Gr CY2004

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Naatuurra�gsources - Di isi n of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) ake CERTIFICATION 0.090e
WELL CONTRACTOR COMPANY NAME - r' a m �� �Y` ! Vl PHONE # ftNi 479tU-S-4
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
34283
I. WELL USE (Check Applicable Box): Residential (ffi Municipal/Public ❑ Industrial ❑ Agricultural ❑
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use
2. WELL LOCATI N: Nearest Town: No4,4,31)15vs9IP County a roII baW1
S6_r✓I Cn V E' 2 8 77 1
(Street Name, Numbers, Community,mSubdivision, Lot No., Zip Code)
3. OWNER: R lrrh 4"n Address °'cL.rv1 C' r'.ot/et atAA
(Street or Routs No.)
Robbflr5V ille A/c as-77/
City or Town State Zip Code
(Is)-'/79-
Area code- Phone number
4. DATE DRILLED /0- 2,0-/aW
5. TOTAL DEPTH: C7$-
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO QI
7. STATIC WATER LEVEL Below Top of Casing: e' , 7f 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): rid METHOD OF TEST (L i r'
10. WATER ZONES (depth): 66
Topographic/Land setting
❑Ridge OSlope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From To Formation Description
I I. DISINFECTION: Type Al Mt
12. CASING:
Depth
From 0 To 5 ?
From To
From To
13. GROUT: Depth
From._ To ,Q0
From To
14. SCREEN: Depth
From To
From To
15. SAND/GRAVEL PACK:
Depth
From To
From To
Diameter
Ft.
Ft.
Ft.
Material
Ft. Cemen7
Amount 0
Wall Thickness
or Weight/Ft. Material
$Dr?( p1/C
Ft.
C
Ct M6
?,
r-D
rj
LOCATION SKETCH c3`
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common road names.
corn J b1T /`/3d4? lake a?N' G-v
a,7 Miles 7-men /elIon vpper^
PvpiFIF Method
Tvsk ee G� a,7 in," le %urn ,r-. r
O 1 So u fl7 JarK G-O , o, SS Y ate
Turn It?, 47 on Same Co ve G v
p. S rn,/e 721 ale o n R r02177-
,
Diameter Slot Size
Ft. in. in.
Ft. in. in.
16. REMARKS:
Material
Size Material
Ft
Ft.
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
"TA- n /`7/. A e
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 Iyes trees - Div ion of Water Quality - Groundwater Section ��s
/1,� CERTIFICATION kaa. 2
WELL CONTRACTOR (INDIVIDUAL) NAME Grab
)
WELL CONTRACTOR COMPANY NAME nala.wi Ug/
cTe fly o
r, /4 j1 a PHONE # rA �s•W79' ESt rt
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ P�IRMIT#
(if applicable) (if applicable)
I. WELL USE (Check Applicable Box): Residential 011 Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery ❑ Heat Pump Water Injection ❑ Other 0 If Other, List Use
2. WELL LOCAT N
Nearest Town: 4-behSils(e County6 -_
Vedlau) r.r as-77i
Oleo Name, Numbers, Community,(tSubdivision, Lot No., Zip Code)
3. OWNER: W il:/3
CJ1 reki /o
Address L E'//a a! Grseq D
(Street or Route No.)
R.aU,,tns v,`l/e A/C ' 2.?77
City or Town State Zip Code
epot- ±`3 -1/59
Area code- Phone number
4. DATE DRILLED /l Ll
5. TOTAL DEPTH:
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO IZ
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 ISA NCAC 2C .0118.
9. YIELD (gpm): ao METHOD F TEST O.! r
10. WATER ZONES (depth): of
11. DISINFECTION: Type .HTy Amount 0, Y 7
Wall Thickness
Diameter or Weight/Ft. At
FL__ t;or2/
12. CASING:
Depth
From_C2___To IfO
From To Ft.
From To Ft.
13. GROUT: Depth
From_f_ To ao
From To
14. SCREEN: Depth
From To
From To
15. SAND/GRAVEL PACK
Depth
From To Ft.
From To Ft.
Material p z
Ft.f PlrieN j'
Ft.
Diameter
Ft. in.
Ft. in.
16. REMARKS:
Size
Topographic/Land setting
[Midge ❑Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From To Formation Description
O
LOCATION SKETCH .0
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
T.m ers common road names.
b and d
tom m int Pia d- )2i Take in"
Go ?,6 •'/es Tvr/) R&bTort
Method ;Ef/l cc.i e reek Reta Go 3
Slot Size Material ter+
in. t.k O$ l'O / .
in.
Material
7,,, /eh' Go. o.l % o-Je//
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
de /0-24-oft
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) CHRISTOPHER L. DICKEY
WELL CONTRACTOR COMPANY NAME CHEROKEE WELL DRILLING AND PUMP COMPANY, INC. pyg»NE S 18281 837-8008
CERTIFICATIONS 2261
STATE WELL CONSTRUCTION PERMITS ASSOCIATED WQ PERMITS
(if applicable) _ (if applicable)
1. WELL USE (Check Applicable Box): Residential El Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring d Recovery 0 Heat Pump Water Injection 0 Other ❑ If Other, List Use
2. WELL LOCATION:
Nearest Town: ROBBINSVILLE
LONG CREEK
(Street Name, Nombas, Community, Subdivision, Lot No.. Zip Code)
3. OWNER: TRACY 8 CHRIS MULLINAX
Address 1924 LONG CREEK
(Street or Route No.)
ROBBINSVILLE, NC 28908
City ce Town State Zip Code
( 828 )- 479-3257
Ama code- Phone riser
4. DATE DRILLED 10-05.2004
5. TOTAL DEPTH: 245'
6. DOES WELL REPLACE EXISTING WELL/ YES 0 NO El
7. STATIC WATER LEVEL Below Top of Casing: 100 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS 1 FT. Above Land Surface'
`Top of easing terminated at/or below land surface requires a
variance In accordance with ISA NCAC 2C .0118.
9. YIELD (gpm): 9 METHOD OF TEST AIR
10. WATER ZONES (depth): 180'
County GRAHAM
11. DISINFECTION: Type CHLORINE
12. CASING:
Depth Diameter
From 0 To 77 Ft. 81/8'
From To Ft.
From To Ft.
13. GROUT: Depth Material
From 0 To 20 Ft. CEMENT
From To Ft.
14. SCREEN: Depth Diameter
From To Ft. in.
From______ To Ft. in.
15. SAND/GRAVEL PACK:
Depth Size Material
Amount 100 PPM
Wall Thickness
or Weight/Ft. Material
SDR 21 PVC
Method
GRAVITY
Slot Size Material
in.
in.
From To Ft.
From To Ft.
16. REMARKS:
I DO HEREBY CERTIFY THAT
CONSTRUCTION STAND
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 D 1 LR t�ING L 3
From To Formation Description
0' TO 60 TAN DIRT
80' TO 7T BLUE GRANITE
7T TO 245' GRANITE
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common road names.
a
G
Qb(2D RD
0
r
0
C)
CO
ELL WAS CONSTRUCTED IN ACCORDANCE WITH I 5A NCAC 2C, WELL
OP 7) OF THIS RE RD HAS BEEN ROVIDED TO THE WELL OWNER
I ' l0 -S--o
PERSON C NSTRU INGTHEW DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1
27699-1636 Phone No. [phone], within 30 days.
6 Mall Service Center - Raleigh, NC
GW-1 REV. 07/2001
303280
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WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
f75
WELL CONTRACTOR (INDIVIDUAL) NAME (print) !!IrIR&f. L T j. VS � CERTIFICATION # �j
WELL CONTRACTOR COMPANY NAME B')u`S UJCLL D21LUFl4 INC
STATE WELL CONSTRUCTION PERMIT!' ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
PHONE gain i9SZ/66
1. WELL USE (Check Applicable Box): Residential 111 Municipal/Public 0 Industrial 0 Agricultural ❑
Monitoring 0 Recovery 0 Heat Pump Water Injection ❑ Other 0 If Other, List Use
2. WELL LOCATION: �oR��l i
N Clj31
Town: KNSVide County
Ghtet84 01K-inock< Lot #ta
(Street Name, Numbers, Community, Subdivision, Lot No., Tip Code)
3. OWNER:Deau,Qig2 p12ra-Zr1(. .,-
x
Address'7c')_30 C'KJ firgenRA RiairITinfo (cif-
.8
-g L2iP Itir cirMcNn.) > 3i -57
City or Town State tip Code
x 06} TE gill
Area code- Phone minter
4 DATE DRI LLED i -2 Z —6)4
5. TOTAL DEPTH: 365
6. DOES WELL REPLACE EXISTING WELL? YESJO NO
7. STATIC WATER LEVEL Below Top of Casing: O FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS Z FT. Above Land Surface'
'Top of casing terminated atror below land surface requires a
variance In accordaafe with ISA NCAC 2C .a118.
9. YIELD (gpm): (o METHOD OF TEST Ps R
10. WATER ZONES (depth): 2O SFr as 211 Ci %&4
11. DISINFECTION: Type I- T (4 Amount /.7 a 7--
12. CASING: Wall Thickness
a Weight/Ft Material
FromS5 Two 3 S Ft SDP?! V C'
FrowjS_Tof2 _Fto 94i27S WC
From To Ft
13. GROUP, Depth Material Method
From L © To a FL Ce1NEt' G2&th fY
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:
IpIdgraphic/Land setting
ger❑Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
._(421, 22s ,tins; °Ss! se)C1
(degte:lB ds)
Latitude/longitude sourccuroe: PS❑Topographic map
(check box)
DEPTH DRILLING LOG
From ToFormation Description
0 - 0�Y
� ClaY
IES4611 Wage weeri4e2e D RarJc
Nat SL2."'6
tot6
SLaTe
LOCATION SICETCIj
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
CONSTRUSTANDARDS, AND T/HHAt,TA COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
Atift 23-
SIGNATURE PERSON CONSTRUCTING THE WELL /� DATE
O
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-1 REV. 07/2001

NC' ✓ UWUEft
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Nat rag Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME Wino t. eCCC CERTIFICATION I redea3
WELL CONTRACTOR COMPANY NAME /IGr - PHONE I Alen -21y
STATE WELL CONSTRUCTION PERMITS ASSOCIATED WQ PERMITS
(if applicable) (if applicable)
I. WELL USE (Check Applicable Box): Residential Municipal/Public 0 Industrial ❑ Agricultural 0
Monitoring ❑ Recovery 0 heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION / //
Nearest Town: /Y4U0-kif6 �E�- County �j/"-C, 47i-/.
L?e4r Creel( 7 /2cr'1-
(Speet Nxmq Nambea, Community. Subdivision, Lot No.. Zip ode)
3. OWNER: 3. i✓,'/(,4snr lorrs><
Address 7 360 Ye How c.✓i< R A
(Street or Route No.)
z
(Rob kt i I1 5 cr � � � e i✓VC_27 /
City or Town Stare Zip Code
Area code- Phone number / _ O
4. DATE DRILLED /A
5. TOTAL DEPTH: /1212
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO 1�
7. STATIC WATER LEVEL Below Top of Casing: FT.
/ (Use "+" if Above Top of Cling)
8. TOP OF CASING IS Fr. Above Land Sur faces
'Top of caring terminated at/or below land .orfate require. a
variance In accordance with ISA NCAC 2C .011a. Air9. YIELD (gpm): .tO MET110D OF TEST
10. WATER ZONES (depth): 720
II. DISINFECTION: Type iiroz
12. CASING:
Depth
From 0 To 6b Ft.
Front To Ft.
Fronr To Ft.
13. GROUT: Depth Adat rial Method
From 0 To,P-+9 Ft.A'7f'7t v ��
From To Ft.
14. SCREEN: Depth Diameter
From To Ft. in.
Front To Ft. in.
15. SAND/GRAVEL PACK:
Depth
Front To Ft.
Front To Ft.
Diauneter
(�Z$�
Amount kitty'
Wall Thickness
or�ght/Ft. Material
Site /
Slot Size Material
in.
in.
Size Mnterial
Latitude/longitude
DEPT!
From To
Topographic/Land setting
[Midge ❑Slupe ❑Valley ❑Ffat�
(check appropriate box)
Latitude/longitudeofwelllocatiori =.
A,139'" /b'/o " r Ai Rid 55'Qfit':
(degree✓n.tnule✓ econds) ; _>
sourcc:❑GPS❑Topograpltic map
(check box)
DRILLING LQG
Formation Description
306461
r
p— 3o
-6a
led- /'z-
CAT- /rr.<vc 1
C/cyy
/rrf.a.'sce°
c/t
C- fLeirt
r-C
—tC
ca
�r
fJ
LOCATION SKETCIi
Show direction and distance in miles fronriat least
two State Roads or County Roads. Include;tbe roads v
numbers and common road names. t-n''_
cc)
x
lieu Gk,
—'-� e yOCk$✓L
�a6`i%lj✓I
16. REMARKS:
I DO HEREBY CERTIFY MAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF TI llS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
L z -Z Z-e
SIGNATURE OF PERSON CONSTRUCTING TILE WELL DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mall Service Center -Raleigh, NC
,".on r.rf Pt....." N,. 10101711-1-771- nllhin ]I) days. OW-1 REV. 07/2001

WELL CONSTRUCTION RECORD 3 0 5 5 2 3
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) ♦/Ft k //�y e CERTIFICATION #065'0
PHONE # fe:2514S'79-'/i-Y
WELL CONTRACTOR COMPANY NAME
STATE WELL CONSTRUCTION PERMIT# 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 ❑ Heat Pump Water Injection 0 Other ❑ If Other, List Use
2. WELL LOCATI N: 1
Nearest Town: MI6: '/{P , Co ("
SYunty -
Setowbttrc RA aG-77/
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: pp7? /'Vitx
Address Seto ti b rr�
(Street or Route No.)
No.) l
Rohb,(Y n5 il; //(# %�"77/
City or Town S e Zip Code
)-4r79
Area code- Phone number
4. DATE DRILLED /I— /9- n y
5. TOTAL DEPTH: Stl 7
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO I'&
7. STATIC WATER LEVEL Below Top of Casing: `36 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 tD METH D OF TEST CA. i' r
10. WATER ZONES (depth): 6/7
11. DISINFECTION: Type J/7 ,V
12. CASING:
Depth
From_ To 0.4)
From To
From To
Amount (), 93
Wall Thickness
Diameter or Weight/Ft. Material
Ft. 6 7 Cnrai PVc
Ft.
Ft.
13. GROUT: Depth Material
From O To .6 Ft. ce)v)
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.
Topographic/Land setting
❑Ridge ❑Slope OValley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From To Formation Description
O'9
t
rT
r
8
F
ni
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
n mbers and common road names.
from r /O3'-iy3 Ake la.9N6°
1, 3 m; JPS T rrl iS a n /via5 Se y
branch Go !nieS %vrn A9h I
On 5noidob1'rri1/4 Rc,Go a,l males
T� rn /gkro/� SnoWbirok R�.
6 o . »- l9s Turr7 len on Snawb,'"id
fU G-0 , 3.9 pile
on p,„, SnoLJbirk Rat G-o l"lmiles
7; well on
Slot Size Material
in.
in
Material
16. REMARKS:
n
Grailrs.m (.✓p// lItne
Method
Pvrnpl'nra
O
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNERCa
i DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
de //-ip oy . 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
N

305522_
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - ivision of Water Quality - Groundwater Section
f) CERTIFICATION #
WELL CONTRACTOR (INDIVIDUAL) NAME (print) .12., Eyi
)/(
WELL CONTRACTOR COMPANY NAME G r'ell A. V7 IAI N (1 t ti j,' PI0 PHONE # n5-9
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
I. WELL USE (Check Applicable Box): Residential M 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
Nflrest Town: County (rre, /Ly]/)
H� b .S"pl a r) r ass 771
(Str Name, Numbers, Community, Subdivision, Lot No., Zip Code)
I OWNER: 3361 n no n,s ril
4h e
Address ,spience r'
I Or (Street or Route No.)
R4bJr1i nsi/f/%P Wr 2.£(77I
City or Town State Zip Code
622)-4/77- 5,J73
Area code- Phone number
4. DATE DRILLED //—/7-nil
5. TOTAL DEPTH: Slog
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO a
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 15A NCAC 2C .0118.
9. YIELD (gpm): 3 METHOD TEST G, i r
10. WATER ZONES (depth): .39.
I I. DISINFECTION: Type /IT# Amount 0.7/
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
From (1 To /5lyd,( AUG
From To Ft.
From To Ft.
13. GROUT: Depth Material
From n To &0 Ft. Gainen'7
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 FI.
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
0
C"1
ra
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common road names
s
:Rro,v) 193 d- la9 %aka 193 Go
- 91 P les Thrn R4hTon,
Method
>DL a s i)G'e Ft q-- /�.U' , G-6 , o. �3
irl;les Torn 1e»T on 1-/,8115p)e4r
Go. U,o2 m,"le Turn )9 1'7Go Ta
-P,'v57" 33r,'ve fri0y en AO
T c��11 bel„�ck hoc -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
SIGNATURE OF PEkSON 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
m
I—
t
2

WELL CONSTRUCTION RECORD
305521
North Carolina - Department of Environment and N_aatturelll esourcps - [vision of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME /�((pp�rint).JA,,/ NNyeJ9 CERTIFICATION#' CO
WELL CONTRACTOR COMPANY NAME V teV1'IQYI') LA to // arkr It t firl PHONE # (STSi(179-51341511-
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ KRMIT#
(if applicable) (if applicable)
I. WELL USE (Check Applicable Box): Residential I L Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCAT N{{ �
Nearest Town:1 o. t n 5 )r. //t4 County (r ra 1i to
S.nowb;rra R 3. 77/
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: Otk. nyIy� Ski ka n
Address �np LJ t
(Street or Route No.)
Rp. :'r>5Vt°I/P i\IG
City or Town Stay Zip Code
( Sr)- 079- WO (o
Area code- Phone number
4. DATE DRILLED id.
5. TOTAL DEPTH: id.
6. DOES WELL REPLACE EXISTING WELL? YES ❑_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 casing terminated at/or below land surface requires a
variance in accordance with 15A NCAC 2C .0118.
9. YIELD (gpm): y METHOD OF TEST CA,/ r
10. WATER ZONES (depth): /FPI
11. DISINFECTION: Type //ry Amount 0.321
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
From-Q_ To Ft. _ SQr.3. i PVc
From To Ft.
From To Ft.
�$771
13. GROUT: Depth Material
From rS To Q.0 Ft. CPYrt P V)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
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 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. , 3 L
-From Rrc\ l /,hr aT 7 7 6
lag 77ke /019u6-0 ),3m»es
Method
pt rnp n� /Urn Jek J on )' A65ey b re&ncl!
0.0 3,a m iiks %Urn Rl h 1 on,
6" no is RI Ga a , j m tt/ec
Trn / T on Snot.Jbir2 RA.
go a m;fr' urn / e4T
tl'rs% r;v-di an /647:
Size Material
16. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH I5A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
;104 l/-
ce //- A 09
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

Nearest Town: ri 1'72SV,'/N County Gnaho, ]y/
/71,0 0 brnnch `s-77/
(Street Name, Numbers, Community, Subdivision, Lot Na, Zip Code)
3. OWNER: 6 cT L3 Lt rcir/ hell
Address /'rc(o W brat c h
(Street or Route No.)
RO6bitn5V,1/,o /VC 77/
City or Town State Zip Code
(at)" VW' as//
Area code- Phone number
4. DATE DRILLED 3O— fpy
5. TOTAL DEPTH:
6. DOES WELL REPLACE EXISTING WELL? YES ❑)IO 6d
7. STATIC WATER LEVEL Below Top of Casing: / J 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): [5 METHOD OF TEST Clr a'
10. WATER ZONES (depth):
11. DISINFECTION: Type grA Amount d,9%
12. CASING:
Depth If Diameter
From O To 44 Ft.
From To Ft.
From To Ft.
13. GROUT: Depth Material
From ri' To `gO Ft.
From To Ft.
14. SCREEN: Depth Diameter
From To Ft. in.
From To Ft. in.
15. SAND/GRAVEL PACK:
Depth
From To Ft.
From To Ft.
16. REMARKS:
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 LOQ
From To Formation asscription--t
rn L'rsl
t r4E2
-71
LOCATION SKETCH
Show direction and distance in miles from at least
Wall Thickness two State Roads or County Roads. Include the road
or Weight/Ft. Material n tubers and common road names.
styl V item/ nr /029 of-Iq/3 7ak6) la?
Go /s, / m,%s Turn /R, hT on
Method
rarn�rri P,rtp„ /4eakL,I branch Go l,a_th,%s
Slot Size Material
in.
in.
Size Material
rvrn /Sr on Mew /Qoao Go
0:3 in,'/G 7 &vidi o4' Rao..JI
Well onA hT,
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
/tyiAN
0(16) 306162
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural rResources - [vision of Water Quality - Groundwater Sectionr
WELL CONTRACTOR (INDIVIDUAL) NAME
�m tiJc (print) j C4d t ? ,, #rydiG CERTIFICATION # 0.61. Q
WELL CONTRACTOR COMPANY NAME 61 fi// Ar'f ltl`,`nl PHONE # troll S/7V*Li$,j
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential RI Municipal/Public ❑ Industrial ❑ Agricultural ❑
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use
2. WELL LOCATION; ,
l2-3o-n9
SIGNATURE OF ItRSON 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

/+ CERTIFICATION #o7(,i5!%
WELL CONTRACTOR COMPANY NAME (T ralicufl tJern PHONE #t4a4)y79-Wq,44f
STATE WELL CONSTRUCTION PERMIT#
(if applicable)
WELL CONSTRUCTION RECORD 306161
North Carolina - Department of Environment and Natural tR�esources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) �PTali //7(Xd
ASSOCIATED WQ PERMIT#
(if applicable)
I. WELL USE (Check Applicable Box): Residential gl Municipal/Public ❑ Industrial ❑ Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection ❑ Other 0 If Other, List Use
2. WELL LOCATI
Nearest T wn: � .. �hch';`//p
Pie o.�nu/ •rcncl) 2fl7/
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER:ArYRL�}. a-ildr,os
Address The ci LU .o n t n»
i)
(Street or Route No.)
Rob; ilfIS J/,d t✓r 2877/
City or Town State Zip Code
(mare- 4f9V -2 R 4
Area code- Phone number
4. DATE DRILLED /2 - -ci e{
5. TOTAL DEPTH: /,C
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO 14
7. STATIC WATER LEVEL Below Top of Casing: rOfl 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): 24 METHOD OF TEST G / r
10. WATER ZONES (depth): J,?S'
11. DISINFECTION: Type 974/
12. CASING:
Depth Diameter
From (y To .SCI Ft.
From To Ft.
From To Ft.
13. GROUT: Depth
From O To ac
County l7l'YAi'10„W!
Amount /'I, ;Z[/
Wall Thickness
or Weight/Ft.Material
$nra) PI/�.
Material
Ft. CoIn.c>,* i
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 � 26
Slot Size Material
in.
in.
Material
Topographic/Land setting
❑Ridge ❑Slope ❑Valley ❑Flat`
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From To Formation Description
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
nigbers and common road names.
n
rn
r_)
rarn l.n-T /29 d- /y3 %kp /�91i1
Go /6u / P7,'/crs %ern !? h r 0n
iitact w ,broLnch Ga, 04. ni,%
%llrn .0q,chr G-0 7a end p 31`
ar,'v9 Wed do R'PO 7:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH ISA NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
SIGNATURE OF PERSON CONSTRUCTING_may
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

30616©
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and NaturalResources- Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print)rre.0f1/�yr{-21cd CERTIFICATION #QQ$2-i
C
WELL CONTRACTOR COMPANY NAME G r,t// 90,14/ L✓F,// fir'//, r'„ PHONE # fr )L'7?ors —y
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable)
(if applicable)
I. WELL USE (Check Applicable Box): Residential ® Municipal/Public El Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION: /-
Nearest Town: R�r>l hnsL,,'l/A County 6 rr,yy/
&er %St,a (ors Creel( 2c-77/
(Street Name, Numbers Communi
Subdivision,
, Lot No., Zip Code)
3. OWNER: Vern /V/&SSc, r✓r
Address %(,✓Nr SA Vyeet Greevk
(Street or Route/No.)
RObbt ncv/i/o Air 2v77/
City or Town Stet ZipCode
i y7f- C.-3C$
Area code- Phone number
4. DATE DRILLED /a - 033-01/
5. TOTAL DEPTH: (p C8
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO
7. STATIC WATER LEVEL Below Top of Casing: /00 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS 1 FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordance with ISA NCAC 2C .0118.
9. YIELD (gpm): .S METHOD /OF TEST CA ,'✓`
10. WATER ZONES (depth): SCJ
11. DISINFECTION: Type
12. CASING:
Depth Diameter
From n To go Ft.
From To Ft.
From To Ft.
13. GROUT: Depth Mated
From__C1__-_ To 510 Ft. re°hi,
From To Ft.
/7`Teg
14. SCREEN: Depth Diameter
Amount p, 5V
Wall Thickness
or Weight/Ft. Material
Snr6L1 Pvc
al Method
r/T Pvwri7,`n�
From To Ft. in.
From To Ft. in.
15. SAND/GRAVEL PACK:
Depth
From To Ft.
From To Ft.
16. REMARKS:
Slot Size Material
in.
in.
Size Material
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
L1
cM
LOCATION SKETCH
Show direction and distance in miles from at leaad t �>
two State Roads or County Roads. Include the road
numbers and common road names.
;Pram T fl b / v3 Zikee a? A &-O
4/"Yes Tvrn R6ihr on lacy-kr,
SA,wA/yers Green Go /,! M,YeiS
%rrrn ",ihr on e eSSrn5r hr'it
ZJe// on %N%
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY/fOF THIS RECORD HAS BEEN PROVIDED TO THEWELLWELL OWNER
"rearT f ?y/1 f J,+C '7�9
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

