Mc CY2004

296230
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) JamnS rJ Can f i Jr CERTIFICATIONp it if{
WELL CONTRACTOR COMPANY NAME rAmpIa Wa11 8, Pnrnr Cn, Tnc PHONE ki078 d51-7122--.
STATE WELL CONSTRUCTION PERMIT/ ,_ASSOCIATED WQ PERMIT/4
(if applicable)
(if applicable)
1. WELL USE (Check Applicable Box): Residential V 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: �6A,�•v" —County C iTh r
ir- .9 Irk aT TC5
(Street Name, Numbers, Community, Su sir, Lot No., Zip Code)
3. OWNER:
,
Address ao0 c7,/r e /rlkit '
4 e (Street or RQutC oZ / z.
Cityor Town Su Zip Code
( )e—I
Area code- Phone number
4. DATE DRILLED 5 " - (} C I
5. TOTAL DEPTH: '\ b S
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO f
7. STATIC WATER LEVEL Below Top of Casing: ' 0 U FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS 1 FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance In accordance with 15A NCAC 2C .0118.
9. YIELD (gpm): S ME HOD OF TEST ki r
•10. WATER ZONES (depth): L: S
11. DISINFECTION: Type rh 1 n r i n r
12. CASING:
From—o To �
From To
From To
13. GROUT: Depth
Fromg To 2 0
From To Ft.
Diameter
FL6 1/4
Ft.
Ft.
Ft.
Amount
Wall Thickness
orWeight/Ft. Material
RD12.21 PVC
Material
Ncat Ccmcnt
Method
Hand
14. SCREEN: Depth Diameter Slot Size Material
Frorn To Ft. in.
From To Ft. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
in.
in.
16. REMARKS:
Topographic/Land setting
Ridge ❑Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degreeslminutesheconds)
Latitude/longitude source:❑GPS❑Topographic trap
(check box)-.____.- ..
DEPTH DRIJ 7 INCG I.Of
From To tion Description
k'n
jOCATION SKETCH N
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common road names.
0
0-
PC5
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCIND IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY 0 THIS RECORD HAS EEN PROVIDED TO THE WELL OWNER
ayld
SIGNATURE OF PERSl7N 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
51-07

296225
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) James w Camp, Jr- CERTIFICATION # 21 38
WELL CONTRACTOR COMPANY NAME
STATE WELL CONSTRUCTION PERMIT('
(if applicable)
rampS Wa11 & Pimp Cr_ Tnr PHONE #al2A) 451-7122
ASSOCIATED WQ PERMIT#
(if applicable)
1. WELL USE (Check Applicable Box): Residential 0-"-Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION:
Nearest Tpwn:_ litI� County 41 t_pi� .if
(Street Name, N1 ben, Community,, bdivis'on. Lot No., Zip Code) , �� p
3. OWNER: YY`�-'`--1 otu.0Q 040.404Q Ut"-L (degrees/minutes/seconds)
Address l r i3c Y L:O Latitude/longitude source: ❑GPS❑Topographic map
i 1 , 'greet or ',tope No.) (check box) 1
C. ,a n IC (9.8 7 t i DRILLING 1,00
gzisC- o4T A te9/ Zip Code I f� VD (
Area code- Phone number
4. DATE DRILLED — �-0 q
5. TOTAL DEPTH: 6 0C
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO 0
7. STATIC WATER LEVEL Below Top of Casing: ld 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 15A NCAC 2C .0118.
9. YIELD (gpm): 1 MET OD OF TEST pir
•10. WATER ZONES (depth): 4.
11. DISINFECTION: Type rh 1 nr i n
12. CASING:
Depth Diameter
From p To� �O Ft. 6 1 / 4
From To Ft.
From To Ft.
13. GROUT: Depth
Frotn_p To 30 Ft.
From To Ft.
14. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in.
From To Ft. in, in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
Amount \ Cu..()
Wall Thickness
or Weight/Ft. Material
SORT' PVC
Material
Neat Cement
16. REMARKS:
DEPTH
From Tip
0 r,
Topo�graj�hic/Land setting
:Ridge laSlope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
tion
l,o 5U told - so s
o
r
n
J.00ATION SKETCF& _r -A
Show direction and distance in miles from at least
two State Roads or County Roads. Include theidad
numbers and common road names. _ ,e
PO -I
PWe
I DO HEREBY CERTIFY THAT THIS WFI I WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY 0 THIS RECORD HAS EEN PROVIDED TO THE WELL OWNER
�y� C
SIGNATURE OF PERS�N CONSTRUCTING THE WELL i 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

296224
WELL CONSTRUCTION RECORD
North Carolina - Department of Envirotunent and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) J a m es car_ Camr Jr - CERTIFICATION # 7 1 11,1
WELL CONTRACTOR COMPANY NAME ('amp' c Wall & Pnmr Cr-) Tnr PHONE #$7R1 d51-7122
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT# - ---
(if applicable)
(if applicable)
1. WELL USE (Check Applicable Box): Residential i rMunicipal/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:
Nearest Town: Coun
"/'r7 /i Y /Yl t' N� / c' ✓e
(Street Name, Numbers, Communi Subdivision, Lot No., Zip Code)
3. OWNER: WkeU
I�
Address 412/7 rlQ/wlnly Voile kJ.
Nebo (SaectiorRout;NoJ ) 7
City o Town State
Zip Code
C�-
Area code- Phone number
4. DATE DRILLED 0
5. TOTAL DEPTH: 6. DOES WELL REPLACE EXISTING WELL? YE(ktt..r NO 0
7. STATIC WATER LEVEL Below Top of Casing: 0 FT,
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS 1 FT. Above Land Surface'
`Top of casing terminated at/or below land surface requires a
• - variance in accord�.p ce with 15A NCAC 2C .0118.
9. YIELD (gpm): 0 ME OD CR TEST
10. WATER ZONES (depth): 0 SAS
A r
11. DISINFECTION: Type rib 1 nr i n
12. CASING:
Depth Diameter
Frott _o To Ft. 6 1 / 4
From To Ft.
From To Ft.
13. GROUT: Dept‘teri
From_o To
From To Ft.
14. SCREEN: Depth Diameter
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:
Amount
Wall Thickness
or Weight/Ft. Material
BR21 PVC
ye 6 ff(fethod
t. Neat Ccmcnt Hand
Slot Size Material
Topa hic/Land setting
❑Ridge lope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DRILLING LO(ti
Formation Description
DEPTH
From To
n
CD
LOCATION SKETCH
Show direction and distance in miles from at lrirt
two State Roads or County Roads. Include the -read
numbers and common road names.
I DO HEREBY CERTIFY THAT THIS WFI I WAS CONSTRUC1hD IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY 0 THIS RECORD HAS EEN PROVIDED TO THE WELL OWNER
a4l , ('wr n 5 -g9-0
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

10. WATER ZONES (depth):
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality
WELL CONTRACTOR (INDIVIDUAL) NAME (print) James r.r- Camp, Jr
WELL CONTRACTOR COMPANY NAME Camp c Wc.11 & Piimp Cn Tnr-
STATE WELL CONSTRUCTION PERMIT#
(if applicable) (if applicable)
296239
- Groundwater Section
CERTIFICATION # 2 1 3 A
PHONE #$7R1 d51_7322
ASSOCIATED WQ PERMIT#
1. WELL USE (Check Applicable Box): Residential VMunicipal/Public 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELLLOCA 1'Ni nn oo
Ne estTown:1 �. - County_iNL�_ FJf�
8k Qom.` 10
(Street Name, LPii hers, Corn unity, Subdivi�*otn�, Lot No., Zip Code)
3. OWNER: Seity&A \( V.
Address V tn-Li l OA.
1V p (Sute( `RC ute No.)
ASV JU." V�
City or Town State Zip Code
Area coda- Phone numbei , �(
4. DATE DRILLED y" 31 . Q \
5. TOTAL DEPTH' 0 S
6. DOES WELL REPLACE EXISTING WELL? YE$.,❑ NO l ,
7. STATIC WATER LEVEL Below Top of Casing: .5 0 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS 1 FT. Above Land Surface"
`Top of cuing terminated at/or below land surface requires ■
. variance in accordattif with 1SA NCAC 2C .0118.
9. YIELD (gpm): j ME'I QF TEST p it
Topo$raphic/Land setting
❑Ridge °S`lope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(cheekFrom To ))RII LING I.ODEPTH ti
ormati De ripEion
n 39
Rns
11. DISINFECTION: Type rh 1 nr i n
12. CASING:
Depth �I Diameter
From 0 To 1 Q Ft- 6 1/
From To Ft.
From To Ft.
13. GROUT: Depth
From o To 2 0
From To
14. SCREEN: Depth Diameter
From To Ft. in
From To Ft. in.
15. SAND/GRAVEL PACK:
Depth Size
Froth To Ft.
From To
Ft.
Amount Lae
Wall Thickness
or Weight/Ft. Material
EDP.21 PVC
Material Method
N at Ccntent Hand
Ft.
Slot Size Material
in.
in.
Material
Ft.
r 10
< Er-
c^
NI
:,. rn;
O S2
LOCATION SKETCH rV
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common road names.
16. REMARKS: ( "
I DO HEREBY CERTIFY THAT THIS WFI r WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY 0 THIS RECORD HASTtlEEN PROVIDED TO THE WELL OWNER
ttiyi w , rl4 /9-04
SIGNATURE OF PERS(7N 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

296238
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) JArrtcg r.r Camp, Jr CERTIFICATION # 21 TA
WELL CONTRACTOR COMPANY NAME ('Amp' S Wa11 R Pump Cr>, Tnr• PHONE #$9Al d51_7322
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 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATN:
Nearest Town: Cu
Chi) G^
(Street Name Numbers,
Address rs, Community, Subdivision, Lot No., Zip
Code) (�
3. OWNER:
@'& 1111 j BONG' sty
attr (Saee[o( pC o) GIS 1 r
0.4
County (V')ertu J`"
Ciry er [asi To S3� rZ tate Zip Code
( )- Q
Area code- Phone number, t
4. DATE DRIITFD l-2,LL`
5. TOTAL DEPTH: IP-2
6. DOES WELL REPLACE EXISTING WELL? YES,p NO
7. STATIC WATER LEVEL Below Top of Casing: V () FT.
(Use "+" if Above Top o1 Casing)
8. TOP OF CASING IS 1 FT. Above Land Surface'
"Top of casing terminated aUor below land surface requires a
variance in accordswith 15A NCAC 2C .0118.
9. YIELD (gpm): ME OD TEST air
10. WATER ZONES (depth):al-
(? 3
11. DISINFECTION: Type rh 1 or i n
12. CASING:
Depth Diameter
From a To S Ft. 6 1 / 4
From To Ft.
From - To Ft.
13. GROUT: Depth
Froth p To 2 0 Ft.
From To Ft.
14. SCREEN: Depth Diameter
From To Ft. in.
From To Ft. in.
15. SAND/GRAVEL PACK:
Depth Size
From To Ft.
From To Ft.
Material
Neat
Amount
Wall Thickness
or Weight/Ft. Material
e D.R.21 PVC
Topo phic/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 QrtnatioDesgdpttion --....
a-
3
U
—c r-
ry
+- _ r
0
Show direction and distance in miles from at I?3 t _�+
two State Roads or County Roads. Include the road �'
numbers and common road names.
LOCATION SKETCH
Method .per
Cciaent Hand (� A.O. F4)
Slot Size Material t��
in.
in.
Material
16. REMARKS:
I DO HEREBY CERTIFY THAT THIS WFI 1 WAS CONSTRUL IED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY 0 THIS RECORD HAS �EEN PROVIDED�TO THE WELL OWNER
w , ( oc-n J
N CONSTRUCTING THE
SIGNATURE OF PER$ 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

296234
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) Jam e 1.7 Caw p, Jr
WELL CONTRACTOR COMPANY NAME (Tamps Win 11 R Pimp ('n Tnr
STATE WELL CONSTRUCTION PERMITS ASSOCIATED WQ PERMIT#
(if applicable)
(if applicable)
CERTIFICATION # 21 1 R
PHONE #t2R) /151-7322
1. WELL USE (Check Applicable Box): Residential b Municipal/Public 0 Industrial 0 Agricultural 0 Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 if Other, List Use
2. WELL LOCATION:
Nearest 01(1 A.F JA RA
•
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: S).0 (^� M 11�
Address r 0 �o X
/ 0.{'I? DN nib (SveetortiouteNo.) oR,$
City or Town State Zip Code
( )-
Area code- Phone numbei
4. DATE DRILLED V - �- - U 14
5. TOTAL DEPTH: 3(-1 C\
6. DOES WELL REPLACE EXISTING WELL? YES 0 tyu 0
7. STATIC WATER LEVEL Below Top of Casing: to 0 FT.
(Use '4" if Above Top of Casing)
8. TOP OF CASING 1S 1 FT. Above Land Surfaces
*Top of casing terminated at/or below land surface requires a
- variance In accordaa a Ith I5A NCAC 2C .0118.
9. YIELD (gpm): MATHOD OF TEST i r
10. WATER ZONES (depth): *p S 3.2s
11. DISINFECTION: Type rh 1
12. CASING:
Dep
From o To_ b Ft.
From To Ft.
From To Ft.
13. GROUT:
0
nri na Amount C r , 1J
Wall Thickness
Diameter or Weight/Ft. Material
6 1/4 SDP.21 PVC
Depth
From To 2 0 Ft.
From To Ft.
Material Method
Nett Cement Hand
14. SCREEN: Depth Diameter
Front To Ft. in.
From To Ft. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
Slot Size Material
in.
in.
County °M C `r. ("Lk Q�'/'
Topographic/Land setting
iciidge ❑Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DRILLING LOG
rmatiors Desc
C
DEPTIj
From To
n �(l
C(.6
VA.t1'
r
--C
0
N
rn_
m
m
JOCATION SKETCH c? ^ 7.;
Show direction and distance in miles from at It
two State Roads or County Roads. Include the road z
number and common road names.
of
16. REMARKS:
I DO HEREBY CERTIFY THAT THIS WFT I WAS CONSTRUCIBD IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY 0 THIS RECORD HAS ildEEN PROVIDED TO THE WELL OWNER
SIGNATURE OF PERS,QN CONSTRUCTING THE WELL DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center -Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-1 REV. 07/2001

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and N
WELL CONTRACTOR (INDIVIDUAL) NAM (paint))
WELL CONTRACTOR COMPANY NAME AA ;.t
STATE WELL CONSTRUCTION PERMIT#
Resources - Division of Water Quality - Groundwater Section
47/Ai
(if applicable)
/ e Sfl 4JCERTIFICATION taj fl7
Edi/.etN nI,p PRONE IS j n°Vet
ASSOCIATED WQ PERMIT#
(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: 777 L t.c. County
yhibcn, C / a It 7sz
(Street Name, umbers, ommani Subdivision, Lot No., Tap Code)
3. OWNER: ralfi
Address b/ 16. At y .2. / . S
C
(Street or Rome No.) _
727r
City or Town State Tap Code
E )
Area code- Phone number
4. DATE DRILLED -3// 8/ E V
5. TOTAL DEPTH: / t C
6. DOES WELL REPLACE EXISTING WFT T ? YES ❑ NO JR
7. STATIC WATER LEVEL Below Top of Casing: 2FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS A. T FT. Above Land Surface*
'Top of wine terminated actor below land surface requires a
variance In accordaa a with 1SA NCAC 2C .0118. •
9. YIELD (gpm): p 6 METHOD OF TESTY.4rLP
10. WATER. ZONES (depth): rs— /o n
/QS
11. DISINFECTION: Type C. t/..11
12. CASING:
Amount
Wall Thickness
Depth ameter or Weight/Ft. Material
From fO To 7D Ft D 5 vq-1 / Q//S
From To Ft
From To FL
13. GROUT: Depth Material Method •
From_ To %en Ft CjitisSI 1 a 1%) OL.i
From To Ft %
14. SCREEN: Depth Diameter Slot Sire Material
Fro ��o Ft in. in.
From / To Ft in. in.
15. SAND/GRAVEL PACK:
th
From Ft.
From To Ft.
16. REMARKS:
Size Material
Topographic/Land setting
['Ridge 0Slope ❑Valleyat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH DRILLING LOG _
From To Formation Description
—
LOCATION SKETCH 0
Show direction and distance in miles >rm at kiast
two State Roads or County Roads. Include the road
numbers and common road names.
0
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUL it.° 124 ACCORDANCE WITH 15A NCAC 2C, WFI
CONSTRUCTION STANDARDS, AND THAT3CDPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
SIGNATURE OF P ON CONSTRUCTING THE WELL DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-1 REV. 07/2001

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Na
WELL CONTRACTOR (INDIVIDUAL) NAME
WELL CONTRACTOR COMPANY NAME y/.I.l./if�lRfJ
STATE WELL CONSTRUCTION PERMIT#
(if applicable)
296084
Resources - Division of Water Quality - Groundwater Section�
/7 J L L-. CERTIFICATION It,,Lr' 7 7
9.P ) i/,Pyf zII HONE if for / / -/2yg7..J
ASSOCIATED WQ PE
(if applicable)
1. WELL USE (Check Applicable Box): Residential ® Municipal/Public 0 Industrial 0 Agricultural ❑
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION-
Neare 1C7
(Street Name, Numben, Community, Subdivision, Lot No., Zip Code)
3. OWNER: f
Address/7 (,
C1
City or TownStale 2ro Code
(——
Alta cede- Phone Dumber /
4. DATE DRILLED _ /€ Kin y
5. TOTAL DEPTH: n Lir
6. DOES WELL REPLACE EXISTING WEI I ? YES 0 NO RI
7. STATIC WATER LEVEL Below Top of Casing: 7 FT.
(Use "+" if Above Top of Cuing)
8. TOP OF CASING IS J FT. Above Land Surface*
'Top of wing terminated at/or below land surface requires •
variance In accordancnritis ISA NCAC 2C .011t
9. YIELD (gpm): C MATHOD OF TEST 12se-r J
10. WATER. ZONES (depth): V5 ' /.'1 �i '
11. DISINFECTION: Type l° . 1 t/. Amount //2
12. CASING: WallThelmess
Depth ut_j7 52La F - or Di ter Weight/Ft y
Werial
Fro To To . Ft
From_ To Ft.
From To Ft.
13.
r
GROUT: Depth
-��From To Ft /v���
From To Ft.
14. SCREEN: Depth Diameter Slot Size Material
Fro Ft in. in.
FroTo Ft in. in.
15. SAND/GRAVEL PACK:
Material
th
From o Ft.
T
From To Ft.
16. REMARKS:
0
Topographic/Land setting
❑Ridge Slope [Walley ❑Flat
( 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
r
LOC ON SKETCH -
Show direction : d distance in miles from
two State Ro ' or County Roads. Incl
numbers and r mmon road names.
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUE tl•.D IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WFI I OWNER
/ 0777. r� G�iJ 3//:5-/b1
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mall Service Center - Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-1 REV. 07/2001

294783
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) WAYNE T-CM CERTIFICATION# 2343
WELL CONTRACTOR COMPANY NAME HIQURtY WFIL TRIILM M. PHONE # f28 V4-0113S
STATE WELL CONSTRUCTION PERMIT# �asOCIA'lED WQ PERMIT#
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential a Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION: h1 DCIt
Nearest Town:NIC(d County
SMT1'ASTT F TR1VF
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: 11 SIIVERS
Address 106 FERNTACCD DRIVE
a I 28k55
City or Town Stab Zip Code
(822 )- 584-3458
Arta code- Phone number
4. DATE DRILLED O3 '
5. TOTAL DEPTH: 365
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO XI
7. STATIC WATER LEVEL Below Top of Casing: 3D FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS 2 FT. Above Land Surface*
*Top of casing terminated at/or below land aerha requires •
variance In accordance with ISA NCAC 2C .0118.
9. YIELD (gpm): 4 METHOD OF TEST BY AIR TEST
10. WATER ZONES (depth):
11. DISINFECTION: Type I-IIH TARS Amount 70
12. CASING: Wall Thickness
From° t/ FL ref MCWpght/F�
From To FL
From______ To FL
13. GROUT: Depth Material Method
From_9_ To 70 Ft. CICUT LOBED
From To Ft.
14. SCREEN: Depth Diameter Slot Size
From To FL in. in.
From______ To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
Material
16. REMARKS:
Topographic/Land setting
❑Ridge ❑Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degnesim7oadesheemdt)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
PF_PTK DRILLING J an
From To Formation Description
c
0 o
v
J
N-'
T`1. J
I OCATION SKETCH
Show direction and distance in miles from BDkast3
two State Roads or County Roads. Include the row?
numbers and common road names.
r
r_
1 DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS&W THAT A COPY OF TIjIS REGORDH)lS BEEN PROVIDED TO THE WELL OWNER
03-31-C4
OF PERSON CONSTRUC I3NB THE WFI r 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

294803
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources Division of Water Quality - Groundwater Section t,
WELL CONTRACTOR(INDIVIDUAL)NAME (prl j 1 `�r1/1 Y 3 SAC C CERTIFICATIONS/ -9/70
WELL CONTRACTOR COMPANY NAME _To it/L'E(iVG/h bi-i'aiNev' moat S/( ) 026-74(7- "YQ
STATE WELL CONSTRUCTION PERMITS/ ASSOCIATED WQ PERMIT,
(if applicable) fif applicable)
1. WELL USE (Check Applicable Sox): Residential fa/ MmncipatPRWic ❑ Industrial 0 Agricultural 0
Monitoring ❑ Recovery 0 Heat Pump Water Injection ❑ Other ❑ If Other, List Use
2. WELL LOCATION: , : L
County in L 4J(i' L✓
Lot Fits" (y.(F lLatu.0 y ill ?I -
(Street Name. Number. Community, Sabmvisioo, let No., Sp Code)
Nearest Town: r
3. OWNER:
Address
(Street or Rome
OLAfcrf ,Q C
)
Lot
Topographic/Land setting
MI/Ridge ❑Slope ❑Valley❑Flat
(deck appeoptiate box)
Latitude/longitude of well location
C3N G (demeradminettateconda
LadtudeJlongitude source:❑GPS❑Tapographic map
(check box)
DRILLING LOG
Formation Description
City or Town Stets, tip Code
(2/)- 'c4- 9535
Area code- Thom number,
4. DATE DRILLED ei?25--z4
5 TOTAL DEPTH: cfLD5
DEPTH
From To
7E/,
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO [�!/
7. STATIC WATER LEVEL Below Top of Casing. 7o FT.
(Um'v" if Above Top of Cosine)
8. TOP OF CASING IS / FT. Above Land Surface*
`Top of using toreia•ted oder bekw Iand serfs require •
variance he
METHONCAC D OF TEST �'//'�
JIM
9. YIELD (gpm):
10. WATER ZONES (depth): 7 I rrI (^—' / S o
11. DISINFECTION: Type ('&1-2/4t e
12. CASING:
Depth
From To
FmP_To /
FromMPI To f7�
13. GROUT: Depth
From To Ft
From_ To FI
Y,S
LOCATION SKETCH cP
J
Amount S CV_ 7?4,Show direction end distance in miles from at 110
Wall 7bidmess two State Roads or County Roads. Include the lead
Diameter or WeighVFt Maemisl mmmbaa and common road mica.
Ft.
F
Ft.
vo
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:
1 DO HEREBY CERTIFY THAT THIS
CONSTRUCTION STANDARDS, AND
SIG
rear
WAS CONSTRUCTED IN ACCORDANCE WrIH ISA NCAC 2C, WELL
T A COPY qF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
Subunit the original to the Division of Water Quality, Groundwater Section, 1636 Mal Service Center - Raleigh„ NC
27699-1636 Phone No. [phone], within 30 days. GW-1 REV. 07/2001

WELL CONSTRUCTION RECORD
294802
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section .
W"
WELL CONTRACTOR (INDIVIDUAL) NAME (primp �C�(gieiii -;! Q S-'t f,� CERTIFICATION I0� (� y�
ELL CONTRACTOR COMPANY NAME J %r tr' s 3 fit , ((�( PHONE II` ( ) 2 -4 � `O
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WO PERM
(if applicable) j (if applicable)
1. W ELL USE (Check Applicable Box): Residential c/olunicipal/Public 0 Industrial ❑ Agricultural 0
Monitoring ❑ Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION:
Nearest Town: QCounty l `t U
l &.e
(Street Name. Numbers, Community, Subdivisioo, Lot No., Zip Code)
3. OWNER: VV`CO).3
Address lM4- I Oa Si-
- (Street or Rome No.)
w O (.tom-- vc) C 2S31 7 51-
City or Town State tip Code
Area code- Phone number
4. DATE DRILLED 2 Z D
5. TOTAL DEPTH: 2 tce
6. DOES WELL REPLACE EXISTING WELL? YES IDI& 0
7. STATIC WATER LEVEL Below Top of Casing:
(Use "t" if Above Top erasing)
8. TOP OF CASING IS / FT. Above Land Surface*
'Top of casing terminated atfor below load surface requires a
variance la accordwse with ISA NCAC 2C .0113.
9. YIELD (gpm): Ci METHOD OF TEST /-) R
l0. WATER ZONES (depth): M A-tr•i n. 200
I1. DISINFECTION: TypeCtO Apt Amount Q e2 e
12. CASING: Wall Thickness
to
r WeidUPMAterial
ID
Depth Di.
From 0 To 28 FL Co
From 2� el To
Tom_ FL
From e 0 To °la Ft
13. GROUT: Depth
From To FL
Frotn_0_ To 2 b FL taf � 1 ` U (� P%A
14. SCREEN: Depth D. r Slot Size Mataial
From To Ft. in. in.
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Size
From To Ft
Topographic/Land setting
°Ridge ❑Slope Dailey :❑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
©--/ p,hr
Ire S adtAia-R
/ Y - 7 25' 6-re-A -
c
;w
-O
t �r^
From To Ft.
16. REMARKS:
Material
Material
Method
LOCATION SKETCH y :
Show direction and distance in miles from at te'fst N i2
two State Roads or County Roads. Include ther"ghd
tannins, and common road names.
I DO HEREBY CERTIFY THAT
CONSTRUCTION STANDARDS,,AN
WELL WAS CONSTRUC tr IN ACCORDANCE WITH 15A NCAC 2C, WELL
THAT A COPY a.— IS RECO a HAS BEEN PROVIDED TO THE WELL OWNER
SIGNA
NSTRUCTING THE WELL
DATE
Submit the original to the Division of Water Quality, Groundwater Section,1636Mail Service Center - Rateigh„NC
27699-1636 Phone No. [phone], within 30 days. GW-I REV. 0T/2001

North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
1636 Mail Service Center - Raleigh, N.C. 27699-1636 - Phone [phone]
WELL CONSTRUCTION RECORD
040028
294191
WELL CONTRACTOR' Dewey Wright Well Pump Co., Inc.
WELL CONTRACTOR CERTIFICATION #. 2787
STATE WELL CONSTRUCTION PERMIT* Jerry Wilson
WELL USE (Check Applicable Box): Residential X Municipal 0 Industrial 0
Recovery 0 Heat Pump Water Injection n Other If Other, List Use:
2. WELL LOCATION: (Show sketch of the location below)
Nearest Town: MA.RION County MCDOWFLL
DEER RIDGE RD OFF OCONEE FALLS OFF DEER RIDG
(Road Name and Numbers, Community, or Subdivision and Lot No.)
3. OWNER HAROLD BRITO
Address 188 PLANTATION BLVD.
!SLAMS` FL
33036
Agricultural: Monitoring
DRILLING LOG
From To
0 300
300 316
City or Town State
4. DATE DRILLED 3/25/2004
5. TOTAL DEPTH 430
6. CUTTINGS COLLECTED YES 0 NO
7. DOES WELL REPLACE EXISTING WELL? YES 0 NO
8. STATIC WATER LEVEL Below Top of Casing: 100 FT
(Use "+" if Above Top of Casing)
9. TOP OF CASING IS 1 FT Above Land Surface*
'Top of casing terminated at/or below land surface requires a variance in accor-
dance with 15A NCAC 2 118
10. YIELD (gpm): _ METHOD OF TEST Air
11. WATER ZONES (depth)10.00 ppm 316-318 50.00ppm 418-420
0.00 qpm 0.00gpm
Zip Code
316 418
418 420
420 430
• DEPTH
Formation Description
CLAY GRANITE LIMESTD
GRANITE
GRANITE
GRANITE
GRANITE
0
a P,
X
m
r
12. CHLORINATION: Type HTH Amount 67
13. CASING:
Wall Thickness
Depth Diameter or Weight/Ft. Material
Rrom 0 To 316 Ft 6 1/4 .188 GALV
From To Ft
From To Ft
14. GROUT:
Depth Material Method
From 0 To 20 Ft Cement Gravity Flow
From To Ft
If additional space is needed use b
of fm
15. SCREEN: `Y
Depth Diameter Slot Size Material ry
From
From
From
To _ Ft.
To Ft.
To Ft.
in
in
in
in
in
in
16. SAND/GRAVEL PACK:
Depth Size Material
From To Ft
From To Ft
17. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A CO OF THIS RECORD HAS EEN P OVIDED TO THE WELL OWNER.
�-c 1/---7 3 a.71tt
LOCATION SKETCH
(Show direction and distance from at least two State
Roads, or other map reference poi s)
FOR OFFICE USE ONLY
SIdNATURE OF PERSON CONSTRUCTING THE WELL DATE
Submit original to Division of Water Quality, Groundwater Section within 30 days
GW-1 REV. 12.99
Quad No'
Serial No.

WELL CONSTRUCTION RECORD
294'795
North Carolina -. Department of Environment and Natural Resources - Division of Water Quality - Gmtmdwaler Secti�oln PS-6WELLCO!YTRACTORm IDUALDMAIE « ) l %I'P-7 �'��t C.L CERTIFICATION a'�`
WELL CONTRACTOR COMPANY NAME 5 'US*, C lC 14! 12.2,4-- 1 r, :.J I-=C non it 1 Z 4- QC-9
2
STATE WELL CO\STR11CT1ON PERMIT* ASSOCIATED WQ PERMITS
(if applicable)
(if applicable)
1. WELL USE (Check Applicable Box): Residential (VMm cipallPublic ❑ Industrial 0 Agricultural 0
Monitoring ❑ Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION: r� r - Cary n -C\6a.
•
Nearest Town: U 1. 'r
(r Cangy.\sebt-s:a.
Numbers. C
(Seed Name. Lw Nee Zip Cade)
3. OWNER: .C' ( lei el/tom..•
Address g 1 7-
(Sutter Rome
F Ijl I, t \,V' C
City or Tow Sate
Zips
()41- i-.o2g
Area cede- Mew amber
4. DATE DRILLED 3 f Z 5 l o 4
5. TOTAL DEPTH: 4 4 r: /
6_ DOES WELL REPLACE EXISTING WELL? YES 0 NO GK
7. STATIC WATER. LEVEL Below Top of Casing; 1 C=Z' Ff.
(UmW if Above TM of Casing)
8. TOP OF CASING IS t FT. Above Lad Surface'
*Top •twain trr•daatd as s r Wear lead ware roman. •
nrtncc m atmrdaam Ida ISA NCAC IC Alt
9. YIELD (gpm): S C METHOD OF TEST A
10. WATER ZONES (depth): ` D e) PM e 2.'t o
Amount 02 (.074,
11. DISINFECTION: Type LOCi 4.!
12. CASING:
Depth From (O To
e`t
Fro ` `I To I'74
Prom j at To 17 f^
13. GROUT: Depth
From To FL
Wall Tbidmess
Diaper awelgtrVR. Material
Ft. (-9,, 4o
Ft. ( `IC, CO QU
Ft if yo tSacs- _
Material Method
nieueerregosterocomen
Latitude/longitude source:❑GPS❑Tepographic map
(check box)
DEPTH DRILLING LOG
From To Formation Description
p: (c S $Nd
�- (_^r5F Yea.I-
1 b - 2 5 C?le.iw: t,: (q .,,c.t-s
Topo�c/Lald setting
❑Ridge ❑Valley❑Flat
(cheek appropriate hoa)
Latitude/longitude of well location
0- Its?
LOCATION SKETCH -0 `c ,
TO Show direction and distance in miles from least@
two State Roads or County Roads. Include thdroar
ql-
rumbas and common road camas.
-1 CC a ery.-{-
�- L,tw""t wAi- Urtt"
�s L"
2
14. SCREEN: Depth 6
frl ,C
From To FL in. in. C d
From To Ft in. in.
(5. SAND/GRAVEL PACK:
Depth
From To Ft.
From To Ft.
FrmnL_Q- To CIE e`
Ft : k` pL k .Q. v vwti��^
Slat Sine Mahaial
Size Material
rs
3 N
( 4- bit); KrilA^t C W
Litt (' l✓-,^ V V
16. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE watt ISA NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
�A ruyy t
SIOt1A RE OP PERSON CONSTRUCTING THE WELL DATE
Submit the original to the Division of Water Qtallity, Gremadveater Section, 1636 Mail Service Center - Raleigh, P C ,
27699-1636 Phan No. [phone], within 30 days. GW-I REV. 07/2001
di!LYN
`Ai „CLIna

294^96
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and NaturalllResources - Division of Water Quality - Groundwater Section
WELL. CONTRACTOR (INDIVIDUAL)NAME (pried)b/a 7 b CU Sti C- CERTIFICATION 8; (SA
WELL CONTRACTOR COMPANY NAME J v 5 * 1 C F_ W /FL( t>rt LL' ,'L'-( ?noNE a ( ) 7'24-
STATE WELL CONSTRUCTION PERMIT/8 ASSOCIATED WQ PERMITS
(if applicable) (if applicable)
1. W ELL USE (Check Applicable Box): Residential EV-Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCAT1Ot4: N PSLQ
Nearest m: TY` Q,q,l.,t-0-- County �til •
iLc
u Community, 'vision, Lot No. rip
Code)
Name. N tubers, C ray.
3. OWNER: (1. rtaa jet
Address rja. Re F »tr"`1) 6 /r ✓e_ Pr(
City or Town slate hip Cada
( }L74 i70
Area code- Phone number 4. DATE DRILLED . ^ 2 € -. vci
5. TOTAL DEPTH: 340 '
6. DOES WELL REPLACE EXISTING WELL') YES 0 NO li
7. STATIC WATER LEVEL Below Top of Casing: L.0 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS 1 FT. Above Land Surface'
*Top of easing terminated Mier below land surface requires ■
variance In accordance wnb ISA NCAC 2C .0118.
9. YIELD (gpm): V2. METHOD OF TEST Sin i
10. WATER ZONES (depth): lit 9 /tn'i (s 20
(Sues or Rowe Na)
11. DISINFECTION: T}peti LCPINC Amount Q,c.Le13`.
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
From To Ft.
From ,��,0,To (u FL (. Yet 40 Vd
From _To Ft. (.0 Yy I HO . z
13. GROUT: Depth Material Method
From To FL
From_a_ To= FL
14. SCREEN: Depth D
From To FL
From To Ft.
15. SAND/GRAVEL PACIC:
Depth
From To Ft.
From To Ft.
Topogr)hic/Land setting
❑Ridge Mope ❑Valley ❑Flat
(check appropriate boa)
Latitude/longitude of well location
oegeemainutememnds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DRILLING LOG
Formation Description
DEPTH
From To
16. REMARKS:
410
LOCATION SKETCH 0 c
Show direction and distance in miles from at (east
two State Roads or County Roads. Include the roaC, ,
numbers and common mad names.
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANC r ISA NCAC 2G WELL
CONSTRUCTION STANS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
SI NATU4OFPERSONCONSTRUCTINGTHEWELL
DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center -Ralpigh;NC
27699-1636 Phone No. [phone], within 30 days. GW-I REVS OV2O9

294797
WELL CONSTRUCTION RECORD
North Carolina - DcpaMsnt of Environment and Naeeal Resources - Division of Water Quality - Gro+adwattr Section
WELL CONTRACTOR (INDmDI1M4t'IAME (R%V) e-S /4 n 1 'So$ f / C ,6 CERTWICAnoN s 1ls
.).. ++cC ?Ala " J2. " 14-1<-7 snout s fi.41 :Ly-G3 'B
STATE WELL CONSTRUCTION PERMITS ASSOCIATED WQ PERMITS
(if applicable)
WELL CONTRACTOR COMPANY NAME
(if applicable)
1. WELL USE (Check Applicable Box): Residential l3' Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring ° Recovery 0 Heat Pump Water Injection ❑ Other 0 If Other, list Use
2. WELL LOCATION:
Neatest Town: Mier Q' t,U
3 c,o /et ; c,).vr D ,z
(Siam Name. Naroberk Crmmenkri Subdivision. Lac No, 27p Cade)
3. OWNER:13Ce/NA 3cb=25
Address QCX
County %Y) `'1)6,1-et L
(SLctor Route Nal '7SZ
MO, �ry ,
City orTown Stare Zip Code
(et' )-C'i2-c.C.;40
Am code- °Mae tooter
4. DATE DRILLED 5 - .3
5. TOTAL DEPTH• y v>
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO Er
7. STATIC WATER LEVEL Below Top of Casing 2d FT.
(Ua'W'if AboveTap of Casing)
S. TOP OF CASING 1S / FT. Above Lad Sulfa&
`Tap Homine amoiraated Nrw bdtw Ma sarime empire m
various 1a armraaaQ oat ISA NCAC 2C MIS.
9. YIELD(gpm): i/L METHOD OF TEST /f(rysir/ui
10. WATER ZONES (depth): '/u %t^' ea 2 ""
�< Se „ C✓ Y'2°
11. DISINFECTION: Type Q CLrt ' L Arnow ie02 E /./P
12. CASING: . Wall Thickness
DiameSsr or wei*IIFI
From E- Tom 1 2 Ft 6' 7/ Y el Pr
Frorn_i_ To /AFL r' V t e o 4 e
Porn // 2 To //4' Ft. C. 'lv / 9 Pf
13. GROUT: Depth Material Method
From To FL
From t; To 7 y FL I%, .t / 120nifid
14. SCREEN: Depth Dimmer Slot Site Wuxi l
From To
Topo�c/[and setting
°Ridge °Valley°Flat
(cheek a-pmp6es box)
Latitrde/Iongitude of well location
mernearedwitevseesivm
Latitude/longitude sourceAGPS°Tapographic map
(cheekbea)
DEPTH DRILLING LOO
From To Formation Description
C/-/o‘i 54n1r pre -
in.
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Size Material D'✓
0 n
v,
c
rr'•c
L OC,ATION SKETCH ? ..
Shaw direction and distance in miles from ati5st rn r
two State RoadsorCowty Roads. Include thetoad c:2,
mmbera and common road names. W -a;o
2 ZIh
ciL 73/'cCt
From To Ft.
From To Ft.
16. REMARKS: / l
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 TOTHE WELL OWNER
SIGNthURF PERSON CONSTRUCTING THE WELL DATE
Submit the original to the Division of Water Quality, Groundwater Section,1636Mr7 Service Center - Ralelg►, NC
27699-1636 Prove No. [phone], within 30 days. GW-I REV. 07 1

294"98
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) l?- .tf TL, CERTIFICATION II /5?)
WELL CONTRACTOR COMPANY NAME jUS+ice WL-Lc D,'LC ivy.) PHONE B ( ) 72,9- r <es,
STATE WELL CONSTRUCTION PERMIT/I ASSOCIATED WQ PERMrTE
(if applicable) (if applicable)
1. W ELL USE (Check Applicable Box): Residential 61ilG 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: /nCLst t? County/0 c.46 -to
St i e r 14,:-La2
(Street Name. Numbers C
omm
unity, Subdivision, Lot No, Zip Code)
3. OWNER:
Address //aq m/frl cc A
(Street or Route Na)
City or Town State tip Code
Area code- Phone nun
4. DATE DRILLED %� Z roc/
5. TOTAL DEPTH: j u�S
6. DOES WELL REPLACE EXISTING WELL? YES 13- 0 ❑
7. STATIC WATER LEVEL Below Top of Casing: Z') FT.
(Use "f" if Above Top of Casing)
8. TOP OF CASING IS I FT. Above Land Surface'
'Top of easing terminated at/or below land octave require •
vadaaee la accordant with ISA NCAC 2C .0118.
9. YIELD (gpm): (L' METHOD OF TEST /1 /
10. WATER. ZONES (depth): 4'1V) w' tic l 1 L t`
11. DISINFECTION: Type C 44-1
12. CASING:
From
From J
From in/
13. GROUT:
Depth Diameter
To Ft.
To f''( Ft.,
Ft.
Depth
Material
Topoprope Land setting
❑Ridge p 8fop❑Vallet,. ❑Flat
(check appropriate box)
Latitude/longitude of well location
(deerec hnitmtes/secatdt)
Latitude/longitude souuce:❑GPS❑Topographic map
(deck box)
DEPTH DRILLING Loft
From To Formation Description
50 An
- /E, C /inr A
c
t
Amount e, 7.7g, Show direction and distance in miles from at lei
Wall Thiclnxss two State Roads or County Roads. Include the raj
or Weighs/FL Matetal nw,dnaa and common road names.
,yl,°,� Sc%c,�yriv/ zt V
1
From To Ft.
Ft.
From To 7 Yt Ft. /
14. SCREEN: Depth Di Slot Size
From To FL in. in.
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From
16. REMARKS:
I DO HEREBY CERTIFY THAT THIS
CONSTRUCTION STANDARDS, A
To Ft.
c
n
t t '''
LOCATION SKETCH 5 ~`
ELL WAS CONSTRUCTED IN ACCORDANCE WITH ISA NCAC 2C, WFt
AT A COPY t F THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER.
TUOF
CONSTRUCTING THE WELL
DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center -Raleigh, N(
27699-1636 Phone No. [phone], within 30 days. - GW-I REV,!07/2001
by UiV(`'»i'ATER SECTION
�J. r'. ..,4•, r)r•,'e

298502
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division off Water Quality - Groundwater Section I
WELL CONTRACTOR (INDIVIDUAL) NAME n (print 1(�` W\ P.S t= C �at N CERTIFICATION # a l! C
WELL CONTRACTOR COMPANY NAME L-00.V4\N \(U el DcA't 1\3
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
PHONE # ligc i) �J 13 471
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 LOCATIO+ Neare.st Town: IS is M County l `\ cttYJC t
C\oCC c c. e. Lox- -0
(Street Name, Numbers, Community, Subdivision, Lot No., Try Code)
3. OWNER: (-) A \(lh •\eco
Address
(Street or Route No.)
Mt c't r\ JJ.0
Cjty or Town Siltec, ce Zip Code
Area code- Phone number
4. DATE DRILLED 1-14-6 4
5. TOTAL DEPTH: 4 43
6. DOES WELL REPLACE EXISTING WFI 19 YES 0 NO Er
7. STATIC WATER. LEVEL Below Top of Casing: a5 FT.
(Use "+" if Above Top of Casing)
S. TOP OF CASING IS \ -5 FT. Above Land Surface'
'Top of casing terminated at/or below land surface requires a
variance in accordance with ISA NCAC 2C .0118. ,
9. YIELD (gpm): i 3 METHOD OF TEST CA\e_C
10. WATER ZONES (depth): RS — //0
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
G2cn
rn
zic
�// 11 J,OCATION SKETCH •t
11. DISINFECTION: Type II T rf Amount / t O Show direction and distance in miles from at leEa
cv-
12. CASING: Wall Thiulmess two State Roads or County Roads. Include the roSt o
Depth Diameter or Weight/Ft. numbers and common road names.
From loll_ To G'S Ft 4r-2S %O
From (, To ! y Ft. L -25 (N
From To Ft.
13. GRO Depth Material
From/ To �d Ft CProP�
From To Ft.
14. SCREEN: Depth Diameter
From. To Ft.
Method
Slot Size Material
in. in.
From To Ft. in. in.
15. SAND/GRAVEL PACK
Depth Size Material
From To Ft.
From To Ft.
16. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRU( j'ION STANDARDS, AND T A PY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
GYIe- l- l- o
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
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 Env6oanient and Natural Resources - Division of Water Quality - Groundwater Section
,
WELL CON RACTOR (,NINVIDUA1)(AME -
WELL CONTRACTOR COMPANY FUME 51't41C( Ga )Q. nr i.L.1 mows a f ) 9u-VWF�
STATE WEAR. COssTRuCTION PERMIT* /
(if cable)
303310
ASSOCIATED WO PERMIT%
or
1. WELL USE (Check Applicable Box): Resided U umicipal/Puaic 0 1Rduanial 0 ALaukura0
Monitoring 0 Recovery 0 Heat Pump Way Injection 0 Odrr 0 If Omer, List Use
2 WELL LOCATIN$ '
Nearest Town: ��il[.�7•�- County /ri h"""-""
4 5 mete, 8/ca•444 ,D
(Stied Name. ttaohva, Casnamity, $.Wma. tar Ne., We Cade)
setting
°Ridge Q�alryr
(cheek unpinning ban)
Latitude/longitude of well Location
3. OWNER: & n .chltil tom)
Address 0 4(f5 Amnia r B4A � Art Latitude/longitude sou ccOGPSOTapogaphic map
(Straw or Rome No.) Windt boa)
Nth° /V c. o9 996/ DEPTH DRILLING Loa
Coy orTwn sae TA Code Fran To Formation Description
(_)- (o S 2-4d/ 2 ' 457-/Zc4
Ana cede- Mama ...aw o%- 4'V <1041 '
4. DATE DRILLED G} - 2 `/' °el ���" "
5. TOTAL DEPTH: .72.5 !ja IC /
6. DOES WELL REPLAN EXISTING WELLY YES O NO CY
7. STATIC WATER LEVEL Below Top fCasint oft)
FT. (00-.. L25.t.... � 64..XZt L/
8. TOP OF CASING 1S / Fr. Above Lad Surface`
Kee wait taraemassa afar ban. Tad sr... .apirs a
flare It are manes Rea ISA (CAC 2C Ala.
9. YIELD (gar): __a_ METHOD OFlEST /9 /2
10. WATER ZONES (depm): r2feen
4
LOCATION SKETCH
rn
11. DISINFECTION: Type C° '/"@ Ammar 9 01- 73, Show direction and distance is miles fnIA at lea$*
C
12. CASING: Wall .tt' s two State Roads or County Roads. IRcbade the road'
ptPlk maw war passon. MsSJ madras and GOMM' toad e®as. r-3 C--
Ftoni O To FL to / 8 8 �� __ 0 .40
Frml o To a. 1/_L_ -o P ' --
From re 6To 4be Et /a �/ AR ii 6'/Q/// ,ifr i
13. GROUT: Depth Material Method ,7-irri
From To FL r
FronL412__TR 92 Ft l'1ew&
14. SCREEN: Depth Diameter Slot Sax 02
From To Ft in. i` "ems(
Fran To Ft in. in. • nd
15. SAND/GRAVEL PACK: /97G'KP
Depth Size Material e,r .49a
From To Ft
From To Ft/ ��
`CfuA,k_
16. REMARKS:
1 DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITS 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, ATj[) HAT A Con' THIS RECORD HAS BEEN PROVIDED TONE WFLI, OWNER
CONSTRUCTING THE WEU. DATE
Submit the original to the Division tif Wain Quality, Crorurdwater Section,1636 Man Service Center -Raleigh, NC
27699-1636 Phone Na. [phone], within 30 deys. GW-1 REV. 07/20Of

-
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL. (I CONTRACTOR NDIVIDUAL)NAME (prim() C f) tJ t ( l 54 C C CERTIFICATION", C
\YELL CONTRACTOR COMPANY NAME �U Yi;es u U L-(Ai PHONE tI f ) 72-41-1-6/9
STATE WELL CONSTRUCTION PERMITS ASSOCIATED WO PERMIT?
(if applicable)
(ifapplicable)
1. WELL USE (Check Applicable Box): Residential �Dnicipal/PuhIic 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION: %/Q
N Town:
MIOM County bowe"-
ertk / Ts; /4673 A,44, J3 /f4•4 red
(Sues Nast], W �uony Subdivision, Lot No_ Tap Code)
3. OWNER: G(5 Ay1?5BUIZ %j
Address ,�tljl 3(OI lanc.ie. l'apt IAZ 'f
CAQatipP... &Uor G eNa) t BZZco
City or loom Sane tie Code
OD- 49y - 9505 o4/-511-ti39
Area code- Thom4. DATE DRILLED 2 Q'" D di
5. TOTAL DEPTH: //00 (
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO fY
7. STATIC WATER LEVEL Below Top of Casing: FT.
(Use"+' if Above Tap of Casing)
8. TOP OF CASING 1S / FT. Above Land Surfae
flop .f ashy ter®rd min below land surface imam a
minas to acreedance with ISA NCAC 2C Atta.
9_ YIELD (gpm): METHOD OF TEST
10. WATER ZONES (depth):
1I. DISINFECTION: Type('LUR/tie Amotmt Fj 0t
12. CASING: Wall Thames
Depth Diameter or WeigbVFL Material
From To FL
From 0 To FL-� <./0
_Topographic/L.and setting
t9tuidge ❑Slope ❑Valley ❑Flat
(check appropriate box)
LatitudeflongitUde of well location
303309
Nereesin ioutdsecouas)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From To Formation Description
12
rpm/
ovL
From (OZ To (j r/ Ft. _��_`i—
13. GROUT: Depth Material Method
From To FL
From (2 _ To 2.5- FLtt
Depth
p
SCREEN:
e
14.
Slot Size trial
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:
GCr'
2 r
5-4
LOCATION SKETCH rn=y
Show dimction end distance in miles from at 1e51a.
c:,-
two State Roads or County Roads. Include the roa0 c-0-O
slumbers and common mad names. O tri
if`�0
tf Air al CI
Iv
1
1 DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED 1N ACCORDANCE WITH ISA NCAC 2C, WELL r-
CONSTRUCTION STANDARDS AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
SIGNA
CS
C
N CONSTRUCTINGTHE WELL
DATE
N
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC r_,
27699-1636 Phone No. [phone], within 30 days. GW-I REV. mow(_J
C

303308
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
��Jy
WELL CONTRACTOR (INDIVIDUAL) NAME (print) QT"fey Zu5�,ie6 CERTIFICATION # 44J l",�(p�}
WELL CONTRACTOR COMPANY NAME Z54.tCF Wea arr.1—i. PHONE # ( ) /2i yJ '(J
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential 2"—Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring ❑ Recovery 0 Heat Pump Water Injection ❑ Other ❑ If Other, List Use
2. WELL LOCATION: .1S®OL�CCY
�A^ t
Nearest Town: /I lael 0/t' County
75 MraQ ,u
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER:
Address %S hJ 47474 %Z!
/(,e.%et
(Street or Route C No.) 97G 2
City or Town State Zip Code/
)- 6S-2- 9fei4
Area code- Phone number„,
4. DATE DRILLED 2
Topograp ' and setting
❑Ridge ope ❑Valley [Mat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From To Formation Description
O- 20 ?Mgt &Atli
Cgic
1 Lone
5. TOTAL DEPTH: 9,10 ZprOt
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO 13'
7. STATIC WATER LEVEL Below Top of Casing: 8Q FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS / FT. Above Land Surface'
'Top of casing terminated at/or below land surface requires a
variance in accordance with ISA NCAC 2C .0118. •
9. YIELD (gpm): _ METHOD OF TEST t,L[/L
10. WATER ZONES (depth): / i2_t
die- /20
/20- goo
11. DISINFECTION: Type S1'f-f Amount eraZ_
12. CASING: Wall Thickness
Depth Diameter
From o To /02- Ft.
From ©Z To /Z2 Ft. (YE
From in To /29 Ft.-61*---
13. GROUT: Depth Material Method
From To Ft.
From 6 To %`. y FLB/
Depth Diameter Slot Size Material
To Ft. in. in.
To Ft. in. in.
14. SCREEN•
From
From
or Weight/Ft. Material
96 Me
GAE it
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
16. REMARKS:
LOCATION SKETCH
Show direction and distance in miles f oral at lei,
two State Roads or County Roads. Incittle the t'
numbers and common road names. >� <
• —4
-o tr
tv 7,30
CD ova
r*+r 1
a 0a
o
A
4Fe,znmepAw
4-
sage
/sh.tct-
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH I5A NCAC 2C, WELL
CONSTRUCTION STANDARD $j AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
SIGNA
URLfIOF PERSON CONSTRUCTING THE WELL DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center- Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-I REV. 07/2001

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural�r1Resources - Division of Water Quality - Groundwater Section
R WELL CONTACTOR(INDIVIDUAL)NAME • �(pout) QA /re7 5uM; Cf. CERTIFICATION nay 0
WELL CONTRACTOR COMPANY NAME . s+i C.e WC L..t- A rJ rl Li. ;AliPHONE i(a'7riSRrjf-jr/SSIB
STATE WELL CONSTRUCTION PERMITS ASSOCIATED WIT PERMITS
Of applicable)
(if litable)
303324
1. WELL USE (Check Applicable Box): Residential @"MtmicipaVPublic 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:
00
County /77-C LL e
&t• Sg {�, a0%
N sae
o (SoName. Numbers, Community. 'Ycbdiviaoa Led
o. ip )
3. OWNER:
Address A 79 (,ARTS 6Vt ROPP
(Sued or Rome No-)
rno.riON nlO', 2875R
City or Town State Zip Code
r yyz-/68S
Area code- Phase somber
4. DATE DRILLED AUG 27 - O1
5. TOTAL DEPTH: «OS
3 * 5o w L t. LW2
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO We
7. STATIC WATER LEVEL Below Top of Casing: 'J FT.
(Use "+^if Above Tap of
8. TOP OF CASING IS / FT. Above Lead Surface'
'Top at casing terminated War bran hood saran rrq. a •
variance he accordance whit ISA NCAC 2C Aiia.
9. YIELD (gpm): /S METHODOFTESTA//?
10. WATER ZONES (depth): 11; ro,H c /r/O
/3 Si, 9prnCP .260
11. DISINFECTION: Type at oft iNG Amount 602 &7394
12. CASING: Wall Thickness
Depth Diameter or Weight/FL Material
From To
Ft.
From 0 To C(�17q FL L9 Yy pw�"o� 41 V e
From 91 To f '! Ft. L4 Y N —R= i')11t LV
13. GROUT: Depth Z.,�Ma
,�teri'e/l Method
From 0 To g FL T Plot+
From To FL
14. SCREEN: Depth Diameter
From 0 Toj6' Ft 4r in.
From 3 Se' To `'O FL 4/ in-
15. SAND/GRAVEL PACK:
Depth Size
From To Ft.
From Toto
16. REMARKS:
Slot Size Material
— in. tee erL_
IL
yy
Statute!
'iceFt. �/y fle 4 grneL
&we --a - & /2 d
Topograpbic/land setting
❑Ridge ❑Slope EW0ey ❑Flat
(check appropriate box)
Latitude/longitude of well location
(aegedmnrmd ecamat)
Latitude/longitude source:❑GPS❑Topograpbic map
{cheek box)
DRILLTNO LOO
Formation Description
/J 1 Is+ jtoc jc
DEPTH
From To
0- en
9/-toe
cz•
Cr, G n
45, t -i1 rl
C �G
\ -O O
0 Q0
rn
1p
Op
LOCATION SKETCH (00la
Show direction end distance in miles from at Ieasa7 tilt
two State Roads or County Roads. Include the —
numbers and common road names.
LAN4
/for/c, e
qc
ehore,4
Pew
GIi6✓oC.
Sor ik
ANmiAt/
44/
—Si ere
1 DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS ND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER --
BISON CONSTRUCTING THE WELL
DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center -Raleigh, NC
27699-1636 Phony No. [phone], within 30 days. GW-I REV. 07/200I

WELL CONSTRUCTION RECORD
303326
2. WELL LOCATIONjjj �T p
Neatest Town: �L1Ca')-- county/id -- kfuriC
� � C�a�am�oLn�-, Subdivision, 0.
3. OWNER: eta / t
Address 9S. 4Zkt e.L
North Carolina - Department of Environment and Na
WELL CONTRACTOR (INDIVIDUAL)NAME (print
W ELL CONTRACTOR COMPANY NAME i �Iy! C
esources - Division of Water Quality - Groundwater Section
215)�% t CERTIFICATION a,,�o-�`.,',,s,-ei B
PHONE * 7v7��/O
STATE WELL CONSTRUCTION PERMIT* ASSOCIATED WQ PERMITS
fit applicable) Of applicable)
1. WELL USE (Check Applicable Box): Residential 0--- micipal/Public 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
(Sum Name.Numbers, aY +Try Code)
lc
tt& (sues ei Na) 76 /
City or Town S�a'(te(L uP Lode
)- 7,
Ann code- Phase umber
4. DATE DRILLED Q'.73,-el/
5. TOTAL DEPTH: S/M
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO O---
7. STATIC WATER LEVEL Below Top of Casing: 5t FT.
(Use'+^ if Above Tap of Cuing)
8. TOP OF CASING 1S I FT. Above Laud Surface'
Top .r casing terminated atlas below Azad snrlre rgaes.
variance in atcerdaaa with 1SA NCAC 2C .01111.
9. YIELD (gpm): .3 METHOD OF TEST /11//2-
10. WATER ZONES (depth): 39 l 67 .?70
Topographic/Land setting
*Ridge &Slops *Valley ❑Flat
(ouch appropriate box)
Latitude/longitude of well location
(descrhnio.edsemrds)
Latitude longitude sourcc.❑GPS❑Topographic map
(check box)
DEPTH DRILLING LOO
From To Formation Description
o-
v
f r)
O rrt.—
M
LOCATION SKETCH
I I. DISINFECTION: Type /1.4/40-e- Amount n3 73, Show direction and distance in miles froRbat leastno
12. CASING: Wall Thithness two State Roads or County Roads. Inclut }he roaSto
Depth Diameta or Weighs/Pt.
From To Ft From To 4 Z
From 6Z To t'G V Ft
13. GROUT: Depth
Flom To Ft
From To 25 Ft r y
14. SCREEN: Depth
From
Material
To Ft in.
From To Ft in.
15. SAND/GRAVEL PACK.:
From
From
Depth
To Ft.
To Ft.
J
Slot Size
Size Material
Material
Method
rumbas and common road names. -a
s Z��
16. REMARKS:
1 DO HEREBY CERTIFY THAT THIS WELL Wj
CONSTRUCTION STANDARDS, ANDTH
SIGN
CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
COPY OF mis RE H
BEEN ROVIDED TO THE WELL OWNER
OPIERSON NG THE WELL
Submit the original to the Division of Water Quality, C
27699-1636 Phone No. [phone], within 30 days.
DATE
water Section, 1636 Mal Service Center - Raleigh, NC
GW-1 REV Y17/2001

0
p00Z
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL)NAME (priat) GARL..Twr:c C CERTIFICATION A 2/5V
WELL CONTRACTOR COMPANY NAME 3:- 5 (C.S W LL Drfc--Wry PHONE s -9,74- V-el-Sztle
STATE WELL CONSTRUCTION PERMIT, ASSOCIATED WQ PERMITt
(if , icable) Of likable)
303327
1. WELL USE (Check Applicable Box): Residential ' Municipal/Public 0 Industrial 0 Agricultural ❑
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION:
Nearest Town: M(2 an4-1 County (�✓_yC,C
Goo /441ai. askto
(Strom Name. Numbers, Commuairy, Subdivisioo, Lot No...29 Code)
3. OWNER: icitedefrt. eantg ..-
Address /D/ /Y///Np Cs /Q U
!Sven or Roane No.)
for-i54 yip it/ 324S4
Ctly «Town Smte Zip Code
( )- zZ4- (e9Gz
Area code- Phase comber`
4. DATE DRILLED 0a/a di— 0V
5. TOTAL DEPTH: 4000
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO ❑i
7. STATIC WATER LEVEL Below Top of Casing: 90 FT.
(Use ^+-it Above Tap &Ceara)
8. TOP OF CASING IS / FT. Above Land Surface'
flap oar cuing terminate/ ode below load surface regains •
varlaace la accordance Ida ISA NCAC 2C ADI,.
9. YIELD (gpm): Kr METHOD OF TEST ...cia' rear.
10. WATER ZONES (depth):'yvtwv /1f/ Soor
LOCATION SKETCH
11. DISINFECTION: TypetfOtCs ✓e Amount rg bZ eg.Show direction and distance in miles from at IeaS m
12. CASING: Wall Thidotess two State Roads or County Roads. !nclu§ the roarjcA
tV
Topographic/Land setting
C7Riage °Slope °Valley ❑Flat
(check appropriale box)
Latitude/longitude of well location
(aegkeechnnvklrshecakds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH DRILL)NO LOG
From To Formation Description
0-75
� - )2o
/ge- GOO
Depth mamma oar weight/Ft maortal mm11baa and conmmn road names.
From / ei/ To f VI Ft Cs Y!/ 135 4.a. -Pi o
Fromf_To_ /'/ FL (; (4' _y? ,4:21C
From /05V To /NLFt. 6,rg _ �d
13. GROUT: Depth Material ethod
From To Ft.
From_ To(' _FL lam f Ag
14. SCREEN: Depth Ursme(er 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:.
a
(ea
I DO HEREBY CER11FY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH I5A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AN THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
/ii/✓
SIATU PERSON CONSTRUCTING THE WELL
•
DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Marl Service Center- Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-1 REV. 07/2001
/ be

303328
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (sus0_1r., -4' G LUC uiCATION R Zi Ste
one a f ) 9Z t453+S
WELL CONTRACTOR COMPANY NAME
STATE WELL CONSTRUCTION PERMIT ASSOCIATED WO PERMITP
(if icabk) (if boble)
I. WELL USE (Check Applicable Box): Residential (iVManicipaUPublic 0 Industrial 0 Ag icuhulal 0
Monitoring 0 Recovery 0 Heat Pump Water- Injection 0 Other 0 If Other, List Use
2- WELL LOCATION:
Nearest Town: PO r4r
/45 L jet v ei 0 d
(Sum Name. Numbers. Commenay, Subdivision. Lot Na.Z4 Code)
3. OWNER: bona- WICC�GUft-rz
Address 37 v S Z Z t rV
County Alboorcei-
(Suers or Rouse No.)
`llp440 i Al e 1' d`75Z
City or Tom Sate Zip Code
(—)- 7 S$ Ij 4 e7 3
Ares code- nose munber
4. DATE DRILLED 7 — GC/
5. TOTAL DEPTH: SO
6. DOES WEIL REPLACE EXISTING WELL? YES 0 NO
7- STATIC WATER LEVEL Below Top of Casing: 4/0 FT.
(use "t'if Above Tap etCanog)
8. TOP OF CASING IS / FT. Above Laad Surfae
-Toper casing teretiaMS ohm below brad surface roe@n e
vedette m ■nurdance with ISA NCAC 2C AIL
9. YIELD (gpm): 10 METHOD S
l0- WATER ZONES (depth): T'//oM
11. DISINFECTION: Typed -Celt AJC Anton& IC)Z
12. CASING: Wall Thickness
Depth Dianna or wad martial
From To Ft
From O To FL ( 4/ .00
From PI To Ft. C Yr/ /E zfrlic
13. GROUT: Depth Material Method
From To Ft
Frorn_Q To '% Ft4-Wee f L'%I-roter
Topographic/fand setting
ORidge OSlope Malley °Flat
one& appropriate boat)
Latitude/longitude of well location
(degreesiontornes/urconds)
)atitudeflongitude source:OGPSOTepographc map
Wreck box)
DEPTH DRILLING LOG
From To Formation Description
—8a
O
..a 0.0
J
r' Ohfn m
� x
Q t C?
LOCATION SKETCH p rt1'n0
Show direction and distance in miles from at hie 9
two State Roads or County Roads. Include the road
umnbas and common road mimeo.
1P A.
L
14. SCREEN: Depth Diameter Slot Size Material al � ra �
From To Ft. in
From To Ft in.
15. SAND/GRAVEL PACK:
Depth Size
From To Ft.
From To Ft.
16. REMARKS: SO
I DO HEREBY CERTIFY THAT THIS WELL. WAS CONSTRUCTED IN ACCORDANCE WITH ISA NCAC 2C, WELL
CONSTRUCTION STANDARDS, A JID THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
Oak
C
Acid -kJ -Ws crli
SIGNA"fUREOF P
ektiv
CONSTRUCTINGTHE WELL
DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mal Service Center - Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-I REV. 07/2001
Pei

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural YjA1Resources - Division of Water Quality - Groundwater Section 4_
WELL CONTRACTOR (INDIVIDUAL) NAME (print) J tsi-t eta CERTIFICATION 02 / 3
CI
WELL CONTRACTOR COMPANY NAME 3US{nc F WC(.,j,, }�f �U&. IN v PHONE ity,oc) 224-45-/(A
STATE WELL CONSTRUCTION PERMIT,/ ASSOCIATED WQ PERMIT,/
(if applicable) (if applicable)
303329
I. WELL USE (Check Applicable Box): Residential 1W Municipal/Public ❑ Industrial ❑ Agricultural ❑
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use
2. WELL LOCATI.NO^N: pp
Nearest Town: //' Q,t.t e' County //IyI QYf
22i-22(R, IJ
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: Ise wN)k it4° C*-e.c
Address 3 Z 2 P, Wwy tc r- 226 ^1
(Street or Route No.)
la orl Nc_ 7eRCZ.
City or Town State Zip Code
( )- 7L9— 4 641-
Area code- Phone number
4. DATE DRILLED 9-/ O-- 0 4-1
5. TOTAL DEPTH: 2 S a
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO YQ
7. STATIC WATER LEVEL Below Top of Casing: Iv0 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS 1 FT. Above Land Surface*
Topographic/Land setting
❑Ridge EIfrlbpe ❑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
u - yo
*Top of casing terminated at/or below land surface requires a
variance in accordance with 15A NCAC 2C .0118.
9. YIELD (gpm): METHOD OF TESTA/2
10. WATER ZONES (depth): 2 gpxti t9 Zit
I1. DISINFECTION: Type CL0f2t NC Amount $d2
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
From To Ft.
From__Q___To1-Ft.
From )11 To )13 Ft. &`Ij /99,
13. GROUT: Depth Material
From To Ft. t
From 0 To 2ri Ft. 2£) PVr•pe--A
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
ale/at., c
(0 0 ta... . gerr .
erg- l 00 Tad se
/DO- /OS ,0;
/OS- Z go B"-oft 4gn n>-c.-
LOCATION SKETCH
Show direction and distance in miles from at least,,„
two State Roads or County Roads. Inclut e�, he roal9
numbers and common road names. A-
O
N
o _to
rnL';
-13
..15 t =�
,ukts
1 ayt 4uAf1fIY
2 it, /
16. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STAND ARQSTIND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER..
SIGNATWRE
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-I

WELL CONSTRUCTION RECORD 294789
North Carolina - Department of Environment and Natural Resaacees - Division of Water Quality - CAotmdwater Section
WELL co:macron (WDIVIDUAUNAME RITMt) QM2% Jo 5 hl e 6 catrrinc*Tron a 2 /5SD
WELL CONTRACTOR COMPANY NAME SUS/4ct$$ Whl/4 A ti%t-, Ai mom i eal 7Z v-rspg
STATE WELL CONSTRUCTION PERaarTI ASSOCIATED WQ PERMITS
(if applicable) (if rote)
1. WELL USE (Check Applicable Box): Residential iicipal/Public 0 Industrial 0 Agricultural]]
Monitoring 0 Reco cry 0 Heat Pump Water Injection 0 Other O If Other, List Use;
2. WELL LOCATION: d pp
�/ � Nearest Town: (tots County e0201!J
(Strad Name, Number, Camm®ity, Subdivision. Lag No_ LpCode)
3. OWNER: 1-1/6 e /1mi°
ev (Street or bottle )be,)
114tzuau
Address //o y 4 4aaUl?Fe L /2. 4
A752 o DEPTH
City or Town State zip Code From To
der} myiRT
Area code- Pone aonber O - 7a'
4. DATE DRILLED 7 ^ 7 6. 75 O
5. TOTAL DEPTH- O 5 , oo
6. DOES WELL REPLACE E)USTINO WELL? YES CI NO 0/ ,c0- 705
7. STATIC WATER LEVEL Below Top ofCasutg:
MeeMove "+' if e Top Casing)
8. TOP OF CASING IS 1 FT. Above Lad Surface'
*Teo .frame te.minJ4 oar bd.w Mod sorts requires n
nrtnce m :mordant t flb 1SA NCAC 2C Alt
9. YIELD (gpm): / METHOD OF TEST .51t%/1.1j4i✓'
10. WATER ZONES (depth); l'be/p..4 Lc /TO )9 (.y 600
I1. DISINFECTION: Type (pdo4-44tL Amount S'W env°
12. CASING: Wall Thcmos
Depth Diameter or Weight/Ft. Materiel
From To FL
Fro 0 To IOFL
Fro To /O q Ft. 09 I t•'h
13. GROUT: Depth Mataisi Method
From To FL 1
From 0 To ZZ FL 2E / ittiod
14. SCREEN: Depth Diameter Slot Size Material
From To Ft.__ in. in.
From To Ft in. in
15. SAND/GRAVEL PACK:
Depth Size Muaia!
From To Ft.
From To Ft.
e
Topoustld silting
ORidge Malley OFlat
(check box)- _..
Latitude/longitude of well location
(degmedmioRedmcardr)
Latitude/longitude somu:OGPSOTopographic nap
(Aeabox)
DRILLING LOQ
Formation Description
r_
—
t O.
LOCATION SKETCH17Po J`
Stow direction and distance in miles from attest
two State Roads or County Roads. Include thEg
numbers and mtmon road names.
Er
N f
(r7
40
e a
4au-ue4z
/2.d
Gtea+Jae.ec'
16. REMARKS: d
1 DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C. WELL
CONSTRUCTION STANDARDS, AND TiAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
ODNSIRUCIING 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
%2d e
46

