Tr CY2003

WELL CONSTRUCTION RECORD q��j
North Carolina - Department of Environment and Natural sources Division of Water Quality Section gdd6� CERTIFICATION #
PHONE it
WELL CONTRACTOR (INDIVIDUAL) NAME (print)
WELL CONTRACTOR COMPANY NAME
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT# �—
(ifa licable) (ifap licable)
1. WELL USE (Check Applicable Box): Residential Ld' flunicipa1iPublic 0 Industrial ❑ Agricultural 0
Monitoring ❑ Recovery ❑ Heat Pump Water Injection 0 Other 0 If Other, List Use
RIMrTZ143
2. WELL LOCAT9N:
Nearest Town:
Counry�///1/1
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: /At"' i ;
Address
(Street or ,2oyte No.)
City 1Sd �f�
°j�7/wn `1q t7 �e P Zi Code
Area code- Phone number
4. DATE DRILLED &C
5. TOTAL DEPTH:
6 DOES WELL REPLACE EXISTING WELL'? YES 0 NO d�
7. STATIC WATER LEVEL Below Top of Casing: _30__
T.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS I.33 . FT. Above Land Surface"
*Top of casing terminated at/or below land surface requires a
variancein aorday{e with ISA METHOD OFTEST
9. YIELDELD(gpm): �• .---
10. WATER ZONES (depth):
Sy Pump i/tstetiel
11 DISINFECTION: Type Amount
CASING: �'/0.
From d To 652e/(/d[�r
From To Ft.
From To Ft. '
13. GROUT:/�Depth ^,,Material °a Qr
From.Q-- To_01O Ft.S.LLz.S— fain__ Tw-n (ulp eer}n/y/e,z-t, drive/ 6)4:op OF hez
From._____ De Ft. -- ------ l_. i-2t'c Q%�Gi"TD 7/�
14. SCREEN: Depth Diameter Slot Size Material 40 // � �! ,L•
From
To Ft. in. in. _— 7-min back. ,ll
From
To Ft. in. 1°' —
Topographic/Land setting
❑Ridge Ft151ope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/Ioneitude source:OGPS❑Topographic map
(check box)
DRILLING LOG
Formation Description
DEPTH
From To
LOCATION
269356
0
W' II Th: kn 's
12.
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
a :c us
to ester or Weight/Ft. Material'ernumbers and
common names.
Depth Q l Ft. f�0 sri -L�/ %� li�- we're/ant T-tare
15. SAND/GRAVEL PACK: Material
Depth Size
To Ft.
To Ft.
From.
From
16. REMARKS:
Tale ar�i9ht a/t GIA✓ k/ �fmr're
Method d. di* drive o 1 the ri ht
THAT THIS WELL WAS CONSTRUCTED !N ACCORDANCE WITH 15.A NCAC 2C, WELL
ARDS, AND THAT A COPY OF THIS RECORD HAS SEEN PROVIDED TO THE WELL OWNER
"k
SIGNATURE OF PERSON CONSTRUCTING HE WELL DATE
07/2001
Submit the origt al o the Division of Water QuaTi h, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
-"276l9=F636thoriNo. ('t9) 733-3221, within 30 days. G1Vr1 REV.

Sorted
North Camara • Department of Environment and Nasal Resources . DiNsion of Water Quality • Groundwater
.WELL ON TRUCTION RECORD WELLcoNTRACTOR: '7F7� //
1636 Mail Service Cantu. Raleigh. N.C. 27699.1636-Phone [phone]
271604
Ati«�/1
WELL CONTRACTOR CERTIFICATION 0: _4/
STATE WELL CONSTRUCTION PERMIT:: T�
1. WELL USE (Check applicable 804 Residential Ltd MuNciPal 0 Industrial 0
Recovery ❑ Heat Pump Water Injection ❑ Other 0 If Other. Ust Use:
Agricultural ❑
Monitoring 0
2 WELL LOGATION:.(Stto�ff sketch of the location below) 7".L4-(//UA/vTilr
NaanatTown: . &C 20.4'County
Ow 7 "A&-.y
or £ubdvIdon and lal No.) DRILLING LOG
(Road Name and Numbers. Community.
. 3. OWNER S/(Fiew v ren•A-74e2e - From To
0` ,
Gast or Cade No.)
.leor /t/. C
City oaten See
4.; DATE DRILLED c
5. "TOTAL DEPTH Sys
6. CUTTINGS COLLECTED YES ❑ . NOS 7. DOES WELL REPLACE EXISTING WELL? YES ❑ N00
8. STATIC WATER LEVEL Below Top of Casing: S o FT.
Woo W' a Mow Top of Castro9.. - TOP OF CASING IS 2 FT. Above Land Surface'
- -: 'Top of caratlg Uradnated oatrto�ebelw pad surfaes n9� a variance in scear-
10. IE 1bg CAC m)::�� METHOD OF TEST A> P'4G✓1 /w'
.'.' �. t0i YIELD (9Pm)�' =f
11. WATER ZONES (depth) /z v — 2 4) a
DES EPTh
Po mades Desaiptia'
.7 ,-•••,- 9-/ lw.vs�z7
Zip Cods
ti �'� sri�wz7F
12. CHLORINATION: Type Amount
13.CASING: p✓c
Fromo
From---. To FL-
From To FL
14 t,�ROUT
r.Depth
From To 2!�—Ft.
From , To FL
15. SCREEN:
'>, Depth
From To —
Rom To
From To
16. SAND/GRAVEL PACK:
• ' DePlh •
From •To —.- Ft,
From To.
17. REMARKS:
FOR OFFICE
Quad No:
Balm Na _
If addltloS space is needed use back of tram
WCAT10N SKET Imo.
(Show direction and distance from at least two Sete
Roads, or other map rafafence points)
W
70
J
Method
Was Thickness Depth 4 DIN,Sr or WagNR. NSW
To __L FL 61— Sae- 2 /
Material
A.P.PF7",r-
Diameter ' Slot Size Material
Ft In. ---1n.
FL in. , In.:
FL In. In..
Size Material
IVvfaMltN±E OF CONSTRUCTING THE VIED.
DATE
Solent o a *Won c Wrier Oak. prourdarater Section within 30 69Y3 41W1 P Int
�HHOE

271603
,1--' w# nn Ca/cane. Department of Environment and Natural Resources . Division of Water Quality . Groundwater section //.
1636 Mae Service Center • Raleigh. N.C. 27688.7636-Phone [phone] Q.i J /.'"w u t Tod
' `WELL CONSTRUCTION RECORD WELL coNTRACTOR:. %l/<i/?r'/ - "7i"A// 1 pat" .
WELL CONTRACTOR CERTIFICATION a: .?/
STATE WELL CONSTRUCTION P RMITM:
WL
1. WELL USE (check Applicable a04 Residential lid' fvlunicipal CI Industrial 0 Agricultural 0 Monitoring 0
' Recovery ❑ Heat Pump Water Injection 0 Other 0 If Other, List Use:
2; -AVF. G LOCATION:. (Show sketch of the location below c>.ebVsrrvA.6vl/f
.;NeareatTown: eiervAR/O3,
bthd-tt t `� DRILLING LOG DEPTH
(Road Name and Numbers Community. or Subdivision and lot No.) pamasett Des�
3. OWNER % h s /o /enrFa' From To
yip 0 - 90 "i3r/Z-,
Address lag �j or t: i,/2,
City aTawt State
4,, DATE DRILLED-9 /0/ - 2 O�
5. -: TOTAL DEPTH /
S:- CUTTINGS COLLECTED YES 0 . NO
7.DOES WELL REPLACE EXISTING WELL? YES 0 NOM/
- S. STATIC WATER LEVEL Below Top of Casing: 20 FT.
. ., - run s+•YAbwe Top or Casino) S. - TOP OF CASING 13_20__ FT. Above Land Surface•
'Top W ceiling Uralktated atror below lend surface requires a variance In accor-
dance with 1SANCA02CA11a re /3[own/
',10.' YIELD (gpm): • V h METHOD OF TEST /�
11. WATER ZONES (depth)• /2 0 - /G 0
Ati
12. CHLORINATION: Type Amount
13. CASING: p v-c - t r'tr•ATION SICFT
_.: WY TNdwas Show direction and d"starnce from at Nast lwo State
Depth i Diameter or WeitinvG. rAatedal
From —•_---To -J / Et. f s.— <Pe- 2 / tef, ✓G Roads. or other map reference paints) o
From---- To FL --J
From
14 GROUT Method �r r/Ay c SEE/ //�
Depth . Material
From —id-- To S Q--Ft. lee-,rirt=
From To FL
15 SCREEN
Depth Diameter ' Slot Size Material
From To Ft In. In.
From , .. -. To FL in. In.
From To FL In. In.
15, Sm D GRAVEL PACK: Size Material
Dep)h
From To Ft....__.— -----------
" From To FL _._.-
17. REMARKS.
I IN ACCORDANCEWITH 15A WAG 2C, WELL
'- � ..:•�••. BEEN PROVIDED TOTHE UVEiLONrF-R'
CO HERESY THIS
STANDARDS,
AN ANDTHAHATAWAS /' RE1
If addltlonal space is needed use back of form
FOR OFFICE U
Quad No:
Soda' No.
- 2 2iO3
�• u 1 U
t''iIrE
T%$E •. CONSTRUCTING TIE WELL DASE
to . el Water Quality. aivundwalw Semen within 30 days GW 1 nIEY 1211

271602
4,; DATE DRILLED o os
5. - TOTALDEPTH YES Li , NO®'
6.` CUTTINGS COLLECTED
7. DOES WELL REPLACE EXISTING WELL? YES 0 NO
FT.
B. STATIC WATER LEVEL Below Top of Casing:
ruse *•i Move Top or Casing)
9. " TOP OF CASING ISFT. Move Land Surface'
•_ 'Top of casing NrminUad arrorbelow land surface requires a variance l eeor-
',10.YED Wpm): .Sdance with 16ANtAC20
1% t of Envfonrrent and Natural Resources • Division of Water Duality • Groundwr Section
1636 Mao Service Center • Raleigh. N.C. 276994636PPhone (919) 7334221
WELL CONSTRUCTION RECORD WELL CONTRACTOR:
CERTIFICATION.: 2iyI-/
STATE WELL CONSTRUCTION PERMIT.:
WELL USE (caeca miaow
Residential Municipal 0 Industrial 0 Agricultural 0 Monitoring 0
1' Recovery 0 Heat Pump Water Injection ❑ Other 0 If Other, Ust Use:
2 WELL LOCATION:. (Show sketch of the location below) �lzsaLYY//ice -
Nearest Town: �- Aroma
or DRILLI G' D��_
--•
(Road Name and -:-Numbers. Correraedly. FormaSon DesuWrica
________ U'�s1__From To om ,��
3. OWNER �y / 5
,, Address GLt d/i/rfiT/X/�
p lharir-
2✓��� .v c 1Zk7%Z �S — 2—
.�--- zip Code
City orTowt State..471{426.2.,
11. WATER ZONES (depth)
•
12. CHLORINATION: Type
13. CASING: stir /
4M /C_77a
CJ
Amount It additional space is needed use back of form
.: DePlh. . -Dianelar orWeiWWFt.
From —=� To -4-(-- Ft. _
Rom--- To. --. FL From To Ft —
14GROUT. Depth �f aterial Method
fyL� _
.. From To .. 0 FL- *2c/
From To ---FL
15 SCREEN
Depth Diameter Slot Size Material
From
To Ft In. 1n.
From To Ft In. In.
From ......To FL M' In.
16. SAND/GRAVEL PACK:: Size Material
From •To-,r---Ft
Ft.
From _ To
17. REMARKS.._;._
1 DO HEREBY
CONSTRUCTI
FOR OFFICE U
Dead Na
SerW Na
,Evr
=2 200
submit
SECTION
!ONAL o.rFICE
r rx•ATION SKESrn,
Material . (Show direction and &stance from at Least two State
ad& or outer map reference pans)
"Ex?)
Vic'Vilfi
220
DA5E
TURE THE WELL
OF
Wales Vr mom carou�� within 30 days Cw•t REV. 1I1L

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and atural Resources
WELL CONTRACTOR (INDIVIDUAL) NAM{�(print)chard
WELL CONTRACTOR COMPANY NAME /!/ 'e'-WP//and
//
STATE WELL CONSTRUCTION PERMIT#
(if applicable)
272261
Division of Water Quality - Groundwater Section /�
CERTIFICATION p20//2
PHONE #
ASSOCIATED WQ PER.YIIT#
(if applicable)
k�R, 649-7TL3
WELL USE (Check Applicable Box): Residential PI Municipal/Public ❑ Industrial ❑ Agricultural ❑
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use
2. WELLLOCAT( :
County74 y X'tt-
tateTY/,M ,sfifes - 'rt-t 3a
(Street Name, Number mmunity, Subdivision, Lot No., Zip Code)
Nearest Town
Topogra c/Landsetting
DRidge lope [Walley DFlat
(check appropriate box)
Latitude/longitude of well location
3. OWNER: (degrees/minutes/seconds)
Address Latitude/longitude source•DGPS❑Topographic map
Fair,'
-(Street or Route No.) (chick box)
Fair%' o)P- / /1 J Qrna/ o653 DEPTH DRILLING LOG
ityof/ own State Zip Code From To Formation Description
�a 5/0
Area code- Phone number?
4. DATE DRILLED �J it a
5. TOTAL DEPTH: 70 '
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO fir-
7. STATIC WATER LEVEL Below Top of Casing: --12D FT.
22 (Use"t" 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 accords a with ISA NCAC 2C .0118.
YIELD :METHOD OF
TEST (gpm ) / /rned
10. W TER ZONES (depth):
1a`inStalSeC
11 DISINFECTION: Type
12. CASING:
From Q
Depth q/
To aff Ft.
From To Ft.
From To Ft.
13. GROUT: Depth
From Material
From (i Toc)'O / Ft./t /lief &
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.
LOCATION SKETCH —
Amount Show direction and distance in miles from at -le -fist . -
Wall Thickness hco State Roads or County Roads. Include theioad=-
numbers and common road names. ty E-
er
snzz/
or WeightiFt. NI vial`rox.brevard o %,deli K
estaies. te yo,a' nd .�'0y .i-
Method and -late_ a /e/ 6- r r' Ka,
�i//ra Drive • 7bX dy,JOU/elain (9 -
%Og uo Vrr/'&- - 2///l 6t 7:
art/of'On- the- /sit past
du/nrniL& Rijc Q '
16. REMARKS:
Cr ONStRUTI
Material
THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
ND T COPY OF THIS RECORD HAS BEEN PROVIDED TO T WELL O t ER
25
IGNATURE OF PER(JONSTRUCTING THE WELL.
DATE
Submit the original to rile Div sion of Water Quality, Groundwater Section, 1636 tllail Service Center -RRaaleigh,EV. /NC01
r'276994636i'hotre-N&{9y,rj) 733-1121, within 30 days.

2'11,j't
WELL CONSTRUCTION RECORD
„e- of ;,,ai' :i,• sr
S°ci
HsLL CCY:PACTOR (i Itii^''A-) NAT:E (?''r: Piitche l D. (,'COk CEd Cr.A.IOh b 2043
er. �hc s '�a11 ilrl 1 -0Y't '� (RY 1'>C3 CZC!
.;=LLcasr?a"o�ccr:?�N�ntut Heed Bxo� r 2, .
FZLL CC,YiTRyCTICN ?1R`UT' AS:CCIATE: Y•'Q?t?.'i
STAT' (Je:;I!:t e.
(Ir aCC'�I:ab�:t)
L WELL VSc (Ch::'x App;i:ab!e Box): Resid:'„ia! cif:b?uhi . C !r'a�;2 G a.yr...l7 —a1 ❑
btc..,,.r ri C :Sec.:very C Heat: ^p h'et:r Ir .,.., C 0:,..r •_ It Ct.. r, List L'se
3, WELL LOCATION: Transylvania
NeareetToft: Lake Toxaway Cr+ y
Bear Wallow
—• �'•:r;,r,, ,'cr:'�, :::9Ydla;. :,: N:., 2.� Cxei
CRdse CSI^ CA'z.i:
(::r.'s spr:;^r_:
I-:at..:r.
0WN=R. Jim FluniSS (:er.:a..r+'::-cr �:n.
3._:�.•. x.•..,de sc-:::e.':C?S_ o ograe:-i
Adcas P(1 Box 269 __.�.- � ,,.._.
(Strat 7:r': N.:) h::a'x'xy.o
Lake Toxaway, NC 28747 -,:o
rTv DRILLING, LOG
., -• T:,, 5. 4 z„ cod: F To : ,.m -: on Des:=,plkn
(828 )• 884-7280 0 39' 'nay�&
4 :2e.?tonev_:.o<r 4 9-03 39' 750' . e.�_r�
4, DATE DRILLED 750'
5, DEPTH: TOT?? .._.,r.:
6, DOES WELL Ri??LACE EXISTrN'0 R'ELL? YES ❑ N0 E
7, STATIC: WATER Lcvc_...ar'Tc; cfCuing! 720F:,
(Vie "•" itko7v: To.; c.'Ca:Ll{i
S e
E. TO? OF CASINO IS 2 T. Above Land ^a:.,
'T:F. of<uH.; tom.la' IV:: :Cow Iar.d :uric: regchu a
vsr,,a:e L•. a::: 3aaa w.:h 114 NCAC :C ,9:19,
9. ,17. D r^4 METHOD OF TEST
blcm-
1n, PATER eZONES (depth;: 60',640', & 728'
.
1:, DISINFECTION: Tre F'ETi Am vi-,, 152
12. OA...N O: We. ZJ
n pry'." .. .. .S M a!e:,!
Fro— 0 Dv?�:� 20 F'.ja—et Idb
r.20'—To 41' :t,
To
-. CROUT: D:,::-. 'Material Met:::'
57 'r.._�_ Tc 22 ' t,)'CS'nH —R ="st± ' pt rT="9
7:77 To F.:.
!d, SCLZENDep'W Dia. S:otSz4 ?/,a_:a:
From To Et,_m•in, 11
Fr To r.t.tn
15. SA'd2'72.R.AVBBL PACK'
pcth Size . Ma: er;a:
Fr .,. To =t.
From. • To F:
6.:LN:ARXS
yQCATI0N' SKETC
S:. dIse i:sn and dls'_,:ein ,....a :r_... at'i.:551
: S1a e R:as or Ccc `; .,.a65s. the
yi-C h1 i�:4-T:si�rr ., WAS CCN':T=LC—J ^;.'A R.:A.1• � �,t;, :AA ,:.-_•_
,l'�N $c"r+Jk.At.216vi•111A A COPY OF, cvcOv 4C :=cN :E; To,,`:.=•iC..�ceCed
n.
-
icbntit t,hi o-;y!na1 to the �D��Ivlslosn of
1 33• R1e P:.^ !S^ (315) 1111,tra Yr 1U'
GPC r LECTi0R
A° E`"'L OFFICE
ti. OF PiRSCN CONS V0.7;N: T.3'1 = _
:ATE
'ater Q.alIt , Groundwater Section, 163'. Nail Smite Ccter • Rale!gb-, NC
In 30 day7, G'n'•1 LV.6Z300:

