Av CY2004

North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
1636 Mail Service Center - Raleigh, N.C. 27699-1636 - Phone [phone]
WELL CONSTRUCTION RECORD
295323
WELL CONTRACTOR. Dewey Wright Well Puma Co Inc
WELL CONTRACTOR CERTIFICATION it. 2688
040172 STATE WELL CONSTRUCTION PERMIT#. Leslie Reece
1. WELL USE (Check Applicable Box): Residential xl Municipal
Recovery Heat Pump Water Injection 0 Other
I I
Industrial I I Agricultural CI Monitoring CI
If Other, List Use:
2. WELL LOCATION: (Show sketch of the location below)
Nearest Town: RANNFR PI V County AVFRV
MEflr1W GVR I rlOP OFF hAGGIlr1W ALIF O F HICKOR
oad ame an um ere, ommumty. or a 'vision and o o.
3. OWNER CHUCK IahUIELRWSKI
Address Ndln P7 9TR==T
WABASS rent or RouteJo.I FL 32970
City or Town State Zip Code
4. DATE DRILLED 5/7/2004
5. TOTAL DEPTH 340
6. CUTTINGS COLLECTED YES 0 NO n
7. DOES WELL REPLACE EXISTING WELL? YES El NO I X I
8. STATIC WATER LEVEL Below Top of Casing: 40 FT
(Use "+" if Above Top of Casing)
9. TOP OF CASING IS 1 FT Above Land Surface*
*Top of casing terminated at/or below land surface requires a variance in accor-
dance with 15A NCAC 2C.0118
W. YIELD lgpm): '1 METHOD OF TEST Air
11. WATER ZONES (depth)• 1 00 corn 1n1-1nn 0 nnacm
0 00 aom 0 00aom
12. CHLORINATION: Type HTH Amount 60
DRILLING LOG ' DEPTH
From To Formation Description
n d1 SIRT
41 101 GRANITE
103 104 SHAI E
104 0.40 GRANITE
If additional space is needed use back of form
13. CASING: LOCATION SKETCH
Wall Thickness
Depth Diameter or Weight/Ft. Material (Show direction and distance from at least two State
-rom 0 To d5 Ft e 1/8 CFO PVC Roads, or other map reference points)
'rem To Ft From To Ft
14. GROUT:
Depth Material Method
From 0 To 20 Ft fempnt Gravity Flow
From To Ft
15. SCREEN:
Depth Diameter Slot Size Material
From _ To Ft in in
From _ To Ft in in
From To Ft in in
16. SAND/GRAVEL PACK:
Depth Size Material
From To Ft
From To Ft
Y
17. REMARKS'
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER.
FOR OFFICE USE ONLY
/►LP/ .i Jn - 3 — 0 4
SI(EATURE OF PERSON CONSTRUCTING THE WELL DATE
Submit original to Division of Water Quality, Groundwater Section within 30 days
GW-1 REV. 12/99
Quad No:
Serial No

North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
1636 Mail Service Center - Raleigh, N.C. 27699-1636 - Phone [phone]
WELL CONSTRUCTION RECORD
296,09
WELL CONTRACTOR. Dewey Wright Well Pump Co., Inc.
WELL CONTRACTOR CERTIFICATION #. 2686
040071 STATE WELL CONSTRUCTION PERMIT#: Leslie Reece
1 WELL USE (Check Applicable Box): Residential 7
Municipal 0 Industrial 0 Agricultural E Monitoring fl
Recovery I I Heat Pump Water Injection I Other 0 If Other, List Use:
2. WELL LOCATION: (Show sketch of the location below)
Nearest Town: I INVILLE County: AVFRY
STURGII L I ANF OFF W THIRD ST OFF RUFFIN ST OF
(Road Name and Numbers, Community, or Subdivision and Lot No.l
3. OWNER IAMFR W RORPRSON
Address P 0 PDX FA?
. . ... _ (Street or Route No.l „7 .,..nay cn 7n o n.NITFI
IC 1
r_
or Town State Y
ip Code 7g Pn
4. DATE DRILLED 4/22/7004 80 151
5. TOTAL DEPTH 11R0 151 1!5? - A
6. CUTTINGS COLLECTED YES fl NO I XI 152 1R0 : • k
7. DOES WELL REPLACE EXISTING WELL? YES I I NO El
8. STATIC WATER LEVEL Below Top of Casing: 40 FT
(Use "+" if Above Top of Casing)
9. TOP OF CASING IS 1 FT Above Land Surface*
*Top of casing terminated at/or below land surface requires a variance in accor-
dance with 15A NCAC 2C.0116
10. YIELD (gpm): SO METHOD OF TEST Air
11. WATER ZONES (depth):20.00 gpm 7g-GO 1(1.00ppm 151-152
0.00 gprn 0.00gom
12. CHLORINATION: Type HTH Amount 28 If additional space is needed use bac
13. CASING:
Wall Thickness
Depth Diameter or Weight/Ft. Material
From 0 To RR_ Ft 611R R50 PVC
From To Ft
From To Ft
14. GROUT:
Depth
From 0 To 20
From To
15. SCREEN:
Method
(:pmAnt Gravity Flow y
DRILLING LOG 'DEPTH
From To Formation Description
0 5'p nIRT
m
of torm
LOCATION SKETCH
(Show direction and distance from at least two State
Roads, or other map reference points)
Depth Diameter Slot Size Material Cl
From _ To Ft in in
From To Ftin in.
From To Ft in in
16. SAND/GRAVEL PACK:
Depth Size Material
From To Ft
From To Ft
17. REMARKS �$ 1
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL bolt
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER.
�ll/cRnest Fi)-ot
.3
FOR OFFICE USE ONLY
Quad No:
SIG URE OF PERSON CONSTRUCTING THE WELL DATE
Submit original t rvlslon of Water Quality, Groundwater Section within 30 days
GW-1 REV. 12(99

North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
1636 Mail Service Center - Raleigh, N.C. 27699-1636 - Phone [phone]
WELL CONSTRUCTION RECORD WELL CONTRACTOR- Dewey Wright Well Pump Co., Inc.
WELL CONTRACTOR CERTIFICATION #: 2686
040032 STATE WELL CONSTRUCTION PERMIT# Leslie Reece
296308
1. WELL USE (Check Applicable Box): Residential I XI Municipal El Industrial 0 Agricultural E. I Monitoring El
Recovery I Heat Pump Water Injection I I Other ❑ If Other, List Use•
2. WELL LOCATION: (Show sketch of the location below)
Nearest Town: BANNER ELK County: AV RY
THREE TOP LANE OFF HORSEBOTTOM RD. OFF DOBBI
(Road Name and Numbers, Community, or subdivision and Lot No.) DRILLING LOG DEPTH
3. OWNER JIM SINNOT/TONY MACANINO From To Formation Description
Address % JACKS CONSTR. , P.O. BOX 130 0 55 DIRT
ViLAS Street or Route No.) NC 28692
City or Town state Zip Code
4. DATE DRILLED 4/29/2004
5. TOTAL DEPTH 185
6. CUTTINGS COLLECTED YES D NO ILI
7. DOES WELL REPLACE EXISTING WELL? YES D NO 0
8. STATIC WATER LEVEL Below Top of Casing: 40 FT
(Use "+" if Above Top of Casing)
9. TOP OF CASING IS 1 FT Above Land Surface*
'Top of casing terminated at/or below land surface requires a variance in accor-
dance with 15A NCAC 2G.0118 Air10. YIELD (gpm): L.METHOD OF TEST
11. WATER ZONES (depth): 2.00 ppm 158-159 0.00 ppm
0.00 ppm 0.00ppm
12. CHLORINATION: Type HTH Amount 30
13. CASING:
Depth Diameter
From 0 To 59 Ft 6 1/6
From To Ft
From To Ft
14. GROUT:
Wall Thickness
or Weight/Ft. Material
.350 PVC
Depth Material Method
From 0 To 20 Ft Cement Gravity Flow
From To Ft
15. SCREEN:
Depth Diameter Slot Size Material
From To Ft in in
From - To Ft in in
From To Ft in. in
16. SAND/GRAVEL PACK:
Depth
From To Ft
From To Ft
Size Material
55 158 GRANITE
158 159 SHALE
159 185 GRANITE
mTO
If additional space is needed us
S144-
LOCATION SKETC
of form
(Shaw direction and distance from .t least t u.°
Roads, or other map reference points)
('.t%
17. REMARKS:Cc. op ✓,
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
lik/
SIG URE OF PERSON CONSTRUCTING THE WELL DATE
Submit original rvlsion of Water Quality, Groundwater Section within 30 days OW REV. 12,94
I 4
cm;
rn
r:
0
FOR OFFICE USE ONLY
Quad No:

North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
1636 Mail Service Center - Raleigh, N.C. 27699-1636 - Phone [phone]
WELL CONSTRUCTION RECORD
z96307
WELL CONTRACTOR. Dewey Wright Well Pump Co., Inc.
WELL CONTRACTOR CERTIFICATION #: 2688
040115 STATE WELL CONSTRUCTION PERMIT#: Leslie Reece
1. WELL USE (Check Applicable Box): Residential n Municipal 0 Industrial 0 Agricultural 0-Monitoring
Recovery I Heat Pump Water Injection Other fl If Other, List Use:
2. WELL LOCATION: (Show sketch of the location below)
Nearest Town: RANNFR FI K
County: AVFRY
RTIINFY RPt C)K L P O dp FARM Rf"l f1FF SHAWN
oad Name and um ers, ommumty, or Su vision and of N
3. OWNER Ht IGI-1 $ PATRI rIA CFRCOPEI V
Address 8dd RTATE FARM R1
(Street or Route No.)
State 21p code
4. DATE DRILLED d/73/7flfld
5. TOTAL DEPTH 178
6. CUTTINGS COLLECTED YES 0 NO
7. DOES WELL REPLACE EXISTING WELL? YES 0 NO
8. STATIC WATER LEVEL Below Top of Casing: an FT
(Use "+" if Above Top of Casing)
9. TOP OF CASING IS 1 FT Above Land Surface*
*Top of casing terminated at/or below land surface requires a variance in accor-
dance with 15A NCAC 2C.0118
10. YIELD (gpm)' 20 METHOD OF TEST Air
11. WATER ZONES (depth):20.00 gpm77-78
0.00 qpm
12. CHLORINATION: Type HTH
0.00 qpm
0.00oom
Amount 18
xl
I. 1
DRILLING LOG DEPTH
From To Formation Description
D dP, nIPT
dR 77 GRANITF'
77 7R RHAI F
7R 125
If additional additional space is needed us
13. CASING: Wall Thickness -.4 LOCATION SKET
(
Depth Diameter or Weight/Ft. Material r (Sh. r direction and distance from
Prom 0 To 52 Ft 8 1!R 350 q Roads, or other map reference points)
From To
From To
14. GROUT:
Depth Material Method
From 0 To 20 Ft. Camant Gravity Flnw
H
ff N V.
1� E
`o
0
l 1?
From To Ft<\1
ry
15. SCREEN: O
Depth Diameter Slot Size Material
From To Ft in in
From To Ft in in
From _ To Ft in in
16. SAND/GRAVEL PACK:
Depth
From _ To
From To
Size Material
Ft
Ft
17. REMARKS: V 0S
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.
W ��^/`i �
SI TURE OF PERSON CONSTRUCTING THE WELL DATE
Submit original o Division of Water Quality, Groundwater Section within 30 days
GW-1 REV. 12/99
FOR OFFICE USE ONLY
Quad No:
Serial No.

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North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
1636 Mail Service Center - Raleigh, N.C. 27699-1636 - Phone [phone]
WELL CONSTRUCTION RECORD
294193
WELL CONTRACTOR. Dewey Wright Well Pump Co., Inc.
WELL CONTRACTOR CERTIFICATION #• 27Q7
040083 STATE WELL CONSTRUCTION PERMIT#• Jerry Wilscn
1. WELL USE (Check Applicable Box): Residential X Municipal n Industrial
Recovery I I Heat Pump Water Injection 0 Other If Other, List Use:
2. WELL LOCATION: (Show sketch of the location below)
Nearest Town: BANNER ELK County: AVERY
PRIVATE DR OFF HWy 184 OFF HWY 105
IRoad Name and Numbers, Community, or Subdivision and Lot No.)
3. OWNER BARBARA RUSSO
Address % AMERICA HOME PLACE , 1750 CATAWBA VALLEY
HICKORYSbeet Or
Rome No.; NC 28602
City or Town State Zip Code
4. DATE DRILLED 3/30/20134
5. TOTAL DEPTH 225
6. CUTTINGS COLLECTED YES 0 NO
7. DOES WELL REPLACE EXISTING WELL? YES El NO
8. STATIC WATER LEVEL Below Top of Casing: 30 FT
(Use "+" if Above Top of Casing)
9. TOP OF CASING IS 1 FT Above Land Surface*
*Top of casing terminated at/or below land surface requires a variance in accor-
dance with 15A NCAC 2C.0118
10. YIELD (gpm): 30 METHOD OF TEST Air
11. WATER ZONES (depth): 3.00 qpm 160-161 27.00ppm 210-211
0.00 qpm 0.00gpm
12. CHLORINATION: Type HTH Amount 40
Ar.
icultdralQ Monitoring {•
DRILLING LOG
From To
0 5
5
180
161
210
211
DEPTH
Formation Description
DIRT
160 GRANITE/QUARTZ
161 SHALE/QUAHiL
210 GRANITE/QUARTZ
211 QUARTZ
225 GRANITE
13. CASING:
I AI
X
Wall Thickness
Depth Diameter or Weight/Ft. Material
Prom 0 To 21 Ft 61/8 .350 PVC
From To Ft
From To Ft- '
14. GROUT:
From
From
Depth
0 To 20 Ft Cement
To Ft
15. SCREEN
Material
Method
Gravity Flow
Depth Diameter Slot Size Material
From To Ft in in
From _To Ft in in
From To Ft in in
16. SAND/GRAVEL PACK:
Depth Size Material
From _ To Ft
From To Ft
C
O
o-'
If additional space is needed use back of fo?th '
LOCATION SKETCH
(Show direction and distance from at I
I/ Roads, or other map reference
17. REMARKS• S
m
C7 cti
t two State
pdnts)F2
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COSY OF THIS RECORD HAS BEEN POOVIDED TO THE WELL OWNER.
FOR OFFICE USE ONLY
Quad No:
GNATURE OF PERSON CONSTRUCTING THE WELL DATE
Submit original to Division of Water Quality, Groundwater Section within 30 days
GW-1 REV. 12,99
Serial No.

North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
1636 Mail Service Center - Raleigh, N.C. 27699-1636 - Phone [phone]
WELL CONSTRUCTION RECORD WELL CONTRACTOR. Dewey Wright Well Pump Co., Inc.
WELL CONTRACTOR CERTIFICATION #• 2t78t1
C40029 STATE WELL CONSTRUCTION PERMIT# Leslie Reece
2980;
1. WELL USE (Check Applicable Box): Residential 0 Municipal Q Industrial Agricultural Q Monitoring 0
Recovery Heat Pump Water Injection 0 Other 0 If Other, List Use.
2. WELL LOCATION: (Show sketch of the location below)
Nearest Town: BANNER ELK County AVERY
BANNER GRANDE OFF BEECH MTN PARKWAY OFF HW
I Road Name and Numbers, Community, or Subdivision and Lot No.)
DRILLING LOG '' DEPTH
3. OWNER ELK VIEW LTD From To Formation Description
Address % CARRICO REALTY , 900 BRYCE CREEK RD. STE E 0 25 GRANITE
CHARLO i7et t or Ro to No.) NC 29205 25 28 GRAVEL
City or Town State Zip Code 29 521 GRANITE
4. DATE DRILLED 1/16/2004 521 522 QUARTZ
5. TOTAL DEPTH 745 522 745 GRANITE
6. CUTTINGS COLLECTED YES Li NO El
7. DOES WELL REPLACE EXISTING WELL? YES Li NO 71
8. STATIC WATER LEVEL Below Top of Casing: 200 FT
(Use "+" if Above Top of Casing)
9. TOP OF CASING IS 1 FT Above Land Surface*
'Top of casing terminated at/or below land surface requires a variance in accor-
dance with 15A NCAC 2 .e]]38
10. YIELD (gpm) .t)d METHOD OF TEST Ar
11. WATER ZONES (depth)' 0.63 porn 521-522 0.00 qpm
0.00 ppm 0.0Oppm
12. CHLORINATION: Type HTH Amount 112
c
v
r
If additional space is needed use
3
m
of Vatm
e
13. CASING: Wall Thickness LOCATION SKETCH
Depth Diameter or Weight/Ft. Material (Show direction and distance from at least two State
From 0 To Y 1 Ft 6 1/8 .350 PVC Roads, or other map reference points)
From To Ft 4----______,
From To Ft
14. GROUT:
Depth Material Method
From =' To 20 Ft C_..'ew J.Ca.y F.C.! -n
n
15. SCREEN:
�m r+ .-r_.:f. Raw
o From To Ft crLTc,
G 8
Y tLr
Depth Diameter Slot Size Material
From To Ft in in
From To Ft in in
From To Ftin in
16. SAND/GRAVEL PACK:
Depth
From To Ft
From To Ft
Size
Material �,9J
17. REMARKS.
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER.R�//
I�/fi'.n. e, . P 3—1 —h7
on inacY(o Division of Water Quality, Groundwater Section within 30 days
FOR OFFICE USE ONLY
Quad No
SI ATURE OF PERSON CONSTRUCTING THE WELL DATE
Submit g y
GW-1 REV. 12/99
Serial No

North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
1636 Mail Service Center - Raleigh, N.C. 27699-1636 - Phone [phone]
299153
WELL CONSTRUCTION RECORD
WELL CONTRACTOR. Dewey Wright Well Pump Co
WELL CONTRACTOR CERTIFICATION A. 2686
040228 STATE WELL CONSTRUCTION PERMIT#• Leslie Reece
1. WELL USE (Check Applicable Box): Residential
Recovery 0 Heat Pump Water Injection
Municipal 0 Industrial 0 Agricultural ❑ Monitoring fl
Other n If Other, List Use'
2. WELL LOCATION: (Show sketch of the location below)
Nearest T
Town: EANNER ELK Count. AVERY
[WgAN SacfRIAP&PF.- ,,tK rr eo i icPEE"d i_mgCH MTN. PAR
3. OWNER
Address
ELK VIEW LTD.
0% r4ol n 1 TV onn o VCo roll on cTC C`Fn
'•Clstr�atoCo?aedtdNb.)•••••,"R.—.. �...... . _.�
City or Tg,O,QRLOTTE State NC 2241Ude
4. DATE DRILLED
5. TOTAL DEPTH
6/26/2004
60o
6. CUTTINGS COLLECTED YES 0 NO n
7. DOES WELL REPLACE EXISTING WELL? YES I NO I x
8. STATIC WATER LEVEL Below Top of Casing: 60 FT.
(Use "+" if Above Top of Casing)
9. TOP OF CASING IS 1 FT Above Land Surface*
'Top of casing terminated at/or below land surface requires a variance in accor-
dance with 15A NCAC 2C.0118
10. YIELD (gpm): 5 METHOD OF TEST Air
11. WATER ZONES (depth): 1 nn gpmQR-Ob d nnpnm A91-172
n nn ppm n Mppm
12. CHLORINATION: Type HTH Amount 111
13. CASING:
Wall Thickness
Depth Diameter or Weight/Ft. Material
prom n To on Ft ? +;2 .3r rnrC
From To Ft
From To Ft
14. GROUT:
Depth Material Method
From 0 To ---210 Ft C meat Gravity Flcw
From To Ft
15. SCREEN:
Depth Diameter Slot Size Material
From To Ft in in
From To Ft in in
From To Ft in in -
16. SAND/GRAVEL PACK:
Depth Size Material
From To Ft
From To Ft
17. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER.
.mar 7- 3 -D 5c
DRILLING LOG
From To
C 7a
76 08
09 09
00 321
bEPTH
Formation Description
DRT cu o
nonur
nrI�ZRTZ
GRANITE
224.. 322 QUARTZ
322 600 GRANITE
B
C--
If additional space is needed use back of 'gem
O
LOCATION SKETCH C
(Show direction and distance from at least two State ' n /
Roads, or other map reference points)�(�h/�_Y�/-'
jatuAL-h, . e
7'
/AL
FOR OFFICE USE ONLY
Quad No•
Serial No
SIGTURE OF PERSON CONSTRUCTING THE WELL DATE
Submit original to Division of Water Quality, Groundwater Section within 30 days
GW-1 REV. 12/99

