Sw CY2003

8. TOP OF CASING IS
*Top of easing terminated st/or below lnd surface requires a
variance In accordance witb ISA NCAC 2C .011S.
9. YIELD (gpm): METHOIpQF TEST Ca.i
10. WATER ZONES (depth): buff �1//
STATE WELL CONSTRUCTION PERMITS
(if applicable)
WELL CONSTRUCTION RECORD 2 7 8 6 5 5
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) Ye-VVei- V yd CERTIFICATION M 0.456
WELL CONTRACTOR COMPANY NAME 6-re% lw.m We // r///rt O PHONE [phone]p—?215Q
ASSOCIATED WQ PERMITS
(if applicable)
I. WELL USE (Check Applicable Box): Residential IS Municipal/Public ❑ Industrial ❑ Agricultural ❑
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use
2. WELL LOCATION:
NgarestTown: QrySen :i Ty___ County 6 we. /n
anion& /a P ESr s
(Street Name. Numbers, Community. Subdivision, Lot No.. Zip Code)
3. OWNER: a Mco116)
Address lcn` t nn /2l'Q f 5Tere
(Street or Route No.)
Ory6eri dry N.C. 2$7/3
City or Town tare Zip Code
(411t)- 373-a99e
Area codc- Phone number
4. DATE DRILLED 9 - 2 t- o3
5. TOTAL DEPTH: 6 11 s
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO f8
7. STATIC WATER LEVEL Below Top of Casing: //o FT.
(Use "+" if Above Top of Casing)
FT. Above Land Surface*
I I. DISINFECTION: Type // r//
12. CASING:
Depth
From_ To d 1c Ft
From To Ft.
From To Ft.
13. GROUT: Depth
From 0 To 9.6 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.
Amount O.5'9
Wall Thickness
iameter or Weight/Ft. Material
Snr `) PVC
Material
Cet"$11
Method o n 741 E Go .3 »7
011 'Pontd-nr-1/4, latke e6a7 o
`S''/ mr/25 Turn Rciii4re -Ponta,
hop I1orrh 6-o, O./ twilts,r1 t,Je'/
an fj' — —4
�hr N3
0
Topographic/Land setting
❑Ridge ❑Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH pRILLING LOG
From To Formation Description
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.
-Lei all -Puna Po5To4:'CC,Zvrhle
c
CM 295.Fo /S'mJe [e�niJ'r
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH I5A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT CO OF THHIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
lyi
SIGNATURE OF PERSON CON STROCTING THE WELL DATE
E�
Submit the original to the Division of Water Quality, Gr
27699-1636 Phone No. [phone], within 30 days.
$ttr ectie4, 7036`,Mai
iee t enter - Raleigh, NC
GW-t REV. 07/2001
GROUNDWATER SECTION
ASHEVILLE REGIONAL OFFICE

278654
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and NaturdlrResources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) �P r Pe' r'y iiyAe CERTIFICATION M 20SV
WELL CONTRACTOR COMPANY NAME graham bit'!! Ari Ill'na PHONE # f9 4/179—�iNS4-
STATE WELL CONSTRUCTION PERMIT,/ ASSOCIATED WQ PERMIT,/
(if applicable) (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 ❑ If Other, List Use
2. WELL LOCATION:
Nearest Town: BryriDn G%Tycounty SWo.i 11
i va.n_S Rd,
(Street Name. Numbers. Community, Subdivision, Lot No., Zip Code)
3. OWNER: a,Sar1 Clark
Address �Vet..NS 5Trvt7-
(Street or Route No.)
fryCO n Slate Zip
SaCl ry ML. DJf7/3
e
( )- 32J - 5 960
Area code- Phone number
4. DATE DRILLED q - `1(Q-0 3
5. TOTAL DEPTH: 2C
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO 1$
7. STATIC WATER LEVEL Below Top of Casing: 3 C FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS i FT. Above Land Surface*
*Top of casing terminated at/or below laud surface requires a
variance In accordance wltb ISA NCAC 2C .0118.
9. YIELD (gpm): 7 METHOD QE TEST al r
10. WATER ZONES (depth): a„zs
I1. DISINFECTION: Type he TR
12. CASING:
Depth Diameter
From_e_ To 75" Ft. 1 iq
From To Ft.
From To Ft.
13. GROUT: Depth
From Q To 10 Ft.
Amount 0 . go
Wall Thickness
or Weight/Ft. Material
50r 1.1 PVC -
Material
CA Mt }CT
From To Ft.
14. SCREEN: Depth Diameter
From To Ft. in.
From To Ft. in.
15. SAND/GRAVEL PACK:
Depth - Size Material
From To Ft.
From To Ft.
16. REMARKS:
Method
101./PripiClog cn,
d W n "-ha.RJR G-o 9.2 Fa, l e,Torn
Slot Size Material 1 m CS -6'
Z
in. RiehT on Torklubkk Relit p
%n %les TornR,o1r! on
6-0 o. . Yrit`leS Torn I erng f&FFT
M'vriiber• a1O Gro Te P;ra T o vl
/ePT well on le -Pr
Topographic/Land setting
❑Ridge ❑Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From To Formation Description
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common �ppad names.
Cram n eti f0 o Ter# a t° T2'r-n l�
on 094f,S 'G-a Is pl les iman R,gghT
on ,Us,/y G=o /1a11 piihtt7 Tan 1e-AT
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
o)eWery llyae
SIGNATURE OF PERS6N CONSTRUCTING T
Submit the original to the Division of Water Quality, Groun
27699-1636 Phone No. [phone], within 30 days.
Ac LEL,
r,G
r - Raleigh, NC
1 REV. 07/2001

278756
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources T-� Division o'frWater Quality - Groundwater Section
ai-7%/ //2t veal CERTIFICATION # � 3 77
WELL CONTRACTOR (INDIVIDUAL) NAhIE��({tptr�i�nt)/�
WELL CONTRACTOR COMPANY NAME t`�/.�/r .er-P'/as1/ ed D/2 PHONE # ff j �— s-SS CM -
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ MIT#
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential Municipal/Public ❑ Industrial ❑ Agricultural ❑
Monitoring ❑ Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATI
Nearest Town: County
(Street Name, Numbers, Community, Subdivision, Lot No.r Zip C
3. OWNER
J 7t n
1 / �1 ck
(degrees,minutes/seconds)
1r ✓ r
Address ��rLYJS nT.9/'0 /j/,- Latitude/longitude source:❑GPS❑Topographic map
(cheek box)
DRILLING LOG
5
Topographic/Land setting
DRidge ❑Valley ❑Flat
(check appropriate box)e4/ 4CLatitude/longitude of well location
(Street or Route No.)
W' »7e/Ao&rne, FA-agioS7
or Tow7,2 6 State68/6 Zip Code
f� �J l
Area code- Phone number
4. DATE DRILLED / 7/0 3
5. TOTAL DEPTH: SD
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO
7. STATIC WATER LEVEL Below Top of Casing: 302C FT.
(Use "+" i f 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 I5A NCAC 2C .0118. 1 r
10. WATER ZONES (depth): ME.d '15pID OF i E,S�e f-Ztiii
%%U - V
11. DISINFECTION: Type
12. CASING:
Depth
From 0 To '39
From To Ft.
From To Ft.
13. GROUT: Depth Material
From (% To .21)
Amount
Wall Thickness
Dia eter or Weight/Ft. Matey al -
Ft. ')v� ,5DK d'iC
Method
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.
DEPTH
From To
v
o??5
.z�/5 �3CS7'
3Lrv— 7`/4
7 /3 - tS1
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. _
F-9- ��5 Zn L<
� o
V1 z ,1
-0 c H
1 0<
`y c
tir-
a mrn
n
O f112D
Ca
W
CT
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
inank�\Re ILAQ
SIGNATURE OF
0/44
RUCTING T1
Submit the original to the Division of Water Quality, Groundwater Secti
27699-1636 Phone No. [phone], within 30 days.
46 Mail Service Center - Ralef hIry
GW-1 RE.�I
I__l
C
001
625
L-

NULL CONSTRUCTION REcOi ;%
North Carolina - Department of Environment and Nat [al Resources - Division of Water Quality -
,& &GL'
WELL CONTRACTOR(INUIPIIIUAL) NAME (print)
/2-
WELL CONTRACTOR COMPANY NAME
STATE WELL CONSTRUCTION PEIUtIIT%
lif 0pplicablc)
ASSOCIATED WQ PEMIITI
(i( Mrplicablc)
278827
Groundwater Section
CERTIFICATION
PHONE F r¢JAy /_2992
1. WELL USE (Check Applicable Box): Residential 12KMunicipal/Public d Industrial d Agricultural 0
Monitoring d Recovery d Neat Pulr'p Water Injection ❑ Other d If Other, List Use
2. WELL LOCATION.:
Nearest Town: C{11,^02LQ.
%?y r R d4e E5t iv s
(Street Name, Number., Conmmnily, Suhdicikion, Lel No., Zlp Code)
3. OWNER: 73-602 vJai�
I Lc-- f G( FYk )1 1
Address S Tu
(slice or Rowe Not LC)
City or Town Stole
Airs code- Phone number O _;
4. DATE DRILLED
5. 'TOTAL DEPTII: 5r0 ---
6. DOES \VELL REPLACE EXISTINCI WELL? YES 0NO EY
7. STATIC WATER LEVEL ['claw Top r.
of ashignr of C•O r
P)
8. TOP OF CASINO IS 1 -' FI-. Above Laird Surface•
•Top of rs,lnt tamin.ltd •Uor below Innl whirr nipping •
.,I,nce In •ccordsnce with ISA NCAC IC.0118.
9. YIELD (rpm): 2._ MRTIIOD OF'FEST /; rf
10. WATER ZONES (depth: 5C
County sWu /2
Zip Corte
++ T /
II. DISINFECTION: 'f}'pc %__ -- Amount !�f
Wolllhickncss
12. CASING or Weight/Ft. Material
Depth Diameter
, r Ai 1.-
Ft. u.2i .S/=z)
Peon � 1'0
Fran To rt.
FVOm To FL.
I3. GROUT: Depth ton
m'__ cnl
From O To_
Ft. c%_t/4,rd
Front, Tom Ft. Ctnt?th e-_ .
Diameter Slot Size
14. SCREEN: DepthhIre
Front Tr•—_ ____ FI._i t.
From__ To
R. in.. in.
15. SAND/GRAVE', PACK: Depth Size Material
To rt.
To Ft.
From
From
lellrod
its' et
tfs r t
Material
Topographic/Land setting
['Ridge ['Slope ['Volley ❑Plat
(check .pprnpdale boa)
Latitude/longitude of well location
4j '4 34. y„ 2I 341.
(degreea/minuler/srend.)
La tiludeJlongilude source.dGPSOTopograpllic mop
(check boa)
PEI,1ll AR)L.LIN_CLLOG
From To Formation Description
0— Cs.
6'ra..; Y e
--- w
LS1CAIIO_N_,5KU_LG_(1 vl c
Show : irer•tion and distance in miles Froinia Iea7#_
two Slate Roads or Courrty Roads. hw!tr'rlp., T
numbers and common road names. mO
MC ^gym
cot
O r1X
n
eJ ti
C/ o
z
16. REMARKS:
I DO IIEREDY CERTIFY 111AT11115 WELL WAS CONSTRUCTED IN ACCORDANCE WITII ISA NCAC2C, WELL
CONSTRUCTION STANDARDS, AND TIIAT A COPY or THIS RECORD ILAS DEEN PROVIDED TO IWELLOWNER
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
Submit Ire original to the Division of Water Quality, Groultdwnttr Section, 1636 Mill Service Ceenter' �, Vg01 4C
17699-1636 Phone No. [phone], n11hh130 days.

WELL CONSTRUCTION 11L1-;vR;;
ulal Resoulccs - Division of Water Quality - Groundwater S•ediuli 7
CER1IF ICA"fION n "Z lied
PIIONE
North Carolina - Uepal(mein of Environment and N��
SPELL CON I RACY OR (INDIVIDUAL) NAME (prl„ 0
WELL CON I ItACIOR COMPANY NAME. ASSOCIA1 EN WO PP,MiII M
.5TA I MILL CONS IDUCtION pElU111r if ardisable
if 'italic
I. WELL USE (Check Applicable Dos): Residential IrMuoicipnl/public U Industlini EJ Agricultural O
Monitoring U Recovcty ❑ Ileat Pump Wnler Injection 1J Other li If Other, Llbl Use
'ropngrnpllin/Land setting
2. Neatest OCATIO IJitidge LlSlope IJVnllcy Dint
Surl Cr fy comity Sw<, rt
Neatest iown�— (check •ie prl Vnll )
h°�le. �4 k. --- —_ __ 71 Code)Lnliluddlougilude of well location
tv. SaFdl visicnt, Inl Nn., p A,3$'.20 t(Y. U" f/J og3 ) % 33 G ,
(Street Name, Nurnbey. Cc:u::•n, I__
J tie peedminuteehr^ndQ
3, OR'Nlilt: Jerefr' W444,4 FJU l Lolilud'I!^neilutle source 001'$OTnpoglaphic m:,p
(check boot)
Address —�/� tte& � �2 OPMA,!J)(J WI
15beel or Route Na) PE r ' 1
1'10111 'IN Emntalion iinctiptiun
City nt Too❑ Slate
A.e• cnlr• Nome number - <]S
•t DM DRILLE.D_�dS____—_—
281J_q
71r Code
5. -IOTAL PERIII:_ G/0_----
6. DOES WELL REPLACE EXISTUJO WELL? YES NO ft(
7. STATIC WATER LEVEL Below c'1't
r° DAbove gTop of Cueing)
ft. TOP Or CASINO IS i L — 1"f. Above Land Sur Face•
• leg rl totting ietminded •I1or hrlon land notice mph.. •
tnlotnce In •rcotd•nte nIih I5A IICAC IC .011N. /,
a. YIr:Ln(gr11):!——METUODor•TES T�
lo. WATElt ZONES (depth): 57o _
.14 �� Amount .=/ C,i
I1. DISlNl'EC1lON: type T___---Wall Thickness
12. CASINO:
Prop( 'ro_ Ft. L..±S
nun, To IT
hew To_ — Et. —Iona
Depth Ihintelint / il...1 '
13. l i tn_ I ai rt. rb —
I tole _ To —
14. SCREEN: Depth Diameter Slot Site Mnletinl
„ in. In.
floor I - —11'—
non,_____ To—
fl. ill. in.
15. SAND/GRAVEL PACK: Depth Site Mnlctlnl
rtnm To It. —'
rnor11 To IT.__ ----
a
y -
Depth Diameter or Weight/It. Mahal
16. REMARKS:
I D° I IERFEY CEIt HIV 1I IAr 11115 WEI.I, WAS CONS
I
CONS I RUC1ION S FAIIDARDS, AND'11IAP A COI'Y OF
r
1.VCM.10_1 KEJ_GJl cn c^�
Show direction and distance in miles ri01iiticasZ}n
Iwo Slate Roads or Courtly Roads. Include1e to
Duutflcls and common rood names v me
3 ern
o rrt
n
c.A -
co O
Z
SKINAlUllE UP PERSON CONSIRUCIIN 111IE WELL
Snlnnit the original to the 11lrldon of Writer Quality, Groundwater Section, 1636 Mall Service Center Raleigh, N 01
2100-1616 Phone No. (9191733-3221, nilhln 311 da)s.
ItUCI ED RI ACCORDANCE WI III 1 sA IICAC 2c, WELL
.11115 RECORD 11AS DEEN PROVIDED 10111E WELL OWNER
DAZE

[\J o (2 (- r rry 1 T
277448
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and
/Natural
,�Resources - Division of Water Quality - Groundwater Section ]
WELL CONTRACTOR (INDIVIDUAL) NAME (print)
/y-r, hj/ //_r� I f >� / ' A�{'IJ( -S / cewrieICATIION # „cS-)// 7
WELL CONTRACTOR COMPANY NAME PrZT I 3 61 r-Q e I �- Qire W e PHONE # (��3J — Sat —�_-S tD
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential.2 Municipal/Public 0 Industrial ❑ Agricultural ❑
Monitoring ❑ Recovery ❑ Heat Pump Water Injection 0 Other 0 If Other, List Use
2. \VELL LOCAT N: Topographic/Land setting
Nearest Town:'.-br-*ySC 7 `1'4Akooun/(yl,L� ❑. — - -- 0—
ce)rtS 'tti)OY `C( 1`LY ',0%�l/c_r(i7C 77
(check appropriate box)
(Street Na e, Numbers, Community, Subdivision, Lot No., Zip Code) %LY( a S—L,iiU(te/longitude of well location
3. OWNER Pia Li2r5 FOVal C LI-410Y�
DRILLING LOG
yy City or Town State Zip Code From To Formation Description
Ct�
Area code- Phone number
4. DATE DRILLED
5. TOTAL DEPTH: 4 - -
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO X
7. STATIC WATER LEVEL Below Top of Casing: 0" FT.
/ (Use "✓' if Above Top of Casing)
8. TOP OF CASING IS / jy 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): / METHODPF TEST �} I r
10. WATER ZONES depth)
(degrees/minutes'seconds)
Address 1 pOrtS Ij 1 O ytd r(�- r Latitude/longitude source:❑GPS❑Topographic map
(check bog)
(li -L � r>Z��Tj- DEPTH
•T /EVI gStreet or RoutyNoa � /+ 3
9 03
11. DISINFECTION: Type T
12. CASING:
Depth flier
From To 5� FL
From To Ft.
From To Ft.
13. GROUT: Depth-
From To 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
Wall Thickness
or Weight/Ft. Material
Sib0-2( Ur_
Material
nMethod
Slot Size Material
in.
in.
Material
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common road names.
�l
16. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, \VELL
CONSTRUCTION STANDAARDS, AND THAT A COP' )T IS RECORD HAS BEEN PROVIDED TO THE WELL O\VNER
•
1-1\
lLtift
a ~ `(�ISIONA SIGNATURE OF ERSOt `' ONSTRVCTING THE WELL
-7f _? o�
DATE,
Submit the original to the Division of Water Quality, Groundwater ectwn, 4436MailSer ice C ter Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. QW.F REV. 07/2001
1,
J
IScu,C'hi L U'� VICE

WELL CONSTRUCTION RECORD
fUa (7.0 I'rn tT
277447
North Carolina - Department of Environment and
Natural
,'Resources - Division of Water Quality - Groundwater Section ./
WELL CONTRACTOR (INDIVIDUAL) NAME (printt))���-All�0 _r" / Pm' Al/ ' Atl31( S / CERTIFICATIONOk �C�)/
WELL CONTRACTOR COMPANY NAME 4Z-t 3 �� Y"e C) I LQ Bre Ix) e PHONE P fgA-t — lft --JSS r�
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERNIIT0
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): ResidentialQunicipal/Public 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery ❑ Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCAT� �t, CZ Topographic/Land setting
Nearest Town:`-bit*ysem ` 6A,County `—)l>l) 0 I n ❑Ridge RSlope ❑Valley ❑Flat
0p y` 15 ': rA) 0 Y` /C� -Rd hR ys co, e r/ (check appropriate box)
(Street Na e,Numbers,Community, Subdisision, Lot No., Zip Code) JUL e-L861Na/longitude of well location
3. OWNER: Players Fo coic a.+1 (�`, // (degrees(minures'seconds)
Address O pUI^�S I_d 1 O V LQ (1?-- r�
Latitude/longitude source:OGPSOTopographic map
(Street or Rout�ho1) (check box)
.� v--yi S N� 'lh' t N C tJ 7f3 DEPTH DRILLING LOG
To Formation Description
ity or Town State Zip Code From
Area code- Phone number
4. DATE DRILLED a4 U3
5. TOTAL DEPTH:
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO X
7. STATIC WATER LEVEL Below Top of Casing: .7D FT.
/ (Use "+" if Above Top of Casing)
S. TOP OF CASING IS / zy FT. Above Land Surface*
crop of casing terminated at/or below land surface requires a
variance in accordance with 15A NCAC 2C .0118. /�
9. YIELD (gpm): 1 METHOD OF TEST mil" / r
10. WATER ZONES (depth): 7D / (19r-n.)
I I. DISINFECTION: Type FIT H-- Amount -36 0-'7-
12. CASING: Wall Thickness
Depth[ Dia set�r or Weight/Ft. Material
�7
From 0 To Ft. Y spe-2/ C
From To Ft.
From To Ft.
13. GROUT: Depth- Material Method
From(0 To ' Ft.
-00.4"nd', -1Qr):-)
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:
2S'
O 3
43-y<Y
G/A- 76
7o - 7/
7/ - gS"Z'
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.
73-6
• tU 1
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COP ' FT IS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
SIGNATURE OF ERSOr ONSTRUCTING THE WELL DATE
( -. I -���'11
Submit the original to the Division of Water Quality, Grounds aterISectionil636 Dlatl Serljee_COt r Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. `, { GV -1 REV. 07/2001

WELL CONSTRUCTION RECORD
No 12Q J,m,t
277446
North Carolina - Department of Environment and
Natural
,'Resources - Division of Water Quality - Groundwater Section
T�j'
WELL CONTRACTOR (INDIVIDUAL) NAME (printt))_AAl il-1_' ± / YNE ill (/+ / i1 E S CERTIFICATION # v5.�)//
WELL CONTRACTOR COMPANY N.ANIE 11 r-T k_1. r-2 e rte.. `ire Lc) ed PHONE # (�L{'J - 5 t c 5 V
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable) �/ (if applicable)
1. WELL USE (Check Applicable Box): Residentialyl�lvlunicipal/Public ❑ Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection ❑ Other ❑ If Other, List Use
2. WELL LOCAT N: �t, Topo raphic/Land setting
Nearest Town:Kb CM l 4Xkoun �L_c_L [Midge 251SIope ❑Valley ❑Flat
``50n r45 ,'.(�._�Or f c LF //
f`%ri(/Scoj Q _ r/� (check appropriate box)
(Street Na to, Numbers, Community, Subdivision, Lot Na, Zip Code) L/C a
I-adi�rt»/longitude of well location
3. OWNER: P/41 l./eIS Fo(.C'11LVCA-�f �^ (degrees/minutes'seconds)
Address / S FEU I^tS tt ) O r '' 6-?__ 4 Latitude/longitude source:DGPSDTopographic map
(Street or RoutNo ^ %` (check box)
"� r`V' .S U7, - 1 I / \. `l Q g 7/R DEPTH DRILLING LOG
(City or Toscn State Zip Code
t4-2i-
Arca code- Phone number _
4. DATE DRILLED ,(0-& -o
3
5. TOTAL DEPTH: 43v
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO X
7. STATIC WATER LEVEL Below Top of Casing: r5/6 FT.
/ (Use "+" if Above Top of Casing)
S. TOP OF CASING IS / zy FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordance with 15A NCAC 2C .0118. /�
9. YIELD (gpm): METHOD OF TEST l%-t / r
10. WATER ZONES (depth): 5 '9 S!Y
') j £ 1 /
3 5-(`/VG'�
11. DISINFECTION: Type I"t T /"f- Amount .5ZT
12. CASING: Wall Thickness
From 0
From
From
13. GROUT: Depth_ /(� Material Method
0 To �-(-) Ft.
FromL(%,-no . -11-97
From To Ft.
Depth f, Diameter
To t/ Ft. tp
To Ft.
To Ft.
or Wei_ht/Ft. N rial
�PRZr
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:
From To Formation Description
J -- 5'
t' -�i
r/— /95
/95 —/9S'5
/g5-c-S — A2
-J `Jar -'1 t—
'yr, `,/t//c
^7/4O —7`�/
L/9/5Ui
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.
G
((7
L liY
-11- cc]
i DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COP FT IS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
Inc 1 al6C--3/--G
SIGNATURE OFPERSO' ONSTRUCTNG THE_ WELL DATE
Submit the original to the Division of Water Quality, Groundn1aterSeetions16f6Mall Scrim Gemter- Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. W-1�dREV. 07/2001
J h

North Carolina - Department of Environment and Natural Resources
S, :02 r i
WELL CONTRACTOR (INDIVIDUAL) NAME (print)
WELL CONTRACTOR COMPANY NAME �j���1//
STATE WELL CONSTRUCTION PERMITS
(if applicable)
WELL CONSTRUCTION RECORD
Division of Water Quality - Groundwater Section
^ {i CERTIFICATIOVR
PHONE (d49 ,-'✓ L
ASSOCIATED WQ PERMITS
(if applicable)
1. WELL USE (Check Applicable Box): Residentiall- Municipal/Public ❑ Industrial 0 Agricultural ❑
Monitoring 0 Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use
2. WELL LOCATION:
Nearest own:
(Street Name, Numbers, Community, Subdi
3. OWNER: au4(
Address
i.„---� (Street or Route No. /
__ 4 el o t/ At,
City or Town State / Zip Code
Area code- Phone number
4. DATE DRILLED 7'�Z.7wA
5. TOTAL DEPTH: (PcsO
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 / 7 �7i 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 1/2 METHOD OF TEST e-
10. WATER ZONES (depth): .3070 2-
(16D Yy
1 I. DISINFECTION: Type ft77-74 Amount 2-.�v�
12. CASING: Wall Thickness �J
Depth Diameter o Weinht/Ft. Mate ial
From 0 To 7.5 Fi. (0 At
From To Ft.
From To Ft.
13. GROUT: Depth Material Method I
From G To-) Ft.
From To Ft.
14. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in.
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Sizc Material
From To Ft.
From To Ft.
ounty
ip Code) .724 773
Topographic/Land setting
DRidge DSlope ❑ValleyclEnlat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:DGPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From To Formation Description
76
TO ->.S
75'-3rb
(foe YV' -
_y„z —GCrD
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.
�/ 10 4
VV n`c,
16. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL \ AS CONSTRUCTED IN ACCORDANCE WITH I5A NCAC 2C, \VELL
CONSTRUCTION STANDARDS, AND THA7A C9 ( OF THIS RECORD HAS BEEN PROVIDED TO THE WEWNER
1.LL 1 /U
)GNA RE OF SON CONST$ TkNG THE WELL-
rll
Submit the original to the Division of Water Q ality, Grout1010t , CUG 1636Af4a'&t er*t*er- Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. I I ;. 4
ILI
l�/-1 REV. 07/2001

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Diva on of Water Quality - Groundwater Section /'
;;yy���� ..,/— �]� �,�/,,�//l CERTIFICATION # q s9 /
WELL CONTRACTOR (INDIVIDUAL) NAME (print) /z/.�`7 jam' �///���z " 5' (�
WELL CONTRACTOR COMPANY NAME eCtS-C— i'S'71:/7 PHONE #fit—�7d�—S, '
ASSOCIATED WQ PERMIT#
97
STATE WELL CONSTRUCTION PERMIT-8 (i fapplicable)
(if applicable)
1. WELL USE (Check Applicable Box)' Residential Municipal/Public ❑ Industrial 0 Agricultural 0
2. WELL LOCATION'
Nearest To\ ounty
(Street Name, Numbers, Commm�muumryT, Subc)%visio�, or 'o., Zid Code)
3. OWNER:: DV lilt/ / /<u Y 111
Address /4/ L�e-i - r5 t
(Street or Route No.) /^C/ ��
FT P/e /G �/ % 7
City or Town State Zip Code
(2,1 ZGe S-- a&le)
Area cod Phone numberL // — U
4. DATE DRILLED
5. TOTAL DEPTH:_
S WELL REPLACE EXISTING WELL? YES 0 NO $
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other ❑ If Other, List Use
Topographic/Land setting
DRidge OSlope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
7. DOES FT.
7. STATIC WATER LEVEL Below Top of Casing: o
/ (Use "+"if Above Top of Casing)
S. TOP OF CASING IS //7/ FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordance with 15A NCAC 2C .0118.
9. YIELD (gpm): �3l/ METHOD F TEST
10. WATER ZONES (depth): -% 4�
j Show direction and distance in miles
0)
11. DISINFECTION: Type
Depth ptagnater or Weight/Ft. Matt numbers and common road names.
From.D To f.32 Z Ft. Cc" YYr ; /yjg ,...,:c„..,42
iu.�.c
From To Ft. %% e.o
To Ft.
DepthMaterial MethodO
Too�jl FL � o� � _
From To Ft.
14. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in.
From To Ft. in. in.
15. SAND/GRAVEL PACK: Material
Depth Si ze
1 /-�-m 0 , t, A- 4
From
13. GROUT:
From C
12. CASING:
277441
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From To Formation Description
© / 7 sc
/7- ZL
From To Ft.
From To Ft.
LOCATION fronIItt leas
Amount - 7,� —
Wall Thickness t\vo State Roads or County Roads. Includ �e road-
—
7/° T 7( 7
7‘-) —
r,)
n
c.
5.4
%t7/ (Zecyz i ' t2- ,
16. REMARKS:
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 EN PROVIDED TO THE WELL OWNER
76c��Ls� 2/3 �4
SIGNATURE OF PERSON CONS CTING,T E WELL
DATE
Submit the original to the Division of Water Quality, Grouter Seetioni 1636 Mail Ser ides terl REV.RaleighC
27699-1636 Phone No. [phone], within 30 days. ._li , J'
it 'I
LI

WELL CONSTRUCTION RECORD 27 3t -L
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
,z1CERTIFICATION# 59L
PHONE # ds7.0
WELL CONTRACTOR (INDIVIDUAL) NAME (print)
WELL CONTRACTOR COMPANY NAME
STATE WELL CONSTRUCTION PERMIT# U 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 LOCATIO
Ne es��T
(Street Name, Numbers, Communii
3. OWNER:
Address
(Street or Route .)c,
a7-7/
r Topographic/Land setting.
❑Ridge 4iSlope ❑Valley ❑Flat
(check appropriate box)
�\ Latitude/longitude of well location
%-
a a, 7/J3 (degrees/minuted/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From To Formation Description
0 — r2z4t
4. DATE DRILLED 7— % — c3 3 , a27E0
5. TOTAL DEPTH: r-?,2 0 c, 47 2 t{ Z-
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO `77 ' C
7. STATIC WATER LEVEL Below Top of Casing: / U FT. COS _ if 7
(Use'+' i(Above Top of Casing) - J _ /9S-
8. TOP OF CASING IS ( FT. Above Land Surface* Cf
•Top of casing terminated atlor be ow land surface requires a
variance In accordance with I5A NCAC 2C .011S.14
9. YIELD (gpm): gl5' 1 ETHOD OF TES f l'
10. WATER ZONES (depth): /9 Lid 2, 3—
2- — / 8
11. DISINFECTION: Type lfjii Amount i IJ
12. CASING: Wall Thickness
City or State Zip Code
Urf /may
Area code- Phone number
Depth anfete
From O To a- Ft.
From To Ft.
From To Ft.
13. GROUT: Depth Material
From 0 To .2-40 FL
or Weicht/Ft. Hater al
From To
14. SCREEN: Depth
From To Ft.
From To Et.
15. S.AND/GRAVELPACK:
Depth Size
From To Ft.
From To Ft.
Ft.
Diameter Slot Size
in. in
16. REMARKS:
Method
Material
in. in.
Material
/ - / 5,31
J'7 - zv
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.
oa L!'J t -
QC
cu
0
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTIOp+ STANDARD AND THAT A COPY OF T IS -RE D HAS BEEN PROVIDED TO THE WELL OWNER
SI TURE OF PER CQFit - IUATE
AI
Submit the original to the Division of Water Quality, Gro�a(fer S 1Ton, 1636 is ail Sery1'de (,kprter - Raleigh, NC
27699-1636 Phone No. [phone], within 30 days.+W-1 REV. 07/2001
L

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural^Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) dB 1
YY} Je r y if ei a CERTIFICATION M.ZG•S0
WELL CONTRACTOR COMPANY NAME fJ rallies p tJ, )t c ll r JiOY PHONE #
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WO PERMIT#
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential ® Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION:
Nearest Town: /3rySOh C, 7 County S trlc.i ✓t
/i/E4 inn re Rd,
(Street Name. Numbers, Community, Subdivision, Lot No.. Zip Code)
3. OWNER: Ih rr.'ei Cap°/'2
Address iioork m,,rev Rek
(Street or Route No.)
Rrysnn G1'7Ty (V-C
City or Town State hip Code
625)- `ietk—i(£/ 7
Area code- Phone number
4. DATE DRILLED 7/%4/O
5. TOTAL DEPTH: 9S"O
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO I-$
7. STATIC WATER LEVEL Below Top of Casing: U 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 wltb ISA NCAC 2C .011 B.
9. YIELD (gpm): 0 METHOD OF TEST CA-/ ✓
10. WATER ZONES (depth): 0
I I. DISINFECTION: Type li rite Amount
12. CASING: Wall Thickness
or Weight/Ft. Material
i2A ! Fur.
Depth Diateter
From To Ft. to II
From To Ft.
From To Ft.
13. GROUT: Depth Material
From_Q_Tomb Ft. CAmps/ 7"
From To Ft.
14. SCREEN: Depth Diameter
From To Ft. in.
From To Ft. in.
15. SAND/GRAVEL PACK:
Depth Size
From To Ft.
From To Ft.
Method
Slot Size Material
in.
in.
Topographic/Land setting
❑Ridge ❑Slope ❑Valley DEW
(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
ca
23
LOCATION SKETCH _.
Show direction and distance in miles from iteleas '
two State Roads or County Roads. Include tilt roaef{)
numbers and common road names. co
—
Preto o.lmenc` past v-Pr%c? 7uvA /64
on a.$_So'o /,'$' m /r5 %orm/Jr col
poinp'nog 711-E oet'olrsttl1 %urn /?1$'4 T d
Me� m r 6 r{ 4. �O ec . j miles To h r)
Rit4hT on 6✓, /rs creek Ri, so
0,6 rii'/es 2'rtj f/�h7 os li''llrt T
Rock RJ(, „no 0.1 th'1 es To to n iEJ r
U,1 )oRot mry, of �G c,f m,;CS 72,
orye 0,3 rl,/95 %'d✓rn N'�lt c(0U
Material
16. REMARKS: %O he cl' yArO trem- .r
Y THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
277064
1 DO HEREBY CERTIF
CONSTRUCTION STANDARDS, AND'THAT A ^COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
ei SIGNATURE OF PERSON C NNSTRUCfING THE WELL D//lt— 6 3
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mall Service Center Raleigh,
27699-1636 Phone No. [phone], within 30 days.i — teREV
/2001
J
GROW—T'T. CP ION
acunni i F REul.v.' t'FACE

