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297640
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resourc- - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print)r �Al1YYct t \ 1�(6 ` /] CERTIFICATION #�Z."
V. ELL CONTRACTOR COMPANY NAME Il ppkit �l:h la_({'�. el 1—i�Y: Ili K�+C PHONE # ID[.D) Dom- a5
STATE WELL CONSTRUCTION PERMIT#
(if applicable)
ASSOCIATED WQ PERMIT#
(if applicable)
1. WELL USE (Check Applicable Box): Residential Vls Municipal/Public ❑ Industrial ❑ Agricultural ❑
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCAT N: __11 (-� Topogra�hie/Land setting
Nearest Town: �! AFL ICY ount J�r+�-' S ❑Ridge Ls15lope ❑Valley ❑Flat
• z 3 Ca�J' e V-e %�- `� Z, /' (check appropriate box)
(Street Name.�
Numbers, Community, Subdivision, Lot No., Zip Code) /, �f1•,, �,f t Latitude/longitude of well location
3. 0W'NERNoYYY�� lQ� (O`6 C� 4. Wed 1a ly
(
b(degrees/minutes/seconds)
Address W tt7 Z.LtY -1 `[ F CI Z" Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH DRILLING LOG
City or Town State Zip Code From To Formation Description
(Street or Ro 1 0.) Q4Kcif��
eY
( )-
Area code- Phone number
4. DATE DRILLED S—IZ—O
5. TOTAL DEPTH: 2_10 f
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO
7. STATIC WATER LEVEL Below Top of Casing: CO in 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): Z. MET OD OF TESTAki L, N`f61
10. WATER ZONES (depth): 2.cko
II. DISINFECTION: Type —Catble4- Amount Z.
12. CASING: Wall Thickness
Dept Diameter or WeightiFt. Material
From V To f Ft.
From To Ft.
From To Ft. 13GROUT: Depth //
Method
FromFt. O Material
�Otic
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:
err -
rJ
LOCATION SKETCH CJ1 0
Show direction and distance in miles from at least —two State Roads or County Roads. Include the road
numbers and common road names.
I�- Z
Cog e lam! f
I DO HEREBY CERTIAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH I5A NCAC 2C, WELL ----`.-'-
CONSTRUCTIONJ.STANDA DS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
s_ ik
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

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HFLL CO'�-'
297632
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WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources^
WELL CONTRACTOR (INDIVIDUAL) HAMS (prim) 6 1 1.—LA ✓
WELL CONTRACTOR COMPANY NAME_RF.UBEN CALDWELL
297208
Division of Water Quality - Groundwater Section
N/14-ci•I CERTIFICATION 1 all
DRILLING, INC• PHONE48 .?54-3581
STATE WELL CONSTRUCTION PERMITS ASSOCIATED WQ PERMITS
(if applicable) (if applicable)
I. WELL USE (Check Applicable Box): Residential 0 Municipal/Public 0 Industrial IS/Agricultural 0
Monitoring 0 Recovery ❑ Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION:
Nearest Town: 1 A`f G'Rt% 1 LLL County @O I C t MQ6
Ws)2 Atft$).v%C
(Street Name, Number, Community, Subdivision, la No., Tip Code)
3. OWNER: ('\VS(1,/-31- C, c-cea--
Address k "lc( j NOtte-%o>J J t
gnat or Roua No.)
RS t4 ts' (Lt-e w C a-g'`ica 3
City or Town State 1 'p Code
tom)- 1 - ` 1 p D
Arca code- Phone number j a i/ A 4
4. DATE DRILLED `
5. TOTAL DEPTH: S t D
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO tel
7. STATIC WATER LEVEL Below Top of Casing: tot FT.
(Use -a' If Above Top of Carina)
8. TOP OF CASING 1S FT. Above Land Surface'
*Top of cssloa lerminated atior below land surface requires a
variance la accardance with ISA NCAC IC.el11. �^ n��
9. YIELD (gpm): 30 METHOD O TEST fpQV �T'AJl-�jfiir-
10. WATER ZONES (depth): 2 d 0 = l'a_ G icy p
b e' �d e
11. DISINFECTION: Type
12. CASING:
DtIt
From 1 To l Ft.
From To Ft.
From To FL
13. GROUT. Depth MaterialMe
From -L To� Ft. ai✓10 r - r 1'U
From To Ft.
14. SCREEN: Depth Diameter Slot Size Material
Frorn To Ft. in. in.
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth
From To
From To Ft.
Amount
Wall Thickness
oro ei IUFt. tr)pteAi�
16. REMARKS:
ter
Size Material
Ft. U
WW`
Topographic/Land setting
❑Ridge ❑Slope ❑Valley MFlat
(duck appropriate box)
Latitude/longitude of well location
(devc ahntmrtnfeeraods)
RA Latitude/longitude source:❑GPS❑Topographic reap
(cheek box)
DRILLING LOG
Formitionffleacciption
c$ ,1 - ma. Gorr)
C Pe r-n'G
CR-bThltQ — 1R-6fr.
C-fLA
DEPTH
Fro (0
se
1.4- '
4-60 '3 i b -,
c_.
LOCATION SKETCH
Show direction and distance in miles from at Toast
two State Roads or County Roads. Include thecroad Ir;—numbers and common road names.
N �
- c.. , Jt t &Jn
34114-1
1 DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANT E WITII ISA NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
/ L
kJ,
SIGNATURE OF PERSON CONSTRUCTING THE WELL
DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mali Service Center - Raleigh, NC.
27699-1636 Phone No. [phone], within 30 days. GW-1 REV. 07/2001

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and "mural Resources
WELL CONTRACTOR (INDIVIDUAL) NAME (prim) "" )L�t
WELL CONTRACTOR COMTANY NAMC_RF.UBEN CALDWELL
297207
-Division of Water Quality - Groundwater Section
AS N ccgnprcAnori / 3 11
DRILLING, INC. PHortEfli8 ,?54-3581
STATE WELL CONSTRUCTION PERMIT/ ASSOCIATED WQ PERMIT/
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential 13 Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION: pp
Nearest Town: WOA'hA'.Tlt_l.E County ccrvt6E.
5t3 NvNi1n G CG(Leec) O -JE
(Street Name, Numben, Community, Subdivision, Los No., lip Code)
3. OWNER:
Address
1�u&tLi AF(N
513 t-‘un -rir, G C,R e-) NZ-(J.
(Sheet w Route Na.)
WbA�ekvtt-( Nc- 3..c- g-
City or Town Stan Zip Code
(Bag)- 61-6 - 4 R 1 a
Ara code- Phan Dumber
4. DATE DRILLED bd l /0 4
5. TOTAL DEPTH: 3 0
6. DOES WELL REPLACE EXISTING WELL*/ YES 0 NO 19
7. STATIC WATER LEVEL Below Top of Casing: 4- O FT.
,( (Use's' if Above Top of Cuing)
8. TOP OF CASING 1S ^I- FT. Above Land Surface*
*Top of cuing lermlaeled atfor below Ind surface requires a
variance In accerdslyce wllb ISA NCAC IC .011a.
9. YIELD(gpm): 'T"0 METHODOFTEST �(G
10. WATER ZONES (depth): t 0 / - ' Q- 0 (3Pr
1 I. DISINFECTION: Type (1-1 14 g 0 L0 Amount Va i - •
12. CASING:
From - To �� 0 Ft I['apletcr
From To Ft. ��
From To Ft.
13. GROUT,: Depth Material Method
From To a- 0 Ft. C6 A E tY 1 f p o J.( D
Wall Thickness
or Wcigh(t/Ft. V C
From To Ft.
14. SCREEN: Depth Diameter Slot Sire Material
From To Ft. in. in.
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Size Materiel
From To Ft.
From To Ft.
Topographic/Land setting
❑Ridge ❑Slope ❑Valley [i}i Iat
(check appropriate box)
Latitude/longitude of well location
(degreeahntmnee/secoods)
Latitude/longitude source:❑GPS❑Topographic map
(cheek box) .. _
DEPTH DRILLING LOG
Frpm / To Formation Description
A $ S o \AgA,. , o e n)
85'- 1.So'
l� o au
3 301
G g-A rJ 1—c
C/JKCL- 4-36GPm
G e-ft Ni CIt
LOCATION SKETCH = -
Show direction and distance in miles frWM at least
two State Roads or County Roads. InclgifWe thead
numben and common road names. ro �_,
e
0
I-1UN i)6
V ate rJ
IL NULL (Zs OCR
5 r..
MstlL-(mor' not
16. REMARKS:
1 DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WTD( ISA NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF 1111S RECORD HAS BEEN PROVIDED TO T WELL WNER
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mall Scrvlce Center- Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-1 REV. 07/2001

297206
WELL CONSTRUCTION, RECORD
North Carolina - Department of Environment and *tan 1 Resources - Diivision of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (prtst) (l—L t e, A S 14 CERTIFICATION / a`l l 1
WELL CONTRACTOR COMPANY NAME RF.UBEN CALDWELL DRILLING, INC•PHONEY8 '754-3581
STATE WELL CONSTRUCTION PERMIT/ ASSOCIATED WQ PERM ITs
(if applicable) (if applicable)
I. WELL USE (Check Applicable Box): Residential DV/Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATIQ�
Nearest Town: C A t R 1130 County(3)1/4-)4‘) ez+M c� e
R15tic) e code I2-oAD
(Street Name, Numbcn, Community, Subdivision, lot No., Zip Codc)
3. OWNER: C J '-TA(Llcc`/
Address '�S �ajSNoP CiJ «-eAc
e`o or Roc Nn' acd 3 0
City or Town State Zip Code
(e�`!)- a'3o - N-►b t
Area coder Phone number
4. DATE DRILLED b—1 S —o •
5. TOTAL DEPTH: 6 Sao 1
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO 13
7. STATIC WATER LEVEL Below Top of Casing: % a FT.
(Usa'4-' If Above Top of Coins)
8. TOP OF CASING IS 4 FT. Above Land Surface•
Top of easing tarmisated at/or below lead surface requlru a
variance to accordcis lib ISA NCAC 2C .0113.
9. YIELD (gpm): 1 '/ 1 _ METHOD9F TEST l G ' A l
10. WATER ZONES (depth): \ W O — \ ci- 6 P rr•
11. DISINFECTION: Type t1Tl4 QO !o Amount 1 16 •
12. CASING: Wall Thickness
( pep Diameter or Weight/Ft, Material
From 1 To�a b Ft. '/f{ " SoRat 'yC.-
From To Ft.
From To Ft.
13. GROUT: Depth Material p� Method
From 1 To 9-0 Ft. �M%Ni PtJ(Z13o
From To Ft.
14. SCREEN: Depth Diameter Slot Sire Material
From To Ft. in. in.
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Dcpth Site Material
From To Ft.
From To Ft.
Topographic/Land setting
[Midge ❑Slope ❑Valley Wflat
(duck appropriate box)
Latitude/longitude of well location
(depeu/mimne ecoods)
Latitude/longitude source:❑GPS❑Topographic map
(check box) `- ........
Phi DRILLING LOG
From / To / Formation Description
— 3 'I o V eat fS�(Lo
31'- 1c6O1
\ so ' \ ` 3- G e, --t
1V) ' - Slo '
16. REMARKS:
J ()CATION SKETCH
Show direction and distance in miles frith at east
two State Roads or County Roads. Include the -road
numbers and common mad names.
31Ar
De
e
sek
Z
VS
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN
CONSTRUCTION STANDARDS. AND THAT A)COPY OF THIS REC
SIGNATURE 0
1..5E
CCORDANCE WITH 15A NCAC 2C, WELL
I(AS BEEN PROVIDED TO TI WE O R
ten 11
PERSON CONSTRUCTING THE WELL
ATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mall Service Center -Raleigh, NC
27699-1636 Phone No.[phone], within 30 day'. GW-1 REV. 07/2001

296846
WELL CONSTRUCTION RECORD
North Carolina - Dcparnnenl oflalvironment and Nirural JZcs urcc;.- jivision oT Water Quality
\\ EI.l. CON'I ItAC'IOlt (ISlllvint:AI.I NAME ( Print) �e% A/ Q�6�/7
\VEI.I. COST RACTHit CO>n'ANV NA.\lI . to l/' fa_// rl Y
STATE WELL CONSTRUCTION 1'EIOIrl# ASSOCIA-rEll WO PERMIT#
lil'a i ilie:ihlcl (ifa ,IieabIc)
1. WELL USE (Cheek Applicable Box): Residential nI onic ip,il/Public 0 Industrial 0 Agriculturd ❑
Monitoring 0 Recovery ❑ heat Pump Water Injection 0 Other El IfOther, List Usc
2. WELL LOCATION: 1
Ncarqest'fo,vn: l Rn),0/e� County i/
�eI {� r/
61rcr1 Name. vwhcrs, Conuvunin V. Subdivision, Lul No., Zip Cadet
3. OWNFIt: AIN .
Address "'###`
t5uact or I<owe Na.)
CM�er Air c871
Coy ur Town Stain Zip Code
( 8)- (&7 Kc'3Y.
Area male- Phone mm�M: _/ Q
4. DATE DRILLILD G//
5. TOTAL DEPTH: 0
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO
7. STATIC WATER LEVEL Below Top ofCasing: area FT.
(tJse "+•• if Above Tap ol'Casing)
S. T01' OI' CASING IS FT. Above Land Surface*
*Top of casing terminated at/ur below land surface requires a
variance in accordance with I5A NCAC 2C .0118.
9. YIELD (gpinl: / METHOD OFTEST
10. WATER ZONES (depth):
11. DISINFECTION: I'ypc--7Amount
12. CASING: Wall Thickness •
Depth r,�icl •r or Weight/Ft. atrial
From To y/ FL pas)tr
From Tf) FI.
From
13. GROUT:
From
Depth .
•I•o 02o
Prom Tb Ft.
14. SCREEN: Depth
From To
Drum_ To
15. SAND/GRAVELPACK
Material
->nl/
- Groundwater Sectio
n
CERTIFICATION(TI/.N�r
PRONE N t�vrol�f� t6
tic/Land c/Land setting
❑Ridge tope ❑Valley ❑Plat
(check appropriate box}
I.alilutldlongit uric of well location
(degrees/minutes/seconds)
Latitude/lungiludc source:❑GPS❑Topographic map
(check box)
DEPTH . DRILLING LOG
From • To Fory,at iyn Description
oCher
Method
Diameter Slot Size Material
PI. in. n.
P1. in. In.
Depth Size Material
Fran
From To
LOCATION SKETCI I
Show direction and distance in miles from at least
two Slate Roads or County Roads. Include the -road
numbers and common road names.
4-
16. It ENI AR KS:
I DO HEREBY (ERTIF)' TI IAT'l'HIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS. AND THAT A COPY OF THIS RECORD HAS 13EEN PROVIDED "1.0 THE WELL OWNER
S' x fx trig— C i
SIGNATURE OF PERSON CONSTRUCTING "I"IlE 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 31) days. GW-I REV. 07/2001

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and N
WELL CONTRACTOR (INDIVIDUAL) NAM (pclot
WELL. CONTRACTOR COMPANY NAME
STATE WELL CONSTRUCTION PERMITS
(if applicable)
298862
Resources - Division of Water Quality - Groundwater Section
% ,�j" ccrr,lF1CATIONiy?f 77
�CL,I.II,liLt [t ) ifY V-or laste PHONE # (.tTh d 79 n en)
ASSOCIATED WQ PERMITS
(if applicable)
N/A7
1. WELL USE (Check Applicable Box): Residential 1St Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATIO pp
Nearest Town: Count34.2•4 flu b
ds /4-sis#wy .iQ7/6
(Stet Name, Nuumben, Community, Subdivision, Lot No., Zip Code)
3. OWNER: !�t aI
Address sc. �5 /9-.2I Ha)y
Ansa (Street or Route No.)
A/.C. .2f17/�
City or Town State Zip Code
C I -
Area code- Phone mmba
4. DATE DRILLED -2IS./ 8 y
5. TOTAL DEPTH: .Z 6 S'
6. DOES WELL REPLACE EXISTING WELL? YESall NO Je
7. STATIC WATER LEVEL Below Top of Casing: -0 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS I. , 5— FT. Above Land Surface*
'Top of casing terminated at/or below land surface requires a
variance (n accorthuacr ISA NCAC 2C .0118. •
9. YIELD (gpm): ITTHOD QF� �eent
10. WATER ZONES (depth): O j
11. DISINFECTION: Type c. Ai. u_
12. CASING:
Dept.?,ter
From 0 To X t" Ft. O L`
From To Ft.
From To Ft.
13. GROUT: Depth /l���`�� Method
From e') To e -/) Ft. L St
From To Ft.
14. SCREEN: Depth Diameter Slot Size Material
Fro o Ft. in. in.
Fro To FL in. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From —To Ft.
Topographic/Land setting
11PRidge ❑Slope ❑Valley ❑Flat
(check appropriate boot)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From To Formation Description
0
yn
c nib
0
Amount (i s OL Show direction and distance in
Wall Thickness two State Roads or County
or Weigbt/Ft. Maitaial numbers and common road
it-2/ ✓dG
16. REMARKS:
es from at ItMt
ads. Include themad
#382_
Ntac�
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUL Lh) IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
� 0— flo-1, .2/'s/o f
SI ATURE OF PERSONCO STRUCTING THE WELL ATE
tB
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
WELL CONTRACTOR (INDIVIDUAL) NAM (print)_
WELL CONTRACTOR COMPANY NAME
STATE WELL CONSTRUCTION PE
(if applicable)
298860
Resources - Division off Water Quality - Groundwater Section �j
/E L3 fY.L L Las11fCATiONtfl7/
�4y/�
�Y 7
PHONE
�CI�f.G/OPiJi/A.f elf ¢! JIf gl.), �(,/7 oV9-O9t
g�Tg ✓ 6R/�/IIT
JSSOCIATED WQ P a
(if applicable)
1. WELL USE (Check Applicable Box): Residential i$ Municipal/Public ❑ Industrial ❑ Agricultural ❑
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use
2. WELL LOCATIO
Nearest To
CountyAellpi
2V-44-cti —2 r71=i
(Street Name, Numbers, Community, Subdivision, Lot No, • Code)
3. OWNE
Address
a/�/7 or Rqum No.)
i ti•V�o C . 2S74
City or Town State Zip Code
(
Area code- Phone number
4. DATE DRILLED "et/ j2/6)
1
5. TOTAL DEPTH: .19 '
6. DOES WELL REPLACE EXISTING WELL? YES 17 NO Jzi
7. STATIC WATER LEVEL Below Top of Casing: 4C2 FT.
(Use "+" if Above Top of Cuing)
8. TOP OF CASING IS / S FT. Above Land Surfaces
'Top of cuing terminated at/or below land surface requires a
variance In accordance with ISA NCAC 2C .8118.
9. YIELD (gpm): 4.2 METHOD OF TEST-71GII-&
10. WATER ZONES (depth): %-2 S
11. DISINFECTION: Type C
12. CASING:
Dept
From D To �K Ft
From To Ft.
From To Ft.
13. GROUT: Depth
From Q To 0
From To
14. SCREEN: Depth
From�To
From / To
15. SAND/GRAVEL PACK
th
From l o
From To
y Amount y tz—
Wall Tbiclmess
jameter orweight/Ft
/ ririLl
16. REMARKS:
Topographic/Land setting
Midge $Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degreeslmimnes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DRILLING LOG
Formation Descttion
0
DEPTH
From To
LOCATION SKETCH
Show direction and distance in miles
two State Roads or County Roads. Inc
numbers and common road names.
LV a
Ft
Ft
Diameter
Ft. in.
Ft. in.
Ft.
Ft.
Size
Slot Size Material
in.
in.
Material
m at least
ude the road
A7s1/Z
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND JHrRT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WFI 1 OWNER
SIGNATURE OF PERSON CONSTRUCTING THE WELL DA
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mall Service Center - Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-1 REV. 07/2001

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Nat cal Resources - Division or Water Quality - Groundwater SectionWELT. CONTRACTOR (INDIVIDUAL) NAME e (print) a(Jr'L) n - — - - CF:RTIFIC:ATIIOON a
WELT. CONTRACTORCOMPANY NAME S-J rife)./.. e✓e s L»1_ 4 ramp PHONE it (8_2 644 _3/ /O
STATE WELL CONSTRUCTION PERMIT# / 7 O t ASSOCIATED WY) PERMIF#
(if applicable) ( if applicable)
298234
1. WELL USE (Check Applicable I3ox): Residential1l, Municipal Public 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 other ❑ Ifother. List Use
2. WELL. LOCATIQ
Ncas Town:
County ].rammbl.
itrt-
(Street Nana. Numbers. Community. Subdivision. Lout Nu.. Zip t. ode)
3. OWNER: C PI / 5 SiC!/1 V /r,,,�Z // Ideuice nulnte.,..seeimd,l
Address .�i 17 Old Q sf Cl , .-. te_a_ . Latitude lonenutic som'ce:❑CiPS❑Topographic map
/') / Street orRouteNo.) p '7 . / Icheck box)
(2Af __ o..�L a 0 / (� /i/, DI PT I I DRILLING LOG
' From - To Formation Description
City or Tosco Slate Zip Code I
Area code- Phone number _� f y3 Lc S r Z"
4. DATE DRILLED a D �� r
5. TOTAL DEPTH: 3 t e 5 1
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO
7. STATIC WATER LEVEL Below Top of Casing: 80 FT.
(lax"." if Above'rop of Casing)
R. TOP OF CASING IS 1 FT. Above Land Surface*
*Top of casing terminated atfor below land surface requires a
variance in accordance with 15A NCAC 2C .0118.
9. YIELD (gpm): I 0 METHOD OF TEST a In rS .
10. WATER ZONES (depth): ate 5 l - I Tp, m _—_
31{-S1- ci
s. Y--v. LUCA'FION SKEFCII
11. DISI N FECTION:'Fype /-} rig Amount,) 2,7 .bi.f Shout direction and distance in miles from at (east
12. CASING: Wall Thickneu, Iwo State Roads or County Roads. Include the road
Depth _ Diameter or Weight -Et. Material numbers and common road names.
PVC.
From To .69 Et. tsIt
From To Ft.
From To Ft.
13. GROUT: Depth f, Material
From D To___at. Ft 0 aN t
From To Ft.
14. SCREEN: Depth Diameter Sim Sire
From To Ft. in. in.
From To Ft. in. in.
..lilteri:d
15. SAND'GRAVEL PACK:
Depth Size Material
Erotn .lo Ft.
From To Ft.
16. REMARKS:
Topographic/Land setting
❑Ridge ❑Slope ❑Valley %let
Icheek appropriate has]
Latitude longitude of well location
c_
oCD
I DO IlEREBY CERTIFY TIIAT TIIIS WELL WAS CONSTRUCTED IN ACCORDANCE WFIII I5A NCAC 2C. WEL.1.
CONSTRUCTION STANDAR S, AND 'HEAT A COPY OF TIIIS RECORD S 131:rN PROVIDED TO TI IE WELL OWNER
SIGNATURE OF PERSON CONSTRtiCTINIi TILT WTI I. DATE
f:
Submit the original to the Division of Water Quality, Groundwater Section, 163o Mail Sers ice Center - Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. OW -I REV. 07:2001
_>

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources—�siolof ater Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) PRO f/L�> / Yl
7 v_ _ _ CERTIFICATION a
//'+ Pa p PHONE # (Sak4/r -3/ 9®
WELL CONTRACTOR COMPANY NAMESJl'Ce. Yl� �r.�5 � �C I � +1- -- / -
/ c/o
(if applicable) (if applicable)
STATE WELL CONSTRUCTION PERMIT#
ASSOCIATED Mt) PERMIITN
298232
1. WELL USE (Check Applicable 13ox): Residential 1 , Municipal:Public 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other ❑ If Other, List Use
2. WELL LOCATIOjJ (�
Ncar�st Town: She VI I )�'- County ElkinC
He-nae_r tr-rNIt 11e Rc&•
(Street Name. Numbers. Community, Subdivision. Lot Ko.. hip Code)
Topographic/Land setting
❑Ridge *Slope 0Valley ❑Flat
(cheek appropriate box)
I .al itude. longitude of well location
3. OWNER: e O e>_.) nr.l.�Q (degree, minutes. eccond,l
Address 14 3-D --1 e_nclV11 I mo. Latitud: longitude source:❑C,PS❑lopogruphic map
t.2i or „te r��
No.)
D�C a g0,3 DIgP(check hall
r!I DRILLING LUG
J 1Jl 1I
city or Town State I lip code Pram To Formation Description
( )-
Area code- Phone number C
4 ATE
5. TOTAL DE TH: 3 tS t — ar, t t le.c� art S aDO)
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO
7
STATIC WATER LEVEL Below Top of Casing: S'O FT.
(Use "i.. if .Abuse Top of Casing)
A. TOP OF CASING 1S FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordance with 15A NCAC 2C .0118.
9. YIELD (rpm): 1 bD-f- METHOD OF "rEst a h vS •
10. WATER ZONES (depth): vn &C t — 1 ac 0`L'].
II
12
[ OC'AIION SKETCH
DISIN1-ECTION:'rype /-4-The Amount 4r/ 44J LLS _ Show direction and distance in miles from at least
CASING: � �t, wait cii ta
it 'thickness taco State Roads or County Roads. Include the road
�t1 I Dep r 1 1 1 erDiameter t Ft. Material numbers and common road names.
Prom "Io Ft.
From To Ft.
From To Ft.
13. ((ROUT: Depth Material //
From d To a o Ft.y�Ar_- 11- u T-
From To Ft.
14. SCREEN: Depth Diameter Slut Size Material
From "To Ft. in. in.
From To Ft. in. in.
15. SAND%GRAVEL PACK:
Depth Size Material
to Ft.
To Ft.
Method
e
From
Prom
16. REMARKS:
1 DO IIEREBY CERTIFY TIIAT THIS WELL. WAS CONSTRUCTED IN ACCORDANCE WI'lll I SA NCAC 22(", WELL
CONSTRUCTION STA D RDS, AND THAT A COPY OF 'MIS RFC( R.D ILY; BIT N PROVIDED TO TIIE WELL OWNER
SIGNATURE OF PERSON CONSTR(1( I IN(( I I11 AAl:I 1. DATE
Submit the original to the Division of Water Quality, Groundwater Section, 163b Mail Sery ice Center - Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. (1W-I REV. 07 2001-

29828r
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and natural Resources - Dii ision of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) 6 \ 1_ 1.., t (` ^rJ A S t CtRTIFICATION a al 1
WELL CONTRACTOR COMPANY NAME _REUBEN CALDWELL DRILLING, INC. PHONtQ?J8 )254-3581
STATE WELL CONSTRUCTION PERMITS ASSOCIATED WQ PERMIT/
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential 0 Municipal/Public 0 Industrial 0 Agricultural Eir
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION: n
Nearest Town: Lt i C e 5 i e, /L county £v, . cc I h2 e—
s ,c b.t 0 n.. J S �`( C c .,-,rye V N t -r
(Street Nurse, Numbers, Community, Subdivision, Int No.. Zip Code)
3. OWNER: (V\\ b c-ILE I
Address`` a- % U- I'- `� C (Lee k (Le A Cs
(Sued or Route No )
City or Town State Zip Code
G<6 3 - 3a59
Area code- Phone Dumber l A
4. DATE DRILLED 3 ! $ 0-
T
5. TOTAL DEPTH: a ok o / /
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO d
7. STATIC WATER LEVEL Below Top of Casing: 3 =+ FT.
(Use `a' if Above Top of Cuing)
8. TOP OF CASING IS 11- FT. Above Land Surface
*Top Musing laminated at/or below Ind serrate reyulru a
mince In accordance with ISA NCAC IC.011 S.
9. YIELD (gpm): a-o METHOD OF TEST (Lt G - A I (c-
10. WATER ZONES (depth): \ N (' ' ' a 0 V P M
11. DISINFECTION: Type
12. CASING:
Depth Dis n9i2r
From 1 Toj a_u FL n %�^
From To Ft.
From To Ft.
13. GROUT: Depth
From -L To a. Ft.
N i N 9 07 Amount '/a lb.
Wall Thiclmess
or Wei t/Ft. Material
1 8 S-rE E
Material Method
From To Ft.
14. SCREEN: Depth Diameter Slot Size . Material
From To Ft. in. in
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
Topographic/Land setting /'
❑Ridge ❑Slope ❑Valley GF1at
(check ap Wtprdate box)
Latitudellongitude of well location
(depaLmimne stsccoadt)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DRILLING LOf(
Forination Descriptiojl
v V (sGLi �!Lo1S h�
W u Cie G ZA &tat.
3PeLod ,2s�7.,eo
3 o
Gen/(�I .,
sn
DEPTH
From , To ,
4 - 1-3s
SS'- H-5
its'- igo
I K C
6o'- .�29o'
yc
_ r
C ) r/r!
..
LOCATION SKETCH IV c
Show direction and distance in miles from at least Z
two State Roads or County Roads. Include the road
numbers and common road names.
N41:12, bake/
CLeek ettik0
W ILL() b)
IS 1cds i c2R-
F(v-)/
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 CORD HAS BEEN PROVIDED TO T WE OWNER
�U 3v�
SIGNATURE OF PERSON CONS UCT1N THE WELL ATE
QA Tc�
Pot;
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mall Service Center -Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. G W-I REV. 07/2001

298285
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and *Win! Resources - Divisio�n`o f Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (prima) r"\ LI—Ve 13AS11 CERTIFICATION a an (
WELL CONTRACTOR COMPANY NAME _RF.UBEN CALDWELL DRILLING, INC.
?HONE Y(8 1254-3581
STATE WELL CONSTRUCTION PERMITS ASSOCIATED WQ PERMIT/
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential 0 Municipal/Public 0 Industrial 0 Agricultural
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCAT1 N�:
Nearest Town: CA a O Lt; Coun ,-) M46-
3 o alto %LS CcA/6 (Ls AO
(Strut Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER:
Address
%o, i23 (too1LS Co\It. i oAcs
(Street w Rowe No.)
CAaQLef1.- PC
City or Town State
('34)- (-) - a5a'1
Area code- Pbona number • /
4. DATE DRILLED VI a o 4
5. TOTAL DEPTH:
6. DOES WELL REPLACE EXISTING WELL? YES E(;1O ❑
7. STATIC WATER LEVEL Below Top of Casing: 6 ° FT.
(Use "4.' 1(Abovc Top of Casing)
8. TOP OF CASING IS a FT. Above Land Surface•
*Top of easing terminated at/or below led surface require
mines In accordance with ISA NCAC IC.0111.
9. YIELD (gpm): aO METHOD OF TEST (1-LG - A i Q--
10. WATER ZONES (depth): 24'0' ' —o G e rn
11. DISINFECTION: Type fA114 '1 O/e/0 Amount 1/(4- 1 b
12. CASING: Wall Thidmess
Depth c„ ter or Weight/Ft.Mate�lal
From 1 To 6 v FL 8 �� CD I 9lu
From To Ft.
Front To Ft.
13. _T:a To From____2'c'to Ft COa)"r
From To Ft.
14. SCREEN: Depth Diameter Slot Sire . Material
From To Ft. in. in.
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
Topographic/Land setting
❑Ridge 0Slope [Walley HFlat
(c&ck apptcgritla box)
Latitude/longitude of well location
(dearoahnimneilaaeoda)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DRILLING LOG
Formation Description
o fa(L(53(UQ Goa
G O-A i r L.) are PK-e-
9-0 C-t P m^
G2nr Gkar�rT�
DEPTH
From / To -5
11S' - a4h'
a40'
Pal-c - 3 SO
a.s lS
Zip Cale
Method
P°0
u
n
A
LOCATION SKETCIj o co::e
Show direction and distance in miles frortrat leRP
two State Roads or County Roads. Inclu the mad
numbers and common road names.
OD
i't-a o le-S
CoV‘
16. REMARKS:
1 DO HEREBY CERTIFYTHAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH ISA NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A CO Y O�CORD SAS BEEN PROVIDED T03 � WELL 1OWNER
SIGNATURE OF PERSON CONSTRUCTING THE WELL ATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mall Service Center -Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-I REV. 07/2001

298284
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and wahual Resources - Division of Water Quality - Groundwater Section /
WELL CONTRACTOR (INDIVIDUAL) NAME (prt•) (I_l.. � A cS CERTIFICATION / allI
WELL CONTRACTOR COMPANY NAMe_RF.UHEN CALDWELL DRILLING, INC. q28 �254-3581..
!HONE
STATE WELL CONSTRUCTION PERMIT/ ASSOCIATED WQ PERMIT/
(if applicable) / (if applicable)
1. WELL USE (Check Applicable Box): Residential i" Municipal/Public 0 Industrial 0 Agricultural
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATIO
Nearest Town: rfl t RJ 1� W County kJvr { CO M
`jA_ CJ�rGN tiAZBL IJA%
(Sneer Name, Numbers, Canmunity, Subdivision, tot No., p Code)
3. OWNER' c:-)I 1€, r-)W-a(,JS
Address LA-hit-6- t 4LA-hit-6Ci 4Z,t3 1-(Street l
VAircZi1b'1A.) No
Arca code- ?bone a
4. DATE DRILLED
5. TOTAL DEPTH: SS u
6. DOES WELL REPLACE EXISTING WELL? YES NO 0
7. STATIC WATER LEVEL Below Top of Casing: 4— ct FT.
(Use'+' if Above Top of Cuing)
8. TOP OF CASING IS FT. Above Land Surface'
*Top of culog terminated atlor below laud surface requires •
variance to according wltk ISA NCAC 2C.011 a. p �
9. YIELD (gpm): l 4 - METHOD OF TEST i�..,,1 Al 1"
10. WATER ZONES (depth): 8.4 o — 1' 'la(P rn
11. DISINFECTION: Type * I N C t a Amount -
12. CASING: Wall Wall Thickness
i To �4S £OIC t1 . Mpsi
is
From ""`
From To
From To
13. GROUT: j Dept& Material Method
Frorn To olb Ft. > tt3t PD Ja. t
From To Ft.
14. SCREEN: Depth Diameter Slot Sire . Material
From To Ft. in. in
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
City or Town Stale Zip Code
6f- )_ �, a-8 i tk3
umber 3/1 � / O 4-
Ft. ��
Diameter
Ft.
Ft.
Topographic/Land setting
❑Ridge ❑Slope ❑Valley lat
(check appropriate box)
Latitudr/longitude of well location
(deyeeshnimneusecaods)
Latitude/longitude source:❑GPS❑Topographic map
(chock box)
DEPTH DRILLING LOO
Frgm '' Tq O Fomption Uscription
4-b '- a,4-D C u-A r itC
24 1 t/d- G P n,
a c'— 55J G 0-4J.i-Cw
0
o n
r
t
pm
N m,
rn
+- 0
LOCATION SKETCH = �w:
Show direction and distance in miles frolat le
two State Roads or County Roads. inclu4the r�a�
numbers and common road names. I.1 ?;
e )LJSi1 A M
C,l t-> e c ()-€tS(<
16. REMARKS: t-5 rn
1 DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 1SA NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A,gOPYOf(FTHIS RE ORDHAS BEEN PROVIDED TOT " `/OWNER
9,Q Q r1 o� �i / i
SIGNATUREOFYERSONCONSTR CTING THE WELL j DA
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mall Service Center- Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-I REV. 07/2001

293303
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Diviision of Water Quality - Groundwater Section
`
WELL CONTRACTOR (INDIVIDUAL) NAME (print) � r � 5 ! in eitt% h - PHONE _ ,e�,usi__�,oaCERTIFICATION I/ a 8
\ r I 1 11
WELL CONTRACTOR COMPANY NAME rA
STATE WELL CONSTRUCTION PERMIT/ (if applicable)
(if applicable)
-ASSOCIATED WQ PERMIT.
1. WELL USE (Check Applicable Box): Residential 0 Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring IfRecovery 0 Heat Pump Water Injection ❑ Other 0 If Other, List Use
2. WELL LOCATIQN: t�
Nearest Town: nalgr' County (3unfArnbe
1495 1),IvO'\.
Nam; $-fwy
(Street Num n, Community,
Subdivision, colt No., Zip Code)
3. OWNER: uuACtkM10t Cn, 10o.r1 r5T tea.
Address -i& 1 Crw-'erx Si-
PIS1(Street .) Z� Route Nov O co
t�p).))1k(3
City or Town State Zip Code
(SZS) Z31.-LIa 14
Area code- Phone number
4. DATE DRILLED s/23 /0L1
5. TOTAL DEPTH: ao �+
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO Lr
7. STATIC WATER LEVEL Below Top of Casing: 1'-I FT.
(Use "+" if Above Top of Cuing)
8. TOP OF CASING IS FT. Above Land Surface'
'Top of wing terminated at/or below land surface requires ■
variance In accordance with ISA NCAC 2C.a1I8.
9. YIELD (gpm): METHOD OF TEST
10. WATER ZONES (depth): I LI'- all'
11. DISINFECTION: Type
12. CASING:
Depth Diameter
�% 5 ct
From To Ft. a>6. 0
From To FL
From To Ft.
Amount
Wall Thickness
or Wei: ght/Ft. Material
13. GROUT: Depth Mahal
Fromm To I Fc r^ ___
From To Ft.
14. SCREEN: Depth Diameter
From 6 To. Ft_a_in.
From To FL
in.
15. SAND/GRAVEL PACK:
From. 3 Tod o2Q Ft. a b1 wA S1 r\�
From T^o^ Ft.
16. REMARKS: ' 1 1k-k) —
I DO HEREBY CER THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH ISA NCAC 2C, WELL
CONSTRUCTION THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO TEE WELL OWNER
W ER
3/Li
DATE
Method
rnur-
Slot Size Material
6,6t6 in. NUe
in.
Topographic/Land setting
❑Ridge ❑Slope I (alley ❑flat
(check appropriate box)
Latitude/1on/gr de of well location
35°,30/ I Z' qSA° 43' 5'0
(deviceeminutesheconds)
Latitude/longitude source:❑GPSEI opographic map
(check box)
DEPTH DRILLING LOG
From To Formation Description S,`I
&els grown CI .
4 -7 rA% ct "e14-
7
I(o
1 la *7_0
C. _-
So
Show direction and distance in miles from at last -
two State Roads or County Roads. Include thuds
number and cgmmon road es. -o r„ r
0
m
CO G
LOCATION SKETCH
SIGNATURE OF PERSON CONSTRUCTING THE WELL
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-1 REV. 07/2001

298302
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resortivision of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print Gras 5,„�, ,,�0 A CERTIFICATION # 31,P%
WELL CONTRACTOR COMPANY NAME Moat n�a, ,1. E rw t WO MP IA PHONE # (4Z41'1C4 51V1
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
1. WELL USE (Ckck Applicable Box): Residential 0 MunicipaVPublic ❑ Industrial 0 Agricultural 0
Monitoring Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION:
lN:
Nearest Town: r\ Er countyQun(AtMb2
Itigs P: 1-k1/4..1
(Street Name, Numbers, Community,fsu visioo, Lot ``No., ZipipCode)
3. OWNER: BUf`t:slmbe L) Bec r-tA OF L.C.+1
Address - Up-1 C.rw en 5'%
k (Street or Route No.)
AS 0\P I,l( 28%si 4
City or Town S Zip Code
(S2K)- 73Z—yt-yt.
Area coda Phone number
4. DATE DRILLED S Z 3 1 0 �I
5. TOTAL DEPTH: Z 0 P 1-
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO 2
7. STATIC WATER LEVEL Below Top of Casing: I & FT.
(Use "F" if Above Top of Casing)
8. TOP OF CASING IS FT. Above Land Surfaces
'Top of wing terminated at/or below land surface requires a
variance In accordance with ISA NCAC 2C .0111I.
9. YIELD (gpm): METHOD OF TEST
10. WATER ZONES (depth): I AO'
11. DISINFECTION: Type
12. CASING:
From Depth J Ft.Diameter
From To Ft.
From_ To Ft.
13. GROUT: Depth
From_ To I Ft.
From To Ft.
14. SCREEN: Depth Diameter Slot Size Material
Fran S To o20 Ft. Z in. 0,010 in. I'll
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Size
From 3 To cab Ft. #ia
From To Ft.
16. REMARKS: m\i‘.\`,
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH I5A NCAC 2C, WELL
Topographic/Land setting
❑Ridge ❑Slope Galley ❑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 at4Fprmation Description
LI r'iArceous CISa�,s� 5,11
y tZ rn: rea„sCi s k
s Iy Co es
ly PC) $rown 5;1f
Amount
Wall Thickness
°s�krial
qo ` PVMatC
6s ^
LOCATION SKETCH -o y y
Show direction and distance in miles from at least3 u,
two State Roads or County Roads. Include the road9 7
numbers and common road names.
CONSTRUCTION STS, AND5HAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
3Jz3)OQ
SIGNATURE OF PERSON CONSTRUCTING THE WELL
DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mall Service Center - Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-1 REV. 07/2001

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and *taunt Resouresc
WILL CONTRACTOR (INDIVIDUAL) NAME (prim) e 1 LLie
WELL CONTRACTOR COMPANY NAME RF.UBEH CALDWELL
STATE WELL CONSTRUCTION PERMIT/
(ifapplicable)
298301
-Division of Water Quality- Groundwater Section
rJ f�
AS 11 CERTIFICATION a a y 1
DRILLING, INC• PHoNerii8 254-3581
ASSOCIATED WQ PERMIT/
(if applicable)
I. WELL USE (Check Applicable Box): Residential @' Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION:
Nearest Towr� (L7�AJ�(Z�J 1 S-L�County QL)& C-cin6 C
�i.MB(L FoR'D (Lc,AD
(Street Name, Numben, Community, Subdivision, Lot No., Zip Code)
14.6 hp "C E
Address
ff Street or Roulo No.)
We+t enV'IC A/C
-
City or Town State �, 3 Zip Code
(;)- 652
Area code- Phone number 4-/3 I 4-
4 . DATE DRILLED A
5. TOTAL DEPTH: dt" l 0
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO d
7. STATIC WATER LEVEL Below Top of Casing: b a FT.
(Use "r" if Above Top of Casing)
8. TOP OF CASING IS - FT. Above Land Surface'
'Top of cuing terminated at/or below had enrfac• requlru •
whoa le seem rd• e wilb 15ANCAC 2C.011E. .1
9. YIELD (gpm): 3 ' 5 METHOD OF TEST tk1(2,
10. WATER ZONES (depth):AL o a 3 .5
Uf/h
1 I. DISINFECTION: Type 11 14 `'toi, Amount ►/a I b
Wall Thickness
3. OWNER:
12. CASING:
From To Depth,1 FL
From To Ft.
From To FL
�787-°1529
S DKa 1/Ft. j(F,(erid
13. GROUT• Depth Materiel
From - To a O Ft. C 3 MEN PT
From To Ft.
14. SCREEN: Depth Diameter
From To Ft. in.
From To Ft. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To FL
Medved
Slot Site . Material
in.
in.
16. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 1SA NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND TH A COP OF THICORD HAS BEEN PROVIDED TO THE LL WNER
/Topographic/L.and setting
dgc ❑Slope ❑Valley ❑Flat
(check appecpttam box)
Latitude/longitude of well location
(degreedmimnea/eeomdi)
Latitude/longitude source:❑GPS❑topographic map
(check boa)
DRILLING LOG
Fonpation Description
0'l b2FS3cLba&J
C, PM
(;GLP S (T‘-
DEPTH
Frgm / To
1 0
1)t, Q6n
IL'— 4©'
C.--1 ..-,
t (n
G n
C=
LOCATION SKETCFJ 0' a
Show direction and distance in miles from at {S$i st r ,
two State Roads or County Roads. Include thefoad to
numbers and common road names. t..
033 G
`.0 Li'
Ft ft
.< M
I % , < Os 0.-3
PA.n
SIGNATURE OF PERSON CONSSIRUCTING THE WELL
ATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mall Service Center -Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. G W-1 REV. 07/2001

WELL CONSTRUCTION RECORD
Noon Cci o'.urt - Ucparunenl t,f F.m iron,nent and Natural Resources
\\f1.1. t U\llt \( 1(1k 11\UI\ IDI. Al.; \:\MF. (prinq __..Lavi
„Lit Ct)\Tk \('t(Ik ( (1\IP\\\ \.%ME
Div
nelOKLICIA.s— ..l .I } PHONE M
I.UUlkl( IIU\ I'ERMIIa__ ASSOC ASSOC.IAOU\YQpER4l'rw",
ni Lpplicd•I1a - .—_ .._..._._..._._
1 if appi:cab!el
' ''•\ E-LI. USE I l hick Applicable Box,. Residential QVAluniontil Public ❑ Industrial 0 A1ricultural ❑
nto(int! C Hccoverr ❑ Heat I'u:np Water Injection 0 Olhc; Ll li China. List Use
2 N E'l.[. LOCATION
\CJ:c•t TUw n ._ J(S
N \ rt hay. 1 orvnanrl. Subd,viiion. Lc,' \I.. ZufS ode'. Z g 1 S'1
i7\1/4N1:R .iJS•!5Care KC-
_ --
.\.d:h..,,,
kicalltii`Lu'lit 21757
>t.nc hip Coae
A4 ta: RI e : D_ 24 "O a uAlc[)Ru.l.Eu
5 'I OTAL DEPTH. _2 2-S /
6 DOES WELL REPLACE EAIS1ING WELL' YE NO e
n STA l IC WATER LEVEL Below Top of Casing __ () FT.
I IS.... .( Abs.; for of ( ssmg,
r, TOP OF CASING IS ____ F'f. A hove Land Surface' ..
-lay of easing Icrnbinered anor below land aurlacr rayulrrs
aril rc in actor wch I5A NC AC:S(. 0118. n //11 1
(>. YIFID;eprrlI )' ,..__ METHOD OF T ST Get t•(GK101.9+ ____.__
III WA TER ZONES I depth t �?Z .___..-`-----
Topographic Land setting
2idge CDSInp: C\•alley',, ❑FIa1
check anrlu^ n hear
Latitude longitude or well location
---"- 13egrres'::01_.:A.secuudsi ---"-
LuliWdc prittirude sourer❑LIPS❑Topographic roan
-neck bos)
PAILLING I.O(i
Formation Descripnoa
293100
n of N'aleer Quality • Groundwater Section
Li_ __._ (ERTIFI(.ATION �rQ3
iZ
)I::' VN.
E'ronl In
___t ___ _ _ LOCATION SKFTCH
i I I:)ISIN1. EC T ION. Typa f b'\C - -_-Amount _.L- _ ____ Show diraction and distance in miles From ;it least
12 CASI N'Ci• Wall Thickness Iwo State Roads or County. Roads. Include the road
^^
Depth D.:lmcter nr N'e;ght1't 1laten;J nambe!s •ind cunmlun road names.
Fein Q.__ lo_4._D._ Ft _ L r
From `-o h( —_ __ ___ to 1
Frol , lsp - E,. — f etc Y �.�� cry i (.01.,I -- Ds plh Malcri _ __ chit. ird
F rnln----- T., _---.. Fi..��-o.te p. __ r(_LAX,I- is {�. a r e r ..
I.: sCRI 1-:N l.lvplh Dnlnnci S,•v .S at \iawr:.l
rfor ._____._ to Ft____ in.
From_.---- T"--- Ft . 'n ----.__ in ..
15 S:\NO'GRA\'EL PACK
Li;pis S re Maicrinl
Hum 11, FI
Ih REN1 \kiss:
ri
•• toz
!')O Hi RI. u'Y ( 1R1IF}' THAT THIS sd'ELL WAS 0 I\STRCC'TED I\ ACCORDANCE \WITH I5A NCAC 2C. R'ELL.
( uNSflt:'('[!i)),5 !A\I)JV{,>,S. AND LH AT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WE/L,L OWNER
•
DATE 1
SIGNATURE Oh r FI1S0.,N LONSTItLCTINii THE WELL
Submit the original to the Di( ision of Water Quality. Cruundlsater Section. 1636 Mail Semite (cnlce • Raleigh. N(.
27199-11On Phony Nt.. 19)9)713-3221• within 30 da)t. CIW•I REV. 07'2001
2

3. OWNER:
Address
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Wanrral Resources
WELL CONTRACTOR (INDIVIDUAL) NAME (print) t t— t— 1 i'
WELL CONTRACTOR COMPANY NAME_RF.UBEN CALDWELL
STATE WELL CONSTRUCTION PERMIT%
(if applicable)
297910
Pivision of Water Quality- Groundwater Section
SAS ry CERTIFICATION Wall/
DRILLING, INC. PHONE[phone]
ASSOCIATED WQ PERMIT/
(ifapplicable)
1. WELL USE (Check Applicable Box): Residential ElMunicipal/Public 0 Industrial 0 Agricultural; D
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION:
Nearest ToA (LOss fO county S u&L MQ
0 )it RNAo
(Street Name, Numben, Community, Subdivision, tot No., Zip Code)
0,4tp P1L�
6 8 CA s S i oy L Pt .c.)
(Sues aRoa No.)
>hleVt�lL ry ags03
(saSS> ily or Town ci 1 Sle4(� Zip Code
Area code- Moo number
1 I
4. DATE DRILLED al 1 `I C 4--
5. TOTAL DEPTH: (c-) i 0 r /
6. DOES WELL REPLACE EXISTING WELL? YE NO LY"
7. STATIC WATER LEVEL Below Top of Casing: FT.
(Vsa'a' If Above Top or Cuing)
8. TOP OF CASING IS FT. Above Land Surfaces
*Top of easing terminated at/or below laud surface requires a
variance In accordant wish ISA NCAC 1C.011a. ill n
9. YIELD (gpm): ct METHOD OF TEST 1`I (3 - N I e-
10.WATERZONES(depth): 2. 40 -- 'aC-, err,
Topographic/Land setting
❑Ridge OSlope ❑Valley QFlat
(check appropriate box)
Latitude/longitude of well location
(deg oearmfoute✓ ecoads)
Latitude/longitude source:❑GPS❑Topographic: map
(check box)
DEPTH DRILLING LOQ
Froln / T a / Formationpescription
o J6(Z-(S�2.De
3 a/ — 9-4-oi Gan G(L/I,at C
a¢;,' a7GPry.
0 o
11. DISINFECTION: Type 14TN QCvl Amount
12. CASING: Wall Thickness
Depth Diuneter or Wei&n/Ft.
From � To 'S 1 Ft. L 7 `S - l
From To Ft.
From To FL
13. GROUT: Depth, Material Method
From 1 To Ft. et one PT"rc,It-6.D
From To Ft.
14. SCREEN: Depth Diameter Slot Size . Material
From To Ft. in. in
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
Ib
M�Ir —
P CCii
16. REMARKS:
3
m
J.00ATION SKETCH a m
Show direction and distance in miles (meld leas! a
two State Roads or County Roads. (ncluderdte road
numbers and common mad names. La z
CocKAfro r1'/
t/.2
v7At�5vcs
3/6 an e L.„D
,sae ter, c(Zaeie-
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE Wim ISA NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS ORDHAS BEEN PROVIDED TOTHE WE(.LOWNER
R ►1w�\ a)11�o4—
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mall Service Center -Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-I REV. 07/2001

WELL CONSTRUCTION RECORD
298097
North Cuao:urj - llcpanm:In of Env ironinent and Natural rResources - Div on of Water Quality • Groundwater Section
\\FI.I.lU\IstSCION (ISUI\ IUt Al.) \ OAT (print)__(SS.. :arc.
\\CLI CI):• t\CTUR COMPA\Y\\\IE �^ i_�,re - S• V`'
NI n1 \H-1 I. CU\Mitt( I ION I'I):R4(Ila._ _ _ _.(SSOC.L\TEUt1QpE.RNIT
tt
i I(I:pplicablo _—_. .. _.._.
f'! applmablel
1\;'.LL SSEIl.heek:\ppll cable Lloxr. Residential V !14ur,icipa('PublicU Industrial 0 A_;rictdturalr.C7
.'Onn.Yul:i C Recove, O Hedt Pump Water Injection 0 (hhcl Li It Oilier. List L'sc
_. v ::.i. LOCATION •�TCi
Nat,.vt Town 21Ct
— Q — ` - Tupogr3phis. Land selling
. ._. Cotlri 1rLt Ol^A ORId'c PSlo c u\xllc
-e S (k) €' QI C_CS _ 2.cOtrii p r " Orin
(check ar pr, i-ia hoed
N. v:c. NI•, I IS. (or'_. a l s Subaal on. lit A � Z: , C (Ale1 r atitude longitude of well location
\\NI R _kC1dre_ eb
Avid' . Z GY-(t J --
Le(eS�eYI.r cf g.
Pita
\ .-...d: P"u i t mon.h)r
4, DAl t DRILLED 2- L't -0
▪ OTAI. DEPT}I. d5_�_,__.__—_._.
n. DOES WELL REPLACE EM:SI INC WELL' YES 0 NO —
▪ STAI IC WATER LEVEL I3eiov, T'up of Casing. if° FT. -
H.S. • •' if Aho.; top of C using,
R TOP Or CASING IS .. ___V____ _ L I Above Land Surface'
•1 op Fit casing icrn4lnared scion help* (and surfacr ray ulnas a
s idiot': to acclydsnte %mh 11A NC'AC 2(. .011 H. /1-_._____ .__.-_.___.__.. ..____.,
9. YIITLD 1eprni: _..Z _ ti1EZH D OF Tb STt1 t' C rIIL`�tYjt
! '.i \CATER ZONES (depth). 5 U _.....
t LOCATION SKr ICI I
I DISiNLEt LION Type �1Q,7 Ameunt - Z. _____ Shona direction and distance in miles num at lean
12 CASI NG Walt Th:ckness Iwo State Roads or County Roads. Include the road
Depth D.amcter or N'e:ght 7t Mlater:;:i numbers and to' Upon road names.
Fruni Q_ fo (1.3 Ft
Zip C'oar
zn
cgrcas ,u, s. serond i
Lau nod. I..ngrtude suui.L OGT SOTopoeraphic roan
neck box)
PALLING 1.0G
Formation Dessrlpnon
L)FP TH
Front To
Front _ ro _ Ft.__.____— _____ ____-_-
Form---- . To__. Ft. _
13 (iROI. I ---Depth'— Malcrr�i D,L,-- ti4:bo`'
h rinn To Et. CO t(4 P.ott'r_-
4 :i1: R EN iJcpm Diameter Sint Sze ...__. vlater
1'tl F1 -._ __tn. ----- nl ---------
S SANO.'GRA\EL PACK
i 7e \lawrinl
Frul•i To FI —
n. RF'M-\RK>'.
— y� Inn y CD
yea5+(Qcie
CERTIFICATION a-Zl
PHONE a A -11)_
O
CO
A
3
tV
ID() Ht. RHO' (. EJ1 IFY THAT THIS 'A ELL WAS CI )NSTRI C'I'ED IN At. C'URDAS( E WI chi I5A NCAC 2C. WELL (J1
ioN rizi 'C'FIO S(.+,r-H*N(DS. AND THAT A COPY OF THIS RECORD HAS BEE N PROVIDED TO !I HE WELL OUNE
2- 2G D
SIGNATL UL On PERSON CONSTI4LCTINLi THL WLLL DATL
Submit the original to the Dls ision of Water Quality, Groundwater Section. 1136 Mail Service (enter- Raleigh, \C
276M?.Iota Phone Son (Y)Y) 713.3221, within 30 Ua)s C. AV -I REV. 07 2001

299095
WELL CONSTRUCTION RECORD
North C1a1 a:lna - Dcparuncnl of Ens iromnent and Natural Rcsourccs - Div
RA ` F1.1.I ON I It U'1OR II \UI PI Ul A1.) \ %)1//(l ((-priint))._ Ada.'ii%T ,tG { 1T CERTIFICATION a_.I
wEL1. (V'7'1 R S CtOR (()\IP V'.\ \t%IE ,,,�1 'w{Iy_y ells-_tLK.. ,``Y7F(�+[i_.I%_lik, PHONEM falli .__
NI UI \s):11. 2 O\s l l(1(17D\FF;RnlFI a-_ _,-,_-,(SSOCL\II:U WO PERMIT,'
•I ,! appl:eablr)
n of Water Quality - Groundwater Section
L 'tV t.LL LSE; r,'Licek \ppt viable Box). Residential LY !t1unicipa!'i'ublic U Industrial 0 A_ricultural
'Yonm,vml;f 0 Hecoven 0 Heat Pump Water fruaction 0 Olhu ❑ It Citiicr. list Use
_. AA F;.L. LOC:ATIOON ��J��
N.v:., t ;own ni L __i. ('oor,tv��
li
:5 .. Wi, N.r„bet urn na.i- Subdivirnn L Ivn Zvi ((Isle
th\\\FR
.„, I dint. lip ('od(
I I-
\....'.d. I''u cr:an'.nct
a Dn.; E oRILI-ED_ Z _J 0...1)-- --
TOTAL DEPT}t.� 0 ------
h. L)C)ES WELL REPLACE EX'S.' ING WELL' YES 0_.NO
SFA I EC WATER LEVEL Below Top ul Casing: _COLS1 .7T. ---
l.'x "irAho., raport:asing, -----
C)P Oh. CASING IS __A__i'T. Above Land Surface -
-----
-Top nt casing Isenhour() n/or brio% land surface requires a
arliots in accordance wCn 1' A NC AC 2( 0118. /1
9. YIELi)lcprnLLa--, \IETHOROFTEST sl'11•eCitial.
111. 77A FER ZONES (depth):
i I DISINFECTION. Type \Q, - Amount
I CAS! NCi Wal' Thickness
^ Dept D:amctcr or W: ght'PI Slates'
Fr a1i1 fo______
From .....__.. T(:.. Ft.
}rout---- T -___— Fl.
13 c.; cif I Ds pih melee, '
h ram__._ TO _ FLC.0101(E
Fitini To }t
,4 .0 HI EN itrm Nankai:- i.nt N zC
_ Tit 11
Ho1.1—..__. 10 __ )t _in __---
_
15 SANU'(IRA\'EL PACK:
U:pis Sze Murcia)
Irori -1" Ft
ii Rh:\I \kKN:
M1 k h` (I
SL1d.L._-
'1atcr
1 opogra Land setting
Lam°Ridge repo ❑\'alley
- ❑Flat
2.%) Icheck anprurnm• u l
Latitude longitude or well Iccatinn
I Ikgrecs ':ali.e;.. secunu.I
Luti nldC b..n Etttide Sua1C.'❑CiPS ❑Telsopriphuc man
bast
0E11rll PKILLING LOG
Front To F Orman un Uesn ipuon
LOCATION SKETCH
Show dir.:ction and di'tancr in miles from at lea..t
two Star; Roads or County Roads. Include thud road
narnbc> and common roar names.
t-f ov "1 t
Did T
Sas 73
c
ern
1 0<
CD ter.
rc
a rri
3 �o
rnz
U1 G
I ')(.I HFRI•ui-CLRI IF THAT THIS WELL WAS C11NS1RUC-TED IN AC COWAN( E WITH I5A ^:('AC 2C. WELL.
(UN't,rkh'fli -Si ARU.AND THAT A COPY(.71- IBIS RECORD HAS BEEN PROVIDED TO'THIi \\ELL OWNER
SICiNATUR L Uh rcksoN t. ONSTit L C'T'NU 'f Hi! \t k.LL
1q- C
DAI'L ----_
Submit the original to the Disision of Water 0u: lit), (,round,. ater Section. I(i36 Nlall Scnice ("enter- Ralrigh, \(
27h29-1 bit, Minns \o. t4147'33-3221, within 3U dry S. :.AV-1 Rh\'. 07 27101

11. DISINFECTION: Type
12. CASING:
From 1 To ath
- FL
From To Ft.
From To Ft.
13. GROUT: Depth Material nMetbod
From__Li___ To ab Ft. C$ne\brJT ro vi(6 A
From To Ft.
14. SCREEN: Depth Diameter Slot Size . Material
From To Ft. in in.
From To Ft. in. in
15. SAND/GRAVEL PACK:
Depth Sire Material
From To Ft.
From To Ft.
298028
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural esources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (paint) 1LL—t ej tJ%S 1.1 CERTIFICATION0 R-I11
WELL CONTRACTOR COMPANY NAME _RF.UBEN CALDWELL DRILLING, INC • PHONEEA8 '254-3581
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 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATI
Nearest To A 2yl EW County Q°> y
LAB Tap p..-r.J 0-e A CI
(Street Name, Numbers, Community, Subdivision, La No., Zip Code)
3. OWNER:
Address
i2o602 en /v o1-O5
P. o . 15i1 15SS
(sine ar Route No.)
CArJOL€ l r.)C aY1I l3
City or Town S Zip Code
(sag)- &i o - b—(
Ara code- Phona number
at-
5. TOTAL DEPTH: 5 3 O
'
4. DATE DRILLED a 9- c c
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO Id
7. STATIC WATER LEVEL Below Top of Casing: F' EFT.
1 (Use if Above Top of Cuing)
8. TOP OF CASING IS FT. Above Land Surface•
'Top of settee terminated at/or below Ind seree requtru •
variance In accordance with ISA NCAC 2C .011 I. - a l
9. YIELD (gpm): a o METHOD OF TEST et
10. WATER ZONES (depth): 5 I 0 / - a oPM
(� j F1 clogo Amount 1 l
Wall Thickness
ter or Weight/Fi. Ma al
16. REMARKS:
Topog�pPhic/L.and setting
❑Ridge It3Siope ❑Valley ❑Flat
(chock appropriate box)
Latitude/longitude of well location
(depeedminute✓secoads)
Latitudc/longitude source:❑GPS❑Topographic map
(check box)
L)RILLING LOG
Formation Description
tY'N1 Tc, EL1a1-0-.CIE.
DEPTH
From r To /
aa
ao 1 fie
530'- S %o'
Sio
5;o- 530
an C f rr
C, C..r+Nl ei C°/
r
O `p
a„
pa Cm
sa
LOCATION SKETCH
Show direction and distance in miles from at leatto
two State Roads or County Roads. Includgle rt
numbers and common road names.
`i- 6
O
O
0Ft
2.5 n
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED M ACCORDANCE WITH ISA NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A CO OF THIS RECO HAS BEEN PROVIDED TO THE LL 01
Onet 4
SIGNATURE OF PERSON CONSTRUCTING THE WELL D/CTE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mall Service Center -Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-I REV. 07/2001

11. DISINFECTION: Type
12. CASING:
1 th
From 1 To g 5
From To
From To
13. GROUT:AA Depth Material Method
From 1 To as Ft. CB %rJT {)O0(8(:S.
From To Ft.
14. SCREEN: Depth Diameter Slot Size . Material
From To Ft. in. in.
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
3. OWNER:
298027
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and u+huall Resource -Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (prier) 6 t 14 Pi A lJ CERTIFICATION/ a-n
CALDWELL DRILLING, INC •PHDNE42(8 )254-3581
WELL CONTRACTOR COMPANY NAME _ REUBEN
STATE WELL CONSTRUCTION PERMIT/ ASSOCIATED WQ PERMIT/
(if applicable)
(if applicable)
1. WELL USE (Check Applicable Box): Residential ET MunicipaVPublic 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION:
Nearest Town: RA I RJ \e I,J County CW Cc. n^ 131
\4 w11\TAKE)2 CIRC-LC a%]3b
(Street Name, Numbers, Community, Subdivision, La No., Zip Code) (
JoE r`�mt \
Address 14- C01-1 t TA Ke-(2 CA (ZCLC
(Strxr or Rowe No.)
r A L M t e uJ (QC- 1 3 0
City or Town State Zip Code
(fX).. 6aa - \-135'
Area coda Phone number
4. DATE DRILLED a -/a 5 / O 4-
5. TOTAL DEPTH: t I O /
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO E
7. STATIC WATER LEVEL Below Top of Casing: 6 P FT.
(Uta -+' if Above Top of Carina)
8. TOP OF CASING 1S a- FT. Above Land Surface*
Top of cuing termtoaled at/or below bed inane requiree a
variance to accordasc with ISA NCAC 2C.01Is.
9. YIELD (gpm): .1 n Cr"METHOD OF TEST 1 ( 1p
"
10. WATER ZONES (depth): 9.720 ' — Yd-
6 10 - '/a G Pin
1-1T+1 907e Amount ..- I b
Wall Thickness
Ft. b'/6 osDR � t °1L
Ft.
Ft.
opographic/Land setting
dge ❑Slope ❑Valley ❑Flat
(check appropriate box)
Latitude longitude of well location
(dcgrecs/mioutes/sccoode)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH DRILLING LOG
Fr m i To / Fort/ation,Description,
— D O J$,(2-(53zDe
SO • - cza.0T G29�t r�
a a.o' Ya
am - 64o' C,2.r°,)I
brT
m
r'I
LOCATIONSKETCI{ na m�
Show direction and distance in miles from aazlease
two State Roads or County Roads. Include t' tog 33
numbers and common road names. ,run
C t (Yt U 7
(.JI-\ITAKel etp Ic
1.0
r`"
/a M�
05 --I4-
16. REMARKS:
1 DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH ISA NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A C P� Y OF THIS RF ORD BEEN PROVIDED TO THE ^ }VEa r\1
SIGNATURE OF PERSON CONSTRUCTING THE WELL
CIZ28K-
JIL,LACny3__--��,
`-"rY
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mall Service Center -Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-1 REV. 07/2001

299077
WELI. CONSTRUCTION RECORD
North Carolina - Depanment of Environment and / T Natural%%Resources - Divisionof \\ ater Quality - Groundwater Section'
WEE.!. CONTRA(TOR (INDIVIDUAL) NAME (print) Ro D) IA � £ r� A n (ERIIF IC.0 It)N # .o1 / 8
�)_ t� 1 p t In 41 a i in
WELL CONTRACTOR comtPANI�NAdIF: tT'2r�/ i3/t5. 0uf-n , reu\F. # &
STATE WELL. CONSTRUCTION PERMIT# / ry 0,2 ASSOCIATED NO PERMIT()
l it applicable) (it' applicable)
I. WELL USE (Check Applicable Buz): Residential pi :Municipal Public ❑ Industrial 0 Agricultural 0
Monitoring ❑ Recovery 0 l feat Pump water Injection 0 Other 0 11Uther. List l'6c
2. WELL LUCAIT
Nearest lbws:
County_A L,K.(I
'Street Nana. Numb s. Community. Suhdi' ioii. Lut Nt,.. Lq. ( ode)
3. OWNER: YCL n y/a/L
Address tn, cll. as )as /-/es/y,
IsetorRoute Nu.' if7/�
AIC
( ilt or tm State /11) (nth'
( )-
Area ethic- Phone number
-I. DAl E DRILLED 6 - /J - 0
5. 1 ORAL DEPTH:
b. DOLS \KI:LI. REPLACE EXISTING WELL? YES 0 NO tit
7. SL:V IIC WATER LEVEL Below lop of Casing: 01C) FT.
(Ilse"t.. i IAbuvclop ul ( using)
S. TOP OF CASIN(i IS ( FT. Above Land Surface
"lop or casing terminated at/or below land surface requires a
variance in accordance with 15A NCAC 2(' .0118. /
9. VILL)(gpin). 1pe5 M1rII0DO-"TEs.1 ,9hr5
10. WATER ZONES (depth): _II gig - 6 p
11. DISIN I. LOTION: Type /jr/-/ Amount q[7 .271_s
12. CASING: Wall Hiickne..,
Depth/� Ueuneter of \\eucht I.t ?hnenal
Iv From, t� _To p 7 Ft. /, // P VG.
From To Fla
Front_-- -- .1.1)
13. (iR011l Depth Material
From6 - _rt.�
From •to
14. SURF:LN: Depth Diameter Slot Svc \laten,il
Front _ To 1`I. in. in.
From To Pt. in. in.
SAND GRAVLI. PACK: - -
Depth Site \ (atenal
From ;Et)
- o
To Ft. _..
Method
LG. REMARKS:
Tope;_ aphic,'Land setting
❑Ridge Slope ❑Valley ❑Flat
check z1propnolc MN)
Latitude longitude of well location
idetI....n.mac. sLCond.l
Latitude longitude source:❑(iPS❑Topographic map
ielweit boa
DI.P I11 I)RII.I.IN(i LUG
From I Formation Description
S5
S�1 S
l OC:\ LION SKF.TCII
Show direction and distance in miles Gant at least
two Stale Roads or ('aunty Roads. Include the road
numbers and common road names.
1 DO 1ILRl.lil' LF.R' IFY l llAl llllS \\lilt. \VAS LUNS I RLCII'.D IN At CORD .\NCI \VI II 115.\ N(A( '_L, \VLI.I
LUNSTROCTIUN ANJ)) RDS, ANI)II IA A LUI'\ ()I HISS IRFLURD IINS fit hN PROVIDED 10 111E \VIAI.I. IAVNI-.It
1/2 J Lc � © 6 —30—ot/
SI(iNA.111Rh. OI I'l.RS()N ( )NSF RI ("IINtI 1111 \\l 11. U.AII
Submit the original to the Division of w ater Quality, Groundwater Section. 1630 \lail SFr. ice Center - Raleigh. M.
27699-1636 Phone No. [phone], within 30 days. ow-1 RIfA'. 07 '11111

299195
WELL CONSTRUCTION RECORD
North Carolina - Departtncnt of Environment and Na ources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAM (print) 6�/.y/ e a 41 L.L_ CERTIFICATION #,2277
WELL CONTRACTOR COMPANY NAME i O�i Q LO/J 7ii44s PHONE N ficolq G U9-bra
ASSOCIATED WQ PERMITS
(if applicable) (if applicable)
STATE WELL CONSTRUCTION PERMITS
1. WELL USE (Check Applicable Box): Residential JR Mttnicipal/Public 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery ❑ Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATIO
Nearest Town:
County 441saatit
(Street Name, Number, Community, Subdivision, Lot No., Zip )
3. OWNER:
Address
121.eeJ'.. �i ;y;(7. 0,g727
City or Town State Zip Code
( )-
Area rode- Phone number
4. DATE DRILLED 9/a0/Dy
5. TOTAL DEPTH: .Z
6. DOES WELL REPLACE SING WELL? YES 0 NO 0 `
7. STATIC WATER LEVEL Below Top of Casing: y 7 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING 15 1. S FT. Above Land Surfaces
'Top of casing terminated at/or below land surface requires a
variance In accordance with ISA NCAC 2C .0115. •
9. YIELD (gpm): /Q MFTHOD OF TEST Las sue
10. WATER ZONES (depth): /a O t
Topographic/Land setting
Ort.idge ❑Slope OValley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/miaurrs/seconds) (,
Latitude/longitude source:❑GPSOTopographic map.
(check box)
DEPTR DRILLING -LOG -
From To Formation Description
LOCATION SKETCH ..
11. DISINFECTION: Type /1. 4 hi- Amount 9 OZ. Show direction and distance in miles m arleast
12. CASING: Wall Thickness two State Roads or County Roads. Include tie mad
Depth/ Diameter or Weight/Ft Material numbers and common road names.
From_ To G D Ft. (/p y rlk.91 j(/1,e_ -- ajs_ 77)
From__ To Ft V
From To Ft.
13. GROUT: DepthMaterial - Method
From To a �Q Ft. L�Mia._ �r [Ja+tf•t.�r
From To Ft
14. SCREEN: Depth Diameter Slot Size Material
Fro To Ft. in. in.
Fro To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
16. REMARKS:
0' '
1 DO HEREBY CERTIFY THAT THIS WFI i WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
• die
SIGNATURE OF� ON CONSTRUCTING THE WELL
fAr/°7
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

299196
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Na Resources - Division�nof Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAM (priot)�y A/ ,p /74, L CERTIFICATION $(. d 77
WELL CONTRACTOR COMPANY NAMELY f, �a ,4y444 1194.).44.1 PHONE M 40 A 99-AVire
STATE WELL CONSTRUCTION PERMITi1 ql/9 ASSQCIATBD WQ PERMTIti AO/ -
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential I8 Municipal/Public 0 Industrial 0 Agricultural ❑
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATIO ..
Nearest County County 6.414It rw i/
.% r7/9"
(Street Name, Number, Community, Subdivision, Lot No., Zip Code)
3. OWNER: LIP sae ta)
Address / 7 9 aes4 /lu/ f
r� (Street r Route No.) I
City or Town State Zip Code
Area
s
647- 3t s
Phone number
4. DATE yi Ds/i0 y
5. TOTAL DEPTH: 3 O.3
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO R
7. STATIC WATER LEVEL Below Top of Casing: 3 D FT.
(Use "+^ if Above Top of Cuing)
8. TOP OF CASING IS A < FT. Above Land Surface'
'Top of casing terminated at/or below land surface requires a
variance in accordance with 15A NCAC 2C .0118.
9. YIELD (gpm): 3 D MATHOD OF TEST —CI -nu
10. WATER ZONES (depth): ,f40
11. DISINFECTION: Type 0.,9 d Amount 1.2 07-
12. CASING: Wall Thickness
Depth Di ter or Weight/Ft Material
From _To So Ft_ 40.7/ ®dL
From To Ft
From To Ft.
13. GROUT: Depth Material
From p To ..7 GI Ft ��/-
From To Ft.
14. SCREEN: Depth Diameter Slot Size Material
Frome Ft.
From / To Ft in. in.
15. SAND/GRAVEL PACK
Depth
From /f"o Ft.
From / To Ft.
m. in.
Sir Material
16. REMARKS:
Topographic/Land setting
ORidge 1lope OValley OFlat
(k appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:OGPSOTopographic map
(meek box)
DEPTI; DRR.LINO too- __
From To Formation Description
LOCATION SKETCH
Show direction and distance in miles 1 at least
two State Roads or County Roads. Inchtde thF cad
numbers and co 1. on road names. =_
.
I DO HEREBY CERTIFY THAT THIS WEI i WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AID THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-1 REV. 07/2001

WELL CONSTRUCTION RECORD
North Carolina Department �Environment and Natural Resources-- Divisionof Water Quality -.Groundwater Section
WELL CONTRACTOR (INDMDUAL) NAME.(print): _; 'CERTIFICATION #:
WELL CONTACTOR COMPA&YNAME ,,, PHONE# --- ---
STATE WELL CONSTRUCTION PERMIT# -! ASSOCIATED WO PERMIT #
(ifapplicable) %:= x . Y. : -• " ' `(itapplicable)`
1. WELL USESA Icablel8ox Residentialu
(Checkppl' ) � ❑ 0Municipal/Public
❑ Other ;If Other LIst,Us:
opographiQQLand Setting;
❑ Slope 0 Valley
(Check the apDrpdate box)
atitude/L"oe_ o ngittidf well location
NCDENR
NIA
Jesse Martin
❑✓ Monitoring ❑ Recovery 0 Heat Pump Water Injection
2. WELL LOCATION.
Nearest Town:
Asheville
County:
Buncombe
Bent Creek R.D.
(Street Name, Numbers, Community Subdivision Lot No, Zlp Code
3. OWNER:
Address:.
U.S, Forestry / NCDENR
❑ Agricultural
P5S
Bent Creek R.D.
8*aorRoadN'p}';
Asheville
City or: Town ;
826-667-5261
(area code - phonepumber)
4. DATE DRILLED
5. TOTAL DEPTH,"
6. DOES WELL REPLACE EXISTING WELL
7. STATIC WATER LEVEL (Below Top of Casing):- 7.06 F.
e + 'if Above Top of CasTrlg)
8. TOP OF CASINGS 2ft Above Land Surface" ^'^•
N.C. 28806
State gy: ';,Zip Code
6/31/2004
17ft
'Top of posing terminated auor beloW)and surface regwres a
variance in acco dance'G4fth 95A NCAC 2C 019$ a
9 YIELD (gpm) METHOD -OF TEST;.
10. WATER ZONES (depth):
11. DISINFECTION,T
12. CASING
bepth`
To
To Ft.
TO
Depth:
To
ToT
From
From
From
13. GROUT
From
From
From'
14. SCREEN--•:
2
4
0
ep
From 12 Toy
From To
From To
15. SAND/GRAVEL PACKSli
Depth `--
From 8 To'
From To.
From Te��.
1
12ft-17ft
N/A
12
17
16. REMARKS:
17
Ft,,
Ft
Fee
Amount
fah Thickness
WeighuFt."
Bladder pump
hole •lug
Cement
iameter %'"cSrot
Find
N/A
poured
mix w water
ateria
sand
❑ Topo Map
0 industrial
0 Flat
82.6407 / 35.4855
z a (degreesrminutr/seconds)4
Latitude)tongdude source GPS
Y(ChecICB"o
0
- 3
red clay
3
- 8
red clay
8
- 13
` tan clay
13
- 17
tan clay
LOCATION SKETOH
Show direction and distance in tiulesfro.m t feast two
State Roads or County Roads i.Tndude the road
numbers and cpmmon road names , -.
'ttR 22 2612
MAR 15 Z012
STANDARDS, AND THAT A,COPY OF 1111S RECORD HAS BE EN PROVIDEDTO THE ELOWNER:
•
SIGNATUR RSON C011ST C ;ING THEW LL DATE,:
Submit the original to the DMswdof .Water Qua Groundwater. SectiAft
on 1636, Mall Service Center Raleigh NC 27699 1636 Phone
, GW-1.REY 07/2001_;.
No. [phone], Within 30 days., °� ' '

298029
WELL CONSTRUCTION RECORD
North Carolina -Department of Environment and *Iatunt Reesourey -Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) g' L L I E rJ A S+& CERTIFICATION I A 7 7
WELL CONTRACTOR COMPANY NAME_RF.UBEN CALDWELL DRILLING, INC:, rxoNE(i?j8 )254-3581
STATE WELL CONSTRUCTION PERMIT/ ASSOCIATED WQ PERMIT/
(if applicable) (if applicable) ".
1. WELL USE (Check Applicable Box): Residential li-MunicipaVPublic 0 Industrial 0 Agricultural 0
Monitoring ❑ Recovery 0 Heat Pump Water Injection 0 Other 0 if Other, List Use
2. WELL LOCATION:
Nearest Town: C Ara a te- County GU&CbMgC,
I aCoe O A Ll= pAictP L arc 35e
(Street Name, Numbers, Community, Subdivision, let No., Zip Code)
3. OWNER: !)et)) A(LKo1� se-rx.
Address 16 t R '0 A 1-E (2-oA A
CAIV 1 1-e-11.- (Street « Routs No.)
ag-i 15
City or Town Stew Zip Code
(6.n)- (,65 - 5 a
Arca code- Phone number
4. DATE DRILLED a I V 04--
5. TOTAL DEPTH: 2 d
6. DOES WELL REPLACE EXISTING WELL? YES NO 0
7. STATIC WATER LEVEL Below Top of Casing: 4—D FT.
(Use `e if Above Top of Casing)
8. TOP OF CASING IS I- FT. Above Land Surface'
*Top of cuing terminated aver below land surface requires •
variance 1n accordance with ISA NCAC 2C.OI lg. ,1
9. YIELD (gpm): 1'� METIIODOFTEST R!G - A t y
10. WATER ZONES (depth): 1 `I-0 - 6 6 PM
203' — (7 GPrv-t
11. DISINFECTION: Type i N Cio` n Amount ' .-
12. CASING: Wall Thickness
Depth 9 ter or Welgbtt/Ft. M)tefi$i
From jTo FL r Yi 2O(�L (� ``(I
From To Ft.
From To Ft.
13. GROUTI' Depth Material {Method
From -1- To Ow Ft. It m�U ( VO J (2-Erco
From To Ft.
14. SCREEN: Depth Diameter Slot Sire . 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: Jn %4 We_tN Llte..eD 1411 ARAN Dnn AGM
1614 - Onjlle-D tee C
I DO H REBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A OPY OF THIS RECO HAS BEEN PROVIDED TO T WE OWNER
DATE
Topographic/Land setting
[Midge ❑Slope ❑Valley teflat
(check appropriate box)
Latitude/longitude of well location
(degrece olaute✓seconds)
Latitude/longitude source:❑GPS❑Topographic nap
(check box)
DRILLING LOCI
Formation Descriptio{t
DEPTH
From ! To ,
- 3o
13c2-- 14o'
lac -'
I¢o a05,
ao5et
2o5'- a3c'
C,gn� t
writJ uL
G ///M
(; ,J c4 , re / W r{ I l e �cC lC.
(.? C') ;CD r"'l
17cC0.27/
S �m
LOCATION SKETCH �7m�
Show direction and distance in miles froln at F°
two State Roads or County Roads. )nclti>d the I
numbers and common road names. a. rn
/ mX
1
c,
v
0
ILE 6 e pnLE�
SIGNATURE OF PERSON CONSTRUCTING THE WELL
(-to i, Ve-2s G a
a�
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mali Service Center -Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. G W-1 REV. 07/2001

1V1'1.1_ CL N.`; 1'RI14.2.1111N It.LCORD
LI Ioumc,-i u y. ,:,,,:4 :-. -Di.i, iOtW.-1rcr Quality- Grourldlratr Section
i CP rIF.RticriON a .2 OAS
_ \ ur,.l Nl 4PL✓ _C.•_rnons2,385a_5Z-Z.V4,
110 PT1'1N'll'1'u
u Pp.,old.1
t ip, :IbIc 1,73 injwin'ial 7 * ',Quin rril ❑ utlll 1111C1 lrll..2uL1J LII ICI La II Ulh cr, Li31 Llyc
�' t.Thwldy_ AJ/ICOM
.ul I•W Zip 1�JJ.J
Ce
C
LIL•fiS V. ELL REPLACE EXIST11ICWELL? YLS 0 h10 l�
T.-T!..1i:•:LER rE1'ELBHow Top o" S
eln_:
DI;•r C+.j'N31S f IUs<":'ifnou ,: Top of Gang
:Abu 1.:111J
1-f lTu:u I; Cut Oclu,r l ufr).0 r r ul
: 1 2:I s c l rei n
'-NII With I51 .V 1.' L ]L'.W IS.
I1ELC tMETHOD ! �
,t
TLI� ti O QF'] t 3"f'%i i�al,,,,,, _ .�
IISiN _l l ILii\ lra I l a p ll
11 111 I fnautc�3 1
. ;pm
DlamcRr 3r`?i¢:111;f1. 6{J1p1.1:1]
raid !Qg hI d ZL(e+.aj A/LS_kz2/
F.
i'F_ F .
.ou
q,I:j�I � - 1\'I ALCrI"JI 1'ilCln.l;l I3—aLG_ F[ CC/1' D/cw_ 1
Le2_.._
R-1L_L p 1iI -l_/
Dimnncr 3101 S12c 1alu ul
FC ul, m.
Ft. n
F1.
F,.
%±lc
1 3 .c?d_ARJ
DC riERSE1 tillr'Y .11 HIS WELL Wi.3 CONS TR-.copy Gh`UC1ED EN ACCORDANCE WITH C2WELL
COILS ri ,cD v31.ND.al:D3NDThfTlH'6CpILI HASBEEN PROVIDED TOTHE WELL OWNER ;
•
3I ON n:e nr. RsON colistaiCTING THE WELL
S. mlr La; all dual EL)in2 Unii io IIar \4amr Lualu � �
iwpc w. [:'IJ ) Grow' a}l :+[cr5ee[la 1 lu3o fl'l;ul 3uwime Cenrm'- Raltigp, NC'JJ•J2:.� lr \Vill �U da)-s.
CW-1 1'EV. 07!?00I
ill it:nJI
—L?__T n3 __
—.I.Q.S—ans
309252
TopognI' 1le/L_ n-t j scnluh'
❑Rings W§Lpo ovan.y DEW
fchccl:.IPpropdort 10X.)
LU[Imdc/longit , 1e of ell [Oia(jDIt
(dcylcc5:1111I1111 Liccnndn)
Lanal;lei INLlgllude warped 'SDTopographi; rnelp
I.LcaIC buN)
OR P'I'H DR ILIIRN LLL_,_
Prom To Pon-n den De. eriplion
Rock
r/`an'X-e
LOCATION SR_ETCN
how direnion rwd dulan;e in miles from ar Icasr
S111e Kailas ar Counry hands. Include [he road.
uulydu'1'3 and common road names.
O-a4/e-r, KC.

WELL CONSTRUCTION RECORD
4302R'75
North Carolina - Department of Environment and Natural Resources Division of Water Quality - Groundwater Section �-r
W ELL CONTRACTOR (INDIVIDUAL) NAME taring 1 c Yo 6y k , Po / CERTIFICATION AtOC o a a
{
WELL CONTRACTOR COMPANY NAME FC a or 0�✓ T LUQ/( n/1/t��/v. Co PHONE RAT)
STATE WELL CONSTRUCTION PERMIT% �/ ASSOCIATED WQ PERIvIIT#
(if applicable)
(if applicable)
1. WELL USE (Check Applicable Box): Residential 12 Municipal/Public ❑ Indusvial ❑ Agricultural ❑
Monitoring ❑ Recovery 0 Heat Pump Water Injection 0 Other ❑ If Other, List Use
2. WELL LOCATION:
Nearest Town: Cand/en
/70 tetr fiat. L(
tSatet Name, Nuhr6ers, Community, Subdivision, Lot No., Zip Code)
County eiVACDNI he
3. OWNER' tee + J3r[nva w net/
Address /70 de r/o/i ,d .
(Street or Rou[d No.)
fg ndie✓ NL o'l%7/ef'
City or Town State Zip Code
(101S)- (r(¢i— Y(1453
Area code- Phone number
4. DATE DRILLED �2/(0
5. TOTAL DEPTH: I /
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO !I�'
7. STATIC WATER LEVEL Below Top of Casing: 30 FT.
(Use "+" if Above Top of Casing)
S. TOP OF CASING 1S / FT. Above Land Surface*
'Top of casing rerminared aver below land surface requires a
variance in accordance with I5A NCAC 2C .0118.
9. YIELD (gpm): 3/i METHOD OF TEST C/1
10. WATER ZONES (depth): 9Q
11. DISINFECTION: Type i.et&/t jj
12. CASING:
Depth Diameter
From D To Qb Fr t LS
From To Ft.
From To Ft.
13. GROUT: Depth
From /1 To A O Ft
From To
14. SCREEN: Depth Diameter
From To Ft. in.
From To Ft. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Fr
From To Ft.
Amount coPS.
W:dl Thickness
or Weight/Ft. Material
fTlL 1a.3 PVc Sit !LA
Material Method
Cnncr.cir PouI'll&
Ft.
Slot Size Material
in.
in.
16. REMARKS:
Top o grap hiciL an� e sting
❑Ridge ❑Slope ZValley ❑Flat
(check appropriate box)
Latitude/longitude of wrzll location
e
(degrees/minute sec onds)
Latitude/longitude source: OGPS❑Topographic map
(check box)
DRILLING LOG
Formation Description
1>/A1'
Lock
- /Q S 6.rQn
°37,17V
DEPTH
From To
— 4/
4t - 46
Grn
O y`
-,I -OD
1 A
O0
tern
—
LOCATION SKETCH a Ca
Show direction and distance in miles from at least' o7 p
two State Roads or CountyRoads. Include the roa r'n
numbers and common road names.
/70 ,-, pIcJe �q/e ,i
Can diet,
U=
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
ATEOr
SIGNAT
OF PERSON CONSTRUCTING THE WELL
Submit [he original to the Division of Water Quality, Groundwater Section,
27699-1636 Phone No. [phone], within 30 days.
1636 Mail Service Center - Raleigh, NC
GW-1 REV. 07/2001
Csm.1
;

3. OWNER:
Address
297912
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and watralResources-DiivisionofWaterQuality-GroundwaterSection
WELL CONTRACTOR (INDIVIDUAL) NAME (plat) / 1 1- Li 6 A StA CERTIFICATION a a1 1 -1
wELLCONTRACTORCOMPANYNAME_REUBEN CALDWELL DRILLING, INC. PHONE4i8 .?54-3581
STATE WELL CONSTRUCTION PERMIT%
(if applicable)
ASSOCIATED WQ PERMIT/
(ifappliable)
1. WELL USE (Check Applicable Box): Residential El Municipal/Public 0 Industrial 0 Agricultural.0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION:
Nearest Town: C.ANN-6/2-- County QvricCrneE
2tlsGet(3ALf SNP
(Street Name, Numben, Community, Subdhision, Lot No., Zip Code)
,cFF CU141TC51136
{'.o. Gcif \81
(Strrat«Rowe o.)
L' A Pa LE a_ p3 Q a-fs 115
City or Town State Zip Code
(32X)- � - 16C3
Ara code- Phone number
4. DATE DRILLED
5. TOTAL DEPTH: a )1/4)
/
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO GI
7. STATIC WATER LEVEL Below Top of Casing: 4-0 FT.
(Use -a' if Above Top of Cuing)
8. TOP OF CASING IS 4- FT. Above Land Surfaces
'Top of cuing terminated at/or below lead surface req ulna a
variance In accordance with ISA NCAC IC.OI i a.
9. YIELD (gpm): 0 METHOD Oy TEST Q- 6 - A 1 (2-
10. WATER ZONES (depth): I a- o - ao Gen-,
'I 70 - 3r, G Per'
11. DISINFECTION: Type N1N d1 o Amount ' 3
12. CASING: Wall Thickness
4 Depth„ Lhalgeter or Wp;ghUFt. blgtgial
From
From To
From To
13. GROUT: Depth Material Method
From To ao Ft. Cz/rieo"r Qo 0
From To Ft.
14. SCREEN: Depth Diameter Slot Size . Material
From To Ft. in. in.
From To Ft. in. in
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
ai o/0 4
Ft.
Ft.
Ft.
16. REMARKS:
Topographic/Land setting „.
❑Ridge ❑Slope ❑Valley UFlet
(check epptcprieta box)
Latitude/longitude of well location
(deyorahotout&secoode)
Latitude/longitude source:❑GPS❑Topographic map
(check boz)
DRILLING LOG
Formation Description
o r��2.a�r-)
6MrJ rrtrWglre. Rick_
ao 76 Pr"
(jAnN 11-B/WN17a 424tic_
3 o G Pr-"
C41-A� 6 33raerC
1- c�
2 ar
DEPTH
From i To
— -15
15 ' -
tau
1 Q0 ' - 170'
10'
110'- 9, to
—
1 SZ
w
DG
LOCATION SKETCH -v ma
Show direction and distance in miles from i eastN=
two State Roads or County Roads. Include ti7 roaC
numbers and common road names. .c' —
Iiaiv /� i. i
12(o6rr 11-rag
11,;:424s GAP
444 W\
f 14w) 19/1 3
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 1 SA NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT f1 COPY OF THIS R,I�CORD HAS BEEN PROVIDED TO THE WELL,OWNER
SIGNATURE
F PERSON CONSTRUCTING THE WELL f DA
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mall Service Center -Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-I REV. 07/2001

284191
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) ' Il C J CERTIFICATIONS( 3 S Z Sr
WELL CONTRACTOR COMPANY NAME en
ou tr?rc. JL E MP StJC.-S PHONE a ( I).55_62T
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WO PERMIT#
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential lir Municipal/Public ❑ Industrial ❑ Agricultural ❑
Monitoring EY Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use
2. WELL LOCATI N:
Nearest Town: Sys). County R.) \LOMJO e
11 Low ktr t Z g`ZOai 14
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: EFIPrr En\A-Z
Address i
Ra
(Street err Route No.)
As�nv,�`e N(
City or Town State Zip Code
c - 2..si3 —I�it7
Area coda Phone number
4. DATE DRILLED 1/(c04
5. TOTAL DEPTH: 7, S
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO (
7. STATIC WATER LEVEL Below Top of Casing: CO FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS FT. Above Land Surface*
flop of cuing terminated at/or below land surface requira a
variance In accordance with 15A NCAC 2C .0118.
9. YIELD (gpm): METHOD OF TEST
10. WATER ZONES (depth): Sr to 7. S t
11. DISINFECTION: Type
12. CASING:
Depth Diameter
From To Z..S Ft. Z'/
From To Ft.
From To Ft.
13. GROUT: Depth
From 0 To 6)
From To
14. SCREEN: Depth
From a.S To 7, s
From To
15. SAND/GRAVEL PACK:
Depth
Topographic/Land setting
[&Ridge ❑Slope ❑Valley ❑Flat
(check appropriate box)
Latitudeflongi, e of well location
(degrees/ ' [&seconds)
Latin:de/longitude source:❑GPS❑Topographic Itap
(check box)
DEPTH DRILLING LOG
From To F tion escription
0 7.0 s�. s, +;
-1,b 7,S
fl
o
0
L r'N
a �m
G CCD
>m
s o<
CO 1-11
LOCATION SKETCH >t
Amount Show direction and distance in miles from easi,,'r�
Wall Thickness two State Roads or County Roads. Include taffy road
oaeghb t. teia numbers and common road names.
v t)
Method
Ft. Po Imo __ -Pour
Ft.
Diameter
Ft. 7- in.
Ft. in.
Slot Size Material
biL in.
in.
Material
Size
From Z To 2 g Ft. it 7-
From To Ft.
10
16. REMARKS: mA�_ \ 1Jtf\'CDN,rt. - rotnl \ I Z/
)
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH I5A NCAC 2C, WELL
CONSTRUANDA.S, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
i I clo1-1
SIGNATURE OF PERSON CONSTRUC IING THE WELL DA
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center -Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-1 REV. 07/2001

293255
13. GROUT: Depth Material
From To Ft.
From 0 To .e 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
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resourcesr- Divisionisof Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) (.74J 4r A VS``�YCL CERTIFICAATTIION#42/�
WELL CONTRACTOR COMPANY NAME 711ch&E WVeaUrr'GC „V4Y PHONE # OF) ("C@CI-5-0
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERM (Tit
HI -applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential GVlvlunicipal/Public ❑ Industrial 0 Agricultural 0
Monitoring ❑ Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION: pp
Nearest Town: �Z� P1 f County ,OU BE
5-}3 L,Bs//g+scr/-/Cd
(Street Name. Num-hers, Commuuniity, Subdivision. Lot No..
Zip Code)
3. OWNER: /4 4� ,4N /6/Ci fsvd4)
Address 3 9 Lq} f j? fe-t ti!
.� / (Street or Route No.)
,4LdCkwt/ `L/C ?Q 7SSZ
Zip Code
City or Town Slate
8)- ee 4 5- 4?/VV
Area code- Phone number
4. DATE DRILLED 2-/I-0
5. TOTAL DEPTH: 4/05-
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO NV'
7. STATIC WATER LEVEL Below Top of Casing: So FT.
(Use "+" if Above Top of Casing)
3. TOP OF CASING IS / FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordance with ISA NCAC 2C .0118.
9. YIELD (gpm): 7 METHOD OF TEST
10. WATER ZONES (depth): 3 ,Pm e girt
// Amount ROBe73%
11. DISINFECTION: Type cucLiA:e
12. CASING: Wall Thickness
Depth
From To Ft.
From 0 To i 61 Ft.____ to / VC
From MT To /// Ft. {o Ay /RS S/ee1
Method
Diameter or Weight/Ft. Material
1,Uvlt'd
From To Ft.
From To Ft.
16. REMARKS:
Topographic/Land setting
giRCIge ❑Slope ❑Valley ❑Flat
(check appropnatc 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- /0C
/or- !/ S cpeARor i-e
O
r-2
t7
am
r*t nrri
LOCATION SKETCH irn
Show direction and distance in miles from c1 easC-rh
two State Roads or County Roads. lncludeic roAa
numbers and common road names. m
Ocnz
m�
o -Y
C.
2
LgSkgtco,2i
1 DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDA CE WI H 5A NCAC 2C, WELL='Y?
CONSTRUCTION STANDARDS, AND'jrHAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
ON CONSTRUCTING THE WELL
DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center- Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-I REV. 07/2001

293253
From To
14. SCREEN: Depth Diameter
From To FL in.
From To Ft in.
15. SAND/GRAVEL PACK:
Depth
From To Ft.
From To Ft.
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) C7.4 tz .S ('3I co" CERTIFICATION I` i 515
WELL CONTRACTOR COMPANY NAME 3 v Si i C l5- %Az/etc 11 Z L//U 4F PHONE 0 f ) 7Zr1' y ce9 i,�
STATE WELL. CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable)
(if applicable)
1. W ELL USE (Check Applicable Box): Residential unicipaUPublic 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATIO : pp e
Nearest Town: $Iir:,LLti Countyll.;� Ci
e rlj5A flit d11Z (check appropriate boa) tD =rn
Latitude/longitude of well locatio� ? �
7>0
(degecr/miautdseconds) �' P�
a
Latitude/longitude source:❑GPS❑Topogra hii �tprtt
(cheek box) O m zit
DEPTH DRILLING- .009
From To Formation Deseriptilafinic
0
(Street Name. Numbers, Community, Subdivision. Lot No- rip Code)
3. OWNER:fZC1Y44r C -R, C�
Address a tl O i q(e f l7 , .1$t. ('L LA
' 73 2-
(Streak Role a)
FMB fl,I
City or Town State Zip Code
Area code- Phone number . / D. C u
4. DATE DRILLED
5. TOTAL DEPTH: QS
6- DOES WELL REPLACE EXISTING WELL? YES d IO C9' <<Ju • / 40
O
Topographic/Land setting r c�
❑Ridge ❑Slope ❑Valley ocn
7. STATIC WATER LEVEL Below Top of Casing: (a FT.
(User if Above Top of Casing)
8. TOP OF CASING IS FT. Above Land Surface+
'Top of easing terniuled aYor below rand saabee regain a
variance m accordance with ISA NCAC 2C .01111.
9. YIELD (gpm): (40 METHOD OF TT
10. WATERZONES(depth): i.O1p" 2 7S
I I. DISINFECTION: Type LLJc\ W-c.
12. CASING:
Depth
FromTo I of Ft..
Fro
From 1'2 o To 17 J. Ft.
l3. GROUT: Depth
From To FL
FL
Amount 411
Wall Thickness
or WeigliVft.
Cfb
16. REMARKS:
©- 36
Co - too
/id- 2g5-
LOCATION SKETCH
t oc..497}LShow direction and distance in miles front at least
two State Roads or County Roads. Include the road
ai numbers and common names.
l t 6
Method
Slot Size Material
in.
in.
Size Material
1 Sat It
1456E
q
1 DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE Wf h1 15A NCAC 2C, WELL
CONSTRUCTION $f�(t�DARDS, AND THAT A COP X OF THIS RECORD HAS BEEN PROVIDED TO THE WELL 0'
n
OF PERSON CONSTRUCTING THE WELL DATE
V
Submit the original to the Division of Water Quality, Groundwater Section,1636 Mail Service Center - Raleigh.
27699-1636 Phone No. (9119) 733-3221, within 30 days. GW-I REV. maim
r
i

WELL CONSTRUCTION RECORD 2 9.316 5
North Carolina - Department of Envircnment and Natural Resources - Division )f Water Quality - Grour dwater Section
CERTI7ICATION # at(Vic
WELL CONTRACTOR (INDIVIDUAL) NA-tE (print) D eee:e-x 1-b9-t`r9i ��NQ CJ
WELL CONTRACTOR COMPANY NAME C-,*%* - Sq`-NIV.0li5Ceri.QV VD. 94" a PHONE 1 (?e/31 (M-S-'`C'
STATE WELL CONSTRUCTION PERMIT ASSOCIATED WQ PERMIT#
(ifapplicable) • ' (if a lcable
1. WELL USE (Check Applicable Bo t): Residential Municipal/Public ❑ Industrial 0 Agriculural ❑
Monitoring 0 Recovery 0 Hea Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION:
Nearest Town: ‘„�..tziv.tiL
tv'a 11, t\ (kirf-AS
(Street Name, Nuribers, Community, Subdi ision, Lot No., Zip Code)
3. OWNER: IA.cr aa41 C.-"C'a-NI.NI
Address
-15 bc: t?:c.c rk xt&' .. \\'L ''t
(Street or Route No.)
vice..-v£cv.r'Ic_ �;:7F1
City or Town State Zip Code
^7'7'-T E33b
Arca code- Phone number
4. DATE DRILLED 1-14- o'k
5. TOTAL DEPTH: 41-ia
6. DOES WELL REPLACE EXIST'',
7. STATIC WATER LEVEL Below]
(Ut
8. TOP OF CASING IS I
`Top of casing terminated at/or below lat
variance in accordance with 15A NCAC
9. YIELD (gpm): H METH(
10. WATER ZONES (depth):
County '. xr\Cc...dns
G WELL? YES ❑ NO El
op of Casing: t 1.0 FT.
"+" if Above Top of Casing)
.T. Above Land Surface*
d surface requires a
.0 .0118.
D OF TEST ' "7
Topograph`.c/Land setting
(]Ridge ❑Slop_ RiCa ley ❑Flat
(check appropriate t tx)
Latitude/longitude of wt II location
(degrees/minutes/seer ids)
Latitude, longitude source:❑GPS-7Topogr
(check 1 ox)
DE 'TH E RILLIN(
From To Forrtation Descrir tic
r t rJ I
Jt
ptic
3rG
�4s i-e.;n:4
11. DISINFECTION: Type f.tu
12. CASING:
Depth
From 1-1 To 7t - Ft.
From To Ft.
From To Ft.
13. GROUT: Depth
From 0 To Ft.
From To Ft.
14
Dian eter
tJ i
Amount
Wall Thickness
or Weight/Ft. Material
'U2i j�io sr:c
M aerial Method
LQvhe^1 pc
SCREEN: Depth Diamet er
From To Ft. In.
From To Ft. in.
15. SAND/GRAVEL PACK:
Depth Siz : Material
Slot Size Material
in.
in.
From To Ft.
From To Ft.
Show di
two Stat
number:
CIL
0
m r'9
w c''
\o o�
LOCATION SKETCH 3 ao
-ection and distance in riles fri:tm at least
Roads or County Roadx. Inci4 the< oa
and common road name;. o E,
z
4=' 1? i
16. REMARKS.
1 DO HEREBY CERTIFY THAT THIS WE WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND TI AT A COPY OF THIS RECORD HAS BEE!! PROVIDED TC THE WELL OWNER
1Za tn�r� Olt •••% -.g \Jc t tti • C H
SIGNATI IRE OF PERSON CONSTRUCTING THE V ELL DATE
Submit the original to the Division of ;Veer Quality, Groundwater Section, 1636 Mail Service Ceenterl REVgh, NC
27699-1636 Phone No. [phone], within 30 days.

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) OtCe rt. K ?\t0..rix
WELL CONTRACTOR COMPANY NAME C\ \c Scarcton kseNve-lump 1•nC PHONE #( (o(05 -antSTATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable)
(if applicable)
293166
CERTIFICATION# 2M3(0
I. WELL USE (Check Applicable Box): Residential 18 Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other ❑ If Other, List Use
2. WELL LOCATION:
Nearest Town: F::•ev e..County 3:,.rxea «be
-ZQt:,Ob s.Rd a lao
(Street Name, Numbersommunity, Subdivision, Lot No.. Zip Code)
3. OWNER: Foeedo v' )tnet ii;nea—,;:)o
Address fc‘'1S Ile -suite sc•iv.t(e li,a
(Street or Route No.) d
F1eleMee NC ae'na
City or Town State Zip Code
(+i ,e )- fc94 vli,ta.
Area code- Phone number
4. DATE DRILLED 1" 13'0'4
5. TOTAL DEPTH: 5d5
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO 111)
7. STATIC WATER LEVEL Below Top of Casing: 3c0 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS 1 FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordance with 15A NCAC 2C .0118.
9. YIELD (gpm): t METHOD OF TEST i2: Q
10. WATER ZONES (depth):
11. DISINFECTION: Type Q;vAS Amount I.
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft.
From t' 1 To 18 FL r4 t'z\
From To Ft.
From To Ft.
13. GROUT: Depth Material Method
From 0 To 20 Ft. Ce.'tan# Po+.rasa
From To Ft.
14. SCREEN: Dcpth Diameter Slot Size Material
From To Ft. in. in.
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Size Material
Material
?idsi'L
From To Ft.
From To Ft.
16. REMARKS:
Topographic/Land setting
❑Ridge B lope ❑Valley ❑Flan-,,:
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds) i ,_I _1 f',
Latitude/longitude source:❑GPS❑Topograpl,i, maf ---
(check box)
DEPTH DRILLING , OG
From To
¥' Ica 713
5as
Formation Description
ever P.A.Tdn.n
(zcan:te r—
O
c't�
m _..r,
w m �
rrt
0<
:sac
LOCATION SKETCH arri
Show direction and distance in miles from aeastg
two State Roads or County Roads. Include j roall
numbers and common road names. a a
z
cld' F<F1 KA
71
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUC 1 ED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
i ,13-t;,.eit 14 ttAAA J oA..•1pat / /3-04
SIGNATURE OF PERSON CONSVRUCTING 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
7

WILL CONSTRUCTION RE CORD 293107
North Carolina - Department of Envin nment and Natural Resources - Division )f Water Quality - Grourdwater Section
WELL CONTRACTOR (INDIVIDUAL) NA`1E (print) beeCt -x 1-11 _t3r CJ CERTIFICATION#_at n is
WELL CONTRACTOR COMPANY NAME e-N041& S',...,N Qco -a Soat-Stt.t4 Pine PHONE 9 (gC Cola-:cZ;t
STATE WELL CONSTRUCTION PERMIT; ASSOCIATED WQ PERMIT#
(if applicable) —(ifappl cahle ig
I. WELL USE (Check Applicable Bot): Residential (S/ Municipal/Public ❑ Industrial ❑ Agricul Ural ❑
Monitoring ❑ Recovery ❑ Hez t Pump Water Injection ❑ Other ❑ If Other, List Use
2. WELL LOCATION:
Nearest Town: CanMQt County f, Ai*, mitt if_
P;yey.). T \i \ u&'.St Qv s.ec \' Roc -a. QE'II6
(Street Name, Numbers, Community, Subdi ision, Lot No., Zip Code)
3. OWNER: ei-sccit (A.Suntc••,.
Address 30 r-spar. tnense,a)ii
(Street or Route No.)
Can ditc nC �0`1 f 5
City or Town State Zip Code
Area code- Phone number
4. DATE DRILLED \•3'cLt
5. -TOTAL DEPTH: `L S
6. DOES WELL REPLACE EXISTII' G WELL? YES ❑ NO p
7. STATIC WATER LEVEL Below 7 op of Casing: SO FT.
(Us : "+" if Above Top of Casing)
8. TOP OF CASING IS I T. Above Land Surface*
*Top of casing terminated at/or below lard surface requires a
variance in accordance with ISA NCAC :C .0118.
9. YIELD (gpm): _`i METH( D OF TEST iv
10. WATER ZONES (depth):
L+v,,.ccti toad
ER OM
TopograpWc/Land setting
[]Ridge LISlop: ❑Valey ❑Flat
(check appropriate b)x)
Latitude/longitude of well location
(degrees/minutes/sect ids)
Latitude, longitude source:❑GPS 7Topographic n ap
(check tox)
DE PTH CR[LLING LOG
From To Forr-lotion Descriptica
Al (aO _QVe< a
(to aos (7CUA �lZ
11. DISINFECTION: Type P.11a
12. CASING:
Depth Dian-eter
From +I To /n0 Ft. b y_
From To Ft.
From To Ft.
13. GROUT: Depth
From e To Ft.
M iterial
Amount S-
Wall Thickness
or Weight/Ft. Material
mod\ ?1aSi'C
From To Ft.
14. SCREEN: Depth Diame. ar
From To Ft. in.
From To Ft. in.
15. SAND/GRAVEL PACK:
Depth Siz , Material
Method
?auced
Slot Size Material
in.
in.
From To Ft.
From To Ft.
16. REMARKS:
LOCATION SKETI
Show di notion and distance in rr idsf,rai at (east
two Stat Roads or County Road ljaif¢lii the Foe'.
numbers and common road name;.
G
1 DO HEREBY CERTIFY THAT THIS WEr.L WAS CONSTRUCTED IN ACCORDAN2E WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND TEAT A COPY OF THIS RECORD HAS BEE? I PROVIDED TO THE WILL OWNER
ctrou cit itre.AA
SIGNATI IRE OF PERSON3rONSTRUCTING THE V ELL DATE
1�3oLA
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-1 REV. 07/2001

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) 'biker :e . 'kt&'t1c
WELL CONTRACTOR COMPANY NAME C 0640Z Settjtct `Son Mef\.r?tLM? .trtC
STATE WELL CONSTRUCTION PERMIT# ' ASSOCIATEDWQ PERMIT#
(if applicable)
(if applicable)
SQwl �e r•;,
293168
1. WELL USE (Check Applicable Box): Residential 1151 Municipal/Public ❑ Industrial 0 Agricultural ❑
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION:
Nearest Town: e,ct_i+atec County ...,\t,e
cc: aoo cza R.:ac%ada%t Lc*. V- t
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: S41i' '(o W Qr
Address P.^ t2s IG\4
(Street or Route No.)
Co.na\ec \ MC
City or Town State
() (0(05• $t�-t;
Area code- Phone number
4. DATE DRILLED \-\2-C`j
5. TOTAL DEPTH: 495
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO i
7. STATIC WATER LEVEL -Below Top ofCasing: la° FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS 1 FT. Above Land Surface*
*Top of casing terminated actor below land surface requires a
variance in accordance with 15A NCAC 2C .0118.
9. YIELD (gpm): 3 METHOD OF TEST (L d
10. WATER ZONES (depth):
a%t1t6
Zip Code
Topographic/Land setting
❑Ridge QSIope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map :.
(check box)
DRILLING LOG
Formation Description
DEPTH
From To
t \ "to
11. DISINFECTION: Type Qi\\S
12. CASING:
Depth Diameter
From tTo 72 Ft. (a y
Amount
Wall Thickness
or Weight/Ft.
a zt
Material
From To Ft.
From To Ft.
13. GROUT: Depth Material Method
From 0 To 2.0 Ft. Ceesa.t+ Po,,,c¢.d
From To Ft.
14. SCREEN: Depth Diameter Slot Size Material
From To Ft. in.
From To Ft. in.
15. SAND/GRAVEL PACK:
Depth Size Material
in.
in.
From To Ft.
From To Ft.
OVtt 9.0¢eclon
Gcis-et : tt
LOCATION SKETCH
Show direction and distance in miles from at (east
two State Roads or County Roads. Include the road
numbers and common road names.
0
t
r'l
IA
%0
3
0
IV
0
16. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
joss n�ch
Ft.atSJ. 1.11-04
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
CERTIFICAACT..,,II,ON# 243fo
PHONE # ( 2g (ofa5-rRon
J
0
0 0
cam
o
rn
0
ri\
0
1,1
ni
r1
ti
0
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Ceenterl RREVgh, C
27699-1636 Phone No. [phone], within 30 days.

293163
WELL CONTRACTOR (INDIVIDUAL) NA 4E (print) bESK`•Clt 14L"?
WELL CONTRACTOR COMPANY NAME Q" M '�SLJyQCO 'a .C.�ti,%fha Pine
STATE. WELL CONSTRUCTION PERMIT.' OO ASSOCIATED WQ PERMIT#
(if applicable) -ilk - (if eon] cable)
1. WELL USE (Check Applicable Boa: Residential 13341 Municipal/Public ❑ Industrial 0 Agricuh. oral ❑
Monitoring 0 Recovery 0 Hea : Pump Water Injection 0 Other 0 If Other, List Use
WELL CONSTRUCTION RECORD
North Carolina - Department of Envirc nment and Natural Resources - Division rf Water Quality - Grour dwater Section
CERTPICATION#_ t '31.0
PHONE 4 (doS- LG22_
2. WELL LOCATION:
Nearest Town: ul4 vr_rd. \\€— County
r. (.\Q.nn E tLYz7 Loth \Ra
(Street Name. Numbers, Community. Subdi ision. Lot No., Zip Code)
3. OWNER: S'-Ln 1-1+o resS
Address "9 (. it" ^ Lst'••\c5
(Street or Route No.)
Ear&nact1.4 .ttt CSC_ 3.taies
City or Town State Zip Code
(C:RE)- `71 1io
Area code- Phone number
4. DATE DRILLED t- \b"�'t
5. -TOTAL DEPTH: Se L
6. DOES WELL REPLACE EXISTIB`
7. STATIC WATER LEVEL Below 1
(U,
8. TOP OF CASING IS t
*Top of casing terminated at/or below lat
variance in accordance with I5A NCAC -
9. YIELD (gpm): 14, METH(
10. WATER ZONES (depth):
G WELL? YES 0 NO 121
op of Casing: 3t3D FT.
"+" if Above Top of Casing)
'T. Above Land Surface*
d surface requires a
C .0118.
D OF TEST
Topograph.c/Land setting
1]Ridge C lope ❑Valey ❑Flat
(check appropriate b )x)
Latitude/longitude of will location
ri
(degrees/minutes/sec( ids)
Latitude, longitude source:❑GPS7Topographie rn. ap
(check 1 ox)
DE'TH E RILLING LOG
From To ForrtationDescrirtic
;\ cc' U*CC eNac6.5
_7L `S L C -c‘i
11. DISINFECTION: Type ¶ .ttS
12. CASING:
Depth Dian eter
From i-\ To ace, Ft ie.;
From To Ft.
From To Ft.
13. GROUT: Depth Material
From c To 2O Ft. (tnie n t
From To Ft.
14. SCREEN: Dcpth Diame! ar Slot Size Material
From To Ft. in. in.
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Siz Material
Amount F
Wall Thickness
or Weight/Ft.
2t
Material
P IcySF.(1,
Method
.( d.
From To Ft.
From To Ft.
LOCATION SKETCH i`^=.'; N
Show di -ection and distance in tr.°les from at least
two Slat : Roads or Cour.ty Road:. Inched -et roa
number: and common rcad name;.
Ir
CO
m
CO
A
O
fN3
0
16. REMARKS:
I DO HEREBY CERTIFY THAT THIS WE.L WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND TEAT A COPY OF THIS RECORD HAS BEEI I PROVIDED TC THE WI LL OWNER
Last .1 1-14-c�:
SIGNATI IRE OF PERS1ON CONSTRUCTING THE V ELL DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center -Raleigh, NC
27699-1636 Phone No. [phone], wit hin 30 days. GW-1 REV. 07/2001
I l_ _.7 i{

From: Carolina Null Enders. Inc To: NC Dept of Env. and Na Resour
Date: 2.6612004 Time: S.3e.:22 PM Page 1 of 4
293116
WELL CONSTRUCTION RECORD
North Carolina ).- upanment of Environment, and Natural Resources - Division of Pi 1t Q :iity Ground water S ctioi
WELL coNTRvCTOR (INDIVIDUAL) NAME (print) SCOTT CANTT CERTIFICATION 82=84
WELL CONTRACTOR COMPANY NAME CAROLINA WELL DRILLERS, INC. PHONE # (734) 434-'7277
STATE WELL CONSTRUCTION PERMIT # ASSOCIATED WQ PERMIT #
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box) : Residential © Municipai ❑ Industrial ❑ AOicuitural ❑ Mon trying ❑
Recovery ❑ Heat Pump Water Injection ❑ Other ❑ if Other, List Use.
t WELL LOCA1
Nearest Mom: F.•,i2 iEtt- County BUNCOMBE
LOT5 WHITA IG.2 d:Tcn TRI.
Topcm-apline Land setting
❑ lodge E Siono ❑ Valley ❑ F of
ihitTiThidd Lor.Riritcche of well loca&n
(Street Name, N.:r o a:. ttle:nrmney. Subdivision, Lot No,. Zip Code)
3. OWNER HICK") X NUT DEVELOPMENT CORP taegees/;nit:a.'seccnds:
ADDRESS FOB 276 Latitude;ongirude source: CPS ❑ Topographic map
St ... -. tn.::e Na.) EVETH DR'LLING LOG
LAKE Li ill E NC 2dC74.5 From To Formation Doosonp`:on
City or Town State Zip Code 0 Clay
528-625-0866
Consolidated Rock
Area Code - Phone i.. me
4 DATE DRILLED I __ 01
5. TOTAL DEPTH
H
6. DOES WELL REPLACE EXISTING WELL?
7_ STATIC WATER I.FAT", Peloo Top of Casing
YES ❑ NO `i
150 FT.
Cisc "*" If Above Tcp of Cuing)
8. TOP OF CASING IS 7 FT. Above Land Surface*
'Top ofcasing ttnxunucd +. w lm.ovafacercquir avan.auem
accordance with 15A NCA.:'
C
0 S
}
CP
'1
rTt c e'a
cm
z
9. Y1ELD (gymP. - METHOD OF TEST ARDM --I h
a.<
lo. WATER ZONES!E-pDO
:_ 520 Ta —I-,u. DISINFECT:OS. C=E H.0OCI-ILORITE Amount 20 c LCJCATIDCs;CTCH 3 �m
❑_ CASING: -
Wall Thickness S he v * d :'Co and dssta_nce C. miles from at least 0 Nz
n
Gep;;, Diameter or Weight/FL Material two Star Roads or County Routh Inciude the road Ca --+
From 0 To 75 Et. 6 114 " SDR 21 PVC numbers and common road nuns. 0 co
13. GROUr:
Dr
14. SCREEN
Retch
From NA
Material Method
GRAVEL MIX GRAVITY
Diameter Slot Size Material
in.
15. SAND/GRAVEL Fe CB
Daptl: Size Material
From NA Ft,
16. REMLARKS.
HWI, 74
VILLAGE RD
\VHI AK ER
/ VIEW T-t<L
WHITAKER
G. RREN !w
I DO HEREBY 1 Trr=AT THIS WELL WAS CONSTRUCTED IN ACCORDANCE t k...te ELL
CONSTRUCTI/3:v STANDARDS, AND THAT COPY OF THIS RECORD HAS BEEN PRtiViLl VD TO LO V Lk OWNER
SIGNATUREOF PERSONCONSIRLCTINCI Ti If VOL..
2s;.34
Dam
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.
r
N>
cm
0
. IPC
jl

x
IN 4-
�_ L
WELL CONSTRUCTION RECORD
92475
North Carolina - Department of Environment and U•hei Resources -^ D_ivision of Water Quality - Groundwater Section
tv
WELL CONTRACTOR (INDIVIDUAL) NAME (pries) 1L L1aIBC CERTIPICATION/ ail J
WELLCONTRACTOR COMPANY NAME_RF.UBEN CALDWELL DRILLING, INC. rtrone11%8 )254-3581.�,
STATE WELL CONSTRUCTION PERM IT/ ASSOCIATED WQ PERMIT/
(if applicable)
(if applicable)
1. WELL USE (Check Applicable Box): Residential l ' Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other f Other, List Use
2. WELL LOCATI9N: Nearest Town: I\Le/A rU O t R county Runi c° erkiS G
(Street Name, Numben, Community, Subdivision, Lot No., Zip Cede)
3. OWNER: tl1i IC 121oGe aAP-TnsI Cl\u2et�1 (degrees/minutes/seconds)
Address 3 Y:1 A-t-ItaT 14 ILL. K-c Arlo Latitude/longitude source:❑GPS❑Topographicmap
AlkiANo>3R. or oc- arc° ( DE tee«DRI
(tca�EityorTow State ZipCode pRtionDesLING LOG
r b S - o b l- (, From To / Fort/b inonnDescriptio
Area code- Phone number / �a , — I 0 a o �1 r-er;D �i
4. DATE DRILLED I! I a/o4- Ito ' 6 CGS M
5. TOTAL DEPTH: 3 \ o /
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO IW j 1 e� a oo (� G-t
7. STATIC WATER LEVEL Below Top of Casing: (2 O FT. a-oc -3 i O " (., GLA 0 tT�
`r' if Above Top of Cuing)
8. TOP OF CASING 1S -1 ma FT. Above Land Surfaces
*Top ofcuiaa terminated at/or below Iced surface requires a ? r''
variance la accordance with ISA NCAC 2C.0111. tG p - y-?T
9. YIELD (gpm): 1 t METHOD 9F TEST 1-fl 1 C- C� J
10. WATER ZONES (depth): 110 - () ' 0 err C
200 /- 4- GY M
11. DISINFECTION: Type NtN ao`7vAmount 1- 1 IS) -
12. CASING: Wall Thickness
Depth ter or Weight/Ft. Material numbers and common mad runes.
From £ To K I FLU '' sc S Otort ei/C,CA
From. To Ft.
From To Ft.
13. GROUT: Depth t�jjterial ()Method
From 1 To ab Ft. C'�M�fJ' Ile. tteD
From To Ft.
14. SCREEN: Depth Diameter Slot Size . Material
From To Ft. in. in. rtiNi HILL pis N W 7
From To Ft. in. in. /�
15. SAND/GRAVEL PACK: 2.5 m a5 a
Depth Size Material
From To Ft.
From To Ft.
Topographic/Land setting ,-
❑Ridge ❑Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
LOCATION SKETCH o �m
Show direction and distance in miles from at lea$rc
two State Roads or County Roads. includtale rd
m
rnz
Ca -+
F� o
oPtT-R ten
M.-
16. REMARKS:
1 DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 1 SA NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT ACOPY FTHIS RECOHAS BEEN PROVIDEJ) TO T WE Lj.OWNER
1
SIGNATURE OF PERSON CONSTRUCTING THE WELL / DA
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mall Service Center -Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-1 REV. 07/2001

3. OWNER:
Address
�c�1TVT
i I II r, r
9?477
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and natural sources -Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (prim)IL-�-I �. •^r.i�SI" CERTIFICATION a��I
WELL CONTRACTOR COMPANY NAME _REUBEN CALDWELL DRILLING, INC. PHONEY2f8 1254-3581_
STATE WELL CONSTRUCTION PERMIT/ ASSOCIATED WQ PERMIT,/1
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential Ei/ Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATIQN•
Nearest Town:
tJAI.ER County "k7uNcoon6e-
A)/1.0g- IA-'Tri
(Street Name, Numbers,, Community, Subdivision, Inc No.• Zip Code)
E FF I�(tNOL-.D
S 5 5. I N D eu CoV11✓ R4 AD
�ANDLEy2 NLeNo.)
ag'I 15
City or Town Stan Zip Code
(sa8)- 4 6- 5 a 5 3
Are. coda Phone number /
4. DATE DRILLED I / ((� l 0 4
5. TOTAL DEPTH: 3 30 - /
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO C1
7. STATIC WATER LEVEL Below Top of Casing: 6 O FT.
(Uu "rat Above Top ercuins)
8. TOP OF CASING IS J- FT. Above Land Surface*
Top of easing lermloe/ed at/or below laud sorfaee requires a
variance la accord aace ISA NCAC 2C.0110.
9. YIELD (gpm): ( -3 METHOD 9F TEST le1 G -- A l 2
10. WATER ZONES (depth): t-c0 •— 1 rj CG P n-..
11. DISINFECTION: Type F-1TN go"ro Amount Va lb,
12. CASING: Wall Thickness
I Depth ter or Weight/Ft.aterial
From -1- To (b0 FL 617V S Dga1 V G
From To Ft.
From To Ft.
13. GROUT; Depth Material
From 1 To aJ Ft. C MEaT eouReb
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 Sire Material
From To Ft.
From To Ft.
Topographic/Land setting
❑Ridge ❑Slope ❑Valley eVlat
(check appropriate box)
Latitude/longitude of well location
I'-) 35° 04..a9' o8a°4a,cba'
(eteaw/mleuled.econds)
Latitude/longitude source:❑GPS❑Topographic reap
(check box)
DRILLING LOCr
Fomytion Description
W2or/J
0 i/ore L,)r{ 1Tr, 'tax_
l� l er-
co2fiNictal e2-AL
Dliali
From To
1 ISS
I55'- Zco
too
70o '-- 33c'
c
C.
u
Z cm
LOCATION SKETCH 06
Show direction and distance in miles fi-omcil least o
two State Roads or County Roads. Include4e
numbers and common road names. ter^
)
I
Da(pWOOD
3 r
ram,)
NZ
rri
e-)�
-i
G
4"a NILL
a
16. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED M ACCORDANCE WITH ISA NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
V klc\/IA--
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mall Service Center- Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-1 REV. 07/2001

292482
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and natural sources - Diviissiion of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) -.CJ'f 1 CCRTIFICATIONS all
WELL CONTRACTOR COMPANY NAME_ REUBEN CALDWELL DRILLIN , INC
STATE WELL CONSTRUCTION PERMITS - ASOCIATED WQ PERMrrs
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential 67' MunicipaVPublic 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION: pp
Nearest Town: (r3gA J8*) 1 I-Lt5 County &e.) Go (n e-
A K-e Ana
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
' PRONe448 1254-3581
3. OWNER:
Address S 6 o l-at3 P t aJ e 1(1_0 A c
t.JgAJtIONI\\-I.- r p3C. ag 1$1
City or Town State Zip Code
any- b 4 c) -- 4 6 ga
Area cods Phone cumber //
4. DATE DRILLED \'lo d*
5 TOTAL DEPTH 2-10
ter
FL R
From To Ft.
From To Ft.
13. GROUT: Depth
From 3- To ao Ft.
'
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO IH/
7. STATIC WATER LEVEL Below Top ofCasing:
se.-6,0 FT.
(Use "' if Above Top of Caring)
8. TOP OF CASING IS a FT. Above Land Surfaces
Top of cuing Iermloated atfor below had surface requires a
variance In accordance with ISA NCAC 2C .013-11.
9. YIELD (gpm): p METHOD O. F TEST A G - A I
10. WATER ZONES (depth): R 30 3 b C� e CC
11. DISINFECTION: Type i,Trl St. `T m Aount '4- I b -
12. CASING: Wall Thickness
Depth or Weight/Ft. Material
°
From ± To I I a %"i` Spea1 pvc,
Material
C�M�NT
From To Ft.
14. SCREEN: Depth Diameter
From - To Ft in.
From To Ft. in.
15. SAND/- GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft
P Method ee
DU
Slot Sire . Material
in.
in.
16. REMARKS:
Topeg�pphic/Land setting
❑Ridge faSlope ❑Valley ❑Flat
(check appropriate box)
!Attitude/longitude of well location
(depeeshnimstes/secoods)
Latitude/longitude source:❑GPS❑Topographic trap
(check box)
DRILLING LOC
Formation DescriptioQn
GQA c 9-m3kre
wad ‘tm (I-oc-IZ-
a30' 3o (,pnv•
c,J iTrs (LocIL)GRA'6RArir
DEPTH
From r To /
ID 1
10( r- Sam
3:20"-a ion
a3o-
F
m
e
c-.
Z C/I
rn
W o<
LOCATION SKETCH o
Show direction and distance in miles front lea.o
two State Roads or County Roads. Include a rog5C"
numbers and common mad names. ••
/ UeW
SvL 01 (etallon/
Adler°
(Loath
yBn
<t3 tt cAJ
3 ocK A8
a„--
2w, e t//-f
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED 1N ACCORDANCE Wim ISA NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT OP.Y OF THIS RF,CQI HAS BEEN PROVIDED TO W)®OWNER
SIGNATURE OF PERSON CONSTRUCTING THE WELL
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mall Service Center -Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-1 REV. 07/2001

WELL CONSTRUCTION
�_'_' I'— �I
18
L
REDO? " --
2483
North Carolina - Department of Environment and Natural Resources - Diivisio\\n of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (prang) IS) LL��
t e AS44 CERTIFICATION N 4111
1
WELL CONTRACTOR COMPANY NAME_RF.UBEN CALDWELL DRILLING, INC. PHONE(leg 54-35131
STATE WELL CONSTRUCTION PERMIT/ ASSOCIATED WQ PERMIT/ I
(if applicable)
(if applicable)
1. WELL USE (Check Applicable Box): Residential I7 MunicipaVPublic 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION: n
Nearest Town: gP� (ZJ(L� countyd�acpr(;g
1 I I Pnro
(Street Name, Numbcn(n,�Canmuniry, Sul}((l��ivirion, Ld11No., Zip Code)
3. OWNER: Rob* ts24Wr)
Address I% O I.D e f it. (coA 0
(Such or Raw )
Wa A J t f•-•5\ r- CNo.DA 1 X `T
Arta code- Phone number
4. DATE DRILLED
5. TOTAL DEPTH: VI O /
City w Town State Zip Code
(` 5� - k4S
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO
7. STATIC WATER LEVEL Below Top of Casing: 0 FT.
(Use `+' if Above Top of Casing)
8. TOP OF CASING IS FT. Above Land Surfaces
*Top of casing termloated at/or below laud surface requires •
mince In accordance with ISA NCAC IC.011S. pp�
9. YIELD (gpm): o2O METHOD QF TEST RIG - A I R-
Topogr ic/Land setting
❑Ridge [Slope ❑Valley 0Flat
(check appropriate box)
Latitude/longitude of well location
(degree Mntauta//secoodr)
Latitude/Iongitude source:❑GPS❑Topographic nap
(chock box)
DRILLING LOG
Formation Description,
Io (Jrn-&)a
(mu r zsitA Lg
DEPTH
From / To 4 /
—
`t4` — `to'
4b' e la
oo' IAt
10.WATER ZONES (depth)• 90 —
Tb G P r'n
11. DISINFECTION: Type �TN Ct0°7 Amount
12. CASING:
Depth
From a. To MI
r
Ft. hi
From To Ft.
From To FL
13. GROUTia Depth Material Method
m Fro1 To a Ft. 0E1M tYT Pone r
From To Ft.
14. SCREEN: Depth Diameter Slot Size . Material
Front To Ft. in. in.
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Size Material
Wall Thickness
From To Ft.
From To Ft.
16. REMARKS:
I DO HEREBY CERTIFYTHAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH ISA NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COP THIS RECORD WAS BEEN PROVIDED TO T1.L OWNER
tl
Gr>n--)
W.Y4 tie- 6'or-4'
G fLn �iZAtaiTb
r o
r__z
Sae u,..t
= c;;
Ca o<
LOCATION SKETCR o vc
Show direction and distance in miles from t leash
two State Roads or County Roads. Includefte roo
numbers and common road names. ce? rna
W --+
F o
z
S0i(. 1JISio(J
Iv 190 diocI<
fi-
SIGNATURE OF PERSON CONSTRUCTING THE WELL
DA
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mall Service Center -Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-1 REV. 07/2001

"'I
From To
14. SCREEN: Depth Diameter
From To Ft. in
From To Ft. in.
15. SAND/GRAVEL PACK:
Depth
From To Ft. p �-4 n o KeQ S G A 9
i
292484
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and *tetural Resources -Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (prim) C4 ^ A5a CLRTIPICATIONa a�I1
WELL CONTRACTOR COMPANY NAME _REUBEN CALDWELL DRILLING, INC. PHONEilia ,�.54-3581r
STATE WELL CONSTRUCTION PERMrrI ASSOCIATED WQ PERMITS
(if applicable)
(if applicable)
1. WELL USE (Check Applicable Box): Residential Or/Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION:
Nearest Town: C AAA 1 IL County goA)cornet
kbl (2,to(De,estol_e -i n
(Street Nune, Numbers, Community, Subdivision, tat No., Zip Code)
3. OWNER:
f)'Gga '%A No Str3
Address 16 1 R1DCE OA Le (Z.oAI�
(Street or Route No.)
C 9-5015
City or Town Sine Zip Code
(81S'} lgb5--15`12
Alai code- Pion number
4. DATE DRILLED \ / 1 4 C
5. TOTAL DEPTH: 3 o i
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO ❑
7. STATIC WATER LEVEL Below Top of Casing: 4-0 FT.
(Use `a' If Above Top of Casing)
8. TOP OF CASING IS -1 FT. Above Land Surface*
*Top analog terminated attor below Ind swine requires •
vial ant is accordance with ISA NCAC 2C .011S.
9. YIELD (gpm): (c' METHOD OFJEST �1 G - A 1 k
10. WATER ZONES (depth): e ,a a 6 G Pry-,
11. DISINFECTION: Type
12. CASING:
Depth
From 4- To
From To
From To
13. GROUT,. Depth
Frorn To az,
Ft.
Slot Size Material
in.
in.
G o"fo Amount
Wall trua.cnw
ter or Weight/Ft. Material
FL �1 B So2aI 'PJC
Ft.
Ft.
Material n Method
Ft. C6PAE10i Cout.e b
Topographic/Land setting
❑Ridge ❑Slope ❑Valley HFlat
(may appropriate box)
Latitude/longitude of well location
(deDttern mnu/secaodi
Latitude/longitude source:❑GPS❑Topographic map
(check boa)
DRILLING LOG
DEPTH
From / To
J t5
-(5'- !�
Ian
aa3O'
Foion Description
b'J -G2r5 vfo e
(,ftnu i T4,/c.Lr(ITe IZGL
6 er .
Ca,2ta�l 02a+-fit i �
9
r_
LOCATION SKETCH pn
Show direction and distance in miles from at leag�°
two State Roads or County Roads. Includge rtikEi
nv..,LCrs and commons strati names. tTl
C,5 ut z
c->
co V'
From To
Size Material
1
02- M
16. REMARKS:
1 DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH ISA NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THA COPY
THIS/
IS j(ECORD HAS BEEN PROVIDED TO THE LL OWNER
1/ \150
SIGNATURE OF PERSON CONSTRUCTING THE WELL
Ft.
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mall Service Center -Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-1 REV. 07/2001

WELL CONSTRUCTION RECORD
North (Thelma - Ueparunenl rf 1 n iron,nent and Natural Resources - Div nn of Water Quality - Groundwater Section
WFI.I li 114U'l OR t1\ul\ !DI M.I \\ M///E}}((��_Dn��_nr/__11.4150,(Yu �y ly CERTIFICATION d-
'O "ELI. (N I R U'TIIH C O\IPA\1\ u1E "� Ny'-'Y•r-'- _ Q.{µ�l(.��� PHONE.
l I IIW EI I. C U\1I441. ( I ION 1'ERht[1a - - ASSOCIATED WO PERMIT
r. t ::pad iathl•; _...-....__ _
293087
\\ h.LL USE tClhcck .\ppheabic Box,. Residential P-41uricipal'Public U Industrfa! 0 Azricuttural 0
.Lmildrin: C.i Recover' 0 Heat Pump Wafer Injection 0 Odic! 0 If Oilicr. List Use
2 N ill. 1. LOCATION"
CV
Ken. ('nr,',j. ,Sul+4tri; eta Lot S. !, •.I Cralct GO7
, It1\NI:R pp_
hs., .AJ,v- .iJ�--�� 11..
Zip Code
•.,_. ,. _lc her r _ r
TOTAL DEPTH.-�----___--- /
b. DOL:S WELL REPLACE EXISTING WELL' YF�.La NO [�
NIA1 if: WATER LE VFL Berow Top of C'using:
`` IO,e.a' A Ahcn t op of f Anng,
r. it )P OF CASING IS--_L f T. Above Land Surface•—
'Ltp or easing Iern )nand silos below hind surface rtqulre+ s-----------
sariauce In accordsnct with 15A NCAC 2(. .011d.
�+ YI I?LD! cprrti. .L L METHOD OF TEST ZY1- LQt4i -
'lr \\A FER ZONLS (depth): 11
iI. DISINFECTION.Type fAtp _-'Q,--_-.-A—
Imount
2 CASING Wall Thickness
Drpth D:amcter or Weght1 r Muter el
To_D- Ft ------ -- ---
Topogra Land setting
❑Ridge lope °Valley OFlut
:check arrentnn.ae box
Latiludrh:ngitudc of well location
Luliun},: L.rnguude swl:c Oil SDTopoui with: roan
-ao:k Kitt;
Uh:'FH QEILLINGX LC)C
From To Formation L) srditi c1c
Frrll„ -r„ FI.
13 (iR(ll_ ( Lit pill Materi t Art
Metros
r
-
ter t. r'� Tr, Ft '
I-; :xr_Rf EN :3,^rift L71nuR1er A•i \Z, AlalerLl
hrort in
-..— YI _ ire.
Erom_ ...T��_.. Ft _In to
I5 SANO C,RA\'EL PACK:
Ocr'n S 7e .Maternal
i son To FI
EtonIn _ . 11
VII on
>o
_._an --
a 1=1
T.—eP
N '1
— o
LOCATIQN SKFTC11
Show dir,,c lion and distance in miles from ;e lea.,t
Iwo State Roads or County Roads. include the road
numbers and coop -non road names.
K_ 'etc d --
ire RI:SI.\AKs: ..-----......— - _
! t)C Ht irl u--Cfil: t' THA THIS WELL W AS CI its SIRL''(''I ED IN AC CORD.AS(E WITH I5A 1' AC 2C HELL
uvSFP+1 f � fANUARU . AND TH AT A COP)' OF PHIS RECORD HAS Bbh`. PROVIDED TO T HE WELL QsdCiER
SIUNATUI<L Of- rtl<SUN r O%STI(1,cTING THL WLLL DATL
Submit the original the Dis ision of Water Quality, Groundwater Section. 1636 Mail Scrsrce ( enter - Raleigh, \(.
27641i-Ibl0 fhnne NO, 1919) 733-3221. within 30 dal s. :,W-1 REV. 07 2001

296521
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and *rahlral Resources:4,Division of War Quality - Groundwater Section
nu, CONTRACTOR
TRACTOR (INDIVIDUAL) NAME Whit) 6(ti. ,V 66,{v CERTIFICATION a p(7'
WELL CONTRACTOR COMPANY NAME RF.UHEN CALDWELL DRILLING, INC. Q 8 �i54-3581 PHONEY
STATE WELL CONSTRUCIlO .PERMITI ASSOCIATED WQ PERMIT'
(if applicable)
id'
/ (if applicable)
1. WELL USE (Check Applicable Box): Residential C7 Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATIO
Nearest Town. ' w�ej Count, 1tp10ate
(Street Name, Number, Cornmuni Subdivision, bet No, Yip Codc)
3. OWNER: i,, A�
Address Q D C° sf �gO
�j—or Row.77 t— 4.3
City For' Town State Zip Code
asis 7 77 - 3o f3
Arca coda Phone number
4. DATE DRILLED A/�O
5. TOTAL DEPTH: /p5
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO
7. STATIC WATER LEVEL Below Top of Cuing: 7 7 FT.
(Use -r' If Above Top of Carina)
8. TOP OF CASING IS / FT. Above Land Surface*
•Top of win lermlaaled at/or below Iced mist/ require. a
variance le atcerdance whb ISA NCAC 1C .0111.
9. YIELD (gpm): 6 METHOD OF TEST
10. WATER ZONES (depth). 0--,--- <f
.-10 6 2
11. DISINFECTION: Type n�. $b Amount 1 I b
12. CASING: Wall Thickness
Depth tYor ngh)/FL Material � To b FL rr�j-( /l1a-
From To Ft.
Pions__ To FL
13. GROUT: Depth Material
From (0 To ' 0 FL reareee
From To Ft.
14. SCREEN: Depth Diarneter
From To Ft. in.
From To Ft. in
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
16. REMARKS:
Topographic/Land setting
❑Ridge ❑Slope galley ❑Flat
(duet appropriate box)
Latitude/longitude of well location
(dearecehilaure aecoodr)
Latitude/longitude source:❑GPS❑Topographic map
(check boa)
DRILLING ILOQ
Lion Descnptlon
DEPTU
From To
/a'2— 4'C
re' r 44
Fo
LOCATION SKETCH
Show direction and distance in miles from 'Fast cm
two State Roads or County Roads. Include thcsoad^S=
numbers and common road names. (.3
Slot Sire . Material
in.
in.
I DO HEREBY CERTIFY THAT THIS WELL, WAS CONSTRUCTED IN ACCORDANCE WITH ISA NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY THIS RECORD HAS BEEN PROVIDED TO THE WE JLL OWNE
SIGNATURE OF ' RSON CONSTRUCTING THE WELL
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mall Service Center - Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-1 REV. 07/2001
2.-( eft