294790
WELL CONSTRUCTION RECORD
North Carolina - Department of Environuta t and f ;
NoOrapl R,�e,sou ces - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (IND/VIDUALINAME (P ) J7/•�") St ��� Ctwfl tCw7TONa 2
f
WELL CONTRACTOR COMPANY NAME �U Sk:jof: ul1 e- U- �) '-U ) nuna ( E) 7t Y yntb)
STATE %YELL CONSTRUCTION PERMITS ASSOCIATED WO PERMIT'S J
Of applicable)
(if applicable)
I. WELL USE (Check Applicable Box): Residential 0 Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other 0 If Olher, List Use
2. WELL LOCATION:
Nearest Town:raj, kJ3
\�-
Name, Number, Commaony, Sa6bviacn, Lan No, Tsp Coda)
3. OWNER: 4 eft) o�
Address 1 `.S it. Z 111 & bzA A
1 103 0 (Street o Route No.) )- q �c1(_ /
City or Town _Sone
0751 t �P
Area code- Place s aebe
4. DATE DRILLED 5'-' °
5. TOTAL DEPTH: 4 O 5
County ma 001A
�opographic/Land setting
Midge °Slope ❑Valley OFlat
(ebek appupuee bon)
Latitude/longitude of well location
meereeowomswoceorto
Latitude(longitude source OGPSQfapographic map
(deck box)
DEPTH DRILLING LOQ
From To Formation Description
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO GV
7. STATIC WATER LEVEL Below Top of Casing: FT.
(Uw' rifAtomTap of Cosiog)
8. TOP OF CASING IS I FT. Above Lad Surfaces
*Top vreasing ta.aafwalaa Wog beim had sarraa. Mira•
vartnce In atmrfaaee with ISA NCAC 2C EIS
9. YIELD (gpm): 3 O METHOD OF TEST 14( vt..
SO. WATER ZONES (depth): 3c^ 7/✓� lrtl .wc,
I I. DISINFECTION: Type cLCrti 4t e Amman t4)02 J�
12. CASING: WaR Thidmess
Depth Diameter
From To FL
m(v FroTo lei F
From, I C I To 1 t) 3 Ft.,
13. GROUT: Depth
From To FL
Material
Fron_LL._ To t° FL 1 lI i Z
or we(eliVFt Marini
Method
14. SCREEN: Depth Uianwar Slot Sim Material
From To Ft.ia in.
From To Ft in. in_
15. SAND/GRAVEL PACK
Depth Size Material
From To Ft.
Fran To Ft.
0 tin
0
t c��
LOCATION SKETCH ?a G c. �n -
Show direction and distance in miles from a7aeast r; c
two State Roads or County Roads. Include . r-
J
nimbus and common road aunts.
s
WcLtty
yzA
wAf"u
16. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONS7RUCTEI) IN ACCORDANCE WITH ISA NCAC 2C, WELL
CONSTRUCTION STANDARDS, A D ThAT A COPY Of mIS RECOIW HAS BEEN PROVIDED TO Bit WELL OWNER
SIGNATU e F P ❑ rr CONSTRUCTING 7HE WELL DATE
Submit the original to the Division of Water Quality, Groatrdwater Section, 1636 Mai Service Center- ItitliOn, NC
27699-1636 Phone No. [phone], within 30 days. GW-1 REV4 D 7/2001
c

294791
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and {Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR(INDIVIDUAL)NAME (pint) &Ark V S ..Sri c. CERTIFICATION , 7�/fl'
wELL CONTRACfoRCOMPANY NAME SCSktCL• (61e1-L PALL, NCI PmoNeaf 172v kS-4g
STATE WELL CO,'STRUCTION PERMIT* ASSOCIATED WQ PERMIT(
(if applicable) (if "Witte)
1. WELL USE (Check Applicable Box): Residential Ltmicipa1/Public 0 Industrial 0 Agricultural 0
Monitoring ❑ Recovery 0 Heat Pump Water Injection[] Otter D If Other, List Use
2. WELL LOCATION: -
Nearest Town: INA GL.n_.c'h-
Cc,.ae
(Stmv Name. Nombas, Camweoit% Sub ivi$oa, Lot No.. Da Code)
3. OWNER: /Je/4G/,a / e;X-
Address i'74 A$WLL,.1,1: fit or. Dr -
(Street
or Rome No.)
/.t1 ;,,t1 vQc
cowryCAE7.4 Ke
.Q$rs2
City or Town Slate tip Code
Area cads Phone mamba qq
4. DATE DRILLED 1 .lr - p 4
5. TOTAL DEPTH: I
6. DOES WELL REPLACE EXISTING WELL? YES G1'FIO D
7. STATIC WATER LEVEL Below Top Of Cosier 15 Ff.
(tha"a-if Acme Top of Casing)
8. TOP OF CASING IS I FT. Above Land Surface'
*Top of embed MWNd infer balaw lead floe regains •
variance Y accordance win ISA NCAC 2C .arts.
9. YIELD (gpm): 1 h METHOD OF TEST A IA
10. WATER ZONES (depth): 1 t G4 r- i 4 ti
Topographidfannd setting
DRidge 0S1ope alley 1 (]Flat
(deck appapihe box)
Latitude/loogitude of well Location
(eepeedmisk�se�ds)
Latitude/longitude so urce.:DGPSOTopographic map
(check box)
DRILLING LOG
Formation Description
DEPTH
From To
Q^ /D
_0
Oo- L.°
(.O-/„S
c,S. I4,5 _
1) , e2-4-
5 Hw
tj;ryh r Feoc is
'54--
G- ,...+i l-C'
LOCATION SKETCH
11. DISINFECTION: Type(! 1.D1Z k J E Amount Leii_CtraiL> Show direction and distance
12. CASING: , Wall Thndmess two State Rum at
Depth J Dins or Weight/FL onnibera and
From 0To fr L)_Ft. (0 V4- 40
From? C) To Ft. G ei
Fro '% To 2. Ft. 6 y4
13. GROUT: Depth Maerisl
From To
From_ _To . o
14. SCREEN: Depth
From To
From To
15. SAND/GRAVEL PACK:
Depth
From To
From_To
FL
FL �'jer"t�2. I
pq�� Slot Sim
FL in. ID.
Ft in. in_
f'(7C
Pre
StPair
Method
Material
Size
Material
o Ft.
<SU Picti
C>
cn
fr
O
otca
16. REMARKS:
1 DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH ISA NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND AT A COPY OF THIS !CORD HAS BEEN PROVIDED TO THE WELL OWNER
SIGNATURE
CONSTRUCTING THE WELL DATE
Submit the original to the Division of Water Qualty, Groundwater Section, 1636 Map Service Center - Raleigh; NC
27699-1636 Phone No. (919) 7333221, within 30 days. GW-I REV. 07/2001
i I

WELL CONSTRUCTION RECORD 2 9 4 '7 9 2
North Carolina - Department of Environment and Natural Resources - Division of Water Qaality - Grotmdwater Section
/Ri 2 i/ •TUS'lice CERTIFICATION 0 '
re
WELL CONTRACTOR (OODMDUAIa(tAME (mist)�9'
WELL CONTRACTOR COMPANY NAME $US4 i.G-4" t/✓ELLOf1L I4XV rooms s f ) .T Zu-415-yy
STATE WELL CONSTRUCTION PERMITS ASSOCIATED WQ PERMIT$
(if :.,, icable) (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 1:1410tha, List Use .i j
2. WELL LOCATIO : , �'����f /
Neaere7st Town: &jL4 bM County t.I.t,K/'t
W t 5 Fr. r h n e iN A
(Sums Name. Numbers, Community, i r
3. OWNER
Address C: 3 r•� 9 H
• (Bret or Rome No.)
/lMrokew » N.
GryorTown State
rr) (c , L-2)o
Area code- Pboae oeabe
4. DATE DRILLED 3-/0- u5'
5. TOTAL DEPTH- LloF
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO MAX
7. STATIC WATER LEVEL Below Top of Casing 6M FT.
(Uss'f ifAbowTop of Casio')
8. TOP OF CASING IS / FT. Above Lad Surfaces
*Top of eases teeada_Md mew bee lead safaee ease a
velars to accordance with 1SA NCAC 2C .pia
9. YIELD (gp u): g`� METHOD OF TEST A i YL
10. WATER ZONES (depth): tl z 1 pal c? 3tc'
�//(�A�trq ?pert co 3' O
I I. DISINFECTION: Type evaz I& Amount gaits �a
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Mslaisl
To
From C To ) (/y`` Ft.
n.
From
From '/ 7 To �l Ft. & ' 6 C/ r/
13. GROUT: Depth Material Method
From To Ft
Fron�fLTo 20 F �
14. SCREEN: Depth Site
From To Ft._ia ice.
Front__ To Ft is in
IS. SAND/GRAVEL PACK:
Depth Size
From To Ft.
Topograp d setting
❑Ridge 9S p16 a OVaHey,, ❑Flat
(1'l r(� r. ,� Ir ` a ']5. (check appropriate box)
Sabdvrsioe. Lot No- rip Code) Latitude/longitude of well location
From To Ft.
16. REMARKS:
oaQYz
Zip Code
Mataial
(degaechoioaos/ttmndt)
Latitude/longitude source:❑GPS❑Tcpographic trap
(dock bon)
DEPTH DRILLING LOG
From To Formation Description
0- too 4/
60--
4a S 62Aw•tj-c
v
LOCATION SKETCH vo ` tri- '
Show direction and distance in miles from atst
two State Roads or County Roads. Include tf road��
numbers and oaraaoT road unman. r r" o
r.•
�/(9a3! 7/ o n�
1 DO HEREBY CERTIFY THAT THIS
CONSTRUCTION STANDARDS,
WAS CONSLRUCIED IN ACCORDANCE WITH I5A NCAC 2C, WELL
AT A CO @'4I OF THJSRE€ORD HAS BEEN PROVIDED TWINE WELL OWNER.
SIGNATU' O14tR90N CONSTRUCTING THE WELL DATE.
Submit the original to the Division of Water Quality, Groundwater Section,1636 Mal Service Center - WOO, NC! -
27699-1636 Phone No. (919) 7333221, within 30 days. GW-I REV. 07/2001

hOligighbfs:17;
&51 � e,g - %/1W
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section,t[./,v
CERTIFICATION # 09/J
WELL CONSTRUCTION RECORD
WELL CONTRACTOR (INDIVIDUAL) NAME (print)
WELL CONTRACTOR COMPANY NAME
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(ifapplicable) (if applicable)
294'793
Zt eye. /J.'f!'Y.e %t/ PHONE # Iire 5/'Y370
1. WELL USE (Check Applicable Box): Residential Er-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: 6LA / 3` _4
te:93 f)oiveex d.
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER:J44IeIQe.ct9iti it) / Noc$S
Address /'7yv I1c4t /e, 4 d gl
(Stre or Route No.)
City or Town State Zip Code
(71')- 867./ 4-°
Area code- Phone number 2
4. DATE DRILLED �.011�/t
5. TOTAL DEPTH: e2(t�Q
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO
7. STATIC WATER LEVEL Below Top of Casing: 470' 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 /k47,,,, �
10. WATER ZONES (depth): 29/1vt Oa'
County /T'
//Topographic/Land setting
.idge ❑Slope ❑Valley 0Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From To Formation Description
v� Co,r
4<; 6,fsr
11. DISINFECTION: Type 6
24.4
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
From To Ft. �r
From © _To 7( Ft. 6 Y Ore
From 7/ To 173 FL 6 Kg
13. GROUT: Depth Material
From To Ft.
From 0 To 22 Ft. 6407
14. SCREEN: Depth Diameter
From To Ft. in.
From To Ft. in.
15. SAND/GRAVEL PACK:
Depth Size
From To
From To
16. REMARKS: &(.1(v?,
I DO HEREBY CERTIFY THAT
CONSTRUCTION STANDA
Amount A'r Z?%
Method
feweit
11 n--t
73
Show direction and distance in miles from at lest o c
two State Roads or County Roads. Include the woad . _
numbers and common road name .
,-01)1 rG p r,m
r
11
W s
Oj
Slot Size Material)
in.
in. fit
Material
9 s
LOCATION SKETCH cT.
Ft.
Ft.
M ��yy-
ha.i t 4. > 110D , titl�r �F1'fa iil.P fia' ''1.4-w
HIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH I5A NCAC 2C, WELL
AND THAT COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
SIGN •4 UR/IF PERSON CONSTRUCTING THE WELL DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
27699-1636 Phone No.[phone], within 30 days. GW-1 REV. 07/2001
^"4rc
/ct 5V ogail 6 t2/

a'
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natrual Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR(rNDIVIDUAL) NAME (print) (�/1r=y tactic 6 CEt' GnoN a.. /
WELL CONTRACTOR COMPANY NAME bt/ -P&L v YRI r iAj Cr PHONE e fEiY'i 2Gy%r?'e
STATE WELL CO,\STRUCfON PERMITS ASSOCIATED WQ PERMITS
(if applicable) (if applicable)
294'788
1. W ELL USE (Check Applicable Box): Residential 0/Municipal/Public 0 Industrial 0 Agricultgtal0
Monitoring CI Recovery 0 Heat Pump Water Injection ❑ Other 0 If Other, List Use
2. WELL LOCATION: �GL'GkJC
Nearest Towne: et ,Ow County
F' 1..a- Cif✓
(Sued Name. Number. Community, Subdivision, Lot No., Tip Code)
3. OWNER: 'SP 2)'t Y h (I t O.
Address ' 2/ Pftr(A/k
tSnect to Rase No.)�r pc 9-5os
Z
CryaTown e tip Code
{ )- L•, 5�1- (,i9 40
Area code- Pbose oat
4. DATE DRILLED -(? U'%
5. TOTAL DEPTH: 3y'C
6_ DOES WELL REPLACE EXISTING WELL? YES 0 NO tax
7. STATIC WATER. LEVEL Below Top of Casing: FT.
(Use - 'ifAhon Top of Cams)
8. TOP OF CASING IS / FT. Above Land Surface`
`Top .rota{ tavaiawd attar Wow Ind smfats ..pin ■
Tarim= Y acesrdanef with ]SA NCAC 2C ADS. '
9. YIELD (gpm): 61 METHOD OF TEST it (h
10. WATER ZONES (depth): No VVet`> - tt
I ). DISINFECTION: Typee wits s Amount hot 7; 6 Show direction and distance in miles from aHliast
rn
12. CASING:
�o�ographic/f .and setting
L�lfftdge OSIope OValley' JF1al
(check approptire boat)
Latitude/longitudedwell location
otegrowootootes/somoss)
Latitude/longitude source:OGPSOTopographic map
(dank boa)
DEPTH »K11 I Vigil fN't
From To Formation Description
ors /YJ-„._
/po
O
r'tq°• ?'/S /-/_ =t-
c
Ccat
Depth
From To Ft.
F Li Tom F4
Flom .// To 7 3 FL
13. GROUT: Depth
From To Ft.
Froiu..__L.To g-G FL
14. SCREEN: Depth
From To Ft
LOCATION SKETCH. TO Z�
Wall Thickness two Stabs Roads or County Roads. Include the!youad
manner or weight/Ft. Muerial nambaa and mtmmn road names. , o
TA'Nt JS-3 3 7�,
Slot Size-� Mat at
in.
From?fCTo 32e, Ft in. V9 yye,
15. SAN /D GRAVEL PACK.
Depth Size Material
From To Ft.
Fromn_To jy5"- Ft. /4' 6/Moe�
16. REMARKS:
in.
1 DO HEREBY CERTIFY THAT THIS WELL
CONSTRUCTION STANDARDS, AND THAT
AS ' .NSTRUCTED IN ACCORDANCE WITH ISA NCAC 2C, WELL
PY OF THIS RECORD HAS BEEN ; o t o to THE WELL OWNER
SIGMA t ROOUCITNGTHE WELL DATE
Submit the original to the Division of Water Quality, Groundwater Sectioa,16i6 Matz Service Center - Raleigh, NC
27699-1636 Phone No. (9i9) 733-3221, within 30 days. GW-I REV. 07/2001

294453
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) James Camp, Tr
WELL CONTRACTOR COMPANY NAME (' mrt c. Wa11 8, Pnmr Cn Tnc PHONE #6281 d53_7322
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential Lc/ 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: iv IA V t o / •. County DU 1 c 1-- . 2
Hidden Lie Nees -Lcl Itf
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: Sec ll 11%01 GAYcY1D .
Address c21I )A");nlf50e 1)r.
(Street or Ffoute No.)
hiiO)Drt. IN taglI0
City or Town State Zip Code
02- — r-2&'71
Area code- Phone number
4. DATE DRILLED , 3 / / b r}
5. TOTAL DEPTH: E. C
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO
7. STATIC WATER LEVEL Below Top of Casing: ICD
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS 1 FT. Above Land Surface*
*Top of casing terminated actor below land surface requires a
variance In accordanseivith 15A NCAC 2C .0118.
9. YIELD (gpm): . 7 METHOD OF TEST 2;1, r
10. WATER ZONES (depth):
11. DISINFECTION: Type r h 1 n r i n a
12. CASING:
Depth
From__#_ To ?n
From To
From_ To
Diameter
Ft.6 1 /4
Ft.
Ft.
Amount f Cap
Wall Thickness
or Weight/Ft. Material
erZg-21 PVC
13. GROUT: Depth Material
From_a____ To 20 Ft. Neat Cement
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
Hand
Slot Size
in.
in.
Material
16. REMARKS:
CERTIFICATION # 2 1 3 8
Topographic/Land setting
❑Ridge ❑Slope [Walley F1 t
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topograp is map
(cheek box)
ttzft
DEPTH DRILLING LOG
From To
0 n
5D ho5
Formation Dessription
r'lct�(. 5and
CcAso /11al rJ rock
G
LOCATION SKETCH
rn
Show direction and distance in miles from at leasN .
two State Roads or County Roads. Include the roam
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
/\n/'tw 0-4 riY.0 LI, 13. LI
e GNATURE OF PERSON CONSTRUCTING THE WELL DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center -Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-1 REV. 07/2001

294446
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) Jamms m r'a mr Tr
WELL CONTRACTOR COMPANY NAME ramp' q Wa11 R Piimp ('n
CERTIFICATION # 7 1 3 R
Tnc PHONE #$9R) dS3 —7322
STATE WELL CONSTRUCTION PERMIT# _ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential rMunicipal/Public ❑ Industrial 0 Agricultural 0
Monitoring ❑ Recovery 0 Heat Pump Water Injection ❑ Other 0 If Other, List Use `� n
2. WELL LOCATION:
Nearest Town: (1 /U.Apr- County 1r\C '�Jf1vtJ-Ij(•C
22� 0WijC-<p c A A
(Street Name, Numbers, Communi _ubddivision, Lot No., Zip Code)
3. OWNER: �/LAL. � -•
Address \{) 0.®K-tr— Q& .
(Street or Route No.)
A Uri C
City or Town State Zip Code
- (o5G _ hG (41Lt
Area code- Phone number `\
4. DATE DRILLED n�341
5. TOTAL DEPTH: `l Ci C -
6. DOES WELL REPLACE EXISTING WELL? YES «NO 0
7. STATIC WATER LEVEL Below Top of Casing: h 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 accorda ce with 15A NCAC 2C .0118.
9. YIELD (gpm): 3j HOD OF TEST Ai
10. WATER ZONES (depth):
11. DISINFECTION: Type rh I nri na
12. CASING:
Depth Diameter
From_( To 0 0 Ft. 6 i/ 4
From To Ft.
From To Ft.
13. GROUT: Depth
From_#_ To 2 0 Ft.
Amount
Wall Thickness
or Weight/Ft. Material
SDR21 PVC
Material
Ncut Ccmcnt
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
Hand
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:❑GPS❑Topographi
(check box)
DEPTH a'ILLIN •
From To F tionDescri
jn„D
0 IO6
Cu
gnat
G
O
F C :D
LOCATION SKETCI
Show direction and distance in mils from at leas(
two State Roads or County Road Include the road
numbers and common road es.
Eatrtreu)
Rd
-io/,W1✓ioK
Ora -CM
Dr-
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
SILLIIJATURE 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
0
`Z
f ¢o
DATE
;cd

294459
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) Jamms
WELL CONTRACTOR COMPANY NAME Camp' c WP11 R Pnmp Cn Tnr PHONE %$9R) 4S9-7322
STATE WELL CONSTRUCTION PERMIT% ASSOCIATED WQ PERMIT%
CERTIFICATION % 2 1 7 R
Camp, .Tr
(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 0 If Other, List Use - !,
2. WELL LOCATIO
Nearest Tq m:
;or>
County Mc Do lid/
(Street Name, Number, Community, Subdivision, /Lot No., Zip Code) -{
3. OWNER: oG So 1 fl (01461jam ([ / oY5
Address �( 3 S Lthc fc r g l d v U)(II
(Street or Ro a No.) J l -h��yy 0(," ts2S%. I
City or Town State
a- h 2R?
Area code- Phone number
4. DATE DRILLED
5. TOTAL DEPTH:
6. DOES WELL REPLACE ISTING WELL? YES ❑ENO
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/or below land surface requires a
variance In accordance with 1SA NCAC 2C .0118.
9. YIELD (gpm): yLo METHOD OF TEST air
10. WATER ZONES (depth): s2 o 5
Zip Code
11. DISINFECTION: Type rh 1 nr
12. CASING:
Depth
Frorn,�_ To�__2_ Ft. 6
From To Ft.
From To Ft.
13. GROUT: Depth
From_ To 20
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.
j np Amount d /at
Wall Thiclm ss
Diameter or Weight/Ft. Material
gDIt'1 PVC
16. REMARKS:
Ft.
N
1/4
Material
at
Method
Ccmcnt Hand
Topographic/Land setting
❑Ridge ❑Slope ❑Vailey G2FI
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topogra
(check box)
DEPTII
From To
0 lip a.L5
Formation Description
dirt clay
Cok5olt(life d vock
c
,ap
-er
LOCATION SKETCH o n
Show direction and distance in miles from at leu=t ? C
two State Roads or County Roads. Include the foyd r*,
numbers and common road names.
,? er. r , O al -
Is 14-
ck. PA
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 T
4- /4--b4
DATE
v v
Submit the original to the Division of Water Quality, Groundwater Section, 1636Mail Service Center - Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-1 REV. 07/2001
Iola,

29e r„y
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Qality - ctommdtwter Section/5
GA�1 �S+IL� EERTIFWATIUNa
WELLCOarrRACTOR tneDMDUAWNAME 0� ---� eg %Z g-.5 7 g
WELL CONTRACTOR COMPANY NAME To S+ t & Lthe-C C Q y LC.t Oki I PHONE e
STATE WELL C •STRUC:UON PP.R3alTa TED WQ PERWITl
fir '-.r •1(cable) `if )
1. WELL USE (Check Applicable Box): Residential 121<amie 0 Industrial ❑ AgncuWmal
Monitoring [ Recovery 0 Heat Puup Water lojedion 0 Other 0 1f Other, List Use
c
LLL / !yTopog aphtcl[eDd�tt°'g
2 Nearest
e rtLOCATION
' ;A-riou ea- ar
thy County i� [Ridge °slope alley .°Flat
ULLA- tk-i,ttc, ✓tom idea aPlarldale had
(Soot, Name. Number. Community, Subdivision. (at No. Er Colic) Ia(inde llmgiwde of well location
3. OWNER: r30—&- h. L.0 n-CO,
Address / 0 2 1e LkJ�f (
(Sues /V o2- No.) 0,S 1 (2 I
City oT vn Sate Tip Code
Area code Pbooe saber
4. DATE DRILLED (0`Z'09
TOTAL DEPTH 405"
Olerriesantolnuesernotin
Latitude/longitude sonce:[GPSQTapographic map
(Medan")
DEPTH DRI1.1.1N0t0 -
From To Formation Description
0 80 (J:n fi
C0- 90
5. =
—/
6. DOES WELL REPLACE fi7QSTING WELL? 'YES ❑ NO UY
7_ STATIC WATRLEVELBelowTopofCasing go- /1a5-
(Use" "if Above Top ofCadn!)
8. TOP OF CASING IS / ET. Above Lad Surface
lap et eosin Madera/ wear bare bed sham .q.i.Q a t
Tarim= to aamtdamvMh ISA NCAC IC Alt
9. YIELD (gpm): 6i METHOD OF TEST At- l iz
10. WATER ZONES (depth): S) r At
11. DISINFECTION: Type 'L L Ne Amount Q O Z 779
12. CASING: WallThicknas
Cenler
From O To a Po F�L� /
From 0o To /0u -�` - 9c) Pvt
From / co To I07. FL Co /U / 47 4_ C7if V
iAr--P /
13. GROUT: Depth Material Malmo
From To FL
From (9 To 2 2- FL -fry, e �
14. SCREEN: Depth >r Stu Se lenal
From To FL in. in.
Fran To FL in. ia.
15. SAND/GRAVEL PACK:
Depth Was Ntta;al 7
From To Ft.
From To Ft.
LOCATION SKETCH
Show direction add distance in miles from at least
two State Roads or County Roads. Whack the road
numbers and common road mimes.
O
16. REMARKS: °
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH I5A NCAC 2C, WELL
CONSTRUCTION STAND R,�(DS,AND
�THAT
A•AC0i' THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
o SIGNATL R OF PERSON CONSIRUCTINGTHE WELL DATE
4
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mad Service Center-Raleltll. NC
21699-1636 Phone No. [phone], within 30 days. GW-I REV. 07/2001

WELL CONSTRUCTION RECORD 2 9 { '7 51
North Carolina - Department of Envaomneot and Natural Resources - Division of Water Qaality - Gmumdwata Section
WELL. CONTRACrOR(IND1VIMAtJNAME L _S1 S_1- c G cstonstCAnoN it 2/S-15
�- W �; LGN7 moon a in 22 V-4/SV/B
WELL CONTRACTOR COMPANY NAME 7 c� Ci IC f P LC �
STATE WELL CONSTRUCTION PERMV[f TED WO PERMITS
(ifaool'cabie) ra Fri liable)
1. WELL USE (Check Applicable Box): Rol ET MwpallPublic 0 Industrial 0 Agricultural O
Monitoring O Recovery 0 Heat Puy Water Injection 0 Other 0 If Other, List ilea
Li L
2. WELL LOCATION: �DaweCG
Nearest Town: M Art bAi county 1 -
)23 (, a/..4.cls. 0at.iry Lof —/7
(mad Name. Numbers. Community, Subdivision. Lot No.. 2ipCode)
3. OWNER: S.1/01-1 S/Yto Hi
Address / Z 3 c -o s s o .4../.Jc 2 0 wr /"
(Sued or Rode Ho,)
jlSa. 20742
City orTown State tip Code
(_} (OSZ-!ta/nc1
Area code- Phase camber
4. DATE DRILLEIK-/ - oy
5. TOTAL DEPTH: 2 2 5-
6. DOES WELL REPLACE Emma WELL? YES 0 NO Or
7. STATIC WATER LEVEL Below Tap of Casing
(Mee' lifter* Top of Cagy
8. TOP OF CASING IS / FT. Above Lad Surface'
*tap Home wmYRJ aahr bite lead new ragairea a
„`a Da'` dance O IA
EETHOD O TEST l/ /t.
4. YA E ZON G r7 .sie / S O
!0. WATER ZONES (degh): `/f'
11. DISINFECTION: Type CLD R; Nc Amoard 862 ifl
12. CASING: Wall Thickness
orwd�MrR
From 0 Tom /03 Ft.��`fa
Eton exj2 %To /13 Ft(r
FtTo /Z S- Ft. A
oaet�2 _i
13. GROUT: Depth Wens'I
From To Ft.
From_.(_ To 40 FL "-Wei raf•/
14. SCREEN: Depth Diameter SIM Size 'al
From To Ft is in.
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Size Material
Front To FL
Topographic an g
(Midge ()Slope 18Valky. 0Flat
(Seat appr-Wvte box)
Latitude/longitude of well location
rn
r> E------
CID
tom)
Latitude/longitude source:OGPSOTopographic map
(dr:tabor)
DSMIt DRILLING LOO
From To Formation Description
O - 1/4 c.Xar /e/.try
.4 ry
6eou4 iV'/
gcta
/00- no hie /j/Ue -Aye .r/
yo'
GD- /o(J
From To FL
e
/ 20- 2 2 C Sj efrti��
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. lachde d m mad
Dumbera mad oorsonon road neon
".\ 40 ?pc -VI/
16. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH ISA NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT, COPY ofj 18 RECOKD HAS BEEN PROVIDED TO ThE WEIL OWNER
SIGNATU + OF P a rm t . DOING THE WELL DATE
Submit the original to the Division of Water Qaalty, Groundwater Section,1636 raga Service Ceder-Etaleigh, NC
27699-1636 Pboae No. [phone], within 30 days. GW-I REV. 07/2001

29f 7/11
North Carolina - Department of Environment and Natural Resources - Divisionvof Water Quality - Groundwater S'ectloil
WELL CONTRACTOR (INDIVIDUAL) NAME (print) � A t l.1 45+i c-t' CERTIFICATION #2I 51)
WELL. CONTRACTOR COMPANY NAME
sr,vrE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable)
WELL CONSTRUCTION RECORD
JJ 4c kA)) C4/a-r PHONE # [phone]
(if applicable)
I. WELL USE (Check Applicable Box): Residential V Municipal/Public 0 Industrial 0 Agricultural
Monitoring 0 Recovery 0 Heat Pump Water Injection ❑ Other 0 If Other, List Use
2. WELL LOCATION: _ 9D
Nearest Town: n\0Akralh/ County qYr �� t w bQ %2I
QLN US 22(-
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: k(}A.r' nPool
Address a01ii� O(.ntJ5 g�t_5
(Scree or Route No.)
yAeolins
City orqTown late Zip Code
)- l;Q,-LfS'i
Area code- Phone number
4. DATE DRILLED 7 -2C.' !)L(
5. TOTAL DEPTH:1615
opographic/Land setting
idge ❑Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
r-
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Toppgra¢(lit map ..
(check box) YY 1
DEPTH DRILLING L01;
From To Formation Description
6. DOES WELL REPLACE EXISTING WELL? YES /NO ❑
7. STATIC WATER LEVEL Below Top of Casing: L 0 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS I FT. Above Land Surface*
`Top of casing terminated atior below land surface requires a
variance in accordance with ISA NCAC 2C .0118. •
9. YIELD (gpm): 10 METHOD OF TEST A t (1-
10. WATER ZONES (depth): Oct e qZJ
I1. DISINFECTION: Type d-LCrth(Q Amount $ 02 732,
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
From _ To Ft.
From 0 To Cot Ft.
From (0 2 To tiU Ft.
13. GROUT: Depth Material
From To Ft.
From�_To 25.--- Ft. 'j-tj ec' ( fzu('✓t! ert
14. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in.
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth
From To Ft.
From To Ft.
16. REMARKS:
Size
•
59- q&2o GtQr 1��
O O
LOCATION SKETCH
Show direction and distance in miles from' Jeast.T
two State Roads or County Roads. Include the
numbers and common road names.
Material /3
/0
00,
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDA CE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, ANLD'HAT A COPY OF THIS RECQ HAS BEEN PROVIDED TO THE WELL 0 'NER
c
211
SIGNATURE URE OF P.RSON NSTRUCTING 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
DATE
0

29 745
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
n- 9�' o /eF CERTIFICATION #2756
\V WELL CONTIi:\CTOR(1NDIVIDUAL)NAA1E (print) ��/lY/¢� � p( }� ,t,� l,�
WELL CONTRACTOR COMPANY NAME J V J( 1//// WP D.0 D rr La r / PHONE # ( ) nTT S�S
SATE WELL CONSTRUCTION PERMIT# ASSOCIATED \%Q 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 0 If Other, List Use
2. WELL LOCATION: ? d�
Nearest Town: ma"r OA/ Countyfi &cO
et,;m .17,,.ry U,'.v en
(Street Name. N
umbers, Community, Subdivision, Lot No., Zip Code)
/C 3. OWNER: OLietP���LB-G{ '�j
Address 0 J10i0 d57o ij/
City or Town State
$2P)- 72Cfrqgs /
Area code- Phone number d G 0
4. DATE DRILLED 5- 20- 014
5. TOTAL DEPTH: Z7_
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO fib
7. STATIC WATER LEVEL Below Top of Casing: %0 FT. ,
/ (Use"+" if Above Top of Casing) / L70
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): 4,0 METHOD OF TEST /9 f, t
Topogiaphic/LamjAetting
❑Ridge ❑Slope alley OFlat
(check appropriate box)
Latitude/longitude of well location
0
0
(degrees/minutes/seconds)
Latitude/longitude source:OGPSOTo4°graphic neap ---
(check box)
DEPTH DRILLING L
From To Formation Description
(Street or Route No.) Ai ir;od ,IIce 2 Q757—
Zip Code
10. WATER ZONES (depth): 61O5fl "t C co' �j
AmounteOZ e2
Wall Thickness
Diameter or Weight/Ft. Material
11. DISINFECTION: Typeeida t
12. CASING:
Depth n , e
From 0 To 4? Ft. G �y lrin f���SJ�f{✓P—�`
From 6z3 ToO Ft � /g 44
From_�LcJfo /no SS Ft. l /8A
13. GROUT: Depth M terial Method
From To Ft. r
From b To ZQ Ft. „VY/
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:
rLzi
/9o-2zr
rzeeh
!Ste /.t�'z na4—
ted-
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include thpjoad
numbers and commord names. o<
• savita) D/r
Ar
0S )403 WN /meinn
OttO tai-
1 DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH I5A NCAC 2C, WELL
CONSTRUCTION STANDARDS, ANDTHATA COPY OF THIS`_ CORD HAS BEEN PROVIDED TO THE WELL OWNER
ATURtE OF PE ON CONSTRUCTING THE WELL DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
27699-1636 Phone No. [phone], within 30 days.
GW-1 REV. 07/2001

WELL CONSTRUCTION RECORD 2 9 '7,/ 4
North Carolina - Dcpartnent of Environment and NMpel Resources - Division of Water Quality - Groundwater Section� D
OAI WELL cols:mACros. (INDNIDJNAME IRMO (��.e/ �� Cri' CER7IFIGEilONr��Yc1l
S051i et P /cLc- Dr,LL:/45 room a 141 7sW
WELL COT:TRACTOR COMPANY NAME
STATE WELL CIESTRUCUOtt PERMIT* —ASSOCIATED WO PERMIT%
(if
(if licabIc)
I. WELL USE (Chock Applicable Box): Reuel 0/Municipal/Public fJ Industrial 0 Agricultural D
Monitoring 0 Recovery 0 Heat Pump Water Injection O Other 0 If Other, List Use
2 WELL LOCATIOnN� a
Nearest Town: Y r dLL�''1� County ��
N.%;44 t -^ y''—b
(Sam Name. Rumba; CammauitA Subdivision, Lot No, Tip Code)
3. OWNER:.. N W Y
Address / 31. 0.4)/12, {(
,\ (Street or Rows NO
!t_ L 0-0, • C - 151-
ttyorTnwn hoe rip Code
( )- iV S Z^ tt 1 ci2
Area oak- nom
4. DATE DRILLED Cal '(i -Uy
5. TOTAL DEPTH: ("CI J
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO E
7. STATIC WATER. LEVEL Below Top of Casing _FT.
Wm"elf Above Top of Odra)
S. TOP OF CASING 1S / FT. Above Lead Surface`
'TM *Team' g ter•t•rad maw briery lad sextet rani. •
vain¢ br aroerdiR¢NM 1SA NCAC IC.NIR
9. YIELD (gpm): & O METHOD OF TESRT I h
10. WATER ZONES (depth): I? 0 `)F n, e (" 60
I I. DISINFECTION: Type C-10K N C
12. CASING:
DPW Diameter
From To Ft
From_a_ To= F
From t(� To j D to Ft.,
l3. GROUT: Depth
From To Ft
Frotttil_
14. SCREEN:
From
From
ropograpbic/ and setting
ElitRidge °Slope °Valley °Flat
(check ap(uepase box)
Iatituddbogitude of well location
C—
c)
np
0
a
Latituddtongitude sarce:OGPSI Ftptlgraphc map
(check )
DEitn' D'
From To Formation Description
(J- ito A.I1.-,�.
lee -- (cc (�
,� LOCATION SKETCH
Amount' C Z Show direction and distance in miles from at least
Wall Midas= two State Roads or County Roads. ler.,1mde thrload
or weaat%, Mat S1 mnrbe a and omsaaon road mum- - --
To i 2 FL +4pE
Depth Danner
To Ft in.
To Ft in.
15. SAND/GRAVEL PACK:
Depth
FromTo
From To
16. REMARKS:
Size
FL
Ft.
it
Method
slot Size Materialti(?;
1n. V
in.
Material
1 DO HEREBY CERTIFY THAT THIS WELL WAS
CONSTRUCTION STANDARDS, AND THAT A CO
SIGNATU
-o
N
1
•" UCTED IN ACCORDANCE WTm ISA NCAC 2C, WELL
FTHIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
CONSTRUCTING THE WELL
DATE
-•
Submit the original to the Division of Water Quality, Groundwater Section, 1 36MadServicCeoter-Raleig►,NC
27699-1636 Man No. [phone], withia 30 days. OW -I REV. 07/2001

WELL CONSTRUCTION RECORD 19 . ', 4 3
North Carolina - Dcpatwent of Environment and Natural Resources - Division of Water Quality - Grotmdwaler SectionwELL CONTRACTOR (Ot0IVIDUM A19NAE M) 9 Anti , ju5 c - CERTIFICATION )i!�
WELL CONTRACTOR COMPANY NAME ,JO r C i I'AVJe r% (IC&4r, mom a 71v'4/5418
STATE WELL CONSTRUCEON PERMITS ASWATED WQ POCKETS
(ifappl'cable) _-- Cifappliulmk)
1. WELL USE (Check Applicable Box): Residential Ia Mmadpa1IPuMic ❑ Industrial 0 Agricultural O
Monitoring ❑ Recovery 0 Heat Pimp Water InjectionQ Other O If Other, List Use
2 WELL LOCATIO �� •
Nearest Town: ,„' //
County /r%%`—the
aP
/00 / ciforn /C•d4'v .(� -
(SLm Name. larmhr; Caomaoa% Srb&tciaa. Lot No, LP Code)
3. OWNER: SO/U b Re/14cA e,YIifS
Address ice) /furVin 2.4e tJr
(Stied at Rome Nt)
j91f11c: /t/G £13-2
City or Town Stale vp Code
(s - T/y- 'S-
Area axle Pttae amber r Z 2 _c:+v
4. DATE DRILLED -7 '
5. TOTAL DEPTH: '905" J�U Z��'
6. DOES WELL REPLACE EXISTING WELLY YES ❑ NO t��
7. STATIC WATER LEVEL Below Top of Casing /LYE' FT. _
(UaawnfAbowTop ofO n*
8. TOP OF CASING IS / FT. Above Lad Surfaces
'rq of arias L.ter•Millitei wain War. lad sift anima a a
variative to acoardanee RIM ISA NCAC 2C Ent
9. YIELD(gpm): 5'i METHODOFTEST ///2
10. WATER ZONES (depth): `a f 7/y7 G' 3CD .
LOCATION SKETCH
11. DISINFECTION: TypeC/L0/2%/Le Amours ei UL 7.J Show direction and distance in miles from at least
12. CASING: WallTbidmess two State Roads or County Roads. Include the road
Depth Di/MC ar numb ra and ormetton mad mores. /ct/Z �o uSe ici
From To //S-FL /O �� liijci
Fran__ To /5 Ft, Ff�
FaTo ,� Ft. &ry s /vi,td
13. GROUT: Depth attain
From To Ft. f
Farm /<'/ To '25 FL � ey fre//fre
14. SCREEN: Depth ilimdder Slot Sim Material
From To FL itt.
y‘pographirAand setting
Eliddge 0Slope OValiey OFlatcr
(Mack apsiontare Ise0
0
Latitude/longitude o£wdl)otation
Latitude/longitude source:CIGPSOTOpographm map
DEPTH
From To
G) i.56
Zc''a• 3so
Weddell
D1A u.lnp LO9 ._._
Formation Description
„oli/=t
e' 0 047.r 4Iecc .
Method
in.
From To Ft in. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
Ran To FL
16. REMARKS:
t DO HEREBY CERTIFY
CONSTRUCTION Sf
Ace' - roc
c
THE WELL DATE
Submit the original to tie Division of Water Quality, Groundwater Section,1636 Mad Service Center - Raleigh, NC
27699-1636 Phone No. (919) T33-3221, within 34)days GW-I REV. 07noo1
0G_
y

29!742
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) G.tely I) 9uq ,_e /i
CERTIFIC�A7,TION
WELL CONTRACTOR COMPANYNAME TC751-/C S j/i49.1 pr/t•J .T PHONE it1C{ij' ,, 4- s-*t?
SLATE WELL CONSTRUCTION PERMIT/1 ASSOCIATED WQ PERNIIT#
(if applicable) (if applicable)
r i—
L WELL USE (Check Applicable Box): Residential �Ivtunicipal/Public 0 Industrial 0 Agricultutal ❑1
Monitoring 0 Recovery 0 Heat Pump Water Injection ❑ Other 0 If Other, List Use
2. WELL LOCATION: Nearest Town: 04-hFWD` County
�rlfi�L1a, /iYl �'7 ��,et r�CJ 3Crn r� k
Street Name. Numbers, Community, Subdivision, Lot No., Zipode)
3. OWNER: r> � -1- ('r:11 -�
Address 3011 Lot iec' nby,AP r 2,1 ,.
topographic/Land sating
edge ❑Slope ❑Valle3i-.4IFlatcr)
(check appropriate bo Qf '^ O
Latitude/longitude of wel tdc 4ion o+�
`! r �f.l (degrees/minuteslsecortk4
Latitude/longitude source:❑GPS❑Topogra
(Street or Route No.) (check box)
C VA c t 1 Ate.- Nk C _ )--9; (c DEPTH DRILLING LOG
pity or Town Stt6tte Zip Code From To Formation Description y
•io;•—"167.3id
Area code- Phone number
4. DATE DRILLED 7.041.
5. TOTAL DEPTH: 70t7 7 U.- 700
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO ❑�
7. STATIC WATER LEVEL Below Top of Casing: fge) FT.
(Use "(-•' if Above Top of Casing)
S. TOP OF CASING IS / FT. Above Land Surface*
•Top of casing terminated at/or below land surface requires a
variance in accordance with ISA NCAC 2C .0118. nn
9. YIELD (gpm): 9 METHOD OF TEST /T/ 6
10. WATER ZONES (depth): 2 L) py0 ,
II. DISINFECTION: Typee.,(44U
12. CASING:
Depth Diameter
From To Ft. 0
From ) To FL 7
7
From �Y To Ft.
13. GROUT: Depth M terial
From To
From 0 To_fO Ft. 2%1i.t-
14. SCREEN: Depth Dianiger Slot Size •terial
From To Ft. in. in.
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Size Material
0-
70 D • Z.Y
LOCATION SKETCH
Amount Gth Show direction and distance in miles from at leasi
Wall Thickness (1 'two State Roads or County Roads. Include the roalf
or Weight/Ft. Material numbers and common road names.
From To Ft.
From To Ft.
16.REMARKS:
Method
1 DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH I5A NCAC 2C, WELL
CONSTRUCTION STANDARDS •••DTHAT ACY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
GNATU
E 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

297519
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) Ja me Tel Camp, ,Zr CERTIFICATIONI 21 7R
WELL CONTRACTOR COMPANY NAME ramp' c Wal1 R Pttmr fin Tnr PRONE a$2R) 451-7322
STATE WELL CONSTRUCTION PERMITS/ ASSOCIATED WQ PERMIT'
• (if applicable)
(if applicable)
1. WELL USE (Check Applicable Box): Residential IYMunicipal/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:
-)‘ \ . .
(Street Name,, Numbers,'mnCommunity, Subdivision, Lot No., Zip Code)
3. OWNER: C'kXM
Address 5 to
( (..iret or RoutecN .)
City or Town State
)- 513' VSgl
Zip Code
Area code- Phone number
4. DATE DRILLED $• al . 0 4
5. TOTAL DEPTH: gS
6. DOES WELL REPLACE EXISTING WELL? YEg 0 NO
7. STATIC WATER LEVEL Below Top of Casing: tQ F.
(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): ) c" ME OD OF TEST a i r
10. WATER ZONES (depth): l aL S
11. DISINFECTION: Type mil nri na
12. CASING:
Dep Diameter
From _ o __ To Ft. 6 1 / 4
From To Ft.
From To Ft.
13. GROUT: Depth
From_p To 2 0 Ft.
Amount ('.Cte
Wall Thickness
or Weight/Ft. Material
eDR21 PVC
Material
N at Cement
From To Ft.
14. SCREEN: Depth Diameter
From To Ft. in.
From To Ft. in.
15. SAND/GRAVEL PACK:
Depth Size Material
ounty ovitit
Topographic/Land setting
❑Ridge ❑Slope ❑Valley laRat
(check appropriate box)
Latitude/longitude of well location
___
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEP
TH DRILLING LOCH _..__o
From ,Toor ton D ripti n
0
Cubt. O a nn
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road O
numbers and common road names.
Method
Hand
()
iJ
Slot Size Material I
in.
in,
From To Ft.
From To Ft.
16. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
SIGNATURE OP PERSON CONSTRUCTING THE WELL D
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mall Service Center -Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. OW-1 REV. 07/2001

297513
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) 1a me S 47 Camp, Tr CERTIFICATION 21 1R
WELL CONTRACTOR COMPANY NAME ramp' ¢ Wa11 & Primp Crt, Tnc PHONE I$78) d5"i-7122
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential ter Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION: (�
N,garesOtAowI /i A a�unryMC`::l;�taoX
r ll�. t-C
(Street Name, Numbers, Community, Subdivision Lot No., Zip Code)
3. OWNER
Address lC
City�
h
ij A
(Street °SR,pple No.)
State
'c'elAAdu
3� I�fl
Zip Code
Area code- Phone numb
4. DATEDRIITFD �• ^(iL
5. TOTAL DEPTH: 10 C
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO d
7. STATIC WATER LEVEL Below Top of Casing: ag FT.
(Use '4" 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 accordance with ISA NCAC 2C .0118.
9. YIELD (pm): I QD OF TEST air
10. WATER ZONES (depth): l 2i l
11. DISINFECTION: Type t'h 1 nr i na
12. CASING:
Depth Diameter
From_0___ To SO Ft. 6 1 / 4
From To Ft.
From To Ft.
13. GROUT: Depth
Frorrt_p_ To 2 0 Ft.
From To Ft.
14. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in.
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
Amount
Wall Thickness
orWeight/Ft. Material
SDR21 PVC
Material
Neat Cement
Method
Hand
16. REMARKS:
Topographic/Land setting
ElaRidge ❑Slope [Walley ❑Flat
(cheek appropriate box)
Latitude/longitude of well location
(degrees ninutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH. DRILLING J.OG
From To tion Dscriptjon
fl Sn
0
0
JOCATION SKETCH o
Show direction and distance in miles from at leaSt.)
two State Roads or County Roads. Include the road
numbers and common road names.
I DO HEREBY CERTIFY THAT THIS WFI T WAS CONSTRUC1bD IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY 0 THIS RECORD HAS EEN PROVIDED TO THE WELL OWNER
CONSTRUCTING THE WELL d
SIGNATURE OF PE
DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center -Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-1 REV. 07/2001
0

297510
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) James cu C a"ip, Jr CERTIFICATION 21 3fi
WELL CONTRACTOR COMPANY NAME Ciampi R WR11 R Plimp rrt Tnr PRONE #83 78) d'S3_7322
STATE WELL CONSTRUCTION PERMITp ASSOCIATED WQ PERMIT/0
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential C' Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection ❑ Other 0 If Other, List Use
2. WELL LOCATION:
Ne zs [ Tpwn:
County_t
(Suva Name, Numbers,�Community, Subdivision, Lot No., Zip Code)
3. OWNER: Q-tM �Q
Address i ;� ` ')a`�AD$`{ l ..1R�F QetAkurtAr
(Street or RoureNoo.)
City or wo State
N1n)- t 9 L— 0 1 M3
Area code- Phone number
4. DATE DRILLED 0 - U • U
5. TOTAL DEPTH: . 0
6. DOES WELL REPLACE EXISTING WELL? YES' ❑ NO Iki
7. STATIC WATER LEVEL Below Top of Casing 0 FT
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS 1 FT. Above Land Surface"
*Top of casing terminated actor below land surface requires a
.variance in accordance with 1SA NCAC IC .0118.
9. YIELD (gpm):
10. WATER ZONES (depth):
\,
ogS-
O OF TEST a j r
11. DISINFECTION: Type rh1 nri na
12. CASING:
Depth Diameter
From p Ton_ Ft 6 1 /
From To Ft.
From To Ft.
13. GROUT: Depth_
From p To .2 p
Amount
Wall Thickness
or Weight/Ft. Material
gDR-21 PVC
Material Method
FL Ndat Cement Hand
From To Ft.
14. SCREEN: Depth Diameter
From To Ft. in.
From To Ft. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
Slot Size Material
in.
in
Topo phic/Land setting
❑Ridge Slope ❑Valley ❑Elat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic trap
(check box)
DRILLING LOG
F tionDetiptio
DEPTH
From To
n a�
Q-)
LOCATION SKETCH o
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common road names.
16. REMARKS: - -
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER.
CA1- 1G. 0'-(
'/iNATURE OF P_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. 07/2001
c
0
Zip Code

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality
WELL CONTRACTOR (INDIVIDUAL) NAME (print) Tame
WELL CONTRACTOR COMPANY NAME
STATE WELL CONSTRUCTION PERMIT#
(if applicable)
Camp, Jr
gip Th0`7
- Groundwater Section
CERTIFICATION 0 21 3 R
r'.amp' c wp11 F, Pnmin CrL Ter' PHONE #. 7Rl dSz_7322
ASSOCIATED WQ PERMIT/i
(if applicable)
1. WELL USE (Check Applicable Box): Residential I:I/Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION:
Ne est(TT\ �'n CotiRty
\•_ . .trn ► A o1 b
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: VI
Address
lea
(Strect or Route No.)
$ C
City 'or Town State
r)-9Q b
Zip Code
( Area code- Phone numbei 'y
t
4. DATE DRILLED 19 —1 l • (I
5. TOTAL DEPTH: % fl s
6. DOES WELL REPLACE EXISTING WELL? YF,S ki--NO 0
7. STATIC WATER LEVEL Below Top of Casing: 1U f) FT
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS 1 FT Above Land Surfaces
'Top of casing terminated at/or below land surface requires a
;variance In accord ace with ISA NCAC 2C .0118.
9. YIELD (gpm): �y�IF`yT�IIiO tp_OF TEST n i r
10. WATER ZONES (depth): d oL
11.DISINFECTION: Type rhlnririp Amount -.t,l.c)
12. CASING: Wall Thiclmess
Dept��� Diameter or Weight/Ft. Material
From_0_ To.?iO Ft. 6 1 / 4
From To Ft
From To Ft.
13. GROUT: Depth Material Method
Front_ To 2 0 Ft.
From To Ft.
14. SCREEN: Depth Diameter Siot 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.
cr1R.21 PVC
Neat Cement Hand
16. REMARKS:
Topogrdphic/Land setting
❑Ridge CVSlope OValley OF1at
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From �q Cgrmation es% 'on
n u
tstoS
fV
-o
LOCATION SKFTCH
Show direction and distance in miles from at lea
two State Roads or County Roads. Include the tegad
numbers and common road names.
tdcS
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
S1
TURF OF PN CONITYR CTING THE WELL
�16by
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 -
WELLCONTRACTOR(INDIVIDUAL)NAME (print) V C.
WELL CONTRACTOR COMPANY NAME Al; LI e /r t)e, I r
297531
Division of Water Quality - Groundwater Section (�,(Q✓7 CERTIFICATION it �,//
PHONE # OK-731437/6
D h , //; /s
STATE WELL CONSTRUCTION PEILMIT# ASSOCIATED WQ PERMIT#
(if applicable) (if applicable) r
1. WELL USE (Check Applicable Box): Residential Br Municipal/Public 0 Industrial ❑ Agricultural ❑`
Monitoring 0 Recovery ❑ Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION:
NearestTown4f.4,f', 04)
County ,t(c.
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: ,4,0AY G.'}'t e.0Sl4
Address f c .S .re Qh /-. // %f l
(Street or Route No.)
462) ,a-t] .C- Y7c.S-
City or Town State Zip Code
Area code- Phone number
4. DATE DRILLED r - 2 7.. O
5. TOTAL DEPTH: G %`7'-
6. DOES WELL REPLACE EXISTING WELL? YES E NO 0
7. STATIC WATER LEVEL Below Top of Casing: 02 ci 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): MEJ4QD F TTESTAFQ, !N
10. WATER ZONES (depth): / 0
11. DISINFECTION: Types).\$ Amountt;9,r, )
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
From To `� / Ft. (a. 15 / P C .
From To Ft.
From To Ft.
13. GROUT: Depth,pMaterial Method
From/'., To-g,�^t1t FL Ci r.. e.d+
From To Ft
14. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in.
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
Topographic/Land setting
❑Ridge ❑Slope ❑Valley (Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(-heck box)
DEPTH DRILLING LOG
From To Formation 1Yesctiptibh
-t- —
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.
`/1'4L t4 t% 4c4Sf /IAac
a%,r DN t,
J-/' // /2d• / 4/ 34z
,At; . Je Ld /I caeJ
AT ,LcfT AL ASA.c/t
7"7 Z teJ c� i,I,cj7t / Gail D c1 ti
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
SIGNA'F(JRE 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

296980
.r, CONSTR.uc.
,:... �.,..., .,.: azdNa%.v1Reso:cC2c .....,, .t. l:(
iN (print) ASFILEY h;::Z a1O1 tJ1.5v
'HORRpE�TTZ /WELL DRILLIK . : ' s !'O4.4=52-1322
S:ti FEM1I79 JV_?4 ASSfr�L'.. ;rr<
^.rc,: `<:.iaerial a'/Mw cpz�i�
_-, Water ,injrizt:cnG 0 e FC
..-� Cc zty i G dsrs
0
S9::5.e<tio.,, Loti'co,
dinT T '1 VE 3 CIstNQ F,aF
_ •a:' is elbte:'A Tp f Cask ss)
•
A no;:st IQ 0 Z =;n,�
Wa]STcicdwass
zr ex YT"'1a-tl1. Mater,6: L '.zis rI,) rtt 2-:C:
n.
IFLci'i%r.;.S'i7.1.1, WAS CONS'tRVClna IN ACCORDANCE
k-:t18, AN'1, THAT A COPY OFT IS RECORD E,A3 ;3F.;.': RC- .1]:
;;A `sir. OF/PERSON C
NSrthU 1 1NO T A.r'%F:3
3' :C-r QvuiUy, Groundw tcrx L i ii.
3" days.
.c..a -r .-:Lt_5.91
{/fir'/ I/
•
- t . kart
C-';- IP,et.xi. the 3Qaa
t4f
1
J
:C
Eat :?9wa_

WELL CONSTRUCTION RECORD
North Carolina — Department of Environment And Natural Resources — Division of Water Quality — Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) NEIL CRAFT CERTIFICATION # 3114
WELL CONTRACTOR COMPANY NAME PITTMAN WELL BORING, LLC PHONE # [phone]
STATE WELL CONSTRUCTION PERMIT # _ ASSOCIATED WQ PERMIT #
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential ® Municipal/Public ❑ Industrial 0 Agricultural ❑
Monitoring 0 Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use
2. WELL LOCATION:
Nearest Town: MARION County MCDWL
WAYCASTER DR.
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: MIKE WAYCASTER
Address WAYCASTER DR.
(Street or Route No.)
MARION NC 28752
City or Town State Zip Code
(828) — 756-4430
Area Code Phone number
4. DATE DRILLED 06/16/04
5. TOTAL DEPTH: 405
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): 4 METHOD OF TEST ARD
10. WATER ZONES (depth):
11. DISINFECTION: Type CHLORYTE Amount 10.5
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
From 0 To 150 Ft. 6-1/4" SDR21 PVC
From To Ft.
From _ To _ Ft. _
13. GROUT: Depth Material Method
From 0 To 20 Ft. QUHCRETE 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
From To
From _ To Ft.
Size Material
Ft.
Topographic/Land setting
0 Ridge ❑ Slope 0 Valley ❑ Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source: 0 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. #221 N. FROM MARION. LEFT ON TOMS
CREEK RD. APPROX.. 2/10 MILE. RT. ON
WAYCASTER DR HOUSE AT DEAD END.
16. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION SSSTTANNDDARDS,AAANND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
o S rNATURE PERSON CO ONSTRUCG THE WELL
(—f(-b
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

301827
WELL CONSTRUCTION RECORD
North Caroline - Department of Environment and JNig/�u}al Resources - Divisio of Water Quality - Groundwater steno( �J
WELL CONTRACTOR (INDIVIDUAL) NAME (prim) £L ed_ c T_,E CERTIFICATION *ails 'I
WELL CONTRACTOR COMPANY NAME. S/ , WATPJiskl. ' PHONE a >(�
STATE WELL CONSTRUCTION PERMIT/
Of applicable)
41/01
ASSOCIATED WQ PERMIT*
(if applicable)
i. WELL USE (Check Applicable Box): Residential i Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring D Recovery D Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION. r
Nearest Town: %llTL/ County,, Q /
/oLt /oA 7h..�_-tg,Q or an /4ke 7/* 'e;
(Street Name. Numbers, Community, Subdivision, Lot No, Zip Code)
3- OWNER:
Address //f y� f1Z $ / /' oi' 9 er JJ�
(Street c Route No.)
i�-1�" ,,v /VG 275 73—
?
CCuy or Town State Zip Codc
l )-
Ara nude. none number
4. DATE DRILLED .5 —/ 6 - o G/
5, TOTAL DEPTH: 10
6. DOES WELL REPLACE EX]STING WELL? YES10 NO
7. STATIC WATER LEVEL Below Top of Casing: 0 FT.
(use"+" if Above Top of Casing)
S. TOP OF CASING IS / Q FT. Above Land Surface'
'Top of eating termfaated odor below had surface requires
variaaa be accordance w(tb ISA NCAC 2C .QI I& /
9. YIELD (gpm): 20 METHOD OF TEST_ U1/4?4mf
10. WATER ZONES (depth): / les
1,1. DISINFECTION: Type C. Amount /0 o
12. CASING: y� Wall Thickness
DFron-t__.D To O Ft a) Tyr fog 1 /7v(
From _ To Ft
From To Ft
13- GROUT: Depth Morena, z
fin_From 0Tc Z!9 F'_CaiO�'C
From To Ft.
14. SCREEN: th DimntIM Slot Size Material
From_ To Ft. in. in __
From To Ft. in. ^ ir,.
15. SAND/GRAVEL PACK
Depth Size Material
From To l� .�
From� To Ft.
Pt. _ s/t:wC
Topo iclLand setting
❑Ridge Slope DValleyDFlat
(check appropriate box) E......... ........ ..
Latitude/longitude of well location
(degrees/mituaea/ceccodal
Lautudeliongitude sotace:DGPSOTopographtc map
(check bat)
DEPTH LIRU.LING LOG
From 7o Formation Description
LOCATION SKETCH
Show direction and distance in miles from at leas:
two State Roads or County Roads. Include the road
numbers and common road names.
h
16 REMARKS:
I DO HEREBY C
CONSTRUCTIO
RTTFY THAT THIS WELL WAS CO
STANDARDS, AND A COP
SIGNATURE OF PERSON
Me /Woe
WF,i:.. l t
A NC 2A� C.
UC I ED IN ACCORDANCE WITH 1
OF THIS REfZORD HAS BEEN PROVIDED TO THE WELL. O44A
NSTRUCTTNGTHE WELL.
DATE
Submit the original W the Division of Water Quality, Groundwater Section, I636 Mail Service Center - Raleigh.:.)
27699-1636 Phone No. [phone], within 30 days. (3W-1 REV. 07 200

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) yA RRReeeS 05 Ili1 C.r‘ CERTIFICATIONC
v Lt.S'f'# 2)S
WELL CONTRACTOR COMPANY NAME i a- F PHONE # (f7a $ 5s'
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
303321
1. WELL USE (Check Applicable Box): Residential NO 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: 14464.e•ti' County
tL... Rr4t-en.
(Street Name. Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: lk`s%Ce'C Z%C, - i&_6(Zti
Address '1 Zc. fa.e&€4 5,ee pre
y, (Street or Route No.)
P�Z tl'G Ai C 2 c -26/
City or Town State Zip Code
(ea). ti,52- 8340
Area code- Phone number,
4. DATE DRILLED g .2 5---C.
5. TOTAL DEPTH: COO
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO IY
7. STATIC WATER LEVEL Below Top of Casing: 60 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS / FT. Above Land Surface"
*Top of casing terminated at/or below land surface requires ■
variance in accortlance with ISA NCAC 2C .0118.
9. YIELD (gpm): .3 METHOD OF TEST 4; •1-
10. WATER ZONES (depth): y7 ' pm ; &If SOC
AYs. :+r P 5t:.o
11. DISINFECTION: Type Amount
12. CASING: Wall Thickness
Depth
From To
From 0 To JOZ
Fromt To /O4
13. GROUT: Depth
From To
From C To 2
14.
15.
Ft.
Diameter or Weight/Ft.
Ft. 62 949
Material
/82
Ft.
Ft. t v'tz r
SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in.
From To Ft. in. in.
SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
Material
Topographic/Land setting
Midge ❑Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From To Formation Description
95 — 6cc? 074A441i
LOCATION SKETCH
Show direction and distance in miles from at (east
two State Roads or County Roads. Include the road
numbers and common road name
Art
i!
AQi36/G
1e(-"
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
'SIGNATURL 0 , 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. Q712001

WELL CONSTRUCTION RECORD
306898
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
T
\\'ELL CONTRACTOR(INDIVIDU.4L)NAME (print) t 9ct.r.. Jt.'J"+ ICC CERTIFICATION #A I
JUSif;S:F W eLL Drt.1-;)1/41 7
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential IIYMunicipal/Public 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
WELL CONTRACTOR COMPANY NAME
PHONE # f?2d 724457 L1
2. WELL LOCATION: Nearest Town: /i14IJta4.. County {19 °,t x/c..ae
adz!' U.cO,4-42 Mf.4-)
(Street Name, Numbers, Community, Subdii ion, Lot No., Zip Code)
3. OWNER: roe cite — V( 6021 l
Address'. 1
(Street or Route No,)
1Y �r
City r Town Mate Zip Code
?R)
&- %y ysz
Area code- Phone number
4. DATE DRILLED //' 2a-'-v
5. TOTAL DEPTH: 503'
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO
7. STATIC WATER LEVEL Below Top of Casing: GO FT.
(Use "+" if Above Top of Casing)
3. TOP OF CASING 1S 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 OE TEST,{/4.
10, WATER ZONES (depth): 7 7,/ e 6y f be
11. DISINFECTION: Type atative Amount r 0 a
12. CASING:
Depth
From To Ft.
To //2 Ft. ei,
From /f Z. To //y Ft
13. GROUT: Depth Material
From To Ft.
From
Wall Thickness
Diameter or Weight/Ft. Material
From 0 To 2 0 Ft. 9 f f ivy
Depth Diameter Slot Size
To Ft. in.
To Ft. in.
15. SAND/GRAVEL PACK:
Depth Size
From To Ft.
From To Ft.
14. SCREEN:
From
From
16. REMARKS:
Material
Topoggraa hic/Land setting
❑Ridge IdSlope ❑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
� - roc. ,jf e_e-cbt.Kic
1')0 - s7}S
t_
2at
IN)
eft
C77
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.
21
414
1 DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C. WELL
CONSTRUCTION STANDARDS, THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
A
SIGNATURE I PERSON CONSTRUCTING THE WELL
DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Senice Center - Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-1 . 09/P02005

WELL CONSTRUCTION RECORD . 306900
North Carolina - Department of Envsolmlatt and Nalaa1 Resources - Division of Water Quality - Goimdwater Section
WELL CONTRACTOR (I NDlV1DUALVIAME a.rt C;;ham Se. t ce ctentecwnon a 2 ($11
WELL CONTRACTOR COMPANY NAME �.f LLi-e_2 D r; LiL m m� mon a ( ) 12Y-4i5 16
STATE WELL CONSTatt tnOn PERMarrs ASSOCIATED WQ
/if ,, it abie) Of
1. WELL USE (Check Applicable Bost Resided LiMamapal/Public O Industrial ❑ Agricultural ❑
Monitoring 0 Recovery O Neat Pump Water Injection 0 Other 0 IfOther, List use
2. WELL LOCATION
Nearest Town: /j� (f°IA-C'L� County l� � �ZTua
taaoh�Cmosax Rrtd�Os.ise n.. co6e
(Sara Name. Moat )
3.OWNER: vt12ci,UJ- SoLtj ci
Address r ltr ben +aCr41, AC (45
Smell 4�1LLt�c� 1kl 2 67S-1
Coy or Ton Sane Sp Cork
(_} (, Ffl - S i 11
Aaacads- Mrs sasther
4. DATE DRILLED 12-+3 -o>'J
5. TOTAL DEPTH- ez-Z •i
6. DOES WELL REPLACE EXISTDr0 WELL? YES Brn0 0
7. STATIC WATER LEVEL Heber Tap of Cosies (n*0 FT.
Wore if AboveTop orclaioa)
8. TOP OF CASING IS FT. Above Lad S
KTorsssis, eomhoesd Wow lobo lid.ariasspi..a
m6am Is amamtraadh 1SA Nc*cac int
9. YIELD (gpm): h 42 METHOD OF 'TEST A m fZ
1O. WATER ZONES (depl); '7 Y t 1 t .y, L ! 2. A,
1 I. DISINFECTION: Type 7 Ll✓14-4-r Ammo g o L.
12. CASING: Wall Madmen
own Dinette
orWelnl. MasaW
From To Ft.
Fran Toa Ft, toy,/ evc
Foam ,cO To i1Z- Ft, fv'%y (7;-1i-L'
13. GROUT: Depth Maoist Method
From To FL
Fromm To 2 i t
14. SCREEN: Depth it. Sias See Material
From______ To Ft_____in. is
Fne m To Ft _ice in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
16. REMARKS:
T setting
Midge TOSiopedLamd Malley OFlat
(coat aggrandise boa)
Wiliddloagitnde dwell Tomtiot
ttennuantawarseanwo
Latitude/longitude source AGPSf7lbpograpbic map
(deck boo)
DEPTH DRILLOVO LOO
From To Formation Description
e- - j 2 u _Se
i't'Zo - 275 q<^AlAu-h2c3
> n
N
C
CD
1
LOCATION SKETCH3
Slow dhedion and distance in miles from at least
ewo State Rods or County Roads. Include deemed
mammas and oatmmmad mm.aa. i i/�, ^
cird
6
Vices
mice: a Aci? fe,
22
cn
I DO HEREBY CERTIFY THAT THIS WAS CONSTRUCTED IN ACCORDANCE WMil 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AIDTA THIS RE ORDRASBEENPROVIDEDTOT EWE(LOWNER
-
OOP6'TRUCIING THE WELL DATE
Submit the orient to the !Noising of Water Quality, Groiadwada- Section,1616 MsaSenior (attar- pit
27699-1636 Phone Na [phone], Maio 30 days Gw-1 REV. 07/2001