• NC 1,7 OWNER
MWD o"7`-C
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment mid Natural Resources - Division of Water Quality - Groundwater3 Sec0ti5i0 8
on9
WELL CONTRACTOR (INDIVIDUAL) NAME (print) At Zee cc_ CERTIFICATION.
./tar
WELL. CONTRACTOR COMPANY NAME
STATE WELL CONSTRUCTION rentals ASSOCIATED WQ PERMIT.
(if applicable) (if applicable)
PHONE . I )
I. WELL USE (Check Applicable Box): Residential Er- 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: /06'J:ij '//
e
oar/ (or e-/ r
(Sure N(me, Numbers, Community, Subdivision, Lot No., Zip Code)
County Gran/ e9�
3. OWNER- • , r/G/A- A47/ e %U'nbA tlural L;.k ter (degrees/minutes/seconds)
Address 2330 Hinton Gen frer )RA
(Street or Route No.)
I clre iIle /VC- 2-3ROt+
City or Town State Zip Code
A rncode- Phone number
4. DATE DRILLED /Z-0)-0'<
5. TOTAL DEPTH: e202-
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO 0'
7. STATIC WATER LEVEL Below Top of Casing: CO Fr.
(Use 'V' If Above 1 op of Casing)
8. TOP OF CASING IS / Ff. Above Land Surfaces
*Top of casing terminated after below land surface requires a
variance In accordance with ISA NCAC 2C .0118.
9. YIELD (gpm): / S' METHOD,
OF TEST /4 r
10. WATER ZONES (depth): /5,
11. DISINFECTION: Type /i%/t Amount kt
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
Front 0 To /e2 d Ft. 6-el" sin' S/dee— /
From To Ft.
From To FL
13. GROUT: Depth Material / Method
From D To S— Ft. A.-/-/and-1S
From ,5 To ole Ft. !!enAs'fe, a✓rr
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:
L
Topographic/Land setting
❑Ridge ❑Slope ❑Valley ❑Flat
(check appropriate box)
La-1�' de/longitude of well location.
IV C° 21 tlt.w • f3%,11/o rr
Latitude/longitude source:❑GPS❑Topographic map
(check box)
PEPTIi DRILLING LOG
From To Formation Description
a - /lo 6/4 f/ — rrrfl--ere- t
//o - ZD 2.
(rrZ' "f"
LOCATION SKETCH
Show direction and distance in miles from atsast
two State Roads or County Roads. Include the jiad
numbers and common road names. r
Stec a(t /((
I DO IIEREBY CERTIFY THAT T111S 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 Mali Service Center- Raleigh, NC
27699-1636 Phone No. [phone], ninth] 30 days. OW-1 REV. 07/2001

WELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources - Division of Water Quality
WELL CONTRACTOR (INDIVIDUAL) NAME (print) WILLIAM BRADLEY LEWIS CERTIFICATION # 3388
WELL CONTRACTOR COMPANY NAME CHEROKEE WELL DRILLING AND PUMP COMPANY, INC. PHONE # [phone]
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
307222
1. WELL USE (Check Applicable Box): Residential X] Municipal/Public 0 Industrial ❑ Agricultural O
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use
2. WELL LOCATION:
Nearest Town: ROBBINSVILLE County GRAHAM
EAST BUFFALO RD
(Street Name, Number, Community, Subdivision, Lot No., Zip Code)
3. OWNER: LORENE FARR
Address 3188 YELLOW CREEK RD
(Street or Route No.)
ROBBINSVILLE NC 28771
City or Town State Zip Code
( 828 )- 479-6131
Area code- Phone number
4. DATE DRILLED 12-30-2004
5. TOTAL DEPTH: 405'
6. DOES WELL REPLACE EXISTING WELL? YES O NO 0
7. STATIC WATER LEVEL Below Top of Casing: 100 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 .011a
9. YIELD (gpm): 3 METHOD OF TEST AIR
10. WATER ZONES (depth):
I L DISINFECTION: Type CHLORINE
12. CASING:
Depth
From 0 To 140
From To
From To
13. GROUT: Depth
From 0 To 20
From To Ft.
Amount 100 PPM
Wall Thickness
Diameter or Weight/Ft. Material
Ft. 61/8" SDR 21 PVC
Ft.
Ft.
Topographic/Land setting
{]Ridge ❑Slope OValley OFIaL
(check appropriate box)
Latitude/longitude of well location
3521.758N/8349.403W
(degrees/minutes/seconds)
Latitude/longitude source>OGPSOTopographic map
(check box)
DRILLING LOG
Formation Description
BROWN SLATE
BLUE SLATE
DARK BLUE SLATE
Material Method
Ft. CEMENT GRAVITY
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
From
From
Ft.
To Ft.
16. REMARKS:
DEPTH
From To
0' TO 40'
40' TO 140'
140' TO 405'
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the mad
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 HIS RECORD HAS BEEN PROVIDED TO THE WELL OWNERPO
"
•
/2-3o -Oy .D
SIGNATURE OF PERSON CONSTII9CTI$ G THE WELL DATE
Submit the original to the Division of Water Quality, Attn: Information Management, 1617 Mail Service Center -
Raleigh, NC 27699-1617, Phone Na [phone], within 30 days.
GW-1 REV. 09/2004

NC D IFII I: I?
/4II U
WELL CONSTRUCTION RECORD
Nord( Carolina - Department of Environment and Natural Resourcesn- Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL)NAME (print) ?err/ gee( F CERTIFICATIONH
WELL CONTRACTOR COMPANY NAME (i�, l e f w 11 PHONE II f )
STATE WELL CONSTRUCTION FERat1TN ASSOCIATED WQ PERMIT/
(if applicable) (if applicable)
I. WELL USE (Check Applicable Box): Residential IV-Municipal/Public ❑ Industrial 0 Agricultural El
Monitoring 0 Recovery O Heat Pump Water injection ❑ Other O If Other, List Use
2. WELL LOCAT10j9:
Nearest Town: 6bb„wSu (lr Count
(Sheet Nurse, Numbers, Community. Subdivision, Lot No., bp Code)
3. OWNER: ✓i%r-'.'"°o (c¢.
Address
(Street or Route No.)
City or Town State Zip Code
( )-
Area code- rhone number
4. DATE DRILLED R/1 K Oy
5. TOTAL DEPTH: 5 G'
6. DOES WELL REPLACE EXISTING WELL? YES U NO 1e-
7. STATIC WATER LEVEL Below Top of Casing: 30 _,1`f.
(Use -+- If Above lop of Casing)
8. TOP or CASING IS j'/T_ vr. Above Land Surface"
"Top of ruing lu ndnaled Mint below land out lore senators a
•ol.nre In accordance with I5A NCAC 2C .0111.
9. YIELD (gpm): 3 METHOD OF TEST A A. C
10. WATER ZONES (depth): r 5'
30691'7
Topographic/Land setting
❑Ridge °Slope alley °Plat
(check approprl.le box)
Latitude/longitude of well location
/ JS3 t /,) LP'/ WR'S° Cr,' V h
(degreealmtnuterhaeonds)
Latitude/longitude source:OGPSOTopographic map
(check box)
DEl'TIt DRILLING L05t
From To Formation Description
/D
ji) S / O'
II. DISINFECTION: Type
12. CASING:
Depth
front (S To az
From To
Front To
13. GROUT: Depth
Fr on b TO zU
C )1 t -
From To
14. SCREEN: Depth
Front To
From To
15. SAND/GRAVEL PACK:
Depth
From To Ft.
from To Ft.
16. REMARKS:
Diameter
Ft. G 1
Ft.
FL
Ft.
Mate ial
Amount S
Wall Thickness
or ,VL
Ft.
Diameter
Ft. ill.
Ft.
N
CO
n
clt
LOCATION SKETCIL
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
Material numbers and common road names.
laPCSlce/
Method
pump
Slot Size
ill.
in.
Material
Size Material
IDOHEREBY CERTIFY TITATTIITS WELL WAS CONSllWCH!1) IN ACCOIWANCE WITH ISA NCAC 2C. WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF TIIIS RECORD HAS BEEN PROVIDED TO TILE WELL OWNER
/� 1>
(2 6
SIGNATURE OF PERSON CONSTRUCTING TILE WELL / ATE
6ti
F
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mall Service Center -Raleigh, NC
27699-1636 Flame No. [phone], within 30 thys. OW-1 REV. 07/2001

294930
WELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
�` (�RTIFTCA77fU'a a C.e/.�
art aro ina -
0
WELL CONTRACTOR (LYDIVIDUALhVAME (print) Cv
Wr. Li. CONTRACTOR COMPANY NAME C ro]V( pi ldk'// r''//'' PRONE 6 fwasIgi 79` sii cej
SPATE WELL CONSTRUCTION PERMITS ASSOCIATED WQ PELSI ITN
(if applicable) (if applicable)
I. WELL USE (Check Applicable Box): Residential W MunicipaUPublic ❑ Industrial ❑ Agricultural O
Monitoring 0 Recovery ❑ Heal Pump Water Injection 0 Other O If Other, List Use
grAp
2. WELL LOCATION: //
Nearest Town: RnNoinsvak/ County/rm,Yiain
// /t/3 M4 ct 2 77/
(Street N{arc. Numbers, Community. Subdivision. La No.. Zip Code)
3. OWNER: /3,4 1nn
Address h W /t1,3 L✓p-; r
(Street a Rourc No.)
RObey III I, Me IV,,r .2c-77/
City or Town Stale Zip Code
(t- 2.97- 2cJt
Area code- Phone numb
4. DATE DRILLED 3/9-OW
5. TOTAL DEPTH: **QC
6. DOES WELL REPLACE EXISTING WELL? YES O NO 61
7. STATIC WATER LEVEL Below Top of Casing: /5TC FT.
(use -+- ifAbove Top otCaaag)
8. TOP OF CASING IS / FT. Above Land Surface'
`Top of casing terminated Woe below lead surface requires a
variance In accordance with 15A NCAC TC .0115.
9. YIELD (gpm): 3 METHOD OF TEST (3„ r
10. WATER ZONES (depth): (Se
II. DISINFECTION. Type
12. CASING:
Depth
From_Q___To //17
From To
From To
13. GROUT: Depth
From (t To W
From To
Ifr"
14. SCREEN: Depth
From To Ft.
From To Ft.
15. SAND/GRAVEL PACK:
Depth Sipe Material
Amount v.J/ 7
Wall Thickness
Diameter or Weight/Ft. Material
FL (o f $.nr2l Pvc.
Ft.
FL
Material Method
Ft. renwny
Ft.
Diameter Slot Size Material
in. in.
in. in.
Topographicaend setting
ORidge OSlope OVa)ley OFl41ox) (check appropriate appropriate b
Latitude/longitude of well location
(degrcesrmunt ewsecooas)
Latitude/longitude source:COPSOTopographic map
leech bon) !.._
))FPTH DRILLING!LOG
From To Formation D4tipiton
dl
A N
ten.
t�? n�
LOCATION SKETCH
Show direction and distance in miles from at least tJ1 �,
two Slate Roads or County Roads. Include the road
numbers and common road names_-�
t'na iu
rocy /93 "ref 02� 7kei
/93 w Go Torn 1N4NT
l�vma,'� Go . o , l %✓I i/E' TO (Ai e // o Yl / T
From To Ft
From To Ft
1b REMARKS'
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH ISA NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT ACOPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
SIGNATURE OF PERSON
arfn F 3/9/0
RUCTINO THE WELL DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail ServiiceCenter- Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-1 REV. 07t2001

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and ft
Nattunt R,csHUMES - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print)1 Je �. 1
WELT. CONTRACTOR COMPANY NAME ( red)nM L✓P/I i.//.' PHONE sjuys)/17`I'• TLK a{
STATE WELL CONSTRUCTION PERMITS ASSOCIATED WQ PERMED/
(Ifappltcatk) (if applicable)
2. WELL LOCATION:
Nearest Town: Rebti inc; v,'l/El County (� e. xtic.trl
(Street Nana, Numbers, Community. Subdmumt Int Na., Zip Code)
3. OWNER: ko-7h r y vl /�/ft ne.A
�rt11
Address ,lI.nTArrIt
(Street a; ROW. No.)
RA.larK AVM VC 4 Sr771
Cny a Town State Zip Code
( . - 73b-/3O
Phone code- Phe number
4. DATE DRILLEDs�,,3/n li
5. TOTAL DEPTH: 7n5
6. DOES WELL REPLACE EXISTING WELL? YES CI NO I
7. STATIC WATER LEVEL Below Top of Casing: /72 FT.
(Use "+' if Above Top of Casing)
S. TOP OF CASING IS I FT. Above Lend Surface*
top of casing terminated War below bad suttee rtqulns
wana
riance in ordenee with ISA NCAC 3C .DI1R
9. YIELD (gpm): METHOD OF TEST 0.' r
10. WATER ZONES (Reath): 533
II. DISINFECTION. Type /IT)-1 Amount A.9r�
12. CASING: Wall Thickness
Depth or Weight/Ft. Material
From_ To 87 / SYlr QJ PVC
From To
From - To
I). GROUT: Depth
From_( To 2.0
From To
14. SCREEN: Depth
From To
From To
15. SAND/GRAVEL PACK:
2949r9
/1 61 CERTIFICATION OAS
I. WELL USE (Check Applicable Box): Residential ® MunicipallPublic CI Industrial O Agricultural ❑
Monitoring ❑ Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
�'VlnanTSrn Gvi//( /ir'n/ 19771
me Diater
Ft. '4
Ft.
FL
Material
Ft. (do Fri en'i
Ft.
Diameter Slot Size
Ft. in. in.
Ft. in. _ in-
Method
Pvnip'n�
From Ft.
From Ft
Depth
To
To
Size
Material
Topographic/Land setting
ORidge °Slope °Valley OFlat ".
(check oppropreate hoe)
Latitude/longitude of well location
(dcgrrzsrminmer/aantes)
Latitude/longitude suurce.00PSOTopograph{c map
(cheek boa)
DRILL NG L
From To Formation Desert Pion
V P
r tiA
( 0__
tl v
r'? O
u� e-
LOCATION SKETCH N ri 1'
Show direction and distance in miles from at least N
two State Roads or County Roads. Include the road
umbers and common road names, A
Ptorn Red logiTo.T popeyes Turn
on l y3 E Go o.s nijes 'Turn
)ekr on upper /')7vc'.i7 ,'en Creek
p20 `a.,l mr/125 Tv,R1�rhr on shore
Hoak CO o 9. Di.'Ies flrn To
W;oolorn way Go. o•y miles 22
Weil on R/81T
Material
16 REMARKS
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH I5A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL. OWNER
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]i within 30 days. GW-1 REV. 07/2001

WELL CONSTRUCTION RECORD 2 B 7 2 O .k
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) James B. Brown
WELL CONTRACTOR COMPANY NAME F11 Brctttars 14.11 Drillir9 Ttr
CERTIFICATION # 2045
PHONE # f808) 154- 591
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
I. WELL USE (Check Applicable Box): Residential Ric 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: Robbinsville County Graham
Jackson Branch
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: F»walt Hyatt
Address 550 Jackson Branch
(Street or Route No.)
Robbinsville, NC 28771
City or Town State Zip Code
(828 )- 835-7947
Area code- Phone number
4. DATE DRILLED 6-16-04
5. TOTAL DEPTH: 400'
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO IX
7. STATIC WATER LEVEL Below Top of Casing: 250' FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS 2 FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance In accordance with I5A NCAC 2C .0118.
9. YIELD (epm): 5 METHOD OF TEST blow
10. WATER ZONES (depth): 142' , 153' , & 225'
It. DISINFECTION: Type H T H
12. CASING:
Depth Diameter
From 0 To 83 Ft. 6"
From 83' To 86 Ft. 6" 188 steel
From To Ft.
13. GROUT: Depth Material Method
From 0 To 20 Ft.bBrnite & cetret _
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 16 nz
Wall Thickness
or Weight/Ft. Material
pvc
Topographic/Land setting
❑Ridge ❑Slope OValley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From To Formation Description
0 84' clay & sand
84' 400' granite
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road_
numbers and common road names.o
IV
en
16. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STA,VQARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
i
r' ,/T�ya (7,1/ % ,j--faett N ) 6 `-/ 4 --0 V
,/ SIGNATU E F PERSON CONSTRUCTING THE WELL DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center -Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-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) James B Brown CERTIFICATION # 2045
WELL CONTRACTOR COMPANY NAME Hatin Brod-ers 14:11 Dri 1 1 MI TM PHONE # IRA) 'oF9-9591
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
297299
1. WELL USE (Check Applicable Box): Residential 63c Municipal/Public ❑ Industrial ❑ Agricultural ❑
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other 0 If Other, List Use
2. WELL LOCATION:
Nearest Town: Robbinsville County Graham
Mountain Creek RD--FPCI well
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: George Wolf
Address 3295 Mountain Creek Rd
(Street or Route No.)
Robhirtsvi 11 ey NC 78771
City or Town State Zip Code
(828)_ 479-2903
Area code. Phone number
4. DATE DRILLED 6-1 7-04
5. TOTAL DEPTH: 190'
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO tic
7. STATIC WATER LEVEL Below Top of Casing: 20 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS 2 FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordance with ISA NCAC 2C .0118.
9. YIELD (gpm): 80+ METHOD OF TEST blow
10. WATER ZONES (depth): 85' r 115' r R 19n'
l I. DISINFECTION: Type H T H Amount 16 nz
12. CASING: Wall Thickness
Depth
From 0 To 60
From To Ft.
From To Ft.
13. GROUT: Depth
From 0 To 20
From To Ft.
14. SCREEN: Depth
From To
From To
15.
Diameter or Weight/Ft. Material
Ft. 6" .188 steel
Material
Ft.bs -iite & mtelt
Method
pwei
Diameter Slot Size Material
Ft.. in. in.
Ft. in. in.
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
(degreeshninutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From To Formation Description
0 58' clay & sand
58' 190' granite
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include t,road
numbers and common road names.
r
tV
Co
Ca)
Cl)
16. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STAt�IRDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
SIGNAT R iF 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//9QI_.__.

s99949
WELL CONSTRUCTION RECORD
North Carolina
-
2. WELL LOCATI N: 1 1
Nearest Town: `>r nsv1'lIP County Gra10.W)
creaLek R.a ,9?771
(Street Name. Numbers, Community, Subdivision, Lot No.. Zip Code)
3.OWNER: ,lkey 67.4,o3 c. 1
Address ri nKS creek RA
RII- II� (Street or Route No.)
Ok}h i n S ti. %/P /V-C PFt77 /
City or Town State Zip Code
(Snit-)-v79 -CONS
Area code- Phone number
4. DATE DRILLED-/O-/11I
5. TOTAL DEPTH: ;.30
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO El
7. STATIC WATER LEVEL Below Top of Casing: £ 0 FT.
(use ••••" if Above Top of Casing)
8. TOP OF CASING IS / FT. Above Land Surface'
*Top of casing terminated at/or below lied surface requires a
variance In accordance with 15A NCAC 2C .011S.
9. YIELD (gpm): // METHOD OF TEST C-,'r
10. WATER ZONES (depth): /2J7
IL DISINFECTION: Type grp
12. CASING:
Depth
From c To .14 Ft.
From To Ft.
From To Ft.
13. GROUT: Depth
From_b____To go
Amount
Wall Thickness
Diameter or Weight/Ft. Material
(cy Snr21 RLI;
Material
Ft. Cato NYi7
From To Ft.
14. SCREEN: Depth Diameter
From To Ft. in.
From To Ft. in.
15. SAND/GRAVEL PACK:
Depth
From To Ft.
From To Ft.
16. REMARKS:
PHONE # ink) Lfly_ g'4,sy
Topographic/Land setting
❑Ridge ❑Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(depots/minutes/seconds)
Latitude/longitude source:❑CPS❑Topographic map
(check box)
DEL H DRILLING LOG
From To Formation Description
r_
LOCATION SKETCH
Show direction and distance in miles familia least:
two State Roads or County Roads. Include the Mad
'}umbersand common road names. k N legS
Tim
r1 Zr27 ) J7 a I y3
&6 ,3,a Inr•%s TurnlE on
Method �,� pOr( RA, 6-0 1,11[In'IeS �TrnS
To brinks creek IQ • 7 ni, eS
Turn /f'J on J.h ve cdeI1
be1.2:211 house
Slot Size Material
in.
in.
Size Material
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
TP P>c 7/,,Q P to —/o --O9
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-! REV. 07/200!

296948
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Nat ma,! I;esource -%�on of Water Quality - Groundwater Section
/Y CERTIFICATION M4000
WELL CONTRACTOR (INDIVIDUAL) NAME (p/ri+nt) k . PHONE N ka2)..ns---
WELL CONTRACTOR COMPANY NAME
STATE WELLCONSTRUCTION PERMIT,/
ASSOCIATED WQ PERMIT,/
(if applicable) (if applicable)
I. WELL USE (Check Applicable Box): Residential 14 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: County
C) /CA T a //r./,6 n Sf 77 i
(Street Name. Numbers, Community, Subdivision, Lot No.. Zip Code)
3. OWNER: r11j� r//SI/h Pp
Address dot
(Streeter Route No.)
Ra)%h.'nsv,'//P N.C. k77I
City or Town State Zip Code
(g2) Lit 79— a030
Area code- Phone number
4. DATE DRILLED (! //1—O tI
5. TOTAL DEPTH: a any
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO El
7. STATIC WATER LEVEL Below Top of Casing: 4c FT.
(use "t- if Above Top of Casing)
8. TOP OF CASING IS / FT. Above Land Surface'
*Top of casing terminated at)or below land surface requires a
variance In accordance with ISA NCAC 2C .0110.
9. YIELD (gpm): LS METHOD OF TEST CS.: r
10. WATER ZONES (depth):
Topographic/Land setting
❑Ridge ❑Slope ❑Valley ❑Flat
(check appropriate box)
Lalimde/longitude of well location
(degreestminuiesiseconds)
Latitude/longitude source:❑GPS❑Topographic map
(cheek box)
DRILLING LOG
Formation Description
DEPTH
From To
I I _ DISINFECTION: Type ii T /y
12. CASING:
Depth
From O To 13(sr
From To
From To
13. GROUT: Depth
From 0 To D C
Amount n,4Je2
Wall Thickness
Diameter or Weight/Ft. Material
Ft. (c Shr3.1 Ptic.
Ft.
Ft.
Material
Ft. LNrr)Pn7
From To Ft.
14. SCREEN: Depth Diameter
From To Ft. in.
From - To Ft. in.
15. SAND/GRAVEL PACK:
From
From
Depth
To
To
16. REMARKS:
Ft.
Ft.
Size
fl
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
nkkmbers and common road names. T� I< E / 5
loin ZnY / J- L/3
GU 3,9_ /njes- Torn /e Tan
Method CA_CrporT IZA, 6-6 legerl les 7vrn
%DUmpi'
Slot Size Material
in.
in.
Material
R,10T On oic 7"014l0.I1 /r0k C-co To
Firs% tloo.cX on /e T We/ton
/E)4 T
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH I 5A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
& 1 O in —/D —0 el
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Ceenter' RREVgh 2001
27699-1636 Phone No. [phone], within 30 days.