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and
WELL CONTRACTOR (INDIVIDUAL) NAN�(prrint)
WELL CONTRACTOR COMPANY NAME a; et
STATE WELL CONSTRUCTION PER.MITN /7/
(if applicable)
272255
atural Resources - Division of Water Quality - Groundwater Section
�t
CERTIFICATION #CQO/�
PHONE NGag b 1-7ZI3
ASSOCIATED WQ PERMIT#
(if applicable)
WELL USE (Check Applicable Box): Residential 21 Nlunicipal/Public 0 Industrial 0 Agricultural 0
Monitoring ❑ Recovery ❑ Heat Pump Water Injection 0 Other ❑ If Other, List Use
2. WELL LOCAT
Coon /✓
V /
Nearest Town: CL ty //(�i%Syl!G(/�/
' Jotija Vijiz 07 VC_
(Street Name, Numbers, Community. Subdivision, Lot No., Zip Code)
3. OWNER:7)QVId Sand rs
Address JS L-> Inez YL-;5t2. Dr) Ye
(Strec[ mute No.)
Zre✓tied- .AIC) Wad
Zip Code
Area code- Phone number ���JJJ /�
4. DATE DRILLED -3
5. TOTAL DEPTH: 5
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO Ur
7. STATIC WATER LEVEL Below Top of Casino: �_FT.
(Lye "+" 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 accords with 15A NCAC 2C .0118.
9. YIELD (gpm): �—_ METHOD OF TEST __,,..rienst
I
10. WATER ZONES (depth):
II. DISINFECTION: Type
12. CASING:
Topographic/Land setting
DRidge ❑Slope ❑Valley [i✓Fla
(check appropriate box)
Latitude/longitude of well location
DEPTH
From To
(degreesns:nates/seconds)
ude/lour;tude source:❑GPS❑Topographic map
(check box)
DRILLING LOG
Formation Description
Amount
Wall Thickness
_ Depthz r Di�ry_eter or Wei !ht/F't. S� riul
From V _ To Ft. (p /�i o7D a.El �[Ls--
From To Ft.
From To Ft.
13. GROU : Depth �I Material
From U To &O Ft(nri/l °J
From To Ft.
14. SCREEN: Depth
From To Ft. in. in.
From To Ft. in. in.
Diameter Slot Size Material Dry Ve-
15. SAND/GRAVEL PACK:
Depth Size Nlatcrial
From To Ft.
From To Ft.
16. REMARKS:
Submit the_orig,i1 to
276934636 Pfuni2WNu. (
HCE
LO
Show direction and distance in miles from atlebst
two State Roads or County Roads. Include the road`.- -
numbers and common road names.
I Ont Ore✓ard alee utiy„�
(f o al ac-d 3//,t &fQ /X, e.. -
D4ethcd /elf ju 4/-
ror�' how/ire al/-eYore
uf (1zntl-e
4C-14l
r2s dn- th eft ec--t Y
fr-terseebron-
w
CATION SKETCH
AT THIS WELL WAS CONSTRIJCTED IN ACCORDANCE WITH I5A NCAC 2C, 1VELL
6, OyVNER
�
7
AND TH.. A COP y-QF T14 S RECORD HAS BEEN PROVIDED TO THE WE
C
SIGNATURE OF PERSON CONSTRUCCINC - - ELL
i
Division of Water Quality, Groundwater Section, 1636 Mail Service Ceen)tterl REVgh, NC
733-3221, within 30 days.
ET

(Street or Route No.)
Sarasota-. FL- 34440
City or Town State Zip Code
( 1)- 32.2—L185
Area code- Phone number �L.
4. DATE DRILLED L}—zq—C2
TOTAL DEPTH: r-io5'
7. STATIC WATER LEVEL Below Top of Casing: .y r FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS I. 3" FT. Above Land Surface*
'Top of casing terminated at/or below land surface requires a
varianceIELDin am): anP.with ISAETHOD OFAC 2C TESTtined
9. YIELD (gpm): at..+
10. WATER ZONES (depth):
�y p jf sla 1(tr
11. DISINFECTION: Type Amount
12. CASING: Wall Thickness
Depth gain' or Weight/Ft. Material
From�To_g�.Ft. SDR2-r PVC -
From To Ft.
From To Ft.
13. GROUT: Depth AA _' Material
Frorn 0 To Q_ Ft.L�(7/lertt�—_
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.
274067
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and N tural Resources - Division of Water Quality - Groundwater Section
/yy�
CERTIFICATIONQTIthin
WELL CONTRACTOR (INDIVIDUAL) NAME (print) /Z/)e�h .il(c PHONE atkiR)64'1_ zz43
WELL CONTRACTOR COMPANY NAME ry,r r Well a�2d
8 1 ASSOCIATED WQ PER.VIITN
STATE WELL CONSTRUCTION PERMIT# (if applicable)
(if applicable)
WELL USE (Check Applicable Box): Residential Municipal/Public ❑ Industrial ❑ Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION:
N arestTo.vn:�/�Vatd County�ransrlv(tf1ia
r 3K A r7�intCiirt - Lot �f
(Street Name, Numbers, Communiry, Subdivision, Lot No., Zip Code)
3. OWNER:
Address
'rts
enQZane
�Opographic/Land setting
(tdge 0Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:LJGPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From To Formation Description
C
S. TO
6 DOES WELL REPLACE EXISTING WELL? YES ❑ NO Y
toesi
y
c)
CO o
LOCATIONH
Show direction and distance in miles from
two State Roads or County Roads. Include
numbers and common road names.
Frorx_ Breyard taRe- M
-fro thug. /8/ /forth 4t
etho - ette a_ 1,eU on Suck Fisher 1d 2
pnr,Mrr� left on_ Pounding Bramekt
C round ?i/ • kik is mw
at least
the road
16.REMARKS:
aoEH RFiBY,�E R','IF
Iil'l�CONS"RUCTIO'NSTAJil 1\1.
•
Submit the on uulal_[li the
^,�T 94 18 Yi3 ,F'hi n; r:L{g 19) 7
k IF West
asf Office_
T THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH I5A NCAC 2C, WELL
S, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
5-
SIGNATURE OF PERSON CONSTRG THE WELL.
DATE
ivision of Water Quality, Groundwater Section, 1636 Nlail Service Center - Raleigh, NC
GW-I REV.07/2001
3-3221, within 30 days.

274064
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural ResourcescI- Division of Water Quality CEGRTIFICATION Sectionr
WELL CONTRACTOR (INDIVIDUAL) NAME p(printt)) ir'h/R rd AaCra ry PHONE N IR 82203
WELL CONTRACTOR COMPANY NA?IE 17ar�/ei tN 'p l/ Q c� Perot L
7.6
Ig�/ ! ASSOCIATEDWQ PERJIIT#
(if applicable)
STATE WELL CONSTRUCTION PERMIT#
(if applicable)
I. WELL USE (Check Applicable Box): Residential fd( Municipal/Public ❑ Industrial ❑ Agricultural 0
Monitoring 0 Recovery ❑ Heat Pump Water Injection ❑ Other ❑ [f Other, List Use
2. WELL LOCATI N: i(orCSylVGKIGi
Nearest Town: r Q.rd County
sCll vent o ad
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: in cwe1019
Address _ • / 14ox IAli
(Street or Route No.)
I�a�Tdxrraw , NC' 28747
City or Town State Zip Code
( )- 8t1Q — ssea)
Area code- Phone number
4. DATE DRILLED i /4 -03
5. TOTAL DEPTH: I}ri t
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO Ir.
7. STATIC WATER LEVEL Below tTop o of
op oCasing)i
Cain ::*UFT.
8. TOP OF CASING IS I • dn.- FT. Above Land Surface'
•Top of casing terminated at/or below land surface requiresrea
vin ac e with IS METHOD OF TEST 1 lir red
CAC 2C .0118.
9. YIELDIELD (gpm): 4
10. WATER ZONES (depth):
�y puny insulter
11. DISINFECTION: Type
12. CASING:
Dept Dia eter
To 3 Ft. is 79
From 0
From To Ft.
From To Ft.
13. GROt,ZT' Depth
Material
From To_52Q_ Ft. (fal e(1910
From To - FL---
14. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in.
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Size
To Ft.
To Ft.
Topograa�pphic/Land setting
❑Ridge IdSlope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
I. atin:de/longitude socrce:❑GPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From To Formation Description
C
0
y �
1s.
N�
LOCATIONKETCH
CO
0
Amount Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
Wa ll Thckn-ss
Spat
tLy• (o H- f,W
m.did toX /e-� tt ! eft on Silverstone
Qrs nrk . Go 4.5 Miles -Er cedar
F(ot'>LBrevard +aXe-
or Weight/Ft. �lIatecommon^al numbers and common road names.
From
From
Method
pat:22 — S10:11.n9 ItiOus€ on_ -the l'+-
beIoUJ -file- road. ttiel- Is mete
-fo driveway near gar”Q•
Material
THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH I5A NCAC 2C, WELL
S, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TOO WELL `ER
�4 (moo
... G THE WELL DATE
SIGNATURE OF PERSON CONSTRU
'1 1i�° i.:717t ul d �LEhe D vision of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
G,n.�GW-1 REV.07/2001
A.a rutty o. (919) 733-3?21, within 30 days.

274061
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
CERTIFICATION p
WELL CONTRACTOR (INDIVIDUAL) NAME (print)
WELL CONTRACTOR COMPANY NAME garktor Wv 11 and
$71 ASSOCIATED WQ PEPLMIT8
STATE WELL CONSTRUCTION PE2MIT8 1(if applicable)
(if applicable)
PHONE NA) 649.7Z63
1. WELL USE (Check Applicable Box): Residential l3' Municipal/Public ❑ Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 if Other, List Use
2. WELL LOCAT N: Topographic Land setting
Nearest Town: County ansy/'mkt. ❑Ridge f(�Saope ❑Valley ❑Flat
WIMP.Rf , _ _ en oak/ Lot,# '! (check appropriate box)
aw,tmLatitude/longitude of well location
(Street Name, tiers, Community, 1nd Subdivision, Lot No., Zip Code)
�,q t Qvianp Vase (DandAlosser-Mdf�
3. OWNER:
Address
t (Stree or
Pisg4t Forest, NC 28768
a+)- R �I A356 Zip Code
Area code- Phone number :J /1
4. DATE DRILLED 5-11"03
5 TOTAL DEPTH' LIn5'
(degrees/minutes/seconds)
Otih(p Rid1 e Vase Latit :d_/long:tu C scurce:❑GPS❑Topngraehic map
Route No)
DEPTH
From To
6 DOES WELL REPLACE EXISTING WELL? YES ❑ NO I8'
7. STATIC WATER LEVEL Below Top of Casing: 120 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS 1.33 FT. Above Land Surface`
•Top of casing terminated at/or below land surface requires a
variance In accorda ce with ISA NCAC 2C .0118. limed
I
9. YIELD (gpm): Q.—_ METHOD OF TEST med
10. WATER ZONES (depth):
pump 1 stacl'or
II. DISINFECTION: Type
12. CASING:
Dept ny tametzr
From 0 To 1 Ft. /V
From To Ft.
From To Ft.
Amount
Wall Thickness
or WeighUFt. Material
i221 eve-
13. GROUT: Depth Material
From C To 2.0 Ft.P_nW)aret�-.
From To Ft.
14. SCREEN: Depth Diameter
From To Ft.
From To Ft. in.
15. SAND/GRAVEL PACK:
Depth Size
From To
From To
16. REMARKS:
Ft.
Ft.
Slot Size Material
in. in.
in.
Material
(check box)
DRILLING LOG
Formation Description
v U
e,
1 —
xt]
W m7
LOCATI ON SKETCH �-
Show direction and distance in miles from at teastt
two State Roads or County Roads. Include the road
numbers and common road names.
Fronk Erevard -La.ke Williamson
Creek_ Road • Tate_ aleft on
rbr„ti gentwood- Go aka
l rytiJe -Will fje to -the- left.
glut 12idieCuerlook- tzt_
Ifq
DO ITE E& ,�III R Y �ERWIF HAi
FONSTRUCTION Sl ANUAP.�
L. A,
9orbt�tat"t,GFib=rirfg$F<tJ-it Utvl
'75 S44)-163k.1'11Le'rt100019j_733-3
IS WELL WAS CONSTRUCTED IN ACCORDANCE WITH ISA NCAC 2C, WELL
ND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE ELL >t WNER
IGNAI'UREOFs�RSON HE WELL
DAT
'ion of Water Quality, Gr'oundwa er Section, 1636 Mail Service Center - Raleigh, NC
221, 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) NAIVE (print) ltet rlCK VI. io.wytLc3 CERTIFICATION # a43to
WELL CONTRACTOR COMPANY NAME OEkQe S¢r.,,a cA a' 5 n oati :Then? inc- PHONE # (Su�
it a 56- .is
STATE WELL CONSTRUCTION PERMIT` ASSOCIATED WQ PERMIT#
(if applicable) E-' ' (if appicable l) am
1. WELL USE (Check Applicable Bc::): Residential 60 Municipal/Public ❑ Industrial 0 Agricultural ❑
Monitoring ❑ Recovery 0 Hen: Pump Water Injection ❑ Other ❑ IfOther, List,Use
2. WELL LOCATION: -
Nearest Town: (Ira es a County 1 t o.n}ybV o.nrc�
c3v.ebec C.O anu&;iU
(Street Name. Numbers, Community, Sabots,ision, Lot No.. Zip Code)
3. OWNER: emerald gab vlaorn
Address (c(oa9 wendtcSwnr:lle riw.b
(Street or Route No.)
F jei— .l.er (C. a573a
City or Town State Zip Code
( )-
Area code- Phone number
4. DATE DRILLED a-o3
5.'TOTAL DEPTH: t1e1-I
6. DOES WELL REPLACLEXLSTING WELL? YES ❑ NO 71P
7. STATIC WATER LEVEL Below "-op of Casing: 9 FT.
(Uv,: "+" if Above Top of Casing) '
8. TOP OF CASING IS # ET. Above Land Surface*
*Top of casing terminated at/or below Izr d surface requires a
variance in accordance with I5A NCAC 2C .0118.
9. YIELD (gpm): 3 METHOD OF TEST
10. WATER ZONES (depth): dd
27481.8
Topographic/Land setting
DRidge QjlSlope ❑Valley DFlat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic crap
(check box)
DEPTH DRILLING LOG:
From To Formation Descript on
9 l y a7 , reon:A
u
C
CD
L
2
11. DISINFECTION: Type 1:1%S
12. CASING:
Depth Diameter
From -'% To e1%
From To Ft.
From To Ft.
13. GROUT: Depth NI.iterial Method
From 0 To ab Ft. C.:nient _ ail_o
Amount 1
Wall Thickness
or Weight/Ft. Material
M .Ri rle,s+:c
From To
14. SCREEN: Depth
From To
From To
15. SAND/GRAVEL PACK
Depth
From To
From To
16. REMARKS:
Ft.
Diameter Slot Size Material
Ft. in. in.
Ft. in. in.
Ft.
Ft.
Size Material
LOCATION SKETCH
Show direction and distance in miles fromat lea --
two State Roads or County Roads. Includ_'' be rca'fi
numbers and common road names.
icy( v
LU —
r♦ of
I r, IFDaidEI EBMIICERjr1Fj i
'' O)4STRIWFIibNiSTAND
J 1
UII L l_I _ SIGNATURE
LSubmit the or_ ioinal to_1_1e DiV
27699L1636 Piiitnc-N6J(9d9) 733-
ASHE ---J= !r EE
HIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH I5A NCAC 2C, WELL
AND T;AT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
ra a- o :3
PERSON CONSTRUCTING THE WELL DATE
ision of Water Quality, Groundwater Section, 1636 Mail Service Center -Raleigh, NC
3221, within 30 days. GW-1 REV. 07/2001

2'72598
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment anddJ4atural Resources -,(Division of Water Quality - GroundwaterpSection
!Mad WELL CONTRACTOR (INDIVIDUAL) NAME (print) KiMa-0 yt eCrary PHONE CERTIFICATION
`�7/
)�
WELL CONTRACTOR COMPANY NAME Vjarller Well and. Pump /
STATE WELL CONSTRUCTION PERMIT# 12 ! l ASSOCIATED WQ PERMIT
(if applicable) (ifapplicable)
I. WELL USE (Check Applicable Box): Residential EI 64unicipal/Public ❑ Industrial 0 Agricultural 0
Monitoring ❑ Recovery 0 Heat Pump Water Injection 0 Other ❑ If Other, List Use
2. WELL LOCAT QN:
Nearest Town reV'ifd
'77iY12See �I
(Street Name, Numbers, Comm, Subdivision, Lot No., Zip Code)
3.OWNER: Address a )4 TIIabPr" Point
County i-anSyl vnnJa-
&revard
((o��� G(Street or Route No.)
CiTowState
)ry7614-BS
s f' Zip Code
Area code- Phone number
4. DATE DRILLED ►-1-11-03
5. TOTAL DEPTH: Q45
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO Er
7. STATIC WATER LEVEL Below Top of Casino: 1401 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS 1 .33 FT. Above Land Surface`
*Top of casing terminated at/or below land surface requires a
variance in accorda9ce with I5A NCAC 2C.0118. Tmed
9. YIELD (gpm): (nd METHOD OF TEST
10. WATER ZONES (depth):
ti pump instt-a/!er
II. DISINFECTION: Type
12. CASING:
Depth From ^ 0 To o
From To
From To
13. GROUT: Depth
From 0 To ao
From To
14. SCREEN: Depth
From To
From To
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
Amount
Wall Thickness
Diam ter or Weight/Ft. N afl
Ft. (o YR 5D2z I five -
Ft.
Ft.
7 Material
FLj tilla-ret•e-
Ft.
Diameter Slot Size Material
Ft. in. in.
Ft. in. in.
16. REMARKS:
opographic/Land setting
tdge ❑Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Laiitude/long rude source:OGPSC]Topographic map
(check box)
DEPTH DRILLING LOG
From To Formation Description
0
W —_
cc'
rt
I oZ
>0
-O
LOCATION SKETCH
Show direction and distance in miles frorr tj leag
two State Roads or County Roads. Include the card
numbers and common road names.
From_ Brevarol take 14- y a!5
-fo Firt- Department. Take �-
Meth d I ef`f on Tanasset Cap • a
Poufs 3/11, Milo and larn r{.tt oru
itiveu)o •
-aulin _
the
2169A1,} f,II*l_`Jtl(1.19)7
THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH I5A NCAC 2C, WELL
S, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO T WEL OWNER
_j� 1�� /f /7V,..
GNATURE OF PERSON CONSTRUCT1 E WELL
'vision of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
-3221, within 30 days. GW-I REV. 07/2001
aJ

STATE WELL CONSTRUCTION PERMITS
(if applicable)
WELL CONSTRUCTION RECORD
276014
North Carolina • Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) Jereply H. Bowman' - . CERTIFICATION S 2 80 9
\\'ELL CONTRACTOR COMPANY NAMED Rntaman We1 1 nY111 Ing Tnr• PHONE # H78 7 5 2-7779
ASSOCIATED WQ PERMITS
(if applicable)
I, WELL USE (Check Applicable Box): Residential (% Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery ❑ Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION:
Nearest Town: Brevard
R(-) Road Lot #24
County Transylvania
(Street Name. Numbers, Community, Subdivision, Lot No„ Zip Code)
3.OWNER: Steven Michael Staton
Address P.O. Box 118
)2nama
(Street or Route No.)
NC 28772
City or Town State Zip Code
( Area code- Phone number
4. DATE DRILLED 'i / 1 2 / f1 T
5.TOTAL DEPTH: 260'
6, DOES WELL REPLACE EXISTING WELL? YES 0 NO Gi
7. STATIC WATER LEVEL Below Top of Casing: 90 FT.
(Use "+" if Above Top of Cuing)
8 TOP OF CASING IS 1 • 4 FT: Above Land Surface'
'Top of cuing terminated aUar below land surface requires a
variance In accordance with l5A NCAC 2C,0118.
9. YIELD(gpm): 7 METHODOPTESTotary air
10. WATER ZONES (depth): 1 80'
240'
I1. DISINFECTION: Type tablet Amount 6
Topographic/Land setting
❑Ridge ❑Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
• (degrees/minutes/seconds)
Latitude/longitude source:❑OPS❑Topographic map
(chock box)
DEPTH DRILLING LOG
From . To . Formation.Description
12. CASING:
Depth
From h To 88
From To
From To
Wall Thickness
Diameter or Weight/Ft. Material
Ft.51/8 Sch_84 PVC
Ft.
Ft.
LOCATION SKETCF{
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
"numbers and common road names. e
0
13. GROUT: Depth Material Method
From 0 To 20 R. concrete gravity flow
From' To Ft.
14. SCREEN; Depth Diameter Slot Size Material
From To Ft, in.
From To Et. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
in,
in,
0
w
c
r—
>a
NJ
0)
16. REMARKS:
t" ‘ i DQ HEREBY CERT, trA
) ,•CONSTRU L10i` Vtk
I
�lt-))(
Il�i
HAT THIS WELL WAS CONSTRUL I ED IN ACCORDANCE WITH I5A NCAC 2C, WELL
ARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
Z%a
SIGNATURE of PERSON CONSTRUCTING THE WELL DATE
L-_ __ a mu the (itr*n41 to t
GRO I#9,9 I'3 'FPYt�'thr a'p. (91
H rtv I'}�F ...
e Division of Water Quality, Groundwater Section, 1636 Mall Service Center -Raleigh, NC
733-3221, within 30 days, GW-I REV. 07/2001

