Ft.
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or Cotmty Roads. Include the road
numbers and common road names.
a o
w
C. 3
1
v 0
id
w a odyv'9
Or
0
CO
fV
0
16. REMARKS: V\ f %ibrt rhe- pvc,L' arse( Loifr act Fe'CICOS i,i vane/ mac t/d riftic�'�'
o ,
1 DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED 1N ACCORDANCE WITH 15A NCAC 2C, WELL • -
CONSTRUCTION STANDARDS, AND THAT A COPY OP THIS RECORD HAS BEEN PROVIDED TO THE WELL O
S
a-C/-03
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
..l` Sul)ulit t'I a ii' igfaar Division of Water Quality, Groundwater Section, 1636 Mall Service Center - Raleigh, NC
27699-1636 Plume F13, I 733-3221, within 30 days. GW-1 REV. 07/2001

2 J`1 J t i- 9
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment andNatmal Reeotw, s - Division of Water Quality - Groundwater Section
WELL cOKraACToa grenrvrouAL) NAME (prier) Se I
eI An.)e 1 t / it- eJ 1 6.411rc- cralIYICATION W. 30
4o
WELL CONTRACTOR COMPANY NAME PRICF WELL OPILLING, INC. PRONE a e2 327 0262
STATU WELL CONSTRUCTION PERMIT) J gqOC1ATEn WQ PERMITS
(if applicable) (if spplieablet
1. WELL USE (Check Applicable Box): Residential P' 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:©1-(47
Nearest Town: County Ins w e t
yS O W 004Sonf}rIlla4Q/ /?„
(Seem Name. Numbers(CeaMMIY, SiibdMsim. tot No.. to Code)
Topog@p�pphic/Land setting
0Pidge 0Slope 0Valley OFlat
(check appropriate box)
Latitude/longitude of well location
3. OWNER: LJ i.7 Oki J.-.-• Taye r" (drpemnaimtlsrbecoada)
Address .514 l 1 ' I-12 t r V I e t✓ Rd Latitude/longitude smace:❑GPS❑Topognphic map
(check box)
DEPTH DRILLING LOG
fir ere
CayaTewe Star Zip Code From To— Fo tienDta ''on
Ara ado -Those iambic „r �C /00 10 era .tk
4. DATE DRILLEDr�J`�
/ ` /de) 3r e) GYP rik4-e-
5. TOTAL DEPTH: / 4-5 C0 f--)--- f - 'TOP en'a n t ice
6. DOES WELL REPLACE EXLSTING WELL? �' O lir Ste> W raj n,;.n, -r-C__
(Scrota or Rom No.)
7. STATIC WATER LEVEL Below Top of Caring 77.? FT.
(Ute `.' if Shove Top of coma)
S. TOP OF CASING IS / /�-1 FT. Above Land Surface*
e7eq of eosin tere)aated rtfor below laved aatice relaters a
wines he stardom;wJtb ISA NCAC 2C.011t
1 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.
CONSTRUCTION
r., it
t bmit the Sri
27699-1636 )boat
Mi ". R3
o war (spat): Z ..L pieD TEST ief5 /etar \
0. WATER ZONES (depth)r:^ /� 'DU ��"
11. DISINFECTION: Type �rti , WI 14 Amotmt b C4 ft
12. CASING: ra ✓10 G 3 Wall Thickness
a Wr� MI
/
Frost ,• T��9 Ft � � I/�
From____ To Ft
From To Ft
13, GROUT: Depth
From e) To &n Ft P/9iv_' a4-K
From To Ft
14. SCREEN: Depth Diameter Slot Sim Material C� / C
From To Ft�n. _ in. 1 y..
Front To Ft in in. i i'
15. SAND/GRAVEL PACK ''
Depth Sim Material `l�
Frorr�_To Ft.
From To Ft. Lv0t5' rJ
kt,_ f • o� Fo Jr
v"
16. REMARKS:
0
1 DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL cut -
YGATIDARDS, THAT OPY O THIS RECORD HAS BEEN PROVIDED TO THE WELT. W4WM E
SIGNATURE OF?ERSON CONSTRUCTING THE WELL DATE
- /3- 03
the Division of Wafer Quality, Groundwater Section,1636 Man Service Center - Raleigh, NC
19) 7334721, within 30 days. GW-1 REV. 07t2001

North Carolina - Department of Environment and Natural Resources - Division of Water Qual
1636 Mail Service Center - Raleigh, N.C. 27699-1636 - Phone [phone]
WELL CONSTRUCTION RECORD
y - Groundwater Section
WELL CONTRACTOR. Dewev Wright Well
WELL CONTRACTOR CERTIFICATION #• 2687
270534
Pump Co., Inc.
030041 STATE WELL CONSTRUCTION PERMIT#• Steve Reece
1. WELL USE (Check Applicable Box): Residential T1 Municipal
Recovery ❑ Heat Pump Water Injection Other
2. WELL LOCATION: (Show sketch of the location below)
Nearest Town:
PI NEOLA
County.
Industrial ❑ Agricultural ❑ Monitoring
If Other, List Use'
M000WELL
3. OWNER OCEAN' A. LIMITED
Address Re(R0n1. ITminm)
City or r own
MARI ON
State
NC 2752de
4. DATE DRILLED 2/12/2n0'
5. TOTAL DEPTH App
6. CUTTINGS COLLECTED YES NO
7. DOES WELL REPLACE EXISTING WELL? YES NO C
8. STATIC WATER LEVEL Below Top of Casing: 80 FT
(Use "+" if Above Top of Casing)
9. TOP OF CASING IS 1 FT Above Land Surface*
*Top of casing terminated at/or below land surface requires a variance in accor-
dance with 15A NCAC 2C.0118
10. YIELD (gpm)• 25 METHOD OF TEST Air
11. WATER ZONES (depth) 2 aom 130-135 23 aom 453-460
0 aom 0 aom
12. CHLORINATION: Type HTH Amount 75
21 OF
DRILLING LOG
From To
13. CASING:
x
Wall Thickness
Depth Diameter or Weight/Ft. Material
From 0 To RBFt 6 aen 18S 341)/
From To Ft
From To Ft
14. GROUT:
From
From
Depth
fl To 7n
15. SCREEN:
From
From
From
To
Depth
To
To
To
16. SAND/GRAVEL PACK:
Depth
DEPTH
Formation Description
DIRT
80 ge u AFSTONE
Cie g8 LIAA=s-roNtiswo1C
Q8 130 tliAFSTnNIF
130 135 PNKLIMESTONF
1'15 330 J PV I IAAFSTnhIF
z30 3z4 PrD SHALF
334 q50 GPY LIMFSTnNIE
g5f1 35d opn RuAI F
SPA. d5 t f;PY I IMFSTQNP
d'53 din RPM I Ih4FSTONJPn VI
If additional space is needed use back of form
LOCATION SKETCH
(Show direction and distance from at least two State
Roads, or other map reference points) • nr"
2c L t"' • It\,V0IL
0
r✓7
Material Method
Ft Comarf rrAvity F!r+et
Ft
Diameter Slot Size
Ft in
Ft in
Ft in
rt} In Yi
bIi-t 2T1063 - LF
17. ')MARKS:
ho HEREBY CERTI6Y THAT Till
NSTRUCTION S1ANDARDS,�
R OFFICE USE ONLY
Caked NO:
Size
in
in
in
Material
Material
L WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
HAT A COPY OF THIS RECOHAS BEEN PROVIDED TO THE WELL OWNER.
2t f- z R-R7 —0_3
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
Submit original to Division of Water Quality, Groundwater Section within 30 days
GW-1 REV. 12/99
Serial No.

North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
1636 Mail Service Center - Raleigh, N.C. 27699-1636 - Phone [phone]
270537
WELL CONSTRUCTION RECORD WELL CONTRACTOR- Dewey Wright Well Pump Co., Inc.
WELL CONTRACTOR CERTIFICATION #• 2887
030031 STATE WELL CONSTRUCTION PERMIT#• Steve Reece
1. WELL USE (Check Applicable Box): Residential Municipal ❑ Industrial ❑ Agricultural ❑ Monitoring ❑
Recovery I I Heat Pump Water Injection I Other I I If Other, List Use.
v
2. WELL LOCATION: (Show sketch of the location below)
Nearest Town• MApinpl County. Mr-DOWELL
RIRINAm 6„2FFy.B g, caPifF +NY 221
3. OWNER RALPH A. vtARI NO
Address a" IOFFR R-D E ts o.l T�JL
1 user or ou
MARION Rii
City or Town State
7
ip Lode
4. DATE DRILLED 214/9lf14
5. TOTAL DEPTH aln
6. CUTTINGS COLLECTED YES ❑ NO 0
7. DOES WELL REPLACE EXISTING WELL? YES fI NO In
8. STATIC WATER LEVEL Below Top of Casing: 120 FT
(Use "+" if Above Top of Casing)
9. TOP OF CASING IS 1 FT Above Land Surface*
`Top of casing terminated at/or below land surtace requires a variance in accor-
dance with 15A NCAC 2C.0118
10. YIELD (gpm)• 3 METHOD OF TEST Air
11. WATER ZONES (depth):3 oom390-3P2 0
aom
n nnm n aom
12. CHLORINATION: Type I-{TH Amount Rfi
DRILLING LOG DEPTH
From To Formation Description
0 240 DIRT
240 300 GRANITE
300 '182 QUAOTZ
3A2 4'10
QRANII TF
If additional space is needed use back of form
13. CASING: Wall Thickness LOCATION SKETCH
Depth Diameter or Weight/Ft. Material (Show direction and distance from at least two State
From n To 7R0 Ft R 114 1RR CRRAl V Roads, or other map reference points)
From To Ft �H Ag-L
From To Ft
0.fCI �C L --I
14. GROUT: CO
Depth Material Method
LT�tr
From 0 To 20 Ft CAment Gravity Flow
From To Ft
15. SCREEN:
Depth Diameter Slot Size Material
From To Ft in in
From To Ft in in
From To Ft in in
16. SAND/GRAVEL PACK:
Depth Size
From To Ft
From To —
Ft
17. REMARKS: ri
11CONSTRUCTION $TANDARDS, �
I DO HEREBY CE"TIFY,ITHAT THIS WELL WAS CO1'J-UCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
I THAT A C� ' THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER.
2 /0,/Q.— 6.09 ,Pi 0 e _ — a 7 -o-Y
Material
co
FOR OFFICE USE
Quad No:
Serial No.
}SIGN
Submit original to
L
/O,19 w�
cL
TURF OF PERSON CONSTRUCTING THE WELL DATE
ivision of Water Quality, Groundwater Section within 30 days
GW-1 REV. 12/99

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and N tural Resources,s- Division of Water Quality - Groundwater Section�7�7
WELL CONTRACTOR (INDIVIDUAL) NAME (print) 0 At A / C= !"/ 42-/- �Z� p CERTIFICATION #. -[ 5/ 7
WELL CONTRACTOR COMPANY NAME.4 CJ JO : J L / Lee', U/N-[/�w,(? di -PHONE # «*) 4 27 jLI
STATE WELL CONSTRUCTION PERMIT# 4/11 ASSOCIATED WQ PERMIT# ,V/ i
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential X 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:
NearegtTown: /y-(=L1 .. County217C ZALL--c'. -6 ,
(Street Name, Numbers, C
3. OWNER:P+a � �/4�hP /�//_
Address* y S- /Q 77VA ',
(Street or Route No.)
t✓-
City or Town State Zip Code
Area coda Phone number j.
4. DATE DRILLED li - U 3
5. TOTAL DEPTH: (- '
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO DI
7. STATIC WATER LEVEL Below Top of Casing: ,4a t.) 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): z� /) METHOD OF TEST /.-C,Lato
10. WATER ZONES (depth): /o`z C.)° _2 / !n '
11. DISINFECTION: Type y ' Amount
12. CASING: ✓" Wall Thickness
Depth Diameter or Wei t/Ft. Material
From �% To Ft. /C'•
From To Ft.
From To Ft.
13. GROUT: Depth n Matetia
From_To &L, Ft.J znf227i
From To Ft.
14. SCREEN: Depth Diameter Slot Size Material
Fro To Ft. in. in.
Fro To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From - To Ft.
U'L
M od •
•
16. REMARKS: _�C)-films%,i'-e-+.
P/ c q i� Sri .✓� S� �.5
ommum ubdivision, Lot No., Zip Code)
LtrLJ.l c ."1,e
1 DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN
CONSTRUCTION STANDARDS, AND
T�(4T A COPY OF THIS RECO I h,S £EPV PRGVIDED TO
Topographic/Land setting
❑Ridge GiSlope ❑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)
LOCATION SKETCH
Show direction and distance in mils from, least -
two State Roads or County Roads.flnclude:Te road
numbers and common road names,
w
cri c-,
SIGNATURE OF PERSON CONSTRU
270639
ID
5XNCAC T 4
GTHEWELL DA
Submit the original to the Division of Water Quality, Groundwatelr Section, 1636 Mail Service Center -
27699-1636 Phone No. [phone], within 30 days. {�
4�l
0
NC,dtLi;
nL.

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Divisionrsof Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) 1Fes,V�*h C/O•" t. CERTIFICATION#D'oq46?
WELL CONTRACTOR COMPANY NAME ta keeel
271151
PHONE # ( )
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable)
(if applicable)
1. WELL USE (Check Applicable Box): Residential Lt'Municipal/Public ❑ Industrial ❑ Agricultural ❑
Monitoring f] Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use Qwy<t f C
a-
2. WELL LOCATION: Nearest Town: NOM(40/J County PC.A9Gte...4
'Av 1()$0 Vpa r Hi .
(Street Name, Num rs, Community, Subdivisio Lot No., Zip Code)
3. OWNER: Aqc. O� Address(,,
(Street or Rbute No.)
, 71.c•
City or Town State
gAS' - (138)_ 35- 5'7
Area code- Phone number
4. DATE DRILLED /
5. TOTAL DEPTH:
6. DOES WELL REPLACE EX1S IN WELL? YES ❑ NO
7. STATIC WATER LEVEL Below Top of Casing: 90 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS 4- FT. Above Land Surface`
a8737
Zip Code
*Top of easing terminated at/or below land surface requires a
variance in accordance with 15A NCAC 2C .0118.
9. YIELD (gpm): -Z METHOD OF TEST kill
10. WATER ZONES (depth): 77- % y'- eiy,/
.977-379- is-517 l
11. DISINFECTION: Type ii-rg Amount 3C)r
12. CASING: Wall Thickness
Depth Dian eter or Weight/Ft. Material
From '' / To :i*- Ft. e3 asviui A/c
From To Ft.
From To Ft.
13. GROUT: Depth Material
From /l To "20 Ft. Grrsa-✓(--
From To Ft.
14. SCREEN: Depth Diameter Slot Size
From To Ft. in. in.
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth
From To Ft.
From To Ft.
Size Material
16. REMARKS:
Topograp 'c/Land 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
Form tion Description
f 4 — 2 3
7.7— P7 ira le
7 7 - 3277
/,‘"? Sir 4-
DEPTH
From To
0— 94
77 �-2'
2P?— V /e
'iic'- /f /9-
s/v — 96c
r1.c1 4-4 ra- /t
fF
w
LOCATION SKETCHShow direction and distance in miles from atleast
two State Roads or County Roads. Include thi road'
numbers and common road names.
v
fittOled
LD
O
w
m
�1 b0 (-kEREBY CERTIFY T.H{yt
EONSTRUCTIONSTANDA7 l s
Submit the original to the Divis
2.7699-1636 Phone No. (919)133-3'
... _........
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
/-217 o Jos
GNATURE OF PERSON —CONSTRUCTING THE WELL DATE
on of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
21, within 30 days. GW-1 REV. 07/2001
rn
CD
z

2. WELL LOCATION: /
Nearest Town: ea/d i9YT County
&•S
(Street Name. Numbers. Community,/Subdivision, Lot Nd., Zip Code)
3. OWNER:35ikf 4-IPh'Y�
Address 750 net Y'
e Id ' --t or RXc�la.)
City or Town Stile /�• Zip Code
WELL CONSTRUCTION RECORD 270 918
North Carolina - Department of Environment and � NaturalyResources -` Division
to Water Qua Groundwater Smite...
WELL CONTRACTOR (INDIVIDUAL) NAME
�� (�pri/n�t)yI� SYYL C115• wl��� CERTIFICCATION/#-7 tin/ a y
WELL CONTItACroR COMPANY NAME HMI tic. 1Vi Y#t„• VI PHONE# tt thlera.3
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT
(if applicable)
(if applicable)
WELL USE (Check Applicable Box): Residential ly Municipal/Public ❑ Industrial ❑ Agricultural ❑
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use
Topographic/Land setting
❑Ridge la$lope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
�(.rtJ fRi (tL7 s Latitude/longitude source:❑GPS❑Topographic map
DEPTH
From
( )-
Area code- Phone number
4. DATE DRILLED e L •/
5. TOTAL DEPTH: Z'45
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO a'
7. STATIC WATER LEVEL Below Top of Casing: SAO FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING 1S ' FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
(check box)
DRILLING LOG
To Formation Description
variance In accordance with ISA NCAC 2C .0118. /1 • ,
9. YIELD (gpm): CD METFIDD OF TEST {.I.191R4t1Pah
10. WATER ZONES (depth): 1
11. DISINFECTION: Type —rab14.-$ Amount Z
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
From To Ft,
From To Ft.
From To Ft.
13. GROUT: Depth / Material Method
From To Ft.\0(
From To FL
14. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in.
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
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.
40
1-1`' 1 7b
)/R.`f W3ka6cl1 k •
4
CO
1; DO`HEREBY CERTIFY
CONSTR N ST
S-
/ SIGNATURE OF PERSON CONSTRUCTING THE WELL
Submit the original to the Dn 'Mon of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
27699-16.6 Phone No, (91-9) 733 3221, within 30 days. GW-1 REV. 07/2001
THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH ISA NCAC 2C, WELL
AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
C�r t 1-Q3
DATE