WELL CONSTRUCTION RECORD FVV 306901
North Carolina - Department of Enviiromnmt and NaOeal Resources - Division of Water Quality - fkmmdwatc Section
WEU. CONTRACTOR (INDIVIDUALptME (PrLn y . rods, f CERTUFIC►TIONa //SO
WEL CONTnACfORCOMPANY NAME josdtec weer Dm",.UG rnonn • fgi-'7zS-v5vi
STATE WELL CONStaucnon PaRMrre asarer. TED WQ PERMITS
fifspvlieaMM fifappiictblo)
1. WELL USE (Cbedt Applicable Boat Residerdial t Maaicipal/Pubiic 0 Industrial 0 Agricultural 0
Monitoring 17 Recovery 0 Heat Pa Water Ilgection 0 Mbar 0 If Oder, List Use
2. WELL LOCATI
k sip T ic/Tand selling
Nearest Town:
!, Cqury i,1 xt✓�L Malley OFlat
ia 7 <-1 I/AA.Au 8IC (gibe* *peptise box)
(Slim Name. Nember& C000mhy, Slabiveio. Ur No. SPCade) Latitude/longitude of well location
3. OWNER: S/f/ (�)
Address /7 d ,.-ate-!`-rp- Cle�d La(i(udd[ tde sourccOGPSOTtpoejaphic urep
f,�y (Street or Rate (dbor)
7nie,)_. yti lr , t. c. Dfr' HT DR11.LinO L4 i
aP Farm To Formation City or Town P, Sme Description
((f,- 7Z 7 `47 c 5-
Annette. wmeamabar
4. DATE DRILLED / Z - 3 - .-4/
5. TOTAL DEMI- y' C
6. DOES WELL REPLACE EXISTING WELLY 'YES 17 NO
7. STATIC WATER LEVEL Below Top offosh* /11O FT.
Nee e(fAboreT4oromas)
8. TOP OF CASING IS / FT. Above land Surface*
'TA snag amohaea 'Mir balm lad �Pne wwi m
waters be amnion Ida ISA'CAC IC.Nia.
9. YIELD (gpm): METHOD OF TEST A- 1/t
10. WATER ZON (depth): /e ,Tarn L'-t, 3 en
1 I. DISINFECTION: Type (7 riaiate Antomt € & 2
12. CASING . WallThidme=
� Orgamec erWeiVE%, saw
From To,
From t To,
F To.
13. GROLTil Depth
FtontTo Ft
From& To 7Y
14. SCREEN: Depth f Sue
From To Ft._ia is. 2�y \
From______ To Ft in. in- KE
15. SAND/GRAVEL PACK j 4a f] en Ait i.,d
Depth SizeIC 4 C" U G/
From To Ft 1(
From To Ft tit g ankle.
16. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONS RUCFED IN ACCORDANCE WITH ISA NCAC2C, WELL
CONSTRUCTION STANDARDS, AND THAT ACOPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
beet
Cr1 A,Q; 4E. 9
n
Material
Method
LOCATION SKETCH 3
Show direction and distance in miles Burn at lead
two State Roads orConaty Roads. Include the mad
oam6aa mad common rood mores.
1
1t t
SIGNA PERSON CONSTRUCINGTHEWEU. DATE
Subwit the origin" to the Division of Water Quality, Groundwater Seedee,1636 Mna Serve Cei ;-Rr r;N4
27699-1636 Phone rte. OM 733-3 , w 30 days. GW-1'REV. 0712001
M" A n

WELL CONSTRUCTION RECORD I�
306902
North Caolna - Department of Environment and Hatted Resources - Division aster Qaity-Groundsman Sates
�
WELL QO.*fr*aCTOROND.VWs[ n wKA - —T 4/tei JtS Neer ClTSblea G�%GCA7`"
WELL CONMACr'oR COMPANY NAME -5O= + 1 c. =1,j e Cl_ p r; L.C.1.1 moons s f ) 1/4'/Q6 S/
STATE WELL CntalLt ieta rue9e e alkiCULTILD wQ fltflt j
of aenticable) hifapp-able)
1. WELL USE (CYech Appfeabk Bask Refidmdil 13/Msi dlta66c O IndmmiS 0 Agricultural D
hlviwtiog O Rieooray 0 Neat Pump Water Injection O Other O If Met, List Use
Neared TovatcMIA Cooly MS. awe(
(S1ee Na inss.Cas/a�its a/id.iies.toskLrCdei
3. OWNER 7-4l A] /! L '''
Ads / . >( / ) i
-`( /) Fc,t+ IUC .1 E762.
OtynTwn Sate Spade
( )- 4 o- C3 //Z.
Asa ellaishir
4. DATE DRILLED /Z'/1i- -mow jrea
5. TOTAL DEPTH: Z $S
6. DOES lama REPLACE Emma WELD YESNO,F]' j o 2- Z
7. STATIC WATERLEVELDebetTapeflarir 'e' .
«teemega meTioetMbd
8. TOP OF CASING IS 1 FT.Abosstadsake
rcw.r...ingere a.n ea.larkeies ep.t..e.ias.
video* blaeesiasoewM BAtiale2tiiiL
9. YIELD (gpm): / METHOD OFTEST Ai9Sl
10. WATER ZONES (des* /ff.,., LY Zfo
LOCATION SKETO(
Shaw friction mid thine l Mu from at last
two Stale Roods aCawtyRollda 1whadatbemad
=duty urea coureace tad/a.
setting
Midge �aley OFW
(de h*te>pFeebed
'..a- elo deofwdtIntim
(sa loaaeceeurl
Lakeadloiiankmmamsoropogapbic map
DltIU.RaO t D0
Fanatiea DesuriptMn
From To
._4
11. DISINFECTION: Type ettkentie man kW.
13 CASINe . VAR Aides
Dope t7�r orW mien Medd
From____ To Fl
From_,._TO
13. GROUT: Depth
From____ To Wald
From h _Ton_
14. SCREEN: Deph
From To Fy_jn.
Fran�To Ft In.
15. SAND/GRAVEL PACK:
Depth Sze
FromU_To Ft.
Frari___To Fi.
` Medal
A el
Slot Site r'/a esial
in
Material
C," jar
rvi �L �✓
I'
)44
f r
05 iXj cart f
ec
ya
16. REMARKS:
1 DO HEREBY CERTIFYTHATTHIS
t n7RUCTIONSTANDARDS,
.WAS OONSIRUf.'TIOR4ACCORDANCE WON ISANCAC2C,WNL
TACOPY OFT1RECORD RASBEEN PROVIDEDTOMEWELL OWNER
tb167RUCTRIGTHE WELL DATE
Submit tbee origin* to the Division of WatarQaalty, Grondwabe Sadien,1636 Mail Service Outer-{Rdtteb NC
276994436 Noe Ha t919/133,33f1. able SO days G11- I'itEV. trinotli
MAR-8'

WELL CONSTRUCTION RECORD
{ 306903
North Caolina -Department of &Tuna• t aadNdad Resources - Division aster Qality-Groundwater Sodas
wean coerauacronormrvawAytuae 0.3 flee csnptcanowm?/5Z
WELL CONTRACTOR COMPANY MIME S t54) e E L.)e-fa b ri LCC5LC� Tits s I 1 71 y-i-/S.
mom nu.eotaaaucaost Tema.'• W4PemaUe
tit applicable) oropp"aMs1
1. WELL USE (Check App&able Busk Residential 0 Maicipal/Fdde /hdsstrwl 0 Agricultural O
Monitoring O Recovery 0 Neat Pimp WMr[ejection 0 Odor O IfOtlmy List Use
2. WELL LOCATION:t���
Neat Tows /( :nail
7�
ZZ/ Z 51st�it rnLe
(SUN Nat tesobeer, Cersim MoakLettbj V de)
3. OWNER: C✓ _1. E
Address / 3 23 AiLif Ca.vnin,c
Vast sr totes tea
ptyalin Sate apCode
E{ �} 7.19 3519 Ft
Toponbjatail selling
dn (dwelt ppapettmt)
ICmddloogimds dwell location
thettethuiemetheteeth
latitudeRosgibdeam 00PSOtapogaaphiemap
Maatae)
DNtunvtl l�l1 .9
Faustian Description
d Amea- Kee araa�
4. DATE DRILLED / se
5. TOTAL DEPTH: LP flr �� q�y
6. DOS WELL REPLACE Exuma WELL? YES@1� 1ff
7. STATICWAT/RLEVELBdvwtapKOS fa0 FT.
t iarroMna74iC1nirot
f.
IL TM' OF CASING IS / FAboveladSur6e' t
'Te►st jaa.wre.wAsaw% mbNis amegia
waruceaaatmAaeeee 1S*IICAiC2CJ►K
9 YIELD (gun} V METHODOFtESf/9/R
10. WATFRZONES (iqitbk it �
11. DISINFECTION: Type ClU.3VAI Arpst "
12. CASING t�y�r Walwiidams
From 0 To
Ft (1)y `> /
FrugJ/ .Tor /16 Pi..,4 /,/
peens _To lr1
13. GROUT: Depth Mtwid
From_____ To R
Fmm—_To FL
14. SCREEN: Depth Daman Sus hSaial
From__ To
From__ To FtFn in
15. SAND/GRAVEL PACK
Depth She Mad
Frain To
From To P.
16. REMARKS:
I DO HEREBY CFR71FYTfHAT
CONSIRUCTKINSf
Vier
Method
1
Front To
p
LOCATION SKEITZI
Skim dmetimafind distance in suesfrom at lei
two Stale Rasda(tasty Rale Inds& the toad
,ache ad cams fined seas.
VULVAS CONSTRUCTION WITH ISANCAC2C, WELL
THAT ACOPY OFTRIS RECORD RAS BEEN PROVIDEDTOTHE WEIL OWNER
lap
am' .
CONSTRUCTING THE WELL DATE ,;'
Submit the erieinl to the Dlydian of Water Quality, Gewdwater Seeds, WdMid Santee Cater te_ Ratdgi,NC
lA 270P-MPinNs.pr9)7A3JT21,wNiin30days Iyv- REV 07/2001
Fi n;

NV
WELL CONSTRUCTION RECORD 3 0 6 9 0 4
North Carolina - Department of Environment and Nand Resewces - Division of Water Quality - Groundwater Secti^on
Rntv WELLCONTACTOR(m .WWNAM AE (pear) C-R t2')' ..�irrPle ,F csartmc&noN•9. tbt
WEI.t. CONTRACTOR COMPANY NAME suS5+1 err. W eibt. 1-wtt.s/Uc7 mown a l ) 9Lv-4/S3,1?
STATE WELL. Ccorci :CUeN PERMI'M ASSOCIATIOD WO PEaaatta
((fapplicahk) (dapplic *le)
I. WELL USE (Chair Applicable Bock Residential Et Mamcipwpglie 0 Industrial Agricuhwal o
Monitoring O Recovery 0 Heat Pump Water Injection 0 Other ❑ If Ober, List Use
L WELL LOCATION: yr/
Nearest
Nest Town. k;'Rr County //9t C
Loh vi,u)
(Sues Nave.IdaS . Cmwsslrs.MEeisioals,No.ZIPCede)
3. OWNER: AL /te C'Ket
Address 'j is tits LAY --r.a S 1141 442(&
(SvaewRomeNW
aretTa° 7 70 TWCLUe
?- l —�� �L7_1glst
Ma cede. Puns robes
4. DATE DRILLED /2-t- 01-f"
5. TOTAL DEPTH- 7 9,C 7L -
SIS1ope Malley settingogipplitalaird ORidge dge alley OFlet
(sheer rPpvpeire hox)
latitude/longitude of well location
(dagoo made saeoas)
Latitudartcagitude aturcm0GPSOTopographle tap
(deatrbox)
DEPTH DRIU.tNO LOO
From To Formation Description
n-7z.
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO ger
7. STATIC WATERLEVEL Bean Top orCast yo PT.
(Use"e ifAbove1h,Stein)
8. TOP OF CASING IS 1 FT. Above Land Surface*
etenteaaiaeaert•ISO Wow Inks, irk swan rapine a
noise a aemriaaee tdR ISA !CAC 2C MIL
9. YIELD (gNa): tL O METHOD OF TEST A I YL
I0.WATER ZONES (degh) (;,o9/.4.4j,. 4i.
2 fi.5 C-ItArvi f-e
I I. DISINFECTION: Type t L(1t7;Pe Amount I - 43 o2- Show
12. CASING: . WaRTlidaes taoState
--,
Dept, Diserc or Weight/Ft. adaload rya and
F To
F To _ -
Fi To _ l �R ,�e / 2/
13. GROUT: Dept, Method
Front__ To FL >
Front_U_To LS Fi tv'IG poenlieC
14. SCREEN: Depth Dimes TSlot Size Material
From To FL . ja in.
Front__ To FL in. in.
l5. SAND/GRAVEL PACK
Deis, Size Material
From To Fr_
From To R .
16. REMARKS: L A ir{ j-Q-E a L
3
N
GO
LOCATION SKETCH c5 'r
distance in miles Iran at lea
Cowry Roads. Include the 43d
toad rows.
I DO HEREBY CERIIFYTHAT THIS WELL WAS CONS7RUC1ED IN ACCORDANCE WITH ISA NCAC2C, WELL
CONSTRUCTION STANDAtyS, AND THATA COPY THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
OP PERSON CONSTRUCHNGTHE WELL DATE
Submit the original to the Divines of Water Quality, Grosadwater Setthe,1636 Mal Sesame Caler-ltalaigl;NC
27699.1636Phone No• M9)733-322.. witido30days. GW-i REV 07/2001

WELL CONSTRUCTION RECORD
306905
North Carolina - Dependent of Environment eOondH�.m;,l �R�O�m�ods-Dividon of Water Quality
orte_
31s3;cr W pril.LtNc/ room a fEaci 22V- 451/3
STATE WELL CDNYTRL"Ctantt man AaaOClAlil wgplRttttt
Ofapplieahle) (ifatoEtabte)
WELL CONTRACTORtamtvauAWRan
WELL CONTRACTOR COMPANY NAME
mow
From__To,
From D T
F_To.
13. GROUT: Depth
From To Ft.
Front_12—To // h'
14. SCREEN: Depth
Front To Erin
From To Ft
15. SAND/GRAVEL PACK
Depth
Froot._T
Freon To
1. WELL USE (ChekApphSIe Boa RmidenlidU/MnehipallPa6Ge 0 bldmnial 0 Agtieaml0
Mettitoriag 0 Recovery 0 eat Prop Wa erWadioa 0 Other 0 IfOder, List Use
2. WELL LOCATION: - ^�
Nearest
Towle IU1/d en- Comity I n C Kern-
0n
C Njt3 pet;.... D fL
(Save Nome. Aerobe s,Cmioori)tlidia6iea.tatNe,L►Cads)
3. OWNER: M1Co`I (MI Olopeze
Addren /Do6 �W. F4a.f-ii,l-;...) a0. lotitodellossitodeaont $01'cpograpbjemap
(
CIVaIley Cleat
setting
(elect appopti latl
ito Ltdddlingimde ofwd( location
/m ue7s- (Snatw NW 4�
DIZIH DRILLING Loa
Coy rten �i'` t 21p� From To FormetianDescription
( }
4se.i. Pleat ant
4. DATEDRILLED /2-Z2-- cv`
5. TOTAL DEPTH: y© S
6. DOES WELL REPLACE EXISTING WELL'? YES 0 1O CV
7. STATIC WAT RLEVEI.BeinTopaf -Sgt LI)C r._r,
(U.•rSllenApttlid
8. TOP OF CASING IS FT. Abovefad Sorbed*
*Tap visaing a._:s.edaeriedear.taod,.- erawsinsa
VMS* 11113* NCACZC.a11<
9- YIELD (gym): /.4 METHODOFTESf
to. WATER ZONES (depth): istI9prn 64/ 1Z�`
(i) — /i F1
//£�•-! g
11. DISINFECTION: Type Anowt
12. CASING
Val Mite=
aumry orwetp/at arMnU
Slat She
s
tV
n
c
LOCATION SKETCH
Show &tractionand &has in milts tramat lett
two Sala Rat ot County Roods. Iodide dos road
a tambao and onto nod eamaa.
in
Sia Material p��y�lu
o R I
16. REMARKS: Fd t d &4 2e .; ) 46*1 q c / P
e4m1
t)6 E
1 DO HEREBY CERTIFY fI1ATTRH WELL WAS CONS1RUCI )INAC X%WAN� WRU ISANCAC2C, WELL
CONSTRUCTION STANDPIDS,A7O THATAC(WYOF7N6SRECORDRASMENPROVIDEDTOMEWELLOWNER
ibt5_L11" PP103DNCONSTRUCTING►HEWELL DATE
Subunit the origin, to the Division of Water QRaRty, Grov alwate r Seeders, 16361 aiaSereica Goatee-.Raktgit; NC
27699616341 Thou 11 .. (919)133-32M widget 30 drys. GW-1 REV, 0712001
MA=,

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) James w Camp, Tr CERTIFICATION B 71 iA
WELL CONTRACTOR COMPANY NAME ramp' c Wa11 & Pnmp fin Tnr• PHONE C$?A) 4 S"i_7122
STATE WELL CONSTRUCTION PERMITU ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
I. WELL USE (Check Applicable Box): Residential f'J 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: M O CountyW C Qs M py✓A
/-0t irk i�'%1•o�-d P l� 1-A kt
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: Pit() / l P PC- 14(
Address el05,2- Sin2_Tc-
C-1461(10 'e Roatle C a e. 4-
City or 'royal_ State Zip Code
e&)- 4 2-gQuer,
Area code- Phone number
4. DATE DRILLED \ • I -i . Q 14
5. TOTAL DEPTH: 6U S
6. DOES WELL REPLACE EXISTING WELL YE ❑ NO 0
7. STATIC WATER LEVEL Below Top of Casing: o (1 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 1SA NCAC 2C .0118.
9. YIELD (gpm): It 51 METHOD OF TEST D i r
10. WATER ZONES (depth): 5.2 0
11. DISINFECTION: Type rh 1
12. CASING:
Depth,
From p To i 6> Ft.
From To Ft.
From To Ft.
13. GROUT: Depth
From p To 20
From To
14. SCREEN: Depth
From To
nri nP
Diameter
6 /4-
From To
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft
From To Ft.
Ft.
Ft.
Diameter
Ft. in.
Ft. in.
Amount // furl
Wall Thiclmess
or Weight/Ft. Material
SDR21 PVC
Material Method
N at Cement IIand
Slot Size Material
in.
in.
Topographic/L setting
❑Ridge ❑Slope alley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DRILLING LOQ
Formation Diption
DEPTH
From ,Tio
0 (DA
Lo�
SLtt
N
Va
LOCATION SKETCH
Show direction and distance in miles from at Least
two State Roads or County Roads. Include the road
numbers and common road names.
16. REMARKS•
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
/� IY h�f/1
SIGNATURE OF PE
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:.
CO
u

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) James to Camp, Jr CERTIFICATION# 71 38
WELL CONTRACTOR COMPANY NAME
STATE WELL CONSTRUCTION PERMIT#
(if applicable)
ramp' a Wa11 R. Pnmp Co Tne PHONE #$9R1 dC1-7322
_ASSOCIATED WQ PERMIT#
(if applicable)
1. WELL USE (Check Applicable Box): Residential Lit Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery ❑ Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION: � p(i
Nearest Town: It oil (gr.' i r County NI r 001-t A o
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
Nu
3. OWNER `A/`n.,Q_AJ
Address 540 Z 68 LA fkeP 1.r o I'd R.
D✓gaNt
(Sn t oroRouv_w No.t\J a76.5s
City or State Zip Code
Area code- Phone number,
4. DATE DRILLED i q t l o LJ
5. TOTAL DEPTH: D
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO
7. STATIC WATER LEVEL Below Top of Casing: Id 0 FT.
(Use "f" 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 accords a with 1SA NCAC 2C .0118.
9. YIELD (gpm): METHaD OF TEST air
10. WATER ZONES (depth): U M -tnu i N-
11. DISINFECTION: Type Chi nr i n a Amount lilA t'
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
en32,2-1 PVC
From p To 5 0 Ft. 6 1/
Tope hic/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 Formation Deriptiwi
6 b • 7 o S. @kt l/ C1-4 tn..
to
CIZ
JOCATION SKETC1i
Show direction and distance in miles from at least
two State Reads or County Roads. Include the read,
numbers and moron road names. I
tv
(.11
0
tit
From To Ft. /�,��'\
13. GROUT: Depth Material Method r
From_o_To 20 Ft. Neat Ccmcnt Iland
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.
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 00THIS RECORD HAS EEN PROVIDED TOTHEWELL OWNER
14 —0s-
SIGNATURE OF PE
'Ch
CONSTRUCTING THE WELL / 'J 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

2. WELL LOCATION:
Nearest Town: \ (9 County-
-rv}rI flm — 1' avie.v DAO- 'RId/-il
(Street Name, Nf )unbars, Community, Subdivision, Lot No., Zip Code) ‘-.1c
IraII) �✓ls LD•
;ri�.ew 11 PI') )onf
3. OWNER:`gichht
Address 3�10
N. (StreetorRoute No.) 7 n i
(i9v�
iry or Town State Zip Code
4 DATE DRIJ f FD a")
6 El WELL REPLACE EXISTING WELL? YE$ NO L
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS L FT. Above Land Surface'
*Top of casing terminated atlor below land surface requires a
• variance to accordance with 15A NCAC 2C .0118.
9. YIELD (gpm): I'H METHODOFF TEST air
10. WATER ZONES (depth):
5. TOTAL DEPTH:
Area code- Phone number
7. STATIC WATER LEVEL Below Top of Casing: it 0 FT.
306838
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
CERTIFICATION # 71 3 R
PRONE #$7R1 dr3-7122
WELL CONTRACTOR (INDIVIDUAL) NAME (print) Ja ma S viz, ramp , Tt-
WELL CONTRACTOR COMPANY NAME ramp' S Wa11 R MUTT, r2, Tnr
STATE WELL CONSTRUCTION PERMIT/ ASSOCIATED WQ PERMIT#
(if applicable)
(if applicable)
1. WELL USE (Check Applicable Box): Residential It Municipal/Public ❑ Industrial ❑ Agricultural ❑
Monitoring ❑ Recovery ❑ Heat Pump Water Injection 0 Other 0 If Other, List Use
Topographic/Land setting
gkidge OSlope ❑Valley OF1at
(check appropriate box)
Latitude/longitude of well location
(degreeslminuteslsewnds)
Latitude/longitude source: ❑GPS ❑Topographic map
(check box)
DRILLING LOG
Formation Description
DEPTH
From ib
0
C ",D ;1 (sera
11. DISINFECTION: Type Ch 1
12. CASING:
Depth; .
From GITo 1I0 Ft.
From To Ft.
From To Ft.
13. GROUT: Depth
Froni.._g To 2 0 Ft.
na Amount i .Jti
Wall Thickness
Diameter or Weight/Ft. Material
6 1ei4 SDP23 PVC
Material Method
Neat Cement Hand
From To Ft.
14. SCREEN: Depth Diameter
From To Ft. in.
From To Ft. in.
15. SAND/GRAVEL PACK:
Depth
From To Ft.
From To Ft.
16. REMARKS:
Slot Size Material
in.
in.
Size Material
z
PO
O
LOCATION SKETCI-[
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 0 THIS RECORD HAS EEN PROVIDED TOT HE WELL OWNER
azknefi-
SIGNATURE OF PE CONSTRUCTING 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
t
7
s3
0

From: Scott Gantt To: DENR Date: 1/24/2005 Time: 6:20:06 PM Page 2 of 3
306761
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment, and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) SCOTT GANTT CERTIFICATION #2584
WELL CONTRACTOR COMPANY NAME CAROLINA WELL DRILLERS, INC. PHONE # [phone]
STATE WELL CONSTRUCTION PERMIT # ASSOCIATED WQ PERMIT #
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box) : Residential ❑ Municipal ❑ Industrial 0 Agricultural ❑ Monitoring ❑
Recovery 0 Heat Pump Water Injection ❑ Other ❑ If Other, List Use:
2. WELL LOCATION:
Nearest town: MARION
1622 SUGAR HILL RD
County McDOWELL
(StreetName,Numbers, Community, Subdivision, Lot No,. Zip Code)
3. OWNER GARY BARTLETT
ADDRESS 1622 SUGAR HILL RD
(Shod or Route No.)
MARION
City or Town
828-652-2097
NC
State
Area Code - Phone Number
4. DATE DRILLED 12/14/04
5. TOTAL DEPTH 260
6. DOES WELL REPLACE EXISTING WELL?
7. STATIC WATER LEVEL Below Top of Casing:
Zip Code
YES ❑ NO El
95 FT.
(usc "+" 1fAbovc Toy of Casing)
8. TOP OF CASING IS 2 FT. Above Land Surface*
"Top of casing terminated at/or below land surface retainer a vaianct is
accordance with 15A NCAC 2C.0118
9. YIELD (gpm): 8 METHOD OF TEST ARDM
10. WATER ZONES (depth): 240
11. DISINFECTION: TYPE HYPOCHLORTTE Amount 9
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
From 0 To 95 FL 61/4" SDR21 PVC
13. GROUT:
Depth
From 0 To 20 FL
14. SCREEN
Topographic/Land setting
0 Ridge ❑ Slope 0 Valley 0 Flat
Latitude/Longitude of well location
35.37.215 / 82.03.432
(degrees/minutes/seconds)
Latitude/longitude source: 0 GPS 0 Topographic map
DEPTH
From To
0 80 Clay
DRILLING LOG
Formation Description
80 260 Consolidated Rock
Oz
Material Method
GRAVEL MIX GRAVITY
Depth Diameter
From NA To Ft. in.
15. SAND/GRAVEL PACK:
Depth Size
From NA To Ft,
16. REMARKS:
Slot Size Material
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.
7
(-11
r
0
r')
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER.
1/15/05
SIGNATURE OF PERSON CONSTRUCTING THE WELL Date
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Servlce center- Raleigh, NC
27699-1636 Phone No. [phone], within 30 days.
GW-1 REV. 07/2001

2. WELL LOCATION:
Nearest Town:
24
(Street Name. Nu no
/mbers, Comm
3. OWNER: TX CNGS
Address
30?I88
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and ^Na Resources/ DiyisionDifof Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME�1(•�pri�rint))T f I L ghee t2-5 "Sp CERTYFICATION #27 84"
WELL CONTRACTOR COMPANY NAMBS Ieert h T`=C ( 0 0 II; a Ci PHONE # ( leratW'oq$o
STATE WELL CONSTRUCTION PERMIT'S __ASSOCIATED WQ PERhIIT#
(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
(deweWminutea/seconds) - s
Latitude/longitude source:❑GPS❑Topographic map
(check box)
PRILLING LOG
Formation Description
Subdivision, to No., Zip Code)
(Street or Route No.)
s4)edo 76
Zips
City or Town State
( )-
Ara code- Phone number
4. DATE DRILLED / 2'!.3 ' 0
5. TOTAL DEPTH: 2 5
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO gr"---
7. STATIC WATER LEVEL Below Top of Casing: t D FT.
(Use "+" if Above Top o Casing)
8. TOP OF CASING IS / • 5 FT. Above Land Surface"
*Top of easing term(eated atior below land mine requires a
variance in accord with ISA NCAC 2C .0118. -�•, J
9. YIELD (gpm): _ ___ METHOD OF TEST / I men
10. WATER ZONES (depth): / 2 5
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
Topo c/Land setting_
Midge BarSlope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
DEPTH
From To
11. DISINFECTION: Type re tit Amount ID 0'7
12. CASING: Wall Thickness
Depth"-, or Weight/Ft Material numbers and common road names.
FroTo n 7 Ftitp 54e2.1
From, To Ft
From To
13. GROUT: Depth
From_ To 20
From To
14. SCREEN: Depth
From To
From To Ft.
I5. SAND/G VEL PACK:
Depth
/ To Ft.
r To Ft.
Ft.
Material
Ftfprt/
Ft
From
From
icezizy
Diameter Slot Size Material
Ft. in. in,
in. in.
Material
Size
S- z
i
16. REMARKS:
1 DO HEREBY
CONSTRU
ERTIFY THAT THIS WELL WAS CONSTRUL fl:U IN ACCORDANCE WITH 15A NCAC 2C, WELL
N STANDARDS, ANA.'HAT A COI>Y OF THIS CORD HAS BEEN PROVIDED TO THE WELL OWNER
t j
SIGNA
PERS(1ltTCONSTRUCTING THE WFI r
it -/)-ail
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

309250
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment a ural Resources - Division of Water Quality - Groundwater Section j
WELL CONTRACTOR (INDIVIDUAL) NAME (print) 7ZI#4 Ai n. �iNE5 CERTIFICATION iN/41Q
WELL CONTRACTOR COMPANY NAME/ aineIii!/L. D.2471thy.LCL LPHONE a�' 2-fl94
,
STATE WELL CONSTRUCTION PERMIT# JJ ASSOCIATEED WQ PERMIT
(if applicable) (if applicable)
I. WELL USE (Check Applicable Box): Residential C( MunicipaUPublic 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery ❑ Heat Pump Water Injection 0 Other ❑ If Other, List Use
Mc poidt 4,
County
2. WELL LOCATION:
Nearest Town:.r%i�
fr.i / r.
(Street Name, Numbers, Community, rS�ubdivision, Lot No., Zip Code)
�ire� •b Y� t+mar.eA-
3. OWNER
Address
�r t-noket-1 ?crt kcokI
Street or Route No.)
A -Sher) le nr as8 G
Ciry or Town State Zip Code
P2)- 5 - (p o 9 9
Area code- Phone number
4. DATE DRILLED //'J • Ot%
5. TOTAL DEPTH: 24 0 /
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO 13
7. STATIC WATER LEVEL Below Top of Casing: !/O FT.
(Use "+" if Above Top of Casing)
S. TOP OF CASING 1S / FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordance with 15A NCAC 2C .0118.
9. YIELD (gpm) (I METHOD OF TEST
Topographic/Land setting
I1511Ridge ❑Slope ❑Valley OFlat
(check appropriate box)
Latitude/longitude of well location
fir' rl.14/`inty.s7'.rX/
(degrees/minutes/seconds)
Latitude/longitude source: IQdPS❑Topographic map
(check box)
DRILLING LOG
Formation Description
DEPTH
From To
(1- S
-.i'C" 6,-•
10. WATER ZONES (depth): /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.
�ySA.thv,lle P.,0L.
Fsv,1 /✓ c-•
11. DISINFECTION:TypC/orl^G Amount /s LcS,
12. CASING: Wall Thickness
{� Depth. - Diameter or Weight/Ft. Material
From1 i To e s' Ft. L-kr j✓ tti
From To Ft.
From To Ft.
13. GROUT: Depth Material Method
From 0 To a,b Ft. CoAceede. 7pagi;v .
From To Ft. JJ
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 CONSTRUCTED IN ACCORDANCE WITH I5A NCAC 2C, WELL
CONSTIjUCTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER; --
511
Ir SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
J/'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

298863
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Na Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAM (print)- AI i P B%iL L CERTIFICATION 4,21 / 7
WELL CONTRACTOR COMPANY NAME Ante.' !A �.l.I��L 9.#4 .ice/ PHONE M (�,(Sf G�F{'d �S�d
STATE WELL CONSTRUCTION PERMIT# /lL/ 41 1aSOCIATED WQ PElt/F/IITI .7/41
(if applicable) r/ (if applicable)
1. WELL USE (Check Applicable Box): Residential 61 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: Old tort county Pc Dowe
sank e-
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
OWNER:
3 Address /4 twins .Gt�
( or Rome No.)
apepecti
City or Town State
S 7sz
Zip Code
Atado- PILL number /�
4. DATE DRILLED l O I.�
5. TOTAL DEPTH: /gam
6. DOES WELL REPLACE EXISTING WELL'/ YES 0 NO g
7. STATIC WATER LEVEL Below Top of Casing: / FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS / .S FT. Above Land Surfaces
`Top of casing terminated at/or below land surface requires a
variance in accordana with ISA NCAC 2C .0118.
9. YIELD (gpm): n METHOD OFTESTT�rvtp
10. WATER ZONES (depth): .2 y t /CO'
11. DISINFECTION: Type l H. H. Amoun
12. CASING: Wall Thickness
/�
Depth," n or Weight/Ft. Material
From To !/ V Ft�O" "Met STac
From To Ft
From To Ft. X�� 11��!
13. GROUT: Depth* ' / �M'i= 1� /
From 0 To 7 Ft. L,m»2P.a,r71'
From To Ft.
Topographic/Land setting
[Midge ❑Slope ❑Valley WFlat
(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
14. SCREEN: Depth Diameter Slot Size Material
Fro o Ft. in. in.
FroTo Ft. in. in
15. SAND/GRAVEL PACK
Depth Size Material
From To Ft.
From To Ft.
•--
C• 0
fV _4
LOCATION SKETCH
Show - tion and distance in miles from at least
two Sta - Roads or County Roads. Include the road
numbers ... common road names.
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH ISA NCAC 2C, WELL
CONSTRUCTION STANDARDS, A�1HjTHATA COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WWFFI.1.T OWNER
niOPPYc�;
SIGNATURE OF PERSON CO TRU G 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

300'784
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and
WELL CONTRACTOR (INDIVIDUAL) NAM _ (print
WELL CONTRACTOR COMPANY NAME
STATE WELL CONSTRUCTION PERMITS ASSOCIATED WQ PERMIT,
(if applicable)
(if applicable)
ttual Resources - Division of Water Quality - Groundwater Secnor
CERTIFICATION as? %%t/p
NE N jtf.�g�e7 nap yeo
I . WELL USE (Check Applicable Box): Residential 61 Municipal/Public 0 Industrial ❑ Agricultural ❑
Monitoring ❑ Recovery 0 Heat Pump Water Injection ❑ Other ❑ If Other, List Use
2. WELL LOCATION.
Nee��yygqs�t Town: �411-y<
Leo -fig%
(Street Name, Numbers, Community, Subdiviaioo, Lot No, Tip Code)
3. OWNER
Address
n, - at
(Baer[ or Route No.)
727S "
City or Town State Zip Code
l 1-
Area Code- Phone comber
4. DATE DRILLED l // S/o y
5 TOTAL DEPTH' % n,
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO B
7. STATIC WATER LEVEL Below Top of Casing:. 1— Ff.
(Use "+" ifAbove Top of Casing)
5. TOP OF CASING IS / ,. FT. Above Land Surface`
'Top of casing termlaated at/or below land surface requires
variance in accordance with ISA NCAC 2C .0118. •
9. YIELD (gpm): o% jj METHOD OF TEST 'r1..tt
10. WATER ZONES (depth.: / /_^I
I i. DISINFECTION
12 CASING.
From 0 To Ft
From To
Ft.
Type Amount 9 at —
Wall Thickness
or Weight/Ft Material
r t. 2/ 9.0 C
From To Ft.
12 GR01 1 Depth Material Method
From O To 4 h FL 6+r-.a� r .I,ei stA/
From To Ft
14 SCREEN: Depth Diameter Slot Size Material
From Ft in. in.
From To Ft. in. in.
15 SAND/GRAVEL PACK
Depth Size Material
From Ft.
From To Ft.
16.REMARKS
County
sfisionsito Topographic/Land setting
❑Ridge Oslope �Vallev ❑
Flat
(check appropriate box
Latitude/longitude of well location
(de reestmimmea/axmds)
Latitude/longitude source:❑GPS❑Topographic map
(check box.
DEPTH DRILLING LOG
From To Formation Description
0
c-)
0
LOCATION SKETCH N ct?
Show direction and distance in miles frost leg!
two State Roads or County Roads. lneludSc rgad
numbers and comrnon road names
I DO HEREBY CERTIFY THAT THIS Apr 1 WAS CONSTRUCTED IN ACCORDANCE WITH ISA NCAC 2C. WELL
CONSTRUCTION STAND AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
SIGMA RE PERSON CONST'AUCTING THE WELL DATE
Submit the original to the Division of Water Quality, Grot)nd*$teeSection, 1636 Mali Service. Center -Raleigh. NC
27699-1636 Phone No. [phone], within 30 days. ! 1
GW-1 REV. 07/2001

300802
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Reno Di ' ' n of Wader Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) X.J t fv.e ut r_1d/1Jp erg• C RTWICATIoN a 473 )- _
WELL CONTRACTOR COMPANY NAME 1.1 r I �r DN W e / t . /// PHONE s LPK / c- S3 L s^
STATE WELL CONSTRUCTION PERMIT*___ASSOCIATED WQ PLRDIITY
(if applicable) (if applicable) _
1. WELL USE (Check Applicable Box): Residential D M/ tmicipal/Public O Industrial ❑ Agricultural ❑
Monitoring O Recovery O Heat Pump Water Injection O Other O If Other, List Us't
2. WELL LOCATI
Nearest Town: A -tier ,- • Co
/) 3 ,Lrir` f)t lc<s
(Street Name, N Community, Subdivision, Lot No., Zip Code)
County
3. OWNER: Cc-lt
Address
C I 1'• i t_� e'
(Sines or
yy%rr1 a >✓
City or � State
coda Phone bet
D ED
tip Code
ltj -Oo k)r l
Topographic/Land setting
Midge OSlope OValley tFlat
(check eppsoprisle box)
Latitude/longiaide of well location
(degeeedraimnesisecatds)
Latitude/longitude sotatce:OGPSOTopbgtaphic map . -_ _
(check box)
DEPTH
From To
DATE
Area 4. /
5. TOTAL DEPTH:
6. DOES WELL REPLACE EXISTING WELL^ ` E`S� _^_ NC) L�
7. STATIC WATER LEVEL Below Top of Casing: 7 a— FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS / FT. Above Land Surface*
'Top of casing terminated at/or below lead surface requires a
variance is userdaacewith 15A NCAC 2C .0118.
9. YIELD (gpm)- METHOD O T$ST
10. WATER ZONES (depth): I (} 9
I1. DISINFECTION: TypeC'JcJ- . -� Amount
12. CASING: Wall Thicimess
Depth/ , Dlmpe)ef 'e'ti'
Fro� - To % G' Ft. f .
From To Ft.
From To Ft.
13. GROUT: Depth Material ^/- Method
From rf To rd C1 Ft. (7/r-ntri�l
From To Ft
14. SCREEN: Depth Diameter Slot Size Material
From To Ft m. in.
From To Ft. in. in.
15. SAND/GRAVEL PACK
Depth Size Material
From To Ft.
From To Ft.
Formation Dexw 1ption
-Ptz
LOCATION SKETCH W 7;73
Show direction and distance in miles from at lets
two State Roads or County Roads. Include the real
numbers and common road names.
` Y1 Pd v/ °;" 11
16. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 1SA NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE 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
1769a1636 Phone No. [phone], within 30 days. G W -i REV. 07/2001

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and N.
WELL. CONTRACTOR (INDIVIDUAL)
WELL CONTRACTOR COMPANY NAME
30090.
*vision f Water Quality - Gro,mdwater Section
(pttar ti r% B F L CERTIFICATION I.?3 2$�
} , ,a- 3 PRONE a 0J( 1 s 5 - 93 SS
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ Plata
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential O Mlmicipal/Public 0 Industrial 0 Agricultural CI
Monitoring O Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATIO
N Town:
Tic C4
(Street Name, Number, Community,
3. OWNER:
Address
/RJtt_9r
^' County , `i Doid fi / l
vision, lot No., Tip Code)
Dok r
Are code- Phone member
4. DATE DRILLED 7 /O /) V"
5. TOTAL DEPTH: '/S 5' /
6. DOES WELL REPLACE EXISTING WELL' YES O NO C3
7. STATIC WATER LEVEL Below Top of' Casing: i / FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS / FT. Above Land Surfaces
crop of easing terminated wor below land surface require, a
variance In accordance 1SA NCAC 2C .011S.
9. YIELD (gpm): METHOD OF T3ST l �ij4 i `F
10. WATER ZONES (depth):
f/
Resources -
Topographic/Land setting
ORidge OSlope OValley OFlat
(check appropriate box)
Latitude/longitude of well location
(aegrees rminues/seconds)
Latitude/longitude sourte:OGPSOTopographic map
(cheek box)
PEPTH PRILL4NG LOG
From To FormationDs....,:ption
/�1 ro (gem Ir r) a
( g°' aiei°ti - nil , C C°d`
11. DISINFECTION. Type
12. CASING:
From Imp TDo�t{5 Ft.
To
From
13. GROUT:
From
From
14. SCREEN: Depth
From__ To
From To
15. SAND/GRAVEL PACK
Depth
From To
From To
Ft.
Wall Thidmess
t Doinga Wei t L numbers and common road names.
To Ft �vletrnal
To- 0 Ft L j err Method
To Ft.
Diameter Slot Size Material
Ft. in in.
Ft. in in.
Size Material
Ft.
Ft.
LOCATION SKETCH N
Show direction and distance in miles from at leasq? i
two State Roads or County Roads. Include the road'
t,T
G/D`
�1I'frite QJ frier I— 4.
16. REMARKS•
I DO HFREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONST tUCTION SJANDARDS, 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
27696-1 ;)6 Phone No. [phone], within 30 days. G W -i BEV. 07/:001

300704
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) Jamag 'aL. Camp, Tr
WELL CONTRACTOR COMPANY NAME Camp' R Wa11 & Prim L'n Tnn PHONE "$7Al 45'i -7322
STATE WELL CONSTRUCTION PERMIT" ASSOCIATED WQ PERMIT"
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): ResidentialMunicipal/Public 0 Industrial ❑ Agricultural ❑
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION.q�
Nearest Town: /YIGY t D County
kf 4-9 /Li'ddeA lakes
SArtv»1 e
(Street Name, Numbers, Community, Subdivision, Lot No., Zip C6de) Ceemm
3. OWNER: e rt4 fSetCLA-be
y
Address 4,..b 5/to ai C.K.TY0.1I
(Street eu Rowe No.)
N Nebo
City or Town Slate Zip Code
Area code- Phone number /y ' I
4. DATE DRILLED / .Z % -0 `Y
5. TOTAL DEPTH: C S
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO
7. STATIC WATER LEVEL Below Top of Casing: (7 a FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS 1 FT. Above Land Surface*
'Top of casing terminated arlor below land surface requires a
variance in accordance with ISA NCAC 2C .0118.
9. YIELD (gpm):.10 METHOD OF TEST air
10. WATER ZONES (depth): t D O
11. DISINFECTION: Type ('h 1 nr i n a Amount I cap
12. CASING: Wall Thickness
Depth . Diameter or Weight/Ft. Material
From p To_L O Ft.6 1 / 4 eDR-21 PVC
From To Ft.
From To Ft.
13. GROUT: Depth Material Method
From p To 30 Et. Neat Cement Hand
From To Ft.
14. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in.
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
16. REMARKS:
CERTIFICATION "_u3$
Topographic/Land setting
Ridge ❑Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minmes/seconds)
Latitude/longitude source:OGPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From To Formation Description
MYt 11d11'
205 ('oYKD1,af11 er4 York
- G
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common road names.
P
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUL 1ED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY 0 THIS RECORD HAS i3EEN PROVIDED TO THE WELL OWNER
44ILa C 8-/5-04
SIGNATURE OF PERSON CONSTRUCTING THE WELL ' A DATE..
Submit the original to the Division of Water Quality, Groundwater Sect01,1636 Mail Service Center - ualei
27699-1636 Phone No. [phone], within 30 days. GW-1-.REV. 07/2001
(VP �
2034

30144
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources/�- Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) Sar„es fits l r CERTa+ICAT1oN # a LV 1
WELL CONTRACTOR COMPANY NAME C r1;:, ink U cr,ll:,.g PHONE # (Yr)6i1.S`t 3109'
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT# - ---
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential 0 Mumicipal/Public 0 industrial ❑ Agricultural ❑
Monitoring 0 Recovery 0 Heat Pump Water Injection ❑ Other 0 If Other, List Use
2. WELL LOCATIO
Nearest Town: r. a, County (NrSir,vuoll
Ivain oct 'RA
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: l C \ Pt-, (deve miaut /axmda)
Address I. r. l V‘s Latitude/longitude source:❑GPS❑Topographic map-
(Street or Route No.) (check box)
/J9!-R) td .0 A 1 c9 t DEPTH pPILLINOI,(Na - _:
City or Town Stain . tip Code From To Formation Description
Area code- Phme cumber
4. DATE DRILLED t� r0 /V Lt
5. TOTAL DEPTH: 1I O
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO B"
7. STATIC WATER. LEVEL Below Top of Casing: cM, FT. i
(Use'*+^ if Above Top artesian) t`�
8. TOP OF CASING IS \ 5 FT. Above Land Surface' tP R
'Top of casing terminated at/or below land surface requires a -O
ventilate ht accordance with ISA NCAC 2C .0118. o n
0
9. YIELD (gpm): _` _ METHOD QF TEST 9vi \eC i13
co
10. WATER ZONES (depth): ---k rJL ti O
��// LOCATION SKETCH p
Tf
11. DISINFECTION: Type Tfi Amotmt I th Show direction and distance in miles from at least*" Q.
Wall Thiclmess two State Roads or County Roads. Include the road -0-
or Weight/Ft Material numbers and common road names.
Topographic/Land setting.
❑Ridge ❑Slope ❑Valley ❑FIat
(check appropriate box)
Latitude/longitude of well location
m
12. CASING: pp
Depth
FroTo Ft.
From To ,5 Ft.
From To Ft
13. GROUT. Depth
From To DO
Ft.
Diameter
(..a5
i-aS
Material
From To Ft.
14. SCREEN: Depth Diameter
From To Ft. in.
From To Ft. in.
15. SAND/GRAVEL PACK:
Depth
From To Ft.
From To Ft.
Method
Slot Size Material
in.
in.
Size Material
tnio�a L e�
16. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH ISA NCAC 2C, WELL
CONS CTION STANDARDS, AND WAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
/i
t1
Submit the 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) \\\\AM`P�,S E (a t CERTIFICATION # QUA
WELL CONTRACTOR COMPANY NAME ��d r• Y t Q-\\ �C t 4 PHONE # F ) (,SC( -341 1(j
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
301446
1. WELL USE (Check Applicable Box): Residential. Mtmicipal/Public ❑ Industrial ❑ Agricultural ❑
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use
2. WELL LOCATIO
Nearest Town: c c County m c Oovje k\
5NNLr St,,.Nocc„r R\
(Street Name, Numbers, Community, Subdivision, LotNo., Zap Code)
3. OWNER:
Address _lief;
(Stint or - No.)
(yorTG S� Sn1501Zip cnae
Area code- Phone number `t
4. DATE DRILLED 3I l (oi t T
5. TOTAL DEPTH 1
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO
7. STATIC WATER. LEVEL Below Top of Casing: 45 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS \ —S FT. Above Land Surface*
"Top of using terminated at/or below land surface requires a
variance in mordants with 1SA NCAC 2C .0118. t
9. YIELD (gpm): 2OT METHOD OF TEST Qx eC.
10. WATER ZONES (depth): %0 %5
11. DISINFECTION: Type 1i * I t
12. CASING:
From
13. GROUT:
From To
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. 2
From To Ft. O
Amount
Wall Thickness
or Weigbt/Ft. Material
Method
Material
Topographic/Land setting
❑Ridge ❑Slope ❑Valley ❑Flat
(check appropriate box)
Latituddiongitude of well Iscation
(degmalmimaestade)
Latitude/longitude source:❑GPS❑Topographic map
(cheek box)
DEPTH PRILLINQ LOG _
From To Formation Description
t n
�
di -eat
F
A
erg -La
t O 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.
Depth, q Diameter
To h_t Ft. lr-.IS
To .5D Ft. ; a5
To Ft.
Depth
To
-20 Ft.
c
0
16. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUC 1tU IN ACCORDANCE WITH 1SA NCAC 2C, WELL
CONSTRUCII STANDARDS, AND THAT A PY OF THIS RECORD HAS BEEN PROVIDED TO THE ;; OWNER
Cvn
SIGNI-MRE OF PERSON CONSTRUCTING THE WELL DATE
Submit !1(e original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-1 REV. 07/2001

301445
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources /-7Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) \\ �ii`MP. s l"�CwdC�.t� CERTIFICATION #
WELL CONTRACTOR COMPANY NAME L" OA. r\ ul e.q N A .A.0 PRONE # IV' LSS - 4+
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential Er-Municipal/Public ❑ Industrial ❑ Agricultural ❑
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use
2. WELL LOCATION \
Nearest Town: / ` \CCar rx County �\ r >vCO I
C�.e�.,.,� K rece5\-
_cE
(Sweet Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER � rst
Address _ 5 n 5t, ac :(V,a
(Street or No.)
1\i\C1C t ( ri -1SD
City or Town — n,¢ \ (i tip Code
Acode- Phone number i ��—``�t
m n N /
4. DATE DRILLED .T d CIS
5. TOTAL DEPTH: \LC3
6. DOES WELL REPLACE EXISTING WELL YES ❑ NO Er
7. STATIC WATER LEVEL Below Top of Casing. —10 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS 1 ,5 FT. Above Land Surfaces
'Top of casing terminated at/or below land surface regains a
variance In accordance with 15A NCAC 2C .0118.
9 YIELD (gpm): la METHOD OF TEST Rar`e(
10. WATER ZONES (depth): L 3c 41)
11. DISINFECTION: Type l4 T /4 Amount ) IIh
12. CASING: Wall Thickness
From It() Too p sle Ft.
From( . To . Ft.
From To Ft
13. GRO Depth M
From b� To X Ft. UPrnenr
From To Ft.
Topographic/Land setting
[Midge ❑Slope ❑Valley °Flat
(cheek appropriate box)
Latitude/longitude of well location
()
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH DRILLING I OG-- -
From To Formation Description
jACATION SKETCH , ¶h oy
Show direction and distance in miles from at least c coci P
two State Roads or County Roads. Include the road .
or Weight/Ft a r• numbers and common road names.
r.."7 G - �
y
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
Slot Size
_in.
in.
Material
Material
16. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUL the IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCi7ON STANDARDS, T A COPY OF THIS RECORD HAS BEEN PROVIDED TO THESLL
j�i
YzAt Fyn 1 ,^ ftw /'`c27
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
tAt

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Wvision of Water Quality - Groundwater Section/
WELL CONTRACTOR (INDIVIDUAL) NAME riot)\\ -SQ �` € , �(� Ccl t CERTIFICpATTIION #r) 1, (17I
WELL CONTRACTOR COMPANY NAME GC1C.I'S YV(.\1 £) 2k\ 4 PHONE # CA) £S) -341 k-
STATE WELL CONSTRUCTION PERMIIYI ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
301444
1. WELL USE (Check Applicable Box): Residential 0 Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring ❑ Recovery 0 Heat Pump Water Injection ❑ Other ❑ If Other, List Use
2. WELL LOCATION
Nearest Town: �c.ct\r. County E' 1 c 0oNle
cots% 9,, A Chi 1
(Street Name, Numbers,``Community, Subdivision, IM No., Zip Code)
3. OWNER: R�t-.•�'(�n S
Address LU4% f�Ko14r� s C\-qe.1 .
(Street or Boute No.)
Alpl>r . OS7G\
(5'-11} or Tz c� S -j53 Zip Code
Ain code- Phone =Alec
4. DATE DRILLED - O1- O‘k
5. TOTAL DEPTH: 110
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO Er
7. STATIC WATER LEVEL Below Top of Casing: FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS I S FT. Above Land Surface*
'Top of casing terminated at/or below land surface regwres a
variance In accordance with ISA NCAC 2C .0I1S.
9. YIELD (gpm): 15 METHOD Of TES' 95:::o\
10. WATER ZONES (depth): 70- SSC
11. DISINFECTION: Type F1
12. CASING:
,pt Piawet
Fro To '�f( t + Ft (o Ser
t
From( To / r'Y Ft. (o -a-
From To Ft.
13. GROUT: Depth
From Tom��rr, Ft
From To Ft.
Material
Amount 1�
Wall Thickness
or Weight/Ft [Material
G
14. SCREEN: Depth Diameter
From To Ft in.
From To Ft. in.
15. SAND/GRAVEL PACK:
Depth Size Material
Topographic/Land setting
❑Ridge ❑Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
rn
(destees m nutes/seeoods)
Latitude/longitude source:❑GPS❑Topogtaphic map
(check box)
DEPTH DRILLING -LOG —
From LD
From To Formation Description
Method
Slot Size Material
in.
in.
From To Ft.
From_ To Ft.
LOCATION SKETCH03.10
Show direction and distance in miles from at 14 -0 -
two State Roads or County Roads. Include the r6o&h 0
t� nap
D Zee
nP
of y
numbers and common road names.
rY-
70 Fla
16. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTR ION STANDARDS, AND T ArGPY OF THIS RECORD HAS BEEN PROVIDED TO THE WPT T OWNER
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
'Submit the original to the Division of Water Quality, Groundwater Section, 1636 Marl Service Center -Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-1 REV. 07/2001

301443
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources -D� ivisip of Water Quality - Groundwater Section f I
WELL CONTRACTOR (INDIVIDUAL) NAME (print) JCNt^QS f ,ncciz CERTIFICATION# rat/tit /tit
WELL CONTRACTOR COMPANY NAME (>tl.Ca .� J e c:s t*, Ki PHONE #' i� ) �i59 - cs7 � 4;
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED✓JWQ PERMIT#
(if applicable) (if applicable)
I. WELL USE (Check Applicable Box): Residential Mimicipal/Public 0 Industrial ❑ Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection ❑ Other 0 If Other, List Use
2. WELL LOCATION: `�
Nearest Town: . County M° 0-wire/it
(Street Name, Numbers, Community, Subdivision. Lot No. Tao Code)
3. OWNER: C pc 1y KA\'‘,.
Address 10 I \r��:,:Qec i� Oak O(
�(� (Street or Route No.)
lr xc;br1 IJC aR75)
�� QC�ity or Town State zip Code
tp - Iosa -
4. DATE DRILLED 9_ n T
5. TOTAL DEPTH: 1 C)
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO m'
7. STATIC WATER LEVEL Below Top of Casing: VieO FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS \ -5 FT. Above Land Surface*
'Top of easing terminated at/or below land surface requires a
variance in ■ccerdor wnh 1SA NCAC 2C AIM
METHOD OF
WATER ZONES (depth): 410
TEST
9. YIELD (gpm): B XeC
11. DISINFECTION: Type,
12. CASING:
Depth Diameter
Fro To -id- Ft. L. :5
Fro To -7ui Ft c a 4
From. To Ft.
13. GROUT: Depth Mztc
From`r� To Ft. /owlen/-
From To Ft.
Amount
Wall Thickness
or Weight/Ft
7_C
14. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in.
From To Ft. in. in.
15. SAND/GRAVEL PACK
Depth Size Material
From To Ft.
From To Ft.
Topographic/Land setting.
❑Ridge 0Slope ❑Valley gnat
(check appropriate ban)
Latitade/longiti de of well location'
CO
r-i
rn
(degreeslmiauteslaamds) -ice
Latitude/longitude source:❑GPS❑Topographic map
DEPTH
From To
DRILLNG LOG
Formation Dpvcriptinn
tvl
n
ovia
ck LOCATION SKETCH cA
Show direction and distance in miles from at least y
two State Roads or County Roads. Include the road a n
numbers and common road names. -'`
16. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRULInu IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTR,CJCTION STANDARDS, AND THAT A QOPY OF THIS RECORD HAS BEEN PROVIDED TO THE WET I QWNER
DATE 11
N
SIGN 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
Area code- Phone num

301442.
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Divisionnof Water Quality - Groundwater Section^
WELL CONTRACTOR (INDIVIDUAL) NAME (print) \ .Tn lw,on E l--,nr Jjn CERTIFICATION�ft .-p( Aft
WELL CONTRACTOR COMPANY NAME l--ri �: n \JAI Dr.' PHONE # Rat W / — 3501
7
STATE WELL CONSTRUCTION PERMITS _ASSOCIATED WQ PERMIT{
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential 12'--Mumtcipal/Public ❑ Industrial ❑ Agricultural ❑
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use
2. WELL LOCATION:
Nearest Town. ig\n,r : zn County My, 0, we
Dot' I`Aenclow nc
(Street Name, Numbers, Community, Subdivision, Tut No., try Code)
3. OWNER: RP\\(), gni,1c (lre.
Address er.1C5 Mev,l nc
g(Street Of Route No) aS 7S
Zip Code
Area code- Phone number
4. DATE DRILLED -7 -1 a. - O`t
5. TOTAL DEPTH: Qt 5
6. DOES WELL REPLACE EXISTING WELL' YES 0 NO II
7. STATIC WATER LEVEL Below Top of Casing: AFT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS \ FT. Above Land Surface*
'Top of using terminated at/or below land surface requires ■
variance In accordance wttb 15A NCAC 2C .0118.
9. YIELD (gpm): METHOD OF TEST .\e<
10. WATER. ZONES (depth): (;e -
7Q-7S'
11. DISINFECTION: Type ii -V 1-1 Amount 1 \�
12. CASING: Wall Thickness
_ Depth Diameter or Weight/Ft
Fran�-�-,¢¢--To C3Q Ft. I',ZS a -
4.
From To ..3c1 Ft (,.)5
From To Ft.
13. GROUT. Death
From l T. DO Ft C e:n<n
From To
14. SCREEN: Depth
From To
From To
15. SAND/GRAVEL PACK:
Depth
From To
Method
Ft.
Diameter Slot Size Material
Ft. in. in.
Ft. in. in.
Size Material
Ft.
From To Ft.
16. REMARKS:
Topographic/Land setting
❑Ridge ❑Slope ❑Valley ❑F1at
(check appropriate box)
Latitude/longitude of well location
(degrenlmimmeshecoods)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From To Formation Description
c n
ay Ar%m r
23,
II
LOCATION SICETCI) u,
Show direction and distance in miles from at least 4 �p
two State Roads or County Roads. Include the road p
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
/'(�' r % "�
/,-1^f;-o\k
G/
SIGNATURE OF PERSON CONSTRUCTING THE WELL
Sub giif the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. 0 41 Okb31D1

301441
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - � Division`of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (pri/nn��t)� \\ ')QC"CS &Or% CERTIFICATION # ai-\
WELL CONTRACTOR COMPANY NAME l7aCd: n W d DC.\11r.V PHONE # IRS) LS9 -v i • J
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED�lW Q PERMIT#
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential PJrMunicipal/Public ❑ Industrial ❑ Agricultural ❑
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use
2. WELL LOCATIOW
Nearest Town• /`Y]f:nr‘ County MC�We.q
V\ ct4v . I(t Ltk 1
(Street Name, Numbed, Community, Subdivision, Lot No., Zip Code)
3. OWNER: �S[�}4u. rQao,�(+
Address ciIGCL .n$ �:\\
(Skeet or No.)
R` tcn >J_c ag?5�
City or
13i �3% Zip code
(�7d}
Area code- Phone comber r
4. DATE DRILLED (j I, l I j't.4
5. TOTAL DEPTH: \kSk
6. DOES WELL REPLACE EXISTING WELL? YES NO i
7. STATIC WATER LEVEL Below Top of Casing: AFT.
(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 ■
variance In accordance with r5A NCAC 2C .0118.
9. YIELD (gpm): S METHOD OF TEST2y,`e
10. WATER. ZONES (depth): P ")0 - l 75
Topographic/Land setting
❑Ridge ❑Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(dank box)
DEPTH DRILLING LOG
From To Formation Description
11. DISINFECTION: Type
12. CASING:
FmmlQ TDot7
From :Z 1 To 4"O
Amount_
Wall Thickness
Diameter or Weight/Ft
Ft. 6,45 .
Ft LJ '
From To Ft.
13. GROUT: Depth skafi}i
From -Tar. —To r _ Ft t
Ft.
From To
14. SCREEN: Depth Diameter
From To Ft. in.
From To Ft. in.
15. SAND/GRAVEL PACK:
Depth
From To Ft.
From To Ft.
Method
Slot Size Material
in.
in.
Size Material
LOCATION SKETCH
Show direction and distance in miles from at least € ,
two State Roads or County Roads. Include the road R, �
numbers and common road names. cr, m
-0 0 0
--Id p rn 00
4u. \\-r Qv1 ty, alo'23
Lek o R i.
G P �¢
q y
70
16. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUC I>;U IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCffION STANDARDS, AND THAT A COP OF S RECORD HAS BEEN PROVIDED TO THE WELL OWNER.
SIGNATURE OF PERSON CONSTRUCTING THE WELL • IDATA i
Suh/mit the original to the Division of Water Quality, Groundwater Section, 1636 Mall Service Center - Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. C/.`f-1,REV.A',7001
SL, 1 b cu

0144c
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - n Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) Sestn GQcl CERTIFICATION # air GG /
WELL CONTRACTOR COMPANY NAME S^ � 24 Sl CC.\\ . f'f3 PHONE # (Q1q - 4S1 -34 7 r
STATE WELL CONSTRUCTION PERMITS _ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential O...Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other 0 If Other, List Use
2. WELL LOCA ION:m ,Wtr U
Nearest Town i t lac; 9 Coun
-40, Cooknec,.5
(Street Name, Numbers, Community, Subdivision, Lot No., tip Code)
3. OWNER: W\rosot. Q� t'
Address :5 /E SLr�.i(**c \\11\
(Street or Route`No.)
Zip Code
(V%}y r-13% 354t
Area code- Phone mnnber
4. DATE DRILLED ('r /aV Ia��
5. TOTAL DEPTH: /Si
6. DOES WELL REPLACE EXISTING WELL YES 0 NO Jar
7. STATIC WATER LEVEL Below Top of Casing FT.
(Use "*" if Above Top of Casing)
8. TOP OF CASING IS /-5 FT. Above Land Surface'
*Top of casing terminated Wor below land surface requires a
variance io accordance wltb 15A NCAC 2C .0118.
9. YIELD (gpm): -% METHOD OF TEST etc;Irir
10. WATER ZONES (depth):
11. DISINFECTION: Type
12. CASING:
Depth
Fro 0 To,
F To
From To
13. GROUT: Depth Matte
From 'Ivy To Ft. /o. en
From To Ft
511/
1
Diameter
Ft LiS
Ft. 4-25'
Ft.
Amount
Wail Thickness
or Weight/Ft
Method
Topogtaphic/Land setting
QRidge ❑Slope ❑Valley ❑Flat
(ditch appropriate box)
Latitude/longitude of well location
(deg[eea/mimneslseconds)
Latitude/longitude source:❑GPS❑Topographic map
(chat box)
DEPTH DRILLING LOG
From To Formation Description
t n
e(3 --ant;
LOCATION SKETCH .p p O
Show direction and distance in miles from aSeasf�;o
two State Roads or County Roads. Include tbfoaj Z
numbers and common road names. o u o
�A
0
14. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in.
From To Ft. in. in.
15. SAND/GRAVEL PACK o
Depth Size Material
From. To Ft.
From To Ft.
16. REMARKS:
Ste -toe,)^
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE W1TH ISA NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT fl COPY,OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
9/(2 41 r1 1GL✓i✓ (, 6 4 /6" 4
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
Submit �original to the Division of Water Quality, Groundwater Section, 1636 Mail,
27699-1636 Phone No. [phone], within 30 days.
f.tnti -*OH NC
i,W-1 REV:074001
SEP 1 6 2004

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources- Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (prim).yvnfS (/nilc A: r CERTWICATION# Wat-A
WELL CONTRACTOR COMPANY NAME ( (Xt k: r Wed' �. :`1'.ina1 # PRONE (IA(S) - 3LTh'
STATE WELL CONSTRUCTION PERMIT# ASSOCIATEDATWQ PERMIT#
(if applicable) (if applicable)
3 01 LTh
1. WELL USE (Chuck Applicable Box): Residential Er Municipal/Public ❑ Industrial ❑ Agricultural ❑
Monitoring 0 Recovery 0 Heat Pump Water Injection ❑ Other ❑ If Other, List Use
2. WFT.T LOCATION
Nearest Town: I`\Ac: N,„ County k\. C
Tonne (kZcL
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: ti\;Vio l Lon rs&C4
Address
(Street or Rome No.)
M(,t; r. i 0 �9:75a
City or Town State Zip Code
( )- Cr 5J — Ti9 CtZ
Area coda Phone number
4. DATE DRILLED
5. TOTAL DEPTH. I
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO Er
7. STATIC WATER LEVEL Below Top of Casing: CIO' FT.
(Use ne if Above Top of Casing)
8. TOP OF CASING IS L 5 FT. Above Land Surface*
'Top of casing terminated atfor below land surface requires a
variance In accordance with ISA NCAC 2C .0118.
9 YIELD (gpm): 1 S METHOD OF TEST (St:Ae C
10. WATER ZONES (depth): 135
11. DISINFECTION: Type Amount
Wall Thickness
Diameter or Weight/Ft.
co.43 0.
12. CASING:
Depth
FroTo,
From I To
From To
13. GROUT: Depth
From Toe To cob`
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
Slot Size Material
in.
in.
16. REMARKS:
Topographic/Land setting
❑Ridge ❑Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(de-dmimuesleemuds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From To Formation Description
arei
ry
LOCATION SKETCH 6
Show direction and distance in miles from€Jeasf' y
two State Roads or County Roads. Include iL�
co
numbers and common road names. o r/'
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRULIFU IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSUCTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
/ ,
4.1(2) %i7( yle 1 2 )(0.nc%,i 7/0hi 1 y.
SIGNATURE OF PERSON CONSTRUCTING THE WELL DikTE j .
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mattsice , I Lt�Center -RRal�eigh, NC
27699-1636 Phone No. [phone], within 30 days. E i O`At7/2001

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources-//D�ivision of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) . �r1 vv. OS (-ric A CERTIFICATION # 2) (.G`
WELL CONTRACTOR COMPANY NAME ('ir c. e. Wo" v PHONE # ( i LS`l
j
uI Cc
'l
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use „_ I T `
2. WELL LOCATION:
Nearest Town: q M rtc. run County, .fle'Ndt
t'1Pn t v V:e..-1 Let\- ;�
(Street Name, Numbers, Community, Subdivision,Lot No., Zip Code)
3. OWNER: wn �:t�i.n 4G
Address ��(lh Si - c"CA \ ,'A_
(Street or Route No.)
N C Q'iS
City or (Rat)- Town State
s4t� Code
Am code- Phone number
4. DATE DRILLED QI to �L/
5. TOTAL DEPTH: 1 Is
6. DOES WELL REPLACE EXISTING WELL?
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
301439
I. WELL USE (Check Applicable Box): Residential Er Mltnicipal/Public 0 Industrial ❑ Agricul
YES 0 NO .Ef
7. STATIC WATER LEVEL Below Top of Casing: lAt FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS \ S FT. Above Land Surface*
'Top of casing terminated actor below land surface requires a
variance In accordance with 15A NCAC 2C .0115
9. YIELD (gpm): 12 METHOD OF TEST �k‘ec
10. WATER ZONES (depth): 1a- 5W
tin-`15
11. DISINFECTION: Type • ,�< C . k Amount
12. CASING: Wall Thickness
Depth or Weight/Ft. Material
From To �.FJ_ Ft.
-�.�
From t . l` To b 4 Ft. it ..15
From To Ft.
13. GROUT: Depth Material ij
From 'toe To ,C Ft. (1/ment-
From To Ft.
14. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in.
From To Ft in in.
15. SAND/GRAVEL PACK
Depth Size Material
From To Ft.
From To Ft.
Method
16. REMARKS:
Topographic/Lad
❑Ridge ❑Slope ❑Valley
(dtaksppmpnate box)
Latitude/longinide of well 1
at `�;
J$7at �,
p
toi° { U L�
rn
°graphic�-
(de)paa/mivutesh )
Latitude/longitu de sourrce:❑GPS❑T
(check box)
DEPTH DRILLING LOG
From To Formation Description
9
9 >r�
J OCATION SKETCH O `q y
�( Show direction and distance in miles from ea8(1 o
two State Roads or County Roads. Include roar t
numbers and common road names. C:2-4Q
Z
Well e1J lam}
4 a�
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUE 1tt IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRU( ION STANDARDS, AND THAT 4 COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
SIGNATURE )^GOF P ERSON CONSTRUCTING THE WELL DATE
Su the 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

301280
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) - ,/ri C A A L' AI may CERTIFICATION # 3a V is
WELL CONTRACTOR COMPANY NAME /` %^ 4 A ` ` . nPHONE # (7A e,^ ^^ - C / '' 5
STATE WELL CONSTRUCTION PERhIIT# AQCOCIATED WQ PERMIT#
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential 13"-Municipal/Public ❑ Industrial ❑ Agricultural ❑
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use
2. WFT T LOCATION:
Nearest Town: A /w / C v' County AM its tit) ti
Iry r.SisP 3/ (Ndt'v, ohtot A,r,K,cI
(Street Name, Numbers, Community, Subdivision, Lot No., 22p Code)
3. OWNER: a `l r= h P.ttTLL
Address /2l6 S' 6'rind ST
(Strata Route No.)
r=r/VEY .CC - y3s-i
City or Town State Zip Code
( &Y} X3e C3i4,
Area code- Phone number,
4. DATE DRILLED )' al I ` r' 9
5. TOTAL DEPTH: //6
6. DOES WELL REPLACE EXISTING WELL? YES G7 NO ❑
7. STATIC WATER. LEVEL Below Top of Casing: AFT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS 4 " FT Above Land Surface*
'Top of casing terminated at/or below land surface requires ■
variance in accordance with 1SA NCAC 2C .0118.
9. YIELD (gpm): 26 Y" METHOD OF TEST LfM t & L- f '
10. WATER ZONES (depth):
11. DISINFECTION: Type
Topographic/Land setting
❑Ridge ['Slope ❑Valley ❑Flat
(that appropriate box)
Latitude/longitude of well location.
(degrees/minutes/seconds)
Latitudellongitude source:❑GPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From To Formation Description
LOCATION SICETCH
hit N Amount /. r G Show direction and distance in miles from at least
12. CASING:
Depths
From T�6 G Ft.
From To Ft.
From To Ft.
13. GROUT: Depth
From To Ft.
From To Ft
Wall Thickness two State Roads or County Roads. Include the road
Diameter or Weight/Ft Material numbers and common road names.
(..-'f .2.. G i4 w r/C
Material
14. SCREEN: Depth Diameter
From To Ft. in.
From To Ft in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
Method
Slot Size Material
in.
in.
From To Ft.
16. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUciw IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
'7-2/-c
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