North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
1636 Mail Service Center - Raleigh, N.C. 27699-1636 - Phone [phone]
299148
WELL CONSTRUCTION RECORD
WELL CONTRACTOR. Dewey Wright Well Pump Co. Inc..
WELL CONTRACTOR CERTIFICATION #: 2688
030629 STATE WELL CONSTRUCTION PERMIT#• Leslie Reece
1. WELL USE (Check Applicable Box): Residential
Recovery ❑ Heat Pump Water Injection
V
Municipal Industrial ❑ Agricultural Monitoring
Other If Other, List Use.
2. WELL LOCATION: (Show sketch of the location below)
Nearest Town: IniVEocuIcI n County nt/ OV
1 'v '1 d
(Road Name and Numbers, Community, or Subdivision and Lot No.)
DRILLING LOG DEPTH
3. OWNER Neil A C TRI VPTTF From To Formation Description
Address 11QQ TYN r',AS—I F HWY ft inn Mt lfl POCK fPAVFI
HANNFR iee or Foute No.)
Nf' 7PjiNg inn 144 C'RANITF
City or Town State Zip Code
1414 145 SHnI F
4. DATE DRILLED 5L31/.70t1d 145 165 nPANiTF
5. TOTAL DEPTH 1e5
6. CUTTINGS COLLECTED YES ❑ NO
7. DOES WELL REPLACE EXISTING WELL? YES I NO L i
8. STATIC WATER LEVEL Below Top of Casing: 411 FT
(Use "+' if Above Top of Casing)
9. TOP OF CASING IS 1 FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a variance in accor-
dance with 15A NCAC 2C.0118
10. YIELD (gpml' 60 METHOD OF TEST Air
11. WATER ZONES (depth):50.00 ppm 144-145 0.00ppm
0.00 ppm 0.00ppm
12. CHLORINATION: Type HTH Amount 26
If additional space is needed use back of form'
f
O
13. CASING: LOCATION SKETCH
Wall Thickness
Depth Diameter or Weight/Ft. Material (Show direction and distance from at least two State
From fl To 1f 5 Ft R 1/d 1RP (A! V Cam/ Roads, or other map reference points)
From To Ft n n IoS
From To Ft
14. GROUT:
Depth Material Method
From r1 To "'fl Ft r'pmpnt era+rty F!nw
From To Ft
15. SCREEN:
Depth Diameter Slot Size Material
From To Ft in in
From _ To Ft in in
From _ To Ft in in
16. SAND/GRAVEL PACK:
Depth
From To Ft
From To Ft
Size Material
17. REMARKS'
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER.
FOR OFFICE USE ONLY
7-3—D�}
Quad No:
Serial No.
SIGNRE OF PERSON CONSTRUCTING THE WELL DATE
Submit original to Division of Water Quality, Groundwater Section within 30 days
GW-1 REV. 12/99

299146
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
1636 Mail Service Center - Raleigh, N.C. 27699-1636 - Phone [phone]
WELL CONSTRUCTION RECORD
WELL CONTRACTOR. Dewey Wright Well Pump Co., Inc.
WELL CONTRACTOR CERTIFICATION #. 2888
040215 STATE WELL CONSTRUCTION PERMIT# Leslie Reece
1. WELL USE (Check Applicable Box): Residential I Municipal fl Industrial ------Agricultural I I Monitoring 0
Recovery n Heat Pump Water Injection Other 0 If Other, List Use.
2. WELL LOCATION: (Show sketch of the location below)
Nearest Town: BANNER PLK County: AVERY
Wra ft,,§1C ?�d 2Efotli,g,69 Yndib .9A= RD OFF H
3. OWNER CONRAD POP
Address 0/, Vol 1 ,phi HI IGurS RANNFR FI rnnigmp P n gnu l7r,1
�5ueelor outeNa)
k NC' 2t;Rnd
City or Town State ipip ode
DRILLING LOG
From To
n aR
DEPTH
Formation Description
nipr
gR 11R GRANITE
115
4. DATE DRILLED 8/7/2204 118
5. TOTAL DEPTH 245 208
6. CUTTINGS COLLECTED YES n NO ni 7f10
7. DOES WELL REPLACE EXISTING WELL? YES NO 0
8. STATIC WATER LEVEL Below Top of Casing: 40 FT
(Use "+" if Above Top of Casing)
9. TOP OF CASING IS 1 FT Above Land Surface*
*Top of casing terminated at/or below land surface requires a variance in accor-
dance with 15A NCAC 2C.0118
10. YIELD (gpm): B METHOD OF TEST Air
11. WATER ZONES (depth): 2.00 apm 115-118 4.00gom 208-200
0.00 porn 0.00gpm
12. CHLORINATION: Type HTH Amount 43
13. CASING:
Depth
From _12,— To f l? Ft
From To Ft
From To Ft
14. GROUT:
Wall Thickness
Diameter or Weight/Ft. Material
9 1/9
75t] PVC
118 RHAI F
208 GRANITE
209 PHA( F
245 GRANITF
O-
U
If additional space is needed use back of-form--
Depth Material Method
From 0 To ?n Ft Cement Gravity Flnw
From To Ft CEMENT GRAVITY Fl OW
15. SCREEN:
Depth Diameter Slot Size Material
From To Ft in in
From _ To Ft in in
From _ To Ft in in
16. SAND/GRAVEL PACK:
Depth
From _ To
From To
Size Material
Ft
Ft
'O
C !l
(Show direction and distance from at least tvlatate"
Roads, or other map reference points)
\s„ I8�
— 3 . S —� \r
p\ �b
®O \A.
LOCATION SKETCH
17. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER.
�✓U,ry„ e .� 7 — 3 —0 9
FOR OFFICE USE ONLY
Quad No
Serial No
SI?19tATURE OF PERSON CONSTRUCTING THE WELL DATE
Submit origins o Division of Water Quality, Groundwater Section within 30 days
OW-1 REV. 12,99

North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
1636 Mail Service Center - Raleigh, N.C. 27699-1636 - Phone [phone]
299145
WELL CONSTRUCTION RECORD
WELL CONTRACTOR. Dewey Wright Well Puma Co. Inc.
WELL CONTRACTOR CERTIFICATION #: 2686
040214 STATE WELL CONSTRUCTION PERMIT#: Leslie Reece
1. WELL USE (Check Applicable Box): Residential b.] Municipal 0 Industrial D Agricultural L Monitoring L..
Recovery I I Heat Pump Water Injection 0 Other 0 If Other, List Use.
2. WELL LOCATION: (Show sketch of the location below)
Nearest Town: PANNP FI K County 45VEPY
SI itvlFv ER c VFFT DR OFF li rKORY NI IT f 4P Rll OFF H
I Road Name and Numbers, Community, or Subdivision and Lot No..)
3. OWNER RRAfl PADHP OR
DRILLING LOG DEPTH
From To Formation Description
Address W.. 5/AI IRUN,I uI Inure r(1N.ICTp P n PnY 17R1 ^ 70 d"UD, ClLA"
(Street or Route No.)
City or roBANNER El K state Air -Age 1 7g QI GRANITE
p ode
07 00 CUAI F
4. DATE DRILLED 6M in04 Gx 187 GRANiTF
5. TOTAL DEPTH "re 197 199 Q)-fAl
6. CUTTINGS COLLECTED YES Li NO n 1Sc 20^ CRA7\1IT=
7. DOES WELL REPLACE EXISTING WELL? YES I I NO [Ti
6. STATIC WATER LEVEL Below Top of Casing: an FT
(Use "+" if Above Top of Casing)
9. TOP OF CASING IS 1 FT Above Land Surface*
'Top of casing terminated at/or below land surface requires a variance in accor-
dance with 15A NCAC 2C.0118
10. YIELD (gpm): 7 METHOD OF TEST
11. WATER ZONES (depth): 3.00 opm97-98
0.00 opm
12. CHLORINATION: Type HT11
AJR
4.00opm 197-188
0.00aom
Amount 35
If additional space is needed use back etform t
13. CASING: LOCATION SKETCH C
Wall Thickness O
Depth Diameter or weight/Ft. Material Show direction and distance from at least two State
prom a To 27,1 Ft f " r^ "--`.0 r^--t,"' _ Roads, or other map reference points)
From To Ft
From To Ft
14. GROUT:
Depth Material Method
From n To 7' Ft rc- rf rr,,: , FIr„�r
From To Ft CFMIPNT CRA\J(TY Fl OW
15. SCREEN:
Depth Diameter Slot Size Material
From To Ft in in
From To Ft in in
From To Ft in in
16. SAND/GRAVEL PACK:
Depth Size Material
From To Ft
From To Ft
17. REMARKS'
18+
A---- 3. S -�
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC ZC, WELL 1
AC
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER.
FOR OFFICE USE ONLY
1a
w RLet 7 -3 —o 9-
Quad No'
Serial No.
�}GNATURE OF PERSON CONSTRUCTING THE WELL DATE
Submit original to Division of Water Quality, Groundwater Section within 30 days
GW-1 REV. 12/99

on 299568
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Sect
1636 Mail Service Center - Raleigh, N.C. 27699-1636 - Phone [phone]
WELL CONSTRUCTION RECORD
040292
WELL CONTRACTOR. Dewey Wright Well Pump Co., Inc.
WELL CONTRACTOR CERTIFICATION it 2686
STATE WELL CONSTRUCTION PERMIT#• Leslie Reece
1. WELL USE (Check Applicable Box): Residential X Municipal El Industrial 0 Agricultural P1 Monitoring 0
Recovery IP Heat Pump Water Injection Other I I If Other, List Use•
2. WELL LOCATION: (Show sketch of the location below)
Nearest Town: RANNFR Fl K County: AVFRY
PRIVATE DR OFF ELK RIVER RD OFF OI D MILL RD 0
(Road Name and Numbers, Community. or Subdivision and Lot No.)
DRILLING LOG DEPTH
3. OWNER HAROLD E PRITCHARD From To Formation Description
Address 929 ELK RIVER RD. 0 18 MUD/GRAVEL
ELK PARRtreet or Route No.)
NC 28622 18 33 GRANITE
City or Town State Zip Code 33 34 SHALE
4. DATE DRILLED 6/17/2004 34 138 GRANITE
5. TOTAL DEPTH 165 138 139 QUARTZ
7. DOES WELL REPLACE EXISTING WELL? YES Li NO
8. STATIC WATER LEVEL Below Top of Casing: 20 FT
(Use "+" if Above Top of Casing)
9. TOP OF CASING IS 1 FT Above Land Surface*
'Top of casing terminated at/or below land surface requires a variance in accor-
dance with 15A NCAC 2C.0118
10. YIELD (gpm): 8 METHOD OF TEST Ar
11. WATER ZONES (depth). 3,00 ppm 33-34 ,.00gpm 138-130
u.UI cam u.Uuppm
6. CUTTINGS COLLECTED YES 0 NO n 139 165 GRANITE°
X
r
"so
Ca
12. CHLORINATION: Type HTH Amount 30
13. CASING:
Wall Thickness
Depth Diameter or Weight/Ft. Material
From 0 To 21 Ft 6 1/4 .188 GALV.
From To Ft
From To Ft
14. GROUT:
IV
If additional space is needed use back of fbjm
Depth Material Method
From 0 To 20 Ft Cement Gravity Flow
From To Ft CEMENT GRAVITY FLOW
15. SCREEN:
Depth Diameter Slot Size Material
From To Ft in in
From To Ft. in in
From To Ft in in
16. SAND/GRAVEL PACK:
Depth Size Material
From To Ft
From To Ft
17. REMARKS'
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER.
LOCATION SKETCH
(Show direction and distance from at least two State
Roads, or other map reference points)
FOR OFFICE USE ONLY
Quad No-
. -ee, 7-go-oy
SI URE OF PERSON CONSTRUCTING THE WELL DATE
Submit original Division of Water Quality, Groundwater Section within 30 days
GW-1 REV. 12/99
Serial No

North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
1636 Mail Service Center - Raleigh, N.C. 27699-1636 - Phone [phone]
WELL CONSTRUCTION RECORD
2 99565
WELL CONTRACTOR. Dewey Wright Well Pump Co., Inc.
WELL CONTRACTOR CERTIFICATION #. 2681
040281 STATE WELL CONSTRUCTION PERMIT#• Steve Petty
1. WELL USE (Check Applicable Box): Residential a Municipal 0 Industrial FE Agricultural E Monitoring n
Recovery Heat Pump Water Injection I I Other 0 If Other, List Use:
2. WELL LOCATION: (Show sketch of the location below)
Nearest Town: BANNER ELK County: AVERY
LOT # 8 OFF FQX MEADOW LAN OFF FOX MEADOW D
I Road Name and Numbers, Community, or Subdivision and Lot No.)
3. OWNER BURKE MAY
Address % FARRELL SHEPHARD , 471 LONNIE HENSON RD.
VI LAS Street or Rouse Na) NC 28692
City or Town State Zip code
4. DATE DRILLED 8/14/2004
5. TOTAL DEPTH 305
6. CUTTINGS COLLECTED YES FE NO n
7. DOES WELL REPLACE EXISTING WELL? YES 0 NO n
8. STATIC WATER LEVEL Below Top of Casing: 30 FT
(Use "+' if Above Top of Casing)
DRILLING LOG
From To
0 7
7 43
DEPTH
Formation Description
DIRT
GRANITE
43 44 SHALE
44 93 GRANITE
93 94 SHALE
94 305 GRANITE/QUARTZ
9. TOP OF CASING IS 1 FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a variance in accor-
dance with 15A NCAC 2C.0118
10. YIELD (gpm): 5 METHOD OF TEST Ar
11. WATER ZONES (depth)' 3.00 ppm43-44 2.O0gpm 03A4
U.UU ppm U.UUppm
12. CHLORINATION: Type HTH
13. CASING:
Depth Diameter
Amount 56
Wall Thickness
or Weight/Ft.
Prom 0 To 20 Ft 6 1/8 .350
cror• To Ft
From To Ft
14. GROUT:
Material
PVC
Depth Material Method
From 0 To 20 Ft Cement Gravity Flow
From
15. SCREEN
To Ft
Depth Diameter Slot Size Material
From To. Ft in in
From To Ft in in
From To Ft in in
16. SAND/GRAVEL PACK:
Depth Size Material
From To Ft
From To Ft
If additional space is needed use bac�of ftrrm
LOCATION SKETCH . _,
(Show direction and distance from at I a�'At two.State
Roads, or other map reference points)
r
17. REMARKS• L "N
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN CORDAN E WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER.
SIGNATURE OF PERSON CONSTRUCT! THE WELL DATE
Submit original to Division of Water Quality, Groun water Section within 30 days
GW-1 REV. 12/99
dos
bo
bo
e Im%--,
i
FOR OFFICE USE ONLY
Quad No•
Serial No

Zip Code
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
1636 Mail Service Center - Raleigh, N.C. 27699-1636 - Phone [phone]
WELL CONSTRUCTION RECORD
040266
299563
WELL CONTRACTOR. Dewey Wright Well Pump Co., Inc.
WELL CONTRACTOR CERTIFICATION #- 2681
STATE WELL CONSTRUCTION PERMIT#• Steve Petty
1. WELL USE (Check Applicable Box): Residential I xJ Municipal I I Industrial Q Agricultural 0 Monitoring D
Recovery Heat Pump Water Injection 0 Other 0 If Other, List Use.
2. WELL LOCATION: (Show sketch of the location below)
Nearest Town: PINEOLA County: AVERY
PRIVATE DR. OFF IHWY 221 OFF HWY 184 OFF HWY 10
(Road Name and Numbers, Community, or Subdivision and Lot No.)
DRILLING LOG r. DEPTH
3. OWNER CLASSIC STONE WORK INC. From To Formation Description
Address P.O. BOX� 'kV
, 0 100 DIRT
BANNER'kV °' flO01e N° l NC 28604 100 120 GRANITE
City or Town State 120 121 SHALE
4. DATE DRILLED 6/15/2004 121 187 GRANITE
5. TOTAL DEPTH 205 187 189 SHALE
6. CUTTINGS COLLECTED YES 0 NO 0 189 205 GRANITE
7. DOES WELL REPLACE EXISTING WELL? YES NO El
8. STATIC WATER LEVEL Below Top of Casing: 40 FT.
(Use "+' if Above Top of Casing)
9. TOP OF CASING IS 1 FT Above Land Surface*
*Top of casing terminated at/or below land surface requires a variance in accor-
dance with 15A NCAC 2C.0118
10. YIELD (gpm): 20 METHOD OF TEST Air
11. WATER ZONES (depth) 2.00 ppm 120-121 18.00ppm 187-199
0.00 ppm 0.00ppm
12. CHLORINATION: Type HTH Amount 35
13. CASING:
Wall Thickness
Depth Diameter or Weight/Ft. Material
Prom _ 0 To 110 Ft. 6 1/8 .350 PVC
From To Ft
From _ To Ft
14. GROUT:
Depth Material Method
From 0 To 20 Ft Cement Gravity Flow
From To Ft
15. SCREEN
Depth Diameter Slot Size Material
From To Ft. in - in
From _To Ft in in
From _To Ft in in
16. SAND/GRAVEL PACK:
Depth Size Material
From To Ft
From To Ft
17. REMARKS•
Iv
rn
If additional space is needed use Salk of farm
(V
LOCATION SKETCHc—
(Show direction and distance from atcast tW.ta State
Roads, or other map reference points)
ti de 61 —�
New br. dfri
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL Q`
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER.
FOR OFFICE USE ONLY
Quad No'
GLsa
Serial No
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
Submit original to Division of Water Quality, Groundwater Section within 30 days
GW-1 REV. 12/99

North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section 302194
21 9 4
OAPof i
1636 Mail Service Center - Raleigh, N.C. 27699-1636 - Phone [phone]
WELL CONSTRUCTION RECORD
WELL CONTRACTOR- Dewey Wright Well Pump Co., Inc.
WELL CONTRACTOR CERTIFICATION #- 2681
040403 STATE WELL CONSTRUCTION PERMIT#• Steve Petty
1. WELL USE (Check Applicable Box): Residential n Municipal ❑ Industrial Agricultural ❑ Monitoring ❑
Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use.
2. WELL LOCATION: (Show sketch of the location below)
Nearest Town: BANNEREI K County. AVFRY
STDNFYRRDDK I N OFF O1 F) FARM RD OFF RHAWNEE
(Road Name and Numbers, Community, or Subdivision and Lot No.)
3. OWNER DAVID T MCMANUR
Address P.O. BOX(51t459
C
BANNER (-i: or Route N° l NC 28604
city or Town State
Zip Code
4. DATE DRILLED 8/16/2004
5. TOTAL DEPTH 205
6. CUTTINGS COLLECTED YES ❑ NO El
7. DOES WELL REPLACE EXISTING WELL? YES ❑ NO
8. STATIC WATER LEVEL Below Top of Casing: 20 FT
(Use'+" if Above Top of Casing)
9. TOP OF CASING IS 1 FT Above Land Surface*
'Top of casing terminated at/or below land surface requires a variance in accor-
dance with 15A NCAC 2C.0118
10. YIELD (gpm): 80 METHOD OF TEST fur
11. WATER ZONES (depth) 2.00 Wm82-83 1.00ppm 97-98
57.00 ppm 190-193 0.00ppm
12. CHLORINATION: Type HTH Amount 39
DRILLING LOG
From To
0 30
DEPTH
Formation Description
DIRT
30 82 GRANITE
82 83 SHALE
83 97 GRANITE
97 98 SHALE
98 190 GRANITE
190
193 SIJA E QUARTZ
193 205 GRANITE
13. CASING:
121
Wall Thickness
Depth Diameter or Weight/Ft. Material
From 0 To 36 Ft 6 1/8 .350 PVC
From To Ft
From To Ft
14. GROUT:
Depth Material Method
From 0 To 20 Ft Cement Gravity Flow
From To Ft
15. SCREEN
Depth Diameter Slot Size Material
From To Ft in in
From To Ft in in
From To Ft in in
16. SAND/GRAVEL PACK:
Depth Size Material
From To Ft
From To Ft
C n1 r'
r-
cr)
•L
O
If additional space is needed use back of 1R4n
-a
LOCATION SKETCH
(Show direction and4stance from at least two S5te
Roads, or otly map Leferf er�c: f rots) fd�
j� �y N1• jitJ�
4.— .10 -1 'f
4—
iNcc.
0
(.%-t
17. REMARKS- (pij
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.
FOR OFFICE USE ONLY
Quad No:
SIGNATURE OF PERSCJN CONSTRUCTING? HE WELL DATE
Submit original to Division of Water Quality, Groundwater Section within 30 days
GW-1 REV. 12/99
Serial No.