296533
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and manual Resources:. yDivision of Water Quality - Groundwater Section
r" c'7 a't - CLRTIPICATION / �'t Z /
WELL CONTRACTOR (INDIVIDUAL) NAME (print)
WELL CONTRACTOR COMPANY NAME_RF.UBEN CALDWELL DRILLING, INC. PHONL11%8 )254-3581
STATE WELL CONSTRUCTION PERMIT/
(if applicable) d
ASSOCIATED WQ PERMIT/
(if applicable)
I. WELL USE (Check Applicable Box): Residential 13' Munieipal/Public 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery ❑ Heat Pump Water injection 0 Other 0 If Other, List Use
2. WELL LOCATION: y LAN .Topographic/Land setting
Nearest Town: S K County p�
L` fit l CA r3e �,� f sign ❑Slope ❑Valley ❑Flat
(oleck appropriate box)
(Street Name, Number, Canmueily, Subdivision, Loi No. Zip Code) _ Latitude/longitude of well location
3. OWNER .S�� dd�y
Address t 14.Atzt16A �'T2EL
CAI .SoZ V I l.R.e Na.^"' a -1 3Cl
Sky or Town Slaw Zip Code
( )- (19z3—\S
Arai code- Pbona number
4. DATE DRILLED 4- /a 3 /°
5. TOTAL DEPTH: 6 3 0
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO 1➢
7. STATIC WATER LEVEL Below Top of Casing: `1c 0 FT.
(Um'V' if Above Top of Casing)
8. TOP OF CASING IS FT. Above Land Surface•
Top of cuing handseled actor belay had entice requires a
valance 1a accerdeare with ISA NCAC 2C.0111. nn
9. YIELD (gpm): -] METHOD OF TEST /tt G ' At IL
10. WATER ZONES (depth): 605 ' -- .-i 0 en-)
1 I. DISINFECTION: Type t4 i H ci 0 e'j. Amount i b
12. CASING: Wall Thickness
Depth Qy ter or Wa t/Fi.
From - To ba FL o i % /i S s L
(degresahaiattulaereede)
Latitude/longitude source:❑GPS❑Topographic map
(check boa)
DEPTH
` F.4_ j 61 Orom To o gtlpzug- obrti-3
`6.? '-- Co cs ." V(L.i-rota-CE
6c5 ' c;crvrcc- -Cr Geo.
Ca 2 yy ,—a 0-- --
rr
o5'— 63c
From To Ft.
Fiom To Ft.
1"V(-
13. GROUT: Depth Material Mcel�boodq
Fronk__ _ To c2.c Ft. C_e mc5N T P% cat
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:
6`evl—LS 6AP .
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, ANDThAn% COPY OF mis RC0RD HAS BEEN PROVIDED TOTHE WELL OWNER
N
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common road names.
1e
f2•1V e,2
CA.Ye
C - 4- at / o46--
SIGNATURE OF PERSON CONSTRt)CTINO THE WELL DA
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mall Service Center -Raleigh, NC -
27699-1636Phone No. [phone],within 30days. GW-I REV. 07/2001
sa

12. CASING.
, Depth
From i To Ci O FL
From To Ft �—
From To FL
13. GROUT: Depth Material , Method
From -I-- To a1/4-O FL C€ Me,.YT Po U(Le er
From To Ft.
14. SCREEN: Depth Diameter Slot Size . Material
From To FL in. in.
From To Ft. in in.
15. SAND/GRAVEL PACK:
Depth Sias Material
From To Ft.
From To Ft.
296532
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and u+tural QResourea -Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAM C (pnel) 'J ILL Ir& /1/45AS+4
WELL CONTRACTOR COMPANY NAME_ r�
REUBEN CALDWELL DRILLING, INC. CERT7rtCATIONa ail
PHONE
Y�(8 \254-3581
STATE WELL. CONSTRUCTION PERMIT/
(if applicable) • ASSOCIATED WQ PERMIT/
(if applicable)
I. WELL USE (Check Applicable Box): Residential p" Municipal/Public 0 Industrial 0 Agricultural CI
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION:
Nearest Town: W(sAdeRv ILLS County
t_I N't 14tt_`. (LoAO
(Street Name, Numben, Community, Subdivision, La No, Zip Code)
Bwro ccfne3C
3.OWNER: M\L<JCLLB" 114on..pSoy�
Address a33.3 w \Ls o.s cb(L\ /e
I\ 5 ticq i Lt,0`sneet NCNB' a e 66
City or Town Stag Zip Code
rta `6)- aSS — o 0 -
Ara code. Phone number
4. DATE DRILLED 4 �a6'64-
5. TOTAL DEPTH: aim'
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO Y]
7. STATIC WATER LEVEL Below Top of Casing: to 0 FT.
8. TOP OF CASING IS (Use -+" IfAbovc Top of Casing)
FT. Above Land Surface*
'Top of casing lermloated actor below land serrate requires a
variance In accordance wllb ISA NCAC 2C.a11a.
9. YIELD (gpm): IS METFJOD pF TEST Q-A 6- A 1
10. WATER ZONES (depth): \ (jcb _ I05 G P r v
11. DISINFECTION: Type tyTN c{ D lb Amount Ab -
Wall Thlckneu unty Roads. include the road
ter or Weight/Ft. Micah! m
numbers and comon road n�rttes.
SDtaJ PC. t't A( N(LL (Lalaj)
Topographic/Land setting 7/
ORidge OSlope ❑Valley LTFIat
(deck appropriate box)
Latitude/longitude of well location
(devectnlaaa aceass)
Latitude/longitude source:OGPSOTopographic map
(check box)
p8prg
Fromr DRILLING LOQ
To / Formation Description,
S eV13figU2Let
k 5— i b o' G ILA ri—C
cg-€Jtcc., )S GPrn
\6o am( GRA/ G' r),vts
(�2
n rnG
16. REMARKS:
LOCATIONSKETCIJ •— M.")Show direction and distance in miles from at legtwo State Roads or Co
S J p I Ter 0- RAID
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH ISA NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COP OF THIS RECO HAS BEEN PROVIDED TO FHE WILL OWNER
SIGNATURE OF PERSON CONSTRUCTING THE WELL
DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mall Service Center -Raleigh, NO 27699-1636 Phone No. [phone], within 30 days.
G W-I REV. 07/2001

WELL CONSTRUCTION RECORD
North Carolina - De rtme f E
pa nt o nvirotunrnt and u+turAl Resoces
WELL CONTRACTOR (INDIVIDUAL) NAME (prim) v ur
�t-4\�
WELL CONTRACTOR COMPANY NAME_RF.USEN CALDWELL
STATE WELL. CONSTRUCTION PERMIT/
(if applicable) a
296531
- Division of Water t Qtta1'ry -Groundwater Section
CERTIFICATION / a-11 I
• PHONE[phone]
iJ ASi4
DRILLING,
INC
ASSOCIATED WQ PERMIT/
(ifapplicable)
1. WELL USE (Check Applicable Box): Residential ®' Municipal/Public 0 Industrial 0 Agricultural O
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATIfQ N:
Nearest Town: kSNG.hM&j SV 1 LLC County $1)r3c0rrt&
FAt(Lwr,oy 5--700-4,6 Sv(bb'' S)oN
(Street Name, Number, Community. Subdivision, ]et No. Yip Code)
3. OWNER: (1--1/4CE
Address ,Lo Con)c, J C(L%?&R
(SUM Of Roues No.)
ARJ1u2pSJILLC NC 'o�p
piDC(
City or To Slate 21p Code
(g1V)- - 3 8 6 4
Area code- Poona number
4. DATE DRILLED 41 sack I0
S. TOTAL DEPTH: a.-10 /
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO le
7. STATIC WATER LEVEL Below Top of Casing: •"f` FT.
A Nu `a"' ItAbovc Top of Cuing)
8. TOP OF CASING IS 1 FT. Above Land Surface*
*Top of cuing Itrmloettd at/or below had antics I./yarn a
variance In accordance with ISA NCAC IC.011 a.
9. YIELD (gpm): 3 O METH D Of TEST 9-‘6 P 1 2
I0. WATER ZONES (depth): 6( d,0 - 3 G en,
11. DISINFECTION: Type *IA R0"Vo Amount %a- 1 k,
12. CASING:
ter
From � Depth To ISa Ft.
From To Ft.
From To FL
13. GROUT; Depth Material
From 1 To a 0 Ft. CFs mean
From To Ft.
14. SCREEN: Depth Diameter Slot Size . Materiel
From To Ft. in. in.
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
Wall Thickness
or Weizhlift. Material
Alb' S1eeF-
Method
16. REMARKS:
Topographic/Land setting
❑Ridge ❑Slope ❑Valley ❑f•l t
(cheek apptaprime Ewa)
Latitude/longitude of well location
(degren/mimrtdceeoods)
Latitude/longitude source:❑GPS❑TopograP(tic flirts-
DEPTH (crack boa) i
DRILLING r.ort
From a To Formation Description
1 - Zo o.1trrz/SvR-Dt,.)
ao - - 4c ' S hkALts Roc is
4-0 -' - 14- 0 e t-A To a-c c K-
l40 '- i 4 5 -- 1-14A0 Qef) aoCie-
4S'- ago' Gt2a,J.TC
�� / c_geVlcrr - 3c GPm
"?-lo' C.((.gt,,lYE
ago
LOCATION SKETCH yc -
Show direction and distance in miles from at least t
li
two State Roads or County Roads. Include thifhbad
numbers and common road names.
gyp ..,_
Ml N (• .
Oc"c^
1,2 -
j=A t R1141Dar A/s��. S
rJttLla�HAen. (i_0A,
6112NAPAJC1 t_ce 14,1
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH ISA NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THATACO Y OF THIS RECORD IASBEEN PROVIDED TOTHE WELL WNER
O J 0 �� cM/WE 9-f 3D�0 L�
SIGNATURE OF PERSON CONSTRUCT] as THE WELL Alt
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mall Service Center -Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-1 REV. 07/2001

12. CASING:
Depth
From- To a 5
From To
Flom To Ft_
13. GROUT: Depth Material Method
From 1- To Oo Ft. Co- Aouget)
From To Ft.
14. SCREEN: Depth Diameter Slot Sire . Material
From To Ft. in. in.
From To Ft. in in.
15. SAND/GRAVEL PACK:
Depth Sire Material
From To Ft.
From To Ft.
c�-MC/oClz(LrJS Routs NoJ 9 r/
City Stue Zip Code
(SS,as) -I b46 - (, (3
Area cods- ?bone number
4. DATE DRILLED 3/ S / C 4-
5. TOTAL DEPTH: 1 -S /
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO lI7
7. STATIC WATER LEVEL Below Top of Casing: '10 FT.
8. TOP OF CASING IS N" ' If Above Top of Cuing)
FT. Above Land Surface*
*Top analog Irrmlai red at/or brow Iced seams requires a
Parlance la accord- a with ISA NCAC IC.01Ia. n �
9. YIELD (gpm): 6 o METHOD OF TEST is G -A 1 R-
10. WATER ZONES (depth): 5 0' 3 o G Pr`n
11. DISINFECTION: Type fiTo cto''lo Amount `A b
Wall Thickness
DtanyTher or Weight/R. Material
Ft. 6I 4 SOt i PJ�
Ft.
16. REMARKS:
296530
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and )Jl.t ual Resources -Division of Water Quality - Groundwater Section
WELL CONTRACr'OR (INDIVIDUAL) NAME (prim) rJ IL -LAG G r-) K S f4 CERTIFICATION N al x 1
WELL CONTRACTOR COMPANY NAME_ REUBEN CALDWELL DRILLING, INC.
rRONE4�(8 )254-3581
STATE WELL CONSTRUCTION TERMI7a
(if applicable) • ASSOCIATED WQPERMIT/
(ifapplicablc)
1. WELL USE (Check Applicable Box): Residential f9" MunicipaVPublic 0 Industrial O Agricultural O
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION:
Nearest Town: N`A(�SIIA1_L county tJroCoMQC
� f i a -we a A2� A
(Stara Nurse, Numben, Community, Subdivision. la No, 71p Code)
3. OWNER: ' j t-1 e g_A!Litt r-D
Address379.
Topographic/Land setting�
ORidge °Slope ❑Valley eFlat
(check appropriates box)
Latitude/longitude of wel l location
:)
u
(dewer+/mtmttea/.ccoad,)
Latitude/longitudesource:OGPSOTopographicmajr
(check box)i.—
DRILLIN r r t
Formation Description
o V ba sJa.. seN
GPar+ vITe
c,ts'lce - 30 Gen-k
(DtfA co( Tt✓
DEMI
From To
Ro' - 50
50
`iv r-130'
J OC.ATION SKETCH o 0
l Show direction and distance in miles from atyastc 1
two State Roads or County Roads. Include theaoad. c�
numbers and common road names.
Pr-
1 es (L1Jc2-
E ro fa0 20
P even. lZ_ 0,4 n
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH ISA NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A C PY OF THIS REE�C`O'R�D_�H,AAS BEEN PROVIDED TO THE WELL OWNER
c)b
SIGNATURE OP PERSON CONSTRUCTING THE WELL �DA78 O
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mall SerHce Center- Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-1 REV. 07/2001
rno

296336
6. DOES WELL REPLACE EXISTING WELL? YES O NO Ig"--
7. STATIC WATER LEVEL Below Top of Casty 2� FT.
Weer if Above Tap of Casimp
8. TOP OF CASING IS " FT. Above Lad Surface`
flew a easing tenpin td ate bWw had flies aspen •
meace to ataflaaee with ISA NCAC 2C JAIL
9. YIELD(gpm): / METHOD OF TEST iWV5/a.✓1
10. WATER ZONES (depth): 77 Fri e
Y2 S/O• K G 5) 0
I I. DISINFECTION: Type de cti N c Amor E c z et/ %t.
12. CASING: Wall Tdidmess
Dept . Diameter or tYtipmas-
From— 7 To_� FL &
Ft. G Vy /bc! Q
Material Method
FL p
FL G4/9/ A-f JUh" 4'
Diameter Slot Size Material
Ft in in.
Ft is is
From /27 To Jig
13. GROUT: Depth
From To
Fmrn © Tor
14. SCREEN: Depth
From To
From To
15. SAND/GRAVEL PACK:
Depth
From__T
From To
16. REMARKS:
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Grotmdwater Section
WELL CONTRACTOR (o4DMDUAWNAME (pr1M) 7 /+ 2 7 �04-(r rl�E, CERTIFICATION s OiSet
WELL CONTRACTOR COMPANY NAME ,J o St; Ce W eJitt P ,wr-c�, t PNONE a r-t 72'�'Q Sfa
STATE WELL CONSTRUCTION PERMITS ASSOCIATED WO PERMITS _-. -.....
(if applicable) (if ttable)
1. WELL USE (Check Applicable Box): Residential t MwddpavPublic 0 Industrial 0 Agricultnal 0
Monitoring 0 Recovery 0 Heat hasp Water Injection 0 Other 0 If Other, List Use
2 WELL LOCATION:
Nearest Town:1) O f ci.- r�'
County C7uri0-9%�-t-
(Sum Name. Nambea; Cammeo�; Subdivision. lot No., Zip Code)
3. OWNER: ,50,-44 us. OC, a 3 5 )t-ti f (r
Address A�t7 '($O$ 3ogw
tU C
City or Tmrn See
( `&2 . (oi; 4 - /99'7
Area cat- Phase she/
4. DATE DRILLED 4 Z 3" d el
5. TOTAL DEPTH- /v k C
2SI?Si
bp�
O To ?7 FL L Y µlc /"n L'
PC
Topogtaphic/Land setting
Madge OSlopc OValley; OFlat
(aback apptaptee box) Latitude/longitude of well location
(del
Latit de/tongitude source:❑GPSOTopographic map
(deck box) '
DEPTH DRILL4NOJQO
From To Formation Description
o- /Zc //O�J/if.l-£�ye
//c.)- /o �/i /Jt`" CSn�
Sae Material
o FL
Ft.
QLn-c X dal ec 0-
0
{
LOCATION SKETCH 0 r=.
Show direction and distance in miles Hasa at k
two State Roads or County Roads. Iaclua theSl
mambas and momon road mint gc?
R S,f" ilrr� r o?t, haw w 2
-4 o
g�dc 0<4 rot
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRICTED IN ACCORDANCE WITi115A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
SIGNATUREOP PERSON CONSTRUCTING THE WELL
DATE
Submit the original to the Division of Water Quality, Groamdwater SectSon,1636 Man Service Center - Raleigh, PC
27699-1636 Phone No. (919) 733J221, within 30 days. GW-1 REV. 07/2001

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and NAtral Resources�- Division�of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAM (print))�// D��A//f%J N i £ L/71i�L i
WELL CONTRACTOR COMPANY NAME ,r date se"; LAZES) 1-62.64 -7 Ise
STATE WELL CONSTRUCTION PERMITS I//�j% ASSOCIATEDtWQ/PERMITS
(if applicable)
(if applicable)
296090
CERTIFICATION IOW
PHONE # I? 1Ji le l%g bgeta
1. WELL USE (Check Applicable Box): Residential k Municipal/Public ❑ Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION
Nearest Town: /..1.ea County Acis.c44
-Co A/ sr1awt. 42 s J
(Street Name, Number, Community, Subdivision Lot No., Zip Code) '( 8'7$'7
3. OWNER: H
Address 2 / /,
(Streeter Route :A -dare v`+ e •
No.)
City or Town State
Otto-eget
Zip Code
Area code Phone number as
4. DATE DRILLED 3/ts 7/D ¥
5. TOTAL DEPTH: ..2..2S
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO RJ
7. STATIC WATER LEVEL Below Top of Casing: yS FT.
(Use"+^ if Above Top of Casing)
8. TOP OF CASING IS /S FT. Above Land Surfaces
'Top of cuing terminated at/or below land surface requires •
variance in accordance with 15A NCAC 2C .0118.
9. YIELD (gpm): 7i tj METHOD OFTEST "Tre
10. WATER ZONES (depth):
11. DISINFECTION: Type C. g N, Amount it
12. CASING: Wall Thickness
thy �j
From O To _'S_5 Ft.
From To Ft.
From_ To Ft.
13. GROUT: Depth Material dhod f
From To �n FL�y1/a r S '
ameter or Weight/Ft. ?ck
1L� (9'
From To Ft.
14. SCREEN: Depth Diameter Slot Size Material
Fro Ft. in. in.
FroTo Ft. in. in.
15. SAND/GRAVEL PACK:
����.. Size Material
v
From Ft.
From _ To Ft.
Topographic/Land setting
❑Ridge tinSlope ❑Valley OFlat
(check appropriate box)
Latitude/longitude of well location
(degras/minures/secsods) _...
Latitude/longitude source:❑GPS❑Topographic map '
(check box) I _ _ -..
DEPTH DRILLING LOG
From To Formation Description
LOCATION SKETCH
Show direction and distance in miles Ern acjej t
two State Roads or County Roads. Include t)(ydad
numbers and common road names. o
en
44 i
3poi"
16. REMARK(& agal _5' � M 44hw
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH ISA NCAC 2C, WELL
CONSTRUCTION STANDARD $C SND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THEW WELL OWNER
aetf-9iit.7"y//S/�(
SIGNATURE OF PERSON CONSTR CTING THE WELL ATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-1 REV. 07/2001

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and N Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME
(print) // / G BfOLh CERTIFICATION
#..l23 �7
WELL CONTRACTOR COMPANY NAME e2-7 -p c mil/�:l /Alen it- Paste
t'X� PHONE # 141 gt
STATE WELL CONSTRUCTION PERMIT#ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
296089
1. WELL USE (Check Applicable Box): Residential $ Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATI
Near Town'
1A
(Street Name, bcn, Commtmity, Subdivision, Lot No., Zip Cade)
3. OWNER: //c9syt P _4Qstun
Address fl Y Rcl
(Street or Ro No.)
0tir N. C .
City or Town State Zip Code
-
Co, liar .asitleett4
Area code- Phone number
4. DATE DRILLED - Z. 2 ti /b V
5. TOTAL DEPTH: 3 0 •.Y
6. DOES WELL REPLACE EXISTING WFI T 9 YES 0 NO la
7. STATIC WATER. LEVEL Below Top of Casing: 'n' ET.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS 1 S FT. Above Land Surfaces
'Top of casing terminated at/or below land surface requires ■
variance in accordance with 1SA NCAC 2C .0118.
9. YIELD (gpm): -S METHOD OF TESTten°
10. WATER ZONES (depth): ,/ yK ' s'16
11. DISINFECTION: Type . //. At. Amount /D m-
12. Wall Thickness two State Roads or County Roads. Include the road
Depth 'ameter or Wei t/Ft names. numbers and common road
Topographie/Land setting
Mudge ❑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
N
-J
a :
<0 7:
r
c>
CASING:
From Q To / a7 Ft. !o .'1/ I/i
From To Ft.
From To Ft.
13. GROUT: Depth t�t���� Method ,
From_ To �o Ft r ..rip CAIN l'14 y
From To
Ft.
14. SCREEN: Depth Diameter Slot Size Material
From To Ft in. in.
To Ft. in. in.
15. SAND/GRAVEL PACK
Depth Size Material
From To Ft.
From To Ft.
16. REMARKS:
LOCATION SKETCH
Show direction and distance in miles from te�least
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED 1N ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
4d
SIGNATURE OF PERSON CONSTRUCTING THE WFT I
_?/.26/a,
DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-1 REV. 07/2001

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Resources -
WELL CONTRACTOR (INDIVIDUAL) NAME) (print) CNN.�L /'e
X
WELL CONTRACTOR COMPANY NAME N 5t .I,A.-r/ c
STATE WELL CONSTRUCTION PERMIT,/
(if applicable)
296083
Division of Water Quality - Groundwater Section
L,�D IL L CERTIFICATION p./..777
IAJ-e' 4,2-e.1 9 PRONE ly (fn1 G49- Oij8Z
ASSOCIATED WQ PE
(if applicable)
I. WELL USE (Check Applicable Box): Residential I$ Municipal/Public ❑ Industrial ❑ Agricultural ❑
Monitoring 0 Recovery ❑ Heat Pump Water Injection ❑ Other 0 If Other, List Use
2. WELL LOCATI
Neare Town:.
�-
�,
A772
(Street Name,, Numbers, Community, Subdivision, Lct No., Zip Code)
3. OWNERID/VHL %I. LU.
Address #-—74pj E L 4? tom,
(Sti ct''or Route No.)
� C mm/ Al C, ra8'97e
City or Tovm State Zip Code
Areacode- Phone member
4. DATE DRILLE t ! y
5. TOTAL DEPTH: cu S
Topographie/Land setting
❑Ridge (SIS1ope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds) -.
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTIt DRILLING LOG
From To Formation Description
6. DOES WELL REPLACE EXISTING WELL? YES//QQ NO el
7. STATIC WATER LEVEL Below Top of Casing: Y^T FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS 7 C FT. Above Land Surfaces
'Top of using terminated at/or below land surface requires ■
variance In accordsnee 1th ISA NCAC 2C .0118. '
9. YIELD (gpm): �FO METHOD OF TEST 7r
10. WATER ZONES (depth): /t' .5l d D/)
11. DISINFECTION: Type (I , i1. I ,
12. CASING:
Depth / ter
From 0 To �/o Ft. a J-
From To Ft.
From To Ft.
13. GROUT: Depth
.Material a
From 0 Too0 Ft. �-�-�
From To Ft.
Amount
Wall Thickness
or Weight/Ft. Material
#—I/ Ft) C_
14. SCREEN: Depth Diameter Slot Size Material
Fro o Ft. in. in.
From To Ft.in. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From /To Ft.
From To Ft.
16. REMARKS:
LOCATION SKETCH
Show direction and distance in miles
two State Roads or County Ro
numbers and common road
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AyD THAT A COPY OF THIS RECORD IIAS BEEN PROVIDED TO THE WELL OWNER
-the /I)
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
iliLG/
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

294801
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment end Natural Resoo(ces -Division of Water Quality - Groundwater Section
�/ G
WELL CONTRAr.TOR(INDIVIDUAL) NAME (pNt) C7Rr y Sc SriC cEnlncwnoNs/
WELL CONTRACTOR COMPANY NAME �V' 5} i c r '(((-, e l-L Dr; L C N Q most a fit? 72Y -40
STATE WELL CONSTRUCTION PERMIT# _ASSOCIATED WQ PERMITS
(ifappiicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential tY MunicipaUPubhe 0 Industrial 0 Agricultural 0
Monitoring ❑ Recovery 0 Heat Pump Water Injection ❑ Other ❑ If Other, List Use
2. WELL LOCATION:
Nearest Town: re/xi:Liu, County eviccoistere
r?'l, (tJ Q For K
(Street Name. Numbers, Community, Subdivision. Lot No, ED Cade)
3. OWNER: 9UAi Cc rusk* Cc 1-,c,4 to 6d()b'1Q1
Address ',) 4- k t \ 5
(Sweet or Rome NO)
City or Town State tip Cade
(K2 )- (07.1; ' ? i q7
Area code- Phase amber
4. DATE DRILLED 3 - l i - 09
5. TOTAL DEPTH:
5
6. DOES WELL REPLACE E �lSTING WELL? YES 0 NO 0/
7. STATIC WATER LEVEL Below Top of Casing
(Ua " ' if Above Tap ofcning)
8. TOP OF CASING IS 1 FT. Above Land Surface`
nap ofeasia# Inattraled odder below hod aria rapaiea a
variant d meordarn wits ISA NCAC 2C ADE
9. YIELD(gpm): 3 OF TEST 11'
10. WATER ZONES (depth):
Topog�pphic/Land setting
[Midge fSSlope ❑Valley ❑Flat
(cheek appaptiab bat)
Latitude/kingitude of well location
(depaeitdo tdmcada)
Latitude/longitude sourca0GPS0Topographic map
(deck bead
DEPTH DRILLING LOG
From To Formation Description
—
�., / /Graz lZ
/ f ley /i,<�
7,9t C
t 1. DISINFECTION: Type f / o e i N e Amount 'J- • r, I (.0 77(7
12. CASING: Wall Thick
Depth Diameter or Weight/Ft Material
From To Ft.
From Tom FL v ✓v.
From e SL To 7 y Ft.
13. GROUT: Depth
From To Ft
QC4c/
M
Frorr__Q_To 27 FL ?t/pe/ Punty���
14. SCREEN: Depth Dianteier Slot Sim Maerial
From To Ft in. is
From To Ft in. in.
15. SAND/GRAVEL PACIC:
Depth Size Material
FtomTo Ft
From To Ft.
0/5
get
16. REMARKS: \l/fizii1i%en./
;o
cc=.
c r.
J OCATION SKETCH '-� %t
Show direction and distance in miles from at least!,
two State Roads or County Roads. Include the font. ti`
mmnbem and ms. common ad name
•
II 4 /N (`jLt1. 1 ,
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
SIG
CONSTRUCTING THE WELL DATE
Submit the original to the Division of Water Quality, Groundwater Section,1636 Mal Service Center - Raleigh, Nb
27699-1636 Phone No. [phone], within 30 days. GW-I REV4 07/2001

WELL CONSTRUCTION RECORD 294257
North Carolina - Department of Environment and *littoral
(�Resources - Division of Water Quality - Groundwater Section -1
WELL CONTRACTOR (INDIVIDUAL) NAME (prier) 6 \ 1..E \ b r`) A S N CERTIFICATION 0 al1
REUBEN CALDWELL DRILLING, INC.PBONE4
WELL CONTRACTOR COMPANY NAME_ �S ?54-3581
STATE WELL CONSTRUCTION PERM
(if applicable) a
ASSOCIATED WQ PERMRN
(if applicable)
1. WELL USE (Check Applicable Box): Residential L9�MunieipaVPublic 0 Industrial 0 Agricultural ❑,'
Monitoring 0 Recovery 0 Heat Pump Water Injection ❑ Other 0 If Other, List Use
2. WELL LOCATION:
Nearest Town: CAA) () L6 il- County
�)S Un) C.a m&
i.-. (JD t J (—t*/ SU( \JtSiot
(Street Name, Number, Canmuaity, Subdivision, L.o1 No., tip Code)
3. OWNER: tab O t l3 2U O1 S I L L
Address \ S-1 0)'1 K t-11t-L (Za A
Sneer or Route No.)
CA r s tg ,.)C
init5
City or Town Swa Zip Code
(�aK}—1IS—b6''ti
Ara code- Phone number
A
4. DATE DRILLED 4�I -I O
5. TOTAL DEPTH: S `Jt
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO LN
7. STATIC WATER LEVEL Below Top of Casing: g.D FT.
(um + ifAbove Top o(CuIna)
8. TOP OF CASING IS - FT. Above Land Surface•
Top a(casleg i.rmleal.d aNar baton Ind rertace requires •
variant le accorduc• whit ISA NCAC2C.OIIa. pp
9. YIELD (gpm): 5 METHOD O,F TEST h 1 G ` Al iv
10. WATER ZONES (depth): 2- So - 'oL G f
5 to' — ei-GPm
11. DISINFECTION: Type 14Tf1 at%6 Amount
12. CASING: Wall Thickness
Depth or Weight/Ft. Material
From - To Depth,
Sbaal 'PJ C_
From To
From To
13. GROUP: Depth Material
From To QS' � Mtr, T
Ft. Et RDiampyr
Ft.
FL
FL
From To Ft.
Method
14. SCREEN: Depth Diameter Slot Size . Material
From To Ft. in. in.
From To Ftin. in.
15. SAND/GRAVEL PACK:
Depth Sire Material
From To Ft.
From To Ft.
16. REMARKS:
,Je jographic/Land setting,
@Ridge ❑Slope ❑Valley °Flat
(deck appropriate boa)
LatitwlJongitude of well location
Latitude/longitude source:❑GPS❑Top graphic irks: -
(cluck box)
DEPTH ',KILLING LOG
Fro To / S S ooV 6 F-Go rmation Description
55'-ago' G9ao•->tie.
a Re. ' czENice- a Germs
n lZalr )\TE
p' cR f\c� 4rS GPm
Cj to 660' Vf-1tY WAlr'rrc
o G
f En�
m
LOCATION SKETCH N o r.,
Show direction and distance in miles from at left
two State Roads or County Roads. include the read i
numbers and common road names.
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH ISA NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT OPT OF THIS RECORDHAS BEEN PROVIDED TO THE I.I.0
,c, --7 o/Q--
SIGNATURE OF PERSON CONSTRUCTING THE WELL
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mall Service Center -Raleigh, NC
27699-1636 Phone No. (919) 733-322I, within 30 days. G W-I REV. 07/2001

294256
WELL CONSTRUCTION RECORD
North Carolina - Department of j EnvironmentandW.tiinlgysourcyzDiivisionofWaterQuality - GroundwaterSection�j
WELL CONTRACTOR (INDIVIDUAL) NAME (prim) 1 ,--1-,\ e. r3A S14 CERTIFICATION M Al �' I
WELL CONTRACTOR COMPANY NAME_RF.UBEN CALDWELL DRILLING, INC. PRONEtHe )54-3581
STATE WELL. CONSTRUCTION PERMITS ASSOCIATED WQ PERMIT/
(if applicable)
(if applicable)
1. WELL USE (Check Applicable Box): Residential Municipal/Public 0 Industrial 0 Agricultunl❑.
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION:
Nearest Town: _LA A,
&J 1L( County Qua)rzr- ?W
c"1-1tS1 N)L"L Ail
(Street Name. Numben, Community, Subdivision, Lot No., Zip Cock)
3. OWNER:
Address
I b 0 Lor.JL p,aC rZaAL,
(Snot or Route No.) ary,.,(�.7
e.AJCr(Lv1LL(j WC OO O
City or Town State Zip Code
(�� Y)- 1-1 c( — a --t -t g
Area code- Phone number
4. DATE DRILLED 1 /a
5. TOTAL DEPTH: a J
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO
7. STATIC WATER LEVEL Below Top of Casing: 4- t FT.
(Use'+" If Above Top of Casing)
8. TOP OF CASING 1S FT. Above Land Surfaces`
*Top of casing terminated at/or below land surface requires a
variance In accordance with 1SA NCAC 2C.01IS. �� _ f� 1 (�
9. YIELD (gpm): (S METHOD OF TEST V
10. WATER ZONES (depth): l c •— '1 '5 6 e 6Y x
1
11. DISINFECTION: Type tV N "t u/r, Amount-
12. CASING: Wall Thickness
Depth �?�;r or Wn t/Ft. Mgtyj�I
From 1 To 1 Ft. r Kr da l 4066
From To Ft.
From To FL
13. GROUT: Depth
m -L FroTo a0 Ft.
Material
From To Ft.
OthAd
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.
(deptr+/mim,us/secmds) :.,
Latitude/longitude source:❑GPS❑Topiugfadhic map
(check box) I i,
mPReILLING LOGDescn non__
k
5'C--Prr4
Gg,/ c5r ) �
h m
Gr^
rJ_
rm
LOCATION SKETCH?„
H
Topogra c/Land setting
❑Ridge at Slope ❑Valley ❑Flat
(check appccpriate box)
Latitude/longitude of well location
DEPTH
Frpm / To 1
1k -t (ice
1gc,
Vc' - as 0
N o
Show direction and distance in miles from at least cJ
two State Roads or County Roads. Include the road
numbers and common road names.
luptvda-
Rxib
1.5rn
16. REMARKS: aSO
1 DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED 1
CONSTRUCTION STANDARDS, AND THAT A QQPY OF THIS REC
t!t
ACCORDANCE WrrN 1SA NCAC 2C, WELL
RD HAS BEEN PROVIDED TO THE JWELLAWNER
asy`
SIGNATURE OF PERSON CONSTRUCTING THE WELL
3J 3
ATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mali Service Center - Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-1 REV. 07/2001

294255
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Uatunl Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (prim) / `J//l
WELL CONTRACTOR COMPANY NAME RF.UBEN-CADWELL DRILLING, INC. PHONEY( rI 8 54-3581
STATE WELL CONSTRUCTION PERMIT/ J/ /l �� OCIATED WQ PERMIT/
fa..licable •
ifsRuble
1. 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
2. WELL LOCAT
Near st 11o d F
0'
($fleet Nurse, Numbcn, Commualty, 5ubdivirion, Lot No, tip Code)
3.
(check box)
DRILLTNG LOG
Topographic/Land setting
❑Ridge ❑Slope ❑Valley °Flat
(deck appropriate box)
Latitude/longitude of well location
L
2
OWNERcZ q T � (deytWmlotcsfseconde)
Address fr y2 / y` "4VI] / We, Latitude/longitude source:❑GPS❑Topographic mesa:__--
S eyteut•
City Town State 0 Zip �e Fonnglion Description
it
7/Lk �
7A CERTIFICATION M h � 7.'
( f5 C-3/v4; (aftan
Arn code- Phone ownb�u
4. DATE DRILLED A)
5. TOTAL DEPTH: / 'Rip
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO 0
7. STATIC WATER LEVEL Below Top of Casing: /r 0' FT.
att• "e' ifAbove Top or Cuing)
8. TOP OF CASING IS / FT. Above Land Surface
'Top of culaa terminated .nor below Lad surface requires a
vstlsace Ia accordion wltk ISA NCAC 2C.011 a. 40,
9. YIELD (gpm): / METHOD OF TEST ^d
10. WATER ZONES (d ): / E 0// 2V6'
�z b Y'
11. DISINFECTION: Type Pic/- 7 Amount .33 eri-
12. CASING: Wall Thickness
Depth Diameter or Wn tlFl. aerialFrom`fl$ To fO FL Lc' Diameter
From To Ft.
From To FL
13. GROUT: Depth 44Lterial ty
From_/ To 2,0 Fi.
From To
3?5443
14. SCREEN: Depth
From To Ft. in. in.
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
16. REMARKS:
Ft.
Diameter SIol Sire . Material
two State Roads or County Roads. include the ros
numbers and common road names.
4-4uct ll
1 DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH I SA NCAC 2C, WELL
CONSTRUCTION $.ThNDARDS, ATJ() T,j4AT A (ZOPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
OFPERSON CONSTRUCTING THE WELL
3/z 7 /10/
DATE
From To
/-1-=> - 72--
7:2 - ei>
'$n _ - Z,U
i'c
ern
G
LOCATION SKETCH ,n >c'
Show direction and distance in miles from at least r
Y
Submit the original (o the Division of Water Quality, Groundwater Section, 1636 Mall Service Center- Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. OW-1 REV. 07/2001

294254
WELL CONSTRUCTION RECORD
North Cuolina - Department of Environment and *natural Reso`urrces -Division of Water Quality- Groundwater Section
WELL COrrr¢ACiOR(INDMDUAL)NAME (nisi)Bu ( N h CERTIIICATION• L7'7 /
WELL CONTRACTOR COMPANY NAME_ REUBEN CALDWELL DRILLING, INC PRoNErFY?(8 �254-3581
STATE WELL CONSTRUCTION PERMIT/ __ASSOCIATED WQ PERMIT/
(if applicable) • (if applicable)
1. WELL USE (Check Applicable Box): Residential O MunicipaVPublic ❑ Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATI a N:
Nearest Town: tro
0 County
s
(Since* None, umbcn Commtmi ubdivleion, Lot No_ Zip Code)
3. OWNER: Kof 1 r/1 D e'I "J
Address r 6 ,‘. O-GNG
fre—(Sucre a Roo. No.)
ft- r eJL— r-JC a Z
City or Town Ste. Zip Code
(a23j- 77? -Z-47
Area Mai na cumber,t�
4. DATE DRILLED'1 S' 0 /
5. TOTAL DEPTH: J a
6. DOES WELL REPLACE EXISTING WELL? YES 0 NCf ❑
7. STATIC WATER LEVEL Below Top of Cuing: L4 r FT.
(Use +' If Above Top of Cuing)
8. TOP OF CASING IS / FT. Above Land Surface•
Top of whiz .rmlaaled at/or Isthmian! audits requires
radiuses 1a accardann with ISA NCAC 3C.0118.
9. YIELD (gpm): J METHOD OF TEST
10. WATER ZONES (depth): / g s
11. DISINFECTION: TYPS #• ` o 'Y,n
12. CASING:
From + To �J FL 6 Diameter
From To Ft.
From To Fi.
13. GROAT: Depth Fro)Lten1 *MeUwd
m To b '1-P Ft. i'2V '✓
41,
From To Ft.
14. SCREEN: Depth Diameter
From To Ft. in.
From To Ft. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
ISP
Amount
TopognipWeLand setting
❑Ridge Mlope OValley
❑Flat
(deck .nerv.rista box)
Latitude/longitude of well location
Latitude/longitude source:❑GPS❑Top phicmlp-__----'.
(check box)
DRILLING LOG
From To Fo ; .lion Description
eQ — L Z-
7-,- frcse,.
;5- c -- S^`
1-1-5.
DEPTH
Wall Thickness
or Weight/Ft. Material
i% LL per Ci
Slot Site . Material
in.
in.
c _:
LOCATION SKETCH 'o r
Show direction and distance in miles from at least cn
two State Roads or County Roads. include the road??
numbers and common road names 2.. r;
`r6
16. REMARKS:
1 DO HEREBY CERTIFYTHAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 1SA NCAC 2C, WEU.
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
k�Dy
SIGNATURE OF PERSON CONSTRt7CDNG T) WELL
DA
Submlt the original to the Division of Water Quality, Groundwater Section, 1636 Mall Service Censer - Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-1 REV. 07/2001

7. STATIC WATER LEVEL Below Top of Cuing: /5 FT.
(Ura'Y It Above Top of Casing)
8. TOP OF CASING IS FT. Above Land Surface*
Top of cuing lermlaatsd• or below Ind serraca requlro a A.
varianceIn accordance wit► 15A NCAC 2C.01 ta.
9. YIELD (gpm): IC. METHOD OF TEST
10. WATER ZONES (depth): [IQ - yb#''t'
gO . / 3 5 fi-.— 1
11. DISINFECTION: Type 4X 9. )Amount /R Y2r/
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. al
Froth-*</ To to c Ft. # L/ PC
From_ To Fl.
From To FL
13. GROUT: Depth jdstnial
From 0 To Ft. C�lltHi(
From To Ft.
14. SCREEN: Depth Diameter Slot Sire . Material
From_ To Ft. in. in.
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
ethod
WELL CONSTRUCTION RECORD 294253
North Carolina - Department of Environment and mature!! Resources -Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) S l )\� ► e 11 CLRTIFICATION N '7_Z 1
WCLLCONTPACTORCOMPANVNAME_RE.UBEN CALDWELL DRILLING, INC. PRONE4�J8 1254-3581
STATE WELL CONSTRUCTION PERMIT/
ASSOCIATED WQ PERMIT/
(if applicable) • (if applicable)
1. WELL USE (Check Applicable Box): Residential 13' Municipal/Public 0 Industrial ❑ Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION:
Nearest To
%r.
(Str- Name. N_m
Coun1y,6i.r tot%-c
Community. Subdivision, Lot No, Zip Cotc)
3. OWNER: •2-�//�'
Address / tt" L. e +� e�
e n jS1 rt�Ront.NN� ,I�'` t9 P 70 /
City or Town Suss Zip Coda
(OAS)- 77f - 24TC
Ana coda Phone Dumber
4. DATE DRILLED 4/4/ 116 /
5. TOTAL DEPTH: S LO
Topo c/Land settin8'''- _ !
❑Ridge f S� lope ❑Valley ❑Fail
(chock appropriate box) _ , ;: i
Latitude/longitude of well location '
(depeu/mimmas/secaods) m
Latitudr/longitude source:❑GPS❑Topo�raphic
(check box)
13II T.ING LOG
Formation Description
-• et f
� `/
�O t3 Crer
DEMI
From To
o — z•S
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO / qto
❑❑ /9O-2SD
C r-rc
-Cr-,rn
(:n
LOCATION SKETCH
Show direction and distance in miles from at least)
two Stale Roads or County Roads. Include the roll'
numbers and common road names. .
16. REMARKS:
I DO HEREBY CERTIFYTHAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 1SA NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE I.I.OWNER
SIGNATURE OF PERSON
ONSTRUCfINGTHE WELL DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mall Service Center- Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-I REV. 07/2001

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and natural Resources
WELL CONTRACTOR (INDIVIDUAL) NAME (prima)
WELL CONTRACTOR COMPANY NAME_RF.UBEN CALDWELL
STATE WELL CONSTRUCTION PERMITI
294252
- Division of Water Quality - Groundwater Section
- (�) AS•i1 CERTIFICATION I �-I \
DRILLING, INC. PHONEQi8 �54-3581
ASSOCIATED WQ PERMIT,
(ifapplicable) d (if applicable)
1. WELL USE (Check Applicable Box): Residential Cr-Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATI a N: /�
Neare Town �L Cv.".,,u��.1( County / tdr✓L2-t97 f,&
(Street Name, Numben, Community, Subdivision, Lot No. Zip Code)
3. OWNER:
Address 4o 7* /v Q.�Lac.. aC%u. y
(Surat or Rowe No.)
Uloruw-ct, OL, r) C. , R 78 7
City or Town Suit Zip Code
(gin- 22k--S-55-3
Mca coda- Thom number
4. DATE DRILLED 377- 4071
Depth
From.&/ To
From To
Fibril__ To
13. : Depth
From 4
From /t/ To 2.-0
From To
14. SCREEN: Depth
Froth To
From To
Topographic/Land setting
19iidge ❑Slope ❑Valley ❑Flat '
(check appropriates boa)
Latitude/longitude of well locati✓ n
(degreuholmituhecoodr) L
Latitude/longitude source:❑GPS❑Topographic reap
(check boa)
DRILLING LOG
Formation Dessription
DEPTH
From To
d- 20 -
2Q - 3D-
5. TOTAL DEPTH: (.0 '�3/ ; .560r
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO f3 p
7. STATIC WATER LEVEL Below TopoICasing: t 91 FT. ,f4o — 4, „
urn -.riff Above Top of Cu g)
8. TOP OF CASING 1S 1 FT. Above Land Surfaces
*Top of culesg termlouad War below land surface reyairu a
variance In accordance wltb 15A NCAC 2C .0111.
9. YIELD (gpm): / �- METHOD OF TES
10. WATER ZONES (depth)::� Cr.� i 2r
11. DISINFECTION: Type ` i tY. "•(Ori Amount i, b9
12. CASING: Wall Thickness
or Wei t/Ft. staid
Diameter
FL
Ft.
Ft.
Materi
Ft.,r
Ft.
Diameter Slot Sire .
FL in. in
Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
16. REMARKS:
Material
L—
c.?
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common road names.
LOCATION SKETCH
1 DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WrrH ISA NCAC 2C. WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
3 1 50
`/E c --tt44��JJ 7 '
SIGNATURE O PERSON C�TROCI1N0 THE WELL — DATE
iL_
i
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mall Service Cooler - Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. G W-I REV. 07/2001

HELL CO �S 1 RUC IlON 12ECQRD
294959
'\, a:n i 110 PI.1-:7Cpari.Pc'1: rf I. il.'fOnteignl rand N3IWdi Rt..u(u' n J', moor Vs Leer Voallty ;.}re u ndn9:a St\nor
\\el i.tU\t eVl ink II♦UI\nit ili\\\7} ,prinq.._ �-1�``]��J �1SiTi ����
•alLt :.lJ\,K11 iI1NIIr\IP \\1 \% I1.fie� ��. 4U. .. ;i'`\; `rr1` Ptit )se Y ..-__ ...
�r _ _ .. __ ........_
• \•1 NhII.rint{ It
1', 1-1, CIIP\Y6N\11U ....
�� i C67J ' ajlli1irl
,\ : , i )I.::\ Ilrc. \,,'!•,71C 1:,„ \ RestCrn ,al 17 111eu.I. Pul,n. J 1'
:.:I C i,;:: t':: n U Heal Pomp \\ amr In, euur. ..
`,� (�gypQ 'hpog' hic Land-etimg
ly
U GW'• Itid�tc cIopc C7na: \y i-Jhl•,
VD•
9
' autudap ngr,ud,• rat Ne i ill:auon
1,11PIi0i •. Pr : .Y.., 4i.:
:. J111 +• i:. I; nyuudc YJtlt.' ncivSn'I opotuaph.0 nu'.•
no.i. t'..•
I (•IlllaitJll I. J•::: fipl.b'
b.7>‘ 1w
ee1.c'ci1/ (Ice .V Q zirN
hip C:..:r
t, f?1J1i\ NV Et I. REPLACE EXISTING 1,B `IO i".
.. .'1 I. lg. 'AA eR I.eV L dete ToP u1'C:wn� �J
` it.:<"• UAh,,; rup al Y Alrlp
1 '.:I' (.1 t.ASIN/i IS .. 1.. .. .. i i kkha,c Lan Sur Ca:.:•
• 119 01 u is.istit tr ,I i d annr hrlow hind s rfltt rt. ulrf t
. Yrb nl. In Yu,?n Y,,; i. n 1!.\ �C k( IC n11$. Cy `_ n � LE4.Y.
1 If l D( 1t1Ii .—!,.1 ZOO
C2 Zbh� 1 lCt V
I. '\.A'1RIUrv1:Sldrp!hl L._
.
ION Type
V(i
;.Tart+clCr nr Ne.¢ht
U I_i'T H
f
Ft um
Q
LW'.
Ucrrlt
hl
FI
FI
r. h N 1)<I'lil D'..uneIe 1.•r: (, Alec: nd.
▪ > \V11,,R,\. h.!. VA'. k
L. t' Pi �, t'• 1.
. —
"---a . cis
m
S!',il.., '1 I,1 •Z.,..
1 N ana I: c1iJ0 dl•.Inq, ❑ i .'.1
iw.. \I 1.: Rcads of ( o'u,:, kn -:,. i.
r:untJl:a u'.d
;,?Ctfne1. 103: ',roe,
6 t -S1E?-
- s t$ *
I'i , WH..1 N AS Cu",IKI1 I El; I\ 41 ( tIR./A\I E'A I Itt I' 4`•c .Ai ]( .IFLI
A\h Tn>1 \COI', i)r 1t INR!,ir)R11 H•\\ ifi'.!'". f'RO\il)eD III IHE •�+-._- 3\'7`: 'i
� ; L. 1 FIE N L I I D A, lllpJJJ\
•f .\A7.1•r .lF n4\lt i\:. V,J\ llt 1. 1.
(, Raleigh,
t..
\ulunil the nfigu pll L'. the pi\r\iun u1 NAlrr Vu:dlh. (�ru Wtd,s ulcr Kw celn. IhtF \tuSn l .i:. (rntnt,r � l.;r n, (
7-:n4V.1G1" 1'bun. \,'., JI'll'1A. 3221. tsilnin 3G rla)\. _- Re R'

294956
II '.t I OK II\tN11U1.
\I 01114 ( (imps.)
., 1•I Nlll. (rlNil N1 C11(nrf,N\IIU .._.._. .. .. _.
acOC
)k'. .1 luca \p;'),: uh0 1,1 hoor JI 0
l: G•.11� RC?ICdn. TI _ \tu!u. l.1111-,1:
L.1.. _ ✓,:: 1, :'> 0 NCXt Pump \\aic; Inl...tiun
>, .. I (IL''.r IN • 1 Topoaphlc Land actt)It
1 L]Rg-
idde ( .Kri D\'t l 7 GFLI.
I nn1111�_. (Junlj kCl
�pa22—�TTTTAA���� gip . X -L! A a nt VCIJItn r
CIZ647, ..nn tu(fc h ❑g1 J ,) Or QeI Ir ;atiun
i\Y'\Pe q Y I..�.. .. - Laulu, L.ny,-.ude wl r.. 'kI(,,C�1':rpor r)I 1,cn1e'.'
;. ,. T (te D Cj___ Ut irl Ir Ittw„on 1nN'r
_ aI
•I I tl csi I)TH _—-'w,ir__ _ _
RCF ALF"XISTINOKtI( `(i-s?IO
FT
.. ::-'( `.. Il. `A.1iFR I. F. `: El i;e,nw Top a .=}L/_.__.
1. >e 114nv>v (a0'+O non
F i ♦H.,.0 lant ,Wfty.:•
,r •a110X •Le, 1 a1Yd atour helm* hind >•l rf•,r req utrra a ,
MIS.
�
mnc>In as An.ra•ni >?t'1(tC TF`I.�r_�5..�.bl4_...._. .. ..__ OF
a i I (1F l ASI\Ci I,
WE L CONS1 RUC i1Oti R£CORI?
i
n,,roronc nt drd Na41IX) RR'c�•v ,ur. .23 `�'•
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on of Vs der (Juan!"
-
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,IV(7 '.1311 Ti)
p; pll:—�+ or V. e.chl •
111
and Crldn.., Jr.., I.,. .( id 1 : , +
1 N'.. )i: r: Roads 6t l',nrr., Ro.i s Ir:'. •.
,-; -, hc'11 C,d :11r11ne1I 1,1I : ' me,
-Hum CD3
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4Yu.)r rr, rcum %,, )In I'd1..4221.>ulhm \CI rl!s>,

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Di'visionof Water Quality
WELL CONTRACTOR (INDIVIDUAL) NAME (print) 13r n-^^- 1ICLe'L=L'
u-v.. G���r� t3rp . coke �.D �.
WELL CONTRACTOR COMPANY NAME__. _...- __- -.- --- �,
STATE WELL CONSTRUCTION PERMIT# / 4{O� ASSOCIATED IA() I'ERMIIT# -
(if applicable} I itapplicuble)
293;708
- Groundwater Section /
cERTIEI('ATION `3D']` (
plloNE # 16gN gig - -/ 171)
I. WELL USE (Check Applicable I3ox): Residential a Municipal Public 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery ❑ Heat Pump Water Injection 0 Other ❑ ;'Other. List Ilse
2. WELL LOCATION: ((��
Nearest Town:1�]- tekck ma-n, County I 1/1-1r 1Yl C_.,
flue �+ k CIL1e
;Street Name- Numbers. Cuntmuf44v Subdivision. Lot No.._Zip
( Ode)
3 OWNER: A marxrko S S�-t-�-rt
Address P D RD--L a 4 z
;Street or Route No.;
S to conr (L1'ce (A C
( as or rote', State Zip (ode
)-
Area code- Phone number
4. DATE DRILLED q - a I - D
5. TOTAL DEPTH:
6. DOES WELL. REPLACE EXISTING WELL:.' YES ❑ NO 4�
7. STATIC WATER LEVEL Below Top of Casing: 1 0 ET.
(I)se"�" It :Ahove Tap of C'asine)
S. TOP OE CASING IS ( PT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordan e with I5A NCAC 2C .0I18.
9. YIELD (glint): METHOD OF TES') -
l0. WATER ZONES (depth): 2_45 I - 3 t{-5
a CC I-)
Topographic/Land setting
❑Ridge1Slope ❑Valley ❑Flat
ff heck appropriate box;
Latitude longitude of well location
Ides:rce, minute:, seconds)
Latitude longitude source:❑(IPS❑ T opographic ',tap
;check ;lox;
DI. PFI I DRILLING l.O(i
From Lo E'onw� tyton Description
D _7 a C) Da_ -
7 a. - I_— a 116 1 __ jhcl✓r-c_ _..
LOCA I ION SKERLI 1
l I. DISINEE(TION: Type l-I-T 1-1_ .)mount (q 9 +baits :-,now.lireetion and distance in ',tiles boot tit least
12. CASING: coral) Thickness two ~talc Roads or County Roods. Inc kid • the road _ri
Depth Diameter or AA -eight Fr >latdrial
numbers and common road names. I " —
From 0 ito I a Et. 6 11 - Sie'_e_L I
From To Et. __. O o
From 'To Ft. �� tti
13. GROUT: Depth Material ethod "-t
From 0 To ae) FL I ;-,_:
From To Ft can -- _
l4. SCREEN: Depth Diameter Slot Size Material --0. --)---
Front To Pt. in. in. -
From - To Et. in. in. IV too :CI
"'`
15. SAN DGRAVP.L PACK: IN)
Depth Size Material 0..) c
From l o Et.
From Ib ET.
16. RLMARKS:
1 DO HEREBY C ER IIPY '111AF TIIIS W EI.I- WAS (ONS HLUC I ED IN AC LORD AN('(: AA I T 11 15 V NC AC 2(. N'LI.I.
CONSTRUCTION SI[ AN ARRDS.AND I I1A F A COPA UP THIS RI:CO II. \ S FN PROA'IDI:1) TU I I II WELI. OWNER
(/-)k,2
D:\ Ip
SIGNATURE OP PERSON oNS FR CCIIN(IIIII-
. ACP.I I.
Submit the original to the Division of Water Quality, Groundwater Section. 163o Mail Sers ice Center - Raleigh. NC
27699-1636 Phone No. [phone], within 31) days. GAA -I REV. 07 2001

293709
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division urWater Quality - Groundwater Section ��
WELL CONTRACTOR (INDIVIDUAL) NAME (print) 6�jr�a t �(Y�(-I-C9- C FRTIFI(Af1ON#
WPM. CONTRACTOR COMPANY NAME gr
PCP, 3rD_- L)AI `� kLVY.p t411-"LC ' PHONE # aO) 11<ig - 3/176
STATE WELL CONSTRUCTION PERMIT#
lit applicable) of applicable)
/4/oa
\SSD('IA I ED WQ PERM(fr
I. WELL USE (Check Applicable 13us): Residential L, Municipal Public El Industrial 0 :Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other ❑ I other. List Esc
2. WELL LOC'AFIO �
Nearest Town: County
-llrt., l Yam(
6vrot Naito. Numhcrs, C%%mmhtnity. Subdivision- Irn No.. Zip (ode)
3 OWNE12:2a I (.%rPP in
7
Address��,1J7Ctv11e-Ya- 1 at!
/� I (Shreet orl��RuutcNo.l a87 lS
C 111aC1 �
(-iry or Town Slate Zip Code
( )
.Arca code- Phone number
4. DATE DRILLED '- aU -U�
5. TOTAL DEPTH:
6. DOES WELL. REPLACE EXISTING WELL? YES 0 NOik
7. STATIC WATER LEVEL Below Top of Casine: 1/4) ET.
((Ise"I-. it Aborc'Fop al( asinp)
eei`l
H. TOP Of CASING IS
PT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordance with ISA NCAC 2C .II118.
9. YIELD (gpm): to/i f METHOD Of TEST .
10. WATER ZONES (depth): LgL' - aDS I
II. D[SIN P f.CIION: Type _%1-1
I2. CASING:
Depth
Prom t To 9/o Ft,
From To Et,
Fromilo Ft.
13. GROUT'. Depth Material NJethod
From rQ To tD Ft. fur
From To I t-
14. SCREEN: Depth Diameter Slo. Size
From Co Ft. in. in.
from -- To
15. SANDT(iRAVEL PACK'.
Depth Site Material
Diameter
/o '
Amount 36 {i,JJs
\\'all Ihie knee
or \\'eight la.
\
PVC_
From To Ft.
From To Ft.
I6. REMARKS
Material
Topographic%Land setting
❑Ridge *Slope ❑Valley ❑Plat
Ichcck appruprmtc boll
Latitude longitude oC well location
[(Ices, ❑❑❑urea second.'
Latitude loneitu(le source:❑UPSO Copographic wait
)cheek bo,vl
DP1'11 1 DRILLING LOG
From Co Ponnation Description
D 96'
96' 21S'
LOC:A[lON SKETCH
Show Jiieelion anti distance in miles from tat .I{:I>t
two State Roads or County Roads. Include thciroad
numbers and common road
o
• n_
rn
▪ c E'
_
Ul
tie- 0
N __
..
r-1)
let
I DU IIERLUY CERTIFY T IIAf 111ES \6T.LI. \VAS CONS" RCC11 D IN ACCORD,ANCCIi V l I II 15.\ NC \C 2C. WELL_
((NSTRUC'TION STANDARDS, ANI) lllAT A COSY OF Tilts RFC))1([ I AS IilFN PROVIDED lt) )III. W [LI. OAVNF_R
D:n.
SI(iNA Itil<L. OF PERSON CONS I RC( TIN( I II I!- AA'l,I L
Submit the original to the Division of Water Quality, Groundwater Section. 163o Hail Sea ire (enter - Raleigh. NC
27699-1636 Phone No. [phone], Within 30 days. (iW-I REV. 07 2001

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and 4ahual Resources -Division of Water Quality - Groundwater Section WELL CONTRACTOR (INDIVIDUAL) NAME (print) \ t..t_Nc ,-)As•R CERTIFICATION / a-11
1'
WELL CONTRACTOR COMPANY NAME _REUBEN CALDWELL DRILLING, INC. PHONEY(8 ,754-3581
STATE WELL CONSTRUCTION PERMrre ASSOCIATED WQ PERMIT/
(ifapplicable) a (if applicable)
1. WELL USE (Check Applicable Box): Residential C MunicipalPublic 0 Industrial 0 Agricultural p`
Monitoring 0 Recovery 0 Heat Pump Water Injection ❑ Other 0 If Other, List Use
2. WELL LOCATION:
Nearest Town: 1, A /t� L L .L€ Coun l�v/J C0IYL(3C
Loco &tit�
(Street Name, Numbers, Community, Subdivision, La No, Zip Code)
Topographic/Lan ettu;Ig'
❑Ridge ❑Slope alley ❑Flat
(,heck appropriate box)
Latitude/longitude of well location
3. OWNER: 1 Pin) V R.l J5 (deporymimnea/memds)
Address act (6 A LA- A SLO ga llSC(I 6C04O Latitude/longitude source:❑GPS❑To ognphic )nap
(Suit or Raw No.) (cbcck box)
LOGA16(2L1p L_e, N L pEPTH DRILLING LOG
City or Town State Zip Code
(gad')- c - alba
Arca coda ?bona number
4. DATE DRILLED
5 TOTAL DEPTH 'a.S
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO II
7. STATIC WATER LEVEL Below Top of Cuing: '� FT.
(Use '+' If Above Top of Cuiag)
8. TOP OF CASING IS S FT. Above Land Surface*
'Top of cuing termlaated at/or below laud surface requires
variance In accordance with ISA NCAC IC.01I t.
9. YIELD (gpm): C 0 METHOD OF TEST 1Q.IC� ' A) R-' ^ %rn
10. WATER ZONES (depth): Z tD / — 3 0 G en--
1
1. DISINFECTION: Type 1 N - t1 O • f Amount (�3- i IP
12. CASING: Wall Thickness
Depth ter r W��ei,��;I/Fi. Material
From To 1 OS� FL 61 SO l Q V C
From To Ft.
From To Ft.
13. GROUT: Depth Materiel n Medved
From 1 To �0 Ft. C n'V�n 1'" P 0 .
FromATo /
4 — i00
t o 0 /-- i3-lr. ,
0240 t- ?50 '
294263
Formador�D escriptiopp
0 2(SuPi,ABN
vat r 6
3 o GP
CO i(-ia,� t itJ
c
O
xm
'-/1(0d-
C
From To FI.
14. SCREEN: Dcpth Diameter Slot Size . Material
From To Ft. in. in.
From______ To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
LOCATION SKETCH
Show direction and distance in miles from at le
two State Roads or County Roads. include the
numbers and common road names.
C�
J
to
16. REMARKS:
1 DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 1SANCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RECQ(tD HAS BEEN PROVIDED TO T LL OWNER
w111,A ¢-a o4DA
-
4,
SIGNATURE OF PERSON CONSTRUCTING THE WELL
-c
crA
-70
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mall Service Center - Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-1 REV. 07/2001

294262
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) (prim).5t 11 �,1k5I-t CERTIfFyICATION/ :�, 7 '7W/
WELL CONTRACTOR COMPANY NAME_RF.UBEN CALDWELL DRILLING, INC. P8ONEF4 8 .754-3581
STATE WELL CONSTRUCTION PERMIT/ ASSOCIATED WQ PERMIT/
(if applicable) d
(if applicable)
1. WELL USE (Check Applicable Box): Residential & MunicipaVPublic ❑ Industrial 0 Agricultural Q
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION: Nearest Town: LAIJn Dti-S- County LGC-Gtvx6/
K-E,Ab
(so —teatime. Numben, Community. Subdivision, Int No, Zip Code)
3. OWNER: l vv.
Address —14 1 o w S' t. A$3
LA Al t. L MC-
ar t (5
try or Town State Zip Code
(&14} bb'D-aa4
Area coda Phone number 4. DATE DRILLED s/ 3 G 7 b l/
r'
5. TOTAL DEPTH: 3 'j 9
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO 0
7. STATIC WATER LEVEL Below Top of Casing: i&f FT.
(Uas'+' if Above Top of Casing)
8. TOP OF CASING IS /fi " FT. Above Land Surface•
•Top of cute( termle•tad after below Ind surface requires a
variance to accordu,�u,L�'It► 15A NCAC2C.0t1/.
9. YIELD (gpm): / MEcTHOD OF TEST>
10. WATER ZONES (depth): k C ' -
11. DISINFECTION: Type /t<- re" Amount
12. CASING: Wall Thickness
,, Depth Diameter or Weight/Ft. steerial
From /R To / /O Ft. d . z/. 1/C�
From To Ft.
From To Ft.�
13. GROUT: Depth ur j fedwd ,1
From 0 To •zf� Ft. �,pyLt
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:
opographic/L.and setting
Ridge ❑Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrseahnimueusecuadr)
Latitude/longitude source:❑GPS❑Togo
(check box)
DEPTH
From r To /
5
CVO 4
\Gin'_ 3to'
phic map
ion Description
.to
DJ UT
GPn-\
1r r.
mG
(? nG
J ()CATION SKETCH t..7
two State Roads or County Roads. Include the roa
numbers and common road names.
Show direction and distance in miles from at leas
tWi
CONSTRUCTIONI DO HEREBY CERTIFY THAT STANDARDS, ,AAND T WASIS WE THIS ((CORD 1IAS BEEN PROVIDED TO TFi� WE[� OWNER
SIGNATURE OF PERSON CONSTRUCI1NO THE WELL MATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mall Service Center - Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. G W-I REV. 07/2001

294261
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and natural Resources -Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (prim) \L, L j c [J AS {a CERTIFICATION • a- �
WELL CONTRACTOR COMPANYNAME_REUBEN CALDWELL DRILLING, INC . PHONEQi8 '?54-3581
STATE WELL CONSTRUCTION PERMIT/ ASSOCIATED WO PERMIT/ (if applicable) ' (if applicable)
1. WELL USE (Check Applicable Box): Residential E 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:
(Strew Name, Number. Canmunity, Subdivision, Lot No, Zip Code)
Al3. OWNER: GJ N� tn9e t7 ( 6Ld
Address ois [moot R`! 1 W of
(S or Routs No.)
A5Clem('L(_ ;tJC_ e2-SVaG
ty or Town State Zip Code
rR� aS 3 — (At 4-0
Area code- Phone number
4. DATE DRILLED '/l W /0 11-
5. TOTAL DEPTH: 'il a
County i'-(.___
6. DOES WELL REPLACE EXISTING WELL? YES NO 0
7. STATIC WATER LEVEL Below Top of Casing: FT.
(Use'+' If Above Top of Coins)
8. TOP OF CASING IS / - FT. Above Land Surface'
*Top of casing lerruleated /tier below land endue requires a
variance la accord•aty with ISA NCAC 2C-0111.
9. YIELD (gpm): / METHOD OF TEST
10. WATER ZONES (depth): i-.s
1
11. DISINFECTION: Type Fi-7-14. efD Amount /© 04.
12. CASING: Wall Thickness
1Depth Diarn*, or Wzg/mt/Ft. pit
From/ ., To / �° I FL 69 if
From To Ft.
From To Ft.�
13. GROUT: Depth Material
From D To t P Ft. C`'�^-A
From To Ft.
14. SCREEN: Depth Diameter Slot Sire . Material
From To Ft. in. in.
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Sire Material
From To Ft.
From To Ft.
Topographic/Land setting
❑Ridge f $ ope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of wet! location
(depeeahninnearucooA)
Latitude/longitude source:❑GPS❑Topogjaphic map,
(cluck box) DEPTH L RILL!NG LOG
From To Formatipn Descriptio,35
`To
COO f©`'
/0/-
9,y
CJ
LOCATION SKETCH N "Mc -
Show direction and distance in miles from at Leith
two State Roads or County Roads. Include the rood
number and common road names.
W60'J iSrYL'
w/t Nteln/ \b'W P-C AO
16. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED M ACCORDANCE WITH ISA NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT COPY OF THIS REppRD HAS BEEN PROVIDED TO T WELL WNER
�/` A—� a o 4—
SIGNATURE OF PERSON CONSTRUCTING THE WELL ' DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mall Service Center- Rslelgh, NC
27699-1636 ?hone No. [phone], within 30 days. GW-1 REV. 07/2001

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources
WELL CONTRACTOR (INDIVIDUAL) NAME (prim) v k I.. L. k
WELL CONTRACTOR COMPANY NAMt_RF.UBEN CALDWELL
294260
-Division of Water Quality - Groundwater Section
V‘.) ASIJ CERTIFICATION / a-t
DRILLING, INC•PRONtY?(8 )254-3581
STATE WELL CONSTAUCTION PERMIT/ ASSOCIATED WQ PERMIT/
(if applicable) • (if applicable)
1. WELL USE (Check Applicable Box): Residential [H MunieipaUPublie ❑ Industrial ❑ Agricultural ❑
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
3. OWNER:
2. WELL LOCATION: /�`
Nearest Town: C-A ,v D L O ((— count, �V N Cc pet&
O _S J ST C.t (�-\pG` c P-0 A (>
(Street Name, Number, Community, Subdivision, col No. hip Code)
!aAG (t. 3
Address eSo J uSt'.c6 (L-tOGc G-a A D
l_A Nts l.4(Z.. eecaC— o) )-tlt5
Front 1 To 15 FL v $ � .. 1 (-
From To
From To
13. GROUT: Depth Material Method
From ear To °�O Ce ma -At DU 13
From To Ft.
14. SCREEN: Depth Diameter Slot Size . Material
From To FL in. in.
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
City Of Town Stata 21p Code
(`��Y)- i of-05i1
Area cads- Phone number
4. DATE DRILLED 4 / R 0 4
5. TOTAL DEPTH: 3°1 O
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO B'
7. STATIC WATER LEVEL Below Top of Casing. (O c FT.
(Usa'.- If Above Top of Casing)
8. TOP OF CASING IS 1 FT. Above Land Surface•
*Top of cuing taneleated attor below Ind surface require. a
variants to accordant win ISA NCAC 2C.011a.
9. YIELD (gpm): a> METHOD OF TEST �t G - A t
10. WATER ZONES (depth): i 4 0 — o U n ^"
11. DISINFECTION: Type 1t i q 0` o Amount ' 3
12. CASING: Will Thickness
Depth Duster or Wert. M (e[ia1
Fl. d V
FL
FL
16. REMARKS:
Topographic/Land setting
❑Ridge ❑Slope [Walley lat
(check apptopriam box)
Latitude/longitude of well location
(degreahutmnes/secoads)
Latitude/longitude source:❑GPS❑Topographic map
(elude boa)
DEPTH DRILLING f OG
From To Formation Description
—
7'o O(3e3
(O — ZOO Cs fi-Arrt7ci
7,Q13 r '7 a G P r✓s c '(�e 1 C-6
7� 1." " aC(a C � N (TE J
O v
-
o --
c
o
LOCATION SKETCH
Show direction and distance in miles from at lean? rc;
two State Roads or County Roads. Include the ropb c�
numbers and common road names.
J015-,c_ I('
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH ISA NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A C9Y OF THIS RECOHAS BEEN PROVIDED TO TI WE O)VNER
W11,\_,
SIGNATURE OF PERSON CONSTRUCTING THE WELL
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mall Service Center -Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-1 REV. 07/2001--
. Srv,
-J 0 iv + /J
DIA4

WELL CONSTRUCTION RECORD
2942.59
North Carolina - Department of Environment and manual Resources -Division of Water Quality - Groundwater Section
WELL CONTRACTOR (prise) NAME (prt.r L — \ G r- A S PA CERTIFICATION / a1 - 1 t
WELL CONTRACTOR COMPANY NAME_RF.UBEN CALDWELL DRILLING, INC. PRONE`11%8 ' 54-3581
STATE WELL CONSTRUCTION PERMIT/ ASSOCIATED WQ PERMIT/
(if applicable) • (ifapplicable)
I. WELL USE (Check Applicable Box): Residential IJ MunicipaVPublie 0 Industrial 0 Agricultural0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION:
11. DISINFECTION: Type
12. CASING:
Depth
From -, To -i O
From To
From To
13. GROUT; Depth
From 1 To eau
From To
14. SCREEN: Depth
From_ To
From To
15. SAND/GRAVEL PACK:
Depth
From_ To
From To
Nearest Town: e^� It fit County uutJLoMi3E-
MOtJ T 2a Co��NG� RoA0.
(Street Name, Number, Community, Subdivision. lot No., lip Code)
3. OWNER: 61t_� t Lt_E�
Address e_ b • •S c. y 5 45
/�/� (Street or Rama No.)
Irer\orri�(LeA t NC 3-15.1
City or Town State _Zip Code
(ens(- (6q— 443-8
Any coda Phone number
4. DATE DRILLED 4-/I 4" o
5. TOTAL DEPTH: `c 1 O '
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO Etd
7. STATIC WATER LEVEL Below Top of Cuing: 2 o t; FT.
(Um ''.0* If Above Top of Carina)
8. TOP OF CASING IS - - FT. Above Land Surface•
Top of casing terminated at/or War bad surface requires a
variance In accords. a wltk ISA NCAC 2C.Olie.
9. YIELD (gpm): 9' • `� METHOD OF TEST 2l 6 - A 1 iL'
10. WATER ZONES (depth): 3 `6 0 ' — ' 3 (- I��')'\
6qp — t-5 Gerr'
1-1iN 9 o`7o Amount tt l b
Wall Thickness
ter or Weight/R. p�tatcnai
Ft. ( SOg pleat!
Ft.
Material
FL CPmelN3
Ft.
Diameter
FL in.
Ft. in.
Size
Ft.
Method
pc, nib
Slot Size . Material
in.
in.
Material
FI.
Topog$ri�pphic/L.and setting
❑Ridge I3Slope ❑Valley ❑filet
(Meek apptopriuo box)
Latitude/longitude of well location
(degreuhnlouiedsocoodr)
Lail tudellongitudesource:❑GPS❑Talpognmphic�p.::_
(check box)
DRILLING LOQ
Formation Description
C a-0 6 0J
5 t ATrT
C., 12 r1 i T
C RtsV,cc `3 GQan
C� P.A rJ t Vic,
rze(,ce , 1.6 Gern
DEPTH
From / To
40
4c ' _ 6S
t: 5 '-- 3 %S C r
3gc �
3S.` / Gctc'
(Tato
(r,gr.'- i3t0'
r1
LOCATION SKETCH
Show direction and distance in miles from at left )
two State Roads or County Roads. Include they d
m
numbers and common road names.. 71 N
_n G
4-ok..
SKy"A' Boat
�ot3t(L€f1( (LCA,p
VS .7D
16. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED
CONSTRUCTION STANDARDS, AND THAT OPY 0 THIS REI
ACCORDANCE WITH 1SANCAC2C, WELL
RD HAS BEEN PROVIDED TO THE WELL OWNER
a/Ay
SIGNATURE OF PERSON CONSTRUCTING THE WELL
DA
Z
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mall Service Center- Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-1 REV. 07/2001

cats*
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Na-tur)11 Resources - DDiiv/ision f Water Quality - Groundwater Secuur.
WELL CONTRACTOR (INDIVIDUAL) NAMEc(-print) /9 r en C /l hdces re CEBTUrICATIONIRt�Z7F:_y
WELL CONTRACTOR COMPANY NAMSSLJCiTwA-TtC (Lie.lj flp: I I;/IG PHONE i Gilt' eT'QLirc
STATE WELL CONSTRUCTION PERMTTM ASSOCIATED WQ PERMIT*
(if applicable) - (if applicable)
1. WELL USE (Check Applicable Box): Residential f3 Mtmicipal/Public 0 Industrial 0 Agricultural
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCAT[ N:
Nearest Town:. LA)S'I eni County_ _U/1t:0
(Street Name, Nurnberg. Community, ( Subdivision, La No., Zip CM',
3. OWNEADOS�vA. 1t. E
V5- wA N revs Rd 217s3
Topo RLattd setting
❑Ridge Gliclope 0Valley ❑Plat
(check appropriate box)
LatitudeJlongitude of well location
(dcgeelninuatifsemo. )
Address amiptir LONG Rei Latitude/longitude sour:e.DGP50Topographicn
(Street or Rome No.)
SwaWA-iuoct $JC-
_ (check box)
2107 7 DEPTid DRILLINGS LOO
City or Town State Zip Code From To Formation Description
Area code- Phone number
4. DATE DRILLED /O "/ 3 -0 '--
5. TOTAL DEPTH: for
6. DOES WELL REPLACE EXISTING WFI t ? YES 0 NO
7. STATIC WATER LEVEL Below Top of Casing: JO FT.
(llse't' if Above Top of Caeutg)
8. TOP GE CASING IS • ! FT. Above Land Surface'
'Top of caning terminate/at/or below land aura regatta a
variance in accordlece alp
ISA NCAC 2C.O11B. ,r• /
9. YIELD (gpm): a METHOD OF TEST /t/l7PA
10. WATER ZONES (depth): / 90
1I. DISINFECTION: Type C J4l N. Amount /0 of
12. CASING: Wall Thickness
Depth Qi er or Weight/Ft. Material
From 0 To.LQ-Ft4 Greta'
SDR`2/ Put
From__s To Ft _
From To Ft
13. GROUT: Depth Depth Material Tv
Frorv.�p.To Z.S Ft`a/Wit le _
From // To Ft.
14. SCREEN' Depth Diameter Slot Size Material
From To Ft in, in.
From __ To Ft. in. in.
15, SANDi,r VELPACK:
Depth Size Material
From To Ft.
From To Ft.
REMARKS:
1 DO HEREBY CER
CONSTRUCTION
T THIS WELL WAS CONSIRU
ARDS, AND THAT A ' ��.�' OF
ATURE OF PERSON CONS
p
LOCATION SKETCH
Show direction and distance m miles from at least
two State Roads or County Roads. In • ude the road
numbers and common road names.
•
t t
•
CCORDANCE WITH ISA NCAC 2C, WELL
BEEN PROVIDED TO THE WELL OWNER
CTING THE WELL
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. OW-1 REV. 0712001

WELL CONSTRUCTION RECORD
North Carolina - Deparnnent of Environment and Na Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) _ i► /1. i` EA/% CERTIFICATION:#Zp9,i�7�7Q
WELL CONTRACTOR COMPANY NAML5W t!C f lfJ /4 )tG I� W [.t/ 7 YIINf /1-TAl�Ion a
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT/
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential W Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery ❑ Heat Pump Water Injection Cl Other ❑ If Other, List Use
2. WELLLLfLOCATIO
e
(Let
��� G Ps iv r' m7
Co
(treet Name, Number, Community, Subdivision, Lot No., Tap Code)
Address rr{{
3. OWNER:1Q4 G ES �f N
/fJbvf Gi f{
or Rare No.)
c_ hPp Rtej /' Al 2.17
City or Town State Tap Code
Area code- Phone number
4. DATE DRILLED /Q -• 3 ' oaf
5. TOTAL DEPTH: Z Z S'
6. DOES WELL REPLACE EXISTING WELL? YES NO 1
7. STATIC WATER LEVEL Below Top of Casing: 'S • FT.
_ (Use"+- if Above Top of Casing)
8. TOP OF CASING IS l• 5 FT. Above Land Surface'
'Top of easing terminated at/or below land surface requires a
variance In aceordaace with ISA NCAC 2C .0118.
9. YIELD (gpm): 10 METHOD OF TEST Tim
t' P
10. WATER ZONES (depth): 7 S
11. DISINFECTION: Type C. H. B. Amount /Q 02
12. CASING: Wall Thiclmess
FromTo 70 Ft. G %4/ sPinn_( /t nC
Depth
From To Ft. _PI
From To Ft
13. GROUT: j Material
From / To 7(9 FCenrie/t t Ns�
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
FroFt. / To
From / To Ft.
16. REMARKS:
303802
T c/Land setting
[Midge Slope Malley ❑Flat
(cheek appropriate box)
Latitude/longitude of well location
(des a/minutedsec )
Latitude/longitude source:❑GPSDTopographic map
(check box)
DEPTH DRILLING LOG
From To Formation Description
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or t , unty Roads. Include the road
mad$As
numbers and co
7.0 INAN
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUC ItU 1N ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRi CTION STANDARDS, AND T COP S RECORD HAS BEEN PROVIDED TO THE WELL OWNER
f 'L'itL- /D
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center -Raleigh, NC
27699-1636 Pbone No. [phone], within 30 days. GW-1 REV. 07/2001

WELL CONSTRUCTION RECORD
North Corium,' - Defiant vent of Fm-ironmenl and Natural Resoure - Division of Water Quality - Groundwater Section
sAT:LL CONIR,U'TOR (INnIA II)( 41) AA%1L ��_(pr��winyyyt:,,)y- / (r )+j{'y- //�y � j� r_,� C'ERTl 1CATION 4210.
\\Et.I. c'ON1R \CTORCOMPA\1'N.1NF_7,( V.l_M1I�+KL 11J r\�YHONE: p � D) /jA7-L53.J
-j 1 :1SSOCLII'!I) \\Q PERM I Eft
Si'\Tt: \\ ELL t'ONSTHt:CITON PERMIT#
(if rpplienblel
(lf cppileab!e)
WELL USE (Check Applicable Box): Residential Ad hltmicipaCPubiiC 0 Industrial ❑ Agricultural 0
Monitoring 0 Re.covery 0 Heat Pump Water Injection ❑ other 0 If Other, List Use
2. WEI L LOCA ri N
Nearest Town'
! Tb'C County Cti)
5v.5Rr Crcet eLitasi l�r 228'%6
I SI.'.0 N;:cue Nn:ubns. C omntuNIY. Subdivinon, Lot No.. Zip Code)
e R
O NLit TT
\ecir s, r
Loy or to Slate ( Zip Code
Area code- Phone nut(tb:r
A. DATE DRILLEQ
5. TOTAL DEPTH] _
6. DOES WELL RLPLACE EXISTING WELL? YES 0 NO 1
7. STATIC WATEit LEVEL Below Top of Casing: Ob FT.
Use "+" if Above '(op of Casing i
ti TOP OF CASINO IS 1 FT. Above Land Sur ace•
-top of casing rcnninated atlor below land surface requires a ,
rariaucr in accorddv' wit 1SA NCAC 2C Al Is.
y1ELD (gptnl: —
ktvtsi rwN��
G>D
rC�ru.S
J_
e METHOD OFTESS1Co Kies ,
lo. WATER ZONESI(depth): 02�10
! i. DISINFECTION: Type I3\157 Amount 7-
12. CASING: Wall Thickness
Depthh Diameter or W'c:ght/Ft.
From e) TO_1 % Ft.
From To ___. Ft.__
From Ter Ft-
!3. GROUT, Deipth n Mareria'1
FrOM To
From_ To_ Ft.
14 SCIRFEN. Depth i)iatneicr
1 i urn To Ft. in
From Trl_ Ft to
15. SANID GRAVEL, PACK:
Depth Size
Front To Ft.
Fr :n TO I't.
16. REMARKS.
Material
Method
►C
Slot Size Material
in
in.
Matcr,ul
303189
Topo�gr�ohiciLand setting
❑Ridge LBSIope ❑Valley ❑Flat
(check appropriate hos )
Latitude/longitude of well location
(degrees:nunmesisecondsl
Latitude/longitude source:❑GPS❑Topographic mai)
teheek'box)
DRILLING LOCH
Formation Deseriptte
DEPTH
From To
LQCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common road names.
ICI •-TLtrfCR e c(C.
EAele7s rlfiv. Ra(
. Ra_
I DO (HEREBY CERTIFY THAT rifts WELL WAS CONSTRUCTED IN ACCORDANCE WITH I5A NCAC 2C, WELL
CONSTRUCTION STANLt ..RDS. AND THAI A COPY OF THIS RECORD HAS BEEN PROVIDED TO I HE WELL OWNER
!T)61/(
SR iN
ERE OF PEItSON CONSTRUCTING THE WELL
Submit the original to the Division of \\ ater Quality. Groundnater Section. 1636 Mail Srr ice Center - Raleigh. NC.
'-'699-1636 Phone No.',19I9) 733-3221, within 30 days. CiW-I REV. 07.20012

303188
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources• - Division of Water Quality - Groundwater Section
\\ t:LL CONTRACT(); (INI)IVIDIiA I.) NAME `(prrinntt)) }/. a�tY•(
'14
\%EI.L CO\7RAC'IOa COMPANY NAME flee �/kV-(�Lica
SI' ATE%%ELL Co\s'tltPERMIT,*i�\ PERMIT
(if appi ic#tele )
y(n CERTIFICATION #Z40.
- A 111J •1NPHONE # 4Lp) 613q 7
ASSUCIATEn %\Q PERMIT# �l
of apphcah'.et
I WELL. USE (Ch}ck Applicable Box): Residential 0 Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring ❑ Recovery 0 Heat Pump Water Injection 0 Other 0 If Othet, List Use
2
WELL LOCANe• rest AiDIt /
1 Srcet N:nne. Numbers_ Community, Subdivision. Lot No.. Zip CAte)
3 OWNER:
Address
tSucet^^or�'�'' No
/v
City or Town: Stale
(__I
Area rode Phone ouipocr
4 DATE DRILLED
5. TOTAL DEPTH_;T�___
6 DOES WELL REPLACE EXISTING WELL? Y ❑ NO
7. STATIC WATER LEVEL Below Top of Casing: VC FT.
(Use "4" if Above 'fop of Casing,
8 TOP OF CASINO IS 1 _ FT. Above Land Surface*
'Top of casing tcrthinated at/or below ,and surface requires a -'
rariance In accord �jn'e with ISA NCAC 2C .011F.
YIELD win):' METHOD OF TES i• delft
10. WATERZONESlydepth):
Topogra Ic•Land setting
❑Ridge lope ❑Valley ❑Flat
(check appropriate bon)
Laiituderiongitudc of well location
t degreesanowes secondnt
Latitude/longitude souree0GPS01 opographic map
'check box;
PTH
From TO
9
Zip Code
I . DISINFECTION': Type _-_t f_ Amount 7.-
12. CASING: Wall Thickness
Depth Diameter or Weight/R. Material
From D TO Ca. Pt.
From_Tp Ft.
From _ TO Ft.
13. (,ROUT: Depth Muxrial /,, me.,
Fr„n, To Fl i �C__. u(
From To Ft. _t-----
14. SCRIiFN: Depth Diameter Slot ,Size Ma:enal
I7nmTO Ft. tn. in.
Ron) ToFt. m. _ in.
15. SAND/GRAVEL PACK:
Depth Size Material
Prune To Ft.
From To Ft
Io REMARKS
DRILLING LOC;
Formation Desc option <
O
'Tim
_art —1
rei
an rrrrt_
<
o �Cti
Cr-1
LOCATION SKETCH
Show (tirea.on and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common road names.
r
of b CANDI-2
a
I DO HEREBY C LR HUY THAT 1TIIS WELL WAS CONSTRUCTED IN ACCORDANCE KITH I5A NCAC 2C. WELL
CONSTRUCTION ION STANL RD�S. AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THEE WELL OWNER .
( SIGNATURE OF PERSON CONSTRUCTING THE N-i: Li. ATE *
Submit the original to the Ok ision of Water Qualify, Groutdn ater Secliun. 1636 Mail St ice Cen,cr - Raleigh, NC
27h 9-Ih36PhoneNo.[phone],Ssitbin30daes. GW-I REV.07'200)

3 OWNER
4
5
6
7
I)
10
Address
S EN'(E\\ ELI. ( ONS'RLC LION PERMIT*/
cif applicble,
I. WELL LSE 1C hick Applicable 13ox)' Residential I°/ MunicipaCPublic ❑ Industrial 0 Agricultural ❑
WELL CONSTRUCTION RECORD
North ( arohna • I)$aruncnl of Ern iromnent and Natural Resourcusu- DI ision of Water Quality - Groundwater Section y,
)\ELL tONTRACIo 113D111DUAL) NAME
��_(p,,,rrrr,,,iyynnrr,,—/}%,+y-�yY�rY '�L5 //may �'` CERTIFICATION p4/ �•O�.+Z
tAF.LI.CON"IRvirrog COMPANY NAMEAappaeAre^�� i_ K. 1__Y•_L��=13 PHOS'E#tzS !u 7
-I , \SSOCIAIED \\Q PERMIT./
I if applicable)
303187
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCA
Neale t Town: fr.( C tulry t�nrw_4J1 WiV
B' SQt � :
( Si reel N. Ni„. s.l oinin unity. Subdivision- Lot No.. Zip CtJe)
7D wD fiLla—
1 S I e0 1 c N o I
kcv; I Eel ,t aiyocn
l n+cn Fwte Zip Code
Arca c,xle Phone number
DATE L)RILLEIb
TOTAL DEPTF:i
DOES WELL REPLACE EXISTING WELL' YES C7 NO C'!'
STATIC: WATER LEVEL Below Top of Casing: RFT.
(Lae "a" if Above lop of Casing;
TOP OF CASING IS FT. Above Land Surfaces
-lop of casing lerrminared al/or below land surface requires a
variante In accord nnnLe//with ISA NCAC 2C.0118. //11>71c
YIELD(epm): "TMETRO3 OF TES 1• (iW%
WATERZO'NES4depth): ,2Gae
)pographic)Land setting
edge OSlope ❑Valley OFIat
(check appropriate box)
Latitude/longitude of well location
tdcgreesr nunuftYseconds)
Latitude longitude source:OGPSOTopographic man
;Meek box)
DEPTH DRILLING LQQ
From To Formation Description
11. DISINFECTION:Type M Amount Z-
12. CASING: Wail Thickness
G� Depth Diameter or Weight 'El Material
From f J To 4Y. Ft.
From To Ft.
From TO El
13 FrimtfGROUT,Depth /t g
From; To Ft. _____
I1 SCREEN: Depth Diameter 5101 Size Mn,era:
1-1-0r1l To_Ft.In. in.
Fru:11_—_._.. TO.___. FL in. in.
15 SANi)/ORAVEL PACK:
Derli Size Malcr;ul
From To It.
16 REMARKS
Method
-
-1
LOCATION SKETCH
Show direction and distance in miles from at least
nao State. Roads or County Roads. Include the road
numbers and common road names.
'K&3&ERd,
DO HER 01' CLR IIFY AT IHIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH I 5A NCAC 2C, WELL
( )NSTI. 'TION STANDARDS. AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER -
SIGNATURE c)F PERSON CONSTItLCTING 1 HE WELL
ATE
Submil the original to the Division of Water Quality, Groundwater Section. 1636 Mail Service Center - Raleigh, NC
21699-1636 Phone NO. 019) 7.33-3221, within 30 days. GW-I REV. 07/2001

WELL CONSTRUCTION RECORD
North (':unlin - Ihturtmcnl of Environment and Natural Resourc
W1:1.L CON'TRAC:'u)* (1NDI\'IDIIAI.) NAME (print,
NT:I..',CONTRACTOR COMPANY N %ME
S I'A'IE \\ ELL CONs'rinu('IIo' PERMIT#
t if applighble)
303186
- Division of Water Quality - Groundwater Section yy,,
CERTIFICATION =LLp.
AI b PHONE # j -1�.3
ASSOCIATED WQ PER\IT#
t if applicable)
/
1. WELL USE (('hick Applicable Box): Residential 0 Municipal/Public 0 Industrial ❑ Agricultural ❑
Monitoring 0 Recovery 0 Heat Pump Water Injection ❑ Other 0 If Other, List Use
2. WELL LOCA'I4 N:
Neure.rit Town.
Diu- C-.o(mty_
ocoL act.
I Sires: Name, Num1><ra Community, Subdien.on. Lot No.. Zip C Je)
OWNER F P(AJ &/3IA-S
: Midi css _f�!(e �= (� ''7�
elm Diejki,c.N Not QC 5?
11'J �s
Cpry or Tulin State Zip (ode
1 I•
Alta code- Phone nu{lber
4 DATE DRILLED
5. TOTAL. DEPTHj�,�F_ _ /
6, DOES WELL RtPLACE EXISTING WELL? YES /❑\ NO C7
7. ST.A'rIC WATE�t LEVEL Below Top of Casing: 6-v ET.
(Use "s" if Abave Top of Casing)
8 TOP OF CASING IS I _ FT. Above Land Surface"
'lop of casing tert*inaied atior below land surface requires a
variance In accord ore with ISA NCAC 2C AMR
9. YIELD(gpm): 12b METHOD OFTES' 1._edal
10. WATER ZONESII.(depth):
I L DISINFECTION: Type__ 1 1-sg._ Amount 7.-
12 CASING: W'a'.1 Thickness
Depth ham/ Diameter or Weight/Ft. Maier:al
From, ff) T01Qt Ft
From To_ Ft._
Froth To Ft. --
I_4. OR O Li'l- Dppth N1awria! Method
(0 To Ft.�x�i1 Q'r'lL�i�--
From TO Ft.
14 SIC KEEN: Dgplh Uimmetc
I ins ro 1-I. io
Hun] _ To Ft. In
:5. SAND%GRAVEL PACK:
Dearth Size
From .
Fenn TO _-- Et.-'_._----
I6 RFVL\RKS.
slot size
in
in
Material
Material
Topog .phiciL.and setting
❑Ridge Slope ❑Vailcy ❑Fiat
(check appropriate hen.:
Latitude/longitude of well location
triegreesontnuiesisecoridsi
Latitude.'Iongnude source.DGPS❑ i epographic map
ICJC,K n0%1
DEPTH DRILLING LOG
Fi em To Formation Description
tg rim
LOCATION SKETCH t DC
Show direction and distance in miles from at toast
two Suite Roads or Count; Roads. Include theroad
members and common road names.
19- t 3
J
JCemi..tcdLout a.
1 DC) HEREBY LIE It 11)-". THAT ll-IIS WELL WAS CONSTRUCTED IN .ACCORD.ANCF WITH I5A NC AC 2U. WELL
CON'STR 1CTION S ND RDS. AND 1 HAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO HE WELL OWNER
_/ram/l
S ;NATURE OF PERSON CONSTRUCTING 7HF. WELL
Submit the original to the I)i% ision of \\ diet Quality, Ground.. titer Section. 1636 %fail Service (enter - Raleigh. NC
27699-1636 Phone Nu.(919) 733.322I. within 30 days,
(.i W -I REV'_ 07,2001

WELL CONSTRUCTION RECORD
303185
North (:irobna - Doi - hutment of Ent ironmenl and Natural Resowc"� - Division of Water Quality - Groundwater Section
_ stir
\\ ELL ( OVER %(- I OIL (INOI\9nLAI. ) NAME (prtnr)
w t. CONIR.WI OR COMPAN\'
S I ATE %\ EI.L ( ()\S fiRLC7IO\ PERMIT
(ifappl;hle)
talcs(
K.
CERTIFICATION
Ai II PHONE # at tan?
ASSOCIATED WQ PERMIT#
tit -applicable)
I. WELL USE It heck Applicable I3ox): Residential UV/Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other ❑ iiOther, List Use
WELL LOLAi.__/
Nearest Town
11 DINE
County 6lAsXC-o—
(ci ec Name. Nembfrs. C'nnnnunity. Subdivision. Lot No
OWNER S
/ ,p\fn1 [(snect / -- uttc C) y u J
. ,::rt ;,,.,, Score
( ode. Phone nurpber
4 DATE DRILLE0
5. TOTAL DEPTH]
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO Er
7. STATIC N`ATER LEVEL Below Top of Casing: /< 0 FT.
(Use" it Above Top of Casing)
8 TOP DE CASINO IS _ ' FT. Above Land Surface*
''fop of aaaing terI inated at/or below land surface requires a
ariatiee in accordf nce with 15A NCAC 3('.0i 18. leo
e' TF F TES
YIELD 4
t
Lem
cs vf-T
Zip Cock
Zip Code)/
ArC
Topogr is -Land setting
DRidge lope ❑Valley DElat
(check appropriate bon)
Latitude/longitude of well location
(dcgreesinun a les'senmds )
Lainud::9ongitude source:CGPS❑Topographic map
(Check box)
DEPTH
From To
DRILLING LOG
Formation Dcscriptiorb
-O
mil
--1(Ti
n
— f+l
c) gp!n)METJ I. (d
II. WATER 70NGS�l ile '.
I Plhj
II DISINFECTION: Type iiii gi_ Artiount Z
12. (.CASING: Wail Thickness
Depth e) Diameter or Weight/Et. Material
Fran TO 12i Ft
From TO Ft. --_-- --.-_-
Fcnn TO Ft-_
I. li Ri)(fi.. Dgpih NI —cna Method
From To Ft.i t� �_
Pont TO Ft
I S('R I" FN. DONI1 Dien'.eter Slot Sizc Aletetia'.
) turn To Ft. in. in. ,_--_--
1-tom To_ It. m. in.
15. SAND/GRAAEL PACK:
Depth Srzc
!trout To Ft.
From TO Ft
REMARK'S
\lateral
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common road names.
I?c)L
Cizzt • #oz
I DO HEREBY CUR I IFV' THAT THIS WELL WAS CONSTRUCTED IN AC:CORDANCF WITH I cA NC.AC 2C, WELL
CONSiRV-DON STANDThIS,AND-IHAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE. WEL OWNER
____SH!NATL RE OF PERSON CONSTRLCI INC THE WELL. DATE
Submit the original to the Division of \\ ater Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
277699-163n Phone No.it919) 733-3221, within 30 doss. CiW-I REV. 07/2001

WELL CONSTRUCTION RECORD
303184
North Carolina - Department of Environment and Natural Resourc - Division�/of Water Quality - Groundwater Section y
WELL CONTRACTOR (IN'DI\'IDUAL)NAME �_�(p,,,riinu}}}taaa) [. d�rYr'Y K.
✓ //�� II U CERTIFICATION tt�}7IIO
WELL CONTRACTOR COMPANY NAMEFife it Cit. ( K.. 11— I c 111, )\ PHONE # gist 6Q 51? 3
STATE WELL CONSTRUCTION PERMIT# •'' 11 ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential /Municipal/Public 0 Industrial ❑ Agricultural ❑
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCA `it 1 ti lA3C
Nearest Tow ^^�� Couny �U1`I`d.J
(Street Name. Numbers,Sm
Community, Subdivision,
,LLott No.. Zip Code)
Nu
3. OWNER: I �06 Q-' RrcQk
Address l(D TA MEL LM3
City or Town State I Zip Code
( )-
Area code- Phone number
4. DATE DRILLED 9lalo
5. TOTAL DEPTH:
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO Er-.
7. STATIC WATER LEVEL Below Top of Casing: (OO 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): MEAT O OFTES'1 $1.11R�!Nh
`i
10. WATER ZONES (depth): 00
Topogr is/Land setting
❑Ridge El Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From To Formation Description
11. DISINFECTION: Type (C7 Amount Z
12. CASING:
Depth Diameter
From E J To Ft.
From To Ft.
From To Ft.
I3. GROUT: Depth Material //e�, Method1
From To FL�N Ci e +i
From To Ft.
14. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in.
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
Wall Thickness
or Weight/Ft.
O
O
n
—1
IV
t A
r—
LOCATION SKETCH .�
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
Material numbers and common road names.
16. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH I5A 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
Submit the original to the Division of NVater Quality, Groundwater Section. 1636 Mail Service Center - Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-1 REV. 07/2001

Mlle-- Count\d.i e_cm6
DY.
Streei N io. Suhd'vi.,. on. Lot No.. Zip Code)
O\1NL.R NC* R-€, `xr-rer)
` '`I 'I'o Route no t ^
�t\3N 1� ,,.. C. CegeltP
( rc oc tow*: ) Stem ZIP C-odc
Topogr tc/Land setring
Nei ne l Lc yi. E]Ridge Slope ❑Valley ❑Flat
'check appoipnatc non:
1_alitudellon-gitude of well location
Arco code Phone nuq.ber
4. DATE DRILLE[j
5. TOTAL DEPTH: r
6. DOES WELL REPLACE EXISTING WELL? YES❑ NO L7
7. STATIC WATER LEVEL Below Top of Casing: 0 ET.
;Use ' if Above Top of Casing)
8 TOP OF CASING IS I__ FT. Above Land Surface' -
*Top of casing terminated a1or below land surface requires a
variance In a ccnr¢¢a�jj. ISA NCAC 2C .0!18.
YIELDtepin:lS• METHOD OF TES $1. Aden
10. \1'A fER ZONiiS'(depth): 100
Ideprees t iessec rods)
Lain lidnsuude sourc\ ❑UPS❑] opographic man
ii.ck box)
DEPTH QFl ._ING LOC;
Ei orn 'Fe Formation Description
r,
WELL CONSTRUCTION RECORD
303183
North ('.irolinu - 1)i4 arnu•ni of Environment and Natural Resourc - - Division of Water Quality - Groundwater Section
\\ELL (Px I R.\l-T Olt (INDI\IMCA I.) NA]1E (prim)
\I E1.1 (O" I'R.\(" Mt COMPANY N %AIL
S1 Silt N EI.1- CO\S tHLC"1I0\ PERMIT#
,df:tpplh:er leI
tERTIPICAYIONp?,Ue
*IJsdJJ %PHONE Nt. anL3
ASSOCIATED MI) PERMIT#
of applicable)
WELL USE iUheck Applicable Box): Residential If< Municipal/Puhlic ❑ industrial 0 Agricultural 0
Moniiering Recovery ❑ Heat Pump Water Injection 0 Other 0 11 Other, List Use
WELL LC)CAfi(1N.
I I. D!S(NF'EC"fi0)`f: Type_._%inf_ Amount Z
12. CASING. /0. Wall Thickness
Depth Diameter or Weight/Ft. Matcriul
FromED TO__-- Ft.
From, ____ To_
Ft.
Fron: To 1-1.
1 4
From
T: Depth Iv7a;erid � yoentoe
Ft,r: �ro bt i. �'�''
I rune_.— To- Ft.
14 SCIZLl.N: Depth Diameter Slop Sat
Flont To FI. in. in.
From _'_ To Ft. in. in.
:5. NAM) ()NAVEL PACK'.
Depth Size Malerta
from Trt Ft_
Own __---- Tr) _--- Ft.__
16 RE.NIARKS
Maas as
O 0
~ >0
C0
r
LOCATION SKETCH "a
Show direction and distance in miles from al IcaTF
two State Roads or County Roads Include the road
numbers and common road names.
1a-a3
Dewve�v�e� IZL�•
I DO i1L111 iY CLR i1F\ THAT OHS WALL \VAS CONSTRUCTED IN ACCORDANCE W!Til I5A NCAC 2C, WELL
( ONSI'R1 i0N N'T \ 1.).AR DS AND THAT A COPY OF THIS RECORD HAS BEEN PROAIDiD TO 1 HE,WELL O`9INN'E
SIiiNATURF OF PERSON CONSTRUCTING THE WELL LI.AT6
Submit the original to the Ui\ ision of Water Quality. Groundn ater Section. 1636 Mail Scnice C enter - Raleigh,.KC
27hyt%-163i: Mimic \o. I`114) 733-3221. within 30 days. GW-1 REV. I i 12oC'1

303181
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources -\Division of Water Quality - Groundwater Section f
WELL CONTRACTOR (INDIVIDUAL) NAME (print) A �� I�K WI 'E 1 1 S'(� �� CERTIFICATIO/N # Q0.�12 -t
WELL CONTRACTOR COMPANY NAME 1 S N II� 4 (A.)&L � i 1 I I 1 '�`i PHONE # (S(d2l G f l- let.c.3
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable)
(if applicable)
1. WELL USE (Check Applicable Box): Residential i Y Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATI
Nearest yTown: �((flliEKf County Ep.
(St° Name, N ben,Cwtmuniy, Subdivision, Lot No Code)
`� D 7 s
3. OWNER: (`.E
Address'JO
E nife
7q-4 Chu (l Kc(.
(Street or R
VEiUilIF
City or Town Stoic
R9fll
tip Code
opographic/L and setting
idge ❑Slope ❑Valley ❑Flat
(check appropriate lox)
Latitude/longitude of well location
(degRdmim teMsec s)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From To Formation Description
Area code- Phone number ..
4. DATE DRILLED r 0- O
5. TOTAL DEPTH: — /
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO Liz
7. STATIC WATER LEVEL Below Top of Casing: 91 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS I FT. Above Land Surface*
'Top of casing terminated atlor below land surface requires a
variance In aecordanp itb ISA NCAC 2C .0118. /1 1 QO (
nric
9. YIELD (gpm): .2 ME O& OF TEST `TUl_
10. WATER. ZONES (depth):
11. DISINFECTION: Type iltss. tSk-e- Amount vL
12. CASING: Wall Thickness
y� t1y., Diameter or Wei t/Ft
Fromy WO Ft To
From To Ft
From To Ft.
13. GROUT: Depth Material
From To
Material
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common road names.
Method
V) D M tt.5 H t �I
f�
FL C MQZL+Z ?o us' —ni
From To Ft.
14. SCREEN: Depth Diameter
From_ To Ft in.
From To Ft. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
Slot Size Material
in.
in.
16. REMARKS:
b
4
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH I5A NCAC 2C, WELL
CONUCTION $TAN19y4RDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE�%V
WELL OWNERW7
O 7,,,;
DATE
SIGNATURE OF PERSON CONSTRUCTING THE WELL
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-1 REV. 07/2001

303180
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural ResoIrcees - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) LA Ry (hi edII � '5CERTIFICATION fl �G 05
WELL CONTRACTOR COMPANY NAME AppA LAM'? R Ad1/Air„ tI
STATE WELL CONSTRUCTION PERMIT,/ ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
PHONE r (i/WI Ca 3- 902023
1. WELL USE (Check Applicable Box): Residential E Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other ❑ If Other, List Use
2. WELL LOCATION:
Nearest Town: ',bee5+e -
Countyi3U.NCGn't&
(Street Name, Numbers, Community,
Subdivision, Lot No., Zip Code)
3. OWNER: I ( lea l' 15�EC
Address 0.3(o tu,tlN 137.l4MCk Ka .
iftersf rtittrect orVr°.) a87,6g
City or Town State Zip Code
6 4-
Am code- Phone rem
. -
4. DATE DRILLED '
5. TOTAL DEPTH- LO5 /
6. DOES WELL REPLACE EXISTING WELL? YE�8 NO IV
7. STATIC WATER LEVEL Below Top of Casing:.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS I FT. Above Land Surface'
`Top of wing terminated at/or below land surface requira a
variance in accord 15A NCAC 2C .011t p ( PAs 1!.-, 7y,,, r
YIELD D OF TEST L�A+�' J�UAJIq.'I tx.►.
10WATER(depth).
TopoiclLand setting
❑Ridge lope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(de�lndnut /seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEL' SIT DRILLING LOG
From To Formation Description
9.(gpm):
ZONES
11. DISINFECTION: Type I1°s Amount
12. CASING: Wall Thickness
Diameter
From To tlp5 Ft or Weight/FL
From To Ft
From To Ft.
13. GROUT: Depth /�
From To P4 A��- POuM
From To Ft.
14. SCREEN: Depth Diameter Slot Size Material
From To Ft in. in.
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
Material numbers and common road names.
}tW v C93
taZoL) 81 r cij
4.5€iN 13Kainc
a, -r,a7
_~ bn
to ril4
CaC0
r +�. G'
r__._
4
16. REMARKS:
I DO HEREBY CERTIFYhTHAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH ISA NCAC 2C, WELL
ARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
DATE
CONST&HCTION
S1
ATURE OF PERSON CONSTRUCTING THE WELL
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleiglt,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 - Grotmdwater Section �{
WELL CONTRACTOR (INDIVIDUAL) NAME (print) �t Il�Ky We I I � CERTIFICATION it ��0./
WELL CONTRACTOR COMPANY NAME hp ftLA C'li/SN L,Je l Dg111 iNj3 PRONE # (2&81683- 92a3
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable)
(if applicable)
1. WELL USE (Check Applicable Box): Residential d Municipal/Public ❑ Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATI N:
Nearest Town: MIA/ County
15QhtctrDea, we, 1givmvie*/ 28'
(Street Name, Numbers, Community, Subdivision, Lot No-, Zip Code)
3. OWNER: Un*SON
Rp�Zy
Address rho F'\P.MNKLI �,A%iQ,
Ar Ile (Street aunt na
8805
City flown Star Zip Code
Area coda Phone numb%'
4. DATE DRILLED ' CI ' � I
5. TOTAL DEPTH: rig
6. DOES WELL REPLACE EXISTING WELL? YES lC � NO Ei/
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS I FT. Above Land Surface*
'Top of casing terminated atlor below land surface requires a
variance in accordance wit:1SA NCAC 2C .0115.
7. STATIC WATER LEVEL Below Top of Casing:, FT.
1/Topographic/Land setting
Ridge ❑Slope 0Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrw/mimdas)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH PRIL.LING LOG
From To Formation Description
9. YIELD(gpm): I '}. METHOD OF TEST GAL. Col•tbzimeic
10. WATER ZONES (depth):
11. DISINFECTION: Type I A L3 f et Amount o2
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft Material
From To 9 Z Ft
From_ To Ft.
From To Ft.
13. GROUT: Depth n�1 _�-�M�aterial Method
From To FtCtN €& Pou,3
From To Ft.
14. SCREEN: Depth Diameter Slot Size Material
From To Ft in. in.
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
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.
Kwi
GxptvairiED
Chi /SA Dee) (ANeM
16. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRU(.1 hU IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONST3UCTION STAbjDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
IGNATURE OF PERSON CONSTRUCTING THE WELL DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-1 REV. 07/2001

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Reso/ur�
WELL CONTRACTOR (INDIVIDUAL) NAME (print) /312 W
A(AC.AUi
WELL CONTRACTOR COMPANY NAME
STATE WELL CONSTRUCTION PERMITS
licable
3031.1
es - Division of Water Quality - Groundwater Section
`t L5 CERTIFICATION #200S
U Dgi« 1 At G PHONE UPtili 6 9-22,4
OCIATED WQ PE
if aoolicable
I. WELL USE (Check Applicable Box): Residential la" Municipal/Public 0 Industrial ❑ Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection ❑ Other 0 If Other, List Use
2. WELL LOCATION:
Nearest Town: i Coun
N (ZIAL C$et. . La
(Street Name,,-KNNu-m(ben, Community, Subdivision, Lot No., Zip Code)
3. OWNER: 1N 3*ekklAm±
Address (1.9% O bb.
-i¢X M1bQt1rNtNn.) A84,0)
City or Town State Zip Code
Area code- Phone mum
4. DATE DRILLED
5. TOTAL DEPTH. itil!C
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO I
7. STATIC WATER LEVEL Below Top of Casing: Ff.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS 1 FT. Above Land Surface*
`Tap of wing terminated at/or below land surface requires ■
Topograp(iid/Land setting
❑Ridge irnSiope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(de8as/miwtesheconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH pRILLING LOG
From To Formation Description
variance In accordance with ISA NCAC 2C .0118. /�'tI,, r
9. YIELD (gpm):5' O METHOD OF TESTC,AL-.Ct3N'EAiIfl
10. WATER ZONES (depth): 'I 30 , (+3
11. DISINFECTION: Type IATitef Amount g
12. CASING: Wall Thickness
TTTo Diameter or Weight/Ft. Material
From V Ft
From_ To FL
From To Ft.
13. GROUT: Depth Material -/ Method
From To Ft CoNCre TfG ? (n IZ
From To Ft
14. SCREEN: Depth Diameter Slot Size Material
Frog( To Ft. in. in.
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
0
N
Ts
� n1
jACATION SKETCH coo Po<
Show direction and distance in miles fro> r'at 1
two State Roads or County Roads. lncluer-the r—
numbers and common road names. -
c o LUCQ.S+ Cc {l W y.
T3V .&.
16. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH I5A NCAC 2C, WELL
CONSTRUCTION STARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
/Q�l tad C1
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

30317
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Naturral Resources /- Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) ERR W,Q+I1I5 Wilt CERTIFICATION#
WELL CONTRACTOR COMPANY NAME A?f LACE Y if h M ,NQI N
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
PHONE # (it%igl 685- (era '3
I. WELL USE (Check Applicable Box): Residential ❑ Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION:
Nej*est,Town: Al VI /L)n/ County lANQO
lU (T AIN of. NQ QjI i
(Sleet Name, Numbers, Community, Subdivision,
Let No., Zip Code)
3. OWNER: ak Pt�I II � QQI
Address A14 QA'KOL D
N-Au-l-a Q TQor '1 rt5 169i
City or Town State Zip Cade
(_.-"
Area code- Phone number
4. DATE DRILLED 1- -AD -O'
5. TOTAL DEPTH: 35' /
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO ICJ
7. STATIC WATER LEVEL Below Top of Casing: c/0 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS / FT. Above Land Surface*
flop of rasing terminated at/or below land surface requires a
variance u accordance with 1SA NCAC 2C .0118.
9. YIELD (gpm): 10 METHOD OF TEST
Topo hic/Land setting
❑Ridge Slope ❑Valley ❑Flat
(check appropriate boa)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
( box)
DRILLING LOG°
Formation Descriptirc
DEPTH
From To
U' A .@ot tnir aiz
10. WATER ZONES (depth): 80. /G . /0, .a CPO
11. DISINFECTION: Type
12. CASING:
From 0 TD o �iit 4 Ft.
From_ To Ft.
From_ To Ft.
Diameter
Wall Thickness
or Weight/Ft Material
13. GROUT: Depth nMa,r-mF�.1g,(�r Method
From To FC.l.
From To Ft.
14. SCREEN: Depth Diameter Slot Siae 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:
4
�o<
rn
4-C
LOCATION SKEI'CR
Amount r Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common road names.
}kWt. 7 o
C zA C ��
GEEN /" r/u. budQi
1 DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION ST BARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
eit
Cl?
SI . ATURE OF PERSON CONSTRUCTING THE WELL DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-1 REV. 07/2001

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality -Groundwater Secon
WELL CONTRACTOR (INDIVIDUAL) NAME (print) si=� ti
WELL CONTRACTOR COMPANY NAME Met.
Set tt t 3en CERTIFICATION # a�t34
STATE WELL CONSTRUCTION PERMIT/it
W
ASSOCIATED PERMIT# - - TT# PHONE # .�
(ifa phcable) _ ; Z� to
(ifa icable
I. WELL USE (Check Applicable Box): Residential « Municipal/Public 0 Agricultural
Monitoring O Recovery ❑ ection Heat Pump Water In O thdustrial ❑
J Other ❑ If Other, List Use ❑
2. WELL. LOCATION:
•
Nearest Town:
' County U COrs C a.3 sac",„ v:E...
(Street None. Numbers, Community. Subdivision, Lot No., Zip Code)
3. OWNER: �7N.er 9-oe£lZ
Address al 'S 4Cti34:2n v;tw
(Street or Route No-)
(A.St+eN:tk
Cib' or Town State
zip code
Area rode- Phone number
4. DATE DRILLED
5.TOTAL .DEPTH:
6. DOES WELL REPLACE EXISTING WELL? YES O NO t�
7. STATIC WATER LEVEL Below Top of Casing: SQ._FT
(Use "+ ifAboce Top of Casing)
8. TOP OF CASING IS
*Top of casing terminated abor below land surfaceT. My Land Surface*
variance in accordancs.aith ISA NCAC 2C .0118.
9. YIELD (gpm): METHOD OF TEST__ q 10. WATER ZONES (depth):—y--
I I. DISINFECTION: Type ph�
12. CASING: �•t— Amount
Wall Thickness
Depth Diameter or Weight/FL Material
From }\ To___44 __ Ft !p ;,
From To — Li �1n.�,�
Ft.
From To Ft.
13. GROUT: Depth
Material
From O To 20
From To Ft + Gowe i
Ft.
14. SCREEN: Depth
�—
P From Diameter Slot Size Material
To Ft.
From n. in.
To Ft. in.
15, SAND/GRAVEL PACK: in.
Depth Size
Material From To
From To
16. REMARKS:
Ft.
Ft.
Topographic/Land setting
ORidge GA lope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:OGPSOTopographic map
(check box)
DRILLING LOG
To Formation Description
} 3/4
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common road names.
• Wa
0
La
0
1 DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
SIGNATURE OF PERS
Method
—Re_ tee
DEPTH
From
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
304818
Grn
rno
`}u
n zjj
Cr i-t'

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR v
304875
(INDI IDUAL) NAME (print)e ntx Me:Ala. - _ -
WELL CONTRACTOR COMPANY NAM
CERTIFICATION .Y O1�I34
fda nlicable) ASSOCIATED WQ PERMIT;=
(ifa licable
1. WELL USE (Check Applicable Box): Residential ErMunicipal/Public 0 Industrial 0 Agricultural 0
Monitoring O Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL. LOCATION: /� Nearest Town:, A S4r O i lif County /� 4
Acerthe
't .. rlaa R
cedie w:o4d �$O4
(Street Nanie. Numbers, Community, Subdivision. Lot No., Zip Code)
3. OWNER: Sock COC4-e S
Address 4 aj Mtei d; uhe. Roca
(Street or Route No.)
Asher:\te , NC
City or Town State
()- 2-5Q. Call
Arca code- Phone number
4. DATE DRILLED /4 a— q
5. :TOTAL .DEPTH: /to 5
Seri
E Stt tv Se
5I ATE WELL CONSTRUCTION PERMIT
vac PHONE d eLA1 teGt;
Zip Code
Topographic/Land setting
DRidge CiAlope DValley OFlat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitudc/longitude source:OGPSDTopographic map
(check box)
DEPTH DRILLING LOG
From To Formation Description
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO a
7. STATIC WATER LEVEL Below Top of Casing: 5 0 FT.
R. TOP OF CASING IS (Use "+" if Above Top of Casing)
FT. Above Land Surface' — --_
*Top orcasing terminated at/or below land surface requires a
variance in accordance with ISA NCAC 2C .0118.
9. YIELD (gpm): a 0 METHOD OF
10. WATER ZONES (depth): J
I I. DISINFECTION: Type p;115
12. CASING:
Depth
From $1 To 7,2 Ft.
From To Ft.
From To Ft.
13. GROUT: Depth Material
Amount 8
Wall Thickness
Diameter or WeightFt. Material
!o p'iost.Y
1- rom O To 20 Ft _Cevoke ._
From To Ft.
14. SCREEN: Depth Diameter
From To Ft. in.
From To Ft. in.
15. SAND/GRAVEL PACK:
Depth Size
From To Ft.
From To Ft.
16. REMARKS:
Method
Slot Svc Material
in.
in.
Material
—4L[bnf�t
LOCATION
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common road names.
(2:3
0)
4C
ro nib
Jt p
▪ (!
▪ rr:
Aley4 v L er 1(d
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 PERS(' ! CONSTRUCTING THE WELL
DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center -Raleigh, NC
27699-I636 Phone No. [phone], within 30 days.
1 4 GW-I REV. 07/2001
C)

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resourcesi WELL - Division of Water Quality - Groundwater Section
LLL CONTRACTOR (INDIVIDUAL) NAME (print) ,tits. Meti
WELL CONTRACTOR COMPANY.NAME P. $R tt CERTIFICATION # ?mu,t 'So
STATE WELL CONSTRUCTION PERMIT# -fat PHONE # j� �g) t�i 2st2
(ifa licable) ASSOCIATED WO PEERMIT#
fifa licable
1. WELL USE (Check Applicable Box): Residential « Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL. LOCATION:
Nearest To.:wn:, Irp o; � County 2 P
_�_1aeK oww c n coat4
(Sirect Name. Numbers., mo ..
Community. Subdivision. Lot No., Zip Code)
3. OWNER:Q r Ir V /
Address .276. E5\acts Oo c Cova
ow.4
(Street or Route No.)
[.and lea 284 t S
City or Town $tat¢ Zip Code
(8ae) Eno. 58
Arco. code- Phone number
4. DATE DRILLED /6-02 7- S/
5. 'TOTAL DEPTH: / G S
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO 7. STATIC WATER LEVEL Below Top of Casing: /S- FT
8. TOP OF CASING IS % (Use +,. if Above Top of Casing)
FT. Above Land Surface*
'Top o(casing terminated at/or below land surface r
variance in accordance with I _Se_ sA NCAC 2C .0118. requires a
9. YIELD (gpm): -METHOD OF TEST
10. WATER ZONES (depth):
11. DISINFECTION: Type —
12. CASING:
Depth
To r14
To
From To
13. GROUT: Depth
From O To 20
From To
14. SCREEN: Depth
From Tv
From To
15. SAND/GRAVEL PACK:
Depth
To
From 4%
From
From
From
16. REMARKS:
To
Amount e
Wall Thickness
Diameter or WeighvEt. Material
Ft. fn y 2i' Zl pi aM,t
Ft.
Ft.
Material Method
Ft.
Diameter Slot Size
Ft. n in.
Ft. in. in.
Size
FL
Ft.
Material
Material
304874
Topographic/Land setting
()Ridge 1 lope ()Valley 0F1at
(check appropriate box)
Latitude/iongitude of well location
Latitudcflongitude source:DGPSOTopographic map
DEPTH (check box)
DRILLING LOG
From To Formation Description
'19
165
'e.n
0
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common road names.
• w•
.C"
CO
0
k -a
Uc Q�
fast IV
Col
1 DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
SIGNATURE OF PERS(�1L CONSTRUCTING THE WELL . y
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
ntr_
-on;
20 :ID
ate.
Lai
r r°Z
—a=7
rnl
ea

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Naenra Resources - -Division of Water Quality - Groundwater Section
R WELL CONTACTOROla (INDIVIDUAL) NAME (prt) BILL -to t.) ASN CERTIFICATION/ a„'
WELL CONTRACTOR COMPANY NAME_ RF.UBEN CALDWELL DRILLING, INC. PRONE4%e )254-3581
STATE WELL CONSTRUCTION PERMIT/
(if applicable) -/ (if applicable)
1. WELL USE (Check Applicable Box): Residential f{3 MunicipaVPublic 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 if Other, List Use
2. WELL LOCATION: /�
NearestTowt(: ikLEX4NOL&e County'Jvia(-"!)'Lt')t7
(Street Name, Humbert, Community, Subdivision, lot No.• Zip Code)
3.OWNER: . D.roN� rirz 2A1.-.()
(S a Rpua No.)
An-0
306309
ASSOCIATED WQ PERMITS
L \( rJ 0 02._ 1-I' Ce
Address ✓.C. ,y /6;5y
City or Town Sr"' Zip Code
Ara cods Phone number 4. DATE DRILLED \ �-- -i ' D 4
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO a
7. STATIC WATER LEVEL Below Top of Casing: Yo FT.
(um -e' if Above Top or Cuing)
8. TOP OF CASING IS FT. Above Land Surface'.
'Top of easing terminated a1/ar below lead foam requires e
variance In accordance with ISA NCAC 2C .0111. n /
9. YIELD (gpm): ao METHOD OF TEST f-tG - 'A I t
10. WATER ZONES (depth): g C ' - a
5. TOTAL DEPTH: 110 '
11. DISINFECTION: Type 4T
12. CASING:
From _I.. To th D O
From To Ft.
From To Ft.
13. GROUT: Depth Material
From 1 To 9-0ry o Ft. CR vl✓�r
From To Ft.
14. SCREEN: Depth Diameter
From To Ft. in.
From To Ft. in.
15. SAND/GRAVEL PACK:
Depth Siu
From To Ft.
From To Ft.
16. REMARKS:
1) qo u Amount VT —Et —
Wall Thickness
Disrsie car or Weight/Ft. ty(a)eG
Ft. b '/ Y, S O 2d-i
Method
PO J('bio
Slot Size Material
in.
in.
Materiel
Rc' 1 l0'
Topographic/Land setting_ /
❑Ridge ❑Slope ❑Valley QFlat
(chrk appropriate box)
Latitude/longitude of well location
(depecahnlatteusecoode)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH qp pDRILLING LOQ
Fro1m / T`FS / 0 DescriptionsibJ2
pJ
2(5
:�' ^ C 0' (3) /1-Nrl t i l
8 D ' e koJPcr t - � v,
Co2A rJ •, Tls
0�"1
i:i
J ()CATION SKETCH i*
Show direction and distance in miles fan at le53V_.
two State Roads or County Roads. Include the Oa -
numbers and common road names.
r
1C ( 1A r"A�72
PLAC
LCic-'5t ,
Ow/
�Lcs?CA,.),cic (CoAD
1 DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WRTi ISA NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF TTRECORD IIAS BEE? PROVIDED TO TIIE WELI/1.�y. 0...
SIGNATURE OF PI:RSUN CONSTRUCTING THE WELL DA
tur
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mall Service Center - Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. OW-1 REV. 07/2001

IiAN 2 5 MO5
"`' 306310
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and u•nval Resources:, Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (prLn) I t-. 1 1
L E � � S fJ CERTIFICATIONI a17
WELL CONTRACTOR COMPANY NAME _RF.UDEN CALDWELL DRILLING, INC- PHONE 448 ,?54 -3581
STATE WELL CONSTRUCTION PERMIT/
(if applicable)
ASSOCIATED WQ PERMIT/
(if applicable)
I. WELL USE (Check Applicable Dot): Residential 0 MunicipaVPublic ❑/ Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other If Other, List Use S 6gN t Cg S-(A \ 1 D r
2. WELL LOCATION:
Nearest Town: 1 JNASLOSV II-LCCounty &NWMrgE
SR LI-0- S—lAV\tr- 1 6Aae�A 2oSUltLU i4t /
(Strew Name, Number, Comnluniry, Subdivision, Id No , Zip Code)
3. OWNER: NH: Li, I -A N E N)Eie-G
Address ^ 0 - o/ 1 a f
vIA-4,1,6000b aRPC/a) as-1
City or Town Stan Zip Code
(Sa8)- 4-sa—a-7a 0 1/-r (5
Area coda Phone number pn
4. DATE DRILLED I a- a ) - 0 '1—
5. TOTAL DEPTH: (Ct 0
6. DOES WELL REPLACE EXISTING WELL? YES NO 0
7. STATIC WATER LEVEL Below Top of Casing: Z 0 FT.
(Use -•' if Above Top of Cuing)
8. TOP OF CASING 1S `- FT. Above Land Surface*
•Top of casing Unblended Woo below lad sarract requite.' s
vaetaota In aemrdata with ISA NCAC 2C At1g. i1
9. YIELD (gpm): ( 6 0 METIIOD OF TEST eA G - A I R-
10. WATER ZONES (depth) 1 g 'c / - (D O (DP cr
1. DISINFECTION: Type 1,I i
12. CASING:
From L To
From To
From To
13. GROAT: Depth
From To a J Ft.
From To Ft.
14. SCREEN: Depth Diameter Slot Sim Material
From To Ft in. in.
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
FL
Ft.
Ft.
❑
o Amount V 1 t3
Wall Thickness
Diameter or Weight/Ft. t/Ft. Material
(e`%4 :I%1f SiebL
Material
T ethod
/�
l'MtpN / D y`a0
16. REMARKS:
Topographic/Land setting y
❑Ridge ❑Slope ❑Valley 19Rlat
(thank aPPropeisu box)
Latitude/longitude of well location
(depaeatrnim,trhetmds)
Latitude/longitude source:❑GPS❑Topographic map
(cluck boa)
PEPTH DRILLMO LOG
Fr m : To i Fommµµtion Descriptionq
4. Q 1 p c Nif 114 .e Dr2 N
l0r - k6
;LS`- 5'
)j
I DS ICI0 '
IC*. -100 Con,
r� �t I i t�
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common road names.
(A QNMo.0&,
T S M
u3 11 J1_g
C ((frt. L.
0
Cis
1 DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITN ISA NCAC 2C,, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY TI�ORD f_IQ1S BEEN PROVIDED ; TO T�iE WE °`i' O � OWNER
SIGNATURE OF PERSON CONSTRUCTING THE WELL / DA
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mall Service Ceoler- Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-1 REV. 07/2001

fgo 306315
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment card uaint(ail Resources^ Divisioon of Water Quality - Groundwater Section WELL CONTRACTOR (INDIVIDUAL) NAME (pilot) ki ) L. ..lg qa[A A$ it C77rP�ICATION/ all
WELLCONTRACIOR COMPANY NAMC_RF.0 BEN CALDWELL DRILLING, INC:• THoNEY?f8 )i 54-3581
STATE WELL CONSTRUCTION PERM/TO ASSOCIATED WQ PERMIT/
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential id Municipal/Public ❑ Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATIQN:
Nearest Town P D 1 13 (L
(Strut Name, N
Iw/ is l
ben Community, Subdivision, Lot No., Lp Codc)
Cotmty gvIJLoftAISE-
3. OWNER: c((��,B Q- \—
Address q-bt .'S PI J (� E LO t-E3 (Z t-Rt3g
cal /96
(Strcet or Rowe No.)
W1L-S9n) (Uc_
City or Town Stale Zip Code
(tea). ao 5 - a,ia
Are coda Phone Dumber
4. DATE DRILLED Q.— Si . 0
5. TOTAL DEPTH: 'Sot 0 c
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO 62
7. STATIC WATER LEVEL Below Top of Casing: b t FT.
A (ow -a- if Above Top of Casing)
8. TOP OF CASING IS + FT. Above Land Surfacee
*Top of cuing terminated Wer below lad swine eryulru a
variance In accords. a with ISA NCAC IC .01:a. Q
9. YIELD (gpm): L 0 METHOD OF TEST I�tG- A I e-
10. WATER ZONES (depth): 3 10 r — oa o (', P rr
11. DISINFECTION: Type
12. CASING:
Depth
From e To I S Ft.
From_ To Ft.
From To Ft.
13. GROUT: ,q( Depth
From .!, To as Ft.
From To
14. SCREEN: Depth
From To
From To
15. SAND/GRAVEL PACK:
Depth
From To
From To
qD% Amount 106
Wall Thickness
Diaoseet r or Wei t/Ft. Materiel
6'7 $CR VC
Material A Method p
Ft.
Diameter
Ft. in.
Ft. in.
Slot Sire Material
in.
in.
Sire Material
Ft.
Ft.
Topographic/Land setting
❑Ridge ❑Slope ❑Valley ®Flat
(check appn prom boa)
Latitude/longitude of well location
(degrsehninrte/aecon4)
Latitude/longitude source:❑GPS❑Topographic map
(check boa)
DRILLING LOIN'
For(ma/tion Description
04(3RQJ ea
PPPTIi
Frgm To
t O
iD9-
- St
S( 0
3i0r - Soto'
0
c—
) OCATION SKETQj-( a,:,
Show direction and distance in miles -from at istf,.
two State Roads or Coun Roads. ln2i?ide tho-roud
numbers and common roe ' names.
S uloo)-.
i 5 LSD
vs q'a3
16. REMARKS:
1 DO HEREBY CERTIFY THAT THIS WELL WAS CONS] RUCfED IN ACCORDANCE W11i1 ISA NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND TI(AT A COP j% OF THIS RECQRD HAS BEEN PROVIDED TO TIIE, WELL iWNER
9k l0 O4
SIGNATURE OF PERSON CONSTRUCTING TILE WELL DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mall Service Center -Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-1 REV. 07/2001

306314
WELL CONSTRUCTION RECORD
North Carolina - Departrnent of Environment and Natural Resources - Division of Water Quality - Groundwater Section
REUBEN CALDWELL
WELL CONTRACTOR (INDIVIDUAL) NAME (print) CCRTIFICATION a 2140
WILL CONTRACTOR COMPANY NAME REUBEN CALDWELL DRILLING, INC. PHONFY2j8 )254-3581
STATE WELL CONSTRUCTION PERMITI 1537 ACCOCIATlD WQ PERMITa
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential Municipal/Public 0 Industrial ❑ Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use c.
2. WELL LOCAT 'nn
Nearest Town: N D �1
€) G Co-v E3
County gum C.-e Mk2
(Street Nurse, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: J K1 /V\% 3 iV1 t L LQ Al
Address ''''yVII- `0 • &O a {hS %
n``
l�
„Sit).
or Town Stele tip Code G)
(6.011)
- a4� — \7 b
Area cods Phone number ,1
4. DATE DRILLED la 30/ ° 4
5. TOTAL DEPTH: o
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO Er
7. STATIC WATER LEVEL Below Top of Casing: 11--0 FT.
(Use `V- if Above Top of Castes)
8. TOP OF CASING IS FT. Above Land Surface*
*Top of easing terminated ator below had surface requires a
variance In accord, a with ISA NCAC 2C .011a. /� p
9. YIELD(gpm): d�`e METHOD OF TEST fv)C" Ttlf"
10. WATER ZONES (depth): b o i — &n (4'r'
11. DISINFECTION: Type Amount
12. CASING: Wall Thickness
Depth Z G 1J pier!, r oSr9W'jght/FL Ma(eri�.
From 1 To .r Ft. b/ L�l W
From To Ft.
Front
13. GROUT::
From
To Ft.
Depth rMaterial/� Mclhod
To CO Ft. C,C'f it1( N'T C O V ('ZC3©
From To Ft.
14. SCREEN: Depth Diameter
From To Ft. in.
From To Ft. in.
15. SAND/GRAVEL PACK:
Depth Size Material
Slot Size Material
in.
in.
From To Ft.
Topographi setting ::c'
❑Ridge ❑Slope alley ❑Ft t±
(check .pp,opriue box) ..
Latitude/longitude of well Iocatitr7
(depxs/mtwte./sereads) , Latitude/longitude source:❑GPS❑Topogriphic map
(check box)
DEPTH DRILLING LOG
FronY To / Fonrrl)taation Desc I�tion
0 Qv�(Zty 1>$ia
C,CZA n3 I P
C_As‘i t C6 - &o Girn
C,RAtJ-r
0
r �sri '•
LOCATION SKETCH ' try
Show direction and distance in miles from.at least;
two State Roads or County Roads. Includelhe rose n
cl
numbers and common road names. .� c_1
low/
0.1C Cc) Nt
d Ste- r,----
nk
•} M
u5 j17j
� —I
From To Ft. -�
16. REMARKS:
1 DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF 7j)IS RECORD B PROVIDED TO THE WELL O
YYYYYYUUUUUU ,y(,j�) v 'c , ! a
SIGNATURE OF PERSON CONSTRUC11NG THE WELL DA
Yemv
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mall Service Center -Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-1 REV. 07/2001

From
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:
WELL CONTRACTOR CERTIFICATION #:i
STATE WELL CONSTRUCTION PERMIT#:
1. WELL USE (check Applicable Box): Residential Municipal ❑ Industrial 0 Agricultural 0 Monitoring 0
Recovery 0 Heat Pump Water Injection ❑ Other II Other, List Use:
2. WELL LOCATIO Show sk t h of the location below) Q
Neares Town: A./ > tt County,C uvz/vni-e
(Road Name Numoers, Con nu ity, or Subdivision and Lot No.)
� V � !
3. OW
NER
Address
City or own
4. DATE DRILLED/2 j
5. TOTAL DEPTH
6. CUTTINGS COLLECTED YES0 NOE
7. DOES WELL REPLACE EXISTING WELL? YES NO�
8. STATIC WATER LEVEL Below Top of Casing: FT.
(Use ': it Above Top of Casing)
9. TOP OF CASING IS FT. Above Land Surface'
'Top of easing terminated at/or below land surface requires a variance In accor-
dance with 15A NCAC 2C. 116
10. YIELD (gpm): METHOD OF TEST /k
11. WATER ZONES (depth): �l
12. CHLORINATION: Type //'t1
13. CASING: -
Amount
DRILLING LOG DEPTH
' From To
1
ii "Description
Z
r•4,lQ
Et'
L
If additional space is needed use back of lotm.
Waif Thickness LOCATION SKETCH
,/ Depth D fo/r or Weight/Ft. Ma " ial _ (Show direction and distance from at least two State
From � To r� Ft ��7 �Si���— Roads, or other map reference points)
From To Ft
From To Ft
14. GROUT:
P1 Depth er f atrOz? ethod
From `' To c77 ° Ft erg G^' �'"
From To FI
15. SCREEN:
Depth Diameter Slot Size Material
To Ft in in
From To Ft , - in in
From To Ft in in
16. SAND/GRAVEL PACK:
Depth Size Material
From To FI
From
17. REMARKS:
To
Ft
/IyA-r 7f
I DO HEREBY COERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A'Cf'OPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER.
"Frl7`is ID�-13`®`1
SIGNATURE OF RSON CONSTRUCTING THE WELL DATE
Submit original to Division of water Duality, Groundwater Section within 30 days GW1 REV. 12199
FOR OFFICE USE ONLY
Ouad No:
306365
;Guy
Sanal No.

or eight/Ft Material numbers and common road tram
From _._Q.lo it Ft. /,
tit
4SING , Show direction and distance in miles from at least
Wall Thickness two State Roads or County Roads. Include thcroad----
Depth Uiametcr W
I tom_.. To Ft.
From To Ft.
13. GROUT: Depth Material
From.._a__ To Method
__�'i.�_ FL Cn _. i. _
From_To Ft._ __
14. S(RKIiN: Depth Diameter Slot Size
From__ To inMaterial
Front ------- in.
To FL - m. in
IS. SAND/GRAVEI.PAC'K: .. —.
Depth Size Material
From To Ft
From ..__To Et.
16. REMARKS:
t._
0
tV
1 DO I IER EBY CERTIFY TI IAT Tin WELL WAS CONSTRUCTED IN ACCORDANCE WIT! I I5A NCAC 2C, WELI.
('ONSTREJCIION S"IANDARDS, AND 'f11AT A COPY OF' THIS RECORD HAS BEEN PROVIDED TO TILE WELL OWNER
SIGNATURE OF PERSON CONSTRUCTING TI IE WELL DATE
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
WELL CONTRACTOR (INDIVIDUAL) NAME (print)...I'N Da_ej )iaS4-1
WELL CONTRACTOR COMPANY NAME 1-,re.e.r,e"Zr` .-11 i Pun A.1=„e.
SI:ATE WELL CONSTRUCTION PERMIT# l_.4D
(if applicable) - ASSOCIATED WO pF,RM1T#
(if applicable)
306331
Groundwater Section ,/
CERTIFICATION # 33.5it
PHONE # 052 44a-3/7n
I . WELL USE (Check Applicable Box): Residential Pt, Municipal/Public O Industrial 0 Agricultural ❑ Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. W ELL LOCATION:
Nearest Town: �trarnar.iaty i) )e County ZLv,* janikt,
- 1 d Inr\ .
I Street Name, Numbers, Community, Subdivision, I.ot No., Zip ('ode)
3. OWNER:, l
Address J 1 $ ! etr
(Street or Route No.)
(tkts+tr % SSG a9 OCo
ity or Town State Zip Code
Area axle- Phone number 4. DATE DRILLED 1 Q - a -
5. TOTAL DEPTH: , if5 /
WELT REPLACE EX !ST
ro Casing:
7. STATIC WATER LEVEL Below ToptYES i t n (t
of Casino. 4 O FT.
-
(Use' 1" if Above Top of Casing)
R. TOP OF CASING IS 1 FT. Above Land Surface*
`fop of casing terminated at/ur below land surface requires a
variance in accordance with 15A NCAC 2C .0118.
9. YIELD (gpm): aD - METHOD OF TEST
Q 10. WATER ZONES (depth): l yg e. �rs
Topo raphic/Land setting
❑Ridge ,$lope OValley OFIat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:OGPSOTopographic map
(check box)
DEPTH DRILLING LOG
From
To� FormationO�Description
)race 1
710' 185r
1 1. DISINFECTION: Type 14 T H Amount 51 .{.61 4_3
LOCATION SKETCH
C.-
C71
nC

11. DISINFECTION: Type
12. CASING:
From 1 th
To I o S
From To
From To
13. GROUT: Depth
From - To oZa Ft.
From To Ft.
306307
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and u naval Resources- Division of Water Quality - Groundwater Section WELL CONTRACTOR (INDIVIDUAL) NAME (print) g i LL t r3 AS *4 CERTIPICATION a al 1 1 /
WELL CONTRACTOR COMPANY NAME _RF.DD EN CALDWELL DRILLING, INC- PRON[428 1254-3581
STATE WELL CONSTRUCTION PERMITS ASSOCIATED WQ PERMITS
(if applicable) (if applicable)
1. WELL USE (Check Applicable Dox): Residential ICl/Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 IfOtha, List Use
2. WELL LOCATION: {� /2
Nearest Town: WC AJt &) LLE County g.iscoM17t
tk
(Street Name, Nuumben, Community, Subdivision, tot No. Zip Code)
�
3. OWNER: V LA Dmt29- nSV L.-1"I.
Address .30 1c C.Ite.��j/r
City or Town State Zip Code
(7,4)- a-,4--Igbo
Arca cods- Plane number
4. DATE DRILLED la - t 8 - a 4
5. TOTAL DEPTH: I t 0
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO lc
7. STATIC WATER LEVEL Below Top of Casing: toe FT.
(Uca -.- it Above Top or Celina)
8. TOP OF CASING IS 1 FT. Above Land Surface
•Top of cuing nr lsoled Wor below lead mine requites a
variants 1a accnrdam. with 15A NCAC 2C.0113.
9. YIELD (gpm): J METHOD OF TEST g.\ G - A i
10. WATER ZONES (depth): R 3 c -- t — P r'
4 ba — Va G er'
}ITN - 9 D u Amount
Wall Thickness
Di{me ter
Ft. b%4-
Ft.
Ft.
5H1_c1((vFL hf.`eC
Material ,."Method
C eM8N i re d(Leo
14. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in.
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Siu Malcom!
From To Ft.
From To Ft.
Topographic/Land setting /
❑Ridge ❑Slope ❑Valley tat
(chock appropriate box)
Lailtude/longitude of wall location
(deperaimimrte✓secunds)
Latitude/longitude source:❑GPS❑Topographic map
DEPTI!
From i To /
— %oo
Da)'1 a• a3C'
alo -
bZ3o• - 9 St"
4xv,
4-Kt' -'1161
(check box)
DRILLING LOG
FgrrjueC escriptEion
✓✓ tttb
TG
C •Cl3J 1C'_� - l�3 Vf'M
C9 r) CT-12:.;
CfwJlce — t/a GeM
GRAI°)1TtT
LOCATION SKETCH{ <
Show direction and distance in miles
4natI to -
two State Roads or County Roads. Include the l*Ateft
numbers and common road names. 't? c?`-
(LAD
3(
CLA(t(4-S
O - ,5 C0iP C ACV L
L%<l
16. REMARKS: •
I DO HEREBY CERTIFY T1(AT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WIT}( ISA NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A CO
Y OF 72IIS RECORD Fj�S BEEN PROVIDED TO 1atyC•I QWhEER
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Ccoter-Raleigh, NC
27699-1636 Phone No. (919) 733-322I, within 30 days. GW-1 REV. 07/2001

AN /_ 5 2005
All'") 306308
WELL CONSTRUCTION RECORD
North Carolina -Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
REUBEN CALDWELL
WELL CONTRACTOR (INDIVIDUAL) NAME (print)
WELL CONTRACTOR COMPANY NAME RF.UBEN
STATE WELL CONSTRUCTION PERMIT/ 1537
(if applicable)
CALDWELL DRILLING, INC
•
CERTIFICATION $ 2140
PRONE448 54-3581
ASSOCIATED WQ PERMIT/
(if applicable)
1. WELL USE (Check Applicable Box): Residential IV...Municipal/Public ❑ Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATI N:
Nearest Town: r3 h L-& (2 County cm-) Ce fn6e
O&Gcoo0cs Y-tWD
(Street Name, Numben,
Community, Subdivision, La No., Zip Code)
3. OWNER: 1" > tbvF--•
Address t 51 O VAT'LoN A v
A5c-1 iS. . it-el
aSO Co
City or Town State Zip Code
(S3- ` (-1 C� 1 iS o �1
Arca code- Phone number
4. DATE DRILLED Ia- c30-of
5. TOTAL DEPTH: JI D J
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO1l,l
7. STATIC WATER LEVEL Below Top of Casing: L CO FT.
(Um ".' if Above Top of Casing)
8. TOP OF CASING IS FT. Above Land Surfaces
Top of casing terminated ator below lead surface requires a
variance 1u accordamaipwith ISA NCAC 2C.0118. ,1
9. YIELD (gpm): /a, METHOD OF TEST R.1 CD-- 41 O
10. WATER ZONES (depth): 1 /ems- 1I/, N PW'
Topographic/Land setting
❑Ridge ❑Slope ❑Valley QFIat
(check appropriate box)
Latitude/longitude of well location
(degreealm inutahecmdr)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DRILLING LOG
Fo tion Description
(e v 6
TH DEPi
Frofn _ / Tirol 5 / �Li� K p
A I"a / Litt O ran iJli
11. DISINFECTION: Type [ITN IO/v Amount /Z 1 `o
12. CASING: Wall Thickness
• Depth Diameter or Weight/Ft. Material
From 1 To I a I Ft. GT S %O(Zol\ r0VC
From To Ft.
From To Ft.
13. GROUT: Depth Material n Method
From ▪ To Depth?,
Ft. (. tawe.NI 'PGLI(Le D
From To FI.
14. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in.
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
LOCATION SKETCH
Show direction and distance in miles front at least
two State Roads or County Roads. Include the road
numbers and common road names.
�9-
1/t GpJct77
fiJ
2.5r-,
uS t0Ja3
O
O
Eft
16. REMARKS:
1 DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH I5A NCAC 2C, W1
CONSTRUCTION STANDARDS, AND THAT A COP OF THIS RECO �S EEN P OVIDED TO T WE OWNER
Pon
SIGNATURE OF PERSON CONSTRUCTING THE WELL
ATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mall Service Center - Ralelgh, NC
27699-1636 Phone No. [phone], within 30 days. GW-1 REV. 07/2001

302859
WELL CONSTRUCTION RECORD
North Carolina - Depanment of Environment and Natural Resources Division of Water
QualityQ- Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) QO b6y t.V t Pv r • ! CERTIFICATION #
O a
WELL CONTRACTOR COMPANY NAMV
E Fc 05-0,V T /W e / t h^/ //In/ Cry . PHONE gun 613' 3 - yyr?
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#(if applicable)
(if applicable)
1. WELL. USE (Check Applicable Box): Residential ll Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION: a
UJ(
c- utlI t(OM
Nearest Town' 1 it County b
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3.OWNER: BYid PS ?ju1\dPrG (brat eau
Address tin tt €q '`tetw
a
(Street ad Route No.) agoya
ELLEAST° nc
Ciry or Town State Zip Code
822)J cts- 517G
Area code- Phone number
4. DATE DRILLED S M/D4
5. TOTAL DEPTH: b
6. DOES WELL REPLACE EXISTING WELL'? YES 0 NO 2
7. STATIC WATER LEVEL Below Top of Casing: MO FT.
(Use "+" if Above Top of Casing)
S. TOP OF CASING 1S / FT. Above Land Surface*
'Top of casing terminated at/or below land surface requires a
variance in accordance with 15A NCAC 2C .0118.q 1
9. YIELD (gprn): � METHOD OF TESTI I%hdin 1 4J
l0. WATER ZONES (depth): la.
Latitudeilongitude source:
DEPTH
From To
0 , 3S
35 — e/D
vo—(tlS
11. DISINFECTION: Type fr It 1$ Amount _13 #3„,_-
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
From_].___ To VO Ft. to, IS 2/4,11.3 '> /U I
From To Ft.
From To Ft.
13. GROUT: Depth Material Method
From___1-_To aj.) Ft. ton(r.tt PO unity
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.
Topog is/Land setting
DRidge Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location •
N3S'30,b
14/0t1°ROa6SI
(degrees/minutess•conds)
PS❑Topographic map
(check box)
DRILLING LOG
Formation Description
OtInl
c-
0 cm
LOCATION SKETCH
Show direction and distance in miles from atclast —+
two State Roads or County Roads. Include th ad as
numbers and common road names. o
..
Fco* rVlat) �OIr�tQ.
`a �rvi ew, nC
%rein
m
1
Go
16. REIv1ARKS:
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
S1GNAT{JRE OF PERSON CONSTRUCTING THE WELL D/Y,L
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Ceenterl REV. Raleigh,0NC ,
27699-1636 Phone No. [phone], within 30 days.

