He CY2004

.P. 307265
WELL CONSTRUCTION J"tECORD
North Caroline - Department of Environment and N�ht ,Refottrees • Dlvlilon of Water Quality • CQLSuti C*fltt S
�j �-1 �JY11
WILL CONTRACTOR (rNOMDVAL) NAMI (pA.e) ..
THONLJ _. ,..
WELL CONTRACTOR COMPANY NAME Gre.fn CLiVff lNe ll� CUTLO WQ TLRMITR
STATE WELLCONSTRUCTION PERMIT/ I(a,;)ieabie
Of applicable
1. WELL USE (Check Applicable Box): Residentitlt'Munitipal/Fpblie 0 Industrial ❑ Agricultnral.0
Other Monitoring 0 Recovery 0 Heat Pump Water Injection her 0 If Other, List Use /'
WELL LOCATION
Nearest Town: 1UVPnk County
tal ono_ innkrc3 i2c4.
(Street Name. Numbcn.tCommuniry. Subdivitione Let No., Zip Cede)
3. OWNER: J &nTfurn
Address 31 AI1` no fYl-tv.�.
(Street I,r Route No.)
e n790
(berTown 715-188 09 tate , zip cede
Tet)j
Area cede- Pben. number
4.- DATE DRILLED I -14 -O4
5. TOTAL DEPTH: t90S
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO Oi
7. STATIC WATER LEVEL Below Top ofCasing: .i SO FT
(Ue. "+' H Above Top of Coins)
8. TOP OF CASING IS 1 FT. Above Land Surface•
'Top of mint termineted .Vor below lied smite* requires a
rut.nee In accord ante with ISA NCAC 2C .0112.
9. YIELD (gpm): I METHOD F TEST 4 12
10. WATER ZONES (depth): 2,e,
11. DISINFECTION: Type HTI4
' 12. CASING:
A Depth Di
Fro_ To 2 Ft. C
From �i 2 To Ft.1
From To
<tee
Ft.
13. GROUT: Depth • . ?`4aterisl " ' '
Etom. To_D _ Ft. Set -Anti
From To Ft.
14. SCREEN: Depth Diameter
From To Ft in.
•From To Ft. in.
15. SAND/GRAVEL PACK:
Depth Size MIUrisl
Amount
Wall
Thickness
2'/. L tt" t'VC
.2r:•c pvC-
Metho
Slot Size Material
in
From To Ft.
From To Ft.
16. REMARKS:
in
Topographic/Land setting;
DRidge BSIope °Valley. OF)at
(deck approprttn boa) :';. ;
Latitude/1 ngitude of well )otation
35c;3' 5r1 "' %vsaea(n(' 1 t w
(degreesrmimitabeeeea.)`:
Latitvde/longitude source:@fet'SOTopographie
(cheek box) -4%i;
DEPTH IThiaatalglat
From To Forma& Peteripti
t.D
LOCATION SKETC3t `-
Show direction and distance in toilet Om at 1
two State Reads or County Roida tii&h2de the rot
numbers r . .. on road name*.'
4;
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED ACCORDANCE WITH ISA NCAC2C,.'Flit
CONSTRUCTION STANDARDS. AND THAT COPY OF THIS R$,SORD HAS BEEN PROVIDED TO THE WELL WAR 3
'O µ.
SIG?IATTJRZ OP`pERSON,CONSTRUCTINO.THE WELL - DATE,;•
tDmte the erie:Ill to the Division of• Water,QilatIty1 dronndfiatir Seetlon;1836 Mi11 Semite Ce Iet•;:Raf eiglte NC
699-1636?bone Ne. (919) 7313221, within 30 days. d* 1 REQ.trm

WELL CONSTRIICTION):CECORD
North Carolina • Department of EnvIronment and Natural Re•eurees • D1 'Islon of Water Quality - Oreuedvntat Seed
'C'iri Inn+ ram•+F1
WILL CONriUCTOR(reDMDUAL)NAMI (pat 0
WELL CONTRACTOR CONSTANT NAMI GIN,t t•1121V\ nano-Triathlon
Mt 11 k Pumo Cn . THONI.I a I
STATE WELL CONSTRUCTION PERMIT, ASSOCIATpp WQ PERM ITI (yat�-1(��4yt,e5
(if appliubiel
Sf applicable) x'.
1
1. WELL USE (Check Applicable Box): Residential lErMwtielpaVPpblie 0 Industrial ❑/ Agrictiltunl O r•a
Monitoring 0 Recovery 0 Heat Pump Water Injection 09Iher 0 If Other, List Vie,
Topographic/Land setting .r,
❑Ridge ❑Slope 0Valleyat
(cheek epprepdau tat) .: >..
LatitvpdeAopgitu s of wilt IoOation
3. OWNER: 1C\ &stn. - e n r (depeee/mimrtaheeotds)'.:. . +'
t I d2
Address aU Pl C \en,— C.meY Latitudrllongitude source:C0GPSOTopbgraphlt,
(Sweet or Route No.) (eheckbet): -.:. - b'
�olnPyv.Ilr rJc asi a, DEPTH DRiIiiNCit
et
Chi' or Tawn Sum . zip Code From To Fomnt((ft Deseri)31i••
(8 1• UN," - 8541 -
Arn redo -Mons number, r
4. DATE DRILLED l to -OH 2
5. TOTAL DEPTH: 2 / 3— 3 . IL
6. DOES WELL REPLACE EXISTING WELL? YES Onto 0
7. STATIC WATER LEVEL Below Top of Cuing: • 75 FT.
(u,e "+'• If Above Top erCntng)
E. TOP OF CASING IS / FT Above Land Surface•
'Top of cuing terminated ever below bed tartlet requires •
rvina In •eterdrnce with ISA NCAC 2C .011a.
9. YIELD (gpm): /00 METHOD OF TEST /aTr%Z
.10. WATER ZONES (depth): A3D
2. WELL LOCATION:
Nearest TowiCD tna- County 4.ruler ter,
CPn f Cte_e C
(Street Name, Numbers. Community. Subdiuidon. Lat No hp Cede)
LOCATION SKETC$p
11. DISINFECTION: Type II %ft Amount Show direction and distaaed.in'dliles Tf01ii It I6
t2. CASING: Wall Webers two State Roads or County tpEtude Itte
Depth ter or Weight/Ft. ate t1 numbers and common road Tom
From To FL 1 -
From To Ft.
From To Ft.
13. GROUT: . Depth Material ' Method
F.ronL•, To Ft.
From To Ft.
14. SCREEN: Depth Diameter Slot Size - Material
From To Ft. in. _ in.
front_____ To Ft. in. _ in
15. SAND/GRAVEL PACK:
Depth Siu Material
Front • To Ft
.Frorm To Ft.
16. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL W CONSTRUCTED 1N4ICCORDANCE WITH ISA NCAC 2C, "ELL
-
CONSTRUCTION 5T • ARDS. AND THAT •?YE)? t. RECORD HAS BEEN PROVIDED TO THE WELL OWNE•
R
SIGNATURE OF PERSON,CONSTRUCTINO.THB WELL , DATE
gbmfleheoriginal tothe Division of.WaterQhtBlybGrouad ati1See4Dr11636 Itvaa1IServtetCeel/it _
• 27699-I636 Then No. (919) 7334521, withtn 30 days. a 2005 ' Giv•I REV 0712

ci on6'
•
WELL CONSTRIIC ION RECORD
North Carolina - Department o(Environment and tun) Resotuees • Division of Water Quality • Oroundwatar Sesetion
a •. i.,, " avertrrc1TtONw
wELt. COMpACron(worms UAL/NAME(►IMI Vc ��q a 1.
STATE COMPANY NAME Gtrw a r\ RIMY r \MY II le PIAm 0 f n - PHONE,/ LC J' 4? aE2
STATE WELL CONSTRUCTION PERMITS ASSOCIATED WQ ?ERMITI i A • "
'Ts liable - fa..liable
t`
1. WELL USE (Check Applicable Box): Aetidential8�btunitipalll?jtbLe 0 Industrial O Agricultural O r
Monitoring 0 Recovery 0 Heat Pump Water Injection Other 0 1f Other, List Use. ,
2. WELL LOCATION:
Nearest Town:rue° County \'evils f
m b'tk.i r LCb
(Street Nun. Numbcn. Community, Svtdiddan• Let No., Zip Cede)
3. OWNERvw.r� Q�.�
Address (e elnekaare_h1 TY'
(Street or Rowe No.)
Servo;o` Giz
C)IyorTewi Suu .ZIp Cods
(Th 59 —`tom
Ares cede- Phone number
4. DATE DRILLED II — ie3-ny
S. TOTAL DEPTH: Mel
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO tY
7. STATIC WATER LEVEL Below Top of Casing: • 2 D FT
(Ut• ^o• it Above Top of Cuing)
8. TOP OF CASING IS 1 FT Above Lind Surface•
*Top of min terminated War below load teem requlru a
mines In aetardence with ISA NCAC 2C.011L
9. YIELD (gpm): rO METHOD OF TEST AIR
•I0. WATER ZONES (depth): 2 L S
1I. DISINFECTION: Type i1TU.
r 12. CASING:
Depth ter
Front 1 To_5¢— Ft.
Fro
• From To Ft.
13. GROUT: Depth • . Material .. ' Method.
Frorn - 0 To 2 D Ft..S-k.3 a f.F Ai.4thecciatE,
From To Ft.
14. SCREEN: Depth Diameter Slot Size Material
From__ To Ft in in
from_ To Ft. in. _ in
.. 1S. SAND/GRAVEL PACK:
Depth Site Material
From To Ft.
From To Ft.
r
16. REMARKS:
1 DO HEREBY CERTIFY THAT THIS WELL WAS CON
CONSTRUCTION STANDARDS, AND j T A COP OF
Tapogra hie/Landsetting,.
ORidge L}Slope °Valley OFlat
(chock apptepdepvex)
,;
Latitude/lo gitndeofwell)o(iation
(deptedmtmttaertateeds) -s
Latitude/longitude source:6GPSOTopoVaphig,
(check Sox) z.
Forltu n Descriptiga
From To
O —. O
et-7°
O - 7o4
I't
LOCATION SK&CFI' .
Amount Show direction end distance .intniles from et
Wdl Thickness two State Roads or County Roads.!naiads the ribs
or Weight/FL aterial numbers and common road names.
,2A
f:Y L
up AA Ra
Tomb la 80$'
CTED IN ACCORDANCE WITH I SA NCAC
IS RECORD.HAS BEEN PROVIDED TO THE WELL OWNER
/ .. /3'• ram,
SIGNA ' �OP PERSON,CONSTRUCRNO,TNE WELL • DATE
ba•btaftthe original to the Division of Water,Qusilty, Croandwatei Seedoa,1636 Mill Service Gerald•:RaiSj1ieNC)',
:27699-I636 Phone No. [phone], within 30 days. • OW I REV :oinoo _ .
MAR - 8 2005. .,•

WELL CONSTRUCTION RECORD 3 0 6 8 9 6
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (Inv
T 1
(PHnt) (TF��K+--� Jl; j`,//�)� t� CERT[FICAT(ON #�%.ice
\YELL CONTRACTOR COMPANY NAME YYY?lRP �E M--1.e LC yf-,r (,C, M5 PHONE # tca
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(ifapplicable )
(if applicable)
I. WELL USE (Check Applicable Box): Residential D Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection ❑ Other 0 If Other, List Use
2. WELL LOCATION: I i
NearestTown: /2Y'.,t Llac,d County Neveh1
t Community, Subdivision, on.Ll incrin Ji
(Street Name, Numbers. Community, Subdivision, Lo Na., Zip Code) pp lief a_
3. OWNER: iittyt (1 t40 S-76-1,'
Address jio 60 x t t'j
(Street or Route No.)
F . .tr• $)t • €477..
City or Town Slate Zip Code
& )- baz-aj.j)
Area code- Phone number
4. DATE DRILLED /, .-27 -09
5. TOTAL DEPTH: OS
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO
7. STATIC WATER LEVEL Below Top of Casing: 60 FT.
(Use "+" if Above Top of Casing)
S. 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):�METHOD OF TEST .5A3M�
10. WATER ZONES (depth): >/Ls�pr ICX�
Depth
From e To pi 9 Ft. �/
From y To_ Ft. y
From To Ft.
13. GROUT: Depth
From To
From 0 To if Ft. nett"
/
rh
14. SCREEN: Depth Diamer Slot Size
From To Ft. in. in.
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Material
From To
From To Ft.
11. DISINFECTION: Type &c'ifitt1 Amount sj 0
12. CASING: Wall Thickness
or Weight/Ft. Material
16. REMARKS:
Otter
(M%/
Material
Ft.
Size
Ft.
Method r
Topogra Land setting
❑Ridge ope ❑Valley °Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:DGPS°Topographic map
(check box)
DRILLING LOG
Formation Description
DEPTH
From To
Its
;Pi R. cots
g4' k,*Q
tau
4
LOCATION SKETCH
Show direction and distance in miles Irma le sr
two State Roads or County Roads. Include the
numbers and common road names.
7'V
1 DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH I5A NCAC2C, WELL
CONSTRUCTION STANDARDS, ATW THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
S NATU E OF RSON CONSTRUCTING THE WELL DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-1 REV. 0N00,
xlpn 6 L0t5

306837
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) JamPS W. Cam Jr CERTIFICATION s 71 3R
WELL CONTRACTOR COMPANY NAME ('amp' a Wa11 R Pnmp Cr, Tnc PRONE 8112R1 451-7122
STATE WELL CONSTRUCTION PERMIT/0 ASSOCIATED WQ PERMIT*
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential t Municipal/Public 0 Industrial 0 Agricultural ❑
Monitoring ❑ Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION:
Nearest
_ untyLQ, tr
J` o 4- tJ-
(Street Name, Numbers, C unity, Subdivision, Lot No., Zip Code)
3. OWNER: AeA.A A t\-kkdu-t��`k"1�
Address I 4 CRP { ve cif? i �n� F, / d o e
(Street or R ute No.
H}ewcievsvn>Jil�e �C— fi 7
City or Town State Zip Code
Area code- Phone numb{ < �t
4. DATE DRILLED 1�. �= -0 {
5. TOTAL DEPTH: \ '413
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO YU
7. STATIC WATER LEVEL Below Top of Casing: 14 0 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS 1 FT. Above Land Surface*
*Top of casing terminated atlor below land surface requires a
• variance in accordance with 15A NCAC 2C .0118.
9. YIELD(gpm): 1D METHOD OF TEST Lir
10. WATER ZONES (depth): { t 0
11. DISINFECTION: Type l'h 1 nr i n
12. CASING:
Deptdy,,Diameter
From_n ToFt. 6 1 / 4
From To Ft.
From_____ To Ft.
13. GROUT: Depth
From ll To 30 Ft.
From To Ft.
14. SCREEN: Depth Diameter Slot Sizc 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/ itke
Wall Thickness
or Weight/Ft. Material
Q 'P21 PVC ! J(f
1
Nirti
Topographic/Land setting
❑Ridge IDSlope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(dogma/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DRILLING LOG
Fott�+Iaation 11��escip on
PEPTH
From _To
0
c rim
Ire
l
ry
Material Method
Neat Cement Hand
16. REMARKS:
(-3
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common road names.
1 DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OkTHIS RECORD HAS EEN PROVIDED TO THE WELL OWNER
- IU. (r
SIGNATURE OF PERSGN CONSTRUCTING THE WELL / �� DATE
ia
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center -Raleigh, NC
27699-1636 Phone No. [phone], within 30.days. GW-1 REV. 07/2001;
E.
•
c7

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality
W ELL CONTRACTOR (INDIVIDUAL) NAME� (print) r!.o_ e_t- �LL(LG--tnL p
W EI,L CONTRACTOR COMPANY NAME /ee ni d3ro • LC)t Q D v Kim)" \'JtC,
STATE WELL CONSTRUCTION PERMIT# / 4 6 - ASSOCIATED WQ FERMUW
(if applicable) (if applicable)
307897
- Groundwater Section ,� jj
CERTIFICATION # -3p35%-
PRONE # frog /n�%9._-. 3 / 7 a
1- WELL USE (Check Applicable Box): Residential Municipal/Public ❑ Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water n)ection ❑ Other 0 If Other, List Use
2. WELL LOCATION':1
Nearest Town: Hatse- lanC .
3
County ar nA e Cr+vs
r . .
OWNER:
Address a2_1;2 I p to r n -E ev)P
(Street Name, Numbers, Community, Subdivision. 1 at No., Zip Code)
LA. Cc, Ylc�r_}_n ttS
\ .(street or Route No-)
%IGhe.v, I le tJC r 881)3
City or Town Stale Zip (de
( Area code- Phone number
4. DATE DRILLED I!-3!)--Q
5. TOTAI, DEPTH: q 0.5]
fr r)r LLO W1.11 RI M A(t I.Xlll tp',(i Wit! 7 YES 1-3 NO la
7. STATIC WATER LEVEL Helow Top of Casing: — FT.
(tJsc "I" if Above Top of Casing)
K. TOP OF CASING 1S / FT. Above Land Surface*
"Top of casing terminated at/or below land surface requires a
variance in accordance with 15A NCAC 2C .0118.
9. YIELD (gpm): - METHOD OF TEST %7rS
10. WATER ZONES (depth):
Topographic/Land setting
p. 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
o S D tea . l
ll. DISINFECTION: Type F-/T/-1 Amount
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
From Q To 4-"-A - Ft. " _kV C
From To FL
From To Ft.
13. GROUT: Depth Material Method
From _D To-,2D
From To Ft.
14, SCREEN: Depth Diameter Slot Size Material
From_.. To Ft. in. in,
Front To Et. in. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
I6. REMARKS:
LOCATION SKETCH
Show direction and distance in miles from at least _
two State Roads or County Roads. Include the roan
CM
numbers and common road names. ij1 em
-Tin
CO -IIm 1
1 730
tD a0
-13
_ .-,
o�
VG
O Bata
cmpi
I IX) I IEREBY CERTIFY TIIAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITI I I5A NCAC 2C, WELT.
CONSTRUCTION SFANDAJ(DS, AND TIIAT A COPY OF THIS RECORD IIAS BEEN PROVIDED TO TIIE WELL OWNER
Ye).2 Ja
SIGNATURE OF PERSON CONSPROCTING TIIE WELL DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-I REV. 07/2001

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality
WELL('ONTRACI'OR (INDIVIDUAL) NAME (print)n( _
yr PI tYLPr. '41-
WELL CONTRACTOR COMPANY NAMR &LSC_Y)C. ��6/roS .Alta_
STATE WELL CONSTRUCTION PERMIT# 1 70 ..Z ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
- Groundwater Section
CERTIFICATIOON/#�l3/�3.5 V
PHONE # ( 7.il_in_L-cT.. _.'3'
1 . WELL USE (Check Applicable Box): Residential 1 Municipal/Public ❑ Industrial ❑ Agricultural O
Monitoring O Recovery ❑ Heat Pump Water Injection O Other O If Other, List Use
2. WELL LOCATION:
Nearest Town:1(Dr 5 .:Sli c
11 County 1-1C r icte. rcerrs
I Me, I- C/f CI C •
(Street Name, Numbers, Community, Subdivision, 1.n1 Nn., Zip Code)
3. OWNER:
Address© /PU6n©a_
/I (Street iv nnt a Nn.l
('ity or Tuwn State
)-
Zip ('ode
Area code- Phone number
4. DATE DRILLED //-/'7 -1)
5. TOTAL DEPTH: /6t (
IV\t a \\/L,l.l REP/ A('I. LYINI lh;l: WE! I ,1 Y!. ILJ NO
7. STATIC WATER LEVEL L3elow Top of Casing: — FT.
(Use "+" if Above Top of Casing)
S. TOP OF CASING 1S / FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordance with 15A NCAC 2C .0118.
9. YIELD (gpm): METHOD OF TEST a Ars
10.WATER ZONES (depth): glob -gias'
/ Topographic/Land setting
$.Ridge ❑Slope OValley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:OGPSOTopographic map
(check box)
DEPTH DRILLING LOG
From To Formation Description
0
3.2 /vo5'
LOCATION SKETCH
1 1. DISINFliC'TION: Type /-tT/--/ Amount l8 3 -FL . Show direction and distance in miles from at least
12. CASING: Wall "thickness two State Roads or County Roads. Include the road
Depth Diameter or Weight/Ft. Material numbers and common road names.
From ED To__,3 Ft. Lo (I PVC
from To Ft.
From To Ft.
13. GROW.: Depth atonal
From Q To 2('� Et. �.
From To Ft.
I4. SCREI'.N: Depth Diameter Slot Size Material
From To Ft. in, in.
From To Ft. in. in.
15. SAND/GRAVELPACK:
Depth Size Material
Method
hip
From To
From _.. --.ro
16. REMARKS:
J
I DO I IEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITII I5A NCAC 2C, WELI.
CONSTRIJ TION STANDARpS, AND THAT A COPY OF THIS RECORD IIAS BEEN PROVIDED TO TIIE WELL OWNER
J% �_)
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
/- 3/--OS
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

091) 30�b�1
North Carolina Department of Environment & Natural Resources
Division of Water Quality - Groundwater Section
1636 Mail Service Center
Raleigh, NC 27699-1636 Phone: [phone]
WELL CONSTRUCTION RECORD
DRILLING CONTRACTOR: j7+Atar-44,#J.r>'/,1;S
STATE WELL
FOR OFFICE USE ONLY
QUAD. NO. SERIAL NO.
Lat. RO.
Minor Basin
Basin Code
Header Ent. GW- I Ent.
CONSTRUCTION /.
DRILLER CERTIFICATION NUMBER: 2�% ' tF� PERMIT NUMBER:
1. WELL LOCATI N: (Show ketch of the location bp19w)
Nearest Town: n�hJtz 5 /1Counts.: RtkiJ/0.PR5j�%
DEPTH DRILLING LOG
(Road, Community, or Subdivision and Lot No.) From To Formation Description
2. OWNER .44 r�a:j. z �u74j
ADDRESS ) izt L✓7 /S1/ en' ,
(Street or Route No.)
r
City or Town t Zip Code
3. DATE DRILLEDW2 -SOOF WELLS=
4. TOTAL DEPTH 4.7c
5. CUTTINGS COLLECTED YES 0 NO ea
,,.--
6. DOES WELL REPLACE EXISTING WELL YES O NO
7. STATIC WATER LEVEL Below Top of Casing: 1.2(7 FT.
(Use " +' if Above Top of Casing)
8. TOP OF CASING (St I FT. Above Land Surface`
`Casing Terminated at/or below land surface is illegal unless a variance is issued
in accordance with IS.A NCAC 2C .0118 �+
9. YIELD (gpm): I ,9 METHOD OF TEST V' t 7
10. WATER ZONES (depth): 417 S
II. CHLORINATION: Type Amount .i
12. CASING: C '��--
Wall Thickness
FromJ De th tag Or W eight/Ft. )Iaterial
( To '1--) .FL 2/� /l���'
From To Ft.
From To Ft.
13. GROUT:
Depth
From n To `% 0 Ft.
From To Ft.
14. SCREEN:
Material 1
Depth Diameter
From To Ft.
From To Ft.
From To Ft.
Slot Size Material
I5. SAND/GRAVEL PACK:
Depth Size
From To Ft.
From To Ft.
16. REMARKS:
(V 19618/ en
5' 4-.25 (tl h jtc.
If additional space is needed use back of form
LOCATION SKETCH
(Show direction and distance from at least two State
Roads, or other map reference points)
n
in. in `0 n 1
in
in N
in. in U
t a�,
3
Material
O
1 DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH ISA NCAC 2C, WELL i-
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL 0
j)ondlc1 /,q'j71C /2(/
Crr,d A Trio C AC reliTO A rTAO ^0 • rrtr r

�k1'Jr,"
North Carolina Department of Environment S Natural Resources
Division of Water Quality - Groundwater Section
1636 Mail Service Center
Raleigh, NC 27699-1636 Phone: [phone]
WELL CONSTRUCTION RECORD
DRILLING CONTRACTOR: / mar Ze //1 1/4) CI
STATE WELL
CONSTRUCTION
DRILLER CERTIFICATION NUMBER: 2t/O PERMIT NUMBER:
FOR OFFICE USE ONLY
QUAD. NO. SERIAL NO.
Lat. Long. RO. •
Minor Basin
Basin Code
Header Ent. •
OW -I Ent.
ear75 tit1R 1 4 'Ir'S
I. WELL LOCATION: (SI w sketch of the location below)
Nearest Town: to cr) Ui fte" County: /terse e-c5041
F5ijc./S sots DC
oad, C'ommunitp, or Subdivision and Lot No.)
2. OWNER et. h -bAS) y�J Ge✓5
ADDRESS®.. -
(Street or Route No.) oy
ger•.k5fini
City or Town State Zip Critic
3. DATE DRILLEDca:i.IU'SE OF WELL Noose_
4. TOTAL DEPTH A3S
5. CUTTINGS COLLECTED YES 0 NO (9�
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO 0
7. STATIC WATER LEVEL Below Top of Casing: 1 f.t FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING I5 1 FT. Above Land Surface*
'Casing Terminated at/or below land surface is illegal unless a variance is issued
in accordance with ISA NCAC 2C .0118
9. YIELD (gpm): METHOD OF TEST PiS
10. WATER ZONES (depth): aso
II. CHLORINATION: Tvpe Amount $ Ug
12. CASING:
Wall Thickness
Depth Dn3ster Or Weight/Ft. Material
From *1 To /f Ft. fie—_ / /� n-,l
From To Ft.
From To Ft
13. GROUT:
Depth Material / Method
From D To V 0 Ft 4-f " 2 Ai '/r
From To Ft.
14. SCREEN:
Depth Diameter Slot Size Material
From To Ft. in. in.
From To Ft in. in
From To Ft in. in
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
DEPTH
Fro m
To
0 l9t
la 1 • .7.9_<
DRILLING; LOG
Formation Description
5/c.et i.7Le'
a Ps
O
rm
If additional space is needed use back of form
yOCATION SKETCH
(Show direction and distance from at least two State
Roads, or other map reference points)
'564-
4,41
L041/
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 RECO HAS BEEN PROVIDED TO THE WELL 0W
pTrond f 0 tridi: $
,u A Trm C flt rnI TD A "'TAD l0 4 l`O1V•t•

1 3699
North Carolina Department of Environment S Natural Resources
Division of Water Quality - Groundwater Section
1636 Mail Service Center
Raleigh, NC 27699-1636 Pbone:[phone]
WELL CONSTRUCTION RECORD nn
DRILLING CONTRACTOR: rjih// fie° f/ vi/ 11F
STATE WELL
CONSTRUCTION to
DRILLER CERTIFICATION NUMBER:
FOR OFFICE USE ONLY
QUAD. NO. SERIAL NO.
Lac Lon. RO_
Minor Basin
Basin Code
Heider Ent. GW-ttEnt,
PERMIT NUMBER:
t 2005
1. WELL LOCATION: (Skew sketch of the location below) //
Nearest Town: per;,I 'fle_ County: Aron C/4sa- DEPTH
(Road, Community, or Subdivision and Lot No.) From To
2. OWNER C!#a..,c.- eatbi Sort
ADDRESS ` t ac. ac-.. elf9'AQ/
(Street or Route No.)
t�
t entk Y7hvI f&._ _2;7 ^_
City or Town State Zip Code
3. DATE DRILLED 230PSE OF WELL
4. TOTAL DEPTH 15-5
5. CUTTINGS COLLECTED YES ❑ NO --"
6. DOES WELL REPLACE EXISTING WELL YES O NO —
7. STATIC WATER LEVEL Below Top of Casing: , 3O FT.
�j� (Use " + " if Above Top of Casing)
8. TOP OF CASING IS T ` FT. Above Land Surface'
•Casing Terminated atior below land surface is illegal unless a variance is issued
in accordance with 15A NCAC 2C .0118
9. YIELD (gpm): I METHOD OF TEST RIJ
10. WATER ZONES (depth): ,t0
11. CHLORINATION: Type Amount - OZ. If additional space is needed use back of form
12. CASING:
DRILLING LOG
Formation Description
�Uerari►'rei-t
,Sfec , tY
Wall Thickness
71 TDepth�, Ft. Dia rt/ eter Or\"3i hUFt renal
From SS /
From To Ft.
From To Ft
13. GROUT:
Depth Material Method
From To Ce/C) Ft Zakgni` t4A11
From To Ft.
14. SCREEN:
Depth Diameter Slot Size Material
From To Ft. in. in
From To Ft. - in. in
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
ti
co
co
Ol P
cr
1
)..00ATION SKETCH
(Show direction and distance from at least two State
Roads, or other map reference points)
y rf R'1
Pou,-Jk)QP, ICA
fret; MLcnip
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 PROV)BED TO THE WELL OWNER.
0114 '' I /�JV)�b C/� 22 TATC
C TrIAI A TAM C nrrnMTo ArTnn /NV arear

309209
WELL CONSTRUCTION RECORD
North Carotins - Department of Environment a urall Resources - Div on of Water Quality - Groundwater Section q q e WELL CONTRACTOR (INDIVIDUAL) NAME (print) Abe 6 PO5 '/ CERTIFICATION -#GfpQAQ
WELL CONTRACTOR COMPANY NAME PERja.S.o/J ttitl` (/P.//& j, I" C PHONE sag) S3P- p994
STATE WELL CONSTRUCTION PERMIT# �JJ ASSOCIATE-D�WWQ PERMIT#
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential a- Municipal/Public ❑ Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION:
Nearest Town: 1-/11etPSbl/Ji//e County t7;•.d
/3+y - e I Lam-. rrS r_
(Street Name, NumbeM, Community, Subdivision, Lot No., Zip Code)
3. OWNER: /{'J/ `eN
Address 7o Re
�meet IYC No.)
OW Y
1,1-4 9
Zip Code
t;n)- �9l- c ssi
Area code- Phone number JJJ
4. DATE DRILLED I #t 344 9"
5. TOTAL DEPTH: 3 !!!
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO er
7. STATIC WATER LEVEL Below Top of Casing: /i/% FT.
(Use ""+" if Above Top o asmg)
S. TOP OF CASING IS / FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordance with ISA NCAC 2C .0118.
9. YIELD (gpm): .3 METHOD2F TES] &i» N�tq
10. WATER ZONES (depth): / 7 5 J
(/tS/74/
Topographic/Land setting
❑Ridge 2lope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
A13 'Zy,t n °/ a°33 2eve
(degrees/mmute�sl� Dods)
Latitude/longitude source: L4GPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From To Formation Description
City or Town State
11. DISINFECTION: Type C^ W i'/4'• Amount 7' a z- Show direction and distance in miles from at least
12. CASING: Wall Thickness two State Roads or County Roads. Include the road
Depth
From 0 To s% Ft.
From To Ft.
From To Ft.
13. GROUT: Depth Material Method
Fromf_To?,0 Ft. doac eke- g_
From To Ft. JJ
14. SCREEN' Depth Diameter Slot Size Material
From To Ft. in. in.
From To Ftin. in.
15. SAND/GRAVEL PACK:
Depth Size Material
To Ft.
To Ft.
LOCATION SKETCH
Diameter or Weight/Ft. aterial numbers and common road names.
G
y. �5 2,,ias CS /
From
From
16. REMARKS:
"Fen eferso
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH l5A NCAC 2C, WELC%i'-
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS *fC2RD HAS BEEN PROVIDED TO THE WELL OWNER
! T AY
SIGNATUR¢'OF PERSON CONS
UCTING THE WELL
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-t REV. 07/2200I

WELL CONSTRUCTION RECORD 3 0 9 21 8
North Carolina - Department of Environment a ural Resources - Div. .on of Water Quality - Groundwater Section �1
WELL CONTRACTOR (INDIVIDUAL) NAME (print) A b I /Afj�T S /. CERTIFICATION 028
WELL CONTRACTOR COMPANY NAMETE. WSO/V WEJ/ LEiIIq � ILC PHONE gag r 52-83 t
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable)
(if applicable)
1. WELL USE (Check Applicable Box): Residential e MunicipaUPublic ❑ Industrial ❑ Agricultural ❑
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use
2. WELL LOCATION. 1
Nearest Town: a C n /County�'CAJtnue
beer W(-44 00/ et" Un/1ur
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: 771 /f /'iv/r/i4 Crupcon./G/ (degrees/minute v ands)
Address di0 ebd relic C 'j�d latitude/longitude source: PS❑Topographic map
(check box)
a8R06 DEPTH DRILLING LOG
From To Formation Description
j�
(Street or Route No.)
4-__Di vile /V ( _
Zip Code
�R)- to/o S— V604 !
City or Town State
Area code- Phone number
4. DATE DRILLED / 2/ R 0 f/
5. TOTAL DEPTH: 2 YS b S 2 V S
Topogra • and setting
❑Ridge lope ❑Valley ❑Flat
(check appropriate box)
Latitude/yp t itude of wel locatio
,v'sS fl, xv tiaf A:VA,I'S'
6. DOES WELL REPLACE EXISTING WELL? YES ElNO
Sl —• b3
7. STATIC WATER LEVEL Below Top of Casing: VC 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): [S METHOD OF TES atilt q
10. WATER ZONES (depth): /r/e �JJ
sd s90fr./e
Ctietli
tt
LOCATION SKETCH
11. DISINFECTION: Type Ch'pJNc Amount 407, Show direction and distance in miles from at (east
12. CASING: Wall Thickness two State Roads or County Roads. Include the road
Depth _ Diameter or Weight/Ft. Material numbers and common road names.
From 0 To6_Ft. 6, d.$ 9,/(,I)S /PC 5DPAf
From To Ft.
From To Ft. �ceC.�j (,t,30ad `a-k ��.
13. GROUT: Depth Material Method f
From n ToarO Ft. COncetf1 'piled:,yl.en/d.Grsow iiii ae-,/ »c
From To Ft. !
14. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in.
From To Ft in. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
16. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH l5A NCAC 2C, WELL
CONSTRUCTION STANDARDS, .AND THAT A COP OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER .
�/�,(/J� d//e
`'�%�G� /SIGNATURE OF PERSONCONSTRUCTING THE WELL / DATAa2 y
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center-Raleigh,NC
27699-1636 Phone No. [phone], within 30 days. GW-I REV. 07/2001

309229
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment a ural Resources - Division of Water Quality - Groundwater Section ��[[
WELL CONTRACTOR (INDIVIDUAL) NAME (print) E//l Al �, C.VnNES CERTIFIICAATION#3/446
WELL CONTRACTOR COMPANY NAMEE AS OW 11 JL./)7) 47ILiJp, LL,C r PHONE taitab. 62 (4
STATE WELL CONSTRUCTION PERMIT# ASSOCIATEED WQ PERMIT#
(if applicable) (if applicable)
I WELL USE (Check Applicable Box): Residential I1 Municipal/Public 0 Industrial ❑ Agricultural ❑
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATI jf
Nearest Town: ,((l tJi)Jt County /�r'+aI'e -s4-+
,t4t veer
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: ).4-/ n17v9/CD �
Address (/ / 3 G: m // , q-I„ Rd_
(Street or Route No.)
/Ica..er tan t/✓,J/tom sir ai2-%9'.z-
Ciry or Town State Zip Code
Rom)- 10 S—R1/
Area code- Phone number
4. DATE DRILLED /2-3-Ltd
5. TOTAL DEPTH: .fLi /
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO 2/
7. STATIC WATER LEVEL Below Top of Casing: JO 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 accordanm with I5A NCAC 2C .0118.
9. YIELD (gpm): / METHOD OF TESTSDGt.lidq'X'q
10. WATER ZONES (depth): 25.
J J
Topographic/Land setting
❑Ridge OSlope ❑Valley OFlat
(check appropriate box)
Latitude/longitude of well location
b' J r 22.7i4 city? "ir. Y5 2'
(degrees/minutes/seconds)
Latitude/longitude source: 126P S ❑Topographic map
(check box)
DEPTH DRILLING LOG
From To Formation Description
.-77
fC Scut/5brC
�L n a`[.
11. DISINFECTION: Type°/Oratt- Amount /i 714.4s
12. CASING: Wall Thickness
Depth - DiaMmeter or Weight/Ft. Material
From 0 To 12- Ft. 4✓ZT ,'6712/ /CCd -
From To Ft.
From To Ft.
13. GROUT: Depth Material Method
From 0To ad Ft. eon62671e. aid D,in/!i
From To Ft. J
14. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in.
From To
15. SAND/GRAVEL PACK:
Ft. in. in.
Depth Size Material
From To Ft.
From To Ft.
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common road names.
/2/9 X' is tr Cci- •
y-endr-rsowu,-/(c NC
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
ZuA. Z 1/ z �— Out
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<- -
'V
at
EA
CT-

STATE WELL CONSTRUCTION PERMIT#
(if applicable)
309238
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment a Ural Resources - Division/"�of Water Quality - Groundwater Section ? �[
WELL CONTRACTOR (INDIVIDUAL) NAME (print) lathes] h, C.L%i/Vss CERTIFICATION #.3/T'6
WELL CONTRACTOR COMPANY NAMES asiat/ (r( fE// /J/t////ltq, �,` r PHONE iia31a52- ((r,
JJ ASSOCIATED WQ PERMIT#
(if applicable%
I. WELL USE (Check Applicable Box): Residential 0"-Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION:
Nearest Town: 41.7fl(t� v.r/IC County /4/1 Se i
Wowilyn (.rhos Lem 3
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER:
Address
-J'o do %. AC/ R
(Street Dr Route No.)
idrrtdrv,7/2_ /)G aS?fl
City or Town State
Zip Code
)- ?a9- 999a,
Area code- Phone number
4. DATE DRILLED i/ -/et-- off%
5. TOTAL DEPTH: .fir -/
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO I7
7. STATIC WATER LE VEL Below Top of Casing: 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): I2 METHOD OF TESTS ✓ J
10. WATER ZONES (depth): 2,0
11. DISINFECTION: Type"' /tv.^. nt Amount
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
From To lrk'' Ft. t./2 £,-M't ,7vc.
From To Ft.
From To Ft.
13. GROUT: Depth Material , Method
From 0 To AO Ft. CoNCecde. ?Q/1P/n/y
From To Ft. J
14. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in.
From To Ft. in. in.
I5. SAND/GRAVEL PACK:
Depth Size Material
From To - Ft.
From To Ft.
16. REMARKS:
yTopographic/Land setting
Midge ❑Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitu)1e of well location
A)3K°zt/.e 3/ bore Z/. 711/
(degreestminute�s/ econds)
Latitude/longitude source: DUPS❑Topographic map
(check box)
DRILLING LOG
Forgtation Description
DEPTH
From To
0 - ) r
rr-co
4 -
r4/7
Lt.. *
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.
too StIN
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

30Jz4I
//'/7-COS/
STATE WELL CONSTRUCTION PERMIT#
(if applicable)
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment a Ural Resources - Division of Water Quality - Groundwater Section ? �[
WELL CONTRACTOR (INDIVIDUAL) NAME (print) lei r%JJN�// //I �iq/�S CERTIFICATION
�($3/446
WELL CONTRACTOR COMPANY NAME E /4SO/v& Ja//Tbzl/i/A1g1 �r PHONE i8 5P-8t%{t
ASSOCIATED WQ PERMIT#
(if applicable)
1. WELL USE (Check Applicable Box): Residential unicipal/Public 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION
Nearest Town: Ce 4t_, (�»f//2.
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: 'RA-rL7t¢/2q 79/9
Address tY
(Scree( or Route No.)
?gender-56/rv.%/e /rC ag79a
City or Town Sigte Zip Code
O2$- 6- a/
County Z rr�a -s:•>
Area code- Phone number
4. DATE DRILLED /-/7 -Ott
5. TOTAL DEPTH: 3rr
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO E
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 aceordanig.twith 15A NCAC 2C .0118.
9. YIELD (gpm): / METHOD OFTEST
Shidq' .'a
10. WATER ZONES (depth):
Il. DISINFECTION: Type elezi jK-
l2. CASING:
Depth
From U To AO
From To
From To
13. GROUT: Depth
From 0 To A Ft.
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
Ft.
Ft.
Ft.
Amount
Wall Thickness
Diameter or Weight/Ft. Material
G.' e/ s/J.tlri f c—
Material CoNce ie.
From To Ft.
Method
'Olt 2/iv q
Material
Topogr is/Land setting
❑Ridgee Malley ❑Flat
(check appropriate box)
Latitude/longitude of well location
r'i2. L.7r rwCfl72&) 7Y5'
(degrees/minute onds)
Latitude/longitude source: ❑fPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From To Formation Description
O - 12:-f
/Yr- /to
/50
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common road names.
N see,t/j c e / -
EdNey invie £C.
From To Ft.
16. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRU N STANDARDS, ANDTHryT 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.
Y GW-I REV. 07/200f ;

1FPI_ .1 Ct�N5T1:N 12LC ELD
309260
- ••I � --r u, tl, .:i bo r3u1,cru :Hid 11 '.: raS] �iv 1 -i\�'arGr Qutt
14
• .i W.. xivX ,-_i1C...,^i ccS o/✓ _.Gdic<L--,4!F'/�Ll..
C,Ionrl(w lcl Scction
LCfTIRle:'riL)N H 23
e liON C y i;ASg a 5 tl-S'Vet
.-.SS3LI- r121) WC,) PV1R,
l:1
:-.::.;ip.: LP.,b G4 1.1 IrlauvITwl L7
cr nU:Gu6:, I] Cnc�i L� Iri_,nccr, List L1
.:. Il.Ji4 p
t X o ccb 11 ", 9t7- Y
,..:..- .5:...:.., co nl:uanl' sucilrvu,.., LA, rl C:., �I' 1 4.1
7,17
O&- 095II
m, c:a L .r MPS�17 f
• ,1 L, ,Ir; 3335
ELL L L 0EEXISTING WELL'? YES ❑ PIC) L1
• STATIC. 4,-;IL]'•LEVEL & Dry Top of — /S
(Use "r" if ADO).: Top ur C„Ius1
F'1'. „A.Uarc LanJ Surladc-"
-1'+p:I:_::nU,-nll:l,:a .:cal' 4,1u1r,9n:i SuIr cC,,u11-
+. -,uu ,i- VC.-C2C Mild. 1
\1EL0. L:-:;d411. 3 METHOD OF TEST: �faJtn_
. u. AT-Ll�.;CN 3f JcpLcd: `0 JJ_
.. CIS,irfE0CLCTh, 1`fp:CJ0 r
KoldooL
— l-:a _i A'G 114,11 Th 0.'li,llci3
,
L'nani,rcr Jr Ati:yhG Fr. iYlalcrnl
I.'
oft
F,.
:s �..JDT
. t,n- pJ FT.
▪ IJcQ1 Dwificl;l Star 512c
Ia. In.
in.
m.
. .oa'. 1'3_
riot T.) Fr
Ls,
ictdn,ral ❑
Topogrru tiLand stain-
Lofidgc 51.,po ❑Valley ❑F].i.f
(ebcc1:.,Fp,opnurt box)
LµIirudc/Iongm,de ofprtll location
wiocl it y�.� �._rti ^L/�
DEP 1'PI
From To
5/
Lacyrcu:rnin uicscconds)
n,d.;longiluda soiree: a" t'SOTopor.iphic limp
ia,ccl: Dux)
DRILLING LOCI
FJrrlaclou Description
_Dirt
=SOS
Roc/
Cs -Pa nil )4
LOCATION SKETCH
Show il,rcrlon and di3Iance in Irides from nc Itasr
i++'o Stare Roads or Counry Roads. Jueludc the rood
uumliar3 and common mild names
rvt_ 70K /l�
;ct i ,%f l! raja
Ib cfla�& p IN'll.,il /� / ,�iI7 , NC
llilcr,al
i}I:Iresul
DO rtRc5\ RIIFI' THAT THIS WELL W AS CONSTRUCTED IN ACC0tW NCE WITH Li NC.AC 2C, WELL
CONSPI:LIC11 v 31'AND -RD3 4.-ND TH.:T A COPY OF Puts RrC01LD HAS BEEN PROVIDED TO THE WELL OWNER
S[ON.. int o
R$ON CON3TRLJCTING�ELL
63LI11L L11c J11'lltal rJ IR' DI11)IJ Ii-J[ li'aftl' `ualirl', Gfu ulldlt':l cc-ScClj Jfl, (636 Ail
Y 1l-1J 1'IIJ IIc .Ao, Li) '737771, 11'1 CI11113U d a )'i.
DATE
1 J'd'vi,;e C3iuci' - Raleigh, NC.
GW-1 REV. 07/2001. :;

1/4, 11_1 C't-)INS1 PLC I it" 11.4-)N REI'(.21,-)1(1-)
3 0 9 2 61
DAVF DRILLREI___60447._
V
Topogri-watitc/Land scaing
DRidge Lp& fa1/411cy C1131.4(
• (encel:•lopiapci:iit box.)
Latiruidd/longirude>cif \von IOCI16011
4t sS ° vo i[rAi nil az 4 7>
Lacsi5cconas)
numhtflorigt rude source: ?It.tDSOTopoieraptmc
boX)
DRILLING LOG-
-
Formation Dacription
.31 LIN ircnirrizoi ii.UN,iui a i ntrit-a.L1 1)1W41-0F - SCCL.1011
by /1./ VC) f) OCE."r1Fi04T1oN H..,ROAS
-.N N IQ reditCSOAll Lida- DP-4.111 'Ai fti3N Rag a •C t'IZV4+ L.1 I kocnCiri AS3 WQ yin •
. IcssmsEttst 117.1 inchriirrica 0 ••-siculn.tral 0
•-•••;•‘-'•••,- Ks0,••,IS0 11•01 •••"71 Other. List U1c
cis-514*We c3Wil 1‘ frAet irtre,
CO
4-t ?;4156
.. 0.).1111”“111). SUL.,1111,1“11. L , Zip
iZierai&i• P
ded-3047/1//,e_ /yr asalz nf
36-.14
,152.43__Ja2 - Ver cf 0 - 419
4"C
far riRpcki (Ss
f1JES VI ELL PLACE EXISTING WELL? YES 0 NO LI'''.
SIstTli2 ILE'vEL btw 110p Casici: 2.0
T3p
CL-i.SING IS
r. r.uoycL,14.1 '
bo..4r 14114 SU iscluir“
ya.••,;:•:•;• wivU 15A_ >ICAO 3C .3.1 is
.l. 11 ATER :ONES otcpiin:
1E14; L,I;pia-t. 2.0 -NiEl NOD OF TES F13.11/1)//ii
Sea
Dilar;t1:1 3r ‘AR.&11;1:1
tcf 1,;•__IL Fr Allta,A3
FL
s•••)61 F.
• • s.
.3 ci;ROOT 4•2<ps;
LOCATION SKETCH
Ell3IW direction and durance in miles Irony ill Itt3S1
06,3 SUN, Roads or Calvary Roads. incInde trIC road
iitanth,t 3 and common road IlculltS.
Coc4R, Yiew Lef1'5(1
Ale* d ers .041 071e- . /KC •
[i3tIL
FL CCSC2C&_to u
1-/ SCREEN 0:pct D.4inctcr SIal Si2c. Mao
FL'1/43,1:
Fl
L3 ?
Dzpui Si4c i414“i4I
Ft.
Ft
3LE,11.A.rcKs
CiNs, ICE 0 • 3T—RucTING THE WELL
ATE
LI7il:1 days.
rric Lac DivRion Warcc Qualiry, LS nrithyaccr Sccrion, 1536 Mail Servica C‘hirci. NO :7:1
i99-1.cao ito tic �. la) 73332wivn in 3
CW-1 UV. 07/200
FromTo
D3 riEC3EB1: CET- 'VERT ThIS WELL WAS coNsTRILICTED CC0tWijNCE WITH 15A NCAC 2C, WELL
CONS IT UCTIQN STAND.A.RDS, AND THAT- COPY OF .FH IS R_E[2.01H) HAS BEEN PROVIDED TO THE WELL OWNER
CON

3 9 2 6 2
..1 U iuJ.sL - 1,1,14 ot Wator • araiinawi 2C:C11011
i JAL.: ebby /-22-th ocettrivititerioN m,20-12
L N--.11V jersua..ip_eci . 0-4,742a4.,
ri)itnilLit
ASSOC:I:4:11P I) W() PVIL1414-113,
•L:2_:_ Inautiatit31 0 t‘gricuIrt4r3I 0
ic.7.4.4-mt-r) 2 Ji3i ?tamp \\MCI'tfljcLI IJ Otio.7.1 LJ imitcr, List lisa
or:hie, EISIspe 0 ValltLy 01:14L
„„TAs-pographiottand sening
--1-404ACIVES_At*e___. zot.2% 7____ (erica appiilliriiiii: [taxa
A/ 3s a
Lthrucknonglaidc 131/11.0C1Iciall
Z3,/tiii teiDste 17 i 1%3 Sr'
- ,-,..,...,,,,,..,..) , La opiLlEiloppi ii4dE SOL/ICC': elifIDSOToposcaphic• map
—ECOde/3 On- vatic_ nc a/97ga
_ DEP PF-I DRILLiNG LOG
ielicel:IWNI
Si-..ii; , —ill i...”
&in_ 4t732, 0/77 Erorn To Pont -Eldon Description
(,) — AS
,' 3 ATE EtAILL4-44D__1,a,3/4 Ji____
.' ICI ^.1. fir P iti 5/1 — US
s CLISS \ \ ELL I:LS:PLACE EXISTING WELL? YES Q NC) 0....."--
LEVEL Eiclow Top or C3S1tibt: 241 __Ff
t Di,: "-r" it NDO‘ 4 l'Op 43131.4_4t1140
C. -.SING 13I_____ Ft ADO 4 c I.J.031 SuriaCe'
4 I,p ..tt p-4tp; 11M111.21.1;[,ur Ocbrir lath) 4urfAct I cq ullcS a N... d.ait:c tii a...a.1,1, vnio 15-4. Ne4..t.: 20 ill id
\Z 1E23 y..;p4ai €61" t i
LC, , \ AYER 2.0 r-L'ES ,,icp1.11). ME PHOD OF TEST112/414,,,..g.t-A
- LEI
zoo'
, 1-.--- LOCATION SKRrim] - ' 011\ft:C CIOP\ r)PILLLQ_At" 41W,...a,___ _itiouni e 0 Z. 211044' etItIcelitin :mil di313nCe in mileS imill PI'
t2 CASIXLS4 lc:1M
WAII 1.1114.11C13
C'Ciicil IWO StAc. Roads or County Roads Inth
clude e roud
- Diiinmcir of iiy.;i0ii.,Ft tviaic, 1.d 111.11i1b01S and 1.3011111T1011 road 111.11111C3,
fc:c.:1.____Cl__ P:__,3,0_, FI _at ?• 5 alizath_3 __c_zoitel/ toe/5 ocat 74.
,,.
., ,i‘t_li D-PHI N'iJICCIA1 FaCinkhl kit 1:1 4,5?
AI Li r‘ilit--
i t 4C3 I.j, Pc Feliye,Ville /7 C ..
.,- -
,-, sc., T R i7N LiZ,-..C11 DIJITICI41 f., 131 SI::%; M1.114:11.1i
c'' ,....11 f 1 in ill
i) SAollachAtAVEL PA.CIK.
Sv.L-Lio
Sti.c NIL:W:114i
r wiz: rj Ft
...
4mm, i-, F;
LEI41.-,.141-L,3:
zs 51)
33 ri3i(EE1 CER fin -HT THIS \YELL WAS CONSPRLICao IN ACCORJD ..\. NCE WITH litk NCAC 212, WELL ••--- ,--
..:ONSPIZOCII3N SI -.ND kal)3. AND THAI' A copy OF PHIS 1ZECORD HAS BEEN PROVIDED TO THE WELL OWNER,
2s--
s oiv RE o [dor., cciriarRUCTIlier THE WELL D.A
LE LIM tit: t.,ritil.4110 if:L. IM.I1011 01 \ V .i.fci- Quality, 134-oLloLlo acct. ScEriont 1.63o Mall SeryiLte Cz-Ittor - Rsicigh, NCI
diOrIC 2)0 4V1j)T3343-12.1, tVirllill 30 dAyS ,-,
C W- I REV. 0740 I

YYFL1. DON--; rki !ION RT CORD
-: a „itill :.,Ir o J J N,: orals ,,, --Dive ofVeV:nor Qupliry- Oroundwyarcr Section
sLL Abby wr ;oftJ
CCl 11Bi0n'r1QN it,f2DIS
: , cr Eras EL-1-Au 1n - nc>J C lellLD N'Q trail -
re
gam_
c 'oP:,ssol 6'-;i- I:as.- ,al 12 nl... dpaL-PubIo 0 Inru9 rtalq
.—r 3'.e0- 0 Baal Puny;:I.-Ifjc uao Goldr ❑ L' Other, L:sr U3c
elet_cdorit Yt a a7
eh Tos$NUt 9.jay
5.cm, town. 1.OP:i.Y 1. VJ:I
::. _ <c. (altarcc
j0.w Zlp Cud
rnanc::., nloc:
D;`i L_ll
fO(W0%
,er-:,Litpl.y t
\`, ELL P PL:�CE E\_ISTING WELL? YES 0 INJ l'J
1'dTiC 4'y <.TPR LEVEL Echow Top or-CSsing- 4U
,u;t.. a.ap„e'Cup urCss:n_,
Ss 1 3:P JJ• CAST —NC is
F'1'-r-'.UJrc Lana Sufi -act'
^ 1.4 sr aa:m; mrrnm,rca a Cur bakor Ia'1J iurr.ct r:quires -a
"a inuh raA NC i7'_C .W Is. _ � � �
' 1"-IEt' , I. ~in METHOD OF TEST It q
. TER :v j r 7cplbl: AM �
DISip,Ft_C'itON T}paC/op4vc.
iI\'3:
;rice lorral L7
Topogr rppll l iLxnd scrring
❑Ridge ancipo DValtcy DEW
(chair!: upp opnule boA)
Lurirudc/Ionginide of well location
Nss°AO,897. WO ° /340
(:7cyrc colour .onJ )
Lnlludrlangitudc sources: eltr.P SOTopodraphic nap
DUN)
DEPTH H DRILLING LOG
From 'To Formation De eriprion
Dlpt
37 - Rock
Y7. - YYS G-ran; X s
0 — 37
ppqq Diam:mr
l/ p" va F[ 6, X.S
Fr.
Fr.
.3. DLT D:p,,,
n9 J[cnul I`AClnoa
�:,,___Q__ 13 a o Fr. C J/YC2c e.
f0unIn
1:Jm Ta Ft,
D'-CICL7FN Dc:ptll DI]1$ICr SIJ1'ii? c i11:113nal
From LI Fc inin.
I,i Fr" in. 111.
L:i SAND.. C3AVEL P-.CK:
DcPi" Sac ill:rcn:,l
I
1rdnl TO
ro:n
sr'3111 r
:mount jAoL
1Vrd ThI34,ncis
or ',-V huFL t',luren:d
.1/b /a S + aaa�
13 RJ1 I IU: -
Fr
Fr.
LOCATION SKETCH
2hub, direction and distance in miles Drum ar Icar.
os'o Sere Roads or Couory Roads. Include Ihd road
uumbar3 and common road names.
,rend.erSop. 1i
DO riEREE :3WD' -MAT THIS WELL WAS CONSTR LICTFD IN :ACCORDANCE WITH 15A NC AC 2C, WELL
C ,NSTl:LC1JOjN STANDARDS AND THAT A DOPY OF THIS RECORD HAS HEEN PROVIDED TO THE WELL OWNER
bs
11 yoev�
.t0}• • RSrON CONSTRUCTING THE WELL D.q E
cDro r tnc Oct ival m 1Re Drvi>ion at Warer Quality, CHroundnarc-Scerion,
a.i-lo3o :hunt 'W r>19) 733.J1:1, wi[ttiu 3U day.
T
I63o Nlai( Service Ciiircr - Raleigh ti C. ,.•,"r'..
GW-I REV.07/2009''>
6.a

11 b'LL C1 )1Y9.1'1.11
� 11 ON 1.1-C u i I L ,� II i m r vi CORD
� .I Kc �-Di
� 656y �V Nil ll''uror QuuGr,.
ri Y tk 141111,-y
71-f-3
I,'1'CG WC) PIL'All'rn
1 tbl IF 1 ::1 1 IlJ 'u0u 13�p<1111 1 0J WILT.
ic
1'1 Il<, Liss
t U>
° CbyplY &nice:Ad iv
CM SOct ti/M4oLnL___
(�� e_ �de�5o�1 �11e__-N �_ l
` L :jr G2/Qyi
i
31 CIS 1, < 1I h L;CE EXISTING WELL? YES
LEVEL b low lop 0 __ �.
Jf C-]3L]g:
—_
OF
I OP ( .SING IS _ (Lis. r oar. l'a, I _L 7
—�� I t � I
1 T
, }'N I L.:, ,m qq a(' ur b l ) P la fT Lk) t.alid S4flj�,;''
1 1Fy-r'i lruo 19 VC=C .0 J1 - `4uo-wa
a'
ir.�lLR_vivc. 11lEY'HOp uF TES T r
•
OISINFECTIO-
yp,
IV dl'I I)mLat,.
F r.lat5 a/bt a-C-5-408r3
F1
FL.
hl af<flal
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Diarnctn J1 y1 .
� -Ighr.Tc A1.11.n;1
, fIJ
CI F(,-C__ZiCear- 111CIIl0i1
o:;;rll
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�_P„ 910[ Si^c
i�i h1lu. ly4rt.;rlal
m,
I 3;.rdp:v&.*A-.EL p. FL,in in, _
o ,I;
1C �ilutc1IAI
Fr
f
f r0111
I a. :i1d
CO3 PI1ZEJ Y CERTIFY THAT THIS WELL l C17Oriv S1.,ND-:GG3. AND TH.AI' A
S f0N.-: iR G
s“sn rl rn: un uul co lac Oi; iiiun Jr }"ACcr
(lib) 733.3771, wirifin 3U
.'.S CONSTRUCTED C
COPY THIS N tk'CCOI'rll.
OF ILECORLEN EPROVIDED
WITHE D NCAC ? L
HAS BEEN FRO i
Ell TO THE WELL 0}VIyEP.
T aR.N(20H3ITYLICTING.CF
ELL
L nahrl, GrOlnia. p TE
U4)'S,
309265
• OCDOndwal.r Scc[i3n
clrrF1'1c Tlon „20,53
y ury4 43(.44.
1g'riclllmr4l 0
pognlphii::/Lund St [Ting
Rids< ❑31„pe OValle
(uhcek .lppru Y ❑F'laf
Lalirulc/louginl lc al w hl l
,v O� T wd!0near'ion
o-wrr y ,
Lduludc lon o Idcgr “: Rnu wcy -; ona ,J
g nulo sourL c: ern-PSOTopographic map
11t Pl'H pyiccr bo.v
Fluor PTO DIULLfNG Lpit
Formapon AY -script -ion
LOC.{Tlerl Sk_
11 w dlrcerio ETCH
n `rnd dlswncc in miles hone ar Icas[
nwnhcrs and'eos or County Roads. lnclildz the fOdJ
mm011 r0'1d nimc..
Core er 1.rf,e
fle rf S
1636 &Iuil Serviac Comer- Ru1Ligh nl
CR'-1 REV.07/20.0E
Ks) ri
v

\\ L'LL Lam, N`iPRLr'
ILON
30926f
an I IL:.0111r1Cril j.u
r�.LIA ILL 1_ N lli (i -, /� al 1�_%Dlr: 1'l�lurcr
'.l: u,, ./_1Vq 61/ ,V 1 p Cl)pJll lJ(OIIpQW9 .-1.TI NI/
.' IFzrl V+TII fer— (al
� / r
-- _�__ .L'P.1'If'1 C.gPl ULYN'
tLltllt l'- alr/� p C �s
0 Heal I AC il,,:
!lJ'Ol:uu 0 100o:inLA -
Gnccr L7) � .3sc:ndnlrxl
I L
urhaLi. Use.
OP.id pographic/L.nd semis
5 CISIspc aValley ❑Flit
(tl 1 Irl ropn Ic Fox)
----k.Lach na� Lprin A3ol inl lc of v-ell iocaf2
�h a;:= m, �'—''New 2 layrcCsrmwu.c VIve
C4�p, �� T"\ a x 9 6 udc Source: f3 SL�Tu �i
-_ice /, , p'v L..e. 1'II}� I I r. Lo.�I P raphic m:/p
y, - From 'o DRILLING LOCI
I 1 `1, 1 ____CLon
1 l L,InI� _ 9 g�-- �ln�
TIC 1:.,1 EXISTING WELL? FEES NO ' 1
LLYELBoWw Top o(C351n_; I
Tel_-�L2.___-pl
OF
C -.SINS' U I� ` r w
J H I Nuf LLI
P :al;q d WurG 11 ^dac Litho 4U(1]�.,"'�--
q:2 su f
> Y!tiL1:.=�O:LLi,f ,.. .: Into 15.-. Ni. �:C w ls. 'juiresu
Ill -E1Z_CicEa
cpinl, _a__ 11LET110D OF 21z4240 _
013 7r p, T}p,r
iR S2 11 omtr q+,, LOCATION S
R-�`a'_ Shun, direr rlo F_E7 TON
p� 1,-Pm Wail I I:Ielar n snd Jlsl./ncc in mile, from 'I —6l_ I.. q'S I-11arncrdr v. V. IWO SC:114 Ptoo e:1kfl:1r
I o'�_ Fr. ' $..11ij Jug �. _ . I'9 and s or Comics' Roads. Include Ilk marl
:r hi �ii FL `-a -n:J uumdc
N.JOI / common road 114177e2,
LrLpl�1l ^
J:iJ "`'�-l� F a 19[crlal — r1 'd 7y �¢� / W Q
�— I. r nlom u / �+I tQ<CejZ.
ai'F=Ri,\ PAIL �cA�i erSo N U .`� e n
spill \
(lai ,1, J191rICICf
ilJl S2c 'N.'
n li— Ili
I.., Si In.
n,a3&.1 EL I' h. in. iu. �- -
h` Size
^rani
--�� FI 81�rcr:al
k.
iskatrt
n SPU
13 1LEI\ 1 :IL._r
;DcI ri 1zEb1' iE,lir�rtITH ,wrksLuN>PiUCILu IPI riCORll:men
L. WELLi 'YU..1C3ThNp001r O FgS BEEN PROVIDED
TO 1•}I ,
�rvi� B.t O .+"��E 5-I ELL OWNER.
I"'r E(r 1'NEI. �
Sw11L1 In; :) M CciNs.r LJCIING C
u rl'uul ra Inc OlWiu❑ a THE WELL la �>
•70i> v1u r'IIJn Of I L TE
rl I"ISJ 7i1 J761, n'I1IJJn 9U jualil , Grbundlsa CCP $cpC1u0, IGjO1,0
d)'' A'I qil Sarviee tE9
Cznr=r-R leigh,V•° NLUt
C1'V-I REV.07/20-0.