North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
1636 Mail Service Center - Raleigh, N.C. 27699-1636- Phone [phone]
WELL CONSTRUCTION RECORD WELL CONTRACTOR.
040430
302196
Dewey Wright Well Pump Co., Inc.
WELL CONTRACTOR CERTIFICATION #• 2681
STATE WELL CONSTRUCTION PERMIT#• Steve Petty
1. WELL USE (Check Applicable Box): Residential n Municipal Industrial ❑ Agricultural ❑ Monitoring ❑
Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use.
2. WELL LOCATION: (Show sketch of the location below)
Nearest Town: BANNER ELK County AVERY
SAM ELLER RD. OFF HWY 194 OFF HWY 184 OFF IHWY
I Road Name and Numbers, Community, or Subdivision and Lot No.)
3. OWNER TONEY W WEATHERMAN
Address 1204 I aLLSBORO STREET
11� 1
RALEIGH(Street or Route No.) NC 27607
City or Town Stale Zip Code
4. DATE DRILLED 8/17/2004
5. TOTAL DEPTH 145
6. CUTTINGS COLLECTED YES ❑ NO 7
7. DOES WELL REPLACE EXISTING WELL? YES ❑ NO -5—I(I
8. STATIC WATER LEVEL Below Top of Casing: 20 FT.
(Use "+" if Above Top of Casing)
9. TOP OF CASING IS 1 FT Above Land Surface*
'Top of casing terminated at/or below land surface requires a variance in accor-
dance with 15A NCAC 2C.0118
10. YIELD (gpm)' 3 METHOD OF TEST Air
11. WATER ZONES (depth)• 1.00 ppm 94-95 2.00 ppm 120-121
0.00 ppm 0.00ppm
12. CHLORINATION: Type HTFi Amount 26
13. CASING:
Wall Thickness
Depth Diameter or Weight/Ft.
From � To B8 Ft B 1/4 188
From To Ft
From To Ft
14. GROUT:
Depth Material Method
From 0 To _20 Ft Cement Gravity Flow
From To Ft
15. SCREEN:
Depth Diameter Slot Size Material
From To Ft in in
From _ To Ft in. in
From To Ft in in
16. SAND/GRAVEL PACK:
Depth Size Material
From To Ft
From To Ft
DRILLING LOG
From To
0 o2
DEPTH
Formation Description
DIRT
82 94 GRANITE
94 95 SHALE
95 120 GRANITE
120 121 SHAI F
121 145 GRANITE
© ^ rn
Nn,3
If additional space
s needed use back of tam s
n C]
LOCATION SKETCH
(Show direction and distance from at least two State
Roads, or other rrt gference points)
17. REMARKS.
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER.
FOR OFFICE USE ONLY
Quad No -
SIGNATURE OF PERSON CONSTRUCTING TFit WELL DATE
Submit original to Division of Water Quality, Groundwater Section within 30 days
GW-1 REV. 12/99
Serial No

North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
1636 Mail Service Center - Raleigh, N.C. 27699-1636 - Phone [phone]
302206
WELL CONSTRUCTION RECORD WELL CONTRACTOR. Dewey Wright Well Pump Co.. Inc.
040128
WELL CONTRACTOR CERTIFICATION #- 2686
STATE WELL CONSTRUCTION PERMIT#• Leslie Reece
1. WELL USE (Check Applicable Box): Residential I XI Municipal D Industrial
Recovery I I Heat Pump Water Injection Other El If Other, List Use.
2. WELL LOCATION: (Show sketch of the location below)
Nearest Town: INVERSHIELD County. AVERY
GWALTNEY RD. OFF HWY 194 OFF HWY 184 OFF HWY
I Road Name and Numbers, Community, or Subdivision and Lot No.)
Agricultural Q Monitoring in
DRILLING LOG DEPTH
3. OWNER RICHARD WOLF From To Formation Description
Address P.O. BOX 1525 , 0 62 GRAVEL BOULDERS
BANNER `s`L% or Route No.1 NC 28604 62 77 GRANITE
City or Town State Zip Code 77 78 SHALE
4. DATE DRILLED 4/27/2004 78 111 GRANITE
5. TOTAL DEPTH 125 111 112 SHALE
6. CUTTINGS COLLECTED YES n NO X 112 125 GRANITE
7. DOES WELL REPLACE EXISTING WELL? YES 0 NO El
8. STATIC WATER LEVEL Below Top of Casing: 10 FT
(Use "." if Above Top of Casing)
9. TOP OF CASING IS 1 FT Above Land Surface*
'Top of casing terminated at/or below land surface requires a variance in accor-
dance with 15A NCAC 2 nn118
10. YIELD (gpml• to METHOD OF TEST Air
11. WATER ZONES (depth)10'00 °pm 77-78 10.00qpm 111-112
0.00 gpm 0.00gpm $ ��
12. CHLORINATION: Type IiTH Amount 23 If additional space is needed use back of fora
O �'c',
r r
N 9e
n
13. CASING:
Wall Thickness
Depth Diameter or Weight/Ft. Material
From 0 To 66 Ft. 6 1/4
From To Ft
From To Ft
14. GROUT:
Depth
From 0 To 20 Ft Cement
From To Ft
15. SCREEN:
.188
Material
GALV
Method
Gravity Flow
Depth Diameter Slot Size
From To Ft in in
From To Ft in. in
From To Ft in in
16. SAND/GRAVEL PACK:
Depth
From To Ft
From To Ft
17. REMARKS.
Size Material
LOCATION SKETCH
(Show direction and distance from at least two State
Roads, or other map reference points)
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
T
a
CONSTRUCTION STANDARDS, AND THAT A COP/Y OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER./
,WritA nt /"16-09
FOR OFFICE USE ONLY
Op
C.
c�
J
Quad No -
Serial No.
SI TURE OF PERSON CONSTRUCTING THE WELL DATE
Submit origins o Division of Water Quality, Groundwater Section within 30 days
GW-1 REV. 12/99

North Carolina - Department of Environment and Natural Resources - Division of Water Quality
1636 Mail Service Center - Raleigh, N.C. 27699-1636 - Phone [phone]
WELL CONSTRUCTION RECORD
040223
Groundwater Section
302205
WELL CONTRACTOR- Dewey Wright Well Pump Co., Inc.
WELL CONTRACTOR CERTIFICATION #. 2686
STATE WELL CONSTRUCTION PERMIT#• Leslie Reece
WELL USE (Check Applicable Box): Residential Municipal I I Industrial Agricultural El Monitoring 0
Recovery 0 Heat Pump Water Injection Q Other P If Other, List Use.
2. WELL LOCATION: (Show sketch of the location below)
Nearest Town: BANNER ELK County. AVERY
BANNER GRANDE OFF BEECH MTN. PARKWAY OFF H
(Road Name and Numbers, Community, or Subdivision and Lot No.)
3. OWNER ELK VIEW LTD.
Address % CARICO REALTY . 800 BRYER CREEK RD. STE.EE
CHARLOTitet or Route No.) NC 28205
City or Town State Zip Code
4. DATE DRILLED 9/17/2004
5. TOTAL DEPTH 800
I I
DRILLING LOG
From To
0 35
DEPTH
Formation Description
DIRT SHALE
35 85 GRANITE
85 88 SHALE
86 361
GRANITE
361 362
6. CUTTINGS COLLECTED YES P NO n 362 485
7. DOES WELL REPLACE EXISTING WELL? YES 0 NO ❑X 485 486
8. STATIC WATER LEVEL Below Top of Casing: 50 FT. 486 800
(Use "+' if Above Top of Casing)
9. TOP OF CASING IS 1 FT Above Land Surface*
*Top of casing terminated at/or below land surface requires a variance in accor-
dance with 15A NCAC 2C.0118
10. YIELD Igpml• 6 METHOD OF TEST Air
11. WATER ZONES (depth) 1.50 pprn85-86 1.50gpm 361-362
3.00 gpm485-486 0.00ppm
12. CHLORINATION: Type HTH Amount 143
13. CASING:
Depth Diameter
From 0 To 41 Ft 6 1/8
From To Ft
From _ To Ft
14. GROUT:
Wall Thickness
or Weight/Ft. Material
.350 PVC
Depth Material Method
From 0 To 20 Ft Cement Gravity Flow
From To Ft
15. SCREEN:
Depth Diameter Slot Size Material
From To Ft in in
From To Ft in. in
From To Ft in in
16. SAND/GRAVEL PACK:
Depth Size Material
From To Ft
From To Ft
GRANITE
GRANITE
QUARTZ
GRANITE
If additional space is needed use back of form
C
EPP
LOCATION SKETCH at n
(Show direction and distance from at least two State
Roads, or other map reference points)
17. REMARKS•
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH
CONSTRUCTION STANDARDS, AND THAT A'C,O/PY OF THIS RECORD HAS BEEN PROVI
'et
FOR OFFICE USE ONLY
Quad No
-Pot_
ATURE OF PERSON CONSTRUCTING THE WELL DATE
Submit origina to Division of Water Quality, Groundwater Section within 30 days
GW-1 REV. 12/99
>rtarts-
�i1L
C 2C, WELL
THE WELL OWNER.
144'
9-/6-0V
Serial No

North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
1636 Mail Service Center - Raleigh, N.C. 27699-1636 - Phone [phone]
30083
WELL CONSTRUCTION RECORD
040355
WELL CONTRACTOR Dewey Wright We!! Pump Co , Inc
WELL CONTRACTOR CERTIFICATION #. 26B1
STATE WELL CONSTRUCTION PERMIT#• Stet Pe' y
1. WELL USE (Check Applicable Box): Residential
Recovery I Heat Pump Water Injection
Municipal Q Industrial El AgrieulturaC— ldotiitorgig
Other Q If Other, List Use:
2. WELL LOCATION: (Show sketch of the location below)
Nearest Town: garu a f,-ni County: A VERY
-WV
3^.1 OFF
'Foau Na ;f rdum�o'era, Communnity. o, Subdi Egon and Lot of
DRILLING LOG DEPTH
3. OWNER ARiuC n i,, TRIuETFF From To Formation Description
Address 7277 RFFrl-I 4TT At 4f1 f1 25 not
1`irreet or Route No.,
ECity or Town iK PARR State NC 2882fc Code 25 5i GRANITE
g2 F1 4HP,1 F
4. DATE DRILLED 7/1E0004 53 120 GRANITE
5. TOTAL DEPTH 105 120 121 CNA' F
6. CUTTINGS COLLECTED YES n NO n 121 142 GRANITE
7. DOES WELL REPLACE EXISTING WELL? YES 0 NO n 14P 15P 4I-1 l r
8. STATIC WATER LEVEL Below Top of Casing: 20 FT 150 ^,ri5 GRANT -FP
(Use "+" if Above Top of Casing)
9. TOP OF CASING IS 1 FT. Above Land Surface*
'Top of casing terminated at/or below land surface requires a variance in accor-
dance with 15A NCAC 2C.011B
10. YIELD (gpm)• 20 METHOD OF TEST Air
11 WATER ZONES (death): 1.00 aom52-53 4.00corn 120-121
13 00 corn 148-15G 0 Mawr,
_OF;NATION• Type HTN
Amount 3n
C
O p
c170
If additional space is needed use bag of f
13. CASING: LOCATION SKETCH S �"
Wall Thickness N N2
Death Diameter or Weight/Ft- Material (Show direction and distance from at leant tw rate
c.... n To in, Ft a n ro een '„,.. Roads, r
To Ft
From To Ft
14. GROUT,
Depth Material Method
From 0 To 22 Ft C_rie t 3r3.Z F!t .
From To Ft.
15. SCREEN
Depth Diameter Slot Size Material
From To Ft. in in
From To Ft in. in
From To Ft. in in
16. SAND:'GRAVEL PACK:
Depth Size Material
From To Ft
From To Ft
17. REMARKS -
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15 ' CAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER.
Lta.t z
FOR OFFICE USE ONLY
Quad No
eo
SIGNATURE OF PERSON COING THE WE L DATE
Submit original to Division of Water Quality, Groundwater Section within 30 days
GW-1 REV. 12/99
Serial No

North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
1636 Mail Service Center - Raleigh, N.C. 27699-1636 - Phone [phone]
300847
WELL CONSTRUCTION RECORD
24035e
WELL CONTRACTOR- De,,-ev Writ* We" Pu-:,p Cc.. Ir8...
WELL CONTRACTOR CERTIFICATION it. 26B6
STATE WELL CONSTRUCTION PERMIT# Les'ia Rcecc
1. WELL USE (Check Applicable Box): Residential Municipal ❑ Industrial ❑
Recovery I Heat Pump Water Injection Other ❑ If Other, List Use•
2. WELL LOCATION: (Show sketch of the location below)
Nearest Town. E County
i . axdx bric4F13,1ot4t(did o6aC5Io,Oe
3. OWNER TYRON EoRKER
Address 374 THOA"sP 1;TAg o,.
City or ' 3gnt
4. DATE DRILLED ',20,,:0n4
5. TOTAL DEPTH 365 242
6. CUTTINGS COLLECTED YES ❑ NO Lid 2' -
7. DOES WELL REPLACE EXISTING WELL? YES El NO n
8. STATIC WATER LEVEL Below Top of Casing: 6*FT
(Use "." if Above Top of Casing)
Sate ^ £Q$de
**VERY
Agricultural
Monitoring Jl
DRILLING LOG
From To
37
DEPTH
Formation Description
DIRT
37 121 GiRtR IITE
9 TOP OF CASING IS 1 FT. Above Land Surface*
`Top of casing terminated at/or below land surface requires a variance in accor-
dance with 15A NCAC 2C0118
10. YIELD (porn,- f METHOD OF TEST Air
'1. WATEEZONES :deoth; 1 nnnor^171_17? 1 Fnn--a' 2d0,-264
C r-t )R.tv'ATION. Type I-M-1 Amount Rd
13. CASING:
Wall Thickness
Dent h Diameter or Weight:Ft. Material
To Ft e ''e
To Ft
From To Ft
14. GROUT.
gcn
Depth Material Method
From To Ft
From To Ft
15. SCREEN
Depth Diameter Slot Size Material
From To Ft. in in
From —_To Ft in in
From _ To Ft in in
16. SAND/GRAVEL PACK:
Depth
From To
From _ To
17. REMARKS -
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER.
1&'a-11 & dieQ g-lc'h9-
AGNATURE OF PERS N CONSTRUCTING THE WELL DATE
Submit original to Division of Water Quality, Groundwater Section within 30 days
GW-1 REV. 12/99
Ft
Ft
Size Material
121 122 QUARTZ
CR»Ni iE
244 SHALE
365 -C:*st A tklu 1_
c
Q
If additional space is needed use back c$ormN2
LOCATION SKETCH J
direction and distance from at least two State
Roads, or other map reference points)
FOR OFFICE USE ONLY
Quad No•
1'
Serial No.