302860
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
CERTIFICATION X
WELL CONTRACTOR (INDIVIDUAL) NAME (print) I' 16c
WELL CONTRACTOR COMPANY NAME F z rr., 5n9t
3226
" yl
W e 1I 17 r:I/tn( ( C PHONE (tt )d.Y`i'!
STATE WELL CONSTRUCTION PERMITP ASSOCIATED WQ PERMIT#
(if applicable.)
(if applicable)
1. WELL USE (Check Applicable Box): Residential 0 MunicipaUPublic ❑ Industrial ❑ Agricultural ❑
Monitoring ❑ Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATIO:
Nearest Town: 4,7 el/ r County 1�inctCort be
i+wsi,ce /?rdye 'cac)
(Street Name, Numbers, Community, Subdivision, Lot No., /Zip Code)
3. OWNER: Ply Son (moon Yf�-t c e
Address I LI I S Vattern I V€J L e
(Street or Route No.)
AsheuC u e nr 2$86Ii,
City or Town State Zip Code
751-1—Q(0G2
Area code- Phone number
4. DATE DRILLED /- / 9 - D
5. TOTAL DEPTH: tF o S
6. DOES WELL REPLACE EXISTING WELL? ar-
7. STATIC WATER LEVEL Below Top of Casing: VD FT.
(Use "+" if Above Top of Casing)
/
8. TOP OF CASING IS FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordance with 15.4 NCAC 2C .0118.
9. YIELD (gpm)• 2 c METHOD OF TEST +
10. WATER ZONES (depth).
YES 0 NO
.2os' 3&
11. DISINFECTION: Type H 1 H4
12. CASING.
Depth Diameter
From 0 To ID( Ft. (=y
From /04 To /2 (: Ft. G ty of 54eC I
From To Ft.
13. GROUT: Depth Material Method From To ?O Ft. it/tater"e Thu red
AmounF"t .`II5
From To Ft.
14. SCREEN• Depth Diameter
From To Ft. in.
From To Ft. in.
15. SAND/GRAVEL PACK:
Depth
From To Ft.
Wall Thickness
or Weight/Ft.
SPRAl
Material
}PLC
Slot Size Material
in.
in.
Size Material
From To Ft.
16. REMARKS:
fl
Topographic/Land setting
Iii!fRidge ❑Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well locatit3/s,3YN-0ZeV aw
(deesiminutesisec nds) Latitude/longitude source: ❑GPS❑Topographic map
(check box)
DEPTH DRILLING LOG
Formation Description
ebay
S.4nd Sici'Lt.
From To
CI 70
ziaL G /N n,' Ae
/27 Grga„ h¢
0 G rl
rnL
CI moo*
LOCATION SKETCH 1 3
Show direction and distance in miles from at leas Cr
__O
two State Roads or County Roads. Include the road 1'`r9g
numbers and common road names. S a,3
4-
crap.
Sus - Hot i2il:dcie Road
Cold ler, ne
Cr%`
1 DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION ST NDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OR
SIGNATURE OF PERSON 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,

302857
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and NaturalujResources - Division)of Water Quality - Groundwater Section a
WELL CONTRACTOR (INDIVIDUAL) NAME (print) Qo by �IN • + d115 CERTIFICATION it
0 a
// t
WELL CONTRACTOR COMPANY NAME FC�Yt1Son f We/( Tr,t//'t�y Co • PHONE {��7)6�53 i fiY
STATE WELL CONSTRUCTION PERMIT# ✓ ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
I. WELL USE (Check Applicable Box): Residential 2 Municipal/Public 0 Industrial 0 Agricultural ❑
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION:
Nearest To raj/ Town:
Cpv-C 1'3wlcf
tStre me, Numbers, Community, Subdivision, L( No., Zip Code)
3. OWNER: Ife C0116i1'(1Lti&n
Address ?tD T,atX fO$ -
(Street or Route No.)
Enka nc
City or Town State
ats- (C10 - W3s
Area code- Phone number
4. DATE DRILLED Visg0`/
5. TOTAL DEPTH: %.OS /
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO 12
7. STATIC WATER LEVEL Below Top of Casing: a FT.
(Use "+" if Above Top of Casing)
S. TOP OF CASING IS / FT. Above Land Surface"
*Top of casing terminated at/or below land surface requires a
variance in accordance with ISA NCAC 2C .0118.
9. YIELD (gpm): 30 METHOD OFTESTAB%u/i77/2 9
10. WATER ZONES (depth): /50
County 031ACZM bt
acna$
Zip Code
TopogriendLand setting
❑Ridge Ti Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
µI ;S. ) 3, FS y /W oat '1/y bad
(degrees minute �/ conds)
Latitude/longitude source: O'CtPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From To Formation Description
tr t
rr I5 - /br k
it; — ADS 6—ran•�C
LOCATION SKETCH
11. DISINFECTION: Type f'gble 1:5 Amount_ Spy Show direction and distance in miles from at least
,.:..-_e..� two State Roads or County Roads. Include the.75ad
v
Qn
12. CASING:
Depth Diameter or Weieht/Ft. Material numbers and common road names.
From_a_To 78 Ft. 4•13 2! ,I1.3 P_US ahl
From To Ft.
From To Ft.
13. GROUT: Depth Material Method
From__4To ;6 Ft. onncrtjt POOP/ A4
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.
Big Cove. Estates
Lai -Kt I er, nC
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
— L3 04(y W.l%.S
� 7l / a V
SIGNAT{1RE OF PERSON CONSTRUCTING THE WELL DA
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center--R400, NC
27699-1636 Phone No. [phone], within 30 days. GW-111kEU. 07/2001
:

Phone number
5.
/
area code-S 0 NO
+ DATE DRILLED WELL'? YESFT.
'TOTAL T E L R CE EXISTING
6. DOES WELL REP LEVEL Below Top, °f If Casing
Top of Casing*
WATER No Land Surface
V. STATIC S / ,FT. Above nireSn
d surface reciti;— /
S
YIELD l"Prn)'Method lAW-t
1 � J
Matz[ia
'TEST
1 or beWW lam
TOP OF CASING orb.
v terminated a� COD pF TE
"r"P of casing accordance With ISA NCA
variance in acc METH
9 TERZONES (depth)'.
Amount
Wall Thickness Material
N Depth
or,. rw Wei
FtFf.SMater"r
li. DISINFECTION Dramater /or
12. CASING. Depth
. Ft�
•
STR U CTION
WELE CON
CORD
of Water 0
Natural Resource
t of Environment and
li.Sr- Depart -sea rurtl
INDIVIDUAL) NAME Winn
North Caro
WELL CONIC ItACTOA
RACTOR COMP ANY N AN' E
STATE WELL \E�1.CONSTRUCTION
if ONSca�d 10N PERMITS
oz)'. Reswc"-Injection
(CheckApplicable0 Heat Pump Water
WELL USE l
piing 0 Recovery �
2. WELL
1.
Montt
tTown. ON'. County
/' 1 ,
est Town' Q Lot No., Zip Code)
Near Subdivision,
Community, tteer afl© Numbers. s ©
N./NER 10
3' Address G
l • S rite
City ar Town
ASS
30851
Groundwater Section ,d�G
ality' CAT10� v
CERTIFt
PNONE
O 1ATED WO FERMIT# Agricultural Industrial �
�NluniciPa1Other 0 11 Other, List Use
ial n Other lope Lan setting Fla[
.Fopogra e alley
ate box)
pRidge (check appropriate
of we lloca[ign
dellongin • ,
I aria
C licablel
(if oPP
4',S3Y
pographic
source Latit
ords)
(degceeslminute PSpTo
udeilongttude sou icheck box G L
G
DRILLING DEPTH Formation D
map
�To
FroL!
9
F rpm _!ate
Tom— Ft.-
From____—____To
—o Ft.
Rome
Depth
13. GROUT- Ft. Material
To Ft.` .
From�fl Slot Size
From To Diameter in.�al
u\ ! to.
1A. SCREEN. Depth Ft.l in.
F m�To— Ft.!
Ted Material
FtOnr�� PACK. Size
15. SANDIGRAVEDeP'I' Ft.
To Ft
Froth Tom
From
L
� O
a{ ast 2 y
LOCATION miles from ad �,14?
distance in to Include tl
Show direction and County Roads. Include Slate Roads or names. r^
two common LOadn
numbers and Comm
SKETCH
CORD A IDEDTOTHE WELL OWNER
UC 1N AC S EEEN PRO
O. REMARKS.THIS WELL W AS COPY ST TH1S RECORD HAS OF DA
DO HEREBY CERTIFND aT AND THAT 'g C000NSTRUCTING "rt1E WELL Raleigh, NC
TRUCTION STANDARDS,
TA TR ref " V O'112001
)NS `iGNAT aRE OF PERSON undvv ater Section, 1636 vice Center Division of Water Quality,
933.3==1. within 30 days.
Su bent the original to the
to a
Cn
us

STRU CTION
WELL CONSTRUCTION
) gesou
North Carolina - Department of Environment an b
TRACTOR (INDIVIDUAL) NAME (print)
WELL CON NAME
WELL CONTRACTOR COMPANY1T$
STATE WELL CONSTRUCTION
ONST UTION PERM
(if applicable)
LL USE (Check Applicable Beat Pump Water Injection
1. oxy Res
Monitoring ❑ Recovery
Monitoring
n..ri
WELLLOCATIONI �.. County
2.
CORD
Division of Water Quality
Resources
d Natural
(if a •plicable
If Other, List U se
�dening
alley ❑Flat
prate box)
idential ❑ MunicipallPublic
0 Other
Town: ( b Lot No Zip Code)
Nearest
Community, Subdivision,
(g¢eet Name, Numbers, w0
t/Y
3 OWNER: L.
No.)
Address l (g¢ee
Leice
zc*$_az
Area code- Phone rum
TEDRILLED,) YES ❑ NO
City or Town
State
bcr
Zip Code
9 A EXISTING WELL. /n —pT.
DATE
OTAL DEPTH: PLACE Be1OW
WELL LEVEL Below Top of f Above: o g)
6. DOES W ATER Use o if Above Top Surface*
1. STATICW—/,F..F.AboveLande5a
t ce reQ
vari ° dance wt HOD 0
variance m
OP OF CASING 15 below land sur a
C ,O1lS.
S•T rerminatedr�15ANCACi FTEST
f whin^
accordance NIET
g, YIELD lgPnt)' —��
ONES (depth); two State Roads or �
W ATER Z A nouns and con non road n
ames. n
b numbers
DISINFECTION, Wall Thickness Material r
11. DFrom orwYghrlFL ste alis+ rai- Sj_—
Diameter �� �y 1 u e t
12. CASING' Depth
l� r� /' � ,;��
Ft. ' ll,
From_, To VI Le.��.eSkiy.,{'r U �l
Tom - Methyd its `�
From_�� t. �^ ^
Tom Material Fromm Depth �_� �L
13. GROUT'. Ft. ;,
To � Material _
From To Ft. Diamn. eter e From,__ Depth Diam m. ��
SCREEN.. DeP Ft. in in. ��
14. S Tom m. _�
From. Ft.�
Material .-
From_ CK: Size _ —
ASSOCIATED bi PE1tryIIT
pgricultural0
Industtl4l ❑
Wisn
Groundwater Section D a�
CERTIFICATIOY fiy
pIlONE
Topographic/La
°Ridge ❑Slope
(check uPPr° f elllneatlOR 2 t
ollongim �b bt/ "/9/
Latitud
(degreesnninua conch) ° raphic map
itudesource: GPS❑Top g
dellong (check box)
Latin G
DRILLIN e e Orion
DEP� Formauon
To
� {r1
).
O 4
Show direction and distance include the roa�
County Roads. �,,
To
15. SANDIGRAVELPA
Depth Ft
From 'T =Ft.� �C WELL
France l S A NC THE WELL OR
ACCORDANCE WITHTO
HAS BEEN PROVIDED N
16. RENIARKS: WAS CONSTRUCTED IN A
_3N WELL Y OF THIS RECORD
AND THAT .4 COP
>O HEREBY CERTIFY STANDARDS, THE WELL _. h, NC:
CONSTRUCTION CONSTRUCTING ter Raleigh, PERSON CO 1636 Mail Service Center l REV. 0112001
N
SIGNAT •RE OF PER ter Section,
of Water Quality. Groundwater , -1
2 - J
Division 0 days.
original to the ,33-3:'--1, within 3
Submit the.__. No. (9l�) .,..
:CFI ��
LOCATION Sk n miles from at lea p

Zip Code
ia 0 0
` If Other, List Use
CIother CI
y, DATE DRILL /J S YES ❑ NO
DEPTH:
ING WELL'.
WELL CONSTRICTION tt�
Noah
aural Resources - Division
Carolina - Department of Environment and N iO IAI
+ /
WELL CONTRACTOR (INDIVIDUAL) NAME (print)
TRACTOR COMPANY NAME
WELL CON
STATE WELL CONSTRUCTION PERM 1T#
(If applicable)
WELL USE (Check Applicable n�>•i Water In)ec
Recovery 0 Heat Pump
Monitoring 0
WELL LOCATION: County "L"
c
Nearest Town: Code)
Subdiv ton, Lot No., Zip
(Street Name, Numbers, Community,
3, OWNER.
Address
302852
CORD
of Water Quality -
Groundwater Section
CERTIFICATION-Y
PHONE A/
ASSOCIATED WQ PERMITS{ -
�� (if applicable)
bl' ❑ industrial ❑ Agricultural
•
Residential [�
Municipal/Public
(Sneer or Route No.)
•Iie State
nY or Town
- (ny`� 4
RIP number
,V ea code- ED
5, TOTAL EYIS FT.
6, DOES WELL REPLACE off Above
LEVEL Below Top. ^ if Above: of Casing)
1. STATIC WATER Surface*
' - Above Land
OF CASING 15r, and surface requires a
S. TOP f
Terminated a C 2C ,pF T t lr�
.dap of casing ANCA TEST
variance in accoroance with i METHOD OF tle5 from at le�sa t ��
9. YIELD (gput)
ZONES (depth). County Roads. Include d1e �d O
Show direction and distance u
11 . CASING.
Thickness
--- two State Roads or
.�,,,{�'�- Amount L on road names. Wall TItI ht/Ft5 numbers and comet
11. DISINFECTIONTYPe orWei3hdFt. Mate5rial4 '�'r ^✓Oss,n
Diameeer ���5 � I D X kx "° 1.
12. CASING'. Depth
Topogra tc/Land setting
ORidge Slope
pValley OFlat
(check appropriate box)
ellongdeoil wel .//a , Latitude/longitude
¢� on t
(aeg0urce _t"SOTopographic map
Latitudeilongitude source: (cheek bon) G LOG
DRILLING
Formation DeSCttP
t
DES
Fro[U T c
Froth_a___ Ft.
To�� -� Merhod
From— To_— Ft.
FrRO_� Material (7d J
13. GROUT'. Depth _
Ft.
From_1)--To FI.�—�'—
From�-T0 h Diameter Slot Size
n.
1. SCREEN'. Depth
in. .
From,_ To Ft. tn. Fromm—VEL PACK: Material
n.
Size
15. SANDiGRA Depth
ToFt —�
From�To_� Ft.��-
From�- l5A NCAC 2C, WELL
1 DO HEREBY CERTIFY THAT
STRUCTED IN ACCORDANCE
WITH THE WELL OWNER
16. RENIARI`S RECORD
EN WIT PROVIDED TO
HIS WELL WAS CON Qy
AND THAT A COPY OF THIS RE
SATE
CONSTRUCTION STANDARDS,
-�'�' T}IE WELL
OF PERSON CONSTRUCTING gaiQ1gh, NC
SIGN AT RE 1636 Mail Service Center
REV. 07/2001
LOCATION SKETCH
G �
c
CP
Submit the original to the Division of Water Quality, Groundwater Section,
27699-1636 Phone No. [phone], within 30 days.

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
\YELL CONTRACTOR (INDIVIDUAL) NAME (print) 8 o toby
WELL CONTRACTOR COMPANY NAME
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
302841
Pori 5 CERTIFICATION # 9 0 a a
(if apnlicablel (if applicable)
ttl
Fca.)SO/VT We/1 h%t/t/I/A/ Cry. PHONE gzatl 65t3-fr
I. WELL USE (Check Applicable Box): Residential 0' Municipal/Public 0 Industrial ❑ Agricultural ❑
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other ❑ If Other, List Use
2. WELL LOCATION:
Nearest Town: 4khr✓r//G
&// crk.
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: 14-Q.k12\ I' omf 5 ,thc.
Address PO B6)C (/t
(Street or Route No.)
5(,lnnknnoa_ nC Q%1-1`h
City or Town State Zip Code
( 8)-t%Z-WOO
County 110/1C.0Mhr>'
Area code- Phone number
4. DATE DRILLED WO y
5. TOTAL DEPTH: yQ S
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO
7. ST.ATIC WATER LEVEL Below Top of Casing:. S FT.
(Use "+" if Above Top of Casing)
S. TOP OF CASING 1S / FT. Above Land Surface*
Top of casing terminated abor below land surface requires a
variance in accordance with I5A NCAC 2C .0118. J
9. YIELD (gpm): /Q METHOD OF TEST3/paof17/1t
10.WATER ZONES (depth): VO
I . DISINFECTION: Type 'Fob I f5
12. CASING:
Depth Diameter
From I To ///% Ft. 6,aS
From To Ft.
From To Ft.
13. GROUT: Depth
From D To A Q Ft.
From To Ft.
14. SCREEN: Depth Diameter
From To Ft. in.
From To Ft. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To - Ft.
From To Ft.
16. REMARKS:
Topogra c/Land setting
❑Ridge lope ❑Va11ey ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degreesiminutes/seconds)
Latitude/longitude source: ❑GPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From To Formation Description
1)/,fi
p - /nS
/05- //d
YoS
Rock
6.tkeyn/ re
LOCATION SKETCH
Amount /0 O z5 Show direction and distance in miles from at5ast
Wall Thickness two State Roads or County Roads. Include th �ad
or Weight/Ft. Material numbers and common road names. O
16 N. /5 Pvc S.oAAi
Material
Coi Lre i't
Method
Poo NI &
Slot Size Material
in.
in.
Thou cveek
Ache i ie,nc
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
SIGNAT RE OF PERSON CONSTRUCTING THE WELL TE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center' REV. Raleigh,hNC
CO]
27699-1636 Phone No. [phone], within 30 days.

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of {W�ate-rr Quality - Groundwater Section a D a
WELL CONTRACTOR (INDIVIDUAL) NAME (print) 60 bLi)by s / e 1 / S CERTIFICATION H
WELL CONTRACTOR COMPANY NAME &ails-041y We/( h^/t///.rif COPHONE gat) 68 3 - yyl9
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
302848
I. WELL USE (Check Applicable Box): Residential S Municipal/Public ❑ Industrial ❑ Agricultural ❑
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use
2. WELL LOCATION:
Nearest Town. ff/eeete/4f!lVie
County Pen C/0M.be
tStrect Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OW Ot�' AddresseV)Ue-
`77 ,aQC
(Sneet or Route No.)
Ashevi Ile in
City orrown state
f�)- &15-727'j
Area code- Phone number
4. DATE DRILLED l/Aeov
5. TOTAL DEPTH: & C
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO
7. STATIC WATER LEVEL Below Top of Casing: IA// FT.
(Use "+" it Above Top oiT`Casmg)
3. TOP OF CASING 1S / FT. Above Land Surface*
*Top of casing terminated actor below land surface requires a
variance in accordance with 15A NCAC 2C .0118. �!t
9. YIELD (gpm): 2 METHOD OF TEST j3rprar / I)
0. WATER ZONES (depth): 1/Q
RRO(n
Zip Code
11. DISINFECTION: Type tab/tTS
12. CASING:
Wall Thickness
Depth Diameter or Weight/Ft. Material
From To _ Ft. 4.15 Alt.. as Put SDR..1/
From To Ft.
From To Ft.
13. GROUT: Depth Material Method
From 0 To XQ Ft. COAL:Ns itf PouP/&
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.
opographic/Land setting
Ridge ❑Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/lin3�itude oftw- I ocation
�/ 3S 4 7//
op03S,306
econds)
PS❑Topographic map
(check box)
DRILLING LOG
Formation Description
DMT
(degreesltifiinute.
Latirudeilongitude source:
DEPTH
From To
0 — Y5
K$- Sa ]Cock
S0 ^ 6OS,/
fir
f,_
sr{.',
LOCATION SKETCH 0 r'`r-1;
Amount /Q62 S Show direction and distance in miles from ar letist -e (11O
two State Roads or Counry Roads. Include Mei roadCo o--
ri
numbers and common road names. �"
Wecl/0-v' e, nC
l6. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, �A-15
A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
fix
SIGNAT RE OF PERSON COAy NSTRUCTING G THE WELL �YATE/
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
Noi

WELL CONSTRUCTION RECORD
302849
North Carolina - Department of Environment and Naturalu�Resources Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (prior) IJ D la 61 IV , Pdlls CERTIFICATION # 94:::)a a
r t�,1Yl
WELL CONTRACTOR COMPANY NAME FC aoso"T tvel( P/vrtI/el/ �Co • PHONE 6S33 - ff p
II
STATE WELL CONSTRUCTION PERMTf - ASSOCIATED WQ PERAllTIS
(if applicable)
cif applicable)
1. WELL USE (Check Applicable Box): Residential 12 Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION: p
Nearest Town: / /r 1c A rN
Avert, P cork
t Name tiers, Caron
County fjtl /1/.DM,�, e-
tSaee unity, Subdivision, Lot No., Zip Code)
•t� �`p Mill
3. OWNERDP5IQI1CP Homes of,4sheVl IIe,;nc. 5 (degrees/minuet conds)
yd + tirade/longitude source: PSOTopographic map
(Street or Route No.) - (check box)
]_P: k,�Sf-ek tic Q.Q�yg DEPTH DRILLING LOG
Cry or Town State Zip Code From To Formation Description
n-�q0-i23ti o -;s u/,tr
Area code- Phone number j S - e/%�) /�OC%�
4. DATE DRILLED . /7 //y Yi, - ID/f S (,.nctA/17It
5. TOTAL DEPTH: (`/'> S
6. DOES WELL REPLACE EXISTING WELL? YES _❑ NO
7. STATIC WATER LEVEL Below Top of Casing: zvoe? FT.
(Use "+" if Above Top of Casing)
S. TOP OF CASING 15 / FT. Above Land Surface'
'Top of casing terminated avor below lend surface requires a
variance in accordance with 15A NCAC 2C .0118.
9. YIELD(gpm): / METHOD OF TEST)3fauv17/ail)
10. WATER ZONES (depth):
//''Topographic/Land setting
L�1Ridge ❑Slope 0Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
.Address V0 Lynx I-355
11. DISINFECTION: Type 'ahlti5 Amount `-
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
From D To 4fel Ft. G as 1,16,IZS PVC S.nRx/
From To Ft.
From To Ft.
13. GROUT: Depth Material Method
From Q To 7,0 Ft. Concnr#r POUr'j
From To Ft.
14. SCREEN: Depth Diarnerer Slot Size Material
From To Ft. in. in.
From To Ftin. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft_
Ft.
From To
T
C c__
LOCATION SKETCH . .Y;j?.
Show direction and distance in miles from atSst _4c
two State Roads or County Roads. Include dis•etad -,in
numbers and common road names. I A
cfa O O
Avery Park
FIe�cher, nC
I6. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH I5A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
SIGNAT
RE OF PERSON CONSTRUCTING THE WELL
DAT
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
o

WELL CONSTRUCTION RECORD
Norm Carolina - Dcpartmenoof Environment and] .Urrut Resources - Division of Water Quallii''j .ry -
\t LLl CONTRACTOR COiIPAP* NE rer.s t,.o / ��1
�L� (/�/ ��✓Q ljPRONE
VAELL CONTRVCI'OFi NAME (pruu)
STATE WELL CONSTRUCTION PERMITa
ui-�CIC,cl.i
302841
Groundwater Section
redenv . !(Jt '(C s CERTIFICATION °3/176
la asr 14_
ASSOCIATED WQ PLRAIITm
(it nppl i cab let
WELL USE (Check A<i pplic blc Box): Res id cntiel aunicipal/Publie ❑ Indvst-Hui ❑
h'annoying 0 Recovery 0 Heat Pump Water Injection 0 Other ID If Other, List Use
C. WELL LOC.
Ncare Town: /� `. V G',/
7ohn Tait 'Drive
Coon Ly 2 a .fo-,i/
iSrcer Nmm, Numbers, Community, SubJivuior,, LJr NO., Zip Code)
3. OWNER al11 &e ck
adress 0 Hlfcr.est Or I've
(Saco Gr Raurc No.)
flshevitlt nC,
Gry or Town SEIO
&22- (DQwc -21(co
ves Coat- Phone numocr
4. DATE DRILLED e— 2 r-0 V.
:. TOTAL Sd7
o. DOES WELL REPLACE EXISTING WELL? YES 0 NO Cd
7. STATIC WATER LEVEL Below Top of Casing: ya FT.
' (Use "r'-iiA bovc Top or Cain
3. TOP OF CASING IS FT_ Above Land Surface'
-Top al resin; terminsria auor below lured eu riyce requires u
.a rianc= in ><w ra ante wirti 15A NCAC 2C .0116. 9. YIELD (;pm): 3 METHOD OF TEST B%Nu 4 5 e77 •9
IQ, WATER ZONES (depth): J
agRey
Zip Cade
I. DISINFECTION: TypeCIOP,i.,
12. CSFNG:
Depth
From b To 20
Frain
From
To
To Fr.
Diameter
F. L./Zr
Ft.
Amount /7 .Les,
Wall Thickness
or Weight/Ft. Material
TPA&, 7' c
13. GROUT: Depth MPatcnal Nlcrnod
From 0 To aeD FL. Care.P.Gtie %O.-•••EJ
From To FL
I'_ SCREEN: Depth Dian -icier Slot Size Material
From To F. in. W.
From 1'o F. in. to.
15. S ND)GRoVEL PACK:
Depth SiZC Rlarerial
From To Ft.
From To Fr
to. I'.EM.ARKS
Agricultural 0
Topogra hielLand serrine
❑Ridge osiops ❑Valley ❑FIa,
(check nppropriare box)
. rrude/longinide of well location
LT ,
° 3►, ou'wo>z° IC7k7
(degrees/m,nu,c�s, cnonds)
Lai i tude)longicude source: �'GPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From To Formation Description
O— 76 �� <
—1-0C
LOCATION SKETCH
Show direction and distance in miles from at 1
nvo State Roads or County Roads. Include the
numbers and common road names.
Shc�nT-ait- 1Dr.
Fcti rview, sic
cast O
roe
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH ISA NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT a COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
2—zr -oy
DATE
SIGNATURE OF PERSON CONSTRUCTING THE WELL
Submit me Original ro trio Division of Warer Quality, Groundwater Section, 1636 Mail Service Censer Raleigh, NO
27699-163o ?hone No. (919) 733.32_21, within 3U days. OW- I REV, 01/2001

33 2
WELL CONSTRUCTION RECORD
-Norm Caroline - Dcparmnenr or Environment and ral Resources - Division of Water Quality - Groundwater Section
� /
VA ELL COATL ,.Cr3f. (INDNIDUAL) NAME iprtnr) Itift lV ). LUi live. 5 CERTIFICATION rl__;l
p ^
\41:'LL CU n'r Ra CrJR CO.\\FAN 1' N'.•.,YIE G�SI�/✓S /.i /P/� 7%p/III//yq �Rag O
?HONE
�O1 S6p YWet,
ASSOCIATED WQ IrERMITV
I if:ipplicablcl
S VAIL \LLL CONSTRUCTION PERSilla._
li wr.l _.bl-:i
. WELL LISE tChecic App6oeblc Box): Res idcnrial Ca Nl unicipaliPublic ❑ Industrial 0 Agricultural 0
Nioniloring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other. List Use
2. \FELL LOCATION.
Nswen Town. 44-4 v• f/C Counp' ihneanfi
"pith,/r:.,lc ,M. i/.c/L if/,
,ia- ci N.inm, Num bets, Cmnrrmmry, Su bcivuion, Lot No„ Zip Coac)
3. 0\1'NERSDIl+h?Yn Shvwease NOUSing
.=.ouress 54 3 Ass�vi I le Hved .J
t>nccr or Rourc No.1
11endfvsanvtlle (lC aS7q 1
Ciryor Town Slone
SIC&- (0.0 2e683
Zip Cud
TopographiciLan g
❑Ridge °Slope/allValley ❑Flan
(check appropriate box)
atirude/longinlde of well location
rr° q,rzo wore1s;'it/
(degrees;minme• Lends)
Laururleilongirude source: GPS❑Topographic map
(check box)
DEPTH DRILLING LOCI
From To Forgyttion Description
0'/7
rose-Plluncou➢bet /7 _ Lz
D=.TE DRILLED 2 /t - 6 t�—
LI /J c
(n. >2
i TOTAL DEPTH. 3 !o
DOES WELL REPLACE EXISTING WELL? YES ❑ NO
7. STATIC WATER LEVEL Below Top Di Casing: JY FT.
i Ust "✓"ii Above Top or Cesng)
3. TOP OF CASINO IS ' FT_ Above Land Surface'
"Top or easm; rrrminuiea sour below Jana surrsee requires
rlm,cc in >ccorua)l%wine ISA NC.C1C Alta,
gpm): 9. YIELD ( A. METHOD OF TEST Bbw4 9 •(Ny
r9
IJ. \.ATER ZONES (uepml: ✓
II. DISINFECTION: Typer /op/pie Amount
12. 0.9.SFNG: Wall Thickness
Dcprh Diar e r or We iehdFi. Material
From 0 To Z 2 pc e. /l r
From To Fr.
Fmm To Ft_
Is
GROUT' Ocprh rvlalcnal �) bicolor'
Froin Q .To c7O Ft. 60/re de ALe,ri
From To F.
I,SCREEN: Depth Diameter Slot Sizc Material
From To FL. uI.
From To F(_ in. in.
I5.S.NDr3RAVELP.ACK_
Deph Si2c Material
From lb Ft.
Front To Fc.
1
06
LOCATION SKETCH -
Bs
Show direction and distance in miles train aticst
Iwo State Roads or County Roads. include theiad �>
numbers and common road names.
Pad er Ridge
Weaverv; Ile Inc
o. REM_ARKS.
I DO HEREBY CERTIFY THA-T THIS WELL WAS CONSTRUCTED [N ACCORDANCE WITH IiA NCAC 2C. WELL
CONSTRUCTION STANDARDS, AND THAT ,A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
1 . '7c vaAik 2— /r. — o�!
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
Suonnt the original m the Division of Water Quality, Groundwater Section, 1636 Mail Service Conner- Raleigh, NC
27399-163o ?bone 1710. [phone], tvirnin 30 days. G W-I REV. 07/2001
rnrri
n2-

WILL CONSTRUCTION RECORD
Noon C;mhr1e • 0cperrnunl or Envuomncnt and rid Resources - Division of Water Quail ry - Groundwater Sterion
// % 1 L
`,1�i LL CO N1'I'.ACl'Jf. (INUlY1DU.al) N.ahlG (prim �. !/ 1 i f✓C. S /' CCI:TIFICA�rT1�Jt fJ >rf,�c,/Zq�
v, ELL CorsTtk CrJll toM11F1N1' Nn.1lE rer 14.5 lfs �ev Dee /f,N€ C, • PHON.0 Adp10S, 0..(4_
3TrrC wtLL CO NfTRUCTION PERntI'1's J aSSOCIA.T2D WQ P7=12h1tT::
(ir.",nPlicablei
I 44 EL USE LChccic App6aubla Hos): Rcsidcnriul Gf MunicipaL%Public ❑ lnuuyrriut 0 AgncuIMral 0
c\Wi Lcrtn3 ❑ Rceo>try 0 Heal Purnp \Varor lnjcslon O Ocher 0 ]r Other, Lisl Ust
2. ;1:ELL LOCATION.
Nearest Town;/¢/er .,./o:
4:1lee ne/ 4 2
13 weer N.m,c, :Num Dcre, Comalun iry, SuG�irleiml, WI Ho., Zip Cone)
Couriry /r e#uc.n1t
3. OWNER: `T AIdprier
Aaaccssaa Efl4 %€r Rawl H a�
tsc[ c`ourc No.)
Al.exahcigtioi
)1.46 r;, Sam
%?-i- -U555
r1[a Ndc- I'nOnc pu:itDcr
DATE DRILLED S�'20.04
5. TOTAL DEP'Ili L/ti r
Zip duos
Topographic/Land sating
ORidge IrEt lope ❑Valley 0Flal
(check nprropriart box)
Jr�arude/longiaide of well location
ri3:`4).vii stems,/2.L,/)
(dcgrecvminmtsnccons)
Lliwdeflongi rude source: 2(GPSOTopographic map
(unccic Dux)
DRILLING LOG
Formation Description
72-?Ft
G. • 4(
DEPTH
From To
o- 77
F2— 5471—
o. DOES \\ELL REPLACE EXISTING WELL? YES 0 NO 2.1
'. STATIC WATER LEVEL below Top of Casing: /00 ET.
(lire -t" if .Above Top orCasing)
3. TOP OF CASING IS / FT. Above Land Surface"
•'fup o1 lfl Ic morares a Liu r bcluw lane suit ce requires a
,arianx m asur0aucc wire IjA NCAC .0116.
3. YIELD tspm): JL• hLETJ-IOD OF TEST Bbail ryq •K.,
lu. \\'.ATER ZONES (depth): 3/0 , .360
II. DISINFECTION T per 77
Ty 1/VG Amount /2
CASING: Wtdl ThleLncss
Dcpm Diameter or WtighuFt. MsscHal
From, b To $ Fr.6•/t; fJ.lzl /'c-
Fro:n To Fr.
From To Ft.
!�. GROUT:: Depth Mental
From Q To a Fr. CONcpck
From To Fr.
I�. ECPLEEN. Dean Diamcccr
From Fr.
From To Fr
u. SANDIGRAVELPtiCK:
Deprb Size Maccrial
To Ft.
To FI.
i\'Icnw tl
Alexander, rlc
Slot Sizc bWmrtal
in.
in.
O
O
LOCATION SKETCH
Show clirecrion and distance in miles from ar
Iwo State Roads or County Roads. Include the roa31
numbers and common road names.
Frain
From
o REMARKS:
'Embl er Road #
DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS 1'LECORD HAS BEEN PROVIDED TO THE WELL OWNER
SIGNATURE OF PERSON CONSTRUCTING THE WELL
3r"20-09
DATE
Sunniir the original m the Division of Warer Quality, Groundwater Section, 1636 Mail Service Cznrcr - Raleigh, NC
21659-1153o flume :No. (015) 733.3?Zl, rvirnin 30 days,
"OW- I PvEV.O?%DUI
LSI

Lry r71 $ rc
JwTIDc(
DATE DRlr LED C"-/c.ot/
roT>.LDEPTH: S-Or
o. DOES WELL REPLACEEXISTING WELL? YES 0 NO i?K
STATIC WATER LEVEL Eclow Top of Casino: FT.
[U;e "r• it .-\Dp),c Top ui' Cooing)
TCCP OF CASTING IS / FT- Above Land Surface -
"Cap or :avu� 1crrnunrta aQur bcluty lane eurr5cc rc9uires a
r.rmu:= w a:cura.gqec with I5d NC.C:C.0116. 9. YIELD (sums. J WIETHOD OF TEST B$jWi» e77 •S
!u. WATER ZONES (depth)' 3°C" J
gricunvral 0
Topogra�uc/Land selling
❑Ridge LS !ope ❑Valley ❑Fla[
(check nppropriare box)
Latitude/longimile of well location
siorz e Sri 257
(Oegreexminuwo�' >cconas)
Laumdeilongitude source; PIGPSOTopographic map
(check box)
DEPTH DRILLING LOG
From To Formation Description
o-N/ .04:t
446 S. ✓siL e
�I.
\4lLL CON TRu T OR COM&-viNY
WELL CONSTRUCTION RECORD
L- psrmxnl or Enauorpncnr and cal Ruowccs - Division of Water Quality - Groundwater Section
cLL CJ\11"1 i iINDIVIDUAL) Y+OiL iprmy (!jtNr S CERTIFICATION
3/ gib
LCSaNS ijel/ D,e////7Co. PHONE 830aYd'iZp/e
,
1tCLr CCr STRUC LION PLl�ll'1'n
ASSOCIATED R'QP•Pmern
iir l,nplicublc't
L. V.ELL TINE , T.Ivcck Appllcablc Box): Raaaidenial alAuunicipaL/Public ❑ Industrial 0
ltonttorm; D. Rcrorc y O Heat Furnp Al tiler Injection 0 Other 0 If Other, List Use
7. Oai,'_ LOCA'I'IJN.
Narest TaynLp -re J..- Couoly ,rlc oast-
N. gr.' Wel is)/1,1r free /14.
,__coo NAM:.il'umacc5, Commumry, Sub,]I vi ion LOi NQ., Zip l:Qoci
01i INER C l • f Woad
1/41r:5_ 1 r rt
rS o'ccr er Rau tc Na.7
ZrosS€1+ct (,4 3091
'_rp Coo,:
DISINFECM.3N, T.peC IOP rive ckrnounl /4
._. i, ]t!N a- W.m Thml:ncsi
Dyrn Diajn icr or bAWcighuFt. Material
From 0 yF Fr. c,/zr— r4%/c/ !)✓c
Prmn a FL
CROUT Dep,e,
FLOW 0 .l, ao FL. (''A1C2ck
horn
la. SCREEN' Dcprn Diemcicr
Fmm Fr. m
om Tc Fr.
if. SAND3iL-.\ I' -,OK.
Dcpin Si%c
Fro,Il - Ta Ft.
From TO Fr
tT S)
IO. REt4L.ALICE
.
Marc nal Mermen
NI4[crlal
302844
LOCATION SKETCH
Show direction and distance in miles from a[ Ic.
nvo Stare Roads or Counry Roads. Include the ra*
numbers and common road names. -'3
CO
NI'kk( w``uij
Leicestek, itC
I DO nEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED CN ACCORDANCE WITH 1.5A NCAC 2C, WELL
CONSTRUCTION ST4.iNDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
p 11:4-1 z, �ta,,t A V y
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
�uOmir rn; urb4inai to me Division OP Water Quality, Groundwater Section, 1636 Mail Service Cznrcr - Raleigh, NC
.y-I0.ro LI cnc !'10. ("lo) 733-.1221, within 30 dayi.
GW-I R,EV.07/2001

WELL CONSTRUCTION RFCORI)
ti -o C roi Dep_rvncnL of Environment end - rat- Resources - Division of Water Quality - Groundwater Sterion
I ELL C3.Vr '1Ot.(INDIVIDUAL) NAME iprinii / '_ /' p� �t LLL CJIIi CCli of\IFaN I'rv.a.YIL fer4tc.S0/✓S e// D,pJ//l�/5 Ce • PHONE Ac31§ 5fJ .7
Ii LL1 .JiN J IiU CTION PERMIT. ASSOCIATED ASSOCIATL'•D WQ PERMIT',
i_ rL: .0 rI' li t.iplicoblcl
30283@
. I, /VC 5 CERTIFICATION 8- /JP
\FELL USE LCI'wd: r-pp liable Bow): ftctidenu l M uirticipaU'Public 0 Incil etriul 0
llonunnnii O. Rcooeery 0 Hest Pump Water Injcctiou ❑ OUi r 0 If Otter. List Usc
2. ;A:ELL LOCATIyON•
N:Srest To rrn: Ce: cry*,
44A Il tne/ .fie/
County N•-nr.»-,tc
,_can Nam:, Nuntocrs, Cannwmry, Subci vision, Lei No., Zip Cork)
1. C11?NEI: 150
• 0 0 Thr•
(Iic2sh,Leiteei I1Lc4 �t7U8
• To,,;, cylc Zip Coat
Isagi_zsy-oizz
-_es sox- Fllunc Ilwn°a1
11RIT LET, `-/
-2o - ve/
5 TOTAL DEPTH: `/vr
n. DOES WELL REPLACE EXISTING WELL? YES 0 NO
STATIC WATER LEVEL Bclow Top or Casing: lr d FT.
(Lite --r"-ir nbovc Top or C.Ding)
3. TOP OF 0.-.SINC 1S / FT. About Land Surface' y,
-Top or ..von mrmli1alca iVur bclutr Irmo turtce rcguires a
r:n.nt=m>ccoraan otrim lid .'CAC20.al la. 0 G�
5. YIELD tSpmT -METHOD OF TEST Bhw4Y *Kali mm -
tu.l1'-:TERZONIEStdcpttl): �r �/z/O' ✓ �bm
LOCATION SKETCH I 73©
Show direcrion and distance in miles from or lea97 O
two State Roods or County Roads. Include the rosy!
numbers and common road names. 3
SS? Z/ pre g ��
..cft
fl
rn
ell 0
grictiltural ❑
Topogra)�hie/Land setting
❑Ridge C3Slope ❑Valley ❑Flan
(cheek appropriate box)
Lalirude/Ionglmde of well location
kyr-11-2 e'/,rnaz` y: Zd6 '
(acgreevminutcsR4onas)
Iroimudtilongitude Source: CEPS❑Topographic map
(check buX)
DEPTH DRILLING LOG
From To Formation Description
5-1 11-
S % - 4vr'
.I_ D ISINFECTION. TypCn/OQ,,vt P,mount As— "Biz
-J. CASING: WoJI Thiclwcss
Lrptn Diameter or WciehrlFt. Materiel
Front 49 Fc 5-or FL 6•/ls
From Po Fr.
From To., Fr.
ii. G ROLIT: Depth frlOrcnal
Oriental
From Q to aO Fr. GONCD_ele f.?,._ •,/
F13In H.. FL
1., SCREEN. Depth Diameter Slot Size NWrcrial
Froro 'la F. in. 111
FIJIII TY F1. In.
Ill,
15. S;IND,13R-.VELPACK
:
Dcpihi Size einateial
FI'o:P. To Fr.
From To Fr
Ic. REM ARIS
Pot ofo e (Branch Ea
Leices3•er, tic
I DO HEREBY CERTIFY THATTHIS 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
97 ti-, 1 !/zo ©Y
SIGN.=,TUP:E OF PERSON CONSTRUCTING THE WELL DATE
EDE MIL rile to Inc Division or W'arer Quality Gro undwarer Section, 16361v1ai1 Set -vier Cenrrr- Raleigh, NC
:7097-!o3u Fnonc tto. t" I9) 775-3Y21, within 3U aays.
OW -I PtEV.07/2001
Co
m
--D
Cad
C

30283�
WELL CONSTRUCTION RECORD
Nona Cmlina - Dcparmunrof Environment and cal Rcsouroos - Division of Water Qualiry - Groundwater Section
l / 2 /L
I1 ELL C01TIti0ro¢ (INDIVIDUAL) NAME' (print) �. c./T�/li /YS 4 //'' CERTIFICATION rlf.'3�j�//��d
HELL CON TRCTO1i CCiaa PANT NA.I1L erQ1CSO/✓S t&k// 7)z/s/l//N� C`! • PHONE R38� a5r-5' 1&
w ELL cetNSTRUCTLON PERntITs �J
,If rl.,,blci
ASSOCIATED WQ PER1v11Tlr
(iira',p lito b lcl
I. '',FELL USE iChcelc Applicable Box): Residential E &iur LcipaL'Public 0 industrial 0 Agricrdrural ❑
bwduonug 0 Rceovcry 0 Heat Purnp Water Injection 0 Other 0 if Other, List Use
2. R;6LL LOCATION:
Ne rest Town'Cie -( ,,/.-- ,> Counry A<�.onit
.'per: t (o... 4/ IC •t k /e4, f
cct am.; . :Wimoc rs, Community, Su beivuion, Lai No., Zip Coact
3 owNEr:thil"'Rury�Fel-f-
A4ir _i P6 L6 rx 'gasp,
Enka Sncecr ltoumTi
�2zy17,or 1i-15i�7 Zia Cans a
«-'fea Nac- Phone pwnbef
DATEDn1LLED 4'-/5-04
3. TOTAL DEPTH: L 0 5-
6. DOES \\'ELL REPLACE EXISTING WELL? YES 0 NO [T
7. STATIC WATER LEVEL Below Top of Casino: /0 0 ET.
(Use "r'ir .Sbarc Top se Opemg)
S. TOP OF CASING IS ' FT. Above Land Surface'
"Gip at trims mr muta too aunt- bcluwr land su rtaot requires a
r:rtsncc m sac oranntc cairn 15A _CAC DC THIS.
;. YIELD t;pmi: METHOD OF TEST Bbw4iq •?rr
1u. WATER ZONES tdcpui): c/� 0 J
u, DISINFECTION Type('/oJ2r vc
12. CA.SrNG:
Dcprn
From D To SJ
From ro
From To
13. GROUT: Depth
Fronl p To ao
m To
Amount
Wall ThielmcsS
Dismeter or WUShljFI. Material
r. C./Lrr i3O.PL./ wG
Ft.
Fr.
Ma[cml
FL GOfCecM
FI.
I-1. SCREEN Dcprli Diameter
From To
Fr.Ln To FI, in_
Ii. Sr.NDr0R=.VELPr.CK:
Depth Sac Material
From - To Fr.
Ivlclnod
Slot Sizc 6latcrial
in.
in.
from To Fr.
lo. REMARKS:
Topographic/Land ser ing
0-Ridge ❑Slope OValley ❑Flat
(check appropriate box)
Lariwde/longitude of well location
gyr°'//. Yet s-'Vo vf. as7'
(dtgreesiminuitys ccondi)
Lalirude)longitude source: M GPSDTopographic map
(cheek box)
DEPTH DRILLING LOCI
From To Formation Description
sr-�CD6 C _ .,e
O
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or CountyRoads. include the roa.l k
numbers and common road names, — coo
rre%
(ft c'a
DaN i 5 Cave 2cl .
Leicester, nc
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCOTUDANCE WITH ISA NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER-
.f. v.,. y is o a
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
Suonllr rile origlnml to the Diviiion Of Water Quality, Groundwater Section, 1636 Nlail Service Carver -Raleigh, NC
27c93-103o ?hone No. [phone], rrirnin 3o days.
OW -I REV.07/L'001

WELL CONSTRUCTION RECORD
Noah Carobna - Dcparrmenrof Environment and • rul Rcsourccs - Division of Water Quality
\\ E LL CONTI'.ACTOR (1ND1VlDUaL) NANIE Ipnni) led AN h'. (.7(_�/i �G S /'
WELL CONTRACTOR CUAIP.aNV N.-ME rert s�s hk/J ().Pi //,)v c;•
ST.A'TE WELL CONSTRUCTION PERNIITA
zflS
- Groundwater Section Q /,�
CERTIFICATION °3146
PHONE$Ipr11OSd-S s&
ASSOCIATED WQ P 1ItnliTv
(if:oplic blei
1. WELL USE ,,Check Applizable Box): Residential ❑unicipaUPublic ❑ lndusrrial ❑ Aericulrurnl 0
Monitoring ❑ Recovery 0 Hest Pump Waver Injection 0 Other 0 if Other, List Use
2. WELL LOCATION: �j
NOSre't Town' . eeer County Qae...r,so,,fo
Iia'o=r N.imc, Nun Dore, Community, Subdivision, Lor No., Zip Cadc)
3. OWldNroEsRs :I1Qnstei CyUrG
(05I mciQ /4,• •
,,Sneerer Rourc No.)
Cared l ev n1
9$715
" n, or Town Slice Zip Cud
222-32A-2742. •
=.ru toot- PEEL pumbu
4. DATE DRILLED J- y 01/
i. TOTAL DEPTH: 2 o f —/
o. DOES WELL REPLACE EXISTING WELL? YES ❑ NO ,7
7. STATIC WATER LEVEL Below Top of Casing: 442 FT.
(Use "r"'if .Above Top of Csm_)
S. TOP OF C, SING IS 1 FT..Above Land Surface*
'rap 0(:sung ¢animated aeor beluw land surface requires a
eariance ,n aawraaucc cairn 15A NCAC 2C .011E.
9. YIELD corn): - 2D AI HOD OF TEST B$W/pq •?•9
0. WATER ZONES (depth): glop 1l
11. DISINFECTION: Type( /024 A,e4c. Amount 7 laJs
t2. CASINO: Wall Thickness
Dcpm Diameter or WnghUFt. lutcrial
From 0 To c// Ft.L./Z! SPt/ vC
From To Ft.
From To Fr.
13. GROUT: Depth hlarcnal Hn ermo
From 0 To c'10 Ft. cc74'c e i°•-"
From To F.
14. SCREEN: Dcprh Diumetcr Slot Size tvlamrial
From To Fr. in. in.
From To Frin. in.
15. SAND/GRAVEL PACK:
Dcpi) Size Hagman
From To Fr.
From To Fr.
lo. REMARKS:
Topogr is/Land setting
❑Ridge Slope ❑Valley ❑Flan
(check uppropriaio box)
Latitude/longinlde of well location
1)3r° c/o. 2 SST" von° y/ lair
(dcgrtcs;minutes ronds)
Latirudeilongirude source: f> UPS❑Topographic lnnp
(check box)
DRILLfNG LOG
Formudon Description
DEPTH
From To
41-.20ir
c
LOCATION SKETCH
Show direction and distance in miles from at least
vivo State Roads or County Roads. Include the toga
numbers and common road names,•
s+
Win is-peri n
Lot # 3G
Le ( cgs+ev-, f C
-Pines
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
SIGN.=,TURF OF PERSON CONSTRUCTING THE WELL DATE
Submit Mt original co the Division of 4Yarer Qualify, Groundwater Section, 1636 Mail Seryrer Cenier-Raleigh, NC
22699-163o Phonc No. [phone], within 3U days.
GW-1 REV.07/2001
CCrn
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-nen
of"
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to
OG
M�

STATE 1F ELL CONSTEUC'I IOti PE1a111TE
.:(.r.11:_GIe I. Ilr ;uP{ii �Dldl
WELL CONSTRUCTION RECORD
Norm C_m6n-_ - OcpsTimenr of Enviromncnt and ral Resources - Division of Water Quality -
VA ELL CONTRACTOR (MDR -IDEAL) N.AMFiprim) D itfi( / LZn//,.Qtvc 5
1I ELL CON'TRaCOR COMPAN\ NAME IerQ �S /Lei✓ i/I/N LdJ
J ASSOCIATED WQ PERMITU
302838
Groundwarcr Section
CCRTIFIC4TION A.i�y/Lib
PHONE J3a8i a5r15 L4,
I. WELL USE tChccic Applmabk Box): f esid mtriel )vdur ioipal/Public ❑ lndusrrial ❑ Agricultural 0
Monitoring 0 Recovery ❑ Hear Pump \Vater lnjccrion 0 Other 0 It Other, Lis[ Use
2. ' EL.L LOCATION:
Near st Town: Le re/A-- County -94^io-,sic
lio'cct N.unc, Nuarocrs, iammunity; Subaivuion, Lot No., Zip Code)
3 OWNER Y"eim NLiichi Yam'
=..)arcs, to-7WI�iP.Liylq ris I Drive
Ashev111cn`:1t _ or t No' aRsoy
cln or Toe+ Suit Zip Codc
$2.S,- (00,6 - q-72g
'yea Ndc- P!Ionc Oumocl'
A DATE DRILLED .% f/-0`i
:.. TOT A.L DEPTH: ZG
E. DOES WELL REPLACE EXISTING WELL'? YES 0 NO 011/
7. STATIC WATER LEVEL Below Top of Casing: 441 FT.
I U,t "-r" if Abovc Top of Csa,na)
3. TOP OF CASING' IS / FT_ Above Land Surface?'
`Tap orcaia; rrminatto aUor bsluw )anti eu riyce requires
;riauccm a:wrQancc i ni 15.1 .NCAC 2C.OJIb.
E. YIELD (gpmj' METHOp OF TEST B%Wipq •�rI
lu. WATER ZONES (depth): ✓Cr ;Er"CO
Topographic/Land selling
❑Ridge ape OValley 0Flac
(check uppropriare box)
Latitude/longinlde of well location
/✓Jr"lJ,3Yl,'Nan2°3C,evs—
(de,recstm inutcascconds)
Lali tudeilongitude source: 2CiPSOTopographje map
(Once: box)
DEPTH DRILLING LOG
From To Fwiation Description
D— Z-7
Set.%
J2 )6C 6 ��
^�z
p aGrn
-o("
OQ
13
,L DISINFECTION: Type('/02r,yc. Amount 1413
i2. CASING: Wall Thickness
Deprn - Di: -nerd or Wcighr/Fr. 14qierial
Frc;m 0 To /2 Fr. C,/Zrl— b-609 ./ /wL
From To Fr.
Fmm To Fr
13. GROUT: Derain Material
From yO To c:0 Fr. C neaele An, 1
From To Fr_
U. SCREEN: Dcpar Diarneler SIor Site iblarcri0.i
From To Frin. in.
n
From To Fr. in. i
IS. SAND/GRAVEL PACK:
- Dcplh Marginal
From To
From To
F c.
Ft.
lo. REMARKS:REMARKS:REMARKS:
LOCATION SKETCH
Show direction and distance in miles from at leasvt
na'o State Roads or County Roads. include the ro S6
numbers and common road names,
0
Mctnod
01 d Lei e es+er 14(.9_ ,
nC
DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, .AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
Cumuli me original ro me Division of Water Quality, Groundwater Section, 1636 NlailService Cenrer- Raleigh C
27u59-i63o Phone No. (9I9) 33 3221, tvHnin 3U days.
GW-I REV 7/200L
tP Q
n

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Qualiry - Groundwater Section �q/
WELL CONTRACTOR (INDIVIDUAL) NAME (print) , 4/t r /Z t �r> t� CERTIFICATION N e
WELL CONTRACTOR COMPANY NAME /-; s'/M soa1 Well br;II:17 PHONE ¢ tY) 6Y3 -9/77
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
302829
1. WELL USE (Check Applicable Box): Residential VMunicipal/Public ❑ Industrial ❑ Agricultural ❑
Monitoring 0 Recovery 0 Heat Pump Water Injection ❑ Other ❑ If Other, List Use
2. WELL LOCATION:
Nearest Town: / t(.. c i:e County u. c. a CreV‘fi
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: t-ARI RZ
Address 1310 Old Gunn Rd.
K l ee.$+€v (Street or Route No.) at7c10
City or Town State Zip Code
$t)-(0is3-5601
Area code- Phone number ,
4. DATE DRILLED (. ' ! 4 - G 7
5. TOTAL DEPTH: a i a
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO —
7. STATIC WATER LEVEL Below Top of Casing: 3 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS / FT. Above Land Surface'
*Top of casing terminated at/or below land surface requires a
variance in accordance with ISA NCAC 2C .0118.
9. YIELD (gpm): 2b METHOD OF TEST '$t9
10. WATER ZONES (depth): /6 0
11. DISINFECTION: Type N 7f/
l2. CASING:
Depth Diameter
From_0 To 9, Ft. 4
From To Ft.
From To Ft.
Amount ai
Wall Thickness
or Weight/Ft. Material
ioRj1 Pyc.
13. GROUT: Depth Material
From 6 To 'al() Ft. eonCr(2 Ee
From _ To Ft.
14. SCREEN: Depth Diameter
From To Ft. in.
From To Ft. in.
6Z.
Method
PO u reJ
Slot Size Material
in.
in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
16. REMARKS:
Topographic/Land setting
1dge ❑Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well cation
-35/31/a'a1&- D9a/4/ 5 3 ).,.1(de greesi m inuttes/seconds)
Latitudeilongitude source: ❑GPS❑Topographic map
(check box)
DRILLING LOG
To Formation Description
DEPTH
From
7/ BS'
5 en SArra-
y e ton /e
r110i ran. 1e
o Vie.
LOCATION SKETCH
Show direction and distance in miles from at lust
two State Roads or County Roads. Include the4@ad
numbers and common road names. y
13 co old r1 cuifcr nd Rd.
Leicester, fC
1 DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER ---,-
a' --- 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.
(.0
nc
c,a
OW -I REV.01/2001
2 ,1.

10. WATER ZONES (depth): /45
II. DISINFECTION: Type t/ 71
12. CASING:
Depth
From 0 To ?(S Ft.
From
From
13. GROUT:
From 0
Diameter
4
To Ft.
To Ft.
Depth Material/
To r220 Ft. ecoCre/c
WELL CONSTRUCTION RECORD 3 0 2 8 3 0
North Carolina - Department of Environment and Natural
Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) Mark Ai!, rs 11 f�CERTIFICATION#3a 86
in¢rta 6r.Lt .c out Weil, 1)ri ic� PHONE P�6.C3—V147
/ ASSOCIATED WQ PERMIT
(if applicable)
WELL CONTRACTOR COMPANY NAME
STATE WELL CONSTRUCTION PERMIT#
(if applicable)
I. WELL USE (Check Applicable Box): Residential C- MunicipaUPublic 0 Industrial 0 Agricultural ❑
Monitoring 0 Recovery ❑ Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION:
Nearest Town: fa; ry
vrte 1. Cre-ck
County31-kcvca,412t
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: l DO-Cw4
Address a�[]eY
I"lCDC ra.
(Street or Route No.)
fair vl4w ric a$-0
Ciry or Town State Zip Code
7-111-21tea
Area code- Phone number
4. DATE DRILLED t -3 - 6 V
5. TOTAL DEPTH: d to I-
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO 1 .-
7. STATIC WATER LEVEL Below Top of Casing: Vo FT.
/ (Use "+" if Above Top of Casing)
8. TOP OF CASING IS / FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordance with I5A NCAC 2C .0118. r�
9. YIELD (gpm): .S M/l METHOD OF TEST 1ci
Topographic/Land setting
❑Ridge ❑Slope 03,411ey ❑Flat
(check appropriate box)
Latitude/longitude of well location
35/3i f /S�'- oFoj✓a1/2 w'
( egrees/minutes/seconds)
Latitude/longitude source: iBGPS❑Topographic map
(check box)
DRILLING LOG
Formation Description
DEPTH
From
To
7D C/477
7/ ?O Bk•tr5h2ly,
Q l--- j 1st ch.c
0
1
LOCATION SKETCH
Amount 2 a 0L• Show direction and distance in miles from at least=
Wall Thickness two State Roads or County Roads. Include the road-6
or Weight/Ft. Material numbers and common road names.
SPR.2/ PVC -
From To Ft.
14. SCREEN: Depth
From To
From To
15. SAND/GRAVEL PACK
Diameter
Ft. in.
Ft. in.
Method
Pcn.eci
Slot Size Material
in.
in.
Depth Size Material
From To Ft.
From To Ft.
GOY r4A4 Creet
Fairvirew, nC
16. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH I5A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND T AT COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
2
•
-et rn
rn
n
rrt
G
o�
mrr
or-
0 o
s
LPp
O n
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
302833
Noun C_raluu Dcprumnr-of Environmcnr and ral RDivision Of - Divisioof \\racer Quuliry - Groundwater Section
11
�j r I
ELL CONTI.4croC i1 NUIVlou.ai.) N.k1 Th
(aria() d-i ibN / . W s NG 6 CERTIFICATION R1 zilf
S�J�iI Z%I/i• 4� PliONL d& a Sdr'.JYjF�
ASSOCIATED WQ P2121\i1Tu
(if r.nplicnble)
\4L'LL CUNTRiC1'JR Clem P,4NI' 4A,PVi
STnl'C \'YELL CONSTRUCTION PER111Ta
Mil . ppl..'_blel
I. WELL USE LCheco Applicable Box): Residential 13 NiunicipaVPublie 0 lndusit at 0 Agricultural Q
'Monitoring 0 Recovery ❑ Heal Pump Water lnjcccion 0 Ocher ❑ It' Other, List Use
2. WELL LOCATI N: ,,��
N;_res( Town' le. '(F6/- cL, yA co-+!(
j%rit (Great Chive'
,So'ecI Name, Numbers, Con' iiuniry, Su bai vu:on, LA No., Zip Cole)
o. OWNER Michael Suryek
A3,lres - a7 DfY e CyP� n l
Acienite Laacc`R(ouc N a) anoc,
llA'ar Town S ie Zip Coac
V1L �e8'S-646I
opographic!Land ser[ing
Ridge ['Slope ❑Valley ❑Plot
(check uppropriare box)
Latirude/longitude of well location
!9 ire d7, 7(4',rLa .l?7t 6s�'
(degrecs;minutc�' 'cCondS)
Laritude/longirudc source: ®"GPS❑Topoeraphic map
truce': box)
DEPTH DRILLING LOCI
0
From , To FoAmation Description
.4ita.uoc-Plmneoumbcr 27- 3L
4. DATEDRILLED /-/4-0 �Z-cAA--
5. TOTAL DEPTH: S/IVC
. DOES WELL REPLACE EXISTING WELL? YES 0 NO
7. STATIC WATER LEVEL Below Top DI Casing: FT.
Above Top ui Ci :na)
S. TOP OF CASING IS / FT. Abe ya Land Surface'
-lop of Hama mrminsc.a avor bcluw land au rra ce rcq ui res v
variance m a;cora:me; with l id NCAC IC .a/ I a. pp
9. YIELD tgpm): ivtETHOD OF TEST B$W/pg
to. WATER ZONES (depm): 4/0�
II. DISINFECTION: TypeC/Opemit— =,mount y/cif
12. O A3FING: Wail Thickness
Depth Domeier or Weight/Ft. N'laitrial
From 0 To 12- Er. 4*/Lr /An./ " /3,e
From Po FL.
From To Ft.
i3. GROUT: Depth Oi arena' N9ethod
From, D To so Ft. Conde Ace.+f
From 'r F[.
I'. SCREEN-. Depth Dlamc cr Slol Size ryltrnrial
From 'Po F. in. In.
Frain To Ft. inin.
li. SAND/GRAVELPACK
Depth Size blacerial
From To Fr.
From To Fr.
to. REMARKS.
LOCATION SKETCH
1-' -
O GrTI
O (It-.
Cn
-e
Show direction and distance in miles from au l fast '2,—.two Stole Roads or County Roads. Include th&kTad �Q
numbers and common road names. _—
3 0
O 3a
�p
Dixie Creek Chapel Pa.
Le(cester, nc
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED EN ACCORDANCE WITH ISA NCAC 2C, WELL
CONSTRUCTION STANDARDS, .AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
SIGNATURE OF PERSON CONSTRUCTINGTHE WELL DATE
Submit the original to the Division of Water Quality, Groundwater Seeriun, 1636 Mail Service Center - Raleigh, NO
27699-l63o Phone No. [phone], within 30 aayi. GW-I REV. 07/200I
_II
w
O

302827
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural�,tResources - Division of Water Quality - Groundwater Section gyp/
WELL CONTRACTOR (INDIVIDUAL) NAME (print) 1 •l6t r k /416 v, CERTIFICATION #��-i d"(p/
WELL CONTRACTOR COMPANY NAME ii'e'/%uSo al UIel1 - ;iI.n1 PHONE(Q'. fl AY3-',illp
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential IfX/Municipal/Public 0 Industrial ❑ Agricultural ❑
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION:
Nearest Town: W¢AYe.f V i le.
County aunCor7/4-4,
tStreet Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER. 6t - _e Bat] &
Address 1;6 *h /'DY,C� koQd
tornard vl_(Street or Route No.) PS709
�YLII/.• Zip Code
City or To n State
(-)- N74
Area code- Phone number �!
4. DATE DRILLED) -a 0 7
5. TOTAL DEPTH: SD
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO Fi'
7. STATIC WATER LEVEL Below Top of Casing: V0 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.s
9. YIELD (gpm): 1 METHOD OF TEST Y
10. WATER ZONES (depth): SI CO
11. DISINFECTION: Type ff 7ff Amount S77 oz.
12. CASING:
Depth
From 0 ToS9
From To
From To
13. GROUT: Depth
From 0 To 2f)
From To
14. SCREEN: Depth
From To
From To
Wall Thickness
Diameter or Weight/Ft. „Material
FL la -W. r✓x.
Ft.
Ft.
Material Method
Ft. Cenci-0Cenci-07� Lk Cenci-0 t-e c rOA)
Ft.
Diameter Slot Size Material
Ft. in. in,
Ft. in. in.
15. SAND/GRAVEL PACK:
Depth
From To Ft.
From To Ft.
Size
Material
ttdgopographic/Land setting
e ❑Slope ❑Valley 0Flat
(check appropriate box)
Latitude 1 ngitude of wel oc tion
(degrees/minutes/ cond
Latitude/longitude source: ❑GPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From To
I ag
Q4 5'2
'f8 CV
Forcnatioq Description
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the ro'
numbers and common road names.
CR
W� 4.VtVVvi l Ie I n,c
16. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
SIGNATURE OF PERSON CONSTRUCTING THE WELL
• Y-OK
DATE _
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center-: Bh1 igf, NC"`
GW-I REV. 07/2001
27699-1636 Phone No. [phone], within 30 days.

WE'LL CONSTRUCTION RECORD
!Varm ]rahas - Gcpnrmicnooi Env i r onmcm and • rid I:csources - CON Division of \Vater QuaQuality- 0 rounowu ter Section
r \lr_L1_CIl:.�1.1r< COMF..N1' N. \.IL_f' i'5�t..5�.1 ��1� (/,�/t///tVi Co. PHONC{¢ldpl�5aJ rp,
31':1'31i iLL CL)rn RUCTION Perm[ ,,. ASSOCIATHD WO P0.11A'11Tn
(if
:r:r lie.dadi
302825
` ,LT
,a ELL CU N'11'.>,C1Ud (nY❑IYlUU a1) NAI\rl ipr u,e) �.(,l ir�✓< �i CCl:T1F1CdT)OfY �7 Lib.
I. `,FELL LIScBo.): Residenti>I t\<asLoLpaL/Public ❑ Induyrrial ❑ Agrictmural 0
\wae.ortoRc3av I-y ❑ Heal Purnp\\atcr injoCrion 0 Other 1f Orher. List Use
2. Pr EL.L LQC.'vTI N:
N c(omsat Town:
R.:mu. Nnai ocr. Comawn icy, Sub.] irnian. Lai PW., 'Lip Cone)
Co u[y Ale•oat.
01\ iNCR:- SUSQYI tOkI CK
aaress awe F.QVC USCM IulLVC
AShevi ll�_:rcer.�tcNa �B�oc�
Aii-ia)Ia:?�T-,„, Sum
-4y0$
-dei aajc- Fllalie Itwilocr
-:. DATE DRILLED 4'-Z1-o4
5 FOTA.L. DEPTH: Jyi
d. DOES WELL REPLACE EXISTING WELL? YES 0 NO r<
,. STATIC W ;'PER LEVEL H,Ww Top of Casine: C D FT.
(rut ";" 1r .Aua\c Top of Cooing)
S. TOP OF CASING IS FT. ?kbove Land Sur hce^
`14ap oi:ono; cc MRi ula isa N L'o r bcruir IPna su rrl Le requires a
ranautc nt.ccm'awcc with ISA N C C 2C .011E.
9 YIELD (;prni: l2 METHOD OF TEST Bpahrif •K.'
10. -WATER ZONES (depth): //r' , fro, sir 5
Zip Coo;
Lali[u el eeilonpirude
DEPTH
From To
0 - /on
Topographic/Land seining
❑Ridge C3S Inpe ❑Valley ❑Flat
(check ,ppropriurc bo.)
Latitude/longitude of well location
,Ojr-•12. /rl'a-orz` sr. 0
niegtees;rminuesncranas)
source: IdU`PS❑Topographic map
(check Liu,:)
DRILLING LOG
Formation Description
(0-7 - / (Z.
I;. DISINFECTION: Type( /o27i.ve. Amount // /cJj
.2. CASING. Walt Thickness
ESpm Dianncltr or WaighUFi. p1stcrial
?rein0I'o /It Fr. L:/L s�,t7, ,VVC
Fton., ro FL.
,From To Ft.
:3. 0 ROUT: Dcplh M9rcnal blcrnorl
FCC.411_-Q_To a0 Fr. CC/kraPGl1e floott-^i
Froth 'To Fr.
iiii SCREEN. Lcpcii Diameter Slot Size ylarcrial
From TJ Ft. in. in.
From Ta Fr. in. in.
D. SAND:OR:WELP.ACK:
Depri, Six Material
Froa+ - To Fr.
rrun, To Fr.
d. REAInRK5
IIL -J4r
S.JJlo„t-
C'.n'4c
m
O �'
Sc'rn
.90
rrirl
CDC)
LOCATION SKETCH CO
Show direction and distance in miles from at lease. 9
two State Roads or County Roads, include the road
numbers and common road names, O
s
Shope Rd.
Ce rid l e r nC
DO riEIEEY CERTIFY TH:ATTHIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH liA NCAC 2C, WELL
CONSTRUCTION STANDARDS, .AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
`124.,
SIGNATURE OF PERSON CONSTRUCTING -THE WELL DATE
]Gamer Lac uripi11a1 to rna Oiyiiien of 111amr Qualiry, Groundwarer Seeciun, 1636 Mail Service Cnucr - Raleigh, NO
37o99-1o.ic Phone Oo. L919) 733-3231, within 30 nays,
GW-1 REV. 07/2001

WELL CONSTRUCTION RECORD
302824
+ nn Tn I L-cpermlem Of EBY ironn>cnr and - rul Resources - Di YISiOn Of Water Quality - Oroe ndwarer Section
\cLL COVITCALC1JC. W❑11'1DU.:11N>,lil
11_1_ CON tl Tort--vrnNVN 4I1)
COnSTRuCtt3N eal.nura ..SSOCIATFD WQ PPI2h1Yr:IC ;00h:rabic)
�<L l , Nx3IQ
C S CERTIFICATIQN b
c.S_1OS Lie/J �,Q/��1 /YQ Co . PHONL Rat 05d YVec,
`AFLL USE r:ln.elc -. ppl,a•Able. Eox): Rcet0onnel O Nihr,icipa UPublic 0 Incluorrisi 0 Agricul[ural q
h imr+lonr._ ❑ Rc0ntcry 0 Heal Pump \\ lnjccrion 0 Other 0 ]['Other, List Use
33El. .L LCC.at MON.
Ncaest Toycn: Le cc. f✓
Ole #zo
3\vNER_
Count'- +c•-1 !l
:vua, ocr. Comnmmrv, Subairu ion, Lot rW., '_ip Coaci
data== 1 Into 1 Old tt ao
t- at.; '' MoiliNo.,
Leicester E'1c
Ce'r .,r Tax. Suce
453-3°CZ
Ybon: uuinocr
DATE. 1-)R_II I Er 6 -
5. POT AL. DEPTH: / rf
a7Lie
Topogrnphic/Land setting
❑Ridge L'JSlope 0-Valley ❑Flat
(check appropriate bead
Latitude/loegimde of well location
N3f° el?. 34" bon/ co, 6 rS'
(degrec;minute�w ''''concls)
Laumdeilongiru de source: O'GPSDTopographic map
teheek bog)
DEPTH DRILLING LOG
From To Formation Description
otiii
Z/ /yr
o. DOES WELL REPLACE EXISTING WELL) YES 0 NO 2--
STATIC WATER LEVEL Below Top of Casing: eo FT.
.Abort Top or Coding)
3. TOP OF CASING IS / FT. Above Land Surface'
"Op or caurg mrmma,o sour bcluw land surrsct rcquirte a
varmn<= u, aacrusacc wail 15A NCAC 2C .0.1 lb.
i. YIELD l poi: (vo METHOD OF TEST B%Wipq •grrq
1u.\\.+:TER23NESlacpth;: )6d' J J
DISLNFECTI r L
�.h�Type� OjL,p�G. .r.n;oum S!
._, CASING: Will Thicl:,ricsi
D:prr: ihomcicr or V' ighr;Fr. 2;luterial
:,oa. o T:, 2I FI. L./L% 'Alt/ .D✓c-
rsat R: Fr
F tone 1b F.
i3_ 3 ROUTDcPln nlarcrlal tc[ciloa
From 0 T6 ao Ft'. CC,VePede tP,.,in/
IYom To Ft.
lam. SCREEN. Dorm Diamcicr
From 'Po FI.
n. 3 .NDiSlks3VEL PACK
Dep. Size nlateriol
riot[. ro Ft.
Frog, T„ Ff.
Slot Size Aiarcrial
in.
F[. in. In.
R r \d.', I-CKE
LOCATION SKETCH `p
Show direction and distance in miles from at least
o.vo State Roads or County Roads. Include the road
numbers and common road names.
Old #aa
Leicestvz_f /•1C
DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED FN ACCORDANCE WITH l5A NCAC 2C, WELL
CONSTRUCTION ST-.iNDARD3, AND THAT A COPY OF THIS RECOIW HAS BEEN PROVIDED TO THE WELL OWNER
t.
SIOONAT1)RB OF PERSON CONSTRUCTING -THE WELL DATE
]40n:t Lac orlural[0ine Division ut\Y]rer Quality, tiro and w ater Section, 1636 Moil Servie° Cenrcr - Raleigh, NO
Pnonc tYo. iS l y) ,33 3231, rrirhin 31i day_.
GW-I REV.07/'001

WELL CONSTRUCTION RLCmu)
Noire C..)rolina - Depsrmlcnr of Environment and - Dal Resources - Civision of V,'arer Qual ir, - Groundwater SCCtiOn
VA ELL CQ.11'Ra Cl-04. (1N Dll'1DU.al) N;•rAifi (prinrl
\\ELL CON TRkC'I'OR CU:})F-.N1'
31'nrE WELL CO:N.9TRUCTION FEtiniITr
ltI 'VcS / ccrtnrlc,TaoN,t�/14d
4I.SU/✓.i`/ DIV/l/NGf l YHONE Sag
ASSOCIATED WQ PERMIT,/
r•oplicablci
VkEL LISE [.'heck App lieebl= Box), Resider -Mel Er"-rviunicipSJPtiblie 0 Indu Srriol ❑
:V lonuorii$ ❑ Recovery ❑ Heel Pump Water lnjccrion 0 Other 0 If Ocher, List Use
2. VrELL LOCATION.
Ncorest Town: LtC L>We
0ouriry "men, it
3 0WNER1
AAdre>s 1
,Sweet Dram:. Nemeses, Camnwnhry, Subdivuiun, Lot NJ., '_ip Coact
dIle s smeiac&�.(E rs 6h)
TY) E YAjLk HWI Y J
gn0 (p
syor T'w,i State Zip CJac
NCvY(IC I ,iJ,>! NJ,
-.:es .612c- castle cuknocr
DATE DRILLED o- F • o✓
3. TOTAL DEPTH: 32 r
riculwral ❑
Topo_gra lic/Land seeing
ld'S ORidge lope OValley ❑Floc
(check( uppropriorc box)
Latitude/Ionamide of well location
,t77ro 77 `d1.2'yon• dl !r0'
(Jegrcevrninulcsrecconds)
Latirudeilongiru de souree: 2 PSOTopographic mop
(cheek: Dux)
DRILLING LOG
Formation Description
D.•,r
/of -JLr
DEPTH
From To
p • /oo
/00 • /D t'
6. DOES WELL REPLACE EXISTING WELL? 'I'ES 0 NO EV
7. STATIC WATER LEVEL Below Top of Casing: an2 FT.
use'.'• it Above Top ur Casing.)
S. TOP OF CASING IS / FT. Above Land Surtace-
• fop orzann; rcrmuu tea pear bcluw land suites require• a
✓ a r,aucc m >aeoraaua with 1>A NC. -Le 2C .b, 1S.
9. YIELD tepmi: j METHOD OF TEST 3$w,,ri •t�'r9
O. WATER ZONES (depth): /to' J
1. DISINFECTION: Type(' /oP rout
12. CASINO,
tl D,prh
From To /Or Ft.
From io Ft.
Ftom To Fr.
Amount // h=f
WaII Thickness
D19711erer or Weight/Ft. hdutcnal
L ./is- r sst .o✓c
ukOUT' Dcpd i Marcnal Manioc')
Ft. COA' em'c �... f
!Toro Ti F.
Fronk © To ao
1-. SCREEN: Dcpcn Dinmctcr
Frail) Fr. in.
Prom To Fr, in.
IS. 3ANDr3Ko.VEL PACK:
Dcprh Size Material
Frmrh To: Ft.
From To FI
Slot Sizc
in.
in.
Material
to. REMARKS.
302823
LOCATION SKETCH
Show direction and distance in mils from ar 15ba
two Sraw Roads or County Roods. Include theSod
numbers and common road names.
TLawry To -WIN 12.d
ices-te , NC-
I DO HEREBY CERTIFY THAT TH!S WELL WAS CONSTRUCTED IN ACCORDANCE WITH ISA NCAC 2C, WELL
COLNST CTION STANDARDS, AND THAT COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
✓▪ /�f-I-
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
Suomit rat ,original ro tat Division of \Varer Quality, Groundwater Section,
2?o99-lo;D Phone No. (9Iy) 737-3221, win in 3U d4yi.
1636 Mail Service Ccnrcr - Raleigh, :NC.
COW -I RE-V.-09/200i
0
err

VYELL CONSTRUCTION RECORD
302822
N 0.rn I, a Ocp_r m cni of Enaironmcni and rut Rcso urccs - Division of 1A'arer Qualiry - Groundwater SteLidn
f )/
n cis Q CON11 1Co. 1tNo1)TOL.>1) N*1v1122 tprinn j. LCfi %YC S C6RTIFIIDAT10N rryti�J(�Rib
lr' L CON i l 'tt _iN olr u\ll' N 1•IL f er j c.$ &e// D,Ql•ill Ng Co • PHONC 4R381 aS8 6 q
w uLL ccn.sraucriON F ELLA]^ .c.SSOC(A'I'PD Si'Q PFRMIT:i
�� :GGhe'�b121
1\ELL USE ,,Cnoolc Applloablt. Box). Rcs idtmiet IS 1\l uruoipoLPublic ❑ lndusrrial 0 Agriculwrnl ❑
awn:Lanug L R.c2orery 0 Heal Pomp Water lnjccrion ❑ Glher ❑ if Other, Lis( Use
_. 9,: ELL LOCATION.
?'coned To v,11 csS/l/ County Lean et
aoc.� N.in'm, Nwnocr, OnAbournry, Subo1vi=ion, l.or No., Zip Cadc)
owNER:
AdoreD
An-D erg „tccrrr Iu(co
:) orToN% SNc
t
'ink st ? —1474
i)J;- Yllunc Diu irl Dcr
7.L.1EDKLLLD 6-7-oU
TOTAL DEPTH: its"
QS-Toy
LIp Loot
Topo�grjphie/Land serving
(Midge I at -Slope ❑Valley ❑Flat
(cheek eppropriart box)
Latitude/longitude of well location
pica x. /lf' wort' VL 7t//'
(degree; minuicsy econas)
Loin—wok/longitude source: PS❑Topographic map
DEPTH (cheek bux)
DRILLING LOG
From To Formation Description
0dG
24 - 3 /
3/ -
o_ DOES WELL REPLACE EXISTING WELL'? YES ❑ 'NO C'f
STATIC WATER LEVEL &low Top of Casing: /oo FT.
/ (Use "." lr.Abort Top of Como_)
TOP OF CASINO IS FT. Above Land Surface'
"Pop or ' m; Im'mmattu Sour bduw Bind surryce rcyuirts a
r Isar.m uc oroiic wan 15A NCAC .01111.
9 YIELD topm: 7 h-IETHOD OF TEST Bhuilirq •Krlq
\\. TER _ONES(oepm): Z/o• JJ
0ISINPECTION:TypcC'/o
Rrrvc,
CASINOS
Dop(n
rrac To, Fr
r rent To Fr
+.0 cunt /L f.,
\V'dl Thini:ncss
Liaptcl:r w WeighrjFt. I:Jaren:41
L • /1 f int I PVC
OROUT: Dtpm (\ arcmol
hlcmon
li_._Q_ Froi_.I.d a FL. CiOnekefRte.,.
, .
irol't) 'I,; FL
Sr.:ND,3RAVELPACK.
Depth Silt bl'afonol
r Ft.
From To FI.
SCREEN. Ucprlt DIwITlcicr 2I01 S12C lblu[Crl4l
From 1'o Fi.
m.
From Po Fi. u�
m.
.c REMARKS
1,
d
4
LOCATION SKETCH
Show direcrion and disrance in miles from ar lcasr
Iwo Scare Roads or County Roads. Include the roads
numbers and common road names.
c
Blve rni5+ Tanks
Hayes Cave Pet
L e Ius- hut , /\!C
D O nEFEB\ CERTIFY THAT THIS WELL WAS CONSTRUCTED EN A000R ANCE WITH 15A NCAC 2C, WELL
Lr NSPiuCTIoN STANDARDS, .AND THAT A COPY OF THIS PvECORD HAS BEEN PROVIDED TO THE WELL OWNER
6,-7-try
SIQNATURE OF PERSON CONSTRLICTINGTHE WELL
DATE
�.unn'. Lne uft6olfal to rise Divide a of Wu far Quality, Groundwater 5ecrion, 1636 Mail Service Cenrer - Ralelbh,.N.0
y _oio Pllouc ,N0. (1Iv) 7333321, rrirlLi 90 days.
GW-I I'`E`♦ ,07kry00L•
as

To a 0
Itom To
1+. SCREEN. Depth Dlamctcr
Front To Ft. In.
Eroln To Fr. in.
15. SANa3& VEL?':ACK:
Depth Slat
Froa'. To Ft.
Fr011 To F.
a. REM .Arj_3.
WELL CONSTRUCTION RECORD
302821
N3rin C4ro60_ - Dcparmlcnh❑f Environmmilr ano - Tel Pcsourcc> - Division of V,'arcr Oualiry - Groundwa er Section
\1 ELL CO\'l l:A Cl'Jt: ilN ulVtDu.al-> N.: nIG iprnaq
\412LL CON R1Cl'Ui"t (1000F.ANV' NAOIL
sr-„rc WILL NSTI UC'TION YE'MIITv
• 2Ch NC S CERTIFICATION N-3/146
LLSOW L a - r PnONE,$assa51?-7Vet.
.ASSOCL&TED WQ'
lit->npllr�bIci
I. \\'ELL LISE rOhc1c Applicable Box): kcsidcntial Q Niu.ricipaL'Public 0 Intluyrrier 0 Agciclllrural 0
\loarionug ❑ accovery 0 Hear Pump \Vinci Injection 0 Other 0 It Other, List Usa
22. Ii ELL LOCATION:
Nciret Town: F,:•"Y:ew
/fey oni/h Sc4•o/ ,tie.
,Sa'cn Nsme. ,NumocN, Coormurory, Subeivuion, Lod No., Zip Code)
CDnl'i 4y14M le
- OWNER. felLTU�ions-F UL+i
Aadress X " al
/15hevi1IrcrfatrcNa' ag8.ly
City 'Tote, Sul[ Yip Coac
i'Imnc oa mbn
-i. DATE DRIP. LEI) 6 • Z �y
TOTAL DEPTH: )ter
__��TopographiciLand setting
LQRidge ❑Slope OVailey ❑Floc
(cheek nppropriare box)
Latitude/longinlde of well location
fir 32.2u'4.cM' 2Y.2/y'
(dcgrecs;rninu�tcl'u'cconas)
Latiludcilongirude source: �GPSOTopogrephic map
(check Dux)
DEPTH DRILLING LOG
From To Formation Description
pt.,. !-
/!.- L/ f(e
it - 3y,- !c
d. DOES WELL REPLACE EXISTING WELL? YES 0 NO d
7. STATIC WATER LEVEL Below Top of Casing: /)° FT.
j Usc "r' it' Acme Top ar Comma)
9. TOP OF CASING IS FT. Above Land Suri ce^
"lop or ip4111, lcrmnla rea Cur Oulu W 1411u su try ce rcc wire$ n
rcnancc m a ccar anec with ISA NCAC 3C.UI le.
-9. YIELD (pm): / L METHOD OF TEST B$Lii4yy •n.rq
lei.\VATERZONES (depth): /7D' J .'
II. DISINFECTION. Typer loprti�. Arll01E1l q Pik
L. CASING': Wad Thielfnass
Dcprn - Dirncret or WeighuF. Narcrial
r-roln 0 To L / Ft. (./lip /4212/ .!1✓G
From To Fc.
ethm To Ft,
13. a ROUT: Depth blamrial
Frolo -0 Ft. CliYC2Gk
Fr.
LOCATION SKETCH
Show direcrion and distance in miles liom of leas(
nvo State Roads or County Roads. Include the roan 0
numbers and common road names. ••
ReyYields &haol 7.4.
Mclllotl
.,7 Fct.t vvt'ZW,
nC
Slot SiZc I\Iaroriol
Ill
Narcrial
1 DO Fi EREEI' CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 1.5A NCAC 2C, WELL
CONSTRUCTION STANDARDS', AND THAT COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
-uet.. %L. 71•.e.Le (,-2-oN
SIONnTURE OF PERSON CONSTRUCTING THE WELL DATE
Suonut me original m the Division or Wafer Qualify, Groundwater Section, 16361Y]ai1 Service Center o Ralragtt; Nei
7769S-163o Phone NO. (519) 732-32_'1, wirnin 3U days.
c
OCT 2 2
n-
J

302S117
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
CERTIFICATION * P� 0 a S
WELL � , t „
WELL CONTRACTOR COMPANY NAME re aJSONr Wenhp,/I/Ay Co. PHONE 481016g3- rY9
STATE WELL CONSTRUCTION PERMIT* �/ ASSOCIATED WQ PERMIT*
(if applicable) (if applicable)
PO- f5
CONTIACTOR(INDIVIDUAL) NAME (print) So b6v t�
1. WELL USE (Check Applicable Box): Residential 13 Municipal/Public 0 Industrial ❑ Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION:
Nearest Town: ItP/tH% County 0/)Cr it.
4,a/l6.. xe '2rS/// hi
(Street Name, Numbers, Coinmuniry, Subdivision. Lot No., Zip Code)
3. OWNER: i' ik.e 01114
�� 7�
Address I4'9 4 6 Vl ef'At "L w.
&kid
uteL� �'ng
Ciry or Town State Zip Code
(g2g)_(Dt1-1$ss 3
Area code- Phone number
4. DATE DRILLED fl////0
5. TOTAL DEPTH: a r/S
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO 13
7. STATIC WATER LEVEL Below Top of Casing: 5/7 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING 1S / FT. Above Land Surface*
*Top of casing terminated actor below land surface requires a
variance in accordance with 15A NCAC 2C .0118. / Q 1
9. YIELD (gpm): $ METHOD OF TEST$intsb‘n 1 FlJ
10. WATER ZONES (depth): //Q/
11. DISINFECTION: Type /16 4 i$
12. CASING:
Depth
From_ 0 _ To 75
From To
From To
13. GROUT: Depth
From_ a_ To 7,1.)
From To
14. SCREEN: Depth
From To
From To
15. SAND/GRAVEL PACK:
Depth
From To
Diameter
Ft. . ),S
Ft.
Ft.
Amount_ FOL
Topograp c/Land setting
❑Ridgee ❑Valley DFlat
(check appropriate box)
Latitude/longitude of well location
/)/3 v° .1.8.734 popSa' 3S.S57
(degrees/m nines/seconds)
Latitude/longitude source: oGPS❑Topographic map
(check box)
DRILLING LOG
Formation Description
j tr-t
Wall Thickness
or Weight/Ft. Material
216.I?.3 pus ngA
Material Method
Ft. et] ncr-e PO nil/
Ft.
Diameter Slot Size Material
Ft. in. in.
Ft. in. in.
Ft.
Size Material
From To Ft.
DEPTH
From To
p — 72
79-75
7s -ZQ15
C. =ri
LOCATION SKETCH tiG
Show direction and distance in miles from at -test 'G p
two State Roads or County Roads. Include diet ad 'u�--4'�;
rR;2
—
Jt•o
numbers and common road names.
O 24
gable ESfates - Lat .}1 /6 ;1°
)-%'WAid Clap Zd,
4rc)eq, nc
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
SIGNAT1:46i7 RE OF PERSON CONNSTRUCTING TFIE WELL DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center
I REV. 0, N001
27699-1636 Phone No. [phone], within 30 days.
rn
m
—D
W
0

3041
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Nat al Resource -. - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAM"Fj (print) ,I l itMa. / I CERTIFICATION�#43.5V
V
WELL CONTRACTOR COMPANY NAME r ent. Bve (JUL y Pun', Jae- . PHONE # p�q .e 9 3/ 7a
STATE WE:LI. CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
L
1. WELL USE (Check Applicable Box): Residential $ Municipal/Public 0 Industrial ❑ Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2_ WELL LOCATION
Nearest T rwn: F4 !rut tit) County.a1n-orn l'
trLoa
(Street Name, NuMbers, Community, Subdivision, Lot No.. Zip Cale)
3. OW NER:__ - 1
11
Address 10/) 7+fly. l n
v �(St eet or Route No.)
- •r ivc a s 7 3 -2-
City or Town State
( )-
Zip Code
Area code, Phone number ,I
4. DATE DRILLED �f-1-DY
5. TOTAL DEPTH: r705 I
OOLS, w..r I Marl .ACE LY,i- inu; WE ! -' YES LI NO
7. STATIC WATER LEVEL Below Top of Casing: 1 OD FT.
(Use "+" it Above Top of Casing)
8. TOPOP CASING IS I FT. Above Land Surface*
*Top of casing terminated atlor below land surface requires a
variance in accordance with 15A NCAC 2C .0118.
9. YIELD (gpm): I METHOD OF TEST ,- In r5
10. WATER ZONES (depth): tigS' - II?. cipm
(n(351 i.Lz. 4nrn
II. DISINFECT ION: Type /-4TlL._ Amount I a ri 4-h1}s .
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
From_.DTo / `r- to Et. (o II P VC.
From To Ft.
From__ To Ft.
13. GROUT: Depth Material Method
From}_ _ To 2,0Ft. Cs.s. .4
From To Ft.
14. SCREEN: Depth Diameter Slot Size Material
FromTo Ft. in. in.
From__. To - Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From _ To Ft.
From _To Ft.
16. REMARKS:
Topographic/Land setting
❑Ridge ❑Slope ❑Valley tklat
(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
b /5La rJ� ..1
/ar 7n' tt. ar
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common road names.
t
c_n
1 DO IIEREBY ('E WHEY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
('ONS'IR(JCTION STANDARDS, AND THAT A COPY OF TIIIS RECORD IIAS BEEN PROVIDED TO THE WELL OWNER
ZL)1/42Q0
�- /b-31-t9,
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. 07/200]

304230
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and 'JanuQal Resource - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (prt.) III LL'IE' YJA✓Gr`ICERTIPICATIONI A, 1'
WELLCONTRAC{ORCOMPANYNAME_RF.UDEN CALDWELL DRILLING, INC. PRONE7 42g 1254-3581
STATE WELL CONSTRUCTION PERMITS ASSOCIATED WQ PERMIT/
(if applicable)
(if applicable)
1. WELL USE (Check Applicable Box): Residential Eft Municipal Public 0 Industrial 0 Agricultural 0
Monitoring ❑ Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION:
Nearest Town: FAIf.`'rt-"-) County
7V, C)ARRbt.) C&eci AL
(Street Name, Nombcn``, Community, Subdivision, bat No., Zip Code)
3. OWNER: J
Address 3 c FLAT Tt, (V'T{.> fZD-
A fkJ t o opuses e1 G No.) -a 813 D
Cityor Town State Zip Code
( S'0 13)- `I l a -cal'
Ara code- Phone cumber ID/I 9 / c
4. DATE DRILLED
5. TOTAL DEPTH: 3 50 /
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO IR
7. STATIC WATER LEVEL Below Top of Cuing: (, 0 FT.
(Um "+" if Above Top of Cuing)
8. TOP OF CASING IS FT. Above Land Surface*
'Top of colas lennInated Wor below land surface require a
variance 1e atcerdaaa with ISA NCAC IC.0I Ia.
9. YIELD (gpm): a o METHOD/OF TEST NC%' A l
10. WATER ZONES (depth): f a b - ao G P t -'
11. DISINFECTION: Type 474 ({o`r/6 Amount IV2 i
12. CASING:
Depth Dj�I��saiir/s)t cr
From 4 To `i ❑ FL O •
From To Ft.
From To Ft.
13. GROUT:{{ Depth
From ..1 To a o Ft.
Wall Thickness
Material
CeMCNT
PMethodr�
oi( e
From To Ft.
14. SCREEN: Depth Diameter Slot Sire 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
efft Ridge ❑Slope ❑Valley ❑Flat
(check appropriate boa)
Latitude/longitude of well location
(dcpeealml.utedsmoods)
Latitude/longitude source:❑GPS❑Topographic nap
(check box)
DRILLING LOQForm
Vtit /Sugt eran
DEPTH
From,To /
^
es
g5' — ago'
aaa
aat, '- 3So '
).00ATION SKETCH O csr
cYr.
Show direction and distance in miles from atdeast Cy5
two State Roads or County Roads. Include tee ad L,
numbers and co .n road names. - =
GAr226Vv
C BIZ
7,5-
3 S
r.
V 5 1 `-
1 DO HEREBY CERTIFY THAT TTi1S WELL WAS CONSTRUCTED IN ACCORDANCE W(Tl1 1SA NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND TIIAT,A COPY F Di RECORDr'sOWNER
IIAS BEEN PROVIDED TOTI{l�a Q
SIGNATURE OF PERSON CONSTRUCTING TILE WELL 'DATE
Submit the original to the Division of Water Quallty, Groundwater Section, 1636 Mall Scrvlce Center- Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-1 REV. 07/2001

304231
WELL CONSTRIJCTION RECORD
North Carolina - Department of Environment and s,l•ril Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (pA•p
WELLCONTRACTOR COMPANY NAM[ RF.UDEN CALDWELL DRILLING, INC
STATE WELL CONSTRUCTION PERM ITa ASSOCIATED WQ PERMIT/
(if applicable)
4 rt t EeP SPX CERTIFICATION /a11
(if applicable)
PHONE[phone]
1. WELL USE (Check Applicable Dox): Residential 19" MunicipaVPublic 0 industrial 0 Agricultural 0
Monitoring ❑ Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION: �7
Nearest Town: e P, &ZJ 1r V-) County � rX.o n'&€
its '1b5 GA0-2 Cv2e,a.IC
(Street Name, Numbernity , Commu, Suivition, La No, Zip Code)
3. OWNER: `J`sbbdev+ CA
Address 3 al o C= L-AC To j W•Tt3
(Suva or Routs No.)
ca t&•) I N.. w INC a 8 --t
Ciry or Town Slate Zip Code
6a%)- - i t o -O a
Ana coda Phone number
4. DATE DRILLED 1°7 oA ej_.
5. TOTAL DEPTH: 'S I 0
6. DOES WELL REPLACE EXISTING WELL/ YES 0 NO 0
7. STATIC WATER LEVEL Delow Top of Casing: 4-0 FT.
(Use -+- it Above Top of Canna)
8. TOP OF CASING 1S 1 FT. Above Land Surface'
'Top ofcnlag terminated aUor below lead scrim requlru •
variance la accordance wilts ISA NCAC IC.0111.
9. YIELD (gpm): 1 5 METHOD OF TEST fl SG - F I R-
10. WATER ZONES (depth): L Y o r - \ 5 (a 9 r.--‘
11. DISINFECTION: Type
12. CASING: n. !+nc r
From - To �C(g Ft. b ' /CS
From To Ft.
From To Ft.
13. GROUT: Depth
FromA... To 'a -CI Ft.
Amount
Wall Thickness
or Weight/Ft. Ma�terial
Syta WC -
Material
CerActa t-
Method
YO V(ZEfl
From To Ft.
14. SCREEN: Depth Diameter Slot Sae Material
From To FI. in. in.
From To Ft. in in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft
From To Ft.
/r opographic/Land setting
Ridge ❑Slope ❑Valley ❑Flat
(chick appropriate box)
Latitude/longitude of well location
(dta+eea/mimsnea/secoads)
Latitude/longitude source:❑GPS❑Topographic nap
(check box)
DEPTH DRILLING LOQ
Frolm / Teo , Formation Description
of 4_,;R-ni:a•-'
ot3i_. , % c e G,2fimtTE
18c- )ec)cM-C/Leitc
(20' '3io' C.,2_1L;JtTI=_.„
LOCATION SKETCFI -6,-;
Show direction and distance in miles from attlt'ast
two State Roads or County Roads. Include thefbad cn:,
numbers and common road naes. t�s
m
GA ./
CReei-
•
d 76 5-
M
us 4-
16. REMARKS:
1 DO HEREBY CERTIFY THAT THIS WELL WAS CONS 1 RUCTED IN ACCORDANCE WTLII ISA NCAC 2C, WELL.
CONSTRUCTION STANDARDS, AND TRAT COPY OF 1111S REORD 11AS BEEN PROVIDED TO TITS WELL. OWNER
SIGNATURE OF PERSON CONSTRU
CTING T
o, 10� a a/ d4-
HE' WELL- ATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mall Service Center - Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-I REV. 07/2001

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and u.//It,tal Resources
WELL CONTRACTORONDIVIDUAL) NAME (prim) 4) I L,(_16
WELL. CONTRACTOR COMPANY NAME_RF.UDEN CALDWELL
STATE WELL CONSTRUCTION PERMITS ASSOCIATED WQ PERMIT/
(if applicable) (if applicable)
304228
^Divisionof Water Quality - Groundwater Section
N3 u� -/
h S ' y` CERTIFICATION / a 1
DRILLING, INC•
PHONCY. r�48 54-3581I
1. WELL USE (Check Applicable Box): Residential �MunicipaVPublie 0 Industrial ❑ Agricultural 0
Monitoring 0 Recovery ❑ Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATIQN� /�
Nearest Town: LAN (� U Iv ACounty b L'N Cc ill ear
tLCA0
(Street Name, Numben,(Canununiry, Subdivision, lot No
• Zip Code)
3. OWNER: V t eve r.1
Address -1 L�(a (g L O`j male_
(Street a Rowe No.) /
fl nlA Ue YL t.c. _ n--Q" `1 I S
Gay a Town Stale Zip Code
(ta )_ lobs - -xa4-1
Area code- Phone number
4. DATE DRILLED \ 0
5. TOTAL DEPTH:_
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO i
7. STATIC WATER LEVEL Below Top of Casing: b O FT.
vice ♦ if Above Top of Cuing)
8. TOP OF CASING IS -& FT. Above Land Surface'
'Top of color lermlaaled Wor below land aortae requlru •
vaiaace In accordance with ISA NCAC IC .0111.
9. YIELD (gpm): a` METHOD OcF TEST 124 6 -At
10. WATER ZONES (depth): 8'10 - a G f rn
11. DISINFECTION: Type \Tc( 0 a Amount
12. CASING: Wall Thickness
,/f Depth To �Ou r or 1. �0
From 1 To 10 Ft.
From To Ft.
From To Ft.
13. GROUT- Depth Material /) Method
From 4 To aa"a Ft. C".ia rAls 1Q T Vb Oat-0
From To Ft.
14. SCREEN: Depth Diameter Slot Sire Material
From To Ft. in. in.
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Sire Material
From To Ft.
From To Ft.
16. REMARKS:
1 DO HEREBY CERTIFY THAT THIS WELL WAS CONST
CONSTRUCTION STANDARDS. AND THAT A COPY 0
Topographic an efling
❑Ridge OSlope g alley ❑Flat
(niblick appropriate hos)
Latitude/longitude of well location
--- ----(de reealmtattes/secands)
Latitude/longitude source:❑GPS❑Topographic map
(check boa)
DRILLING LOQ
Foo g131Z Description
PEPTn
Fr/— To io S l
OS 1— at0
a(o
olio'- 5101
3,.
0 lot.,.,
v
r�
LOCATION SKETCH -op'
Show direction and distance in miles fronjst (east' r ,
two State Roads or County Roads. IncludeMe roadtl"t
numben and common road names. --r.
1coiJL4rl
Meta
I
•
kg g a.5
ANCE WITH 1SA NCAC 2C, WELL
EEN PROVIDED TO TIIE lyEl.L )DWb1ER
SIGNATURE OF PERSON CONSTRUCTING 711E WELL
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mali Service Censer - Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-I REV. 07/2001

8. TOP OF CASING 1S 4 FT. Above Land Surface*
*Top or cuing termlamed at/or belew had sarrue requires .
variance la accerduc with ISA NCAC 2C.0111. n
9. YIELD (gpm): METHOD OF TEST t a - A 1 Y`
10. WATER ZONES (depth): 3 I 0 / - a- P r1
304226
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and 1,1en`I..L.oral Resources --r)ivlsion of Water Quality - Groundwater Section
WILL CONTRACTOR O NDIVID UAL)N AMC (print) V ) I 1 C;, 574 (
CERTIFICATION a 1 1 `Ti7
WELL CONTRACTOR COMPANY NAME _ RF.UBEN CALDWELL DRILLING, INC. NO448 54-3581
N!
STATE WILL CONSTRUCTION PERMIT/ ----- - -- - - -
(if applicable) ASSOCIATED WQ ttR14I11
(if applicable)
1. WELL USE (Check Applicable Dot): Residential ili MunicipaVPublie 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATI N:
Nearest Town: �A bLE62-- County GU&ctmt e
Topographic/Lend setting /
❑Ridge ❑Slope ❑Valley gnat
(Sack eppropriapy box)
Latitude/longitude of well location
Orsreealmiau swa ecaods)
Latitude/longitude source:❑GPS❑Topographic map
(check boa)_
DEPTH DRILLING LOG
Fr9im l TqFormation Description
f 0 VE g6,)fioEtJ
4-3'-- 310�
3 i o�- M 0� ` L2t;4 1 C EJ - a vfD
aP-A>JITC�
�10'
yy1 1 s Lek PJ E
(Street Name, Numben, Commit/lily, Subdivision, Lat No , hp Code)
3. OWNER: LA 94 . oc_, 14D 0
_ _ Address ( I 9-5 '—
CA ' n u ju j'jC al 1 15
City or Town Siete Zip Code
(? )- a`1q-553�
Arca coda- Phone number
4. DATE DRILLED 1 0/1 3/0 4
5. TOTAL DEPTH: 11 0
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO a/
7. STATIC WATER LEVEL Below Top of Casing: 1 CV Fr•,
(Use 'e'tr Above Top or Caro)
11. DISINFECTION: Type
12. CASING• j2�e�r�s
From � DFo th`i—c FL'b '/4c" r
From To Ft.
From To FL
13. GROUT Depth, Material �Qd
FrorrL _To at FL CPO01�PO
03-\ J1--43
From To Ft.
14. SCREEN: Depth Diameter Slot Sim Material
From To Ft. in. in.
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Siu Maruul
From To Ft.
From To Ft.
Amount ra 1 b
Wall Thickness
o Weigh i. M
16. REMARKS:
+at',"
CJ
-ot`'
� J
LOCATION SKETCH 0
r is
Show direction and distance in miles from atdeast :^,
two State Roads or County Roads. Include th2'-road
numbers and common mad names. X t ?
t-L
cr.t�
645e
C.�vC (9
Cj (f+ u'Kia R-D aM
1 D0 HEREBY CERTIFY TILAT THIS WELL WAS CONS ROC -ED M A CORDANCE WITH 1SA NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND TIIAT A CO Y OF THIS RECO • o (AS BEEN PROVIDED TO TI r: WELL s WNER
�o
SIGNATURE OF PERSON CONSTRUCTING THE LL
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mall Service Center -Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-1 REV. 072001

Cue
304225
WELL CONSTRLJCTION RECORD
North Carolina - Department of Environment and *r,ruralfK1j�Rjesources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (pr/u) L1t�L'C �)A
WELL CONTRACTOR COMPANY NAME RF.UBEN CALDWELL DRILLING, INC G[RT1P)CATION/ ail
rtlont42(8 ?54-3581
STATE WELL. CONSTRUCTION PERMIT/
(if appNesble) OCIATLD WQ PERMIT/
if applicsble)
1. WELL USE (Check Applicable Doe): Residential cc—Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Otha, List Use
2. WELL LOCATIO n
Neare;tTown: nL‘liSti County ‘r'n1
�..p LL, t_ 1—t A rr.s Lett.
(Street Name, Number, Community, Subdivision, Inc No, Zip Code)
3. OWNER: L-LO Q,6 `9 g4Z
_Address_..
or
AS}iEv\\ (Street- 1�"_e' % a g c a
satcry or Town State Zip Code
Area code- Phone number
4. DATE DRILLED A o l /0 4
5. TOTAL DEPTH:
( —I 3 -I
Wall
Front To �6 a Ft.
From To Ft.
From To Ft.
13. GROUT' Depth, Material a.f
From To Tl Ft. C_ m L'ot re ORic hod {,
From To Ft.
14. SCREEN: Depth Diameter Slot Siza Material
From To Ft. in. in.
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO M
7. STATIC WATER LEVEL Below Top of Casing: _ _n-
8. TOP OF CASING IS (Use `+' if Above Top of Cuing
FT. Above Land Surface•
'Top of cuing lermloaled •IIor baler Ind surface require.' •
valance In accord ac with 13A NCAC IC.011I.
9. YIELD (gpm): METH D O TEST I c - A l it
10. WATER ZONES (depth): 1 — 1' C� Yr b-,
11. DISINFECTION: Type t4TN o gAmounl / 1 L Show direction and distance in miles from east or.;
12. CASING: Ttuckncas two State Roads or County Roads. Include a road _:
Di to or Weight/Ft. 1/FI. Ma numbers and common road names. <;a
6%K $Aga(
Topographictand setting /
❑Ridge ❑Slope ❑Valley 12DIat
(chock appropriate box)
Latitude/longitude of well location
Latitude/longitude source:❑GPS❑Topographic map
(cock box)
PEPTIi
Frn, To /
"—We
Fo
c, ' 04 \TE
City 1 cc- t a GR0-)
16. REMARKS:
DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED M AC
CONSTRUCTION STANDARDS, AND T11AT A Cf1RY OF TI ITS RECORD
LOCATION ETA
.c
6
::yc�
s rep
rt _LS
1L G>4�
W I t,.4 I A ;, . S jZ0
RDANCE WTDI ISA NCAC 2C, WELL
S BEEN PROVIDED TO THE
10
SIGNATURE OF PL•XS UN CONSTRUCTING T1IE WELL DA
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mall Service Center - Raleigh, NC
27699-1636 Phone No. [phone], within 30 days.
GW-1 REV. 07/2001
0[�

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resourc :Division of Water Quality - Groundwater Section 2
WELL CONTRACTOR (INDIVIDUAL) NAME rtnt /�� : /\ � /�� CERTIFICATIONr./#O/i/�gnd1
63E1 / Ue /It I`�l4 PHONE # tNW) FD�i�-/AO13
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT'S
(if applicable)
WELL CONTRACTOR COMPANY NAME
(if applicable)
I. WELL USE (Check Applicable Box): Residential 9" Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION:
Nearest own:.
J N ca
Lot
County
,-,?err-54
(Street Name, Numbers, .. ity, Subdivision, Lot No., Zip Code)
3. OWNER: VEgE Z Et C-44 U
Address O. t `I- 9 t{'
(Street or Route No.)
g-e(ceb-Ce r tJc
City or Town State tip Code
(—�
Area code- Phone number
4. DATE DRILLED /0" I }' y'
ci'ai5'
5. TOTAL DEPTH:
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO
7. STATIC WATER LEVEL Below Top of Casing: Cp0 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS 1 FT. Above Land Surface'
*Top of easing termiaated at/or below land surface requires a
variance to aceord a with 1SA NCAC 2C .0118. n
YIELD (gpm): � METHOD OF
t • r/�
10. WATER ZONES (depth): I �
LOCATIONSKETCR
graphic/Land setting
dge ['Slope ❑Valley ❑Flat
( appropriate box)
of well location
(deatealminuteslseeoada)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From To Formation Description
TEST
9. �&C
11. DISINFECTION: Type /!reLl Amount
12. CASING: Wall Thickness
From To / �CP Ft Diameter or Weight/Ft Material
From To Ft
From To Ft.
13. GROUT: Depth
From To
From To
14. SCREEN: Depth
From______ To Ft in.
From To Ft in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
Ftl .OMu6f f
Ft
Diameter Slot Size Material
in.
in.
3o4038
lv
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common road names.
Ow
mzd Sz .
16. REMARKS:
1 DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CON s' UCTION ST s ' s S, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-1 REV. 07/2001

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resorr�Cut1es - /Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) I -Ale y W Fii (AL CERTIFICATION Mika,.
WELL CONTRACTOR COMPANY NAE IACWfN WE. i'� ell Mika,.MII rit� PRONE # a4) 03- 7 .
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT&
(if applicable) i (if applicable)
1. WELL USE (Check Applicable Box): Residential I/ 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 own: F12'tcx�e� County
cep M -tN\ Q . ikkks r 81-3a
(Street Name, Numbers, Community, Subdivision, tot No., Tip Code)
I Er+ G' iii'mfV
3. OWNER:
Address
All EN T EiVE
Pie-4-clnec(S Ni No.) 9.48.?3
City or Town State tip Code
Am code- Phone number
4. DATE DRILLED 1 O - K - 0 H-
5. TOTAL DEPTH- 54'5
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO Erz
7. STATIC WATER LEVEL Below Top of Casing: 0 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS 1 FT. Above Land Surface*
'Top of casing terminated at/or below land surface requires a
variance in accordance with ISA NCAC 2C .011& �6/�e/,Z
9. YIELD (gpm): METHOD OF TES
10. WATER ZONES (depth): 4- O
TopogrOhic/Land setting
❑Ridge MSlope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DE DRILLING LOG
From To Formation Description
11. DISINFECTION: Type IA6k Cif Amount c2_
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft Material
From d To I 9" Ft Erg
From To Ft
From To FL
13. GROUT: Depth
From To FLe/l
M�
From To Ft
14. SCREEN: Depth Diameter Slot Size Material
From To Ft in. in.
From To Ft in. in.
15. SAND/GRAVEL PACK
Depth Size Material
From To Ft.
From To Ft.
LOCATION SKETCH.
Show direction and distance in miles frofaat least
two State Roads or County Roads. Include the road
numbers and common road names. ti
16. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUI, it.0 IN ACCORDANCE W1TH 15A NCAC 2C, WELL
CONST12,1JCTION STANpARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
G
GNATURE OF PERSON CONSTRUCTING THE WELL ATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-1 REV. 07/2001

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Reso Division of Water Quality - Groundwater Section /�
WELL CONTRACTOR (INDIVIDUAL) NAMEE (print),PiZX �1S !1 CERTIFICATION
"t#S 94y 31
WELL CONTRACTOR COMPANY NAME Fl jJfrl(XiA..Y `% M4 WEAL ! 11 i'A . PHONE it (tat) t¢.b3- 5ap3
STATE WELL CONSTRUCRON PERMIT# ' ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential /MunicipalPublic ❑ Industrial ❑ Agricultural ❑
Monitoring ❑ Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION:
Nearest Town:
I+Y TpfOtu {E�I .
(Street Name, Numbers, Community, Subdivision, Lot No Zip Code)
3. OWNER: 11 Y-P
Address i o. tSdt a53 %-
County gIkt`tC
(c'es5-ICte. NC oute NnaageVhg
City or Town Stan tip Code
L�
Area code- Phone comber
4. DATE DRILLED I Q - I ' O /'{'
5. TOTAL DEPTH: 0
6. DOES WELL REPLACE EXISTING WELL? YESo0 NO
7. STATIC WATER LEVEL Below Top of Casing: t C) FT.
(Use "+" if Aboa Top of Casing)
8. TOP OF CASING IS I FT. Above Land Surface'
'Top of easing terminated at/or below land surface requires a
variance he accordance with ISA NCAC 2C .e11& �i
9. YIELD (gpm): MF�Ti�I�OF TEST a L ��
10. WATER ZONES (depth): ( UU
11. DISINFECTION: Type 1A @' £ f .Amount vL
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft Material
From 0 To 1 Ft.
From To Ft.
From To Ft
13. GROUT: Depth
From To
/Topogtapltic/Land setting
Ridge ❑Slope ❑Valley 0F1at
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH PRILLING LOG
From To Formation Description
FLC flk
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.
0
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common road names.
� ey4Ki b Not .
%;p--DH R < t M.
16. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONS Cf1ON STM IDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WFJ.f OWNER
SIGNATURE OF PERSON CONSTRUCTING THE WELL
DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-1 REV. 07/2001

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Reso es�- Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME ilk—) I d- CERTIFICATION tt�G03,
WELL CONTRACTOR COMPANY NAME f LA h 14-N Ei I J)gi l i il9 PHONE e (f2t)643.92Z3
STATE WELL CONSTRUCTION PERM1Td ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
30034
I. WELL USE (Check Applicable Box): Residential Iff Muaicipal/Public ❑ Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection ❑ Other 0 If Other, List Use
2. WELL LOCATI
Nearest Town: h Cotmtyy?3
F#r /ION..lwfc wy. La't*53 g MSG
(Sine`s Name, Numbers,1Canmuni ,, Subdivision, Lott rNo, Zip Code)
3. OWNER: i�O�1N -(• C i.l ZA�k1'L
N.
Address fig, 14\47-k • .`RNi C 'iEWY Coet'S�i
(Street a Rome No.)
a�tce mc_s a880�
City or Town State Zip Code
Area code- Phone number
4. DATE DRILLED I0aI-�1'f
5. TOTAL DEPTH:
6. DOES WELL REPLACE EXISTING WELL? YP I 1 NO / ;
7. STATIC WATER LEVEL Below Top of Casing: �Ff.
(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 requtra a
variance in accordance with ISA NCAC 2C .011& /1 n
9. YIELD (gpm): 9METHOD OF TEST( 7%�L • l ;Of4'i(-il MtP
10. WATER ZONES (depth): / AO
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.
MeaKKI N 4`'E•
3f,Avt?\ DAnel ict .
Elk Ytd-(J. oe,uc -guy
opographic/Land setting
idge ❑Slope 0Valley ❑Flat
(check appropriate box)
Latitude/longittide of well location
(degreWmins/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From To Formation Description
11. DISINFECTION: Type 1 M) I i;±. Amount £
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft Material
From To 1% Ft
From__ To Ft.
From To Ft.
13. GROUT: Depth /� } ,L Method
From To Fil ,O/4 Ktf i_ y SLi
From To Ft J
14. SCREEN: Depth Diameter Slot Size Material
From To Ft in. in.
From - To Ft in. in.
15. SAND/GRAVEL PACK
Depth Size Material
From To Ft.
From To Ft.
16. REMARKS:
1 DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION ST.pNDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
Jd-J -D9-
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-1 REV. 07/2001

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and aural e^ - Division of Water Quality - Groundwater Section ??
WELL CONTRACTOR (INDIVIDUAL) NAM5 (print / 'c, /•,q CERTIFICATION tO
WELL CONTRACTOR COMPANY NAME 7 1�,D4 U' 1 %I'Yi`G Ch J lIl ! v.R PRONE # (060) IDOp 3- 1cZa
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential f] Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring ❑ Recovery ❑ Heat Pump Water Injection 0 Other ❑ If Other, List Use
2. WELL LOCA ON:
: �� Coun 11/41 OI &
1 st Town:
EL . CRnbmC .7.8 15
(Street Name, Numbers, CommiiuSubdivision, Lot No., Zip Code)
3. OWNER: L
Address .3 OWUTL
F k^2(A Lt 9.j� No.) agO(v
City or Town State Zip Code
Area code- Phone number
4. DATE DRILLED (0 -a6-(-rif
5. TOTAL DEPTH: 41-65'
6. DOES WELL REPLACE EXISTING WELL? YES El NO a
Topoi hic/Land setting
❑Ridge Slope ❑Valley ❑F1at
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From To Formation Description
7. STATIC WATER LEVEL Below Top of Casing: / 60 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS FT. Above Land Surface*
'Top of casing terminated at/or below land surface requires a
variance In accord a 1SA NCAC 2C .0118. n
9. YIELD (gpm): OD OF TEST.
10. WATER ZONES (��
11. DISINFECTION: Type /
12. CASING:
CDepth Diameter or Weight/Ft Material
From To �A Ft
From To Ft.
From To Ft.
13. GROUT: Depth
From To Ftl 'n
Dht C t'(
From To Ft.
14. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in.
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
Amount ot—
Wall Thickness
N
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common road names.
OS 5
/L zi
1Cb5/EL /',no &
16. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONS ION STAND AI;DS..AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
SIGNATillW OF PERSON CONSTRUCTING THE WELL DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mall Service Center -Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-1 REV. 07/2001

WELL CONSTRUCTION RECORD 30 418 3
North Carolina - Department of l:uvironmcnt audit 1111-n Rcso rces - ivision oT Water Quality - Groundwater Sectionnj
WELL('OM RACTOR (INDIVIDUAL) NAME�(print) / f�� t�/ ��)'P�" CERTIFICATIONp �"�
NI. ELL conics( -mu C)MI'ANV NAME eft/ �' /ir/ PHONE # gotgad7-1 5`%
STATE wf:1.1. CONSTRUCTION PEI(Mrr#
l it -applicable) (if ap+licahle)
,s.sa..W�n -.x.
I. WIiLL USE (('heck Applicable HOx): Residential gee—Municipal/Public 0 Industrial ❑ Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other ❑ If Other. List Use
AS.SOCLVrEn WQ rERMIT#
2. WELLLOCA"TION; /,
Nearest Town• r• County Aiefat e-
fle K! Foy jot
(Street Name. Nnntl,crx. Cwnmunily. Subdivision, lad No.. Zip Code)
Arlrh:css it4Vft [ Ed•
e`W111
(titrect or l/otae No.) 7ijg
(rya fit,
zip Code Area cafe- Pone numhc(,,,ryryry
A. DATE DRILLED /& /� `"©
5. TOTAL DEPTH: f?6-
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO 0
7. STATIC WATER LEVEL Below Top of Casing: 60 ET.
(Use "+" if Above Top of Casing)
S. TOP OF CASING IS 0( FT. Above Land Surface*
•Tap of casing terminated atior below land surface requires a
variance in accordance with ISA NCAC 2C .011 a.
9. YIELD(gpm): .3 METHOD OFTEST P1r
10. WATER ZONES (depth):
I1. DISINFECTION: Type
12. CASING:
Depth � Dia ier
From TO_iL Ft.
Ft.
From To
From _ To
13. GROUT: Depth
From f% To Vv
From To
14. SCREEN: Depth
From Tu
From To
15. SAND/GRAVEL PACK:
Depth
From To Ft.
Topographic/Land setting
❑Ridge ❑Slope ❑Valley glint
(check appropriate box)
I aiilu(Idlongiludc of well location
(degees/mitauesis cwtds)
Latitude/longitude source:❑GPS❑Topographic 111a1)
(check hax)
DEPTH . DRILLING LOG
From • To FyrylyitiuniUcscription
0
LOCATION SKETCH
Amount Show direction and distance in miles from al least
Wall Thickness two State Roads or County Roads. Include the road
or )UF(.,Oriali numbers and common road names.
' MaterialL Method
Ft. CS •"'eg7
Ft.
Diameter Slot Sin Material
Ft. in. in.
Ft. in.
Size Material
From To Ft.
I6. REMARKS:
I DO HEREBY CERTIFY TIIAT 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
%lam 1040-0 Li
SIGNATURE OF PERSON CONSTRUCrINGTHE WELL DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
27699-1636 Phone Na. [phone], within 30 (lays. GW-I REV. 07/2001

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Diyisiou or Water Quality
WELL CONTRACTOR (INDIVIDUAL) NAME ‘print) �('iJ`b r n L .)e
WELLa.CONTRACTOR COMPANY NAMFe ret:Int grog .tJe L11 4 Ptt'.•.p ,
STATE \\ 1:I.t. CONSTRUCTION PERMI I# _ / 40 __ASSOC IA' I'ED \CO PE.RMup#
if applicable) (if applicahlel
- (i roundwater Section
(ERTIFI(- Vru)N #.7 41) 8
PHONE # (gar4./- 3, la
I. WILLUSI: ((heck Applicable Box): Residential fi�l Municipal Public ❑ Industrial ❑ Agricultural 0
Monitoring 0 Recovery ❑ Heat Pump Water nlection 0 Other 0 If Other. List I use
3. WELL LO(ATio4: ,
Nearest Town: /J i CY i t Ls ) County �' *ym % t
To 1ln_ Ta.i-r __ea •
Street Name Numbers, ('ommutity. Subdn is'un. lot Nu_. hp (
3. (IWNLR: . 1J)np l 11 S I,Cr
Address I(O1 CIaincrG�
--'1i4r -
��r 1Street Or Route No.l
1eta ksa1,a, )k FL_..._,.. aaal,
('irc ur town State Lip Ledo
:Area ends -Phone number
DATEDRILLED'1 -a3-04
L. DOES WELL. REPLACE EXISTING WEE.i .' YES 0 NO14
7. S.EAIIC WAFER LEVEL, Below 'lop of (asine: 4PO _I'T.
(Esa..,'. if:Aho clop et ('asing)
OP CASINGS. T0CASING1S _. I PT. Abo'e Lund SW" t tees
*Top of casing terminated at/or below land surface requires a
variance in aceordan"o with 15A NCA(' 2(' .0118.
9. YIELD Igpin): 1:2 _ METHOD OF IIES� .�%rs
10. WAFER ZONES (depth): SOS 1 - 1 L C{ pcY\..._.
\1 _ I.O(.\ LION S6l:'I'('II
11. UISIN Ph( I I( )N: Type. %-17 fr{ :\mount /54 -443l4s-. Show direction anti dist:mce in miles from at least
12. CASING: Wall Thickness two State Roads or l-aunty Roads- Include the road
-..
Depth _ Diameter or Weight. ht. NI:aerial numbers and common road names. O
Prom,_ lb .j I Et. •' r
From 'Tcoo 0
From 'fo Et. —I
13. (iROlrE: Depth !Material Method NI
Froth Tn eve, PI.- ,i J S�
From To Pt.
(4. SC12I(EN: Depth Diameter Slot Site Almcrial
From 'To Pt. in. in.
From, To _______ PL_ in.
15. SAND GRAVEL_ PACK:
Ucpth Site \latcnal
Front fo Ft.
front to ._- It. _..
Ib. REMARKS:
Topogrphic/Land setting
❑Ridge oSlope ❑Valley Flat
(Cheek appropriate ate hos)
Latitudelongitude of well location
idcp,rrt. nunute>second.,
odd. longitude soon e:O(iPS❑"Topogrphic nap
(check bop)
DPI'TII DRILLIN(i LOG
From -- fo r Formation Uc
scri -Mon
-57
si ( gijsC
TOTAL. I/1:1'El I:
01
N
I DO III'RIiRV CERTIFY TIIATIIlIS Nlil_I. AA:AS CONSIRG(EF:D IN rACCURO1NC1: Wllll ISV N(AC :C, will.
('ONSTRUt. (ION STAND RDS, AND"III:Af :A CUP( OF THIS RECORD II.AS 13F.P.N PROA IDIEI)TO TIIIL WELL AR
__.._S-CJ SL .A41- - i '.Z / - D
SI(iNA'IURP. OF PERSON CONS 1 1 I IN(, 1111• Uli1 I. D.A'il(
Submit the original to the Division of Hater Quality, Groundwater Section, 163o Mail Seri ice ('enter- Raleigh, \(
27699-1636 Phone No. [phone]. within 30 days. (iW-I RI*. 07 2001

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and 4ural Resources - Divisione/of Water Quality - Groundwater Secuot.
WELL CONTRACTOR (INDIVIDUAL) NAME (prriut)) Atilt e 361/ CERT1P1CATION it a 77
W
WELL CONTRACTOR COMPANY NAMES+Iallfl'i e{ 9e 1 r K.j 10 P' I (I /i G PHONE 1 i a49-0117C
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential 'Mtmicipal/Public 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery ❑ Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATIO ..
Neatest Town: ICOunty.t.L�_
nt Rut I`�}i � Jr/
(Street Name, Nwnbbtets, Comm , Subdi i Lot No., Zip Code)
3. OWNER: G' It/ f 1 r o
Address 77 d4'
(Swett lama
.)
eWI jL4/A) N c 2$ 7 i
City or Town Stae Zip Cole
t >-
Area code- Phone number
4. DATE DRILLED d' Z
5. TOTAL DEPTH:
6. DOES WELL REPLAC EXISTING WELL? - ;NO Er
7. STATIC WATER LEVEL Below Top of Casing: FT.
/ (Use "+" if Above Top of Casing)
8. TOP OF CASING 1S / • 5 FT. Above Land Surface`
'Top of casing terminated at/or below bnd surface requires a
dr
variance is accordancewith ISA NCAC 2C .0118. +'/
9. YIELD (gpm): 3_ METHOD OF TEST // me
10. WATER ZONES (depth):
-o
L
11. DISINFECTION: Type r -C.%%
12. CASING:
w r.
From ie To `�7 2 Ft
From To Ft
From To Ft.
13. GROUT:
From
From
Amount /O of
Wall Thickness
501--re(
kv
or Weight(Ft �at«cal
vC-
Material
TTo 20 Ft. CoMCI-
ptt
To Ft.
14. SCREEN: Depth Diameter
From _ To Ft. in
From To ` Ft. / in.
15. SAND/GRAVEL PACK:
Depth Size
From To Ft. /
From / To / Ft.
16. REMARKS:
Tope Gland setting
❑Ridge lope DValley ❑Flat
(chock appropriate box)
Latitudefongitude of well location
(degreeatminwaeIs weds)
Latitude/longitude source:❑GPS❑Topographie, map
(check boa)
DEPTH DRILLING LOG
From To Formation Description
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and cotnmon road names.
t
oft
1 DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCT ED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCT STANDARDSPAND THAT A COP jar THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER.
SIGNATURE OF ON CONSTRUCTING TEE WET DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-1 REV, 07/2001

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and N'Resources - DDivisio of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print)�// f A G „ACK e$ )JS CERTIFICAATTIIONN/tarrt V
WELL CONTRACTOR COMPANY NAME W ee i' W ef�✓ wed/7 A.",Z G PHONE 1 I R7 7 -ri no
STATE WELL CONSTRUCTION PERMIT,/ ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
I. WELL USE (Check Applicable Box): Residential 03 MunicipalPublic 0 Industrial ❑ Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION: Suarez,
Town`°0 : V)%Atli County
27 6 G/' tat
(Street Name, Numbers, Comm®ny, Subdivision, Lot No., Zip Code)
3.OWNER: HOWe,d C4(M.
Address 2 7 Elie, C41.16 Re/
Route No.)
alp eau ewig a N L 28 7 $ 7
City or Town Stale Zip Code
(
)-
Mn cods Phone number
4. DATE DRILLED /0 - a /
5. TOTAL DEPTH: 2 0 f"
6. DOES WELL REPLACE EXISTING WELL? YES IBC 0
7. STATIC WATER LEVEL Below Top of Casing: / 2 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS / 5 FT. Above Land Surface"
'Top of cuing terminated atlor below land surface requires a
varina in accordance with 15A NCAC 2C .0118. �^►
9. YIELD (gpm): 20 METHOD OF TEST / / nl re
10. WATER ZONES (depth): 485- ' / 4!O ` /q0 r
11. DISINFECTION: Type En/(Lg
12. CASING:
Fro
Depth _
To y d Ft.
From ' To FL
From To Ft.
13. GROUT: Depth
From To 20
From To
14. SCRE
From,
From
15. SAND/G
Depth
To
To
VEL PA4:
Depth
From/To
Fro To
tt
16. REMARKS:
Amount /O o2
Wall Thickness
or Weight/Ft Material
SD$2/ puG
Material
Ft.GOMICPe/tC.
Ft.
Diameter
Ft
Ft.
Ft.
Ft.
in.
I DO HERE Y CERTIFY THAT THIS WELL
CONS TI( ION STANDARDS
6-
SIGNATURE OF jtRSON CONSTRUCTING THE WELL
Slot Size Material
in.
in.
Topo clLand setting
ORidge lope Malley OFlat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitudellongitude source:OGPSOTopographic map
(check box)
DEPTH DRILLING LOQ
From To Formation Description
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common road names.
AS CONSTRUCTED IN ACCORDANCE WITH I A NCAC 2C, WELL
A COPY S RECORD HAS BEEN PROVIDED TO THE WELL OWNER
/U-zl—Or
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 Envirorunent and Na Resources - Divv}v's�ionp f Water Quality - Groundwater Sec um,
WELL CONTRACTOR (INDIVIDUAL) NAME(print) Rho d de S zT 2 CERTIFICATION Barrie
WELL CONTRACTOR COMPANY NAMbSzJC i Tw141 C Wei L 0 r: I b is PHONE 0 131.i16u 'Q14gO
STATE WELL. CONSTRUCTION PERMIT# _ASSOCIATED WQ PERMIT0
(if applicable) (if applicable)
303808
I. WELL USE (Check Applicable Box): Residential Q' MunicipavPublic ❑ Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELLLOCAT_I
Nearest Town- g ynty GWiGt�
inn
((Street Name, Num es, Community, Subdivision, Lot No., Zip code)
I r I tom___ 3. OWNER: " I I t t
Address /10 6o et t e+si �[
FlecAge `$e"t$)Cve8e) Z$73 Z.
City or Town State Zip Code
}-
Ann code- Phase number
4. DATE DRILLED /O — ZO — O "/
5. TOTAL DEPTH: 2e y 5
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO f
7. STATIC WATER LEVEL Below Top of Casing: Jo r FT.
(Lite "t' it Above Top of Casing)
8. TOP OF CASING 1S !r 5J FT. Above Land Surface•
'Top of cuing terminated *tier below land swim requires
nutmeg In aceortanC With ISA NCAC 3C .011& .�
9. YIELD (gpm): t1 METHOD OF TEST/ //Y1
10. WATER ZONES (depth):
TopogivSrcland setting
❑kidge reslope DValley DF1at
(check mptapr; r box)
Latitude/longitude of well location
(degruatmimuss - ads)
Latitude/longitude source:OGPSOTopographic nap
(rheok box)
DRILLING LOG
Formation Description
DEPTH
From To
J,OCATION SKETCH.
It. DISINFECTION: TypeC.y- y . Amount /0 or Show direction and distance in miles from at least
12. CASING: �� dye Wall nicknna two State Roads or County Roads. Include the road
L r spe 2% L flambe
FroFrom FP To �0� FL p UC
From—__r To Ft_
From To FL
13. GROUT: Depth Material
From 0 To ZO Ft.CfWCoefe
From _ To Ft,
14. SCREEN: Depth
Diameter
From To Ft. in
From To Ft. in.
15. SAND/G VEL PACK:
Depth Siza
From To Ft.
Frain To Ft.
M thud r
Slot Size Material
in.
in.
Material
and
16. REMARKS:
I DO HEREB
CONS
CERTIFY THAT THIS WELL WAS
ION STANDARDS, s AT A
..1.
SIGNA
ONSTRUCCI:s IN ACCORDANCE WITH 15ANCAC 2C, WELL
Y OF THI CORD HAS BEEN PROVIDED TO THE WELL OWNER
OF PERSO CONSTRUCTING THE WELL
—20-oY
DATE
Subrnit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
27699-1636 Phone No. (919) 733-322I, within 30 days- GW-1 REV. 07/2001

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources .- Division of Water Quality
WELL CONTRACTOR (INDIVIDUAL) NAME (print)T�Ah1 / CU— K«
WELL CONTRACTOR COMPANY NAMBaLICATwtarTec (tje.71 (r: I I; nth
30380'7
- Groundwater sec inn
CT-RTII•ICATION a al?
PHONE # ( (Q4:1-0g70
STATE WELL CONSTRUCTION PERMITS ASSOCIATED WQ PERMIT#
if applicable) (if applicable)
I. WELL USE (Check Applicable Box): Residential liMtmicipaVPublic 0 Industrial 0 Agricultural 0
Monitoring ❑ Recovery ❑ Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATIO";
Nearest •T wn: G lNo•/e r County � A._
we tica FA fa
i r
(S a Nam , Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNERrTt ysescl
Address Z 0 P ws t neon, t
(Street ar Rave No.)
nd/et PC 2Z7/4--
City or Town State Zip CM.,
( )-
Arp code- Phone number
4. DATE DRILLED /O - e 8 -or
5. TOTAL DEPTH: /* r
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO @-----
7. STATIC WATER LEVEL Below Top of Casing: _ /2 FT.
(Use "+" if Above Top of Casing)
g. TOP OF CASING IS (• S FT. Above Land Surface"
*Top of casing terminated et/ar below land solace requires a
variance in accordance with ISA NCAC 2C .011& —a ,
9. YIELD (gpm): 75- METHOD OF TEST / i sir
10. WATER ZONES (depth): /6 1, a
11. DISINFECTION: Type_ S `-r , Amount /0 0 a
12. CASING: Wall Thickness
fd Depth f f wit u or Weight/F al
Frnm To 43Ft. VG
From_ ToFt
From To Ft.
13. GROUT: Depth Material M
From_i_ _ To 20 FL 9$CtC f C W e $#7%
From _ To Ft
14. SCREEN: Depth Diameter Slot Size Material
From_ To Ft in, in. _
From To_____ Ft. in. _ in.
15_ SAND/OrVEL PACK:
Depth Size Material
From To Ft
From To Ft.
16. REMARKS:
C. pup
Topo eriand setting
❑Ridge Lope ❑Valley ❑Flat
(cheek appropriate bail
Latitude/longitude of well location
(degrecs/minumsiaccoedr )
Latitude/longitude source:❑GPSDTopograpl
(check box)
DEPTH
From To
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common
Rd
ad
tti
1 DO HEREBY CERTIFY THAT THIS WEI 1 WAS CONSTRUCTED IN ACCORDANCE WITH ISA NCAC 2C, WELL
CONSTRUCT! ] STANDARDS, AND THAT
AACCOPY O S RECORD HAS BEEN PROVIDED TO THE
%WELL OWNER
SIGNATURE OF PERSON CONSTRUCTING THE WELL
DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Servi
27699-1636 Phone No. [phone], within 30 days.
Center - Raleigh, NC
GW-1 REV, 0712001

300.778
WELL CONS [RUCTION RECOR
- I itilart.rati:: Envtionmeni and
‘4 C(YNT RA C T-OR INN SIDI_ AI ) NAN! et
I ; ((rN] f Kok C/ii. COM40 !' '45 NAM/
s; CONSTRUCTION PERIvITIA
(if Dileate'r
1
3opIJI-,i, Reul -soLe:, - Dn )visio(,* W atcr (_h, A', . ,,j70.1.1(1ws1,-- `,C, ',
4/111s_ e_SLI-
1(prl4.0".1,1., 4.4.14ge/ VAine 446-k , if as(4$19,490
ASSOCIATED WQ PLKM11;
(if appII“.atic
Ito. $07SP7_47
....1 I..'SE (Check Apphcahle Box i Residential 11 Municipal.Public D inciustria 7 Agricti!tyir-a! 7
M on, L-mnp 0 Recovery CI Heat Purnp Watei Injection 0 Other 0 II Othel...i.iF; Us,.:
istatictsch"....z.
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V. 70.4 cytt.9?4
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17:
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appr.,e,
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tJ
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Liacce bo•
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' Dr. i5tell- rif \ Quahjy_ firoorubs:-..ler Necv:iz: 16:iu