vv t ii_ F 21. OLiD
ul w nil b-nlciil a1 :,II .�urcos : ri: 1151' \Y [or Qualirp - OroLino3lcr SC.[ion
=�w
1 N ,1f it Abby wr dff� o
/� ,- CLl l lf`1 L.1'PiJn x s
rr c jrC_r544 or✓41.__.rd1�l/ 7?eLlfN5 _• 11Rag a41-2
YHJry11
It21lJry r Lit)it '.. '(i�Li P4� AVQPPilch-11'4
tr.rl i:.cl ❑ Indusp'iut
..". -� ul' ❑ 11 al Furrll 1-acr lglc a r] lJ '-S'r�CtllNral {]
n lei ❑ II tlrncr, il: Ll,c_
r�nty0//% C. w1,1•; fildareares
/RpW/C4uMtAr fist
:v,....0 IWluilnA'. Juwlyeaivp.
,C/1PA2A
N
Topogr 1phle/Land scainy
01:1dgc aSlone ❑Valley lac
(chc I 1 prupri;4tc box.)
Larimdeilongimle of well location
L5u nuldrlon g it
OFRT'H
a� a —3 3 Co 7 Lip Fram - To
v89
1 1p,j"r' Dr:if l LI',
f0IAL. LEP1'N
E:ES A EL L I ENLACE EXISTING WELL? YES ❑ Pl, i
lc—
•-� Tp�A: IT?. LEVEL Eclow Top of Casin_:
of FT
1 U;u .. 'lrnoa,c'lap ufC.ulni;
Jl' �'_Sl':Vu !S �_ FT �. ba sc
°M - n mid tCq .:[br Gclulr lanai rra.v :q uirea a
,rile IJ.i .VI'i:?C UI IS
r
,:NE
. " /O EIHODOFTEST 1i{,tar ,to
DI :NFEC7tJi`. T oc �i� /n n .:.�
:llliourn �A 7
r3
\\'nlI'I'I,:e LJroes
��rrn Dla;m •r-r3111V:ii41111 Ft_ . amml uumbar find common road mews.
tacvmuylilcsrmcm,de)
do sour-:?fl. SOTopographicmap
ti GcC l: 0081
DRILLING LOG
Fonnation Dc3eription
/mA. S%e /
:raln
L:LT Dcp:ll tIumn:n
t`tJit1�� Fr aJN r
ni Ft.
If nL Jtp(Il
LiOgl I'-,.
r re'.❑ ____ ib
r.. ;11: :ELP...C:K:
Dcpltl Sizc b1JL rwl
tvm:'. Pa Ft.
El nCcridI
! a. FlEp.I ELKS
Q lmlla C( Slat S14p
F[ a. in.
Ff. in.
LOCATION SJCE'TCH
Shaw direction and dislance in lridos from or kasr.
two S11.ite Ro:14s or Counry Roodsinclude the road
7qppfc,(-4.-ht-ry es4.
�olna-5n • C
I i u nEI:E}3l I
;1 !pY T11IS \YELL VV a.S CONSTR LIC3 E 0 114 A.000RDANCE WITH 13A NCAC 2 C WELL
C.N PRUCIJ V S . NL` LG3 =.ND THAT A COPY OF THIS RECORD HAS 2E.EN PROVIDED TO THE WELL OWNER
N. IcE Of.'FtTvcN CON3Tlt Ut:T11Yv THE WELL
al..nn rr1, U11 II141 m 1t. Di: i;ion of W❑ror Qu4Iiry, GrOUlldvI aver SGC0o11,
J-10,i0 CI One:\0. l-"! 11 J�•J::1, Yrl Cll 111 311
)
1636 Mail Service Cenrcr - Raleigh, NO
GW-I REV.07/_204
c5 i
o
0

WE'LL I -110r r.hculu)
ui : :1 L aim: t 'IlJ Iv ,iu: 1 j
I u .c -Lawl-
1Cj
/� , 1I �Ti�'paler Cu;lllp - rp Llpolyd lcl' ScJ[iJn
. 0\ _. L11.14U 1 Y dlL _ ,lei))., &6C.y Jf rf / !
11Y.�rvl Y lld ftriti—SQevLs CC 111h1Ld'1'loryr ��
JJLL_ �'tli;Val �v p p PLC22 y
4.
S>J2141'I f: 15'Q 1'tl',-ni LTu
cry 0 lical Purjp 1A::wr
DD
n '1�
309285
LP. q loth/ n'ial 0 crdalral
J Odic] 01 11'ilnc�r. Lis'Uac
,?'E RILL _ r, i o c(
,, 1 LIErIII ----2es__-
2 DOSS 1 EL L LEFLACE EXISTING WELL'? 2T_S ❑ iID fn..----'
L,_Cic 1 .;:!LB. Lt-vELbaow Tap of Casiag
I C1) 1 L SrN6 1S �_U>. . b as Ito urL cc -
up .n - , o-rmwiz ma ;;Cur ccl lrIturd clluircaa
" '"f9 truL lJd VI'" CiC.Jl1d
-2,0____ 111E"1H OD OF TESL ' L
I, OFER 1\E> L Cpini_ 6S' fL: TD,
Topogr I lie/Land scrting
❑Ridge 2"211E,pc OV311cy ❑Flat'
(Chca n rmpria(r I'a )
LahrucH/Iouymldc rI A'ell locd IUII
la<gr niuy%v, ,onds)
Luufu do lallgI[o de SO4r_L; LDSOTJ o ,
p raplu; mep
l a,ccl, oox)
DRILLING LOG._
Formadq❑ Dcieriprioll
1/1:P'fH
From To
yYie
- 1,1 IH'- rL:!�1„ T.1 p"
c/+ /„ r. ' LOCATION SKETCH
O SiV '-"°.�rdCS., . n -unL __S� �_ I:J,v direction and dlla snct in miles 1'rcm or Ica3[
11 dl I I 1 I:n�,- L o Sr4Le Roads or Coonry Roads. ioelude the road
'fn LianScrcr o111
',"�_ 1 J - hr: Pr. A1arn,l uulrrGus and Common roodmutes.
[. FL Gr.— _ 3LL+.1___ }�VSAQA/
mwr' _ - F
.3 .:..OLT --
'ICI 11'I:IICrIAI
I' 1�61� A9dnou
-�LZ FL C-./Yrlo p_
ln T,; ►or�n_
lulnalcr Sbr SI='4 Motto-GIEr
rJ;I!
Ft.n.
a.
r
!a. :P.Lf`3.
S'-'c b15Ln:al
Dv ricl�cE\ �IIFI"'l CHAT THIS WELL WAS
CCrvS S.:,EBY NRYIF1 U. p:r . N CONSTLUClED CN A CCORDANCE WITH l5A NCAC 2C, WELL
D THAT cOp1 OF THIS RtC31w HIS SEEN PROVIDED TO THE WELL OWVNER. CN-: !RE OPT Cf 3uN COIYSTRUCTI1 O�;LL
Lauilr rnv ul I irr.,l ro Inc DirKion or AYarnr Qualu D�'TE
"9 lolo elior- �, p. Hi)) )� J."')': (Ciro until+'artr Sce[loq 163 ri p9 ail Service Cmuu'- RalcLbp .1, Irnniu 311 d9y>.
GW-I REV. 07/ E0I
U
0

309290
11 1211_ N";fiQI rI,)N
.:� ut cGi art : 1 nc-u a N,��ra L_. Dl,i^ : rr Wamr Qunliry-!Ofoun01Y4Lcr 3ticrian�t
L\LI, IUU..L �',1< il: eb6by kir Tofi�s C4l1trich.TIi)n n�Sr�aR
', ur.nt v ,IE ftr jGS�ON,�_ z/i 11..dh . rHL)ne y RS a677z41l¢,
v
'� lL iiV t'ClLillln 55ii i'L.'I'LD WO 1)21 At19'u
ial Id i': a,,.: L.dp, L'P„Lli� C1 I i3t: nisl 0 .igrk,dwral ID
I,r rnj:auG i ❑ GLhci ❑ I(�JIher. Lit Ll>c
MC�£cIncyui/% "� frrn�fiSO�✓
QA/S lamfr Cnti4 /o?' e/3
n.....-aur�wwl' .0.111J4 . 4l fl:. Gip Ca<cl
R /era/er/ic_5_
r1(3.4,c rva)
Lr key iYc ak73 a
Ludc
- 7.1-E p a L _ f 0,4V
13rI_7-L DEP I Li. 2_7.$
7 :IDES1\ELL ITLEILOEEXISTING 1VELL' TEs 0 t
-_TIC TER. LEVEL Hi:low Top di CiGing
yo Fr
is. "r"ir nop, c lap �r C+cui81
!. DP OF CASING' is FT 7,bO1'c L alit j41'19i c n4or Gcl ,r laud iu:'f+ Irl uir ca
7. YIaLL t�pn-a: fop METHOD OF TES -P Bti , ;ai._.g
J "
itsTEF _0\'ES 7V
Topogmphie Land setting
❑Ridge ❑si ps EICLIcy 0Flat
(chc I: oppiopriait bax)
L itini1c/Iou,itnde of ell IO2:1110I1
lacrcca. mow cL>-cards)
L oun:dcarnipuinic derma' eritiSOTopographic map
,chccl. ID,)
DRILLING' LOG
Formacwn Description
DIE IH
From To
C� — /07 bl��'
/07- /0. cif
LiISIivFL�.., _ , LOCATION SIrETCH
arvi:
L..-pm Doan -cite"
Frain _!b //a% Ft41?.5
r.ri,r, PG' F1
rom ____E.;_ Fi.
.-imaum 6_L Show direct -ion and dislanca in miles from Ar Ict
1V:111 TlacGnces IWO Slale Roads or Counl}' Roads. Include the road
or '6 ;'sheFt. i,aarn.,l numbers end common road names.
2,4 11,3 PVC imiev
hieRdowS Lew isCAetrc.
Limet/ uNC- I-61M/3
1rlarcnal
1. at--Q.— C-C212 _ Fr.ail
iriinli (u Pt_
:T ECITEEtt i`'—
M.,nll Lluln:Ipf
Ema: I'�, 'Wr'i2c LT/acrid
F[ ul in.
Flin w
o
EL P,.Cl1:
ail
ma,
.o. _.EAI_7.R}_j_
tatietfrt
n Lcrnou
S;<c dIum rul
Fr.
DO BEFEE\ CERTIFY TU PTHIS WELL W ^,S CONSTRUCTED IN nCCOI(DANCE WITH I 5 A NCAC ^_C, WELL
u NRPI:UC71 lv STANDARDS, DS, AND THAT -. COP, of THIS I,LCORD HAS BEEN PROVIDED TO THE WELL OWNER
SIGN-i Pit 0I-r t11oN CONST$UCTING THE WELL
:. our Cn: ul :3iva! CO tRC Dif Rion of 1Uz to Quality Groundtt"a rcr Seeder, L 636 11)1a
i 10;o f+w ..a. hl Ir 733-3:21, reitrun 30 LUys.
Service Canter Ralcign, rye-
GW-I REV.07/201)
•

\1 G L L tTh t) ;N 7 R L }cm' ION 12,.1.1tc (r D
309291
. u . al Jr Lr rn-nr , a a .1 1 r. c- - Divi, ofAA`Ater Qu0.1ir3 - Groilnnlyatcr Section Q v'lfw/,�;/ pi :�� ��,613y // VI//� /T/1�p /) Coc'ER 1iviic:A�rno:44 ic20- Sa
1Y-,r.,-..,,1: 1e-1�"4a-Q141- �1e/- ✓�l'`!iQ Co . YHJIYL Jrj(l�pl a lA(24_+ek.,
„rr. a l u— iu' s» -•r,. reu Wi) PI"ithii rn
nil.:,x1, 11
.:ol_ 1: <sia �,a:�ul �J .. :{paL'P.I L.I L. ❑ luulrarial 0 Agriculaital 0
licw Pomp 1i .,rr in;v.rlou ❑ LIlhC[ Ti li Jtllcr, Li3i llsc
-.Ilyq-eAuteYh1J1'fie Cowl,; /--/rAjersp[J
%S C 4 Ia n/ f /4 c c to L-y-ev
:.il li1, ]tiL.rpYlalwil, 1.,:: IYa , Jip l�Ju'l
pogral ht Land strung
Igc aSiont ❑Valley DFi.1r
(chwl_ µy. upli4rc pox)
lyaliNde/IOn'midi. Oi,11 II l
3°a it,
e h r6 ` ,Li41se s i cr..�t
_51L3 ,,jfiem;//` w �hSe iacblcc Inlnu
L�uru.l67aculgnnd=sour
derSOMMle Nl`ta , ag79/
WL - (e K 7— a 88 3
DIXILLED O�r�y
OS
�.c_ 1\ ELL I.EYLACE EXISTING WELL- YES 0 N0 IS'''.
3.S . FIC1',.STEiRLEVEL B;IOwTop °iCastiy: 3Q --1']-
(Vic `T" 3 i0J,c Top urG-ulgl
_. P OF C<3ING tS F'P-.Above 1 1.nd rl3a"
1';.p ;(:.:m� rrrnuuroa hear ['char pnJ surf-i4 r:gwrc+
r.Yuhy trllpl5:.NC:C1C.WId.
3 YIELD 011I: J METHOD OF TESP_p�.g!'
J �
f ocur�n
Gta a 1,/lb
oo� )
tPSOTopo;r aphic wino
c no\l
LHP'I'H DRILLING LOG
from To Formation Dct eription
(? — /50 blpt
/50- /SS
/S 5 - t'S
n'TEh on`E51Jeptrll: ea/ I
DISLNF�ECTIOIh12. 1, i
rp:�IOJz/N�.,
- Di:, meter
ao:h_— _ h° /55 Fi 4, d.5 AM,/A) PVC 5Q2J1/
Yr.3al Fr
izio•in To F.
:3 .lK3LIT 3 p,il
- cotl1 To.
Ii SCREEN 1.)cpu1 Diamcicr
io a: Y'„ F1
la.
I:;a; 1 J t'l. 1n
.:. 3<.ND:Ci_=.4' EL P.a,OK:
: cpn. S1Lrn'41
ks.1: ID Ft.
rranl To Ft.
hl Arcn.11 nlctn OQ
Fr CiOnn2eile, e94,
FI.
Stof EI2; i11urG'ul
n.
u1.
!u.
Rode
6-rani it
LOCATION SKETCH
rivanunt Z,Z4 Show diracrion and dislnnee in milts Yront u[ Ica;r.
11�au Thneicnce; two .SEite Romor County Roads. Inetode the road
ur A11clyhuFt, nQulpllal unmbAr9 and COmmon road names
01.1
��,,ej�rsoN✓;llet KC
DD neb:EEl CERTIFY IS WELL WAS CONSTRUCTED CN ACCORDANCE WITH ISA NCAC 2C, WELL
oSrl oT oN sl '.ND. 1 LS,.A..A..NG THAT A copy•
/DFTHH/IS RECORD HAS' BEEN PROVIDED TO THE FOWNERIVEELL OWNER
------- 3�Il' O •R;„0N t UCTING1'H t; WELL /+![' 0�
D. E
Siiffuut me al I inpl CO teem Dlrision oT 11 arcr Quality Uraundm arcr SeeNNon, 1676 Mail Service Ctnrcr-Raleigh, NC.
> o3o Phan.:ro. ty11) 73i•32:1, rrirllin 3U hays.
GW-I ILEA/ . 07/200.1

11 1;1_ 1_ Ct)NS l`R1.11.T 1'11)IN R :colo
SRC ul al'L I.'uncnl and „ui f. „.,,r:c> Di\Y Di,' o1aror Quatic;'
antscrdn Lid , WUL.r NA. 12 i,.:, b W o
t�r5 4oi✓s y%aa 22es'Lirvv5 Co •
E. WC) PThltA11`J'll
- GrounjN al'r Sjcc[icrp
cCr 1If C.�Tl'laN:202 f?
1-1-13Nl, /AK a5z, e,,,
J ..>�, ory ❑ ficu Pump 11
L �d,tey 110/4
r''V a4u9y et-tewty cttte le/
I ia+i t.. _ .p,r „ulla ❑ Intlbvrrial O _'. gri cl'lnlrul l�
F1Ucaucll ❑ L)LIIC [Ti lr'iJ lh cr, Li>f Lldc
2
01873 .
-_c_ -.L,. rJIJIL i+ill0u
1-E L=1 5/3/�O
T tit v 5
Vi ELL REPLACE EXISTING: WEl L? ITS 0 NO
l.! ;.LEV'ELBclowTopofCSsrc /0 1'p.
Topogrqp hLc; Lon�d ftirig
DRidgc ❑nl P . T'ollcy ❑Fi.0
(chat/ ipp uprialc hex)
Lui ride/Ionginldt orw,o+ Ioearion
(dcifc ;[011L and )
La ii iticEsIdiligitudc soar ersThSOTopographic reap
f lical: hont
DEPTH DRILLING LOG
From To Formation Description
0 — /az DJn1'
tam Lac RocK
».7 — 4t25 frran/ $ < —
(Use t. if.coo cfop „re I a;
TOP OR
CASING IS l I. ^.bJ,ciSur lSc c"'
Tap Lcirn i f:a aCur Gcl Ir la0,l aurr-a cituluirct a
tii41 . wile 15.i .VI. C.2C.UI15.
a YIELD r, ,, g LiE I HOD Of TES izZ
„ TrR INI S 0c:al): L
3 L0
LOCATION is:ETCH
ICI !ivr _`_ tc, ` h'Ip'C' :Illount //CZ ._ li, v direction and d1 lance in miles from at Icast
�RCi Wan I Icl m:rs t ,o Starr Roads or County Roads. (uelude the coal
aiaa Lr nicer u1 11 - g it ri mrakcrl,l cumbers and eommon roiid names.
>rJ,n 0 IH__ZAL
rr--/t,_J.l_ ALle./a3 PVC 1M21/
FL
:oof L. F,.
; 0LI` •qh F. n h tcrlai& vlclilon
c
Picini To Fr
IT -IICq_Fp
JCi:(I D10n[Kr i1'IUlcr DI
Dom I; ht. to
:Il[ I'J Ff.
in
I `. s -.:'N a v ic.-. \ E L F -. C\Edwaii
L„ r
-!Ulll TO
!J. !TE -I-RKS
Stec blal.nal
Ft.
F1.
%14-(,d0k15 Lew.3lReek
d rve!//fe. XC
Da) riclf EE1 SRTlrl' IHar THIS WELL WAS CONSTR Do IN ACCORDANCE WITH l5A AI CAC 2C, WELL
v:TROCTI N T^'ND ut.cs, AND THAT A copy OF THIS R.LCORD HAS BEEN PROVIDED TO THE WELL OWNER
3fia tY:l:£ Of FEI:S�u�LRLll'
CONSTRUCTING THE WELL (0%
ATE
L21.111r [nc u11.111a1 ru Lac Dlpliluu Of \\'afc t' Quahr)' Gr0urlhrarcr accrluo, 10 p,lo I .tee.., ::e i-,o3o ikon :vo. L:+l_i) 773-i2 1, wllllin 3ti daps. _
C\lr-1 REV/:1I1220o Imo'
s
O
01

V\ ELL C OiNS'Pie i c 1 1 i)N R1'CORE)
309295
-? m ...ii lin,. irc..iiillzrif
lUN/j,lu1:4ll-.':c-'"-L?i.(j`- cf�' waaor Quttt iy- Ground ater Section �/� p
! - C . i l LI\ IUli.m.l v ,li p ' Wbby Lida / (f / /I // Co0 11Flper.. ri N x�JA>(I�1�. C�1�
1 „ lr i`i ,N 11l fcr3h1.Sofi -_/- ids De,(-(_(f Ia? C. ehIJNc U'lplfi O'Sd R-�-[
-- ( ?1111 it kErCi111]ti .e tl]'CLi"I GD 11'n tY itM1'llI
'--2pLS2DIa IEs
I Le 1.. ▪ .i p,1 Pr lli.: ❑ Ifl4uslrial 1.7 .. yrindnu'al L7
LJ li.il Yufph �\ .4cf 1Clic,-I 1 4J i tllcl I.J I l L ether. Llil Usc
2I Glgj/PC„ul1reu"16 _ E`er._[
_a %a rt tr
'�- 13 1
2,7a7
_, *TE E tSsL LEE',
tEt I' -tr. DII
_CIES Vt ELL PiPLA.CE EXISTING WELL? YES 0 NJ L1
STATIC' tt i i-I: LEVEL Blow Top of Gres_. /0 1:1}
(D "ir nol Top „fC
-rt I CAGING' IS rrr.+_bole -
nd Sure
SJp ul :_. l.r,Tuu gq Maur Gaulr laaa surface I'cQuires a
1,I Lau g NAM1'.lvinl IS.i VLC' JW C.IS
O poo 30 ntETH0DOFTEsr`..
TopoEr. to 1 :.nd sr -ring
01 Idgc Slope OVslley OFlat
(chat Llopnufc Fax)
Launldc/ICiii fnyc of wcl IQCafia1
.Y3sa .t/ S'�/fl2 /$./38"
(dc,c :mu1w toads)
L auulJc,longitude source: a'u�PSIDTapognphic map
kclicek Im1)
DRILLING LOG
Fort-nu/ion Description
Dent
RbcC(t
Gra rid s
From To
-e
ss — /as
LOCATION /RETCH
DIStrsEEC' I`''f'`,Ifr ' G ;.mount 6 dZ 'hoar direcrion and distance in milts from at kart
WI/1 l Nli.acis r lu Stale Roads or County Roads. Include the road
fttrgin Diameter J1 t1 - road names.
} hcFf. ivwrn Li uuiiib ro and common
Ft J
�ra:I. f • hr. �r�__� dL4..fA� t�Ve snab/
ail Af<NJI 111C111.14
Ft C_ N
t. DON
SCRs; DCpC11 --. .F DI]IilCl cr 310[ :;12c ire nlci la
in Inin
�cpili
• FL
r'ma1 To, FI.
I3. ftEMA FCK.S
3"c 114ic0al
ass Han-) s 3i9sitkRd.
A-4 Ckue-, N-C .
- 3 n6ZEBI CERDFI" FEAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH ISA NC.AC 2C, WELL
CUNSIDOCTIDN S1.'ND.A ND THAT A COP 'it OF THIS RECORD HAS ocoa,
PROVIDED TD THE WELL OWNER • -
13�11:E Olt P.SJfpSTRfp CTIIyG THE WELL
LA
'not Lac.; 0l1 on31 ro tfc Diriiion or 11 arcr Quality, GrouIdq'ar,rr Scer)on,
EX3itio.to of-:Vo.(Su/ 733.3J: 1, rrifnin 36 days.
1636 AQuil Strviet Cenrcr - Raleigh, NG
GW-I R.EV.07/200c
IJ

1__ gat...
rl:cl�,•rioN RV CIP �
L: iC,nm 1 -and IV,iul, I I
�'bbb .:r:-Di��:
:LYLI 1DU l Vinli l,i„. �,
11r.�i�� Y'ili _Ls
1 LGI G:�Y L'CI II II;i
r 'a:
a ell' ❑ Hcal Puull. ,
.vl ✓� nl u.: L.:
lnl.4uw1 LJ
309298
\f puror Quality - Uropn3Wa tar SCCr1a1^�vt
T0j / -- r.11 rfl'1C.i'1'lOn xt V J
CIA 'PCD 1VQ PpEL11 u
iI, up L:.J:IcI
L P:daio I] InJU sn'ial
litho ❑ Jr' J 41'�mdnual ❑
� rlmT, f.i31 U3c__
T3pogr ;Land scning
❑Ridbc skip. DVallc
y ❑Flat
.,. no., C.,u:.l (chctl: .Iylu:lpna¢ boa.)
LA nrodciluuymf 11 II IlcJc J
Y-_A,, (� U� Jia(lJll
tr/o�i7od%iS dL .dS /�q2 •J 7• f'p&'S1
IOcb'I ccRun ul!' tongs)
t - s , ) LuuruJ longlrudc sowI
J e: �'OTopogrsphic tin[Ip
DIULLINC, LO i
Drum To ---"
Furrnaclon Dcserip(ion
.m •
Ft.
TE
l< 3 l
e�
Uo. 1
1F 1 H
1 ELL. I'�PLACE EXISTING WELL/ YES' ❑ No _rt LEVEL Below
TopTC
1' F �I.N� IS ...f Aw Top cfu I oI
L'MFT . Abu +c Laro Surh4✓�. —
AFur G 1 1 Lulu 1r44t r.rtuR'ce a _ A"aLEL:iu r.]AI": lxnp IJi Yl C :l.011Y.
y iliLl
a` kiEIFTonOF'rts-c. bt;n Ze.:
WQaej' LOCATION SKETCH
�- uru°IShow direcnon and dis[ance in miles from ar Ita[
W al f 1 I t;n I '° SIa IG [toads or County Roads. Include the n)ad
Du-ditt:r W lI
hlT'r_ Pdutn Isl uumEcrs and common meld names,
,,,:poi M]rcnal
r:.:ra___Q__ C*rdc Ff. C'Dii� �-
2fJ!11 T.)
Fr.
I7 S h5i`y i�;C�ol
Fro:❑ ,I'o.
Gunlncr Slot Si
EroimF[ ut.
FL In.
): V&A.VEL PALL_: 'n,
DCplIl
OU:
SJsc
From To
Ft.
i1'Iclltoit
� 4lrncnal
't1lcrixl
� 0 0 A-zt /E}� GJa eci7
Hc/u4ersb.0 u,%le N. C
DO nEf<E&l oI YTIF\ THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE
L NSri UCTI IV YC.+,iV D..l:D3 .AND THAT A COI `I , iWANCE WITH- 2
OF THIS IZSC3 W ED T OTC _W WELL
OWNER IJ. H.iS 6EEN FRO VIDED TO THE 4YELL
ScN.,
I ;SON COiv3TRUCTINOTHE LL
'mu' Ln; urt i11 1 ro tnc Llilhiun o111'arcr Lushly, Groundn ,L,;r Seaton,
i 030fliofic hJ. (il9) 7io 7::1 within 30 days.
I l 3o Mull Service Cenrcr - Raleihh:.1`lti.
Gw-I REV, 027av0t
V9
0
C>
t

\ ,J:1L1_ CI INSTR.L14...71'10N R12COi D
309299
aI kl 1 ,run: nd nnI I
P�vii lei \4'arcr Qualh -- Oroundxa[a Sccrion
INI,1IDu r Y ,,1L tin ebbby W
r�%��-'L'l: C1F1 C.iTlOry rv2a�_
Persc oN, Ll Z2eL/it
-__YtlJryli-any-C/LKJet.,
S nnllnlra l Q
nl _,p rl .Ibna
a-) ❑ lie Pump , ICI Inl �I:., LJ Inullvnlol C1
G ihcr ❑ II I]nccr, Li91 Llit
a8793
., GIP
from To
:.! LEP
CIE l L l ,.L CEL\— ELL ? YES N
,TI „'..TERLEVEL HclawTopor'C„Il; 11J LJ
up
I T"r_ II3IS FT
Lana Surface'
lact'
o„r belulr I 1;I ,ui•.t r4ulrcal rys _ I lSiE„ - 3METHO
D OF l
Tas
I llcb lc[S: rill 11
oale longirudc so uraa:
DEPTH
Togo ffr , /; Long setting
DR idgc (�'I�pe QVallcy ❑FL1
(cbcci:appi'opn4r bps)
Lgrimdc/lo❑inrlc Of 1 ell tozadion
e.,
u'-`'QTopo8r:lphic map
Icllccl: boa)
DRILLING' IOC
Fonnu[ionon Description
_Bock
llU ivr �l iJft =1',, p; �- .m0unl
' LOCAT JCFTCJ
holy diron cop find dislancc in milts frOill 41:
Fvul fhlel;ncs9 LFo Sralc Roids or Co
CJ'
:I Q_ f:,�2_ eLCIll
Ft CmjY�-`_ r��t,,,
I CCILLC^Pp _'
'�`>n m "Diancr
FrJ.'i I':; Fr.
I) Sc,..rvn:C.IC.,,b. EL 1' CI_. In.
Jcpiil Si_c
T;J:I'. pJ I1l]ICr:]I
r;._
Fair! -I To, Fr.
r
--�-- Fc•—_iA__ hr.
e YFIq
101 glen al IV II
ID) nel:EEl CERTIFYTh1T IRIS WELL WAS CONSTRUCTED IN ACCORDANCE
CONSTRUCTIONL1 NU_:P.G3 AND THAT yD.�IyCE WITH IipNC�C2'
. D TRH T CJP I OFTTTHHHIS RECORD H�.S BEEN PROVIDEll W LL O
TO THE 4\ WELL OWNER::
IRE OR I i.vr1STR UCTING I E
E WELL
SiJ1 'i'-c M o i Ylal
in.
ul.
lalncl:r „r 4v;l�hcpr um}' Roads. Include the road
iurn:d riocrlhors and Common road namas,
3-y2 Cow MA/ Pd. 4 icitt
9dy'
S y
a nut me on ival IQ [pc
.l- lii-iu or 144fur Qu:tr , Ground wtdsaCcr $reriun, IG3pNC.nrm-RaltlypeThlIl0eMIOric 7).:1, rrfhin ys. DfE
ClV-I REV.07/1201
Pim

\V'14 1_ CI-• N P I lr` J'L1--)[V C-11,ThrP.1
- ui a;i 61L , .iu�rn, ]u.i �Yp ora/l I
1 —VV� �,,;chl,,i. io iCif l. arcr `up
, LL l _u Li p1llDri L Y'Bll' t t ::, Y W �o��.
..- ,'1 '11,-.111:I IP.J r 6-50// ._a/L_ 2
, 3 I ! 1. it ! l h:\, 11':i
----rrc u'r� errthlrr,l
_ _ ,pi•a-cl o .P. Lc -I yr AA r P ]
.�gr,cid rtu-al ❑
i Purnp V -:lcf InJ-" . , IJ Crtner ❑ I r OrLcr, Li>t U9c
r
—dtiloiL�rYr� AC C1-41bcw GJ?`31 /5�_
-_: ? - 1r:,..m - am.�n,p :uctrvoia„, 1. I;..,
...._-.._ 6VYlGS nine MCA
. __,�10 ru
,'--I.e_ c\zer(nnitl -11 j\(C ab%q 1
r OcPIr C
1' EEL REPLACE EXISTING WELL?
_STATIC' .5N_., YES 0 1__ D
„� r.LL-JELticlow'ToporC,stng -
���_ 1P
�c W ^;i nr fop �rC .�
LI - �! CASINO IS —
l.,,a 1 .. , ,-rm�, - 7 1 . 'ubov c l and Sul ih.,, —
a.;15:Gcl \ la,J.ui'is mlullcav
41 ,r 111: Ij.i :Vl -C .U115 _
YIELD ,A, r —L___ 11E"I li lDr •,
/l/, OF TESq
,1 .'TER `-i\IDS tdcptnl lV Fn r LJ
Tapogrn2jliolL3ndserring
IJP.idgc SI yc ❑Valley 011z1
(atic µy. opnE¢ box)
Lunnldc/lougintdc of wall location
iacgrc rn iuu,clrmcnnat)
Luu,nJcac,ntiludc Sour -. C I'SOTopog[aphic nli,p
ULFIH t'r nr uo.\i
DIHLLI�OCI
Frurn TO Founanon Dcscripnon
oi '-fir �
clirccrion :nd di3rancenmiesm
a[ Itasrrq ATION SiEref]
v di I I I rnc„
1)cp'n ,0 Slate Roads or County Roads. include the road
� Daro;.r, o, u
_,ghch'r. Aran.:) m uubcrs and common road names.
I
'Gil_ rr_Gra 3 die r� 4 spur sna��
Fr._
51001 hL- F:.
:!c3L:r- Jcpiii:Roil EJ
iAla,cnjl
F,._�'(/i-_- �pr?_ c,non
_SCRS RN J. rdl DurnncrSIX-
Fm:u p_ :;lzc
m.
n
1'. Sr.iv il:cn. ;'EL ?AOp_; w.
ocpm
Fra°'' lb
From T
SIEc
Fr.
Fr.
1.!arcr,ul
ivl
111ulcrr-1
;`. S,ya(ows L of th l
! DO riE1EEST CERTIEV TIHIA.TTHIS WELL N ,S CONSTRUCTED IN ACCORDAIYCn WfTH 15A NCAC 2C, WELL
L:r Ns rf 1JC17uv STANDARDS, AND THAT T A Copy OE THIS REC31L.n HAS SEEN PROVIDED TD THE WELL 01V15IER
ON.; R.S.!O rcUG CONSTRUCTING THE
-'4 Ill Clic Orl I Id! CO tllc D!AJY(o fi or AV'Arcr Quality, Gr0uitd\tarot Scerjon, 1636 MA)) ScPYi
?uric No. t9 LI) 33>771, rrirhi❑ 30 qg
y i.
+A
D. TE
Center -
R;ileign, 7v C.
G 11/-1 REV, +137t200 I
309304
my - taroundwurcr $perip❑
H20 3
Ci i 11FJpc4-rTo 4 -
ZD i. ▪ i▪ ce- ,
o r:
0

VPli1 1_ 0CMS 1'RI. C 1'10D; I2PC'ORD
I •:- - IYI,CHI I Lco,il:
- CJivi;-' I OP waist-
� -.• r I ❑I „
1r
IUL 1 Y.�11LL ;ug. Qtl ll rr UrJU ❑dlvaltt 3ci[i Jll
1'.-' 1' L�r_ '�LYL• s iFic���'L,/y (/+�, H
'-rLl 11 ]:i, MJNy' a.�0-7
ebbs 111,PTh
309307
Lu r1Flc:ryoN
RITE. 1l Q l MUN 119 n
bl.'I
_Ir
.. \ I �2p1� u0-O'li'I I�
-'sriadmral ❑
LJr)- U ,:"1 n1 u.G.',p LPublia ' 0 Jicd1 Pump\::Rr 111 1 cu LJ c Indr iiTltll q
.tiler ❑ ll'l7iher, Lisf Leo
_-�0•� m. CIO u
,T'@
i0T l_0 FP O,$
\\EEL R RL OE EMS G 11 ELL? YES 0 NO
I :,T1L1i 1ER LEY EL Bclow'Top al Casiae_
�9 BT.
rL .. it oo I-r YrL
1 L 31hj lS�FT 'I
C+N rrlrlaalsq A0rb =_r1{ 1U S4flasc"
—
LII 1 \ IIII ui'f c,I II'ia :1 +14' Il.. hill: ]L .UI Id. 1 ItLl_ lJ
13 n-,.TER w�r�Il lrl}iOD OF TY (R[•I111!,.,_� 2' plc pill ): MET '�'�""�eel_. ZL
Topogra i /Land 9cq
ORiagc - >I.;pe OVSIIc
(ehcelc-ppropn:a: box)
L41i11.3de/Ioogi lode of iycl Iocation
rl8 3A3'
racvl "mupUK$t'pn;s)
eltcj OTopo;l 1phic map
(shiny: pox)
DRILLING-
F'onna[ion Ds eriprion
s
OFI:u
IruLld Ionei111do source:
DIRIN
Flom To
5
'.:i.Nr. ""`RI` unl IOLyi___-ETCH
Snow direction and dlslanec In miles from a[ kasr
-.,,I❑ _ Wlll Ihu'Iplc>s l4J
Outmost- „I yl - Srait Roads or County Roads. include the road
.: n- -- hL—%.T_— Fr.-(R.1 a, �— sItuFc aa,ronai aumh4rs and common ro;ld names.
3 <JL FI. /19cIOGJ / 4�: pill Ad
`
P f3al- 'hi 'ELT
a: nl DiJific L;f
Ffo,ll -f Ft SlorSi:c I)inrulal
n. In.
Fr.
f i. Sd1V a t3R_.,r In ul.
SIzc
tool
Fj.
Fr.
o REMARKS:
! DO Efc81 ° iu Fl"Th'T TH3 11ELL WAS CONSTRUC1ED [N ACCORDANCE 1ITH T 20, WELL
CONSTRUCTION vDD3,.ANDTH T.Acop OF THIS hEcO;D hLAsBEENPROVIDEDTOTHE WELL OWNER -
Flu N, l%ClrCE of F :aiJf
CONSTRICTING T
�.�olu me on iugl ro me Division n[ Water Quality, AT
•' Uli J.io i' Ir W hp. "in o )', Groundu a rc
r ) 3a J2:1, rrftin dU nays. 1 r Sccrion, 1036 Mtil 3crvitc Cznrw• - Raleigh,N�
C111-1 REV. 07/241
<r
0
0
err

a.879/
PL,OEEXISTING1'rr•IL? YES ❑ No -
6t 3�,v
Si t 11' IV lr U for Sur Ip_I
I l SI�'V 12 / FT
• L'.'H I - rlrolal:p pour G lbclu tr ^.UJ1c I ?11' .i url Ja c••
rw 1 2 1 iurr .(l ulrca u
r.l+ IrI1L IJ.i .\'l.'l 'l'.Ul 1p
ti V!471 �nL
1 ----�_ METHOD HOD OF TES r, a �------ —_
l CriNt i�, it T;p,C1elZLOC �TICN sx E 1 u11 .�1 \ II unl __..�� -0 II r direcrion sad distance In mhos fruln tie Ica,r
\t dl 11 1 Ium 3 I O Sr:7lc Roads or Counr' R
L''''In � L 5 1 cicr u1 1
l a S \ hoar- malty:d uurnbors and common road nn>zs,lgclude the road
s
a n
Ath,r
L 1'I ; , /g'+- /ram Slin-doy1 Let*'(/v
.2; 1L11 0 N.
C� III
11-rl 1. Ct INSrl.h1
�'1 L4�N LLuP.1)
�:11 �, uIL
11m 1 nJ JQo' I I - p�vi r\Yorcr
'L_ 1 LL:1 \'ILU 1 V,111L 1 1 „, / yl �€y �n )` p Lu71il;' ClrOuntllvdrel'ScC[iun
\ ;1 'lE.fil J 1I iTc('" -�C'VV.6/�yV �pu41.'P1F1�C�p•O.n�xp (�[JG)s
t' C• -. /1.C���— KV L / . SGL _•—.. V flank' In On .2511L_/1 4,
V
is L P Iblio ❑ 41qu31rici1 L7
L7 li �l Pu µ :Act' L11 I wl 0 Lgld ❑ II i '1 Gcalmrsl []
2;1
�J
yac) Lilll'I.IJ L..11.i., SIN !�VJ.1
atzsal.a L� Fiw
crk w: IYar
G—t
Rai :. ----,_ i?tP'lH
R d.
brom Po
- D`�'F p1.V11
Topogr�1 - -L , Land scrting
❑Ridgc 3I I. c [7Vnllc
Y ❑1`laf
(ch I 1r I•mGrinlc Vac)
Lldrudci101i till'1c Cl
�wcll loceltoll
y� 43)
9 3fCG
eS Aiwa.* Idcbr '1111114
„mud,. IduLiiwac 000r ±: i so T
❑Topographic map
Iclmch uu,Cj
DRILL1iC.
Forinu[lola Dc3Crlpr W n
S
c 1 II. pi:�/7S
sOf -. LEVEL below Top or'C;,in_
oc
hl a1c rl'.Il
Q I0 Q__ Fr_Caor1O I\1c11I31.1
16 Fl.
I -r _ CYO r,.,, ----- --_.. —
:Jcrn Gimnncr - --
lmoil SIJI Si_c
'I', lliu[on�l
Ft.itl oar: 1 In.
h1. m.
_op,' SI is
..Call pJ El Ntatc1la1
Ft.
nit]l
t.73 nLE1.l'E&1 CERTIFY 111),..T
RTIFITH^T THIS WELL H.v° CONSTRUCTED EN a. CCOJD>.VCE d1TH lip
NCAC_W,WELL LC1YyD:RL,AND THAT A COP', OF THIS '6coP HAS BEEN PROVIDED
•
TO THE WELL O1VIyE1'v
ON0 F •RaON C ONSTn LICTINCiT-'- 1L WELL
on in,l W Lnc Ll i'�ioion .ATE
t "0.To PIlo1 uI aim Lnahl
r1 t"Ill °7c J.'l, aim 3u 113y5.
1' Grounder arar Sccriun, 1636 Mail SOCVi
to Cmucr-Raltlghr
G111-1 REV, 07/20,,F
f ,eyvOOra-rc
rna

\\RELIT et TINS-FRT.CftON RV CORD
309310
OfLln I - intooi r 1J11-1,lurat I ...,.c - Dirt I OY wafoi 1
n bby hi' {�+1� Luulir, - f7 rountllti al-r $cc[inn
CH_ 1 � l L11'IDU L � dL[ �It `/�'(1/n ILA.0�} p
�� <,.��,/ �� %� / / D � �.Cl 1lFlpC]h�'[P1JN nrtpcQ�a(.Cjp
ce.r5"`-s[YL• S aile.(il �,yY,�Il�/p cj . Ytl:]Nl: 4l ag a.5A X f
et
tICN P lvlll l'n _. i5:3i11-..'I'OD AAO PCL`N'IIIV
ili .A:p Le dNo1
b' 11 1 Publi,: I -"v+ ❑ IcUrtrut
❑-�gnmdnu-ul 17 or)❑ li ]I t'un Y \ :,Icf lnJ"ten., I (] �. ihcl ❑ I I f llhci, Lul Dsc
fjuyiar
Con11r- /yr,//14aYotJ
teu.1k �{w_
)-IrhderS�jl': uri
,c .217.9
2a8 (t7- a883 0 _ AS
Topogr ic; Land scning
❑Rialto KSIsoe 0ValIcy ❑Elxr
(check apwvpnulO box)
Lnrimdc/Iongialdc of well 10iarlon
4.4yeb,S404046Q, W
-s..SiHq Lourud:aontitudc 3nurc: � 0Topogl1ph,a reap
J Icl-act bu,t
DRILLING LOO
Formation Description
cgl m ulul yr aan
) u
12,69/ o )za6,7S8'
-q�)
r C i`= Ijict Er,
FO No. CEP rti.
DEPTH
Zip `o°' Gram TO
LOSS vvL REPLACE EXISTING! 11.ELL2 YES 0 INO [�
STATIC \i ATER Lv EL Bclor, Top or Cestng: _ LO PP'
tuac "r" i(Lioa, c Top urCavual
TOP DP C _S1NC' IS �_ FT. Above r .
114IfCo l9:,,
.. ulai,a :ear Gelid, IauJ iuiI r. it ulres a
raaut,uu lSn .Vu.-C'_C w IS.
T I:,LI v ,,,.; METHOD Cr TEST ith
/� t q
\t TER_0N=S vacpLnj: 60 r� •�
'30 — 2S
ICl'ihr� 1!Ji; T /� � .-- LOCATION SKETCI9
rpZ /12 G n ulu Show ilircCfia -
CASINO': On and distance In miles from ar leash
Wan TI"chno, l , o Srarc Roads or County ,Roads. include Lha road
Diameter or 11"
ghCFr 64alcnol u4lilbklB arid COrtImO❑ fnild ❑alnes.
Fi kb..IA5 PVC..1..DRai
2;1.oln rc- F'r. ---
.3 R "LIT- Ocptii lvl afcnal
h'I
- .-__ CI IL1t!
-.XU-.. Qr:._ag_FlC'ON---'-
`Ce _ POu"_'LA-p
.: mu o 'r 1. TT_
S4 hU 1'f,� �—
1:,,_nl DiJlncl:f Slot jl'_p
Furl: hi n. In.
am L; F 1.
n. m.
Dcpiil SRC
Ylaee lal
rcn To, Ft.
!a R. .RK :
/'S geladt 9s
enden €3&•./fe_ n C
DO nht:E51 CERTIFY THAT THIS' \\ELL WAS CON STR Lica° IN A000ILDANCE WITH 15A NCAC 2C WELL
Nsrizucti0ly STANDARDS', .AND THAT .A C01 `, OF THIS RECORD HAS ELEN PROVIDED TO THE WELL 01VNER
i SON CO7NS TAL CTIlNO'PHE WELL
elloe'S-eo3o Rlone clo. Le us) naa :n: ul I shot ro tflc Di rii iu li uI \V�rcf Qubliry, Ground\gar00 Sceriuo, 1636 Moll Service Cenrm' - Lalm h
'3� 7::1 Idfliin 7U frays.
6 NCR
GW-1 REV. oipoi
=A

\4ELL_ Cri�S 11:I'�'] tl�N Rl7(ThO1.D
- ui.-w OIL i on'c� 1 u N.:ur I I'
,".'. - - Di Vi - of \Yaror QupliE - i�roundwatcr Scerial
T p' / / cr nrlrlc.,*T,on x.2Qaag 11r-.iv1 Y„114, �C LPN_S-. _., �cLL_,[.C.a..{.,Li�_N C h
•--1' , •> 1 C I WAY ell illI J'r J JG7 ___.^ PH!]Nli a'+I��/L,('9(t.
11411•-Plin11.1-1 -a.r
Abby W, offs
-O'ER ECHIES yp' �
01 ,ryF`EC IO;\ I•,,hrPJZe
r1 ,ll Ili `Ipto>3
;L_ ),/1 /h5 �Vl� ,1
Fl � 1JB�/
F,.
ROIL
lAI[rlal n9Clr:oll
aCREghh
h1.
ucpra Di,mncr
`ra;L -p,, Slot Si2c l}laI YII
Et iil
in
t SA:': Il: vim=1EL p_..CI<: --- in.
,cpliN S“C
Ft.
min To_ Fr.
au
�.-ry' ❑ iic i fu«p R nt.r lojco•oo:
�Q RN N
—�/ /Ye aRh?,4
?AY � -3 P
LL TIE a aL1aD rZ/ _
L;7 L LL) P
c DOES E' P PL CE EXJSTtNG
�l,TI .ATER LEVEL Bolove Top ofC„In_
AD.), j lC.ninsl
�F .� .. lc Land Su
Yn �rrp Afar Lcl
" .4..: .-»au 15n .Y11 rJJ;mr, �,quirwu
a
V!EL� Dili T.
-AIEIHOD OF TEST
_z9
eip 1 P ut o la Indio trial 0 .�gricl:lnleal L]
J Vitro ❑ II Utlicr, Li21 Lsc
'TELL! YES 0 NO -
3093ii
Topu�gr�tu 1.1c;Lund sexing
❑Ridge 1T51rLpo C Valley DEW
(chock apfropliatc box)
La tinldc/langitudc of we I location
3so /�i.ri9' ' l,pq ° ,889
1.1cgFcci;m 1nuJcv,ccunds)
L�unlJc loliguuJc sonrae: l pSO]To og-_
P I,ph;a run
Dt>f �rR I�r�col: oosl
DRILLINGLOLT.
From To Fonnatian Dcseription
1J�Q —yam— (ran ' X f T
LOCATION SKETCH
o ww J u CCIIO1 and Juwnce m mllas troll') at Icasc
l ,o Stale Roods or County Roads. Include the road
' ''!h Liamcier or ,� , I-n.'Ft. Prl- uumbcrs and common road names,
9/0 f3Yfrf 20jk _
�rgje-ri v/uu,l/G /% S
'P
03 nEREEl CERri FT M L THIS WELL W�,S CON$TRUCIED EN ..i.CORll>, }
NSTLLCT13N ST-.,NDkl:p> ;ND THAT .A COP'NCL PROVIDED
DTO NCAC 2 �' OF THIS RECORD HAS BEEN PROVL' WELL
1D Ell THE WELL O}}r(ygrv..
S GNP' 11'.$ 0' - L SON COlaST1<UCTINCrTHE WELL 0
a �.a J11r tar ou dual to iht 1]H-In is fi uI 11'arcr Quality, ATE _ �7
5Y-103o HIQ3 )', Uruundlratcl' Se[rion l03o Nl ail Service C:nrm'- Raleigh, fY'L
c hp. to In i $ion, t ❑1arcr Juali
C\ I UV. 07/ 0.01

1
1�llitr3
e rnvic-vrioN x as
t'tt JN 4' ims a /(yV�
:,.1 .4L: �'ulI C: Inivafri l 0 AgLiculal r5l Q
lc',., .., GDUI.' L1 If ,,-'lllcT L.i>I Lhc.
err /w/-e{1/�:�9i
, S ._i, ➢JuJu\ L ,Mai, lJ IJ. W /�� 7.
_,p Caucl
� �✓�,, it-Cfspr QLLS r Ny
fi5 It Hwy
LUJ[
PO P .DEr1" 5A5
't E t PL CEEXLSTING\\ELL? YES a NO L'j
A, -,fE LEVEL EcIOw Top of essi g: L.p
t U+� ..+'.. i t sbm c 'fop ..r C..ul_
•_ TOP OF CASING IS �_ FT
_ Abort wires l99dc
-! p JI 1 F rfrllup r[q AAuf Golulr I Il I yl'rie2 ! 'I If2s4
' -Aii,4 Ill UA Nl: L 2C..ui is
Vial) , to). 3 METHOD OF TEST �1
M. „ t R I� S ,CopLrI). _2,00 - Yr90 � ��
Topo„ ri to/Land serong
° LlRiagc L SI-gle QVnllcy ❑FI. t
( o mel:.lI I ,opriu¢ boz)
LatinlJc I wginl 1c of well loiafion
LV33°a,z,�Ixl/wo s 31,v70'
La k_ccvmwui-congsl
Lilo:- I.,ligiludc oo t,rt.. err. 'SOTopognphic miip
• ,nlctl: box)
DRILLING LOT
Fonns[imi Dcscripioo
bi At
• OLSIN ECCLOP T}p:
12. 5'iivCi-
_ W0ii II I lutc,y r,LL
!9prn Diamu.r or11 hi'Fr taicn:J uI
VVI'LL L"'LINYl'L:Ut�'T f4 Rrce,f:S>•
u u ul Ifl I n1 ,lr.irJ N,i ura l -
�� ,� `,ru c, 11'gatcr QI Jlir, - i�roundwa[ r 5ccnJn
iI,Li."4 OL \IC y (J I L/
qa ..
T
ed-54, Lief/
4.)11F1�l::111]':. _ rssoc1•.'rL G 11'i) I'Cli.
fl..'l1
H1ncictiMbil lc
%iY/or CoAe57-
-in�ount
Al ,fA4 PVC ma
D[=
from•
To
309317
JocK
Gran; Ss
— `%/a 2 10
—111I llioa—
icout
.7 SCREEN -----
Dtinl Diameter °lor'-'i"c u'aul
:13111Co hl.
. Doi Tc FL.
OLI h.Dcpoi n lawn al
n !1
Lzpfll Site Slltcnal
..JII' V-0 ir.
fmn To Ft.
OCVTLCrSRETCH
' ,v dircnion :rod di3l3'ce in milts from ar Icasr
1 SIAIC Ro:rds or Cot r5' Roods. Include the road
tll �.-rs And common .i`Id names.
,c esf
•
D3 Icl E5T .I RI Irl TIPAT THIS WELL 1VAS CONSTI LIC.'G'o [PP ACCORDANCE WITH I5A PICAC 2C; WELL
CJIvSfl C173N S .kND RLS, AND THAT A CJI"i Jh lHI U RECORD HAS BEEN PROM,
PROVIDED TO TILE WELL O1VNElf
N IRE OE • f 3T1.Ur'TING THE WELL
7/0l/0
'.GtlLr LC 0r1'111'41 r0 Llc Division ur A5"arcr QuAiry, GrouLith‘.,1kci-Scccion, L63o Mail Servitc Ccnrcr - RAIcIbh, N'C-
'a i io,o I'Itmi `o. ("l9) 773•j771, trirhln 30 dot's, -..
GW-I REV.07/20S?I

309319
s•TER. 6,'ES
�g98-/ss asip LsSs
pyi-r *TE DRILLED 7/24,e
DES 11 EL! REPLACE EXISTING. WELD' YES 0 1\10 lJ�
ST.-TIC \i =.TER LEVEL Bclaw Top of Cssing: ZiO i r
_ if noa,. ip urg)
Cpo,n
S. . C:F C-.Sihu IS I FT. :c.bo c l arld Surfa�z'.
`isp of a_. mrmuorea pour GcL,Ir hind surrpee requires u
111 Asspr.rpass.„uL 15.3. .VC.C7 C. ul IS.
v1"'LL prl- nIETHODOFrtsrBh',;��.�,�
nJ: /6Q
1-1 .ri_i_ c,r-)NSri:l11.C1'1ON Izi (2Or
- i❑ :p ui �1 u! LI lt:J1 uJ fLIP I 1L - Di,i:i:yr1 c -Or QuinIr - cirouudWBlcr $tc[ion
\IDli.�l V'\lc y. r VV W C9 iL'Rl IApL'uLT10N N201S
___ ". 1e' Y 1:V 11AL-A: 11L "�K 24Ie1� 'Nisi
C5. YHJNG Veit4 aSp
Rucl I ]N FLf 111]':i AS O 31, 11?C, AVQ I 12L9rn
Ir
u np L,:
__ .-..,p La�cl b'sl acL 1,a I 2' ,,,,:::._:.p4LP ubIia ❑ In3uinivl 0
_a:dl}. 0 Heal Purlip ;i ,I,r lgjcerim, 4U C'il i ❑ 11.00,cr, List tic,
-� //
Crab Creek "-zjan, /J
- :v...nocn Caaurmnul' iNLdl1'ml✓!1. 4.�r 1Y1, Sip csucJ
rbees
1341,r /
/1- D dr'c,
sect (ice rs /VC a879 S FPTH
:r Ns.amv,%%
From To
�. yrit'',Rural ❑
Topogr l lc; Land seeing
❑Ridge 10.111tSicLpu CIV'alley OFlaf
(omit: appeopneet Lax-)
Lu Imdc/lou� m1r le of w III cation
on
-rr oulcsiscA Qi)
+.`i0TOpOgr;p Inc rllap
r rl: Lov
DRILLING LOO
Fonnacion Dcserip[ion
0 — /3d b!At
130-- E35 flock
33 —GrpC. o-ro,ll$S
LOCATIuN SJCETCH
olSl1Yr AEc i icl1 'T' a �0 ' _
!P'-�17r�{3, �_tiiuunl di/0 Z Show iluecuon and J' islancz in miles from ar 1Caic
S1-6iV. Winn R hIBIJlc33 two Shale Roads or Counry Roads. include the road
"Pin D,9rncler Dr Wt. ghL'Ff. mar,, -,pi tjti nbors and common road names.
0 Fc l3i F[ 6,k3 A/16 i?S Puc spy/
Fe.
:coin 13_ F,.
,36.0L1- D,piii NI:nell]I
nnxi
. i:nu oU 'J'u �Ly—
FI.
SCREEN VCCdn Lufnct:(
a meal
From Pa F[. i,l.
15. _.,.:vD,Cn.-.', P-.CK:
Dcpll, SiSC iv c,
10 Ft.
To Fr.
FI in.
r'rehr.
46 7 OR.-6 Crate. ?di
y2rRatu3dNild/c r C
I DO riSicEBY CESTEEY1H3TTHIS WELL W. S CONST RUCIED EN ACCORDANCE WITH ISA NCAC2C, WELL
C.SNS ST,.Nll. I DS, AND THAT A COPY OF THIS RECORD HAS; BEEN PROVIDED TO THE WELL OWNER.
7 2
er`- 0 Ra JD UOTI1VCi THE WELL D/
TE
i.Pn,r fn: ou ilral Co in Division Of \Yafnr Qualify, Crntlrld W afer Seecion, 1636 Mail SServiee Ccltrcr- RaJeigo, NC5
:ThrIy-/o3o ?none .'io(if lJ) 33i221, 111CfIn 3 o r79ys.
GW-I REV. 07/2°L

\V'1 LL C.)Nst3T1:LICTIiTh7 FtLCOf:D
ro
-;v atalks. VEL P.AC
cp<r:
f IOI1L T.1
309321
L: t 641
Lino �6b •,,;: `; _ o, Wafer
�,1L Quality - r3 rOUndlvdr[r �C4I1011
1 `L �l I __,�, [ LIl1D 1 NAM-.111(1' /�'� <<,,...�.,..J,/ a / /� AO R�j[�
", Ci-, Ul1Y J1 N 1IC T C3`�[YL_S __./�S.eFL—.(-G�L",L.�//1'4 LO ' rno NCj 111 �'SP 417
eic
�bll 'I t�•:Y FII :(tf _. :3]OCLi''4D 11'Q PJTiItA11TL
l:ed.I�,
CC1:ruri CATlon H 2oaS
u
iie]I Pu111:, :ncr tnJc:r�ou LJ
f✓. NM.)fitI e
fr/-rnpit!`ttn!
layl0i` Fora, r c-trt r
4-e r3 6N U/ 1 f'Sc 479
1
$2_8,- (o. 7- 3-82 3
;,I,10.,
3i or;r p:Pr}h_
C ES i EL s REPLACE EXISTING WELL? YES 0 I'lu
'I _-.TIC h 'I R LEVEL Below Top ofC.,eu:g: 9i(i .__Fr.
lust "T'•ii
CLL,FOF C-.S!F•L, IS F'F..=-bore r
Alyd s4rl]da"
'-: ol:coai I:rmaarcq 1 I Gcloh' 4aJ suJ l ei r. rl ulr6a
'Na -trnn lJ.i Nl'-']C .In is
l �- li l p 1 1. ` / - _ I` IEl HOD OF TEST 31j(D/ini-0
UPI Q In4uSnia1 0 -'. grkulnlral
ulhcr ❑ II wirer, Lisr Use
,IS1 .IFSCYICis l-}p C_J izea -
l5 owu _Zan_
Viso l'h wl;:nos,
cixn
LiSmercr of 4; yhr; FL���`bn latcnl
!, _ - � Fr 4L&.& ZL&113 c.-�" ag2,/
Fr
DFPI H
From To
O — "PS
SO—Ybt
Topognl hie/Lind sening
❑Ridge tr-Slcipt DValicy DFtzr
(cticLk.lppropriarc box.)
Lurirudc/longhude nl"""w II Irxarion
4/3c°2d,cl79' en n [a35;yya'
(aeg'r ntilui Nnns)
Lon iLlcaongirudc sodre c: erii iS❑To og". p [iplue map
IuloeK oaf)
DRILLING LOC.
Formation Description
lL I MBrcn]I41
I o_a __ Fr. GN r ntanwa l CterS6Aide7t
Roc----- /T ---�
I'ran'�
-coin lam. HI.
D •lu DIJnlgyr
Slol' 9izc
F t. a.
r a:n roc
nl. _ m
Ft.
Fr.
h li[n'ul
LOCATION
Show direction and distance in mi es 1'rwn ar Icasr
I O Su,c Roads or County Roods. include the road
uunlhcrs and common road nsmzs. 1
IO,2 j t�7.
DC nEREEy 2ER'PIFI' THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH
LIONSEnbiSTION STANDARDS, AND THAT A COPY OF THE RECORD HAS BEEN PR
OVIDED TO THE WELL 01VNEll
3 r3N_•RE 0 • .RSOH coNsTRucTiNoTruE WELL
�. out me ul I iapl m !Re Dn Isiuu of AYurcr Qua lip-, Grounolw.Lrer Sccrion,
?hone '1G. I"It)) 733.9::1, tt-i[Ilin 3u days.
1636 Moll SCrviee Ctnrcr - RA16e
64, Nl'.
GW-I REV. 07/2001-=-_
To -
I
r
'3

309337
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Naturalu(��Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) 12) O 136V
Pa 1! 5 CERTIFICATION # ?� 0 a 75
WELL CONTRACTOR COMPANY NAME re efAir We/i tnit/f/A; CO
14
PHONE win 68'3 — 9fr?
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential Municipal/Public ❑ Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION: /
Nearest Town: f ti!r 'er County NrdeAremJ
S'-b w<4 Lot 2—►I
(Sneer Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: SaIAaId CSAOwenG
Address 5it/ 3 Asheudle lft.uy
(Sneer or Route No.)
/len d.'aal Ut II._ /V C 2117q /
City or Town State Zip Code
la 9)- 6 l7- 117 V-
Area code- Phone number
4. DATE DRILLED 0,0
5. TOTAL DEPTH: ay5
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO Gil
7. STATIC WATER LEVEL Below Top of Casing: 30 FT.
(Use "+" if Above Top of Casing)
S. TOP OF CASING IS / FT. Above Land Surface
*Top of casing terminated arlor below land surface requires a
variance in accordance with 15A NCAC 2C .0118.
9. YIELD (gpm): 30 METHOD OF TEST tatty/4j
10. WATER ZONES (depth): p? 30r
11. DISINFECTION: Type labit:15 Amount
12. CASING:
Depth
From D To G
From To
From To
Wall Thickness
Diameter or Weight/Ft. Material
FLL15
Ft.
Ft.
214.la.3 PVC SDA.I
13. GROUT: Depth Material Method
Fromm To 7, Q Ft. Canc.r'e ltc Poo Nt
From To Fr.
14. SCREEN: Depth Diameter
From To Ft. in,
From To Ft. in.
Slot Size Material
in.
in.
15.SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
Topogra /Land setting
❑Ridge lope ❑Valley ❑Flat
(check appropriate box)
Latitude/lon itude of well location
•�.V
(degrees/minu
Latitude/longitude source:
DEPTH
From To
s-Gy
bc� -ivy
l
ands)
GPS❑Topographic map
(check box)
DRILLING LOG
Formation Description
1)in1'
Kock
757
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.
113 Rht.e5 LI a a -A
1- - - 4 rsorrut%IGr
N.0
_ a
From To Ft.
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.
SIGNAT RE OF PERSON CONSTRUCTING TFIE WELL / ATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh,,IN#c
27699-1636 Phone No.[phone], within 30 days. GW-t REV.07/2R1

309334
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources(Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) IQOIOO,V to, Perf l S CERTIFICATION it 20 a.a
WELL CONTRACTOR COMPANY NAME Fe yoS ONi We /( h/4t///et9 CC, PHONE EAY16g 3-9rrf'9
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 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION: Nearest Town: tokeyut// L County 1"-1-ede$SD4j
C(w'uleat /vtiN, 252k/es- it - Si
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER:
No); Phe /p
Address SVO 9 /174.og - „t vz, ✓e.
eet or Route No.)
to sas A ef-17.A, C4 44 6;a o
City or Town State Zip Code
ow,- a as -9.690
Area code- Phone number
4. DATE DRILLED 7/f v
Topogra c/Land setting
['Ridge lope ❑Valley OFIat
(check appropriate box)
Latitude/longitude ofpell location
q/ 3S:12/2 SY'//Jett'/$G/ye
(degrees/min es/seco ds)
Latitude/longitude source: PS❑Topographic map
(check box)
DRILLING LOG
Formation Description
5. TOTAL DEPTH: YOS /
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO (7
7. STATIC WATER LEVEL Below Top of Casing: 1.-0 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS f FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordance with l5A NCAC 2C .0118.
9. YIELD (gpm): V/ METHOD OF TEST&'auiy,4 j
10. WATER ZONES (depth): 350
11
12. CASING:
13
14
15
Depth
From_ To l7G
From To
From To
DISINFECTION: Type
Diameter
Ftb.LS
Ft.
Ft.
GROUT: Depth
Fromm To 2.0 Ft.
From To Ft.
DEPTH
From To
Q — t//
- l/.6 floc/f
//b -e(OS (nn,t. Y-c
LOCATION SKETCH
Amount // 0 Show direction and distance in miles from at least
Wall Thickness two State Roads or County Roads. Include the road
or Weight/Ft. Material numbers and common road names.
ye. as Pit .Soity
Material
eel ncPG/C
Method
Poona
SCREEN: Depth Diameter Slot Size
From To Ftin. in.
From To Ft. in. in.
SAND/GRAVEL PACK:
Depth Size Material
From To - Ft.
From To
Ft.
Material
el e tiv; eee) /HiN. ES4.hfeS
2.CfYS
4-dNeyuifie ,/vc.
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
tit Par
SIGNATURE OF PERSON CONSTRUCTING THE WELL %ATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center- Raleigh, N�e
27699-1636 Phone No. [phone], within 30 days. GW-1 REV. 07/1001
N
east
1' eri

WELL CONSTRUCTION RECORD 3 0 9 3 3 3
North Carolina - Department of Environment and Natural Resources Division of Water Quality - Groundwater Section �-t
WELL CONTRACTOR (INDIVIDUAL) NAME (print) ISO 66y W t Pry([5 CERTIFICATION # 2Qa
WELL CONTRACTOR COMPANY NAME Fe /YJS'04 J- Welt Cn . PHONE pat 6%3 ' 9?r?
STATE WELL CONSTRUCTION PERMIT# J ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential C l Municipal/Public ❑ Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATIONJ:
Nearest Town• neyyrtiIC p�
� r £'W e JY/' M.
(Street Name, Numbers, CMlmuniry, Subdivision, Lot No., Zip Code)
Address /59 toura-5
(Street or Route No.)
/e/cbter n' C
Ciry or Town State
($.1$)- 77S- 0a/3
Area code- Phone number
4. DATE DRILLED 7l$/0 r/
5. TOTAL DEPTH: V s —/
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO L�
7. STATIC WATER LEVEL Below Top of Casing: 20 FT.
(Use' +„ if Above Top of Casing)
8. TOP OF CASING IS / FT. Above Land Surface'
'Top of casing terminated atior below land surface requires a
variance in accordance with l5A NCAC 2C .0118.
9. YIELD (gpm): ?
METHOD OF TES
10. WATER ZONES (depth): ago t
County /1/-eA /e/t30
/
3. OWNER: /U /r- ' /-1)o izc
p e— Pd
73 -a-
Zip Code
Cat
Topogra /Land setting
❑Ridge Mlope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of w 1 location
V aS'aA. WS�/1e708a'
onds)
(degrees/minute
Latitude/longitude source: L'IGPS❑Topographic map
(check box)
DRILLING LOG
Forma .09 Description
DEPTH
From To
0 -/22,
/,u-/x7
PC, - VOS
T
N"-W,
11. DISINFECTION: Type ispbiti Amount /2.4 z>
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
/ OI nth
(r
/t7N/)ft
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common road names.
From_Q_ To a7 Ft biAS 'ii/`./X3 sDRd/0/G
From To Ft.
From To Ft.
13. GROUT: Depth Material Method
From 0 To AO Ft. COA(,ICYC &e fr y
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.
Al. Z-915
/fine ersmn'd'•ht,#r.
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
lU. 7(3,
SIGNAT RE OF PERSON CONSTRUCTING THE WELL N .
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Cenrer - Raleigli;NC Iv
27699-1636 Phone No. [phone], within 30 days. GW-1 REV. 0.001
_ J
u

-11 PRI CL-liNc3 FILITC•110N lin-20RD
- 01 alIJ ,duJAI ic - Waror Qualify - GroundwinLy SibeTiOn
LL COI:b Tic ,tift:b1 ebbby !AIN
ocr-rinc.„..rion
1544sLO/1/ .4.feta aezilli /1,5 Ca PI-13111i' Rag a .5 ktVite<
AS' C/C(4.41'fI2ri SW) rjii
. E....it 1P33..3 LicaLp4[Pubbinduciriai
31-1 ar) Pump `o. tniroficii IJ usher 0 If Other, Lin Lie
fIt
iiy• hi //e -r• de A041
leocecil weiti tocriet earif--7
NC-nide-It OW (42.-
St-a-
0 —JY
-_C.: ,ik.1110‘C
aii,TE ID RI LT. B.El 77/17
3 POP.9.LORP PH: /0 YoS
DOES \ ELL REPLACE EXISTING- WELL'? YES 0 NO
STATIC. \`. :CEP, LEVEL Below Top oralnii: 2-0 r.
S TOP OF CASING is
1“TITi111.21‘d ;;L,or bcluw 1-and surf -Act rcquirts
a
arLaaaa Li, nut' 15". Ne.ke 20
9 YIELD 1E-MOD OP FEST WIr/ri egp)
AYER /ONES iacpull: 3 70
DiSiNFEC NOP ,c_inouni /Co?
(2. C.4..SINC3'
Well Thidal.cdr i
WcaMilf.:Fr 64..ik.T.C141
AthaL5 P
f VC •
39 —
iii.gricuinirdcJ
Topogrs11.14-elLiind seeing
laRidge OVAlley °Flat
(chacl:.ipproprififr box)
Larirodedonginide of well location
itt3.5 0
tinvccsTritinfiliii.c.condi)
LioirinlCilinigi fink SOW -CO: eri_ThSOTopo,graphic map
owe]: box.)
iltn- PH DRILU-N.G LOG
From To Formation Description
Di/4-
E0c
— Yo5 0-ra At'R.
Fr.
11)
Nc. 0-379
LO CATION SKETCH
Show direction and distance in miles from ac Haar.
tWO Stint Roods or County Roads. Include the road
niir0ber3 and common road flAine3
ia012
3 N1,711106 , cat 417
f
47/37__
T EL- Ville, A/C-.
SCR.EI'N C-Hpcit
E-linarral
309332
,•
SAND, alk..9.1TEL P ACK:
1:11.7pit,
SiZe
Fti,1 ft
Flint TO,
F.
Diaincier
Pt.
3 IlibniAIRICS
SLtr S
M.
IJJ
M414:1141
AA ce-Ced View eS/Mies
i Lei- riEBy CC' itTIFY thr?..r THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15 t1 NCAC 20, WELL -:
CONSTRUCTION S'TANDkaos, A NO THAT A COPY OF THIS nicopz HAS BEEN PROVIDED TO THE WELL OWNER
4d Airg5
S CI,iN...Ifth 01) brt (OCONSTRUCTINCITHE WELL
4(1/
Si-LiLAIC ill; oriz;iiial In Inc Onn1011 Cit 1 l' L4 (cc Qualify) Grout-1th, .flat Scetiun, WO Mail Service Caiticr -11,aleiglisfl:
a'o39-1o.lo ?folic ii:i iP I iii 7r3,)1, iranin 3d days.
GW-I REV. 0/200i
"T.
—0
'ED
01
i/ts 7 -44/7,1.