277063
11. DISINFECTION: Type Amount
12. CASING: Wall Thickness
Depth Diameteryor Weight/Ft.
From To 6-7 t Ft. 6i 50 r aZl
From To Ft.
From To Ft:
13. GROUT: Depth Material
From_ -_ To 12, FL cc-wen-1
From To Ft.
14. SCREEN: Depth Diameter
From To Ft. in.
From To Ft. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft
Material
pvc,
Slot Size Material &o TO s T d p Sr 9d/1 T e-A I e1 Z on �/eTre,
in. P
in.
16. REMARKS: ;s IP
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Naturiesources - Division of Water Quality - Groundwater Section
-{ CERTIFICATION 0 ZU 5-d
WELL CONTRACTOR (INDlVtDUAL) NAME (print) air' Ery tYe PHONE M E7iSr) y79'"44‘y
WELL CONTRACTOR COMPANY NAME GrnAhn-nn (,Je/? �'�r il//Y)�
ASSOCIATED WQ PERMITS
STATE WELL CONSTRUCTION PERMITIt (if applicable)
(if applicable)
1. WELL USE (Check Applicable Box): Residential ® Municipal/Public 0 industrial ❑ Agricultural ❑
Monitoring 0 Recovery ❑ Heat Pump Water Injection 0 Other ❑ If Other, List Use
2. WELL LOCATION:
Nearest Town: BrySOn G, T7 County S wa.t rl
leAr,rtll S erresek lag Cabin 1
(Street Name. Numbers, Communit,P,'Subdivision, Lot No., Zip Code)
3. OWNER: Re,h/f, tit)etrarer
Address 3334 e.Jfl w„ R2 fryson CiTy
(Street or Route No.) % l
!i ry San eiry N•C 2
3
City or Town State Zip Code
( )- `iSt- 9793
Area code- Phone number
4. DATE DRILLED 7-9'" 03
5, TOTAL DEPTH: /noC'
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO El
7. STATIC WATER LEVEL Below Top of Casing: 0 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS / FT. Above Land Surface'
*Top of casing terminated atior below land surface requires ■
variance In accordance with 1SA NCAC 2C .0118.
9. YIELD (gpm): 0 METHOD OF TEST C.i P
10. WATER ZONES (depth): 0
Topographic/Land setting
❑Ridge ❑Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minute-s/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From To Formation Description
w
373°
cD
LOCATION SKETCH v
Show direction and distance in miles from'at leaf ,'I,!
two State Roads or County Roads. Indudt to rof
numbers and common road names. _ _=
front al nun et POST 0t-• - �d
/eis m%les %OPS le•t7on 74'4 G'
Method
rump', Q.3 miles Td rx; 7 67 723 lry5o n c,
J3 I V erd 7; STar 1/Gghicro s rrct;gh
-0., rough 6-d re Co✓T,ah /,c9h &-e
STratsh7on fro.nkelen Breve ohorc,
Rd Co /.G miles Turns 7o l3oli'Tao.n
Read 6-c I M/'le5 G-u O,l ride Turn RA
r
THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH I5A NCAC 2C, WELL
(e
ve
1 DO HEREBY CERTIFY
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
71pP4'ery l?yele 7-9-03
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
'r &icti�bn,48341a0SV ice Center - Raleigh, NC
GW-I REV. 07/2001
Submit the original to the Division of Water Quality
27699-1636 Phone No. [phone], within 30 days.
GC- 2 9
GROI'R SECTION
ASHEV0,1 %1!qL OFFICE

WELL CONST1tUCTLON ItECOItll
N(nll, (:rtoliva - Dep;uhnent of Environment and Natural liesDun: es - Division of Wale! Quality - Groundwater Section ppQ
N)laL((IN IIL\(' I nit (INDIVIDUAL) NAME. Orrin() }< A.)1 '7� Lc) . r�O^St CEIkTIFICA1 ION 0.�00
wI:I.I. ( (IN 1 It 1 (' I OIt (-(tnl l(A NV NAME. �2OSet5 t €_tL— 111�_j t-V-
SI,tII )cFl.I.((INSII It(dim1'EIt 11IN .. AssuuIA I ED N'OEEIIMIIII
lid applicabtc) (if applicable)
273916
I'lI(1NE N fV'3) ii42.-3N3
1. \1'I I. I_ I ISIF ((heck Applicable Box): Residential Ad Municipal/Public 0 Industrial 0 Agricultural ❑
hionihniug ❑ Recocety ❑ Ilea( I'wnp Willer Injection 0 Other ❑ Ir Oilier, List Use
2 WI''I.I • I OC'A 11(1(4 . %I opographic/l.: and selling
Nearest Iown: ►}R�SON) C1 4 Couuly .5.&14-1 Midge ❑SIopc Malley ❑Plat
(check appngvinle hne)
(Nose, thane. Numhcl c. I('nnhoonily, $uhJivis/�iio/�nj LL,olnNo.. Zip Code) I.:Illllidc/Iollgittltte of well location
O\1'NFR I4r s4_-i4_11�QTI A_1 Idagrccs4uinutcs/scnnvlsl
ken/ -/MR.
-a3Li SLcetc't) RIDCsE Dxtvc
L:diludcAungiludc sourcc:0O11S0Topogrrphic map
I NucrateNn)
(check ho.
)
grnN I�J�C 2:g 71 3
l it v Shale Zip Code 1'1tun ) Io
1—
Arr., IINtf I Ilnllf 11/11111 1'I
.1. I/AIIIORII.LIiD -13'-c'3 -- } 1_—
s. TOTAL NW 111: '- -'JD
6-ants WPLI. ItIUI.ACE GxIS IING WELL? YES NO
7. S 1 A Ill' W All1R I.IiVlil, Below lop of -Casing: 90 .PT.
(Use"r" if Above 1Tp of (-vier,
R 'I ()I' (I (-ASING IS / I. Above Land Surface*
• I yip or castor terminated of/or below land i n'Ince require,
+a.i:nlrr in acr„td:ulrr ollh 15A NrAC 2C .ah I$.
o. 1 11' I.O I vino). _1 Z _-- MCTI 101) of iTEST /91
la AVAIlilt 7.)NIS(depth):____�uQ_
II. I)ISIN fi!('IION:Type-,y .11LRRIye Antolini / cL4
12. CASING: Wall Thickness
Depth c Dior er or Weight/FL Material
Il,m,__ .�_. Ti, 6a_.-. il. 6I) / [ LP L
(Mini to I1. -- -
I non _ To , PI. -
11 (;ROM.Dept, blatcrinl
It(nn D To e20 It. Ce Me'vi
I Itnn._ a.Q_ To.0`i__ rl._�,('1.-r_^-Xl.s
I1 St'Rf.IIN: Urpnl Dimncicr /Slut Sit
1-,,„„ 111 I.
Mellon!
(.laded i
in. —_ in.
1 owl lb 1"L iu, in.
11. SANI)/1 il2AVF1, I'AI K:
Depth Size Maletial
1 inm-----._- I ('...__.-
1 tom to Pt.
Ili. RI'1LARKS:
(.)NsII+U( IRONSi AN
SinlinlRihl_(iri+'h6•d to II
441P).'I 4(16 R1u'rtfc ,. ((11'
Ulil'III DRILLING LOG
_ Formation Description
CItsi JG—
Slstec
c
-�
LUCAII(JN SKEICII IN)
nix,
Show diteclion and dislatice in miles Emilia IcaP
two Slate Roads or County Roads. IncludRlle r@d
numbers and common road names.
LAT 1111S WELL WAS CONSII(W I I'D IN ACCOItDAN('P. WI Il l I5A NCAC 2C. WELL
ItI)S. Al)Ilt'I1IAT A COI'Y/UP'I IIIS IU (URU IIAS BEEN OVIDEI) tO DIE WELL OWNER
AVjt
I(ONATUIZEE OP PERSON CUIISIRUCTINN 11IF WEI.1. DAII?
Division or\1'aler ()Wilily, Groundwater Seddon, 1636 Mall Serilcc Cenlcr- Raleigh, NC
711-3221, Iv llhln 30 dnys.` (iW-I REV. 07/21101

268164
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division�of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) 3 C F F �Rj 141 7 .0 CERTIFICATION #2OS0
PHONE # t$Z$1 ri % 9 �g iiS4
WELL CONTRACTORCOMPANYNAVE
STA'I E WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
l
WELL USE (Check Applicable Box): Residential ® Municipal/Public ❑ Industrial 0 Agricultural ❑
Monitoring D Recovery 0 Heat Pump Water Injection 0 Other ❑ if Other, List Use
2. WELL LOCATION:
Nearest Town:
S Kit: ri A C)
(Street Name. Number, Community,/Subdivision, Lot No., Zip Code)
3. OWNER:ant-4n Mt —
Address Li Gs Skil RLot. D rt&A,
(Street or Route NS )
u.ln.an CLtJ �]').0 �.A7 D2
Cr, or Town State Zip Code
(70K)- 29s— 3s38
County S-24,045r-'
Area code- Phone number
4. DATE DRILLED // et.J a o 3
5. TOTAL DEPTH: 4, o
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO (A
7. STATIC WATER LEVEL Below Top of Casing: ;4 L a FT.
(Use "r" if Above Top of Casing)
8. TOP OF CASING IS ) FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordance with 15A NCAC 2C .0118.
9. YIELD (gpm): / a METHOD OF TEST A
10. WATER ZONES (depth): 3 ci $
I1. DISINFECTION: Type PHTH Amount 0•70
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
From 0 To /csS Ft. 6lb- SDR),/ pVc
From To Ft.
From To Ft.
13. GROUT: Depth Material
From 0 To 7—o Ft.e4YNt'r f
From To Ft.
Method
�
W U
14. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in.
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
16. REMARKS:
Topographic/Land setting
❑Ridge ❑Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitud of well location
3r 19`0-0I' 83`3,PiC7„
(degrees/n nutes/seconds)
Latitude/longitude source:KGPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From To Formation Description
_LA1a/ — //t/a 3
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.
erect c ,imr� e
Wu- ' d"4-,1/41 #aSS -<
to t�n,rs-
Of• r y 1 i y sm.t s,.,°
ti 1 Lit rZJ ere, tilt_ at2
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 HASBEEN PROVIDED _TQ-THE WELL OWNER
SIG A E OF PERSON CO STRUCTING THE WELL '..DATE
Submit the original to the Division of Water Quality,
27699-1636 Phone No. [phone], within 30 days.
t3W-I REV. 07/2001

WJLLL CONSTRUCTION RECORD
CERTIFICATION" `!03
North Carolina - Department of Environment and Natural
Resources
Division of Water Quality Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) /L p CORE N f�)�
e/� i�}ea ( Oil I I i ��
WELL CONTRACTOR COMPANY NAME ASSOCIATED WQ PERMIT"
if applicable)
STATE WELL CONSTRUCTION PERMIT"
if applicable)
1. WELL USE (Check Recovery Applicable Box): Residential B Municipal/Public ❑ Industrial ❑ Agricultural ❑
Monitoring ❑ Recovery ❑ Heat Putnp Water Injection ❑ Other ❑ If Other, List Use
Topographic/Land setting
❑Ridge ❑Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
.vas`,2 0o..''woYJ`i9''{2•5''
(degrces/minutes/secondr)
Latitude/longitude source:❑GPS❑Topographic neap
(check box)
= H From To Formation Description
280137
2. WELL LOCATION:, -Cunt:PI
1
Nearest Town: .±2 ee County
owl artwick nd.
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: %L —d� 5?N' `k
Address
City or Town �4
(__)- 0 S 0
Area code- Phone number .5 - j OD"��" ft. =---1
4. DATE DRILLED 5- -- °— ---- (
5. TOTAL DEPTH: 3 oD r _--
6. DOES WELL REPLACE EXISTING WELL?i 8 S.2. NO ) _
7. STATIC WATER LEVEL Below se +p of Above Top of Casing)
l :
8. TOP OF CASING IS 7�—
FT. Above Land Surfaces
*Top variancef cuing termtnsted h IS below land surface requires ■
LD accordance with ISA
OF TEST�-
9. YIELD (gpm):
10. WATER ZONES (depth): G r nre�rlf)N SKETCH
c�P Show direction and distance in miles from at least
11. DISINFECTION: ION: Type l� r Amount _ es two State Roads or County Roads. In4indeithe tnad
Wall Thickness names. 12. CASING: cr N.Ve;,oht/R. Material numbers and common total n..me
Depth liiu,ta;r�. ... �--�r
Frotn (7 To _CY Ft.
6.,15 s0� A/G w n
c �'
•--I c- n
z
t
—o m„
3 m
N�-
W m%
tV
CO z
State Zip Code
From To Ft
From To Ft. ethod
crial �=
13. GROUT: Depth _ iActh d
From � To�_ Ft.
From To Ft. 14. SCREEN: Depth Diameter Slot Size Material
From To
Ft. in. in.
Ft. in. in.
From To
15. SAND/GRAVEL PACK: Depth Size Material
From To Ft. ---- —
From To Ft. ----
16. REMARKS: WELL
1 DOON HEREBY CERTIFY THAT ANWELL WAS CONSTRUCTED IN ACCORDANCE WITH I 5A NCAC 2C, D THAT A COPY OF THIS RECORD HASEEN PROVIDED TO THE WELL OWNER
CONSTRUCTION STANDARDS, 7 -.2 Y "'03
DATE
SIGNATURE OF PERSON CONSTRUCTING THE WELL
, NC
Subrtdt the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center - Ralelgb
27699-1636 Phone No. [phone], within 30 days. GW-1 REV. h

WELL CONSTRUCTION RECORD
Division of Water Quality - Groundwater Section
North Carolina - Department of Environment and
WELL CONTRACTOR (INDIVIDUAL) NAME (print) 1
WELL CONTRACTOR COMPANY NAME t
STATE WELLCONSTRUCTION PERMITS/
if a
280131
Natural Resources - W• V� iCERTIFICATION S/ L39$
;1 e� lsot1
SSOCIATED WQ PERMITS/
if a..licable
Residential a Munir n IWublic 0 industrial 0
1.
WELL USE (Check Applicable Box):
esi
Monitoring 0 Recovery ❑ Heat Purnp Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION: County
Nearest "4 own,SrL�
(Street Name, Number, Community, Subdivision, Lot No., Zip Cede)
3. OWNER: M4L
Address
Area code- Phone number
4. DATE DRILLED
5. TOTAL DEPTH:
REPLACE EXISTING WELL/ YES ❑ NO
svJ4,lJ
6. DOES WELL _M__FT.
7. STATIC WATER LEVEL Below oP of Above Top of Casing)
8. TOP OF CASING IS �-
FT. Above Land Surface"
Top of casing terminated at/or below land surface require t
variance In accordance with ISAMETHOD OF TEST IE_�---
9. YIELD (gpm)� �---
10. WATER ZONES (depth):
11. DISINFECTION: Type" Amount
Wall Thickness
12. CASING: Depth Diameter or Weight/Ft. Material
a From To y�
From To Ft.
Froth To FL --
Material �M�ood
Depth , �
13. GROUT: TQ _Ft. Ao^ `P�
Method
Front s.L_— To
From To Ft.
14. SCREEN: DepthDiameter
Ft in.
From To
From To Ft. in.
15. SAND/GRAVEL PACK: Depth Size Material
From______To Ft.
From To Ft.
Agricultural 0
Topographic/Land setting
❑Ridge 0Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
ZS
(degreesn ,:^' •texisecond;)
Latitude/longitude source:❑GPSOTuY�graphic .v.p
(check box)
Dt�L r*'•'•ca tl-
pFPTii Formation Description
From To C-1
--0------------- 3p�.uT,I�
16. REMARKS:
I DO HEREBY CERTIFY THATTHIS WELL
THAT A COPY OF THIS S RECORD HASEEN PROVIDED TO T WELL OWNER
CONSTRUCTION STANDARDD�,AND � /
SIGNATURE OF PERSON CONSTRUCTING THE WELL ►ATE
, NC
Submit the original to the Division of Water Quality, Groundwater Section, I636 Mall Service Center - Raleigh,
27699.1636 Phone No. [phone], within 30 days. GW-1 REV. h
Slot Size Material
in.
in.
t O ATION�KFTCH _
Show direction and distance in miles from at -Tea -at
two State Roads or County Roads. Include the road __
numbers and common road names.
-o
W
N
CC)

280096
Topographic/Land setting
°Ridge °Slope flValley °Flat
(cheek appropriate box)
Latitude/longitude of well location
tdrpecs/mimnrstseearrtt)
Latitude/longitude sourcc:OOPSOTopographie map
(check box)
DEPTH ARILL)N1TLOr "r
From To Formation Description
LOCATION SKETCH
Show direction and distance in miles from at )eaq-- ..
two State Roads or County Roads. Include the road
numbers and common road names rG e `le ro SS
(�
?Cram /xlmonol Pe s i o-f
Parkne T Re,0 J1/4 7 p
/ /n,'l� jvr 9 //J on 5 h,'ners
Go. ot In/'1es %1nn
1Jeil o7 R rcyh T
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural es urces - Division of Water Quality - Groundwater Section
'YELL CONTRACTOR (INDIVIDUAL) NAME
//(print))I -320 4 cry ,lydN CERTIFICATION ^ �' d
W ELI. CONTRACFORCOMPANY NAME lr hA.ry/t /v Lr/r`// ,ir/)//:19 PHONE S f5-o4/79-9N,5-4/
STATE WELL COASTRUCT1ON PERMITS ASSOCIATED WO PERMITS
(if applicable) (if applicable)
I . WELL USE (Check Applicable Box): Residential Cz¢ iivlunicipalIPublic 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection ° Other 0 If Other, List Use
2. WELL LOCATION:
Nearest Town: NYv 1011 G/ 7"/ Counly S Cticuil n
Round( Tn /?A /
(Street Name. Numbers. Community. Subdivision. lot No.. lip Code)
3. OWNER: X)a Yr o// l% Prrao..r.S,' co
Address %)toe-nd Tap Rd,
(Street o Rome Nu.)
t3rySon c/'Ty /V.G a.97/1
Cny or Town State Zip Cot
(,5-24)- `�G9— .23/5'
Area made- Plume number
4. DATE DRILLED 9—/9-07
5. TOTAL DEPTH' 70
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO (g.
7. STATIC WATER LEVEL Below Top of Casing: 0 FT.
(Use "+' if Above Top ofCasing)
8. TOP OF CASING IS / FT. Above Land Surface*
`Top aiming trrmtmtrd afar below land surface requires a
nrianet in accordance RIM ISA NCAC 2C .011S.
9. YIELD (gpm): rt METHOD OF TEST ad r
10. WATER ZONES (depth): D
11. DISINFECTION. Type /1 %hi Amount 0
12. CASING: Wall Thidmcss
Depth Diameter or weighb'Ft. Material
From__ To 91-5 rt.(4_ 6I)YbZ/ P1/G
From To Ft.
From To FL _
13. GROUT: Depth Material
From 6 To 0.O Ft. 6&men
From To Ft.
Method
14. SCREEN: Depth Diameter Slol Size Material
From To Ft. in. in.
From Tn Ft. in in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
16 REMARKS' 60ei/ 7-0 he ^/y/iYD YGtGjvrr°
O
1 DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH I SA NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNE W
SA, Go
/4,15h G jo
SIGNATURE OPPERSONCONSfRUCTING THE WELL DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center- Raleigh, NC
27699-1636 Phone No. (919) 733-32Zt, within 30 days. GW-) REV. D7/2001
/1,
/0 /

280095
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural R urces - Division of Water Quality - Groundwater Section
%YELL CONTRACTOR (L`iDI VIDUAL) NAME (print)
r3P--F I'y yAe
tt ,
WELL. CONTRACTOR COMPANY NAME %r Yo. h/Am .i2e/( rnr/ )i l h
STATE WELL CONSTRUCTION PEIWtIT# ASSOCIATED WO PERMITH
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential ® Municipal/Public ❑ Industrial 0 Agricultural 0
Monitoring ❑ Recovery 13 Heat Pump Water Injection ❑ Other 0 IPOther, List Use
CERTIFICATON e A052/
PHONE 4 (t24 N79-srr-lSy-
2. WELL LOCATION:
N restTown: flry:5 n C/T` County t5Loa( n
PenTand. 1akp f672CT 24-7/3
(Street Name. Numbers. Community, Subdivision, Lot No.. Zip Code)
3. OWNER: r.13r.etY) l✓,/G&MC
Address on lake f5TTeS
(Street or Route Nu.)
l3ryson c/Ty IV,C 25'7/3
City or Towy, State r� Zip Code
(7Cf — 74-/ ` 9 9 a
Area nde- Phone number
4. DATE DRILLED 9 -/S- O 3
5. TOTAL DEPTH: .r) 0
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO 2
7. STATIC WATER LEVEL Below Top ofCasiny: Sri ET.
(Use "+' if Above Top of Casing)
S. TOP OF CASING IS I FT. Above Land Surface*
`Top of costae ierminatcd at/or below land surface requires a
variants in accordance Rita 15A NCAC 2C .0115.
9. YIELD (gpm): 020 METHOD OF TEST o-J f
ID. WATER ZONES (depth); 11a3
11. DISINFECTION. Type ItTN Amount 0.76
12. CASING: Wall Thickness
Depth Diameter or Weight/FL Materiel
From O To /Ott Et._2 _ 60(2.1 PVO-
From To Ft.
From_._ To
13. GROUT: Depth
From 6 To 2.6
From To Ft.
14. SCREEN: Depth
From To
FL
Material
Ft. Comenj
Method
PL. vn pi`r
Diameter Slim Size Material
Ft. in. in.
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Size Material
To Ft.
To Ft
FromFrom
Topographic/Land setting
❑Ridge ❑Slopc °Valley ❑Flat
(check memoriam box)
Latitude/longitude of well location
(depees/mitwru/suonds)
Latitudcllongi ludo sourcc:OOPS°Topegraphic map
ernectiro) (--
DEPTH pRILI •ING �O('t : t ,
From To Formation Dcstripti t= L"-n'.
LOCATION SKETCH I -
_----_`�
Show direction and distance in miles from at least
two Slate Roads or County Roads. Include the road
numbers and common road names.
�raf� rtiln�anct p05 T O IL-P.'Ge %urn
/p4T on a 5, Go Ivy m,116's
turn / Ton 74/E, G-o
iar C 5Tar,
%ern %�T °t�' °' L�%�� l��T
6-0- 3 , i /rl,YeS Tn 14/� ott-- ,
16 REMARKS..
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH ISA NCAC 2C, WELL ca
CONSTRUCTION STANDARDS, AND THATA COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
rry }1yiP 9-/5-03
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
1
Q1
a
(-�
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

280094
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural sources - Divisiirn of Water Quality - Groundwater Section
WELL COYTRACTOR (LNDIVIDUAL) NAME (print)1 ',LotITC'r> 1-/)/t. F� CERTIFICATIr1N/dl%SD
WELL CONTRACTOR COMPANY NAME 6- ra. n G rh L�f'/%/ d.rirl/1001, PHONE tt Kraii79-seiis- 1
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ ?Sabin-8
Of applicable) (if applicable)
I. WELL USE (Check Applicable Box): Residential 2 Municipal/Public 0 Indusinal 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION:
N£arcstTown: 13Yy50 Gin ),county 5Y1
nn7ctnn /u N f 722D „2S'7/.3
(Street Name. Numbers. Community. Subdivision, tnt No., Zip Codel
J. OWNER: (, kC hec rA L\ bdO/b.. r
Address nn72nA /akp E5TaTeS
(Sven w Rome No.)
ryy 5on C.'Ty N.t AS'7/3
Cny priors: SubsZip Codc
V 7)- 5 &7 -1 /it/ -40
Area rade- Phone number
4. DATE DRILLED 9-%a- 03
5. TOTAL DEPTH: (., 5 C
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO la
7. STATIC WATER LEVEL Below Top of Casing: /S-,i FT.
(Use "e` if Above Top or Casntg)
S. TOP OF CASING IS / FT. Above Land Surface*
`Tap of casting terminated suer below lend surface regains a
verlanre in accord Etna MO ISA NCAC 2C .0118.
9. YIELD (gpm): /'-1 METHOD OF TEST (1.. i r
10. WATER ZONES (depth): .5-4 6
Topographic/Land setting
❑Ridge ❑Slope ❑Valley ❑Flat
(check appmptiam bait)
Latitude/longitude of well location
(drprestmorutcstsecwtth)
Latitude/longitude soarce:00PS❑Topographic map
(cheek box) 1
DEPTH pRILLIN(} Lori - .
From To Formation DcsMtiption
11. DISINFECTION. Type it TN Arnount 0.96
12. CASING: Wall Thidmess
Depth Diameter or Weight/FL Material
From_ (1— To 76 rtia.ii—
From To Ft.
SDr pvc
Fcom To FL _
IT. GROUT: Depth Material
From () To 0.0 Ft. Lr'Wt,YtT
From To Ft.
14. SCREEN: Depth Diameter Slot Size
From To Ft. in. in.
From Tn Ft. in. in.
IS. SAND/GRAVEL PACK:
Depth Size MNerial
From To Ft.
From To FI.
LOCATION SJCETCH t -- —
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and
d common road names.
-Pw37 a.lmdl4d Pas? 0 ,�� Turn
le T on S. Go /.fr ri,'lrS %inn
MP Me /Z-J-PT on 749 6-o a,3 j9/// /&rn
/e-1T on it t7tne( lake £S74%5 G-o
Material
3 ii,'les Ie/rn Riehr—.PPci"`h,'
Gvay 11)//es 72 n ±T Co
G,l m;/P 7o Well on Je, of
16 REM ARILS:
T z
—1 c
p m�
ITT
i DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH ISA NCAC 2C, WELL -• m "'
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELLOWNE Chi.) -1
SIGNATURE OF I
MytAP ON CONSTRUCTING THE WELL DAT03 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. (17/2001

280093
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural j[%%
WELL CONTRACTOR (INDIVIDUAL) NAME (print) e P y
6-rah
WELL CONTRACTOR COMPANY NAME
STATE WELL CONSTRUCTION PERM ITN
(if applicable)
^1%eesources - Division of Water Quality - Groundwater Section
'1�-(- r A6' CERTIFICATION zo5e
Wf // A r t l i,'Ng PHONE N f n4 4/79—A'445
ASSOCIATED WQ PERM ITN
(if applicable)
I. WELL USE (Check Applicable Box): Residential 0 Municipal/Public 0 Industrial ❑ Agricultural ❑
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use
2. WELL LOCATION:
Nearest Town: .fir y.S6 n C i Ty County S L✓nj
#&kJ 7`I /3r y s- n C , Y�i Eir7/
(Street Nine. Numbers. Commodity, Subdivision, Lot o.. Zip Code)
3. OWNER: tiLFIA cL ' Lk; l''1,'4
Address //e,; y 7'� / /3 r y is-r! C Ty
(Street or Route o.)
73r\/tan (-fry rv--. 'o�ir7/3
Cd'y or Town State Zip Code
(Ss2.)- tree —fit; 33
Area code- Phone number
4. DATE DRILLED 9-//- O 3
5. TOTAL DEPTH: 70.E
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO fa
7. STATIC WATER LEVEL Below Top of Casing: /9C FT.
(Use "+" if Above Top or Casing)
8. TOP OF CASING 1S / FT. Above Land Surface'
*Top of casing terminated at/or below bad rurface requires a
variance In accordance with ISA NCAC 2C .0118.
9. YIELD (gpm): / METHOD OF TEST Cx i r
10. WATER ZONES (depth): 5/0
I I. DISINFECTION: Type // r // Amount /7. 9i
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
From 0 To Si?' Ft. f SO 21 PVL
From To Ft.
From To Ft.
13. GROUT: Depth Material Method
From O To 20 Ft. eemenj Pvmpr'42
From To Ft.
14. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft
From To Ft.
16. REMARKS:
Topographic/Land setting
❑Ridge ❑Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH �RILL�NCr-L,9Cs-----
From To Formation;Descriptio(r—
t, L—
LOCATION SKETCH I
Show direction and distance in miles fr- - -
two State Roads or County Roads. Include the road
numbers and common road names.
Prom alIna n� /�&ST o P>", oe 72 r/l
/p,'T eYl gg-,S Go
zrn /€ t[on 7'ie, Gm Ir ill'INS
Trh R, hT 6-O, U.� �,'� ? /orfl
f/h 7 r,/ell v n
t71 �r
rn
O n7
t;A
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
ry
SIGNATURE OF PERSON CONSULTING THE WELL DATE 0 3
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mall Service Center- Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-1 REV. 07/2001

WELL CONSTRUCTION RECORD
280092
North Carolina - Department of Environment and Natura
Iesources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) Er y #ey� ao CERTIFICATION # 2052
WELL CONTRACTOR COMPANY NAME rr VdCAA Jii L✓f'// GC r/ /l/YIL) PHONE # (i91/79—S'15Q'
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
I. WELL USE (Check Applicable Box): Residential S 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 T99wn:.3ry.Son C/Ty County Stoo Y1
,rPFA/o if Rd a2sS 7/1
(Street Name. Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: c/ie/✓fSP
Address /lreoer Inve /1d
(Street or Route No.)
Bry.San Cry IV•O-
a�7/3
f Zip Code
ity or Town State
(V__a)-'/fl - 2 577
Arca code. Phonc number
4. DATE DRILLED 9—sr—n 3
5. TOTAL DEPTH: 33e
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO a
7. STATIC WATER LEVEL Below Top of Casing: 1710 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING 1S / FT. Above Land Surfaces
'Top of casing terminated at/or below land surface requires a
variance in accordance with 15A NCAC 1C .0118.
9. YIELD (gpm): 2 METHOD OF TEST RI r
10. WATER ZONES (depth): 29e
I I. DISINFECTION: Type HT 71 Amount O. 0-
Wall Thickness
Depth Diameter or Weight/Ft. Material
From O To 97 Ft. I . St)r AI PVG
12. CASING:
From To Ft.
From To Ft.
13. GROUT: Depth
From ci To rao Ft.
From To Ft.
14. SCREEN: Depth Diameter
From To Ft. in.
From To Ft. in.
15. SAND/GRAVEL PACK:
Depth Size
From To Ft.
From To Ft.
16. REMARKS:
Material
Ce Men7
Slot Size
in.
in.
Material
Topographic/Land setting
❑Ridge ❑Slope OValley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH DRILLING -Loa___
From To Formation Descriptiofi---
/
LOCATION SKETCH 1
Show direction and distance in miles I4ernat-leasi J
two State Roads or County Roads. Include the road
numbers and common road names.
-V,umc,,,)mano( Po67o 'te 72:1-n /FT
nn 66o /.flyr7,'lr>S 'Torn
//d roil
Method 7y5 6-0 S. mJe$ Tu/1
/^n 04/7 ea-
r vmPiney bAir (off elo-rkeiices To $ToPS•at/75
Material MOThT°N Hwy /9, l^DnnzHie,S
/vrn R,,hT an l'/(r54es .5rrral`k;=T�T'Cr, D.(S�
Nees �,rn fe7� tln /J0- 4;ve ICC�
6-6 . C).3 rrn,/e5 &' // c
n1
c-s
A3 o
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY
��O/FF THIS RECORD HAS BEEN PROVIDED TOT THE WELL OWNER
fte
P
SIGNATURE F PERSON CONSTRUCTING THE WELL 7 DATE 3
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center- Raleigh, NC
27699-1636 Phonc No. [phone], within 30 days. GW-1 REV. 07/2001

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Nettled Resources - DitJvision of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) 3?-1- ery �%yme CERTIFICATION#%�ASQ
G]�. PHONE # JSf1il �77--914154
WELL CONTRACTOR COMPANY NAME
6-ratiarvr IAA -II rt'1I ;
280091
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
I. WELL USE (Check Applicable Box): Residential IS 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: /ry.SOf C' 7y County 5'we_ i /7
-�nnretAA lake S,7a7P.5 e9S7/.3
(Street Name. Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: A.A.'/ KPl/
Address -=unTtho /akp tsr47-es
(Street or Route No.)
Bryson Cry MC- a.S-7/3
City or Town State Zip Code
Qt93( )- L/g --/D70
Area code- Phone number
4. DATE DRILLED 15." 6 3
5. TOTAL DEPTH: 70,E
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO 131
7. STATIC WATER LEVEL Below Top of Casing: 0 FT.
(Use "+" if Above Top of Cuing)
8. TOP OF CASING IS / FT. Above Land Surfaces
*Top of casing terminated at/or below land surface requires a
variance In accordance with 15A NCAC 2C .0118.
9. YIELD (gpm): h METHOD OF TEST 0.1r
10. WATER ZONES (depth): 0
11. DISINFECTION: Type %/ % f/ Amount 0
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
From m To /OA Ft. 6.1 Sn!'.21 PUG
From To Ft.
From To Ft.
13. GROUT: Depth Material r1 Method
From el To aO Ft. %Pmen'T Putni N1
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
To
From Ft.
From Ft. ' / r
16. REMARKS: i✓e// 7;;)b e !T yc)lY[) ?
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH I 5A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
Topographic/Land setting
❑Ridge ❑Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box) f .
DEPTH DRILLINQ LOG j S,
From To Formation De9efiption -- '--- —.,
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers ann on rad names.
Tcommon
vnctOST O
t r'c e rver4
t co S.S Go /,ss miles %urvl
1= (o A.3 mile S �,rn
an 7�t. — s7r't �S 6-0/P Ton Pomona /akP�noclC7r
tf,l./ Wies Tvrn R,��9 K '17oN
b/e). -F float\ G-o a.l lyl. S c
1 0=
e
SIGNATUR OF PER ON CONSTRUCTING THE WELL DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center- Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-I REV. 07/2001

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural(��Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAM/Er (print) •DiJ/1 /1� e Cr .ewv P CERTIFICATION ISO, /
WELL CONTRACTOR COMPANY NAME J �F1/1C f� x b Y -e `/ c J`r. l /. A -JNc-. PHONE # er21,t3 <7.9J-49
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential -Er Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATIQN:
est Town:_A�
(Street Name, Number, Community, Subdivision, Lot No., Zip Code)
3. OWNER: (1 'S
Address Pb t)C_ )2 3
County SCJ,4'id
(Sweet or Rome No.)
Sup( „ (/Tr at LI
City or Town State Zip Code
L)-
Area code Phone number
4. DATE DRILLED O / - 03
5. TOTAL DEPTH:
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO 0
7. STATIC WATER LEVEL Below Top of Casing: Ff.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS / FT. Above Land Surface*
'Top of cuing terminated at/or below land surface requires a
variance In accordance with ISA NCAC 2C .0118.
9. YIELD (gpm): 2 d METHOD OF TEST air.
10. WATER ZONES (depth):
11. DISINFECTION: Type
12. CASING:
Depth Diameter
From0To 7V Ft. G%v
From To Ft.
From To Ft.
13. GROUT: Depth
From O To 0 Ft.
From To Ft.
14. SCREEN: Depth Diameter
From______ To Ft. in.
From To Ft. in.
15. SAND/GRAVEL PACK:
Depth Size Material
Amount
Wall Thickness
or Weight/Ft. Material
L
Topographic/Land setting
❑Ridge ❑Slope ❑Valley OFI
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topogra
(chock box)
DEPTH
From To
to ,y_ o C
Material Method
C/0/4,. - paw., 7
Slot Size Material
in.
in.
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.
16. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15ANCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-1 REV. 07/2001