3 0 0 7 7 7
WELL CONSTRUCTION- RECORI
Norm Aisiiii•A • 1.kpiirtliirn: f Environment and
coN-I 1_ oR (EN ) NAM 1priat
'••• 151.1. C t/N lFtAT1�P cONti. 4N) NANth
STATE 1,4 LLL CONSTRICTION PLR:vino
(if applicable',
1- turalRes.oujrLes BlivisioLn or Water Quail
iv4/c13t(Tmundwarti •ecrio
flux VW
.C•0
AsSoCIATED PERmI _ .
(if applmdlthit
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Opograpin 'Land serum
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WELL CONSTRUCTION RECORD
300493
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
CERTIFICATION # 24116
PHONE # Sl f.fnS-L.6Z
WELL CONTRACTOR (INDIVIDUAL) NAME (print) tQsrtCK '11e sit. Sasa.. t t
.
WELL CONTRACTOR COMP ANY NAME eA.hde saar tSew MU
STATE w'ELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if apt. iicable) (if applicable)
I. WELL. USE (Check Applicable Box). Residential 121/ Municipal/Public ❑ Industrial 0 Agricultural 0
Monitoring ❑ Recovery 0 Heat Pump Water Injection ❑ Other 0 If Other, List Use
2. WELL LOCATION:
Nearest Town: CQaejjer County 8 r.te e.wlrtt
I so Fos%s... cam: vit arz;s
(Street Name. Numbers. Community. Subdivision, Lot No., Zip Code)
3. OWNER.alhae
Address I51.. S erp{e..t
(Street •o1Route No.)
twin. Mn..as; Ale .iii9ll
City or Town State
(flag)- yas• 95a4
Zip Code
Arca code- Phone number
4. DATE DRILLED 3• l9.01.1
5. TOTAL DEPTH: 2.o5 _ /
6. DOES WELL REPLACE EXISTING WELL? YES El NO (3
7. STATIC WATER LEVEL Below Top of Casing: 40 FT.
(Use "-" if Above Top of Casing)
3. TOP OF CASING IS 1 FT. Above Land Surface`
'Top of casing terminated at/or below land surface requires a
variance in accordance with 15A NCAC 2C .0118.
9. YIELD (gpm): 5 METHOD OF TEST R:).
10. WATER ZONES (depth):
I I. DISINFECTION. Tvpc 9:1t5
12. CASING:
Depth
From let To 55 Ft.
From To Ft.
From To Ft.
Amount
Wall Thickness
Diameter or WeightFt. Material
(c .,
13. GROUT. Depth
From 0 To 2D Ft.
From To Ft.
Material
_Z1 taMt1.Y
14. SCREEN: Depth Diameter
From To Ft. in.
From To Ft. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
Method
?OutOA
Slot Size Material
in
in.
Topographic/Land setting
DRidge ❑valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitudc/Iongitude source:OGPSOTopographic map
(check box)
DEPTH DRILLING LOG
From To Formation Description
ar 35 AVe. A.4&.-•
S5 1.5 6 cs..14e
LOCATION SKETCH
Show direction and distance in miles from al least
two State Roads or County Roads. Include the road
numbers and common road names.
O_
0 o
9 `rt
ec r,
,n �m
N c=
W sr
0
F(n
CO O
16. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C. WELL
CONSTRUCTION STANDARDS. AND THAT A COPY�OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
tntL fl ij.a.. �c70w�pat+o -1-19. Oy
SIGNATURE OF PERS 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

300111
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources -^Division` of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (prim) I3 I1_L( CNS 1`L` CEATIPICATION/ a-i1
WELL CONTRACTOR COMPANY NAME _REUBEN CALDWELL DRILLING, INC•PHONE [phone]
STATE WELL CONSTRUCTION PERMIT/ ASSOCIATED WQ PERMIT/
(if applicable) • - (if applicable)
/
I. WELL USE (Check Applicable Box): Residential i3 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: Lk I C 3 S-f i, ft_ County a UNCo,r.QC
t.-t 1 tt I(: L Co'•-r-t....J cV�/y
(Street None, Number; Community, Subdivision, Lot T•- Zip Code)
3. OWNER: V b Or-. 1c,-5e,(La
Address e_ o. Go/ 53 " i
Le1CGS��,�auto �evuNo.) -8-�4if
City or Town Stales Zip Code
CIA o83- 11fl
Asp coda- Phone number I
4. DATE DRILLED 4' 30% 4-
S. TOTAL DEPTH: 4 t
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO
7. STATIC WATER LEVEL Below Top of Cuing: ° FT.
(Use's' If Above Top of Cuing)
8. TOP OF CASING IS A FT Above Land Surface•
*Top of cuing Imneldaled al/or below Ind nuts/ requires a
vartuu 1n aceardenee with ISA NCAC IC MIL9. YIELD (gpm): 3 METHOD OF TEST Q-(G - At
10. WATER. ZONES (depth): 1 k ° ' - 3 G P rr\
go'rio
11. DISINFECTION: Type N TIA Amount '/a- lb .
12. CASING:
9tcr
From -L To 6 Ft. b 1/ r5
From To Ft.
Fiom To FL
13. GROUT Material Method
From 4 To � ° Ft. Ca dY\ 1/40J-1 A .:�'
Wall Thickness
or o ( 1. t7fVlC al
From To Ft.
14. SCREEN: Depth Diameter Slot Sizc . Material
From To FL in. in
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Sire Material
From To Ft.
From To Ft.
16. REMARKS:
Topographic/Landietting
❑Ridge ❑Slope WY -alley ❑Flat
(cheek app.vptiva box)
Latitude/longitude of well location
(depaa/mimnedsermde)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH DRILLING LOG
Fr / To / Fomption Description
.1 - 8 S e Vrs(t-a ua_bb ►v
RS ' — 14c ' r; PaaJurg
14 / C./Lr '((.cc 3 G Pr-,
1.46 ' 4 i o ' G (LA r••s
gal
.C'
C
YJ�
0„I
cc,
bra
Q ;I',
LOCATION SKITTCF{ ->c
Show direction and distance in miles fron1Ca'leaw
two State Roads or County Roads. Includa:111e road
numbers and common mad names. z
or'
Ci Abct.%BltooK
&DAD
•
s,.
C2.tl1✓lt`w
W 4t 1 \ l
6 .y.
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WfmH ISA NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A CO OF IS RECOj(D HA$ BEEN PROVIDED TO THE OWNER
`\ wYAYA� 5 h 34—
A
SIGNATURE OF PERSON CONSTRUCTING THE WELL
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mall Service Center -Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-I REV. 07/2001

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and uantnl Resources
WELL CONTRACTOR (INDIVIDUAL) NAME (pilot)
WELL CONTRACTOR COMPANY NAME RF.UBEN CALDWELL
300121
^
- Diy.:sion of Water Quality - Groundwater Section
[J A N CERTIFICATION
DRILLING, INC • PHONEQ2j8 '?54-3581
STATE WELL CONSTRUCTION PERMIT/ ASSOCIATED WQ PERMITS
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential 51' MunicipaVPublic 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION:
Nearest Town: W15- Af t R-1 1 LL(County
LL�� riju\-m4, s Sue, .
(Street Name, Number. Community, S f, Lot No., Lp Code)
C 3.OWNER: A oJG v1/4 PS
Address f D . r,' d cg c /
,,, / (Such or Routs No.) 07,e71(7
City or Town Shia „Zip Code
Ara code- Phone number 4. DATE DRILLED "1 - a- —O 4
5. TOTAL DEPTH: act /
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO El
7. STATIC WATER LEVEL Below Top of Casing: (e+,D FT.
j (Use `4.' if Above Top of Cuing)
8. TOP OF CASING 1S - FT. Above Land Surface•
'Top of easing terminated at/or below lad surface requires a
variance In accordant, with 15A NCAC IC .at 11.
9. YIELD (gpm): t o METHOD OF TEST R(V - A i
10. WATER ZONES (depth): a-h O ` - L e n^
I1. DISINFECTION: Type a TH O b Amount Q '
12. CASING: Walt Thickness
j Depth Ihametcr or Weight/Ft.terial
From To To \`d0 Ft. b1/$ SE41.$ V4C
From To Ft.
From To Ft.
13. GROUT:I Depth,Material A Method
From 1 To et Ft. L ti T Po1CMI)
From To Ft.
14. SCREEN: Depth
From To
From To
15. SAND/GRAVEL PACK:
Depth Sire Materisl
From To Ft.
From To Ft.
Diameter Slot Site Material
Ft. in. in.
Topographic/Lan etting
❑Ridge ❑Slope alley ❑Flat
(check appropriate box)
Latitudeflongitude of well location
(deyaeahnimneshecmdr)
Latitudeflongitude solace:❑GPS❑Topographic map
DEPTH
Frgm/ _ To
f I S/
-
9-60'
aqo'
(chock boa)
DRILLING LOG
FmloVµtion ription
k5 Ua-Aeta
G('ANt1
CRe4ics- bbfo"
6 Q-A c'1 t-'f e
rrn
J ()CATION SKETCII = ma
Show direction and distance in miles frame.. Ir
two State Roads or County Roads. Includ&e''then
numbers and common road names. N
3/1-
,..,
Ft.
riW/ f S-79
Q-M
St{tp(AfL.D &lek rZc.,ft Gt_OAD
US HWY 14fa-3
I6. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH I5A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY IS RECORD HAS,IEEN PROVIDED TO T WELL WNER
SIGNATURE OF PERSON CONSTRUCTING
cv,,,, -,` a t I o 4-
WELL DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mall Service Cen er - Raleigh, NC
27699-I636 Phone No. [phone], within 30 days. GW-1 REV. 07/2001

3. OWNER:
Address 44a
3001,'O
WELL CONSTRUCTION RECORD
North Cuolina - Department of Environment and kietturaA Resources -^ Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (prim() t_L lam1a .AS CERTIFICATIONa ail
WELL CONTRACTOR COMPANY NAME_RF.UBEN CALDWELL DRILLINGINC., PHONE(R8 ,754-3581
STATE WELL CONSTRUCTION PERMITS ASSOCIATED WQ PERMITt
(if applicable)
(if applicable)
1. 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
2. WELL LOCATION: Nearest To : WBAJt (IV )LL County (LOP Wr n
rnQ t{iz 1-.� NILL.5 tASTA`fi&S
(Street Name, Number, Common Subdivision, lot No., Zip Code)
C,NAr ( C
r�,
1 11LLC
1,W P PAX]) C 12A Nc(4 �At
Di I3AJ13('V(staxt or Routs No.)
ry
�OCiorT 66 %a\IC, Zip Code
Ana cods Phone number
4. DATE DRILLED 1 - — 0 4'
5. TOTAL DEPTH: 0 o '
6. DOES WELL REPLACE EXISTING WELL? YES GI NO 1/
7. STATIC WATER LEVEL Below Top of Casing: a - 0 FT.
(Ua "+" if Above Top of Cuing)
8. TOP OF CASING IS FT. Above Land Surface*
*Top of cuing terminated at/or below Ind terrace revil( a a
variance In accordance with ISA NCAC 2C .0111.
9. YIELD (gpm): at, METHOD OF TEST Q t G- t4 t Q'
10. WATER ZONES (depth): 11f 0 /''// - an G Prrn
11. DISINFECTION: Type tJ i td 9 0 4, Amount % l b .
12. CASING:
Depth Di} ter
m Fro1 To 1 aS Ft. ( / N
From To Ft.
From To Fi.
13. GROUT: Depth Material Method
From iTo ao Ft. CrYM610T 90 e b dW, r From To Ft. aC
J 14. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in.
From To Ft. in. in. 9 na.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
Wall Thickness
or Weight/Ft. Material
rota i Q'JC
16. REMARKS:
Topographic/Land setting �-
❑Ridge ❑Slope ❑Valley EPint
((Lack appropriate box)
Latitude/longitude of well location
(devea/mimnea/secmds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DRILLING LOQ
FoVlSion ukbbttrl
Cites 'ltCC a- a . GPM
CaRAeJtT6
DEEM
Frrmi_ Tia,O/
\ao' — \Ro'
\ISD'
IRe, ' a5o'
G o
a
t_
C
Cn
LOCATION SKETCH — no
Show direction and distance in miles frog at 1414
two State Roads or County Roads. IncID�e th
numbers and common road names.
JNcrPPA R!
&2n rAc_N
lam
wi (Vacs
fJl -t (/L ^ '
01
1 DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTEDo�IN ACCORDANCE WITH I5A NCAC 2C, WELL L.
CONSTRUCTION STANDARDS, AND THAT AOPY OF THIS'ORD HAS BEEN PROVIDED II TOTI!EW ILL, OWfIE lice
SIGNATURE OF PERSON CONSTRUCTING THE WELL
ATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mall Service Center- Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-I REV. 07/2001

300111
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and man u�.Resowces -Division of Water Quality - Groundwater Section
WELL. CONTRACTOR (INDmDVAL) NAME (print) 11.-L ✓ash CERTIFICATION 1 a1-1 1
w ELL CONTRACTOR COMPANY NAME _REUBEN CALDWELL DRILLING, INC. rnonEEI%B '754-3561
STATE WELL CONSTRUCTION PERMIT/ ASSOCIATED WQ PERMITS - --
(if applicable) (if applicable)
I. WELL USE (Check Applicable Box): Residential IS/Municipal/Public 0 Industrial 0 Agricultural
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION:
Nearest Town: CA rJ) 6 Le (1 - County I11uN C<, Cr%
latil
(Strew Nome, Numbers, 5emmuility, Subdivision, lot No., hip Code)
3. OWNER: i your.) CD
Address 7? 61rd3 fa.k
(Sued Of RoWi No.)
ran e:- /✓c- 2E'7/5"
(06_ Town b Sure as rLp rode
Area code- Phone number
4. DATE DRILLED "1 I So b 4
5. TOTAL DEPTH: LF-So '
6. DOES WELL REPLACE EXISTING WELL? YES QQ NO 1E
7. STATIC WATER LEVEL Below Top of Casing: h�L FT.
(Use "+- if Above Top of Carina)
8. TOP OF CASING IS FT. Above Land Surface'
Top analog terminated at/or below land urf•c. requires •
variants I. accord anre with ISA NCAC IC.OI1a.
9. YIELD (gpm): 4- METHOD OF TEST L L G a 1GZ-
10. WATER ZONES (depth): ea ea 0 ' _ 'J- G 9 v1
11. DISINFECTION: Type I W Z o Amount 3/4 j b
12. CASING: Wall Thickness
Depth ter or��W�cigghnt/Ft. Material
From .L To ri D FL b S SU1Ld( eve
From To Ft.
From To
13. GROUT: Depth
From_a_ To el-D
From To
14. SCREEN: Depth
From To
From To
15. SAND/GRAVEL PACK:
Depth
From To
From To
Ft.
Material /� Method
Ft.Cb MFs Krr PO i)
Ft
Diameter
Ft. in.
Ft. in.
Ft.
Ft.
Site
Slot Sire Material
in.
in.
Material
Topographic/Lan setting
❑Ridge ❑Slope alley Ellie
(check apprepriue box)
Latitude/longitude of well location
(degrees/miaow/seconds)
Latitude/longitude source:❑GPS❑Topographic map;
(check box)
D131'TH DRILLTh LOQ
Frgaa 4 To5 7 o� uji D �
u
ta0' fLt5V lc€ - - r11
a �rn
G7 Cm
— C {
mot.
DP
L r B
Nei
0vet
rr W
JOCATION SKETCH cn --4
Show direction and distance in miles froftft le t
two State Roads or County Roads. Include the road
numbers and common road names.
l j51
�- 3 U'--
r) w� 1949- 3
16. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED M ACCORDANCE WITH I5A NCAC 2C, WELL
CON511tUCT10N STANDARDS, AND THAT A COPY OF�')11 BEEN PROVIDED TO T V OWNER
SIGNATURE OF PERSON(CONSTRUCTING THE WELL3-6
D TE Vnr~,
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Malt Service Center -Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-i REV. 07/2001

300118
3. OWNER:
Address
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Manual Resources - Diivision of Water Quality - Groundwater Section \
WELL CONTRACTOR (INDIVIDUAL) NAME (print) t L.L) E tJ A'j' CERTIFICATION / ai 1
CALDWELL DRILLING, INC•PRONE47f8 )254-3581
WELL CONTRACTOR COMPANY NAME _ REUBEN
STATE WELL CONSTRUCTION PERMIT/ ASSOCIATED WQ PERMIT/
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential It7 MunicipaVPublic ❑ Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION:
Nearest Town: 6AR,t)ARD$VILL ,unty 6Un)C.Orvl(3C
'd."lei L'%k - TImo(C6 S(2-&n)CA4
(Street Name, Numbus, Community, Subdivision, Id No., Zip Code)
Rl c # A Kt,Q.A Ni
gaol W 4ITT tmo ke 6R-6 tJc-I.4
(Street or Roue No.)
QARNAMSNC- ag-r09T
City or Town Stale Zip Code
(gag). (eN G O o
Area coda Plana oumbcr
4. DATE DRILLED 61' a ^ 0
5. TOTAL DEPTH: a-'t 0
6. DOES WELL REPLACE EXISTINO WELL? YES ❑ NO 6
7. STATIC WATER LEVEL Below Top of Casing: 4 FT.
(Use `ea If Above Top of Cuing)
8. TOP OF CASING 1S -' FT. Above Land Surface*
Top or casing terminated War below land aortae, requires ■
variance le accordance with ISA NCAC 2C.0111.
9. YIELD (gpm)' 19 METHOD OF TEST 9-1 G- AIR.
10. WATER ZONES (depth): 649.0 ' S a GPM
11. DISINFECTION: Type 14h c10 .
12. CASING:
From - To Ft. FDWI
From To Ft.
From______ To Ft.
Amount /A I b .
Wall Thickness
or ba j 1.
kV'Jc"''
13. GROUT,( Depth, Material
From 1 To aD Ft. Ciirr)gn)T
Firkins),
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/
[Midge ❑Slope ❑Valley 0Flat
(check appreprtuo box)
Latituddiongitude of well location
(degren/mtmnrahaoade)
Latitude/longitude source:❑GPS❑Topographic map
DEMI
From/ as Tiq /
199/ ., ago.
2ao'
o '— 91o'
(check box)
DRILLING LOG
Fprmation Description
Cat2.-A rte.
GK.KVt c6 - 1 a Gem
GRANITE
c
rn
oc
D0
�CC
LOCATION SKETCH S F
Show direction and distance in miles fromptcleastofri
two State Roads or County Roads. Include roW
numbers and common road names Y( en
ea4NGd4 �n
us
l.2
M
Q /9- 3
6AtoAPs,( vtt-t_6 ito
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC2C, WELL
CONSTRUCTION STANDARDS. AND THAT A COPY ?F THIS RECORD BEEN PROVIDED TO T LL OWNER
SIGNATURE OF PERSON CONSTRUCTING THE WELL DA
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mall Service Center -Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. G W-I REV. 07/2001

11. DISINFECTION: Type
12. CASING:
t
From S. To 4 3
300117
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and ' .tygl Resources^ Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDWIDUAL) NAME (prt.t) t t-t-, a 4s N CERTIFICATION a a-11 I
WELL CONTRACTOR COMPANY NAME_RFUBEN CALDWELL DRILLING INCPHONE448 )254 - 3581
STATE WELL CONSTRUCTION PERMIT/
ASSOCIATED WO PERMIT/ ---
(if applicable)
(if applicable)
1. WELL USE (Check Applicable Box): Residential '8/Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION: �`
Nearest To`� TiC 14 B � I LiA County � i1/41c,,4
18-151434wA�tD(J
(Street Name, Numben, Community, Subdivision, rat No., Zip Code)
3. OWNER: c)t k--r %—coc-I<eizAge6t
Address at) /e fi3 n2\ d 6
(Street a Route No.)
A5}1gJtt_t_e Ng
( City
a4- rim SAS 6 o & tale Zip code
Ara coda Phan number
4. DATE DRILLED
s-a4
5. TOTAL DEPTH: A-S /
6. DOES WELL REPLACE EXISTING WELL/ YES 0 NO 12
7. STATIC WATER LEVEL Below Top of Cuing: 6 o FT.
(Use `r' if Above Top *Caning)
8. TOP OF CASING IS 4 FT. Above Land Surface'
Top of cuing terminated at/or below load surface requirns a
varloace la accordascor lilt ISA NCAC 2C .0111.
9. YIELD (gpm): 1 METHOD OF TESJ KA P A I
10. WATER ZONES (depth): i 70,,1 yvm
i,T4 C10` 15 Amount 3/4 IWall Thickness
ter or Wei t/Ft. Material
FL h
From To Ft.
From To Ft.
13. GROUT: Dept))
From 1 To 0PLD FI.
From To Ft.
Material
c-e rver i
14. SCREEN: Depth Diameter
From To Ft. in.
From To Ft. in.
15. SAND/GRAVEL PACK:
Depth Sire Material
From To Ft.
From To Ft.
Slot Size
in.
in.
Fe Method
Material
opographicfLand setting
dge ❑Slope ❑Valley OFIat
(dock appropriate box)
Latitude/longitude of well location
(degneemiauteuseconds)
LatitudeAongitude source:OGPS❑Topographic trap.
MEM
From et.To
38 / - I -tot
t (pi
F
DRILLING LOCI
grmation Descri tign
n
70r,.
O rnx
LOCATION SKETCH -2
Show direction and distance in miles fro*}ht let
two State Roads or County Roads. Include the road
number and common road names.
IV
60 ALLei)
;v
q>,o, +J D
IW
5m
•
1-60 ca-ra N W/
3.56-v,
PThf7 &1/4/E"
16. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED,
CONSTRUCTION STANDARDS, AND TH A COP OF THIS
ACCORDANCE WITH ISA NCAC 2C, WELL
)RD ij4 ©EEN PROVIDED TO THE WELL QWNER
q-a
SIGNATURE OF PERSON CONSTRUCTING THE WELL
DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mall Service Center -Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. G W-1 REV. 07/2001

Depth
From
To� Ft.
From To Ft.
From To Ft.
13. GROUT1 Depth
From ToO
From To
14. SCREEN: Depth
From To
From To
15. SAND/GRAVEL PACK:
Depth
From To
From To
16. REMARKS:
WELL CONSTRUCTION RECORD
WELL CONTRACTOR (INDIVIDUAL) NAM! (prlet)
North Carolina -Department of Environment and Kim 1RLt_ �^ Di=s:on of Water Quality _uodwater Section
WELL CONTRACTOR COMPANY NAM!_ REUBEN CALDWEllsi tJ LIS(k
DWELL DRILLiG C CERTIFICATION a 1 1 WELL CONSTRUCTION PERMIT, . INC, r�
PHONEY 8 84-3881
(Lfapplicable) OCIAT2D WQ MINIM
if 'feeble I. WELL USE (Check Applicable Box): Residential Municipal/Public ❑ Industrial ❑
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
Agricultural ❑
2. WELL LOCATIQN
Nearest Town: r A t (i\/ t .1
a-, County v---c0 G t f3t�
6L�oC, ,(Lo P
(Street Name. Numbers, Community, Subdivisi
on. la No., Zip Cock)
3. OWNER:
Address
(Sued or Rowe No.)
L-L€ r.)(—
tat
hY W Town Sye
-- .�, qg fie:: 1. Zip Code
Area code- Phone number
4. DATE DRILLED —t a. $- O -
5. TOTAL DEPTH: 9 O 6. DOES WELL REPLACE EXISTING WELL? YES 0 NO g/
7. STATIC WATER LEVEL Below Top of Casing: o j.
1 (Use's' if Above Top of Cubit)
8. TOP OF CASING IS
*Tap ofculoa (anointed aio ad Arf�Vace °eulna•and face*
variance to accordme with ISA NCAC IC .0111.
9. YIELD (gpm): j 01 METRO OF TEST G-fg ( 10. WATER ZONES (depth): i �j p
1I. DISINFECTION: Type NTN 0 0
12. CASING: Amount
Walt Thickness
Diameter or Wei t/Ft. Material
I
K f G
Material
Ft. LE tar
Ft.
Diameter
Ft. in.
Ft. in.
Size
Ft._
Ft.
Slot Size
in.
in.
Material
Method
Material
1 DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCIE
CONSTRUCTION STANDARDS, AND THAT OP o ; THIS
Topographic/Land setting -
°Ridge °Slope ❑Valley Mat
Latitude/longitude oofwelllocation
Latitude/longitude
Frgm To
Ito
50
So'
(4DeNmtnnesheeo�)
source:OGPSOTopographic map
(check box)
DR1LLWaLQion pQ
Frmaoo tion
it2QJ2-p6N
_c_Ag 1GS TrPM
Thr
IS CATIO`01 -ni
Show direction and distance in miles freat iMs[' two State Roads or County Roads. Inctu; thcp
numbers and common road names. 0 �w
C17 --e
0
SIGNATURE OF PERSON CONSTRUCTING THE WELL
Submit the original to the Division of Water Quality,NC
DA
27699-1636 Phone No. [phone], within 30 days, Groundwater Section, 1636 Mall Service Center -
Raleigh, 20
G W.1 REV. 07/2001
O (2-t.0C€
M ACCORDANCE WITH 1SA NCAC 2C, WELL
0 a ftAS BEEN PROVIDED TO T'1• WE 0
•.TE
3e 0
�jt—

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
" ELL CONTRACTOR (INDIVIDUAL) NAME (print) RV:CX %eisim 430, *S CERTIFICATION ay34
WELL CONTRACTOR COMPANY NAME C.,4te Saw.a�etSen -^--ra`e"t _ PHONE # ice) to65-Zset
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential V Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring ❑ Recovery ❑ Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL. LOCATION:
Nearest Town: C.p...dtee County CA...nee,.. kto
"kw � 5t Curl, , @tett (lrawa apt715
m (Sired Ns Numbers, Community, Subdivision. Lot No.. Zip Code)
3. OWNER: 1/+4-ka}rx `}j anr.atn
Address Po t3n't( ltlya
(Street or Route No.)
C.12-a\Cc AIC
City or Town State
(Gas)- Grlo -tne%
Arca code- Phone number
4. DATE DRILLED lotea toy
28"11 S
Zip Codc
Topographic/Land setting
DRidge gAlope DValley ❑Flat
(check appropriate box)
Latitude/longitude of well location
rn
n
(degrees/minutes/seconds)
Latitude/longitude source:DGPS❑'Topographic map
(check box) -
DEPTH DRILLING LOG
From To Formation Description
4. 101 saes e3r.ea
5. -TOTAL DEPTH: I S 5 o l
6. DOES WELL REPLACE EXISTING WELL? YES IDNO E
7. STATIC WATER LEVEL Below Top of Casing: 15 FT.
(Use "4" if Above Top of Casing)
R. TOP OF CASING 1S FT- Above Land Surface"
*Top of casing terminated at/or below and surface requires a
variance in accordance with 15A NCAC 2C .0118.
o_ YIELD (gpm): SO METHOD OF TEST (fit y
10_ WATER ZONES (depth):
0110%
18 cv...++e
1 1. DISINFECTION: Type Q: NS Amount la
I2. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
i From % To 101 Ft (esIt0 t _plait_
From To Ft
Prom To Ft.
13. GROUT: Depth Material Method
From 0 To tt Ft. C€v it kV--Tmerl-
From To Ft.
14. SCREEN: Depth Diameter Slot Size Material
From To Ft. in_ m.
From To Ft. in. in.
15. SAND!GRAVELPACK:
Depth Size . Material
From To Ft.
From To Ft.
LOCATION SKETCH t
Show direction and distance in milts f
two State Roads or County Roads. Inc
numbers and common road names. 1
—to
n-rn
' *We at-
---T 0.4a.•
to a v
Cu. rn�
tDCseeltiRd
u=.
c_m
at leR j
the 257E
-orn
19123
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 PERS(7N CONSTRUCTING THE WELL
to Iblo4
DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center -Raleigh, NC
27699-1636 Phone No. [phone], within 30 days.
GW-1 REV. 07/2001

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
\\JELL CONTRACTOR (INDIVIDUAL) NAME (print) 'pc -!trait laehh Baum t S CERTIFICATION # 2Y3f.
WELL CONTRACTOR COMPANY NAME P4.,__ y'c S4Yu to tSew tatuO R. PHONE # Sta) (o65—Zltt.
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable)
(if applicable)
I. WELL USE (Check Applicable Box): Residential V Municipal/Public ❑ Industrial ❑ Agricultural ❑
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use
2. WELL. LOCATION:
Nearest Town: LeIct•s.eo County
(Street Nana Numbers. Community, Subdivision, Lot No.; Zip Code)
3. OWNER: et.< Fo.. Uoeteh
Address 5o Puc tc po'..k
(Street or Route No.)
ataxa*.de! t NC
City or Town State
(828 )- Co56- 13611
Area code- Phone number
4. DATE DRILLED 4-31'OH
5. TOTAL DEPTH: 325 IO( 3a5 ha (`an e
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO. (3
7. STATIC WATER LEVEL Below Top of Casing: 80 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS \ FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordance with 15A NCAC 2C .0118.
9. YIELD (gpm): 5 METHOD OF TEST Rt e3
10
aavol
Zip Code
Topographic/Land setting
❑Ridge ItQlope ❑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
}\ I1 twee (fade..
WATER ZONES (depth):
11. DISINFECTION: Type Q. tA5
12. CASING:
Depth Diameter
From 4.\ To of Ft. (p i.
From To Ft.
From To Ft.
13. GROUT: Depth Material Method
From 0 To 1* Ft. CRmeata 4outt.a
From To Ft.
I4. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in.
From To Ft. in. in.
15. SAND/GRAVEL PACK: -
Depth Size Material
Amount tO
Wall Thickness
or Weight/Ft. Material
tt tt Flock r
From To Ft.
From To Ft.
16. REMARKS:
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common road names.
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
q• 9 t. o V
DATE
/CSo..r: 'ite~o. X�at.+,asps
SIGNATURE OF PERS CONSTRUCTING THE WELL
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-1 REV. 07/2001

WELL CONTRACTOR (INDIVIDUAL) NAME (print) t)Q-t C:+JC '1iec.14 StiwuticS
.14tK1et s k %en lJt\l e
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
CERTIFICATION # e2Y34
YELL CONTRACTOR COMPANY NAME
e. PHONE # &t) (oho.-tett
STATE w'ELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMITS'
(if applicable)
(if applicable) -
WELL USE (Check Applicable Box): Residential PC Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring ❑ Recovery ❑ Heat Pump Water Injection 0 Other ❑ If Other, List Use
2. WELL. LOCATION:
Nearest Town:, Slack M....
410 e /At L�He coat qj- artUk
(Street Name. Numbed., Community, Subdivision. Lot No., Zip Code)
3. OWNER:
Address
County
Los-osaGos se#t
2 LA_c+l 'I-1 ' t r. 2o ad
(Street or Route No.)
ed1ee, a)o Di-loy
City or Town State Zip Code
(a28)- 329. 1b9.o
Arca code- Phone number
4. DATE DRILLED Q-3o'o`t
5. TOTAL DEPTH: 0.05
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO
7. STATIC WATER LEVEL Below Top of Casing: 180 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): t 5 METHOD OF TEST f -
10. WATER ZONES (depth):
Topographic/Landsetting
❑Ridge lthlope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/in inutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From To Formation Description
he♦ 82 ®Mee testier.
$P- 'L5
to eswl't
I1. DISINFECTION: Type 17tt5 Amount 12
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
From 4-1 To 82. Ft. (at :, it21 Ptee54 r
To Ft.
To Ft.
Depth Material Method
To 2/s Ft. CS...sevtF witcL
From_
From
13. GROUT:
From 0
From To Ft
14. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in.
From To Ft. in. in.
15. SAND/GRAVELPACK: -
Depth Size Material
From To Ft.
From To Ft.
16. REMARKS:
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common road names.
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 PEPRSS 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
lr-

WELL CONSTRUCTION RECORD
North Carolina - Depanment of Environment and Natural Resources - Division of Water Quality - Groundwater Section ��''tt
CERTIFICATION # a 0 a a
WELL CONTRACTOR (INDIVIDUAL) NAME (print)
a o 6 by ul , Peri5
t WELL CONTRACTOR COMPANY NAME Fr DO AttT W e I ( trl /I/A� y CO . PHONE gxT) 6 E 3 — rit?
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential 2' Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION:
Nearest Town: �AIPUPGw County
off Whi ,A1 S
(Street Name, Numbers, Community, Subdivision. Lot No., Zip Code)
�6�y 06ape
PI
3. OWNER:
Address 97 TXQX torn V2-.
AS/ 1 eU I I l eSveet or Route No.)
Ciry or Town Stare
$2 ))-2i (n— y4 33
9%3y
Zip Code
Area code- Phone number
4. DATE DRILLED Wise
5. TOTAL DEPTH: 3 4S /
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO l3
7. STATIC WATER LEVEL Below Top of Casing: 3/5 FT.
(Use "+" if Above Top of Casing)
3. TOP OF CASING IS / FT. Above Land Surface*
*Top or casing terminated at/or below and surface requires a
variance in accordance with 15A NCAC 2C .011S. /
9. YIELD (gpm): (�_ METHOD OF TESTIS(!)Ilrtni Qtr?
10. WATER ZONES (depth): $0 "
Amount az
11. DISINFECTION: Type friitbte
12. CASING:
Depth
From_ To Ft.
From To Ft.
From To Ft.
13. GROUT: Depth
From Q To vv Ft.
From To Ft.
14. SCREEN' Depth
From To
From To
15. SAND/GRAVEL PACK:
Depth
From To Ft.
From To Ft.
Wall Thickness
Diameter or Weight/Ft. Material
4.)S 2(6.113 Pis saAA(
Topogric/Land setting
❑Ridge Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/Iongitudg of well location
Nlc°la, /a/Aioga'Z31 S7
(degrees/mr ute�ss/' conds)
Latitude/longitude source: C'GPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From To Formation Description
Ir 1
0/ - 46 Pr k
44 — 3215
Material
toncrti<
Method
FPO drm(/
Diameter Slot Size Marerial
Ft. in. in.
Fr. in. in.
16. REMARKS:
Size Material
6-ran!trc
O
rtn
LOCATION SKETCH 1 0�
Show direction and distance in miles from aGRast trit i
n
two State Roads or County Roads. Include t1i oad
Crn
numbers and common road names.
off Whi}uker Rci•
Fain/ i e)w, r1C
cn
m
-o
w
O
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
'W. Par
SIGNATXJRE OF PERSON CONSTRUCTING THE WELL D TE p
n
—I
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
GW-1 REV:'07/20Ot
27699-1636 Phone No. [phone], within 30 days.
r1

WELL CONSTRUCTION RECORD
3429 4
N::rrn C r tool - pep: micnr of Envlronmcm and ral Rcso orccs - Division of Water - -
1 '�/ // // Qualify - Grounawatcr Sccnon 2 /L \\ ELL Poar o .ITOIt ihNDIv1DU.. L) NAME (punt) 7 . L 1 %VGS CERTIFIC.;T10N 3/46
I / ' _ Cop1 tl r'
\i LLL CO�\T12.C1'JI: COMEiNY N.i\1L ill D,�_/./h'hi L• PHONE yRrWt a5,1 d �
ST.-:1'F v lcLL CONnTaUCTLON E.E'RAllT-n gSSOCLATLD WQ PJLRHIIT'u
i1raGGlitwblcl
'NELL LISE LCilca:-.pplrcabl: Sox): Re,idamial Ld' ,Ylunicipob'Public 0 lnclusrrial ❑ Agricultural O
ilimtfwrio ❑ recovery ❑ Haar Purnp \Voter Injection 0 Other 0 If Other. List Use
2. ;g EL.L LOC.z &N'.
Ncoredt TownA�rwyf //t•%K
Jan ctiff
rcc=i Nunm, :vu nDcn, Community, 3ubdinaion, Lor No., Zip Cod.)
OWNER. ma�Fainw,cov e Thy.
A03icss -- 6 S a '!caf l�jaad
CbdPY50.11vi l IC %Vc"�' afs7ei
County'�+ron�
Jr Town. Swie Zip Cuoc
8 I - 6ZV - n4 7
i1 Irioce
DATEDRILLED L-/1 -av
TOTAL DEPTH: ge s
TopographiciLand setting
age ❑Slope OVallcy ❑Flat
(check appropriate box)
Latitudt/!onginlde Of well location
,✓rr° to. rso'varteet. yin-1
(dcgrets:nlinutcs,scconos)
Latitude/longitude source: f'SOTopographic map
[thee]: DUN)
DEPTH DRILLING LOG
From To Formation Description
V- r/ G._:f
f/ • rc
fc -tioa
o. DOES FELL REPLACE EXISTING WELL? YES 0 NO V�
. STATIC WATER LEVEL Below Top of Casing: /La FT.
/ 1Ua"r'.-ir -\bov c Top or Casm_1
9. TOP OF CASING IS FT. Above Land Surface'
'Tap Of aaan rcrm unrea hour bdulr Iena su rr's ce rag wires a
ra rmu:cm aaoNdaac wifb Iid .NCAC2C .01 I.
9. YIELD \ epnli: 30 METHOD OF TEST Bb wi/rq ex°q
10. WATER _ONES lticpth): /S0' J J
t. DISINFECTION: Type' JOP 'net.
._. CASING':
D,pm - Diarnektr
rro.n d Pc f4 Ft. L./2f
Prom To Fr.
From 1'o Fr.
!3. OROUT: Dcplli
Froa1___Q_ To a 0
1710In To Ft.
ii SCREEN: Dcnnt
From To FI in.
Erma To Ft. in.
15. SAND' GRAVEL PACK:
Depn-. Size
From - To Ft.
Fron-L To Fr.
I a. 1tE>VIA RhS:
Amount /a id)
Willi Thickness
or Weight/FL iv1utrial
fizz/ ,P✓c
Crreevt TP,id Fcd(5
MBrcnal Monlotl
FL cc*e ck �1.e•/)l ?Jar nardsvil (e NC
Diamefec Sloe Size Mtn's!ial
In.
MM0re,ial
v
Q
-vrel
LOCATION SKETCH c0 c)
Show direction and distance in miles From at tors[ 0
IWO SIOLC Roads or County Roads. Include lh _watl ��
numbers and common road names. U =a
N Ulp
O n
DC nEIREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED EN ACCORDANCE WITH l5A NCAC 2C, WELL
CCINSTRLJC ION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
•
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
St.omlt rn; originni to Inc Division of Water Quality, Groundwater Section, 1636 Mail Serviec Center- l:aleagh, NO
' 7o'9-colo Phunc IVp. 019) 733-3221, lrirnin 3U nays,
GW-I REV. 07,12001

WELL CONSTRUCTION RECORD 302907
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section 11 --��
WELL CONTRACTOR (INDIVIDUAL) NAME (print) )•IpC1' Ala CI /1 CERTIFICATION #3 F
t
WELL CONTRACTOR COMPANY NAME erCi LAIDlt/ W �.61 t[ rr 11;et, Ca. PHONE W )
STATE WELL CONSTRUCTION PERMIT#
(if applicable)
ASSOCIATED WQ PERMIT#
(if applicable)
1. WELL USE (Check Applicable Box): Residential pi Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery ❑ Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION:
Nearest Town:let6avervt id6
�lidghrook Estnfes
(Street Nadi& Numbers, Community, Subdivision, Lot No., Zip Code)
County ?)4nCorvie,
3. OWNER: ?r N%a
Address as LI le Knob Rd.
AShev,�ie (Street orCRoute No.)
NN assay
City or Town State Zip Code
(828)-Zqs- 2433
Area code- Phone number
4. DATE DRILLED 5--7C)
5. TOTAL DEPTH: ?y V
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO C4
7. STATIC WATER LEVEL Below Top of Casing: WC 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): V METH, OF EST �t;4
0. WATER ZONES de th
11. DISINFECTION: Type N % f/ Amount 3s e9Z
12. CASING: Wall Thickness
Depth Dianyter or Weight/Ft. aterial
From 0 To -73 Ft. (o "Y SIN? a p Y 6
From To Ft.
From To Ft.
13. GROUT: Depth Material i .Th`'lethod
From () To a0 Ft. COnera-te— rOLctick
From To Ft.
14. SCREEN: Depth Diameter Slot Size Material
From To Ftin. in.
From To Ftin. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To - Ft.
From To Ft.
16. REMARKS:
Topographic/Land setting
'dge ❑Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well locatio
3^ rsw—oP.2/_3r• yw
(degrees/minutes/seconds)
Latitude/longitude source: CBPPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From To Formation Description
e La s,.dcJ <s&„ e
43 72 Gran: %-
74"- - gine,.'Jc-
CD
S cn
T0 cr1
LOCATION SKETCH n 72L
Show direction and distance in miles from at' `ast lip
two State Roads or County Roads. include thugad oa
numbers and common road names. Mr"
d
g --tom
Aicf9ebrook Fsfa1esZ
Weo,vC/rvllie,NC
!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 / /
it a ils s = "/— 0 7
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center -Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-1 REV. 07/2001
171

WELL coNST$' UC ioN RECORD
302906
ortn Csroiji - Dcparmlcnr of Environmcor and �N ref Resources - Division of Water Quality - Groundwater Section
VAELL CO.V'1T.aCroi. iIND1VIDUAIT NANIE Iprioq I72-iAN
GLL CON-C i_kCrOI: CUh1FANY NA,IdE
3'i.- rioo IY CLL. COir.TRUCTION F6RA11TF
IA 4 ;IeS CCRTIB1Ca9'iON
ASSOCIAT1ir WQ F211.1v1t'1
(ii ., P plicyb ldi
ONF rR 8a5YY 1e-
I. ',FELL USE IChcel. Appboable Boa): Resitlmaial j pMiunioipoliPublie ❑ lnduyniel 0 A bionitorm3 0 Recovery 0 Heat Pump Abater injection 0 Other 0 If Other. Lis[ Use Sncn lru ral 0
_. 'A: EL.L LOCATt.OLJ:
N. rear Town. dit-?kq County 42^^r.4 e
tSacc, N. :Ymnozrs Community, Subdivision, Lai No., Zip Coact
3.OWNER. C-J'GY Q jel-r kcwski
l.th�l%r
tSn c��P
nerTotru Swle
.=.ici C0ac- PhunG nunlDcc
DATE. DRILLEn -Zr-by
TOT.ALDEPTH 34,—
.3dre53
�$71S
Zip Coac
„...TopographiciLand scrling
erRldge ❑Slope ❑Valley 0FIa1
(check nppropnere box)
Latitude/longinrde of well loc- rion
rf/31-'J%'7)t�Crt �/O/a`
l degreesrm inuic cconds)
Lalirudeilongirude source DO PSOTopographic map
[check boz)
DEPTH DRILLfNG LOG
From To
0 - "s
Lv - 3c r
o. DOES WELL REPLACE EXISTING WELL? YES 0 NO L�
7. STATIC WATER LEVEL Below Top of Carina: � FT.
/ (US e"r"'if ..bovc Top otCaamg)
S. TOP OF CASING 1S FT. Above Land Sur aCe'
`Cop of `aura; cur -minute. poor bcluw Juno surly ce rey uirts a
vanancc m .ccora;i .Q Willi 15A NCAC 2C.01 IS.
9. YIELD (;pmi: METHOD OF TEST B%&Jiryq -/�•'�
lu. WATER ZONES (dcpin): i )30' J
11. D1SINFECTION: Type
CASING:
Q Drpcn
From -fc,_Q
From To
From To
13. GROUT: Dcpal
Froln„Q,_ To_a_a_
From To Fr
i-:. SCREEN: Dcpm Diemctor
From -Po Fr. in,
From To Fr.
m
Is, SAND;UIZA,VI L PACK.
Depth
Froth Pa F1.
From To, Ft.
l a. REM. -JCS:
ajp_p_Amount
Wail Thickness
Diameter or Wcight.Ft. Priatcriul
Fr. 6/Z S/JL e
Ft.
Ft,
hlercnal n-lctnod
Slot Size iM incrial
in.
in.
Size material
Formation Doseriprion
O
=-1
LOCATION SKETCH
Show direcrion and distance in miles from ar lea3P_
(Ivo Stale Roads or County Roads, Include [he a
numbers and common road names.
t3
O
Rhthan- Road
Enka, NC
31GN=.TVRE OF PERSON CONSTRUCTING THE WELL
Suamir rise ori;inal ro me Division of Water Quality, Groundwater Section, 1636 Mail Service Cenmr- Raleigh, NC
099-l03o Phone Ho. (919) 73e 3221, within 3U nays.
OW -I REV, 07/200i
! DO HEREBY CERTIFY THA-TTHIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C WELL
CONSTRUCTION ST.A-iNDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
•
DATE
073
ern
-"m
0a
tnrn
c-,
t.
n

N.;rin C_mGoa - Department or Environment seta - ,..r�a�i Resources - Division of Water Quality - Gronndwater OaSecl-
[io
w ELL CON -r It{JI'J 11 cons iN1'N'�.:1I E irerj4-5P .$r AA /lea Dp///��,.J7 CO , ?uori ea S&
r.+rc WILL COIF ..T RUCTION PERMITr. ,.. ASsOCI.:'rich WQ PPflU,-t0"u
(ii .;pplitoblel
WELL USE LL,hcck P.ppGable EDx): Residential gr-1\sunicipaLPublic ❑ Indusrriul 0 Ageicnlmral ❑
\ianP.ortng Rocoeery 0 Heat Purnp stet- injection ❑ Other 0 IIOther, List Use
2. + CELL LOCATION:
N,aresr Towi-t-.h , �t� County /J+^r,...r,*
Sh.e., ie..--
,�acc :Nuntocro, Cai inwn.ry1, 5u baty ui0n, LA NO
\\ _ oNER-I2��bl�aa�v 1P foni
yl
Asheville "°"t»tc No
City ,7713'99 75
te
,8 S
'�r, roaa Pnon: ilumoer
4. DATE DR'L LED f Li -o4
5. POTa.LDEPTH: 7Oc
o. DOES WELL REPLACE EXISTING
'. STATIC WATER LEVEL Below Top
rUse..
3. TOP OF CASING IS FT.
'top Of:nan; ' rmmu tea soot bclu W land
vorisn:c m a: c ora.noc wirti 15A NCAC 2C
9. YIELD (;pm): / METHOD
O. \YnTER ZONES (depth):
=ip LJ.c
Zip Cuic)
pogrnphic/Land selling
rage ❑Slope DValley ❑Flat
(check uppropriare box)
Laurude/longinlde of well location
/'3ro
(ucgrecs:m inucsiscconns)
Latimtleilongirude source: BGPS❑Topographic map
rtnccl: box)
DFPTH DRILLING LOG
From To Formation Description
6-yi
5trs/
Ao - Tor` G._.,:1t
WELL'? YES 0 NO ILK
of Casirm: FT.
-r" it- .SbOvc Top or Csn,ngl
Above Land Suncce'
nausea roguires o
.UIIS. OF TEST B%facj .gfa'i,
I1. DISINFECTION: Typea ./o&,jvc,
I2. C :SING.
D<prn ' Diameter
frou'. (`% "Pa t 0 Fr. ./ i
Fro,n Po Ft.
From To Fr.
13. GROUT Depot Marcrul
From,_a_ To at Fr. C ACEde
From To Pr
i-, SCREEN: Dcprh DiDmncr
From Tc Ft.
to
from 'Pc Fr in
n. SAND/GRAVEL PACK:
Dept, She
F ram - To Ft.
From To Fr.
Amount
W dl Thickness
Or Weight/Ft. L?larcrial
Can, a
ID. Ren1APSIS
.
Metnyrt
Slot Ens< Illarcrlal
in.
in.
Material
F
CD
LOCATION SKETCH t�
Show direction and distance in miles from at- Icasr
two State Roads or County Roads. Include the i,1
numbers and common road names.
0
fV
O
%der BY. Rd -
Leicester, Nc
I DO HEREBY CERTIFY THATTHIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH liA NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS 1' CORD HAS BEEN PROVIDED TO THE WELL OWNER
2
- Zr-Ott
SIGNATURE OF PERSON CONSTRUCTING THE WELL
WELL CONSTRUCTION RECORD
302904
d i1LL C0 N1'Rv2'rJu ilNDl\'lDU.L) INAML (prinq , �j IVC S CCRT1FICATION 31546
DATE
Sunmir Lne to me Division of Witter Quality, Groundwater Section, 1636 Mail Serviee Ccnror - Raleigh, NO
27099-l6io none .NC). [phone], nirnin ail days,
GW-I REV. 07/2d01

WELL CONSTRUCTION R-rco1.D
Norm Caro!nu! - Dcpsru entar Environment and �N�,��'�ruI Resources 1-'Divisionof Water Qualiry - Oroundwa[cr Section
C. O LL CON11 i.Crol: (1NCn9DU.t) NAP LC ( print) K. L //'rVC S
r16LL O ri .c'rol COb1PAN'V N..4:11E rer4ksonts /clejJ DP//�l/Yq Co .
��lJ J PHONE Baas asp ��
S 1'i TG 1rLLL 2J NISl t UCT1bN YCFn IITs ,.. ASSOCIATED wQ PCRAVTn
iif :,pplir�bdl
1. WELL USE LOhco1 AppIicsble Box): Rcsidcnlial Aiunicip411Public ❑ lnduslrial ❑ n tonttcnn9 0 Reeoetry ❑ Hear Pump Water lnjccrion 0 Other 0 ]I' Other. Lis[ Use
2. VfELL LOCATION:
Nearest Town-Q, .-. - frith
474, .7t erecr/,..5
U=ca N.Ino: :Yum ocrs Conmun,ry, Subai vuiml, Lai No., Zip CuQc)
3. OWNER: ��m�8
.=.m1I,),Pi�i�7
adress 01_M �1{ 6 P—OQL�
Wealuervi 1`1e"NYC"NJ1
as7s7
.' Ta.r: 3 (Ut
(oy5-IA73
nuns ntanDcf
4. DATE Deli LET) S'-/J-ot
T. TOTAL DEPTH: 2yr
C. DOES WELL REPLACE EXISTING WELL? YES 0 NO d
STATIC., WATER LEVEL Below Top of Casing: (oi.) FT. �
/ to "r"'if .ibovc Top Jr Cscm_)
3. TOP OF CASING IS FT. Above Land Sunccc^
`Lop aR:,m rermuu[id crier bclulr land sit ris cc rcyuires A
va naucc In an Ora4ucc warn 1ii :NCAC 2C .01 Id.
F. YIELD (;pmi: it METHOD OF TEST ' 9
10. W *TER ZONES 1dcpch): 7C'
County i..ift
LLP Copc
x.Lgn_'
A gricutru rpl ❑
Topographic/Land setting
❑Ridge C3'S{lope ❑Valley ❑F1a[
(cheek nppropriarc box)
Luri[ude/louginlde of }yell location
,r)r°c//.Yoa',ar!"jr, ;KO'
Idcgrecs:minutc+''cconds)
Laolude)longitude souse: QtPSOTopogaphic map
DL'-PTN (check bus)
DRILLING L0�9
From To Formation Description
r9 zS
1. DISINFECTION Type
CASING:
Dcprn
Fio:u1 e To J4 Fr.
rani T- FL.
From To Fr.
13. GROUT: Dcpii
Froin__..Q__ To_a_0_,
From To
I+. SCREEN. Depth
From To
From To
la. , 3AiNDIGI`=,VFLP.ACK:
Deprr,
Frorr: 13 Fr.
From T, F[
!D. REMARKS.
Dianlelrr
/Lr
Amount
W'lll TI nn.ncss
or Wahl/Fr. I,lajerlal
SDZG/ YE
141arcrlal lvlclrto11
Fr—CS/CRCO. ,n
Fr.
Diameter
Ft
Ft
Slor Size
in,
in.
iV-lorcria]
Sac Material
2c-i-I
PI- 2VI—
:02g02
r
0
--i
LOCATION SKETCH ��—
Show direcrion and distance in miles from ar Ica,;
two State Roads or Counry Roads. Include the rid
numbers and common road names. •'
O
Alpine hleadours
Weavevv; Ile, NC,
!DO hEREBy CERTIFY THAT THIS WELL WAS CONSTRUCTED EN ACCORDANCE WITH laA NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT COPY OF THIS I'_EC01'.D HASS BEEN PROVIDED TO THE WELL OWNER
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE TE 0
nuntni[ fpc original rO me Diviiion dI Water Quality, Gruunuwa ter Sesciun, 1636 Mull Servico Cefirer- Raleigh, NC
770 •9 lo:lb Fhonc No. (F13') 73a 3i31, tritnin 30 days.
GW-I REV: 07/2001
cD7J
Gfn
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{nl-
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73
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mT
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0
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c)

302897
WELL CONSTRUCTION RECORD
Norm coroiraa - Dcp_rm enror Environmcnr eau �- Tel Resources - Division( 01 Water Qualiry - Groundwater Section Q
\\ ELL cON vit- cr a ONDI\7DU.;1) NAME (prior) 2/rAN/' /'H. &f 'vc S CERTIF1C4T10N n.J/46
ti1LL CoV JIJa CUn1PiP1Y n.+✓vjE Q6-5U/✓S We/� D,Q/�I �l N4 1'HONP. �a�as�y7 Lam,
�1'.+l'L- \vsu CJr raU CTtON YL-£luTa ASSOCIATED WQ P-2111.1r11TN
(if inplicoble)
I. 44 ELL LIST- LCllctl: Appl
\to nimnng ❑ I:ccov cry
\YELL LOCATION:
Nearest Thorn' `✓G✓tre ✓' fie Counq�^^ ce it
4/,G':c /'!c<do✓s
iSoca Name. iYumocn Commumq', Subai vision. Lai N., 2ip Cdc
3. O1WNER.
stile Box): Residential „ie1 1i'iunicipaUPublic 0 lnduerrial ❑ Agricultural ❑
0 Hear Pump AVatcr'lnjrcrion ❑ Onc6r❑ If Other, List Use
'•eoger V/ Ile ioiroor ar CC No.)
-n ar To, a Su¢
51S-(oti5-gg73
v re :Oise-Itllupe numocr
+. DATE DKILLED o<'
S. TOTAL DEPTH: Z7.f
as7s7
Zip Cudc
opographic/Land seeing
.idge ❑Slope ❑Valley ❑Flay
(check appropriate box)
Latirude/longintde of well location
t a r° cll. 1-73 "(.'odd' 3 r 3.1/
(degrees;minura�i conas)
Lulitude)longiw c source: ZGPSOTopographic map
DEPTH (chccla aox)
DRILLING LOG
Formation Description
b
From To
rJ_
/7— 2L Sca/giant
22— / 7sr
D. DOES WELL REPLACE EXISTING WELL? YES ❑ NO 1L�
?. STTIC WATER LEVEL Below Top of Casing: /oo FT
(ime "r"lf .Above Top of Casing)
O. TOP OF CASING IS / FT. Above Land Surface'
"74p or eaaiii rtrmina rep avor below 1'enp $u rra ct requires u
rarisncc m aaeoroom, IvicL I5a NC..0 2.C.011s.
9. YIELD (;pm : t 0 METHOD OF TEST B$W4yy •K°r
1u. WATER ZONES Laeprh): /S o, • Z/r-' ✓ •,
II. DISINFECTION: TypcC'/OSaive- Amount (. 44r
12. C. ii-.
Wall Thiclrncss
Daprn ianu rcr or WeiehwEr. '-laranal
From D T'_a_ F. Ffi1Cii 0✓C_
From ro Ft.
From To Ft.
13_ GROUT: Depth
Marenal n-Icrbon
0 ro ao Fr. COAreSeie /ow.-/cy
*OM '1-o Fr.
i-i SCREEN. Dcprh Diameter Slot Si2c Millcriul
From 'fa FTin. in.
FNn-' To Fi in. in.
[5. SAND/GRAVEL PACK:
Dcp1h Sizc Materiel
From To Fr.
From To Fr.
c REMARKS
LOCATION SKETCH W
Show direction and distance in miles from or Igtk$t
nvo Stale Roads or County Roads. Include thel d
numbers and common road names. O
..O
A-Jpine Meadows
tteavervi II e,IVC
I DO HEREBY CERTIFY THATTH13 WELL WAS CONSTRUCTED M ACCORDANCE WITH I5A NCAC 2C, WELL
CCNST rUCTION STANDARDS, AND A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER�/�n✓✓JJ
• ,/
SIGNATURE OF PERSON CONSTRUCTING THE WELL
DATE
3uonur the orion,l ro rno Division of Water Qualiry, Croundvrarer Section, 1636 Mail Service Center- Raleigh.; NC
?699-103o ?boric Au. [phone], wirnin 3u days,
(OW -I REV. 07!^_001
71v
nn
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wcs
rnol
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302894
3. OWNER:
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and NaturaltResources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) I o.v k Ailey, CERTIFICATION # 30 d 6
WELL CONTRACTOR COMPANY NAME /'ere�t'sotl Viet' 'De jli PHONE 1 011E 68L 9 /9
STATE WELL CONSTRUCTION PERMIT# ` ASSOCIATED WQ PERMIT*/
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential ❑ Municipal/Public 0 Industrial 0 Agricultural E—
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION: I
Nearest Town: Lt:ctir-le4"
County 251wAco PIA et
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
k rw,CC,
—i'//'.i�
Address 3 LIJY)q Q (C
: (S ee �o`%oute No.)
�dCv Q 8715
City or Town State Zip Code
(Z28)-2e7 3— Q4 6 2
Area code- Phone number , /
4. DATE DRILLED S- aSt O SF
5. TOTAL DEPTH: ("AC
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO Q-
7. STATIC WATER LEVEL Below Top of Casing: S/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 accordan.ce/ with 15A NCAC 2C .0118.
9. YIELD (gpm): 4 METHOD OF TEST
10. WATER ZONES (depth): .l`d r
11. DISINFECTION: TyperAmount �Z-
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. .,.p�dtaterial
From 0 To /00 Ft. 6 it arropai C✓�.
From To Ft.
From To Ft.
13. GROUT: Depth Material Method
_ From0 To aU Ft 47Ctat r44r-B:1
From To Ft.
14. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in.
From To Ft. • in. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
16. REMARKS:
Topographic/Land setting
Agyridie ❑Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/Ion itude of well location
3 /yof44F2 - rJga2/4/o7091^-/
(d reesimi onds)
Latitude/longitude source:
DEPTH
From To
notes c
GPS❑Topographic map
(check box)
DRILLING LOG
Fo ation Description
23*
LOCATION SKETCH
Show direction and distance in miles from at leaQ
two State Roads or County Roads. Include the roa4
numbers and common road names. vD
Alexander Flood
Lei tester, NC
1 DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH I5A NCAC 2C, WELL
CONSTRUCTION STAND�2DS, 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
L � C7
T
00
in 0
rn
n

WELL CONSTRUCTION RECORD
302895.
N.hin lei - • Geparmcnr or Environment endN.. rut Rcsou,cc$- Division of Waver Quality- Oroundwarer Section 1'J���� r 2
t cLl_�u Vll l'Ju 11iV ll1nl Uli iLi NanIQ ipt ,n,i // -T7� ilI/C 5 /' CERTIFICATION 3/qo
�1 _mr �rrt vv rv.1�IL e4-5ONS UIe I� U?�/�i Nq L6 ,riOriR d&057StYl�
sl :rc lr L1LL .unsi'RUCrlon rel:nu ra �JJ ... ASSOC-I.-CUD WO P11U iT,r
LI( uplicuGhi
iScLL LIS'c c'll.-.Ic -.pp LcablG Box)' kc>idcntial Grh.9u..icipoUPubtic ❑ Indusniul 0 Agriculture° Q
Alonuorl110 ❑ tci1J+c01 ❑ Hcsr Pump Water injection 0 Other 0 If Other, List Use
2. ELL LCC=. 1'iON:
Nc]rest Town �.!• eCS Ire /� Couni�i d'�ca,..It
AV Z7 1✓.-7Aid +-•'Sy
Nunloc ro. Coon nl unity, 3ubains iml, 431 NO., Zip Co0c)
OWNER.
A30rc__
der JZbad
3:rcc1 ar Rouic No j
Alexander Nc Q.8701
Sam
,82;-1023-051l
?none. pu0Dcr
rDATFITRIrrt,D f-2C-cy
_ EDT AL DEPTH. `/L \
Coac
Topographic/Lend sewing
❑Ridge dope OValley ❑Flat
(check nppropriare box)
Larirude/longim�e of well location
Nis" 3r s 20 >>j'
I dcgreca/ minmesisceands)
Ls irudeilongitude source: 14t3PSOTopographic map
(cheek box)
DEPTH DRILLING LOCI
From To FormacionDescription
c9 Y7 -�
Y 7- SZ rf<nr�yh,<
4Z e/2r 6• , k
z. ODES WELL REPLACE EXISTING WELL? YES 0 NO
STATIC W.s,TER LEVEL Below Top of Casing: 4/4 FT.
knit "r'-ir.;bo,; Top oe Camng)
S. TOP OF CASING IS FT. Above Land Surface'
11rrmmma avur Dcluw Iano surf cc rcQuirts
r:nmrccw a:c urr:uec wietl la.i :VC C:C.al le.
YIELD taumj- Z tvIETHOD OF TEST BbW,$q 'R.3
to. 1\'.+.TER _ONES tucprhl: fieJ
.I. DISINFLCTIOIv.7
CASINC
Float Q
From
rroal
13. Ji:OUT.
rrl❑ 0
NIL
1�. SC1:EEN.
Fran
From
15. S+.ND;GR=,VEL PACK-
!�cptll
L'cpin
0 5L
To�_Cz_ Fr Wiy('Qre1,_
Ft.
Dcprn Diamder Slot Size iMarenul
Io Fc. in in.
F1. in.
pceDZ,NG riA nlount iv,
Wall Th i almcss
or Weight/Fr. 1\tarc11g1
Lion etcr
Fr ,rLr
Fr.
Ft
hl alcrl4l hIc11100
Ft.
From To Fr
I0. f<EINiAh_S.
S12c NLItel'151
c
Q
LOCATION SKETCH
Show direction and distance in miles from al Ica
IWO State Roads or County Roads. Include toe root
numbers and common road names. o
C�i l li5 Road
Lees hey rie
DO ri EREEY CERTIFY TH:A.T THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH LOA NCAC?C, WELL
CONSTRUCTION ST.AND.1RDS, .AND THAT A COPY OF THIS I'._ECORD HAS BEEN PROVIDED TO THE WELL OWNER
S '
SIONATUR OF PERSON CON'STRUCTMDATTEE O THE WELL O
Su0mrr me orI InOI m trio Division of Water Quality, Grounder arer Stcrion, 1636 Mull Service CenterRaleigh, NC
2?o ,-Ioao Puonr tvo. ti'l3) 733-334 lrlrnin 3u days.
GW-I REV 07/200I

01\'1NER
-1dres
Co ur1iy ooylt
tSecet Nmc. :Nualocr>, Community, Sub d iruion, Lor No., Zip Codc)
e.
o7YA
IS n'ccr CC Rxrc Na)
0 m T „ scat 'Ip Codc
'_ci iJJc- Ph3nc Ilwil Ocr
+. DATE DRILLED (/— r=oLf
5. TOTAL RE pTx lo—O. DOES WELL REPLACE EXISTING YES 0 NO ❑
7. STATIC WATER LEVEL Below Top of Casing: oo FT.
'use "." ir.ibovc Top of Casing)
3. TOP OF CASING IS FT.
Above Land S arract°
rtAprtn nhIraRpnc with
actor bNCAland
.011 . icyuirt5u
vanvrcc m acem'o�nc� cairn I5i. NCAC?C.OII1.
9. YIELD (gpm): / METHOD OF TEST
O. WATER. ZONES (depth):
Bk 9
1. DISINFECTION: Type(
;., / t Amount As_
CASINO:
Wall ThicicncSS
Diemtter or WeightrEL P.da[crial
Tpat
Depth
To /10
To
To
WELL CONSTRUCTION RECO1u)
Noun Carotin_ - Dcp,rmncru-of Enviromncnr and ral Resources - Division Of\Varcr Quality - nn Gro d
\1 LLL CONTILaCTOr1 (INDIVIDUAL) N&MiFuu)
L i
i
\,LILL Co:N-ra1C'Iv1: COO.ICANY (NAME'
5LKP1 w1LL COrNSTaUCTION PEIina :1
302890
wa2r Section
.,r
CCRTIFICAT10N jigs?
1. 4�ELL LISE (Cheat Appli oble Box): Re3idcmial Id hdunicipauPublic 0 l ddmrironng ❑ Recovery 0 Hear Purn \Vain In ecrion 0her, Lial 0 Agricultural 0
P 1Other 0 lT Other, Lisr Use
22. P\ELL LOCATION:
Nearesi Town' 1.e%ccp
fun V/ Ai
Ft G,rtr
Fr.
Fr.
3. GROUT: Depth 'via/chat
Froin�_ To IYlnnon
�L Fr. C"fJ/Y Di%a
From 'Po Ft.
li SCREEN.
Depot Diameter Slo[ Sizc
From To, iylarcrul
FL
in. in.
From TO Ft -
Ls. S.ND/OR&Y'EL PACK: m in.
Dean) Size Material
NOM To Fr.
From To Ft.
I o. REM.-RIS:
I Du hEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED !N ACCORDANCE WITH ISA NC.AC 2C, WELL _
CONSTRUCTION STANDARDS, `ND/THAT A COPY OF THISRECORD HAS BEEN PROVIDED TO THE WELL OWNER:'
SIGNATURE OF PERSON CONSTRUCTING THE WELL Gd
Suomi[ the original to the Division of Water Quality, re) Section, 1636 Mail Service Cnucr - Raleigh, NO
'-?udy-lo.id Phone iN J. (Y 19) 777.7?2l, Iv1rNn 30 days.
TopogriiphiciLand seeing
Midge 2Slopc ❑Valley ❑Flay
(check appropriate box)
Latitude/longinrde of well location
.7s- J Sco votz."44,
(dcgrec>:nnnuw> ends)
Laurude)longirude source: L�GPSOTo og p raphic map
DEPTH (cheek bog)
DRILLING i_
From To Formation Description
Cfn
LOCATION SKETCH
Show direction and distance in miles from or least pp
two Stare Roads or County Roads. Include the roads
numbers and common rood names. CJ
711,4r, pins N✓/Rd-
/ e, es7et , e
DATE
GW-I REV .07/2001

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natuu}ral Resources - Division of Watery Quality - Groundwater Section
NV ELL CONTIUCTOR(INDIVIDUAL)NAMME (print) �3Q 10 by T Po-ti5 CERTIFICATION p aoas
WELL CONTRACTOR COMPANYNAhIE Fr arIsoa/T GVe/( A^1/1/450 CO PHONE {el) 6t3 - ”"Sf9
STATE WELL CONSTRUCTION PERMITh ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
3 028 77
1. WELL USE (Check Applicable Box): Residential Municipal/Public ❑ Industrial ❑ Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION:
Nearest Town: # F/dr/tcn County 13 e bL
to t- 0A-K
(Scree( Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: $eve Wiggins C 0.f v jab)
Address 17 Walno+-'Lane
(Sneer or Route No.)
FJtTong /7C 0s732-
Ciry or Town State Zip Code
(gam- laCAi -GQ(5a
Area code- Phone number
4. DATE DRILLED 715 a v
5. TOTAL DEPTH: N r
6. DOES WELL REPLACE EXISTING WELL')
YES 0 NO 4d
�Topographic%Land setting
19Ridge ❑Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude o well location
d�3s0A6,7/7' w82f37t //9T'
(degrees/nil
Latimde/Iongirude source:
DEPTH
From To
0 - 75
7$ - 8O
7. STATIC WATER LEVEL Below Top of Casing: ‘O FT.
(Use "+" if Above Top of Casing)
S. TOP OF CASING 1S / FT. Above Land Surface'
*Top of casing Terminated actor below land surface requires a
variance in accordance with 1.5A NCAC 2C ill In.
9. YIELD (gpm): (oO METHOD OF TESTr�_
10. WATER ZONES (depth): 4'/D
LOCATION SKETCH
Show direction and distance in miles from at lea4S
two State Roads or County Roads. Include the roams
numbers and common road names.
11. DISINFECTION: Type XaSJt jj
12. CASING:
Depth
From a To to Ft
From To FT
From To Ft
Diameter
6e1S
Amount // 07S
Wall Thickness
or Weight/Ft. Material
AIL 113 PVC St/L2./
13. GROUT: Depth Material Method
From t9 To X0 F[ Cnncrr'fr PoorT&
From To Ft.
14. SCREEN: Depth Diameter Slot Size Material
From To Fe. in. in.
From To Ft in. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
tes/seconds)
PS❑Topographic map
(check box)
DRILLING LOG
Formation Description
0//r
ice
6-eve nit
�enk 0'K
FLETCNE_2, nc
16. REMARKS:
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
SIGNATCIRE OF PERSON CONSTRUCTING THE WELL
Submit the original to the Division of Warer Quality, Groundwater Section, 1636 Mail Service Center- Raleigh,-Nc
GW '1.REV.07/20b1
27699-1636 Phone No. [phone], within 30 days.

WELL CONSTRUCTION RECORD
302878
North Carolina - Depanment of Environment and Natural Resources/ - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) N AME (print) ao L3OV . PdIi5 CERTIFICATION # a o a5
WELL CONTRACTOR COMPANY NAME 050A%J- IWel( h^!Rld� Cr). PHONE aril 6$3-9yY9
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
WELL USE (Check Applicable Box): Residential 2/Municipal/Public 0 Industrial 0 Agricultural ❑
Monitoring ❑. Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use
2. WELL LOCATION:
Nearest Town' fat PU ?Cu) County ,e;0111cOMhe.
Mx- frc 506, di. 1Mcerlfl5 lave
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: 1)91UIfttc,h
Address aa5 I'l. 13eartsnll tsj fld•
(Street or Route No.)
Fleisher nc Q87 32
City or Town State Zip Code
)- H/A
Area code- Phone number
4. DATE DRILLED V�/by
5. TOTAL DEPTH: 005
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO
7. STATIC WATER LEVEL Below Top of Casing: TO FT.
(Use "+" if Above Top of Casing)
S. TOP OF CASING 1S / FT. Above Land Surface'
*Top of casing terminated alor below land surface requires a
variance in accordance with 15d NCAC 2C .0118.
9. YIELD (gpm): a METHOD OF TESTJ3fpre,t#///9
10. WATER ZONES (depth): 2-YO
Topogr4hic/Land setting
❑Ridge Slope ❑Valley ❑FIat
(check appropriate box)
Latitudelon ude fwell loation
'/it 3S°3/,3Ivtick5, 76
(degreeslm utestseconds) Latitudeilongitude source: ❑GPS❑Topographic map
(check box)
DRILLING LOG
Formation Description
D/A 1'
DEPTH
From To
N — y8 ICOck
().non/if
11. DISINFECTION: Type lab irm
12. CASING:
Depth Diameter
From o To 41 Ft. 6 a S
From To Ft.
From To Ft.
13. GROUT: Depth Material Method
From D To AQ Ft. Concrc#t Poo rl''y
From To Ft.
14. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in.
From To Ft. in. in.
15. SAND/GRAVELPACK.
Depth Size Material
From To Ft.
Amount /4. 0?) Show direction and distance in miles from at leas-E•
Wall Thickness two State Roads or County Roads. Include the rotigt
or Weight/Ft. Material numbers and common road navies. ,
7JL.I13 Pvc 54R2/
From To Ft.
mevri l(5
Fair v'i eu%,
l6. REMARKS:
I D0 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
SIGNATYIRE 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
® G.n
n
0-0`....;0-
O
cy's'
S.--li�
LOCATION SKETCH .- p0
cr c.
trl
cs

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Naturalu�Resources/Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) 13 o 10 u . Pcfri5 CERTIFICATION p 2D a CJV
WELL CONTRACTOR COMPANY NANIE Fe DOS OA/ r Wei( hiliVI/gy CO . PHONE A7). 6II 3 - ?flirt
STATE WELL CONSTRUCTION PERMITS ASSOCIATED WQ PERMITS
(if applicable) (if applicable)
302879
1. WELL USE (Check Applicable Box): Residential 117 Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring ❑. Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION: Topogr rc/Land setting
Nearest Town: ,/r Yr htd^ Counry 0/IA/te ✓"Il4e ❑Ridge II Slope ❑Valley ❑Flat
4 ttcjy Atm Lot- /S 3 (check appropriate box)
(Street Name, Nunibers, Community, Subdivision. Lot No., Zip Code) Latitude/longitude of well location
/� N 3S° ab d�yp/AtoSA` 37 Sip'
3. OWNER: Se ., i anc (degrees/mmu[es Dods)
Address '/ 4uep dale � it/e Latitude/longitude source: GPS❑Topographic map
(Sneer or Route No.) (check box)
4rde,i pc .2876 / DEPTH DRILLING LOG
City or Town State Zip Code From To Formation Description
(0)- _ 273-YSs7 p —).D DMT
Area code- Phone number 21) — 2,5 lock
4. DATE DRILLED VW/26/ 2.5 -'3'KS 610nll7lt
5. TOTAL DEPTH: 3
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO
7. STATIC WATER LEVEL Below Top of Casing: ro FT.
(Use '4" if Above Top of Casing)
3. TOP OF CASING IS / FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordance with I5A NCAC 2C .0118.
9. YIELD (gpm): C/ METHOD OF TESTIfow17/.9
10. WATER ZONES (depth): /IQ
LOCATION SKETCH
Show direction and distance in miles from at lea
two State Roads or County Roads. Include the road
numbers and common road names. i
.D
O
1
11. DISINFECTION: Type 'I'abfr j5 Amount 99197 f
12. CASING: Wall Thickness
Depth Diameter or Weida/Ft. Material
From D To 49..; Ft. 4.3S da/L.1a3 PVC SOP -A/
From To Ft.
From To Et.
13. GROUT: Depth
From 0 To a Q
From To Ft
14. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in.
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
Material Method
Ft. Ctttu.cir Poor/
From To Ft.
l6. REMARKS:
gun r lenn
/at ijAC3
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
SIGNAT{7RE 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
302880
North Carolina - Department of Environment and Natural Resources - Divisjon of Water Qualiry - Groundwater Section 1,
VI ELL CONTRACTOR (IND1YlDUAL) NAME ((prim) f tk /� . k/�i, nci CERTIFICATION # 'l//v
WELL CONTRACTOR COMPANY NAME /Cr1r. Sun J WEN //r% /l• nj PHONE ✓ fs-' Frnt
STATE \YELL CONSTRUCTION PERMITS ASSOCIATED WQ PERMIT#
(if applicable)
Ali soplsable)
I. WELL USE (Checlr Applicable Box): Residential 3 MunicipaVPublic 0 Industrial 0 Agricultural 0
Imoniloring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION:
Nz�1/rest/Totln. kc ct ✓/ /4 �fCounry pk ncnni,
Ll/t r-/co�C. �i(, Itecn,i Cree k
(Succt Marne, Numbers, Cmnmuniry, Subdivision, Loi No., Zip Code)
3. OWNER: AtIdl-ew Tor„ linSryn
Address PO \:Sox j19-1 31
(Such or Room No.)
Asheville NC a�81'f
Clry or Town State Zip Code
Z`d)-a5—yeel
Area code- Phone numbel
4. DATE DRILLED / - 23-Q�
5. TOTAL DEPTH: 32s-
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO
7. STATIC WATER LEVEL Below Top of Casing: %O FT
(Use "*" if.Above Top of Casing)
S. TOP OF CASING IS 1 FT. Above Land Surface*
"Top or casing terminared aVor below land surface requires u
variance in saco rdunce with I5A NCAC SC .0118.
9. YIELD (gpm): j r METHO, OF TEST /%_' — '4
10. WATER ZONES (depth): 1'/r, /7-„n?
11. DISINFECTION: TypeCl27r/"e Amount/2 /c f
12. CASING: Wail Thickness
Deprh Diamerer or Weight/FL. Material
From 0 To 7/ Fr. G •/Lr 5-PL2l /16/C
From To Fr.
From To Ft.
13. GROLIT: Depth Material
From O To 2a Ft. Cone
From To Fr.
I-. SCREEN. Depth Diameter Slot Size Ivlurcrial
From To Fr. in. in.
From To Fr. in. in.
15. S.AND/GRAVELP.ACK:
Depth Size Material
From To Fr
From To Ft.
_�Topographic/Land sexing
13Ridge ❑Slope ❑Valley ❑Flat
(check appropriate box)
Latirude/Ion rirude of well location
Nil° </a. Y5/ :von' 3r/ DoS,
(degreesrminute�sl• ands)
Latirudeilongirude source: 3iGPS❑Topographic map
(check box)
DRILLING LOG
Form rionDescription
L{r,fr
DEPTH
Flom To
`
4
61. - 7/ St,,,/ S lent
7/ - ?er C9,w.: lc
1
LOCATION SKETCH
Show direction and distance in miles from at leg.
two State Roads or Counry Roads. Include the mad
numbers and common road names. ••
13loff Cove goad
Method
Weavervi Ile, NC
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
/ -2)-oV
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
27699-163o 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) / • Ir. e k A nen CERTIFICATION # 30) a,6
WELL CONTRACTOR COMPANY NAME
�zr• c n It,./ (ID r;//;.,c (r' PHONE P )6S':--%'92,9
STATE WELL CONSTRUCTION PERMIT ASSOCIATED WQ PERMIT#
(if applicable) / (if applicable)
1. WELL USE (Check Applicable Box): Residential I MunicipalPublic 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other ❑ If Other, List Use
2. WELL LOCATION: //
Nearest Town: Lei Co S'Ye( County i3Lntonl AC
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: (��rr(, /err
Address 40 Hoatevs C76e/7 Rd.
LeIGeJie2Sveer17C NoJ 0871
City or Town State Zip Code
aik- /V/A
Area code- Phone number (/
4. DATE DRILLED 3 •—cZCY �Dr
5. TOTAL DEPTH: /
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO 0
7. STATIC WATER LEVEL Below Top of Casing: 50 FT.
/ (Use "+" if Above Top of Casing)
/
8. TOP OF CASING IS FT. Above Land Surface*
*'fop of casing terminated ador below land surface requires a
variance in accordance with ISA NCAC 2C .0118.
9. YIELD (gpm): a20 METHOD OF TEST
10. WATER ZONES (depth): /3 0 t • y
pographic/Land setting
edge ❑Slope ❑Valley ❑Flat
(check appropriate box)
Latitud /lon itude of well location
c��7553n1-Osa/ i/W�
(de rees/minutesiseconds)
Latitude/longitude source: ❑GPS❑Topographic map
(check box)
DRILLING LOG
Fogripttiion Description
Gi
t ••`nril
� L
I 0
▪ rr
▪ a a
LOCATION SKETCH 0 g
C-I
11. DISINFECTION: Type H I H Amount p : I) s 1m. Show direction and distance in miles from at least �,Q
12. CASING: Wall Thickness two State Roads or County Roads. Include the road 1/49 0
Depth Diameter or WeightlFt. Iaaterial numbers and common road names.
From 0 To 9r Ft. 6 2S> �5' 1�„( ti Ve.
From To Ft.
From To Ft.
13. GROUT: Depth �Mtaterial Method
From .0 To ;O Ft. `'tncr.-la Thur-ed y�
From To Ft. LEICESTEQ, a lC
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:
'7 'AG Ggen VAcL�
1 DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH ISA NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND tATTAA COPY OF THIS
RECORD HAS BEEN PROVIDED TO THE WELL OWNER
3-029- oy
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) Mar k Aiit n CERTIFICATION # 3a 8-6
WELL CONTRACTOR COMPANY NAME 'icrr// t L.Son 1A/611 'Dc '/Hn , CO• PHONE $ P) bY3 -Ivry
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential !7 Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION:
Nearest Town: k art County a to rt ih tikt)p
Parar /O U7/l 7.cf A.C%
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: LeAdat n2e-S
Address // 9 / ICS �irw..l� /
/,VYrs �(7/et ortyCeNo.) ak7.sy
Ciry or Town SW Zip Code
-, J- 6k9' — YYa D
Area code- Phone number /
4. DATE DRILLED \�3U —dY
5. TOTAL DEPTH: C O C !
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO
7. STATIC WATER LEVEL Below Top of Casing: /5... FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS / FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordance with ISA NCAC 2C .0118.
9. YIELD(gpm): /C METHOD OF TEST IS.i'
10. WATER ZONES (depth): WC) ` 44' k'
11. DISINFECTION: Type // 7/-% Amount b lk of
12. CASING: Wall Thickness
0Depth , / Di and aterial
e or Weight/Ft. �'lateal
From To Ft. `t— SPR a/
From To Ft.
From To Ft.
13. GROUT: Depth Material // m,�pethod
From C To c70 Ft. Csncrc it /Ou/
From To Ft.
14. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in.
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
16. REMARKS:
Topographic/Land setting
ridge ❑Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well loca 'on
Aril r/t9Al'U SG
(degrees/minutes/seconds)
Latitude/longitude source: ❑GPS❑Topographic map
(check box)
DRILLING LOG
Formation Description
DEPTH
From To
v
9-14.1
SP
071
PM
T
crl
'nrt
O
t WC)
U' OiOTt
m
LOCATION SKETCH CI
t�
Show direction and distance in miles from at leafs0ea
two State Roads or County Roads. Include the row (Pp
numbers and common road names. 4P n
paved,' Conner IS 4.
rylars -11t7// ✓VC:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH I5A NCAC 2C, WELL
CONSTRUCTION STAN1 ARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER_,
V oa-07
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-1 REV. 07/2001

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section WELL CONTRACTOR (INDIVIDUAL) NAME (print) /lr v- k 4 ^$ 11<n CERTIFICATION a ju% (F4
11.1e1117r PHONE 04 )( ff:'j99ry
STATE WELL CONSTRUCTION PERMITa ASSOCIATED WQ PERMIT/4
(if applicable)
WELL CONTRACTOR COMPANY NAME fYf., Vest)
(if applicable)
302869
1. WELL USE (Check Applicable Box): Residential El• Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring ❑ Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION:
Near Town: Le' a .a r Co my,(-i Q,
t_rh
ed CAE ►?a/a: Co
s
I
(Street Name, Numbers, Community, Subdivision, Lot/ No., Zip Code)
3. OWNER: Dot.9/' Gaitafruc7r¢4,r.
Address lisrN/J I; J1LC.
(Street or Route No.)
SS �4e nc'1753
City or Town State Zip Code
(t%11)- 7r- 34. Si
Area code- Phone number ( /
4. DATE DRILLED sZ/� a7'
5. TOTAL DEPTH: ez? y r r
6. DOES WELL REPLACE EXISTING WELL YES 0 NO •
-
7. STATIC WATER LEVEL Below Top of Casing: i es 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 IS.A NCAC 2C .0118. 9. YIELD (gpm):, 1(U METHOD OF TEST c
10. WATER ZONES (depth): /G C ro?3 b'
I
12
Depth ,L
From 0 To d T Ft.
From To Ft.
From To Ft.
tIdgopographic/Land setting
e 0Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
.36/7974eN- oirt/ 3/.?G-W
(degrees/minutes/seconds)
Latitude/longitude source: BGPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From To Fopption Description
O 50 p L
r/ 77 d�amr» �J'C3zc
b'S% (ye4594
rr G'+Prf is
73
14:" G r
L
rn
rn
-cc"
c1 frirn
477
?€d od P/44/71a7'4
(e.Ceaf'J ,vC
_' LOCATION SKETCH
DISINFECTION: Type 1{ 7 /) Amount : 1) s�(( 4Iow direction and distance in miles from at leas y
CASING: Wall Thickness two State Roads or County Roads. Include the roagt
or Weight/Ft. .Material numbers and common road names. •
� fSl
l
Diameter
.J de d
d 'Y
13. GROUT: Depth
From .0 To ?U
From
/he
Material
Ft. e:,CE-art
To Ft.
14. SCREEN• Depth
From To
From To
15. SAND/GRAVEL PACK
Depth
From To
Method
Tar.d
Diameter Slot Size Material
Ft. in. in.
Ft. in. in.
Ft.
From To Ft.
Size Material
16. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH I5A NCAC 2C, WELL
CONSTRUCTION ST�DS, .A 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. [phone], within 30 days. GW-1 REV. 07/2001

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
A //i
WELL CONTRACTOR COMPANY NAME Fafu (nn 1>J2l) 17 nlitna, C:
3yLa
PHONE (tl ) 49 -/p y
CERTIFICATION #
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable)
(if applicable)
2
WELL USE (Check Applicable Box): Residential 0 Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
WELL LOCATION: f
Nearest Town:/,efce5/w.r County 7Ru.n.Conn4t
3. OWNER:
(Street Name, Numbers, Community, /Subdiivision, Lot No., Zip Code)
/"<
n t-t 441, a,
Address . $e K / %
(Street or Route No.)
/ficeaM/de.i /3 e a 876 /
Ciry or Town State Zip Code
(q)9)- 623•Yov7
302866
WELL CONTRACTOR (INDIVIDUAL) NAME (print) Ins k
YES CY5O ❑
7. STATIC WATER LEVEL Below Top of Casing: /5 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS / FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordance with 15A NCAC 2C .0118. 9. YIELD (gpm): /) METHOD OF TES ,
•
10. WATER ZONES (depth):
Area code- Phone number
4. DATE DRILLED 3 - //- o e
5. TOTAL DEPTH: 44 YID
6. DOES WELL REPLACE EXISTING WELL?
11. DISINFECTION: Type H 1 /1
Typographic/Land setting
tdge ❑Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
s 7 /0 - 0 f.,21j •i/
(degreesiminutes/seconds) L
Latitude/longitude source:'86PS❑Topographic map
(check box)
DEPTH DRILLING LOG
From To Formation Description
0 30
3/ £46 and sire
64 11
LOCATION SKETCH
Amount —p : 1) s y j-, Show direction and distance in miles from at leaQ
12. CASING: Wall Thickness two State Roads or County Roads. Include the road
Depth Diameter or Weight/Ft. MV arerial numbers and common road names.
From e To 41XFt. 6 =$2 S012 „2/ ✓YC 1
From To Ft. f/.e fchea /4/R-ifoN zd •-
From To Ft. glerc'N iCR. /y C
13. GROUT: Depth Material Method
From .0 To 20 Ft. tncerits Thu real
From To Ft.
14. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in.
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
16. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, A ,D THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
SIGNATURE OF PERSON CONSTRUCTMG 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

302862
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) /liaar IC. Al lest CERTIFICATION #c.5^8‘
WELL CONTRACTOR COMPANY NAME Fvyi.Fnr Witt bill /;11r PHONE *PM LQd-fie.
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(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: Bar net ekVole County 73 (Antes rib?.
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: t,9rJttg / //-"rrrohd
Address 3'5 1-11))CYQ6t -P,OQCd Lai- 11
(Street or Route No.)
Ashtu ille ric_ 2it64
City or Town State Zip Code
(l)- 3a1-2s05
Area code- Phone number
4. DATE DRILLED 7- O,
5. TOTAL DEPTH: S06-
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO al-
7. STATIC WATER LEVEL Below Top of Casing: VS FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS / FT. Above Land Surface*
*Top of casing terminated actor below land surface requires a
variance in accordance with ISA NCAC 2C .0118.
9. YIELD (gpm): METHOD OF TEST R7
10. WATER ZONES (depth): 4/co
11. DISINFECTION: Type f-/ rid Amounty 7/
12. CASING: Wall Thi ess
Depth DiaTeter or Weight/Ft. Material
From 0 To at Ft. L - Sb4e 2/ P VL
From To Ft.
From To Ft.
13. GROUT: Depth Material
From 0 To j 1 Ft. Concrt c
From To Ft.
14. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in.
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Size Material
Methoyl
bore
From To
From To
16. REMARKS:
Ft.
Ft.
Topographic/Land setting
fiKidge ❑Slope ❑Valley OFlat
(check appropriate box)
Latitude/1 ngitude of w 11 to tion
33/97%3N oar f �44.)
(degrees/minutesisecon )
Latitude/longitude source: ❑GPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From To Formation Description
p /D rf»nc £Fe„-r.
// .74 rHrtrLc-
a2 t - �ian, ;te
O -
co 73,4
�t -aa
D°
cO 'mrn
-A
Z0
el 0
cn
LOCATION SKETCH
Show direction and distance in miles from at lease
two State Roads or County Roads. Include the road
numbers and common road names. cT
WhCttemor€- 93vwet ck
P3Ga-ncadsVCIl2, nC
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDA DS, . ND THAT ACOPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER 016 OF PERSON CONSTRUCTING THE WELL DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-1 REV. 07/2001

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality- Groundwater Section t'
WELL CONTRACTOR (INDIVIDUAL) NAME (print) /Vim.- k A /I ,, CERTIFICATION # 3,714
WELL CONTRACTOR COMPANY NAME Pe f., in✓r Ws? 11 D r, llin( ' (` PHONE p
STATE WELL CONSTRUCTION PERMITi$ ASSOCIATED WQ PERMIT/3
(if applicable) (if applicable)
1. WELL. USE (Check Applicable Box): Residential G7-wlunicipal/Public 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION: Jj/
Nearest Town: CAn d!e ✓
• WARRsd C'c.lc
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: CLC(Ain
County 10 Li„c rn be
Address ill 65 Ca7 q Rock l_rane
arxilar Stref<Route 213
71
City or Town State Zip Code
3121-(D1.5-Q330
Area code- Phone number /
4. DATE DRILLED r --1a V
5. TOTAL DEPTH: r? SEtr
•
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO 0
7. STATIC WATER LEVEL Below Top of Casing: aD FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS / FT. Above Land Surface`
"Top of casing terminated at/or below land surface requires a
variance in accordance with 15A NCAC 2C .0118.
9. YIELD (gpm): 9 C METHOD OF TEST /., yy
10. WATER ZONES (depth): /CO l td 4- a Se0
LOCATION SKETCH
Topographic/Land setting
❑Ridge ❑Slope ®-Valley ❑Flat
(check appropriate box)
Latitu a/�long�itude of well location
15" ,-2 a 14 - Or' ' g w
( egreesiminutesise onds)
Latitude/longitude source: ❑GPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From To Formation Description
W C �Rtt <
57 �� d G rrwh-✓%c-
0
11. DISINFECTION: Type H J f-i Amount p :1 ) t0j
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
From T) To (CO Ft. 6 2y 5PRa/ Piet
From To Ft.
From To Ft.
13. GROUT: Depth
From .0 To Ft.
From To Ft.
Material
eeVaCteitO
a-r�M,erhod
IV
U r eCl
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.
0 Show direction and distance in miles from at leash
two State Roads or County Roads. Include the ro4
numbers and common road names. CO
Warren Creek-
00.ndter1 nc
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
Li'7arX G _ o? — © V
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-1 REV. 07/2001
Ert

Fran
Fwln
From To
13. GROUT: Depth
From D To a D
From Ta
SCREEN: Copra
Frain To
l:. SAND/GRAVEL PACK -
Depth
To
To
Si -Alt AILL ,L'lNs 2 VLrlUfl Y4Rhll'rn
\VELL CONSTRUCTION RECORD
:N n, C;r l a Dcpsrunaet of Environment ono h - rul Resources - Division of Water Qualiry - Groundwater Section of L— CONTI1DR 1hill117D1Jsl)NAMMLff ipvii, //,� ° Li 'Ate S CERTIFICATION »r. /1/1)
wieLL co:\ 1'RaC'r3f C3,NP.+NI' N.+�\lli f LcSGV✓3 //feCOD.P1////r4 l_. NHONII nl aSd YZ Lp
&
�Jf ASSOCLATI D WO Pt1Uilr-Is
i ,epliesblcl
I. \WELL LISE tea -,car Applicable Box): Rcetacnt 1 IG Ivl uru:ipShPubI o 0 lndwsrrial ❑ .Agriculnerul Q
1Lminarrna ❑ Rc.oecry 0 Hear Pump \\Suer lnjcctiun 0 Other 0 If'Other, List Use
2 1'iELL LOCATI-y)N:
N.-3rest Tot, r it //C Couno; +G41024
er 7h ch•f- 2d
,-_c_t Name N„mocrs. Commu cry, Subaivuimn, Lt No.. Zip Coact
_. O\\NER.
A O.Ic-S;
LSacct or Route No
rasa .1I e f\C
Ca) -a: To,. Stare
s I- (.,75-Spe Si
Fa 2S :OOc- i°lone pu nlDcr
D-.TE DRILLED 2 — 4 — v (-/
av-i 1 4
'Zip Cues
s. TOTAL DEPTH: Z o i
o. DOES WELL REPLACE EXISTING WELL'? YES 0 NO If<
7 STATIC' WATER LEVEL Below Top of Casino: T O FT.
Above Top ci Csain6)
S. TOP DE CASINO IS ' FT. Above Land Surface*
Cap or ta:uh RI -minuted 5D'ur below lune Su riu ee require' u
aa: ara_i cc with ISA. NC.+C 2C PI ISi. YIELD t=.pun): }..1 METHOD OF TEST B$Iriiryq .Kid
W. 'WATER ZONES (depth): 7S— //d' J .+
L. DISINFECTION: Typea P a ojLtivc
12. LASING_
0
From
From
Dcpm - DlanlL Idr
To 61 Er 4,/27
To Ft.
F r.
.-Amount % /GSI
Wall "fYuclmcss
or WeiehtFr. Material
✓.Dili/ ,Pk(
manned
Fr GONCeefre
Fr.
Diamcicr
Ft.
Ft. in.
Fr.
Fr.
PIcrnun
Air
Slot Size Material
in.
II),
Site Memnal
to REMARKS:
Topogr�aphic/Land setting
[Midge I2lope ❑Valley DEW
(check appropriate box)
Lirirude/longitude of well location
.v d f a ?f 764 ' J- -. ° 37. /S/'
(aceracs:minute�s/ -anils)
Lvlirudeflongirude source: rcheRS❑Topographic map
tcheck box)
DFYTH DRILLING LOG
From To Formation Description
O
42, - L>
r
6"7 -2°+
0
—4
=L
LOCATION SKETCH
Show direction and distance in miles from at leasr�
two Stare Roads or County Roads. Include the rode%
numbers and common road names.
—t ek°tC..'.c/
70(g5(1//C
I DO HEREBY CERTIFY TI-iATTHIS WELL WAS CONSTRUCTED EN ACCORDANCE WITH I5A NCAC?C, WELL
CONSTRUCTION STAND.kRDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OW1 ER
O 7�
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
SUGI➢lt the ori;iml ro the Division of Wirer Qudliry, Groundwater Section, 1636 Mali Service Cenrer- Raleigh, NC
27699-133e Phone No. [phone], within 3U days.
GW- I REV. 07/?00I
c1
-tiresn
0
3)rn
b0
Cr'
"'ran
0
n
NC)

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and N/a/g_'a1 Resources.- Division of Water Quality - Groundwater Section�/rJ
WELL CONTRACTOR (INDIVIDUAL) NAME (print) �£ DA/il iP1 -1)& L" CERTIFICATION err 222
WELL CONTRACTOR COMPANY NAME e /l3tl �d.k (AJAIY'i. oadeoL+r PHONE a fa Lyra yS
STATE WELL CONSTRUCTION PERMIT# V
/1///J ASSOCIATED WQ PERMITS 11//ar
(if applicable) (if applicable)
299194
1. WELL USE (Check Applicable Box): Residential ¢a Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATIO
Nearest "f)pwn: _ Coun i a 77 / pi
(Street Name, Numbers, Community, Subdivision, I.ut No, Zip Codc)
3. OWNER:
Address ra G tJci� L'9.L�'lN R'Q
(Street or Route No.)
Nsc•
City or Town State Zip Code
Area 4. DATE code-
PILDRILLED 9//9/n 7
5. TOTAL DEPTH: 3 p_S"'
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO g
7. STATIC WATER LEVEL Below Top of Casing: /. n FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS . s FT. Above Land Surface*
flop of caving terminated at/or below (and surface rennin. •
variance In accordance with 1SA NCAC 2C .0118. •
9. YIELD (gpm): s METHOD OF TEST74a ..i
10. WATER ZONES (depth): a..2.2
11. DISINFECTION: Type E.g. 4/
12. CASING:
Depth Diameter
From_0 To 7 Ft. Lit
From To Ft.
From To Ft.
13. GROUT: Depth ial
From D To.�1 Ft_.Matert�:
From To Ft.
14. SCREEN: Depth Diameter Slot Size Material
From To Ft. in in.
From To Ft. in. in.
15. SAND/GRAVEL PACIC:
Depth Size Material
0
Amount /D dr"
Wall Thickness
or Weight/Ft. Material
ate a/ ®tic.
Topographic/Land setting
❑Ridge N,Slope ['Valley ❑Flat
(check appropriate boa)
Latitude/longitude of well location
(degrees/minutes/second)
Latitude/longitude source:❑GPS❑Topographic map
(check boa)
DEPTH DRLLLING LOG
From To Formation Description
Method
44
From /f Ft.
From / To Ft.
16. REMARKS:
n
LOCATION SKETCH°
Show direction and distance in miles..6om at least
two State Roads or County Roads. Includethe road
numbers and common road names.
0 O'er " y
I DO HEREBY CERTIFY THAT THIS WFI 1 WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
a� i H /9//D
SIGNAATTUR 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

299248
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and natural Resourgss -Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (pellet) 13 1 L.L.\ € pi ri S ry CERTIFICATION I all I
WELLCONTRAcroRcontPANYNAME RF.UBEN CALDWELL DRILLING, INC. PRONEQ%8 1254-3581
STATE WELL CONSTRUCTION PERMIT/
(if applicable) (if applicable)
ASSOCIATED WQ PERMIT/
1. WELL USE (Check Applicable Box): Residential tMunicipaVPublic 0 Industrial 0 Agricultural
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION: m13Ci
Nearest Town: AL$ Ar4beltcseCounty guA)Co
at StyeelrSG 1Toi4e Lie— -
(Street Name, Numbers, Community, Subdivision, Id No., Zip Cock)
3.OWNER: C.).E3&36 G 11/4)Te Z.
Address 9-1 5'-ri3 pet IJ G S"7o tJ L3 u(L
A1-ij/Rnl`De(LRowe No.)� arr°i
City or Town State 1 Zia Code
(1118)- (O B E - a 39 3
A,ts coda Phone number
4. DATE DRILLED 6- 3O -- 0
S. TOTAL DEPTH: 51 O
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO I/
7. STATIC WATER LEVEL Below Top of Casing: Z,o 0 FT.
(Uri `a` if Above Top of Cuing)
8. TOP OF CASING IS a FT. Above Land Surface*
*Top of ruing termlealed at/or below lead serfats requlru •
variants la mundane with ISA NCAC 2C .0111. p� n
9. YIELD (gpm): &o METHOD/[OF TEST (�G - At0-
10. WATER ZONES (depth): OR.0 3 o G e M
pographic/Land setting
dge ❑Slope ❑Valley ❑Flat
(cluck appropriue box)
Latitude/longitude of well location
(deIIoeumimuu/secoads)
Latitude/longitude source:❑GPS❑Topographic map.
(check box) ..
DEPTH MULLING -rop..
Frgm. To ,. Formation Description
1 -
SoVe243uR-oct3
4S ' - 5a-o ` G !Z.Ar. ITe
Sao' CRBVice asGPnn
eat `- cstio/ C-,RnNtTE
11. DISINFECTION: Type
12. CASING:
Depth
From A To 5v
From To
From To
13. GROUT` Depth
From To aeD
FIN 4 01 Amount l b
Diameter
Ft. 6%f(
Ft.
Ft.
Wall 'Thickness
Sor DP-al
t/Ft. eta al
Material Method
Ft. Cerix,\.or PO U (2e (�
From To Ft.
14. SCREEN: Depth Diameter Slot Size Material
Front To Ft. in. in.
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Sire Material
From To Ft.
From To Ft.
16. REMARKS:
0
LOCATION SKETCH
Show direction and distance in miles fromat
least
two State Roads or County Roads.
numbers . d common road names.
5Teeetr36 S
Include the road-
1-.1 L'f_-O6L.V e
2(-+
c.J c,
OIb JAW/ it 20
O L o 'Le 06-r &
(t'C ' OR (tw.d
1 DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 1SA NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A Y OF T)IIS RECORD J(AS BEEN PROVIDED TO T7{R� o 0
SIGNATURE OF PERSON CONSTRUCTING THE WELL / DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Malt Service Center -Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. G W 1 REV. 07/2001

299249
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources -^Diivision of Water Quality - Groundwater Section
u
WELL CONTRACTOR (INDIVIDUAL) NAME (print) •✓ \t-L1f3 rJA314 CERTIFICATION / )-i ,1
WELL CONTRACTOR COMPANY NAME_RF.UBEN CALDWELL DRILLING, INC. PHONE448 54 —3581
STATE WELL CONSTRUCTION PERMIT/
(if applicable) (if applicable)
ASSOCIATED WQ PERM as
1. WELL USE (Check Applicable Box): Residential B.'. Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATIgN: ((�1
Nearest Town: PWW%ief\LLt.`'_ County QOJCuMal'e
\C(0 tC1:O \„AaJE
(Street Name, Number, Community, Subdivision, lot No., Zip Code)
3. OWNER: L)`t-\-IPry-s MPST
Address 14 o EWE 0 (Z\ J �
ieboo (Street Route No.)
>� aa NC
a-8 lob
69 Cityor Town abbe- ) l-aip Code
g)- `Y o
Asa code- Phone number
4. DATE DRILLED to- a `J cfj
5. TOTAL DEPTH: 4 \ o
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO O
7. STATIC WATER LEVEL Below Top of Cuing: Z( 0 FT.
A (Use'+' If Above Top of Cuing)
8. TOP OF CASING IS —1 FT. Above Land Surface'
*Top of eating terminated atror below land innate requires a
variance In accordant with ISA NCAC IC .01 IS.
9. YIELD (gpm): 1- METHOD OF TEST 21G A I
10. WATER ZONES (depth): 1 bO / - ' ± GPr"1
11. DISINFECTION: Type NT QO o Amount ;.7 1 b
12. CASING: Wall Thickness
,( Depth
From -t To 5 `3
From To
From To
13. GROUT; Depth
m 3 FroTo oa° Ft.
From To
14. SCREEN: Depth
From To
Ft. n);
Dir�cSoRaR QY
ter or Wcj ht/F'. Meycbtal
Ft.
Ft.
Material Method
CAT rile aJT Q o --te D
Ft.
Diameter Slot Size Material
Ft. in.
From To Ft. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft. (ATiara
From To Ft. A alb
in.
in.
Topographic/Land setting
❑Ridge ❑Slope ❑Valley QFlat
(check appopriatc box)
Latitude/longitude of well location
(depoahnlma retraeconds)
Latitude/longitude source:❑GPS❑Topographic map
(duck box)
DEPTH DRILLING LOG
Rom/ To , — 8 OV Fonp�aLion�QlSDev2scroktiptroion
9
4Br - GR1c+t.IT6,
bn c 6LEV1Ce .1 Gpti.
Cho' tatrn^)\TC.
LOCATION SKETCH —.
Show direction and distance in miles fromat least.
two State Roads or County Roads. Include the toad
numbers and common mad names. _,
16. REMARKS:
EG)i o
bA462.0lei,-)
(Lf5
evv
0
R,SGaK FIFA.)
L.S,
1 DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED M ACCORDANCE W)TII ISA NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL 0
SIGNATURE OF RSON CONSTRUCTING TICE WELL D TE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mall Service Center- Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-1 REV. 07/2001

299336
WELL CONSTRUCTION RECORD
North Carolina - Department of Environt lent and Natural Resources - Division of Water Quality - Groundwater Section
�16
WELL CONTRACTOR (INDIVIDUAL) NAME (print) Oecc:cK Tls:e't'I+ +Sa`"`�4 og CERTIFICATION #
a'JoA t\Q- ?ur.t AnC PHONE # =..� (o (c$-7p22
WELL CONTRACTOR COMPANY NAME �\ Q sS-QN i 4f� R1e�
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PEFLMIT#
(if applicable) (if applicable)
ansaisz
1. WELL USE (Check Applicable Box) Residential 1N Municipal/Public 0 Industrial ❑ Agricultural 0 _ "--
Monitoring 0 Recovery 0 Heat I ump Water Injection 0 Other 0 ITOther, List Use
2. WELL LOCATION:
Nearest Town: , Coact ._ County PRutna:b ht.
(Sweet Name, Numbers. Community. Subdivis'±n, Lot No.. Zip Code)
3. OWNER: IN Ian Mrt iP ti es
Address J2\ E' .St Main j-t tti
(Street or Route No.)
-S \va i AJC aQ115
eity or Town State Zip Code
(et2e)- 23t gIF:a
Area code- Phone number
4. DATE DRILLED b- a- o`!
5. TOTAL DEPTH: ao.3
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO
7- STATIC WATER LEVEL -Below Tole of Casing: Llc FT.
(Use' f if Above Top of Casing)
8. TOP OF CASING IS 1 FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordance with I5A NCAC 2C _VI 8.
9. YIELD (gpm): _$s't _ METHOE OF TEST R.:q: d
10. WATER ZONES (depth):
11. DISINFECTION: Type Q;\\S
12. CASING:
Depth Diameter
From t % To it2 Ft. - Cosi
From To Ft.
From To Ft.
13. GROUT: Depth Mat trial Method
From O To Qo Ft. Ca- nan+ Pc_. .. _
From To Ft.
14. SCREEN: Depth Diameter Slot Size Material
From To Ft. Ea. in.
From To Ft. ;n, in.
15. SAND/GRAVEL PACK
Depth
From To Ft. —
From To Ft. —
Amount IC
Wall Thickness
or Weight/Ft. Material
ezt ? Q4:stx
Topo ur phic/Land setting
DRidge N Slope ❑Valley ❑Flat
(check appropriate bo::)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From To Fomiation De"scrtpTiin
}i
:o iIZ.
11 2.
Size Material
eves WQedar.
G-Co.n: t e
LOCATION SKETC'
Show direction and distance in miics from at least.
two State Roads or County Roads. Include the road
numbers and common road names.
:r?
CD
16. REMARKS:
1 DO HEREBY CERTIFY THAT THIS WELL . WAS CONSTRUL I ED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THA. T A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
NSTRUCTING THE WELL DATE
rhArse '1. 74 �a
SIGNATUI E OF PERSON
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Ceenter' RaleighREV. gh, 2C01
27699-1636 Phone No. [phone], with 30 days.

299335-
WELL CONSTRUCTION RECORD
North Carolina - Department of Environr tent and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAMF (print) Doer ZCK Wheleri. CERTIF'CATION# 241fo
WELL CONTRACTOR COMPANY NAME C.. Q CJ a .S. on ' enQ-'Punt(' Ant PHONE #
STATE WELL CONSTRUCTION PERMIT#
ASSOCIATED WQ PERMIT#
(if applicable)
(if applicable
L WELL USE (Check Applicable Box). Residential Municipal/Public 0 Industrial ❑ Agricultural 0
Monitoring 0 Recovery 0 Heat I ump Water Injection 0 Other 0 IfCther, List Use
2 WELL LOCATION:
Nearest Town: _Gana tlt'r
C.„.uvC
(Street Name, Numbers. Community, Subdivis 20, Lot No.. Zip Code)
County B,...ytC.ay..kle_
3. OWNER: :(:-F.•. M.riti e..
Address 4%Ce �J^-a^ V;.t_,:,
(Street or Route No.)
NZ _g$i IS
City or Town State Zip Code
( )- 5 aw 033ti
Area code- Phone number
4. DATE DRILLED V.. ;;;•u'\
5. TOTAL DEPTH: \(o`.i
6 DOES WELL REPLACE EXISTING WELL? YES 0 NO 11
Topogg �aphic/Land sating
❑Ridge f�Slope ❑Valley ❑Flat
(check appropriate bo-)
Latitude/longitude of w-eh location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPSDTopographic map
(check bet)
DEPTH DRILLING LOG
From To Formation Description
te
-o 4(0 o.vtC kLecdon
Lila a Ib5
7. STATIC WATER LEVEL -Below To; of Casing: 2.5 FT.
(Use' - if Above Top of Casing)
8. TOP OF CASING IS t FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordance with ISA NCAC 2C .QI 18.
9. YIELD (gpm): oLO METHOE bF TEST Rc%
10. WATER ZONES (depth):
II. DISINFECTION: Type e--,,
12. CASING:
Depth Diameer
From Y i To His, Ft. (04
From To Ft.
From To Ft.
13. GROUT: Depth Mat rial Method
From 0 To 20 Ft. CZ- ^«} 31?,Nm-
From To Ft.
14. SCREEN: Depth Diameter Slot Size Material
From To Ft. -a. in.
From To Ft. -4. in.
15. SAND/GRAVEL PACK: Material
Depth Size
To Ft. _ __-----
To Ft.
Amount
Wall Thickness
or Weight/Ft. Material
a3
From
From
Gran: t
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common mad names.
16.REMARKS.
I DO HEREBY CERTIFY THAT THIS WELI WAS CONSTRUCTED IN ACCORDANCH WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THA. T A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
14 ta-
SIGNATUt:E OF PER N CONSTRUCTING THE WELL DATE
C
Submit the original to the Division of W ater Quality, Groundwater Section, 1636 Mail Service Ceenter' Falegh,N 07/2001
27699-1636 Phone No. [phone], with 30 days.

3. OWNER:
Address
.AS
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Ktantral Resources -Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) lt-t_l E to AS H CEnnpPICATION/
CALDWELL DRILLING, INC. PHONEY?f8 )254-3581
WELL. CONTRACTOR COMPANY NAME REUBEN
STATE WELL CONSTRUCTION PERMIT/
(if applicable)
ASSOCIATED WQ PERMIT/
(if applicable)
9'9 Ea
I. WELL USE (Check Applicable Box): Residential fit/Municipal/Public ❑ Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATI /
Nearest Town: R\-kY 11-& 8 C e- County tv N co ry 4
r3eA2- cteelz �Afl
(Svxt Nun:, Numbers, Community, Subdtviaion, id No. lip Code)
e tL N\ a p '/ c A
4- u Yt1 Waste
T
(Strut or Rowe No.)
c)ANIA rt^A 3-3101D4-
City or Town state Zip Code
(1154-j- saS—pan
Area code- Phone number ,1
4. DATE DRILLED "-1- 14 —1) Q,
5. TOTAL DEPTH: (a \ O
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO
7. STATIC WATER LEVEL Below Top of Casing: 6 L' FT.
(Use "+- If Above Top of Casing)
8. TOP OF CASING IS FT. Above Land Surface•
*Top of easing terminated ator below land mane requires •
varlanee in atwrdaneyA,with ISA NCAC IC.0111. rt
9. YIELD (gpm): a METHODOF TEST RIG - At la-
10. WATER ZONES (depth): 21c' 'S 6 err.
Topographic/Lan e ttin g
❑Ridge ❑Slope alley ❑Flat
(check appepriatc box)
Latitude/longitude of well location
(degroedm (m,ta/soconds)
Latitude/longitude source: ❑GPS❑Topographic map
(chuck box)
DRILLINQj,OQ
DEPTH
Frgm 0 To / Formation Description
— 'olb 0Jts�g���t�,J
G 6rt
Cf. V lc.e - 6Prn
ease-, iTe
ab'- a4o'
a4o'
a4-o 0051
11. DISINFECTION: Type etTt1 9016 Amount '/a. 1 b
12. CASING: Wall Thickness
From To th3 I Ft. �I)tarpetcr
From To Ft. '��
From To Ft.
13. GROUT' Depth Material Metho4
From 1 To a0 Ft. 0-1;mt.n1.T POJ�Eis�
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
�/
orDRdWeiqI ��VFt. aG al
Fj
From To Ft.
From To Ft.
16. REMARKS:
),OCATION SKETCH
Show direction and distance in miles front at (east
two State Roads or County Roads. Induct; the -road
numbers and common road names. —
t
Au J/rr.tm62 (2.7A
LG,ces"teg 1.111
1 DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH ISA NCAC 2C. WELL
CONSTRUCTION STANDARDS, AND THAT A CO py OF T)(IS RECOR(@ HAS BEEN PROVIDED TO THE WELL OWNER
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mall Service Center- Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-1 REV. 07/2001

WELL CONSTRUCTION RECORD
North Cuolina - Department of Environment and Kish Resources -Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (prim) t—L.\e) NASA CERTIFICATION/ a1 �
WELL CONTRACTOR COMPANY NAME_RE.UBEN CALDWELL DRILLING, INC- PRONE4?(8 )254-3581
STATE WELL CONSTRUCTION PERMIT/
(if applicable) / (if applicable)
1. WELL USE (Check Applicable Box): Residential LY Municipal Public 0 industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
ASSOCIATED WQ PERMIT/
Address 7 d . phG o osQJ_
(Street or twee Nt)
02g.7672 DEPTH
From / To
1. T +_ t bo
bo+
5. TOTAL DEPTH: a 10 1 b p + - of 10
6. DOES WELL REPLACE EXISTING WELL? YEsp NO
7. STATIC WATER LEVEL Below Top of Casing: O FT.
(Use -a- if Above Top of Cuing)
8. TOP OF CASING 1S & FT. Above Land Surface'
Top or cuing terminated atfor below land surface requires a
variance 1n accordance with ISA NCAC 2C .0111.
9. YIELD (gpm): 2-0 METHOD OF TEST RIG 't IL
IO. WATER ZONES (depth): 16 p - 'a-o G Y r-
2. WELL LOCATION: /�
Nearest Town: LA i4ClZ.\
`J f ILO County QV IJCiDa)
(Street Name, Numbcn, Cunmuniy, Subddimion, Lot No., Zip Code)
3. OWNER: -J • S 1�
(depeuhnimnes/secomds)
Latitude/longitude source:❑GPS❑Topographic map
(check box) ._ --.--
rrDnRILLING ionLOG 1�
/ criptio
0l)ti tR- JFo,De5a-So d-)
Cja-A&t i
Cte-,rtce a-O 6 °r-r
C') t26 u5i t':C,
299651
Topographic/Land setting /'
❑Ridge ❑Slope ❑Valley OYlat
(duck eppeopdatc box)
Latitude/longitude of well location
City or Town State Zip Code
Area code- Phone number
4. DATE DRILLED --f,15 104—
11. DISINFECTION: Type {JTrA q ei/o Amount `72.
12. CASING: Wall Thickness
Depth _ Di ter or W 'ght/F'. tilt!
From -I To -ta- Ft. 6 c 7D a[ VC.
From To Ft.
Front To Ft.
13. GROUT: Dcpth Material ((JJ Method
From i-- To 9-0 Ft. C.K)vit)Pr( 'Vo u eeD
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:
[b
J<OCATIONSKEI'CH In .
Show direction and distance in miles frcrat least
two State Roads or County Roads. Include the read
numbers and common road names.
0
Ot.A..1C La eat IA
1.5 1
7KON�.
,I M
5-10 -
Irn
1 DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED M ACCORDANCE W1711 ISA NCACC, WELL
CONSTRUCTION STANDARDS, AND THAT A C OF T►(IS RECORDB"-21EEN t PROVIDED TO TF WELL�DWf<J);R
tal 0
SIGNATURE OF PERSON CONSTRUCTING TILE WELL / DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mall Service Center -Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-1 REV. 07/2001

299652
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natura(lResou ce3 - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (pries) V Lt—Lt )..f yi S }'� CER77tF-`ICATION/ a'-1,
W
WELL CONTRACTOR COMPANY NAME_RF.UBEN CALDWELL DRILLING, INC. PBONEY?fg 54=35$1
STATE WELL CONSTRUCTION PERMIT/ ASSOCIATED WQ PERMITI
(if applicable)
(if applicable)
1. WELL USE (Check Applicable Box): Residential "MunicipaVPublic 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATI N: n
Nearestown: Ste V t� coon, 1 cb vr) Con.JS
4- iicAvt3hr`s p c3t f
(Strut Name, Num , Community, Subdivision, Lot No., Zip Code)
i0
3. OWNER:
1 � (a— f t5Y1A f- GIA k rOrJl jt2
Address -3 4- }{E.-A�(G-r-i S A (so ✓6
(Street a Raw No.)
Ast-lt-v,L.L Nc,
2- cif b
Ba rya Town State Zip Code
-
Ara code- Phone number % A
4. DATE DRILLED 749....0 //o ! o 4
5. TOTAL DEPTH: 1 0
6. DOES WELL REPLACE EXISTING WELL? YES NO ❑
7. STATIC WATER LEVEL Below Top of Casing: 0 FT.
(Use `+' If Above Top of Coins)
8. TOP OF CASING IS FT. Above Land Surface*
*Top of cuing terminated at/or below land surface requires •
variance la accorday ce with ISA NCAC 2C.01111. n-� �� A 4 '
9. YIELD (gpm): b METHQ,P OF TEST V1 11`- "
10. WATER ZONES (depth)1:I 1 a 0 / - b (�Pr- 1
11. DISINFECTION: Type N I'l( 9 a "/o Amount l 3-( 2
12. CASING: Wan Thickness
ej th r or W_eightfFl. a rid
From -l- To O Ft. SDjc -I _�j
From To Ft.
From To Ft.
Topographic/Land setting
❑Ridge ❑Slope ❑Valley 64flat
(duck appropriate box)
Latitude/longitude of well location
(maataimtm,teae«ooa,)
Latitude/longitude source:❑GPS❑Topographic-mag' - -
(chuck box)
DEMI DRILLING LOO
Fpp / To i Formation -im— 35 eJet6v Weg�.
35f— ‘.bo' C,ail eJt e-
1 $ 0 % cis (ice- - Co GPr-r
1B0/-4ro' C.,4-"-)k e
0
13. GROUT: Depth Material (di ethod ^
From -4- To a o Ft. (. eTA6 01- t`0 U08 1 ✓
From To Ft.
14. SCREEN: Depth Diameter Slot Size Material
From To Ft in. in.
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
16. REMARKS:
JOCATION SKETCI-j
Show direction and distance in miles from at least;
two State Roads or County Roads. Indic) the:toad
numbers and common road names. 7-73
LItC6
bL.O l cTrC rS7�/Z N
Z r-"
S t6�
tiW•
e4 77o,.J A ✓C
1 DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED M ACCORDANCE WITH ISA NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THA COPY OF T}IIS CORD HAS BEEN PROVIDED TO THEtyE1 0�VN
SIGNATURE OF PERSON CONSTRUCTING THE WELL p/ATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mall Service Center- Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-1 REV. 07/2001

299634
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and u+nual,Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (prim) `� 1 i.- L..\ L (� ('J CERTIFICATION I al 1
WILL CONTRACTOR COMPANY NAME_ RF.UBEN CALDWELL DRILLING, INC, PHONEY s�?j8 54-3581
STATE WELL CONSTRUCTION PERMIT/
(if applicable) (if applicable)
ASSOCIATED WQ PERMIT/
1. WELL USE (Check Applicable Box): Residential 13/Municipal/Public 0 industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION:
Nearest Town: t..? e 642. / I L.LC County igU t•I C o fv -13
(CGCin5 Ce--eeIC
(Street Name, Numbcn, Community. Subdivision. Lot No., Zip Code)
3. OWNER: (-) >-.t t3 G A 20 ©f a
Address 53g S64) C)L.ip)S E3RIVC
wsAve-i � l Ne'Nc '4to i
City or Town State Zip Code
(S )- iIa—la- bo
Area code- Phone number 4. DATE DRILLED / 7 D 4
5. TOTAL DEPTH: 3 5 o —
6. DOES WELL REPLACE EXISTING WELL? YESJ7 NO [H
7. STATIC WATER LEVEL Below Top of Casing: 'fj 0 ET.
.il (Use`+' If Above Top of Cuing)
8. TOP OF CASING 1S 1 FT. Above Land Surface•
Top of easing lermlomed at/or below Ind surface require a
valance 1n accordaw with ISA NCAC 2C.0I IS.
9. YIELD (gpm): 6D METHODJDF TEST
10. WATER ZONES (depth): 3 l O — 30 C ern
I I. DISINFECTION: Type *13( C'I (t-/r��� Amount /a
12. CASING: Wall Thickness
From
Depthq ter or Weir!.lrtkyrial
To l�V
From To
From To
13. GROUT Depth Material Method
From 4- To ao Ft. C.aY�I31)C fin o(Le D
From To Ft.
14. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in.
Front To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Sire Material
D
Ft.6 C 5iK G
Ft.
Ft.
From To Ft.
From To Ft.
16. REMARKS:
z7bpographic/Laad setting
al Ridge ❑Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(depe Wmimttatxeoods)
Latitude/longitude source:❑GPS❑Topographic map
(check boa)
DEPTH DRILLING LOG
From / To / Fo ignition Description
1 e S-9 0 241.rt—e i•
39 I — 3ta' C-,e—A 1'3iti$
3 ID ' e Rro/t cE, -- "Se,"Se,6Pm
3 la - So G C ,v t-r"G-
LOCATION SKETCH _ -
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common road names. w —
if '
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH ISA NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY THIS RECOMAS BEEN PROVIDED TO THU WELL 0
AR)
SIGNATURE OF PERSON CONSTRUCTING THE
LI 1�T� I °
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mall Service Center - Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-I REV. 07/2001

299635
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and )Jamral esourcy - Diivision of Water Quality - Groundwater Section
WELL CONTRACTORONDIVIDUAL) NAME (prim)51 LLte 7-SA S44 CERTIFICATION a7-rl
WELL CONTRACTOR COMPANYNAME_REUBEN CALDWELL DRILLING, INC. rxotveQ%8 )254-3581
STATE WELL CONSTRUCTION PERMIT/ ASSOCIATED WQ PERMIT/
(if applicable) (if applicable)
1. WELL USE (Check Applicable Boa): Residential/Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATIOL
Nearest Town: YA t KV I F3(A1 County &L f 13
PtMWWk V—) 1-0 (2-13
(Street Name, Numbers, Community. Subdivision, tot No., Zip Code)
3. OWNER: eD fl (a//�1L
6 t14 C
Address ( o 6 c)t 112— S7
rAl(kJ 18i� RittY a813o
City or Town State Zip Code
( 3-
Arca coda Phone number
4. DATE DRILLED Y / OIL 0 Ath
5. TOTAL DEPTH: (4 0
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO
7. STATIC WATER LEVEL Below Top of Casing: 179 FT.
(Usa -+- if Above Top of Cuing)
8. TOP OF CASING IS FT. Above Land Surface'
`Top of autos tarmtasted at/or below had torten requires a
whine 1n accordao a wllb 15A NCAC 2C.01111.
9. YIELD (gpm): (0 METHOD OF TEST {.1 G — a i a'
10. WATER ZONES (depth): Z — . G
I I. DISINFECTION: Type T 0` o Amount '� D
12. CASING: Wall Thickness
4 Depth ter or Wei VFt. v ial
From —i To 3 t FL �J S - i irV �--�
From To Ft.
From To FL
13. GROUT:A Depth Material
From 1 To aA Ft. c rninrr
From To Ft.
14. SCREEN: Depth Diameter Slot Sire 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:
Method
Po(xzeD
j Topographic./Land setting
Midge ❑Slope ❑Valley ❑Flat
(chock appropriate box)
Latitude/longitude of well location
(desrouimimslealsecoods)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH DRILLING LOG
Fr / To / Formation Description
Rek otao ' Co RA "' 1-rc
AR.°/ Cite (1C-t- Urn
0, RA N iTr
ocRD 4-3o'
Cr)
LOCATION SKETCH._
Show direction and distance in milef jromcat feast
two State Roads or County Roads. 1' gl' udgtjle road
numbers ,nd common road names.
spa
15-
RJIQQW
Fori3S
J C\
•
01-6
M
1 DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED M ACCORDANCE wait ISA NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A C YOFTHIS RECOflAlIASBEEN PROVIDED TO TH/VE•I.ijOWNER
3
SIGNATURE OF PERSON CONSTRUCTING TILE WELL IJATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mall Service Center -Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-I REV. 07/2001

299636
WELL CONSTRUCTION RECORD
North Cuolina - Department of Environment and KryL.L
attire! Resources -Division of Water Quality - Groundwater Section
IV
WELL CONTRACTOR ONDIDUAL)NAME (prim)\•7 1\� NAS VACERTIFICATIONAil
1 I
WELL CONTRACTOR COMPANY NAME FHONLY?(B 54-3581
STATE WELL CONSTRUCTION rzRMns
REUBEN CALDWELL DRILLING, INC.
(if applicable) ASSOCIATED WQ FLAMITI
(if applicable)
I. WELL USE (Check Applicable Dos): Residential Q MunicipaVPublic 0 Industrial ❑ Agricultural 0
Monitoring 0 Recovery 0 heat Pump Water Injection 0 Other 0 If Other, List Usc
2. WELL LOCA
Nearest Town:
County
(Street dune, Numbers, Cry, Subdivision, Int No.. Zip Code)
3. OWNER: 4•6
Address 1 03 CA iQ LL/�LA O IG
A-S140ILrrtar Raw, NCa-.' a D o 3
Iy or Town Suit Zip Cods
- Z7 -ij #f — 2Z7-1
Mca coda Phone number
4. DATE DRILLED 7 t7o t�
S. TOTAL DEPTH: I v /
6. DOES WELL REPLACE EXISTING WELL? YES 0
7. STATIC WATER LEVEL Below Top of Casing:
/ (Ua• + 1(Above Top of we)
8. TOP OF CASING IS ! - FT. Above Land Surface'
•Top of gulag termlom,d War below land sedan requires •
vadaaea le acwrduc wit► 15A NCAC 2C.0t 11.
9. YIELD (gpm): METH OD OF TEST Pa-1--7
10. WATER ZONES (depth): iT
Topographicitand setting
❑Ridge ❑Slope ❑Flat
(check apptvpriare box).:.
Latitude/longitudeofwell location
(deyenhviauiea/eecooda)_
Lan tudcAongitude source:❑GPS❑7opognphicniap
(abed box)!;
PRIit nTGTOQ
Formation Description
PEPTI I
From To
O❑ 5e gin
D
e: 0 — 7,0
11. DISINFECTION: Type-t7earnount 1 t; kJ)
12. CASING: Wall Thjcknw
Depth Diameter or Wright/H.' From / To__ Ft. ics
From To Ft.
From To Ft.
13. GROUT: Depth at
From 0 To 22-Ft. -d
From To Ft.
14. SCREEN: Depth Diameter
From To Ft. in. in.
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Sire Material
From To Ft.
From To Ft.
16. REMARKS:
Slot Si cc
Material
0
J ()CATION SKETCH' -
Show direction and distance in miles cam at least
two State Roads or County Roads. Include the road
numbers and common road names.
e
C8+)c. CRa44C
C t ecl.0
1 DO HEREBY CERTIFY THAT TI11S WELL WAS CONSTRUCTED TN ACCORDANCE WIT11 ISA NCAC 2C, WELL
CONSTRUCTION STANDARDS. AND TIIAT A COPY OF THIS RECORD IIAS DE EN PROVIDED TO TILE WELL OWNER
SIGNATURE OF Pala'
T
77 o
NG WELL D
Submit the original to the Division of Water Quality, Groundwater Section, 1636 M11a11 Service Center- Raleigh, NC
27699-1636 Thone No. [phone], within 30 days. GW-I REV. 07/2001

Topographic/LansEtting
❑Ridge ❑Slope Medley ❑Flat
(check appeopriste box)
Latitude/longitude of well location
(dearea/rntmues/secondr)
Latitude/longitude source:❑GPS❑Topographic map
(check boa)
DEPTH DRILLING LOG
From/ To / Forutati n escri tion
1 — ,9.._ es OV U (L,ge)/J
ao'- o' Gar (`-'1Te
`c‘orlo /aSc' CC R J t �� Gf M
tJ
LOCATION SKETCH --
Show direction and distance in miles horn at least
two State Roads or County Roads. Incl#1e the road
numben and common roades. cI
Dt7(1---
3/4-
S-rA ajaS
Cot
M
/r✓
tV
—r e (i0, (uZ
299895
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and 14 shwa! Resource. - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (prime) 6 1 LL\ 1, tJ ASi4 CERTIFICATION/I a-7 I
WELL CONTRACTOR COMPANYNAME_RF.UBEN CALDWELL DRILLING, INC. PRONEVf8 '?54-3581
STATE WELL. CONSTRUCTION PERMITS ASSOCIATED WQ PERMITS
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential ® MunicipaVPublic 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
3. OWNER:
Address
2. WELL
restTo : f1 6 NtrM6 Nearest Tows �-i 5 W6 "—LC.County v
iltVT t r+ D 4L
(Street Name, Numbers, Community. Suldiviaion, Lot No., Zip Code)
i TV\ t� )_To fJ
a \ Pi- F � rJ c jt TIC I)^
AS Nc t/1 t_ erR NNC:2 as go to
try or Tr E \ suit
airy
( ) "3-1 iZip Cods
Area code- Phone number C
4. DATE DRILLED 1/ 1 b 0
5. TOTAL DEPTH: as v
6. DOES WELL REPLACE EXISTING WELL? YES p NO
7. STATIC WATER LEVEL Below Top of Casing: 4- O FT.
(Use "•" if Above Top of Casing)
8. TOP OF CASING IS - FT. Above Land Surface•
*Top of cuing tinning/if at/or below Ind goatee requires a
variance to acaorda c web ISA NCAC 2C .011 S.
9. YIELD(gpm): 1� METHOD9FTEST iG AIR'
10. WATER ZONES (depth): C a 0 — I' 6 P rr
11. DISINFECTION: Type
12. CASING:
k Depth
From To
Ft.
From To Ft.
clo
Amount a- '
Wall Thickness
j)i{tpieter orSWeight/Ft. Material iy2.v-c,
From To Ft.
13. GROUT: Depth
From 1— To as Ft.
From To Ft.
14. SCREEN: Depth Diameter
From To Ft. in
From To Ft. in.
15. SAND/GRAVEL PACK:
Depth Sire
From To Ft.
From To Ft.
Material Method
CEmc f3Q-0 LRD
Slot Sim Material
in.
in.
Material
/1
16. REMARKS: /
1 DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE wmt 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TOTE 11
WELL rOW R
SIGNATURE OF PERSON CONSTRUCTING TILE WELL DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mall Service Center - Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-1 REV. 07/2001

299894
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and manual Resources -Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (prior) 1LL-1 i IQAS j.l CERTIFICATIONI
WILL CONTRACTOR COMPANY NAME _RF.UBEN CALDWELL DRILLING, INC. rnONt�78 )Z54-3581
STATE WELL. CONSTRUCTION PERMIT/
(if applicable)
ASSOCIATED WQ PERMIT/
(if applicable)
1. WELL USE (Check Applicable Box): Residential IW MunicipaVPublic 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION:
Nearest Town: AS tit0/1
GVr..�15 (Loot
(Stein Name, Number, Community, Subdivision, Lot No., Zip Code)
3. OWNER: I I4cn••A S V ir be P3
Address 5d G It.-.t,1 S 20 A O
(Swat or Route No.)lac
(CI*Citor Town % State,a O Zip Code
Arta code Phone nnumbet /) ally / O 4.
4. DATE DRILLED
5. TOTAL DEPTH: 0.)0
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO Ef
7. STATIC WATER LEVEL Below Top of Casing: 4- a FT.
(Use `+` if Above Top of Casing)
8. TOP OF CASING IS �- FT. Above Land Surface*
'Top ofenlog terminated aUor below land surface requlru a
variance In accordance with ISA NCAC 2C .011/.
9. YIELD (gpm): 'alp METHOD OF TEST %1 �' '
10. WATER ZONES (depth): 1 to ' — • a o (.2 P r�
11. DISINFECTION: Type \ T R ctl) Amount Y- t b
12. CASING: Will Thickness
,( Depth Diaq,�ter or Weight/Ft. Material
From 1 To SS Ft. h'/t{ SOeal 6'vC_
From To Ft.
From To Ft.
13. GROUT: Depth Material Method
From To g`� Ft. Cbr \13t.) (10‘)A.Glat
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.
County ' J•-'+4 LCrA&_
Topogr fdfl.and setting
❑Ridge OSlope ❑Valley ❑Flat
(clock appropriate box)
Latitude/longitude of well location
(degreee/mimury/secoods)
Latitude/longitude source:❑GPS❑Topographic map
(cheek box)
DEPTH DRILLING LOCI
From1 To , Formation Descriptio
1 — S 0 o Jslz(i�n 4er�
5 o r_ 1 '1 0' C� 2A r� r T�
l `(o ' Ct2-42,V` tee a o (zpM
1 lo' O1O' c.,its
0
J ()CATION SKETCH W
Show direction and distance in miles from at -least
two State Roads or County Roads. Include the road
number and common road names. o
CJI
61 v1
LC CN5 716 L
Lk ICU T-C 2
0 1- 0
3/4
n
16. REMARKS:
1 DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COP yr F THIS RECO HAS BEEN PROVIDED TO THE WE OWNER
L �,ta., -,/a© I
SIGNATURE OF PERSON CONSTRUCTING THE WELL DA
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mall Service Center -Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-1 REV. 07,2001. ..

299893
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and waturitnnN f ,s
al ResouretFees -Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) 'i L—L\ . 4,( CERTIFICATION $ al 1
WELL CONTRACTOR COMPANY NAME._ CALDWELL DRILLING, INC. PHONEfl8 ,54-3581
STATE WELL. CONSTRUCTION PERM ITa ASSOCIATED WQ PERMITS
(if applicable) a (if applicable)
1. WELL USE (Check Applicable Box): Residential 15 MunicipaVPublie 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION:
Nearest Town: W GA ✓1tst�-1/ t L_L B County (S-):J Co n-s
nlfs(,.) STo c. K_ !to $.
(Street Name, Numbers, Community, Subdivision, tor No. lip Code)
3. OWNER:
Address
(3LA,Le 'tC 2R
�b dJbw S-ro I�
(Street a Route No.)
Ast ..- /tLe- NC_
(tza»»} a' 1 t %- Istate3 IQ 5- 21p Code
Ara cods ?bona number
4. DATE DRILLED %4 71 4
5. TOTAL DEPTH: S t o
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO
7. STATIC WATER LEVEL Below Top of Casing: 6 FT.
(Use -+' if Above Top of Casing)
8. TOP OF CASING IS FT. Above Land Surface*
*Top of easing terminated at/or below lead surface requires a
variance 1n accordeaea wine ISA NCAC IC.01I S.
9. YIELD (gpm): 15 METHOD OF TEST R' G -
10. WATER ZONES (depth): cc<01 G Q'rvr
1e -. ct GP'-�
o o Amount 1 b
11. DISINFECTION: Type
12. CASING:
AA Depth b?' ter
From + To 50 Ft. d% 1S
I1TN
From To Ft.
From To FL
13. GROUT:, Depth
From To 9-o Ft.
From To Ft.
14. SCREEN: Depth Diameter Slot Sire . Material
From To Ft. in. in.
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
Walt Thickness
or Weight/Ft. Material
t2a ct N
Material
(-Est./ 4/ sa
Mcthod
eouneo
16. REMARKS:
Topographic/Land setting
❑Ridge ❑Slope ❑Valley Flat
(check appropriate box)
Latitude/longitude of well location
(deyxaim)anesheconds)
Latitude/longitude source:❑GPS❑Topographic map
(duck box)
DRILLING LOQ
Formation Description
J J L . tYLOcsrJ
Coa-A a
cQl'r`(t cc - Co GPM
l A a CT C
C2t J(c ct Gen-
6 RA.,.),T6
PEPTI(
From / To- 1-5
41 J - -. Icsoi
IKCe.
IS(c' — 4 for
-To�
4 7o'--Sro'
Cr)
LOCATION SKETCH lj
Show direction and distance in miles from at least
two State Roads or County Roads. Includd the_road
numbers and common road names. -
us )qt a
N1co, o S. 1J SL L<=;
1 DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH I SA NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COP OF THRECORD�[AS BEEN PROVIDED TO THE WELL OWNER
,I«
SIGNATURE OF PERSON CONSTRUCI1N0 THE WELL DAI
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mall Service Center -Raleigh, NC' —
27699-1636 Phone No. [phone], within 30 days. G W-I REV. 07/2001

is r lmn u•: Zip C .ale
I 1-
4 D' 1 E DRILLED 5 cif .\L DEP TH _.__ a.f.‘.� .----•
t. DOES WELL REPLACE EXISTING WELL.' YES 0 NC) le
7 ST 11 IC W \TER LEVEL Below Top of Casing. _9d __ El
is se •" if Abwc lap of Caona,
£ TOP 1:>F (:'AS!NG IS j. FT. Above Land Surface•
• top of e.rinl; laminated sl/or below land surface requires •-_-,_-_-
.arisnce in areordanae with ISA NC. \C ZC .OIIR. --'---'
a. l,.:LD(gpmt _l0_ METHOD OF FESIAlt l — .-_-
11 WATER ?ONES I Jeptll).. 10 33o —
' Loc. it)N'Kt-TCH.
11. I)I INI E(' 1-ION. Tvpc_ iti Cr4 _ ;\nrount -2.. --_ Sltoii WI and tlistamc.t In tnthis trans s.I Maas•.
U alI h kr-ss ts:. St nc Roads or C t./WIO Roads. Includ Il : read
12 CASING numbers and Common road names
Dept❑ U'�dlneler or \cc yhl rt. \1 s:.ujl
I root_ © _ To .- 2 Ft.___-- _�a'1'TDK Avg,
I7nm To EI. --- ...-- ' =
Him( lJ_._...-- Ft -- _ 7�L6 �1. O
p1as; oat\ti l td
i1 c,ItGll- n;,tn F /1___,a✓ Tglifl•— �� f�!{i7�% 1—ivQ • -y•
c3
i. N( RI - - Dprt Oamctce clot 5. \I: t:ru. g ,I
r i mi Tu____. it._ _1n in
__. _ is ▪ r:...
---
IS SAND GRA':ELPAC K: ▪ `.�..
Depth 5:2c
F .nnl __To._ Ft N
c.n
WELL CONSTRUCTION RECORD 299922
Nord: (� iol i u • L1ep.,nmmnl of Etreironmenl and Natural Resuur- • • Dr, of Water Quality - (,ound\uat.r Section
1 VYY �� .. -- C ERTIFICA I IONN/LE!". mat
w ka.l ('11\IN\('111R �,1\Lll\IDCNL)]A\tE (prinq ▪ C. �s1 `,. /�
g r,w a ._
C.Itti. LIDS __ PHONE. 12
\cEl I. ((1N1N\(IOR CGM1IVA\\ SAM1Ip ��N.i� J -,__._
.\SSOC'IA1 LO\\Q►ENN1TIr _____.__—.- _-
Siltl. SFEaMrf+._.—_._._. ---- (Oa `Ilcsblel
rd a t,1:CdN;c1 cl
\1 L.'. L L. ;C het k 1ppIlcabIc Bax)' Residential (y Athol. I p.il Pl.r.)l,: 0 Industrial D A_ticultural ❑
Heal Pump \\ales ln)xl,on 0 Ottear 0 IC Other, List Use___ ----
N10all(Il(, 0 Rccovrry 0
n ar 1 iosn. I Count), YK-»G
i. e-r..ne. ,bc-c,C n•.m unite Saha vi slot, L,t':u.[p Cody.
i.
t d 14Wi thQ YV(C�
Topographic Land setting
Idbc °Stripe ❑Valley ❑Fiat
tcncck PPr'r 1+: huv> .
Latitude Icngi ud. of well IG;al um
-
ileg'e 'I �•'
• .. Y� _ I wd \llongnuu< cou:eCtl°fir I ot.c znl le mac,
Di- Pali Dith LING LOCL,
To rJrlllu•1:f Dcy fPIWI'.
Do iL(cUY1 L.itTIFV i'Ar 14S%ELt.WASCUNSI10AlEDINACCORDANCE Wlllil\ANC V-2C WELL
iN., its 1. fl(l\ ST RDS, AND i HAT A COPY UP.I HIS RECORD liA5 BEEN PROVIDED I 1 HE1 WELL OWNER
- _SI L'Itc OF I'EIc3'.)N Cl �t_iil
NJiR''.Ii'-itF.UELI. J /DA f7.( ��'`--1jjl
Submit themgloat to the Division of Water Qualll), (%ruundl\nter Se.rim'
2'1199.I6.16 111--.m: No. [phone]. Nlrliin 30 days.
163b Mat/ Jer\u'e Cr ale r. Rslcigh, N(.
UW' I RFV. tin JI;01

WELL CONSTRUCTION RECORD
Ueparunent :,f Em,ronmenl and Natural Resourc - DI) nlon of Water Qualty • Groundwater
r Section
cttL4
29992_1
\„r;,l ( :rsIlet L YY14. CE n_�
)\4:1,('In, IN \CC I(In l\Ul\ADCAL1\4ME (OPPPU,__. -•_t .- ` iirrW. --- "JO"- ri 101 3r1-s
)t! 1 1 S'O� lit vC ion CO\1 Pa]\ ,AfSl f' �b ��.�1.1-JS-.
VI ,it '•)V-Li t't„a'rN•;,.: U\YE.xbllln_______
____.)Ssek IAI'E1) )vej PERMIT,* ___ _.___ _..
Of ,,;,_able!
, pia"I�:'at•;c, (/ �-"_ _..
�\ t L I. sit 11 heLk Applicable Is x)' Residential Lr Nl ttni ipal Punk: 0 Industrial 0 A,riculluraI 0 ___ I.
`.1..,:I:on nE. Q Recev:ry 0 Heat Dump Water In)ocuon ❑ O ! r 0 If Other, List list'.-_ ....— - _
2 \', CL!. i OCa1 IQN' 7opog d h!c,Lal d setting
ts aro•>tl'o,.n. Q(C a-- GRidge lope p\'alle} ❑Flat
�.�.1� , ennl,_ 1.L-_i%Q-Y'laia[, r')
47 LCI. ,9CsA _?5ii� rr s rrv„p a 6,w
Lwne ..,bcQ��- - 1.alitude l ngthtd: ,. well!ucahon,
te.i r.unr. hJ "ber•: Cowrie! Cy tio6U,cb L(1 :o I R•Jf.
t'� 4. / Ide ce can n ,d..
1 i A\ N ( t.id. �JC.1! �- - Q-t`� I ❑IrPSU, o{ o>,ri I n: !ni)p
)u �� �,.��(--i!%'1�—.-lL_3 I a!i11Je:lon3�tuuc souse b .,
� fr„m Tu Formaunn U ti r,nuon
Z�6'1
c, �.,. )-,n 1 . Zip (... is
Pi.:ec nw,'.he-ram
4. U.\,.F'. DRIL iH --
r•. DOES WELL REPLACE EXISTING WELL I' VES 0 NO
7 ST'AI!CW\TEKLEVELHQoitTop ofCasing .IDO--__-FT.
it I C,' r'ASlNC IS
FT. Above Land Set IdJC• - ___....
lop
o _r ,—_ -----
•Iup,drrsine rflntrtdhtfurl$. Cslandt requires a
•arlanrr in accordance %Ms 15A NC at 3C .0118.
J, YI'ELDleprnt I..3—V!tTHODOF TEST
1.
p� La:e 11010Iw!0-1
in, WATER ZONES !earth) ._.. O '- - -
�-y _—...
b, �j1C �• lmount •
.,._ Sh, , d'-r .n:,n aid Jp.tau in tuuu (coin at leas!
:1. )ISIING I ION. Tyne tr., ,,!� Roads or Count: Roads Include lac road
I�. CASING, a'.Neig .bt
Dtpc, D,amt!or or \�, e,gb t'h?. at.a:,!cl numbers and Common road names.
tvr+n, _ To_...--- Ft _
, , ! iIt( L T \laurtyal \tct rd
i4 SCR h1iN. :icon D,:aacte, Slnl S'.,'.: Ak.l:na.
in tn-----_.
Is S-\N!).GikA%EL. PA( K.
Utp:G Sst
lac•v.
10 Rt11ARSs!
; DU HL!ti't1 V CI. it I IF) I HAT ';!!i:i`ItLL WASLV\ll!t'-t IbL' IN ACCUkD KCt. W I'IH I51 NC AI 2C. WEL!. N `:
: GISr:t; c. Tlfy' NDAb DS.A\D 1HAT ACO!\' Of THIS Rt.t ORi) HASI3hE. 1'RONIUFJ 1U I HE 1\EL. !. ON'tG&
___.
-O n�rt
- ---- ,I(,G\rL'Itt Oh PElc,.i^,ip\,1 ht.i-, ,'.t, '-, .. )El.l
y\k.k‘st v. cLe 1,“
5.5
1
:.J
Submit the original to the Dirision of Water Quality, lirnund:):ltei Steliun. 1636 \t an servirr Uv to I REeigh, Nf
'_7699 1 bil. ?Inn, Nu. [phone]. Nithin }fi (hi))S.