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) Jeregty H. Bowman' - CERTIFICATION 12809
WELL CONTRACTOR COMPANY NAME
STATE WELL CONSTRUCTION PERMIT#
(if applicable)
276013
D Amman Well fir{ 11 {ngr Tnrr PHONE # 17R 757-7779
ASSOCIATED WQ PERMIT#
(if applicable)
I. WELL USE (Check Applicable Box): Residential (X Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION:
Nearest Town: Brevard
Ross Road Lot #24
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: Steven Michael Staton
Address P.O. Box 118
JZncman,
(Street or Route No.)
Nr 28772
City or Town State hip Code
( )-
County Transylvania
Topographic/Land setting
❑Ridge ❑Slope ❑Valley DFlat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH{ DRILLING LOG
From To Formation Description
Area code Phone number
4. DATE DRILLED 3/17/n1
5. TOTAL DEPTH: 260i
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO CI
7. STATIC WATER LEVEL Below Top of Casing: 40 FT.
(Use "t" if Above Top of Cuing)
8. TOP OF CASING IS 1 • 4 FT, Above Land Surface*
•Top of casing terminated actor below land surface requires a
valance In accordance with ISA NCAC 2C .011S,
9, YIELD (gpm): 7 METHOD OF TEST'.: rotary air
10, WATER ZONES (depth): 1 80'
240'
11 DISINFECTION: Type tablet Amount 6
12. CASING:
Depth Diameter
From 0 To 88 P161/8
From To Ft.
From To Ft.
13. GROUT: Depth Material Method
From 0 To 20 Ft. concrete gravity flow
From To Ft.
14. SCREEN: Depth Diameter Slot Size Material
From To Ft, in. in.
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft,
From To Ft.
Wall Thickness
or Weight/Ft. Material
Sr+ 80 PVC
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common road names.
0
16. REMARKS:
_�O HFREE Y_CERS1EY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
COrItSTRUCTIONSTA. RDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
Submit the origina
of
L.__—_-2-149944.14-Plwnclsl.). (919
OF tE
/ Lit 3
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
e Division of Water Quality, Groundwater Section, 1636 Mall Service Center -Raleigh, NC
733-3221, within 30 days. GW-I REV. 07/2001
N

WELL CONSTRUCTION RECORD 276011
North Carolina - Department of Environment and Natural Resources • Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) Jerepty H. Bowman' - CERTIFICATIONS 2809
WELL CONTRACTOR COMPANY NAME D Amman WP11 Dri 111 ng Tnr PHONE Y 878 757-7779
STATE \YELL CONSTRUCTION PERMITS ASSOCIATED WQ PERMITH
(if applicable)
(ifapplicable)
I. WELL USE (Check Applicable Box): Residential X Municipal/Public ❑ Industrial ❑ Agricultural 0
Monitoring ❑ Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION:
Nearest Town: Balsam C;rnVP County Transylvania
Old Wagih Road
(Siren Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER:
Address
Brandon Rathbone
P.O. Box 182
(Street or Route No.)
T a1.o ox awaa"y
City or Town State
rv� 28747
Zip Code
Topographic/Land setting
ORidge ❑Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
•
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box) r.
DEPTH. DRILLING LOG
From To Formation Description
( )"
Area code- Phone number
4. DATE DRILLED 3/06/03
5. TOTAL DEPTH: 1 4 0 '
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO IX
7. STATIC WATER LEVEL Below Top of Casing: 1 0 FT,
(Use "+" if Above Top of Cuing)
8. TOP OF CASINO IS 1 • 4 FT. Above Land Surface'
'Top of casing terminated at/or below land surface requires a
variance In accordance with 15A NCAC IC .011g,
9. YIELD (gpm): 30 METHOD OFTEST'-rotary air
10. WATER ZONES (depth): 7 0 '
100' 120'
1I. DISINFECTION: Type tablet
12. CASING:
Depth Diameter
From _To 70 Ft.h1 /8
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
From To Ft.
Amount 6
Wall Thickness
or Weight/Ft. Material
Srh 80 PVC'
Material
Method
LOCATION SKETCK
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common road names.
R. concrete gravity flow
Ft.
Diameter Slot Size Material
Ft. in. in.
Ft. in. in.
Size Material
From To Ft.
16. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUC IED IN ACCORDANCE WITH I5A NCAC 2C, WELL
S, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
Submit the the origina
27699-1636 Phone N
t rOl)RUlr( 4 iLC110N
ASPL'VF _L
3
SIGNATURE OF PERSON CONSTRUCTING THE WELL
3/bt, /G3
DATE
Division of Water Quality, Groundwater Section, 1636 Mall Service Center -Raleigh, NC
(919 733-3221, within 30 days. OW-1 REV. 07/2001

WELL CONSTRUCTION RECORD
276200
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) RICHARD MCCRARY CERTIFICATION # 2016
WELL CONTRACTOR COMPANY NAME BARKER CONSTRUCTION, INC./BARKER WELL & PUMP PNONE # [phone]
STATE WELL CONSTRUCTION PERMIT# 1871 ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential El MunicipaUPublic 0 Industrial 0 Agricultural 0
Monitoring ❑ Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION:
Nearest Town: BREVARD County TRANSYLVANIA
HWY. 280
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: EDWIN POINDEXTER
Address 525 ASHEVILLE HIGHWAY
(Street or Route No.)
BLANTYRE NC 28768
City or Town State
( 828 )- 877-3359
Area code- Phone number
4. DATE DRILLED 06/27/2003
5. TOTAL DEPTH: 325'
Zip Code
Topographic/Land setting
❑Ridge ®Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:0GPSf7Topographic map
(check box)
DEPTH DRILLING LOG
From To Formation Descrip4Dn
r
r-
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO Gill
7. STATIC WATER LEVEL Below Top of Casing: 10 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS 1.33 FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordance with 15A NCAC 2C .0118.
9. YIELD (gpm): 2 METHOD OF TEST TIMED
10. WATER ZONES (depth):
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common road names.
11. DISINFECTION: Type ay PUMP INSTALLER Amount
12. CASING:
Depth
From 0 To 20 Ft.
From To Ft.
From To Ft.
13. GROUT: Depth
From 0 To 20
Wall Thickness
Diameter or Weight/Ft. Material
61/8 SDR21 PVC
Material
Ft. CONCRETE
From To Ft.
14. SCREEN: Depth Diameter
From To Ft. in.
From To Ft. in.
15. SAND/GRAVEL PACK:
Depth Size
From To Ft.
From To Ft.
Method
POURED
Slot Size Material
in.
in.
Material
O
c9' P 1- JcLc.d 2a- s siJpu�. c220.
)t1a l fca2.rnc X - . <~J, i N. 4e.
kiw.Q-14- k trvo 6k- kit /tLti
C 011 "cam ,LACA-,ti- Matt
16. REMARKS:
1 DO,HEREBY CERT fl' THA' THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, ELL
CONS1'R I TIOty'ST AND THAT A COPY OF THIS ECOR HAS BEEN PROVIDED TO THE ELL OWNER
L s1
L Submit the original to the DivIision of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
27699-1636 Phdne No(919) 7331-3221, within 30 days. GW-1 REV. 07/2001
URE OF PERSON CONSTRUCTI
WELL DATE
0
0

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
,/t1 ,, I,) � CERTIFICATION -'> 0 ,
WELL CONTRACTOR (INDIVIDUAL) NAME (print) rr�� `J/Z ya t �Mi �r!
WELL CONTRACTOR COMPANY NAME Gil-9.Ln 1SNe r I( 5 PLAIT) 2 (n PHONE e
STATE WELL CONSTRUCTION PERMITN ASSOCIATED WQ PERMIT*/
(if applicable) (if applicable)
WELL USE (Check Applicable Box): Residential Cr-Municipal/Public ❑ Industrial ❑ Agricultural ❑
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other O If Other, List Use
2 WELL LOCATION:
Nearest Town: L�I_v-%o ' n�
(Street Name, Numbers, Community, Subdivision. Lot No., Zip Code)
OWNER. John mtct_no Address 3-rJ
3`I -S (�(er„en1 1A •
County Tft-L-„5-.I `vxu '.c,
(Street or oute No.)
City or Town
State .Zip Code
cxa3)- te,ya - 05 a
Ara code- Phone number
4 DATE DRILLED 3 - 2 Y-0 3
5 TOTAL DEPTH:
6 DOES WELL REPLACE EXISTING WELL? YES O NO 13z
STATIC WATER LEVEL Below Top of Casing: / 00 FT.
(Use "6" if Above Top of Casing)
8. TOP OF CASING IS / FT. Above Land Surface•
•Top of cuing termineted +t/or below land surface requires a
variance In accordance with 15A NCAC IC .01I13.
9. YIELD (gpm): / 2 METHOD OF TEST /i-ri
10 WATER ZONES (depth):
Ii. DISINFECTION: Type
12. CASING'
Depth Diameter
From / To i Fe Ft —6
From re To 70 Ft. ( ),1 L Pi/c-
From To Ft.
13 GROUT: Depth Material
From 0 To 2, 0 Ft. ..S4kfir7t/S
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.
276116
I./21)L43-12OC
Topographic/Land setting
CV}flidge ❑Slope ❑Valley ❑Flat
(check appropriate box)
Latitudailongim e of well location
35 °/o 07o7z° Hx' oA OS
(d c grecsimi nu traisecc nda)
latitude/longitude source:ROPSOTopographic map
(check box)
PEPTH DRILLING i3OG
From To Formation Description
5t0 LO
L 07 2, ys- UP,,-iti
16. REMARKS.
Amount
Wall Thickness
or Weight/Ft. Material
LOCATION SKETCH o r'
a
Show direction and distance in miles from eat Least`=.
two State Roads or County Roads. Include
numbers . d common road names.
1 DQ HEREBY CERTIFY 77;iNIT THIS WELL WAS CONSTRULIED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION-STIA1�1',DAOS, AND THfS)I' A COPOF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
3-a8-o3
SIGNATURE OF PERSON CONSTRUL I ING THE WELL DATE
Submit the original to the qivision of Water Quality, Groundwater Section, 1636 Mail Service Center -Raleigh, NC
27699-..1'616fhotie Not. .[phone], within 30 days. GW-I REV. 07/2001

2'76115
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural(Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print)
/�%1I/1,2 -sM/i`h, CERTIFICATION .-'70)I
WELL CONTRACTOR COh1PANY NAME C'7rc ie n RIVY r ANQ II S PtArr r` f0 PHONE S fP27.) Le (5' 12 or
STATE WELL CONSTRUCTION PERM ITN ASSOCIATED WQ PERMITS
(if applicable) (if applicable)
1 WELL USE (Check Applicable Box): Residential Q' Municipal/Public 0 Industrial ❑ Agricultural ❑
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other ❑ If Other, List Use
2. WELL LOCATION:
Nearest Town: 8i,'t`✓t?/s C'1
Edc1= if
County /Rrf.Uby I✓zcv,;-
(Street Name.' umbcn, Community, Subdivision. Lot No., Zip Code)
3 OWNER: Trcd LJ65 Arn,T Ai/r✓
Address q ✓c,tfr RcA
(Svicet or Route No.)
FOROSt A/C 28.74
City or Town State . Zip Code
C- fl7-'tl2),
Area code, Phone number
4 DATE DRILLED '3 --2 8 - 03
5 TOTAL DEPTH: % OS-
6. DOES WELL REPLACE EXISTING WELL? YES ill/NO 0
STATIC WATER LEVEL Below Top of Casing: )'0 FT.
(Use "+" if Above Top of Cuing)
8 TOP OF CASING IS / FT. Above Land Surface'
•Top of cuing terminated atfor below land surface requires a
variance In accordance with I5A NCAC 2C .0118.
9 YIELD (pm): 2 /2 METHOD OF TEST t4 /Z
10. WATER ZONES (depth):
11. DISINFECTION: Type
:2. CASING:
Depth From I To O p
/-t T/t Amount
Wall Thickness
Diameter or Weight/Ft. Material
Pt G to 21, L PYG
From 5 To G S' ter G 1r 2 i: c Pvc-
From To
13 GROUT: Depth
From (7 To 20
From To
14. SCREEN: Depth
From To
From
Topographic/Land setting
❑Ridge ❑Slope 2-Valley ❑Flat
(check appropriate box)
Latitude-longitudeof well location
37` /H /iN 0521'.90"11-,11-✓
(degrces/minurtdseconda)
Latitude/longitude source:SV-PS❑Topographic map
(check box)
PE?TH pRILLING LOU
From To Forn tion Description
0 — 40 �nv
510 C.
Material Method
Ft. G,4k, 1.r1E M;y Y—i'k>1Z
Ft.
Diameter Slot Size Material
Ft. in. in.
To Ft. in. in.
15 SAND/GRAVEL PACK
Depth
From To
From To
I6. REMARKS:
Size Material
Ft.
Ft.
G d /05-
CI
LOCATION SKETCH CO
3ItarShow direction and distance in miles fromcleast�.-
two State Roads or County Roads. IncludeqPe road.
numbers and common road names.
1 citiSis-drtuctribt4
ll
THIS WELL WAS CONSTRUU ED IN ACCORDANCE WITH 15A NCAC 2C, WELL
S. AND TH�T%A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
LSubmit the original tcD
27699-1636 Phone No. ( 19) 7
Jh!
SIGNATURE OF PERSON CONSTRUL I ING THE WELL DATE
ivision of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
3-3221, within 30 days. GW- 1 REV. 07/2001
RetA

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and �Natural Resources Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print)" eta'i% /j(n envy CERTIFICATION Naf0/0
WELL CONTRACTOR COMPANY NAME p.y
STATE WELL CONSTRUCTION PER..IITI /O 71 ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
276209
rfer Wd e2/1l' Apr PHONE Nato )6 1-92e
1. WELL USE (Check Applicable Box): Residential {Jr-Municipal/Public 0 Industrial 0 Agricultural ❑
Monitoring ❑ Recovery 0 Heat Pump Water Injection 0 Other ❑ If Other, List Use
2. WELL LOCATION:
Nearest Town'
I(j/ler ' Odd
CountyF(113'X/L/O/7/CL
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER:/J(lilt/PS4an-
Address / 80
Ail ittst
(Street or Route No.)
Sri -yard
City or Town State
gr )- 86M- 3600
2-87/z
Zip Code
Area code- Phone number
4. DATE DRILLED 7 03
5. TOTAL DEPTH: b
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO V
7. STATIC WATER LEVEL Below Top of Casino: ¥O FT.
�t (Use "+" if Above Top of Casing)
8. TOP OF CASING IS f•SS 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 7thead
I0. WATER ZONES (depth):
11
12
13
14. SCREEN:
From
From
15. SAND/GRAVEL PACK:
Depth
From To Ft.
From To Ft.
DI/i° I/tst4.uer
DI It FEC ION: Type Amount
CASING:
Topo�g�_r��phic/Land setting
DRidge IidSlope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
L atirude/!o:u-itude source:❑GPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From To Formation Description
w
r
r—
Wall Thickness
Depth Diameter (/I%
m�eter or Weieht/Ft. tllateral
From 0 To /err Ft. (o 1d SO/221
From To Ft.
From To Ft.
GROUT: Depth Material M-=__t^hod
From (7 To 20 Ft.�V .ftle- flow
Frnrr. To Ft.
Depth Diameter Slot Size Material
To Ft. in. in.
To Ft. in. in.
16. REMARKS:
1'DO`H@IEBir
�- CONSTRUCTION{
Size Material
LOCATION SKETCH— „.
Show direction and distance in milestrom g'least
two State Roads or County Roads. ISudellie road
r_.
numbers and common road names.
1aXe ,ilu�� 6if West Nark.
Bi+eva.rd ."(jab ale
✓Adler loadGo 0.5
ncht°c on PoltAIler
f,oad eY/rt.sioa,
THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH I5A NCAC 2C, WELL
WARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO TF(E WELL OWNER
6 7o 3
SIGNATURE OF PERSO
Gri,,j', Submit the ni iginal to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
ASRE . i illir) -Ib i?9C1I11�-NU. �I 19) 733-3221, within 30 days.
CONSTRUCTING THE WELL DATE
GW-I REV. 07/2001

WELL CONSTRUCTION RECORD 277993
North C arohna Doartment o Environment f E t and Natural Rcsolyces - Division oQ Water Qua 't - Groundwater Sect
11102-
WELL CO\TR%CFOR(I\DIVIDUAL) NAME (prior) A
Will -'� 1''a .,
1
e�+�1n�
tPELT. COVIRACTOR COMPANY NAME lUP till ill 6 1 PHONE ft IQ{*1
SLCrE %PP.1.t. CONSI RUCTION PERMITM ASSOCIATED WQ PERNIIT
CJ
I if applicable) (if applicable)
I. WELL USE (Check Applicable Boz): Residential l8/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: opographiciLand setting
d e OSlope DValley OFIat
Nearest Tow t: ��� C`� County t%M SC �t)ijN g
.�tl _/ i (check appropriate bast
.�SYr ^ j�{, 1 tj�7 PV� Z� `IZ Latitude/longitude of well location
� y
Y1 Ina- r �1
Lc
CERTIFICATIONa sat
11
N In
Street Name. Numbers. nnanity, Subdivision, Lot No.. Zip Code)
3. OW'NER&t
Addr, ss 3) e Yi 0
ci or Route c,s,7s7 PEPrt±
��City or Town S
From To
AreaCode
Area code- ?hone number I L Z
4. DATE DRILLED 5. TOTAL DEPTH:_, o-
6 1¢
DOES WELL REPLACE EXISTING WELL? YES NO '
(degrecshrontaes/seconds)
Latitude/longitude source:OGPSOTopographie map
(check box)
DRILLING LOG
Formation Description
7. STATIC WATER LEVEL Below Top of Casing: PT
(Use if Above Top of Casing)
3. TOP OF CASING IS 1 FT. Above Land Surfaces
'Top of casing terminated atlor below land surface requires a•
variance In accordance with ISA NCAC 2C .0118. �a�
e. YIELD (gpm). 7— METHOD OF TES? .1I �® Vaiia%1
10. WATER ZONES (depth): , -2) 46
li. DISINFECTION: Type "1b1idlr Amount T.
12. CASING: Wall Thickness
Depth _ Diameter or Weight/Ft. Material
From C To 3S Ft. —
From____ To Ft. —�
From__ To Ft.
13. GROUT: Depth Material
From To Ft.
From- To Ft.
14 SCREEN: Depth Diameter Slot Size Material
From _ To- Ft. in. . in. _
From To___—_ Ft. in. in.
15. SAND/GRAVEL PACK: Material
Depth Size
Method
From _ To__ Ft
From _To__ Ft.
LOCATION SKETCH
Show direction and distance in miles from at (east
two State Roads or County Roads. Include the road
numbers and common road names.
`t H. . z`1C0
-CC c- rr \A o-• '
E1tQQ1 R. LiKs,. s{ .
16. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH I5A NCAC 2C, WELL
CONSTRUCTIO STAND DS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
`kAJ SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
Submit the o4'ginal to the Division of Water Quality, Groundwater Section, 1636 Mail
27699-1636 Phone No. [phone], within 30 days.
•
GROUNDWATER SECTION
ASHEVILLE REGIONAL OFFICE