3. TOP OF CASING Is
'Top of casing terminated at/or below land surface requires a
variance in accordance with 15A NCAC 2C .0118.
9. YIELD(gpm): 9.0C-z?t(ET,),1ODOFTEST rN1C
ID. WATER ZONES (depth): / creostt
270722
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME
E(("print)` \'7 Q r t`�\'1''j�\�1CP CERTIFICATIONg�# ' / '0
\\ ELL CONTRACTOR CO\II'ANYNAME \ \l; `5V ce Lt e \\ M )� \`11t\y PHONE # f7 lay-q5-1
STATE \FELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(i c applicable) (if applicable)
1. WELL, USE (Check Applicable Box): Residential X 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: M R )c 11n\'\
ie'(jc' <C"A'
(Street Name. Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER:.e.)``-\ u.2.1C`
Address 3-45l1 N5w,cA•
(Street or Route No.)
1\1\Qc\nc\ )C
City or Town State Zip Code
Area code- Phone number
4. DATE DRILLED c7-,-nt-C7�
5. TOTAL DEPTH: ;.15
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO
7. STATIC WATER LEVEL Below Top of Casing: tit FT.
(Use "+" if Above Top of Casing)
FT. Above Land Surface'
County {"\Lbr •v..;P 1\
11. DISINFECTION: Type 0.-\\,cc�.�a.
12. CASING:
Depth Diameter
From To Ft.
From (`) To 77 FLU
From 77 To 79 Ft. (o V9
13. GROUT: Depth Material
From 0 To
Amount\ r& t 37o
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
From To Ft.
From To Ft.
16. REMARKS:
D(;?tHF}f Et r' GERM-
'ffik C; 1Ok si k
}^n
+ rl
_7
Size
THIS WE
AND T
Slot Size
in.
in.
4ALLf
Method
Material
Material
Topo ra /Land setting
❑Ridge X,Lope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitudeflongitude source:❑GPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From To Formation Description
tv— 7 z
7Z- VS'
-'.
LOCATION SKETCH
Show direction and distance in miles froasat least
two State Roads or County Roads. Include the road
numbers and common road names.
etc
WAS CONSTRUCTED IN ACCORDANCE WITH I5A NCAC 2C. WELL
T A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
S GNA URE OF PE
ON CONSTRUCTING THE WELL
DATE
Submit the original to{the 1 n'ision of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, INC
27699-1636Phone No.t( 19) 7 -3221, within 30 days. GW-I REV. 07/2001
cAf

6. DOES WELL REPLACE EXISTING WELL? YES 0 NO EB-
7. STATIC WATER LEVEL Below Top of Casing: AO FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS 1 FT. Above Land Surface*
'Top of casing terminated at/or below land surface requires a
variance in accordance with 15A NCAC 2C .0118.
9. YIELD (gpm): /3- METHOD OF TEST /) -
10. WATER ZONES (depth): / Sypm & 7
I I. DISINFECTION: Type
12. CASING:
Depth
From 0 To /O
From±Of_ To ' Z`t
Fron._ Ost] To /3 i
13. GROUT: Depth
From To
From O To 21
10/Z1 N
Diameter or Weight/Ft. Material
Ft. L /7v li 0 Pi'C-
Ft. 6, %9- ,i? Pt' -
Ft. a'/Y - .l =,eLC
Material Method
Ft.
Ft. a,,r / ACM/F�
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.
r !D,_. - 7
Submit the original to the Division
27699-1636. Phone No. (919).733-3221
WELL CONSTRUCTION RECORD
270720
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section��l,'
WELL CONTRACTOR (INDIVIDUAL) NAME (print) GyetiYi�TIGF CERTIFICATION 440�f99//�✓ G
WELL CONTRACT OR COMPANY NAME �L15'f k 6 tor) e. l( 0 L( AA' (. PHONE # f ) /Z7v8
STATE. WELL CONSTRUCTION PERMIT# ASSOCIATED WO PERMIT#
(if applicable) (if applicable)
I. WELL USE (Check Applicable Box): Residential Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection ❑ Other 0 IFOther, List Use
2. WELL LOCATION:
Nearest Town: nil gnoN
3'7 Sn,,',Lz- N%Le- rah
County MSlY 1e
(Street Name. Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER:
Address
la it b>zew eL~L-
137 S m;d-ti hi'u- r?
(Street or Route No.)
Iln glx-ib h<
City or Town State
( )- 73t1 - S34-Z
Arca cede- Phone number
4. DATE DRILLED 7 --2 3-- u 3
7 P7i2-
Zip Code
Topographic/Land setting
❑Ridge IESiope ❑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
4,1- /,2 D t S 1
5. TOTAL DEPTH: 32 S /2 S`
3 zr 4,94ti, t
co
LOCATION SKETCH C3
Amount 1 / Re 7- 7},2 Show direction and distance in miles from.at hest-..
Wall Thickness two State Roads or County Roads. Inclu�[he fi4ad
a u
numbers and common road names. p r*1-
12.uki.i kGj4o
k
WELL WAS CONSTRUL t ED IN ACCORDANCE WITH 15A NCAC 2C, WELL
)U HAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
ATUROF
RSON CONSTRUCTING THE WELL
DATE
of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
within 30 days. GW-I REV. 07/2001
6

STATE \\'ELL CONSTRUCTION PERMIT#
(if applicable)
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Divisionsiof Water Quality - Groundwater Section
RBLL CON'I RACTOR(INDIVIDUAL)NANIE (print) -b- yUj}ic CERTIFICATION#' I3
\\' ELL CONTRACTORCO]IPANY NAME Ji)SILL c._ Luc- tipY: LA-1 PHONE # ( ) •7Z4'—Cf3—`/6
ASSOCIATED WQ PERMIT#
(if applicable)
270719
WELL USE (Check Applicable Box): Residential Ld' Mrmicipal/Public ❑ Industrial ❑ Agricultural ❑
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use
2. WELL LOCATION: Nearest Town: Nter ]••]�� County VIA Y elec. /"k
(Street Name. Numbers, �nm Subdi visit No., Zip Code)
3. OWNER:
Address
geld
40# /O (Street or KOULL
//NOKII,c0 f
art, C
,/(CCiity or I own State Zip Code
( )- �3Q-'3778
Area code- Phone number
4. DATE DRILLED 0 -Z7-o 3
5. TOTAL DEPTH: Q as-
6 DOES WELL REPLACE EXISTING WELL? YES ❑ NO
7. STATIC WATER LEVEL Below Top of Casing: 3-0 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS Jt 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 METHOD OF TEST f4//2
I0. WATER ZONES (depth): '9pa4 C 2 SO
I I. DISINFECTION: Type CZ0t.v(
12. CASING:
ographic/Land setting
edge DSlope ❑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
�../oU
q/ boo- 7f35
Depth D' wer
From 0 To I0" Ft. - r. /{O Pe e_
From To Ft.
From (°3 To/05" FL �'l7! lbe
13. GROUT: Depth Material Method
From To Ft.
From (t) To 27 Ft.
14. SCREEN: Depth Dial
From To Ft.
From To Ft.
15. SAND/GRAVEL PACK:
Depth Size
From To Ft.
From To Ft.
D>/Zvt
(ID
CfJ
LOCATION SKETCH 5
Amount 9026)-nzz, Show direction and distance in miles from jcastE,
Wall Thickness two State Roads or County Roads. Include td'2, roaf
or Weight/Ft. Material numbers and common road names.
n
eter Slot Size Material
in. in.
in. in.
Material
16. REMARKS:
`OI�Lf�3Y[Ijl I , TI9�:FT
NSTRUCf 10N STANDA S ".
Suit the original to thel1N'ision
27(. Ll636 Phone No. (919) 7733G3221,
WELL WAS CONSTRUCTED ]N ACCORDANCE WITH 15A NCAC 2C, WELL
THATA •PY OFTH ' ': RD HAS BEEN PROVIDED TO THE WELL OWNER
T RE OF
2SON CONSTRUCTING THE WELL DATE
of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
within 30 days. GW-1 REV. 07/2001

WELL CONSTRUCTION RECORD 270716
North Carolina - Department of Environment and Natural Resourcess - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print)--1Cs, \J 5\\CP CERTIFICATION#c�15n
WELL CON'IR:\CTOI2 COMPANY NAME tIkS3-liCP
s FA rE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
PHONE # -Ia"1-`7J7
I. WELL USE (Check Applicable Box): ResidentiaW Municipal/Public ❑ Industrial ❑ Agricultural 0
Monitoring ❑ Recovery 0 Heat Pump Water Injection ❑ Other 0 If Other, List Use
2. WELL LOCATION:
Nearest Town: M R (-'\ n r1
SUrnn N's 1\ blr-\.
(Street Site. Numbers, Community, Subdivision, Lot No.. Zip Code)
3. OWNER:_C+PUP.--slr{isV1\
Address ?Y 1L{ L QC \\\\\' 1�e�.
(Street or Ro to Jo.)
CLCAr iA f\1 C D-V1.5 �.
City or Town State Zip Code
(s)-r13C.S 3v19
Area code- Phone number
4. DATE DRILLED 1- 7- (-3
5. TOTAL DEPTH: y 05
County M(-1)cs a,1
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO 0
7. STATIC WATER LEVEL Below Top of Casing: 1`.s 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): METHOD OF TEST At
10. WATER ZONES (depth):
LOCATION SKETCH
Show direction and distance in miles froitis4 lea
two State Roads or County Roads. lnclue r
numbers and common road names,/
Topogra ic/Land setting
DRidge 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
©—//0i4-/114-/
h z- 4os
11. DISINFECTION: Type C_:h\or,nP
12. CASING:
Depth
From C To c38 Ft
From (2.,Y To//Rd Ft
From / / e To I20 Ft
13. GROUT: Depth Material�r!
From C) To a Ft.. I ypC I
From To Ft. /
Amount'437()
Wall Thickness
Dian)etcr or Weight/Ft. Material
6 1/ • qd 0 C.
14. SCREEN: Depth Diameter
From To FL in.
From To Ft. in.
I5. SAND/GRAVEL PACK:
Depth
From To Ft.
From To Ft.
Size
Slot Size Material
in.
in.
Material
A`ll__lJ
16. REMARKS:
CCU
I DO HEREBY t - • HIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
R( :T(OT\C1r/rAj?><I)'j1. AND THAT A COPY OF THIS RECORD I IAS BEEN PROVIDED TO THE WELL OWNER
//� ppqq - 7 2'1i3
Sub`diit'the original to th
'27699 1636 Phone No. (919
RE OF PERSON CONSTRUCTING THE WELL
DATE
ion of Water Quality, Groundwater Section, 1636 Mail Service Center- Raleigh, NC
21, 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
' / c7
WELL CONTR:\CTOR (INDIVIDUAL)NAME
'"�(p�rirn�ty) C5-iJn y 1 US->`/(/.� CERTIFICATION /�
WELL CONTRACTOR COMPANY NAME ✓t1.91C -' - e (-C.id rt. a, )w i PHONE # C'L /1 7 .-'S' '6'
SLATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
270717
I. WELL USE (Check Applicable Box): Residential LJ�unicipal/Public ❑ Industrial ❑ Agricultural ❑
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use
2. WELL LOCATION:
Nearest Town: I1.14/C/O>tl
yyyy// a
County ///—(.Y%'tir
(Street Name. Nufd(Rrs, Community, Subdivision, Lot No. Zip Code)
3. OWNER: hj4/C/ y 60rclreryC!
Address 'ail C'4-70SS 4'11"oftd
(Street or Route No.)
,f9
City or Town State Zip Code
(
Area code- Phone number
4. DATE DRILLED 1-3-- 03
5. TOTAL DEPTH: 4kf
6. DOES WELL REPLACE EXISTING WELL? YES [Q NO ❑
7. STATIC WATER LEVEL Below Top of Casing: Y� FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS 1 FT. Above Land Surface*
Top of casing terminated atfor below land surface requires a
variance in accordance with 1SA NCAC 2C .0118. '
9. YIELD (gpm): I METHOD O,,�F�TEST /7/2jS'Y i
10. WATER ZONES (depth): Jrj/'m I'?
7 WO
1I. DISINFECTION:Typie10/6.t:.0
12. CASING:
Depth Diameter
From 0 To I/O Ft. 6//4/
From 4'o To 4'z Ft. Wk.
From To Ft.
13. GROUT: Depth
From i17 To Z' Ft.
Topoc/Landsetting
DRidge lope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From To Formation Description
LOCATION SKETCH
Amount ' .? 7"7/ `.L. Show direction and distance in miles from actiast=
Wall Thickness two State Roads or County Roads. Include fEe road_,
or Weight/Ft. Material numbers and common road.names. a
&Ai C %L7$1//cs7
PC) f%r/iLG/
Material' ;hod /J
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. 2'� I�LLecv %Lr(
From To Ft.
Slot Size Material
in.
in.
/
P ! or04
16. REMARKS.
I PWIRELE,& C ER1Tj F1(iTH
CONSTRUCTIONSTAN
APR — 7 2. 9i
Sleek tIci
-/ fV zfyi%tj�
HIS WEL WAS CONSTRUCTED IN ACCORDANCE WITH ISA NCAC 2C, WELL
AND IR T A COPY OF THIS I9CORD HAS BEEN PROVIDED TO THE WELL OWNER
iJ =:
4j/-2
GNATURE OF P(Ept(7N CONSTRUCTING THE WELL DATE
Submit the original to the Divi ion of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
P27699-1636 Phone No. (9I9)-733-3221, within 30 days. GW-1 REV. 07/2001

3. OWNER:
271736
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
%VELL CONTRACTOR (INDIVIDUAL) NAME (print) 94 /OLO J (IS`f %C £ CERTIFICATION #,9/'S
WELL CONTRACrORCONMP.ANY NAME TO S'i'iCEt' We —Le ,b f—.i.(i Ns? PHONE # ( ) gr25574'-9S 'H
SLATE WELL CONSTRUCTION PERMED/ ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
WELL USE (Check Applicable Box): Residential Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery O Heat Pump Water Injection 0 Other 0 If Other, List Use
WELL LOCATION:
Nearest Town: bFiJr County /Y1-�C
+.Ll:4C.LC_
3 i+75 6-b f .*I" $ u<;M-
(Street Name. Numbers, Community. Subdivision, Lot No., Zip Code)
(CJc' 4 ,n 'Z -41. j
Address /'0.0XL5.
(Street or Route No.)
e)Z, rtrt pv
City or Town State Zip Code
( )- Gip-9339
2876 -
Area code- Phone number
4. DATE DRILLED 03
5. TOTAL DEPTH: 70$
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO Ir
7. STATIC WATER LEVEL Below Top of Casing L%O 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): �1� METHOD OF TEST514(d
10. WATER ZONES (depth): 1/2 Spr+ G-si 7 oS
-
Topographic/Land setting
❑Ridge ❑Slope (Icy ❑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
7%0 - 765- etembk
LOCATION SKETCH
I I. DISINFECTION: Typel Loci 4. C' Amount ' i 62 CS 732 Show direction and distance in miles from a6-Past -.
12. CASING: Wall Thickness two State Roads or County Roads. Include the'Joadi . A
Depth Diameter or Weight/Ft. Material numbers and common road names. %a --
From To Ft. 1
From C.0 T4'$
From CC To y7
13. GROUT: Depth
From To Ft.
From 0 To 70 Ire e
14. SCREEN: Depth iameter Slot Size
From To Ft. in. in.
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Material
Pb
Method
Ft. gel
Ft. 42 yfr—`y,S.--
Matenal
Depth Size
From To Ft.
From To Ft.
16.. REMARKS.
CLOFr
7
bO.UEREtSY �CE[ T1F`t1 I- At
CONSTRUCTION STANDA 1
I MAY
HIS W LL WAS CONSTRUCTED IN ACCORDANCE WITH I5A NCAC 2C, WELL
Al2Iq/THAT A COPY OF THIS RFfORD HAS BEEN PROVIDED TO THE WELL OWNER
SIGNATURE
F PEI
N CONSTRUCTING THE WELL DATE
t tt [Ite origiuk t tahhe Didision of NVater Quality, Groundwater Section, 1636 Dlail Service Center - Raleigh, NC
711-1221 within 30 days. GW-I REV. 07/2001

271'735 `-`
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) (1^I'.i/ er ', f-,c, CERTIFICATION#��S'
WELL CONTRACTOR COMPANY NAME -\ i ,'/ i c," 1 "; t PHONE # ff) /<° Y'7S//ry
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
WELL USE (Check Applicable Box): Residential IS/Municipal/Public 0 Industrial 0 Agricultural ❑
Monitoring ❑ Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION:
Nearest Town: OLD t ± County 17)t.:.t>'S-Q
Let S% 54K11-('rf F L rho
(Street Name. Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: ; "'>Z.�(-;/ /•// )V( 'N
Address 37tC1 /1 /Er Ica/
(Street or Route No.)
/3,e/te r41)t n� 2-27l
City or T wn rate Zip Code
(y<r) 4,67 L74c1-
Area code- Phone number _
4. DATE DRILLED 7. —
5. TOTAL DEPTH: '705
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO lir
7. STATIC WATER LEVEL Below Top of Casing: 2co 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 accordapee with 15A NCAC 2C .a118.
9. YIELD (gpm): METHOD OF TEST S11174
10. WATER ZONES (depth): ?x�,/» try %.DO
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
Topophic/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
yN (-71-
'7o
5
/2
�Art'i
I I. DISINFECTION: Type 91OC ,,Aie Amount tV S02 73r)•
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
From To Ft.
From To it Ft. cdy y� Q le C
-
FromTo �` Ft. (Si 4 4r' g4L(1
13. GROUT: Depth Material Method
From To Ft. I
From e To -2?7 - Ft. £L-4 p.4I VOvvq,:? 1
14. SCREEN: Depth Diameter Slot Size
From To Ft. in. in.
From To Ft. in. in.
15. SAND/GRAVEL PACK:
From
From
Depth
To
To
Material
Size Material
Ft.
Ft.
4-10 -7r9`fKi`l--
\_-- f1
75 P {ir'1 {'rn .' l ex,_
CERTIF
CONSTRUCTION STAN
2 C')3
T TH
)S. A
0
(.f1
0
UcPV re r
I> A4-crir,eILL
OLD
[34
WELL WAS CONSTRUC I ED IN ACCORDANCE WITH I5A NCAC 2C, WELL
D THAT A COPY OF ECORD HAS BEEN PROVIDED TO THE WELL OWNER
-e‘
__�
SIGNATURE
FP
ON CONSTRUCTING THE WELL
DATE
pc,,, Submit the origina8£fth ivision of Water Quality, Groundwater Section, 1636 Mail Service Center -Raleigh, NC
-77699-1636 Phone No. [phone], within 30 days. GW-1 REV. 07/2001