309331
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and W Natural(jResources//- ��)Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) 1Jo teOt , Pot/ 5 CERTIFICATION # 20a
WELL CONTRACTOR COMPANY NAME Fe go.. emir W e /( n/t/ ///A/ Co , PHONE MA 6133 - 9yf 9
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential Er-Municipal/Public ❑ Industrial ❑ Agricultural 0
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other 0 If Other, List Use
2. WELL LOCATIO : / /
Nearest Town: YN M4'4 tCoun He lean/
tpn it clear calf
(Street Name, Nu ors, Community, Subdivu on, Lot No., Zip Code)
3. OWNER: t (/L�rt! 1k' ,>
Address (ID 0 i U ,va
eo (Sntt[or RCM o)
k M //03973
mot
Ciry or Town State Zip Code
(2 - 311 —4739
Area code- Phone number
4. DATE DRILLED
Ofey
5. TOTAL DEPTH: SOS
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO 6
7. STATIC WATER LEVEL Below Top of Casing:. fa FT.
(Use "+" if Above Top of Casing)
S. TOP OF CASING IS / FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordance with ISA NCAC 1C .0118.
9. YIELD (gpm): ( METHOD OF TESTRilhtlrt77/ 1
10. WATER ZONES (depth):
11. DISINFECTION: Type /a b%{ Is
12. CASING:
Depth Diameter
From1_ To eV Ft. (y, iS
From To Ft.
From To Ft.
13. GROUT: Depth
From_ Tomb Ft.
From To Ft.
pographic/Land setting
Ridge ❑Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude 9f ell locatjon
N3S`a3.37Y WDS as,/Qy
(degrees/min es,• onds)
Latitude/longitude source: I3fPS❑Topographic map
(check box)
DRILLING LOG
Formation Description
P.Irt
DEPTH
From To
35 - 'ID Aark
tip —505 6-ren,'fe
Amount (}02
Wall Thickness
or Weight/Ft. Material
216t113 at riCMM
Material
Caner{f{
14. SCREEN: Depth Diameter
From To Ft. in.
From To Ft. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
Method
Po 0ri �O
Slot Size Material
in.
in.
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common road names.
Sa Gv Makletwry i a[.
Pen 4e/st1 1' /✓C .
16. REMARKS:
l DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH I5A NCAC 2C, WELL -
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
SIGNAT RE OF PERSON CONSTRUCTING THE WELL ATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC N
27699-1636 Phone No. [phone], within 30 days. GW-1 REV_`O7/20018
aar

VYELL CONSTRUCTION RECORD
_cprultcni or Env ironincnl Ond.b15iorid. R.su woes - Divis of Water
�b€�Quality - Groundwater $CLnJn
A '1 LLL 1I .JrJt 1YD11IDU.1' YaAl1; (p, uu; r
� "-i. fir' �TJIt `11b.•.iYY ,Y.v11L
YCL n.lcltOn PGRLI-ra .YSSDCLA'PC6 IYQ PURIV n
.nphc;44.1.1
309329
CCRTWA0. T10N xiROa8
(rcesoi✓s 4.fe!/ /%iv, Co . rNONe 15,RS 057-Zriee.
LLLL]- 1p laaol E s}: RtSi3ctllal let p16,n icing L/Public' ❑ lodl15Ri01 C7. A.grieuIr rul ❑
1 Lo.
0 Ic..o, _r1, 0 lie.at Pump 11 alcr lfjcOrian 0 Cdier 0 I Other, Lis[ Use
/&/4.-''rOr
--..� N.,.n: -1 .rlll.ri, Comawn ny. Su boi nion, Lot rW.. Zip Coot)
\tic.
a& f
(6r - rltou�c Nol
its,. a9cs, 5916c =1p
fll.ilio,)v01Dcr
-< DATE DRILLED FD 77/3/0g1
TOT- Ai. DEPEft 305
D3ES\AELL REPLACE EXISTING \YELL? YES 0 NO
STATIC \\ ;:IZZ'ii LEVEL Below Top or Casing: / 5 PT
/ lu3p' •T'-ir Abort Top er Gamin
3. COP OF CASINO' IS FT. Abo Ye Land Sur1Dcc
' Cop of r. vnmrmunrea zvur brIo\r lanq $urt4 c rcquirm a
Y.n c Lit., a. uru:n;c with I S.i .VCAC 2.0 .011.
y. YIELD unii. 3 l\ lETHCD OF TEST B%(11i/Yg •gri
! J. ii' TER _QNES LJcprh): ISO
Topogra ie/Land seriing
❑Ridge IleSlope DVallcy ❑Fla[
(ohcelc .ippropriart box)
Lurirude/longinrde oft ell location
(acgrc minu srrocon
L:Ilirudclongirudc sourer': eiti's SI:Topographic inop
vhcel: bo.V
DEPTH ORILLTNG LOG
From To Formation Description
0 — P$ bttt
/al— /33 _Rocr't
/3S— ..905 Gra Ali x-e
I. D!S!NFLCTiC 1'ypC/OR,;,
Licprn Diameter
Fl. ir,_..O_-_ Eo /33 Fe 6, a.5
F.role To Ft.
P.um» To Ft.
!3. 3 ROLiT. D, III
P hlarcnal
i ml'a— _ ro-. _ Fr GO!%CQGfe.
L:[OR1 TO Fr.
1-i '''C iEEIN Ucptn
Diameter
From f Fr. in
UIJL❑ r FL in.
i 3.ANIOCELA -EL P.ACK.
Depth, Si,>c
Kiiiiettii
iron: To
F!onl p
/1 LOCATION SKETCH
.Al000,11 Q'1 Show direcrion and distance to miles tiara a[ leas[
'Wlt This (wo Shure Roads or Count' Roads. Include the road
or N,,;ghwFr Prlatn';al oumbars and common rood names.
.Z/k.tA3 PVC 5DR)t/
IA{cn10a
Slot 3;2c
in.
iYlamnal
I c. RE,AdAREIS:
Pr.
Fr.
Y9/ sew 4,ie '2z.
l e n 4'ers o ry u ale. '
I Du Ii Ef.EBY CERTIFY "THAT THIS \YELL WAS CONSTRUCTED EN ACCORDANCE WITH ISA NCAC 2C, WELL
CONSTRUCTION STANDARDS, .AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDE-0 TO THE WELL OWNER
/S aNA. Irt Or -PERSON L, ON ON ING THE WELL ?Ayer �rLL,, [ DATE
omir the onginaI C tnc Dlniiuft of Water Quality, Grourldwacer Sccrion, 1636 Mail Service Cenrcr - Raleigh, NC
6dJ-Io3o Phone rYo. i9 Iv) 733.3222 trifnin 30 days.
GW-I REV.07/200g

309341
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) k7 o ba V IN . Per! 5 CERTIFICATION # R 0 as
WELL CONTRACTOR COMPANY NAME Fe /YUSON' I GV e /J flMt/I/at/ Cei . PHONE (SAY) 6S 3 ' 9`/Y9
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(ifapplicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential ITMunicipal/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: FICA/ Wilt/i/fC
'ounty 11-64 yi,5-04/
2plije PS1refe5 1
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: (TOSt1Z 6-ese-/er/m
Address / Wiie tiler, remca. »-
(Sneer r Route No.)
?lel(ctleisontdf,,- /✓C a t79/
City or Town State Zip Code
iae)- kg?. 28n
Area code- Phone number '
4. DATE DRILLED / �S/D Ye
5.TOTALDEPTH: i-gS
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO
7. STATIC WATER LEVEL Below Top of Casing: ca FT.
(Use "+" i r Above Top of Casing)
S. TOP OF CASING IS / FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordance with ISA NCAC 2C .0118.
9. YIELD (gpm): S METHOD OF TEST)gilhdrtny74�
l0
Topogra is/Land setting
DRidge lope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
N 3 S° xLe J y7'/uJen, 27, 67/
FAIR (degrees/minu[� onds)
Latitudeilongitude source: OUPS❑Topographic map
(check box)
DEPTH
From To
$ trf
i4 s - tI irk
— 2 'yet! � t_
WATER ZONES (depth): /2-D
11. DISINFECTION: Type 18k6Jt is
12. CASING:
Depth Diameter
From d To 9 Ft. 4. a.$
From To Ft.
From To Ft.
Amount. goy
Wall Thickness
or Weight/Ft. Material
13. GROUT: Depth Material
From_O_To 3b Ft. tont rite
From To Ft.
Method
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:
DRILLING LOG
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.
ff��'J"�.�q �f"/G
�v uJEtJ7
ueled.
NervelLrsdN.f'lit
JJ C
1 DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH ISA NCAC 2C, WELL ,
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWFL Ri-
SIGNATDRE OF PERSON CONSTRUCTING THE WELL #/ I�A1O T
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh,gYQ
27699-1636 Phone No. [phone], within 30 days.
GW-1 REV.01220p1
+ _J

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural ources - Division of ater Quality�4�- Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) /� /7 Jlt/ /-/N 22DCERTIFICATION # *ye/ J
WELL CONTRACTOR COMPANY NAME �ir'J'1 ht7J1 TG/ L. •9',c/E!,L .its' f'YHONE # Wan Sr•70c; >'G"
STATE WELL CONSTRUCTION PERMIT# /:.2 ./. ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential @3 Municipal/Public 0 Industrial 0 Agricultural ❑
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other ❑ If Other, List Use
2. WELL LOCATION:
Nearest Town:.,--.-y.rn z e County c tek*eca4/
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: ZAs1/40 C 4[!>FlT
Address �d . tezOK ,'flO
(Street or Route No.)
AareA DEPTH
City or Town State Zip Code From To
(0,0- O—
Area code- Phone number
4. DATE DRILLED y - /t, /94/
5. TOTAL DEPTH: ? HS
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO ❑
7. STATIC WATER LEVEL Below Top of Casing: 2 0 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS 1 FT. Above Land Surface*
'Top of casing terminated at/or below land surface requires a
variance In accordance with ISA NCAC 2C .0118.
9. YIELD (gpm): s METHOD OF TEST ASV
V
10. WATER ZONES (depth): 2 e, 0 — 2 e0
Topographic/Land ng
❑Ridge ❑Slope alley ❑Flat
(check appropriate box) C�
Latitude/longitude of well Iocatio
(degrees/minutes/seconds) 0 21
Latitude/longitude source:❑GPS❑Topogra�l jc ma$
(check box)
DRILLING LOG
Formation Description
/7 ?Vs-- ,ci'HlvtT`
11. DISINFECTION: Type
12. CASING:
From
From
From
0
13. GROUT:
From a
From To Ft.
14. SCREEN: Depth Di
From To Ft.
From To Ft.
15
Depth Diameter
To 20 Ft. 6 eif
To Ft.
To Ft.
Depth
To_¢ Ft.
M terial
LOCATION SKETCH
Amount Show direction and distance in miles from at least
Wall Thickness two State Roads or County Roads. Include the road
or Weight/Ft. Mate ial numbers and common road names.
tali' 2=0/
SAND/GRAVEL PACK:
Depth
From To Ft.
From To Ft.
ameter
in.
in.
16. REMARKS:
Method
/h ZXr:tt>a :!'c
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 Afe bF THIS 'HAP SBE�L'NPROVIDED TO THE WELLOWNER
�r+
I
TUI2 IOF PERSON C
NSTRUCTING 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

10. WATER ZONES (depth):
11. DISINFECTION: Type
12. CASING:
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) i4R/Jq/ K Res TG7lJR/ CERTIFICATION it ?/414f
WELL CONTRACTOR COMPANY NAME e: J-t�= Jl.e%! L Wed L. 71- o t' PHONE # ((WO 2'79-4,40-Coi
STATE WELL CONSTRUCTION PERMIT# /.i.?_ ASSOCIATED WQ PERMIT('
(if applicable)
(if applicable)
1. WELL USE (Check Applicable Box): Residential U Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2 WELL LOCATION: `"�
Nearest Town:/l` 'iy✓r,e,c County %ez... o-1414
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
opographic/Land setting
idge ❑Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
3. OWNER: SZj.3 de .?„.id e c.., e z ve (degrees/minutes/seconds)
Address � n . /7D 11 , oCJ Latitude/longitude source:❑GPS❑Topographic map
(Street or Route No.) (check box)
itRify-lilij/er ,V, G. DEPTH DRILLING LOG
City or Town State Zip Code From To Formation Description
( 2 - 27 - i3d 1jr—ieT_
Area code- Phone number
4. DATE DRILLED 9- /n — o f1
5. TOTAL DEPTH: 32s
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO / .3z S ei--:461014-077�
7. STATIC WATER LEVEL Below Top of Casing: CO FT.
/3©—i5%S Gvr�.cwr
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordance with ISA NCAC 2C .0118. ,�J
9. YIELD (gpm): 3o METHOD OF TEST ipaJBJ4/ra1.14/
/ 8/> 2 ,tcD
Depth
From 0 To / '/S Ft.
From To Ft,
From To Ft.
13. GROUT: Depth
From !. To 20 _ Ft.
From To Ft.
Diameter
l%v
M4erial
Amount
Wall Thickness
or ight/Ft. Material
'? UC
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.
L
e=
LOCATION SKETCH
7-1
Show direction and distance in miles from at least *,
two State Roads or County Roads. Include the road '4
numbers and common road narpes.
I�
Method
J4vj2X-21ja 2147?
Slot Size Material
in.
in.
16. REMARKS:
J �^
0
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH l5A NCAC 2C, WELL
• CONSTRUCTION STANDARDS, AND THAT A COPY OF T CORD EN PROVIDED TO THE WELL OWNER
i d� :eiJ%O C%5
SIGNATURE OF PERS
CONSTRUCTING THE WELL DATE
• Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center -Raleigh, NC cr
_ 2769 9.1636 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) / Pi r/ ✓ `�9 e/7e CERTIFICATION## 7P� 0//
WELL CONTRACTOR COMPANY NAME /1"Pr,/ 1/lei/'t c//%fl'/) PHONE # (c7' qj' ? 7prcc
STATE WELL CONSTRUCTION PERMIT# j JL t'/ 7ti q ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential fd' Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION:
Nearest Town: /fir ,...ezennK/.tCourny a -zs
(Street Name, Numbers, Coyymmmunity,//Subdivision, Lot No., Zip Code)
3. OWNER: (degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH DRILLING LOG
City or Town State From To Formation Description
(9)4# C4'11-7177
Area code- Phone number
4. DATE DRILLED tea17"0rT
Address Ji /l "vat 499e7
)_ (Street or Route No.)
teie/' "P e-
Zip Code
5. TOTAL DEPTH: [, 4 4
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO
7. STATIC WATER LEVEL Below Top of Casing: JdP FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS 41 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'g7 METHOD OF TEST
10. WATER ZONES (depth): (,' "3 h-
11. DISINFECTION: Type
12. CASING:
From 0
From
—
Topogr fc/Land setting :-
❑Ridge lope ❑Valley OHS
(check appropriate box)
Latitude/longitude of well location COI
0 -17
� icY — 9a
/44 =(h�
LOCATION SKETCH
Amount Show direction and distance in miles from at least
Wall Thickness two State Roads or County Roads. Include the road
Depth Diameter or Weight/Ft. Material numbers and commons road/names.
To/ 7 `f FLU %5' cargo,- CJ: % Ate'' cze
To Ft.
From To Ft.
13. GROUT: Depth Materiaj
From 0 To_te Ft.�t�r n. —n,
From To Ft.
14. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in.
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Size Material
t/'7S
t3J c' el
otid
Method
ra r 2--
From
From
1¢: AEM-AR :
I DU HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH I5A NCAC 2C, WELL'
CONSTRUCTION STA PiARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
ge7hrZit 5"/
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
To Ft.
To Ft.
,' N 2 7 2OO
Jil
o .SanthtiEhe{ p,ri(Diato the ivision of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
77699 1636 Phone No. (9 iv) 33-3221, within 30 days. GW-I REV. 07/2001

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Na I Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print)_ .?//A/ moe rn.. V CERTIFICATION # ?/e/t/
WELL CONTRACTOR COMPANY NAME %19F.P,t2rii PHONE # fRiA4 17-SV4/SO
STATE WELL CONSTRUCTION PERMIT# 0a J 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:
Nearest Town:ryrvoe,ecoAJt'-C County `Zf%%/i>i.lYpif(
rv. 120.
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: &-/ten
c $(. (Apes
Street or Rout
]���� ( eNo.)
City or Town State
Zip Code
(--)_
Area code- Phone number
4. DATE DRILLED '7- / 9 - 0 L1
5. TOTAL DEPTH: 4/2 S
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO Er
7. STATIC WATER LEVEL Below Top of Casing: 40 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 TEST4,, e/piu r/
10. WATER ZONES (depth):
C..-
opographic/Land setting Z
idge ❑Slope ❑Valley ❑
(check appropriate box)
Latitude/longitude of well locatioO
c1 ..g
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From To Formation Description
n - O .2
20 - c fi f1iIirr
VC? •---2 "9,/zr�
4�. — '/<2S Ga,*vtrc
11. DISINFECTION: Type o"c;
12. CASING:
Depth Diameter
From r5 To 5-2 Ft. rp t_
From To Ft.
From To Ft.
13. GROUT: Depth Material aterial Method
From O To 20 Ft..,-t'n .�qc ' "v. -I,Al-r-
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.
Amount
Wall Thickness
orWeight/Ft. Material
do
Material
-- — ARKS:
it i
1 i V1� ifER'EBY'CFJ TIi HAT THIS WELL WAS CONS
CONSTRUCTIO ipy4RDS, AND THAT A COP
;
I flat i 7 1�
SIGNATU
"an g#
OF RSON CON RUCTING THE WELL
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common road names.
9.eorS.v, rN;z/).
CTED IN �A�C� ORDANCE WITH 15A NCAC 2C, WELL
HIS REC,P )"'S BEEN PROVIDED TO THE WELL OWNER
- /9
DATE -
�5ii'tfhitf w glpal to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC,
Si
.2.1b2��Ci3b_Phorte;I10. (919j 733-3221, within 30 days. GW-1 REV. 07f2001

2. WELL LOCATION:
Nearest Town: *cAJeig.py.'//e Countyppdase f
9, au lei/ frho L.nq
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: flaunt O9fl7b!/ ! n a
Address 2rt Glen f a-ho Gne.e_
/ (Street or Route No.)
q4,
! /e. LS $r Sin fie ,4 C.
City or Town State Zip Code
( .11-C97-7//1
Area code- Phone number
4. DATE DRILLED 9. % /
5. TOTAL DEPTH: 7- 9 *j
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources�r- Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME(print)Cie/7/1.7 E i-C'//P CERTIFICATION # 2 G /7
WELL CONTRACTOR COMPANY NAME /%r'i',-j // Jrf// f//ri 2v
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
PHONE # fs/j 5 77-5/a/xj
xi
c-f
I. WELL USE (Check Applicable Box): Residential ❑ Municipal/Public ❑ Industrial ❑ Agricultural ❑
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use +}+
it
r1'
O
Topographic/Land setting p
❑Ridge ❑Slope ❑Valley ❑Ffelt
(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- ?O /1//-
7. STATIC WATER LEVEL Below Top of Casing: 4'0 FT. get_ fry,
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS 3 FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance In accordance with ISA NCAC 2C .0118.
9. YIELD (gpm): 0 METHOD OF TEST r
10. WATER ZONES (depth): S. 0-# / 94
I1. DISINFECTION: Type
12. CASING:
Depth Diameter
From, To `'r Ft.f%/i ,2/
From To Ft.
From To
13. GROUT: Depth
From d' To/
From To
14. SCREEN: Depth
From To
From To
15. SAND/GRAVEL PACK:
Amount
Wall Thickness
or Weight/Ft. Material
flv�
Ft.
Material Method
peat
Ft✓rr0v6 /Vi%
Ft.
Diameter Slot Size Material
Ft. in. in.
in.
Ft. in.
Depth Size Material
From To Ft.
From To Ft.
\REEMAdiIC,S:'
is
II'D1f) HEREBY CERTIFY THAT THIS. WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL.
ISTRUCTION STANDARDS, AN A HCO
/ils 1 �HAS BEEN PROVIDED TO THE WELL.OWNER
Li L
I �I iJUN 2 i 20lit
DATE
9/ en, /'2
.S'Aif•��
/4r� 7th- /d./; /
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.
Grua era eA >o/- Gtl/7
?o G/P/7 ,'c. 4a y '
t— IIGNA(TURE OF PERSON CONSTRUCTING THE WELL
Sub#6Nthe btigieta oo-the'Dtirision 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) f-iti°XCA/ ,>?Ciar7irai/
CERTIFICATION # WV*"
WELL CONTRACTOR COMPANY NAME--72sC } ,?vvr A PHONE P.SR11;1917419.-Cel
(
STATE WELL CONSTRUCTION PERMIT# /:f ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential NI 1.<icipal/Public ❑ Industrial 0 Agricultural ❑
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other ❑ If Other, List Use
2. WELL LOCATION:
Nearest Town: ,/..-.vvr.eCevli r s Countyezal/
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER:
Address ,z kg 1.• s,r�.v r Tio
Sr-cpf .y/! <flt/cF ric
q(Street or Route No.)
r//62,v/i. 7v- C
City or Town State Zip Code
(.&L)- '7'6
Area code- Phone number
4. DATE DRILLED a - Z2 - O y
5. TOTAL DEPTH: //6n
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO 0
7. STATIC WATER LEVEL Below Top of Casing: / 0 0 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS / FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance In accordance with 15A NCAC 2C .0118.
9. YIELD (gpm): ?t) METHOD OF TEST/ z,eRec) wet/
10. WATER ZONES (depth): //4?n t 45-0
,2opographic/Land setting
edge ❑Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From To Formation Description
o - 5 clrzi
O je'o C% /.-i+A.r, yE
2n -
/IC0 (Cie Ats
11. DISINFECTION: Type Amount
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
From 0 To 20 Ft. F %i $n /7; ,.OVC
From To Ft.
From To Ft.
13. GROUT: Depth Material
From G To 2 r7 Ft. rlsAVX-r>`
From To Ft.
14. SCREEN: Depth Diameter
From
To Ft. in.
From To Ft. in.
15. SAND/GRAVEL PACK:
Depth Size
From To Ft.
From To Ft.
16. REMARKS:
Method
lrtrk//s Oar
Slot Size Material
in.
in.
Material
CD
0
fV
LOCATION SKETCH
Show direction and distance in miles fro1Rat least:
two State Roads or County Roads. Inclu e he road
numbers and common road names.
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 1SA NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT AOF THI REEORD HAS BEEN PROVIDED TO THE WELL OWNER
SIGNATURE OF PERSO
t2/2,2%ay
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
LI

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natur Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) /5=/c70/1./ /9/1":07_7G7Q4/ CERTIFICATION q//Z/a/
WELL CONTRACTOR COMPANY NAME .d nr'?.frty z of f f [ /y9 L.-1.yyp PHONE q 14 trt7J 414-CV
STATE WELL CONSTRUCTION PERMIT# /02e ASSOCIATED WQ PERMIT#
(if applicable) / (if applicable)
1. WELL USE (Check Applicable Box): Residential Municipal/Public 0 Industrial ❑ Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection ❑ Other 0 If Other, List Use
2. WELL LOCATION:
Nearest Town: 9rir[c C /ZCvii? County /, O t47SOif/
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: 77S�/9707/ty
Address 3 V Triiriv/ t-E /
(Street or Route No.)
t/t/ //.r'. 2g9Dr%
City or Town State Zip Code
(Thhfj- W90—
Area code- Phone number
4. DATE DRILLED S — / j 0 y
5. TOTAL DEPTH: / ES
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO IT
7. STATIC WATER LEVEL Below Top of Casing: /(5 FT.
(Use' +" if Above Top of Casing)
8. TOP OF CASING IS / FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance In accordance with ISA NCAC 2C .0118. ��//
9. YIELD (gpm): /4 METHOD OF TEST /�FiT/1/OU/if/
10. WATER ZONES (depth): FO — i? 0A2
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Incl de the road..
n mbers and co on road names.
_Topographic/Land setting
Midge ❑Slope ❑Valley OFIat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DRILLING LOG
Formation Description
DEPTH
From To
O — S-o
So — 6/
/.Lvz.t r/rTF
— /,Cif 6/li%tirTG�
11. DISINFECTION: Type Amount
12. CASING: Wall Thickness
Depth Diameter or Wei ht/Ft.
From en To C / Ft
From To Ft./ //i
From To Ft.
13. GROUT: Depth Material
From (j To 2 0 Ft. Csetde .72C
From To Ft.
14. SCREEN: Depth Diameter Slot Size
From To Ft. in in.
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
16. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL
CONSTRUCTION STANDARDS, AND T
Material
/7vC
Method
a2
ii
Ora c/2'op✓e t L
i7
SIGNATURE 0
CONSTRUCTED IN ACCORDANCE WITH ISA NCAC 2C, WELL
COPY • - RECORD HAS BEEN PROVIDED TO THE WELL OWNER
RSON CONSTRUCTING THE WELL DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-I REV. 07/2001

WELL CONSTRUCTION RECORD OW
North Carolina - Department of Environment and Natur I Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) 4A/Z/2A/ y/y/T/ 7(1/\/ CERTIFICATION #3/5//
WELL CONTRACTOR COMPANY NAME *Pl%F/r%e'J/( Cr/,EL ( 74-704,)71-1/0, PHONE # /?C1 r%,j4 c/e/cd
STATE WELL CONSTRUCTION PERMIT# /d 2 ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
1. 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 LOCATION:
Nearest Town: 'r/! C /2zuAi7County ///>Wdce /
977 c/E/?Airy /cam/,
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: 7ia i nrsty 7M1/iZ,v�"
Address
(Street or Route No.)
A�,N fi c 24r7
City or Town State Zip Code
(a, -)- ?71J — 2052
Area code- Phone number
4. DATE DRILLED ?//4-J%J
5. TOTAL DEPTH: /?<
Topoggra 'c/Land setting
❑Ridge MSlope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From To Formation Description
�7 -
—
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO t3 6 Sa /8-S
7. STATIC WATER LEVEL Below Top of Casing: 4't2 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS / FT. Above Land Surface*
*Top of casing terminated atfor below land surface requires a
variance in accordance}�Ith ISA NCAC 2C .0118. �%
9. YIELD (gpm): /oL METHOD OF TEST ,/"/3�,P/4/p LAW
10. WATER ZONES (depth): 94 - /3cFT
11. DISINFECTION: Type
12. CASING:
Depth
From O To C 5 -Ft.
From To Ft.
From To Ft.
13. GROUT: Depth Material
From n To 20 Ft. ,t£Z-9M erP"
From To Ft.
14. SCREEN: Depth Diameter Slot Size
From To Ft. in. in.
From To Ft. in in.
15. SAND/GRAVEL PACK:
Depth Size
From To Ft.
From To Ft.
Amount
Wall Thickness
Diameter or eight/Ft. Material
✓G,
16. REMARKS:
1 DO HEREBY CERTIFY THAT THIS WELL WAS C
CONSTRUCTION STANDARDS, AND THAT A
�.QA,1rZY6
IN)
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include th- road
numbers and common road names.
RUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
OF THIyHAS 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 Natura esources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) .00/7' el", �9...eser-0-0..AZ CERTIFICATION # 3/Yy
WELL CONTRACTOR COMPANY NAME %05,477/7L LAJ.Ce-/ A,O(H,o- PHONE # } 4 tV
STATE WELL CONSTRUCTION PERMIT# /Ro2 ASSOCIATED WQ PERMIT#
(if applicable)
(if applicable)
I. WELL USE (Check Applicable Box): Residential La' Municipal/Public 0 Industrial ❑ Agricultural 0
Monitoring 0 Recovery ❑ Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION:
Nearest Town: R/i,v„.-r,rexaewe„E Countyar/
df u..n.r. ci2 rwEFl G,KNI. � NFi�Atf/J Can?.
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: r�Lra.�d r /�Le4lZ,,7lNlr
Address Qp ic+....srF.v9ui`iTT7.FLVF
(Street or Route No.)
,tom.C. 28-73/
City or Town State Zip Code
(512_0- 6 y 9 - s�s3
Area code- Phone number
4. DATE DRILLED ?- /d - p L/
5. TOTAL DEPTH: SD C
6. DOES WELL REPLACE EXISTING WELL? YES B'NO ❑
7. STATIC WATER LEVEL Below Top of Casing: Z, o o FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS / FT. Above Land Surface'
*Top of casing terminated at/or below land surface requires a
variance in accordance with 15A NCAC 2C .0118.
9. YIELD (gpm): S' METHOD OF TEST
Topographic/Land setting
❑Ridge ❑Slope 1311.a.11ey ❑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
so — vZ �RGN/iE
Y2- was
10. WATER ZONES (depth): 7 2Q — 756 tj
11. DISINFECTION: Type
12. CASING:
Depth
From n To v9 Ft.
From To Ft.
From To Ft.
13. GROUT: Depth Material
Amount
Wall Thickness
Diameter or Weight/Ft. Material
6 ,aP-5/ ,ovr^
From a To 26 Ft. .seiarvsli'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.
Grtc�.v�-,c
n
--1
LOCATION SKETCH
Show direction and distance in miles fronts least~
two State Roads or County Roads. Includu.the road
numbe and common read names.
Method
rn rs� oyOnrs2
Slot Size Material
in.
in.
Material
From To Ft.
16. REMARKS:
1 DO HEREBY CERTIFY THAT THIS WELL WAS C
CONSTRUCTION STANDARDS, AND THAT A
RUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
OF THIS HAS BEEN PROVIDED TO THE WELL OWNER
T /O-6y
SIGNATURE OF PERSO CONSTRUCTING THE WELL DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-1 REV. 07/2001
L"v

7. STATIC WATER LEVEL Below Top of Casing: C 4 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): 2METHOD OF TEST tiZ& Ow»l
10. WATER ZONES (depth): /90-MO- 24,0-z'/b-
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural ources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) - 'teats/ i.itl re -..A/ CERTIFICATION # ?Zen/
WELL CONTRACTOR COMPANY NAME `J271*tee>7, / ` O.tCCL . - •�r.✓tA PHONE # 6S G.rn-«c.s i
STATE WELL CONSTRUCTION PERMIT# /-Q.2 ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential N IZicipal/Public ❑ Industrial ❑ Agricultural ❑
Monitoring ❑ Recovery ❑ Heat Pump Water Injection 0 Other ❑ If Other, List Use
2. WELL LOCATION:
Nearest Town: a n n, c €R ru.c-,p County_ c.o re/>syV
er 0 even. ti/Y
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: ra.A Serf: ',-
Address '.i8- w.s272rs-- e r ecFw ,e_o.
(Street or Route No.)
City or Town State Zip Code
Z� CCa)f .Z?/7
Area code- Phone number
Top ographi c/Lantting
❑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
- 5 S der
4. DATE DRILLED 7-ii - p 4/ SS — 6 6
5. TOTAL DEPTH: 4 DS
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO (J' 6�_ �B S
11. DISINFECTION: Type
12. CASING:
Depth Diameter
From O To 6C Ft. 6. %y
From To Ft.
From To Ft.
13. GROUT: Depth Miaterial
From a To 2O Ft. Mfl7
From To Ft.
Amount
Wall Thickness
or Weight/Ft. Material
riC a'? ?/ /1?f.0
14. SCREEN: Depth Diameter
From To Ft. in.
From To Ft. in.
15. SAND/GRAVEL PACK:
From
From To Ft.
Depth Size
To Ft.
Slot Size Material
in.
in.
Material
G.z ptv rrie
Giegivr�F
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads .or County Roads. Include the road
numbers and co on road na es.
c
'37 c.cow e
-7rt, y 2 g O
16. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL W CONSTRUCTED IN ACCORDANCE WITH I5A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND TI- COPY. H1S RECORD HAS BEEN PROVIDED TO THE WELL OWNER
SIGNATURE OF PERSON CONSTRUCTING THE WELL
//- Or
DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-I REV. 07/2001

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural urces - Divisjo of Water Quality - Groundwater Section WELL CONTRACTOR (INDIVIDUAL) NAME (print) �1-tee / ar e707, CERTIFICATION # 7/9( f
WELL CONTRACTOR COMPANY NAME "7"..Cier fret (N,CG PHONE # Wit 9r'f%'YYJC/
STATE WELL CONSTRUCTION PERMIT# /92 ASSOCIATED WQ PERMIT#
(if applicable)
(if applicable)
1. WELL USE (Check Applicable Box): Residential 1C1 Municipal/Public ❑ Industrial 0 Agricultural 0
Monitoring ❑ Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
Area code- Phone number
4. DATE DRILLED V- 4 - n y
5. TOTAL DEPTH: 25�S
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO
7. STATIC WATER LEVEL Below Top of Casing: 4;0 FT.
(Use "+•' if Above Top of Casing)
8. TOP OF CASING IS / FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance In accordance ith ISA NCAC 2C A118.
9. YIELD (gpm): 23 METHOD OF TEST .,e/3LOrsm✓
10. WATER ZONES (depth): — /yb154--
Topographic/Lan etting
❑Ridge ❑Slope alley ❑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 — So yet_.>r
sn 6� f.cdoit
2. WELL LOCATION:
Nearest Town: ,gc tz4e jff6County
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: C n
Address /70 /?n }( 9/c/
(Street or Route No.)
,C2.4vr ieOLe ,r/, r 27 7
City or Town State Zip Code
69.E-- i3oy
11. DISINFECTION: Type catoc me
12. CASING:
Depth
/ Diameter
From_, To h / Ft.
From To Ft.
From To Ft.
Amount
Wall Thickness
or Weight/Ft. Material
fl�,P-ems/
'C
N
0
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common road names.
13. GROUT: Depth erial Method
From O To7Q_Ft. ..da.twar.or trat717f-frame
From To Ft.
14. SCREEN: Depth Diameter Material
From To Ft. in.
From To Ft. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
Slot Size
in.
in
16. REMARKS:
Girrt
/blJi
I DO HEREBY CERTIFY THAT THIS WELL W CONSTRUCTED IN ACCORDANCE WITH I5A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND TH COPY 0 :".5-RECORD HS BEEN PROVIDED TO THE WELL OWNER
SIGNATURE 0 ":' 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
5 2905

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natura esources - Division of Water Quality - Groundwater Section WELL'/
CONTRACTOR (INDIVIDUAL) NAME (print) ✓J.7aN /�i4/ii rtrevZ / CERTIFICATION # �/S/7
WELL CONTRACTOR COMPANY NAME �ylC'i2/IT// LAC,: / re/7ti.0.a-./' PHONE # &SSY,
STATE WELL CONSTRUCTION PERMIT# /2 2 ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential I9' Municipal/Public ❑ Industrial 0 Agricultural ❑
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION:
Nearest Town: N '2'c,P« vv/f County NNEiv..o,c, ,tJ.
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: 'a.vn.rr•
Address .$ 2 r»Ccrni T ,a/%
(Street or Route No.)
City or Town State Zip Code
(yam)-?9/P-
Area code- Phone number
4. DATE DRILLED ?- /- o S/
5. TOTAL DEPTH: r O S
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO lY
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): 6 METHOD OF TEST,. e&n.,.fv
10. WATER ZONES (depth): 2 o e - 6n FT
Topographic/Land setting
❑Ridge ❑Slope ❑Valley lat
(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 - YR- .q0sr.z i-
- s'7
Ste- Por
11. DISINFECTION: Type
12. CASING:
Depth
From a To 5' Ft.
From To Ft
From To Ft.
13. GROUT:
From -p
Diameter
Amount
Wall Thickness
or Weight/Ft. Material
p / �VG
Depth MaterialJ
To 2,o Ft. e+0//1,e-nn..
From To Ft.
14. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in.
From To Ft. in in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
Method
/acrtc ..00 Lee
16. REMARKS:
/zvvcr-.c
e e.a�rr4
C7
LOCATION SKETCH Q
Show direction and distance in miles frtf44at least
two State Roads or County Roads. Include the road
numbe s and common road names.
.r2'Cerno.e• ,er.
G//6s'TivvT .P,C�
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A OF TFWSj3E$ORD 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

CI r
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) �y ia.vnN 9743.1.7l/ 72 )
CERTIFICATION # S«%e/
WELL CONTRACTOR COMPANY NAME Jl'J -Ci7r) Z C. L '3V,_ GL. Y-/> viN lam- PHONE # (.Irj $'7-7- yySCi
STATE WELL CONSTRUCTION PERMIT# /22 ASSOCIATED WQ PERMIT#
(if applicable)
(if applicable)
1. WELL USE (Check Applicable Box): Residential Ni- Municipal/Public ❑ Industrial ❑ Agricultural ❑
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use
2. WELL LOCATION:
Nearest Town:?/"7Z4ie/)
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
County //'rN/AAd2x/✓
3. OWNER:c y, >/2
Address /?n . /3n,t /S// c/t,C.<
(Street or Route No.)
�l/9 /7OIX /v, 6 2 4 '7-7
City or Town State Zip Code
Area code- Phone number
4. DATE DRILLED 2-.2 e/
5. TOTAL DEPTH: -rQ' C-
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO I3
7. STATIC WATER LEVEL Below Top of Casing: rf,' 0 FT.
(Use'+" if Above Top of Casing)
8. TOP OF CASING IS / FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance In accordance with 15A NCAC 2C .0118.
9. YIELD (gpm): 7 METHOD OF TEST ,PQinwwwt/
10. WATER ZONES (depth): 2.00 - .;70/7 ,c-74:
I I. DISINFECTION: Type
12. CASING:
Depth Diameter
From (" To 70 Ft. t %7
From To Ft.
From To Ft.
13. GROUT: Depth
From 7 To 26 Ft.
From To Ft.
14. SCREEN: Depth Diameter
From To Ft. in.
Amount
Wall Thickness
or Weight/Ft. Material
M�aii)eertat Method
From To Ft. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
Slot Size Material
in.
in.
From To Ft.
opographic/Land setting
edge ❑Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From. To Formation Description
i0 —26 /c: 9A/ZTF
��/arvS7F
r-i
0
M
0
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common r. ad names.
ti
777 1� /e, o
Y/ / 6L/
16. REMARKS:
I D0 HEREBY CERTIFY THAT THIS WELL WAS C
CONSTRUCTION STANDARDS, AND THAT A
SIGNA
TRUCTED IN ACCORDANCE WITH ISA NCAC 2C, WELL
RD HAS BEEN PROVIDED TO THE WELL OWNER
URE 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 ►red *,rural Roourtes - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAAtt (prise) 131 LL1 E tJAS
CERTIFICATION■ i�%7'
WELL CONTRACTOR COMPANY NAME-REUDEN CALDWELL DRILLING, INC. rr�t
STATE WELL CONSTRUCTION ►ERMrr, PHONE[phone]
(Ifapplicable) PERMIT.
WQ PERrrp
(ifapplicable
_/
1. WELL USE (Check Applicable Box): Residential ty MunicipaVPublic 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCAT C :
Nearest Town: 6106eetSo1dS1ILI County JCAB(i-ScN
n1 N O JU iZc A C1
(Street Nuns, Numbed. Continually, Subdivision, Let No, Zip Code)
3. OWNER: KE.Nh)k;il-( COcv='LE; '
Address 5 c {�e,Ar� 04 (des sintavc.amd,)
"
(Sued ore/ twd No.) Latitude/longitude source:❑GPS❑Topographic reap
(^I ARVLI SISLclv Po) avc`j5 (check box)
Airy or Town State Zip Code DEPTH DRI - .IN O
0043 g V _ 00 From i To / Formation Description
Area cods. Phone number 1— 3�--3 3 i 0_11r '�t3y 2f
4. DATE DRILLED 10/a(�/o4 ��� b Arai �-
5. TOTAL DEPTH: (15 f / S-- ° C ITV 1 CE - ea /1 \
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO 3 l0 ' — r, e O
SSI D — G 2Ar— \ ce
7. STATIC WATER LEVEL Below Top ofCasing: S 0 CK� O - \ $ Gp -�
8. TOP OF CASING IS 4 Nu-.- ifAbove Top of Cuing) t� G 65 C20.-AadItras
*Top of cuing lermlaeled at/nr below Ind rim requires t- FT. Above Land Surface*
valance In accordance with ISA NCAC IC.0111. 9. YIELD (gpm): at) METROp OFT£ T 1�1 /�
10. WATER ZONES (depth): 310 v r r r 1
II. DISINFECTION: Type 41TN Q0%o AmountG1 b
•
12. CASING Wail Thickness
Depth to or WcighUFt. Material
From 1 To 1$ Ft. trite; ter
Q f G
From To Ft.
From To FL
13. GROUT: Depth Material Method
From A. To a 0 Ft. LE n')ticir Pc u&e±
From To Ft.
14. SCREEN: Depth Diameter Slot Size
From To Material
Ft. in. in.
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Siu Material
From To Ft. T-ab
From To Ft.
304227
16. REMARKS:
Topographic/Land setting
❑Ridge ❑Slope ❑Valley QFlat
(check appeop ins box)
Latitude/longitude of well location
rnt
LQCATI�KEfCH r
Show direction and distance in miles fromat�leastn
two State Roads or County Roads. Include the road tcr:
1-3
numbers and common road names. ?= `{'
rnci
pp i
r�A+�tic>2 L=A iaM
I.5 6n.
1.1 a 8 b
hn"
1 DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WLT)I ISA NCAC 2C, WELL.
CONSTRUCTION STANDARDS, AND THAT COPY OF THIS RE60RD HAS BEEN PROVIDED TO TI jE WEL.LhWNER
Wit
SIGNATURE OF PERSON CONSTR(/CTING THE WE. 1
LL
DATE
04--
Submit the original to the Division of Stater Quality, Groundwater Section, 1636 Man Service Center- Raleigh, pc
27699-1636 Phone No. [phone], within 30 days.
GW-1 R.EV. 07/2001

WELL CONSTRUCTION RECORD
3P 4262
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (pro RICHARD MCCRARY CERTIFICATION # 2010
WELL CONTRACTOR COMPANY NAME BARKER CONSTRUCTION, INC./BARKER WELL & PUMP PHONE # [phone]
STATE WELL CONSTRUCTION PERMIT# 1871 ASSOCIATED WQ PERaII1?I
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential El Municipal/Public ❑ Industrial ❑ Agricultural ❑
Monitoring ❑ Recovery O Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION:
Nearest Town: HENDERSONVILLE county HENDERSON
BLUEBIRD LANE
(Sheet Name, Nun bens, Con muoity, Subdivision, Lot No., Zip Code)
3. OWNER EARL & JANE POWELL
Address 9901 BOYLSTON HIGHWAY
(Sheet or Route No.)
HORSE SHOE NC 28742
City or Town Slate Zap Code
( 828 )_ 891-3435
Area code- Phone number
4. DATE DRILLED OCTOBER 27, 2004
5. TOTAL DEPTH: 605'
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO KI
7. STATIC WATER LEVEL Below Top of Casing: 30 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS 1.33 FT. Above Land Surface*
'Top of casing terminated attar below land surface requires a
variance to accordance with 1SA NCAC 2C .6118.
9. YIELD (gpm): 20 METHOD OF TEST TIMED
10. WATER ZONES (depth):
Topographic/Land setting
°Ridge ®Slope °Valley °Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/mirages/seconds)
Latitude/longitude soutrce:OGPSOTopographic map
(check box)
DEPTH DRILLING LOG
From To Formation Description
11. DISINFECTION: Type BY PUMP INSTALLER Anauu
12. CASING:
Depth Diameter
From 0 To 46 Ft 61/8
From To Ft
From To Ft.
13. GROUT: Depth Material
From 0 To 20 Ft. CONCRETE
Wall Thickness
or Weight/FL Material
SDR21 PVC
From To Ft.
14. SCREEN: Depth Diameter
From To Ft. in.
From To Ft. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft
Slot Size
in.
in.
0
rV
t
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common road names.
horn .�l ,u1crl tk4e>
.4u,(. y. 470 uk 4u r/a d .
Method 10 / y,wm (�%C_ I _,;, ,,,
POURED (+ 0�%a9 tO� 7( J�^�
thice-ta Ape_ i ant.. e�.
it atai1>
Material
16. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH I5A AC 2C WELL
CONSTRUCTION STANDARD j,'PHAT /)�C()1•Y,OF TINS RECORD HAS BEEN PROVIDED 7THE) ELL OWNER
lb
SIGNATURE OF PERSON l2QfTISTRUCTING THE WELL
z yDATE
�erq
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 - Dwain u..nt of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) KENNETH MCCRARY
CERTIFICATION If 2008
WELL CONTRACTOR COMPANY NAME BARKER CONSTRUCTION, INC./BARKER WELL & PUMP PRONE p [phone]
STATE WELL CONSTRUCTION PERMIT# 1871 ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential El Municipal/Public ❑ Industrial ❑ Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection ❑ Other ❑ If Other, List Use
2. WELL LOCATION:
Nearest Town:, HENDERSONVILLE Coady HENDERSON
PEACEFUL VIEW ESTATES, LOT #1
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER JEFFREY HARVEY
Address 263 LAMB MOUNTAIN ROAD
(Sheet or Route No.)
HENDERSONVILLE NC
City or Town Sate
( 828 )_ 685-2291
Area code- Phone number
4. DATE DRILLED OCTOBER 18, 2004
5. TOTAL DEPTH: 530'
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO El
7. STATIC WATER LEVEL Below Top of Casing: 30 FT.
(Use ^+" if Above Top of Casing)
8. TOP OF CASING IS 1.33 FT. Above Land Surface'
'Top rinsing terminated at/or below land surface requires a
variance In accordance with ISA NCAC 2C MIS.
9. YIELD (grim): 2 METHOD OF TEST TIMED
10. WATER ZONES (depth):
28792
Tip Code
Topographic/Land setting
❑Ridge ®Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(cheek box)
DEPTH DRILLING LOG
From To Formation Description
11. DISINFECTION: Type BY PUMP INSTALLER Amount
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
From 0 To 63 pt. 61/8 SDR21 PVC
From To FL
From To FL
13. GROUT: Depth
From 0 To 20
From To Ft.
14. SCREEN: Depth Diameter
From To FL in.
From To Ft. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
Material
Ft. CONCRETE
16. REMARKS:
Method
POURED
O
c
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common road names. C�
tf4oix t�diotattozz. tle,� .Ua/7Gt-
aad.o1.uur hadat
Giza_ (Jut
i
a 70_ r /// Ja�Ee-
Slot Size Material 1d -la l.-o d (a
PAgiatd_ o %/ . ile_
rt- -(�t0)C,e.G
�t / .GC.CIJ
At en.
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
/Le./YVV•.t-1fr—dt..'i'fl& 4/ /0
SIGNATURE OF PERSON CONSTRUCTING THE WELL DA
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center- Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-I REV. 07/2001

WELL CONSTRUCTION RECORD
North Carolina -Bali nt of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) RICHARD MCCRARY
CERTIFICATION # 2010
WELL CONTRACTOR COMPANY NAME BARKER CONSTRUCTION, INC./BARKER WELL & PUMP PAOp # f 826) 697-7263
STATE WELL CONSTRUCTION PERMIT# 1871 ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential El Mtmicipal/Public 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION:
Nearest Town: HENDERSONVILLE Coanty HENDERSON
PINNACLE VIEW, LOT #4
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: JOHN CHERRY - MIKE WITT, BUILDER
Address 54 JP HUGGINS DRIVE, FOXWOOD S.D.
(Street or Route No.)
HENDERSONVLLE NC 28791
City or Town State Zip Code
( 828 } 693-6700
Area code- Phone number
4. DATE DRILLED OCTOBER 14, 2004
5. TOTAL DEPTH: 266'
6. DOES WEII REPLACE EXISTING WELL? YES O NO Ki
7. STATIC WATER LEVEL Below Top of Casing: 40 FT.
(Use "+^ ifAbove Top of Casing)
8. TOP OF CASING IS 1.33 FT. Above Land Surface*
'Top of casing terminated at/or below hind surface requires a
variance in accordance with 1SA NCAC 2C .0118.
9. YIELD (gam): 6 METHOD OF TEST TIMED
10. WATER ZONES (depth):
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
From To Formation DescdWion
c
{0
1 1%:
t„T,:t
11. DISINFECTION: Type BY PUMP INSTALLER
12. CASING:
Depth Diameter
From 0 To 93 Ft, 6118
From To Ft
From To Ft.
Amount
Wall Thickness
or Weight/Ft. Material
SDR21 PVC
13. GROUT: Depth Material
From 0 To 20 Ft. CONCRETE
From To Ft.
14. SCREEN: Depth Diameter
From To FL in.
Fmnn__ To Ft in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
Method
POURED
Slot Size Material
iR
in
c
LOCATION SKETCH
Show direction and distance in miles from at (east
two State Roads or County Roads. Include the road
numbers and common road names.
Lizanc. ��d a i 2r
.,eat a
`7):0fricart Vaal
16. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH I5A NCAC
CONSTRUCTION STANDARDANDT}-IAT A OF TJ•HS RECORD PROVIDED TO
OF PERSO
NSTRUCTING THE WELL
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail
27699-1636 Phone No. [phone], within 30 days.
WFIT
LL OWNER
ervice Center - Raleigh, NC
GW-1 REV. 07/2001

3Q4041
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural - Divisionsiof Water Quality - Groundwater Section R
WELL CONTRACTOR (INDIVIDUAL) NAME�]] (print)) _LIl-?Y<t.j 'j3E-t (5 /� CERTIFIC,A�TIIO�Np#�g(061 C
WELL CONTRACTOR COMPANY NAME -fl�A 4A CY11Ai4G (k 7H .F)ii I IF N y PHONE # Tina `!N:/
STATE WELL CONSTRUCTION PERMITS/ ASSOCIATED WQ PERML #
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential Q Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION:
Nearest Town: Ft e1*ek ca.
5(931 41 u. bk\ i
tlift
(Street Name, Numbers, Commrmity, Subdivision,Lot No., Zip Code)
3. OWNER: I4N �N V"N V.N
Address �}•
f4tc -y c (suer an.3?
City or Town State Zip Code
Ara code- Phone number
4. DATE DRILLED 12 - I t - O 4
5. TOTAL DEPTH:
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO
7. STATIC WATER LEVEL Below Top of Casing: I O FT.
(Use "+* if Above Top of Casing)
8. TOP OF CASING IS 1 FT. Above Land Surface'
'Top of wing terminated at/or below land surface requires ■
variance in accordance with ISA NCAC 2C.0118.
Topogrjphic/Land setting
❑Ridge B lope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH PRJLLING LOG
From To Formation Description
9. YIELD (gpm): oQ. METHOD OF TEST Psi; coNipaMEI(
10. WATER ZONES (depth):
LOCATION SKETCH
11. DISINFECTION: Type I R ci Z'�, Amount Show direction and distance in miles from i least
Wan Thickness two State Roads or County Roads. Include the road
DAP Diameter or Weight/Ft Material numbers and common road names.
From 0 To & b Ft
From To Ft.
From To Ft.
13. GROUT: Depth Material -t Method
From To FtPa Q.2C-k z.- ? U
From To Ft
14. SCREEN: Depth Diameter Slot Size Material
From To Ft in. in.
From To Ft in. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
12. CASING:
Houyi-Erb GPyp IZcQ
H UFch M-Ft . rEci
16. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUC LW IN ACCORDANCE WITH I SA NCAC 2C, WELL
CONSTRUCTION STARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL�'"� OWNER
(DATE/
SIGNATURE OF PERSON CONSTRUCTING THE WELL
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Man Service Center - Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-1 REV. 07/2001

15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From ( To Ft.
3to 413
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division^lof Water Quality - Groundwater Section
n.
WELL CONTRACTOR (INDIVIDUAL) NAME (print) 1?one 5ry// CERTIFICATION sZ 277
WELL CONTRACTOR COMPANY NAME<tl�//W/ /Or I Lae, ti A /1aTit PONE a ailei t
/ o
STATE WELL CONSTRUCTION PERMIT, _._ MATED Q PRMITS 0 ei/Orp /l/ 391G
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential 0 Mtmicipal/Public 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection ❑ Other O If Other, List Use
2. WELL LOCATIQN: / /
Nearest Town: Iftet So isVeCounty 64N//ti/Soy
AST 2 SuQr t flo'a *1
(Street Name, Meath, Community, Subdivision, Lot No., Zip Cade)
3. OWNER: /g1 ittl e/¢f/
Address .0. /4R//' 11JG
0 9n1, (Street e- Na.) 2% 12 4/
agr Us-- 3 S G y Zip code
Ana code- Phone number
4. DATE DRILLED 7-20-Oy
5. TOTAL DEPTH: '/ 0 5
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO I--
7. STATIC WATER LEVEL Below Top of Casing: / S , FT.
�+ 8. TOP OF CASING IS /• (use
if Above Top of Caning)
J FT. Above Land Surface*
`Top of casing terminated at/or below land surface requires a
curtain la aeeordanre} ISANCAC 2C All& —
9 YIELD (gpm): 6'/ METHOD OF TEST // 01r�
10. WATER ZONES (depth): /20'
Topographic/Land setting
Midge °Slope Malley Mat
(check appropriate boa)
Latitude/longitude of well location
(degeahnimaa he000ds)
Latitude/longitude source:OGPSOTopographic map
(cheek box)
DRILLING LOG
Formation Description
DEPTH
From To
11. DISINFECTION: Type C. H. //
12. CASING:
DeTo
From To Ft.
From To Ft.
From To Ft
13. GROUT: Depth Material //
Fmm &To SO FLOSOIo•elie
From To Ft
14. SCREEN: Depth Diameter Slot Size Material
Fro To Ft.
in. in.
From To Ft. in. in.
Amount /n er
Wall Thickness
a Weight/Ft Material
SbR p,/ ptc
16. REMARKS:
LOCATION SKETCH
Snow direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common road names.
1 DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH I5A NCAC 2C, WELL
CON $v RUCTION STANDARDS,AID TKpft COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
Al nn of • i .//L ,/
SIGNATUEIOF PERSON CONSTRUCTING THE WELL - Z�
DATE
0
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