301279
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resourcesl- Division of Water Quality - Groundwater Section 3 0 y
WELL CONTRACTOR (INDIVIDUAL) NAME (print) e/ .P4 • G/vtM4°3 /1A✓ CERTIFICATION #
WELL CONTRACTOR COMPANY NAME �O 44$141( 0A /AA'/le" S PHONE # r.oma z 2-L /
STATE WELL CONSTRUCTION PERMIT!, ASSOCIATED WQ PERMIT.,
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential PreMunicipa1/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: /Y#h 'a.y county/PM Douai.
Wi/.dwaod /_Sr t1 (zar>SJ
(Street Nam; Numbers, Community, Subdivision, Lot No., Zip Cods)
3. OWNER: E(Ad/t_ »7i'vTZ
Address f0,ac,if i3?/i `�
DF klvr, (StreetNo.) Dry e y(a/ /7
City or Town State Zip Code
iar)_ 1434-9794r
Topographic/Land setting
❑Ridge ❑Slope ❑Valey ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degreea/mimitealsecoads)
Latitude/longitude source:❑GPS❑Topographic map
(check box) s...
DEPTH DRILLING LpG
From To Formation Descr.Won
Area code- Phone [umber .,
4. DATE DRILLED AP —/i' O''''
5. TOTAL DEPTH: / .72a
6. DOES WELL REPLACE STING WELL? YES 0 NO
, 7. STATIC WATER LEVEL Below Top of Casing: TM> FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS /07 `` FT. Above Land Surface'
"Top of casing terminated at/or below land surface mares a
variance in aecordaks with 1SA NCAC 2C .0118.
9. YIELD (gpm): '3 1- METHOD OF TESTTA 1 /• /2
10. WATER ZONES (depth):
j.00ATION SKETCH
Show direction and distance in miles from at lust
two State Roads or County Roads. Include the road
numbers and common road names.
11. DISINFECTION: Type /9-1776 Amount /.L
•
From Tothin"
From To
From To
13. GROUT: Depth
From To
From To
14. SCREEN: Depth
From To
Ft Deter
Ft
Ft.
or Weight/Ft Material
,PHSnG.
a
Mnn:dial Method
Ft.
Ft
Diameter Slot Size Material
Ft. in. in.
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
9�"
ti.
From To Ft.
16. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUE 1tU IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
fdrt eGe t 7=r3 -ate
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

301278
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
M
WELL CONTRACTOR (INDIVIDUAL) NAME (print) / A i, Y L• h A "id � CERTIFICATION #o
WELL CONTRACTOR COMPANY NAE / 7 0H f'N 4 j2,.. 4 4 r i ' 5 PHONE # ( 1—G''- G (? T
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential PI-Municipal/Public ❑ Industrial ❑ Agricultural ❑
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use
2. WELL LOCATION:
Nearest Town: MP h'CA/ County N C Da. i 1 i"4.1.
(ice( /WrRO' U`ohdi�u= /.r'S&aur.IJcv'fi'/
(Street Name, Numbers, Community, Subdivision, Tot No., Zip Code)
3. OWNER: 7 /1 /' /-1.-4 IS I'
Address /Ud, ticl �Oir9
(Street or Route No.)
/ve, .7 S / t
City or Town State
(;2S} ))r-' .%2eSI/
Area code- Phone :rumba y
4. DATE DRILLED a -.2 7 - 41474.
5. TOTAL DEPTH: / 2 .Z
6. DOES WELL REPLACE EXISTING WFI f 1 YES ❑ NO $-
7. STATIC WATER LEVEL Below Top of Casing: FT.
(Use "+" if Above Top of Cuing)
8. TOP OF CASING IS /.2 FT. Above Land Surfaces
'Top of casing terminated at/or below land surface requlres a
variance in aeeordaaeewith 1SA NCAC 2C .0118.
9. YIELD (gpm): /CY- METHOD OF TEST ify' LtriI"
10. WATER ZONES (depth):
Zip Code
11. DISINFECTION: Type /-7 j n
12. CASING:
Depth , Diameter
From To 5/Z Ft G. "
From To Ft.
From To Ft.
13. GROUT: Depib
From To
N: renal
Ft.
Topographic/Land setting
!Midge ❑Slope ❑Valley ❑Flat_
(check appropriate box) ..
Latitude/longitude of well location
(de lmimnes/e )
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From To FonnationDescription
-
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.
b ,Rf,Ann
From To Ft
14. SCREEN: Depth
From To
From_ To
15. SAND/GRAVEL PACK:
Method
Diameter Slot Size Material
Ft. in. in.
Ft in. in.
Depth Size Material
From To Ft.
From To Ft.
16. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
47(
SIGNATURE OF PERSON CONSTRUCTING THE WELL o DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center -Raleigh, NC
27699-1636 Phooe No. [phone], within 30 days. GW-1 REV. 07/2001

301277
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) PO 4 6 Y -� /? , r'o /. �/J d
WELL CONTRACTOR COMPANY NAME /7e:,h1EEr%/ 2 ,b h / Ink.
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
CERTIFICATION # Ps-4 4
PRONE # (/1'�)— ('4- a- •
I. 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: z )Zb iv) tt ,V/1/e County /W Pr , t l^4
/f• l ^! /\<C. tZ a k,`.w ni-
(Street Name, Numbers, Community, Subdivision, No., lap Code)r� , S.2
3. OWNER: /19AV /3op t s�� ( mimies/ )
Address /, N'a nil VALE C Y Latitude/longitude source:❑GPS❑T phic map
(Street a Rode No.) (cheek box) -.
h,"oi,/ /V is ,Q %cSA DEPTH DRILLING LOG
City or Town State Zip Code From To FormatibaDex.iptiun
(�'S)- 92 st tits
Area code- Phone number/
4. DATE DRILLED L' `/' - 0
5. TOTAL DEPTH. / 3 7
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO
7. STATIC WATER LEVEL Below Top of Casing: IZ FT.
(Use 'sr if Above Top of Casing) ---
8. TOP OF CASING IS /- FT. Above Land Surface*
'Top of easing terminated at/or below land surface requires a
variance in accordance with ISA NCAC 2C .0118. /�
9. YIELD (gpm): / 1% t METHOD OF TEST / ?MI6s A
10. WATER ZONES (depth):
11. DISINFECTION: Type
12. CASING:
Fro / TDepth md O
Front To
From To
13. GROUT: Depth
From To .20
From To
14. SCREEN: Depth
From To
From To
15. SAND/GRAVEL PACK:
Diameter
Ft. tell
Ft.
Ft.
Topographic/Land setting /`
❑Ridge ❑Slope ❑Valley; oat
(check appropriate boot)
Latitude/longitude of well location
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.
27,4 A4t•asrte.
Material Method
Ft. ('r
Ft.
Diameter Slot Size Material
Ft in. in.
Ft. in in
Depth Size Material
From. To Ft.
From To Ft.
cP A� FOB
Fo �c3
CiPb
121,6
16. REMARKS.
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
0 /2 (2,,, ~ ri. 0 y
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-1 REV. 07/2001

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Nanual Resources - Division of Water Quality - Groundwater Section WELL CONTRACTOR (INDIVIDUAL) NAME (print) era b 6 y Ro1,19 Aid CERTIFICATION # '2 a /(y
WELL CONTRACTOR COMPANY NAME ✓? t; L ..O ✓ d 0s. i 6. L ! N tj
PHONE #OA66-2-L/)
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
I. WELL USE (Check Applicable Box): Residential ET 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: NMI' io+' County /Vitt PC' (: L
J� c#nssMr P/iI;VU CPT- #2G
(Street Name. Numbers, Community, Subdivision, Lot No, Zip Code)
3. OWNER:Coit70M izLr'T/Z 46Mt S
Address ,Qs. Rox 733 y
(Street or Route No.
D aKei.
City or Town State tip Code
(.LT)- 43i.. a�9)Si S.
4. DATERILLED / a J - O
Area code- Phone
5. TOTAL DEPTH 33
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO iI
7. STATIC WATER LEVEL Below Top of Casing: •6t' FT.
(Use "F" if Above Top of Casing)
8. TOP OF CASING IS 16" FT. Above Land Surface'
*Top of casing terminated Wor below land surface requires a
variance in accordance with ISA NCAC 2C .0118.
9. YIELD (gpm): .X C r METHOD OF TEST A ti i^
10. WATER ZONES (depth):
Topographic/Land setting
❑Ridge ❑Slope ❑Valley ❑Flat
(cbeck appropriate box)
Latitude/longitude of well location
(degreermtmud/aeemda)
Latitude/longitude source:❑GPS❑Topographic map
(check box)DEEMDRILLING LOG
From To Formation Description
on
11. DISINFECTION: Type h`T,9
12. CASING:
Depth Diameterri
pzerin r W d To lfl 0 Ft.
From To Ft.
From. To Ft.
13. GROUT: Depth
From To Ft.
From To Ft.
Material
Amount ) b
Wall Thickness
or Weight/Ft Material
17.i pkaSV c
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
Slot Size Material
_ in.
in.
SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common road names.
PG to
-to NcO-
cr) Oes 3
c'O f)
Op
16. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCir1) IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
, " re. ✓1-c-�+ 7-iG-u
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
301275
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Grotmdwater Section
CERTIFICATION #. 30
PRONE #(&*_L6"-GI%7
WELL CONTRACTOR (INDIVIDUAL) NAME (print) S'M C h $ /"nokAM,
WELL CONTRACTOR COMPANY NAME PO Lig Ai A
STATE WELL CONSTRUCTION PERMITS ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residentialo 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: t�
Nearest Town: /yF—ht 'Vic • Cotmty' 47dWeis I-
C EAdr,6'.0 tr,r $T
(Street Name, Numbers, Community, Subdivision, Lot No., bp Code)
3. OWNER: Ct"S% '? , t MI
Address Po 337Se
f9oM 14
(Street or Rome No.)
D .41)(6 . N e, _e1 c 1,
City or Town State Zip Code
(1n)- 41_1/2 - 9791..
Ares code- Phone number i ,
4. DATE DRILLED tc ` /) o
5. TOTAL DEPTH: 9 2
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO S.
7. STATIC WATER LEVEL Below Top of Casing: 3 0 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS /2 "" FT. Above Land Surface*
*Top of casing terminated atlor below land surface requires a
variance in accordance with 1SA NCAC 2C .0115.
9. YIELD (gpm): r2 rt METHOD OF TEST
10. WATER ZONES (depth):
`-f
!7/ t. 4 L.
11. DISINFECTION: Type {,lry
12. CASING:
Depth Diameter
From Tom— Ft. 4
From To Ft.
From To Ft.
13. GROUT: Depth
From. To 07 0. Ft.
Material
Topogrchic/Land setting
❑Ridge ESlope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrealmimroeslseronda)
Latitude/longitude source:❑GPS❑TopograPhic map
(check box)
pEPTII PRILLING,LOG
From To Formation Descnpu6n
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.
77 (v ,4- s ; rG -y P
C'
Method SCO j
ra d-iGh3_ i A co co
r O
a n?*i
Slot Size Material 2 0
in.
From To Ft.
14. SCREEN: Depth Diameter
From To Ft. in
From To Ft. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
16. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION ST ARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
"+(? "l. 10 .r- (t -/!g- 05,
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) J am e c Camp Tr CERTIFICATLON W 7 1 i 8
WELL CONTRACTOR COMPANY NAME ('amp' c Wc11 R Piimp ('n. Tnr PHONE #$7R) LS1_7322
STATE WELL CONSTRUCTION PERMIT,/ ASSOCIATED WQ PERMIT,/
(if applicable)
(if applicable)
300708
1. WELL USE (Check Applicable Box): Residential Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION.
Nearest Town: J✓(ft non Counry/1 ODDOeli
475-0 raYron j GP'o% /44
(Street Name, Numbers, Community, gubctimst n, Lot No., Zip Code)
3.OWNER: lie✓ eftter
Address t r
t1e 6o
tt
foile
(Burn qt. No.) /
City or Town State Zip Code
IX) -e'5,R-3b33
Area coda Phone number c�
4. DATE DRILLED D
5. TOTAL DEPTH: ADS //
6. DOES WELL REPLACE EXISTING WELL? YES l "NO 0
7. STATIC WATER LEVEL Below Top of Casing: 2'o 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 to accordance whb 15A NCAC 1C .0118.
9. YIELD (gpm): 5' METHOD OF TEST D is
10. WATER ZONES (depth): I `i 5
11. DISINFECTION: Type rh 1 n r i ma Amount 1 Ctlf
12. CASING: Wall Thiclmess
Depth Diameter or Weight/Ft. Material
From O 6 1 9
/4 °R21 PVC
From To Ft.
From To Ft.
Topo phic/Land setting
❑Ridge Slope ❑Valley ❑Flat
(cheek appropriate box)
Latitude/longitude of well location
(degreea/minutes/secands)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH 22RILLTN('r J Orr
From To Formation Description
n 65- r)a SAM
6 5- a a 5--PDn4b hdafied rock
O
QG
�*cmO
MO
LOCATION SKETCFj i 05 A
Show direction and distance in miles from at least i7 eny
two State Roads or County Roads, Include the road cJ
numbers and common road names.
pr'cr.
13. GROUT: Depth Material Method
From p To 20 FL Neat Cement Hand
From To Ft.
14. SCREEN: Depth Diameter Slot Size Material
Front To Ft. in. in.
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft. I+10.J,
16. REMARKS:
r e c
i
orwrr`i
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCO WANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY 0 THIS RECORD HAS SEEN PROVIDED TO THE WELL OWNER
(t-41L d II , C . /1-13 ---,Oil
SIGNATURE OF PERN 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. OW-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) Ja mes t.r Camp, Tr CERTIFICATION. 21 38
WELL CONTRACTOR COMPANY NAME ('amp' ¢ WP11 & Pr, mr rn Tnn PHONE H$7Al 45'_7122
STATE WELL CONSTRUCTION PERMIT. ASSOCIATED WQ PERMIT.
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential"Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION j�
Nearest Town: (P lM r, CA County /1// O i.o& /
Lct 4/7 / ddeA lake-6 fysarf✓;
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code Mm 3. OWNER: tila.me5 �'`I/ e,Y{iCh/
Address
` /g„zsl L oAn/e briar ('✓,
( i'(A.r"i0 ?T
eet orKIC
C- No.)
0/8A7'J
City or Town State Zip Code
Area code- Phone number "I
4. DATE DRILLED 7-A/7 D7"
5. TOTAL DEPTH: AC S
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO 6d"
7. STATIC WATER LEVEL Below Top of Casing: %D FT.
8. TOP OF CASING IS one "+" if Above Top of Casing)
1 FT. Above Land Surface.
'Top of casing terminated at/or below land surface requires a
variance in accordsgg a with 1SA NCAC 2C .0118.
9. YIELD (gpm): ,}G METHOD OF TEST & r
10. WATER ZONES (depth): caC c
11. DISINFECTION: Type Ohl nri nP
12. CASING:
Depth Diameter
From,_ To AC Ft. 6 1 / 4
From To Ft.
From To Ft.
13. GROUT: Depth Material Method
Frorn_o_To 20 Ft. Neat Cement Hand
From To Ft.
14. SCREEN: Depth Diameter Slot Size Material
Front To Ft. in. in.
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Dcpth Size Material
From To Ft.
From To Ft.
Amount
Wall Thickness
or Weight/Ft. Material
SDR21 PVC
16. REMARKS:
Topographic/Land setting
dge ❑Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
300705
(degrees/minutes/seconds)
Latitude/longitude source;❑GPS❑Topographic map
(check box)
DRILLING LOG
orm lion Description
.wT
DEPTH
From To
-ZO
�wS
i i scjt d at.ri i-,'
0
7pe cT
-C
_s
rn
rn
U e
LOCATION SKETCH can n
Show direction and distance in miles from at least -cD r
two State Roads or County Roads. Include the road
numbers and common road names.
r.3
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY 0THIS RECORD FILAASIEEN PROVIDED TO THE WELL OWNER
6
C' Yf'1Gti gr-1.3 "L)2/
SIGNATURE OF PERS. qN CONSTRUCTING4 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
SEA U S32..1
E`•

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division)of Water Quality - Groundwater Section �-t
WELL CONTRACTOR (INDIVIDUAL) NAME (print) QO l31Y W . PCB l 5 CERTIFICATION # aoa a
WELL CONTRACTOR COMPANY NAME Fe /YayottI J We I ( n!t/t/I/et1 C. PHONE 001 683 " frY9
STATE WELL CONSTRUCTION PERMIT# Day
ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential 12 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: 0 / el Font County fricngu)C N
mat/r)A) -�
(Street Name, Numbers, Community, Subdivision. Lot No., Zip Code)
3. OWNER: C l�qyj."V %I 1<
Address 2C5 Cellar 5—G-�e Oren" Rd.
1516d min.(Snttg nrYRoute No.) W7I1
ZS)-ry(o(oor 1 9(a56e Zip Code
Area code- Phone number
4. DATE DRILLED tell /Q y
5. TOTAL DEPTH: 303
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO
7. STATIC WATER LEVEL Below Top of Casing: 2D FT.
(Use `+" it Above Top of Casing)
S. TOP OF CASING IS / FT. Above Land Surface'
*'fop or casing germinated ator below land surface requires a
variance in accordance with ISA NCAC 2C .0118. p
9. YIELD (gpm) P.0 METHOD OF TEST)11/h,li p/tvv)
10. WATER ZONES (depth) 2 SDi
Topogra 'c/Land setting
❑Ridge Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude otw ll location
N 550 33 r74lzero:IC,6bS'
(degreeslminut� Dods)
Latitude/longitude source: I&GPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From To Formation Description
o - 3s Dint
ca - SS
.Sg ^3vS jy/rafA 1r'G
Mrk
cm
,- -ric1
. t rri
n ..-G
LOCATION SKETCH il 46O
11. DISINFECTION: Type 1,4.6it tS Amount _ $O7 Show direction and distance in miles from a>rbeast Op
12. CASING. Wall Thickness two State Roads or County Roads. Include ttt e road n
Depth Diamerer or Weieht/Ft. Material numbers and common road names. 7C —+�
From_O_To 5'5 Ft. (o.as 2/4,1XS PUC So/U1 p 90
From To Ft. � I - IVN
From To Ft
,may
. ^' ROGlQ
13. GROUT: Depth Material Method `�'f�I U�
From-�_To INS) Ft. tpncr'lc P60Piny Gad For{ NC
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.
l6. 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{5RE OF PERSON CONSTRUCTING THE WELL 1 DATTE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center- Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-1 REV. 07/2001

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Resources-//Divii�sion of jWater Quality - Grctmdwater Section _
WELL CONTRACTOR (INDIVIDUAL) NAME (pefm) ci-Ce-
WELL CONTP ACTOR COMPANY NAME — I GS . n..' Le) // J / in // /� PHONE cif) N a S7 -_S 5 — 9-
1 S .S
ainitSTATE WELL CONSTRUCTION PEHaIITY ASSOCIATED WQ
(iFapplicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential E MtmicipalRublic 0 Industrial ❑ Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection ❑ Omer 0 If Omer, List Use
2. WELL LCCATIO /� /
Nair To •l A-) . County %/%'f uJY /
(Seat Namt, Nuumbe�r, Ca iu mity, SubdiviM , fat No, tip Code)
3.OWNER K#L^Yt* ler e'l--d
Address // rd r 0 l�i yds-
-
(Sink or RoleN) _
r%1"/ e r— /C •C. �}" 7"7 y 1�
City or ay� n �Sri tip Code
�}'pbooe//"� Arca code- �br
4. DATE DRILLED /,-C) 47(
5. TOTAL DEPTH: / d a '
6. DOES WELL REPLACE EXISTING WELL' YES'❑ JJO 0
7. STATIC WATER LEVEL Below Top of Casing: o ? 4,--FT.
(Use "+" if Above Top Casing)
8. TOP OF CASING IS FT. Above Land Surface*
'Top of caslag terminated at/or blow land surface requires aMETHOD OF TEST /
el —
variance 1n accordance with ISA NCAC 2C .0118. n
9. YIELD (gpm): /�
10. WATER ZONES (depth):
gr
11. DISINFECTION: Type. ,Ie»- J / 7— Amount / /A
12. CASING: Wall Thickness
Depth 'Y` °`1 __Sift
From_ To Ft S
From J To Ft
From To
13. GROUT: Depth
From To ,2C'
From To
14. SCREEN: Depth
From To
From To
15. SAND/GRAVEL PACK:
Depth
From To
From To
Ft.
,Materal Method
Ft l 1, 11L7-7
Ft
Diameter Slot Size Material
Ft. in. in.
Ft. in. in.
Size
Ft.
Material
Ft.
Topoglaphic/Land setting
❑Ridge ❑Slope Malley 0Flat
(meet approptiaee boot)
Latitude/longitude of well location
3S039 bzzr (2 62. SY4 •
(degreev secooS)
Latitude/longitude source:❑GPS❑Topographic map __----
(check box)
DEPTR pRILLING LOQ
From To Formation Description ,fj/�L�
/e Z///4N
07
r
'2A S /Z72 2 f t:
ST- OZ.ss'4r
0
• o
- Z`
s
LOCATION SKETCH y
Show direction and distance in miles from at lea$a �?
two State Roads or County Roads. Include the roes" :t
numbers and common road names. cJ i
yo
_l� Ir IA
tr 10k
VI
16. REMARKS:
1 DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCED IN ACCORDANCE WITH ISA NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF TM_ RECORD HAS BEEN PROVIDED TO THE WELL OWNER
)471
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center -Raleigh, NG.
176°°-1636 Phone No. [phone], within 30 days. L.G .-t iRLV Q7/2oQl

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment anr
Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (prim)d lit D -.- cn IFICAnoN �r 3 ?- S_WELL CONTRACTOR COMPANY NAME atiI- N i ),aIKAi i! / �— PRONE r yt%d t G5l -. 23.. S
STATE WELL CONSTRUCTION Prawn ASSOCIATED WQ PLRMTIY _... _
(if applicable) (if applicable)
Z-o9Z
300900
1. WELL USE (Check Applicable Box): Residential «i tmicipa1/Public ❑ Industrial ❑ Agricultural ❑
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other 0 If Other, List Use
2. WELL LOCATION;
Town:
`5l /i 5 s
(Street Name, Numbers, Community, Subdiviooci Lot No., Zip Code)
3. OWNER:• �/\ OS /J Sit'' ,j-
Address T ? fl- y fp Sd Ae ••S
f1-fic e, 2-
(sae`rr? 2s DEPTH
i� From To
City or Town Stale tip Code
(PS')- $ ,� 9- 3 6v3 0
Area code Phone number
4. DATE DRILLED 7 9-a -v
5. TOTAL DEPTH: / 510 'se
6. DOES WELL REPLACE EXISTING WELL? YES NO i
7. STATIC WATER LEVEL Below Top of Casing: - 3 FT.
` (Use "+" if Above Top of Casing)
8. TOP OF CASING IS /- FT. Above Land Surface*
`Top of caring terminated atfor below land surface require ■
verlance In accordance with ISA NCAC 2C .0118. I
9. YIELD (gpm): j0 METHOD OF TEST 1.3A i /4 /✓
10. WATER ZONES (depth):
-jbc 37.10er
04.3T4i
,% Topographic/Land setting
ie/ Midge ❑Slope ❑Valley ❑Flat
(Merit appropriate boa)
Latitude/I • of well location
35039.Z$ 81eo4.3% I
(derma/ semods)
Latitude/longitude ❑GPS❑Topographic map
(cheek box) -
DRILLING LOG
Formation Description
LOCATION SKETCH TYPenAmmult11. DISINFECTION: TypeAmount Show direction and distance in miles from at least
12. CASING: Wall Thickness
From / C0
From
From
/ or two State Roads or County Roads. Include the road
e tl / Ft / ght/Ft M al numbers and common road names.
ToTo Ft. �j �'(
To Ft.
13. GROUT: Depth Method
From To '�3 Ft. ('C/,!i'Y/
From To Ft.
Depth Diameter Slot Size Material
To Ft. in. in.
To Ft. in in.
15. SAND/GRAVEL PACK
Depth Size Material
To Ft.
To Ft.
14. SCREEN:
From_
From
From,
From
16. REMARKS:
I DO HEREBY CERTIFY THAT TH'S WELL WAS CONSTRUCTED IN ACCORDANCE WITH I5A NCAC 2C, WELL
CONSTRUCTIOJ7 STANDARDS, A 4D 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 Divisioo of Water Quality, Groundwater Section, 1636 Mail Service Center -Raleigh, NC
2/690-1636 Phone No. (919) 1133-32 ' 1. within 30 days. GW-i REV. 07l2001

North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
1636 Mail Service Center - Raleigh, N.C. 27699-1636 - Phone [phone]
WELL CONSTRUCTION RECORD
304143
WELL CONTRACTOR: Dewey Wright Well Pump Co., Inc.
WELL CONTRACTOR CERTIFICATION #• 2797
040340 STATE WELL CONSTRUCTION PERMIT#. Jerry Wilson
1. WELL USE (Check Applicable Box): Residential X Municipal I t Industrial ❑
Agricultural ❑ Monitoring ❑
Recovery Heat Pump Water Injection E Other ❑ If Other, List Use•
2. WELL LOCATION: (Show sketch of the location below)
Nearest Town: LINVILLE County MCDOWFLL
V 1LDFRNESame and S DR_ OFF bers,Community, OF division andtF ot NHWY 221
(Roa3. OWNER ALFRED VELLETRI
Address 981 SUNRISE DR. .
GARNER (Street or Route No
NC 27529
DRILLING LOG
From
0
DEPTH
To Formation Description
5 DIRT SHALE
5 340 SHALE
City or Town State
Zip Code
4. DATE DRILLED 9/23/2004
5. TOTAL DEPTH 845
6. CUTTINGS COLLECTED YES ❑ NO
7. DOES WELL REPLACE EXISTING WELL? YES ❑ NO
8. STATIC WATER LEVEL Below Top of Casing: 300 FT
(Use "+' if Above Top of Casing)
9. TOP OF CASING IS 1 FT Above Land Surface*
*Top of casing terminated at/or below land surface requires a variance in accor-
dance with 15A NCAC 2C.0118
10. YIELD (gpm)• 3 METHOD OF TEST Air
11. WATER ZONES (depth): 1.00 gpm340-341 2.00ppm 816-817
0.00 gpm 0.00aom
12. CHLORINATION: Type HTH Amount 70 If additional space is needed use back of form
340 341 SHALE
341 616 SHALE GRAY GRANITE
816 617 QUARTZ
617 865 GRANITE QUARTZ
13. CASING:
X
Wall Thickness
Depth Diameter or Weight/Ft. Material
ltrom 0 To 21 Ft 81/8 .350 PVC
From To Ft
From To Ft
14. GROUT:
Depth Material Method
From 0 To 20 Ft Cement Gravity Flow
From To Ft
15. SCREEN:
Depth Diameter Slot Size
From To Ft in in
From To Ft in in
From To Ft in in
16. SAND/GRAVEL PACK: Q
Depth Size Material .Piet`.
From To Ft l�L! •
From To Ft
LOCATION SKETCH
(Show direction and distance from at least two State
Roads, or other map reference points)_ >tr'
17. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RECORD BPROVIDED TO
r
FOR OFFICE USE ONLY
-
C7
ATURE OF PERSON CONSTRUCTING THE WELL DATE
Submit original to Division of Water Quality, Groundwater Section within 30 days
GW-1 REV. 12/99
Quad No:

North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
1636 Mail Service Center - Raleigh, N.C. 27699-1636 - Phone [phone]
304451
WELL CONSTRUCTION RECORD WELL CONTRACTOR: Dewey Wright Well Pump Co Inc
WELL CONTRACTOR CERTIFICATION #• 2791
STATE WELL CONSTRUCTION PERMIT#• Albert Slate
040513
1. WELL USE (Check Applicable Box): Residential
Recovery ❑ Heat Pump Water Injection
2. WELL LOCATION: (Show sketch of the location below)
Nearest Town:
MORGATITON
3. OWNER PF,NG YANG
Address 'Fr. FREEPsQ�e'T tcdaiffg.l.
city or TPrrWTON
Stale
Municipal ❑ Industrial ❑ Agricultural I I Monitoring ❑
Other ❑ If Other, List Use-
1255 H`NY 70 If :EST
NC 2`gkade
DRILLING LOG DEPTH
From To Formation Description
0 66 DIRT
66 666 GRANITE
565 566 CREVICE
4. DATE DRILLED 10ABt2004 666 600 CRANITE
5. TOTAL DEPTH 600
6. CUTTINGS COLLECTED YES ❑ NO I xI
7. DOES WELL REPLACE EXISTING WELL? YES ❑ NO n
8. STATIC WATER LEVEL Below Top of Casing: 70 FT
(Use "+" if Above Top of Casing)
9. TOP OF CASING IS 1 FT Above Land Surface*
*Top of casing terminated at/or below land surface requires a variance in accor-
dance with 15A NCAC 2C.0118
10. YIELD (gpm): 10 METHOD OF TEST Air
11. WATER ZONES (depth ):10 00 ppmM59-_556 ❑ 00ppm
n nn ppm n 0npftrn
12. CHLORINATION: Type I-1TH Amount 1O0
13. CASING:
Depth
•-rom Q To _ 74Ft
From To Ft
From To Ft
14. GROUT:
Depth
From n To _ 20 Ft rement
From To Ft
Wall Thickness
Diameter or Weight/Ft. Material
61/8 .350 PVC
15. SCREEN
Material
Depth Diameter Slot Size
From To Ft in in 4
From To Ft in in
From To Ft in in n_'.
16. SAND/GRAVEL PACK: 1�
Depth Size Material lit
From To Ft
From To Ft
LOCATION SKETCH
(Show direction and distance from at least two State
Roads, or (net reference points)
If additional space is needed use back of form
its
Pflt fox 3
17. REMARKS.
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WE
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL • NER.
do
A� y�µd�e
.
FOR OFFICE USE ONLY
Quad No:
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
Submit original to Division of Water Quality, Groundwater Section within 30 days GW-1 REV. 12/99

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Na
WELL CONTRACTOR (INDIVIDUAL) N
WELL CONTRACTOR COMPANY
STATE WELL CONSTRUCTION PERMIT',
(if applicable)
Resources - Divisionof Water Quality - Groundwater Section
�j
(Prier -Kfl L CERTIFICATIO�N AOIa 2
11219e ,-V_ PHONE 0 ift40-l�?/!—�wa
ASSOCIATED WQ PERMIT', y/At
41
(if applicable)
1. WELL USE (Check Applicable Box): Residential 131' 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: JJ //
Nearest Town: /01-10d County fco o W E`/
W 2/ S /Ake_ tti9i 1 es Rd
(Street Name, Number, Community, Subdivision, Lot No, Tip Code)
3. OWNER:tA9l1I;AAiYi Intel/
Address y 2LS /Ake CAst1 s Rd
(Street or Rare No.)
Ju tP f /) N G 2 Fs 7 5' Z-
City or Town Stale Zip Code
(_}
Area code- Phone number
4. DATE DRILLED 9 ` 2 7- O V
5. TOTAL DEPTH: Z N S`
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO E
7. STATIC WATER LEVEL Below Top of Casing: / 7 FT.
(Use +" if Above Top of Casing)
8. TOP OF CASING IS /4 r FT. Above Land Surface*
'Top of casing terminated at/er below land surface requires a
variance V accordant with ISA NCAC 2C .0118. /
9. YIELD (gpm): / 5' METHOD OF TEST // nit e
10. WATER. ZONES (depth): / 7S *
11. DISINFECTION: Type C,/(/./%
12. CASING:
From 9 TDepth
o / Zo Ft�
From To Ft.
From To Ft
Amount RIP car —
Wall Thickness
or Weight/Ft Material
SDR2( /PuC.
13. GROUT: Depth Material
From t� Too3O Ft�e41GPe�t'
From To Ft
14. SCREEN: Depth Diameter Slot Size Material
FroTo Ft. in. in.
From SAND/G VEL To Ft in. in.
15. PACK
Depth Size Material
From 1 To Ft.
From To Ft.
16. REMARKS:
T�c/Land setting
[Midge 0Valley ❑Flat
(check appropriate boz)
Latitude/longitude of well location
(degemhniwees/sxoods)
Latitude/longitude source:❑GPS❑Topogtaphic map
(check box)
DEPTH, DRILLING LOG
From To Formation Description
roil
LOCATION SKETCH
Show direction and distance in miles from at lessb
two State Roads or County Roads. Include the rS P:
numbers and common road names. e-,
I DO HEREB CERTIFY THAT THIS WELL WAS NSTRUCPED IN ACCORDANCE WITH ISA NCAC 2C, WELL
CONSTRWC ON STANDARDS, TKAT A PY OF T!j►6 RECORD HAS BEEN PROVIDED TO THE WELL OWNER
7-z? ©y
SIGNA OF P N CONSTRUCTING THE WELL DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-1 REV. 07/2001

G
WELL CONSTRUCTION RECORD
North Carolina - Department of Environutwut and Natural Resources - Division o Water Quality - Ciruundwater Secuon
WELL CONTRACTOR (INDIVIDUAL) NAME (print) j4/len C. I�J%t-r-�,/�._._., CERI'IFdCAA�TION(C/ (1�y
WELL CONTRACTOR COMPANY NAMbif✓tathel-1eC t cs-- Weir PRONE # jari .b,T'r-07
STATE WELL CONSTRUCTION PERMIT# /CJ/� ASSOCIATED WQiPtERMI- T#
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential IB/Municipal/Public 0 Industrial 0 Agricultural. G
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION:)
Nearest Town: ofd Tarr
CC l r te51aN
(Street Name, Number, Community, Subdivision, Lot No., rep Code)
3. OWNER: i%.e,., NC/bO
Address"#" rG/ clies vie
County f/yr44#7
Oa go Sttcct r Route No.) 76 2.ry 2$
City or Town State Zip Code
( )-
Ala code- Phone number
4. DATE DRILLED 1-3 'ohs
5. TOTAL DEPTH: 5" 5f3— /
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO LT
7. STATIC WATER LEVEL Below Top of Casing: engirt
e se (Use"+" if Above Top of Casing)
d. TOP OF CASING IS / O FT. Above Land Surface'
'Top of wing terminated ajar below land surface requires a
variance in accordance with ISA NCAC 2C .011E
9. YIELD (gpm): % S METHOD OF TEST / / me d
10. WATER ZONES (depth): %7200tl- 5j'OD
11. DISINFECTION: Type.,H, H. Amount /0 O T'
12. CASING: Wall Thickness
Depth - P� or w-Z / PI/ Matrial
t'
FroTo Ft S'{]R Z
From To Ft
From To Ft.
Depth Matctial M ad t �'�.
To ? Q._. Ft1'eAenit �1_ 1or. Mt Cc
13. GROUT:
From Q
From To Ft.
14. SCREEN: Depth Diameter Slot Size
From T - Ft. in. in.
From_ o Ft. in. in.
15. SAND/G VEL PACK.
th Size Material
Material
From To Ft.
From To Ft.
16. REMARKS.
A opographic/ and setting
(midge 0Slope ❑Valley ❑Flat
(check appropriate boa)
Latitude/longitude of well location
(degtee/mimresisecoo6)
Latitude/longitude source:❑GPS❑Topograpluc map
(deck box!
DRILLING LOG
Formation Description
DEPTH
From To
-o
) )CATION SKETCH
Show direction and distance in miles from at st
two State Roads or County Roads. Include the road
numbers and common road names.
r" , G
1 DO HEREBY CER THAT THIS WELL WAS CONS 1 R X.1ED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONS"IRUCTIOIJ ANDARDS, AND j T COPY a, THIS REC a ' a HAS BEEN PROVIDED TO THE WEI i OWNER,
0
SI A OF P i' ON C4%'•' ' UCTING THE WELL
DATE
- a C.)
r <i.
a7
CO
9
Submit the original to the Division of Water Quality, rouodwater Section, 1636 Mail Service Center - Raleigh, NC
GW-1 REV. 07/200
27699-1636 Phone No. [phone], within 30 days.

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) Jam'S UT Capp, 7r CERTIFICATION it 711E
WELL CONTRACTOR COMPANY NAME ramps G Wa11 & Pnmp CQ Tnr PHONE #$7R) 4S1-7322
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable) s (if applicable)
1. WELL USE (Check Applicable Box): Residentialr Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
WELL LOCATION:
Nearest Town. u County tV1 e 1-11-1:) Whit
(Street Name, Numbers, Commu tiry, Subdivision.iut No., Zip Code)
3. OW es
Address 1.
,3 )1 ar �r fi: n#Dr/Pt!
(� (Str tt or Route No.) yetI �Y0.5ant S c acl b 4
City or Town State Zip Code
Area code- Phone numb
4. DATE DRILLED
Topographic/Land setting
❑Ridge ❑Slope tatallcy ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DRILLING LOG
�grmatio escription
DEPTH
From
n
To
it0
5. TOTAL DEPTH: C) 5 yy + O S
6. DOES WELL REPLACE EXISTING WELL? YEStpNO L?
7. STATIC WATER LEVEL Below Top of Casing: (? FL
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS 1 FT. Above Land Surface*
• *Top of cuing terminated at/or below land surface requires a
-variance In accordwa with 15A NCAC 2C .0118.
9. YIELD (gpm): 1 Q' METH OF TEST a i r
10. WATER ZONES (depth):
11. DISINFECTION: Type r h 1 n r i n a Amount CA 2—e
12. CASING: Wall Thickness
Depth Diameter orWeight/Ft. Material
From O To I I U• 6 1/ 4 a n1;.21 PVC
From To Ft.
From To Ft.
13. GROUT: Depth Material
From_0___ To 2 0 Ft.
From To Ft.
14. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in.
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
Neat
Cement
Method
H.arlt3
LOCATION SKETCII
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common road names.
d e`'
o ri`=
n
-r' 0
N
W tits
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
16. REMARKS:
NATURE OF P ON CONSTRLXTING THE WELL
DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mall Service Center -Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-1 REV. 07/2001

303849
WELL CONSTRUCTION RECORD
North Carolina — Department of Environment And Natural Resources — Division of Water Quality — Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) ROBIN MCNEELY CERTIFICATION # 2567
WELL CONTRACTOR COMPANY NAME PITTMAN WELL BORING, LLC PHONE # [phone]
STATE WELL CONSTRUCTION PERMIT # _ ASSOCIATED WQ PERMIT #
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential ® Municipal/Public ❑ Industrial 0 Agricultural ❑
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use
2. WELL LOCATION:
Nearest Town: MARION County MCDOWL
VEIN MTN. RD.
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: GUY MOORE
Address VEIN MTN. RD.
(Street or Route No.)
MARION NC 28752
City or Town State Zip Code
(828) — 287-5728
Area Code Phone number
4. DATE DRILLED 10/07/04
5. TOTAL DEPTH: 56
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO
7. STATIC WATER LEVEL Below Top of Casing: 36 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 STEEL TAPE
10. WATER ZONES (depth):
11. DISINFECTION: Type CHLORYTE Amount 9.2
12. CASING: Wall Thickness
Depth Diameter or Weight/FL Material
From 0 To 56 Ft. 24" CEMENT
From _ To _ Ft. _
From _To_Ft.
_
13. GROUT: Depth Material
From 0 To 20 Ft. CEMENT
From _ To _ Ft.
14.SCREEN: Depth Diameter
From _To_Ft.
_
From _To_Ft.
_
15. SAND/GRAVEL PACK:
Depth Size
From 36 To 56 Ft. 78M
From_ To_Ft. _
16. REMARKS:
Method
POURED
Slot Size Material
in. in.
in. in.
Material
GRAVEL
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. #226 N. FROM POLKVILLE. LEFT ON
VEIN MTN. RD. 3.8 MILES ON LEFT. ca r
7,0
"'Or' _.
I Q'
•
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
raj; / C � 7c�XA.SL/ /0 - 7 - G /
GNATURE OF ON C NSTRUCTING THE BLL 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(J�- Division of Water Quality - Groundwater Sec noi. y
WELL CONTRACTOR (INDIVIDUAL) NAME (print) plle_s G khoa s T!l CERTIFICATION N 2_?a(
WELL CONTRACTOR COMPANY NAM OC110 --Tee (jk.1( DP: I I4IIG PHONE # (�R)��"O C;
STATE WELL CONSTRUCTION PERMIT* ASSOCIATED WQ PERMIT*
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential 0 Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 if Other, List Use
2. WELL LOCATION: A
N tTown: 4 / i
County1
(Street Name, Numbers, Community, Subdivision, lot No., Zip Code)
3. O WNER: 8,0, 4w
Address K�
(s� or Route No.)
Did oir ( 1%)
City or Town State zip code
Area code- Pbooc tuber
4. DATE DR1TTED/Oa21' Or
5. TOTAL DEPTH: (p0
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO FY-
7. STATIC WATER LEVEL Below Top of Casing: 35O FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS `J FT. Above Land Surface'
'Top of cuing terminated attar below hand surface requires a
variance In accordance with ISA NCAC 2C .0118. /
9. YIELD (gpm): / METHOD OF TEST 1 r Nt flf
10. WATER ZONES (depth):
r
Topographic/Land setting 7
❑Ridge ❑Slope ❑Valley Flat
(check appropriate box)
Latitude/longitude of well location
(deatemlminuses seconds)
Latitude/longitude source:❑GPS❑Topographic nap
(cbeck box)
DRILLING LOG
Formation Description
DEPTH
From To
11. DISINFECTION: Type GC.N.
12. CASING:
From To GPO
From To
From To
13. GROUT:: ,i Depth
FromSt_ To 20
From
14. SCREEN:
From
From
15. SAND/G
Diameter
To Ft. in.
To R. in..
VEL PACK
Depth Size
From / To Ft.
From To Ft.
16. REMARKS:
Wall Thickness
Diameter or Wei /p(Ft Material
5.0k1
roc
FL
Ft
Material Mjthod
Ft1O GC C W f i /N()C
To Ft.
Depth, Slot Size Material
in.
in.
Material
Amount !O 02 Show direction and distance in miles from at least
two State up ty
numbers and common mad names.
LOCATION SKETCH
Road or CoRoads. Includthe road
A°
I DO HEREBY CERTIFY THA
CONSTRUCTION STAND
THIS
WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mali Service Center - Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-I REV. 0712001

WELL CONSTRUCTION RECORD
North Carolina - Department of Envirormtent and tural Resources - Division of W r Quality - Groundwater Sec no.:
WELL. CONTRACTOR (INDIVIDUAL) NAME a (p�rin�t)...onn f e RA CERTIFICATION/ 7777
WELL CONTRACTOR COMPANY NA SIIC 7014'TtC 1a1Ca tOP:I R el y PHONE silikf(o49-OYya
STATE WELL CONSTRUCTION PERMIT/
._ASSOCIATED WQ PERI%
(if aplicableL (if applicable)
WELL USE (Check Applicable Box): Residential 3Municipal/Public ❑ Industrial 0 Agricultural o
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2, WEL1 LOCATION:
Nearest Town:
int 27
(Street Name. Num
Count
critear
Cocnmlcmity, Subdivision, Lot No.,Zip Cock)
OWNER: es
/
Address v 27 Q%-[2ETZ��G�L /eB5f` /.i/2
gh o (Street L e No_) 2l'7( ✓ Z.
City or Town State Zip Code
l )-
A{ea code- Phone number
4. DATE DRILLED /v"r/Z—'oitt
5. TOTAL DEPTH: 3t f
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO Lr
7. STATIC WATER LEVEL Below Top of Casing: (od FT.
r (Use "t' if Above Top of Casing)
3. TOP OF CASING IS /i.5 FT. Above Land Surface`
flop of cashes terminated attar below land surface requires a
varlaace 1a accordance eW 158 NCAC 2C MIS, .—^y
9. YIELD (pm): METHOD OF TEST / /h'12
10. WATER ZONES (depth):
Topo c/Land setting
DRidge nitSlope OValley ❑Flat
(check appropriate box)
Latitudellongitude of well location
(depeahninarrs/aemada)
Latitude/longitude source:OGPSOTopographic map
(chock box)
DRILLING LOG
Formation Description
DEPTH
From To
DISINFECTION: Type cgs /)f
12. CASING:
Depth trine/ From (P ToLZD Ft
From„_,
Front___
13. GROUT:
From pf
From
,OCATION SKETCH[
Amount /D p z Show direction and distance in miles from at least
Wall Thirkeect two State Roads or County Roads. Include the road
Sor AW©�, t PMaterial numbers and common road names_
Ta F Ft_
To Ft
Depth Material
To 2Q Ft/ O/lC/rlo f'.0.
To Ft
14. SCREEN: Depth Diameter
From To Ft. in.
From To Ft._ _in.
15 SAND/ RAVEL PACK:
Dent1
s
16. REMARKS:
S�; s
Slot Size Material
____ in. ______
iR;sr-:;y
l DO HEREBY CERTIFY THAI' THIS WEI I WAS CO. STRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONS "' ION STANDARDS, AND,T+[iy/d�T A C+' /OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER.
ON CONSTRUCTING THE WET I
1p /Z
DATE
ty, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-.I REV. 07;2001

303323
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources`- Division of Water Quality - Groundwater Section�°IS°
WELL CONTRACTOR (INDIVIDUAL) NAME (print) l]p7Q1 t)tL$t/C CERTIFICATION J
C
riewr(f(i ie On �.e PHONE It ( )
WELL CONTRACTOR COMPANY NAME
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential Q'Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION: sA ^
Nearest Town: �"'s' County i,IOZG
Oeearl Sr. in
(Street Name. Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: �ld/M..t� ran
Address
(Street or Route No.)
Ytd "Cris N L . f8 7St
_City or Town State Zip Code
N_y17.
Area code- Phone number -
4. DATE DRILLED - /11-2. (,O Li
5. TOTAL DEPTH- 2 gj 0
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO
7. STATIC WATER LEVEL Below Top of Casing: 400 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS / FT. Above Land Surfaces
*Top of casing terminated at/or below land surface requires a
variance in accordance with ISA NCAC 2C .0118.
9. YIELD (gpm): 7 G METHOD OF TEST it' PC
10. WATER ZONES (depth): 2.e 6D 2r•/6
11. DISINFECTION: Typt/ Cridve
12. CASING:
Depth Diameter
From 6 To $7 Ft. O
Q
From 6 7 To /CO Ft
From /V? To / VT Ft
13. GROUT: Depth
From To Ft.
From_Q_ To 72 Ft.
14. SCREEN: Depth Dia e_
From To Ft. in. in. ��I(
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From
Amount Eke 73%
Wall Thickness
or Weight/Ft.
9O
O
erial ethod
16. REMARKS:
To Ft.
P°Meta
Slot Size Material
pographic/Land setting
Age ❑Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From To Formation Description
D-4o 4i2f
4/O- Ilit h,/Cd,eidc
/42- 2PCJ (S,o i41_
LOCATION SKETCH
Show direction and distance in miles from at leas*
two State Roads or County Roads. Inclt dig the m@
numbers and common road names. r =+tit
0 rn�
+ p t N �o 7
`'i O rrcorrict
2
N -
mG
n
a
4.1
O
t37
1 DO HEREBY CERTIFY TH
CONSTRUCTION STAND
HIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
AND THAT A COPY OFHAS BEEN PROVIDED TO THE WELL OWNER
SIGNAT
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

303322
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources'}�- Divisionirof Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME
(print) ail y .) LD�.SI-Icix CERTIFICATION* /Xi a j/(�
WELLCONTRACTOR COMPANY NAME JoJ'fic ilk tr -'tc+% PHONE IIff: 72ysS/Q
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WO PERMIT#
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential E Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION: ,, (J
Nearest Town: & C 6 Fue-± county H A -Do LAYA-
P1-3 r CCte /2A
(Street Name. Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: Sd/9N FOre.cdea
Address Spl3 f,',-1) -C Cc, .P_ (2
(Street or Route No.)
/xb/ trd- NC -9"?€.;2
City or Town State Zip Code
eZ )- G(n2- 7278
Area code- Phone number
4. DATE DRILLED etUG Z
5. TOTAL DEPTH: (/Uo
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO Cr
Topographic/Land setting
GRidge ❑Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/tongitude source:❑GPS❑Topographic trap
(check box)
DEPTH DRILLING LOG
From To Formation Description
-2o 4,4 e
7. STATIC WATER LEVEL Below Top of Casing: ,./C FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING 1S / FT. Above Land Surfaces
•Top of casing terminated at/or below land surface requires a
variance in accordance with 15A NCAC 2C .0I18.
9. YIELD (gpm): / METHOD OF TEST /¢/ %L
10. WATER ZONES (depth): / fret -2-O°
11. DISINFECTION: Type et(}IC;Ne-
12. CASING:
Depth
From To Ft.
From c To 5Ci Ft.
From . i c.' To th C Ft.
13. GROUT: Depth
From To Ft.
From 0 To Ft. 7---rag.
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:
Diameter
4//i
Material
Amount 8 0Z7'9,
Wall Thickness
or Weight/Ft.
Material
t/o n'C
/RP Ghod t1/
Method
lie. SC
mi 9
Slot Size Material
in.
in.
Material
Ade?
4'00 W'
(je72/4wt.L[�y��CJ((V
it
1(CVv
LOCATION SKETCH q
Show direction and distance in miles from St, east el
two State Roads or County Roads. Include tgroad ,G
numbers and common road names. -
--4 -0 0
SV 0r
O -4
— �p
ti
r? DO
r
"4 if)
n
be,
o nZ
DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS. AND T A COPY OF THIS RECO ' -IDED TO THE WELL OWNER
C-
CL"2
SIGN T E OF PERSON STRUCTING THE WELL DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center -Raleigh, NC
27699-1636 Phone No. 1919) 733-3221, within 30 days. GW-1 REV. 07/2001

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section O
WELL CONTRACTOR (INDIVIDUAL)NAME <DIVIDUAL)NAME (prim) I /9' SOS4, -i. LaR7uICAT1ONa q?/S
WELL CONTRACTOR COMPANY NAME 31,S4 I CC UJ r;CL_ by jt.0 (V 5 PIIONn it (84)i 7c5/--VSPS-'
STATE WELL CONSTRUCTION PERMITS ASSOCIATED WQ PERMITt
(if 4.licable) (if liable)
303320
1. WELL USE (Check Applicable Box): Residential EK-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: 01 A/t 061 County Ai 1ucxt
.3 ch 5 P a;,rR p.^
(Stan Name. Numbben,"Cuommnity, Subdivision, Lot No.,rTip Code)
3. OWNER: P• - I Li
Address 347 S6/on.,+Or
(Sired er Rome NO
e-t .
City or Town State
( )- c, 54 • -3-7.1Y
ATM code- Phase number
4. DATE DRILLED 16 41--Oc
5. TOTAL DEPTH: 2 o
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO GI/
7. STATIC WATER LEVEL Below Top of Casing: 9° Fr.
(Use "+" if Above Tap of Claim)
8. TOP OF CASING IS / FT. Above Land Surface*
'Top at easing terouued nS blew Mud wen rqares
variance M atcwrdaare with ISA NCAC 2C A11L
9. YIELD (gpm): /0 METHOD OF TEST /102
10. WATER ZONES (depth): zip 9PH 67 4- ?t,
Zip Code
Topographic/Land setting
°Ridge 6 lope °Valley °Flat
(cheek appropriate box)
Latitude/longitude of well location
Latitude/longitude source:OGPSOTopographic map
(ciao heal
DRILLING L(N't
Formation Description
DEPTH
From To
0- 6S
g5'- 90
C 'J - Zo ti
a: ti f
D, eni f tr .tIc
lac) - z 20 Q -c✓
11. DISINFECTION: Type el.OilI NG Amount f3 c>Z C7)L
Wall Thin
Depth Diameter or WeigbYFt Material
To
To /e2 FL y Pre
re
To jc4 Ft_ Cc Y >Pe Q'A/c`
Depth Materiel Method
To Ft
12. CASING:
From
From 0
From AZ
13. GROUT:
From
From 0 To 2S" FL
14_ SCREEN: Depth
From To Ft in.
From To Ft in.
15. SAND/GRAVEL PACK:
Depth Size Material
To FL
To Ft.
From
From
Pe/ /wire
Slot Size Material
in.
in.
92ofIto (f-Z44de 4cn.2Z'
LOCATION SKETCH
Show direction and distance in miles frorlmt least Gr�*t
two State Roads or County Roads. Mel ude%e road nrt
numbers and common road names.
1614
16. REMARKS: "/51
�1
Al
1 DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED 1N ACCORDANCE WITH 15A NCAC 2C, Wes.
CONSTRUCTION STANDARDS, A AT A COPY OF THIS RD HAS BEEN PROVIDED TO THE WELL OWNER- -
SIGNATURE
N 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 3 0 3 314
North Carolina - Department of Enveomrent and Natural Rtsoisces - Division of Water Quality - Groundwater Section
WELL CONTRACTOR(NDMDUAL)NAME (pht) C74r\t *Z-1 i c(t. cERnstcwnoNr2IC0
WELL CONTRACTOR COMPANY NAME l J S j i t c lW r 1 ( P' • t v INc7 PHoNE r( ) 724 -einia
STATE WELL CONSTRUCTION PERMITS ASSOCIATED WO PERMITS
Of aoplicable) Of ap�liah)e)
1. WELL USE (check Applicable Box): Residential" Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Otter 0 If Other List Use
2. WELL LOCATION: p
Nernst Town: fl( Per .1--County �5` ''mac LL
£lo`,t...z-r.e C1,, cc 1n IR?-
(Sum Name.. Numbers. �Cammaoa& N r, +Asian. Lei n. Titer)
`-'1WnQ4_0
3. OWNER: 4 it xtvie /Z MegmesTeakateshomada
Address I O I 1 E ... C 9 ...� .-- fed latitude longitude sourcceGPSQfapographic map
(Saco or Rowe Nal (dredcbaa)
Oct) rivr-Town We 2ip0*
DEPTH DRILLING LOO
City «Toad SORB tide From To FotDOatim Description
(da)- L(r83-ZD)f
W.' 95- 0140---5/4NL
Am code- Phone amber
4. DATE DRILLED 7-2 ' - c'ei
5. TOTAL DEPTH: 5t> j %i. 5D•(5 ceveAt7VV,7
6. DOES WELL REPLACE EXISTING) WELL? YES rNNO 0
7. STATIC WATER LEVEL Below Top of Casing / 5 ' FT.
(Ua "+" if Above Tap of clay)
8. TOP OF CASING 1S I FT. Above Lad Surface`
"r.pdeenz termirtied *MgrWar ten seta .M•i s• .n.11
varia•rx M aceadaaa MIR l3A NCAC 2C Silo. t,
9. YIELD (gpm): _._ METHOD OF TEST )> 1 12 't a4
10. WATER ZONES (depth): j yg ii C"r .2 5T) Fa c,
. ` e CI Sv LOCATION SKETCH o �>m
I I. DISINFECTION: TypeC C"i r t i� -e Amount t) C.)2- Show direction and distance in miles from at jsast
rrI12. CASING: Well Thita®ess two Slate Roads or Canty Roads. Include taroad o 0
t» Drumm or wnamopt taeteri o aumbea and common road canes. toe Z
From To Ft. in co
0 rn
Fromm — To 9Fi, - 510 fPV `-- at a
i 15b ()ace'
Method
Topographiotapd setting
❑Ridge 0Slope CIFlat
(cledc approprars box)
Latitude/longitude of well location
From__To te Ft. t• V.(
13. GROUT: Depth Material
From To Ft ,r
FL Y-y/a / PV/4/11 r
Doaetere' Stet Sae Mania)
Front To He
14. SCREEN: Depth
From To in.
From To Ft in ice.
15. SAND/GRAVEL PACK
Depth Site Material
From To Ft
From To Ft
16. REMARKS:
o CA
(7© W'
£! blNrLe„.
e ku rc l,.
) DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, A$D THAT A a! OF THIS ' e' s RD HAS BEEN PROVIDED TO THE WELL OWNER
CONSTRUCTING THE WELL DATE
Submit the original to the Divisioa of Water Quality, Grouadwatn Section,1636 Mae Service Ceder -Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-1 REV. 07/2001.

WELL CONSTRUCTION RECORD
303313
North Carolina - Department of Environment and Natural Resources
WELL CONTRACTOR (INDIVIDUAL)NAME (prat) C 1 i �� < L r
WELL CONTRACTOR COMPANY NAME (11n4-/ :l +t c C
STATE WELL CONSTRUCTION PERMITI
(if applicable)
era®
I. WELL USE (Check Applicable Box): Residential /MunicipatPublic 0 Industrial ❑ Agricultural 0
- Division of Water Quality - Groundwater Section
�tv - lt_.. }..'z CERTIFICATION It )1 5 `i
PHONES ( ) V iJ
ASSOCIATED WO PERMIT/
(if applicable)
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 IF Other, List Use
2. WELL LOCATIO! A F�
Nearest Town: UL
0LQ Fe
(Sum Name. Numbers,Com
munity, Subdivision, Lot NO- rip Code)
3. OWNER: �'Alt 0 LS 0 A)
Address 15n 1, pe +fit ow.p sae
k 3-7G7
&f_.P Fort-
(Swett N tr come No.)
Zip Code
Q�B)- CO (0 16155
City or Town State
Ares code- Phan serrAA.
14.-OC{
4. DATE DRILLED S `7
5. TOTAL DEPTH: 9 e
)- Z
6_ DOES WELL REPLACE EXISTING WELL? YES 0 NO [Y ,9C- ,i T
7. STATIC WATER LEVEL Below Top of Casing: (o FT.
(Use "+" if Above Top of Caste
8. TOP OF CASING IS I FT. Above Land Surfae
'Tap st easing tsrmiated aria below lead surface reumres a
variance In arserdame with ISA /CAC 2C .011S.
9. YIELD (gpm):.2 METHOD OF TEST 4 fer
10. WATER ZONES (depth): j/mf+'/ /'y 7ct
11. DISINFECTION: Type C (Of:. aic Amount f tr. Z
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
From To Ft
From E' To '3 4 FL
From 346 To 3IC Ft..
13. GROUT: Depth t+laieriel Method
From To Ft
From — To ZO Ft {{--JJ�� n-� / /`1.ie9e,,,
14. SCREEN: Depth Diantealr" 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:
4 p�2`
ts�t" 4Arti
Topographic/Land setting /
ORidge 0Slope Malley lellrlat
(check appropriate box)
Latitude/longitude of well location
NegcNminutdaxonito
latitude/longitude source:OGPSOTopographic map
(check box)
DEPTH DRILL)NO LOG
From To Formation Description
()-5 �•rcf
6 re r-
A;a t
.61.c,”7. /2zk
O
LOCATION SKETCH -moo
Show direction and distance in miles from at least'
two State Roads or County Roads. Include the roae
numbers and common road4otcs. O
t1I(‘ 1
CC C
1 DO HEREBY CERTIFY THAT THIS
CONSTRUCTION STANDARDS, AN
WAS CONSTRUCTED IN ACCORDANCE WITH I5A NCAC 2C, WELL
AT A COPY OF ISM HAS BEEN PROVIDED TO THE WELL OWNER
SIGNATURE 0
CONSTRUCTING THE WELL DATE
Submit the original to the Division of Water Qu*ty, Groundwater Section,1636 Mail Service Center - Raleigh, NC '
27699-1636 Phone Na. [phone], withia 30 days. GW-1 REV. 07/2001 '''
•

WELL CONSTRUCTION RECORD 3 0 3 312
North Carolina - Department of Environment and Manual Resourcess-- Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME ORW^)l4 Tv S#it. CQTnt7catrioN$ rif5Z1
T
WELL CONTRACTOR COMPANY NAME 7-114; t;c 1 Nx-0 r>t ` . mow jX 71 7 B'
STATE WELL CONSTRUCTION PERMITS ASSOCIATED WC) ruttani
(it applicable) of applicthlel
1. WELL USE (Cited( Applicable Boa): Rol ❑ Monicipal/Public 0 Industrial 0 Agricultural ❑
Monitoring ❑ Recovery 0 teat Punp Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION: '
Nearest Town: if i A - . ountY
Mad . -_.
(Saco Name. Numbn Cromanky,
lSubdivision, bit No, Tap Code)
3. OWNER: C� rtl. ✓YA.
Address a a n u 'tA et.t eh led
Amot? (StreetaRNn, :7-Ct2
in"an
Coy ar Town State Zip Code
)- yy2-2OZ1
Am code- Mame flambe:
4. DATE DRILLED rr-`71-0T
TopoSaTJ1c/Land setting
C E. ORidgc !1ffiope ❑VaBay ❑Flat
(chock appropvle boa)
Latihddloogiwde of well fixation
(de)
Latittdelongitude source:❑GPS❑Tapographic map
(deck boa)
DEPTH DRIILtHO LOG
From To Formation Description
o/
0 2."
5. TOTAL DEPTH: %1,0 2:S 790
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO EY
7. STATIC WATER LEVEL Below Top ofCasiDf: Ff,
(Um ^t-if Above Tap at Caving)
8. TOP OF CASING IS ' FT. Above Lad Surface`
`Tap .teasing a War balm I..d swims ...,4.....
variant g amm+aaeewas METHOD OF TEST /�/�jS7`i4�
A NCAC 2C -MIL
9. YIELD (gpn): � i
10. WATER ZONES (depth): i p.r..1/.y tore
11. DISINFECTION: Type _IG_Jtehanoum
4 �t n
r
0
LOCATION SKETCH 341/"_
Show direction and distance in miles from at Iet� '1`
12. CASING: Wall Thickness two State Reads or County Roads. hrclmde the
Depth Diametcr em WeigbVR. Maria] m.uLaa and cmtmon road mums
From To Ft
From_ To F
Fran_3/__To .2 Et 4,21
13. GROUT: Depth
From To F
Froen_� To 22 FL ly/el
14. SCREEN: Depth D'mmaer Slat Size
From To Ft.__itt it
From To
15. SAND/GRAVEL PACK: Et is in. s 7
Depth Size Material
From To FL
From To Ft.
L
16. REMARKS:
mg26 "i
&t:
algid
1 DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WIT815A NCAC 2C, WELL
CONSTRUCTION STANDARDS AND THACOPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
(15
No
poetlys-ceic
Sv 744LG
Submit the original to the Division of Water (*arty, Groundwater Section, 1636 Mal Service Cater- Raleig►` NC
27699-1636 Phalle No. [phone], within 30 days. GW-1 REV. 07/2001

WELL CONSTRUCTION RECORD
North Carolina - Department of Envuomneet and Natural Resources - Division of Water Quality - Groundwater Section WELL CONTRACTOR (O4DZVIDUAt)NAME (prWM) t.Mt 4OSPV1 CERTInc*now a) ts ti
WELL CONTRACFOR COMPANY NAME 111
STATE WELL OOrTFRUC ION ►ERrarr7
(if applicable)
303311
"501t r i PHONE •) 11 t 4' 4 5 9 ?
ASSOCIATED WO PERMIT:
Of applauds)
I. WELL USE (Check Applicable Boa): Residential Q MamcipalPublic CI Industrial 0 AgricuNmal o
Monitoring 0 Recovery 0 Heat Pump Waterejection 0 Other 0 If Other, List Use
2 WELL LOCATION: 1 ` �bCY-'-a
Nest Tower CountyNearest
3 511 at/ Vc YZ-t
(sum Naate, N moots, unity, said aa,LiI Non, al Coda)
3. OWNER: LSD C 5`r"� _k
Address 35gn c-te wt l4-S
1j•-i�so (Sint or No) 0 (no Z
City Of Town Set to Code
(t'a2t). tet.%-L20'\
Are tads -Wan nua►w F]�
4. DATE DRILLED tr 2 R-
5. TOTAL DEPTH:_,a A /
6. DOES WELL REPLACE EXISTWO WELL? YES G O O
7. STATIC WATER LEVEL BdowTop ofCasing U FT.
(tha'v- if AUoe Tbr of Onied
8. TOP OF CASING 1S 1 FL Above lad Surfaces
'Tap .refs tattled .sla. blew Ind aria. ..pi®.
valiant to mate wide ISA NCAC 2C all
9. YIELD (gym): 12 METHOD OF TEST 14s, 1 12
10. WATER ZONES (depth) 1 ? 1to ,. F'
I I. DISINFECTION: Type &ADrtNC-
I 2. CASING:
DePlb
Frora_To,
From i_F/._TpthiiP__
From __To►ik F
13. GROUT: Depth
From To Ft
From To 7, 1-30 M
Oeaeneler 1-loeli
14. SCREEN: Depth Slot Size Almeria)
From_ To Ft is in.
Front_To Ft. in. in.
15. SANWGRAVEL PACK
Depth Size Menial
FrwtTo Fi.
Fmm To Ft.
Anna tG t i
Wall Thebes
or weitva taunt
ei0 Ric
kU L
CV. L.I
Method
Topographic/Land setting
Midge Oslope Malley OFtat
(ask toveap last bait)
Letitnddloogitude of well location
(daps:hrocanstw aids)
Lath ddlougitude souce:OGPSOTopographic map
trta box)
DEPTH D H,LAK LOO
Ram To Formation Description
— 43� Oe��1sc �St
9 i^ S.-rts 2 tr-
t�
LOCATION SKETCH - n
7%Q
Show direction and distance in stiles:least So
two State Route orCounty Roads Include gm soadrn, r'_
a erbta sad common road ®sou.
Oa
Cr'
r'
16. REMARKS:
1 DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WIm ISA NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER -
sIGI4ATURZOF PERSON CONSTRUC7INGTHE WELL DATE
Submit the original to the Divisiea of Water Quality, Groundwater Section, 1636 Mad Service Center - Raleigh, PC
27699-1636 Phone Na. [phone], within 30 days. GW-I REV.; 07,R001

13. GROUT:
From ,7
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and N
WELL CONTRACTOR (INDIVIDUAL) NAMFjlprtat) F,V/f) C Nit
WELL CONTRACTOR COMPANY NAME-[yfA.!>�iYitZ-< tT.T.a' �Jcs
STATE WELL CONSTRUCTION PERMIT#
(if applicable)
//41
ASSOCIATED WQ P
(if applicable)
298910
Resources - Division of Water Quality - Grotmdwater Section v �7/7
CERTIFICATION # ..i O / /
PHONE/ (1.6221. / 99-0 4/10
1. WELL USE (Check Applicable Box): Residential"' Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring ❑ Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION:
Nearest Town: Co
Subdivision, Lot No., Zip Code)
(Street Name, Numbers, Carom
3. OWNER: ;(LI
Address # c Rftd4(2./—saennilsir ,
(Street or Route No.)
Y2%[1te0u ,f/e. S7s±—.
City or Town State Zip Code
Area code- Phone comber
4. DATE DRILLED /
5. TOTAL DEPTH: / R
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO .E
7. STATIC WATER LEVEL Below Top of Casing: /_5—. FT.
(Use "t" if Above Top of Casing)
8. TOP OF CASING IS / Jr 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): /b ,..—i OD OF TEST / re
10. WATER ZONES (depth): ��
LOCATION SKETCH
11. DISINFECTION: Type Lt . !i, fi Amotmt % y a - 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 Weiaht/Ft. numbers and common road names.
TopoitrapPhic/Land setting
❑Ridge UdSlope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of weU location
(degees/miuutes/seaoads)
Latitude/longitude source:❑GPS❑Topopraphic map
(check box)
PEPTH DRILLING 06
From To Formation pscrigton
L7
CI
rV
From
From To Ft.
From To Ft.
Depth }/�/t aterisl
To 2 C Ft / O ate
From To Ft.
14. SCREEN:
Fro
Fro
Depth Diameter Slot Size Material
o Ft. in. in.
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 WFf I WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, At1 THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE OWNER
/// %
DATE
SIGNATURE 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-1 REV. 07/2001