271734
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources
- Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) Cl/at' �.VSV-/CE CERTIFICATION #02/S(
WELL CONTRACTOR COMPANY NANIE
US } L PHONE # ( ) 7Z4'-VSWt
5rATf. \\'ELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential IZI..41unicipal/Public ❑ Industrial ❑ Agricultural ❑
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use
2. WELL LOCATION: � Topograp nd setting
Nearest Town: Anti /-/O /� County fir Aw,�� ❑Ridge ope ❑Valley ❑Flat
15 I 6 L fl 11 ) .�+IA/(�76 L � 4, (check appropriate box)
(Street Name, Numbers, a/umunity, Subdivision, Lot No.. Zip Code) Latitude/longitude of well location
-� I-renciv (rjcce 5
3. OWNER: gt� � P
Cr r4t.I c (degrees/minutes/seconds)
Address O.l t i ,O kictse (tuloyek
r ()cc. (Street or Route No.)
[`;SZ t"''",r"_- Air C
At: J.! /i
City or Town State Lip Code
&'l)_ 73�--vg82
�.4i7J.I DEPTH
Area code- Phone number
4. DATE DRILLED no
5. TOTAL DEPTH: / 43
6. DOES WELL. REPLACE EXISTING WELL? YES ❑ NO
7. STATIC WATER LEVEL Below Top of Casing: 40 FT. fj. /6
From To
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DRILLING LOG
Formation Description
n-2s p:at
7S SO
(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): foe) METHOD OF TEST /1/(Z-
10. WATER ZONES (depth): &Orp/72 ( / ' /
II. DISINFECTION. Type r&«//'1'�e_
12. CASING:
Depth Diameter
From To
From 0 To ? 2
From g2 To
13. GROUT: Depth
Prom l'o
From 0 To 3[/
14. SCREEN: Depth
From To
From To
Amount 7)(Z6 c,J
Wall Thickness
or Weight/Ft. Material
Ft.
FL 6,/Zp)
Ft. I[/
Material
Ft.
Ft. /2101,61.
Diameter Slot Size Material
Ft. in. in.
Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
16. REMARKS:
LLI 1 do H�WEBY C'ERT FY TH
CONSTRUCT ION STA-N-4
/, /2)WAe -42,
LOCATION SKETCH
Show direction and distance in miles from cast-
two State Roads or County Roads. Include:Vic roa
numbers and common road names.
THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH ISA NCAC 2C, WELL
THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
l ,JZC-, • r / a
SIG 1ATU1(E C)QI'ERSON CONSTRUCTING THE WELL DATE
Submit the original to the D vision of Water Quality, Groundwater Section, 1636 Nlail Service Center - Raleigh, NC
27699-1636 Phone No. (919)73 -3221, within 30 days. GW-I REV. 07/2001

271733
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Nyptral Resources - Division of Water Quality - Groundwater Section -
WELL CONTRACTOR (INDIVIDUAL) NAME (print) l 4Ct �. JV's41C e CERTIFICATION #�f 5-0
PHONE # ( )7ZS'Y(4Sit
WELL CONTRACTOR COMPANY NAME
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
�c:54.ct t ctLDK1cUrJci
1. WELL USE (Check Applicable Box): Residential W'Municipal/Public 0 Industrial 0 Agricultural ❑
Monitoring O Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
t9YiO Nearest Town:
2. WELL LOCATION: Y�%I�.FIr�L
ii✓I W Count Y
OLA irr/P.,:icrd 12
(Street Name. Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: 3�oii /9L [.. !
Address e,, oz i'/.J, al�r >rct'J? Ch' n '/(. Q s (%--
(Street or Route tttto.
Aei—C.1-- Ai<
City or Town State Zip Code
($ZS )_ 75-6- 2 SSco
Area code- Phone number
4. DATE DRILLED 3/?/ O3
Topographic/Land setting
❑Ridge 1rglope OValley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:OGPSOTopographic map
(check box)
DEPTH DRILLING LOG
From To Formation Description
a—1
5. TOTAL DEPTH: 0 - � s � Sso
6. DOES WELL REPLACE EXISTING WELLS YES 0 NO 0-------
7. STATIC WATER LEVEL Below Top of Casing: fo0 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS 1 FT. Above Land Surface*
'Top of casing terminated atfor below land surface requires a
variance in accordance with I5A NCAC 2C .0118.
9. YIELD (gpm): 30 METHOD OF TEST '4/ R
10. WATER ZONES (depth): / /'k 6" 2 VO
2 .,4,t Z6O
11. DISINFECTION:Typet2IOtt Amount /i/Ct✓(
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
From To Ft.
From (9 To e FL--(o cid re.
From $3 To 5 Ft. (o ic/ jj9] (2A-a/
13. GROUT: Depth Material Method
From To Ft.
From 6 To 22 Ft. 1
14. SCREEN: Depth DiatleSlot Size
From To Ft. in. in.
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
s fif /§eic
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include troach:
numbers and common road nar es.
Ott/
p/07r°6AP e .ScP_
Material
16. REMARKS:
22a5
22/
— o
Moo"-ct5 '
6L5 6te,Jct/t24
..� I w
r^ IL tl H R Y RTfR THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH I5A NCAC 2C, WELL
C NNFSFRk IoAFStA 1 ARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
L
SIGNAA'URE OF PERSON CONSTRUCTING THE WELL
DATE
Lr - Submit thecerigiLl to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center -Raleigh, NC
ASHE ' 27699-1636 Rhone [phone], within 30 days. GW-1 REV. 07/2001

271553
WELL CONSTRUCTION RECORD
North Carolina — Department of Environment And Natural Resources — Division of Water Quality — Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) ROBIN MCNEELY CERTIFICATION # 2567
WELL CONTRACTOR COMPANY NAME PITTMAN WELL BORING, LLC PHONE # [phone]
STATE WELL CONSTRUCTION PERMIT # _ ASSOCIATED WQ PERMIT #
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential ® Municipal/Public ❑ Industrial ❑ Agricultural 0
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use
2. WELL LOCATION:
Nearest Town: OLD FORT County MCDOWL
FALC ON CREST RD.
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: WAYNE KING
Address FALCON CREST RD.
(Street or Route No.)
OLD FORT NC 28762
City or Town State Zip Code
(828) — 668-9500
Area Code Phone number
4. DATE DRILLED 03/11/03
5. TOTAL DEPTH: 36
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO
7. STATIC WATER LEVEL Below Top of Casing: 21 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS 1-1/2 FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordance with 15A NCAC 2C .0118.
9. YIELD (gpm): 15 METHOD OF TEST STEEL TAPE
10. WATER ZONES (depth):
11. DISINFECTION: Type
12. CASING:
Depth
From 0 To 36 Ft.
From To _ Ft.
From To _ Ft.
13. GROUT: Depth
From 0 To 20 Ft.
From To Ft.
CHLORYTE Amount 6.9
Wall Thickness
Diameter or Weight/Ft. Material
24" CEMENT
Material
CEMENT
I4.SCREEN: Depth Diameter
From To Ft.
From _ To _ Ft. _
15. SAND/GRAVEL PACK:
Depth Size
From 21 To 36 Ft. 78M
From To Ft.
16. REMARKS:
Method
POURED
Slot Size Material
in. in.
in. in.
Material
GRAVEL
Topographic/Land setting
0 Ridge 0 Slope ❑ Valley ❑ Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source: 0 GPS ❑ Topographic map
(check box)
DEPTH
From To
DRILLING LOG
From To
LOCATION SKETCH
Show direction and distance in miles from at least
Two State Roads or County Roads. Include the road
number and common names
I40 W. FROM MARION. EXIT A #75 & CROSS
BACK OVER I40 ONTO PARKER PADGETT RD.
CROSS RIVER & LEFT ON PARKER PADGETT RD.
AGAIN. APPROX. 2 MILES. LEFT ON DENVER
RIDGE RD. LEFT ON EAGLEWOOD ESTATES. RT.
ON FALCON CREST RD. LOT ON LEFT AT DEAD
END.
-77
ry
rn
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTR TION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
/i 7i c 0 �I v ,l-.,
SIGI IA'xURE O PERS NING 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

272369
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Nflal Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL)NAME (print) (/Ipn/c 8 tit. CERTIFICATION 9S77
WELL CONTRACTOR COMPANY NAME I A t% +sI ' Z�..G PHONE it gam) Gy}Z fra
STATE WELL CONSTRUCTION PERMIT/ Wig ASSOCIATED WQ PERMIT#
w//1
(if applicable) (if applicable)
I. WELL USE (Check Applicable Box): Residential tiG Municipal/Public 0 Industrial ❑ Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION: ./�
Ne�ct � er�e4 Te"��q .yus+,r County IM tak ��
IdG.2$ 9S�
(Street Name, Numbers, Community, Subdi ' on, Lot No., Zip Code)
3. OWNER;/$t9s4 if 1
Address //2 AC -/ do s.) 02en f
(Street or Route No.)
7fat- Wee..
City or Town State Zip Code
(Clio- a99- 0 ma
Area code- Phone number
4. DATE DRILLED4A,7-5 /D 3
5.. TOTAL DEPTH: .2 b! T
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO tiG
7. STATIC WATER LEVEL Below Top of Casing%% FT.
(Use 'kr if Above Top of Casing)
8. TOP OF CASING IS 1 s FT. Above Land Surface*
`Top of rasing terminated at/or below land surface requires a
variance in accordant, with 15A NCAC 2C .0118. •
9. YIELD (gpm): / o MRHOD OF TEST i 2a4/
10. WATER ZONES (depth): 71i' 19S'
11. DISINFECTION: Type
12. CASING:
From Q
From
From
13. GROUT:
From D
From
Depth
To
%h2 Ft.
.2%7s t_
To Ft
To Ft.
Depth
To m�D Ft.
To Ft.
Amount 2 At
Wall Thickness
171or Weight/Ft Material
Xtta (Pd L
eatical
Material Mod ,
14. SCREEN: Depth Diameter Material
Slot Size
Fro To Ft. in. in.
From �To Ft in. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From / To Ft.
16. REMARKS:
n DO, WREBy CEA
II
1— Submit -the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
r (.
7 79--1(:}6 Phone o. [phone], within 30 days GW-1 REV. 07/2001
Topographic/Land setting
❑Ridge I$Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longittide of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH PRILLING LOG
From To Formation Description
Show direction an distance in miles from at least
two State Roads o County Roads. Include the road
numbers and co, „on road names.
4
1
T THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
ARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
1914-,vlei QGLt�1 _3/.267 0 3
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE

272368
2
GPO (' 1: /, „5i"N 5 Crin J
ASHP1iL!_ "FD01!PL G R F
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and�j�jf$urall Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAMEQ(pri�nt))�p O /r/._',![ ( c f7 /i.1 1. CERTIFICATION #377
WELL CONTRACTOR COMPANY NAME,O•CCLCOVidat0/ (.t2Ll� PHONE 0 (2f7 Gy1 OW
STATE WELL CONSTRUCTION PERMIT# 4//f1 ASSOCIATED WQ/PERMIT0 4in
(if applicable) (if applicable)
I. WELL USE (Check Applicable Box): Residential ®1 Municipal/Public ❑ Industrial ❑ Agricultural ❑
Monitoring 0 Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use
2. WELL LOCATION:
Nearest Town: %f t214-e-r� County Me erzle i/,"
/%re1/77-di%/ c o2Q7.T2
(Sheet Name, Numbers, Community, Subdivision, Lot No., Zip Code)
Address -it& 4- 3. OWNER:VTU-e .f e�
(Street or Route N../ `� led
727aa AI•e. -2I7S-
City or Town State tip Code
(_�
Area DATE Phone EDnum„Di A,//
4. DRILLED e� 7 0.3
5. TOTAL DEPTH: t,2S'
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO fp
7. STATIC WATER LEVEL Below Top of Casing: 7 FT.
(Use "t" if Above Top of Casing)
8. TOP OF CASING IS / S FT. Above Land Surface*
'Top of casing terminated at/or below land surface requira a
variance in accordance with 1SA NCAC 2C .0t18. •
9. YIELD (gpm): /0 METHOD OF TEST—T ss.iP
10. WATER ZONES (depth): /ri S
LOCATION SKETCH
Show direction and distance in miles from at (east
two State Roads or County Roads. Include the
numbers and common road names.
Topographic/Land setting
❑Ridge ❑Slope lilValley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH PRILLING LOG
From To Formation Description
11. DISINFECTION: Type "�o
12. CASING:
Amount 7 of
Wall Thickness
Depth�j� or Weight/Ft Material
From_ To� Ft
_� a".J/ ®!/C-
From To Ft
From To Ft.
13. GROUT: Depth Material Methodpr,
From 0 To t�0 Ft. etnyee ii r . LN 14tw y
From To Ft.
14. SCREEN: Depth Diameter Slot Size Material
FroTo Ft. in. in.
From To Ft in. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From STo Ft.
From To Ft.
16. REMARKS:
r� ra
LE � cork
.,
Af
%%'a
w
T THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
S ARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WFf I OWNER
�an�w (gat, .3Js2(1/a 3
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
Submit the origi al to e Division of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
b o. 9 9) 733-3221, within 30 days. GW-1 REV. 07/2001

272367
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME QLt (print)JL L C. AA/ Rai A r! c S 007: CERTIFICATION #,2 70
y$
WELL CONTRACTOR COMPANY NAME ed.e. kJ.O AJJ (/ %J(/9.4- L Z / PHONE 1sf Gy9 fpottlira
STATE WELL CONSTRUCTION PERMIT# Nga ASSOCIATED WQ ERMIT#n 41/41
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential 141 Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery ❑ Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION: -
N Town: County MC. .!4/d,
(Street Nam4Numbers, Community, Subdivision, Lot No, Tip Code)
3. OWNER
Sed
Address /a1.9
(Street or Route No.)
7,7�.e,.t N. t.
Jk%sS2:
City or Town State Zip Code
6ra�) G r- q d 9
Area code- Phone number ry//��O 3
4. DATE DRILLED J
5. TOTAL DEPTH: 3 nS
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO a
7. STATIC WATER LEVEL Below Top of Casing: 4!) FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS / S Ff. Above Land Surface'
'Top of caring terminated at/or below land surface requires a
variance in accordance with 15A NCAC 2C .0118.
9. YIELD (gpm): / METHOD OF TEST%Lrr-rJ
10. WATER ZONES (depth): t.-2/0 ' .2 GS
11. DISINFECTION: Type ; : .
12. CASING: v
Depth
From 0 To G n Ft.
From To Ft.
From To Ft.
Amount // of
Wall Thickness
or Weight/Ft Material
A2/ �f/C
13. GROUT: Depth Material
From1_ Too Ft eons LeaeeTi`
From To Ft.
14. SCREEN: Depth Diameter Slot Size Material
From To Ft. in.
From To Ft in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From / To Ft.
16. REMARKS:
Method
(1).WYky
in.
in.
Topographic/Land setting
12Ridge ❑Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From To Formation Description
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Incl t the road
numbers and common road names.
t ^ T THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
ANDARDS, AND THATA COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WF) I OWNER
Qri-rt.-t. Gr3aadi S/ly/D . 3
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
Submit the origin>tjo the
GA 0276994161661liinin N1 . (919)
pspycli LE RE(LOLAI. OFILC!
Division of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
'33-3221, within 30 days. GW-1 REV. 07/2001

272365
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section �7
.
WELL CONTRACTOR (INDIVIDUAL) NAME�JJJJ(pppprlat) agO A/N / . !3 ALL � yCERTIFICATION #eL 77/
WELL CONTRACTOR COMPANY NAME -c-+ � -aa-4 triter e� "'—`"-BONE # (fail h 99- 4 4/Sb
STATE WELL CONSTRUCTION PERMIT# iiiMt ASSOCIATED WQ PERMIT# AO,
(if applicable) (if applicable)
I. WELL USE (Check Applicable Box): Residential)RL 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: 717724Gszc-
.<1i� y zt ra
(Sweet Name, Numbers, Community, Subdivision, Lot No., Tip Code)
3. OWNER: 4aLaa'L�
Address �93naIYa)y ,tt' rt.
, (Street or Route No.)
71144.4 - A/.r . .7&'952—
City or Town State tip Code
(919)- 870 - 0/set
Area code- Phone number
CountyL
t187. 2_
4. DATE DRILLED _3//.2 / a 3
6. TOTAL DEPTH:
6. DOES WELL REPLACE EXISTING WELL YES 0 NO
7. STATIC WATER LEVEL Below Top of Casing: / T FT.
(Use "+" if Above Top of Casing)
S. TOP OF CASING IS 2 S FT. Above Land Surfaces
`Top of casing termlaated actor below land surface requires a
rat -lance In accordance with 1SA NCAC 2C .011& 9. YIELD (gpm): -3b METHOD OF TES _
aa*�
10. WATER ZONES (depth): Siff
Topographic/Land setting
❑Ridge Pi Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrealminuresiseconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From To Formation Description
11. DISINFECTION: Type age-4- Amount g:.S °Z'
12. CASING: Wall Thickness
Depth Diameter or Weight/FL
From n To 41,2 Ft. /. e saa s—
From To Ft
From To Ft.
�/
13. GROUT: Depth Material Method ,
From (i To 71 Ft aira• t I L4l
From
14. SCREEN:
From
Fro
15. SAND
To Ft.
Diameter
t in.
Ft. in.
Depth
Slot Size Material
in.
in.
GRAVEL PACK:
Depth Size Material
From A o / Ft.
From
16. REMARKS:
BY CERTIFY THAT THIS WELL WAS CONSTRUC I to IN ACCORDANCE WITH 15A NCAC 2C, WELL
.-, I toNp-RUZ;ri'�N',>a7-AlID ,AND THAT»1'AACOPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
_, (J/J/e .ei And, ,3/1 /0 3
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
/ Ft.
N
Show direction and di . ce in miles from at least
two State Roads or aunty Roads. Incite the -road
numbers and comm, n road names.
Submit the original to
27699-1636 Phone No. (91 ) 733.
C;A0L' J';"'dTFr ` CIION
f V ILLE AFi .�N L OFFICE
vision of Water Quality, Groundwater Section, 1636 Marl Service Center Raleigh, NC
3221, within 30 days. GW-1 REV. 07/2001