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
CERTIFICATION # 2008
WELL CONTRACTOR (INDIVIDUAL) NAME (print) Kenneth McCrary
WELL CONTRACTOR COMPANY NAME Barker Construction, Inc/Barker Well & Pump
277351
PHONE # [phone]
STATE WELL CONSTRUCTION PERMIT(' 1871 ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential Ea Municipal/Public 0 Industrial 0 Agricultural ❑
Monitoring ❑ Recovery 0 Heat Pump Water Injection 0 Other [] If Other, List Use
2. WELL LOCATION:
Nearest Town: Brevard
Fox Crossing Subdivision, Lot #58
County Transylvania
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: Jack Henson
Address 1124 South Country Club Road
Brevard
(Street or Route No.)
NC 28712
City or Town State Zip Code
( 828 )_ 883-4589
Area code- Phone number
4. DATE DRILLED January 18, 2003
5. TOTAL DEPTH: 380
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO
7. STATIC WATER LEVEL Below Top of Casing: 30 FT,
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS 1.33 FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordance with 15A NCAC 2C .0118.
9. YIELD (gpm): 12 METHOD OF TEST Timed
10. WATER ZONES (depth):
11. DISINFECTION: Type By pump installer Amount
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
From 0 To 65 Ft. 61/8 SDR21 PVC
From To Ft.
From To Ft.
13. GROUT: Depth Material Method c '$2 it g? _
From 0 To 20 Ft. Concrete Poured .
CD
From To Ft. fa —
14. SCREEN' Depth Diameter Slot Size MaterialFrom To Ft. in. in. c
0
From To Ft. in. in.
15. SAND/GRAVEL PACK: '.c---
Depth Size Material —J
From To Ft.
From To Ft. IN)
Topographic/Land setting
❑Ridge ❑Slope ❑Valley KlFlat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:0GPSDTopographic map
(check box)
Cr1
16. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
SIGNATURE OF PERSON CONSTRUCTIN THE WELL DATE
Submit the original to the Division of Water Quality, Grroundwater Section, 1636 Mail Service Center - Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. . IGW-1 REV. 07/2001

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
CERTIFICATION # 2008
WELL CONTRACTOR (INDIVIDUAL) NAME (print) Kenneth McCrary
WELL CONTRACTOR COMPANY NAME
STATE WELL CONSTRUCTION PERMIT# 1871 ASSOCIATED WQ PERMIT#
(if applicable)
(if applicable)
Barker Construction, Inc/Barker
Well & Pump PRONE # f 828) 697-7263
1. WELL USE (Check Applicable Box): Residential ® Municipal/Public D Industrial O Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION:
Nearest Town: Brevard
Lake Toxaway Estates, Lot #N5
County Transylvania
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: Frank & Cindy Pidala
Address 8815 Misty Morning Trail
(Street or Route No.)
Odessa FL
33556
City or Town State Zip Code
( 813 )_ 926-6160
Area code- Phone number
4. DATE DRILLED September 25, 2003
5. TOTAL DEPTH: 280
6. DOES WELL REPLACE EXISTING WELL? YES O NO El
7. STATIC WATER LEVEL Below Top of Casing: 20 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS 1.33 FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordance with 15A NCAC 2C .0118.
9. YIELD (gpm): 15 METHOD OF TEST Timed
10. WATER ZONES (depth):
Topographic/Land setting
❑Ridge ❑Slope OValley KlFlat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:OGPSOTopographic map
(check box) _— r
DEPTH DRILLINGLL�i� L—
From To Formation Descriptionr-, _�__: I
..7
Tril-
rc
11. DISINFECTION: Type By Pump installer
12. CASING:
Depth Diameter
From 0 To 75 Ft. 61/8
From To Ft.
From To Ft.
13. GROUT: Depth Material
From 0 To 20 Ft. Concrete
From To Ft.
Amount
Wall Thickness
or Weight/Ft- Material
SDR21 PVC
LOCATION SKETCH
Show direction and distance in miles from at east
two State Roads or County Roads. Include the road
numbers and common road names.
c31t0,2 flu htd tab- /. &HIt/
to Cad f1(ount a in toad _ -o
VigAtiLeetti
trk6 '�- - rpeo
gad. Arty la Ukike-iii1
clut_ct .
Method
Poured
14. SCREEN: Depth Diameter Slot Size
From To Ft. in. in.
From To Ft. in. is
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
16. REMARKS:
Material
279730
c2nauttf&
n
—4
rcw,A5-
`c-
._
o.t
rn
-'O --tom
m;
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, N rn
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
1'--1-t1/Yl--/tt- r V VCL G1 / 7 j
fianif
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Centerl Raleigh,
le gh,REV. NC
27699-1636 Phone No. [phone], within 30 days.

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources
WELL CONTRACTOR (INDIVIDUAL) NAME (print) Richard McCrary
WELL CONTRACTOR COMPANY NAME Barker Construction, Inc.Barker Well & Pump
279728
Division of Water Quality - Groundwater Section
CERTIFICATION S 2010
PHONES [phone]
STATE WELL CONSTRUCTION PERMITS 1872 ASSOCIATED WQ PERMITS
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential El Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION:
Nearest Town: Brevard
County Transylvania
Walnut Cove Road
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: Paul and Nita Small
Address 80 Walnut Cove Road
(Street or Route No.)
Brevard NC
28712
City or Town State Zip Code
( 828 )_ 885-2886
Area code- Phone number
4. DATE DRILLED September 23, 2003
5. TOTAL DEPTH: 345
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO El
7. STATIC WATER LEVEL Below Top of Casing: 40 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS 1.33 FT. Above Land Surface*
*Top of casing terminated aUor below land surface requires a
variance in accordance with ISA NCAC 2C .0118.
9. YIELD (gpm): 3 METHOD OF TEST Timed
10. WATER ZONES (depth):
Topographic/Land setting
®Ridge ❑Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:OGPSOTopographic map
(check box)
DEPTH
From To
DRILLING LOG
FormationDescdptio
11. DISINFECTION: Type BY pump installer Amount
12. CASING: Wall Thickness
Depth Diameter or Weight/Pt. Material
From 0 To 88 Ft. 61/8 SDR21 PVC
From To Ft.
From To Ft.
13. GROUT: Depth
From 0 To 20
Material
Ft. Concrete
From To Ft.
14. SCREEN: Depth Diameter
From To Ft. in.
From To Ft. in.
15. SAND/GRAVEL PACK:
Depth
From To Ft.
From To Ft.
Method
Poured
Slot Size Material
in.
in.
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common road names.
t_if.[Y)f £az/aA d e Q976 . q74
axe At tlx jla ea/zd d d toad. ,do
/X.r_2PD . t Avvit Ater Olt 4(a4ctt
ao aninctattRa&
0J222224_
/1.9a. Zb /-/C.e , 27-c
ea6-e/X aocd to n •luoad '
, Size Material n_ _ - _ .. _ „ ,r-,. i A' A /�
0 � o
r-,
W m t
a
Z
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 RECORD ' BEEN PROVIDED TO THE WEJ, OWI R
7 if
SIGAA URE OF PERSON ONSTR
ING TH
ATE
26
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mall Service Center - Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-1 REV. 07/2001

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) Richard McCrary CERTIFICATION # 2010
279726
WELL CONTRACTOR COMPANY NAME Barker Construction, IncJBarker Well & Pump PHONE # f 828) 697-7263
STATE WELL CONSTRUCTION PERMITS 1871 ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential El Municipal/Public ❑ Industrial ❑ Agricultural ❑
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use
2. WELL LOCATION:
Nearest Town: Brevard
Wlanut Cove Road
County Transylvania
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Co&)
3. OWNER: Robert & Michelle Dupree
Address 70 Walnut Cove Road
(Street or Route No.)
Brevard NC 28712
City or Town State Zip Code
( 828 )_ 883-9750
Area code- Phone number
4. DATE DRILLED September 18, 2003
5. TOTAL DEPTH: 205
6. DOES WELL REPLACE EXISTING WELL? YES El NO ❑
7. STATIC WATER LEVEL Below Top of Casing: 40 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS 1.33 FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance In accordance with 15A NCAC 2C .0118.
9. YIELD (gpm): 9 METHOD OF TEST Timed
10. WATER ZONES (depth):
Topographic/Land setting
❑Ridge ®Slope ❑Valley Gnat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds) -_.__
Latitude/longitude source:❑GPS❑Topographic map"
(check box)
DEPTH DRILLING LOG
From To Formation Description-
L
11. DISINFECTION: Type By Pump installer Amount
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
From 0 To 96 Ft. 61/8 SDR21
Ft.
From To
From To
13. GROUT: Depth
From 0 To 20
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.
Ft.
Material
Ft. Concrete
Slot Size �/
pT/a t/p.Olf/ rd
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. /
PVC SOM.4t.2.ocLLLL fait. f• c;r%(o iv
LlO a.& ei9 u1, do c//%tW .
a bit o7L 2(/ ccL& rala i/ay ,
utd ro /&t a a' 3 //tieto a
d Jad . o%LLt a.
Method
Poured
in.
'axe _Copy Oa16%./
Material ,g A L . , J_
16. REMARKS:
W
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL •
CONSTRUCTION STANDARDS, AND THAT A COPY O0 THIS RECORD HAS BEEN PROVIDED TO THE LL WNP.
SIGNAOF PERSON C• `S 1' . INGTITE WELL
7 9/o?
DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-1 REV. 07/2001

WELL CONSTRUCTION RECORD
279725
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
CERTIFICATION # 2010
PHONE # [phone]
WELL CONTRACTOR (INDIVIDUAL) NAME (print) Richard McCrary
WELL CONTRACTOR COMPANY NAME Baiter Construction, Inc/Barker Wall & Pump
STATE WELL CONSTRUCTION PERMIT# 1871 ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential El Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery ❑ Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION:
Nearest Town: Brevard
Lake Honda, Lot #15-B
County Transylvania
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: Danny Jacques
Address 200 Springwater Drive
(Street or Route No.)
Brevard NC 28712
City or Town State Zip Code
( 828 )_ 884-8600
Area code- Phone number
4. DATE DRILLED September 17, 2003
5. TOTAL DEPTH: 345'
6. DOES WELL REPLACE EXISTING WELL? YES ® NO 0
7. STATIC WATER LEVEL Below Top of Casing: 50' FI'.
(Ilse "+" if Above Top of Casing)
8. TOP OF CASING IS 1.33 FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance In accordance with 15A NCAC 2C .0118.
9. YIELD (gpm): 2 METHOD OF TEST Tinned
10. WATER ZONES (depth):
11. DISINFECTION: Type By pump installer Amount
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft.
From 0 To 38 61/8 SDR21
From To
From To
13. GROUT: Depth
From 0 To 20
From To
14. SCREEN: Depth
From To
From To
15. SAND/GRAVEL PACK:
Depth
From To
From To
16. REMARKS:
Ft.
Ft.
Ft.
Ft.
Ft.
Material
Ft. Concrete
Ft.
Diameter Slot Size
Ft. in. in.
FL in. in.
MaterialPjlitW z �' An /
Size
Material
PVC
Topographic/Land setting
Midge ❑Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:ElGPSDTopographic map
DEPTH
From To
(check box)
DRILLING LOG
Formation Description
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
nuand dco,, Im,,,,mon// road�-Jnnames.
,f,,. /-
gotta Julttr .rama. gd10 Q /�� I'�,2',vttnt,ALO
Method /ppµ,�Q 414/Ida-. 2u /Y7 t
Poured n�,.i,,,,,,,,� rf_ _ 1� -1-1)
Material �/)r^�^�","�I' o:L �utnc , /
N
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C
CONSTRUCTION STANDARDS, AND THAT A COPY OF S RECORDS 4AS BEEN PROVIDED TO THE7
r
SIGNATURE OF PE ON CONSTRUCT
E WELL
..9
r.l
Submit the original to the Division of Water Quality, Groundwater Section,1636 Mail Service Center - Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-1 REV. 07/2001
Um--J

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) Richard MCCrary CERTIFICATION # 2010
WELL CONTRACTOR COMPANY NAME Barker Construction, IncJBarker Well & Pump PHONE # [phone]
STATE WELL CONSTRUCTION PERMIT# 1871 ASSOCIATED WQ PERMIT#
Of applicable) (if applicable)
279724
I. WELL USE (Check Applicable Box): Residential El Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection [ Other 0 If Other, List Use
2. WELL LOCATION:
Nearest Town: Brevard County Transylvania
Honda Lakes Subdivision, Lot #11
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: Bruce & Diane Eberlein
Address 22 Fountain Square
(Street or Route No.)
Belleau FL 33756
City or Town State Zip Code
( 727 )_ 585-3195
Area code- Phone number
4. DATE DRILLED September 16, 2003
5. TOTAL DEPTH: 245'
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO
7. STATIC WATER LEVEL Below Top of Casing: 20' FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS 1.33 FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordance with 1SA NCAC 2C .0118.
9. YIELD (gpm): 12 METHOD OF TEST Timed
10. WATER ZONES (depth):
Topographic/Land setting
[Ridge ®Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:[GPS[Topograpfde-map-----
(check box) r % +L-�
DEPTH DRILLING QG t'.__.-�_�
From To Formation Desciiplie 1E -
11. DISINFECTION: Type By pump installer Amount
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
From 0 To 36 Ft, 61/8 SDR21 PVC
From To Ft.
From To Ft.
13. GROUT: Depth Material
From 0 To 20 Ft. Concrete
From To Ft.
14. SCREEN: Depth Diameter
From To Ft. in.
From To Ft. in.
15. SAND/GRAVEL PACK:
Depth
From To FL
From To Ft.
N
-
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.
hizom6Aland taiea%S. to ecui. j& -
£oact. 40 up �Eppa__.dggt��� dotIG td.Q..rict tan
Method o d4cinda- OLt k-icg- P_ZQpd ��.V""K�c lD S:av-v /kekw
Poured `�� Zo 1 �/�tlii1/41 7/f�, �1 and
aba..trgd Lat. odJ Duce Lap
•qI'L� -.i7Qc�dtd2-�! L J2aii .
GG U o p
Slot Size Material
in.
m.
Size Material
16. REMARKS:
W
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCO ANCE WITH 15A NCAC 2C,y✓ELL
CONSTRUCTION STANDARDS, AND THAT A C9PY QF' INS CORD BEEN PROVIDED TO THE
�NSIGNATUR OF PERSON CONS
CTING 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
279723
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) Kenneth McCrary CERTIFICATION # 2008
WELL CONTRACTOR COMPANY NAME Barker Construction, Inc./Barker Well & Pump PEONS # [phone]
STATE WELL CONSTRUCTION PERMIT# 1871 ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential fp Municipal/Public ❑ Industrial ❑ Agricultural ❑
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use
2. WELL LOCATION:
Nearest Town: Brevard
Cherryfield Creek Road
County Transylvania
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: Tim Waldrop
Address 814 Cathy's Creek Church Road
(Street or Route No.)
Brevard NC
28712
City or Town State Zip Code
( 828 )_ 884-2411
Area code- Phone number
4. DATE DRILLED September 18, 2003
5. TOTAL DEPTH: 330'
6. DOES WELL REPLACE EXISTING WELL? YES O NO El
7. STATIC WATER LEVEL Below Top of Casing: 20' FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS 1.33 FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordance with ISA NCAC 2C .0118.
9. YIELD (gpm): 1 F+ METHOD OF TEST Timed
10. WATER ZONES (depth):
Topographic/Land setting
❑Ridge ®Slope DValley DFlat
(checc appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:DGPSDTopographicmap___..
(check box)
DEPTH DRILLING LOG
From To Formation Description
11. DISINFECTION: Type By pump installer Amount
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
From 0 To 78 Ft. 61/8 SDR21 PVC
From To Ft.
From To Ft.
13. GROUT: Depth
From 0 To 20
Material
Ft. Concrete
From To Ft.
14. SCREEN: Depth Diameter
From To Ft. in.
From To Ft. in.
15. SAND/GRAVEL PACK:
Depth Size
From To Ft.
From To Ft.
Method
Poured
Slot Size Material
in.
in.
Material
16. REMARKS:
n
-+-
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common road names.
3-,co t Atwato talcv 611WC 9ak a_
/t a o ./ Jr' irga 4&.
iiic
Cad Ebe. ,spat, bp Ckluii
,6/c t and 90 Is .-€'Rd toad.
lift qa & a U424D o Q$ .
(1 CO0
0
0
'O
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 O'
VCc vn.cf rL !Mt c / i c,
SIGNATURE OF PERSON CONSTRUCTING THE LL DATE
Submit the original to the Division of Water Quallty, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-1 REV. 07/2001
Zr_1
oC
n
rno
crn
N±
rnz
t7
H
0

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) Kenneth McCrary CERTIFICATION # 2008
279722
WELL CONTRACTOR COMPANY NAME Barker Construction, Inc/Barker Well & Pump FRONE a [phone]
STATE WELL CONSTRUCTION PERMIT# 1871 ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential ® Municipal/Public O Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection ❑ Other O If Other, List Use
2. WELL LOCATION:
Nearest Town: Brevard
Lake Sega
County Transylvania
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: Gail C. Meyers
Address 16818 127th Drive North
(Street or Route No.)
Jupiter FL 33478
City or Town State Zip Code
( 561 )_ 473-0163
Area code- Phone number
4. DATE DRILLED September 11, 2003
5. TOTAL DEPTH: 480'
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO El
7. STATIC WATER LEVEL Below Top of Casing: 20 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS 1.33 FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance In accordance with 15A NCAC 2C .0118.
9. YIELD (gpm): 2 METHOD OF TEST Timed
10. WATER ZONES (depth):
Topographic/Land setting
ORidge ElSlope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degreeslm inutes/smonds)
Latitude/longitude source:OGPSOTopographic map
(check box)
DEPTH DRILLING LOG
From To Formation Description
LOCATION SKETCH
11. DISINFECTION: Type By pump installer Amount Show direction and distance in miles from at least
12. CASING: Wall Thickness two State Roads or County Roads. Include the road
Depth Diameter or Weight/Ft. Material numbers and common road names.
From 0 To 124 Ft. 61/8 SDR21 PVC JitAMC lia/Zi ±0 Lp ,iw y. bitWitt.
From To Ft. Jab- a �; t O?t d . 0 •. -'"u Yatu,, �
From To Ft. '""a !(.Q�.CI�tn�/ r�^-".'�'
13. GROUT: Depth Material Method a� , � (jy to ye'a Iju
From 0 To 20 Ft. Concrete Poured ai -/ ,/J ,r
From To Ft. ian" w 8_(A d�[/0-lf.Q�." Jar-'
14. SCREEN: Depth Diameter Slot Size Material ,���(/�",(pp�.�/� � b q.Jc c / ega-.cc,, 07 �i, �����
From To Ft. in. in. p� 0Q %X.C(fd Q? lWQ — ,,Z>
From To Ft. in. in. y/ �,p� d �^� n, n� -71�
15. SAND/GRAVEL PACK: 7Iu-a((AJ.. /Wa-.l % "4
Depth Size Material
From To Ft. 2-o
From To Ft. 0
rt
rn;
16. REMARKS: W rn
0
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 0
SIGNATURE OF PERSON CONSTRUCT THE WELL DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-1 REV. 07/2001