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources- Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME
r (print) C:e i94/C. CERTIFICATION # -7d7-9
frr
WELL CONTRACTOR COMPANY NAME (� I'y5. G</9Ia < t J/L PHONE # ire",-"2‘
STATE WELL CONSTRUCTION PERMIT# _ASSOCIATED WQ PERMIT#
(if applicable) (if applicable) f--_
um ti
1. WELL USE (Check Applicable Box): Residential-C Municipal/Public 0 Industrial 0 Agricultural ❑
Monitoring ❑ Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION:
Nearest Town: C1R1 County SWWik
OP toe le
(Street Name:Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: (Vyl 51110,i/
Address \ 1't-, i C✓eel
(stye t orRoute No.)
w r$DA) City Alt Or 2/3
City 6r Town State Zip Code
Area code- Phone number
4. DATE DRILLED //- �
5. TOTAL DEPTH: S/°S
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO 0
7. STATIC WATER. LEVEL Below Top of Casing: c FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS / FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordance with ISA NCAC 2C .0118.
9. YIELD (gpm): / 1) METHOD OF TEST 1, Y
10. WATER ZONES (depth):
11. DISINFECTION: Type Amount
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft Material
From6To /re Ft. &7Y tdG
From To Ft.
From To Ft.
13. GROUT: Depth Material Meth«}
From b To a-0 Ft. cent n-* ii>vriNy
From To Ft. /
14. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in.
From. To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
16. REMARKS:
r_�
rn
m0
Topographic/Land setting ; T.
❑Ridge ❑Slope 0Valley ❑Flab
(check appropriate box)'„
Latitude/longitude of well location
-i
ri 0
(degre&minutealsaaoods)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH DRILLING LOQ
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 15ANCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WET T OWNER
—a3
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-1 REV. 07/2001
r-n
C)
tirrj
Erri
Jt

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print)/ Uc.5et 1 Ivr t� CERTIFICATION#02/.�j
7
WELL CONTRACTOR COMPANY NAME IA �rreen e_ + )rros.w /) �JI t�I=J�
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
279531
PHONE # f )
I. WELL USE (Check Applicable Box): Residential V Municipal/Public ❑ Industrial ❑ Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCAT N:
Nearest Town: Y` n7) L( County S1.0 Q 1
lea I d N htii bms,t—)(hetre,,,, k,)
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
� C��� p� 3. OWNER: ILC.CIq�)'v /�
Address 2 O- -i-'�a nit)-(12-0 C-p' # f 7 f
r Rou"1-te1
No.) oz d
l/` City or Town State Zip Code
( 7nF SOS - 75/ —
Area code- Phone number
4. DATE DRILLED y - .z/ - O 3
5. TOTAL DEPTH: 350
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO Ni
7. STATIC WATER LEVEL. Below Top of Casing: / 0 FT.
/ (Use "+" if Abase Top of Casing)
8. TOP OF CASING IS 1 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): O METHOD OF TEST f-tl een
10. WATER ZONES (depth): l8'0
0
11. DISINFECTION: Type f+ %i
12. CASING:
Depth Diameter
From 6 To 33 Ft. (01/1
From To Ft.
From To Ft.
13. GROUT. Depth Material Method
From V Tom_ 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.
Arnount IS:7C ti 1
Wall Thickness
or Weight/Ft. Material
`.wai OOc
Topographic/Land setting
❑Ridge jH$lope ❑Valley ['Fiat
.'1-.. (check appropriate box)
Latitude/longitude of well location'
7/11
(degrees/minutes,/seconds) • -
Latitude/longitude source:OGPSOTopogiaph c
(check box)
DEPTH DRILL!
From To
c�—,�
— I Ka
rQq.s- -3oo
3cV —3or
30 -Rot_
— 301 -.35-3
Formation Description
Ca i
en
LOCATION SKETCH rn -a-
Show direction and distance in miles fro/kV lenttD
o
two State Roads or County Roads. Includahe r&a
numbers and common road names. o
$ rn
r7
-4
0
l zt ;� sr PPS/0
fe, sR%)7 J71 n
e -S-L7 c �C
u_i_rta U1 do tDU
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
Ctla7 SIGN URE OF, 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
LJ

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section h
D CERTIFICATION #367/
w'ELI.CON"r CONTRACTOR (INDIVIDUAL) NAME (print) `��iJi--n��n/9 %e't e�-t�'/4�✓Ir ('��'Sd�'/��
%VELL. CONTRACTOR CONIPANY NAN1EetAi1G. `(]Y'r�$, L/Jet/ "�" I i%/U H r - 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 0 Other ❑ If Other, List Use
2. WELL LOCATION: �,�
Ja-kk_Sm y County i¢,jl
NIw4.l A)4441}4
(Street Name. Numbers, Commdnnity, Subdivision, Lot No., Zip Code)
3. OWNER: �// 8��✓
Address y 0 ,dr/4,
����� (Street or Route No.)
el A)C- &Y?oa.
C y or Town State Zip Code
Nearest Town:
( )-
Area code- Phone number
4. DATE DRILLED %-//- "0 3
5. TOTAL DEPTH: %'a f�
6. DOES WELL REPLACE EXISTING WELL? YES ❑NO ®'
7. STATIC WATER LEVEL Below Top of Casing: ` FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS / FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordance with I5A NCAC 2C .0118.
9. YIELD (gpm): .2-0 METHOD OF TEST Zt--
10. WATER ZONES (depth):
27.9618
Topographic/Land setting
DRidge ❑Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From Too Formation Description
-
175- Jog- fc frL
11. DISINFECTION: Type Amount
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
From 0 To 15- Ft. to lY pUc
From To Ft.
From To Ft.
13. GROUT: Depth Material
From %) To _ Ft. COrn-dA,
From To Ft.
14. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in.
From To Ft. in. it.
15. SAND/GRAVEL PACK:
Depth Size y Material
Method
d+,t
jag
From To Ft.
From To Ft.
I6.REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL 1 -.'
CONST UCTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
fi ► I t1
DATE
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
o
CO
CO a�
m O
ern
tV SE
CJI E rrn
rn
-40 'r,
m�
SIGNATURE
Submit the original to the Division of Watei n ity,§1pund\7IterL SeCtiol
•
27699-1636 Phone No. [phone], within 3 a
Mail Service Center - Ralei0, NC
GW-I REV..07/2001
GBnUNEJWATER,SECTION
,S1-SVILLE PESIGi:AL OFFICE

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Nah al Resources - Division of Water Quality - Groundwater Secti0"
WELL CONTRACTOR (INDIVIDUAL) NAME (print) CERTIFICATION M
,
WELL CONTRACTOR COMPANY NAME PHONE N SSOCIATED WQ PERMIT#
fif applicable)
STATE WELL CONSTRUCTION PERMIT#
(if applicable)
1. WELL USE (Check Applicable Box): Residential 8/Municipa1/Public 0 Industrial 0 Agricultural 0
Monitoring ❑ Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
Topographic/Land setting
❑Ridge ❑Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location .
N35`;29 nz ��“i 0 13 `;Z/ 22.y
j OS l (degreeahninuteJseconds)
Latitude/longitude somr:c:OriPSG T op0r,.aphtc map
(check box)
�a nf0
1 f V ,2:
2. WELL LOCATION:: S c cc,�
Nearest Town: C� ± c_t _ County
4.
ennivictnn, Lot r o.. hip Code)
(Street Name, NwuLars, Cs-^'':ri..;, _,
3. OWNER 6z/1ethe eve«02de: r B g417-
Address
final 'Qoff�01'l.:r
(Street or Route No.)
., City or Town State
Area Phone number", �a Z
4. DATE DRILLED
5. TOTAL DEPTH: 34,
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO
7. STATIC WATER LEVEL Below tTop o ifCasing op of Casing)0Ff.
8. TOP OF CASING IS FT. Above Land Surface'
*Top of casing terminated atior below land surface requires a
variance In accordance with 1SA NCAC 2C .0118.
9. YIELD (gpm): METHOD OF TEST %
10. WATER ZONES (depth): .210
Amount
11. DISINFECTION: Type T -- 12. CASING: Wall Thickness
Diameter or Weight/Ft. Material/vc,
D_ _o Ftc• Zs' soz/
rani I
Zip Code
From+ To /f1� Sf e e /
FromT off.-- Ft. 6. ;2 s'
From To Ft.
atenal
13. GROUT: Depth ethod
/v,sS:<-C
From -To 3 Ft. Oilc�4q� .,
From ? Tom - Ft. b't/_ o - j -
14. SCREEN: Depth Diameter Slot Size Material
From
To Ftin. in.
in.
From
To Ft. in.
15. SAND/GRAVEL PACK: ;
DepthSize Material
From To Ft. From To Ft. - --- —
Frop TH
To
ztiC
YS"-'-r00
16. REMARKS:
1 DO HEREBY CERTIFY THAT THiS WELL WAS CONSTRUCTED IN ACCORDANCE WiTH 15A NCAC 2C, WELL
__
--
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO HE WELf, OWNS
)1.0-' '¢ec� DATE
SIGNATURE OF PERSON CONSTRUCTING THE WELL
nt •einn GW-1 REV. NC
Submit the original to ilia ..::.-__-- of Water Quality, Groundwater Section; t 63¢ Moil S?^4c• Center - Raleigh, NC
27699-1636 Phone No. [phone], within 30 days.
nail f TNG LOG
Formation Description
Gjuq. t-c
) & ATION SKETQI
Show direction and distance in miles f atgast
two State Roads or County Roads. ince th eInad
numbers and common road names. .. cm
w
zr i (=7_i
r.c
Fri

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
�iivy L%C6 N. %jjqo
CERTIFICATION IY '2
WELL CONTRACTOR (INDIVIDUAL) NAME (print) / ' 8 r' y y
l llnn
WELL CONTRACTOR COMPANY NAME -//er NelDr ; PHONE sSSOCTAT ED Q ratryi v
.(l GN�II 11e
if applicable)
STATE WELL CONSTRIICTION i—iiiiviva
lammos(if applicable)
1. WELL USE (Check Applicable Box): Residential Er-Municipal/Public 0 Industrial u A_Ericultms: El_
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
279219
2. WELL LOCATION: C'.tL_ County Su u /!
Nearest Town:, 6`1
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
SJ� FLa.Ana.b5
City or Town
Area code- Pbone number
4. DATE DRILLED 02
5. TOTAL DEPTH: 2
90
6. DOES WELL REPLACE EXISTING WELL? YES ❑ONO 191
7. STATIC WATER LEVEL Below(Use
U Top of " if Top of Casing)
8. TOP OF CASING IS / FT. Above Land Surfaces
*Top of casing terminated at/or below land surface requires a
variance In accordance with 15A NCAC 2C .0118.
9. YIELD (gpm): 7 METHOD OF TEST /%�—
10. WATER ZONES (depth): .265"
YL}�
11. DISINFECTION: Type r H — W Thickness
12. CASING:
Depth Diameter or Weight/Ft. Material
p D To Ft. 6-,2c SSlaty/'Jc I
9
State Zip Code
Tom
From To !!/ Ft. 6-25' 'at
From To FL
13. GROUT: DepthMaterial
From J2___.To , Ft. �orf"—
Ft. Lien tt ' fe
From_ _ To _ Diameter Slot Size
Ft.
Ft. in. in.
Material
14. SCREEN: Depth
From______ To
From_ To
15. SAND/GRAVEL PACK:
Depth
From To
From _To_____
Ft
Ft
Size
ethod
/2SJyiG
Material
Anal
Topographic/Land setting
❑Ridge ['Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location ,
N3i°26'22.2" W oR?`2,f '51-ri
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DRILLllSCQI.OG
Formation Description
DEPTH
From To
6o- /oo
/Oo „leo
—
Al/4 rrt-
r is t0N SKETCH o cl L J
Show direction and distance in miles �"
two State Roads or County Roads. Mali e t1Pad
al
numbers and common road names. —0
m
� o
m`
o
m
NZ
m7a
0
16. REMARKS:
1 DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH i5ANCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
GNATURE OF PERSON CONSTRUCTING THEWELL DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Ceenterl RRaleigh, C01
27699-1636 Phone No. [phone], within 30 days.

WELL CONTRACTOR COMPANY N.4AIE
STATE WELL CONSTRUCTION PERMIT#
(if applicable)
278993
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and N
val Resourcesou- Division of Water Quality - Groundwater Section
VYELL CO,ATIL\CI OR (INDIVIDUAL) NAME (print)_ /TZ/'� ( ��G D��
-J i CERTIFICATIO.N'i!�// p
�Ll%xi VJ j- PHONE # 1 �72j-'t
ASSOCIATED \YQ PERMIT#
(if applicable)
I. WELI. USE (Check Applicable Box): Residential 8' Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection ❑ Other ❑ If Other, List Use
2. WELL. LOCATI
Nearest Town:
(St
01 GU (Zt
Numbers, Con
3. OWNER:
Address
County �[j�QGvn)
unity, Subdivision, Lot No., Zip Code)
Cify or Torsn j5te
( e tet.
Area code- Piton m nber
4. DATE DRILLED 7 d
5. TOTAI, DEPTH: y3 6
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO 0
7. STATIC WATER LEVEL Below Top of Casing: SO' FT.
(Use `+" if Above Top of Casing)
8. TOP OF CASING IS / FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordance with 15A NCAC 2C .0118.
9. YIELD (gpm): pJ j METHOD OF TEST
10. WATER ZONES (depth):
Zip Code
Topographic/Land setting
❑Ridge ❑Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/m inures/seconds)
Latitude/longitude source:❑GPS❑Topoe raphic map
(check box)
DEPTH DRILLING LOG
From 'to Formation Description
oTh - f3c
1 I. DISINFECTION: Type Amount
12. CASING: Wall Thickness
Depth i Diameter orAA'ci eht'Ft. Material
From O To YU Ft. (' i2 Q ULi
From To Ft. /
From To Ft.
13. GROUT: Depth Material Method
From 0 To (a 0 Ft. Ly"yyti-id
From To Ft.
14. SCREEN: Depth Diameter Slot Size Material
From To Pt. in. in.
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Size , Material
From To Ft.
From To Ft.
16. REMARKS:
0
O 0
vC
LOCATION SKETCH C Show direction and distance in miles froth leas -
two State Roads or County Roads. Include -he rof4
numbers and common road names. Gt1 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
O
W
p
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. 07/200i "
0
0
r'
r

WELL CONSTRUCTION RECORD 278990
North Carolina - Department of Environment an Natural Resources
- Division of Water Quality - Groundwater Section
w'EI.1. CONTRACTOR (INDIVIDUAL) NAME
(EriintC� A4 P U ��ie_ CERTIFICAATTI{OON 3CF-7/
‘YELL CONT R.\CTO12 COMPANY NAME V ��"� . PHONE # �}er7/6 2 }���b
Sl ATE \YELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residentialk Municipal/Public ❑ Industrial 0 Agricultural 0
Monitoring 0 Recovery D Heat Pump Water Injection 0 Other ❑ If Other, List Use
2. WELL LOCATIO :
Nearest Town- County
liner
&4t2A
(StrNumbers, Community, Subdivision. Lot No.. Zip Code)
Topographic/Land setting
❑Ridge ❑Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
3. OWNER: tn. j/—G[/vI�-ai �� ��}fl.6., (degrees/minutes/seconds)
Address ( QC� / � e�14 �j`i✓atttu e/longitude source:❑GPS❑Topographic map
trect or Rout._ No) (chuck box/
DRILLING LOG
Formation Description
6 r Sps P. Af c_ a 8'7 /3
DEPTH
Cit,;u Town / Sta g ZiCode From To
Area code- Phone number
4. DATE DRILLED 2—/5----03
5.TOTAL DEPTH: S 6
6. DOES WELL REPLACE EXISTING WELL? YES D NO 0
7. STATIC WATER LEVEL Below Top of Casing: 4/0 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS / FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordance with 15A NCAC 2C .0118.
9. YIELD (pm): 70f METHOD OF TEST &!�
10. WATER ZONES (depth):
I L DISINFECTION: Type Amount
12. CASING: Wall Thickness
Depth°- Dia etc or Weight/Ft. Material
From C.)To 6 4, Ft. //
From To Ft.
From To Ft.
13. GROUT: Depth Material Method
From D To_a_ 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 Material
From To
From to
I6. REMARKS:
Size
Ft.
Ft.
0
CIw
—121 rCS
t_t
rTi
LOCATION SKETCH m�
0
Show direction and distance in miles Bol leastFr„
two State Roads or County Roads. Includ&te ro w
numbers and common road names.
c a
ci
0
CO
0
C_
c F'^----
I DO HEREBY CERTIFY TFIAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITFI ISA NCAC 2C, WELL
CON RUCTION STANDARDS. HAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
/1\//lrin%!�-G� SIGNATURE OF PERSON CONSTRUCTING THE WELL
DATEO-3
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center- Raleigh lac___.__...
27699-1636 Phone No. [phone], within 30 days. GW-1 REV. 07/2001

280'747
WELL CONSTRUCTION RECORD
North Caroline. - Department of Environment and Natural Resources - Division of Water Quality
WELL CONTRACTOR (INDIVIDUAL) NAME (print) Jaynes B. Brown
R ELL CONTRACTOR COMPANY NAME Redden Brothers Well Drilling, Inc
Groundwater Section
CERTIFICATION ? 2045
PHONE # ( 828 369-9591
STATE WELL CONSTRUCTION PERMIT= ASSOCIATED RQ PERMIT=
(if applicable) (if applicable)
I. WELL USE (Check Applicable Box): Residential E Nlunicipa'YPu'bllc ❑ Ind,.>..ial 0 Anricu'.tura' 0
Ntonimring ❑ Recovery 0 Heat Pump Water Injection ❑ Other 0 If Other, List Use
2. WELL LOCATION:
Nearest Town• Bryson City County Swain
Hughes Br -Shook RD-Jenkins Br -West Jenkins Br
(Street Name. N'.unbers, Convn un ity, Subdbison, Lot No., Zip Code)
3. OWNER: Roger Clapp
Address 835 Main Strr�et
(Street or Route No.)
Bryson City, NC 28713
City er To'.^. State Zip Cottle
(828 )- 488-8413
Area cod:- PI•,one cumber
4, DATE DRILLED 10-10-03
5.TOTAL DEPTH: 300'
6. DOES WELL REPLACE EXISTING WELL? YES 0 NOx
7. STATIC WATER LEVEL Below Top of Casino: 250 FT.
(Use "-" if Above Top of Casing)
5, T0? OF CASING IS 2 FT. Above Land Surface'
•Top of rasing terminated at'or below land surface requires a
variance in accordance svlth ISA NCAC 2C .0118,
9. YIELD (epm): 20 NIETHOD OF TEST blow
10 WATER ZONES (depth): 115' & 240'
i, DISINFECTION: Type H T H
12. CASING:
Depth Diameter
From 0 To 91 Ft. 6"
From To Ft.
From To Ft.
13. GROUT: Depth
From 0 To
From To
14. SCREEN: Depth
From To
From To
15. SAND "GRAVEL PACK:
Depth
From To
From To
Amount 16 cz
Wali Thickness
or1':eip t'Ft. Ma, a.
.188 steel
Nta:eriai btz:hoc
20 Ftbe-mite & (I:Art1. [urtxl
Ft.
Diameter Slot Size Material
Ft. in. in.
Ft. in. in.
16. REMARKS:
Ft.
F.
Size Ntater:zl
Topographic`Land setting
❑Ridge 0Slope ❑Valley ❑Fiat
(cheek appropriate box)
Latitude longitude of well location
Latitude.'loneitu
DEPTH
From To
0 89'
89' 300'
seconds,
source.❑GPS ❑Tcpa_rap'nr ma
eye ok box)
DRILLU CLOG
Formation Description
clay & sane
_granite
LOCATION SKETCH
Show direction and distance in miles fro:. at least
two State Roads or County Roads. Include the road
numbers and common road names.
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH ISA NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND —HAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL 0\\NER
p-03
NATURE OF PERSON CONSTRUCTING THE WELL DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Nlail Service Center - Raleigh. NC
27699-1636 Phony No. [phone], within 30 days. GAV'-I REV. 07 2001

North Carolina - Department of Environment and Natvl
WELL CONTRACTOR (INDIVIDUAL) NAME LpthO de
ra.6in
WF.LI. CONTRACTOR COMPANY NAME
STATE WELL CONSTRUCTION PEI4NITP
(tf applicable)
WELL CONSTRUCTION RECORD
281267
-DP Water Quality - Groundwater Section
ter Division
RT
kilt
/ cainte/mon a 2L�0
C✓P // Art /t'l PHONE i rr li .9_z 4,.54/
setnCUTED WQ PERMIT/ -�
(irunlinhle
I. WELL USE (Cheek Applicable Box): Residential RI MunicipaVPublic CI Industnal 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water injection Other if Other, List Use
2. WELL LOCATION:
Nearest Town: Br Srn C.'Ty County cS/ ✓ /n
-TQ.,Tann IA KP FSTeNres g7/1
tsueet Name, Nimbus. ComtmMay. smmYiuoti tm Hai. as Cod:)
3. OWNER: EqC4r I7 Rolle& �y
Address OnTenn late es 7.,./PS
(aunt at RUM Pb.)
a3r�r.san CityMC, 7/3
ityc ame /Sum2apCo&
`jRS—/DID
Ana ma. Pinot namaer
4. DATE DRILLED //-iy-o3
5. TOTAL DEPTH- 6E1,5
6. DOES WELL. REPLACE EXISTING WELL? YES O NO VI
7. STATIC WATER LEVEL Below Top of Casing:
(User if Atom Tos RfCntn&
S. TOP OF CASING 1S 1 FT. Above Lend Surfaces
flop etsad•e termini*/ ttlar Win tend suttee regains •
vtrtrnee In arcarotnee rsna 15A !CAC 7C AI ie.
9. YIELD (Spm): 3 METHOD OF TEST 8S r
(0. WATER. ZONES (depth): L/ 9S
I I. DISINFECTION. Type /-HT/i Amount n. R9
12. CASING: Walfbidmrst
Depth Diameter or welphitFt. (*atrial
Fmm_[Z_ToSS- FL64 Snr21 Pvc
From To Ft.
From TO Ft. --
13. GROUT: Depth Maaeaiot
From(_ To a O Ft Crain/eV/ T
From To Ft,
14. SCREEN: Depth Dirmrtcr Slot Six
From To Ft. in. in.
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Sire Mtderini
From To Ft.
From To Ft.
16 REM AIt.KS•
Topographid 1 and setting
°Ridge ❑Slope °Valley °Flat
(check appoptnm Itat1
Latitude/longitude of well location
-c
7,
tmerresrminutertiaconMi
Latitude/longitude suurar.00PSOTopoVnp$
(deck 6n.) 12F2TH DRILLING LOG l ) )
From To Formation Description
0
n
LOCATION SKETCH(
Show direction and distance in mules from at least
two State Roads or County Roads Include the road
mtmbers and commonroadnames�rorn C�//n4<7q p r6 c' urn/D Tol
S,Go/8/�,//TarnC/ Tan7��
Au nlrethod
co a yn,./e.s. j0rn /,Tan-PonTPei /akee
MntseinI ESTr4TcG0 Q /inde'c Torn/TAT GU
0.1m//D lDL ,/
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE went ISA NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT^^j
A COPY OF THISRECORD HAS BEEN PROVIDED TO THE WELL OWNER
r) ter�y /I e
UPPEIZS�CONSI
SIGNATURE
SIGN RUCDNGTHE WELL
Submit the original to tie Divislof of Water Quality. Groundwater Section, 1636 M&1 Semite GW i REV.Raleigh,
NC
27699-1636 Phone No. (9193733-3221, within 30 days.
/-/y-o3
DATE

North Carolina • Department of Envitunmem and Na
281266
cetrnviciamrsP Cj
WELL CONTRACTOR ( 'M• - PHONE Y y, 2G1 77:- J 1-
WF.LI. CONTRACTOR COMPANY NAME tIJD.iill t✓d �y(
STATE WELL CONSTRUCTION PERMITp ASSOCIATED WQ PERA1Ra
(Ifappbrabte) Cfat livable)
I. WELL USE (Check Applicable Box): Residet(lat ® MunicipallPubtic ❑ Industnal 0 Agricultural f3
Monitoring 0 Recovery 0 Neat Pump Water Injection 0 Other If Other, List Use
INDWIDUALINAE nnl `
WELL CONSTRUCTION RECORD
esoaress - Division of Water Quality • Groundwater Section
l r /tyr%e
2. WELL LOCATION:
Nearest Tow : County, 7/ �i
Sa r J ire, C r,�rk r
(Street Num. Numbers, Community. SiWsvitia4 Lai Ho_ ZinCot)
3. OWNER: DO .5 /0.Y-
Address S&L/ MB/ tree ll J�rl,
(Heat or Rune ib.)
Bryson c%Ty N,c aw,7/i
my Town lin Code
me
(BTUs)- &&9- ' 5..3`-I
Ain cads- Pho,c member
4. DATE DRILLED //(- 0
5. TOTAL DEPTH- (7j C1•5
6. DOES WELL REPLACE EXISTING WELL? YES O NO IA
7. STATIC WATER LEVEL Below Top of CSheave Top •
S. TOP OF CASING 1S / FT. Above Lend Surfer'
*Tep atndat termiota War b.bw tad surface nimbus
valance in aKernsree�wt h 1SA NCAC 2C .011t.
9. YIELD (gpm): •-i-ct•-- METHO T)=ST Gk Y
� n
t0. WATER ZONES (depth): 5
1 I. DISINFECTION. Type
12. CASING:
Depth
From,__(_ To 7
From _ To
Front To
43. GROUT; Depth
From_ To ao
H Tf/ Amount O • / D
Wall Thidmess
Diameter or Wcighi/Ft. Material
FL G r <'OF21 ,VC
Ft. Cro J 8 JFS `Turn /AFT on 7942 R G-0 -
Ft
a
Topogiaphic/Land setting
DRidge OSlope OValley OFIpt-_
Rhvehapproptiae ha)
Latitudc/longitude of welt location
tom)
Latitude/longitude souree:DOPSOTopo
(she %boa)
DEEM
From To
Um
)
O o
C
l', tp
Formation D
Mivai01 Meshed
Ft. Cen4 n'1 Pqv: v
From To Ft.
14, SCREEN; Depth Diamatcr
From To Ft._ ;n.
From To Ft.�,.,_in.
15. SAND/GRAVEL PACK:
Depth sizt Msferial
From To Ft.
Front To Ft
Slotsix Material
in.
in.
LiaC2.47.121.-areMd
Show direction and distance in miles from at lest
Two Stale Roads or County Roads. Include the road ,l
numbers end common road mums. 'GP Torn Jt'T %o as
almond Posi G .
/or✓1 RhTon 9C5, Go.o.gm;l)S
lvrn 16-#1- on 56..1...)n7,'l1GEa K/J, c.
e-7 in: /e Turn R�hi nn f`J Y
Grp C.9'1";les 'TVrn /t T Go e r;Je�
To we i l on R Grh T
16 REM ARKS.
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WTTtt 4SA NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS SEEN PROVIDED TO THE WELL OWNER
Jt-H-urjjLL Nyci //- a&-o3
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
Submit me original to the Division of Water Quality. Groundwattr Section, 1636 Mn0 Service CCenter NC
27699-I W6 Phone No. (9 t9) 733-3221, within 30 days.

281265
2. WELL LOCATION:
Nearest Town: Rr>/SO/7 C � Ty County C L✓� tin
C-lnh\/ Mnoirrk.-1 27/..3
(street Nl Nambets, Community. Subdivision. tat No., Zip Code)
3. OWNER: Ch!i a/Ien
Address Crary r0ovn7an
meta Roma No.)
Rr,5oei C/Ty %S/.c �7/3
Mal- 4 £r4Z - (C/ 3
Area code- Phone number
4. DATE DRILLED // /�—G�
5. TOTAL DEPTH: v t' -
6. DOES WELL REPLACE EXISTING WELL? YES ° NO El
7. STATIC WATER LEVEL Beiow Top of Casing: / `l5 FT.
(Use -4- If Above T� ofCaelng)
8. TOP OF CASING IS / FT. Above Land Surfaces
*Top of =mine terminated Dior below Ind surrne requires
variance in ncardanee with 17A NCAC 3C .0111. �` I I"9. YIELD (gm):�.__ METHOD OF TEST
10. WATER ZONES (depth): y /0
North Carolina - Department of Environment and NaW
WELL CONTRACTOR (INDIVIDUAL) NAME(prIa0 %F
WELI. CONTRACTOR COMPANY NAME l r ra h a ne,
S PATE WELL CONSTRUCTION PERMITM
(if applicable)
WELL CONSTRUCTION RECORD
Resources - Divisio9 of Water Quality - Groundwater Section
tit
G✓F'// (�.rie/1419 PHONE M MAW �fNSt{
ASSOCIATED WQ PERMITII
fey 17%rr/�
6fappliicable)
CERTIFICATION Ri[LLIr
I. WELL USE (Check Applicable Box): Residential El Municipal/Public ❑ industnal 0 Agriculturai ❑
Monitoring 0 Recovery 0 Heat Pump Water injection 0 Other 0 If Other, List Use
TapographidLand setting
°Ridge °Slope °Valley OF
(check appropriate box).
LalitudeAongitude of well Iacono
at
(d&grcesiminutWcecwtds) -'
Latitude/longitude source:OGPSOTopogtaPllie
(ehcckbm)
DEPTH DRILLINGmLOG
From To Forn ation D scription
Gym Town State Zip Code
II. DISINFECTION. Type H7-I-% Amount O.73
t2. CASING: WallThicknas
Depth Diameter or Weight/FL Matetial
_ From_ To 93 Ft. (aiq cnr21 P✓G
From To Ft. -
From To Ft.
13. GROUT: Depth Material
From 0 To 90 Ft. C Qm /77-
From To Ft.
I4. SCREEN: Depth Diameter
From_ To Ft. in.
From To Ft. in.
15. SAND/GRAVEL PACK:
Depth Size
From To Ft.
From To Fl
J[ )t
d
•cly G
l.+
V>CJ
:,
LOCATIONN c
SKETCH
Show direction and distance in miles from at least O
two State Roads or County Roads. Include the road
numbers and common road names. ht.� C Q /-
�con') d,lmond( Po5 O j
Tvrh /c-kTdn 71--/E,G0 c2.1/)ar/NS ref,
Method A ' h ( on 1I/PEY)k mor 6/ Rein Cr•O ,6014, /CS
PannP,'r(c/ GrCc%Clot (rCJ
R &h'T ova tt''gr'n5
Liar �6C!
Slot size Material hT O n
in. Mile' %ur/) %�''C � �E,�T ot� G/o✓`y
in. RA. 6- O- l %r� r'/E�S Turn r � 10 T
Material Mounr10 RA Go 1, 3 m/hoS Tat
�o o-Q Yorn 1 e>�' i od
on(,'y�useQ1�
Nic E' CreST Rok- GO g. 1n,YPS Tc� C✓el
CS ie
16 REMARKS
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED M ACCORDANCE Wirth I5A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
;re "VC I-ly.�e //-/9-03
SIGNATURE OF PERSON t 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-I REV. 072001

WELL CONSTRUCTION RECORD 2 812 6 4
North Carolina - Deparunent or Environment and Natural u es - Division of Water Quality - Groundwater Section
-0—eft r y Nytitb CErmnCAnot<a _
WELL CONTRACTOR comvir(INDIVIDUAL)ME (3:r (� ' ' PRONE a �bJ 4
wF.L1. C07(T'RALTOR COMPANY NAME
�rrah<in (JN// (hi' i
STATE WELL CONSTRUCTION PERM Ili ASSOCIATED WO PERMrri
(If applecabte) (if roRtinble)
I. WELL USE (Check Applicable Box): Residential IR Municipal/Public d Industnal 0 Agricultural L
Monitoring 0 Recovery 0 Heat Pump Water Injection Other IFOlbtr.List Use
2. WELL LOCATION: Topographic/Land setting
Nearest Town: sLry5on City Courtly �62c.., h °Ridge
Mope 0
/Va m ; n Rd a
Latitude/longitude or welt Watt
Nuae. NPnben. Commway, s: S-^:s=.Id ow-zaeotl
3. OWNER: al/P t- ./ i S y r tdrv.cv )
Address
Addrs Si/Var Yrl,'n4 lalituddlnngitude shun:e:OOfopo > ¢tiwP �-i
(stccOPSt bw)
(attar or KWIC No.) _ �)3
Ryon <i7y h/,< 2From To Formation scDUnl
roman (c —/1
C4Y at Tow Sena Zip Colo
Area carte- Plane number vJ 0
Crl
4. DATE DRILLED //-//- hi _ —cn c„
5. TOTAL DEPTH: an S
6. DOES WELL REPLACEEXISTING WELL? YES D NO E c,, o
7. STATIC WATER LEVEL Below Top ofCasing: 'Z o FT• =t—
(lnc'`-tfAttare lbp ur[artaiv
ro
FT. Above Land Staufsuc --. ~
S. TOP it CASING IS / — t...:-,--
..—
Mira,
*Tap of nag tvminrei .. Went bed wthea.eq.tns. sv
In aRmEanee xah 15A NCAC IC.01 ia.
O .1
9. YIELD (gpm): 40 METHOD OF TEST 4-' r
10. WATER ZONES (depth): 17 S
11. DISINFECTION. Type )iTII
12. CASINO:
Depth Ditaxtei
From O To 3Sr FL /p
From To Ft.
From To FL
43. GROUT: Dcpth
From______ To a0 Ft.
From To Ft.
Amount O.zI
Welt Ttidtnas
or Weight/Ft Mi(edfsl
Sorat AVc-
Mauriaa Method
Cc.'rvIBh7 pbmpihl
14. SCREEN: Dcpth Dinmctcr
From To Ft.___,,, in.
From To Ft. in.
15. SAND/GRAVEL PACK:
Depth Si2e Material
From To Ft.
Flom To F1.
Slot Sim Mnmrint
in.
in.
LOCATION SKETCH
Show ditretion and distance in mites from at least
two State Roads or Courtly Roads. Include the road
num
bers and cotmtton Mad names
tom C,\htmoncl p0577 d-tTlce Turn lE r
on 0.2S, G-0 /• pi, les ,rn
UYI 19Go L/.2 mt'/es Tvrn INfY°n
S;f>/cr mina Rd GO l.ts h�;les Turn
RC. 6, j pi' Its % tje/) h6,1)'nck
110U5P,
16 REMARKS'
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE waft ISA NCAC 2C, WELL
CONSTRUCTION STANDARDS, ANL) THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
l-
�etyae 1/-8-03
SIGNAn, RE OF PERSON CONSTRUCTING THE WELL DATE
Submit the original to the Division of Water Quality, Groundwater Section,1636 Men serrIce Cente- Ratcig NC
21699-1636 Vaunt No. (919) )33-3221, within 30 days GW-I REV. OOf2001