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and N
WELL CONTRACTOR (INDIVIDUAL) NAME riot)
WELL CONTRACTOR COMPANY NAME ./A 4,
298809
Resources - Division of Water Quality - Groundwater Section
e .6 CERTIFICATION a.2 8 7
/,12PgSC- /G�itc�% PHONE r
STATE WELL CONSTRUCTION PERMITO
(if applicable)
y/,
ASSOCIATED WQ P8
(if pplicable)
fssiA4AW
l/;
1. WELL USE (Check Applicable Box): Residential K Municipal/Public 0 Industrial ❑ Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCCATIO
ty
(Street Name, Numbers, Community,
Subdivision, Lot No., Tap Code)
3. OWNER: %!
AddressPFy a&Z- Sr-rrri/IKt.
• (Street or Route No.)
%>%z2u c- 7S-
City or Town Stare Zip Code
Area code- Phone cumber
4. DATE DRILLED ///.t/» y
5. TOTAL DEPTH: /T, 5
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO /0
7. STATIC WATER LEVEL Below Top of Casing: 9'v FT.
(Use "+^ if Above Top of Casing)
8. TOP OF CASING IS / S FT. Above Land Surface*
flop creasing terminated at/or below land surface require a
variance In accordance with 15A NCAC 2C .0118.
9. YIELD (gpm): /0 METHOD OF TESTC-n
10. WATER ZONES (depth): /DO
11. DISINFECTION: Type 7P, 4/. l/. Amount /0 * C:1?-
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft
From,) To ,57 Ft. it p #�
From To FL
From
13. GROUT:
From 0
To Ft.
Material
Toth Method ,
%h Ft. --.r (..3 i—Hc,r
From To Ft
14. SCREEN: Depth Diameter
Fro o Ft. in.
From To Ft. in.
15. SAND/GRAVEL PACK
Depth Size Material
From o Ft.
From To Ft.
Slot Size Material
in.
in.
16. REMARKS:
Topographic/Land setting
❑Ridge ❑Slope ®Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degtees/mtmrses/seeonds)
Latitude/longitude source:❑GPS❑Topbgraphtc-map
(check box) c
DEPTH mawIet713
From To Formation47escrl$ion
N
rim
rn
--a
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 ISA NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
65:71497-ii-tr p / Tiro/
SIGNATURE OF PERSON CONSTRUCTING THE WELL ATE
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-1 REV. 07/2001

298806
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Na Resources, Division of Water Quality - Groundwater Section
y
WELL CONTRACTOR (INDIVIDUAL) NAM riot)IT/7 C7/�/ // E'I !� ,V 1. /'. CERTIFICATION Id%7S 77
WELL CONTRACTOR COMPANY NAME PHONE XVc/ O#'ty'a
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERHIITN y
(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! County
z i 79%rr34/1--tP ✓ 117i Z—
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNERidCt4 v .l i e� ,s-P
Address
pp��'9iv (p r o/ 792byiil,� d,
/9 GGY / e C . 0 L
City or Town State Zip Code
(-}
Area coda Phone comber /!
4. DATE DRILLED � //o `f% 7
5. TOTAL DEPTH: ,S f>_S
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO Je'
7. STATIC WATER LEVEL Below Top of Casing: CZ 0 5—FT.
(the *4-* if Above Top of Casing)
8. TOP OF CASING IS 1 If FT. Above Land Surface*
'Top of caslog terminated at/or below land surface requires a
variance In accordaac55,,with ISA NCAC 2C .0118.
9. YIELD (gpm): L ME OD OF TES 7-LP
10. WATER ZONES (depth): E�.J� .Z lc _ti i
Va
11. DISINFECTION: Type 0, f/, /1 Amount �3. T "-
12. CASING: Wall Thickness
ter orWd�UF t ni
To Ft Weight/Ft
i
From ��
From To Ft. `
From To Ft.
13. GROUT: Depth,
_) i
From 0 Tooet D Ft �%n7 3T
From To Ft
14. SCREEN: Depth Diameter Slot Size Material
From —To Ft in. in.
From / To Ft in. in
15. SAND/GRAVEL PACK:
Depth Size Material
Topographic/Land setting
®Ridge ❑Slope Malley ❑Flat
(check appropriate box
Latitude/longitude of well location
(de&sea/mimoeslseeoo4s)
Latitude/longitude source:❑GPSC7fopographic map
DEPTH
From To
Froo Ft.
Fro m To Ft.
16. REMARKS:
PRILLING LOG
FormationoDescNition
r
73.
�`
PO 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.
1 DO HEREBY CERTIFY THAT THIS WFI I WAS CONSTRUC1t:D IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND A COPY OF THIS RECORD HAS BEEN PROVIDED TO OWNER
.6 THEiny
SIGNATURE OP PERSON CONSTRUCTING THE WFT T DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center -Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-1 REV. 07/2001

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and N
WELL CONTRACTOR (INDIVIDUAL) NAMprint)
WELL CONTRACTOR COMPANY NAME let
STATE WELL. CONSTRUCTION PERMIT# , ASSOCIATED WQ P
(if applicable) (if applicable)
291871
Resources - Division of Water Quality - Groundwater Section
L, CERTIFIC/A�TION�%�%
/�fE�
PHONE a g 29 6 yyo9Aa
,t//f
1. WELL USE (Check Applicable Box): Residential IS Municipal/Public 0 Industrial ❑ Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATfON:
Nearest Town-
6-4 6-4 87 52—
Community, Subdivisioo, Lot No., Zip Code)
(Seat Name, Numbe
3. OWNER:7Li 21
Address /„Z.5' .727 c �r�
(Street or Route ph.)
City or Town State Zip Code
Area code- Phone number
4. DATE DRILLED �/.�
5. TOTAL DEPTH: `3 0J
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO 13)
7. STATIC WATER LEVEL Below Top of Casing: .5? O FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS / . S FT. Above Land Surfaces
"Top of cuing terminated at/or below land surface requires ■
variance In accordance with ISA NCAC 2C .0118. -
9. YIELD (gpm): CMOITHOD OF TEST Tje�/-c0
10. WATER ZONES (depth): 'L /P i
11. DISINFECTION: Type C. it /j Amount Jo
12. CASING: Wall Thickness
arneter or Weight/Ft. Material
From () TDo FL fl/ 6/G
From To Ft.
From To Ft.
F
13. GROUT: Depth,
From D To °�`�' i _inn;
�.. et t onor2p�-/
From To Ft.
14. SCREEN: Depth Diameter Slot Size Material
From ZTo Ft. in. in.
From / To Ft. in. in.
Topographic/Land setting
❑Ridge SSlope Malley ❑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
15. SAND/GRAVEL PACK:
th
From
From
16. REMARKS:
1 DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUE Ihi) IN ACCORDANCE WITH 15A NCAC 2C, WET f
CONSTRUCTION STANDARDS .Ad3D THAT A COPY OF THIS RECORD HpASS BEEN PROVIDED TO THE WFFI 1 OWNER
SIGNATURE OF PERSON CONSTRUCTING THE WELL I5ATE
Size Material
To Ft.
To Ft.
o<
rn
rV -y
1,OCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common mad names.
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-1 REV. 07/2001

North Carolina - Department of Environment and
WELL CONTRACTOR (INDIVIDUAL) NAM flirt
WELL CONTRACTOR COMPANY NAME y/
STATE WELL CONSTRUCTION PERMTr# /Y/ice
(if applicable)
WELL CONSTRUCTION RECORD
298857
Resources - Division of Water Quality - Groundwater Section
�F(� Y N /7 />��j,L. n CERTIFICATION
# 8 � //'cal
,(1-fU Le�CJ' •�^> ( PHONE # ( l (c � d 70 U
ASSOCIATED WQ VPERMITit/'/ 7747.. -..
(if applicable)
1. WELL USE (Check Applicable Box): Residential g Municipal/Public ❑ Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection ❑ Other 0 If Other, List Use
2. WELL LOCATION:
Near wn, / ty;
-/- P 1-1_ /74.P 1j��47(02,
(Street ame, N ben, Community, Subdivision, Lot No., Zip Code)
3. OWNER: j Ci)�C 6`���
Address ..2 S1 7 f_c o C T z[ V
(C-fy". 4/d",.) .j27(0 t
City or Town State Tip Code
Area coda Phone number /6 y
4. DATE DRILLED 7
5. TOTAL DEPTH: .2 5-
6. DOES WELL REPLACE EXISTING WFI I ? YES 0 NO g
7. STATIC WATER LEVEL Below Top of Casing: in FT.
// tune "+" if Above Top of Casing)
8. TOP OF CASING IS /. 5 FT. Above Land Surface*
'Top of wing terminated at/or below land surface requlrn a
variance In accordance with 15A NCAC 2C .0118.
9. YIELD (gpm): __ METI)OD OF TEST T�lrtif P
10. WATER ZONES (depth): / n•---6- ' 1-trig t
LOCATION SKETCH
11. DISINFECTION: Type (I, f/. Ai Amount P// oz- Show direction and distance in miles from at
12. CASING: Wall Thiclmess two State Roads or County Roads. Include the
Depth
,,ameter or Weight/Ft. l4tgrisl numbers and common road names.
From_12___ To _,j__Ft. »`&/ qyc
From To Ft.
To Ft.
Toth ,��rta1 �t��d
/ Ft. / '1_a —
To Ft.
Depth Diameter Slot Size Material
o Ft. in. in.
To FL in. in.
Topographic/Land setting
❑Ridge . Slope ❑Valley ['Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From To Formation Description
c
j o
n
CD
From
13. GROUT:
From ��
From
14. SCREEN:
From,
From
15. SANIS/GRAVEL PACK:
Dep
From o Ft.
From To Ft.
16. REMARKS:
Size Material
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUC ir.i IN ACCORDANCE Wr)H 15A NCAC 2C, WELL
CONSTRUCTION STANDAi;DS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
&t S6 Y
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
O
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-1 REV. 07/2001

295505
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment anddl Natural Resources - Division o Water Quality - Groundwater Section
1{((, (J
WE
CONTRACTOR
VIDUAL) NAME
rint
WELL CONTRACTOR CCOOMPAN NAME C- r C'O�i". W e Il �C�\ fx5 PHONCERTIFICATION (� LSC) 3 1 7 J
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMrru
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential-E Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection ❑ Other 0 If Other, List Use
2. WELL LOCATI
Neargst Town:
CroSS
(Street Name, Number, Community, Subdivision, Lot No., Zip Code)
3. 3. OWNER:i�J(1\ RC RNU ti1&QC
Address eC YQr
y 'V A (Strut pA Route No.) 16��
(iA o Town QSian%LiLaZip Code
County Inc L ( (
Topographic/Land setting
❑Ridge ❑Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degarlminmaes/saods)
Latitude/longitude source:❑GPS❑Topographic map
(cheek box)
DEPTH DRILLING LOG
From To Formation Description
Area code- Phone number ��((
4. DATE DRILLED o� -�oio -0
5. TOTAL DEPTH: I as
6. DOES WELL REPLACE EXISTING WFI.I ? YES 0 NO 0T
7. STATIC WATER LEVEL Below Top of Casing: .5S FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS 1 -S FT. Above Land Surface*
`Top of cuing terminated at/or below land surface requires a
variance In accordance with 1SA NCAC 2C .0118.
9. YIELD (gpm): / S METHO OF TEST
10. WATER ZONES (depth): lib— NS
r
ci
0 T.
rn
G
LOCATION SKETCH tCI
11. DISINFECTION: Type NTH Amount / lb 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 Wei t/Ft ria1 numbers and common road name
From To Ft �.a5
From � / To 9`(' FL (o a.S di
From To Ft.
13. GROUT: Dept
From Too To a Ft
From To Ft
14. SCREEN: Depth Diameter
From To Ft.
Material
ClAitqJ
in.
From To Ft in.
15. SAND/GRAVEL PACK:
Depth Size
From To Ft.
From To Ft.
16. REMARKS:
Method
Slot Size
in.
in.
Material
rit
man
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C WELL
CONSTRUCTION;lANDARDS, AND THAT A CQPY OFF'THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
SIGNATURE OF PERSON CONSTRUCTING THE WFf f DATE
Submit t 1re original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center -Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-1 REV. 07/2001
0

2985C4
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section II to WELL CONTRACTOR (INDIVIDUAL) NAME Driot"��)��,�j ` CERTIFICATION Ifp ( tQ I
`
WELL CONTRACTOR COMPANY NAME -nc.c r ij e N� IN5 PHONE # (? (G3° (
3 r Ctf
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable) / (if applicable)
1. WELL USE (Check Applicable Box): Residential elMunicipal/Public 0 Industrial ❑ Agricultural 0
Monitoring ❑ Recovery 0 Heat Pump Water Injection ❑ Other 0 If Other, List Use
2. WELL LOCATION• /�� /(
Near tTown:_ County neLOWC
C.45 cee
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
.ff) phi ec, R., icier
Ueec \'ac t
(Street or Route No.)
3. OWNER:
Address
dD b
r J ttyo`T45 ` a Zip Code
Area code- Phone number
4. DATE DRILLED a-X 64
5. TOTAL DEPTH: I
Topographic/Land setting
❑Ridge ❑Slope ❑Valley ❑Flat
(check zpprpriat box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude sou rce:OGPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From To Formation Description
6. DOES WELL REPLACE EXISTING WELL? YES Q NO 0
7. STATIC WATER LEVEL Below Top of Casing: Qu FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS / -5 FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires ■
variance in accordance 5lth 15A NCAC 2C .0118.
9. YIELD (gpm): /5 METHOD OF TEST elder
10. WATER ZONES (depth): 90 - 9,5
11. DISINFECTION: Type
12. CASING:
Depth %a
Fro To
Fro To -75
From To
13. GROUT- Depth
From___ To �1)
From To
14. SCREEN: Depth
From To
From To
15. SAND/GRAVEL PACK:
Ht if Amount
Wall Thickness
Ft
Diameter or Weight/Ft. Materialic V al
Ft &A 1I((tutCCt
Ft.
Material Method
Ft �'me•n'�
Ft
Diameter Slot Size Material
Ft. in. in.
Ft. in. in.
Depth Size Material
From To Ft.
From To Ft.
16. REMARKS:
LOCATION SKETCH fl r w,
Show direction and distance in miles from at lest to ^
two State Roads or County Roads. Include the odd
numbers and common road names.
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C WELL
CONSTRUCT!STANDARDS, AND THAT
A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
v
Q' x
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
Ct055
Ctee(

11. DISINFECTION: Type ti+(i
12. CASING:
rt� Depth Diameter
From 1.::: To %5 Ft. 6 0)5
From 1S To 7R" Ft. 6-25
From To Ft.
13. GROUT: Depth Method
From-T0 To_s2O_Ft. Zont'n`l)"
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.
298503
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resourcess-- Division of Water Quality - Groundwater Section I -
WELL CONTRACTOR (INDIVIDUAL) NAME
(prlot1) ShVnel5 Omsk: N CERTIFICATION it DLL.*
WELL CONTRACTOR COMPANY NAME l iC�4� n '4€U OCR\\ t\.9 PHONE # JP% c,51— 3W14
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PER3IIIT#
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residentially tmicipal/Public ❑ Industrial ❑ Agricultural ❑
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use
2. WELL LOCATION : (�(� Topographic/Land setting
Nearest Town: IT4 +� CountyV\C�Owe-i1 ❑Ridge ❑Slope ❑Valley ❑Flat
ZLI-1 ockse_ .d- (check appropriate box)
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code) Latitude/longitude of well location
3. OWNER: A T. rvq, hFO(degrees/minutes/seconds)Address i�Sc' sf.\\C. lOC-SLX (o3y Latitude/longitude source:DGPSDTopograpbic map
\ for Ro a No J (check box)1.\gY�Q�( ( (\k Q �, L DEPTH pRILLING LOG
� City or Town SState�, q Zip Code From To Formation Description
(%.)- a-Sa
Area code- Phone mmmber,
4. DATE DRILLED .� 5 - O-1
5. TOTAL DEPTH:
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO
7. STATIC WATER LEVEL Below Top of Casing: FF.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS \ _5 FT. Above Land Surface'
`Top of casing terminated at/or below land surface requires a
variance in accordant with ISA NCAC 2C .0118. ^ , _
9. YIELD (gpm): \ METHOD TEST
10. WATER. ZONES (depth): (ono
i 15
Amount (10
Wall Thickness
or Weight/Ft Maw4al
16. REMARKS:
i
0 cm
cr
vcn
O r"-'
rn
rr?,j
LOCATION SKETCH
Show direction and distance in miles from at least 6` y
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 COP OF THIS RECORD HAS BEEN PROVIDED TO OWNER
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
Submit tyre 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

298281
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Na Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME(print)p,� f1 N.�// e !h J7L I CERTIHCAT1oN/rt�/8Y7
WELL CONTRACTOR COMPANY NAME Y L,2 2 SLf [' )i dJ2 t 67./�� ���(/y�y�J PHONE # (,ZI) /. 1/9-evs-
STATE WELL CONSTRUCTION PERMIT# /Wei ASSOCIATED WQ PERDIIT# 47g
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential SJ Municipal/Public ❑ Industrial ❑ Agricultural ❑
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use
2. WELL LOCATION:
Nearest Town: 7/%/%/.
County mil%et1Ymr2e
(Street Name, NCommunity Subdivision, Lot No., Zip Code)
3. OWNER:
Address S 4 ° e1�1.rac 72D/ &t .
(Street or Route No.)
City or Town State tip Code
(- )
Area code- Phone tuber !
4. DATE DRILLED ./� D 'i
5. TOTAL DEPTH: .Z �+
6. DOES WELL REPLACE EXISTING WELL YES ❑ NO 21
7. STATIC WATER LEVEL Below Top of Casing:.. C> FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS 1.. q FT. Above Land Surface*
'Top of casing terminated at/or below land surface requires a
variance in accordance with 1SA NCAC 2C .0118.
9. YIELD (gpm): -In METHOD OF ST' �.G'nF
10. WATER ZONES (depth): //O / /%� /
11. DISINFECTION: Type,
12. CASING:
From [J
From /o r
From
13. GROUT:
From 0
Depth
To 4r)
To y
To
Depth
To r) Ft
Amount
Wall Thickness
Diameter or Weight/Ft.
FL� /Fag
FLf_ Lalged
Ft.
Material
.n
From To Ft.
14. SCREEN: Depth Diameter
Frotin - To FL in.
From / To Ft.
in.
Method
Slot Size Material
in.
in.
15. SAND/GRAVEL PACK
Depth Size Material
From o Ft.
From To Ft.
16. REMARKS:
Topographic/Land setting
❑Ridge ❑Slope Di)Valley ❑Fiat
(check appropriate box)
Latitude/longitude of well location
(degreeshnth s/seconds)
Latitude/longitude source:❑GPS❑Topograpbic map
(cheek bat)
DEPTH PRILLING LOG
From To Formation Description
rr,
LOCATION SICETCH _ ^ n
Show direction and distance in miles fry at t ali;
two State Roads or County Roads. Indite th `%ad
numbers and common road names. N
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUL. MU IN ACCORDANCE WITH ISA NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
all
OF PERSOONS7RUCTING THE WELL DA "
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mall Service Center -Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-1 REV. 07/2001

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and N
WELL CONTRACTOR (INDIVIDUAL) NAM fy (print)
WELL CONTRACTOR COMPANY N
STATE WELL CONSTRUCTION PERMIT#
(if applicable)
298280
Resoou/rces - DivisionofWater Quality - Groundwater Section
✓V �E 5J ?z L CERTIFICATION #,.L S'7'7M
PHONE # (._75fG,yy— 7X0
A941
ASSOCIATED WQ PERMIT#
(if applicable)
I. WELL USE (Check Applicable Box): Residential, Municipal/Public ❑ Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection ❑ Other 0 If Other, List Use
2. WELL LOCCATION:
N2/st C
(Street Name, N
3. OWNER: !fz
Address -$ 5-7> ?i ✓ `��J��u
(Street or Route No.)
'Ziiic7-c- 4/. l' .
City or Town Stare
Ara code- Phone number
4. DATE DRILLED //�b
5. TOTAL DEPTH: D C
6. DOES WELL REPLACE EXISTING WELL YES ❑ NO El
7. STATIC WATER LEVEL Below Top of Casing: //& FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS 1, C FT. Above Land Surfaces
'Top of casing terminated at/er below land surface requires ■
variance In accordance with 15A NCAC 2C .0118.
9. YIELD (gpm): /4/ METHOD OF TEST�n2v
10. WATER ZONES (depth): //O r S rt.
County
,2 7672
�, " Zip Code)
Zip Code
11. DISINFECTION: Type e.
12. CASING:
DeP
From 0 To 70 Ft. b7
9
From To Ft.
To Ft
To �1i Ft U a
To Ft
From
13. GROUT:
From /7
From
Amount // , j OL
Wall Thickness
or Weigbt/Ft Wiaital
Topographic/Land setting
❑Ridge ❑Slope QtiValley ❑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
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 jl'o Ft.
From / To Ft.
16. REMARKS:
-v
INS
a,
! c
H ='c
Show direction . d distance in miles frocPat it+, �-','
two State Roads o County Roads. Inchl8e the2ad
numbers and Comm. , road names. N o
1 DO HEREBY CERTIFY THAT THIS WEI I WAS CONSTRUL tEU IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT COPY OF THIS RECORD HAS BEEN PROVIDED TO //7/Dy
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center -Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-1 REV. 07/2001

298279
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and N Resources - Division of Water Quality - Groundwater Section�/
WELL CONTRACTOR (INDIVIDUAL) NAM rtnt) �L Fi !!L /7 L CERTIFICATION #..L97`/J
WELL CONTRACTOR COMPANY NAME
,lY.
fJ!?i7�f.f PHONE # 99 D yp Z
STATE WELL CONSTRUCTION PERMTT#ASSOCIATED WQ PERMIT# 'tYnt
(if applicable) (if applicable)
I. WELL USE (Check Applicable Box): Residential X 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: %27C-Merit_. County M
I Jpr e c y 7ri .2_R 7 5"2
(5 Name, Number, Community, Subdivision, Lot No., Zip Code)
3.
11-7
OWNER:
Address y%.% // orxomeN�).21
77(2A A/.�0 ... a S?%. %
uy or rfv67-n/, 3- /own State Zip Code
Area code- Phone number jjj /�
4. DATE DRILLED // / L� l
5. TOTAL DEPTH: p,
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO $1
7. STATIC WATER LEVEL Below Top of Casing:.-_2/n Ff.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS /: FT. Above Land Surface*
*Top of easing terminated at/or below land surface requires a
variance in accordance whb 15A NCAC 2C .0118.
9. YIELD (gpm): / MBJHOD OF TESTTr-CTro
10. WATER. ZONES (depth): - _/0
t{ji/YL
Topographic/Land setting
Ridge ❑Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(depees&mtmtes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DRILLING LOG
Formation Description
=
DEPTH
From To
11. DISINFECTION: Type (. �_ ji. Amount /3// t
12. CASING: Wall Thickness
Depth Dyvnetet orwcigbt/FL
From �% To h/�FL -#"2/ lJr,
From To FL
From To Ft.
13. GROUT: Depth ��(,� From 0 To © Ft.
From To Ft.
14. SCREEN: Depth Diameter Slot Size Material
Fro To Ft. in. in.
From To Ft. in. in.
15. SAND/ RAVEL PACK:
Size Material
From / To Ft.
LOCATION SKETCII
Show direction and distance in miles from at least
two State Roads or County Roads. Include the
numbers and common road names.
From Ft.
16. REMARKS:
I DO HEREBY CERTIFY THAT THIS WFI f WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND T A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WFI 1 OWNER
SIGNATURE OF PERSON CONSTRUCTING THE WELL /DATE
Loaf
O
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center -Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-I REV. 07/2001

297846
WELL CONSTRUCTION RECORD
North Carolina — Department of Environment And Natural Resources — Division of Water Quality — Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) ROBIN MCNEELY CERTIFICATION # 2567
WELL CONTRACTOR COMPANY NAME PITTMAN WELL BORING, LLC PHONE # [phone]
STATE WELL CONSTRUCTION PERMIT # ASSOCIATED WQ PERMIT #
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential ® Municipal/Public ❑ Industrial ❑ Agricultural ❑
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other List Use
2. WELL LOCATION:
Nearest Town: MARION County MCDOWELL
SUGARHILL RD.
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: KAY )(EVILER
Address 7048 SUGARHILL RD.
(Street or Route No.)
MARION NC 28752
City or Town State Zip Code
(828) — 442-2799
Area Code Phone number
4. DATE DRILLED 02/11/04
5. TOTAL DEPTH: 32
6. DOES WELL REPLACE EXISTING WELL? YES ® NO ❑
7. STATIC WATER LEVEL Below Top of Casing: 20 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): 12 METHOD OF TEST STEEL TAPE
10. WATER ZONES (depth):
11. DISINFECTION: Type CHLORYTE Amount 5.52
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
From 0 To 32 Ft. 24" CEMENT
From To Ft. _
From _ To _ Ft.
13. GROUT: Depth Material Method
From 0 To 20 Ft. CEMENT 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 20 To 32 Ft. 78M GRAVEL
From _ To _ FL _
16. REMARKS:
Topographic/Land setting
❑ Ridge ❑ Slope ❑ Valley ❑ Flat
(check appropriate box)
Latitude/longitude of well location
(degees/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
FROM RUTH GO UP 64/74. RIGHT ON COVE RD.
INTO MCDOWELL CO. LEFT ON SUGARHILL RD.
1 MILE ON LEFT.
v
N
cn
N
0
0
0
rt,
0�
O{
*m
pc
rrnn
xrn
rnz
CI
0
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A (COPPYY�OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
� � ) L P <I CONSTRUCTING
WELL%��1lPA r"- / A Q `
SIGNATURE7
Submit the 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

(� (Ultl)t � )Lae.'II
Topogra Land setting
. °Ridge �Vauey, ❑Flat
r_ L !check anpr ;n•ue heal
N 1::,c. Nanhrn. ('on!monry. Subd,'I :on. Lel Nu Zi Code
()l\NI:R ..�a_Ls%7:Y"��IC�._'SC_Kj�TY'-'\,
Latitude; longitude of well location
_ l)hl_TI1
•,. o. toe,i >:JIc lip co:r Flom Te
N , my Vot c : anher
4. DAl r DRILLED, ICI:. ---
roTAI. DEPTH�7 a 2-------- /
6. DOES WELL REPLACE EN!SI1NG WEL.I.? YES NO t>,�7 -'" --
STAIIC WATER LEVEL. Below Top )fC'asing- -CQQ .FT.
tt —tusc"• ' 1 Abe,: rap or( acing,
8 --�—
TOP OF CASING IS L EAbe,: Above Land Surface* ---
•7 up of casing ttrminnyared aver below land surface rtqulrv, a --------
9. } _p _..__. OD OF IE_TGtl • t //1tGIC bI �—
(. 12 AS!NG'. Wal'i. Thickness
%ariauce inacc.rdanL..Ch 15.N CAC B. .01I8.
'D. WA TER ZONES (dcp:hi: 5 2--
___ LOCATION SKETC II
!I DISINli ECTION. Type__ �j \Q, - _ Amount ,_ j-. Show din:ction and distance in miles from ❑t Icast
Iwo .State Roads or County Roads. Include the road
'degrees ,:vn.:,: s. seconds i
LuiiILJ-. I„ntiiiJe sow. r❑GPS❑Topo¢raphic roan
,.:1e,:k box)
1)B1LL1NG LOCI
Formation Dcscripuon
Depth reDslnetcr or 34'o,ght Tl Mlaten;J narobel s and cnrm)on road names
Fron. Q To 1 Et - -_--- -_--_-_—.
From _....__.-'I0 Ft.--- ------ -- ----
Frorn To l-i __
13 (iR(
jt 1__. Dt.plh ..._ _hlalcfi M1lNhoe
CO I-r iil T„ FI.b_ct.e43 Patk\C__
Rota--- _ To _ Ft
WELL CONSTRUCTION RECORD
North i'ci \r!ma - L)cp;tn mcnl If Ens inlntnent and Natural Resources - Div
WF't1.tO\ I it U\s
' I OK I I` DIN IDt nt.l\,,,1F Y (prino__ a
('t)\i R \C r1)R( O\IPANV \:\\16 hi
\I \ I I \\e.t I. (U\SIRI ( I10\ I'h:R\tfta __
nr;yg•hcs{ci _ .____.
CERTIFICATION al PHONE a �ID�Q
ASSOCIATED WO PE RMITO
('! appi:cxblrl
'sl i'.LL USE it 'hock \ pheable Box). Residential 12 NItinicipari'ublic Li Industrial 0 r\_�ricultural ❑
l n;! Ci Recovers 0 Heat Pump Water h)p_ction 0 Chhcr 0 I( Otter. List l'se
LOCATION
Nra:: nl Toss 1.4
_13`N
vcriit
I: :,t. k FEN. i}:p!h Dlnmztc' S. of Sec- ___\'al:•ru
Erma .__. "1'0 FI _._._ in.
To _ l __.... In. --_—_. in ----
!5 S:\NDGRA\'ELPAC K
U:p•, S ce \faierial
Frt'rl _ II, Ft
298099
on or` Water Quality • Groundwater Section
o
in Rt:\11RLx _ -- ao
! L)C' Nt RHO. CER1 F. THAT [HIS 'NFU. WAS CONS-IRLCIED IN AC(URDAN( E WITH I5A PICA(' 2C. WELL N
(UNS FRI VTR O\ AROS. ANDJIll AT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THEW ELL OWN&Q
(. )-C d Z • Z `Q -
SIGNATURE t)h PERSON ( ONSTI(LCTINCi THE WELL DATE
Submit the original o the Di\ ision of Water Quality, Groundwater Section. 1636 Mail Srnicr ( "enter - Raleigh. NC
27699-I0In Phone No D09) 133.3221. within MI day: (.,W-I REV. 01.1001

298098
WELL CONSTRUCTION RECORD
North (. I o:ucr - iepartmenl n1 Em ❑amnent and Natural Resouled% - Div
wFir r In It IA IOH IINDI\IUI AI.1\1V1[II (priint)___ a,rY_
n LLL('VN'tk\(- Ink (.O\IP.Wi\+NiE-
�T -1
N1 tit wr.t I. ( UNNI kt ( 110\ 1'F:MN1111--_
nl'upi•Ireahivi — — - ASSOC IVIED WO PERMITS
r:! appEohlet
'I\ r'LI- USE tC heck .Applicable Dos). Residential IL3" htunicipal'Public ❑ Industrial 0abut:ILural 0
nit n-trig C Recovery 0 Heat Pump Water Injection 0 Othcl 0 If Other. List Use
= AAi-..1. LOCATION
Neaty,t Town jP
13ti 4U IILJ
.1, L;: -\ 4riv. \;rnhcrs Ci r, nunry.
il\\!NEk I Q�•
coon!} Me.N 1.L \ (
I t_Mil0 1/4. z w1 t.
ubdu-iiion, Lot NM. Lin C Adel
z-tf 5 Z.
,, •i I\i,rn •ialc Zip Cinir
1-
\•_,,d: i-,.. c.: u:'.her �-T
d. DAl t 1RILI ED Z— ----- 04
• 1OTAL DEPTH Z5 )_..._---
n of1 Water Quality • Groundwater Section r�
.._ CfRTIF IC.AT1UN�R Q3
PIto�NE r .11 _
Topogr�phie. Land setting
ORidgc 3Slope O\'alhey.:DFIal
(check unpn,nfum bc*
Lalitudc.'lungilude or well location
decrees n....A second),
LulilrA: I-nEi ode soutec DCiPSOTopogr'.tphie roan
.-ile,:k Full
P_$ILLING LOG
FUrnut IUn Dtai rlptlJlt
DEI'rH
Fran) To
b. DC/ES WELL REPLACE EXIST ING WELL? YES Noe —
▪ STAI I( WATER LEVEL Below Top afCasing: —_ 0 FT --
i . t-•ir • • ":r Ann.. F r'orI acing,
A. TOP Or CASING IS ____I_____ IT. Abovc Land Surface•
-lop of rasing rerminatrd at/or below land surface ray aim a
, anion, in accordance with IS,A NC':AC U. .0118. /1
U. YIELD lgprni:._._5 METHOD OF TEST h 1. ` "U✓1 --
11r. \\ A IER ZONES (depth):.__ L08) _ll_'o___.___—______—
t _ __ LOCATJON \KETCH
!I 1)1SIS F ECTION. Type_-(ia1 e,�' Amount `_.� _--_ Show direction and dtstaree in miles from al lea.Nt
12 C.ASI NCi• Wall Thickness -�-- Iwo State Roads or County Roads. Include the road
Depth j) Domeier or Wight Pt Material numbers and common road names.
Fruit, 0 To Z -u- Ft
From_ -- Tu___ IL_ —.
13 (.ROL:I O..plh \1aier1•y NiChcr
From to.----._._ rt.° litt - . .--
Iron,T' Et
..
Id Al. kF EN i),ri Dlmneler S,nt SVaC ._.__.Mats:.
FR,rl- -r F1 _.._._ In. ,---- ;n
Hon T., —._.— El _._.. 'n ----- 'n
! 5 SAND GRAVEL PACK:
Depte S m .Material
I tit,I u_.
} FW l-
zzI
>,•Kk --W.
I(• I'L\.l \kh\:— _— ---_..._. AD
I Do Hi III•ui CEI )
( i)Ns rR!
'HAT THIS 'A'ELLW-ASC1)NSTRLCrEDINACCURDAN(EWITH 15AsCAC2C WELL.
5 PANDA D�HAT •ACOPY OF,HIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
SIGNATL'kb or f tKSO\ t. 0!NSTR I,CTI\G iHF. UCII DAT[
Submit the original to the Di\ ision of Water Quality, Groundw titer Section. 1(3A Mail Scr ice (e,,Ivr - Kaleigh, N(
I'o'!'l-It.tn Phone No. (9tvl 733.322i, within 30 da%. <iW•I REV. 07'2001
0
0
0
cn
n
z D'
ire
cr1
➢c
rn
—c
NT
m a
n_.
p
z

North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
1636 Mail Service Center - Raleigh, N.C. 27699-1636 - Phone [phone]
299154
3. OWNER R, PHJ LIP—ALSTON, JP
Address 214fi ci AV= NnPTH
ST PFTFgE112l , re Ne.)
6lty or Town State
WELL CONSTRUCTION RECORD
WELL CONTRACTOR: Dewey Wright Well Pump Co
WELL CONTRACTOR CERTIFICATION #. 2797
040087 STATE WELL CONSTRUCTION PERMIT#• Jvrry Wilson
Inc.
1. WELL USE (Check Applicable Box): Residential
Recovery l I Heat Pump Water Injection
v
Municipal I I Industrial ❑ Agricultural] l Monitoring ❑
Other ❑ If Other, List Use. - -
2. WELL LOCATION: (Show sketch of the location below)
Nearest Town: LINVILLE County !/1CDO'.\'ELL
4 3Td latYriArN)...CP n aQ CFI kt Y 221-
DRILLING LOG
From To
1
FL 337137073
Zip Code
4. DATE DRILLED 3/30/2004
5. TOTAL DEPTH 450
6. CUTTINGS COLLECTED YES ❑ NO
7. DOES WELL REPLACE EXISTING WELL? YES
8. STATIC WATER LEVEL Below Top of Casing: 180 FT
(Use "+" if Above Top of Casing)
9. TOP OF CASING IS 1 FT Above Land Surface*
*Top of casing terminated at/or below land surface requires a variance in accor-
dance with 15A NCAC 2C.0118
10. YIELD (gpm): 1 5 METHOD OF TEST Air
11. WATER ZONES (depth): 1 50 nnm 17 -176 0 nnonm
0 GO flpm 0 ❑Oppm
12. CHLORINATION: Type HTI-1 Amount
13. CASING:
From
Fro;
From
X
Wall Thickness
Depth Diameter or Weight/Ft. Material
n To 2n Ft e PVC
14. GROUT:
From
From
15. SCREEN:
From
From
From
To Ft
To Ft
Depth Material Method
0 To 70 Ft C>mert Gravity Flnw
To Ft
Depth Diameter Slot Size Material
To Ft in in.
To Ft in. in
To Ft in in
16. SAND/GRAVEL PACK:
Depth Size Material
To Ft
17.
FOR OFFICE USE ONLY
Quad No:
From
From
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 PR IDED TO THE WELL OWNER.
SI URE OF PERSON CONSTRUCTING THE WELL DATE
Submit original to Division of Water Quality, Groundwater Section within 30 days
GW-1 REV. 12/99
To Ft
pLo
v
1 179
175 17e
176 450
DEPTH
Formation Description
nor
GRANITF OtJART7
f'LIART7
GRANITF Cal IARTZ
NO n
rto
If additional space is needed use back of for
LOCATION SKETCH
(Show direction and distance from at least two State
Roads, or other map reference points)
roe 4 a a
c
O
!83 W,
(h
41,tle-j
CD>
Serial No.

3. OWNER:/4
Address /
ma(2114r Route < N'Cr. Y R7V t
City or Town State tip Cade
Area code- Phone number 4. DATE DRILLED S/7/
5
6
7
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Na
WELL CONTRACTOR (INDIVIDUAL) NAME riot)
WELL CONTRACTOR COMPANY NAME
STATE WELL CONSTRUCTION PERMIT#
(if applicable)
299"r4
Resources - Division of Water Quality - Groundwater Section
on �J
D A/ A%/ a 3,4 t L CERTIFICATION ry S / /
���Sart (/ La PRONE # (. 6H9-641V3
/•V) ASSOCIATED WQ PERMED AI14
(if applicable)
/41
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: C ,/), ,!
Ne�stTown: QfLCl� County L�l/o_w�!!
(Street Name, Numbers, Community, Subdivision, Lot No, Zip Code)
Topographic/Land setting
❑Ridge %Slope Malley DFlat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/Iongitude source:❑GPS❑Topographic map
(check box)
DEPTH PRILLLBIG LOG
From To Formationpescription
. TOTAL DEPTH: e7 /D S
. DOES WELL REPLACE EXISTING WELL? YES 0 NO AI
. STATIC WATER LEVEL Below Top of Casing: .31t FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS Ii3 FT. Above Land Surface*
'Top of casing terminated atfor below land surface requires a
variance in accordance with 15A NCAC 2C .0118.
9. YIELD (gpm): ,/ 'S— METHOD OF TES i -cJ
10. WATER ZONES (depth): `7S'
11. DISINFECTION: Type C ./1
12. CASING:
Depth Diameter
Frotnb Toro
From To
From To
13. GROUT: Depth
From Q To aQ
From To
14. SCREEN: Depth
From
From To
15. S GRAVEL PACK
Depth
From lo
Fro To
16. REMARKS:
Ft.
Ft.
Material
Ft. (pats. t
Ft.
Diameter Slot Size Material
Fc in. in.
Ft. in in.
Amount Q -? te—
Wall Thiclmess
or Weight/Ft. Ivjpterial
Size
Ft.
Ft.
Material
fl
LOCATION SKETCH
Show direction and distance in miles from a east
two State Roads or County Roads. Includ i e road
numbers and common road names.
I DO HEREBY CERTIFY THAT THIS WET T WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND JM4T A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
ow -pc -id 400.29 SIGNATURE OFCONSTRUCTING THE WELL ��A �/
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center -Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-1 REV. 07/2001

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and NaatJ�Jral Resources - Division of Water Quality - Groundwater Section �j
WELL CONTRACTOR (INDIVIDUAL) NAME (print) off) 4/ Al / t iJ N 2nL' " CERTIFICATION #of D / 7
WELL CONTRACTOR COMPANY NAME e3 • • � �� 1L�y i ..4..y PHONE # De..21(61 y9 difria
STATE WELL CONSTRUCTION PERMIT# 7,,47. ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
/f/+
299201
1. WELL USE (Check Applicable Box): Residential lie Municipal/Public ❑ Industrial ❑ Agricultural ❑
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use
2. WELL LOCATION;
Nearest Town:
County 2net /I tk,
1274 t—
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER:
Address
,qd
-eel_ (Street or Route No.)
f Ate . ,2 87/
City or Town State tip Code
Ares e- num/G /!/
4. DATE DRILLED S /4
5. TOTAL DEPTH:
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO `$
7. STATIC WATER LEVEL Below Top of Casing: /Q FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS /. S� FT. Above Land Surface'
'Top of using terminated at/or below land surface requires a
variance in accordance with 15A NCAC 2C .0118.
9. YIELD (gpm): THOD OF TESTTt�s.r
10. WATER ZONES (depth): VO I
11. DISINFECTION: Type LI. f/ y
12. CASING:
From_ To Depth,
From To
From To
13. GROUT: Depth
From_( Top" p
From To Ft.
Diameter
Ft. G •l
Ft.
Ft.
Material
Ft. �12�
Amount 8 s oL
Wall Thicloress
or Weight/Ft. Material
#JL / (Pat
14. SCREEN: Depth Diameter Slot Size Material
Fro o Ft. in. in.
From-7.--To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From Ft.
From r To Ft.
16. REMARKS:
Topographic/Land setting
❑Ridge NSlope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box) '..
DEP' PRILLING LOG
From To Formation Description
4
CO -17
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common mad names.
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C WELL
CONSTRUCTION STANDARDS, ANjYTF T A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
s74i�y
SIGNATURE OF PERSON C STRU 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 N Resources - Divisionivvitioof Water Quality - Groundwater Section
pylJ
WELL CONTRACTOR (INDIVIDUAL) NAM (print) US 9NN/ G L7 /Y�'�1-. CERTIFICATION Mp(I!
WELL CONTRACTOR COMPANY NAME artare, vL f2444.yi PHONE # Liar 417 Wirt
STATE WELL CONSTRUCTION PERMIT# ,{I /9 _ASSOCIATED WQ PERM T# A//4
(if applicable) (if applicable)
299202
1. WELL USE (Check Applicable Box): Residential $ Municipal/Public 0 Industrial ❑ Agricultural 0
Monitoring 0 Recovery ❑ Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION:
Nearest County
(Street Name, Numbers, Community, Subdivision, Lot No
3. OWNER:--1e4/
Address .2 !/ J
�' a (Sheet or oom` e) t L
City or Town Stale Zip Code
(3/4--±,
Axes code- Phone number
4. DATE DRILLED S�bV
5. TOTAL DEPTH: T
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO jj!
7. STATIC WATER LEVEL Below Top of Casing: fri n FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS J. 4 FT. Above Land Surface"
'Top of wing terminated at/or below land surface requires •
variance In accordance with 1SA NCAC 2C .0118.
9. YIELD (gpm): / D METHOD OF TEST
10. WATER ZONES (depth): /.7f — / 7t
11. DISINFECTION: Type [ •• A yi Amount /
12. CASING: Wall Thickness
or Weight/Ft. Material
,rh2/ fd e.
u2W1-
Zip
Code)
Dnein
From 0 To �d 0 Ft.
From To Ft
From To Ft.
13. GROUT: Depth
From-0_ To 6/0 Ft
From To Ft.
14. SCREEN: Depth Diameter Slot Size Material
From o Ft in. in.
From To Ft. in. in.
15. SAND/GRAVEL PACK
Depth Size Material
From—�y ���.�r o Ft.
From / To Ft.
et(
r'-
16. REMARKS:
Topographic/Land setting
DRidge ❑Slope Walley ❑Flat
(check appropriate boa)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(che .k boa) -
DRILLn G LOG
Formation Description
DEPTH
From To
0
Show direction and . tance in miles frontrit leer
two State Roads or a ounty Roads. Include the raid
numbers and co., ...n mad names.
tis
1 DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH I5ANCAC 2C, WELL
CONSTRUCTION STANDARDS, AIJH)THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
SIGNATURE CONSTR�CCING THE WFT t
APY
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-1 REV. 07/2001

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and N Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAM riot) Q A/ N J c. �Q 4. 1. LI _ I CERTIFICATION rant $ 7 �%
WELL CONTRACTOR COMPANY NAME �iC.feGAVf f t44W 4 P ONE a 4244 yy.5 y4
(if applicable) V
STATE WELL CONSTRUCTION PERMIT/ N/,f�' AVSOCIATED WQ PERMIT#
(if applicable)
299201
1. WELL USE (Check Applicable Box): Residential% MtmicipalPublic 0 Industrial 0 Agricultural 0
Monitoring ❑ Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION:
N Town:Qil�.pyt"
C
tmtyslazgaii
-eats v d -� e4 -fps 2 .
( meet Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER& dea .442.
Address g01-6,2 $_ t. . 79..40
(Street or Route No.)
City or Town State Zip Code
Artacode- Rhone numtxt ,/� / D
4. DATE DRILLED //,/ 4
5. TOTAL DEPTH: af" p
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO
7. STATIC WATER LEVEL Below Top of Casing: _ken FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS i. s FT. Above Land Surface*
`Top of casing terminated at/or below lad surface requires
variance to accords with ISA NCAC 2C .0118.
9. YIELD (gpm): METHOD OF TEST��Gryti
10. WATER ZONES epth):
Topographic/Land setting
l kidge ❑Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/mimdcs/scconds)
Latitude/longitude source:❑GPS❑Topographicmap.
(check box) ..
DEPTH DRILLING LOG
From To Formation Descnphoa
11. DISINFECTION: Type e. se A
12. CASING:
Depth Ditazyter
From D To 77 Ft
From To Ft.
From To FL
13. GROUT: Depth .Material - t
From Too Ft. [ _______
From To Ft.
14. SCREEN: Depth Diameter Slot Size Material
From ....„--.To Ft in. in.
From . To Ft. in. in.
15. SAND/GRAVEL PACK:
Amount
Wall Thickness
or Weight/Ft.
Pvtt
th Size Material
From o Ft.
From / To Ft.
16. REMARKS.
Ul —
•
n
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.
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WFi
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
SIGNATURE OF 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

209200
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Na 1 Resources - Division of Water Quality Groundwater Section p
WELL CONTRACTOR (INDIVIDUAL) NAME (print) t o#H/G 53 4j L L CERTIFICATION a CZO J
WELL. CONTRACTOR COMPANY NAME ageoLadakweafre 1,41alv. pieta, PHONE M figitradathialb
STATE WELL CONSTRUCTION PERMIT# why _AScOC1ATED WQ PERMIT"
(if applicable) (if applicable)
y/4
1. WELL USE (Check Applicable Box): Residential ix Municipal/Public ❑ Industrial ❑ Agricultural ❑
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use
2. WELL LOCATWNi
Neared Town:,
County )72 tape/Jell
(Street Note, Number, Community, Subdivision, Lot No., Zip
3. OWNER,
Address
(goat oc Rowe No.)
Ciry or Town State
ed
427St_
Zip Code
•
9. YIELD (gpm): / METHOD OF TEST,,_
10. WATER ZONES (depth): /M 0 r
LOCATION SKETCH(
Topographic/Land setting
❑Ridge OfSlope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degreea/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographk rnap
(check box)
DRILLING LOG
Formation Description
DEPTH
From To
r_
Arca code- Phone number,
4. DATE DRILLEDpa S / O 4/
5. TOTAL DEPTH: os-
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO ❑
7. STATIC WATER LEVEL Below Top of Casing: 4,/a n FT.
(Use .+" if Above Top of Casing)
8. TOP OF CASING IS A ,,r FT. Above Land Surface'
'Top of wing terminated at/or below land surface rcgaire, •
variance In scandium with ISA NCAC 2C .0118.
11. DISINFECTION: Type /', /«
12. CASING:
From b
From
From
Depth
To Lob F
To FL
To Ft.
13. GROUT: Depth
From /'i To w2 F)
From To
14. SCREEN: Depth
From To
From To
15. SAND/GRAVEL PACK
Amount / 9 ei
Wall Thickness
or Weight/Ft. piral
rlita
a _Material
w
Ft. ( .mint.)/
Ft.
Diameter Slot Size Material
Ft. in. in.
Ft. in. in.
Depth Size Material
From / To Ft.
From / To Ft.
16. REMARKS:
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 WF)1 WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WFI I
CONSTRUCTION STANDARDS, AND {AT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WFI.I OWNER
/��,Q�Q a� o
SIGNATURERSON 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

299199
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Na
WELL CONTRACTOR (INDIVIDUAL) NAM (print
W�l ��Q ,ELL CONTRACTOR COMPANY NAME .tom ! .G.(1% L 2eitot yti.
STATE WELL CONSTRUCTION PERMITat_41/41_ ASSOCIATED WQ PERMIT*
(if applicable) (if applicable)
Resources - Division of Water Quality - Groundwater Section qx 6p
LERru2CATION 48
.77
PHONE N ( )
ry/'7
1. WELL USE (Check Applicable Box): Residential PI Municipal/Public ❑ Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection ❑ Other 0 If Other, List Use
2. WELL LOCATIONy
Nearest Town: a _a'Co ty %n
in >�-.4
o.)k �� v at.
vlb
(Street Name, Number, Community, Subdivision, Lot Ao., Zip Cade)
Met code- Phone number
4. DATE DRILLED y1 s 7/0 y
5. TOTAL DEPTH: a vs.
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO fJE
7. STATIC WATER. LEVEL Below Top of Casing: JJ F r.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS /. S FT. Above Land Surface's
'Top of casing terminated at/or below land surface requires a
variance In accordance with ISA NCAC 2C .0118. •
9. YIELD (gpm): /'D HOD OF TEST7tea4I
10. WATER ZONES (depth): t�' f i/ob,
11. DISINFECTION: Type a // A
12. CASING:
Depth
riir
From a To 74. Ft.
3. �}�e/�
OWNER: �4�,,,`
Address�` _
"%�Yl��j oL/Lli•% _�_/�,(e%p
�(Sunect or Rase No.)
7v�! C• .2776
City or Town State Zip Code
40.4 !sL 7- 39/4f
From To Ft
From To Ft.
Atmunt J b O>;►
Wall Thickness
or ght/Ft t item
13. GROUT: Depth tcrial
From Q To � o Ft. eas�r
From To Ft
14. SCREEN: Depth Diameter
From To Ft in.
J
From / To Ft. in.
15. SAND/GRAVEL PACK
Depth Size Material
From To Ft.
From /To Ft.
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:❑GPS❑Topographic map
(chock box), ...__..... _..
pEPT{j DRILLING LOG
From To Formation Description
LJ
_
0
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and commo r road names.
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT Aj OPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
SIGNATURE OF PERSON CCONS'IRUC THE WELL
y/i7' 9
Submit the 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

'99193
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Na Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAM (print) A/.(//G !3/9I 1.- CERTIFICATION*t.if7%
WELL CONTRACTOR COMPANY NAME „bei.e..rial „ate j 1sLi v.624.1str PRONE % It2 5 I V 9-if yki)
STATE WELL CONSTRUCTION PERMIT# N/42 ASSOCIATED WQ PERMIT* /�/19
(if applicable) (if applicable)
I. WELL USE (Check Applicable Box): Residential EX Municipal/Public 0 Industrial 0 Agriculnual ❑
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
aPacid
2. WELL LOCATION:
C
Nearest Town: %�`Jy,lrs7ie County in
a__
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER:J -'C. /C1-
Address fit` ya y.
, (Street or Route No.)
499
Q'uoer" NC. tart75`i—
City or Town State Zip Code
(- }-
Ana Coe oumby v
4. DATEE R
DRILLED Y �i -/i/ D
5. TOTAL DEPTH: `f.7 S
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO J$
7. STATIC WATER LEVEL Below Top of Casing: V,4 f FT.
(Use "+" if Above To of Casing)
8. TOP OF CASING IS / S FT. Above Land Surface*
'Top of cuing terminated at/or below land surface requires a
variance In accordant with ISA *CAC 2C .0118. •
9. YIELD (gpm): METHOD OF TEST 1 C#Lt1
10. WATER ZONES (depth): e..2 'y.,,/ r
/�
11. DISINFECTION: Type L . eif. Y. Amount /a
12. CASING: Wall Thickness ���,,,fff��A�tt���rrr,,,
Depth Djameter or Weight/Ft M,�te et
From D To 1p Ft. /• '� 0.11
li/(%
From To FL
From To Ft.
13. GROUT: Depth �ert�l
From__ To an Ft. 2r11p�1,
From To Ft.
14. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in.
From r_To Ft. in. in.
15. SAND/GRAVEL PACK
Depth Size Material
From
_�TTo Ft.
From !/ o Ft.
16. REMARKS:
I DO HEREBY CERTIFY THAT THIS WFI f WAS CONSTRUCTED IN ACCORDANCE WITH I5A NCAC 2C, WELL
CONSTRUCTION STANDARDS, ANLZTHAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
Topographic/Land setting
Fgaidge ❑Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/mirages/seconds)Latitude/longitude source:❑GPS❑Topographic map
(check box)
PEPTH PULLING LOG
From To Formation Description
U7
LOCATION SKETCH
Show direction and distance in miles froth at least
two State Roads or County Roads. Include the road
numbers and common road names. o
So13
B i'/e
�� yes /
ACites*
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

299192
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Na Resources - Division of Water Quality - Groundwater Section �/
WELL CONTRACTOR (INDIVIDUAL) NAME (mist) �.f�4/ N I r /3 .4 L'L ,, CERTIFICATION th n / / r�
WELL CONTRACTOR COMPANY NAME s&ectk�li] /.1 Zt3tJA ale& tialeta PRONE $ f� N L yQ oS�p t
STATE WELL CONSTRUCTION PERMIT# WM _ASSOCIATED WQ PERMITS /Yf4
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential 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:
Meares f own: %%1at402.4.
Topographic/Land setting
Countyi% *Ridge ❑Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(StreetName,Name, Number, Community, Subdivision, Lot No., Zip Code)
3. OWNER:.fl.e
Address ?tie' 32 .�Lr sS.t Yd
. (Street or Route No.)
Matte" N 1C
0 7Ss
City or Town Stare Zip Code
Arm code- Phone number / /
4. DATE DRILLED f 0
5. TOTAL DEPTH: �f' 9
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO g
7. STATIC WATER LEVEL Below Top of Casing: f if, a FT.
(Use "+" if Above Top of Cuing)
8. TOP OF CASING IS /..0 FT. Above Land Surface'
'Top of casing terminated at/or below tend surface requires a
variance la accords with ISA NCAC 2C .011& •
9. YIELD (gpm): METHOD OF TEST? rear #
10. WATER ZONES (depth): t.2
11. DISINFECTION: Type f . iti //. Amount /1 Ar—
12. CASING: Wall Thickness
Depth / Diameter or Weight/Ft Material
From_ To G 3 Ft. li 4 /#.1/ cPL C
From To Ft.
From To Ft.
13. GROUT: Depth Material
From 0 To alp Ft
From To Ft
14. SCREEN: Depth Diameter Slot Size Material
Fro Ft in. in.
Flom / To Ft, in. in.
15. SAND/GRAVEL PACK
Method
From o Ft.
T
From To Ft.
Size Material
16. REMARKS:
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topogiaphic map
(chock box)
pEYIS3 DRILLING LOG
From To Formation Description'
r_
JI
LOCATION SKETCH Sr.
Show direction and distance in miles from at (east"
two State Roads or County Roads. Include thes6ad
numbers and common road names.y
MA44$1 1711
0 -
S 0 9
I DO HEREBY CERTIFY THAT THIS WFI 1 WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
•o t all y�91ti2/t 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
GW-1 REV. 07/2001
27699-1636 Phone No. [phone], within 30 days.

From__ T
From To Ft
13. GROUT: Depth Material
From_) To 3 t)
From To Ft
14. SCREEN: Depth Diameter Slot Size
Fro To FL in. in.
FromTo Ft in. in.
15. SAND/GRAVEL PACK:
Depth
From To Ft.
From To Ft.
299101
WELL CONSTRUCTION RECORD
Notth Carolina - Department of Environment and Na Resources - Division of Water Quality - Groundwater Section
p
WELL CONTRACTOR (INDIVIDUAL) NAME riot) ` ' /V /V� e. $� /91. L CERTIFICATION ttlLO 72
WELL. CONTRACTOR COMPANY NAME .i t., ...,, uJ�4-gL1si/ PHONE # f.82521 Z gig)y�
STATE WELL CONSTRUCTION PERMIT# /V /A ASSOCIATED WQPERMIT#
(if applicable) (if applicable)
N/4
I. WELL USE (Check Applicable Box): Residential la Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER:f1f eyM-i4_ icat2 ti
Address J.J � 04 •
(Street or Route No.)
7ildt.412. NC •
City or Town State Zip Cork
(—}
Areacode- number" /
4. DATE DRILLED/D 1 y
5. TOTAL DEPTH:
6. DOES WELL REPLACE EXISTING WELL? YES O NO g!
7. STATIC WATER LEVEL Below Top of Casing: sr FT
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS 1. ,s FT. Above Land Surface" n
"Top of wing terminated at/or below land surface requires
variance In accordance w�ith 1SA NCAC 2C A118. •_ -
9. YIELD (gpm): (� METJ3�D OF TEST -resets,
10. WATER ZONES (depth): 712 f •s s '
Topographic/Land setting
DRidge OSlope Walley OFlat
(dick appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:OGPSOTopographic map
(dick box)
PEPTU PULLING LOG
From To Formation Description
JJ 7St
11. DISINFECTION: Type L.
12. CASING:
Depthp Diameter
From 0 To n t) F. In
o Ft
Atnoumt S_ f at'
Wall Thickness
or Weight/FL Material
Oa/ ed..
Method
16. REMARKS:
Material
Size Material
Show direction and • • ce in miles froi$ at leas
two State Roads or Coun Roads. Include the id
numbers and common ro d names. • •
0
1 DO HEREBY CERTIFY THAT THIS WY; 1 WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WFI I
CONSTRUCTION STANDARDS, AND THAT COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
SIGNATUREOFPEERSOONC TRUCI7NGTHE 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

299190
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and rel Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAMTF7 (print) CERTIFICATION # c2Z77
WELL CONTRACTOR COMPANY NAME /CL�IJl.(jei 11 %Fn ,_ PHONE # (fCai i {i9 dn
STATE WELL CONSTRUCTION PERMIT# N� ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential ga Municipal/Public O Industrial 0 Agricultural 0
Monitoring O Recovery 0 Heat Pump Water Injection O Other O If Other, List Use
2. WELL LOCATION:
Nearest o n: A County_M C LIJ( 44�
1
4 489SZ-
(Street Name, Numbers, Community, Subdivisioo, Lot No., Zip Code)
3. OWNER:
Address
i/CoPA a .
(Street or Route No.)
Ina nA../ e• t>7Y�trL
City or Town Stare Zip Code
( ).'
Area code Prune nttmberuu
4. DATE DRILLED 7// I ¥
5. TOTAL DEPTH: .Z S/,5
6. DOES WELL REPLACE EXISTING WFr I ? YE ❑ NO NI
7. STATIC WATER LEVEL Below Top of Casing: 7. FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS /• S FT. Above Land Surface'
'Top of casing terminated at/or below land surface requires ■
variance In accordance with ISA NCAC 2C .0118. •
9. YIELD (gpm)- 3 n METHOD OF TE.rST�"a..-�a.#s.tJ
A 10. WATER ZONES (depth): Z Or L.2 J l
11. DISINFECTION: Type C• M N
12. CASING:
nDiameter
Fro fG— TDo� %i% Ft.
From__ To Ft.
From To Ft.
13. GROUT: Depth
From Q To J rt Ft.
Amount 7:6 °a -
Wall Tbiicness
ior ➢ia/ Weight/Ft. ptpialC.
From To Ft.
14. SCREEN: Depth Diameter
From Ft. in.
From To Ft. in.
15. SAND/GRAVEL PACK
th Size Material
From
Slot Size Material
in.
in.
Ft.
From To Ft.
16. REMARKS:
Topographic/Land setting
❑Ridge OSlope )Valley OFlat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:OGPSOTopographic map
(check box)
PTH
DEDRILLIN2Jft' .O
From To Formation Description
•s
0 c
W
LOCATION SKETCH.
Show direction and distance in miles from at least
two State ' • ads or County Roads. Include the road
numbers an • • mmon road name
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WRT.I OWNER
SIGNATURE OF PERSON CONSTRUCTING THE WELL
Hl/DATEid%
D
ea/
Submit the 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
299311
North Carolina - Dcpartnent of Envuomnent and Natural Resources - Division of Water Quality - G oundwat Section
WELL CONTRACIOR(INDIV1DUAWNAME (PrW)_ CrA ay 'D. TO C44n r cnnncs►no$w 2/ ,50
WELL CONTRACTOR COMPANY NAME J .%54•ICE. kit CLt."n,;(4' r"' rHONE a Pell :L`/-11.5e7
STATE WELL COASTRUCRON PERMITS ASSOCIATED WRPERMITS
(if applicable) of applilWe) __...
1. WELL USE (Check Applicable Box): Residential ❑ Municipal/Public [t' Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pun" Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION:
Nearest Town: (.' ' { c. SN/; f-L•r(&b4lCmmty 1\XCI)o.. t.c
22C.-R
(Sum Name. Nether:, Community, Sandiviska rat Na IrsCode)
3. OWNER: 1N+L,l V C (S fat 'FrcAt
Address T n F, . g:ZS
(Seater Rome )
1F 114)
* 7 e 6l6, nr t&
City or Town State ) Zip Code
(fir)- ?_hG- 4S-73
Area code- Phase amaba
4. DATE DRILLED Li . 10— 04
5. TOTAL DEPTH: i o 5 e•
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO �to
7. STAT1C WATER LEVEL Below Top of Casing _FI.
(Uaa"t-'ifAboreTop ofCldoW
S. TOP OF CASING IS .3• Fr. Above Lad Surface"
row of wain L. 4... ed atr bd,w l d flee rapine •
write= Ia atmrdana wait 15A NCAC 2C Alt
9. YIELD(gpm): 3n METHOD OF TEST /4/2-
10. WATER ZONES (depth): L / o 4-0
11. DISINFECTION: Type c.Lz-..{ N Z
12. CASING:
Depth
From To FL
FromQ_To Z Ft, !c• Yc1 0
Fros_Z. To Ft. O /V /E%
l3. GROUT: Depth Material
From To FL
FromS To_____ FL & 1 r H '
14. SCREEN: Depth Diameter Slot Size 'al
From To Fi. itt in.
Front_ To Ft in. in-
15. SAND/GRAVEL PACK:
Depth Size MSial
From To FL
From To FL
Amoane 4:g oZ < 1
Well Tbirkness
Dial w weiglulR. Meeeiel
Topographic/tang selling
°Ridge DSlope ®(alley. °Flat
(check approptiatt box)
Latitude/longitude of weft location
(dereuelui rsistco ds) L
Latittdeltongitude sowce:OGPSOTtipographic map
(drcdrbox) l _
DEPTH Dane gnak
From To Formation Description
C XS S4Akg
16. REMARKS:
'Acid
inoe
Method
3$ /e556
LOCATION SKETCH CO
Show direction ad distance in miles from kart-',
two State Rods or County Roads. Iachdelie rani
madam and common road names.
4pLAAA Z1! l)
E)�rl�lt
22/
titjoyd
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH I5A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND AT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
Osit
SIGNATURE OF CONSTRUCTING THE WELL DATE
Submit the original to the Division of Water Quality, Groaadwatrr Seetion,1636 Mali Service Center - Raleigh, NC
27699-1636 Phone No. [phone], whin 30 days. GW-1 REV. 07/2001

the
WELL CONSTRUCTION RECORD 293257
North Carolina - Dcpartnent of Environment and Natural Rrsou<ces �- Division tAo, of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (Prot) 5)SiIfi Cat (Pau- Ur,Lten) carriICAnoN era%/
WELL COATRACfOR COMPANY NAME (/I✓'y T1.�a. PRONE a f ) 7e 9-4, fl
STATE WELL. CONSTRUCTION PERMIT" ASSOCIATED WQ PERMITS
(if applicable) (Happb le) ['
1. WELL USE (Check Applicable Sox): Residential IR' Municipal/Public 0 Industrial 0 Agricultural 0 o a m
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other O If Other, List Use c , , n
2. WELL LOCATION: ��Gj �/J
Nearest Town: 4'Cl'2/.(/T County Y
(Snag Name. Numbe,s,Wmmunitx ten. Lee No- Tip Code)
3. OWNER: CLIQC/DL' CI)' (1jF)v
Address I /s/ /Oafrr5I 4 of
(Street or Rome No.)
flt-CrG jt/c. DEPTH
City or Town State zip Code From To
(_)- c 62_
Area code- Mom mmmber
4. DATE DRILLED 9 -i $ 5•
5. TOTAL DEPTH: 2 :Q S
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO or'
7. STATIC WATER LEVEL Below Top ofCasmg; C' 0 FT.
(Ua '+" if Abow Tap of Casing)
8. TOP OF CASING IS / FT. Above Lod Surfaces
'Tan of casing teendSMd atM below bed maW raps.
.sine 1. accordance wiu ISA NCAC 2C AIM
9. YIELD(gpm): ,.z.c METHOD OF TEST /biI2
10. WATER ZONES (depth):
c3o-/De)
rzi
Topographic/Land setting w o
C'JEidge (]slope [Valley °Flat ��
(check apprapdam box) rn ran
Latitude/longitude of well location en
(deer "dS) W —i
Latitude/longitude source:OGPSOTopograplii ma
(midday)
DRILLING LOG
Formation Description
/eCi Z;3S /J/ A
11. DISINFECTION: Type
12. CASING: Wall ci II ess
or weight/FL is necku numbers and COMM
40
Ftc / _ / j15' 71u 1 O
Mammal Method Il
,2c,7'
From ✓ To i 9 Ft.
Front To (et F
From lc(' To f ®±I
l3. GROUT: Depth
From To
Frorri_t To & Z
14. SCREEN: Depth
From To
FL
FL T�.Tys'/ Dry
i)waetEr SIMMSix if
FL in. in.
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Site
To Fi.
From
From
16. REMARKS:
To Ft.
Material
1 DO HEREBY CERTIFY THAT THIS
CONSTRUCTION STANDARDS, Art
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or Cotmty Roads. Include the road
dVc
i
oatrtes.
WAS CONSTRUCTED IN ACCORDANCE WTIH 15A NCAC 2C,
AT A COPY QF TJ$ RECORD HAS BEEN PROVIDED TO THE WELL
CONSTRUCTING THE WELL
DATE
INNER
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Man Service Center -Rdei ;NC
27699-1636 Phone Na. (919) 7333721, within 30 days. GW-I REV ; 07,42001 __-_
1.__ ._�_

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resauce-ssr - �Division of Water Quality - Geoundwater Section
WELL CONTRACTOR (INDIVIDUAL)NAME (prir. ,iy.S.t 1,Y CERTIFICATION Itraat
WELL CONTRACTOR COMPANY NAME )I) I C45-- LLI eCt-- I) IL i L2 ivi'Uettote s f 1 72 y-y5-9,
STATE WELL CONSTRUCTION PERMITS ASSOCIATED WQ PERMITS
(if applicable) Of applicable)
I. W ELL USE (Check Applicable Box): Raidcntial 0 Mmticipal/Public ❑ industrial 0 Agricuiturai ❑
Monitoring 0 Recovery 0 Heat Pump Water Injection ❑ Other 0 if Other, Lisl Use
2 WELL LOCATION;
Nearest Town: l itLet.--
upographic/Land seating
County ei I7tridge ❑Slope ❑Valley °Flat
(check appropriate box)
Latitude/longitude of well location
(Suit Name. Numbers, Community, Subdivision, Lot No., Tap Code)
3. OWNER:U(/1'k) /Hllo17�prt///l
Address 1 �U 14°X 1124
(Suer or Rase No.) S
/L1 goat//V, e � 74
City orTann State Zip Code
(7o7)- 757'-2///0
Area cede- Plate ember
4. DATE DRILLED r51' / %- 7
5. TOTAL DEPTH: 3's —/
6 DOES WELL REPLACE EXISTING WELL? YES 0 NO I
7. STATIC WATER LEVEL Below Top ofCasiag: a FT
(the'r if Above Top of Casing)
8. TOP OF CASING IS I FT. Above Land Surface'
flap efentag terairaa ulor blow Ind serfage requires a
radium a accordance with ISA NCAC 2C Alea.
9. YIELD (gpm): qi- METHOD OF TEST4 /
ice.,%K
10. WATER ZONES (depth): � , c` ' 20G
I I. DISINFECTION: Type. lfr\ "l1t Amomt a 07
12. CASING:
Depth Dierode
From To Ft.
From_ To 7/ FL
From "/ t To 15 Ft.,
13. GROUT: Depth Material Method
From To FL
From Q To 72 FL (-Lip
14. SCREEN: Depth Diameter
From To FL in.
From To Ft. in.
•
(depwhuim emeroods)
latitude/longitude sourcefGPS❑Topographlc map
(dtckbmc)
DBJWNG LOG
Formation Description
DEPTH
From To
p- af3
—12c
!} i2?'
n
lrfA
f,t
ry r-
„t
tV
W 2m
-a. XI.,"
LOCATION SKETCH o 27)
n%Show direction and distance in miles frokt•8t ;tail
Wall Thidora two State Roads or County Roads. inclufietbe%d
15. SAND/GRAVEL PACIC:
Depth
From To
From To FL
16. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WRH 15A NCAC 2C, WE -la
CONSTRUCTION STANDARDS, AND THAT ACOPY OFTHIS RECORD HAS BEEN PROVIDED TOTHE WELL!
(SIGN RE OF PERSON CONSTRUCTING THE WELL DATE
293256
or weighs t Mnterid numbers and common road mums.
���� � Sal-2zCa
d V'
•
B
eitt
21 Z
SIW Size
in. �( 1
iR
Size Material
FL
� _I
Submit the original to the Division of Water Quality, Groundwater Section,1636 Mal Service Center-IWgi NC
27699-1636 Phone No. [phone], within 30 days. GW-1 REV Oh2001