299920
WELL CONSTRUCTION RECORD
North C'arohna - Department of Environment and Natural Resoure 5 - Division of Water Quality. - Groundwater Section
CON rR4C'I OR IJNUI\'IDOAL) \A\1E (print) L�K Y�1 i� a-_ CERTIFICATION # Sec) ����
WEI 1. CONTR:+("f OR ('ONI PAN} NAME tptbt�rh 4.1i12)11µg PIi ONE #
ASSOCIATED \AO PERMIT*
.St.AI E s+111.1. CONS"(RLCTION PERNUT#
d applcable) (if applicable)
I. WELL ESE (Check Applicable Box): Residential 01/Muni:ipal!Public 0 Industrial 0 Auricultural ❑
Nionitoriing 0 Recovery Cl Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELLLOCAT�I� TopographiciLandsetting
NearestTow1111 1 •
eiry)I e-- Count ys avo_ol"`�-�C. GKidgc lope ❑Valley GFlat
3fl piI l �e C V�[)e . z�'t4"1 (check appropriate box,
l jtrecl Name. Numbers, Connvuni:q, Subdivision, Lot tie., Zip Code,
Latitude/longitude of well location
tdegreesamn iiesowNoodsi
L, atin.lde longitude source:❑GPS❑Topographic !nap
ichcek bast
DEPTH
From DRII LI^1C' Of;_ --.....-
From To Formation Description
.-
Ill WATER ZONES (depth). Z(O 1 Z(PO LOCATION SKETCH
i I. DISINFECTION: Type Amount Z. Show direction and distance in miles frbnnat Last
12. CASING: Wall Thickness two State Roads or County Roads. Include the road
De tit or WcightiFt. Alatcnal numbers and common road names.
0 P
From To 1_51 Ft.
From To Et.
Mom To Ft.
l;. !stem T: Depth
Front To Ft -
Address
q tswrt cr Houre!�',IQ. Z-11l
IA )Q� ��►�1e N �S
s'i:< or 'I men S:ate Zip Code
l I-
.\6'a cede- Phi number
4. DATE DRILLED 7—�_-0
5. TOTAL DEPTH: Z$ 5r
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO B"
7. STATIC WATER LEVEL Below: Top of Casing: ) 0 0 FT.
t 0 se `'•' if Above Top of Casmg)
i
8
. TOP OF CASING IS __ FT. Above Land Surface`
•top of easing terminated atlor below land surface requires a
variance in accordance with I5A NCAC 2C .0118. AA.. `tl.
9. YIELD Igpm) 10 METHOD OF'TESTAi t. a i hI
Flom To Ft.
in
Diameter
Material Method
14 SCREEN: Depth Diameter
From 'To Ft. in
From lo Ft. in
15, SAND:GRAVEL PACK:
Depth Size
Flom To Ft.__ —
Front To it
16. REMARKS:
\lateria
-ZCD
oid ,khY6 -th
4 iti:-4 Cs-ce.k CL
t7-2
—
I DO IIEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NC4(.2 2C, WELL
('ON TRtgifl0 TAN ARDS AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
e/C93-- - - Zia
SIGNATURE OF PERSON CONSTRUC.TiNG THE WELL DATE
Submit the original to the Division of Water Quality, Groundwater Seclion. 1636 Mail Service Center Raleigh, ��01
27699-1636 Phone No. [phone], within 30 da)s.

WELL CONSTRUCTION RECORD
299918
North Carolina - Department of Environment and Natural Resourc Division of Water Quality - Groundwater Section
1 _ CERTIFICATION N L`t
t\ELL CON I'ICACI OR (INDIVIDUAL) NAVE (print) /-._r (. r(� , �t
WILL ('ON I R ACC t OR CO\IPAN, NAME ilK�SYekLhK- 1'iQYL Lh PHONE k y-$S.4zz3
s t A I E sc l:t. lit (rnS'rKt:(I ION PERMIT# ASSOCIATED WQ PER!NIT#-------
ii`.'applicablel
Of
WELL LLiF (Cheek Applicable 13ox): Residential VMunicipal!Pubh. 0 Industrial ❑ Agricultural ❑
Modr.or'l'.g 0 Rccoery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use _—_
2 WELL LOCATIO.
Nearest TownTg5 ti 't---�-- County �4
.5 y. tt.� ._
U. ... N.rnc. Numbers, Commuri'. v. $uhdivieio1+Lot No., Zip Cote]3. OWNE \(: -�.al (11 '[.° P
I
tStreet w Nye a No-i ZS y
Cm or'I a'n Statehip Codc
I_ )-
Arca code- 'Phone nua',hu
4. DATE DRILLED CQ• J4- 0 z
5 TOTAL DEP VH: 3Ca~7 a
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO B"
7 STATIC WATER LEVEL Below Top of Casing:,
(Use "+" if Abaci:- Top of Casing)
8. TOP OE CASING IS _ ` _ FT. Above Land Surface'
'Fop of casing terminated at/or below land surface requires a ,�
variance in accordance wish I5A NC AC 2C A118. /� // `' •
9. YIELD (epm): Si 5 METHOD OF TESTA I. K 61*-11A
Topographic/Land setting
dgc ❑Slope ❑Valley • ❑Flat
(check appropriate box)
Latitude longitude of well location
(degrees/minutes/seconds)
Latitud.dlongitude sourcc:❑CrPSOTopographic map
check box)
DEPTH DRILLING_LOG
From To Formation Description
I0. WATER ZONES (depth): 14- ,. 1'S a. 3 40
11. DISINFECTION: Type Amount 2-
12. CASING: Wall Thickness
iG�N Depth D .amelr or Weight'Ft. Material
F7om0 To Et.
From To Ft
From TO Et
I3. (ROUT: Depth Vlutcdal blcthod
�ctCtla �Ll``__-_-
From_ - — F't._ To .r
From To Ft. _--
14. SC'RLEN: Depth Diameter Sint Size Material
From To_-- Ft. in. in. - ---
To Ft in. in.
15. SAND/GRAVEL PACK:
Ucplh Size Mater'a:
Fran i
From To Ft
From To Ft.
I6. RENIARKS:
G.)
LOCATION SKETCH t-
Show direction and distance In miles from at leas! -
two Slate Roads or County Roadsinclude the road
numbers and common road names.
1 DO HEREBY CERT
CONSTIRUCTIONL.
AT fllb \'. EL.L WAS CONSTRUCTED IN ACCORDANCE WITH ISA NCAC 2C, WELL.
)S. A9 THAT A. COI'Y OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWN
ER
SIGNATURE GE PERSON CONSTRUCTING THE WELL DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1616 .Mail Service Center - Raleigh, NC
27699-I636 Phone Nn. [phone], within 30 daAs. CiW-I REV. 07;'2001

from To
From To
16. REMARKS:
WELL CONSTRUCTION RECORD
North Csrohna - Department of Environment and Natural Resourc" - Division of Water Quality - Groundwater Section
L.t Yr.� _ CERTIFICATION it Z`��
\\ F:L(. ('US IRS\CTOR (INDIVIDUAL) NAME (print) «1 —t a.a `(� —*-- ��
as b t-�rilb—K� _ PIIOME a
VA Ell. CON"' N:\Cri)N C'O?I hA\\ NAME aS:r • ASSOC
I tl El/ AND PER\MIT%
s'r,crE \\r:u. cu>srNl: clluN releau'ra (if al,licable)
(a, �Grablel
WELL USE (Check Applicable l3ox): Residential ri M1lunicip.lPublie ❑ Industrial O Auricultural ❑
\Innitoring 0 Recovery O Heal Pump Water Injection 0 Other 0 If Other, List Use___
2. WELL LOCATI( N: •
Nearest To\, iv .Le. l c (.5
Srec. l.nrc. Ncmbcrs. Connnunity, Suhd
3. OWNER. J&Y l e1.e-1
\ddress l ut. J
Lei c .54:e et or itReeo.1 rzs'i'-�
299915
t_ Topographic/Land setting
County 0%�13'>! ./ ridge ❑Slope Valley.• [Mat��' eS5 2- g`74- d tcheck a iproprtatc host
Lot No. z.ip Code l Latitude/longitude of well location,
City or Tian State Zip Cod:
t )-
Ate.i c,ide- Phor.e r.un'.her
4_ DATE DRILLED?' Z 11 - n
5 TOTAL DEPTH: 7-QC)
E. DOES WELL REPLACE EXISTING WELL" YE.S opt NO lirs
7. STAV IC WATER LEVEL Below Top of Casing. (P FT.
t Use •'4•'tf .Above Top of Casing) t'S
R. TOP OF CASING IS _ l FT. Above Land Surface*
"ip et casing terminated at/or below land surface requires a
variance In accordance with ISA NC AC 2C .0118.
�1� I `
9. YIELD (gpml: �� MET {OD OF TEST
CIi I, �44l�Pa-
10. WATER ZONES (depth): HOT ZS5
t degresr nn n. lies/seconds )
Lathude/lungimde source:OGPSOTopographic nmap.
t d,ec� boei
DEPTH, DRILLING LOC_
From To Formation Description
11. DISINFECTION: Type_
12. CASING:
D,:pth
From
0 r(131
Ft.
From ___ To_ Ft.
From To Ft.
13. GROUT'. Depth
.'v1at.:ria1 Method
From To
Frt•11 To Ft14. SCREEN. Depth Dian'eter Slot Size .Material
Rtnp To Ft in. in.
Front To Ft. in. in
15. SAND'GRAVEL PACK:
Amount �.
Wall thickness
Blame: er cr Weight/P. Material
Ft �Astat ' ,11c.__
Depth Size
Ft.
Ft
Material
LOCATION SKETCH
Show direction and distanet in nnlcs from at Ictii. t
two Suite Roads or County Roads. Include the kid
nunibers and common road names.
moo 3 NI et,\ V
I DO IIEREBY CERTIFY THAT rl HIS RELL WAS CONSTRUCTED IN ACCORDANCE WITH I5A. NCAC 2C, WELL
CONSTRICT] ND. D .. A,NI 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 Sersicc Center- Raleigh, NC
?7699-I GJ6 Phone No. [phone]. within 30 days.
OW-: REV.07/2001
11

300049
WELL CONSTRUCTION��RECORD
North Carolina - Department of Environment andx IJatural
�1J[ Jurces - Divisionlof Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAM (print q//-� r a al L— CERTIFIICAT,tIgON Ora 0 7,7
WELL CONTRACTOR COMPANY NAME.P..A%fi LA J.SG/ 1f.1r e/ 74PHONEri4 2 4-4 pie'-
STATE WELL CONSTRUCTION PERMIT# _&, ASSOCIATED WQ PERMIT# 41/h'
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential $ Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATIO
Nearest Town:
countgathdandi
s7s2
(Street Nam; Numbers, Community, Subdivision, Lot No., rip Code)
3. OWNER:
Address
, ;ljnc. 0289§
City(Street or4Roor Town State Zip Code
Arca code- Phone number
4. DATE DRILLED sM 7/eN
5. TOTAL DEPTH:..? «S'
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO 0
7. STATIC WATER LEVEL Below Top of Casing: Y C FT.
(Use "+^ if Above Top of Casing)
8. TOP OF CASING IS % S FT. Above Land Surface"
`Top of cuing terminated at/or below land surface requires a
variance In accordance wl h ISA NCAC 2C ADS. •
9. YIELD (gpm): / 5 METROP OF TESTT�rri
10. WATER ZONES (depth): .Z rvs '
11. DISINFECTION: Type r, i9 /•i
12. CASING:
Depth
From_ /2 _To%DO Ft.
From To Ft.
From To Ft.
13. GROUT: Depth *aerial Method,t
From_ To ..2(�. 2 0 Ft. a+rs.� /. Play
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
Ft.
Ft.
16. REMARKS:
ameter
Topographic/Land setting
Ridge 0Slope OValley ❑Flat
(check appropriate box)
Latitude/longitude of well location
Latitude/longitude
DEPTH
From To
v
(degrees/minutes/seconds)
source: ❑ GP S ❑Topagraphi o_map
(check box)
DRILLING LOG
Formation Description
9
CS
rr
c
Do
LOCATION SKETCH tv CA
Amount / D Z— Show direction and distance in miles frwi at least'
Wall Thickness two State Roads or County Roads. Inclth thud
or Weight/Ft t al numbers and common road names. z
r#2/
1 DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WFT r
CONSTRUCTION STANDARDS, AND T}iA.3 A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
o-2 ta s�t,z WO V
SIGNATURE OF PERSON CONSTRU G THE WELL ATE
=:1
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

301535
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment anti v•fJ({r rat RLL,csoureta - D`Aivisionof Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (prtar) U , \ N S;J CERTIFICATION I a1-1 I
WELL CONTRACTOR COMPANY NAMCRF.UBEN CALDWELL DRILLING, INC. PHONE 1 q8 54-3581
STATE WELL CONSTRUCTION PERMITS
(if applicable) / (if applicable)
1. WELL USE (Check Applicable Box): Residential LDl MunicipaVPublic 0 Industrial 0 Agricultural 0
Monitoring ❑ Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
ASSOCIATED WQ PERMITS
2. WELL LOCATI
Nearest Town:
14-
eV Cf County "N c`' cvmg
tt ' i E e.)A'7
anmunirf, Subdivision, Lot No Zip
(Strew Name, Numben, CCode)
3. OWNER: o�)4 (4At`S TaNe
Address I P LC; —"Leer 1,JA`/
AS Y,LL tajjC-N)
Qi?Xo6
(Sae)""Taas s aab I Zip Code
Ares code- Phone slumber
4. DATE DRILLED 1i — a`
5. TOTAL DEPTH: a `J co
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO 121
7. STATIC WATER LEVEL Below Top of Casing: 60 FT.
mi.♦ if Above Top of Casing)8. TOP OF CASING 1S FT. Above Land Surface'
0 -G 4-
TopograpM Land setting
❑Ridge IBS`lope ❑Valley ❑Flat
(check eppeoprieta box)
Latitude/longitude of well location
(eeyteahnimaSandj)
Latitude/longitude source:❑GPS❑Topographic map
(check boa)
DRILLING LOQ
Fogqmmaation Description
DV 6 ell 0CZA6N
uC6Vtc€ - ao GPin
GUF2'
PEPTIi
From l To /
o9 - I(on/
16o r
1 bo' aSo
*Top of cadal t.rmleted al/or betaw led surface require.' •
variance In accord.jc.with ISA NCAC )C.OIII.
9. YIELD (gpm): Cse 0 METHOD OF TEST `<i G- A I re,
10. WATER ZONES (depth) 1 100 / - 2ao G (''f
11. DISINFECTION: Type
12. CASING:
Diarpper
From To �1 14- Ft. by
From To Ft.
From To Ft.
13. GROUT:1 Dcpth Materiel nMe
Fro1- To a a Ft. C/i tin is tJ ( t J 17
m
From To Ft.
14. SCREEN: Depth Diameter Slot Sire Material
From To Ft. in. in.
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Size Material
O Amount
Wall Thickness
or aWeight/Ft. Material J,c>
From To Ft.
From To Ft.
16. REMARKS:
f( c
cix
fp
LOCATION SKETCI{
Show direction and distance in miles from at (cast
two State Roads or County Roads. Include the road
numbers and common road names.
Qv% -C(Led 14
cif) M
cb (Pt
LS 7
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITHI ISA NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RECORD 1 AS BEEN PROVIDED TO THE WELL OWNER
rva�t. % - 1 S - 0
SIGNATURE OF PERSON )CONSTRUCTING T1iE WELL DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mali Service Center -Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-1 REV. 07/2001

301551
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment And Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) NEIL CRAFT CERIINICATION # 3114
WELL CONTRACTOR COMPANY NAME PITTMAN WELL BORING, LLC PHONE # [phone]
STATE WELL CONSTRUCTION PERMIT # _ ASSOCIATED WQ PERMIT #
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential ® Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION:
Nearest Town: BLACK MTN.
GOLD ANCHOR LANE
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: ANDER SCHREINER
Address 68 GOLD ANCHOR LANE
(Street or Route No.)
BLACK MTN, NC 28711
City or Town State Zip Code
(828) - 230-4193
Area Code Phone number
4. DATE DRILLED 08/13/04
5. TOTAL DEPTH: 405
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO
7. STATIC WATER LEVEL Below Top of Casing: 60 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS 1-1/2 FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordance with 15A NCAC 2C .0118.
9. YIELD (gpm): 2 METHOD OF TEST ARD
10. WATER ZONES (depth):
County BUNC
11. DISINFECTION: Type CHLORYTE Amount 10.5
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
From 0 To 32 Ft. 6-1/4" SDR21 PVC
From To Ft.
From To Ft. _
13. GROUT: Depth Material Method
From 0 To 20 Ft. QU KItETE POURED
From To _ Ft.
14.SCREEN: Depth Diameter Slot Size Material
From _ To _ Ft. _ in.
From _ To _ Ft. in. _ in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
Topographic/Land setting
❑ Ridge ❑ Slope ❑ Valley ❑ Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source: 0 GPS 0 Topographic map
(check box)
DEPTH
From To
DRILLING LOG
From To
LOCATION SKETCH
Show direction and distance in miles from at least
Two State Roads or County Roads. Include the road
number and common names
HWY. #9 N. FROM BAT CAVE. GO APPROX. 8
MILES. LEFT ON GOLD ANCHOR LANE. STAY
LEFT AT FORK. GO TO DEAD END.
te
tr
t �y
cP
% . 0
Q
16. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT AA COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
OF PERSON CONSTRUCTING LL DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-1 REV. 07/2001

301550
WELL CONSTRUCTION RECORD
North Carolina — Department of Environment And Natural Resources — Division of Water Quality — Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) NEIL CRAFT CERTIFICATION # 3114
WELL CONTRACTOR COMPANY NAME PITTMAN WELL BORING, LLC PHONE # [phone]
STATE WELL CONSTRUCTION PERMIT # _ ASSOCIATED WQ PERMIT #
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential ® Municipal/Public ❑ Industrial ❑ Agricultural 0
Monitoring 0 Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use
2. WELL LOCATION:
Nearest Town: BLACK MTN
GOLD ANCHOR LANE
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: BILL SHARP
Address 30 GOLD ANCHOR LANE
(Street or Route No.)
BLACK MTN. NC 28711
City or Town State Zip Code
(561) — 512-2510
Area Code Phone number
4. DATE DRILLED 08/16/04
5. TOTAL DEPTH: 105
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO
7. STATIC WATER LEVEL Below Top of Casing: N 40 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS 1-1/2 FT. Above Land Surface*
*Top of casing terminated atlor below land surface requires a
variance in accordance with 15A NCAC 2C .0118.
9. YIELD (gpm): 25 METHOD OF TEST ARD
10. WATER ZONES (depth):
County BUNC
11. DISINFECTION: Type CHLORYTE Amount 3
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
From 0 To 55 Ft. 6-1/4" SDR21 PVC
From To Ft.
From To Ft. _
13. GROUT: Depth Material Method
From 0 To 20 Ft. QUIKRETE POURED
From To _ Ft.
14.SCREEN: Depth Diameter Slot Size Material
From _ To _ Ft. _ in. _ in.
From _ To _ Ft. _ in. _ in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
Topographic/Land setting
❑ Ridge ❑ Slope ❑ Valley ❑ Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source: ❑ GPS ❑ Topographic map
(check box)
DEPTH
From To
DRILLING LOG
From To
LOCATION SKETCH
Show direction and distance in miles from at least
Two State Roads or County Roads. Include the road
number and common names
HWY. #9 N. FROM BAT CAVE. GO APPROX. 9
MILES & LEFT ON GOLD ANCHOR LANE. RT. AT
FORK HOUSE AT DEADEND.
16. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THA'�%A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
f/ .�, TR P2'/)\Ci -/ 4 " e7
SI .NA " OF PERSON CONS UCTING 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

301539
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and watuRral Resourc�e-., {s - Division of `Water Quality - Groundwater Section -7 �/
WELL CONTRACTOR (INDIVIDUAL) NAME (prier) k3 L.t.- % G tJ A 6) N CERTIFICATION Y a- 1 1 I
WELL CONTRACTOR COMPANY NAME_REUBEN CALDWELL DRILLING, INC. PHoNE4%8 1254-3581
STATE WELL CONSTRUCTION PERMIT/ ASSOCIATED WQ PERMIT/
(if applicable) (if applicable)
I. WELL USE (Check Applicable Box): Residential cif
Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION:
Nearest To : LiJCA/tT2411L--t County V
P ITat1 tilt 4S
(Swett Name, Number, Community, Subdiivision, Lot No., hip Code)
3. OWNER: RI e.,fr R&D Pi)Ni)r3
Address �l4 �v((- e (2_," "AL)
outs No.)
G)t.A1gl�dt w R ►JC arl'&
(gCi(ty or Town SWe tip Code
(04S %65a
Aran coda Phone number
4. DATE DRILLED % - as — 04,
5. TOTAL DEPTH: 'a' a '
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO
7. STATIC WATER LEVEL Below Top of Casing:
Wu -+" If Above Top or Cuing)
8. TOP OF CASING IS 1 FT. Above Land Surface*
*Top of colas terminated afar below laud surface requires •
variance la •ccerd•ve with ISA NCAC 2C .0111.
9. YIELD (gpm): l t) METH OF TEST
10. WATER ZONES (depth):/'
11. DISINFECTION: Type I1TH Q O Amount ,l/a ( 6
12. CASING: Wall Thickness
th ter or Wei Ft. al
From £ To i a I Ft. 8 5OOE I
From To Ft.
e7
FT.
m
From To Ft.
13. GROUT,' Dept)L Material Method
Frorrt_.To ola Ft. LATentsAurr voOte-6(>
From To Ft.
14. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in.
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
Topographic/Land setting /
❑Ridge ❑Slope ❑Valley Flat
(check appropriate box)
Latitude/longitude of well location
(deveu(mimaedceemds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH DRILLING I.OG
From /t T. r Forr!yntaatio9Description_
0V6 c1a- Ofa%
6 a.s ra L-r €r
1. o� Cf 1/ic - (DC,PM
6bo' - d.3o' CG
cek
LP re,
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common road nam
errtsg 5 b
J uPra:R
Ntuj
16. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED M ACCORDANCE WTDt 15A NCAC 2C, WELL - -
CONSTRUCTION STANDARDS, AND THAT A COPY THIS CORD I BEEN PROVIDED TO THE WELL WNER�
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
Submlt the original to the Division of Water Quality, Groundwater Section, 1636 Malt Service Center- Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-1 REV. 07/2001

301533
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natnural Resources - DiGroundwater
vision of Water Quality - Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) 7) \ <.L1 E PA s (d CERTIFICATION / a'—{ I
WELL CONTRACTOR COMPANY NAME_REUBEN CALDWELL DRILLING, INC. PRONEQk8 ).54-3581
STATE WELL CONSTRUCTION PERMIT/ ASSOCIATED WQ PERMIT/
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential t9" Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery ❑ Heat Pump Water Injection 0 Other 0 If Other, List Use
County
2. WELL LOCATIORN:
M-iks41 La- 6" �NcomP3E-
A0-wq _'..-0 J
(Sueel Name, Numben, Community, Subdivisions Lot No., Zip Code)
3. OWNER: 12—'4 fv5 m1T 4
Address % A ram t2, er"" ba.
(Suer or Route No.)
Nearest T
NS a6VL t,Lr (3 C g' o (e
�er,�tg2c��C��ity or ToytQ l S Suts5 s 3 Zip Code
lc) d�
Area cods Phone number �I
4. DATE DRILLED Qi — Ql — D4
5. TOTAL DEPTH: 6
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO d
7. STATIC WATER LEVEL Below Top of Casing: Co 0 FT.
A (Use `a' if Above Top of Casing)
8. TOP OF CASING IS FT. Above Land Surface*
Top of easing terminated atior below lead surface requires a
variance In sccordaa wltb ISA NCAC 2C .0111.
9. YIELD (gpm)• `0/ METHOPD OF TEST I`-t
WATER ZONES d� CQ — GPM
C'Ttg-
10. AT R O (depth).
11. DISINFECTION: Type
12. CASING:
44 Depth
3
From To
From To
From To
13. GROUT: ��((� Depth
From .-1 To
4'
TM �{ Q Amo—flunt
Wall Thickness
or Weight/Ft. Matfris
SOXal (//Vv
Ft.
Msecrisl
(`_tiMENT
From To Ft.
14. SCREEN: Depth Diameter
From To Ft. in.
From To Ft. in.
15. SAND/GRAVEL PACK:
Depth Size
From To Ft.
From To Ft.
16. REMARKS:
rOOttel
Slot Size Material
in.
in.
Material
/fopographic/Land setting
IffRidge ❑Slope ❑Valley OFlat
(check appropriate box)
Latitude/longitude of well location
(degreeahulnutn/tecoodt)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DRILLING LOG
Fom{ation gescription
OVtS(Zu(ZO�,
G RA r�•TL
t(L6dttc ()PA-%
DEPTH
FroSn r! To /
5t'- alto'
0-.6o'
tabub1o'
C-re4atact!s
P
it r3'v
o�`ko
e__�, 4.
LOCATION SKETCHsr O�4''
Show direction and distance in miles from at least .
two State Roads or County Roads. Include the road
numbers an common road t es.
AO.1-J 1-L,ac: I
M
ICcS7a t./4 co
4 . S /
CA-rro, A /e
1 DO HEREBY CERTIFY THAT THIS WELL W CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A PY OF T},{IS RECOHAS BEEN PROVIDED TO HE WELL OWNER
SIGNATURE OF PERSON CONSTRUCTING THE WELL
DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Malt Service Center- Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. G W-1 REV. 07/2001

3. OWNER:
Address
301537
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of, 'Water Quality - Groundwater Sectione..t
WELL CONTRACTOR (INDIVIDUAL) NAME (prier) I)N.- \ SJ P. S W CIRTIPICATIONa al
weLLcoNTRACroR COMPANY NAME_REUBEN CALDWELL DRILLING, INC. PHONE ;54-3581
STATE WELL CONSTRUCTION PIRMITI ASSOCIATED WQ PERMITa _
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential Ef Municipal/Public 0 Industrial 0 Agricultural-0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION
Nearest Town A $ A'-eP- County
fro C T t_#e (C a A 0
(Street Name. Nu ben, Cmrununity, Subdivirian, Lot No., lip Code)
M.A&' & k u Pit Si C t2— -
5 a tan.' t of t 1,4 A (LT JCo A
�ANA (Street "etc."_°' Q_C'l IS
City or Town State Zip Code
(,(,c �i--( 8'
Area coda- Phone number
4. DATE DRILLED s 1 a. " O4.
5. TOTAL DEPTH: 5 10 /
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO
7. STATIC WATER LEVEL Below Top of Cuing: 1( D FT.
(Use -+' if Above Top of Casing)
8. TOP OF CASING IS FT. Above Land Surface*
*Top of cuing terminated War belaw Ind surface requires a
vat -Inca In accordant wllh ISA NCAC 2C .01 t1.
9. YIELD (gpm)• tO METHOD t,F TES
10. WATER ZONES (depth): 4 IS o,�/
I1. DISINFECTION: Typei�ti4 L(13`(o Amount 1 16
12. CASING: Wall Thickness
Depth ter or Weight/Ft. a al
From To bS Ft. r� %ail -a( V
From To Ft.
From______ To Ft.
13. GROUT: Depth Material Method
From a To am Ft. C- r NY( r©u O
From To Ft.
14. SCREEN: Depth Diameter Material
From To Ft. in.
From To Ft. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
T -Al2
m
Slot Size
in.
in.
16. REMARKS:
i)vdJeomi3e.
opographic/L.and setting
F3Ridge ❑Slope ❑Valley ❑Flat
(check appeopriete box)
Latitude/longitude of well location
(depeea6ntmaesisecoade)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DRILLING LOG
DEPTH
From / To /
4-Jo'
4_e 0 /
4%0' -
oFo a io 00-40Descripi6on�
C±nCA-r4 tttC N
cReit tc-c - G G4)sin
cr
C.o l J
,7 DLO
LOCATION SKETCH O C,,p
Show direction and distance in miles from at least Oy
two State Roads or County Roads. Include the road
numben and common wct.tirojcir cite (3 V-
,3m�
r7 irk
t,"
lSl
1 DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED ACCORDANCE WITH ISA NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A Y OF THIS REC HAS BEEN PROVIDED TO THE WELL OWNE
Cait"v — tb —O 4--
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mall Service Center -Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-I REV. 072001

301536
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and mount Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (pent) 9, I t. L . IJ S 7.1 CERTIFICATION / an 1
WELL CONTRACTOR COMPANY NAME_RF.UBEN CALDWELL DRILLING, INC. PHONE
448 ;54-3581
STATE WELL CONSTRUCTION PERMIT/ ASSOCIATED WQ PERMIT/
(if applicable) (if applicable)
I. WELL USE (Check Applicable Box): Residential 1/Municipal/Public 0 Industrial ❑ Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 if Other, List Use
2. WELL LOCATLON:
Nearest Town: NANA RISSV I lure County
A ft.) ot,taiso),1 CaV�
(Street Name, Numbers, Community, Subdivision, tot No., Zip Code)
3. OWNER: Ul- eV A _ e(LJ
Address 114 t 44 Ap A A✓e.
S j 18 (S Ten o< Route No.) /
�lt_t r P C- a%�'0k,
try or Town Stale Zip Code
y.
Area code- Phone number 4. DATE DRILLED % 1 c1 - 0 4
S. TOTAL DEPTH: a 5 O
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO YZJ
7. STATIC WATER LEVEL Below Top of Casing: 1-, V FT.
a. (Use `+' If Above Top of Casing)
8. TOP OF CASING IS FT. Above Land Surface'
*Top of cuing terminated at/or below land surface requires •
varlalee In accord ace with ISA NCAC 2C .011S.
9. YIELD (gpm): rot'o METHop OF TEST ICA G - A I
10. WATER ZONES (depth): 1 *c - a e G I m
c•I CO Iva
'Topographic/Land setting
Ridge ❑Slope ❑Valley ❑Flat
(deck appropriate box)
Latitude/longitude of well location
(degreeahoimans sermds)
Latitude/longitude source:❑GPS❑Topographic map
(chock box)
DRILLING LOG
Forrpation Description
0
(Vof2— �/2—tat3�
17c-A .-c715-
.c - ao Gfrs
6a-P �C",
try ��/g
e ni p
DEPTH
Frpm
4; S"- 14-0
i4-12
40 `- 9-So'
1 I. DISINFECTION: Type
12. CASING.
Depthe
From To Do
14TN fl!o Amount y�a
From To
From To
13. GROUT:2 Depth
From To c� Ft.
From To
14. SCREEN: Depth
From To
From To
IS. SAND/GRAVEL PACK:
Wall Thickness
Ft. bf r Sa#- tr t4
Ft. C'
Ft.
MtErneNT Pooethod
p
6
Ft.
Diameter Slot Sire Material
Ft. in. in.
Ft. in. in.
Depth Sire Material
From To Ft.
From To Ft.
�O OD `nc�V
J OCATION SKETC)-I s
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common road names.
16. REMARKS: lW "/
A) „A Op
1 DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH ISA NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND TH OPY OF THIS RE�ARD HAS BEEN PROVIDED TO HE WELL WNER
o 4-
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mall SeMee Center- Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-1 REV. 07/2001

301832
WELL CONSTRUCTION RECORD
North Carolina - Department of Enviratwaaut and Natural Resources - Division of Water Quality - Groundwater Secucr
WELL CONTRACTOR (INDIVIDUAL) NAME
�-��(,�,p�-rri��utt)--)/////R�aOn/ C. �/ ry // CERTIFICATION b Z..3 7.7
WELL CONTRACTOR COMPANY NAMES'WGC-t (V4T€( Weal PIINN/L Tt t/J PHONE o 11A+ i.64 Ysa
STATE WELL CONSTRUCTION PERMTr% 4/6 ASSOCIATED WQ ERMrrs
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential /Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other ❑ If Other, List Use
2. WELL LOCATION. (/
4.Qjj/„
Nearest Town: edt04#Ure/fe CountyR 4
/f Tea i e/rq t
(Seca Name, Numbers, unity, Subdivision, Lot No., Zip Code)
3. OWNER' &[y. (, P(UN
Address /5 /Pa r/ i9
lira or R�NN6)
t,.9eauteo�/ Z%7$ 7
$21)- 4, ` 5S 7C) zp Code
Ater code- Phone mum
4. DATE DRILLED be 2 4 '- d l/
5. TOTAL DEPTH: to 6 /
6. DOES WELL REPLACE EXISTING WELL? YES P1 NO 0
7. STATIC WATER LEVEL Below Top of Casing: 9D' FT.
f/ Nse"+" if Above Top of Casing)
8. TOP OF CASING IS / 8 FT. Above Land Surface'
'Top of easing terminated at/er below Iaad surface requires a
ransom to accordance with 1SA NCAC 2C.011& .tr �,
9. YIELD (gpm): /Q HOD OF TEST / # t �(
10. WATER ZONES (depth): /FQ'
11. DISINFECTION: Type G,/('j
12. CASING:
Depth
From To_a£ Ft
To Ft.
Froze_ To Ft
13. GROUT:
From 0
From
14. SCREEN:
Fro
Fro
15. SAND/
From /
From
Depth
To_1041 Ft
To Ft.
Depth Diameter
To Ft in.
To Ft. in.
VEL PACK:
Depth Size
To Ft.
To Ft.
Annotmt /0 0 T.
Wall Thidmess
or Weight/Ft Material
S4I? 2J P JC
Material
�vIY' /
Slot Size
in.
in.
Material
Topographic/Land setting
❑Ridge ESlope ❑Valley ❑Flat
(check appropriate box.
Latitude/longitude of well location
Latitudelong
(degmes-miawestseconds `.—
tude source:❑GPS❑Topographic map
DEPTH
From To
DRILLING LOG
LOCATION SKETCH
Show direction and distance in miles from at (east
two State Roads or County Roads. Include the road
numbers and common road names.,
O
16. REMARKS.
1 DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUC EWINAOCORDANCE WITH 15A NCAC 2C, WEIR
CONSTRU N STANDARDS, AND THAT A coif %TH1SR D HAS BEEN PROVIDED TO THE WELL OWNER
SIGNATURE OERSON
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. 07,200

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources Division of Water Quality - Groundwater Section c �/ WELL CONTRACTOR (INDIVIDUAL) NAME (print)411eh el C_ /. Dp 5 7'g_ CERTIFICATION * T Q7
WELL CONTRACTOR COMPANY NAME j eaSet 0 J,e_i wLtenleY C _ PHONE *�(-(�Y 2b
STATE WELL CONSTRUCTION PERMIT* __2//¢ ASSOCIATED WQ PERMIT*
(if applicable) //'''' (if applicable)
i. WELL USE (Check Applicable Box): Residential l7J Municipal/Public O Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other ° If Other, List Use
2. WELL LOCATION:
Nearest Town: ` ► ✓/ County-
PNE+ FUr
(Strut Name, Number, Ccenmuaity, Suomvisioo, Lot No, Tip Code)
3. OWNER:9/t (L ( r7^ IL e 5I /{
Address 1 /q Pi/tit T Fa'/( (?.1
c�5tit (S9Nt- for Route Ie Nt-
�APtuar
City or Town State Zip Code
( Area code- Phone number
4. DATE DRILLED $ ' 2 / • o y
5. TOTAL DEPTH: cc,- /
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO le
7. STATIC WATER LEVEL Below Top of Casing- (.6 FT.
U ruse..." if Above Top of Casing)
/
S. TOY OF CASING IS ! 7) FT. Above Land Surface'
'Top of casing terminated at/ar below Iand surface remakes a
variance in accordance with ISA NCAC 2C .011*.
9. YIELD (gpm): 7 THOD OF TEST if/ sin C d _
10. WATER ZONES (depth): B0#
11. DISINFECTION: Type C // H
12. CASING:
Fron�O_
From
From
13. GROUT:
From_.
From
14. SCREEN:
From
From
15. SAND/G
From
From
Dept
To-_Q Ft
To Ft
To Ft. Material/
Depth
T� FVeclto_T e
Amount 10 o z.
Wall Thickness
or Weighr/Ft. Material
$pe 2/ C.
To Ft
ethod
srla #.1j�
Diameter Slot Size Material
Ft. in. in.
To Ft. in. in.
EL PACK:
Depth S
To Ft.
To Ft.
Material
16. REMARKS.
301821
Topoic/Land setting
°Ridge ((dope °Valley °Flat
(check appropriate box)
Latitude/longitude of well location
(degraNminutWsxmds)
Latitudellongitude source:°GPS°Topogtaphic map._
(dads box)
DEPTH
From To
Formation Desc ..lion.
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.
/9 1
1 DO HEREBY CER I IF Y THAT THIS
CONSTRUCTION STANDARDS
WAS CONSTRUC.1 ED IN ACCO
TACOPY OFTHI RD
SI s 'ATURE OF PERSON CONSTRUCTING
ANCE WITH ISA NCAC 2C. WELL.
BEEN P • • VIDED TO THE WELL OWNER
WELL DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh. Ni.
27699-1636 Phone No. [phone], within 30 days. GW-1 REV. 07/200

301824
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and N� /•'.. . / c 8 Resources Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAM (print) �//i A Nit- CERTIFICATION
�4, 77
WELL CONTRACTOR COMPANY NAME {yr 4 ia: l • (4l ael.Fa leatie -s7 PHONE # i 8
STATE WELL CONSTRUCTION PERMIT# N//%t ASSOCIATED WQ PERMIT*
(if applicable)
(if applicable)
1. WELL USE (Check Applicable Box): Residential Q1 Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATIO
Nearest Town:
//a2/
(Street Name,
3. OWNER:
County
t J
unity, Subdivision, Lot No., Zip Code)
Address /969 fans filth
t or Route No.) Q
���Iyz C. 02n7/ A/•r
(i%7t}y447-33Si' or Town State Zip Code
Area code- Phone nmnber
4. DATE DRILLED 7/9/ D y
5. TOTAL DEPTH: /G.S
6. DOES WELL REPLACE EXISTING WELLS YES 0 NO I®
7. STATIC WATER LEVEL Below Top of Casing: 02 s FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS LS- FT. Above Land Surface"
'Top of casing terminated actor below land surface requires a
variance 1n accordance with ISA NCAC 2C .0118. •
9. YIELD (gpm):ZT-/OD METHOD OFTEST%sv
10. WATER ZONES (depth): ADD / 9 4-
II. DISINFECTION: Type C. it N. Amount f. i OL
12. CASING: Wall Thickness
FromL_P___ o 7� FtDnTt4htFt M$crjal
From..... To FL
From To Ft
13. GROUT: Depth
From 0 To 'n t) Ft.
From To Ft.
14. SCREEN: Depth Diameter
Fromo Ft
From To Ft.
15. SAND/GRAVEL PACK:
Depth
From Ft.
From To Ft.
16. REMARKS:
Size
Slot Size Material
in. in.
in. in.
Material
Topographic/Land setting
❑Ridge ❑Slope &Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPSfTopographic map
(check box)
DRILLING LOG
Formation Description
DEPTH
From To
LOCATION SKETCR
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common road names.
I DO HEREBY CERTIFY THAT THIS WFi I WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS,THAT A COPY OF THIS RJORD j BEEN PROVIDED TO THE WELL OWNER
oo SIGNA OF PERSON CONSTRU G THE WET I
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-I REV. 07/2001

301817
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) SO 411/Jt -y17 'Vi. &.. %�� CERTIFICATION aKoS7 �7
WELL CONTRACTOR COMPANY NAME (AJ,e / .9ar1"yy 7.l�Ir.! PHONE # (tM gi%)7 llir
STATE WELL CONSTRUCTION PERMIT,/ /1/i7i _ASSOCIATED WQ PERMIT# 41/44(
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential le Municipal/Public ❑ Industrial ❑ Agricultural ❑
Monitoring 0 Recovery 0 Heat Pump Water Injection ❑ Other ❑ If Other, List Use
2. WRT.T LOCATI
Nearest To
(Street Name, Numbers,
3. OWNER:
County .)44
e2 ?V
unity, Subdivision, Lot No., Zip Code)
Address /
L(Steel or Rout�lo.)
d iu N.C. .2g,ya"
City or Town State Zip Code
Area code- Phone number
4. DATE DRILLED //ii / C
5. TOTAL DEPTH: %8 T
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO pa
7. STATIC WATER LEVEL Below Top of Casing: 43 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS 2 S FT Above Land Surface*
'Top of casing tenanted allor below land surface requires ■
variance In accordant wab ISA NCAC 2C .0118.
9. YIELD (gpm): D METHOD OF TEST
10. WATER. ZONES (depth): /Do
•
11. DISINFECTION: Type C.Hi/
12. CASING:
From 0 Tom.. 3 Ft jn to
From To Ft.
From_ To Ft.
13. GROUT: Depth Material Method
-el 0 To D Ft. Lisstottll Lt 4-ncy
From To Ft.
14. SCREEN: Depth Diameter Slot Size Material
Fro o Ft in. in.
From To Ft in. in.
15. SAND/GRAVEL PACK:
Depth Size Material
Amount Lg—
Wall Thickness
or Weigbt/Ft Material
From
From To Ft.
Ft.
16. REMARKS.
Topographic/Land setting
❑Ridge DISlope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degreeshnimd a/seeondl)
Latitude/longitude source:❑GPS❑Topogrphic'map
(check box)
DEPTH DRILLING —LOG—
From To Formation Description
LOCATION SKETC$
Show direction and distance in miles from at least
two State Roads or County Roads. Include the
numbers and common road names.
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH I5A NCAC 2C, WELL
CONSTRUCTION STANDARDS THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL 0
� JO I/
SIGNATURE OF PERSON CON UCT NG THE WELL
J/aDATE
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

301813
WELL CONSTRUCTION RECORD
artment of Environment and N Task Resources - Division of Water Quality - Groundwater Section �/�
North Carolina - Dep CERTIFICATION a 2
WELL CONTRACTOR (INDIVIDUAL) (Print) NE # tilflt
WELL CONTRACTOR COMPANY NAME �/� ASSOCIATED WQ PERMITd — ..
STATE WELL CONSTRUCTION PERMIT*, if liable
(if liable
Applicable Box): Residential �. Municipal/Public 0 Industrial 0 Agricultural O
1. WELL USE (ChecktWater Injection 0 Other 0 If Other, List Use �---
Monitoring 0 Recovvery 0 Heat Pump
Topographic/Iand setting
'
untY4ciAtledifettli ORidge ®Slope °Vey at
(chat appropriate
Latitude/longitude of well location
(des edmi°uwheeenas)
Latitude/longitude source:OGPSOTop1gtaphic map
(check boa) �_��...._
2. WELL LOCATI
NearfSt Town:.
(strut N
3. OWNER:
Address
City or Town
Area number
4. DATE DRILLED
5. TOTAL DEPTH:
6. DOES WELL REPLACE EXISTING WELL? YES Q NO Ftit
7. STATIC WATER LEVEL Below Top of Casing: (UK "+" if Above Top of Casing)
8. TOP OF CASING IS 1. S FT. Above Land Surfaces
'Top of casing terminated atior below land surface requires ■ 01111. ,
variance Inaccordance with I5A NCAC la OF ST T --
9. YIELD (gpm): �L�— r /% 7
10. WATER ZONES (depth):
State
Zip Code
11. DISINFECTION: Type-
12. CASING: Depth Diameter
From_ To Ft. ha 4
From To Ft
From To Ft.
13. GROUT: Depth
From_ To�
From To Ft
14. SCREEN: Depth Diameter Slot Size Material
in.
Front_ To Ft in.
Fro* To
Ftin. in.
15. SAND/GRAVEL PACK Depth Size Material
From To Ft.
From To Ft.
Amount
Wall Thickness
or Wei t/Ft
16. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONS I RUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION ST i a S, AND THAT A COPY OF THIS CORD HAS BEEN PROVIDED TO THE WELL OWNER
4,
IGNATURE OF PERSO CONSTRUCTING THE WELL
Submit the original to the Division of Water Quality, Groundwater Section,1636 Mail Service CGW ; RREVgh, C01
27699-1636 Phone No. [phone], within 30 days.
DEPTH
From To
C
C)
Formation Description
r OCATIO�IC WK least
Show direction and distancen mileds. s from
atde the road
two State Roads or County
numbers and common road names.
DA

301812
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and N Resources - Division of Water Quality - Groundwater Section
L CERTIFICATION to 277
WELL CONTRACTOR COMPANY .I_ A. .. 1. ..r HONE 01as`s"-DAD
STATE WELL CONSTRUCTION PERM A(41 - ASSOCIATED WQ PE
(if applicable)
WELL CONTRACTOR (INDIVIDUAL) NAM
(if applicable)
1. WELL USE (Check Applicable Box): Residential M Mtmicipal/Public ❑ Industrial ❑ Agticul
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
sit(Street Name, Number, Commr �`
� w/Ji�y, Subdivision, Lot No., Zp Code)
3. OWNER% .L'crG 7J%C [mac_
Address � w rw�i�
'SAtrSet�- No.)
a/LL�wM w.%/O A/N:r.ea
City:*Town S Zip Code
it)
Area code- Phone comber
4. DATE DRILLED ///cs/D y
5. TOTAL DEPTH: So t
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO
7. STATIC WATER LEVEL Below Top of Casing: (j 1- FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS / s FT. Above Land Surface'
'Top of casing terminated at/tr below Mod surface requires a
variance la accordance with ISA NCAC 2C .0118.
9. YIELD (gpm): .S MEJHOODD OF TEST flne.
10. WATER ZONES (depth): 71
11. DISINFECTION: Type
12. CASING:
(print)
Amount /y
Wall Thickness
Depth lter aght/Ft �cl
From 0 To .��� Ft i r
From To Ft
From To Ft.
13. GROUT: Depth, __
From, n To u.0 Ft
From To Ft
14. SCREEN: Depth Diameter Slot Size Material
Fro o Ft. in. in.
Fro To Ft. in. in.
15. SAND GRAVEL PACK:
Depth Size Material
From
From
16. REMARKS:
1 DO HEREBY CERTIFY THAT
CONSTRUCTION STAND
Ft.
Ft.
Topographic/Land sejd'ng i t
❑Ridge ❑Slope [Walley :SFiat
(check appropriate boa) r',
Latitude/longitude of well °cation a
( minurcyaccmdt ;;-i--_--
Latitudellongitude source:❑GPS❑topographic map
owe* b�oa,.�
mit:ETRG'-OG _
Formation Description
DEPTH
From To
LOCATION SKETCH
Show direction and distance in miles fr• at least
two State Roads or County Roads. .elude the road
numbers and common road
WELL WAS CONSTRUC 1tD IN ACCORDANCE WITH 15A NCAC 2C, WFI I
THAT A COPY OF THIS REEQRD HAS BEEN PROVIDED TO THE WFI t
SIetel N CbNSTRUCTING THE WELL
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-1 REV. 07/2001

301811
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and
/N$zral Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAMEQ(print) 1pp///J f//Q�YQQ�J L' .�J2 L /� CERTIFICATION 11 f7J
WELL CONTRACTOR COMPANY NAME.Aire �!f/(ca4.a 0/ .€b1l �/)077 2t PHONE •
STATE WELL CONSTRUCTION PERMIT. N/4? ASSOCIATED WQ�PPERMIT*
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential X Municipal/Public 0 Industrial 0 Agri
Monitoring 0 Recovery ❑ Heat Pump Water Injection 0 Other 0 If Other, List Use —1 I
2. WELL LOCATI a N:
Neatest Town
� �ty_i
(Street None, Numbers, Community, Subdivisioo, lot No., Tcp
3. OWNER:
Address
City or Town Stele tip Code
«l- .3s9- 99(.
Area code Pbooe number
4. DATE DRILLED ///�' ./1) f'
5. TOTAL DEPTH: gS
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO j@
7. STATIC WATER LEVEL Below Top of Casing: /0 b FT.
(Usc "+^ if Above Top of Casing)
8. TOP OF CASING IS /. Se FT. Above Land Surfaces
'Top of casing terminated atlas below land surface requires a
variance In accordance with ISA NCAC 2C .011L •
9. YIELD (gpm): 3 METHOD OF TEST? n v o
10. WATER ZONES (depth): ./T 1`r
11. DISINFECTION: Type C.g .4& Amount .2y e -
12. CASING: Wall Thickness
or Weight/Ft I�Ier,al
dt1/ fvdP
Depthter
From- To 7 u b Ft
From To Ft.
From To Ft.
13. GROUT: Depth
From Q To tat n Ft
From To Ft
14. SCREEN: Depth Diameter
From To Ft in.
From- To Ft. in.
15. SAND/GRAVEL PACK:
Depth Size
From To Ft.
From 7- To Ft
16. REMARKS:
Slot Size
in.
in.
Method ,
Material
CD �-
_dial
P
l
g❑Fl —'
it.)
-
� o
Topographic/Land
gRidge ❑Slope ❑V
(check sPproPrute
Latitude/longitude of weatudationa
(depedmimrtn/exr )
Latitude/longitude source:❑GPS r7Topograjthic map
DEPTH
From To
DRILLING LOG
Formation Description
LOCATION SKETCH
Show direction and distance in mi
two State Roads or County
numbers and common ro
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANL]Adj.DS, AND THAT A COP THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
SIGNATURE
F PERSON CONSTRUCTING THE WELL
e•
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center -Raleigh, NC
27699-1636 ?bone No. [phone], within 30 days. GW-1 REV. 07/2001

301810
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAMF��(,(print) rj L. L CERTIFICATION
N lag %2
WELL CONTRACTOR COMPANY NAME./ a ,,// N ttlij.9y l s� zhe PHONE M L'97-- Q '7O
STATE WELL CONSTRUCTION PERMIT* AO ASSOCIATED WQ PERMIT* 407
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential P. Municipal/Public ❑ Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATIO
N- Town:
-941717
(Street Nane, Numbers, Community, Subdivision, Lot No., Zip Code)
•
3. OWNER:7/2. (degreeymimacaseconds)
Address $/ M I/t Latitude/longitude source:❑GPS❑Topographic map
(cheek box)
DRILLING LOG
Formation Description
(Street or Route No.)
�J g.G 0l$7#7
City or Town State Zip Code
(—Y
Area code- Pbme nmnber
4. DATE DRILLED 7/.z7D 'Y
5. TOTAL DEPTH: .2 f,5 '
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO X
7. STATIC WATER LEVEL Below Top of Casing: t.2 5- FT.
(Use "4-- if Above Top of Casing)
8. TOP OF CASING IS A J FT. Above Land Surfaces
'Top of casing terminated at/er below land surface requires a 7�0� SON
variance in accordance with ISA NCAC 2C .0118. C
9. YIELD (gpm): . SZ> METHOD OF T�/.isze
10. WATER ZONES (depth): //5 ' /5Q r
11. DISINFECTION: Type e.g. N. Amount g �— Show : on and distance in miles from at least
12. CASING: Wall Thickness two State ' oads or County Roads. Include the road
Depth Diameter or Weight/Ft N�at�nat numb - and common road names
From 0 To $D Ft. /o *+`'a.2./ !YI/C TUPITc2 'd
From To Ft.
From To Ft.
13. GROUT:Depth rtateria� / oMetbod ,
From DToe FC (j�yrLlkj 1Ltx {1�
From To Ft
14. SCREEN: Depth Diameter Slot Size Material
Fro To FL in. in.
From / To Ft. in. in.
15. SAND/GRAVEL PACK
Depth Size Material
From To Ft.
From / To Ft.
Topo hic/Land setting
❑Ridge Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
DEPTH
From To
.0 Or °F
tPF 1 F�l� r,t
oo F�
16. REMARKS:
11)O HEREBY CERTIFY THAT THIS WELL WAS CONSTRUC1hU_ IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDA9S, AND THAT A COPY OF THIS ;FEN P OVIDED.TO THE WELL OWNER
/0 ,1
BSI A OF PERSON CON
Submit the original to the Division of Water Quality, Gro
27699-1636 Phone No. [phone], within 30 days.
GT�HE WELL
wilier Sc('n, 16/36/1RbRSe
TE
ter - Raleigh, NC
W-I REV. 07/2001
G' 'eSFH Sr:; ^PJ

302016
WELL CONSTRUCTION RECORD
North Carolina - Department of Envimnmcnt and *t•nr.ual Resources -• `Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) !> I LL I O tJ A S44 CERTIFICATION! a—( -i
WELL CONTRACTOR COMPANY NAME_ CALDWELL DRILLING, INC. P»ONE(R8 i54-3581
STATE WELL CONSTRUCTION PERMIT/ ASSOCIATED WQ PERMIT/
(if applicable)
(if applicable)
I. WELL USE (Check Applicable Box): Residential D Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION: (�
Nearest Town: WtT" \4517-Vtt.L€ County `I-oUri iv-Ac
`3(% 6 ,3 F V t L o (2-0 r17
3. OWNER: �n1
Address 3(k ( t-)ale 4-D IAA D
(Street Name, Numbest, Community, Subdivision, tnt No., Zip Code)
toCte L ltoJD
We -A rQ1(Streetu W Rotas No.)
V tnw
City or Town State Zip Code
X( )- '5%— cC3b
Area coda- Fiona number 4. DATE DRILLED 3 - 04
5. TOTAL DEPTH: 69 0 r
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO IS
7. STATIC WATER LEVEL Below Top of Cuing: bo FT.
(Use -.- if Above Top of Cana)
8. TOP OF CASING 1S -& Canna)
FT. Above Land Surface•
*Top of casing terminated Woe baste Isad seam tequila •
vdnau 1a meordams wltb ISA NCAC IC .0111111 �r
9. YIELD (gpm): t_ METHOD 9F TEST F-( t7 - A t K--
10. WATER ZONES (depth): 6 5 o — t-O G? M
11. DISINFECTION: Type xi14 '1 b%, Amount Y Z
12. CASING:
(
Wall Thickness
Depth o Weight/Fi. 1.�aterisl
From 't- To 5 DDGt V�(C.
From To
From To
13. GROUT: Depth
From £ To a o
From To
14. SCREEN: Depth
From To
From To
15. SAND/GRAVEL PACK:
Depth
To
Malarial Method
Ft. C-NYVai
Ft.
Diameter Slot Sim Msterial
Ft. in. in.
FI. in. in.
Sire Material
From Ft.
From To Ft.
16. REMARKS:
opographic/Land setting
dge ❑Slope ❑Valley ❑Flat
(cLeck appeepriue boa)
Latitude/longitude of well location
(dep«anatmnea/sccoods)
Latitude/longitude source:❑GPS❑Topographic map
(cheek box)
MULLING LOQ
Formation Description
b J b O- , 32-0 E (J
2ArSITsa
C: P_A0-4 I F.
nePTli
From/ To
4,
41` - bso' `
h5c'- b9o'
+im
0
9
e . O {ors
m%
LOCATION SKETCH
Show direction and distance in miles from aOeast y
two State Roads or County Roads. Include n •ad cnci
rn
numbers and common road names. at n
-ZSr.
SA i_uiab
aRA Nc.(y
,5r>.
_5 M
O� CPees�L
3M- e
R et r^ S cy-et5IC
1 DO NEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED M ACCORDANCE WM I ISA NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND T11 COPY F THIS 1 ORD IIAS BEEN PROVIDED TTi WELL OWNE
SIGNATURE OF PERSON CONSTRUCTING THE WELL
DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mill Service Center - Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-I REV. 07/2001

302015
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and' • nl Resource, - Diivision of
Water Quality - Groundwater Section
F.
WELL CONTRACTOR (INDIVID UAL) NAME (,rent) •V tl..^L lC L)1Q SW CLRTIqYICATION/a 1 11
WELL CONTRACTOR COMPANY NAME CALDWELL DRILLING, INC. PHONEY48 ?54-3581
STATE WELL CONSTRUCTION PERMIT/ ASSOCIATED WQ PERMIT/
(if applicable) / (if applicable)
1. WELL USE (Check Applicable Box): Residential LeMunicipaVPublie 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery ❑ Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATIR N: I�i1
Nearest Town: 1, A N U LS 60- county "`cu,- orr'.&
47ia (L6-61/4(tS Ct'I A9
(Strut Name, Numben, Community. Subdivision, La No., Zip Cods)
3. OWNER: At_gaerr ofCCypr�
Address qq (Le&JeS Cpdc. It-oAO
AN rfLe(sir "
si ,ec NL) $'(t 5
City or Town Slate 5 Zip Code
,p�
(O"-i)- Lobs — C
4. DATE DRILLED o ' a 5- 04
5. TOTAL DEPTH: 31 D ' /
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO l
7. STATIC WATER LEVEL Below Top ofCasing: S C FT.
(Use -c- if Above Top of Coins)
8. TOP OF CASING IS FT. Above Land Surfaces
'Top of colas terminated atior below had seance rty sir ea •
variance la acardas with ISA NCAC IC .0111.
9. YIELD (gpm): 50 4 METHOD OF TEST
Area coda Plana number
Topographic/Land setting 7
❑Ridge ❑Slope ❑Valley L?f'lit
(cheek appropriate box)
Latitude/longitude of well location
(deyuahnlmndaecnode)
Latitude/longitude source:❑GPS❑Topographic nap
(check box)
DRILLING I OG
6Formation
()aura 04;,t)
6 4-A . kr( %
�'��,,•rtes - �,o# 6,ere
-tLt-
DEPTH
From / To /
a
�ci.o'
kct f 3 in
c,-- r,-- Alt
10. WATER ZONES (depth): I CI D - 'S0 4 Gery
11. DISINFECTION: Type N i Amount
12. CASING: Wall Thicknen
A Depth pitryk
From i To -15 r Ft. b of $ a81r-aI t T V'-
From To Ft.
From To Ft.
13. GROUT: j Dcp Material n Method
From____ To Ft. Qk en rtiOT roe, S P D
From To Ft.
I4. 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.
I OCATION SKETCH w
Show direction and distance in miles from a9east�
two State Roads or County Roads. Include a road o p
orumia en and common road names.
6`V?ttfil+rn 0G•
6c
tJ 1 Cxectotak
1.-(1)4S ICp
2m
SAND Ivl)t_L I -,
Ret1b
16. REMARKS: • 5 �"
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN A
CONSTRUCTION STANDARDS, AND THAT A CO OFTY, THIS RECO
CORDANCE WIT)1 15A NCAC2C, WELL
IAS BEEN PROVIDED TO1E WEL4 Or.
( I /L11�
Y al 0
SIGNATURE OF PERSON CONSTRUCTING If IE WELL • DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mali Service Center -Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. G W-I REV. 07/2001

9.
10. WATER ZONES (depth): art C - t,ern
11. DISINFECTION: Type I bi 7 S na Amount 1 % C {'
12. CASING: Wall Thickness
Depth�ier or ,W,e,.ight/Ft. Ma a1
From To J'a FI. 7n,`i,nc
t / K S-Or-Ot
From To Ft.
From To FL
13. GROUTA• Depth
From .J- To Depth."
Ft.
From To Ft.
Crenre3-r PD hittl&
14. SCREEN: Depth Diameter Slot Size Material
From To Fi. in. in.
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Sire Material
From To Ft.
From To Ft.
16. REMARKS:
30207S
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and tiMUM al Resources..., Division of Water Quality - Groundwater Section —(
WELL CONTRACTOR (INDIVIDUAL) NAME (prim) (21 •L. ej �.A,S CERTIFICATIONH
WELL CONTRACTOR COMPANY NAME RF.UBEN CALDWELL DRILLING, INC. PHONEY rr�I4g 1254-3561
STATE WELL CONSTRUCTION PERMIT/
(if applicable)
ASSOCIATED WQ PERMIT/
(if applicable)
1. WELL USE (Check Applicable Dox): Residential 11d Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION:
Nearest Town: R2\1AR6S1I LLf: County 63/44000 Mee.
3e Pr1Y,LewA/ Ok\(E
(Suety Name, Numben, Cecun nrniry, Sued, non. tnl No., Zip Code)
3. OWNER: L I I2.I Prfh FES Pea-5 a rJ
Address 3 0 e A I..Ln LJ Al n (Zl f e
QAR.miztsd LiE NL at o`1
)
Cityor Town Stye Zip Cods
(Fdg)- bah - a3o a
Arm coda Plana numbers*, ,I
4. DATE DRILLED — 4 a -0
5. TOTAL DEPTH: _3i 1 `0
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO nil
7. STATIC WATER LEVEL Below Top of Casing: 6 'c FT.
Nsa-•- if Above Top of Cuing)
8. TOP OF CASING 1S FT. Above Land Surface•
*Top of cuing Irrrelensd War brow lud mine requlm a
varlaaca le acwrduca with ISA NCAC IC.0111.
YIELD (gpm). I MET/IODIDE TEST &I C: - A 1 (L
"Topographic/Land setting
Ridge OSlope ❑Valley ❑Fiat
(rhack appropriac box)
Latitude/longitude of well location
(dez eeaAnimue✓secoods)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
PEPTI; DRILLING LOQ
F=/ teoaD,e2pr
S r-r-
exte j(e€- 15 6fr
00_24 N t-rer
rJ
4.3
.aa.0 '— s �D
S
J OCATION SKETCF( t
Show direction and distance in miles from at 1 sa t
two State Roads or County Roads. Include the cad
numbers and common road namts.
3®
{ A fLiD) A-a—DISv PI Hl
1 DO HEREBY CERTIFY T)IAT T111S WELL WAS CONSTRUCTED IN ACCORDANCE WM1 I3A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND 1AT A COPY OF Ti IFS RECORD HAS BEEN PROVIDED TO THE WELL 0 R
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
Submlt the original to the Division of Water Quality, Croundwaler Section, 1636 Mall Service Center -Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-1 REV. 07/2001

302017
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and *ianu/Jal Resources -^ Divis ion of Water Quality - Groundwater Section
WELL CONTRA CI (INDIVIDUAL) NAME (prim) ti) L L \)✓r S 1-I CERTIFICATION a
T O1 1 1
WELL CONTRACTOR COMPANY NAME_REUBEN CALDWELL DRILLING, INC. PHONEQ7f8 )254-3581
STATE WELL CONSTRUCTION PERMITO
(if applicable)
ASSOCIATED WQ PERMIT/
(if applicable)
1. WELL USE (Check Applicable Box): Residential NJ Municipsl/Public 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION
Nearest Town: leilh IV A ult. county 6oNo,ni3
c os'Stc (4_(06e= RziA.D
(Strut None, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: li LJA/ f Lb frmor4 S
Address
(Surat or Raw No.)
(UN} or Town t b. - �-I f Zip Code
Atal code- Phone numbs:
4. DATE DRILLED if - a 4- - °
5. TOTAL DEPTH: dot 0
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO Litt
7. STATIC WATER LEVEL Below Top of Cuing: /o 0 FT.
ruts -4.' if Above Top of Cuing)
8. TOP OF CASING IS -a- FT. Above Land Surfaces
*Top of tulog terminated aUer below had surface requlret a
variance In accordance with ISA NCAC 2C .011S. /�
9. YIELD (gpm): 4( METHOI OF TEST RA V -
10. WATER ZONES (depth): t 4 o /
Topographic/Land setting
❑Ridge ❑Slope ❑Valley tat
(check appropriate box)
Latitude/longitude of well location
(degr ealtnln tea/ueoods)
Latitude/longitude source:OGPS❑Topographic map
(check box)
DEEM DRILLING LOQ
Frotn e To / Forriation,pescription,
2eo OJr 2.(SUf1-Og(o
ato' - a-4o' ;211aJCTe-
a4 V ' c fI Ce - g 6t,''\
a4-ot- ram%-eto � 0 (2-Af•) ITS
---�.� J,OCATION SKFTCI{ -o
jr 11. DISINFECTION: Type ••10/n Amount 71 I.6 Show direction and distance in miles from at gst
12. CASING: Wall Thickness two State Roads or County Roads. Include theSad
�A1 Depth ODeft or Wei t/FI. Material numbers and common ro . names.
From 1 Toa S FL .I Sieel
From To Ft.
From To FL
13. GROUT Depth Material
From a To a-O Ft. �MgNT (JpJ MethodL�
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
04103
t toss Nw7
40
-II ST(cCg- D66
4 fin
16. REMARKS.
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH ISA NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A 9PPY OF mis RECOIL) HAS BEEN PROVIDED TO THEIWELL 0
k& e
SIGNATURE OF PERSON CONSTRUCTING THE WELL
a7
DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mall Service Center -Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-1 REV. 07/2001

300771
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) KENNETH MCCRARY
CERTIFICATION # 2008
WELL CONTRACTOR COMPANY NAME BARKER CONSTRUCTION, INC./BARKER WELL & PUMP PRONE # [phone]
STATE WELL CONSTRUCTION PERMIT# 1871
ASsocIATED WO PERMIT#
(if applicable) (if applicable)
1
WELL USE (Check Applicable Box): Residential l MumicipaVPublic ❑ Industrial O Agricultural CI
Monitoring O Recovery ID Heat Pump Water Injection O Other O If Other, List Use
2. WELL LOCATION:
Nearest Town: ASHEVILLE County BUNCOMBE
SHUMONT MOUNTAIN ROAD
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: MARVIN RICHARDS
Address 627 CATAWBA ROAD
(Street or Route No.)
DAVIDSON NC 28036
City or Town State
( 704 )_ 896-0507
Area code- Phone number
4. DATE DRILLED JULY 9, 2004
Zip Code
5. TOTAL DEPTH: 180'
6. DOES WELL REPLACE EXISTING WELL? YES O NO El
7. STATIC WATER LEVEL Below Top of Casing: 20 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS 1.33 FT. Above Land Surface*
'Top of casing terminated at/or below land surface requires a
variance in accordance with 15A NCAC 2C .0118.
9. YIELD (gpm): 50 METHOD OF TEST TIMED
10. WATER ZONES (depth):
Topographic/Land setting
ORidge ❑Slope OValley KIFlat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude sou rce:OGPSOTopographic map
(check box)
DEPTH DRILLING I OG
From To Formation Description
O
r �m
9 or
6 %G
rcn
p'x yto
L "i
CA.O
1.% y
LOCATION SKETCH
11. DISINFECTION: Type BY PUMP INSTALLER Amount Show direction and distance in miles from at least
12. CASING: Wall Thickness two State Roads or County Roads. Include the road
Depth Diameter or Weight/Ft. Material numbers{and common road names. n /
From 0 To 66 Ft. 6 1/4 .184 STEEL OT,(AQ/7I- J UAate�-td :44 y 64 1
From To Ft t Ail (nu e A %aAn2 chin_ 0J ¢�
From To Ft. L �p (/ v
13. GROUT: Depth Material Method AS/Lit t and- O affr Ok.. ii r)t.c..�R_ •
From 0 To 20 Ft. CONCRETE POURED . �1... _vV _ /,�. go . ci afoot
From To Ft. C(Act Vtrnt u��QO[��' # 9 Q Li F do Yvon -
14. SCREEN: Depth Diameter Slot Size Material p" �/
From To Ft. in. in. CI,W (41C/)I�LC_ /4-iLQ . nacim-
From To Ft. in. in. � en hu.0 i- f( fj • 2d• and
15. SAND/GRAVEL PACK: a.1/2. /IttiiDt0 Wilt(?-4
pkr Depth Size Material Offrynt
From To Ft. 0/'n tj h i autut enA.c9 t
From To Ft. *" """f' �•
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 TILE WELL OWNER
SIGNATURE OF PERSON CONSTRUCTM HE WELL
'7— IL. -D
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-1REV,07/2001
1 4 2004

300738
WELL CONSTRUCTION RECORD
North Carolina • Department of Environment and
WELL CONTRACTOR (INDIVIDUAL) NAM
WELL CONTRACTOR COMPANY N
STATE WELL CONSTRUCTION PERMITS'
(if applicable)
(Prtn
tura] Resources - Divisiongar(
of Water Quality - Groundwater Secuor�9
C L7 /� (L7 y/�— CERTIFICATION�/4in
�4 ) Ooieric y/J' IC -PHONE. �I /,Y/--s+F_ a-:..
ASSOCIATED WQ PERMTIs era-
7 -
---
(if applicable)
I WELL USE (Check Applicable Box): Residential % Mtrnicipal/Public ❑ Industrial 0 Agricultural ❑
Monitoring ❑ Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATIO 2
Cotmty
Nearest Town
.2 797
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER dLY(�i(kpr�
Address /0/ /W e
(Street or Rpae No.)
City or Town Stare
Area code Phone number / O
4. DATE DRILLED&/L/
.' e 1
5 TOTAL DEPTH:
3 .5
6 DOES WELL REPLACE EXISTING WELL? YES NO le
7 STATIC WATER LEVEL Below Top of Casing: , FT.
(Use "+" if Above Top of Casing`
a. TOP OF CASING 1S j 25 FT Above Land Surface•
'Top of casing terminated at/or below land surface requires s
variance in accordansi wn ISA NCAC 2C .0118. i
9 YIELD (gpm): N METHOD OF TEST
i b WATER ZONES (depth: / r 3 /d s'
1 i. DISINFECTION: Type L. A h( Amount
12 CASING Wall Thickness
Depth Diameter or Weight/Ft Material
hoot Q To /Dn Ft. 4-fr.
Fron'-------- To F:
From To Ft.
From
- Dept . M„V,
From To Ft
14. SCREEN. Depth Diameter Slot Size Material
From
Ft. in. in.
From o
To Ft. in. in.
15. SAND/GRAVEL PACK
Depth Size Material
From <To Ft.
From To Ft.
-d
Method
16 REMARKS
ASO
Topographic/Land settidg
AIRidge ❑Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds;
Latitude/longitude source:❑GPS❑Topographtc map: -
DEPTH
From To
Sho
two
num
J1XILL[NG LOG
Formation D notion
G A
sei
cn
LOCATION SKETCH
direction and distance in miles from at least
tate Roads or County Roads. Include the road
ers and common road name::
Ho�Sc
It D
D
1 DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C. WELL
CONSTRUCTION ION STANDAFy];, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER.
SIGNATURE OF PERSON CO STRUCTING THE WELL DATE
G/t.2 y/o y
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

300785
WELL CONSTRUCTION RECORD
North Carolina - Department of Environrrient and N$ural Resources - Division of Water Quality - Groundwater Secnor.
WELL CONTRACTOR (INDIVIDUAL) NAN$ (print) �p L
WELL CONTRACTOR COMPANY NAME .CI��)�i.LI/r di i.t Iy�j 1C 9.1.... /� yQe
STATE WELL CONSTRUCTION PERMIT/ /Y/q •SSOCIATED WQ PERMIT*
(if applicable) (if applicable)
CERTIFICATION it.7277
PHONE a
itaktean
y/
1. WELL USE (Check Applicable Box): Residential if MtmicipallPublic 0 Industrial 0 Agricultutsl ❑-
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION: ' n,
Nearest Town Bd/S1 County/a&..-41f4a--.,�(r
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
Addr(sow oiRne No.)
ess
�� d�
Cny or Town State Zip
Area code- Phone mm be,
4. DATE DRILLED 4// rJ/D y
5 TOTAL DEPTH: ei2OS I
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO 14
7. STATIC WATER LEVEL Below Top of Casing: 1j ^ FT
„tlse "+- if Above Top of Casing)
3. TOP OF CASING IS .• 3 FT. Above Land Surface'
'Top of casing terminated attar below land surface requires
variance in accordance with ISA NCAC 2C .0118. •
9 YIELD (gpm): D METHOD OF TEST t.GN. f
10- WATER ZONES (depth:. /'S— f
J7 fl7
I i. DISINFECTION. Type ..N /,l. Amount /e
12 CASING. Wall Thickness
Depth�r 1r�ter or Weight/Ft. Material
Front if." To .�i3 Ft U .Se2Z./ ft'C
From To
From. To Ft.
iiHU?;7.. • From if, To
To 076 FL C`/!��al
_F_b. WL/
From To Ft.
14 SCREEN: Depth Diameter Slot Size
Fromo Ft in. in.
From / To Ft, in. in.
15 SAND/GRAVEL PACK -
Depth
From To Ft.
From / To Ft.
16. REMARKS
Method
inaylesis?
Material
Topographic/Land settiag
❑Ridge StSlope ❑Valley ❑Flat
(check appropriate hot
Latitudellongitude of weal location
(degreesimtmaesiseemdsi
Latitude/longitude source:❑GPS0Topographte32tap _
(check box,
P • n LING LOG- -----
Formation Description
DEPTH
From To
LOCATION SKFFC),
Show direction and distance in miles Gott leak
two State Roads or County Roads. Include the road
numbers and common road names
I DO 1LEREBY CERTIFY THAT THIS WFI l WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C. WELL
CONSTRUCTION ST S. AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
DA
SIGNATURE OF PERSON C
NSTRUCITNGTHE WELL
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh. NC
27699-1636 ?bone No. [phone], within 30 days. GW-i REV. 07/20C..

300782
WELL CONSTRUCTION RECORIt
North Carolina - Department of Environment and tural Resources - Division of Water Quality - Groundwater Secnot.
WELL CONTRACTOR (INDIVIDUAL) NAME (print) L 7
CERTIFICATION Xp�/q
WELL CONTRACTOR COMPANY NAME.G1r�[l�iFi
HONE a
STATE WELL CONSTRUCTION PERMIT/ - --
(if applicable)
ASSOCIATED ERMITa
3. OWNER:
Address /1"g=u.41 t�,,,p
U (Street ar a, No.; _r��1 yf� 7J %ye at fl
City or Town State Zip Code
4 DATE DRILLED lj/�/ /Q y
5 TOTAL DEPTH: _ 4er
6. DOES WELL REPLACE EXISTING WELL? YES 0 NOI?
7. STATIC WATER LEVEL Below Top of Casing: /s FT,
se "+" if Above Top of Casing)
e TOP Of CASING IS FT. Above Land Surface'
'Top or cadog terminated at/or below laud surface requires a
variant in accordance wit ISA NCAC 2C .011b.
9 YIELD (gpm): � METHOD OF TEST %� y
I0. WATER ZONES (depth:: 2Q.S^ G i�
11 DISINFECTION: Type , fij/
12 CASING
Diameter
(if applicable)
I. WELL USE (Check Applicable Box): Residential Cif MtlnicipallPublic O
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0
2. WELL LOCATION:
Near st Town:
py� I Cotmtyejye,�r4�.aL�/
(Street Name, Numbers, Cmim .77 , o 7
/� I unit', Subdivision, Lot No, Tip Code)
Area code- Phone member
Depth
From D To 9D Ft
From To _ Ft.
From To Ft
GR(�U: Depth
Amount /D
Wall Thickness
or Weight FL will
From f7 To r.G n Ft ael
From To Ft.
14. SCREEN' Depth Diameter
Fr
om
From To
o Ft. in.
Ft. in.
15. SAND/GRAVEL PACK
th Size Material
From To Ft.
From To Ft.
ethos
�t.1 ILA.
Slot Size Material
in
16.REMARKS
in.
Industrial 0 Agricultural ❑
1f Other, List Use
Topographic/Land setting
DRidge 'Slope Malley OFlat
(check appropriate boa7.
Latitude/longitude of well location
Latitudeilongitude sou rce:OGP&bTopograpltic map
(check box'
DRILLING LOG
Formation Degription
DEPTH
From To
o s+
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common road names
1 DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH ISA NCAC 2C WET 1
CONSTRUCTION SI'dW RDS AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
--e:Wireeet0
SIGNATURE OF P
ON CON UCTING THE WELL-i6J642 6 V
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. 07/260.

294258
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Nahum Resources.,-. Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (prim) la' t I(y N 5`4,- . CERTIPICATION a a 1 1
WE Lt. CONTRACTOR COMPANY NAMt:_REUBEN CALDWELL DRILLING, INC. PHONEQi8 ,?54-3581
STATE WELL CONSTRUCTION PERMITS_ ASSOCIATCD WQ PERMITS (-
(if applicable) • (inapplicable)
1. WELL USE (Check Applicable Dox): Residential'0/ Municlpal/Public 0 Industrial 0 Agricultural ❑'
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATI N: �� ���//�� �-/
Nearest To lir+uCLu4 county
ter s 5cfae ezQ 7esr (god&&,y
(Strut Name. Numbul Community, Subdivision, lot No, hip Code) OW kat-
3. OWNER:*� &r AC ee:n74 .
Address /t2 c/cttc4aQ (-)ia ij at .
Surat or R No.)
/VC z ir-.g-Q�
City or Town State Zip Code
( - 7/ 7. - go—QO
Area cods- Mons number
4. DATE DRILLED 5` 5-/0 ,'
5. TOTAL DEPTH: 3 b
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO
7. STATIC WATER LEVEL Below Top ofCasing: 2- FT.
V (U at "s" 1f Above Top or Castes)
8. TOP OF CASING 1S /yi FT. Above Land Surface*
•Top ofcaries termlaared aunr below Iaad narrate requires •
varleace 1a accordance with ISA NCAC IC.011 a.
9. YIELD (gpm)- 3 M HQ D)� OF TEST
10. WATER ZONES (depth): ` 5
11. DISINFECTION: Type ` TA ZArnount ..ac 0
12. CASING: Wall Thickness
Topogr�ayhic/Land setting
❑Ridge Mope OValley ❑Flat
(deck appropriate box)
Latitude/longitude of well location
Latitude/longitude source:❑GPS❑Ta agraph c map-- -
(check box)
DEPTH DRILLING I.nr --
From To Formation Description
O - 6f '
- 3''
i� / //5
- 63t
9 cc
t
- �
0
LOCATION SKETcH r
Show direction and distance in miles from at least r.
two State Roads or County Roads. Include the road W
Fronrt I To If FL 1 Deptl p DnFF .. ..t/F,. al numbers and road
names. tv
From To Ft.
From To Ft
13. GROUT";Depth Material
Frorn /L_ To .J/> Ft. 7'd77ti 't
From To Ft.
14. SCREEN: Depth Diameter Slot Size . Material
From To Ft. in. in
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
16. REMARKS:
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 PERS N$'&'tJ hNO THE WELL 9/Ct?
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mall Service Center -!Weigh, NC
27699-1636 Phone No. [phone], within 30 days. G W-1 REV. 07/2001

WELL CONSTRUCTION RECORD
29 740
North Carolina - Department of Envaomnent and Natutai Resources - Division of Water Quality - Cmotmdwatn' Saxton
WELL COnTRACron (Dm1V1DOAIJNAME (ONO (y//85 'S(5¢ic-C CERrtncanoN le'7l St)
WEtLCONTRACFOR COMPANY NAME CcJSA-i C,E LJeL1 r��L.r��i PNONE a OM ^�•. ,-:�.
_Ass:Ot'tawED WO PERMIT S
ref
STATE WELL CONSTRUCTION PERMIT.
(ifr teankl
1. WELL USE (Check Applicable Box): Residential Q�ancipaUPuhlic O Indusiial ❑ Agricultural 0
Monitoring O Recovery 0 Heat Pump Water Injection ❑ Other 0 If 0lha, List Use
C7
G7
2 WELL LOCATION: qq T�cJ[and setting--L'� CO
Nearest Town: F(te w-l.tr County /Ji l�v ea�"'Z ORidgt ❑Valley Mat No
'lee m.-nee a 'r<ei )Pa (Mack appropriate box) .o
Latitude/longitude of wdl location
(Sato Name. Nambe s. Cmm■aax Subdivision.lat Ro.. av code)
3. OWNER: (.Mi.'vt £-4-Yl Pe +.., (degearmivarSseca dt)
Address • ?C.c. W, N) i r` 3.41 0)A le Yam : 1 Lawudenongiwde soacaOGPSOT
A �\ tStnxtoRom Nul tioSlJta.a$�r�cp'1 0 - (rhtckbox)
f� Cty°flon Saar
i.—
phis ma�._�_
{ gitik0 DEPTH DRILLING LOD
From To Formation Description
(Lai} :2.5-2-2f-73
Area cat- Nome ember
4. DATE DRILLED /4 Oct-
5. TOTAL DEPTH: 4v5
(ei - 5 o 2 0
6. DOES WELL REPLACE EX1St'BQG WELL? YES a NO I j"7' .:
7. O
STATIC WATER LEVEL Below Top of Canny
(Uw'V`ifAboveTw.ofCas V
8. TOP OF CASING IS / /Z Fr. Above Lad Surface*
*Top *fanner asmi•med tl.v bdawla 4 albs regabs•
variance to mmrdemxwilt ISA NCAC 2C Alt
9. YIELD (gpm): . c METHOD OF TEST /4/41-
10. WATER ZONES (depth): �7 fi cam e +-r - 3, -+0 `
•
/Z�-
/24Y !e
LOCATION SKETCH
e 11. DISINFECTION: Type t%�"��- Amount 0Z. e`77co Show direction and distance in miles from at least
12. CASING: Wall Thickness two State Roads orCoimryRoads. Include the woad
Depth mane er wdyia e, tar rSI mmbera ad COMM, Toad aantea.
Fro
From 0
From lift
13. GROUT:
m To FL
To G; ( Fi. L, 4 it 1/ 0
To L,' vt. (I, WI I R i
Depth Manxfil
From To Ft.
FrortTo f 0 Ft i~ t./ / Pe ti p-rf
14. SCREEN: Depth Diantan- Slot Size Menial
From To FL_- in. in.
From__ To FL in. in.
15. SAND/GRAVEL PACK
Depth
From To FL
From To Ft.
16. REMARKS:
Sae Material
pYe
<{,iz-e
Method
p
F4n fpe L FaesL
1 DO HEREBY CERTIFY THAT THIS WELL WAS CONSm UcrED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARD AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
S RE J3F PERSON ODNSERUC17NG THE WELL DATE
Su beak the otigisal to the Divisio. of Water Quality, Groundwater Setxtioa,1636Man Service Center -Rakish, NC
27699-1636 ranee No. (919) 733a221, within 30 days. GW-I REV. 07/2001

297524
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and ma rural Resources - Diivvision of Water Quality - Groundwater Section
WILL CONTRACTOR (INDIVIDUAL) NAME (prim) t LL\�+ A..) A S 4 CERTIFICATION . all
WELL CONTRACTOR COMPANY NAMC_RF.USEN CALDWELL DRILLING, INC. PHONEY?( Tr�t g•5.473581
-
STATE WELL CONSTRUCTION PERMrr. ASSOCIATED WO PERMIT.
(if applicable) • (if applicable)
I. WELL USE (Check Applicable Box): Residential Di Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
•
2. WELL LOCATION: n
Nearest Town: U-U\C85��s12 county 6u,Ax_P n S
\.A'TSFrL 2cAc
(Street Name. Nurnberg, Community, Subdivision, Lot No. rip Code)
3. OWNER: J 62OrYt4 (.JAG JG2
Address t3e5 KEtsWco0 012-tVC
(Street or Routs No.
L C Wtt.3DSo(o}.D(LAcicOSSo
Gtp City or Town State Zip Code
C)- 6Ab - --\ 554
Arca coda ?bona number / b ik
4. DATE DRILLED
5. TOTAL DEPTH: io t 0 '
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO C(
7. STATIC WATER LEVEL Below Top of Cuing: ce D FT.
A (Uscr' if Above Top of Casing)
8. TOP OF CASING IS FT. Above Land Surface*
*Top of carlug Isrmlaaled at/or bd.w land surface requires a
vadancs laaccordaufa with 15A NCACIC.eII$. p
9. YIELD (gpm): tiJ MET�j,OD OF TEST R kG - I
10. WATER ZONES (depth): 02.5 O - t} G ,P rn
55 e . a e,er-•
11. DISINFECTION: Type 14Ird C'(OTCAmount l Jo
12. CASING: Wall Thickness
l Depth ..Wjg1t
From ] To O FL oJ(SICati VJC-
From To Ft. S�
Fiom To Ft.
13. GROUT: Depty,
From To ot.0 Ft.
From To Ft.
14. SCREEN:
Material
C\ /0aNT f't P
Depth Diameter Slot Size . Materiel
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
S'Ridge ❑Slope ❑Valley ❑Flat
(duck appropriate box)
Latitude/longitude ofweli location
(depoa/mimrte✓sccoodr)
Latitude/longitude source:❑GPS❑Topographic nap
(check box)
DRILLING: LOG;
Formation Description
b V 4 of.-fl /J
R-0^�ITt
cAte-NJ tee _4 GPrn
C�i A r- t-r
CF.Jkc,-aGPM
DEPTH
From To
A 65�
ES'— aSo'
a c) ' 5 50'
-6to'
C%
LOCATION SKETCIj
Show direction and distance in miles from at least-
two State Roads or County Roads. Include to roadT.
numbers and common road names.
w
o
N ct
W ATSt-L,
at/to
ICi4k0 3CQ N
16. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH ISA NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT OPY OF THIS RECO HAS BEEN PROVIDED TO WE WNER
SIGNATURE OF PERSON CONSTRUCTING THE WELL DA
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mall Service Center - Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-1 REV. 07/2001

297 536
STATE WELL CONSTRUCTION PERMIT/
(if applicable) •
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources -Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (prise) 0t"'l-I �} j�I A Ji-� CERTIFICATION a a—
wELLCONTRACrORCOMPANYNAMt_RF.1 6 CALDWELL DRILLING, INC. PHONEY ti4g 54-35B1
ASSOCIATED WQ PERMITS
(if applicable)
1. WELL USE (Check Applicable Box): Residential I/Municipal/Public 0 Industrial 0 Agricultural ❑
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATIQQ N:
Nearest Town: LANDLeR County un)ctmgE
c.u,,c-rts cRcsK.
(Street Name, Numbers, Community, Subdivision, La No., Zip Code)
3. OWNER: DAvio YY\Do(L6
Address p. 0 Go)( is 4-
(Street otJRoute GNe.) agi3o
(gag;. ai 5 State
et ga3 Zip Code
Area code- Phone number
4. DATE DRILLED 5/ (-I / n 4
5. TOTAL DEPTH: 5 '
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO lii.
7. STATIC WATER LEVEL Below Top of Casing: F FT.
1
,1 (llss'i' if Above Top of Carina)
8. TOP OF CASING IS FT. Above Land Surface*
*Top of cuing terminated ever below Ind surface requires a
variance In accordancewit► ISA NCAC 2C Slit
9. YIELD (gpm): b METHOD OF TEST -I 6 - P 42-
10. WATER ZONES (depth): a 40 1 3 vP M
31t'— 3 r,pnA
11. DISINFECTION: Type Amount
12. CASING: Wall Thickness
Depth ter or Weight/Ft. Material
From _To l5 FL ('/� 5,1)Ra( \(C-
From To Ft.
Flom To FL
13. GROUT: „Method Material _
From To '�a° FL C6IY\CN t Y U Q
From To Ft.
14. SCREEN: Depth Diameter Slot Size . Material
Front To Ft. in. in,
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
16. REMARKS:
Topographicitand setting V
DRidge °Slope ❑Valley °M1at
(shack appropriate box)
Latitude/longitude of well location
(deperdm(aute✓secoads)
Latitude/longitude source:DGPSUTopognph1 map
(cluck box) ..
DCPTF{ DRILLING LOCI
From,- To / Formation Description
,.1oV e I2(3v20gi0
OC
b2a-C'-3io' 2-C.�/,cF. - S G4Pr�
�t "mac
310 / u�6J(cQcA - &'m
•31o'- 35o'
r
J OCATION SKETCH
Show direction and distance in miles tron> i least'v
two State Roads or County Roads. Include the rpid
numbers and common road names.
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH ISA NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT ACOPY OOFF'Q`THIS REC HAS
`BEEN PROVIDED TOTHE WE OWNER
0
SIGNATURE OF PERSON CONSTRUCTING THE WELL DA
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mali Service Center -Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-I REV. 07/2001

297648
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305134
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Gromdwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) KENNETH MCCRARY CERTIFICATION A 200E
wELL CONTRACTOR COMPANY NAME BARKER CONSTRUCTION, INC/BARKER WELL & PUMP
STATE WELL CONSTRUCTION PERMIT.; 1871 ASSOCIATED WQ PERMIT%
(ifappticaMe) Of applicable)
PHONE a f 828) 697-7263
1. WELL USE (Circa Applicable Box): Residential El Mtnicipal/Public 0 Industrial ❑ Agricultural 0
Monitoring ❑ Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION:
Nearest Town: ASHEVILLE County BUNCOMBE
LAUREL WOODS SUBDIVISION
(Shut Nana, Numbers, Comuumity, Subcbvision, lot No., rip Code)
3, OWNER: MIKE DAMPIER
Address PO BOX 6400
(Street or Roue Na)
HENDERSONVILE NC 28793
City or Town State Tip Code
( )—
Area code- Plane numbs
4. DATE DRILLED NOVEMBER 12, 2004
5. TOTAL DEPTH: 1000*
6. DOES WFJ.1 REPLACE EXISTING WELL? YES 0 NO K1
7. STATIC WATER LEVEL Below Top of Casing: 180' FT.
(Use "r' if Above: Top catalog)
8. TOP OF CASING IS 1-33 FT. Above Land Surface*
*Top etusiaa tvudnted attr below land sarface requires a
variance in accordant with ISA NCAC 2C .9118
9. YIELD (gpm): 1% METHOD OF TEST TIMED
10. WATER ZONES (depth):
Topographic/Land setting
®Ridge ❑Slope ❑Valley ❑Flat
(cleric appropriate box)
Latitude/longitude of well location
(degreenmimdesisecoods)
Latitude/longitude sotnce:❑GPS❑Topographic map
(check box)
DEPTH DRILLING LOG 72,
From To FonnationDesStion c1-7.
F C.11 ri
C± p r
O
s r:""--
-5 C.
11. DISINFECTION: Type BY PUMP INSTALLER Amount
12. CASING:
Depth Diameter
Frott�To 67 Ft. 61/8
From To Ft.
From To Ft.
Wall Thickness
or WeightiFt Material
SDR21 PVC
13. GROUT: Depth Material
From 0 To 20 Ft, CONCRETE
From To Ft.
14. SCREEN: Depth Diameter
From To Ft. in.
From To FL in,
15. SAND/GRAVEL PACK:
Depth She Material
Frorn To Ft.
From To Ft.
J
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common road names.
Litoft q4 v,vim,74/fo
o3aettia2.0 . jttM cxto
4/tauNaltot u .a • t f
A,a �t eau.zentv
1o,tap r1_ &flair,u.mA- 67L
Mott . E.. 4 d t o�auutW &ads
kn
CAA:Jades 1ocz4.
Method
POURED
Slot size
in.
in.
Material
kit Ait
16. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELT WAS CONSTRUCTED IN ACCORDANCE WITH I SA NCAC 2C, WFJJ
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
ICZAttneudet, enwtAl i 1 - I Z - 64
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
Submit the original to the Division of Water Quality, Groundwater Section,1636 Mall Service Center - Raleigh, NC
27699-1636 Phone Na [phone], within 30 days. GW-1 REV. 07/2001

C
305134
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
CERTIFICATION # 2008
WELLCONTRACTOR (INDIVIDUAL) NAME (pint) KENNETH MCCRARY
WELL CONERACfOR COMPANY NAME BARKER CONSTRUCTION, INC./BARKER WELL & PUMP
STATE WELL CONSTRUCTION PERMIT# 1871 ASSOCIATED WQ PERM!T#
(if applicable) (if applicable)
PHONE # 1�) 691-7263
1. WELL USE (Check Applicable Box): Residential El Municipal/Public ° Industrial 0 Agricultural 0
Monitoring ° Recovery 0 Heat Pump Water Injection ❑ Other ° If Other, List Use
2. WELL LOCATION:
Nearest Town: ASHEVILLE County BUNCOMBE
LAUREL WOODS SUBDIVISION
(Street Name, Numbm, Cammmtity. Sub&visun, tat No., ZP Code)
3. OWNER: MIKE DAMPIER
Address PO BOX 6400
(Street or Rate No.)
HENDERSONVILLE NC 28793
City or Town State Zp Code
( Area code- Phone number
4. DATE DRILLED NOVEMBER 12, 2004
5. TOTAL DEPTH: 1000
6. DOES WELL REPLACE EXISTING WELL? YES ° NO El
7. STATIC WATER LEVEL Below Top of Casing 180' FT.
(Use'+^ ifAbove Top of Casing)
8. TOP OF CASING IS 1.33 FT. Above Land Surfaces
`Top of casing terminated at/or bebw land surface requires a
variance in accordance with ISA NCAC 2C .0118.
9. YIELD (awn): 1% METHOD OF TEST TIMED
10. WATER ZONES (depth):
Topographic/Land setting
®Ridge °Slope °Valley °Flat
(cheek appropriate box)
Latitude/longitude of well location
(aegreeshMouses/scmnds)
Latitude/longitude source:°GPSDTopoglaphic map
(check box)
DEPTH DRILLING LOG -
From To FonnationDesStion 0
rnr*s
;err_
ga
f, fl4
T'• con
0
r'T
c-7
11. DISINFECTION: Type BY PUMP INSTALLER Amotmt
12. CASING: Wall Thielaess
DepthFrom 0 TT
From To
From To
13. GROUT: Depth
From 0 To 20
From To
14. SCREEN: Depth
From To
From To
15. SAND/GRAVEL PACK:
Depth
From To
From To
16. REMARKS:
Diameter or Weight/Ft. Material
Ft. 6118 SDR21 PVC
Ft.
Ft
Material
FL CONCRETE
Ft.
Diameter Slot Size
Ft. in. in.
Ft in. in.
Method
POURED
Material
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common road names.
J,//tom.g4kL LLLC -St /L4y' 74Zo
07R/.Cl l.C21.v a�Gt t/K JIX tato
e�� oaLt lLlledd
aw
to grip n arLG o .
Mad_ r act is ��.ttut treads
FL �oad. laf.Qofe)L,
Ft
Size Material
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WFI.I
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
'Vitt erZWIL/ 1 - Z-pL}
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mali Service Cotter - Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-1 REV. 07/2001

305002
WELL CONSTRUCTION RECORD
North Carolina — Department of Environment And Natural Resources — Division of Water Quality — Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) ROBIN MCNEELY CER1IFICATION # 2567
WELL CONTRACTOR COMPANY NAME PITTMAN WELL BORING, LLC PHONE # [phone]
STATE WELL CONSTRUCTION PERMIT # _ ASSOCIATED WQ PERMIT #
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential ® Mumicipal/Public ❑ Industrial ❑ Agricultural ❑
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use
2. WELL LOCATION:
Nearest Town: ASHEVILLE County BUNCOMBE
37 LOST MTN. LANE
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: JAMES & ALLEN CHANDLER
Address 37 LOST MTN. LANE
(Street or RouteNo.)
ASHEVILLE NC 28805
City or Town State Zip Code
NA) — 298-6699
Area Code Phone number
4. DATE DRILLED 11/11/04
5. TOTAL DEPTH: 33
6. DOES WELL REPLACE EXISTING WELL? YES ® NO ❑
7. STATIC WATER LEVEL Below Top of Casing: 0 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS 1-1/2 FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordance with 15A NCAC 2C .0118.
9. YIELD (gpm): 0 METHOD OF TEST STEEL TAPE
10. WATER ZONES (depth):
11. DISINFECTION: Type CHLORYTE Amount CUSTOMER
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft Material
From 0 To 0 Ft. CUSTOMER
From _ To _ Ft. _
From To Ft.
13. GROUT: Depth Material
From 0 To 0 Ft. CEMENT
From To Ft.
14.SCREEN: Depth Diameter Slot
From _ To _ Ft. _ im _
From _ To _ Ft. _ in. _
15. SAND/GRAVEL PACK:
Depth Size
From 0 To 0 Ft. 78M
From To Ft.
Method
POURED
Size Material
in.
in.
Material
GRAVEL
Topographic/Land setting
0 Ridge ❑ Slope ❑ Valley ❑ Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source: ❑ GPS ❑ Topographic map
(check box)
DEPTH
From To
DRILLING LOG
From To
LOCATION SKETCH
Show direction and distance in miles from at least
Two State Roads or County Roads. Include the road
number and common names
I-40 W. FROM MARION. EXIT RT. ON #55.
RT.ON HWY. 70. LEFT ON WARREN WILSON
COLLEGE RD. CROSS RIVER. LEFT ON
RICEVILLE RD. RT. ON 2Nn DILLINGHAM
CIRCLE. LEFT ON MCKINNEY RD. LEFT ON LEEL
DR. APPROX. 1/10 MILE RT. ON LOST MTN. LANE.
1/10 MILE ON RT.
8
2
16. REMARKS -CUSTOMER INSTALLED CASING HIMSELF_ WOULDN'T ALLOW US TO ABANDON WELL.
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
SI NA OF P CONSTRUCTING THE WEL 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

0\5'
306541
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Reso1(i[ ees - Division of Water Quality - Groundwater SectionWELL CONTRACTOR (INDIVIDUAL) NAME(print)M_R ( LudIr Ia CERTIFICATION Age 03
WELL CONTRACTOR COMPANY NAME Fl?pPrIAW\IA34 (DEA( DRNI11i-:G PHONE O a2s4S3-I07a .
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMrr#
(if applicable) (if applicable)
I. WELL USE (Check Applicable Box): Residential B Municipal/Public ❑ Industrial ❑ Agricultural ❑
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use
2. WELL LOCATION:
N Towns W^ Ar 1/4-
(Street Name, Numbers, Community, Subdivision, Lot No, Tip Code)
3. OWNER: v& t
h+ fU
Address /`�(r'y t. MA). Maw
,5 ?Last li a2 8
County "A 0
City or Town State tip Code
Area code- Phone num
4. DATE DRILLED *PC r
5. TOTAL DEPTH: $C#5
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO
7. STATIC WATER LEVEL Below Top of Casing: FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS 1' FT. Above Land Surface*
'Top of casing terminated at/or below land surface require ■
variance in accordance with ISA NCAC 2C.0118.(.
9. YIELD (gpm): METHOD OF TES l� a fLla
10. WATER ZONES depth): )
11. DISINFECTION: Type 146.0 (' Amount v—
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
From d To I I / f Ft.
From To Ft.
From To Ft.
13. GROUT: Depth (1� A,l PM
From To Ft SKY 1 U
From To Ft.
14. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in.
From To Ft in. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft
Topottap}(Ic/Land setting
[Ridge p ope ❑Valley ❑Flat
(cheek appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topograpbic map
(check box)
DEPTH DRILLING LOG
From To Formation Description
16. REMARKS:
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common mad names.
flG O k1-t3. [,/ki
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
SI /� 9 0
ATURE OF PERSON CONSTRUCTING THE WELL DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-1 REV. 07/2001

Depth
To
From To
15. SAND/GRAVEL PACK:
Depth
From To
From To Ft.
WELL CONSTRUCTION RECORD
North Carolina - Department of Envirotnnent and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) KENNETH MCCRARY CERTIFICATION a 2008
306167
WELL CONTRACTOR COMPANY NAME BARKER CONSTRUCTION, INC./BARKER WELL & PUMP pjuoNg a f828) 697.7263
STATE WELL CONSTRUCTION PERMIT# 1871 ASSOCIATED WQ PERMIT,/
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential RI Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION:
Nearest Town: ASHEVILLE
LAUREL WOODS SUBDIVISION
County BUNCOMBE
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER MICHAEL PATRICK HOME BUILDERS
Address PO BOX 6400
(Street or Route No.)
HENDERSONVILLE NC 28793
City or Town State Zip Code
( 828 )_ 628-4525
Area code- Phone number
4. DATE DRILLED DECEMBER 30, 2004
5. TOTAL DEPTH: 405'
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO gl
7. STATIC WATER LEVEL Below Top of Casing: 80 Ff.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS 1.33 FT. Above Land Surface*
*Top of casing terminated aUor below land surface requires a
variance in accordance with ISA NCAC 2C .a11&
9. YIELD (gpm): 15 METHOD OF TEST TIMED
10. WATER ZONES (depth):
Topographic/Land setting
®Ridge ❑Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From To Formation Description
I1. DISINFECTION: Type BY PUMP INSTALLER Amount
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft Material
From 0 To 45 Ft. 61/8 SDR21 PVC
From To Ft
From To Ft.
13. GROUT: Depth Material Method
From 0 To 20 Ft. CONCRETE POURED
From To Ft.
14. SCREEN:
From Ft.
Ft. in.
S
Ft.
16. REMARKS:
(St
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common mad names.
J�to/x t� . %4
�. da'v z putt 07 end
,ems. ( ,tazd / Ca4.e. ,S )
L./at-Lear-di v14972 ..e c n4 K ,tt2.Gt. c.Q
6�c eiace,L (cad tezzeZood
®
Diameter A,6 a��� .c-c.0 in. ut �L/
Slot Size Material �/ [ g-,,yy
in. ex/Aida
a XKJ �u .�0%/7d�/v//q/,/rj'f"-ii�zit
Material and z °t^.� Q 7 �LTJ ir-vtr-R...
tL atet a[d ^� -6. l/AA.61.24
Int Lilt.
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
6.444tatil.1
SIGNATURE OF PERSON CONSTRUCTING LL
2 DA B' 611'
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mall Service Center • Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-1 REV. 07/2001

EmONS 11La..1
,. .10, ti 411J Si s1U1.11 - y cta4.1 1Vaior Qtialiru
y - Olondsvalcr CLL kiJ • Set) b‘by /1) 0.211..nFlo,,..rion ;las
cooat; fer54a,5,12e/ liva.? Co
11 LL IL1LJft tCRAtt i'”
113PV,10111
. 1.74C4 , Ip41:P”blic 17-1 o
itrio•lLllLI3rjt (anima, List Dsc.
ca/a1VISAlea Z.Vitealik
309233
TopogrtjsailoiLnnd serving
FJ111108c tIrSlotoo OVAlicy
(chc“1:.ippiopriat no:a)
Latirudoloogtrudepf sstll location
\ S. in ehtLJAILj:Efar__
/6 4, (4cviccsmiu)
ft' lek3
- SOut-Cs: err5SOTopo8raptii,:
ruip
1)1- P l'H DRILUNG LOG
box)
Coe
Ei
Formation Dseription
urn To
:DATE DfuLLL-T, / V
or Diu I. di
3 DatES V, ELL 11IPLA0E EXISTING WELL? ',IS 0 Nap
STATIC' 10 ATER. LEVEL Eiclatw Top of CaSing:
T014 geCa.:0"sir;) FOP •:;r !NC IS FT. AtJoy 1.0110 Sw.t.Jaa
i‘crcular‘a .; cur ulrc v.:quit-vs u
in. Ne_4.0
9 1 IELC cs.p,11). _a_ i\ iFT1-10D 2 TESTliaj,ilai_f.ar_13
7 i
altaNE3 LacpLrn:
C .4.311N
: OISiNFECTICIN pcy_414(ga,aes_ Krnount
Driantlti Dr 11,:g1-11..'St
-144143 al_Ctes/
FL.
F.
.3 3QQU r
a111:0cr1.0
1-',-0tia
•;in-. 0— 13—ga-42_ F1—CfP_LiCeCa_ tytat
fanoo
FL
a:CREEL:
-II Doinstar 3101 Sta.:. iotataitat
Ec tit. in
at
La SAN I-1, ailcs.`t EL P
iDcplr, Sixc Matt:ILI! Ft
atom ro Et
! 3 ilEAIAI-C,•_C
Dal riSE‘' CERIIE1 i-H:*r Th IS WLL WAS CONSTRucTED IN .A.ocon_o*HcE WITH ISA NOAC.. 20, WELL
j C i d IP.I.,0TiON ScD.HZDS' A.ND TLI AT a, 00 P V or -rills RECORD HAS BEEN PROVIDED TO THE WELL OVINERE--
61\1..‘
ni: 0 1:::3011 coh3TaICTIT,IG THE WELL
1:‘,C1Il1l Lit: Lilllii.si [0 ific Cli1•11011 or ll'afcr QU4Iiiy, CaMOLIII all Alcr S0011,
:Mi./v-403c, l'itii41( .10•G'11:))7)]-3:121 wirtlin 3d d4as,
LOCATION SKETCH
Shan, do -cotton :and 1111103 ITOLTI At 1,-;;If
twO SUlc Ronda or Counry Roads. Include the road
intamors :and common rod mimes.
6,no,47
Ke'
1636 Aqui! Service Ce firer ILdtigh, PLC_
G REV. 07/2i)[)i

309287
14. SCREEN:
From
From
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section -�
WELL CONTRACTOR (INDIVIDUAL) NAME (print) /llAr% 41(n h CERTIFICATION#3Q261
WELL CONTRACTOR COMPANY NAME Fe rw Sox)
\Ai GII ��i nine) PHONE WW1 %y3 —7Y‘7/
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable)
(if applicable)
I. WELL USE (Check Applicable Box): Residential 13"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: �( //e County Bwnoon.-be
1 Crez 1`��cw.'Ife Rd
(Street Name, Numbers, Community, Subdivisio
3. OWNER: h1! £Lt&
Address �zaW 2tca
n, Lot No., Zip Code)
eo01
(Sweet or Route No.)
/}sAs ✓m& ,ye 4 &Rnl
Ciry or Town State Zip Code
49B - � o
Area code- Hone number/
4. DATE DRILLED / D - /3 — OV
5. TOTAL DEPTH: 3 b S '
Topographic/Land setting
❑Ridge ❑Slope ❑Flat
(check appropriate box)
Latitude/longitude of well location
;/a /17 N- a?z/a
(degrees/minuttesisen6nds)
Latitude/longitude source: ❑GPS❑Topographic map
(check box)
DRILLING LOG
Formation Description
Clay
X,9n rid rr/n
&•c ) L__
DEPTH
From To
0 /0
V6
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO 13
7. STATIC WATER LEVEL Below Top of Casing: /0 r FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS / FT. Above Land Surface*
`Top of easing terminated atlor below land surface requires a
variance in accordance with 15A NCAC 2C .0118.
9. YIELD (gpm): 25 METHOD OF TEST /?r'p
10. WATER ZONES (depth):
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common road names.
11. DISINFECTION: Type
12. CASING:
From
N 71/
Depth Diameter
0 To F8 Ft. 44
From To Ft.
From To Ft.
13. GROUT: Depth Material
From (3 To 9 /5 Ft. Conc ro FP
Amount / — 5-64-
Wall Thickness
or Weight/Ft. Material
5 -a/ Pvc
From To Ft.
Depth Diameter
To Ft. in.
To Ft. in.
15. SAND/GRAVEL PACK:
Depth
From To Ft.
From To Ft.
Size
/94.4 Witte- M
Method
Po t.ere d
Slot Size Material
in.
in.
Material
16. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH ISA NCAC 2C, WELL
CONSTRUCTION STANDARDS, A D THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER-
77f— 3—o�
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-1 REV. 07/2001
n
c D

309313
\WELL CONSTRUCTION IZECORD
P+r;rrn of I Lc2_I'Irlleril of Enr ironmcnr and - rat Rasu1'r'
ulccs - Division of Quality - Groundwater Section
A V D:LL UII TJc LLNntA9DUA1) NAME (P,Inn iA /✓ /�' f f fi r C 2 /
£' — r y / ! N C61:TIF1Ca1'lOry ».J!� Tr LIT_ u 1LTNIP--SI Oft Ch1PxpiT lY.andG o.air. c . T ... Cr,
1' . -c li C11, CONSTRUCTION aEnigi Tn
ASSOCL.tPEG We PLRAten;
it .nphc461c1
'WELL USE LC11I =.pp Laabi Box): Rzsid=nriel
a toe n� ❑ I I.step: ❑ HCarPump Water Injcuornr❑Na Orherl❑ If Ocher.induytrialList Ugse-�Suct�ln,ral q
ALL LOCATION. �7
Nearsl Tolrre St. ., ,c. :nova Counry/care".,.-. !e
SA/lei act
._.:R.inlc.:vwfmca, ronrm`mry Subairuian, let Po., Zip fade)
3 01AiAL3R ±3 (Cu T'G11�a nl.�
:dicsS -- 0 3 Sss
Ixrct or asurc iYa)
Swing KC ?877?
c.e. arT
p Coot:
S .JJo- Pll.irc °toilet
1'E
DRILLED r - i - 0'I
Topog�rhie/Land setring
:Ridge ZSIope ❑Valley :Flat
(check epproprisfc box)
Latitude/lougimde of well location
uodr2ca.7vr'
(degrmrminutyc stconds)
Latitude/longitude source: f3GPSOTopo8raphic map
(tllccl: box)
DRILLING 1.00
Fornation Description
DEPTH
From To
0-
,5 Y-- J
y:0 - 5ps—
DOES \\ ELL REPLACE EXISTING WELLS YES 0 NO C/
ST.rsTIC WATER LEVEL Eclow Top of Casing:
FT.
'Ilia . "Sr .i Tap Surface)
S. TOP OF CASING' a FT.
`rap cl :a:ui; Icrtrllllalc:l aver Ddulr land sure Land (SCC rcquirts grlaeC"
.arwr, w a[wrpNut.lnnl Ijd :N C.iC 2C.ol us.
�. YIELD (gpm): 1 M1ETHOD OF TEST Bbui4y vg
u- WATER ZONES idCpgl):------------
! OiSINFEOTJJCv: Types,
L'cprn - Diacr
ri:mn_Q mdr
L 0 Fr .11r'
F.
o
GROUT
FlCill_-�__
Front
l- SCJZEEN. D,pnr
Front
Frnai
u E._Na3R;
From
o REY,JARk3:
Amount t; Lcli�
Wit Thiclrnaaa
or Weight/Ft. Boa renal
Fr. —
Dcpih Marcnal
rD Fr.
Ft
Fc
'EL PACK
Depth
Po.
To_
Fr.
Diameter Slot Size
111 in
hlclnotl
LrIUrcrial
Sac Mucus!
! llu nEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED EN ACCORDANCE WITH liA NCAC 20, WELL
CONSTRUCTION STANDARDS, .AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER; —.
et. -2:
SION..ATUI'.E OF PERSON CONSTRUCTINGTHE WELL
DATE
S4uuur me urigivai w tnc Division of Wacer Qualiry, Crpundlya[er SSecriun, 1636 Mail Sarviae Cenrar- Rulalyh N2
l7o9y-163o Phone Iva. "Iy . vo
l ) 7)3 3., 1, %runic 70 days.
GW-I REV.07/''04
LOCATION N SKETc11
Show direction and distance in miles "torn at IeaSr
CWO Scat Roads or County Roads. Include the road
❑umbers and common road names.
1 2 sfp4e'-y oA-k Wn-1
cum -iv ,(t} an% /11. C
CD
c 7

309335
WELL CONSTRUCTION RFCOI'1D
rr mCsrnlinn .cp,rm,anr-of Environment and • ral Resources - Division of l\'arcr Quality - Groundwater Section
4�// 11 cl1 CO1 �A11O& RNDIA'iDU.�L) NAhtL' (prim) �, I�IrNe S CCRTIF1CajT10N I,.�1"Fd
'Rag J ry
11tiLL CON I':t-.�I., I: CU,11PAN1',Y' Vll J er Lc.saw,rs �`/ 7)p;J/,»' Cie, &nONG'Rag Si dW�
v-rt, Vr CLL CJ,�3TItUCrtON PIa:111ITa ASSOCIATED WQ P- 112A31Tn
if
usE LL.ncctc App4.:able Box): Ra>ideoriul Ld A'iunioip
L'Puhlie ❑ Industrial ❑
Agricultural ❑
Atam-orLu 0 Rcootcry 0 Hcar Pump Water lnjccr!on 0 Other If Other, List Use
2. O. ELL LOCATION:
NeDrest Town' eidetic CDuil ly SICr+.H Sc
,_-.:, �.,n vuai uc n' Canmun,ry, Subdivision, Lor I`I0., Zip coaci
3 0 \ ER.'
�o s4.a; s
AS ley, tSnwrar:2ourc Na.)
We Nc aego
a.8!- .6e4e 5. HttCa3
-_co aauc Hume aun:oer
DATE DRILLED 7' 2 -Oti
3 FOTa.L. DEPTH: 24r
Zip Cons
a. DOES WELL REPLACE EXISTING WELL') YES 0 NO
STATIC WATER LEVEL Below Top of Casing: 6o F.T.
I Use "r"-if.Abavc Top ai Cmin)
�. TOP OF CASING IS FT. Abo;d Land Surtaee+
`top ur:av; :crmu.ua aver bcluw land su rt se rvy ui its a
v]r14:13e m accoraane. wire ISA NC.0 2C.0l2e.
9. h,
YIELD L;pml: 20 METHOD OF TEST Bj(iJ4qq ./1„r
id, \Y.>.TER ZONES tdcplh): %S - /`V - J .'
DISINFECTION: Type( /DQ,Ne• Amount // J
off
CASING: Wall Thiclamss
©
L`cprn Di9n,cicr or WcighdFt. PdureriuI
rrom PO 1.3-- F[. CM, SJdp /✓G
rro,n to Fr.
.tom .ro Fr.
3..;ROUT: Dcpilt Marcnal
hlcmod
Fro:n__._,Q_ to j _ Fr. ('O/YCQCtie. ro---75
Froln 'Fd Fr.
I;. SCREEN.
Froa Slot Si?c Melfelial
Ocpru Diameter
Po Fr. in
Frdmlo Fr
I?. S ND R ,CK in.
Dt.prn
ocb
Ft Cm
o REMARKS
F r.
In.
Size hlsterial
To, Fr.
Topograp�hh c/Land seeing
❑Ridge f33'ropo DI/alloy ❑Flat
(cheek ,:ppmprinft box)
Latiruddr/longirude of well location
(degrees;minutcsAcconds)
Latirudeflongicude source: O'L{PSLDToporaphic map
rtllcA: bu..\)
DEPTH DRILLING LOG
From To Formation Description
Gc7
SC -,✓St •1P
LOCATION SKETCH
Show direction and di3rance in miles from ar IoaSI
twa State Roads or County Roads. Include ncroad
numbers and common road I14111C3.
Ste %3cLshwrr/d/,�L.v.
S&.Ia, Amvs,0%!/r. C•
I DO HEREET CERTIFY THATTHIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH tiANCAC 2C, WELL
CDlN3TRUOTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
a
fld
01
SIGNATURE OF PERSON CONSTRUCTING THE WELL
DATE n
T - 3J
]u0::11r trio original ro the Division or AVarer Qualiry, Geo un dw ucer Section, 1636 Mail Service Cenrer -Raleigh NC T,
i769)-Io3o Fiume :No. r919) 733.3221, Wirnin 30 days. Na • d .
is..)0$1
GW-I REV. 07/2

l�W
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division/�l//of Water Quality - Groundwater Section �ll ��99//
WELL CONTRACTOR (INDIVIDUAL) NAME (print) illn r k f'f l t h CERTIFICATION #�.�1 f/p/q
WELL CONTRACTOR COMPANY NAME /Ctrus*eJ iNGII it a•( II fvrg PHONE (gp2Y) %Y3-p34i/
STATE WELL CONSTRUCTION PERMITS/ ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential IPJ Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION:
Nearest Town: A ' / County 8U06o,.vbz
at, -We Miu fir,'-,� c
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER:-. i..s%e/ -8CD Isn't
Address AOts1 .�'OCi[an.Y Cull ,'I.
(Street or Gee No.)
4510-urile,A138195
City or Town State
(&Q8) a V• 3 7.5
Area code- Phone number
4. DATE DRILLED g P' D f%
5. TOTAL DEPTH: SOC
Zip Code
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO FiilV
7. STATIC WATER LEVEL Below Top of Casing: . lab FT.
(Use '4" if Above Top of Casing)
8. TOP OF CASING IS / FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordance with ISA NCAC 2C .0118.
9. YIELD (gpm): /%+ METHOD OF TEST RR79
10. WATER ZONES (depth):
11. DISINFECTION: Type H 7f/
12. CASING:
Depth Dia1neter
From 0 To a%r 8 Ft.f y
From To Ft.
From To Ft.
13. GROUT: Depth
From 0 To 9(I Ft.
Amount /3_ 4 Oz.
Wall Thickness
or Weight/Ft. Material
£VL21 PVc
Material
Cr>ncroie
From To Ft.
14. SCREEN: Depth Diameter
From To Ft. in.
From To Ft. in.
15. SAND/GRAVEL PACK:
Depth Size
From To
From To
16. REMARKS:
Ft.
Ft.
Method)
Po tAroJ
Slot Size
in,
in.
Material
Material
Topographic/Land setting
ORidge ❑Slope ❑Valley ❑Flat
(check appropriate box)
Latt e/1 nPPitude of weill loc ion
?r 3/ 4b ts- o ga in,22rA)
degrees/minutes/seconds)
Latitude/longitude source: ®CPS❑Topographic map
(check box)
DEPTH DRILLING LOG
To Formation Description
10
b
W
rn
Cn
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 4.4/a Mw. c3*Afes
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDA
CONSTRUCTION STANDARq,St, AND THAT A COPY OF THIS RECORD HAS BE
$ WITH i5A t1,fj WELL
PROVIDES TCTHEWELL OWNER
SIGNATURE OF PERSON CONSTRUCTING THE WELL
DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-1 REV. 07/2001

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section -� �p�
WELL CONTRACTOR (INDIVIDUAL) NAME (print) Mitt r k Al to Y1 CERTIFICATION #3Q 4
WELL CONTRACTOR COMPANY NAME Ar rri, Son) id el 1 r':l(,nry PHONE QQ(1 %n93-9}41/
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
311415
I. WELL USE (Check Applicable Box): Residential DV Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION: � /]
Nearest Town: SUSA^
I)AI1rin County -nt fOtrim 1..t
(Street Name, Numbers, CCoinmunity, Subdivision, Lot No., Zip Code)
3. OWNER: Z I 0244 •
Address //a in O..q. t t nod Ski.
(Street or Route No.)
S�wt _ it 49 9' R
Zip Code
City or Town State
(tom yre - -?790
Area code- Phone number
4. DATE DRILLED Ie2 30 — 0
5. TOTAL DEPTH:
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO Q
7. STATIC WATER LEVEL Below Top of Casing: /0 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS / FT. Above Land Surface*
"Top of casing terminated atlor below land surface requires a
variance in accordance with ISA NCAC 2C .0118.
9. YIELD (gpm): /,S METHOD OF TEST t i
10. WATER ZONES (depth): / `% 4—a
11. DISINFECTION: Type ill 7 //
12. CASING:
¢� Depth �j irneter
From (O To i 9 Ft. P
Frorn& To 3 Ft. 7(
From To Ft.
13. GROUT: Depth
From(Z To 91) Ft.
Amount ? Oz.
Wall Thickness
or Weight/Ft. atenal
,SpE-)/ VC..
C(-
Material
Lane ro I-e
From To Ft.
14. SCREEN: Depth Diameter
From To Ft. in.
From To Ft. in.
15. SAND/GRAVEL PACK:
Depth
From To
From To
Method
Patna
Slot Size Material
in.
in.
Size Material
Ft.
Ft.
Topographic/Land setting
❑Ridge ❑Slope ❑Valley Bfiat
(check appropriate box)
Latitude/longitude of well locatio
1G/RS/60c+- DRaia59V&1
(degrees/minutes/seco ds)
Latitude/longitude source: giairS0Topographic map
(check box)
DRILLING LOG
Fxmation Description
3/ :LLr
(o (a �9r1 r
sh a(._
DEPTH
From To
0 3O
S
513
1 fl
LOCATION SKETCH c�11
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road,
numbers and common road names.
cu/wa a2, ,C
16. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH ISA NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
7 �/ - 1� 3O -Di
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

STATE WELL CONSTRUCTION PERMIT#
(ifap licable) ASSOCIATED WQ PERMIT#
(ifa icable)
WELL USE (Check Applicable Box): Residential ❑ Municipal/Public 0 Industrial ❑ Agricultural d—
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use
WELL LOCATION:
Nearest Town: Lercg l-e County co 6
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3.OWNER: Li./4-
Address
1
2
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Naturalur�jResources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR COMPANY NAME
/
WELL CONTRACTOR (INDIVIDUAL) NAME (print) / I0.r k p/�f
CERTIFICATION #/
PHONE Is )683-91ily
City or Town State
Zip Code
Area ode- Phone number
5. DATEDEPTH:
.t'/9-o�
TO
5. TOTALLDEPTH:
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO Li 7. STATIC WATER LEVEL Below Top of Casing: /
FT.
8. TOP OF CASING IS (Use FT. if Above Top of Casing)
Above Land Surface* *Top of casing terminated at/or below land surface requires a
variance in accordance with 15A NCAC 2C .0118.
9. YIELD (gpm): (2___ METHOD OF TEST
10. WATER ZONES (depth): ��-� ��
11. DISINFECTION: Type
12. CASING: Amount Cn
Wall Thickness
Depth Diameter or Weight/Ft. Material
From
From_Q To[ Ft.,�' _ E8/ --
To Ft.
From To Ft. _
13. GROUT: Depth Material
From 0 Tom Ft. Cw}Grrkv
From To Ft
14. SCREEN: Depth Diameter
From Slot Size Material
To Ft. in.
From To in.
Ft.
in.
15. SAND/GRAVEL PACK
in.
Depth Size Material
From To Ft.
From To Ft
16. REMARKS:
MethoA7
recta*
Topographic/Land setting
❑Ridge ❑Slope ❑Valley'
(check appropriate box)
Latitude/longitude of well location
oFaalit)
(dJgreesiminutesisec ndys
Latitude/longitude source: I116PS❑Topographic map
(check box)
DRILLING LOG
Formation Descriptiotcy
DEPTH
From To
it ofVe
LOCATION SCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common road names.
Ae
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC2C, WLL
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNE
SIGNATURE OF PERSON CONSTRUCTING THE WELL v '
DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center- Raleigh, N -
27699-1636 Phone No. [phone], within 30 days.c ?
GW-1 REV.07/ L
r
310829
tr-

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water WELL CONTRACTOR (INDIVIDUAL) NAME (print) Qualit__ - Groundwater Section
WELL CONTRACTOR COMPANY NAME [ CERTIFICATION #‘.3'2:f4
STATE WELL CONSTRUCTION PERMIT[/ I PHONE Sl /yr _9SL19
(if applicable) ASSOCIATED WQ PERMIT,/
(ifa plicable)
1. WELL USE (Check Applicable Box): Residential M
Agricultural 0
Monitoring 0 Recovery0 p to unicipaOtheric 0
Industrial ❑
Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION:
Nearest Town: GCS est Countyat.s e itSt
ga
(Street Name, Numbers, Community, Subdivision. Lot No., Zip Code)
3. OWNER:
Address
ay or Town tare Zip Code
's�
ea Eode. Phone number
4. DATE DRILLED _ 0
5. TOTAL DEPTH:
6. DOES WELL REPLACE EXISTING WELL'? YES ❑ NO ❑ ---
7.STA
TIC WATER LEVEL Below Top of Casing:
Use "+" if Above Top of Casing)
8. TOP OF CASING 1S Surface*
FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordance with l5A NCAC 2C .0118.
9. YIELD (gpm); __ METHOD OF TESTjlv
10. WATER ZONES (depth): a
11. DISINFECTION: Type_, i/___ZS
12. CASING:
D DDepthpq Di meter
From _ Fi
From To Ft
From To Ft.
13. GROUT: Depth
From_ To Material
From—'— Ft.tide__
To Ft._ —_ 14. SCREEN: Depth Diameter
From Slot Size
To Ft. in.
From To in. _
15. SAND/GRAVELFt is in.
PACK: -
Depth Size Material
From To Ft.
From To Ft.
Amount
Wall Thickness
or Weight/Ft. pMaterial
SDI
16. REMARKS:
6Z.
P Method
Material
310832
topographic/Land setting
e ❑Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
t'-O
(degrees/minutes/seconds)
Latitude/longitude source: ❑GPS❑Topographic map
DEPTH (check box)
DRILLING LOG
From To Frahm) Description
O D A—sy-
I c - Rram, C t
inc
,.y
Tht-
LOCATION
Show direction and distance In miles fromatat teas`
two State Roads or County Roads. Include the ro
numbers and common road names,
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH I5A NCAC 2C, WELL
CONSTRUCTION STANDARD , AND /THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL 0
/17
SIGNATURE OF PERSON CONSTRUCTING THE WELL o
DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center -Ralei
27699-1636 Phone No. [phone], within 30 days.
GW-1 REV.