272361
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Na Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAM (print) .1/,(LW / C. f3 f,nn % L- CERTIFICATION trig'?
WELL CONTRACTOR COMPANY NAME �)4 _ 2GLP V!i S 7Jit c PHONE # iZQ1 4 N9-6 SW
STATE WELL CONSTRUCTION PERMTTN
y/4
(if applicable) (if applicable)
_ASSOCIATED WQ PERMIT?!
1. WELL USE (Check Applicable Box): Residential IL Municipal/Public ❑ Industrial ❑ Agricultural ❑
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use
2. WELL LOCATION: •
Nearest T _.r.—ed n . Couma9's a
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: LLtd
t
Address // 9 i e e<a'am% tL2w .
(Street or Route No.)
°7s9- 5 a 9t
Zip Code
Area code- Phone number
4. DATE DRILLED W I/ D 3
5. TOTAL DEPTH: pie
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO ES
7. STATIC WATER LEVEL Below Top of Casing: a r FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS /..0 Fr. Above Land Surface*
`Top of casing terminated atlor below land surface requires a
variance in acwrdan a with 15A NCAC 2C .0118. •
9. YIELD (gpm): METT� OD OF TEST ran,
10. WATER ZONES (depth): YU r / 84 r
11. DISINFECTION: Type/. ..
12. CASING:
Depth Diameter
From To�01 Ft. G fr
From To Ft.
From To Ft.
13. GROUT: Depth Material l4eutod
From 0 To cQ l7 Ft. Garr
From To Ft
14. SCREEN: Depth Diameter
Fro To Ft. in.
Fro To Ft in.
15. SAND GRAVEL PACK
/Depth Size
From / To Ft.
From To Ft.
Amount 7 at,
Wall Thickness
or Weight/Ft Material
/ LPI/C
Slot Size Material
in.
in.
Material
CONSTRUCTION ST
L_
14the Division of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
iti9}Xi:-3221, within 30 days. GW-1 REV. 07/2001
Topographic/Land setting
❑Ridge ❑Slope [Valley ❑F1at
(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 ' CH
Show direction and distan • in miles from'i least
two State Roads or Coun Roads. Include the road
numbers and common ro • names.
IS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 1SA NCAC 2C, WELL
AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
aft
SIGNATURE OF PERSON CONSTRUCTING THE WELL
.3/y/o 3
DATE

2711101
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR(INDIVIDUAL)NAME (print) Jamg. s Came, Jr,
WELL CONTRACTOR COMPANY NAME
STATE WELL CONSTRUCTION PERMIT/4
(if applicable)
CERTIFICATION # 7 1 R f4
Camp' c Win) 1 R Primp ('n T n r PHONE #67A1 d54-7 %22
ASSOCIATED WQ PERMIT#
(if applicable)
1. WELL USE (Check Applicable Box): Residential dN Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection ❑ Other ❑ If Other, List Use
2. WELL LOCATION),
Nearest Town: NH V to A County wlc 00 (I
1LI A-sk y+lv Rd .
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: Lk t y h,le IV 1 tt Vl
Address Of `- :15 ('l it)oY Lane
(Scree( or Ref uce No.)
I�arloR I\\C_
5. TOTAL DEPTH: / g 5
6. DOES WELL REPLACE EXISTING WELL? YES OVNO ❑
7. STATIC WATER LEVEL Below Top of Casing: !{'0 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS i FT. Above Land Surface'
`Top of casing terminated alloy below land surface requires a
-variance In accords ce with 15A NCAC 2C .0118.
9. YIELD (gpm): O METHOD OF TEST kir
10. WATER ZONES (depth): / % 0
�•, city or Town �(ate Zip Code
Area code- Phone number
4. DATE DRII I FD 7 - 10 - 0-3
11. DISINFECTION: Type rill nr i n
12. CASING:
Depth Diameter
From 0 To2_ Ft. 6 1 / 4_
From To Ft.
From To Ft.
13. GROUT: Depth
From_0 To 20
From To
14. SCREEN: Depth
From To
From To
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
Amount j cufn
Wall Thickness
or Weight/Ft. Material
SDR21 PVC
Material Method
FL Neat Cement Hand
Ft.
Diameter
Ft. in.
Ft. in.
Slot Size Material
in.
in.
From To Ft.
Topophic/Land setting
❑Ridge ope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source: ❑GPS ❑Topographic map
(check boxy •
DRILLING LOG
Formation Description
/t 1•r 1
fnj15o/idnfed rcck
PEPTH
From To
Q /6"
%5 /9`-
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common road names.
iv! 0.YIDN
0
CO
-17
0
fir
16. REMARKS:
I i.;l ��? i_I41' 4bRI,YiiY
i _ ? ,CONSTRUCTION STAt
S
1S WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WFI
THAT A COPY 0 THIS RECORD HAS EEN PROVIDED TO THE WELL OWNER
tit1 w, �GLI ;4n• `i_ID D3
NATURE OF PERSON CONSTRUCTING THE WELL
DATE
Submit-ltv-ariernil-te+he Divis on of Water Quality, Groundwater Section, 1636 Mall Service Center -Raleigh, NC
2T69971636,1'honeNV,p'.1033-3:21, 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) James w
272215
Camis, .Jr. CERTIFICATION % 71 3A
WELL CONTRACTOR COMPANY NAME C'amp' s Wr 11 R Pmrap _Cm Tnr- PHONE bia2Al AS1-7322
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT%
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential CV Municipal/Public D Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other ❑ If Other, List Use
2. WELL LOCATION
Nearest Town: Al O rl
387 #,Yin Iev RA •
(Street Name, Numbers, Community, Su division, Lot No., Zip Code)
County /r c tD1.0e
3. OWNER: ICU ji I)IAI1C0.ry
Address 3 R 1 YrtPt� Rd .
f` (4)(/ U A (Street /w, &oete No.) g'7 C)
iry orG?o7 .2 —
Zip Code
Area coda- Phone number '' II
4. DATE DRILLED 0 - 7 - 03
5. TOTAL DEPTH: y{
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO J°l
7. STATIC WATER LEVEL Below Top of Casing: '73 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
-variance In accordance with 15A NCAC 2C .0118.
9. YIELD (gpm): ;,r METHOD OF TEST A;_r
10, WATER ZONES (depth). .360
11. DISINFECTION: Type rh 1 nr i Hp
12. CASING:
Depth Diameter
From__0 To /3`) Ft.6 1 / 4
From To Ft.
From To Ft.
13. GROUT: Depth
FroL n To .
r2 0 Ft.
Amount /%t Cup
Wall Thickness
or Weight/Ft. Material
W9R71 PVC
Material
Method
N at Ccmr_nt Hand
From To Ft.
14. SCREEN: Depth Diameter
From To Ft. in.
From To Ft. in.
15. SAND/GRAVEL PACK:
Depth Size From To Ft.
From To Ft.
Slot Size Material
in.
in.
Material
Topo hic/Land setting
❑Ridge OrSlope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic trap
(check boxy
DEPTH DRILLING LOG
FromnI 3TS oram Fvei ion
)35 3 5" i enso/idated rb!K
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
r �p f PYGl Y°� L1
rn
16. REMARKS:
.VZLL WAS CONSTRUC1hD IN ACCORDANCE WITH 15A NCAC 2C, WELL
IV ,IAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
Submit the original to the Divi $ on of
27699-4Ofr Ybone No. _(9-19) 73.,..3 21, w
44/ L w (/�fv`{J
CONSTRUCTING THE WELL ✓
OF PERSON
DATE
-/0-43
Water Quality, Groundwater Section,1636 Mail Service Center -Raleigh, NC
thin 30 days. GW-1 REV. 07/2001

North Carolina • Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
1636 Mail Service Center - Raleigh, N.C. 27699-1636-Phone [phone]
WELL CONSTRUCTION RECORD
WELL CONTRACTOR' 1/4_)n, Ty\ 9,5
WELL CONTRACTOR CERTIFICATION #:
271923
Cat1
STATE WELL CONSTRUCTION PERMIT#:
1. WELL USE (Check Applicable Box): Residential 2 Municipal ❑ industrial ❑ Agricultural ❑ Monitoring ❑
Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use:
2. WELL LOCATION: (Show sketch of the location below) M
Nearest Town: t'\ra`;in^ County: to\c vs)v
r.\ADeC
(Road Name andi�N``k�mbers(Community, t Subdivision and Lot No.) DRILLING LOG DEPTH
3. OWNER W\4\A-6o1\ K-a\\-� From To FormationDescdptiu,i
Address
��co4 4 \\
reet or Houle
City or Town State
4. DATE DRILLED t itt)(0a3
5. TOTAL DEPTH 14D
6. CUTTINGS COLLECTED YES I NOF�
7. DOES WELL REPLACE EXISTING WELL? YES
8. STATIC WATER LEVEL Below Top of Casing:
9. TOP OF CASING IS
'Top of casing terminated at/or
dance with 15A NCAC 2C.0118
10. YIELD (gpm)'
11. WATER ZONES (dept
as-/52
Zip Code
NO
FT.
(Use'+' if Above Top of Casing)
\ S FT Above Land Surface'
below land surface requires a variance in actor -
METHOD OF TEST --Bn1\PC
h)• 1\ O'- 115'
12. CHLORINATION: Type
13. CASING:
Depth,From To
From To 9\
From To
14. GROUT:
� �Q Depths ,)vlateriatt
____ C From To Ft 2-0•c-
From To F1
15. SCREEN:
NT
Amount 1
Wall Thickness
or Weight/Ft. alenal
. Iv
RIGck
DiarReter
Ft. ..i1
Ft C -zs
Ft
6
Method
Depth Diameter Slot Size Material
From To Ft in in
From To Ft
From To Ft
16. SAND/GRAVEL PACK:
FLLDIrI l—1 TrL
rom I o
la REMARKS:
MAY - 7 2,1
I DO HEREBY CERTIFY THAT TH
CQN$TRUCTION STANDAlIDS,
in
in
Size
in
in
Material
If additional space is needed use back of form
LOCATION SKETCH
(Show direction and distance from at least two State
C,)
Roads, or other map reference points)
FOR_OFFICE USE ONLY
Quad No:
Serial No.
S WELL WAS CONS»IUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
ND THAT A COPY THIS RECORD HAS BEEN PROVID PROVIDE TO THE WELL OWNER.
iv<
1/03
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
Sub o foal to Division of Water Duality, Groundwater Section within 30 days
GW-1 REV. 12/99

North Carolina - Department of Environment and Natural Resources - Division of Water Quality • Groundwater Section
1636 Mail Service Center - Raleigh, N.C. 27699-1636-Phone [phone] TT
WELL CONSTRUCTION RECORD WELL CONTRACTOR. CDc.cd\+\
271924.
WELL CONTRACTOR CERTIFICATION #: (t (4
STATE WELL CONSTRUCTION PERMIT#:
1. WELL USE (Check Applicable Box): Residential I' I Municipal ❑ Industrial ❑ Agricultural ❑ Monitoring ❑
Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use:
2. WELL LOCATION: (Show sketch of the location below) n�
Nearest Town. MCC 'on County: ,` \Q.Y�I e.�`
33e) Thanccr. "Dc
(Road Name and Numbers, Community. or Subdivision and Lot No.) DRILLING LOG DEPTH
3. OWNER ' cxc e� o1 From To
Address 330 tQnc 0� V c
(Street or Rau o No.)
City or Town State
4. DATE DRILLED / /03
5. TOTAL DEPTH IL-10
6. CUTTINGS COLLECTED YES NO
7.
8. STATIC WATER LEVEL Below Top of Casing:
DOES WELL REPLACE EXISTING WELL? YES
QfriS
Zip Code
b
NO
FT.
(I
(Use'.' it Above Top of Casing)
9. TOP OF CASING IS , FT Above Land Surface'
'Top of casing terminated aVor below land surface requires a variance In accor-
dance with 15A NCAC 2C.0118 �
10. YIELD (gpm)• SOT METHOD OF TEST C1 q\\eC
11. WATER ZONES (depth) \ as _
3S '
12. CHLORINATION: Type ��i� Amount I I�
13. CASING:
Depth /� ��_L(
Diameter
From ) To J— Ft .as
From To elK Ft (,-)
From To Ft
14. GROUT:
Wall Thickness
or WeighVFt.
a�.(,
Material
eYC
E eet
Depth Material Method
From Toe To DO Ft CgmerA
From To Ft
15. SCREEN:
Depth Diameter Slot Size Material
From To Ft in in
From To Ft in in
From To Ft in in
16. SAND/GRAVEL PACK:
i) 49re, From
r
17. REMARKS:
I DO HEREBY CERTIFY THAT TI
CONSTRUCTION STANDARDS,
FOR OFFICE USE ONLY
ouad No:
Serial No
Size Material
Formation Description
If additional space is needed use back of form
f's
w
LOCATION SKETCH ,,..
J
(Show direction and distance from at least two State
Roads, or other map reference points)
c
u
v
A
rV
'7
J
fV
rJ1
IS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
AND THAT A CO OF THIS RECORD HAS EEN PROVIDED TO THE WELL OWNS .
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
pri
original to Division of Water Quality. Groundwater Section within 30 days
GW.l REV. 12/99
co
C'

North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
1636 Mail Service Center - Raleigh, N.C. 27699-1636-Phone [phone]
WELL CONSTRUCTION RECORD WELL CONTRACTOR- CTn,'Me5
WELL CONTRACTOR CERTIFICATION #: a LA Li? \
STATE WELL CONSTRUCTION PERMIT#:
271925\\
E Gacc,:iN
1. WELL USE (Check Applicable Box): Residential Municipal ❑ Industrial ❑ Agricultural D Monitoring El
Recovery ❑ Heat Pump Water Injection El Other ❑ If Other, List Use:
2. WELL LOCATION: (Show sketch p1�f the ocation below) M `1
Nearest Town: C) c'( roc County. \ \�- cw 2
achec � cgeT
(Road Name d Numbers. Co :r nity or Subdivision and Lot No.) DRILLING LOG
3. OWNER
DEPTH
CO��/ N��',�-�e_��+ From To FormationDescnptiu�l
ij
Address
\
City or Town State Zip Code
4. DATE DRILLED 3./aa10.3
5. TOTAL DEPTH IOU
6. CUTTINGS COLLECTED YES n NOQ�
7. DOES WELL REPLACE EXISTING WELL? YES NOQ
8. STATIC WATER LEVEL Below Top of Casing: �- FT.
(Use'+' if Above Top of Casing)
9. TOP OF CASING IS \-5 FT Above Land Surface'
'Top of casing terminated at/or below land surface requires a variance In accor-
dance with 15A NCAC 2C .0118T 10. YIELD (gpm)' 9p METHOD OF TEST cn.\ eC
11. WATER ZONES (depth) 65 . 7-512. CHLORINATION: Type 14 4 M Amount
13. CASING:
aCke( T e+
t1-- yytreet or Rou1lo, o.
rOC ` N
Depth
From To
From To
From To
14. GROUT:
Ft.
Ft
Ft.
Wall Thickness
Diameter or Weight/Fl. ,�t�Cat
' c, as a }
(, -as Qic.ck s ce
Depth Material` Method
From lrc To 30 Ft 0.erneIN1"
From To Ft
15. SCREEN:
Depth Diameter Slot Size
From To Ft in
From To Ft in
From To Ft in
16. SAND/GRAVEL PACK:
From To
17. REMARKS:
Ft
Size
Material
in
in
in
Material
r,
If additional space is needed use back of lorniro
LOCATION SKETCH
(Show direction and distance from at least two Statg
Roads, or other map reference points)
G\d FA 0 (4.
-
rV
I DO HEREBY CERTIFY THAT
CONSTRUCTION STANDARD
FOR OFFICE USE ONLY
Quad No:
Serial No.
THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
3, AND THAT A COP OF THIS RECORD HAS BEEN PRQVIDED TO THE WELL OWNER.
3/aa/03
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
S$m original to Division o1 Water Quality, Groundwater Section within 30 days
GW-1 REV
12/99

North Carolina - Department of Environment and Natural Resources • Division of Water Quality • Groundwater Section
1636 Mail Service Center - Raleigh, N.C. 27699-1636-Phone [phone]
WELL CONSTRUCTION RECORD WELL CONTRACTOR- �dt^e3 c c: •
i'
WELL CONTRACTOR CERTIFICATION #:
STATE WELL CONSTRUCTION PERMIT#:
1. WELL USE (Check Applicable Box): Residential Er Municipal ❑ Industrial ❑ Agricultural ❑ Monitoring ❑
Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use:
2. WELL LOCATION: (Show sketch of the location below) nn G`��e11
Nearest Town: ;"1\Qt�O 1 County. 1 't \
I'. rAcrec R DEPTH
(Road Name and Numbers, Community, o ubdivi 'on and Lot No.) DRILLING LOG
3. OWNER VI VA jt:h V ec+` i From To Formation Descnptiat
rb
et or ou o. ;COS)
City or Town State Zip Code
4. DATE DRILLED
5. TOTAL DEPTH \4v
6. CUTTINGS COLLECTED YES El NO
7. DOES WELL REPLACE EXISTING WELL? YES fI NOI -t
555
8. STATIC WATER LEVEL Below Top of Casing: . FT.
(Use'+' if Above Top of Casing)
9. TOP OF CASING IS ) _S FT. Above Land Surface'
'Top of casing terminated at/or below land surface requires a variance In accor-
dance with 1 SA NCAC 2C .01i13
10. YIELD (gpm): 6' METHOD, F TEST I' S B`1 e C
11. WATER ZONES (depth)
Address A r
tre
12. CHLORINATION: Type ti T µ
13. CASING:
271922
Amount b If additional space is needed use back of form
Wall Thickness
Depth otphQ Diameter or Weight/Ft.
From.i. ppp ____________To 0 1 Ft L'-a-5 ...
From To-`3- Ft (D. L3loc
From To
14. GROUT:
Ft
_ Depth Materia Method
From*-10-----
I To ;C Ft (Crnent
From To Ft
15. SCREEN:
Depth Diameter Slot Size Material
From To Ft in in
From To Ft in in
From To Ftin. in
16. SAND/GRAVEL PACK:
Depth Size Material
rsor 1-. Li Ft
.F7orE Li t,) i Ft
117. REMARKS:
LOCATION SKETCH
(Show direction and distance from at least two State
Roads, or other map reference points)
L°Mb 19Es1EBY CSRTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY o THIS RECORD HAS EN PROVIDED TO THE WELL OWNER. �/� /
`��
FOR OFFICE USE ONLY Inrintl L��y/\/
Quad No: �GNATURE OF PERSON CONSTRUCTING THE WELL
Submit
DATE
_... lity, Groundwater Sect:__ within an days
;.ry. — _. son _...__ _. GW-1 REV. 12199
Serial No.