North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section 3 O f p J 2
1636 Mail Service Center - Raleigh, N.C. 27699-1636 - Phone [phone] I O
WELL CONSTRUCTION RECORD
040277
WELL CONTRACTOR. Dewey'.4'rp '!Ye" Pump
WELL CONTRACTOR CERTIFICATION #. 27g7
STATE WELL CONSTRUCTION PERMIT#- Jerry I;Iso^
1. WELL USE (Check Applicable Box): Residential Municipal n Industrial n
Recovery I Heat Pump Water Injection Other 0 If Other, List Use'
2. WELL LOCATION: (Show sketch of the location below)
Nearest Tyown: Inp,4FPS-1lrtg Lt[[,r County. AV VER
.coed nd um NamtaNbeo rs, Cmm¢K or �ubG ry tlrson ana Lot Nos' L'^~ WI OF
3. OWNER
Address
4E.t7Cit T.' ES
o< kntrv.• ono-rcC• p n onv Cr•nc
_ fStreetorMoutd No. i ' --- �},�
coy o-'t n "1'7ER EL`. state NC 2 '.Cbde
4. DATE DRILLED 7,1,3r2CD'
5. TOTAL DEPTH enr
6. CUTTINGS COLLECTED YES j} NO
7. DOES WELL REPLACE EXISTING WELL? YES El NO LEI
8. STATIC WATER LEVEL Below Top of Casing' :40 FT.
(Use''" if Above Top of Casing)
9 TOP OF CASING IS 1 FT. Above Land Surface*
`Top of casing terminated at/or below land surface requires a variance in accor-
dance with 15A NCAC 2C.0118
10. YIELD (gpmt: 7 METHOD OF TEST Air
11. WATER ZONES Ideothi: A nn onm7nr,-7nF, 4 5nnom 414 rIAL11
Agricultural L J Monitoring
DRILLING LOG
From To
or, -4'.
CH_L)RAATION. Type kT Amount 115
13. CASING:
Wall Thickness
Depth Diameter or Weight Ft Material
n To 2 C Ft. e C lC
-�c- To Ft
From To Ft
14. GROUT:
Cog
Depth Material
From ^ To Ft (—
From To Ft
15. SCREEN:
`A' ,r
Method
,F. Ci,
Depth Diameter Slot Size Material
From To Ft in in
From To Ft in in
From To Ft. in in
16. SAND/GRAVEL PACK:
Depth
From To Ft
Size Material
From To Ft
17. REMARKS -
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, ELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER.
2-73—a76'd
0 12
DEPTH
Formation Description.
411171" a nLF�iF}fll'JITF
12 205 GRciu«TE QUARTZ
205 206 GRANITE
206 "6'2 SR/04iTE CtuARTZ
410 411 BROWN SHALE
441 605 CRAW: -PE QUARTZ
O
r
0
0 -.
c
r
If additional space is needed use bacflf form
Yr'
4
LOCATION SKETCH —0 ro
Pt
(Show direction and distance from at leas g
t�wo Sta
Roads, or other map reference poirlls) '
� t
J
�-- 1 s
.6
I FOR OFFICE USE ONLY
Quad No'
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
Submit original to Division of Water Quality, Groundwater Section within 30 days
GW-1 REV. 12/99
3
Serial No

North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
1636 Mail Service Center - Raleigh, N.C. 27699-1636 - Phone [phone]
300850
WELL CONSTRUCTION RECORD
WELL CONTRACTOR. Dewey 'Night We"
WELL CONTRACTOR CERTIFICATION A. 2787
Pumc Co. Inc.
022e2 STATE WELL CONSTRUCTION PERMIT#' Jer^: 'r".^.!sor,
1. WELL USE (Check Applicable Box): Residential Municipal n Industrial
Recovery —I Heat Pump Water Injection Other U If Other, List Use:
2. WELL LOCATION: (Show sketch of the location below)
Nearest Town: oANo.Imp Pi V County A VPPv
MEA ' Ti:Y AvEN E OFF NICKOKti NUT QAP Ri/ OFF 18
iRoed Name and Numbers, Community, or Subdivision and Lot No
3. OWNER K:-PA C 0iiC Rh&C'Ti Nid lNrl
Address c177 et.' Irii O.n1*rnCD no
(Street or cure A o
City or Towiv'ILI4 state NC
4. DATE DRILLED 7l9:200L
5. TOTAL DEPTH g2F
6. CUTTINGS COLLECTED YES n NO 17
7. DOES WELL REPLACE EXISTING WELL? YES fl NO 7
8. STATIC WATER LEVEL Below Top of Casing n0 FT.
I Use N-' if Above Top of Casing)
5 TOP OF CASING IS I FT Above Land Surface*
•Top of casing terminated at/or below land surface requires a variance in accor-
dance with 15A NCAC 2C.D118
2
*Ode
AgricuTtulal I I --;'Monitoring -
DRILLING LOG
From To
en
60 423
DEPTH
Formation Description
nioT cual c-f^*7Dsro1
&rya,: - i s GiJARTZ
420 421 GROAIITF
10- YIEI D igprM: is
1. 1NcTEP ZONES depth
METHOD OF TEST Air
a On cnm47n-471 12 nnacm' 478-479
QC nnm O 77aoo
NATION: Type NTH Amount CO
13. CASING.
Wall Thickness
Depth Diameter or Weight/Ft Material
To '^ Ft e +ro scat R,/r•
Tc Ft
From To Ft
14. GROUT:
Depth Material Method
From To :— Ft ^--r= i+ 3ra'.4;
From To Ft
15. SCREEN:
Depth Diameter Slot Size Material
From _ To Ft, in in
From To Ft in in
From To Ft in in
16. SAND'GRAVEL PACK:
Depth Size Material
From _ To Ft
From To Ft
421 478
478 470
"70 5QE
If add
Ae4iTE QUARTZ
GRAN! TE
GRANITE
z—
onal space is needed use back Ior s0
LOCATION SKETCH
(Show direction and distance from at least top Stake)
Roads, or other map reference points,
J
-11
O t
ts
teeit
i 7r
17, REMARKS'
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN P,&OVIDED TO THE WELL OWNER.
u
FOR OFFICE USE ONLY
Quad No
SI6IGATURE OF PERSON CONSTRUCTING THE WELL DATE
Submit original to Division of Water Quality, Groundwater Section within 30 days
GW-1 REV. 12/99
„4
Serial Nn

North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
1636 Mail Service Center - Raleigh, N.C. 27699-1636 - Phone [phone]
WELL CONSTRUCTION RECORD
04021E STATE WELL CONSTRUCTION PERMIT#• S+eve pEw.
300836'
WELL CONTRACTOR. Dewey Wright WeIl Pun--; Co Int
WELL CONTRACTOR CERTIFICATION # 768;
1. WELL USE (Check Applicable Box): Residential
Recovery I Heat Pump Water Injection
Municipal E Industrial n
Other I I If Other, List Use•
2. WELL LOCATION: (Show sketch of the location below)
Nearest Town: ennnic Count a ,r_ y; O"
','d�Ua Name i'imbe s C mmunn orr .l O F , ' t'FF H
Sobdims,on and Lot No / .
3. OWNER MA', = r ;
Address 201 inuNt ifN)cc Cr'
JStreet or Route No./
rArt r.
i
L
City or Town State Zip Code
4. DATE DRILLED 7 5J334
5. TOTAL DEPTH 3nF
Agricultural El
DRILLING LO t DEPTH
From To Formation Description
n or n,4r
47
C-UY {4IU: R-
47 40 cunt c
45 267 GrtriviTE
2E'n 7P^ Sual c
6. CUTTINGS COLLECTED YES El NO 262 a=, Gnti;u,-E
7. DOES WELL REPLACE EXISTING WELL? YES CI NO 0
8. STATIC WATER LEVEL Below Top of Casing' 10 FT.
(Use "_" if Above Top of Casing)
9 TOP OF CASING IS I FT. Above Land Surface*
`Top of casing terminated at/or below land surface requires a variance in accor-
dance with 15A NCAC 2C.0118
10. YIELD lgpm't- ; F METHOD OF TEST
11 WATER ZONES (deoth): n Rn non, 7_ c a nnnnn Z' -
7F P_
1 aciv 2
cH__'R•NATION: Type 1-- Amount 5g
13. CASING.
Wall Thickness
Depth Diameter or V/eight/Ft. Material
- To .' Ft a „o lc f,,,r
To Ft
From To Ft
14. GROUT:
Depth Material Method
From _ _ To 2_ Ft
From _ To Ft
15. SCREEN:
Depth Diameter Slot Size Material
From _ To Ft. in in
From. To Ft in. in
From _ To Ft in in
16. SAND'GRAVEL PACK:
Depth Size Material
From _ To Ft
From To Ft
17. REMARKS -
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER.
I FOR OFFICE USE ONLY f 974 -'°52
SIGNATURE OF PERSON CON TRUCTINOrHE WELL DATE
Submit original to Division of Water Quality, Groundwater Section within 30 days
GW-1 REV. 12,/99
c
CC'J CC'�
FV ot<Tc
F �n
If additional space is needed use bat for`Mr1
IV r1
n
LOCATION SKETCH r
(Show direction and distance from at least State
Roads, or other map reference points)
Quad No'
Serial No.

North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
1636 Mail Service Center - Raleigh, N.C. 27699-1636 - Phone [phone]
304179
WELL CONSTRUCTION RECORD WELL CONTRACTOR- Dewey Wright Well Pump Co Inc
WELL CONTRACTOR CERTIFICATION #: 2881
040498 STATE WELL CONSTRUCTION PERMIT#- Steve Petty
1. WELL USE (Check Applicable Box): Residential
Recovery 0 Heat Pump Water Injection
Municipal Industrial Agricultural Monitoring ❑
Other 0 If Other, List Use'
2. WELL LOCATION: (Show sketch of the location below)
Nearest Town: BANNER ELK County' AVERY
cuewntcc on ncc ct let Tntcv on PEF 9124DFc soe OF
amxzna Numbers, comhlanitp, er sm�aroison ana Lot r,Pl
3. OWNER EMERAI I) OFPORTI INt73FS
Address ' PVRAF Deor oua o. {S PO BOX 1205
tre
BANNER ELK NC 28t>LP 15 85 GRANITE
City or Town State otle
DRILLING LOG DEPTH
From To Formation Description
4. DATE DRILLED 1.0/41?004
0 15 DIRT
85 86 -SHALE
36 270 GRANITE
5. TOTAL DEPTH 705 270 272 ewe! EN !Agri
6. CUTTINGS COLLECTED YES I I NO L xl 272 020-r4FANITE
7. DOES WELL REPLACE EXISTING WELL? YES 0 NO LxJ R7I1 677 RI -IMF
8. STATIC WATER LEVEL Below Top of Casing: SF FT 672 -rm GRANITF
(Use "+" if Above Top of Casing)
9. TOP OF CASING IS 1 FT Above Land Surface*
*Top of casing terminated at/or below land surface requires a variance in accor-
dance with 15A NCAC 2C.0118
10. YIELD (gpm)' 8 METHOD OF TEST Air
11. WATER ZONES (depth): 2.00 Glom 85-86 1 00aam 270-272
F lf1 anm A90-R77 0 00aom
If additional space is needed use back of form
12. CHLORINATION: Type HTH Amount 123
13. CASING: LOCATION SKETCH
Wall Thickness
Depth Diameter or Weight/Ft. Material (Show direction and distance from at least two State
From _Cl_ To 71 Ft 6 'IF$ 3C0 PvC Roads, or other map reference points)
From To Ft
From To Ft
14. GROUT:
Depth Material Method
From Ii To _20_ Ft r*om M _Gravity Flaw
From To Ft
15. SCREEN:
Depth Diameter Slot Size Material
From To Ft in in
From To Ft in in
From To Ft in in
16. SAND/GRAVEL PACK:
Depth Size Material
From To Ft
From To Ft
ft+
105 --+ n
O CD Y+
C" Cry'(
Z -no
0 rum
'C r<
I 'tyrri
CO ®o
—l_✓
rim
eaz
17. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS HAS BEEN PROVIDED TO THE WELL OWNER.
FOR OFFICE USE ONLY
Quad No:
Serial No.
SIGNATURE OF PERSON CONSTRLj,ETING THE WELL DATE
Submit original to Division of Water Quality, Groundwater Section within 30 days
GW-1 REV. 12/99

asoLti
15. SCREEN:
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
1636 Mail Service Center - Raleigh, N.C. 27699-1636 - Phone [phone]
WELL CONSTRUCTION RECORD
040496
WELL CONTRACTOR. Dewey Wright Well Pump Co., Inc.
WELL CONTRACTOR CERTIFICATION #- 2681
STATE WELL CONSTRUCTION PERMIT#- Steve Petty
1. WELL USE (Check Applicable Box): Residential I XI Municipal El Industrial fl Agricultural 0 Monitoring 0
Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use:
2. WELL LOCATION: (Show sketch of the location below)
Nearest Town: BANNER ELK County AVERY
SHAWNEE RD OFF GWALTIEY RD OFF 194 OFF 184 O
(Road Name and Numbers, Community, or ubdivision and Lot No.) DRILLING LOG DEPTH
3. OWNER EMERALD OPPORTUNITIES From To Formation Description
Address % PYRAMID BLDRS . P.O. BOX 1205 0 18 DIRT
BANNER t tP or Route No.) NC 286Zip04 18 97 GRANITE
City or Town State Code 97 96 rTHAt F
4. DATE DRILLED 9/22/2004 98 407 GRANITE
5. TOTAL DEPTH 705 407 408 GRANITE_QUARTZ
6. CUTTINGS COLLECTED YES 0 NO nX 408 630 GRANITE
7. DOES WELL REPLACE EXISTING WELL? YES 0 NO n 630 633 SHALE
8. STATIC WATER LEVEL Below Top of Casing: 100 FT 633 705 GRANITE
(Use "+' if Above Top of Casing)
9. TOP OF CASING IS 1 FT Above Land Surface*
"Top of casing terminated at/or below land surface requires a variance in accor-
dance with 15A NCAC 2C.0118
10. YIELD (gpm) 6 METHOD OF TEST Adr
11. WATER ZONES (depth): 1.00 gpm97-98 3.00ppm 405-006
2.00 gom630-633 0.00ppm
12. CHLORINATION: Type NTH Amount 121 If additional space is needed use back of form
13. CASING:
Wall Thickness
Depth Diameter or Weight/Ft. Material
From 0 To 24 Ft 6 1/8 -350 PVC
From To Ft
From To Ft
14. GROUT:
LOCATION SKETCH
(Show direction and distance from at least two State
Roads, or other map reference points)
Nos
1'
Depth Material Method
From 0 To 20 Ft Cement Gravity Flow i4� rirn
From To Ft
4— I.6 r. 00
Rte r-t-to
Depth Diameter Slot Size Material 1� 3„ c��_
From To Ft in in nn��p.�. • —4�
From To Ft in in l7�" '� - , (�JIf1` •�-r
From To Ft in in
16. SAND/GRAVEL PACK:
Depth Size Material
From To Ft
From To Ft
17. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RECORD ABEEN PROVIDED TO THE WELL OWNER.
Jo aa0-Oc
SIGNATURE OF PERSON CONSTRUCTINDXI-IE WELL DATE
Submit original to Division of Water Quality, Groundwater Section within 30 days
GW-1 REV. 12/99
FOR OFFICE USE ONLY
Quad No:
Ccrinl Nln

North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
1636 Mail Service Center - Raleigh, N.C. 27699-1636 - Phone [phone]
WELL CONSTRUCTION RECORD
040419
304181
WELL CONTRACTOR: Dewey Wright Well Pump Co., Inc.
WELL CONTRACTOR CERTIFICATION #• 2881
STATE WELL CONSTRUCTION PERMIT#- Steve Petty
1. WELL USE (Check Applicable Box): Residential El Municipal 0 Industrial 0 Agricultural E Monitoring E
Recovery E Heat Pump Water Injection 0 Other 0 If Other, List Use:
2. WELL LOCATION: (Show sketch of the location below)
Nearest Town: LINVILLE County: AVERY
BLOOMING WAY CIRCLE OFF ALPINEN OFF HW LY 18
load ameandNumbers,Community,or ub ivisionandLotNo.) DRILLING LOG DEPTH
3. OWNER JIM TOPELSKI From To Formation Description
Address % BEAR ROCK BLDRS. , 5458 NC HWY 105 S 0 85 DIRT
BANNER 6"L9k or Rou1e No.) NC 28604 85 130 GRANITE
City or Town State Zip Code 130 131 SHALE
4. DATE DRILLED 9/15J2004 131 215 GRANITE
5. TOTAL DEPTH 225 215 218 SHALE
6. CUTTINGS COLLECTED YES I I NO 0 218 225 GRANITE
7. DOES WELL REPLACE EXISTING WELL? YES 0 NO El
8. STATIC WATER LEVEL Below Top of Casing: 20 FT
(Use "+" it Above Top of Casing)
9. TOP OF CASING IS 1 FT Above Land Surface*
*Top of casing terminated at/or below land surface requires a variance in accor-
dance with 15A NCAC 2C.0118
10. YIELD (gpml' 400 METHOD OF TEST Air
11. WATER ZONES ;depth) 1.00 ppm 130-131 399.00ppm 215-218
0.00 am 0.00ppm
12. CHLORINATION: Type HTH Amount 43
If additional space is needed use back of form
13. CASING: LOCATION SKETCH
Wall Thickness
Depth Diameter or Weight/Ft. Material (Show direction and distance from at least two State
rom 0 To 90 Ft 8 1/8 _ .350 PVC Roads, other map reference points)
From To Ft \ !At
From To Ft
14. GROUT:
Depth Material Method
From 0 To 20 Ft Cement Gravity Flow
From To Ft
15. SCREEN:
Depth Diameter Slot Size Material
From To Ft in in
From To Ft in in
From To Ft in in
16. SAND/GRAVEL PACK:
Depth Size Material
From To Ft
From To Ft -
.1\\CI
U
17. REMARKS'
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER.
105
C
G �C
-ID CI
w C-r
mM
--1:0
p CD
CD
7
co
tV r,7
0
FOR OFFICE USE ONLY
Quad No:
Serial No.
SIGNATURE OF PERSON COy.8TRUCTING THE WELL DATE
Submit original to Division of Water Quality, Groundwater Section within 30 days
GW-1 REV. 12/99

North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
1636 Mail Service Center - Raleigh, N.C. 27699-1636 - Phone [phone]
WELL CONSTRUCTION RECORD
0404137
304171
WELL CONTRACTOR. Dewey Wright Well Pump Co., Inc.
WELL CONTRACTOR CERTIFICATION #• 2681
STATE WELL CONSTRUCTION PERMIT#• Steve Petty
1. WELL USE (Check Applicable Box): Residential 0 Municipal El Industrial Agricultural El Monitoring El
Recovery I I Heat Pump Water Injection 0 Other I I If Other, List Use.
2. WELL LOCATION: (Show sketch of the location below)
Nearest Town: BANNER El K County: AVERY
OF
SHAWNEE RD OFF GUALTNEY RD OFF 1Q4 OFF 184
1 oatl ame and umbers, ommunity, or Subdivision an Loth o )
3. OWNER EMERALD OPPORTUNITIES
Address %PYRAM BUILDERS PO BOX 1205
BANNER Gyr or Route No.) NC 28605
City or Town State Zip Code
DRILLING LOG
From To
0 20
DEPTH
Formation Description
DIRT
20 105 GRANITE
105 108 SHALE
4. DATE DRILLED 9/28/2004
5. TOTAL DEPTH 645
6. CUTTINGS COLLECTED YES 0 NO 0
7. DOES WELL REPLACE EXISTING WELL? YES 0 NO
8. STATIC WATER LEVEL Below Top of Casing: 100 FT
(Use "+" if Above Top of Casing)
9. TOP OF CASING IS 1 FT Above Land Surface*
*Top of casing terminated at/or below land surface requires a variance in accor-
dance with 15A NCAC 2C.0118
10. YIELD (gpml' 30 METHOD OF TEST Air
11. WATER ZONES (depth): 2.00 ppm 105-106 3.00ppm 280-282
25.00 ppm 320-322 0.00opm
12. CHLORINATION: Type HTH Amount 112
13. CASING:
Wall Thickness
Depth Diameter or Weight/Ft. Material
From 0 To 24 Ft 6 1/8 .350 PVC
From To Ft
From To Ft
14. GROUT:
From
Depth Material Method
0 To 20 Ft Cement
From To Ft
15. SCREEN:
Gravity Flow
Depth Diameter Slot Size Material
From To Ft in in
From To ' Ft in in
From To Ft in in
16. SAND/GRAVEL PACK:
Depth Size Material
From To Ft
From To Ft
106 280 GRANITE
280 282 SHALE
282 320 GRANITE
320 322 SHALE
322 645 GRANITE
If additional space is needed use back of form
LOCATION SKETCH
(Show direction and distance from at least two State
Roads, or other map reference points)
17. REMARKS: [a
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.
YI
I FOR OFFICE USE ONLY
/O,'.d-p
Quad No -
Serial No.
SIGNATURE OF PERSON CONSTRUCTINC�/THE WELL DATE
Submit original to Division of Water Quality, Groundwater Section within 30 days
GW-1 REV. 12/99