296947
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
` CERTIFICATION 0000
WELL CONTRACTOR (INDIVIDUAL) NAME (print) �P4 NA-1
WELL CONTRACTOR COMPANY NAME
6 reA-.hrArn lw/P 1/ ki ll /> / PHONE 0 (k2rai79-S"E43/
STATE WELL CONSTRUCTION PERMIT,/ASSOCIATED WQ PERMIT,/(if applicable)
(if applicable)
I. WELL USE (Check Applicable Box): Residential Eil 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:R,4 ntv, //A County (J'rckher yr)
22 e, i/7), 977/
(Street Name. Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: /eon Sm'/7h
Address Q sr. So u T h
l (Street or Route No.)
Rn�ea;ng1,,we N'c, 9k77/
City or Town State Zip Code
(4405-)-`i79.— (d) 4/6"
Area code- Phone number
4. DATE DRILLED —/4/ 0 '/
5. TOTAL DEPTH: 0 / S
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO G
7. STATIC WATER LEVEL Below Top of Casing: Rio 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 1SA NCAC 2C .0110.
9. YIELD (gpm): 7 METHOD OFTEST a r
10. WATER ZONES (depth): //
I I. DISINFECTION: Type H T fl
12. CASING:
Depth Di9tneter
From 6 To 9 / Ft. 1
From To Ft.
From To Ft.
13. GROUT: Depth
From 6 To .Q 6
Amount n,`.)C{
Wall Thiclmess
or Weight/Ft. Material
•STNN
Material
Ft. CProen /
Topographic/Land setting
❑Ridge CI Slope OValley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:OGPSIDTopographic map
(check box)
DEPTH DRILLING LOG
From To Formation Description
Method
r‘Y/5.4
From To Ft.
14. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in.
From . To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
CD
LOCATION SKETCH
direction and distance in miles frontscm—
Show least=
two State Roads or County Roads. Include the mid
numbers and common road names.
-troll /93 5 T ice-, ,Q�
Co-t,yrt,'/es T'rn 9t:9h7
Cry Tp Ta� o� Ile1// tue/1011
( i(;Qh T
16. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH I 5A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
27699-I636 Phone No. [phone], within 30 days.
GW-1 REV. 02/2001

96943
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resourr/c/es- Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) ylP74 #y6te `` CERTIFICATION #s20ICU
WELL CONTRACTOR COMPANY NAME (Tt'«1r,0.Wi 144! (ATJII, YlQ PHONE # JFfiS)H79-4/5-41
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
I. 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: /o 1
Nearest Town: Reswi� n S v� le' County (rr(.✓/la No
/kn7-17Pr <rNeck e14771
(Street Name. Numbers, Community, Subdivision. Lot No.. Zip Code)
I OWNER: rfr SN 11 male
Address Pei. n7h,4r
(Sneer or Rome No.) ^
Rnhbttn St/al/if) Ale-Qs7% 1
City or Town State Zip Code
( )->3.5 z - (� ys_
Area code- Phone number CI 4. DATE DRILLED 6- dLi
-0q
5. TOTAL DEPTH: 33Sf0
6. DOES WELL REPLACE EXISTING WELL? YES CI NO El
7. STATIC WATER LEVEL Below Top of Casing: 96 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS / FT. Above Land Surfaces
'Top of casing terminated atlor below land inflate requires a
variance in accordance with ISA NCAC 3C .011S.
9. YIELD (gpm): Ff METHOD OF TEST C:. i r
10. WATER ZONES (depth):
I I. DISINFECTION: Type f%T N Amount n . 57
12. CASING: Wan Thickness
Depth Diameter or Weight/FL Material
From (5 To )/Z Ft. Snrai Pvc
From To Ft.
From To Ft.
13. GROUT: Depth Material Method
From !1 To an Ft. C ern &�h- %3U hip no
From To Ft.
14. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in.
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth
From To Ft.
From To Ft.
Size Material
16. REMARKS:
Topographic/Land setting
❑Ridge OSlope ❑Valley OFIat
(check appropriate box)
Latitude/longitude of well location
(degreeshninutes/secatds)
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 leas(:.
two State Roads or County Roads- Includeihe road
U1 -
n tubers and common road names.
;L-
rom CJrn0nck f asT G-G /YID es
on ,€s-N 7-urn /et T on fo,nrhor creek
Croi l,5 ,"IE's Torn To 5hP// STanot
R fro - 6'9 In;IP rvrn
6-6 To tcro\ e)• Ch•eirliVe
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
'
1-1
SIGNATURE OF PERSON CONSTRUCTING THE WELL �DA7TEL/n
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, C
27699-1636 Phone No. [phone], within 30 days. GW-I REV. 07/_004

29G942
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural esou - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print)ri�++Off d N CERTIFICATION # tgO5G
WELL CONTRACTORCOMPANY NAME 6r0..k0..)n IJf/l (.r, Ili 7 PHONE Si fg.1s;)iny-y,«
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT!!
(if applicable) (if applicable)
I. WELL USE (Check Applicable Box): Residential fi:1 Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL NeaestTown: fIMot* 1'YtSVi /lP County itrcJlotrn
77,J4nrn ire+tr H a771
(Street Name. Numbers. Community, Subdivision. Lot No.. Zip Code)
3. OWNER: //j % / I10.11eld
Address Tnhhacn Rr«lnch
("met or Route No.)
Rn4
Jj, nstl, //P Alie a s-77 I
City or Town State Zip Code
(yry; )- 745 - 7274
Area code- Phone number
4. DATE DRILLED -O q
5. TOTAL DEPTH: 4CtC
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO El
7. STATIC WATER LEVEL Below Top of Casing. S{'D FT.
(Use "a^ if Above Top of Casing)
8. TOP OF CASING IS / FT. Above Land Surface'
'Top of casing terminated alloy below laud surface requires ■
variance In accordance with ISA NCAC 2C.611S.
9. YIELD (gpm): / METHOD OF TEST air
10. WATER ZONES (depth): 5 tC
1 I. DISINFECTION: Type
I2. CASING:
Depth
From_ To /Xi
//TN
Diameter
Ft. (
From To Ft.
From To Ft.
13. GROUT: Depth Material
From 6 To Q0 FL (c-'mehT
Amount 6,919
Wall Thickness
or Weight/FL 1Naterial
nral JPt/c
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 Size Material
in.
in.
Material
•
Topographic/Land setting
❑Ridge ❑Slope ❑Valley ❑Fiat
(check appropriate box)
Latitude/longitude of well location
(dcgrcdminuodsecnrrds)
Latitude/longitude source:OGPSOTopographic map
(check. box)
DEPTH DRILLING LOG
From To Formation Description
C
LOCATION SKETCH _
Show direction and distance in miles fromat I(---
two State Roads or County Roads. Inclttdg Ute r212d_-
bers and common road names. 1 `-
fr1
6it\c.)nlond\ Po i(-0 O 3.7in,16
G n N 7-1 r n /947 on %G h hc..c0 h ro-nc
Co, 0.9 piles Turn le T an NorTh
hor.cUe4ran G� 0 •D•� ntle 7a
°ri V[5)
on IpTT 0 76 %P OT h; )!
WaIIonMist h-r.
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

29R953
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater
Section N ,
CE
WELL CONTRACTOR (INDIVIDUAL) NAME (print)/'�TPT F. `rye" A )Qn�) y7y�vS Y
(f//-i1eko (-Li '0/7 rAr, I/rY)r) PHONE#Ea„d_�—
WELL CONTRACTOR COMPANY NAME p!
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT('
(if applicable)
(if applicable)
I. WELL USE (Check Applicable Box): Residential 1E3 Municipal/Public 0 Industrial ❑ Agricultural 0
Monitoring ❑ Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATI r
Nearest Town: Koh hin5Vine County 6Lr4iah')
l LI;; Ilr'A Cnl(/"n _o2877/
(Street Name. Numbers, Community, Subdivision, Lot No.. Zip Code)
nn i yyyy�� /'_ Vry (degas/minutes/seconds)
3. OWNER: �1l r P 1/, t", rAp A Latitude/longitude source:❑GPS❑Topographic map
Address ly ill, �n V�1r ter"' (cheek box)
R, - DEPTH DRILLING LOG
(Street or Route No.)
City or Town State
(23&)- Q79- (1 %-T
Area code- Phone number
4. DATE DRILLED (n-I _0
5. TOTAL DEPTH: a S'6
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO IJ
7. STATIC WATER LEVEL Below Top of Casing: /00 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS I 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): 12 METHOD OF TEST 0-4 r
10. WATER ZONES (depth): /gn
11. DISINFECTION: Type Li // Amount r1.32.
12. CASING: Wall Thickness
or Weight/Ft. aterial
.SnrJ-( NI�G "rinorY7 r-nr ia90- Iva Take /r291'6-o
0.1188itl:le Turn /e-It"! On W,'/l, ecol v.'rl
Rd,, G-d To ,r51 i2tVe un lelbr
EeL mckeilAry £a . o.N mt'le To GJe l I ,
a77 I
Zip Code
Depth Diameter
From 6 To %33 Ft.6 ie
From To Ft.
From To Ft.
13. GROUT: Depth Material Method
From r9 To `90 Ft. GemE-'n7 PumPiinq
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
Topographic/Land setting
❑Ridge ❑Slope OValley ❑Flat
(check appropriate box)
Latitude/longitude of well location
From To Formation Description
CT
From To Ft.
From To Ft.
16. REMARKS:
r rt
LOCATION SKETCH 01 E
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 PERSON CONSTRUCTING THE WELL DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Ceenter' RREVgh, NC-- _
27699-1636 Phone No. [phone], within 30 days.

296952
From
13. GROUT: Depth
From 0 To a O
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural RReso ices - Division of Water Quality - Groundwater Section
(print) T-t= - A
WELL CONTRACTOR (INDIVIDUAL) NAME JI CERTIFICATION a. ra.')�
'SHONE S tAy% y"X!/ �cl
WELL CONTRACTOR COMPANY NAME 6:ra ha.wr (+ R"// cir, i/r'ne
STATE WELL CONSTRUCTION PERMITS ASSOCIATED WQ PERMIT'S
(if applicable)
(if applicable)
I. WELL USE (Check Applicable Box): Residential ® Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION:
n DM ' v,'t'ho County (r6J, to
Nearest Town: ortD,pS
IA)//lid 1p)Vin ,Q-J S77/
(Street Name. Numbers, Community, Subdivision, Lot No.. Zip Code)
3. OWNER: Rona") a })SPS,IF)
Address L-/ %//At ten /V i'n Rek
(Street or Route No.)
Rhbhinsvfi)R AL& ak771
City or Town State Zip Code
(A` ) �(79 7Y43
Area code- Phone number
4. DATE DRILLED (0 -
5. TOTAL DEPTH: in 5
6. DOES WELL REPLACE EXISTING WELL? YES O NO
7. STATIC WATER LEVEL Below Top of Casing: /60 FT.
(Use ^+" if Above Top of Casing)
8. TOP OF CASING IS I FT. Above Land Surface*
*Top of casing terminated atior below land surface requires a
variance In accordance with ISA NCAC 2C .01Ia.
9. YIELD (gpm): q METHOD F TEST 0,..;t^ i
10. WATER ZONES (depth): �
I. DISINFECTION: Type ri1 TN Amount 0, rife,
12. CASING: WallThickness
Depth Diameter or Weight/Ft. Material
From 0 To I la. FL /c lq S O r 3 1 AVG
From To Ft.
To Ft.
Material Method
Ft. C'omen7 Pumfsn�
Topographic/Land setting
ORidge ❑Slope OValley OFlat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude sotrce:OGPSOTopographic map
(cheek box)
DEPTH DRILLING LOG
From To Formation Description
From To Ft.
14. SCREEN: Depth Diameter
From To Ft. in.
From To Ft. in.
15. SAND/GRAVEL PACK:
Depth
From To Ft.
From To Ft.
Slot Size Material
in.
in.
Size Material
LOCATION SKETCH c..
Show direction and distance in miles from at least'
two State Roads or County Roads. Include the road
numbers and common road names.
- rem 707" 1a7d- l y3 Take lA%" G=o , o- &
in 166 T'r/n/efrTon Go/v,in RA
�O To 1','rsT c(ri'vo on ltiT T
Plclry TLC Go 7J, Sec e,Ad
on le4-1- Q,,), PI,1g To Anus&_,
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
4 /I to 6-a-a4-1
SIGNATURE OF PERSCEN CONSTRUCTING THE WELL DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center RalREVgh 2001
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
-� rr /� CERTIFICATION # lOCC1
WELL CONTRACTOR (INDIVIDUAL) NAME (print)
rJ/P r + / / yA�fP
WELL CONTRACTOR COMPANY NAME lY r,t/yt Wl LiP// al._;MI nQ PHONE p 22,ac1ni:C9-s2/
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
Topographic/Land setting
ORidge ❑Slope OValley ❑Flat
(check appropriate box)
Latitude/longitude of well location
2. WELL LOCATI N,: r/ I
Nearest Town: KnitK).n S v,'/%Et County (croft ojtl
/0J-1A, Ilq.c ag77/
(Street Name. NObers, Community, Subdivision, Lot No.. Zip Code)
(degreeslminuoeshecrosds)
3. OWNER: Tn ri h/G nl Latitude/longitude source:❑GPS❑Topographicmap
Address /G YI(A.a%15 (rhea box)
6 (StiltorRou/V DEPTH DRILLING LOG
P6orTo7n State NC• Code Formation Description
City or Town State Zip Code From To
)-Y79-3/7
Area code- Phone number
4. DATE DRILLED G-4' O /
5. TOTAL DEPTH: 630
6. DOES WELL REPLACE EXISTING WELL? YES £NO F0
7. STATIC WATER LEVEL Below Top of Casing:
T.
(Use -4-" if Above Top orCasing)
8. TOP OF CASING IS / FT. Above Land Surface'
*Top or casing terminated at/or below land surface requires a
valiance In accordance with ISA NCAC 2C .01111.
9. YIELD (gpm): / `/ METHOD OF TEST O3., r
10. WATER ZONES (depth): tit .0
2a 9 )1
11. DISINFECTION: Type H T 11 Amount 0.92
12. CASING:
Depth
From O To 35-
From To
From To
13. GROUT: Depth
From O To �V
From To
14. SCREEN: Depth
From To
From .- To
15. SAND/GRAVEL PACK:
Depth
To
To
Wall Thickness
Diameter or Weight/Ft. Material lake)
/�c/ N
Ft. /n .Cnral PVc % Qfv
Ft. / Tvr/7 /4T an To
Ft. GO o2 /n CS n /f %ram!
Material Method fie' /o-J7ol/ing s- 6-0, 0-cC%%")'
Ft. Cement i�um�,'n� d (,,JP//
FL R 'ggh r` Go. To NncT o Yea-
Diameter Slot Size Material CT
Ft. in. in, on /f,J T.
Ft. in. in.
Size
From Ft.
From Ft.
Material
LOCATION SKETCH c.rt
Show direction and distance in miles froip%t least
two State Roads or County Roads. Include the road
umbers and common road names.
rom snr /�/,3 d /�
16. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH I 5A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
rca - #,rig (o-PI;
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

293950
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
'
WELL CONTRACTOR (INDIVIDUAL) NAME (print) -r/ E' CERTIFICATION O.2(ASO
WELL CONTRACTOR COMPANY NAME Crrn..ha.m tom/ rGi)l,'/)rn PHONE 0 Kfa�,-179- ed
STATE WELL CONSTRUCTION PERMITS/ ASSOCIATED WQ PERMITS/
(if applicable) (if applicable)
I. WELL USE (Check Applicable Box): Residential ® Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATI NII•
Nearest Town: Ao6Dh,nSv.l,& County Crre, s)1».t✓i
_re)r(enceok Q5"77I
(Street Name, Numbers, Community, Subdivision, Lot No.. Zip Code)
3. OWNER: re VP 7rn.rnmN//
Address FA(kran rr,00)G
I (Street or Route No.)
ROW.);V7¢l;,'/l& MG, 2C'77!
City or Town State Zip Code
(770 )- 599-
Area code- Phone number
4. DATE DRILLED CO'aI—G 47'
5. TOTAL DEPTH: '/6 C
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO El
7. STATIC WATER LEVEL Below Top of Casing: TL3 FT.
(Use `e if Above Top of Casing)
8. TOP OF CASING IS I FT. Above Land Surface'
*Top of casing terminated at/or below bed surface requires a
variance In accordance with ISA NCAC 2C .0118.
9. YIELD (gpm): 5. METHOD OF TEST C.t. i'r
10. WATER ZONES (depth): 7 Sic
I I. DISINFECTION: Type HT�I
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
r
CO
A OC TIONSKETCH
Amount 0 • Ca Show direction and distance in miles from it least
12. CASING: Wall Thickness two State Roads or County Roads. include�tte road
Depth Diameter or Weight/Ft. aterial }umbers and common road names. .--re _
From 0 To qq Ft. dI6- SOr�.) VC, +rep/ 2nT /0/3 d- /a9 To r n IQ'gjl %
From To Ft.
From To Ft.
13. GROUT: Depth Material
Fromm To %o Ft. (Lem° nl7
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
Method
i/v rip, ', V
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
-0'64 k ydt P 6-9- a (I- ,1
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE .-
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-I REV. 07/2001
L
on lP.9N G/r>7,7e-S Torn A,gh -
on Cockren (reek Go, o.a,71,-)/lP
Torn /Z.ic9JT C_-o To enc\ of Or,'Ve 1~/01/4y
Lie/I on I6-41-

WELL CONSTRUCTION RECORD
�;p,$533
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Sc I
CERTIFICAI ION 11�244=/
PHONE a fh�Yl `i -c7- 29C7
WELL CONTRACTOR (INDIVIDUAL) NAME. (print)
WELL CONTRACTOR COMPANY NAME fY3,1t P{ t,1Gal rdr.11
STATE WELL CONSTRUCTION PERMIT"
if applicable
r5
ASSOCIATED WQ PERMIT"
if nn'livable
I. WELL USE (Check Applicable Box): Residential ❑-- Municipal/Public ❑ Industrial 0 Agricultural 0
Monitoring 0 Recovery ❑ heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION:
Nearest Town: Kc. tn4 Y' I10 Countyiecthirvv
(As CC9F_k —
(Sheet Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNED. Lee- CA -VS
`ll��
Address o"� guts —
(Street or Route No.)
V)AYlSvi\\t %%TLkl
City or Town Stale Zip Code
( )-
Area code- Phone number
4. DATE DRILLED 03-rrf-O LI
5. TOTAL DEPTH: Ilo5' --
6. DOES WELL REPLACE EXISTING WELL? YES ❑ 140 ri-I--
7. STATIC WATER LEVEL Below Top of Casing: 5e)' FL
(Use "Y' if Above Top of Casing)
8. TOP OF CASING IS _1-- I T. Above Land Surface`
*Top of casing terminated aVur below land t•aface requires a
v..I.nre In accordance with I5A NCAC 2C.OI la.
9. YIELD lgntnl'
Iru shoo nl' TPSI A;I
10. WATER ZONES (depth):
Topographic/Land selling
DRidge LIS1bpe ❑Valley ❑Flat
(check opproptiale box)
Latitude/longitude of well location
f196 We tief:.06
(degrees/minutfej secands)
Latitude/longitude sourced CIPS❑Topographic map
(check bo :)
pi;ILLINg I,GO.
Unrinat tilt U sc; ip11U11
hrSCS
II. DISINFECTION: Typebkh Amount in
12. CASING: Wall Thickness
Depth Diameter or WeighUFt. Material
From C To {Sr , Ft. , S. SOC.zl _LC.-J Ft.
Front To
From To Ft. _--
13. GROUT: Depth Mpterinl Method('PSSrtT
From_
To ao' Ft. en: �IGyI� P e
FromTo Ft.
14. SCREEN: Depth Diameter Slut Size Material
From t To Ft. in.
From To Ft. in. in.
15. SAND/GRAVEL PACK: Depth Size Mntclial
From To Ft.
From To Ft.
16. REMARKS:
I DO HEREBY CERTIFY MAT TIES WELL WAS CONSTRUCTED IN ACCOIUJANCE WI771 I5A NCAC 2C, WELL
CONSTRUCI ION STANDARDS, AND TUNE A COPY OF 11115 RECORD I IAS BEEN PROVIDED TO TI IE WELL OWNER
— 03 pl-Ou
;2;1. SIGNATURE OF PERSON CONSTRUCTING TILE WELL DATE
Front To
�> — Qt)'
LOCA'rto_ag 'I l
Show direction avid distance in miles from at least
two State Roads or County Roads.:elude the road
nurtwrbcrs and common road names.
iu'Fs
(„„ceek
Submit (lie origiunl to the DI% Won of Water Quality, Groundwater Section, 1636 Mail Service Centers RZ- LVgh,//]!)01
27699-1636 Phonic No. [phone], Within 30 days.

NC
J
WELL CONSTRUCTION RECORD
299766
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACfOlt (INDI VI DUAL) NAME (print) Ct R. CAD; ) SOtri CERTIFICATION N^-ZUQ(/
WELL CONTMCIOIl COMrANY NAME 0'1 r)IOC LK)OII c C.`‘i A5 rrtONE N hn RS aCCY
STATE WELL CONSTRUE-1 ION FERMI IN ASSOCIATED WI) PERMITN
(ifnpplicable) (if applicable)
I. WELL USE (Check Applicable Hon): Residedinl I_YMwdcipsl/Public CI Industrial Cl Agricultural LI
Monitoring C1 Recovery O Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION:(( /�?+ //
Nearest Town: gi(O'.YISVi\IQ. County(7r21QJI?
(Surer Name. Numbers, Community. SubdilIvlelon, Lot No., Zip Code)
3. OWNER: 66,9111P5)r,, I-lcrt-c
Address (it 'D Rowe N ) oer e c ,
-. Sams(I�` 6, &3r?a'
City or Town Stale Zip Code
( 3-
Arta cede- rhone number
4. DATE DRILLED'1- N--oQ
5. TOTAL DEPTH: los'
6. DOES WELL REPLACE EXISTINO WELL? YES O NO IU-
7. STATIC WATER LEVEL Below Top of Casing: _.Q' FT.
(We-4-If Above lop of Cueing)
8. TOP OF CASING IS ) FT. Above Land SotFace•
•Top of mini Irrmindrd aVor below land twine, requites ■
reliance In accordance with ISA NCAC IC.011A.
9. YIELD (gpur): (C, METHOD OF TEST A;( -
IV. WATER ZONES (depth):
I I. DISINFECTION: Type bk A PoI)o Vs Amount
12. CASING: Wall thickness
Depth Diameter or Weight/Ft. Material
From 0 To 3D' FI. (0.075 SDr2I prJt_
From To Ft.
from To FL
13. GROUT: Depth Mplerial Method
From b To 2 ' Ft. ?nr 1''aklci jlrp<SdrP
From To Ft.
14. SCREEN: Depth Diameter Slot Size Material
Fronr To ft.
Ervin To Ft. in.
15. SAND/GRAVEI. PACK:
Depth Size Material
from to
Front To
16. REMARKS:
Ft.
Ft.
COI
Topographic/Ulm] selling
ORUdge OSlope ❑Valley ❑flat
(check appropthoe box)
Latitude/longitude of well location
N Cw'U3y/7e3°f08/6"
(deareea/m Inutee/recon dQ
Latitude/longitude souree:OGPSOTopograplric wrap
(check box)
PRILLILICLOQ
Formation Description
PEP'lll
From To
0 - in'
I 0 -r
001 — Jos'
LOCATION SKETCH.
Show direction and distance In mileaorn:aE1east
two Slate Roads or County Roads. Irsoludellre road
numbers and common road names. —
RdlowilstAlle
I DO HEREBY CERTIFY THAT 1111S WELL WAS CONS I IWCIED IN ACCORDANCE WITH I5A NCAC 2C, WELL
CONS] RUCI ION STANDARDS, AND MAT A COI'Y OF THIS RECORD HAS BEEN PROVIDED TO TI lE WELL OWNER
SIGNATURE OF PERSON CONS"I'RUCTINO'fI1E WELL DATE
Submit the urlglnal to the Division of Water Quality, Groundwater Section, 1636 Mall Service Center- Raleigh, NC
17699-1636 Phone No. [phone], w illtIn 30 days. UW-I IU?V. 07/200I