WELL CONSTRUCTION RECORD
North Carolina - Dcpartment of Environment and Natural Resources - Division of Water Qua
WELL CONTRACTOR (INDIVIDUAL) NAME (print) Mitchell D. Cook
1\ ELL CONIRACTOR COMPANY N'ANIE Hca=11 Bitches 'b11 Inllins, Inc
281728
lity - Groundwater Section
CERTIFICATION. 2043
PHONE : [phone]
STATE WELL CONSTRUCTION PERMIT ASSOCIATED WQ PERMITS
(ifapplicable) (if applicable)
1.
2.
WELL USE (Check Applicable Box): Residential GS Municipal/Public ❑ Industrial 0 .Agricultural 0
.Monitoring 0 Recovery ❑ Heat Pump Water Injection 0 Other 0 If Other, List Use
WELL LOCATION:
Nearest Town: Whittier County Swain
Conley's Creek to Sam Davis RD
(Street Name. Numbers, Community, Subdivision, Lot No., Zip Code)
3. O\VNER: Howie Suttles
Address 108 Johnson Branch Rd
(Street or Route No.)
Bryson City, NC 28713
City or Tour. State Zip Code
( 828- 497-8981
Area code- Phone number
4. DATE DRILLED 10-23-03
5, TOTAL DEPTH: 250'
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO Dec
7. STATIC WATER LEVEL Below Top of Casino: 100 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 IiA NCAC 2C .0118.
9. YIELD (gpm): "30 NIETHOD OF TEST blow
10. WATER ZONES (depth): 65' & 215'
I I. DISINFECTION: Tvpe H T H
12. CASING:
Depth Diameter
From 0 To 35 Ft. 6"
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.
From To Ft.
Amount 16oz
Wall Thickness
or Weieht'Ft. Nlaterial
.188 steel
Nlaterial
Ftka-ahite & Carat.
Ft.
Diameter
Ft. in.
Ft. in.
Method
priced
Slot Size Material
in.
in.
Topographic'Land setting
DRidge ❑Slope ❑Valley 0Flat
(check appropriate box)
Latitude'longitude of well location
(degrees't im,r:es. seconds)
Latitude'longitude source:0GPS❑Topographic map
(check too)
DEPTH DRILLING LOG
From To Formation Description
0 33' clay & arid
33' 250' granite
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road e
numbers and common road names, oW
O
rri
t
16. REMARKS: I
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 1 SA NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPYOPOF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
331 .moo GooT2 /0/.2..RA3
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
VY ELL CONTRACTOR (INDIVIDUAL) NAME (print) Mitchell D. Cook
w ELL CON-IRACTOR COYIPA:NY NAME !team B5 henCe llim, Lr
281727
CERTIFICATION 2043
PHONE e 628) 369-9591
STATE WELL CONSTRUCTION PERMIT. ASSOCIATED WQ PERMIT:
(ifapolicabie) (if applicable)
1. WELL USE (Check Applicable Box): Residential PS Municipal/Public O Industrial 0 Agricultural ❑
N1e nitoring 0 Recovery 0 Heat Pump Rater Injection ❑ Other 0 If Other, List Use
2. WELL LOCATION:
Nearest Town: Whittier
Conley's Creek
County Swain
(Street Name. Number, Community, Subdiviron, Lot No., Zip Code)
3. OWNER: Johnnie Fortner
Adcross PO BOx 199
(Street or Route No.)
Bryson City, NC 28713
City or Town State Zip Code
[phone]
Area rode- Phone number
4. DATE DRILLED 10=24-03
5,TOTAL DEPTH: 100'
6. DOES WELL REPLACE EXISTING WELL? YES O NO IZIx
7. STATIC WATER LEVEL Below Top of Casing: 25 FT.
(Use "+" if Above Top of Casing)
8. TO? OF CASING IS 2 FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordance with ISA NCAC 2C .0118.
9. YIELD (gpm): 30 METHOD OF TEST blow
10, WATER ZONES (depth): 35', 60', & 90'
11 DISINFECTION: Tppe H T H Amount 16oz
12. CASING: Wall Thickness
Depth Diameter or \Veieht'Ft. Nlaterial
From 0 To 25 Ft. 6" .168- steel
From To Ft.
From To Ft.
13. GROUT: Depth Material Method
Frc:n 0 To 20 Remznite & cermt riuped
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
Frcm To Ft.
From To Ft.
16. RENIARKS:
1 DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH ISA , R'ELL�
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
Topographic:Land setting
❑Ridge 0Sloee ❑Valley ❑Flat
(check appropriate box)
Latitude'longitude of well location
(degrees nt.:es'seconds)
Latitudedongitude source:OGPSOTopographio map
(check box)
DEPTH DRILLING LOG
From To Formation Description
0 23' clay & sa-d
23' 100' granite
LOCATION SKETCH qC�
Show direction and distance in miles From atcL'st
two State Roads or County Roads. Include tiCitcadn
Fri
numbers and common road names. e -_
0
SIGNATURE OF PERSON CONSTRUCTING THE WELL 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

282467
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Nature pryj,.Sourced - Divisionof/Water Quality - Groundwater Section
WELL CONTRACTOR(IND IVIDUAL) NAME (prim) r�f If' r'/'�,,''II /{y I�l•J' CERTIFICATION 920 plc)
WWELLCONIri
RACI'OR COMPANY NAME (T r0..1 a-k%1 t.✓r" GPr 1/t 61 C! PRONE 1111(4) 479- Slrt4 i
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable) (if epplicablel
1. WELL USE (Check Applicable Box): Residential at Municipal/Public 0 Industrial 0 Agncultural 0
Monitoring 0 Recovery 0 Heat Pump Water injection 0 Other 0 If Other, List Use
2. WELL LOCATION:
Nearest Town: 13r .j e'n G, T y County S (Jet t ✓1
6L/ i Cr )fF 7/3
(Street Name. Numbers, Cmnmunity. Subd,visiw, Lot No.. Zip Code)
3. OWNER: (U-TA er YonC&
Address (r l6, Cc+ V Et
(Street or Route No.)
[3ry)64l G/Ty AL6, T5?7/3
City or Tom Stoic Zip Code
dt'- as-9149
Area ntde- Prinne number
4. DATE DRILLED /,OJ 2 — C 7
5. TOTAL DEPTH:
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO
7. STATIC WATER LEVEL Below Top of Casing: (> Ff.
(Use "a" if Above Top of Casing)
8. TOP OF CASING IS / Ff. Above Land Surface'
'Top of easing ternslaated at/or below land surface requires a
vartanre in aecardante wnh ISA NCAC 2C .011S.
9. YIELD (gpm): 36 METHOD QF TEST (• _ tr
10. WATER ZONES (depth): Ms 0
I I. DISINFECTION. Type
12. CASING:
Depth
From (.1 To 36
From To
From--___ To
t3. GROUT: Depth
From 6 To 2.,6
l-1 T /-/ Amount Cl , 63
Wall Thickness
Diameter or Weight/Ft. Matenel
FL C A? SnR) i p 1/G
Ft.
FL
Material
FL Gen-ienT
From To Ft.
)4. SCREEN: Depth Diameter
From To Ft. in.
From To FL in.
15. SAND/GRAVEL PACK:
Depth Size Maleria)
Slot Size
in. /' .. -f,. %i 17 _
� c
O
-C
1 __
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL — cn
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER -
From To Ft.
From To FI
16 REMARKS'.
Topographic/Land setting
❑Ridge OSiope DValley 0FIa1
(check appropriate box)
Latitude/longitude of well location
(dcgrees/minutelleceandt)
Latitudellongitude Source.DOPSDTopograph lc map
(check box)
DEPT DRILLING LOG
From To Fonnati
N SKE
Show direction and distance in mil
two State Roads or County Roads.
nu hers and cmmmon road names.
-0 »1 ci 1 yno n rl %fin 5 T
7 orn
AP -ET on .»'s, Go 1.8r+'1,'ies
Porhp,•n [/(re n `�/iT err /-�ttvy //9 Go
Material nC - O rn iVeb $ r U r n /e / (.`-O. Q.
WF 11 on /e7ET
from at le
elude the
At �E I PEELS ON —n
CO)�STR CTING THE WELL ATE
SIGN _ z
Submit the original to the Division of Water Quality, Groundwater Section, t636 Mail Service Center- Raleigh, NC
27699-163619mnc No. [phone], within 30 days. GW-I REV. 0712001

WELL CONSTRUCTION RECORD 2 8 4 3 3 5
North Carolina - Department of Environment and Natur 1 Resources - Division of Water Quality - Groundwater Section /� y / en: e CERTIFICATION 8 7'D
WELL CON'iRACTOR(INDIVIDUAL)NAM1fE (print)/�� 5).?? -f; 7
i4/ W21�A a O 'i?Z
WELL CONTRACTOR COMPANY NAME PHONE _�tSSOCIATED WQ PERMITM-----�—
STATE WELL CONSTRUCTION PERMIT" i(a licable
ifa licable
1. WELLUSE (Check Applicable Box): Residential DMunicipal/Public 0 Industrial ❑ Agricultural 0
Monitoring ❑ Recovery 0 Heat Pump Water Injection 0 Other 0 if Other, List Use
Topographic/Land setting
❑Ridge 0Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrceshninuteslseconds)
Latitude/longitude Source:UGPS❑Topographic map
(check box)
DRILLINCc_1 OG
Formation Dascription
2. WELL LOCATION: iy County �� '�
Nearest Town: l>/y ""
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER. t tJ/I �n4'S
Address
(Street or Route No.) 1
5r r CGAIt IOC
City or Town
State Zip Code
Area code- Phone number 0� 0 f
4. DATE DRILLED /A
r&p
5. TOTAL DEPTH: _---
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO El'
7. STATIC WATER LEVEL Below Top of Casing: G D FT •
(Use "+" if Above Top of Casing)
/ FT. Above Land Surface'
8. TOP OF CASING IS
*Top of casingIterminated at/or below land surface requires 2
variance In accordance with ISA NCAC 2C .0118.
9. YIELD (gpm): __4_,-- MEIIOD OF TEST / i-/___ ____---
10. WATER ZONES (depth): Sat
ION SKETat
Sliow direction and distance in miles from at lest
11. DISINFECTION: T[ON: Type /5% Amount F- s two State Roads or County Roads. InclisD thegoad
12. CASING: Wall Thickness numbers and common road names. ��
Depth Diameter or Weight/Ft. Material a c"'
Z �m
From L To b �r�
Front To t. �. .7-,.
o
From ToEt.Method t ^ m
Depth_, MutcrialGI
13. GROUT: P �. iii ( j _Lc o m�
From_ --AZ w _+
From T° Ft. — c
co
Diameter Slot Size Material --4
14. SCREEN: Depth in — {
From To Ft in.
From
To Ft. in. in.
15. SAND/GRAVEL PACK: Depth Size Material
From To Ft.
From To Ft.
From To
O 6 a---7--.ic
16. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND TIIAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
/Z C�-
is DATE
SIGNATURE OF PERSON CONSTRUCTING THE WELL
GW-1 REV. h, NC
Submit the original to the ll1i3221, wi Water
30Qny9ity, Groundwater Section, 1636 Mail Service Center -Raleigh, NC
27699-1636 Phone No. (919)

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Grooundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (Print) S PHONE N Sla1531-2-g9�1
WELL CONTRACTOR COMPANY NAME �1 \ "� 11 `l nA
ASSOCIATED WQ PERMITN
(ifappticable)
STATE WELL CONSTRUCTION PERMITN
if applicable)
1. WELL USE (Check Applicable Box): Residential ❑ MunicipaUPublic 0 Industrial ❑ Agricultural ❑
Monitoring 0 Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use
Topographic/Land setting
❑Ridge ❑Slope Cgvalley [Mat
(check appropriate box)
Latitude/longitude of well location
I N
(degrees/minu es/seconds)
Latitude/Iongitude sourcc:LIGPSOTopographic map
(check box)
LFILG-i. JG
From To F,'srrl ation D scriptiOn
�y
284334
2. WELL LOCATION:
Nearest Town:
(Street me, umbers, Community, Subdivision, Lot No., Zip Code)
3. OwriEr,.
Address
County, -7
City or Town to Zip Code
Am code- Phone number
4. DATE DRILLED
5. TOTAL DEPTII: L /U/
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO F0-
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 .0116.
9 YIELD (onm): _ METHOD OF TEST At'r
10. WATER ZONES (d"-Nt')'
11. DISINFECTION: Tyra—Li-1— Amount
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
To��_ FL ( a
Front �
From To Ft.
From To Ft.
Material Method
13. GROUT: Tepth/ FS
Fromm-_ Tom Ft. 2�'
From To Ft._—,_— — 14. SCREEN: Depth Diameter Slot Size Material
To Ft. in. in.
From in.
From
To Ft. in.
15. SAND/GRAVEL PACK: Depth Sim Material
From To Ft.From To Ft. ---
r. oTtl
j OCATrnN SKE- CH
:Thew direction and distance in miles from at least
two State Roads or Ccrty Roads. me lc OW road
numbers and common road names. L a�
re - :cr."
o<
Do
A nio
NZ
ITC 'Do
9m,.
r.3 -
16. REMARKS:
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 WELLO ER
DATE
S NATURE OF PERSON CONSTRUCTING THE WELL
Submit the original to the Oilision of Water Quality, Groundwater Section, 1636 Mail Service Ceenter, R leigh, NC
27699-1636 Phone No. [phone], within 30 days.

284199
WELL CONSTRUCTION RECORD
North Carolina- Department of Environment and NaturalResources-3Di)ivision of Water Quality - Groundwater Section n'7
WELL CONTRACTOR (INDIVIDUAL) NAME (print)/ j 1\' I A P fj11\ (1`1A t 1 I S CERTIFICATION #
WELL CONTRACTOR COMPANY NAME AAA V t'L'en e ''� �T� If iJ,ICI et PHONE # (R2-- K c -. 5 5 0
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
WELL USE (Check Applicable Box): Residential% Municipal/Public ❑ Industrial ❑ Agricultural 0. ;.
Monitoring ❑ Recovery D Heat Pump Water Injection ❑ Other ❑ If Other, List Use
2. WELL LOCATION: `j Topoo aphic Land setting -
Nearest T wn: I i 1 I er Cou ty �1�0.1 n ❑Ridge lope DValley ❑Flat
(, 5 C Lie' 61--X- fl (-Z7s
e Numhers mmuni , S •division, Lot No., Zip Code)
check appropriate box)
(Street Name, ry, Latitude/longitude of well location
3. OWNER: I /✓1'1reek Pr/
Address U 5 q L
( tror Route o. 6lscwees a c
2S
y or T wn Stat I Zip Code
Area code- Phone number
4 DATE DRILLED D / c Q3
5. TOTAL DEPTH:
6. DOES WELL REPLACE EXISTING WELL? YES D NO)
7. STATIC WATER LEVEL Below Top of Casing: -q0 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 15A NCAC 2C .0118. 4.
9. YIELD (gpm): ` r ' METHOD OF TEST 1I"
10. WATER ZONES (depth) (�!) �p S
if 135
11. DISINFECTION: Type '+ T I-- Amount i L,
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. N aterial
From U To c' Ft. it/ SOIL 21 1G
From To Ft.
From To Ft.
13. GROUT: Depth Material Method
From 0 To ,VC) Ce7h e'Fr 573.-)
To
Ft.
From Ft.
14. SCREEN: Diameter Slot Size Material
From Ft. in. in.
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
Depth
To
16. REMARKS:
(degrees/minutes/seconds)
Latitude/longitude source:DGPSDTopograPhllc mmp --:.
(check box)
DEPTH DRILLING LOG ---
From To Formation Description
w
LOCATION SKETCH me
Show direction and distance in miles from at lust"L
two State Roads or County Roads. Include the R
numbers and common road names. O -'
7 — % _ C,
(Gr)UL6) C i J %V ./712--C.
1-2, ,,_.Cc cCt�&--w
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
CL-t ` '�-Z�—Q_� i a - 6 - U 3
SIGNATURE OF P SON CONSTIf( CTING THE WELL DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. - GW-I REV. 07/2001
lc".7�

284197
WELL CONSTRUCTION RECORD
North Carolina Department of Environment and
"NN"at,(urral�Rye�sour s - Division of Water Quality - Groundwater Section ��/�
WELL CONTRACTOR (INDIVIDUAL) NAME (print) rY D f 1I C�JJ r(tr1 ' CERTIFICATION(�##,-X�i//t'J, C 2
WELL CONTRACTOR COa1PANY NAME & AA- (Jf` e 'e rl-��f�Jt(DS /A/P � PHONE # (/�Xd3 . O�
STATE WELL CONSTRUCTION PERMIT# CJ . ASSOCIATED WQ PER,IIT#
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential Ig Municipal/Public ❑ Industrial ❑ Agricultural L
Monitoring D Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use
2. \VELL LOCATLQN
Nearest Town:
�113v
(Street Nacre, Numbers
3. OWNER:
Address
County J(it)nti
munity, Sub ivision, Lot 4o., Zip Code) J a 713
»C12-h - l 1 r././ _
(Street or Route No.)
City
2-70, 7e- J F'
City or Town State
3 V 7//
Zip Code
- JY-6(773
Area code- Phone number
4. DATE DRILLED /0 -;70 --1)3
5. TOTAL DEPTH: too
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO h"
7. STATIC WATER LEVEL Below Top of Casing: I/,' ni S- FT.
i (Usc "✓' if Above Top of Casing)
8. TOP OF CASING IS 1 7� FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
9. YIELD (gpm):= -�}-' METHOD OF TEST /9- I'
10. WATER ZONES (depth): -0-
11
12
variance in accordance with 15A NCAC 2C .011S.
CASING: ""
From /9 Tom//// Ft.a__ 5 nezr Ply_
From To Ft.
From To • Ft.
13. GROUT:- Depth /I Material Method
From To tX fJ Ft. Cj2.4->t0-7-* iL�L-,
From To Ft. h''
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.
46-6 2-
DISINFECTION: Type 'c"f'� Amount
Wall Thickness
Depth Diameter or Weight/Ft. Material
From To FL
16. REMARKS:
Topographic/Land setting
Ridge ❑Slope ❑Valley ❑Flat
(check appropriate box) "'
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box) =
DRILLING Lb7`i t
Formation (Description'.... __:_
DEPTH
From To
Ca
1
CO
fn 1t
Show direction and distance in miles froWat legw
two State Roads or County Roads. Inc1uRthe mead
numbers and common road names.
LOCATION SKETCH
I DO HEREBY CERTIFY THAT THIS WELL \VAS CONSTRUCTED TN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY 0 THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
e !../2/24 �%� � Uin f� l / -�0- 0
/
DATE
SIGNAT@.E OF ERSON C
STRUCTING THE WELL
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center -Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-I REV. 07/2001

284138
WELL CONSTRUCTION RECORD
North Carolina- Department of Environment and NaturaluResources - Division of Water Quality - Groundwater Section �//n
WELL CONTRACTOR (INDIVIDUAL) NAME (print) cif) 171 e , r CERTIFICATION 4 21 u ,0
/��./� ���_la•� PHONE # (VS -2UtU .O
WELL CONTRACTOR COhIPANY NAME AAA QreiJne W flf
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT# (if applicable) .--
(if applicable) r
1. WELL USE (Check Applicable Box): Residential( Municipal/Public ❑ Industrial ❑ Agricultural 4::
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use
Topoo aphic/Land setting
❑Ridge 'Slope ❑Valley ❑Flat,
(check appropriate box)
2. WELL LOCATIO
Nearest Town:
(Street Name, Nu
3. OWNER:
Address
(Street or Route ski
( fPrmOn-f- °V. 3LI %l
(orTaw? (State) V73 Zip Code
Area code- Phone number
as7/3 Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑TopOgrap map--v =_
(check box)
DEPTH
From To
4. DATE DRILLED / n - - - °3 OM -33
5. TOTAL DEPTH: `15 v r� 3.3 - 7 'o
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO Ss2 a - lJ��
7. STATIC WATER LEVEL Below Top of Casing: ;e2g0 FT. /S" -- 7 -ti
(Use "+" if Above Top of Casing)
S. TOP OF CASING IS / /_ FT. Above Land Surface*
*Top of casing terminated atlor below land surface requires a
variance In accordanse with ISA NCAC 2C .0118. 1n
/-_
9. YIELD (gpm): ` /rir METHOD OF TEST 1---"t-'
10. WATER ZONES (depth): .0 9 D
11. DISINFECTION: Type
12. CASING: Wall Thickness
Depth Diameter or AVeight/Ft. Material
From To_ -93 Ft. � `/.1 5"Dterit1 f
From To Ft.
From To Ft.
Depth
To aQ_ 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
13. GROUT:
From 0
Material
('G771Q-11
Method
From To Ft.
From To Ft.
t.i
DRTLLING LOCH _.--
Formation Description
LOCATION SKETCH w E E
Show direction and distance in miles from at lea -sip
two State Roads or County Roads. Incluc then Z
numbers and common road names.
ca.?
O
cV
16. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE \VITH 15A NCAC 2C, \VELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
-613
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Nail Service Center
I REVgh, NC
27699-1636 Phone No. [phone], within 30 days.

WELL CONSTRUCTION RECORD 284021
Divi n f Water Quality- Groundwater Section
Noah Carolina - Department of £nvironmern and Natural Resources - , sf °y � CE�FICwTtntt t •�� `� �
WELL CONTRACTOR (INDIVIDUAL) NAME (print) iri Cram/ H P Kray7yb<c)
(Hr./ Aei.M 1n /r' if ('AY.I /I / NGf PHONE a
wE41. CONTRACTOR COMPANY NAME 7
STATE WELL. CONSTRUCTION PERMITI ASSOCIATED WQ rim:H tt
Idappticable) 6faapti able)
I. WELL USE (Check Monitoring ❑ Recovery 0 Applicable Heat Pump Resideniial
njection 0 Pal Otheer0 if Other. List) Use
Agr1G (lures) D
2. WELL LOCATION: .Sl,Jcti,
Nearest Town: R r y I n n r=i Ty County
Sf SQiITh 2N7/3
(Street Name. Hun ben. Camanfity, Subdanstaa. tat No- Zia Coil
3. OWNER: .S %Ivan t7l .rr
Address ,Q 5)' SO i/ rh
(Sties, at Mane Na)
r yea n c ;Ty lVI c: AR7 /.3
Cnyw Taws Stdc be Cade
Arts rate- Phone number
4. DATE DRILLED la - a 0 3
5. TOTAL DEPTH- 0.8.4'
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO Il
7. STATIC WATER LEVEL Below Top of : Mane Top of Oat*
S. TOP OF CASING IS i FT. Above Land Surface*
*Tap or e.daa terml..Ied nlor Odom bad auntie eeieb.t.
var4ate in outdone WO ISA NCAC 2C MIL
9. YIELD (gpm): / 0 METHODOF TEST c, ,' r
10. WATER ZONES {depth): / g `Q
TopogaphidLand setting
ORidbre t)1 Flat
i
Latitudeaongitude of well location
(drgeesmu+vtvh )
Latitude/longitude sourus OOPSOTopolraphie map
(.hest box)
DEPTH DRILLING L013
From To formation Description
II. DISINFECTION. Type HT k Amount 0,31
12. CASING: Wall Thickness
Depth Diameter or Weight/FL Material
From 0 To •35- FL Sflrst PVC
From To Ft.
From To Pi
l3. GROUT: M¢u;nol
From d
From
14. SCREEN:
From
LOCATLON SKETCH
Show direction and distance in miles from at least
two Stale Roads or County Roads. Include Iht road
mtmbers and common mad names C. C F C-O • Sl I'�'S • t'
r07"I GUyn n p0�1
ntnt
hit n) c- T c n 7 y E (L e /fl ie s 7''
I3 Method
4 ,�11 r O r) )_&' S, (0 Cl , r/ /v r /E s (G'T /1
To �.0 ft. CFYhr Y1 T i�um �., �i� t
To Ft. l I i - , ,
bi le's t
��- ✓el1 on /ET r
Depth Diameter Slot Size Menial / C.
To FL. in. in.
From To Ft. . in. in
15. SAND/GRAVEL PACK.
Depth Size Material
From To Ft.
Fran) To Fl.
16 REMARKS'
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH t 5A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
DATE
SIGNATURE OF PERSON CONSTRUCTING THE WELL
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Sent* Center - Raleigh,
27699-1436 Ptinne No. (9(91733-3221, Wli hin 30 days. G W-I REV. 07/1001
O
0
rn
cn
on
cm
o<
{ rn
0
rn
mo
rri
r1
O

North Carotin - Department or Environment and Natural
WELL CONTRACTOR (INDIVIDUAL) NAME (pdnq
WFLt. CONTRACT OR COMPANY NAME
STATE WELL COASTRI)CrtON PETug ITO ASSOCIATPD WQ PERMIT
(tf appbwbk) f f apptierble)
I. WELL USE (Check Applicable Box): Residential Et MunicipaUPublic 0 Industrial 0 Agricultural 0
Monitoring Recovery 0 Heat Pump Water Injection 0 Other 0 if Other, List Use
28400
2. WELL LOCATI N:
Nearest Town: C' tCounly
rnf'rr76 p n 5f7/3
(Street None. Nunhtn, Camnnndy. SaM.,ny_, tat tdu.. Lp cite
3. OWNER: ) C r PP /�?(; SS•'1
Address -krte iT7ctf1 RnnA
(Suter (X Rant Na.)
cr5'rl c / Al( 7/3
n
.
Ales elide. Phnnc •Innbet
4. DATE DRILLED /a— 3 - 6 3
5. TOTAL DEPTH- .5-73 n
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO Et
7. STATIC WATER LEVEL Below Top of Casing:
(thew' v Rat ofCtdaa)
8. TOP OF CASING IS I FT. Above Lend Surface
*Tap at ruin termhr.ted seor Who* ?slid wine mitres •
mince In aaaraanee wtth !SA NCAC 20 A171.
9. YIELD (gpm):2_METHOD OFTFST G, r
10. WATER ZONES (depth): 1-/6C.)
I1. DISINFECTION. Type ftTN Amount 0.7.2.
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
From Cl To 53 FL_f - Snrli Pvc
From To FL
From To FL
43. GROUT: Depth Mvaial
From 6 To ac, Ft. Kerne/YT
Fromm To Ft.
I4, SCREEN: Ocpth
From To FL__in.
Dior -cc -lc?
From To Ft,_ in.
15. SAND/GRAVEL PACK_
Depth Site Material
From To Ft.
Frorr__.,..To 19
WELL CONSTRUCTION RECORD
gets- Division,of Water Quality - Groundwater Section
CERTlFICATlOtf e+91,5o "Cole a y4S) 92-9-1(S5- /u
Topographic/tand selling
DRidge °SlopwItcaaypro08318rosy
y OFlal
Latitude/longitude of well focatton
(de®revnul.nnisccon )
Latitude/longitude source. DOPSOTopognphic map
(cheek bw)
DEM. pRILLING LOG
From To Formation Description
e—
x
LOCATLON SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the mad —
n qym�bers and common mad names. .T
KC)%)1 &IntoOtA PST /��rt. E'/
7`/1 Go • 6.1 w; Ite Tor// i
0
0
oa
:a
o�
cm
of
m
flea
m_
rNn=
C7
0n Pre-6Vrtc.i1 /Aernee\ . O NJ,
is P c
Slot Site Material tc i/ 11 >f
fT
in.
IR
Method
Pt..n,p
16 REMARKS -
I DO HERESY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH ISA NCAC 2C. WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROV IDEA TO THE WELL OWNER
/c,2-n3-63
DATE
6)
SIGNATURE OF PERSON STRUNG THE WELL
Submit the original to the Division of Water Quality, Groundwater Seaton, 1636 Mail Streit* Center- Raleigh, N ' --- -
27699-1636 Phone No.[phone], within 30 days GW-1 REV. 07/2001 r -

Address Rnh,)tsr'n G-c& Rnc
(mama Rune Na.)
lry-Sor, C%Ty IV-C-
d 7 d
Ares cafe- PDTe number
4. DATE DRILLED /2 k 0 i
5. TOTAL DEPTH- /,S5-
6. DOES WELL REPLACE EXISTING WELL? YES Of(0 IS
7- STATIC WATER LEVEL Below Top of Casing:
(use "t'ifA&n Tt9 or Cast )
8. TOP OF CASING IS / FT. Above Lend Surfaces
'Top at slag ie.-minted .Uor 6e1W tasd swine ravens s
verter= In aacamanee Hato IJA MCAC 2C .011I.
9. YIELD (gpm): L c> METHOD OF TEST C'`t )"
10. WATER ZONES (depth): / /tD
WELL CONSTRUCTION RECORD 284019
North Carolina - Department of Environment and Nattuurra' l ,RT/�� urcces - Division f Water Quality - Groundwater Sectirro�n
WELL CONTRACTOR (INDIVIn UAL) NAME (pWan 7Nt4-er� , ceratricAT10M 1 d O5U
g PttoNEyfatlLi -kvSt/
w F.Lt. CO.r1YGC)OR COMPANY NAME GY'/ti. �/A. Y19 LP 11 (�, Y't IIiY"1C/
•CSnCMATPD WO rERMRI
fi fEspticable)
STATE WELL CONSTRUCTION PERMITS
(if applicable)
I. WELL USE (Cheek Applicable Dox): Residential Q MunicipaVPublic 0 Industnal 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection Other❑ If Other. List Use
2. WELL LOCATI
Eras: Towr
n,,iSr
County Swa,'n
t Namt, Numbers. ay. otfrvis _, lot Si. 2W CUE)
7. OWNER: T.. PircS I ✓t'c en \
2�57/3
C Tea Tawa se 24P Cadc
1I. DISINFECTION_Typel-1 rk
12. CASING:
Depth Diameter
From C. To 3 S FL (0 y
From To Fs.
From To FL
13. GROUT: Dc(uh
From_C_ To 9,6 Ft.
Anount v./9
Wall Thidtncsc
or WctghiFt. Wens/
S,3r `LI P vc
From To Ft.
14. SCREEN: Depth Diameter
From To FL in.
From To Ft. in.
15. SAND/GRAVEL PACK.
Depth Sim
From To Ft.
From To Ft
Topographic/Land setting
Daidge awlopv �Q,Vet Ile ❑Flat
Latitudttlongitude of well location
(degsesmunutnheeo n0
Latitude/longitude sounx:OOPS❑Topographic map
(ricc%bra)
�Eisil DRILLING LOG
From To Formation Description
O
Y
J
LOCATION SKETCH y
Show direction and distance in miles from at least 3
two Siate Roads or County Roads. Include the road
n tubers and common road,rmmew
M , /rn, f�6k pc. C•�'
O
rt �n 9 >5 G o /,Fs rn,-/e
1e! L
M� ^Tn 7/L Ga
/� ait Cam;
5,,9n Ter? �, TG
o.
STD/ sTe o sTurn T'r'
CiC/G5 � C✓C /' l(�SS /C. / �,�i�
�f'71%Un , Go O•/ )),1,'le T'rn
Slot Sim Material
in.
in_
16 REMARKS-
Material
%1 d0.C. (,—a C„6—iY/, /C s
Ci 1� Rob/ Ii56,1 C'c`%� /o r�
C*-Li, Q. //1Oi /e-c %C, Lci e,/
%'i ,a %d ��l � Rj69127-
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 SEEN PRO V IDEA TO THE WELL OWNER
T' - -re- \ gy AE' [2-- -03
DATE
SIGNAT
URE OF PEl?SZ1N CONS`IRUCDNG THE WELL
I
Submit the original to the Division of Water Quality. Groundwater 8ec(iem, 1636 Man Se viceCenter- Raleigh, NC
27699-1676 Phone NG.(9l9) 733-3221, within 30 days. GW-1 REV, 07R00i

WELL CONSTRUCTION RECORD 2 8 4 018
North Carolina - Department of Environment and Natuni mots - Division of Water Quality - Groundwater Section
p CEt:r1:ICw77ON / �5-7)
WELL CONTRACTOR (INDIVIDUAL) NAME fpr+ntl �reJ try flyG�O rvi�r •9-6%
WF.LI.CU'r1TIALZUR COMPANY NAME Grr�lL;ho Wed Avidity
PHONE Y ��_—
STATE WELL COAS7RUCTtON PER IITI ASSOCIATED u'Q PERMfri
f tf applicable) (i f rpplinble)
I. WELL USE (Check Applicable Box): Residential 0 Municipal/Pubtic 0 Industrial D Agricultural Li
Monitoring Recovery 0 Heat Pump Water Injection 0 Other 0 If Other. List Use
2. WELL LOCATION:
Nearest Towm ry ci, G r7y County 5 We,/ l/7
_I) % TNr- rt.pp RnnA 2,5r7Q
(Strut Nuns, Mambas. Communa/y�. Sabdreiman• tat Ha, Zip Cat)
3. OWNER: F e)-'» k / IU ryet1
Address rsTr&r Creek Rceuk
(stnzi a Rwrte Na.) �7
r .Sc;n //'Tv/ oSI7/3
City or Two Step Zip Code
l_3 (4)-- 33 /;2
Arun Cndc. Pbnnt !Im ba
4. DATE DRILLED i, L -/G -r7
5. TOTAL DEPTH- 355
6. DOES WELL REPLACE EXISTING WELL? YES D NO 0
7. STATIC WATER LEVEL Below Top of Casing: )fT-
(Use 4+- if Abut Top of Cata{)
S. TOP OF CASINO 1S l FT. Above Lend Surfer e
Kap ands' teewIt.te4 nlorbetem land wAue rewires
vatenre In ircwNenct Wilt ISA NCAC 7C .011e.
9. YIELD (gpm): ). METHOD OF TEST O-, r
I0. WATER ZONES (depth):
Topographic/Land setting
°Ridge °Slope °Valley °Flat
trhtctc tppraptiae tat)
Latitudtlllongitude of well tocauon
(degeemurar WS 0 1 )
Latitude/longitude sourcp.00PSDTopovvphic map
(ehak boa)
DE= pRfLUNGLOG
From To Formation Description
1 I. DISINFECTION. Type HT ff
12. CASING: W&II Thickness
Depth Diameter or Weight/FL Mltnil)
From__ To 6y FL Snra-I PYG
Frum To FL
From To FL
t3. GROUT: Depth Mninicl
From_- _To .O Ft. CeTr? E nT
Amount Q.'-/3
From To Ft.
14. SCREEN: Depth Diameter Slot Sias
From To FL in.
From To Ft._in.
13. SAND/GRAVEL PACK:
Depth Sale
From To Ft.
From_Jo _ Ft
16 REMARK;•
Metlwd
Puntp�'
Merritt
in.
in.
Material
hi iv et .T' lc/d° it (17 g '2' r
tn
]s - ▪ o�
at
I o
�! �m
mo
=C3
GO
ri-t--lw
LOCATION SKETCii '—
Show diieetion and distance in miles from at leas%-
two State Roads or County Roads. include the road
numbers and column ro r ernes .. Th . [ /f' T h ?J
trcrh pns7 a. JL /9s C-o
Get ljS'72 i6)'S T,rilRj Tor
C,✓� ah OC `teC
/YI'�PS rein//e+Tot1ttI aT7rr
»eF "T ,-fl 1l -
�`C' �" mn,'lE' -%urn
Cr cc-
C O,/
6-C;
«1 ,Jed/i]C-y 1(dye �r-O . )
/�,g{)T 179f /Cfe Rrovok a-
0
O
( DO HERESY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH ISA NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROV IDEA TO THE WELL OWNER
Tt I &i v LZ e I( O 3
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mai Service Center- Raleig0.Nl --
27699-1636 Phone No. [phone], veilbin 30 days- GW-I REV. (174061.