280313
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) Kenneth McCrary CERTIFICATION # 2008
WELL CONTRACTOR COMPANY NAME Barker Construction, Inc. PHONE # [phone]
STATE WELL CONSTRUCTION PERMIT# 1871 ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential El Municipal/Public 0 Industrial O Agricultural ❑
Monitoring 0 Recovery 0 Heat Pump Water Injection O Other 0 If Other, List Use
2. WELL LOCATION:
Nearest Town: Brevard
Lankford Road
County Transylvania
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: Randall Lankford, Jr.
Address 202 Lankford Road
(Street or Route No.)
Pisgah Forest NC 28768
City or Town State Zip Code
( 828 )_ 884-9778
Area code- Phone number
4. DATE DRILLED September 29, 2003
5. TOTAL DEPTH: 280
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO gl
7. STATIC WATER LEVEL Below Top of Casing: 20 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS 1.33 FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordance with 15A NCAC 2C .0118.
9. YIELD (gpm): 2 METHOD OF TEST Timed
10. WATER ZONES (depth):
11. DISINFECTION: Type By pump installer Amount
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
From 0 To 103 Ft. 61/8 SDR21 PVC
From To Ft.
From To Ft.
13. GROUT: Depth Material
From 0 To 20 Ft. Concrete
From To Ft.
14. SCREEN: Depth Diameter Slot Size
From To Ft. in. in.
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Size Material
To
To
From
From
16. REMARKS:
Ft.
Ft.
Method
Poured ��-��c��-'
�� z / r
Material IA ��j�
Topographic/Land setting
[Ridge ®Slope DValley ❑Flats
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:0 GPSOTopograplj1c map
(check box)
DEPTH DRILLING LOG
From To Formation Description
O
w
n
c
0
,
r.)
0
—O
a 53-c
(..) en:2-
LOCATION SKETCH rn
Show direction and distance in miles from leas"
two State Roads or County Roads. Include the ro2r1
numbers and common road names.
J1w'n &wcud tcL&- &d 641&Ut.
Jana p,�� ak kert.P azoe fad
Aite
artat_
v7�! /K . yao
I DO FIEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
v
SIGNATURE CONSTRUCTING TH LL �' � 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) NAM} (print) Dcrr:(K NsAWri *}cb.:N VS CERTIFICATION# a4Jto
WELL CONTRACTOR COMPANY NAME C\
ZS .Son meet *- .nj . nC PHONE # (ug (o(05
STATE WELL CONSTRUCTION PERMIT# '" ASSOCIATED W Q PERMIT#
(if applicable
(if applicable)
1. WELL USE (Check Applicable Box) Residential Oi Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring ❑ Recovery 0 Heat I ump Water Injection 0 Other ❑ If Other, List Use
46. 4179'94)
2. WELL LOCATION:
Nearest Town: ?le VI ders;,n11Y:iIC County Te0.n5L\
Jetec t'v\1n Read
(Street Name. Numbers. Community. Subdivis on, Lot No.. Zip Code)
3. OWNER:
Address
AO t W \\o W �y
(Street or Route No.)
7de tndc c *—
City or Town State Zip Code
352C
Area code- Phone number
4. DATE DRILLED � -28 3
5. TOTAL DEPTH: 010,5
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO
7. STATIC WATER LEVEL -Below Top of Casing: Lam% FT.
(Use' F" if Above Top of Casing)
8. TOP OF CASING IS 1 FT. Above Land Surface'
*Top of casing terminated at/or below land surface requires a
variance in accordance with 15A NCAC 2C .9118. 9. YIELD (gpm): lO METHOE OF TEST «q; b
10. WATER ZONES (depth):
11. DISINFECTION: Type Q:\\SAmount
12. CASING: Wall Thickness
Depth Diameer or Weight/Ft.
From Y\ To ' Ft. Colt tk2.
Topographic/Land setting
❑Ridge I2Slope ❑Valley ❑Flat
(check appropriate box
Latitude/longitude of well location
(degrees/minutes/secon is)
Latitude/longitude source:❑GPS❑Topographic ma p
(check hoe)
DEP"; H DRILLING LOG
From To Fomtation Description
le \ : o (j0
QVtt Qaereinn
C20 ; re
Material
?145't:L
From To Ft.
From To Ft.
13. GROUT: Depth Mat :rial Method
From 0 To 2,0 Ft. Cat afl* Pow%3
From To Ft.
14. SCREEN: Depth Diameter Slot Size Material
From To Ft. )3. in.
From To Ft. .n. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft. _
From To Ft.
16. REMARKS:
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the red
numbers and common road names. O o
CJ
r/) vo
m
--00 c z_ m
_
tp gm
y0
r ▪ rn
3 a�
rns
0 rn23
Ci1
Z r_
i
I DO HEREBY CERTIFY THAT THIS WELI WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THA T A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL ORiNER
SIGNATUI E OF PEI SON CONSTRUCTING THE WELL DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center ' KEVg07 2001
27699-1636 Phone No. [phone], with n 30 days.

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) Richard McCrary CERTIFICATION # 2010
WELL CONTRACTOR COMPANY NAME Barker Constnidion, Inc.Barker Well & Pump
282300
PRONE', [phone]
STATE WELL CONSTRUCTION PERMIT', 1871 ASSOCIATED WQ PERMIT# [ L
,17
(if applicable)
(if applicable)
1. WELL USE (Check Applicable Box): Residential fli Municipal/Public O Industrial O Agricultural ❑ ' i
Monitoring O Recovery 0 Heat Pump Water Injection O Other O If Other, List Use
2. WELL LOCATION:
Nearest Town: Brevard
Shepherd's Ridge
County Transylvania
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: Cardinal Building Systems
Address PO Box 746
(Street or Route No.)
Brevard NC
28712
City or Town State Zip Code
( 828 )_ 862-6755
Area code- Phone number
4. DATE DRILLED October 16, 2003
5. TOTAL DEPTH: 605
6. DOES WELL REPLACE EXISTING WELL? YES O NO ria
7. STATIC WATER LEVEL Below Top of Casing: 100 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS 1.33 FT. Above Land Surface*
*Top of caning terminated at/or below land surface requires a
variance in accordance with 15A NCAC 2C .0118.
9. YIELD (gpm): 3 METHOD OF TEST Timed
10. WATER ZONES (depth):
11. DISINFECTION: Type By pump installer Amount
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft Material
From 0 To 20 Ft. 61/8 SDR21 PVC
From To Ft.
From To Ft.
13. GROUT: Depth
From 0 To 20
Material
Ft. Concrete
From To Ft.
Method
Poured
14. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in.
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Size Material n- /1
From To Ft. PIll
From To Ft. /
16. REMARKS:
Topographic/Land setting
®Ridge ❑Slope ❑Valley Pfati
(check appropriate box)
Latitude/longitude of well location''
(degrees/minutes/seconds)
Latitude/longitude source:OGPSOToprgap
(check box) C
tNCi 1.0
DEPTH DRILLG %c T
From To Formation Description
—
O
CO
0
O
W
LOCATION SKETCH N
Show direction and distance in miles from at'leasg
two State Roads or County Roads. Include the road
numbers and common road names.
JA-0/ igilt /aLd eagAttlt
-76-oad. tialt a'
.4Qdio2.ea_ ZirVitailixdd
u,�.e
At /20
eitta
/L(%Qd -
1 of row -
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 ' ' OVID D TO THE WELL OWNER
G
SIGNA ' OF PERSON CON CUING THE LL 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

284502
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) RICHARD MCCRARY CERTIFICATION # 2616
WELL CONTRACTOR COMPANY NAME BARKER CONSTRUCTION, INC./BARKER WELL & PUMP
PHONE # [phone]
STATE WELL CONSTRUCTION PERMIT# 1871 ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential El Municipal/Public O Industrial O Agricultural ❑
Monitoring O Recovery 0 Heat Pump Water Injection O Other O If Other, List Use
2. WELL LOCATION:
Nearest Town: BREVARD County TRANSYLVANIA
MEADOWLARK LANE, LOT #64
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: TRANSYLVANIA HABITAT FOR HUMANITY
Address PO BOX 1071
(Street or Route No.)
BREVARD NC 28712
City or Town State Zip Code
( 828 )_ 884-3464
Area code- Phone number
4. DATE DRILLED DECEMBER 11, 2003
5. TOTAL DEPTH: 185
6. DOES WELL REPLACE EXISTING WELL? YES O NO Dia
7. STATIC WATER LEVEL Below Top of Casing: 30 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS 1.33 FT. Above Land Surface*
`Top of casing terminated at/or below land surface requires a
variance in accordance with 15A NCAC 2C .0118.
9. YIELD (gpm): 40+ METHOD OF TEST TIMED
10. WATER ZONES (depth):
I1. DISINFECTION: Type BY PUMP INSTALLER Amount
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
From 0 To 48 Ft. 61/8 SDR21 PVC
From To Ft.
From To Ft.
13. GROUT: Depth Material
From 0 To 20 Ft. CONCRETE
From To Ft.
14. SCREEN' Depth Diameter Slot Size
From To Ft. in. in.
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth
From To
From To
Ft.
FL
Size Material
Topographic/Land setting
❑Ridge ❑Slope ❑Valley g]Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:OGPSOTopographicmap
(check box)
DEPTH DRILLING LOG...
From To Formation Description
0
0
r a�
m
� cm
LOCATION SKETCH -p
Show direction and distance in miles frotu'�' t le&e om
two State Roads or County Roads. hicludralhe rpaiK
numbers and common road names. tV 2
d34ax c,f i21,,teal,td ,faAil( t - ,cagu-r-y, >a� Weil
/ ✓LOae. bio * Q/Lce
Method C414 fen f2.d„/.,.,, WQ
POURED �>«�K- �/t{ i«uJ!/
4e (afre
Material Vt . o
Wi-Ate• al.Lut zuzze k a-
q ii4
,� �.L %&
16. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY qF THIS R�CORD HAS BEEN PROVIDED TOT E W(?LL OWNER
SIGNATURE OF PERSON CONST UUCtING 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

284500
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) RICHARD MCCRARY CERTIFICATION # 2010
WELL CONTRACTOR COMPANY NAME BARKER CONSTRUCTION, INC./BARKER WELL & PUMP PHONE # [phone]
STATE WELL CONSTRUCTION PERMIT# 1871 ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential El Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other O If Other, List Use
2. WELL LOCATION:
Nearest Town: BREVARD
HENRY MOUNTAIN ROAD
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
County TRANSYLVANIA
3. OWNER: ANNA LEE
Address 445 DEWEY AVENUE
(Street or Route No.)
BOLDER CO 80304
City or Town State Zip Code
( 303 )_ 442-4973
Area code- Phone number
4. DATE DRILLED DECEMBER 9, 2003
5. TOTAL DEPTH: 965
6. DOES WELL REPLACE EXISTING WELL? YES O NO KI
7. STATIC WATER LEVEL Below Top of Casing: 50 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS 1.33 FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordance with 15A NCAC 2C .0118.
9. YIELD (gpm): 2 METHOD OF TEST TIMED
10. WATER ZONES (depth):
11. DISINFECTION: Type BY PUMP INSTALLER Amount
12. CASING: Wall Thickness
Depth Diameter or Weight/FL Material
From 0 To 34 Ft. 61/8 SDR21 PVC
From To Ft.
From To Ft.
13. GROUT: Depth
From 0
To 20
Material
Ft. CONCRETE
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.
Method
POURED
Topographic/Land setting
[Midge ElSlope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:OGPSOopographicmap -
(check
DEPTH DRILLINGiLOG
From To Formation Description
Material
s,
A
IV
IV =4
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common road names.
JiwOt 4,Czcic t teat J.Land
J'c¢Cot ;eo2� As 2Lfatnctt kazdateguo
;ztd o 1/.24 %emu
Road . .0210 . 7l&teI LAnt
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 RECORj) HAS BEEN�PROVIDED TO THE
SIGNATURE OF PARSON COATRU
/2
G THE WELL DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-1 REV. 07/2001

WELL CONSTRUCTION RECORD 29Z'e
North Carolina - Department of Environment and Natural Resources
ook
WELL CONTRACTOR (INDIVIDUAL) NAME (print) Mitchell. D, C
WELL CONTRACTOR COMPANY NAME H1'Y 5 F.11
Division of Water Quality • Groundwater Section
CERTIFICATION # 2043
PHONE k 6251 369-9591
STATE• WELL CONSTRUCTION PERhllTB ASSOCIATED W'Q FERMI-1#
(if applicable) • (ifaoplicable)
I. WELL USE (Check Applicable Box); Residential 6 Municipal/Public ❑ Industrial 0 Agricultural 0
Monitoring ❑ Recovery ❑ _Heat Pump Water Injection ❑. Other ❑ If Other, List Use
WELL LOCATION:
Nearest Town Sapphire
County Translyvania
Hemlock Lane
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3, OWNER: John McKinney
Address PO Box 105
(Street or Route No.)
Lake Toxaway,NC 28747
'City or Town State Zip Cod:
P28 )-862-3382 -
Area code. Phone number
4. DATE DRILLED 11-24-03
5. TOTAL DEPTH: 100'
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO
7. STATIC WATER LEVEL Below Top of Casing: 10 FT,
(Use "*" if Above Top of Cas;rg)
8. TOP OF CASING IS - 2 FT, Above Land Surface*
`Top of easing terminated at'or below land surface requires a
variance In accordance with 15A NCAC 2C .0118.
9, YIELD (gpm); 20 METHOD OF TEST blow
10. WATER ZONES -(depth): 45' & 85'
11. DISINFECTION: Type H T H Amount 160z
12. CASING:
Depth
From 0. To 19
From 19' To 23
From To
13. GROUT: Dept
From 0 To 20
Wall Thickness
Diameter or Weight/Ft. Material
Ft, 6" pvc
Ft 6" .188 steel
Ft.
Material Method
Ftb lhite & l.0 t>=s1 CUrce5
From To Ft.
14, SCREEN: Depth Diameter Slot Size : Material
From To Ftin, in,
From To Ft.- in. in.
I5, SAND/GRAVELPACK.
Depth Size Material
From To Ft,
From To Ft.
Topographic/Land setting
ORidge ❑Slope OValley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees:minutes/seconds)
Latitude/lon(2.itude source:DGPSOTopographic mup
(check box)
DEPTH DRILLING LOG
Formation Description
C.lav & s3rr1
From To
0 21'
21' 100'
granite
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common road names.
O
'*7
rn
co
A
O
lD
16. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH ISA NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN ?ROVIDED TO THE WELL OWNER
y�. oil), • /f /--1 cL /a:
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mall Service Center -Raleigh, NC
27699-1636 Phone No. (919) 733 221, within 30 days. _ OW -I REV. 07/2001
E

WELL CONSTRUCTION RECORD
N_rt'r. C ii 'a - D-a., .ent of En. ironrent and Natural Resources D visicn cF )(Vale: Qu
WELLCONTRACTOR (I:NDIVIDUAL)NA,ME. (print\ Mitchell D. COOK
WELL CONTRACTOR CON?A:vY:N.-0IR 't' Veil a-L11 r,. Try
293859
Orcundix.ter Se -:ion
CERTIFICATION 20413
PHONE E28)
STATE WELL CONSTRUCTION PERMITO ASSOCIATED WQ PERNIIT;
(ifaoolicable) (if zoolicable)
WELL USE (Cheek' Applicable Box); Residential R Municipal/Public C Industrial 0 - -,
tNloni:Cring ❑ -Recovery ❑ Heat Pump Water Injection ❑ 0t'ner C ill Other, Lis; Use
2. WELL LOCATION
Nearest Town:
// ��� �� /11.9JJLI. Coun
£-v`h2 tt1L i'
(Sweet Name, C1 usee:;, C
u.0),VNER
Add
nunit , Su: dig. isb.r, Lo: No., Zip Code)
(er. r R:..e No.)
($Z Koc9 33 a Zip C
;:de• Phone nu racer
4. DATE DRILLED .I - ALI -63
5. TOTAL DEPTH: / 001
6. DOES WELL RE?LACE EXISTING WELL? YES ❑ NO ❑
7. STATIC WATER LEVEL Below Top ot-Casin;: /S FT.
(Use i.`Abcve Top of Casing'
8. TO? OF CASING IS 2 FT. Above Land Surface
•Top or casing terminated at or below land surface requires a
variance In actordarr ice with I5A NCAC 2C .0118.
9. YIELD (;pm): r": NI-H TQD OF TEST blow
t
ID. WATER ZONES (deotc) �5 ft R i
II. DISINFECTION Type
12. CASING:
Depth
From 0 To [Z Ft.
From / q ' To
From Tc
13. GROUT: Depth
zi T H Amount
Ft
Material
From f1 To 20 F u,1te &
From To FL
14. SCREEN: Depth Diameter
From To F. in.
From Tc Ft. in.
15.SAND'GRAVELPACK.
Depth S'.ze
From To -Ft.
n-lier
16oz
Wall Thickness
or A4'ei;h:i :. Nkterial
Method
tarceft
Slot Size Diate ir,l
in.
Material
C„' 'al ❑
Topo°rai .r'Land se line
CRidge ESicce ❑VaUe Fat
(c:re:k arpr,P.m: hce):
Latitude' longitude of c:ea location
ude _ou.__CGPSCT_. r';o ,pbri>m-p- .
DEPTH DS1L_tNC' LOG
Fson''. To , Formation Des_rip:ion
l&emu
r71' 00` granite
LOCATION SKETCH
Sho.v d:r anon and dis:_nce in .miles .ion^, a least
t ,o 5:a:e Roads or Coa.mty Roads. Include the road
numbers and Com-,on road names,
O
W
3
3
w
W
lD
From To Fr.
16. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH ISA NCAC 2C, AAZLL
CONSTRUCT:ON STANDARDS, AND THAT A COPY OF THIS RICO, HAS BEEN PROVIDED TO THE \'•.ELL OWNER
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
Submit the original to the Division of Water Quality; Groundwater Section, 1636 Mall Service Center • Raleigh, NC
27699.1636 Phone No. [phone], w!thin 30 days. OW -I REV. 07/2:31

293858
WELL CONSTRUCTION RECORD
North Cr oI na • Dcpartment of Environment and Natural Resource: • D: is on of Water Qu:Jr
;i
ELL CONTRACTOR (hV'DIVIDUAL)NAME (pr(n!) Mitchell D. Cook
R ELL COY( RACTOR C071?ANY NAME ir'e✓ a^"?_I"t"'S FF11 ai-sl ixr Try
STATE WELL CO:A'STRUCTIO;N PER.NIIT3 AcsOCI 7ED eW'Q PERYIT%:
(if zoo:Icable) (if xe_li:ace)
• Grounthvater Sec: on
CERTIFICAT(OtV� 20d3
P;Kmz. E 5) 369-9791
I. WELL USE (Check Applicable Box): Reslderdia! Z Municipal:Pu'.blic C kdustria! ❑ cult_,_: ❑
Monitoring 0 Recovery ❑ Heat Funp Water Injection C. Other 0 !f Other, Lis: Use
2. WELL LOC.ATIO,
NeajgstTcwn, UAL) Count
41dAti t (MLO/TtI
(S ee M1 N‘r;oers, C rtmanity, S,i:d: •'.cn, Lot No.. Zip Code)
3. OWNER: &W z +14A / r
,ddr is !0n 4x ®l///4. dfaint
lS 'x c• Rava ^ )
LOLL, fie. a87 74
hr 95 Zip Core
Area codo!•.: r:,m r
DATE DRILLED
(08
5, TOTAL DEPTH: (pQ0
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO t
7. STATIC WATER. LEVEL Ee:ow Top of Casing: F I .
-(Use". .o e Top of Casinyr
S. TOP OF CASING IS 2 FT. Above Land Surface'
'Top of calm; terminated atlor below land surface requires a
variance In accordance w' : ISA NCAC 2C .011S.
9, YIELD(zcm): NIETHOD OF TEST blow
ID. WATER ZONES (depth):
I i. DISINFECTION: Tvoe H T H Amount 1 Eoz •
12. CASINO: Wall Th:ck.ness
Depthq- Dia/n_!er orV'ei;h::F:: Mhteriai
From 0 To d 5 Ft. Cto" f (gy o
From Tc F.
From To Ft. 13. GROUT: Depth, Mlaserial . Method
From, 0 To 20 Fd-cJi1-e & oat_ curd
From To Ft.
L. SCREEN: Depth. , Diameter Slog Size ML:erizl
:From To Ft. in. in,
From: To Ft.- in. in.
l5. SAND'GR_k'. EL PACK.:
Depth Size h{dterfai
From To
From To Ft.
Topograp'nic/Land se:tinz
ORidge ES '.oce =Va!!e
(en c.< ] r cox)
La:ltude lon i:ude or well locator.
;;dcrzei
L. '.. _.. ,.. scar _C. aC - c mop
7TH DP. IN„ LUG
From To I Forma:ion Des: _ cn
0 7 3 r•lav & 4 cl
23&OC' granite
LOCATION SKETCH
Show direction and distance in ;-i!e .
to-c 5:a_te Roads or County Roads. Include ,.,._
nur..'7ers and corramo n tea::: names.
6C:C Wd C-AVWh0
f6. REMARKS,
I DO HEREBY CERTIFY THAT TH;S WELL WAS CONSTRUCTED IN ACCORDANCE WITH !SA NCAC 2C, WELL
• CONSTRUCTION STANDARDS, AND THAT A COPY OF TH'S RSCOP.D HAS BEEN?ROVIDEDTO THE `�VELL o'.'N'E?.
La,
SIGNATURE OF PERSON CONSTRUCTING THE WELL . DATE
Submit the original to the Division of Water Quality; Groundwater Section, 1636 Mail Servioe Center • Raleigh, \C
:7699.1636 Phonc No. (919) 733.3.21, »!thin 30 days. 0W•: RE.V. OD 2i2:

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources'lam-
of%Water Quality - Groundwater Section ('
WELL CONTRACTOR (INDIVIDUAL) NAME (print)pr`" "" 6 1 J-k$t if �1-F' CERTIFICATION # �/y1/
WELL CONTRACTOR COMPANY NAME adERIZ(I( }���C_ CT ✓ Itd( PHONE #W79 iS4/L„
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
et
1. WELL USE (Check Applicable Box): Residential 9-Municipal/Pub1c ❑ Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATIION:
Nearest Town: GaDJ' County/R •
(Street `Name, Numbers, Community, Subdivision, Lott No., Zip Code)
3. OWNER('rvu m ,Sulh.6•US-k
Address t}Azu 24
(Street or Route No.)
-lAl r. A 2R7h('
City or Town State Zip Code
( )-
Area code- Phone number
4. DATE DRILLED h —S =
5. TOTAL DEPTH: je0C
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO
7. STATIC WATER LEVEL Below Top of Casing: '.C? FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS I FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordance with ISA NCAC 2C .0118.
9. YIELD (gpm): 2v METHOD OF TEST A.4 R .
10. WATER ZONES (depth): ) STD
11. DISINFECTION: Type
12. CASING:
Depth Di
From0 To453_ Ft.�
Amount 0/ (u
Wall Thickness
eter or Weight/Ft. Material
sail_ 2-1 y'JL
From To Ft.
From To Ft.
13. GROUT: Depth Material
From t) To 7r > Ft. 5raettc� f
From To Ft.
14. SCREEN: Depth Diameter
From To Ft. in.
From To Ft. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
Method
Dull_
Slot Size Material
in.
in.
Topogr c/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 TCoO FormaationnDescription
Cr)
--t
LOCATION SKETCH 0
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common road names. -'
16. REMARKS:
I DO HEREBY CERTJF 'HAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTIO DARDS - T„ LQQ?Y 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

9 T C
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Rest Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) Ma-44' YCAriee I--CATION#31 Sao
Merril
WELL CONTRACTOR COMPANY NAME ( 1 1.4..t ( ( 1pv'' P PRONE ii igigi0 7 i '1'1 3 V
STATE WELL CONSTRUCTION PERMITS / ASSOCIATED WQ PERMIT#
(if applicable) (ifapplicable)
1. WELL USE (Check Applicable Box): Residential f9eMunicipaVPublic 0 Industrial ❑ Agricultural ❑
Monitoring 0 Recovery ❑ Heat Pump Water Injection ❑ Other O If Other, List Use
2_ WELL LOCATION:
Nearest Town- RoS—
County Tree t 5 I ira n,'(A_
(Street Name, Numbers, Community, Subdivision, Lot No, rip Code)
3. OWNER: )011`" ` 14-ei
Address 4 n SeeOW td
(Street or Route No.)
frei.ac( N C_
...-Topographic/Land setting
FiRidge OSlope Malley OFlat
(cheek box)
Latitude/longitude of well location
Ed Rem(' /. ( )
City or Town Zip Cade
� } seyS3g9
Area code- Phone number
4. DATE DRILLED 10`1y-03
5. TOTAL DEPTH: 3 5
6. DOES WELL REPLACE EXISTING WELL? YES p7 NO ❑
7. STATIC WATER LEVEL BelowTop of (rasing S 0 FT.
i (their if Above Tap&Casing)
8. TOP OF CASING IS 1 FT. Above Land Surface*
'Top of casing terssiaated atIor below laud surface requires a
variance la accordatm wlth ISA NCAC 2C MIS. ✓
9. YIELD (gpm): 3 ,r METHOD OF TEST Q
10. WATER ZONES (depth):
Latitude/longitude somce:CIGPS0Topographic map
(check box)
DRILLING LOG
F,pmntion Description
r
SChock_
Ik' ( Qoc/C 7
DEPTH
From To
O 110
it 76
70 7tt
11. DISINFECTION: Type ti 7 H Amount
12. CASING: D
o ( From 0 Tv Ft.(Dili
From To Ft.
Wall Thickness
Diameter or Weight/Ft. Material
SORzi rvC
From To Ft.
13. GROUT: Depth
From O To LA
From To Ft.
14. SCREEN: Depth
From To
Material
FL S&t.tt
In i`te /Inn'
c0
--1
r
crt
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.
Diameter Slot Size
Ft. in. in.
From To Ft. in. in.
Material
15. SAND/GRAVEL PACK
Depth Size Material
Front. To FL
From To Ft.
Oto5 l
16. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH ISA NCAC 2C, WELL
CONSTRUCT! N ST ARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
�a�D_Isoj
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
0
Submit the original to the Division of Water Quality, Groundwater Sectian,1636 Mail Service Center - Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. 4 5 t. J GW-1 REV. 07/2001

3 ° C° 6
• WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and
yvoitmral R urces - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print)!' "'-4f r`"er CERTIFICATION# 3/5(c
WELL CONTRACTOR COMPANY NAME Memt11 We if 4- tail PRONE (bit) k77. 4 L{5O
STATE WELL CONSTRUCTION PERMITS ASSOCIATED WQ PERMITS
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential IieMunicipal/Public ❑ Industrial 0 Agricultural ❑
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other ❑ If Other, List Use
2. WELL LOCATION:
NearestTown: (\eCt/!M�
Stec Icier, IS
County /an5y t/0.1k'a,
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER Lint d& Me 1 rose
Addjess JSA`i u P: i,-w1 ' Afre
�`� (Street or Route No.)
�Ftl Co& t olaq
(4City or Towa State Z,iF Code
)it as °l — I O 4.&. er(fiar1l fir —1 t% 9 L
Area code- Phone number
4. DATE DRILLED q^/4-03
5. TOTAL DEPTH: CF&O
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO 131--""
7. STATIC WATER LEVEL Below Top of Casing: $C' FT.
• (Use"✓" if Above Top of Casing)
8. TOP OF CASING IS 1 FT. Above Land Surface"
`Top of casing terminated at/or below land surface requires a
variance in accordance with ISA NCAC 2C .0118. /1' WO (al9. YIELD (gpm): tf METHOD OF TEST 11 f
10. WATER ZONES (depth):
1 I . DISINFECTION: Type KU/
12. CASING:
Depth
From m To N I Ft.
From To Ft.
From To Ft.
13. GROUT: Depth Material
Ftoua 0 To 'a 6 Ft. S lwnk
Amount
,Topographic/Land setting
edge DSlope Malley DFIat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:DGPSDTopographic map
(check box)
DEPTH DRILLING LOG
JF Dom a`I pmationDescription
elci 30 osoCAOakk
30 S� b w}
$� 3 o cai1(�.�/c
3 to 41 14'44 Rode
4/ (AA' IL?
Walt Thiclmess
Diameter or Weight/Ft.Material
t%y bust fvc
From To Ft.
14. SCREEN: Depth Diameter
From To Ft. in.
From To Ft. in.
15. SAND/GRAVEL PACK:
Depth Size Material
Fmm 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.
lir wcl 1
eth
�fePour
Slot Size Material
in.
in.
O
n
0
01
16. REMARKS:
I DO HEREBY CERTIFY THAT TF
CONSTRUCTION STANDARDS``,
,r?
1
SI
s
WA1S, CONS tRUCTED IN ACCORDANCE WITH I5A NCAC 2C, WELL
A ,COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
3NATURE 0
PERSON CONSTRUCTING THE WELL.
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. 1 GW-1 REV. 07/2001

oeto
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resoources - Division of Water Quality- Groundwater Section 20 t'L
WELL CONTRACTOR worvIDUAL) NAME (print) 4% a.tt 'j.. /Lat4w CERTIIICATION#
WELL CONTRACTOR COMPANY NAME `t^. G) =. 4,4 CZCt4' PHONE # ( ) (TY 7 * V 5 a'
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PEEM1IIT#
(tfapplicable) - (if applicable)
1. WELL USE (Check Applicable Box): Residential EI Mmricipal/Public ❑ Industrial ❑ Agricultural 0
Monitoring ❑ Recovery O Heat Pump Water Injection ❑ Other 0 If Other, List Use
2. WELL LOCATIO
N,: To
County
(Street Name, Nambets, Community, S L,otNo_ Zip Code)
3. OWNER /L N42n t //ti.[.Gr!a�s�'
Address 1-U per "l
(street aEmnd Nit)
i / R oeasr N(C
arTown Swe pCade
Area code- Phone aaunber
4. DATE DRILLED 7 d /
5. TOTAL DEPTH: 9 d
6. DOES WELL REPLACE EXISTING WELL? YES O NO
7. STATIC WATER. LEVEL Below Top of Casing Lice' FT. -75-4—
(Use "w uAbove Top of Casing)
8_ TOP OF CASING IS 1 FT. Above Land Surface'
'Top of casing terminated atfor below land surface regains a
variance to aa«aauce with I5A NCAC 2C .ollt
9. YIELD (gpm): :Le METIIODOFTEST (nal)
10. WATER. ZONES (depth): 7-se an- 78 d
-flpo c/Land setting
ge �e Malley QFlat
(checkapDropriate box)
Latitude/longitude of well location
( )
Latimde/longitude source OGPS❑Topograpbuc map
DEPTH (check DRILLING LOG
From To Formation Description
Q-901 cam)
11. DISINFECTION: Type Amount
12. CASING: Walt Thickness
Diameter or Weight/Ft Material
From d To 7 Ft 6 %/ f 6-G
From To Ft
From To Ft.
13. GROUT: Depth
From 0 To 'a Ft
From To Ft
14. SCREEN: Depth Diameter
From To Ft in.
From To Ft. in.
15. SAND/GRAVEL PACK
Depth Size Material
From To Ft
FromTo Ft
Method
1004
Slot Size Material
in.
75.4"- 'fl t3' -,
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or Cmmty Roads. Include the mad
numbers and common road metes.
16. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH I5A NCAC 2C, WEIL
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
�F PERSON CONSTRUCTING THE WELL DATEJ03
Submit the original to the Division of Water Quality, Gronudwater Section, 1636 Mae Service Curate -Raleigh, NC
27699-1636 Phone No. (919) 7333222, within 30 days. GW-1 REV. 07/2001

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Reso 11
WELL CONTRACTOR (INDIVIDUAL) NAME (print) (%Q41— (—`k
pits-A1r(I (Nell y—f't rn/J
WELL CONTRACTOR COMPANY NAME
STATE WELL CONSTRUCTION PERMIT#
(if applicable)
ces - Division of Water Quality - Groundwater Section �`
Cz' CERTIFICATION W
(## ?) IS /
PHONE # fit•I )-1-1430
ASSOCIATED WQ PERMIT#
(if applicable)
1. WELL USE (Check Applicable Box): Residential PK-Municipal/Public 0 Industrial ❑ Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATJQN:
Nearest Town: Ore Leek.
co Jo'NeS RcQ
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: &c%i y R rt -v �
Address pc. Gv r. i s—
(Street or Route No.)
Ckc--IP)ter%- S C
City or Town State Zip Code
( �`(�- TW ke) 3 `(
Area code- Phone number
4. DATE DRILLED 1(— I -03
5. TOTAL DEPTH: IS-0
J\
6. DOES WELL REPLACE EXISTING WELL'? YES ❑ NO 17K
7. STATIC WATER LEVEL Below Top of Casing: WI FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS I FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance In accordance with 15A NCAC 2C .0118. /� fV -
9. YIELD (gpm): WO METHOD OF TEST kr wOw
10. WATER ZONES (depth):
County ttC..,'s/ I get" ff
Topographic/Land setting
Mirclge ❑Slope ❑Valley [Mat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From (Ty F/grmafon Description
`f UtP1-
N0 t.j iJaRe(ic
n
1 S) rd 4 `GCIf
0
0
11. DISINFECTION: Type 1 t 14 Amount
12. CASING: Wall Thickness
Depthr, DiarTreter or Weight/Ft. Material
From To D FL `� �y S D e- 21 If%VL.
From To Ft.
From To Ft.
13. GROUT: Depth Material
From l7 To 2 0 Ft. 'c tf`e1
0
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common road names.
Method
PI! ittA roc, -
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.
free f_.
16. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION TA
t NDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
fly% P= -- r I c ` /z "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 - Department of Environment and NaturalA Resources - DiTvisio/ry/pf Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) ^^9-`t/ f _ „nice Jam"- CERTIFICATION ti 3 1 ("EC
WELL CONTRACTOR COMPANY NAME f)ic(fil/ li✓C-(/ s-` it+-19 PHONE it
STATE WELL CONSTRUCTION PERMIT(' ASSOCIATED WQ PERMIT('
(if applicable) (if applicable)
( fl ef45o
1. WELL USE (Check Applicable Box): Residential vtunicipal/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: IitetarvA. Countyr:45SiIVA rt,`0,,
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: a*^>' S t a Po 1'
Address gOO 7a/o-w4 ill tit (ed
Street or Route No.)
City or Town State Zip Code
(gig) - b8L/ S tyS-
Area code- Phone number
4. DATE DRILLED / 3
5. TOTAL DEPTH: 13 0
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO 0
7. STATIC WATER LEVEL Below Top of Casing: h OI FT.
I (Use "+" if Above Top of Casing)
8. TOP OF CASING IS t FT. Above Land Surface*
`Top of casing terminated at/or below land surface requires a
variance in accordan4e with ISA NCAC 2C .0118.
9. YIELD (gpm): 'I 0 METHOD OF TESTh.1'r
10. WATER ZONES (depth):
11. DISINFECTION: Type
12. CASING:
Tographic/Land setting
DiRid-ge ❑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 FArmatjon Description
v '3 ur
3 Lf f 6z4-C,lc
j / 1-1 it
Depth Diameter
From 0 To CIS Ft. & 11c j SO v pvc-
From To Ft.
From To Ft.
13. GROUT: Depth Material Method
From 0 To 2.0 Ft. Ccen
From To Ft.
14. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in.
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
Amount
Wall Thickness
or Weight/Ft. Material
16. REMARKS:
O
_.t
k
Q
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common road names.
S*toe5
� �Un
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STAN A S, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
1v1 A"'
SIGNATURE OF PERSON CONSTRUCTING THE WELL
i/-17 -o3
DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-1 REV. 07/2001

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print)_ //.� ��,- &/ rLF ✓ CERTIFICATION # 3/4/V
WELL CONTRACTOR COMPANY NAME 07, 772.77»7 - rr PHONE # Lr2.$)
STATE WELL CONSTRUCTION PERMIT# /a ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential IJY Municipal/Public 0 Industrial 0 Agricultural ❑
Monitoring 0 Recovery ❑ Heat Pump Water Injection ❑ Other 0 If Other, List Use
2. WELL LOCATION:
Nearest Town: County 70, 77A•emi., _ sz,
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
7 epographic/Land setting
ILI6dge DSlope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
3. OWNER: A7.- ..„y ,l'";. y (degrees/minutes/seconds)
Address .F,,-t/.0 A /=>3«2.,, s Latitude/longitude source:❑GPS❑Topographic map
(Street or Route No.) (check box)
77—cc.e.v7=2,7,77„c. ? ?l$ DEPTH DRILLING LOG
City or Town State Zip Code From To Formation Description
(%s'")- S-.. &-GvQ/ n --7o a0T,ar
Area code- Phone number
4. DATE DRILLED / / -,,2 -6 s
5. TOTAL DEPTH: -3 2 S
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO w-,--) - qa-C
7. STATIC WATER LEVEL Below Top of' Casing: cro FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS / FT. Above Land Surface*
*Top of casing terminated atior below land surface requires a
variance in accordance with ISA NCAC 2C .0118.
9. YIELD (gpm): S METHOD OF TEST,--4,
10. WATER ZONES (depth): /2 c - :PO --
11. DISINFECTION: Type Amount
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
From r• To 7,-, Ft. C ij s%),r-z/ ,-ter
From To Ft.
From To Ft.
13. GROUT: Depth Material Method
From o To ;c c Ft. 4.e7,74,7F>7r 7.77-�_ , 7 „N�2
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:
G�e�.ar
0
fV
LOCATION SKETCH
Show direction and distance in miles frorat least'
two State Roads or County Roads. Include the road.
numbers and common road names.
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
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

13. GROUT:
From CS
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural/JResources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) /-C Rxn.✓ '2t.-,n.-.>, .Tr, CERTIFICATION it ? iv"e/
WELL CONTRACTOR COMPANY NAME ra-» .ri?,zre e. 2J._ c_ c_ .t- /. u,,-,/) PHONE # (pa c) i-77.9- / 5 0
STATE WELL CONSTRUCTION PERMIT# /22 ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential CSY Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery ❑ Heat Pump Water Injection ❑ Other 0 If Other, List Use
2. WELL LOCATION:
Nearest Town: c, -r
CountyJ.�.,✓Svir... r�
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: `, r7%/
Address /7r, / /e c Y / s
(Street or Route No.)
City or Town State Zip Code
() P/7'7—?s15-
S
Area code- Phone number
4. DATE DRILLED /c - - v
5. TOTAL DEPTH: 2 n r
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO 0
7. STATIC WATER LEVEL Below Top of Casing: i n FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS / FT. Above Land Surface*
`Top of casing terminated at/or below land surface requires a
variance in accordance with ISA NCAC 2C .0118.
9. YIELD (gpm): METHOD OF TEST vz'rca
10. WATER ZONES (depth): G n -
11. DISINFECTION: Type Amount
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
From n To 5? Ft. 6 -., /s'Y>,.,eic /tee/
From To Ft.
From To Ft.
Depth Method
To z o Ft.
Material
_cn ETA
.v,rV
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 N#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
h — r 7ri2 T--62-. 2 v_>cv t /
- 5 17
S"•'7 - z !> S !' ir.rn..l7F_
n
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.
G71
I DO HEREBY CERTIFY THAT THIS WEL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AN AT A COPY OF THIS • CORD HAS BEEN PROVIDED TO THE WELL OWNER
SIGNATURE OF PERSO 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 Re(s}Q/urcpa - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) CP ( //3 frr(CERTIFICATION .20 Or
WELL CONTRACTOR COMPANY NAME YI'le P r ; l! 4 td( if d P u Yn p PHONE # Or* 77-11r152)
STATE WELL CONSTRUCTION PERMIT#
3
ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
I. WELL USE (Check Applicable Box): Residential I'J 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: & r,c r County TTe c tali/ l van rc
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: 77 VY) Oatilt
Address as 1 N+tl'' ffr OreVarJ
(Street or Route No.)
City or Town State Zip Code
(GA- 997 — 30a 3
Area code- Phone number
4. DATE DRILLED b - 30 — C J
5. TOTAL DEPTH: 70 S
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO
7. STATIC WATER LEVEL Below Top of Casing: FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS 1 FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordance with 15A NCAC 2C .0119.
9. YIELD (gpm): 3 METHOD OF TEST tier Ain Leap
10. WATER ZONES (depth):
� Topographic/Land setting
al 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
0 — 3® Dr 1 f
3 0 — 6a. $h e /I
- 705 _ar1.:f
11. DISINFECTION: Type
12. CASING:
Depth
From 0 To bog
From To Ft.
From To Ft.
13. GROUT: Depth Material
From 0 To aO Ft. Co /Ge'f-
From To Ft.
Amount
Wall Thickness
Diameter or Weight/Ft. Material
Ft. b SPr 21 PVC
14. SCREEN: Depth Diameter
From_ To Ft. in.
From To Ft. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
Method
ft7eitpeot
Slot Size Material
in.
in.
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common road names.
16. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH I5A NCAC 2C, WELL
CONSTRUCTION STANDA 1 ,At THA A /t •Y OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
SIGNATURE 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 Natural Resources - Division of Water Quality - Groundwater Section �
WELL CONTRACTOR (INDIVIDUAL) NAME
/(!rimprint) I s4 P&r( C-C CERTIFICATION # 3 t 5 G/p
WELL CONTRACTOR COMPANY NAME ( we(Pvt., p (S'ZYI Y7.i PHONE # tyse
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PEIL%IIT#
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential C2Municipal/Public ❑ Industrial ❑ Agricultural ❑
Monitoring 0 Recovery ❑ Heat Pump Water Injection 0 Other ❑ If Other, List Use
2. WELL LOCATION:
Nearest Town: art(44-0( County «44.ir/3#4,4
Cote" Ga.nno- -
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: 57 4
Address O�olj
0 (Street or Route No.)
I XitVnte: t'JC ' `(11')
e City ar awn S to Zip Code
Area code- Phone number'
4. DATE DRILLED — 03 —63
5. TOTAL DEPTH: (vas
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO GY
7. STATIC WATER LEVEL Below Top of Casing: 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 accordanc with ISA NCAC 2C .0118. Air n (0,..„9. YIELD (gpm): METHOD OF TEST 1 fJ
10. WATER ZONES (depth): _ s-alt
11. DISINFECTION: Type
12. CASING:
Depth
From To S
From To
From To
13. GROUT: Depth
From 6 To IA
From To
14. SCREEN: Depth
Amount
Wall Thickness
Diameter or eight/Ft. Material
Ft.&Ve SOP-21 PvL-
Ft.
Ft.
Material
Ft. $.k+.f-
Ft.
Diameter Slot Size Material
Topographic/Land setting
DRidge 2Slope ❑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 Tp
QForth ion Description
2orLG
12' Yr' p.v.-4—
to 4(' R-4/C
t
LOCATION SKETCH
Show direction and distance in miles from ab7east
two State Roads or County Roads. Include the road
numbers and common road names.
Method
/N4r71ern ®off
From To Ft. in. in.
From To
15. SAND/GRAVEL PACK:
From
From
Depth
To
To
Ft. in. in.
Size
Ft.
Ft.
Material
Breaj
0
fond -
Rat
16. REMARKS:
1 DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH I5A NCAC 2C, WELL
CONSTRUCTION STANDARDS, N H A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
SIG
ATURE OF PERSON CONSTRUCTING THE WELL
DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center -Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-1 REV. 07/2001