303100
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section��7
\YELL CONTRACTOR (INDIVIDUAL) NAME (print) '14eVlo-� G� CERTIFICATION #ori51p
O
w'ELL CONTRACTOR COMPANY NAME d/`4.S/¢/+4-/l wow 4, j ///'Ail PHONE # (nA 733 awe?
STATE %VELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable)
(if applicable)
I. WELL USE (Check Applicable Box): Residential ❑ Municipal/Public 13' Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection ❑ Other 0 If Other, List Use
2. WELL LOCATION:
Nearest Town: iti nr j�a County wur y
5"&i pe. 7`L� (Street Name. umbers, ommunity. Subdwisigin, Lot No.. Zip Co4)
e,, geiCALK. C SuyAR Ihf/1•
3. OWNER:
Address 333 mAirJ A1/e.
(Street /or Route No.)
Pic hey tv.c-
City or Town State
(103)- 3z11- Dyb b
Area code- Phone number
4. DATE DRILLED f —n 9
5. TOTAL DEPTH: 70
Zip Code
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO @-
7, STATIC WATER LEVEL Below Top of Casing: G 0 FT.
(Use "+" if Above Top of Casing)
S. TOP OF CASING IS a- FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordance with ISA NCAC 2C .0118.
9. YIELD (gpm): /a- METHOD OF TEST
10. WATER ZONES (depth): % e — IC 61.7.
1 I. DISINFECTION: Type /Y7-61
12. CASING:
Depth Diameter
From —/ To :5-.02- FL 2 (ra/v
From To Ft.
From To Ft.
13. GROUT: Depth Material Method
From 6 To 513 Ft. Crs+env- {— /eztved
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 7 e z
Wall Thickness
or Weight/Ft. Material
Topographic/Land setting
IZKidge ❑Slope OValley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From To Formation Description
— 410 Irnwrvdiri-
40 'T3 ,rite /Ot`noki grvvz IP
hoot/ ft ✓ ib
7 0 - 8n ' &mou/,,, 540 /e
20-7Oe ,•.,o.u; fe,
f-e elude yJ
LOCATION SKETCH
Show direction and distance in miles from at least;=
two State Roads or County Roads. lncluc he roaEg
numbers and common road name . C m• n
•kokor1A 74
rn
3 • z�
cp et'',
rear, • Ca
a —17.0
16. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH I 5A NCAC 2C, WELL
CONSTRUCTION ST AND AT Fp COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
vzik
C7 I .7--9-0 y
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
0
o
Cf)O
rn

303099
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section�i
vn6f-7 f/^� med4A. CERTIFICATION Q4 let
WELL CONTRACTOR COMPANY NAME fih?S d/c.Q Wes! L rr(111c PHONE # ( )
WELL CONTRACTOR (INDIVIDUAL) NAME (print)
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
I. WELL USE (Check Applicable Box): Residential)"Municipal/Public 0 Industrial 0 Agricultural ❑
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use pido i-e
2. WELL LOCATIO: /�
Nearest Town: tet h %1?N't County iiv y
re
l Viettm) artier /et/
(Street Name. Numbers, Community. Subdivision, Lot No.. Zip Code)
3. OWNER:
Address
A/s sr r trendy
7/s geed.geed./ . Pty.
Street or Route
No.)
of e, /3.e• t<1D
City or Town State Zip Code
(—)-
Area code- Phone number
4. DATE DRILLED *9 :2ff--0¢
5. TOTAL DEPTH: G SAC
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO $'
7. STATIC WATER LEVEL Below Top of Casing: G O FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS / FT. Above Land Surface"
*Top of casing terminated at/or below land surface requires a
variance in accordance with ISA NCAC 2C .0118.
9. YIELD (gpm): 02- METHOD OF TEST A n
10. WATER ZONES (depth): 2r- 7F d)c/
II. DISINFECTION: Type firer
12. CASING:
13
14
15
Depth Diameter
From - / To .26 Ft. G
From To Ft.
From To Ft.
Amount GeV
Wall Thickness
or Weight/Ft. Material
/76 Gel"
GROUT: Depth Material
From 6 To AO Ft. "'cc As!
To Ft.
From
SCREEN: Depth
From To
From To
Diameter
Ft. in.
Ft. in.
Method/00 ?to//
Slot Size Material
in.
in.
� ,,Topographic/Land setting
Ridge OSlope OValley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DRILLING LOG
Formation Description
rce/dI% /
/�'prd vifo re
rg.v.`fr
ksla244
DEPTH
From To
a-
3 — 7S
7s-9A
7Fd 690
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.
deee,knei
SAND/GRAVEL PACK: co
Depth Size Material ' aeo r�� p,
To Ft.
To Ft. O
0)
16. REMARKS: F"
From
From
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
SIGNATURE OF PERSON CO
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. 1919) 733-3221, within 30 days. GW-1 REV. 07/2001

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resourceses-^7Diivisioln of Water Quality - Groundwater Section ,�!
WELL CONTRACTOR (INDIVIDUAL) NAME /(�pprint) /YGNet7e1h CT.-ar'v>L. CERTIFICATION
r�#044
WELL CONTRACTOR COMPANY NAME f✓%Cl.i�/el /Ciel%PAC /ftsy PHONE #( )/13 '�%
STATE WELL CONSTRUCTION PERMIT/4 ASSOCIATED WQ✓PERMIT#
(if applicable) (if applicable)
303097
I. WELL USE (Check Applicable Box): Residential Pr Municipal/Public ❑ Industrial D A 'ricultural ❑
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other CI If Other, List Use ,Jtr'L.e le
2. WELL LOCATION:
/K n
Nearest Tow : f Y t.%It County dit011
5/K l&' e AD
(Street Name, Numbers, Community,
Subdivision, Lot No.. Zip Code)
3. OWNER: J Ativ v D AMfth )
Address / 357 G /e f_/t re .
L/ L P trees or'Route No.) ? j, z l_ T/3 a-
City or Town StateattG Zip Code
Area code- Phone number
4. DATE DRILLED /- o2/'-O Ii
5. TOTAL DEPTH: / 70
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO j2'
7. STATIC WATER LEVEL Below Top of Casing: /}O FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS / FT. Above Land Surface*
•Top of casing terminated at/or below land surface requires a
variance in accordant wills 15A NCAC 2C .0118.
9. YIELD (gpm): METHOD OF TEST 41C.F
t�
10. WATER ZONES (depth): / s oyo / /SO /g¢/
/ioire/
II. DISINFECTION: Type L/tht Amount LYb7
12. CASING: Wall Thickness
Depth Diaeter or Weieht/Ft. Material
From -/ To et: Ft. a /1 4/G
From To Ft.
From To Ft.
13. GROUT: Depth Material Method
From 6 To AO Ft. ri!-.s'o-+ / oceele
From To Ft. /
14. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in.
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
Topographic/Land setting
egidge ❑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`tiDescription
1il
�s
Zr
-o '"5k/c c
20-lc, o
re...„ r 0
/Jo-/3.S 6Ao sA..ire
/35- /SD
/10 --/:
/s,3 —/ re
v 4i. { 71en,-n,hr
e e.C.-l7Cam.
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 ern
tan
tan
xi<
-vrn
co 00
7 ram-.^, n
t r
CP CD
Cs, U .
ftCD
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
-a <-05/
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-I REV. 07/2001-i
TI

303095
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Divisionricj7 of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) /L6tJl'V A'obe,CERTIFICATION #Ariel
WELL CONTRACTOR COMPANY NAME ibf'C5aJ t// (E/% At; 7/L JJ PHONE # (fail P-Ys#600b
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
( if applicable) (if applicable)
I. WELL USE (Check Applicable Box): Residential D'...Municipal/Public 0 Industrial ❑ Agricultural 0
Monitoring ❑ Recovery 0 Heat Pump Water Injection ❑ Other 0 If Other, List Use pivldm¢ e.
2. WELL LOCATION:
Nearest Town: Newtovc_f
County /4Pest/
(Street Name. Numbers, Community, Subdivision, Lot No., Zip Code)
3.OWNER: ieloodf?
Address O.Sex
, , ((Street pr Route No.) e /
y
Zip Code
C'
Coy or Town State
( )-
Area code- Phone number
4, DATE DRILLED /—/li --0 9-
5 TOTAL DEPTH: #400
6, DOES WELL REPLACE EXISTING WELL? YES ❑ NO IZL,
7. STATIC WATER LEVEL Below Top of Casing: G 6 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS I FT. Above Land Surface'
*Top of casing terminated at/or below land surface requires a
variance in accordance with 15A NCAC 2C .0118.
9. YIELD (gpm): ID METHOD OF TEST /eh,*
10. WATER ZONES (depth): %O Yt.S
3309,5
1 I. DISINFECTION: Type lIT/V1 Amount SO7
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
From '' To 59 Ft. Co .,»An PVC
From To Ft.
From To Ft.
13. GROUT: Depth Material Method
From D To to Ft. CcA/r�->h f00q,ece
From To Ft.
14. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in.
From To Ft. tn. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
Topographic/Land setting
idge OSlope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DRILLING LOG
Formation Description
feary/i
g rode-/
Jk.-Ie
tp ent,rfre'u..kr
t7 no-, f L
DEPTH
From To
0 l
9-1— 90
90— Yr
95— 3Q--r
3fr 3so
Sic'-- Yon
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.
,dam
x
to
o cm
in
—cm
I I. 5O
cD OQ
retri
O c;)[7
W r-n o
C.
n
16. REMARKS:
I DO HEREBY CERjiFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION ANDAR a . ' a T AT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
SI tt 1ATUI2E OF PERSON CONSTRUCTING THE WELL
f 4
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 Sectionio//
WELL CONTRACTOR (INDIVIDUAL) NAME (print)ri/l,e,v 'E:�t A.-4,aw CERTIFICATIONr�f/�r�//,,'
\\'ELL CONTRACTOR COa1PANY NAME </ ^Elfze erl ''cif/ Fire /t' PHONE A kVA /Y3•�'a4f
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
( if applicable) (if applicable)
303108
I. WELL USE (Check Applicable Box): Residential r Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use Pit eve /4€
2. WELL LOCATION:
Nearest Town: li(6H! kJ
Sf'a4,;s6 c9"nkr ICO
(Street Name. Numbers.
rCommunity, Subdivision. Lot No.. Zip Code)
3. OWNER: pppeecccvvvv.BO&Aie/t
Address •O. golf 94/9
County
(Street or Route No.)
nnlle. N.C. ar�y�
City or Town State Zip Code
( )-
Area code- Phone number
4. DATE DRILLED /'-go? -O S`
5. TOTAL DEPTH: aye
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO
7. STATIC WATER LEVEL Below Top of Casing: 41- D FT.
(Use "*" if Above Top of Casing)
8. TOP OF CASING IS / FT. Above Land Surfaces
*Top of casing terminated at/or below land surface requires a
variance in accordan a with 15A NCAC 2C .0118. �/
9. YIELD (gpm): 00 METHOD OF TEST /T/
10. WATER ZONES (depth): %O* `TJ -33q/
a/0-owiy✓gt/
11. DISINFECTION: Type /%%-! Amount 3C7
12. CASING: Wall Thickness
or Weight/Ft. Material
Depth Diaweter
From - l To 42 FL 6 4. YflP-/ Pre
From To Ft.
From To Ft.
13. GROUT: Depth Material Method
From fJ To Depth,
Ft. Ceac4,1- Pove::
From To Ft.
14. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in.
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
Topographic/Land setting
LTfiltidge ❑Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DRILLING LOG
Formation Description
d/o ce,s4
Apra WA,°Aim,
Ct7 4.100.54,76
DEPTH
From To
O sa
2- Lc
9m 75
9 5 -- oti/O
ale as'
o`t/ti o-to
O Gn
"litTt
LOCATION SKETCH -0�
Show direction and distance in miles from at least 7o�
two State Roads or County Roads. Include thei ad m
ril
numbers and common road names. S �=
a-)p0
(„)Was
U7 n
•
•s7 /_
/nay/
Ga/f%a' /4-4./,40,
16. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS. AND THAT A COPY OF TH RECORD HAS BEEN PROVIDED TO THE WELL OWNER.
✓ � I - as -69-,
SIGNATURE OF PERSON CON
CTING THE WELL
DATE
Submit the original to the Division of Water Quality, Groundwater Section. 1636 Mail Service Center -Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-1 REV. 07/2001

303106
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Nat al Resources - Division of Water Quality - Groundwater Section pp
WELL CONTRACTOR (INDIVIDUAL) NAME (print) CRAJ-B k45 tic L. L CERTIFICATION #d3t8
At4IP c// v'e-It Tit' III NQ PHONE # J-y�f 733-2 ird2.
STATE WELL CONSTRUCTION PERMITS/ASSOCIATED WQ PERMIT# J
(if applicable) (if applicable)
WELL CONTRACTOR COMPANY NAME
1. WELL USE (Check Applicable Box): Residential Municipal/Public ❑ Industrial 0 Agricultural 0
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use e Ut/'1C
2. WELL LOCATION:
Nearest Town: Aaastrt jf//i County
Be `ch d .
(Street Name, Q
Address (�, Numbers, Community, Subdivision, Lot No., Zip Code)
-ft
3. OWNER: 9OJcya _ )12.3 00d
I( Route No.)
4. U , G crl0 c 6
City or Town State Zip Code
( )-
Area code- Phone number
4. DATE DRILLED S /ie —O_j
5. TOTAL DEPTH: OR C.a
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO Er
7. STATIC WATER LEVEL Below Top of Casing: 1Vt FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS FT. Above Land Surface'
*Top of casing terminated at/or below land surface requires a
variance in accordance with 15A NCAC 2C .0118.
9. YIELD (gpm): 30 METHOD OF TEST Ai 'r
10. WATER ZONES (depth): /16 - /33 t59/
11. DISINFECTION: Type
12. CASING:
Depth D�ia�eter or Weight/Ft. Material
From — / To P6 Ft. 6-SD/P2/ INN[
From To Ft.
From To Ft.
13. GROUT: Depth Material Method
From D To d/1 Ft. /-ewe'�+'%L "Acme/'
From To Ft.
14. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in
From To Ft. in. in
IS. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
Topographic/Land setting
❑Ridge ❑Slope OValley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DRILLING LOG
Formation Description
C,� !//a peer t5 v4 or
3s p �9 ft7avi2e
5� > s3 .f/c4racK
S'3 /3r> _ h�a v 7ce
DEPTH
From To
o— 3r
156 /3.?
/la�-/AO
/y6 -/73
/9g- a?de
6/©uitvsdo
c
0
y9'Sot a�ej I /y y /c�/ LOCATION SKETCH
4 o.�3 f C .
Amount Show direction and distance in miles fronea lea:ELT
[ ^.
two State Roads or CountyRoads. Include the r
Wall Thickness C.
t
numbers and common road names. o -.—
—CI' m
S ,ro
Kz fV r
t
C =- c
oo0�t m
\o om
m;
3
.4:7ec//
co)
16. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH ISA NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
SIGNATUR OF PERSON CONSTRUCTING THE WELL DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center -Raleigh,,NC,'I
27699-1636 Phone No. [phone], within 30 days. GW-I REV. 07/200
1

WELL CONSTRUCTION RECORD
303104
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section /�
WELL CONTRACTOR (INDIVIDUAL) NAME (print)�"'tic, G/r,'r/e / A ✓.A�Pr CERTIFICATION #Oor��7
WELL CONTRACTOR COMPANY NAME Fi//`GSOC a t'-C // la, l //I Ai- PHONE # f27 1 %33"tb/ej'
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
I. WELL USE (Check Applicable Box): Residential "Municipal/Public ❑ Industrial ❑ Agricultural ❑
Monitoring ❑ Recovery ❑ Heat Pump Water Injection 0 Other 0 If Other, List Use f i' /nrf
2. WELL LOCATION:
Nearest Town: CQi(ont of County !>;^ent,
in)n. ei
ii
Gn
(Street Name. NNuumbers, Community, Subdivision, Lot No.. Zip Code)
3. OWNER: ►JICkg-15°n
Address Wi{ CD/IytLUCTI'f31 iits3
AJt (Streetor Route NoAL C..) 07 8t -7
City or Town State
Zip Code
( )-
Area code- Phone number
4. DATE DRILLED Q —a/—G
5. TOTAL DEPTH: 9Od
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO ®'
7. STATIC WATER LEVEL Below Top of Casing: 'o B FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS / FT. Above Land Surface`
'Top of casing terminated at/or below land surface requires a
variance in accordance with 15A NCAC 2C .0118.
9. YIELD(gpm): IPS METHOD OF TEST f/! a
10. WATER ZONES (depth): Soo—SO3, .S
Teo 7of /Se/
11. DISINFECTION: Type #tM Amount E 07
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
From ^/ To 59 Ft. 64.- SoAAt P✓C
From To Ft.
From To Ft.
13. GROUT: Depth Material Method
From 0 To a-0 Ft. �Cerrt.-+ petted
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
I2Ridge ❑Slope OValley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
6LFr.Pt Rd. Latitude/longitude source:❑GPS❑Topographic map
(check box)
DRILLING LOG
Formation Description
Pet!) to retatVell tit
_."--het
A�< A.; Tee
relfw.l Bret %O..e-'4
,r el ers-Me
DEPTH
From To
o— Y-
J Soc
fcN ,f'o3
Sea -Pot
760 705
703 n0
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.
clukk
D
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH I 5A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY
OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
/ 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 30days. GW-1 REV. GW-1 REV.07/2001