284015
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural(oLAtrccs - Division f Water Quality - Groundwater Section
NAME CONTRACTOR (INDIVIDUAL) NAE (print)
/I�� TNT ,Erg/ hly.i' CERTIFICATIONS-2OS2/
WELL. CONTRACTOR COMPAN V NAME Ci' Ylrt i'i LIP/ / Ital. 1/14 PHONE fi 15451 971-,5-Y. Sy
SPATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMR#
(if applecabie) (if applicable)
I. WELL USE (Check Applicable Box): Residential ® Municipal/Public Cl Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 if Other, List Use
2. WELL LOCATION:
Nearest Town: Tiry <c' n (i Ty County 5 C'-'r2 / n
(Air nCJ16- Ter aLFf77-3
(Street Name. Numbers, Community, Sobdi'iSim. tot No., Zip Code)
3. OWNER: ('OPCKy Tei-tNr on
Address Winc:itr'51E'r Rona
(sum a Route Na.)
13rystn C/' Fy c.
City or Town State Zip Code
(c29)- 9a6 -0r116
agr 7% 3
Area code- Pbnne number
4. DATE DRILLED / so-0 -3
5. TOTAL DEPTH: SO,$
6. DOES WELL REPLACE EXISTING WELL? YES D N0 el
7. STATIC WATER LEVEL Below Top of Casing: / `a,S Ff.
(Use "+- if Above Top of Casing)
8. TOP OF CASING IS / FT. Above Land Surface*
*Top of casing terminated auor bebw load surface requires a
variance in accordance aim ISA NCAC 2C .6I IL
9. YIELD (gpm): 1 METHOD OF TEST ram, r
10. WATER ZONES (depth): 3 ?t-'
11. DISINFECTION. Type /7 % /7
12. CASING:
Depth Diameter
From 0 To tart Ft. i/
From To FI.
From To Ft.
13. GROUT: Depth Material
Fromm To et Ft. Cement
Topographic/Land setting
°Ridge °Slope °Valley °Flat
(check appropriate hold
Latitudellongitude of well location
(dcgreesfmimnalseconda)
Latitude/longitude suurce.00PSDTopographic map
(check box)
DEPTH. DRILLING LOG
From To Formation Description
0
0 0
.4--C7
L a
300— aim
z^'
ca.c
-.a >0
m0
rrt
LOCATION SKETCH 77 m2
Amount 13• g6. Show direction and distance in miles from at host 2
Wall Thickness two State Roads or County Roads. Include the'TCad z ``
or Weight/Ft. serial numbers and common road names. k ,cc, -re,,,,.7 /Ey H r
Sor
t 'c (-iCnl ct./Mertc{ pc5TC
?L.
can acssGo I,-rn,)/tec7i,%"nIe-P7-can
Method PuManl te �G %� Top 'sor % tarn IN'7- (;
TO7//,E GG 5,2 P7,/PS 72, E7'T 6y
iteAT STOS', it -To '7 i7 8q(7T (-O
,l
,9/72 7(s -7-6 57if I,, '17TTvnv1 /c"+ l
/ hr 7-2..nil
R1: 1)T Go .ojm//es %C STrsr'n turn
R1991)T C--o l c /5r Ro,cc 0 el le-NT Th6)17
G-o To 6.72,p ,80 it/r/1 /64 I U n
ouc&r
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
i n.
in_
Material
16 REMARKS•
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED M ACCORDANCE WITH ISA NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
:re P ry t-» Je la -36-03
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Moil Service Center- Raleigh, NC
27699-1636 Phone No. (9L9) 733-3221, within 30 days. GW-1 REV. 07200d;_.

YELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Rater Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) James B. Brown CERTIFICATIONS 2045
wEt.LCONTRACTOR COMPANY .NAMEHedden Brothers Well Drilling, Inc PHONE#[phone]
STATE WELL CONSTRUCTION PERMITh ASSOCIATED \\'Q PERMIT:
(if applicable) (if applicable)
283496
I. WELL USE (Check Applicable Box): Residential Municipal/Public 0 Industrial ❑ Agricultural 0
INionitoring 0 Recovery 0 Heat Pump Water Injection 0 Other ❑ IC Other, List Use
2. WELL LOCATION:
Nearest Town: Cherokee County Swain
Birdtown Cot ununity--Ey'I well
(Street Name. Numbers, Community, Subdivision, Lot No_, Zip Corte)
3. OWNER: Sharon Blanton Jr.
Address PO Box 571
(Street or Route No.)
Cherokee, NC 28719
City cr Town State Zip Code
( 828- 497-6626
Area cede• Phone number
4. DATE DRILLED 11 —1 0-03
5, TOTAL DEPTH: 350'
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO g}oc
7. STATIC WATER LEVEL Below Top of Casing,: 5 FT.
(L'se "r' if Above Top of Casing)
S. TOP OF CASING IS 2 FT. Above Land Surface*
*Top of casing terminated atior belosv land surface requires a
variance In accordance svith 15A NCAC 2C .0118.
9. YIELD (gpm): 50+ METHOD OF TEST blow
10. WATER ZONES (depth): 340
11. DISINFECTION: Type H T H Amount 16 oz
12. CASING: Wall Thickness
Depth Diameter or WeightFt. Nlateria'
From 0 To 72 Ft. 6" pvc
From 72' To 75 Ft. 6" 1 RR Stpc,1
From To Ft.
13. GROUT: Depth Material Method
From 0 To 20 Ft. ba ill ite & cx3taiL pumped
From To Ft,
14. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in.
From To Ft. in. in.
15, SAND/GRAVEL PACK'.
Depth Size Nlateria)
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 ST.ADS, AND THAT A„OPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL O\\ ;j1ER
Topo2raphicitand setting
❑Ridge DSlope ❑\'alley DFlat
(check appropriate box)
Latitude longitude of well location
(degrees':ninutes seconds)
Latitudo.Iongitude sour:e:❑GPS❑Topographic map
(cl•.ee.K box)
DEPTH DRILLING LOG
From To FaDescription
' Formation
&sand
73' 350' granite
LOCATION SKETCH
Show direction and distance in miles from airrt�lst _
two State Roads or Countv Roads. Include the road ='
n
numbers and common road names. _et .off;
n
0
N tur.
SIGNATURE OF PERSON CONSTRUCTING THE WELL
Submit the original to the Division of Water Quality', Groundwater Section, 1636 Mail Service Center - Raleigh, NC
27699-1636 Phone No, [phone], within 30 days. GAW-1 REV. 07'2001

13. GROUT:
From 0
From, To
14. SCREEN: Depth Diameter Siot Size tMlateriol
From ` To Ft. in. in. _3
From To Ft. in. in.
nc
15,SAND/GRAVEL PACK:
Depth Size N9ateriai O.
From To Ft. co
WELL CONSTRUCTION RECORD
North Carolina Dcp.artment of En ironment and Natura' Resources - Division of Water Quality - Groundwater Section
CERTIFICATION # 2043
WELL CONTRACTOR (INDIVIDUAL) NAME (print) Mitchell D. Cock
WELL CONTRACTOR COMPANYNANIE - 1Prohars Irc
STATE.WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMITS
(if applicable)
(if applicable)
PHONE [phone]
1. WELL USE.(Check Applicable Box): Residential 6 Municipal/Public ❑ Industrial ❑ Agricultural ❑
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑. Other ❑ If Other, List Use
2. WELL LOCATION:
Nearest Town: Cherokee
Soco RD--EBCI well'
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
County Swain
3. oW'NER: John Crow
Addross PO Box 805 -
(Sveec or Route No.)
Cherokee, NC 28719
• City or Town Sate Zip Code
(828 497-7990
Area code- Phone number
4. DATE DRILLED 1 2-1 6-03
5. TOTAL DEPTH: • 400'
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO Rl
7, STATIC WATER LEVEL Below Top of Casing: 1 50 FT
(Use "+" if Above Top of Casing)
S. TOP OF CASING IS 2 FT, Above Land Surface`
•Top of casing terminated at/or below land surface requires a
variance In accordance with 15A NCAC 2C .0118.
9. YIELD (gpm): 1 0 METHOD OF TEST blow
10.WATER ZONES (depth): • 21 0'• & 305'
II. DISINFECTION: Type
12. CHASING:
Topographic/Land setting
❑Ridge :Slope ❑Valley ❑Flat
(c'neck appropriate box)
Latitude/longitude of well location
(de greesrnlinn tests econde)
Latitudo/longitude source:DGPS0Topograohlc map
(check box)
DEPTH DRILLING LOG
From To Formation Description
0 124' clay & sand
124' 400' granite
LOCATION SKETCH
H T H Amount 1 6oz - Show direction and distance in miles from at least
Wall Thickness two State Roads or County Roads. Include the road
Depth Diameter or Weight/Ft. Material numbers and common road names.
From- 0 To 1 26 fit. 6" .188 steel
From To Ft.
From To Ft.
Depth_ Material Method
To 20 Ft}x?rnite & ore* ,pn 3
Ft.
From To Ft.
I6. 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
.21) 251-- /i g- /03
SIGNATURE OF PERSON CONSTRUCTING THE WELL . DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center -Raleigh, NC
27699-1636 Phone No, [phone], within 30 days. . . GW-I REV. 07/2001

WELL CONSTRUCTION RECORD
North Carolina - D partment of Environment and Natural Resources Division of Water Quality • Ground',vater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print Mitchell D. Cook CERTIFICATION 2043
WELL CON'IRACTOR COMPANY NAME Fiedatair add- S;I iTlllimr It - PHONE 0 ES 369-9591
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED \YQ PER:.\IIT0
(if applicable)
(if applicable)
WELL USE (Check Applicable Box): Residential C9 Municipal/Public ❑ Industrial ❑ Agricultural 0
Monitoring ❑ Recovery 0 Heat Pump Water Injection ❑ Other ❑ If Other, List Use
2. WELL LOCATION:
Nearest Town: Whittier County Swain
7 Springs Rd -1st dr on R
(Street Name, Numbers, Community, Subdivision, Lot No.. Zip Code)
3.OWNER :Harris Jarriel
Address 278 Circle Drives
cr Route No.)
St. Augustine. FL
City or Town State Zip Code
(904). 824-0502
Area code- Phone number
4. DATE DRILLED 12-03-03
5. TOTAL DEPTH, 300'
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO
7. STATIC WATER LEVEL Below Top of Casing: 200
(Use "+" if Above Tor of Casing)
8, TOP OF CASING IS 2 FT. Above Land Surface'
*Top of casing terminated attor below land surface requires a
variance In accordance with ISA NCAC 2C .0118.
9. YIELD (¢pm): 15 METHOD OF TEST blow
10. WATER ZONES -(depth): 135' & 265'
FT.
I L DISINFECTION: Type H T H
12, CASING:
Depth
From 0 To 87 Ft.
87-to 91 ' Ft.
To Ft.
From
From
13. GROUT:
From 0
From
14.SCREEN:'
From
From
To Ft.
15. SAND/GRAVEL PACK:
Depth
From To
From To
16, REMARKS:
Diameter
6"
6"
Amount 16oz
Wall Thickness
or Weight/Ft, Material
pvc
.188 steel''
Depth Material Method.
To 20 ' Fthairnite & k.ait tL mimed
To Ft.
Depth Diameter Slot Size Material
To 'Ftin. in.
in. in.
Size Material
Ft,
Ft.
Topographic/Land setting
❑Ridge :Slope ❑Valley :Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:CGPS❑Topographic mup
(check box)
DEPTH DRILLING LOG
From To Formation Description
0 89' clay & eucl
89' 300' granite
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common road names. C)
-n
0
0
0
0A
CO on
nrn
n
y0
0
m�
o
cn z
cni�
1 D0 HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH ISA NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
SIGNATURE OF PERSON CONSTRUCTING THE WELL ATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
27699.1636 Phone No, (919) 7333221, within 30 days. OW -I R.EV. 07/2001
0
z

293852
WELL CONSTRUCTION RECORD
'' Ima•D partment Environment
Natural R.. Divdsioc o. Water Qua!i
1YELLCO11R:aCTOR(IND( !DUAL)N A'11E (a :rd)
J= eS fi. Brown
WELL CO:N':RACTOR PAN N A11 EHe3Q^s: Brothers t,e11 Drilling, Inc
SPATE WELL CONSTRUCTION PERMIT; ASSOCIATED WQ PER'liT:
(ifacr,6ica'olel. (ifa_mrable)t
C cur Section
n-
C RTIF1AT10N- 20=J
PHONE. E2,36 369-9591
• i: u
WELL USE (Check r paea ' Rae) Residential E$ P t. i a, c❑ lrs A;ricultura `-
:3.1oriOrin_ ❑ Recovery ❑ Heat Pump Wa:er Injec i-n C Other ❑ I10 , L:_: Use
2. WELLLOC.AT' N:
tat2de
.V.
C•oi r
Art L& o
(S ea .,. seers Co: sn: units S bdiYiainn a r.o.• Zip Cctei
rnth .
cr Re-te Na)
2.2 Coat
E DRILLED /o-a� -03
. TOTAL DEPTH: Ry0
DOES WELL REPLACE EXISTING WELL? YES, 'NO ❑
7 STATIC WATER LEVEL 3elof Top, of Ca:InaFT.
(use" c Abcv: Top c Casln;
S. TOP OF CASINO IS 2 FT. Above Land Surface"
'Top orcasln;:arm:la:ad aVor belay, land Jul. -race requires a
variance In accordance th ISA N'CAC 2C .0115.
9. YIELD (gem) METHOD OF TEST blow
10. WATER ZONES (d pth):
Toro^^ .uLand se..
❑Ridte nSlo ❑Va!'
( e k aap r Ie
'a., elo g d of ell location:
c,r:e_, I
DEPTH DRir_L!NG 'LOG_._._
;clay =& Description
sand
149
r
LSO' c:an+te
11..DISINFEECTION:Type H T H
12, CASINO:
Depth I6' D a.-iyter
Fran„ 0 To
From LISt To
n; To
13. GROUT: . Depth Nlateral Method
From, 0 ' To 20 Ft, L trite pur.-:rWi
From Tc Ft.
Iu. SCREEN: Depth. . D'2. e::: sic! Size tNf
From To Ft.in. in,
Frcrn To Ftin.
LOCATION SKETC'r'
Amount 1 c oZ Show direction and dls:ance in miles rrz:r, atleast
Nall Thickhess heo State Roads or Cot,nty RdadS. Inalt.de the road
er 4: eich t m!eriai npmbers and cot, T, .. road names.
PVC
ytRR Q
15. SAND,'ORAVEL PACK:
Depth
From To Ft,
From To Ft.
5
ze
Material
16. RE;MARKS,
I DO HERESY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, \\'c_L
CONSTRUCTION STAN'D.ARPAND THAT A COPY .9 THIS CORO HAS SEEN PROVIDED TO THE A4EL: O `•NER
./6 --3o -of
aiclNATUR£ OF PERSON C6NSTRUCTINO THE WELL,
DATE
Submit the original to the Div'sion of Water Quality, Groundwater Section, 1636 Mai:Service Center - Raleigh, NC
27699-1536 Phone No. [phone], within 30 days. OW-1 P v. 07,:001

293851
WELL CONSTRICTION RECORD
es Division of \`tater Qua!
NurtV1 Carolnc •Department cf r.r I cnmen aN a-u:a '� J'c"
ti1ELLCO)TRACI'0R(IVDIYIDUAL)NA)1E(pint? JamesE. Erown
WE:LCOIN'rRACiORCOMPANY NAME Redden Brothers Well Drilling, Inc
STATE WELL CONSTRLCTIO,N PERMIT; ASSOCIATED 1VQ PESMLT:
(if aoolicable) - (ifaDDliczble)'.
/• Gro.und5iiater Section
CERTIFICATION 2045
PHONE 291 36_97_9191
L WELL USE (Cheok.Applicable Box): Residential Pdunia pal-'Rubiic 0 Industrial ❑ P. ricui:':ral 0
Monitoring C 'Recovery .❑ Heat Pump Water lnjzcticn ❑ Other ❑ 110ther, List lime
2. WELL LOCATiO �����,y��
Near�+j'i'o•Nni� Count;-y al-4`
5a'^?ivislon, Lo: No , Zip Code?
(S:r Nair
3. OWNER
-ca -
tt
N Conn
��,we.
S7 Rc NNc
L
(0)g-1(09-10 2
A t21 dPoriie Junto.
4. DATE DR;LLED /p-/41
5,TOTALDE?TH' neCi
6, DOES WELL REPLACE EXISTING l ELL? YES ❑ NOE
". _,.A1IC WATER LEVEL 13e;ow Tcp of Casing. r I,
('use "i: Abcve Top of fail,¢,
e
E, TOP OF CAS:\'G IS 2 FT Above and 5:,,_..
J
'Top °leasing terminated at or below land sarroce requires 3
voriaoce In accorder c ith 15A ,N' CAC 2C .011 a.
9, YIELD (rpm) METHOD OF TEST blow
10, WATER ZONES (depth):
Code
7/3
lope Lade tang
DRidge OSIcce EiVaney❑Flag
p ec< arp.co : 121: -‘)
Latitudelon :lude ef'»el! location
: � 1
..,-_ 0acnt rap
!N
DEPTH DRIL. :G LOG
o., To
O n se; ua ice_
0 clay & =ar-a
11, DISINFECTION: Type H T H Amount 16 oz
12. CASING: V1 11 Inickr.e3.3
D ah Dla Tefe; cr W_nL Ft Maieria:
From_ To '!1' Ft.L _,
Frio
From.. To Ft
13. GROUT: Depth iNloierla! Ib(etnod.
From 0 To 20 Ft. Lcuiite & .. pu.,,rc-ei
From To Ft
Id SCREEN: Depth Diameter Sias Sze ta:e;io'i.
From To Ft in. In.
From To Ft. in. in.
15.SAND(R_AVELPACK:
Depth Size - Ma,trial
From To Ft
From To Ft.
LOCATION SKETCH.
Sho.v dire:tion and distance in miles fir,n at legs.
t',vo State. Roads o: County Roads tine road
numbers and comm..cr, road - -.
CO
CO
16. REVIA.RKS`
1 DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 1 f..A NCAC EC, lwELL
CONSTRUCTION ION STANDARDS, AN T A COPY OF THIS 'h=CORD H S BEEN PROVIDED TO E WELLG'NER
LIRE OF PERSON CONSTRUCTING THE WELL DATE
Submit the original to the Division of Water Quality, Groundwater Seotion, 1636 L\IaII Service Center • Raleigh, NC
2'699.1635 Phnna No. [phone], within 30 days. OW-1 ?Iv, 0 :2001

u.Sseu
North Catalina Department of Environment and
YY'ELL CONTRACTOR (iNDMDUAL) NAME (pri
WELL CONTRACTOR CO>IPANYNAME
STATE WELL CONSTRUCTION PERYIIT%
(if applicable)
WELL CONSTRUCTION RECORD 298188
Mural Resources - Division of Water Quality - Groundwater Section
11 a4
QC -Cc \ 0 -r - CERTIFIC
nAT
IO
N
#,�j
/ /7
Y-e€l1-L', (TS t.V-ea PHONE II ad �5 &-3537)
ASSOCIATED WQ PERMIT:
(if applicable)
1. WELL USE (Check Applicable Box): Residential Municipal/Public ❑ Industrial 0 Agricultural ❑
Monitoring ❑ Recovery 0 Heat Pump Water njection 0 Other 0 If Other, List Use
2. WELL LOCATI N: r
Nearest Town: I tj .S [:) a, l o b y
Numbers, Comm oily, Subdivision Lot No. Zi
3. OWNER: (! 1 c� l V S OJ CU L h
Address PC /} (ry /V 7
(Strict or Route No
.)1
Pr^0 %< c' -e /U G c ? r�57/ `1'
ity rT9,„'n S�:e / ZipCod:
Area code Phone number
4. DATE DRILLED / - S 3
5. TOTAL DEPTH: 7 7S
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO. .
7. STATIC WATER LEVEL Below Top of Casino: n 5 Z) FT.
1 (Use"+" i.r Above Top of Casing)
S. TOP OF CASING IS f /2- FT. Above Land Surface
Top of es sing terminated a L'or below land surface requires a
rariance In accordance with 15A NCAC 2C .0 t IS.
9. YIELD (pm): , 3 • METHOD OF TEST 12 "�
10. WATER ZONES (depth): 7;Z[)
wee /i
(Street Name, . p Code 7 r
11. DISINFECTION: Type /-1
Amounts2V/ C)
12. CASING: Wall Thickness
Depth Diameter or Weizh:'Ft. jktateria'
From To 2--,( Ft. % 4f SORE( • } OC_--
From. To Ft.
From To Ft.
13. GROUT: Depth
From 6) To 02 U
From To
14. SCREEN: Depth
From To
From To
15. SAND 'GRAVEL PACK:
Depth
From To
From To
Topoa aphic/Land setting
idee,X.Slope • ❑Va11ey ❑Flat
95 tchcci appropriate box) •
f 3Latitud /longitude of Well location
(deg:::iminutes.'seconds)
Latitude,9ongitude source:❑GPS❑Topographic nap
(check box)
DEPTH DRILLING LOG
From To Formation Description
0-
/4' — 7o7D
726-7a3
1.91/43 — 775
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.
t7
S..i.1/L1�(5LZ j-c\
Material Method.--{----,
FL (i e)'YIc N 72/ ki.) r1 StyN
Ft. r' l
Diameter Slot Size Material
Ft. in. in.
Ft. in. in.
Size Material
Ft.
Ft.
c
D
m
>r0
:o
rnrn
rn
nz
1,1
6
16. REMARKS:
N
co
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED N ACCORDANCE \VITH ISA NCAC 2C, WELL
CON5TRJde-ION STANDARDS, AND THATAk COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER .
tv / C J _
� G9r. � _) —0
SIGNA OFPc12SONCONSTRUCTING THE WELL DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center -Raleigh, NC
27699-1636 Phone No. [phone], Within 30 days. GW-1 REV, 07/2001

WELL CONSTRUCTION RECORD 2 7 0 6 3 7
North Carolina - Department of Environment and Natural Resources -(Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) TE F F E R hl y.bc CERTIFICATION #-Z06-0
\\'F.LI. CONTRACTOR COMPANY NAME lrlol cS&Nx1'rl LA) 2-Ci alt-t-EC:iry- PHO\'E # 49 tf )%- Sys3,8
SFAT{: WELL CONSTRUCTION PERMIT# .ASSOCIAT D WQ FERMI -Est
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential gl Municipal/Public ❑ Industrial ❑ Agricultural ❑
Monitoring 0 Recovery ❑ Heat Pump Water Injection ❑ Other 0 If Other, List Use
2. WELL LOCATION:
Nearest Town: lei P,
County SW 0.-L4N-
(Street Name. Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER:
Address
(Street or Route No.)
Ca.t'j 't C
C or Town State
(954)- 5zs-$37/
Area code- Phone number
4. DATE DRILLED ..%/.3ja033
5. TOTAL DEPTH: -7rnS
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO RI
7. STATIC WATER LEVEL Below Top of Casing: 75 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): 2 METHOD OF TEST A A,v
10.WATER ZONES (depth) '
Zip Code
II. DISINFECTION: Type J+ilk
12. CASING:
Depth Di�aj�'eter
From 0 To S i Ft. Z. 19
From To Ft.
From To Ft.
13. GROUT: Depth Material
From r) To .20 Ft. err'11x
From To Ft.
14. SCREEN: Depth Diameter
From To Ft. in.
From To Ft. in.
15. SAND/GRAVEL PACK:
Depth Size
From To Et.
From To Ft.
16. REMARKS:
Amount 0./ l .3
Wall Thickness
or Weight/Ft. Material
1.Z1 TVC
Method
Slot Size Material
in.
in.
Material
Topographic/Land setting
❑Ridge ❑Slope DValley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From To Formation Description
LOCATION SKETCH c
Show direction and distance in 1G+7es fin at least
two State Roads or County Roa Incic(deihe road
numbers and common road nami '-
el i
d- Ltta-.t.ut t �(rq'n�c-r-s (C,11�4r7 C-Cti
1.
) iuv -LLvn. All - J.14;S:;. c cj
7417y.°r' �/roYt'`t_Ltict roy.,LLk-
r n )1 i p—a-ktyc'`, - ,• 7,3 S.(. is ,2)
tLutifl, LP' en FcrClln, j 4icibe,. h-L
;�2c�c,l,r �c 4 % 'fl.& c.v UL1/7U..
1-Li /1i- C'r\. {Rae/lati gtt.t.i _lb n,L.Asc.,
t
i
9t, in/O YI\.tlC.v twUrt. E. rat Ith0
/ i;,t
IY•-LLe..,ar- +Lut -. .'*1" , JI� 1/2o yr.t �--
utcE( c.a, critJ-Lc_re,;_,i,-
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH I5A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RECiiiR2 1A13fiN"t5126VIDED 1 d HL '4LLL OWNER
�a T k
SIIGD TUREQF PERSON CONSTRjJtTING THE WELL
_2Lt,.7.003
Submit the original to the Division of Water Quality, GroundsJater'Section, 1636 Mail Service Ct'tifir
27699-1636 Phone No. [phone], within 30 days. i,_ OW -I
Raleigh, NC
REV. 07/2001

267857
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Reso
WELL CONTRACTOR (INDIVIDUAL) NAME (print)
WELL CONTRACTOR COMPANY NAME
SLATE. WELL CONSTRUCTION PERMIT#
Iif applicable)
2
ces - Division?
Water Qua
ASSOCIATED WQ PERMIT
(if applicable)
Groundwater Section
CERTIFICATION S�#�3j�
PHONE It rSf �i
�Z
WELL USE (Check Applicable Box): Residential Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other ❑ If Other, List Use
Topographic/Land setting
❑Ridge RSlope ❑Valley ❑Flat
itt,/ (check appropriate box)
t Latitude/longitude of well location
(degrecshninutes/seconds)
Latitude/longitude source:❑GP3❑Topographic map
(chec
box)
DEPTH DRILLING LOG
Formation Description
WELL LOCATION:
Nearest Town:
0
(Street Name. Numbers, Community,.Spbdivisiuq Lot No., Zip Co
3. OWNER:
Address
(Street or It lute No.)
N'
City or Town State
)"
Area code- Phone number
4. DATE DRILLED_
5. TOTAL DEPTH:
6. DOES WELL REPLACE EXISTING WELL? YESPI ) O Fes'
7. STATIC WATER LEVEL Below Top of Casing:
T.
(Use"+" ifAbove 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 wiry ISA NCAC 2C .0118. Tf , Os4yru.tA
9. YIELD (gpm): 2L" METHOD OF TES
10. WATER ZONES (depth): f
Count
1
t-CS -�
)
255QuC'J_
From
To
Zip Code
11. DISINFECTION: Type��
12. CASING: Depth F. Diameter
/�
Frotn_a_. To 5 Li Ft.
From To Ft.,
From To FL
13. GROUT: Depth
From To
From To
14. SCREEN: Depth
From To
FromTo_
15. SAND/GRAVEL PACK
Depth
From To Ft.,
From To Ft.
16. REMARKS:
1 DO HEREBY GER3 iEY
1CONSTRUtFf)STAN`
Amount
Wall Thickness
or Weight/Ft. Material
Material
Ft.�'_,•
Ft.
Diameter
Ft. in.
Ft. in.
Slot Size
in.
in.
Method
Size Material
Material
LOCATION
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common road names.
z3-t�
O
W
—n
rn
rfl
rV
F
0
IS WELL WAS CONSTRUCTED IN ACCORDANCE WITH I5A NCAC 2C, WELL
ND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
INATURE OF PERSON CONSTRUCTING THE WELL
Submit the original to the .pivisi(,n of Water Quality, Groundwater Section, 1636 Mail Service CCnnn�rf Raleigh, NC
_- within 30 days.
2t7GJ9-1 G3 ti Phone No. (9I9) 733-32 I,

2. \vIlk LUCAI-ION:
Neatestown:
2,- fOfJ C,tV County S"'' /1
(Slreel Hittite, Numhen, Ca::::'•""Ity, Subdivision, Lot No., 7.Ip Code)
J. OWNER: C G /E Idnie,����.
Addiess �__-
(Sneel or Route No.)
bti
Q tryy or Tenn "3 Stale
Argil rode. Mute nnmher �� 3
. d. DATE DRILLED z
5. TOTAL DEP 111: _zee, _-------
6. DUBS VvELL ILEI'LACE EXISTINU WEL1-7 YES U r. NO 13
7. STATICWATER LEVEL I7clot(we
U e'p o[ CasAbove lop or CAtb,g)
P. 'KW OI' CASINO IS __ _ El Above Land Smfnce•
• l pp et c•tlne lennlneltd .Ifni below lord nol•tt troth's •
t Went! In ertonlence nllh I5A NCAC 1C .ohlA.
METI IOD UI' TEST /1-'
Ill. WATER ZONES (depth): -255
ra Amount_ 1/Y —
II. UISINPIiC1lUN:'I)Pe �r-- : --Wall -thickness
12. CASINO: Walt
Di a ncter or WeighhtEI. M kiln]
Front C To P I'1. SO�i 2j o
From To Ft. -
1 rout "l o__ FI. nedlOd
Mnlf1 %l )
IJ. GROUT: Depth c ar7a/l <Jfurl-
Front 42 To ,c'.a 1't. �.
Flom_____ fo—-1't.— --- • Material
rat Diameter Slot Size 14. sou, Depth in.
In IL in.
From- — in.
lo--11. in.
I 1 mn---
15. SAND/GRAVEL PACK: Size Material
Depth
f r o n 1 o I'l. hum To To 1't.----------'__
16. REMARKS:
r v '
i 'I i}DITFIFRFD Yt:ERIIE'1 11 iIIIS\vELLWAS CONS IILUCIIIDINACCORDANCEWllll I5A1ICAC2C,WELL
CONS IItUCI ION SLAM?, tip AND'IIIAT A COI'Y Uf 1111S RECORD 11AS BEEN PROVIDED 10111E WELL OWNER
7.lp Code
1YLLL CONSTRUCTION RELOiW
North Carolina - Depallmcut of Environment awl Natural Resources - Division of Water Quality Gro ndwIFICter Section p3
w' ELL CON I RACI O IL(INUIVIIIUAL) NAME (prom) /__ r -.— YI e- rI ERI r �"(1S5,
/ems
w FAA, CON iMCIOR COnIpANYNMIF. ASSOCIA1 Wfj pERMIIA
(if oP dicnblc)
SfAfE WELL CONS IRtICIION EEIIMIIr
iif npplialblc)
WELL USE (Clerk Applicable Box): Residential IvJ_lrinnlcipal/Public U Industrial El Agricultural U
Monitoring ❑ Recovery ❑ Ileal Pump (Valet Injection U Other U If Other, Lisl Use
Topoginphic/l.nnd selling
Ullidge LISlope IT/alley UFlnl
(check nprinpdale hnQ
Latitude/longitude of well location
.2J /:2•4' cvo33 S 55e-6
(drprret/ndnoiesh aria')
nlitud;(!^ngi(ude source:35C71'SOTopographic Inv
(check bon)
PM"( UMILLI 1.QO
From To Formation Description
270294
(vliS_KEJ-GI1
S1;n'v direction and distance in miles from ni least
two Stale Roads vi C^'ollY Roads. Include the road
mutants and common toad naiaC5.
ord(un iel;
rite-
trz•
slayG`ek /
.wwPaK
Sf try frA(;&
0
u1
CONS WELL
Submit the nrightal to the Division of Water Quality, Groundwater Section, 1636 Mall Service Curler
Raleigh,
LVgh 2001
17600_16J6 Phone No. (919) 733J111, wl(l in 311 days.

2. WELL LOCATION/��
Ncnrest-I own. C I a',
L
(Street Nano, Number", Com"!' e"I.v, Subdivision, Lot No., 7.1p Code)
/,
3. OWNER: r,'e(c�`-
Address
City or Tenn Stile
I_)-
Arra code- flume number
4 DATE DRILLED Z 1-Ci
- ----
6. DOES WELL REPLACE EXISTING WELL/ YES D NO Ff.
5. TOTAL DEI`TIT _��, .,
.
7. STATIC \VATER LEVEL Below Top c 11r of CaAbsing err of outing)
8. TOP OF CASING IS Y 1-f. Above Land Surface•
•Top of caelne terminated •tlor below land roe fare requires •
rulawce In accordance with ISA NCAC IC .0116.
9. YIELD (gpn,): �--
METHOD/OF TEST iSL --
10. WATER ZONES (depth): ,2 i
WELL CONSTRUCTION 1Uit;iral
North Carolina - Department of Environment and Not al ResoeCG Division of Water Quality
W ELL CON TRACTOR (INDIVIDUAL) NA01E (prt - 1•IPII I fl��
WELL CONTRACTOR COrI (ANY NAME
SEA 1E WELL CONSTRUCTION IERMITa
(if opplicnblc)
I Box). R i lential Cd�luuicipal/public LI Industrial IA Agricultural ❑
I. WELL USE (Check
caba os : es r
Monitoring El Recovery
D Ideal Coup Water Injection D Other D If Other, List Use
Topogrnpllic/Lond setting
DRidge OSlope ❑Volley DFlat
(chock appenpelale box)
Lalilude/Iougilude of well location
(d e g r e e a/m i n u l e,J s ocn n d, )
In Laiiiudclkogitude source:DGPSDTopographic map
(check boa)
pEP111 pA)LLINQ i 9G
From To Formation Description
County -Ctile
ASSOCIATP.0 WO PFMII II/
lif ovlrlicablc)_
270282
- Groundwater S• (lion
CERTIFICA f10N
PRONE / rG'sl J��Z$57
11. DISINFECTION: Type
12. CASING: Depth. Diameter
front L,�f
nmld s "/ To1LL _ Ft.
Front_—_
13. GROUT:
From c
From
14. SCREEN:
f foul_
from___
15. SAND/GRAVEL PACK:
Depth
Ftm❑ To Fl.
From
To 1'I.
/f Amount_
Wnll Thickness
or Wcight/El. Material
SO11r / �2
To Ft.
Depth
OS:1 n.
To FL
_ --
Depth Diameter
T. _ Elin.
in. in.
To _ IT
Size Material
Material
Slot Size
in.
Method
`/!fS c• t
Material
U—
—_
6-
LALCRI
ION Kell
Show direction and distance in miles from at lead
two Stale Roads or Courtly Ronda. Include the road
numbers and couunon rood names.
«i4
O
16. REMARKS
1 DO HEREBY CERTIFY TIIA,1111S WELL WAS CONSTRUCTED IN ACCORDANCE WI rli ISA NCAC 2C, WEOWNER
LL
•
CONSTRUCTION STAf1DAIU.1 AND TIIAT A COPY OF TIIIS RECORD IIAS BEEN PROVIDED O Tl1 WELL
0
[Ec(-- DATE
SIGNATURE OF PERSON CONSTRUCITNG TILE WELL
Submit the original to fire- talon of \Voter Qunhlty, Groundwater Section, 1636 Mall Service CQVer- - Raleigh, NC 1
21699-1636 thane No. (919) 73J�-3121, w'Itilbs 30 (lays.