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of WateratQuality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAM/F�1� (print) rd`T,0. II
e 5 (�tA ' CA I'v\ p U r . CERTIFICATIONO/�M aI .3 e
WELL CONTRACTOR COMPANY NAME UltiAl 5 We II t YUM (oh ILC PHONE u(pa8)453-73:22
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
273535
1. WELL USE (Check Applicable Box): Residential Si Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring ❑ Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATIQA:
Nearest Town: in G`Y t o N County,' DO
gill 5u 4( Hill RA.
e Numbers Com�i Subdivision, Lot
(Street Name, ty, No., Zip Code)
3. OWNER: 170YACe Teel
Address f 11) I 5 me co" H I J A
(Street or R e No.)
n�
Mgr)ovl_ /VC 2S7CA
City or own rate Zip Code
( cc.
4453
Area code- Phone number ti
4. DATE DRILLED 1i - % — 03
5. TOTAL DEPTH: 4 I} S
6. DOES WELL REPLACE EXISTING WELL? YES Ea/NO 0
7. STATIC WATER LEVEL Below Top of Casing: 6q FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS I FT. Above Land Surfaces
*Top of casing terminated atler below land surface requires a
variance in accordance with ISA NCAC 2C .0118.
9. YIELD (gpm): 10 METHOD OF TEST a 1 Y
10. WATER ZONES (depth): 120
11. DISINFECTION: Type pe IIett Amount I /� CUnS
12. CASING: // Wall Thickness
Depth Diameter or Weight/Ft. Material
From 0 To 1I0 Ft. (eye{ $DRal PVC
From To Ft.
From To Ft.
13. GROUT: Depth Material 1 Method
From 0 To ,7O Ft. heat Cewten1 ka vva
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 OSlope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH PRILLTNG LO(i
From To rr Formation Description
0 IIo flit j`ctt)e Sond
Jlo 4115J CDktScfTda eJ rock
O
tr.)
Sao c
rt,
Cn 00 <
—r-
y0
� m
LOCATION SKETCH nc -T
Show direction and distance in miles from apbOast rei 2--
two State Roads or County Roads. Include %road
t. (3 5
numbers and common road names.
16. REMARKS:
MO HEREBY GEN IE 1-
1S WELL WAS CONSTRUCTED IN ACCORDANCE WITH ISA NCAC 2C, WELL
N] THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WFI OWNER
w.�
ATURE OF PERSON CONSTRUCT G THE WELL DATE
-D�
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center -Raleigh, NC
27699-1636Phone No..(919) 733: 221, within 30 days. GW-1 REV. 07/2001

From. Scott Gantt To:
Date: 5/15/2003 Time: 9155:48 PM Page 5 of 6
273529
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment, and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (1NDIVIDUAL)NAME (print) SCOTT GANTT CERTIFICATION # 2=84
\\ ELL CONTRACTOR COMPANY NAME CAROLINA WELL DRILLERS, INC. PHONE # [phone]
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
1. 11/1tI,L I1SE (Check Applicable Box): Residential © Municipal ❑ Industrial ❑ Agricultural ❑ Monitoring ❑
Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use:
,. WELL LOCATION:
Vr:6c t Icon: MARION
562 GOOSE CREEK RD
County MCDOWELL
1 SneN. \ anc. Numbers. Community, Subdivision, Lot No,. Zip Code)
S. On:22IR HORTON HOMES OF RUTHERFORDTON
.PJDsESS 342 HWY74.A BY-PASS
(Street or Route No.)
RiTHERFORDTON NC
(a, a, town State
28139
Zip Code
Topographic/Land setting
❑ Ridge ❑ Slope ❑ Valley ❑ Flat
Latitude/Longitude of well location
35.37.197 / 82.01.016
(degrees/minutes/seconds)
Latimdedongitude source: ® GPS ❑ Topographic map
DEPTH DRILLING LOG
From To Formation Deaenption
0 45 Clay
g28-2S--3316 45 320 Consolidated Rock
Area Co; e - Phone Number
�. DATE DRILLED 4123/03
'. TOTAL DEPTH 220
6. D01:'3 RELL REPLACE EXISTING WELL? YES ❑ NO 0
STATIC AV.000R LEVEL Below Top of Casing: 5 FT.
(Ilse "+" If Above Top of Casing)
s- TOP OE CASING IS 2 FT. Above Land Surface"
• I opt etwa,tha letrainated actor below land surface requires a variance in
...o. doneeI5ANC.AC 2C0118
v 1 [LLD ignm): 10 METHOD OF TEST ARDh1
310
1e 1V AN ZONES (depth):
n
u. Di_!NFECTION. TYPE HYPOCHLORITE Amount 10 0z LOCATION SKETCH C3 o
Wall Thickness Show direction and distance in miles from at least (4 C N
Depth Diameter or Weight/Ft. Material two State Roads or County Roads. Include the road =to o
en
tr:, •. c To 50 Ft. 6 1/4 " SDR 21 PVC numbers and common road names. • - C c rn
o r
u a NOWT: :c_rn'
jo
Depth Material Method A Cm
pi 31,6 0 To 20 Ft GRAVEL MIX GRAVITY 3 o
t. sCFdNiEtt O M233
Dept li Diameter Slot Size Material cT
. Y To F[. in ill J G
Z
1 e. SANit GRAVEL PACK:
DepthSize Material
NA To F1,
t: It T5DRIGN
! DO I IE REBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
_STP.PCTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER.
4/23/03
SIGNATURE OF PERSON CONSTRUCTING THE WELL Date
Subinil the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service center - Raleigh, NC
within 30 days.
GW-1 REV. 0T 2 )0i

274077
WELL CONSTRUCTION RECORD
North Carolina — Department of Environment And Natural Resources — Division of Water Quality — Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) NEIL CRAFT CERTIFICATION # 3114
WELL CONTRACTOR COMPANY NAME PITTMAN WELL BORING, LLC PHONE # [phone]
STATE WELL CONSTRUCTION PERMIT # _ ASSOCIATED WQ PERMIT #
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential ® Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring ❑ Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION:
Nearest Town: NEBO County MCDWL
TATER TOWN
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: MICKEY RADFORD
Address TATER TOWN
(Street or Route No.)
NEBO NC 28761
City or Town State Zip Code
(828) — 659-1398
Area Code Phone number
4. DATE DRILLED 05/28/03
5. TOTAL DEPTH: 385
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO
7. STATIC WATER LEVEL Below Top of Casing: 80 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS 1-1/2 FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordance with 15A NCAC 2C .0118.
9. YIELD (gpm): 10 METHOD OF TEST ARD
10. WATER ZONES (depth):
11. DISINFECTION: Type CHLORYTE Amount 10.5
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
From 0 To 40 Ft. 6-1/4" SDR21 PVC
From To Ft.
From _ To Ft.
13. GROUT: Depth Material Method
From 0 To 20 Ft. QULKRETE POURED
From To Ft.
14.SCREEN: Depth Diameter Slot Size Material
From _ To Ft. _ in. _ in.
From _ To Ft. _ in. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To _ Ft.
From To Ft.
16. REMARKS:
Topographic/Land setting
0 Ridge 0 Slope 0 Valley 0 Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source: 0 GPS ❑ Topographic map
(check box)
DEPTH
From To
DRILLING LOG
From To
LOCATION SKETCH
Show direction and distance in miles from at least
Two State Roads or County Roads. Include the road
number and common names
HWY. #226 N. FROM POLKVILLE. GO INTO
DYSARTSVILLE AND TURN LEFT 0 TAJiR
TOWN RD. (BESIDE CHEVRON STA NM N)NEW
DRIVE 1 MILE ON RIGHT. am
:r c T
LID
-D
w
rn
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
'‘Iinnit the original to the I�ivisi
OF PERSON CONSTRUCTING THE WELL DATE
on of Water Quality, Groundwater Section, 1636 Mail Service Center — Raleigh, NC
733-3221, within 30 days. GW-1 REV. 07/2001
GFFFCE

275642
WELL CONSTRUCTION RECORD
North Carolina — Department of Environment And Natural Resources — Division of Water Quality — Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) DEAN SHEHAN CERTIFICATION # 2160
WELL CONTRACTOR COMPANY NAME PITTMAN WELL BORING, LLC PHONE # [phone]
STATE WELL CONSTRUCTION PERMIT # _ ASSOCIATED WQ PERMIT #
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential ® Municipal/Public 0 Industrial ❑ Agricultural
Monitoring ❑ Recovery 0 Heat Pump Water Injection 0 Other ❑ If Other, List Use
2. WELL LOCATION:
Nearest Town: OLD FORT County MCDWL
CONNER RIDGE DR
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: JUDY HORNER
Address CONNER RIDGE DR.
(Street or Route No.)
OLD FORT NC 28762
City or Town State Zip Code
(828) — 669-9751
Area Code Phone number
4. DATE DRILLED 06/30/03
5. TOTAL DEPTH: 505
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO
7. STATIC WATER LEVEL Below Top of Casing: 60 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS 1-1/2 FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordance with 15A NCAC 2C .0118.
9. YIELD (gpm): 2 METHOD OF TEST ARD
10. WATER ZONES (depth):
11. DISINFECTION: T
12. CASING:
Depth
From 0 To 90
From _ To
From To
13. GROUT: Depth
From 0 To 20
From_ To
14.SCREEN: Depth
From To
From To_
15. SAND/GRAVEL PACK:
Depth Size
Front To Ft.
From To Ft.
CHLORYTE Amount 13.5
Wall Thickness
Diameter or Weight/Ft. Material
Ft. 6-1/4" SDR.21 PVC
Ft.
Ft.
Material Method
Ft. QUHCRETE POURED
Ft.
Diameter Slot Size Material
Ft. in. in.
Ft. in. in.
Material
Topographic/Land setting
0 Ridge ❑ Slope 0 Valley ❑ Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source: 0 GPS ❑ Topographic map
(check box)
DEPTH
From To
DRILLING LOG
From To
LOCATION SKETCH
Show direction and distance in miles from at least
Two State Roads or County Roads. Include the road
number and common names
HWY. #40 W. FROM MARION. GET OFF ON
EXIT 73. TURN LEFT ON BAT CAVE RD. GO 4/10
MILE. TURN LEFT ON SUGAR HILL RD GO 7/10
MILER. TURN LEFT ON WILDLIFE RD. GO 1/2
MILE. TURN LEFT ON CONNER RIDGE RD. NEW
MODULAR 2/10 MILE ON RIGHT.
0
CO
c
r-
r
0
0
(n
16. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
NSTRUCTIO1'1 ST n • ;u C r• THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
a�N� CT i CrCf?' , - i 6 r r7 R
,
SIGN t ' OF ER/S CONSTRU ING THE WELL DATE
Gl
Sub it the original to the D visio
276 636,PhorterK4" i,. 33
AS ^r,,
of Water Quality, Groundwater Section, 1636 Mail Service Center — Raleigh, NC
21, within 30 days. GW-1 REV. 07/2001

275 599
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL COVERAC'TOR (INDIVIDUAL) NAME (print) 4,v f/e-y-k Lie CERTIFICATION 4¢6.4y
WELL CONTRACTOR COMPANY NAME 'd'' J PRONE # (rothi -733 -dG oa
STATE \WELT. CONSTRUCTION PERMIT# ASSOCIATED \VQ FERN IT#
(if applicable)
(if applicable)
1. WELL USE (Check Applicable Box): Residential Er Municipal/Public D Industrial ❑ Agricultural ❑
Monitoring ❑ Recovery ❑ Heat Pump Water Injection 0 Other ❑ If Other, List Use P.+:✓es 1
WELL LOCATION:
Nearest Town: 0-4)
Sol 0 AL •
County Ait-J
(Street Name. Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER:_fri_j__Hvgins
4
5
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO 12-
7. STATIC WATER LEVEL Below Top of Casing So FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS / ET. Above Land Surface*
'Top of casing terminated at/or below land surface requires a
variance in accordance with I5A NCAC 2C.0t 18.
9. YIELD (pm): .3o METHOD OF TEST )-In
10. WATER ZONES (depth): -7,2AL ,/
9o-9-2ci,c/
Address _oo F3:urywa Ftri at
(Street or Route No.)
fYkAytn/1 t.S C
City or Toa n State
„-$7sa
Zip Code
(8 )- C.'a-3559
Area code- Phone number
DATE DRILLED (2`7 - 03
TOTAL DEPTH: / 8G
11. DISINFECTION: Type. frzczt Amount %t
12. CASING: Wall Thickness
Depth Diameter
From '-( To a Ft. a
From To Et.
From To Ft.
13. GROUT: Depth
From 0 To Ao Ft.
From To Pt.
14. SCREEN: Depth Diameter
From To PI. in.
From To Et. in.
15. SAND/GRAVEL PACK:
Depth Size
From To Ft.
or Weight/Ft. Material
1,0r%1/ FtC'
Material Method
From To Ft.
Slot Size Material
in.
in.
Material
Topographic/Land setting
DRidge 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 FormatiFpn Description
t5 - .t% Ac e tuna- `CX--
Sa-a6 „row Mc
tb,./ev. t Fo %
5'6 23 IGrec /ed,
CA)
C_
t—
r- Ta ?di
ca.<
0
LOCATION SKETCH Li.0
Show direction and distance in miles from ateast
two State Roads or County Roads. Include road'%<=
a
numbers and common road names.
-
16. REMARKS:
1 DRHEREBY CGSTIF,S' THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH I5A NCAC 2C, WELL
1
UCTIONSTACOPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
STAND • C, AND THAT A
1 CONSTR---%
(i i I - ' iIJ SIGNATURE OF PERSON CONSTRUCTING THE \YELL DATE
ISubmit the on Final to the Div sion of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
27(\Ht1rt96=Pbrima4d 0i9) 733-221, within 30 days. GW-1 REV. 07/2001
: '=-.- �_�) CAE

WELL CONSTRUCTION RECORD
275594
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Sectiong
\\ ELL CONTR,ACI OR (INDIVIDUAL) NAME (printlr U ate eAWC,\ �CERTIFICATION #g2_ 3J
WELT. CONIR:\CrOR COMPANY NAME her Sicc// (Ail.($-- '_ '"__'^}- PHONE # f )
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED \VQ PERMIT#
Of -applicable) (if applicable)
WELL USE (Check Applicable Box): Residential 0 Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water injection 0 Other 0 If Other, List Use
2. WELL LOCATION: ��//
Nearest Town: Si „I. 4 , County, Cct)e4&/
L d- S-(-4._) S4-' e
(Street Nvnc. Nunbers, Conunu n ity. Subdivision, Lot No., Zip Code)
3. OWNER: GWI? 46
Acidress 4-o13 fgpsh 9 0% z 4'r//"Q40
(Street or Route No.)
NN
ebo c a8 yt/
City or Town State Zip Code
)-
Area rude- Phone number
4. DATE DRILLED 6-717---03
5. TOTAL DEPTH:
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO
7. STATIC WATER LEVEL Below Top of Casing: 66 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS .4. 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): 20 METHOD OF TEST'n
10. WATER ZONES (depth): //O '4,74 %c / Z%So y5134
I I. DISINFECTION: Type Amount
12. CASING: Wall Thickness
Depth Dtam ller or Weight/Ft. Material
From 1—I To 6'd Et. _• $ehlt Au
From To Ft.
From To Ft.
13. GROUT:
From G
7
Depth Material Method
To 40 Ft. #c..ot"'7`stCa.-let icineety
[ram To Ft.
14. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in.
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Size Material
To Ft.
To Ft.
From
From
16. REMARKS:
Topographic/Land setting
❑Ridge 0Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/ininutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From To Formation Description
rtee 19,- .✓ICi
sa - /ad 90 ;}C
/PoYaZ3 ketry t'rsift:
1 z3— Y/7 %A.,sic
!__-2-9ai-hp," e
�'t'3/- 9`5Z, ye-r c r/r� 7s50 —T ferri !�/1rO4r.
LOCATION SKETCH c
Show direction and distance in miles from mast r
two State Roads or County Roads. Include tbs..roa
numbers and common road names.
O
yuc
T,S
I DO HEREBY CERTIFM'I�Fi{\T THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH I5A NCAC 2C, WELL
TIt --CONSUCTrOETSTA1W DS, At AND ThAT A COPY OS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
SIGNATURE OF PERS( N CONSTRUCTING THE WELL DATE
ivision of Water Quality, Groundwater Section, 1636 Mail Service Center- Raleigh, NC
3-3221, within 30 days. GW-I REV. 07/2001
Submit,t1WeltiCtFllty,Ito the
/-69tb1436,k'hnpc(F ia4919) 7