NC J
OWNER
ftWO
29975E
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL/NAME (print) JrlvNO C R. L..)A5nr1 CERTIFICATION a iUvt/
ritouE a j8ayyi37-299�
WELL CONTRACTOR COMPANY NAME
STATE WELL CONS (RUCTION FERMI IN ASSOCIATED WQ rr.RMIT$
(if applicable) (if applicable)
YYI,11Af \n't( ar+W1iri
I. WELL USE (Check Applicable Pox). Residential la- Municipal/Public U Indushiat U Age icuitutal
Monitoring U Recovery U I teat Pump Wnlcr Injection U Other U If Other, List Use
2. \VELI. LOCATION:
Nearest Town: g ridnC6.4, tr � e. County CIrri 't
(Sueel Name, Nunbeu, Community, Sut,d vinlon, Lot No., Zip Gale)
3. OWNER: 1-,PCA V1't;na_"
Address Ir IiZT1iE15 bFIJ2
(Sheet or Route No.)
c, \R6\11Ile, NC $r7',7I
City or Town Stale Zip Code
L�-
Ares code. Rhone number
4. DATE DRILLED 7- IL ' Oct
5. TOTAL DEPTH: I ar
6. DOES WELL REPLACE EXISTING WELL? YES U NO LW-
7. STATIC WATER LEVEL Below Top of Casing: 15 ET.
(Ore "•" If Above Top of Cn+ing)
8. TOT' OF CASING IS I PT. Above Land Sot face•
flop of cubit terminated al/or below land err lace requiter a
vulanre In accordance nub 15A NCAC IC .0118.
9. YIELD (gpm): 110 METHOD OF TEST 4; f7
ID. WATER ZONES (depth):
II. DISINFECTION:'fypeVi\\'19 11tj; Amount 15
12. CASING: Wall *thickness
Depth Diameter or Weight/FL Material
Front 0 To ID I' FL L'.D .1`f4 S\-e.nS
From To Ft.
Front To FL
I). GROUT: Depth f� Material Method
from 71 To aO' FL P rirt✓+r( PrpsiofP
From To Ft.
14. SCREEN: Depth Diameter Slot Size Material
Eton t To Ft. in. in.
From To _ Ft. in. in.
15. SAND/GRAVEL l'ACK:
Depth Size Material
Front To Ft.
)'roll) To 1't.
16. REMARKS:
I DO REREUY CERTIFY TIIAT'tlilS WELL WAS CONSIAUCIED IN ACCORDANCE WITH ISA NCAC 2C, WELL.;
CONS1RUCI ION STANDARDS, AND THAT A COPY OF'EI IIS RECORD HAS BEEN PROVIDED TO TI IE WELL OWilER
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
Submit (Ile oi;gloat to the Division of Water Quality, Groundwater Section, 1636 Mall Service Ceder - Raleigh, NC
OW -I REV. U7/2001
Topogr�nI llic/Lnnd selling
UlUdge llSlope ❑Valley UFlat
(check appropdnie box)
Latitude/longitude of well location
tJ3f°21'7", w57°'f1'/0"
(degrees/minutedeecond+)
Latitude/longitude sourcc:UGPSUTupographic neap
(check box)
UIULLINO LOU
four lion Upg{{cription
iSI„rIC S• It
(-,-c )Pla LbetAdOES
(;rane',e.
pin
From To
0 - '
S - GI'
ail - I>5'
0
LOCATION SKETCH 7 ,.
Show direction and distance in rnileii'omat least
Iwo State Roads or County Roads. IRclu ilte road
numbers and common road names.
4sroPr
_i.TooFe\
4-ar
c

WELL CONSTRUCTION RECORD
29982E
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) LARRY F. JONES
CERTIFICATION N 3295
WELL CONTRACTOR COMPANY NAME CHEROKEE WELL DRILLING AND PUMP COMPANY, INC. PHONE # [phone]
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
I. WELL USE (Check Applicable Box): Residential El Municipal/Public O Industrial O Agricultural ❑
Monitoring O Recovery O Heat Pump Water Injection O Other O If Other, List Use
2. WELL LOCATION:
Nearest Town: STECOAH County GRAHAM
LAKEVIEW ESTATES LOT 34
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: DAN BURDEN
Address 2659 HOPE LANE WEST
(Stitt or Route No.)
PALM BCH GRDN, FL 33410
City or Town State Zip Code
( 561 )- 775-3566
Area code- Phone number
4. DATE DRILLED 07-23-2004
5. TOTAL DEPTH: 405'
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO RI
7. STATIC WATER LEVEL Below Top of Casing: 120 FT.
(Use "e” if Above Top of Casing)
8. TOP OF CASING IS 1 FT. Above Land Surface'
*Top of easing terminated Mier below land surface require a
variance in accordance with ISA NCAC 2C .0118.
9. YIELD (gpm): 3 METHOD OF TEST AIR
10. WATER ZONES (depth): 120', 325'
I I. DISINFECTION: Type CHLORINE
Amount 100 PPM
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
From 0 To 80 Ft. 6 1/8" SDR 21 PVC
From To Ft.
From To Ft.
13. GROUT: Depth Material Method
From 0 To 20 Ft. CEMENT GRAVITY
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
From To
Ft.
Ft.
Topographic/Land setting
®Ridge ❑Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
3525.121N/8343.779W
(dcgrccs/minutes/scconds)
Latitude/longitude source:ElGPSOTopographic map
(check box)
DEPTH DRILLING LOG
From To Formation Description
0' TO 20' RED SLATE
20' TO 40' SANDSTONE
40' TO 60' BLACK DIRT
60' TO 80' GRANITE
80' TO 405' GRANITE
O
LOCATION SKETCH
Show direction and distance in miles from ableast two State Roads or County Roads. Includellje road.,
numbers and common road names.
C71
16. REMARKS:
l DO IIEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITII I 5A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A PY OF TILLS RECORIjft&S BEEN PROVIDED TO THE WELL OWNER,
NG 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

299825
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) LARRY F. JONES CERTIFICATION ,/ 3295
WELL CONTRACTOR COMPANY NAME CHEROKEE WELL DRILLING AND PUMP COMPANY, INC. IIIONE f [phone]
STATE WELL CONSTRUCTION PERMIT,/ ASSOCIATED WQ PERMIT,/
(if applicable) (if applicable)
I. WELL USE (Check Applicable Box): Residential El 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: STECOAH County GRAHAM
TOBACCO BRANCH
(Street Name, Numbers, Community, Subdivision, let No., Zip Code)
3. OWNER: GEORGE E. SPELLMEYER, JR.
Address P.O. BOX 189
(Street or Route No.)
GRAND BAY, AL
City or Town State
( 251 )_ 421-3553
Area code- Phone number
4. DATE DRILLED 07-21-2004
36541
Zip Code
5. TOTAL DEPTH: 425'
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO El
7. STATIC WATER LEVEL Below Top of Casing: 120 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): 20 METHOD OF TEST AIR
10. WATER ZONES (depth): 375'
I I. DISINFECTION: Type CHLORINE Amount 100 PPM
12. CASING: - Wall Thickness
Depth Diameter or Weight/Ft. Material
From 0 To 150 FL 6 1/8" SDR 21 PVC
From To Ft.
From To Ft.
13. GROUT:
From 0
Depth Material
To 20 FL CEMENT
From To
14. SCREEN: Depth
From To
From To
15. SAND/GRAVEL PACK:
Method
GRAVITY
Ft.
Diameter Slot Size Material
Ft. in. in.
Ft. in. in.
Depth Size Material
From To Ft.
From To Ft.
16. REMARKS:
Topographic/Land setting
®Ridge ❑Slope DValley ❑Flat
(check appropriate box)
Latitude/longitude of well location
3522.927N/8338.368W
(dcgreeshninutesfseconds)
Latitude/longitude source:RlGPSOTopographic map
(check box)
DEPTH DRILLING LOG
From To Formation Description
0' TO 60' RED CLAY
60' TO 80' BLACK DIRT
80' TO 120' RED CLAY
120' TO 150' GRANITE
150' TO 425' GRANITE
r_
C.)
C
LOCATION SKETCH
Show direction and distance in miles fromiYleast��t.
two State Roads or County Roads. Include, road
numbers and common road names. "J c
l DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITIE I5A NCAC 2C, WELL !
CONSTRUCTION STANDARDS, AND THAT A CY OF THIS RECORD HAS BEENN PROVIDED TO THE WELL OWNER
SIGNATURof OF PE'tyI•
CON RUP THE WELL DATE W L
Submit the original to the Division of Water Quality, Groundwater Section, I636 Mail Service Center - Ralelgh,'NQ;
27699-1636 Phone No. [phone], within 30 days. GW-1 REV. 07/2001
a-_
iris

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural (tetourcesDivision of Water Quality
WELL CONTRACTOR (INDIVIDUAL) NAME (print) �'{=-{- i/ 1 ling
WELL CONTRACTOR COMPANY NAME C- mirk -Y✓i 1..3f ` Alt' r l tf" 1K
—
STATE WELL CONSTRUCTION PERMITS ASSOCIATED WQ PERMITS
(if applicable)
(if applicable)
I. WELL USE (Check Applicable Box): Residential I21 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: O14);nsv, lP County Gay rho.t✓1
a Fs NorTh
(Street Name. Numbers. Community. Subdivision. Lot No.. Zip Code)
3. OWNER: c<,he/,k G-rointn
Address l 1 tyrn b'1 e
(Street or Route No.)
-PO U,ay ..1,31R Ai.C.
City or Town State
(ear-)- Q79-S>;G6
Area code- Phone number
4. DATE DRILLED 7 -44 - 014
5. TOTAL DEPTH: Sr) '
6. DOES WELL REPLACE EXISTING WELL? YES O NO El
7. STATIC WATER LEVEL Below of Casing: 3 3 FT.
Top or Caring)
8. TOP OF CASING IS / FT. Above Land Surface*
*Top of caning fermi mated at/or below land aaetaee regsbes s
variance la accords with ISA NCAC 2C .a11a.
9. YIELD (Wm): METHOD OF TEST C� Y
10. WATER ZONES (de th):3
Zip Code
11_ DISINFECTION: Type N TA'
12. CASING:
Depth Di ter
Fromm To 9 / Ft.
From To Ft.
From To Ft.
13. GROUT: Depth Material
From n To a0 Ft. cernCOT
Amount (7 ,
Wall Thickness
or Weight/FL Material
SO a,.t PUG
From To
14. SCREEN: Depth
From To Ft. in.
From To Ft. in.
15. SAND/GRAVEL PACK:
Depth Size
From To Ft.
From To Ft.
299901
- Groundwater Section
CERTIFICATION S
PHONE S i"t' -S H
Topographic/Land setting
❑Ridge ❑Slope ❑Valley ❑Flat
(check appropriate box)
Latitudeflongitude of well location
( °us/ucands)
Latitude/longitude source:❑GPSDTopographic map
(check box)
DEPTH DRILLING LOG
From To Formation Description
0
cr' ._
C- o
LOCATION SKETCH
Shoop direction and distance in miles from at least
two State Roads or County Roads. Include the mad
numbers and common j3ad names
"From adman Po. Turn Rt9hT
Orr &CS " G0 lndes Toro
A Mmthod AighT G-0 TO Top 6'P h, t i -7-0 Size Material
in.
in.
Material
16. REMARKS:
1 DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
Suit tote 7'
SIGNATURE OF PERS N CONSTRUCTING THE WELL DATE
Ft.
Diameter
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Ceenter' R leigh, NC
27699-1636 Phone No. [phone], within 30 days.

WELL CONSTRUCTION RECORD
300753
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) DAVID F. MCKINNON
CERTIFICATION 8 2411
WELL CONTRACTOR COMPANY NAME CHEROKEE WELL DRILLING AND PUMP COMPANY, INC. PION p [phone]
STATE WELL CONSTRUCTION PERMITB ASSOCIATED WQ PERMITS/
(if applicable) (if applicable)
I. WELL USE (Check Applicable Box): Residential ID MunicipaVPublic 0 Industrial ❑ Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION:
Nearest Town: STECOAH
LOWER SAWYERS CREEK
County GRAHAM
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: NOEL JONES
Address 1582 LOWER SAWYERS CREEK
(Street or Route No.)
ROBBINSVILLE, NC 28771
City or Town State Zip Code
( 828 )- 479-4948
Area code- Phone number
4. DATE DRILLED 08-06-2004
5. TOTAL DEPTH: 125'
6. DOES WELL REPLACE EXISTING WELL? YES O NO 10
7. STATIC WATER LEVEL Below Top of Casing: 30 FT
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS 1 FT. Above Land Surface*
'Top of easing terminated 'taw below land surface requires a
variance in accordance with 15A NCAC 2C .0118.
9. YIELD (gpm): 20 METHOD OF TEST AIR
10. WATER ZONES (depth): 80'
I I. DISINFECTION: Type CHLORINE
12. CASING:
Depth
From 0 To 46 Ft.
From To Ft.
From To Ft.
13. GROUT:
From 0
Depth
To 20
Material
Ft. CEMENT
Amount 100 PPM
Wall Thickness
Diameter or Weight/Ft. Material
6 1/4' .188 STEEL
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
GRAVITY
Slot Size Material
in.
in.
Material
Topographic/Land setting
❑Ridge ®Slope 0Valley ❑Flat
(check appropriate box)
Latittde/ongitude of well location
(deerees minutesheconds)
Latitude/longitude source:l7GPSOTopographic map
(check box)
DEPTH DRILLING LOG
From To Formation Description
0' TO 20' BROWN DIRT/SAND/GRAV
20' TO 40' SANDIGRAVEVGRANI71.
40'TO46' GRANITE O P
46' TO 125' GRANITE
C c,,0
"m
30' r rnra
Gr G
iJ =
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
16. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH I5A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OFj TIIIS RECORD IIAS BtE,KPROVIIUED TO THE WELL OWNER
SIGNATU
OF PERSON CONSTRUCTING THE WEE
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
SEP r Li. ` `] )1
l

300750
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) DAVID F. MCKINNON CERTIFICATIONS 2411
WELL CONTRACTOR COMPANY NAME CHEROKEE WELL DRILLING AND PUMP COMPANY, INC. PHONE ,/ j 828) 837-8008
STATE WELL CONSTRUCTION PERMITS ASSOCIATED WQ PERMIT,/
(if applicable) (if applicable)
I. WELL USE (Check Applicable Box): Residential El Municipal/Public 1 Industrial El Agricultural ❑
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use
2. WELL LOCATION:
Nearest Town: STECOAH
HWY 28 - LAKEVIEW ESTATES
County GRAHAM
(Street Name, Numbers, Community, Subdivision, Lot No., lip Code)
3. OWNER: AIMEE DURAND I CARL SWARTZ
Address 3310 HIBISCUS DR
(Street or Route No.)
FT. MYERS, FL 33901
City or Town State Zip Code
( 239 )_ 476-9069
Area code- Phone number
4. DATE DRILLED 07-29-2004
5. TOTAL DEPTH: 805'
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO El
7. STATIC WATER LEVEL Below Top of Casing: 120 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS 1 FT. Above Land Surface`
`Top of casing terminated alor below land surface requires a
variance in accordance with ISA NCAC 2C .011a.
9. YIELD (gpm): QUART METHOD OF TEST AIR
10. WATER ZONES (depth):
II. DISINFECTION: Type CHLORINE
Amount 100 PPM
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
From 0 To 110 Ft. 6 1/8" SDR 21 PVC
From To Ft.
From To Ft.
13. GROUT: Depth Material Method
From 0 To 20 Ft. CEMENT GRAVITY
From To Ft.
14. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in.
From To Ft. in. in.
IS. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
Topographic/Land setting
®Ridge OSlope ❑Valley ❑Flat
(check appmprtate box)
Latitude/longitude of well location
3525.074N/8343.530W
(degrees/minutes/seconds)
Latitude/longitude source:RlGPSEITopographic map
(check box)
DEPTH DRILLING LOG
From To Formation Description
0' TO 40' SANDSTONE
40' TO 80' RED CLAY
80' TO 110' GRANITE
110' TO 805' GRANITE
G
c^
0—
serf`
LOCATION SKETCH as ,71=3
Show direction and distance in miles from at le {" ry
nrn
two State Roads or County Roads. Include the road to
numbers and common road names. .? n
c
rat =
I'MeAlea' e5T
16. REMARKS:
I DO HEREBY CERTIFY THAT T111S WELL WAS CONSTRUCTED IN ACCORDANCE WITII ISA NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEN PRQVIDEO TO THE WELL OWNER
SIGNATURE OF PERSON CONS
UCTING TIIE 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
301384
North Carolina - Department of Environment and Natural R ources - Division of Water Quality - Groundwater Section
ld...`` CJn CERTIFICATION # 205-0
PHONE # f$-*'f 7?- flit�y y
WELL CONTRACTOR (INDIVIDUAL) NAME (print)
Cr r'c.t, is m G ip°
ASSOCIATED WQ PERMIT#
(if applicable)
WELL CONTRACTOR COMPANY NAME
STATE WELL CONSTRUCTION PERMED
(if applicable)
I. WELL USE (Check Applicable Box): Residential ® Municipal/Public 0 Industrial 0 Agricultural ❑
Monitoring 0 Recovery ❑ Heat Pump Water Injection ❑ Other 0 If Other, List Use
2. WELL LOCATIQN:
Nearest Town: Krt d s rt N / /P County 6- raffia WI
%li&A SpiencA,er ar771
(StreeName, Numbers, Community, Subdivision, Lot No.. Zip Code)
3. OWNER: G/1 ,Y / is %yv/�.sTA
Address N/t Sple-'nc.Pr
v" (Street or Route !�
Rot bins v:ijp /ta 5'77/
City �or Town State Zip Code
+
Area code- Phone number
4. DATE DRILLED Fi?"- 26 -04/
5. TOTAL DEPTH: 3-.6
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO IR
7. STATIC WATER LEVEL Below Top of Casing: U FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS / FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordance with 15A NCAC 2C .0118.
9. YIELD (gpm): P METHOD OF TEST
10. WATER ZONES (depth): 8
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
11. DISINFECTION: Type h
12. CASING:
Depth Diameter
FromC To_ FL/4_
From To Ft.
From To Ft.
13. GROUT: Depth
From6 To r2.!)
Amount O
Wall Thickness
or Weight/Ft. Material
Snrll Pvc.
Material Method
Ft. cromehr Putnpinuati
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
From To
From To
16. REMARKS:
Ft.
Ft.
Well
Material
gir
-'rep
%
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
rtltmbers and common road names.
T.
rc, m "T /a7t 1e/3 Take l y3
Go. 02,1 in, Tvrn
on old 5werTwccTer RA, GO
�, 3 m des Turn ;e,ET oi'1
higiy) S phonder ReA. 6-0 1,
102
ihNes 77) Well on R1zhT,
TA e /7'VL-A rct.r7Zjre
1 DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY��uQ OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
SIGNATURE OF PERSON CONSTRUCTING THE WELL c?D TE Y64,
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 hRessourcess - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) ' 64 /1yiP CERTIFICATION #raoS/2
WELL CONTRACTOR COMPANY NAME fit rnjn s)M We/I c\r1)ltra
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WO PERMIT#
(if applicable) (if applicable)
I. 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 LOCATION: /'
Nearest Town: Robb
,'r Av; l/B County G-r,Jto, m
knell '7 70 Rnc.41 2a77/
(Street Name, Numbers" Community,niSubdivision,vLot No., Zip Code)
3. OWNER: /O.n/e 8(.27Jtor
(Street o Route No..)
Address Kiln/ I) Td p J2
ptbiL%/% pit . 01t77 )
City or Town State Zip Code
(776- 1S-- 35Q9
Area code- Phone number
4. DATE DRILLED 5 -9.3—n4
5. TOTAL DEPTH: 70S
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO
7. STATIC WATER LEVEL Below Top of Casing: 25(0 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS / FT. Above Land Surface'
"Top of casing terminated at/or below Ianq surface requires a
variance in accordance with ISA NCAC 2C .0118.
9. YIELD (gpm): IL METHOD OF TEST LiC r
10. WATER ZONES (depth): y d1s
11. DISINFECTION: Type
12. CASING:
Depth Diameter
From C To 60
From To Ft.
From To Ft.
Amount 0.74
Wall Thickness
or Weight/Ft. Material
'2)r21 Pvc
13. GROUT: Depth Material
FrombTO 24) Ft. GNrnenr
From To Ft.
14. SCREEN: Depth Diameter
From To Ft. in.
From To Ft. in.
15. SAND/GRAVEL PACK:
Depth
Frorp To Ft.
From To Ft.
PHONE # 525,1 4 74- Wry
Topographic/Land setting
❑Ridge ❑Slope OValley ❑Flat•
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map---
(check box)
DEPTH DRILLING -LOG ---
From To Formation Description
tot
sF� 'tipm
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.
'tam Jc";hnson Gap Turn oh 193 k.
Method GO . o.7 nhi'/t 7ern 1(4 T o tn,
Pvmp4 knell Top Gv. o,a. n-i,')e %urn
/eT oi've L✓o,y t&Jeil on
let T,
Slot Size Material
in.
in.
Size Material
16. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH I5A NCAC 2C, WELL.
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
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

3013$3
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources-JjD�ivis on of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) -TP.L+AR y4 f CERTIFICATION #2os7
WELL CONTRACTOR COMPANY NAME 6 r/a.ha.m tue// (1f .r//: rig
PHONE # IR/4) 979-af S L#
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable) (if applicable) -
I. WELL USE (Check Applicable Box): Residential ® Municipal/Public ❑ Industrial 0 Agricultural 0
Monitoring ❑ Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION:
Nearest Town: pnOp p4 ✓e //e' County Cea ha./4
Pi'nheolr Road ace77)
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: fin 2r,e5 r rVf'f
Address H';el honk Rnack
(Street or Route No.)
Ro�t�ion<Oh/ /VG.
2%77 f
City or Town State Zip Code
4211-'4 7 9- / 3 .-)
Area code- Phone number
4. DATE DRILLED 9- 2 Lt - c (-)
5. TOTAL DEPTH: �aS
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO a
7. STATIC WATER LEVEL Below Top of Casing: 6 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS I FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordance with ISA NCAC 2C .0118.
9. YIELD (gpm): U METHOD OF TEST Q
10. WATER ZONES (depth): 0
11. DISINFECTION: Type
12. CASING:
Depth
From_Q_ To al
From To
From To
13. GROUT: Depth
From O To t,o 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.
1-lyrtrcl -Prat Tur&
Wall Thickness
Diameter or Weight/Ft. Material
Ft. (n 4i Sor ai pvc
O Amount f/
Material
CNMF rrt
Method
Purnpri
Slot Size Material
in.
in.
Ft.
Ft.
16. REMARKS: lAJe%' -le inP
Topographic/Land setting
❑Ridge OSlope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH 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
n tubers and common road names.
r�or'i ZnT /93 - Jai %akev )4/3 6
3,;;- % files Turn /E'?T on P1'n hook
Rost Go • o,(o m;/r Turn
on ar,'Ve U.fo,y Well AT bacc/(
o4
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
//y&
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
--,.ci-o�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

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources
/- Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) "' 0—et7� 'yc1 e CERTIFICATION # di1.59
WELL CONTRACTOR COMPANY NAME irwJ7 q pi (Sion ci<.r'11r/II PHONE # S.Iri7%-SiNj"1
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
301382
I. WELL USE (Check Applicable Box): Residential 121 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: Rpe es..rwirlNA County G-radln m
€/QI/harYnn
(Street Nlme, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: kenn4 T4 tw./r' Erns
Address Sk e°CCfin
p F (Street or Route No.)
Robb%n'n'://P
City or Town State Zip Code
Area code- Phone number
4. DATE DRILLED 8*-4 -04
5. TOTAL DEPTH: VCC
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO 51
7. STATIC WATER LEVEL Below Top of Casing: ;.Li- 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): G METHOD OF TEST cw 2 r
10. WATER ZONES (depth): D.30
2t77)
II. DISINFECTION: Type %ITA/ Amount n.'i/
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
From_a_To 2.6 Ft. 6)44 Snr21 PVc
From To Ft.
From To Ft.
13. GROUT: Depth Material Method
Fromt To 2h Ft. (di Me t7 j 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
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 DRILLING LOG ---
From To Formation Description
tate
C.� o cOFy�/
uQ
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.
- rorve r'nT G- 12y J- 14'3 Taker I113
a miles Turn /a.hT on siayjoacc.'F
6o, o,/ ynr'/e' Turn le �v
/0 %P 0 4 Gt r f'v# t,✓oty well
6 n le4 T.
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 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
DIr�
WELLCONTRACTORUNVIDVAL)NAME,�vri`1�1 q rYV r`Ve FZLI CERTIFICATION 13L) b a'
WELL CONTRACTOR COMPANY NAME fia5E5 hiP U r (15 PRONE a 603) yya-3/31
STATE WELL CONSTRUCTION PERR OTP w.iSOCIATED W1) Pathan
lit applicable) (fapplicable)
I. WELL USE (Check Applicable Box): Residential k Municipal/Public 0 Industrial ❑ Agricultural 0
Monitoring D Recovery 0 Nat Pump Watts Injection ❑ Other O If Other. List Use
2. WELL LOCATI
Nearest Town
CA
County 6J1I4.i
(Sent Noma a�. aN-umbas. c mr uky. Subdivision.No.. Ti Lei n Ca)
3.OWNER:)Lhn Alex AA de r
Address P D Root /U OU Go E `h toe f rit
(Steel or Route No.)
ROO)n5 vi1i., N, C. D�'771
Ct y et Town taw $ Me
Area ace. Phone nut
4. DATE DRILLED %- /'oi -
S. TOTAL DEPTH: '4 60 a
6. DOES WELL REPLACE E)US7ING WEt.L7 YES Cl NO
7. STATIC WATER LEVEL Below Top of Casing: /
(Use 'N' if AM.* Top of Casing)
8. TOP OF CASING IS a FT. Above Land Surfaces
'Top of mina In dealed al/or blow land onset replrn
Variance in a werdanec with ISA NCAC 2C SIM
9. YIELD (gpm): 4 , S METHOD OFS$sT A i C{
10. WATER ZONES (depth): 'k} 'I F. fi
I I. DISINFECTION: Tyne h'LOON P
12. CASING:
Depth Diameter
From (; ToS,L5L Ft. (t lY
From To Ft.
From To Ft
Amount /LefiPM
Wall Thickness
or Wcip,IWFt. Material
/XS ST fPC
13. GROUT: Depth Material ^Method
From L' To d2 D Ft. OFrht'n¢
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 FL
From To Ft.
Topographic/Land setting
%Ridge DSlopc OValley OFlat
(cheek g9mputc boil
Latitudefongitude of well location
(Jgprr✓moiutes/uoaulq
Latitude/longitude source:OGPSOTopographic map
(cheek boa)
DEPTH pRIj.LUNG LOG
From To Formation Deseri tion
A' 9�' Piro,a thretfyrian.4-(
it,' /t`h r ectAnrtY
JGee' vie0 Gra le
LOCATION SKETCH
Show direction and distance in miles from at least
Iwo State Roads or County Roads. Include the road
numbers and caman road names.
/y3
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
S/a��f��,��,�/(]�_t L 3t 2 3 - a `f
SIGN RE OF PERSON CONSTRUCI1NG THE WELL DATE
Submit the original to the Divbdon of Water Quality, Groundwater Section, 1636 Mall Service Center- Raleigh NC -.
27699-1636 fhoae No. [phone], within 30 days. GW-I REV.072001
``0-1 4
e%LFu
300907
T