3U3545
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division f Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print /jt/J C RA D� 7 e CERTIFICATION # 27331
WELL CONTRACTOR COMPANY NAME J (pet /W &/e/ (jpaII 1 �vn/,(4, /Sr� PHONE d 04 ‘Q IJIj�O
STATE WELL CONSTRUCTION PERMIT# /U! / v
(if applicable) �rgOCGTI.D WQ p -
(if applicable)
1. WELL USE (Check Applicable Box): Residential l lunicipal/Public 0 Industrial ❑ Agricultural 0 Monitoring 0 Recovery 0 Heat Pump Water Injection E Other 0 If Other, List Use
2. WELL LOCATI • N.
Nearest Toown:. { t _ e r„„ ty /YC sctiv
h'e CMs tiQ (.in AA, a792.
(Street Name. Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER:7'l1cafltluFj.�
Address g C 74 r..e njr y
(Street orxytae No.)
Ilemrivispnui'/!r /UG 26792
' aerostat Zip Code
log el 4/
Area Phone number
4. DATE DRILLED 9 -/S--O
5. TOTAL DEPTH: ZDS'
6. DOES WELL REPLACE EXISTING WELL? YES NO
7. STATIC WATER. LEVEL Below Top of Casing:,
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS 1. FT. Above Land Surface•
`Top of casing terminated at/er below land surface requires ■
variance la accordance with ISA NCAC 2C .0118. /
9. YIELD (gpm): 7 METHOD OF TEST Pined
10. WATER ZONES (depth): ire
11. DISINFECTION: Type C.//./1,
12. CASING:
Depth
From 0 Ton_ Ft
From__ To Ft.
From
13. GROUT:
From /2
From
14. SCREEN:
Fro
From
15. SAND/G
From
From
16. REMARKS:
To Ft
Depth
To Zr
To
Depth
To
Amount /0 02
Wall Thickness
or Weight/Ft ibitotatal
2/
Material / Method
FtCeRCOPet1 r toE T /Myi(
Ft
Diameter Slot Size Material
Ft. in in.
To Ft. in in.
VEL PACK:
Depth Size Material
_To Ft.
_To Ft.
Topographic/La-Jeetting
❑Ridge °Slope p alley °Flat
(cheek appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:EIGPS°Topographic map
(check box)
DARLING LOQ
From To Formation Description
w
LOCATIONSKETCU t7
Show direction and distance in miles from at least
two State Roads or County Roads. ncluip the
/ , � 0
numbers and common road names. �A(,.n —�'i_
Cva
k Li
teiNI
Y CER1717 THAT THIS WELL WAS
ON5A NCAC 2C, WELL
STANDAXDS[S[ AND A CO ➢Y OCONSTRUCTED IHIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
SG 9,1ra`/
SIGNA 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
cn
c
xd

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - DivisionLvof Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) go /C leg,/ T CERTIFICATION a 26��77
WELL CONTRACTOR COMPANY NANDSpite/U7 U04ll4 puimp r/•Ir PHONE I �� o
STATE WELL CONSTRUCTION PERMIT# /Ul/Q AnnOCIATED WQ PERMITS
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential [B"Municipal/Public 0 Industrial 0 Agricultural ❑
Monitoring ❑ Recovery 0 Heat Pump Water Injection ❑ Other 0 If Other, List Use
2. WET r LOCATION: [
Nearest Town:r��IJ ogle County gedite so/t7
j 62. Pu.40. 14 e. Tat 7 f 2
(Street Name. Number, Community, Subdivision LotNo., Zip Code)
3. OWNER: PA14 A�l`/t%
Address 74% FFFLucer fts#G OR
(Silencer Route No.)
gestaiilfed4A/ e NL 2`1 79 Z
City or Town State Zip Code
Area dodo- Phone number
4. DATE DRILLED 9-/h/-OY
5. TOTAL DEPTH• TO('
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO Ire
7. STATIC WATER. LEVEL Below Top of Casing: &/5 Ff.
(Use seifAbove Top of Casing)
8. TOP OF CASING IS I • Jr FT. Above Land Surface*
'Top of codas terminated at/or below land Barbee requires a
variance la accordance with 1SA NCAC 2C A11& —,
9 YIELD (gpm): / j- METHOD OF
Topo setting
[Midge Oglope Malley 0Flat
(check appropriate box)
Latitude/longitude of well location
(degcalmimnea/samds)
Latitude/longitude source:❑GPS❑Topographic map
(cheek box)
DEPTH DRILLING T D i
From To Formation Description
T ire
10. WATER ZONES (depth): f,t ' — / 9
11. DISINFECTION: Type C.N. // . Amount / 0 O 2-
. CASING: Wall Thickness
or Weight/Ft
From To Depth.30 Ft I 5DR Z/ V G.
From To Ft
From To Ft.
13. GROUT: Depth Material M
From To 3t/ Ft(eaoten)4:/ we Ati/
From To Ft
14. SCREEN: Depth Diameter Slot Size Material
Fro To Ft. in. in.
Fro To Ft_ in. in.
15. SAND/G VEL PACK:
Fro
Fro
16. REMARKS:
1 DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WFd
CONSTRION STANDepS, AND TA $PY 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
Depth
To
To Ft.
LOCATION SKETCH {?
Show direction and distance in miles from at least 0
two State Roads or County Roads. Include the road 0
num and common mad

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and NNatiral Resources
- Di i*ton of Water
pQuality - Groundwater Section
�r�/
WELL CONTRACTOR (INDIVIDUAL) NAME (print) en c /\ �thi Oe s 7.R CERTIFICATION it 77 RV
WELL CONTRACTOR COMPANY NAME 5 W e t u-'Lej4' 11J ealr,2ti p
STATE WELL CONSTRUCTION PERMIT# aJ�ASSOCIATED WQ/PERMTT#
(if applicable) (if applicable)
PRONE a 10G0 6y9 BY80
1. WELL USE (Check Applicable Box): Residential 6" Mtmicipal/Public 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery ❑ Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION;
2 Town- /4Jf pp
Co y A s1 ! esoev
(Street Name,Ndos a. Carauaity, Subdivision, Lot No, Tip Code)
3. OWNER: .S t / //91A 44e
Address IA/ x/� e /ter, oe
FIRS leAc NNic 2S73
City or Taw State Tap Code
(------}'
Arca code- Phone number p
4 DATE DRILLED % i 3 `0 C�
5. TOTAL DEPTH: / S'
6. DOES WELL REPLACE EXISTING WEI I ? YES 0 NO C9r
7. STATIC WATER LEVEL Below Top of Casing: /5—' Fr.
(Use "+- if Above Top of Casing)
8. TOP OF CASING IS L. s FT. Above Land Surface*
`Top of wing terminated atlor below rand surface require a
variance In um ISA NCAC 2C .0118.
9. YIELD (gpm):rd7 _ METHOD OF TEST T 01 pa
10. WATER. ZONES (depth): 90 - lilt"
11. DISINFECTION: Type GK N Amount /n 0 P.
12. CASING: Wall Tlrictmess
Dep orW ' t/FL Material
From 0 To 00 Ft. 5op / re
From To Ft.
From To Ft.
13. GROUT: Depth Material M r
From_�To7(ZFt. COACP0AW WP AaI/
From To Ft.
14. SCREEN: Depth Diameter Slot Size Material
Fro To Ft. in. in.
Fro To Ft. in. in.
15. SAND/ VEL PACK:
Depth Size Material
TopopraDltic/Land setting
°Ridge lope °Valley ❑Flat
(check appmpdat bac)
Latitude/longitude of well location
(degnaalmimaesise )
Latitude/longitude source:0GPSOTopographic map
(check bra)
DEPTH DRILLING LOG
From To Formation Description
Fro To Ft.
Fro To Ft.
I OCATION SKEETCCH v,T
Show direction and distance in miles from at least 0
two State Roads or County Roads. Include the road O
numbers and common road
I DO HEREBY C TIFY THAT THIS WELL WAS NSTRUt.1tD + ACCORDANCE WITH I5ANCAC 2 WELL
CONSTRU STANDARDS, T A PY OF THIS ORD HAS BEEN PROVIDED TO THE WI)TERR
Or
S GNATURE OF PERS t a TRUCTING THE WELL /lir /
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

zngf
WELL CONSTRUCTION RECORD
North Carolina — Department of Environment And Natural Resources — Division of Water Quality — Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) NEIL CRAFT CER11FICATION # 3114
WELL CONTRACTOR COMPANY NAME PITTMAN WELL BORING. LLC PHONE # [phone]
STATE WELL CONSTRUCTION PERMIT # _ ASSOCIATED WQ PERMIT #
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential Z MunicipaUPublic ❑ Industrial ❑ Agricultural ❑
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use
2. WELL LOCATION:
Nearest Town: EDNEYVILLE County REND
REEDY PATCH CREEK DR. -LOT #2
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: TERRY DUFFY
Address REEDY PATCH CREEK DR
(Street or Route No.)
EDNEYVILLE NC 28727
City or Town State Zip Code
8(28) — 625-1997
Area Code Phone number
4. DATE DRILLED 10/21/04
5. TOTAL DEPTH: 185
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO
7. STATIC WATER LEVEL Below Top of Casing: 80 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS 1-1/2 FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordance with 15A NCAC 2C .0118.
9. YIELD (gpm): 20 METHOD OF TEST ARD
10. WATER ZONES (depth):
11. DISINFECTION: Type CHLORYTE Amount 3.5
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft Material
From 0 To 60 Ft. 6-1/4" SDR.21 PVC
From To FL_
From To Ft. _
13. GROUT: Depth Material Method
From 0 To 20 Ft. QUIKRETE POURED
From _ To _ Ft.
14.SCREEN: Depth Diameter Slot Size Material
From _ To _ Ft. _ in. _ in.
From _ To _ Ft. _ in. _ in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft
From To Ft
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
From To
DRILLING LOG
From To
LOCATION SKETCH
Show direction and distance in miles from at least
Two State Roads or County Roads. Include the road
number and common names
HWY. #64 E. FROM BAT CAVE. APPROX. 1 MILE
LEFT ON REEDY PATCH CRK. DR. LOT 1/4 MILE
ON RIGHT.
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUC1ED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION`, STANDARDS, AND THAT A COPY OF THIS
RECORD HAS BEEN PROVIDED TO THE WELL OWNER
111 SIGN��K OF PERSON CONSTRUCTING THE LL DATE /
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center— Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-1 REV. 07/2001

30383'
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment And Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) NEH. CRAFT CERI IFICATION # 3114
WELL CONTRACTOR COMPANY NAME PITTMAN WELL BORING, LLC PHONE # [phone]
STATE WELL CONSTRUCTION PERMIT # _ ASSOCIATED WQ PERMIT #
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential ® Municipal/Public ❑ Industrial 0 Agricultural
Monitoring 0 Recovery ❑ Heat Pump Water Injection 0 Other ❑ If Other, List Use
2. WELL LOCATION:
Nearest Town: EDNEYVILLE
J.J. LANE
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: BOBBY IHUSSEY
Address 315 J.J. LANE
(Street or Route No.)
EDNEYVILLE NC 28728
City or Town State Zip Code
(828) - 606-1172
Area Code Phone number
4. DATE DRILLED 10/27/04
5. TOTAL DEPTH: 145
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO El
7. STATIC WATER LEVEL Below Top of Casing: 40 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS 1-1/2 FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordance with 15A NCAC 2C .0118.
9. YIELD (gpm): 15 METHOD OF TEST ARD
10. WATER ZONES (depth):
County HEND
11. DISINFECTION: Type CHLORYTE Amount 3
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
From 0 To 50 Ft 6-1/4" SDIL21 PVC
From To Ft. _
From To Ft _
13. GROUT: Depth Material Method
From 0 To 20 Ft.OUIKRETE POURED
From _ To _ Ft.
14.SCREEN: Depth Diameter Slot Size Material
From _ To _ Ft. _ in. _ in.
From _ To _ Ft. _ in. _ in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To_Ft.
From To Ft.
16. REMARKS:
Topographic/Land setting
❑ Ridge ❑ Slope ❑ Valley ❑ Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source: D GPS ❑ Topographic map
(check box)
DEPTH
From To
DRILLING LOG
From To
LOCATION SKETCH
Show direction and distance in miles from at least
Two State Roads or County Roads. Include the road
number and common names
HWY. #64 W. FROM BAT CAVE. APPROX. 5
MILES. LEFT ON J.J. LANE. BEAR LEFT AT END
OF PAVEMENT. LEFT AGAIN ON THE NEXT
GRAVEL DRIVE. NEW GRADED LOT AT DEAD
END.
o
r
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUC 1ED 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 /PER
0- 7 f
CONSTRUCTING THE LL DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center- Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-1 REV. 07/2001

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and atural Resource,\ Division of Water Quality - Groundwater Sectionn
WELL CONTRACTOR (INDIVIDUAL) NAME (print) _P(.4 W \tom.1 1.5. "� CERTIFICATION`/ # 9 `0/�
Otzt
WELL CONTRACTOR COMPANY NAME pp N. &OA\Ac lAJT l ei1lllVq PHONE# PI�DS, -g 3-
STATE WELL CONSTRUCTION PERMIT#
(if applicable)
303182
ASSOCIATED WQ PERMIT#
(if applicable)
1. WELL USE (Check Applicable Box): Residential 121"Municipal/Public ❑ Industrial 0 Agricultural 0
Monitoring 0 Recovery ❑ Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATIO
Neanst,Town: W p`IC1/4.
68 yastot
(Street Name, Numbers, Community, Subdivision, Lot No., Try Code)
3. OWNER: 1kM 4 Q i te(3
Address (D % Vd 9\S off). Pr L
ruksT /' - 0 5 Zip Code
County lI.l ` 5O %1
Topohic/Land setting
❑Ridge GISlope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
PEPTH DRILLING LOG
From To Formation Description
Area code- Phone amber
4. DATE DRILLED IT T
5. TOTAL DEPTH: I5 /
O p
6. DOES WELL REPLACE EXISTING WELL? YE NO 6�
7. STATIC WATER LEVEL Below Top of Casing: 'I 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 accordwiwnh ISA NCAC 2C .0118. n_ et".1 Jeri
9. YIELD gpm): i7V (depth):
N 1 QD OFTESTLifl
10. WATERL
11. DISINFECTION: Type 1Pcrace, Amount
12. CASING: Wall Thickness
ff11 Depth Diameter or Weight/Ft. Material
From 0 To 130 Ft
Fromm_ To Ft.
From_ To Ft.
13. GROUT: Depth S� etho�d
From To_ Ft M
From To Ft.
14. SCREEN: Depth Diameter Material
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
16. REMARKS:
e-.
1z
--1
s
Dn
r.a Q1Ti
✓ '
r—
j.00ATION SKETCH
Show direction and distance in miles from at lea▪ st
two State Roads or County Roads. Include the road
numbers and common road names.
-plWt \\OW
j \ ev 5cAl .
e,va sziC
fs S-V7.0(._
1 DO HEREBY CERTIFY THAT THIS WFi f WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONS ON SSTANDpRDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
%v ,A) Q `I
SIGN 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)_ tt 14
WELL CONTRACTOR COMPANY NAME S4 e6;` ti.. CERTIFICATION :1Y36
STATE WELL CONSTRUCTION PERMIT# et t Sew s C. PHONE #sta�a Zet;
(ifa,plicable) ASSOCIATED WQ PERMIT#
(ifa icable)
1. WELL USE (Check Applicab;e Box): Residential « Municipal/Public D
Monitoring 0 Recovery ❑ Heat Pump Water Injection ❑ Industrial ❑ At,
Other ❑ 1f Other, List Use cultural ❑
2. WELL LOCATION: r Nearest Town:C �kn S
o n U r l �o
County fCSQ
USG.
• a
(Street Name. Numbers, Community. S division. Lot No., Zip Code)
3. OWNER: Its- rt os r
Address ___ScLew.[w. w_ _ - .ay --'-------
(Street or RN.
($28)- 99t• �qq Zip
r
A ca code- Phone number
4. DATE DRILLED
5.-TOTAL.DEPTH: 3.2
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO E7
7. STATIC WATER LEVEL Below Top of Casing: FT
R. CASING IS >t (Use +.. if Above Top of Casing)
TOP o OF C ET. Above Land Surface*
P g terminated at/or below land surface requires a
variance in accordance with ISA NCAC 2C 9118.
9. YIELD (apm): 3 METHOD OF
0. WATER ZONES
Dote o )
City or Town aM10l4o(t ...� Ak• rL.
State Cod'
1 ES (depth):
11. DISINFECTION: Type A: qt
12. CASING:--- Amount
Wall Thickness
or Weight/Ft. Material
sl _post -
From }�
From
From
Depth Diameter
To .s9 FL (oi,,
To Ft.
To Ft.
13. GROUT: Depth
From_-Q._ To 2a
From To
14. SCREEN: Depth
From To
From To
15. SAND/GRAVEL PACK
Depth
From To Ft
From To Ft
16. REMARKS:
Material
Ft.
Diameter
Ft. in.
Ft. in.
Method
e •eon
Slot Size Material
in.
in.
Size Material
304877
Topographic/Land setting
:Midge hope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/nuances/seconds)
Latitude/longitude source:❑GPS❑Topographic map
DEPTH (check box)
From DRILLING LOG
To Formation Description
LOCATION SKETCH Show direction and distance in miles frorLatjleast Ft�'—_ ,
two State Roads or County Roads. Include4ce road;-V.-.1
numbers and common road names. fry C
CD-ri 1 Sri,
Ca
O-.t!J
rjt'.l
ro (ra
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 PERS CONSTRUCTING THE WELL DATE
Submit the original to the Division of Water Quality Groundwater Section, 1636 Mail Service Center - Raleigh, NC
GW-I REV. 07/2001
y

Thu?
WELL CONSTRiJCTION RECORD
North Carolina - Depart of Enviromnent and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (prim) KENNETH MCCRARY CERTIFICATION & 2008
WELL CONTRACTOR COMPANY NAME BARKER CONSTRUCTION, INC.BARKER WELL & PUMP
STATE WELL CONSTRUCTION PERMIT& 1871 ASSOCIATED WQ PERMIT&
(if applicable) (if applicable)
PHONE & [phone]
I. WELL USE (Check Applicable Box): Residential BI Mu nicipaVPublic ❑ Industrial ❑ Agricultural ❑
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other 0 If Other, List Use
2. WELL LOCATION:
Nearest Town: HENDERSONVILLE County HENDERSON
GILREATH LOOP ROAD
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: JULIANNA STOUT
Address 21 GIRDWOOD HEIGHT$
(Street or Route No.)
CANTON NC 28715-6456
City or Towm State Tip Code
( 828 )- 648-3912
Area code- Phone numbs
4. DATE DRILLED NOVEMBER 15, 2004
5. TOTAL DEPTH: 405'
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO KI
7. STATIC WATER LEVEL Below Top of Casing: 20 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS 1.33 FT. Above Land Surface*
'Top of aunts terminated at/or below land surface regnira a
variance in accordance with ISA NCAC 2C .911t
9. YIELD (gpm): 6 METHOD OF TEST TIMED
10. WATER ZONES (depth):
11. DISINFECTION: Type BY PUMP INSTALLER Amount
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft
Fron._To 109 Ft. 61/8 SDR21
From To Ft
From To Ft.
Depth
To 20
13. GROUT:
From 0
Material
FL CONCRETE
From To Ft.
14. SCREEN: Depth Diameter
From To FL in.
From To Ft in.
15. SAND/GRAVEL PACK:
Depth
From To Ft
Material
PVC
Topographic/Land setting
❑Ridge ❑Slope QValley 10FIat
(check appropriate ban)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH DRILLING LAG
From To Formation Description
Method
POURED
Size Material
0
1*7
LOCATION SKETCH .,-
Show direction and distance in miles from at least
two State Roads or County Roads. Include the
numbers and common road names.
.744/72. le ./211. uo&cCrn �(�.ctt. tiled
bAtayto
�o . 3 �4c t/At
pad. a.. ALt.
Frort�`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 T(jIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
SIGNATURE OF PERSON CONS TRUC`I1NG 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

H2O
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL coNrRACIY)R OND/VIDUAL) NAME (pint) KENNETH MCCRARY CERTIFICATION Y 2008
WELL CONTRACTOR COMPANY NAME BARKER CONSTRUCTION. INCJBARKER WELL & PUMP
STATE WELL CONSTRUCTION PERMIT./ 1871 ASSOCIATED WQ PERMIT#
Cifapplicable) (if applicable)
PHONE F [phone]
1. WFI I USE (Check Applicable Box): Residential El Municipal/Public ❑ hxhistrial 0 Agricultural 0
Monitoring 0 Recovery ❑ Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION:
Nearest Town: HENDERSONVILLE County HENDERSON
TRY AND FIND R DRIVE
(Sheet Name, Numbers, Community, Subtbvision, tut No., Tip Code)
3. OWNER CLFFORD BISHOP
Address 127 TRY AND FIND IT DRIVE
(Street or Route No.)
HENDERSONVILE NC 28792
City or Town State Tap Code
( 828 r 697-9990
Area code- [hone member
4. DATE DRILLED NOVEMBER 16, 2004
5. TOTAL DEPTH:.255'
6. DOES WELL REPLACE EXISTING WEIL? YES 0 NO El
7. STATIC WATER LEVEL Below Top of Casing: 10 FT.
(Use"+^ if Above Top of Casing)
8. TOP OF CASING IS 1.33 FT. Above Land Surfaces
'Top of casing ttrSeated atlor below land swan requires a
misses la armnWa wits 15A NCAC 2C .611a.
9. YIELD (gpm): 30 METHOD OF TEST TIMED
10. WATER ZONES (depth):
11. DISINFECTION: Type Br PUMP INSTALLER
12. CASING:
Depth Diameter
From 0 To 94 FL 61M8
Amount
Wall Thickness
or Weight/Ft. Material
SDR21 PVC
From To Ft.
From To Ft.
13. GROUT: Depth Material
From 0 To 20 Ft. CONCRETE
From___ To Ft.
14. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in.
From To Ft in. in.
15. SAND/GRAVEL PACK:
Depth Size Material
To Ft.
To Ft.
Method
POURED
From
From
TopograpbiclLand setting
❑Ridge ()Slope ❑Valley ®Flat
(checkappapriatebox)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From To Formation Description
SR
h
as
LOCATION SKETCH '
Show direction and distance in miles front at 1e
two State Roads or County Roads. Include the
meters and common road names.ldes
.Z�
, . �70 to ikitcieud..
aiu- ' l�,acad anQt .
ail itoac4 and Lae
1119 toad ��
adi t fl-c nun_
L& ��
aJ r-ir/ d d4J7d Yf .CIt- .
,r� �r Oauit -04
16. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WFI1
CONSTRUCTION STANDARDS, AND T A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
��tivw(�Gt Mr- i -�q--a 4
SIGNATURE OF PERSON CONSTRUCTING WELL DATE
Submit the original to the Division of Water Quality, Groundwater Section,1636 Man Service Center- Raleigh, NC
27699.1636 Phone No. [phone], within 30 days. GW-1 REV, 07/2001

WELL CONSTRUCTION RECORD 3 0 51.3 5
North Carolina- Deparnnent of Environma t and Natural Resources - Division of Water Quality - Groundwater Section
W LLCON/RACTOR (INDIVIDUAL) NAME (pint) RICHARD MCCRARY CERTIFICATION g 2010
PHONE R f 828) 697-7263
WELL CONI'RACU3R COMPANY NAME BARKER CONSTRUCTION, INCJBARKER WELL & PUMP
STATE WELL CONSTRUCTION PRRMITI 1871 ASSOCIATED WQ PERMIT'#
(ifappiicabk) (ifapplicable)
1. WELL USE (Check[[ Applicable Box): Residential ® Municipal/Public ❑ Industrial 0 Agricultural 0
Monitoring CI Recovery 0 Heat Pump Water Injection 0 Otter 0 If Other, List Use
2. WELL LOCATION:
Neatest Town: HENDERSONVILLE
SAVANNAH VILLAGE, LOT #2
(Street Name, Numbers, Community, Subdivision, Lot No., np Code)
County HENDERSON
3. OWNER: STEVEN CANNON
Address 517 OAK GROVE ROAD
(Stret eor Rome No.)
RAT ROCK NC 28731
City or Town State no Code
( 828 )• 692-0169lan Area code- Pe number
4. DATE DRILLED NOVEMBER 18, 2004
5. TOTAL DEPTH: 205'
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO
7. STATIC WATER LEVEL Below Top of Casing: 30 FT.
(use "+" ifAbove Top of Casing)
8. TOP OF CASING IS 1.33 FT. Above Land Surface;
lop dosing [endowed atior bebw toad unlace requires
valiance to accordance with 1SA NCAC 2C .0I18.
9. YIELD (gpm): 7% METHOD OF TEST TIMED
10. WATER ZONES (depth):
11. DISINFECTION: Type BY PUMP INSTALLER
Amount
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
From 0 To 62 FL 61/8 SDR21
From To Ft.
From To FL
13. GROUT: Depth Material
From 0 To 20 FL CONCRETE
From To FL
Topographic/Land setting
®Ridge ❑Slope °Valley °Flat
(check appropriate bur)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude longitude souree:OGPSOTopographic map
(check box)
DEPTH DRILLING LOG
From To Formation Description
LOCATION SKETCH
Show direction and distance in miles from at feast two State Roads or County Roads. Include the road
numbers and common road names.
PVC Ji(.0 rt. ul(snciutottutUt ti[, ii_ 1157.5
,datak #o baba Cjt tx,k Exit. Jzotno
_Nit at- hal ey aitta bab
Auk,Pd. l�o � �vd ant
axio dump et.ee.,�/ -&.
twitsti.cZ nctia JZ�G�U4O
Onto � ' �,-�}} fix'
t.rn/�
Method
POURED
14. SCREEN: Depth Diameter Slot Size
From To Ft in. in.
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft
Material
16. REMARKS:
(54I288). io
ha/anatra-llaicrr.
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUC IEEU IN ACCORDANCE WITH I5A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND T A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
( SIGNATUREPERSON CONSTRUCTING THE WELL
2'
Submit the original to the Division of Water Quality, +Groundwater Section, 1636 Mall Service Center- Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-1 REV. 07/2001

WELL CONSTRiJCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) KENNETH MCCRARY CERTIFICATION # 2008
waLLcoNrRACroRcoMPANY NAME BARKER CONSTRUCTION, INCJBARKER WELL & PUMP PHONE # [phone]
STATE WELL CONSTRUCTION PFJLM1'T# 1871 ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
I. WELL USE (Check Applicable Box): Residential ® Monicipal/Public ❑ Industrial I] Agricultural ❑
Monitoring ❑ Recovery ❑ Heat Pump Water Injection 0 Other O If Other, List Use
2. WELL LOCATION:
Nearest Town: HENDERSONVILLE County HENDERSON
GILREATH LOOP ROAD
(Street Name, Minium, Community, Subdvisioa, Lot No., Zip Code)
3. OWNER JULLANNA STOUT
Address 21 GIRDWOOD HEIGHTS
(Street or Rare No.)
CANTON NC 2871641456
Cdyor Town State Tip Code
( 828 )- 648-3912
Area code- Phone ameba
4. DATE DRILLED NOVEMBER 15, 2004
5. TOTAL DEPTH: 405'
6. DOES WELL REPLACE EXISTING WELL 7 YES 0 NO El
7. STATIC WATER LEVEL Below Top of Casing: 20 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS 1.33 FT. Above Land Surfaces
'Top of eosins terminated at/or below land surface retrains a
variance In accordance with ISA NCAC 2C A118.
9. YIELD (gpm): 6 METHOD OF TEST TIMED
10. WATER ZONES (depth):
11. DISINFECTION: Type BY PUMP INSTALLER
12. CASING:
Depth
Frost( 0,_ To 109
From To
From To
13. GROUT: Depth
From D To 20
Mama
Wall Thickness
Diameter or Weight/Ft Material
Ft. 6118 SDR21 PVC
Ft
Ft.
Topographic/Land setting
ORidge OSk pe OValley ®Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/nunutes/seands) ..
Latitude/longitude source:OGPSOTopogtaphic map
(check box)
DEPTH DRILLING LOG
From To Formation Description
Material Method
Ft. CONCRETE POURED
From To Ft
14. SCREEN: Depth Diameter
From To Ft in.
From To Ft in.
15. SAND/GRAVEL PACK:
Depth Sine
From To Ft.
From�To Ft.
Slot Size
in.
in.
Material
LOCATION SKETCH r
Show direction and distance in miles from at (east
two State Roads or County Roads. Include the roa
numbers and common road names.
L4. dt itare;i#. taie, 4/0.
ovn TLCg 697 VJ.CrrtltiE
3 4&e.' A eana61.,
cad. gta 1p._ etc
m
etuidir
16. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF RECORD HAS BEEN PROVIDED TO THE WELL OWNER
net
ithwnkvi
SIGNATURE OF PERSON CONSTRUCTING, THE WELL DATE _ vct
Submit the original to the Division of Water Quality, Groundwater Section,1636 Mail Service Center - Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-1 REV. 07/2001

e 119
WELL CONSTRUCTION RECORD 3 13
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
CERTIFICATION a 20D8
WELL CONTRACTOR (INDIVIDUAL) NAME (prof) KENNETH MCCRARY
WELL CONTRACTOR COMPANY NAME BARKER CONSTRUCTION. INCJBARKER WELL & PUMP
STATE WELL CONSTRUCTION PERMIT# 1871 ACW WUIT'ED WQ PERMIT,/
(if applicable) (iif"tym°hle)
PHONE # [phone]
1. WELL USE (Check Applicable Box): Residential el Municipal/Public ❑ Industrial 0 Agricultural 0
Monitoring ❑ Recovery 0 Heat Pump Water Injection ❑ Otber ❑ If Other, List Use
2. WELL LOCATION:
Nearest Town: HENDERSONVILLE County HENDERSON
TRY AND FIND IT DRIVE
(Street Name, Numbea, Community, Subdivision, LotNo., Zap Code)
3. OWNER CLFFORD BISHOP
Address 127 TRY AND FIND IT DRIVE
(Street or Rase No.)
HENDERSONVILLE NC 28792
City or Town State Tip Code
( 828 ). 697-9990
Area ode- Phone number
4. DATE DRILLED NOVEMBER 16, 2004
5. TOTAL DEPTH: 255'
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO Kt
7. STATIC WATER LEVEL Below Top of Casing: 10 FT.
(Use `+" if Above Top of Casing)
8. TOP OF CASING IS 1.33 FT. Above Land Surfaces
"Top of casing terminated at/or below bind surface requires a
variorum in accordance with ISA NCAC 2C A1t8.
9_ YIELD (gpm): 30 METHOD OF TEST TIMED
10. WATER ZONES (depth):
11. DISINFECTION: Type BY PUMP INSTALLER Amour
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft Material
From 0 To 94 Ft_ 61/8 SDR21 PVC
From To Ft
From To Ft
13. GROUT: Depth Material
From.A____ To 20 Ft, CONCRETE
From To Ft
14. SCREEN: Depth Dimneter 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 EJFlat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topogmphic map
(check box)
DEPTH DRILLING LOG
From To Formation Description
a
4JA.0m tt( t;.,vo fag)
ratio- (gad itaufacti
Method Gaya /road astd Tale. a- n
POURED a it I r2Yan2' , d
Leo a4- utt Dec c_ rx &Q
ity aind sauna:'1 - 0Lc e- .
49 r ettace - jam
tT
LOCATION SKETCH
Include the
Show direction and distance in miles from at 1e1 two State Roads or County Roads.
numbers and common road names.
16. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND T A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
SIGNATURE OF PERSON CONSTRUCTING WELL DATE
Submit the original to the Division of Water Quality, Groundwater Section,1636 Mall Service Center- Raleigh, NC
27699-1636 Phone Na [phone], within 30 days. GW-1 REV. 07/2001
rri

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality
WELL CONTRACTOR (PiDMDUAL) NAME (prier° RICHARD MCCRARY
WELL CONTRACTOR COMPANY NAME BARKER CONSTRUCTION. INC.BARKER WELL & PUMP pinONE # [phone]
STATE WELL CONSTRUCTION PERMITS 1871 ASSOCIATED WQ PERMITS
(if applicable) (if applicable)
345135
- Groundwater Section
cERTIncATTON d 2010
1. WELL USE (Check Applicable Box): Residential El MlnicipalPublic ❑ Industrial ❑ Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection ❑ Other ❑ If Other, List Use
2. WELL LOCATION:
Nearest Town: HENDERSONVILLE County HENDERSON
SAVANNAH VILLAGE, LOT #2
(Street Name, Numbers, Conmtmtty, Subdivision, LotNo., Zap Code)
3. OWNER: STEVEN CANNON
Address 517 OAK GROVE ROAD
(Street or Rome No.)
FLAT ROCK NC 28731
City or Town Slate Zip Code
( 828 )_ 692-0169
Area code- Phone member
4. DATE DRILLED NOVEMBER 18, 2004
5. TOTAL DEPTH: 205'
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO R1
7. STATIC WATER LEVEL Below Top of Casing: 30 FT.
(Use `+" if Above Top ofCasiog)
8. TOP OF CASING IS 1.33 Ff. Above Land Surface
'Top of easing tennhuted atlor below Iaad surface requires a
variance In accordance with ISA NCAC 2C .011S.
9. YIELD (gpm): 7% METHOD OF TEST TIMED
10. WATER ZONES (depth):
Topographic/Land setting
/Ridge ❑Slope ❑Valley ❑Flat
(check appropriate box)
Latitudeflongitude of well location
(degreesimimoesisecmds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From To Formation Description
11. DISINFECTION: Type BY PUMP INSTALLER
12. CASING:
Depth Diameter
Frotq _To 67 FL 51/8
From To FL
From To FL
13. GROUT: Depth
From0 To20
From To Ft.
14. SCREEN: Depth Diameter Slot Size
From To R. in. is
Fsom To Ft. in. in.
15. SAND/GRAVEL PACK:
Amount
Wall Thickness
or Weight/Ft. Material
SDR21 PVC
Method
POURED
From
From
Depth
To Ft.
Material
Ft CONCRETE
Material
Size Material
To Ft.
16. REMARKS:
LOCATION SKETCH
Slow direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common road names.
o3,tart itidueaeut la to 115 01 5
Itiolitit to &AA CIt.c.(;k fz.ct• Soon
^,�t tat- .�tt6-m ml to &_s
Cl11 t ka • silo �/L,4. LUI 9W I(R•
u is X2 9� •'"�� � A
(SR Iz88). „do ,cut #
ikA.tf- Qrxot twvn.
Ja.Jamoutll-VitLar
I DO HEREBY CERTIFY THAT THIS WFI I WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
SIGNATURE9f: PERSON CONSTRUCTING THE WELL 7 C DATE/,
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mall Service Center - Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-1 REV. 07/2001

Qom'
304986
WELL CONSTRUCTION RECORD
North Carolina — Department of Environment And Natural Resources — Division of Water Quality — Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) RODNEY ROBBINS CERTIFICATION # 2785
WELL CONTRACTOR COMPANY NAME PITTMAN WELL BORING, LLC PHONE # [phone]
STATE WELL CONSTRUCTION PERMIT # _ ASSOCIATED WQ PERMIT #
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential ® Municipal/Public D Industrial 0 Agricultural ❑
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other ❑ If Other, List Use
2. WELL LOCATION:
Nearest Town: HENDERSONVILLE County HEND
BIG RAVEN LANE
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: DAVID ROWE
Address BIG RAVEN LANE
(Street or Route No.)
HENDERSONVILLE NC 28739
City or Town State Zip Code
(828) — 863-4253
Area Code Phone number
4. DATE DRILLED 11/10/04
5. TOTAL DEPTH: 145
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO El
7. STATIC WATER LEVEL Below Top of Casing: 60 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS 1-1/2 FT. Above Land Surface"
*Top of casing terminated at/or below land surface requires a
variance in accordance with 15A NCAC 2C .0118.
9. YIELD (gpm): 20 METHOD OF TEST ARD
10. WATER ZONES (depth):
11. DISINFECTION: Type CHLORYTE Amount 3
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft Material
From 0 To 100 Ft. 6-1/4" SDR.21 PVC
From To Ft_
From To _
13. GROUT: Depth Material Method
From 0 To 20 Ft.OUIKRETE POURED
From To Ft
14. SCREEN: Depth Diameter Slot Size Material
From _To_Ft. _ in. _ in.
From To _ Ft. _ in. _ in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
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
From To
DRILLING LOG
From To
LOCATION SKETCH
Show direction and distance in miles from at least
Two State Roads or County Roads. Include the road
number and common names
HWY. #176 E. FROM SALUDA. 1.7 MILES RIGHT
ON MACEDONIA RD. GO 6/10 MILE. RIGHT ON
WINFIELD COVE DR. RIGHT ON BIG RAVEN
LANE. APPROX. 3/10 MILE ON RIGHT.
0
c�
co
0
0
0
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
0 A i�r / < 1P� �//�a { /?7/AU 1/ — / p •- / 1 ty
SIGNATURE OF PERSO CO UCTING'1]its 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

306085
WELL CONSTRUCTION RECORD
North Carolina — Department of Environment And Natural Resources — Division of Water Quality — Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) NEIL CRAFT CERTIFICATION # 3114
WELL CONTRACTOR COMPANY NAME PITTMAN WELL BORING, LLC PHONE # [phone]
STATE WELL CONSTRUCTION PERMIT # _ ASSOCIATED WQ PERMIT #
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential ® Municipal/Public 0 Industrial ❑ Agricultural ❑
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use
2. WELL LOCATION:
Nearest Town: FLAT ROCK
120 CHANDLER CAPPS DR.
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: TERESSA COLE
Address 120 CHANDLER CAPPS DR.
(Street or Route No.)
FLAT ROCK NC 28731
City or Town State Zip Code
(864) — 457-2325
Area Code Phone number
4. DATE DRILLED 12/16/04
5. TOTAL DEPTH: 185
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO
7. STATIC WATER LEVEL Below Top of Casing: 60 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS 1-1/2 FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordance with 15A NCAC 2C .0118.
9. YIELD (gpm): 15 METHOD OF TEST ARD
10. WATER ZONES (depth):
County HEND
11. DISINFECTION: Type CHLORYTE Amount 3.5
12. CASING: Wall Thickness
or Weight/Ft Material
SDR.21 PVC
Depth Diameter
From 0 To 70 Ft 6-1/4"
From To Ft.
From To Ft.
13. GROUT: Depth Material
From 0 To 20 Ft. QUIKRETE
From _ To _ Ft.
14.SCREEN Depth Diameter Slot Size
From _ To _ Ft. _ in.
From To _ Ft. in
15. SAND/GRAVEL PACK:
Depth Size Material
From _To_Ft.
_
From To Ft.
16. REMARKS:
Method
POURED
Material
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
From To
DRILLING LOG
From To
LOCATION SKETCH
Show direction and distance in miles from at least
Two State Roads or County Roads. Include the road
number and common names
I-26 W. FROM COLUMBUS. GET OFF EXIT AT
UPWARD RD. TURN RT. APPROX.1/4 MILE. TURN
RT. ON EDUCATION DR. STAY LEFT AROUND
BEHIND SCHOOL STOP SIGN TURN RT. ON
CREST RD GO 1/4 MILE -LEFT ON HOWARD GAP
LOOP RD 1/10 MILE -RIGHT ON GRAVEL DR.
m
ti
cD
0
H
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT
COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
— /6
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

c" 30653I
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Reso a' vision of Water Quality - Groundwater Section 7
Writ)
WELL CONTRACTOR (INDIVIDUAL) NAME[j(,prriinnt)) _ice CIC CERTIFICATION#OS7W- -
WELL CONTRACTOR COMPANY NAME !7/�IJFYIF}� 1 ' N' ( E f!( a L'] Q PHONE p.,
STATE WELL CONSTRUCTION PERMITS ASSOCIATED WQ _
(if applicable) _ (if applicable)
1. WELL USE (Check Applicable Box): Residential 2/ Municipal/Public ❑ Industrial ❑ Agricultural 0
Monitoring ❑ Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WET I LOCATION:
Nearest own: C lr Co ty
sr
(Street Name, Numbers, Comm • Subdivision, Lot No., rap Code)
3. OWNER*
UlN (i �2
Addresst' �'A1.i1 C2
.R P , I (Street a Route
Nze rc_ No.) a% -4-ts
City or Town State Zip Code
Area code Phone number
4. DATE DRILLED Fir
I'
5. TOTAL DEPTH: O '
6. DOES WELL REPLACE EXISTING WELL? YES ❑ O
7. STATIC WATER LEVEL Below Top of Casing: __•
QFT.
(Uae'4' if Above Top of Casing)
8. TOP OF CASING IS 1 FT. Above Land Surface*
flop of wing terminated at/or below land surface requires a
variance in accordance with ISA NCAC 2C.01111.
Topoc/Land setting
❑Ridge lope Malley ❑Flat
(check appropriate boa)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(cheek boa)
DEPTH DRILLING LOG
From To Formation Description
9. YIELD (gpm): MERi0Af91;TES'1(?frL .I.UIJi'0%1Qt�
10. WATER ZONES (depth): $° , r nj
11. DISINFECTION: Type t
12. CASING: Wall Thickness
Depth, Diameter or Weight/Ft. Material
From To (1,Ft
From_ To Ft
From To Ft.
13. GROUT: Depth
From To
From To
14. SCREEN: Depth
From To
From To
15. SAND/GRAVEL PACK
Depth Size Material
{fir IAA Y�z Amount rr
FteAre-(E, Method
Ft
Diameter Slot Size Material
Ft in. in.
Ft in. in.
From To Ft.
From To Ft.
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common road names.
G CK •
Cots; tK C>f
16. REMARKS.
I DO HEREBY CERTIFY
CONS a' CTION ST
T THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
S, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
SIGNATURE OF PERSON CONSTRUCTING THE WELL
S mit 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) RICHARD MCCRARY
WELL CONTRACTOR COMPANY NAME BARKER CONSTRUCTION, INCJBARKER WELL & PUMP
STATE WELL CONSTRUCTION PERMIT# 1871 ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
306164
CERTIFICATION# 2010
PHONE # [phone]
I. WELL USE (Check Applicable Box): Residential El Municipal/Public ❑ Industrial 0 Agricultural 0
Monitoring ❑ Recovery 0 Heat Pump Water Injection ❑ Other ❑ If Other, List Use
2. WELL LOCATION:
Nearest Town: HENDERSONVILLE County HENDERSON
KANUGA FOREST, LOT #6
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: RICHARD FRITTS
Address 54 J.P. HUGGINS DRIVE
(Street or Route No.)
HENDERSONVILLE NC 28791
City or Town State Zip Code
( 828 )- 697-8131
Area code- Phone number
4. DATE DRILLED DECEMBER 2, 2004
5. TOTAL DEPTH: 605'
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO El
7. STATIC WATER LEVEL Below Top of Casing: 60 FT.
(Use w' if Above Top of Casing)
8. TOP OF CASING IS 1.33
FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance ht accordance with ISA NCAC 2C .011&
9. YIELD (gpm): 2 METHOD OF TEST TIMED
10. WATER ZONES (depth):
11. DISINFECTION: Type
12. CASING:
Depth Diameter
From 0 To 83 FL 61/8
From To FL
From To Ft.
13. GROUT: Depth
From 0 To 20
From To
14. SCREEN: Depth Diameter
From To Ft. in.
From To Ft. in.
15. SAND/GRAVEL PACK
1epth Size
From To Ft.
From To Ft.
16. REMARKS:
Amount
Wall Thickness
or Weight/Ft. Material
SDR21 PVC
Material
Topographic/Land setting
®Ridge ❑Slope ❑Valley ❑Flat
(chock appropriate box)
Latitude/longitude of well location
Negras/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
DEPTH (check box)
DRILLING LOC
From To Formation Description
n
c 1
—n
0)
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.
0.14ent. ida—Ac
' it_ �'ant ,EO &zit
�/` i.ocwto!
t uctt_ c
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUC 1'FJ) IN ANCE WITH 15A NCC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY THIS RD HAS BEEN PROVIDED TO HE WILL 0
/ rSIGNA OF P CONSTRUCTING THE WELL
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
27699-1636 Phone No. [phone], within 30 days.
GW-1 REV. 07/2001

3
06502
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and N 'ra1 Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAM (print) (/ J Ib 4/4/ / E U.'1 L CERTIFICATION Jean
WELL CONTRACTOR COMPANY NAME AJ e j PHONE s GLZB14 y - Dy5-a
STATE WELL CONSTRUCITON PERMIT# /y/Lz ASSOCIATED WQ PERMED/
(if applicable)
(if applicable)
1. WELL USE (Check Applicable Box): Residential $ Municipal/Public ❑ Industrial ❑ Agricultural 0
Monitoring ❑ Recovery ❑ Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATIO1 t: D �% �
Nearest Tor, h ' — unt)'+/euteott.
St Name, N ��r... o/Qi9L
( Community, Subdivision, Lot No., rip Code)
Address 7#/d
Jestii r
( Route No.)
g S 44c. 01s792.
City or own State Zip Code
} is9g-St
Area code- Phan number."
4. DATE DRILLED .//9/D 7
5. TOTAL DEPTH: / PS
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO Jla
7. STATIC WATER LEVEL Below Top of Casing:42S ' FT•
(Use`+^ if Above Top of Casing)
8. TOP OF CASING IS J. _ FT. Above Land Surfaces
flop of easing terminated at/or below land surface requires a
variance ha aewrdaa with ISA NCAC IC .etlt •
9. YIELD (gpm): METHOD OF TEST t4.no
10. WATER ZONES (depth):
11. DISINFECTION: Type
12. CASING:
From To�y
c� 3 Ft.
From.. To FL
Front To Ft
13. GROUT: Depth
From Q_ To t _ Ft.
From To Ft
Amount
Wall Thickness
or Wei Material
# ®vc
o Ft in.
Fro o Ft. in
15. SAND/GRAVEL PACK:
Depth Size
From o
From To Ft.
o Ft.
14. SCREEN: Depth Diameter
Fr
o
:"."7-`"
T
Slot Size Material
in.
in.
Material
045-2/
Topographic/Land setting
❑Ridge ❑Slope ❑Valley ZF7at
(cheek appropriate box)
Latitude/longitude of well location
(degreeslmimtraslsecmds)
Latitude/longitude sotuce:❑GPS❑Topographic map
(deck box)
DEPTH DRILLING LOG
From To Formation Description
LOCATION SKETCH • •
Show direction and distance in miles gm a7east
two State Roads or County Roads. Include tie' road
numbers and common road names.
FEB 1 4 2005
16. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRU(.1ht) IN ACCORDANCE W1TH 15A NCAC 2C, WELI,
CONSTRUCTION STANDARDS, AN99IAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
!nfry?gyp s 400
D
SIGNATURE OF PERSON STRUCI'ING THE WELL
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-1 REV. 07/2001

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural7jResources7- Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) Ron/i! C a n 7 377
TW ate 1 CERTIFICATION # C
WELL CONTRACTOR COMPANY NAM�JW (' Li t /� J P: I I. its PRONE # (S?t%149-041,0
STATE WELL CONSTRUCTION PERMIT# _ AOCIATED WQ PERMIT#
(if applicable)
(if applicable)
1. WELL USE (Check Applicable Box): Residential unicipal/Public 0 Industrial ❑ Agricultural ❑
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATI N.
Nearest Town: CoN
Z� /2owp c.T hls,ri ltscj, try � NG
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code) �'� %/ 2
3. OWNER:C.3T f3r'ooAs
Address PO B0/ l/20
,f// (Street or Rome No.) PQT"/U hot N G 2? 7s 8
City or Town State Zip Code
(
Area code- Phone number
4. DATE DRILLED // ` i, ' 0 V
5. TOTAL DEPTH: 7 5
6. DOES WELL REPLACE EXISTING WET I ? YES 0 NO (r
7. STATIC WATER LEVEL Below Top of Casing:
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS /• 5 FT. Above Land Surface*
*Top of wing terminated at/or below land surface requires a
variance in accordance with 1SA NCAC 2C .0118.
9. YIELD (gpm): / 0 METHOD OF TEST inner/
10. WATER ZONES (depth): /20
11. DISINFECTION: Type C,Cfi Amount /O c I.
12. CASING: Wall Thickness
From,_ Toi _ Fir ?2/
4U cSnNFt I
From To FL
From To
13
Ft.
. GROUT: Depth Material/
From ( To 20 Ft CC/WYft
From To Ft.
14. SCREEN: Depth Diameter Slot Sim Material
From To Ft in in.
From / To FL in. in.
15. SAND/GRAVEL PACK
Depth Size Material
From / To Ft.
From To Ft.
16. REMARKS:
Topographic/Land setting ..
❑Ridge Malley 0Flat
(check appropriate box) ..
Latitude/longitude of well location
(dearns/mimmm+secoads)
Latitude/longitude source:❑GPS❑Topographic map
(ehxk box)
DRILLING LOG
Formation Description
DEPTH
From To
LOCATION SKETCI;
Sb w direction and distance in miles from at least
State Roads or County Roads. Include the road
nu and common road names.
I DO HEREBY CERTIFY THAT THIS WFI f WAS CONSTRUCTED IN ACCORDANCE WITH ISA NCAC 2C, WELL
CONSTRUCTn()Pt)STANDARDS, AND THAT A CBPY OF S RECORD HAS BEEN PROVIDED TO THE WELL OWNER
SIGNATURE OF PERSdN CONSTRUCTING THE WELL
DATE
z
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

COS°
307302
WELL CONSTRUCTION RECORD
North. Carolira • Department ofEnvlronmmt and Natural Resources • Dlvis Ion of Water Quality • CGrouu nd 170Nocd
wL1.L COMMCrORfrNDMDUAL)NAME ()riQ
-�,�� n1r Smi IAA •
WLLt.CONTPACTOR COMPANY NAMEC9f?.f n Qnsi rAIY II k Pvjn0 en • PHONE./ • I
STATE WELL CONSTRUCTION PERMITS . }ttottATLD WQ PERMITS
if liable ea • •liable
I. WELL USE (Check Applicable Box): Retidential p!blunlelpaUPyblie 0 Industrial D/ Apiculi rs1 D:
Monitoring 0 Recovery 0 Heat Pump Water Injection ❑ Lfither 0 If Other, List Ute.
2. WELL LOCATI N:
Nearest Town: 1() n(1n er• County,
rk CreeK
(Svni Nurse. Numben, Community, Subdivision, Lot No., Zip Code)
3. OWNER- Tt>m �r
Address . Y ket e i Pr 4�rIAle.'%At
F1 D_�(Suecte�No.) Riureon
in
Cit'yor Town SUte .Zip Code
($4). (.92`1- 0.Wg
An sod. Phone number
4. 'DATE DRILLED 1\ - 1-I "Ot1
5. TOTAL DEPTH: :3U5
6. DOES WELL. REPLACE EXISTING WELL? YES Q 1O
7. STATIC WATER LEVEL Below Top oCCuing: • S¶O
(Use No. If Above Top of Cuing)
S. TOP OF CASING 15 , \ FT. Above Land Surface*
'Tip o(mlet terminated Wee below land serrate requires e
variance In accordance with ISA NCAC2C.0111.
9. YIELD (gpm): METHOD OF TEST AIR
10. WATER ZONES (depth): /$D
11. DISINFECTION: Type tiTt-1- Amount
' 12. CASING: Wall Thickness
Depth Ipazeter or We(ghVF4
Frorn_/ To 694 Ft. a 4 A.Q. 4
From_G To_t Ft. L / ' .2Ys
From To Ft.
13. GROUT: Depth • . Material .. - - Method
Frorn_19 To 2. 0 FL 6r41kRNvea' MK.'y Foc,t
From To Ft.
14. SCREEN:. Depth Diameter Slot Sim Msterhl
From To Ft. in __ in
•From To Ft. in. _ in.
-.15. SAND/GRAVEL PACK:
Depth Size MtUrhl
From To Ft.
From To Ft.
CIY
FT.
16. REMARKS:
medal
—//Topographic/Land setting
YdRidge OSlope OVtlley. tFlat
(ab.ck eppropilstabea) •;';... :
Latinidelloptitudeotwelllobation
(depers/mleuterr ed4) }
Latitude/longitude source: PSOToP ograD hie
(cheek lea) ?#:
Forma ttDeseriphoii
DEPTH
From To
CJ - 40
/D — `S D
2//-
rs' — N9'
J.00ATION SKETCH:
Show direction and distance inmiles :i matI
two State Roads or County Roadie lnelndathe loti
numbers tnd common road names.'
Rao
raaR R4
I DO HEREBY CERTIFY THAT THIS WELL WAS CO`krD IN ACCORDANCE WITH ISA NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COP F THI RECORD HAS BEEN PROVIDED TO THE WELL OWNER'
(( „ ,j�'/'f
SIGN OF PERSON,CONSTRUC)TNOTH&WtLLI' , L;AA'r0-
Scbialttbe original to the Division of•WaterQflallty, dreittndwater Stetlon,1636 Mill Service Cantata Ralelt=b NC
276,94636?bone No. [phone],within 30days.OWIREV Q77/2001
MAR — 8.2005 �'"

307304
WELL CONSTRUCTION RECORD
Quality Groundwater Section��ii.
North COton oR zrvncnt of A nvironm rnt and Natural Ref ouk es •4„il�on�of Water Qu ry • CERT CATtON.. •�affir
WELL. CONTRA OTOR (T`2MDU/-L) NAMt (prim) n�n rHONi.aOb
�$�Y
WELL CONTRACTOR COMPANY NAME ")r9 t r�•
STATE WELL CONSTRUCTION PERMrr,____..-----ASSOCIATED WQ PLRM 17s ns I tit? ail 'Ati;:'.
- "L-
ifa licable
ifa lirablc
I. WELL USE (Check Applicable Box): Retidential OThtlnieipal/Pybhe 0 Industrial 0/ Agric
ultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection Other 0 110ther, List Use,
2. WELL LOCATION.
Nearest Town. 524 s a
.'P
(Scree Neme, Nlumben. Commune . Subdiviricn, tot No., Zip Code)
3. OWNER: 1,
Address e4(a9% Wl .,tQ'�"�
(Street or Route No.)
• CR•y or Town Stott
(4m)- Ch0S- 31-n0
Arta Bodo- Pbone number
4. DATE DRILLED 11-$'Ctl
5. TOTAL DEPTH,: 4aS /
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO t7
7. STATIC WATER LEVEL Below Top of Casing: • /n O e FT.
(Uu "m" If Above Top of Gant)
8. TOP OF CASING IS l FT. Above Land Surfacce
'Top et ruler terrain 'ted .Uor below lend snrfete require' a
rvhnee In eceord,nce with ISA NCAC2C.011e,
9. YIELD (gpm): fr. METHOD OF TEST 4 I R.
IO. WATER ZONES (depth).. At_ /9,oen
11. DISINFECTION. Type INN Ameiint
12. CASING: Wall thickness
ter or Welgbt/Ft. Meterial
�ZI;E PL'r,
h
From_ri °9. Ft
From To .9 Ft.
From To Ft.
13. GROUT: Depth • .
FrOm__ 0 To 2, 0 Ft.,SAicaeFic /'try L IOo&?
From To Ft.
14. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in.
Froth_ To Ft. in. _ in.
15. SAND/GRAVEL PACK:
Depth Site Maldrial
Eaa)a
Zip Code
From To Ft.
From To Ft.
Material Method
Topographic/Land setting:
County».leifl.rsf3r °Ridge eS1 pe °Valley °Flat
(cheek eppr°prl eta box)
tratitudeeo gitude of well location
35a 13 3 3 CVa°rOa' oo` i
(de reegmieuteSheeeeds)
L.atitude/longitudesource:L9CPi SOTopographiernap`;•,
(cheekInnz)
Daaajall422.z.
Fomutl`on Descriptit b
DEPTH
From To
© / /J
le -
W
LOCATION SKETCH
a
Show direction end distance in miles from at leist;:'
two State Roads or County Roads. InEIude the road'
numbers and common road names.
16. REMARKS:
I DO HEREBY CERTIFY THAT THIS WFI L WAS CONSTRUCTED TN ACCORDANCE WITH ISA NCAC 2C, k?tETL-
CONSTRUCTION STANDtDS. AND THA COPY THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
TJ( T/
:;L:
5:.
VSI&NATURB OF PERSON CONSTRUCTING THE WEIL DATE
Sisbmlt the original to the Division of Water Quality, drotlndwater Section, 1636 Mill Service Coate -DLO NC
27699-1636 Phone No. [phone], within 30 days.
Con
c.D

307305
WELL CONSTRUCTION RECORD
North Carolina - Dcparancnt or Environment and Ne�y,1ry,._I Resources - vispn of Water Quality Crroundwater Section •
J��%�
/rG" �a t �� .( CLATfr1CATION •�_•7
/ w
WELL CONTRA Cron (iW MOUAl) NAME (print) RI • PHONE a
WELL CONTRACTOR COMPANY NAME C:7rf.t(l R1VS r\>J< 11\ Pv.m2 (r1 OHONEA g5 /
STATE tVELL CONSTRUCTION PERMIT/
(if applicable)
WELL USE (Check Applicable Box): Residential f '1AunicipalThiblie 0 Industrial ❑ Agricultural 0
Monitoring 0 Rccovtry 0 Heat Pump Water Injection ❑ j'ther 0 If Other, List Usc
2. WELL LOCATI N �yCJ1f�0rS,Y'
Nearest Town-. -re.0 �( 1kCounty
1.) CA gar CrlPt
(Strict `June. Number,. Community, Subdivision. Let No., Zip Code)
3. OWNER: —1-hQrnn< on,
Address LA III ioi
• City or Town State
(24, )- 109eD — 531S
(S..-n of Rome No.)
it01IL, < . .3F14D
, Zip Code
ASSOCIATED WC) PERM IT%
le table
Area eodeo Phone number
4. DATE DRILLED / / -/C ' 0 41
5. TOTAL DEPTH,. 2. e5
6. DOES WELL REPLACE EXISTING WELL? YES NO fi4-
7. STATIC WATER E V EL Below Top of Casing: • 0 FT.
(UBo •t• If Above Top or Casing)
8. TOP OF CASING IS / FT. Above Land Surface'
`Top of cuiot t ernln tied ,Vor below lend Barrett requires x
vuienee In 1mi-elInce with 15A NCAC 2C .011S.
9. YIELD (gpm): t METHOD OF TEST /fit✓,
10. WATER ZONES (depth). .2i 4
I . DISINFECTION. Typo 8T/f
r 12. CASING:
Depth ,! , Dimeter
From / To "0 Ft.
From `ty To Co FL
From To Ft.
13. GROUT: Depth. • .
From, 0 To 2 O Ft.
From To Ft.
14. SCREEN: Depth Diameter Slot Site Material
From To Ft. in. in.
From To Ft. in. in
Amount
Wall Thickness
ox ivFt. veil
.2/sL
Topographic/Land setting .
fdR'dgc OSlope ❑Valley ❑Flat
(check eppropriete box)
Latitude/longitude of well location
31 `.14 574/ 097°1d 7.04J
(depmts/miautes/second1)
Latitude/longitude source:@3'GPS0Topographic map
(check box)
DRILLING LOQ
Formation Description
DEPTH
From To
C2-20
A -30
30 — Set
SO — Z175
rn
I
LCa
LOCATION SKETCH
Show direction and distance in rniles from at I
two State Roads or County Roads. Include the road
numbers and common road names.
Material Method
3 f ki?iz fi.: M i ctPapvz,
15. SAND/GRAVEL PACK.
Depth
From To
From To
16. REMARKS.
Size Mffieriai
Ft.
Fl.
lif
y
s
n
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTR
CONSTRUCTION STANDARDS, THAT A COPY OF T
S I GN4AZ7RH
_D IN ACCORDANCE WITH I SA NCAC 2C, VdELL
RECORt HAS BEEN PROVIDED TO THE WELL OWNER
ll —/0 a `f
OF PERSON CONSTRUCTING THE WELL DATE
Submit the original to t he Division of Water Quality, Groundwater Section, 1636 Mill Service Ceolet • RsleIgh, NC
27699-1636 Phone No. [phone], within 30 day'. GW-1 REV. 07/2001