North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section !) p
1636 Mail Service Center - Raleigh, N.C. 27699-1636-Phone [phone] G O
WELL CONSTRUCTION RECORD WELL CONTRACTOR- E e4ca'lr\
WELL CONTRACTOR CERTIFICATION #: Qc La\
STATE WELL CONSTRUCTION PERMIT#:
1. WELL USE (Check Applicable Box): Residential L'J Municipal ❑ Industrial ❑ Agricultural ❑ Monitoring ❑
Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use:
2. WELL LOCATION: (Show sketch of the location below) pt� d w
Nearest Town. (\\rx<� tan County. Iv\rnc"
Mac\nwe 1�e\_
(Road Name and Numbers, Community or Subc(�'vvision and Lot No.) DRILLING LOG DEPTH
3. OWNER M�}� Ok eF?t From To Formation Description
Address a<\d�` �a
(Street or Route o.
(Arty;-4, a ax1Sa
City or Town / / / State Zip Code
4. DATE DRILLED lL 6.-3
5. TOTAL DEPTH WO
6. CUTTINGS COLLECTED YES I 1 NOS --1-
7. DOES WELL REPLACE EXISTING WELL? YES I I NO
8. STATIC WATER LEVEL Below Top of Casing: 45 FT.
H
(Use if Above Top of Casing)
9. TOP OF CASING IS FT Above Land Surface'
'Top of casing terminated aVor below land surface requires a variance In accor-
dance with 15A NCAC 2C .0118
10. YIELD (gpm): METHOD OFTEST t5cx1eC
11. WATER ZONES (depth):
12. CHLORINATION: Type N
13. CASING:
C _.
CD -rr;
Amount \ IS If additional space is needed use back of tornro
LOCATION SKETCH -
Wall Thickness
-�' Depth 66
Diameter or Weight/Ft. ienai (Show direction and distance from at least two Stal
From tar To ��.`, Ft 6-.1 5 (-77 G Roads, or other map reference points)
From ('& To Ft L.*-71S Ric.<k From To To Ft
14. GROUT:
Depth Material J Method
From _. To (5)6 Ft�'r)e meat
From To Ft
15.SCREEN:
Depth Diameter Slot Size Material
From To Ft in in
From To Ft in in
From To Ft in in
16. SAND/GRAVEL PACK:
Depth Size Material
From To Ft
To Ft
From
17. REMARKS:
I DO HERE
CONSTRU
FOR OFFIC
Quad No:
Serial No.
a?4 5''°}
��,,
Fa`T{FYrTMd�F,TNIS IIELIEWAS
IS IANUARDS,ANU I HAI.
origin
NSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OW
cicala_21
riff
NER.
/3/3
GNATURE OF PERSON CONSTRUCTING THE WELL DATE
to Division of Water Quality. Groundwater Section within 30 days
GW-I REV. 12/99
r;r,'JR rv4 iER SECTION
ASHEVILLE REGIONAL OFFICE

North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section r 2 r 3 16.16 Mail Service Center - Raleigh, N.C. 27699-1636-Phone [phone]
WELL CONSTRUCTION RECORD WELL CONTRACTOR- ' N.)n. E
WELL CONTRACTOR CERTIFICATION #:
STATE WELL CONSTRUCTION PERMIT#:
1. WELL USE (Check Applicable Box): Residential I' I Municipal ❑ Industrial ❑ Agricultural ❑ Monitoring ❑
Recovery n Heat Pump Water Injection ❑ Other ❑ If Other, List Use:
2. WELL LOCATION: (Show sketch of the location below)
Nearest Town: mCiC i1n, County:
'.. o vtankKec v.a
(Road Name and Numbers.r�Community, or Subdiv ion and Lot No.) DRILLING LOG DEPTH
Krum\k 0 ttr•—<A
50 b 1/44 jc 2cL
Street or Hou o o
City or Town State Zip Code
4. DATE DRILLED CrI,'o%
5. TOTAL DEPTH 4-IT
6. CUTTINGS COLLECTED YES I NO Fr
7. DOES WELL REPLACE EXISTING WELL? YES NOI1
6. STATIC WATER LEVEL BclDW Top of Casing: QFT.
(Use's' if Above Top of Casing)
9. TOP OF CASING IS t S _ FT. Above Land Surface'
'Top of casing terminated aUor belo.t land surface requires a variance In accor-
dance with 15A NCAC 2C .0118
10. YIELD (gpm): I ME1 HOD OF
11. WATER ZONES (depth): I3o"
18-c ,
12. CHLORINATION: Type /'u N Amount \ `b If additional space is needed use back of form W
13. CASING:
3. OWNER
Address
From To
Formation Descdptiud
c
o a
c.1
L
0
"'0
to
Walt Thickness
Depth Diameter or W�eig�hVFt.
_
From T� To FL L.a$ '7)1
From I To Ft. v 4:5
From To Ft
14. GROUT:
Depth Materilal
From _T .c To n2b / Ft Cemt
From To Ft
15. SCREEN:
Material
Method
Depth Diameter Slot Size Material
From To Ft in in
From To Ft in in
From To Ft. In. _ in
16. SAND/GRAVEL PACK:
Depth Size Material
From To Ft
From To Ft
17. REMARKS:
I DO HEREB
CONSTRUC
FOR OFFICE
(!u, d No:
LOCATION SKETCH
(Show direction and distance from at least two State
Roads, or other map reference points)
W�c n
v
i3
co
C6
rIrJf�$TAJD&i`Duu AND l[HATU. C c5Por
NLYl
SOtt mi{'o
TRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
F THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER.
norte,0 AA_
NATURE OF PERSON CONSTRUCTING THE WELL DATE
Division al Water Quality. Groundwater Section within 30 days
I.olial No.
GROUNDWATER SECTION
ASHEVILLE REGIONAL OFFICE
GW-1 REV. 12/99

North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
1636 Mail Service Center - Raleigh, N.C. 27699-1636-Phor [phone]
WELL CONSTRUCTION RECORD WELLCONTRACTOR• "1D.e•, v3,C �\
WELL CONTRACTOR CERTIFICATION #: �L `E
STATE WELL CONSTRUCTION PERMIT#:
275256
1 WELL USE (Check Applicable Box): R5 tential ❑ Municipal ❑ Industrial ❑ Agricultural ❑ Monitoring ❑
Recovery [1 Heat Pump Watt eclion [1 Other ❑ If Other, List Use:
2. WELL LOCATION: (Show sketch of location below)
Nearest Town: 14 AI \ ram. c \ c m County' 'Ai., - 0 .tv 2. \\
L.\-(2tAc C N\z-. -,:i'CSL\\.- LA- -)1
(Road Name and Numbers, Community, or 'division and Lot No.) DRILLING LOG
\VA. Av.v' n qe_.V\\--
3V5 S3( 06 V\ \\
( trees or Rout? No
3. OWNER
Address
NC r) I'SD
City or Town . I Stale Zip Code
4. DATE DRILLED 't /r--c/S
5. 10TAL DEPTH IDS
6. CUTTINGS COLLECTED YES i I NOFT
7. DOES WELL REPLACE EXISTING WELL? YES I I N0I-1-
8. STATIC WATER LEVEL Below Top of C king: I C(3 FT.
(Use'+' if \ )ove Top of Casing)
9. TOP OF CASING IS k -5. FT. Abo Land Surface'
From To
'Top of casing terminated
dance with 15A NCAC 2C
10. YIELD (gpm):
11. WATER ZONES (
at/o@@r,,below land surface ilres a variance In accor-
METHODOFT[ T �,�Ne_C
depth): A — 1 lC
Amount \_�h
12. CHLORINATION: Type (� T (\
13. CASING:
�, Depth _
From To [ Ft
From To Ft
From To Ft
14. GROUT:
Depth
From (G-f) To cm Ft
From To Ft.
15. SCREEN:
Depth
From To
From To
From To
16. SAND/GRAVEL PACK:
Depth
To
To
From
From
17. REMARKS:
I DO HERE
CONSTRUC
FOR OFFIC
Quad No:
Serial No.
Diameter
.f-5
DEPTH
Formation Description
Wall Thickness
or Weight/Ft. Mp4erial
T:C!
Material Method
l.etrc c
Diameter Slot Size Material
Ft in in
in in
In. in
Ft
Ft
Size Material
0
It additional space is needed use back of form C
c
r
LOCATION SKETCH cJ
n
(Show direction and distance from at least two State
Roads, or other map reference points) Lo\---7D rn
W
N E
C\�:,
CO cse
(In c_n62 co
NLY
Submit
GROUNDWATER SECTION
ASHEVILLE REGIONAL OFFICE
STRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
051THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER.
NATURE OF PERSON CONSTRUCTING THE WELL
o Division of Water Qualify. Groundwater Section within 30 days
DATE
1)s
C 7.1 REV. 12/99

ram r Scott Gantt To Date: 6/11/2003 Time: 11 0718 PM
275003
WELL CONSTRUCTION RECORD
Corti) Carolina -Department of Environment, and Natural Resources -Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL)NAME (print) SCOTT GANTT CERTIFICATION # 2584
WVELI, CONTRACTOR COMPANY NAME CAROLINA WELL DRILLERS, INC. PHONE # [phone]
STATE. WELL CONSTRUCTION PERMIT # ASSOCIATED WQ PERMIT #
if applicable) (if applicable)
WELL USE ;Check Applicable Box): Residential ® Municipal ❑ Industrial Agricultural ❑ \lonitortno ❑
kecc,; r; ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use:
- A; ELL LOCATION.
...,.LIOi MARION
St73 HiL_. ESTATES LOT 30
County MoDOWEl.1.
m Name. rocu, Couununity, Subdivision. Lot No,. Zip Code)
1 i IGSrk HORTON HOMES OFRLITHERFORDTON
-ADOIlkss 342 HWY 74A BY-PASS
'Oast or Routs No.)
1t1-fH ERFORDTON
NC
State
......e N utibe,
..__ i DRILLED 6: _i,'0:
-[AL DEPTH 200
o I TT RT11. 1_ REPLACE' EXISTING WELL?
_ 111C W 2: r Fk LEIFI. Below Top of Casing:
28139
Zip Code
ES ❑ NO D
55 FT.
(rise `+' IfAlloys Top of Casing)
L. ICc' O'l U1SIAG IS FL Above Land Surface*
�. t_rrdurst aebr telow land ssvfaec requires a variance in
....,..,.... w,. ,!.:N C 2C.01IS
'd'LD o.:a:.. METHOD OF TEST ARDM
i.. 70.3TER ZONES ileatl'u.. 195
Topographic'Land setting
❑ Ridge ❑ Slope ❑ Valley ni_ ....
L atitude/'Loneitude of welt locanar.
3538.73' 82.01.519
(degrees minutes seenn ,'
Lalituda9engitede source: El GPS ❑ Topogolplu: ntap
DEPTH DRILLIAG LC(I
To Formation Darin -tin -ion
50 Clay
From
0
50 200 Consohdared Rook
:I ISAl FrTON'. TVPF HYPOCHLORITE Amount 5
Depth
To
NA
Dcp)1
.._:., NA_ ,o
REMARKS.
Wall Thickness
Diameter or WeightPe Material
60 Et. 61/1" SDR 21 PVC
20 Ft.
Oa
Material Method
GRAVEL MIX GRAVITY
Diameter
Ft in.
FI,
Size
Sint Sin Nlalcrial
m
Material
LOCATION SKETCII
Show cWection and distance in miles from ai la:ol
Iwo State Roads or County Roads. Include the r, ed
numbers and common road nrunes. L,)
L
C
IV
a
CA
O
J_' EERLit) CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH ISA NCAC 2C. WELL
p I I Y. STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER.
La
SIGNATURE OF PERSON CONSTRUCTING DE WELL
6. 11;03
Date
tat to the Division of Wa er Quality, Groundwater Section, 1636 Mail Service center- Raleigh, C
/ 3AiPLope No (9I9i 73JE32na'v(i bin 30 days.
III
G.0OUL,GL
ASH'E'VILLE !,,,
Gt. Rd-.
E

From Scat Gantt To- Date' 6/110003 Time: 11 07:13 PM
2750'02
WELL CONSTRUCTION RECORD
'''orth Carol inn - Department of Environment, and Natural Resources - Division of Water Quality- Groundwater Section
WELL CONTRACTOR (INDIVIDUAL)NAME (print) SCOTT GANTT CERTIFICATION # 2584
\1-E LI, CONTRACTOR CONIPANY NAME CAROLINA WELL DRILLERS, INC. PHONE # [phone]
ST _ATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
I. F'FLL LSE (Check Applicable Box): Residential ® Municipal ❑ Industrial❑ Agricultural ❑ )lonitoru
i1ecove'y ❑ Heat Pump Water Injection D Other ❑ If Other, List Use:
e AULL LOCATION
Nr.ureUasu. A14RION
1 ROCK I10JSE RD
County McDOWELL
Numbery Conitunily. Subdivision, Lot No,. Zip Code)
Topographic -Land setting
❑ Ridge ❑ Slope ❑ valley ❑ 14u
Latitude/Longitude of hell location
35,44.414, 82.01OY
U',lHORIO\ HOMHS OF RUI'HERFORDTON (depee- mines >econdsl
Lriitude4ongitude source: ❑ GPS ❑ Topoumpnic :aai
DEPTH DRILLING Lu.i
NC 28139 From To Formation Descs; I:
State Zip Cole 0 %0 Clay
t11)11ESS 342H1111174A BY-PASS
,>.,.,: o: Rout. So.)
fu iiIERFOREEION
Fitanc Ntmtber
DATF. DRILLED 6'7'03
.LDI7))) 200
DOES WELL. REPLACE EXISTING WELL?
. S' R'ATEe I EVE, Eclow Top of Casing:
YES ❑ NO O
70 ET
(Inc v" IfAbove Top of casing)
'J I' Or' Cv !N.1 6 FI'. Above Land Surface*
• rRa- 0¢mr P.mo^ mnu
below land aface requirso voanin
obi no kith NC AC 'C.0118
iIILll ltitmP. S Is1E1 HOD OF TEST ARDM
- WATER TONES ueaht 90 180
200 Consolidated Rock
DiSio.17.179.1CIN''v\'py. HYPOCHLORITF Amount 4 0a LOCATION SFETCII
Wall Thickness Show direction and distance in miles front at lees1
Diameter or Weight/Ft, Material Rvo State Road or County Roads. Include the :oe:o
a 78 Fr no
6 1/4 " SDR 21 PVC nubers and common road names.
_ 0
CO
Material MethodC-
0 To 20 Ft, GRAVEL MIX GRAVITY
I.) troA
Donilr Diameter Slot Slit Material —tco
-
,r Fr in in. p r^,,
Ft,
c
0
CO ri--
Size Material n
O —r
lc) G
Z
HEREBY CERTIFY TIIAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH IiA NCAC 2C, WELL
\SIRUCTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER.
6 11/03
SIGNATURE OF PERSON CONSTRUCTING THE WELL Date
the orioinol to the Division of Water Quality, Groundwater Section, 1636 Mail Service center- Raleigh, NC
L:276,9.S-1 3'6 Mori!,„So.j(pI : 221, within 30 days.
LJ/
GW-1 REA,,
GROUNDWATER SEGTiJN
ASHEViLLE REGIONAL OFFICE

North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section '
1636 Mail Service Center - Raleigh, N.C. 27699-1636 - Phone [phone]
WELL CONSTRUCTION RECORD
030037-2
274871
WELL CONTRACTOR Dewey Wright Well Pump Co., Inc.
WELL CONTRACTOR CERTIFICATION #• 268/
STATE WELL CONSTRUCTION PERMIT# 52eve Kee
1. WELL USE (Check Applicable Box): Residential Xi Municipal 0 Industrial
Recovery 0 Heat Pump Water Injection
Other If Other, List Use'
2. WELL LOCATION: (Show sketch of the location below)
Nearest Town: PIt'EOLA County' MC DOWELL
LINVILLE DR OFF I- NY 221
I Road Name and Numbers, Community, or Subdivision and Lot No.)
3. OWNER
Address
ROBERT CHAFEE
7231 BR.ANSOP! MILL RD ,
Agricultural E Monitoring
DRILLING LOG DEPTH
From To Formation Description
0 40 DIRT
PLEASAIteeMOE'Nf l NC 27313
40 180 GRANITE
City or Town
4, DATE DRILLED
5. TOTAL DEPTH
6,
7.
8.
State Zip Code
4/28/2003
350
CUTTINGS COLLECTED
YES
NO
I r1
DOES WELL REPLACE EXISTING WELL? YES NO
STATIC WATER LEVEL Below Top of Casing: 140 FT
(Use "+" if Above Top of Casing)
9. TOP OF CASING IS 1 FT Above Land Surface*
*Top of casing terminated at/or below land surface requires a variance in accor-
dance with 15A NCAC 2C.O1 t8
10. YIELD (gpm): METHOD OF18 TES,
11 WATER ZONES (depth) gprn 1Oo
Air
180 163 SHALE
163 350 GRANITE
0
0
c_.
T_.
f,d
0 qpm
0 pprn - 0 GPrn
12. CHLORINATION: Type Fi'FFt Amount 44 If additional space is needed use bac forlF'
13. CASING:
Wall Thickness
Depth Diameter or Weight/Ft. Material
From _ 0 To 83 Ft a ,': .188 GALV
From To Ft
From To Ft
14. GROUT:
Depth Material Method
From 0 To 220 Ft 'Cernent Gravity Flow
From To Ft
15. SCREEN
From
From
From
Depth
To
To
To
16. SAND/GRAVEL PACK:
Depth
From To
From To
17. REMARKS:
Diameter Slot Size
Ft in in
Ft in in
Ft in in
Size
Ft
Ft
Material
Material
I DO HEREBY qE
CONSTRUCTIgN
FOR OFFICE USE
-`ruaT Y[ilc �nr�i iTn[���a�
ANDARDS, AND THAT A COI'
cn
•-•-1
7.7
LOCATION SKETCH
(Show direction and distance from at least two State
Roads, or other map reference points)
1a
?nzD Io5J-22I
3TRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER. /7 /-2-A�PTR (O —�/ Q3
2
Quad No:
Serial No.
SIC NATURE OF PERSON CONSTRUCTING THE WELL DATE
�m't 'riginal to Division of Water Quality, Groundwater Section within 30 days
GROUNEWATER SECTION
ASHEVILLE REGIONAL OFFICE
GW-1 REV. 12/99