WELL CONSTRUCTION RECORD
North Carolina - Department of Futvironmait and. Natural Resoutees - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME
( �((prier) W J4y !V e JSP CERTIFICATIONS .70�'d'
WILL CONTRACTOR (:OMFANY NAME , ,D .C'P".S V'JN �\ ' ri \\INJ ?HONE .(�aa4ya-3y3/
STATE WELL CONSTRUCTION PERMIT. ___________,ASSOCIATED WO PERMIT*
(if applicable) (ifapplicable)
I. WELL USE (Cheek Applicable Box): Residential* MtmicipaYPublk 0 Industrial 0 Agricultural 0
Monitoring O Recovery 0 Heat Pump Water Injection 0 Other 0 If Other. List Use
2. WELL LOCATI
Town: Count
l eUe rY.T� Tee It d
(Shea None. Numbers. CmmmUly. Subdivision. tot No.. Zip rode)
3. OWNER: G,.ITt or el C R R
Address P r) 6-k / /i /nkn'r /7JTrlf tt K rev
(Sew or Rome No.
(2 sb(�� /v� X /
Citym own hue Zip Sc
Met auk. ade. Home mamba
4. DATE DRILLED 7' ?' JAI
5. TOTAL DEPTH: ea rrii 5
6. DOES WELL REPLACE EXISTING WELL? YES Q NO Lt
7. STATIC WATER LEVEL Below Top of Casing: / 1'C-
(Uu'r^ if Abut lap or Caseig)
8. TOP OF CASING 1S t I FT. Above Land Surface'
'Ted el minx fermi uW Wen below hid anrraee rumba a
earthen id ac nl 'sea ISA NCAC 2C Gilt
9. YIELD (gpm): 6 METHOD O • TEST Id t
10. WATER ZONES (depth): / 9 D 7 Jq
It. DISINFECTION: Type ChM nn0 Amount /or; PPm
12. CASING: Wall Thictrncss
Depth Diameter or WA' II/Ft. Material
From r To al Ft. %1 %� L 6 i( 5 ref L
From To Ft.
From To Ft
13. GROUT: Depth Material
From Cr-) To.9b Ft. t'Qmpri
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
GrA,h iy
300906'
Topographic/Land setting
ORidge OSlopc OValley Y1Flat
(cheek appropriate hm)
Latitude/longitude of well location
latitude/longitude sourec:OGPSOTopographic map
(cheek box)
DEPTH PRIJJLI rO L i
From To ,( Fo bon scri ti
Fes.,_ i r 'ran./P
Co' / C� '-erAnd/
n�) a�S Vl�/-ni �C
s FIt}e
i �ran,
LOCATION SKET(:H
Show direction and distance in miles from at least
two State Roads or County Roads. Include the roa
numbers and common road names. '
TINT
\ v
Qr�
b�
J
eP
0
O o
r
a am
r
C' � `f
IV oZ•
qo
��
m
%r
NZ
IV rct?
t '"
I DO HEREBY CERTIFY THAT THIS WELL WAS CANS7'RUCTEA IN ACCORDANCE WITH ISA NCAC 2C, WELL Z
CONSTRUCTION STANDAI(DS, AND THAT AJPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
b
NATURE OF PERSON CONSTRUCUNG THE WELL DATE
Submit the original to the Division of Water Quality, Groundwater Section, t636 Mall Service Center- Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. OW-1 REV. 072001
Nearest
N

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Waler Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAMEnn(grist) p li. C CERTIFICATION 13 tiC rY
WELL CONTRACTOR COMPANY NAME (112,SP S 1,4 t 1, it NIS PRONE Y 1S/1?) 944 -3'13
STATE WELL CONSTRUCTION PERR OTY !SOCIATED W{f PERMITS
Of applicable) (if applicabk)
I. WELL USE (Check Applicable Box): Residential I Municipal/Public 0 Industrial 0 Agricultural O
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other O If Other, List Use
2. WELL LOCATIQN.�
Nearest Town: tt16/7In5 r . / 14.. Countyerr p kiln
IPit .&v,.J b.044
(Sten Nutter. Numben, Community. Subdivision. tat No.. Zip Cork)
3. OWNER: VIP 61-cy "Tr Artlr7R LL
Address '41cis o L I-I`le ,Sit Ai,/ bit A
(Seen a Route No.)
RI) it-ltV;IIij N,C.
City or awn Stme
Ann and.. Phone number
4, DATE DRILLED 7—& ' a 41
5. TOTAL DEPTH: / a
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO 0
7. STATIC WATER LEVEL Below Top of Casing: 3 0 FT.
(cc '1Y' aAbove Tap of Casing)
8. TOP OF CASING 1S ) FT Above Land Surface'
'Top of using terai,Wd •per below Mad orlon moires a
variant is acandn sec wills ISA NCAC 2C .0110.
9. YIELD (gpm): :3 3. METHOD OF TEST I R
10. WATER ZONES (depth): %/ O re
1 I. DISINFECTION: Type Chia el v C
12. CASING:
Depth
From b To :-j 1 Ft.
From To Ft.
From To Ft.
13. GROUT: Depth
from L To cSY FL
From To Ft.
14. SCREEN: Depth Diameter
From To Ft. in.
From To Ft. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To FL
From To Ft.
Alnotmt Ot: PP!17
Wall Thickness
Diameter or Weight/Ft. Material
l 1/4 /aA' S-tftL
Material
LFrT trA
Method
Slot Size Material
_ in.
in.
16. REMARKS:
TopographicJLand setting
❑Ridge OSlopc OValley Fist
(cheek a pmteiale h,.)
Latitude/longitude of well location
300905
(degeevmuuesiseoondv)
Latitude/longitude solucc:OGPSOTopographic map
(cheek bon)
DEPTH DRIJ.LING LOG
From To , Formation Description
C'TodR^%5 A5Pnci/l>'rflue L
A5 ' 7 o /nl S e r g n, i E
C
n 2--
LOCATION SKETCH C
Show direction and distance in miles from at Elist
(wo State Roads or County Roads. Include thawed E
numberspei common road names. ' N ES
'4 61;x`pe F.
jycu"1.
7
raz
0
SLY
L:}
fV
r
r0
I DO HP.REHY 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
EA/ /A S— 2 3 0 y
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mdl Service Center. Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-I REV. 0712001

WELL CONSTRUCTION RECORD
North Carodna - Department of Environment and Natural Resources -/Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (pAet) WA AJ ( OSe CERTIFICATION a 3tit8
PROr4E a /Ia319Va-3 3/
Wma. ccoTRACTOR COMPANY NAME Ro Stu tS e kk OC. 11‘r-45
STATE WELL CONSTRUCru1N PERMIT*/ ASSOCIATED Rik/ PERMIT*
(if applicable)
(if applicable)
I. WELL USE (Cheek Applicable Box): Residential di Municipal/Public O Industrial ❑ Agricultural 0
Monitoring D Recovery 0 Heat Pump Water Injection 0 Other O If Other, List Use
2. WELL LOCATIQ N
Nearest Town: /(Obb(Y 1 le
Li7-7-LM' g Ss /n
(Street Nome. Numbers. Community. Subdivision. la No.. Zip Code)
County Wp
3. OWNER: 0Tr JrrVS
Address XC i Sib r io-CI, M.
(Sweet or Rome No.)
abbe, 6/1//e &ie. 196
City o- Thum Sate 2ip Code
(j•
Area emde. PSoue number
4. DATE DRILLED 7� / y - A y
5. TOTAL DEPTH: '71a' O 4't
6. DOES WELL REPLACE EXISTING WELL? YES O NO Ell
7. STATIC WATER LEVEL Below Top ofCasing: ,/6 L FT.
r. (Use''" i(AM.e Tic of Cubs)8. TOP OF CASING IS /• 5 FT. Above Land Surfaces
•Tep or taboo teratiamed suer below teed sedate requirms
ver)nMt is acmrdasa with ISA NCAC 2C Gilt
9. YIELD (gpm): Cj" METHOD OF TEST PI1 R
10. WATER ZONES (depth): 9 9 t'
I I. DISINFECTION- T)peCt}Amount /OC RPM
12. CASING: Wall Thieluicu
Depth DYryIp��++rr or Wei t'Ft. Material
From C To r77 Ft. it Y�/ / k 5?'f
From To Ft
From_ To Ft.
13. GROUT Depth Method
�f GnAYrqy r
.y Topographic/Land setting
Lr(cidge OSlopc OValley OFIst
(chock gpmprisIt hn.)
Latitude/longitude of well location
mcwecombmros,coo4q
Latitudeflongitude soutcc;OGPSOTopographic map
(chock bowl
DEPTH DRILLING LOG
From To r F rmation Description
C' %C rou-11 S Teo/C/CrAa,,1e
r1c' 'Ti' 0-ep..;Af
'17r 'f' J 6-enpl 1-V
I�
From U To SO Ft. aerial
F /M
From To Ft.
LOCATION SKETCH
Show direction and distance in miles from at le
two State Roads or County Roads. hul
numbers and common road names.
14. SCREEN: Depth Diameter Slot Size Material aa
From To FL in. in. G J
From To FL in. art. h ! F
15. SAND/GRAVEL PACK:
Depth Size Material Af
Oki Prom To FL
From To Ft.
16. REMARKS:
CCyLoAdi r
I DO HP.RERY 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
'-e fire'_ a 3 - a Y
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mali Sertke Center -Raleigh, NC
27699-1636 rhea, No. [phone], within 30 days. GW-1REV. 072001
300904

WELL CONSTRUCTION RECORD
North Carolina - Department of Foivirutumaa and Natural Resources -(Division of Wales Quality - Groundwater Section
p WELL CONTRACTOR (INDIVIDUAL) NAMES (pint) WA yr tl a SP CERTIFICATION p3()p wttL CONTRACTOR COMPANY NAME P(Q VI 5 q "e ,i roe; IN t%4 j PRONE I 031 4 S4' - 3.113 /
STATE WELL CONSTRUCTION PERMITS
•iIX'IA7EU WQ PERMTS _
(ifappliable) (if applicable)
i- WELL USE (CheckApplicabk Box): Residential tit Municipal/Public O Industrial ❑ Agricultural O
Monitoring O Recovery ❑ Heat Pump Water Irtjectino ❑ Other O If Other, List Use
2. WELL LOCAT)OjJ:
Nearest Town.. t v 7 iC IV A
Ton 7An P
County Cral,c,.n
(Seep Name Ntanbos, Cmtmmky. Reese .sim. to No., lip Code)
3. OWNER: Ly'. v On r 1 Sit
Address kwr, r u5 1cr9Pp
Lb
(Seto or Rat No.)
R(i Lb el c5 u(//e N C:. ab' 7 /
City or Town State Zip Code
Alfa talc. Phase nwaba �t,�
ADATE DRILLED 7 -do C 4
5. TOTAL DEPTH. 5490 56, Q, f
6. DOES WELL REPLACE EXISTING WELL? YE ONO t]
7. STATIC WATER LEVEL Below Top of Casing: ieR i) FT.
(Use 'r if Above Top or Casing)
8. TOP OF CASING IS / , 7 FT. Above Land Sulfates
'Top of calm rvnosatvd Wei below had nett rewires
varinnet is aeesrdasa with ISA NCAC 2C AIM
9. YIELD (gpm): '3 METHOD OF TEST A l R
10. WATER ZONES (depth): / Al e Cif-1
�jPn- 5 i',Ti
II. DISINFECTION: Typal pe,ye Amount /OD PF^I
12. CASING. Wall Thickness
Depth Dstorter or Weight/Ft. Material
From 0 To DI Ft. lCY4 Egg Suer
From To Ft.
Frota To Ft
13. GROUT: Depth
From /-' To •Q L) Ft.
From To Ft.
Material Method
14. SCREEN: Depth Diatocta 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.
300903
Topographic/Land setting
Ridge OSlopc OValky OFIet
(check opemprisn blot
Latitude/longitude of well location
eleenCedmimrcs/seomA()
Latitude/longitude sourec:OGPSOTopogaphitc rr�...
(ekes. bon)
DRi ..LING
Fomuhon s staiption-
Q2IH
From To ,
err
2 /' S(; D
i f
rR
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and 1Q5ad names.
C
L
7C
stl
16. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH ISA NCAC 2C, WELL
CONSTRUCTION STANDARDS, A)9D THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
TURE OF PERSON CONSTRUC17NG THE WELL
DATE
Submit the original to the Division of Water Quality, Groundwater Section, t(76 Mall Service Center- Raleigh, NC
27699-1636 teem No. [phone], within 30 days. GW-I REV. 07200)

11(
111;11L COINS RUC'lION itECURD
I4o11h Cmolinn - Derailment of Luviluumcul rind IJn//l/lgal Itenoom�mces - Division of Water Quality - Utoundwnlct Section '
n ELLI:uN I IUCIull (11111n'IIIUAL) NAME. (pi Ing_�6ty/Lee.CE- crIt1IrICAnun N-24/d9
//��_.,l/,ef mow. N 192b')73?-aSF?
ttEl.I, CUNIIUCIIIItCUn11'ANk'NAaI F. /�C _.—
ASSuCtAlEn WYI) 1'EIta111N
SI. ttF, I,Litt n•S Idit'lb IIOCIIUn 1'F.IUIIIM if n 1likable
nldr
I. WEI.I.IISE (Chettk Applicable Ilex): Itesidrnlinl4fr--tlunit•ipnl/Public LI ludunitinl ILI AF;l'colon al LI Mooing Mg LI Recovriy LI ile:d Pump Wain Injection Ll (Juliet U If Other, Llsi Use
2. WELL I.t)CA,IUI,•��_/l" / 17w, t ('ounly GjnQ ant-,
IJcmccl l//ut.n'_/JU
/V0I , 4A(( Beec/LCrte/S
(Sum Nnnlr, nnud Tit l ononunily, Solniidoloo. I nl I lo, 71110,40
1. O\1'LlElt:_- E.ri--- (8�,c,,�- tr------_. _._—_
Addles _.�_�$ LeY Fork Ete._ec h. C..r-K
(Sheet of Annie flu )
R.0bb115.s-u Ile AJC2- 771_
---_-t'ily nl I writ Slnlr lip l'odr
Art, rnalr- Mint, windier
d. HA IF IJithil Ni) -yy,0/
5. IUFAL DIP TiL 30R
6. DOES 11'EI,I, lit?I'LACIt EXISIIN(' \ViU.l.7 YES U NU
7. S I-A11C A1'AI ER LEVIiL Below Top of Caning: rid..-
/ ((I•. •'l"If Ahovr lop of (•n.inn)
•
.1Ur(IF • IS I"I'. Above I.nnd Sml'sce
l'ASIf1Uy__
• 1n1' of r••hq Ira oJi.ittl •Imitt Winn lima opt hire .rguhre
si
rn hoer in .rrnldulte Tillie 15A NUM' 11.'.111111.
V. 1'I1:II)(PI'111): __MIRINUDUFll'.SI /c`r
I(I.AVAIFitlull ES((cpill): 220 —.
II. IIISIIIIICIlull:'F)pe l7//74
12. C'ASIIJU:
l hpill Ilinntelrr
1.tian_ —v _ fo 41.5_ n. G- 511._
flow `f Io g' Pi. 6.i-s—
10 I I._
Depth Sjlnlrii:
riL 1
(mill t o PL_
H. SCItEEtI: Urpih Diameter
Mont •Ili—_ P1. in
Tu
Isom - _._.. It. —__in
15. SAlt Dili RAVI:1. I'ACL::
i irplll Sire
Inns! I1, IT
Flom To It_
Flom
U. (MAW F:
limn D
y/Y
Amount _ _`J` L
Wall Ili rknrsi
of \fright/fl. hlnlci181
Sde'z I w�
0,
Slot Site Alnirlinl
iii.
in. _
trbdri inl
Ivlliod
cs-C_
301200
'fupugrnp1lic/Lnnd .101'ng
Clllidµc I.1Slapc CiVnllry lJflal
(rh.rk ggu r.pelno- Ito.)
Lniituddlongilu'wolf'
c of well location
7v; 5°.20'0 t/•D wolf iy! c.z.'/
Opp re•ho hultr d,.ron,l,
Lnliludc/longitude nuurec:I il'SU Iupominpllie leap
(check I.,+)
U1:11u UIU L1.1111U I)10
Ptont 'to Emulation I)csci;Mimi
0 — 6 0 iy
0-30y — - •el r G
LQCA11U11SKILCI l
Show dilcclion and distance in niiIcs Runt at least
Iwo Sink Roads or Comity Ronda. Include the toad
numbers and colllllloll load Ilnlllra.
0
c,
�7m
G �c
L o
-4-_
. me
r
r n-
�
ev o
11S
L
SEP — 1 2004
16. REMARKS:
1 DU ill lu'IIY LEII11I'Y'II IAI1111S WELL WAS t'UNS I RUCIIED IN ACCURI ANCH`YT1'lll 1.5.A. 'M 2L W
CUNS l RUCI ION S FANDAIIDS, AND MAT A COPY UI1111S RECORD IIAS BEEN PIIUVIDL'u 1 U 111E WELL OWI IER
--v7a;_cE,
SIUIIA I UItI! UP I'EIISUN CONS 'KULA 1b10.1IILi WELL DA"I I.
?'IPndl lite wiglnsl to the Uhltluu of 11'alrr Quality, GIoundlvalel Section, 1636 Mill Service Center
h,
I ItIirig2(1101
1;(,,0.1616 Haim- Nu.l"IV) 731-1211, n Rhin 311 Mt) a.

NC V
U II IYCIt
WELL CONSTRUCTION 1tECOIW
North Carolina - Depot timid of Enviromnenl and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTnACIOR (INDIVIDUAL) NAME (print) ,)avNe.4\\ K.yy L,71t1 son CERTIFICATION°a0OU
WELL CONTRACIORCOMPANY NAME MAN f L3Pk. (YClr11.45 ritoNE a ffr2s) IsSY-.2 +Y
STATE WELL CONSTRUCTION FERMI I ASSOCIATED WQ LERMtT0
(ifnpplicnblc) (If applicable)
I. WELL USE (Check Applicable Dux): Residential Lk Municipal/Public O Industrial C1 Agricullmal LI
Monitoring ❑ Recovery O Ilea( Pump Water Injection O Other O If Other, List Use
2. WELL LOCAtIONi 11 \
Nearest Town: p w1SQ1 P ComdyGfOVYTv1A
ye)Jocft cl prok
(Stint Name, Nmnbeu, Community, Subdivieloty Lot No., Zip Code)
3. OWNER: c)42X)Vlt¢ V.)CLJQ.
Address
(Stint or Route No.)
City or Town Stile Zip Code
( )-
Ain rode- Phone number
4. DATE DRILLED%,2; Del
5. TOTAL DEI'TI l: /o
6. DOES WELL REPLACE EXISTING WELL? YES L I NO O
7. STATIC WATER LEVEL Below Top of Casing: 02D / Ft.
(Ure "+" if Above lop of Coring)
8. TOP OF CASINO IS / El'. Above Land Sin face•
•Top of raring terminated et/or below Tend melon requiter •
mintier In eccordence wllb 15A NCAC 2C .0118.
9. YIELD (gpnr): A9n METHOD OFT'ESI'_Aril
10. WATER ZONES (depth):
I I. DISINFECTION: Type/iH po// s
12. CASING:
Depth
From h To 55
From To
From To
13. GROUT: Depth
Front p To ao
To It.
Front
14. SCREEN:
Front_
Depth
To
Front To
15. SAND/G1tAVEI. PACK:
Depth
From To
Front To
16. REMARKS: qq���
1DOIIEREUYCERTIFYTIIATTIIISWELL VkkCON6fiR1C1EbI CCORDA$CEWITHI5ANCAC2C,WELL
CONSTRUCTION STANDARDS, AND TIIAIIA COPY OF T IIIS RECORD HAS BEEN PROVIDED TO TILE WELL OWNER
Amount /5`
Wall Thickness
Diameter or Weight/Ft. Material
II. /2,074 <l c( pvc
Ft.
FL
Male ial Method
FI. perk1„ ,re. Cs" terra
Diameter Slot Size Mateilnl
Ft. in. In.
Ft. In. in.
Size Material
Ft.
Ft.
301204
T'opogrnphic/Land setting
❑1UJge tilSlope OValley IJFIat
(check epproprinle box)
Lalituddlpy Fitute of well location
p � 1- �!3" HJ 3° 97I 25 I
(deareeJm inutee/eeconda )
Latitude/longitude source:OGPSOTopographic strap
(check box)
DRILLING LQQ
Fomr(al*on Description
DEPTH
Front To
0 - ID'
lb - Q5
N5 — )fib
LOCATION SULU I
Show direction and distance in miles from
two State Roads or County Roads. Include
numbers ancommon road names.
the road
l AJC/
ATUI' tls OI—IlERSON CONSTRUCTING TIIE WELL DATE
Submit the original to the Division of Water Quality, Groundwater Section,1636 Mall Service Center- Raleigh, NC
I7699-1636 Phone No. [phone], within 30 days. GW-I REV. 07/2001

02972
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - eDivision of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) J ? /7/y/Ae / CERTIFICATION # 2U.S/1
WELL CONTRACTOR COMPANY NAME G ra i,a m lie// arrl//'na PHONE #(g.2F)fi%%E'cigt{
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
I. WELL USE (Check Applicable Box): Residential l$ Municipal/Public Industrial ❑ Agricultural ❑
Monitoring ❑ Recovery ❑ Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION:
Nearest-�Town: R` 666 i n,s l 1 // B County G rckia t✓)
'r6b0.Con errand, 2»771
(Street Name. Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: *s rr? TQ%s
Address Tnln&s rc0 J3rgnr Ln
(Street or Route No.)
RA )n5 Ihrde AEC ,
City or Town State
Olarr)- N74 -
Area code- Phone number
4. DATE DRILLED 9-a1-6y
5. TOTAL DEPTH: S;.-0
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO Di
7. STATIC WATER LEVEL Below Top of Casing: 8'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): 1),* METHOD F TEST a
10. WATER ZONES (depth): - s
1 I. DISINFECTION: Type ill 777/ Amount O. /i0
12. CASING: - Wall Thickness
Depth Diameter or Weight/Ft. Material
From A To laa Ft. (e 4 snral Pvc
From To Ft.
13
From
GROUT:
From O
To
Depth
To olO
From To
14. SCREEN: Depth
From To
From To
15. SAND/GRAVEL PACK
Depth
From To Ft.
From To Ft.
aa771
Zip Code
Topographic/Land setting
❑Ridge ❑Slope OValley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From To Formation Description
G r`n
rn--
il
.A4
tie O n
nA
00
NCI
rn
LOCATION SKETCH
Show direction and distance in miles from at letd tt
two State Roads or County Roads. Include the tied
ny�tubers and common road aloes.
tror� cx)ponc Po Turn Rsh7
on Ac-NGo 3,7mf'ies Turn IS7
Ft. h A 6r
Material Method C//1 /U_ //6LtCCU 4B/'gYtG !C (7"U
Ft. °ornen7 Parnci'ne9 Y
Ft. / X/ !e /I//rn /eh— Gn 0ouble
Diameter Slot Size Material t
Ft. in. in. Sp ring Go, o,Cmi/e Turn
Ft. in. in.
16. REMARKS:
Size
Material
R19hr0.0 Tend0P RocAA
Well on IeT,
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
1rN Wieiu
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) Te 1T\i Ally/I cA9 CERTIFICATION # 0_0_12
1VELL CONTRACTOR COMPANY NAME [T i^[RYH W /L� /+r� j%�'r�lJ PHONE # 1c2211 Y 79-@el/
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
I. WELL USE (Check Applicable Box): Residential lal Municipal/Public 0 Industrial ❑ Agricultural ❑
Monitoring ❑ Recovery ❑ Heat Pump Water Injection 0 Other 0 If Other, List Use
R0l,%,'nSV,'Ue VC,
City or Town State
(9/a)- 6WQ-SQO�s
Area code- Phone number
4. DATE DRILLED 9-23-cq
5. TOTAL DEPTH: fOS
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO LEI
7. STATIC WATER LEVEL Below Top of Casing: 3'10 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS / FT. Above Land Surface*
'Top of casing terminated at/or below land surface requires a
variance in accordance with ISA NCAC 2C .0118.
9. YIELD (gpm): / METHOD OF TEST 0. i /'
10. WATER ZONES (depth): 366-
I I. DISINFECTION: Type ft%# Amount tl./aS
Wall Thickness
2. WELL LOCATION:
Nearest Town: Rob lii' n IA /JP County �r ei..y')
al/ rr,s R4 .9g77I
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: Icon 1-tW%4 sn l
Address 5, // e r,S/7 -A.
(Street or Route No.)
2fr7? /
Zip Code
12. CASING:
Depth Diameter
From n To //Iln Ft.
From To Ft.
From To Ft.
or Weight/Ft. Material
cnra% Pvc
13. GROUT: Depth Material
From 0 To ID FL C MPnt
From To Ft.
14. SCREEN: Depth Diameter
From To Ft. in.
From To Ft. in.
15. SAND/GRAVEL PACK:
Depth
To
From Ft.
From To Ft.
Slot Size
in.
in.
Topographic/Land setting
❑Ridge 0Slope ❑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
tr.s
7.1
o �n
n
o fly.—
'0C
7O 0
73
LOCATION SKETCH cO Cr."'0
Show direction and distance in miles from at I t Q
e3s n.z
two State Roads or County Roads. Include thetad o
ntgnbers and common road names. C?
roM 74 i /113 d Q Fr T.Ke Fs c6--a
m,rles Turn le -PT -on 13; /l cr,'s
V ethod
PRd- GO, clog Pit'/t /Urn RIahT
on &Tr;or,Or, 6-0. 0,1 reh le
Turn IePr Go 7 tarok 04" RoaA-
Material
Size Material
3029`73
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
rePI 1-1yrle 9-aa-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-1 REV. 07/2001