From To
13. GROUT: Depth Material ,/ c'-
Method
C From To A Ft. c-mc4-4C fie QA,
From To ar Ft. "att.cliesVC er�Aere,
14. SCREEN: Depth Diameter Slot Size Material
From To Ft. in.
From To Ft. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
11. DISINFECTION: Type
12. CASING:
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division ofWater Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print),//ri�/t&'An . /J0 d e/'STO/7// CERTIFICATION
WELL CONTRACTOR COMPANY NAME (U /'4Sk/e %/ /fie. //g,61 /// d!� Wao PHONE # ) P.r,3ouQj`
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMITS/
Of applicable) (if applicable)
303114
I. WELL USE (Check Applicable Box): Residential Er Municipal/Public ❑ Industrial ❑ Agriculturpl ❑
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use f/'ii"o-f
2. WELL LOCATION: GG'�
Nearest Town: /Jq,r//u,e/' L/ k
?`AI_ Fo, M 2 s % 317
(Street Name. Numbers. Community. Subdivision, Lot No., Zip Code)
3. OWNER:
County 4-yercq
Address 0 (tater Si-. 3''f 201
( reel or R ute No.)
AOitTar/ /YC .. e2 11:SS-- 3313
City or ll6wo State Zip Code
( )-
Area code- Phone number
4. DATE DRILLED .S 'o20 — 0 41
5. TOTAL DEPTH: 700
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO €Y
7. STATIC WATER LEVEL Below Top of Casing: /026 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING 1S / FT. Above Land Surface"
'Top of casing terminated at/or below land surface requires a
variance in accordance with I5A NCAC 2C .0118. �7
9. YIELD (gpm): METHOD OF TEST /T%n
10. WATER ZONES (depth): /30 /33 ..i'
990-9193 ar
fFTN Amount /o err
Depth Diameter
From=I To .2e Ft. 64
From To Ft.
Ft.
Wall Thickness
or Weight/Ft. Material
/7A 6a&.
16. REMARKS:
in.
in.
Topographic/Land setting
t�Ridge OSlope ❑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 '— P 11.4c-4061Jt."
j , /.ice ^oa.Iig
ife-/53 /.'.. jwfi:k°4o'i
7.194, !le
/90 -aio 6to•vys/.4
A-20 -5190 Troot-SO
'490 —99r e rSvt4e etnite-tr
Y r- Toe ;"."osv; 7/...-
/3.3- /90
Or Ccm
f
LOCATION SKETCH O mom'
Show direction and distance in miles fron a4a! least �..orrnn
two State Roads or County Roads. Includeee roado
numbers and common road names. —'ram
� a z o c
ro
al
INI
C')
C5
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRU ION STANDARDS. AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
�u�- 5-16 ---40$1.
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center -Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-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) Ha id I no, RO b en ao
WELL CONTRACTOR COMPANY NAME QrQJwe/I )OP I //'tipsy
n
CERTIFICATIONAy��f eGrg7-
gQ
PHONE # (324S P3,3• Gen
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
I. WELL USE (Check Applicable Box): Residential I?' Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring ❑ Recovery 0 Heat Pump Water Injection 0 Other ❑ If Other, List Use pt (✓r.'{c
2. WELL LOCATION:
Nearest Town: l6 IJ$J ^ 0/ K County /4 u
Frtd,ll ,oa,eac, at -A/
(Street Name. Numbers, Community, Subdivision, Lot No.. Zip Code)
3. OWNER: 1303 m}7 E
Address 77
( treet or Route No.) p //
enisi
City or Town State Zip Code
Area code- Phone number
4. DATE DRILLED 4t - 9 — 0 4'
5. TOTAL DEPTH: / S 0
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO
7. STATIC WATER LEVEL Below Top of Casing: ci O FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS / FT. Above Land Surface*
"Top of casing terminated at/or below land surface requires a
variance in accordance with 15A NCAC 2C .0118.
9. YIELD (gpm): 8 METHOD OF TEST Ai 'iv'
10. WATER ZONES (depth): sr,— 4 p Sock 1
II. DISINFECTION: Type /7FTN Amount 30 Ze
12. CASING: Wall Thickness
Depth Diameter or Weieht/Ft. Material
From —/ To 2O Ft. 4 4. /8R Cot
From To Ft.
From To Ft.
13. GROUT: Depth Material Method
From C To t D Ft. Bfle,'7ft f)Ourccj
From To Ft.
14. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in.
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
Topographic/Land setting
L%�tidge ❑Slope DValley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From To Formation Description
0 — ,r tco/d i'. 4-
S^ S7 f ltvk1Ale
c.f 7- 40 DnenxaoAda /cam
So- /2o ,r1.Ks/a let
Shia er le le
numbers and common road names. ern
o G7-1
rn
>c-- Tea
en
LOCATION SKETCH n �
Show direction and distance in miles from at leatt -oa
two State Roads or County Roads. Include the tad 7.3--
_40
D
kith
O cat
w No
16. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH I 5A NCAC 2C, WELL
CONSTRUCT;
N STANI:ja, D 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.1919) 733-3221, within 30 days. GW-I REV. 07/2001

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natur Resources/ -[Division of Water Quality - Groundwater Sectionq/
WELL CONTRACTOR (INDIVIDUAL) NAME (print) %' CAT ec!4 /jja/il 44//.. CERTIFICATION tY9667p
WELL CONTRACTOR COMPANY NAME *qec4 t,e,' J' eta,- nti5 PHONE # (+«9) 7.71 Gd.t
STATE WELL CONSTRUCTION PERMIT ASSOCIATED WQ PERMITN
(if applicable) (if applicable)
1
WELL USE (Check Applicable Box): Residential 0 Municipal/Public Industrial 0
Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION:
Nearest Town: .s 43 Y M�
County
(Street Name, Numbers. Community. Subdivision, Lot No.. Zip Code)
3. OWNER: a/r ! .Vf�lLd, Cows,
Address 33•O)Ain 1'3JC. A). e
(Street or Route No.)
cbay yC raD
( )- 32V -o46, Zip Code
ity or Town State
From `'O— To SL Ft.
From To Ft.
From To Ft.
13. GROUT: Depth Material Method 6e From 0 To 53 Ft. 2en, t pa,vai
From To Ft.
14. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in.
From To Ft. in. in.
IS. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
64/'-
Area code- Phone number
4. DATE DRILLED 3 "1?-o 41
5. TOTAL DEPTH: /p2o 0
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO git^
7. STATIC WATER LEVEL Below Top of Casing: r-a FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS s. FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordance with ISA NCAC 2C .0118.
9. YIELD (gpm): i METHOD OF TEST Al%r
10. WATER ZONES (depth): 76 —9 S— cant.
7So-987
/7sa/
I I. DISINFECTION: Type 17`// Amount /r d'�l
12. CASING: Wall Thickness
Depth Di eter or Weight/Ft. Material
Topographic/Land setting
edge ❑Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DRILLING LOG
Formation Description
bk JCeIin 4.
75 — 9 8 broK..v-7.4/r
% 70 9Ps' q 41-e o-aa-- 6 .1
DEPTH
From To
O— %
)3-
303111
7 PT /ADO
� ravf-f•o
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road Ax
numbers and common road names. 0 Om
C ^iti
cii en
C
—4 —orn
I pt7
CO Oa
rwrn
i ��
cJ Lo0
n
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 PERSO ONSTRUCTING THE WELL
3 ,7?-cdS9-
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

303110
WELL CONSTRUCTION RECORD \)
North Carolina - Department of Environment and Natural Resourcres- Division of Water Quality - Groundwater Section
WELL. CONTRACTOR (INDIVIDUAL) NAME (pprrint) QSJ Jrl' see We/I CERTIFICATION#./is
4ti ,A/♦;// /(IG// ,6 //rt5 PHONE #(;)733—o2"2—
WELL CONTRACTOR COMPANY NAME
STATE WELL CONSTRUCTION PERMIT ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential e Municipal/Public ❑ Industrial ❑ Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use ph.* le
2. WELL LOCATION: �/O
Nearest Town: /�{�/1 r40 k County 1�47
(Vt Ai4 f ln.[t kI
(Street Name, Numbers. Community. Subdivision, Lot No., Zip Code)
3. OWNER
Address
re AN+.• A/.et
E/t e (Slree jr ste No.) C12 �� �2.
City or Town State Zip Code
( )-
Area code- Phone number
4. DATE DRILLED y - 42-0 i
5. TOTAL DEPTH: 96&o
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO er
7. STATIC WATER LEVEL Below Top of Casing: Ott' FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS / FT. Above Land Surface*
'Top of casing terminated at/or below land surface requires a
variance in accordance with 15A NCAC 2C .0118. �/
9. YIELD (gpm): / METHOD OF TEST /Tit
10. WATER ZONES (depth): /0 %- //o
II. DISINFECTION: Type
12. CASING:
Depth
From � To 97 Ft
From To Ft
From To Ft
/
/f%Ije Amount
13. GROUT: Depth
From 6 To fl0 Ft.
From To Ft.
Wall Thickness
Diamet r or Weight/Ft. Material
F /2 3 CCU,
Material Method A
Ceara- 7( Dar to
14. SCREEN: Depth Diameter
From To Ft. in.
From To Ft. in.
15. SAND/GRAVEL PACK:
Depth
Slot Size Material
in.
in.
Size Material
From To Ft.
From To Ft.
Topographic/Land setting
eidge ❑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
77-/O1
/D 7— //O
// a e/PO
Formation Description��
r+ 9 le /�dUC
ite..- /Ye
1
LOCATION SKETCH a
Show direction and distance in miles from at leas
two State Roads or County Roads. Include the roal
numbers and common road names.
at
4P'Vab.A E6,f'
16. REMARKS:
1 DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH I5A NCAC 2C, WELL
CONSTRUCTION STANDARDS. AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
SIGNATURE OF PERSON CONSTRUCTING THE WELL
3-/a -o4
DATE
Submit the original to the Division of Water Quality, Groundwater Section, I636 Mail Service Center - Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-1 REV. 07/2001
70
rrt

WELL CONSTRUCTION RECORD
303190
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) /faleVf N fee £r/1./! /01q , CERTIFICATION# C (
WELL CONTRACTOR COMPANY NAME 4//5 K/</1 iG//4" r7i, :t..5 PHONE # (rtf) 713- mid2
STATE. WELL CONSTRUCTION PERMIT,/ ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
I. WELL USE (Check Applicable Box): Residential 0 Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring ❑ Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATIONPl : ��,,p
Nearest Town: w�L `Q
i"C. County AGn_I
e" k¶ .li&7xa,
(Street Name, Numbers, Community. Subdivision, Lot No., Zip Code)
3. OWNER: JQ I1r?
Address 51.gfue2 Rot
�kk_pA StreetorRCteNo.)
r2gt22
City or Town State Zip Code
( )-
Area code- Phone number
4. DATE DRILLED i4-'/2 OS/
5. TOTAL DEPTH: S0 6
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO El-
7
II
12. CASING:
From —�
From
STATIC WATER LEVEL Below Top of Casing: .30 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): V-0 METHOD OF TEST 17-/
10. WATER ZONES (depth): /36/3.3 ,etc./p
.3o'+y3%'— lrf
/ /h1 Amount n
Wall Thickness
Diameter or Weight/Ft. Material
G djftj PVC
DISINFECTION: Type
Depth
To 7Ft.
To
Ft.
From To Ft.
13. GROUT: Depth
From 0 To %
From To
14. SCREEN: Depth Diameter
From To Ft. in.
From To Ft. in.
15. SAND/GRAVEL PACK:
Depth
From To Ft.
From To Ft.
Material
Ft. CCtict-*
Ft.
Slot Size Material
in.
in.
Method
peetCQ
Size Material
Topographic/Land setting
Midge ❑Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From To Formation Description
0 — e 6 6AoPn. €ZA$
6 4 — /Jn 9"ref fL
/JO^/3f &rot-t
4/ —4 JGIv /e J/G
-es-et
rri
Ci 73G
�O
A
t --
LOCATION SKETCH cp �C
Show direction and distance in miles from at least nm
two State Roads or County Roads. Include the �d •-"4�
numbers and common road names. p ;%O
N p`rn
tr n
t.e&eht /P ie
16. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH ISA NCAC 2C, WELL
CONSTRUCTION STAN ARDS. AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-I REV. 07/2001

303045
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) ! `rrt/N nth h Cercneati CERTIFICATION q
WELL CONTRACTOR COMPANY NAME V ,na..n -e (1 /y(/T /, ae. /l
STATE WELL CONSTRUCTION PERMIT*/ ASSOCIATED WQ PERMIT*/
(if applicable) (if applicable)
PHONE */ (090 23.311.4
I. WELL USE (Check Applicable Box): Residential I''Municipal/Public 0 Industrial ❑ Agricultural ❑
Monitoring ❑ Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use Pit
2. WELL LOCATION:
Nearest Town: Nett rued' f County %�t/tn7
Cear berry CRect- Fs4ct4'es
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: Th tiCkL. Lot SG�W UaC{Z
Address /0//1 /C/-CcreSf 'DEN VC,
(Street or Route No.)
%lunfersvdie N.C, R8078
City or Town State Zip Code
(_)-
Area code- Phone number
4. DATE DRILLED % :3t1--O `f
5. TOTAL DEPTH: `for)
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO Rh
7. STATIC WATER LEVEL Below Top of Casing: i / FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS / FT. Above Land Surface'
*Top of casing terminated at/or below land surface requires a
variance in accordance with 15A NCAC 2C .0118.
9. YIELD (gpm): / a_ METHOD OF TEST ar
10. WATER ZONES (depth): /CO ,t J 6da'e/
.9ro 2-03 /d,,P/
11. DISINFECTION: Type //7/H Amount 3a2
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
From l To 80 Ft. 4Giatf Jae /le"
From To Ft.
From To Ft.
13. GROUT: Depth Material Method
From To 04.0 Ft. {tnet-a O
From To Ft. i/
14. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in.
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth
From To
From To
Ft.
Ft.
Size Material
Topographic/Land setting
Midge ❑Slope OValley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From To Formation Description
e — 6d /acfbeourrl?
6 e 7D .rie"oe-k
}Q— /6Q rA O.tit e
/6/3 /(3 41.vet,n.. TA. e/
P
/60 7-Ye ict.vr' zee
S90 S5e ? b�Qacua-s,r l
$93 Ito yo,r' : le
0
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the raltd
numbers and common road names. —
o& d
* see
16. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH I5A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
SIGNATURE OF PERSON CONSTRUCTING THE WELL 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
=r12-n
fr�
o'
rest°
�A
AdItjerfill

WELL CONSTRUCTION RECORD
303046
North Carolina - Department of Environment and Natural
Resources
-- Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) ('QS' yam( it ter5&r�i It CERTIFICATION#a21
WELL CONTRACTOR COMPANY NAME /enai t/ye// �t-/I f/arr/llAY� PHONE # (Si 73?X42
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT# if applicable) (if applicable)
WELL USE (Check Applicable Box): Residential Y'Municipal/Public 0 Industrial ❑ Agricultural ❑
Monitoring 0 Recovery 0 Heat Pump Water Injection ❑ Other ❑ If Other, List User i vas
2. WELL LOCATION:/ G t�
Nearest Town: F7/a_A4vice-r��rN
Lv(?4 Tynen64-le
County /9e.Yi,
(Street Name. Numbers, Community, Subdivision, Lot No.. Zip Code)
3. OWNER: ere1 5',�WLIIkt
Address 92V %yndock,LS2h
trees or pate No.) aa22404
nn�� Ik•P.C.
City or Town State Zip Code
( )-
Area code- Phone number
4. DATE DRILLED 17 `oZ i-01j
5. TOTAL DEPTH: St D0
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO B-
7. STATIC WATER LEVEL Below Top of Casing: 20 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS / FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordance with 15A NCAC 2C .0118.
9. YIELD (gpm): 121 J METHOD OF TEST 4 .--
Jo. WATER ZONES (depth): !/I "/ (r /.,�
V7— Sf0 /Or/
11. DISINFECTION: Type /it/7t Amount 3 o'2
12. CASING: Wall Thickness
Depth Dia ter or Weight/EL Material
From ' l To at Ft. /en Cott,
From To Ft.
From To Ft.
13. GROUT: Depth Material Method
From C To a C Ft. eeaec.' rower
From To Ft.
14. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in.
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
Topographic/Land setting
I4idge ❑Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DRILLING LOG
Formation Description
rc atl••4
DEPTH
From To
/i Re
/C — ZOO
3 7 -7- o
3JD tt.»
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common road names.
P
r____Yi:j;tlo,
r
O rn
O:,--a6_
rl
0o
rrl in
oer '
0
N 13 —..
16. REMARKS:
et< ar. lLpL
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 PROV]DED 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
n

3. OWNER
Address
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and NaturaltuResourcesD-//Division
//of Water Quality - Groundwater Section�tCp
WELL CONTRACTOR (INDIVIDUAL) NAMEQp(yy//5�int) /C6(// i(/ .`O fi rem,) . CERTIFICATION # Off/ /in
WELL CONTRACTOR COMPANY NAME salat -r/. /404t Thim,eLH?p PHONE # ( )
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
30304�
I. WELL USE (Check Applicable Box): Residential ❑ Municipal/Public Er- Industrial 0 Agricultural 0
Monitoring ❑ Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION:
Nearest Town: C/`tp,lsde
#7-X.mc-e n a ICI
(Street Name. Numbers, Community, Subdivision, Lot �No., Zip Code)
Lnk klfe I& %— e-e0
County iticsai,y
(Stree or oute No.)
City or Town State
L 'Cd ( z 57
Zip Code
( )-
Area code- Phone number
4. DATE DRILLED J.-;- 0
5. TOTAL DEPTH:
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO Er
7. STATIC WATER LEVEL Below Top of Casing: $' n FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS .2 FT. Above Land Surface'
*Top of casing terminated at/or below land surface requires a
variance in accordant with 15A NCAC 2C .0118.
9. YIELD (gpm): 5 METHOD OF TEST Air
10. WATER ZONES (depth): go -99J / r/ L' 2 ZLfl jeI
952, via >/__-_
11. DISINFECTION: Type /ttM- Amount 6 or
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
From �/ To ,f9— FL 64 Ada con,
From To Ft.
From To Ft.
13. Depth Material Method
To S 4' Ft. etcina.t L f & yJ e,
From To Ft.
14. SCREEN: Depth Diameter
From To Ft. in.
From To Ft. in.
15. SAND/GRAVEL PACK:
Depth Size Material
GROUT:
From 0
Slot Size Material
in.
in.
From To Ft.
From To Ft.
Topographic/Land setting
DRidge ❑Slope ®Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DRILLING LOG
Formation D scr/iption
resle
s� Celr
yr, __
DEPTH
From To
PO
C/.3— 7in
Vic — Yy�
9_12 9.'1
59SP— 96
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
0
ei
a
16. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH I5A NCAC 2C, WELL
CONSTRUC I�DARDS, AD THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
a 9t/pie.__ a5�a,
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
303048
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME ��(tIp��rint) ir,<✓/'. 16 star FiSOq CERTIFICATION
ttaci s
WELL CONTRACTOR COMPANY NAME ka rd-e // k'c // .v/)/// 5v PHONE # J A) 1J.326O2
STATE WELL CONSTRUCTION PERMIT*/ ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
I. WELL USE (Check Applicable Box): Residential ❑ Municipal/Public a' Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION:
NearesteTown: Cre 1 sn.o/I e County An r
fleet. i
/feet . Play /Caro-,
(Street Name. Numbers. Community, Subdivision, Lot No.. Zip Code)
is'r'v L 3.OWNER:xlnc.ij(e 4vy Ann.
Address w-C4 / /
,, f /4reStreet or Route o,) 02%%57
City or Town State Zip Code
( )-
Area code- Phone number
4. DATE DRILLED +4-3o - 0 2f
5. TOTAL DEPTH: /!© e
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO D-
7. STATIC WATER LEVEL Below Top of Casing: a[7 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS p2 FT. Above Land Surface*
'Top of casing terminated at/or below land surface requires a
variance in accordance with 15A NCAC 2C .0118.
9. YIELD (gpm): / METHOD OF TEST /7. ^
10. WATER ZONES (depth): `70 9,3 agog/
7r7x 7fro /o5q/
I I. DISINFECTION: Type //Th4 Amount YCZ
12. CASING: Wall Thickness
Depth Diameter or Weight/Et. Material
From ^-/ To 67 Ft. #
From To Ft.
From To Ft.
13. GROUT: Depth Material ��t Method
From (i To o Ft. C/syr v 7 l4na/Ar9/
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
CAftdge ❑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
Gn — ry 67 z.'7'P
9e- r3 t eenr.>she/'
13 - 7,9 � re es, :it
"Pra.e. /Vi;.a.e_it
9 V 9 fee, 7 fin, •
7.38 site
LOCATION SKETCH
Show direction and distance in miles from a
two State Roads or County Roads. Include t
numbers and common road names.
Zia —�
aa/
Twi:e. 0G.F0
CO
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH ISA NCAC 2C, WELL
CONSTRUCTION STANIJARDS. AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
SIGNATURE OF PERSON CONSTRUCTING THE WELL
DATE tV
c3)
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