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and N
WELL CONTRACTOR (INDIVIDUAL) NAME riot)
WELL CONTRACTOR COMPANY NAM
301809
Resources - Division of Water Quality - Groundwater Section �/
�,(Jp CERTIFICATION # go.77
f �-r� P/d/J f .ic'PaoNE# fk -1/✓t S/Q d
STATE WELL CONSTRUCTION PERMIT* /Y/i% ASSOCIATED WQ PERMIT* a TJ py
(if applicable)
(if applicable)
1. WELL USE (Check Applicable Box): Residential fQ Municipal/Public ❑ Industrial 0 Agricultural ❑
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCA *N:
Nearest �...��,,.. 44 ezf992
(Street Name. Numbers, C , Subdivision, Lot No., Zip Code)
3. OWNE1t»j1.4 hFy 1 _
Address 7f r 01,2.c%c cy7 p+.— Aleje
jArar(saset or Ease �Nriej
A/. C. a2999/
City aTown y"3;g.3 Zip Code
Area code Phme Number
4. DATE DRILLED 7// //) 4/
5. TOTAL DEPTH: s2 0 6
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO I
7. STATIC WATER LEVEL Below Top of Casing: .2 S FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS A .S FT. Above Land Surface'
'op of caslo8 termlaated at/or below land surface requires •■
ono
variance hi accordance with ISA NCAC 2C .0118. •
9. flop
(gpm): /S METHOD OF TES
10. WATER ZONES (depth): %S' /90 t
11. DISINFECTION: Type 0. All Amount 9 4r-
12. CASING: Wall Thickness
Depth Diameter or Wdgbt/Ft tt:rial
From Q To_ Sn Ft i i 2 —
From To Ft.
From______ To Ft.
13. GROUT: Depth Material Method
From_ i) Toa17 FL _car ev (A1 my
From To Ft.
14. SCREEN: Depth Diameter Slot Size Material
From To Ft in. in.
From 7 To Ft. in. in.
15. SAND/GRAVEL PACK
Depth Size Material
FromcTo Ft.
From / To Ft.
16. REMARKS:
Topographic/Land setting
❑Ridge 0Slope ❑Valley WF1at
(check appropriate boa)
Latitude/longitude of well location
(degre-minmes/eeemde)
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.lude the road
numbers and co. road
I DO HEREBY CERTIFY THAT THIS WI I WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS .AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
FftiyLr,
SIGNATURE OF PERSON CONSTRUCTING THE WFT I
7// / o f
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

301SDS
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (prior)
RICHARD MCCRARY CERTIFICATION # 2010
WELL CONTRACTOR COMPANY NAME BARKER CONSTRUCTION, INC.BARKER WELL 8 PUMP men # [phone]
STATE WELL CONSTRUCTION PERMIT# 1871 ASSOCIATED WO PERMIT#
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential El Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery ❑ Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION:
Nearest Town: HENDERSONVILLE County HENDERSON
BRANNON ROAD
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: MARSHALL R. MATTHEWS
Address 174 MONTFORD AVENUE
(Street or Route No.)
ASHEVILLE NC 28801
City or Town State Zip Code
( 828 )_ 779-8671
Area code- Phone number
4. DATE DRILLED AUGUST 25, 2004
5. TOTAL DEPTH: 185'
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO D
7. STATIC WATER LEVEL Below Top of Casing: 40 FT.
(Use `+" if Above Top of Casing)
8. TOP OF CASING IS 1.33 FT. Above Land Surface'
*Top of casing terminated at/or below land surface requires a
variance In accordance with ISA NCAC 2C .0118.
9. YIELD (gpm): 20 METHOD OF TEST TIMED
10. WATER ZONES (depth):
Topographic/Land setting
(Ridge DSlope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH DRILLING I flf;
From To Formation Description
11. DISINFECTION: Type BY PUMP INSTALLER Amount
12. CASING: Wall Thickness
Depth Diameter or Weight/FL Material
From 0 To 73 Ft. 61/8 SDR21 PVC
From To Ft.
From, To Ft.
13. GROUT: Depth Material
From 0 To 20 Ft. CONCRETE
From To Ft.
go
atool F�%/
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common road names.
Likom %W1Adtetda rat t W
f�of a On a utu d�tf/vnc%W
Method 4 /0 &at a e ye�ax
POURED n
/64-� rt.,..fd- S i
it a_ ,Q&il.%�. ok a5'l / eaci doc 21
dit�D i U ratisia4t.
14. SCREEN: Depth Diameter Slot Size
From To Ft. in. in.
From To Ft. in. in.
15. SAND/GRAVEL PACK
Depth
From To Ft.
From To Ft.
Material
16. REMARKS:
Size 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
/C- 1/4(111C 2iy S' 2i —Cy.
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 Na [phone], within 30 days. GW-1 REV. 07/2001

3019117
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) KENNETH MCCRARY CERTIFICATION # 2008
WELL CONTRACTOR COMPANY NAME BARKER CONSTRUCTION, INC./BARKER WELL & PUMP PHONE */ [phone]
STATE WELL CONSTRUCTION PERMIT# 1871 ASSOCIATED WQ PERMIT*/
(if applicable)
(if applicable)
1. WELL USE (Check Applicable Box): Residential El Municipal/Public 0 Industrial 0 Agricultural ❑
Monitoring 0 Recovery ❑ Beat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION:
Nearest Town: HENDERSONVILLE
STEPP ACRES LANE
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: DAVID OATES
Address 13 LAKEWOOD ROAD
(Street or Route No.)
HENDERSONVILLE NC 28739
City or Town State Zip Code
( 828 )_ 697-1974
Area code- Phone number
4. DATE DRILLED AUGUST 25, 2004
5. TOTAL DEPTH: 605
6. DOES WFIJ REPLACE EXISTING WELL? YES ❑ NO El
7. STATIC WATER LEVEL Below Top of Casing: 60 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS 1.33 FT. Above Land Surface*
'Top of casing terminated at/or below land surface requires a
variance In accordance with 15A NCAC 2C .011&
9. YIELD (gpm): 1% METHOD OF TEST TIMED
10. WATER ZONES (depth):
County HENDERSON
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
11. DISINFECTION: Type BY PUMP INSTALLER Amount
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
From 0 To 46 Ft. 61/8 SDR21 PVC
From To Ft.
From To Ft.
13. GROUT: Depth Material
From 0 To 20 Ft. CONCRETE
From To FL
14. SCREEN: Depth Diameter
From To Ft. in.
From To Ft. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
16. REMARKS:
,T(�p �r0'tc 164alp�
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common road names.
J.Loax J✓victota� to 1
6 gad- Qom/ ixc�, ae" �/!,[L-ore
Method //,fu fern -s ?dint Au- -L- /%(� q
POURED `/"' /1 _ . _ , �a� - of o cJ
Slot Size Material - �A (•L^ (,. rD L
in CC -CC `---(-(- TD
in. ,�/ �
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
k.....2-tle‘e1/1"."-At ✓nc.C'rva_n_4�. • P l - D y
SIGNATURE OF PERSON CONSTRdCT?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-1 REV. 07/2001

301805
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quplity - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) KENNETH MCCRARY CERTIFICATION # 2008
WF.I I CONTRACTOR COMPANY NAME BARKER CONSTRUCTION, INC./BARKER WELL & PUMP pjcNE # [phone]
STATE WELL CONSTRUCTION PERMIT# 1871 ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential El Municipal/Public 0 Industrial ❑ Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION: HENDERSON
Nearest Town: HENDERSONVILLE County
LACE FALLS SUBDNISION, LOT #2
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: ALLEN AND FLORENCE BOEHS
Address 88 STAR POINT DRIVE
(Street or Rome No.)
HENDERSONVILLE NC 28792
City or Town State Zip Code
( 828 )- 272-0535
Area code- Phone number
4. DATE DRILLED AUGUST 19, 2004
5. TOTAL DEPTH: 180'
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO RI
7. STATIC WATER LEVEL Below Top of Casing:
11 FT.
(Use "*" if Above Top of Casing)
8. TOP OF CASING IS 1.33 FT. Above Land Surface*
'Top of casing terminated at/or below land surface requires a
variance in accordance with 15A NCAC 2C .0118.
9. YIELD (gpm): 75 METHOD OF TEST TIMED
10. WATER ZONES (depth):
Topographic/Land setting
❑Ridge ❑Slope ❑Valley KJFlat
(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 BY PUMP INSTALLER
12. CASING:
Depth
From 0 To 38
From To
From To
13. GROUT: Depth
From 0 To 20
From To Ft.
Amount
Wall Thickness
or Weight/FL Material
.185 STEEL
14 SCREEN: Depth
Diameter
Ft, 6
Ft
Ft.
Material
Ft. CONCRETE
From To Ft. in.
FromTo Ft. in.
15. SAND/GRAVEL PACK:
Depth
From To Ft.
Method
POURED
Diameter Slot Size Material
in
in.
Size - Material
From To Ft.
16. REMARKS:
q/t/`n
? c�nD/4'
sFP FCr� Oir
l3eeo,
LOCATION SKETCH
Show direction and distance in miles from at (east
two State Roads or County Roads. Include the road
numbers and common road names.
N4'tt
t".. tCat
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUC lED IN ACCORDANCE WITH I5A NCAC 2C, WE I
CONSTRUCTION STANDARDS, AND THAT
=AyCOPY OF
THIS RECORD HAS BEEN PROVIDED TO THE
pWELL OWNER
SIGNATURE OF PERSONICONSTRUCT THE WELL IE 2-0DATE
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

301806
City or Town State Zip Code
( 828 )_ 693-1106
Area code- Phone number
4. DATE DRILLED AUGUST 18, 2004
5. TOTAL DEPTH: 285'
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO RI
7. STATIC WATER LEVEL Below Top of Casing: 4' FT.
(Use "+- if Above Top of Casing)
8. TOP OF CASING IS 1.33 FT. Above Land Surface*
`Top of casing terminated atior below land surface requires a
variance in accordance with ISA NCAC 2C .6118.
9. YIELD (gpm): 12 METHOD OF TEST TIMED
10. WATER ZONES (depth):
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (prier) RICHARD MCCRARY CERTIFICATION # 2010
WELL CONTRACTOR COMPANY NAME BARKER CONSTRUCTION, INC./BARKER WELL & PUMP PAO # 1828) 697-7263
STATE WELL CONSTRUCTION PERMIT# 1871 ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential RI Municipal/Public ❑ Industrial ❑ Agricultural 0
Monitoring 0 Recovery ❑ Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION:
Nearest Town: HENDERSONVILLE County HENDERSON
PRINCE ROAD
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
Topographic/Land setting
❑Ridge 0Slope ❑Valley !OHM
(check appropriate box)
Latitude/longitude of well location
3. OWNER: BILLY STEPP (degrees/minutes/seconds)
Address 603 PRINCE ROAD Latitude/longitude source:❑GPS❑Topographie map
(Street or Route No.) (check box)
HENDERSONVILLE NC 28792 DEPTH DRILLING LOG From To Formation Description
LOCATION SKETCH
11. DISINFECTION: Type BY PUMP INSTALLER Arnoumt Show direction and distance in miles from at least
12. CASING: Wall Thickness two State Roads or County Roads. Include the road
Depth Diameter or Weight/Ft. Material numbers and common road names.
From 0 To 80 Ft. 6 1/8 SDR21 PVC v¢,.a/K t-di�,dtt .r �T71t. -c,�� ai.
From To Ft. Jab_ Q q`- ` 7±T 6)c' 71,i ,ix- cr©a(d
From To Ft. �� �� �� /
13. GROUT: Depth Material Method (i- / 1Q-�26 and lab a -
From 0 To 20 Ft. CONCRETE POURED 1,� R-7u lu& e. Lam
From To Ft.
14. SCREEN: Depth Diameter Slot Size Material Q (I ILi �L �/Lc%7�
y
From To Ft. in. in. ,(%0 ad��0 '%/(Q D'L a
From To Ft. in. inJilt ,,, /�4 Q a15. SAND/GRAVEL PACK: /{�
Depth Size Material
From To Ft.
From To Ft.
16. REMARKS:
1 DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, THAT A 7Y OF THIS RECORD HAS BEEN PROVIDED TO TIE WELL ^'
/GNATURE OF PERSON TRUCTING THE WELL
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center- Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-1 REV. 07/2001

State
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) KENNETH MCCRARY CERTIFICATION # 2008
WFLI CONTRACTOR COMPANY NAME BARKER CONSTRUCTION, INC./BARKER WELL 8 PUMP FRONE # [phone]
STATE WELL CONSTRUCTION PERMIT# 1871 ASSOCIATEDDWQ PERMIT#
(if applicable)
301803
1. WELL USE (Check Applicable Box): Residential 181 Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION:
Nearest Town: HENDERSONVILLE County HENDERSON
PINNACLE VIEW, LOT #20
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: PEGGY SNODDY (BOBBY MORGAN-BUILDER)
Address PO BOX 1031
(Street or Route No.)
HORSESHOE NC
City or Town
( 828 )- 243-2031
Area code- Phone number
4. DATE DRILLED AUGUST 16, 2004
5. TOTAL DEPTH: 455'
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO gl
7. STATIC WATER LEVEL Below Top of Casing: 20 FT.
(Use "+" if Above Top of Casing)
S. TOP OF CASING IS 133 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): 4 METHOD OF TEST TIMED
10. WATER ZONES (depth):
28742
Zip Code
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 BY PUMP INSTALLER Amount
Wall Thickness
or Weight/Ft. Material
SDR21
12. CASING:
Depth Diameter
From 0 To 70 Ft. 61/8
From To Ft
From To Ft.
13. GROUT: Depth Material
From 0 To 20
From To
14. SCREEN: Depth
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common road names. p
PVC J'hAM c�%Lo-t A- �, ei 1 Q1 ke / t .�Rv(Veat,
toad j-o C 44 �:.c-t.t,tt, e m U
RA-LaAs_ hit. yi..u>t .tn c��
Method
Ft. CONCRETE Ft. � �7M[�
POURED ./GE7h�lar I. , A„ .1
Diameter Slot Size Material .i) ad_ amck„ & J1 t.
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
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED 1N ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND
�THAT
�A COPY 0 THIS RECORD 1-IAS BEEN PROVIDED TO THE WELL OWNER
SIGNATURE OF PERSON CONS C11NG THE WELL DME -dy
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

301801
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print)
RICHARD MCCRARY CERTIFICATION # 2010
WELL CONTRACTOR COMPANY NAME BARKER CONSTRUCTION, INC./BARKER WELL 8. PUMP ppYNE # I828) 697-7263
STATE WELL CONSTRUCTION PERMTTil 1871 ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential El MumicipaIPublic ❑ Industrial ❑ Agricultural ❑
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other ❑ If Other, List Use
2. WELL LOCATION:
Nearest Town: HENDERSONVILLE County HENDERSON
BLOOMINGDALE SUBDIVISION, LOT #5
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: BRENT CULBERTSON
Address 50 STONEY BROOK COURT
(Street or Route No.)
FLETCHER NC
28732
City or Town State Zip Code
( 828 )- 697-2836
Area code- Phone number
4. DATE DRILLED AUGUST 13, 2004
5. TOTAL DEPTH: 385'
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO El
7. STATIC WATER LEVEL Below Top of Casing: 40 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS 1.33 FT. Above Land Surface'
`Top of casing terminated at/or below land surface requires a
variance in accordance with 15A NCAC 2C .0112.
9. YIELD (gpm): 3 METHOD OF TEST TIMED
10. WATER ZONES (depth):
Topographic/Land setting
❑Ridge ❑Slope ❑Valley KIFlat
(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 BY PUMP INSTALLER Amount
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
From 0 To 70 Ft. 61/8 SDR21 PVC
From To Ft
From To Ft.
13. GROUT: Depth
From 0 To 20 Ft.
From To Ft.
14. SCREEN: Depth Diameter Slot Size
From To Ft. in. in.
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
Material
CONCRETE
Method
POURED
16. REMARKS:
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common road names.
Li cant S erututoisuitu -kakie_ I- a& .
3th aL02 / 4. h
Jail_ aALS ton Al awa taLdeaf;
-to a- .teitl- on. 9c&-loon 2d..15,4
Material /Z hid 0 it ekoOnu A
QrtdothA f-trt ox, Li,Rf• Jajrnah
Azad t ,16aLL I ao(Ccu,i-601
to ,Q,at # 5 tot_ iu_ght at
aCC4 t CV .
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THJAT A CO1'�' OFT S �CO�BEEN PROVIDED TO THE j} LL O'
IGNATUR)` OF PERSON"CO
UCFING THE WELL
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center- Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-1 REV. 07/2001

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment t and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (pant)
RICHARD MCCRARY CERTIFICATION # 20 iL
\%t_.LLCaratiflOR CQNOAIINY-NAME BARKER CONSTRUCTION, INC./BARKER WELL & PUMP
STATE WELL CONSTRUCTION PERMIT# 1871 ASSOCIATED WQ PERMIT#
it{appltcahLOf annlicablei) _m . _ _ .._-_ _
301800
PRONE # I S26i 697-7263
1. WELL. USE. (Check Applicable Hox): Residential El Municipal/Public ❑ Industrial 0 Agricultural ❑
Monitoring 0 Recovery El Heat Pica. `Vats injection 0 Other 0 Lr Other, List Use
2. WELL LOCATION:
Nearest Town: HENDERSONVILLE
MCM NN ROAD
County HENDERSON
(Street Name. Numbers, Community. Subdivision. Lot No.. Zip Code)
3. OWNER.; N,LtaLithcaiNViLLE HOW= vYtiTtMS
Address PO BOX 568
(Street or Route No.)
HEiiDERSONVILLE, NC
City or Town State
( 828 )_ 692-7299
Aira code- Phone number
4. DATE DRILLED AUGUST 6, 2004
5. TOTAL DEPTH: 165'
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO i
7. STATIC WATER LEVEL Below Top of Casing: 60 FT.
/� /. (Use "r' if Above Top of Casing)
8. TOP OF CASING IS 1 93 AboveSurface'
FT. Land
+Top of casing terminated attor below land surface requires a
variance in accordance with 15A NCAC 2C .0118.
9. YIELD (wen): 15 METHOD OF TEST TIMED
10. WATER ZONES (depth):
28793
Zip Code
Topographie/Land setting
giRidge ❑Slope ❑Valley ❑Flat
(clock appropriate box)
Iztitude.Bongitude of well location
Latitude.Aoneitude source:0GPSDTopographic map
(check Mx)
DTP I H DRJL T I N`_ LOG
From To Formation Description
11. DISLNFECTION:Type F'P:luvn4NTASI" Amount
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft.
From 0 To 25 Ft. 6115 SUB'S
From To Ft.
From To Ft.
13. GROUT: Depth 'fate a1
From 0 To 20 Ft. CONCRETE
From To Ft.
14. Material
SCREEN: Depth Diameter Slut S
From To Ft. in.
From To Ft. in.
Material
Fire-
Method
POURED
15. SAND/GRAVEL PACK:
Depth
From To Ft.
From To Ft.
16. REMARKS:
Size
in.
in.
Material
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common road names.
,r3A.om_ ilQn tti (�c t /a4E.
dun al- °LtJakety)_ .
Joteat.dGt /J
Un. �� l t-o
Ciu_e.A_ Ro! , t1 a -I s Jz/t mum e.Bkinn
got. JAI,'0.J.t I�,9Pi/ !
nu Q2f u to . J.uw.t ,b
Attiat ncutect-p'i A
Inc HEREBY CERTIFY THAT THIS WELL WAS CONSTR U ui. IN ACCORDANCE CE - ITI; 15A NCAC 22Cj€ WELL
CONSTRUCTION STANDARDS, ANT) THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO T 11.
SIGNA
_ .
inLii iGNu itticwbLL ut'
Submit the original to the Dnision of Water Quality, Groundwater Section, 1636 Mail Senice Center - Raleigh, NC
G V- t REV. 07 2rk i i
_; 6� I6361'hgnc No. ("' n)'33-32?', within "in days.•

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) KENNETH MCCRARY CERTIFICATION # 2008
WELL CONTRACTOR COMPANY NAME BARKER CONSTRUCTION, INC./BARKER WELL & PUMP PHO # f8281 697-7263
STATE WELL CONSTRUCTION PERMIT# 1871 ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
301793
1. WELL USE (Check Applicable Box): Residential I Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring ❑ Recovery 0 Heat Pump Water Injection 0 Other 0 If Orlin, List Use
2. WELL LOCATION:
Nearest Town: HENDERSONVILLE County HENDERSON
BROOKSIDE CAMP ROAD, SOUTHBROOK ROAD
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: DOROTHY HOOTS TERRY
Address PO BOX 295
(Street or Route No.)
NAPLES NC
City or Town State
( 828 )- 692-7137
Area code- Phone number
4. DATE DRILLED AUGUST 6. 2004
28760
Zip Code
5. TOTAL DEPTH: 180'
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO
7. STATIC WATER LEVEL Below Top of Casing: 20 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS 1.33 FT. Above Land Surface'
*Top of easing terminated at/or below land surface requires a
variance in accordance with 15A NCAC 2C .Ol It
9. YIELD (gpm): 15 METHOD OF TEST TIMED
10. WATER ZONES (depth):
Topographic/Land setting
❑Ridge ❑Slope ❑Valley ElFlat
(check appropriate box)
Latitude/longitude of well location
(degreesiminutes/seconds)
Latitude/longitude source:❑GPS❑Topographic reap
(check box)
DEPTH DRILLING LOG
From To Formation Description
11. DISINFECTION: Type BY PUMP INSTALLER Amount
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
From 0 To 42 Ft. 6 1I8 SDR21 PVC L*LO/WL .. , , • tat)
From To FL yCI�AAA�X/.,^��G'�•-^�J
From To Ft. c2,5 -t'O E,wo, Q.ictL 2Wi&p Pd.
13. GROUT: Depth Material Method II II oo r (� it
From 0 To 20 Ft. CONCRETE POURED j34,dd SW,LC.fLO2A1, R`I �J
From To Ft. A ut at- 11-a(, ti-6{,N.6tAL Ed.
14. SCREEN: Depth Diameter Slot Size Material 00
From To Ft. in. in. J",u/,t 010_/ Ojt_ .-
From To Ft. in. in. AAA ((,Utic. JJaa 411-Cttad.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
16. REMARKS:
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common road names.
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 1r).- 0/1/0A it.A9 g- G - b y
SIGNATURE OF PERSON CONSTRUCTING THEVELL DATE
Submit the original to the Division of Water Quality, Groundwater Section,1636 Mali Service Center- Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-1 REV. 07/2001

3O17°T8
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) KENNETH MCCRARY CERTIFICATION # 2008
WELL CONTRACTOR COMPANY NAME BARKER CONSTRUCTION, INCJBARKER WELL & PUMP
STATE WELL CONSTRUCTION PERMITS 1871 ASSOCIATED WQ PERMITS
(if applicable) (if applicable)
PHONE # [phone]
1. WELL USE (Cheek Applicable Box): Residential E3 Municipal/Public 0 Industrial 0 Agricultural ❑
Monitoring ❑ Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION:
Nearest Town: HENDERSONVILLE
County HENDERSON
GREY HAVEN SUBDIVISION, LOT #5
(Street Name, Numbers, Community, Subdivision, lot No., Zip Code)
3. OWNER: NATHAN MCCOLLIN
Address 20 GOLDENWOOD TRAIL
(Street or Route No.)
ARDEN NC
City or Town State
( 828 )- 713-4821
Area code- Phone number
4. DATE DRILLED AUGUST 4, 2004
28704
Zip Code
5. TOTAL DEPTH: 405
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO gl
7. STATIC WATER LEVEL Below Top of Casing: 20 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS 1.33 FT. Above Land Surfaces
flop of easing terminated at/or below land surface requires a
variance In accordance with 15A NCAC 2C .0118.
9. YIELD (gym): 1 METHOD OF TEST TIMED
10. WATER ZONES (depth):
11. DISINFECTION: Type BY PUMP INSTALLER Amount
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft Material '
From 0 To 51 Ft. 6 1/8 SOR21 PVC Juni ,/ / „ ,i „ t, AQq
From To Ft A/�,(w,lJ I,e�lxJt-(a-r-�•.•' �A`�^'`�n�'L-`�'./��--GY1
13. GROUT: Depth Material Method 31 - . /CO . J Ga t/ 'J
From To Ft.
From 0 To 20 Ft, CONCRETE POURED Flavin !Jt iu-Q- • (.1,can.
From To Ft. kkt�
14. SCREEN: Depth Diameter Slot Size Material Al- O / \ /
From To FL in. in. Q /WWII 0 0 lll. Y l�-J -
From To Ft in. to 15. SAND/GRAVEL PACK: %-tt- ft .5 al A , (J
J zO /IOWAA,.—,/4t5
Topographic/Land setting
❑Ridge ®Slope ❑Valley ❑F1at
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From To Formation Description
Depth Size Material
From To Ft.
From To Ft.
16. REMARKS:
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common road names.
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH I5A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY
OF"T}31`SRECORD HAS BEEN PROVIDED TO THE WELL OWNER
I,-� 14
SIG A� v
PERSON UONSTR G THE WELL DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-1 REV. 07/2001

302052
WELL CONSTRUCTION RECORD
North Carolina - Depai uncut of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) Jamns Tat- Caw1,, JZ'
CERTIFICATION" 71 ifS
WELL CONTRACTOR COMPANY NAME Csmn's Wp11 R Paimp en Tnr PHONE i$9Rl d5'i_7322
STATE WELL CONSTRUCTION PERMIT"
(if applicable)
ASSOCIATED WQ PERMIT"
(if applicable)
1. WELL USE (Check Applicable Box): Residential bee-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 ON:
Nehrest Town:
'&12\/` 111.tQ1
(Stint Name, Numbers, Community, Subdivision, lot No., Zip Code)
N-
3.'-OWNER: O(rutt� X{„t Ctw
Address 7) k
(Scree: or Route NO
R-rtn tJ c- QC 813 9
City of Town State Zip Code
t`61`6)- v a -S - it 211
Area code- Phone number
4. DATE DRILLED 2 • 1. 0 LA
5. TOTAL DEPTH: � g.r1
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO C9
7. STATIC WATER LEVEL Below Top of Casing: SD (7 FT.
(use '4" if Above Top of Casing)
8. TOP OF CASING IS t FT. Above Land Surface*
• *Top of casing terminated at/or below land surface requires a
variance in accordance with ISA NCAC 2C .0118.
9. YIELD (gpm): ej—L\ MET OD OF TEST p jr_
10. WATER ZONES (depth): \Ark Itmg
11. DISINFECTION: Type rh 1 nr i np
12. CASING:
Depth Diameter
Fro _o To e`I L- Ft. 6 t / 4
From To Ft.
From To Ft.
13. GROUT: Depth_
From p To 3 0 Ft.
From To R.
14. SCREEN: Depth Diameter
From To Ft. in.
From To Ft. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
Amount (AAP
Wall Thickness
or Weight/Ft. Material
gBR3l PVC
Material
Neat Cement
Method
Hand
Slot Size Material
in.
in.
Countycounty_liathadchthiktt,th
Topographic/Land setting
t Zidge ❑Slope ❑Valley ❑Flat
(cbcck appropriate box)
Latitude/longitude of well location
(degreea/minutes/aeconds)
Latitude/longitude source:❑GPS❑Topographic map
(check bon)
DEPTH DRILLING I O(2
From To Fo tion Description
at\ i et,&
`1 FSS ^•6LAJ Uk-(1 ma.),
-0
LOCATION SKETCI-1
Show direction and distance in miles from at let%
two State Roads or County Roads. Include the road
numbers and common road names.
CP
16. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAAT tCOPY OF THIS RECO HAS EEN PROV TO THE WELL OWNER
SIGNATURE/OF PERSON CONSTRUCTING THE LLB 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
z•
G C'•
1-
min
AL
-v+Tt
�yo
00
Trim
0
en
0

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) James wL Camp, Tr
WELL CONTRACTOR COMPANY NAME ramp' G Wp11 & pttmp ('n
302049
CERTIFICATION # 21 1 R
Tnr PHONE #$7R) Il51_7122
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable)
(if applicable)
1. WELL USE (Check Applicable Box): Residential 0 Municipal/Public ❑ Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCAT •N• (t
Neare��Tho� AA.1U 0
u J� 1� Clr�
(Street Name, umbers. Community; Subdivision. Lot No.. Zip Code)
3. OWNER: t((Y`nR�l C
- �A
Address `'- ; 0 g
e\'`-,
„ ry (Street to Ro 0 No.)
City oorr`T\owoo State V` Zip Code
6050- --N g . g 3 2 �,
Area code- Phone numb
ern
DATE DRILLED e aO • 8
5. TOTAL DEPTH: 1 es-
Ll
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO ri
7. STATIC WATER LEVEL Below Top of Casing: W 0 FT.
(Use "r" 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 occur nee with 1SA NCAC 2C .0118.
9. YIELD (gpm): Q METHOD OF TEST Sir
10. WATER ZONES (depth): $0
11. DISINFECTION: Type rhl nri np Amount
12. CASING: Wall Thickness
DeptDiameter or Weight/Ft. Material
From o ToFt.6 1 /4 SDR21 PVC
From To Ft.
Fromt To Ft.
13. GROUT: Depth Material
Frortt__Q__To 20 Ft. Ncctt Cement
From To Ft.
14. SCREEN: Depth Diameter Slot Size Material
Front To Ft. in. in.
From To Ft. in. in.
Method
Hand
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
16. REMARKS'
County4isaatA
Topographic/Lan setting
❑Ridge ❑Slope Malley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source: ❑GPS❑Topographic map
(check boa)
DEPTH pRII LING LOG
From To Fcskinnation Descryption
my L)/L
VOLT Ig5- (.n4,
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. iT
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT ACOPY OF THIS RECORD BEEN PRO>IDED TO THE WELL OWNER
q 9-0q
DATE
a 1i!..124
SIGNATURE OF PERSON CONSTRUCTING THE
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
3006772
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) RICHARD MCCRARY CERTIFICATION # 2010
WELL CONTRACTOR COMPANY NAME BARKER CONSTRUCTION, INC./BARKER WELL & PUMP
STATE WELL CONSTRUCTION PERMIT# 1871 ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential ® Municipal/Public 0 Industrial 0 Agricultural ❑
Monitoring 0 Recovery 0 Heat Pump Water Injection ❑ Other 0 If Other, List Use
2. WELL LOCATION:
Nearest Town: HENDERSONVILLE
COGGINS COVE
County HENDERSON
(Street Name, Numbers, Corm tmity, Subdivision, Lot No., Zip Code)
3. OWNER: DANIEL AND STEPHANIE BAILEY
Address 268 COGGINS COVE
(Street or Route No.)
ZIRCONIA NC
City or Town State
( 828 )- 685-2214
Area code- Phone number
4. DATE DRILLED JULY 9, 2004
5. TOTAL DEPTH: 245'
28790
Zip Code
6. DOES WELL REPLACE EXISTING WELL? YES O NO al
7. STATIC WATER LEVEL Below Top of Casing: 40 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS 1.33 FT. Above Land Surface*
'Top of casing terminated at/or below Laud surface requires a
variance In accordance with ISA NCAC 2C .0118.
9. YIELD (gpm): 20 METHOD OF TEST TIMED
10. WATER ZONES (depth):
II. DISINFECTION: Type eY PUMP INSTALLER Amount
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
From 0 To 61 Ft. 61/8 SDR21 PVC
From To Ft.
From To Ft.
13, GROUT: Depth
From 0 To 20
From To Ft.
14. SCREEN' Depth
From To
From To
Material
Ft. CONCRETE
Diameter
Ft. in.
Ft. in.
15. SAND/GRAVEL PACK:
Depth
From To Ft.
From To Ft.
Size
Slot Size
in.
in.
Met
POURED :rnils-cc-Q'iL, . c a_zefitt
et Rid ,cad Van.
tC/
Lkyt tut
C.f�ll-C- ,� l� ea/tut
� �O
PHONE # 1828)
Topographic/Land setting
ORidge ®Slope OValley OFIat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude sou rce:OGPSOTopographic map
(check box)
DEPTH DRILLING LOG
From To Formation Description
G
O O
9 0rn
-411
rO
o
M
m
LOCATION SKETCH cat
Z
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common road names.
697-7263
Lien 3.4`c atat-aczze to
.41-u4t /76 As2a 4 u s015
Material
16. REMARKS:
I DO HEREBY CERTIFY THAT THIS ) WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
A7p
CONSTRUCTION STANDARDS, / THAT A DOPY OF THIS RECORD HAS BEEN PROVIDED TO THE W,LL OWNER
// 7 Q Ai
SIGNATURE OF PERSON CONSTRUC'i7NG 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-IREV.07/2001"

WELL CONSTRUCTION RECORD
3007 0
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) RICHARD MCCRARY
CERTIFICATION a 2010
WELL CONTRACTOR COMPANY NAME BARKER CONSTRUCTION, INC./BARKER WELL & PUMP PHONE I [phone]
STATE WELL CONSTRUCTION TERMITE* 1871 ASSOCIATED WQ PERMIT*
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential I➢ Mtmicipal/Public ❑ Industrial 0 Agricultural ❑
Monitoring ❑ Recovery ❑ Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION:
Nearest Towm HENDERSONVILLE County HENDERSON
WINDY ACRES DRIVE
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: L.N. & PAMELA MINNICK
Address 235 WINDY ACRES DRIVE
(Street or Rare No.)
HENDERSONVILLE NC 28792
City a Town State
( 828 )_ 272-0735
Area code- Phone numba
4. DATE DRILLED JULY 11, 2004
5. TOTAL DEPTH: 185'
Zip Code
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO KI
7. STATIC WATER LEVEL Below Top of Casing: 40 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS 1.33 FT. Above Land Surface*
'Top of easing terminated at/or below Bad surface requires a
variance in accordance with ISA NCAC 2C .011&
9. YIELD (gpm): 30 METHOD OF TEST TIMED
10. WATER ZONES (depth):
II. DISINFECTION: Type BY PUMP INSTALLER Amount
12. CASING: Wall Thickness
Depth
From 0 To 44 Ft.
From To Ft.
From To Ft.
13. GROUT: Depth Material
From 0 To 20 Ft. CONCRETE
Diameter or Weight/Ft. Material
61/8 SDR21 PVC
From To Ft.
14. SCREEN: Depth Diameter
From To Ft. in.
From To Ft. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
Method
POURED
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
�pG
Q+ yt0
A
LOCATION SKETCH ry
Show direction and distance in miles from at (east
two State Roads or County Roads. Include the road
numbers and common road names.
from 1Jender5on' le taKe fituq.6LIE
-inward Ecinepilit .Tpk a lel-E-
o11th Frl.dtl C14 id Eoad :Tait
e- a
IeF+ ors LaTLCas-kr Rot. late c_
ra
Slot Size Material (i't7ililt- into Oiind,/ s4cres .Tare
in• tFie. !eft Tor k tt bottom of
hlII•
16. REMARKS:
1 DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C,
CONSTRUCTION STANDARDS, AND THAT A COPY THIS RE RD HAS BEEN PROVIDED TO THE LL R
/.tee by
SI NATURE OF rERSON CONSTRU
G THE WELL
DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center- Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. 'GW-.I RSV., 07/2001,; /

30G",.3
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) RICHARD MCCRARY CERTIFICATION a 2010
WELL CONTRACTOR COMPANY NAME BARKER CONSTRUCTION, INC./BARKER WELL 8 PUMP PHONE # [phone]
STATE WELL CONSTRUCTION PERMIT# 1871 ASSMIATED WQ PERMITN
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential I Municipal/Public 0 Industrial El Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION:
Nearest Town: HENDERSONVILLE County HENDERSON
BOB'S CREEK ROAD
(Strut Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: SCOTT EMORY
Address 749 JACKSON ROAD
et (Sheor Route No
FLETCHER NC
28732
City or Town State
( 828 )_ 684-6620
Area code- Phone number
4. DATE DRILLED JULY 16, 2004
5. TOTAL DEPTH: 165
Zip Code
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO EB
7. STATIC WATER LEVEL Below Top of Casing: 30 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS 1.33 FT. Above Land Surface*
`Top of easing
terminated at/or below hind surface requires ■
variance in accordance with 15A NCAC 2C .011&
9. YIELD (gpm): 30 METHOD OF TEST TIMED
10. WATER ZONES (depth):
11. DISINFECTION: Type BY PUMP INSTALLER Amount
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
From 0 To 20 Ft. 61/8 SDR21
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
W
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and comnnn road names.
PVC From NendersorniLle -Lae. 4a Z55.
to Exit I - BohsC'reekllaoad. lrWrt.
rickt at koforn of ramp artxkgor'
POURED a-9z hoes • Wh.ltz° kou$e. oYi ``((IoTC
5 (ttial back oFF road a.la-out300.
Upper b ounaary , l owes b.oundairy
at Ir*ersgtia- of -Anderson .
13. GROUT: Depth Material Method
From 0 To 20 Ft. CONCRETE
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:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUC 11.0 IN ACCORDANCE WITH I5A NCAC 2C,
CONSTRUCTION STANDARDS, AND T A COPY OF S RECO HAS BEEN PROVIDED TO
•
la Me
SIGNATURE OF PERSON CO STRU G 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. ` £W-1 NEV. 07/2001
OWNER
/V
Z

30( CS
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) KENNETH MCCRARY
CERTIFICATION # 2008
WELL CONTRACTOR COMPANY NAME BARKER CONSTRUCTION, INC./BARKER WELL 8 PUMP PHONE # J 828) 697-7263
STATE WELL CONSTRUCTION PERMIT# 1871 ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential ® Municipal/Public ❑ Industrial 0 Agricultural 0
Monitoring ❑ Recovery 0 Heat Pump Water Injection O Other O If Other, List Use
2. WELL LOCATION:
Nearest Town: HENDERSONVILLE County HENDERSON
GERTON HWY.
(Street Name, Numbers, Community, Subdivision, Lot No., lip Code)
3. OWNER: RANDY BRANNON
Address 4412 GERTON HIGHWAY
(Street or Route No.)
GERTON NC 28735
City or Town State Zip Code
( 828 )- 625-0267
Area code- Phone number
4. DATE DRILLED JULY 21, 2004
5. TOTAL DEPTH: 180
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO gl
7. STATIC WATER LEVEL Below Top of Casing: 20 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS 1.33 FT. Above Land Surface*
'Top of casing terminated st/or below land surface requires a
variance In accordance with ISA NCAC 2C .0118.
9. YIELD (gpm): 20 METHOD OF TEST TIMED
10. WATER ZONES (depth):
11. DISINFECTION: Type BY PUMP INSTALLER Amount
12. CASING: Wall Thickness
Depth
From 0 To 42 Ft. 6 % .185 STEEL
Diameter or Weight/Ft. Material
From To Ft.
From To Ft.
Topographic/Land setting
ORidge ®Slope OValley OFlat
(check appropriate box)
Latitude/longitude of well location
(degrees/mimnea/seconds)
Latitude/longitude source:OGPSOTopographic map
(check box)
DEPTH DRILLING LOG
From To Formation Description
O
9 3
m 9�
"1,
A '
fit
W c,
LOCATION SKETCH W
Show direction and distance in miles from at leastl•3 %
two State Roads or County Roads. Include the road
numbers and common road names.
,��LO//x. eictuLpi at tL —
242
13. GROUT: Depth Material Method q P 1�� �[o (Auk) z - . ,I
From 0 To 20 Ft. CONCRETE POURED y f rj- .k 7-f,4 C tcu u) � 4412.
From Toe Ft. "("Cpi�'�� n^ ,n^� 0/2
14. SCREEN: Depth Diameter Slot Size Material L(./t�/ 1. / t-lr-z-t�
From To Ft. in. in. r
From To Ft. in. in.
--"- -n�"�� ��,//����� 1L����
15. SAND/GRAVEL PACK: �!//nl y,.-L —e- - 49 12- -C.I eOil- ^w"7�•
Depth Size Material '"'``^�^'"" ""''""((JJ
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
-z knew A., - 3 - 09
SIGNATURE OF PERSON CONSTRU 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 3 0 0 ., C 7
North Carolina - Department of Envirotnnent and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) KENNETH MCCRARY CERTIFICATION # 2008
WELL CONTRACTOR COMPANY NAME BARKER CONSTRUCTION, INC./BARKER WELL 8 PUMP PHONE # [phone]
STATE WELL CONSTRUCTION PERMIT# 1871 ASSOCIATED WQ PERMITT#
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential El Municipal/Public ❑ Industrial ❑ Agricultural ❑
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION:
Nearest Town: HENDERSONVILLE County HENDERSON
BLOOMINGDALE SUBDIVISION, LOT#10
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: TOM WOOD
Address 86 PORTOBELLO ROAD
(Street or Route No.)
ARDEN NC
28704
City or Town State
( 804 )- 731-3304
Area code- Phone number
4. DATE DRILLED JULY 22, 2004
5. TOTAL DEPTH: 430
Zip Code
6. DOES WELL REPLACE EXISTING WELL? YES O NO in
7. STATIC WATER LEVEL Below Top of Casing: 20 FT.
(Use "f" if Above Top of Casing)
8. TOP OF CASING IS 1.33 FT. Above Land Surface*
`Top of rasing terminated atior below land surface requires a
variance in accordance with ISA NCAC 2C .0118.
9. YIELD (gpm): 2 METHOD OF TEST TIMED
10. WATER ZONES (depth):
11. DISINFECTION: Type BY PUMP INSTALLER Amount
12. CASING: Wall Thickness
Depth
From 0 To 100
From To
From To Ft.
Diameter or Weight/Ft. Material
Ft. 61/8 SDR21 PVC
Ft.
13. GROUT: Depth Material Method
From 0 To 20 Ft. CONCRETE POURED
From To Ft.
14. SCREEN: Depth Diameter
From To Ft. in.
From To Ft. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
Slot Size Material
in.
tn.
16. REMARKS:
Topographic/Land setting
ORidge ❑Slope OValley ®Flat
(check appropriate box)
latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:OGPSOTopographic map
(check box)
DEPTH DRILLING LOG
From To Formation Description
t.•
R* y0
rn
rno
Z pm
LOCATION SKETCH crip
Show direction and distance in miles from at lea 2
two State Roads or County Roads. Include the pad 'oz
numbers and common road names.
J4ay. as{(&tth . J14 L L itt
CJ2 JJ6tha,LOL iai¢
Q out. 2 a (LI .cn Aa d
coca .9- fujus 1E0 &arra-
(4/0
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUC FEU IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
NER
CZyWtC,4>L Y)1 data w)/ - 3 _ C
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center- RWeigh,.NC
27699-1636 Phone No. [phone], within 30 days. 3W-) REV.:07/2001;

WELL CONSTRUCTION RECORD
300766
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) RICHARD MCCRARY
CERTIFICATION # 2010
WELL CONTRACTOR COMPANY NAME BARKER CONSTRUCTION, INC./BARKER WELL & PUMP PHONE # [phone]
STATE WELL CONSTRUCTION PERMIT# 1871 ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential 1D Municipal/Public 0 Industrial ❑ Agricultural O
Monitoring ❑ Recovery 0 Heat Pump Water Injection ❑ Other O If Other, List Use
2. WELL LOCATION:
Nearest Town: HENDERSONVILLE County HENDERSON
PACE ROAD OFF OF SUGAR LOAF ROAD
(Street Name, Numbers, Community, Subdivision, Lot No., Tip Code)
3. OWNER: JEFF MCCRAIN
Address RT. 6, BOX 333 SUGAR LOAF ROAD
(Street or Route No.)
HENDERSONVILLE NC 28792
City or Town State
( 828 )_ 685-7343
Area code- Phone number
4. DATE DRILLED JULY 28, 2004
Zip Code
5. TOTAL DEPTH: 150'
6. DOES WELL REPLACE EXISTING WELL? YES O NO FO
7. STATIC WATER LEVEL Below Top of Casing: 20 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS 1.33 FT Above Land Surface`
'Top of casing terminated at/or below land surface requires a
variance in accordance witb ISA NCAC 2C .611&
9. YIELD (gpm): 30 METHOD OF TEST TIMED
10. WATER ZONES (depth):
11. DISINFECTION Type BY PUMP INSTALLER Amount
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
From 0 To 80 Ft. 61/8 SDR21 PVC
From To Ft,
From To Ft.
13. GROUT: Depth Material Method
From 0 To 20 Ft, CONCRETE POURED
From To Ft.
14. SCREEN: 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)
Latitude/longitude source:OGPSOTopographic map
(check box)
DEPTH DRILLING LOG
From To Formation Description
r
o0,
• o.c
GIN 0
LOCATION SKETCH
Show direction and distance in miles from at (east n.) Z
two State Roads or County Roads. Include the road
numbers and common road names.
Jzom ,acat 2fL
lirW0jest S' Y'
q!t _ Pg-ci_ toad
and_
offrtaL a/00 /k Ge .
L a4
Jt a,ce ,tt ! Atax, t ae.
ark tiret".
16. REMARKS:
1 DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN AC
CONSTRUCTION STANDARDS, AND THAT A COPY 0 THIS REC
t`zm14
SIGNATURE OF P ' SO. ONSTRUCTING THE WELL
ANCE WITH ISA NCAC 2C, WELL
HAS BEEN PROVIDED TO THE WELL OWNER
DA
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center Raleigh, -NC
27699-1636 Phone No. [phone], within 30 days. GW 1 Apt,. O7/40011/
_ I
1 3 , r,34

WELL CONSTRUCTION RECORD
30C7Gt
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) RICHARD MCCRARY
CERTIFICATION a 2010
WELL CONTRACTOR COMPANY NAME BARKER CONSTRUCTION, INC./BARKER WELL & PUMP PHONE # J828) 697-7263
STATE WELL CONSTRUCTION PERMIT# 1871 ASSOCIATED WQ PERMITa
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential El Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection O Other ❑ If Other, List Use
2. WELL LOCATION:
Nearest Town HENDERSONVILLE County HENDERSON
WEBB SUBDIVISION, LOT #2
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: BOB AND LINDA WEBB
Address 211 RED BIRD LANE
(Street or Route No.)
HENDERSONVILLE NC
28791
City or Town State
( 828 )- 891-3731
Area code- Phone number
4. DATE DRILLED JULY 7, 2004
Zip Code
5. TOTAL DEPTH: 365'
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO HI
7. STATIC WATER LEVEL Below Top of Casing: 60 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS 1.33 FT. Above Land Surface'
'Top of casing terminated at/or below land surface requires a
variance in accordance with ISA NCAC 2C .0118.
9. YIELD (gpm): 7 METHOD OF TEST TIMED
10. WATER ZONES (depth):
Topographic/Land setting
❑Ridge 0Slope OValley ®Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:OGPSOTopographic map
(check box)
DEPTH DRILLING LOG
From To Formation Drccription
11. DISINFECTION: Type BVPUMP INSTALLER Amount
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
From 0 To 73 Ft. 61/8 SDR21 PVC
From To FL
From To Ft.
13. GROUT: Depth Material Method
From 0 To 20 Ft. CONCRETE POURED
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.
O_ o
c:7
G�
rn
pG
LOCATION SKETCH
Show direction and distance in miles from at leases,
two State Roads or County Roads. Include the road
numbers and common road names.
JitArx j.uictea aastte .t.0.wx-
6. -G 4:tvu)aii. Whit
,���,�L////���� �at- 3tisc cWa arc tkt-
Slot Size Material -A'.
in. I
G -4-1 4�u et
uistit 2_2
16. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WF! I
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE LL WNFER
t 7 9 2
SIGNATURE OF PERSON C STRUCTING THE WELL DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mall Setv(ce Center-Raleigt, NC
27699-1636 Phone No. [phone], within 30 days. GW-j I;EV. 074001;:
I,

Depth Diameter
From d To_1 FL (p, XS
From To Ft.
From To Ft.
13. GROUT: Depth
From 0 To 2j? Ft.
From To Ft.
14. SCREEN: Depth Diameter
From To Ft. in.
From To Ft. in.
15. SAND/GRAVEL PACK:
Depth Size
From To Ft.
From To Ft.
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) 13Q �6y 14 , Pd715 CERTIFICATION#a'a
WELL CONTRACTOR COMPANY NAME Fc �Yttio417 Welt h/tlll1/A17 Co' , PHONE (oa7) 6t 33 ' 9fY9
STATE WELL CONSTRUCTION PERMIT# �.l ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential EMunicipal/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: fires Gent/ i'Ik County Hepdies0 N'
(Street Name, Nwnbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: £ i10 Pr�IO r' �nks/
dy
Address S1 a flirt roctjt . Rd.
Bar novd5 vl 11 Qt or NC
No.)
aa7oe
Ciry or Town State Zip Code
(M-34190
.Area code- Phone number
4. DATE DRILLED S//$/0 N
5. TOTAL DEPTH: I/6s
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO
7. STATIC WATER LEVEL Below Top of Casing: FT.
(Use "+" if Above Top of acing)
S. TOP OF CASING 1S / FT. Above Land Surface*
`Top or casing terminated auor below land surface requires a
variance in accordance with 15A NCAC 2C .0118.
9. YIELD tr to :p
(,,p ) 8 METHOD OF .�r�
10. WATER ZONES (depth): 2 S/' /s70'
LOCATION SKETCH
11. DISINFECTION: Type t-q 6te Amount _ // O= Show direction and distance in miles frmnMleast g.45
12. CASING: Wall Thickness two State Roads or County Roads. Include road3
or Weight/Ft. Material numbers and common road names. ••
2lbrlxs Put 54/41 ! (no
n
lay oak meadow La
H end ers rn vile , IVe
Topogr is/Land setting
❑Ridge (dSlope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
Nis'a+-Z377w0u'29,S03
(degrees/min to� onds)
Latitude/longitude source: atPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From To Formation Description
n Mric
115 — '+05 6.newl1 c
Material
torcre c
Method
P&ortA4
Slot Size Material
in.
in.
Material
O a_ tt
_lac"
O
Cn
16. REMARKS:
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
s
SIGNAT
RE OF PERSON CONSTRUCTING THE WELL / DrtTE
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
mat

302908
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Naturalu�Resources - Division of Water Quality - Groundwater Section -t
WELL CONTRACTOR (INDIVIDUAL) NAME (print) IJ 013by id t Pi l (5 CERTIFICATION# 20 GZ
WELL CONTRACTOR COMPANY NAME FC atISONi We/( hin/Wielli CO PHONE *WA 6'.83c� ffef
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential Ir--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: la' t Q County Mngref 4/
5'6 - ISz n 144 c f i s z
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: t` ray Pace.
Address 9 (OZi Ybtr Joo4
(Street or Route No.)
Zino-actNc a£796
City or Town State Zip Code
87,8)-4592-OQ38.
Area code- Phone number
4. DATE DRILLED 447 i/
5. TOTAL DEPTH: ,305
6. DOES WELL REPLACE EXISTING WELL?
YES 0 NO 1
7. STATIC WATER LEVEL Below Top of Casing: /6 FT.
(Use "+" i f Above'fop 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)• 4 METHOD OF TESTRGhaftny/f-19
O. WATER ZONES (depth): /n
LOCATION SKETCH
Topogra /Land setting
❑Ridge lope ❑Valley ❑Flat
(check epprophaic box)
Latitude/longitude of well location
4/3S°12.4f47 caoSrak.k7,S%6
(degrees/minute conds)
Latitude/longitude source: PS❑Topographic map
(check box)
DRILLING LOG
Formation Description
0.1
[&Drk
6 rran.ltC
DEPTH
From To
0 —7/
7 / - 76
7 6 - 3os
11. DISINFECTION: Type /n}j/i Amount
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
From /) To_24Ft. (y J.S 2/6.ILS Ptt sra&Af
From To Ft.
From To Ft.
13. GROUT: Depth Material
From r) To 7,.b FL rnfir r?J<
From To Ft.
t4. SCREEN: Depth Diameter
From To Ft. in.
From To Ft. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
Method
Pa U/tin0
Slot Size Material
in.
in.
Show direction and distance in miles from atdpast
two State Roads or County Roads. Include the road
Tim
numbers and common road names.
5loy 'Barber Road
Tuxedo, NC
tV
0
16. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, .AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
- 41A7 GU. P
SIGNAT RE OF PERSON CONSTRUCTING THE WELL
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-1 REV. 07/2001
O Col
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r)

WELL CONSTRUCTION RECORD
North Carolina - Depanment of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) 12>0 bb/ - k , PCB i CERTIFICATION #Q 0a a
PHONE RAY) 6$p
3 - fir/
WELL CONTRACTOR COMPANY NAME F-r/Yt)SD/ti,r We/( T]/1/t///^/ Cr9,
STATE WELL CONSTRUCTION PERMIT/4 �l.// ASSOCIATED WQ PER1vIITa
i if aapplicable': (if applicable)
1. WELL USE (Check Applicable Box): Residential Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION: ,/ ry /Ly '
Al
Nearest Town: 6-t^1(oty CounAt tPSd
/IS Thetw4-Pey tip 14 iZd,
tSncet Name, Numbers. Commumry, Subdivision, Lot No., Zip Code)
3. OWNER: fM'C M1t 4f'/cC P�} r�
Address 52400 5. (0 ) 5+ 5+. 0-.'
UIV?C6(rl Sate Route Nd.j Wn51I0
Ciry or Town State Zip Code
( )-4 5 — 056E
Nea code- Phone number
F. DATE DRILLED 3/S,D r/
5. TOTAL DEPTH: SOS
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO lit'
7. STATIC WATER LEVEL Below Top of Casing: /ZQ FT.
(Use "+" it Above Top of Casing)
S. TOP OF CASING 15 / FT. Above Land Surface"
`Top of casing terminated actor below land surface requires a
variance in accordance with 15A NCAC 3C .0118.
9. YIELD (gpm): / METHOD OF TEST t 4fr
10. WATER ZONES (depth):
11. DISINFECTION: Type 'Fab it 75 Amount
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
From D To AS r Fr. L aS 2,%L I13 PVC 5.4(t,Z/
From To Ft.
From To Ft.
13. GROUT: Depth Material
From 0 To 2. 0 Ft. (aACJvt i'e
From To FL
14. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in.
From To Ftin. in_
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
Method
touricyGe'toll r NC
topographic/Land setting
Idge ❑Slope OValley ❑Flat
(check appropriate box)
Latirude/longitude oft well location
A/ 3 S. R%, 409 /,v 05s2 °21, 3 V6
(degrees/minutek/seconds)
Latitude/longitude source: OGPSOTopographic reap
(check box)
DEPTH DRILLING LOG
From To Formation Description
0 - 2 D UPAT
20 - 2S
2S ^$a&
Rock
6.,1qnul
Gen
min
0 ruin
A rn
f C•
CO0
—t0
rim
n..t�
Oct
O
LOCATION SKETCH
Show direction and distance in miles from at len
two Stale Roads or County Roads. Include the rp'ad
numbers and common road names. t7
0
1 J5 fllc&u f'eij %follow gate
From To Ft.
lb. 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' -
SIGNATZJRE OF PERSON CONSTRUCTING THE WELL
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center -Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-1 REV. 07/2001

WELL CONSTRUCTION RECORD
Norm CawGna - Dcparvnenror Environment and rat Rc>ourccs - DivisWater of atcr Quality - Groundwater Scerion
11 ELL CONTRA:r3R i1N DIVIDUaL) NA6LE jusiou) .D lt.LtN// H. 2 f, �1 5 CERTIFICATION jyig°
\t LLL CONrRi C'rre OCOA1PnNV N.1.YIE LCSC/✓j ulc/� DIP/'///NQ PHONE Rd& alydYE4
ST.- E. WELL CONSTRUCTION PERMIT;, .S30C1.&TPL WQ1 PRIM1Tv
lif]ppllazh lal
302899
I. WELL USE rCllcctr Applioabl: Box): Rcstdtnrial Gr Ni unicippUPublic 0 lnduyrria(❑ Agricultural ❑
l\Wniloring ❑ Recovery 0 Heat Pump Water lnjccrion 0 Or11er ❑ 110ther, List Use
2. WEL.L LOCATION
Nearest Town /�'% i
;J ,Pint/
4/-
County / hip.- 7."
r�aca Nomc, Numbers, Comm1uniry, Suboivuion. LOI PIO., Zip C1ac)
O\\NER Rw 1d Reed
e = x 101'7
`
Norse ShoetrrNCreN , 2S74P
lfl )4)"u 3mlc Zip Coati
,3 �i, g9-ioa
tic root- Phone nurnocr
D=.'TE DNLLED / ` /2 -01
5. TOTAL DEPTH: Tor
a, DOES WELL REPLACE EXISTING WELL'? YES ❑ NO
ST.9.TIC \\' kTER LEVEL Below Top of Casing: id— FT.
/ (Ula'.:'ii. Above Top of Caning))
TOF OF CASING IS FT. ..Above Land Surface^.
*Tap ar rung mrmma lea Ivor bcluw mop su try cc requires u
varins:c m accorauncc Wir1I 13A NC.0 2C .011 b.
9. YIELD Icpmi: Z METHOD OF TEST B%Wi/vc5 -R'.r
lu. \V.ATER ZONES (depth): fro ,/ .�
Topogr xhic/Land seeing
DRidge S)opc ❑Valley ❑Flay
(check appropriate box)
Lutirude/longitude of well locario t
i✓�r� L e?W'vnyt•7sl yir'
(degrees;minor eeonas)
Latitudwlongitude source: GPSOTopogrAphic map
(ebeck box)
DEPTH DRILLING LOCI
From To Foarttgion Description
0- -n
7$ /y17r S 6/
C.—'ft
II. DISINFECTION: TypeC/O
jL/nc
12. C :;INU.
Depth Diameter
Fran 0 To 78 Fr.LJZr—
Froln l'o Er.
From To Ft.
13. 3RDU T: Dcpih Marcnal
Ivlc[hotl
r rOtn_-_Q-_'To c O Fr. CY744' le ®ov-y
From 'lb Fr.
Amount 27 his
Watt Thickness
or We iehr/FI. Material
rS4,12,/ „�✓-
I;. SCREEN: Depth Diameter Slot Size iPelarcrial
From To Fr in.
Fmin In
'I'o Fr in. in
15. SAND/GRAVEL PACK-_
Dcpn) S;-,c
11s[cn0.1
Frole 1'o Fr.
From To Fr
Io. FEMAFJTS
Or
CC-1
rn
O
- Wrn
LOCATION SKETCH O Cr—
LOCATION
Show direction and distance i t f fir`
1
n mies tom at leOa—
two Stare Roads or County Roads. Include the a, fir,
n
umbers and common road names. ••
O
N
O r
Bel lair Drive
,Mills River, NC
I DO HERESY CERTIFY THAT THIS WELL WAS CONSTRUCTED EN ACCORDANCE WITH I5A NCAC 2C, WELL
CONSTR ION S9A1 ARDS, .AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
SIGNADATTEE
TURE OF PERSON CONSTRUCTING THE WELL / y6
Suhmlr me 0ri�in,l Et) the Division of Wu ter Qualiry, CCU undw'Ater Section,
27693-1o3o Pnunc IYo. [phone]) rrlrllln 3D bay.
1636 Mail Service Center - R;ileigb,, NC
CAW -I REVr O7i_doi
OCT 22 20J8
Ul;i

302898
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Qualiry - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) IJ013Li ,
WELL CONTRACTOR COMPANY NAME
Po 1715 CERTIFICATION ffi 90 a s
FCau; nit- We fA`/I%n7 Cr, . PHONE Z7.Y) 6% frit?
STATE WELL CONSTRUCTION PERMITX ASSOCIATED WQ PERMITK
i it applicable (if applicable)
I. WELL USE (Check Applicable Box): Residential fG Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION:
Nearest Town: bi}n/A County /7 rnJtram/
f-1,14AyA4s c,or/9 14 1../ S
(Srrect Name, Numbers, Community, Subdivision, Los No., Zip Code)
Topo�gr�ajibic!Land setting
LQ ❑Ridge Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
3. OWNER: Metrii .4/ DlIbA/P Nf5Yv iKeNRrxd6iH3sg7VD.L Qn Z°73 364
miniuteonds)
Address (o5 Hns n� Ioa Latitude/longitude PSOTopographic
ssmap
FM.1 Rock (SheerRoute No.)
C 281
3'
City or Town Scare Zip Code
- C°43eGaici
Area code- Phone number
4. DATE DRILLED 34D7DV
5. TOTAL DEPTH: a,GS
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO ('
7. STATIC WATER LEVEL Below Top of Casing: ?5 FT.
(Use "+" i1 Above Top of Casing)
8. TOP OF CASING IS / FT. Above Land Surface*
'Top of casing terminated at/or below land surface requires a
variance in accordance with I5A NCAC 2C .0118.
9. YIELD (gprn): K METHOI; OF TEST ' '
10. WATER ZONES (depth).• 13.0 %SO
11. DISINFECTION: Type
12. CASING:
1-alit_ 7S Amount 6 v,
Depth
From D To 653 Ft.
From To Ft.
From To Ft
13. GROUT: Depth
From 6 To 9. Q Ft.
From To
14. SCREEN' Depth Diameter
From To Pc. in.
From To Ft. in.
I5. SAND/GRAVEL PACK:
Depth Size Nlarerial
From To FI.
From To Fc.
Wall Thickness
Diameter or Weight/Ft. Material
Lac ,2/L.la3 Pvc SDJLA(
Material Method
Qoncric$r Poor1�y
Ft.
Slot Size Ntaterial
in.
in.
DEPTH
From To
O — b�
(check box)
DRILLING LOG
Formation Description
0M7'
63 r� Rock
i
D
Q a
,3.G
07—
rthrn
C
veto
LOCATION SKETCH
Show direction and distance in miles from at leajb.
two State Roads or Counry Roads. Include the ro
numbers and common road names. O
14604.1115 SpvinU Rd.
Daher, NC
l6. 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
SIGNAT{)RE OF PERSON CONSTRUCTING THE WELL ATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center -Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-1 REV. 07/2001
•