North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
1636 Mail Service Center - Raleigh, N.C. 27699-1636 - Phone [phone]
274870
WELL CONSTRUCTION RECORD WELL CONTRACTOR.
Dewey \Alright Well Pump Co., Inc.
2bdl
030037-1 STATE WELL CONSTRUCTION PERMIT#- ��� Keece
WELL CONTRACTOR CERTIFICATION St.
1. WELL USE (Check Applicable Box): Residential Municipal E Industrial n Agricultural Monitoring
Recovery I I Heat Pump Water Injection Other If Other, List Use.
2. WELL LOCATION: (Show sketch of the location below)
Nearest Town: PINEOLP` County: Mr DOWELL
NORTH VIEW POINT DR. OFF LINVILLE DR. OFF HWY 2
(Road Name and Numbers. Community, or Subdivision and Lot No.)
3. OWNER ROBERT 5. CHAFEE
Address 7231 BRANSON MILL RD.
DRILLING LOG DEPTH
From To Formation Description
0 3 DIRT
PLEA5All'eSAASEN8' NC 27313
3 260 DIRT ROCK
City or Town Stare
Zip Code
4. DATE DRILLED 4/24/2003
5. TOTAL DEPTH 330
6. CUTTINGS COLLECTED YES NO r'
7. DOES WELL REPLACE EXISTING WELL? YES I _ I NO
8. STATIC WATER LEVEL Below Top of Casing: 38D FT
(Use "+" if Above Top of Casing)
9. TOP OF CASING IS 1 FT Above Land Surface*
I AI
'Top of casing terminated at/or below land surface requires a variance in accor-
dance with 15A NCAC 2C.01 t8
V
10. YIELD (gpm) ETHOD pF Ai-
11. WATER ZONES (depth)• CIPM uRY fOLt U ppm
D PON) 0 gorn
260 880 GRANITE
0
v)
-.
t_
T
_o
m
12. CHLORINATION: Type --- Amount
13. CASING:
Wall Thickness
Depth Diameteroor Weight/Ft. MAterial
From - To _. u Ft ir`� s �L',,.�
From To Ft
From To Ft
14. GROUT:
Depth Material Method
From 0 To �0 Ft Cement Gravity Flow
From To Ft
15. SCREEN:
Depth Diameter Slot Size Material
From To Ft in in
From To Ft. in in
From To Ft in in
16. SAND/GRAVEL PACK:
Depth
From To Ft
From To Ft
17. REMARKS:
I DO HEREBY
CONSTRUC
FOR OFFICE U
Quad No:
Serial No.
E
Size Material
If additional space is needed use back'oiforr''`'
J o
LOCATION SKETCH
(Show direction and distance from at least two State
Roads, or other map reference points)
I0S4-ZZI
1-‘
n
tct
1a v
3 2 �❑
TiRit T tATILLHIt \4 LLI'v ASt 'JSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
TANDARDS, AND TI IAT A CO OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER.
1
v -a-u //- 0 3
NL . .. , j - �
IGNATURE OF PERSON CONSTRUCTING THE WELL DATE
1 Submi original to Division of Water Quality, Groundwater Section within 30 days
t GW-1 REV. 12/99
GROUND'/P TER SECTION
^SPEY' FEW- /'H!_ OFFICE
L.v
J11{

North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
1636 Mail Service Center - Raleigh, N.C. 27699-1636 - Phone [phone]
274869
WELL CONSTRUCTION RECORD WELL CONTRACTOR'
030029
Dewey Wright Well Purrip Co., Inc.
WELL CONTRACTOR CERTIFICATION it2tl8!
STATE WELL CONSTRUCTION PERMIT btzve Haste
PERMIT*
1. WELL USE (Check Applicable Box): Residential al Municipal Industrial
Recovery Heat Pump Water Injection Other I I If Other, List Use.
2. WELL LOCATION: (Show sketch of the location below)
Nearest Town: PINEOLA. County' MCDOWELL
LiNVILLE DR. OFF LINVILLE FOREST OFF 221
(Road Name and Numbers, Community, or Subdivision and Lot No.(
Agricultural
Monitoring n
DRILLING LOG DEPTH
3. OWNER ARTHUR LLOYD From To Formation Description
Address 4159 SADDLE CLUB DR. , 0 75 ROCK DIRT
NEW SM(1SP➢OI,°E ° NP4 FL 321E8
75 220 GRANITE
E
City or Town State Zip Code
4. DATE DRILLED 4/17/2003
5. TOTAL DEPTH 420
6. CUTTINGS COLLECTED YES NO
7. DOES WELL REPLACE EXISTING WELL? YES NO
8. STATIC WATER LEVEL Below Top of Casing: 100 FT
(Use "+" if Above Top of Casing(
9. TOP OF CASING IS FT Above Land Surface*
'Top of casing terminated at/or below land surface requires a variance in accor-
dance with 15A NCAC 2C.0118
10. YIELD (gpm): METHOD QFFT
11. WATER ZONES (depth)' �Gt� r�T 5�� t ppm sa0-3 3
Gun n 0 Guru
220 222 SHALE
222 380 GRANITE
380 383 QUARTZ SHALE
333 420 GRANITE
r-r
W
n
Air
HTH 45
12. CHLORINATION: Type Amount
r)
rit
If additional space is needed use back p(forrr}'n"'3
C.G) ri
0
13. CASING: Wall Thickness LOCATION SKETCH ......1 LOCATION
Depth Diameter or Wei ht/Ft. Material (Show direction and distance from at least two State
From 0 To 24 Ft 6 114 ' 183q GALV Roads, or other map reference points)
From To Ft
From To Ft C(0.r ‘Di
14. GROUT:
n ,�� Cement
Depth Material ` Methoduy)
From To 20 Ft
From To Ft
15. SCREEN:
Depth Diameter Slot Size Material
From To Ft in in
From To Ft in in
From To Ft in in
16. SAND/GRAVEL PACK:
Depth Size
From To Ft
From To Ft
17. REMAR
I DO HE
CONSTR
EKE I ,T AT HIS,
SPA ND TH ,I
FOR OFFI
1
onµ.y,
Material
J_
(P/ 4—Smi
T
rW�rot
i1 oCq�A-tort
ONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
OPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER.
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
Su it on final to•'Division of Water Quality, Groundwater Section within 30 days
R SECTION Gw-1 REV. 12/99
IONAL OFFICE
p ok`
Quad No:
Serial No.
GROUNUWAI
RE

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) `- iehe% SUS*/ CERTIFICATION#.2/S°
WELL CON1 RAC1'OR COMPANY NAME -
274800
L/•N6 PHONE # t/ cp.22Qewg
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential 0 Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery ❑ Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATlQI PI
Ne5 s�t Town: t�L-zY 7f /�.�t n� c/C(�L
(Street Name. Numbers, Community, Subdivision. Lot No.. Zip Code)
3. OWNER: U pA2€
Address f l /-noi(P-!iii= - Leo
(Street or Route rvo.t
bL2 FZkJ- WC- ae76I
City or Town Smte Zip Code
M )- 66 P - 97y0
Area code- Phone number
4. DATE DRILLED WV/7i (r'- 03
5. TOTAL DEPTH: 2 H i
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO f�
7. STATIC WATER LEVEL Below Top of Casing: 90 FT.
t (Use "+" if Above Top of Casing)
S. TOP OF CASING IS / FT. Above Land Surface'"
*Top of casing terminated at/or below land surface requires a
variance in accordance ith 15A NCAC 2C .0I18.
9. YIELD (gpm): G METHOD OF TEST 51-x>v
10. WATER ZONES (depth): / Y2 /frk l7 2 6Z/
I I. DISINFECTION: Type tLc,t1.4't
12. CASING:
Depth Diameter
From cU To 5-3 Ft. /64
From 0
From / 2 'i
13. GROUT:
From Q
From
Amount Si c'?
Wall Thickness
or Weight/Ft. Materia
s Caoe
To/Z/ Ft. G 4(0
To,31, Ft.() � tiU
Pece
Depth Material Method
To 9 2 Ft. dt fe/ / 014, l
To Ft.
14. SCREEN: Depth Diameter Slot Size Material
From To FL in. in.
From To Ft. in. in.
5. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
16. REMARKS:
ig t'y.tj r=
DO HEREBY CERTIE
r CONSTRUCTION STA
Topographic/Lan setting
❑Ridge ❑Slope alley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check bos)
DEPTH DRILLING LOG
From To
Formation Description
0, 4 9 5'Alui
yh- /20 Yet( /'ar C-41
/Lv - 2t35 bKo4
LOCATION SKETCH
Show direction and distance in miles fro
two State Roads or County Roads. Inclu
numbers and common road names
gef
t let
('t
THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH I5A NCAC 2C, WELL
S, A D THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
PERSON CONSTRUCTING THE WELL
DATE
Submit the original to the vision of Water Quality, Groundwater Section, 1636 Mail Service Center- Raleigh, NC
27699-1636 Phone No, [phone], within 30 days. GW-1 REV. 07/2001
13

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Sectionr/ S G�_
�? CERTIFICATION at:
WELL CONTRACTOR (INDIVIDUAL) C� NAME (pries) �'4'9 �CERTIFICATION
PHONE A ( )���yy.Vg
Ttu t iE-Q.'C,'b r t (L. N+-1
WELL CONTRACTOR COMPANY NAME
ASSOCIATED WQ PERMIT#
STATE WELL CONSTRUCTION PEWNIT# (if applicable)
(if applicable)
I. WELL USE (Check Applicable Box): Residential ly tunicipal/Public 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION
auras
Iiist l.'JGt-_F P,1J )eddret(rI1'Vln.
(Street Name, Numbers. Community, Subdivision, Lot No.. Zip Code)
N tT Town:
�Lh Fef " County VV4.:,3Lye Lt.
3.OWNER: C7U217terz Sc.r
Address (a5i' WelLe'S
(Street or Route No.)
yr '.4) t- jLri_
City or Town State
8A)- E`f<'--. 3 Ce63
Zip Code
274797
opographic/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 Formation Description
Area code- Phone number
4. DATE DRILLED St' Zc " 0 3
5. TOTAL DEPTH: / �L7
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO ❑-
7. STATIC WATER LEVEL Below Top of Casing: 5v0' "f FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS J FT. Above Land Surface*
*Top of easing tenniaated atfor below land surface requires a
variance in accordance with ISA NCAC 2C .0118.
9. YIELD (gpm): .2 METHOD OF TEST S"rii - J}i R
l0. WATER ZONES (depth): J.ri..n �..+m. yZ it
7ytv.4.e�L'Y.�
I1. DISINFECTION: TypeCiewr'-`' Amount iirt?ot
12. CASING: WallThtckness
Diameter or Weight/Ft. Material
Depth
From To Ft
From 0 To Ho Pt,c.
From 8,0 To h`( f44lil
13. GROUT: Depth Material Method
From To Ft.
14. SCREEN: Depth Diameter Slot Size aterial
From 0 Tel, z Ft. z)•(
From To Ft. in. in.
Front— To Ft. in. in.
15. SAND/GRAVEL PACK: Material
Ft. 6-VP. )?o
Ft. coy 12e.
0- 73
• iOC 5
Cyx.,4 ;/'t
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. CDt
COe.
C.::
_.
' /
�r-t
S
rn C
0
0
From To Ft.
From To Ft.
16. REMARKS:
gyp_ ft„)IG(�FiREBYCER
ICJ --EONS-11tUCTTON
IL
\
sKt
t'.
`L.4ka Cc ct
HAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH ISA NCAC 2C, WELL
ARD?, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
SIG TU
F PERSON CONSTRUCTING THE WELL DATE
---757Iffitirentecill to the Division of Water Quality, Groundwater Section, 1636 Mail Service CeentGteer' Raleigh,
NC
Lnnui 4-163G i°hPw19. (91 ) 733-3221, within 30 days.

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
`�)i �� CERTIFICATION ita! .— C)
WELL CONTRACTOR(INDIVIDUAL)
I NAME (Print) PHONE # / o
WELL CONTRACTOR COMPANY NAME
STATE WELL CONSTRUCTION PERMIT#
j� (if applicable)
1. WELL USE (Check Applicable Box): Residential Ur-Municipal/Public ❑ Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heal Pump Water Injection 0 Other 0 If Other, List Use
274796
ASSOCIATED WQ PERMIT#
(if applicable)
�45 i'C-QQ
2. WELL LOCATION:
Nearest Town: r (. �^ County 4
329' 11=4- tr/a-t. iv
(Street Name. Numbers. Community, sion, lat o., Zip Code)
3. OWNER:
Address
•9ity or Town State State Zip Code
/4 )- Or:,L— 54:cf(
Area code- Phone number s
4. DATE DRILLED eJ 2 1''6
5. TOTAL DEPTH: 0 j
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO
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 at/or below land surface requires a
variance in accordance with ISA NCAC 2C .0118.
(gpm): le METHTEST1 r
9. YIELD m : OD OE L
10. WATER ZONES (depth):
11. DISINFECTION: Typ
12. CASING:
From 0
From iytr
From
13. GROUT:
From
From 0
14. SCREEN:
From
From
15. SAND/GRAVEL PACK:
Depth
From To Ft
From Tot Ft
Amount Ali �' �
Wall Thickness
Depth � Diameter . _Eq. Weight/Ft. Material
To_
To f O Ft.}_ 1--
To Ft.
Depth Material Method
To Ft.
De tb Z Ft rrt
Depth iameter Slot Size Material
To Ft. in. in.
To Ft. in. in.
0.5 DEPTH
From
16. REMARKS:
1 DO HER'`Y
14
L//{{y ,$$ ��{{{h��elI,,.A,ginal
As EVILS RE ` f4A�'Ovrf1C cNt
Size Material
Topographic/Land setting
❑Ridge ❑Slope ❑Valley ❑Flat
(cheek appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DRILLING LOG
To Formation Description
t OCATI�__ON 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 J� /o z
f7 t w tJ
c
Y THAT AWE AIL A DPCONSTRUCTED
Y OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
ARDS, AND
SIG
ATURE OP PERSON coNsTRUcTING THE WELL
DATE
to the Division of Water Quality, Groundwater Section,1636 Mad Service Ceentr' lREeig07/2
�1
[phone], within 30 days.

WELL CONSTRUCTION RECORD
279795
North Carolina - Department of Environment and Natural Resources - Ant Division of Water Quality - Groundwater Section 7�
WELL CONTRACTOR (INDIVIDUAL) NAME (print) G,30_54r/pS
,,Cf / CERTIFICATION a �O/
WELL CONTRACTOR COMPANY NAME So Wit W 9 L. .tQ 0r:a ; PHONE # P4" 72y La's228
STATE WELL CONSTRUCTION PERMIT# _ ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential CUB Municipal/Public 0 Industrial 0 Agricultural ❑
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 IFOther, List Use
2. WELL LOCATION: (/hv� - / /
Nearest Town: �i>>2r' 210 I l Count wv GGCs
/y:>4L .c., ,4iZA.U: L.
(Street Name. Numbers, Community, Subdivision, Lot No.. Zip Code)
Topographic/Landietting
❑Ridge ❑Slope &Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
3. OWNER: /C / ./A ttn.d /� e24, .IY.O (degrees/minutes/seconds)
Address r%5r•Z — let ;tics CFi n t C': rt. Latitude/longitude source:OGPS❑Topographic map
(Street or Route No.) (check box)
Mgei%u d(JL 2.81C Z DEPTH DRILLING LOG
City or Town State Zip Code From To Formation Description
(d)- 756o`4'71/
Area code- Phone number
4. DATE DRILLED li7/99 / o'r
5. TOTAL DEPTH: be 5'
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 1S / FT. Above Land Surface`
'Top of casing terminated at/or below land surface requires a
variance is accordance with 15A NCAC 2C .0118.
9. YIELD (gpm): %Z METHOD OF TEST 54:4.0d
10. WATER ZONES (depth): 429iA" C 65-6 `
11. DISINFECTION: Type (t MMf Amount /19040'zt
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
From To Ft.
From 0 To Z b Ft. / 4t3 I YCr-
From .O To 36' FL , /80 (rp4/1/
Method
13. GROUT: Depth Material
From To Ft.
From© To e' Z Ft. 2 p 1
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. REMARK$:
j I I'1-, i O 4ERPBYY"CE _
—Al.r CONSTRUCTION ST
_1
;'•'Submit the original to the (Division of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
27699-1636 Plume No. 091.91133-3221, within 30 days. GW-I REV. 07/2001
D
0— /7 /J//2.
Sc/f/ Ci�gAtt t R„)
LOCATION SKETCH
Show direction and distance in miles from at least F
two State Roads or County Roads. Include tF(oad0
numbers and common road names.
.17
AT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
L
G
CS
;taxrn
L� G
tDS, AND TH -T COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
SIGN ' U
F P N CONSTRUCTING THE WELL DATE

13. ' Katerial
Ft.
From (0 To Z7 Ft. 2E1
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.
WELL CONSTRUCTION RECORD 274 792
North Carolina - Department of Environment and Natural Resources-r'- Division of Water Quality - Groundwater Section `7.
WELL CONTRACTOR (INDIVIDUAL) NAME (print) 17/Air(/ ��1a-41cc,rr�� CERTIFICATION #2 4a vJ' /(�
WELL CONTRACTOR COMPANY NAME ($ Sd' if e t>•-- .A 0,-;U / LVC PHONE ,/ P " 72y 4548
STATE WELL CONSTRUCTION PERMIT,/ ASSOCIATED WQ PERM/ IT,/
(ifappliable) (if applicable)
1. WELL USE (Check Applicable Box): Residential (D' Municipal/Public ❑ Industrial ❑ Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other ❑ If Other, List Use
2. WELL LOCATION: . ' / (nv� [.
- /
Nearest Town: /�i /i//Z'O,C CountM���// GCs
H///� /3 a PIrve'2,
(Street Name. Numbers, Community, Subdivision, t.ot No., Zip Code)
3. OWNER: 7t m rh-u% 54Gr'4z44A1
Address ;2 )j AYGAJL%,.r„o f: ,Cakes. gri
(Street or Route No.)
( City or Town State Zip Code
Z 7—4>7C
Area code- Phone number
4. DATE DRILLED 5 Z —0 '3
Topograp,biefLand setting
❑Ridge 00Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/Iongitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DRILLING LOG
Formation Description
DEPTH
From To
Q-5s
5. TOTAL DEPTH: L/Oq— ,5"
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO Car
7. STATIC WATER LEVEL Below Top of Casing: en FT.
(Use"+" if Above Top of Cuing)
8. TOP OF CASING IS ` FT. Above Land Surface*
*Top of easing terminated at/or below land surface regaire, a
variance in accordance with ISA NCAC 2C .0118.
9. YIELD (gpm): .3 METHOD OF TEST
10. WATER ZONES (depth): if,nt Cc- 3410
II. DISINFECTION:Typed&OCe'A) Amount t62C.)7l�
12. CASING:
Wall Thickness
Depth Diameter or Weight/Ft. Material
From To Ft.
From 0 To Fi 2- Ft..
From&Z To 61 Ft..
GROUT: Depth
From To
Method
,�br✓ive41
a;r f gee0
643 /1 n
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include th�-fpad
numbers and common road names. v�
16. REMARKS: rf% A7 )Dv)
,` I�'HO HfReBltf�ER31f
-aUTtS 112UL 11UN N14
1,
D
c_ C
c•
m•_
P• r,
r
Ol
,I z
T THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
DS, AND TH T COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
SIGN • UR
FP
N CONSTRUCTING THE WELL DATE
,bW90,lpe aicArt2o the Division of Water Quality, Groundwater Section, 1636 Mail Service Center -Raleigh, NC
ASV Z159%4636 Phone P{o{.[phone], within 30 days. GW-I REV. 07/2001