1VELL CONSTRUCTION ItE;CO W
North Carolina - Dcpalltnent of Euvhonoenl and Natural Itesoutces - Division of Writer Qualify -
wF.LLCON IMCIOn(INIIIVIUUAL) /,//Z� e11 PHONEWELL CON I RACI OR COMPANY NAME.
STA IE %vFLL CONS tIlUCF10N hEltMtlf
ASSUCIAi VII We) FERMI It
if o t Ilicablc
'f I blc
WELL USE (Check Applicable Ilox): Itesidenlinl f-hlunieipal/public ❑ Industrial Ll AgriculturalLl
2'70280
Groundwater Section
CEnh lrtch-tt0N 0,2(703
lr
?Acidic!' ing U Recovery U Ilenl pump Writer
2. WELL LOCAPION' /��
Nearest l own: ErC —
NAME (pilot) t% e-C
Injection El Other Ll If Other, List Use
ounty d rnlc
(Sure) Name, Number., Cc:::^:'"•,hv, Subdivi.lon, dot No., Zip Code)
3. p\VNE.IL Slr. t/ Code
AddlcSS y/F,---
(steel or Route No.)
._ hip Code
CityUor Town
Nra rnle. flume numbar� 0 .% �.}
A. II TP DRILLED-- 5. TOTAL DEEI 1 -- -
6. DOES WELL REPLACE EXISTING W RLI3 YES U NO 1
7. STATIC WATER LEVEL L7elow Top of Cnsnlg: ,2 0 _I I
(Use If Move lop of Colon)
R. r to of CASINO IS( FL Above I,nud SotInce�
I _(,_
•
•'p nl nn
climb)! let Wet below laud *urine ruining
•I Ln<e ln.crnra en llh 15/1 11G tiny. or.1 usr /�-
111.
o. 1'IF.LU(Fpnl) _— E IL SI
Ip. \VATEIt ZONES (depth):
II. UISINPlCT10N:-type
12. CASINO:
Depth
front D re Ll F1.
Flom to
nee 1o_
13. UROUC Depth
From 0 fo.-11.
from— I0_—fL--
SURE I Depth Uinnleler
p, ._
Ptnllt — _I1iii
io.
11.
Diameter
6-2.5
'fopogrnpllic/Lntld selling
Midge USlopc 11Vnlley UI'Int
(check npFIoV
Latitude/longitude of well location
v35c3/`42 3'' /6 36.0
i` Lntiludct!nll
54.1
uLlw
Flom
Amount
\Noll I Ilickncss
or WciglIUEt. Ivi�Ltinl
Z' 2.1
FL= -
lnnc inl
'/ 11
front—_ -
To__ Il.
15. SAND/GRAVEL pb'ACK:
Depth
•to 1t
fo
front
Rent
16 REMARKS:—
C IMIinPRERY'CEIt7Ii�
COfIS1RUC110N STP,N
It.
Slot Sire
in
in.
Size Mnlcrinl
letl od
rep ti,
Material
(depreedminuleshetri'•1')
eitude source:U01'SUTopogtapllic ot'p
rel,eck her;
UliLL1140 i3OO
"fo Formation Ucsct plivn
WSAI).LON SKE7_G)l
Show direction and distance in Miles Don nt Icnsl
Iwo Slnit Roods or Courtly flonds. Include the road
numbers and common rood names.
SIONAIU1111, 01' I'EItSUN CONS IRUCIINCIllle WELL
0W-I Raleigh, NC
Slilludl the original lu Ih Division of Water Quality, CromndwnleF Section, 1636 pull Service Cenkr - Rn1eIRh, NC
733-3221, tvllhhn 311 tiny,.
0
N
0
0
us
1161a.I636 phone Noy
AT 11115 \VELI. WAS CONS I IWCI ED IN ACCORDANCE \VI111 I SA fICAC 2C,
WELL
ILDS, AND TIIAf A COI'Y OF 11IIS RECORD IIAS f1EEN rROViuE1/1 0111 WELL
OWNER
DAIS

270278
iloilll Catehurl - Dcpmimmtit of Envllouulcul and Nnl
vv ELL CONInnClllit (lNUll'IUUAI,)Nnn1E ,��2/ Well Dr. II'
1%r..LI, coo I ItACl oil COMEAnv NAME
Assoctnl Eu \v11 rennulw
S IA I E writ, CONS I IllICI ION l'Eltnil U __. if n I Il rabic !n•araarr•
if n r dicnblc ./
WELL USE II Ick API
dicable nos): Ilcsidrnlial l� NI nlicipnl/i'u61ic U IuJushin] I -_I Agricultural U
Mouiloii,lg U Rccovcly U Ilmd I'uulp \Voter hlfcclion U Uthcr U If Other, List sc
fopuglnplric/Lmld ^•riling
2. WELL L1 owle UN' S,✓<,.j Ultldge I.ISIope UVnllry UI Int
/' fO!% �" � county —�--- it lied np,n rynlalr hoar
14 env— _
sl I oa.u, .___F----
;l/ dd• Lnlilude/longitudcofwell -- --- loci -Ilion
1 Nuu,brlr, i'; :::� „P"I n. SnhJivialvn, I nl lla, ]Ip Gnit) �2G-'�
ICbrrll Flame,
(JrprzrJnd,,,rlrJr-r•nrir)
J. U\'iics L C- �aro_
I�— —�-I)� r� Lnliludc'I^"eiiuor soutce:urnit- ',79 glnPhic ne-gyp
Y (check Hai
AIIJIcss —1 'iGt vi P or Flo }
.rr.rrl nl nnille Trot flI_P tl liIIILLIIJI; LI).tl
r��� -1Ie — Plum 'to 1'onnalion P esci iption
l k111J__ Zip Cvdr U, _ C�k!/
Coy nt Im,n Slnte ±—�-�--
Y'3PO __ ____6---4q.2o
sr 1---)------
Aso crtlr. rhnnr,rnnrhrr 17 D
.1 DATE DIM Ll!I) Z--
5. lu7AL Dbl•tfl.___----11�\\,pll7 tiESU iiU
G. DuES WELL 17111 Al I'. EXl S 111171
7. SIAl IC WA IEIt LEVEL Ilelorvllop ti rC Ingve !r p ol � t6r____I:
_I:I
iI'f. Abnvc I.nnrl Sul trice'
g.I Ir Irl CASINO rei''�Irrr•
•,ri, vl t..L�r In nrU�d,rl dhn bilge, Irrr.I nn lore wilder,
,nlnttr In arty'd•irre nlllr ISA NCAC IC .nI IP.
h1E1NUD1WIESI___
NI. W AI lilt ZONES ltlrpul). _ 3 60 ----
Arnnnul ,e ,
\Vnll'1 blrknrns
llrpdr Dinincler of \Wight/It Mnlclinl
.I n1 171 6.;1-
lion l
riplll -In_ II --
how_In_--II---..--
I1. l)IUrlh Inlutnl
fl. o�fla<y�
Ilonionl_ � io�
Io_ 1'I ----._-
fCan__-- Dinmelct Slot Sirc
IA. SCREEN! Nrplll In.
I r, El ill. _.—
how - � ill. III.
i loll'----_ 1lr_—___ 11.
15. SAND/017AVE•,l, l'ACK:
urlrill Sire
70_— 171 717Q H.
1..,/�r-7t
II. DISINIPCIIUN:�I)1r_
12. CASINU'
WELL CUNS'1'RUC'f1UN RECORD
al Resources - Division of Water Quality - Ur omldn nlet S'erlion
ec e. C(KI IF ten -I n)N
ritorir • IS•161 S'�7-zst�
blurb_
non
16, ttpt1AItKS.
•
1DU11p11r1\-cn11rlfti
CONS lnoullo N S1AND
i
Six-1 ! /eex
61eurod
Tett-VC
nhilrlinl
Mnlctinl
1-7
JALCATIOIJ-SK.I:J-c )l
Show 'Election and dislnnce in miles now nl last
Iwo Stale hinds of Coui ily hood+. Include the toad
numbers mid common rind unntes.
I(
11115 WEI WAS CUIIS I RUUl Ill) 11J ACCURDAIICE WI111 ISA lICAC 2C, WALL
S AIJU'111At A COPY Uf'I111S RECORD IIAS BEEN EROVIDE,L/ 111ll WELL UWI)fib
`-- --- ---
IONAIUII Uf PERSON CONSIRUCIINU'i11L WELL uAle
OW-1 itoei h,FIC 1
Submit the nrLFinnl In the lit' Won of 1Vnlrr Ilunlllp, CI nunlhsnler Section, I636 Mall Service Center - IInIeIRh, NC
116vo-I616 limit No. I9191133-3121, within 311 dnps.

27027
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Na,aural Resources - Division of Water Quality - Groun 1 dtter
CONTRACTORCOMP
Section
/elt� (eec-t
WELL CONTRACTOR IDUAL) NAME (print) PHONE,/ tr.
WELL CONTRACTOR COMPANY NAME ASSOCIA ED WQ PERMIT,/
STATE WELL CONSTRUCTION PERMIT# (i(epplicable)
(ifa licablc)
1. WELL USE (Check Applicable Box): Residential IrMunicipa)/Pubitc 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 heat Pump Water Injection ❑ Other 0 If Other, List Use
Topographic/Land setting
❑Ridge ❑Slope ❑Valley ❑Flat
(check appropriate box)
Latitude longitude of well location
nn I (degrees/minutes/seconds)
3. OWNER: 1%�" - G 4 Latitude/longitude source:❑GPS❑Topographic map
Address �/ /t A L f • (check box)
(Street rrRRoute No.) �Rh,(� DE DRILLING LOG
31-1C Town ^�' "l From To Formation Description
State Zip Corte
City or ��—
�_)_ U n
Ares code- Phone number 712%�
4. DATE DRILLED 1 _/
5. TOTAL DEPTH: :Z(a r
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO
7. STATIC WATER LEVEL Below Top of Casing: cC FT•
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS FT. Above Land Surfaces
*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 .h_—
10. WATER ZONES (depth): 2 C
2. WELL LOCATION:
Nearest Town: _ --
County -IA:e-t•./(
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
Amount P,_,_...
11. DISINFECTION: Type h'ry — Wall Thickness
12. CASING: Diameter or Weight/Ft. Material
Depth FL I -Ai 711121 .'
From C To_2_/__—
From To Ft.
From To Ft.
eriai Method Iir. 5if:
13. GROUT: Depth ///Mase,
From 0TojL.— AV" Ft.t—"--
From To Ft..�---
14. SCREEN: Depth Diameter Slot Size Material
To Ft. in. in.
From - _ in.
From To Ft.
in.15..SAND/GRAVEL PACK: Depth Size Material
From To Ft. ---
From To Ft
16. REMARKS:
L DOLHEREBY CERTIFY + e�
CONSTRUCTION STANDD^
5
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mall Service Ceenter' �Vgh, NC N001
27699-1636.Phone No. [phone], within 30 days.
1 OCATiON SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common road names.
cm
N
CD -_
0
u1
WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
THAT • COP OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
2 —7/- C1
i�L ��,itcv IATURE OF PERSON CONSTRUCTING THE WELL DATE

270273
Honk Carolina - Department of Euvltouuoenl mod N
at
vc ELL CON 1 MCI OI111NUIv'I DUAL) NAM F. (rrinl)
writ CON T ItACI Orr COMrANY NAn1F.
S to rE WYE1.L CONS NIUCIION rElUll fll
II nl plicnblc)
WELL USE (Check Applicable 11ux): Residential 14--"E11lllicipal/Public U Industrial Cl
Mouilol iug U Itccovmy LL Ileal I'uul Wain Injection ❑ Oilier Cl If Other, List Use
•Ibpogtophir/Lalld scllin�Plal
L]ltidge ['Slope I0 V alley
(clteck nprropdsle Ins)
Latitude/longitude of well location
(degreet/ndnulrtlsxnrult)
Lnlitudcl!nn!itude sourceLJOPSCITopograpllic n:I t
Icheck Ina)
ftKILLIN0 IS. 1
Founalion Description
z/ /s
2. WELL LOCATION: ,f�Js?,/1
Neatesi1own! ,_Vic -, County
_------
(Slrcel Name, Number', i:c:::::'•ordly. //Subdivision, 1ar1 Ulu:, Zip Code)
J. O\VNIiR:
i ,le eh !'net/1
i /-_ r,+
I_ rl fjo.
Adnc�ss �L
(Street m Route NoLt`
Cirymloon Slnle Zip Code
AIN" vale. rbone number Di
PAIN DRILLED �`/7
5"'10FAI,OE1'TIL_/ere --------
6. DOES WELL REPLACE EXIS VINO WELT;! YES Ll NO I
7. STATIC WATEl1 LEVEL Below Top oft asing0Above 11 rc ti''p) rt.
R. TOp 171' CASINO Is L--- Er. Above I .nud Smince'
•7 cp pi rating Imnin•ted •Ilnr idea hint nnI•tt ttrIlIII tr
v nlante Lr actordaine Stir ISA NCAC IC .011a.
/S MIET110P OF TEST i7�—
I(1. WAFER ZUNES (depth): /7e
DISINFECTION: Type HT_—
12. CASINO:
Iwo C
Roni 1 —
nom To_ _ clboJ
13. GROUT: Depth / lediod �
lo�-Ft
fJ
from_ _ ---
I"lone--_ 10_ S Mnlclinl
SCREEN: DI
Id. sC...�.RJ: Depth
Elmo rn,__—FI.
__ Ft
Flom —_,.to
15. SAND/GRAVELIPACK: pthSire Mntcrinl
f min
Ln Et.
Chill,
To Pl.
WELL CONSTRUCTION 1U&QiW
al Resoulccs - Division of Water Quality - Utouudwnlcr Section j
eeCe- CEP1IFICATION F
Y f / r11oNE / 4R1Y1 S
Flolll to
l)rp111
To i� ft.
Ft.
r 16iIIFREbY—Ctif rti'1
cONsiRucfl0NNSIAN
i1'�f f1 - DA"IE
J SIGN -Al UIIEOF PERSON CONS 111UCIINC 111E W
p j l J urthl7re ura{zlrx ,": Won of \Vnler Qunllly, Crnmldtvnler Section, 1636 MsII Service Cvn rI !Weigh,
VRV7 2001
11600-1616l'ilvlle No. (919) 7JJ-J221, tvllhln 30 days.
Dimoelcr
�plc!i 1
it erg
Ft.- --
Diameter Slot ❑e
III. in
ill. in
Autioillll . �c(l
Wall Thickness
tir Weight/Et. Inlntetinl
ASSOCIA I VII WC) rFMIfI,
lif nuplivablcy_
0 -
LVSA1421 S.-Y._Eit
Show direction and distance in miles fiom al lead
Iwo Slate Roads or nuttily Ronda. Include the toad
IIullabels rind colltilloll turn; names.
La
day Gcrc 7i`. 133,
Aglicullwal U
Sky v..w rye•«
ACCURITh
7 AND "DIA l A COPY OF!MSfIItECORD IIAS LIMN PROVIDED 10111E WELL OWNER
ft. _a 03-

WELL CONSTRUCTION RECORD 270 R ? R
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME(PrInt)��ir E)" F E R U /AIM E CERTIFICATION 0 a.O 5.0
WELL CONTRACTOR COMPANY NAME hAr—paWTx LC Quit -bhLLL
STATE WELL CONSTRUCTION PERMIT* ASSOCIATED WQ PERMIT*
(if applicable) (if applicable)
PHONE * f(l.a 1%79- c�a}s
I. WELL USE (Check Applicable Box): Residential ® Municipal/Public ❑ Industrial 0 Agricultural 0
Monitoring 0 Recovery ❑ Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION:
Nearest T+-1—/ ,.y.o-wn:131}-1JGrL LJ County 5-Lt' cwro �
(Street Name. Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: )`,�''Af/ !1%YhSLJI
Address FCrCtc-rvc-"cJ.t Ea-tcL t4-
(Street or Route No.)
gun :),g 7 /3
C ty or Town State Zip Code
Ares code- Phone number
4. DATE DRILLED /S� l) 3
5. TOTAL DEPTH: S S C'
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO ful
7. STATIC WATER LEVEL Below Top of Casing: / 9s FT.
(Use "+" if Above Top of Cuing)
8. TOP OF CASING IS / FT. Above Land Surface•
•Top of casing terminated sdor below land surface requires a
variance to accordance with ISA (CAC 2C .01111.
9. YIELD (gpm): as- METHOD OF TEST 4 'L
10. WATER ZONES (depth): 3. 13
1 I. DISINFECTION: Type
12. CASING:
Depth
From 0 To 'Pi Ft.
From To Ft.
From To Ft.
13. GROUT. Depth
From i') To ,fit) Ft.
From Tc Ft.
Pf l /i Amount 0 , 6 S
Wall Thickness
Diameter or Weight/Ft. Material
/u- Sup{ "k) - v`c.
Mate: al.y
(Q/)T &Jn#
14. SCREEN: Depth Diameter
From To Ft. in.
From To Ft. in.
15. SAND/GRAVEL PACK:
Depth San
From To Ft.
From To - Ft.
Method
-pwyrt'
Slot Size Material
in.
in.
Material
Topographic/Land setting
❑Ridge ❑Slope ❑Valley CFlat
(check appropriate box)
Latitude/longitude of well location
(degrees'minuteeseconds)
Latitude/longitude source:❑GPSCTopographic map
(check box)
DEPTH DRILLING 1 OG
From Tc Formation Description
1 OCATION SKETCH
Show direction and distance in miles from at leapt`
two State Roads or County Roads. Includae Mid
numbers and common road names.
/ ,uvcLt 4dss r`ti�, 9,/$ 6it L
[ltit- v. LL:LTA. 'L? c-n. ,71.17•� (� ..�j�.
CL- �r0-(yea,. `tU& Lit,/ Or F(11R6II:'nCU
yn1oau.anuLe2'�
01A- APpRl (LK���LsvJr.�. i.J oil ''Ia. • 0
)TLL.LC+v `tLtn�,[ LEci��/. !G : 3 r}LL &co-
tL.'Vry n. n/.. )0_ '//Jpa huLt<L.4 'tt.t-vn,
',
LL✓
if C�c,—Lb L) Jr <A ° Z)tc /IL' {
a$ EP'( w 'r�'t/tc •zi
16. REMARKS: 7'
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
fxSIGNATURE OF' EI(SON CGINSTRUCTING THE WELL
Submit the original to the Division of Water Quality, Groifdw4tekSeetionr]636 Miii( Servli
27699-I636 Phone No. [phone], within 30 days.-----
J.9-513.003
DATE
er - Raleigh, NC
r-I REV. 07/2001

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality
WELL CONTRACTOR (INDIVIDUAL) NAME (print) tt,S E F F I R D 11 9 n E
At-r
WELL CONTRACTOR COMPANY NAME +i tt'rft 1-1.5cU U/u LLt'r<
STATE WELL CONSTRUCTION PERMIT# 07
ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
270638
- Groundwater Section
CERTIFICATION # 2-0S O
PHONE # 6L-`,sl 47)-SAS 4
1 WELL USE (Check Applicable Box): Residential IS) Municipal'Public ❑ Industrial ❑ Agricultural C
Monitoring 0 Recovery 0 Heat Pump Water Injection C Other 0 If Other, List Use
2. WELL LOCATION: }
Nearest Town: R/4-ire l ex-qcf County SW LLt,a'L
r farms , 2k
(Street Name, Numbblers. Community, Subdivision, Lot No., Zip Code)
3. OWNER: K6-8-tc J ,3 -Ji -.)
Address FctiiknN
(Street or Route No,)
`11.C. }A7) 3
Clay or Town State Zip Code
(t)Zs)- 12S-).309
Area code- Phone number
4. DATE DRILLED ;J 5 J Lio v 3
5. TOTAL DEPTH: -7 C.S-
6. DOES WELL REPLACE EXISTING WELL? YES NO El
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 15A NCAC 2C .0118.
9. YIELD (gpm): 7 METHOD OF TEST
10. WATER ZONES (depth): 9 G-V
Topographic/Land setting
❑Ridge ❑Slope CValley ❑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
II. DISINFECTION: Type NT7-1
12. CASING.
Depth Diameter
From 0 To 1 O D FL (ih
From To Ft.
From To Ft.
13. GROUT: Depth
From 0 To 7- r5
Amount 0 , S 4-
Wall Thickness
or Weight/Ft. Material
pf ?VC
Material
Ft. C4rlyts- Jl
Method
ttrrrf
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 FL
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. '
CULL d.L'7YKr"A ;96'
t'a./Li_ i14;L.1-N'&L( # :. S- "
L t..4J2J ,-f Ch rl^- -Llrr� I
7Yk. .-'i- Lc
r t Irc�1.L 1:.
L9.1 an -to i=c,r
tiar.. J
cam[
L�. {it cw f e' idAc,)
city rya.: 9c Lj' L-I e ,2 - iC"g
cl
E., Lo -t L't &it
C).±itC_ LtJt:
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
/ a0 03
r
U TINGTH£-WELL ATE
Submit the original to the Division of Water Quality, Gro hdwater Section, 163E 1lfail Scr
27699-1636 Phone No. [phone], within 30 days.
�(I L
SIGNATUR OE} RSOt�I CO
er - Raleigh, NC
W-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) -3 &FFE R/Dc. CERTIFICATION ft
PHONE 0 13-zsar+)9-`3`-Ny-
WELL CONTRACTOR COMPANY NAME
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED PERMIT('
(if applicable) (if applicable)
GO e-eE DM
271637
1. WELL USE (Check Applicable Box): Residential 51 Municipal/Public ❑ Industrial ❑ Agricultural ❑
Monitoring ❑ Recovery ❑ Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION:
Nearest Town: C
/4t.f o tt to• RRJ
(Street Mune. Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER:RC� .h
Address 14t0.t t`'IRtt-)' RtruQ
(Street or Route No.)
County 54-42164--71
,(javrwir, C. YI , C- S 71 d
ny or Town State Zip Code
('4,)-L s1 -l�7v
Area code- Phone number
4. DATE DRILLED 3J.9.G /aoo 3
5. TOTAL DEPTH: an S
6. DOES WELL REPLACE EXISTING WELL'? YES 0 NO (td
7. STATIC WATER LEVEL Below Top of Casing: 60 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS l FT. Above Land Surfaces
'Top of cuing terminated at/or below land surface requires a
variance In accordance with 15A NCAC 2C .0118.
9. YIELD (gpm): % . METHOD OF TEST 7/ tit
10. WATER ZONES (depth): ) L./LC;
11. DISINFECTION: Type
12. CASING:
Amount 0
Depth
From 0 To )/
From To
From To
13. GROUT: Depth
From n To :1.O
From To
14. SCREEN: Depth
From To
From To
15. SAND/GRAVEL PACK:
Depth
From To
From
Wall Thickness
Diameter or Weight/Ft. Material
FL '/t} SDR ) PV
Ft.
Ft.
Material
Ft. C.rrnluAt
Ft.
Diameter Slot Size
Ft. in. in.
Ft. in. in.
Topographic/Land setting
❑Ridge ❑Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes,'seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From To Formation Description
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common road names.
Method-pAvny l) t t,L1,1,
Material 7$-leef. 8e t yty-da Stunny'
Size
Ft.
To Ft.
16. REMARKS:
I IOER '.HYBY.. CERTIFY THAT 'IN
CONS IICUCTION STAND.ARDS.,'A Ni
Material (-p j
/9c""-'i �. Cates j "' `ti .b. -
ttvvrk, iuc . cam, 'ic e b1 , 4d
SIGH
. ELL WAS CONSTRUCTED IN ACCORDANCE WITH I5A NCAC 2C, WELL
THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
ilAT
E OF PERSONrCONSTRUCTING THE WELL DATE
7i11G-Jon3
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 Resouces - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print)
(print) 3 f F F T R ail N 1 E CERTIFICATION # 0 S0
WELL CONTRACTOR COMPANY NAME /A ALJ vrn 1-0 Dn2tQ1).0 PHONE 4/182-S)4?9-9454
STATE WELL CONSTRUCTION PERMIT,/ ASSOCIATED WQ PERMIT#
(if applicable)
(if applicable)
1. WELL USE (Check Applicable Box): Residential ® Municipal/Public 0 Industrial ❑ Agricultural ❑
Monitoring 0 Recovery ❑ Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION:
Nearest Town: 13na•tn Ct' County S.GCoarav
B a ➢A Tetun
(Street Naine. Numbers. Community, Subdivision, Lot No., Zip Code)
3. OWNER: fRawv Fitcm.ctth
Address f .QL! Tc-Wrt '7Ze-ak
(Street or Route No.)
„ ati -n -<• 327 13
laity or Town State Zip Code
(Szg)-'i -97 93
Area code- Phone number
4. DATE DRILLED 31M9/2003
5. TOTAL DEPTH: 75-0 r
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO E
7. STATIC WATER LEVEL Below Top of Casing: 0 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS ) FT. Above Land Surface*
'Top of casing terminated ao'or below land surface requires a
variance In accordance with ISA NCAC 2C .01.1e.
9. YIELD (gpm): 0 METHOD OF TEST Avi..,
10. WATER ZONES (depth): 11
11. DISINFECTION: Type b Amount cD
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
From o To 33 Ft &54t SuR''I TV< -
From To Ft.
From To Ft.
13. GROUT: Depth
From 0 To .&'
From To
14. SCREEN: Depth Diameter Slot Size Material
Topographic/Land setting
DRidge ❑Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees'minutesheconds)
Latitude/longitude source:❑GPS❑Topographic map
(checkboa)
DEPTH DRILLING LOG
From To Formation Description
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common road names.
c-=^-4.9 II
tt.vVfl tkJJct )iartr c,y tk'74. g`, 93/o )p, l •2C'
Maten I Method �L I
Ft. l�O.7rue.'r ?Pm?: &)SL #E'7, '/ 3't 5,r_�t �±'zvn
Ft. v &P'.e . VL vZtptD. pt•V, cy. E GtJ t t
f s.ti..o-L R;�-t1v c.-i.Az-V.,x"d
From To Ft. in. in. ryn 5u,;�.-1`,°e C(.twtCo-r�.
From To Ft. in. in. t.. 2zc, Fnr✓--itiry -ycuC 1Zz(• tit. j Vic
15. SAND/GRAVEL PACK: .J
ys . l4JVIVX, t9 r3 cis Te il:_,
Depth Size Material
From To Ft. j yy>A,Ct,'Pczji 'Li/ma- T. Vj4c.V et, v '
271636
From To Ft.
16. REMARKS:
ri)_ 9.6 o
/W Lf_i cT5,3 jc. r� Crl/I'o c-: -
I PO HEREBY CERTIFY THAltTh
CONSTRUCTION STANDARDS �!
WELL WAS CONSTRUCTED IN ACCORDANCE WITH 1 5A NCAC 2C, WELL
THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
�,,��ss p �+I J(�''�� l;),yaoo 3
SIGI4 T�4E OF PERSON CONSTRUCTING THE WELL DA I t
Submit the original to the Divisioh of Water Quality, Groundwater Section, 1636 Mail Service Ceenµteerl Raleigh,
a e gREV. h, NC
DO1
27699-1636 Phone No. (919) 733-322 , within 30 days.

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
3
WELL CONTRACTOR (INDIVIDUAL)NAME
��(pdnt) SkFF ERY NII) E CERTIFICATION NAAO S
D
WELL CONTRACTOR COMPANY NAME lrl Askillyrn w �)4.FL .c PHONE # fag)�)79-H+}S)}
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential SI 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: County 5t0 (wn
/Z)R�
(Street Name. Numbers. Community. Subdivision, Lot No., Zip Code)
3. OWNER:) �0.2.0 ;hit)
Address ' / < 1-A-a t
(Street or Route No.)
n
Ci or Town State Zip Code
(%;r)- 447. 736G
Area code- Phone number
4. DATE DRILLED 3) i c7) 073
5. TOTAL DEPTH: 3 R a
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO 64
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 casing terminated at/or below land surface requires a
variance In accordance with 1SA NCAC 2C .0118.
9. YIELD (gpm): 1 METHOD OF TEST i{ i&
10. WATER ZONES (depth): .-0
11. DISINFECTION: Type IFTH
12. CASING:
Depth , Diameter
From i9 To SS-6" Ft. 614
From To Ft.
From To Ft.
13. GROUT: Depth Material
From 0 To 9,0 Ftturru vri
From To Ft.
14. SCREEN: Depth Diameter
From To Ft. in.
From To Ft. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
Amount 0,S4
Wall Thickness
or WeightiFt. Material
sofa) PVC
Slot Size
in.
in.
16. REMARKS:
Method
}. ',�}
P M ter %. al JR tc, jl, al'/ S,ti-�1 St.-^��h 't“eiD.. /yzu0
'twtm. 11.�;4 LM- 73 D nt'ittj ' • Qz
73 �/) p TY�ac°, tctM�, i i on %icf-%:3-o'7.-'C 4-
DLQe.lop,'rrvri:: `JL 4),o tr i tir+1L)
Heat zx> R z e en, /d r1elq di .t
Topographic/Land setting
❑Ridge OSlope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(theca box)
DEPTH DRILLING LOG
From To Formation Description
271635
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.
an'k ,r-k 62c c c ' - 1-6-13-e-
tize_ £._Y tf'ak E. µ Z� slap Sirdn- wvY.
Cr c
I DO-HEREBY'eEnw r ?FTAT WELL WAS CONSTRUCTED IN ACCORDANCE WITH 1 5A NCAC 2C, WELL
ONSTI�t.CTION�,STANDARLS D THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
I. f ide 3) / !/ e03
SIGN9TNa OF PERSON CONSTRUCTING THE WELL DA'c
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Ceenter' RaleighNC
27699-1636 Phone No. (919) 733-322C, within 30 days.

WELL CONSTRUCTION RECORD 271632
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) JE FFF R 7 MY O[ CERTIFICATION M aZOSO
Q.I (�3� jD/t,Lrr QQ » PHONE II (q?A11179-
WELL CONTRACTOR COMPANY NAME .rt 'T�
STATE WELL CONSTRUCTION PERMITS _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
Topographic/Land setting
❑Ridge ❑Slope ❑Valley ['Flat
(check appropriate box)
Latitude/longitude of well location
2. WELL LOCATION:
Nearest Town:B/a-c
Pt—Jar/NC., �eEnt
(Street Name. Numbers. Community, Subdivision, Lot No.. Zip Code)
3. OWNER:AAarrt 7p»riLila)
Address Fente:n'c `p.' -h-t E. zEti:
(Street or Route No.)
e t pc-n 11.c
/y or Town State
(9t9) 'dS — /090
Area code- Phone number
4. DATE DRILLED 3/3J x1 o 3
5. TOTAL DEPTH: 70S
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO E
7. STATIC WATER LEVEL Below Top of Casing: O FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS i FT. Above Land Surface'
*Top of cuing terminated atlor below land surface requires a
variance In accordance with ISA NCAC 2C .0i IS.
9. YIELD (gpm): O METHOD OF TEST H ^ti
10. WATER ZONES (depth): 0
County 5 (Lyn.:
a7)3
Zip Code
(degrees'minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From To Formation Description
11. DISINFECTION: Type 0 Amount C
Wall Thickness
12. CASING:
From rl
From
From
13. GROUT:
From :7
From
14. SCREEN:
From
Depth Diameter
To / SI s FL Ay
To Ft.
To Ft.
Depth Material
To to Ft. C.rttwr4
To Ft.
To Ft.
From To
15. SAND/GRAVEL PAC
Depth
To Ft.
To Ft.
From
From
or WeightlFt. Material
SDR.l1 PVC.
Depth Diameter
in.
Ft. in.
K:
16. REMARKS:
Size
Slot Size
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.
L'Ul tC UAn -C nnn Q(9,$$ 9 1d A- -L.�cilt_
I�� Jny#rossccL �z)y/t
0/w4t
Method ±Lt.lin. lt_/j 114,40 7f'79- 2c 340
-pannfsno yriiLrv�Vuw7 LLF) t
Material 1���-' '4 0 m't_-.V1'rx. G y ms
L'TLt111C. c� nit/40ZZ
1 - —
fri
Gti tL( c . /1- nt ci-C G,.>L )t4LA,
iiifilJJll <71 r
Material
OEHE FBY CERTIFY THAT'
NSTRRUETIG(J S1rA�*IbAIthS�
WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
Submit the original to the Division
27699.1-636 Phone No. (919) 7331-3221,
1L .3, 3/ 003
F PE SON 4134 NSTRUCTING THE WELL DATE
of Water Quality, Groundwater Section, 1636 Mail Service Ceentterl Raleigh,EVNC
within 30 days.