WELL CONSTRUCTION RECORD
302892
North Carolina - Depanment of Environment and Natuujral Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) 13a toby /4/ ,
CERTIFICATION# 0a
,
WELL CONTRACTOR COMPANY NAME Fr VS 0 Ai W e /1 h/t/t/l(.(7 CO . PHONE i�a7) 6$ 3 - fry?
STATE WELL CONSTRUCTION PERMIT# �J ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
POD/ S
1. WELL USE (Check Applicable Box): Residential (d Municipal/Public ❑ Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 if Other, List Use
2. WELL LOCATION: p
Nearest Town: ills H vet County K rrtie/SBW
44 yip- RP-0 — L.e% /6 A4
(Sneer Nam/ Numbers, Community, Subdivision. Lot No., Zip Code)
3. OWNER: SOu i nJ Sk6W CASE fla‘,A;n
Address
(Sneer or Route No.)
1-Lerd.' U,71ne a819/
City or Town State Zip Code
11)- &87— .:,NR3
Area code- Phone number
4. DATE DRILLED 1-74 /0 V
5. TOTAL DEPTH: ` ADS'
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO
7. STATIC WATER LEVEL Below Top of Casing: 14 FT.
(Use "+" if Above Top of Casing)
S. TOP OF CASING IS / FT. Above Land Surface'
'Top of casing germinated actor below land surface requires a
variance in accordance with 15A NCAC 2C .0118. t
9. YIELD(gpm): y METHOD OFTEST) Oitlrnp/Z+j
l0. WATER ZONES (depth): 2.2.6
11. DISINFECTION: Type 6te t5
12. CASING:
Depth
From___S_ To //216
From To
From To
13. GROUT: Depth Material
From 0 To )b Ft. Uri(rite
From To Ft.
Diameter
Ft.
Ft.
Ft.
Amount _ g' pZ
Wall Thickness
or Weight/Ft. Material
2/6,IXS put s I&
Method
Pa ()Pliny
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.
Topogr is/Land setting
❑Ridge .Slope ❑Valley ❑Fiat
(check appropriate box)
Latitude6/longitude ofwe location
4/ RS 2),. Q21//& 2 °i5, v2b'
(degrees/minute� conds)
Latitudeilongitude source: aiGPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From To Formation Description
0 •-. (D/ P.'nt
/0/ — /Ob /tick
(0b —3DS
6-ran C
O
ra
LOCATION SKETCH J
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common road names.
-Myer ro fen l LD441 K0*
Ycn1
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
SIGNAT RE OF PERSON CONSTRUCTING THE WELL DA E
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center- Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-I.R,EV. 07/2001

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources/ - Division of Water(
Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) Q0 to 6), 1.1 , Pali 5 CERTIFICATION # 2D& fJv
WELL CONTRACTOR COMPANY NAME re /yo O#VT We /I hr,'/I/qy Co, PHONE agar G$3 " frig
STATE WELL CONSTRUCTION PERMIT# �ASSOCIATED WQ PERMIT#
(ifapplicablel (if applicable)
1. WELL USE (Check Applicable Box): Residential Ll 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 TUP own: @SSUM/ILIe County /-/tenelreseal/
tot War Pi)/`t Sll totfl
(Street Name, Alumbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER;Sou-f4e11/I Sj'10'WcaSe RtJ(/5�nq
IA1ddressD 5413 Asheville Huta.
Rendeyson ll/eorlfuC No.) .'p.-ngI
City or Town State Zip Code
VA)- c2411- a$83
.Area code- Phone number
4. DATE DRILLED y'/Q/OY
5. TOTAL DEPTH: 1'3 S
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO E
7. STATIC WATER LEVEL Below Top of Casing: 4/0 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS / FT. Above Land Surface*
*Tap of casing terminated avor below and surface requires a
variance in accordance with 15A NCAC 2C .0118.
9. YIELD (gpm): 3 METHOD OF TESTRbt4rny /4�
10. WATER ZONES (depth): /26'
11. DISINFECTION: Type /'4/i ts
12. CASING: Wall Thickness two State Roads or County Roads. Include the road
Depth Diameter or Weight/Ft. Material numbers and common road names.
From d To /OA Ft. 6,, )„S 2(6,1),S » _s_a_Af
From To Fr.
From To Ft.
13. GROUT: Depth Material Method
From !) To VU FL tory r{t{ hB
From To Ft
14. SCREEN: Deprh Diameter Slor Size Material
From To Ft. in. in.
From To Fr in. in.
15. SAND/GRAVEL PACK:
Deprh Size Material
From To Ft.
From To Ft.
Topogr Ic/Land setting
❑Ridge Slope ❑Valley ❑Flat
(check appropriate box)
Latirude/longitude of well location
/✓3S6/7r.“6, lain'A,3, 3se -
(degrees/minutes/seconds)
Latitudeilongitude source: aGPSOTopographic map
(check box)
DEPTH DRILLING LOG
From To Formation Description
0.1n t
0 ^ 97
97 -IDA
hex-305
302889
Pick
16. REMARKS:
LOCATION SKETCH
Amount __ V 0> Show direction and distance in miles from at least `D
Tcty Vtsr For esf Lod
Neat ersanvi ((e, nC
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH I5A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF TFIIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER--
SIGNAT RE OF PERSON CONSTRUCTING TFIE WELL V/e
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center.- Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW4RE-V. 07/2001
o aVA
OCT 2 2 2004

302888
WELL CONSTRUCTION RECORD
North Carolina - Depanment of Environment and Natural Resources - Division)of Water
{.Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) IJ 0 43bY t . P I (S CERTIFICATION # RO & a
WELL CONTRACTOR COMPANY NAME Feat);onit Well /lnt`/ hi'/ Cr4 . PHONE «SaY) 683 - Irit
STATE WELL CONSTRUCTION PERM1T8 ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential El Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection ❑ Other 0 If Other, List Use
2. WELL LOCATION: Nearest Town: Hr ItUJ We County Hen d f»s, ✓
et an eta*/ Place tofr B
(Street Name, Numbers, Cmnmunity,Subdivision, Lai No., Zip Code)
3. OWNER: JO1444. a 5houx45e
Address Sq/ 3 Asheu.//e Hwy
'Nrr'' (Street or Route No.)
C rjeh J./ie Ise
Ciry or Town State Zip Code
(US.)- 4%7- 3193
Area code- Phone number
4. DATE DRILLED y/F/0
5. TOTAL DEPTH: t
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO Er
7. STATIC WATER LEVEL Below Top of Casing: A' ,0 FT.
(Use "+" it Above Top of Casing)
S. TOP OF CASING IS / FT. Above Land Surface*
Top of casing terminated avor below land surface requires a
variance in accordance with 15.A NCAC 2C .0118.
9. YIELD (gpm): )e METHOD OF TEST$/lht)iny/ft1J,
10. WATER ZONES (depth): / SD)
LOCATION SKETCH `'••
=79 /
Topogr Ic/Land setting
❑Ridge lope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude o well location
N )1s' / 7, Z/Yiuop. °a3 rgs/ r
(degrees/in' utesr Bonds
To
-,u
s
11. DISINFECTION: Type t-Qblt t$
12. CASING:
Depth Diameter
From d To la FL 6,.%5
From To Ft.
Amount
� )
Latitude/longitude source: IdGPS❑Topographic map
(check box)
DRILLING LOG
Formation Description
a`nt
DEPTH
From
0
1S -10
30 — /ffS
O_
5 at Show direction and distance in miles from at least ',�p
Wall Thickness two State Roads or County Roads. Include the road
or Weight/Ft. Material numbers and common road names.
2lbtlxs pi saha(
From To Ft.
13. GROUT: Depth Material
From 0 To 2j) Ft. to tic ri.i
From To Ft.
Method
Po OPrlAl
14. SCREEN• Depth Diameter Slot Size Material
From To Ft in. in.
From To Ftin. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
16. REMARKS:
err:scti,Rkc.e Lo-S $
nd4a_r5csnu.11re (NO.
).
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-
at tor
SIGNATi7RE OF PERSON CONSTRUCTING THE WELL
Submit the original to the Division of Water Quality, Groundwater Section,
27699-1636 Phone No. [phone], within 30 days.
0V
E
1636 Mail Service Center - Raleigh, NC
GW-1 REV. 07/2001
OCT 22 2004

Dcprh
From 0 To it
Fram T From To
13. GROUT: Depth
From_ To„ a F
From To
14. SCREEN. Depth
Frolil To
From po
15. SAF DrORAVEL PACK
Depm
From To
From To
I d. REMARKS:
WELL CONSTRUCTION RECORD
Norrn urollde - Dcparuncor or Enviromncnr and lye
\1 ELL CONTRACTOR )INDIVIDUAL) NAM (priuc)
14LLL CONTRACTOR CO,41PnNP
STATE 14 ELL CONSTRUCTION PERh11Ta
Ilr ...nz l:;_cicl ASSOCL+.TED WQ PRIINrlTn
lir.pplic9b1c)
302887
aal Resources - Division of Water Qualiry - Groundwater Section
CERTIFICATION p, _%
PHONE lopl 5 vet.
I. WELL USE rCBece pptic/9Na Box): Rcgidcnrial I 1\qunicipayPublic 0 Incharrial 0 AgriculNral D
iiWniwring 0 Recovery 0 Heat Fump Water Injection 0 Other 0 ]f Other: List Use
WELL LOCATION: pp
N,restTown:•A7:�/lfie;rei Count}. Ltd Tope 6T. Ic/Land Bening
fin. �o ` esl ! L � � ORidge 0-Slope ❑Valley ❑Flay
mry, Suboinsioa, Lot No., Zip Coon) (check ;,pdroprinm box)
Latitude/longrnlde of well location
NJitl<, :Nual Dcrq COWER
OWNER.
Address
CAd (Saccr cr Rourc No./
Q� iry oc To -n Sioi
IRL2I- D 7 ,i0 Zip awe
.Ares daac- Phone pumDer
4. DATE DRILLED 3 z° - oy
S. TOTAL
DOES WELL REPLACE EXISTING WELL'? YES 0 NO 7. STATIC WATER LEVEL Below Top of Casing: ri4D FT.
S. TOP OF (Use ":' it .♦bovc Top of Cae,na)
CASING IS FT. Above Land Surface"
'Top ei %Ruing rerminart a aver b duw land sun -nee rcy uiros a
va rianc. In aaco ruanef with I5,� :NC. C 2C .011d.
9. YIELD (Z: e- METHOD OF TEST/,(�,
19. WATER ZONES vie -pall: JGa'
t I. DISINFECTION: Type t /5� f' St 13. CASING: Amount Thickness
Wall Thickness
Dal -nerd! or Weigh t.I B. '1vlutcrial
ij
Ft. G• r2f 5 1k I /wc.
Ft.
Fr.
(vlarcriol
Diameter
Fr. n.
Ft n.
FI.
Fr.
Slot Si2c
In.
in.
Sat Uarenal
nlemod
m .
hd (caul
(devtesiminm�c.) conds)
Larirudwlongiruue source: L�1GPS❑Topographic map
DEPTH (oleo; box)
DRILLING
as
From To Formation Description ((JJ
6'Z'--. o- r J(e
G I
o
-orno
oQ
LOCATION SKETCH
Show direction and distance in miles from ar least r
two State Roads or County Roads. Include the road
numbers and common road names.
7 7/6R Cee/ L°f 3
it �n d ese a 7k n C
1 DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED [N ACCORDANCE WITH ISA NCAC 2C WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS I2EC0
- '1 RD HAS BEEN PROVIDED TO THE WELL OWNER';
SIGNATURE OF PERSON CGNSTfcUCT `3 —Z O — O
MG THE WELL DATE
Submit the original m the Division or Water Quality, Graundvv a ter Section, 1636
Mail J'erviez Colter.- Raleigh; NC/
'-?u99-lo_,o Phone No. [phone], wirfin all days.
GW-I REV.07lYOU1

WELL CONSTRUCTION RECORD
302886
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
PU I! 5 CERTIFICATION # a Q a s
WELL CONTRACTOR COMPANY NAME FC ads o& f W e II �/1II�Ihi O Cr J§
, PHONE t%T R G
65 - ifs?
STATE WELL CONSTRUCTION PERMIT#. ��.lJ ASSOCIATED WQ FERrv1IT#
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential LLB Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Hear Pump Water Injection 0 Other 0 If Other, List Use
\Y ELL CONTRACTOR (INDIVIDUAL.) NAME (print) Q06 Oy (,(/ ,
2. WELL LOCATION: 1/
Nearest Town: £i4czR'A1 Counry l7GtL!!/`SD�/
;we /3n,Wyc Pnni-t y� �s-y
[Sneer Name, Numbers, Communiry, Subdivision, Lot No., Zip Code)
3. OWNER:
Address
Flei-cher (SprerCRoue
Ciry or Town(orate
(%79f- (eKU—IQ(p9
Area code- Phone number
4. DATE DRILLED a oV
5. TOTAL DEPTH: y 5
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO
7. STATIC WATER LEVEL Below Top of Casing: 2,0 FT.
(Use "+" if Above Top of Casing)
3. TOP OF CASING 15 / FT. Above Land Surface*
"Top or cuing terminated war below and surface requires a
variance in accordance with 15A NCAC 2C.01 IS.
9. YIELD (gpm): / METHOD OF TESTWoIv/ly/r4i)
10. WATER ZONES (depth): 78
ag732-
Zip Code
11. DISINFECTION: Type 1-ab/t1-5 Amount i/ Gzs
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
From a To SA Fc.__J 1_5 ,Z/(o,WJ Pvc sdaAI
From To Ft.
From To Ft.
13. GROUT: Depth Material Method
From 0 To ?,a Ft. Cr) ncnrit Poor/ny
From To Fr.
14. SCREEN: Depth Diameter Slot Size Material
From To Ftin. in.
From To Frin. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Fs.
From To Fr.
La
DEPTH
From To
0 y7
Y7 - Sz
Si - Y?S
Topoaa
grrc/Land setting
❑Ridge 0Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
w.SS°/fr 7VS weir:'32,06g'
(degrees/minu s/seconds)
itudeilongitude source: 12CFS❑Topographic map
(check box)
DRILLING LOG
Formation Description
D/AD
Kock
G., , it
cm
t �n
rn
▪ 23rn
0
LOCATION SKETCH rut"++'--.
Show direction and distance in miles from at lea ?t
two State Roads or Counry Roads. Include the ro o O
numbers and common road names :£
<P O
1/4D cI
Vole t H dcy.. Fares+ 14.
E-Fowaii , NC
16. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15.A NCAC 2C, WEIa.I,_,...,_.,._—.-.:
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
SIGNATYIRE OF PERSON CONSTRUCTING THE WELL DAT
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center -Raleigh, NC
GW-1 REV. 07/2001
27699-1636 Phone No. [phone], within 30 days.
OCT 2 2 2004

WELL CONSTRUCTION RECORD
302885
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (prior) QO 66V h . PCB 1 ! 5 CERTIFICATION # O2Qa a
WELL CONTRACTOR COMPANY NAME �C /Y JS001/ i� /%Ne ( of/t H/rt> CO PHONE Rain) 6133 - yyK9
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(it applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential I Municipal/Public ❑ Industrial ❑ Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION: �/��
Nearest Town: 7-Vkec/O County b/rt'l enay
i/a if i1e O9cLea/ /-e7- 't
(Seect Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER:
Address S'
eu.//e ca..)
(Sayer or Route No.)
el{crole-es nv./r
Ciry or Town State Zip Code
(erg)-4 s 7- s 8e 3
Area coae- Phone number
4. DATE DRILLED
nr n 9/
5. TOTAL DEPTH: 41143
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO
7. STATIC WATER LEVEL Below Top of Casing: Isa FT.
(Use "+" it 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 (gpin): / METHOD OF TESTO,'pmi17/9
10. WATER ZONES (depth): eV a
11. DISINFECTION: Type lab /t
12. CASING:
Depth Diameter
From 0 To ??. Ft ‘ 1.5
From To Ft.
From To Ft.
13. GROUT: Depth
From O To Q
pographic/Land setting
Ridge ❑Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude o well location
/U3So /51e0/7r LUDBl° 25,[, set/
C. (degrees/mi utes/seconds)
Latitude/longitude source: 0—GPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From To Formation Description
o —v PhD
Amount /(e 27
Wall Thickness
or Weight/Ft. Material
211. 113 PVc SOR)./
Material
Ft. Qnr\cnr i t
From To Ft.
14. SCREEN: Depth Diameter
From To Ft. in.
From To Ft. in.
15. SAND/GRAVEL PACK:
Depth Size
From To
From To
l6. REMARKS:
Ft.
Ft.
Method
Poorllny
Slot Size Material
in.
in.
Material
/7-2�
-6-refs/lir
lock
Gr'
rites
rn
n.
23O
LOCATION SKETCH c3rea,.,
Show direction and distance in miles from at lease, na
two State Roads or County Roads. Include the roa o O
numbers and common road names. r7 g
on
D r
)/4 H%. t We e n a
F7'G/19ter56wdie t1 C
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED M ACCORDANCE WITH I5.A NCAC 2C, WELL
CONSTRUCTION STANDARDS, .AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
SIGNAT RE OFPE SON CONSTRUCTING THE WELL
ATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Nl ail Service'Csenk4-Mleith, NC L'
27699-1636 Phone No. [phone], within 30 days. GW-1 REV. 07/2001
0

WELL CONSTRUCTION RECORD
302884
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) kJO �6V Li/i Pot/5 CERTIFICATION # 2 0a a
WELL CONTRACTOR COMPANY NAME Fe Donn✓T /W a /I �/tl\/I/�I q Cc') . PHONE err) 6S 3 p
— f ri"p
STATE WELL CONSTRUCTION PERMIT% ASSOCIATED WQ/PERh11T#
iif applicable) (ifapplicable)
1. WELL USE (Check Applicable Box): Residential L/l Municipal/Public ❑ Industrial 0 Agricultural 0
Monitoring 0 Recovery ❑ Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION:
Nearest To\vn: Ns/r( Y./YD Ai J/ifilLounry friend! C'SOp)
/3ern -c"' Pace e'/» /
outerName, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER:
.Address 54
(Street or Route No.)
RP11d�5 OY11/l it e n/c
Cry or Town State
)- (t1-a$%3
Area code- Phone number
-i. DATE DRILLED 3/$/Oy
5. TOTAL DEPTH: /$'S r
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO !t�'
7. STATIC WATER LEVEL Below Top of Casing: so FT.
(Use "+" If Above Top of Casing)
S. TOP OF CASING 1S / FT. Above Land Surface"
'Top of casing terminated avor below land surface requires a
variance in accordance with 15A NCAC 2C .011N.
9. YIELD (gpm): METHOD OF TEST atin1 /L)
ID. WATER ZONES (depth):
28191
Zip Code
Topogra rc/Land setting
❑Ridge lope OValley ❑Flat
(check appropriate box)
Latitude/longitude of well location
.\ /1/3S°/7.al4" wfl2,a 3,Mt
e VYJ1 (degrees/min es`cconds)
Lau deilongitude source: GPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From To Formation Description
I/A
71— 7,4
76 -flT'
11. DISINFECTION: Type 'ba5Jtt5 Amount `pL
12. CASING. . Wall Thickness
Depth Diameter or Weiehl7Ft. Material
From 0 To 74' Ft. G. a.S d(G.113 PVC 54e_AI
From To Ft.
From To Ft.
13. GROUT: Depth Material Method
From 6 To "},Q Ft. Cnnrse#f Povrl1ny 14end erson vi. Ile nC
From To FL f
14. SCREEN: Depth Diameter Slot Size Material
From To Ft. in in.
From To Ft. in. in.
L. SAND/GRAVEL PACK:
Depth Size Material
Kock
6Atni r
From To Ft.
From To Ft.
LOCATION SKETCH C
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road "0-
numbers and common road names. O
r_
3enr lscni Place Lori # -I _.
I . REn1ARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15.A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
SIGNATXJRE OF PERSON CONSTRUCTING THE WELL
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Nlail Service Cell er, 2 Raleigh, NC
27699-1636 Phone No. [phone], within 30 days.
GW-1 REV. 07/2001
OCT 22
-IA fin
VIV-1"
Cnrn
111
0

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print)
p CERTIFICATION p OG 0 a a
WELL CONTRACTOR COMPANY NAME well hill ll/A/ CO
STATE WELL CONSTRUCTION PERMITS �l ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential 0 Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION: / Topogra is/Land setting
Nearest Town" Flfo1J feiAuhffC CountyH+Mtt`cA Al ❑Ridge aClope DValley ❑Flat
t o y& r Fort sit L it 9 (check appropriate box)
(Scree{ Nord, Numbers, Cmnmuniry, Subdivision, Lot No., Zip Code) Latitude/longitude of well location
Al3S'»a.fsif/Aue*x :3S: SA'
3. OWNER: SC11Iftley YI ShowccLSe HOBSlt/ (degrees/ muteyconds)
Address 5411 AShPM:I Lk Run. �J Latitude/longitude source: C7GPSQTopographic map
(Street or Route No.) 0 (check box)
\-(“exiel�onvl l it nc ass- Cj 1 DEPTH DRILLING LOG
City or Town Scale Zip Code From To Formation Description
6L2-1)- Leal-2 3 0 — - SO rt
so — SYS (rrQA.ric
Area code- Phone number
4. DATE DRILLED s/27/O
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO
7. STATIC WATER LEVEL Below Top of Casing: /AD FT.
(Use"+" if Above Top of Casing)
8. TOP OF CASING IS / FT. Above Land Surface"
`Top of casing terminated avor below land surface requires a
variance in accordance with 15A NCAC 2C .0118.
9. YIELD(gpm): / METHOD OFTEST$1Duhle77 s
.91
10. WATER ZONES (depth): 240
5. TOTAL DEPTH: 5 YS
11. DISINFECTION: Type wit
12. CASING:
Depth
From_,_ Toil— Ft.
From To Ft.
From To Ft.
13. GROUT: Depth
From_O__To Ft.
Amount__ (kQ2_
Wall Thickness
Diameter or Weight/Ft. Material
6,, XS ?Ala: p t Sz4j
Material
eAncrtit
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
P6 Pliny
Slot Size Material
in.
in.
Material
302858
PHONE iga71 683 — 9rr?
S r
-on
7o
LOCATION SKETCH GO or:,
Show direction and distance in miles from at least II
two State Roads or County Roads. Include the rid -4
-73
YQ
numbers and common road names. s
Totloy -Forest Lot
Need ersunvi 11 e
1 DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH I5A NCAC 2C, WELL
CONSTRUCTION STANDARDS-1AAND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNS
SIGN617 OF PERSON CONSTRUCTING THE WELL , 5/A`� D�
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
a 0 to 61 k) , Poll _5

302850
WELL CONSTRTJCTION RECORD
North Carolina - Depanment of Environment and Natural Resources
WELL CONTRACTOR (INDIVIDUAL) NAME (print)
WELL CONTRACTOR COMPANY NAME Fc t1SGA/ r
STATE WELL CONSTRUCTION PERMIT#
(if applicable) (if applicable)
- Division of Water Quality -
IS o b by U.), Peri 5
We!( beY/I/Ay Co
ASSOCIATED WQ PERMIT#
Groundwater Section
CERTIFICATION # IX O a a
PHONE aria, 6s 3 - ?ref
1. WELL USE (Check Applicable Box): Residential C3 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: hIi Topogra is/Land setting
Nearest Town- r(t1-cle County firJ eeSdr ❑Ridge 2Slope ❑Valley ❑Flat
S ti-6 frcra t"tct a _� (check appropriate box)
Illocation7 ,yY�i
)Street)StreetName, Numbers, Community,
ofw
g
, Subdivision, Lai No., Zip Code)
3. OWNER: t✓T€Yk1 5YIQWCc0.Se Haas n JM'Igo 2?] (degrees/minum3tcond$)
Address 5U1a /-ISkUPVi F i-itinA. Latitudeilongitudesource:L4GPS❑Topographicmap
U (check box)
(Sneer or Route No.) DEPTH DRILLING LOG
NQ)'I Cary r own) IC to Zip Code From To Formation Description
City or Town State Zip Code
5,224--Pg !- a883 Si0 — b y it k
Area rode- Phone number
4. DATE DRILLED s1R IrG// GY —aa 5 6yraw. c.
5. TOTAL DEPTH: 0S
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO
7. STATIC WATER LEVEL Below Top of Casing: 7-0 FT.
(Use `+" if Above Top of Casing)
S. TOP OF CASING IS / FT. Above Land Surface*
'Top of casing terminated atlor below land surface requires a
variance in accordance with 15A NCAC 2C .0118.
9. YIELD (gm): J5 METHOD OF TESTS/Out/ !.9
10. WATER ZONES (depth):
O�
O Grn
LOCATION SKETCH t =mom
11. DISINFECTION: Type 1-it Amount _._ `0L Show direction and distance in miles from ast -:G
b
Wall Thickness two State Roads or County Roads. Include (hell -Dad -O p
I?. CASING: numbers and common road names. rp 3 o
n Depth Diameter or Wzight/Ft. Material r icn
From_.__To kg Fr. `•iS 216rIJS TIL.SOLA( y riZ
From To Fe. po
From To Ft. Sd" l3 Acres TY0.Ct _-
13. GROUT: Depth Material Method
.0
From 0 To 7,0 Ft. &nnrrejt PO dnin9 'FI.+Chet', tic t?�: ... .c'r
From To Ft. /l
14. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in.
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
16. REMARKS:
1 DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH ISA NCAC 2C, WELL ...
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
SIGNAT RE OF PERSON CONSTRUCTING THE WELL D
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-1 REV ,(17/7,091

302855
WELL CONSTRUCTION RECORD Groundwater Section �-I �t
t L IAJ rd___ CERTIFICATION # PG .0.
North Carolina - Depanment of Environmem and Natural Resources�-Division of Water Qua - 5g 3 ����
NAME (print) PHONE S,..----
WELL CONTRACTOR COMPANY
(INDIVIDUAL) N I
15
_. ASSOCIATED WQ PERMIT#
WELL CONTRACTOR COMPANY NAME i I applicable)
STATE WELL CONSTRUCTION PERMITS
E3 M icipal/Public 0 Industrial 0 Agricultural 0
1.
Topogra /Land setting
❑Ridge lope ❑Valley ❑Flat
(check appropriate box)
Latitt�Cie/longitude 4f well location
Afa,5 1 7 nJ�9,g,A.G, !S
(degrees/mmu�s�//, ponds)
Latitude/longitude source: (eOOPS❑Topographic map
heck box)
DRILLS G
Formation Description
17 t/r i'
(ifapplicabW't
Residential un List Use
WELL USE (Check Applicable Box): Other 0 If Other,
Nloni[oring 0 Recovery 0 Heat Pump Water Injection 0
2. WELL LOCATION:
Nearest Town:
'I rJ
County t ��
Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER:
Address
(Street or Route No.)
State Zip Code
Ciry or Town
)r r - aln�
Area code- Phone number
4. DATE DRILLED
5. TOTAL DEPTH:_-—
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO
FT.
7. STATIC WATER LEVEL Below (Useo4-' if.bo e Top of Casing)
S. TOP OF CASING IS--
FT. Above Land Surface*
*Top of casing terminared actor below land surface requires a [ t
variance in accordance with I METHOD OFI8.
TESTRL I 4J
9. YIELD (gptnl: �-- i
10 WATER ZONES (depth):
(day__
DEPTH
From T o
w -+ .Z—
a
.0
LOCATION SKETCH
Show direction and disc from at last �0
1 I Amount two State Roads or County Roads. Include rhe�ad �Ot
i 1 DISINFECTION: Type4pr-- d names
12.
t
Twin 3voolcs Lot i# 14--�� -
Method VI �`e n�
Depth Material i _ I1 end US r
13. GROUT: �FI pan r �t �'QyjP1A�-- l V"
From_�_To Ft. �—
From To
14. SCREEN: Depth
From To
From To
15. SAND/GRAVELDepth
hACK-: Size
To Ft.__
To Ft.
DISI � Wall Thickness Material
, I numbers and common road
CASING:
acsam
From_Li_
From
Depth Diameter or^ rW; Weight/Ft. b a' OGT
To Ft.._(y...— ef�u-ab
To Ft.
To Ft.
From
From.
Fruit
Diameter Slot Size Material
Ft.
n. in.
F t.
n. In.
Material
16 REMARKS: WELL
l DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C,
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS CORD HAS BEEN PROVIDED TO THE WELL OWNER
SIGNAT RE OF PERSON CONSTRUCTING THE WELL
Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
S
27 99-1 the hone original . ([ 9)e 733-3221 o i Water Q days.y,
GW-1 REV.07/2001
?7699-1636 Phone No. 1919)733-3=-I.

302854
WELL CONSTRUCTION RECORD
_ ualiry - Groundwater Section
CERTIFICATION ��g� a �Y ?
North Carolina - Department of Environment and Natural Resources - Division of Water Q
W ELL CONTRACTOR (INDIVIDUAL) NAME (print) r , AT D PHONE
as
ASSOCIATED WQ pEliNllTit
WELL CONTRACTOR COMPANY NAM1IE
(if applicable)
RUCTION PERrv1]Tit
5
(1 -
Nlumctpz
List Use
\Voter Injection 0 Other 0 If Other,
WELL USE (Check Applicable Box): Residential Heat Pump
Monitoring ❑ Recovery ❑
STATE WELL CONSTRUCTION
i�
[n
A riculrur¢l 0
i. Topograta DI -applicable) 0 g
l/public ❑
c/Land setting Flat
❑Ridge lope ❑Valley
(check appropriate box)
Latitude/longitude of well location
Submit the original to the Division of Water Quality, Groundwater Section,
2'1699-1636 Phone No. [phone], within 30 days.
2. WELL LOCATION: d h County r
Nearest Town:
Community, Subdivision, Lot No., Zip Code)
(Seem Nome, Numbers.
[
3. OWNER:
Address
pp //qqCi�, -TOM S®tz
Area code- Phone numbery /i3 D y
4. DATE DRILLED
5. TOTAL DEPTFl:ES 0 NO .
(i. DOES WELL REPLACE EXISTING WELL?of Casing. ES ❑ NO
7. STATIC WATER LEVEL Below (U e +" it Above Top of Casing)
S. TOP OF CASING nS _�-- FT Above Land Surface'
*Top of casing terminated actor beluh+land surface requires n
variance in accordance with
OFTb.
EST
9. YIELD (pin):
tVauji1_,Ath
W 3 t/S / 3-S G48
(degreeslmin to tends')
Latitude/longitude source: GPS❑Topographic map
(check box)
DRILL
DEPTH Formation Description
From To
10. WATER ZONES (depth).
•�, IT y"4.__ Amount M9 01
11. DISINFECTION: Type Wall Thickness
12. CASING: Depth, �f Diametet orarG !iiehat•PVMaterial '
�_ To1.Q_ Ft...k..S--
From FL,
From T°
To Ft. Method
13.
Prom Material
Pyrvu
GROUT: Depth
ro a th Ft. Cow
From To-
14. SCREEN: Depth
From To_
From TO
15. SAND'GRAVELPACK:
Depth
From To
To_
From
16. REMARKS:
� WELL
I D0 HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15 20
A NCAC , /
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
Ft
Diaineter Slot Size Material
n.
Ft.in.in.
F[.in.
Size Material
Ft.
Ft
LOC Show dire distance in miles O from at le:ict
two State Roads or County Roads. Include the ad
numbers and common road names.
�0tv1 Creek
°w t Y)C
SIGN AT'RE OF PERSON CONSTRUCTING TFIE WELL
1636 Mail Service Centegh, NC
G W- - REV . 07 2001
rr
DA

302835
WELL CONSTRUCTION RECOFW
?Vann C1rotn]-_ - Department, of Environment antl rul Resources - Division of Water Quuliry - Groundwater Section
%r 14011 LLL CO nTI.ACTO12 iIN UIv9DU.aL) N.anil f(pup() �� . Li i rf 5 //'' CERTIFICATION f�l�7pv/
Uts0/✓.S /tk// DP/ /�//1JQ Ld . PHONE iTa aSL��YZ heat,
ASSOCIATED WQ PPYIiAarlN
(itaupficable)
\t E LL CO NI' R- C I-O R CO AI ANY N.A'I E
SPACE WELL CON]TRUCTION PERMIT#
I. WELL USE (.Chccrc Applicable Box): Residential Ll NlunioipoUPublie ❑ Industrial ❑ Agricultural 0
l io n4Wruh 0 Reoovery 0 Heat Purnp Water Injection 0 Omer 0 If Other, List Use
2. WELL LOCATION: N,iesr Town: 6 . ....IX County 180.64
-0. fie"
/Ca y(4+ (ruse /7., end) Ctat
,s acai N.imc, NunIocrs, Commmairy, Subaivuion, Lai NO., Zip Co.1c)
'3.OWNER. t4 r>
Aadress 'Po x 1712-
w n er ncc Na
Fl of chel
La) .rTSwn Stet
$CBI 1044 B774/
aV1as
vac- Phone nu meet
4. DATE DRILLED � IJ- Q N
TOTAL DEPTH: 36 a
Zip Code
Topographic/Land swing
❑Ridge 2"Slope OVaticy ❑Fla(
(check appropnata box)
Latlmdc/IOI]glnlde of well location
,Gar° /y.4j3'vono 77. 3ia'
(oeoacmninwesncconds)
Lliwde)longitude source: O'&PSOTopographic map
(.heel: bob)
DRILLING LOCI
Formation Description
2'•. r
7Z - 77 rcotsA.nc
77- 36S b•m• rfc
DEPTH
From To
0 - 72
O. DOES WELL REPLACE EXISTING WELL') YES NO CI
7. STATIC WATER LEVEL Below Top of Casing: FT.
(Use "."'i r Above Top of Chm )g)
3. TOP OF CASING IS 1 FT. Above Land Surface*
"'Pap or cam; corm ins ma sour bcluw land sutrace requires a
cariancc nt aceorganec with 13A NCAC 2C.011 n.
9. YIELD tspnlY IZ METIf OD OF TEST 3,6 4j 'Ki
in. WATER ZONES ldepm): / /D - 6",a,.,
9
J
3 20' - 75i,,,, s
Il. DISINFECT1ON:TypeC/Oprive., Amount 77 As,
12. CASING: Wall Tluclmcss
D<pth Diameter or Wciehr/Ft. Marorlal
From 0 To 77 Fr.`JIC S eli ,ode
Hon to F.
Fmm To Fr.
i3. GROUT: Depth Mantel Method
Front 0 To ..0 Fr CpNcee /.--. t
From To Fr.
I;. SCREEN: Depth Diameter Slot Size iylareriai
From TZ' Fr in, in.
From To Ft. in. in.
15. SAND/GRAVEL PACK
pooch Six; Material
From To F't.
From To Fr-
lo. REMARKS:
n
n,
-OrT1
d [s,
f1cre
--;22
cat"
LOCATION SKETCH tf)
rrl
Show direction and distance in miles from at leastn n
two State Roads or County Roads. Include the road
numbers and common road names.
Gtab Creek - Raveh Creek
E-1-atookil
1 DO HEREBY CERTIFY TH.ATTHIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 1SA NCAC 2C, WELL CONSTRUCTION STANDARDS, .AID THAT .A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
'fJ4P, ✓,� �/"".� 1— l3-OW
SIGNATURE OF PERSON CONSTRUCTINGTHE WELL DATE
Su➢nlic rn; original to me Division of Water Quality, Groundwater Seerion, 1636 Mali Service Cenrer - Raleigh, NC
?699-103r Paonc rso. [phone], wirtlin 30 days.
cw-I REV. oP/poor

WELL CONSTRUCTION RECORD 3 0 2 8 2 0
North Carolina - Depanment of Environment and Naturalr�Resources Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) a 0 bby N/ . Pa 1/.% CERTIFICATION # IX o Ot a
WELL CONTRACTOR COMPANY NAME Fr DOS 0a r Welt N'lt/I/A/ Co. PHONE Oat 6W 3 — 99Y9
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential Er-Municipal/Public ❑ Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2,
WELL LOCATIONi
Nearest Town: M//, Cr County HTAel[ASON
Mill R%dr i�t #R
Comma k Subdivision Lot No Zi
(Street Name, Numbers kg, p Code)
3. OWNER:
Address
Topograp�hic/Land setting
❑Ridge C�Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
,�/3S'at/,Y/0' h/d8t/3Y.ZSr'
and Imes LLt Or" i-/oJ/x,.chJ g )
{ de rees/ inure econds
Latitude/longitude source: GPS❑Topographic map
Steer or Route No.) (check box)
nvsvll e YIC- �A78(c DRILLING LOG
iry or Town State Zip Code
-Qi3-93sq
Area code- Phone number
4. DATE DRILLED 7//,Q�/
5. TOTAL DEPTH: 363 /
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO E
7. STATIC WATER LEVEL Below Top of Casing: 41V FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS / FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordance with ISA .NCAC 2C .0118.
9. YIELD (gpm): / C METHOD OF TEST//Veuk7, fr
10. WATER ZONES (depth): TO
11. DISINFECTION: Type' a/t:y-5 Amount
12. CASING: Wall Thickness
Depth Diameter or Weieht/Ft. Material
From 0 To 6D Ft bekJ ;AEOS /Pt
From To Ft.
From To Ft.
13. GROUT: Depth Material ��I Method
From To) / Ft. to CAI it 4dil/r11
From To Ft.
14. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in.
From To Ft. in. in.
I5. SAND/GRAVEL PACK:
Depot Size Material
From To Ft,
From To Ft.
16. REMARKS:
DEPTH
From To
0
SS
s
GO -36c
Formation Dgscription
A
O
-4
LOCATION SKETCH
Show direction and distance in miles from at st
two State Roads or County Roads. Include head
numbers and common road names.
Mill R.idce — Lot 1*B
P1i 115 lZi ve,Y, 11C ---
en
rn
-t
eJi
O
i�
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH ISA NCAC 2C, WELL ,_ t .--_,
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER i IL a�^'
SIGNAT RE OF PERSON CONSTRUCTING THE WELL ATE- - -
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center.Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-1 REV. 07/2001
�i SFCI I' 114

WELL CONSTRUCTION RECORD
North Carolina - Depanment of Environment and Natural Resources - Division of Water .Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) c RO b5 y Gil , P I/ . CERTIFICATION # 20 a a
,
WELL CONTRACTOR COMPANY NAME 1 c auson/r i� W e /l ^lt�, / et, C0 , PHONE exY 6W 3 - f?PI
STATE WELL CONSTRUCTION PERMIT/0ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
302819
1. WELL USE (Check Applicable Box): Residential E Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION:
Nearest Town' "A Vi tie County Jtnjtae✓
. Lookout kt pr 4�`" °`7
(Street Name, Numbers, Community, Subd ision, Lot No., Zip Code)
3. OWNER: r Oter6S+ J-cm,e i3ui (d eys
Address 17 RBC1 Y(xi I Dr 1 vP
(S r or Rte No.)
Hence r.5r i vl ticen�o
_City or Town State
24"13-01-7
Area code- Phone number
4. DATE DRILLED b/&y4c/
5. TOTAL DEPTH: &OS
0%1Q,"Z
Zip Code
Latitude/longitude source:
DEPTH
From To
0 — aS
OS
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)
3. TOP OF CASING 1S / FT. Above Land Surface*
*Top of casing terminated ar/or below land surface requires a
variance in accordance with 15A NCAC 2C .0118. p i
9. YIELD (gpm): f METH3/D OF TEST)T/thtiftny74g
10. WATER ZONES (depth):3b9 1'
11. DISINFECTION: Type
12. CASING:
Depth
From__ To 36
From To
From To
topographic/Land setting
Ridge ❑Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
• nt -..ee ..ne•
(degrees/minures(s Qeeonds)
PS❑Topographic map
(check box)
DRILLING LOG
Formation Description
0 `rt
fleck
6-ran.l tG
• S87'
n
LOCATION SKETCH
Amount _ /kjZ Show direction and distance in miles from at leg
Wall Thickness two State Roads or County Roads. Include the rS1
Diameter or Weight/Ft. Material numbers and common road names.
Ft. `.),S 2/6,Ix= putsn/4I
Ft.
Ft.
13. GROUT: Depth Material Method
From_O__To ?vU Ft. toncrtjt tP'OJridp
From To Ft. l
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.
WVkv' Zed -Lc1
C2)
m
c.l
16. REMARKS: o
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL,
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
SIGNATYIRE OF PERSON CONSTRUCTING THE WELL
ATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center- Raleigh, NC
GW-1 REV.07/2001
27699-1636 Phone No. [phone], within 30 days.
•
en
tnen
r"
on
;La'
ir0

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water .Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (prin0 80 bby W/r PC� I (i CERTIFICATION # ROa a
WELL CONTRACTOR COMPANY NAME FL rbtISGN r We / ( lirfrl (/A), Cr, , PHONE ant 6%3 - frig?
STATE WELL CONSTRUCTION PERMITn �l ASSOCIATED WQ PERMIT#
applicable) (if applicable)
302816
1. WELL USE (Check Applicable Box): Residential ci Municipal/Public ❑ Industrial 0 Agricultural ❑
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other 0 If Other, List Use
2. WELL LOCATION:
Nearest Town: Sky ("tot County NYA/testA✓
Bq4 c 461';s1 Church
(Sneer Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: Eat+ Cave pcp-hst Cher-ch
Address [xn( r li- 147 -
(Sneer or Route No.)
tat CA,vhe nc
City or Town State
c)-(0%5 - 0-1 as
2Ri ID
Zip Code
Area code- Phone number
4. DATE DRILLED wiKo y
5. TOTAL DEPTH:
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO ere
7. STATIC WATER LEVEL Below Top of Casing: 30 FT.
(Use "+" if Above Top of Casing)
S. TOP OF CASING IS / FT. Above Land Surface*
*Top of casing terminated atior below land surface requires a
variance in accordance with 15d NCAC 2C .0118.
9. YIELD (gpni): / S METHOD OFTEST$hfhalttnp,l4:9
10. WATER ZONES (depth): 3/5
t
�Opographic/Land setting
tdge 0Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of w II location
NS3'a.7.Ov7/s# o It.40-7"
(degrees/minute � coeds)
Latitude/longitude source: IdGPSOTopographic map
(check box)
DEPTH DRILLING LOG
From To Formation Description
o -- s3 /WA t'
53 — (3//tera(C
3 $ — YOS 6-raM i! r
11 DISINFECTION: Type
1,4,13
Amount_ //�-
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
From_j_ To St Ft. (y, i.S afirt s p�st2SAf
From To Ft.
From To Ft.
13. GROUT: Depth Material
From Q To �V Ft. Um(rt%<
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
Po or/n4
Slot Size Material
in.
in.
Material
}>
o �.4
▪ 7:▪ 1O
or-1
LOCATION SKETCH r„cYt
Show direction and distance in miles from at let
two State Roads or County Roads. Include the refl
numbers and common road names. - s�
►}may. (p4
Bat Caw e, i'tc
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
SIGNAT
OF PERSON CONSTRUCTING THE WELL
Submit the original to the Division of Water Quality, Groundwater Section,
27699-1636 Phone No. [phone], within 30 days.
1636 Mail Service Center- Raleigh, NC
GW-I REV. 07/2001

302815
WELL CONSTRIJCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section ao a
CERTIFICATION #
WELL CONTRACTOR (INDIVIDUAL) NAME (print) Qo bby it)
Poll 5
WELL CONTRACTOR COMPANY NAME Fe ✓ o,ioiV I- Gvel( A/t/t Inv CO PHONE (Dill 65c3 - rf Y
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
1.
WELL USE (Check Applicable Box): Residential Id Municipal/Public 0 Industrial 0 Agricultural ❑
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If'Other, List Use
WELL LOCATION: /
Nearest Town: County /-1/417/0304/
Rann/t.Jel( 4cr.c5
(Street Name, Numbers, Community, Subdivision. Lot No., Zip Code)
3. OWNER: I} LEAMy tt%e l J
Address inn Veit liQI1 HC2E5 Dlz.
(S/r t or Route No.)
He.wie .50Ylvl,fe nc a87??
Ciry or Town State Zip Code
(€22)-(0$i — 37 4
Area code- Phone number /
4. DATE DRILLED e y
5. TOTAL DEPTH: 777/ S
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO l<
7. STATIC WATER LEVEL Below Top of Casing:. y(% FT.
(Use "+" it Above Top of Casing)
3. TOP OF CASING IS / FT. Above Land Surface'"
*Top of casing terminated at/or below land surface requires a
variance in accorda ce with 15A NCAC 2C .0118.
9. YIELD (gpm): METHOD OF TEST$t/h.Ltny//J
10. WATER ZONES (depth): (SD
11. DISINFECTION: Type /Adlt tj
12. CASING:
Depth Diameter
From____,_ To 3Y Ft. (y. LS
From To Ft.
From To Ft.
13. GROUT: Depth
From Q To ) C Ft
Amount Sot
Wall Thickness
or Weight/Ft. Material
)16,1)$ py .-snaa
Material
tom' fit it
From To Ft.
14. SCREEN: Depth Diameter
From To Ft. in.
From To Ft. in.
15. SAND/GRAVEL PACK:
Depth
From To
From To
l6. REMARKS:
Size
Ft.
Ft.
Method
P60P/Ay
Slot Size Material
in.
in.
Material
Topographic/Lannd�d setting
❑Ridge ❑Slope OValley ❑Flat
(check appropriate box)
Latitude/longitude of we I location
N`39 I) idoga° 2Z,'/3y
(degrees/mmut �/' conds)
Latitude/longitude source: CTGPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From To Formation Description
2.9 trt
at9 - 3 Y /torrk
3 v — ids wre,,,tte.
O
LOCATION SKETCH 0n21`
Show direction and distance in miles fronC least ;a
two State Roads or County Roads. Include jhe road")`a
numbers and common road names. f. 4fl
nC2
s �':4
lb0 13 CAN h Lk) 211 Act7-.F.� D4;;t
4tndar6CMI I 1 I , fC
l DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED M ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
SIGNATZ)RE OF�`SON CONSTRUCTING G THE WELL
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
27699-1636 Phone No. [phone], within 30 days.
GW-I REV.07/2001
OCT 2 2

WELL CONSTRUCTION RECORD
302814
North Carolina - Department of Environment and Natural Resources - Divisionvof Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) a L36y ✓c t
WELL CONTRACTOR COMPANYl/ NAME re oso„, r l/w e It brit ///A/ CO * PHONE that 6131 - 9rK9
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable)
(if applicable)
Potts CERTIFICATION # O20 a 3
1. WELL USE (Check Applicable Box): Residential Er--Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection ❑ Other 0 1f Other, List Use
2. WELL LOCATION: /
Nearest Town: E'h0wa h County htAd-O ,9 k/
- tht /titMMM, OP- ac-tcr MN,
(Street Name, Numbers, Community, Subdivision. Lot No., Zip Code)
3. OWNER: {1t js-`Cif-11
Address 10 x I
Fr(e ° eeNo.) kt
�I .lCiry or Town State Zip Code
tq)- q'7G- ny57
Area code- Phone number
4. DATE DRILLED Of /p r/
5. TOTAL DEPTH: D 5
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO
7. STATIC WATER LEVEL Below Top of Casing: '(0 FT.
(Use "+" if Above Top of Casing)
S. TOP OF CASING IS / FT. Above Land Surface*
*Top of casing terminated avor below land surface requires a
variance in accordance with I5A NCAC 2C .0118.
9. YIELD (gpm): a METHOD OF TEST.06blaa)ttiiy tfJj1
10. WATER ZONES (depth): QO 1 �/
11. DISINFECTION: Type f-ap/i is
12. CASING:
Depth et Diameter
From Q To SS Ft. 6,, AS
From To Ft.
From To Ft.
13. GROUT: Depth
From Q To 7‘,0 Ft.
From To Ft.
14. SCREEN: Depth
From To
Amount _ / 02.
Wall Thickness
or Weight/Ft. Material
a!6a01.3 put saL'
Material
COnrriit
Diameter
Ft. in.
From To Ft. in.
15. SAND/GRAVEL PACK:
Depth Size Material
Topograpkrrc/Land setting
❑Ridge L1'lope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
N3S' iq,e1Y67AMU' 3 S,7ga'
(degrees/mi utes�/ onds)
Latitude/Iongiwde source: L7GPS❑Topographic map
(cheek box)
DEPTH DRILLING LOG `--
From To Formation Description
S3 a�t
St, - SB Pr
scs — 6oS (rna�lyc
O
n
N
ti
r' _- .
to
LOCATION SKETCH 0 Ill--
Show direction and distance in miles from.aslleast _nrry
two State Roads or County Roads. Include the road
numbers and common road names. ocoo
0 2
GO
`�,, inn
The ale Khotisof
Paop/n4 P`A� t 'yrc
Slot Size Material
in.
in.
From To Ft.
From To Fr.
16. REMARKS:
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
— 4/ RA Pr
SIGNAT RE OF PERSON CONSTRUCTING THE WELL
/, y
E
YD TE
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
J' u
u

C 4255
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (pr®t) KENNETH MCCRARY CERTIFICATION 2008
WELL CONTRACTOR COMPANY NAME BARKER CONSTRUCTION, INC./BARKER WELL & PUMP PHONE, # [phone]
STATE WELL CONSTRUCTION PERMIT# 1871 ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential ID Municipal/Public ❑ Industrial ❑ Agricultural ❑
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use
2. WELL LOCATION:
Nearest Town: HENDERSONVILLE County HENDERSON
BEAR ROCK ROAD
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: FRADY FARMS - JAMES FRADY
Address 691 CRAB CREEK ROAD
(Street or Route No.)
HENDERSONVILLE NC 28739
City or Town State Zip Code
( 828 r 674-6111
Area code- Phone number
4. DATE DRILLED OCTOBER 8, 2004
5. TOTAL DEPTH: 405'
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO RI
7. STATIC WATER LEVEL Below Top of Casing: 20 FT.
(Use" " if Above Top of Casing)
8. TOP OF CASING IS 1.33 FT. Above Land Surface'
flop of easing terminated at/or below land surface requires a
variance In accordance with I5A NCAC 2C .0118.
9. YIELD (gpm): 25 METHOD OF TEST TIMED
10. WATER ZONES (depth):
Topographic/Land setting
❑Ridge ['Slope ❑Valley ®Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/mimltes/seconds)
Latitude/longitude sourrce:❑GPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From To Formation Description
11. DISINFECTION: Type BY PUMP INSTALLER Amount
12. CASING:
Depth
From 0 To 208
From To
From To Ft.
13. GROUT: Depth
From 0 To 20
Wall Thickness
Diameter or Weight/Ft. Material
Ft. 6 Y. 185 STEEL
Ft
Material
Ft. CONCRETE
From To Ft.
14. SCREEN: Depth Diameter
From To Ft in.
From To Ft in.
15. SAND/GRAVEL PACK:
Depth Size Material
From. To Ft.
From To FL
0
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common road names.
LAWLJAItyladRatied
4ct_t 'oad &a6
itdph;c�C:QGcea7� a, `60�at
Slot Size Material ial u.t IPA,
in, tea 4E.t-S.-eac-I'cat
Oad - tJ s [mac Azk /o Tit
in
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
) 61-1114t.t. five X o — Q_ in v
SIGNATURE OF PERSON CONSTRU G THE WELL DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center- Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-1 REV. 07/2001

zoo's
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) KENNETH MCCRARY 2008
CERTIFICATION fi
WELL CONTRACTOR COMPANY NAME BARKER CONSTRUCTION, INC./BARKER WELL & PUMP PROM, # [phone]
STATE WELL CONSTRUCTION PERMIT/ 1871 ASSOCIATED WO PERMITl
(if applicable) (if applicable)
I. WELL USE (Check Applicable Box): Residential El MtmicipaVPublic ❑ Industrial ❑ Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION:
Nearest Town: HENDERSONVILLE County HENDERSON
PEACEFUL VIEW ESTATES, LOT#14
(Street Name, Numbers, Community, Subdivisiuo, Lot No., Tip Code)
3. OWNER: JEFFREY HARVEY
Address 263 LAMB MOUNTAIN ROAD
(Street or Route No.)
HENDERSONVILLE NC 28792
City or Town Sate Tip Code
( 828 )- 685-2291
Area code- Phone number
4. DATE DRILLED OCTOBER 13, 2004
5. TOTAL DEPTH: 305
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO lia
7. STATIC WATER LEVEL Below Top of Casing: 3D FT.
(Use "+^ if Above Top of Casing)
8. TOP OF CASING IS 1.33 FT. Above Land Surface'
'Top of casing terminated at/or below land surface requires a
variance In accordance with 15A NCAC 2C AtIR
9. YIELD (gpm): 7X METHOD OF TEST TIMED
10. WATER ZONES (depth):
Topographic/Land setting
❑Ridge ®Slope ❑valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/mimnes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From To Formation Description
LOCATION SKETCH
11. DISINFECTION: Type BY PUMP INSTALLER Amotmt Show direction and distance in miles from at least
12. CASING: Wall Thickness two State Roads or County Roads. Include the road
Depth Diameter or Weight/Ft. Material numbers and common road names
From 0 To 57 Ft. 61/8 SDR21
From To Ft
From To Ft
13. GROUT: Depth Material
From 0 To 20 FL CONCRETE
From To Ft.
14. SCREEN: Depth Diameter Slot Size
From To Ft in. in.
From To Ft in. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
cs
PVC LAVA eimaxailte /tide_ &vat,
(Apace • JzoV ton eice .I'OQd
Method wQ,r�Z, c- Z��ay ' aL v ..e/Zt
POURED t4 . c27Z,lLiZed%L t 1ta.te_
/treMaterial
y..-eatcut 9J c age a
. / /icat et. Qicat Ze Q Dxzzo
Gee , f-/4 Ae dad .atGk
ASS,me.51449-ctistaal 4/11--
16. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WFJ I
CONSTRUCTION STANDARDS,
�AND THAT AA�COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
i���DA
"' _ " _ Id— ,r. Off
SIGNATURE OF PERSO CONSTRUCTING THE WELL DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-1 REV. 07/2001
cPY tL)
c%

304229
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and wnual Resource, - Diiv ision of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (prlao)-_ jan, LI I t`) A S N
WELL CONTRACTOR COMPANY NAME _REUBEN CALDWELL DRILLING, INC. CERTIFICATION a
PHONCYffI%2(8 ? )2S4-358131
STATE WELL CONSTRUCTION PERMIT/
(if applicable) ASSOCIATED WQ PERMIT/
(if applicable)
1. WELL USE (Check Applicable Box): Residential DI/Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery ❑ Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION:
Nearest Town: KC I3JILL6County
(Street Name, Numbers,, Community, Subdsnsion, Lot No, Zip Codc)
3. OWNER: \`Cj,IC Stiu4 L
Add a&/ ugJ
ASNGJtw "NC) a£(iO3
City or Town Swe Zip Code
(o&%. '59A- 433D
Ares coda- Phone Dumber
4. DATE DRILLED 0 /ag/0 4-
I11/4 N PkieSC 1.)
5. TOTAL DEPTH: 4-30 " /
6. DOES WELL REPLACE EXISTING WELL? YES O NO 13
7. STATIC WATER LEVEL Below Top of Casing: b 0 ET.
A (Ust -a'it Above Top of Carina)
8. TOP OF CASING IS FT. Above Land Surface•
•Top of cning termlaated st/or below lard iodate repulses a
radium Is neardamp with ISA NCAC 1C.011I.
9. YIELD (gpm): b METHOD 9F TEST P-t4- 4 i (L'
10. WATER ZONES (depth): a b o 6 GP r..•
11. DISINFECTION: Type lv l rt C(n o Amount
12. CASING: Wall Thickness
A Depth Di r or W t UFt.
From To t OO Ft. (',, 5tK1
From To Ft.
From To Ft.
13. GROUT: Depth-1 ,�e Material Method
From a To Fi. Mb"lJT eo vl (te 0
From To Ft.
14. SCREEN: Depth Diameter Slot Sire Material
From To Ft. in. in.
From To Ft.
15. SAND/GRAVEL PACK:
Depth
From To
From To
16. REMARKS:
in. in.
Sire
Ft.
Ft.
Topographic/Land setting� �j
❑Ridge OSlope ❑Valley @Flat
(check appeopriete box)
Latitude/longitude of well location
(depmahaimetes/secmds)
Latitude/longitude source:OGPSOTopognphic map
(check box)
DRILLING LOQ
Formation Description,
6J le 2 �rz e rJ
2A r t'Tl4
c(Ltdt c.6 lk Gen
C-, ant.) -re
DEPTH
Frore 7'c 5
ci5/ — a-bD
at
- 4'
g
LOCATION SKETCH nit'.
Show direction and distance in miles from adeast t a=°
two State Roads or County Roads. Include tbgroad 9."-'?
numbers and common road names. '" cict-
1 ,5,w
TA,
LA/Lucie,
Ao
,i$en
iL G,) flee ex.
1 DO HEREBY CERTIFY T1iAT THIS WELL WAS CONS ERUCTED IN ACCORDANCE WITH ISA NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT 44OP OF TIIIS RFORD HAS BEEN PROVIDED TO TI1BjWELL OWNER
n It r
SIGNATURE OF PERSON CONSTRUCTING THE WELL
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mall Service Center- Raleigh, NC 27699-1636 Phone No. [phone], within 30 days.
GW-I REV. 07/2001

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) KENNETH MCCRARY CERTIFICATION# 2006
PHONE # [phone]
WELL CONTRACTOR COMPANY NAME BARKER CONSTRUCTION, INC./BARKER WELL 8 PUMP
STATE WELL CONSTRUCTION PERMIT# 1871 ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential VI Municipal/Public 0 Industrial ❑ Agricultural ❑
Monitoring 0 Recovery ❑ Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION:
Nearest Town: HENDERSONVILLE
BELMONT HEIGHTS, LOT #16
(Street Name, Numbers, Community, Subdivision, lot No., Zip Code)
3. OWNER: JOHN & CAROL ROSNER
Address 6422 WHITE OAK LANE
(Street or Route No.)
BROAD RUN VA 20137
City or Town State Zip Code
( 540 )_ 341-3640
Area code- Phone number
4. DATE DRILLED JANUARY 2, 2004
5. TOTAL DEPTH: 755
6. DOES WELL REPLACE EXISTING WELLS YES O NO El
7. STATIC WATER LEVEL Below Top of Casing: 200 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS 1.33 FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordance with 15A NCAC 2C .0118.
9. YIELD (gpm): 4 METHOD OF TEST TIMED
10. WATER ZONES (depth):
County HENDERSON
11. DISINFECTION: Type BY PUMP INSTALLER
12. CASING:
Depth
From 0 To 95
From To
From To
13. GROUT: Depth
From 0 To 20
Amount
Wall Thickness
Diameter or Weight/Ft. Material
Ft. 61/8 SDR21 PVC
Ft.
Ft.
Material
Ft. CONCRETE
From To Ft.
14. SCREEN. Depth Diameter Slot Size
From To Ft. in. in.
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Size
From To Ft.
From To Ft.
Method
POURED
284494
Topographic/Land setting
®Ridge ❑Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:OGPSOTopographic map
(check box)
DEPTH DRILLING.±OG
From To Formation Description
Material
Material
16. REMARKS:
L)2
cr1
IV
m�
LOCATION SKETCH 9
Show direction and distance in miles frorq' t lea
two State Roads or County Roads. Includrhe rc!1
numbers and common road names.
June d.e L z tab aS.
AL& Q Jt ,B, ern. aLaide dog.
r 7.
tra ca azc ai.d.-day and
thS ea- .cat mod- GzkS . to stile,[ Q U )c j c it .� OeJ-a 2-4a-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 DA C /
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

293164
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) DQOC:cK 'rktC lx .SO.A%e DS CERTIFICATION# 2436
WELL CONTRACTOR COMPANY NAME C.A S*iuoce a Son 4ex C PHONE # (Tag (0(a5 -rRo22
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
I. WELL USE (Check Applicable Box): Residential 29 Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery ❑ Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION:
Nearest Town: 1-Ie ndtc'sce i:1\e County i'(endtt-eso•.
WRaM\. 4d 2Av92
(Street Name. Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: F.vtda>f CLhoae,S
Address t233 ( \%C.am. be'"‘ rya
(Street or Route No.)
"aVlc11.
City or Town State
(19aa)- (As-
Zip Code
Area code- Phone number
4. DATE DRILLED 1' \ U4
5. TOTAL DEPTH: aoS
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO 14
7. STATIC WATER LEVELBelowTop of Casing: l(ov FT.
(Use ••+•• if Above Top of Casing)
8. TOP OF CASING IS 1 FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordance with ISA NCAC 2C .011 S.
9. YIELD (gpm): 5 METHOD OF TEST R; 4
10. WATER ZONES (depth):
1l. DISINFECTION: Type CAS Amount
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material numbers and common road names.
From Y\ To 13% Ft. (Ai +tzt p1a5't'L
From To Ft.
From To Ft.
13. GROUT: Depth Material Method
From 0 To $0 Ft. Ca n.i)4. Pot.re.a
From To Ft.
14. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in.
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Dcpth Size Material
From To Ft.
From To Ft.
16. REMARKS:
Topographic/Land setting
❑Ridge B3Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DRILLING LOG
To Formation Description
DEPTH
From
}v "lc 1St
eves- C3¢cdon
I3i *Tel 305 (con:to
p
Ocp
-
- I -I
LOCATION SKETCH corri
cm
Show direction and distance in miles from aHeast two State Roads or County Roads. Include tiiQroato
a —I�
S xo
O CA=
-. rri
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 PERSOONSTRUCTING THE WELL
\-1•
DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center -Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-1 REV. 07/2001