WELL CONSTRUCTION RECORD 274791
North Carolina - Department of Environment and Natural/Resources - Division of Water Quality - Groundwater Section7
WELL CONTRACTOR (INDIVIDUAL) NAME (print) IQJ7.L� iK TO54/CE CERTIFICATION Mt/WELL CONTRACTOR COMPANY NAME 7
Illi__i PHONE # �S' 724'- 4 '8
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential ID MunicipalfPublic ❑ Industrial 0 Agricultural D
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION:
Nearest Town: IO/v Coun
O Sf71hS 67Zi
(Street Name, Numbers, Community, Subdivision, Lot No.. Zip Code)
3. OWNER:
Address
J; ni M zcI S I k"-$
2Zy Moskiw5 4i4rcL
(Street or Route No.)
'N9 t'i•S i Ali -
2 ')S. 2-
City or Town State Zip Code
(62ti)- 7yC• "/QC i
Area code- Phone number
4. DATE DRILLED 5 - 3 ' 03
5. TOTAL DEPTH: /
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO KY
7. STATIC WATER LEVEL Below Top of Casing: 5 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): ?c , METHOD OF TEST 4i /2
10. WATER ZONES (depth): .tit-7nt
t 1. DISINFECTION: TypeflLlriitte-
12. CASING:
Depth
From To
From 0 To b
From 50 To67
13, GROUT: Depth
From To Ft. G ,, /
From e7 To 20 Ft. 2 C / / 'Ad
14, SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in.
From To Ft. in. in.
Topographic/L_a_ndf�setting
❑Ridge ❑Slope EWailey ❑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 — 3o 4 rn.-/ 5m'4 -
dLYs--fr
S`o - / 23 g'J2t4 JV7tz5)
LOCATION SKETCH
Amount In oZ e 7322how direction and distance in miles from at least
Wall Thickness two State Roads or County Roads. Included to road
Diameter or Weight/Ft. Material numbers and common road names. CJ
/RQ !3.av
Method
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
If1 nt';c)J
16. REMARKS:
weibitie;- pp,
fr ON)
cn—
Ln C.L.
F c
Zl,Z 26" N
it' (,^' fib
- "VDCFHEREF)Y CORT uu AT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH I5A NCAC 2C, WELL
CONS 1 RUL I town NNARDS, AND THAT l COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
SIGN
N CONSTRUCTING THE WELL DATE
rSub[n—tI F , 1 to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center -Raleigh, NC
AS` r=276199A6,3,B,Plrynic [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) WAYNE. T (m CERTIFICATION N 734'3
WELL CONTRACTOR COMPANY NAME ifCQC' I4B-1- DM-MtCI PHONES [phone]
STATE WELL CONSTRUCTION PERMITS ASSOCIATED WQ PERMITS
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential& Municipal/Public ❑ Industrial ❑ Agricultural ❑
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use
2. WF1 f LOCATION:
Nearest Town: MaRICE'
County PtECWELL
251 PINE VALLEY DRIVE
(StreetName,Numbes, Community, Subdivision, Lot No., Zip Code)
3. OWNER: I14VID NQ4ICN
Address 251 PINE VALLEY DRIVE
[IKON, NC R28752)
City or Town State Zip Code
( R7R} 732,-3199
Area code- Phone number
4. DATE DRILLED 549-03
5. TOTAL DEPTH: 345
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO 12I
7. STATIC WATER LEVEL Below Top of Casing: 50 FT.
(Use'+" if Above Top of Casing)
8. TOP OF CASING IS 2 FT. Above Land Surfaces
`Top of casing terminated at/or below land surface require a
valance In accordance with 15A NCAC 2C .0118.
9. YIELD (gpm): 3 METHOD OF TEST BY AIR TESL
10. WATER ZONES (depth):
274570
Topographic/Land setting
❑Ridge ❑Slope ❑Valley ❑Flat
(check appropr+ale 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 Hill TAPS
12. CASING:
Depth
From 0 To Ft.
From To FL
From To FL
13. GROUT: Depth Material
From 0 To 20 Ft. C1UJF
From To Ft.
14. SCREEN: Depth Diameter
From To FL in.
From_ To Ft. in.
15. SAND/GRAVEL PACK
Depth Size Material
From To Ft.
Amount 62
Wall Thickness
Oatoeter gteighVFt. , jvj;jgal
0-4
Method
PWRED
Slot Size Material
in.
in.
From To Ft.
16. REMARKS:
'— ----- 1 DO HEREBY Cam'
�. CONSTR
{IUir----
I
Subm_ j_t_thesuigina to th
12769941af Phoite No. (919
c
O
c0
f
0
[/rz
rn�
Show direction and distance in miles from at -leas `C
two State Roads or County Roads. Include le mail
numbers and common mad names.
LOCATION SKETCH
T THIS WFI T WAS CONSTRUC[RH 1N ACCORDANCE WITH 15A NCAC 2C, WELL
, AND Tfj/jTACOPY OF CORDHAS BEEN PROVIDED TOTHE WF•11 OWNER
SIGNATURE OF PERSON CONSTRUCTING THE WTI
05-29-03
DATE
Division of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
733-3221, within 30 days. GW-1 REV. 07/2001
eir

North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
1636 Mail Service Center - Raleigh, N.C. 27699-1636 - Phone [phone]
274876
WELL CONSTRUCTION RECORD
030038
WELL CONTRACTOR. Dewey Wright Well Pump Co., Inc.
WELL CONTRACTOR CERTIFICATION P. G587
STATE WELL CONSTRUCTION PERMIT#• Steve fleece
WELL USE (Check Applicable Box): Residential I 1 Municipal
Recovery I I Heat Pump Water Injection n Other
Industrial
If Other, List Use'
Agricultural n Monitoring
2. WELL LOCATION: (Show sketch of the location beiow)
Nearest Town: M.gRION Countyy. MCDOWELL
DEER RIDGE TRAIL OFF OCONEE DR. OFF H WY 221
(Road Name and Numbers, Community, or Subdivision and Lot No.)
3. OWNER Vb1LLIAM O. POWELL
905 GEORGE HECKER
DRILLING LOG DEPTH
From To Formation Description
0 105 MUD
S. DAYTI9tE41 or Route No.) FL 32119
105 115
LIMESTONE
City or Town
tate zip Code
4. DATE DRILLED 5/7/2003
5. TOTAL DEPTH 360
6. CUTTINGS COLLECTED YES NO
7.
8.
I r{
115 117
WATER MUD
117 380 LIMESTONE
c
DOES WELL REPLACE EXISTING WELL? YES NO w 0
STATIC WATER LEVEL Below Top of Casing: ''bu FT Jsufr' 9/3/Q3 -71
(Use "+" if Above Top of Casing)
9. TOP OF CASING IS ' FT Above Land Surface* 3$1552t/b O "
'Top of casing terminated at/or below land surface requires a variance in accor-
dance with 15A NCAC 2C.0118
u Air �� rT
10. YIELD (gpm): IL(pETHOD QF URRRYS�-TOLE 0 ppm
0 porn t.) ppm •• r- -
n
0
12. CHLORINATION: Type ~ I Amount If additional space is needed use bade/ for
11. WATER ZONES (depth):
Sn• ra*ozs "
13. CASING
Wall Thickness
Depth Diameter or Weight/Ft. Material
From To 110Ft 8 114 .1SS GL! V
From To Ft
From To Ft
14. GROUT:
Depth Material Method
From 0 To n Ft `�ernent Gravity Flow
From To Ft
15. SCREEN:
Depth Diameter Slot Size Material
From To Ft in in
From To Ft in in
From To Ft in in
16. SAND/GRAVEL PACK:
Depth Size Material
From To Ft
From To Ft
17. REMARKS• , 1
I DO HEREBY C F[Yf1TH&tTH' S C li
CONSTRUCTION STANDARDS, AND THAT A C Y
I,
FOR OFFICE USEtNLY
Quad No'
SIGI
Submit or ginal t
SEC
l :AL OFFICE
G
lV
LOCATION SKETCH
(Show direction and distance from at least two State
Roads, or other map reference points)
RUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
F THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER.
ATURE OF PERSON CONSTRUCTING THE WELL DATE
Division of Water Quality, Groundwater Section within 30 days
GW'1 REV. 12.!99
Serial No.

272606
j
J•
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
343
WAYNE LONG CERTIFICATION #
WELL CONTRACTOR (INDIVIDUAL) NAME (print)
WELL CONTRACTOR COMPANY NAME HICKORY WELL DRILLING CO.PHONE # (82& 324-0035
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
I. WELL USE (Check Applicable Box): Residential 1$X 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: OT .I) FORT County Mr Tinwp T 1
835 PIONEER DRIVE
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
Topographic/Land setting
❑Ridge ❑Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
3. OWNER: REDWOOD DE. CO./ROLAND & ELIZABETH HARRIS (degrees/minutes/seconds)
Address PO BOX 2935
MORGANTON,aNC) 28680
City or Town State Zip Code
(82R)- 437-2364
Area code- Phone number
4. DATE DRILLED 04-04-03
5. TOTAL DEPTH: 425
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO
7. STATIC WATER LEVEL Below Top of Casing: 50 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS 2 FT Above Land Surface'
'Top of easing terminated at/or below land surface requires a
variance In accordance with 15A NCAC 2C .0118.
9. YIELD (gpm): 2 METHOD OF TEST BY AIR _LEST
10. WATER ZONES (depth):
11. DISINFECTION: Type Hill TABS
12. CASING:
DePti
From 0 To 02
From To
From_ To
13. GROUT: Depth Material Method
From 0 To 20 Ft. Cal lT Fri RFD
From To Ft.
Ft.
Ft.
Ft.
Amount 79
Wall Thickness
Djrppeter or Weight/Ft. Material
64 GALV. STEEL
14. SCREEN: Depth Diameter
From To Ft. in.
From To Ft. in.
15. SAND/GRAVEL PACK
Depth Size Material
From_ To Ft.
From_ To Ft.
Slot Size Material
in.
in.
— 16 RBMARIC-&-.
rll I�
{ 1 DO HF rFiRTI'pY
CONSTRUCTION STAND , AND THAT A Y F T OHIS
L J r � C4-07-03
CS** the origi'itre('3fi t¢e Division of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
276994634-phglaRAto {�39}Z33 3221, within 30 days. GW-I REV. 07/2001
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From To Formation Description
O
m
LOCATION SKETCH " tm-rci
Show direction and distance in miles from atgast
two State Roads or County Roads. Include the road=
numbers and common road names.
N
CID ica,ar
r
THIS WELL WAS CONSTRUCTED IN
RDANCE WITH 15ANCAC 2C, WELL
S BEEN PROVIDED TO THE WELL OWNER
SIGNATURE OF PERSON CONSTRUCPI vG THE WELL DATE

w EI.L CONTRACTOR CO?IPANY NAME 1 iI
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Reso rces - �Diivision of Water Quality - Groundwater Section f�
WELL CONTRACTOR (INDIVIDUAL) NAME print)Y,/0 � Q. � kcr?V-JA7` CERTIFICATION
-t/ Clr)
>✓L I'`- z/ I f III/US PHONE # j�}') 33 0(C .
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
2
272525
WELL USE (Check Applicable Box): Residential E1 Municipal/Public ❑ Industrial ❑ Agriculturalp❑
Monitoring 0 Recovery 0 Heat Pump Water Injection ❑ Other El/' If Other, List Use r ✓ri fc,,
WELL LOCATION:
Nearest Town: - County
,2723 n`fi x,v
Street Name Numbers, Community, Subdivision, Lot No.. Zip Code)
3. OWNER:'--)lI/{"S'- ?\ ICen
Address t723 M4 Inr^io rec
(treet or Route Nt4)
City or Town State
Zip Code
Area code- Phone number
4. DATE DRILLED
5. TOTAL DEPTH:
6. DOES WELL REPLACE EXISYTING WELL? YES ❑ J S
7. STATIC WATER LEVEL Below Top of Casing: NFT.
(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): .X.1 METHOD OF TEST .42
10. WATER ZONES (depth): 1-f) AJ2o
\6235 /
11. DISINFECTION: Type_c hieik;A L Amount (>ro7,
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft....material
From 0 To Cle Ft. &'Yt/ ,97R etk.
From To Ft.
From To Ft.
13. GROUT: Depth
From 0 To 2‹ 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
Material
�
Method
From
From
To Ft.
To Ft.
Topogra is/Land setting
DRidge lope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DRILLING LOG
Formation Description
sir/kr., `fe- /io/e,^ter,.
".rr..-;fie
�:ue
DEPTH
From To
0 — i d
Pe' /So
/04U—/e2.i
o'i 3S=o�36
c23L—IGc
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
43
a
a
N
0t
WELL WAS CONSTRUCTED IN ACCORDANCE WITH I5A NCAC 2C, WELL
THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
y- 9y-03
ATURE OF PERSON CONSTRUCTING THE WELL DATE
0
0
rn
c
fr
r+t
v.1
>0
---1
rnrn
en
enX
mz
0
2
SuAali t ttle opigin5I try -the' ivision
27699-1636 Phone No. [phone].
of Water Quality, Groundwater Section, 1636 Mail Service Center- Raleigh, NC
within 30 days. GW-I REV. 07/2001

11. DISINFECTION: Type
12. CASING:
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) 4 Vi &tA) ems` &.RS<a,.0 CERTIFICATION #2 VIC
WELL CONTRACTOR COMPANY NAME,-iItc-Wv-k 1--4L.(I Mt I';3a PHONE # c)733—`ROOK
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
WELL USE (Check Applicable Box): Residential Municipal/Public ❑ Industrial ❑
Monitoring 0 Recovery ❑ Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION:
Nearest Town: I ina.p;a.l: County fit.. c. t
aa5 that-)4-5,, le[? fie, (alen)hacta eiL a,)
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER; tRtyt:�
Address .R ,7.t_
(Street or RouteNo.) 8. 737
)A aPt(R. .
City or Town State Zip Code
( )-
Area code- Phone number
4. DATE DRILLED
5. TOTAL DEPTH:
6. DOES WELL REPLACE EXI TING WELL? YES 0 NO Qr
7. STATIC WATER LEVEL Below Top of Casing: `7o FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS I FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordance with ISA NCAC 2C .0118.
9. YIELD (gpm): JO METHOD OF TEST A-,&
10. WATER ZONES (depth): 9& / aciO
Gil fuel_ Amount (_; cyp
Wall Thickness
Depth Diameter
From 0 To LVZ Ft. Ei 4
From To Ft.
From To Ft.
13. GROUT: Depth
From el) To '30
or Weight/Ft. Material
Material t Meth
Ft. Ce-t--� 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.
UHC.KEBYC.CK IIF Y 1H
ONSTRUCTION,STAND
272524
Agricultural 0
pographic/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 Formation Description
l-5- 7 `31 72. - 0
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common road names.
4
tZ.
al IS WELL WAS CONSTRUCTED IN ACCORDANCE WITH I5A NCAC 2C, WELL
APND 1 THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
X.
O
Q1
-
SI .,NATURE OF PERSON CONSTRUCTING THE WELL
DATE
Submit the -original to. fielDivisson of Water Quality, Groundwater Section, 1636 Mail Service Center- Raleigh, NC
27699-1636 Phone No. (919) /33-3221, within 30 days. GW-1 REV. 07/2001

WELL CONSTRUCTION RECORD 272514
North Carolina - Department of Environment and Natural Resources*rc- Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME �(print) y)IO rpbee<,,,cro CERTIFICATION
WELL CONTRACTOR COMPANY NAME `%rV't`S1,til & lI of I I.03 PHONE # to f733- C'Z
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
L WELL USE (Check Applicable Box): Residential Pr.-Municipal/Public 0 Industrial ❑ Agricultural ❑
Monitoring ❑ Recovery ❑ Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION:
Nearest Town:
'L)
•
County mc.lXic:
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
t
�_ 3. OWNER: ;7 1 I � Imo/
Address .39 ,— �i14j a\ 'DR.
(Street or Rote No.)
City or Town State
( )- 115H_I-11JO
Area code- Phone number
4. DATE DRILLED 3--y-o
5. TOTAL DEPTH:
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO
7. STATIC WATER LEVEL Below Top of Casing: sib FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS 1 FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordance with 15A NCAC 2C .0118.
9. YIELD (gpm): 1 % METHO,7,OF TEST AIR ,
10. WATER ZONES (depth): \j f'3b..��(
1I. DISINFECTION: Type ('1t16$,41-7e—Amount'-] of
12. CASING: Wall Thickness
Depth Diameter or��1'e�' ¢UFt. Materal
From �% To f �'f Ft. c 4S t/' D �t�J�s
From To Ft.
From To Ft.
13. GROUT: Depth Material Method
From 0 To Ft. 4i
From To Ft. v
14. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in.
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
Zip Code
Topogra is/Land setting
❑Ridge ope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DRILLING LOG
Formation Description
DEPTH
From To
d- •So
.3o._
yp- i00
!CO- Ito
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common road names.
O
W
-t
330
O
CFI
J
c
0
;cn
c-ccn
r'
=
>a
rn
rn
cn
N2
Pi 7a
0-4
G
z
16. REMARKS:
1 DO HEREBY,'. CERTIFY Tait.I-HIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION S-TANDrt Rq$f D THAT A F f-IIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
A C 1 u_. C- 3_ 9-03
GNATURE OF PERSON CONSTRUCTING THE WELL DATE
LSubmit the original to the Div sion of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
27699-1636 Phone No. (919) 733- 221, within 30 days. GW-1 REV. 07/2001