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL)NAME MI 4 .11)�C'EJ C% CERTIFICATIONS 2) 5p
WELL CONTRACTOR COMPANY NAME ..1 r S 1-1 c f V C LC Dr; L Z i N5 PHONE f f ) 72V�'1 "p
STATE WELL CONSTRUCTION PERMITS ASSOCIATED WQ PERMITt
(if applicable) (if arcade)
?93254
1. WELL USE (Check Applicable Box): Residential l� MuuicipalfPubliic 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water injection 0 Other 0 If Other, List Use
2. WELL LOCATION; ry iti . n A
Nearest Town: / 't a4LAn' County r - Dry (r'ux�
T6 f'S l -bt
(Sweet Name, Numbers, Community, Subdivision. Lot No-. Kip Code)
3. OWNER: VIIZ6ljlll�i'
Address RZ2 4a
(Street m Route Nal
fl4&t ei- 2,e+fz
City or Town Sate Zip Code
(_- qZt rf{c. 33
Ana code- Phone mm�ber 2 - a ' 4. DATE DRILLED
5. TOTAL DEPTH: 2 RS
6. DOES WELL REPLACE EXISTING WELL? YES NO 0
7. STATIC WATER LEVEL Below Top of Casing: L{ 7 FT.
(Use' W" if Above Top arming)
8. TOP OF CASING IS 1 FT. Above Land Surface`
flop areaaK Ie atimea altar Who trued avba repairs a
radiate Y aemrdaaee with ISA NCAC 2C .its.
9. YIELD (gpm): AY'S M OD OF TEST In
10. WATER ZONES (depth): a 2 1 to *A 1 2- 8S
Topographic/Land setting
Midge ❑Slope ❑Valley ❑Flat
(deckapprapriatebox)
Latitude/longitude of well location O
(depc hniaras/taoakas) or o
Latitude/longitude source:❑GPS❑Tapograpitic rreo
(dteckboa) rn Qm
DRILLUNOfryOO zm
Formation DescsiptioW,�„
>0
DEPTH
From To
— 7o A/itt
70 ^ ,)SS-
L� G
LOCATION SKETCH
11. DISINFECTION: Type e-to 4J E Amount it -in 7370 Show direction and distance in miles from at least
12. CASING: Wall Thickness two State Roads or County Roads. Include the road
Diameter or We igbVFr. Idatad rial numbers and cowmen road names.
From�_TOom 7 Ft (&Yr( Lo
From701To 'f 9 Ft. (- fly .4$.S1 4-et(
From_ To ` Ft.
13. GROUT: Depth
From To
From © To 2 2
14. SCREEN: Depth
From To
From To
15. SAND/GRAVEL PACK:
Depth
From To
From To
16. REMARKS:
Material
Method
FL fi'(.�tl�Ye
Demeter Slot Sine Material
Ft. in. in.
FL in. in.
Size
Ft.
Ft.
Material
g 4014 crc-tic /e-d
• Q
70
I DO HEREBY CERTIFY
CONSTRUCTION STAN
T THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C,
t
S, AND TAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWFIEIt--
SIGNATURcyOF PERSON CONSTRUCTING THE WELL. DATE
Submit the original to the Divisioa of Water Quality, Groundwater Section, 1636 Mani Service Center - Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-I REV. 07/3001

WELL CONSTRUCTION RECORD 293250
North Carolina - Dcpaturant of Environment and Natural Resources - Division of Water Quality - Groundwater Section
LL WECONTRACTOR (INDIVIDUAL) NAME (year) l
T A tZ IUi-fl CE CERTIFICATION a2/sit
WELL. CONTRACTOR COMPANY NAME J ii 5I-i CZ PRONE it (
STATE WELL CONSTRUCTION PERMITS ASSOCIATED WQ PERMIT'/
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential flwiicipal/Publc ❑ Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Ptanp Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION: , /�
Nearest Town: e�'QFd�/1,t� County /iiCZ)0,<�-"�
410 st 7)2r+ h
led
(Sued Name. Numbers, Community, Subdision, Int Nit Zip Code)
3, OWNER: S-u4r- /A.ht4'4>1
Address jNZO Qily.e [ ode
coined a Roame No.)
City or Town Sate Zip Code
4
Ara code -Place mother
4. DATE DRILLED / 9 _ p
5. TOTAL DEPTH- a S
6. DOES WELL REPLACE EXISTING WELL? YES ° NO
7. STATIC WATER LEVEL Below Top ofCastor
Tapofl ° /20 J 21'S
8. TOP OF CASING IS / rz- FT. Above Land Surface*
*To demure tennomed mkt law land asks nos m
variance in — with ISA
9. YIELD (gpm): g METHOD OF TEST /0/�
10. WATER ZONES (depth): fret G / 2°
11. DISINFECTION: Type eLOR'/t% Amount 4ROL
12. CASING:
r4
7tY%G 2
Wall Thickness
Depth Diameter or WeighlFL Material
FroO Tore (<yy' O ,P6•�-
FY To 1Y 6:" Tv S)4t k
13. GROUT: Depth Material Method
From To FL
Front Taal__ FL % i//i 0/�(l/�1IdOc'.l
14. SCREEN: Depth i3aokkr Slot Sim Material
in. in.
From To FL
FL
Ft.
From To Ft
Front__ To Ft._in. in.
15. SAND/GRAVEL PACK:
Depth Size Menial
From To FL
From To Ft.
16. REMARKS:
O
Topographic/Land setting rr*I
°Ridge ❑Slope INBifay °FIatca
(cheek sppreads box) W
Latitude/longitude of well location
Q r0
oreervonarautemenno) rn
S NZ
Latitude/longitude source:°GPS°Tapographanal '°
Meekban
DEPTH
From To
0
0
nA
m
c.5
DRILLtNO L0G
Formation Description
� 25• >ZI7 Ste ler-4
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. 1 road
moms and common road
0
R 't
ni
0
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH I5A NCAC 2C, WELL
CONSTRUCTION STANDARD$, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
(7
SIGMA 1JgtOF PERSON CONSTRUCHNG 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. OW -I REV. 0712001

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural(n�nR�esources - Division of Water Quality - Groundwater Sections�7�
`T1Ut l 1 0S.4-/Get CERTIFICATION #.ar/J t) [�
S�Sifcf tJ,tt bfr/L'+'t`i PHONE NJU`YJZcifQt1Yd
WELL CONTRACTOR (INDIVIDUAL) NAME (print)
WELL CONTRACTOR COMPANY NAME
STATE \YELL CONSTRUCTION PERMITS/ ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
WELL USE (Check Applicable Box): Residential UV-Municipal/Public ❑ Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use -G
0
WELL LOCATIOy /t14j
sp
Nearest Town::/Clount
/011/10
(y <.1",t/ 4,e
(Street Name. 4Numbers, Cortimum_ty, Subdivision, Lot No., Zip Code)
3.OWNER:Q/4J y9-1017cJ1/19
Address 52/ 1ted1* + dK
(Street or Route N ) 9 876 2-
City or Town State
(F25 )- 4q - 32 sae,
Area code- Phon umber
Zip Code
Latitude/longitude source:❑GPS❑Topograpic meg
(check box) 02
DEPTH DRILLING�60G o
From To Formation Description
A ©— /00
4. DATE DRILLED i _ .- °q /4.0-/RO
5 TOTAL DEPTH 440 5 / vein
6 DOES WELL REPLACE EXISTING WELL? YES 0 NO CIkr ,4 7 „ems
CI
Topogra c/Land setting IrT om
❑Ridgee ❑Valley ❑Ff3P Zm
(check appropriate box) N o <
Latitude/longitude of well locatio& yo
a m
7. STATIC WATER LEVEL Below Top of Casing: 6 FT. 200. z ‘,0
8. TOP OF CASING IS 1 FT. Above Land Surface"
"9Lo - 90
(Use "+" if Above Top of Casing)
'Top of casing terminated at/or below land surface requires a
34,,- I5-0
variance in accordance with ISA NCAC 2C .0118. 33-o - goo
9. YIELD (gpm): / Z. METHOD OF TEST A /K
10. WATER ZONES (depth): / 2 "OA
1I. DISINFECTION:TypeeketAe Amount (202 737.1
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
From 0 To /q 4 Ft. / c Po e-
Froml1{4 To?[6,s Ft. . 0 POG
Fro fv6 TIM_Ft. !oyy if2,6 SdeeL
13. GROUT: Depth Material Method
From To Ft.
From 0 To 20 Ft. Type ( }�Ow'PQA
14. SCREEN: Depth Diame er 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: Q r Y 5 i -ru d e 1 80
(degrees/minutes/seconds) w
293249
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.
2DO 32io-S, Ac`t
1 DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WEL
CONSTRUCTION STANDARDS, N/DTHAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL
SiG ATUI2E OF P SON CONSTRUCTING THE WELL
r
rrl
c
i
DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center -Ral,gh,. C
27699-1636 Phone No. [phone], within 30 days. GW-1 RE AN 001 N
flfc
1

WELL CONSTRUCTION RECORD
- Division of Water Quality - Groundwater Section O
North Carolina - Department of Environment and Natural Resources � � � ` CERTIFICATION rz7L�
WELL CONTRACTOR (INDIVIDUAL) NAME (print c" pCERT g %h y`�
/ C L O < < ✓r
♦YELL CONTRACTOR COMPANY NAME ASSOCIATED YYQ PERMITS
SPATE WELL CONSTRUCTION PERMITS (if a livable)
(if a icable) Agricultural I. WELL USE (Check Applicable Box): Residential E'1'MunicipaUPublic O Industrial 0
Monitoring 0 Recovery 0 Heat Pump Water injection 0 Other 0 If Other, List Use
2. WELL LOCATION: Fu ' County
Nearest Town: .,/�
3. OWNER:
Address
JX
City
/n `lolde Cc
Topographic/Land setting
ORidge Mope OValley OFlat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/wont)
Latitude/longitude source:OGPSOTopographic map
(check box)
nR {CLING LQG
F ation Description
-w i.J Q 8
E
From To
Armcode- Phone number Sn,
4. DATE DRILLED 1 ' O y
6. DOES WELL REPLACE EXISTING WELL? YES ElNO 5 5 n 3
5. TOTAL DEPTH: 34�
7. STATIC WATER LEVEL Below Top ofCasing:OI . —FT' �---
(Use "+w if Above Top of Casing)
8. TOP OFCASING IS
FT. Above Land Surface'
of
*Top of easing terwiwttal at/or below land surface requires a
variance In accordance with 15A NCAC 2C .0tla.
9. YIELD (gpm): _ 1E1 METHOD OF TEST
tp, WATER ZONES (depth):
(4 °U
11. DISINFECTION: Type(/�02,__—�{ — Amomt730—
Wall Thickness
Depth Diameter or Weight/FL
From To --- Ft.
From—Cr To Ft.
From_ To Ft.
13. GROUT: Depth FL
From To
From__ To Ft.
14. SCREEN: Depth Di er Slot Size Ft. in. in.
From To
From
To Ftin. in.
15. SAND/GRAVEL PACK: SizeMaterial
Depth
From To Ft.
From To Ft.
16. REMARKS: K 2
jj CC WffH ISA NCAC 2C, WELL
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRU
CONSTRUCTION STANDARDS NDTHAT ACOPY OFTHIS RECORD HAS BEEN PROVIDEDTOTHEWELLOWNER
�SlGNA I Urcc v,v�, ERSON CONSTRUCTING THE WELL
DAT (--
Section,
1636 Mail Service Center,hNC
12. CASING:
orm
o �
Material
Method
Material
c
H N zc�C
Show direction and distance in miles fromat lea rt
two State Roads or County Roads. includ�jhe rrn
�
numbers and common road names.
C...)
'Ral�
GW I III Y• 07J2001
Submit the original to the Division of Water Quality, Groundwater
27699-1636 Phone No. [phone], within 30 days.

WELL CONSTRUCTION RECORD
North Carolina - Dcpatutent of Enviromtat and Natural Resumes - Division off Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (prfat) CJ�rl. rt.j • �'L.5`}'I LE CERTIFICATION a,_$_/.L
WELL CONTRACTOR COMPANY NAME S (*IA ce IJy ELL l)fi 0-;l�)7 PRONE a (yyC1 ?Z 9-9 si$
STATE WELL CONSTRUCTION PERMIT., ASSOCIATED WO PERMIT.,
(if applicable) Cif applicable)
293247
1. WELL USE (Check Applicable Box): Residential W" MuticipaUPublic 0 Industrial 0 Agricultural O
Monitoring O Recovery 0 Hat Pup Water Injection ❑ Oder O If Other, List Use
2. WELL LOCATION:
Nearest Town: 'I- 6 nor+ County MCJ)o(,aetC.
/-(04 gtig VA;-k-iie/L (-Lew A r
(Saes Name. Numbers, Community,Sabdkissea. lot No.. Dp Code)
3. OWNER: Pf
ACE, 41 Ainl V . E TLC KS
Address l CI S M i-, Derr) on) 5$i of
10RL a,tioo (Street Route Na) L 3Z 803
City
( 9t � 7"_ 0,i i (bed Zip yz- Sl05-
Arca code- Phone number
4. DATE DRILLED S A'41 - U l
5. TOTAL DEPTH: 3 4 5
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO cr
7. STATIC WATER LEVEL Below Top of Casing: eG FT.
(Una "F" if Above Top etCasmg)
S. TOP OF CASING IS I FT. Above Land Surface`
'Top of casing terstireated infer Now lead surface . a
•.,Tunica in aaardaoce with ISA NCAC 2C Alt
9. YIELD (gpm): ! `t- METHOD OF
1(z-
10. WATER ZONES (depth): 12 cityn b o
11. DISINFECTION: Type ei-f-)16 Pi
12. CASING:
Depth
From U To l l 6 Ft
From (/,9 To 139 Ft. i
From k 3'7 To l iN Ft. /0 U�l
13. GROUT: Depth Material
From To Ft.
From_t_ ToZ FL 9 i r e 1
14. SCREEN: Depth Diameter
From To Ft in.
From To Ft
15. SAND/GRAVEL PACK:
Depth Sim
From To Fr.
From To Ft.
16. REMARKS:
Amount ca 02
Wall TMdmas
or Weigtii(PL Material
(o
Ys6 $ Ens
Method
Topographic/Land setting
°Ridge 1128lope °Valley °Flat
(cheek appioptate box)
Latitude/longitude of well location
Wepeedmiemestseconed
Latitde/longitude source:OGPSOTopographic map
td,cct box)
DEPTH
From To
/20-1(NO
t'Lwi Pad
Slot Size Material
in.
in.
(Material
//oo -?`/s'
DRILLING LOO
Formation Description
S BiI-aunt SC�pict
LOCATION SKETCH o 0
Show direction and distance in miles from at least
two State Roads or County Roads. Include thead
numbers and common road names. Co e m
03 o<
coy0
A
= =m
Q (Aam'
rn
r)
pjteLA)
n
C i I hhS e,uo r
Iie�G
Viet)
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE W17T115A NCAC 2C, WEL .
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
6A. 1\
SIGMA ARE
PERSON CONSTRUCTING THE Was 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. 074001
0
z

WELL CONSTRUCTION RECORD
North Carolina - Depamnent of Environment and Natural Resources - Division of Water Quality - Groundwater Section
;i3.8G
c,t ('amp 7r CERTIFICATIONa 21 313
WELL CONTRACTOR (INDIVIDUAL) NAME (print) Jamnc
WELL CONTRACTOR COMPANY NAME ('amp' R Wa11
STATE WELL CONSTRUCTION PERMIT'S
(if applicable)
& Piimp ('n T n r PHONE 2A) d51-7322
,...„ASSOCIATED WQ PERMIT'S
(if applicable)
1. WELL USE (Check Applicable Box): Residential Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring ❑ Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELLLOCATION: �4 ��e�
Nearest Town: aY) n n County i
ail%R /Yjenfink Ricci
(Street Name, Numbers, Community, Subdivision, Ldt No., Zip Code)
3. OWNER: Date `J1e tcU
Address ?iI !fi /'�Ie.yt-+iak Wa
l�e �I
(Street or Route No.) 1
ti� IC— �g76
try orTowy�-
_ �S Zip Code
((j cj '7 (r74 W f
Area code- Phone number . , f
4. DATE DRILLED /—�' 0 `+
5. TOTAL DEPTH: A.0 5
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO
7. STATIC WATER LEVEL Below Top of Casing: 4-o FT.
(Use "t" 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 vilib 15ANCAC 2C.0118.
9. YIELD (pm): / METHOD OF TEST Air
10. WATER ZONES (depth): / b O
11. DISINFECTION: Type ch.' nri na
12. CASING:
Depth r�
From p To J �- Ft. 6 -1 / 4
From To Ft
From To Ft.
13. GROUT: Depth
From—_ To 2 p Ft.
From To Ft.
14. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in.
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Size
From To Ft.
From To Ft.
Amount
Wall Thickness
Diameter or Weight/Ft.
SDR21
Material
Noat Cement
CTMP
Material
Material
PVC
16. REMARKS:
Topo hic/Land setting
❑Ridge lope ❑Valley ❑Flat: -
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topograpiiie ni4p
(check box)
PEPTU DRILLING To
From To Formation D�esch tio¢
52- 2D5 nylso)1dated rock
c
o
r
m
LOCATIONSKETCI-L ' crUs
Show direction and distance in miles frontak least
two State Roads or County Roads. Includetle roa
numbers and common road names.
I DO HEREBY CERTIFY THAT THIS WELL WAS C
CONSTRUCTION STANDARDS, AND THAT A�
ONSTRUCTED IN ACCORDANCE WITH ISA NCAC 2C, WELL
C6PY OF THIS RECORD HAS EEN PROVIDED TO THE WELL OWNER
SIGNATURE V ERSON CONSTRUCTING THE WE 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
to

293185
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) JampS CampJr CERTIFICATION# S
WELL CONTRACTOR COMPANY NAME
STATE WELL CONSTRUCTION PERMIT#
(if applicable)
1.
ramp I Wa11 & Primp erL Tnr PHONE#t7M) AS1-7322
ASSOCIATED WQ PERMIT#
(if applicable)
WELL USE (Check Applicable Box): Residential II Municipal/Public ❑ Industrial ❑ Agricultural ❑
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other 0 If Other, List Use
2. WELL LOCATION• j�
Nearest To �tY I ar Co�uunptyC /JD 14.1C
le ✓r e lid . nFF tN alKe
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
`C- 3. OWNER: /-14 LC,S/.rci(ti jQ.
Address (.c I O Da. r f- R
�' I
\ (Street or RopteCNo.) � .2s '7
\VI YJ� O
tA`y"I T47-- Zip Code
Area code- Phone number
4. DATE DRILLED / — j 5- D ij
5. TOTAL DEPTH: y' B 6-
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO
7. STATIC WATER LEVEL Below Top of Casing:
(Use "t" if Above Top of Casing)
8. TOP OF CASING IS 1 FT. Above Land Surface'
• *Top of casing terminated at/or below land surface requires a
variance in accordance with 15A NCAC 2C .0118.
9. YIELD (gpm): 3 METHOD OF TEST & 1 r
10. WATER ZONES (depth):
11. DISINFECTION: Type r' h 1 nr i n a Amount
12. CASING: Wall Tbiclmess
Depth or Weight/Ft. Material
From_a_To (s5 1 /4 SDR21 PVC
From To
From To
13. GROUT: Depth
From o___ To 2 0 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.
Diameter
Ft. 6
Ft.
Ft.
Material
Neat Cement
16. REMARKS:
Topophic/Land setting
❑Ridge MSlope ❑Valley ❑Fig
(check appropriate box)
Latitude/longitude of well locatipn
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topogphi mac j_` --
JEPTI-t
From To
n �/yc
‘-S 405
(check box)
DRILLTN
Formayation Description
(JArt
(Dfr14O'1) a ad YTc}K
0
r
tD
yV
3 �;o
JOCATION SKETCR N m�
Show direction and distance in miles fromat leas
two State Roads or County Roads. IncludSe re?d
numbers and common road names.
1
1 DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT, COPY OF THIS RECQRD HAS BEEN PROVIDED TO THE WELL OWNER
SIGNATURF PERSON CONSTRUCTING THE/A/E
2— IL —D tf
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

203181
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) Sa me s ur Cai"r, 7r CERTIFICATION # 211R
(;amp' rr Wszil1 & Pump f n Inr PHONE #$7Al 4S1-7322
_ASSOCIATED WQ PERMIT#
(if applicable) -
WELL CONTRACTOR COMPANY NAME
STATE WELL CONSTRUCTION PERhIIT#
(if applicable)
1. WELL USE (Check Applicable Box): Residential IV 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: U l c k t county I r (.00 ti P i
i4.35 L./Ile Min . /CA
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: 144l ✓ o I CI Pt,l f t a wv
Address %-vile IVIi-n. kel
C0Ici 1V7I (StreetotlRoote
City or Tow State
(2-- - 3 I S N
Zip Code
Area code- Phone number
4. DATE DRILLED /
5. TOTAL DEPTH: I
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO Jdl
7. STATIC WATER LEVEL Below Top of Casing: 3-5—
(use "+" if Above Top of Casing)
8. TOP OF CASING IS 1 FT. Above Land Surfaces
• *Top of casing terminated at/er below land surface requires a
variance in accordance with 15A NCAC 1C .0118.
9. YIELD (gpm): 2,U METHOD OF TEST a; r
10. WATER ZONES (depth): / 4 S
11. DISINFECTION: Type Chlnrina
12. CASING:
Depth Diameter
From___( To 5.5 Ft. 6 1 / 4
From To Ft.
From______ To Ft.
Amount 1/. C u p
Wall Thickness
or Weight/Ft. Material
'DR21 PVC
13. GROUT: Depth Material Method
From_g To 2 0 Ft.
From To Ft.
Neat Cement Hand
Topo 'Q./Land setting
❑Ridge lope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds) -
Latitude/longitude source:❑GPS❑Topographic_tna�
(check box) n
RULING LCIG
Formation Descnphnn-
$4Kc t✓lam
MEM
From To
n h3
6-5" i lac colt5o1 atd rock
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:
Material
•r
LOCATION SKETCK rn
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common road names.
0
_
m
G
2
iu ok:i Fr. go
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THATt COPY OF THIS ICORI) HAS BEEN PgOVIDED TO THE WELL OWNER
'll/x/rvtei /rL (� , 16 —011
DATE
SIGNATURE' OF PERSON CONSTRUCTING T
Submit the original to the Division of Water Quality, Groundwater Section,1.636 Mail Service Center - Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-1 REV. 07/2001

From: Carolina Well Ditile:s .;no To: NC Dept of Env. and Na Resour Date: 211o"i2034 Time: 8:38:22 PM
Page 4 of 4
WELL CONSTRUCTION RECORD 293113
North Carolina - Deoarment of Environment, and Natural Resources - Division of Water Quality - Groundwater Section
WELI, CONTRACTOR (INDIVIDUAL) NAME (print) SCOTT GANTT CERTIFICA T iON # 2=S4
WELL CONTR 1CT. OR COMPANY NAME CAROLINA WELL DRILLERS, INC. PHONE # [phone]
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
1. WELL LSE (CI1::c Applicable Box) : Residential ❑ Municipal ❑ Industrial ❑ Agrionfn:ral ❑ fA oniterirg ❑
Recovery E Heat Pump Water Injection ❑ Other ❑ If Other, List e
2. WELL LOCATION-
Nearesttown: Majcio'N County McDOWELL
LOT65 GRANTS .FOUNTAIN
(Street Name. Nutr re, Cdans:mr.. Subdivision, Lot Not. Zip Code)
3. OWNER DAWNFi1ZGERALD
Topographic 'Land setting
1-1 Ridge ❑ Slope ❑ Valley 7 Flat
La tulle i onaitede of well location
353y.165 18i5S 615
(degAtast minuted hercu .;1
ADDRESS LOT 65 GRANT MTN ESTATES Lattice longitude source: ❑ GP Tc_ camphic map
Gm,: or Rxe No.)
MARION
Cry or Town
704-542-4721
NC
State
Area Code - Pitons
-1. DATEDRILLE)
5. TOTAL DFP'fli
6. DOES WELL RE:'L.;CE
5,0+
.S10NG'.VELL.
7. STATIC WATER LE.I EL Seiot: Top of Casing:
Zip Code
TES ❑ NO 72,
240 ET.
/we """ IfAbovc Top of Casino)
a. TOP OF CASING 1S - ET. Above Land Surface"
"Top of casing tomtit:ldow la
nd and earfacc :ernes a vananccin
:r
areordancewith 15A NC - 2,'.0.'.S
9. YIELD (ep:ur 1 CLOD OF TEST ARDM
10. WATER ZONES :p'. 75C
DEPTH
From To
DRILLING LOG
Fora.-_n Dso .oxen
0 40 Clay
40 760 Co:roidzted Rock
11. DISINFEC:..0t i 2E HY?OCHLORITE
12. CASING:
D.cti. Diameter
From 0 U:, 48 Ft 61/4"
13. GROUP:
From 0
14. SCREEN
r^.
t v
—
_� rm
CO cry
Amount 16 0z LOCATION SKETCH
Wall "thickness Show r rec7_n and distance in miles from aI lea
or Weight/Ft Material
SDR21 PVC
Material Method
To 20 Ft. GRAVEL MIX GRAVITY
ne.iy
From N.A To
15. SAND/OR.AVET
D14)1:1
From NA To
16. REMARKS
Ft.
Diameter
in.
Slot Size Material
Size Material
CD wed.
J m
-4c
mrn
m
cnz
two StarT;.ers or County Roeds. Include -_2o r:Ot) r.rw
numbers and concnon road names. e�
W --4
O Y
rr
L
r
V
1 DO HEREBY CLdil TI-LAT THIS WELL WAS CONSTRUCTED IX ACCORDANCE WITH lH 1 A XCAC 20, WELL
CONSTRLCTII'..,. -. DAR,_)S, AND THAT A COPY OF THIS RECORD HAS BEEN Pr .D TO THE WELL C:VNHR
;i16 G4
SIGNATURE OF PERSON CONSTRUCTING THE t+Ef:. Dine
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Servica center - Raleigh, NC
27699-1636 Phone No. [phone], within 30 days.
Rai
ET' -I %... 0-:21,01 1

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) 0 aea
WELL CONTRACTOR COMPANY NAME /I.() I / C.
STATE WELL CONSTRUCTION PERMIT# a
(if applicable)
,'' /11%� I �
��) CERTIFICATION # a l e.?
WC, Ik, —a. PHONE d IGid '-+-'� /ts
ASSOCIATED WQ PERMIT#
(if applicable)
1. WELL USE (Check Applicable Box): Residential l' Municipal/Public 0 Industrial ❑ Agricultural ❑
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use
2. WELL LOCATION:
Nearest Town: a / ) )° f County „tea ku tl
//2 8 s:'JVeit [.)P./t"ir Pc)
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER:
AddressititzLik
d (Street or Route No.)
all A},t
City or Town State Zip Code
GGY- Sz 27
Area code- Phone number
4. DATE DRILLED— 2 d - b j
5. TOTAL DEPTH: / / $' . �
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO 1:3
• 7: STATIC WATER LEVEL Below Top of Casing: *c_a_FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS / FT. Above Land Surface*
- *Top of casing term. iated at/or below land surface requires a
variance in accordance with ISA NCAC 2C .0115.
9. YIELD (gprn): 2' METHOD OF TEST
10. WATER ZONES (depth): / O j-'r
trui
Afliza
11 DISINFECTION: Type CA k''/ Amount
12. CASING: Wall Thickness
Depth Di meter or Weight/Ft. Y aterial
From 11101 To f Ft. . 5. ,Pc:,_
From To Ft.
From To Ft.
13. GROUT: Depth Material Method
From/ To ,2 0 Ft. e G,[i1-
Frem 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
DRidge fl lope DValley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees mi:utes'seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From To Formation Description
r
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common road names.
d l) bfr r rcr1.R.e
I
alj
Lc,4Xc ticart sA L/z Y
t.r5 c < c, t Re) eC
u)e, 1/ j v 3 ci4 ?e Age- t.c.I
2c Jddcc /t4 11' h-
16. REMARKS:
W �rn
--.:
N >0
mC7
ana
(V m2
Q
..
I DO HERF:I3Y CERTIFY TIJAT THIS WELL WAS CONSTRUCTED TN ACCORDANCE WITH ISA NCAC 2C, WELL
CONSTRUCTIONNTANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED.TO THE WELL OWNER. _ .. -
c,
.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

i
Center Raleigh, N.C. n27699-16316-Pho e (919) 7333221sources - n of Water Quality - Groundwater Section
1636 Mali Service e ter
WELL CONSTRUCTION RECORD WELL CONTRACTOR CERTIFICATION #: 1>.43 3
STATE WELL CONSTRUCTION PERMIT#:
2)(nr 2
1. WELL USE (Check Applicable Box): Residential& Municipal ❑ Industrial ❑ Agrlcullura
Recovery ❑ Heat Pump Water Injection ❑ Other If Other, List Use:
2. WELL LOCATION: (Show sketch of "'ration below)
Nearest Town: 6 /d i D County: za
//ays;/veAo IcApd.
(Road Name and Numbers, Community. or Subdivision and lot No.)
3. OWNER X 4 )' R1y
Address / (Stoolornome)J i _ ,
b id ray-3- � . c. ? Yen ,
City or Town 4 Ste.e Zip Code
4. DATE DRILLED
5. TOTAL DEPTH / t
6. CUTTINGS COLLECTED YES f NO[9--
7. DOES WELL REPLACE EXISTING WELL? YES f NO Pr.
8. STATIC WATER LEVEL Below Top of Casing: 6 't FT.
(Use'+' 11 Above Top o1 Casing)
9. TOP OF CASING IS 1 FT Above Land Surface'
*Top of casing terminated aVor below land surface requires a variance In accor-
dance with 15A NCAC 2C .0118 h
10. YIELD (gpm): -3 METHOD OF TEST, f�- Jc
11. WATER ZONES (depth). / .3 b T
DRILLING LOG
From To
12. CHLORINATION: Type /'-/T .P%)I. AmountA//,)4f
13. CASING:
Wall Thickness
Depth D meteror Weight/Ft. Aj•aterg`
From —To el' of Ft ,I• a
From To Ft.
From To Ft
14. GROUT:
Depth
From To
From To _
15. SCREEN:
Depth
From To _ Ft
From _ To Ft
From _ To Ft
16. SAND/GRAVEL PACK:
Depth
From To
From To
17. REMARKS:
Material Method
Ft C'. -c,t(e /
Ft
Diameter Slot Size
in
in
In
Size
Fi
Ft
Material
In
In
In
Material
CI
.r am
rrt
r v=
N
If additional space is needed use back of form
LOCATION SKETCH
(Show direction and distance from at least two State
Roads, or other map reference points)
AA D/c? l=aR
f{ : if A 9), 716-42- /tc f7` /?u
/`02 r s i, ! de 11 &IQ l c JL'
paste
.zt,lc s
Lr. Ji 'Ci
Wei( ! <- G J C 7-0.01 -g
//
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY F THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER.
f/-'.>'
i. ,.� � ,{ter t .1 �
SIGNATURE OF P SON CONSTRUCTING THE WELL DATE
Submit original to Division o1 Water Quality, Groundwater Section within 30 days GW t REV. 12/99
FOR OFFICE USE ONLY
Quad No:
Serial No

295404
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 ❑ Industrial ❑ Agricultural ❑
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use
2. WELL LOCATION:
Nearest Town: NEBO County MCDOW
BASSWOOD DR.
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: KAREN MORGAN
Address 151 BASSWOOD DR.
(Street or Route No.)
NEBO NC 28761
City or Town State Zip Code
(8) - 652-3198
Area Code Phone number
4. DATE DRILLED 05/10/04
5. TOTAL DEPTH: 265
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): 50 METHOD OF TEST ARD
10. WATER ZONES (depth):
11. DISINFECTION: Type CHLORYTE Amount 6.5
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
From 0 To 70 Ft. 6-1/4" SDR21 PVC
From To Ft. _
From To Ft.
13. GROUT: Depth Material Method
From 0 To 20 Ft. QUIKRETE POURED
From _ To _ Ft.
14.SCREEN: Depth Diameter Slot Size Material
From _ To _ Ft. _ in. _ in.
From _ To _ Ft. _ in. _ in.
15. SAND/GRAVEL PACK:
Depth Size Material
To Ft.
To Ft.
From
From
16. REMARKS:
Topograpbic/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. #226 N. FROM GOLDEN VALLEY. RIGHT
ON ROCKY PASS CH. RD. GO 1/2 MILE. LEFT
INTO NORTHWOOD ESTATES. TAKE 1ST LEFT
ON BASSWOOD. LOT STRAIGHT AHEAD AT CUL-
DE-SAC.
;
•
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUC IED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
SIGNA OF PERS CONSTRUCTING WE ADATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-1 REV. 07/2001

295381
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment And Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) ROBIN MCNEELY CERTIFICATION # 2567
WELL CONTRACTOR COMPANY NAME PITTMAN WELL BORING. LLC PHONE # [phone]
STATE WELL CONSTRUCTION PERMIT # ASSOCIATED WQ PERMIT #
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential ►l Municipal/Public ❑ Industrial ❑ Agricultural ❑
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use
2. WELL LOCATION:
Nearest Town: NEBO
WALNUT GROVE DR.
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: JOHN NEWTON
Address WALNUT GROVE DR.
(Street or Route No.)
NEBO NC 28761
City or Town State Zip Code
(828) — 652-6122
Area Code Phone number
4. DATE DRILLED 05/21/04
5. TOTAL DEPTH: 36
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO
7. STATIC WATER LEVEL Below Top of Casing: 20 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): 16 METHOD OF TEST STEEL TAPE
10. WATER ZONES (depth):
County MCDOWL
11. DISINFECTION: Type CHLORYTE Amount 7.36
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
From 0 To 36 Ft. 24" CEMENT
From To Ft.
From To Ft.
13. GROUT: Depth Material Method
From 0 To 20 Ft. CEMENT 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 20 To 36 Ft. 78M GRAVEL
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. #226 N. FROM GOLDEN VALLEY. RIGHT
ON ROCKY PASS CH. RD. APROX. 2 MILES.
RIGHT ON WALNUT GROVE DR. RIGHT AT
FORK. NEW DRIVE GOES STRIAGHT AT DEAD
END.
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUC1ED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRICTION STANDARDS, AND THAT A COPY O S RECORD HAS BEEN PROVIDED TO THE WELL OWNER
N C a S UCTTIING D TE
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

302051
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (prim) Ja mL eS ' Camp Jr CERTIFICATION# 21 -iR
WELL CONTRACTOR COMPANY NAME Camp' c telel l R primp en Tnn PHONE #(67R) d5'_7322
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential 0 Municipal/Public 0 Industrial 0 Agricultural tr-
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION:
Ne8%est Town: tt/UN%
J.t AV., KA.i
(Street Namia,Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: Nrio M
Address 3 '1 U Y )YU f lc fI
(Su or oute No.)
• GIVIDVl NC ,+7) 52
City or Town State Zip Code
(S23)- 11R—g6.I1,
Area code- Phone numbs(-,
4. DATE DRILLED etas • b L\
5. TOTAL DEPTH: 0 S
6. DOES WELL REPLACE EXISTING WET T 9 YES 0 NO IA
7. STATIC WATER LEVEL Below Top of Casing: C FT
(Use "+' if Above Top of Casing)
8. TOP OF CASING IS 1 FT. Above Land Surfaces
• *Top of casing terminated at/or below land surface requires a
tvariance in accordance wit 1SA NCAC 2C .0118.
9. YIELD (gpm): METHOD OF TEST p i r
10. WATER ZONES (depth): eg
11. DISINFECTION: Type ('h 1 nr i np Amount Ci A )
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
Ft 6 1 / 4 RDA21 PVC
Froth_ To 1 S—
From To Ft.
From To Ft
13. GROUT: Depth
From_p To 2 0
From To
14. SCREEN: Depth Slot Size
From_ To in
From To in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
Material Method
Ft. N 3t Cement Hand
Ft.
Diameter
Ft. in.
Ft. in
County 'M ( e f!1A.fP.CJ�
Topographic/Land setting
❑Ridge ❑Slope Qa11ey ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(Check boa)
DEPTH DRILLING LOG
From To FS �aanon Descridogg.,,
n l l �1 u f dotal o�t�e�l
13 • d-0 S AAk.PNA
i
T
ni
v -orn
'v o �
5 OCATION SKETCH nit"
Show direction and distance in miles from at least ▪ nt
two State Roads or County Roads. Include the road.
numbers and common road names. ▪ trip
T n
16. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUC I hD IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THATjP COPY OF THIS R6EE/COR D H/A/^�/�BEE�Ny/PRO (VI{��ED TO TIES WELL OWNER
•
SIGNATURi'aF PERSON CONSTRUCTING THE WELL // DATE �' O
•
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center -Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. - OW -I REV. 07/2001
•

WELL CONSTRUCTION RECORD
302050
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) J a meS C amp , Jr CERTIFICATION s 2 1 'I R
WELL CONTRACTOR COMPANY NAME ('amp' a Wa11 R Pump rn • Tnc PHONE #$2R1 dY7-7322
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential t13' Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2, WELL LOCATION: f�
Nearest Town:
\\ 9u County MC titfSllAo
11
(Steer Name, Numb Community; Subdivision, Lot No., Zip Code)
3. OWNER: 11 � `\
Address
(Streets or Route o.) ,j\4
City or,T owo State_
Zi Co e
($a`6)• lelq(- -bl Ct D #
Area code- Phone numb
4. DATE DRILLED \ . c 4 •OL\
5. TOTAL DEPTH: n S
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO al
7. STATIC WATER LEVEL Below Top of Casing: ,.2 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 1SA NCAC 2C .0118.
9, YIELD (gpm): 1 D0 #' METHOD OF TEST n 1 ,-
10. WATER ZONES (depth): 1 L p
11. DISINFECTION: Type r h 1 n r I n a
12. CASING:
Depth Diameter
Frotn_0 To CS Ft. 6 1 / 4
From To Ft
From To Ft.
13. GROUT: Depth
From Q To .2 0 Ft.
From To Ft.
14. SCREEN: Depth Diameter
From To Ft. in
From To Ft. in.
15. SAND/GRAVEL PACK:
Amount (f
Wall Thickness
or Weight/Ft. Material
GBB.'l PVC
Material Method
Neat Cement Hand
From Ft. \ n
From Ft. CL .,�
16. REMARKS: ^ ��
Slot Size Material
in.
in.
Size Material
Topographic/Land setting
URidge ❑Slope DValley DF1at
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:DGPSDTopographic map
(check box)
DRILLING I,Ofi
F_ omta�on Description
DEPTH
From o ss
n
Ss_ ras S nsaD Cut
O
rri
-O
LOCATION SKETCH N
Show direction and distance in miles from at leastC
two State Roads or County Roads. Include the roa4,.
numbers and common road names.
ow ws-
Depth
To
To
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH I SA NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A POYY OF THIS RECORD FjAS B,FEN PROVIDE TO THE WELL OWNER
SIGNATURE OF'P'ERSON CONSTRUCTING THE
prcrOtj
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
CT.

WELL CONSTRUCTION RECORD
North Carolina - Deparunent of Environment and Natural Resources - Div,ision of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) James m Caml'r Tr CERTIFICATION it 21 3A
WELL CONTRACTOR COMPANY NAME C'smp' a WP11 R Pnmp f'n
STATE WELL CONSTRUCTION PERMIT#
(if applicable)
Tnr•
302046
PHONE #ffi9Al d53-7322
ASSOCIATED WQ PERMIT#
(if applicable)
1. WELL USE (Check Applicable Box): Residential CIvfunicipal/Public ❑ Industrial 0 Agricultural ❑
Monitoring 0 Recovery ❑ Heat Pump Water Injection 0 Other ❑ 1f Other, List Use
2. WELL LOCATION: (� ,
Nearest Town: county
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: gOtrO.A. t 0w t
(AYA 1 A al _ A(Sheet orRouteCNow)1L4�.t
City or ToRwwn J.t State Zip Code
Address 5' \iV tny&.4 u CA.
($X)- - RI LK
Area code- Phana number
4. DATE DRILLED lc- W. O -
5. TOTAL DEPTH: S V C
6. DOES WFT 1 REPLACE EXISTING WELL? YES ❑ NO I;9.
7. STATIC WATER LEVEL Below Top of Casing: \/ U FT
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS 1 FT. Above Land Surface*
`Top of casing terminated ac/or below land surface requires ■
variance In accordance with 1SA NCAC 2C .0118.
9. YIELD (gpm): \oll-- METHOD OF TEST air
10. WATER ZONES (depth): C 3 (7
11. DISINFECTION: Type rh 1 nr i np Amount C .Q
.12. CASING: Wall Thickness
Depth Diameter or Weight/Ft.
From_0 To \ty Ft. 6 1 / 4 g9@.21
From To Ft.
From To Ft.
Material
PVC
13. GROUT: Depth Material Method
From,_ To 2 0 Ft.
' From To Ft.
Neat
Cement Hand
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 INVIat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From b fm
To
Coatlon D2cshcriptign
�{ Lra mm��99
l,y S y_s .��AAAA
LOCATION SKETCH y
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road "
numbers and common road names. Cr
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT AAPY OF THIS RECORD HAS BEEN PROV ID9 D TO THE
WELL OWNER
t
Lvrr Kim 0. OJAI
SIGNATURE PERSON CONSTRUCTING THE W
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

30204'7
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) James To Cawp, Jr CERTIFICATION, 21 7R
WELL CONTRACTOR COMPANY NAME ('arnp' a Wa11 R Pnmp ('n Tnr' PHONE 1/62R) 457_7322
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT,
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential ' Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION:
N ar st Town:
a-k9
(Stint Name, Numbers,
, Community, -Subdivision, Lot No., Zip Code)
3. OWNER: VYIA l /{_
Address G � � n1 i& �l�,r�,n lJ
(Street, utf N' c 7c rs
AMcode-
o�el t
O $alga Zip Code
Area -code- Phone number `! �
4. DATE DRILLED - el. 0
5. TOTAL DEPTH: U
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO
7. STATIC WATER LEVEL Below Top of Casing: (/
(Use "+" if Above Top of Casing)
8, TOP OF CASING 1S t FT. Above Land Surface*
`Top or casing terminated atlor below land surface requires a
-variance In accordance with 1SA NCAC 2C .0118.
9. YIELD (gpm): \ WY-S.— METHOD OF TEST n `> I
10. WATER ZONES (depth): l u C
,ts�
County l pl ( O uu.r,
11. DISINFECTION: Type Ch 1 nri na Amount CELAA'
.,12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
From_p_To 1.0 Ft.6 1 /4 SDR21 PVC
From To Ft.
From To Ft.
13. GROUT: Depth
From_a___ To '2 0 Ft.
Material
14 cit
Method
Ccmcnt Hand
' 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 B'Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH FRILLING LOG
From T V FiR tion D cription
U
10 . LI�tl
(Just,
cyl
t
rr-1
—O
c
J.00ATION SKETCJI
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common road names.
Gu
16. REMARKS•
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WJTH I SA NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A PY OF THIS RECORD HAS BEEN PROVID_
SIGNATURE PERSON CONSTRUCTING THE
TO THE WELL OWNER
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

299408
WELL CONSTRUCTION RECORD
North Carolina - Deparnnent of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) Ja mns r.r Carp, Jr- CERTIFICATION N 71 3R
R WELLCONTACTOR COMPANY NAME Camp' c Wa11 R Primp en__Tnr PHONE "67R) AS3-7322
STATE WELL CONSTRUCTION PERh11TN ASSOCIATED WQ PERMITl _
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential GI 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
v: n (�
Town: Vi0 County%'IcDotr.�f'
err EV1 1 e.5
(Street Name, Numbers,Community, Subdivision, Lot No., Zip Code)
3. OWNER• W, I it Reler'Ser1
Address 37 5tl,irte_ A l,ie
E (Sneer or liotNo.) c 1?d
City or Town
Sure
Zip Code
0,124- %fit-r/6S5
Area code- Phone number ..//
4. DATE DRILLED - D
5. TOTAL DEPTH: 2 tic
6. DOES WFM I REPLACE EXISTING WELL? YES CI NO A
7. STATIC WATER LEVEL Below Top of Casing: FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING 1S 1 FT. Above Land Surface"
`Top of cuing terminated at/or below land surface requires a
variance In accordance with ISA NCAC 2C .0118.
9. YIELD (gpm): 100 METHOD OF TEST p lr
10. WATER ZONES (depth): Afh
11. DISINFECTION: Type rhlnrinn
12. CASING:
Depth Diameter
From p To Ft. 6 1 / 4
From To Ft.
From To Ft.
13. GROUT: Depth Material
From_a___ To 2 0 Ft.
' From To Ft.
Amount I Cup
Wall Thicimess
or Weight/Ft. Material
SDR21 PVC
Plant Cclacnt
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-
Method
Hand
/ Topographic/Land setting
[;aRidge ❑Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:OGPS❑Topographic map
(check box)
DFPTH DRILLING LOG
From To ormation Description
40 dirt/ 54n.t-el
/f-n �5 eDn5olidated rocK
0
t\)
LOCATION SKETCH p
Show direction and distance in miles from at 1e3t
two State Roads or County Roads. Include the road
numbers and common road names.
Slot Size Material
in.
in,
1r
V
C"D
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A QPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
6Z411-144-- /�•
PERSON CONSTRUCTING THE
i
SIGNATURE
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
llLk

300706
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) James s-> Carnr, Tr CERTIFICATION N 211B
WELL CONTRACTOR COMPANY NAME ramp' ¢ Wa11 & Primp Pn Tnr
STATE WELL CONSTRUCTION PERMIT,/ ASSOCIATED WQ PERMITW
(if applicable) (if applicable)
PHONE :$2Al d5"i_7322
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. WELLLOCATION•
Nearest Town: _
Lei 6R 'id ,-n kes %154rj- it e
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code) epmryt
D
3. OWNER: A.-1 e 41 m5
Address 273 14.) S6 'f'ti btJRY
„ifSneer or Route No.)
CT D nqs FL 33o1.
City or Town Stand Zip Code
Coun
Area code- Phone number ^
4. DATE DRILLED ,!
5. TOTAL DEPTH: 4575
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO A
7. STATIC WATER LEVEL Below Top of Casing: 30 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING 1S 1 FT. Above Land Surface*
'Top of casing terminated arior below land surface requires a
variance in accordance with 1SA NCAC 2C .0118.
9. YIELD (gpm): IOC t METHOD OF TEST pir
10. WATER ZONES (depth): 4 5-5
11. DISINFECTION: Type rh 1 nr i n a
12. CASING:
Depth Diameter
From_ To_ Ft. 6 1 / 4
From To Ft.
From To Ft.
13. GROUT: Depth
Frort>_o_ To 3 0 Ft.
From To Ft.
Amount . CL-i S
Wall Thickness
or Weight/Ft, Material
SDR21 PVC
Material
Neat Cement
Method
Hand
14. SCREEN: Depth Diameter Slot Size Material
From To Ft. in in.
From To Ft. in, in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
16. REMARKS:
/Topographic/Land setting
Midge ❑Slope DValley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check boa)
DEPTH DRILLING LOG
From To Formation Description
511 455- caticuarixayArrrt
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 0 THIS RECORD HAS $EEN PROVIDED TO THE WELL OWNER
L1Jf
SIGNATURE OF PERN CON
STRUCTING TRUCTING THE WELL / DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center - l;alei (t, tilC v
27699-1636 Phone No. [phone], within 30 days. GW-1 RTY.7/200I'`=
O
tip
Z L
0
yo
rn
Z
opti p10C
t,)
J'', rr•

303325
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (f iDIVIDUAL)NAME (prL1) 2
�VS�tJs we. LC,br L.-Ct61 PHONE af$zt72Y-<(Csie
WELL CONTRACTOR COMPANY NAME
CERTIFICATION a
STATE WELL CONSTRUCTION PERMITS ASSOCIATED WQ PERMITS
(if applicable) (if applicable)
I. WELL USE (Check Applicable Box): Residential unicipal/Public 0 Industrial 0 Agricultural 0
Monitoring ❑ Recovery 0 Heat Pump Water Injection ❑ Other ❑ If Other, List Use
2. WELL LOCATI2^11P opographic/ and setting
Nearest Town: ► n Mai LC1-. County (t'lita ICdge °Slope (]Valley °Flat
:j (check appropriate box)
(Sum Name.
nNN111umbers ✓ao-- 'vision, `` vTp ode) Latitude/longitude of well location
3. OWNER:grnjo. givi awl,
rjr7o &C 4w4 avavSYI 0
Caner i Subkvisi la NoSip
Address 75 Ti a- el
i�Q.r�aN
(Sued or
ems) 2S75-2-
City or Term State zip Code
6aSS?- (ns2 f0t7
At., cads- P�aa wrtbv
4. DATE DRILLED g—) %- a'if
(aepe sta imettyseemdt)
Latitude/longitude smuce:°GPS°Topographic map
(dick tox)
DRILLING LOG
Formation Description
DEPTH
From To
D - 5a
5. TOTAL DEPTH: <Ltt O 3t7 -
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO uv
7. STATIC WATER LEVEL Below Top of Casing: /013 FT.
(Use w^ if Above Top of Casio&
8. TOP OF CASING IS FT. Above Lead Surface'
'Tap Measly termtetd mho below bead surface regains a
variance la armrdssee Ma 1SA NCAC 2C .0115.
9. YIELD (gpm): tab° METHOD OFTEST /a !tc
10. WATER ZONES (depth): 1 gervi a SC
2q9 ce 38o
11. DISINFECTION: Type a talc; Ai -se Amomtt 9102 75%
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft Mamie)
From To Ft
From_Q_To 54 Ft 01(i _o PV C
From_Tom_Ft- (OHej 1'cAR ()q/V
13_ GROUT: Depth
From To Ft
From To 2S FL �J120
14. SCREEN: Depth Dyer Slot Size
From To Ft in. in.
From To Ft- in. is
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft-
Material Method
16. REMARKS:
I DO HEREBY CERTIFY THAT THIS
CONSTRUCTION STANDARDS, A
SIG
D, rzr
C%b ca eyg fin+.
O
LOCATION SKETCH r.,3 - c�
Show direction and distance in miles froma-2 least
two State Roads or County Roads. Include -ye roadr -
mmbers and common road names.
LOS(%(0,
0
chcilbesE
(o 9-.1
WAS CONSTRUCTED 1N ACCORDANCE WITH 15A NCAC 2C, WELL
THAT A COPY OF THIS RECO' a HAS BEEN PROVIDED TO THE WELL OWNER
TURE
CONSTRUCTING THE WELL DATE
Submit the original to the Division of Water Quality, Groundwater Section,1636 Mal Service Center- Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-1 REV. '07/2001

297511
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) Tames or Cawr, Jr CERTIFICATION R 71 3R
WELL CONTRACTOR COMPANY NAME Clamp ¢ Wal 1 R Pimp CrL Tnc PHONE W$7R) 453-7322
STATE WELL CONSTRUCTION PERM1Tp ASSOCIATED WQ PERM1Tj
(if applicable) • (if applicable)
1. WELL USE (Check Applicable Box): Residential " Municipa1Public 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCAT ON:
Ne zs $r t Tgwn:
t t`�...0
M 4lig
-
CrutySiC f7smiQ
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: li l tt Q ?i tin
(�/v`
Address y3 N k � �� •
t(Street or Route No.) 0-%I J rC
h 10
City or Town State Zip Code
( Area code- Phone numbef
4. DATE DRILLED \r Q. 0
5. TOTAL DEPTH: \-k Ck �
6. DOES WELL REPLACE EXISTING WELL? YES ° NO th
7. STATIC WATER LEVEL Below Top of Casing: 1/41.c FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS 1 FT. Above Land Surface"
*Top of casing terminated actor below land surface requires a
;variance In accordance with 13A NCAC 2C .0118.
9. YIELD (gpm)' \ 001' iv} THOD OF TEST nit
10. WATER ZONES (depth): -\,S
11.DISINFECTION: Type rhlnrina Amount ClA43
12. CASING: Wall Thickness
Diameter or Weight/Ft. Material
gna71 PVC
Dep
From p To 1.0"l Ft. 6 1 / 4
From______ To Ft.
From To Ft.
13. GROUT: Depth
From p To 2 0 Ft.
From To Ft.
Material
Neat Cement
Method
Hand
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
gage °Slope °Valley °Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:OGPSOTopographic map
(check box)
DEPTH PRILLING LOG
From ,Tg /EclrmationD ription d
l
was
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.
W
O
16. REMARKS•
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
SIGNA FPERSONCONSTRUCTINGTHEWELL
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) Tamns W Camp, Jr
WELL CONTRACTOR COMPANY NAME Camp' c Wall R Primp rn
CERTIFICATION # 2 1 R R
Tnc PHONE if$ R) d5Y_7322
STATE WELL CONSTRUCTION PERMIT/ ASSOCIATED WQ PERMIT" (if applicable) • (if applicable)
1. WELL USE (Check Applicable Box): Residential` J(t " MunicipalRublic ❑ 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, o r1. County
Ifld4evt L-a-kes - Lo]
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER:
Address
reici N1c-fiel )
clD Gloucester Ka.
Fri 1 -o rt (1Tect1 " 5) c olv �4
City or Town State Zip Code
( ).-
Area code- Phone number , /
4. DATE DRILLED �o - J "6
5. TOTAL DEPTH: (.960
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO
7. STATIC WATER LEVEL Below Top of Casing: 40
(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)• 10 0 METHOD OF TEST Air
10. WATER ZONES (depth): l ra 0
11. DISINFECTION: Type rh 1 nr
12. CASING:
Depth Diameter
From p To 30 Ft. 6 1 / d_
From To Ft.
From To Ft.
13. GROUT: Depth
Front To 3 0 Ft.
From To Ft.
14. SCREEN: Depth Diameter
From To
From To
15. SAND/GRAVEL PACK:
Depth Size
From To Ft.
From To Ft.
Amount I Gala
Wall Thickness
or Weight/Ft. Material
SDR21 PVC
Material
rl�t
Ft. in.
Ft. in.
Method
Ccment IIand
Slot Size Material
in,
in.
Material
Topographic/Land settin
❑Ridge ❑Slope ❑Vallcy 1at
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic Chap
(check box)
DEPTH DRILLING LOCI
From To Formation D scription
3D clay, San
30 6o Coplsoficia ed rocc
G
J.00ATION SKETCI-j c.ai
Show direction and distance in miles from at 'cab
two State Roads or County Roads. Include the road
numbers and common road name
16. REMARKS:
1 DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUG IhD IN ACCORDANCE WITH I5A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF IS RECORD HAS BEEN PROVIDED O THE WELL OWNER
UC w. WELL
—/Z
SIGNATURE OF PERS CONSTRUCTING THE WELL / DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-1 REV. 07/2001
7D1<
/40

WELL CONSTRUCTION RECORD
303330
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater t Section
Jv51i�� tuvI2, Dye. C!. r,Jet rlroN:. f )-y2y-Us98
WELL CONTRACTOR (RlDIVIDUAL)NAME
WELL CONTRACTOR COMPANY NAME
SATE WELL CONSTRUCTION PEWtITa_ ASSOCIATED WO PERMIT
(if applicable) (it applicable)
1. WELL USE (Check Applicable 8o4 Residential 13.- MDnicipaUPublic 0 Industrial 0 AgriculwRal ❑
Monitoring O Recovery 0 teat Ptsp Water Injection 0 Odor 0 If Other, List Use
2. WELL LOCATION: /�A�
Nearest Tow.: OLD rencT County 44-10
Q3? 1erek;y hcwJs'
(Shea Name. Hornbeck Caemaky, &vS . tins No, By Cade)
3. OWNER:
: ���Y5 she 7aV
(Street or Ranh No.)
Cary arTown Sate Z.Q' e
(_} 4014,-oo2/
Am mac- Moe e mbr
4. DATE DRILLED 9-2/'WN
5. TOTAL DEPTH- .7 2 S-
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO C3-
7. STATIC WATER LEVEL Bdow Top oft.. fl PT.
(Ua^PifAbove Tgof4Sdnd
8_ TOP OF CASING IS J FT. Above Lad Surface*
rf.p elf easing torocArstad rarer biro Mai sir ..waive
whom IN marahmee VIM ISA NCAC 1C S1t
9. YIELD (gp.): Q METHOD OF TEST 4/ ✓L
10. WATER ZONES (depth): Pi i en Cr, ZcxO'
11. DISINFECTION: Type 649,CiN! Amount 53C 2-
12. CASING: Wall llamas
Depth Erneter or Weirlint Mortal
From To Ft.
From 0 To / '
Frca aW To J e3 P
13. GROUT: Depth
From To FL Za7 /
Fron� l—To_ FL /
14. SCREEN: Dept Dawns Net
From To Ft in. in.
Fran To Ft is 1R.
15. SAND/GRAVEL PACK:
Dept Size Material
From To FL
From To FL
4e
Material
Toposoubioliand setting
❑Ridge allgopte Malley °Flat
meet appetite hoe)
Latihdefloogimdc dwell location
(dam)
Lwit ddloagitude sosccOGPSOTopogaphie map
(cheettead
DEPTH DRILLING 1.00
From To Ruination Description
b e-9.3
' 6- e r
a at
Sr see c
A't7ie,
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. IRcks& the road
toomcca zed common road men.
y
O Cr'
T`
en
O 73C
-on
P0 �O
CD
-40
Erin
an t
tK
c.� 0 xo
O rro
c I rn
r7
16. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS C014S1RUCItD IN ACCORDANCE WTTH ISA NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND
THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TOME WE4L OWNER
SIGNATURES P / CONSIRUCTING THE WELL DATE
Submit the original to the Division of Water Quality, Groundwater Section,1636 Mad Service Cevater -Thdeigh, NC
27699-1636 Phone Pkg. [phone], within 30 days. GW-) REV, 07/2001

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural /R�esource�ss -
Diiv. ision of WatersQuality
� - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) �'I'e y J� . CQ.J ✓LCCt'fP1fERTIF#t(ATI, h�zica
WELL CONTRACTOR COMPANY NAME �/ / )T ✓ , 7•
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
303331
1. WELL USE (Check Applicable Box): Residential V.--Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCAfr.,�J •�g'OS/
Nearest Town:: /'/LLLGfw County
/07 SMPLitr.%r/r Z. c- 9!
(Street Name. Numbers, Community, Subdivision. Lot No., Zip Code)
3. OWNER: T2All.ebch-.-rv#Jjthraw,
Address /07 4Mef-t•rc /.+ri LL 0a
(Street or Route No.)
Akeit,.,r e e9 Rs' —
City or Town State Zip Code
(R7$ )- 77 P— 4,072
Area code- Phone number
4. DATE DRILLED q% 24.--01/
5. TOTAL DEPTH: aid$
6. DOES WELL REPLACE EXISTING WELL? YES B NO ❑
7. STATIC WATER LEVEL Below Top of Casing: SO FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING 1S / FT. Above Land Surface*
'Top of casing terminated at/or below land surface requires a
variance in accordance with I5A NCAC 2C .0118.
9. YIELD (gpm): ,S- METHOD OF TEST�/ni / 2
10. WATER ZONES (depth): SC/pyu " // SOd
11. DISINFECTION: Type C.621nrs Amount i� 02 73%n
12. CASING: Wall Thickness
Depth Diame er or Weight/Ft. Material
From O Tog° Fi. is (oil
From 90 To 0 Ft. l6b
From //O To //z FL /89
13. GROUT: Depth Material Method
From To Ft.
From_0_ To 'j( Ft. '/,�0.� i
14. SCREEN: Depth Diain er Slot Size Ma rial
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 IDSIope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From To Formation Description
0-- /00 r g+
/CO -3 Yr
,n O
C- rt
a --- C.
o r„-n
C7 t.0
Show direction and distance in miles frottr*t least-ol"
two State Roads or County Roads. Includdie roacb--
numbers and common road names. rnr
-13tx,m
3
LOCATION SKETCH
I DO HEREBY CERTIFY THAT THI WELL WAS CONSTRUCTED I ACCORDANCE WITH I5A NCAC 2C. WELL
CONSTRUCTION STANDARDS, • THAT A COPY OF T - - AS BEEN PROVIDED TO THE WELL OWNER,
cf.?
O
rll
SIGNATUR OF Pr 'lN 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 EnvironmeN and Natural Resources (IDivision of Water Quality - Groundwater Section p�
WELL CONTRACTOR (INDIVIDUAL) NAME (P/120 ,^l &4 �y ()S / r/ Pi/' CtK1IP'CATION 1DV�V
'YELL CONTRACTOR COMPANY NAME
STATE WELL CONSTRUCTION P£RMTfl ASSOCIATED WQ PERMIT?
(if applicable)
303332
'Sa4.1(C6 (ticLC DACC Yu? PHONE IIf )e7,A-72y- f'
1. WELL USE (Check Applicable Box): Residential Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heal Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION: a r
NTown:
earest To: G O r
.3oF�JzR
(Suers Name. Numbers, Community, Subdivision, let No.,+Zip Code)
3. OWNER: �'e-e� 7ti/.-- /(/61.(lfeiO4,`-
Address 20 /t/
_ (Suers or Route lam) f7 7.�2
/� 44, . eel d
City or Town State Zip Code
(32e )- & SZ - Q00 3
County sb0
Ares code- Those uwmber
4. DATE DRILLED %"—/ oY
5. TOTAL DEPTH: _,2fa0 �f0
Topogrgphic/Land setting
❑Ridge &Slope [Walley ❑Flat
(check appropriate box)
latitudeflongitude of well location
Nearatriminamecondo
Latitude/longitude source:❑GPS❑Topographic map
(deck box)
DEPTH DRIB -LINO LOO
From To Formation Description
— y�
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO IIl-yr
7_ STATIC WATER LEVEL Below Top of Casing. </0 FT.
(User if Above Top ofCama)
8. TOP OF CASING IS / FT. Above Land Surface`
"Top at rasing ter®aurd allw beam laud Whitt aria. a
variaare la accordance with ISA NCAC 2C Alta.
9. YIELD (gpm): S METHOD OF TEST /9(
10. WATER ZONES (depth): 5-9fn, 6 Z co
Amount e 0 2-
Wall Thickness
11. DISINFECTION: Type CLO/2;N-e
12. CASING:
Depth Diameter W Weight/Ft. Material
From To Ft
From 0 To 5-0 Ft. Ca kg A/C)
From bt To 12- Ft. /n VII /638
13. GROUT: Depth Material
From To Ft
From To FL
14. SCREEN: Depth Diameter
From To Ft in.
From To Ft in.
15. SAND/GRAVEL PACK:
Depth
From To
From To
Ft.
t
Method
Slot Size Material
_ is
in.
Size Material
Ft.
-ego
O
i
Y
nT ;o.0
rrt
LOCATION SKETCH N 77°
Show direction and distance in miles from atjaast a a
two State Roads or Cotmty Roads. Include the tad n'"2
numbers and common road names.
0d
NO
t*w
• p
Cd
16. REMARKS:
1 DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH ISA NCAC 2C, WELL.
CONSTRUCTION STANDARDS, AND iy T A COPY F THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
SIGNA
RE a P 14 CONSTRuCflNG 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 3 3 3 3
North Carolina - Department of Envioans sad Named Rmosces - Division of Water Quality-Grotmdwater Sectia.
WELL CONTRACTOR (INDwVWOAIJRAME t. l ��.9 —'St'c e ccanFacwrronaa/SO
wtaCotrrRAcroaCOMPANY NAME cf(2Pnn
PMORS a I 1
STATE WEIJ. COI.Sra ICn o.i PERMITu ASSOCIATED VA] PERMITS
fitappiioele)
fir le)
1. WELL USE (Check App6nWe SoO Resit l ts®6paVPubbe D ltdmaial D Ageadtaral D
Monitoring D Recovery 0 Heat Pump Water Iaj . Go. D Ober D If Other, List Use
2 WELL LOCAn
NroreaTows 'ss..ni Coa ly meekAri",(
ems- I lies: iced
1SaaeNanaM then. oafs Sitni .laINs.L►Caie)
3. OWNER: Q1 Qo y'U 5/?
Address 9iC P L • ak jtl
. a,., RCS
110
ne _375 Z.
Gtyo/Tas SRt Zoe&
62s- 4'4 o- 7c-)3t
4. DATE DRILLED /D-/S" O `V
5. TOTAL DEPTH: /ZO'
6. DOES WELL REPLACE EXISTING WELLY YES 0 NO DV
7_ STATIC WATER. LEVEL. BebeTap attar FT.
tUM4`Ira Iran Tap ei uive
8. TOP OF CASINO 15 / FT. Above Lad Surface
fl.p.f1t__-ir tninsilrrw Siwaad seise ..pion.,
Win INsexere Me silk Rh NCAC EC MIL
'
♦y,
9 YIELD (gpm): 75 METHOD OFTEST# / h
to. WATER ZONES (depth):T 5 )p i / /O
11. DISINFECTION: Type doer e,
12. CABIN&
OeMb
Frew To
FlmtT_To„a-la_
raa,erg m jl
13. GROUT: Dap*
From To Ft
Fran__n__To 2C Ft / 1c2Wfllcc_/
14. SCREEN: Deed Slat Sin a nail
From__ To
Amore R 0 Z
Wall Thaws
er seedy._._ Mtaaill
«_
Da®w
is
From__ To Ft in. is
15. SAND/GRAVEL PACK:
Depot Size Menial
From To Ft
Frwa___To Ft
ToPtiffereadfalAll setting °Ridgalley CIFbit
Week amorist box)
LSitS&loogimde afwe l loeatioi
Iderwialiamentwonels)
1. tudeAo S_ a aosce:OGPSOT pographic rap
FoinSwi Description
OMB
From To
o 1
-orn
LOCATION SKETCH O�
Stow a and ice in Rt'ks Gom at Ieaetr n
two Stale Iboada a Comity Rea& laciadithe told
rim. and common and eaaeats. c
(7.J a
O 1,-n
rn
Z
eseVitiz-
mom
16_ REMARKS:
1 DO HEREBY CERTIFY THAT THIS WFL. WAS CONSTRUCTED IN ACCORDANCE WITH ISA NCAC 2C, WB1L
CONSTRUCTION STANDARDS, Al® THAT A (�p�l' OF TIS RECORD HAS BEE$ PROVIDED TO THE WEILOWNER
Submit the *rightal to the Division of Warr Quality, Graaadwater Sea*, )4614a4Ser.ie t to lialet , NC
27690-1636 Para Ma FAY) 733-3221, wllbi 30 days. G*Y-1'. RSV. OW2001

WELL CONSTRUCTION RECORD 3 0 3 3 3 5
North Carolina - Dcpannent of Environment and Narral Resources - Division of Water Quality - Groundwater Section
WELL 07NTRACTOR (INDIVIDUAI4RAME (pet) jC ��IIy, 4 y ?'r: Swi f.Z cn rscwnon t,o2/S e
WELL CONTRACTOR COMPANY NAME Tu S *1 r F vUP.C.L PNONE a I )
STATE WELL CONETRUCTION PERMITS ASSOCIATED WO PERMITS
(if applicable) faappliralle)
1. WELL USE (Check Applicable Bost Residential Municipal/Public Er Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection ° Other O If Other, List Use
2. WELL LOCATION:
Neatest Tows: Spita:.F_ P NC
//o AL '72 b- i4
(stee Name. NvsLas. Cmoeoiy, Seleftvisiee. Isle Na, Zip Cede)
3. OWNER: Wiy L4gait LcciC
Address tS ay 'isOres le
NkSWfi wC )
4..98i44
City ofTown Stye by Code
(°28} 741.Y- 1Z5 1
Ana nude. Pla mar Z
County MS0e(wccC
Topo�c/Laad setting
°Ridge Malley OF1at
(cheek antaphre box)
Wiiddlongitude of location
Wegrastedoeentsecootta
LatitudeAongiiude sosccOGPSOTopographic map
ale& box)
DEPTH LZR)1LlN(3 LOO
From To Formation Description
4. DATE DRILLED 10-4 -Olt / Z _ / B
5. TOTAL DEPTH- .2 A D IL 2 5
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO Gi 7 5- 2 5
7. STATIC WATER LEVEL Below Top dC'R G FT. 75- 4-0
(Herr if AboveTap efcm(ad 50 -//5-
8. TOP OF CASING IS FT. Above Land Surfaces i/S uQ
*Top .r.mrt sersail War ba r.d sense alms
mat `eteenbeee PM. ISA NCAC 2C:ata. /16- Z B0
9 YIELD(gpm): 'i0 METHOD OF TEST ill IC
W. WATER ZONES (depth): 40 GPM c0 t 15.
11. DISINFECTION: TypeCLot N[
12. CASING:
Depth That
From To FL
Fray* 0 Tot#Z F
F f¢2_To hf _
13. GROUT: Depth
Fawn_ To FL
From 0 To ,oY Ft_ ,�,ff /
14. SCREEN: Depth Dmahkr
From(_ To is
Frai_To Ft is
15. SAND/GRAVEL PACK:
Depth Size Material
FromL_To Ft
From To Ft.
Ae (Ar-
A,cr
oz
ttoct
13 Rey* /£ •- 6 raxe;N
clo n A. I -e ga-11.
LOCATION SKETCH
Amount R oz a, Show direction and distance in miles from at least
Wall Thickness two State Roads &County Roads. Include abe mad
or WSW/ t. MaerW numbers and canners mad mwa
Sawa
-2
,
V tm=
0 oQ
o cc) PI
S --m
0
cJ � .
O C%0
16. REMARKS: CIc:
1 DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WEL
CONSTRUCTION STANDARDS, HATACOPxOFTHIS RECORD HAS BEEN PROVIDED TOTHE WELL OWNER
SIGNATU� DH 0131437RUCTING THE WELL DATE; !'
Submit the origiusl to the Division of Water Quality, Grouadwater Section, 1636 Mid Service Center - Raleigh, NC
t9V-LIjEV. 07/2001
27699-1636 Papa Ne. [phone], within 30 days.