311358
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section /q
WELL CONTRACTOR (INDIVIDUAL) NAME (print) !ll r k /41t, CERTIFICATION #.a?,t'la -
PHONE (Vi'cii) L V3 —954/7
WELL CONTRACTOR COMPANY NAME frerr2.-, sea.
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential 13/ Municipal/Public ❑ Industrial 0 Agricultural 0
Monitoring 0 Recovery ❑ Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION:
Nearest Town: L. e ersler
MC. In
:,Jill bi-?IlOo?
County $cu.ncorn.6e
(Sweet Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: DLI WIN)
Address 55- /7)an/ ye. `eou
( neet or -route No.)
o
,4 ci tui 1 s or Town State
427010
- ./e al.-"`r/%
:Me- Phone number
4. DATE DRILLED 1,,yo %
Topo�grap�h�'c/Land setting
❑Ridge W&t pe ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of' well location
34'/d iln nl - o8a/ 4.104.40
t9
(degrees/minutes/seconds)
Latitude/longitude source: ❑GPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From To
0 .20
5. TOTAL DEPTH: r-?aS" g,
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO lid
7. STATIC WATER LEVEL Below Top of Casing: o70 FT.
(Use"+" if Above Top of Casing)
8. TOP OF CASING IS / FT. Above Land Surface*
*'Cop of casing terminated at/or below land surface requires a
variance in accordance with 15A NCAC 2C .0118.
9. YIELD (gpm): METHOD OF TEST Rey
10. WATER ZONES (depth):
11. DISINFECTION: Type H 7H
12. CASING:
Depth
From a To Vie Ft.
From To Ft.
From To Ft.
13. GROUT: Depth Material Method
t
From O To 91) Ft. Conero 1-e 1-"0u 'p..0
From To Ft.
14. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in.
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft
Amount 9 6a.
Wall Thickness
Diameter or Weight/Ft. Material&As SDR Il j'YC
16. REMARKS:
Formation Description
Clay/
r? l V o sapid X
IL/ (LA Gran:l-e
Cmzna-c
—s
C
w -o
(JI
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common road names.
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED EN ACCORDANCE WITH I5A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
777aer c'aA* — -7— ?-6V
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

311354
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) . gR r k .41t
CERTIFICATION 83.2!O
WELL CONTRACTOR COMPANY NAME fi'rrwSotJ ..1i GI I I' -; l!.n PHONE pew) %Y3 -9}ti/
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential ($ Municipal/Public 0 Industrial ❑ Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION:
Nearest Town: Ccnc1 I e.0 County auxxxxac,
Nwold Genet Rd. •/ S!
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER:
Address
(Street or Route No.)
Ciry or Town State_ Zip Code
Area code- Phone numberG 4S-//ii
4. DATE DRILLED 7—l7
5. TOTAL DEPTH: S6
Topographic/Land setting
Edge ❑Slope ❑Valley ❑Flat
(check appropriate box)
Latitpde/longitude of well location
W
(degrees/minutes/seconds)
Latitude/longitude source: e 'PS❑Topographic map
(check box)
DRILLING LOG
Formation
Description
DEPTH
From To
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO
7. STATIC WATER LEVEL Below Top of Casing: Gd- FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS FT. Above Land Surface*
"'fop of casing terminated at/or below land surface requires a
variance in accordance with 15A NCAC 2C .0118.
9. YIELD (gpm): S METHOD OF TEST Wi/
10. WATER ZONES (depth): San
11. DISINFECTION: Type fr 7fl Amount 6L.
12. CASING:
Depth�. 1/
From Q To TQ Ft
From To Ft
From To Ft
13. GROUT: Depth Material
From d To 9 () Ft. Cone ro {-p
Diamerer
Wall Thickness
or Weight/Ft. Material
Saki. ?Si
r
S r
From To Ft.
Method
POUrad
14. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in.
From To Ft. in. in.
I . SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
16. REMARKS:
,l
r'
C..3
LOCATION SKETCH
tJl
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common road names.
1 DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH ISA NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
7�a 7-7- o/
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center -Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-1 REV. 07/2001

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Naturalrat�tIResources - Division/�lof Water Quality - Groundwater Section �--�� ��yy��
WELL CONTRACTOR (INDIVIDUAL) NAME (print) i • frt r k A-110 Yl CERTIFICATION #.�fp
WELL CONTRACTOR COMPANY NAME FerriSoo)01 tit Zlc al.n7 PHONE flare) !93-5541
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
WELL USE (Check Applicable Box): Residential LW" Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION:
Nearest Town: WQ.avec't \e
f A,S iCe. U sand
County �1 i..ncerrlls.
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3.OWNER: -D'aJ rr1t.tL r
Address ,0 tf/i'loal( (9i,r/o
72 (Street or Route No.) ®8 Q� au �C
Ci':y Zip Code
or Town rate
Gs/S-�y
.,,e�e- Phone number
4. DATE DRILLED 8 - b 7 -
5. TOTAL DEPTH: 3dC
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO lir
7. STATIC WATER LEVEL Below Top of Casing: TO FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS / FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordance with ISA NCAC 2C .0I18.
9. YIELD (gpm): /5 MET OD OF TEST
R
10. WATER ZONES (depth): b r•
11. DISINFECTION: Type
l2. CASING:
Depth
From 0 To /0/ Ft.
From To Ft.
From To Ft.
13. GROUT: Depth
From 0 Tod U Ft.
f/ Amount /a 6z.
Wall Thickness
Diameter or Weight/Ft. Material
/P Sf2a l re_
Material
Cone ro 1-e
From To Ft.
14. SCREEN: Depth Diameter
From To Ft. in.
From To Ft. in.
15. SAND/GRAVEL PACK:
Depth Size
From To Ft.
From To Ft.
Method)
..r,„
urQA
Slot Size Material
in.
in.
Material
topographic/Land setting
rdge ❑Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well 1 cation
3 V/Via l4-0R y/31r✓
(degrees/minutes/seconds)
Latitude/longitude source: ❑GPS❑Topographic map
(check box)
DRILLING LOG
Formation Description
Clay
DEPTH
From To
0 as
90 Sand r5{awe
to
Gran "tom..
7
LOCATION SKETCH '^*
Show direction and distance in miles from at least 44
two State Roads or County Roads. Include the road
numbers and common road names.
eadtitaiano
t,,Lus,fie c.
16. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH ISA NqAC2C, WELL
CONSTRUCTION STAN,D,ARDSS, ANDDD TTLHAAT_A COPY OF THIS RECORD HAS BEEN -PROVIDED TOTHE WELL OWNER
7102/
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
31011
North Carolina - Department of Environment and Natural Resources - Division______�y�
of Water Quality - Groundwater Section --�
WELL CONTRACTOR (INDIVIDUAL) NAME (print) wrn r k ,416 Yl CERTIFICATION #q
WELL CONTRACTOR COMPANY NAME Ferru Sall U1UI Zlt-(1(:ng PHONE (g3' %Y;-9itV
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential Municipal/Public ❑ Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION:
Nearest Town:21 rd.e dfn)l.
ler
(StreetName N nbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER:
Address 73 t'qr
•
t,/) freer or Rpute No.
Ciry or Town State
(42114 - r in- Loflj2
Area ode- Plione number
4. DATE DRILLED ,S'/2 t//a K
(
5. TOTAL DEPTH: 0,76.i
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO
7. STATIC WATER LEVEL Below Top of Casing: /(. FT.
(Use "+• if Above Top of Casing)
8. TOP OF CASING IS FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordance with ISA NCAC 2C .0118.
9. YIELD (gpm): ,3 METHOD OF TEST_
10. WATER ZONES (depth):
County 'Du.ncoa76r
Latin
cot
�ro9
Zi7tode
11. DISINFECTION: Type H 7//
12. CASING:
Depth Diameter
From 0 To 3i Ft. to 4
From To Ft.
From To Ft.
13. GROUT: Depth Material Method
From__O___ n To 90 Ft. (oCro 1-e PotAr )
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
Amount //. A tat'
Wall Thickness
or Weight/Ft. Material
S)etJ
From To Ft.
From To Ft.
Topographic/Land setting
❑Ridge 0Slope ❑Valley r ai t
(check appropriate box)
Latitude/longitude of well location
3s/ rer/2.1I!-hrol xpti-J
(degrees/minutes/seconds)
Latitude/longitude source: h3GPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From To Formation D%scription
v StrG,v^e�l
1 '7 -e
78 G�-w
6rtits j'iC
td
--c
LOCATION SKETCH tJ
Show direction and distance in miles from at lgvast
two State Roads or County Roads. Include tltefmoad I -
-
numbers and common road names.
6 au t zthriZUSL, re
16. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORIYANCE With 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS: BEEN PROVIDED TO THE WELL OWNER
777 VV
9era,61-t
SIGNATURE OF PERSON CONSTRUCTING THE WELL DAT
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
rlaa

3113'17
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) llla r i• A -I I, h CERTIFICATION tiaaej
q
WELL CONTRACTOR COMPANY NAME / e'//vs:5J uietl "Nr:il:n, PHONE fag) ivd'hi/7
Ti
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential YJ Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use _
2. WELL LOCATION: �,r
Nearest Town: 8arn,ell v,fie County Rion ccr4e-
7; /a,fl Breann.j. pet
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3
Address �,2L atica?n-Lr �nutn -
(Sneer t/oro Route No.)
.ea
t�uie
OWNER:
Topographic/Land setting
❑Ridge Glpe ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location/t�1r 35/ys�OP2/�yI/3IA)
(degreesiminutea/secontds)
atitude/longitude source: ❑GPS❑Topographic map
O (check box)
Z A% , 48%07 DEPTH DRILLING LOG
City or Town Sate Zip Code
Are1 code- Phone number
4. DATE DRILLED ?- IY -d 9
5. TOTAL DEPTH: 6 cc-
6 DOES WELL REPLACE EXISTING WELL? YES lnO 0
7. STATIC WATER LEVEL Below Top of Casing: FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS / FT. Above Land Surface*
*"Pop of casing terminated at/or below land surface requires a
variance in accordance with I5A NCAC 2C .0118.
9. YIELD (gpm): 0 METHOD OF TEST
10. WATER ZONES (depth): IV/A;
11. DISINFECTION: Type N 7f�
l2. CASING:
Depth Diameter
From D Tor& FL G 7
From To Ft.
Amount 30
Wall Thickness
or' isht/Ft. Material
s4e/
04.
From To Ft.
13. GROUT: Depth Material Method
From (3 To 9n Ft. COnGroI-e pOurQj
From To Ft.
I4. 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.
From
0
36
Formation Description
apna
Bata ArnetGran fie'
-
W
LOCATION SKETCH '{i0
Show direction and distance in miles from at least ti
two State Roads or County Roads. Include the road
numbers and common road names.
tL QcWA la1 / (,glad
6a2Aut..tolawilt Ne ' 4 /70 9
16. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH ISA WRAC 2C, WELL
CONSTRUCTION STANDARDS AND THAT A COPY OF THIS RECORD HAS 6EEN PROVIDED TO TIE WELL OWNER
l 4 -t)
SIGNATURE OF PERSON CONSTRUCTING TFIE WELL DATE
Submit the original to the Division of Water Quality, Groundwater Section, t636 Mail Service Center - Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-1 REV. 07/2001

t) 31i3"i
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) rrir k
WELL CONTRACTOR COMPANY NAME frCrei�.foal
STATE WELL CONSTRUCTION PERMIT*,
(if applicable)
416 h CERTIFICATION *,
i,Utll brill:nq PHONE WW1 6Y3
ASSOCIATED WQ PERMIT*,
(if applicable)
1. WELL USE (Check Applicable Box): Residential 4J Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other ❑ If Other, List Use
2. WELL LOCATION: M�v
Nearest Town: 8!-n /nci r+.
/I i h IRinc fi G i/-NieS
(Street Name! Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER:
Address s�yj pm ��j2 ry
City or Town State Zip Code
(84$ yyL - 36yy
County co rtbr
olkoti
i0aze 1'j�id 0,014 � :�q/
Stre for Route No.) G
Area code- Phone number
4. DATE DRILLED 9— 15.— rot
5. TOTAL DEPTH: Y VC
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO 1
7. STATIC WATER LEVEL Below Top of Casing: FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS / FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordance with 15.4 NCAC 2C .0118.
9. YIELD (gpm): it METHOD OF TEST r,,
10. WATER ZONES (depth):
l I. DISINFECTION: Type N 7f/ Amount
12. CASING: Wall Thickness
Depth Dipeter
From b To gJ Ft. 1/ V
From To Ft.
From To Ft.
13. GROUT: Depth Material
From n To 9!1 Ft. LbnGro E-2
From To Ft.
14. SCREEN' Depth Diameter Slot Size Material
From To Ft. in. in.
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Size Material
OZ.
or Weight/Ft. Material
SPZ 2/ PVG
Method
Po urvJ
From To Ft.
From To Ft.
Typographic/Land setting
Ittkrige ❑Slope 0Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
3V—05///fir M A -,1� `/
(de ees/minutes/second
Latitude/longitude source:❑Topographic map
(check box)
DEPTH DRILLING LOG
From To Formation Description
Ge
Il .27
aQ 7C
�L- (3
9V
S,®ne' S'Cou,
6'rq-a., �C-
!f-r e
�fl
-
LOCATION SKETCH 0 4
Show direction and distance in miles from at4EAst `
two State Roads or County Roads. Include the road
numbers and common road names.
cad( itotvidatk) Aid
C.LL
16. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE. WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, A D THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
9-/cam - a
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-1 REV. 07/2001

t
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural��Resources - Divisionisof Water Quality - Groundwater Section t' /
WELL CONTRACTOR (INDIVIDUAL) NAME (print) /' Iue k /'7 1/i n CERTIFICATION #3c) O'(il
r,9
WELL CONTRACTOR COMPANY NAME 2ry�n ion la1e1 I I�r.(i[nr �'C: PHONE (M )�,.f' '%�7Y
STATE WELL CONSTRUCTION PERMIT# / ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential 0/Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION:
Nearest Town: / e eeCJr f County Bt.onc.on r
* .z
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: G2 iVao,s'
Address of €cllt}.0 !
(Street ofr RouteNo.)
e:ces—fer, 1J c n87�{C
City or To to Zip Code
)- /fn •hoit
Area code- Phone numb r
4. DATE DRILLED 3 - %— U t%
5. TOTAL DEPTH: 07 yS
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO C
7. STATIC WATER LEVEL Below Top of Casing: 3O FT.
(Use "+" if Above Top of Casing)
S. TOP OF CASING IS / FT. Above Land Surface*
"Top of casing terminated at/or below land surface requires a
variance in accordance with 15A NCAC 2C .0118.
9. YIELD (gpm): 3 METHOD OF TEST /: y
10. WATER ZONES (depth): At Al-
11. DISINFECTION: Type
l2. CASING:
From
Depth
0
To (o
From 40 To i. 4'
From To
13. GROUT: Depth
From .0 To 20
From To
14. SCREEN' Depth
From To
To
From
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
T'1
t; 1
Topographic/Land setting t
ledge ❑Slope ❑Valley 0F1a
(check appropriate box)
Latitude/longitude of well location W
0
cp
(degrees/minutes/seconds) (Jl F,.9
Latitude/longitude source: ❑GPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From To Formation!Description
v / �� s�oY
L3-9 6 Y CERA,fe
LOCATION SKETCH
1/ 7 /'/ Amount - 1 i 1 Show direction and distance in miles from at least
Diameter
Ft. 4,
Ft. /ir -Jr
Ft.
Material
Ft. ezincez 0
Ft.
Wall Thickness two State Roads or County Roads. Include the road
or Weight/Ft. Material numbers and common road names. .
SDP 'a( Pvr
/A' nice/
Method'
Thu rzcl
Diameter Slot Size Material'
Ft. in. in.
Ft. in. in.
16. REMARKS:
1 DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTE
CONSTRUCTION STANDARDS, THAT A CO�[3'kECORD
ITH 15A NCAC 2C, WELL
EN PROVIDED TO THE WELL OWNER
3-9- Dy
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
rx
0

31141'7
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural��tResources - Divisionn�of Water Quality - Groundwater Section -� -� �9�
WELL CONTRACTOR (INDIVIDUAL) NAME (print) i rla r % -i L. v l CERTIFICATION # ems-__
WELL CONTRACTOR COMPANY NAME FtrS,msaa) 111/tII brill<nry PHONE Wpm GY3'/Tr/
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential QI/Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION: /I
Nearest Town: /('41,f i/niti. County $'uAAtdxr.9
(Street Name, Numbers, Community, Subdivision, Lo(No., Zip Code)
3. OWNER 1' ✓2-1 a Address 35� t.
aptreet or Route
6— CAt.VaA e ll Lb 7 438797
/V Zip Code
Ciry or Town State
(8.78)- ,?An . 142L
Area code- Phone number
4. DATE DRILLED ,, --O/
5. TOTAL DEPTH: %FOSS
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO
7. STATIC WATER LEVEL Below Top qf Casing: FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS if FT. Above Land Surface*
*Top of casing terminated auor below land surface requires a
variance in accordance with 15A NCAC 2C .0118.
9. YIELD (gpm): 40 METHOD OF TEST ibtki,
10. WATER ZONES (depth): /d 0 -a— o78D
I . DISINFECTION: Type f% trii Amount /
l2. CASING: Wall Thickness
Depth Diameter or Weight/Ft. aterial
From To 10 9 Ft. [e F six -it ✓
From To Ft.
From To Ft.
Depth Material Method
t
To 90 FL £bnCroI-z POLAresi
To Ft.
14. SCREEN: Depth Diameter Slot Size Material
in.
in.
13. GROUT:
From 0
From
From To Ft, in.
From To Ft. in.
15. SAND/GRAVEL PACK:
Depth Size
From To
From To
Ft.
Ft.
DZ.
Material
Topographic/Land setting
$Ridge ❑Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
J5 °/3 P/s91- 0&Q /17�/Old
(de es/minutes/second
Latimde/longitude source: PS❑Topographic map
(check box)
DRILLING LOG
Formation Description
DEPTH
From To
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers andcommontroad names.
N eaesi-Lt, /YC
16. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STAND AR S, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
S NATURE 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

311418
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) An c k ,414 CERTIFICATION #
PHONE WWI , V3 -/Tr/
WELL CONTRACTOR COMPANY NAME
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
jr-),,Soal vJt1I Zlcill�nc;
1. WELL USE (Check Applicable Box): Residential VJ Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other ❑ If Other, List Use
2. WELL LOCATION:
Nearest Town: Le'? e'er
. /ttt%I.[) / Cdrt,L
(Street Name, Nuin,ers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: —%l sn:et. ads atin
Address 940. S4 an Sat
(Street or Route No.)
City or Town State
(R-7$ WS- /o44
Area code- Phone number
4. DATE DRILLED dg'2J-G7) 7
5. TOTAL DEPTH: 0
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO ❑
7. STATIC WATER LEVEL Below Top of Casing: CO FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS / FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordance with ISA NCAC 2C .0118.
9. YIELD (gpm): 30 METHOD OF TESTT
10. WATER ZONES (depth):
11. DISINFECTION: Type 7N Amount // 454'
12. CASING: Wall Thickness
ri Deptho_Diary r or Weight/Ft. Ffvri�
From [/ To_ Fc V �' ((��
From To Ft.
From To Ft.
County Bur✓nillbt
l3. GROUT' Depth
d8710
Zip Code
Material Method
From6 To 9 /7 Ft. L'onC ro k Poc*raj
From To
14. SCREEN: Depth
From To
From To
Ft.
Diameter
Ft in.
Ft. in.
15. SAND/GRAVEL PACK:
Depth Size
From To Ft.
From To Ft.
Slot Size Material
in.
in.
Material
topographic/Land setting
ge ❑Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/ n itude of well loc tion
3yti WA' . tie) 3v)
(degrees/minutes/secon
Latitude/longitude source: ❑GPS❑Topographic map
(check box)
DRILLING LOG
Formation Description
DEPTH
From To
3
qn>`anc
`yrra.ri�p � ..a
Gccvv)i, -
-
w
0
to
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County-Roadsf Gtclude the road
numbers aid commonroad nerves.
Attga, ,c
r�r
16. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH ISA NCAC 2C, WELL
CONSTRUCTION STANDA Si, A D THAT COPCORD HAS BEEN PROVIDED TO THE WELL OWNER
Gti /02 - a- Z —o
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-1 REV. 07/2001

3114;0
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME print) Qf� CERTIFICATION�'p(o #�/
WELL CONTRACTOR COMPANY NAME 1.%j Ustf it) /y`/J/ /iQ PHONE fafiLTIL OV'W
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQQ PERMIT#
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential 2 Municipal/Public 0 Industrial ❑ Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION:
Nearest Town: Z. ilea Vac. CountyZ(/4CG'MI/.
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: Ltd,. L: irw L )
Address , 511- Q1fta ws. a,
(Street or i iute No.)
7-0 ar-Lolvo_i4 A(
6-69
Gty or Town Slate #Code
Area code- Phone number
4. DATE DRILLED /4 /O moo/
5. TOTAL DEPTH: ....9010
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO
7. STATIC WATER LEVEL Below Top of Casing: FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS 6/ FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordancccepith ISA NCAC 2C .0118.
9. YIELD (gpm): y METHOD OF TEST
10. WATER ZONES (depth): PTO . I Sr I
I1. DISINFECTION: Type Amount
12. CASING:
Wall Thickness
Depth Diameter or Weight/Ft. Material
From_ To & A Ft.
From To Ft.
From To Ft.
13. GROUT: Depth Material Method
From 0 To 4Q Ft.
From To Ft.
14. SCREEN' Depth Diameter Slot Size Material
From To Ft. in. in.
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
16. REMARKS:
Topographic/Land setting v
I Ridge ❑Slope ❑Valley 0F1514
(check appropriate box)
Latitude/longitude of well location,
(degrees/minutes/seconds) 01 p3
Latitude/longitude source: ❑GPS❑Topographic map
(check box)
DRILLING LOG
Fonjoian Description
/OVO so,(
i.4.Olrocs(
be drool(
DEPTH
From To
G �e
i 0 - (00
D-- 3Da
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. .. - . .
foe'
0.8
c,1t
ra het #39
mat
Icti
0al( piatotrat..
Ttie y&teatRd
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRU N STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
/2 -2o-os
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

311421
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) J 4n r F
414bn CERTIFICATION #y p`,f0
WELL CONTRACTOR COMPANY NAME Fi f/+$o a7 ) IAi GI 1 -1-1i.17 PHONE WQ� to V3-9,4/q
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 0 Recovery 0 Heat Pump Water Injection ❑ Other 0 If Other, List Use
2. WELL LOCATION:
Nearest Town: L e it n $"ev (� Cqunty Linn
&P.,•t i/ too-'n / ' LM oco; P
(Street Nam& Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: 64914/6C Z?oyd
Address ri 7 .Er% lips 7411.1n Lk/v!
(Street or&toute No.)
/A%ele-S /C NC - B7/11
Zip Code
- 615 774 — SOJ6
City or Town State
Area code- Phone number
4. DATE DRILLED _(a=a/ b 7
5. TOTAL DEPTH: % 5
6. DOES WELL REPLACE EXISTING WELL? YES
0 NO
7. STATIC WATER LEVEL Below Top of Casing: J71 FT.
I (Use "+" if Above Top of Casing)
8. TOP OF CASING IS / FT. Above Land Surface`
"Top of casing terminated aUor below land surface requires a
variance in accordance with 15A NCAC 2C A118.
9. YIELD (gpm): S 0 METHOD OF TEST Q /7
10. WATER ZONES (depth):
11. DISINFECTION: Type le 7 hi
12. CASING:
Depth Diameter
From To jd' FL 61 S
From To Ft.
From To Ft.
Amount ./ dz'
Wall Thickness
or Weight/Ft. aterial
13. GROUT: Depth Material Method
From b To 9/7 Ft, AonCro i'e Pour )
From To Ft.
14. SCREEN:
From
From
Depth Diameter
To Ft. in.
To Ft. in.
Slot Size Material
in.
in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
Topographic/Land setting
❑Ridge ❑Slope ❑Valley ❑Flat
(check appropriate box)
Lah de/I ngitude of well location
3,c7372/Ohl •OYa/3 $ /3 geij
( egrees/minutes/secon s)
Latitude/longitude source: ❑GPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From To Fp� tion Description
(& ..
/1
w
CD
(Jt
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or CountyRoada, Include the road
numbers and comtndh read:names.
/Heed/eA- Mf
16. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUC IED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARD , AND THAT COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
Ii C /� J l
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

311422
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division/�lof Water Quality - Groundwater Section --�� --tt ��qq//
WELL CONTRACTOR (INDIVIDUAL) NAME (print) i�ne I- 4it el CERTIFICATION#Jp�•.,ee
WELL CONTRACTOR COMPANY NAME /CY�G. Se a1 Irr7L1 I I�ro`Il.ng PHONE fan Io V3-9)41
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential -Q' Municipal/Public ❑ Industrial ❑ Agricultural ❑
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use
2. WELL LOCATION
Nearest Town: waver v1 t 1
County -G/ 2Jt-
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: Ail th B',k7
Address ye* �(, t7hfL. f(tah 7'Sad
( treet or Route No.)
nd6 0�../c NC' 488os
_ 1[y orQ # Q . flute „3 Zip Code
( O ws
Area code- Phone number ,/
4. DATE DRILLED /off- /G " U/
5. TOTAL DEPTH: a0
6. DOES WELL REPLACE EXISTING WELL? YES O. NO I —
7. STATIC WATER LEVEL Below Top of Casing: FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS / FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordance with ISA NCAC 2C .0118. �j
9. YIELD (gpm): /5 METHOD OF TEST Jl rY
10. WATER ZONES (depth): / VC
11. DISINFECTION: Type W 7N Amount 7 oz.
12. CASING:
Depth Diameter
From f% To 5 / Ft. IF?'
From To Ft.
From To Ft.
13. GROUT: Depth Material Method
l
From 0 To an Ft. ConCra k-e POuc'
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
Wall Thickness
or Weight/Ft. __Material
JD/ 21 /VC
From To Ft.
From To Ft.
Topographic/Land setting
❑Ridge ❑Slope Icy ❑Flat
(check appropriate box)
Latitude/longitude of well location
'3s/«yAmpi. 0Q'ac/6-7 (✓
degrees/minutes/seconds)
Latitude/longitude source: ❑GPS❑Topographic map
(check box)
DRILLING LOG
Formation Description
C/.
DEPTH
From To
0 as
cQ V4
? si
-c
r.f
(n
LOCATION SKETCH =i
Show direction and distance in miles from at least -
two State Roads or County Roads. Include the road
numbers add cothmon road naiki s.
/R:aerisicen
(ciao-at/EL/om.
,, C...
16. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUC LED IN ACCORDANCE WITH ISA NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT
AA COOPY—OFF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER 57-
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-1 REV. 07/2001

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section -��9�
WELL CONTRACTOR (INDIVIDUAL) NAME (print) i 4Ar k r-it bn CERTIFICATION #_fp/p
WELL CONTRACTOR COMPANY NAME Aefr ieaJ W EI1 Tail%ing PHONE %93'�$r/
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
I. WELL USE (Check Applicable Box): Residential 2-- Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION: {�
Nearest Town: Weavesvt III County 6t.incennht
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: rt//ciJ tmil`nk- J
Address is b/AWL JIMA i7nryr16
(Street or Route o.)
/2 wits, NC rgeg
City or Town State Zip Code
( -49t- �
Area code- Phone number
4. DATE DRILLED /a
5. TOTAL DEPTH: 1f0
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO 1W
7. STATIC WATER LEVEL Below Top of Casing: `i5 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS / FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordance with l5A NCAC 2C
9. YIELD (gpm): .,3 METHOD OF TEST R 710. WATER ZONES (depth): (J
1l. DISINFECTION: Type
12
CASING:
H 7// Amount
Depth,Lq . Diameter
From D To TV Ft. e7
From To Ft.
/5C Oz.
Wall Thickness
or Weight/Ft. Material
,SURl/ PVc—
From To Ft.
13. GROUT: Depth Material Method
From6To 9/1 Ft. /3nnCroi-e POu.r2J
From To Ft.
14. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in.
From To Ft. in. in.
l5. SAND/GRAVEL PACK:
Depth
From To Ft.
From To Ft.
Size Material
DEPTH
From To
0 070
ra/ 3,1
Topographic/Land setting
❑Ridge ❑Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well locatio
37w/nt1 0��735-7S "n✓
(degreesiminutes/s onds)
Latitude/longitude source: WPS❑Topographic map
(check box)
DRILLING LOG
Formation Description
33(./ ni
'
7dd/
_'e
W
LOCATION SKETCH 01
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common road names.
�i;of Iwtoo etAtega)
a" stew. Lilt, we •
16. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUE IED IN ACCORDANCE WITH ISA NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND TIJAT 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

WELL CONSTRUCTION RECORD 63 (-
North Carolina - Department of' Environment and Natural Resources - Division��of Water Quality - Groundwater Section ' -� ,9/
WELL CONTRACTOR (INDIVIDUAL) NAME (print) i 4/i r 1' 41 tr) ✓\ CERTIFICATION # .i
WELL CONTRACTOR COMPANY NAME Fero/L. son) U) tl I T r:ll.nsy PHONE ilS ) % V3'/Q/4i/
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable)
(if applicable)
I. WELL USE (Check Applicable Box): Residential IlY Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery ❑ Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELLLOCATIO.
Nearest TC unn ,,r tIb.1 I ��
tin /% 6S2 �o.,9F� �'6,Se latd dJ
(Street Name, Numbers, Community, Subdivision, Lot No., hip Code)
3. OWNER: (iiC /4. /�
Address e f ,EA OAC- TA to
(Street or Route No.)
/4'wA41) L1el. a8803
City or Town State hip Code
(—)-
Area code- Phone number
4. DATE DRILLED /- 2 -/7-0
5. TOTAL DEPTH: 7 cis--
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO EY
7. STATIC WATER LEVEL Below Top of Casing: FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS 1 FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordance, th ISA NCAC 2C 0118
9. YIELD (gpm): t/� ME
10. WATER ZONES (depth):
11. DISINFECTION: Type %! 7it/ Amount �` /2 OL'
12. CASING: Wall Thickness
Depth i meter or Weight/Ft.„Material
To ?/ F[.�y atnit
To Ft.
To Ft.
13. Depth Material
To 9!) Ft, Ctpncro Ee
To Ft.
14. SCREEN: Depth Diameter
From To Ft. in.
From To Ft. in.
15. SAND/GRAVEL PACK:
Depth Size
From To Ft.
From
From
From
GROUT:
From d
From
Method
POLAr�
Slot Size Material
in.
in.
Material
°graphic/Land setting
idge ❑Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/jongitude of well Ioca3ion
c14 -Otyz
(degrees/minute9secon
Latitude/longitude source: ❑GPS❑Topographic map
(check box)
DEPTH DRILLING LOG
Front To Fo tion De cription
0 ?/ ( i
L-�'d b ni% i L')
i)
THOD ,1 T
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common road names.
nhAtAfille, We
From To Ft.
16. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH ISA NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND AT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
to
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-1 REV. 07/2001

wk tor'
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Naturalt�tResources - Division�of Water Quality - Groundwater Section -� --. �y�
WELL CONTRACTOR (INDIVIDUAL) NAME (print) illar /`"E-it CERTIFICATION#�[,�fp/q
Fer'r�Soal Weil 7�rI11.;a� PRONE jVlv�!/1 %Y3-9}1T/
ASSOCIATED WQ PERMIT#
(if applicable)
WELL CONTRACTOR COMPANY NAME
STATE WELL CONSTRUCTION PERMIT#
(if applicable)
I. WELL USE (Check Applicable Box): Residential @VMunicipal/Public ❑ Industrial 0 Agricultural 0
Monitoring 0 Recovery ❑ Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION: J
NearestTown.Geieez (/
(Street Name, Numbers, Community; Subdivision, Lot No., Zip Code)
3. OWNER: .ita (Ire '/
Address s%/� IA/Cr 1/10/11 dwite✓? Dr,
C,�, [[���� (Street or Route No.) ,/�T'
ei �l e/'.—t NC % Y /
Ciry or Tywn- „� .71 770 Zip Code
County 3t t.ncO n'j %a2
Area code- Phone number
4. DATE DRILLED / . 8- 0
ttdopographic/Land setting
ge ❑Slope ❑Valley ['Flat(check appropriate box)
Latitude/longitude of well location
3,s%j..7/4 As- nsa/4FL iS ate
(degrees/minutesfseconds)
Latitude/longitude source: ❑GPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From To Formation Description
5. TOTAL DEPTH: c2x5 is
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO I➢/
7. STATIC WATER LEVEL Below Top of Casing: -DS FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS / FT. Above Land Surface*
"Top of casing terminated atlor below land surface requires a
variance in accordance with ISA NCAC 2C .0118.
9. YIELD (gpm): /06 METHOD OF TEST �p
10. WATER ZONES (depth): /r7
11. DISINFECTION: Type H T //
12. CASING:
Depth Diameter
From 0 To /49' Ft. 4?/
From To Ft.
From To Ft.
Amount / OZ.
Wall Thickness
or Weight/Ft. Material
SP.e)) ?vc_
13. GROUT: Depth /���Material Method
From O To 9/) Ft. WnCrote POuaoj
From To Ft.
14. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in.
From To Ft in. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
16. REMARKS:
LOCATION,SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common road names. -
oicta / Qc zn'oad
12-te dot- /, < e.
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY 0 THIS RECORD HAS BEEN PROVIDED TO THE 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

31
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) / eii r
WELL CONTRACTOR COMPANY NAME
',^
/4l6 Y\ CERTIFICATION # /
ferp.t spat tnitll 1lvillfng PHONE' fl �va-9 r9
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable) - (if applicable)
1. WELL USE (Check Applicable Box): Residential FE" MunicipaUPublic 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION: ^2
Nearest Town: War. np l [o County I )rwQ Co"
[lit (9ov-'- R,d
(Street Name, Numbers, Community, Subdivision. Lot No., Zip Code)
3. OWNER: yt T 1l n Address C( v
A(Street or Route No.)
1A-a* a,,, NO a 8130
City or Town State Zip Code
c347*8 G 9/. 7.133
.Area code- Phone number
4. DATE DRILLED //— d6,-01-1
5. TOTAL DEPTH: 42
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO
7. STATIC WATER LEVEL Below Top of Casing: / FT.
/ (Use "+" if Above Top of Casing)
8. TOP OF CASING IS / FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordance with ISA NCAC 2C .0118.
9. YIELD (gpm): Jo METHOD OF TEST RI
10. WATER ZONES (depth):
Amount 6.3 az'
11. DISINFECTION: Type N 7 -/
l2. CASING:
Depth
From To Q3 Ft.
From To Ft.
From To Ft.
Wall Thickness
Diameter or Weight/Ft. Material
4if i.5h12-at
13. GROUT: Depth Material
From0 To_' 9 Ft. eOnc ro (-e
From To Ft.
Method
Pourrd
14. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in.
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
16. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
/r
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
ytfpographic/Land setting
"Midge 0Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
3 7Vn Ang$$-hRa0.cl 57 w
(degrees/minutes/seconds)
Latitude/longitude source: ❑GPS❑Topographic trap
(check box)
DEPTH DRILLING LOG
From To Formation Description
d tfo Chori
inSO 6/Q.Qd skAra
I 3 6 rc>,,,YL 0
-.y
's
LJ
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common mad names.

311113"7
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section -� p�
CERTIFICATION dace
WELL CONTRACTOR (INDIVIDUAL) NAME (print) Alel e k ,41 1n h /p
WELL CONTRACTOR COMPANY NAME Fero,&so a) t1JGll ire IL', PHONE jeQ•fiel IaY3 �In�i/
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential ® Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION: AS Nearest Town: �1P v t 1 �qq County -Aunt a rev 4°rt.'
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: "lie° OJa"// nm sr,n
Address
/(Street or Route No.)
A% aS�i, tit' /N IV (. 018
clG$
City or Town State Zip Code
(—)-
Area code- Phone number
4. DATE DRILLED / / /7 o V
5. TOTAL DEPTH: a G r
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO
7. STATIC WATER LEVEL Below Top of Casing: 7 D FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS / FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordance with ISA NCAC 2C .0118.
9. YIELD (gpm): / 0 METHOD OF TEST
10. WATER ZONES (depth): , )40
11. DISINFECTION: Type
12. CASING:
1,/
19 771 Amount 9
Depth
From 0 To CSFt.
From To Ft.
From To Ft.
13. GROUT: Depth
From,_ Tod'0 Ft.
OZ.
Wall Thickness
Diameter or Weight/Ft. Material
5.1Aa/ PVC
(„ -p
Material
eonc r"o FP
From To Ft.
14. SCREEN: Depth Diameter
From To Ft. in.
From To Ft in.
15. SAND/GRAVEL PACK:
Depth Size
From To Ft.
From To Ft.
Method
t
Pa urn
Slot Size Material
in.
in.
Material
Topographic/Land setting
CRid e ❑Slope ❑Valley ❑Flat
(check appropriate box)
Lati de/lo igitude of well 1Rcatto
33- 3 ofre9' 6962/Joo`/*�--a1
( egrees/minutes/sec nds)
Latitude/longitude source: ❑GPS❑Topographic trap
(check box)
DRILLING LOG
Fortnption Description
DEPTH
From To
() oO
LOCATION SKETCH
Show direction and diitance mnles from at least
two State Roads or County Roads: Include the road
numbers and common road nathes.
dne
.,954 w%//r. A%Lt
16. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND T T A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNE
//— 77 -0
SIGNATURE 0 ERSON CONSTRUCTING THE WELL DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-1 REV. 07/2001

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
���
CERTIFICATION.r,p# of
PHONE fI � Reg
WELL CONTRACTOR (INDIVIDUAL) NAM tint)
WELL CONTRACTOR COMPANY NAM�C/aj7rc. /I/
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ YERMIT#
(if applicable)
(if applicable)
1. WELL USE (Check Applicable Box): Residential ® Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other ❑ If Other, List Use
2. WELL LOCATION:
Nearest Town: C,a44/e ✓
County fie 1»Pd1140,
(Street Name, Numbers, Community,/Su"bdiivvision, Lot No., Zip Code)
3. OWNER: OW/ WaJZnn .
Address • fit• C( /e04,
/ (Street or Route No.)
ea S/o% 211h
City or Town �� / Zip Code
/o45- If
Area code- Phone number /
4. DATE DRILLED //- /.4 -0 i
5. TOTAL DEPTH: .J3'O
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO It
7
STATIC WATER LEVEL Below Top of Casing: SD 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 MET
10. WATER ZONES (depth):
11. DISINFECTION: Type
12. CASING:
From
From
13. GROUT: Depth Material
From (0 To_p_ Ft. donere tit
From To Ft.
14. SCREEN: Depth Diameter
From To Ft. in.
From To Ft. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
HOD OF TEST i
y9TN Amount /2 a
Depth
From To.Ft.
4
Diamj er
To to Ft.
To Ft.
Wall Thickness
or Weight/Ft. Material
SPR d/
/ ?`-4
.5 Mc t
Method
tn/,r zi
Topographic/Land setting
❑Ridge ❑Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source: ❑GPS❑Topographic map
(check box)
DRILLING LOG Formation Description
Slot Size Material
in.
in.
16. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
/8-1__.
u SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center
I REVg, NC
07/2001
27699-1636 Phone No. [phone], within 30 days.
DEPTH
From To
s 4i
Cd .- tc6ccsrock"
leis• " CO ran,ic t9
r
•
--C
c-n
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common road names.

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural���Resources - Division of Water Quality - Groundwater Section --�� ,�qq��
WELL CONTRACTOR (INDIVIDUAL) NAME (print) MAr k .416 YA CERTIFICATION #.--�� f0
WELL CONTRACTOR COMPANY NAME f-t/,/+Soal WGI I 16.r:114y PHONE 4'c1) Io V3'2V/
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
I.
WELL USE (Check Applicable Box): Residential 13" Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water lnjection 0 Other 0 If Other, List Use
WELL LOCATIOO:
Nearest Town: is hi_ „JL County 73Lin Cdr.✓ba 1
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER%� ,;tee ' .CS f rnkit")
•
Address LO O Ls latze:th
(Street or mute No.) ""/�
/,; tn/n /O a9104
City o7 Town - GtaL3/ Zip Code
Area code- Phone number ,f
4. DATE DRILLED /A I/, ' OY
5. TOTAL DEPTH: tL O 5-
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO 1r
7. STATIC WATER LEVEL Below Top of Casing: /00 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS ! .FT. Above Land Surface*
"Top of casing terminated aoor below land surface requires a
variance in accordance ith ISA NCAC 2C .0118. ,��,
9. YIELD (gpm): METHOD OF TEST /T r,'
10. WATER ZONES (depth): /V/
11. DISINFECTION: Type 9 771
12. CASING:
Depth
From D To
From To
From To
Ft.
Ft.
Ft.
13. GROUT: Depth
From_(L To 9 h Ft.
From To
14. SCREEN: Depth
From To
From To
15. SAND/GRAVEL PACK:
Depth
From To
From To
Ft.
Diameter
44
Amount 221Z5--Z.
Wall Thickness
or Weight/Ft. Material
J/ PVC_
Material
eoncro Ee
Method
POLkrat'
Diameter Slot Size Material
Ft. in. in.
Ft. in. in.
Size Material
Ft.
Ft.
DEPTH
‘, From To
Topographic/Land setting
❑Ridge 0Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well ocaho
(3Sagremi✓-fi tends)
v�
( egrees/minutes/ tends)
Latitude/longitude source: ❑GPS❑Topographic map
(check box)
DRILLING LOG
Formation Description
,S.9fjri 04ru -
("erg,
O
cn
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.
fls4ev,//t NC
16. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARI]fS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
/A- L —a
93
SIGNATURE OF PERSON CONSTRUCTING THE WELL
DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-1 REV. 07/2001

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division2'of Water Quality - Groundwater Section
1.
WELL CONTRACTOR (INDIVIDUAL) NAME (print) .0.8.s.✓ tan'.>nc/ CERTIFICATION # Pit VS/
WELL CONTRACTOR COMPANY NAME 032.7F.C."1ri.
STATE WELL CONSTRUCTION PERMIT# /22
(if applicable)
f- O v." r PHONE # (aa,F3 2?-77-UXz7
ASSOCIATED WQ PERMIT#
(if applicable)
1. WELL USE (Check Applicable Box): Residential L9< Municipal/Public 0 Industrial ❑ Agricultural ❑
Monitoring 0 Recovery 0 Heat Pump Water Injection ❑ Other 0 If Other, List Use
2. WELL LOCATION:
Nearest Town: «iree a njuril County cant ie.
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: _coy
Address PO /?» 6333.
(Street Route No.)
1 oo/ oy
City or Town State Zip Code
(—)-
Area code- Phone number
4. DATE DRILLED S=5—O9.
5. TOTAL DEPTH:
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO IJr
7. STATIC WATER LEVEL Below Top of Casing: FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS / FT Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance In accordance with I5A NCAC 2C .0118.
9. YIELD (gpm): • METHOD OF TESTAi.cspu'.✓
10. WATER ZONES (depth):
11. DISINFECTION: Type es,. Amount
12. CASING:
Depth
From 0 To 2 S.-
From To
From To
13. GROUT: Depth
From f7 To ?p_
From To
14. SCREEN: Depth
From To
From To
15. SAND/GRAVEL PACK:
Depth
From To
From
Wall Thickness
Diameter or{(eight/Ft. Material
Ft. %r/ 8/iJP-2/ At4c
Ft.
Ft.
Material Method
Ft._IS,Arir6fy"
Ft.
Diameter Slot Size Material
Ft. in. in.
Ft. in. in.
Topographic/Land setting
DRidge ❑Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From To Formation Description
n — /S sr�sizi
/s— 2 £ G,e ary
0
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common road names.
m 2x'//00 a-t
Ft.
To Ft.
16. REMARKS:
Size Material
0
cn
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED Rif ACCORDANCE WITH ISA NCACII2C, WELL
CONSTRUCTION STANDARDS, AND THr COPY T IS '. ORD HAS BEEN PROVIDED TO THE WELL OWNER!
s=shy
SIGNATURE 1 PERSON CONSTRUCTING THE WELL DATE
Submit the original to the Division of Water Quality, Groundwater Section,1636 Mall Service Center -;Raleigh, NC
27699-1636 Phone No. [phone], within 30 days.
GW-1 REV. 07/2001
GA

c3
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) �y.1Un/ ----
"'�' CERTIFICATION # '/yy'
WELL CONTRACTOR COMPANY NAME ' l�ij&J7, �vE!! y �c.,-•� . PHONE # (> _r /7 «9 2 /
STATE WELL CONSTRUCTION PERMIT# /22 ASSOCIATED WQ PERMIT#
(if applicable)
—/ (if applicable)
1. WELL USE (Check Applicable Box): Residential tW Municipal/Public ❑ Industrial ❑ Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION:
Nearest Town: _ins County e cos:-
„,../;.. -ry
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: r0�'eJy,-,p�y�y
Address !. )/.ss.74 Pr •
OtA/:ih(Scree Route No.) calnat?
City or Town State Zip Code
Area code- Phone number
ographic/Land setting
kaffidge ❑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 — SS �7rizT
4. DATE DRILLED is-C- 0 Y
es" —
5. TOTAL DEPTH: T 0 S
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO rr
ls— sor
7. STATIC WATER LEVEL Below Top of Casing: /Qp 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): /0 METHOD OFTEST4Iacu/n/
10. WATER ZONES (depth): 'to -
11. DISINFECTION: Type 3 ern. Amount
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
From 0 To C f Ft. a %v b.t e/ Luc
From To Ft.
From To Ft.
13. GROUT: Depth Material
From , To 20 Ft.-f„r"t.,er'r
From To Ft.
14. SCREEN' Depth Diameter Slot Size Material
From To Ft. in. in.
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Size Material
To
To
From
From
16. REMARKS:
Ft.
Ft.
Method
sw r v,`j>oPA;
^,n
0
LOCATION SKETCH o
Show direction and distance in miles fronf,41 least -I
two State Roads or County Roads. Include the roati
numbers and common road names.
1 DO HEREBY CERTIFY THAT THIS WEL WAS CONSTRUCTED IN ACCORDANCE WITH I5A NCAC 2C, WELL :.
CONSTRUCTION STANDARDS, A �#'' T A COHIS RECORD HAS BEEN PROVIDED TO THE WELLOWNER ->
o y
SIGNATU"O PERSON CONSTRUCTING THE WELL DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
GW-1 RFV.-07/2001
27699-1636 Phone No. [phone], within 30 days.

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natur esources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) y p/N /-t .f/JtM/
WELL CONTRACTOR COMPANY NAME 714FNi[fl/ --ZC/tCC -
CERTIFICATION #a/4/y
PHONE # gash 2.'72 4/4/50
STATE WELL CONSTRUCTION PERMIT# /2'z ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential 5✓ Municipal/Public ❑ Industrial ❑ Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection ❑ Other 0 If Other, List Use
2. WELL LOCATION•
Nearest Town: e..e,40 Countyi3,..a,eon. 6e
r /».er e. {o,a .3S!
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER:
TFesy /criz
Address CA0 60/ J'itg
(Street or Route No.)
gait .Shot NC-,229(1.2
City or Town State Zip Code
(1"2r)- 696-t-n7
Area code- Phone number
4. DATE DRILLED S- /7- 0 t/
5. TOTAL DEPTH: 2 0S
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO Er-
7. STATIC WATER LEVEL Below Top of Casing: 4/0 FT.
(Use "+•' if Above Top of Casing)
8. TOP OF CASING IS l FT. Above Land Surface*
*Tap of casing terminated at/or below land surface requires a
variance In accordance with ISA NCAC 2C .0118.
9. YIELD (gpm): 60 METHOD OF TESTwo /e .Oturs/
10. WATER ZONES (depth): 7o - / 2 o Fi
Topographic/Land setting
DRidge ❑Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:DGPSDTopographic map
(check box)
DEPTH DRILLING LOG
From To Formation Description
o - '3o cCrizea-
30 - r.e) is iz..FNl>F
ya - z ID s G.<..-"ze -E
11. DISINFECTION: Typece zeac Amount
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
From 0 To 4/n Ft.0 iy 4ae--2/ ntc.
From To Ft.
From To Ft.
13. GROUT: Depth Material
From n To 20 Ft. rein RJiFTF
From To Ft.
14. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in.
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
Method
16. REMARKS:
C-2
iJ
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Inclu, e the road
numbers and common road names.
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A,%- Y OF THIS t. CORD HAS BEEN PROVIDED TO THE WELL OWNER
SIG AT RE OF PERS • ` CONSTRUCTING THE WELL
DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-1 REV. 07/2001

E A
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natura
esources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) .an../
aiw CERTIFICATION # /y r-(
WELL CONTRACTOR COMPANY NAME On tedfre Z/eZe i . PHONE # (428) 97¢ yy50
STATE WELL CONSTRUCTION PERMIT# /22- - ASSOCIATED WQ PERMIT('
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential II Municipal/Public 0 Industrial ❑ Agricultural ❑
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION:
Nearest Town: S., a, ,f r�County/3
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER:-5C0I-4- (Y) c f r 4-14h
Address 15 -V.tc %. n .i) r -
(Street or Route No.) coJA� 9
r� (� e o1Rr
City or Town State Zip Code
( )-
Area code- Phone number
4. DATE DRILLED 3— 2i — O 4/
5. TOTAL DEPTH: 2 0 5"
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO H-
7. STATIC WATER LEVEL Below Top of Casing: io FT.
(Use `+" if Above Top of Casing)
8. TOP OF CASING IS / FT. Above Land Surface"
'Top of easing terminated at/or below land surface requires a
variance in accordance with ISA NCAC 2C .0119. �J
9. YIELD (gpm): 2 0 METHOD OF TEST /4-ee'nnw v
10. WATER ZONES (depth): — / ti n ..c>
� ,Topographic/Land setting
WTUdge ❑Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From To Formation Description
n — S S ryca/ei,.c/ .
rr — 62 G/?QA/rre
G 0 - 2 0 G.� ?�✓rrc
11. DISINFECTION: Types,,,, r r
12. CASING:
Depth Diameter
From n To 6 2 Ft. 6 %/
From To Ft.
From To Ft.
13. GROUT: Depth Material
From n To 00 _ Ft. sefetrsv.
Amount
Wall Thickness
or Weight/Ft. Material
From To Ft.
14. SCREEN: Depth Diameter
From To Ft. in.
From To Ft. in.
15. SAND/GRAVEL PACK:
Depth
From To Ft.
Method
Slot Size Material
in.
in.
Size Material
From To Ft.
16. REMARKS:
n
t7
LOCATION SKETCH O
Show direction and distance in miles froMAt leastr
two State Roads or County Roads. Include th road
numbers and common road names, ....
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND T1i OPY 0.3HI RECORD HAS BEEN PROVIDED TO THE WELL OWNER
r-�
a2- o�/
GNATURE 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

297537
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and mania! Resources -Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (prim) Ic7 )Lt_\ t✓ 13 f‘5 H CERTIFICATION a an 1
WELL CONTRACTOR COMPANYNAML_RF.UBEN CALDWELL DRILLING, INC • PHONE` 48 )254-3581
STATE WELL CONSTRUCTION PERMITa ASSOCIATED WQ PERMITa
(ifapplicable) • (if applicable)_--_�._
1. WELL USE Check Applicable Box): Residential ( PP ) 63/MunicipaVPublic 0 Industrial 0 Agricultural 0
Monitoring ❑ Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION: n
Nearest Town: P.-$A�DCR- County k�v11COM��
bt\hd- i (LOAQ
1i Cock
A&Am !Y`CI'�v30
C64 iY\AC-taOc(0)A (2e i
outdA Lelmo J 2 or r c_ 9-8 `10 I
City (Sag} or Town a l Statea ({ G} Zip Cade
Ares cods- Pbona number
4. DATE DRILLED 6/ 41-/ 0 4
5. TOTAL DEPTH: a`� 0 ' /
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO CV(
7. STATIC WATER LEVEL Below Top of Casing: (co FT.
(Use'+' if Above Top or Cuing)
8. TOP OF CASING 1S �. FT. Above Land Surface•
*Top or cuing Cermin ted at/or below Ind Barran requires a
variance In accordance wick ISA NCAC IC.0111.
9. YIELD (gpm): -1 METHOD OF TEST '�') C7 - Al R-
10. WATER ZONES (depth): 04-0 / - . 1 G P M
Numbers. Community. Subdivision.
(Street Name, N P )
3. OWNER:
Address
11. DISINFECTION: Type_f
12. CASING:
Depth
From To C5
From To
From To
13. GROUT: Depth
From S- To &O
From To
14. SCREEN: Depth
From To
From To
15. SAND/GRAVEL PACK:
Depth
From To
From To
y in `Ian/o Amount %a tr
9ror Weight
Wall Thickness
FL Si 8SDKt/1 Pa\G
Ft.
FL
Material
ar'3 FL (`�aYy'T
Ft.
Diameter
FL in.
Ft. in.
Method
Po JQG b
Slot Sire . Material
in
in
Sire Material
Ft.
Ft.
Topograg6'tcfLand setting
❑Ridge Dglope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degren/mimnuhecomr)
Latitude/longitude source:❑GPS❑Topographic map
(cheek box)
DRILLING LOG
%0 FoorrjatiL(5UPri8!kJ
JJ ed�(SU(z.t� N
614tNtT�
ci2s1e--'GPrv\
raurJt-ram
DEPTH
Frofn r To /
5-0 ` - o6t9-0
ago'
ago ago
v
t
LOCATION SKETCH -a
Show direction and distance in miles from at Ie`ast
two State Roads or County Roads. Inclufri the road
numbers and common mad names. o
COI1tS
PA21�� sz,
aIN.) 4/ m,Act't f)try
16. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH ISA NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A OPY OF THIS RECORD HAS BEEN PROVIDED TO TH WE°WIER
SIGNATURE OF PERSON CONSTRUCTING THE WELL ATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mali Service Center Raleigh, NC
27699-1636 Phone No. [phone], wllhin 30 days. GW-1 REV. 07/2001

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) At r k
309281
WELL CONTRACTOR COMPANY NAME CERTIFICATION d �p
ls5v so a) W e11 Z,re l/.nq PHONE (WWI tY3 _9yi/9
STATE WELL CONSTRUCTION PERMIT/4
(if applicable) ASSOCIATED WQ PERMIT#
(if applicable)
1. WELL USE (Check Applicable Box): Residential Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION:
Nearest Town: Weavt,rv; I it. County 3 4ncernbc
- 01( ertelc ; L[lara Pn,1th
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: ZS C'Le--is
Address
City or Town State 'Zip Code
s3- rR s
.,,ea code- Phbne number /
4. DATE DRILLED /0-49,0/ t{
5. TOTAL DEPTH: Q00'
6. DOES WELL REPLACE EXISTING WELL'? YES 0 NO Er
7. STATIC WATER LEVEL Below Top of Casing: /b FT.
/ (Use "+" if Above Top of Casing)
8. TOP OF CASING IS
FT. Above Land Surface*
*Top of casing terminated atior below land surface requires a
variance in accordance with I5A NCAC 2C .0118.
9. YIELD (gpm): /06 METHOD OF TEST RI 10. WATER ZONES (depth):
11. DISINFECTION: Type /' 7f-/
12. CASING:
Depth Diameter
From 0 To S? Ft. G B
From S$ To 7 7 Ft. (v %p
From To Ft.
13. GROUT: Depth Material Method
From (1 To 9 n Ft. e0aC ra to Ft urezi
From To Ft.
14. SCREEN: Depth Diameter Slot Size Material
From To Ft in.
in.
From
To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
Amount
Wall Thickness
or Weight/Ft.
3:72R-_7/
/ Pa
Material
VG
16. REMARKS:
Topo�gr�aphic/Land setting
❑Ridge Slope OValley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source: ❑GPSOTopographic map
(check box)
DEPTH DRILLING LOG
From To Formation Description
0 /0c/
/% 6-67 ft 5�1�%%�raknot,
Of 2 ? �
.1.--
LOCATION SKETCH
9 6Z- Show direction and distance in miles from at least
two State Roads or County Roads. Include the.road
numbers and common road names.
W, cwKaidig / IOC
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH I5A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT ACOPy 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,ii4C
27699-1636 Phone No. [phone], within 30 days.
GW-1 REV. 0232001
r.

299333
WELL CONSTRUCTION RECORD
North Carolina - Department of Environr lent and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) DQeC EC. IL. cr-,+�Q rg
q c u oct .Son 'Je'\''' pumr -tnc PHONE # f Z (n cc at,
WELL. CONTRACTOR COMPANY NAME \ - `� .'�
STATE WELL CONSTRUCTION PERMIT/4 .- ASSOCIATED iiQ PERMIT#
(if applicable) - (if applicable)..
1 WELL USE (Check Applicable Box). Residential 18 Municipal/Public ❑ Industrial ❑ Agricultural ❑ _
Monitoring ❑ Recovery ❑ Heat I ump Water Injection ❑ Other ❑ IfCther, List Use
WELL LOCATION:
Nearest Town: 6'-4<=nnr i.zae- County lit ..a c;,,,tine
f>,.r3d\e (ICo-C.
(Street Name, Numbers. Community. Subdivis an, Lot No.. Zip Code)
3. OWNER:
Address
res..... t3an04,5
Ili old L'ta.e. 141tn
(Street or Route No.)
tkTDQ,A l fC .2. c.lc..v
CityorTown State Zip Code
( Sao- aal.5 3510
Area code- Phone number
4. DATE DRILLED G.. (t-Cv
5. TOTAL DEPTH: 2 oC
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO
7. STATIC WATER LEVEL -Below To)- of Casing: .30 FT.
(Use' if Above Top of Casing)
8- TOP OF CASING IS 1 FT. Above Land Surface*
'Top of casing terminated at/or below land surface requires a
variance in accordance with ISA NCAC 2C .9118.
9. YIELD (gpm): •5c. METHOE OF TEST R;�
10. WATER ZONES (depth):
Topographic/Land setting
❑Ridge [Mope ❑Valley DFlat
(check appropriate bo:')
1 atitude/longitude of web location
(degrees/minutes/seconds)
Latitude/longitude source:DGPSCTopogmphic mzp •
(check box) I
DEPTH DRILLING LUG
From To Formation Description
}i
:o y
QV S R-ieidar,
E r >lfr=C: GC an: r
11. DISINFECTION: Type eza
12. CASING:
Depth Diame'_r
From Y\ To $F5 Ft. (a1z
From To Ft.
From To Ft.
13. GROUT: Depth
From 0 To Qo
From To
14_ SCREEN: Depth
From To
From To
15. SAND/GRAVEL PACK
From
From
Depth
To
To
Mat rial
Amount
Wall Thickness
or Weieht/Ft.
t32t
Ft. Ca. Aan+
Ft.
Diameter Slot Size Material
Ft. o- in.
Ft. n. in.
Material
Method
Po»-caa_
Ft.
Ft.
Size Material
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers end common road names.
SIGNATUI.E OF PERSON C STR "LING THE WILL
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
27699-1636 Phone No. [phone], with n 30 days.
GW-I REV. 07/2001
0
02
CERTIFICATION# 245t'o
16. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THP T A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
4'' " }�' DATE

Ct)NS FRI L? I 1 1N L I'CuP.D
309258
-r'ul--u�"4Li f.11➢Crl-I-w_N//�a�al
....,.. I,LI11::4 1 Y. \li 1 i eb6bY
",fr -.N1 v: _, IC ic.a 4l.$0J✓.1._
r icoc rlolI [CICOIIki
..ra: - nivi: l oiVYarcr Quolmy
- 1Jf011nd,\altl' Scenon
CCRTIAI enl Paiv nf,,2�•t /
nom in(nnlRRasd $V{(L
.A 0CL+:I'LD WC 1t nicru
_. 1
Q hell eur
til Id' fv,.a:_:.p..LPablia 17.1 tn4I, i- t t 0
p t1 .:Icf Ltic+uou IJ O[hcr LJ IjOlhcr Lis[ Llsc
LeilcesY8uncernhe-
!t Il6 o_c_A2m„ry e
_1Sbrii,Y/er" /KC ak2o 6
a8 �5a-Oa91 U
nuLL_r• ��/f�OS� 1 S
LLIiFfti QS ZU
ELL REPLACE EXISTING WELL? YES 0 NU J
T_+TI 5;-;11?I.LEVEL &lowTop or' C„ills.
1 DSc •T U noa,. Mia Lae G:ul;,
TJP "F C<GIN0 IS F'1'.:=Uorc l.alld SWRIC.c^.
`rJN I 1 1:1711:111l.ta a Curti r, r,i.'ruff` trcrl LOCO:u
-.f watt 15A NC 2c uil5.
'ILL , ;. ,'. "/i: NIETHOD OF 1-es r.ibw/r:1 -ELI
,tarp ZONES c.lcp[nl: —�
gdctl lrL,ral 17
Tapoga 1-1 and seriing
OPidgc nl-p' OValloy OFlat
LCtic
I q fl'�Priaa bay)
L4linldc/Io11gi nldc of roll location
N3S°.tci3/YYWeSz° Z,b,46,51'
Igcg1:1111n rcx'w, mtgs)
Llurydc longitude Source: ern', coop
talmel: no.V
DFP-PH DRILLING- LOO
131um
To Forraaoon Dtseripi on
IS bitt
ZD Rock"
LOCATION SKETCH
-
lISL F Ci LOP) T}pc� �O.__ga,;_li;ounl /L/A, Show i it crion and drwnce in miles from a[ IcasT
Aa CL\
N nl I hlcR.ncte I.WO Su[c Bonds or County Roads. Include lhd road
'c-Duirn,r or11] yhr:Fr trlalcn:d numhcrs and c0
0 °m le
—/ �— F[,. a. common meld names.
rroal ,_ i'.FI
._1 ji12Oul' ,-pot
. ,. l,___Q_ i ,..Q„_ FL CP.ti-- . to u r
_,Lill_ -ri
Ft.
0.-1.rll DulpClcf S10( 25I"c ill ur.r[II
f [o:L -1.: F[
nl, I11.
t�4w I" 1`t. In. Ill
i.-': 315_55\ EL P.a.CK
ll'I]iii SILO ,11$c1'131
mood To, Fi.
.3. ill_`I illi4_S.
I195rcrlgl iVlclnoil
Dix ezee_,(; Oilopel.O'.:
eSfef AC,
D3 FIER.SEY CERIIFY"TILA.T'THIS WELL WAS CONSTRUc,.TED EN ACCORDANCE WITH ISA NCAC 2C, WELL
,N.STRL T1ON 31'.�:ND 1 D3 .A ND THAT A COI" C OF FHIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
14/
T4
!l:C RJN COiv9TRUCTIlyO THE WELL
AT_
'ulllll [n; Ol t»ill:al co in D111$illli of 11'a[cr `ualill' Lil'uundlt'aCcr Sccriull, 1636 Mail( Service C2n[cr - RAleign, NO
0i>-10.30 IW lc h0. l-"1 7l 73332:1, witIl1l 30 da a
GW-I REV. 07/.2Igo

309259
WELL CONSTRUCTION RECORD
Nona 'lJ11 .a - Lcpsrullprrl Or Envlronnlcir and rut Resourdes-.Oivision of Waxer Quaiiry - OroonUwater Scecion
dLl 11r1 .41 - t (rN 111 \'iDll tU V+11iG (prim) Ji �1/r S CE1tTTF1CiT1UfV >t.il Z�_
iLl 1-' -.:I 11<'uAll'iNY NAAILr far u_so/✓,f /.ale// 7>P//I �� C6 . YHONG jogs a5g-7
-1 11 C -Jl 11.UCLIoIrr PLLAIlT J _.. .iSSOCL,. fGL WQ PERMITIl
(IC IPplic:Mle'i
.. `\ELL USE t P k Appliabla Box): Pcsidemisl a(ldunieipuLiPublio ❑ 1 eluarrlul
lto l cm:4 ❑ 1 zrery 0 Hczt Purnp Watcr lnjccrion ❑ Oilier 0 if Orhzr. List ❑c �'.gnculru rill p
_. 1inLl LOC: 1 l,��v
C �� TopogrtppJ /Land scrring
wunl} I(f v�rc � ��i 01 Id z pSlo OV
Nc6.9r.Tomp (�! G"
C4��'t (cheek nppropriprc bar)
,_-w�iN.l.nr Yu.FI ucn, Cmnnmrl ny, S uboine ion, Lot rla., zip C ouc)
�111 i\CR.- (.4&a KQa„Z
<.4: /a0 , S4 4-ke �,r.
f/Cer,,::r 1z,"/rc ab73a
-.g urlb i 1a Lp Cuac
�aB�l- /4 - �988
duNbcr
-r. D:�.TgD rr L /9.) 0y
FST.,. DEPTli' $-0 ---_
2 5 pe alley OFlar
d. DOES WELL REPLACE EXISTING WELL? YES 0 NOII L`
STATE' w. I'ER LEVEL Below Top of Casing: 20 FT.
(rise "T' i? .Above Tap u? Cssul8)
S. TOP OF CASING 13.L._ FT. Above Land Surfce*
.1:Pp or aary rcrmulatca a vur bclmr land sureAc< rcy ui res
`- .m c..sr44as. wall I jA NCAC 7C .0116.
11ELD Doll(: Z METHOD OF TEST Ubw/nqq .1'•r
16. Vy ATER CONES Lncpth): to
. DISINFECTION Ty pli%'/O__
._. l _n1N3
u.-pin
Lan to
::Onl To
ro111
l+. SCREEN.
hrol(I
From _
S=iVLI:�R F
Luricudeilongintdc of well Ioaarioll
w "JY" .73 i / 7-1,04ez `r/3771'
(dcgrccsrminurc� cconas)
Lalimdeilongirude source; e-GPSOTopographic mrip
rchcclr box)
DEPTH DRILLING LOCI
torn To Formation Description
Y,63
moll
__Lan
?trnoUlll 21 Jf JJ
Wi111 hhioElcs3
Diannoler Of Weishr/FI Mare ial
Fr. i1r f4 f'e/ At
F t.
Fr.
Dcpd1 Adarenal NIcrlmor1
To—.aFZ_ Fr. CO/C e
.r. J------_
FL
Depth Diameter SIOr Sizc -
.1,i lNzrcrldl
Fr in. - in
PO Fr. —._.in. i
EL P A CK - in.
Dcprl'� -.
1'0
Size
F.
To- Fr.
Material
Ps
LOCATION SKETCH
Show direcrion Ally( distance In miles from 4( le43t
IWO Slate Roads or County Roads, lnclude rho road
numbers and common road names.
C ec%XC.
DJ riEREEY CERTIFY THAT THIS WELL1'AS CONSTRUCTED IN ACCORDANCE WITH 1SA NCAC 2C, WELL
CONSTRUCTION ST-.iND..RD3, .AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
SIGNATURE OF PERSON CONSTRUCTING -THE WELL DATE
Sun Lair the uric Anal ro me Division or Wsrer Quahry, Groialldwncer Section, 1636 Mail Service Cenrer - Raleigh, NC
'76i9-1616 Pltonc 1Yo, r319) 733.3d31, wirnin 30 days,
GW-I REV.07/2001

WELL CONS'ImikLJ CTIO
It ";lal a r��parmmutoi Envh-cnmrnranu- iV 1LCCORD
1 ALL 0111 1 Apl4ti1 1 Of
col R.aouitcs - Division pp r
V.ntl (ply„q f 1'+aror QuttlioJ-aroun
r- dtva[ar Sccaon
,i apt 'r alz aout vr"N-v11 C' P!',l, t 'S N�s__
-'li i I. O � 1GU CERTIFICATION 'd l lOry Ylliplrl'a q
.wESOCItTPHONCligai aSy_ 4114.,
Rfi 1.51Q P 126T1'1': <
\ lit: I:plic�bl�t
'- U] o al: ppl c::bla
It t w,:u ❑ 1 c2pttry ❑ - S '). l:cido vial
H$ P Cr' 'O'l' r 0tlu
Pump R.ticr lnjccciuio `Pan ❑ lnertialq
ELL Ll-�iIIVN: Dnlc(] If Other, I ... •:_- .4,.Sneultyral q
1v�erest To 1. it: 54 .4,y
00 ay.".o
V 11
. Ca w,liq Subai
COwnuy
n, l.ot No., Zip Cwcj
p J
p�_lc P' 'iP end,.
ownocr
ll:,l'g 11N LL h'l; /0/I_oe/
OTAI.itrhl".H Jot
DOES -\\ ELL
KEEL ACE EXIST LL? YES 0 NO
EL,S,Iow1'apol'Casing: 60
3. �,!' uP i'; :,SI.Nu IS / lust v-ir.Aoop PT.
`1'Jp or_n-y Icrnlularta FT' ."`hove LanJ c
_ Anu. -1UrinLGT
V �clulY 1-
'c Ili a:cu ra�n.> !run I 4fla°C «yuirca' u
Y YIELD ljpfl!1: � Ji .VCd l'?C.at IY.
U'. W..TE.R ZONES �'lET IiOD OF TEST,,
lacplh ): �
CJIJiNFi:LTILN T,p ii t --_
h :iliVv i--1D-dCc,, Amount /(/�
Ucpin - AVrlll ThklCncs3
Diiim let ar A�Iti Po ��� gho'Fr. bla[n'i51
Ft.
a
_ la
Dcplh
arcngl
Fwnl I. FLaR
1, aD
CREEN_ p
opal
r ran, Dumncr
- To
icofn
I S. SAND/ OiX.=.\.Fr.
' - E L YACK: ---ut.
= cprh
flniil
Sec
Fr._
FL
NlernOd
„eh_
Slot:;izc hlarcnal
in.
�Is[crial
La
3s i
Nile/Ion d
grru e source:
DEPTH
From To
�
.7TOpographic/Land seeing
tidge ❑Slopo 0Vallty ❑Flay
(cheek appropriu¢ box)
1.33itirUde/longitude of well
location
(�egrccs;minurc' ceonds)
PS❑Topographic nib
Niebb box)
DRILLING 0i
Fo�rmation Description
LOCATION SKETCH
Show direction arid distance in miles t'rona a1 leas!
IWo Stara Roads or Counry Roads, Include the roan
numbers and common road names.
Cohco I c
�
N .0
DO HEREBY CERTIFI` �'
'ON3TilUCTIOiV ,.. l H+.TTHIS WELL
1 tF (.r ROS, WAS CONSTRUCTED W ACCORDANCE
AND
BEEN
CORD HAS BEEN PROVIDED hA NC.AC 2C, WELL
��,`L...v�i VIDEll TO THE WELL O)yiyE
S/GN<.TUI'.t OF Y w R
PERSON CONSTRUCTMG 0 - �G -8
:Lime rn; uriinal ra Inc Di TH'E WELL
osr)-1 o.io rision a FVarcr Qu:ilir DATE
Yllunchp, lylg) Div joa rrlrYo f d. yo Groutrdly-
atw Sec[I I1n, 1536 mail Strvi¢e Ce
days.
rarer - l:alcigh, NC
GW-I REV. 07/2001
p
309267

L L.u\,I:
\PEEL (1)NS'Ela
ul:: I !LI ir.% nI tams
L-ra111LL r
w 11tL :a J'IS/AIcr Cualiry-iv rDundtl'aler $Ci GOq
�6�y GU,otFs ���p
cen l'1 Rl C.,,ngN x aS
V ..114 lr (. j}
cl-Eo>.1 I
❑ licalY rip ,1 :1
e71_2
.Co; .-_.. YH`JNG
pp(2A119'il
LLcauo:; LJ itHIc 1.-I
Giber ❑ II
;.
11
J :: nc a873.
R
, D 14 I'� LL-
5 L L�L-u1i; T'T----
f
LEVEL bdow'TopofCasla_:_�_�
- ...; l C-s1NulS—. tbs.: it,c�„.nop url'._I:�
I M 5:crmu ��--�- h i-T'utr4c4 La11J
" .:.,,ru I -trm:�l inur udCcluir 1. e u r arcq ulry Ur75�c,
1' E7 L 1,,,�1<I. L SC .ui IS O
L30„rE.R1CNE �l]; 1'HL-iQ OP TES .2
apTi
S
I,r r4p:C� �,
-� LOCATION SIC
,� :;lrounL _ETCI9—,1.-Y1Lz Slip
'ThCi ES 1\ ELL `L ACE EXISTING W ELL? YES
1'1 )N I.i�CORD
CIIY
1r:aun'is1 L1 1_rictdn
�I[Lci. LiS1 L19c Iral O
Tapogr0phie/L:uld sating
j.idec OSL,pc OVallcy DEW (uhccl: uppro pn4lc hpy)
L:uirtldc/longinldc Of Well IGeatian
S / rRS!'(dc
L.�umdc: l„lygilndc oaur Irtlnut xonds}
ierin
([15cc1,
"OTopogt-Aphle too
bov
3�5,
DRI
rRra Fonnunion Docnpi
on
P I H
NO
,1 Ill I-h IL4;n..-3 „ duccllu❑ And distance �' ir^ trolri
A:; I,rnilk ro f
pq L4TnEitrr w 11 t to SCAR Ra'
--b� 1;,_y� Fi. Ighc'FC PAalcri:1 a uQ� aP� rohd IhuAd9. rgClU do the rgilrJ
_ ttA3-- than ,end ca
4: snQa/ mman ro.I� name,.
.s rob r - FL_
Tr1;lrcrr.11 6101)104 /
UC��ll1 I)imn[ICr —
rLy11 'd Slat SIpC
Pr io.
mn�l
rt.la
r'1.
.P;n:3R,-VEL P in. ,— __ in.
cic:
0;p1r, s_
1rru:IL�_ro - c 141srcr;al
Flinc PI
Io
309268
a ttE,Ai��_S
COtic1.E_y-1
ti 11F1"1'H.'T1'HG WELL WAS
O ri cELI" C s 1 VU�I p3
jCN
. AND TH. 7 Copy CONSTRUCTED IN .>.000ItU ONCE -
F THIS ILECOI.D FL B WITH UD DTh W WELL
1=&N PROVIDED TO THE WELL OWNER. `.
Fi.
r+N.=: 01E. Oh
Sup nu L 'f .wN CD1'iSTRUCTI7 Rc on Iua1 W r YG THE WELL
na Qiri Iu 1i u[ 1ha[n-QuSlu D.q E
-� i> rolo P11o1 :Ao. "1n 733 3_21, Irirllin 3U d
), Cr() uud,ta[cr ScCOUn, 163o A9ui1 Ser
�s C
n[cr-12J1t`Ibh fVl :
GW-I REV.07/,294i
p

PROVIDED TO THE WELL OWNER
\VEILL CONs4TRuclro RECOIAD
r m ;!n I L pa ranorrof Enaironmcnr and - I '
11 L o.\lI 1 't Cal It 9Jw C--a'i iv 0q 97 \\1a[er
[ inY llrl'1D U.a1) V.prL QuPliol- l3 court ' L 'JA I,��� ih��!��!1 / r (J 4Y4[CL $CC[ioll
rJR CubIP •.:Y 1':Y ttl Lr
cerrwitiv°lon:32
C 14` oibsraUC'rrO'Y FE1NIlT9
PHONG aar asp ryil`�.
- 1hQ P lthlrrp • 4
YELL USE ri]nadc 1ppl;ybl
lalr.a, tad 0 14.Jt ery ❑
",=LL LOu ni'IVN'.
Nc4!- TJ�e11:�tn(/�r
Cmnn1nnny, Suby i ruimt, �'-
1i �VE`i
Sox): RsiganyaI L'J Ativa.icipa
1Yc31 Rump \Valor lnjcenon
County il�..e us 1.e
(if $:pllcoblci
L'public Q lndlraaiul Q Agriculrural []
Oncr ❑ 7f Other, Lis Use
Topo�gra hie/Land scam .
ORidge 'a"OPe OVsijc. OFlar
(check npproprium box)
Latitude/langinrde of well location
7s
Ran,c : � pkti-ccs mmurc
rat
ILL', SLJ La
1gD:UIrEL /0 7 or
rotkr.ilEnki.
DOES 11 ELL REPL.ACE�TI VW ELL) YES ❑ N0
ST TI` W::,T17P. LEVEL &low Top of Casing: elo
1'Ol' OF CASING !S N32..�,"'il.- bo,-c Tap
/ FT.. aura„ne)
�P ur:.vn; mrm,m rcq avor b.l :Above ;QUir
an:: III-urylana Surface"
°fapuc:lru 4 l$n - C _ o +urlaa rcyuirca 5. �IFL tgpN): %:� fp�� .0.1
'a ;1 - TFI; ZONES pacptn): (DO -JOD OF TEST
-JP cuac
aN
DISINFECTION Ty
L =.l INli:
Dcprn
con; � J Y
mn
.1' )CIRCRIL
17(3 LJ
rrom
5011EEh. Fr.
u.pm Di
Fr`i71— -I'o lliarncrcr SIo[3i2c
Frain Frin.
1'o in.
5 SeND,OR'V EL 1 F. in.
Dcprh
Fi oa'1 FL
Sias
Fr.
pc
t V3Jj l7M
Wait I'h,c I4la 3
Daunt let or Weighr'FI. 4/la/anal
Fri_ ✓L
Fr.
l'larcnal
Macn',aI
DEPTH
From To
0- 7i—
CPSOTopograptlic. fl1 p
(c heel: bog)
DRILL 11V G 1.0 Q
Formation Dcscriprion
LOCATION SKETCH
Show direcrion and distance in miles from r I -
r.vo Sule Rollds or (.Conn[ a cair
numbers and commonY Roads. faclpdt the road
road names.
IC friAir-2/4
ettet
U� riEIFBI' CERTIFY 1'H;+
L:N3TRUC'PIr7iV3'1'=.i\!D 11'1'H13VYELLN'ASCO-
.u,Ds, AND THAT NSTRUCTED EN ACCORDANCE E
ACOPYOF THIS RECORD HAS B . WITH lSA
6ENA NCAC2C,WELL
3IONATU E OF PERSON CONSTRUCT
❑ally rn: uri;inal ra me l)ivisiun MGTH'fi WELL
9-!u.io rha, ar 4Vartr) DATE
c �V. p"19) 733.3:a lays. rirU andW
.a rri ruin 30 days. arer SCCrIDn, 1636
Mail Serri¢e Center , Raleighr NC.
CW-I REV. 07/200I
309269

GIc
D_;1'EDidrIEn /c�-
POTDEPTH' " D•/
o. DOLES STATIC 4. I, REPLACE L WELL?
ITS 0 NO
LR LEVEL below Top or Casing: Top ac als3 .
.i. FOP OF C EINV' IS lute . Above
L Surface
ldy of;J,m� lcrmin Aida ada [tor IJnT. ,11n Yc Land
$U[iprc'"
41 C 111 ""'r a^IIcc lrin, rid NC _C J ,'urib rcy uirca
MELD _Frnl: /r ac-al T
:O.-iY:..TERZONES l;lcplh): METHOD / OF TEST
/ S'
nlallNF �+ ---
!Jfv 1'YP " `«rAtAmount
Well I'hrekac s
Dianlerzr or WOighb Fr. Pdu[crial Sit f'✓t
FL.
Fr
iY:-rat �oroLiu - Usp-rnncrlr or En,-ironmonr and
11 CLL.. CC.\TRa3' 1'Du (11\ EIVIDU.:L) N AiiIG iln-inq
CCP.TTT
:T[li iLL CJ,li IliL._11Pi IFl I'd9'IQN V
309270
iLL do.Nre-.c'rOR Q081T.i:YY :V— ig
rLlN 117b
`.\.ELL USE,L'.ncal:=.PFga:bla Box): Res a .olon::orlu� ❑ RccO+t cartel
�' ❑ Hcar Pump Water
. LOCATION:
N,jr:al Town: n.'/-
7..:. �. —�-County ay==�sb
Cc:mm�iry, 3ubairuiml, Lai NO., Zip Coacj
011
O ol Tt
fa
Ocplh
h Wln n-larcnal
From Ta EL
-
I, w'1',.1EIN. Ff.
-Dcprn
FBiS,ncrcr r,;;, , slorsi
Frrin ,I Ft. lNumnal
5. S.:ND/3R=,VEL PACK: in,
in, in,
otprh
nom o Fr
LSocci a. Raum
Zip Cuac
Fran-1 '"
Fr.
in.
WELL CONS TR 1.1) CT1ON RECORD
3;zc blacerial
Mcn1Jd
ral h\Ca041Lca-pivis(on o?
r Rarer euWir7 - Groundwater Section
.r530C1.1'1'GD W4 PT1.1n11T,
-,tga��
AioRLapab'Public
njccrion ❑ ❑. riul ❑ - gricalrtrral ❑ Oro=r ❑ it Odhar. l�r. List Use_
• PHO N1i en
Topographic/Land scaling
❑Ridge 2FSiope CS/alley ❑Flan
(check nPPropripfn box)
Lufide/IDnginrde of well radon
Wirt2 p� r"Ivor `vf`� -1y7
(17cgrcca; m inurcys=cnngs)
Larinlderlongirudcsource: LPS❑Topographie map
DEPTH (chzel; Dux)
From To DRILL IN0 i per,
Fognation Desorption
LOCATION SKETCH
Slow chi -tenon and displace in miles from Si 1
eaSi
nvo Scatc Roads or County Roads, Include Lbc toad
oumb1rs and common road names.
0 4 iv o �i2 .�✓ �,
dic lee, ,'v(
!D 110h'1AF_FS:
D� riE'I:EhI' CERTIFY 1'H+.
'iD3 riE R1I' C RTIFY TH r THIS \YELL WAS CONSTRUCTED EN ACCORDANCE DS, AND THAT .A Copy OF THIS EENPROVIDED
EO NC AC 2C, WWELL
O
_ �� •/Y � RECORD HAS H6EN AROVIDED TO THE A'ELL OWNER
/0-6-dr
3ION.iTURE OF PERSON CONSTRUCTING
rat unin,l EL) 1 THE WELL
nc llivisiun of Water Q. DATE
;dr1-16.10 cheat hJ, 3"1J) 733.3.' : :iliry, Groundw
.a lrirnin 30 d. a[dr Section, 1636 Mail Szrviva Ce
ayi. nrcr -Raleigh, NC
CW-1 REV, 07/2001

WELL C0NsTR0C:Tl0N RP
INC]:
ill `aof l i -COLD
cparinl'f1r Jr EnbirennlcM and cal Rcaoyitcg_
I .A'r a Fria LLNDl17DU.a.1) NaMLL D,vision of ArarGr
ip,-,,,,1
/ l �ualiQuality- Orounfhvatar gccria} LL 33ry1'I I' ),' CJhll, Y1 ,Vehlt; J—------___ _ r ' CCRTIFIC,A.TION,��L��
l_1}�Ll LYJI RVCI IJY n II FLRFr:- a , ��--i-"
l-tONL fpia a5nLrq/
lz rPiRnrcrT•a
✓iE iir 'niI bhl
U� � tr. '-PPI"blcB �
uo, nn 0 t.APPI 0 Box): Ra31dCanal pj,,.
Heal Pump Wmlcr L1jce[iaq ''pa VP„bl' q InsU5Riul q .
ISe
_ ❑ Oilier 0 leOther, r :...., "'Saco rmrpl q
-�, L0C,.1�1yN
N em, TO,.n- /ml�itt%'{✓
., nvi: Nuu, m
o:r5. Lfd i o J �'��_
p1 3ubairnio4 Ls No., Zip Coda)
J }1 ne7:
00 cci a; Ro3ra No )
Scatc
Zip CoJu
33.c-!her,uwnocr
Di 3. Ct l_I
r3TAi ➢EP]H:
3 DD WELL 1_EPLaCEE�_
'. 3I TIC N..kT p LEVEL oV E asiug: ❑ fV0 .
E„IDty Toparc s Yv
PT. S. YO;f. - lUgT. Abo aLc M Suri
OF CASINO a FT. z5)
'fop or_.:,,R; Icrmma,t0 uQur ^-race cQuir sa :Surface'
';4,1 m a:;oru,; bNCA lung .011b.e rcy utr<s n
YIELD - .nta./,.irb Rid .V C'a':C.U110.
I'p'!IJ. h-ET 1O D !J, n TEIR'ZOiNESI,IcpN): L/J� fee ?'EST r
_/,d
Topographic/Land string
ORidgc OSlope ❑Vallay 0Flaf
(check nPpropr 41e boa)
/Lati ode/longinRde o!well locatiarl /U s`r1 ✓c
n Zc d6Zl:
(dZaccs;minuyrsrronds)
Lalinfdeilongitudesources: �
le rasp
lelioeL DON)
DRILL INCT
Formation D„scription
1r.
309271
DEPTH
From To
O S1
Cl!Jfv ',p, t
"SI DISINFL 1'-.amount 1 LOCATION SKETCH
ast
W-JI Thickness 51 Show direction and distance in miles 11u
pin - Dh as P,lp[crial �Wa Sian Roads or County Roads_includeMeom tit ci )ad
;on AIn— Jt Si'ci
to S� Fl ht,hr
Stint Ft. l' S,i312/ "tic
um6crs and common road names.
r,
1-00in To Ft. e fps. RC(.
,3. ..a ROUT' ---_ ----
D:p,h 1
PrJn1 /l -1•o pm�ya�te,r,i,a�l �� �--
fronl "�— Fr._CC nlomun
��- • l GG./ M.
/ /,, C /�
D:Frn
Fri„1l _ Diureter Slat Site •
61a[cnal
Fran___ Po Fe. in. in.
Dcpm
Fro:'.1 1 o ht
Ff. �'�0 acr,al
r rooTo
t
Do' �iERE5Y �ERTIFI"PH:+.TTHIS WELL 'DNS0ri t1/CT' C RT.IFY TH T WAS CONSTRUCTS
AND TH.AT,A COPY OF THIS RECORD DCACCORDANCE
HAS BEEN A WITH tiq NC,�C C WELL
'�„%,�„�� PROVIDED TO THE WELL
S I ON.�T OWNER
URE OF PERSON CONSTRUCT /C" [ n,tnf rn; uninal COrile Oi . - CONSTRUCTING WELL /-0 j
d-A u3o liaiun Di Wart(' DATE
Phone No. 3(519ItrIC 7 )J•33i Quality, Lraund}
1, ni thin 31) ra[cr Section, 1636 b/ail Service CeRuar -
days.
Raleigh, NC
ppW-I REV.07/2001

IS
From To
l� SCREEN. I ,_ Fr.-_
Proin to �-F q1 Dimncrcr
Limn To Fr. in.
*21D'GkAVELP.iCK: Fr.
llCprh
.ri.i,l", I'J
teal Fr.
-"--To Fl.
!o DEALziii3:
WELL CONSTRUCTION 11-L+COP.D
n C.1'01, Lcparmxcnr Jr Environment and - rare,.-o
LL 0:1'Il x 4 (tryuivlowuy N+1il; a 4"" - Division of Hrcr �a
r�`� �. - QU411i11 - all rOndlYd [Cr 1'�GC[iJll
(prim.)
L cJ.\ l lc Cu 11PAWL Nw,"dl J' d'1^ (S�Q.L✓ CERTIFICATION „ 3 j= d
rz 1i-iLy NS IItUCTtON fL{NI('rb PHONGAS.SOCLATIth
Q RIYATr
1 1 -np Gc.tacf
t _ LISh - I: =-ppl .acre Box) P..gid �ntial ,/
uJt:p,ul ❑ u...o3e y iii tCiPa Oili r l] FtI r isi ❑
- O' ❑ Hcal Pump 11'alcr lnjccciun ❑ Outer ❑ ] Orhzr. List Use
ELL L0Cl Iv
Ne1rs5i. To n:,.'..r
n.ui, v a wa nu f
SubQ1Y'si3o. L.Ji i'io., Zip lAa.j
_ a
Simi;
a
Zip C00c
1. D A'E D n L i E n 9- 27 .,9y
rot Ai. DEP.i I.'�"--
.. DOES WELL REPLACE EXISTING WELL?/
1. S I ] IC W.4..T R LEVEL Below - 0 Nu [.
w Top or Casing: �l�
lust ": .ir.ADovc Top saint PT.
L. IOP OF CASING iS our _-
`fop of:avna mrmmam-auir FT. .''bone niLl
S 4f7t1Cc+ a 415 DtCAta2J Yar s. rcy ulrGYu
n9u.c m a::orazuea i«I lid Nl'.=_C d. YIELD (;pail: = .aiOF T.
10. WATER ZONES '— METHOD OF TEST r I�
lacptn):•
DISINFECTION TyP;
CASING: :irnomn 7 l .
Lkpfn Willi Thickness
ro:r Pc 73 +n sier or Wei hriF,
Fr. -'e J r Marc
roia r,y�lzi y��
erial
Fmm Fr.
Po Fr.
Z!:OUT ooflh
material
Site 4larzri;ll
Irlcnwd
tat. -tier
A.grictilru 1 0
Topogrgphic/Lsnd seeing
ORidge sIJPc OValley ❑Flan
(check 4PPrapriafc box)
Latirnde/longinlde of well location
(degrees•
Lanni dci longi rud
DEPTH
From
O' G r To
'77 .
0 30nrCc:
minuleyy second,)
l3GPS0To og-.
P laphiu map
(chccic Dui)
DRILL.( 1 UCT
Formation Description
LOCATION SKETCH
Show direction and distance in miles frog two Sralz Roads or Count n ar least
numbers and common rod names, include aid road
;€.441 ri-Aty Chuick
! UJ ricREgy CER1'IF1'1'H:+.TTH15lVELLN',�'
)DEC r rcIC'PIrJN RT.ziVD..rRDS .A S CONSTRUCTED IN;',^
NDTH.aT,iCOPYOFTHISRECORDHASBENPROVIDEDTOTHEAELL01
WITH l5r4 NCAC 2C, WELL
CCMyTRUuTMGT 21-e y -.
SIGNATURE OF PERSON CONSTRUCTING me olio final w rnu Division^ HE WELL
? or lVzrdr �u DATE
0`1j1o:ro ?Aare No. (91e) 953.322 alirY, Groundwater Sections
.1, wirnin 30 d4Y;, lo3 ri Mail Service Center - Raleigh,
6 LYI:
GW-I REV. 07/513iI
309272

•J1 I 1
L CE EXISTING W ELL, 1LS ❑ ND
h-
rEL Bcloly Top 'Cs-
I JP OW C IS _ 'ir cJ = "I'up
"r4F ., u t‘rRW aH,d . laud:/ ;ui het r,Li, ui111'cr 4C7�e C'
1.1'�.I it1r1
with 15.i u)
NC JI' I5.
i ,l.,. �H0 D OF TEE I' r 7
wl r 1, 3IdE� l cpin): �`Lq
11-EL1_ CrIiVSl'l:ll.'1`10N� 12L:C'Ofa)
hl;cql r): writ I 4'5.1 (Ya .,,
4b6 ,,,.:�w h�h�/4�'I (1-1:5rGr
- , I L'Itluu t� v.4i11L /_ N yuUli ol- Oroundlvalcr Sea rion
j_crs„4GN s yf�j�l� 2D/i . D,¢
Yf3NG Epp, a�/LKJ/
.-- SSJCI IL D 111Q Y211I,1r1/i
u,a �
Vl ,J
al' LJ i--ic Fir ,1II I iJ L oG. ❑ Ii,4lwaniwl I] .iynCrdnlrgl ❑ mold! lr Cnhcr. I_is1 Lsc
L44.��G rir^ IC �'Jull�; 1�"Coy%%_.
"L)Ytlics
n
i7C�0 Yu'
��ac
nt�(O ii42 L' Flom
ail I ill ��
Fr.
FL—�„Ilt. -
Ii. _...'i ll.v, w m.
r EL P,zC1<:
;,prn S_
_ Fr.
r ton; To
Topog I1cnd scning
❑Ridge SI.:/L:l
I QVallcy ❑Flat
/I
LariruiicOngrmdc of y' S H'cll Ip i`;1flJn
trig
Wee,my wes, eanq,) _� �I
Lduf udc longiludc Our
c' ❑'Popogr tphi; mop
;chock Uadl
U1:ILLl�OC1
To Fonnafion Dc SC rrp Pion
v dircent.111and durance in miles from of Ica,[
Doom _ 'w1 J11Prl;no, I �
L'iarn;Icr J, 44 - Stott Ronde or County Roads. Suelllde the road
'a:._ 1-a Fr a shr;Fr ml,l,-_n:d uu!nt,are and common rood names.
FL
Hwy
�1 •,:h h%cnal
,»--CG— 1.,.�CZ_ Fr. C'/i_—� jiv "� rn.,u t 4-/ - j% e <21 /6-
tr,lt,
r. /° f� —
u:p;n Dumncr
flat ;il?G Mtllu"I151
:J n i:EB1 R IF1' Trim "THIS WELL 442AS CONSI RU'"
Iv Ci LiC17�N �l �V DRG ;NU TH � l.7LU CM ACCORD +.
1 COPY OF THIS AE000Lf HAS BEEN WITH CD Tip
THE
2C, WELL
BEEN PROVIDED TO THE IwELL OWNER
ON.)RE O P P3uti CONSTRUCTINOTHE WELL =uUuri rn; on in,l w me Uir liiun of 1Larcr Quality, ATE
- LI Ln rci ! Do. r' Di L ality, Gco uildltxrrr
I)) 1=71, rriIDin 3U SeC rion, 1630 Al ut13er days. use Cnrcr-7lalaig h, fY 1. _
GW-I REV. 07/200f-`
clrrcic,'rioN x2Q_S
309273

=IV Quo,
ilqrliDce
WELL CONSThTJCTTON RECORD
I In rol, I r y-rm1 ❑ref Environment and s
11 LIL uSl'I rat l2eources-Diarer
1 uu itNlli VICLI.A_L)IN.allL ' �)ualiq-Qroundlvator'
its'"I I Eoction -._•_ cud-1' Itw iOf: CumP.♦ty 1' Nahl E'
/
n,r T---.__ C612TIF1CiT10N ta o. is it coosTRu,:110'V teRnilTa ��// /Iry ,//'
ASSOCIATED q J
Q fl12hllT'p
t : ul'':,ble'I
n t: =.pphmble. Box):2 11 a: u1y L I J!:c 1 c>id anrqul L�1 J11ur L;iPa LPubl
ie D ❑ Haar Purnp \baler lnjccrion ❑ q lner, Lis l q .�, ;
O[hcr ❑ ]1 Oilier, :_..._ sr ca4yral
-. ,.fill_ LOCATIIy..TI/
D. "�„ County d ;t
m,u uu"7, cublrumn. Lar IYo., Zip !'oac)
D'ILI K-
349215
FHO Nfi -bYC]/
4opographic/L and seeing
e OSlope OValley OFIar
(check appropriate ba%)
Latitude/longinrde of well location.
Nj+ J
Y.
(degrees/mmme. scconas)
Latitude/longitude source;
DEPTH
From To
111�jt I Fll 0 SOY
F3T;L. iDEPTHT rerer
3 DOES l\ EL L. REPLACE irk
31 ATIC 1\ .* FER t .• EXISTING WELL? YES 0 N u , -
t4'EL blow Top Jr'Gasin>: L!O
;i.COP UT CASING IS I use r u..bay-c Top or Cs�ln3)
rod or:gvn� Ic' n1 I u Cufir bbcluu r IAIIU su Above
e Land Surface'' III4"� rpall:c trial l jA .Nl.•- ircy uirasa
i. YIELn!g(m0: ) ._DOFCIIC s.
u.1YTER'OiYES METHOD OF
01SiiNF_:CTIO[v Typ, JJ
C S!iV3 - ;mount 2 47 , AS,
=:pin W;dI Thslinse
r W;n 0 Diarnpter or WciyhUF(. Prlytcrial
'2LL Fr. Zc ..,
^cad) ro Fr.
.i CRJLIT. Fr.
O:pn^Front
NI arena!
Mcinotl
It. SCREEN. aFf
.prn
h ro:n I'a
Ft -inn I,. '--.__ in.
u. S-.tvL 3&.\ELP,..•.-
Clg111
ranii T`_
Diameter
Ft
Pr
Sine
Fr._
Fr.
Slur Size i}inrerul
in.
Ill,
Y11UCl'l11
GPS❑Topographic map
lehcat b0.2)
DRILLl_NG 1 GC)
Formation Description
LOCATION
Show direction and distance in miles from 41 Icait
two Stale Roads or County Roads. Include tha road
numbers and common road names.
ow to t.escee_
45Aeu,"l/e p C ,
a Pia-t—A R _S:
DDIv 3tTiERlUEC9PYlOCivERS11.Iti"1HRADTSTHINSD
YTEHL.ALTWAACOCPO1NOSTTRHUICS I„
DCCN0'pDACHCAOS:llHAEENNCEARWOIVDET OCTAH
C•-Xy„,: �EWELL
VyEp
SIGNATURE OF PERSON CONSTPIUCT <4' emu me uri�inai to tnc Division MGTHE WELL -f _ 6N
-!V;o Fhonch a n3iJn or WA ter ! DATE
N. o I.)) Divisi3 Quality, Cro [in dw u[et' Section, 1636 Ael.
1, tri[0 in 9D days. ail Service Cancer - l:alei>
CW-I REV.6h7NC
07/^_001

ELL coNsTaucrioN f-:i.cour) n � -� -.;I, r,rp,r�1erir or Em-irnnmcnr anu
1. \1'! ral Rauu, cc,— ,v; 'io„ ai Warcr
,1 _ 1, 1 J1 inYn111DU.1) n.anlE Iprult) t .�i.�.�d I
QualirY - Oround;va[ar Sccual
UTrI I' 1i JJdI IVY IV+bI A �j _C��(^�J(� d <
VF I�
------ CERTIFICATION
1 1F L_s. 0 b11:UCrV:PI b Eltnlf P-' PHONE Lit a.itz
4.
pi ASSOCIATED WQ P 12Anm..
Fir r.rP n,r..CdC
L,j r Ic _.�w�l•
, I .,::uj ❑ 'J, PPI "aGla Bow) Remtl=nrial '
1 jo11 •iPa Otllb lie
rY L7 Hcal amp 11'alcr lnjccriou 0 ❑ Ltier, iial 0
-1- Li=��r11'I Jiv Ogler 0 ] Other. List List
Nc r-sl Ta,s/I J
Cnuru
:Nu 1)“1. Epp-„u un nl', su D�l1',�I LJr PI J.,
SIP {'JJ<J
Ya8 '.IR3 �a ,IaB7
p Coda
D. EDtuLrr,l
TOTAL. LEPTii:_�ZT
a ODES 11 ELL ILEPL,*CE EXIS�WELL?
I..:NC ik::_rER LEVEL Help YES 0 Now Top of 2
I'.`Iput:' r ill>z 'r"orp 1T.
�'.-.S.NCi I$%Ir.ieL Top uCmme:)
"r4p or:a mrmm, .a acror bciuly l nL Above Land s4r7HCo*
rl" v ul >:.yrJ511oc WWI 1 'ul'lSee re. ull'p9
11i6LIll_:❑I c''YC.=C)C.a1lo.
u. IY 11,1 10 ZONES METHOD OF TEST
Lacprnj:_ /d'(i"
SIN. LCCIJP' Typ,a/ r
=SINU •'inlpLlltfi
='-'pin - W:IIi Thiclulcss
/ Diameter Jr WriOUFr. A9urcrial
D I', CC) Fr. 6_/er
rraln r.) -- dv / �o
Ff0111 To
.3 C]IiJLT' - Pi
rJah {�_` (J nl °Fero al
�LZ_ Fr.a nlenwn
E.
frJnl .IJ �j,'
Imo. j�.'IEi�
FI. 3
Fr
L oonI! To
o,r fo
I:; .ND,Q&AVEL PACK:
IDcpcli SP_C
fl:31Lam_I,J—
Diarnc lcr
Frin
F r.
Fr.
Slot 3i3c
Ail/aerial
n.
Agricultural 10
(aegrecs;min�uw�vs-t
Lauludeilongitude source.: �%PSI:Topographic reap
(ehcel: Dux)
DRILLING 1 Oar
Formation Description
T°Pog1-yhic/Land selling
°Ridge MOpe °Valley ❑Flat
(cheek 'lppropriara box)
Larirudc/longintde Di well location
/l1 `'</1 c77' Livrit /1j.
DLPTH
From To
o - s-c-
ones)
S„s
LOCATION SKETCH
Show direction and disrancei
n mies from 4I lest
nvo Srala Roads or County Roads! Include the road
numbers and common road names.
(o C eet.e/7 /✓e r
a. ilEillARJCS:--------_
Du ricl;Eh'\' CER1'IF1'1'I-1.=.T'1'HIS WELL WAS
JNSTlRUCPIOiv CERTIFY
THAT _MDT S CONSTRUCTED
THAT `• COPY OF THIS RECORD HAS BEEN
WITH laA NCAC 3C, WELL
N AROUIDEll TO THE WELL
SIGN-.TU1 OWNER OF PERSON CONSTRUCTINGTHE
lrlt mtn- DiyisiJn
e on,inal ro SWELL 1 -de.
� or Wirer Qudlir DATE
Fnunc NO. L"U) 773.3:;1, rrirnin 30 d Grcundw' firer Secgon, 1634 Mail Service Cenrcr -
R
a•>.
ultigh, NC
CW-I REV. 07/200I
309278
tisJ
0
c.r,

\YELL CIONS•1'11L2CTION RE
r rll'.]rJf r RECORD
'paftTllUli of Environment an
ZI 'Q.\ rOsxi2 rut: i1Nlll\'1DU.:L) N a\{L (prim:
;r LLL JG,A rR.:;q)R CudlP :NV NAJ 14
..: :rr,\L-r, Cja rnuc'rlon rt1:n 11Ta
YELL LISkj: Iry -PFls:+0 la boa): P.a,id _.
uo-troru ❑ I -..o;O
zottal l� lviu-ici
ry ❑ Htot Pump 1'V]rcr In ioe[ion n Pa Otbor 0 Indus i LLbTobl0
N.ssresi TJrati,
,--;=, n.inm :v nn,iiuc s. Co,rinwni7, 3uoairuion, Lai X10.7 Zip Coop)
ruf F,.aow i.es - Division of 1�['a[er � O
[ Qualio>> Oroundwa[cr SeoLon
CERTIFICATION
G� i. fr • or'/ Zip Cuoc
e=acap-1'nan=oualOcrs g DATE DRILLED 5-w-�y
TOT..1 DEP fl 3 Os—
ci DOES \\ ELL REPLACE EXISTING YES 0 NO
SI ATIC 14 ;'FER LEVEL Below Top of Casing: 40
11-15t •ii .iopvp To FT.FOP OF CASING IS FT.
`rsp :still mrmma ar FT' .•ibo Ye Land $urffl'aJeSurface-,I Ddurr Jana surface rcyuirb'u
WWI Ij,-1 VC=?C.JJ Io.
>. YIELDnli: p n.irEP\ nn. ONES pL FIE"h]-IOD OF TEST (AcptR): to
Couruy
GISINFEC'ILON
Amount /._ 5 - i
�_Prn W;ill Thmlmas
rroa, C aim orWeishUFr Bib r lal
I'o G Ft. -iLt-
rm'n rJ
com Fr.
ro Fr.
,..3IXOUT Depth
r'rJal�_Q Ns -soot -Jai
atonal
From -�L— Fr.
,er_ oi&, nmu,Jn
TJ Fc Id. 3C1;EN_ I ��----� .Jcprll —�_
pion.] .L` Uiarncicr Slo[ S'iZa Aiutcnal
Fr. in
Frm❑ TJ n.
L. ] iV D: O' FLin. _
K.iyEL PACK: in.
I-:f,n-i Si.,t
F1J,Il ro Nsacenal
sroni TO_
io I'EM,KRIS:
pc
Fr.
Fr.
'D�tiEl�:hhl CERTIFI'1HaPTHIS WELL WAS
I DN& riCR L I ION R'TIFY THAT
THAT
S CONSTRUCTED
AND T AT,� copy OF THIS ILECOlW HAS BEEN PROVIDED TO THE WELL
ACCORDANCE WITH PR15AOVIDED
2C, WELL
�� cl OWNER .- --
SIGN.A,TURE OF PERSON CONSTRUCTING THE WELL Ai y
uuul,r rn: urioinal w rRc Oh' lsiun of Wafer' Qualify, DATE
y.1oin euonc:�0. l" l9) 7)3.33:1, Q xliry, Gru und\ruter
Malin ao days, Section, 1636 Mail Service Ca n�er - Rula;g4, NC
CW-I REV.07/200'l. i
,r;
So'1r A/c_
.+S�CCI.i 1'Gli WQ fl1thitTn
tppnc:.Llcl
• F HO NF yipal aS j%Q'LIli
AgricujNral
Topogra io/La.nd serving
❑Ridge 2SIope 0Valley CFlar
(check,rPPropriaro box)
L iLudc/lony+inrdc of well location
W_431
(aoutes mmure' c<onde)
La lirudci longitude source:
DEPTH
From To
)
L9 GPSCTopographic nlap
(cfinel: box)
MULLl�NT1 0�r
Forma ion D„ scriprion
,o.._ol
f
LOCATION SKETCH
Show dirccrion and distance in miles from au le
sr
two Suave Roads or Canary Roads..Include Lie Toad
numbers and common road names.
(,esce»ter, /YC

309286
\VELL CONSTRUCTION RECOI',D
''ram 11 iiiiirOliiiii DoJar tnlenr of Environment and rxl Rcaources - Division of Waver Quality - Oroundlvarer SCCrion
111.LL O\ll.-.�1 t. (LN111v1DU.aL) NAMP i rims) ll' % 3/4i.
p r fj•'/rT/�/NG5 /' CCI:TI$1CiTlgry rr.,J/d
,,,LLL JD,�11_-.c10a 0U�1le1/4Nl iv.-Lm E're r514_50/✓ S e`/ 7 ,'//,> Ct. . P110f2 Rag1 i5ii e,
,et-.reirC__,c1$:RUCn3NeW IT» J
ASSOCL-erGL N'Q trei tan'n
i t ',pplic,blcl
I. `YELL USIn LCeaLaz =. pplioabie Box): R4sidcntl,i n. pa
OrJ 11iring ❑ 10
o' en, 0 Htat Pump Dater lnjcunan0 Other' 0 If Other,yLis Use Agricultural q
_. 1tELL LDDA.110
qt-
641f Ai/
CJtlnry NNnLJW S(
:voo1 oars, Callnuniry, Subgiruion. (.Ji 'Io Zip Cooc)
m>°s,c
h "(eenU 11J (C. a g
l': Sur. ZiV Coac
Il „,TE IIJI r Else 7 -4• et(
i. FOT_;L.DEPTR 2y r
o. DDES 11 EL L 1LFFL:;CE E� WELL? YES 0 NO C�
STATIC WATER LEVEL Blow Top of Casing: /0 FT.
S. (use "r "if Above Top J1 Cw mgl
TOP OF CASING IS FT. Abova Land Surface's
"TJp al mrmma : acl r bclulr lane su riacz ray uirCs u
"r' a::o;cal+=)nrn 1-i1 .NC-C 2C.011d.
'. t'Q11IFL=ltBprn): b1ETPIODOFTEs'TB%hJrr .��'
O. AC.-TEIR ZONES (0cpNJ: � U .`�
t DISINFECTION pea/Q.42.46es_ Amount
Wait Thickness
or Weight/,. Mare-nal
0
[Jrl:
F J,11
.3. Ji DuT:
From.
Diameltr
fo rr FI../l r .
ro Ft
Fr. _
D,p111 Marcrlal
dD:2a 2 _ Fr. Cger
Fr.
D:Hm
I.`
Po
EL P.kc.!.:
*pin
Po
To
Dimncicr
Fcin.
FL_in.
Fr.
Emai
Fr.
Size
Slot Size
in
in.
i,lararial
Sae, Alt
IYIcmntl
atonal
opo�'aphic/Land setting
.idge ❑Slope OVallay OFlar
(abaci:appropriate box)
Latitude/longinrde of well location
/1✓3r�' LY, -74Y won `s C sat
` locgrcdrminutasrscconas)
Lstimdeilongirudc source: OOPS❑Topographic map
(cheek:bus)
DEPTH DRILLING1.00
From To Formation Description
O-sv
$ G'1 . Y
s r= z1r
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads..Include 111c road
oumbcrs and common road names.
Gr2.3-+- mall
S, i.i.iar0d- R C .
0,3 riEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH l5A NCAC 2C, WELL
CONSTRUCTION STANDARDS, .AND THAT .A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
SIGN-,TI.(RE OF PERSON CONSTRUCT - ` Vc�
INGTHE WELL DATE
Sul -Auld me criviuxl w me Division of 112Arer Quality, GroundwAcrr Section, 1636 Nail Sdrvieo Center-P.alaign, NC
99-1610 Pnonc rya. (913) 733.33:1, within 30 days.
GW-I REV.07/2001
0
0
F`�

309288
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section -� -� �9�
WELL CONTRACTOR (INDIVIDUAL) NAME (print) / 4rr r k ,411, V\ CERTIFICATION #32e
WELL CONTRACTOR COMPANY NAME fe rj,cso al U/r I I 11ri1(;„ PHONE @Q.yr) %a93—/Tr/
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential G MunicipaUPublic 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION:
Nea.$ rest Town:sr Ord sv;)Ir
c(/: //l,,4 ,on Li .
(Street Nark, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: VTny "' ba
Address '5/nn fyeh. OQ
( 6E
Sn et or Route No.)
New tale. ✓,4
by rTown State
-4/Be�-t�6
Area
Area code- Phone number
4. DATE DRILLED /0 - / F - c t/
5. TOTAL DEPTH: es if
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO 0
7. STATIC WATER LEVEL Below Top of Casing: in FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS / FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordance with ISA NCAC 2C .01 Hi9. YIELD (gpm): / i METHOD OF TEST iel)9
10. WATER ZONES (depth):
County Bea c0M C-
3ega
Zip Code
11. DISINFECTION: Type ill 7f-/ Amount c2 " 6L.
12. CASING: Wall Thickness
D
Depth Diameter or Weight/Ft. Material
From To go FL C1y ?Z)/ sVL
From To Ft
Ft.
From
13. GROUT:
From C3
From
14. SCREEN:
From
From
To
Depth
To 9fl Ft.
To
Depth
To
To
Material
rbr1G ro Fe
Ft.
Diameter
Ft in.
Ft. in.
Method
POuCe.d
Slot Size Material
in.
in.
Topographic/Land setting
❑Ridge ❑Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/Iongitude of w 11 location
rf/11 09eP763 La
(degrees/minutes/seconds)
Latitude/longitude source: ❑GPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From To Fongpation Description
// 26 cinc-nd S/-o nt
si/Lr
4 - L(D r, r /tr
02 — 3 r
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. include the road
numbers and common road names.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Fi.
16. REMARKS: _ r tiA
, #e
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF IS RECORD HAS BEEN 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.._.

309293
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division/of Water Quality - Groundwater Section (� �r
WELL CONTRACTOR (INDIVIDUAL) NAMrEr��(yy__✓✓rint) r32a/J-As )f , [mains CERTIFICATION n3/90
WELL CONTRACTOR COMPANY NAME 7--cr i seA NC) PHONE ,3T- u94.
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential E" MunicipalPublic ❑ Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION:�
Nearest Town: rAi /✓.•ett
LAiit:S➢<r.tatL ?o 1'2.1
(Street Name,,eNumberd, Community, Subdivision, Lot No., Zip Code)
3. OWNER: iVdarkf .r,bee to, /da»w.
Address '3 it orisat fylnt• a.. d ra etc/
��� (Street or Route No.)
/..4.-rv."eu I r g k73 o
City or Town State Zip Code
z`t)- f<?b' 3*%M
Area code- Phone number
4. DATE DRILLED t' 3 /- oy
5. TOTAL DEPTH: Li oT
TopogSri�phic/Land setting
❑Ridge EPSlope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
N3a°34, flViipaz°.78.753f
(degrees/minutes/seconds)
Latitude/longitude source: ❑GPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From To Equation Description
0 - 33:r h
33- 3H Sewct 4ia.e
3 8 - 46 r
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO Q-
7. STATIC WATER LEVEL Below Top of Casing: sv FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS 7 FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordance with 15A NCAC 2C .0118.
9. YIELD (gpm): 7 METHOD OF TEST 237nu0,4,-2/5
10. WATER ZONES (depth): to . 1 SS
From
From
13. GROUT: Depth
From U To a
11. DISINFECTION: Type C(°r2.'N,a Amount s3
12. CASING: Wall Thickness
Diameter or Weight/Ft. Material
0 To 3 Ft. L✓ay- 50'La7 Pvc
To Ft.
To Ft.
Material Method
Ft. noncra �swrv,
Depth
From
County LAresarI'e-
From To Ft.
14. SCREEN: Depth Diameter
From To Ft. in.
From To Ft. in.
15. SAND/GRAVEL PACK:
Depth Size Material
Slot Size Material
in.
in.
From To Ft.
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common road names.
mtk2%%sN-� �.
ar. 5 2� ,2
iph:p
_)t
c
From To Ft
16. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNERS
r- 37-6 44-;
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh,NG-,
27699-1636 Phone No. [phone], within 30 days. GW-1 REV. 074001

309297
WE CON'ER ocfioN RECORD
`id, in 4-o4n5 - L p.:renew or Environment and - rat Pcsourcc; - pivie ion of 'hearer Qa 1iry - Groundlvater SoCtion
.3146 d e L l ll ..:1 r irntill'lUU al) V.a\iG (In-u,q �� /��, 1,/T(/fi �C^ 5 /' C61:TIF1pC A�rTIUN ry ry/rq
41: LL 'UPI „I ,1 U'ui,1r•.1 Y1 iv-llli f�k ScvV &kj/ L�P,,//,/Y. Cal • PHONIZ gag a5E-! F4_
r.: L ii uLL CCitiI Iw C'noir r Ebb IIT6 ... d.SSOCIaxTED WQ RpiMb
in' tionlicoblirl
I. 1FCL.L USE LCnca- A4apGa_bl_ Box): Residential Ci belcn!cipaL'Public ❑ LnGUSrribl O AgricldMr4I 0
raion:rarrn 0 rccao‘-pry 0 Hcai Pump Water lnjeCtion 0 Other ❑ 11'Other, List Lisc
LOCAI'ION:
N:a:-s To.JJu L"Cc'e: //C . County Le -^ran �L
Aim
�_...n i�;d'r., :v_ucrs, Cantu unary, Su bdi nsion, Lot NO., Zip 4:aoc)
`,.11 ,E
.v es intact- S plait 9s re.
tS a'cci Roars rvo.)
We4-ue'u ;fie /vc d8787
"l J: ICNu .S{.am Zip Cud.:
tat- In 45- BOO4
_.a :d�_ Poonc aumocr
-r 'TKO. En Y-26 -0,-/
S TOT =.1.DEP NE: 2os-
3. DOES WELL REPLACE EXISTING WELL? YES 0 NO 07
ST*TIC 11':e:PEj'. LEVEL Below Top or Casing: eo 1"T.
I U,; .r"'if .iborc Top seCamng)
LO
P OF OF CASING IS T FT. Above Land Surface's
-rip JI ul brmmaita aUur Lick* land suripce reyuires
anAn:c in a:. urma uc xinl 19,t ; (CC 2C .0111i.
`rIELDhpml:—METHODOFTEST Bb&i4' •ir.'
a.11.-iTER_0NES 07 cptnl: 2X2 .� .�
DIStNF'_CTIJI`' TlptC-,
irnoum %/ art.
Jcpin
Fro` D 72
mm_ Po
From T,
CnSlNu:
_ W:dl Thlctutest
Diameter or WcighVFt. Pdatcriul
Ft. G./ir ✓C
Ft.
Fr.
tvDrcnul
Fro:r1--0_'[o_.�FL_ Ft.__ 1.a ,
Flom Tu
Pi.
Nlctlwn
-'S
I-r SCREEN. Ocpnl Diama[cr Sin[ Size i4lurcrul
! m:n 'Po Fi. in. .
Fir, In
Fr In. m.
Dcpi1' Sac Matcnal
Fwrll Po Fr.
from To Fr.
Oil\ LARKS.
Topogra hie/Land sexing
❑Ridge SSiope OValley 0Flat
(chock approprwte bog)
Latitude/longintde of well 10eatiOn
j(l6r° 2r7'initee4%1764/
(dgrecslmjourc� seconds)
Latitude/longitude Source: QGPSOTopographic map
mien: pug)
DEPTH DRILLING LOCI
From To Formation Description
T➢ 72 /2:--'-
72 -72
77 - /AC
tow,
LOCATION SKETCH
Show direction and distance in miles from at least
nvo State Roads or County Roads. include the road
numbers and common road names,
-raj %a iodk 1•Jls
weAties, U./kf Nr.
llO ricIEBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH t]A NCAC 2C, WELL
CONSTRUCTION STANDARDS, .AND THAT A Copy OF THIS RECORD FRS BEEN PROVIDED TO THE WELL OWNER
SIGNATURE OF PERSON CDATE
VNSTRUCTING THE WELL �G - y
SuQnLI Lae UCL tIIal ro me Division et Wurcr Quality, Groundlr41;er Secriun, 1636 Mail Service Cznrer- Raleigh, NC
?odd-:u3o Phony ,Va. 11419) 733.3221, Fiji -bin 30 days.
GW-1 REV.0742001

309300
.... r,u
.. 49cLE ash Cn.ek=_
y • o�Gii tpria
❑ I`ccor'e0' 0 �Hcar Pump \Nara
2. P, c'LL LOCATION'.
N,.ucal To“111'
01AN
�.; "n arT:,r„
ZIp Cone
se.: taac- t era oo mocr
D. TE DnjLJ El-) -&5 Dt1
r0T !DEPTH: _/
6' DOES 1\ ELL REPLACE EXISTING WELL? YES 0 NO Le
STATIC N TER LEVEL Below Top or Casing: le ET
Cr:)Pi)Fi'gsl!VU'IS,.i.•if Aboyc Top of Casing) —
FT. Above Lao Surface„
"Tap orterm matte atiur .nd su tea ci rcq uirts a _
a`carasacc with 1SA NC AC 2C .01 Is.
). Y[ELD Igont): Z.
METHOD ofrESTAa[ 5 —
�
U'
111 l'iUUaL)N.aMC (,-wq,
T
\FELL CONSRUCTION RL.COP.D
Nc:1n of - L pai mtcllr of rn
EnvInittcn[ and - r. i1 I'cSourCcS - Di4i>lOq Of Wow QUa1iry - (3 f0 URdlYarer $eutiOA
GLL 4\LI ;mil' r: (IN
1i L 2
Li COnl'.CI Ok Cuh1P.1w1' N&Odl r C@liTIF1CdTION N �'V
s /i/o// 71 ' /i
sr.-r: 1 i'[LL CONS mud; R''JON ? ilia
______ASSOCIATCD WQ PRIIMI U
(if ;pplic:.bi
PPl,�abl Box): P d I ErniuniuiAPP public E l I
uo
ndu5[r[vl 0 A'rrculnual 0
njcerion 0 O[nar 0 If Other, Liar Use
PHONR
Coumy rO'n !.
WO, Wr No., Zip cJilc)
1.TE,;zoNE� tacp(hj: 3
DISINFECTION: Type/a D--
- C �IlVu "^"�-- Amount
ii Dcprn
Froft,ne er
Em,n ro
From -co Fr.
:�. C'0LIT: Ccplh
marcnal
ream
Fa Fr.
I-, SCREEN. D,pm
^rom .r3
From
To Fr
I]. S-.NDJ0R:VELPACK:
Dtpol
r ro;r: ro
Front To.
F
°- Fr.
o REMARKS.
W'1111hiclatcas
or Wcighr/Ft. blarcrial
Sl1�l ,/G
Mcrnod
Diamcrr Slot Siac
Material
FL in.
In.
in. in.
S"-L bt,rrcrill
1 Da nELEEy CERTIFY rH;aT THIS WELL WAS CONSTRUCTED [N ACCORDANCE WITH I iVCAC?C, WELL
COiN3rRUCTION S'1' :iND.ARDS, .AND THAT D HAS BEEN COPY OF THIS RECORD N PROVIDED TO THE WELL OWNER.
Topographic/Land sewing
ORidge Gt' Iope OValley ❑]:lac
(check nppropriarc hoc)
Larindde/Iouginrde nlwell Iocarion
fir �7 r/r .
(degrecs;min,uljc"�'icCands)
Lalirudeilongirude source: fSGPSOTopographic mrlp
DEPTH DRILLING
box)
DRILLING L.00r
From To �"e-----
-- / FoTlation Dcseriprion
ZZ r' t
LOCATION SKETCH
Show direcrion and di,rance in miles from ar leas[
nao Stale Ronde or Counry Roads. Include the road
numbers and common road names.
4sheu-//e MC-
SIGNATURE OF PERSON CONSTRUCTING THE WELL
Suurnrt tnc arlvinpl ra lnc Divliwn at Warer Qu:tiiry, Groundwater Section, 1636 Mail Service
'.7o9 -logo Yhonc :Ya. E919) 733d::1, wicnin 30 days.
DATE
Center - Raleigh, NC:--'
GW-I REV.07/2031:<

WELL CONSTI UCT10N 1'.12COT'S>
Naan oGn' Oc2nrmmnr Of Enviramnrnr and rat R.esourscs - Division of Warcr
\\ ELL COA Cnor:. aNDIVIDU.AL) N1NU2 (prtar)
,ticLL Cunt It.Crol; COaid.anr n.-.Alla' r'�jG�jp/y1
ol �rn \YLL i �J
Ca.AsTtluCtiOrt &ERA 'n
309301
Quality - aroundwarcr Bowdon
CERTIFICATION ?taiga
• PHONE itkalla5k.74 /
ASSOCIATED WQ P .121y11Tt,
�i 'r.;rrlic:.Fld
I. 1\EiUSE iia,. 1 ._ppUzabl Box): Rcsidagrial
__ 1A a w 0 - oruy ❑ Heal' Pump \Valcr lnjscrioo spa Other
0 1 lne� List
Use0 .q, '
Oe4cr [] ]f Oilier, Lisr yuculn,ral 0
7. ;1 E1L LOCn9'I3N:
\:1ccs1 To v.n:.St.
Counry C+moo•+�
n.uu � wmuucrs, wunnaniry, Subai,49i01. Wr No., _Zip t; ooc)
O 11t; ER.
A-Nl1
a8;17 ar Ta
=pivac
Iiu abet
-. DATE DRILLED Y-25-04
FOT.A.L. DEPTH: 22r ---_
DOES 1\ ELL ILFLACE E\—WWELL? YES 0 NO
STATIC WATER LEVEL Below Top of Casing:
(Use "tr,ibovc Top or Cssin2)
S. TOP OF CASING IS FT
. Above `Top of a:nl; Icrmrri aver bclmr land tulrxct rcy ui'ress an9Cc'"
arian:c m areurpaam ,am I in .NCAC 2C.61In.
9 YIELD (�pnq: b METHOD OF TEST
I O. 1YnYER _ONES (dopm):
. DISINFECTION: TyptathiR �'
C-_SI!NG:-,"_"_"��— AmountS'- L—__
Th
tiVelll Thielmess
Pi. -pin
an Io
Diameter
Pt. G,/Li
Fr.
Ft.
or WcighriFI. Material
.2. CLKLILIT: Dtpni
Fr0111 Nlarcn9f
�'O fo-a ra__�ON! oFr.lio
nc FraTo _"
Fr.
SCREEN Papal
Frog➢
Fr.ym re
I?. SAND/GRAVEL P.xC
Pooch
Fro: 1`o
From
ID REMARKS.
Diameter Slot Sizc
Ft in. in
Ft in.
in.
sire
Fr._
Fr.
htoeerial
141gmnal
U- L�—
Topogr9hie Lund seri tag
ORidge slope ❑Valley ❑Flat
(cheats appropriate box)
Latitude/longitude of well location
.�sr •is SYt 37
'iiVf J7d' j
(acgrecs;mnutc�s conds)
Laontat/longitude source: FSGPS❑Topographic map
DEPTH (cheek bog)
DRILL _NGIo_r
From To Formation Description
LOCATION SKETCH
Show direcrion and distance in miles from sr last
two S[are Roads or County Roads. Tuclude the road
numbers and common road names.
tyto BA/fo2 e eL.,cC.
„9.,//1'A" i✓4-Aso -, N C
I Du HEREBY CERTIFY THATTHIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2'
L
CONSTRUCTION STAND kl DS AND THAT A COP( OF THIS RHAS BEEN PROVIDED
i ___-1�`� ,, •� RO\ IDED TO THE WELL OWNER'',
(f' "Zoo - 0
SIGN..ATUPvE OF PERSON CONSTRUCTING THE WELL
JSuumir the original m the Division of Water Qualir DATE
?o 9-1oao Phone! Y, Groundwater Section, lh'36 NI aA S'uviee Cnrr- Rulalyh N�
Pro (yt vl Division within r dual.
GW-I R.EV.07/j

309302
avCLI. CONSIIC.,1C.TtON rr.t:ntrra • YnonL ad8S a511-5'Wi(C.
.,S,OCI .T12D \vQ P2111,11'1•
Gr ‘rpllevblci
LISE •.node?PoL bid Box): P . 'a ,-/
�-T Asdcu ln,rpt C]
-'. "Ly,,.. LOB.* IUAi
No.r Tn, kr
3. DIVE i\EPA.=
mccs _o,nmunirv, Suboivuian, Lor NO., Zip Coac)
acct ar Rourc iV a)
Igo
R) or Tarzio .. ju —Jc
-cs to�c Iu.,u-uamou
DTTEDRILLED
3. POT.A.IDEPTH: U01-
o. ODES \\ ELL REPLACE EXISTING YES 0 NO -7
STATIC W.tTER LEVEL Below Top or'Casing: /Or7
AT.
S. OP OFF I Rosa "�r.y. L od Surface_
CASING I$ 7
tap cf r: tarn'ei aria Atour be FT. .''bo Above Land Surface'
..r:an-` cCaN'�ii.. bail 1' 1v lurid surf-s.c rcq ulr Cy
c�:V L'dC 2C .pLl 6.
YIELD t�rn) / 'METHOD OF r
6. WATER _ONES (atom): i?/ TEST
• DISIINFECTIoN: Typee a
-'. CASING:
"`-rdGl.L1CG Amount
Wall Thickness
D-p rb Diameter r_
or 4l cighG'FL Isla Carial
Fr. L.il,- 1 � w
WELL C.ONSTT UCTIO �-�
N 1.1.CO12D
.1'lln Cora tun - LcpruTicuc Of EflYlrnrnllenr anal rat huwyrecs - .
1 LLL aU\II 1C1 r ( LJBl1'IDU.L)Y.apip(p,-inq�ivof water QUcllirl'QrOtIRd1Y9[dr ��a
�tap�y� / section Jae)
1 Jlll .�1 JI Wbl P.tiY1 iY illl f j`J � l'C1iP1F1 CiT10n azJl y
.Rain D F04.3
r ro: rt_ To .�_ __ Fr.
r.man po
E.
3 JkOUT, Depot
i'rot77 a del -in
--Q� 1 a.a2_ Fr. Nl ee
I'ro ill- 'FL)
I-, SCREEN: De Ff.
Dept Dihoncrcr
hroill
l'J
Finn 1,_ Ff. in.
Fr. ill li. S_.N'Dl3R1VE m.
L PzCK:
rma:
From
o. !EIdARk3
D,pfh
1•a
To
Ft
Fr.
Nlctnon
Slur Sizc
itiltlrtr191
Size r4larn'ial
Vra.:ro:ah 0 R.a01c.11p tn491 roil icipa UPub Gc ❑
n' 0 Heat Pump \Voter ln)ccdon ❑ Ogrer ❑ It Orh�rsLiat ol OUse
Topographic/Land setting
ORidge Qftope OValle
yComa.n ) ❑Flst
Lafirude/longinlde of well location
(degrtcs;minulcy. serungs)
Lafinldeilongitude source: QGPSOTopographic mop
DBFTH lehcel: oux)
From DRILLING LOQ
To Formation Dascriprion
LOCATION SKETCH
Show direction and distance in miles from
ar ast
two State Roads or Counry Roads. Include rhe�road
numbers and common rood names.
£pi,''M qS
Mg, /v r
sa.
DO nEfcEBY CERTIFY THA.T THIS WELL WARS CONSTRUCTED IN ACCORDANCE WITH ISA NCAC _C
CO;V3TitliCl'IOivS'T+.ND.�hDs',.ANllTH.-�T.�CONI' ,�� OF THIS RECORD HAS BEEN PROVIDED WELL
TO THE WELL OWNER
SIGN..ATUR.E OF PERSON Service Canter- Ru
CONSTRUCTING + ` Q
SuJanr rna uriv final ra rnt Division a[ Wamr u 1 TING THE WELL
DATE-'7c E-!u.io PhoncrYo, aIg , Q •ality, GroundwIl ter
t- ) 733.3--1, within 30 daps. Section, 1636 Man lt, gy6p,
NC.
GW-1 REV. 07/200L

309303
\\-'ELL CONSTRUCTION RECORD
Plcrrn oL la Gcparmt;iu of Env ironmenr and run Rcso arced - Division of Waror iQualify - Groundwater SGC [iJR
11 ELL Ci3O tiliCia2Tut. IINU[V1DUaL) NAME (pral) {r 2{�(/ �1.
�r / 7111 .�-7c�f.�✓�• �+ �+ CCl TIF1CiTlOf•I l+�.'�--_t_=
�y e'LL �J�II -t ct! coiiP."NY lNsJIC rer jksowS /clef/ 7/ed./41 L6 • PxoNE MRS a5r-7 4
L L 4VIl.S1 auc ton rGAnt('1'F cuJ _. .As ocr _'rRn WQ P12h1era
III=nPlmublui
',EL USE' Applioablit Box): Raaidemial Q/1\iantcipaUPabllc 0 tndusrriut 0 Agrnctllrurul 0 isuiiarnig❑ Rczoyery 0 Hcai Pump 1A'atcr Injcctfou ❑ Oilier 0 It Other, List: Use
2. P,ELL LOCATION:
Nearest Torn:4 ern/it,'
ems^ tar.
Courny Aaines•.dt
N.rm. iVu iID;r , C3,n111unirv, Subci vni on, Lan NO., Zip Coac)
_. d1ANER:.
.Azar;;; la 7
l`smcrrRoomij
//PO .PI n/ C
an los,. Scala
161-'CO0 - 9,71a5?
-ie.i L,:o-:- el1311e Gull r
nATE DRILL En k /i- o`/
3 TOT.*L DEPTH: lcr
Cuaa
o. DOES 1\ ELL REPLACE EXISTING WELL') YES 0 NO (I"
ST <.TIC WA rER LEVEL Blow Top of Casing: S/J FT.
/ 1Ust"r'"it .Aboo Top arCamnjl
S. TOP OF CASING IS FT. Above Land Surface'^
Tap of :.::ury mrm lna rtu avur bcluw land eurract ray uirta a
c al aawrauuaa Walt IS t.NC _C '2C.0I le.
>. YIELD t>plm: Lti METHOD OF TEST Bbt i4M •K.3
J. \\ TER ZONES (depth): PO /,>'C J
Topograahic/Land scaing
❑Ridge C3S lope ❑Vslley ❑Flan
(check epproprials box)
Latitude/longmlde of well location/
ne 4/0rzcidel x/
Oegrces; minureslscconds)
Lari[udc/longitude source: O'PSDTopographic reap
(enact: box)
DEPTH DRILLING LOG
From To
.77
Formation Description
rl Se/,
— zos (-.,; fC
DISIiNFECTION• TypeCJQ
Amount
L2- LiSEN1/43- W3Ji Thielmas>
Dcpal Diameter or Wclghb
Fro: c_ _4J _
r men
F:om
3. L!ZOLITI
h f3 IL D
Front
SCREEN. Ocnm
Front T3
[5. S*R=.
ND,GVELP.ACK:
Deem
From 1'a Fr.
Fmm TO_ Fr.
I D..91EMARK3:
Diamcicr
Ft. in.
Fr in.
1'o S'2 ci 'Fr. haarcrial
F t. /zs' .r / ✓G
Fr.
Fr.
Depth tvl9[er:a1 hlernoa
1 D�� Ft. co t--- 442- ,r
SIDE Size
in.
in.
S"e blamriol
i\iutn ial
! Did HEREBY CERTIFY THATTHIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH OOA NCAC 2e, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
LOCATION SKETCH
Show direction and distance in miles from at least
nvo State Roads or County Roads. Include the road
numbers and common road names.
116CIh9S 22-.
( y�Llt'2 iYC p
SIGNATUURE OF PERSON CONSTRUCTINGTHE WELL
]ulaillrt in a rr;ntal to [Re Division of Wafer Qualify, Groundwater Section,
12o39-1o3o Poona I' o. (9E3) 733.3221, win in 30 days.
DATE
1.636 Mail Strviee Canner - Raleigh, NC:'
GW-I REV. 07/2to4-1.=
(

Flow
:s. JLOUT.
+.-i.'1LFEN.
Frond__
Mom
r'loin
Front
0. REMARKS.
:OT_--LDEP]H: -re DOES 11 ELL REPLACE E\�1VELL? YES 0 NO Cr
STATJC W.. TER LEVEL Below Top of Casing:
S. lUl'OF CASING
/ lU,z"-v '?bnvc Tula ur Cas,ng) -
rdp Of CA rcr a1:nxita iiror ['char hind suFT. `fxre rLyuidcSurhlte'" -
vorthdiec w a<co raxna, with lid NC C 2
%. YIELD (Rpm): 30 METHOD OF
Iu. 1r ATER COiNE.
S IDcp1h): �'Jp'
TEST
DISINFEC'TIOl'r'1'yp„
C-_S1fTC: Amount
1Y&11 Thmlmces
y.� L'.-prn - DiAFIl ter or &V
V 10 y7 Fr. ./If ����t�ez,, �his/Fc Pam,1u[�crul
dodo To Ft. r_.1L-
1b Fr.
Oeput marcrril
I o�0- n'Icowrl
To. his.
D:r.m
1'0
Po
EL PACK.
Li prll
P:
To
Diameter
Fc in.
Fr in.
F r.
Fr.
Slot' Size Illamrial
in.
Mincr:al
CCti'PIFIC• ;TIO
Lenrodc/longitude source
DEPTH
From To
0-C/2
it l uucrwry PCLf,I[Tn
.�aSOCtaTED WO e mnT,i
GZ;npne:l�I
))S2 USE !.:'_I t +,pp Gcabl; Boa): Resideniinl 4� 1uuiaipaL'Public ❑ I d
Ala o in 17 I nvcry ❑ Heal Pump 1Vatcr lujccd-n 0 n useinl 0 q,
Oilier ❑ ]f Other, List List
Agricultural q
ELL LOCATION:
,4.... cnunt>
,door, n.,, Yuaiocrs ,nnwniry, Subdivision. Lois rlo, "'
-�P Code)
011 i','ER.- --•-- .i�h �--te...
._= � d oc
iSpezt or
iv Ho)
cle..
sal= —'
I n„uc oumbcrr
-r DATE DRILLED
`e7- Or
309305
Topogi-- phic/Land Bening
ORidge DiSlope OVa11cy ❑Flat
(sheck,:ppropnem box)
Lurinlde/longintde of well location
kit Z7 Gorlyvyr us 177 ' :
(dcgrccs;minw�cs seconds)
PdOPSOTopographic map
(chee6 Dux)
DRILLING
Formation De$eriprion
54' % dodo._
LOCATION SKETCH ----
Show direction and distance in miles trout ar lease
Rau State Roads or County Roads. Include the ropd
numbers and common road names.
{�dcry 5 C2 k Pd.
sky /a44. NC
I DU riSREEY CERTIFY THAT THIS WELL WAS CONSTRUCTED 1N ACCORDANCE
CuivSTRUCTIOiv S'1'=,ivD.�P,DS, AND THAT ,A COPY OF THIS RECORD HAS BEEN PROVIDED
EDA O THE EW WELL
0
• •'ilj: ROVIDED TO 1YELL OWNER
SIGNATURE OF PERSON CONSTRUCTINGTH ATE -'flu/
Su0❑[n rh, urioinal ru rRc !Million or Water Qualify, E WELL DATE
2:u 9 !Dodo Phone y, Groundwater Seeriun, 1636 Mail Via. [phone], wirfin 30 days, ail Service Cznrar - Raleigh,
CW-1 REV.07/2001
WELL CONS'TRI CTION RECORD
N.;:rn ICI .i - LcparN[cnr of Envirotnnent and
rut Resources - Division of
i'- t; an D[r9 DUgl) N.aME r Water Quality - Oroundwatcr Scctiax
1prn,q r
\4LLL �J�\l'Ii-.c IJR Ctln1PnNY N-Luceni W
.14 • PHONE agaIIS a5 rk
dodo. 1tt LCu - `�.
�-o

DO n ERF5\' CERTIFY THAT THIS WELL I S CONSTRUCTION w RTIFVD.1R T WAS CONSTRUCTED IN ACCORD,
NCE`�SAJOTI0I STANDARDS,
AN AND THAT ,A COPY OF THIS 1'.ECEEN P WITH ED O THE 2LLL
0I'�D HAS HEEN PROVIDED TO WELL OWNER
-
1-1tL Lco Ns iwc-cron e 4lcnit Ts
..SSOCt TCD WO P 1 11TI
Gr>pplieublei
`.4t USE LCI- 1 ..ppl;cuble J3os): Residomial ,�/
\W t o nl I nj iou.+iaip: Other ❑ Iher serial 0
ovzn' ❑ Hear Pump 1Varcr ln)c4tiou ❑ Other 0 If Other, Lis[ USE_ Agricultural q
-. V.EL.L LOCx'FI- N:
N- :st To v.n:K./t-SiYs
CnuoiY �... ✓.
^mas. Lonmwmry, SubQiruimi. Lor rlo., Zip
t.oac,i
-. N7+ER.-_
11b'ararRoGeNor t2
' C c Ste/ 7
oumocr
DATE DRILLEDY "Or
3 FJT_. i DEPTH: Jyf
3. DOES 14ELL REPLACEELL? YES 0 NO 171/
SL*TIC WATER LEVEL Below Top of Casing: _F'T.
O. T��P OF C.>.S1Nu [S ome • T• i?.'bprc Top ofCsmn3)
"I'P+ era CA Icl'm mat FT. 'Above Land Surrbee-
A 5oor bclutr land aurtucc rcyuires
mnac m xco ru>ucc With I5A :VC _C
YIELD „ D OF T.
t;Ifnl: ---�_. METHOD OF TEST 1J.'i1'.-tTERZONES (dcpuQ:
DISINFECTION: Typea'(Q _
12. CASING.
Amount /�
O Dcprn
rro,n Po
icon) 1'o
:3 CROUT, Depiii
fro NIaerial
1 0-�_ F[. C01
From To
I�. SCREEN. Fr.-_ -
D:pn, Diameter Fwal Six size
T2�
From l'o F[.—_.in.
Fr
li. S?.:NLIC/RAVELPzCK: in.
in.
Depth' Size
:non: ---__To
Froni
REMARKS.
W411 l'Ji cl ncs5
Di:7meicr or WcighWFc bl1rclial
Fr, ./ZJ'
H.
WELL. CONSTRUC2T1ON 12EC012D
NGrrli lox - L cp:r1I11;wi Of Environnitnt and
rul Rcsow ccs Divi9ion of S1+ator Qualify -
[iELL l\1'h;�'LJGiLV❑I1'1DU aL)N.a
N 1./r.,__
hlG (Frio el [
' FLL CD.fit. cro[ iUh1P aI.N1'N.Vr11�
T2.1whay?,
Material
Mcnlon
DEPTH
FromlcTo
D—.
Midge
soling
'-ucidge ❑Slope OValley ❑Flay
(check nppropriatc box)
Lurirude/Iongimde of well location
c//
(dcgrecs;mmulycc seconds)
Lau[ude/longitude source; C3GPSOTopographie mop
(cheek pun)
DRILLING LOG
For{rration Description
Sce
LOC.?T10N SJ:ETCI 1
Show direcrion and distance in miles from ar Ica,[ wo Scare Roads or Counry Roads. luelude the road
numbers and common road names,
SIGNATURE' OF PERSON CONSTRUCT
MG THE WELL
Lio Phone ly) rirVda) ,Swwtnr rnaoriviial Et) lc Dlri1i0n or FYarer Qualify, Grawarer
S2cUon, 1i36Mail Service Czq[cr- RNCDHTE
GW-I REV.O7/20
309306
OroliRQwarer Scorion
CERTIFICATION it,,AP
1'HON I: Igiaitasrr unit..
Du_S[7 /frivi
Zeiget /ez /v .