3029'7 4
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural
Resourcese- Div sion of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) // cl eoP // y(a� P / CERTIFICATION _
WELL CONTRACTOR COMPANY NAME �r O(.J1a /n t,.✓f'7// .4 e:/ /, YL q PHONE ft OW 4179—Er4.i9
STATE WELL CONSTRUCTION PERMITS( ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
I. WELL USE (Check Applicable Box): Residential ($ Municipal/Public ❑ Industrial ❑ Agricultural El
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use
2. WELL LOCATION:
Nearest Town:
c0iP C
(Street Name, Numbers, Community,mSubdivision, Lot No., Zip Code)
3. OWNER: tJC Roynev
Address Gn/f Coarse tra
County Grex htt ni
,7 (Street or Route No.)
Rd Lht`nfv.7/f.' A/.!. fl77/
City or Town State Zip Code
(gas)- 11/9-339/
Area code- Phone number
4. DATE DRILLED q- 7-6L1
5. TOTAL DEPTH: .5"a8
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO N.
7. STATIC WATER LEVEL Below Top of Casing: a 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): H METHOD OF TEST 0- g (
10. WATER ZONES (depth): 31,6
I I. DISINFECTION: Type
12. CASING:
Depth
From 0 To SS? Ft.
From To Ft.
From To Ft.
13. GROUT: Depth
From 0 To ao
From To
14. SCREEN: Depth
From To
From To
15. SAND/GRAVEL PACK:
7y
Amount d r '5 q
Wall Thickness
Diameter or Weight/Ft. Material
6l SnrAi Piet
Material Method
Ft. Can[7 ranT ! enc.,n
Ft.
Diameter Slot Size Material
Ft. in. in.
Ft. in. in.
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 DRILLING LOG
From To Formation Description
LOCATION SKETCH GO 2C
Show direction and distance in miles from at lea*..j rrn
two State Roads or County Roads. Include the roar n
n tubers and common road names.
Ora yvr ---rfr / />3 d-(2.9 Turn Rt'h r
on 12311(7=o 31m.'/es Turn RIghr
on 6-017- Course RoL, —urn le -PT
G-o. o.)m:IP %urn/e-FT
O loY To well .
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
.i, 1/401 9- 2.7-01/
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 r�
(INDIVIDUAL)NAME (print) !4 'YP /�'r/ylJll CERTIFICATION #oriDV l/
WELL CONTRACTOR mil arm LJ,o // Art /j, I7!% PHONE # 84.£S4 4/7?-94/5".
WELL CONTRACTOR COMPANY NAME _
STATE WELL CONSTRUCTION PERMIT#
(if applicable)
ASSOCIATED WQ PERMIT('
(if applicable)
I. WELL USE (Check Applicable Box): Residential 2 Municipal/Public-❑ Industrial 0 Agricultural ❑
Monitoring ❑ Recovery 0 Heat Pump Water Injection ❑ Other ❑ If Other, List Use
2. WELL LOCATIN: //
Nearest Town: nhh;nS(r,'I/O County6-raiia-h4
�u 6- p 2f771
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: Le, rfr y it/iren
Address 1 X u (Th.?
Rol, %Il
o 1/, 6 n51/1'11E3 111C, '771
City or Town State Zip Code
(SW- 926- 7so3
Area code- Phone number
4. DATE DRILLED 9- Otte
5. TOTAL DEPTH: ate)
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO
7. STATIC WATER LEVEL Below Top of Casing: IOC FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS J FT. Above Land Surface'
'Top of casing terminated at/or below land surface requires a
variance In accordance with ISA NCAC 2C .0118. -
9. YIELD (gpm): 1 U METHOD OF TEST A t d`
10. WATER ZONES (depth): / 'O
(Street r Route No.)
11. DISINFECTION: Type /-/ 7 f%
12. CASING:
Depth Diameter
From_ To Lia Ft. /___
From To Ft.
From To Ft.
Amount ®. 31-
Wall Thickness
or Weight/Ft. Material
sor2l PVC
13. GROUT: Depth Material
From /) To 10 Ft. CerenT
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
Porn p"ng
Slot Size Material
in.
in.
Material
302915
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
O
LOCATION SKETCH Iv
Show direction and distance in miles from at leapt
two State Roads or County Roads. Include the road
ny&nbers and common road names.
+ron'1 2 /7 lag cf-Jy3 Take la9M
Go /,y miles Tvrn 1e4Y on.
/YlAS5Cy )Jreunc/1 Ro(, GO 32mt'h
Turn r1r,)T"i an 5not/b,'rd1I ReX.
G-o m/tees Turn /e/'Ton tU
G0,1) Rot, Go miler Tpn
O,y/p-h'/e To /oT
Well on /e]T
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
P-fi /1/d e
SIGNATURE OF PERSONCONSTRUCTING 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 - Divisi n of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print)/i e#/ t4i4N CERTIFICATION# a�L1SU
WELL CONTRACTOR COMPANY NAME fY7Path ..rr7 t✓Nll ,4%r trl-snot/ PHONE # (Tali 2179— Vvicy
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT*
(if applicable) (if applicable)
o2n5
I. WELL USE (Check Applicable Box): Residential 114 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: I
Nearest Town: Obbi 5L'r,l/P CountyC-rc&to hat
;Rh r sp/,vn � Fr asr7 71
(Stree ame, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: CYG- rr / Si✓1. ''T/1
Address N/gir7 speneLEir
(Street or Route No.)
&Li, ;PS VOh, A%,r. 72.77
City or Town State Zip Code
(SC.& Rfl—
Area code- Phone number
4. DATE DRILLED 1— 9— d 'l
5. TOTAL DEPTH: For
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)
8. TOP OF CASING IS j 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): p METHOD OF TEST U
10. WATER ZONES (depth): o
11. DISINFECTION: Type o
12. CASING:
Depth Diameter
From_C To 7,5- Ft.ip_te _
From To Ft.
From To Ft.
Amount U
Wall Thickness
or Weight/Ft. Material
,S,Br21 Pvc-
13. GROUT: Depth Material
From a To 'a,A Ft. Geatrie-Wr
From To Ft.
14. SCREEN: Depth Diameter Slot Size
From To Ft. in. in.
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft. 1
16. REMARKS: 1.4P1/ re be /Iyen 7ro,c%turf
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
a tc
O x.
LOCATION SKETCH ' 0
Show direction and distance in miles from at least t '�
two State Roads or County Roads. Include the road
nymbers and common road names.
rem .&iT )a96- iy6- make /4j3E
Method �CJ 2.'1 rn,rles %vrn R/dyiTon
fill mP,nar O/cl SWetrWat-TN in i etch
6.0. 0,3 yn,'/e Torn le4`7-on
h:yh S f chcl er 1Qoc, j 6o /4.
in,xles —7 /.✓a/1 on R/61h7-.
Material
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
SIGN RE OF PEttSO CONSTRUCTING THE WELL DATE
9-i-oty
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Centeri_- Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-tREV: 07/2001

3029"
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) Q ? jyck e CERTIFICATION # afiCo
WELL CONTRACTOR COMPANY NAME U ho,Aes- in %.VFal/ °kr,'11?njj PHONE #Eal w79—p4( q
STATE WELL CONSTRUCTION PERMIT(' ASSOCIATED WQ PERMITL#Y
(if applicable) (if applicable)
I. WELL USE (Check Applicable Box): Residential 14 Municipal/Public ❑ Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION:
Nearest Town: R 1)h,SVr1/cd County 6%'ei.hai»
a rock Nero cX 527 I
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: /Ylo.rvY ipepp
Address cirri k Nesei,
(Street or Route No.)
Ro6ro iirisy,'//p Wc. as,-771
City or Town State
(tCC0- S93-3/7/
Area code- Phone number
4. DATE DRILLED 5l — 7 —Oil
5. TOTAL DEPTH: ,SOS
Zip Code
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO Dil
7. STATIC WATER LEVEL Below Top of Casing: 266 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): 26 METHOD OF TEST ch, Y
10. WATER ZONES (depth):
11. DISINFECTION: Type NThe Amount C7.R(<
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
From () To e/k FLU __ 6nraJ PVc
Ft.
From To
To
13. GROUT: Depth
From O To dO
From Ft.
Material
Ft. (',otnE'n7
From To Ft.
14. SCREEN: Depth Diameter
From To Ft. in.
From To Ft. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
Topographic/Land setting
❑Ridge ❑Slope OValley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From To Formation Description
cnra
S _4Z
LOCATION SKETCH O aG
Show direction and distance in miles from at left 010
rn
two State Roads or County Roads. Include the ran n
numbers and common road names.
ram T /29 of 193 Take 1,9 w T
Red 1,67hr onol Torn
Pvm101' /o STo/c) S,gN %rrrn Ie4T,
GD o,`/. 7Y/,'/a 72'rn /6141/4T arl
Snow "A Roaok Go 1,3 /11 r'/Ns
Torn 16)7T on c&Toc., Rou,J
Method
Slot Size Material
in.
in.
Go 6:3 nn,'/es T &de)l on
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
�) e M l e
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

0292
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources'/ - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) //J t ?yAe CERTIFICATION# Dk.7,52)
WELL CONTRACTOR COMPANY NAME G ra Yt6..i9'I l-ele// l71 dine PHONE # (nF)1/79— 14,15—I
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
I. WELL USE (Check Applicable Box): Residential lirj 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: RObk i its i/ /l/B County 6ro lia WI
"TA bbtu" n 13rcentk .2$'771
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER:7rr,rr Vares
Address Tntihayeo Ero,nrin
(Street or Route No.)
Rnlb;nsti;/le nu, aa77!
Zip Code
City or Town State
(vast)- I-179 -
Area code- Phone number
4. DATE DRILLED 9-aI-6y
5. TOTAL DEPTH: 90C
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO CI
7. STATIC WATER LEVEL Below Top of Casing: 8'O FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS ! FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordance with ISA NCAC 2C .0118.
9. YIELD (gpm): .4 METHOD9F TEST Ora r
10. WATER ZONES (depth): 723
I I. DISINFECTION: Type
12. CASING:
Depth
From n To 122
HTH
From To
From To
13. GROUT: Depth
From O To aO
From To
14. SCREEN: Depth
From To
From To
15. SAND/GRAVEL PACK:
Depth
To
To
From
From
16. REMARKS:
Diameter
Ft. 6 4
Ft.
Ft.
Amount 0a130
Wall Thickness
or Weight/Ft. Material
snral Pvc-
Material
Ft. G,0menT
Ft.
Diameter
Ft. in.
Ft. in.
Ft.
Ft.
Method
PVrapt rnc$
Slot Size Material
in.
in.
Size Material
Topographic/Land setting
❑Ridge ❑Slope ❑Valley DFlat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From To Formation Description
LOCATION SKETCH
Show direction and distance in miles from at le_sl
two State Roads or County Roads. Include the 1pd
n tubers and common road
on AgNG0 m 3,7,'les Turn lS7
O) Thbba.cco Branch RA Go.
/ m,'l7 Turn >e±r on Qouble
Spr;no Go, o,Sm,r/e Turn
R 19 h r «o 723 en cL 01' Ra c,.d
well on le- T<
ames.
Po Turn R9h r
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 1-/ A p `- 9,1-01-1
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center -Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-I REV. 07/2001

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
71
WELL CONTRACTOR (INDIVIDUAL) NAME /(print) �P i !Y CERTIFICATION ii 0
(l
WELL CONTRACTOR COMPANY NAME l T ers /In n, L✓/)/I Q, r"' 1 ''I10
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WO PERMIT#
(if applicable)
(if applicable)
3029'73
PHONE # *414 79`gy
-w
I. WELL USE (Check Applicable Box): Residential 51 Municipal/Public❑ Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other ❑ If Other, List Use
2. WELL LOCATION: �
NearestTown:%CObht nSVr'l1P County /r'rcJ,'.yr1
Ba' crisp RA 3Vf77/
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: /CPO Ua%n,ncAA I
Address 45.i // e rip Rt)
(Street or Route No.) Rp�,�lt'nsv'l/d ilr, QS-77 /
City or Town State Zip Code
(9/a)- ‘?Q —6.-QO9
Area code- Phone number
4. DATE DRILLED 9-23-ro
5. TOTAL DEPTH: GOS
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO IX
7. STATIC WATER LEVEL Below Top of Casing: I'/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): METHOD OF TEST 0. i r
10. WATER ZONES (depth): 3 6S
11. DISINFECTION: Type %/%fib
12. CASING:
Depth Diameter
From-Q_To /n/n Ft._fo _ Snr21 PVc
From To Ft.
From To Ft.
Amount 0.6C
Wall Thickness
or Weight/Ft. Material
13. GROUT: Depth Material
From_To at FL Cotnrnt
From To Ft.
14. SCREEN: Depth Diameter
From To Ft. in.
From To Ft. in.
15. SAND/GRAVEL PACK:
Depth
From To Ft.
From To Ft.
Topographic/Land setting
DRidge ❑Slope ❑Valley DFlat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From To Formation Description
Method
Pv rn p, n
ty
9
CD d7.0
ill
riT
C .G
-on
t '7O
LOCATION SKETCH GO oa
Show direction and distance in miles from at 19st ter`
two State Roads or County Roads. Include the'ad oT
n bers and common road names. O
ro1✓I 7-n- /113 d- `ot Fr Takpir.a8 G-o
m,'/es Turn /e-Fron t3;//crf's/
Rd- 60, va »7,'/e Turn Ri$hT
Poxr;or Or, Go . o,/ p-i,`le
Slot Size Material
in. Turn eh- co To enc o-� Ramat -
Slot
in.
Size Material
16. REMARKS:
on
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
TeP Aiyote 9—a3—ote
SIGNATURE OF PERSOlg 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

30291 A
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Naturall esResources - Div lion of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) / c/ et T !74/ j.4 CERTIFICATION#020, Sei
WELL CONTRACTOR COMPANY NAME �rodtam &-J -' i AYis/li.j'2 G9 PHONE # (R,£4)4f77— ?4,C9
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED wQ PERMIT#
(if applicable) (if applicable)
I. WELL USE (Check Applicable Box): Residential Z Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery ❑ Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATIN: II
Nearest Town: Rp66t nSU'lie County (T-rnhayn
CTriblCornrse Re
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: LADRe-dyne,-
Address Gnif Conrse Ra.
.�7 (Street or Route No.)
RDhd»'rsv'UN A/.r. 2ir77/
City or Town State Zip Code
(E2g)- Ll77-339/
Area code- Phone number
4. DATE DRILLED q-07-6y
5. TOTAL DEPTH: SCO
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO St
7. STATIC WATER LEVEL Below Top of Casing: ant.) 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 I5A NCAC 2C .0118.
9. YIELD (gpm): LI METHOD OF TEST Os /4 ►'
10. WATER ZONES (depth): 36
11. DISINFECTION: Type H 7 /1
12. CASING:
From 0
From
From
13. GROUT:
From O
From To Ft.
14. SCREEN: Depth Diameter
From To Ft. in.
From To Ft. in.
15. SAND/GRAVEL PACK:
Depth
From To
From To
Amount h r ei ij
Wall Thickness
Depth Diameter or Weight/Ft. Material
To 6-cf Ft 6-1-4 5nra1 P V c
To Ft.
To Ft.
Depth Material Method
To ao Ft. Cam Pnr PO kni0,
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
t'
0
CO
LOCATION SKETCH
Show direction and distance in miles from at lead
two State Roads or County Roads. Include the roar
numbers and common road names.
ran znT /93 d-12.9 Turn RtoghT
on 1ayi6=o 31m,'Yec Turn R,ghr
vn 6-014" Course 1Zck, %ut n e-PT
Slot Size Material Go . Oil ni ; 10 Turn l e -PY
in. kid( in. v n /c'_ ( T kid ( r
Size Material
Ft.
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
Use Nyoro
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
9- 27-av
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 R@sources - Division of Water Quality - Groundwater Section
7T` //yl/lltdl
WELL CONTRACTOR COMPANY NAME «roil aM G✓,o// !TF^, i/ ,I7G
WELL CONTRACTOR (INDIVIDUAL) NAME (print) J..) irk
3029'75
CERTIFICATION # 9,416-4
PHONE # erica in?'9414-et
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
I. WELL USE (Check Applicable Box): Residential 2 Municipal/Public ❑ Industrial 0 Agricultural 0
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use
2. WELL LOCATI N: Nearest Town: Neik1in5(trt/lP County Graf -lair,
6V .p Rei ag7Z!
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: Lg ) 4n Inl/Skin
v Address I (y%p R
AA�� I 6 11 (Street or Route No.)
Lid �j; n 1�rtllN Wc, 2 77
City or Town State Zip Code
($ )- 906- 7So3
Area code- Phone number
4. DATE DRILLED 9- Q C)9
5. TOTAL DEPTH: a S o
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO MI
7. STATIC WATER LEVEL Below Top of Casing: HBO FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS J FT. Above Land Surface'
*Top of casing terminated at/or below land surface requires a
variance in accordance(� with ISA NCAC 2C .0118.
9. YIELD (gpm): 1 d.r METHOD OF TEST O. r P
10. WATER ZONES (depth):
I I. DISINFECTION: Type
12. CASING:
Depth Diameter
From_ To 92,
From To Ft.
From To Ft.
13. GROUT: Depth Material
From 0 To ao FL C.e'/rwnr
Topographic/Land setting
ORidge OSlope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From To Formation Description
Amount f9. 3 `l
Wall Thickness
or Weight/Ft. Material
Car21 Pvc
From To
14. SCREEN: Depth Diameter
From To Ft. in.
From To Ft. in
15. SAND/GRAVEL PACK:
Depth Size
From To Ft.
7/71
From To Ft.
16. REMARKS:
LOCATION SKETCH tJ
Show direction and distance in miles from at leaf
two State Roads or County Roads. Include the road
an
ommon road
s.
n- ro!'✓Ido�11T /29e-4y3 Tke /29N
mdes Tarn let on.
Massey Ijranchi Rd. 6To 3,2�1,/,
Ft.
Slot Size Material 7 'rn reir % o n snotibi'rclRJ%
in.
in. 6o [�In,Yes Turn IetTon ZU
Material tr4.P Ro , lT0 miles %vrn
�I h Go, o, q, ,'/e To /o r
Weil on /e Tr
Method
Pum pi')w
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
� �.,t ;J A 9- ads -off
SIGNATURE OF PERSOCONSTRUCTING 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
I0
n

zo2966
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources /- Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME ((pprint) V2? I /i`VCe CERTIFICATION #d�cG
WELL CONTRACTOR COMPANY NAME CI-f-VA AA it F�/a Aria /f/ In, PHONE #
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#G
(if applicable) (if applicable)
I. WELL USE (Check Applicable Box): Residential Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection ❑ Other 0 If Other, List Use
2. WELL LOCATION: Q.1
m o.
Nearest Town: R 11h,� V,ll� County ijfecdiToO� Recce 5771
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: l✓io..ry /oe P p
Address 4l76 r7lA
(Street or Route No.)
Rnbbsinsy ll.t n/•r
a--771
City or Town State Zip Code
(Rfb)- Sf93 -3/7/
Area code- Phone number
4. DATE DRILLED 2— 7-oil
5. TOTAL DEPTH: .SO.S
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO Di
7. STATIC WATER LEVEL Below Top of Casing: 266 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.
METHOD OF TEST G., r
10. WATER ZONES (depth): 30 C
9. YIELD (gpm): 26
11. DISINFECTION: Type
12. CASING:
Depth
From O To yk
From To
From To
13. GROUT: Depth
From r) To ao
From To Ft.
H T /f Amount 0.:1r
Wall Thickness
Diameter or Weight/Ft. Material
Ft. to-4 6nral Pvt.
Ft.
Ft.
Material Method
Ft, r:,onle»7 pvm/04
Topographic/Land setting
❑Ridge ❑Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From To Formation Description
LOCATION SKETCH S
Show direction and distance in miles from at lei
two State Roads or County Roads. Include the raid
n mbers and common road names.
Ton. T /al el- /93 Take l ag m T
Red l,.hr0.noi Torn lt;,hT Go
76 STo, s,ciN Trn /&'r -
GD 0,Y. Iyi,'1e Tarn %4 T �n
snow b,rof Rootol Go /,3 IN),'Yes
ir�rn 16-)J"T on 0.Tact. rioa.cn ,
Go 5.3m,./es T (,.ie)( on
16. REMARKS:
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.
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH ISA NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 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-gDiivisi n of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) Y,o"Eso/-1`�/G�f1 CERTIFICATION #o1L7sCJ
W//1 WELL CONTRACTOR COMPANY NAME (Y re J-1 a. »7 tJ,o // e4, i l/, incx9 PHONE # (72'0 H79_V.H.ry
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
I. WELL USE (Check Applicable Box): Residential 6a Municipal/Public ❑ Industrial ❑ Agricultural ❑
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use
2. WELL LOCATIQN:
Nearest Town: ] O14;ryS U,'Ile County C—re, hetavt
hl qbr SlolNnal F" 1ff-77/
(StreetName, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: CO -is / sm,'rh
Address N'hT .f p1 en�.E.f
(Street or Route No.)
Rebi-„rrs //,o A/IC, .2, 771
City or Town State Zip Code
( s33 - 6gsg 9
Area code- Phone number
4. DATE DRILLED y— 9— o Li
5. TOTAL DEPTH: ErdS
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO 2
7. STATIC WATER LEVEL Below Top of Casing: 6 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS / FT. Above Land Surface'
'Top of casing terminated at/or below land surface requires a
variance in accordance with 1SA NCAC 2C .0118.
9. YIELD (gpm): n METHOD OF TEST C'
10. WATER ZONES (depth): o
11. DISINFECTION: Type o
12. CASING:
Depth Diameter
From0 To 75
From To Ft.
From To Ft.
13. GROUT: Depth
From_a_ To aA Ft
From To Ft.
Amount U
Wall Thickness
or Weight/Ft. Material
,sjrai Atic
Material an Method
C°tnen7 Pemp,',19
14. SCREEN: Depth Diameter
From To Ft. in.
From To Ft. in.
15. SAND/GRAVEL PACK:
Depth
From To Ft.
From To Ft.
Size
Slot Size Material
in.
in.
Material
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
V
Ott
✓ *T
—4
-OO
-
▪ a
3 - 3 if,
rye
Show direction and distance in miles from at least ay —
two `�
State Roads or County Roads. Include the road
nymbers and common road names.
LOCATION SKETCH
roll-i .-/)T m96- 14/6- Take /L/3E
old
/ m,r/F5 Turn Rl1h i o n
ole( Slue ertJ'0./er I?o0.ei.
d o, 0,3 1n,'/e Torn le h- n
Ih%beh s pienJ9r 120c,c( 6o /,,..
m,'les 7; 6,7ed on R,'61h7"
.
16. REMARKS: to l / % be /iyeAr0 "Lc it v f
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