304808
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and tura,1 Resources - vision of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME ()etas) /c-CNL T?I 1- �So)—" CERTIFICATION o 73�t�
WELL CONTRACTOR COMPANY NAME Ear /tear> CAE// n h' i/I NS PHONE a &78) 6S-5 - 93515
STATE WELL CONSTRUCTION PERMITIt 1CCOCIATED WQ PERMIT*
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential C i Municipal/Public ❑ Industrial ❑ Agricultural ❑
Monitoring 0 Recovery ❑ Heat Pump Water Injection ❑ Other 0 If Other, List Use
2. WELL LOCATIO
Nearest Town: / ' County,
/a9 Po f
(Street Name, Number, Community, Subdivision, Lot No., Zip Code)
3. OWNER• . SAPC/k9-5»--
Address '3 O % der--
/41{-IU STtvrt
(Street or Route.)
O�il l�-
hYa itS j-SCia 76
9r95;-.
ZIP Code
Area code- Phone number �
4. DATE DRILLED Al - / —0 /
5. TOTAL DEPTH: /4 6
6. DOES WELL REPLACE EXISTING WELL? YES a NO ❑
7. STATIC WATER LEVEL Below Top of Casing: 7- FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS / 9 FT. Above Land Surface*
`Top of casing terminated at/or below land surface requires ■
variance in accordae£with ISA NCAC 2C .0118.
9. YIELD (gpm): / d— METcicrF OD OF TEST $ f i t�
10. WATER ZONES (depth): 741
11. DISINFECTION: Type CJ,.' + Amount / 1/4 .
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft
FromAL. To 3 t- Ft_CI.
From To Ft.
From To Ft
13. GROUT: Depth Material Method
From 7O To 91 Ft. Carol
From To Ft
14. SCREEN: Depth Diameter Slot Size Material
From To Ft in. in.
From To Ft in. in.
15. SAND/GRAVEL PACK
Depth Size Material
From To Ft.
From To Ft.
16. REMARKS:
Topographic/land setting
(Midge ❑Slope Malley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(deveealmimaWseconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From To Formation Description
CO
0
IS v,
LOCATION SKETCH tit {n
Show direction and distance in miles from at leasf¶
two State Roads or County Roads. Include the road
numbers and common road names.
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACC( RDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND TIIpT A COPY OF THIS RECORD FL ..3 BEEN PROVIDED TO THE WELL OWNERic
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
Submit the original to the Division of Water Quality, Groundwater Stction, 1636 Mail Service Center - Raleigh, NC
t769q_1636 Phone No. [phone], within 30 days. G W -i REV. 07/2001

WELL CONSTRUCTION RECORD
North Carolina • Departoent ofEnvuomnent and N „ - Division of Water Quality - e,
WELL CONTRACTOR ONDIYDIUAL) NAME �.. ./ Sur- conic t1'irolf .'
WELL CONTRACTOR COMPANY NAME 1 JSurrs vas-, �all h� /A-t PEONZ a Mil t 4-
STATE WELL CONSTRUCTION PYRAIIT#_ ASSOCIATED WQ PERMIT*
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential L7 Mtmicipal/Public ❑ Industrial ❑ Agricultural ❑
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use
2. WELL LOCATIO ° y)
Nearest Tows /O 1-• County/ ' l QDa�J,r/7
21/ [err StLz a-k75".L
(Sweet Name, Numbers, Community, Subdivision, let No., ZIp Code)
3. OWNER: .3Pi N
Address / /`l c)r'c( .c%-/-k
m (Sweet or Rome .)
city or Town State n� zip Code
(f2t)- 6,S?/
Ana cods Phone comber _
4. DATE DC/Q -/3 ' d 5‘
5. TOTAL DEPTH: / /e ' /
6. DOES WELL REPLACE EXISTING WELL? YES (1 NO 0
7. STATIC WATER LEVEL Below Top of Casing: /l FT.
(Uw "+• if Above Top of Casing)
8. TOP OF CASING IS / ?-- FT. Above Land Surface°
flop of casing terminated odor below land saran regains a
mriva la aemrdeace with 15A NCAC 2C .a11&
9. YIELD (gpm): / el -ME OD OF TEST /i/4t .t i—
10. WATER ZONES (depth): 5'
LOCATION SKETC11 0-1
Amount / 1/ ` Show direction and distance in miles from at least
Wall Thiclmes two State Roads or County Roads. Include the road
or Weight/Ft. numbers and common road names.
r / L f e- -1- Y
Topographic/Land setting
Midge ❑Slope Malley ❑Flat
(Merck appropriate box)
Latitudenongitnde of well location
(degnrshmmmnlseecads)
Latitudellongitude source:❑GPS0Topographic map
(check boa)
DEPTH DRILLING LOG
From To Formation Description
tJ
.n
-o
11. DISINFECTION: Type$%✓c.4 i
12. CASING:
Depth Diameter
From / O,P To .2 . Ft_1'
From_ To Ft.
From To Ft
13. GROUT: Depth , Material — Method
From Ty To `a" 5 Ft. erns
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:
Leg
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCC RDANCE WITH I5A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RECORD Hi S BEEN PROVIDED TO THE WELL OWNER
/0-
SIGNATUREOF PERSON CONSTRUCTING THE WELL DATE
Submit the original to the Division of Water Quality, Groundwater Stction, 1636 Mail Service Center - Raleigh, NC
7,1Foo-1636 Phone No. 919),ni3221_, within 30 days. i J:"00 i

WELL CONSTRU
North Carolina - Department oflnvironment and Heppe! Resourc
WEt.i. CONTRACTOR (INDIVIDUAL) NAME
/. , a / t) ),klZ'-]] t I/.�
WELL CONTRACTOR COMPANY NAME d.x.2 f- SOA' LJ/2f,/ �S—lr i /"LiS
SPATE WELL CONSTRUCTION PERMTT# ASSOCIATED WQ PERMIT/
applicable) (if Pliable)
CERTIFICASIOIV _
PRONE a Jtr}%rb
1. WELL USE (Check Applicable Box): Residential E Mnoicipal/Public 0 Indtun Pal 0 Agricultural ❑
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATIO» /t
County 1` Ili) LV,Lc
PA f / v2t
(Sheet Name. Nomben. Community, Subdivision, Lot No., tip Code),...
3. OWNF_R:! A4k- A //t"�'.+1T/'
Address n2G� tf Werj-eq f‘/ td a=
Nearest Town:
Arlo r (stte .) rib s3'
7 Ct 9 state3 r 9 Cade
Area cods Pbooe number ^
4. DATE DRILLED 7
- 4D--a
5. TOTAL DEPTH: / . /
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO O
7. STATIC WATER LEVEL Below Top of Cicing: 17t 0 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS / FT. Above Land Surfaces
'Top of easing terminated atfor below land surface regdrea a
variance in acmrdaaee,v�hh ISA NCAC 2C .0118.
9. YIELD (pm): _,2_ METH D OF TEST bA f ��
10. WATER9 ZONES (depth):
Topographic/arid setting
( ORidge 0Slope OValley OFIat
(cheek appropriate box)
Latitude/longitude of well location
304506,
(deped,mmusheramle)
Latitude/longitude source:OGPSOTopographic map
(check box)
DEPTH DRILLING LOG
From To Formation Description
11. DISINFECTION: Type d ten t_k- , t Amount % L
12. CASING: Wall Thickness
_ •- Diameter or Weight/FL
From / et, TDo 9S Ft_Lt_ 1/L
Frotrt To Ft
From To Ft
13. GROUT: Depth Mid
From To Q A Ft l l a 1_
From To Ft
14. SCREEN: Depth Diameter
From To Ft in.
From To Ft in.
15. SAND/GRAVEL PACK
Depth Size Material
Slot Size Attain
in.
in.
From To Ft.
From To Ft.
O
.
c,
LOCATION SKETCH -w C
Show direction and distance in miles from at lefit M. T.;.
two State Roads or County Roads. Include the fdLd :25
numbers and common mad names. IT r'0'
9
16. REMARKS -
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCC RDANCE WITH 15A NCAC 2C. WELL
CONSTRU N STANDARDS, ANU. HATA COPY OF THIS RECORD H. BEEN PROVIDED TO THE WELL OWNER
9—/D --off
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
Submit the original to the Division of Water Quality, Groundwater Stctioo, 1636 Mai! Service Center - Raleigh, NC
1v694_1.634 Phone 'Jo. 919)+11-1221. within 3^ days. G W -; E7 . "i i:001

North Carolina -DepartmentofEnviroumentand Naturfl Resources Ofalsmaquality
-Cramd
WILL CONTRACTOR (INDIVIDUAL) NAME ENL� C� t tyrrvrcwT ., — , a ..
WELL CONTRACTOR COMPANY NAME 1 k t^ - ):S a.v fit- -I / / i' ( PRONE s fa?is
81 A 3 , - 4 3:�'"S
STATE WELL CONSTRUCTION PEReOTT!< ASSOCIATED WQ PRR/ff117
(rfappliable) _. '(ltswplicable)
1. WELL USE (Check Applicable Box): Residential Mtmicipal/Public 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Otha, List Use
2. WELL LOCATION.
Nearest Town: h /o 4 County
g'2kAto.' 15J . Het.%
(Stint Name, Numbers, Community. Subdivision, rot No. VT Cede)
U%!'(� Topographic/Land setting
alley CIFIat
Al G . WS)._ (cheek boa)
Latitude/longitude of well location
3. OWNER: Sus A, f)-A- / AJ C
Address f f l % fVx�«iugsi- .0 Sr /)i)7d OWel-
(D /)n ii A or LAC- )• 98//3
City or Town Stage Tip Code
(1??l- 41,y-- %is,'
Area cads- Phone mtmber a�
4. DATE DRILLED /d - d d 7-
6
5. TOTAL DEPTH: / /
6. DOES WELL REPLACE EXISTING WELD YES 0 NO E
7. STATIC WATER LEVEL Below Top of Casing:. C. 57 FT.
(Use "+" if Above Top of Casing)
3. TOP OF CASING IS __ FT. Above Land Surfaces
`Top of casing ternaated ads below land asrfaea regadres a
variant la aemrdaace with I5A NCAC 2C .011& ` 1 r_
9. YIELD (gpm): i 1 - -
10. WATER ZONES (depth):
ue4
(depewminuma eaods)
Laitudedlongitude source:❑GPS❑Topogtaphic map
(chat boc)
l DRILLING LOG
From To Formation Description
11. DISINFECTION: Type_thrkilL. Amount
12. CASING: Wall Thidmess
or Weight/Ft G
From �, To_4p� P_ it.
Fmm To Ft.
From To Ft
13. GROUT: Depth Maw Method
From 1.214 To a 0 Ft (Ma
From To Ft
14. SCREEN: Depth Diameter Slot Size Material
From____ To Ft. in. is
From_. To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Sim Martial
From To Ft
From To Ft
c.
0 5
U.(
cn
is fr
J OCATION SIO TCFj 0
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers co y6nnaa0mess I)
/s.ihisionny
4�
16. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCC RDANCE WITH 15ANCAC 2G WELL
CONSTRUCTION STANDARDS, AND flIAT A COPY OF THIS RECORD 11,S BEEN PROVIDED TO TILE WELL OWNER
dry
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
Submit the original to the Division of Water Quality, Groundwater Section. 1636 Mail Service Center: Raleigh, NC
7,40O I616 nyo9e N^..:Oro' '33 3f2within 30 dayz. ��w V. 27:26

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) .7 a min c tat, Ca mn Tr - CERTIFICATION # 7 1 'i S
WELL CONTRACTOR COMPANY NAME (amp' c (Alin 11 X. Primp r'n Tnr PHONE #$2S1 454-7322
STATE WELL CONSTRUCTION PERMIT,/ ASSOCIATED WQ PERMIT#
(if applicable) r (if applicable)
1. WELL USE (Check Applicable Box): Residential 0 Municipal/Public ❑ Industrial 0 Agricultural ❑
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use
2. WELL LOCATION:
Nearest Town: fiAiiA.^t—
M1,.O (.1.3R
(Street Name, Numbers, Commumry, Subdivision, Lot No., Zip Code)
3. OWNER: I-U`M Pi
Address S `? (�
(Street or Route No.)
4l/ -(
County M ON (k,U J IA
City or Town State Zip Code
')S )- LSq
Area code- Phone number , l
4. DATE DRILLED i 01 Q (1 LA
5. TOTAL DEPTH: 6 a S
6. DOES WELL REPLACE EXISTING WFI T 9 YES Cl NO Iti
7. STATIC WATER LEVEL Below Top of Casing: 14 IJ FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS 1 FT. Above Land Surface*
*Top of casing terminated actor below land surface requires a
-variance In accordsqce with ISA NCAC 2C .0118.
9. YIELD (gpm): J METHOD OF TEST air
10. WATER ZONES (depth): S
11. DISINFECTION: Type rh l nr i n a
12. CASING:
Depth. Diameter
From p To. Ft. 6 1 /
From To Ft.
From To Ft.
13. GROUT: Depth
Fronr_0 _ To 2 0 Ft.
From To Ft.
14. SCREEN: Depth Diameter
Front To Ft. in.
From To Ft. in.
15. SAND/GRAVEL PACK:
Depth Size Material
Amount Ct>,()
Walt Thickness
or Weight/Ft. Material
gDP21 PVC
Material
Neat Ccmcnt
Method
Hand
Slot Size Material
in.
in.
From To
From To
Ft.
Ft.
Topographic/Land setting
❑Ridge ❑Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minuteslsecoads)
Latitude/longitude source:❑GPS❑Topographic map
(check box) -.
PEPTI-t DRILLING LOG
From To FgpnationDescription
5 is
LOCATION SKETCR
Show direction and distance in miles from at least
two State Roads or County Roads. Inc
numbers and common road names.
the roars
CtAX
16. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH I5A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND TI)iAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
SIGNATUit/E OF PERSON GOINSTRUCTIN(TTHE WELL DATE `I
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center -Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-1 REV. 07/2001

WELL CC..-cST' TCrTON RECORD
North Car o'im: - Depa.--.ent of Envirc me _t and Natural R -:.Cartes - D1 sio:. of W.ter Quc.1_ty - Crow ndwater Section
WELLCCNTRf0TC_:,INDIV'DUAL)NAME Cori], -- -_ •7 o:-
WELL CONT.:lACTCRCOMPAN:al .'t1:, r'a7-.n' Y,7.77 -
STATE WELL CONSTETCTION PERM'.7"
e7372icaol ei
1. WELL',Check AraicaK e;1
Monitoring ..our-,:..i.' HF
2. WELL LOCAT"_Q'.
Nearest Torn: \JV
ZV (I-um4 u i'
(pee( Name Numbers, Carman .rd, Sub--, 9 r. _„,,
3. OWNER: Ct ' t
Adirt is e. p U
\V (Sate: or RN ec
'' City or Town state
Area code- Phone number 4. DATE Di ILLEJ I 0 ' I' • 0 4
5. TOTAL DEPTH: \-41 S
6. DOES W MET —AC x: SG v
7. STATICWATER LEV_Beim;;-o _
Tr- CER" FICATION p 7 1 3 R
o, p7'^+n '" ""nr. nCNE 5ffi:: r._�'1_7'22
ASSOCIATED WC, PERMLTP
(ifaop:icab!e;:
, M d cithiit
o Code
D T_.[?.r'..V....a� "_ Far: :_ 4.L'a1
IfO is .se
Topo phic/Land. setting
❑R=g2S1ope ❑Valley 'Flat -
(checic aocropda a `-ox)
P1 . -git. ce of well location
(degreesirunu eslseconds)
ititude/iongitude s. urce:DGPSCTc_ og aphicmap
(check box)
DEFT- ;. ELI:NG LOG
From
Q ( Fo. c 1:;:scriprUaro
U i{ CO t-t LhL.i • JL
.,o al LI OS
8. TOP OF CASINO IS 1ar 3
• *Top of casing terminated atior below :inn:. surfs_ - ^tires a
-variance la accordance wi:h ISANCAC 2C C'-
9. YIELD (. vs) ? -l.MT r 3.51. _
10. WATER s.ONES depth): Int D —
11. DISINFECTION: Type C ' n_v::.._ Ane=. a L1
12. CASING: T Lc_ciesi
Dept`. ;er
Fromm T,CSELFt-g
From To Ft.
From To Ft.
13. GROUT: ^,Prth Ste. - -mod
From_e To 1C_Ft._:; _ Otto `_ --and
From Te Ft.
14. SCP.EEN __ .Dia..tesr Sic. 'iv;
From To Ft.
From To Ft. :n
15. SAND/GRAVEL PACK.
Dec.h
From To Ft
From . _ : t.
16. REMARKS:
IDOHEP. EY0E.,IL Y;_A1THIS TJ.L ✓A NS
CONSTRUCT:19N STANDARDS, Al.- A c.r..
teria'
v
Submit the or 2 * a_ to the D!visic e F+'
27699-1636 ?hone No. (919) 't.:-32.:.r wait
a
1.0CALON SKB.TC aa
Show direc-i:nn a:ad distance in nile$ from at least
two State Row?: ,,. Ccc: ty, Roads. In;iude the road 1:
numbers a-: d commc c
)ao
_. ED 11y AOOOn_A`:: WITH I :1",.< NCA^_2C, W7. L
'IS RECORD HAS 72, ?EN PROVID,T. :OTHE VtEu,.OWNER
T:-CTING THE WET_:—
DATE
Mgr Secti.on,). 63f. Mal ?a^:ae Ciente!. -.Raleigh, NC
GW'-'. REV. 07/2001
rJ1
0
D

304350
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) s47/4ni1 C hA $Ms1 N CERTIFICATION/��,.,��#3 ° `f (.l
WELL CONTRACTOR COMPANY NAME o L. AA/ el [/R4 1.4 trit/S PHONE / OS) 42-1 -6,`T /
STATE WELL CONSTRUCTION PERMIT/ ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential l9 MunicipallPublic ❑ Industrial ❑ Agricultural ❑
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use
2. WELL LOCATION„
Nearest Town: l/AAI ° Al County in €Datil L
o ' n7caesr(1.rt,✓e;qI NA"atrot es' ST la' 6
(Street Name, Numbers, Community, Subdivision, La No., Tip Code)
3. OWNER: 6' b19 61'916 6
Address s'C9'L 7-DNEY Rd
(Street or Route No.)
Ail +-.'aeV N.C-
2t s
City or Town State Zip Code
(rig} Gs9-2G7C
Area Bode- Phone number
4. DATE DRILLED 0-.? 3 -err
5. TOTAL DEPTH: / -
6. DOES WELL REPLACE EXISTING WELL? YE NO NO
7. STATIC WATER. LEVEL Below Top of Casing: 6F
(Use
w if
8. TOP OF CASING IS /St "' FT. AboveLandLand Surfaces
'Top of wing terminated at/or below land surface requires a
variance in aceordance_31111 15A NCAC 2C .0118. �� h
9. YIELD (gpm): / `t METHOD OF TEST A
10. WATER ZONES (depth):
11. DISINFECTION: Type N72'
12. CASING:
Depth Diameter
From To s% Ft 1"
From.......... To Ft.
From To Ft
13. GROUT: Depth Material Method
From To Ft.
From To Ft
14. SCREEN: Depth Diameter
From To Ft in.
From To Ft. in
15. SAND/GRAVEL PACK:
Depth Size Material
Slot Size Material
in.
in.
From To Ft.
From To Ft.
Topographic/Land setting
❑Ridge ❑Slope ❑Valley ❑Flat
(checkappropriete box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(cheek box)
DEPTH DRILLING LOG
From To Formation Description
LOCATION SKETCH
Amount �;A b Show direction and distance in miles front least G,3
Wall Thickness two State Roads or County Roads. Includtlhtie roatCr 1
or Weight/Ft Material numbers and common road names. o R m
2).' g f;ia ea =ri.-
-pm
16. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
-2
SIGNAVURE 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

North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
1636 Mall Service Center - Raleigh, N.C. 27699-1636-Phone [phone] ,(
WELL CONSTRUCTION RECORD WELLCONTRACTOR /' /A4/A
WELL CONTRACTOR CERTIFICATION #: 304 Z.+
STATE WELL CONSTRUCTION PERMIT#:
304349
1 WELL USE (Check Applicable Box), Residential Municipal ❑ Industrial ❑ Agricultural ❑ Monitoring L I
Recovery n deat Pump Water Injection ❑ Other 0 If Other, List Use:
2 WELL LOCATION- (Show sketch of the location below)
Nearest Town. M%7 hi oit/ County
(Road Name and Numbers, Community, or Subdivision and Lot No.)
3. OWNER RAY lOt-.ANcl
Address fink /?64m,r,/E
(Street or Houle No.)
/tlm. r'o ry N,c,
City or Town State
DATE DRILLED 9
5. TOTAL DEPTH Z23't
6. CUTTINGS COLLECTED YES
7. DOES WELL REPLACE EXISTING WELL? YES f NO[
E. STATIC WATER LEVEL Below Top of Casing: //6— FT.
(Useit Above Top of Casing)
9 TOP OF CASING IS /14 FT. Above Land Surface'
'Top of casing terminated at/or below land surface requires a variance in accor-
dance with 15A NCAC 2C .0116
10. YIELD (gprn): / METHOD OF TEST 4319/ ^ • Fv
11. WATER ZONES (depth)
From To
DEPTH
Formation Descripoud
Zip Code
12. CHLORINATION: Type - HTh/ Amount /i 6 If additional space is needed use back of form
13. CASING:
Depth 0 Diamgior
From To Ft
From To Ft.
From To Ft
14. GROUT:
Wall Thickness
or Weight/Ft. Morena!
✓Z i. 4 /02. vcrG
Depth Material Method
From To Ft
From To Ft
15. SCREEN:
Depth Diameter Slot Size Material
From To Ft in in
From To ' Ft in. in
From To Ft in in.
16. SAND/GRAVEL PACK:
Depth Size Material
From _ To Ft
From To Ft
17. REMARKS:
LOCATION SKETCH
(Show direction and distance from at least two State
Roads, or other map reference points)
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS. AND THAT A COPY OF THIS RECORD HAS BJEN PROVIDED TO
OnTHE WELL OWNER.
-/6 -0
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
Submit original to Division of Water Duality. Groundwater Section within 30 days
GW-I REV. 12199
FOR OFFICE USE ONLY
Ouao No:
Sena! No

WELL CONSTRUCTION RECORD
North Carolina - Deparmunt of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) : SC/s A"1 n l f4/. ,CER:TIFICQA�TIION r 30
t)7%✓9 6..
WELL CONTRACTOR COMPANY NAME 1 f O%'W (.v EL(. CA i 4LIA� S PRONE I (32;) L 6�Z' G/'i
STATE WELL CONSTRUCTION PERMITS ASSOCIATED WQ PERMITS
(if applicable) (if applicable)
1. WELL USE (Meek Applicable Box): Residential Q Municipal/Public O Industrial CI Agricultural O
Monitoring ❑ Recovery ❑ Heat Pump Water Injection 0 Other If Other, List Use
2. WELL LOCATION:
Nearest Town. MI?h%a"/ County tl
1�2 M/rSt_ ld r'n//i D►+
(Street Name, Numbee, Community, Subdividao 'LotNo., 7+V.Cede)
3 OWNER. %(t/ 9I,bb/j(
Address 11/ try a#d /NC DA
(Street or Rome No.) ;..
AMA lam rte. . edgr,
(Fr3}r?6'i6 ss •4tti 3 tip Co
Area code- Phone number
4 DATE DRILLED %b3 ^0
5. TOTAL DEPTH. /L
6. DOES WELL REPLACE EXISTING WELL? YES C{ NO
7. STATIC WATER LEVEL Below Top of Casing L O _
ware if Above Top of Casing)
8. TOP OF CASING IS /S i/ FT. Above Land Surthce•
Topovaphic/Land setting
ORidge ClSlope ClValley' °Flat
(dwekappropdat box)
Latitude/longitude of Weil location
(deg)
Latituddiongitude source:OGPSL]Topographic map
(cheek bca)
METH DRILLING LOG
From To Formation Description
'Tap of wtna taemfuted at/er below rand aaefiee eegaiw a
vari ne. in aaorduee whb ISA NCAC 2C.a11R:
9. YIELD (gpm): i METHOD OF TEST &. h G
10. WATER ZONES (depth):
road
JOCATION SKETC$
11. DISINFECTION: Type ilr/1 A # Amount /,° show direction end distance in miles from at least
12. CASING: wall Tluclmess two State Roads or County Roads. Include the
Diameter or wcght/Ft. Material numbers and common road names.
From To Ft /. SOAS/ (OANSnc_
FrontTo Ft —
From To Ft.
13. GROUT: Depth Material
From To Ft
From ` To Ft.
14. SCREEN: Depth Diameter
From To Ft in.
From To Ft in.
15. SAND/GRAVELPACK:
Depth Size
From To Ft
From To Ft.
16. REMARKS:
Slot Size Material
in.
in.
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE waft ISA NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mall Service Center -Raleigh, NC
27699-1636 Phone No. [phone], within 30 days.
GW-1 REV. 07/2001

zOkZ46
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) S/v in G 4 AflA%#'t/ CERTIFICATIxON? u te
WELL CONTRACTOR
COACTOR COMPANY NAME /7Q h ��Q# b A L46 W Si PHONE # ((aegis G S24 / 7 7
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential treMunicipal/Public ❑ Industrial ❑ Agricultural ❑
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use
2. WELL LOCATION:
Nearest Town: mph o'\./ County M a be, Wei. C
(Strut flame, Nuumbcn, Community, Suedivisiem, Co' No., Zip Code)
3. OWNER: 6AI25 S ( i / )
Address b re Y /4 d Latitude/longitude source:❑GPS❑Topographic map
(Street or Route No.) (check box)
I? i ,` / N,, .2 8" 76 PEPTFI DRILLING LOG
(tea City
o Town 5 n 2 LState at r Zip
Code From To Formation Description
Area code- Phone number
4. DATE DRILLED /a - i - ° tf
5. TOTAL DEPTH: /b 7
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO E-
7. STATIC WATER LEVEL Below Top of Casing: 2r FT
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS / G `� FT. Above Land Surfaces
'Top of casing terminated at/or below tend surface requires a
variance in accordance with 15A NCAC 2C .011a.
9. YIELD (gpm): /d 7/" METHOD OF TEST 09 / 4
10. WATER ZONES (depth):
11. DISINFECTION: Type //7WN
12. CASING:
DepthDiameter
From To T G Ft_h__
From To Ft
From To Ft
13. GROUT: Depth
From To
From To
Topographic/Land setting
❑Ridge ❑Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
LOCATION SKETCH
Amount fhb Show direction and distance in miles from at (east
Wall Thickness two State Roads or County Roads. Include the road
or weight/Ft Material numbers and common road names.
t7. L. p4es`7'ic-
Ft.
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:
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 WEI I OWNER
—Jinn ch#0,.---. /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

North Carolina - Department of Environment and Natural Resources • Division of Water Quality - Groundwater Section
1636 Mall Service Center - Raleigh, N.C. 27699-1636-Phone [phone]
WELL CONSTRUCTION RECORD WELLCONTRACTOR• Rd4#-ra Ohs L A'>1r S-
WELL CONTRACTOR CERTIFICATION tt: 267. 9
z04345
STATE WELL CONSTRUCTION PERMIT#:
1 WELL USE (Check Applicable Box). Residential LJ Municipal ❑ Industrial ❑
Recovery j Heal Pump Water Injection ❑ Other ❑ If Other, List Use:
Agricultural E
Monitoring n
2. WELL LOCATION:(Show sketch of the location below)
Nearest Town- 41`v ear County. P79 lJOW h4%
`1.49 it4 $ r flAyNLe:
(Roan Name ano Numbers, Community. or Subdivision and Lot No.) DRILLING LOG DEPTH
Formation Descnptiai
3 OWNER fifth //' CuhN6Tr From To
Address 93rave coif; nd
(Street or Flout(' No.)
Vf✓r`ork/ A .4 5 N C.
City or Town Stale
4 DATE DRILLED he 9_2).°9
5. TOTAL DEPTH /L
6. CUTTINGS COLLECTED YES NO©-
7. DOES WELL REPLACE EXISTING WELL? YES
E. STATIC WATER LEVEL Below Top of Casing: 90
9. TOP OF CASING IS /l5 Vr
02a)/G)
Zip Code
NOLt
FT.
(Use'+' it Above Top of Casing)
FT. Above Land Surface'
I
'Top of casing terminated at/or below land surface requires a variance In accor-
dance with 15A NCAC 2C .0118 ,�/
10. YIELD (gpm): /a iF qs METHOD OF TEST /4 tr L S H
11. WATER ZONES (depth)
12. CHLORINATION: Typn 11771
13. CASING.
From
From
From
14. GROUT:
Depth
Amount /:b
Wall Thickness
Depth Diamfter or WeighciFl. Material (Show direction and distance from at leas( Iwo State
To /40 Ft. L X d2),b 10.b477'G
If additional space is needed use back of form
To Ft
To Ft
Frorn To Ft
From To Ft
15. SCREEN:
Material Method
Depth Diameter Slot Size Material
From To Ft in. in
Frorn To ' Ft in in
From To FL in in.
16. SAND/GRAVEL PACK:
Depth Size Material
From _ To Ft
From To Ft.
17. REMARKS:
LOCATION SKETCH
Roads, or other map reference points)
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 1SA NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER.
l�✓ EC/l. 9 - z I - a y
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
Submil original Io Division of Water Quality, Groundwater Section within 30 days
FOR OFFICE USE ONLY
Quad No.
Serial No.
Gw-1 REV. 12199

North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
1636 Mail Service Center - Raleigh, N.C. 27699-1636 - Phone [phone]
WELL CONSTRUCTION RECORD
306376
WELL CONTRACTOR- Dewey Wright Well Pump Co., Inc.
WELL CONTRACTOR CERTIFICATION #. 2878
040627 STATE WELL CONSTRUCTION PERMIT#• Steve Price
1. WELL USE (Check Applicable Box): Residential E Municipal ❑ Industrial ❑ Agricultural ❑
Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use:
2. WELL LOCATION: (Show sketch of the location below)
Nearest Town: SPRUCE PINE County: MCDOWELL
PRIVATE DR. OFF HWY 226 A OFF HWY 228 OFF HWY
(Road Name and Numbers, Community, or Subdivision and Lot No.)
3. OWNER MICHAEL R 51tGMAN
Address 180 W MAPLEHURST DR. ,
ROSCOMM1014' 8O°te NO) MI
City or Town State
48653
Zip Code
4. DATE DRILLED 12/23/2004
5. TOTAL DEPTH 305
6. CUTTINGS COLLECTED YES ❑ NO F1
7. DOES WELL REPLACE EXISTING WELL? YES ❑ NO 171
8. STATIC WATER LEVEL Below Top of Casing: 80 FT
(Use "+" if Above Top of Casing)
9. TOP OF CASING IS 1 FT Above Land Surface*
*Top of casing terminated at/or below land surface requires a variance in accor-
dance with 15A NCAC 2 . 118
10. YIELD (gpm) METHOD OF TEST fur
11. WATER ZONES (depth)' 0.50 apm240-241 0.50PPM 270-271
19.00 gom 290-291 0.00aDm
,1 n
Monitoring -I
JAN 2 5 2005
DRILLING LOG DEPTH
From To Formation Description
0 140 DIRT/SAND
140 240 GRANITE
240 241 QUARTZ
241 270 GRANITE
270 271 QUARTZ
271 290 GRANITE
290 291 QUARTZ
291 305 GRANITE
12. CHLORINATION: Type HTH Amount 48
If additional space is needed use back of form
13. CASING: Wall Thickness LOCATION SKETCH
Depth Diameter or Weight/Ft. Material (Show direction and distance from at least two Stet
From 0 To 145 Ft 6 1/8 .350 PVC Roads, or other map reference points/
From To Ft
From To Ft
14. GROUT:
Depth Material
From 0 To 20 Et Cement
From To Ft
15. SCREEN:
Method
Gravity Flow
Depth Diameter Slot Size Material
From To Ft in in
From To Ft in in
From To Ft in in
16. SAND/GRAVEL PACK:
Depth Size Material
From To Ft
From To Ft
17. REMARKS•
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY
THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER.
©'>
t.
tv :n `c,
r0
0
act. A t +M
a4g,
FOR OFFICE USE ONLY
Quad No•
Serial No
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
Submit original to Division of Water Quality, Groundwater Section within 30 days
GW-1 REV. 12/99

304989
WELL CONSTRUCTION RECORD
North Carolina — Department of Environment And Natural Resources — Division of Water Quality — Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) NEIL CRAFT CERTIFICATION # 3114
WELL CONTRACTOR COMPANY NAME PITTMAN WELL BORING, LLC PHONE # [phone]
STATE WELL CONSTRUCTION PERMIT # _ ASSOCIATED WQ PERMIT #
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential ® Municipal/Public ❑ Industrial ❑ Agricultural ❑
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use
2. WELL LOCATION:
Nearest Town: MARION County MCDWL
MUNFORD COVE RD.
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: EARL LYTLE
Address 13294 MUNFORD COVE RD.
(Street or Route No.)
MARION NC 28752
City or Town State Zip Code
8(28) — 738-4259
Area Code Phone number
4. DATE DRILLED 11/19/04
5. TOTAL DEPTH: 405
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO Eg
7. STATIC WAIER LEVEL Below Top of Casing: 0 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS 1-1/2 FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordance with I5A NCAC 2C .0118.
9. YIELD (gpm): 0 METHOD OF TEST ARD
10. WATER ZONES (depth):
11. DISINFECTION: Type CHLORYTE Amount 10.5
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
From 0 To 80 Ft 6-1/4" SDR21 PVC
From _To_Ft.
_ _
From To Ft_ _
13. GROUT: Depth Material Method
From 0 To 20 Ft.OUTKRETE 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
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. #64/74A W. FROM RUTHERFORDTON.
RT. ON COVE RD. INTO MCDOWELL CO. 1/2 MILE
ON LEFT. (13294 ON BOX)
0
rn
N
CO
rn
5-4
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
S NA F PERSON CONSTRUCTIN 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 5 5 0 8
North Carolina - Depanvent of Environment and
WELL CONTRACTOR (OCIV1EUA{4NAME
WELL CONTRACTOR COMPANY NAME
STATE WELL CaMTRUCRON PW.MU*
fif applicable)
Natural Resmaces - Division of War Quality- &omdwater Section
Habitat
J:.s*' L CIERMIcATION.aist
rF Leta ter:&.c,'ri mops .r 1 7z'f4S96
ASSOCIATED WQ MOMS
tlfsnolip6le)
1. WELL USE (Check Applicahk Bonk Residential GfriAtokipaUPublic ❑ Industrial 0 Agricultural 0
Monitoring 0 Recovery a Heat Piap Watt' bjection 0 Otter O If Other, list Use
2. WELL LOCATION: ��
Nearest Ton: S— 3* t County %t't=Or;tte-ti
tCirAFfdFwtii
ram tfame.mot et. Cm.aoixS.1irreides,L NO. rip Cede)
3. OWNER: t Gb MCI 1e rd.) .
Address 50 HZell aim fig frf Z
Ono or Route No.)
Q1.6 it"- t- try (✓ ,)r }ls Z
City erTom Sate Sp Cede
(_?- b rS-1W f B
Aenads. Flom abet
4. DATE DRILLED /O- Z7-04/
Topogaphi&Landselling
Midge °Slope Milky °Flat
(Neck appapisebox)
taitSdkngitode dwell location
MegneermismestsemodO
tatiadc longipade somemOGPSCfopographic map
(Oak
IA=WQ
From To FomaUw Description
5. TOTAL DEPTH: L/ D< 41- Iretr
6. DOES WELL EXISTING WELL? YES 13 NO ®�
7. STATIC WATERLEVEl. Below Top of ?06 Fr.
(Ua'flMowTeo 010 of
8. TOP OF CASING IS 1 FT. Above Lad Surfaces
flap .feathor4AArd.n a are..a.d. rksmre l.e.
.mime I. maer.aaee wra ISA (CAC 2C Su
9. YIELD(gpi): 30 METHODOFTEST
WO.WATER ZONES (depbx 390.tr Q Z06"
11. DISINFECTION Type
12. CASING
papa
From_____ To
From._-_-. To
Faoae iG To Cty
13. GROUT: Depth
From__ To
F�To 'a
14. SCREEN: Depth
Daaeei
Et
----
Ft. a-ye1
McRaiel
FL
Amount 1.•0'7
Wall Midtown
4'Set Mae.W
Method
Pietin
ifed
1e.:4r. ifecLt
LOCATION SKETCH S'
Sow and distance in miles front at Melt
two Sate Roads or County Roads. Wade
iambs and COMOSIM road memo..
EL -pet Puri , d
Dtamwler Stet Sim mmerial
From To Ft,_ �a in.
From To Ft _in. in.
15. SAND/GRAVEL PACK:
Depth Sine Material
From To FL
From To Ft.
16. REMARKS:
iDOHEREBYCERTIFYTHATTHISWELLWASCONSTRUCTEDINACOORDANCEWITHISANCAC2C,WELL
CONSTRUCTION STANTHAT ACOPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
PERSON CONSTRUCTING THE WELL DATE
Submit the original to the Division of Water Quality, Groundwater Scenes, IQ6 MaR Service Cater-Releigle, NC
27699-1636 Pt.m Na [phone], Teak' 30 drys. GW-I REV. 072001�

305507
WELL CONSTRUCTION RECORD
North Carolina - Department of Enve a nent and Natural Reenacts - Division of Water Qality-Gramdwater Section
WEI.CONTRACTOR w+wrvtouewNAME a'w rcSt%c eaenrxwrtavwAire
wULL couttucrott COMPANY NAM ruL #-;GG Laktia f tLth'J q moms w L ) 7z41y83.9
STATE WELL. CCtSCRRCSUCN PERMR* ASSOCIATED WI PEEWITS
(ifeppliatle) ftfspplteablej
1. WELL USE (Cheek Applicable 8o4 Residential 07-MnoicipaIlPebie 0 lahmtrial 0 AgiiSmal 0
Monitoring 0 Recovery 0 Neat Pimp Waterkhjcclion 0 Other 0 If Other, List Use
2. WELL LOCATION
Neatest Town: rriurlop
' County //4dbd
.gO.rt, a- 14 -l_
(Stunt Nana tLnkwa. ,. Akd'Ntio4lrNo, ZpCede)
3. OWNER: it� L..(tlyQ
Address £3/ 2 ¶c col f y t o fiat
Stott meN or I ,r
(! IZAiNer .c#i N e of 9o3Z
CayeTown Sono Zip Code
(P/ } eZy- 5-fft5,
mem cot. Mime gam
4. DATE DRILLED / /-/7-oil
5. TOTAL DEPTH: i `/S
6. DOES WELL REPLACE Emma Wmtt YES 0 NO Mr
7. STATIC WATER LEVEL Heber Top ofCai r (T 0 FT.
Ste M WAkoteToperC esieH
8. TOP OF CASING IS / FT. Above Lad Sulfate
fl.p.tn. 1... ...L.
mina to accordance wf ISA NCAC2C SIl
9. YIELD(gpm): /S METHOD O/FJTEST,*lie
10. WATER ZONES (der*/,Sn 6-e/y p 2 SD
11. DISINFECTION: Type dice; NZ
12. CASING:
Front. To
From /Pi To ilk
F�To
13. GROUT: Depth
Ftmt_ To
Fran_tZTo
14. SCREEN: Depth
From To
Ft.
Amon* t c 2
Watt Mites
oWeiniNPL
r
mw
/BS Lim
Material Method
Ltidgesetting
�dktt Mat
(cheek *maple bead
tatitaddlangitudeofwellloation
(dam)
Lsknde/kagitude aoaccf3Pl0Togographe nap
tackler)
Dtyfli DRILLING LOG
From To Formation Description
0 -- /00 /IZ
/eo - 34C
(/¢,a-w, Ike
0
m
c�
LOCATION SKETCH
Show diiret on and distance in raves Rowe
two State Rods or County Reads bedside the
mnrbaa adeanistan Toedtuns.
AlatIlwel
Diame4r Sla Size Attain)
Ft_jn, ix
Frmn To Ft in. is
15. SAND/GRAVEL PACK
Depth Sin Mtlerial
From To Ft.
From To Ft.
16. REMARKS:
FL
LeJzz SaT
nit
1 DO HEREBY CERTIFY
CONSTRUCTION STAN
TTHIS WELL WAS CONSRUCIEDINACCORDANCE WITH ISANCAC2C, WELL
AND THAT ADOPT OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
e
OP PERSON CONSTRUCTING THE WELL DATE
Submit the original to the Division of Water Quality, Groaadwaler Sectiae,1630 Mae Service Cater-PIISgh, NC
2T619-1636 Phone Na (919) 7143221, within 30 days. GW-I REV. 07/2001

WELL CONSTRUCTION RECORD
305506
North Carolina - Department of Environment aid Natural Resources - Division of Water Quality -Groundwater Section
WELL CONTRACTOR ONDIVIDUALMDAME aertl_ i i +ir.s . Tt) S# i L,E. CtcnwcwnoNa5+ eC
WELL CONTRACTOR COMPANY NAME :St`sti• LLB { /C Li- ) r ,.Y..i. .1:1 mots sj
STATE WELL CONSTRUCTION PERMIT! ASEOCIATCO WQ PtRMnn
((f texble) Of
) /71-t cl&l
I. WELL USE (Check Appladbk Rork Residential n MmitipallPuie 0 Indumuial [] Agricuhwal ❑
Monitoring O Recovery I] Heat Prop Water bjalio. CI Other 0 If Other, List Use
2. WELL LOCATION: `� .�
Nearest Tame VON C e tNka County ) pbL kei\l;ZLL
1r4 j /7{0,1_4 .CE)Z
(Baer Name. tieahv+. Cmaae jy, -. 2.. w.laNIL EPt edt)
3. OWNER: rtF; L 'CrG p. '
Address 132 J 1`#M tdi
(Strut or Run lea)
491O;LL4 A) it ;;VP-6
cans -km Sulu rip Code
(—) 3C1 - et413
wads. Pfr...ober
4. DATE DRILLED i/-1 b -t}Lk
5. TOTAL DEPTH o
6. DOES WEIS REPL--Tiota waffle WELLY YES El NO life
7. STATIC WATER LEVEL HdowTop afeawer €C FT.
(ttr'w #Above ILp afOJot
8. TOP OF CASING IS FT. Above Lad Surfaces
Ke►K..atia.r..L.e.d Woe bonawane rapier .
venoms to semNemewi ISANCAC2CJali
9. YIELD (monk 7 METHOD OF TEST /+ 1
to. WATER ZONES (dephk 3 R r m E 2 N- i
11. DISINFECTION: T
12. CASING:
neeLLCC.;It Awoad CZ
From_ TTo g (s
Fran /Cta To /Of',
Faoa�_To
13. GROUT: Depth
F To
FTo
Ft rerL I ei,101PC,l
14. SCREEN: Depth aa� Shat Size Meaaial
From__To Ft�jn, ice.
F To Ft in. it
15. SAND/GRAVEL PACK:
Depth Sine Material
Fromn_To Ft.
From To Ft
16. REMARKS:
Wall Madams
Ft _ids_ Q
Ft.
Muaid Method
FL
MOW
Midge ;grope t
(dark wimple WO
Witddloagimde ofwell location
()
Latitdelal�wde mwce:OGPSQfapogapbic map
it edrkm)
_ liT 1]9t1U.i4O CSI
From To Formation Description
LOCATION SKETCH
Show direction end dismnce to males from at
two Sisk Roads or County Reeds. Include the mad;
mdeaaadonrmwemod mom AAA l: it
grin/'' .$
iffi COO
Am t
isjcp
c-e,i# zz1Orr
1 DO HEREBY CERTIFY THAT THIS WELL WAS CONSIRUCIED IN ACCORDANCE WITH 15A NCAC2C, WELL
CONSIR NSTANDARDS, AND
-THAT ACOPY OFTHIS RECORD HAS BEEN PROVIDED TOTHE WELL OWNER
TUREOP PERSON CONSTRUCTING THE WELL DATE
Submit the eriganal to the Division of Water Qtalhy, Groundwater Sation,1636 MA Service Ceara-Rdeigb, NC
27699-1636 Phone Nw (91 7D3-3721, wphh 30 days OW-1 REV. 0712001
0
A.'

WELL CONSTRUCTION RECORD . 3 0 5 5 0 5
North Carolina - Department of Environment and Natural Resources - DiVieion of Wax Quality -Groundwater Section
WELL CONrRACroa(mnIVwWAranAME Qem�r._ .araty :>Sµ iC l CQ71notarmsar2/.i O
WELL CONTRACTOR COMPANY NAME tush•iae V✓t%/L t)i n (.Gi )U e " PNOtnn al ) 7241-t' 4S
STATE WELL 00ASCRRCUON PRRMrra ASSOCIATED WO PCRattta
(if applicable) fdandirabkl
1. WELL USE (Check Applicable 8o4 Residenta)1diMamcipaVPablie 0 Industrial 0 Agticuku al 0
Monitoring 0 Remaly 0 Not Pump Wakrtiieclion O Odra 0 If Other, List Use
2. WELL LOCATImart
N: /�
Nearest Town: a r tQ (�i County I YTS" P&&e CC
fliEret et.irc agi5:q
(Sher! Name N etheeR Lbs a Shl ivisiaa.Let Ns, LPCade)
3. OWNER: l ai Ckl ✓i ASS
Address 1 ✓o Oro( Q 3.11
jMAO ri otstretRotei.Non ZM' 75"t
City
C or Two State
(Sat.} (c a: 2 -
Aesaede- le setthet
4. DATE DRILLED // - /n -Cq
5. TOTAL DEPTH- 4OO'
6. DOES WELL REPLACE EXISTING WELL? YBS o NO se
7. STATIC WATER LEVEL Below Top ofCavity 'r _,ter.
guew7MowDPeratiail
8. TOP OF CASING IS / FT. Above Lad Surfaces
flop seats te mi.r.a .tree tram WSamieeespies. •
"wham S aemrMem with r3A NCAC tC MIL
9. YIELD (spiny 3n METHOD OFIEST A I r2
t0.WATER ZONES (daps* .2sia.L (-,'
/0 cf,4L e 7. n
11. DISINFECTION: Type (W, it r ate Amount 9 /)7
12. CASING. Wan Madmen
Depth tea orwajda uavLt
Front a To ii FL C.9 //te fie et/e
Emma To nil Ft & fee / 00 t A2
Feeat_To EZ.
13. GROUT: Depth Material
Fain To FL
Fmnn_p__Tor 14. SCREEN: F'p�m�i tz
Depth Star Sit
From To Ft jn. in.
From To Ft in. in.
15. SAND/GRAVEL PACK:
Depth Mae Material
From To Ft.
From__To Ft.
Method
T cfiand setting
ORidge IIISlope Malley OFlat
(cheek appepiitshoe)
latitude/longitude &wdl location
(•urcarethenettecondo
lass udegongiDtda sountOGPSOTopographic map
WETTH DRILLING LOO
From To Formation Description
're Pict"
944
o
LOCATION SKETCR o?
Show traction and distance in miles from at a
two State Roads oCounty Roads. Include�ad
t omb=sad cam toad moms.
16. REMARKS: Ll
,olce .ieve tLs
C4.1 i
1 DO HEREBY CERTIFYTHAT TUTS WELL WAS CONSTRUCTED RN ACCORDANCE WRH 15A NCACZC, WELL
CONSTRUCTION STANDARDS, t) TA COPY OF IS RECORD RASBEEN PROVIDED TOTHE WELLOWNER
j1 (9-'t/
DATE
Submit the original to the Division of Water Quality, Groadwater Section, 1636 Mal Service Canter -RASO, NC
27699-1636 rase NO. [phone],wilW 30 days. GW-I REV. 07I200I

WELL CONSTRUCTION RECORD
305502
North Caolina - Department of Environment and Natural Resources - Division of Water Qnlity-&otmdwater Section
WELL. CONTRACTOR (nnDWIDOAL)NAME (wLn a D. t /S'
WELL CONTRACTOR COMPANY NAME 3 �?c4; c C 0 r, cited") rooms a f ) 7eu4 Sajg
STATE WELL. COMInueTOtt PERMITS ASSOCIATED BYO PERMIT'S
(ifapphcable)
Crfappliable)
1. WELL USE (Check Applicable 8o:k Residuals) [ ijumcipal/Public 0 Sumba O Agricukuial ❑
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other ❑ If Odtq List Use
2 WELL LOCATION: A Topotpapbi&LaDd Ong
Nearest Toas IVl�t�y�rr county 1•vy i &hi -cep 0� p pyalky C1FIat
JtX%G) CG,..L@ VU,dg. (rhedreppmprdrsbcw)
(Sum Name wmre.r,OmmakAstseaeautaa irta LskSenongiludeofa'dllocation
3. OWNER: C A tJ 1 l_t 1
Adder tat be per (`\curt �-. %� fliellaegitude soaccQGPsEW
e`� n an 1 Jq
{ntaeare
5�- teabsa)
n � :1�'i n»rx DRlLLI)�
GineTwm Sae 21p Cods From To
( )-4lca-Stir,
An aide- PloonseMs
4. DATE DRILLED // -/5 - Of
5. TOTAL DEPTH- 3 t
6. DOES WELLREPLACE EXISTING WELL? YES 0 NO D-
7. STATIC WATER LEVEL Below Top of Casts 3r W Fr_
b ttbs'w'dshana ettesis)
8. TOP OF CASING IS / 12 FT. Above Lad Surfaces
•tepef .r e....t... -NewWow rmd..w.rapine •
variomL acomimmak 1SA NCACICAnt
9. YIELD (gpmk go METHOD OF TEST A//c
10. WATER ZONES (deptlk rigni c2 /e/S'
ni LOCATION SKETCH
1I. DISINFECTION: Type Ze x ADaaa 902 Show dhe ios and distinct in miles from at lam
12. CASINO: . Wall Ibidomm two State Roads oCounty Rends. lade .thema!
From n To dpDip* Ft, L= ff W ;Ty
mmbaa ad common road ans.
From__ ToFt.Kl - (Gw(L eJed
F To Ft. ./ At
13. GROUT: Depth P4scSi Method ! S¢
From__, To FL D 1
14. SCREEN: De a5 FL �s�/"t / f�ON Q w'
Do —... r Stet a: /2iqp.{ �ax<�.
From To Ft� in, is
Frtan EToL Ft io in r a ,
15. SAND/GRAVEL PACK
Depth Sine Material
From To Ft ` OT 14
From To Fr_ C
16. REMARKS: Z L L a' l�s' l""
2r3—
36-ft.
FaRmtion
4;is•tir
,tcc't
4-
sc.- ?cis- qie.ricao
I DO HEREBY CERTIFYmHATTHIS
.............a.rn.au ..
CONSTRUCTION STANDARDS, AN�Tj�ATA COPY OF TH �:'., r. a e , wAer wRrror PSnarrmm� Tn �.sm v.c....v,.,en rn
n
CONSTRUCTING1HE WELL DATE oa
00
Submit the original to the Division of Water Quality, Groundwater Section i 36Mia&spiteCenter-Raleigh. NC
27699.1636 Phone No. [phone], witbiu 30 daps. GW-1 REV. 07/2001

WELL CONSTRUCTION RECORD
/vl�
(�1
305501_
North Carolina - Dcpanment ofEnvionment and Manta' Resources - Division of Water Quality - (iotmdamer Section
p T(trCt( C." CERTIFICATION / /
5
WELL CONTRACTOR COMPANY NAME 01.7°i4ir. roma sf )
SPATE WELLCO\LTRuCTIOta PERMIT* assnn&TED WQ PERMITS
(ifapplicWb) Of )
1. WELL USE (Check Applicable Souk Residential IS/ MasrcipalPoblc 0 hidustrial f] Agriatlteal O
Motoring 0 Recovery 0 Heat Pump Water bjeaion 0 Other 0 If Other, List Use
2 WELL LOCATION ylib-
, gi
Town:
Nearest Trnva: /lQ/x,(r j-, .
WELL CONTRACTOR ONIM IDIJMJNAME
Topographic/Land setting
adopt Malley
/6' 2Z /t'on.z..7 /rylseat( t' ORid` (Oak appa ion Mat
(Saw. tea Neaten. Cases+ ROiaisiaa.to Ne. 2ii Lode) latimdelloogitode of well location
3. OWNER:
Address
Mum or Rada
L()
City arTown Same
(`Zr)- jam/
Asa eat- P4sswNer
4. DATE DRILLED OC F 2S a4
(.agneeanR)
Lataude rde somem0GPS0Topogtaphic map
(!#Rita.[)
T2>:PLti DRILLINQ UA
From To Form t mn Description
o-'10
5. TOTAL C+ 70.. 9
6. DOES WELL REPLACE EXISTING WELLY YES CI NO (IV
7. STATIC WATER LEVEL BebwTap ofc `/O Fr'. 9SN Yt:5--
S_ TOP OF CASING IS / FT_ Above Land Surface*
Mperasing sa tt.ra.rerYirwrsdsae arapen
ember Y amreneewak 1St NCACIC JNiE
9. YIELD (gpm): / METHOD OFTEST it//L5S¢l/K'1
10. WATER ZONES (depth): /S/Cjyttr 57k)'
LOCATION SKETO( r
Show direction and distance in miles 60pt at
two State Roads orCounty Reds. Was the mad
asabetssad COMM= road asams
Nw'W'"Above TapafCbt*
11. DISINFECTION: Type 610 4",UL
12. CASING:
Depth _____ ee
From_ To
Fretn C) To—r �L p
From /UA To //O
Method
Ft
erthnfiA
T>mi a
Depth Stag Mawrial
Ft __ jrt Itt
Ft—in.in.
o
AAmountS O Z
Wall Midas's
es Wa�YPt. aaserial
13. GROUP: Depth F
From To
From CLT
14. SCREEN:
From T
From To
15. SAND/GRAVEI. PACK:
Depth
From To
From To
Sae Material
Ft.
Ft.
/lit "be
7aAs)
Lit
16. REMARKS:
Submit the original to the Dirbana of Water Quality, Groundwatm Swops, UN Mad Service Cater -Raleigh, NC w
27691-1636 Plana Ne. [phone], wfbia 30 days. GW-I REV. 07/2001

CUB
WELL CONSTRUCTION RECORD 305500
North Carolina - Department of Environment and Natal Resources -/Division of Water Qality- Groundwater Section
WELL CONIRACTORONDIVIDUMJNAME -r res4TM' 1 ca71Fncamon• 215t
WELL CONTRACTOR COMPANY must Y: 44% tit jr ecc- A r.; u.:,:1y anon a f t 72'd-f5fl.'
STATE WELL CONATRUCRCNi Muni, __ASSOCIATED WQ P€RMITs
(ifapplicable) fdwvticele)
1. WELL USE (Check Applicable Burr); Residential 3Mmidpal/Pablic O Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other C If Other, List Use
2. WELL LOCATION:
Nearest Tows: AA It o4 County /04-66wea
430 .hocts,At A a.
(Two Name. M bas, Casaanity,t1ar.diaktiymer..=Cade/
3. OAddress �4rLRi t3 ttih c-lcsrdclil2
71/4
2
0
1,6 (street re etb.) &Q col
Cayce Teen Soso C. Tip Code
(47.x}- t4 - "2Q3
Ana aide- Pie as kar
4. DATE DRILLED
5. TOTAL DEPTH: 3 4 i
6. DOES WELL REPLACE EXISTING WELL? YES C NO CV
7. STATIC WATER LEVET,Reber Tap ofCawrg 13 PT.
tuarrintameles eras*
S. TOP OF CASING IS / FT. Above Lai Surface*
`Te ntesr esed.eod ere. hde. r.a..sw e.0.i_.
•arian wastiouswIlkISANCAC2C ADD
9. YIELD (gpa): 7 METHOD OFTEST paz
to. WATERZONES (depth): Q9grro " 4£30
aern -320
1 I. DISINFECTION: Type Ct4t'v Ale Amour )- B t-
12. CASING: , Wall Thietr ss
Depot crew erwesteY& lSaRid
F To
F To�
From v To 61 Ft._ _ _ in tat__
13. GROUT: Depth Memiat 116od
From To FL
Fran_SZ_ To j 'Aetna
14. SCREEN: Depth Dhersa Sim Site Malaria/
Front____ To Ft�n. ia.
From To Ft In. v.
15. SAND/GRAVEL PACK:
Depth Size Menial
From _To Fc.
FraR__To Ft.
sei
iti'dgeTopograpiric/Land setting
°Slope Malley [33at tn
(atria swww*S.raa) r*t
Ltlkaddkogitude *Ewell lent oa
(+) -
latkrddlongitude rnuccWWPSUrojng9hie Sp
(deck box)
DEPtH DIU 1S4O LOO
Front To
e'9 "5
q -Sb
a--
Formation
Formation
bad-
s fsact
0.944 Ye/ 4)u.cr,ars
,ace -ass' 4rgr, , /Mecg
LOCATION SKETCH
Show direction and distance in milks from at least
two Sate Roads at County Roads. Include the mad
emotes and common mad mina.
a
MetrioA'AL pp Ark
-F_
16. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WfIH ISA NCAC 2C, WEL
CONSTRUCTION STANDARDS, THAT COPY OF THIS RECORD RAS BEEN PROVIDED TO THE WELLOWNER
0
T
ERSON CONSTRUCTOR:1111E WELL DATE
IV
Submit the original to the Division of WaterQtmfty, Groundwater Section,1636 Mad Service Caster -Rakish, NC 0o
2769-1636 Phew Nw 019) 733-3221. within 30 SOIL GW-I REV. 07R001 V

WELL CONSTRUCTION RECORD 3 0 5 4 9 9
North Cat - Duman or Favireament sad Nand Resetrees - Divides of Water Quality - Groundwater SenUoe
was coN,aAcraatasmv uAadtun or as a., S+«tt sore. a/3t
nix corrraAcrotrCOMPANY nma .atiR ec. Veit Dr LL; Oct mote a f8A 124-LitQ9
STATE WELL COSETTACION w. TMP TS
of [. )--ASSOCIATEDWhathaila)
1. WELL USE (Check Appiprble hoer( Residential Maicip*VPsbie O Iadrurid O Agricelaral 0
Moaning O Recovery 0 Heat Paw Waterhyenion O Other 0 IlOder, List Use
2 WELL LOCATION: el
Nana Toww 0 Li) ra!-i
re £cx yc,v
tsarNat rraaaa,.1S—yttafrobl ,barer(.,a aae7
3. owNEa:yfrtwl Roz2 st Li
Address a(oS 1N9- hotter Nett
o Lb 4r4- Settrealasj f&Z
Coyertwo Stine TRtbae
ti- 02-92to
Anna- lininumbor
4. DATE DRILLED 10- Z 9, oil
5. TOTAL DEPTH:
6. DOES WEIL tma.oWELT YES Q NO
cam, m ° (stye t
T0P0MMIbiedatEEITTEZ
I Ridge Mope Walley OFlal
wadrrtpa.dreetma)
la itoddbog ade of well Hatton
(d)
latitudeflonlede seteceeMPSCITeparaphic rap
» plUlanaoio0
From To FaDaiaDartiption
.94N
r5-a8 FjRaveL-Sdis.1
7. STATIC WR. ATELEVELDenTopa[cb:g LPT• 4/2-SS
SherfArweltipsf rea/ ? 6O
8. TOP OFCASING IS 1 FT. Above Lad Swaths x°-.219C
•TApeaemYa*nisi scar e•a.wrad•araaeq•1.••
+arisartaaamraaatewM IININCAC2CAUS. _
9. YIELD (pp* 3 METHODOFI
10. WATER ZONES (daprhk /gs>brrO /Pc
4v6eft
r-,
ao%.. - Sa LOCATION SKETCH
CH —
11. DISINFECTION: Type L0fiiNZ- A ., t 11i 01 SbrdirectionamddisOmoaiaoileshowat
12. CASINCk VIA Moth' same two Sin Roads orCounty Roads. WOthe
MPS DiaNe mi" arwiairraR ISMS
Frow _Q_To40_ Ft. � &' Asa Sied
Frain a To 440 Pt /oVy 40 PVC
13. GROUT: Depth
o - ~t l3/i EEIV
ite-
Fre n To Ft
Fiere_D_To aU,+,eogd
14 SCREEN: Depth Set She Marist
Fin__ To Ft.__a. is.
Front__ To Ft b. is.
15. SAND GRAVEL PACK:
F�—Dqo To Ft.
Marid
Feaat_To FL
16. REMARKS:
al8rs and comma Toad over®ea.
1,1ib AD 10W
e lean di'
ciedi
Lib
Mo(Cjhdttl
c
iDOHEREBY wain THAT THIS WELL WAS CONSTRUCTED INACCORDANCE WITH ISANCAC2C.WELL
CONSTRUCTION STANDARDS, AINTHAT ACOPY OFTBMMORDHAS BED1 PROVIDED TOTBEWELL OWNFdt
h
m
OOt6IRUCHNOTHEWELL DATE
Submit the original to the Divides of WaUrQsa* y, Quainter Sean,1SM MaSrvia Can-RYrigh,NC
270%4434 !bee No. 1'S1 73,3221,wlL 30 days
GW-I REV 07/201/1

WELL CONSTRUCTION RECORD
G 12-
305497
North Carolina - Department of Eaveoammt and N&U ral Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (n$SIVIO4AJNAME Nr "c L ci-I c fi CERTIFICAITON 0 01 $'D
wax. CONTRACTOR COMPANY NAME 11614 c.E LA c Lc. b r; Lt_; A. rtmtas a f€2) 72.5`-vsv9
STATE WELL CCaRTRUCTTON mown Ssv•eTQA WR Panel
rifapiIiable) rtfappeabk)
1. WELL USE (Check Applicable 8* Residential £iacipaUPabic 0 IRdwarial 0 AgeiculRaal O
Monitoring 0 Recovery 0 Heat Pump Waterhoe-Lion 0 Otbw 0 If Other, List Use
2. WELL LOCATION:
Nearest Toww C 0 roe* Canty IN\ flawea
1413 oL0 F'er1 S c , t1`tu EA -
(Sleet* Name tlatlaL Cmmesblt atiivma natNt. TapCade)
3. OWNER: Pills RA Ctit49-
Addressress 3 e`to 0I-o Fo<.l- 5dcytr (l„(1-t r2„.1.
(Seedy Rut tree
Foe+ �.• l6Z
City orTows State iSp Code
t OA- (ea- in,
Annette- Plea ao•ier
4. DATE DRILLED 1c-' o-°`l
5. TOTAL DEPTH- & AO e
6. DOES WEIi. REPLACE li=ISTING WELL? YES 0 NO lit
7. STATIC WATER LEVEL Heber Top of Caner
Ma'wRAbow1.epetteenti
8. TOP OF CASING IS 1 FT. Above Lend Steam
Ke•.remmitmmimd wafer terwa.a• amra.aeawlea.
Imbues et aemr&.Q with ISA NCAC 2C .Mot
9. YIELD (ma): (0 METHOD OF TEST A I it
to. WATER ZONES (dgelbk f (9/'
11. DISINFEOION: Type &l e R %Ai
12. CASING:
Depth tAamewr
From To Ft
F3
D To i og
Fttm / 3 To l O.5 Fe. eV -
Ammo C2
Wall Thames'
n iyaaat. U id
'Topographic/Land setting
°Slope OValey °Flat
cheat appaanhtehmt)
IAfasadeiloogitude ofwdl location
(de9emadi.adaaeeadt)
LttdeM1 de source 150Tapograpbie map
D8a1.1NO t.DG
Formation Description
DMA
Fteun To
%_— ,so
1f-"-6y�
siet #a f. Aeats-
� y
C3
AS —
LOCATION SKETCH
Show rlizection and dislanoe in miles from at least
TWO State Roads areaway Roads. lacludo We road
namberamed mtmwt Toad nenum t
71
13. GROUT: Depth bhkml
From__. To FL
Q
Frotee__O__ T C F _ 'r , pin e rl t 00.
14. SCREEN: Depth Stet Size Mama' I kr •
From
To Ftjn. it.
Foam To Ft in. in.
I5. SAND/GRAVEL PACK
Depth Size Mauaial
Flellt_To FL
From To R.
16. REMARKS:
` tip' iti
a
Lt`% .e�"1 fVl5`ysrtth;Ll. ft.
OLD
t;4 y;btiL
1 DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTS) IN ACCORDANCE WRH ISA NCAC2C, REM
CONSfRUCTlO)i STANDARD AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WEZLOWNER
PERSON CONSTRUCTING THE WELL
DATE
rn
rn
n
iv
Submit the orLSwai to the Division raster Groundwater Seethe, 1636Mail Service Center -Palma, NC t
27699.16M Phone Nw. [phone], wkW 31 thys ow-1 REV. 07/2001 �:.