WELL CONSTRUCTION
�L;rin olnl� - D p, rml,:nr or En ironmcnr and r al I' cso urCcs - Division of Water
\1dLL L1 LI ♦C'lul (tN➢IVIDU.il) N.apit jornin r QUalioj-af011ndlYd[ei T1ONn
6
LL u L -tom• /��t �� S CCI.TIF1CnTlq (y p�'__
41- On �Udlr'nIY1 N.u1IL'�I"ei�u/L�,$(J/✓j--�4Si°;-�LLKI
sT.-.rc v -L LL COA$r aucrIJN eernn'ra cJ• Pnona y�$� a5� y[ (�
.ASSOCL.4) UL WQ P1ZtUIIT
l il'.1 GVl,d1 nlc}
309309
',YELL LIS'_ °hoc& Apphaabld Box): Re;,ddn4al C niiutddp>UPublic ❑ Indtlyaial 0 Ag
Sro 1 0 in,: 0 1 pr.ry 0 Hear Pump A-V LLr 11-1jccuon ❑ Other 0 If Ortier, Lisr Usc_
PrELL LJCAI'!ON:
ii':_resi To Yr11: Ale•z,• Counry :.^ On Sq
/3, k 10 )1- tt 95
L--cm P.IOr.., :Yurlocri Co nmunlry, Sy bpivuion, W! NJ , 2ip (3,3ae) --
..ar,_,
�Irccl ar UerRou- No.) (U I h c
cm, ..11. Tr.rr II �wco -
S. QAS--L - pl 'riS
-_e fOdc- I'll,illc lionlOcr
-. D:;TEDR.I:LRn 1r-/1-o.1
MDT AL DEPTH S or — — Rs - s_-__ o
o DOES 1\ ELLREPLACE E� WELL? YES 0 NO 2...-- -'----------
STATIC !1 AiTER LEVEL blow Top of Casing: YD FT ------
--� Ntc..-r ir.iborc Top or Cmut_) -- [CT OF i'_ S1,iNC IS
FT Above Land Surface' ---
"1'Jp el Ilia IcrAn“ i ti 1 r bdotr l2 sutra [e requires u t.ruu-=m>crol'asn.c In, 1j�:YC C 2C.G]la'.--
r. YIELD r;pnq: FIETIjOD OF TEST �—
L11. 1Y.-TER ZONES rocpm)' fr--------
1 1 OISINFiCTIJti-T e
yP=tmounr Zr Aso
_ Wall Thicanc.43
Drprn Diameter or or W;VICp1. lst E 1:11
n Fo .t
` �� FL. LAC_ VILE_
r„:Po Fr.
MOW To Fr.
:3. CI:CUM Depth
n-serene! hl
cinoc
Fr
Frost, Po __•^
SCREEN. Ocprh Diamcrcr Sbr Silo
Fran ra FL hlamnal
I�r.iln Po Ill, in —
Ff In. ill.
D. S *.JND:(—RAVEL P.�CK
Dean' 3i=c
'Moo. no Pc Fr.
ProEil 1O -----
Fc
crlin4r41 0
,,,Topographic/Land seeing
Midge ❑31ope ❑Vail y Dan
(check nppropriam box)
Latitude/longinlde of wall location
/tl3r egt_ Z3f',-Pre 2?j Vert
(dcgrtcs(minuu�re�s cconds)
LauludwIongituda source: L-d'GPSDTopographic map
DEPTH lCucek bo.1)
DRILLING LOQ
0. REMARKS:
From To Fon-ru ion Description
7rs'"
LOCATION SKETCj
Show direction and distance in miles hole at Icasr
two State Roads or Counry Roads. Include the road
oumb;rs and common rood names.
reed 6.obkW•115
Lb 9 9
Du riEILEBT CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH ISA NCAC 2C, WELL
CONSTRUCTION STANDARDS AND THAT A COPY OF THIS F C01'i.D HAS BEEN PROVIDED TO THE WELL OWNER o�
SIGNATURE OF PERSON CONSTRUCT
NGTHE WELL DATE Sac nue Ltsi.ivinal ro [tic Diviiion of Warer Quality, Croundwarer Secriun, 1636 &sail Servie Cenrcr - Pvulel h
-19-1o.io Fhonc CYO. [phone], wirnin 30 days.
N4�
GW-1 P•EV, 07/20.04p

WELL CONSTRUCTION RECORD
nrrm rot la-G p,rlmcnr of Environncn[ and
rat
t'„aourccs k-Division of Varcr Qualiq - Oroun¢varar $cztimt1 LL CA LI'Cr3IVn1VIDU:1.) NAMR priop j N CERTIFICATION ^
/
sr-siriir
„ ns .ucrlon ear 11 •ff -__zssOCln`rtD w4 rrIlTi vF_L JV11 CTJe JhlP1N1 N1A1LS +BONS: x$d8a5
4,
tip-,oplieoblcl
\-EL.L. Ll3 i•Cliccic Apptaabl- Box): Psidoniial flwsLLn aLi
\IJ t a ,n' 0 I Ovary ❑ H•ar Pump \Nato 1n cction 0 P Puelie ❑ there Riul 0 gg[icn lcrral 0
1 Omer 0 ]i'Ocher, List Lisa
S. :ELL LOS:ATI Ni Topographic/Lund seaing
_
y
/s .__`___%1orr44•“no(c ORidge lafPe ❑ Valley 7FIarissssi n r NitillOcCS, wm,nuro 7,Subait,ion, List No., Zip Cod.)
i Usa ";'•ir m-c Top al Can �y FT.
Ab Ls I OP OFCASING' IS 7
FT.:Wbovc L SuSurface'TJp of it nrmmnrq hoar club' Lind ru rrs ez rey U antr es n r 1qp"ma"orasl:.. von: Ira V C _C 3C.0I l&
?. MELD METHOD OF TEST
TER _'ONES tdcpth): 0"),- ' r
Zfo'
•
DISINFECTION Type
AI"IIJLn!
(check oppropriura box)
Latitude/longitude of well location
ACKi- e e,,ei.-e, V' y• r
'
(ecgresm %rnurcvscconds)
Ladnldeilongitudz sourcb: O ?SOTopographic mil
,w,rl'o,.,, 'PTH (chcel. nu.�)
Zip C�oc From DP.ILLIOC,
�% µ G To
'_ :'i , t lltic OwTlocr Formanon Description
- . D.-,TDRILLED�'/� - c i TE DEPTH: yeacG- — l
A —Air —at"- fr
O. DJES ELL I'.EF'LACE EXISTING WELL? YES 0 NO ( '. STATIC WATER LEVEL BclowTop ofCasing:
-
309312
Wall Thichncss
LIsprn Diamcrcr or Wcigho'Ft. Aiercrial
rrou; 0 ToG I_Pr ./PT
ro,n rJ 3vyz/ _/�,� __
Fr.
Pi oin To Fr.
:3 i2i ROUT Dcpnr
blamnal
f�idn:__Ql 1 J &lemon
a_Q_ Fr. �y�iY re
Ft OM To O .-_�
I, SCREE I'f
N_ D.-prn Diameter Slo[ Size nIamrtof
From To Fr.
Picini ini TF
o pit n.
in
t'. S-.A'D vkiVEL PACK: CIn.
Dcprh
From - Fr 1[c Nticional
Frain To_
lo. he\1.�RiCS:
Fr.
DO nEREBY CERTIFY TH;tiTTHIS WELL WAS CONSTRUCTED IN ACCORDANCE
CDwSTlw, 'ION STANDARDS,
DS, .AND THAT A COPY OP THIS RECORD HAS BEENWITH PROVIDED TO D O THE WCAC 2WELLLL O
OIVNEP.
SIGNATURE OF PERSON CONSTRUCTING THE TO—Qy
Subaru tnc uri;inal CO rRa Division o[ Wdrer Qualir , �E WELL DATE
PnonclYo. 9 , Y Gro undwaler Section, 1636 Mail Service Canrzr-Baler h
l- I-) Division of
r thuy,.
B N�-'
GW-I REV. 07/2(4?
LOCATION SKETCT-I
Show iliracrion and disrdnce in miles from ar Icasi
[WO Stara Roads or County Roads. Include the road
numbers and common rood ❑times

\ \ EL c..c)NsrRi.icrioN
- ,2,2,2;uncnr I Ent n-onninn orrd ntuslinninnroet - Di F/44 1S14.1101- QW4111-Y Grotmthya[ty Sention
ent_ .2.ns i.non. rtnun Ino*Lo N.:nu] kyna ,et\yEy13)/1 fr/01-1:5 CERTIllaiTION
,L C—L, :Li< L:04Li L.ts N-a1te. ,Lcr_sk.s_Qp/_L Zjecii__2/eziliff . FrioNin vgagS ackLiZ44174,
2: s n22 .2.-nsirrnun'ttrtns ennstirry
.--Strundl'ED PURAir) /I
.11
. .122!: EptC)-. iC4(((acitli(4i carlini.,',p41.-Publi.:: Indlisnoni 0 \ :1141 iCI:JC!.:(1C, II LI r 'jot Lkrn_
„Si 2 t. I (JCL
P it 1"er 1:0141:0 I211,Q1,±LDC- TopogrriphielL;m4 seRing:
noiltry cbt_t A- ORidge 031ope OValley lar14(
(sheer: oppropriine aax)
Lafill/dc/ICaiglilide of wc11 toc-4fion
tic* f aiwnct 39i
_ _ L,Hrud,torigitudo source: elyifFISOTopogaptne wry
gas & 9 5 to& /
Lower:Du:0
OFF -pH DRILITN" _LOG
.:: 2.DrES Vi ELL REFIL.CE EXISTING W ELL? YES 0 NO lif---- - • STot_TIC 4 \ ATER LEVEL Below Top al Onsing: P.r.
(us:, ie.,..,, Tap orCapily,..)
S. I.S.DS OF C.sSINCi IS i_____ FT Above Lnitini Surincs'
;,.,-rniti.“,ta .1uur 0.1,./w houi iL(CNCL FcCILIICGS (1 k CUiaitCc Ili :1,.:(WQ-CiiC:, porn i 5;., NC:A C 2C .ui i S.
.A.IER 22INES ocprrt):
9 YIELD :-,prin. nib:91130D OF TEST
,13,bithaeyse__
309314
..4P Cud, brurn To Formarion Description
blAt
. t ATION SKETCH
DISINF EC Crt:Thr i'tipeaka4ces_ -..111014111. r2 C.',...al3 SILO‘v threCilun and distnnee in miles from or lesnr
LOC
Win linelniee3
urpen LW° Sutt RO:14. Or COU11151 Roads. ineltide the road
Dultriarr of 1/4„„,0,[1-7( id,,i numbers and
rnommon
troodFI4 6JA5 gceeaz. FC—il.1 MOOa,c3i_oac_ , nnmEestd
. .
2300
C&i-, 9.
s Loin ft Pi
A 1
t -, nt.lrioL Or Dcpdt Dinneter Slot Stze nun:Lira 1 J .1
F
--. - r3 Fr in
VI
s
Isnn I', FI 11 _ in
- -
I:: S',ND.1/4.31t.4.. % 'EL P -.OK_
, ,--
S,2c .il
Depm
rs:J
Fron To Fr
;
j .7 7:-
itOm To, Fr
r`
13
FS-MIA Ri9iS
!DO *SIZES Y CERTIFY rn:,.1. THIS WELL WAS CONSTRucrEc N ACCORD.APICE WITH 15A iNICAC 20, WELL
CtSitSra,0-1-,:m kaos., AND THAT *Copy OF THIS IZSCORD HAS BEEN PROVIDED TO THE WELL OWND.R.
S ON.-1 R.L3CYN C-0-1\15TRUCTING THE WELL
Suntan; Lae uri,i;lital CO Ma ph-li101i or W !frt. Quality, etruuntinnrer Scedurt, 1636 Mail SI'VieC CCIliCt
110;7- i030 Fii011C .)c) kt,19) 7.33.:f.:4 wirflin 30 tl4yS
G W-1 REv:+57/30 cn

309315
4Ytl COOL l'IC-..2I.11 C.IUfl\1FnNl NI. -LA 112 .S 1' to ?[L 11rL OOP, RUC'r10,Y 1•LRall1 it PHONE apl_ 725,tiVetiz
________________ASSOCIATED WO Z12T119"p �-r
ii :pplic,.bl.l
.. 'h ELL USE r`I I -ppnoublz Box) ke3 idea ial O
Sio1Lai in 0 I "1•,++r{pa Oth Gu ❑ Iheusrriul 0 ggricr,ln,ral Q
or�c0' ❑ Htar Pump Wntzr lnjcumn 0 Other 0 II Other, Lis[ Use
-. i',:E1.1_ L0C.ii'ION:
WELL CONSTtLJCTION RECORD
+ OCrn of 1 - G p rmi i Of Erni ironmcnc and
rat 1'c3:ouYuc3 1 Division pPH+p[Lr eUalir 1 fLL L\11 ."ro IhNUI\1DU a1)Vnn1R (pYu,p Y'�rollnlYlYA[dL ]'GCri011
L [ CERTIFICATION Jig&
To l;a4rl ly v w
01\ iNER.__.
ISn—tar Rout N.o
C 7oc7
�rr�f� 2�p 1'at
-�Z=.OJa I lun: uemocr
DATE DR LEn %' S _ py J�j !YQ
5 TOT,L DEPTI-1 Jyr i!/J 2
C. DOES WELL REPLACE L—WELL? YES 0 �/ —��—
STATIC W.*TER LEVEL Below Top of Casin,: NO_RT. "-----�.
.� rU "'}fO-c Top ofCzin2)-----�_
CDIl OF CASING IS
'Tap Jr r: fcrminalto uvu� la ulf5cc r;quiov +re uf11Lc"•
Ian :VC
"r'aa °=IIIa:°a''aailcc with .=.0 2C .U1
1a'. �-----
YIELD I pin : € METVOD r
\G;.TER :ZONES:ZONESucOF TEST ,t�',rrQ a�_,�
1 nth): ]Lr
Y
e
DISINFECTION 'Tut
LH.SI D
D;prn
Fr n D Po UJ
.ran Fo
r
:3_ .;RJUT: 0cplh
hioln To
i,. SCREEN_ D:pull
aIn Pa
F i:ull
t SAND: (31C*VEL P.ACK:
C',pm
f IJ.II I`i
From TO
!a IZ E i`,LARKS:
ab t _
Amount
FVall "I'hlclals3
Diarncr'.r or \elicigh[/Ft. P,latcl-ial
Ft.
Ft.
Ft.
rYlorcnzl
Fr. SON^ ee
Fr.
Diameter Slot S
Ft. in
Fr.__in
Mc plod
i2c �l atu ial
in
to.
Y11[cnq!
Topograa lie/Land setting
❑Ridge L7slope ❑Vaticy ❑Flan
(check appropriate box)
Latitude/longitude of wall location
A 'ei) i
(dewessmnm�tc�sr• coods)
Latitude/longitude source: !?GPSOTopogrephic map
DEPTH lchccic 6U,3)
DRILLING-1 O0
From To Formation Description
O - /Jr
LOCATION SKETCH '--------
Show clirecrion and distance in miles &onl at Ices[
fW0 Stare Roads or County Roads. Include the road
numbers and common road names."
(/, :nb by V,e-ea
IA) a -a e r d ,
/V C'
DC nEREBy CERTIFY THAT THIS WELDWAS CONSTRUCTED IN ACCORDANCE WITH t]A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND
AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL
OWNER
SIGNATURE OF PERSON CGNSTRUCT / -'25 - vI!
Suoallr rn. Zrigiuul to the Dlvlsian of Wa[ar - CONSTRUCTINGTHE WELL
DATE
+h'9-lo.lo Phone Ho. (yl f) on 733-j:. 30 days,
Quality, Caroundwa[er Section, 11i36 Mail Service Cznmr - Rul nigh, NO rrirain
GW-I REV.07/2001' '_0
1
en
re
t
:i'
r J
1
UN
c

309316
WELL CONSTRUCTION RECORD
+orm� rJl la Ec,. rm]cr]r or Env ironmeor and - Piisorccs- Division of Warm- Quality - Crounllwdrer Scedion
1 LLL 1V LI TOi (INDLYI DUAL) NAMLP (priao .�5 iu»,y'� l44)
�� //' r Rom.%! i v
`^-'r/�� S //�� CCI:TIF1CgTlpry
r ELL CJ11 .'l ore CUarFdNY NA,i 1E. fee son, e// 22r /(I jy Cs •
c../ PHONE Rags a5r� el/WILL 1, n L 4U1311 Uc'PIJ,Y FL1U1r1 ]'n
-1.. ASSOCIATED WQ PTi1L1119''R
r. `,\=I L USE ,_Chcole A ppl;eablt Box), Rcs,denrlel MuniniP L%PLIblio ❑ Indunnlal 0 al r LL ❑ 17caoncry ❑ Hc2i Pump \Farce lojcc ion ❑ +Oilier 0 If Other, Liar Use yncu lm ral 0
ELL LuCnl'I}-�N:
Ncpcsr Town: L,P,c. if Counry it"<o-n54
1c1Sc✓, G✓
,C„Ce , nu.rm :Voruocr, Gmniumry Sub4iYu1o11, Lai No„ Zip C uc)
Zis
crc ,e,c? , f/Au .a'
L— ccr a. Rour<ti )
<e•nesllet' ,mc S7V8
C:n arT:,Swr<
pCoo<
cacc- eIUric Ir wll Der
DATE
TOT.,.L
o DCE3 \FELL REPLACE EXISTING WELL? YES 0 NO q""
STATIC WATER LEVEL Blow Top or Casing: 6 J FT.
(pis "- "'i(Sbovc To or
P Csem8)
S. TOP OF CASINO IS FT Abo TJy' n
c Land Surlica•
fire>:nib rcrmpYariput Iland iueraricywres;4f,rcmaceroaewirtlid eCAC 2C.011a.
1�
Ei YIELD B
OD OF TEST t3pm7: _ METHOD
L4 1�. TER ZONES tcicpvh): / %i METES
rygirq
DISINFECTION Type
.3. CASINO':
Lrcprn - Diameter
. ro n:,_ `O, 1.0 /4r- Fc to
morn Po
Fc.
i•roin Po F.
`3. ":R`YLIT:/� Dcpllt MI'arcrlal
r' r,i, ll.._C.C__ I p_AO___ Fr. N /ei>_
i't01n 'Ed Fr.
Li. SCREEN. Dcrirll
F¢un Ta
FCaai ,pV
L). S*NDGRAVELPACK:
Di -pill
r rorn p,,
From To
!o. REMARKS:
Fr
Fr
Fr
Fr
Sae
/ L Amp u nc ( y(eS
'Vadl Threlmcss
or YVciglu/Fi.
fizeLI _ i�✓(-
3101 Si?c
in
Ill.
&Iarcridi
MICLllpri
V,✓NAC
Illarcrlal
DEPTH
From To
27 - /(cr3
/Li - /4Y
Topographic/Land serving
lita'idge ❑Slope ❑Valley ❑Flay
(check nppropriaro box)
Lavinlde/longinrde pP well location
p r elt�. il4r 1�7;�a a/D.Gfr'
Libre en minurts;sceonas)
Latitude/longitude source: 12/GPS❑Topographic neap
(chcul: box)
DRILTENNG LOC/.
Formation Description
LOCATION
Show clirecrion and durance in miles born ar lcasr
odo State Roads or Counry Roads. Include LhC road
numbers and common road names,
le)64/1/ ear /vi
I DO nEREBY CERTIFYTH.r,TTHIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
LurlsrRUCTtoN STANDARDS, .AND THAT A COPY OF THIS REC0M HAS BEEN PROVIDED TO THE WELL OWNER
SIGNATURE OF PERSON CONSTRUCTING THE WEL
]wblwL rn; orivinul to me 33.3221 of �Vucer Quality, (; ruundws[er Section, 1636 Mail Service Canter -Raleigh, NC
=Todd-lo.la P ionc rVo. tyl9) 733J331, rennin 70 days.
GW-1 REV.07/'_'001
7-2b-eV

Swm Zip Cuac
-_e :a.x-Pu,ac,iwTlOcr
�- D PE DRILLED 7— V
3. TOTAL DEPTH: e7,- Ws--
o. DOES \\ ELL REPLACE EXISTING WELL? YES 0 NO Er-
S"I'.,TIC \4TER LEVEL Below Top of Casing: 6 ca FT. �--
114t "T i1 ::bovc Top or Cas,ng)
S. TOP OF C.ASINid laFT..Above Land Surfacer
`rod of 1crrnmtea xaur bclu\r linil surrict icy a i itsriall:v
c m accura.ue-wirl, 15.i NCAC 2C.0i'le.
ATER ZONES lacpvh):
9. YIELD (;pnl): MET! -OD OF TEST BbJiyl3.(�Ar
ru. \P __'----
309318
Topographic/Land serving
0
❑Ridge lope ❑Valley ❑Flar
(check aPPmpriare bus)
Laritudc/longinrde of well location
(dcgrcarrnpupc cconds)
1 DISINFECTION Type
?.jI-N C i
Do -pin
Fro,n Fo�
om To
:�. OiROUT: Depth
WELL CONSTRUCTION RECORD
N --in ol, is Dcp imiciir of Env unnmmnc and ral I'ccowcres - Division of Waver Quality - aroundwarer Scedon
\\ ELL CC\11 ‘.'1UR (lti LIVIDU.AL) NAA{G jprinol (' / I 2 /46
[-.r(�J i./YC� S C61:TIFlCA.T10N x.Jl Tv
\4LLL LJ\11 IVI: J11F.1N1' NnA'1L'' ire%j/tiSl�.� /deO// /ID.'//,r /� . D p 74d
LS ✓V I L[5• FHONG {7o�,°i 175ir (Z i 11 L L �lJ'rl UC'l tON FLl<+lll1'R• AS30 CIA`rtD YVQ P
iir:PPGnbI=1
.. `,FELL L1SE v,Heel, a-pplioabic Box), P.e3idontiat p' Myplcl aUPublic 0 I dusrrial 0 Agricultural i1w,1Aartng O 14corcry 0 Hedi PumpAWater lnjccrion 0p Orher 0 IYOrher, List Use gueulmral ❑
7. ;SECS LOCAATION:
N:orcL Town' /Z .l county�a«-,%
r<„r.•t..� �es.s' 'l �,IY A'..oe-y�.t„.I.
Camawmry, Subairuion, Lot NO.,'_•
ip Coac)
3 3\\f 9R ?a.,v /rl'eder house
scc,or Ro.,,c iVa)r
e� 3a�5 2'
-cr��tttGS, �rnounr2/ TS,
Wall Thichncss
Diamercr Or WcightiFt. P-iocor al
Fr 4l2s' ✓c.
Ff.
Munro!
From 'Po
i,oal__Q_ po �12 Fr. N iJa p r
Fr.
F,C EFN ----
�c°rh Di mcl�er Slot Si c !!atrial
Fn'rI Fr.
in. in.
FL Fr. in.
I S. S?.il'D. In.
F ro.11,
From
Tai
1,o
EL PACK
Deem
Po_
To
Si2C llurn'ial
Fc.
Fr._
Latitude/longitude source: 2PSOTopographie map
(cheek bo.\)
DRILLING LOG
Fonnation Description
DEPTH
From To
O-6a
&2-e.7
LOCATION SKETCH
Show direcrion and distance in miles Irma at least
DNo Stare Roads or County Roads. Include the road
numbers and common road names.
,U' -eini e,, fin
Q e5
1
Mctnoct H� 11 . C461, 1-V IZ'E5 ?Cl
ems, /11 ,
I DO nEREBT CERTIFY THAT THIS WELL WAS CONSTRUCTED M ACCORDANCE WITH lSA NCAC 2C, WELL
CONSTRUCTION STANDARDS. A1ND:ARDS. .AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE - U�
DATE
Eu2311e in: ufl IJ14l ro the Division of Wafer Quality, Groundwater Section, 1636 Mail Service Center- Raleigh NC
?u '9-133o Phonc,Y3. i919) 733.3221, witnin 30 days.
GW-1 REV.07/?pill

309320
WELL CONSTRUCTION RECORD
:rnl C4E011411 • Dcp_rtmenr of Environmanr and rut Resources - Division of Waror Quulicy - Groundwater Scecion
11cLLrag LNrolri0U.u) N.+nti grins Ij/ t
�� %p/ /, �T�' 1 IYG S CCI:TIFIC?,T1UfV h� 146
1'LLL CLIrI .:IL)R U1ll•ANY Nv41C fer A_50NS h-eL/ //rjf,
_ �JJ �LI` YHONF t+aS)a1'S f�Y�
1\L L'J�l31l UCCLJN YLltl, (ITN
�ssocln•ran wQ Y I2At1Tn
(ir".;pclieubldl
\'ELL LISE 1Cncyc __pphcable Box): ILt3inennal Cile".A4unicipaLPublic ❑ Inctutrrial Lo:.:wr uh 0 I.cairery ❑ Hcat Pump \Viler lnjctLion 0 Other 0 lr'Orkiat- Lisr ❑c Ayricu lrurAl 0
Pi ELL LOC/ii i'Iy:N: p
Nea si Town:i.. -3„� County O.4C3.n4'
ts
/c.0"y. ses -or 4 co Lu.u<
:vuramcrs, Carmmn.ry, Su baivuion. 4or '10., Zip Coact
D\l\su
i ER» c Qp/ JYJ/N• 045•
-0 p
12.
L Saccr,:r Roust No
u, P01 Are t S173O
u Y r Toss:. Sum Zip L'aoc
12Q�20_ 7771• gv7V.P
J L,1JP tlioii� pump
-. D o,TF 11Kg r RN 7-zz -oc/
IDTAL DEPTH: Mr)' / n. DOES WELL REPLACE EXISTINGWELL? YES 0 NO L3
STzTIC W _TER LEVEL Below Top of Casing: 60 FT.
(List "r"'ir .A.bavc Top orCsa l )
S. TOP OF CASING IS FT above Land Surface*
`fop 01:_:my r°rmin ran our below 14nd su ri ce requires a
.armnao ma:curaanec lto lid :NCC 2C.blltl.
YIELD l pm): J METHOD OF TEST Bb,vai •K.3
1o.'r TE_R ZONES Ldcpth): 130' 3YJ' J
.. !DISINFECTION TyptC .R ' —'
- --Q_-_tip,_ Amount z:�
_ Wt111 ThicknessDcpm Diamc rcr or Wcigh.Ft. Material
r ro:n__Q_ I.: 5/V Fr. itILL1 lea/ ✓L
.1mat Io Fi.
To Ft.
i S. C ROUT: Dapin
tvla[criaf
FwnL__Q_'1•,—a __ Fl.—S' !' i0
:Stout Tn Fr.
i4. SCREEN: DcF.Ln Diameter
Front 'In Ft.
m
t'ro:n To Ar. in
15. S-.iVD:i3R=.VELPACK
:
Depth Sire M i:anal
final To Ft.
Front To
Fr.
!c. R117MWRKS:
Slot Sizc Renno ial
in
in.
Topogr9 hie/Land s<ning
❑Ridge D2rlope OVaticy ❑Flan
(enact nppropriarc boY.)
Latitude/longitude of well location
1�7+'T3 Trl'442b27W.7ty'
(dcgracsrminuicv Callas)
L lirude/longitude source: C3UPSOTopographic map
lineal bo:;)
From > To
clef
yj —</V sent/$fot
DEPTH DRILLINGLOG
Formation Description
KF�
LOCATION SKETCH
Show direction and distance in miles from at (cast
nao Stale Roads or County Roads. Include the road
numbers and common road names,
*pie 75Resw.�%�f�.
I DU nEREBY CERTIFYTHAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH l5A NCAC 2C, WELL
CLINSTRUCTIoN STANDARDS', =iND:ARDS', AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
SIGNATURE OF PERSON CONSTRUCTING THE WELL 7 _ > >
mac- Y
DATE
San011r CRe011(;inal cc me Division at Water Qualify, Groundwater Section, 1636 Mail Serviiie Gamer-Ruleigh,Ta�'e
37o'9.Io)o Fhone LV e. 1919) 733.3::1, witnin 30 days.
GW-I REV.O'R_Z+01
6
err

WELL CONSTRUCTION RECORD
Amrm C;roI .0 - Cepartnmut.o( Environm_or and - rat Resources - Division of Warer Quality - OrouniawaFer S
_LL ��]l,l c o U111'1Y1'l 11L' re r5asons Lve// Del/11N�Ct. PrlONP gaga6fl4/76.„
-��� uCPIJN FCKn u'rr. J .4SSOCL rgD W 1
a L11L L o�ll
Q I2Ati1Tn
if ; pplicohlc1
I. Yr ELL USE L�.haal: AppIaublc Box): l:e3iq=ntivl ❑<
6 wauonug 0 Rero,e 0 Hear Pump Water luccci In n0 pulOthert4 if Other,sLiar U❑so-��rtcuu"ralq
n' P 1
_. i;:ELL LOCATION:
Ncorcar'Cown:4-Wray./ County 40'016{
eca0n 2
11 ALL CO:S SIC1., ru P. ihvUll'l UUa1) N.antle (print) )1, �Is NG S x..i/40
11 r f CERTIFICATION
c.
IT. SCREEN: Dcpnt
From Pc.
Fran
U- S;-:NDrORAVEL PACK
Dcprn
Froca
oln To _
,--.n n.,nm :V„�n oc re Cammumry, SubJivui on, Wr no., Zip Coac,i
�" ,anal ar Ro t Na.t
(ivu.//— A't 3€8a6
d•; ,i; T4,n, Sic Zip Cuac
3a- /93
-.; t.; ;aac- Plant,,V ITIDGr
D?•TE DRILLED
3. COT AL DEPTH 301— � — / o. DOES \\DEL L REPLACE EXISTINGWELL? YES 0 NO 1.�
STATIC W.>:TER LEVEL Below Top of Casing: (cO ET.
j U;c "4" if .ADo ve Tup or Casing)
S TDP GE CASING IS._�_ FT '.hove Land Surface'
Coy al :.;any mrmmarta pour Gduw Lino su trace rcyuiras u
" c u:..caraanccy.irti I5A NCAC 2C .011e.
YIELD (;pm) Z U METHOD OF TJST BkaI1 •K1
I. \ .-'.TER'ONES acprn): /zu L�r 9
i!. DISINFLCTIOv:T'ypcCQ.RJ L Amount / dc$—'
.. AS1NC3: Wall Thiclmes3
L,pm Dianic rcr or WcighuF(. tvljtcrial
r(u V Cc_ tt_ F[. 6. ler SD
r rmn ---— �
To J'Fr
Fr00, fa_ Fr.
:i. 6kOUTDepth Nlprcfi I
tttifi a_-Tos20—FL N 1a
From Tu Fr..—_.—�_
Diamcrcr Slot S izc Vfan nil
F[in. in _
Frin. in.
FE
Fr
Sl'SL Material
309322
/�Topographic/Land seeing
f kidge ❑Slope ❑Valley ❑Fla[
(cheek,ipproprierc box)
Latitude/longintde of well location
Mr' tit ss Y'4'V z j2f.3fr
wegrec5/minutesy' seconCs)
Latitude/longitude source: PJGPSOTopographic reap
(cheek Dux)
DEPTH DRILLING 1
From To Formation Description
0' 4' �•.
Iol•da•
(.G - ?or
LOCATION SKETCH
Show direction and distance in miles from in least
(we State Roads or County Roods. lochlde the road
numbers and common road names.
CAoCrtIes/ .
FRWish; /" C
DD nEREE' CERTIFY II -TAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15ANCAC 2C, WELL
COiNSLRLICTI O-iN STANDARDS', .AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
(J)al l l.L h . 1-4 „ 4
SIGN-;TURE OF PERSON CONSTRUCTING THE WELL DATE
'DV
ATE
3uu our Tao „l ivinxl to um- Division or Warec Quality, Groundw;t tr Section, 1636 Mail Service Center - Raleigh, NC
7u149-103o Phone iyo. (F19) 733•0221, rrirfin 30 days.
CW-I REV. 07/2001

IP.:11,1.. CFI N cITIZAT C'T14.79) N RECOICD
- I I Cksill1cCii - ri:tia1 Of V1/ 41-Or QIiry - Cif01.111aWil Far ScCli011.
,INDIN DU
4aby Pti fr--(91-173
ccfatric.,,TIon ei.,20423
C..)Uf.• N I C Lieft 21e7.11,1>vi Co ?none. ag5 i-Etke„.
re-L:4)111a ASSLittitiAtt'ED NYQ C9C.C_1111171
i oplic
0 littatiJrrissl 0 .-Lgrictisinsrat
; 0 1-1,--:t1 Pump tittzt I nit:601i LJ 0Llithi El I List Use
poi\ e
cot., 1u1/^(004hs_
Gt/ FO"e 3 t
Ii,i,iy ScL,/iYiThJi) ,
n 4114 3141441
/Ili 2(1 NAC 82 3
5?9- p 73 ••.fkl:W 3
5-Do 1:4"42 t/•:ee.. • ko Re__,62 •
Li..7i.;cn LIG:aillt.1
0
EroJE P5 Et
it'itittE PE_ Ft
.3 1/4:::::.' au r 3,poi
c9e) P.
.,
.r.. coal f Li P.
1-; ',Cr< A9r•N t.);poi 01:1111Ct‘f
Fruil. Pc id
l )ExNI):a..3. \ • E L P AJTK.
t5:.-pol SliG 1.C191.41
FIC.,,A 13 Pc
I'Lrolii TO Fl
o
ihaliDcf
3 DATE L L. ED -7//4/0
IIDT.3.L.DEPILII VOS
:'XIIES \\EL REPLACE EXISTING WELL? YES 0 Ni
.5.1\LTT.2 .3.TER LEVEL &low Top of 0isto3:
Uic Abo‘ Tap ur04:.iiiti
I1/4-)PJE 031NGIS FT..-\bOYC L Suctitscilt
tip ot i,AMIllaf441Acor bcluIr 1:4111 3UrrAcc rcguirts
wittathic tit r.r.4111T1111 NC -ACC ts
3 \TELE S METHOD OE TEST 13 A) urpri-g.
1/4):i
,. -WATER iONEL3 LdcptrHi Rs'
309323
Idrographicitand seeing
- ‘idge EISIcspe LEIValley 0Flac
(arca .ipinopria(e baa.)
Latirode/longiruOt cif well location
fri 3s •Wr
td111 ctifCCS:111141CS'S COIltli)
LIIIIOJWIL)figill4dt 30111-2i±: eall)i Staropogaphic imp
tcloto: box)
DEPtH DRILLING LOCI
From To Forrnarion Description
0 — Sf Dint
sr - We __Poch -
Se — r 0 3 6-rapid s
LOCATION SKE'TC.211
01S:I\IFEOTICi\ .A.titOuilL /702 ShwWreefiOn and distance in miles 119011.1
Yid I ThidClcSi ONO SGil Roads or Counry Roads. laultJde LI14 itlad
or Wttsjirik ei.jaL;j1,,j numbers and Common rood names,
AthiA5 PVC 5kfl/ 4.st Pia
e5, 4,..ebleu.'111
.NC -
INT-311530
3131 Size Mali:11o]
in.
cud
ilLi ri&EEY CERTIFY THT THIS WELL WAS CONSIRLICFEL5 TN ACCORDANCE WITH 15A NCAC 20, WELL
CONSTRUCTION ST3.ND kfIDS .AND TEL\ T CDPII OF THIS II-ECC) RD HASBEEN PROVIDED TO THE WELL OWNER
S CYNW.
ILSQN CONSTRUCTING TELE WELL
D.W
.iknoio: Lac comii;oLor ro trI3 \-ision of Warts QUalily, G fUt111 dll r Scolith, 1636 Mail Ss -vise C3/4:111cf
2?oiY-10.10 PIM1c313 9111)735.-J221, wiatm 3u days
GW- I P‘EV. 37/200 I
TL

309324
JCASINO
WELL CONSTRUCTION 1'.ECOR1 >
iNc in C;ro La_ - Dcparmmur or Environment and cal Riesourees - Division of Water Quality - Groundtvarcr Sccrion
V1
/ I Q
ELL CC:AT'R:CtD1: itND1'1 tDU.aL) NAMQ �/ I �(print) v (r S CCiRTW1CAT1ON Q
LL: N11 "I'011 ui11F.iNl'N.-u1.1L- rerj/.(—Sonts /de`/ De4,'//i�� Co • THONG {gapsra5d l9yfj4
:FL 11 L L NSTI UUri3N PL 1kMtTR ASSOCLL'f L'•D WQ p jllr.119'Ii
fir '.r,plicobl.)
\ELL LISc [:;heck:Lppli.able Box): Rcsid=nhal L7 nihniuipaL%Public ❑ lnduyrrial 0 Agricultural
lwau°rrlh ❑ Recovery ❑ Hear PumpWatcr Lnjccrion ❑ Other ❑ JYOrher. List Use 0
-. sL•LL LJ2.,,1•)I0N:
N..rrc>l TJfleC CJrlmy XV", ,.-,4
%iC tens Alowjj
,__.:, N.mlc. :v„mo<r, Cml�nmmry' Subtli ruiun, Lot PILL, Zip Code)
01
1..„_R (11 2t
a6/kea
mm,0 d-
.� v �rSn:cl ar Ra��)
'ay uTa $rae Zip Cuac
Lek- er gb/o a
i.:ap ,l V:r10G'
DATE DRJLLEn
r0TAL. DEPTH: ie-r
O. DOES WELL REPLACE EXISTING WELL) YES 0 NO Fr
7. STATIC WATER LEVEL &low Top of Casing: .O- AFT.
I (U3e "r".ir.Areve Top of CaainS)
S. TOP OF CASING IS FT. Above Land Surr'ace* Tap Jre->::n [crmmuea aOur ['claw Ian4 ;u rrsa rev uirca a
c m a,aoruanac Wire 15..k NCAC 2C.0116.
. . r,an:
y. YIELD 4,e. METHOD OF TEST Bbrihrr .K.r
!u. 'A. A+TER ZONES (dc pta /0r ' - ale
,,/ ,,
Topographic:/Land seeing
DI -Ridge ❑Slope OVslley ❑Flat
(check appropriarr: Doi)
Lu[irude/longintde of well locatinn
Ad " JY,/Si-'i. 'is' Ozp'
(dcgrtes; m inutes�� coeds)
Latiludeilongitude soured: (7GPSOTopographic map
(check Dui)
DEPTH DRILLLNG LOG
From To Formation Description
6-er v <
s-Mr
t. 01SIIVFLC1ION: Typ:C_ QR ey ArnoUlll
Q Dcpn
toJ
ro:n ro
.3. CRDUT' Depth
/31.11 __ 0_-. T°_a.,z_
_'Coln
1-,. SCREEN. Depot
From Tei
rcom To
u. 9;.ND;vR,,,A'EL PACK:
Depth
FL oil
From To
D. RENIAFUTS'.
/2 far
4V:Ji Thjchna,
Diamcln Jr Wcighr/F(. Nlarcrral
Ft e. /a' Sven "L-'
FL
FL
marcrlat WlcrnOL
Fr. ref .
Er.
Diameter
Ft. in.
Fr in.
Ft.
Fr.
Six Size bl-ar.;rial
in
in.
Size r41a[crial
1 DO nEREBY CERTIFY THAT WELL WAS CONSTRUCTED EN ACCORDANCE WITH 15A NCAC 2C, WELL
COLLSTRLICTION STANDARDS, AND THAT,: COPY OF THfS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
r.
LOCATION SKETCH
Show direcrion and distance in miles from ar lead
two State Roads or County Roads. Include the road
numbers and common road names.
e ffao/ls
jWA-mS et ?Ci
SIGNATURE OF PERSON CONSTRUCTING THE WDATE ELL ��
SLDarit me orig ival CO the Di Isiah Of 1Va¢r �ualir re)
y,UroundwttrerSec[ion, 1o36NlailService Cmu<r-Balogh,NC~? IV
'load -Lome Phone 1Yo. (919) 7313221] Within 3U days. _
GW-I R.EV.07/_'0651 ' 8
O
a
cx'

0 ___ FcLSij__ FL4,a. 5 2/4 MS
15%),vi12
1?Ll_ Ci-1)N7•3-1 _NA CT IONRECoro
101111±4-iit
rq:,.M2 Lf3b bky
N.-a Q: fersian
2 „ L i‘o rt "
1/1) 01-f)
aiz 224416 'All c
- Di f Warcr QiJaliCy
OiL-II?I2 WO IflAiflj,
309325
Sca-..Liort
Cli.a171.NO,L:Pi3N
• Prl3N111. 2,3)§ ,D ii"-,ZVZr,
. Lulli. L ac.xL, Inausruca.
Pump tiLLL-Lmoil I:J 01-111 0 JiDIicr, Lui Lisc
Th... lc /In ti <GU c2wIIIyjucobr
N1
filihfr
... 1„..10a.1, SUb.411Palaa
9(421_7 et I 4..•-___CO
r. • 0_g_a0
r'" No)
Cw
--a: 0.111a‘l
*I :;_11-1_1-;
` fOT,L.DRT ffi
Art
."1173
LOOE. :1`, ELL PcSPLACE EXISTING WELL? YES 0
STATIC C:‘ LEVEL ENow Top 31'
"-r" i f "Do -I of
S. TOP OF CASING IS Fr Uoyc Lo4o Si.JCLICe'
'f4p iorrriLam‘a acur bctu‘r fali1411'01 a
ai'iat,:a a“Loraaaa:11.1111 ..11 IS
3 YIELD 'Jl:1 2. iEnic_)q -rEst.4bu41yg.)
,v.A. TER JONES LscpSH:
.-‘gricLeIrtiral ID
Topogr,L01.1..ks'Lniad sc aing
Likidg3 ar-linpc EIValicy OF1.-44
(ch‘cL.ippiopnalc
Ultirode/longialild nice I locLuLoit
•
icegrccsinipm scconcs)
issuruclevIcriginnic sources ellSOTopogr.lphic 1'114)
0lux!: DON/
DRILLING LOCI
Formacion Description
PTH
Erorn
To
0
S ^ .S
S -- YS
RoiC
LOCATION SKETCH
DISiNFECLELLOLN _ r;_linDulli. a oz.
show direction and distance III fro Lit ILt.ast
ThiLLNIci3
CL:iLtt 0:vo St::::4Lt Roads or counry Roods. include ilk road
f2pixrlitftr or nurnbcrs and common rood natueS.
FL
Ft
..) r:LOUT L;.;piii MaicriA I 61.71113.1.
rlOM
6C31,1-0__ F3_420__ Fi.a.ea—
Ts Ft roOpiln.) _
1
-:‘::CREPrq 03pni Disinctcr Slot Sizc italc
Crust: P[ in In.
Rs 31 in tn.
III. S ±.-i•I IA L.3 V EL P CK:
CL:pcil Sizc &Lath I.LI
IL;i: 13 Ft.
L,
r rum l3.. Fl —
1-13 S
3 1.1ELLA. RKS
,44ti-A471cA
/vr
A:h./04e
03 nEiEEy CLERTiFY THAT THIS \YELL WAS CONSTRUCTED IN A.CCORDANCE WITH ISA NCAC 2C, WELL
CONSTRUCTION STANDARDS' AND THAT A COPY OR THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
ON.A, ITtLL 0LZR:;ON CONSTRUCTING- THE WELL LL.T
JZI LILL t or \ Qu4liry, Gruanthisucr Sccrion, t636 Seryko Ceracr -1241eigh,
rllQllc -7? .
(&1:)) 733•:1221, iyanin 3 flys.NC 3
GW- REV. 07/2001:
r-1,3
1S2J

WELL CONSTRUCTION RECORD
Na nn ":v Loa - Gcpal-umnr-nf Env ironmcnr and iJ.; rul Resources - Division of .1arer C)uan n,- Groundwater S O •r.o
`16LL C3. 14CL 1. ,INUTAIDUnl) N&H6 (prim) r _ gag ry p
)4LLL �u Y1 "ICI CONIP+.,41'Nwnr rerGIk30,is //ere// »,e,/f,'yq C6 • YHUNE gags a57-574 F�
1. rL 1, L an i'l I ucrlo,Y PLl<Alrrn ASSOCLi`rEn WQ P 1UyiiT1/
309328
�% cc , n 22
` [live s CERTIPieNTION a. 4;0
`h ELL LGB ,, Oncck Applioable Box): Residential L7 hiuni:ipollPublic ❑ lntlusrrlal 0
.lrmmortI g O Rca .cry ❑ Hcor Pump Wdlcr injection ❑ Oilier 0 if Orher, Lisr Use
itbLL LOCATION: ��77
Ncaresn Town: CCcel/e- County 2.4e- -44
Ca ,cooteed tt, /1
,__.:. h.un:. :vurn uc rs, iam,nwr�Subdivuion, Lot PIo., hip Cuc)
- JIYNEr: et/ S / al(tm b
1Yc t(148
Zip Cu]c
C'C e7_„tle(wrc N )
0„I - Tsar„ JG¢
ta)- to 8"3 • -1 q 1
i.., ;J:Ic- PIIJIIS 0o nlbcr
D,TE DILL EL; 7-/d-ov
TOT & .DEPTH: 32 r
DC)ES V. REPLACE EXISTING WELL) YES 0 NO O'
STATIC WAFER LEVEL Below Top of Casing: Lo FT.
i Use `r" if .Above Top of Grimy)
grmulmral ❑
_-�Topographic/Land serving
Midge ❑Slope ❑Valley ❑Flat
(check approp,iarc box)
Luritude/longin,de of well location
Air° dr.6)O r/Or[°31.71-o'
(acgrccs minutc.csbennds)
Latitude/longitude source: GPSOTopograpbic map
(check Dux)
DEPTH DRILLING LOG
From To Formation Dcscriplion
/r7- jcz Siprlr/s<-ti
/±. _-22r --r.lt
3. TOP OF CASING IS / FT. Above Land Surtacc's
`Cup ar:a.'ny lu'murs lea avur talon, land surta c rcyuires
.ansu:c m a1:1:ur0 a ;watt lj.+. NC C 2C .01 IS.
9 YIELD I5Pn1i: / r METHOD OF TEST BbL1 4rgg •g r
lu.'iF-,TERR_ONESIdcprh): 2io' J .'
DISINFECTION TypeQ/o TL t IL ids., rimounl
CASING.
Wall Th iehriesi
D=prn - Diameter or WclghuF. Material
FchILC
r3,11 Po FL.
From To Fr.
3. GROUT- De Ih
p Maternal
1'0_a12_ Plaa
110111 To Ft
I+. SCI_=EN. Dcpcn Di0mricr i
Slof ll?c bi'lalcl lal
From 1'o Fr.
n. n
Frou. To Ftin in.
—
u. Sr-NDrGRANEL YACF:.
l?cpil-' Yla[crml
F10g1 1'b Fr,
From To Fr.
bic `noel
13 REMARKS:
5i'c
I DO nbkEB' CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH ISA NCAC 2C, WELL
CONSTRUCTION STANDARDS, .AND THAT COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWHER3:.
SIGNATUREOF PERSON CONSTRUCTING THE WELL 7 T _btJ
DATE
LOCATION SKETCH
Show direcrion and distance in miles from at ]cast
(wo State Roads or Couory Roads. Liclude the road
numbers and common road names.
Did [e.`c es -Lc/ Hw
Le Fee, N(.."•
uG moor Lhc urivinal CO the llivision oL\Varer Quality, Groundwater Section,
17o9)-10 io Phone NO. IyIY) 733-3221, trithill 30 days.
1636 Mail
Service Cenrcr - Raleigh, NCIIH
GW-I REV.07/2lii)3-'

WELL CONSTR. U CTlON RECORD
I mein L wl r DcpenTheur ar Environmcnl and rat. Resources - Division of Water Qualify -
1 SLL ddm t IOC 'r3 t. ‘pi-intl .w./ (/
1' 'LLCO111 `IV1:COMPANY N�.TIEf'rG/LSevyS bIt✓{/ De/Viet), -
l .1 L li C.P.L. CON,PTIUr: rtON ant rs11Ta
ASSDC[a'1'CD WQ PiERs ITH
air cpplic:.bld,
309336
arow-111m cr Section
CCP:rifle:CsQ N ;,3 Rib
PPIONG iRaIl a5kr-s" Lg&
I. E)L. USE ri7natic Applicable Box): Pasidanrial l AlunicipaL%Public ❑ 'lndusrrial ❑ Agricultural 0
iAw,tuo,,,1 ❑ Rc2o1-cry 0 Heat Pump AValet lnjctcion 0 Other 0 3I.Orhar, Lisc Use
_. -„ELL LOCATION:
N ,src$ Town' Celcta h- County .8r, v..$
,--._, P.m:, :N„nucr,, Cantu unary, S ubairuian, Loi lo., Zip Cadc)
- C\11oER. marry rheaelo.os
r._> two 'Sex 1B�C�
/ tSa:cr ar Ractc Ni)
l cie•ester,Nc a87vk
'd) a. To S.nc Zip Guile
(oq 3- a 34/
aVmDGI�7
DA/TF DRJ En -/•-ot/
5. FDT.*L. DEPTH: 34/r-
o. DOES WELL REPLACE EXISTING WELL? YES 0 NO (�
3T.+.TIC \V ;:12 R LEVEL Below Top or Casing: ro FT.
t U;c "t "ir .Aba-c Top oe C:umsl
S. COP OF CASThu is t FT. Above Land Sun'ace^
`Tap Icrmwe eta Amur bclule lAn4 su riyec r;q uirts a
. l-aum m awuraApee trite I$ .:VC..0 2C.ulld.
YIELD tion0: '/ NETHOD OF TE
T Bj,rui;,rgJ.KitJ
IQ. W. T_QZONES tocptn): /
II
.-. C LLNu:
DI31NFECTION Type( Iot2.p.c,
Dcpte - Diameter
Fro❑., D Co /VC Fr.4,/2r
rr.;,r . re, FL.
::roan To Ft.
.3 .;ROUT: Dzplh mlarcnal
Floln 0 "fa a0 Ft. CO/YCEGA
P10IIl 'FL) Ft.
I+SCREEN. Dcprli Diameter
From To Fr. in
Fc,m l'o Fr. in
I ]. S ^.N'D/3&. V EL 1'.ACK:
Depth Si,c tilarn'ial
?Jodi Po Fr.
Front To Fr.
Amount it Let
\Val l'I'hlcicncse
or NlzighUFr. Prlaterial
2I Pic
lvlcrnod
Pthatitif
Slot Si2c Material
in.
in.
0 1' F! l ti
Topograjphic/Land seeing
ORidge 2Iope ❑Valley ❑Flat
(chccL,ippropriart hox)
Lurirude/longitude of well location
par •/'. qh J' -oyC ch. /rt'
(deacesrm in utcascconds)
Lalimdeilongimde source,: 2I6PSOTopographic map
(ellcel box)
DRILLING LOCr
Formation Description
D: t
DEPTH
From To
0
/Vfl•/'Ir stitA
-Jyr
LOCATION SKETCH
Show direcrion and distance in miles from au least
two State Roads or County Roads. Include the road
numbers and common road names.
Lco0ydAl Ff 4
'En
hil I$ONljN �L
LACee -i-e♦ NC
I DO HEREBY CERTIFY THA.TTHIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH L5A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
•Zeti:, 1c iJ4;t,, ,/- Gy
SIGNATURE OF PERSON CONSTRUCTINGTHE WELL DATE
.Suctim Lnz urivinai to the Division or Warer Qualify, Groundwater Section, 1636 Mail Service Caner - Raleigh, NC
1?a99-163o ein nc Clo. [phone], rvirnin 30 days, mT
GW-I REV, O?/_200IS
a
01

WELL CONS'TRIJCT1ON RECORD
309330
r+-rin oli r ,cpsruncrlr or. Environmcn[ and - rat Rcsowccs - Division of Waror Quplity - Oroundwarcr Scccion
VA LLL COA1 loft (LNUTA'IDUat) NAME (prim) r / /' r 2 (/60
P r �� �,p � �l (.%(�J i �G S /' CERTIFICATION trt.Y.J�yI TGJ
\4 ELT_ C ,r L J 3 t cU\1r.- V NA.O1 E. rerj 3c/✓4 Zileel 7)P ///N4 CJ . PHONE t`xax a56 6 4 E%
.ASSOCL4'l'ED WQ Rhll']b
r if ;pp he�blc1
L-12w OINSTRUOILON F EL/luau
In,ELL USE 'Ilea. -ppl'oabic Box): Residertioi DitivitsiipuLiPtiblie ❑ lndusrrial q Agcieillnrral ❑ Moniisilio. ❑ Rc.overy 0 Hcar Purnp W—. to Injection 0 Cabo- 0 ll Other, Lisc Use
-. A; S1.L LJCATION:
NcarciL Town' it,YPo/CiJ
ta
IN.:p,;, :Norrloca, COmmumry, Subui nsion. L.ot PIJ., Zip l:Jdc)
O,;NER- Steve- iSlora.,-.h r �
3/7__-li.dcr
t c .,I O�[c No.)
�n r i
Le: /11-C
�Cd) ur -Iowa $= SHi �g3- aig(
lei ass,- I'Itane OwilDcr
D..TE Dk1LLEn 7-/L -oq
>. TOTAL DEPTH: air /
DJES 11 ELL REPLACE EXISTING WELL') YES ❑ NO L
STATIC W+;TER LEVEL Below Top of Casing: C/D FT.
/ " "'it.Rbovc Top or Casing)
S. TOP OF C,AS1N'u IS FT jAbove Land Sunuce,
tcl'nll➢a[Gd aQur bclulr hind hit -lace rcirll ires'v
"' rculiaCaI'aIIQ Ivira r5A:NCAC 2C.0116.
9. YIELD l>Pm1: i\IETHOD OF TEST Bbw4 q•K,r
IQ, ',RATERZONES Idcpth): )n7 ,,1 .'
Cann r)' 4.1 C:, net_
Zip Cuuc
I. DISINFECTION • TypeC'/D ;vim
.—_-_ :Amount l�. %<SF
.=. C 3IN u.- Weil Thickness
DiamtIdr or Wcighr/Ei. Paarcriu(
LtL SOKzr /'✓t_
irrpth
rmni ro Ft.
hiJa) To Fr.
3. OROUT• otplh Maccnat
rruln_,Q__'1'c_aQ_ Fr.C'OiYCRee r
FORD TJ Er.
I+. SCREEN. Dcptn Dlamcrer
Foam Ti Fr in.
Foam ru PI. in.
D. SAND:3R-.VEL P.*CK:
Oeprlt Silt Marcrial
From. ro Fr.
From To- Fr.
Mcleod
SIX Si2c hlarcrial
in.
in.
! o. GEMARj(S:
I Du NEREEY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH OANCAC 2C, WELL
CONSTRUCTION STAiND:4120S, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER,.
Z- o..v"
SIGNATURE OF PERSON CONSTRUCTINGTHE WELL DATTEE 0/
Suomic tree urlginal w tad. Division of Water Quality, (; ro undwaler Sec[iun, 771636 Mull SuWee Center - RaleigA, Ni3?-�,
o99-Lo3o Phone No. I919) 733-3221, 30 days.
rrirnin
GW-I REV.O-2/2n
Topogrnylue/Land sening
❑Ridge OValley ❑Flat
(check nppmpriare box)
Lari[ude/longinude of well Iocarion
iJ.3 ° 3Y.7)'4' wVrt-21. 7-dt/
(Je rceilminuies�n contls)
Latitude/longitude source: Ia'GPSOTopographic reap
Ichccl: DUX)
DEPTH DRILLING LOG
From To Formation Deserip[ion
D- a / F
ry_
YS - z,/r- 6 xi
S..
LOCATION SKETCH
Show direction and distance in miles from a[ leas[
cw'o Stare Roads or County Roads. Include the road
numbers and common road names.
Slasje_1(.1L9-1ve-A(%/ -

309338
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources Division of Water
r
WELL CONTRACTOR (INDIVIDUAL) NAME (print) Qo �6Y u t PC 1
/ t
WELL CONTRACTOR COMPANY NAME Fr DoSentir Wel( Q%VtlIbt�
STATE WELL CONSTRUCTION PERMIT# �% ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
ualiry - Groundwater Section
S CERTIFICATION #20aa
Co, PHONE Oh7I68r?
1. WELL USE (Check Applicable Box): Residential [71 MunicipaVPublic ❑ Industrial ❑ Agricultural 0
Monitoring O. Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2, WELL LOCATION:
Nearest Town: fit ltA
u/hl`fc 4An PATAN 41,
en County ktril6AM ie
(Sweet Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: Taff—'. S.�f��
.Address f.0 O/C
(Street or Route No.)
A5Aau.We /vC A88 /Cf
City or Town State
ASz-9og9
Zip Code
Area code- Phone number
4. DATE DRILLED riftiOy
5. TOTAL DEPTH: / OS
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO Cd
7. ST.ATIC WATER LEVEL Below Top of Casing: VO 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): 30 METHOD OF TESTIYou y/.Cl)
10. WATER ZONES (depth): .ZSS
11. DISINFECTION: Type labAmount
12. CASING:
Depth
From o To SO Ft.
From To Fr.
From To Ft.
13. GROUT: Depth
Fromi To A Q Ft.
From To Ft.
14. SCREEN: Depth Diameter
From To Ft. in.
From To Ft. in.
15. SAND/GRAVEL PACK:
Depth Size
From To - Ft.
From To Ft.
Diameter
G d5
Topogra ithie/Land setting
❑Ridge BSTope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
A/3S'LS.75"/' a/Oaz•22;sue
(degrees/minut she ►nds)
Latitude/longitude source: attsCITopographic map
(check box)
DRILLING LOG
Formation Description
0/1A
)Cock
6.rt4n/I if
DEPTH
From To
0-45
Ys— Sn
KO ^YO5
LOCATION SKETCH
//02 Show direction and distance in miles from at least
Wall Thickness two State Roads or Counry Roads. Include the road
or Weight/Ft. Material numbers and common road na es.
XL I13 PVC SOP -Al
Material Method
eortu.t *r PoorPKj
Slot Size Material
in.
in.
Material
Wh :-/-e Oa A Y/, WlA'%1'n '
fckI 4Rr ✓C
l6. REMARKS:
1 DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH ISA NCAC 2C, WELL = -. .
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNE!}E a .,
n, G T:
ro •
Submit the original to the Division of Water Quality, Groundwater Section,
27699-1636 Phone No. [phone], within 30 days.
GW-1 REV.07/2$01
1636 Mail Service Center - Raleiglp3Ye
,.J
re

WELL. CONSTRUCTION 121;_'CORD
N 401 L of 1a DOPolOTIZ111 or Environment and rul Resources -' /Divis/ion/'Qf Waror Qualicy - Oroundwarer Section ^q�^� //
1 LILL Cu N1 RACroa (INDN'3DUa1)INAME (prmr) ( / 7. /.LJ, e.S /' CERTIFICATION s./141)
BILL CON -1R,J I'Ol ODPIleANV Ni,Ill erjLcso,sI s /del/ 7pi J4> L6 • PHONR attn 05 i iet,
„_ .ASSOCIATED WQ PtRA41T„
ii :pplic':,blc)
11 LLl co Na I RucrIJN YLl>stll,]
309339
ELL L:SE iCnedk Appli. blc Box): Rcaidenual 13 N'luni::ipa L'Public q Indusrriul 0 Agricultural ❑
bwauarno, D. Rcaorery ❑ Hear Pump Water lnjcccion 0 OncCr 0 if Other, List Use
_. 1`r EL.L i.CCAI'I/J�N:
Courny/folio.. It
P.•ley fit
,--cc,. Nom:.;vum ous, Community, Subui vmion Lir Plo., Zip Coac)
•
3\\NER- .bb1N ?air?7s
:....,. 1 erg //lilgni% Ciei/o
(So cast Rovrc Na.)
„4-s6ev//e NC . S70.
GI)- ar Te,m Slalc
$22 - a5 a- 751 •2
D::sac- P1ljllc IiwTl Dcr
TED-ICI LED C-tJ-0'i
3 TOTAL DEPTH: rot
o. DOES WELL REFLACEEXISTING WELL) YES 0 NO le —
STATIC WATER LEVEL Below Top of Casing: /03 FT.
I (We Y'iLAbove Tap of Casm3)
S. TOP OF C.=.SING IS ET. Above Land Surface'
' Cap dr:dun; mrmunr.d auur below )and su rr5ce requires v '
a na n:e m.:eoraauce Willi 15A. :NCAC 2C .01 l s.
i. YIELD (_pml: 2• METHOD OF TEST BbW4iJ �'K1
ti1-+TEP. _ONE.i (dcpN): 'd—
Zip Cuac
I. DISINFECTION: Type(/oaatjvc
CnSfiNLT
D.pin
''ton', To 21 El.
wa'. co F.
ri-om To Ft.
:3..ROUT: Depth mlarcnal
R:duti_--, , To 410 Fr. C.C/YeSeile.
11.0111 To FL
I-. SCREEN: Dcpnt Diamctcr Slor Sizc iblurcrial
From 'Po Fr.
F(;lm To Fr in. in.
I . 3AND/ 3RAVEL PACK.
Depol Size M1rcn11
Fran'. 13
:.mount
/6 Ali
Will Thickness
Diameter or We igIhrFr. iv rcrial
G./ tr. ii'Q i vC,
Men -oil
/Pou..iy
o REMARKS:
41, m.
Pr.
To F.
Midge
sening
L�SRidge ❑Slope ❑Vs11cy ❑Flat
(check ,Ippropriarc box)
Latitude/louginide of well location
1o.4,f21 vow'
(ieviceerminul�c' conds)
Lalitudeilongirude source: CliGPSOTopographic map
(check box)
DRILLING LOCI
Formation Description
v.-_ fr
DEPTH
From To
b- 2i
ZZ—L
277 C°r
LOCATION SKETCH
Show direcrion and distance in miles from at (cast
two State Roads or County Roads. Include the road
numbers and common road names.
3A; /e 1e,•dse Pd.
C..flAct kC •
I DO HEREBY CERTIFY THAT THIS \YELL WAS CONSTRUCTED 1N ACCORDANCE WITH 1.5ANCAC 2C, WELL
CONSTRUCTION STANDARDS', .AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER T?
7 z
d-0!
SIONATIJ1RI OF PERSON CONSTRUCTING THE WELL DATE
Sunm;1 rn: original to the Division of Water Quality, r L y, Ciro S'eeriun, 1ti361V1ai1 Sarvica Center- Raleigh, NO
l7o99-lo3D Phone :11). (9I9) 733.3221, yriroin 30 days. i w
GW-I REV. 07/200FE;;

Fina:
From
COm To_
13. JROLIT: Deem
t1"aal___KL To a 0
From Tu
1-i SCREEN. D.prn Diameter
From T3 F. in.
t'i cnn It.) Ff in.
15. S..ND,3R:VEL P.ACIti:
Donn Sloe
Isom ra Fr
From To_ Fr.
WELL CONSTRUCTION RECORD
dorm id; ronia - Dcpernweric ai Env ironmcn r and - "rat Rcsour os - Division of Waver Qualiry - Oroundwarcr SCCrion
`d ELL Cu:\T ft CrD illvUl\'IUU.al) N.{hlE (prinq idea A lr Vie._ /' CERTIFICATION mr,Jrl/iqb
\\ALL ctpm.I.,ca-ot CU�1MF:NY NIA.INE"ferj&.SO#V$ rde// Die/ //f/YG� CS. Fungi ,sagI aSE d�j
51::1'C li CLL CuII TItuCTION eirnhll'1'a
�_.. .I.:,cl:)
309340
ASSOCIATED WQ P-ERMIT,t
Spp6eub lam)
YELL USE Rees: tepphaable Box): Rea igcminl G�niu„L:ipa L'P ublie ❑ lndu9rrial 0 Agrieulnual 0
\wiYhornny 0 Rcaoeery 0 Hear Purnp Water injection 0 Oilier 0 It Other, List Use
-. V,OIL LOCATION:
N.xc>I T3wiv le; 4-e - CJulit Hen (an iL
�i,.V /' L: ws .1� k /' /fin pd
Com.uun' , Subai vuim\ Lot No., Zip CJacj
o \?,ER- .7 a.t owA-/..k
- 4,..._C s y#tad°a�recC/C.
1vmcl or Rot cc Ya)
Rshco,We 4C' d8ao &
c.p-ar Taw, Seta Zip Caao
t2L;- yp.l - 9Cite 9
- :� it]JC I'ncn4 lLymOC(
D-.TE D;:1L LED -26-0q
FOT>.L DEPTH: 78
Topographic/Land setting
Midge ❑Slope OValky OFlar
(check appmpriarb box)
Lutirudellonginrde of well location
PJr3Y.1Cc'V0 tot/L.7P+i'
(dcgrecaminuresmcoonds)
Latitude/longitude source: 3 PSOTopographic map
(cheek bo\)
DRILLING TOG
Formation Description
/Lr_ t
/La-/X r Z«/ter
DEPTH
From To
- /61
6. DOES \\ ELL ('REPLACE EXISTING WELL'? YES 0 NO L�J
STATIC WATER LEVEL Below Top of Casing: /60 FT.
(Nit -r"'it .Above Top ue Caalnyl
TOP OF CASING IS FT. Above Land Surface'''.
• Wp or )vur bclu,r land surface rag dims a
anao:e m accuraaua wily 15A NCAC 2C.0116-
9. YIELD l,pm): / h'IETHOD OF TEST BbWipq •K1.3
id. WATER -'_ONES \atom): t2� , J
1. DISINFECTION: TypeCJQ c. Amount 22.344.1
-- ` 3fN3 Walt Thickness
Dcprn - Demeter or WeighuFr. Material
'Co N. Fr�,[C_ SAZC/ P✓c
To Fc
Fr.
nlarcrnl lvtcmod
Fr. CO,fl 0
Pr
Sior Si2G Illarenal
in.
ill
Material
LOCATION SKETCH
Show direction and distance in miles from at least
[WO Stale Roads or County Roads. de the road
numbers and common road names.
bb:i-NRL
L,•tclei, _.4<
D1 n ERB'S CERTIFYTHAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH Li A. NCAC 2C, WELL i„r
CONSTRUCTION STANDARDS', .AND THAT ,A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER!F._ ' m
31 GN.A.TUR OF PERSON CONSTRUCTING THE WELL �o ABch --.
' DATTEE rr c!
Sil Mint [I:Oivinyl to the Division or Water Quality, Groundwater Section, 1636 Mail Service Cenrer - Raicigh, NC AlI ,
'?u 9-Lo3o Phone1Ap. t9U) 733.3221, within 30 days.
GW-I R.EV.09/20 `S°',
:'mod VI

o))
307642
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resourc - Division of Water Quality - Groundwater Sectiinn�,
(print 2 CERTIFICATION �pjOyc`�G✓�
/J Ili M. PRONE 0 MI �0 Dc 1,223
WELL CONTRACTOR (INDIVIDUAL) NAM
WELL CONTRACTOR COMPANY NAME
STATE WELL CONSTRUCTION PERMIT/
(if applicable)
ASSOCIATED WQ PE
(if applicable)
1. WELL USE (Check Applicable Box): Residentially Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection ❑ Other 0 If Other, List Use
2. WELL LOCATI N:
Nearest Town eieLk Coun
t(O OIDn CtLo�c/J5%i �K�(y�
3. OWNERi .(''YK( J(y � G
/Add�reesss I(O 01tO�1gt kt9 ?di Ojai?s.
VlAlt-le C N)
AA
(Street Name, Number, Commmi , Subdivision, Lot No., Zip Code)
City or Town State Zip Code
(—)-
Area code- Phone number ..gy�pp
4. DATE DRILLED ba7 A7- 07"
5. TOTAL DEPTH: aa.' /
6. DOES WELL REPLACE EXISTING WELL? YE ❑ NO TE
7. STATIC WATER LEVEL Below Top of Casing: FT
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS / FT. Above Land Surface'
`Top of casing terminated at/or below land surface regatta a
variance in accordance with 15A NCAC 2C.611S.
Topoghic/Land setting
❑Ridge Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map( <'
(check box)
DEPTH DRILLING LOG
From To Formation Description
9. YIELD (gpm): j 0 METHOD OF TA C'
10. WATER ZONES (depth): / 2 d , (a u
11. DISINFECTION: Type—TireiThount
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft
From To test' Ft
From To Ft.
From To FL
13. GROUT: Depth
From To
Feat
From To Ft
14. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in.
From To Ft in. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
Material numbers and common road names.
16. REMARKS:
43/4)7 In
&ttOy Ebrc roe
O/D d-eaowsh,J`D
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CON CTION S)ARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
/- f'- OC
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
a
Is
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

Ft0!11 0 co z z
i roan Ta
Plow
13. 3kOUT: Dcplh
From_ ro So
rom To
WELL CONSTRUCTION RECORD
Jorin LnmC r - Dcparm[anr or Environment and rat Resources - Division of Wafer Quality
// //' ,
6 LLL CO1MAC:l'Oi'. (IN UI I'IDUal) Nnl\iL' (pang /� ,-�. [/ J � �[/C• �j
\AeLL CON r�i CTOn catienn�� N+haE tef-'QLtSONS
Wei/ [�P '/lejv
SrdrE\4ELLiIONsTnUCTIONPERb11Ta cJ
309342
Groundwater `Section
CERTIFICATION IC'Ri�
,( PRONE ®a�a5td
ASSOCIATED WO L`Rliii'1'n
lit `vlicublci
. `k ELL LSE LChcck -.pp hi -rabid Box): Residential ❑ Industrial ❑ Agricultural 0
\ionuoririp 0 Bcro.ory ❑ Htat Pump Water Injection ❑ Other ❑ if Other, List Use
_. ti\.tL.L LOC,.T101�
Nearest Town'�Ciene�e/ County dI-la i.,6..
/03od/d/fn.asM-,, #wy,__RfeuJ/e
:Yumocrs. Commum Sub W[ o _ _
ry, N ip coast
OWNER-fiea'eJ1Rioad 2aee (AMp4.nUt.d-
ASOr.:f 10 30 d %d rnaesJ ..,, ywr� J
Ashci/ 7/e ,>/e 1.11So`f
C,p -r TCod,:e: 3rdtc Zip Cod
-6vSs— 677a.
-. DATE DULLED s --/°" "4
5 TOTAL DEPTH: 3cr
[]awrGr l ourc No j
Puonc nwnbn
opographic/Land scaing
Ridge ❑Slope ❑Valley ❑Eta[
(check appropriarc boz)
L4[irude/longitude of well locarion
A 3s" i1,)- ems' e-'OrL' 36. ?OL'
(degreea m inuresncconos)
Lail udeilongitude source: IDDGrPSOTopographiL map
(cheek box)
DEPTH DRILLINGLOG
From To Formation Descrip[ion
a~ /7
/7 - Lz
LZ -34) : /e
o. DOES WELL REPLACE EXISTING WELL? YES ❑ NO r
ST .TIC WATER LEVEL Below Top of Casing /La FT,
(tire ": •'ir Above Top of Casing)
3. TOP OF CASING IS FT. Above Land Surface'
`l'�p or:ovu� to murs[e3 aeur bdu lr land surface rug wires
autt rixac in aur0ancc with lid NCAC 2C .01 IS.
9. YIELD )gpsn): 6 a METHOD OF TEST 3%(.t hy1 •gr9
tu. WATER ZONES (depth): 4%� J
it. DISINFECTION. Type(/Opi;ve.
._. CASINO:
Dcprh - DE-ander
Fr. G•/t.'
F.
Fr
Material
Amount q /-(4,
Well Thickness
or WeighiiF[.
Fr. CONCOC'c
Ft.
!+. SCREEN. Dopm Diameter
From To Ft. in.
Frain 'Po Fr in,
15. SAND/GRAVEL PACK:
Dcpnn Site Material
From To Ft.
From To Fr.
�1urcnal
V✓c,
Mcrnos1
nj
Six Size Manorial
in.
in.
!o. REMARKS:
LOCATION SKETCH
Show direction and distance in miles from ar least
wo Stale Roads or County Roads. include the road
numbers and common rood names.
t2/cl r44.iz3 ha-il red—
Abbe...A/O/et 414C.
I GO HEREBY CERTIFY THAT MIN WELL WAS CONSTRUCTED IN ACCORDANCE WITH ISA NCAC 2C, WELL
CONSTRUCTION STANDARDS, .AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
SEGURAL Lne original to the Division or Warer Quality, Groundwarer Section,
'•7399-103o Prone No. t9IS) 733-3221, within 30 days.
re
1
1636 Mail Service Cen[cr - Raleigh, NC
GW-I REV. 07/2001--;

a l'.•: rE 1 tLLL . JN.STRUCT[0N I' ESAUFR
WELL CONSTRUCTION RECORD
309343
Norm C oI a Deparmlcnr or Environrncnr and rat Resources - Division of Warw. Qualiry - Groundwater Section
irN es / r //d
11 cu.COC11 CONTRACTOR ut ClDU.aL) N.�m1E (prinq red �, [,(J t �1/� S CERTIFICATION a�2 J/7
r /� /' pp ��g ry (�� rq (FELL EL)NTEACTJIi CUh1P AN1' NA -NIL re rjeOLSOA S Lc%// PP/1/ l/Pi 05 • ?HONE MRI 0SA-O 4- { et„
JJ ASSOCI 'IED WQ •Rh1i TU
rir.;pplicviLlei
44 ELL LISE iChctc Appliozble Box): Residential IS nviunicipaWPublic ❑ Indusrriul ❑
nlouhonug 0 Rccotery 0 Hoar Pump Walcr lnjccnmij ❑ Other 0 If Orher, List 'Lisa
Rcco ei-y Hoar Pump \Val r lnjccuor ❑ Oilier It Orher, List Usa
22. V:ELL LOCAATIiN d
Nc_resl Tov.n'fhc/t /y .. 71 County' .w+�en/c
D/J £..-I'2/ sir1 fees A' 'L4M
,Sosci NadiC Non1D4r4, Camnwniry, SS ub4i vision, Car No., Zip Coac)
• 3 011 i\ER 7)0/7 A/el %SEA we N5
-8;aed CPeeA Es,wg
tSnccr or Rourc No.)
lilor Tarn Su). Zip Cods
7.s4- uos7
Pnanc pLl11Dcr
n.ATEDRILLED 6-J-0`P
roT.=.L DEPTH: arr
o. DOES WELL REPLACE EXISTING WELL') VES No [I
7. STATIC WATER LEVEL Below Top of Casing: y(/ FT.
/ (uis ... "if ribose Top of Casino)
S. TOP OF CASING IS FT. Above Land Surface'
top artanj roam ma rep auor bciuw )and sir rraee rcyuirex a
"riancc m a.wn]zasc trial tin NCAC 2C All IS. 9 YIELD (,pm): METHOD OF TEST BkAilfpq •/�y
rl
lu,WATER ZONE3(depm): (0' 27D� J 9
DISINFECTION: Type( Leg, ;vie. Amount Jo 41
L. C.AS1N u31
WaJI Thicl:ncse
Diameter or Waighr/Fc. P&)urcricl
L./z,*" ,Sddt/ . —'c
Dcptn
From 0 To rY Fr,
Fran ro Ft.
From To Ft.
> L3LOUT: Depm
From Q To a0
From To Pr.
I+. SC1'.EEN: Dcprh Diameter Slor Size [ aterial
From To Er, in,
From in.
'Po Ft. m. u1.
n, S,AND%GRAVEL PACK.
Dcprh Size M4¢r1ul
Flour - To
Fr:
From To Fr.
lo. REMARKS:
Nlarcrlal NreMod
Fr. CCdt A--,
grleumural ❑
Topo�gr�a�hie/Land setting
ORidge &Slope OVallcy OFldr
(chock eppropri4re box)
Lu[itudc/longitude of well location
A1dt';1,1)01 very' .II,kkr/
(degrcesim inulcccconds)
Latimdeilongitude source: CT GPSOTopographic map
(check bug)
DRILLING LOG
Formation Description
tics- enf Sa✓St.+c
DEPTH
From To
0 VS
6 <c
LOCATION SKETCH
Show direction and distance in miles from au leas[
P,,v0 State Roads or County Roads. loctude the road
numbers and common road names,
MR-4 CieeeA tc5
:c
J
I DO 3EREBY CERTIFY TH.ATTHIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH ISA NCAC 2C. WELL COiNST SUCTION STANDARDS, .AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNI
G-1-ay
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
IV
Suomi[ me ori;inal [o [he Division of Warer Quality, Groundwater Section, 1636 Mail Set. ea Cantor- Raleigh, s T !V
227u99-1o3o PIIons i' o. (9l9) 733.3221, within 3U days.
i T J
c,�
c-

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment a ural Resources - Division of Water Quality - Groundwater Section �[
WELL CONTRACTOR (INDIVIDUAL) NAME (print) kith id
j'.%�( titn'A 5/ CERTIFIICAATION#3/44Q/
WELL CONTRACTOR COMPANY NAME tEiy(eS t 2 hh72/2/JLfv9, LL.+ PHONE pAyu)a,48'O7/(G
STATE WELL CONSTRUCTION PERMIT# J ASSOCIATEED WQ PERMIT#
(if applicable) (if applicable)
309344
1. WELL USE (Check Applicable Box): Residential ❑' Municipal/Public ❑ Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection ❑ Other 0 If Other, List Use
2. WELL LOCATION:
Nearest Town: a cas /cr �( Countyi-+e'-_Se
AA i..Sf.s/r ill bcic el°, is Pei
. (Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: a,�te _il l.1/15
Address o `d ;act.) 0 i rCi r
^ Lei;
l.E' ($meet or Route o.)n a g .54f
City or Town State Zip Code
PS)- a,'a -.-s53
Area code- Phone number
4. DATE DRILLED 2-1-6'11
5. TOTAL DEPTH: 2-r
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO la"
7. STATIC WATER LEVEL Below Top of Casing: 4.0 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS / FT. Above Land Surface'
*Tap of easing terminated at/or below land surface requires a
variance in accordance with ISA NCAC 2C .0118.
9. YIELD (gpm): 7D METpOD OF TEST�� ✓ J
10. WATER ZONES (depth): /a'
11. DISINFECTION: Type (!tt-A e
l2. CASING:
Depth
From C7 To Cc,
From To
From To
13. GROUT: Depth
From 0 To 20
From To
14. SCREEN: Depth
From To
From To
I5. SAND/GRAVEL PACK:
Diameter
Ft. 4/Z.-
Ft.
Ft.
Amount r
Wall Thickness
or Weight/Ft. Material
Si/en Put_.
Material 1 Method
Ft. CANCedda ?nu Pig"
FL J
Diameter
Ft. in.
Ft. in.
Slot Size Material
in.
in.
Depth Size Material
From To Ft.
From To Ft.
Topogragtric/Land setting
❑Ridge Q lope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
N7s° 3r. 7 0r • ra''3,, /z
(degrees/minutes/seconds)
Latitude/longitude source: . PS❑Topographic map
(check box)
DRILLING LOG
Formation Description
DEPTH
From To
0-6/
G/ Gt) fee1/
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.
/Yfaced-04 �t
ev/ j(e-
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 OWI'125
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
Y T
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleighit ,
27699-1636 Phone No. [phone], within 30 days. GW-1 REV. 07.(21:101
r,-
Iz

WELL LOCATION:
Nearest Town:_ edty
r'o ---._County �
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: et .-,.,,,Ey fie Jos
Address
* (Street or Route No.)
Sig
0 State Zip Code
Area code- Pb e number
4. DATE DRILLED % - J _
5. TOTAL --_
AL DEPTH, .50
34
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water
WELL CONTRACTOR (INDIVIDUAL) NAME (print) )^
Quality - GroundwFIC TIONn
WELL CONTRACTOR COMPANY NAME
STATE WELL CONSTRUCERTIFICATION#y�
CTfON PE
(if ap.licable) RMIT# PHONE e` %o y: tJ_y[ e,
WELL USE (Check Applicable Box): Residential C Municipal/Public 0 Industrial 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
Agricultural 0
ASSOCIATED WQ PERMIT#
(ifa.plicable)
31081j
Topographic/Land setting
❑Ridge p&lope ❑Valle
y(checks box) ❑Fla[
Latitude/longitude of well location
P / /
(degrees/minutes/seconds)
Latitude/longitude source:
CyGPS❑Topographic map
DEPTH (check box)
From DRILLING LOG
To Formation Description
CM
6. DOES WELL REPLACE E WELL? STATIC WATER LEVEL BelowL? YES 0
NO pJ
Top of Casing: ���
S. TOP OF (Use "+" if Above Topop o f--ring) FT.
CASING IS L FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordancelvith ISq NCAC 2C .0118.
9. YIELD (gpm):
f
10. WATER ZONES (depth): METHOD F TEST_
11. DISINFECTION: Type H T bz
12. CASING: — -- Amount_
Depth Wall Thickness
From D `7� DDiaapeter or Weight/Ft. Material
From To�Ft. g_ SDI2( ✓C-
From Ft.
To Ft.
13. GROUT: Depth
From_ To Material P Method
From To
_o2r) Ft' LOnC r 1-e
14. SCREEN: Depth Ft. From _--_-
To Diameter Slot Size Material
From Ft.—�_in.
To Ft. in.
I.S. SAND/GRAVEL PACK:
�tl in. -
Depth Size
From To Ft Material
From To ---�
Ft.
16. REMARKS:
OZ.
-<
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.
atui u teto, Waif
I I
2) I a b
U(11 — 1 2005
w
0
(T
I DO HEREBY CERTIFY
ICONSTRUCTIONCRTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE THAT AACCOPY OF EENIs D" THE
THIS RECORD HAS BEEN PROVIDED TO TH WELL OWNER
SIGNATURE OF PERSON CONSTRUCTING THE WELL Submit the original to the Division of Water Q DATE
Submit
Phone No. the9) Division
Quality, Groundwater Section, 16
36 within 30 days. 636 Mail Service Center -Raleigh, NC
GW-1 REV. 07/2001

2. WELL LOCATION.
Weave Town
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - WELL CONTRACTOR (INDIVIDUAL) NAME (print)�q Di/v�ision of Water Quality - Groundwater Section
.r/n �' /-t��. �.
WELL CONTRACTOR COMPANY NAME - f- CERTIFICATION #
'•' Jzll i\ 'lip:.,,.. PHONE EE sa Ay7 -96,7
STATE WELL CONSTRUCTION PERMIT#
(if applicable)
ASSOCIATED WQ PERMIT#
(if a plicable)
V
1. WELL USE (Check Applicable Box): Residential Municipal/Public ❑
Monitoring 0 Recovery ❑ Heat Pump Water Injection 0 Industrial List ❑ Agricultural ❑
Other ❑ If Other, List Use
s10824
County �u---.ths.
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
9 OWNER -
Address
City or Town Stale
L.. de�� Zip Code
.Are code Phan r number
4. DATE DRILLED._-__ o�
5. TOTAL DEPTH:S,
6. DOES WELL REPLACE EXISTING WELL? YES NO r
7. STATIC WATER LEVEL Below Top of Casing: FT.
(Use "+'• boveAbove Top
Sufa ring)
8. TOP OF CASING IS
*Top of casing terminated at/or below lad surface requirres ace"
variance in accordance th ISA NCAC 2C .0118.
9. YIELD (gpm):_ METHOD OFThST
10. WATER ZONES (depth):
11. DISINFECTION: Type H ,L�
12. CASING: `-7—�'j
— Amount
Wn
Depth
From_ To(�
From is 7 To ,D /k
From To
13. GROUT: Depth
From__ To a/1
From To
14. SCREEN: Depth
From To
From To
15. SAND/GRAVEL PACK
Depth
From To
From To
16. REMARKS:
a Thickness
Diameter or Weight/Ft. Material
Ft.jy c,
Ft. �T _car_
Ft.
Material Method
Ft. CsnCr i-e n tr
Ft.
az.
Diameter
Ft. in.
Ft. in.
Ft.
Ft.
Slot Size Material
in.
in.
Size Material
Topographic/Land setting
❑Ridge afSope ❑Valley OF
(check appropriate box)
Latitude/I n nude of well location
(degrees/minutes/se conds)
Latitude/longitude source: pt map
❑GPS❑ToP g o r CD
o
(check box) -
DRILLING
Formation DeEsgtiption
aTT L /
DEPTH
From To
LOCATION SKETCH
Show direction and distance from at lea [
two State Roads or County Roads. Include the road
numbers and common road names.
2f
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 OWNFI
SIGNATUR OF PERSON CONSTRUCTING THE WELL ..! 0
Submit the original to theDivision of Water Qualit DATE
27699-1636 Phone No. (919) 21, within 30 days.
Yr Groundwater Section, 1636 Mail Service Center -
Raleigh, NC
GW-1 REV. 07/2001
Tra
C2
-d

310826
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR COMPANY NAME
WELL CONTRACTOR (INDIVIDUAL) NAME (print) i r/ ///,_ /I
CERTIFICATION #6/
Il,:6r .A�i Gyr - PHONE s 9yLi9
STATE WELL CONSTRUCTION PERMIT#
(if applicable)
ASSOCIATED WQ PERMIT#
(ifa plicable)
1. WELL USE (Check Applicable Box): Residential 1E1'.. Municipal/Public 0 Industrial 0 Agricultural ❑
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
(D g -o�Q2_FT.
8. TOP OF CASING IS
*Top of casing terminated at/ola d ufaceerequires Surface*
variance in accordance with 15A NCAC 2C .0118.
9. YIELD (gpm): _� METHOD OF TEST_ /Z
10 . WATER ZONES (depth):--p----
11. DISINFECTION: Type H 7 F/
12. CASING: �-- Amount /s a Oz.
Depth Wall Thickness
From Diameter or Weight/Ft. aterial
--� To__tz_L Ft. (off
From To Ft.
From To Ft
13. GROUT: Depth
From_ To Material Method
From 'a!1 Ft. L'� n—s_ P/J
To Ft.
14. SCREEN: Depth Diameter
From To Ft n1 Slot Size Material
From To in.
15. SAND/GRAVELFt. in.in.
PACK:
Depth Size Material
From To Ft.
From
16. REMARKS:
To Ft
City or Town tat
Zip Code
eatode- I ne number
4. DATE DRILLED_ ffL /4� /J p_ c`_
5. TOTAL DEPTH:
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO I� �"--�--
7. STATIC WATER LEVEL Below Top of Casing:
se'•+" if Above Top of Casing)
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL 0 WNE
aasal
v
2. WELL LOCATION:
Nearest Town: we
County can rd
(Street
Name,
Numbers, Community,
ry, Subdivision, Lot No., Zip Code)
3. OWNER:
Address
i
Topographic/Land setting
Budge ❑Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well locatio
(degrees/minutes/se— csl
Latitude/longitude source: ❑GPS❑Topographic map
(check box)
DRILLING LOG
Formation Description
DEPTH
From To
C6
w
al
LOCATION
Show direction and distance in miles from at 11t C
two State Roads or County Roads. Include the road
1-873
numbers and common road names. 'wt
f%dte, //, ve
SIGNATURE OF PERSON CINSTRUCTING THE WELL
Submit the original to the Division of Water Quality, Groundwater Section,
27699-1636 Phone No. [phone], within 30 days.
DATE
1636 Mail Service Center - Raleigh,
GW-1 REV. 07/

STATE WELL CONSTRUCTIONPERMIT#
(if applicable)
ASSOCIATED WQ PENT#
(if applicable)
1. WELL USE (Check Applicable Box)' Residential 1r M
Agricultural 0
Monitoring0 Municipal/Public 0 Industrial 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2 WELL LOCATION:
Topographic/Land setting _:_'_ a
Nearest Town:_ �tin-t __
County
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER:
Address
Area
f
City r To vn tate
AI Z p Code
ode- Pho a numbe
4. DATE DRILLED___
5. TOTAL DEPTH: ,7 A .2 I_
6. DOES WELL REPLACE EXISTING WELLS YES 0 NO 13--
7. STATIC WATER LEVEL Below Top of Casing:
(Use "+" if Above Top of Casing) FT.
8. TOP OF CASING IS � FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordance ith I5A NCAC 2C .0118.
9. YIELD (gpm): METHOD OF TEST
10. WATER ZONES (depth): /t-0
11. DISINFECTION: Type
12. CASING:
From 0
From
From
13. GROUT:
From 0
From
14. SCREEN:
From
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality
WELL CONTRACTOR (INDIVIDUAL) NAME (prior) Q 0' - Groundwater Section
WELL CONTRACTOR COMPANY NAME CERTIFICATION #
PHONE 1 N �.9i'�S�l�i�
s
Depth
To .S Q
To
To
..r
Amount 3�oz
Wall Thickness
Diat)terer or Weight/Ft. Material
Ft.�
Ft
Ft.
.15M1b-
Depth Material /
To Ft. ram
To Ft.
Depth Diameter
To Ft, in.
From To Ft.
15. SAND/GRAVEL PACK: m
Depth Size
From To Ft
From To Ft
16. REMARKS:
e-Method
Q r
Slot Size Material
in.
in.
Material
310827
[Midge ❑Slope they ❑ ? z
(check appropriate box) z
Latitude/longitude of well loca ion =-
6
grees/minute econds) t O
Latitude/longitude source: GPS❑Topogr T i map "
(check box) _ z
DRILLING `'61---
Formation esc iption
G'rq
ftT
ci
}
DEPTH
From
0
LOCATION N-CH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common road names.
1 DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH I5A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
SIGNATURE OF PERSONCONSTRUCTING THE WELL D ^ ` O
DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Cennter- Raleigh, NC
27699-1636 Phone No. [phone], within 30 days.
GW-1 REV. 07/24401
r

4
3p5048
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources
- Division of Water Quality - Groundwater Section f,
WELL CONTRACTOR (INDIVIDUAL) NAME (print) art [i `S' 4-N-0IN� (� CERTIFICATION # 5a6
r./� 1 et#o�t1 SpltJiCCS PHONE # (5�'d)�15G-S18=t
WELL CONTRACTOR COMPANY NAME I ItOun'�t.p �v'fU��
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable)
(if applicable)
1. WELL USE (Check Applicable Box): Residential 0 Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring lW Recovery 0 Heat Pump Water Injection O Other 0 If Other, List Use
2. WELL LOCATION: (�
Nearest Town: ra �County1Pa' CitinC r Q �7
U(]l et\41r4.n. Ufi ht l / I5-
(Street Name.'Numbers. Community, Subdivision, Lot No., Zip Code)
3. OWNER: .1—_'py`��-=c—te-r U,
Address lee ID-S 14crn\,no o, mov,k&a �1
I (Street or Route No.) nit e
Wit ;we ru t4C
City or Town State,. Zip Code
dal.)- &SR -%S act
Area code- Phone number
4. DATE DRILLED II%II
5. TOTAL DEPTH: la
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO ®'
7. STATIC WATER LEVEL Below Top of Casing: 3,a8 FT.
���p (Use "+" if Above Top of Casing)
8. TOP OF CASING IS FT. Above Land Surface*
*Top of casing terminated atior below land surface requires a
variance in aceordane with ISA NCAC 2C .0118.
9. YIELD (gpm): NA METHOD OF TEST
10. WATER ZONES (depth): 3-act to ) a-?t"
11. DISINFECTION: Type Amount
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
To a Ft. L
From
From To Ft.
From To Ft.
13. GROUT: Depth
From 0 TomFt.
U
From To
14. SCREEN: Depth
From a To 1 a
From To
15. SAND/GRAVEL PACK
Depth
From 1,5 To is
From To 1_1
16. REMARKS: r.(Yt
Ivta(etita:
C4� t PVC_ ,>N
Topographic/Land setting
ORidge I25(ope OValley °Flat
(check appropriate box)
35'631' SS.yILI
Latitude/longitudee of w 11 Ioca�tion R) a
N/Sa
(degrees/minutes/+�onds)
Latitudeflongitude source:OGPSOTopographic map
(check box)
DEPTH DRILLING LOG
From To Formation gescription
1 e2.5'
a, t .'0'
3 55t.0'
1.0 I a,O
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the roa
numbers and common road names.
I DO HEREBY CERTIFY T
CONSTRUCTI TAND
Ft.
Diameter
Ft. a in.
Ft. in.
Size
Ft. 31 a
Ft.
Method
Paur
Slot Size ,-Material
0,0%6 in. (PVC -
in.
[Material
Stl:ta SAM
T THIS W LL WAS CONSTRUCTED IN ACCORDANCE WITH I5A NCAC 2C, WELL
HAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO TH WE L OWNER
la -DLL
AT
GNATURE OF PERSON CONSTRUCTING THE WELL
ei
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Ceenter' RREV gh, C
27699-1636 Phone No. [phone], within 30 days. DEC 2 8 S

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Nataal Resources - Division of War Quality -Groundwater Section
WELL eoNTRACrOR ONMYIDAALMMTIE QM.e y Si2Sli c4C CERTIFICATION IPL
WELL CONTRACTOR COMPANY NAME gltdli..-E. e,..,L?.e 4,eiacy FHONE s 7 e,e-rsyt/&
STATE WELL CONSTRUCTION PERMITS ASSOCIATED WQ PCRMW1
(ifapplieable)
Cc,
305503
1. WELL USE ((heck Applicable 8ux) Residential CYMoaicipal/PEblic 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Hat Pup Water Injection 0 Oder 0 If Odle, List Use
2. WELL LOCATION- -
Nearest Town: p�� �
4.1 def epki
(Sue Nara►r o6d�t Cm/s Arc & eit. ..tat NI. ZIP Cade)
3. OWNER: C every-/ 4/0 3 C'l/4r!!s $
Address 372, yeta a Ale Cc4(
��
tSITaraMatel
esker`"v<e•.•v ve V'7ao
Cay( forg 2Siae rip Code
Camay git,Pteliesbe
Aaaacede- P\a aasa►ar
4. DATE DRILLED /I- / 0- tig
5. TOTAL DEPTH:
6. DOES WELL RHPLAG �(LSf WO WELL? YES O NO RV-
7. STATIC WATER LEVEL Below Top ofCaimg:
Wane, Maws Tbjaf
8. TOP OF CASING IS / FT. Above Lad Sustain.
Kap atembilawind Saw edam sad make aaanea
•adat* taamwAaace MSISO NCAC2C :nu
9. YIELD (gp4 l4 METHOD OF TEST Aire
10. WATER ZONES (depth): //'. , 2 t c
I I. DISINFECTION: Type 17.t t 1Ulrer Amount a 02
12. CASING: War Mite s
Dope Olean or weeny. sanerid
F,o4�To
Fre n R1 ToeTW�t t1
Faonvol3 To I/O _FL
13. GROUT: Depth
Flak__To Ft
From_ To Ft
(4. SCREEN: Dept Dicer Slot Sac MNseaial
From__ To F1. j . is
Fran To Ft in. in.
15. SAND/GRAVEL PACK:
Depth Sae Wenn
Frole_To Ft.
From To R.
16. REMARKS:
Topographic/Landsetting
(Midge OSlope alley anal
(cheat apptapthe boa)
Iatikaddlougitude of well lotion
(Legastea..ldteaaade) .-
Side/longitude soner..0311.0Topmpaph.
ordain) 0"
DEPTH
From To Fanalion
d - /to AS,-smOa t
Si''
WO- ?SS"
LOCATION SKETCtI rn
v
Show dand dos ty la miles fan at
two Stale Ronda arCamy Rosh. hhcjlde
aaabaa wad COMM=read smea.
gA�
F
17•
Eel
CuaN
1 DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH ISA NCAC2C, WEL
CONSTRUCTION STAN�THATA COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
SIGNA7UREO, PERSON CONSTRUCTING THE WELL DATE
v
N
Subthe original to the Divhien of Water Quality, Groaadwater Stttl n,1636 Mail Service Center -Raleigh, NC Ito
s
276994636 Ma Pia [phone]. Wads 39 days. GW-1 REV. 07/2001 y2

opki
WELL CONSTRUCTION RECORD 3 0 5 5 0 4
North Carolina - Denaturant of Entrainment and Natural R - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (waDNVIBUAwNAMC -r�$ b "C4= :ce= CR71FtcATION It iSC
WELL coNTnAcfoa COMPANY NA= TQStic-e t°`a-?t 0 A,Litr � ruont s faiy -vs-sit;
STATE WELL COMIEECnON TCRMRa •KTam ono naterta
Cif applicable) (ifapplicahle)
I. WELL USE (Check Applicable Bo:* Residential �MScipal/Publc D ladusicial O Agdcukwal O
Monitoring O Recovery 0 Neat Pump Water bjection 0 Other CI If Other, List Use
2. WELL LOCATION: y � TcpognphirlLand setting
Nc7ttTow/uri/.lvS�JLcr,WCF' yr,(,�- /�
Z mum fig N�ie.�( t k.* de-m-vt 0 aell d ti, OVbin) sa,
)4 asiieiooe.Lei Ne., Speedy) (el mgommapd1wtll
C
( umade) n Q
L�tdert arde roacct]GPSOropappbi
(dedctoz)
From To Formation
3. OWNER: S,f 'Mteti
Address j l',o G ti vv-
tSamer Root )ton
7.`•`sci{ir:.t; C-
Cap TeSate rip Code
(fat} (,as Z'Co- /4
Anat. RAMS sabot
4. DATE DRILLED I/
L2 ``7 3 t =
0-65
TOTAL5. ✓�-
7 Pl �i' s�
DOESWELLREPLA W EXISTING YESD NO [LIB
6.
7. STATIC WATERLEVELEdgar Topattains CO 75- .7cc � � .;0/.;.:u
(MOW'iWAbow1ipaft wire 1 8. TOP OF CASING IS / FT. Above Lad SurfaceC .+,
Lt
etepefer iaw.ulwer shot b.Yreod niwwwi.-. !1 .Y
.aa.aerama e.ae.iY MANCACaCMa I'l/rott
9. YIELD (gp): % METHOD OF TEST 6,
10. WATER ZONES (depth): ritvrh Gy Gets Ai », fl ist 7tC'
LOCATION SKEItI(
11. DISINFECTION: Typee.la el- Amount e 02 Show direction and distance in miles!Fan at least
12. CASING: . Wall thickness two State Roads or County Rends. Include the mat
Frorn__TTo Dar or Weight/Pt Lurid smothers aed aologrion iaad a ee tit co ° j
From To C^E C yo G
FreTo 40 Ft. Ilk iBt'l OM
13. GROUT: Depth Mate l h&tWd dr F4'4
Wet iii,Je:
From__ To Ft.
tit"'
14. SCREEN: Depth Dim Cy7eSki Site Hernia! in Z,7el e)4/
l
From__ To Ft ______in. in. /�
Front__ To Ft in. in.
15. SAND/GRAVEL PACK
Depth Size Nutria!
Froo1._To Ft.
From_ __.To FL
16. REMARKS:
1544
rk'4 7Q
,C,:),i ureu
E DO HEREBY CERTIFY THAT THLS WET. WAS CONSTRUCTED IN ACCORDANCE WITH ISA NCAC2C, WELL
CONSTRUCTION STANQ S, AND THAT A COS OF THIS RECORD RAS BEEN PROVIDED 70WHE WELL OWNER
PERSON CONSTRUCTING THEWEU. DATE
Submit the original to the Division of Water Quality, Groundwater Section,1636 Mrs Service Cu-atRaleigh, NC
D699-1636 Phan Non (419) T13,3m. within 30 days. OW -I REV. 07/2001

lJ`"
306538
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and atu��ral((Resott[(��e�J PDi ision of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) /,p 1 `^' EL (5 CERTIFICATIO//NY Cla e
WELL CONTRACTOR COMPANY NAME ?pp iA 1 A M C.OM � 11 in. q PRONE it f nt562 - I H t�
STATE WELL CONSTRUCTION PERMITS 1 ASSOCIATED WQ P
(if applicable) (if applicable)
I. WELL USE (Check Applicable Box): Residential 13 Municipal/Public ❑ Industrial ❑ Agricultural 0
Monitoring 0 Recovery ❑ Heat Pump Water Injection ❑ Other 0 If Other, List Use
2. WFT.T LOCATION: r
Nearest Town: Leice 't ce CounrylCt� Q SN )C
1'1 Shr4Mao ricA 'Ray. ,2nwAt
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER A' mpie j
Address .2 5 T'i6R+->tv
; _ciLen
(..eleSinsetizitoLte No.) an gisz
City or Town State tip Code
Area code- Plume number
4. DATE DRILLED I vi 1 104,
5. TOTAL DEPTH: 3OS
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO @'
7. STATIC WATER. LEVEL Below Top of Casing: 1 C) Ff.
(Use'*+" if Above Top of Casing)
8. TOP OF CASING IS FT. Above Land Surface*
'Top of casing terminated atror below land surface requires a
variance la accordance wltb 1SA NCAC 2C .0I18.
9. YIELD (gpm): E)-. 5 METHOD OF TES
10. WATER ZONES (depth): GO'
11. DISINFECTION: Type 1 Ke.A Q+t Amount o2-
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
From 0 To n Ft
From To Ft.
From To Ft.
13. GROUT: Depth Material
From To Ft e,Oti.,eLt.`44. —
From To Ft
14. SCREEN: Depth Diameter Slot Size Material
From To Ft in in.
From To Ft in in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft
From To Ft
Method
PCXX-
Topoanc d setting
❑Ridge Inlope ❑Valley ❑Fiat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(cheek box)
DEPTH DRILLING LOG
From To Formation Description
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common road names.
O1 D NituSoLXnV. IL .
151?ow $uwQ -
16. REMARKS.
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
SIGNATURE OF PERSON CONSTRUCTING THE WELL ATED��a
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-1 REV. 07/2001

GgP
306536
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
^/�
WELL CONTRACTOR (INDIVIDUAL) NAMJ (print) AM. W e I t 5 CERTIFICATION
pp#zoot �t
WELL CONTRACTOR COMPANY NAME I I A R 1) tV W&I\ LRi '( 1)49 PRONE # liri8)Vu3.Qat3
STATE WELL CONSTRUCTION PERMIT# 1 t ASSOCIATED WQ PE
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential El Municipal/Public 0 industrial 0 Agricultural 0
Monitoring 0 Recovery ❑ Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCAW r Cgtt Coun �ViJ omeN+
Nearest Town:(- u¢'
AM -&run*. t jikaeW ,W3°
(Street Name• Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER 3f 4 �t"'tl¢ IV e
Addresttvts9- ?JWVI.8 -rl \2, rt..
t c♦ is ILLutute .)
2t730
City or Town Sense Zip Code
�1-
Area code- Phone comber
4. DATE DRILLED � OBI'
5. TOTAL DEPTH: tS
opographic/Land setting
dge ❑Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/moods)
Latitude/longitude source:❑GPS❑Topographic map
(Meek box)
DEPTH PRILLING LOG
From To Formation Description
6. DOES WELL REPLACE EXISTING WELT 7 YES 0 NO 133---
7. STATIC WATER LEVEL Below Top of Casing: Go FT.
(Use "+' if Above Top of Casing)
8. TOP OF CASING IS � FT. Above Land Surface*
'Top of casing terminated atlor below land surface requires a
variance In accorducenk ISA NCAC 2C A11& ,,
9. YIELD (gpm): IS • METHOD OF TEST CZf5L •nW ?(Ikiel
10. WATER ZONES (depth):
11. DISINFECTION: Type roe** Amount
12. CASING:
Diameter
From 0 To 'T'T• Ft.
From_ To Ft.
From To Ft.
13. GROUT: Depth Method
From To Ft_AMS* t �-
From To Ft.
Wall Thickness
or Weight/Ft
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
Material numbers and common mad names.
c� kIc
@rraG30- �`ooc^(rl, _®
14. SCREEN: Depth Diameter Slot Size Material
From To Ft in, in.
From To Ft in. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From _ To Ft.
From To Ft
16. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH I5A NCAC 2C, WELL
CONSTR ON ST s • s S, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
zPa
SIGNA • OF PERSON CONSTRUCTING THE WELL ✓DATE
rn
Cin
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

13. GROUT: Depth
From To
From To Ft
14. SCREEN: Depth Diameter
From To Ft. in.
From To Ft in.
15.SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and );Iantral Resourc,
WELL CONTRACTOR (INDIVIDUAL) NAM
WELL CONTRACTOR COMPANY NAME
STATE WELL CONSTRUCTION PERMIT?
(if applicable)
ols)
306535
ion of Water Quality - Groundwater Section CERTIFICATION It e ('/er+'
PHONE e giS G 53- 9ao73
ASSOCIATED WQ P
(if applicable)
1. WELL USE (Check Applicable Box): Residential 9/Municipal/Public 0 Industrial ❑ Agricultural ❑
Monitoring 0 Recovery ❑ Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION:
N3 gpwnNati County,
van
(Street Name• NumbersCanmmity, Subdivision, Lot No., Tip Code)
3. OWNER: (o the - Gp QL
Address 34'5
fPr'vtVlat3 sUeet«_IiwdeC-N6) a$ 3C1
City or Town State tip Code
(j-
Area code- Phone number
4. DATE DRILLED 1 a- is- d4-
/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)
DES DRILLING LOG
From To Formation Description
5. TOTAL DEPTH: 1K C5
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO LT
7. STATIC WATER LEVEL Below Top of Casing: ,`3C7o FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS I FT Above Land Surfaces
'Top of casing terminated at/or below land surface rumba a
varfmcein accord cc 15ANCAC2C.011L t
9. YIELD (gpm)• METHOD OF TEST C.
10. WATER ZONES ( th):
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common road names.
11. DISINFECTION: Type —IAA t t"-( Amount
12. CASING: Wall Thickness
CffDiameter or Weight/Ft Material
From To Ft
From To Ft.
From To Ft.
F1� IV �14:.C2.
Slot Size Material
in.
in.
KwLy 7 4 Aci,Caoebb M .
16. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUL1r.0 IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTgjiq 10 STANDARDS AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
SIGNA
OF PERSON CONSTRUCTING THE WELL DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center -Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-1 REV. 07/2001

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Reso
WELL CONTRACTOR (INDIVIDUAL) NANT etk,at
WELL CONTRACTOR COMPANY NAME till LA
03\9 306533
ivision of Water Quality - Groundwater Section
5— CERTIFICATION#2003
PHONE', at) (43.9043
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT',
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential S' Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCA ON: �, • , I �C_
E County d
(Street Name,
Numbers, Comm
3. OWNER: N 4 c+
Address 4'3 5ht
„�_ ,(Snatq No.)
iffin
City or Town State
Area code- Phone number
on, ' No., Zip Code)
Topogra oidc/Land setting
❑Ridge tiglope ❑Valley ❑FIat
(check appropriate box)
Latitude/longitude of well location
(degrcWmlmttea/aeeaods)
pp" 7 ^ ',KLatitude/longitude source:❑GPS❑Topograp)tic map
box
ag 7-3 / DEPTH ( ) ILLING LOG
Zip Code From To Formation Description
4. DATE DRILLED
i5
5. TOTAL DEPTH: % D. r /
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO ET
7. STATIC WATER LEVEL Below Top of Casing: as 0 FT.
(Use"+" if Above Top of Casing)
8. TOP OF CASING IS FT. Above Land Surface*
'Top of casing terminated apor below land surface requires ■
6 +
ur.
variance In accordance with ISA NCAC 2C .0I111.aipptiKef
/"� ft
9. YIELD (gpm): 12. ME OD OF TESTGO" W
10. WATER ZONES (depth): 9 (40
11. DISINFECTION: TypeT' i5 Amount oZ
12. CASING: Wall Thickness
Dia
meter ameter or Weight/Ft Material
From t� To X Ft.
Fran To Ft
From To Ft.
13. GROUT: Depth (��1
From To Ft10..0M-4- , �MeshoL�.
From To Ft.
14. SCREEN: Depth Diameter Slot Size Material
From To Ft in. in.
From To Ft in in
15. SAND/GRAVEL PACK
Depth Size Material
From To Ft.
From To Ft.
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common road names.
14eirt 1 KjSr.
16. REMARKS.
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRU«". sN STAND S, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO
R]ER
SIGNA OF PERSON CONSTRUCTING THE WELL DA
Submit t e 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

306047
WELL CONSI lit tillOa RECORD
North Carolina - Department of Environment and natural ((R��esoureca -Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDWIDUAL) NAME (print) t�/1-t.,\t`- t,} 5iA CERTIFICATION / al
WELL CONTRACTOR COMPANYNAME_RF.UBEN CALDWELL DRILLING, INC. PHONE[phone]
STATE WELL. CONSTRUCTION PERMIT/ ASSOCIATED WQ PERMIT/
(if applicable)
(if applicable)
1. WELL USE (Check Applicable Box): Residential Q Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery ❑ Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION:
Nearest Town: We. P E R"I I V LE County (J CO rn a tS
CL.A Q4L,S C t4 A Pe L. 6/
(Street Nurse, Number, Community, Subdivision, Id No., Zip Code)
3. OWNER: `1 ^yv l U 1 —1 1 AM S
Address o "1 C id A r t. Ow o„
(Strut or Rowse.)
As NI b,110-6
aggo3
(!_,.';ryor b'y v State__ 9 Zip Coda
(Mg)- FJ J 0 i __
Ain cods Phone number
4. DATE DRILLED I a —0q-
5. TOTAL DEPTH: 3 9 O
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO II
7. STATIC WATER LEVEL Below Top of Casing: $ 0 FT.
(Use -•- it Above Top of Cuing)
8. TOP OF CASING 1S — FT. Above Land Surface°
'Top of cuing terminated at/or below had sorts( requires •
variance In accardur Ith ISA NCAC IC.0111.
9. YIELD (gpm): METHOD OF TEST
�
10. WATER ZONES (depth): 1 ' 0 - In YthE
Topographic/Land setting
❑Ridge ❑Slope ❑Valley @flat
(check apprcpritte box)
Latitude/longitude of well location
(devoe+Antauteilsecoodt)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH
Frm / Tc. 3
ct 3 /_ I fro
Ro/
(so/ .- 3cto/
11. DISINFECTION: Type Pi (lb /U Amount 7- ' E)
12. CASING: �i I Wall ThicknessFrom .- , To th Ft. R r or Weight/Ft. nte_ial
From To Ft. SAL34 1 C
From To Ft.
13. GROUT; Depth
From 1- To 9---0 FL
From To Ft.
14. SCREEN: Depth
From To
From To
15. SAND/GRAVEL PACK:
Depth
From To Ft.
From To Ft.
16. REMARKS:
Material Method
CEMt3N( �tibia
Diameter Slot Size Material
Ft. in. in.
Ft. in. in.
Size Material
Fp lion Description
U lot- u {tD N Aj
C teitc& - 3 (.Q9r n
03it-AP-ri1 Ft...
JOCATION SKETCH.
Show direction and distance in miles frongat least
two State Roads or County Roads. lnclude:pie roads,
numbers and common road names.
C \-A 2K5 C r1 A PO L
tit
1 DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED
CONSTRUCTION STANDARDS, AND THA COPY OF THIS
ACCORDANCE WITH ISA NCAC 2C, WELL
RD HAS BEEN PROVIDED TO THE LL 0
SIGNATURE OF PERSON CONSTRUCTING WELL TE
a 4
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mall Service Center -Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-I REV. 07/2001

E i w E
JAN31B105
306050
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and "z•nual Resources^ Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (Woe) CS\ LA.t C tJA 5 CI CERTIFICATION/ 1-11
1
WELL CONTRACTOR COMPANY NAME_RF.UBEN CALDWELL DRILLING, INC. PRONE448 54-3581
STATE WELL CONSTRUCTION PERMITS ASSOCIATED WQ PERMtT/
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential 13 Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery ❑ Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATIQt4
Nearest Town: IVSNe.V(LA- (5-) County tUt)to b
oa 14E64 Co ..16 6 c,
(S1reel Name, Numbers, Community, Subdivision, to No., Lp Code)
3. OWNER: jV D t L A (o e,
Address 555 O a- cab a a C-C..I
(Suer or Raw No.)
City or Town Sts1e Zip Code
(s} )- a $'6- at 0
Ma coda Phone number
4. DATE DRILLED \ a- 1 3- 0 q
5. TOTAL DEPTH: a l 0
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO f
7. STATIC WATER LEVEL Below Top of Casing: 2-° FT.
mu -.-it Above Top of Casing)
8. TOP OF CASING IS ! FT. Above Land Surface*
•Top of easing tarmlasted War below lad terrace a gq ulra a
valance is scmordap} with ISA NCAC IC.01IS. ./�
9. YIELD (gpm): 5 o MET}I D OF TEST \`-4G - A it:
W. WATER ZONES (depth): \ Lez ' - Z o G (!"`
11. DISINFECTION: Type W T ra gif`%
12. CASING:
A �'
From 4-3
+ To
From To
From To
13. GROUT: Depth Material Me
t)wd
From �- To �- 0 Ft. CA Mk3 6)1 Po ,; �g p
From To Ft.
14. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in.
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
kr or W lghUFt Material Ft. 4' 1 6 P[3Y
Ft.
Ft.
/TopographicfLand setting
dge Mope Macy ❑Flat
(cheek appropriate boa)
Latitude/longitude of well location
(deveuhoimna lscnods)
Latitude/longitude source:OGPS❑Topographic map
(check toe)
DEPTH DRILLING LOQ
From /_ To / Fo Lion escri lion,
'35 I- 14 a' C� H(>J(-A,
40' tit-Sl e,- 30 Gee"
1q-0/-- alb' (J(ZAzI('CS
J OCATION SKETCH
Amount 1 a b 1. Show direction and distance in miles frontlet least;,=i
Wall Thickness two State Roads or County Roads. Includr?�}te roet%.=;,_ �+
1 ■ numbers and common road names. 'a c:"
9 c,`
t• )
-r
16. REMARKS: ^K 9-g-la.o6) AJUS
1 DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WIi)I ISA NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND TIIAT A COP F T1 1S CORD I,N BEEN PROVIDED TO THE LLOWNER
hi —
SIGNATURE OF PERSON CONSTRUCTING TIIIEE WELL D TE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mali Service Center - Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-1 REV. 07/2001

306049
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and "Inturral Resources^ Piz iston of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME Oman G \ L. L—k t r S tA CTRTIFICATION/&\-1 I
RF.UBEN CALDWELL DRILLING, INC. PRONLII*1 )254-3581
WELL CONTRACT OR COMPANY NAME_
STATE WELL CONSTRUCTION PERMIT/
(if applicable)
ASSOCIATED WQ PERMIT/
(if applicable)
1. WELL USE (Check Applicable Box): Residential B' Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATI N:
Nearest To S 06 V I l-€ County
c.s.)ts G6.
lJV ri C.c,rJ
(Street None, No(mben, Community,
Subdivision, Id No., Zip Code)
3.OWNER: c t;ttts tC0i3 y)�o�l
Address �(G L.) C/C ()ma_ 4C1-'D
(Slrat a Roue No.) 'a s O G 5
Ity or Town ct Sue ® Zip Code
Area coda- Phone number' n Ea / O /{ .
4. DATE DRILLED N 6 I , T
5. TOTAL DEPTH. (.
6. DOES WELL REPLACE (STING WELL? YES ❑ NO i[t
7. STATIC WATER LEVEL Below Top of Casing: )/1\ FT.
4 (Use -.- if Above Top of Casing)8. TOP OF CASING IS FT. Above Land Surface•
'Top of cube termlaared aUar Wow (sad ..Mace requiru a
variance to Recordation's ISA NCAC IC.0111. G _ �l
9. YIELD (gpm): METHOD OF T ST ICI
10. WATER ZONES (depth): p )� A
II. DISINFECTION: Type
12. CASING
peps Di ter
From To 3p Ft. 43
From To Ft.
From To Ft.
13. GROUT: Depth Materiel Method
From To Ft.
From To Ft.
14. SCREEN: Depth Diameter Slot Sire Material
From To Ft. in. in.
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Size Materal
From To Ft.
From To Ft.
Amount
Wall ThicknessShickncR
aly
SOKat
Topographic/Land setting
Ridge ❑Slope ❑Valley ❑Flat
(dock apprapritlo box)
Latitude/longitude of well location
(depeea/mimnea/eaeoode)
Latitudcllongitude source:❑GPS❑Topographic map
(check box)
Fo Cop Description',
o ISNsva-oei�
G(r+r-) iTu(T
a,,
L.3
-r,
icy
.
LOCATION SKETCH
Show direction and distance in miles from at bast +
two State Roads or County Roads. Include the ad
numbers and common road names.
14
2 05e' tl LL / ftg
,1\.-
16. REMARKS:
1 DO HEREBY CERTIFY THAT THIS WELL WAS CONST RUCFED IN ACCORDANCE WITH 1SA NCAC 2C, WE
CONSTRUCTION STANDARDS, AND THAT A CO OF T)I S RECORD ((AS BEEN PROVIDED TO THE
CYAy\
SIGNATURE OF PERSON
�GTHE WELL WUjLL
DA
Submit the orlglnal to the Division of Water Quality, Groundwater Section, 1636 Mall Service Center -Raleigh, NC
27699-1636 Phone No. (919) 77}7221, within 30 days.
cW-I REV. 07/2001
rieJ Qs cvie
, 75 inti

� 17
JAN 31 2005
VVEI;L CON StitiTe t rRECORD
North Carolina - Department of Environment and )4 mural
Resources -Division of Water Quality - Groundwater Section -t / WELL CONTRACTOR(NDIVIDUAL)NMrl IZ (pe 0V 1 I--t..t t ASd CERTIFICATION/ a 1 i I
WELL CONTRACTOR COMPANY NAME_ REUBEN CALDWELL DRILLING, INC. PNONC448 )254-3581
306048
STATE WELL. CONSTRUCTION PERMITS ASSOCIATED WQ PERMIT/
(if applicable)
(if applicable)
1. WELL USE (Check Applicable Box): Residential IJ' Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATIONi/�
Nearest Town: Rt E rJ County 3u iJ Lc r^ �
W 65-r NA-4era DP.tVt
(Street Name, Number, Community, Subdivision, Lot No., Zip Code)
3. OWNER: 9-o bee-13 Tt (-ins
Address a.lb \ f3 NeN(L-(y5..)a'J1(t
A A 061J (Streetor Route
Ne.) aS 1 o 4-
Ci(G'ty or Toaa 3C 5(.14 (7 53 Zip Code
Arcs code- Phone number i l/ 0
4. DATE DRILLED
O O FL h/S t. pV
From 1- To
From To Ft.
From To Ft.
13. GROUT: Depth Material (� Method
From To o2es Ft. (It Mfj o'r
From To Ft. YO.:{Z-6 G%
5. TOTAL DEPTH: 4- 5 a
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO Cd
7. STATIC WATER LEVEL Below Top of Casing: 10 O FT.
4 (Use it Above Top or Cuing)
8. TOP OF CASING IS FT. Above Land Surface'
*Top ofeuloa Urmluted at/or below lad surface requbte a
animate la accordance vansISA NCAC IC .0111.
9. YIELD (gpm): to METHOD OF TEST F.1 G - A I R --
10. WATER ZONES (depth): l iS 0 - a G ° r'^
3Y0'
11. DISINFECTION: Type a 0 b Amount %3 IYJ
12. CASING: Wali Thicknw
Depth Di to or Wert/Ft. M*}Frial
14. SCREEN: Depth Diameter Slot Sire Material
From To Ft. in. in.
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
Topographic/Land setting��
❑Ridge ❑Slope ❑Valley Flat
(eher2 appr:prime box)
Latitude/longitude of well location
(deveearmiouteermeoodr)
Latirude longitude source:❑GPS❑Topographic map
(check box)
DRILLING LOG
Fo7�t/ttaation Description
v aKfau l
DEPTH
From / To
3 5 5
tgc'
kYo1'
3g0�
Mt"— 4sb
e-OGN
GT-AJ) ,re
CIA:, j1c GF'M
av ITS
cfa tcc - 4 Gp..
GMat-r6
0
).00ATION SKETCH1
Show direction and distance in miles from ttPleast-`'-',
two Stale Roads or CountyRoads. Include t'"
tF�gmed c%c;
numbers and conunon mad names.
b
WeslNn,j,*)
DR
a5 M
16. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITS( ISA NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND TIIAT A CO Y U� TilS RECORfAIIAS BEEN PROVIDED TO TI{a WELL OWNER
SIGNATURE OF PERSON CONSTRUCTING TIME WELL
Submit the original to the D11431012 of Water Quality, Groundwater Section, 1636 Mall Sarvtce Center -Raleigh, NC
27699-1636 Phone No. (919) 733-322I, within 30 days. GW-I REV. 07/2001

cp
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME�f (print) Rojzj/ e , CERTIFICATION II 2 l! ! 7 7
WELL CONTRACTOR COMPANY NAMS,,,Xaite. -W14:1-92l(` L/G.t ( O P : "t 49 PHONE # in49-0y1r0
STATE WELL CONSTRUCTION PERMIT# _ ASCSOC1ATEn WQ PER "Jl
(if applicable) -. -
(if applicable)
305793
I. WELL USE (Check Applicable Box): Residential Lys Iv iuoicipal/Public 0 Industrial 0
Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATIO
Nearest Tow�ryry: / ,,,, ♦ Countya �
irie
/27 C/eaa2 cg'gt IIbWW
(Street Name, N,umben, Community, Subdivision, Lot No., Zip Code)
3. OWNER:Sat-4 a
Address /Zr r/ t emcee kr/
Pii
( Area code- Phone number
4. DATE DRILLED // Jf -Or
5. TOTAL DEPTH: . 8r
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO C!I�
7. STATIC WATER LEVEL Below Top of Casing: //ja FC.
B. TOP OF CASING IS �• S (Use w+' if Above Top of Casing)
FT. Above Land Surface"
*Top of casing terminated at/or below land surface requires a
variance in accordance with 1SA NCAC 2C .0118. ,
9. YIELD (gpm): ( METHOD OF TEST /Mee
10. WATER ZONES (depth):
TopoO�d settingt
[]Ridge ope []Valley OFiat
(check appropriate boa)
Latitude/longitude of well location
(degrealminutes/s )
Latitude/longitude source:OGPSOTopographic map
(check box)
FRILLING LOG
Formation Description
DEPTH
From To
11. DISINFECTION: Type CC/%
12. CASING:
Fro
From
From
13. GROUT:
From
From
14. SCREEN:
From
From
15. SAND/
(Street or Route No.)
ity or Town State Zip Code
From Ft.
From Ft.
Amount /a' O Z.
���0� Wall Thickness
Depth,, Ft :liter
or Weight/Ft. Material
f/ SD,e2/ pvc
To Ft.
To Ft
Depth Material //
To 7� Ft/O/!G/'G1Cj' ,Al? Milt
To Ft.
Depth Diameter Slot Size Material
To Ft. in. in.
To Ft. in. in.
VEL PACK:
Depth Size Material
` To
(/ To
16. REMARKS:
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common road names.
47 L
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSCTION STANQARDS, AND PY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
SIGNA
OF PERSON CONSTRUCTING THE WELL
fill;°Y
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

( >-
Area code- Phone number
4. DATE DRILLED n 0 2 O C�
5. TOTAL DEPTH:5
6. DOES WELL REPLACE EXISTING WELT. ` =v. 11i0 k'a
7. STATIC WATER LEVEL Below Top at C
t(Use 3 ifm§nv: top 0.
8. TOP OF CASING IS / •.5 FT: Above Land Surface
'Top Menial terminated at/er below land surface requires a
variance hi aetordane ISA NCAC 2C .0118. .—.r
9. YIELD (gpm): 0 METHOD OF TEST //1» eof
10. WATER ZONES (depth):
11. DISINFECTION: Type C.C. /✓
t2. CASING:
. 0 rt. fart
From To Ft.
13. GROUT: Depth Material M ejhod r
From To 'LA FL eCihellef P W et Mir
From To Ft. /
14. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in.
From To Ft. in. in.
15. SAND/G VEL PACK:
Depth Size
From To Ft.
From / To Ft.
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and N ��Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (p(paint)e///e ,qiy/
WELL CONTRACTOR COMPANY NAMES/me otet- see G (1 J (t: / (t n
STATE WELL CONSTRUCTION PERMIT./ SSOCIATED WQ PERMIT()
(if applicable) OF applicable)
CERTIFICATION 8 Z8 7 7
PHONE a itfl449'0440
1. WELL USE (Check Applicable Box): Residential I MuuicipaI/Public ❑ Industrial ❑ Agricultural ❑
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other ❑ If Other, List Use
2. WELL LOCATION:
Nearest Town51J74Q I' O re. County 81411CoWl
27C Tones -oco_e fct 247SY
(Street Name, Numbers, Community. Subdivision, Lot No., Zip Code)
3. OWNER:
Address
SWAIN AM; «Nc'
City or Town State Tip Code
.7 R95—v
Amount /Q e z
'-Vmi11iaicbes;
cr WSf M coal
.f, . ozi _Inks
16. REMARKS:
Material
Topogr phic/Land setting
❑Ridge 114Slope ❑Valley ❑Fiat
(check appropriate box)
Latitude/longitude of well location
(deareesiminnmt/seco ) Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From To Formation Description
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common mad names.
I DO HEREBY CERTI
CONSTRUCTIO
THAT THIS WELT WAS CONSTRU
)ARDS, AND THAT
Air
SIGNATURE OF P
at IN ACCORDANCE WITH I5A NCAC 2C, WELL
Y O PIS RECORD HAS BEEN PROVIDED TO TFIE WELL OWNER.
ON CONSTRUCTING THE WELL
//DA f V
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 NatwJ Resources - Divisign of Water QualityGroundwater Section
CONTRACTOR COMPANY. vw n/aJt�Jc.t 1wirTIC LL ( (.1 P: I Is n9 PRONE # s(oqq-ogpo
STATE WELL CONSTRUCTION PER6IIT#_ AS.00IATED WQ PERMIT#
(if applicable) _ / (if applicable)
1. WELL USE (Check Applicable Box): Residential IJ Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION:
Nearest Town: County GO��
LoT�574 n inns �(na �jrc4& en /9/k.
(Street Name, Numbers, Community, Subdivision, Lot No-, Tap Code)
3. OWNER: Lam) eof'to � / le
Address L.,aT SA• V hors /1nAh Tfrehia.4
No.)
aiW
305791
y 'con
WELL CONTRACTOR (INDIVIDUAL) NAME (print) ,j (.r RitO to 5 V'2'-CERTIPiCATION #y J7y
WELL
City or Town State Zip Code
Area code- Plume number
4. DATE DRILLED ifs lc" Or
5. TOTAL DEPTH: S� yf
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO 0
7. STATIC WATER LEVEL Below Top of Casing: / /O FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS 1. FT. Above Land Surface'
*Top of casing terminated at/or belaw land surface requires a
variance rat accordaue MIS. 1SA NCAC 2C 18. —t /
9 YIELD (gpm): 'd METHOD OF TEST ///h ref
10. WATER ZONES (depth):
11. DISINFECTION: Type r . CJ'!
12. CASING:
Depth,
From 00 To Ft.
From_ To Ft.
From To Ft.
Tapogtaphic/Land setting
❑Ridge 3, Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(deweClmiwtes/saonda)
Latitude/longitude source:❑GPS❑To hiv Map
P
(check boa)
pEPTu
From To
DRILLING LOG
Formation Description
LOCATION SKETCH
Amount /U e Z Show direction and distance in tiles from at least
Wall Thickness two State Roads or County Roads. Include the road
5 pit IJL numbers and co., names.
13. GROUT: Depth Material /
From To tO Ft. rOnC/Cie
From To Ft.
14. SCREEN: Depth Diameter
From To Ft. in
From To Ft. in.
15. SAND/GRAVEL PACK
Depth Size Material
From To Ft.
From To Ft.
Slot Size Material
in.
in.
1 DO HEREBY CERTIiY THAT THIS WELL WAS CONS I IyOettu IN A ORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION� 1I(NDARDS,//AND THApY Oft uiS RECOHAS BEEN PROVIDED TO THE WELL OWNER
SIGNATORE OF PERSON CON IRUCTING THE WELL DATE
Submit the original to the Division of Water Quality, Groundwater Section, I636 Mail Service Center - Raleigh, NC
27699-1636 Phone No. (919) 7333221, within 30 days.
GW-1 REV. 07/2001

305805
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and N•rota.Rcsourccs - Division oft 'Water Quality - Groundwater Section y
WELL CONTRACTOR (INDIVIDUAL) NAME (rim) (3 1 )"')'-'( C., F31A S N CERTIFICATION ,a-i I (
WELL CONTRACTOR COMPANYNAME_RUDEN CALDWELL DRILLING, INC. PHONEY?(8 )254-3581
STATE WELL CONSTRUCTION PERMIT/ ASSOCIATED WQ PERMIT/
(if applicable) (i f applicable)
I. WELL USE (Check Applicable Box): Residential Er/Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION: �n � /I
Nearest Town: EAJ S �'4t LLE County UiJa) r/Y.1/46
WOG �1tOei .AC)
(Street Name, Numbcn, Community, Subdins,on, Let No., Zip Coda)
3.OWNER: 1` GeR- `3)IL"yr'n
Address `VI O L O n1f s. I aJ CI (Lo
No
tea e mf izA .C) t3 C &% `(81
,.,,,City or Town stale ip Code
Ann code- Phone number AA
4. DATE DRILLED \ a 6 - ` `l
5. TOTAL DEPTH: 3 1 0 f /
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO IS
7. STATIC WATER LEVEL E low Top of Cuing: (O D FT.
(UsC+ if Above Top of Carina)
8. TOP OF CASING 1S FT. Above Land Surface'
•Top of caking tsrmlaated at/or below lead eurfsu requires a
variance in accardeacytelia ISA NCAC 2C .011a. /�
9. YIELD (gpm): 1 METHOD OF TEST (Lt G - f't i a'
10. WATER ZONES (depth):
11. DISINFECTION: Type 'I c(a G' Amount
12. CASING: Wall Thickness
Depth St or Wcia WFt.
Front To 5D Ft. so a k
From To Ft.
From To Ft.
13. GROUT; Depth, Depth Material Method
From .1 To 90 FL C`aMLta.f Pooilt-D
From To Ft.
14. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in.
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Site Niaienal
From To Ft.
Front To Ft.
int
Topographic/Land settin
❑Ridge ❑Slope ❑Valley tat
(check appropriate box)
Latitude/longitude of well location
(depvcehniantedaecoods)
Latitude/longitude source:❑GPS❑Topographic map
(cheek box)
DRILLING LOG
Fo do Desccriiption�
pEPTIi
From / To¢5
4^5 ; - at5
a4s '
�1$5r-310'
citNtc6 - a
gia 'TF
J 0 ).00ATION SKETCH F:
Show direction and distance in miles from at It
two State Roads or County Roads. Include the ad
numbers and common road names.
(Q al An
t Q2AtacrF
e
Kc6KJ /LO
-15 r"
x
1'
16. REMARKS:
1 DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED M ACCORDANCE WITH 1SA NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND TIIAT 4OPY OF THIS RECORD BEEN PROVIDED TO THE WELL OWNER
J.St c. 1 1 : a-1 - o 4-
SIGNATURE 0
ERSON CONSTRUCTING TIIE WELL
DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mali Service Center -Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-1 REV. 07/2001

WELL CONSTRUCTION RECORD
305803
North Carolina - Department of Environment and hi•nual Resource..? - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (prise) 6 1 Li-%t, F')A S'v CERTIpFICATION$ al 1
WELL CONTRACTOR COMPANY NAME_RF.UDEN CALDWELL DRILLING, INC. PNONCY?j8 )54-3561
STATE WELL CONSTRUCTION PERMIT/ ASSOCIATED WQ PERMIT/
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential fH/ Municipal/Publie 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION: /
Nearest Town: 11Sj1e I 1--L4 County
S P t J MT^)
Subdina
Numbers. C unity,
(Street Name, N ry, ion, tot No• Zip Code)
3.OWNER: Dcoc., 'IUJb'r?_
Address /1 \ S 146IZDC e, �•
p yt b-nATe
D4€1l Le a Rou^lat N�.) a•• O 0 Z'
try or Town SWe Zip Code
g5 —vat\
Area coda Pbona number
4. DATE DRILLED 1
5. TOTAL DEPTH:
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO l
7. STATIC WATER LEVEL Below Top of Casing: .bFT.
tun • it Above Top of Cams)
8. TOP OF CASING IS FT. Above Land Surface*
`Top of cuing terminated aUar bel•w laud surface repulru •
variance la accord. with ISA NCAC 2C.0111.
9. YIELD (gpm): aD METHOD OF TEST gA G R i L
10. WATER. ZONES (depth): J
(( bO�J ao (yam crt
I
11. DISINFECTION: Type N1TEJ `�O/o Amount %a tp
12. CASING: Wall Thickness
Depth r or Wei 1/Fi. • nal
From 1 To I3•0 Ft. 6 S it k
From To Ft.
From To Ft.
13. GROUT -A. Depth Material
From To at) Ft.
From To Ft.
14. SCREEN: Depth Diameter Slot Sire Material
From To Fi. in. in.
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Size hlatuul
From To Ft
From To Ft.
16. REMARKS:
Topographic/Land setting
Ridge 0Slepe ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(deyaeNmbatesiaecoodr)
Latitude/longitude source:❑GPS❑Topographic map
(chak box)
DEPTH DRILLING LOG
Fr n / To / Formation Description,
26vf�t,("a
R171— 3(06i 6P-NN lib
3ba4,661 C i(IC� ac Urn
GA-P N t7t
LOCATION SKETCH
Show direction and distance in miles from3Cieast
two State Roads or County Roads. Include the road
numbers and common road names.
SPldn l rvcr rri
rr J
Nk-KI MAii S N C-0'(t6
rn Yi
JaN'5ioa ScLD.L (.»
1 DO HEREBY CERTIFY TIIAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WM1 ISA NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT P TI(IS I\CO fIAS BEEN PROVIDED TO TI WELL O R
1,30 IOA-
SIGNATURE OF PERSON CONSTRUCTING TILE WELL /DATE
/
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mall Service Center -Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. G W-1 REV. 07/2001

/� , tQ�!'LL t/CAT! 1 CERTIFICATION��# 3354
DELI, CON TR4C' 'OR COMPANY NAME &tent S &).(-a, w ra m n.S kite, PRONE # M.a�K L , - 3170
SLATE WELL CONSTRUCTION PERMIT# a -a
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print)
ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
1. WELL ESE (Check Applicable Box): Residential Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water njection 0 Other 0 If Other, List Use
2. WELL, LOCATION•
Ne:Ir'stTown: F, Ca.nn�i��
tea >LexaLAI r'CLJrt '
(Street Name, Numbers, Community, Subdivision, Lot No.. Zip Code)
3. OWNER:
Address et -re, > •1 -
-) IS eet or Route No) C
City or Town Stut1
( )-
County sL"jt 2JC.plrn ).J i
3h C .Q ? /S'
Zip Code
11. DISINFECTION: Type
12. CASINO:
Depth
FromQTo (,p3.[ Ft. 1(a e)
From To Ft.
From __ To Ft.
13. GROUT: Depth Material
Frornl_40 To aQ
From To Ft.
I4- SCREEN: Depth Diameter
From _ _..._ To Ft. in.
From To - Ft. in.
15. SAND/GRAVEL PACK:
Depth Size
From.___. To Ft.
From _ To Ft.
Aie i code- Phone number
4. DATE DRILLED 1 1- 1 - 6 1
5. TOTAL DEPTH: .P1,32 5
))3 ,S %:I.1 1 REPLACE I:YIC'l!NIL AAIL.I-1 9 VI.S 1 1 NO 1A4
7. STATIC' WATER LEVEL Below Top of Casing: 1 fl FT.
(Use"+" if Above Top of Casing)
H. TOP OF CASING IS / FT. Above Land Surface*
'Top of casing terminated at/ur below land surface requires a
variance in accordance with 15A NCAC 2C .0118.
9. YIELD (gpm): (p METHOD OF TEST 11
h__ -
0. WATER ZONES (depth): / `IS ( t�-
"r..
7 u
/17/-i Amount q 1 4-1, f
Wall Thickness
Diameter or Weight/Ft.
Topographic/Land setting
at
❑Ridge ❑Slope ❑Valley Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topogta}thic map
(check box) -
DRILLING LOG
Formation Description
DEPTHTr)From T
43.E
.- 1 - 21pY�
FtSoar 7F
16.REMARKS:
Materi
i<
al
PVG
Method
Slot Size
in.
in.
Material
Material
Celeb
305725
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common road names.
I DO I IERFI3Y ('ERTIFY THAT T111S WELL WAS CONSTRUCTED IN ACCORDANCE WITII 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RECORD IIAS BEEN PROVIDED TO THE WELL OWNER
?�J4ee ao lu It"31) of
SIGNA DIRE 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

305723
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print)Rpq J kl_S 1 1 _
WELL CONTRACTOR COMPANY NAME l 1- `4 f� CERTIFICATION #,3g,/j
"Ere G1'1C rn S/ 1 )t1L �J Pnx t- t_ PHONE # (s2 Co `>f `{_ .3 1 7 STATE WELL CONSTRUCTION PERMIT#,.. I Qa
ASSOCIATED WQ PF,RMIT#
(if applicable)
(if applicable)
1 WELL USE (('heck Applicable Box): Residential, Municipal/Public ❑ Industrial ❑ Agricultural ❑
Monitoring ❑ Recovery ❑ Beat Pump Water Injection ❑ Other ❑ If Other, List Use
2. WELL LOCATION:
Nearest Town:
(Street Name, Numbers, Community, Subdivision, Lot No.. Zip Code)
Nu
3. OWNER: Pa-3/41-t
Address
( Street or Route No) rCll (Ay or Town Slate Zip Code
Area code- Phone number
4. DATI1 DRILLED I p
5. TOTAL
()DES WI! I REPLACE I VII,'!!! ,3 1AlPl I'J YES I 1 NII *4
7. STATIC' WATER LEVEL Below Top of Casing:
___,21Z_FT.
R. TOP OF CASING IS _— FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordance with ISA N(:AC 2C .0118.
9. YILLD (gpm):. METHOD OF TEST _ hra
10. WATER ZONES (depth):
II. DISINFECTION: Type
12. C'ASIN(E
Depth
From._-
From To
epth
Prurn� __. "I�_
From To
14. S('REEN: Depth
From ___ To
To
From__ To
15. SAND/GRAVEL PACK:
Depth
From To
From._ To
(Use "+" if Above Top of Casing)
1.71114_ Amount a9 _ 1 l5_,
Wall Thickness
Diameter or Weight/Ft. Material
Et.— ` 11
Ft.
FromTo Ft.
13. GROUT: D ------
16. REMARKS:
Material Method
Ft.
Diameter Slot Size Material
Ft. in.
in. - — in.
Size Material
Ft._
Ft.
Topo raphic/Land setting
❑Ridge '$slope ❑Valley ❑Flat
tcheck 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
S_e1_ iu�I antie
LOCATION
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common road names.
I DO IIEREBY CERTIFY TIAAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
(ONS'IRUC ION STANDARDS, AND'1HAT A COPY OF THIS RECOORDD HAS BEEN PROVIDED TO TIIE WELL OWNER
SIGNATURE I URF OF PERSON CONSTRUCTING TIIE 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)_ 1 ,)
//�'� . Pr:-_..-�UVQ_� l CERTIFICATIONC,,#,.�3.5i
WELL CONTRACTOR COMPANY NAME GrQ.!'1 t_a Cnr, 1f/La t Pvt. �rA4 ,PHONE k(�t.,(Q.4311._„7_.3/%a
STATE WELL CONSTRUCTION PERMIT#
(if applicable) - -- ASSOCIATED WQ PERMIT#
(if applicable)
4/6,7
I. WELL USE (Check Applicable Box): Residential Municipal/Public ❑ Industrial ❑ Agricultural ❑ Monitoring ❑ Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATIO
Nearest Town: r County p *440___;
/
' . -:Ork
treet I SN; ne Numbers. Community. SubtlivitAon. Lot No.. Zip Code)
3. OWNER.
Address __. Pe') 8Ax %5.2,S __ ___ Lt to
/ (Stt Route No.)
C ity or Tuwn/�YY/C ���/�
Stale � Zip Code
Arcs code- Phone number
4. DATE DRILLED /6 _LW
5. TOTAL DEPTH: 2 per-
!;!?I.Q AAll:l I RkP /,/'t. I: VIC'l INI: AA/I.t ') V t. ' t I NO Y/I
7. STATIC WATER LEVEL Below Top of Casing:. _FT.
(use "+" if Above Top of Casing)
R. TOP OF CASING 1S / FT. Above Land Surface*
*'1 op of casing terminated at/or below land surface requires a
variance in accordance with 15A NCAC 2C .0118.
9. YIELD (gpm): _422— METHOD OF TEST_ .Q /, rs
I0. WATER ZONES (depth):
an
11. DISINFECTION: Type /-/ TJI Amount
12. CASING: 1/0
Wall Thickness
Depth Diameter or Weight/Ft. Material
From_ a To / S/ / Ft. /±
From __ To Ft ��.
From —___To Ft.
13. GROUT: Depth Material
Method
P✓e4.
From f To ,4 _ Ft. 10 .4410 if i
From To Ft.
14- SCREEN: Depth Diameter Slot Size
From_ Material
_ TO Ft. in. in.
From. _ To Ft. in
15. S.AND/GRAVELPACK: m.
Depth Size Material
From __ To Ft.
From ____ To Ft.
16. REMARKS:
I DO IIEREBY CERTIFY TIIAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCT ION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO TIIE WELL OWNER
k_7
` / Topographic/Land setting
)Ridge ❑Slope ❑Valley ['Flat/ )4
(cheek appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(cheek hox)
DEPTH DRILLING LOG
From To Formation Description
6 /11/ / P
I,OCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common road names.
SIGNATURE OF PERSON CONSTRUC'TING TIIE WELL
CL/26
305722
// .3d -6 V
DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
27699-1636 Phone No. [phone], within 30 days.
GW-I REV. 07/2001
1;a

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources
- Division of Water Quality
WELL CONTRACTOR (INDIVIDUAL) NAME
1 (print) i e_P .LJLI Vet (1
/
WELL CONTRACTOR COMPANY NAME I Yee1'le l3YQlIS. Lop,Palm L1_rwc—
STATE WELL CONSTRUCTION PERMIT#
ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
1414
305721
- Groundwater Section ,/
CERTIFICATTIION #'3_� of
PHONE # (R'..I <o'f�' "..3� 76
I. WELL USE. (Check Applicable Box): Residential Xl Municipal/Public ❑ Industrial ❑ Agricultural ❑
Monitoring ❑ Recovery O Heat Pump Water Injection ❑ Other ❑ If Other, List Use
WELL LOCATION:
Nearest Town: ( c.n, Abe County2tuacinisb
(Street Name, ambers, Community. Subdivision, Lot No., Zip Code)
3. OWNER:
Address
L(S wl or Rout Noj
City or gown State e
( Ai ea Bode- Phone number
4. DATE DRILLED I0-Q(o-ID
5. TOTAL DEPTH: 3R5t
. /)LI UILI I UI.PI AU!' LYIC"I I8M1 Wk!.! 7 V1.,8 LI NU
7. STATIC WATER LEVEL Below Top of Casing: 40 FT.
(Use "+" if Above Top of Casing)
fi. TOP OF CASING IS I FT. Above Land Surface*
*'lop of casing terminated at/or below land surface requires a
sariance in accordance with 15A NCAC 2C.0118.
9. YILLD (gpm): l OD METHOD OF TEST a krs
10.WATER ZONES (depth): €DSI-I`ac�pm R5= I�S�pe
Si. 1-
*)RhIS
Zip (Ode
Topographic/Land setting
l.Ridge ❑Slope OVallcy DFlat.
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source: ❑GPSDTopographic map
(check box)
DRILLING LOG
Formation Description
DEPTH
From To
® .to
.Ra In .i45_
IOS' 70 ciiP^
1 1 _ DISINFECTION: Type_E{'T}-1 Amount L 3 91,I1-S
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
From b To 3A.LA Ft. (p 11 P\I C
From To Et.
From To Ft.
13. GROUT_ Depth Material yy
From fl To cD Ft. .k ?pe;n I
From To Ft.
14. SCREEN: Depth Diameter Slot Size Material
From To Ft. in, in.
From To - Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
16. REMARKS:
Method
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common road namcs.
1 DO I IEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
('UNSfRU('LION STANDARDS, AND THAT A COPY OF TIIIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
VAX 4-2
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-1 REV. 07/2001
Y

30'7264
nhmTnH ECORD
W LL e
Department or Environment end Natures Refoureea • Dlvi{Ion of Water Quality • Grouodwatts Section
North Carolina • Dep CLRTnICATSON eaa
a52LL COf•TRGCTOR (rNDMDUM.)N �L (pdel) R ..`` (* 11 t PtA rY10 Cn TNONi./,1.
a
WELL CONTRACTOR COMPANY NAME --,---------ASSOCIATED WO TLRMIT'
STATE WELL CONSTRUCTION PERMITt ft••lieable
It liable
strial / O'
1: WELL USE (Check very 0bleHat Box):
WaterlInjection D.L9Sher)❑ if Other, List We. Agricultural 1
Monitoring 0 Recovery P
2.
WELL LOCATLON:
Nearest Town: ((��t r� County^
(Street Herm Numbers. Community• Subdivision. tal No., lip Code)
3. OWNER: e t� i bF — :a —
Address ST 54,12er -'^- J
(Street or Route No.)
� I'
'�orkr_rni-73 tJ
• Cif/ or Town State .Zip Cade
( )- 45-t11111
Ares code- none number
4. DATE DRILLED-Itn-04
5. TOTAL DEPTH,: 1�
6. DOES WELL. RPLACE EXISTING WELL? YES ❑ 1.10 O-
7. STATIC WATER LEVEL Below Top of Casing: • Af FT.
vita "*" If Above Top of Culnt)
8. TOP OF CASING IS 1 FT. Above Land Surface*
*Top of ruler terminated Aver below Ind endue ndulree a
mina In *Nard,nee with ISA NCAC2C.0111.
9. YIELD (gpm): 50 METHOD OF TEST VICE;
•10. WATER ZONES (depth): /2 5 S 0 spot
.IL
DISINFECTION: Type
4ITN Amount
r 12. CASING: Will Thickness
j1AUTt. twill
FronL�TpIh Di eter or W32, Ft, a `, t'C
Fromaz To 52, Ft
From To Ft
13. GROUT: Depth M/ayterial'
F.to'M (9 To 2 fl Ft. <AL/SR iE
From To Ft.
14 SCREEN: Depth Diameter Slot Size Material
From To Ft. in. ___ in.
-From_ To Ft. in. _ in.
I5. SAND/GRAVEL PACK. Size MitEriJ
Depth
Frorn To Ft.
s
-.From To Ft.
16. REMARKS:
I DO REREBY CERTIFY THAT THIS WELL WAS CONSTRU
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS
SIGN ATURad P1 SOCONSTRUCTIN0T133WEUe . DATS
•
�fi*t�tthe original to tb e Division oT�WateT Quality,C
ffDTetm i?atefStetlon,1626 Mill Ser+iee Ceei`1+t7
i.mi=�t I626 ?bone No. [phone], wlthtn 30 days.
Akr_ •
(d.Qeesrmieutettteeetet)
Latitude/longitvde source:1:9G7SOT0POgaph10
(cheek be)"--. " �ao.
Fo tioil t esetiptiCn
Topographic/Land settitg .
°Ridge ❑Slope 13ley °Flat
(deck apprepdau bes)
LetiNdeAon2girUtrdedwell location
as a U=1oSa°I 7'-L1 "r
From To
a - Vo
O — 5
t44 Lc5—
Si Of1�
Show direction and distance in tittles T(Qjt1 atll
two State Roads or County RoidsIneliide the
numbers and common road names.'
its )yy/7 gy
D IN ACCORDANCE WITH 'ISA NCAC 2C, Why'
CCVS BEEN PROVIDED TO THE WELL.OWNER
fifr /z /C-t'

C307 (.+V 6
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and 1-I Refounes • D)yltlo ; of Water Quality • Orouodwtiit Sectefli
WILL CONTRA CTOR (iW MDVAL)NAML (ono 1
15f1 1(�, t Srn dri N . CZRrtrto TIO$ •at
r�
WELL CONTRACTOR COMPANY NAME Girl n Malta' \Ms Ilk Pvcrr1 P en ?stoma.' ftih L R 4 l.; ,1
STATE WELL CONSTRUcnon PERMED ASSOCIATED WQ PERMIT% „y
fa applicable) (feppliuble) a'
( PP I. WELL USE (Check Applicable Box): Residential 0 MunicipalSlic 0 Industrial 0 Agricultural O
Monitoring 0 Recovery Cl�I
Neat Pump Water Injection Oher 0 If Other, List Use /'
2. WELL LOCATIQJ'
Nearest Town: 1 PP�ixn
I, t mt7vH ca. •
(Street Name. Numbers. Communiy, Subdiv(tien, Let Ne" Zip Cede)
3. OWNER: 1' 11 Arh Merr i,r],
Address t`QnS 5hLarttn\+"Kota
(Street or Route No.)
df117.). Me
• City or Town Stem
(ire()• IBB'4—ily4
Area code- Pbont number
4. DATE DRILLED // — 2 If —Oh"
5. TOTAL DEPTH: 7‘<}
6. DOES WELL REPLACE EXISTING WELL? YES �OjNO 6
G
7. STATIC WATER LEVEL Below Top of Casing: • t9 FT.
(Ue• "+" If Above Top of Cuing)
8. TOP OF CASING IS / FT. Above Land Surface*
'Top of nag terminated ever below Iced serimN requires t
variance In accordente with ISA NCAC 2C .011e.
9. YIELD (gpm): 2 0 METHOD OF TEST %4-, 2
.10. WATER ZONES (depth): %. A 7 ,,
County "-ZCane_cn*4-4,-.•
I I. DISINFECTION: Type
12. CASINO:
Froi
Fro
Fro
Depth
To
To
To
as1 u
. Zip Code
/f 77t
13. GROUT: Depth • .
From - & Tom Ft.
From To Ft.
14. SCREEN: Depth Diameter Slot Size Material
From To Ft in in.
'From To Ft. in in.
15. SAND/GRAVEL PACK:
Depth Site Mg eritl
From To Ft. f'
From To Ft.
Amount
Wall Thickness
Ohm et or Weight/Ft. Material
214
Ma{etisi � ' Metho
S/¢KIZSte t{1 Z
16. REMARKS:
1 DO HEREBY CERTIFY THAT THIS WELL WAS C
CONSTRUCTION STAI RDS, AND THAT A COP
Topo�graphie/Land setting •
W'S ❑Ridge lope °Valley. dF1at
(check appropriem boa)
Latittde/longitud ofwell dobatio ''.%.
3S 2e San/ ot2 /t SVte?
(den tes/mieetuheeeeds)�.!;
Latitude/longihide souree:OG`PS❑To¢ogaphio.
(cheek Tex); -v.:y
DR1LL1140 L4(''
Forms D INterigi
CIA
DEPTH
From To_
0 " /5
/3'— /2C
/ 5 — / 2S—"
`4 — 'A //h
/7Ars, arc
LOCATION SKETCfi:
Show direction and distance in
two State Roads or County R. ii 1hflifde
numbers and common road nam'
aiy 611/Zit
.; STRUCTED IN ACCORDANCE WITH ISA NCAC 2C, %FEJS.
OP THIS a CORD HAS BEEN PROVIDED TO THE WELL OWNER -:
It ems,. // 2'y-by d
51C NATURE OF PERSON,CONSTRUCTINO,THE WELL DATE.;.'
' ontiBl throriginal to the Division oGWatei;QUalltys G+Potsndil�itef Seet]on 1636 Mill Ser+iee Coe/et;
:27699-1676 ?boos No. [phone], synths 30 days.' cm' I ]t$Cr, 6T/2
MAn o ..._

306899
WELL CONSTRUCTION RECORD
North Carolina - Dcpanment of Environment and Naturalat%Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) &ti ey ✓ &S 1? CERTIFICATION Fel°
tt'E LLCONTRACI'ORCOMI'ANY NAME t�5�-t C$ LJPI D% LCtr72
/ puONE # ( ) - Lira
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
tifapplicable) (if applicable)
I. WELL USE (Check Applicable Box): Residential El/ Municipal/Public ❑ Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection ❑ Other 0 If Other, List Use
WELL LOCATION:
Nearest own: 't•-eG/GL
(Street N t -c, Numbers. Com unity, Subdivision, Lot No.. Zip Code)
County ff%itt.eent t''t
3. OWNER: e trog*,_,Ofi
Address 517 !/t:, L SC ,4,, /
(Street or Route No.)
"-hiCti' rU e Q70Q
,City or Town State Zip Code
(fa-, )- ('o�em7^ '2 7fq
Area code- Phone number
4. DATE DRILLED 12
Topo is/Land setting
❑Ridge lope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degreestminutas/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From To Formation Description
5. TOTAL DEPTH:, S
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO f-
7. STATIC WATER LEVEL Below Top of Casing: FT.
(Use "s^ if Above Top of Casing)
8. TOP OF CASING IS / FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordance with I5A NCAC 2C .0118.
9. YIELD (gpm): / 2- METHOD OF TEST
10. WATER ZONES (depth):
!2 'g^rC Zoe
I I. DISINFECTION: Type(icif;bti Amount e6it 7.P
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
From To
From 0 To 7v
13. GROUT: Depth Material
From To Ft.
From CI To `Z 7 Ft. '�(/-tt
14. SCREEN: Depth Diameter Slot Size
From To Ft. in. in.
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Size
From To Ft.
From To /- Ft. nn ,{ / a p
16. REMARKS: (j(� 'At 6-/i9 /C2ai' ,i itet 126
Material
1 DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARD ND THAT A COPY9F THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
F PERSON CONSTRUCTING THE WELL
© tco
fin— 2tY)
LOCATION SKETCH
Show direction and distance in miles from at (east
two State Roads or County Roads. Include the
numbers and common road names.
Yd f) t z
eE 6,4Li
Method *)
XP
DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Senice Center -Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-1 REV. 07/2001
MAR - 8 2OO
bike
4

WELL CONSTRUCTION RECORD P 3 0 6 9 U 6
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
\V ELL CONTRACTOR (INDIVIDUAL) NAME (print) L4r4 .J GS`/1 Lt CERTIFICATION '
w ELL CONTRACTOR COMPANY NAME
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
t if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other ❑ If Other, List Use
2. WELL LOCATION: �t �"
Nearest Town: &Li. County /bw�.ee7.ti-C-
/6 Cente_ Pei
(Street Name, Numbers. Community. Subdivision, Lot No.. Zip Code)
3. OWNER: de6✓ y�cnv—
Address a7g ie a gal !?' We/Ltd
(Street or Rome No.)
City or Town State Zip Code
( )- ('05-771y
Area code- Phone number
4. DATE DRILLED /Z— 27_cq
_Teptigraphic/Land setting
edge ❑Slope ❑Valley ❑Flat
(check appropriate box) c�
Latitude/longitude of well location Z ,
N
(degrees/minutes/seconds) 03
Latitude/longitude source:❑GPS❑Topographiijnap ;tea
(check box) C.11
DEPTH DRILLING LOG
From To Formation Description
!%i
5. TOTAL DEPTH: cr s— efie L
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO C3�
7. STATIC WATER LEVEL Below Top of Casing: nu; FT.
(Use'4^ if Above Top of Casing)
3. TOP OF CASING IS FT. Above Land Surface*
*Top of casing terminated atlor below land surface requires a
variance in accordance with 15A NCAC 2C .0118.
9. YIELD(gpm): 6 METHOD OFTEST d4/rC
10. WATER ZONES (depth): G e2",Gy f ces
1 I. DISINFECTION: Typeeg,tie-y.—e.
12. CASING:
From $rr
13. GROUT:
From
From C7 To ev )
14. SCREEN: Depth
From To
From To
15. SAND/GRAVEL PACK:
Depth
From To
From
Depth
From To Ft.
From (9 To r/ Ft.
To Cf FL
Depth
To
r't CY/ C4- 4-jett iir: «"3 HOPIE a ( ) )?Le-4d%{de
Amount le U v
WaII Thickness
Diameter or Weight/Ft. Material
/51
Material
c/o pc -r
/iv 5,,4C
Ft.
Ft. /j-ai1
Diameter Slot Size Materi
Ft. in. in.
Ft. in. in.
Method
Size
Ft.
To FL
16. REMARKS:
1 DO HEREBY CERTIFY THATTHI
CONSTRUCTION STANDARDS„A
Material
50"_ice fii t2�
52- 3Y5-
6-rr
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.
Gkt tri
WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
SIGNATUI
F PERSON CONSTRUCTING THE WELL
DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Senicc Center -Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-1 REV. 07/2001
MAR - 8 2005

01S-)
306 43
WELL, CONSTRUCTION RECORD
North Carolina - Department of Environment and U t,)rlel Ruourcc, - Division of Water Quality - Groundwater Section
WCLL CONTRACTOR (INDIVIDUAL) NAME. (prlel) .) 1 t_t_t NI0„,s RRT7PICATION/ ,I I
CALDWELL DRILLING, INC.
WELL CONT RAI IOR COIN rANY NAME REUBEtN
PHONE
STATE WELL CONSTRUCTION PERM RI ASSOCIATED WQ Pt RM fie
(if applicable) (i (appl iuble)
Q?I8 54-3581
1. WELL USE (Check Applicable Box): Residential Q' MunicipaVPublic 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Nest Pump Waite Injection 0 Other 0 If Other, List Use
2. WELL LOCATION:
Nearest Town: e f1S ti ff \t w
tV -1t 5 GA2(Zc1 Cttt.e IC
(S Ueer Name, tlumbcn, Community, Subdrnnon, law No, Zip Cafe)
3. OWNER:
County b'—' act , 'i
Address 3 ' v L nT -TO { iyvTN tcL r
(Suter or Rowe No )
A. 1IZJ 1 ('_ 4v 'N C
a8-1"3u
City or Town Sum Zip Coale
Ina-03 t l
Ana code- Phone number
4. DATE DRILLED It)/
5. TOTAL DEPTH: I p '
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO 0
7. STATIC WATER LEVEL Below Top of Casing 4- U FT.
1 are • if Above top of Coma)
8. TOP OF CASING IS FT. Above Land Surface•
'Top of colon laminated Wet baba bed sofas, requites •
via -Macs la madam veins ISA NCAC IC .0111.
9. YIELD (gpm): 1 5 METHOD OF TEST r' G - P I
10. WATER ZONES (depth): 1 Y L - \ `j Le,.,
11. DISINFECTION: Type ($n&-
12. CASING:
Depth Diameter
From 1 To Li g Ft. b CS
From To Ft.
From To Ft
13. GROUT: Depth
From 1 To a O Ft.
Amount I/7
WJI Illicitness
or Weight/Ft. Material
',r)a (C_
Material
L c r ACN r
From To Ft.
14. SCREEN: Depth Diameter Slot Sat Material
From To Ft. in. in.
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Silt hLluul
From To Ft.
From To Ft.
Method
16. REMARKS:
/ FopogTaphi c/L and setting
mkidge ❑Slope ❑Valley ❑Flat
(Sack appropriate box)
L aiitudr/longitude of well location
(deV taht inu musaconde )
Latitude/longitude sourcc:OGPS❑Topographic map
(clink boa)
DEPT!! DRILLING LOQ
From / To / Formation Description
.9 - C OvLrt(%viCOtu
r13/- l�C C-ailuvtTC
1$c' tea Ger‘.Cg-ellCC
3
N
(I1
LOCATION SKEFCII eat
Show direction and distance in miles from atast
two State Roads or County Roads. Include the road
numbers and common road names.
('ttec
d 7G 5-
VS 1 q-
1 DO IIEREDY CERTIFY T1IAT THIS WELL WAS CONS 1 RUC(L'D IN ACCORDANCE WITTI ISA NCAC 2C. WELL
CONSTRUCTION STANDARDS, AND THAT COPY OF DOS RESORD IIAS PROVIDED TO TIES WELL OWNER
l , (AAA iL Va4-
SIGNATURE OF PERSON CONSTRUCTING 11111 WELL AT[!
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mall Service Cerra- Raleigh, NC
27699-1636 Phone No. (919) 733-322I, within 30 days. GW-I REV. 07/2001

306768
WELL, ('(INSTRUCTION RECORD
North Carotins - Department of Envuonn,cnl and ti•r.,rraal Reaource_s - Division of Water Quality - Grouodwaler Section
WELL CONTRACTOR (INDIVIDUAL) NAME (PNu1 /I r-LIC- "-1\sr CERTIFICATION / 11
WELL CONTRACTOR COMPANY NAME- RF.UBEN CALDWELL DRILLING, INC. i8 )21
rltoNE4 54-358
STATE WELL CONSTRUCTION PERMIT/ OCIATED WQ PERM IT/
(if applicable) (if applicable)
1. WELL USE (Check Applicable Dos): Residential f3 Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION:
Nearest Town: FAIK•i LK) County
—7A C>AARtr3 C.Cr-AIL
(Saver Name, Numbcn, Conununiry, Sutxtt n Ld No, bp Cod()
3. OWNER: L F i 1`4
Address 2) Q" c rtL.A"i Te,lt3 YV•Tr., Ro-
A K.)Suter w Row. No)
��w(� a g-13u
Ciry or Town Suit Zip Codc
(3O5)- `l to - o:. 1 1
Ara code- one number t0/I 4 / 9—
4. DATE DRILLED Ph
5. TOTAL DEPTH:
6. DOES WELL REPLACE EXISTING WELL/ YES ❑ NO U
7. STATIC WATER LEVEL Below Top of Cuing: L o FT.
Nta -e- if Above Top or Ca/in)
8. TOP OF CASING IS .d FT. Above Land Surface•
'Top of culag Itrmlantd aLor below Isad surface regal/as
variance la accordaaa. with UA NCAC 2C.0111. /0r
9. YIELD (gpm): �� o METIIODJOF TEST FIG — A 1 I�
10. WATER ZONES (depth): 3 b - a o G e r—'
11. DISINFECTION: Type f4i'i q0ie
12. CASING:
DJyn:"
From � lXpth To � 0 Ft{j'
From To Ft.
From To. Ft.
13. GROUT:4 Depth
From 1 To bt- o Ft.
Amount �3 1
Wall Thic.knw
or Wein at.
soky 1 M.
`'
Material Method
M(J CE FT PoU('�C—n
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 Matenal
From To Ft.
From To Ft.
16. REMARKS:
/ " Topographic/Land setting
L9 Ridge ❑Slope ❑Valley ❑Flat
(ruck apprvpiara box)
Latitude/longitude of well location
(denosnolmndaecoodr)
Latitudr/longitude source:❑GPS❑Topographic rnap
(check boa)
PEPTI( DRILLING COQ
FromTo / Foutio Description
-
8 5 Formation
-ra
a .Y O / (A.D c: t-) nr• 7 CRC 1 CL
E, ' — '3 SG " C/V-Arm 1 TE','
LOCATION SKETCII
Show direction and distance in miles from at leantl:
two State Roads or County Roads. Include the Sid
numbers and co r n road names.
7C,�
�i1 A /Cgyv
C i1C-1"MZ
I DO HEREBY CERTIFY THAT TIIIS WELL WAS CONSTRUCTED IN ACCORDANCE WM 1 I5A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF TN RECORD HAS BEEN PROVIDED TO Ti WELL WNER
r\1 pr
fi yt\ to 3, a Po 4-
SIGNATURE OF PERSON CONSTRUCTING TILL' WELL DATE
Submit the original to the Division of Water Quality, Croundwaier Sec(Ion, 1636 Mall Service Censer- Raleigh, NC
27699-1636 Phone No.[phone], within 30 days. GW-I REV. 07/2001---- "

C09 p ry
3077187
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME
��11 (print) /�p-�-'rI/I'! of _'5/^9�� cERTrntcATtoN # 2227
WELL CONTRACTOR COMPANY NAMBSLJCRUW A-Tt((' (Lic a ( 1 J p: I (: n C,i PHONE # j$ �0t14'DY�O
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
1. WELL USE (Cluck Applicable Box): Residential C3' Municipal/Public 0 Industrial ❑ Agricultural ❑
Monitoring 0 Recovery ❑ Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATI N:
Nearest Town: 14I/'Vl ew County g-Us is4
L/l w-`nrl� dhf/ow 02 2' 73d
(Strut Name, Nulm Community, Subdi . On, Lot No., Zip Code)
3.OWNER: SAt0/e /c,/rJ
Address / % win fl v/ Ip//Ott
(Street orEtoote No.)
City or Town State Zip Code
( Area code- Phone number
4. DATE DRILLED / 2 —/s—o y
5. TOTAL DEPTH: �j 47 �j
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO
7. STATIC WATER LEVEL Below Top of Casing: 202 ' FT.
(Use ^+^ if Above Top of Casing)
8. TOP OF CASING IS 1 S FT. Above Land Surface*
'Top of casing terminated at/or below land surface requires a
valiance In accordance with 1SA NCAC 2C .0118.
9. YIELD (gpm): j METHOD OF TEST // ✓nsPd
I0. WATER ZONES (depth):
Topo b/Land setting
®Ridge lope Malley DF1at
( appropriate �).
Latitude/longitude of well location
-n
(degrees/minutes/seconds)
Latitude/longitude source:OGPSOTopographic map
(check box)
DRILLING LOG
Formation Description
11. DISINFECTION: Type C,Gf�
12. CASING:
Fro
From
From
13. GROUT:
From To 20
From To
14. SCREEN: Depth
From To
From To
15. SAND/C3RAVEL PACK:
Depth
From / To
From !/ To
Depth
To�� Ft
To Ft
To Ft.
Depth Material M od
FLrenetCYt°- e
Ft.
Diameter Slot Size Material
Ft. in. in.
Ft. in. in.
Amount /D 6i
Wall Thickness
or Weight/Ft. Material
spez/ pUC
16. REMARKS:
Size
Ft.
Material
Ft.
I DO HEREBY CERTIFY THAT THIS WW1 WAS CONSTRUCTED IN A
CONSTRUCTION ANDARDS, AND THAT A COPY OF S RECORD
DEPTH
From To
Va
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common mad names.
CE WITH 15A NCAC 2C, WELL
BEEN PROVIDED TO THE WELL OWNER
-flNSflts ,: Ji Tllc 2 L
la—Z6*°7
talc

307189
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and NaturalNpResourcepss - Division of Water Quality - Groundwater Section
Q 7
WELL CONTRACTOR (R4DIVIDUAL) NAME (print) fi0%9h/ e , �fi7g// CERTIFICATION A? a / 7
WELL CONTRACTOR COMPANY NAMIS LtJ C.eTW taTGt USIA Q f : t 11 Ai PRONE % Pal [O C49`0U,15
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT'S
(if applicable) (if applicable)
I. WELL USE (Check Applicable Box): Residential t Mtmicipal/Public 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery ❑ Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION:
Nearest Town: W 0.V t°/'U1 //e
JI44t ge N. %/
(Street Name, Numbers, Community, Subdivisioo, LotNo., Zip Code)
3. OWNER: D/9 ///2'y Wye
Address St 27 Sc4 p/,Ar held
(Streets,� Route No.)
tueau tot u-i /F NC
countyfiU Tm`n
City or Town State Zip Code
(..—�
Area code- Phone number
4. DATE DRILLED / Z'. Z. 7 C V
5. TOTAL DEPTH: 2 115
6. DOES WELL REPLACE EXISTING WELL YES ❑ NO t
7. STATIC WATER LEVEL Below Top of Casing: 4✓0 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS / • h^ FT. Above Land Surface*
`Top of easing terminated at/er below land surface requires a
variance in aecordaace with ISA NCAC 2C .a118.
9. YIELD (gpm): /0 METHOD OF TEST / / of e
10. WATER ZONES (depth): /
11. DISINFECTION: Type f C /T Amount /0 u 2-
12. CASING: Wall Thicimess
Diacgyer or
From To Depth
Ft (e!`/ SDt Pat
From_ To Ft.
From To Ft.
13. fi
GROUT: Depth Material ,/
From (0 To 2-0 Ft. Cone/e/t'
From To Ft.
14. SCREEN: Depth Diameter Slot Size Material
Fro To Ft in. in.
Fro To Ft. in. in.
15. SAND/G VEL PACK
Depth Size Material
To
m / To
From
From
16. REMARKS:
Ft.
Ft.
Topold setting
❑Ridge lope 0Valley ❑Flat
(check appropriate box) -'
Latitude/longitude of well location
(degreeslm'mutelsmonds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From To Formation Description
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common road names.
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH I5A NCAC 2C, WELL
CONSTRUCTION ST riisARDS, AND THAT A COPY OF S REC�O HAS BEEN PROVIDED TO THE WELL O
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-1 REV. 07/2001

CEO
307190
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and NaturalpResources -/Division of Water Quality - Groundwater Section
WELL CONTRACTOR (IND1VID�
UAL) NAME (print) l204n/ e /,�j/ CERTIFICATION#ZZZ.7
) 1'
WELL CONTRACTOR COMPANY NAMES W td W ATu Ai O t ; t (t nch_-PHONE # �yl� US6
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMTT#(if applicable)
(if applicable)
1. WELL USE (Check Applicable Box): Residential 'i icip�/Pub1ic Other 0 If Other, al 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump ItgUse
2. WELL LOCATION: ,
Nearest Town: 1 e / C es j/eP County /5M co/02
il>iki tPAV 2is�
(Street Name, Number/s, Canmuuity, Subdivision, Lot No., Tip Code)
3. OWNER: Onn 4 Ivf7 /l / ," Z
Address Nl4/t, W
(Street or Route L
/e/ c es )het flJ
City or Town State Zip Code
Area code- Phone number
4. DATE DRILLED / Z iS - O L/
5. TOTAL DEPTH: 21/6-
6. DOES WFT T REPLACE EXISTING WELL? YES 0 NO er
7. STATIC WATER LEVEL Below Top of Casing:
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS ,• 5 FT. Above Land Surfaces
'Top of casing terminated at/or below land surface requires a
variant m accordance with ISAMETHOD OF TEST / / /91 {!p
9. YIELD (gpm): 7
10. WATER. ZONES (depth):
11. DISINFECTION: Type re At mint 0 ,Z
12. CASING: Wall
ess
,00,f( th � or Weigbt/FL pl./latent)
Front_ DepTo-1L_ Ft_ 1 ZJ
From To Ft
From To Ft. M
13. GROUT: Depth Material -/
From_6To 20 FLCOf7Gre/r VJC rw/X
From To Ft.
14. SCREEN�:( Depth Diameter Slot Size Material
,�
From r� To Ft in. in.
From______ To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From ( To Ft.
From To Ft.
Topoc/Land setting
ORidge (3Slope Malley OFlat
(check appropriate box)
Latitude/longitude of well location
(temirmtesiscteds)
Latitude/longitude source:0GPS0Topographic map
(cheek bac)
DEPTH DRILLING LOG
From To Formation Description
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common road names.
V,io
pt/
G
16. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUE trill IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STA$ ARDS, AND THAT A COPY OF THIS WCORD HAS BEEN PROVIDED T
f.®
OTHE 0
,z g scr
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
enter -
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service CGWr1 RgVgh, NC 1
27699-1636 Phone No. [phone], within 30 days.