2719?0
«YELL CONSTRUCTION RECORD
Lr.1
N' Ci.QiiPu'i/S�a.-uur�.; �i�ri��i;�i 11.d��lP.hiu N:.r
� 1 wZL CONTRACTOR (i?y,‘,1DC!_`yA.Y1i G72ii25 B. Brown
Cirts7ICAT;Ctie L 5
Tn^. c;;C,i 4 E�41l�-='-''
WELL CCtiTFJ.CCCR CCX7A.Y: YA.YIi liedde. Brothers Well Dr11�iRC:
STATE H ELL CCVsmneCTicY PER>tITI
(i< a ::.1:a.1:e)
;Check A-licab;e Box): Reslden:Ia' Z Munk;
WELL USESRWa's Ir :
;.tor.i:n:ing ❑ ::cverry C Heat Pc.., .._.. ❑
2. WELL LOCATION: SwainNearestTo;:r.,:Bryson City Cc'wir�
Buckner Branch
Z'; Cxe?
;. OWN_R: Quentin Smtih
Ad =Tess
Cordele
(229)• 273-1864
A, ,:;do- Ph:ae
4. DATE DRILLED Harm 2003
c, TOTAL DEPTk; 70_ �—_ ---
6. DOES WELL REPLACE EXISTING WELL? YES C NO IX
7. STATIC WATER LEVEL -low Tc; ct Casing: FOQ'
(use '4" :f3. Cu:s,
TO? OF CASINO IS r,, AbcY: Land S:^ace'
'rep of <ulcq Irplrnll. a:or Clow lied ser.i<s re;alr❑
1 ISA tiCAC:C f1:3,
ra?.srtr. Ir. c:v: u�:ew.� h�ctd
9, YIELD (S; :'.)
1 METHOD OF TEST
10, WATER ZONES (de;;;;)', 11 5
11. DISINFECTION E—.
12. CASING:
Frc•... 5R' Tc_ SLFt. 611 .188
IS GROUT: Ft
ph Mal:rid • Method
0 Tc 23;.LtL1i�- & o7e-i r
ia
we, T,r:cuss
crWCytrt.
pvc
steel
tic
14, SCREEN':
c.,, , Tc___
-rcr Tc
15. SAND'C•RAYEL PACK:
-ro^ Tc,._,__
Tc
I< C-F. !At{c:
D,aIr:: 5 S z _ Ma -a
7.
in.
S. ze Maceria:
A5<.CCiATED F'Q PERSl;T?
ra0:h IIG� , is: Us:
T c;ro aThiC.LL:d s. L_
0...id3e CSlcre CV2aey 'Cr.a
(<_rk srrcp ns•_ bcxI
(der.,es
L=°`..:lcrglydce sow:c,:., „_.
;DEPTH;TRILLING S.00'
From 55' c- =y & 3:1,x�=
^i t9
55' 700'
LOCATION S CP
v `.^ C; and .1;s2_tC ir. n,;.es cr.-.a:
r S;a!e Tic3_s cc C: R__d3 1r;l_de '_..:;car.
and ant as _-_ names.
; a7Nc s, SSY C yr,F =::s M _L WAS CCN$TRI C-C ;ti• ACCO?-t,ZCS �` �..t 3A `CAC AC . ~ ..
} `_.LC,w�_R
., `�asn'v'ciIG\}.s!��Ax..< ..,ANC xY ;e4- �0: 'f OP ir: i�0"9,: SAS BEES P,-i :v ^ _
ag-0
, ' i
19999,JJJJ J. the original to the Dw131on o: W
693 Ild3E_PForatio (919) 735.71:11 with
`
F PERSON coNSTRUCTNG T:= WELL DATE
ate; Quality, Groundwater Sect!en, 1536 Mal Seni:e Ce-:er • Ra'.e:gh, NC
G•'.. EV 0' 22I I
n :0 days, ' .. .

2e719 9
WELL CONSTRUCTION RECORD
STATE WELL CONSTRUCTION ?ER'd1T'
• (if aod•iea lel
1.1i'ELL U5=(Check Applicable cox): Resider. C a., ; ..0�• Lls: Use
b`.critorins G Rear/try C.)Heat Pump Watt,: Injec:icr. Oih.e: G If
;'r'a'.ar Q a;i`; C^ Ld',t•:r S,c',',.ri
CZRT,TICATION : L0C5
Inc. ?:lc s 828 1 591
Ca: C!If
NcrthdNa'y-alRe:owaa
3 • j16QL�,e'.t F^YIfO
Ci Me3l arid
25 B. BrownW ILL CONTRACTOR (INi�1DL'AL) NAME Csr;nt)
WELLCC,NTRACTOR CCM?A.N•Y ,NA.N? Hedeten Brothers Well Drilll not,
A5SOCiATED WQ ?ERMIT#
(ifat,el•
2. WELL LOCATION:
�n citySwain
Nearest Town, r Cc'�.v
2668 Deep Ce p RD
(Snit h's—, e, i ti'u.7.: cn, Ccmc:c..-.'sA Su.diril'.;:, L:: N:, 2',7 Ca;
3, 0µ'hcS',_ Bil1 & Fdith ❑inglP
Address 2f1RR ilcPP r Rri
(Srrt cr 'Acct.
Bryson City, NC 28713
��� Ciy c: Tco, S'au ZipCode
\J B)- noo eGLA
A t4 cccd:• ?..'a n•.^,k:
4 DATE DRILLED 3-26-03
5, TOTAL DEPTH: 300
6, DOES WELL R ?LAC° EXISTING WELL? YES ❑ NO XS
7. STATIC WATER LEV'E..EeiCW' TCPofCasins: 200 ; 1.
(vae"en If AScvs Tap:rCu'.�j?
-. TO? OF CASING 15 2 FT, A'ocve Land Surface'
'Top or cu;c.i lu ths:te. st'or a:cr Isnd r:rhu ngaru
n'ante In s::o:danee sd:h ISA "CAC SC ,OIIP.
•
5. YIELD (g; c.): __1..i M"ZTFHOD OF TEST
10. w'ATER ZONES (depth): 155. 205' . & 280'
•
1:, DISINIF^TICS: T'7a
12. CASINO:
• Dom; .h
F-tr 0 To 63
Tc_�
To�
l3. GROUT: D:pth
From 0 Tc 20
14, SOR=EN: Depth
Tc__
Frost Tc_
i5, SAND,'CRAVELPACK:
DrC;
=rocs Tc Ft.
Prom Tc Ft.
r.
7..h.'cles.3
cr .1$$ ' steel —
Mate ;a: •
Ft.txenrnite & ctt
DL 1
F: • I,,
Pt.__in.
IE. REMARXc.
C
5
Size
S;ct S:u
PIrCEd
kater.al.
?/.a', is
Tcpagraphiclaz4 se...Dg
C'R!dse CS lope ey _Fia•
(cues e-::,::Ptt
cf •» ; I^.a;ia.,
soz::,C0?SCT:Ft ai.,
ahxz'xa)
D E?T Rif LI''G L00
Tc For,.a::cr. Dessrio2a a
0 61 e r �y &
61' 300'
LOCATION SICETCH
S)t6A ,.,...,,.n anti in milts hc.-. a: ,ea>.
r-C 5:a:: R.ads r. Cc `+'.Cads ....._.- -,-'c'-=
,.ambers a.d c.. ^ad n...•-..
.iss-A.1•DA-(ZS A:ND.' t
I,
j L:
Ca'"rs; r.
WAS CCNSTRUC7SD rN ACCC ZA.N'CS W T.; 11A 1'CAC 2C, ti cLL
A COPY OF%^;i5 RBCO.R20 HAS BEEN PROVIDED TOTE! Cw:CER
�aG o3
OF PE:n50N CONSTRUCTING TEE WELL DATE
bnit he OrigInal to tha DlrsIon,of W tar Quality, Groundwatar Seat1o11, 163E Nail 5eni:e Getter - Aweigh NC
6>3-1 S C'w-1REV C./200i
'1v (4t�k.7y3.33.'i; withi 0 days,
ASH i,

WE'LL CONSTRUCTION RECORD
'�u u..:s • •n'vis!ri kt(>QI^t'"
J�S B. $rOkT1
"ILL CCNTRACTOR(1ND1A"IDCL)NA E (i r,""I }r r � � Dr1111i1C
WELL CCNTRAC:CR CC':?AN':' NAMZ BrOAc<OC;ATED �''"� ?: R`:IT�
SLATE wZLL CCNSTRvCTION' Pii�'I17� Q
life::fi z 1
'b'
WELL USE (C;^,.o'fi Applicable Heat
Box). Rai "lia,M.;m,':
❑
M c nicor nb ❑ Re:ov4 0 ea;? LL:.r Wacer In,i:c
WELL LOCATION:
Nearest -' nfl -Cit-V Cc d.r�in
C C:de
i a�a, naa d'I fl"2
Aa .z e. ?`:,ee':.`ar 3_27_(1'?
4. DATE DR LLED
5 TOTAL D./FIFTH: 25__-� :
6. DOES WELL L RE?LACE EXISTING ING WELL' YES
c
7. STATIC WATERLE1'ELS:',o'�'To;oiCasira [111
,Vn"4"I AS:r: Topa
S. TO? OF CASING IS IT, Abov: Lana S-r ac
'Tcpor culnq ;e; mina; IVor E.:Sw;Snd s r'a:e re;areta
va Cancs (r, aa:a.ancs wk'. '{'CAC GC ,C11.
9, YIELD_EOD F TEST 1k0,''
10.WATER ZONES (depth):
115 & 22
271938
C i'nTiF ICATICN : L 5
In - _?:.CND ?
C.:
01're: G If Other, Lis; Use
Ridge (c':elk f_. :
bsx)
-
e❑G2:'JT:pc-a:
•ra t: r j Qy'
11, 2115rNFEC.Ti.1.N: T;re
12. CASNC: P,y .e'.!r
—CL__— T o__42__ F:. f
From - To F;
Nta:er.a:
From Q TC
13 GROUT'. Tc_ 20 t; SYnite & n RirL
From To Ft.
14, SCREEN: D^,'2:2 Lia.;. • SCt51 Ma'_ -',a
e• To �In, ,.
Front To, r.
15, SA.ND'CRA1'EIn L PACK: '—va;< .i
Gc::ti S!z<
Ft.
It.
..C,US
Cr Wei.S S—FL, N'.ate'.a:
1RA Gtapl
From
From
e'.
To
Tc
0From 40y
-401 2501 ctrantte
Des_ -
r nCAT;,QN sX TCH
'n:'A/ dice;:it'n and dis'._,:e ir. miies fr.n z•.',eas'.
CSC State R:aa or CC.-.';' Roads. i .',:I__. ane
Nr., WAS CC T_r >•CAC tC,
AND T:4?ACOPY
OF}PI-CORD :-1SBEEN _RGr�O°.T,.-
� �� :c- c STRUC^ef�'CT:='�=LL DATE
, NA iL ?IF -SON CamOS
CiMri6. )z Dl ,sloa of Water Groundwater Sec;:onMail 53b SerkeCee'ar•iie
A 733 3221, within 30 days, C V
2
rJ

274251
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) S£ F K R Y N t/ b E
CERTIFICATION a '40 CO
� (� Lt-)ofl_ Ti ls.t.i�tmc` PHONE,/ A2,1t cj) . r sii-
WELL CONTRACTOR COMPANY NAME h1'tQ-iu7.'rn OO
ASSOCIATED WQ PERMIT,/
STATE WELL CONSTRUCTION PERMIT,/ (if applicable)
(if applicable)
1. WELL USE (Check Applicable Box): Residential W Municipal/Public ❑ Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2 Topographic/Landsetting
❑Ridge ❑Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS0Topographic map
(cheek box/
DEPTH DRILLING LOG
From To Formation Description
WELL LOCATION:
Nearest Town: g/tA.)/Ldfl
C'MOiMtu
(Street Name. Numbers, Community, Subdivision, Lot No.. Zip Code)
3. OWNER: td/-�Lct
Address -qtr.-to-ma,£'-tabu'
(Street or Rowe No.)
Cityfor Town State Zip Code
(239)-59/- Lb'/G
Area code- Phone number
4. DATE DRILLED 9/..1.0 q3
5. TOTAL DEPTH: 8 0 S
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO gl
7. STATIC WATER LEVEL Below Top of Casing: 6 FT.
(use "+" if Above Top of Casing)
8. TOP OF CASING 1S 1 FT. Above Land Surface'
*Top of cuing terminated at/or below laud surface requires a
variance in accordance with ISA NCAC 2C .0118. -
9. YIELD (gpm): O METHOD OF TEST iA 4-'1„.
10. WATER ZONES (depth): tl
County5v.)0..t
11. DISINFECTION: Type c7
12. CASING:
Depth Diameter
From (3 To R - FL CAI
From To Ft.
From To Ft.
13. GROUT: Depth Material
From 0 To as Ft.CR
To Ft.
Amount 0
Wall Thickness
or Weight/Ft. Material
seR ) t YC
From
14. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in.
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Material
Method
From
From
Depth Size
To Ft.
To Ft.
16. REMARKS: IA) Ca, AR hill d t.14.<IRRa
FDOHEREBY CERT
CONSTRUCTION St
I'�
S-ubmitthe orlg(gal to t
27699,1636 Phone NO. (919
LOCATION SKETCH
Show direction and distance in miles from at (east
two State Roads or County Roads. Include the road
,numbers and conunon road names.
. ,f{.cfYrca ?@IJ t*CC c
Yo t2i to vr.. ,f? on
err. y ' ' . e`r +`t-
bp' 47-cnttun"2
net. 0,C ti Vittitrra)
ter.- Re-% cy /3irl) .'i4 a1 :0;w
--team- Q h1 cit,l.u-L tbj ttkt
1LicjV , EMI o� the- -e '4 jdhL
U 7O O
AT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
DS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
1� 5/ (J 0 3
SIG I TU$ /OFRSON CONSTRUCTING THE WELL DATE
Division of Water Quality, Groundwater Section, 1636 Mail Service Center
I REV Raleigh,
INC
733-3221, within 30 days.

275878
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
tt ,t CERTIFICATION QSO
WELL CONTRACTOR (INDIVIDUAL) NAM "lpHnt) S� FEAR Ts 1 / Y,�II ,y
n fv to di 1 P J_111 PHONE # fH2> y'S T
WELL CONTRACTOR COMPANY NAME nti �fj
STATE WELL CONSTRUCTION PERMIT# ASSOCLAT WQ PERMIT#
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential Municipal/Public ❑ Industrial 0 Agricultural ❑
Monitoring ❑ Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION:
Nearest Town: t3/)Ma n tct1
fir. C,--E's ¢ M.
(Street Name. Numbers, Community, Subdivision, Lot No.. Zip Code)
County C Q-Lr•-)
3. OWNER: FLQ'
Address Pi.1Le9Ai<.'t 020.1-122,
(Street or Route No.)
/3.- n-tr "n 8 71.3
City or Town Stile hip Code
(12a)- 447-6S3fc
Area code- Phone number
4. DATE DRILLED ee, Ja.o/ao03
5. TOTAL DEPTH: (} 30
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO In
7. STATIC WATER LEVEL Below Top of Casing: 7 S FT.
(Use "+" if Above Top of Cuing)
8. TOP OF CASING 1S / FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance In accordance with 15A NCAC 2C .0118.
9. YIELD (gpm): 1 0 METHOD OF TEST R-1-11,
10. WATER ZONES (depth): 9 /S
Topographic/Land setting
❑Ridge ❑Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degreu/minutes/secoruis)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From To Formation Descriptipn
CJ r
11. DISINFECTION: Type NTH
12. CASING:
Depth Diameter
From 0 To LS Ft. 4I9
From To Ft.
From To Ft.
13. GROUT: Depth Materiel
From 0 To L0 Ft. l`-G>N-or
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 _ . 7 5
Wall Thickness
or Weight/Ft. Material
SJIR 21 IPV C
-1k. REMARKS:
_� t)-D& I IEREB-Y-THAT T ,HAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH ISA NCAC 2C, WELL
j', (CONSTRUCTION STANDARDS,'] AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
Method
Qwrt67 carry
Slot Size Material
in.
in.
Material
w
C
n2
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
n bers and common road names.
rj r1.Vme (e 641
teLL-at"0.y-2ss),u:
,
I �o -3-e4y.t.“- b.
lLL L,t.. ht.{7J O fn Pettlro.: ,1tc 4-R-- ILL
v
N1�'�qI frl j4t.idt �/ o)aoD3
PllI YJRE OF PERSON CONSTRUCTING THE WELL ATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
L_ _"s'iF'oo_1ti36.Phtilfc-)4a.'(9'19) 33-421, within 30 days. G W -1 REV . 07/2001

WELL CONSTRUCTION RECORD
2758'77
North Carolina - Department of Environment and Natural Resources )-,1Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME � (print) TL- )=F /�"R7 era T�177 nbrL` CERTIFICATION M ao s o
w ELL CONTRACTOR COMPANYNAME FJrt-ft.i'SCCTh Loa .IJ/1u-wrra PHONE # JS & -&�3
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
I. WELL USE (Check Applicable Box): Residential a Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION:
Nearest Town: County5GUtlurt
(Street Name. Numbers, Community, Subdivision, Lot No., Zip Cede)
3. OWNER:
Address
fn� RcL
(Street or Route No.)
aS%/3
City r Town State Zip Code
you-9951
Area code- Phone number
4. DATE DRILLED 4 J/ 3J2a o 3
5. TOTAL DEPTH: 2Z3 0
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO
7. STATIC WATER LEVEL Below Top of Casing: of o r FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS / FT. Above Land Surface'
*Top of casing terminated at/or below land surface requires a
variance In accordance with ISA NCAC 2C .0118.
9. YIELD (gpm): aO METHOD OF TEST 4 AFL,
10. WATER ZONES (depth): / 90
I I. DISINFECTION: Type
12. CASING:
h} rN
Depth Diameter
From 0 To (c / Ft. &
From To Ft.
From To Ft.
13. GROUT: Depth Material
From 0 To ,a0 Ft.elirns mr
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 0.3 9-
Wall Thickness
or Weight/Ft. Material
SDRa ?VC
Topographic/Land setting
❑Ridge ❑Slope ❑Valley OFlat
(cheek appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:OGPSOTopographic map
(check box)
DEPTH DRILLING LOG
From To Formation Description
8
t—
r
G
f— c
'o
J,OCATION SKETCH cni
Show direction and distance in miles frotibc lead
two State Roads or County Roads. Include the road
numbers and common road name¢¢. <,'�����.�''-��'a"".. n _
rrntsx.a B m-aJ`" f 0-f'—
Method 52/,, IN Fl an.,
Slot Size Material
in.
in.
Material
#s8 Sm.eah..5.e. / /a trti.L�
AtesyLi # 7 (L tta
�. ' of 7a
/r�.,c- I+/i o m Ltu)-, z 'p
Su ,n y (f ` �` tv. )ttaLF s jop Stgi ,
tt 2c j J Q Eat "te yytt . q �t / 9. ac 11P�{,,
`fro "uq�vn, l tjI�-- en, 8 rta�n.f J3/ '' �.
hci , O 2 Y/q tYu.iRdi'rwvn .tn & ox CLwt .
6fvoin,tl,� Rc�L�, ja� aasjotn;_ a) t�� �� y4?L Cr.
iV.r�z 1�/lA.l)7'• ct, a n '• a tt.t .
e C1'w tt-.
16. REMARKS:
D
r 1 O HEREBY cE RTIFY THj�('7811S WELL WAS CONSTRUCTED IN ACCORDANCE WITH ISA NCAC 2C, WELL
I rml ) CtJ STRU(TION STANDAI.bbS,AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
l
iAA'QR OF)PERSOCONSTRUCTING THE WELL
Dar
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
f%k99-1636-Phone No c9J,1j4/33-32i21, within 30 days. GW-1 REV. 07/2001

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Divisionrof Water Quality - Groundwater Section
WELL CONTRACTOR(INDIVIDUAL)NAME (print) .-T EFF E R �t inT/DC CERTIFICATION N;Z0 CO
Q
WELL CONTRACTOR COMPANY NAME .c"J k11's a' ail 33 t71'--s
STATE WELL CONSTRUCTION PERMIT,/ ASSOCIAT WQ PERMITN
(if applicable) (if applicable)
275876
PHONE N f tS 979` S45Y-
I. WELL USE (Check Applicable Box): Residential tiO Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring ❑ Recovery 0 Heat Pump Water Injection ❑ Other 0 If Other, List Use
2. WELL LOCATION:
Nearest Town: HrU34.tn 1. j County 54.00- nt.
(Street Name, Numbers, Coppmtnunity. Subdivision,, Lot No., Zip Cede)
3. OWNER: Fdr_0Ontt &C1 tta,Ft)
Address 6.11.01. n 4t an-k _, Rd -
/ (Street or Route No.)
n.c.3
ity or Town State Zip Code
lrz_ ✓�4-28-55 O%6.
Area code- Phone number
4. DATE DRILLED 6/ix f ao o 3
5. TOTAL DEPTH: 7 5 S '
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO El
7. STATIC WATER LEVEL Below Top of Casing: P FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS / FT. 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): fl METHOD OF TEST 11 A' I
10. WATER ZONES (depth): en)
I I. DISINFECTION: Type Jf H
12. CASING:
Depth Diameter
From t9 To 5S Ft. E1/if
From To Ft.
From To Ft.
13. GROUT: Depth Material,
From b To :.J, et) Ft. eUrro:rr
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. nn -- j'n
16. REMARKS: LO UP. Lz ja. `1<ici �"ac-Q21.
Amount C
Wall Thickness
or Weight/Ft. Material
SJ.)R 7,j ?V C_
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 ,RyscriLion
f.
L z;
-o
CT o
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and commonroadnames. .1
V.fi-Q-> - 7LNMcM ee-a-/ • [ oisc
*x tk- ..,i S,
CnY, on. tw�
Qv 7/4
�l.+.Mr tho s¢`` D . 5 X0m��t-•/). 1'.:.:.'4T. /L./:ri - lt1 AA"A it
Material 5 tw>,r., fZ,:<,je%t: en- .oltu-x... . Rd.
d" 9'//O Tr 1_ n00-1'tu:L n. (,c7`' try. E09/C.
FCcr-a M. / 7�Tyff[,, yr; /c&) it.t.L�Th/ - I
li`*ere_ an Vtiw Rai, Or 7J0TftJtG
click( La,trct L` R.:pi
5�&„k�:
rIF.AO HEREBY CERTIFY THAT TFHS WELL WAS CONSTRUCTED IN ACCORDANCE WITH ISA NCAC 2C, WELL
C TRI )CFION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
6142603
O SON aONSTRUCTING THE WELL DATE
SIG
Submit the original (o the Division of Water Quality, Groundwater Section, 1636 Mail Service Center- Raleigh, NC
276994636 Phone No.y949)U33 322[ Jlwithin 30 days. GW-1 REV. 07/2001

275875
City Town State
(47t- 9a9- 4666
Area code- Phone number
4. DATE DRILLED 6/ di R.0 o 3
5. TOTAL DEPTH: $ O J
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO 51
7. STATIC WATER LEVEL Below Top of Casing: ) 0° FT.
(Us "+" 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 15A NCAC 2C .0118.
9. YIELD (gpm): Z METHOD OF TEST A
10. WATER ZONES (depth): 7 $*.S'
11. DISINFECTION: Type 117-1-1 Amount O. C.7
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
From 0 To_ L Ft. 6 Yy SARaI .PV'c'
From To Ft.
From To Ft.
13_ Depth MaterialalMethod
To )-.0m O FL CPu.-rf lTu-'n'j� ,j
To Ft. v
Depth Diameter Slot Size Material
From To Ft. in. in.
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth
To Ft.
To Et.
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (I 12NDIVIDUAL) NAME (print) YE )' t 1= Q N I3 E CERTIFICATION a s SO
Li LPL _boki-LtLeeo
a�}} u't`
WELL CONTRACTOR COMPANY NAME rck (-L'var\ PHONE # (rt> G=H \fs4
ASSOCIATED WQ PERMITS(
(if applicable)
STATE WELL CONSTRUCTION PERMIT#
(if applicable)
I. WELL USE (Check Applicable Box): Residential El Municipal/Public 0 industrial 0 Agricultural 0
2. WELL LOCATION:
Nearest Town: an. ,A Cat./
(Street ame, Numbers, Community, Subdivision. Lot No.. Zip Code)
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
Topographic/Land setting
❑Ridge ❑Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
County 5 iv Lt/,tro
3. OWNER:
Address
A
a r (Street or Route No.)
3,,✓yf net( YI.C. . fS7/3
Zip Code
GROUT:
From 0
From
14. SCREEN:
From
From
16. REMARKS:
Size Material
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From To Formation Description
b
r�
1
co
LOCATION SKETCH r c
Show direction and distance in miles front lei
two State Roads or County Roads. Include the 'rigid
numbers and common road ,n,,a^m¢es.
u 5' )4 r� 6T.
fiRciA,kut„ AA. Z .9�e3 YFQ_ 2T tu:vTu
hp- th\- ei P ge- R4 . o
Yy y ic�v �.t% vt. Rri c�.t l o tr-c
Le al4,1-1.t &UWt.
1I OBEREBYCERTIFY THAT'Tf11Sj WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
i13STRDCTTONSTANDARDSj AND THAT""///jA COPY OF THIS RECORD HAS BEEN PROVIDED TO TH/E WELL OWNER
P1R'EE4OF PERSON ONSTRUCTING THE WELL 6'DATE'OD?i
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
2i60-9 1¢5b Phit9-Nifd9l'9}1h33-3221, within 30 days.
GW-1 REV.07/2001

WELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources - Division of Water Quality
275814
- Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) T EFF P R 4/ )44,1) 6 CERTIFICATION flab 6.0
W�,t
WELL CONTRACTOR COMPANY NAME TLOILI'rn W QQL , M PHONE #
ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
WELL USE (Check Applicable Box): Residential Tie Municipal/Public❑ Industrial 0 Agricultural 0
Monitoring ❑ Recovery ❑ Heat Pump Water Injection 0 Other 0 If Other, List Use
STATE WELL CONSTRUCTION PERMITt
2. WELL LOCATION:
Nearest Town: C,I,W County SWALt r'-'
Fc-ra'n/run? n.R.e F 99 &
(Street Name. Numbers, Community. Subdivision, Lot No.. Zip Code)
3. OWNER: )PJri 'P-�
Address 9`�cs.n r t E,otatN
(Street or Route No.)
)n.a,,. c,tJ -yl ,(' . a_ 713
(Ay or Town J State hip Code
(US)-;090
Area code- Phone number
4. DATE DRILLED 443h,003
5. TOTAL DEPTH: SOS
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO
7. STATIC WATER LEVEL Below Top of Casing: 0 FT.
(use "+" if Above Top of Casing)
8. TOP OF CASING IS 1 FT. Above Land Surface`
*Top of casing terminated at/or below land surface requires a
variance In accordance with 15A NCAC 2C .0118.
9. YIELD (gpm): a METHOD OF TEST fI ^n
10. WATER ZONES (depth): 0
11. DISINFECTION: Type ,0
12. CASING:
Depth D;ameter
From 0 To .3& Ft. 4 fiti
From To Ft.
From To Ft.
13. GROUT: Depth Material
From f) To2Q,_ Ft. Csontnr
From To Ft.
14. SCREEN: Depth Diameter Slot Size
From To Ft. in. in.
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Size
From To Ft.
From To Ft. e
16. REMARKS: t(1 St11 t ,L s.. >a.
1 DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
C STRUCTION -STANDARDS, AND THAT A COPY OF THISHRECORD HAS BEEN PROVIDED TO THE WELL OWNER
11l. /n-L de `/ 0 i 20433
Amount 0
Walt Thickness
or Weight/Ft. Material
SDR.1 -PVC
Method
@,t'vrrip J
Material
Material
ifl niat 4
Topographic/Land setting
❑Ridge ❑Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degreWminures/secortds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From To Formation Description
O c-
C1
'
Ca �m
1-1 Cc
N
c�
S
2
LOCATION SKETCH PI o
Show direction and distance in miles from at leash
two State Roads or County Roads. Include the road
numbers and common rod names.
�j iaA��
-I, �u#aes
// 0 auLat wr., li e r- l i
�n
c r 56t Yl�, U A, v,JW-a,
V� r— -- — SIGN' U f PEaSON CONSTRUCTING THE WELL DATE
bull the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
GW-1 REV.07/2001
699-I+36 Phone No. (919)-773-32ZIr-w*ithin 30 days.

WELL CONSTRUCTION RECORD
275324
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL. CONTRACTOR (INDIVIDUAL) NAME r ((YyY -t \_ Y /l<- 9
A(P/r�int) lea N 1111 Cs—A--�\�(� �CJ CERTIFICATION #71:J I
WELL. CONTRACTOR COMPANY' N'A\1E' A A eeN e_. r0a UJ eunTcgL.PPHON'E k 1b*tc-isvE JS5Zt
STATE %VELL CONSTRUCTION PERMIT/ ASSOCIATED WQ PERMIT#
(if applicable) - (if applicable)
I. WELL USE (Check Applicable Box): Residential Ei Municipal/Public 0 Industrial ❑ Agricultural 0
Monitoring 0 Recovery ❑ Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION:
Neares Town:
6 -2
(Street Name. Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER:I`)&Mril, G(Y\ Als
'`
DIU r�" County Sun ,j
Address Pint 7S x (p ? 5
(Street or Rowe No.)
e{�pt^1 Cnet) Q c---1/4.{ AJC P.8% i3
City rTown Sate Zip Code
1 ?- 3 -55'
Arca code- Phone mints;
4. DATE DRILLED) �F("cNeY' a c9,00a
5. TOTAL DEPTH: 6'' \ �(QL —r
&,�,
�__
Topoggraa ic/Land setting
ORidge MSlope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:OGPSOTopographic map
(check box)
DRILLING LOG
Fornmtion Desctipti on
6. DOES WELL REPLACE EXISTIN ELL
?
YES ❑ NO ❑ 47h <
7. STATIC WATER LEVEL Below Top of Casing9 5 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 ISA NCAC 2C.0118
9. YIELD (gpm);
,NIFtT Oirl,OF TEST l I t
one. hts
10. WATER ZONES'�de'ihj:- rl -tlm�
p
I I. DISINFECTION: Type WI- \A
12. CASING:
0 Depth, f ia eter
From To Iy-) Ft. to%ci
From To Ft.
From To Ft.
13. GROUT: Depth /} Material
From C) To a()_ Ft. \_ _`L'fi�ea)+
From To Ft.
14. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in.
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Size
From To Ft.
From To Ft.
Amount ,'fJ, 13 OZ.
Wall Thickness
or Wei_ht/Ft. Material
4 I
d
—Method
k aP
Material
DEPTH
From To
- /3K
icf3
ranucst
ca n i fe>
LOCATION SKETCH _
Show direction and distance in miles from attgast
two State Roads or County Roads. Include tlfdioad.-,
numbers and common road names.
r�SZ3K
SR. 133(a bee
S R . is59 to S gVreeK
SR . )3 4 3 B e1i-rn :-
sbeN/,C WO Oct-
N
16. REi\IARKS: .Llt I tt(o3 dee r a 5 r -i- 5P,o'd qa r' U 2 IC ""'t
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
1_— . -. Ynij A 0 n
( ' ,[yA'ti
SIGNATURE OF PERS01' CONSTRIjT IN THEWELL ^
r•
Submit the original to the Division of Rater Quality, Groundwyttef ,ISe'ction, 1636 mail Service Ceptl•r)
sleigh, NC
i u
•

Froc,_Q__ To 82 F'
Fr3t. 82' To 102 F:.
To
13. GROUT: Dr,_: -
From 0 To 20
R'e,LL C0.1TR.1CCR (INDI 'IDCAL) NAMZ Ortn^ James B. BroAT.
WELL CCNTRACTCR COMPANY ,'A.MZ
STATE. -ZLL CC. STRC CTION PZRyNIT#
(If aooii:zilel
Hedce^.
Brothers
275268
WELL CONSTRUCTION RECORD
: Ca cNr_ • D:: ,,7,ur.t of EiiYInnr,en12:�J ll:�l.�11�:: �'u v�) LE I: �. r. o IY�.1>. (���.�4� C N� C111?1' S1:rr1�7,
�( CERTIFICATION : 2043
Piell Drillina, Inc. DunN4' 4 R7c1 69 E51
ASSOC(ATZD WO ?ZR.ytr, i
(!f a;Cli:abl:�
1 W 12LL USE (Che:5 .Applicable BOX): Reside .aa. h:'�,icipa�': Irndus:nal ❑ .=._'..,.=
:Mo .,.,,r'ng ❑ Re::ver, ❑ Heal F a;.p Water In .icr.0 0:ha.: .i Oth , Lis: Us:
2, WELL LOCATION:
N arcs: To',. -,a: Bryson City Cc' -w Swain
intersection of Rd ,Te ski ns & Mrnirry Rd
Cc.-r..:n 1,s.S:i4sH.G: Na, ZpCccr
5. Ov.NER, Harley Cunningham
Address 103 Mount Noble Rd
(strr:'. c ?:a s No.)
Cherokee, NC 2R719
Citycr Tcw-, S a- Z:; Cc. s
(828)• 497-4402
A.�a :�c• ?::nc
DATE DRILLED 5-23-03
5. TOTAL DEPTH: 200'
6, DOES WELL RE? —ACE EXISTING: WELL? :'ES 0 NO X8
7. STATIC WATER LEVEL Ee:owTop cfOnIng: 1251 Fi.
(use" I!As:>:T:;:rc
5. TOP OF CASINO 1S 2 Si,Abcve Land Surface*
•Tc; Gf <ufaq ler-ln a;e: 2;cr ngarel a
Yl'IVC: In a:::rdance r4>, IJA ,1CAC SC ,C!!d.
9, YIELD 30 METHOD OF TEST bin,:
I0, WATER ZONES (depl:i): 115' x 1 5n'
LOCATION 5)CETCF
Show dIrec:, r, ar,C rr.lIes .,-.., a: ,en:
r«'c S:a e R:ais es COC _--a_..._.___ --_ p
c—
C=
Tc:Q-a:'_'o::,a.:'_ s:.`.•.z_
:Ridge ❑S:
(:'cr's
DE?T•r
From To
0 101'
101' 700'
11, D:S;NPECI;ON;Tyr,: 1"
12, CASING: V-i!
Dl_,.e:er cr Vi C. y.'-fl. ? atera1
�11
6"
pin
1RR gtaa1
Material Met•,:,
;,LL3u ite & c.e.;
From it Ft.
14, SOREEN: Cep::: C';a_:,t:r
Fror To In
From T^ Fi. in.
15. SAND, GRAVEL PACK:
Depth
dm ' Tc
, T^ Si
s:L: Ma-nia
5:z: Ma:e=a!
:ems,,.
;;jr LP•
_:iCr,
H v & s
16, REMAC<s:
I DC 1-!R! ' CEFrIFY THAT T--:IS WELL WAS CC 3TFUC-D "N. ACCCZ.rtivCF, '-'1 :- 15A }C AC :C.,t'.-•'
CCNSTP.L'CT:ONcl-ANDA?.DS,AN: T•- AT A COPY OF ir.:S RE C C RD:LAS BEEN ?RO iDEDT3T P_ =_L C`«\=?,
SIGNATURE OF PERS G'r 20 e,i "r(\a.TR ri 1I
I I
sabr't the original to the Division o: Water Quality, G o4tt: a G No , 1536 Nail Sent!!II 1 �j.
17699.1636 Phone No.(919) 733.31E1, within 30 days, f r r
er • rule:g'^, NC
ca
0
-P-
CJ
w
(7