North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
1636 Mail Service Center - Raleigh, N.C. 27699-1636 - Phone [phone]
WELL CONSTRUCTION RECORD
040383
WELL CONTRACTOR.
304696
Dewey Wright Well Pump Co.. Inc.
WELL CONTRACTOR CERTIFICATION #:
eat fleece
STATE WELL CONSTRUCTION PERMIT#'
1. WELL USE (Check Applicable Box): Residential I xI Municipal 0 Industrial 0
Recovery fl Heat Pump Water Injection D Other 0 If Other, List Use'
2. WELL LOCATION: (Show sketch of the location below) AVERY
Nearest Town: NOT GROUTED PILE County:
PRIVATE DR. OFF HWY 19E OFF HWY 194
(Road Name and Numbers, Community, or Subdivision and Lot No.)
3. OWNER LILLIAN PATTON
Address 217 CLERMONT AVE. ,
City or Town State
4. DATE DRILLED 7/19/2004
5. TOTAL DEPTH 125
6. CUTTINGS COLLECTED YES 0 NO C J
7. DOES WELL REPLACE EXISTING WELL? YES NO
8. STATIC WATER LEVEL Below Top of Casing: FT
(Use "+' if Above Top of Casing)
FT. Above Land Surface*
land surface requires�ira variance in accor-
.00 3T54 T a
ppm 62U.UU ppm 98-191
BROOKLN1Neet or Route No.l NY 11205
Zip Code
9. TOP OF CASING IS
*Top of casing terminated at/or below
dance with 15A NCAC 2CR118
10. YIELD (gpm)•
11. WATER ZONES (depth))
1
X
O.UO ppm U.OUgpm
HTH Amount 22
12. CHLORINATION: Type
13. CASING:
Wall Thickness
Depth Diameter or Weight/Ft. Material
From To 42 Ft 8 1/4 .188 OALV.
From To Ft
From To Ft
14. GROUT:
Depth Material
From 0 To 20 Ft Ceme
From To Ft
15. SCREEN:
Depth Diameter Slot Size
From To Ft in in
From To Ft in in
From To Ft. in in
16. SAND/GRAVEL PACK:
Depth
From To Ft
From To Ft
Size
Method
Gravity ow
Material
Material
Agricultural ❑ Monitoring E
DRILLING LOG
FromT 0 40
40 53
53 54
DEPTH
MUD/GRatAVEDescription
escr pti on
GRANITE
SHALE
54 98 GRANT tE
98 97 SHALE
97 125 GRANITE
If additional space is needed use back of form
LOCATION SKETCH
(Show direction and distance from at least two State
Roads, or Omap reference points)
-4p
v!
W
V—
Iq�
17. REMARKS.
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER.
U/cu /tuff 11'23 - 051
GNATURE OF PERSON CONSTRUCTING THE WELL DATE
Submit original to Division of Water Quality, Groundwater Section within 30 days GW-1 REV. 12/99
FOR OFFICE USE ONLY
Quad No:

rtt�
SHAWNEE RD OFF DUAL NtY kU UHF � OFF 184 OF
(Road Name and Numbers, Community, or Subdivision and Lot No.)
3. OWNER EMERALD OPPORTUNTIES
Address % ANDY PORTER , PO BOX 1205
INV AVERY
Ne
arest Sown
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
1636 Mail Service Center - Raleigh, N.C. 27699-1636 - Phone [phone]
WELL CONSTRUCTION RECORD
040277-2
WELL CONTRACTOR:
WELL CONTRACTOR CERTIFICATION #: Leslie Reccc
STATE WELL CONSTRUCTION PERMIT#•
304697
Dewey Wright Well Pump Co., Inc.
1. WELL USE (Check Applicable Box): Residential I "I Municipal El Industrial ❑
Recovery El Heat Pump Water Injection El Other IL If Other, List Use:
2. WELL LOCATION: IShow6ghIELDe location below)
Et BANNER t4 or Route Na) NC 28804
Agricultural El Monitoring ❑
DRILLING LOG
FromT5
O 8
DEPTH
FormatDIRTion Description
City or Town State
11/4/2004 284 4b1
4. DATE DRILLED 700 451 452
5. TOTAL DEPTH
6. CUTTINGS COLLECTED YES ❑ NO ICI �--1
7. DOES WELL REPLACE EXISTING WELL? YES y NO Fri
8. STATIC WATER LEVEL Below Top of Casing: ��oouu FT
(Use "+" if Above Top of Casing)
58 283 GRANIIE
283 284
HALE
ORANI IE
QUAR rz
452 700
9. TOP OF CASING IS 1 FT Above Land Surface*
'Top of casing terminated at/or below land surface requires a variance in accor-
dance with 15A NCAC (a t NE a18 2i .0Oppm 31-4e
11. WATER ZONES (depth)' 11.UU ppm O.QOppm
12. CHLORINATION: Type tilR Amount 92
10. YIELD (gpm):
Zip Code
GRANITt
13. CASING:
Wall Thickness
Depth Diameter or Weight/Ft. Material
Prom 0 To 63 Ft 8 1/8 .350 PVC
From To Ft
From To Ft
14. GROUT:
Depth Material Matho
From 0 To 20 Ft Cement Gravity low
From To Ft
15. SCREEN:
From
From
From
Depth Diameter Slot Size Material
To Ft in in
To Ft. in in
To Ft in in
16. SAND/GRAVEL PACK:
Depth Size Material
From To Ft
From To Ft
If additional space is needed use back of form
LOCATION SKETCH
(Show direction and distance from at least two State
Roads, or other map referra?nce points)
T
•
F-- I rS -art 2-
v \
et
• 3 •
17. REMARKS'
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER.
� t_ 11-a3 v�
SI ATURE OF PERSON CONSTRUCTING THE WELL DATE
Submit origins o Division of Water Quality, Groundwater Section within 30 days GW-1 REV. 12/99
FOR OFFICE USE ONLY
Quad No:
Sarial Nn

North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
1636 Mail Service Center - Raleigh, N.C. 27699-1636 - Phone [phone]
WELL CONSTRUCTION RECORD WELL CONTRACTOR: Dewey Wright Well Pump Co., inc.
201313
040433-2 eeoe
STATE WELL CONSTRUCTION PERMIT#: Les le R
WELL CONTRACTOR CERTIFICATION #•
304699
1. WELL USE (Check Applicable Box): Residential X Municipal I I Industrial ❑
Recovery Heat Pump Water Injection ❑ Other ❑ If Other, List Use:
Agricultural ❑
Monitoring ❑
2. WELL LOCATION: (Show sketch of the location below)
BANNER ELK AVERY
Nearest Town: County.:
ELDERBERRY RIDGE RD OFF BEECH MOU AIN PARK
(Road Name and Numbers, Community, or Subdivision and Lot No.)
3. OWNER M & K DEVELOPMENT CORP.
Address 510 ELDERBERRY RIDGE RD ,
BEECH MGt PTM'tNool NC
28604
City or Town State
4. DATE DRILLED 11/4/2004
5. TOTAL DEPTH 180
6. CUTTINGS COLLECTED YES ❑ NO ICI
7. DOES WELL REPLACE EXISTING WELL? YES NO
8. STATIC WATER LEVEL Below Top of Casing: 11uU FT.
(Use'+' if Above Top of Casing)
Zip Code
9. TOP OF CASING IS 1 FT Above Land Surface*
*Top of casing terminated at/or below land surface requires a variance in accor-
dance
A NCAC
10 YIELD s(gpml' �11a p T�{OD Opp TEgT Air
11. WATER ZONES (depth)3 oa Qpm31-33
(LOU ppm U.Ouppm
0.00 ppm
A
DRILLING LOG
DEPTH
From To Formation Description
0 19 DIRT MUD GRAVEL
19 31 GRANITE
31 33 SHALE
33 160 GRANITE
O
•
-o
12. CHLORINATION: Type HTH Amount 28
13. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
From 0 To 21 Ft 8 1/4 .186 OALV
From To Ft
From To Ft
14. GROUT:
If additional space is needed use back of form
LOCATION SKETCH
F
CP
(Show direction and distance from at least two State
Roads, or other map reference points)
io5
From 0 DToth 20 Ft MaCement Gravity
Method
GravityFow a ,//
From To Ft l9`'t'
15. SCREEN: ^'1L '14 —,
Depth Diameter Slot Size Material �"`
From
From
From
To
To
To
Ft
Ft
Ft
in
in
in
in
in
in
tzt
16. SAND/GRAVEL PACK: — . 6
Depth Size Material
From To Ft Ekbat 6efry die_ �i f� . •
From To Ft `) Q
17. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER.
FOR OFFICE USE ONLY
Quad No:
Ccrinl Nn
GNATURE OF PERSON CONSTRUCTING THE WELL DATE
Submit original to Division of Water Quality, Groundwater Section within 30 days
GW-1 REV. 12/99

North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
1636 Mail Service Center - Raleigh, N.C. 27699-1636 - Phone [phone]
304698
WELL CONSTRUCTION RECORD WELL CONTRACTOR Dewey Wright Well Pump Co., Inc.
WELL CONTRACTOR CERTIFICATION #•
040433-1
STATE WELL CONSTRUCTION PERMIT# - _esue rteece
1. WELL USE (Check Applicable Box): Residential M Municipal 0 Industrial 0 Agricultural ❑ Monitoring 0
Recovery n Heat Pump Water Injection n Other D If Other, List Use-
2. WELL LOCATION: (S6ANER ELKe location below) AVERY
Nearest Town: Count
ELDERBERRY RIDGE RD. OFF BEECH MTN PARKWAY
(Road Name and Numbers, Community, or Subdivision and Lot No.)
3. OWNER M& K DEV CORP.
Address 510 ELDERBERRY RIDGE RD. ,
BEECH-MTN5 or Route No.) NC
28604
ay or Town State
4. DATE DRILLED 11/1/2004
TOTAL DEPTH 300
5.
6. CUTTINGS COLLECTED
7. DOES WELL REPLACE EXI
8. STATIC WATER LEVEL Bel
YES E NO
STING WELL? YES NO L
ow Top of Casing: GS FT
(Use "+" if Above Top of Casing)
Zip Code
9. TOP OF CASING IS 1 FT Above Land Surface*
'Top of casing terminated at/or below land surface requires a variance in accor-
dance with 15A NCAC tort
18 AIR
rem APmt8iT 0.00 gpm
10. YIELD (gpm):
11. WATER ZONES (depth)' D.00 gpm
X
0.00qpm
64
12. CHLORINATION: Type Amount
DRILLING LOG
From To
0 21
21 48
DEPTH
Formation Description
DIRT
GRANITE
48 49 -SHALE
49 300 t3RANITE
13. CASING:
Depth
From 0 To
From To Ft
From To Ft
HTH
25 Ft Dim
14. GROUT:
Wall Thickness
or�Vyelght/Ft.
Mt ri I
From od
0 Depth 20 Ft Cement
Gravity Flow
From To Ft tS+ FI
15. SCREEN:
From
From
From
Depth Diameter Slot Size Material
To Ft in in
To Ft in in
To Ft in in
16. SAND/GRAVEL PACK:
Depth
From To Ft
From To Ft
Size
Material
17. REMARKS.
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER.
0
If additional space is needed use back of form
r»
(PJ
GIN it
LOCATION SKETCH
(Show direction and distance from at least two State
Roads, or other map reference points)
(DS
® 5 - I
J1_I
I FOR OFFICE USE ONLY
atuibut"
:. I/-as-o5'
Quad No'
coriol Kin
S
Submit origin
ATURE OF PERSON CONSTRUCTING THE WELL DATE
Division of Water Quality, Groundwater Section within 30 days
GW-1 REV. 12/99

North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
1636 Mail Service Center - Raleigh, N.C. 27699-1636 - Phone [phone]
WELL CONSTRUCTION RECORD
040548
OjcD
304701
WELL CONTRACTOR Dewey Wright Well Pump Co., Inc.
WELL CONTRACTOR CERTIFICATION Srlt5tlt3
STATE WELL CONSTRUCTION PERMIT# Leslie Reece
1. WELL USE (Check Applicable Box): Residential 0 Municipal El Industrial 0 Agricultural n Monitoring 0
Recovery Heat Pump Water Injection LI Other ❑ If Other, List Use:
2. WELL LOCATION: (Show sketch of the location below)
Nearest Town: BOONE County AVERY
HICKORY NUT GAP RD. OFF 184 OFF 105
(Road Name and Numbers, Community, or Subdivision and Lot No.)
3. OWNER DONNIE S HUGHES
DRILLING LOG DEPTH
From To Formation Description
Address P.O. BOX 1232 , 0 77 DIRT
BANNER E`L4i or Route No") NC 28804 77 94 GRANITE
City or Town State Zip Code 94 95 SHALE
4. DATE DRILLED 10/19/2004 95 288 GRANITE
5. TOTAL DEPTH 305 268 269 QUARTZ
6. CUTTINGS COLLECTED YES 0 NO 0 289 305 GRANITE
7. DOES WELL REPLACE EXISTING WELL? YES 0 NO In
8. STATIC WATER LEVEL Below Top of Casing: 20 FT
(Use "+" if Above Top of Casing)
9. TOP OF CASING IS 1 FT Above Land Surface*
*Top of casing terminated at/or below land surface requires a variance in accor-
dance with 15A NCAC 2C.0118
10. YIELD (gpm): 2.5 METHOD OF TEST Air
11. WATER ZONES (depth): 0.50 gpm94-95 2.00gpm 268-269
0.00 gram 0.0014pm
12. CHLORINATION: Type HTH Amount 57
c
u
If additional space is needed use back biform" 7,I
D.
13. CASING: Wall Thickness LOCATION SKETCH C.2 -
Depth Diameter or Weight/Ft. Material (Show direction and distance from at least tr State .," -;
Prom 0 To 81 Ft 8 1/8 .350 PVC Roads, or other map reference points1T ,3
From To Ft
From To Ft
14. GROUT:
Depth Material Method
From 0 To 20 Ft Cement Gravity Flow
From To Ft
15. SCREEN:
Depth Diameter Slot Size Material
From To Ft in in
From To Ft in in
From To Ft in in
16. SAND/GRAVEL PACK:
Depth
From To Ft
From To Ft
Size
Material
17. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER.
FOR OFFICE USE ONLY
Quad No:
ATURE OF PERSON CONSTRUCTING THE WELL DATE
Submit origi to Division of Water Quality, Groundwater Section within 30 days
GW-1 REV. 12/99

North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
1636 Mail Service Center - Raleigh, N.C. 27699-1636 - Phone [phone]
WELL CONSTRUCTION RECORD WELL CONTRACTOR: Dewey Wright Well Pump Ca Inc, ' 3 3
040288 WELL CONTRACTOR CERTIFICATION #: 2881
STATE WELL CONSTRUCTION PERMIT#: Steve Petty
1. WELL USE (Check Applicable Box): Residential n Municipal 0 Industrial 0 Agricultural 1 I Monitoring 0
Recovery I I Heat Pump Water Injection El Other
n If Other, List Use:
2. WELL LOCATION: (Show sketch of the location below)
Nearest Town: INVERSHIFLD County: AVERY
FQX (Road MEADOWSsOFF SHOEMAKERommunity, or SubdivisionaRD OFF 194 OFF 18
3. OWNER WAYNE MAGEE/KAREN & GRANT MERCER
Address gag FOX MEADOW RD. ,
BEECH t or Houte No.) NC 28804
City or Town State
4. DATE DRILLED 10/8/2004 88
Zip Code
DRILLING LOG
From To
0 22
DEPTH
Formation Description
DIRT
22 87 GRANITE
5. TOTAL DEPTH 305 270
6. CUTTINGS COLLECTED YES n NO n 272
87
7. DOES WELL REPLACE EXISTING WELL? YES 7 NO n
8. STATIC WATER LEVEL Below Top of Casing: 40 FT.
(Use "+" if Above Top of Casing)
9. TOP OF CASING IS 1 FT Above Land Surface*
Top of casing terminated at/or below land surface requires a variance in accor-
dance with 15A NCAC 2C.0118
10. YIELD (gpm)' 8 METHOD OF TEST Air
11. WATER ZONES (depth): 1.00 gpm87-68 6.000m 270-272
0.00ppm
Amount 54
88 SHALE
270 GRANITE
272 SHALE
305 GRANITE
0.00 ppm
12. CHLORINATION: Type HTH
13. CASING:
Depth Wall Thickness
P Diameter or Weight/Ft. Material
From 0 To 28 Ft 8 1/8 .350 PVC
From To Ft
From To Ft
14. GROUT:
Depth Material Method
From 0 To 20 Ft Cement
Gravity Flow
From To Ft
15. SCREEN:
Depth Diameter Slot Size
From To Ft
in.
From To Ft. in
From To Ft. in.
16. SAND/GRAVEL PACK:
Depth
From To Ft.
From To Ft
17. REMARKS:
Size
Material
in
in
in.
Material
If additional space is needed use back of form
LOCATION SKETCH
(Show direction and distance from at least two Sta
Roads, or other map reference poi s)
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.
SIGNAfORE OF PERSON CONSTRUCTING THE WELL DATE
Submit original to Division of Water Quality, Groundwater Section within 30 days
GW-1 REV. 12/99
FOR OFFICE USE ONLY
Quad No:
Serial No.