W) CLL CONSTRUCTION RE CORD
North Carolina - Department of Envirt nment and Natural Resources - Division rf Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NA 9E (print) DeeAa-A -4]a."jQra
WELL CONTRACTOR COMPANY NAME C--.• StLsJ *aer74 1a (au"?
STATE WELL CONSTRUCTION PERMIT: ASSOCIATED WQ PERMIT# _
(if applicable) • (ifa 1cable)
1. WELL USE (Check Applicable Bo t): Residential Hi Municipal/Public 0 Industrial 0 Agricul' ural 0
Monitoring 0 Recovery 0 Hen : Pump Water Injection 0 Other 0 If Other, List Use
293162
CERTI TICATION # •aa' 3to
PHONE r (?€' Coda S- 2.0z=-
2. WELL LOCATION:
Nearest Town: Ile ruts v, anv:ite County he'cdgc53-t
Nainer Let
(Streett Name, i'umbcrs, Commr unity. Subdi ision. Lot No., Zip Code)
3. OWNER: S
Address MGS
'He.x Mrsc-r,`t
City or Town
( T-s Wit:)- At- i'
:a Lrti.7
Jio.fo» Pond
(Street or Route No.)
+te - nc
State
- kti
Area code- Phone number
4. DATE DRILLED t' 1 -O
5.-TOTAL DEPTH: 3t.=s
6. DOES WELL REPLACE EXISTII'
7. STATIC WATER LEVEL Below 1
(Ur
8. TOP OF CASING IS
*Top of casing terminated at/or below tat
variance in accordance with I5A NCAC
9. YIELD (gpm): 3 METH(
10. WATER ZONES (depth):
Zip Code
G WELL? YES 0 NO 171
op of Casine: .VP° FT.
: `+' if Above Top of Casing)
Above Land Surface*
d surface requires a
.0 .0113.
D OF TEST
,ct
owns
Topographc/Land setting
[Midge CVSIope ❑Va ley ❑Flat
(check appropriate b >x)
Latitude/longitude of wt 11 location
(degrees/minutes/sec( ids)
Latitude, longitude source:❑GPS7Topographic n np
(check I-ox)
DEPTH E R!LLING LCG
From To Fortlation Descriptic -
t 13=t
11. DISINFECTION: Type r It rs
12. CASING:
Amount :)
Depth Dian eter
From -;-1 To i —1 Ft. `. 'q
From To Ft.
From To Ft.
13. GROUT: Depth
From C To :24-- Ft.
From To Ft.
14. SCREEN: Depth Diame IT Slot Size Material
From To Ft. in. in.
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Siz : Material
From To Ft.
From To Ft.
LOCATION SKETCH
Show di -ection and distance in m-les from at least
Wall Thickness two Stat Roads or Courty Road:--. Include the roa I
or WcighUFt. Material number: and common read name;.
,,,-mot
M aerial
CA:Lyn tor
Method
as
O
tvaeW
S
O
0
O
0
a�
em
ern
E5-c
HO
rn
cn
nii x,
--1
c
z
16. REMARKS: -
I DO HEREBY CERTIFY THAT THIS WE L WAS CONSTRUCTED IN ACCORDAN 1WITH 15A NCAC 2C, VELLI i
CONSTRUCTION STANDARDS, AND TF AT A COPY OF TEIS RECORD HAS BEET l PROVIDED TO THE WI LL OWNS .
Dst,rt zx W r cy -(
DATE I "�-1
SIGNAT'.IRE OF PERS CONSTRUCTING THE V'ELL i o
i
Submit the original to the Division of Water Quality, Groundwater Section,163G Mail Service Center- Raieigr, PKI
27699-1636 Phone No. [phone], wit hin 30 days. GW-1 REV. ,ITi t
n
JL,
C
btu
r.,

WELL CONSTRUCTION RECORD 2 e7 3 1 10
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) KENNETH MCCRARY CERTIFICATION # 2008
WELL CONTRACTOR COMPANY NAME BARKER CONSTRUCTION, INC./BARKER WELL & PUMP PHONE # [phone]
STATE WELL CONSTRUCTION PERMIT# 1871 ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential El MumicipalPublic 0 Industrial 0 Agricultural ❑
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION:
Nearest Town: HENDERSONVILLE County HENDERSON
WILLOW LAKE OFF OF CUMMINGS ROAD
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: JERRY CLEARWATER
Address PO BOX 364
(Street or Route No.)
ETOWAH NC 28729
City or Town State Zip Code
( 828 )- 891-4119
Area code- Phone number
4. DATE DRILLED JANUARY 13, 2004
5. TOTAL DEPTH: 230
6. DOES WELL REPLACE EXISTING WELL? YES O NO El
7. STATIC WATER LEVEL Below Top of Casing: 20 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS 1.33 FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordance with ISA NCAC 2C .0118.
9. YIELD (gpm): 15 METHOD OF TEST TIMED
10. WATER ZONES (depth):
11. DISINFECTION: Type BY PUMP INSTALLER
12. CASING:
Depth Diameter
From 0 To 95 Ft. 61/8
From To Ft
From To Ft.
Amount
Wall Thicimess
or Weight/Ft. Material
SDR21 PVC
13. GROUT: Depth Material
From 0 To 20 Ft. CONCRETE
From To Ft.
14. SCREEN: Depth Diameter
From To Ft. in.
From To Ft. in.
15. SAND/GRAVEL PACK:
Depth Size Material
Method
POURED
6¢W.
jolt a gjt on &utnn(Lnc9 2Octd. -�o
ix) ,end 9 Cumrx .s �d . rl
and_
ta&ct,
do 'acii) •' i�+v i rx7
d
e � c CX1leaco� "con #12 e Pop
)6 ,
/Uf k,Q9xLJ (�.Uy. "goad
Slot Size Material
in.
in.
From To Ft.
From To Ft.
16. REMARKS:
(tL
Topographic/Land setting
DRidge ['Slope ❑Valley ®Flat
(check appropriate box)
LatitudeAongitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:OGPSOTopographic map
(check box)
DEPTH DRILLING LOG
From To Formation Description
c
orz
n
'T1
p1
cO
CCm �
oc
LT
LOCATION SKETCH
Show direction and distance in miles frordt lea 0
two State Roads or County Roads. Include -the roa&
numbers and common road names. c0
i,,tom itandttionr•: tto,' t*a-
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 0
SIGNATURE OF RSON CO UCTING THE WELL DATE
Submit the original to the Division of Water Quality, Groundwater Section,1636 Mail Service Center- Raleigh, Nl
27699-1636 Phone No. [phone], within 30 days. GW-1 REV am/2
LLJJ
uncTi
001
v
r�
C_)
G=>
ya
�rl

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) RICHARD MCCRARY
WELL CONTRACTOR COMPANY NAME BARKER CONSTRUCTION, INC./BARKER WELL & PUMP PHONE # [phone]
STATE WELL CONSTRUCTION PERMIT# 1871 ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
CERTIFICATION # 2010
1. WELL USE (Check Applicable Box): Residential in Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery ❑ Heat Pump Water Injection 0 Other ❑ If Other, List Use
2. WELL LOCATION:
Nearest Town: HENDERSONVILLE
KANUGA FOREST- LOT #19
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: DANA SANTOS
Address 1400 RAMBLING OAKS TRAIL
(Street or Route No.)
HENDERSONVILLE NC 28739
City or Town State Zip Code
( 828 )- 696-9994
Area code- Phone number
4. DATE DRILLED JANUARY 14, 2004
5. TOTAL DEPTH: 205'
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO El
7. STATIC WATER LEVEL Below Top of' Casing: 80 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS 1.33 FT. Above Land Surfaces
"Top of using terminated at/or below land surface requires a
variance in accordance with ISA NCAC 2C .0118.
9. YIELD (gpm): a METHOD OF TEST TIMED
10. WATER ZONES (depth):
County HENDERSON
I I . DISINFECTION: Type BY PUMP INSTALLER
12. CASING:
Depth Diameter
From 0 To 5t Ft. 61/8
From To Ft.
From To Ft.
13. GROUT:
From 0
Depth
To 20
Amount
Wall Thickness
or Weight/Ft. Material
SDR21 PVC
Material
Ft. CONCRETE
From To Ft.
14. SCREEN: Depth Diameter
From To Ft. in.
From To Ft. in.
15. SAND/GRAVEL PACK:
Depth Size
From To Ft.
Slot Size
in.
in.
Topographic/Land setting
®Ridge ❑Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
293141
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographicp
(check box) n
DEPTH DRILLING
From To Formation
0
U 0
'rl
r
CO am-'
-1—
m
rrl
.-1
LOCATION SKETCH m 0
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common road names.
Jitan JLencubtlostiat tom°
"l"'uva" Road fo Ea/situ
(° , ,f1,o ,up ,dui Q ?tk
tali aL on Ago/Yiiu.
07.5-ftucp ttp
11 ' C,orzna.
Material A-0A, CYO/C.l'J-C� #��
Method
POURED
Material
From To Ft.
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 O R
SIGNATURE OF PERSON CONSTR G THE WELL ATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center- Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-1 REV. 07/2001

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) RICHARD MCCRARY CERTIFICATION # 2010
293142
WELL CONTRACTOR COMPANY NAME BARKER CONSTRUCTION, INC./BARKER WELL & PUMP PHONE # [phone]
STATE WELL CONSTRUCTION PERMIT# 1871 ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential rgl 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: HENDERSONVILLE County HENDERSON
MALLET ROAD OFF OF RIVER ROAD
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: JOHN PAYNE
Address 341 N. MAIN STREET
(Street or Route No.)
HENDERSONVILLE NC
28792
City or Town State Zip Code
( 828 )_ 693-4125
Area code- Phone number
4. DATE DRILLED JANUARY 6, 2004
5. TOTAL DEPTH: 405'
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO RI
7. STATIC WATER LEVEL Below Top of Casing: 30 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS 1.33 FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordance with ISA NCAC 2C .Off&
9. YIELD (gpm): 4 METHOD OF TEST TIMED
10. WATER ZONES (depth):
11. DISINFECTION: Type BY PUMP INSTALLER Amount
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
From 0 To 54 Ft. 61/8 SDR21 PVC
From To Ft.
From To Ft.
13. GROUT: Depth Material Method
From 0 To 20 Ft. CONCRETE POURED
From To
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:
Ft.
Slot Size Material
in.
in.
Material
Topographic/Land setting1
❑Ridge ❑Slope °Valley KIFlat
(check appropriate box)
Latitude/longitude of well !mat Ot
(degrees/minutes/seconds) r_
Latitude/longitude source:°GPS°Topoaph
(check box)
DEPTH DRILLING LOG
From To Formation Description
CC
O
u
a22
CO cm
CO
Dn
a
rn
rn
ma
LOCATION SKETCH
Show direction and distance in miles from at left
two State Roads or County Roads. Include the road
numbers and common road names.
1J44/n .1✓aitedCvuueitate;
6izaia-. clam
Gild &Mit
aazd ,etuinz
at domte1
C fj
y vad - //5/xitt � � a accI,�.`uarn
D/? %(aa,t&Kd
QCCQit %LU x4 . i gaLc .
Loaterei-727ti1d DX .
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH ISA NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT COPY OF THIS RECORD HAS BEEN PROVIDED TO LL OWNER
/�/ t�J
SIGNATURE OF PERSO ONSTRUCTING THE WELL [DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center- Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-1 REV. 07/2001

WELL CONSTRUCTION RECORD
293143
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) RICHARD MCCRARY CERTIFICATION # 2010
WELL CONTRACTOR COMPANY NAME BARKER CONSTRUCTION, INC./BARKER WELL & PUMP PHONE # [phone]
STATE WELL CONSTRUCTION PERMIT# 1871 ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
I. WELL USE (Check Applicable Box): Residential El MunicipaVPublic 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection ❑ Other 0 If Other, List Use
2. WELL LOCATION:
Nearest Town: HENDERSONVILLE
County HENDERSON
KANUGA FOREST, LOT#20
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: ED GOODMAN
Address 54 JP HUGGINS DR. FOXWOOD SUBDIVISION
(Street or Route No.)
HENDERSONVILLE NC 28791-8511
City or Town State Zip Code
( 828 )- 693-6700
Area code- Phone number
4. DATE DRILLED JANUARY 16, 2004
5. TOTAL DEPTH: 305
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO El
7. STATIC WATER LEVEL Below Top of Casing: 60 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS 1.33 FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordance with ISA NCAC 2C .0118.
9. YIELD (gpm): 2% METHOD OF TEST TIMED
10. WATER ZONES (depth):
11. DISINFECTION: Type BY PUMP INSTALLER
12. CASING:
Depth Diameter
From 0 To 65 Ft. 61/8
From To Ft.
From To Ft.
13. GROUT: Depth Material
From 0 To 20 Ft. CONCRETE
From To Ft.
Topographic/Land setting
®Ridge ❑Slope OValley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:OGPSOTopograic map I (
(check box)
DEPTH - DR)LLINC LOt,
From To Formation Description°
C7 $
,G— u
TT! Lim
to m
I
oC
rn=
MINIS
0
LOCATION SKETCH
Amount Show direction and distance in miles from at least
Wall Thickness two State Roads or County Roads. Include the road
or Weight/Ft. Material numbers and common,//road names. - l"_ �Q"_
SDR21 PVC L e& jth-nd tOnCIAL .✓?'ea e.
Zaru.cra. Zazd A eta e
Method (f t u /ct (/ p
POUREDsat d Q<!t/f.
# zo Gx. -
14. SCREEN: Depth Diameter
From To Ft. in.
From To Ft. in.
Slot Size Material
in.
in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
tiawatattat-
(/LK-f
16. REMARKS:
1 DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED M ACCORDANCE WITH 15A NC
CONSTRUCTION STANDARDS, Al T'HAT COPY OF THIS RECQ*D HAS BEEN PROVIDED TO
2C, WbLL
WNER
PERSON CONSTRUG7�NU f-THE WELL / PIATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mae Service Center- Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-1 REV. 07/2001

WELL CONSTRUCTION RECORD 293144
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) KENNETH MCCRARY CERTIFICATION # 2008
WELL CONTRACTOR COMPANY NAME BARKER CONSTRUCTION, INC./BARKER WELL & PUMP PHONE # (628
STATE WELL CONSTRUCTION PERMIT# 1871 ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential ® Municipal/Public ❑ Industrial 0 Agricultural 0
Monitoring 0 Recovery ❑ Heat Pump Water Injection 0 Other ❑ If Other, List Use
2. WELL LOCATION:
Nearest Town: HENDERSONVILLE
FORGE CREST SUBDIVISION, LOT #18
County HENDERSON
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: JOHN & BONNIE LUCAS
Address 11450 PLATHBURG ROAD
(Street or Route No.)
SOUTH CHARLESTON OHIO 45368
City or Town State Zip Code
( 937 )- 568-4552
Area code- Phone number
4. DATE DRILLED JANUARY 21, 2004
5. TOTAL DEPTH: 805
6. DOES WELL REPLACE EXISTING WELL? YES O NO El
7. STATIC WATER LEVEL Below Top of Casing: 60 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS 1.33 FT. Above Land Surface*
"Top of casing terminated actor below land surface requires a
variance In accordance with 15A NCAC 2C .0118.
9. YIELD (gpm): % METHOD OF TEST TIMED
10. WATER ZONES (depth):
Topographic/Land settin
®Ridge ['Slope ❑Valley
(check appropriate box)
Latitude/longitude of well locati4tr_,,
QF($(
)/L
�Zz
(degrees/minutes/seconds) r ` =.�
Latitude/longitude source:OGPSOTopographic ma
(check box)
DEPTH DRILLING LOGc, --- From To Formation Dr9riiptig
11. DISINFECTION: Type BY PUMP INSTALLER
12. CASING:
Depth Diameter
From 0 To 25 Ft. 61/8
From To Ft.
From To Ft.
Amount
Wall Thickness
or Weight/Ft. Material
SDR21 PVC
13. GROUT: Depth Material
From 0 To 20 Ft. CONCRETE
From To Ft.
14. SCREEN: Depth Diameter Slot Size
From To Ft. in. in.
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Size
From To Ft.
From To Ft.
Method
POURED
16. REMARKS:
,
r -t m
cc�
-gym
oc
CO cni
Do
a,
.Zl
m
- rnT
fT1A
- —1
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common road names.
J/t.om gat intr _.,_ wnL &w f c/�U�,"°� "a e,
)1 .280 ;War otsi -
/c�+a�`"^ `/1�L�Cx�.l�l'. itt ato&.cuxt e oJJ��yy!lLg,cLL�_►►�p
LL�-....
Material n. _ . U /I, rL (qJ,y %�Z1,.I-„
ctit
�avn. `oat a Mt,
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
SIGNATURE OF PERSON CONSTRUCTING THE *ELL DATE
- or)
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 9 314 5
North Carolina - Departrnent of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) RICHARD MCCRARY CERTIFICATION It 2010
PHONE # [phone]
WELL CONTRACTOR COMPANY NAME BARKER CONSTRUCTION, INC./BARKER WELL & PUMP
STATE WELL CONSTRUCTION PERMIT# 1871 ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
I. WELL USE (Check Applicable Box): Residential I Municipal/Public 0 Industrial 0 Agricultural ❑
Monitoring ❑ Recovery 0 Heat Pump Water Injection 0 Other ❑ If Other, List Use
2. WELL LOCATION:
Nearest Town: HENDERSONVILLE
CRAB CREEK ROAD
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: LARRY KNOTT
Address 1261 CRAB CREEK ROAD
(Street or Route No.)
HENDERSONVILLE NC 28739
City or Town State Zip Code
( 828 )- 698-6691
Area code- Phone number
4. DATE DRILLED JANUARY 22, 2004
5. TOTAL DEPTH: 165
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO
7. STATIC WATER LEVEL Below Top of Casing: 5 FT.
(Ilse "+" if Above Top of Casing)
8. TOP OF CASING IS 1.33 FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordance with ISA NCAC 2C .0118.
9. YIELD (gpm): 20 METHOD OF TEST TIMED
10. WATER ZONES (depth):
County HENDERSON
Topographic/Land setting
❑Ridge ❑Slope OValley KIF
(check appropriate box)
Latitude/longitude of well Iocatici
la
(degrees/minutes/seconds) m I__._
Latitude/longitude source:OGPSOTopogtaphic mapl j g
(check box) l,_ _
DEPTH DRILLING LUG
From To Formation Descriptio1.n
U1fu
CS1
▪ a
Tl
✓ on
m
Sm
r c
CO =crn
-vo
cn
rn3
C7
CO c
11. DISINFECTION: Type BY PUMP INSTALLER Amount
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
From 0 To 34 Ft. 6 % .185 STEEL
From To Ft.
From To Ft.
13. GROUT: Depth
From 0 To 20
From To Ft.
14. SCREEN:
Material
Ft. CONCRETE
Depth Diameter
From To Ft. in.
From To Ft. in.
15. SAND/GRAVEL PACK:
Depth Size Material
Slot Size
in.
in.
Material
From To Ft.
From To Ft.
16. REMARKS:
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common road names.
S tat
Seen a//tat
`�oza 2'a L7.4.(...e Gc cal —
qWcateiefr M
1 DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF -INS RECORD H EEN PROVIDED TO THE7ELL cr
/S GNATURE O PERSCOCONS
CTING THE WELL
//z
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 3 14 6
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDMDUAL) NAME (print) RICHARD MCCRARY CERTIFICATION # 2010
WELL CONTRACTOR COMPANY NAME BARKER CONSTRUCTION, INC./BARKER WELL & PUMP PRONE # (828) 6Q7-7263
STATE WELL CONSTRUCTION PERMIT# 1871 ASSOCIATED WQ PERMIT#
(if applicable) (if applicable) ?'
1. WELL USE (Check Applicable Box): Residential 1 Municipal/Public ❑ Industrial ❑ Agricultural O
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION:
Nearest Town: HENDERSONVILLE
CHESTNUT GAP ROAD
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: ODELL BARNWELL & SONS LLC
Address 175 POINT HOPE LANE
(Street or Route No.)
HENDERSONVILLE NC 28792
City or Town State Zip Code
( 828 )_ 685-7300
Area code- Phone number
4. DATE DRILLED JANUARY 30, 2004
5. TOTAL DEPTH: 225'
6. DOES WELL REPLACE EXISTING WELL? YES O NO gl
7. STATIC WATER LEVEL Below Top of Casing: 30 FT.
(Use "+^ if Above Top of Casing)
8. TOP OF CASING IS 1.33 FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordance with ISA NCAC 2C .0118.
9. YIELD (gpm): 6 METHOD OF TEST TIMED
10. WATER ZONES (depth):
County HENDERSON
11. DISINFECTION: Type BY PUMP INSTALLER
12. CASING:
Depth Diameter
From 0 To 82 Ft. 61/8
From To Ft.
From To Ft.
13. GROUT: Depth
From 0 To 20 Ft.
From To Ft.
14. SCREEN: Depth Diameter
From To Ft.
From To Ft.
Amount
Wall Thickness
or Weight/Ft. Material
SDR21 PVC
Topographic/Land setting
❑Ridge ❑Slope ❑Valley ®ttat,
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:OGPSOTopogFaphic ma ...�._.
(check box)
DEPTH DRILLING LOG
From To Formation Description
r-
.a.
no
33 rn
�F
r
rn
LOCATION SKETCH .... ?
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common road names.
J.tor7c J.tila!ta r� ta.ett
o �V 6�a�-�-•' A �'D�n a �vCZO
Material Method 't� I� 424.
�rs.�- "cad-
CONCRETE POURED , / et/t-
c
Slot Size Material
in. in.
in. in.
15. SAND/GRAVEL PACK:
Depth
From To Ft.
From To Ft.
16. REMARKS:
Size
Material
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN A CORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT OF THIS CO HAS B PROVIDED TO T WEJ2L OWNER
SIGN ACP)RE OF PERSON CONSTRUL GTHE 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

295416
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) KENNETH MCCRARY
CERTIFICATION 2008
WELL CONTRACTOR COMPANY NAME BARKER CONSTRUCTION, INC./BARKER WELL & PUMP pgpryE # [phone]
STATE WELL CONSTRUCTION PERMIT# 1871 ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential tia Municipal/Public ❑ Industrial 0 Agricultural ❑
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION:
Nearest Town: HENDERSONVILLE County HENDERSON
STANLEY CREEK
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: MONROE MORRISON
Address PO BOX 61
(Street or Route No.)
EDNEYVILLE NC
28727
City or Town State Zip Code
Area code- Phone number
4. DATE DRILLED MAY 28, 2004
5. TOTAL DEPTH: 305'
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO RI
7. STATIC WATER LEVEL Below Top of Casing: 70 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS 1.33 FT. Above Land Surface*
*Top of using terminated at/or below land surface requires a
variance In accordance with ISA NCAC 2C .0118.
9. YIELD (gpm): 1 METHOD OF TEST TIMED
10. WATER ZONES (depth):
11. DISINFECTION: Type OY PUMP INSTALLER
12. CASING:
Depth Diameter
From 0 To 86 Ft. 61/8
From To Ft.
From To Ft.
13. GROUT: Depth Material
From 0 To 20 Ft. CONCRETE
Amount
Wall Thickness
or Weight/Ft. Material
SDR21 PVC
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:OGPSOTopographic map
(check box)
DEPTH DRILLING LOG
From To Formation Description
O
o
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common road names.
J,tc0r)L,41..�nclic.taort,tu e i&k
¢�Q . (� f E. JUL a irk--
POURED0 / ( a, TAU—
,
Method
Slot Size
in.
in.
Material
-;gyp n Q • q c- Ike
p u p fat' . JA. t Ok.
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
HH�7/"AOWNER�S BEEN PROVIDED TO THE WELL (
OF
SIGNATURE\C TRUCTIN6 THE WELL ATE /
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-1 REV. 07/2001

29 H 1 3
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) KENNETH MCCRARY CERTIFICATION # 2008
WELL CONTRACTOR COMPANY NAME BARKER CONSTRUCTION, INC./BARKER WELL & PUMP pnasig /828) 697-7263
STATE WELL CONSTRUCTION PERMIT# 1871
ASSOCIATED WQ PERMIT#
(if applicable) (if applicable) _..
1. WELL USE (Check Applicable Box): Residential El 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: HENDERSONVILLE
BLOOMINGDALE SUBDIVISION, LOT #4
County HENDERSON
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: CRAIG BOOHER
Address 101 FAIRVIEW HILLS DRIVE
(Street or Route No.)
FAIRVIEW NC 28730
CityorTown State Zip Code
( 828 )_ 230-9295
Area code- Phone number
4. DATE DRILLED MAY 10, 2004
5. TOTAL DEPTH: 505'
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO El
7. STATIC WATER LEVEL Below Top of Casing: 20 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS 1.33 FT. Above Land Surface'
*Top of casing terminated at/or below land surface requires a
variance In accordance with ISA NCAC 2C .011&
9. YIELD (gpm): 2 METHOD OF TEST TIMED
10. WATER ZONES (depth):
11. DISINFECTION: Type e
12. CASING:
Depth
From 0 To 73 Ft.
From To Ft.
From To Ft.
13. GROUT:
From 0
Depth
To 20
From To
14. SCREEN: Depth Diameter
From To Ft. in.
From To Ft. in.
15. SAND/GRAVEL PACK:
Depth Size
From To Ft.
From To Ft.
Material
Ft. CONCRETE
Topographic/Land setting
❑Ridge ❑Slope OValley ®Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude sotrce:OGPSOTopographic map
(check box)
DEPTH DRILLING LOG
From To Formation Description
Y PUMP INSTALLER Amount
Wall Thickness
Diameter or Weight/Ft. Material
61/8 SDR21 PVC
Ft.
Slot Size Material
in.
in.
Method
POURED
Material
J
LOCATION SKETCH (,;
Show direction and distance in miles froro3t Iej4's'('td
two State Roads or County Roads. Includethe road
numbers and common road names. C")
From Hendersonville +ate N�u.{. �5
Forth -ln heteher.TaKe a ri9lL£ on,
to HoWard Gap Read. ToLke 0-
r(ht Onto �(�kson Raid . 00
c pw i ntatel�t 4i( wile - pproperty
is an the rJ(etkt on eerin j
�Ioonci d. e.Ltbclivision .
Lot #4
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
l� nCr(-I z -
SIGNATURE OF PERSON CONSTRUCTING ;WWII 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 J 41 4
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section^^
WELL CONTRACTOR (INDIVIDUAL) NAME (printf R 10 hard _1 cClra ry CERTIFICATION # dO 10
WELL CONTRACTOR COMPANY NAME fnprKe GYlstr)IctioniTne /&irKerWeUI tFfdrip PHONE # tV1)01-721,3
STATE WELL CONSTRUCTION PERMIT# I89 I ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential Er 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: N end er5o)Nt I IP County i endPYSOl
1?)rf2dfnrrl Trms Lot 4 ' a5 R
(Street Name, Numbers, Community,u^Subdivision, Lot No., Zip Code)
3. OWNER: ter+ 5`tanFiPJd
Address Q q BradFord Nilf 'Road
(Street or Route No.)
Arden. 2870tf
-J'1C
City or Town State Zip Code
(010-811-4400
Area code- Phone number
4. DATE DRILLED Fri^a5-04
5. TOTAL DEPTH: 225'
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO ge*--
7. STATIC WATER LEVEL Below Top of Casing: HHO FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS 1.33 FT. Above Land Surface*
'Top of casing terminated at/or below land surface requires a
variance In accordance with ISA NCAC 2C .0118.
9. YIELD (gpm): 5 METHOD OF TESTTi Y)1eci
10. WATER
nZONES (depth):
$I5 FE instal1,er
D IN CTION:
Type
11. yp
12. CASING:
Depth�1rt Diameter
From 0 To a!'1 Ft. 678
From To Ft.
From To Ft.
13. GROUT: Depth Material
From r) To 20 Ft. Concrete
Amount
Wall Thickness
or Weight/Ft. Material
S'DR71 PVC
From To Ft.
14. SCREEN: Depth Diameter
From To Ft. in.
From To Ft. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
Slot Size
in.
in.
Topographic/Land setting
❑Ridge a3 lope ❑Valley OFlat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:OGPSOTopographie map
(check box)
DEPTH DRILLING LOG
From To Formation Description
O^ -J
LOCATION SKETCH
Show direction and distance in miles from at leas€j o�
two State Roads or County Roads. Include the road
numbers and common road names.
Front )4endersonviUe{axe Hwy. Pi+o
fc'Aowell.'goad • Yale a left -ED
13 rad Fcrd rant `goad • Turn riiqq ht
Method
cPnured and o -iv stop sign. TaKe a
Material (� iL� ft Lot tr- 25'R .
# 222 Br d%r'd ill2.oa4{
.Bract -Cord farms) Lot he25 R.
16. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CO,NSSTRUCTED IN ACCORDANCE WITH ISA NCAC 2C, WELL/
CONSTRUCTION STANDARDS, AND THAT A OPY F THIS
HAS BEEN PROVIDED TO
OWNER
SIGNATURE OF PERSON STRUCTING THE WELL DA
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-1 REV. 07/2001

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) KENNETH MCCRARY CERTIFICATION # 2008
295411
WELL CONTRACTOR COMPANY NAME BARKER CONSTRUCTION, INC/BARKER WELL 8 PUMP PHONE # [phone]
STATE WELL CONSTRUCTION PERMIT# 1871 ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential 131 Municipal/Public 0 Industrial ❑ Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other ❑ If Other, List Use
2. WELL LOCATION:
Nearest Town: HENDERSONVILLE
RIDGEFIELD SUBDIVISION
County HENDERSON
(Street Name, Numbers, Community, Subdivision. Lot No., Zip Code)
3. OWNER: BENNETTAVREY
Address 7 PINE NEEDLE DRIVE
(Street or Route No.)
FLETCHER NC
28732
City or Town State Zip Code
( 828 )- 687-2000
Area code- Phone number
4. DATE DRILLED MAY 6, 2004
5. TOTAL DEPTH: 680
6. DOES WELL REPLACE EXISTING WELL? YES O NO El
7. STATIC WATER LEVEL Below Top of Casing: 30 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS 1.33 FT. Above Land Surface`
"Top of casing terminated at/or below land surface requires a
variance in accordance with ISA NCAC 2C .0118.
9. YIELD (gpm): 10 METHOD OF TEST TIMED
10. WATER ZONES (depth):
Topographic/Land setting
❑Ridge ❑Slope ❑Valley KIF1at
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitudeflongitude sauce:OGPSDTopographi¢ map —(check box)
DEPTH DRILLING LO�Ci
From To Formation Description
II. DISINFECTION: Type BY PUMP INSTALLER
12. CASING:
Depth Diameter
From 0 To 102 Ft. 61/8
From To Ft
From To Ft.
13. GROUT: Depth Material
From 0 To 20 Ft. CONCRETE
From To Ft.
Amount
Wall Thickness
or Weight/Ft. Material
SDR21 PVC
Method
POURED
14. SCREEN: Depth Diameter Slot Size
From To Ft. in. in.
From To Ft. in. in.
15. SAND/GRAVEL PACK:
From
From
Depth
To Ft.
To Ft.
16. REMARKS:
Size
v
J
LOCATION SKETCH (.9
Show direction and distance in miles from at (east F
two State Roads or County Roads. Include the road o
numbers and common road names.
.iwm Astuhate tau
eicE• iv d EA. djxvvrts
an7d_ �¢u eonte-
Material n - LAMA( np ' 7( 1 Q %'(,(
I AtiloCLLt.cd(.en 6X
Cep pa at. riCIJ'2o f1 m -
Material
Pithor4 tf,51617,8
1 DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH I5A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
SIGNATURE OF PERSON CONSTRUCTING THE WELL / DA 1'
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-1 REV. 07/2001

296595
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) KENNETH MCCRARY
CERTIFICATION # 2008
WELL CONTRACTOR COMPANY NAME BARKER CONSTRUCTION, INC./BARKER WELL & PUMP puoitig# [phone]
STATE WELL CONSTRUCTION PERMIT# 1871
(if applicable)
ASSOCIATED WQ PERMIT# ..
(if applicable) ._
1. WELL USE (Check Applicable Box): Residential El 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: HENDERSONVILLE County HENDERSON
BLOOMINGDALE SUBDIVISION, LOT #11
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: ED HOLLAND
Address 151 JACKSON ROAD
(Street or Route No.)
FLETCHER NC
28732
City or Town State
( 828 )- 777-6778
Area code- Phone number
4. DATE DRILLED APRIL 21, 2004
5. TOTAL DEPTH: 330
Zip Code
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO El
7. STATIC WATER LEVEL Below Top of Casing: 20 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS 1.33 FT Above Land Surface*
`Top of casing terminated at/or below land surface requires a
variance in accordance with 15A NCAC 2C .0118.
9. YIELD (gpm): 2 METHOD OF TEST TIMED
10. WATER ZONES (depth):
Topographic/Land setting,
❑Ridge ❑Slope ❑Valley JFlat
(check appropriate box)
LatitudeAongitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:OGPSOTopggtuphicmap
(check box)
DEPTH DRILLING LOG
From To Formation bescnption
6
Q 0
LOCATION SKETCH
11. DISINFECTION: Type BY PUMP INSTALLER Amount Show direction and distance in miles from at least
12. CASING: Wall Thickness two State Roads or County Roads. Include the road
Depth Diameter or Weight/Ft. Material numbers and common road names.
From 0 To 75 Ft. 61/8 SDR21 PVC From )le%1-derscytvilie-Lake cti 2S
From To Ft. From To Ft. Xortlet -I-D Heed -der • Take & r(Qht
13. GROUT: a)�/
From 0
From To Ft.
14. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in.
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Size Material
Material
Ft. CONCRETE
Method
POURED
Depth
To 20
From To Ft
From To Ft
Om& Froward Gap Road. T a_
r19ht On Sackson TLoad- G-o
'fio m-i?'e . Fropertt.( Is on the
r(Q{tt. J
$loonci9dade SiLlacLivlsiofl-
Lot*II
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

29
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) RICHARD MCCRARY CERTIFICATION # 2010
WELL CONTRACTOR COMPANY NAME BARKER CONSTRUCTION, INC./BARKER WELL 8 PUMP PHONE # (828) 697,72A3
STATE WELL CONSTRUCTION PERMIT# 1871 ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
I. WELL USE (Check Applicable Box): Residential D Municipal/Public ❑ Industrial 0 Agricultural 0
Monitoring ❑ Recovery 0 Heat Pump Water Injection O Other 0 If Other, List Use
2. WELL LOCATION:
Nearest Town: HENDERSONVILLE County HENDERSON
BLOOMINGDALE SUBDIVISION, LOT #9
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: ED HOLLAND
Address 151 JACKSON ROAD
(Street or Route No.)
FLETCHER NC
28732
City or Town State
( 828 )_ 777-6778
Area code- Phone number
4. DATE DRILLED APRIL 21, 2004
5. TOTAL DEPTH: 245
Zip Code
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO Ell
7. STATIC WATER LEVEL Below Top of Casing: 40 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS 1.33 FT. Above Land Surface*
'Top of casing terminated at/or below land surface requires a
variance in accordance with 15A NCAC 2C .0118.
9. YIELD (gpm): 3 METHOD OF TEST TIMED
10. WATER ZONES (depth):
Topographic/Land setting
❑Ridge ❑Slope ❑Valley KIFIat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:OGPSOTopograpjiic map
(check box)
DEPTH DRILLING LOG
From To Formation Description
0
1I. DISINFECTION: Type BY PUMP INSTALLER Amount
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft.
From 0 To 89 Ft. 61/8 SDR21
From To Ft
From To Ft.
13. GROUT: Depth Material
From 0 To 20 Ft. CONCRETE
From To Ft.
14. SCREEN: Depth Diameter Slot Size
From To Ft. in. in.
From To Ft in. in.
15. SAND/GRAVEL PACK:
Depth Size Material
Material
PVC
Method
POURED
From To Ft.
From To Ft.
O
tc
0
LOCATION $KETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common road names.
From '4enderscavi Uc -z<n Kc Ai .25
Xorth ,<o FieLeher. Tale& a_ right
Onto FFoa)ard Gap 'R.oad . Ta Ve a
rise t On. Jackson `Road. Go 7/io
Material rYLILL. i'ropertt.j Is on the rjht..
594
-BIoonti dale 5ubdiv(siort_.
Lot tr9
16. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH I5A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT .� C, OPY OF S RECORD HAS BE PROVIDED TO TWEyi, OWNER
`/�'70/���/!//J� Z
SIGNATURE
Il GNATURE OF PERSON UC ENG THE WELL
-'y
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-1 REV. 07/2001

WELL CONSTRUCTION RECORD
29092
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) RICHARD MCCRARY
CERTIFICATION # 2010
WELL CONTRACTOR COMPANY NAME BARKER CONSTRUCTION, INC./BARKER WELL & PUMP PHONE # f 828) 697-7263
STATE WELL CONSTRUCTION PERMIT# 1871 ASSOCIATED WQ PERMIT#
(if applicable)
(if applicable)
1. WELL USE (Check Applicable Box): Residential El MunicipaVPublic ❑ Industrial 0 Agricultural ❑
Monitoring ❑ Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION:
Nearest Town: HENDERSONVILLE
246 HOWARD GAP ROAD
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
County HENDERSON
3. OWNER: BRIAN K. WILLIAMS
Address PO BOX 61
(Street or Route No.)
FLETCHER NC 28732
City or Town State Zip Code
( 828 )- 687-2965
Area code- Phone number
4. DATE DRILLED APRIL 15, 2004
5. TOTAL DEPTH: 245
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO El
7. STATIC WATER LEVEL Below Top of Casing: 40 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS 1.33 FT. Above Land Surface*
'Top of casing terminated at/or below land surface requires a
variance In accordance with 15A NCAC 2C .0118.
9. YIELD (gpm): 6 METHOD OF TEST TIMED
10. WATER ZONES (depth):
11. DISINFECTION: Type BY PUMP INSTALLER Amount
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
From 0 To 81 Ft. 61/8
From To Ft.
From To Ft.
13. GROUT: Depth Material Method
From 0 To 20 Ft. CONCRETE POURED
From To Ft.
14. SCREEN: Depth Diameter Slot Size
From To Ft. in. in.
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
16. REMARKS:
Topographic/Land setting,
❑Ridge ❑Slope ❑Valley ®Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude sou rce:DGPSOTopographic map
(check box)
DEPTH DRILLING LOG
From To Formation Description
c
O
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.
SDR21 PVC J.'t p. p .N�l7.d.. /twilit teat mot
s- -to S Jae IncLegif
vn lea& 12oad . J1t -la
W & Road la
/1 awiand nap &act ccvvn Afret
o tb 409..)a(Lot 4ap. IthU fie )11e-
m3n4 At -
°NC, 462waad .flap road,
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAJ A$ OPY OTHIS RE e • a HAS BEEN PROVIDED TO TyiE WE OWNER
S1GNA'It(JREOFP 'SOS ONSTRUCfINGTHE WELL
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center- Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-1 REV. 07/2001

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Sec
WELL,tEiNTRACTOR (INDLVIDUAL) NAME (print) RICHARD MCCRARY CERTIFICATION
WELLJCONTRACTOR COMPANY NAME BARKER CONSTRUCTION, INC./BARKER WELL & PUMP PHONE it {828) 69
STAT* WELL CONSTRUCTION PERMIT# 1871 ASSOCIATED WO PERMIT#
(if applicable) (if applicable)
LL USE (Check Applicable Box): Residential El MunicipaVPublic 0 Industrial 0 Agricultural 0
onitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION:
Nearest Town: HENDERSONVILLE
246 HOWARD GAP ROAD
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: BRIAN K. WILLIAMS
Address PO BOX 61
(Street or Route No.)
FLETCHER NC 28732
City or Town State Zip Code
( 828 )_ 687-2965
Area code- Phone number
4. DATE DRILLED APRIL 15, 2004
5. TOTAL DEPTH: 245
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO El
7. STATIC WATER LEVEL Below Top of Casing: 40 FT.
(use "+" if Above Top of Casing)
8. TOP OF CASING IS 1.33 FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance In accordance with 15A NCAC 2C .0118.
9. YIELD (gpm): 6 METHOD OF TEST TIMED
10. WATER ZONES (depth):
11. DISINFECTION: Type BY PUMP INSTALLER
12. CASING:
County HENDERSON
Amount
Wall Thickness
From 0 DepthTo 8t or Weight/Ft. Material ,/ /
Ft. SDR21 PVC k - .L Jjgactu-torr,UA.UQ tt
From To Ft. q� �/
From To Ft. at / �' M 02}'P p d.(� •
13. GROUT: Depth Material Method t& c(,, �d and to 1 p
Jim_ 0_ /
From 0 To 20 Ft. CONCRETE POURED From To Ft. an-46 Cad- � 4 . JaD-
14. SCREEN: Depth Diameter Slot Size Material Seto
Acce`/ iat7 pL Re
From To Ft. in. in. N&0 Set &ad""_. 2L(/V%1
From To Ft. in. in. B`t r
15. SAND/GRAVEL PACK: Qf2) 1
Depth Size Material akit 7V4faf' ""---
From To Ft. From To Ft. , 3n.d Qi{.ti�2. Alit.
Topggraphic/Land setting
❑Ridge 'OSlope ❑Valley HJFL
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:OGPSOTopograp
(check box)
DEPTH DRILLING I
From To Formation F)ew
C
16. REMARKS:
Diameter
6 1/8
LOCATION SKETCH
Show direction and distance in miles from at
two State Roads or County Roads. Include th
numbers and common road names.
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAJ A f,QPY OTHIS REGARD HAS BEEN PROVIDED TO T)IE WELL OWNER
SIGNA'ItiJRE OF PE SO ONSTRUCTING THE WELL
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center- Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-1 REV 07/20/

296086
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and N 1 Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAMy�i( (pritnt) L' ,, CERTIFICATION Ae.t Q %
WELL CONTRACTOR COMPANY NAME�INif/i L4 4 k/2t2#t7 tt PHONE 1 t4r6 517-OS/n
STATE WELL CONSTRUCTION PERMIT# Vie/ ASSOCIATED WQ PERMIT# gra 3
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential N Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCH N:
Neafejt Town•
(Street Nam dNinn
tY
cif 9/
Community, Subdivision, Lot No., Zip Code)
3. OWNERci? Y 4 i CradfrfGL
Address /G fl A/ j; r cf
(Streets Ro )
Henze.°`,4 C. e24179/
m
Zip Cade
r3u)
Acode- Phone number
4. DATE DRILLED 3/,9.1/Q y
5. TOTAL DEPTH: at/ S
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO el
7. STATIC WATER LEVEL Below Top of Casing: 3s FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS 1, 6-FT. Above Land Surfaces
`Top of cuing terminated at/or below land surface reclaim a
variance In accordance with ISA NCAC IC .0118.
9. YIELD (gpm): 3 n M OD OF TESTt nt.,
10. WATER ZONES (depth): y 5- r '2 a / '
ge.% - t
pCity or own State
b lP
11. DISINFECTION: Type 1. H. At.
12. CASING:
Depth
From 0To Depth, Ft.
From To Ft.
From To Ft.
13. GROUT: Depthr/
From 0 To of D Ft. ii�
From To Ft.
14. SCREEN: Depth Diameter Slot Size Material
Fro To Ft in. in.
Ftom To Ft in. in.
15. SAND/GRAVELPACIC
Depth Size Material
o Ft.
To Ft.
Diameter
Amount k'
Wall Thickness
or #-�/t/Ft I�j�tenal
Topographic/Land setting
❑Ridge ❑Slope ❑Valley Flat
(check appropbox)
Latitude/longitude of well location
(degrees/minutea/seconds)
Latitude/longitude source:❑GPS❑Topographic map.
DEPTH
From To
LIATionsyd
From
From
16. REMARKS:
DRILLING LOG
Formation Description
LOCATION SKETCH o 2-V
Show direction and distance in miles from at least
two State Roads or County Roads. Include the Tad
numbers and common road names.
vfr
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH ISA NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THA A COPY OF THIS RE ORD HAS BEEN PROVIDED TO THE WELL OWNER
P7f-or-re get, 3A2 3/4y
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 Njiral Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAM (print) A/iV /F 92221 CnreslrlCA710N+b1Fs%
WELL CONTRACTOR COMPANY NAME
PHONE It Skill'y ) 441Dye
STATE WELL CONSTRUCTION PERMIT', ,L ASSOCIATED WQ PERMIT# # /e 77.2 r
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential $ Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATIO,
Nea Tor.:
e/
/f
(S Name,N
3. OWNER:
Address t7.46i
Topographic/Land setting
❑Ridge ❑Slope ❑Valley )$Flat
r-r-�• ett•19/9Z. (cheek appropriate box)
Community, Subdivision, Lot No., tip code) Latitude/longitude of well location
(S Rare No.)
CLIP ivy , a879 t_
(fix} or9skis Zip Code
Area code- Phone number
4. DATE DRILLED 3/J 9/D
5. TOTAL DEPTH: /PS
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO PO
7. STATIC WATER LEVEL Below Top of Casing:e:S FT•
(Use"+" if Above Top of Casing)
8. TOP OF CASING IS 1 -5 FT. Above Land Surface'
'Top of casing terminated atlor below land surface requlra a
variance in accordmc witb ISA NCAC 2C .0118. •
9. YIELD (gpm): .VD METHOD OF TEST T�Gis:O
10. WATER ZONES (depth):
11. DISINFECTION: Type Amount
12. CASING: Wall Thicbiess
or Weight/Ft. Material
From Q TDom13 Ft #.2/ PUC
From To Ft.
From______ To Ft.
13. GROUT: Depth
From To v.1 b
From To Ft
14. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in.
Fro To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Size Material
Ft
From jl'o Ft.
From / To Ft.
16. REMARKS:
(degrees/Minutes/seconds)
Latitude/longitude source:❑GPS❑Topogr4phic map
(check box)
DEPTH DRILLING we ---
From To Formation Description
LOCATION SKETCH, " t:
Show direction and distance in miles gm a9east
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, ANL9IAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WF11 OWNER.
SIGNATURE OF PERSON C STRUCTING THE WELL DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center -Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-1 REV. 07/2001

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Na
WELL CONTRACTOR (INDIVIDUAL) NAM)',, (print)
WELL CONTRACTOR COMPANY NAME
STATE WELL CONSTRUCTION PERMITS N3/47
(if applicable)
296078
Resources - Division of Water Quality - Groundwater Section r�
\\ � . ^^ L- CERTIFICA-1I(ON� �K ,?7,
u L'%aV 'Ll�til PHONE M fF,411In�Q C'LiU
_ASSOCIATED WQ PERMIT (p 4.3 7
(if applicable)
1. WELL USE (Check Applicable Box): Residential (1J Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCH N: /j
Nearest own• unty/ u
Co C' C �Rxi-
(Street Name, Numbers, Community, Subdivision, lot No., Zip Code)
3. OWNER /
Address
(Street R e No.) v . � N C. a 129 2--
City or Town State Zip Code
Area code Phone number
4. DATE DRILLED ?/.J /n y
5. TOTAL DEPTH: . C O
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO El
7. STATIC WATER LEVEL Below Top of Casing: /, r FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS 7.5 FT. Above Land Surface*
`Top of wing terminated at/or below land surface requires •
variance is accordance with ISA NCAC 2C .0I18.
9. YIELD (gpm): ✓` METHOD OF TEST T-,--no
10. WATER ZONES (depth): 75 '
11. DISINFECTION: Type /' , /t F/ Amount / 9._4-
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft Material
From9To ..0 Ft6-7-7t&2/ l9yC
From__ To Ft.
From To Ft.
13. GROUT: Depth /lMaterial Me�d
From (i To�D Ft. !.vi l 'a ( wtetho' .�-!
From To Ft
14. SCREEN: Depth Diameter Slot Size Material
Fro To Ft. in. in.
From To Ft. in. in.
15. SAND GRAVEL PACK:
Depth Size Material
From To Ft.
From �To Ft.
16. REMARKS:
Topographic/Land setting
❑Ridge CiIS1ope ❑Valley ❑Fiat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
DEPTH
From To
DRILLING LOG
Formation Description
0
LOCATION SKETCH
Show direction and distance in miles from at 0" "-
two State Roads or County Roads. Includy road
numbers and common road names.
_u
T
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND 3th 5E A COPY OF THIS RERD HAS BEEN PROVIDED TO THE WELL O'
6—
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

296077
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAM£��((print) II ,,41,,L L.I CERTIFICATION 41277
WELL CONTRACTOR COMPANY NAME J4aigegj [.tJ.Gf..Pf./1v�1ie.ti,p PRONE a rat yyoggv
ASSOCIATED VWQ PERMIVTT# .7& „Waif
(if applicable)
STATE WELL CONSTRUCTION PERMIT#
(if applicable)
f/9
1. WELL USE (Check Applicable Box): Residential a Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery ❑ Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION: /J
Nearest Town: unty�r mea--arzL
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER a i t1 ] �� /
Address /�5i la ij/.v.(id[ h Ytia (Street or_lipute No.)CI
v Ks G aA 97
City or Town State Zip Code
(--)-
Area code- Phone number
4. DATE DRILLED "7 / o 9
5. TOTAL DEPTH: V r
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO 1$
7. STATIC WATER. LEVEL Below Top of Casing: pFT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS A,r FT. Above Land Surface'
'Top of caring terminated at/or below land surface requires a
variance In accordance with ISA NCAC 2C .0118. •
9. YIELD (gpm): ./D OD OF TEST—Eatoco
10.WATER ZONES (deptb): Y/7f /XT'
11. DISINFECTION: Type
12. CASING:
Diameter
From 0 To y0 Ft. hi
From_ To Ft.
From To Ft
13. GROUT: Depth
From 0 To �n Ft.
From To Ft
Material
11, fi- N. Amount /O Ox—
Wall Thickness
o e it/Ft. M iat
.z/ (f'f/i
14. SCREEN: Depth Diameter Slot Size Material
Fromm Ft. in. in.
From / To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From Ft.
From To Ft.
Topographic/Land setting
�itidge ❑Slope ❑Valley Mat
(check appropriate bat)
Latitude/longitude of well location
(degrees/minutes/seconds) i
Latitude/longitude source:❑GPS❑Topotraphic map
(check box)
DRILLING LOG
Formatiotttbescr-jtion
DEPTH
From To
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common road names. • c'-)'e`'e
16. REMARKS: 41...84W-4-t. f 42i /?7.it.C-#iJ.it i7
1 DO HEREBY CERTIFY THAT THIS WFI 1 WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
One-; e e _3�1/Zn `f
SIGNATURE OF PERSON CONS UCTING THE WELL D
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

294 ;'61
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) RICHARD MCCRARY
CERTIFICATION # 2010
WELL CONTRACTOR COMPANY NAME BARKER CONSTRUCTION, INC./BARKER WELL &PUMP PHONE # f8281,697-7263----
STATE WELL CONSTRUCTION PERMIT# 1871 ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential 03 Municipal/Public ❑ Industrial O Agricultural ❑
Monitoring 0 Recovery 0 Heat Pump Water Injection ❑ Other 0 If Other, List Use
2. WELL LOCATION:
Nearest Town: HENDERSONVILLE County HENDERSON
JETER MOUNTAIN TERRACE
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: ROBERT L. CHILES
Address 303 BROOK HOLLOW DRIVE
(Street or Route No.)
COLUMBIA SC
29229-8813
City or Town State
( 803 )_ 865-0129
Area code- Phone number
4. DATE DRILLED MARCH 31, 2004
5. TOTAL DEPTH: 205
Zip Code
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO 131
7. STATIC WATER LEVEL Below Top of Casing: 30 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS 1.33 FT. Above Land Surface"
*Top of casing terminated at/or below land surface requires a
variance 1n accordance with 15A NCAC 2C .011&
9. YIELD (gpm): 15 METHOD OF TEST TIMED
10. WATER ZONES (depth):
1 I. DISINFECTION: Type BY PUMP INSTALLER Amount
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
From 0 To 36 Ft. 61/8 SDR21 PVC
From To Ft.
From To Ft.
13. GROUT: Depth Material
From 0 To 20 Ft. CONCRETE
From To Ft.
14. SCREEN: Depth Diameter 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)
Latitude/longitude source:OGPSOTopogmphic map
(check box) -
DEPTH DRILLING LOG
From To Formation Description
o -Cr)
F-o T.
i F
(J
3,r
r,
LOCATION SKETCH tJ G
Show direction and distance in miles from at least CD
two State Roads or County Roads. Include the road
numbers and common road names.
JA.Ont old 0/n��2�C�Zt�t�.14s6xthat to h0
cl-
otinlet
-a t- il(62Lutta.vrt Road • do a_
O .
44t
fi0 Un.ano-D (. ,fa ti
at IL.CO�L.(_.
sntfl 2.uq(ja cn ( i2maa_a..
16. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN AC RDANCE WITH 15A NCAC C, WELL
CONSTRUCTION STANDARDS, AND THAT Qfa )PY OF S RECO HAS BEEN PROVIDED O TTI$ WELL OWNER
E OF PERS STRUCTING THE WELL 7DATE
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) RICHARD MCCRARY CERTIFICATION # 2010
294760
WELL CONTRACTOR COMPANY NAME BARKER CONSTRUCTION, INC./BARKER WELL & PUMP PHONE # [phone]
STATE WELL CONSTRUCTION PERMIT# 1871 ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential El Municipal/Public ❑ Industrial 0 Agricultural ❑
Monitoring ❑ Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION:
Nearest Town: HENDERSONVILLE County HENDERSON
SOUTH MILLS RIVER ROAD
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: BARBARA GUSTIN (PAUL TAYLOR - CONTRACTOR)
Address 217 KIMBERLY ANN DRIVE
(Street or Route No.)
HENDERSONVILLE NC 28792
City or Town State Zip Code
( 828 )- 693-3596
Area code- Phone number
4. DATE DRILLED MARCH 24, 2004
5. TOTAL DEPTH: 405'
6. DOES WELL REPLACE EXISTING WELL? YES O NO Igl
7. STATIC WATER LEVEL Below Top of Casing: 20 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS 1.33 FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance In accordance with ISA NCAC 2C .0118.
9. YIELD (gpm): 6 METHOD OF TEST TIMED
10. WATER ZONES (depth):
Topographic/Land setting
❑Ridge ®Slope ❑Valley OFlat
(check appropriate box)
Latitudelongitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:OGPSOTopograkhiemap
(check box)
DEPTH DRILLING LOG
From To Fomiation Description
LOCATION SKETCH
11. DISINFECTION: Type BY PUMP INSTALLER Amount Show direction and distance in miles from at least
12. CASING: Wall Thickness two State Roads or County Roads. Include the road
Depth Diameter or Weight/Ft. Material numbers and common road names. O , /
From 0 To 22 Ft. 6 1/8 SDR21 PVC J, t�difi-�/._ ?a. �Afac ( .
From To Ft. o7Jr�.r-t-t-M• n1l1K.J fnd° _ o
From To Ft. Sid per{/ Q
13.FroGRm 0: DepthTo 20 Ft. CONCRETE POURED JAI
• tar . �p a
From To Ft. ix^�-• otgO. 4�/.QC.I�C.e-��a_
ad-
14. SCREEN: Depth Diameter Slot Size Material '(,Ql JI, •- /`^^^i^—V�-'�� -• Q1 :11 From To Ft. in. in. pzut CG, # t _ p-
From To Ft. in. in. 3tl.�
15. SAND/GRAVEL PACK: nn� �c,, �7
Depth Size Material Gt4.L. 11 r__ t �yry
From To Ft. (f
From To Ft.
16. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUC 1ED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND T}{AT AJOPY F THIS RECORD S BEEN PROVIDED T HE LL OWNER
SIGNATURE OF PERSON
STRUC ING THE WELL
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center- Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-1 REV. 07/2001

WELL CONSTRUCTION RECORD
294759
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) KENNETH MCCRARY CERTIFICATION it2008
WELL CONTRACTOR COMPANY NAME BARKER CONSTRUCTION, INC./BARKER WELL & PUMP PHONE # [phone]
STATE WELL CONSTRUCTION PERMITS*1871 ASSOCIATED WQ PERMIT#
(if applicable) (if applicable) .._ .-
1. WELL USE (Check Applicable Box): Residential I 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: HENDERSONVILLE
LAUREL VIEW LOT # 2 & 3
County HENDERSON
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: TERESA HILL
Address 119 POWELL STREET
(Street or Route No.)
HENDERSONVILLE NC 28739
City or Town State Zip Code
( 828 )_ 692-2741
Area code- Phone number
4. DATE DRILLED MARCH 22, 2004
5. TOTAL DEPTH: 555
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO 131
7. STATIC WATER LEVEL Below Top of Casing: 80 FT.
(Use "*" if Above Top of Casing)
8. TOP OF CASING IS 1.33 FT. Above Land Surface*
`Top of casing terminated at/or below land surface requires a
variance in accordance with ISA NCAC 2C .0118.
9. YIELD (gpm): 2 METHOD OF TEST TIMED
10. WATER ZONES (depth):
11. DISINFECTION: Type BY PUMP INSTALLER
12. CASING:
From 0
From
From
13. GROUT: Depth
From 0 To 20
From To
14. SCREEN: Depth,._ FromTo
From To
Depth
To 68
Diameter
Ft. 61/8
To Ft.
To Ft.
Amount
Wall Thickness
or Weight/Ft. Material
SDR21 PVC
Material
Ft. CONCRETE
Ft.
Diameter
Ft. in.
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:DGPSOTopographic map
(check box)
DEPTH DRILLING LOG ,
From To Forrnation,Description: _.
O o
c
/ r_ f`
r c
9 r.
i u,
A
LOCATION SKETCH 03 a-
Show direction and distance in miles from at least two State Roads or County Roads. Include the road
numbers and common road names.
Soft biLutcationdaa to isi
i-catitheoad . Alt Lt-
POURED Gk Sant,gbacit load
Slot Size
in.
in.
Material
�QLut L U.L(%
a,27f rf
16. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDA$DS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
— 94
SIGNATURE OF PERSON CONS CTING THE WELL DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center- Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-I REV. 07/2001

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) KENNETH MCCRARY
294758
CERTIFICATION # 2008
WELL CONTRACTOR COMPANY NAME BARKER CONSTRUCTION, INC./BARKER WELL 8 PUMP PHONE # [phone]
STATE WELL CONSTRUCTION PERMIT# 1871 ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential l Municipal/Public 0 Industrial ❑ Agricultural 0
Monitoring O Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION:
Nearest Town: HENDERSONVILLE County HENDERSON
SARA KING ROAD
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: PAUL AND BRENDA WOOD
Address 608 CANAL DRIVE
(Street or Route No.)
HENDERSONVILLE NC 28739
City or Town State Zip Code
( 828 )_ 699-1986
Area code- Phone number
4. DATE DRILLED MARCH 24, 2004
5. TOTAL DEPTH: 380
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO
7. STATIC WATER LEVEL Below Top of Casing: 60 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS 1.33 FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordance with ISA NCAC 2C .0118.
9. YIELD (gpm): 3 METHOD OF TEST TIMED
10. WATER ZONES (depth):
11. DISINFECTION: Type BY PUMP INSTALLER Amount
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft.
Front 0 To 90 Ft. 61/8 SDR21
From To FL
From To Ft.
13. GROUT: Depth Material
From 0 To 20 Ft. CONCRETE
From To Ft.
14. SCREEN: Depth Diameter
From To Ft. in.
From To Ft. in.
15. SAND/GRAVEL PACK:
Slot Size
in.
in.
Material
PVC
Method
POURED
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:OGPSOTopographic map
(check box)
DEPTH DRILLING LOG
From To Formation Description
q
rn
LOCATION SKETCH A r
Show direction and distance in miles from at leashQ rti
two State Roads or County Roads. Include the roarY'
numbers and common road names. c�
J,t&n J/2/[c& zt dO fait)
Youc�z `�Zd fa 6,6a_4 end.
)a tt¢- a_ McZtil "Se ae
tOCLOt O a_ G '_9ilf ere_
Material i p / u f 2. / U� 2
y Zit
at .0)C-d
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 PBH'SON CONSTRUCTING THE WELL DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center- Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-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) RICHARD MCCRARY CERTIFICATION # 2010
WELL CONTRACTOR COMPANY NAME BARKER CONSTRUCTION, INC./BARKER WELL & PUMP PHONE # f828) 697.7263
STATE WELL CONSTRUCTION PERMIT# 1871 ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
294757
1. WELL USE (Check Applicable Box): Residential El Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION:
Nearest Town: HENDERSONVILLE County HENDERSON
CORNER OF BRYSON AND KIMZEY ROADS
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: MICHAELARISON
Address PO BOX 11-1605
(Street or Route No.)
MIAMI FL
33111-1650
City or Town State
( 828 )_ 890-1796
Area code- Phone number
4. DATE DRILLED MARCH 22, 2004
5. TOTAL DEPTH: 205
Zip Code
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO El
7. STATIC WATER LEVEL Below Top of Casing: 15 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS 1.33 FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordance with ISA NCAC 2C .0118.
9. YIELD (gpm): 30 METHOD OF TEST TIMED
10. WATER ZONES (depth):
11. DISINFECTION: Type BY PUMP INSTALLER Amount
12. CASING: Wall Thickness
Depth
From 0 To 50 Ft.
From To Ft.
From To Ft.
13. GROUT: Depth Material
From 0 To 20 Ft. CONCRETE
From To Ft.
14. SCREEN: Depth Diameter
From To Ft. in.
From To Ft. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
Diameter or Weight/Ft. Material
61/8 SDR21 PVC
Slot Size Material
in.
in.
16. REMARKS:
Topographic/Land setting
❑Ridge ®Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds) _.
Latitude/longitude source:OGPSOTopographic map
(check box)
DEPTH DRILLING LOG
From To Formation Description
c
C!,
t� .o
cs
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.
slam brit/ ,c tCt a tutt-
,y6,/ • #/9/ .CV. `�8O— a-
ex, # 210 , rag,
�IufL 4ixd /Y_I�tJx.� CC��^'�"1 ((//
J�•Wad �C.YJoaten
, -4 A --
?Coact. 140 g`t`r
thiv 6x Z22y
a -
. (X-t th
C,c 'L ads -
1 DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE IT}}}HDDDDI5A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND T COPY OF THIS RECORD HAS BEEN P TO THE WELL OWNER
SIGNATURE 0 SON CONSTRUCTING THE LL / /
DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center- Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-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) RICHARD MCCRARY CERTIFICATION # 2010
WELL CONTRACTOR COMPANY NAME BARKER CONSTRUCTION, INC./BARKER WELL 8 PUMP
294754
PHONE # [phone]
STATE WELL CONSTRUCTION PERMIT# 1871 ASSOCIATED WQ PERMIT# _----- ...
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential El MunlicipaUPublic 0 Industrial 0 Agricultural O
Monitoring ❑ Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION:
Nearest Town: HENDERSONVILLE County HENDERSON
OLD CLEAR CREEK RD., PASS WEATHEROW RIDGE ROAD
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: MARK D. FREEMAN
Address 120 LOWER CHRIST SCHOOL ROAD
(Street or Route No.)
FLETCHER NC 28732
City or Town State
( 828 )- 684-1826
Area code- Phone number
4. DATE DRILLED MARCH 9, 2004
Zip Code
5. TOTAL DEPTH: 245'
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO gl
7. STATIC WATER LEVEL Below Top of Casing: 60 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS 1.33 FT. Above Land Surface'
*Top of casing terminated at/or below land surface requires a
variance in accordance with 15A NCAC 2C .0118.
9. YIELD (gpm): 6 METHOD OF TEST TIMED
10. WATER ZONES (depth):
Topographic/Land setting
®Ridge ❑Slope ❑Valley EFlat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/ongitude source:OGPSOTopographic map
(check box)
DEPTH DRILLING LO({
From To Formation Description
11. DISINFECTION: Type aYPUMP INSTALLER Amount
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
From 0 To 41 Ft. 61/8 SDR21 PVC
From To FL
From To Ft.
13. GROUT:
From 0
Depth Material
To 20 Ft. CONCRETE
From To Ft.
14. SCREEN: Depth Diameter
From To Ft. in.
From To Ft. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
Slot Size
in.
in.
Method
POURED
LOCATION SKETCH . %"
Show direction and distance in miles from at least ' s
two State Roads or County Roads. Include the road y
numbers and common road names.
Front Hendersovni Ile +a VI East- 40 !S.r
Cree t P.d. Tate Clear erect Y2a . -tD fru-i+tand -
01dCIeargreeted. -ppass 2 large fiberjrciss
bulls orL left ak Ehod,es toad, paw
Ldea.I-here wTLidoe .Theft- i ticdfive
Material Oft lef-1- - 11 It arl a e_ c*' l ef+ is pass
et_ paved. drisewifh.break_ eolumrls.
two barns - proper-- ort4he left•
16. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH ISA NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A GOPY,pF THIS RECORD HAS BEEN PROVIDED TO THE ELL OWNER
oC,
UCTING THE WELL D
/ATE (
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center- Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-1 REV. 07/2001