304282
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Dvision of Water Quality - Groundwater Section
e WELL CONTRACTOR (INDIVIDUAL) NAME (print) y e CERTIFICATION # 2OSo
WELL CONTRACTOR COMPANY NAME G re.. 0.47) LA.) ell air t' l',inl, PHONE # (c1f4479'6-ff
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential Municipal/Public ❑ Industrial ❑ Agricultural ❑
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use
2. WELL LOCATION: /� 11
Nearest Town: Rp l,b i n 5 it f' l �A County 6.f^ailA. h'1
cSamF re,vP 277/
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: /I1'r b sanekerS
Address 'ct-wie rmttf,°
(Street or Route No.)
o b i j-LS be /l e 'Vt 77 it
City or Town State Zip Code
Area code- Phone number
4. DATE DRILLED /O - /4-O v
5. TOTAL DEPTH: /&O
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO Dil
7. STATIC WATER LEVEL Below Top of Casing: •sC FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS / FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordan with 15A NCAC 2C .0118. 9. YIELD (gpm): METHOD OF TEST air
10. WATER ZONES (depth): /2 5-
1 I. DISINFECTION: Type /f %/if Amount v . 0
Topographic/Land setting
❑Ridge ❑Slope OValley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From To Formation Description
q? --
LOCATION SKETCH dr
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. atenal numbers and common road names.
From_t) To 5-7 Ft. 6 5nr,Qj V _ -From hT /93 ,-.2Fs Take 2S N
From To Ft.
From To Ft.
13. GROUT: Depth Material
From To 2.0 Ft. Ce Menfj
From To Ft.
14. SCREEN: Depth Diameter
From To Ft. in.
Go 'Zt7mj7/es Tarn/6-'71'T an
d
PMetinetho! upper Tit5/Ceoaee Go, o.°'»1//es
mptiv
Turn/e?Ton South Antic 6-0
p„sm,'/e `Tvrn NisgMT on Sa.mc
Cove Raffia 6-0, o. 1a n- 'Ye id
t✓e/I on Rishr:
Slot Size Material
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 CONSTRUC l ED IN ACCORDANCE WITH I5A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF HlS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
}� e /4 _/9 o4
SIGNATURE OF PER ON CONSTRUCTING THE WELL DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh;, NC
27699-1636 Phone No. [phone], within 30 days. GW-1 REV. 07/2001

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural
esources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME/ (print) 1�PJ-T l/yAen CERTIFICATION#
WELL CONTRACTOR COMPANY NAME Crl^aL17 as in./0II eJ1 Nt'I J. h(a PHONE # p tS)Vn-fsr/.Si%
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
304281
I. WELL USE (Check Applicable Box): Residential IX Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCAT N: II
Nearest Town: A66 s wS V4'/IN County G-hT.N,i N?
&ajF Cove 2k771
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER:
Address
fri i`rD /1/4, e r
rhtvt'//e Scl pile COVE
(Street or Route No.)
Robb; ,7 s Uf'!/a
City or Town State Zip Code
( )-1-1 — Q5 / 7
Area code- Phone number
4. DATE DRILLED /O—/V d'/
5. TOTAL DEPTH: aO5
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO (S1
7. STATIC WATER LEVEL Below Top of Casing: CO FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS I FT. Above Land Surface'
*Top of casing terminated ator below land surface requires a
variance in accordance with ISA NCAC 2C .0118.
9. YIELD (gpm): (p METHOD OF TEST ar r
10. WATER ZONES (depth): / KC
I I. DISINFECTION: Type // TA/ Amount O.27
12. CASING: Wall Thickness
Depth
From alTo d/. 3
Diameter or Weight/Ft. Material
FL & "17 E oral pl/e.
From To Ft.
From To Ft.
13. GROUT: Depth
From_ To an
From To
14. SCREEN: Depth Diameter
From To Ft. in.
From To Ft. in.
15. SAND/GRAVEL PACK:
Depth
From To
From To
Material Method
Ft. Cer?en-r 1VS1pLiu Upper MsA-ewe& 6-0, 0.7 Pei, le S
Ft.
Topographic/Land setting
❑Ridge ❑Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From To Formation Description
LOCATION SKETCH r
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
ntmbers and common road names.
tt-
r?
[cam
Slot Size Material
in.
in.
Size Material
Ft.
Ft.
tom -x#r /4'3 9Le 7ake Q5-IV
Go. 02,7 inNes 7rnr to To n
%Urr? /eP%on Saoi), orK7r-o
le "Mtn r n scone
Cove RoJ Go, o,L male To
&Jtl/ on le-hT,
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
P
/I,,
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. G W-1 REV. 07/2001
N.,

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) P CERTIFICATION #ci6cn2)
WELL CONTRACTOR COMPANY NAME Gt-'.h0.rn td#/% ate ii. Ina PHONE # Iffps)U79-kv5'tj
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
304280
1. WELL USE (Check Applicable Box): Residential al Municipal/Public ❑ Industrial ❑ Agricultural ❑
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use
2. WELL LOCATINII�:
d r
Nearest Town: 'L2n S ir. //P County Crrntinekni
,c4,.y ben pet-) 2&77I
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: rbn..r/, er7 :5J1 U/Nr
Address CA x/ km nal
(Street or Route No.)
Ro6br'»sar;iiP iW 1771
City or Town State Zip Code
(12c )- 479 -
Area code- Phone number
4. DATE DRILLED Jet —/a —6 y
5. TOTAL DEPTH: *C
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO IR
7. STATIC WATER LEVEL Below Top of Casing: 76 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 I5A NCAC 2C .0118.
9. YIELD (gpm): 9 METHOD OF TEST a 1r
10. WATER ZONES (depth): .335
I I. DISINFECTION: Type 87 f%
12. CASING:
Depth ,Diameter
From 0 To kJC Ft. __
From To Ft.
From To Ft.
13. GROUT: Depth
From_C To ao
From To Ft.
Amount n.66
Wall Thickness
or Weight/Ft. Material
gnr21 PSG
Material
Ft. cc. fn<nT
Method
Plitt y) 'rg
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 DFlat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From To Formation Description
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
nl abers and common road names.
To 3 octch Ra0.4 (,-6- v. 3 P V /e
T s7y' s%reeogAT %S1reg
axvo5i7h f Cooky branch Rea
Go , a. i no,'/P Tvrn /e T To
Wet/ vh /e47.
,
F
cP
16. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH I 5A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
314P /-4ycke lo-/3-641
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-I636 Phone No. [phone], within 30 days. GW-1 REV. 07/2001:

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Reesource�s/- D' ision of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) rl C- %$v4 e ) CERTIFICATION is c,�
WELL CONTRACTOR COMPANY NAME G-r rA.N'n 1-,)e11 �i^srtlono(�Sj PHONE #t y 77 cri/54
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMITT#�
(if applicable) (if applicable)
I. WELL USE (Check Applicable Box): Residential ® Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring ❑ Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION:
Nearest Town: Robb, n,$v,1/i' County a itheCYn
&2JP@ ro tiak77i
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: kes'7h C#,'sp
Address me Co//to
(Sweet or Route No.)
R0661f1SVe%/e NG ea a 7 7
City or Town State Zip Code
)- 417q- bye
Area code- Phone number
4. DATE DRILLED hi— 21-a q
5. TOTAL DEPTH: 26Z5
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO
7. STATIC WATER LEVEL Below Top of Casing: (p 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 accordancep with 15A NCAC 2C .0118.
9. YIELD (gpm): to METHOD OF TEST ex.., r
10. WATER ZONES (depth): / QtS
11. DISINFECTION: Type hire/ Amount 0. 3....r
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
From (`.+ To fl Ft. 6 j /9PSr .Shoe)
From To Ft.
From To Ft.
13. GROUT: Depth Material Method
From r) To .10 Ft. Cerrie' T SaIrechjad
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 DRILLING LOG
From To Formation Description
3(14284
r9
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
n mbers and common road names.
rorl Zni I1/3J-r15'Tke62S-a
Go , (9,,7ri 7es %Ur/7 1e4Ton
'upper 72skeace G-o D,�ri,'/e
'Men loihr on Saud; 7k3r/c
6-c c,5m/11e %vrn Rfo4%T
o i) Sump Cove Olel/ on
R/;9h7,
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
/O- 2i-r7y
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
U6'4' b
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

304285
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print)�+tale# flyA ep CERTIFICATION #.2OSd
WELL CONTRACTOR COMPANY NAME Gr0. ho.p4 L idI C7l.r+ II I'k15 PHONE # f,428) 479-5;-4,Y9
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
I. WELL USE (Check Applicable Box): Residential 2 Municipal/Public ❑ Industrial 0 Agricultural 0
Monitoring ❑ Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION::1
Nearest Town: RAS7hiriS i//P County-r,-J10..1t1
WA/re Gn.k 2$r77/
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: 1—P?Y- CO-bF
Address l.1h,'i' Auk
(Street or Route No.)
Robb1n5vale Mr. 2,277 f
City or Town State Zip Code
(14.-Se - 1/79— >7ao
Area code- Phone number
4. DATE DRILLED /o—nN
5. TOTAL DEPTH: ID,C
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO RI
7. STATIC WATER LEVEL Below Top of Casing: </o FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS / FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordance with ISA NCAC 2C .0118.
9. YIELD (gpm): an METHOD OF TEST G. i r
10. WATER ZONES (depth):
6.5"
11. DISINFECTION: Type , rf/ Amount et . //
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
From 0 To �/7 Ft. 44 Enra.i Pit
From To Ft.
From To Ft.
13. GROUT: Depth Material Method
From cD To 20 Ft. r,orncny PUer pin,g
From To Ft.
14. SCREEN: Depth Diameter Slot Size
From To Ft. in. in.
From To Ft. in. in.
Topographic/Land setting
❑Ridge ❑Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From To Formation Description
C c?
u> n
LOCATION SKETCH c
4�
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
n mbers and common road names.
2/77.- 8d-/4'3 'aka, a.&W G0
/,/e Trn on /oif/F'r 3ctwyer5
Cre,1C Go . a,:Z /rf,'/Ns Tarn )4'2
Material en tuh/re Oak f)OAGI &ro /intk
T OJe!! on I071 j,
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 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 P ources - Divisio of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (prior)r.)P Pram/ a4'ycX e CERTIFICATION /�[J O
WELL CONTRACTOR COMPANY NAME Pa, ha. HI arl P// Qy vt Ili 'nog PHONNEr jyzsr1 N77- -eyrq
STATE WELL CONSTRUCTION PERMIT! ASSOCIATED WQ PERMIT!
(if applicable) (if applicable)
29`_695
I. WELL USE (Check Applicable Box): Residential Ei Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery ❑ Heat Pump Water Injection ° Other If Other, List Use
2. WELL LOCATIONJ://
Nearest Town: Atibbtlt5v;/We County 6:ra hatn
laUfir So.l✓y,rrs Creek
(Street Name, Numbers, Community, Subdivision? ton Re-. Zip Code)
3. OWNER: Ucrry/ (. 7, //,rum 5
Address /o (,le r 5A_w ,ors <'rppk
(Street or Route/NNo.)
�e.I-th,nsJAI //t NG. 2277/
City or Town State Zip Code
(820- 4)7, - 3 A't
Area rode- Phone number
4. DATE DRILLED /-2tp9
5. TOTAL DEPTH: 56.5
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO 51
7. STATIC WATER LEVEL Below Top of Casing 1(1/45- Fr.
Nu "e' If Above Top of Cooing)
8. TOP OF CASING IS / Fr. Above Land Surfame•
Top of easing terminated odor below bad wrfate requires a
variance in accordance with ISA NCAC at .ot ta.
9. YIELD (gpm): / I METHOD OF TEST (7.. : r
10. WATER ZONES (depth): C
11. DISINFECTION. Type }I-T H Amount (T, 7S
I2. CASINO: Wall Thickness
Depth Diaolctcr or Weight/Ft. Material
From l) To //7 Ft./2 SAra.) Pvc
From To Ft.
From To FL
13. GROUT: Depth Material Method
From n To aQ Ft CeMen7 Piimy0tln tc
From To Ft. c�
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
ORidge °Slope °Valley °Flat
ow& approprime Mx)
Latitude/longitude of welt location
(deyeesrmimaWueoodr)
Latitude/longitude source: 0OPSCITopographic map
(cheek boa)
DEPTH DRILLING LOG
From To Formation Description
to
ono
ern
(ACATLON SKETCH rr��tyx
Show direction and distance in miles from at let ern -
two State Roads or County Roads. Include theNd --i
n tubers un and cenon road names. _ z
4rorfrl iohnsar Gap =r 72r5ect 'n
/1-1,3cva GQ5- lake a& north Gci
J,/ in,"/Lesit kWer SUtoyerS creN4'
gh G6 a. t m/ /es 7a ,44),..7.6,
Oo�.If k lQt Il rJnIe�T / /iarrc/
sT ,
vCDaa`
6„ >e-frro- o,4-) )4-)//es 7a kJ 7-
Liell on /E'i7,
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
OF Phttg(XNVSfRUGTti THE
WELL
IGNATURE DATE
Submit the original to the Division of Water Quality, Groundwater Section, t636 Moil Service CortyyzRltteiglr,NC----
22699-1636 Phone No. [phone]. within 30 days. (`tW-9 ftEV. 07/2001

WELL CONSTRUCTION RECORD
292692
North Carolina - Department of Environment and Naltm�rt (Rcsy outces - Divt ion of Water Quality Groundwater Section
WELL COATRACrOR (INDIVIDUAL) NAME (print) JE'7 Ttr/ l7 ! f CERTIFICATION. Qn-C6
WELL. CONTRACTOR COMPANY NAME Gro. haMN WPI/ rr)l �/tCi PRONE FJ{-) en% S4-1S'rf
STATE WELL COASTRUCTION PERMIT/ ASSOCIATED WO PPERMIT#
Of applicable) (ifpplcable)
I. WELL USE (Check Applicable Box): Residential ® Municipal/Public ❑ Industrial 0 Agricultural ❑
Monitoring Recovery 0 Heat Pump Water Injection Other 0 IF Other, List Use
2. WELL LOCATI N:
Nearest Town: Nobli n 5 v,7/? County Gra ho.Irl
fahcrea .3'rancA Rc( ,9 g>7!
(Street Name. Numbers, Ceamunity. Subdivision, lm No.. Zip Code)
3. OWNER: ROber7- Si 'rip Son
Address Thacco Bra.nth Rd
(Sheer a Route No.)
Roh) ,'nsv,%/e
City or Tan State
(Sas)-W77 19) 2
Area code- Phone number
4. DATE DRILLED /—/S—c"i
5. TOTAL DEPTH: 60_5—
PS77I
Zip Code
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO lI
7. STATIC WATER LEVEL Below Top of Casing l oG FT.
(Use 'r if Above Top ofCasing)
8. TOP OF CASING IS / Ft Above Land Surface*
sTap among terminated attar below land seine requires •
variance in accordance woe I3A NCAC 2C .011a.
9. YIELD (gpm): a METHOD OF TEST O. t'r
10. WATER ZONES (depth): L/ q 6
I I. DISINFECTION. Type 45T l-1 Amount 0. k9
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
From / To /t%.z Ft ( / SOr at AVC
From To Ft.
From To FL
13. GROUT: Depth
From / To 2,0 Ft.
From To Ft.
14. SCREEN: Depth Diameter
. From To Ft. in.
From To Ft. in
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft
Material
CepnenT
Method
P ti vri p i r
Slot Size Material
in.
in.
Topographic/Land setting
ORidge ❑Slope [Walley OFIat
(cheek appropriate hex)
Latitude/longitude of well location
(dregasrmioumx/secends)
Latitude/longitude auuren:OGPSDTopographic map
(cheek boa)
PFPTH DRILLING LOG
From To Formation Description ;'
c `cs
r1 Cn• l,
a
pry i .ve,
Zrn
z_
vc
>m
Dv
ti�
ma
am
en
in 73
C)
c4
—i
r1 G
CS)
(1
LOCATION KETCH
Show direction and distance in miles from at least
two Slate Roads or County Roads. Include the road
numbers and common mid names.
-Pro trio.Irnon PosTo ''CTorn R,c07
on a8 N GD 3.7/n-'1es %urn /N T
On Tobacco Qremcb .
1/°Jvn )Q I$hT o✓J Tobacco /arc fCI1
C,PC) C)GO 0.3M-)esTfrrlilleiT,4 0
Ltiay we// IS Srr.01}IIAT
.head 0, l rn t'les
16 REMARIcS-
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH I SA NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
Hyde is o
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Serrice Center- Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-1 REV. 07/2001

WELL CONSTRUCTION RECORD 293109
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print)in//.tr "'etc CERTIFICATION N YO'f
WELL CONTRACTOR COMPANY NAME ,e //qr^ Well t,_Jt t\it PHONE N glen cif? Sy
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential cniunicipal/Public ❑ Industrial ❑ Agricultural ❑
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use
2. WELL LOCATIO /
Nearest Town: p64wv/4-
.SGuzr f tdolet
County 6:/447/2
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER. /t�/1/ /4n/ lt %#e,�
Address 9-I Orr'nnCXn
I 1 .
(Street or Route No.)
City or Town State Zip Code
Area code- Phone number
4. DATE DRILLED /-0i-o
5. TOTAL DEPTH: S-DO
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO F�
7. STATIC WATER LEVEL Below Top of Casing: / D FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS / FT. Above Land Surfaces
'Top of casing terminated at/or below land surface requires a
variance In accordance with ISA NCAC 2C .0119.
9. YIELD (gpm): / METHOD OF TEST / Y
10. WATER ZONES (depth): e2CO '
11. DISINFECTION: Type //r '
12. CASING:
Depth
4 Front t' To -%
From 32 To 60
From To
13. GROUT: Depth
From O Tom'
Amount &y`4.<17
Wall Thickness
Diameter or Weight/Ft. Material
Ft. G. �s- -via/ f'Vt
Ft. G Z5 ./f'6' 5J`«!
Ft.
at rial
Ft '-i% -
From To Ft.
14. SCREEN: Depth Diameter
From To Ft. in.
From To Ft. in.
15. SAND/GRAVEL PACK:
Depth Size Material
,Method
e_
Slot Size Material
in.
in.
From To Ft.
From To Ft.
Topographic/Land setting
DRidge ❑Slope OValley ❑Flat
(check appropriate box)
Latitude/longitude of well location
4131",(/:ad"' 400/3` V.?'SB,a,
(degrees/minutes/seconds)
Latitude/longitude source:L LOPS❑Topographic map
(check box)
,r/EPTI-t DRILLING 1. ..
From To Formation Dkscription
so 3-co Gi
7'-
C
v o
0 *t C •
,
LOCATION SKETCI{ rn
Show direction and distance in miles from mast
two State Roads or County Roads. 'tilde goad
numbers and common road names. co rn%
O —ni
16. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, D THAT A COPY OF TILTS RECORD HAS BEEN PROVIDED TO TILE WELL OWNER
14<0,--__ /-Of-ey
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 Phnn:ANn. [phone], within 30 days. G W-1 REV. 07/2001

WELL CONSTRUCTION RECORD 293107
North Carolina - Department of Environment and Nat/,rI Resourr5ys - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print), / /, ?'vy /teeCe- CERTIFICATION It29°3
WELL CONTRACTOR COMPANY NAME ///,//ef \\fCA) Drill, PHONE N (W2 g3 % -2PC 2
STATE WELL CONSTRUCTION PERMIT/ ASSOCIA D WQ PERMIT/
(if applicable)
1. WELL USE (Check Applicable Box): Residential I:Y.-Municipal/Public ❑ Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
(if applicable)
2. WELL LOCATIO
Nearest Town: Atha/lw,-& County triajeciA.
t/v7/tow Cie -tic
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: <Shaw/! I/elj
Address IC1 .Ae`((1An StteQ*
(Street or Route No.)
6(-)YnhmSnc
C/o Tgrr• Nr)C,Omb
City or Town State Zip Code
Area code- Phone number
4. DATE DRILLED /-/(,-bti
5. TOTAL DEPTH: .20O I
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO 1;1-"
7. STATIC WATER LEVEL Below Top of Casing: 2 D FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS / t- ti £. Ahnve land Surface
*Top of casing terminated at/or below land surface requires ■
variance In accordance with ISA NCAC IC .0118.
9. YIELD (gpm): VO METHOD OF TEST /52—Y
10. WATER ZONES (depth): / 90'
11. DISINFECTION: Type
12. CASING:
Depth
d Front_()_ To `tf
fyrf/
From To
From To
13. GROUT: _ Depth
From 0 To v7-0
Amount -4/6-/
Wall Thickness
Diameter or Weight/Ft. Material
Ft. 6-25 ,/br 51`«
Ft.
Ft.
4v1ater
Ft. �Oi
Topographic/Land setting
❑Ridge ❑Slope OValley ❑Flat
(check appropriate box)
Latitude/longitude of well location
4 as',.e€,'32 ,,1 °Y'3` 'A?
(degrees/minutes/seconds)
Latitude/longitude 5ource:UGPS❑Topographic map
(check box)
DEPTI-I DRILLING I,OQ
From To Fnrmatiott Description
b - /O
/65-,BCD
G.hte..l
c
p
co
sr'
o_
cT
^'m
m
LOCATION SKETCH
Show direction and distance in miles fr n at$ast
two State Roads or County Roads. Include thf road
numbers and common road names.
god
/r SSry 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
From To Ft.
From To Ft.
16. REMARKS:
Size Material
r
1 DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH I5A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THATCOPY 0 THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
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.
DATE

8)9rron
4.
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources/ - Q{ '
.T�vision of Water Quality - Groundwater Sectionet
WELL CONTRACTOR (INDIVIDUAL) NAME (print) -ib>c /xx/0JJ CERTIPICATIONI.2IO -27
WELL CONTRACTOR COMPANY NAME �rex ha in LJ,o// rAr, %frrt? PHONE I asp) 4'7 9-4cCr{
STATE WELL CONSTRUCTION PERMIT*/ ASSOCIATED WQ PERMIT$
(if applicable) (if applicable)
I. WELL USE (Check Applicable Box); Residential Ill Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery ❑ Heat Pump Water Injection ° Other 0 if Other, List Use
2. WELL LOCATION:
Nearest Town: Rei ns,, i //e County Chet hewn
tt/r'ST ,l, ran 2,?77/
(Street Name. Numbers. Communhy, Subdivision. Lot No.. Zip Code)
3. OWNER: 13r.o,,,, G o.)�/// in
Address WP.tr Sup e-On
(Sven a Route No.)
Rnt,b,'l,s v, i/e nit. $ S77
City or Town State Zip Code
)-4174- 9/7S
Ares woe. Phone number
4. DATE DRILLED S 2(o-0y
5. TOTAL DEPTH: ,5-0
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO la
7. STATIC WATER LEVEL Below Top of Casing: 60 FT.
(the "a' if Above Top &Cadet/
8. TOP OF CASING IS ! FT. Above Land Surface*
'Tip of cats terminated attar below land aaaraee minim a
variance I. accordance with ISA NCAC 2C .alit.
9. YIELD (gm): ti METHOD_O F TEST
10. WATER ZONES (depth). �Ir%
I I. DISINFECTION: Type
12. CASING:
Depth
From_„_ To 7 7
From To
From To
13, GROUT: Depth
From A To 9.0
From To FL
14. SCREEN: Depth Diameter
From To Ft. in
From To Ft. in.
I5. SAND/GRAVEL PACK:
Depth Size Material
if TN Amami! a.So
Wall Thickness
Diameter or Weight/FL Material
Ft. / 1- Snr&i At/c
Ft. /
Ft.
Material t{7� Method
Ft (EMPnf Pomp.' 1Q
Slot Size Material
in.
in.
From To Ft
From To Ft.
Topographic/Land setting
°Ridge ❑Slope °Valley OFIed
(check appropriate box)
Latitude/longitude of well location;
(degnedrrtiou cshmads)
Latitude/longitude source:OGPS0Topo
(then box)
DEPTH DRILLIN
From To Formation De
L-
c,
n
r
ink
LOCATION SKETCH, .-
Show direction and distance in ®ks Dom c-
-
atle+st .
two State Roads or County Roads. include the mat
fFibers and common mad names
rom tn"r lag d-14'3 Take la?"
Go 1,9 m,%s %urn /e7bT vn
Massey branch 6-o 3.2ri,'1eS Tvrn
b.' 1 RA_ Go
,'n To Scknry ,lctA
Tvrn k'1 ro n (dr,5
')es TornR,BhT ;
R ,,0hT
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
TieiP NyeA
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
5 -'2 6 - oo it
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