3. OWNER
Address
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
1636 Mail Service Center - Raleigh, N.C. 27699-1636 - Phone [phone]
WELL CONSTRUCTION RECORD
040534
3°4732
WELL CONTRACTOR' Dewey Wright Well Pump Co., Inc.
WELL CONTRACTOR CERTIFICATION #: 2681
STATE WELL CONSTRUCTION PERMIT#: Steve Petty
1. WELL USE (Check Applicable Box): Residential n Municipal ❑ Industrial Ti
Recovery ❑ Heat Pump Water Injection ❑ Other Ti If Other, List Use-
2. WELL LOCATION: (Show sketch of the location below)
Nearest Town: BANNER ELK County: AVERY
SHOMAKER RD. OFF 194 OFF 184 OFF 105
(Road Name and Numbers, Community, or Subdivision and Lot No.)
BILLY R HICKS
P.O. BOX 97 ,
PI NEOLA(street or Route No.)
Clty or Town State
NC 28662
Zip Code
4. DATE DRILLED 10/11/2004
5. TOTAL DEPTH 125
6. CUTTINGS COLLECTED YES Ti NO n
7. DOES WELL REPLACE EXISTING WELL? YES Ti NO Ti
8. STATIC WATER LEVEL Below Top of Casing: 20 FT
(Use "+" if Above Top of Casing)
9. TOP OF CASING IS 1 FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a variance in accor-
dance with 15A NCAC 2C.8118
10. YIELD (gpm): 150 METHOD OF TEST Air
11. WATER ZONES (depth).10.00 Ppm56-57 140.00ppm 93-95
0.00 gpm O.00ppm
12. CHLORINATION: Type HTH Amount 22
13. CASING:
De th Wall Thickness
p Diameter or Weight/Ft. Material
From 0 To 21 Ft 6 1/8 .350 PVC
From To Ft
From To Ft
14. GROUT:
From
Depth
0 To 20 Ft Cement
Material
From To Ft
15. SCREEN:
Method
Gravity Flow
Depth Diameter Slot Size Material
From To Ft. in in
From To Ft in
in
From To Ft. in. in
16. SAND/GRAVEL PACK:
Depth Size Material
From To Ft
From To Ft
Agricultural ❑ - Monitoring ❑
DRILLING LOG
From To
0 15
DEPTH
Formation Description
DIRT
15 58 GRANITE
58 57 SHALE
57 93 GRANITE
93 95 SHALE
95 125 GRANITE
t
iJ
'.9
If additional space is needed use back of feon
LOCATION SKETCH r
(Show direction and distance from at least two $tat(y
Roads, or other map reference points) tQ
49
•
I94-
17. REMARKS' \ 105
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER.
FOR OFFICE USE ONLY
Quad No
01/4
SIGNATURE OF PERSON CON$X1iUCTING THE WELL DATE
Submit original to Division of Water Quality, Groundwater Section within 30 days
GW-1 REV. 12/99
r
Serial No.

North Carolina - Department of Environment and Natural Resources - Division of Water Quality
1636 Mail Service Center - Raleigh, N.C. 27699-1636 - Phone [phone]
Groundwater Section
306381
WELL CONSTRUCTION RECORD WELL CONTRACTOR: Dewey Wright Well Pump Co., Inc.
WELL CONTRACTOR CERTIFICATION #• 2687
040628 STATE WELL CONSTRUCTION PERMIT#: Steve Reece
1. WELL USE (Check Applicable Box): Residential M Municipal 0 Industrial CI Agricultural CI Monitoring CI
Recovery 0 Heat Pump Water Injection 0 Other El If Other, List Use:
2. WELL LOCATION: (Show sketch of the location below)
Nearest Town: BANNER ELK County: AVERY
PILOT RIDGE RD. OFF 221 OFF ROLLAWAY MTN. RD. 0
(Road Name and Numbers, Community, or Subdivision and Lot No.)
3. OWNER DALE C POPE
Address P.O. BOX 871
LINCOLN Or Rou1e No 1 NC 28093
DRILLING LOG
From To
0 44
44 90
City or Town Stale
4. DATE DRILLED 12/30/2004
5. TOTAL DEPTH 180
6. CUTTINGS COLLECTED YES 0 NO 0
7. DOES WELL REPLACE EXISTING WELL? YES El NO 0
8. STATIC WATER LEVEL Below Top of Casing: 50 FT.
(Use "+" if Above Top of Casing)
9. TOP OF CASING IS 1 FT Above Land Surface*
'Top of casing terminated at/or below land surface requires a variance in accor-
dance with 15A NCAC 2C.0118
10. YIELD (gpm): ?0 METHOD OF TEST Air
11. WATER ZONES (depth): 5.00 ppm90-93 15.00opm 155-158
0.00opm
Zip Code
90
93
155
158
93
155
158
180
0.00 Qom
12. CHLORINATION: Type HTH
13. CASING:
From
From
From
Depth
0 To
To
To
14. GROUT:
Amount 27
Wall Thickness
or Weight/Ft. Material
.350 'PVC
Depth Material Method
From 0 To 20 Ft Cement Gravity Flow
From To Ft
15. SCREEN:
Depth Diameter Slot Size Material
From To Ft in in
From To Ft in in
From To Ft in in
16. SAND/GRAVEL PACK:
Depth
From To
From To
Ft
Ft
Size Material
DEPTH•'
Formation-Deseviptiorl b
DIRT tat
GRANITE
SHALE
GRANITE
SHALE
GRANITE
If additional space is needed use back of form
LOCATION SKETCH
direction and distance from at least twp3tate
Roads, or other map reference points) tJ
los
71
y' 1
K
h
Aral.
(- J
17. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF TEI1S RECORD HAS BE F.Aj PROVIDED TO THE WELL OWNER.
FOR OFFICE USE ONLY
Quad No:
Serial No
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
Submit original to Division of Water Quality, Groundwater Section within 30 days
GW-1 REV. 12/99

North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
1636 Mail Service Center - Raleigh, N.C. 27699-1636 - Phone [phone]
WELL CONSTRUCTION RECORD
040339
305993
WELL CONTRACTOR Dewey Wright Well Pump Co., Inc.
WELL CONTRACTOR CERTIFICATION #: 2881
STATE WELL CONSTRUCTION PERMIT#: Steve Petty
I; r7, i
1. WELL USE (Check Applicable Box): Residential 0 Municipal fl Industrial 0 Agricultural n Monitoring n
Recovery Heat Pump Water Injection 0 Other fl If Other, List Use: JAL„r
2. WELL LOCATION: (Show sketch of the location below)
Nearest Town: BANNER ELK County: AVERY
SAM ELLER RD. OFF 194 OFF 184 OFF 105
(Road Name and Numbers, Community, or Subdivision and Lot No.)
3. OWNER STEVEN VALENTINE
Address 9-175 NNE CASTLE HWY
BANNER E t or Route No.) NC 28604
City or Town State Zip Code
DRILLING LOG DEPTH
From To Formation Description
0 45 DIRT
45 86 GRANITE
86 87 SHALE
4. DATE DRILLED 11/10/2004 87 170 GRANITE
5. TOTAL DEPTH 205 170 171 SHALE
6. CUTTINGS COLLECTED YES 0 NO 7 171 205 GRANITE
7. DOES WELL REPLACE EXISTING WELL? YEScoi NO Lx
8. STATIC WATER LEVEL Below Top of Casing: FT
(Use "+" if Above Top of Casing)
9. TOP OF CASING IS 1 FT Above Land Surface*
`Top of casing terminated at/or below land surface requires a variance in accor-
dance with 15A NCAC 2 .0118 H F TES 10. YIELD (gpm): NI %ppm86155T �r3.00ppm 170-171
11. WATER ZONES (depth)'
0.00 ppm 0.0014pm
12. CHLORINATION: Type HTH Amount 35 If additional space is needed use back of form
13. CASING: LOCATION SKETCH
Wall Thickness
Depth Diameter or Weight/Ft. Material (Show direction and distance from at least two State
crom 0 To 50 Ft 6 116 .350 PVC Roads, or other map reference points)
From To Ft
From To Ft
14. GROUT:
Depth Material Method
From 0 To 20 Ft Cement
From To Ft
15. SCREEN:
Depth Diameter Slot Size
From To Ft in in
From To Ft in in
From To Ft in in
Gravity Flow
16. SAND/GRAVEL PACK:
Depth
From To Ft
From To Ft
17. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER.
Size
Material
Elder
its
I oS
vc
cal
W
r
\C%
FOR OFFICE USE ONLY
Quad No -
Serial No.
SIGNATURE OF PERSON CONMTRUCTING THE WELL DATE
Submit original to Division of Water Quality, Groundwater Section within 30 days
GW-1 REV. 12/99

North Carolina - Department of Environment and Natural Resources - Division of Water Qual
1636 Mail Service Center - Raleigh, N.C. 27699-1636 - Phone [phone]
y
Groundwater Section
305983
WELL CONSTRUCTION RECORD WELL CONTRACTOR: Dewey Wright Well Pump Co., Inc.
WELL CONTRACTOR CERTIFICATION #: 296tl
040441 STATE WELL CONSTRUCTION PERMIT#: Leslie Reece
WELL USE (Check Applicable Box): Residential El Municipal ❑ Industrial El
Recovery Heat Pump Water Injection El Other El If Other, List Use:
2. WELL LOCATION: (Show sketch of the location below)
Nearest Town: BOONE County: AVERY
PINNACLE RIDGE RD. OFF BUCKEYE LAKE OFF BUCKE
(Road Name and Numbers, Community, or Subdivision and Lot No.)
3. OWNER ROLLING RIDGE DEV., INC.
Address 917 BLOWING ROCK RD. ,
BOONE (Street or Route No.) NC
Agricultural ❑
1, .
Monitoring
LS
DRILLING LOG
From To
0 66
28607 66
81 82
City or Town State
Zip Code
JAN312005
DEPTH
Formation Description
MUD GRAVEL BOULDEF
91 GRANITE
4. DATE DRILLED 11/19/2004 92 244
5. TOTAL DEPTH 405 244 245
6. CUTTINGS COLLECTED YES ❑ NO 245 405
7. DOES WELL REPLACE EXISTING WELL? YES ❑ NO PCI
8. STATIC WATER LEVEL Below Top of Casing: 30 FT
(Use "+" if Above Top of Casing)
9. TOP OF CASING IS 1 FT Above Land Surface*
*Top of casing terminated at/or below land surface requires a variance in accor-
dance with 15A NCAC 2i0118
10. YIELD (gpm): N,7IEa'1IOPDnOg1T69T Air
SHALE
GRANITE
SHALE
GRANITE
Ca
11. WATER ZONES (depth): 1.UU ppm 244-14b
D.00 ppm 0.00qpm
12. CHLORINATION: Type HIM Amount 74
13. CASING:
Depth
crom 0 To
From To
From To
14. GROUT:
Wall Thickness
or Weight/Ft. Material
.188 GALV
Depth Material Method
From 0 To 20 Ft Cement Gravity Flow
From To Ft
15. SCREEN:
Depth Diameter Slot Size Material
From To Ft in in
From To Ft in in
From To Ft in in
16. SAND/GRAVEL PACK:
Depth
From To
From To
17. REMARKS.
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER.
I-io -or
Ft
Ft
Size Material
3
S
If additional space is needed use back of form
L
LOCATION SKETCH
direction and distance from at least two State
Roads, or other map reference points)
1
th
4, e-- a. 4 -�
fatalestt, LYe
b 4,.
FOR OFFICE USE ONLY
Quad No:
Serial No
Groundwater
ATURE OF PERSON CONSTRUCTING THE WELL
Submitg Section within 30 days
on ina o Division of Water Quality,
DATE
GW-1 REV. 12/99

North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
1636 Mail Service Center - Raleigh, N.C. 27699-1636 - Phone [phone]
D-R6Th-1
305978
WELL CONSTRUCTION RECORD WELL CONTRACTOR: (7PwPy Wright WPIl Pt imp Cn Inr
WELL CONTRACTOR CERTIFICATION #: 2888
040584 STATE WELL CONSTRUCTION PERMIT#• I PSIIP RPPr.P
1. WELL USE (Check Applicable Box): Residential
Recovery ❑ Heat Pump Water Injection
2. WELL LOCATION: (Show sketch of the location below)
Nearest Town: CROSeNOPE County AVERY
-§Alticeff4HKTAn u e s, u bd n o
3. OWNER DAVID COX, JR.
Municipal ❑ Industrial ❑ Agricultural ❑
DMonitoringl�l I. Other ❑ If Other, List Use.
JAN 3 1 2005
DRILLING LOG
From To
DEPTH.;
Formation Description
Address P.O. BO)Ss1r1Po,Rout. No.l 0 75 DIRT
City or TaWnState
oae
4. DATE DRILLED__1/66/_
5. TOTAL DEPTH 386
6. CUTTINGS COLLECTED YES ❑ NO n
7. DOES WELL REPLACE EXISTING WELL? YES ❑ NO CI
8. STATIC WATER LEVEL Below Top of Casing: 100 FT
(Use "+" if Above Top of Casing)
9. TOP OF CASING IS 1 FT Above Land Surface*
*Top of casing terminated at/or below land surface requires a variance in accor-
dance with 15A NCAC 2C.0118
10. YIELD (gpm)• 15— METHOD OF TEST Air
11. WATER ZONES(depth).'I(it1nnm15R-RFQ OOOnnm
0 00 nnm n nnppm
12. CHLORINATION: Type HTH Amount 57
13. CASING:
Depth Diameter
From 0 To 7RFt. 61/8
From To
Ft
From To Ft
14. GROUT:
Wall Thickness
or Weight/Ft. Material
150 PVC
76 368 GRANITE
358 350
359 305
SHALE
GRANITE
If additional space is needed use back of form
Depth Material Method
From 0 To _20—Ft romant
From To Ft yb`
ci:
15. SCREEN: 43.,
Depth Diameter Slot Size Material
From To Ft in in
From To Ft in in
From
LOCATION SKETCH
(Show direction and distance from at least two State
Roads, or other map reference points) 1:
e (Kr
3 mat Pa
glob 44910 at 4
.I -�
To Ft in in
16. SAND/GRAVEL PACK:
Depth Size Material
From To Ft
From To Ft
c
'C
osiktVted
17. REMARKS: cif
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ' CORDANCE WITH 15A NCAC 2C, WEE
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER.
FOR OFFICE USE ONLY
_Race 4-10-OL
Quad No:
Serial No.
$IQNATURE OF PERSON CONSTRUCTING THE WELL DATE
Submit origin to Division of Water Quality, Groundwater Section within 30 days
GW-1 REV. 12/99

North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
1636 Mail Service Center - Raleigh, N.C. 27699-1636 - Phone [phone]
3C5995
WELL CONSTRUCTION RECORD WELL CONTRACTOR- Dewey Wright Well Pump Co., Inc.
WELL CONTRACTOR CERTIFICATION #• 2881
040565 STATE WELL CONSTRUCTION PERMIT#: Steve Petty
I, \
WELL USE (Check Applicable Box): Residential L1 Municipal ❑ Industrial ❑ Agricultural ❑ Monitoring
Recovery Heat Pump Water Injection ❑ Other ❑ If Other, List Use
2. WELL LOCATION: (Show sketch of the location below)
Nearest Town: NEWLAND County: AVERY
MISTY MTh! LN. OFF STAPLES JOHNSON RD. OFF SQUI
(Road Name and Numbers, Community, or Subdivision and Lot No.)
JAN 3 I a05
DRILLING LOG DEPTH
3. OWNER CINDY M MARTIN From To Formation Description
Address 94 BEN KNOWLES , 7891 HWY 751 0 g0 DIRT
DURHAM(so-eet or Route No.) NC 27717 90 382 GRANITE
City or -Town State Zip Code 382 405 GRANITE
4. DATE DRILLED 11/11/2004
5. TOTAL DEPTH 405 0
6. CUTTINGS COLLECTED YES El NO n
7. DOES WELL REPLACE EXISTING WELL? YES ❑ NOF W.
8. STATIC.WATER LEVEL Below Top of Casing: 100 FT.
(Use "+" if Above Top of Casing) Ca
9. TOP OF CASING IS 1 FT Above Land Surface*
*Top of casing terminated at/or below land surface requires a variance in accor-
dance with 15A NCAC 2C.0118
10. YIELD (gpm): 4 METHOD OF TEST Alr
11. WATER ZONES (depth)' 4.00 gpm382-383 0.00apm
0.00 ppm 0.00ppm
rt
12. CHLORINATION: Type HTH Amount 64
13. CASING:
Depth
From 0 To 97 Ft
From To Ft
From To Ft
14. GROUT:
Depth
From 0 To 20 Ft Cement Gravity Flow
Wall Thickness
or Weight/Ft. Material
.350 PVC
From To Ft
15. SCREEN:
Material Method
If additional space is needed use back of form
i(v
LOCATION SKETCH
(Shp direction and distance from at least two State
Roads, or other map reference points)
106
\CS
Depth Diameter Slot Size Material 1gtk
From To Ft in in
From To Ft in. in
From To Ft in in
16. SAND/GRAVEL PACK:
Depth
From To Ft
From To Ft
17. REMARKS -
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN AC 0*!%- - 5A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER.
Size Material
cp.
Samples Uchsism, pa " 4,
It—
L.
unlitte-
.10 —
A
FOR OFFICE USE ONLY
Quad No.
Serial No
SIGNATURE OF PERSON CON6TRUCTING THE WELL DATE
Submit original to Division of Water Quality, Groundwater Section within 30 days
GW-1 REV. 12/99

• (1 ,r ;
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
1636 Mail Service Center - Raleigh, N.C. 27699-1636 - Phone [phone]
WELL CONSTRUCTION RECORD
040587
366017
WELL CONTRACTOR: Dewey Wright Well Pump Co., Inc.
WELL CONTRACTOR CERTIFICATION #•
2/VJ
STATE WELL CONSTRUCTION PERMITS,:Jerry Wilson
1. WELL USE (Check Applicable Box): Residential 0 Municipal 0 Industrial El Agricultural El MbnitoYin§i
Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use:
2. WELL LOCATION: (Show sketch of the location below) AVERY
Nearest Town: ELK MILLS County'
FLAT SPRINGS RD. OFF 321 OFF 421
(Road Name and Numbers, Community, or Subdivision and Lot No.)
3. OWNER JOHN H CHAFEY II
Address 908 36 AVE. DR. WEST ,
PALMETTfyset or Route No.) FL 34221
City or Town State Zip Code
4. DATE DRILLED 11/17/2004
5. TOTAL DEPTH 405
6. CUTTINGS COLLECTED YES El NO PI
7. DOES WELL REPLACE EXISTING WELL? YES 0 NO ri
8.,STATIC WATER LEVEL Below Top of Casing: 60 FT
co (Use "+' if Above Top of Casing)
9. TOP OF CASING IS 1 FT Above Land Surface*
'Top of casing terminated at/or below land surface requires a variance in accor-
dance with 15A NCAC 2C.4218 Air10 YIELD (gprtl). i3•D METHOD OF TEST
11. WATER ZONES (depth): 8.50 ppm 0.00 OM
0.00 ppm 0.00ppm
12. CHLORINATION: Type HTH Amount 70
13. CASING:
Wall Thickness
Depth Diameter or Weight/Ft. Material
From 0 To 21 Ft H 1/8 .350 PVC
From To Ft
From To Ft
14. GROUT:
From
From
Depth Material Method
0 To 20 Ft Cement
15. SCREEN:
To Ft
Gravity Flow
Depth Diameter Slot Size Material
From To Ft in in
From To Ft in in
From To Ftin in
DRILLING LOG
From To
0 9
JAN 31 2005
DEP Er and i,:•;
Formation Description
DIRT
8 88 GRANITE
68 89 SHALE
69 405 GRANITE QUARTZ
16. SAND/GRAVEL PACK:
Depth
From To
From To
Ft
Ft
Size Material
-a
If additional space is needed use back of form
d
LOCATION SKETCH
(Show direction and distance from at least two State
Roads, or other map reference points)
tig
t' k Spit 1\ S
17. REMARKS.
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL /j
CONSTRUCTION STANDARDS, AND THAT A COPY OF THISRECORD HAS S BEEN PR I TO THE WELLOWNER. e /�G71 l
.,..ATURE OF PERSON CONSTRUCTING THE WELL DATE
Submit original to Division of Water Quality, Groundwater Section within 30 days GW-1 REV. 12/99
FOR OFFICE USE ONLY
Quad No:
Serial No.