297724
WELL CONSTRUCTION RECORD
North Carolina - Department of Environs -tent and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) QQeCZCIC ?14t.e&'tti ,SG Z.% Cl CERTIFICATION# 243f0
W ELL CONTRACTOR COMPANY NAME S1'Q So1a14of�a5on r1E-t\�{�umP Ane PHONE #(54 665-tTo'2'L
T SATE WELL CONSTRUCTION PERMIT# O ASSOCIATED WQ PERMIT#
mommi(ifapplicablc) emenummisimm(ifapplictble)
1. WELL USE (Check Applicable Box) Residential 18 Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery ❑ Heat I ump Water Injection ❑ Other 0 If Cther, List Use
2. WELL LOCATION: r.
Nearest Town: Per Nt Sotel [IC County LrSD4
N RuVc Rena
(Street Name. Numbers. Community, Subdivi 'on, Lot No., Zip Code)
3. OWNER: A1nd.J Y-l..det'nan eLc. 1dst '
Address PC %GA a138
(Street or Route No.)
1a ¢crecv. to /JC a Q lQrl
City or Town State Zip Code
(Salt- (o 50 OP(c.cc
Area code- Phone number
4. DATE DRILLED 5- 1z-o`1
5. TOTAL DEPTH: a46
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO [I
7. STATIC WATER LEVEL -Below To) of Casing: (C) FT.
(Use "F" if Above Top of Casing)
8. TOP OF CASING IS t FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordance with ISA NCAC 2C .2118.
9. YIELD (gpm): 2 METHOE OF TEST 4
10. WATER ZONES (depth): d
11. DISINFECTION: Type e:a. Amount 6
12. CASING: Wall Thickness
Diametar or Weight/Ft.
Ft. fo E
i 21
Ft.
Ft.
Depth
From irk To 19
From To
From To
13. GROUT: Depth
From 0 To i0 Ft.
From To Ft.
14. SCREEN: Depth Diameter
From To Ft. io
From To Ft. i n
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
16. REMARKS:
Mat :vial
Material
'E145 F:C_
Topo�gzyphic/Land setting
DRidge LKSIope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
Latitude/longitude
DEP-. H
From To
(degrees/minutes/seconds)
source:❑GPS❑Topographic ma p
(check box) '
DRILLI G LOG_
Fomiation Description
}1 -to r]9
q To a45
Method
Po,,.ceta
Slot Size Material
in.
in.
ON/QC C Wan.n
C;co is ce
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers end common road names.
I DO HEREBY CERTIFY THAT THIS WELT . WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THA T A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
lsnytLex I4QPt r-W /.Ina+�^a,AvvtK 5• 12- OM
SIGNATUF E OF PERSMCONSTRUCTING THE WELL DATE
Submit the original to the Division of W ater Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
27699-1636 Phone No. [phone], with 30 days. GW-I REV. 07/2001

297647
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resourc
\\EI.L ('ON I RA CI OR (INDIVI D(AL) NAME (print) WN/tj
W Eta. CON I RAC I OR CO,M PANT NAME AftsialSS.K1.lYri._33
S I.\IE \\ El . CONS I ION PENNI ITN
it -applicable)
- Division of Water Quality - Groundwater Section
CERTIFICATIONNL`b_
r
}21f QY1��IOQ PHONE d gjrjyyt151.a5
ASSOC:LI1 Ell PE RM ITN ------
(if applicable)
WELL USE (Cheek Applicable Box)' Residential Tit" NIunicipaUPt:bi C 0 Industrial ❑ Auricultural 0
Mcnh ..ring. ❑ Rccosery 0 Heat Pump \Va:er Injection 0 Other ❑ li Other, List Usc
2. WELL LOCATION; _/
Nearest T•n\n, Cff County
l tY 40 w
LD-4 Ida 1n111ia ub• i1/4/. —
(Slrect Name. Numbers. Community. subdivision, law No_ h p Coto
TopographiciLand setting
Midge ❑Slope ❑Valley ,-OFIat
(check appropriate boxI
Latitude/longitude of well location
3. OWNER' Q i _destc (deg:tesmmmmey seconds:
.\ddres; _. l.Z—_-- I.:alitude luneltude source:❑CiPS❑Topographic map
u , Ho of ��� 1� QE(chuck burl
�"Y b PTH DRILLING De LOG
Frontn:. To FormationatiooDescription
t'v) or T,mn State Lip Code
4. DATE DRILLED CA - 17 © 4
:Arta c.we- Phone number
5. TOTAL DEPTH:__aa S-±—__.
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO
7 STATIC WATER LEVEL Below Top of Casing: `a° FT.
Il,Bse if Above Top of Cavagl
S. TOP OF CASING IS t FT Above Land Surface"
''I up of casing terminated atlur below land surface require. a
varFence in accordance with 154 NC AC 2C. Atlb. a ! `—
9. YIELD(uptn)'. 7- METHOD OF i' 101
10. WATER ZONES {depth):_--��`__y-.L._._
t 1. DISINFECTION: Type _fig e�yL,.Z— Amettnt - .__
12. CASING. Wa'.! Thickness
Dcpthr7 0Diameter er Weight'Ft. Material
From To 7_.. _ FtFrom To Ft. ---------
F7om To Et.
13. GROUT: Dc:;th i/n Ataateerriaal -�,, Aleeihod
From To -_— Ft.LAI -t1Y"
From To Fl. -_ —__
I SCRGE N' Depth D:emcter S'il Si: Matcna!
Front To Ft. in. in.
Front — To Et in. in.
15. SAND/GRAVEL PACK:
Dcpiit Size Atztcrial
FlomTo Ft
Prom Tu Fi
LOCATION SKETCH
Show titfeclion and disian.e in miles from at least
two State Roads or Count) Roads. Include the road
numbers and common road names
*cwt.( z-86
e%.90 f U64 a
fV
16. REMARKS:
! DO HEREBY CERTI v THAT "PHIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH I5A N'CAC 2C. WELL
CONSTitUCTION ST • •ARDS, AND TJIAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
02- 5- 04
SIGNATURE.. OF PERSON CONSTRUCTING THE \1 ELI.
DATE
Submit the original to the Dirision of Water Quality, Groundwater Section. tn36 Mail Service Center- Raleigh, NC
27699-106 Phone No. (919) -?3-3221, within 30 days.REV. 0 ,2001
/tn

297643
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WELL CONSTRUC TION RECORD 297631
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296817
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) KENNETH MCCRARY CERTIFICATION # 2008
WELL CONTRACTOR COMPANY NAME BARKER CONSTRUCTION, INC./BARKER WELL & PUMP PRONE # [phone]
STATE WELL CONSTRUCTION PERMIT# 1871 ASSOCIATED WQ PERMIT#
(if applicable) (if applicable) -- -
1. WELL USE (Check Applicable Box): Residential D Municipal/Public ❑ Industrial O Agricultural O
Monitoring ❑ Recovery 0 Heat Pump Water Injection ❑ Other 0 If Other, List Use
2. WELL LOCATION:
Nearest Town: HENDERSONVILLE County HENDERSON
LAUREL CREEK VIEW DRIVE
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: LEON AND ROBBIE ALLISON
Address PO BOX 245
(Street or Route No.)
ZIRCONIA NC 28790
City or Town State Zip Code
( 828 )_ 674-0731
Area code- Phone number
4. DATE DRILLED JUNE 30, 2004
5. TOTAL DEPTH: 130'
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO RI
7. STATIC WATER LEVEL Below Top of Casing: 20 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS 1.33 FT. Above Land Surface*
'Top of casing terminated at/or below land surface requires a
variance in accordance with ISA NCAC 2C .0118.
9. YIELD (gpm): 25 METHOD OF TEST TIMED
10. WATER ZONES (depth):
11. DISINFECTION: Type BY PUMP INSTALLER Amount
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
From 0 To 36 Ft. 6 % .185 STEEL
From To Ft.
From To Ft.
Topographic/Land setting
[Ridge ❑Slope ❑Valley K1Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:OGPSOTopographic map
(check box)
DEPTH DRILLING LOG
From To Formation Description
13. GROUT: Depth Material Method
From 0 To 20 Ft. CONCRETE POURED
From To
Ft.
14. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in.
From To Ft. in. in.
15. SAND/GRAVEL PACK:
- Depth Size Material
From To Ft.
From To Ft.
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common road names.
J,wm JJAndur oju,cd€ 2t %
�/, . /762&dL.!J a
at clu.Ly.day-cab_ a_
,cnS ctcoce-t Octet VA )
p& z J t 4LLYZ4t 9 t
ceaunct Ce icca_ed
Lcuot4{o ^ Xau.t-e
�.e2�/LGGL�
16. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
?-a-(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- I REV. 07/2001

WELL CONSTRUCTION RECORD
29G975
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) KENNETH MCCRARY
CERTIFICATION # 2008
WELL CONTRACTOR COMPANY NAME BARKER CONSTRUCTION, INC./BARKER WELL & PUMP PHONE # {828) 697-7263
STATE WELL CONSTRUCTION PERMIT# 1871 ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential NI Mtmicipal/Public 0 Industrial 0 Agricultural ❑
Monitoring 0 Recovery 0 Heat Pump Water Injection ❑ Other ❑ If Other, List Use
2. WELL LOCATION:
Nearest Town: HENDERSONVILLE
NEWMAN ESTATES, LOT #4
County HENDERSON
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: BUD MARSHALL
Address 2606 KANUGA ROAD
(Street or Route No.)
HENDERSONVILLE NC
28739
City or Town State
( 828 )_ 693-4671
Area code- Phone number
4. DATE DRILLED JUNE 22, 2004
5. TOTAL DEPTH: 280'
Zip Code
6. DOES WELL REPLACE EXISTING WELL? YES O NO Ea
7. STATIC WATER LEVEL Below Top of Casing: 40 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS 1.33 FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance In accordance with ISA NCAC 2C .0118.
9. YIELD (gpm): 4 METHOD OF TEST TIMED
10. WATER ZONES (depth):
Topographic/Landsetting
DRidge ®Slope °Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:OGPSDTopographic map
(check box)
DEPTH DRILLING LOG _.
From To Formation De@e�riptiori
11. DISINFECTION: Type 6Y PUMP INSTALLER
12. CASING:
Depth Diameter
From 0 To 77 Ft, 61/8
From To Ft.
From To Ft.
13. GROUT: Depth Material
From 0 To 20 Ft. CONCRETE
From To Ft.
14. SCREEN: Depth Diameter
From To Ft. in.
From To Ft. in.
Amount
Wall Thickness
or Weight/Ft. Material
SDR21 PVC
Method
POURED
C)
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common road names.
Jim b l_ani P.titott u C L _ t.
/a19a food G�ta_6 eic ei.
dace_�-/ Q.�i.�/ At fan �e.d.&en(,�t/�{"�-/�
Slot Size Material /COQ.GI. ova_ _Op kt I f iewma
in. (_' a $) t
/
15. SAND/GRAVEL PACK:
-- Depth Size Material
From To Ft.
From To Ft.
16. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH I5A NCAC 2C, WELL
CONSTRUCTION STANDARDS, ANDD'THAT
"AA CCO�P-Y OF THIS RECORD HAS�—B-EEEN PROVIDED TO THE WELL OWNER
y/'
Lo
pi
SIGNATURE OF PERSONCONSTRUCTING THE WELL DATE -t 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-1 REV. 07/2001

WELL CONSTRUCTION RECORD
?96814
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) KENNETH MCCRARY CERTIFICATION # 2008
WELL CONTRACTOR COMPANY NAME BARKER CONSTRUCTION, INC./BARKER WELL & PUMP PHONE # [phone]
STATE WELL CONSTRUCTION PERMIT# 1871 ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
1
WELL USE (Check Applicable Box): Residential El Municipal/Public ❑ Industrial 0 Agricultural ❑
Monitoring ❑ Recovery 0 Heat Pump Water Injection O Other ❑ If Other, List Use
2. WELL LOCATION:
Nearest Town: HENDERSONVILLE County HENDERSON
NEWMAN ESTATES, LOT #3
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: BUD MARSHALL
Address 2606 KANUGA ROAD
(Street or Route No.)
HENDERSONVILLE NC
28739
City or Town State
( 828 )- 693-4671
Area code- Phone number
4. DATE DRILLED JUNE 23, 2004
Zip Code
5. TOTAL DEPTH: 280'
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO El
7. STATIC WATER LEVEL Below Top of Casing: 40 FT.
(Use "*" if Above Top of Casing)
8. TOP OF CASING IS 1.33 FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordance with 15A NCAC 2C .0118.
9. YIELD (gpm): 4 METHOD OF TEST TIMED
10. WATER ZONES (depth):
11. DISINFECTION: Type BY PUMP INSTALLER
Amount
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
From 0 To 74 Ft. 61/8 SDR21 PVC
From To Ft.
From To Ft.
13. GROUT: Depth Material Method
From 0 To 20 Ft, CONCRETE POURED
From To
Ft.
14. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in.
in.
Material
Topographic/Land setting
❑Ridge ®Slope OValley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:OGPSOTopographic map
(check box)
DEPTH DRILLING LOG
From To Formation Description
From To Ft. in.
15. SAND/GRAVEL PACK:
Depth Size
From To Ft.
From To Ft.
O
L
c-
s
7 —
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.
&Lot JLvtc(LUoktkk at -tato
Yantiaa_.2oad to @n.a b
a,&. &.& .
J� a_fLB O� RacLGLLTL Rd.
16. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITII 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
1 �rvru-w, I�l�ljz C�—Lc— 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

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) KENNETH MCCRARY CERTIFICATION # 2008
WELL CONTRACTOR COMPANY NAME BARKER CONSTRUCTION, INC./BARKER WELL & PUMP PHONE # [phone]
STATE WELL CONSTRUCTION PERMIT# 1871 ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
296813
1. WELL USE (Check Applicable Box): Residential El MtmicipaVPublic 0 Industrial 0 Agricultural 0
Monitoring ❑ Recovery O Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION:
Nearest Town: HENDERSONVILLE
County HENDERSON
PEACEFUL VIEW ESTATE, LOT #8
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: EDDY ASKEW
Address 209 LYNDALE ROAD
(Street or Route No.)
HENDERSONVILLE NC 28739
City or Town State
( 828 )_ 329-0667
Area code- Phone number
4. DATE DRILLED JUNE 18, 2004
Zip Code
5. TOTAL DEPTH: 505'
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO 131
7. STATIC WATER LEVEL Below Top of Casing: 40 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS 1.33 FT. Above Land Surface*
'Top of casing terminated at/or below land surface requires a
variance in accordance with 15A NCAC 2C .0118.
9. YIELD (gpm): 3 METHOD OF TEST TIMED
10. WATER ZONES (depth):
11. DISINFECTION: Type BY PUMP INSTALLER
12. CASING:
Amount
Wall Thickness
Depth Diameter or Weight/Ft. Material
From 0 To 47 Ft. 61/8 SDR21 PVC
From To Ft.
From To Ft.
13. GROUT:
From 0
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.
Depth
To 20
Material
Ft. CONCRETE
Slot Size
in.
in.
Topographic/Land setting
❑Ridge ®Slope OValley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds) I
Latitude/longitude source:OGPSOTopographiamap----
(check box)
DEPTH DRILLING LOG
From To Formation Description
Method
POURED
LOCATION SKETCH r --
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common road names.
t wtnc-lien ra&L& - Ea.fa'-G," Baez.
Jab a_/(d±Cit ♦ ti r• r/�,aQlf!.
,coo A .5- P Sicend
aJugJ�'t.t2a2>`, d`ite U
autCatalta-
taced
ditia-
fax
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
c
SIGNATURE OF PERSON CONSTRUCTING TllJ WELL
- 1 5-)- dt
DATE 1'
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-1 REV. 07/2001

WELL CONSTRUCTION RECORD t 9 6 812
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) KENNETH MCCRARY CERTIFICATION # 2008
WELL CONTRACTOR COMPANY NAME BARKER CONSTRUCTION, INC./BARKER WELL & PUMP PHONE # [phone]
STATE WELL CONSTRUCTION PERMIT# 1871 ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential El Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring ❑ Recovery 0 Heat Pump Water Injection ❑ Other 0 If Other, List Use
2. WELL LOCATION:
Nearest Town: HENDERSONVILLE
THE RIDGE, LOT#2
County HENDERSON
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: CATHY AND MIKE BURNS
Address 2304 LABURNUM AVENUE
(Street or Route No.)
CHARLOTTE NC 28205
City or Town State Zap Code
( 704 )_ 344-1003
Area code- Phone number
4. DATE DRILLED JUNE 16, 2004
5. TOTAL DEPTH: 880'
6. DOES WELL REPLACE EXISTING WELL? YES O NO RI
7. STATIC WATER LEVEL Below Top of Casing: 30 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS 1.33 FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance In accordance with 15A NCAC 2C .0118.
9 YIELD (gpm): h METHOD OF TEST TIMED
10. WATER ZONES (depth):
I1. DISINFECTION: Type BY PUMP INSTALLER Amount
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
From 0 To 51 Ft. 61/8 SDR21 PVC
From To Ft.
From To Ft.
Topographic/Land setting
®Ridge 0Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:OGPSEITopographic ma-p
(check box)
DEPTH DRILLING LOG
From To Formation Description
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.
J*cm khiag taru,uut, *alt d%tcJea
toukud etvc k1h eicpic eesuiat'tat
go to emu- iC,9act. dait_a.
LT?t auttenct tom/ rau goad
/42-Ltu2d a tetlaitd . So to Atte-end
lntttamee P,ca %J.-Lazio; .
t/iQ %LOGtcL . 7710 nat.lI it / 4 ph_ -o?
/dot/� o /GcGiLZF fT�/ /Load_.
13. GROUT: Depth Material Method
From 0 To 20 Ft. CONCRETE POURED
From To Ft.
14. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in.
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
16. REMARKS:
11/l�f pr/J.
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
l am —PLC -1�`
SIGNATURE OF PERSON CONSTRUCTIN HE 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
296311
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) KENNETH MCCRARY CERTIFICATION # 2008
WELL CONTRACTOR COMPANY NAME BARKER CONSTRUCTION, INC./BARKER WELL & PUMP PHONE # [phone]
STATE WELL CONSTRUCTION PERMIT# 1871 ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential ® Municipal/Public 0 Industrial ❑ Agricultural 0
Monitoring 0 Recovery ❑ Heat Pump Water Injection ❑ Other 0 If Other, List Use
2. WELL LOCATION:
Nearest Town: HENDERSONVILLE
AMBER KNOLL SUBDIVISION, LOT #3
County HENDERSON
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: GREG DALTON
Address 541 SUMMER ROAD
(Street or Route No.)
HENDERSONVILLE NC
28792
City or Town State
( 828 )_ 685-1003
Area code- Phone number
4. DATE DRILLED JUNE 3, 2004
5. TOTAL DEPTH: 505'
Zip Code
6. DOES WELL REPLACE EXISTING WELL? YES LI NO CU
7. STATIC WATER LEVEL Below Top of Casing: 60 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS 1.33 FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordance with 15A NCAC 2C .0118
9. YIELD (gpm): 1 G METHOD OF TEST TIMED
10. WATER ZONES (depth):
Topographic/Land setting
❑Ridge ®Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds) _
Latitude/longitude sourcc:OGPSOTopo4raphic map
(check box) - _
DEPTH DRILLING LOG
From To Formation Description
O
r_
LOCATION SKETCH
11. DISINFECTION: Type BY PUMP INSTALLER Amount Show direction and distance in miles from at least
12. CASING: Wall Thiclmess two State Roads or County Roads. Include the road
Depth Diameter or Weight/Ft. Material numbers1 Iand common road names.
From 0 To 60 Ft. 61/8 SOR21 PVC-7IENDERSCNIVILI._E TAKE %4 EAST
From To Ft. "TURN RIC4fTAT GIWAMMTN.ROAD.
TURN L.6FTAT SUGAI2LoAf KIN. Ro4D•
TURN RIGHT AT SLU11lKER 'ROAD• TURN
LEFT AT KERRR RoAD. TAKE A
14. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in. 2-NO LOT ON THE RIGHT From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Size Material Ake ER KN011 .u31D 1V)$ ION)
From To Ft. LOT- 3
From To Ft.
From To Ft.
13. GROUT: Depth Material Method
From 0 To 20 Ft, CONCRETE POURED
From To Ft.
RIGHT IN-ro iihISEKKNou.. sub')NISIOti
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
)esvin,
n
SIGNATURE OF PERSON CONSTRU ING THE WELL
`y -o,�
DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-1 REV. 07/2001

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and NA Resources - Division of Water Quality - Groundwater Section �7 �7
!1
WELL CONTRACTOR (INDIVIDUAL) NAM(( (print) /(1 i Imo/ L - i . CERTIFICATION # R / /
WELL CONTRACTOR COMPANY NAME t/a iP //X L(.%P-PAV/J.e cQ PRONE # (t&74fl-D�.YLJ
1S.SOCIATED WQ PERMIT# - ?at)
STATE WELL CONSTRUCTION PERMIT#
(if applicable) 4/79
(if applicable)
298808
1. WELL USE (Check Applicable Box): Residential 14 Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection ❑ Other 0 If Other, List Use
2. WELL LOCATIO
Neare Town: County
2--
(StreetNadfe, Number, Community, Subdivision, Lot No., Tap Codc)
. ,Ltu.r I IdLt . (S t. or,/p 2
Route No.) d 2.3. t1.r�/ State tip Code
3. OWNER:
Address,
City or Town
(_)-
Area code- Phone number
4. DATE DRILLED ///�//, 4i
5. TOTAL DEPTH: ..Z O..'i '
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO SI
7. STATIC WATER LEVEL Below Top of Casing: 4/D FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS 1 5 FT. Above Land Surface*
'Top or casing terminated at/or below land surface requires a
variance hi accordance rith 1SA NCAC 2C .0118. •
9. YIELD (gpm): METHOD OF TESTTrrrne
10. WATER ZONES (depth): %e2. O
11. DISINFECTION: Type (1.. N. it/ Amount 7 az-
12. CASING: Wall ThicknessDepth Diameter or Mace
-#a2/WeighuFt rydC
al
From_�� To . �1 i) Ft t'
From To Ft
From To Ft.
13. GROUT: Depth Material -i
From_ fZ_ To�jL Ft Material
e '
From To Ft.
14. SCREEN: Depth Diameter Slot Size Material
Fro To Ft. in. in.
From To Ft. in
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To�Ft.
16. REMARKS:
Topographic/Land setting
Midge ❑Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/mimnes/seconds)
Latitude/longitude source:❑GPS❑Toppgraphic map
(check box) 1
DEPTH DRILI.rtic LOG_
From To Formation Description
0
m�
(V --�
G
LOCATION 1SKETCF(
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 WFI f WAS CONSTRUL iris IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WFT I OWNER
e // /f,y
SIGNATURE OF PERSON CONSTRUCTING THE WELL MUT
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

298807
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and N2tttra1 Resources - Division of Water Quality - Groundwater Section
rj/7
WELL CONTRACTOR (INDIVIDUAL) NAME (print) ! /) %� n//U / e /'S NL//L" CERTIFICATION #,9 JS / /
WELL CONTRACTOR COMPANY NAMEXL..r Lr'v�//'AL�.�e Y-5Zi 4n t� PHONE # 4?z1ft g7-t' Vera
STATE WELL CONSTRUCTION PERMIT# (4 _ASSOCIATED WQ PERMIT(/ # 57/ 0 -y._._-__
(if applicable) (if pplicable)
1. WELL USE (Check Applicable Box): Residential ( Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATI9JI:
'nil
oZ 3779Z
(Street Name, Numbers, Community, Subdivisi66, Lot No., Zip Code)
3. OWNER/II014e 4 4
Address /!r 9 y ive /f
(Street or Route No.)
City or Town State tip Code
Area code- Phone number
4. DATE DRILLED /.S/ n //
5. TOTAL DEPTH: ¶. 9 S
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO {$(
7. STATIC WATER LEVEL Below Top of Casing: 2 5— FT.
(Use "+' if Above Top of Casing)
8. TOP OF CASING IS / 5 FT. Above Land Surface'
'Top of wing terminated at/or below land surface requires a
variance ha accordance with ISA NCAC SC .0118.
9. YIELD (gpm): S' METHOD OF TEST / .(,a[j
10. WATER ZONES (depth):
LOCATION SKETCH o t"=
rn:;
//, // Amount V Bz Show direction and distance in miles Nap at l6st
Wall Thickness two State Roads or County Roads. Inclide that -clad
Djamerer or Wei UR. Material numbers and common road names.
Topographic/Land setting
❑Ridge 6ilSlope ❑Valley ❑Flat
(deck appropriate box)
Latitude/longitude of well location
(degreetlm®strs/seconds)
Latitude/longitude source:❑GPS❑Topdgraphic map
(check box) ' _.
DEPTH DRILLING LOG
From To Formation Description
11. DISINFECTION: Type /',
12. CASING:
Depth
From P", Ft. •
From. To FL
From To Ft
13. GROUT: Depth ��
From 0 To 1) Ft. (# ,91
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 o Ft.
From To Ft.
16. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUC TW IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, ANIjTHAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
/1/431/iy
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
Dee 1L
/R (d 9 r
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

2-ou 63
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and attr-4 Resources - D vision of Water Quality - Groundwater Section
I c 1
WELL CONTRACTOR (INDIVIDUAL) NAME (print) Kf 5 Jt IW`O - . CERTIFICATION a �3a 8
WELL CONTRACTOR COMPANY NAME Mr £rtv J PHONE Si fiZttl 4S4r-579q
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMITS
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential 0 Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATIO _
Nearest Town: 1Tee %
1-7 Came Creek P.ct
(Street Name, Number, Community, Subdivision, Lot No., Zip Code)
,II ► I 1%
3. OWNER: Vtrite.5 C1nn5t A AC Errt /
Address - 11 Cone. Cre.. k ea
(StreetCttnmexn.)
Clelr kn ZB1'XZ
County 14GX2erstn
City or Town S Zip Code
(4Zs} lo7L-'9 l
Area code- Phone number
4. DATE DRILLED .3/11 f3t-1
5. TOTAL DEPTH: T4
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO I-
7. STATIC WATER LEVEL Below Top of Casing: 1 b • Co Fr.
(Use "+" if Above Top of Cuing)
8. TOP OF CASING IS FT. Above Land Surface*
Top of cuing terminated at/or below land surface requires a
variance In accordance with ISA NCAC 2C .011&
9. YIELD (gpm): METIIqD OF TEST
10. WATER ZONES (depth): 1 O.k' ZU r
11. DISINFECTION: Type
12. CASING:
From,To_ m
From To
From To
13. GROUT: Depth
From 0 To Z
From To
Ft.
Ft.
Ft.
Amount
Wall Thickness
Dipter 5or rretiitift. I.1aUtepal
tj
Ft.
Method
pOVr
14. SCREEN: Depth Diameter Slot Size terial
From q To Zy Ft._ai in. ()eon in.
From To Ft. in. in.
15. SAND/GRAVEL PACK: If�aatt 1
From_i_To�ay FL Wa. S, I1c4 Sc r ck
From To Ft.
16. REMARKS:
Topographic/Land setting
IBkidge ['Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitud of well location
75 ?if so"NJSZazq'S9'w
(degtcp/munutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(cheek
DRILLING LOG
Jormatioq. escriptioono / 11
j .,3A L 11°` ' l
mtteitcovb C.1 its, 5'liW -Rad
Brown IY1,Gtteetls °s:ft ,
Brownm:r.etnoe.Set 6a,.S.W
DEPTH
From —T�o
D 'D
1(� 16
IS 11
►� ao
z& Z4
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.
• mo-1
S
1 DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH ISA NCAC 2C, WELL IV
CONSTRUCTION STA�I BARDS THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNED
/1i/ny
SIGNATURE OF PERSON CONSTRUCTING THE WELL DA���-EE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mall Service Center -Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-1 REV. 07/2001
c

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (prior) KENNETH MCCRARY
298143
CERTIFICATION # 2008
WELL CONTRACTOR COMPANY NAME BARKER CONSTRUCTION, INC./BARKER WELL & PUMP PHONE # [phone]
STATE WELL CONSTRUCTION PERMIT# 1871 ASSOCIATED WQ PERMIT# _.
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential D MunicipaYPublic 0 Industrial 0 Agricultural ❑
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION:
Nearest Town: HENDERSONVILLE County HENDERSON
RAVENWOOD FOREST - LOT #27
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: JERRY DYER
Address PO BOX 2056
(Street or Route No.)
HENDERSONVILLE NC 28793
City or Town State Zip Code
( 828 )- 891-2153
Area code- Phone number
4. DATE DRILLED FEBRUARY 10, 2004
5. TOTAL DEPTH: 280
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO El
7. STATIC WATER LEVEL Below Top of Casing: 20 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS 1.33 FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordance with 15A NCAC 2C .011&
9. YIELD (gpm): 15 METHOD OF TEST TIMED
10. WATER ZONES (depth):
11. DISINFECTION: Type BY PUMP INSTALLER Amount
12. CASING: Wall Thiclmess
Depth Diameter or Weight/Ft.
From 0 To 86 Ft. 61/8 SDR21
From To Ft.
From To Ft.
13. GROUT: Depth
From 0 To 20
Material
Ft. CONCRETE
From To Ft.
14. SCREEN: Depth
From To
From To
15.
Material
PVC
Method
POURED
Topographic/Land setting
❑Ridge ®Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:OGPSOTopographic map
(check box)
DEPTH DRILLING LOG
From To Formation Description
c
r-I
1 c<.
XJ _ rr
Y>
rn
ma
0 —+
LOCATION SKETCH z
Show direction and distance in miles from at (east
two State Roads or County Roads. Include the road
numbers and common road names.
,4-itomJIrsnh00P &CtitlQ¥ //th±
to a lU ltitOn 6Q�i(l CIA- JO P�7CT d. 4aJt
O I,� &Ldol c 12oa3 . &agoa-
info kcwsfitlt fi d oT 'Lfo cc -
Diameter Slot Size Material MC RO, _, I ' CN d Lei
Ft. in. in. ��`�(�7/��7��� l�(!f(f�a ( L W W fix-
Ft. in. in.
Size Material
SAND/GRAVEL PACK:
Depth
From To Ft.
From To Ft.
16. REMARKS:
1 DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUL IED 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 l. DATE
J
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 29814 2
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) RICHARD MCCRARY CERTIFICATION # 2010
WELL CONTRACTOR COMPANY NAME BARKER CONSTRUCTION, INC./BARKER WELL & PUMP _ PHONE # [phone]
STATE WELL CONSTRUCTION PERMIT# 1871 ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential RI Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery ❑ Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION:
Nearest Town: HENDERSONVILLE
County HENDERSON
NORTH RIDGE ROAD
(Street Name, Numbers, Community, Subdivision, Ltd No., Zip Code)
3. OWNER: WAYNE AND GAIL PACE
Address 1090 NORTH RIDGE ROAD
(Street or Route No.)
HENDERSONVILLE
NC
28792
City or Town
( 828 )- 685-7865
Area code- Phone number
State
Zip Code
4. DATE DRILLED FEBRUARY 11, 2004
5. TOTAL DEPTH: 245
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO
7. STATIC WATER LEVEL Below Top of Casing: 5 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS 1.33 FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordance with ISA NCAC 2C .0118.
9. YIELD (gpm): 12 METHOD OF TEST TIMED
10. WATER ZONES (depth):
11. DISINFECTION: Type BY PUMP INSTALLER Amount
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material , - 0
From 0 To 105 Ft. 61/8 SDR21 PVC A //�tcatQ> Ltae Tom- d#
From To Ft. pj o�V p /J n -
From To Ft. 44f- -/�^4 Qd. WRY
13. GROUT: Depth CONCRETE
Material Method V � O Goad and
From 0 To 20 Ft. CONCRETE POURED Q7tc �/L /i.!/
From To Ft. /I�� &am_ r _ and iZ(/i//C-
14. SCREEN: Depth Diameter Slot Size Material ////////"""" ,������t�!
From To Ft. in. in. /t 4 ^>,, � ct.
From To Ft. in. in. tA(7 2 /)o g Q�tt CntOL
15. SAND/GRAVEL PACK: �JO ✓/
Depth Size Material A^�,.-
From To Ft. WL L EL
From To Ft.
Topographic/Land setting
❑Ridge ❑Slope ❑Valley KlFIat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:OGPSOTopographic map
(check box)
DEPTH DRILLING LOG
From To Formation Description
c
r o
3
-a
CO rE
yJ
rn
rn�
W —+--
LOCATION SKETCH N 2
Show direction and distance in miles from at lease -
two State Roads or County Roads. Include the road
numbers and common road names.
16. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A
CONSTRUCTION STANDARDS, AND THAT A CQPY OF THIS RECORD 1AS BEEN PROVIDED,
SIGNA`fURE OF PERSO
CONSTRUCTING TIIE WELL
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center- Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-I REV. 07/2001

29 <CS
WELL CONSTRUCTION RECORD
North Carolina — Department of Environment And Natural Resources — Division of Water Quality — Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) NEIL CRAFT CERTIFICATION # 3114
WELL CONTRACTOR COMPANY NAME PITTMAN WELL BORING. LLC PHONE # [phone]
STATE WELL CONSTRUCTION PERMIT # _ ASSOCIATED WQ PERMIT #
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential ® MunicipaVPublic ❑ Industrial ❑ Agricultural ❑
Monitoring 0 Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use
2. WELL LOCATION:
Nearest Town: HENDERSONVILLE
CHELSEA NIX LANE
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: GILBERT BARBOZA
Address CHELSEA NIX LANE
(Street or Route No.)
HENDERSONVILLE NC 28739
City or Town State Zip Code
(828) — 681-2864
Area Code Phone number
4. DATE DRILLED 02/25/04
5. TOTAL DEPTH: 205
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO El
7. STATIC WATER LEVEL Below Top of Casing: 80 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS 1-1/2 FT. Above Land Surface'
'Top of casing terminated at/or below land surface requires a
variance in accordance with 15A NCAC 2C .0118.
9. YIELD (gpm): 6 METHOD OF TEST ARD
10. WATER ZONES (depth):
County HEND
11. DISINFECTION: Type CHLORYTE Amount 4.5
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
From 0 To 80 Ft. 6-1/4" SDR.21 PVC
From _ To _ Ft.
POURED
From_ To _ Ft.
13. GROUT: Depth Material Method
From 0 To 20 Ft. QUIKP
From To Ft.
14.SCREEN: Depth Diameter
From _To_Ft.
_
From _To_Ft.
_
15. SAND/GRAVEL PACK:
Depth Size Material
From_ To _ Ft. _
From To Ft.
Slot Size Material
in. _ in.
in. in.
16. REMARKS:
Topographic/Land setting
0 Ridge ❑ Slope ❑ Valley ❑ Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source: ❑ GPS ❑ Topographic map
(check box)
DEPTH
From To
DRILLING LOG
From To
LOCATION SKETCH
Show direction and distance in miles from at least
Two State Roads or County Roads. Include the road
number and common names
HWY. #64 W. FROM BAT CAVE. GO APPROX. 6
MILES & RT. ON S. MILLS GAP RD. RT. ON
BEARWALLOW RD. GO TO STOP SIGN & RT. ON
OLD CLEAR CRK RD. RT. ON CHELSEA NIX
LANE. 2ND LOT ON RT. c
O o
c �x
-,m
t o<
3 rn
m
fV nz
rn
u1
c:
G
z
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
0,4
SI NA 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

299198
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Resources - Division of Water Quality - Groundwater Section�/
WELL CONTRACTOR (INDIVIDUAL) NAM (print) Na0 /YN "r �i�� I9L L CERTIFICATION if s J/
WELL CONTRACTOR COMPANY NAME [cede ViiLra.li PHONE
�//M �ii h4,11940
STATE WELL CONSTRUCTION PERMIT# t'//4' ASSOCIATED WQ PERMIT./ i 7 %/ 1,
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential I,O' Municipal/Public ❑ Industrial ❑ Agricultural ❑
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use
2. WELL LOCATION:
Nearest Town: tmtyA/Lnitathattel-•
f<+.C—
(Street Name, Numbers, Cammuoity, Subdivision, Lot No., Zip Code)
3. OWNER -
Address
e
(Street or Route No.) -,
et net.,.. /v.c• 0.28732
Zip Code
tty or owtste
(lazo d2 7n t1- 2.23 4
Area code- Phone numbs
4. DATE DRILLED 'YE/ ts2 3Jo V
5. TOTAL DEPTH: a. 4(
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO I?
7. STATIC WATER LEVEL Below Top of Casing: (p a' FT.
u "+" if Above Top of Casing)
8. TOP OF CASING IS A FT. Above Land Surface*
'Top of wing terminated aNur below land surface require a
vanilla In accordance with 1SA NCAC 2C .011S.
9. YIELD (gpm): p2 C ME OD OF TEST —Cana
10. WATER ZONES (depth): Ys t e2 al"
11. DISINFECTION: Type e. Amount 9
12. CASING: Wall Thickness
Depth
From_0 To .aI 7 Ft.
From To FL
From To Ft.
13. GROUT:. Depth
From_0 To_alQ_ FL
From To Ft.
Dianieter or Wt/Ft. Material
ateal
Pric
Material
Topographic/Land setting
[Midge lAS1ope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrreesimimnesisecond%)
Latitude/longitude source: ❑GPS❑Topographic map
(check box)
DEPTH, DRILLING LOG
From To Formation Description
Method .
(.4.1tYkleal
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 Ft.
From To Ft.
16.RE S:
rn —
)LOCATION SKETCH
Show direction and distance in miles from at (east
two State Roads or County Roads. Include the road
numbers and common road names.
AO-
1 DO HEREBY CERTIFY THAT THIS WFI r WAS CONSTRUCIb,D IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
• T C9 Sk fC�ONSa lf
SIGNATUREOFP ON WELL
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-1 REV. 07/2001

299197
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) a 4,4,ie 5.941. L- CERTIFICATION or'7
WELL CONTRACTOR COMPANY NAME 4 4I'MM—= yteL+ AP. IL ' &LW j PRONE a fkZJ)/.I9,l ydeA
STATE WELL CONSTRUCTION PERMIT'S A/AY _ASSOCIATED WQ PERMITS' 3* 276
6 s _ .. -...
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential A Municipal/Public 0 Industrial 0 Agricultural O
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION: �J
Nearest To w�t ° County it.t.d /C./ .
—ter-
(SoecCN'ame, Numben, Community, Subdivision, Tat No., Zip Code
3. OWNERS
Address day/
Ares code- Phone number,
4. DATE DRILLED 9/►2.ZJO
5. TOTAL DEPTH: .2 ,j
6. DOES WELL REPLACEEXISTING WELL? YES 0 NO �Q
7. STATIC WATER LEVEL Below Top of Casing: 93 FT.
!(Use "+" if Above Top of Casing)
8. TOP OF CASING IS J. v7 FT. Above Land Surface'
'Top of casing terminated at/or below land surface requires
variance In accordance with ISA NCAC 2C .0118.
9. YIELD (gpm): /4. METHOD OF TESTTi[sand
10. WATER ZONES (depth): %S ' / is '
Amount rens
Wall Thickness
N
(Street or Route No.)
7�tr>041 NY /a75'b
City or Town State Zip Code
ty,c- 7t9-Gs627
11. DISINFECTION: Type C.h6N.
12. CASING:
Depth Diameter or Weight/Ft Material
From/_ TOSQ-_ Ft. 4 y Ai- ,2./ Alt
From__ To Ft
From To Ft
13. GROUT: Depth From fTo� Q Ft. Material d sun?. -
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 re To Ft.
From To Ft.
16. REMARKS:
Topographic/Land setting
❑Ridge *Slope ❑Valley OFlat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:OGPSOTopographic map
(check box)
DEPTH DRILLING LOG
From To Formation Description
7
.
LOCATION SKETCH
Show direction and distance in miles m at-jeast
two State Roads or County Roads. Include to road
numbers and common road names
0
032
1 DO HEREBY CERTIFY THAT THIS WFI I WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
6 � 6a,� s74.2)o y
SIGNATURE OF PERSON CONSTRUCTING THE WELL ATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-1 REV. 07/2001

2992 9
WELL CONSTRUCTION RECORD
North Carolina - Department of Environr tent and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) Dfer Zc K. }t40.'t-1. 5a+:+ "S r1t
WELL CONTRACTOR COMPANY NAME C-Llak.I.ARna Son Net\Q-punt - aC PHONE # ( 6 (05-7o22_
STATE WELL CONSTRUCTION PERMIT#_"" ASSOCIATED W Q PERMIT#
(if applicable) (if applicable)
CERTIFICATION oZ41fo
1. WELL USE (Check Applicable Box): Residential 111111 Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery ❑ Heat 1 ump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION:
Nearest Town: rtt]e,.darionvtl.N County i{encitrlo:l
3e not sc.t place 1-c4 *'7
(Street Name. Numbers. Community. Subdivis. :n, Lot No.. Zip Code)
3. OWNER: VA...tec n. _ioata
Address l.L.`79 140,...1ernr.:,1/2air 1rl3
(Street or Route No.)
Flet•ctnee \ MC a 7:i3
City or Town State Zip Code
(a)- l0$"1 a-ibb"+l
Area code- Phone number
4. DATE DRILLED 5 15 •'
5. TOTAL DEPTH: 1445
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO MO
7. STATIC WATER LEVEL -Below Tor of Casing: -30 FT.
(Use' F^ 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 .211S.
9. YIELD (gpm): *L METHOE F TEST (Z: q d
10. WATER ZONES (depth):
1 I. DISINFECTION: Type gain
12. CASING:
Topographic/Land setting
❑Ridge 131elope ❑Vall.y ❑Flat
(check appropriate box)
Latitude/longitude ofweli location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topogtapliic mzp
(check box) I,-t
DEP-H DRILLIN LOG
From To Formation Description- -----
t tot
to Tn \45
0v2.- e,tcdon
CGCo+n; T C
0
LOCATION SKETCH
Amount e - Show direction and distance in miles from atibast `.
Wall Thickness two State Roads or County Roads. Include thesoad
Depth Diame, sr or Weight/Ft. Material numbers znd common road names.
From t i To $9 Ft. (p : tn.% p1445 c:c_. .j J
From To Ft.
From To Ft.
13. GROUT: Depth Mat .vial Method
From 0 To :CC) Ft. Ce-n4.t+ Powaa
From To Ft.
14. SCREEN: Depth Diameter Slot Size Material
From To Ft. 'a. in.
From To Ft. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
16. REMARKS:
I DO HEREBY CERTIFY THAT THIS W ELI - WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THA. T A COPYOFTHIS RECORDECHAS BEEN PROVIDED TO THE WELL OWNER
D-Qnittic3t 11-a-•�C` AQ- *Qs RC -
DATE
SIGNATUI E OF PERSON CONSTRUCTING THE WELL
Submit the original to the Division of W ater Quality, Groundwater Section, 1636 Mail Service Ceenterf Pa e V. NC27699-1636 Phonc No. [phone], with 30 days.
0 Ex

WELL CONSTRUCTION RECORD
North Carolina - Department of Environs tent and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) DeCC:CK Y.Qa'tlh
WELL CONTRACTOR COMPANY NAME CA Q
STATE WELL CONSTRUCTION PERMIT#
(if applicable)
299238
CERTIFICATION # 241(o
co .'Sun Tnc PHONE $ f .Z3 (0(05-aim
ASSOCIATED WQ PERMIT#
(if applicable)
abn 1/4.v¢ t' g
mea*-'Nene
I. WELL USE (Check Applicable Box): Residential ® Municipal/Public ❑ Industrial 0 Agricultural ❑;.
Monitoring 0 Recovery 0 Heat I ump Water Injection ❑ Other 0 IfCther, List Use
2- WELL LOCATION:
Nearest Town: 'Re..den".owlne County Renders:..•
'[%%Qn.•::s+. p\case. Ue:t+off
(Street Name, Numbers. Community. Subdivis an, Lot No.. Zip Code)
3. OWNER: F caxas... 1-)1 •+eJ
Address (ac)S 'Nend1/41/40'6cr.0 .i.e.
(Street or Route No.)
Vtniclatc nc. 2V131
[� City or Town State Zip Code
(8QP)-.ELa 46402
Area code- Phone number
4. DATE DRILLED 3- 21• -04
5. TOTAL DEPTH: t`•, 5
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO
7. STATIC WATER LEVEL -Below Tot of Casing: la FT.
(Use' t' 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 . i 18.
9. YIELD(gpm): tee METHOL OF TEST R.:a•c
10. WATER ZONES (depth):
Topographic/Land setting
❑Ridge L3Slope ❑Valley DFlat
(check appropriate bo:')
Latitude/longitude of wel- location
(degrees/minutes/seconds) °_T..-
Latitude/longitude source:❑GPS❑Topgraphie-rip.
(check box) k ".
DRILLING LOG _ _
Fomtation Description
DEP-.-H
From To
}V To qi
CVec %WADe%
Ct`t To t4.5 Gcw.: re
l 1. DISINFECTION: Type trWS
12 CASING:
Depth Diameter
From Y \ To 44 FL (o !.
From To Ft.
From To Ft.
13. GROUT: Depth Mat _rial Method
From 0 To dG Ft. CQ•wtn+ �‘+-.a
From To Ft.
14. SCREEN: Depth Diameter Slot Size Material
From To Ft. -a. m.
From To Ft. n. in.
Amount 12
Wall Thickness
or Weight/Ft. Material
LOCATION SKETCH
Show direction and distance in miles from atleasu�'
two State Roads or County Roads. Include ¶e road.' ---
numbers and common road names.
421 _ 1asit_
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
16. REMARKS:
I DO HEREBY CERTIFY THAT THIS W ELt WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
W
O
9l¢A.c n •aa c4
SIGNATUI.E OF PERSON
CrTING THE WELL DATE
Submit the original to the Division of W ater Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
27699-1636 Phone No. [phone], with n 30 days.
GW-1 REV. 07/2001

WELL CONSTRUCTION RECORD
299334
North Carolina - Department of Environr lent and Natural Resources - Division of Water Quality - Groundwater Section
CERTIFICATION # axi)!o
21 jon ( ( fl
WELL CONTRACTOR COMPANY� NAME \`�% SQta_ to tf� '3e1\t- �wr P )ne PHONE if
STATE WELL CONSTRUCTION PERMITS ASSOCIATED WQ PERMITS •- -- ----
(if applicable) (if applicable
1. WELL USE (Check Applicable Box): Residential El9 Municipal/Public 0 Industrial 0 Agricultural O
•
Monitoring O Recovery 0 Heat I ump Water Injection 0 Other 0 IfCther, List Use
WELL CONTRACTOR (INDIVIDUAL) NAMI (print) V341..oe1cK '\Re -b'
2. WELL LOCATION:
Nearest Town: ?iCnAweevAvl lip _ County \ienAttaa-.
445 7-iow . t_u'C 2S'7ei'2
(Street Name, Numbers. Community. Subdivis. an, Lot No., Zip Code)
3. OWNER: :r::inn R Clnl•C'S
Address '-\`15 Nc Mt 5 4.0ne
(Street or Route No.)
\iv�ndctte o,iv;ile , n)C ae'CI 'a
City or Town State Zip Code
-11-11
Area code- Phone number
4. DATE DRILLED (6- 3- O't
5. TOTAL DEPTH: 5°.5
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO
7. STATICWATERLEVEL-Below To)•ofCasing: 'aft. FT.
(Use' )3 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 .9Q11S. 9. YIELD(gpm)_ i METHOEOFTEST Rt q d
10. WATER ZONES (depth):
I1. DISINFECTION: Type
12. CASING:
From \- \
From
From
13. GROUT:
From 0
From
14. SCREEN:
From_
From
I5
Topog9phic/Land setting
ORidge L7SIope DVaIY_y OFlat
(check appropriate bo::)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:OGPSDTopographid rriar
(check box)
DEP-H DRILLING LOG- -
From To Formation Description
}i -ro z()
CVCr R',2edan
2!c Ta S.:+ti Gcon:te
Depth Diametx
To 2 ' Fr. folz
To Ft.
To Ft.
Depth
To Qo Ft.
To Ft.
Depth Diameter
To Ft. n.
To Ft.
SAND/GRAVEL PACK:
Depth Size
From To Ft. _
From To Ft.
Amount
Wall Thickness
eight/F
f3z1
or W t. Material
Mat..rial
Ca- nan}
Method
vov�aa
Slot Size Material
in.
in.
Material
LOCATION SKETCH
Show direction and distance in miles fronffleast`_'
two State Roads or County Roads. Include:ffie road
numbers and common road names.
$
O
0
16. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL. WAS CONSTRUCTED IN ACCORDANC. WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THA T A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
24 to- 3 •Cie
SIGNATUF.E OF PERSO 'CONSTRUCTING THE WELL DATE
C
Submit the original to the Division of \eater Quality, Groundwater Section, 1636 Mail Service Ceenter1 pa e gh, N 001
27699-1636 Phone No. [phone], with n 30 days.

299412
WELL CONSTRUCTION RECORD
North Carolina - Deparnnent of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) Ja meg uL C mr jr CERTIFICATION# 71 ifl
WELL CONTRACTOR COMPANY NAME ('amp' S Wo11 R Piimp ('n Tnr PHONE #a7A) 4ri3_7322
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable)
(if applicable)
1. WELL USE (Check Applicable Box): Residential M Municipal/Public 0 Industrial 0 Agricultural ❑
Monitoring 0 Recovery ❑ Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION.
Nearest Tows
County etc/coat
Q cl Cif/1 [6
(Sweet Name, Numbers, C.mmunicq�// Subdivision, Lot No., Zip Cade)
3. OWNER:
Address
qq KK ,,C rri
a' ar4. ,ct- 7
N (S ee[ or R/ C—
�7 a ✓eyt/', V So 13
City or Towu
12. CASING:
State Zip Code
Area coda- Phone number n
4. DATE DRILLED I /2 d 'Y
5. TOTAL DEPTH: 2261 /
6. DOES WFr 1 REPLACE EXISTING WELL? YES ® NO 0
7. STATIC WATER LEVEL Below Top of Casing: Eo FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING 1S 1 FT. Above Land Surface'
*Top of casing terminated at/or below land surface requires a
;variance In accordanice with 1SA NCAC 2C .0118.
9. YIELD (gpm): / O METHOD OF TEST D i r
10. WATER ZONES (depth): //6 S
11. DISINFECTION: Type r h 1 n r i n a Amount % cttfl
Wall Thickness
or Weight/Ft. Material
gDR.71 PVC
Depth Diameter
From p To cc" Ft 6 1 / 4
From To Ft.
From To Ft.
13. GROUT: Depth Material
From U To 30 Ft. Neat Cement
' From To Ft.
14. SCREEN: Depth Diameter Slot Size
From To Ft in in.
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
16. REMARKS:
Method
Hand
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 pRILLING LOG:
From To
5-O
Co 9,2.5
Formation Descriptidn
drr1-
dan5o%'4afed Kock
r--
iV
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-�
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH
CONSTRUCTION STANDARDS, AND THAT A RPY OF THIS RECORD
% HAS BEEN PROV
/AJ-
SIGNATURE 3F PERSON CONSTRUCTING THE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail
27699-1636 Phone No, [phone], within 30 days.
15ANCAC 2C, WELL
TO THE WELL OWNER
- g -o
DATE
Service Center - Raleigh, NC
GW-1 REV. 07/2001

WELL CONSTRUCTION RECORD t.) (?;
North Carolina - Department of Environment and N tural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME /(print)0 Sep 1n r1.„ LIr IIicn.vts CERTIFICATION # Z3
WELL CONTRACTOR COMPANY NAME {/—E.e SI`Zyi5 Jeri 11irrq &4)teS)grpnONEq fees LyA —26g'-
STATE WELL CONSTRUCTION PERMITN h/5 0 i — Q(J d27 ASSOCIATED WQ PERMIT#
(i f applicable) (if applicable)
I. WELL USE (Check Applicable Box): Residential 0 Municipal/Public
Monitoring ❑ Recovery ❑ Heat Pump Water Injection 0 Other)
2. WELL LOCATION:
Near st Town: Fie,tcde -S.ry , . County ( tJJirS y�
�� ;as (' Q I E Aim �`'t'L7
r
(Street ame, Numbers, of munity, Subdivision, Lot No.. Zip Code)
3. OWNER: Tit&
Address
Ts Cy,
d
ity or TZip Code
ode
(� ') Cc —1 7 �
Area code- Phone number,/ I
4. DATE DRILLED ` I LI _n L�"
5. TOTAL DEPTH: q 2_, 5 '
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO
7. STATIC WATER LEVEL Below Top of Casing: / a FT.
-+(Use "+" if Above Top of Casing)
8. TOP OF CASING IS 't 5 FT. Above Land Surface*
"Top of casing terminated at/or below land surface requires a
variance in accordance wig) ISA NCAC 2C .0118.
9. YIELD (gpm): 9 METHOD OF TEST A11L LI( r
10. WATER ZONES (depth): 50 p ^'' b a
nr
!' ' (Street or Route No.)
/rcu4eICJ s KC-5— sc
- 5 r„, @ 3 ©S
Amount S? cn .
12. CASING: Wall
Depth
To -S'Z iFI'--C�-3fv 62c I ,
To Ft.
To Ft.
13.
I I. DISINFECTION: Type HC L l
From
From
From
GROUT:,,✓✓11 Depth,/ aterial/M�Method
From V' To ST, 5_ Ft. al eh:*
From To Ft.
14. SCREEN.) Diameter Slot Size Material
From To Ft. in. in.
From To �FJk. in. in.
15. SAND/GRAVEL PACK: r
Depth Size Material
From To Ft.
From To Ft.
Diameter /or Weight/Ft. Material
16. REMARKS:
I Industrial 0 Agricultural 0
If Other, List Use nrjy -�-e Srin !� a d EIZ Sys r.
Topographic/Land setting
di/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
S /
C./2<.
a 55m
c, Cm
1 E<
s �n
Do
A m�
3 o
c ---mom
LOCATION SKETCH
Show direction and distance in miles from dffleast z
two State Roads or County Roads. Inclu
numbers and common road names. �1
I
!
I� `I
1 DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH I5A NCAC 2C. WELT.
CONSTRUCTIeN 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. G W-I REV. 07/2001
7- zn -o 5(

301534
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and *I mural Resources - Division of11 Water Quality - Groundwater Section
WILL CONTRACTOR (INDIVIDUAL) NAME (prim) 1J LL\ tJ 31 A 5 CERTIFICATION, a 11 J
WELL CONTRACTOR COMPANY NAME_RF.UBEN CALDWELL DRILLING, INC. Q�8 �.rog.._�5Q1
PHONE
STATE WELL CONSTRUCTION PERMIT/ ASSOCIATED WQ PERMIT/
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential Er Municipal/Public 0 Industrial 0 Agricultural ❑
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use - -
2. WELL LOCATION: '
Nearest Town: FLEtC-Ne(Z County f"+6n)bEitS0rJ
TumgLeLueED TRA IL_
(Strat Name, Numbers, Communiy, Subdivision, d Subdsion, INo., by Code)
3.OWNER: CAit.o SNeet4R,4
Address '.O. % 3 a
(stiedLETCI{g I.Jc) 9.173a
City or Town Stare Zip Code
(80)- 650- eiFf33
Ace coda- Phone number 4. DATE DRILLED R - a 6, 0+
5. TOTAL DEPTH: 3 10
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO
7. STATIC WATER LEVEL Below Top of Casing: b D FT.
.( (Use + it Above Top of Caswg)
8. TOP OF CASING IS -+- FT. Above Land Surface*
'Top or ruing in -minted at/or beta* lad serf act requites a
variants to Accordance with ISA NCAC IC .011 I.
9. YIELD (gpm): % 0 METHOD Or TEST g(G - A I K-
10. WATER ZONES (depth): 29;0 .\ 0 G P M
11. DISINFECTION: Type NTN 1 et: Amount a 't b .
12. CASING: Wall Thickness
Depth Di ter or Weight/Ft. slerial
From 1' To l\R Ft. b,/_ 5DRaI rYt
From To Ft.
From To Ft.
13. GROUT: Depth Material n Method
From 1 To a s Ft. Ge m e 0-r b up-C r7
From To Ft.
14. SCREEN: Depth Diameter $lot Sire Malarial
From To Ft. in. in.
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Sire Matenel
From To Ft.
From To Ft.
16. REMARKS:
Topographic/Land setting
[Midge ❑Slope ❑Valley HFlat
(cback apprcp,iLc box)
Latitude/longitude of well location
(deveahnimnsahecoods
Latitude longitude source:❑GPS❑Topographic map
(check box)
DRILLING LOf'(
Formation Description
O V E cJ ja 1a r)
G 2F n)(Ttg
CE tV t c.€ - I GPM
G IL$ ru'Cl
n IsCee-
O� 0
cP
n O
PPPTIi
From ( To /
1 - \i3
aat o'
aa0'- -5 to
LOCATION SKETCH
Show direction and distance in miles from at least y
two State Roads or County Roads. Include the . ad
numbers and common road names.
fitdi
a5
CgotlIZ
.5 M
Uk t 4 CQ2$
•
(u �(SI�WtS&D
• 5M
1 DO HEREBY CERTIFY THAT THIS WELL WAS ONSTRUCTED IN ACCORDANCE WITH ISA NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND TI1AT A 0 Y OF THIS REC HAS BEEN PROVIDED TO TIIE WELL OWNER
Wa'K/ CIC- oil - pet --
SIGNATURE OF PERSON CONSTRUCTING TILE WELL DATE
Submlt 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

301823
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Na
WELL CONTRACTOR (INDIVIDUAL) NAM�F�(,(prtnt),
WELL CONTRACTOR COMPANY NAME.CL
STATE WELL CONSTRUCTION PERMIT#
(if applicable)
Resources - Division of Water Quality - Groundwater Section
L _ CERTIFICATION
#rfl 77
ONE # f' ,
y/q ASSOCIATE WQ P$RRMn# . /�� 1; or�
SSfa 7/
(if aa licable)
1. WELL USE (Check Applicable Box): Residential * Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATI
Nearest'To
(Street Name., Nu¢ rs, Community, Subdivision, Lot No., Zip Code)
3. OWNER:
County/tan. La. t
.2 r79L
Address /ae27
-a,i a%VC.) el: 79L
7,45 Code
Area code- Phone number
4. DATE DRILLED p/3JD7
5. TOTAL DEPTH: /G S'
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO 1113
7. STATIC WATER LEVEL Below Top of Casing: , JA Ff.
(Use "+^ if Above Top of Casing)
8. TOP OF CASING IS %S FT. Above Land Surface'
'Top of casing terminated at/or below land surface requires a
variance 1n aceordanc with 1SA NCAC 2C .0118. •
9. YIELD (gpm): n OD OF TEST? s4-00
10. WATER ZONES (depth): 12 ' /1l, s'
11. DISINFECTION: Type _ Amount ___7� r-
12. CASING: Wall Thickness 7
Depth Diameter or Weight/FL taial
From 0 To %D Ft h -p Oa/ exit
From To Ft.
From To Ft.
13. GROUT: Depth FromUJ2Method to ....2 li Ft.
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 Ft.
From To Ft.
Topographic/Land setting
❑Ridge OSlope ❑Valley %Flat
(check appropriate box)
Latitude/longitude of well location
(degreeMmmaceslasonds)
Latitude/longitude source:❑GPS❑Topographic map
(cited( box) ..
DEPTH pR1LLIN9'LOG
From To Formation Doscription
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.
tJ•0
titif
16. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUE l ED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, T A COPY OF THIS ,ECORA Ij/lS BEEN PROVIDED TO THE WELL OWNER
SIGNATURE OF OF ON CONS UCTING THE WFT 1
ATE
/67
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