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural�R`agrources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) Tea 1 T l-�y4v i CERTIFICATION n]tr xcG
WELL CONTRACTORCOMPANY NAME GraJm l.J,v// r ,Y,//r'Yl(I PHONE • fRbj,S)Yi?-Jr+(rit
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
6a33..
I. 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 LOCATI N::
Nearest Town: ob�t,nSv.//e County 6 PetAct*?
f ,'n Aonk ac(77/
(Street Name. Numbers, Community, Subdivision, Lot No.. Zip Code)
3. OWNER: Bro,nrion C o/L-'
Address Pi In /f nn k
(Street or Route No.)
Robb 'ns i/0 A/c
City or Town Stale Zip Code
(S.2.5)- y 72— .5'S
7/
Area code- Phone number
4. DATE DRILLED .S- II-0A'/
5. TOTAL DEPTH: NOS
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO RI
7. STATIC WATER LEVEL Below Top of Casing: L/D 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 •
variance In accordance with 15A NCAC 2C .0110.
9. YIELD (gpm): 'v1 METHOD OF TEST Ct it
10. WATER ZONES (depth): 366
I I. DISINFECTION: Type !3/7-* Amount (7.6.
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
From el To QQ Ft. G nr<t) PLUG
From To Ft.
From To Ft.
13. GROUT: Depth Material
From r, To a0 Ft. C.emenT
From To Ft.
14. SCREEN: Depth Diameter
From To Ft. in.
From To Ft. in.
IS. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
Method
Slot Size Material
in.
in.
From To Ft.
Topographic/Land setting
ORidge ❑Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degreea/minuuaheconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From To Formation Description
C`
0
I --
C
w
ri
),OCATION SKETCH _ =
r _
Show direction and distance in miles Bentz least
two State Roads or County Roads. Include -the rpsd
n kmbers and common road names.
-} rom ReaCL /,bgh r o r /1-I3 d/ 9 T 1-N
/93 3.a Aides Turn /ef run
n/0o1(6o . 0.7 fm/e Tiro RI:9AT
GO 72 Nnct o jr, vN bicy %
G+/e /1
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
n2e/—Oc/
SIGNATURE OF PERSO4 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) JE'l r t[T/4p6/Pt
CERTIFICATION
WELL CONTRACTOR COMPANY NAME G-rnh0.YN /n/PI/ r%/I't PHONE N alk.22: 4�5
ttl
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
( if applicable) (if applicable)
I. 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
N
2. WELLLOCATION:/r
Nearest Town: Rd n& InSv,iJP County G inhca.rn
chi- , s 7? not. Col/c .`, 7 7 /
(Street Name. Numbers, Community, Subdivision, Lot No.. Zip Code)
3. OWNER: r n%7 n 6-&kh n61
Address C F I.STa4 Go//P
(Street orRoute No.)
Roh6,'nbu,l/e Nc. ;28771
City or Town State Zip Code
(z )-Li77-clack
Area code- Phone number
4. DATE DRILLED .i 7 - 0`I
5. TOTAL DEPTH: G n T
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO fl
7. STATIC WATER LEVEL Below Top of Casing: *AO FT.
(Use "e" 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 accord• ce with ISA NCAC 2C .0I I6.
9. YIELD (gpm): • METHOD OF TEST 0. r
10. WATER ZONES (depth): 1/0b
I I. DISINFECTION: Type fi T/I
12. CASING:
Depth
From O To
From To
From To
13. GROUT: Depth
From 0 To ao
From To
14. SCREEN: Depth
From To
Ft.
Ft.
Ft.
Amount n.7�
Wall Thia tut
or Weight/FL_Material
.sor P VC
Material n Method
Ft. (-cc MP/Yr 1-uhi fp
Ft.
Diameter
Ft. in.
From To Ft. in.
15. SAND/GRAVEL PACK:
Depth Size Material
Slot Size Material
in.
in.
From To Ft.
From To Ft.
16. REMARKS:
Topographic/Land setting
❑Ridge ❑Slope OValley p❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrmlminutesfucondc)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From To Formation Descriptiop
O
o
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the mad
numbers and common road names.
4 ,'O ,7 sn j /1`3 d- / 9 T ke /ail
IUarTfi Go (9,F m,/cs Tara leo PT
an c%r,'srnq Cove 0. 6,2
tde,'/ ©n R,L9h l
r
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 1 'ELIe OWNER
.S-Q `l
/2016
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. OW -I REV. 07/2001

WELL CONSTRUCTION RECORD 293764
North Carolina - Department of Environment and Natural Resources - Division of Water Quality
WELL CONTRACTOR (INDIVIDUAL) NAME (print) Mitchell D. Cook
WELL CONTRACTOR CONIPANYNANIE Flxl?ti1 B1:Gt1- s 11 Criairt?, Dr
Groundwater Section
CERTIFICATION # 2043
PHONE P P28) 369-9591
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED 1VQ PERMIT#
(if applicable) • (if applicable)
WELL USE (Check Applicable Box): Residential I I Municipal/Publics Industrial ❑ Agricultural C
Monitoring 0 Recovery ❑ Heat Pump Water Injection ❑ Other 0 If Ocher, List Use
2, WELL LOCATION:
Nearest Town: Robbinsville
Cheoah Point Campground
(Street Naive, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: USFS (US Forest Service)
Address PO Box 1250
(Street or Route No.)
Asheville, NC 28802
County Graham
City or Town State Zip Code
(828): 257-4208
Area code- Phone number
4. DATE DRILLED 3-15-04
5.TOTAL DEPTH: 300'
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO)C
7. STATIC WATER LEVEL Below Top of Casing' 20 FT.
(Use "✓' if Above Top of Casing)
S. TOP OF CASING IS 2 FT. Above Land Surface*
•Top of casing terminated at/or below land surface requires a
variance In accordance with ISA NCAC 2C ,0118.
9. YIELD (gpm)• 40 METHOD OF TEST blow
10. WATER ZONES (depth): 140' & 280'
11. DISINFECTION: Type H T H Amount 1 6oz
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
From 0 To 103 Ft. 6" pvc
From 101' To 107Ft. F" 1RR ataal
From To Ft.
13. GROUT: Depth Material - Method
• From 0 To 107 FtbHr ite & c tail p rpe3
From To Ft.
14. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in.
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth
From To Ft.
From To Ft.
Topographic/Land setting"
❑Ridge ❑Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minuses/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box) i iri L_ _
DEPTH DRILLING UOG
From To Formation Description
0 105' clay & sand
105' 300' granite
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common road names.
0
S
w
Size Material
3
ram)
C.)
16. REMARKS: c.)
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED. IN ACCORDANCE WITH ISA NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. . GW-I REV. 07/2001

WELL CONSTRUCTION RECORD 293662
North Carolina - Department of Environment and Natural Resources - [vision of Water Quality - Groundwater Section
� �j� �% Dl
WELL CONTRACTOR (INDIVIDUAL) NAME (print) .Tr—i /'/jy/7, CERTIFICATION #,Q SU
WELL CONTRACTOR COMPANY NAME Graham Well l r t rt � PHONE a Ms') 9-79-9c-/6-4
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
I. WELL USE (Check Applicable Box): Residential ® Municipal/Public 0 Industrial ❑ Agricultural ❑
Monitoring 0 Recovery 0 Heat Pump Water Injection ❑ Other ❑ If Other, List Use
2. WELL LOCATI N:
Nearest Town: b6:nsv'51/9 County Grckh&Yh
it LJe r .Sati)ysr_s Orrick ,2Fs77/
(Street Name. Numbers. Community, Subdivision. Lot No.. Zip Code)
3. OWNER: frl C),e5nKly
Address /d Wei r ,Sa pJ y.a KS" G r Pe h
(Street or Route No.)
R6- HS le MC, �Fr77/
City or Town State Zip Code
(at )-'i79- aCRc
Area code- Phone number
4. DATE DRILLED L/ <)i{
5. TOTAL DEPTH: (6,n S�
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO KI
7. STATIC WATER LEVEL Below Top of Casing: S 6 FT.
(Use"+" if Above Top of Casing)
8. TOP OF CASING IS / FT. Above Land Surface'
*Top of wing terminated actor below land surface requires •
variance In accordance with ISA NCAC 2C .0110.
9. YIELD (gpm): � METHOD OF TEST a r
10. WATER ZONES (depth): , Si A5—
I I. DISINFECTION: Type H r N Amount O. 919
12. CASING: Wall Thickness
or Weight/Ft. Material
Snr2,) Pvc
Depth Diameter
From C To in (t) Ft. ip yy
From To Ft.
From To Ft.
13. GROUT: Depth
From O To AO Ft.
Material
(men7
From To Ft.
14. SCREEN: Depth Diameter
From To Ft. in.
From To Ft. in.
15. SAND/GRAVEL PACK:
Depth Size
From To Ft.
From To Ft.
Slot Size
in.
in.
Material
Method
Rum
Material
Topographic/Land setting
❑Ridge OSlope OValley ❑Flat 'r-
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographi
(check box)
DEPTH DRILLIt4I..
From To Formation D6 riptgtprn
I CD
Ut
—0 21
N)
• r,
N3
- a G
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.
-cram ZnT �a 01 )Q3 C-Gf
lake ASV 6-0 1. i','J0S jarn
/Qlcdh an lower So,wyers GreeK
Ga )• Irt-)es Torn lePT an-
h/6/lanl5ar N/bI Fckwcky Go- 0.3
fh//e) Ta we/1 rat R,ihT.
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
Trv- -k 11 AP nor
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
North Carolina - Department of Environment and Natural Resources -
WELL CONTRACTOR (INDIVIDUAL) NAME
�{ (print) LU Q-ll
11141
WELL CONTRACTOR COMPANY NAME t4 t W.2J-t t
293660
Division of Water Quality - Groundwater Section
ale CERTIFICATION*S
I1.L.L`4,v It PHONE 0 ltak>1-179-$t%Stt
STATE WELL CONSTRUCTION FERMITN ASSOCIATED WQ PERMITIt
(if applicable) (if applicable)
I. WELL USE (Check Applicable Box): Residential g Municipal/Public ❑ Industrial ❑ Agricultural ❑
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use
2. WELL LOCATION: q��
Nearest Town:Re:.itt�L L. Ar.. County ,4A aam
,t.t ) i a n ter t Rat
(Street Wait:Numbers, Community, Sfandivision, Lot No., Zip Code)
3. OWNER: E4QLL G L�*lGeNtt
Address S a,t. ,. CekL 'Rd
(Street or Route No.)
1(Ct ()(jUrty.elt-u r '1) •c
City or Town State Zip Code
()-419^f qq3
Area code- Phone number
4. DATE DRILLED `f ,-7-J ao o
5. TOTAL DEPTH: 4O S.
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO
7. STATIC WATER LEVEL Below Top of Casing: $G FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS j FT. Above Land Surface*
`Top of casing terminated atior below laud surface requires a
variance to accordance with ISA NCAC 2C .0113.
9. YIELD (gpm): I METHOD OF TEST lel -tit.
10. WATER ZONES (depth): 5 a S
I I. DISINFECTION: Type Ifni
12. CASING:
Depth Diameter
From C) To a 7 Ft. 6 �y
From To Ft.
From To Ft.
13. GROUT: Depth
From f3 To ;.n
Amount O. 9 S'
Wall Thickness
or Weight/FL Material
SM211 P1/C.
Material
Ft. Cfirltt.rw'
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. 9 /h
O Nl, L.ry i'Lr` /I-45k* en e
From To Ft. r ),y,m%1- e ruzs .aI�.Vr 0 WCA,Zta- /!` JJ
aZiu-L fi c41 tz "eh< t_ckt to Z.0 arm 4mel7 Gtdr,t
Method
' itirlylvrq
Slot Size Material
in.
in.
C
O
(degrees/mmutethaatds)
Latitude/longitude source:❑GPS❑Topogatihic trap
(check box) I n c
DEPTH DRILLING'-OG:7-
From To Formation Desaipti
rt
co o
LOCATION SKETCH T,
Show direction and distance in miles fro at least •
two State Roads or County Roads. Include the road _- _
Topographic/Land setting
ORidge OSlope OValley ❑Flat
(check appropriate box)
Latitude/longitude of well locatic
16. REMARKS:
numbers and common road names.
P.te,T yF.ytteyt.b trct.:1). ,8 +/ v 3
?/ 4 to G-c47, ; 0.
*-;-8" lv' Ct ;2 /1 JIW Z « Jj <t.
Le en ,L4- p vi. t/,,-Ja&(�.-Cl. RA,
5t A-alone-�i' )')ittit tCLU(ll- 1.93—
L+tip t Jett1=c it.. .1C1'• '-
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH I 5A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-1 REV. 07/2001

293659
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natur Re
WELL CONTRACTOR (INDIVIDUAL) NAME (print) :/.> —T
WELL CONTRACTOR COMPANY NAME ( i^cL�Ct fY1
STATE WELL CONSTRUCTION PERMITP
(if applicable)
sours- 9ivisionof Water Quality - Groundwater Section
f yda& CERTIFICATION M 2 C15n LJeLLrtr.'11,)1(/ PHONE a 15,01417 9-.cfit5i‘
_ASSOCIATED WQ PERMMMITW
(if applicable)
I. WELL USE (Check Applicable Box): Residential lit Municipal/Public 0 Industrial ❑ Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 if Other, List Use
2. WELLLOCATI(ANII r
Nearest Town: lCOLL ✓1 v. IlP County (r He ,t m
onT.+n RDnr� 2(7-7
(Street Name, Numbers. Community, Subdivision. Lot No.. Zip Code)
3. OWNER: (r4 5 ,-V7
Address n.o it Tn in Ro etA
(SUM m Rome No.)
RA61-),.n.—;/' d 1V,G 9-s77t
City or Town State Zip Code
(334)-Q%1-o/5r
Area code- Phone number
4. DATE DRILLED l/ - 2 -S -c 4
5. TOTAL DEPTH: / 5-0
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO RI
7. STATIC WATER LEVEL Below Top of Casing: S",C FT.
tun —yell Above Top erCaainj
8. TOP OF CASING IS / FT. Above Land Surface'
*Top or cuing terminated et/or below land note requlrea a
variant In mordent? with 15A NCAC IC .0115,
9. YIELD (gpm): :20 METHOD OF TEST C>`.. r
10. WATER ZONES (depth): I :1S
I I. DISINFECTION: Type /it -TN
12. CASING:
Depth Diameter
From_a__ To SCS, FL 6 4
From To Ft.
From To Ft.
13. GROUT: Depth
From n To 0 0 A.
From To FL
14. SCREEN: Depth Diameter
From To Ft. in.
From To Ft.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
Amotnt o.21
Wall Tbidmes
or Weight/Ft. �latnt'a
Snr2.i �VG
Material
Gc lrlvnT
nI,
From To Ft
Slot Size Material
in.
in. _ in.
Topographic/Land setting
❑Ridge intone OValley OFtat
(check appropriate box)
Latitude/longitude of well location
(deareshninuttsheeatdr)
Latitude/longitude source:DOPSOTopographic map
(check bea>
DEPTH DRILLING LOG
From To Formation Description e
O `p
n
�rn
am
rn 1^
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.
ram PoPcoyes %urn /etTon /a.9N
G-0 I-3 m,'les Turn /6'4I-on Jfl $$5&
Brctnch 6 o. at u,Q, t Mies /rn hr
Olt /Jenrolt ��dgc4G0. o.ln^m,'/F
T rn / hT GO To 6'/70'l 0 T &ea.
w&)// kmh,i-lc( hease
16. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH I5A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPPLnY OF THIS
fr 1RE}C�RR RECORD HAS BEEN PROVIDED TO THE WELL OWNER
II' a:3
SIGNATURE OF PERSON CON S'DRUCf INTHE WELL DATE O
I '3
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mall Service Center- Rettig NC `- _
27699-1636 Phone No. [phone], within 30 days. GW-I REV. Y7/2001

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural a our)ce/s - [vision of Water Quality
WELL CONTRACTOR (INDIVIDUAL) NAME (print)(p TO->�F biy[�.
WELL CONTRACTOR COMPANY NAME (2rafi0.m Wean a r, / l /4
STATE WELL CONSTRUCTION PERMIT%
(if applicable)
293658
- Groundwater Section
CERTIFICATION # g6.50
PHONE # 1241,197i-9'1715-4
ASSOCIATED WQ PERMIT#
(if applicable)
I. WELL USE (Check Applicable Box): Residential Municipal/Public ❑ Industrial ❑ Agricultural 0
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other 0 If Other, List Use
2. WELL LOCATIRN(ri Nearest Town: ICCik1 'h5V, ix County6-recbAM
Eo.T Quflr d RR.6I
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: rlCtl0.4 Sec.Slay
Address F. eAS /U
(Street or Route No.)
i E)/4") t(.,'I/e 4/,c 2st'77/
City or Town State Zip Code
(4�i) 1-)79- 3,9(c`oL
Area code- Phone number
4. DATE DRILLED y- 7-Ott,
5. TOTAL DEPTH: /O,
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO Ed
7. STATIC WATER LEVEL Below Top of Casing: ,C/ FT.
(Use "-" if Above Top of Casing)
8. TOP OF CASING IS / FT. Above Land Surface"
•Top of casing terminated at/or below land surface requires a
variance in accordance with ISA NCAC 2C .0118.
9. YIELD (gpm): .3c1 METHOD OF TEST a.; r
10. WATER ZONES (depth):
I I. DISINFECTION: Type /1—P Amount C1 , 9
12, CASING: Walt Thickness
Depth Diameter or Weighr/Ft. Material
From 0 To a_3 Ft.64 5Atli PV(
From To . Ft.
From To ' Ft.
13. GROUT: Material Method
From 0 Ft. C e rrhe e
From
14. SCREEN: Slot Size Material
From__ in.
From To in.
15, SAND/GRAVEL PACK:
Depth Size Material
To
To
Topographic/Land setting
❑Ridge OSlope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degreeshninutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH DRILLING LOGS
From To Formation Dep1e ipti§
nA
—e Crn
1 os
Depth
To Q-O
To Ft.
Depth Diameter
To Ft. in.
Ft. in.
From Ft.
From Ft.
rn
r
N !n'
N
LJJ U
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road pm and common road names.
r0ni P0fryes Tarn /6)-PTon J 9N
G-O y. 3 mi,7e'S Ti-rn I?, h T o n
EaST 3u' IoJ0Go, O-`a>»1,'/P
Turn R,$hr T ,Or/ ve clay'
To tdeil tjNl rill house.
r-
16. REMARKS:
1 DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL - -
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNT,R ' �';
T?-'k i/,,k Li- 2.7-09
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE -- 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. G W-I REV. 07/2001

293656
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natura
;F R souregs - tDivision of Water Quality - Groundwater Section
r y e CERTIFICATION # Ar7<52)
WELL CONTRACTOR (INDIVIDUAL) NAME (print)
i
WELL CONTRACTOR COMPANY NAME 6 rr.1-)6 h'I I.J e I) a irl l l r ng.
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT,/
(if applicable) (if applicable)
I. WELL USE (Check Applicable Box): Residential ® Municipal/Public ❑ Industrial 0 Agricultural 0
Monitoring ❑ Recovery ❑ Heat Pump Water Injection 0 Other ❑ If Other, List Use
PHONE # tgil) t)'7 9 - 8 9 CLI
2. WELL LOCATI N'
Nearest Town: t)n')iy15lU )1N County Cr; hail A,m
Slay (,cke n 771
(Street Name, Numbers. Community, Subdivision, Lot No., Zip Code)
3.OWNER:mrlif' Urr
Address SlA�/ 5G.Cnn
(Street or Route No.)
RAO10 5 t; ; ii,o Nt. as-77/
City or Town State Zip Code
(2S') y77- 9,15
Area code- Phone number
4. DATE DRILLED 61-- 24—O t/
5. TOTAL DEPTH: 7.Ori
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO $I
7. STATIC WATER LEVEL Below Top of Casing: 6 FT
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS I FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordance with ISA NCAC 2C .0118.
13. GROUT:
From O
Frorn
14. SCREEN:
From
From
15
•
9. YIELD (gpm): I S METHOD OF TEST G. 1 T`
10. WATER ZONES (depth): /94
II. DISINFECTION: Type /4T11 Amount O.;i.-i
12. CASING: Wall Thickness
Depth �D�ia�meter or Weight/Ft. Material
_ From Q To_ Ft. t18555 5Teel
From To Ft.
From To Ft.
Depth Material Method
To d...O Ft. (Nm& i'T NJ-rip:
To Ft.
Depth Slot Size Material
To in.
To in.
Diameter
Ft. in.
Ft. in.
SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
t_:
Ic
Topographic/Land setting a _u
❑Ridge OSlope ❑Valley ❑Flat_
(check appropriate box) ,- o��--"'
Latitude/longitude of well Iocatitin::
(degrees/minutes/seconds) iI I--
Latituda9ongitude source:❑GPS❑Topog
(check box) -i
DEPTH pRILLI 3 L6€
From To FormationTscriRimt
�cm-)
-I r1
aph maps
tV
• S
C)
fV —1
CO 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.
trot~l znr /q36 129 Take / 6/3
a m,'/Ps "Torn 1 e7k on s lay /34c.
6. 0,6 Id,/Es Wei/ 0 n 16,7e T
16. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH I5A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
der ti4yc6 f 2.41 oN
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 293796
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) James B. Brown CERTIFICATION # 2045
WELL CONTRACTOR COMPANY NAaIEHedden Brothers Well Drilling, Inc PHONE [phone]
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable) (if applicable) --.
I. WELL USE (Check Applicable Box): Residential Municipal/Public 0 Industrial 0 Agricultural ❑
Monitoring 0 Recovery ❑ Heat Pump Water Injection 0 Other 0 1fOther, List Use
2. WELL LOCATION:
Nearest Town: Robbinsville County Graham
Cheoa Point Campground --Well #2 •
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: US Forest, Service
Address PO Box 1250
(Street or Route No.)
Asheville, NC 28802
City or Town State Zip Code
(128 )- 257-4293
Area code- Phone number
4. DATE DRILLED 3-29-04
5. TOTAL DEPTH: 600'
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO Ex
7. STATIC WATER LEVEL Below Top of Casing: FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS 2 FT. Above Land Surface*
'Top of casing terminated at/or below land surface requires a
variance In accordance with 15A NCAC 2C ,0118.
9. YIELD (gpm): 0 METHOD OF TEST blow
10. WATER ZONES (depth):
I I. DISINFECTION: Type H T H Amount - 16 oz
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
From 0 To 97 Ft. 6" pvc
From 97' To 100 FL 6" .188 steel
From To Ft.
13. GROUT: Depth Material Method
From 0 To 20 Ft. banate & oana t pumped
From To Ft.
14. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in.
From - To Ft. in in.
15.SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
Topographic/Land setting
❑Ridge ❑Slope OValley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitudo/longitudesource:❑GPS❑Topographic map
(check box)
DEPTH DRILLING ILOG
FOrom To Formation Desch"Lt[ian
98' clay & sand
98' 600' granite
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road o
numbers and common road names,
0
16. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STA RDS, AND THAT A CO. OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
SIGNAT iF 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 2 9. 795
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) James B. Brown CERTIFICATION # 2045
WELL CONTRACTOR COMPANY NAME Hedden Brothers Well Drilling, Inc PHONE #$281 369-9591
STATE WELL CONSTRUCTION PERMIT# - ASSOCIATED WQ PERMIT#
(if applicable) - (ifeoolicable)
I. WELL USE (Check Applicable Box): Residential Municipal/Public ❑ Industrial 0 Agricultural ❑
Monitoring ❑ Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION:
Nearest Town: Robbinsville County Graham
Cheoah Point Campground —Well #3
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: US Forest Service
Address PO Pox 1250
(Stree: or Route No.)
Asheville, NC 28802
City or Town State '
(82B)- 257-4293
Area code. Phone number
4. DATE DRILLED 4-2-04
5. TOTAL DEPTH: 300'
Zip Code
Topographic/Land setting r
❑Ridge ❑Slope DValley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/mi nuies/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH DRILLING LOG
Dom To 55' Fclaytio& n seancdotion
55 300' granite
6. DOES WELL REPLACE EXISTING WELL? YES 0 NOS
7. STATIC WATER LEVEL Below Top of Casing: 100 FT.
(Use "+" if Above Top of Casing)
8, TOP OF CASING IS 2 FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance In accordance with 15A NCAC 2C .0118.
9. YIELD (epm): 30 METHOD OF TEST blow
10. WATER ZONES (depth): 70'. 103' , 110', & 268'
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common road names.
• 13. Material Method
Ft. balalite & wtt-s,L pumped
From To Ft. 14. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in.
From To Ft. in in.
IS. SAND/GRAVEL PACK:
Depth Size Material
11. DISINFECTION: Type H T H Amount 16 oz
12. CASING: Wall Thickness
Depth Diiineter or Weight/Ft. Material
From 0 To 54 Ft. 6 pvc
From 54' To 57'Ft. 6" .188 steel
From To Ft.
GROUT: Depth
From 0 To 20
From To Ft.
From To Ft.
h£ £ bd £- kVW'i0
16. REMARKS`
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH ISA NCAC 2C, WELL
CONSTRUCTION STANIS$RDS, AND THAT A C OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
-'-02-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-I REV. 07/2001