WELL CONSTRUCTION RECORD 2 7 5 2 6 6
h':r•h Ca:olin: • D6, ,w',<c; o: _rr;ln,: ,:n, a 'a71.-;'', R::a� n;a D!' isi.,� (of 44'a',,r Q1a
Jams B. Brown
WrLLcoNTrucoR(a1�D"•lr".L!titi"E (<�,�,,� �gc�
WELL CCNTELICTC2 CCm?,0: NAME He' Qen Brother1 _
s 6ce11 Driin4, Inc. PY.C.VE P 8) 363 �'1
ASSOCIATED WQ ?f RN1:4
6iAiE �'-ELL COAiTn�CTICN PIT fif a_cacddia
CEaT T1CA71CT e 20' 5
V;.,. - al^ lndUi: i :_ uI
I. WELL USE (C�^,::k A?;I!cxb;e Box): Residentia; �❑ A_.
.ip_ u.,!c _�
Mcr.itd ng C Re; ve , 0 cut . ' 'a:: 1•je ��a 0:,,e: ❑ If 0. , List Lis:
2. WELL LOCATION:
Nearest Tc,:.T.: Bryson City CoW,ti Swain
Wet ,Tenkins Br 1-n Porky Warn 1,,41'it
(5711: tv YTt, Zp. r,
3W\ER': James Walrim] ip
?.!cos s PO Box 1677
Rowe N>.)
Bryson City, NC 28711
r. <: T.,v763'.e Zlp C: e
(828)• 488-897e
A.a.xe.
4. DATE DRILT cD 5-21-01
S. TOTAL DEF Tr : 300'
6. DOES WELL Fi?LACE EXISTING WELL? YES C NO acx
7. STATIC WATER LEVEL Below Tc; of Casing: 200 r s.
(chi " 'IfAS:re rCvLn3)
S. TO? OF CASING IS 2 FT. Abcve Land Sar aa'
'rep of culns le: minut'. tt'rr Sel.w lied r:rfue re;':'cei
ar.an<e L•. t<aordan:t 'a:,`. 1'A NCAC ZC,C1:5.
9. YIELD (pm): 10 METHOD CF TEST
10. WATER ZONES (death): 115' & 141'
11, Dlsl\'?EOTiO\' Tyra rz
i
13. CASINO:
0 Cr,C 50 F: Air:'::
F:cam 50To 59 Ft. 6" 1 AR
TJ
13 GROUT: C^ N!a::rIa: ::•Ity
0 Tc 220 F;,& ceT r'.t
From Ta It.
14. SCREEN: "yt cat, Siat S.re '/aural
Prism Ta
IS SAND/GRAVEL PACK:
A.: a n t I ECZ
14'aa T;:ccness
cr
pvr
st ea1
' T^ Ft.
Frarr, T^
Tc,~ os-:eD :::an set
ORidgeCS',c CVa 0.
rr-,
PE;TFri:Lr R'G r
ic
57' 300'
-_te
LOCATI N 5:cT
. •saS.
5;... Rcad or-.-'-.-
6. i M.&R:iC,
x H=LEY C_P,r1FY -AT =:a WELL WAS CCNSTP. 'C ED r:q AC CC R.:rNCZ '-1T- ISANCAC tc,
CO\S-,:CTi ' 'CARTS ANT.: .-LAT A OFY OF ir.:5 RE00RD AS BEEN _ ___
5:ONAILJREOFPERSON CONS
,
Submit the the original to the Div!sloa at Watar Quail:if, Grocn
27699-163E Phona Na. (919)7334221, within 30 days,
Stc;,Rr 1636,'6;1-Sa,nias
3--o
• Fu:e!gh, NC
REV, 4'2 0
GROUNDWPJER SECTION
ASHEVILLE REGIONAL OFFICE

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
Is ELL CON1 RACTOR (WWI VIIUAL) NAME //(pprhrint) /Gatift/ Q.e��. CC CERI'IFICATIONN
WELL CONTRACTOR COMPANY NAME /!v'//c WMI 0611; na PHONE N WAY) 132-2ss7
STATE WE'LL CONS RUCtION PERNITN ASSOCIAI PI) WQ PE.RMI"TN
I i lapRlicabic (if applicable)
274590
I. W ELL USE (Check Applicable Dos): Residential WII". Municipal/Public 13 Industrial ❑ Agricultural ❑
tomiloring L7 Recovery ❑ Ileat I'utup Water Injection 13 Other 11 1f O01er, List Use
2. WELL LOCATION:
Nearest 'town: Citrate-
e)1C\ eve
(Street Nam Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: Anti e C4/6J't
Address\S.
(Street or Route N
�noYC\LD0 fi)C-"
City or Town Stan
(- )-
Arra cafe- Phone number
1. DATE DRILLED `/-25"
5. TOTAL DEP
6. DOES WELL REPLACE EXISTING WELL/ YES U NO E3'
7. STATIC WATER LEVEL Belo'.: Top of 1-f.
(Use "+" if Above Top of Coiling)
8. TOP OF CASINO IS / Y rr. Above Lnnd Surface'
•rep nr coring terminated .Von heron land mama requires a
v.rIonce In accordance with ISA NCAC IC .01III.
.. YIELD (gram): /0.--- METIIOD Or TEST 4er
10. WATER ZONES (depth):
County
PC x-(11— i
2-ZAV°L
Zip Code
I I. DISINFECTION: Type ffTH
12. CASING:
Amount vrife
Wall Thickness
Depth Diameter or Weight/Et. Material
From 0 To / Ft. 6 25" JFY Pee
Flem To It
From To Ft.
13. GROUT: Depth 4 Mnt%prinl
From n To:20 Ft. orflki/
From_ To Ft.
14SCREEN: Depth Diameter Slot Size Material
Front Tn• Ft.
From To I'1. iu. in.
15. SAND/GRAVELPACK:
Depth Size Material
Roth To rt.
Flom To FI.
Method
i/JfUrc.
16. REMARKS:
Topographic/Land setting
❑Ridge ❑Slope ❑Valley OFlat
(check nppmptt.te box)
Latitude/longitude of well location
NJS'344 r2.5 wo33'iI '4f3.7"
(degreen/ninutr,Rcronds)
Latitude/longitude sourcc:DOPSE1Topogtapltic amp
(check bon)
DEPTIi DRILLIN_Q 40c
Irronm To Formation Description
0 //5' (/4 )
//I-- )Ls'
c
r
LOCATION SKE7_41( "
Show direction and distance in miles fro150l Ica'�st�
Iwo Stale Roads or County Roads. Include'ille
numbers and common toad names.
-e}(�ONST ITONSFAN �S,AND TACO YOFT11S ) RECORD IIASDEENPROVIDED 10 11EWELL OWNER
OF I'ERSON CONSIRUCIINOTIIE WELL DATE
�+ JUL
2003 IJ
I
SIGNATU
M1O Q I@fifeil�ti1t1i �l;lrblon of Water Quality, Groundwater Section, 1636 Mali Service COW -I REV. 07/2001
�1 3211 within 30 days.

WELL CONSTRUCTION RECORD
274589
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
W ELL CONTRACTOR (INDIVIDUAL) NAME (p(hri) ©T// beee CERTIFICATION II
`�%��€/ 9,[bj i3 n- 2 597
WELL CONTRACTOR COMPANY NAME hie nrt�It�� FIIONE N f
SEA TE tv ELL CONSTRUCTION fEMASSOCIATED WQ FERMI TN
11TN {if apdrlicabic)
(if opplicnblc
WELL USE (Check Applicable Dos): Residential cr Mt nicipal/I'ublic L7 Industrial O Agricultural O
Ptoniloriug ❑ Recovery ❑ heat Pump Water Injection O 011tcr O If Other, List Use
2. WELL LOCATION:
Nearest 'Jowl': ier02Ce County ,$r,,;.T,7)
Qic eve
(Street Name, Nutnbtu, Cormunily, Subdivision, Lot No., Zip Code)
1. OWNER: Z,5et fekci
Address dip !Y•bu/ C04it,
(SC (Street or Route No.)
Pe PCM 5yF)
City or Torn State Zip Code
Arrx cote- rhone number �15`J 3
• 4. DATE DRILLED
5 TOTAL DL•PTII' G!J'
Topographic/Land setting
❑Ridge OSlopc ❑Vnllcy ❑Plat
(cheek nppropriale box)
Latitude/longitude of well Iocalion
NJS 3V'os.sx' 1,0013 64'5g•s"
(degrret/m l n ulc a/s cc nnde )
Latitude/Imigilude sourcc:OGPSOTopographic map
(check box)
PEP TIl PRILLIRIQ I,OG
From To Formation Description
Civ/
-L/<veI
0 — LIED
VJ - l/5- Cray
//r— 6/J (3rawr/ e-
6. DOES WELL REPLACE EXISTINO WELL7 YES O NO a
7. S I ATiC WATER LEVEL Below Top of Casing: SO rf.
(the "4" it Above Top of C.dng)
S. TOP OF CASINO IS try.. ET. Above Land Sul face•
clop or r.tlne Irrudn.ttd •Vnr btton hand no fate rvpd,ee
..rl.nte In .ccord•itte nigh 15A NCAC IC .0119.
9. YIELD (gpni): - METHOD OF TEST /91r
I0. WATER ZONES (depth): G 00
11. DISINFECTION: Type fT.M
12. CASING:
iamsler
Ft. ,.Ls
From To It.
From To Ft.
13. GROUT: Dept /�'1nprinl Method
From o To )-) FL tett/4nI
Front to Ft.
14. SCREEN: Depth Diameter Slot Size Materiel
n
From
rFI. iu, in.
—
From To il, in, in.
15. SAND/GRAVSAND/GRAVELPACK:
Depth Size Material
From To FI.
q
fi
Amount 7Y4ch#
Wall lhicknass
Depth or WcighVPt. Material
ironr D To /� r ice ,flee
From To EI.
16. REMARKS:
f �CA'FION SKEI_CII
Show direction and distance in miles frot4t, I leash
Iwo Stale Roads or County Roads. Inclu lie rgg '
numbers and common road names.
Cfl
o
JUL -.3 2003
iIUNATUR
pliiUtiyxL RIpclF ^I!o the Division orl IVIn er (Innlity, Groundwater Section, 1636 Mall Service Cenler - italeigh, NC
N j OW-1 REV. 07/2001
ASFI�6AEt ��F,! � )
IIIS WELL WAS CONS I RUCIED IN ACCORDANCE Wfhl ISA NCAC 2C, WELL
AND TIIAT A COPY OF TIIIS RECORD IIAS BEEN PROVIDED TO TIIE WELL OWNER
�ctivr�v�cc (I-2- - 03
OF PERSON CONS IRUCiINO TIIE WELL DATE

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME
t(print)) T C F F F R Y HV b i_
WELL CONTRACTOR COMPANY NAME /1.21- Vvrx Lt5 oxl •D/t.t-Ltra\
272677
CERTIFICATION # 20 Sc
PHONE I flag) 419 -Sgrit
STATE WELL CONSTRUCTION PERMIT,/ ASSOCMTED WQ PERMIT#
(if applicable) (if applicable)
I. WELL USE (Check Applicable Box): Residential 0 Municipal/Public ❑ Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION:
Nearest Town: . -1-. G-t.1
1797y- GiS� kJ, J
(Street Name. Numbers, ommuniry, Subdivision, Lot No.. Zip Code)
3. OWNER "2Y. klat MCl/TN,
Address / 79 `7 4z o.%r Rcl,
(Street or Rbute No.)
mtit j'n.c S7i3
City or Town State Zip Codc
(jlq)- 3a)- 597S.
Area code- Phone number
4. DATE DRILLED 5'/79/?.003
5. TOTAL DEPTH: 6OS-
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO .ID
7. STATIC WATER LEVEL Below Top of Casing: 3o FT.
(Use "+" if Above Top of Cuing)
8. TOP OF CASING IS % FT. Above Land Surface*
*Top of cuing terminated at/or below land surface requires a
variance In accordance with 15A NCAC 2C .0118.
9. YIELD (gpm): 7 METHOD OF TEST
10. WATER ZONES (depth): 5 7 S
County St.t)
11. DISINFECTION: Type HT/-1 Amount 0./Ojl
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
From 0 To 37 Ft. 6 //9- SDR
From To Ft.
From To Ft.
13. GROUT: Depth Material Method
From O To 72.0 Ft. Ct7na rv± (PA rrkntrsc,
From To Ft. U U
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.
REMARKS
`I n6 HF'RcRy R j1^tHAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH I5A NCAC 2C, WELL
CONSTRUCTIONS AIN..ARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
II
Topographic/Land setting
❑Ridge ❑Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topogtaphic map
(check box)
DEPTH DRILLING LOG
From To Formation Description
c
LOCATION SKETCH W `o
Show direction and distance in miles frogat legt=
two State Roads or County Roads. Inclut he nutccT
numbers and common road names.
o<
0
Us/9.5`! i! %trtlet ,,
Le Ln rN.t ak rtxt.
p 546 9%p
Jj
4*RE OF PERSON CONSTRUCTING THE WELL
DATE
Submit theoriginal to t Division of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
,till 17699 1636 PhoneiNb. (91 733-3221, within 30 days. GW-1 REV. 07/2001

WELL CONSTRUCTION ItELOiW
Notch Catolina - Depattutent of Euvhoumcul and ntNnlutal Ilesoutces - Division of Wnlcr Quality - Groundwater S1cIioui 3
WELL CON IMCIUIr (INIII\'IUUAL) NAME tpilnl) /`/ry Aech" crtuirICAl7UNN
; /At v)ti! Dr; III PHONE IIJc--4) 6'32 —255.7
WELL CUNT ItACI ON CUa1PANY NAME.J
ASSOCIATED WI) PEItMtIN
S rArE WELT, CONS rI1NCIl ON fEIU111N if opt Rent)
(if oVplicnblc) _
276093
I. WELL USE (Check Applicable Ibis): Residential f hhuticipal/public U Indust'inl LI Aglicullwal
:Amino' Mg Rccovcly U llcnl Pump \Vnlct Injection U Olhcr LI If Other, List Use
2. \V f l- I. LOCA-I-ION:
Neatest olvnt_
L3% c,i CI )1/ County fw ti
7— —
51Y/eS__ a4� — =
(Smeel Hone, Num ha!, nbv, 5nbdi vision, Uri No., Zip Code)
3. OWNER: frG/7/Cr C Jcr1lr it')
Address %n Tr,'b.,l 604sF•
(Sir rel of Houle No.)
Cn). nr lotto 51n1e
Pn it h,4'7
Zlp Code
Ara coclr. f lione number-
.,1. DATEDRILLEO
5. -10rm. D1TrN:_—i00
( DOES WELL REPLACE EXISONG WELL'! YES U NO lE'
7. S VATIC WATER LEVEL Below Top of Casing: (S .. ._I 1 •
(Lite If Alcove lop of Cminp)
P. 101' Or CASINO IS /L2i ___ ET. Above Land SuuIirce'
Iry of wine Irnnbi•Ird •tlnr orlon Hunt nitl.er let/nitro •
'edam! In •rcord•irte with I5A NCAC IC .OI IN.
u. YIN.) (gpnt): _(_S ___ METII9D 0!' rrP
10. WATER ZONES (depth): go
I I. DISINFECTION:1)pc 1f t 1
12. CASING:
Depth
front 0 10 i5
•
f tool Io
ftout ho
13. OROU L: Depth
foot 62 To L
Diameter
FL 6"'S'
VI.
1' I.
Mrt
"/// inl
IA-7
fl. C%""jjGvls
//(i c ✓�
Amount
\Noll l lrickoroi
or \VciglrUEi. Material
502) I /CI"
Holt' To
scRC•FN: Dcplh
how l -_
from To
15. SAND/GRAVEL PACK:
Depth Size
I1.
float
float
16. REMARKS:
io
To
Method
Cs./
I./inflicter Slot Size Mnluinl
In.
in.
Mateinl
'fapogrnpitic/Loud setting
Ultidge LISIope UVnllcy UI'Ia(
(check npp,oprlile hoc)
Latitude/longitude of well locn(iou
.1/35c 7'05-3c o fl 26.1
(degrredndnulc:o , ndQ
Lnliiadcf!rrn¢iludc SOMCC:U(i I'SLI I opogr^:ride imp
- (check bokl.
ULJ't l UiQI"L!NU LU_Q
(rout 10 formation Ucscriptiun
iOky
s( o G,irz.
LVQATIOILSYU ll
Show direction and distance in mile Pan nl least.
Iwo Slnle Roads or County Ronds. includdhe road
numbers and common rood names.
Cr)
t1IIER,PP'i ICf 1NNl 1
Fee#5-1*W I O N`STMtfj
IIIS WELL WAS CONS IitUCI L'D IN ACCORDANCE, WI III I5A NCAC 2C, WELL
AND 1IIAT A COl'Y Of 1111S RECORD IIAS PEEN PROVIDED 10111E WELL OWNER
/1--/6-Df
SIUNATUJU Of PERSON CONS] RUCI IN011IP WELL WOE
Hd wIt Dtrrsu. r,/ 1 o Ill Hon of Willer Qunllly, Groundwater Stella!), 1636 Mall Service Culler - Ralelglr, NC
1VIs111)th'OGIttROAM/ 73- 3211; itititln 30 uoy3.
0 W- I REV. 0712001

WELL CONSTRUCTION au+, A/W.! 276582
North Cntulina - Department of linvlionoretl! nod Nnl !al Ilasoulccs - I)ivlslon of 1Vntcr (lunlily - Clloundw(dcr Sccliun
?fry �'ecc�. crnrlrlcA hint z`f6'3
NI ELL CON IIUCI 1111 IINI,l\!IIIIAI.) NAPIF Ir hit) �`
n-Cl,l, corn RACI UII COP' ['ANY NAnlr
I Il'I ION rF1U1110 ASSUCIAIP,I' \Vr) PF,ItN❑IN
SIAIF. aFI. )
1 ruvNr, r
IJQI i 1
I. CONS rll--------- — (il npplicnblc
(il npplic ablc� /
I. \RI.I, USI1 (Check Applicable Iltr ): Rrsidculinl v Aluuicipal/rubric LI Indnsllinl L_I Aglicullulnl LI
t.lnuilo' Mg U Recovery LI I Ic:rt hoop \Valet Inf cclion LI Ulher U If (Mier, Llsl Use
2. WEII.LUCAIIUNy [ Sc..J{ /t
Nearest -Itor n: C-'4e'_-J [cc e _-Comity
1. U\Vflplt Lt••/ L 7,5 ic.
Atklirss yin 7 6'1 Ce11)/- _ 0-0__P:\<- r1kk
(Shur OF Route Nn.)
n1 I min Slide 71110mle
„
An" udr Phone mm,brl d
,I, Ilnlli l)Itii LRN L_ 25 = -_--
5.-I171AI. NRI'IIL[HIPS__
VI'I I pl'I'I.C11 I' XIS WO \V111.1,7 ti'RS C1 NU 1.V
7. S I-AJ IC WATER I.p1'IiL llclnw optof onine. Coning: __SO,,,
n O,,, __
Olgr1' 1-. Above Loud Surlirce'
A. -INV (ll" CASINO IS _ 1-i7i _ . _
•1rp rl , a,l,q 1,n,d„•Ir d •II„r I„ln., land nn l• ra 1 npJ, e, a
•Jinn In ,rtrcnlaiitt "dill Isn NUM' IC.0I I,.
Q. YIPI.I' (!'I'lll) _ t2—,_ nsi 1IUI! or TIisT- j
1-d_ _
Ill. R'ATRIt lUNI!S (Jrplh): �_ ---
.nl 7`if Auluuul ��Y t
1I. UISINI rcI IUN:.I)pc_L_----\Vnlldhirknras
12. CASINO:
Ihplli, Uinmetcr of Wright/It N11 c1in1
f loaf Q To ,5 PL_�, �_ 5€.1•-
,21 f
hmu i— to iot_ rLJ'j-2-(__ ../zifit ee /
I'tmlr-_-- 1r__—I1_ -. _. ------ --
lnlclinl / 'Whorl
I1. UR o Ilcplh �fi'GSic/-e-
I'rtnn �7— rvp_II. %�/i flit/lam —
llnlrr------ lo_ I I-. _.----- --- - -- --- —
Ilirundct Slul Sire t,lnlerinl
14_ SCn, I!I°N: Ilrpdr In.
Tr Il. _ in. __ In.
Ilan_-_____ .-. .__ —
IS. SAtII)/UItAVII, PACE: Alnlrllnl
!lrrilll Sire
opolp npliidl.mnl'elfin(;
Ultidge, I,ISlopc LI Valley Llrinl
ILLrr4 nrprta„la. hoar
Lnllludc/lougilude of well Incnl) iN
,1.15so269: y5 vu1wo83 22 09-s
p1r}'rrdminn0y11a-•,,d,j
Ls nulcc;U' ll'SCi fopttpi IIic r.:
--I,.d
I)IL'Ul URll,i,l'!-- I CA)
I'10111 -Io polmnlion Ucsctipliun
— 7- 'c "T-
5s .zYo-G"_)-e
ftoln—Io--_hL_
from 1e —1.1._
LVLA7IUl!_S1<IJt;11
Show tlitccllou nod dialnnce in Miles ROM nl lead
Iwo 51nle Rinds or Couuly Ronda_ Include the trod
numbers nod common tond Aortas.
III. REMARKS: _ _______ --____
I _ 1rju Iirnf115 6111 Lin. i iris wrl 1, WAS CUf15 IRUCIPU III ACCUIIUAIICII WI III I5A IICA12C', WELL . r1 t7NS+ItrR_F,411-vf.AId11Q1?) i�IIl)IIIAI.ACOPY U1''IIII5RECORD IIASDail I'IIUVIDLD"10"IIU!WELL OWNER
-/1
_, IC,tIAfUlll! UI�1'IiItSUN CVI Isl RUCI INU 7I IU WELL
DA I -
I
snit-0 1r! oilamnl ly-FI4e IIII llnn nl \Vnlri llunllly, CI ounthrnler Section, 1636 Moll Service Center) !Weigh, ru:
1401 R%6 1'Jtour No ,(qlp) 711- 111, nllhlu 311 tiny,.

276489
o #�5v
WELL CONTRACTOR COMPANY NAME CTY In Lc) encKt'/�/117 PHONE itf3'/t{t Z/77- S£y6i
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMITS
(if applicable) (if applicable)
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Nature 4esources -'Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) de,T`'J p/'i/ LY�/G{F CERTIFICATION
1. WELL USE (Check Applicable Box): Residential 12i 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• h y50 f4 Li Ty County s IA; o..: h
C./mr,n,. )/lax Fad k g4
(Street Name. Numbers, Community,
Subdivision, Lot No., Zip Code)o
3. OWNER: BOi,1 Ra r 0.f-iC Z�OL
bac T P
(Street or Route No.)
Qt Son err N.,(
(51x)-yp:1 3 " .4'4,'o
Arca codc- Phone number
4. DATE DRILLED 7-ih,V U
5. TOTAL DEPTH: '/( C
rs-7/3
Zip Code
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO Gd
7. STATIC WATER LEVEL Below Top of Casing: J a-0 FT.
(Use "4-" 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 1SA NCAC 2C .0118.
9. YIELD (gpm): '7 MET4OD TEST a., i^
10. WATER ZONES (depth): .-23 5
11. DISINFECTION: Type
12. CASING:
Depth
From 0 To //&
From To
From To
H 714 Amount d . G 3
Wall Thickness
Diameter or Weight/Ft. Material
tin Rat Pvc
Ft.
Ft.
13. GROUT: Depth Material r� Method
From A To 2Q Ft. C.e1•72 7� YUmprh
From To Ft. OOLC9
14. SCREEN: Depth Diameter
From To Ft. in.
From To Ft. in.
15. SAND/GRAVEL PACK:
Depth Size
From To Ft.
From To Ft.
Slot Size
in.
in.
Topographic/Land setting
❑Ridge ❑Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/iongitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From To Formation Description
v
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.
ran o-1 monA f'o6T 0-�4":'te Turn,
/eIN an ,.5 m; lk
Turn 16PT on a.lrnonul bocci -
Material ^k ^� 1 e 'Torn
Y. r 'Ih( G-o 0•S m•
IdT" 6-6 0.1 roes welt on
14T
Material
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
e4I'ery ilyd e 7-27-6t3
SIGNATURE ct 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. G W-1-REV. 07/2001

276488
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Nature/� esources - Diiviisionj f Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME/ (print) aiN'/'Cery yet e) CERTIFICATION # .2 6 )
WELL CONTRACTOR COMPANY NAME 6-rct Ll0. N'1 G /B// .( Y.///1(1.7 PHONE a (S-124- Y79—�"1f5'G
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential WI Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other ❑ If Other, List Use
2. WELL LOCATION:
Nearest Town: Bryson Gt•Tx County 3lAlc.,n
CkirnonA h„a7 perk rya.
(Street Name. Numbers, Community, Subdivision, Lot No.. Zip Code)
3. OWNER: !`O.y sS,Igpec)^A
Address Ot wren ecs T fi AYk R.d
YY (Street Route No.)/7
arlSign ciry
Sato i'V' Zrp�S' / /3
CiCode
( - (-l9Sr /997
Area code- Phone number
4. DATE DRILLED 7 ` 2'-1- o 3
5. TOTAL DEPTH: 1/4.5-3/0
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO a
7. STATIC WATER LEVEL Below Top of Casing: //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): 7 METJD9F TEST O` /r
10. WATER ZONES (depth): y
I1. DISINFECTION: Type /� T/t%
12. CASING:
Depth
From 0 To /07 Ft
From To Ft.
From To Ft.
13. GROUT: Depth Material
From 0 To 16 Ft. C emf n T
From To Ft.
14. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in.
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Size Material
er
Amount 0.7Y
Wall Thiclmess
or Weight/Ft. Material (� (. I�
SEA PVC Pro in almdM)o\ IosT o-rtr'G>=`
Topographic/Land setting
❑Ridge ❑Slope ❑Valley 0Flat
(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
w
G
From To Ft.
From To Ft.
LOCATION SKETCH 9
Show direction and distance in miles fronuapleast---
two State Roads or County Roads. Include -Me raid
numbers and common road names.
Turn /eIT on ag_ 5 6 e
Method
p"VD rCV m/e Tern hot on c.lInc
boo-T ark RJ. 6Lo 0.1 Tor n
T G O.1 Mile &IJe// on
/ef T
16. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH I5A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY
YYO�FFTHIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
tery
e
e kSI NATURE OF PE SON 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 Natura
WELL CONTRACTOR (INDIVIDUAL) NAME/�(print) ve
WELL CONTRACTOR COMPANY NAME Crdtbafrr1
STATE WELL CONSTRUCTION PERMIT#
(if applicable)
276487
I $esources - Divisio of Water Quality - Groundwater Section
f rY /Ci CERTIFICATION H 2C) S0
tc/p //' CX t i //+fig PHONE B 12;25 9%y Jysti
ASSOCIATED WQ PERMIT('
(if applicable)
I. WELL USE (Check Applicable Box): Residential ® Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring ❑ Recovery 0 Heat Pump Water Injection ❑ Other 0 If Other, List Use
2. WELL LOCATION:
Nekrest Town: County 6. Ufa, n
TO✓1'T .nA /a<P es- Tp
(Street Name. Numbers, Community, Subdivision, Lot No.. Zip Code)
3. OWNER: Cbh+5 lien "Id ft\)///))
Address la) torrilrr-q' Tr n.CP
(Sweet or R acts No.)
City or Town State Zip Code
Area code- Phone number
4. DATE DRILLED 7' 2J — 3
5. TOTAL DEPTH: C,r
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO 14
7. STATIC WATER LEVEL Below Top of Casing: WO 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 .011B.
9. YIELD (gpm): k METHOD OE TEST G.+ }"
10. WATER ZONES (depth): 515
11. DISINFECTION: Type N r 1 Amount f). 9�
12. CASING: Wall Thickness
Depth Diaa�meter or Weight/Ft. laterial n
FFromrom e TToo 74 Ft.Ft, (ri 4 Sbkal {SVC �ydrn G�M�n� ��57 d } G,e rfl
From To Ft. 5 r� %2'J+BPS �TUI^)7
13 GROUT: Depth Material Method 1 e• • T o n ,2ss-
G `.
From 6 To r1U Ft. Cornt n7 rfvmp+n1 JQPron 7l/—Co 2,3 ins JPS Tur✓!
From To Ft. i #T on oif�anc( /akat5Ta%e era 3
14. SCREEN: Depth Diameter Slot Size Material / P
From To Ft. in. in. JeS, p h ] O n �%�a 167� v�1
From To Ft. in. in.ill •��rn l`e�
15. SAND/GRAVELPACK: jt16s! (j-° Q,(p M!-�P %Ur✓) 1gr T
Depth Size Material f/ )e it
From To Ft.h wen on f t
From To Ft. �d ()el +
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 to
Show direction and distance in miles fromnt Teas-C
two State Roads or County Roads. Include the road
numbers and common road names.
16. REMARKS:
1 DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUC I ED 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 COI �UCTING THE WELL DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Servke C4nter Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. - 'GW I- REV. 07f2004----

276486
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME
(print) detier/l�r y' llyi e CERTIFICATION MU.O 5-.6)WELL CON'IRACTOR COMPANY NAME Vrct ki YVj IAJe)// 9i'ithemer PHONE*, 1L ii't'7Q'$y5d/
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT*,
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential ® Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection ❑ Other 0 If Other, List Use
2. WELL LOCATION:
Nearest Town: Drys»n i7y County Su kV /I
t�ke s»Ie Pl„I
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: 4-n1nigri Ty kin mCS
Address fe'nTtatt /ok`STAT'
(Street or Route No.)
Bryyson City !ALL 1,$-713
City or Town State Zip Code
(at)- Vi4- 3s'i7
Area code- Phone number
4. DATE DRILLED 7—/6— 03
5. TOTAL DEPTH: yAS"
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO
7 STATIC WATER LEVEL Below Top of Casing: CO FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS / FT. Above Land Surfaces
*Top of casing terminated at/or below Ind surface requires a
variance In accordance with 1SA NCAC 2C .0118.
9. YIELD (gpm): %a METHOD OF TEST 0.'
10. WATER ZONES (depth): 3CS
I I. DISINFECTION: Type 14 THl
12. CASING:
Depth Diameter
From To4'Z Ft. __
From To Ft. t
From To Ft.
13. GROUT: Depth
From_ To rid
Amount
Wall Thickness
or W'eight/Ft. Material
5or21 Air
Material
Ft. CeltngnT
From To Ft.
14. SCREEN: Depth Diameter
From To Ft. in.
From To Ft. in,
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
Topographic/Land setting
❑Ridge ❑Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
tcheck box)
DEPTH DRILLING LOG
From To Formation Description
CO
LOCATION SKETCH
Show direction and distance in miles frontal leak!,::
two State Roads or County Roads. Includ to njad
numbers and common road names. —
prom eimoha Pos7 o Ce turn. lei T
on �' -5 Go /. roes %ul^rl bah" an.
Method
pt,r,pn 74-E G'o 1.3 mi./es Fornhr>tl on
icon T2 i /akP E5) T e Go 6.YMileS
�rn Rc,l7r an •Ponia.na looP IVor % h
610 0-Sm/'le5 TornR hron lake
5;6e po/nT Go G•1 m;k's To well
Slot Size Material
in.
in.
16. REMARKS: 0 n R togh T
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 �` /G - D 3
PERSON CONSTRUCTING THE WELL Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center -.Raleigh, NC_..
27699-1636 Phone No. [phone], within 30 days.-.`.GW-1 REV. 07/2001

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
\ ELL CONTRACTOR (I,NDIVIDLAL) NAME (print) James B. Brown
276475
CERTIFICATION : 2045
\\ELL coN TRACTOR CoMPAVY NAJ1e Hedden Brothers Well Drilling, Inc PHONE = (828 369-9591
STATE WELL CONSTRUCTION PERNIIT4 ASSOCIATED \\'Q PER\IIT
(ifaeol icable) (if applicable)
I. WELL USE (Check Applicable Box): Residential N, Municipal'Pu'blic 0 Industrial 0 Aerieultural ❑
,Nlonitoring ❑ Recovery ❑ Heat Pump Water Injection 0 Other ❑ If Other, List Use
2. WELL LOCATION:
Nearest Town: Bryson City
1044 Wesser Rd
County Swain
(Sireel Name, NN:nbers. Community. Subdivision, Lot No., Zip Code)
Topooraphic/Land setting
❑Ridge ❑Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
3. OWNER: Roy Lindsey
(degrees 4minutes seconds)
Address 1044 Wesser Rd Latitudeloneitude source:❑GPS❑Topographic map
(Street or Route No.) (ace:: bus)
Bryson City, NC 28713 DEPTH DRILLING LOG
City or Town State
(828- 488-1534
Area :ode- Piro:,e number
4. DATE DRILLED 6-26-03
Zip Code
5. TOTAL DEPTH: 600'
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO C�4
7. STATIC WATER LEVEL Below Top of Casing.: 550 FT.
(Use "." if Abote Top of Casing)
S. TOP OF CASING IS 2 FT. Above Land Surface*
*Top of casing terminated atior below land surface requires a
variance in accordance with ISA NCAC 2C .0118.
9. YIELD (gpm): 15 METHOD OF TEST blow
10. WATER ZONES (depth): 566'
From To
0 43'
Formation Description
clay & sand
43' 600' granite
LOCATION SKETCH
11 DISINFECTION: Type H T H Amount 16 oz Show direction and distance in miles from at least
12. CASING: Waal Thickness two State Roads or Count.: Roads. Include the road
Depth Diameter or Weight 'Ft. Material numbers and common road names.
From 0 To 45 Et, 6" pvc
From To Ft.
From To Ft.
13. GROUT: Depth Material Nlethod
From 0 To 20 Ft.henonite & L i aiL Pxlced
From To Ft.
14. SCREEN: Depth Diameter Siot 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.
O
16. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH I5A NCAC 2C, \VELL
CONSTRUCTION ST3.> 31RDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
'S .�cht) - _.3
SIGN. TURZ E OF PERSON CONSTRUCTING THE WELL DATE
Submit the original to the Disision of Water Quality, Groundwater Section, 1636 Mail Service Cenfed=Rnleigh, NC
Gy\'-1 REV. 07,2001
27699-1636 Phone No. [phone], within 30 [lays.