`E
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of' Water Quality - Groundwater Section WELL CONTRACTOR (INDIVIDUAL) NAME (print) �G°2FlyZ7"� CERTIFICATION # 72179/
WELL CONTRACTOR COMPANY NAME ijerY/J PHONE # (g.,Zft}_ 2,-In
STATE WELL CONSTRUCTION PERMIT# /,Z2. ASSOCIATED WQ PERMIT#
(if applicable)
(if applicable)
1. WELL USE (Check Applicable Box): Residential IcrMunicipal/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: L? C 'zl/9 Coun
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: !'1 44'r' ti4sNet>/,<av>�3
Address 6 SO Sad--tn. ,6tc.sr—iFh
(Street or Route No.)
dir/rl6.r-yam w. C. ;7Ce°701C;-
Cityor Town State
Zip Code
( t)- 5 4/-,2/O("i`
Area code- Phone number
Topographic/Land ing
❑Ridge ❑Slope 57galley ❑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 Dgscription
4. DATE DRILLED S— / 0'70—
5. TOTAL DEPTH: "s'S
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO lErr
7. STATIC WATER LEVEL Below Top of Casing: -tZ 0 FT.
(Use "+" if Above Top of Casing)
S. TOP OF CASING IS / FT. Above Land Surface*
'Top of casing terminated at/or below land surface requires a
variance in accordance with 15A NCAC 2C .0118.
9. YIELD (gpm): s METHOD OF TES fi%ittr'L✓
10. WATER ZONES (depth): n e, o C1 2,-
11. DISINFECTION: Type Amount
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
From t. To Srr Ft. IT '1% %gcvsA1! 51tc.c
From To Ft.
From To Ft.
13. GROUT: Depth /Material Method
From 0 To "..0 Ft. aFCr.n,rrr ,/? 1' MVW'
From To Ft.
14. SCREEN: Depth Diameter Slot Size
From To Ft. in. in.
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
16. REMARKS:
0
ON SKETCH
N
Show direction andistance in miles from at least
two State Roads r County Roads. Include tf)e{oad —
numbers and co t on road names. Il
1
I .�
'4
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 1SA NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND TtiT A COP OJLRECORD HAS BEEN PROVIDED TO THE WELL OWNER
Xi
STRUCTING THE WELL DATE/
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-1 REV. 07/2001

p. 4- C
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and NaturalraalResources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) J7//it G/.1 �/i b.= e-,T.-'-l/✓ CERTIFICATION # 4/4/..e/
WELL CONTRACTOR COMPANY NAME '?rr.e 22 c R.e. �GL /'? el.ao /� , PHONE # (512$ vyj tY
STATE WELL CONSTRUCTION PERMIT# / ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residentialm Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other O If Other, List Use
2. WELL LOCATION:
Nearest Town:, ,c0 _. COunty74e vsWg).4. ,/zoltr..
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: Orr;
Address J€Co r.aiue.zr.eO.
(Street or Route No.)
City or Town State
(2 t irk
Area code- Phone number
4. DATE DRILLED 4.7413--
5. TOTAL DEPTH: ;?: se
Zip Code
opographic/Land setting
dge ❑Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:OGPSOTopographic map
(check box)
DEPTH DRILLING LOG
From To Formation Description
. Wa
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO IV--
e j_ 2 6,1r
7. STATIC WATER LEVEL Below Top of Casing: to FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS / FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance In accordanc with 15A NCAC 2C .0118.
9. YIELD (gpm): Wiz_ METHOD OF TEST l_
10. WATER ZONES (depth): "'VO — 7Y0,CY—
I I. DISINFECTION: Type
12. CASING:
Depth Diaeter
From V To (a S Ft. -Ay
From To Ft.
From To Ft.
13. GROUT: Depth
From (5 To zee Ft.
From To Ft.
14. SCREEN: Depth Diameter
From To Ft. in.
From To Ft.
15. SAND/GRAVEL PACK:
Depth
From To
From To Ft.
Amount
Wall Thickness
or Weight/Ft. Material
pa,e-.rc./ /of/C
Material Method
"1-x.f> f arras -,?w,r
Slot Size Material
in.
it:. in.
Size Material
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 <mes.
16. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL
CONSTRUCTION STANDARDS, AND
CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
COPY. e . RECORD HAS BEEN PROVIDED TO THE WELL OWNER
URE OF PERSON CONSTRUCTING THE WELL
AT
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

From i7 To as Ft. (O Mj
From To Ft.
From To Ft.
13. GROUT: Depth
From 0 To a.,O
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) %r (APt, ram-
p CERTIFICATION # J 1St0
WELL CONTRACTOR COMPANY NAME me re: L1 weed y pump PHONE # tla Q 77" 4455
STATE WELL CONSTRUCTION PERMIT# 1 a. a ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential El/ Municipal/Public ❑ Industrial ❑ Agricultural ❑
Monitoring ❑ Recovery D Heat Pump Water Injection D Other 0 If Other, List Use
2. WELL LOCATION: '1
NearQ)st Town: 6PZ V a C GS County TYa /lsy I van
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: EsiraajA L S as Vc II
Address a7 LJhf+a Lag )G Li
(Street or Route No.) /
LsItair6r r4 c tZQ71:9
City or Town State Zip Code
43 • b 77 5
Area code- Phone number
4. DATE DRILLED 7-7- O3
Topographic/Land setting
Ridge ❑Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From To Formation Description
D 5 Omit
5. TOTAL DEPTH: 3. «0
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO El
7. STATIC WATER LEVEL Below Top of Casing: FT.
14 ghat(
(Use"+" if Above Top of Casing) 23
-
8. TOP OF CASING IS 1 FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordance with ISA NCAC 2C .0118.
9. YIELD (gpm): 5 METHOD OF TEST Ad r Idly,
10. WATER ZONES (depth):
2.3
hPrN
11. DISINFECTION: Type Amount
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
fPRXI PV4
Material
FL a Kai'
From To Ft.
14. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in.
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
Method
)(bvd&
9tan:4-
f
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common road names.
0
n)
0
rn
16. REMARKS:
I DO HEREBY CE{ZTIF HAT THIS WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTIO A ARD A AT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
7- YY-0
SIGNATURE OF PERSON CONSTRUCTING THE WELL
DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-1 REV. 07/2001

tl
0
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Gromdwater Sedan
WW. CONTRACTOR (iItnlvwUAL) NAME emstunad Peer— MITIFIcwnoN s 3 LQ(o
emu coN272AcroRCOMPANY NAME Me t r: I I Weil 8 pu (rt p norm s (zj A77-e/940
sum wRdd, ooNbTRuctum raano la a ASSOCIATED WQ PEEMITA
Ofapptitable) orapplicable)
1. WELL USE (Check Applicable Boa): Residential VMunitriyaVPublie 0 Industrial 0 Agricultural 0
Monitoring 0 Raceway 0 Heat Pump Water Injection ❑ Other 0 If Oar, List use
2. WELL LOCATION:
in
Nearest Town: Dretatt County raCa/1JyltMfie
(Sheet Name, Numbers, Community, Subdivision. 1st No., VP Code)
bpographic/Land setting
°Slope Malley OFha
NfioAtamemiLtetar�
L tindeacemimde of well location
3. OWNER: (Qi�Iem eMr:smn (dam)
Address VO (io it OW 2„. LatidMe/tongitude samee:0GPSDTopogapbic map
� eAktr (Street No) a �-13� (�edPU
City err Town soretLLDdG LOG
44- 1054 - 7 /I& F`0 Z5 Formation 0r:4-
MaaodsFame mower
4. DATE DULLED g - 9 - D 3
5. TOTAL DEPTH: 35 5
6. DOES WELL REPLACE E GSTWO WELL? YES 0 NO
7. STATIC WATERIEVSLBelow Top ofCasing FT.
(Um M ifMom Top of Casing)
8. TOP OF CASING IS / FT. Above land Surface'
'Tap datbg renamed Marbettw Led salsa regdaa
vacvami.c d walk ISANCAC2C.o11a
9. YIELD (gpm): = "9. METHOD OF TESTQ4 r die s,/
10. WATER ZONES (depth):
as 9a ShelI
93, gIo sdn,t-
11. DISINFECTION: Type /trH Amount
12. CASING: � Michaels
Midm
Fr T�_9(, ? Ft 5 fluWrem PVC
ht/ft Maeda!
From_ To Ft.
From To Ft
13. GROUT: Depth Material Method
ham 0 To 2.4 Ft Ce4 ,4WV tend
Frog_ To Ft.
14. SCREEN: Depth Diameter Slot Slim Material
From_ To Ft. in. an.
From To Ft- _jn. is
15, SAND/GRAVELPACK:
DtPlli
From To
From To
16. REMARKS:
Sine MAMA
Ft.
Ft
n
LOCATION SKETQI ry
Show direction and distance in miles from at lain
two State Roads or County Rods, Include theesad
numbers and common road name. cn
4 e°lit q
Ittd
IDO HEREBY CERTIFY THAT TIES WELL WAS CONSTRUCTED IN ACCORDANCE WII1I ISA NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF TED RECORD RAS BEEN PROVIDED TO THE WELL OWNER
ao-o3
SIGNATURE OF PERSON CONSTRUCTING TEE WELL DATE
Submit the original to the Malden of Water Quality, Groundwater Section,1636 Mail Service Center -RaMgh, NC
27699-1636 Phone low [phone], within 30 days. GW I REV. 07/2001

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources -�D�ivision of Water Quality - Groundwater Section ""
WELL CONTRACTOR (INDIVIDUAL) NAME (print) Lt4t t (Yr..vyct f-- CERTIFICATION # «.p
WELL CONTRACTOR COMPANY NAME tV\ err , 1 I G 1I f pump PHONE # dal 77-•Y45d
STATE WELL CONSTRUCTION PERMIT# i 2. a. ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential 12"---Municipal/Public ❑ Industrial ❑ Agricultural 0
Monitoring 0 Recovery ❑ Heat Pump Water Injection ❑ Other 0 If Other, List Use
2. WELL LOCATION: -r�
Nearest Town: &reVat d County/r' f '
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: 6-'ilev Greve 11
Address fed. &- o257
(Street or Route No.)
LORe Tr,xe,aitty Ni
City or Town Stafe Zip Code
(got-2)- 853 r I St
Area code- Phone number
4. DATE DRILLED 7- /6 -0 3
5. TOTAL DEPTH:_-W /
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO M
7. STATIC WATER LEVEL Below Top of Casing: — (f0 FT.
(Use "+" if Above Top of Casing)
S. TOP,OF CASING IS _.1 FT. Above Land Surface*
-Top of casing terminated atior below land surface requires a
variance in accordance with 15A NCAC 2C .0118. •
9. YIELD (gpm): j S METHOD OF TESTaerI3 ioa ,
10. WATER ZONES (depth):
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common road names.
Topographic/Land setting
❑Ridge ❑Slope tB(lley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/rtinutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From To Formation Description
0 30 l�r ti
�0 ?S
1 ] . DISINFECTION: Type MIN Amount
12. CASING:
Wall Thickness
Depth Diameter or Weight/Ft. Material
From 0 To 4 a. Ft, it, y SO r.Z j PVC
From To Ft.
From To Ft.
13. GROUT: Depth Material
From 0 To 2.0 Ft. Sa 11'e7
From To Ft.
she l/
Meth d
pitike•C focr
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.
aq/
O
n
--f
roo
16. REMARKS:
PI
U7
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-1 REV. 07/2001

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) fid K'r— CERTIFICATION # 9 «C
WELL CONTRACTOR COMPANY NAME ei err: I cv eon trump
STATE WELL CONSTRUCTION PERMIT# I a, ai ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
PHONE # (B.Z2) 977- 4450
I. 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: MCP t Va r d County Meanly w011c
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: tottnn 3 in ridiaird
Address c..ej Stwldnr..eee( Dr
rz - (Streeoqk t1 Fi 1
CityRoute No.)
t omor Town State Zip Code
(Ea- 0'4 -oto7' -
Area code- Phone number
4. DATE DRILLED 7- It - 03
5. TOTAL DEPTH: 5 0 5 /
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO ICJ
7. STATIC WATER LEVEL Below Top of Casing: FT.
(Use "+" if Above Top of Casing)
S. TOP OF CASING IS 1 FT. Above Land Surface*
*Top of casing terminated odor below land surface requires a
variance in nee .rdance with 15A NCAC 2C .0118.
9. YIELD (gprn): I METHOD OF TEST air OIO L_
10. WATER ZONES (depth):
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common road names.
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
O fr or • f-
8 5 ITS rani/ rer-
11.5 /20 9an: P
11. DISINFECTION: Type 141-H
12. CASING:
Depth
From 0 To!an
From To
From To
13. GROUT: Depth
From 0 To 2.,0
From To
14. SCREEN: Depth
From To
From To
Diameter
Ft.1
Ft.
Ft.
M teria!
Ft. SFAffe!Le
Ft.
Amount
Wall Thickness
or Weight/Ft. Material
Meth
rt7te..$ Pour
Diameter Slot Size Material
Ft. in. in.
Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
16. REMARKS:
O
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED TN ACCORDANCE WITH I5A NCAC 2C, WELL art
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
0 a / as -¢5
SIGNATURE OF PERSON CONSTRUCTING THE WELL
DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center -Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-1 REV. 07/2001

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural
eseso ces - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) ' N/� , CERTIFICATION p OLS5CP
WELL CONTRACTOR COMPANY NAME /71 e r r: II L._/ 21 118 p u rnr PHONE a ( 0 7 7 -Q y sp
STATE WELL CONSTRUCTION PERMIT# i rs a ASSOCIATED WQ PERMIT/4
(if applicable) (if applicable)
WELL USE (Check Applicable Box): Residential "Municipal/Public ❑ Industrial ❑ Agricultural ❑
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION:
Nearest Town:13 rc VA r County f an tie, n ,9
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: RA v jf.:f a � . t-"- ..t... Pt--Sh
Address t j,4 a, q Z-t 'al S
(Street or oute No.)
()au- tu5V; ile c-.o 2013s
City or Town State Zip Code
(t)- cliAs " ,9 3
Area code- Phone number
4. DATE DRILLED 7 / Z{ - 63
5. TOTAL DEPTH: a- 0 S
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO 1
7. STATIC WATER LEVEL Below Top of Casing: FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS 1 FT. Above Land Surface*
"Top of casing terminated at/or below land surface requires a
variance in accordance with ISA NCAC 2C .0118. s
9. YIELD (gpm): 1 METHOD OF TEST O.t r (3 4G,,/
10. WATER ZONES (depth):
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common road names.
_�// Topographic/Land setting
Midge ❑Slope ❑Valiey ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From To Formation Description
c so nc;
11. DISINFECTION: Type Nil'/
12. CASING:
Depth
From 4% To k Q Ft.
From To Ft.
From To Ft.
Diameter
Amount
Wall Thickness
or Weight/Ft. Material
C-Rr21 PVc.
13. GROUT: Depth Material Method
From 0 To 3-0 Ft. Sakti- MA piss.).
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.
Material
9411 n : r"
I
4
_N\s tics a f`
ti
N
16. REMARKS: cn
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
SIGNATURE OF PERSON CONSTRUCTING THE WELL
l7-2°..°3
DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center -Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-1 REV. 07/2001

611 r,
�.r F 1,,1 1.
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural
Resources/_- Division of Water Quality - Groundwater Sectioniop
WELL CONTRACTOR (INDIVIDUAL) NAME (print) / '� / CYIWCC CERTIFICATION # 31JCo
WELL CONTRACTOR COMPANY NAME Mere; II y�t� G f ! i- p urn p PHONE # ac2$t T 7?- 51/2S0
STATE WELL CONSTRUCTION PERMIT# 1a.a_ ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential Er/Municipal/Public O Industrial O Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other ❑ If Other, List Use
2. WELL LOCATION: /I
Nearest Town: et if (/iSP tl. County i rA ti
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER:Stir,e A1v1-hf
Address Stir,
(3o 4. &it
(Street or Route No.)
6 rect A rA-C XV112.
City or Town State Zip Code
(ga8)aa.b - a 1'Ma.
Area code- Phone numbeL.
4. DATE DRILLED 7 —30— 03
5. TOTAL DEPTH: g0 $
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO
7. STATIC WATER LEVEL Below Top of Casing: 70 0 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordance with I5A NCAC 2C .0118.
9. YIELD (grim): X METHOD OF TEST der 13IOw
10. WATER ZONES (depth):
Topographic/Land setting
Ridge ❑Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:OGPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From To Formation Description
0 ro 0r,,'r
10
a.5 shell
3.5 3 yPd~b:e"
11. DISINFECTION: Type y TH Amount
12. CASING:
Depth Diameter
From0 To .7?-3 Ft. 6 1
From To Ft.
From To Ft.
13. GROUT: Depth r''Mrateri31
From 0 To .2,O Ft. sp Urf61'
From To Ft.
Wall Thickness
or Weight/Ft. Material
3.0= 2.I2t P✓e
14. SCREEN: Depth Diameter
From To Ft. in.
From To Ft. in.
15. SAND/GRAVEL PACK:
Depth
From To Ft.
From To Ft.
Size
IIlethod
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.
16. REMARKS:
1 DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
gager," //-2043
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 Resour cs -/Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) f I0-410 r— CERTIFICATION # 3 15c-
WELL CONTRACTOR COMPANY NAME Merrill WC 11 -f' p u M p PHONE # (fa) F- 71 K°(S0
STATE WELL CONSTRUCTION PERMIT# a .2 ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
B
1. WELL USE (Check Applicable Box): Residential Er- Municipal/Public ❑ Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATIQN:
Nearest Town: Pe%/Ar4
County Ir .r4'41v
(Street Name, Numbers, Community,
Subdivision, Lot No., Zip Code)
3. OWNER: &e ro i{s Pcq.nier (degrees/minutes/seconds)
Address a50? cArandelI way 1-dIto fus5 Po3L attq tude/longitude source:❑GPS❑Topographicmap
(check box)
2�.
(Street or Route No.)
1:LI141104932 - 3,1 30S1.
City or Town State Zip Code
(fto )- q 7 `7 -RRS 7
Area code- Phone number
4. DATE DRILLED & 9- e)
5. TOTAL DEPTH: f 005
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO ICI
7. STATIC WATER LEVEL Below Top of Casing: FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS f FT. Above Land Surface*
"fop of casing terminated at/or below land surface requires a
variance in accordance with 15A NCAC ZC .0118.
9. YIELD (gpm): :kJ.- METHOD OF TEST ear 8 bta.1
10. WATER ZONES (depth):
4opographic/Land setting
Ridge ❑Slope ❑Valley DFlat
(check appropriate box)
Latitude/longitude of well location
DEPTH DRILLING LOG
From To Formation Description
8 «0 r!i
V 90 5hetI
90 96o y(iat)
11. DISINFECTION: Type f{T'1( Amount
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
From dTo 9b Ft. iot'N >Li'r'
From To Ft.
From To Ft.
13. GROUT: Depth
From 0 To a.0 Ft.
From To Ft.
14. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in.
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
ethqd
ret. tt C f
Material
5c1 I cf e
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common road names.
4 .
/4 Cr(
16. REMARKS:
0
--1
fV
c11
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED TN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
it2-03
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-1 REV. 07/2001