307241
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Na a al RCSN CALDDELLn of Water Quality - Groundwater SectionRWELL CONTRACTOR (INDIVIDUAL) NAME (print) CERTIFICATION # 214Q
WELL CONTRACTOR COMPANY NAME RF.UBEN CALDWELL DRILLING, INC •PHONEY7(B )254 -3581
STATE WELL CONSTRUCTION PERMIT# 1 537 ASSOCIATED WQ PERMIT/
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential 1/MunicipaVPublic 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELLLOCATIOy: � County "c'�'mE' CeG Nearest Town: (i
(Street Name, Numben, Community, Subdivision, Lot No., Zip Code)
3. OWNER: 3 A CR% e 't-,C'K-iJ) 2e)
Address t-n6 A Dt t.J &LOOK D!L
tref or Rou (o ] a s -iIs
,tyity or Towtc .Sit. as 371 Code
Area code- Phony number
DATE DRILLED � 31 � l�
TOTAL DEPTH: $$$$$$
4. 0 4-
5. a
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO
7. STATIC WATER LEVEL Below Top of Casing: b 0 FT.
(Use "t- if Above Top of Cuing)
8. TOP OF CASING IS ET. Above Land Surface*
*Top of win terminated at/or below lead surface requires •
varl•oce In accordc lib ISA NCAC 2C .01111. ,9
9. YIELD (gpm): _L_j_ METHOD OF TEST I. i
10. WATER ZONES (depth): t fl 0 / k a._Ci P
I
11. DISINFECTION: Type ia/bI (0 Amotmt �� (.6
12. CASING: Wall Thickness
polar),
From To 16J
From To Ft.
From To Ft.
13. GROUT: Depth Material Method
From To �0 Ft. Ckd M 63) ( 9oug '
From To Ft.
14. SCREEN: Depth Diameter Slot Site Material
From To Ft. in. in.
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
Ft. 6jiPgxter orDP tt. teal
16. REMARKS:
Topographi c/Lan'setling
❑Ridge ❑Slope alley ❑Flat
(check appropriate box)
Latitudeflongitude of well location'
(dcpea/minutca/ramd.)
Latitude/longitude source:❑GPS❑Topographic map
(chock box)
Dr RILLINO 11,O
Q1 ot/ iiFDRtR.. Iion.DeL`ion
S i26 TE
C.g 1 cb - 0-69( t
Gt
DEPTH
Frgm% To 0 /
11ct%o — }-Its'
\`Cn'
\`(0'-aSt'
LOCATION SKETCH -a
.
Show direction and distance in miles fromatleast
two State Roads or County Roads. Include the road
numbers and common road names.
NI. MR
I-l1A q/ 3
cA
0
1,,.,16(SeL g-D
100 VAS
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED M ACCORDANCE WITH ISA NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY ,QFTHIS2ECORD HABE P VIDED10 HE WE 0
SIGNATURE OF PERSON CONSTRUCTING THE WELL DA
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center -Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-1 REV. 07/2001

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
/gyp pies_ C'ONTRAC"rOR(INDIVIDUrU,)NAMF; (Print)("-[�In Y�-RD bile, LCJl:a ts CERTIFICATION ad/8 n ��(y � '/r'
WELL CON'I'RA("I'OR COMPANY NAME (7CCP ✓ t I3Y0 . LJQ)_L. t Pt, , .. -PHONE # 1Q.yty_tp74_: `3/ 96
STATE WELL CONSTRUCTION PERMIT# We i- ASSOCIATED WQ PERMITS(
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential) Municipal/Public O Industrial O Agricultural O
Monitoring O Recovery O Heat Pump Water Injection O Other O If Other, List Use
2. WTNLL.IACATI()
Nearest To
County &t fttrn,. b. n--
(Street Name, Numbers, Community, Subdivision, lot No. Zip ('ode)
3. OWNER:
Address 5
(Street or Route No.)
()¢.A.J ./.e-1 Al C.-
( 'ity or Town Ate Zip Code
(
8'7/S
Area aide- Phone number
4. DATE DRILLED 12 - 3 I - 0 (-
5. TOTAI, DEPTH: 1 SS
r. Irio:E 'Arta I )I:I)I A('I. Vl.-1 LJ nlrl f"
7. STATIC WATER LEVEL Below Top of Casing: e1 D FT.
(use 4" if Above Top of Casing)
X. TOP OF CASING IS / FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordance with I5A NCAC 2C .0118. 9. YIELD (gpm): PiMETHOD OF TEST oCq
A r
10. WATER ZONES (depth): I Le S' - `7 gihrn
11. DISINFE('TION: Type_
2. CASING:
Depth
From Q_ To /o
From To
From To
13. GROUT: Depth
From A To ai>
From To
14. SI'REEN: Depth
From To
From To
15. SAND/(iRAVEL.PACK:
Depth
From To Ft.
From To Ft.
Topographic/Land setting
❑Ridge ❑Slope OVallcy Elat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:OGPSOTopographic map
(check box)
DEPTH DRILLING LOG
From To Formation Description
/) Le yCO,{
.�-tic° a pi-Q.,
/i TILL_ Amount 3 ') +L)3s
Wall Thickness
Diameter or Weight/Ft. Material
Ft. 1c 11
Ft.
Ft.
Material Method
Ft. l!!a wnvi1.d-L.
Ft.
Diameter Slot Size Material
Ft. in. in.
Ft. in. in.
Si/A:
Material
16. REMARKS:
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common road names.
90 :I kid 6- 93i SO
A
ern
-71n
rnT^
•mtril
77a
Cr".
rnri
-to
c�—
ac!
tfsa5
n
I DO I IEREBY CERTIFY TEAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITII I5A NCAC 2C', WELL
CONSTRUCTION ST'ANDA DS, AND TIIAT A COPY OF THIS RECORD
IIASS BEEN PROVIDED TO TI IE WELL OWNER
__fJ e2 h �E�u t_ ( n v / 3 / ��
SIGNATURE OF PERSON C'ONSTRUC' ' TILE WELL DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center- Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-1 REV. 07/2001

North Carolina Department of Environment S Natural Resources
Division of Water Quality - Groundwater Section
1636 Mail Service Center
Raleigh, NC 27699-1636 Phone: [phone]
WELL CONSTRUCTION RECORD
DRILLING CONTRACTOR: / 14.'X rri.4-la."4./ 41.00
CONSTRUCTION
DRILLER CERTIFICATION NUMBER: 2 Stile PERNIIT NUMBER:
STATE WELL
QUAD NO.
Lat.
Minor Basin
Basin Code
Header Ent.
FOR OFFICE USE ONLY
SERIAL NO.
Long,. RO.
GW.I Ent.
I. WELL LOCATION: (Show sketch of the location bei w)
Nearest Town: C(S)1J` El Le Counhv: ElITII zc;n dSL
(Road, Community, or Subdivision and Lot No.) From To
2. OWNER Le..r.*. ' cJJ Plj 1
ADDR£SS4,06 •c �J:Q�.� IL(
(Stret or Route No.) t'
City or Town State Zip Code
3. DATE DRILLED /t-/ ,USE OF WELL //r/Nt✓
4. TOTAL DEPTH Ito-S
5. CUTTINGS COLLECTED YES ❑ NO lam_
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO
7. STATIC WATER LEVEL Below Top of Casing: FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS 1 FT. Above Land Surface*
`Casing Terminated at/or below land surface is illegal unless a variance is issued
in accordance with 15A NCAC 2C .0118 pC
9. YIELD (gpmft): 1 0 - METHOD OF TEST VI
10. WATER ZONES (depth):
11. CHLORINATION: Type Amount
12. CASING:
Wall Thickness
Depth Diajneter Or \ "ei�ht/Ft. aterial
From 17 To -31 Ft. 103t % ✓ - L.c
From To Ft.
From To Ft.
13. GROUT:
Depth
From 0 To 20 Ft.
From To Ft.
14. SCREEN:
Material a
enter,
ocL
f 4 tt11`
Depth Diameter Slot Size Material
From To Ft. in in
From To Ft. _ in. in
From To Ft. in. in.
15. SAND/GRAVEL PACK
Depth Size Material
From To Ft.
From To Ft.
16. REMARKS:
0 3/
DEPTH DRILLING LOG
Formation Description
I90crA tr /-1
m
CO
If additional space is needed use back of form
J OCATION 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
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEFIT/ PROVIDED TO THE WELL OWNER.
Dwi (l kV
crrNI A TTID t nt rnnrrn s rmno no . rr,vr

yQ() 307694
DRILLING CONTRACTOR:
3 c� u t c u
(Road, Commun I, or Subdivision and Lot No.)
ll
2. OWNER T/ -y Crtrr r,
ADDRESS •30 a, aF's^ L
(Street or Route No'
1. WELL LOCATION: (Shaw sketch of the location below)
Nearest Town: 25 ,, /l y County: ai) yrz c isi 6 r
r
L tI`Gas4
City or Town
3. DATE DRILLED/U:e
4. TOTAL DEPTH J1
5. CUTTINGS COLLECTED
North Carolina Department of Environment & Natural Resources
Division of Water Quality - Groundwater Section
1636 Mail Service Center
Raleigh, NC 27699-1636 Phone: [phone]
WELL CONSTRUCTION RECORD
Tts,nvr' W E-' %/ Orli
CONSTRUCTION
DRILLER CERTIFICATION NUMBER:
STATE ELL
PERMIT NUMBER:
qfc
State Zip Code
�%*JSE OF WELL it th- j c
YES 0 NO C�
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO ❑
7. STATIC WATER LEVEL Below Top of Casing. CO FT.
(Use " + " i(Above Top of Casing)
8. TOP OF CASING IS -�- l FT. Above Land Surface*
•Casing Terminated atior below land surface is illegal unless a variance is issued
in accordance with 15A NCAC 2C .0118
9. YIELD (gpm): ;2® METHOD OF TEST R L
10. WATER ZONES (depth): /
II. CHLORINATION: Type Amount ?DC
12. CASING:
Wall Thickness
• Depth Dip ttyeter Or'1 i hUFt. hitrenal
From "f `) To i 0 FL 6.- ' .
From To Ft.
From To Ft.
13. GROUT:
Depth Material Method
From To 20 FL Loa— f sZ/iy
From To Ft.
14. SCREEN:
Depth Diameter Slot Size Material
From To Ft. in. in
From To Ft. in. in
From To Ft. in. in
15. SAND/GRAVEL PACK:
Depth Size
From To Ft.
From To Ft.
16. REMARKS:
Material
FOR OFFICE USE ONL Y
QUAD NO. SERIAL NO.
L3L Lons. RO.
Minor Basin
Basin Code
Header Ent.
DEPTH
From To
0 70
Mt R 'In
DRILLING LOG
Formation Description
f/1.21-•-2Cv.,/1%•s
If additional space is needed use back of form
73
LOCATION SKETCH
(Show direction and distance from at least two State
Roads, o other map reference poi ts)
Tyr 4t Irr
/Mier dvp tn,
Joel
/ZQ IL-O'G..elee/
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.
dc

North Carolina Department of Environment & Natural Resources
Division of Water Quality - Groundwater Section
1636 Mail Service Center
Raleigh, NC 27699-1636 Phone: [phone]
WELL CONSTRUCTION RECORD
DRILLING CONTRACTOR:
STATE WELL
FOR OFFICE L'SE ONLY
OL'AO. NO, SERIAL NO.
Lac Long. R0.
Minor Basin
Basin Code
Headcr Ent. - GW- Ent.
CONSTRUCTION
DRILLER CERTIFICATION NUMBER: 9_5 9 ce PERMIT NUNIBER:
1. WELL LOCATION: (Show sketch of the location below)
Nearest Town,:: !-}hrv»tl f County: Avi1Qc i. bie
(Road, Communi , or Subdivision and Lot No,)
2. OWNER /2cs0s/ti5 1149/J/C,
ADDRESS
(Street or RouteNo.)
/jig
City or Town State Zip Codc
3. DATE DRILLED/M►-OUSE OF WELL thee ct
4. TOTAL DEPTH yt csS
5..CUTTINGS COLLECTED YES 0 NO Q--
6. DOES WELL REPLACE EXISTING WELL'. YES O NO ❑
7. STATIC WATER LEVEL Below Top of Casino: ke FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS F / FT. Above Land Surface*
`Casing Terminated atior below land surface is illegal unless a variance is issued
in accordance with I5A NCAC 2C .0118 y�
9. YIELD (gpm): 5 O RIETHOD OF TEST 4t 5
10. WATER ZONES (depth): ,2 %O
11. CHLORINATION: Type
12. CASING:
Amount az
Wall Thickness
Depth piameter Or Weight/Ft. h'"ter>)
From f / To J FL G ., 7 Ur
From To Ft.
From To FL
13. GROUT:
Depth Material Method
From t) To 2 D FL ✓tne,7 !H
From To Ft.
14. SCREEN:
W
EPTH
DRILLING LOG
From To Formation Description
T
0 -- 70 Out, / 1-re t
r -- s S 9T sl /1/-Te_
CO g
Gr1
If additional space is needed use back of form
JOCATION SKETCH
(Show direction and d stance from at least two State
Roads. or other m. p reference points)
Depth Diameter Slot Size Material wo'2'
From To FL in. in. �(
From To Ft in. in al
From To Ft in. in
RP eh
\eve .I
p
15. SAND/GRAVEL PACK
Depth Size Material
From To FL _
From To Ft. r /
16. REMARKS:
et(
1 DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNE
0 ha (cl P U—r {) I'd i'� 5
fir. rain
err NA T(IDC !!C r`hA1TD !"TelO no

D" 307697
North Carolina Department of Environment & Natural Resources
Division of Water Quality - Groundwater Section
1636 Mail Service Center
Raleigh, NC 27699-1636 Phone: [phone]
WELL CONSTRUCTION RECORD
DRILLING CONTRACTOR: or Se."' tA)e, �(
CONSTRUCTION
DRILLER CERTIFICATION NUMBER: -.S 94
Prf(IPnS
STATE WELL
PERMIT NUMBER:
1. WELL LOCATION: (Show sketch of the location below)
Nearest Town: County: fead.hp., ,ltjLv
(Road,_communirv, or Subdivision and Lot No.)
2. OWNER % o-r
v1nd /l3rcq .a ,-
ADDRESS t-r/y F{r.akt4 Gnus�l2r[
(Street or Route No.)
ifiA---44a r i„ < 733
City or Town State Zip Code
3. DATE DRILLEDP, ,,USE OF WELL 5.ioO
4. TOTAL DEPTH 6,05
5. CUTTINGS COLLECTED YES ❑ NO li /
6. DOES WELL REPLACE EXISTING WELL"! YES ❑ NO FY
7. STATIC WATER LEVEL Below Top of Casino: '--(-)FT.
(Use " + " if Above Top of Casing)
8. TOP OF CASING IS T 1 FT. Above Land Surface"
*Casing Terminated at/or below land surface is illegal unless a variance is issued
in accordance with 15A NCAC 2C .0118
9. YIELD (gpm): (0' - METHOD OF TEST
#95
10. WATER ZONES (depth):
11. CHLORINATION: Type Amount
12. CASING:
Wall Thickness
`f Depth,Dia eter Or Weight/Ft.n�rial
From T 1 To o FL fQ f
From To Ft.
From To Ft.
13. GROUT:
Depth dd ^ Material Method
From (l To d V Ft emen114 ik
From To Ft.
14. SCREEN:
Depth Diameter Slot Size Material
From To Ft. in. in
From To Ft. in. in
From To Ft. in. in
15. SAND/GRAVEL PACK
Depth Size Material
From To Ft.
From To Ft.
FOR OFFICE USE ONLY
QUAD. NO. SERIAL N0.
Lat. Long. Ro.
Minor Basin
Basin Code
Header Ent. • Gw.I Ent.
DEPTH
From To
0
DRILLING. LOG
Formation Description
019o-A., 0'Pv�
''1 {
m
CO n
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)'
16. RENLARKS:
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 RAS BEEN PROVIDED TO THE WELL OWNER.
aid!0ram/ )))
c ATtroc rrnnrro,sr^rno nn *rrxrr
2.7

3°7701
North Carolina Department of Environment & Natural Resources
Division of Water Quality - Groundwater Section
1636 Mail Service Center
Raleigh, NC 27699-1636 Phone: [phone]
WELL CONSTRUCTION RECORD
DRILLING CONTRACTOR: /1.2")/ ,-- U'e 7/ /T Y j 11114.5
STATE WELL
CONSTRUCTION
DRILLER CERTIFICATION NUMBER: �.6g 0 PERMIT NUMBER:
FOR OFFICE USE ONLY
QUAD. NO. SERIAL NO.
Lot. Long. RO. -
Minor Basin
Basin Code
Header Ent GW-I Ent.
I. WELL LOCATION: (Show sketch of the location belo�lw) ,Q unt-t a.r 6,r
Nearest T`o`wln: V- J,v; //r Counh: [> Qntcvsh Arr
5otj r� f ".mil ,-s,, , , k
(Road, ommuniry, tfr Subdivision and Lot No.") ��,.r V Cr?
OWNER
VQ ri'Lj I� 4.9 d:'hyC with -'vim
/ / (Street oteRoute No.)
4 Yric.•.- Y/ * r ^ii741
City or Town State Zip Code
3. DATE DRILLED1 /D-ctSE OF WELL Iic-:5`cr-
4. TOTAL DEPTH °.'Los
5. CUTTINGS COLLECTED YES ❑ NO sr
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO Er"'
7. STATIC WATER LEVEL Below Top of Casina:.5r) FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING 15 t-1 FT. Above Land Surface*
'Casing Terminated at/or below land surface is illegal unless a variance is issued
in accordance with I5A NCAC 2C .0118
9. YIELD (gpm): J/METHODSOF TEST Ali /
10. WATER ZONES (depth): 1 i)
11. CHLORINATION: Type 12. CASING: Amount /r0 i CZ If additional space is needed use back of form
Wall Thickness
From t To
Deb Ft. ✓D Diat'eter Or Y ight/Ft. Material
Werial
=�
From tip To Ft. V_r_ .i d-2: LOCATION SKETCH
From To Ft. (Show direction and distance from at least two State
Roads, or other map reference points)
(
DEPTH
DRILLING LOG
From To Formation Description
1©0 v:hireler
)ex) - 2D
Jran f'l-Y
t4'
rri
m
to
CO
01
13. GROUT:
/� Depth Material Met)to
From V To a� Ft. £r•71e.1* /1'Lr/
From To Ft.
14. SCREEN:
Depth Diameter Slot Size Material
From To FL in. in
From To Ft. - in. in
From To Ft. in. in
15. SAND/GRAVEL PACK
Depth Size Material
From To Ft.
From To Ft.
16. REIVL4RKS:
n
MAR 7 ,r n
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
iDO/hd!A a A-4,tjg✓'1$ 10-09
GW-1 REV. 11/99
SIGNATURE OF CONTRACTOR OR AGENT DATE
Snhmit orioinal to Divicinn of Wntnr A„nUUu and a rnnv ♦n a..11 ,......e.

North Carolina Department of Environment S. Natural Resources
Division of Water Quality - Groundwater Section
1636 Mail Service Center
Raleigh, NC 27699-1636 Phone: [phone]
WELL CONSTRUCTION RECORD
DRILLING CONTRACTOR:
STATE WELL
QUAD NO.
Lac
Minor Basin
Basin Code
Header Ent.
307702
FOR OFFICE USE ONLY
SERIAL NO.
Long. RO
GW.I Ent.
CONSTRUCTION 2
DRILLER CERTIFICATION NUMBER: 29 6 PERMIT NUMBER:
1. WELL LOCATI N: (Show sketch of the location below) '7
Nearest Tvn `j�� et (��Count 13uI1(C w)8e
4,e1 ©CL/K /.p TbO - DEPTH
(Road. Community, or Subdivision and Lot No.) From To
2. OWNER L,�+'1SPfre 0i>y
0,)A1
ADDRESS 1'40 pk.46C7r ,L,9to
(Street dr Route No.)
)95c10; jig . ,7sr5i
City or Town ��
+
DATE
�U Zip Code
3. . DRILL D L OF WELL H�(.(�E'
4. TOTAL DEPTH 70 ��v^'
5. CUTTINGS COLLECT EIi YES 0 NO.IV"'
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO I$"
7. STATIC WATER LEVEL Below Top of Casing: l r: r;' FT.
,j (Use "+" if Above Top of Casing)
8. TOP OF CASING IS+ '/ FT. Above Land Surface•
'Casing Terminated atior below land surface is illegal unless a variance is issued
in accordance with I5A NCAC 2C .0118
9. YIELD (gpm): 0 METHOD OFTEST [s i9
10. WATER ZONES (depth):
11. CHLORINATION: Type
12. CASING:
Dept
From l To
From gr) To
From To
Ft.
Ft.
Ft.
13. GROUT:
Depth ,7
From a_ To e/ Ft.
From To Ft.
14. SCREEN:
Depth
Amount
Wall Thickness
On/Ft. , ai nl
( i "r'Ip " /1f M
Diameter Slot Size Material
From To Ft. in. in
From To Ft. in. in
From To Ft. in. in
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
16. REMARKS:
0
„7
DRILLING LOG
Formation Description
Gr �� tJ V /jr/r -/)
6r?ell7/fr
If additional space is needed use back of form
LOCATION SKETCH
(Show direction and distance from at least two State
Roads, or other map reference points)
To-4
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER.
0nLLi amC$
Cif` N.1 tyto r 11C!`(\IUTD 1rrnn nn ♦roar! ;?mo

307703
North Carolina Department of Environment & Natural Resources
Division of Water Quality - Groundwater Section
1636 Mail Service Center
Raleigh, NC 27699-1636 Phone: [phone]
WELL CONSTRUCTION RECORD �/
DRILLING CONTRACTOR: / h/'IZv-- Wel 041l/ttt
STArEWELL
FOR OFFICE USE ONLY
QUAD. NO. SERIAL NO.
La Long. RO.
Minor Basin
Basin Cade
Header Ent. GW. I Ent.
CONSTRUCTION c '> /Z'
DRILLER CERTIFICATION NUMBER: ? S j tom' PERMIT NUMBER:
1. WELL LOCATN: ($how skeetch of the location below)
Nearest Tewa: 4 5 h �14 f I County: J?t/nce wipe
(Road, Community, or S bdivision and Lot No.)
2. OWNER / f e y IJe.6I0A
ADDRESS S`a E.T jet ty-1 CrO71
(Street or Route No.)
11 I Ili 0c a��G
City or Town ! ate Zip Code
3. DATE DRILLED'4f ' USE OF WELL_HO U S c%
4. TOTAL DEPTH
5. CUTTINGS COLLECTED YES 0 NO
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO
7. STATIC WATER LEVEL Below Top of Casino: ;- ()GIFT.
A (Use"+" if Above Top of Casing)
8. TOP OF CASING 1S f'jFT. Above Land Surface*
`Casing Terminated at/or below land surface is illegal unless a variance is issued
in accordance with ..I/SA NCAC 2C .0118 aa
9. YIELD (gpm): 743 METHOD OF TEST Yt I,9
10. WATER ZONES (depth): / u ti f"' 7c7, S
•
II. CHLORINATION: Type
12. CASING:
Dept11,7
From t/ To ff Ft.
From 0To / On Ft.
From To Ft.
13. GROUT:
in Depth ,
From _ To O Ft.
From To Ft.
14. SCREEN:
Amount k? J 7
Wall Thickness
Diaper Or Wet ht/Ft. Materi.al
2
_Material M dt
((/Mt'r /,l
Depth Diameter
From To Ft.
From To Ft.
From To Ft.
Slot Size Material
in. in
in. in
in. in
15. SAND/GRAVEL PACK:
Depth Size
From To Ft.
From To Ft.
16. REMARKS:
Material
LiG
DEPTH DRILLING LOG
From To
Formation Description
-t'1 CO
rrl
CO
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)
lair al --
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 in
CWIVATrmc en.rnuTD arorno!1 D arrwrr

307704
North Carolina Department of Environment & Natural Resources
Division of Water Quality • Groundwater Section
1636 Mail Service Center
Raleigh, NC 27699-1636 Phone: [phone]
WELL CONSTRUCTION RECORD
DRILLING CONTRACTOR: 7 rh-tltoet hilt 5
STATE WELL
CONSTRUCTION J� �j
DRILLER CERTIFICATION NUMBER: 4.' / @ PERMIT NUMBER:
FOR OFFICE USE ONLY
QUAD NO. SERIAL NO.
Lat. Long. RO.
Minor Basin
Basin Code
Header Ent.
.[{ W.II.Ent
MAR I P;2005
1. WELL LOCATION: (Show sketch of the location below)
Nearesst7Tow :7)4'c�J Aj
// County: 4y2 G, n � r
(Road, Communiry, or Subdivision and /Lot No.)
2. OWNER ltlQS` &A n)), /
ADDRESS S/ ✓ cl. evi COpa
(Street or Route No.)
9t511v1 Jl v '2 4. g<o le
City or Towo !%J Zip Codc
3. DATE DRILLEDO ljS`E F WELL Hcut
d. TOTAL DEPTH5CC-
5. CUTTINGS COLLECTED YES 0 NO R�
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO
7. STATIC WATER LEVEL Below Top of Casing: 1 j FT.
Use "+" it Above Top of Casing)
8. TOP OF CASING IS %o '' d1" FT. Above Land Surface*
'Casing Terminated atior below land surface is illegal unless a variance is issued
in accordance with 15A AC 2C .0118 ,✓
9. YIELD (gpm):/ r/'7 METHOD OF TEST Ci�S
10. WATER ZONES (depth): 7207
-5y1 // <C1
I1. CHLORINATION: Type Amount
12. CASING:
Wall Thickness
•
Depth.Di� {meter Or Weight/Ft. etelia!
From t To • 0 FL t -_ __
From To Ft.
From To Ft.
13. GROUT:
n Depth... Material
From t,i To e— Ft. l _-____P7-
From To Ft.
14. SCREEN:
Depth Diameter Slot Size Material
From To Ft. in. in
From To Ft - in. in
From To Ft. in. in
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To FL
16. RENLIRKS:
DEPTH
From To
DRILLING LOG
Formation Description
0 - 3 0 Ode/-61) de>
co
O
If additional space is needed use back of$J m
,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
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
ncr�'�i f,) p V�/Jitm5
et nu A TITO C ACrnluTD ArTAO no arrkrT
TI TC

North Carolina Department of Environment & Natural Resources
Division of Water Quality - Groundwater Section
1636 Mail Service Center
Raleigh, NC 27699-1636 Phone: [phone]
WELL CONSTRUCTION RECORD
DRILLING CONTRACTOR:
7;7-n C.••-e 12-f/%/S.5
STATE WELL
CONSTRUCTION �f
DRILLER CERTIFICATION NUMBER: or S
PERMIT NUMBER:
03 307705
FOR OFFICE USE ONLY
CILIA . NO. SERIAL NO.
Lat. Long. RO.
Minor Basin
Basin Code
Header Ens.
GW.I Ent.
s L,
1. WELL LOCATION. (Show sketch of the location below)
f Nearest Town: 4j,I;.t//rt. County: Ait' c 'tt
2 t %/ v.5, ALLJJit
(Road, mmunity, or 96bdivision and Lot No.)
2. OWNER �A
ADDRESS L vim//G <9 tc /4. u 7 y5'
(Street or Route No.)
City or Town State Zip Code
3. DATE DRILLED/O.-/vt/USE OF WELL J/a%Sti
3. TOTAL DEPTH L/2s
5. CUTTINGS COLLECTED YES 0 NO 5�.
6. DOES WELL REPLACE EXISTING YELL" YES O NO l�
7. STATIC WATER LEVEL Below Top of Casing: /D / FT.
(Use "+. if Above Top of Casing)
8. TOP OF CASING 1S f / FT. Above Land Surface•
•Casing Terminated atior below land surface is illegal unless a variance is issued
in accordance with ISA NCAC 2C .0118
9. YIELD (gpm): .( . RIETHOD OF TEST--+j.5
10. WATER ZONES (depth): LAO
DEPTH
From To
DRILLING LOG
Formation Description
DLte=A'.`c %'l
%) - y .S J rrN!'
I1. CHLORINATION: Type Amount If additional space is needed use back of form
12. CASING:
Wall Thickness
From / / ,I, Depth77 FL Danyeter Or Rgi t/Ft. M1t�fcril
1lnn / �2 f� b
From To Ft. ,LOCATION SKETCH
From To Ft. (Show direction and distance from at least two State
Roads, or other map reference points)
13. GROUT;
Depth Material M hp
From b To •lc. Ft. Ctaint
From To Ft.
14. SCREEN:
Depth Diameter Slot Size Material
From To Ft in. in
From To Ft. in. in
From To Ft. in. in
15. SAND/GRAVEL PACK
Depth Size
From To Ft.
From To Ft.
16. REMARKS:
Material
005 lye-
t
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS R ORD HAS BEN PROVIDED TO THE WELL OWNER.
CordldQwt' "7/0(71
Ctr NI A'Min r nr rummer° A rents no arrwrr nA rr

307i46
North Carolina Department of Environment & Natural Resources
Division of Water Quality - Groundwater Section
1636 Mail Service Center
Raleigh, NC 27699-1636 Phone: [phone]
WELL CONSTRUCTION RECORD
DRILLING CONTRACTOR: / ps ft g! L rrv� D- ,tj •75
STATE WELL
CONSTRUCTION
DRILLER CERTIFICATION NUMBER: S `7 ce PERMIT NUMBER:
FOR OFFICE USE ONLY
QUAD NO. SERIAL NO.
Lat. Long. RO.
Minor Basin
Basin Code
Header Ent. Gw, 1 Ent.
d! P
I. WELL LOCATION: (Show sketch of the location below)
Nearest Town: flr h,t; ll4 County: QIy11 Lt M,bY
an, Y.
(Road, Community, or ubdivision and Lot No.)
2. OWNER Actn4 'tt)rn e t
ADDRESS o�,J•
1•1 (Stt'et ortRoute No.) 1,
City or Town State Zip Code
3. DATE DRILLED -97EFSE OF WELL fie 4),c_.
4. TOTAL DEPTH /LJ
5. CUTTINGS COLLECTED YES 0 NO
6. DOES WELL REPLACE EXISTING WELL? YES( 0J NO CGK
7
7. STATIC WATER LEVEL Below Top of Casing: 0 FT.
(Use " + " if Above Top of Casing)
8. TOP OF CASING I5 t 1 FT. Above Land Surface'
'Casing Terminated at/or below land surface is illegal unless a variance is issued
in accordance with 15A NCAC 2C .0118 n
9. 'YIELD (gpm): / L7 klETHOD OF TEST �( t'S
10. WATER ZONES (depth): / 1(�
11. CHLORINATION: Type
12. CASING:
Dept
From 1-1 To 7G Ft.
From To Ft.
From To Ft.
13. GROUT:
Depth
From 6 To ab Ft
From To Ft.
14. SCREEN:
DEPTH DRILLING LOG
From To Formation Description
0
-2(0
it
00erb;.Arie
Sr3n�'t-r
•
Amount tor If additional space is needed use back of form
Wall Thickness
Diameter Or\ e ht/Ft. Ma
y F
Material M jiipd
G ea/kw i11 i
Depth Diameter Slot Size Material
From To
From To
From To
FL in. in
Ft in. in
Ft. in. in
15. SAND/GRAVEL PACK
Depth Size Material
From To Ft.
From To Ft.
16. REMARKS:
LOCATION SKETCH
(Show direction and distance from at least two State
Roads, or other map reference points)
1.4. 63
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) O THE WELL OWNER
19g )10 p t-iWi�iikk9 d 7 _e�

307667
13. GROUT:
Depth Material ethod
From 1./ To 2-a Ft LrMeter
From To Ft.
14. SCREEN:
Depth Diameter Slot Size Material
From To Ft. in. in
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:
North Carolina Department of Environment S Natural Resources
Division of Water Quality - Groundwater Section
1636 Mail Service Center
Raleigh, NC 27699-1636 Phone: [phone]
WELL CONSTRUCTION RECORD
it DRILLING CONTRACTOR. »rive, tsiel/ ,dll1/11t
STATE WELL
CONSTRUCTION �!
DRILLER CERTIFICATION NUMBER: -'—� 7 (Ea
PERMIT NUMBER:
FOR OFFICE USE ONLY
QUAO NO. SERIAL NO.
Lat, long. RO.
Minor Basin
Basin Code
Header Ent GW- 1 Ent.
1. WELL LOCATION: (Show sketch of the location below)
Nearest Town: /is $ vj i / e County- 13tr g 4a/so
,S et Ar i
(Road, Community, or Su division and Lot No.)
2. OWNER I /K rn
ADDRESS it ! a i_e_tt-e,-7`2'i---
s.e t'L0S e-- (Street or Route No.) !/
City or Town State Zip Cade
3. DATE DRILLED igrtIPSE OF WELL Na?SC_
�. TOTAL DEPTH
5. CUTTINGS COLLECTED YES 0 NO f3-
6. DOES WELL REPLACE EXISTING WELL? YES O NO ar
7. STATIC WATER LEVEL Below Top of Casing: 1 % 1 FT.
// (Use"+" if Above Top of Casing)
8. TOP OF CASING IS i ! FT. Above Land Surface'
'Casing Terminated atior below land surface is illegal unless a variance is issued
in accordance with I5A NCAC 2C .0118
9. YIELD (gpm): S METHOD OF TEST 4 r S
10. WATER ZONES (depth): O
DEPTH DRILLING LOG
From To
Formation Description
0 37 ©J+s/aUrileii
37 .2s5 6rr/. "Lc
ram e
t
1 K
W
t-,
cn
11. CHLORINATION: Tvpe Amount 4'D Z If additional space is needed use back of form
12. CASING:
Wall Thickness
1 Dept Di mster Or Weight/Ft. M terial
From • .To .5 7 Ft G At a ♦ pat -
From To Ft. LOCATION SKETCH
From To Ft. (Show direction and distance from at leas two State
Roads, or other map reference points)
l�
yGr/
CJier+%�t/U,J Ail•
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.
L»r&d o ct . /7/4frii S -30-0 Y
Clr`N•TTior nr rYINToh/`Till, rl0 a frxrT rt1'TV

307668
North Carolina Department of Environment & Natural Resources
Division of Water Quality - Groundwater Section
1636 Mail Service Center Raleigh, NC 27699-1636 Phone: [phone]
WELL CONSTRUCTION RECORD
DRILLING CONTRACTOR: yrt v� C4J /(
CONSTRUCTION ��((^^ n/�
DRILLER CERTIFICATION NUMBER:2 9.6
t' l tts
STATE WELL
PERMIT NUMBER:
FOR OFFICE USE ONLY
QUAD NO. SERIAL NO.
Lat. Long. RO.
Minor Basin
Basin Code
Header Ent. -GW-1 Ent
I. WELL LOCATION: (Show sketch of the location below)
Nearest Town: County: /g Yrsr yp, ,,,6 e-'
Kn c,.Lr.s SS t'.
(Road, Community, or Subdivision and Lot No.)
2. OWNER Perlin s5 $rlson
ADDRESS IV-, <'irs f,Aj'w.�i
(Street or Route No.)
City or Town au S Zip Code
3. DATE DRILLED S OF WELL'' louse
4. TOTAL DEPTH_
5. CUTTINGS COLLECTED YES 0 NO
6. DOES WELL REPLACE EXISTING WELL" YES O NO (3
7. STATIC WATER LEVEL Below Top of Casing: JOGS FT.
(Use " + " if Above Top of Casing}
8. TOP OF CASING IS* L FT. Above Land Surface*
'Casing Terminated atior below land surface is illegal unless a variance is issued
in accordance with I5A NCAC 2C .0118 n q
9. YIELD(gpm): !ij - METHOD OF TEST /1t✓
10. WATER ZONES (depth): 2�
II. CHLORINATION: Type
12. CASING: From /- ' ToDeL 111111�tfFL
From ea To /9 Ft.
From To Ft.
Amount
Wall Thickness
eter Or21 ghUFt. ..3Y1atDrial
13. GROUT:
0 Depth IVIateria' 1�Q io�J
From To 2.0 Ft. rt'P/'+ /413 A
From To Ft.
14. SCREEN:
Depth Diameter
From To Ft.
From To Ft.
From To Ft.
15. SAND/GRAVEL PACK:
Depth Size
To Ft.
To Ft.
From
From
16. RENLIRICS:
Slot Size Material
in. in
in. in
in. in.
Material
vt-
DEPTH DRILLING LOG
From To Formation Description
12-4 2 fry 53coh/fe
(26
9
n
G!
t� 1
1
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)
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS R ORD HAS BEEN PROVIDED TO THE WELL OW
Dona D urjy6J '
Clr,U A Trm C nr rnIIVTo a rTnn no a rrivT
name

307670
North Carolina Department of Environment & Natural Resources
Division of Water Quality - Groundwater Section
1636 Mail Service Center
Raleigh, NC 27699-1636 Phone: [phone]
WELL CONSTRUCTION RECORD
DRILLING CONTRACTOR:
STATE WELL
FOR OFFICE USE ONLY
QUAD. NO. SERIAL NO.
Lat Long. RO.
Minor Basin
Basin Code
Header Ent GW- I Ent
CONSTRUCTION
DRILLER CERTIFICATION NUMBER: r 5�i to PERMIT NUMBER:
1. WELL LOCATION:�"A
(Show sketch of the location below)
yr
Nearest Town: / 6h' yY.— County: 8 L'n ccn*h 't=—
%[-t Uui a_.t- Q 41. - DEPTH DRILLING LOG
(Road, Community, or Subdivision and Lot No.) From To Formation Description
2. OWNER 5 �' + farb irl Jr
ADDRESS ) t_ . i1» .--,_ Q(
(Street or Route No.)
1.e IC .12 tear 474. 097'4 � -2 D 623 Into o j t e-
City or Town Stott Zip Code
3. DATE DRILLED lirn USE OF WELL ra.-rn..
4. TOTAL DEPTH &+-2.
5. CUTTINGS COLLECTED YES 0 NO t4�
6. DOES WELL REPLACE EXISTING WELL". YES ❑ NO ❑
7. STATIC WATER LEVEL Below Top of Casing: /L21) FT.
(Use " + " if Above Top of Casing)
8. TOP OF CASING IS 11 FT. Above Land Surface'
'Casing Terminated atior below land surface is illegal unless a variance is issued
in accordance with71�5A NCAC 2C .0118
9. YIELD (gpm): ii METHOD OFTESTR �i
10. WATER ZONES (depth): �J
D -its DL1 e-Mo ci2r-
s
m
O
VI
II. CHLORINATION: Type Amount If additional space is needed use back of form
12. CASING:
L Dep h
From 7 i To FL
From To Ft.
From To Ft.
Wall Thickness
Dia eter Or 1' iignlhUFt. Material
13. GROUT:
Depth Material Method
From __bTo 20 FL toytenr tan i V
From To Ft.
14. SCREEN:
Depth Diameter Slot Size Material
From To Ft. in. in
From To Ft in. in
From To Ft. in. in
15. SAND/GRAVEL PACK
Depth Size Material
From To Ft.
From To FL
16. REMARKS:
j.00ATION SKETCH
(Show direction and distance from at least two State
Roads, or ether map reference points)
�� 76, ��.
to
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
Q of1d/d D 11-.41 li w75
CT A Trip C tit rewro Ar'rno rin Arrwir Tr Tr

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resourc
WELL CONTRACTOR (INDIVIDUAL) NAMES (pint)
WELL CONTRACTOR COMPANY NAME 1-I
STATE WELL CONSTRUCTION PERMIT/
(if applicable)
307639
- Division of Water Quality - Groundwater Section
(� CERTIFICATION EA ems'
a ;Ill n PRONE/MAC- 7M 3
ASSOCIATED WQ PE
(if applicable)
1. WELL USE (Check Applicable Box): Residential unicipa1/Public ❑ Industrial ❑ Agricultural ❑
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use
2. WELL LOCH ON:
NeareTo
(y rufj2. .
a�3 M ; CtA+ CrK. . .233
(Street Name, Numbers, Commurfity, Subdivisi000, LotNo., Zap Code)
3. OWNER: t4pi(547A4 tat(/r
A�d(ddrress,���`Y/S� NORl'/f 1ZAt31Ce.y Q�cr .
/ C;OZf.7TiL Aire No.) o2Fr i
City or Town State tip Code
Area code- Phone comber
4. DATE DRILLED I
5. TOTAL DEPTH:_'as
6. DOES WELL REPLACE EXISTING WELL? YF O
7. STATIC WATER LEVEL Below Top of Casing: FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS �— FT. Above Land Surface*
'Top of casing terminated at/or below land surface requires a
variance in aces ee 15A NCAC 2C.61111.
YIELD m METHOD OF TE
10. WATER ZONES (depth): �'f�bp-� J
11. DISINFECTION: T 77.L5 T -
12. CASING:
Diameter
From Toi 6 Ft
From To Ft
From To Ft
13. GROUT: Teeth r�Y MateppljeL u
From To Ft\ YXJ[Q,
From To Ft
14. SCREEN: Depth Diameter Slot Size Material
From To Ft in. in.
From To Ft in. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From_To Ft.
Amount oti
Wall Thickness
or Weight/Ft Material
16. REMARKS:
I DO HEREBY CERTIFY THAT THIS
CONSTR NSTAND A$DS,AND
SIGMA
Topographic/Land setting
dge ❑Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEP' DRILLING LOG
From To Formation Description
LOCATION SKETC1�
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common mad names.
AS CONSTRUCTED IN ACCORDANCE WITH ISA NCAC 2C, WELL
T A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
-71
rn
CO
CO
to
OF PERSON CONSTRUCTING THE WELL DATE
r
n
9. (gP ) SIQvC. Cy1:01
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

307638
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resouip - D. 'al n of Water Quality - Groundwater Section
CERTIFICATION tiZOO 9
PHONE # 112g)‘13• 11)23
WELL CONTRACTOR (INDIVIDUAL) NAME
WELL CONTRACTOR COMPANY NAME
STATE WELL CONSTRUCTION PERMITS __ASSOCIATED WQ PE
(if applicable) (if applicable)
1. WELL. USE (Check Applicable Box): Residential E Municipal/Public 0 Industrial 0 Agricultural ❑
Monitoring ❑ Recovery 0 Heat Pump Water Injection 0 Other ❑ If Other, List Use
on, Lot No., Zap Code)
3. OWNER �, e
Address a `,�, ,
City or Town State Zip Code
(-1
Area code- Phone number, //10(
5. TOTAL DEPTH:] l/a�r
6. DOES WELL REPLACE EXISTING WFT T 7 YE ❑ NO
7. STATIC WATER LEVEL Below Top of Casing: 9a FT,
(Use''+" if Above Top of Casing)
8. TOP OF CASING IS I FT. Above Land Surface*
"Top of easing terminated at/or below land surface requires a
variance in amoraaysitb 15A NCAC 2C .0118.
YIELD m : 'T'
1 (depth):
11. DISINFECTION: Type 1 Amount �-
12. CASING: Wall Thickness
Diameter or Weight/Ft Material
4. DATE DRILLED#t O
From 0 To T Ft.
From To Ft
From To FL 1v ia� ��
13. GROth
From_ ToTFt ..0mare '$T_
From To Ft
14. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in.
From To Ft in in.
15. SAND/GRAVEL PACK
Depth Size Material
From To Ft.
From To Ft.
Topogip c/Land setting
❑Ridge B lope ❑Valley ❑Flat
(cheek appropriate box)
Latitude/longitude of well location
(degrees/minas/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH. DRILLING LOG
From To Formation Description
9. (gp) MF IjOD fin . (%C��
0. WATER ZONES d tb : Gff CCJJ �$ ((�]
-r1
4
c
LOCATION SKETCij -
Show direction and distance in miles from atikst
two State Roads or County Roads. Include the road 3
numbers and common road names..
51D m;\.\G
16. REMARKS.
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRULIFU IN ACCORDANCE WITH 15A NCAC 2C, WELL
CON CrION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
SIGNATURE OF PERSON CONSTRUCTING THE WELL / DAB
Submit thdoriginal to the Division of Water Quality, Groundwater Section, 1636 Mall Service Center - Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-1 REV. 07/2001

307637
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Reso//LL11,LL,��\\e�s.-I Division of Water Quality - Groundwater Section
��/`
WELL CONTRACTOR (INDIVIDUAL) NAME (print)) L�y V*JiA� CERTIFICATION/ti;>n
WELL CONTRACTOR COMPANY NAME R wi a1 1 //\\��\\ ill M t I, i l� PHONE a (6o�A 423- 92. 3.
STATE WELL CONSTRUCTION PERMIT/ (� ♦ecO�pTP,D WQ PERMITS
(if applicable) - . (if applicable)
1. WELL USE (Check Applicable Box): Residential 0/Municipal/Public ❑ Industrial ❑ Agricultural ❑
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use
2. WELL LOCH N
(l�
AO Cr o►D
ui
Nearest Town: w dty
(Street Name, Number, Catammity. Subdi 'ow, Lot No., Zip Code)
3.OWNER:`�C1R 'f p{ `fr ef(a
Address i�ml Cif t � gy"(K� (t
1M„1 I �QStRet ar-Rpto) a OD"✓
City or Town State Zip Code
Area code- Phone number
4. DATE DRILLED 4
5. TOTAL DEPTH:S
6. DOES WELL REPLACE EXISTING WELL? YYS.❑ NO
7. STATIC WATER LEVEL Below Top of CasinF4 Ff.
(Use'+^ if Above Top of Casing)
8. TOP OF CASING IS I FT. Above Land Surface'
Topohic/Land setting
❑Ridge Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/mimtea/seomds)
Latitude/longitude source:❑GPS❑Topograpbic map
(check box)
DEPTH. DRILLING LOG
From To Formation Description
*Top of casing terminated at/or below land surface requires a
variance in accordance with ISA NCAC 2C A118.
9. YIELD (gpm): /OD I ,T D OF TESTGel L . Qorrea n erg
: �'j'+�i
10. WATER ZONES (depth)
11. DISINFECTION: Type Amotmt p�-
12. CASING: Wall Thickness
,s� Depth Diameter or Weight/Ft. Material
From 1 J To 50 Ft.
From__ To Ft.
From To Ft.
13. GROUT: Depth Q.,��
From To Ftlt.d►lCl
From To Ft.
14. SCREEN: Depth Diameter Slot Size Material
From To Ft in.
From To Ft. in
15. SAND/GRAVEL PACK
Depth Size Material
From To Ft.
From To Ft.
in.
in.
r*1
CD
n
LOCATION SKETCii�,,,
Show direction and distance in miles from at leasti*
two State Roads or County Roads. Include the road
numbers and common road names.
4kGJ (icQ
m; DD/cBcoi� R.� .
dlb H�-(�.
16. REMARKS:
I DO HEREBY CERTIFY THAT
CONSTRU N STAND
SIGNATURE OF P
WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
DATE
ON CONSTRUCTING THE WELL
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-1 REV. 07/2001

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural
Re�sourrcPgJ
WELL CONTRACTOR (INDIVIDUAL) NAME (print
""
WELL CONTRACTOR COMPANY NAME
307643
'on of Water Quality - Groundwater Section � A
p
CERTIFICATION #O( n \
PHONE # 3 a/9 ) �1 w (,b !/b 1
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT# JJJ
(if applicable) / (if applicable)
Zi
1. WELL USE (Check Applicable Box): Residential V2' Municipa1/Public ❑ Industrial ❑ Agricultural 0
Monitoring 0 Recovery ❑ Heat Pump Water Injection 0 Other ❑ If Other, List Use
2. WELL LOCA 19I)[:n
Nearest Town: �l
6 ��ai.�q
f I/
(Street Nunay,
eet Name, , Subdivision, Lot No., Zip Code)
3. OWNER:�3��}�m���m (�
Address�`ru-o+—Fa l ✓�,� If".(A.) (J�
1r eAt-i sneer rNo.) a gEo cp
City or Town State Zip Code
(�1
Area coda Phone number (�
4. DATE DRILLED ") " 2)- T
5. TOTAL DEPTH: 4P1 /
6. DOES WELL REPLACE EXISTING WELL? YE O e
7. STATIC WATER. LEVEL Below Top of Casing: FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS I FT. Above Land Surface*
'Top of casing termlaated at/or below land surface requires
a
YIELD m •v /1 ,,
9. (gp )• S METHOD OF TEST) lCC (� • W ( ri
10. WATER ZONES (depth):
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common road names.
Topographic/Load setting
❑Ridge lope ❑Valley ❑Flat
( appropriate box)
of well location
(degrees/mimupa/eamda)
Latitude/longitude source:❑GPS❑Topograpbic map
(check box)
DEPTH DRILLING LOG From To Formation Description
variance in accord wRb 15A NCAC 2C .0118.
11. DISINFECTION: Type��" Amount
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft Material
From To . 7/ Ft
From_ To Ft.
From To Ft.
13. GROUT: _ �/-�Iethod-<
From To � Fd ? QI I_,C.>-t,
From To Ft
14. SCREEN: Depth Diameter
From To Ft in.
From To Ft in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
Slot Size Material
in.
in.
16. REMARKS:
flti ��-
mac i&?t; if(
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSI�.UCTION STANDARD$, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
/ / -
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
SubmiYthe original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-1 REV. 07/2001

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and
WELL CONTRACTOR (INDIVIDUAL) NAM{F\ (print)
WELL CONTRACTOR COMPANY NAME 1 1 ypf ]p,
at/u�ral
307641
- D'vtsion of Water Quality - Groundwater Section
CERTIFICATION�[# �9166
CI PRONE # 621c(�d-3-9(2)Oj`)
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMED/
(if applicable) (if applicable)
I. WELL USE (Check Applicable Box): Residential 6---M1micipal/Public 0 Industrial 0 Agricultural ❑
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
(Street Name Numbers, Community, Subdivision, Lot No., Zip Code)
(a) �L
3. OWNER: L� )av- L 1 fl
Addressss 1j)Ja�z- ( wV E C & .
ham'cefri]�/(Simi No.)
City or Town State
O\b `k D
ZIP Code
Area code- Phone mmbe
4. DATE DRILLED p�' � - a 7
5. TOTAL DEPTH: 1
6. DOES WELL REPLACE EXISTING WELL? YE LINO
7. STATIC WATER LEVEL Below Top of Casing:FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS I FT. Above Land Surface*
'Top of easing terminated at/or below land surface requires a
variance � accord ISA NCAC 2C .0118.
9. YIELD m : METHOD OF TES lli l
10. WATER ZONES (depth): /r% 0
11. DISINFECTION: Type iti-' Amount 9
12. CASING: Wall Thickness
j To�O Ft. Diameter or Weight/Ft. Material
From C
From To Ft.
From To Ft.
13. GROUT: /� ethpd
From To FttOtt}t i� cv-'1`
From To Ft.
14. SCREEN: Depth Diameter
From To Ft._in.
From To Ft in.
15. SAND/GRAVEL PACK:
Depth Size Material
Topograplrrc/Lard setting
❑Ridge L lope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH PRILLING LOG
From To Formation Description
Slot Size Material
_in.
in.
From To Ft.
From To Ft.
16. REMARKS:
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common road names.
�. mii6c44 C(( .
6anb1 m CIZ .
Odor t&ci (WE
co
co
0
WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
/ - c7(- - `"
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-1 REV. 07/2001

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and
WELL CONTRACTOR (INDIVIDUAL) NAM")(print) WELL CONTRACTOR COMPANY NAME ripPAIRCI2 -
307645
atural ResoDivision of Water Quality - Groundwater Section d
/�}t�/[�{�� Sc(( CERTIFICATION 14a6 v
W fill �ith � PRONE M WICa Gr3 %
STATE WELL CONSTRUCTION PERMITS ASSOCIATED WQ PERMIT#
(if applicable)
(if applicable)
1. WELL USE (Check Applicable Box): Residential la Municipal/Public ❑ Industrial ❑ Agricultural ❑
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use
2. WELL LOCA'
Nearest wn: —IQ CounAt-v llu. S
WNSC
es t (,J c� &i1a Rc , o; $q-!j
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: E&5,-' Cc et) to M
Address •(31(ol Orb en ua� 7-O'UN5-F o-ii
.tau: M. akreNi g?-(1
City or Town State Zip Code
(_}
Area code- Phone number L/,
4. DATE DRILLED
5. TOTAL DEPTH: Cp5' /
6. DOES WELL REPLACE EXISTING WELL? YES p, NO E
7. STATIC WATER LEVEL Below Top of Casing: 41 FT.
1 (Use"+" if Above Top of Casing)
FT. Above Land Surface
'Top of wing terminated at/or below land surface requires s
variance is accordance with ISA NCAC 2C .011S. n // /7 n. / i
9. YIELD (gpm): ! A METiQD OF TES'1. 11 l C) ip7 ✓1F�'
10. WATER. ZONES (depth): C3'*'U
11. DISINFECTION: Type PI 6( tk
�Topographic/Land setting
'Midge ❑Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrealminutes/seeonds)
Latitude/longitude source:❑GPS❑Topographic map
( �)
DEPTH DRILLING L
From To Formation Description
8. TOP OF CASING IS
12. CASING:
Depth
From To
From To
From To
13. GROUT: Depth
From To
From To
14. SCREEN: Depth
From To_
Amount oZ-
Wall Thickness
Diameter or Weight/Ft Material
Ft.
Ft
Ft iLr,
Ft.04 t6
Ft
Diameter
Ft in.
From To Ft. in.
15. SAND/GRAVEL PACK
Depth Size Material
From To Ft.
From To Ft,
Slot Size Material
in.
in.
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common road names.
Crab KEb CZ .
Ca t-Pi03i fi I3
"ia 7tfaUfJ A0
16. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRULit1) IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
SIGNATURE OPjPERSON CONSTRUCTING THE WELL
DATE
Submit thu3original 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

STATE WELL CONSTRUCTION PERMIT#
(if applicable)
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment a ural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) 'ki AAi �{ // 83/4Q
//� /%. C�iN�$ CERTIFICATION WELL CONTRACTOR COMPANY NAMEi'i AiOW (,(/��/ram, �a PHONE p,t)I6Q-SW�
ASSOCIATED WQ PERMIT#
(if applicable)
1
WELL USE (Check Applicable Box): Residential I 1 Municipal/Public ❑
Monitoring 0 Recovery ❑ Heat Pump Water Injection 0
2. WELL LOCATIO�N
Nearest Town: "V-547,//c'
Zip Code
��)- f4t,4— 1532'
Area code- Phone number
4. DATE DRILLED /I-7/- Oy
5. TOTAL DEPTH: c%''
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO Cd-
7. STATIC WATER LEVEL Below Top of Casing: pia FT.
8. TOP OF CASING IS (Use "+" if Above Top of Casing)
FT. Above Land Surface
*Top of easing terminated auor below land surface requires a
variance in accordance with 15A NCAC 2C .0118.
9. YIELD (gpm): Jo METHOD OF TESTr• J
4,
10. WATER ZONES (depth): 0 '
Industrial ❑ Agricultural ❑
Other ❑ If Other, List Use
SS County f't:.-.e,,.,/,f
(Street dame, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: ZjN Wocaco4
Address e 0 Bent ct u
(Street or Route No.)
n}S-1 sQ..t.l .11.e h C
City or Town State
I1. DISINFECTION: Type Oy-.At
12. CASING:
Depth
From /9 To it
From To
From To _
13. GROUT: Depth
From.__Q_To alb
From To
14. SCREEN: Depth
From To
From To
15. SAND/GRAVEL PACK:
Depth
From To
From To
Diameter
Ft.
Ft.
16. REMARKS:
Amount 22clr
Wall Thickness
or Weight/Ft. Material
At
Material
Ft. CoNCQG.e.
Ft.
Diameter
Ft. in.
Ft. in.
Ft.
Ft.
Size
Method
Slot Size Material
in.
in.
Material
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH I5A NCAC 2C, WELL
CONSTRU TION STAAjNDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
SIGNATURE OF PERSON CONSTRUCTING THE WELL L ,/� �O 1
DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
27699-1636 Phone No. [phone], within 30 days.
GW-I REV. 07/200I
309208
Topographic/Land setting
C7Ridge OSlope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
11)1'3,r 3u`r,,cne
(degreesimin�ute econds)
Latitude/longitude source: @GPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From To Formation Description
1)- .29. P e
27- 32. -Co//
3L - ems'
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.
6
f(•e✓ 7fe NC
cr.
arks I)
CD.)
FT
Cjel

309210
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment a ural Resources - Division of Water Quality - Groundwater Section Jp ��[[ WELL CONTRACTOR (INDIVIDUAL) NAME (print) kt4A/ l ILN 5 CERTIFICATION th /TO
WELL CONTRACTOR COMPANY NAMEKG L6SOiil (,(lE��2kQ,�JJ1 , �,Ge PHONE ruyu� Q�B=j94
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable)
(if applicable)
I. WELL USE (Check Applicable Box): Residential Pr Municipal/Public ❑ Industrial ❑ Agricultural ❑
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use
2. WELL LOCATION:
Nearest Town: zeS ter
'c/(so., ["b. c
(Street Name, Numbers,/Community, Subdivision, Lot No., Zip Code)
3. OWNER: 4 dNrson fctrr, ,'lid 1�G/ryf.5
Address So ,Sp ,r d ; 5 ,�Py
'/Ieee[ or Route i�a8gd 6
r City or
t
Town State
(C9W)- /ors Vie 63
Area code- Phone number
4. DATE DRILLED /2. 2k- ev
5. TOTAL DEPTH: 32. /
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO Q
7. STATIC WATER LEVEL Below Top of Casing: 40 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 accordan a with ISA NCAC 2C .0118.
9. YIELD (gpm): fQ M THOD OF TESTS J1.84
J
10. WATER ZONES (depth): JDS''
County .01,.-,a--./c
Zip Code
11. DISINFECTION: Type C lariat- Amount/pit,6)
12. CASING: Wall Thickness
Depth - Diameter or Weight/Ft. Material
From b To 70 Ft. 1. /Ls- SD/Tj , ' c
From To Ft.
From To Ft.
13. GROUT: Depth Material Method
From D To ao Ft. CoNCQege. 7pl22in/q
From To Ft. J
14. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in.
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To • FL
From To Ft.
16. REMARKS:
Topographic/Land setting
C3lfidge ❑Slope ❑Valley OFlat
(check appropriate box)
Latitude/longitude of well location
55.5 5�i . nve
(degrees/minute4econds)
Latitude/longitude source: QPSOTopographic map
(check box)
DRILLING LOG
Formation Description
DEPTH
From To
01 ..
7to a/s a z
7n 5cr G--sn.
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.
Set�CamfeCt
(e•Ced'er NC
1 DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH l5A NCAC 2C, r
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
/2 -Lf - oti
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

309211
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment a ural Resources - Division/of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) r€/N M', Lu/dNES,I ION //1Q
WELL CONTRACTOR COMPANY NAME
S4SOA/�,(!�/�� l�Zt�gJ !-rt.�a PHONEIFI �B.� g4
STATE WELL CONSTRUCTION PERMIT# WYo)
(if applicable)
ASSOCIATED WQ PERMIT#
(if applicable)
1. WELL USE (Check Applicable Box): Residential E Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION:
Near,ee�st Town: Wef"1"
�tt
(Street Name, (lumbers, Community, Subdivision, Lot No., Zip Code)
3. O)W�N�ER: deor,.e QRmc�`
1049 -t lt/i n rf .9.g7 f 7'
City or Town State Zip Code
(PR)- Jsa-69G
Area code- Phone number
Address 33 /I/Jy,4 Eno e_ /7r✓
(Street or Route o.)
County .6cr.,e.+,...(/
4. DATE DRILLED /Z' 2 r"- e/y
5. TOTAL DEPTH: /5/s'
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO
7. STATIC WATER LEVEL Below Top of Casing: la FT.
8. TOP OF CASING IS , (Use'•+" if Above Top of Casing)
FT. Above Land Surface*
'Top of casing terminated aVor below land surface requires a
variance in accordance with 15A NCAC 2C .0118.
9. YIELD (gpm): /L' METHOD OF TEST
10. WATER ZONES (depth): fer'
11. DISINFECTION: Type ('%arrr.l-
12. CASING:
Depth
From To To 2rf
From To
From To
13. GROUT: Depth
From__To an
From To
14. SCREEN: Depth
From To
From To
15. SAND/GRAVEL PACK
Depth
From To
From To
16. REMARKS:
Ft.
Ft.
Ft.
Amount 7 AAS1
Wall Thickness
Diameter or Weight/Ft. Material
Material
Ft. AwcZeie-
Ft.
Diameter Slot Size
Ft. in.
Ft. in.
Size
Ft.
Ft.
Method
?0 PrNa
Material
in.
in.
Material
Topographic/Land setting
❑Ridge ❑Slope QValley ❑Flat
(check appropriate box)
Latitude/longitude of well location
AJjr °yl ylv3'Arun.° df).31 / '
(degrees/minutes/seconds)
Latitude/longitude source: DGPS❑Topographic map
(check box)
DEPTH DRILLING LOG
Formation Description
54a
Zit— /Vr—
From To
/c
/r— Zit
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.
33 /I'l u AJd G" Pd .
f. 1e& 1/JJI� Y7 L
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH ISA NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
R
SIGNATURE OF PERSON CONSTRUCTING THE WELL / A - ZY-«/
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

300212
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment a urarll Resources - DivJ/5j]on of Water Quality - Groundwater Section q �t o
WELL CONTRACTOR (INDIVIDUAL) NAME' (print) n bi lALPAS CERTIFICATION # 2O�2Q
WELL CONTRACTOR COMPANY NAMEFERq(JsO/U wEJJ .PJAil, 1 —C PHONE gli a5S'OTY4
STATE WELL CONSTRUCTION PERMIT# �JJ ASSOCIATE-DJWQ PERMIT#
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential la "unicipal/Public ❑ Industrial 0 Agricultural 0
Monitoring ❑ Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION: ,(
Nearest Town: L6//GGs/ c7' County BUIl(a" IL
w
7'a »v 7u //I -y ri-e izd
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER 3 un^
6M Cn/(esp e
Address 74/0 /17 7a.✓k'ap &r.e hr/
/ (Street or Route No.) 7
l CPS/ Pr /vC 2-87VA'
Ciry or Town Siam Zip Code
62k)- Coisi- Qa37
Area code- Phone number _ /
4. DATE DRILLED / 24/C Se5. TOTAL DEPTH: 2./).5
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO
Topographic/Land setting
❑Ridge ❑Slope ❑Valley ♦3Flat
(check appropriate box)
Latitude/longitude of well location
N Sir .2/7/wo820Y6,ao6 •
(degrees/minuteee rannds)
Latitude/longitude source: C9GPS❑Topographic map
(check box)
DRILLING LOG
Formation Description
o — as
DEPTH
From To
zS—v7
v) - 52.
Ca 1 MS
7. STATIC WATER LEVEL Below Top of Casing: FT.
(Use "+" if Above Top of asing)
8. TOP OF CASING IS FT. Above Land Surface*
*Top of casing terminated abor below land surface requires a
variance in accordance with ISA NCAC 2C .0118.
9. YIELD (gpm): d METHOD OF TESTBI'bLt/JNap ?.'9
10. WATER ZONES (depth): !(pl%
11
l2
DISINFECTION: Type Ch /a ti41G Amount S O 2
CASING: Wall Thickness
Depth
From O To Sd. Ft.
From To Ft.
From To Ft.
13. GROUT: Depth
From (2 To0
From To
l4. SCREEN: Depth
From To Ft.
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
Diameter or Weight/Ft, Material numbers and common road names.
4yaiv,
--724_,h,7er,--/Zi -1.
4,015 alL7n #YCSOR.l1
Material Method
Ft. Co41czE)E
Ft.
Diameter Slot Size Material
in. in.
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth
From To Ft.
From To Ft.
lb. REMARKS:
Size
Material
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH I5A NCAC 2C, WELL 11 r
CONSTRUCTION STANDARDS, AND THAT A COPY OF T RECORD HAS BEEN PROVIDED TO THE WELL OWNER •
SIGNATUJCE OF PERSO CONSTRUCTING THE WELL ATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-I REV. 07/2001

WELL CONSTRUCTION RECORD 309213
North Carolina - Department of Environment a,•,.�►��r�y-�-'t��_'ral Resources - Div on of Water Quality - Groundwater Section tt �1
WELL CONTRACTOR (INDIVIDUAL) NAME (print)). 7/16 bI rA fs '(-' s CERTIFICATION # N6A8
/ lill
WELL CONTRACTOR COMPANY NAME/FILE](( 40/1)
STATE WELL CONSTRUCTION PERMIT#
(if applicable)
El a///L/G% ILC. PHONE pasp)a624514,
ASSOCIATED WQ PERMIT#
(if applicable)
1. WELL USE (Check Applicable Box): Residential 0 Municipal/Public 0 Industrial 0 Agricultural 13----
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION: ,�// //��
Nearest Town: Lt%C )1C /. County LSUn/pey be,
f140-A l uti e y Creek. L,'
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: S-eery_ C/4!/S�
Address 97 / /Y , Tatk..� C.-4-24
(Street or Route No.)
City or Town Stare
(DS)- &53F- 7.739
Area code- Phone number
4. DATE DRILLED 1�I/7 V
5. TOTAL DEPTH: S
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO 0 %— DVS
7. STATIC WATER LEVEL Below Top of Casing: /Q FT.
(Use "+" if Above Top of Casing)
S. TOP OF CASING IS / FT. Above Land Surface'
"Top of casing terminated at/or below land surface requires a
variance in accordance with ISA NCAC 2C .0118.
9. YIELD (gpm): as METHOD OF TES T�4GIikq /irq
10. WATER ZONES (depth): / ..J J
ass 71-2
Zip Code
11. DISINFECTION: Type CA/pnAte Amount ,$ a,
12. CASING:
Depth Diameter
From___ To 7y
From To
From To
13. GROUT: Depth
From 4 Toa,O
From To
14. SCREEN: Depth
From To
From To
15. SAND/GRAVEL PACK:
Depth Size
From To Ft.
From To Ft.
16. REMARKS:
Wall Thickness
or Weight/Ft.
Ft. G tax ./gg
Ft.
Ft.
Material
sicc/
Material Method
Ft. Coaceeli G
Ft. SLO
Diameter Slot Size Material
Ft. in. in.
Ft. in. in.
Material
Topographic/Land setting ,
❑Ridge ❑Slope ❑Valley 2Plat
(check appropriate box)
Latitude/longitude of well}ocation
tang) °Y6/9/3
(degrees/minutes Eonds)
Latitude/longitude source:
DEPTH
From To
0'-'/5
ni it°37,
ICV -77
PS❑Topographic map
(check box)
DRILLING LOG
Formation Description
clayso at
/IOGMC y
CMwi}c
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.
N. Tlc/kL, Cr�.e.tRd
Lc.tce&/er, IVC
1 DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCILD IN ACCORDANCE WITH I5A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF T S RECORD HAS BEEN PROVIDED TO THE WELL OWNER
C,
OF PERSO
Submit the original to the Division of Water Quality, Groundwater Section,
27699-1636 Phone No. [phone], within 30 days.
CONSTRUCTING THE WELL idlaryo y
DAT
1636 Mail Service Center - Raleigh, NC
GW-I REV. 07/2001

309214
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment a
WELL CONTRACTOR (INDIVIDUAL) NAME (print)
ural Resources - Division of Water Quality - Groundwater Section Q
krlhN • (�/t#AM5/� CERTIFICATION iS3/4tO
WELL CONTRACTOR COMPANY NAh1E�rE 1.44OW E/)2 /!//�tqJ LI_C PHONES Ia' 2-$5'94
STATE WELL CONSTRUCTION PERMIT# JJ ASSOCIATED-WQ PERMIT#
(if applicable)
(if applicable)
1. WELL USE (Check Applicable Box): Residential 13'Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION:
Nearest Town: /41-. --✓.//r
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER:R /3 Yr,//cr Corp
Address 07 /!%ef.ia.-//a J2el
(Street or Route No.)
big erect / . I/r_ 4' e 5L k 7 fs 7#
City or Town State
(S )- (2YV- & 17?
Zip Code
County itieswot
Area code- Phone number
4. DATE DRILLED /2
5. TOTAL DEPTH: 20 r
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO Q'
7. STATIC WATER LEVEL Below Top of Casing: t/J FT.
8. TOP OF CASING IS (Use "+" if Above Top of Casing)
FT. Above Land Surface`
*Top o1'casing terminated at/or below land surface requires a
variance in accordance with ISA NCAC 2C .0118.
9. YIELD (gpm): s'iJ METHOD OF TEST_
10. WATER ZONES (depth): /Ot' '
11. DISINFECTION: Type C/cr. ae
12. CASING:
Q Depth
From To .52
From To
From To
Amount /£' �ajf
Wall Thickness
Diameter or Weight/Ft. Material
Ft./r,/Z,- 5.. ✓c
Ft.
Ft.
13. GROUT: Depth Material
From 0 To 10 Ft. CONCeele*
From To Ft.
14. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in.
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
Method
16. REMARKS:
Topogra hic/Land setting
❑Ridge Mope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
/7J'NL DJ,.in
(degrees/minutes/seconds)
Latitude/Iongitude source: Et6PS❑Topographic map
(check box)
DEPTH DRILLING LOG
Formation Description
From To
O'- ??
27- aZ
32 -2Qr'
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common road names.
l'[lp,'t'e mead' 65
/,lQa.Afe-`Ui7l e- /VC
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL.
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
27699-1636 Phone No. [phone], within 30 days.
GW-1 REV. 07/2001

L L 1 t \
V'L'LI_ L'L)Nj [:I
�` iurl Diri,:;i 11'arcr Quail, - aroundwdr`r scc[ion
Y
W c9- fs
309215
,r r •v \...rl I: I'�C�f_GSS-4L✓�_ .:cknilervrioN 11,203
�3..1J ._/ja _L! ' LII.�Q rtOHG i a5u%r.[-t`c.
vs li u...v r�i cu r.-; ❑ fr ai 1':,rrll \. lcr lrfl; -; N'r P blie CI
I11cf: List
O . riculn+ral C]
I-J lLI]cl ❑ If ulhcr. Di:-
_
•i �� - L o
c _ —
!w .7/
.114
0/0
m,:
,LI I:
Ih
i'LACE EXISTING 11 ELL? YES ❑ f`!,_, L�
I FIJ 1l ,!_-.LEl'6LEc'o,vTop.fC:i3Jli.
U ��
'1+ alc ,, , rrm.11.^:Ua Yc land -:�ul'IS:G"'
1'.
[ r oN C. lJ2 1 ul'r`ju( G:J Nlfpa' u
11L11�- `9 41,4 WWI IJA .Y I.L L Wli
i1 r.h I --°A.. \IETij ph Tk:sI �r9
In,_-UfZ_ Pi.__J_✓—`mil_
Fr
F.
Dui
- - Pal aicngl
..11&.s 1 EL F
^Cara!^ 1'0
Di,onn,r
rr hJ
F1.
Fl
�c n 7cnY,:I ^IIhY119+TTNIS 41'ELL 4Y.-tS CONSL
IGUCTEDINACCORDANCE ?.NDTHATACopyOF IRIS RECORDI-L�SSVfTH ED NC.-4C2W4LLo
BEEN PP,OVIDED TO THE WELL OWNER.
3 UN4 Ilia .P' sO ^----
t'iiiV9'R,Uc1 INv THE
lJt ql :;rh lnal CJ 1 t WkLL D 'TE
Tic Di of 11':uce Qualify, Urou ndl)•Cr Sccripn, 1636111�'
Syi. uJl Strvitc Qllaa'- Raltlh
CA' -I LEV, 07/2020d1
S¢c
1V:111 11JlIpJ.A3
Slat Srsr iNarcrul
in.
11.1 -
1llrcn al
or^Spoicr sc
p1) is L.Jtd (-hag
Jgc O3I pc 0 Valley ❑Flat
(Utica: Irp'Opriarc 11JS)
LnufJdt/IonsJwic of vcll tccea o2
was° ,IY3
la blic rill uci; :LtJ(la:l
L auullid tilltllgac 30r1.1e: U �FSOTopographl, rn`.lp
(glcaL box)
Forrnation Description
DEEP H
groin 1`p
�l4qll,V(�o
lism
��OckA ji-
LOCA.TIDri SKETCH
Show direction ¢md distance- -
i'.116 SCAIy. Rou Of o o ds. J to aL Icasr
County Roads. cludo rha roan numbers and common road Ilal]1t5.
it) n wozrl
C d 4ri /Vc

309216
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment a Ural Resources'/ - Division��//of Water Quality - Groundwater Section ? �[ WELL CONTRACTOR (INDIVIDUAL) NAME (print) ,e,.4.JAJ( /J, / _k,VPS)� � CERTIFICATION�t S�7Q
WELL CONTRACTOR COMPANY NAME�,E z4ioA/ t%A2).2i/Ji4l11 L-F-. .e PHONE a a' 52-8't 4
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential Ill Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other ❑ If Other, List Use
2. WELL LOCATION:
Nearest Town:4. rr,
Ali k// ,`s/-ks
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
County Bi.,.rati4-
3. OWNER: reee.ci0 m htscri .
Address Sao n Herdct5 oN. Ile �k�tV
-' `' (Street or Route No.) /
t taed N C 0.273
City or Town State Zip Code
(41.4- 1o,24-if&(6,
Area code- Phone number
4. DATE DRILLED /2-
5. TOTAL DEPTH: yE r
6
7
DOES WELL REPLACE EXISTING WELL? YES ❑ NO ❑�
STATIC WATER LEVEL Below Top of Casing: Ail FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS / FT. Above Land Surface*
*Top of easing terminated at/or below land surface requires a
variance in accordance with 15A NCAC 2C .0118.
9. YIELD (gpm). /0 METHOD OF TEST30WiiJq-&-
10. WATER ZONES (depth): `r9V) J
Topographic/Land setting
BlCdge ❑Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes�/s conds)
Latitude/longitude source: 0GPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From To Formation Description
D - /c'
�Olc - /// J<r //
/// — e/br
11. DISINFECTION: Type talc+!° A{ Amount /!t )A g
12. CASING: Wall Thickness
or Weight/Ft. Material
Depth
From
From
From
Diameter
0 To %// Ft. 4./G'
To Ft.
To Ft.
13. GROUT: Depth
FromQ_ To 20
From To
14. SCREEN: Depth
From To
From To
15. SAND/GRAVEL PACK:
Depth
From To
From To
Material Method
Ft. dO/Keehe, i�A![D.iJn/�}
Ft. i
Diameter Slot Size Material
Ft, in. in.
Ft. in. in.
Size
Ft.
Ft.
Material
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common road names.
//,'g h l/a lluj aiSe
(L „tJttr, l .
l6. 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
443
SIGNATURE OF PERSON CONSTRUCTING THE WELL
-Cy
DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-1 REV. 07/2001:

Depth
From__ To 2
From To
From To
13. GROUT: Depth
From 0 To ao
From To
14. SCREEN: Depth Diameter
From To Ft. in.
From To Ft. in.
15. SAND/GRAVEL PACK:
Depth Size
From To Ft.
From To Ft.
16. REMARKS:
2
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment a ural Resources/ - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) Ries;/V / //i LtL NpS ?///Q
WELL CONTRACTOR COMPANY NAME CERTIFICATION
#Jp i
Rr.�l.6.SoN2[%//�.2i/l/NQ {�.Le PHONE PwICIaL]8'O�`ii
STATE WELL CONSTRUCTION PERMIT#
(if applicable) ASSOCIATED WQ PERMIT#
(if applicable)
WELL USE (Check Applicable Box): Residential ir-MunicipalPublic ❑ Industrial ❑ Agricultural ❑ Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use
WELL LOCATION:
Nearest Town: b1/ <<'.t /c-- County .+/.;; ft
49/,/ %� . il G, tr./ O c j( y/.i Arf,a.,
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER:
CJ,
Address Neer , , , / wciet-
Le Streetor Route No.)
r ecvLe irc ak7VC?
City or Town State Zip Code
si.fi)- • tag 3-340a°
Area code- Phone number
4. DATE DRILLED /2 -2 / - c y
5. TOTAL DEPTH: der
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO ler
7. STATIC WATER LEVEL Below Top of Casing: c 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): 70 METHOD OFTESTND thAti lr cf
10. WATER ZONES (depth): J
I1. DISINFECTION: Type Ch.,;At Amount // As%
12. CASING: Wall Thiclmess
Diameter or Weight/Ft. Material
5-A3ra>/ i3's_
309219
Topogr,a�pPhic/Land setting
❑Ridge QSlope OValley ❑Flat
(check appropriate box)
Latitude/longitude of well location
c/1%idY2'//1jzy'
(degrees/min�ute "econds)
Latitude/longitude source: WGPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From To Formation Description
b/-7C S.lP//
Ft.G--'t
Ft.
Ft.
Material Method
Ft. CoNCQdde. Ft. ?alit �,B/N5
Slot Size Material
in.
in.
Material
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common road names.
Lcrc'estCi NC
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. 07/200I

309220
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment a
Odd' ural Resources -D/ivision of Water Quality -Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print),dRt, Al C.C.ii/YF S
WELL CONTRACTOR COMPANY NAME CERTIFICATION
STATE WELL CONSTRUCTION PERMIT#
(if applicable)
ASSOCIATED WQ PERMIT#
(if applicable)
PHONE rgyp76Q'SW 4.
1. WELL USE (Check Applicable Box): Residential 13 Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION:
Nearest Town: it cos Are -
County AC.74.:',"7
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER:
Address
/ ( tree[ or Route No.
J
(C t C -estet )V C
City or Town State
r w
a$7S/ec?
Zip Code
(Ka?S> lQ 8 ? -996S-
Area code- Phone number
4. DATE DRILLED /Z -4- -ot{
5. TOTAL DEPTH: 1Vr-
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO Er
7. STATIC WATER LEVEL Below Top of Casing:
8. TOP OF CASING IS (Use '+" if Above Top of Casing)
'Top of casing terminated atior below land surface requires FT. Above Land Surface*
a
variance in accordance with ISA NCAC 2C .0118.
9. YIELD (gpm): %2 METHOD OF TESTli
10. WATER ZONES (depth):
11. DISINFECTION: Type u:. -st Amount 4e %ids
12. CASING.
From 0
From
From
15. SAND/GRAVEL PACK: to
Depth Size
From To Ft._
From To Ft.
Wall Thickness
Depth - Diameter or Weight/Ft. Material
To g_o Ft.fetain S f uC
To Ft.
To Ft.
13. GROUT: Depth Material
From_Q_To 20 FL G G
From To Ft
14. SCREEN: Depth Diameter
From To Ft. in.
From To Ft
16. REMARKS:
-T� ,/Metthod
"'J''
Slot Size Material
in.
in.
Material
1 DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH l5A 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 iZ- /Y_ U y
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>
Topographic/Land setting
Midge ❑Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minuteseconds)
Latitude/longitude source: PS❑Topographic map
(check box)
DRILLING LOG
Formation Description
.U--f
G: cs J t
DEPTH
From To
0-
LOCATION
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common road names.
33.-4 W h-Peer co / C.crPc
�. tjr, Ne ag7i�8

309222
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment a
WELL CONTRACTOR (INDIVIDUAL) NAME (print)
WELL CONTRACTOR COMPANY NAME
STATE WELL CONSTRUCTION PERMIT#
(if applicable)
ural Resources - Division of Water Quality- Groundwater Section :NE S CERTIFICATION 1.5/4'e)
.A
a/12)21.1 /A1q ill-C., ., PHONE P
a 'S1! !{�
ASSOCIATED WQ PERMIT'S
(if applicable)
1. WELL USE (Check Applicable Box): Residential Er Municipal/Public ❑ Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION: �
Nearest Town:L✓[..rie//t County AC-et-,dc
iir eyy ie 1 t
(Street Nuke, Numbers,//��Community, Subdivision, Lot No., Zip Code)
3. OWNER: 17D/NSnof f%er.ta
Address
7S a4,7 Aftk a/
(S4SRCVt We-Vee[orR c.) nl SBo6
ea.)-
or Town State Zip Code
ea.)- a sa-6 6 9?
Area code- Phone number
4. DATE DRILLED /L - /h - oc/
5. TOTAL DEPTH: 24 r'
Topoggraaphic/Land setting
❑Ridge MSlope OValley OFIat
(check appropriate box)
Latitude/longitude of well location i
*ire a/3.432 r2 i2''Z7. Q'o
(degrees/minutes/seconds)
Latitude/longitude source: 2th'S❑Topographic map
(check box)
DRILLING LOG
Formation Description
S!a//
DEPTH
From To
1') - 7
7Z-,YL
Sz --7_tr
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO d
7. STATIC WATER LEVEL Below Top of Casing: S-0 FT.
( Use "+" if Above Top of Casing)
8. TOP OF CASING IS / FT Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordance with ISA NCAC 2C .0118. ����
9. YIELD (gpm): r METHOD OF TESTj� �_Jj7��-�
10. WATER ZONES (depth): r7(i0'
I
12. CASING:
Depth
From D To CI'? Ft
From To Ft.
From To Ft.
13. GROUT: Depth
From D To AD Ft
From To Ft
DISINFECTION: Type (la•Nne Amount '3 k-S.
Wall Thickness
Diameter or Weight/Ft. Material
Material
deNCieede,
14. SCREEN: Depth Diameter
From To Ft. in.
From To Ft, in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
Method
�!1ltQiN q
Slot Size Material
in.
in.
16. REMARKS:
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common road names.
MGN ei ?r&MJ
W2tueru:e 1UC
1 DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH ISA NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
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

309223
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment aural Resources - Division of Water Quality - Groundwater Section WELL CONTRACTOR (INDIVIDUAL) NAME (print) 'rg/l i �e ??
{� A NE 5 CERTIFICATION /hJ��Q WELL CONTRACTOR COMPANY NAMEd�Yl3✓a
STATE WELL CONSTRUCTION PERMIT*
(if applicable)
1. WELL USE (Check Applicable Box): Residential
Monitoring 0 Recovery 0 Heat Pump Water
2. WELL LOCATION:
Nearest Town: c! at, ji County v-c.a-s sr
C,r,dcr,.r CSyr:/ 27
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3.OWNER: for, t-"c/lS Address Cadeers LAapef
(Sire t or Route No.)
Ciry or Town State Zip Code
)-
Area code- Phone number
4. DATE DRILLED 12 -
5. TOTAL DEPTH: 2 /s"
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO V
7. STATIC WATER LEVEL Below Top of Casing: 7O FT
8. TOP OF CASING IS ' (Use "+ if Above Top of Casing)
FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordarLce with /SA NCAC 2C .0118.
9. YIELD (gpm): ✓ METHOD OF TESTDW4 DD�y
WATER ZONES (depth): /y0 9
rnJ
10.
11. DISINFECTION: Type (w.--'-.z Amount 9 Air
12. CASING: Wall Thickness
, Depth - Diameter or Weight/Ft. Material
To //✓" Ft. ' 1f' SLL+7i Alt
To Ft.
To Ft.
13. GROUT: Depth Material
FromQ_ To t> Ft. G ge
From
From
From
14.
From
Ft
SCREEN: Depth Diameter
From To Ft. in.
From To Ft. in.
15. SAND/GRAVEL PACK:
Depth Size
From To Ft.
From To Ft.
16. REMARKS:
Method
Slot Size Material
in.
in.
Material
Latitude/longitude source:
DEPTH
From To
ASSOCIATED WQ WQ PERMIT*
(if applicable)
PHONE 068-8,9 iZ
I:"Municipal/Public 0 Industrial 0 Agricultural 0
Injection 0 Other 0 If Other, List Use
opographic/Land setting
Midge ❑Slope ❑Valley gnat
(check appropriate box)
Latitude/longitude of well location
rc5/I ✓br
green/minute�s/ onds)
L7GPS❑Topographic map
(check box)
DRILLING LOG
Formation Description
Sr✓s,t ,�
LOCATION
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common road names.
(!-c.4etz S C,497o .f /2
Leicester/ 4' C
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
J=
SIGNATURE OF PERSON CONSTRUCTING THE WELL Z.
` _ �y
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

309224
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment a / ^?� ��[[
WELL CONTRACTOR (INDIVIDUAL) NAME (print) r�/!�j/!�l 11. /L Nfs CERTIF''IIC�A,TION+ti1/T6
WELL CONTRACTOR COMPANY NAME �Jf54jo1{/ ufA/T7zi/LiN9� .1 i' . PHONE p.�.tp',' Q-$:jg4
STATE WELL CONSTRUCTION Lf.-�.
ASSOCIATED WQ PERMIT#
(if applicable)
1. WELL USE (Check Applicable Box): Residential ❑-' Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring ❑ Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION:
Near st Town<<'.-e>> County tY �,�+...lr
PERMIT#
(if applicable)
ural Resources - Division of Water Quality - Groundwater Section
.;i ton, /7 //
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER tbenSles Ce 5-/rc�t_4-:oAJ
Address /GC /-jm,� Ut—
(Scree( or Route No.)
rat /vc aSt7/r
City or Town State Zip Code
(P2)- WPC- 7833
Area code- Phone number
4. DATE DRILLED /2 - it!- y
5. TOTAL DEPTH: 2 ✓r
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO t�
7. STATIC WATER LEVEL Below Top of Casing: ' u FT.
8. TOP OF CASING IS (Use "+" if Above Top of Casing)
FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordance with 15A NCAC 2C .0118.
9. YIELD (gpm): '2 METHOD OF TEST3OLO/ni -X'q
IO. WATER ZONES (depth): /3L 'J J
11. DISINFECTION: Type Cheer e.
12. CASING:
Depth
From Z1 To /!C
From To
From To
13. GROUT: Depth
From 0 To AO Ft.
From To Ft.
14. SCREEN: Depth
From To Ft.
From To Ft,
15. SAND/GRAVEL PACK:
Depth
From To Ft.
From To Ft.
16. REMARKS:
Amount j %s`j
Wall Thickness
- Diameter or Weight/Ft. Material
Ft. 6 -/e,- S i-ee! /'vr
Ft.
Ft.
Material
CoNCede.
Diameter
t. in.
in. in.
Method
7n4ErN q
Slot Size Material
Size Material
Topographic/Land setting
Midge ❑Slope OValley ❑Flat
(check appropriate box)
Latitude/longitude of well location
45! 'J%//v- r✓nt ' 4'Kroo'
(degrees/minutes/seconds)
Latitude/longitude source: E PS❑Topographic trap
(check box)
DEPTH DRILLING LOG
From To Formation Description
/07- //e Sf-//
//! - 2 yr` C.->. 1c
LOCATION SKETCH
Show direction and distance in mites from at least
two State Roads or County Roads. Include the road
numbers and common road names.
Lre'cei-er /►'C_
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUL l'ED 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 D /y - Q -/
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

309225
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment a oral Resources - Division of Water Quality - Groundwater Section p �
WELL CONTRACTOR(INDIVIDUAL) NAME (print) ZItA/ /L(_t 4S CERTIFICATION/1 /T[Q
WELL CONTRACTOR COMPANY NAME A- 144O4V6 Ia»Tbzi!l1Al9, LLCI, PHONE pt1t76)a'52Fri 4
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential nunicipal/Public 0 Industrial 0 Agricultural 0
Monitoring ❑ Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION:
Nearest Town: County Aft bird*" f-t
Mom'• f. Al d A.
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: pi tOh) JOktS
Address 110 f2-8o)L of 3 a y
� (Street or Route No.)
rQ'J U/7C
as72..a
City or Town State Zip Code
($az- Lag-44oa
Area code- Phone number
4. DATE DRILLED /2 - )T -
5. TOTAL DEPTH: gar /
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO Q
7. STATIC WATER LEVEL Below Top of Casing: `42 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
9. YIELD (gpm): G METHOD OF TEST1 J J
10. WATER ZONES (depth): 7[rO'i (/00•
11. DISINFECTION: Type ("/C ;,.c, Amount 2/ ,kla
12. CASING:
Wall Thickness
Depth - Diameter or Weight/Ft. Material
From 0 To 14 Ft. 6,/Lc 3'Pitl A /c
From To Ft.
From To Ft.
13. GROUT: Depth Material Method
From 0 To ao Ft. CANceele. 7/ nli2rn/i
From To Ft.
14. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in.
From To Ft. in. in.
I5. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
16. REMARKS:
Topographic/Land setting
❑Ridge 12Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
�l032' 3/ -7(.1- .': el) it"ga'
(degrees minute seconds)
Latitude/longitude source: BOPS❑Topographic map
(check box)
DRILLING LOG
Formation Description
8:-t
DEPTH
F,[om To
(01-7.>
`70 - </05
.Sic )l
LOCATION SKETCH
Show direction and distance in [Hiles from at least
two State Roads or County Roads. Include the road
numbers and common road names.
�� g-.-/I Ted_53yrn°•5 try •
N
1 DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH ISA NCAC 2C, WELL
CONSTRUCTION STANDARDS, .AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
'u1-14 i 'fir 12 -aLt
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
GW-1 REV. 07/2001
27699-1636 Phone No. [phone], within 30 days.

3 09 22 6
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment a ural Resources
WELL CONTRACTOR (INDIVIDUAL) NAME (print) A bi
Divy/5�)on of Water Quality - Groundwater Section
!. T— S CERTIFICATION # 2028
WELL CONTRACTOR COMPANY NAME litie&so/J WE././ hi�j IL t PHONE SaSi JS'07/�Q,
STATE WELL CONSTRUCTION PERMIT# �JJ ASSOCIATED✓WQ PERMIT#
(if applicable)
(if applicable)
1. WELL USE (Check Applicable Box): Residential 12 Municipal/Public ❑ Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection ❑ Other 0 If Other, List Use
2. WELL LOCATION:
Nearest Town: Let ces1-er- County &Thep/vibe
- Nut wits* Fnrwts at 77
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3.OWNER: C,NnO2/�/ERs4ive R /�
Address / 70 Oki Fa? f red •
(Street or Route No.)
rr.Zr/a eta /YC a',73 0
City or Town State Zip Code
( 2- / 2W?- 006 9
Area code- Phone number
4. DATE DRILLED !a.frorn v
5. TOTAL DEPTH: 4l1S QC
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO
7. STATIC WATER LEVEL Below Top of Casing: 70 FT.
(Use "+" if Above Top of Casing)
S. TOP OF CASING IS / FT. Above Land Surface'
Topogra 'c/Land setting
❑Ridge @Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
A/ bS°3G,M/4/r.ttOQa°c/1,s7S'
(degrees/min e�s!seconddss)
Latitude/longitude source: I?GP S ❑Topographic map
(check box)
DEPTH DRILLING LOG
From To Formation Description
0 — so Nay
$nn/S7tea/G
is — 4 0 Lock
— 603 (wrvwn rtie
*Top of casing terminated at/or below land surface requires a
variance in accordance with l5A NCAC 2C .0118.
9. YIELD (gpm): aMETHOD OF TES Ff�60/Idlq ? q
10. WATER ZONES (depth): MO .JJ J
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common road names.
11. DISINFECTION: Type Ch lOry'q/t
12. CASING:
Depth
From 0 To 90 Ft.
From To Ft.
From To Ft.
13. GROUT: Depth
From49 To r%O
From To
14. SCREEN: Depth
From To
From To
15. SAND/GRAVEL PACK:
Depth
From To
Amount /7pz
Wall Thickness
Diameter or Weight/Ft. Material
b, dS ?Gfr, sDIW Ov -
luem Z rnS 1-611A77
Material Method
FL COnceE1F j J
Ft.
Diameter Slot Size Material
Ft. in. in.
Ft, in. in.
Size Material
Ft.
From To Ft.
16. REMARKS: -
1 DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH I5A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
kV,
SIGN URE OF PERSON TRUCTING THE WELL
A
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-I REV. 07/2001

309227
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment a ural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) kin Ai /1 �eN?S ?/i/Q
_QQ // CERTIFICATION'p.g,i1J T
WELL CONTRACTOR COMPANY NAME) e4s0,v fl d//7D.il1.4f9.1 LL. C PHONE a58-$r94
STATE WELL CONSTRUCTION PERMIT# JJ ASSOCIATED WQ PERMIT#
(if applicable)
(if applicable)
I. WELL USE (Check Applicable Box): Residential Er—Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION:
Nearest Town:
County
(Street IV/me, Numbers, Cmnmunity, Subdivision, Lot No., Zip Code)
3. OWNER: Co�p+5/ ry7;,,, - &Das -
Address ! O Rs,/ SA a
,/- (Street or Route No.)
,« 'it_Jz eca, /Jr a,8%3et
City or Town State Zip Code
( )- &AR- ?o&-
Area code- Phone number
4. DATE DRILLED rz Y �y
5. TOTAL DEPTH: fl'r
Topographic/Land setting
❑Ridge �e ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minute�s/ conds)
Latitude/longitude source: C3GPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From To Formation Description
0-�% /:r
-' - Yy 3k//
- roc .Sl,[/l -
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO L�
7. STATIC WATER LEVEL Below Top of Casing: 70 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS 1 FT. Above Land Surface'
`Top of casing terminated auor below land surface requires a
variance in accordance with I5A NCAC 2C .0118.
9 YIELD ,.-..... 1 METHOD
ET -- ------fir
--
10 WATER ZONES (depth): r
abi
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.
FA- //?h euj /Y C .
11. DISINFECTION: Type Clot-
12. CASING:
Depth - Diameter
From 0 To IV Ft. 6-ter
From To Ft.
From To Ft.
13. GROUT: Depth Method
From 0 To AO 7A/t2riVq
From To .2
14. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in.
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Size Material
To
To
Amount e'd— '4Ss
Wall Thickness
or Weight/Ft. Material
SO.i'[ I flvC
Material1
Ft. CONCeedC.
Ft.
From Ft.
From Ft.
16. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH l5A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
/2- t'-a v
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-1 REV. 07/2001

309228
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment a
WELL CONTRACTOR (INDIVIDUAL) NAME (print) —
WELL CONTRACTOR COMPANY NAME
STATE WELL CONSTRUCTION PERMIT# J ASSOCIATEDJWQ PERMIT#
(if applicable)
ral Resources - DivjS'on of Water Quality - Groundwater Section q q (�
CERTIFICATIONp���.s�# G1 �oj�2{Q
PHONE &2 i a 5 ». n4
(if applicable)
7
3. OWNER:
WELL USE (Check Applicable Box): Residential iMunicipaUPublic ❑ Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
WELL LOCATION:
Nearest Town: riot IMQ 'CiAr
Middk FD/`ff
County AM!001 be
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
!Y f.VO b dCOCk
Address �0 Be r 96103
(Street or Route No.)
liS,icv,'/le .CC alb /(a
City or Town State Zip Code
Fa.)- 061-/5ip
Area code- Phone number
4. DATE DRILLED 11 /7/Q t/
5. TOTAL DEPTH: b
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO
7. STATIC WATER LEVEL Below Top of Casing: id 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 TES 6Ltl/Nq q
10. WATER ZONES (depth): .�13 J J
LOCATION SKETCH
l 1. DISINFECTION: Type C10ryn 4 Amount (S n 7 Show direction and distance in miles from at least
12. CASING: Wall Thickness two State Roads or County Roads. Include the road
Diameter or Weight/Ft. Material numbers and common road names.
From 0 Ft.6.?S 2fb,dXS Stt/r SOW
From Fr.
�Topographic/Land setting
Midge 0Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
N 23°' 7, Sty WUnik.S,M3
(degrees/mi teslseconds)
Latitude/longitude source: ❑GPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From To Formation Description
n - 4/0 y,tit X�,.tc
Q10 - od
/os - //0
l/r)) -6FS bllotq,'1tP
Depth
To fie
To
From To
13. GROUT: Depth
From .0 To ri O
From To
14. SCREEN: Depth
From To
From To
15. SAND/GRAVEL PACK:
Depth
To
To
Ft.
Material Method
Ft. Co/v .zk}E OGP
Ft.
Diameter Slot Size
Material
Ft. in. in.
Ft. in. in.
Size Material
From Ft.
From Ft.
16. REMARKS:
d d /e /iaA/2,1,
1/leUre(Ai /V.C.
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
SIGNA RE OF PERSON CONSTRUCTING THE WELL / aAM"EO y
V+
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center -Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-1 REV. 07/2001

__c C31 -. //1�� /� ` - ' 1,r1��1IJ/Ij r \5'arcr Quality - Oronor
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"..in Llianlcrn Jr ,1
I•� hr ahr7' irlJl--H uurrlhdrs and common road nor'tsladudc the road
a snag
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wolf D -.
r�Q FI. Manor
rail _CJi Cec -
SCT
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nu'ccs l",:I i;l lrl� 1'li �.l 11y13 141=1L 41' -.
L
:DO rI i I.x llJN 51 - Y TH.. 3 S COI N1 R LlcTED IN . CCOI' AND THAT Copy OF l HU R6c o _ B ENCL WITH ED TO THE
W LL O t 1 L 11.45' BEEN PROVIDED
TO THE WELL 01V1yER....
J NYO Tt1k WELL
5n:1 u: unvur I CO :CIO Division or ii'u[cr l
riYi :In a lualiq•, Grown award-SseAou, 1630
: )3 J==1, -noun 3 u daps.
a Mall 3crvieb Cauor • P.u1a
GW-1 REV. 07/2- R
111:u.rlal
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vN
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309230
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N_La lc
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RE! � Lu.y
opo6lhpllic!l.an1 scaing
ec DSic•pc OVaIIcy OFlar
(chest .Ipl;rop:-.r Ii4s)
LglilUd01011gilUdc a vyd1 lac,lr,{on
RFd 37 SRay O8�" 140.
1��yrcc,rf ..
Illlul yi do11a1)
bulbar. luligiludc sour-'. L�ILF!>`;pTapoaraphic map
hw4 bug)
DIULLENG LOC_
Form:Mao Dtscriprion
Rom'
LOCATION SR_E1'CN
SL:; •,v clirccrion and distance in milts from ar l 11J - tail:

From To
13. GROUT: Depth Material �[
From 0 To a Ft. CANced.M.
From To Ft.
14. SCREEN: Depth Diameter
From To Ft. in.
From To Ft. in.
I . SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
WELL CONTRACTOR COMPANY NAME
STATE WELL CONSTRUCTION PERMIT/ ASSOCIATED WQ PERMITt
(if applicable)
(if applicable)
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment a ural Resources - Division of Water Quality - Groundwater Section p
WELL CONTRACTOR (INDIVIDUAL) NAME (print) ki /Ai 1l, LI4%VEs CERTIFICATION d-Siciia
E 44S046!E�fz/ll/NgJ LI—C.r PHONE [phone]gfi4
309231
I. WELL USE (Check Applicable Box): Residential Er Municipal/Public ❑ Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATI(yJ:
Nearest Town:Js.-r. [✓
L9/c� L L Ael
County 4,«.at
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: %)b 7;deho_J}/
Address a1 /1-4 M14-nd
Street or Route No.)
vele 4e a88otf
Ciry or Town State Zip Code
gag)- aib-lit 53
Area code- Phone number
4. DATE DRILLED IZ
5. TOTAL DEPTH: .7yf /
6. DOES WELL REPLACE EXISTING WELL? YES0 NO Q
7. STATIC WATER LEVEL Below Top of Casing: 50 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS / FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordance with ISA NCAC 2C .0118. �,,��-_=�1p�
9. YIELD (gpm) JO METHOD OF TESTS g d
10. WATER ZONES (depth): dir
11. DISINFECTION: Type Cltr,PC Amount /f t.Es
12. CASING: Wall Thickness
Depth - Diameter or Weight/Ft. Material
From 0 To S Z- Ft. 4. /2 r$J/Z/ /P4/4.-
From To Ft.
Ft.
Method
?AG Pitt/5
Slot Size Material
in.
in.
ttdgopographic/Land setting
e ❑Slope ❑Valley OFlat
(check appropriate box)
Latitude/longitude of well location
Kira de. 0'I✓Ofl'2Vt),Z7
(degrees/minutes/seconds)
Latitude/longitude source: BPS❑Topographic map
(check box)
DRILLING LOG
Fot>,rtation Description
AC-
S4-//
DEPTH
From To
0 - S/7
y7-s2_
L - 1t/s
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.
cidfai
`;4Lal//eLvl /r se
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
Zo.a /z-1
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE _.
Submit the original to the Division of Water Quality, Croundwater Section, (636 Mail Service Center - Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-1 REV. 07/2001

309234
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment a Ural Resources - Division of Water Quality - Groundwater Section ? �[
WELL CONTRACTOR(INDIVIDUAL) NAME (print) 'k,4�J/t// M. L-L i/ s/� CERTIFIICrATION#. /T'a
WELL CONTRACTOR COMPANY NAME�E/�C L6So�Ii 1 fE47).2i iLiti, 6Fce PHONE Ala.,;624g94
STATE WELL CONSTRUCTION PERMIT# JJ ASSOCIATEED WQ PERMIT#
(if applicable)
(if applicable)
1. WELL USE (Check Applicable Box): Residential Q" MunicipaUPublic ❑ Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION:
NeaLtst Town: ivevz. V/
,/LI.v}r.? At//S
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: r¢Sc 1 /ije.S
Address e, 'ny /9-?.
County
(Sneer or Route No.)
LJe1 .yerv;%1" /? C' a8787
City or Town State Zip Code
-3000
Area code- Phone number
4. DATE DRILLED //- Zo - chi
5. TOTAL DEPTH: yet
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO
7. STATIC WATER LEVEL Below Top of Casing: 6L1 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 accord ce with 15A NCAC 2C .0118.
9. YIELD (gpm): _ METHOD OF TESTS J
10. WATER ZONES (depth): (Ft--
trdopographic/Land setting
ge ❑Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
Jfrir 4 t/s7''don''V. /7J
(degrees/minutereeconds)
Latitude/longitude source: 2 PS❑Topographic map
(check box)
DRILLING LOG
Formation Description
DEPTH
From To
4c
Yc /0/ 54/I
/ad -'1lr 4_.'�i
11. DISINFECTION: Typer/on.:'c
I2. CASING;
Depth
From © To it i Ft.
From To Ft.
From To Ft.
13. GROUT: Depth
From D To ao
From To
14. SCREEN: Depth
From To
From To
15. SAND/GRAVEL PACK
Depth
From To Ft.
From To Ft.
Diameter
6. /l%
16. REMARKS:
Amount
Wall Thickness
or Weight/Ft. Material
Material Method
Ft. CoNcee1e. ?nu211111c
Ft.
Diameter Slot Size Material
Ft in. in.
Ft. in. in.
Size Material
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common road names.
Jp.71-/s ?t //5
WeAde/Ull(e-)iC-
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH I5A NCAC 2C, WELL
CONS RUCTION
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
GW-I REV. 07/2001
27699-1636 Phone No. [phone], within 30 days.

WI,ILc_ CT'!)Ngl'kI,CTI/)N RIPCORD
:,ul '('t - n cru .1 iY:,;Li. ,l 1 rx--Divi,yyl o�,rcr
by w Y eu;lliry-r7ronnt,yurn -ri3nn
'7� / / / cerrrFlcilran xr�Qa.:$
:.i< Aii; yr ,..iii.,ireLi j4O!✓ il_1—!.L1L/1'Q l J o _.,. rnJnv „tiaet ate/
i'll �N eCI ll rl ::- SJi'I1'I'G li WO1'T%1'.trrl f'u `",
309235
B ;- I:_: -n,1
r LI Intl-Li4t 0 cr$' 0 Ji 'IY rnl 1 CI u lrric.o I� C.IUcr 0 I(i;1111cT.Li91W.-
COupl`iL/ptif-hc.
Ala
-la„c
rat.i DE ECES I t ELL REPLACE EXISTING \YELL? YES Q hl)
LEVELEslowTop ol'Csslr;g.
' .I, la 7::oa lot r4. nyr
vl � ' SENO LS' __,_�____ F . bow l
1 P of ry 1 i111' $4f7a 'C''
^ _..c fm ura (.a ,;Gut u4u1 !q 1:1 our ra cc r.rl4O'ca u
.._. -. WWI li}.V i:.'-"C.w is
ILLL I.
IQ___ i\lE'I'HOD OF T'P:ST (4,24if L
.r '.TER_,DNES cucpinl: O�J '�' -L
Lida.
gnctllowal C]
Topo�gr:�- aiciL•and scaing
DRldgc IASL:pc CIV'slIcy ❑rl.0
cobcalc Appropriate box)
Lurinldc/longinlie of Noll lacarian
N-_3,5 f5/ et %ynsrz��f1.6fl
ticgrcc: rn In111cLSctg19S)
L:;u[uiRtlongiludc sOnr2c: ol. SIDTopographic map
Off' 'T'FI tclmel: bout
DRILLING Lpyr_
Gr°m T- Formation Dcacripliaa
1:11INFEC' !CiN C,e ��t.eLS__p�h n ciir crlon and diswnee in mUes oIcas[LOC&TIOON SKETCH
Witt 1-Iclurey
.;xn 1 1 State Roads Or Counry Roads. Include the road
Dom, -.ter or 41 }hc Fr. r, Iat.rl:rl uumbcrs and 00mma17 rood names.
1 l c sDaJ
Er.
:�..,.OLrI• 3iprl
' hi arcnal C:Iclnoir
r:.a o F,. �.�N---- k,. to u r�'�
El.
Dum,7w Slar 5rtc
Fro,L 'pc i4l arcnal
Fr a. n.
Ft
I17. IIJ.
:'api" SILL
1`I AII•1'I AI
Li rr.
rin-r �' Fr.
�ei c ester, /✓C •
I D' r'. 1'EE al lrl' THAT THIS WELL WAS CONSTRUCTED IN AOCOlw NCE \VITH A NC.-4 C ? C. WELLs
C NSF LJCTJ2 v St lND.it D3 AND THAT A COP OF THIS RECORD *
I �
hl.., FiEtiN PROVIDED TO TriE WELL OSYNEp.
T aVN CONSTRISCTINOThE WELL
S,,tiall tit; onin,l ra lad Unuluu L[1Yarn•Luslu �, _'c>'�;o i-nOuc ilia. i'll)7 -3:' ) Grpuild,ra Let Scn'ion, 163a&t ail Su•vite C.prcr-Ralcigp,(VC'-
.1, rrirll in e da)-li,
el -I REV. 07/2001
F.s

309237
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment a ural Resources - Division of Water Quality - Groundwater Section WELL CONTRACTOR (INDIVIDUAL) NAME (print) kith Al . A/ 'iVfS �• CERTIFIICAATIIONN#5/41
WELL CONTRACTOR COMPANY NAME�� G4SUN bJA/)7).P�/i/Alq, LLC. e PHONE#3.v.158-$r9Fz
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable)
(if applicable)
7
WELL USE (Check Applicable Box): Residential Ei Municipal/Public ❑ Industrial ❑ Agricultural ❑
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use
WELL LOCATION:
Nearest Town: 14.67 LA'; //e
• --t 1---esP 22—
County Ave —
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: h N 7Ct
Address IS T. ive F�e•es•t'Dr.
) (Street or Route No.)
fklPAve ru 7/e Eno
a t7a
City or Town State Zip Code
(8a8)- /06-8-/3a7
Area code- Phone number
4. DATE DRILLED // —ZZ - En/
5. TOTAL DEPTH: roc"
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO I3"
7. STATIC WATER LEVEL Below Top of Casing: ro 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): _A___METHOD OF TESTJiOL hd
10. WATER ZONES (depth): J J
11. DISINFECTION: Type (Jo, • ^L Amount ZC 74,-fs
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
From 0 To ,16 Ft. &. /er S re, At -
From To Ft.
From To Ft.
13. GROUT: Depth Material Method
From 0 To aO Ft. C[oNC2c�e. ?rit12fAi5
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:
Topoggr hic/Land setting
❑Ridge 061ope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
sr' cit /s `wen'j Tv,
(degrees/minutey3!aaeconds)
Latitude/longitude source: 2OPS❑Topographic map
(check box)
DRILLING LOG
Fo�Rmtion Description
5-4//
DEPTH
Erom To
C-2/
//-.76
.fog'
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.
?r'/ip /'o(tS�- 172.
(,vaguevas 7/e_nC.
1 DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
lettat'+ Zee_ .� ll 22_ of
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-
n0

El:llrY lilN h:CCC11.11
:r t : ((ALL:
'.1 N.t:41 ,..L;,l) r.; l,iivisiurl u>ror Qullll I"//�'W rWC) / l $
ill 01111 L711 dttt' pClrOn
C¢11TJr1crcrlon
_ it icersa&zzi..1_.LlD2,'21/ C , enon42aasa5rr-Lr 4.
110111'4 s 3Cj, I'4 CI N'.? PTi P.nIL'l'u
. -q O 11.ai Yung
Iv/ rester LUul:I'r &MiCa/t rJt
i.I ,. : ip.a I.P u6tie 0 Iindunr,:l 0
:r lr�i=alou ❑ Gthcr CJ 1r' �hh ur, Liar 11 c
01'.,L. DEP 1 H
EL L REPL E EXISTING WELL? YES 0 NO
1 -T1C ,1 :I L;. LEVEL Hclow Top of Cash_: Z& FT.
iLua"r'Ir .Aoolc Tap„r
.JP EVE CASINO 1SFp .:-boac - Lana
C N'::':my IerpluLi aL: r Lelu\r land Burr r cilWICan u
(4.0(Lifticiicz nup
9 YIELD o 1
q iA IETHOD OF TLd 3Y.A!11
q ,,.-.1 Ed�_,,nn<:.dcpLnJ: A/lD r /pq
'. rIcL.Iraral l7
Topogro ,. iC!Land setting
llRidgc alLipc CIVa11cy ❑Flag
t t'hctG ePl;:np�inrc box)
Lutimdc/longitude of 'sell lacarion
Ai ir, iB Girl /. _ter_ ♦
Ococ n a unge)
_ L,wludu;l.,rlgirurJcsource: L SOTo o3-:
/) `nO, rr1r P �t 1phie rtlap
DbP hl DRILLING'L��C�
1U O .•'/iy-,ry _ _ -1V mow.:
�aLrom . To FonnationDia.•.iprlon
,�tl -�e _
/Orr — // S/
p1S:1YF_C1 JCril Put (• 12/2.4..:�.-
1c /ir/ Fri c PIc ag21/
.s o.T L:I=E39,1 — lS
- Iriarcr:al
e-i et-5 -71Et2, fi✓C
K JluunL
Y1':111 PiliOl ros3
Diam.lCr 31' L cri'.a
FL
..J:i,-0 (:, L rrl.n,o.1
Ez_ Fr._S' l i0/ zG.Lil' P0unLn
V:ptii Ciamcicr 5131 513c I\lalcrul
FIC..r: 'IC Fc.
In. In.
:ill I'.i Fl.
0. Ili
zpri' Sr1C
iVlaLCrlal
Pc. Fi
^!u:1i 1'0
FI
LOCATION SJCE'1011
Show dmccrlan stud dislanct in mi-Ics t'roln ar Icasr
ROF1ds Of County Roads..[gcludc rhr goal
uumbcrs and common road names.
e QMr ,,,1/4/ oN
ri6i Eu\ CECI.ciPY FIiAT THIS \YELL W. 3 CL_NSFRLICTED IN.A.CCOED4,NCE WITH ISA NCAC2C, WELL
.9C2NSTR.t9C-143iv s14.NO PD9 .AND TH 1 A COPY or rid Lt:COt0 HAS EEF.N PROVIDED TO THE WELL OWNER
3t o'N COTi3TRUCTR4u ` THE
•7gTE'
P Laic rn: on ival ru Ins Diva ion o[ 11,u ice Quality, Iaroundl,aCc1' Secriun, 1636 Mail Srrviee CRaleigh, NC
�o.io Pnorc Va. 00)733•i:a, wail 3U days.
6
GW-I UV. 07/2-001

0251
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment a oral Resources - Division/�of Water Quality - Groundwater Section Q �'[/
WELL CONTRACTOR (INDIVIDUAL) NAME (print) Ik ,4�%A�1 . LLLN..s CERTIF"_IIC�ATION#N/TQ/
WELL CONTRACTOR COMPANY NAM A- 14S/%V 4e I±-47 e171.:0 t LI.G. PHONE #37d1a5245'96
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential E MunicipaVPublic 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
WELL LOCATION:
Nearest Town: Ft-rv✓
County
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: n,a Skid er
Address 4% (0/n' Jzf 7d .
(Street or Route No.)
J}/.�7l/I'CGv c
p273a
City or Town State Zip Code
fag )- fo al - ?a9V
Area code- Phone number
4. DATE DRILLED it I' O/
5. TOTAL DEPTH: 20'
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO 0
7. STATIC WATER LEVEL Below Top of Casing: 42 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)• 20 METIJOD OF TEST
10. WATER ZONES (depth): /7E)
11. DISINFECTION: Type CJ# hi, Amount q kc61
12. CASING: Wall Thickness
Depth - Diameter or Weight/Ft. Material
From0 To 5' Ft. �i./Z/' Cat/ /91/c--
From To Ft.
From To Ft.
13. Material Method
Ft. CoNCQ6fes ?AltPsn/q
From Ft. JJ
14. SCREEN: Diameter Slot Size Material
From To Ft. in. in.
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Size
From To Ft.
From To Ft.
Topogrohic/Land setting
❑Ridge I SSlope ❑Valley OFlat
(check appropriate box)
Latitude/longitude of well location
/Or"1L, Chrl `voc' 111, 2.,tg
(degrees/minutes�/s conds)
Latitude/longitude source: OGPSOTopographic map
(check box)
DRILLING LOG
Formation Description
rt
DEPTH
From To
© s�
50-5'3- 5-4,
sr- an -
GROUT: Depth
From D To a,0
To
Depth
Material
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common road names.
Rd
1A-Ira GUI '" C
16. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH ISA NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
-R /l - I- oil
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
Submit the original to the Division of Water Quality, Groundwater Section,
27699-1636 Phone No. [phone], within 30 days.
1636 Mail Service Center - Raleigh, NC; '
a9 .,.rl
GW-1 REV. 07/20.®`i
n

11P.L_1_ Ct-1NS FR IIt.' HON RIi'l: ORD
�,- , II. Y[l. L,lll l i
- lti'4 i'L1tht rru
u1'a'm uJ Iy aural l _._ _ fivio o water Qll"lhl' - l�rJllndlYdl'1' SeC{IJII
Y',LL it b .,... dtFs _
Y // D n / / ccitrirlc,'rioN „2(2,13
309253
._ '- ?p L_(cl a i-I:. 1 „.I 1x
1.� Ii ILuvn'ial
c17 ❑ 11,31 P„i nl 1:,Icr 1m [ --u IJ Cthcr Li1rG -��riculrtlral 4
ILcr, List Use
.. ....:..I Iambi
1 , .IN 1. qJCJ
DATE C';uiLLED
of AA.. DE1'I }i
vi ELL IYEpL-cEE� G WELL? YES a No In C.,CIS. 41 :..IER Li-YEL Below Top or'Ca3tn_'
I. J!'v(, ".;I :V I, Wsc.' •-,r .ioa,c'I'ap., r C.aln)
FTT-Uorc Lima Surface ^];'p +:_:Ina Iprn1 ulal:a. Our Oclulr Iunj surf- ct rc,luu'ca u
. ra'.;I ln, IJ.t Ni,.' e 1C.w IS. 0 \ iU i
n 1'L't i- --flIr1 HOD Oh'TtST , 1
IY:JI 'I'r,Iclutce3
L
Topoicrtlph ioi Land selling
GR.idgc Q3I.,pc f�aIle Y ❑Fl (
(.hc I II I;mprialc Val)
1-41iniC /Wupl lil7e u1 c•ell location
lacyr 'rninul mctuuts)
utudc:lougilude source: eri5SOToporaphic rmip
B F LH luncan VON)
DP tion DN_- L1�_ CT_
gram '1'o Formation DcstR i
on
LOC4TIGN SKETCH
m DTnicc1cr ar 1d',_,yhvFc Gdalcrl:d
}PVC
FL_
:s. . OLl`
IYl arcrial
Io_ F. C'�N erg .•.Ian.al
�21L^L
i'IJIu I.i. fi.
Di3MilCr 3101 :i12C I`W,11 1' . pi al.rlal
FL u111.
Fl. ul.
31ZG
Fr.
Fi.
! i.i2,1,.ltiCj:
hJ w direction and distance in miles from at Ita4r
two State Rou43 or County Roads, Include the road
uUmhcr3 and Common road Ilame3.
G'/etv &'4Sc led.
A-tSe/✓, N C
i D3 rn&CEBV CER.Ti F1' k'Tl'h IS WELL WAS CONSTRUCTED
.2 StiltiTIOvSlA:NDuD3 ISECN:DELA'�lEENPDANCE PROVIDED
EDNC.-�0?C, LLOWNERTHAT'PHISRECORDELAS
-'- 3 (TN. l':fi 0 • .RSJI'�UC.1'04G" 3,F„'-- lk WELL
tstnic me un uul [o [pc Dili iali.a 1}•JCcr QuSli[y, Gi'u undlr5q'I' Sccriun, 1636 fl9 all Servite Qgra'- Raloi+p,
> o io FlIth 10. t3l9) 733p71, rritnin 30 da
ys. 6 NC.
C1}i-I REV. 07/200I

309254
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment a ural Resources - Division of Water Quality - Groundwater Section QQ ��[[
WELL CONTRACTOR (INDIVIDUAL) NAME (print) ks4Al fi. Lill /VPSI, CERTIFICATION#SSO/
WELL CONTRACTOR COMPANY NAME�ER t6SON2l%/I .zJJints 4F-Ca PHONE a5245t(4
STATE WELL CONSTRUCTION PERMIT# JJ . ASSOCIATEED WQ PERMIT#
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential 1MunicipaUPublic 0 Industrial ❑ Agricultural 0
Monitoring ❑ Recovery ❑ Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION:
Nearest Town: Atet-V 't.✓ County 2e4 € c•'. i L
O/d Ad-/— ter.
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: `D4-R2I1 / "I Lueel
Address 409 Qd to eft
(Street or Route No.)
taQr}uetu/We— fl C e� 87f 7
City or Town State Zip Code
( 08)- (vs— O 794e
Area code- Phone number
4. DATE DRILLED al— 27 - 0,/
5. TOTAL DEPTH: ?oi /
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO E
7
STATIC WATER LEVEL Below Top of Casing: 447 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS / FT. Above Land Surface'
*Top of casing terminated at/or below land surface requires a
variance in accordance with 15A NCAC 2C .0118.
9. YIELD (gpm): /o METHOD OFTESTSOW-A
10. WATER ZONES (depth): /W ✓ J
11. DISINFECTION: Type( lc .^tt- Amount /c/ ,./e.he
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
From V To 47'7 Ft. in./IC SPIG/ rwC
From To Ft.
From To Ft.
13. GROUT: Depth Material 1 Method
From 0 To oZO Ft. CONCeede. `�Att24;1/q
From To Ft. / J
14. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in.
From To Ft. in. in.
I5.
Topogrpy�hic/Land setting
❑Ridge 13Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
p"3C' JJ. E!T)C-Vrea, wr'
(degrees/minute�aaseeconds)
Latitude/longitude source: ❑'GPS❑Topographic map
(check box)
DRILLING LOG
Formation Description
r>.,
.2 - 37 f! //
:37 - 3O) On, le
DEPTH
From To
SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
16. REMARKS:
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common road names.
o{f d fo2f tad.
rAt.e✓/eLv NC_
1 DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCT' N STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER `.'-
% d Z��-�,, - /o _ Zc - 05l
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
NO IT:

WELL CONSTRUCTION RR CORD
309257
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n )
\LILL 'p,LI l•1.: n11JU.:L)Drluul �I1 opaiunyrJrEnvlronmanc andrulRco.uccs DivisionfWarcrQu0.1iry'Groundwater $cCr
CERTIF1CA.TIQN it5_4/6co lfr nn11Lffe"�“.SoNS
I-1P—n
• L/"C,rr4l bl
CLL
q
_. liAT19'n
A5sociA'LD NQ
WELL USE etc ppLaAola Sox): Re31roaLial wipa o 0 7hrria7 0 ggrimlyry�r a.a 10 .c.o1p 0 Heal Pump 1Ydcr Injection ❑ Onier❑11Orher, Li>r U3c
-.
Q.
n,
Nc..rc( CJ4ry
as'
:W„im:rs. Caanun,n, uLa( No., Zip Cooc)
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'
1>n:cr
leigera• 87raowrcY)tact
itola
awimcr
-_...191::11c
D 4 TE DRILLED /u -20 --G%,r
TOTAL ^.L. DEPTf N• DOES 11 ELL REPLACE EXISTING WELL? YES 0 NO ET/
STATIC 11.•.IER LEVEL Bdow Top of Casing:
(bit C in2.)
1 "irA e L nd Suribc _1
l'�IF OF CASINO 1S
4n jurove Land Surfutc,. ' LoN or t_:ni� IcflTn:aicA anor b.law land sumac rcoulrw'
‘anal:: in a<adroau:o rnrt 15.1. .NC C7C.o1ja'.
IWATERZONES locpLh):YIELD (pno): -- N.IETHOD OF TEST "`%j"[i�
//r' " f
DISINFECTION T}peC%
. Amount / rL —_
. C.�S1rwI
Winn 'Ili c)um3
l.icpin
,
r. Mu[mul
_ [
m,rPo Fr
To—
S
.
0
RO
U
O
o
p:
h
. DL4u
m! cl.r oSr W e s1G
Io Ur h
Fr.
NIA[cfial NlcfllOtl
ice
.
rmF ro
Ceod
DTI',
J.op
,
From To
=C!:_EV: Dcpnr
L Y.,.CD:
mni To
Frspy_
Diameter Slor Size irinrorul
Frin.
in.
Frin.
m.
She
Fr._
Fr.
la I;EA1-k I:i;_S
i DJ OEREhY CERriry'1 H.+.TTHIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH ISA NCAC 2C, WELL
CONSTRUCTION STANDARDS, THAT .� COPY ' , ANDir
OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
0 '20 — 0
Mammal
Tupo�gr�nyjuc/Lruid string
❑Ridge lope OValley OFlar
(cheek appropriarc box)
Lutirudt/longinide of well location
A Drecip,'7 n Lvd tr2' ;et L✓' ✓
(agiccs;rnin�uic' cconas)
Lalinideflongirudesource: tenPSOTopographic map
D1iPTH lcheal:eol)
DRILL IN—.' 0_r
From To Fomurion Description
LOCATION SKETCH
Show direction and durance in miles fror 4[ hair
IWO State Roads or County Roads, include the road
numbers and common road names,
%jow ezoss.'a/c Pe! .
Weaerd /
/(e j/ C
SIGNATURE OF PERSON_ CONSTRUCTING THE WELL
u!i uLrt rn; crioinar co Inc lliri: ien of 1Yartr �u DATE
U bteio Phone :NO. v q L.„ Quality, Groundwater Section, 1o36 Nlail Service CenterI:Alalbh,N
l- L) 9i3 l, rrlrOln 30 day>.
CW-I REV.07/2OLE)_)
rLa