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and N ra1 LResattpes/j- Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) —I CERTIFICATION it 3
we/1 to- f'c-b,/ PHONE # (PC.) 7� cftinc
WELL CONTRACTOR COMPANY NAME
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
I. WELL USE (Check Applicable Box): Residential Cr-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: breve -et County 1 run...S11
) ..05 RA
-
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: &Art
Address Po. acst 133� Y
(Street or Route No.)
CnL�leSlon s ud
City or Town State Zip Code
($43)- 5f visit
Area code- Phone number
4. DATE DRILLED 1 1-11-03
5. TOTAL DEPTH: Z I'O
6. DOES WELL REPLACE EXISTING WELL? YES 0 NLR O '
7. STATIC WATER LEVEL Below Top of Casing: 40 r FT.
t (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): 't c METHOD OF TEST Pte r 84t.,
10. WATER ZONES (depth):
11. DISINFECTION: Type pi r1t
12. CASING:
Amount
Wall Thickness
Depth Diameter or Weight/Ft. Material
From i) To 1+ 2. Ft Wit s b t t i f b(
From To Ft.
From To Ft.
13. GROUT: Depth Material
From (7 To 2 O Ft. Crr-'LX
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 FL
16. REMARKS:
Met od
1 v�
Slot Size Material
in.
in.
/Topographic/Land setting
eigRidge ❑Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From To Formation,Description
0 .s'O O r: r
30 3g sanj toytf(
3? LI3
gretn
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.
tfrct1
St\tr.
2e1
_1V
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH ISA NCAC 2C, WELL
CONSTRUCTION 9NDARDS, 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 - Deportment of Environment and N
sew. copantacrowonexoUAL) MANE
WELL corattscrcn commMYNAsa m rr,
STATE wn., CONSTRUCTION PFRba t___1 2
fdappYmble)
Resources - Division of Water Quality - Groundwater Section
AiL O n/ 221r2 m>-..rn N CERTI}1CATION
LJa l l r !7 a r» y rrron . (f)S)'?77. 4'450
parry
WQ PERMITS
(Wrpliable)
1. WELL USE (Check Applicable Box): Evidential (3" Municipal/Public O Industrial O Agricultural C
Monitoring 0 Recovery 0 Hat Pump Water Injection C Other 0 If Other, List Use
2. WELL LOCATION:
Nearest • rC a' CountyT.Af lran?
bAk L inn
(Seca Name, Namba; Cammnim Subdiv tit Ica Nn, tip Code)
3. OWNER: .' //.'a M eferp e r
Addwss Vet/ eV, tf-A
(Swets e� No.)
kien IV ('� 9n (G4
Cray or Two Star 4, Code
(fz>r} f!?? ii3fa.
Ataeoda- Plane samba
4. DATE DRILLED 4 - l 9 -0 3
5. TOTAL DEPTH: a go
6. DOES WELL REPLACE EXISTING WELL? YES O NO 0'
7. STATIC WATER LEVEL BebwTop ofCasing n.
A 8. TOP OF CASING IS 1 FT. Above Land Surface*
*Top areater twahared attarbelow had sedate neera
amine to aeardms wins NA NCAC ]C .011a.
9. YIELD (gpm): 6 METHOD OF TESTA ft biota
10. WATER TONES (depth): VD at 0 0
11. DISINFECITON:lype Aumuat
12. CASING: Wall Thickness
nepns, Ditaegta err Welgbvrt. Masadwi
rran O To b of Ft (ote S On s' P eVC
d
From_ To Ft
Frma To Ft
13. GROUT: Depth Mreoiai Method
Flaw CZ_To A.0 Ft. Sakt 9r� Method
From —To FL
14. SCREEN: Depth Deter Slot Sim Material
Front_ To Ft._jn. M.
From To Ft__jn. it
15. SAND/GRAVELPACK:
Depth Sim Fowl
From To ft•
Front To Ft
—1Topographic/Land setting
L dge OSlope Miley OFht
(cupprupiSsbos)
Latitude/ktogitude of well Manion
(Vegweatiwaraecosein
Latitude/longitude soome:OGPSOTopograpphic map
(deck bus)
PEA DRILLING LOG
From To Forma ion Description
0 So a.it
a 0 Sur Sand ro`(t
Sy' (.y aa, f-
ct a90 gan;r•
LOCATION SKETCH
Show direction and distance in males Rota at lean
two State Roads or County Roads. include the road
mambas and common road names.
to
CO
16. REMARKS:
0
N
0
cn
I DO HEREBY CERTIFY THAT THIS WELLfl(CONS7RUCIED IN ACCORDANCE wag ISA NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND COPY Y9 BEEN PROVIDED TO THE WELL OWNER
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE / / —
Submit the original to the Division of Water Quality, Groundwater Seclion,1636 Man sonar Center -Auld*, NC
27619-1636 Peon Na (919) 7333221, within 30 days. GW-1 REV. 07/2001

.7; ;."- •
• North Garodna • Denartment ol Environment and Nahsal Resources • Division of Water Quietly • Groundwater Section
1636 Mall Service Center • Raleigh. N.C. 276994536-Phone tau° 733.3221 •
WELL CONSTRUCTION RECORD wEU. coUTRACTOR:
WELL CONTRACTOR CERTIFICATION it: /2- 2-
STATE WELL CONSTRUCTION PERMIT.: 2 /
1. WELL, USE Whack Appeal:Is nos): Residential 0 Municipal CI Industrial 121 Agricultural 0 Monitoring 0
Recovery 0 Heat Pump Water Injection In Other oIf Other, Ust Use:
• . !leanest Towns 0-44-61,-1c.es..,- COW* k
,Trysdy.rrhon ano Loma.) DRIWNG LOG
3. OWNER
Address. f 0 rd. '
OS Of 1191
1:14-.24';WEUL LOCAT941: (Shwa sketchiptthe location Wass) -7c(Ctiiii1/41\tati
itN (
City or Toan State
4., DATE DRILLED _let -3
5. TOTAL DEM 796
• 6.- CUTTINGs COLLECTED YES . NOLiard
" 7. DOES WELL REPLACE EXISTING WELL? YES 0 NO(
8. STATIC WATER LEVEL Below Top of Casing: FT.
Mao Top ol Cad*
9. TOP OF CASING IS FT. Above Land Surface*
•*Too or casino lawdnatod ador below bad surface aquas* a radiate la scoop
dance with ISA HOAG aS
= yiELD (gprn): METICID,OF TEST rez-e--1-
• 11. WATER ZONES (depth): 14 a
From To
- /etc
Co' - /We
EpOodo
e- 7/'4
12. CHLORINATION: Typo
13. CASING:
Amount
) Depth 4�ianisiv
From To
r•-• .; FromTo FL
Mad& • Method
From To FL "417e1/ rt."-
3,bhn
• - From To
Depth Diameter Slot Sizit Material
From To Ft
ADM To FL.- In. In.
From To Ft. Ina
.- it sibuwpmvp., PACK
Mmo
• : : From To
• From To R.
‘17. REMARK&
I DO HEREBY CERTIFY THAT THIS WEL,. WAS CONSTRUCTED IN ACCORDANCE WITH 15A /CAC 2C, WELL
Wall Thickness
era ,t
Material
DEPTH
FOnnaSOn Ossaiptice
-•-ratifeJLA-c'e
creel:42C
If addidonal space is needed use back ol loom
LocknoN SKETCH
(Show crinanion and saran from et least ans state
Roads, or osier map rahmtnce points)
LP/'9.2 9 (- t4S4J
0
0
CONSTRUCTION STANDARDS. AND ',HATA COPY OF THIS RECORD HAS.F.,N PROVIDED TOME wet ONIEFL
/ - e
SuiNATURE OP PERSON consmuctrio THE WELL Dag
Sublotodfnal lo Divhbn gi was. Os Goats swan within 30 clays
GYM ASV. tar
1 FOR OFFICE USE ONLY
Ousd No:
Sada Na

a
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment andNat ral Resources - Division of Water Quality - Groundwater Section
WELL cont./croft q'mnvwu.u4 NAME �/evz/7 5�to/7 rE /7e: tearrmIGTIOIY!%l7//
WELL CONTRACTOR COMPANY NAME Atitcjl,p��i✓fri.0 �/ Zn -- mom a (fi11 SI77-L/1i�� l>
STATE WELL CONSTRUCTION PERMITS ASSOCIATED WQ MOM
Of applicable) Of applicable)
1. WEIL USE (Check Applicable Boa)_ Residential 0MwiaPal/Poblic 0 Industrial CI Agricultural 0
Monitoring Recovery 0 Heat Pump Ws Iajaaion0 Other 0IfOther, List Use
2. WELL LOCATI •
Nearest Town r «in rc/ Camty 7__Atokns
(Stitt N®F Nwmbw . - , S,idiviriva.IdNo. alp Cads)
3. OWNER' d2 Y/
a
Address IS06 ((
` (Street er Haute No.)
ilgiciis ;►o 0Y1.ii
city at Town sat, Zip Cods
Pbconvioolitc
4. DADRI LED 7 `%/_ c 2
Topo Land setting
!]Ridge lope � OFIu
(
Iatitndedo o8Nde of wen location
(dam)
Latitude/l t:kade aomce:OGPSOTopopapbic nap
(dark box)
DEPTH DING LOCI
From To Formation Description
5. TOTAL DEFER:, 2- t-e7 ti--- L/c ._/i 7
6. DOES WELL RE?LACB EXISTING WELL? YES 0 NO
7. STATIC WATERIEYBLBelow Top ofCaSg F[.
(Us,Above Top of Castes)
8. TOP OF CASINO IS FT, Above Land Surface'
`Tap of aim eamkswd vier Sow had salasraisins a
variants m veil ISA NCAC 1C Ala9. YIELD (Spun):' METHOD OF TEST 77-4e '
10. WATER ZONES (depth): 2-5 CI
11. DISINFECTION: Type Amount
12 CASING Wait Thckness
Pruett)To�97 Ft CA- that etjArt. M:asoAt
Favor To
From ) 7 To h 7 Ft G 1: , /tc
13. GROUT
From d To�c-l/ M
Ft Maenad
From— To FL
14. SCREEN: Depth Diameter
From_ To Fr�1a
From To Ft.in.
15. SAND/GRAVELPAC&
Depth Sure Maeda]
From To Ft.
Fromt•_To Ft
Slot Sim Material
ia.
in.
LgcrAngaZireil
Show dhecbiota and distance in nob from at )east
two State Roads or County Roads. Include the road
numbers and commonroad
6.
16. REMARXS:
1 DO REREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED) IN ACCORDANCE WXIB ISA NCAC 2C, WELL
CONSTRUCTION ST ARDS, AND THAT 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, Creandwater Section, lee Mall Serrlce Ceamr-Raldgh, NC
27699-1636 Phone Na 819) 733-3221, within 30 days. GW-1 REY. 07/2001

"r North Catalina. D.pattrnKalEnvironment and NAM Resources -DiwsionofWan Clay - Groundwater Section
163o Mal Sanit» Gnaw. Bait, N.C.27MY-1630.Phone [phone] '
'WELL- CONSTRUCTION RECORD antcoNmAcron: 1t4--f�"5:""rje
—
WELL CONTRACTOR CERTIFICATION o: %0 61
STATE WELL CONSTRUCTION PERMITS: ' 7-
7
• 1cRecovery E ❑ Heat Pump Appuedie WaterInjection ❑ Other En Other, list Use: 7 1t-ems
7, :WELLLOCA IC�.(SowHtald%d.the location bolo%
(Road Name ad and tot )
FF " 5 2 Run • o
i'l;et• Adding - {�5 a -ice
CE-4R arLIG 2Si15'
Cap«Tart . 4 JggN Zip Coda
4.:DATE DRILLFA. .� �Jd — %td
5.r-TOTALDEPTH 'lc^
6 , minus Gs COLLECTED YES D ` No 3t ®~� �d
7... DOES WELL REPLACE EXISTING WEAL? YES Neve
- & STATIC WATER LEVEL Sew Top d Casing: 14 FT.
were raerwe'reercay)
'G." TOP OF CASING IS ` r FT. Above Land Surface°
":. 'Top o►e.:ugwdead Wart gwInd«rNm.spies.radon=maaeor-
101YIE7.D 0111e): t METHOD OF TEST
11. WATER ZONES (depth): 2 2 o
ORIWNG LOG
1L1- �6
12. GW.ORINAT)OI* Type
1S. CASING:
IFOR OFFICE USE ONLY f
OesldMac
Watts
From 631 To
..To.
_To.
To.
Wrlddara
p «Wrywrs watt
R ,l5'ree
R ihit.2,7
Diameter Slot Skil Mated.,
Ft In. 1n.
R. In. In.
PL' Mt In.
SAMO!AVEL PACK:::
.To.:,.
To.
DEPTH
addSotd span is traded oa twdud ban
LOCATION SKETCH
(Show stoodanand canna from
Roads, orol ar asp Samna pots)
ez 76 -- Cc`lcoc ,Z
. IDOHERESY-CERTIFY TNATTHISWELLWASCONSTRUCTED INA NOEvd%m15A NGYC2C.WELL
CONSTRUCTION STANDARDS. AND THAT ACOPY OFTISSRECORD HASOEEN WIPE WELL OMR-
�- �-r+ .��-lam' q ! LI -0 3
SIGNAnaW OF PERSON CONSTRUCTING THE WELL OKIE
Stan* =W dloMAWafWat«GuSGasadrwt«Sanatw1Wn90days GYM REY Sal

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resource - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) f rr�ri -'-' CERTIFICATION it 2 LCCa
WELL CONTRACTOR COMPANY NAME me / LzJi2/( r' p(//Y)p PHONE # ( )
STATE WELL CONSTRUCTION PERMIT# f a. a ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential B Municipal/Public ❑ Industrial ❑ Agricultural ❑
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use
2. WELL LOCATION:
Nearest Town: Srr% Vet r rt County %Pa n yivr/l4
(Street Name, Numbers,I
Community, Subdivision, Lot No., Zip Code)
3. OWNER: 0 11 A Sac '! 5 o ✓1
Address 12,1
(Street: No.)
City or Town State
(fae)- SR3-932_3
Zip Code
T�pographic/Land setting
pledge ❑Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From To Formation Description
0 o9. .S r/r :1
Area code- Phone number
4. DATE DRILLED A— V '-C7 3 a 5
5. TOTAL DEPTH: 5 3 0 /
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO C�
7. STATIC WATER LEVEL Below Top of Casing: FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS 1 FT. Above Land Surface*
*Top of casing terminated at/or oelow land surface requires a
variance in accordance with I5A NCAC 2C .0118. 1
9. YIELD (gpm): 5 0 METHOD OF TEST*S r L'31OL
10. WATER ZONES (depth):
1 I. DISINFECTION: Type /(7(4
12. CASING:
Depth Diameter
From 0 To 4 ( Ft. 11 yW l k( 3f tg
From To Ft.
From To Ft.
13. GROUT: Depth Material
From C'I To 2-.O Ft. Sa )fret
From To Ft.
Amount
Wall Thickness
or Weight/Ft. Material
Method
41 .9 rani 1`
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common road names.
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.
W b‘(
;th)a „d tad
O
c7
16. REMARKS: N
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH I5ANCAC 2C, WELD
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
SIGNATURE PERSON CONSTRUCTING THE WELL DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center -Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-1 REV. 07/2001

North Carafes • DirMenntnt of Environment and Natural Resources • Division of Water Quality • Groundwater Section 'j A n CI
1638 Mal Service Center • Ratdph. N.C. 27699.1639Ptwne [phone] • U
•
4WELL -CONSTRUCTION RECORD WELL CONTRACTOR: %y/<��T" "F"
WELL CONTRACTOR CERTIFICATION.: / r/ e/
STATE WELL CONSTRUCTION PERMIT.: i2-2
1. Wall. USE Whoa Apqicata.5*Residential D Municipal CI Industrial CI Agricultural Monitoring❑
Recovery ❑ Heal Pump Water InJecdon ❑ Other ❑ If Other, List Use:
• 2: €WELL LOCATION: - (Show sketch of the location below)
Nearest nom rf_ iv"i 0 4,C CawtiY• i/7An/sy/r.%•3w.r.&r.,.
. (Reed bane and Numbers. Community. or au00vIslon and tot Nt) DRI W NG LOG
3. OWNER /D — 3i-1s9c,te7 - From To
is Address_' %,7s .2. ' -- ,- r., ` 'S" U
City OfTowa Sale
4.;_: DATE DRILLED ,0-2-O ?
5.-_-TOTAL DEPTH .?
1/1-
�
Code
&., CUTTINGS COLLECTED YES ❑ : NOC
•• 7... ES WELL REPLACE EXISTING WELL? YES 0 - & SSTTATIC WATER LEVEL Below Top Casing: zFT.F�
WNW rAbowToP w Cdlel►
- Sr TOP OF CASING 1S s FT. Above Land Sudaoa•
*Top of salts lerdwMd atkr below lead sodas*regascow
a In sa
dance with ISANC*C2C
10, -YIELD (gptn): ^ METHOD OF TEST
11. WATER ZONES (depth): V o o — } e
•
12. CHLORINATION: Type
13. CASING:
Depth s of n s see wsi Thickness
ft
From_ z. Tp 6 0 pt, G'_ ,/ L • a_
Front --•-To
Rom,= -To • FL
Tr REMARKS:
DO HERESY CERTIFY THATTHIS WELL WAS CONSTRUCTED IN /1CCORDANCE Joann55A NCAC 2C. WELL
CONSTRUCTION STANDARDS. AND THAT ACOPY OF �Lvz � PA% g �D TO THE WELL ONt1En-
//>/a/ R OUSE ONLY- ; E SIGNATURE OF PERSON commuters THE WEU. DOE
d No Seam edging b Divbbnawaur Quality. (bardv at r Section within 30 d4ys
..� G*1 REV.1291
FF(CE
To FL
To Ft.
•
Ai 1/
Method
107E X-OOU/2.
DEPTH
Famta3m Dssaipdse
7-
/7.9A/7_7:-
0
0
If additional space is needed uses back tf ram
LOCATION SKETCH
(Show direction and inhorn el Masten Slate
Roads. or other nap rerem a phi
Serial No.