305590
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural
t Resources - Division of Water Quality - Groundwater Section
/(�'^^7��
WELL CONTRACTOR (INDIVIDUAL) NAME (print) l'r At? c\ CERTIFICATION /J �-'
WELL CONTRACTOR COMPANY NAME 3tsf;r fE/ \eeLC r:c.L4 PHONE # to G) �'2%ct ip
SLATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
I. WELL USE (Check Applicable Box): Residential kV-Municipal/Public ❑ Industrial ❑ Agricultural ❑
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use
2. WELL LOCATION: P`'�'���,r�,�
Nearest Town: //% /C, oft County �% �Qw'C.es-
e 2d;tuaL Fitem
(Street Name. Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: bou6 y(/tic le
Address 45/ matret- C� G G_ Ft, SW
(Street or Route No.)
S" 1014 �� e 84(02
City or Town State Zip Code
tom)- •101 -235$
Area code- Phone number
4. DATE DRILLED - I-0
5. TOTAL DEPTH:
6. DOES WELL REP ACE EXISTING WELL? YES ❑ NO ❑
7. STATIC WATER LEVEL Below Top ofCasing: 2/)o / FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS / FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordance with ISA NCAC 2C .0118.
9. YIELD (gpm): I, METHOD OF TEST /19/C
10. WATER ZONES (depth): )9,4 I CEP 20...;
h92.., 3Go
11. DISINFECTION: Type CC4Cv/t,'e Amount eat
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft.
From To Ft.
From0To I/l Ft. kty Sr90 Mid
From /1/ Tot 13 Ft. 6 fry 'RR epic
13. GROUT: Depth Material Method
From To Ft.
From To Ft.
14. SCREEN: Depth Diameter Slot Size Material
From To Ft. in in.
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
Topographic/Land setting
[�Itidge ❑Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From To Formation Description
0- /00
/Ck0- 1 ciC
6iad-
/HPd *+ c
>es, vos 4i yc ate'
1 r"t
%3.0
LOCATION SKETCH
• -':
Show direction and distance in miles froma—t least "s,'
two State Roads or County Roads. Includd4hc road!
numbers and common road names. tr.
rite
J e`oseteuee
i2.s
C AIld i 1.
FrfentS
16. REMARKS: ki451 /1005E oN
I DO HEREBY CERTIFY TH T THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH I5A NCAC 2C, WELL
CONSTRUCTION STANDAR S, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
SIGNAT
Material
0
DATE IV
Co
Submit the 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,
PERSON CONSTRUCTING THE WELL

306091
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 PI'I TMAN WELL BORING, LLC PHONE # [phone]
STATE WELL CONSTRUCTION PERMIT # ASSOCIATED WQ PERMIT #
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential ® Municipal/Public ❑ Industrial ❑ Agricultural
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other 0 If Other, List Use
2. WELL LOCATION:
Nearest Town: MARION
LAKEVIEW HILLS
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: ALLEN GURLEY
Address LAKEVIEW HILLS
(Street or Route No.)
MARION NC 28752
City or Town State Zip Code
(828) - 652-9329
Area Code Phone number
4. DATE DRILLED 12/17/04
5. TOTAL DEPTH: 605
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): 2 METHOD OF TEST ARD
10. WATER ZONES (depth):
11. DISINFECTION: Type
12. CASING:
Depth
From 0 To 70 FL
From _ To _ Ft.
From _ To FL
13. GROUT: Depth
From 0 To 20 Ft. OUIKRETE
From ____ To _____Ft
14.SCREEN: Depth Diameter Slot Size
From _ To _ Ft. _ in.
From _ To _ Ft. _ in.
15. SAND/GRAVEL PACK:
Depth Size Material
CHLORYTE Amount 16.5
Wall Thickness
Diameter or Weight/Ft. Material
6-1/4" SDR21 PVC
County MCDL
From To_Ft.
From To Ft.
16. REMARKS:
Material
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 al least
Two State Roads or County Roads. Include the road
number and common names
HWY. #226 N. FROM POLKVILLE. RT. ON I40 E.
GET OFF EXIT 90 & RT. ON HARMONY GROVE
RD. STRAIGHT AT STOP SIGN ON NEBO SCHOOL
RD. STRAIGHT AT STOP SIGN ON OLD HWY. #10
RT. ON WILDLIFE RD. GO APPROX. 2 MILES &
LEFT INTO LAKEVIEW HILLS LEFT ON
DOBSONS VIEW DR LEFT ON RAVENWOOD_DER.
HOUSE AT DEAD END.
vt
T
m
m
V
W
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
SIGN OF PERS CONSTRUCTING THE LL
/ - /� - •r%L
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

306081
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment And Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) ROBIN MCNEELY CERTIFICATION # 2567
WELL CONTRACTOR COMPANY NAME PITTMAN WELL BORING, LLC PHONE # [phone]
STATE WELL CONSTRUCTION PERMIT # _ ASSOCIATED WQ PERMIT #
(if applicable) (if applicable)
I. WELL USE (Check Applicable Box): Residential ® Municipal/Public ❑ Industrial ❑ Agricultural .0
Monitoring 0 Recovery ❑ Heat Pump Water Injection ❑ Other 0 If Other, List Use _ F E S q
2. WELL LOCATION:
Nearest Town. NEBO County MCDWL
BRACKETT TOWN RD.
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: SHANE CLINE
Address 2211 BRACKETT TOWN RD.
(Street or Route No.)
NEBO NC 28761
City or Town State Zip Code
8( 28) - 287-0257
Area Code Phone number
4. DATE DRILLED 12/22/04
5. TOTAL DEPTH: 67
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO El
7. STATIC WATER LEVEL Below Top of Casing: 47 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 STEEL TAPE
10. WATER ZONES (depth):
11. DISINFECTION: Type CHLORYTE Amount 9.2
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
From 0 To 67 Ft. 24" CEMENT
From_ To_Ft._
From _To_Ft.
_
13. GROUT: Depth Material
From 0 To 20 Ft. CEMENT
From _ To _ Ft
14.SCREEN: Depth Diameter
From _ To _ Ft. _
From To Ft.
15. SAND/GRAVEL PACK:
Depth Size
From 47 To 67 Ft. 78M
From _ To _ Ft
Method
POURED
Slot Size Material
in. _ in.
In in.
Material
GRAVEL
Topograpbic/Landesg
❑ Ridge ❑ Slope ❑ Valley ❑ Flat -
(check appropnat ..e-, . , ••-a
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. #226 N. FROM POLKVILLE. LEFT ON
VEIN MTN. RD. LEFT ON BRACKETT TOWN RD.
APPROX. 2 MILES ON RIGHT.
0
w
0
'D
16. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WFI7
CON$TBUCTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
i e _C
TT is�'74%Q� /A7 - 42
ON CONSTRUCTINGWELL 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
306540
North Carolina - Department of Environment and Natural
Resources - Division of Water Quality - Groundwater Section (�
WELL CONTRACTOR (INDIVIDUAL) NAME^_(p—rint)1 -1`-,_-0I(-e K s3 t 111 . I� CERTIFICATION Gam', 2
WELL CONTRACTOR COMPANY NAME f l) Ht+Fd W CI � W I1 t 1 \q PHONE # tY(00_ /032
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ P
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential F Municipal/Public ❑ Industrial ❑ Agricultural ❑
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use
2. WELL LOCATION: n ,
Nearest Town: MR IbN County AC' ft\QE1, 1
(ol9cp (o5 76 cyst as ascot
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: ?laid % ,(3G(,�tice*&
Address ( c/�v U,5 70 6A:5*
a96z
OID kazf (C iG Na.)
City or Town State Zip Code
Area coda Pie number
4. DATE DRILLED I1 =-1 (—)'T'
5. TOTAL DEPTH: 5SdT /
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO El
7. STATIC WATER LEVEL Below Top of Casing: RC FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS / FT. Above Land Surface*
'Top of easing terminated at/or below land surface regnirea ■
variance in accordance with ISAMON�CTAAC 2C .0118.Gpikricrkel
9. YIELD (gpm): i `SV DCO' � T -sel i.
10. WATER ZONES (depth):
Topograpbic/Land setting /
❑Ridge ❑Slope ❑Valley Pilliat
(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 kl (let Amount
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
FromL2— To Co CP Ft.
From To Ft.
From To Ft.
13. GROUT: Depth Materia) Method
From To Ft.�7'CCCf
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.
UL3 -140 cvQ
16. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUE Ito IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRU 'ION STANDS, 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

306539
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Divisionsof Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) LAW y /W/''��F..//� � pti / 1 / CERTIFICATION pP66
WELL CONTRACTOR COMPANY NAME AppA (A di i A- xi (all 1 !( 1 I,4��C�� PHONE a (54160' 791
STATE WELL CONSTRUCTION PERMITS ASSOCIATED WQ ;STD
(if applicable) (if applicable)
I. WELL USE (Check Applicable Box): Residential is 1 unicipal/Public 0 Industrial 0 Agricultural 0
Monitoring ❑ Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WFI i LOCATIO :
Neare t Towrni 6)4 County_
<� Ca u� �5 oJD tSt ?42
(Street Name, Numbers, Cwummity, Subdivision, Lot No., Tip Code)
3. OWNER: Me f0
Address Co Cc
e
oho Sue" c No' a s 96-R
City or Town State
Zip Code
Topographic/Land setting
❑Ridge ❑Slope ❑Valley alat
(check appropriate box)
Latitude/longitude of well location
(degrees/mwaes/samds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From To Formation Description
Area code- Phone numba
4. DATE DRILLED / (- I O' b ` '
5. TOTAL DEPTH: C3'H-5
6. DOES WELL REPLACE EXISTING WELL? YF,S 0 NO Et"---
7. STATIC WATER. LEVEL Below Top of Casing: ET.
(Use'*+" if Above Top of Cuing)
8. TOP OF CASING IS 1 FT. Above Land Surfaces
`Top of casing terminated at/or below tend surface requires a
variance illaccordane with MAMN�CAC 2C .0I1ST
9. YIELD (gpm): o� OD OF CEU A6, COi lf-l4iiCC/lc
10. WATER ZONES (depth):
11. DISINFECTION: Ty;TA 6('
12. CASING: Wall Thickness
Diameter or Weight/Ft.
From Cam_ To Ft
From To Ft
From To Ft.
13. GROUT: Depth Method
From To
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
Amount cZ- Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
Material numbers and common road names.
16. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONS TRISCFIO�jARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
SIGNATURE OF PERSON CONSTRUCTING THE WELL
DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-1 REV. 07/2001

WELL CONSTRUCTION RECORD 3 0 0 5 3 7
North Carolina - Department of Environment and Natural Resources�\�-r Division of Water Quality - Groundwater Sect'iggn
WELL CONTRACTOR (INDIVIDUAL) NAME^(print) ILAZQV (J._JU.(5 n- CERTIVICAATION#iKi°A
WELL CONTRACTOR COMPANY NAME I • .iii A iNciA i 1I YJ E,I ( .LS i II I PHONE # te.ti\ cs5- Y,A
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable) / _ (if applicable)
1. WELL USE (Check Applicable Box): Residential ❑ Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOC a ON:
t�earestwn.l`i•; tt( a..% s untg 9[ft
Igrl alvEt D 5 DrVIAVo/.) 289.51
(Street Name Numbers, Community, Subdivision, Lot No,Zi Code)
3. OWNER: f`OIPihtsO &L)5 j,, I
Address 13? (.J; ID(i)Ooor.
-rnickgro
IJ(street /JET..)
City or Town State
Area code- Phone number
4. DATE DRILLED I2%/ 3/ 6 —
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO Id/
7. STATIC WATER LEVEL Below Top of Casing: I GO FT.
(the
"" if Above Top of Casing)
'Top of casing terminated at/or below Ind surface requires ■
variance in accordance with ISA NCAC 2C.011&
5. TOTAL DEPTH: R e
graphic/Land setting
dge ❑Slope ❑Valley ❑Fiat
(check appropriate box)
Latitude/longitude of well location
(degrea/miwte&h )
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From To Formation Description
69,5$45a
Zip Code
FT. Above Land Surface*
TOP OF CASING IS
9. YIELD (gpm): .3 ME D OF TESTiTCtI!i, 00401Y(•n
10. WATER ZONES (depth):
11. DISINFECTION: Type I /41.5 It ` Amount CC-
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft Material
From d To 9" Ft.
From To FL
From To Ft.
13. GROUT: n --- i
From To
FA. �.���
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.
f 7 0 II''
P-4X
16. REMARKS:
1 DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 1 SA NCAC 2C, WELL = -
CONS ION S j ARD , AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE OWNER
SIGN
TITRE OF PERSON CONSTRUCTING THE WELL
Sub the 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 comma410N=
North Carolina - Department ofEnvhaoment and Reaoaeeas - oewara
WELL CONTRACTOR W4DNIDUAL) NAME (print)A k� But^ /4 0 AI
WELL CONTRACTOR COMPANY NAME .F A J l2"s a (D /i /), . //,,-.
STATE waLL CONSTRUCTION PERMIT/ ASSOCIATEDt
ZIOSETli
Cif applicable)
1. WELL USE (Check Applicable Box): Residential f Manicipal/Pablic n Industrial ° Agr1Wmnal °
Monitoring 0 Recovery. a Heat Pump Water Injection n Other 0 If Other, List use
2.
WELL LOCAT!(1*,u C o Co ,�jJG 10� /
Nearest Tower '+/U o�rf � I
s' SY pre Lx' 6_o 9 g7e
(S N e. Numbers. Community, Sobdhid%%%o . bat No, Zp Code)..
3. OWNER: ge.01 t tri^ JO An'
Sr I- Address l er No.)
it)/5ho a g 26 /
City or Town State ZW Cade
(9)8 } G 6-,2 - //o
Area cede- Phone member — o
4 DAT DRILLED / S �. Cc
5. TOTALDEPTH: / /a fJ
6. DOES WELL REPLACE EXISTING WELL? YES 0 IjO C'i'
7. STATIC WATER LEVEL Below Top of Casing: d 2 FT.
(User Casing)
3. if Above Top of Ca.
3. TOP OF CASING IS / FT. Above Land Surfaces
crop of cosine terminated ever blow and surface requires a
variance in accordance with ISA NCAC 2C All&
9 YIELD (gpm): D OF.TEST hi, I lti-
10. WATER. ZONES (depth): i
S r k ' 4 Aram= / / Show direction and distance in miles from at least
Topographic/Land setting
Midge °Valley I7Flat
(d mrt appropriate bra)
Latitude/longitude of well location
(depaa lmio.r/raeood.)
Latitude/longitude source:°GPS°Topograpbic map
(dock box)
INZOI DRILLING LOG
From To Formation Description
CIl13ICATI
LOCATION SKErCa
11. DISINFECTION: Type
12. CASING: Wall Thickness two State Roads or County Roads. include the mge..
Depth i (� ee or Weight/Ft numbers and common road names.
Fro�/OQ To 4bV Ft
.--
From // To Ft i
From To Ft.
13. GROUT: Depth Material
From 7279 To a-/ Ft. enntri /
From To Ft
14. SCREEN: Depth Diameter Siot Size Material
From To Ft. in. in. ri
From To Ft in. in. /
15. SAND/GRAVEL PACK
Depth
From To Ft.
From To Ft.
Sim Material
Merbod .mtntDF�
o
add S
/Oils
16. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH I5A NCAC 2C, WELL
CONSTRUCTION STANDARDS. AND T A COPYpF THIS RECORD He.S BEEN PROVIDED TO THE WELL OWNER
/J/yam r
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center taleigh, NC
rton_1624 "'stone "Is. ,010\—12-1221 •vithir. 20 days. tin- -u..
C: C

WELL CONSTRUCFION RECORD 1 U 6 O 7
North Carolina "Department ofEnvuonment and Natural Reaoaeeea Division of Water Quality - Groundwater Section
Ina croxrewcfoaONnrvmuAr.)NAME Ora; /o � Alk� 131a.-th:- -
e ceurmc non. 332i
was. CprrrRACtort COMPANY NAMR f ur /fd/N /.t)tA/ Qirk; I//Pi MOM .Ua3L S7 is' -
STATE WELL COMEMUCrION Psaha1a AS OQATLD WQ
reapptioeble) i Cttapplitabte)
I. WELL USE (Cheek Applicable Box): Residential VKuniapalPublic Cl Industrial o Agricultural ❑
Monitoring o Recovery 0 Heat Pump Water Injection o Other ❑ IfOther, List Use
2. WELL LOCATIO : e /� _ t tl 1
!Iearest Town: frf!' t' County M' a
/ lift
rk IN s fJ!b 0 t2.
(Street Name, Mambas, Community, Subdivision.gLot No.. Me- Code)
3. OWNER:A%� Si.✓ hksLa_nte
Address P t i/h4A. s h .
(street or Rom1gNo.)
M.kt.' /i5 re u ht— , i t 2f .-
taty at Town � _ Sows S Zip Cade
t d)- 6_ /
Na code- Phone amber
4. DATE DRILLED / -" _ D 4-
5. TOTAL DEPTH: j% t 4 i '
6. DOES WELL REPLACE EXISTING WELL? YES !7NO ❑
7. STATIC WATER LEVEL Below Top of Casing: 3 a. FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS / FT. Above Land Surface*
•lop of ming terdaasid at/or below load serfage regains a
•arttnce to ueeardeace with 15A NCAC 2C.011*. ,.
9. YIELD ( ): 1/2")METHOD OF TEST 6Aa I .
to. WATERZONES(depth): 26 ' 6 `•
11. DISINFECTION• T Amoum b
12. CASING: Wall Thickness
Diameter or Weight/Ft. pnl
From TOR To Ft r'
From To Ft
Prom_ To Ft
13. GROUT: Depth Material Method
From f d f To ,00 Ft. ('r/'t �
From To Ft
14. SCREEN: Depth Diameter Slot Size Material
From To Ft in. in.
From_ To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From_ To Ft.
From To Ft.
r e/Land setting
❑Ridgelope ❑Valley °Flat
(duck appropriate box)
Latitude/longitude of well location
(degreer/mimaserasmdt)
Latitude/longitude source:❑GPSETopogtaphic map
(abeek box)
nggli DRILLING LOG
From To Formation Description
1.6. REMARKS:
C:7
4.
11
t,-
c•.
w
0
LOCATION SKETC1
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 TIAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH ISA NCAC 2C, WELL
CONSTRUCTION STAND..RDS, AND THAT A COPY OF THIS RECORD H.S BEEN PROVIDED TO THE WELL OWNER
/
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
Submit the original to the Division of Water Quality, Groundwater Stction,1636 Mail Service Center -Raleigh, NC
t"400-1635 "wotte vc. - o,c. •._,: 122!. -rit:in 30 days. Gw-; ?._ 3;; =GGi

11. DISINFECTION: Type rh 1 LOCATION FTC g OO
12. CASING: �---- Amount Show direction and distance in miles from atleast
Depth
Wall Thickness two State Roads or CountyRoads. Include
Diameter or Weight/Ft Material numbers and common road names.
From To y ' d c o
From Ft.
To Ft.
13. GROUT; Depth
From n Material Method
Tom Ft._a e
From To_ Ftt+ent z_
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources
WELL CONTRACTOR Division of Water Quality - Groundwater Section
(INDIVIDUAL) NAME (print
WELL CONTRACTOR COMPANY NAME t CERTIFICATION# �77R
STATE WELL CONSTRUCTION PERMIT# PHONE # i$ {y)w •� Z z 2
(ifa licable) OCIATED WQ pE.l.#
(ifa licable)
I. WELL USE (Check Applicable Box): Residential tr
trial 0 Agricultural ❑
2. WELL LOCATION:
Nearest Town: �A
County
(Street Name,bars, Community, Subdivision, Lot No., tip Code)
3. OWNER:
Address
Monitoring 0 Recovery 0 Heat Pumst enttal Municipal/Public
Other ❑
P Water Injection 0 Other 0 If Other, List Use
cityofro�ot
P�( JJ
(.wit o —� po Zip Code
Area code- Phone number
4. DATE DRILLED it lJ _ O) L�
5. TOTAL DEPTH: '1 r1
6. DOES WELL REPLACE EXISTING WELL? YES ,❑, '�NO CO
7. STATIC WATER LEVEL Below Top of Casing: AFT
8. TOP OF CASING IS d (U8C `4. if Above Top of Casing)
• 'Top of casing terminated at/or below lansurface vroequand s asurfacee
variance in accordaaawith 15A NCAC 2C .0118.
9 YIELD (gpm): 3_ METIjO OF TEST ram_ 10. WATER ZONES (depth): tt L{
Topographic/Land setting
Ridge DS1ope OValley OFlat
(check appropriate box)
Latitude/longitude of well location
Latitude/longitude ource OGPSOTo o a liana tl
(chuck P gr P ' p
DEPTH DRI IN O
Forman° Description
From Jos
n
BUJ
i'P11einI
From___p To_� 5 Ft.
N& 1 - nr>n
14. SCREEN: Depth
From To
From To
15. SAND/GRAVEL PACK:
Depth
From To
From To
16. REMARKS:
Diameter
Ft
Ft. in.
Ft.
Ft.
Size
Slot Size Material
in.
in.
Material
*Cutter 10
ltJ
arw
t7
DO
I DO B RUCI lON RTCERTIFY
THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
AND THAT A COPY 0 THIS RECORD HAS EEN PROVIDED TO THE WELL OWNER
SIGNATURE OF PE • i N CONSTRUCTING THE WELL,
Submit the original to the Division of Water Quality, Groundwater Section,1636 Mail Servi e C o err--Rale1
DA
27699-1636 Phone No. [phone], within 30 days.
Raleigh NC
GW-1 REV. 07/2001

CbeiS
305881
North Carolina - Dep
artment of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print)
WELL CONTRACTOR COMPANY NAME _ !+a m r r ONEIFICATION p 9 7 a R
��GTc 1 1 D STATE WELL CONSTRUCTION PERMIT,, PHONE M q)-� 2 2
(ifa icable) SOCIATED WQ pERbII•I•p
(ifa licabfe) 1. WELL USE (Check Applicable Box); Residential Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring ❑ Recovery ❑ Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION:
Neares Town: �1111nr:ty, County
(Street Name, Num en, n(Community, Subdivision, Lot No., Zip Code)
3. OWNER: t.&
Address
WELL CONSTRUCTION RECORD
City or
Area code- Phone number
4. DATE DRILLED -
5. TOTAL DEPTH: 1 I)-�-
6. DOES WELL REPLACE EXISTING WELL? Y S is!!O 4
7. STATIC WATER LEVEL Below Top of Casing: aill.FT.
8. TOP OF CASING IS (Use Y if Above Top of Casing)
*Top of casing terminated actor below landa
s rce requires es a d Surface*
variance in according
with 15A NCAC 2C .0118.
9. YIELD (gpm): MET OD OF TEST_ n y
10. WATER ZONES (depth):
11. DISINFECTION: Type rh lip Amount
12. CASING;
Wall Thickness
Depth Diameter or Weight/Ft. Material
From_a_ ToTo Ft e ng 71�,�
From
From - To Ft.
13. GROUT; Depth Material
From ,,
n To_�DFt ,... ti Method
From To Ft. c��ement zam_
14. SCREEN: Depth Diane
From slot Size Material
To Ft. in. in.
From To Ft in
15. SAND/GRAVEL PACK: in.
From Depth Size Material
To Ft.
From To Ft - —'
16. REMARKS:
Topographic/Land setting
113itidge ❑Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
Latitude/longitude source:OGPS❑Topographic Wisp
(check box)
DEPTH jataLusawQ
FromTo, For tiol( Description
•
LOCATION SKETCu
a CD
r.
Show direction and distance in miles from at lest
two State Roads or County Roads. Include the said
numbers and co r r on road names.
V
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH I SA NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY: THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
SIGNATURE OF P • o CONSTRUCTING THE WELL
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center err
27699-1636 Phone No. [phone], within 30 days. Raleigh, NC
GW-1 REV. 07/2001

14. SCREEN: Depth
From To_
From To
15. SAND/GRAVEL PACK:
Depth
From To_
From To
16. REMARKS:
2. WELL LOCATION: , Nearest County IM C (ri t p � A
(Street Name, Numbers, Community, Subdivisi i
yD of No., Zip Code)
3. OWNER: ?lit Yeit Y(
Address
City 4u To n Zip Code
tD -G—'l�O R9
4. DATE DRILLED -
Area code- Phone numb
. 1
5. TOTAL DEPTH: S 0 S
6. DOES WELL REPLACE EXISTING WELL? YES#NO X
7. STATIC WATER LEVEL Below Top of Casing:. SO______FT.
8. TOP OF CASING IS (Use "+' if Above Top of Casing)
• "Top of casing terminated at/or below land surfacevrequ�d s asU[f8ee"
variance to accordan with 15A NCAC 2C .0118.
9. YIELD (gpm):__ HOD OF TEST__
10. WATER ZONES (depth): $
11. DISINFECTION: Type Ch l ne Amount
12. CASING:
Wall Thickness
Depth Diameter or Weight/Ft. Material
Frott>__e__ To Ft.
From To Ft
GBQ31 ncrn
From To Ft
13. GROUT: Depth Material
Fron_y�_ Tom_ Method
From To Ft'fent_
Diameter
_ Ft. in.
Ft • in.
Size
Ft.
Ft
Slot Size Material
in.
in.
Material
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water
WELL CONTRACTOR (INDIVIDUAL) NAME (print) Qualtry - G RTIFICATITndwATSection
CER
WELL CONTRACTOR COMPANY NAME ASSOCIATED W Q pEON . 1 �B
STATE WELL CONSTRUCTION PERMITN PRONE 8 i8 A) 2 z
(if a..licable) RM1TN
(if a..licable)
1. WELL USE (Check Applicable Box): Residential V Municipal/Public ❑ Industrial 0 Agricultural 0 _
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use -
,,.Topographic/Land setting
a�Ridge OSlope OVa11ey OFlat
(check appropriate box) _
Latitude/longitude of well location
(deg
Latitude/longitude source:OGPSOTopographic'ttihp
DEPTH (check box)
From DRI. IN OG
To -)_ F 'motion Description
avd----
M
LOCATIO Lim
Show direction and distance in miles from at least j
two State Roads or County Roads. Include the roa
numbers and common road names.
026
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY 0 THIS RECORD HAS BEEN PROVIDED TO THE WELL OAR
SIGNATURE OF PE • r N CONSTRUCTING THE WELL
Submit the original to the Division of Water Quality, Groundwater Section,1636 Mail Service Center E Raleigh, NC
27699-1636 Phone No. [phone], within 30 days.
OW-1 REV. 07/2001
i 5-0
1SP
7.
6..
J

atc
305790
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources tpivisiop of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) /4 //biz C / tAo" es Tie CERTIFICATION *War
WELL CONTRACTOR COMPANY NAMB$r.JCilZwt4-Tee WC) i 0 I I;n9 PRONE it jTftS1(e44-0.010
STATE WELL CONSTRUCTION PERMIT# ,ASSOCIATED WQ PERMITS
(if applicable) / (if applicable)
QY
1. WELL USE (Check Applicable Box): Residential Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring E Recovery 0 Heat Pump Water) Injection E Other 0 If Other, List Use
2. WELL LOCATION: ) �• 0tog/
14 ttTowa: Td/tr County ri J/
iTv cues DR
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: i e IV — /) /iS/ a (degrees/minutes/seconds)
Address N v& y Mira /V. Latitude/longitude source:0GPS0.m Topographicap
(check box)
l % Pt fl n IngTo n« !' ) (l C/ 3 DEPTH DRILLING LOQ
City or Town State Zip Code From To Formation Description
( )- 7"no -4.2o2
Area coda Phone number
4. DATE DRILLED /1 4r 0 9
5. TOTAL DEPTH: Z N5
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO 11;1
7. STATIC WATER LEVEL Below Top of Casing: 60 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS �0.J FT. Above Land Surface's
flop of casing terminated at/or below laud surface requires a
Tarn in accordance with ISA NCAC 2C .0118. ►—, /
9. YIELD (gpm): 2 0 METHOD OF TEST /e Of ee
10. WATER ZONES (depth):
11. DISINFECTION: Type is C. i7 , Amount /0 02
12. CASING: � Wall Thickness
From # Tth
o La Ft. l7� �j%)R 21or � PUGS
From To FL
From To Ft.
13. GROUT: Depth Material Method ,
From fr To 2O Ft.COACPG�C (a)et Ih1)C
From To Ft
14. SCREEN: Depth Diarmter Slot Size Material
From To Ft in.
Fro To Ft. in.
15. SAND/ VEL PACK:
Depth Size Material
From To Ft
From To Ft.
16. REMARKS:
Topo c/Land setting _
❑Ridge lope °Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
O
C7
O
I DO HEREBY CERTI
CONSTRUCTION
LOCATION SKETCH
Show direction and distance in miles from at 1
two State Roads or County Roads. Inc de the
number& . common mad names.
t,
RDANCE WITH I5A NCAC 2C, WELL
BEEN PROVIDED TO THE WELL OWNER
SIGNATURE OF PERSON CONS GCMG THE WELL
// 1'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

(Street Name, Numbers, Community, subdivision, Lot No., Zip Code)
3. OWNER: if! /h5'/4%qqcn lig
JY(AJ1/'�/1 UntaRouleN9
uy orT State
NN Y
Area code- Phone number
4. DATE DRILLED
5. TOTAL DEPTH:
6. DOES WELL REP CE EXISTING WFI T ? YES 0 NO L+f
7. STATIC WATER LEVEL Below Top of Casing: •
/ (Use "t" if Above Top of Casing
S. TOP OF CASING IS / ' 0 FT. Above Land Surface
'Top of casing terntanted allor below land surface requires a
variance to accordante with ISA NCAC 2C .011& -
9. YIELD (gpm): % METHOD OF TEST // /2/ tell
10. WATER ZONES (depth): LOCATION SKETCH
11. DISINFECTION: Type?. Amount / ea 0 Z Show direction and distance in miles from at least
12. CASING: Wall Thickness two State Roads or County Roads. Inc a road
Depth,_ Di We}ght/Ft numbers and common road names.
From To AO Ft %a Yy Ci�/C 7/ 7 GPP
O
From To Ft.
From To Ft. ;Q
13. GROUT: Depth Material Method From To 20 FtConrte7 wet /no<
From To Ft.
14. SCREEN: Depth Diameter Slot Size Material
From // To Ft in. in.
From, h— To Ft in. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From / To Ft.
305'788
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section` -7
�
WELL CONTRACTOR (INDIVIDUAL) NAME (print) gonit/ r /� 191/ CERTIFICATION War /
WELL CONTRACTOR COMPANY NAM ESIJart o STeC We-4(n r. (I z n9 PHONE it (829449-0V1l0
STATE WELL. CONSTRUCTION PERMIT', ASSOCIATED WQ PERhIIT#
(if applicable)
(if applicable)
1. WELL USE (Check Applicable Box): Residential Ti 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/ % y County do op //
Nearest Town: O/d 7"0
#f't riesloA
Address /OA R i q TnA r •
117y3
Zip Code
T d setting
Midge ope OValley ['Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds) ,-
Latitude/longitude source:OGPS❑Topographmap
(cheek box)
DEPTH pRILLING LOG ---
From To Formation Description
From To Ft.
16. REMARKS:
I DO HEREBY CERTIFY THAT THIS WFI I WAS CON CTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUg1pN STANDARD THAT OPY S RECORD HAS BEEN PROVIDED TO THE WO' 1 OWNER
i/ -may
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

Q��(15c:L. 1-1S-oi3 4 g
WELL CONSTRUCTION RECORD
North Carolina - Dcpaitment of Environment and Naa(mal Resaeces - Division of Water
WELL CONTRACTOR (INDIVIDUAL)NAME (prim) VA Ili 30511ce"
WELL CONTRACTOR COMPANY NAME TlY ;Ca ztL .D ! 1 -!
Groundwater -Section 3 0 6 8 9;
CERTTPIG77ONL / 0
PHONE a f )'yZv'�+�5t9
STATE WELL CONSTRUCTION PERMITS _.ASSOCIATED WQ PERMITS
(if applicable) (if =y.lirable)
1. WELL USE (Check Applicable Box): Residential ft1unicipal/Public 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery ❑ Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION-
N Town: WIARiOM County/0g Po idea
64 1155 /qq Ai44AU1 M4lt1
(Street Name.Na .Cormn oonit7 Subdivision,
Lot .+?ICode)
19,
3. OWNER: i3l tr15 f1r11521l/2z,
Address 3(o) fa merit- iffte C /Zvi
C/lclrkeile,(Smreat�ttaxeNa) 8Z710
City oCroWu Sole Cade
(7°`L)- SyV - 950S - ay'sy3'`klr9 Meer axle- Phone torohns
4. DATE DRILLED Z Or 0 cif
5. TOTAL DEPTH- //oo
6. DOES WELL REPLACE EXISTING Wad? YES 9 NO W
7. STATIC WATER LEVEL Below Tap ofCasing: f D% Fr.
8. TOP OF CASING IS (Use if Above Top of Cuing)
FT. Above Land Surfaces
'Top of eat ur at d War being load carobs m W a6ma
vaiaam W asconloam Plot ISA NCAC 2C Alfa
9. YIELD (gpm): sA METHOD Og_ ESf,/
1O.WATER ZONES (depth):Irein �' 5j 7'
1 I. DISINFECTION: Type(-LOR/Nt Amount 8 © 2-
12. CASING: Wall Thickness
Diameter or Weight/FL Materiel
From Fk
From 0
From /AZ
13. GROUT:
From
From h
14. SCREEN:
From Ft in. in.
From To
15. SAND/GRAVEL PACK:
DepthFrom To
From To FL
Depth
To
To (off Ft. fl �!U
To V FAR/
Depth Material Method
To
To ZS
Depth
To
FL
Ft. dt(/t /
tSia erial ) 1
Dian
FL in. in.
Size Material
Fi.
opographic/Land setting
Midge ❑Slope ❑Valley ❑Flat
(week appmpriale box)
Latitude/longitude of well location
(degea/mio ttd:)
Latitude/longitude source:❑GPS❑Topographic map
Mark hex)
DEPTH DRILLING LOG
From To Formation Description
o - sv
So /Y o gi4,4 . A-e
r_
CO
O E
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers
and common ad Dams.
Q
Asir()
16. REMARKS: y
1 DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARD;. AND THAT A COPY OF IS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
SIGNA CONSTRUCTING THE WELL DATE
Submit the original to the Division of Water Quality, Groundwater Section,1636 Mali Service Center -Raleigh, NC
27699-1636 Phone Na [phone], within 30 days. GW-f REV. =07/2001
MAR - 8 2005

WELL CONSTRUCTION RECORD
Notes Carolina - Departutent of Environment and Nasal Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR(INDIV1DUAL)NAME (rat) (l �"n .�"S`F MC,r C T1PtcwnoNa / �
WELL CONTRACTOR COMPANY NAME -j.':f�(.r LiLI •c$ 1)1r1Y.&4 110TIE
__A-WN nsTED WO PERMIT:
STATE WELL CO\TtRICtlON PERMITS
(if, .livable) ftf
299310
1. WELL USE (Check Applicable Box): Residential 0,--liamicipaUPublic 0 Industrial ❑ Agricultural D
Monitoring 0 Recovery ❑ Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION:
Neatest Town: tYl�i% it 6'Y� / lC �1
Nam:. Numbers. Id N0.. =4
county
!i ` graphic/Land setting
t3 idge CISlope 0Val Flat
(ebb& apprentices box)
%'..
(Stow anoni y, // Cade)
3. OWNER: A L/� r� /3Cc
Address
a Rmtt Nnl
Cty or Town State Tip Code
22
Arta code Rae number
4. DATE DRILLED / 1 - (' Y
5. TOTAL DEPTH: -)--0
>
6. DOES WELL REPLACE EXISTING WELL? YES O NO f
7. STATIC WATER LEVEL BelowTopofcasinv ZP0 Fr.
(User Abovelbo ofttd.a)
8. TOP OF CASING IS / FT. Above Lad Surface'
*Tap Kean; tssrrred Woe Warr brad safest seems
vartea= In atmrdaum with 1SA !CAC 2C Alt
9. YIELD (gptn): ,x (. METHOD OFTEST / (2-
10. WATER ZONES (depth): C" 94 e)
11. DISINFECTION: Type /4-ten 4 /cf. Amoaut li 2-4-
12. CASING: Wallfhidmess
Depot otwnaer or WtagIVVR. ?SW
From To col/ ft. (')4, Co per
F To / Ft,( f/ '! % G't
Ftoen//f-'(& To IStA:1 Ft 4-rr ikPei C'-;F�
13. GROUT: Depth Material Method
From To FL /
F 7 To 7 Z FLi''-<' / - 1�6t .r -%
14. SCREEN: Depth kSlot Sim Material
From To FL in. is
From To Ft. in. is
15. SAND/GRAVEL PACK:
Depth Size Marini
From To FL
From To Ft.
>f O
16. REMARKS: �`�
1 DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STAND AND7TIATACOPYOFTHIS RECORD HAS BEEN PROVIDED TOTHE WELL OWNER
Latituddlongitude of web location
Latitude/longitude sowce:OGPSOTlipograph map
WE* b0S)
DEPTH DR.1HiB 69[t
From To Formation Description
:co•
o _ n;.z
1'.. flare( tea
F
eA) -
10N
r'Sbow shadie i and
two State Rowdsor
owners and common
1f /i / [4-
•
ij
£z Ad? b 7�
1 Cyr' CU7- /L:(
ET
in miles from at bast
Roads. IacMde the road
OF PERSON CONSTRUCIING THE WELL
t4
1
DATE
Submit the original to the Division of Water Quality, Groundwater Section,1636 Mali Service Canter -Raleigh, NC
27699-1636 Phone No. [phone]. within 30 days. GWa REV. 07/2001

3. OWNER:
WELL CONSTRUCTION RECORD 2,9632
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
41
%YELL CONTRACTOR (INDIVIDUAL) NAME (print) ( AIUJ 5t {i CG CERTIFICAT�ION 021 S>
WELL CONTRACTOR COMPANY NAME ' ,ktC,E WL t-( t) ft C(-I✓Y' PHONES f2A 729-4 Pig
STATE WELL CONSTRUCTION PERMITS ASSOCIATED WQ PERMITS----
(ifapplicabie) (if applicable)
1. WELL USE (Check Applicable Box): Residential ly MunicipallPublic 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
County Vt bbt,)CLL
(Street Plane. Numbers, Cmnnunity, Subdivision, Inc No., Zip Cade)
T.%'PI 5 L)L2tscr4:
Address T(,2 l) j it, o(i2- F4'1TSi-
& € C (Sued of Route No.) /
City or Town State Zip Code
(&14 73Q-3<5rio
Area code- Phone number
4. DATE DRILLED r% - tl "G 4
5. TOTAL DEPTH: ACI
6. DOES WELL REPLACE EXISTING WELLS YES 0 NO Ere
7. STATIC WATER. LEVEL Below Top of Casing: Po FT.
(Use "+" if Above Top of Cuing)
8. TOP OF CASING IS / FT. Above Land Surfaces
'Top of casing terminated War below land surface require •
variance In actordaaee with 15A NCAC 2C.011S.
9. YIELD (gpm): / METHOD OF TEST A 12
10. WATER ZONES (depth): /?,a Ad & 200'
11. DISINFECTION: Typed tc)g. C Amount S 02
12. CASING: Wall Thidmess
Depth Diatn ?)er Of Weight/Ft. Material
From CJ To g g FL 4i five
From SO To /O6' ��` Ft-,(
re
From / To //0 Ft. /
13. GROUT: Depth
Material
Method
From To FL
From_42_ To 7 2 FL •((l eo ( /turf eJ
14. SCREEN: Depth Digger Slot Size Material
From To FL in. in.
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Sire Material
From To Ft.
From To Ft.
16. REMARKS:
Topog$tra?pphic/Land setting
❑Ridge 6]Slope 0Valley 0Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH DMA-WWIOC2-
From To Formation Description
A) -
4,/1- el S
lo
ro5'.2A5-
Di a1-
cAAid
a/4,ckF e14Y
LOCATION SKETCH
Show direction and distance in miles from at (east
two State Roads or County Roads. Include the mad
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 OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
SIG
A
TU OF PERSON CONSTRUCTING THE WELL DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mal Service Center -Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-1 REV. 07/2001

WELL CONSTRUCTION RECORD
North Carolina - Dcparutent of Envirorane nt and Natural Resources - Division of Water Quality - Caolmdwater Section.
t
WELL CONTRACTOR(NDIVIDUAI9NAME debt) C4 A(L1 Oft, CF`, CERTIFICATION a �15
WELLCONTRACTOR COMPANY NAME 'S *I Lf.�. QLL Di1 L'V N� PHONE )7Zy' y e
STATE WELL CaXSTRUCRON PERMITS ASSOCIATED WQ PERMITS
(if applicable) (if 'petiolate)
1. WELL USE (Check Applicable Box): Residential MwticipauPublic 0 Industrial 0 Agricultural ❑
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other 0 If Other, List Use
2. WELL LOCATION:
Nearest Town: b County IA 4 �Ul.
et t.ol,(l n 'Q
(Saw Name Numbers, Cmmtnity, SLbmM oa, Lot No. to Code)
3. OWNER: O 5 F ot., id &-
Address u? 1(5 C'i NC%
(Sew C L 1) For 1 i C Rate Nn)
,-t )
City or Town Sate
JLcc.)Aes
lc( A'C. Fr1TLm t7!'
t� 'i (P2
Zip Cede
( lb l?(p`G' 0Z. q_
Area code Plane amber
4. DATE DRILLED 1" I LI' O Lf
5. TOTAL DEPTH- 25,0
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO tsr/
7. STATIC WATER. LEVEL Below Top ofCaanng 2a FT.
ii (Use 'Y-+ifMove Top of Casing)
8. TOP OF CASING IS t FF. Above Land Surface'
`Tap of main fiord Wan balm lad mime eopie m
variance Inat aTIM ISA
NCAC2C Silt
OF TEST A1 9. YIELD (gpm): METHOD
10. WATER ZONES (depth): 3 ri r �? ,Z co
11. DISINFECTION: Type L IOY't.t 1-1 Amount 02
12. CASING:
Depth
From To Ft.
From *[) To 4G F
From Lin To LI Z Ft..
13. GROUT: Depth
From To
Wall Thidaess
Diameter or WeiOIVR. Material
From_a_ To 3 fl
14. SCREEN: Depth
From To
From To
15. SAND/GRAVEL PACK
Depth
From To
1BE (,,II✓
Material Method
FL n
�.W FL {1.IGI
S(or Sure Ytliria!
pTh Nuance' al
Ft. in. in.
Ft in. in.
From To
16. REMARKS:
Size Material
Ft.
Ft.
Topogtapbic/ and setting [Walley❑Ridge �oopp[Walley'LIFlat
(Mack ap xop'ux box)
Latitude/longitude of well locaiion
Latitude/longitude somce:❑GPS❑Tcpographic map
pink MO
DEPTH DRILL.INC+Loa
From To Formation Description
3 Se
2'eo U//44,-.
•
LOCATION SKETCH D -..'
Show direction and distance in miles from at least _ two State Roads or County Roads. lacludeie road
nandrers and common road names. Cho
t
Z
C' , ►` 1s 4
vgi (re IL
4U
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, )DTHAT ACOPY OFTHIS RECORD HAS BEEN PROVIDED TOTHE WELL OWNER
TURE e P CONSTRUCTING THE WELL
DATE
Submit the original to the Division of Water Quality, Groaadwater Section, 1636 Mani Service Center -Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. OW -I REV. 07/2001

WELL CONSTRUCTION RECORD 2 9 9 2 18
North Carolina - Dcpariment of Environment and Natural Resources - Division of Water Quality - Groundwater Section
�y S—
WELL WELL CONTRACTOR (INDIVIDUAL)NAME (pint) (( ttt ZJ S�l Cot LERI It 'CATION 09614
WELL CONTRACTOR COMPANY NAME o 5� (2_ VL ei k �+ ('; LL., r" (k PHONE . yY) `if 54,9
STATE WELL CONSTRUCTION PERMIT. ASSOCIATED WQ PERMIU
(if applicable) (if applicable)
1. W ELL USE (Check Applicable Box): Residential e1 Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring ❑ Recovery ❑ Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION: ��
Nearest Town: 4p. tr. O 1 County Ain e� `Z=L�Q.,
(Sweet Name. Numbers, Community, Subdivision, Let No.rip Cade)
3. OWNER:
Address
o►�p�a�� wcL�
-1 "1 4 1A irl t r
(Street of Na)
Iribv Vh,�C �Ca�
City or Town State Zip Code
( )- ltt/ 4073
Area code- Mom amber
4. DATE DRILLED 2—/ ' O t -
5. TOTAL DEPTH:
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO El
7. STATIC WATER. LEVEL Below Top of Casing: G0 FT.
(Use "+" if Above Tcp of Casing)
8. TOP OF CASING IS / FT. Above Land Surface
'Top of casing terminated attar below iod unlace requires
variaace in accordance `� �with 1SA NCAC 2C Ala9. YIELD (gpm): i& METHOD OF TEST A /a
10. WATER ZONES (depth): 8 c' p .el (71 a So
11. DISINFECTION: Type tl b..W /VC Amount Q 02
12. CASING: Wall Thidwiess
Depth Diameter or Weight/Ft. Material
From To Ft.
From C To 6, 7 FL
13. GROUT: Depth
From To FL
Front_C To ZZ FL type / fOn+1oPr(
14. SCREEN: Depth Diameter Slot Size Material
From To FL in. in.
From To Ft. in. in.
15. SAND/GRAVEL PACK.:
Depth Size Material
Topog$9�pphic/Land setting
❑Ridge lope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degreeinira,tchecords)
Latitude/longitude source:❑GPS❑Topographic-map---- _.
(cheek box)
DEPTH DRILLING LOG
From To Formation Description
o — inrl i>/,��
iatt_
From 7 To 7,g Ft.
Material Method
From To Ft.
From To Ft.
16. REMARKS:
r_
LOCATION SKETCH
Show direction and distance in miles from at !East
two State Roads or County Roads. Include thin %ad
numbers and common mad Dames. PC CtC.
ick or y q
9-0 `D
ftt5 f k/
j/A rno y
gel
/95/1Y+r,tc
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH I5A NCAC 2C, WELL
CONSTRUCTION STANDARDS, F)ND THAT &COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
elate
^/24
SIGMA
PERSON CONSTRUCTINGTHE WELL DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mali Service Center -Raleigh, NC
27699-1636 Phone No. (9l9) 733-3221, within 30 days. GW-I REV. 07/2001

WELL CONSTRUCTION RECORD
299316
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Secs
WELL CONTRACTOR (INDIVIDUAL)NAME hullo 6Ai/ t J (1_Sy1 CC �t CERTIFICATION
``
WELL CONTRACTOR COMPANY NAME ! r t-F I C. L k7.t Q b r' - " 1 PHONE a &a i2y•-95-#8
STATE WELL. CONSTRUCTION PERMIT. ASSOCIATED WQ PERMIT' 1
(if ylicable) (if applicable)
ACn
1. WELL USE (Check Applicable Box): Residential a unicipal/Public 0 Industrial ❑ Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other ❑ If Other, List Use
2- WELL LOCATION: 'A
Nearest Town: %�r '` County fV^ ' W (PCB
0 Lin,,., R )dal
(Sued Namc. Numbers, Community,1Subdivision. Lot Non Zp Code)
3. OWNER: S0.vtAJ D (4 t 4j i
Address ZO9 t4zZ,. u.., 1,C-4
(Sues w Rmne No.)
VIA -ow N L 2 1-2
City or Town Suite tip Code
Area code- Pbo.e number n
4. DATE DRILLED 74"
O
5- TOTAL DEPTH: 340
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO (W
7. STATIC WATER. LEVEL Below Top of Casing:�Ff" F .
(Use" " if Above Top of Cam
8. TOP OF CASING IS ( FT. Above Land Surface`
flop of casing terminated aior below bind swfaa reggae a
vadaace In accordance wits ISA NCAC 2C AllR
0 9. YIELD (gpm): 3 METHOD OF TEST *L
0 1+ 10. WATER ZONES (depth): ;rj fn+ e soo
1 I. DISINFECTION: Type L%tC•Ne Amount a G2
12. CASING: Wall Thiclmess
Depth Diameter or Weight/Ft Material
FL
Ft. (41
Ft. Li l(!.i/v
Material
FL
Fromm._ To QZ Ft fir14. SCREEN: Depth Diameter Slot Sir aterial
From To Ft. in. is
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
From To
From a To SC
From To gZ
13. GROUT: Depth
From To
T9pographic/Land setting
grtage ❑Slope ❑Valley ❑Flat
(theca appropriate bon)
Latitude/longitude of well location
(de&ashninuteaccoms)
Latitude/longitude source:❑GPS❑Topographic map ,
(check boa)
DEPTH DRILLING LOG
From To Formation Description-
- Z Ai,t( CSAJJ C k
�J� J
340 ,Stet Kk�,,. - C
co Pi/G
Method
16. REMARKS:
LOCATION SKETCH
Show direction and distance in miles troniiii least:;;
two State Roads or County Roads. Include Rik road;
numbers and common road names. ca1/40
0
4-5
Lit, rZt
ftl
57V-dee 1CN-e
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED 1N ACCORDANCE WrrH 15A NCAC 2C, WELL .
CONSTRUCTION STANDARD 5Z AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
S GNJT. E 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
0

WELL CONSTRUCTION RECORD - 2 9 9 314
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Grotmdwalef Section
WELL CONTRACTOR (INDMDiUAL)NAME (pW) CiyasS, 45/i CERTWIC'ATION 0fa/ SD
T(
WELL CONTRACTOR COMPANY NAME Tinier: t.aa-. Q.YL tC( »' q PRon a? W7tquSLy 8
STATE WELL CONSTRUCTION PERMITS ASSOCIATED WQ PERMITS _. _...
(if applicable) (if tr t�rliclble)
1. WELL USE (Check Applicable Box): Residential 1B' MmicipaUPublic 0 Industrial 0 Agricultural 0
Monitoring O Recovery ❑ Heat Pump Water Injection ❑ Giber O If Other, List Use
2. WELL LOCATION: C Y ��(k
Nearest Town: OG() 6YI County
*ll-
(Street Name. Commmik Sti?":te No. LP Code)
3. OWNER: figa4, % q✓y CrorEC'ku
Address Crinu•, L pri Air
(Streets Of Rome Nal
6LO Fir h IC GX,2
Ctyotr7orm Slate Zip Cede
(h& } arm
47 2 c
Arta coati non ameba
4. DATE DRILLED %- 7-UV
5. TOTAL DEPTH- son' PTO - (bOCi 6sgior✓r i4
6. DOES WELL REPLACE EXISTING WELL? YES lia*3 ('
7. STATIC WATER LEVEL Below Top ofCasing'dc)t:' FT.
(ua^r-ifAbowTop otersIet)
& TOP OF CASING IS / V2 FT. Above Land Surfaces
flop of crag t.rad.rta odor bairn Mead surface rage.
variance as accordant rdM 1SA NCAC 2C £11$.
9. YIELD (gpm): c METHOD OF TEST /4/2
10. WATER ZONES (depth): . iPnf ey
S00
•
I I . DISINFECTION: Type eiCr? Aelt a Amount 7"3/7 a
12. CASING: Wall Madmen
Depth Damn(- or Wei3zv[.
From G To (OG FL 43 (�5/ 4O
Front_/C�To /0/ FL G t/t� ?()
From RI/ To /c* Ft. 4V (b
13. GROUT: Depth Material
From To FL
From_LTo EA" FL 21/ POrierd
14. SCREEN: Depth Dicer Slot Size Mania/
From To FL in. in.
From To Ft. is in.
15. SAND/GRAVEL PACK
Depth Size Material
From To FL
From To Ft.
Tge °SlopeJCandCR/ setting
[8((i ge OSbpe ❑Valley ❑Flat
(duck apprun(re box)
Latit ddkwgitude of well location
(degnalminacsfseconds)
LNitudeflonginde source:OGPS❑Tcvographic map
(tleckboa)
DEPTH DRIILINQ LOG
Fran To Formation Description
0 - t3a
0
LOCATION SKETCH
Show direction and distance in miles from least
two State Roads or County Roads. Include die toad
numbers and oonmmon road name.
,49
Pao'
16. REMARKS:
Kµ z.t
IAA 1.
O4-0f3-(-
I DO HEREBY CERTIFY THAT 1S WELL WAS CONSTRUCTED IN ACCORDANCE WITH I5A NCAC 2C, WELL
CONSTRUCTION STAND far}:,ANDT T A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
RE OF PERSON CONSTRUCTING THE WELL
DATE
Submit the original to the Division of Water Quality, Groundwater Section, Mail Service Center - Rack NC
27699-1636 Phone No. (919) 733J221, within 30 days. GW-1 REV. 07/2001

299312
9
10. WATER ZONES (depth): o'pm fryo'
I I. DISINFECTION: Type (CcPR/Nt/ .WSAmount l UZ
12. CASING: WallThittman
Diameter or Weight/Ft. Material
Ft.
Depth
From To
From G To
From 91 To
l3. GROUT: Depth
From To Ft.
FromTo Ft.
14. SCREEN: Depth Diameter
From To FL in.
From To Ft. in.
15. SAND/GRAVEL PACK:
Depth
From To
From To
Material
16. REMARKS:
pt/'
Method
Slot Size Material
in.
in.
Size Material
Ft.
Ft.
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section J�
eJ
WELL CONTRACTOR (INDIVIDUAL)NAME (printt)) L] .4 �• /I C4\, F CERTIFICATION LD
15
WELL CONTRACTOR COMPANY NAME Q.S44 0 F l %f ( L. 9 c-,1 1 .IVt) PHONE * Ste 721- q S4 e
STATE WELL CONSTRUCTION PERMITS ASSOCIATED WQ PERMI
(if applicable) (if applicable)
1. W ELL USE (Check Applicable Box): Residential ❑ icipa1/Public 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION: ' C �J
Nearest Town: Mc elites t' County flit t C Jf
'173 e /Let L_ m.,i
(Street Name, Numbers, Community, Subdivision, Lot No.. Zip Code)
3. OWNER: bti'Ui
Address 73 4-4 R n C 4 N-e
(Street or Route_ Na) SiG /
City or Town late Zip Code
)- CO Sz.— 84r(
Area code- Plane number,
4. DATE DRILLED CP `I met
5. TOTAL DEPTH: `ZOO
6. DOES WELL REPLACE EXISTING WELL? YES I1340 0
7. STATIC WATER. LEVEL Below Top ofCasing: .SO FT.
/ (Ilse "+' if Above Top of Casing)
8. TOP OF CASING IS FT. Above Land Surface'
'Top of easing termiaatd at/or below land sw6n requires a
variance In accordance with 1SA NCAC 2C AII8. r _ _
. YIELD (gpm): METHOD OF TESTfr $¢/4 ,$
,,,Topographic/Land setting
Ridge ❑Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degas/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map _
(check box)
DEPTH DRILLING Log
From To Formation Description-
0 - Pc' n/ t21"
(I�Raunts
LOCATION SKETCH
Show direction and distance in miles from at just
two State Roads or County Roads. Include the toad
mambas and common road names. .L& 4/1-t �' .1 ".
66 -Wei
coSSe
1 DO HEREBY CERTIFY AT THIS WELL WAS CONSTR
CONSTRUCTION 4-•c1,' ' DS, AND THAT ACy Y
SIGN
4
ACCORDANCE WITH I5A NCAC 2C, WELL
RECORD HAS BEEN PROVIDED TO THE WELL OWNER
0 i,ERSONCONSTRUCTING 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. OW-1 REV. 07/2001

North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
1636 Mail Service Center - Raleigh, N.C. 27699-1636 - Phone [phone]
WELL CONSTRUCTION RECORD
299535
WELL CONTRACTOR- Dewey Wright Well Pump Co., Inc.
WELL CONTRACTOR CERTIFICATION #. 2797
040247 STATE WELL CONSTRUCTION PERMIT#• Jerry Wilson
1. WELL USE (Check Applicable Box): Residential X Municipal 0 Industrial LE Agricultural D Monitoring
Recovery I I Heat Pump Water Injection 0 Other If Other, List Use: —.
2. WELL LOCATION: (Show sketch of the location below)
Nearest Town: MARI ON County MCDOWFI I
LOT # 74 GRANTS MTN St 19 OFF ASHWORTH an OFF
(Road Name and Numbers, Community, or Subdivision and Lot No.l DRILLING LOG DEPTH
3. OWNER RONAI O R TAf71 OCK From To Formation Description .._i
Address 270 JALA LANE 0 PO DIRT SHALF GRANITE
r et or Route No.)
nnermXINGT� State wn
NC 2 z(agCode g0 1045 GRPNI� QUARTZ
4. DATE DRILLED 7/1/2004
5. TOTAL DEPTH 1045
6. CUTTINGS COLLECTED YES I I NO 0
7. DOES WELL REPLACE EXISTING WELL? YES 0 NO n
8. STATIC WATER LEVEL Below Top of Casing: FT
IUse "«" if Above Top of Casing)
9. TOP OF CASING IS 1 FT Above Land Surface*
`Top of casing terminated at/or below land surface requires a variance in accor-
dance with 15A NCAC 2C.0118
10. YIELD (gpm): 0 METHOD OF TEST Ar
11. WATER ZONES (depth): 0.00 nom DRY HOLE 0.00gpm
0.00 gpm 0.00gram
12. CHLORINATION: Type HTH Amount
13. CASING:
Depth
From 0 To 1115,Ft 61/8
From To Ft
From To Ft
14. GROUT:
0
-731
i1 —
If additional space is needed use back otform
Wall Thickness
Diameter or Weight/Ft. Material
R.90
PVC
Depth Material Method
From 0 To 20 Ft Cement Gravity Flow
From To Ft
15. SCREEN:
Depth Diameter Slot Size
From To Ft in in.
From To Ft in. in
From To Ft in in
16. SAND/GRAVEL PACK:
Depth Size Material
From To Ft
From To Ft
LOCATION SKETCH
(Show direction and distance from at least two State
Roads, or other map reference poi is
Lok,t1 I
17. REMARKS
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COP OF THIS RECORD HAS BEEN PROVID TO THE WELL OWNER.
FOR OFFICE USE ONLY
ATURE OF PERSON CONSTRUCTING THE WELL DATE
Submit original to Division of Water Quality, Groundwater Section within 30 clays
GW-1 REV. 12/99
Quad No:
Serial No.

29.994E
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment And Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) NEIL CRAFT CERTIFICATION # 3114
WELL CONTRACTOR COMPANY NAME PITTMAN WELL BORING, LLC PHONE # [phone]
STATE WELL CONSTRUCTION PERMIT # _ ASSOCIATED WQ PERMIT #
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential ® Municipal/Public ❑ Industrial ❑ Agricultural
Monitoring ❑ Recovery D Heat Pump Water Injection ❑ Other 0 If Other, List Use
2. WELL LOCATION:
Nearest Town: OLD FORT County MCDOWL
VIOLET LANE
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: JOSH CLARK
Address VIOLET LANE
(Street or Route No.)
OLD FORT NC
City or Town State Zip Code
(8) - 287-4239
Area Code Phone number
4. DATE DRILLED 07/19/04
5. TOTAL DEPTH: 125
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 1-1/2 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): 60 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 70 Ft. 6-1/4" SDR.21 PVC
From _ To Ft. _
From To Ft. _
13. GROUT: Depth Material Method
From 0 To 20 Ft. QUIKRETE POURED
From _ To Ft.
14.SCREEN: Depth Diameter Slot Size Material
From _ To _ Ft. _ in. in.
From _ To _ Ft. in _ in.
15. SAND/GRAVEL PACK:
Depth Size Material
From _ To _ Ft.
From To Ft.
16. REMARKS
Topographic/Land setting
0 Ridge 0 Slope 0 Valley ❑ Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)-__.--._..._
Latitude/longitude source: 0 GPS ❑ Topographic map
(check box) --- _
DEPTH
From To
DRILLING LOG
From To
LOCATION SKETCH
Show direction and distance in miles from at least Two State Roads or County Roads. Include the road
number and common names
I-40 W. FROM MARION TO XIT 73 (OLD FORT).
LEFT AT LIGHT. APPROX. 2-1/2 MILES & LEFT
ON SILVER WELCH RD. CROSS BRIDGE & STAY
RT. ON SILVER WELCH. RT. ON LAVENDER RD.
CROSS BRIDGE & TAKE 1ST DRIVE TO LEFT. -
VIOLET LANE -NO SIGN. 1ST DR. ON LEFT.
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
(4e, ���3%,,,� *?/),e _ '� — / �i - n
SIG TURE 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

300048
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Na ources - Division of Water Quality - Groundwater Sectionrp �7
WELL CONTRACTOR (INDIVIDUAL) NAM (pr1nt) Q�L(%"/� ,C, ' � L L CERTIFICATION ihui % /
WELL CONTRACTOR COMPANY NAME/ .d /.Ly ..Yi' 1_1.4 G "HONE # Rog 2 G rII49d 9ra
STATE WELL CONSTRUCTION PERMIT# /.a ASSOCIATED WQ P
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential ie. Municipal/Public 0 Industrial 0 Agricultural C
Monitoring 0 Recovery ❑ Heat Pump Water Injection ❑ Other 0 If Other, List Use
c, 3
2. WELL LOCATION:
N To _ County
f f.C� C el' fr7, Z.
(Street Name, N bets, Community, Subdivision, Lot No, Zip Code)
3. OWNER: 1
Address?
S
ter -
(Street orNo.)
7o� .� iytc b2$7sz,
City own State
Zip Code
Area code- Phone number
4. DATE DRILLED s/<S/e) y
5. TOTAL DEPTH: 3 oS
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO al
7. STATIC WATER LEVEL Below Top of Casing: /0 D FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS /4 FT. Above Land Surface*
'Top of wing terminated actor below land surface requires s
variance in accordance with ISA NCAC 2C .0118.
9. YIELD (gpm): S METHOD OF TEST72n.te
10. WATER ZONES (depth): `7.�L S' l �� l
•
11. DISINFECTION: Type e.g. N.
12. CASING: ,y,/
iTter
From n To �8 7 Ft. /n
Ft.
From To
From To
GROUT: Depth
From Q To 4 D Ft.
Ft.
From To Ft.
SCREEN: Depth Diameter
From To Ft. in.
From To Ft.
SAND/GRAVEL PACK
Depth
From To Ft.
From To Ft.
in.
Amount // "—
Wall Thickness
or
tt / WeightfFt. Matedal
L
Slot Size Material
in.
in.
Size Material
16. REMARKS:
Topographic/Land setting
.*Ridge ❑Slope ❑Valley; OFlat
(check appropriate box)
Latitude/longitude of well location
c_D
0
(degrees/minutes/seconds _
Latitude/longitude source:❑GPS❑Tl pographie map
(checkbox)I
DEPTH pRItti1QG"LOG
From To Formation Description
j.00ATTON SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. include oad
numbers and common road names.
Law
•
:C Wd 9- any to
CD
0
t=c)
0<
m111�
ro�
rn 73
t7
CO a
I DO HEREBY CERTIFY THAT THIS Wpi 1 WAS CONSTRUE 1ED IN ACCORDANCE WITH 15A NCAC 2C, WELL Z
CONSTRUCTION STANDARDS, AND COPY F� SRDHAS EN PROVIDED TO
4 A
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
4
Submit the 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) N �s (print)
WELL CONTRACTOR COMPANY
Resources - Division of Water Quality - Groundwater Section
CERTIFICATION tt-.2l f 9
(.4,4Pw p n-e PHONE # T:Wr-L)a
STATE WELL CONSTRUCTION PERMrf# 444 ASSOCIATED WQ PERMrr#
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential VI 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:
County ea
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER:
Address 5f'rr/A
or Route No.)
4/C' r .2 e ? (E, 2—
Zip Code
City or Town
State
(—
Area code- Phone number
4. DATE DRILLED .3�irD JS/it
5. TOTAL DEPTH: e.0 Q S
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO Al
7. STATIC WATER LEVEL Below Top of Casing: ij.S FT
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS 1 j FT. Above Land Surface*
'Top of casing terminated ater below land surface requires a
variance in accordance with ISA NCAC 2C .0118.
9. YIELD (gpm): _S METHOD OF TEST /...L.vci
10. WATER ZONES (depth): .
11. DISINFECTION: Type,
12. CASING:
Frorrt__�Depth T, Ft.
From To Ft.
From______ To Ft.
13. GROUT: Depth
From_ To� Ft
From To Ft.
14. SCREEN: Depth Diameter Slot Size Material
From To Ft in. in.
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
Amount
Wall Thickness
ter or Weight/Ft �pMaterial
G)
Topographic/Land setting
❑Ridge IgiSiope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
v
f3
c>
(degrees&mimrtes/seconds).. ___
Latitude/longitude source:❑GPS❑Topograp1lk map
(check box)
DEPTH DRILLING LOG
From To Formation Description
atecial
a'
16. REMARKS:
c
LOCATION SKETCH CO Z
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common r ad names.
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WFI I
CONSTRUCTION STANDARDS, T A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
SIGNATURE OF PERSON
ONSTR
S7/.9ld/
CTING THE WELL DATE
I
S_-
Submit the 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

30en,4,^,
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Na Resources - Division of Water Quality - Groundwater Section �i �/
WELL CONTRACTOR (INDIVIDUAL) NAM ��.[-..,-,(pprim) �A/Jr ��JJ�� //77L�L / CERTIFICATION it 2 / [ p�
WELL CONTRACTOR COMPANY NAME o'jj . .t/o t JQ% V/yr�si ��CYHONE # ,TiODn (O g9 g yp C�
STATE WELL CONSTRUCTION PERMIT# N/i/ ASSOCIATED WQ P RMIT#
(if applicable) (if applicable)
eir
1. WELL USE (Check Applicable Box): Residential tit Municipal/Public 0 Industrial ❑ Agricultural
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
4y. c
City or Town State Zip Code
E )
Arca code- Phone number
4. DATE DRILLED L Z Cl/,n y
5. TOTAL DEPTH: ..r
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO Al
7. STATIC WATER LEVEL Below Top of Casing: n FT.
_JUsc "+" if Above Top of Casing)
8. TOP OF CASING IS /5 , 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 f) TROD OF ST LLr* of
10. WATER ZONES (depth): X7 t D
2. WELL LOCATION:
Nearest Town:.2ir County
(Street Natr(e, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNERSvfil/
Address 7.15P (it/j
(Street odtouts No.)
11. DISINFECTION: Type e /l/ j
12. CASING:
Depth atgeter
From Q To e I Ft Go lti
From To Ft
From To Ft.
13. GROUT: Depths, Material
From p To (-in Ft. CmniitLY
From To Ft.
Amount % z'
Wall Thickness
or Weight/Ft Material
/ ,Pdt
14. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in.
From To Ft. in. in.
15. S /GRAVEL PACK
Depth Size Material
From -To Ft.
From 7— To Ft.
16. REMARKS:
from at (east
elude the road
Topographic/Land setting
❑Ridge ❑Slope Walley °Flat
(check appropriate box)
Latitude/longitude of well location
0
v
0
a
(degrees/minutes/seconds) ; ,1 r ..
Latitude/longitude source:❑GPS❑Tolsographic map .
(check box) L.
DEPTH DRILLING LOG
From To Formation Descriftin
a�
cn
LOCATION SKETCH
Show direction and distance in mil
two State Roads or County Roads.
numbers and common road name
VY
I DO HEREBY CERTIFY THAT THIS WEI.) WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, A 7HAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
/ Le g5�j.Z/6 V
GNATURE OF PERSON CONS UCTING THE WELL ATE
n
Submit the 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 N
WELL CONTRACTOR (INDIVIDUAL) NAM (print)
WELL CONTRACTOR COMPANY N
STATE WELL CONSTRUCTION PERMIT#
(if applicable)
�000•
Resources - Division of Water Quality - Groundwater Section
I - �/L� _ CERTIFICATION t , 't y
AMF,f .!/./.ii� .Gf 597
A i4/ w Xicvr�� �NE # M 4 99- 7 00
y/� ASSOCIATEDVWQ PERMITS # QIAff �.
(if applicable)
I. WELL USE (Check Applicable Box): Residential Municipal/Public 0 Industrial ❑ Agricultural ❑
Monitoring ❑ Recovery ❑ Heat Pump Water Injection 0 Other 0 If Other, List Use
5. TOTAL DE V�_'r
6. DOES WELL E EXISTING WELL? YE NO
7. STATIC WA L Below Top of Casing: .
(Use"+" if Above Top of Casing)
8. TOP OF CAS s FT. Above Land Surface*
'Top of casing t at/or below land surface requires a
fi
variance In accordance 15A NCAC 2C .0118.
9. YIELD (gpm) METHOD OF TEST12nL
10.WATERZO ): yS' Son'
11. DISINFECTION: d . fi! N Amount /y C
•
12. CASING: Wall Thickness
Dy�eter or Weight/Ft. terial
From 0Ft. Critter
#f2/ llr.
DEPTH:
REPLACE
LEVEL
CASING
terminated
ZONES
2. WELL LOCATION.
Nearest toy�: i4 GII'RTa— _ County
0 5?i/ 2-
(Street Name, Numbers, Community, Subdifsion, Lot No., Zip Code)
3. OWNER:%
Address 4Iter = /it...Ea Gyi/i
/t / r(stfeet or Rom�No.) �O7ln 7_
City or Town State Zip Code
( -- Area code- Phone number
4. DATE DRILLED ..////d Y
TER
IS
rdance with
: /b
(depth
ON: Type
TDothV
From
From
13. GROUT:
From 0
From
To
Ft.
To Ft.
Depth
Tor•[1 Ft.
To Ft.
^Material M od
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 o Ft.
From To Ft.
16. REMARKS:
Topographic/Land setting
❑Ridge ]$IS1ope ❑Valley DF12t
(check appropriate box)
Latitude/longitude of well location
v
a
(degrees/minutes/seconds) k vi 1_ -.
Latitude/longitude source:❑GPS❑Toiographic niap- -
(cheekbox) : - -
DEPTH DRILL�INU Lw t'
From To Formation Description
N2
LOCATION SKETCH
Show direction and distance in miles from . least
two State Roads or County Roads. Inclu. the road
numbers and common road names. )I,1V*n `O Iuou
1 DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND TH4T4'COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
/TE/4 V
THE WELL DATE
SIGMA
1:icidt.SON CONSTRUCTIN
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-1 REV. 07/2001

From: Scott & Jo Mn To: Division of Water Quality Date: 9/132004 Time: 6:40:20 PM
Page 2 of 10
301735
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment, and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) SCOTT GANTT CERTIFICATION # 2584
WELL CONTRACTOR COMPANY NAME CAROLINA WELL DRILLERS, INC. PHONE. # [phone]
STATE WELL CONSTRUCTION PERMIT # ASSOCIATED WQ PERMIT
(if applicable) (if applicable)
I. WELL USE (Check Applicable Box) Residential ❑ Municipal ❑ Industrial ❑ Agricultural ❑ Monitoring ❑
Recovery ❑ Heat Pump Water Injection 0 Other ❑ If Other, List Use:
2. WELL LOCATION:
Nearest town: MARION
456 SUGAR HILL RD
County McDOWELL
(Street Name, Numbers, Community, Subdivision, Lot No,. Zip Code)
3. OWNER JOEY HEMPHILL
ADDRESS 456 SUGAR HILL RD
(Street or Route No.)
MARION
City or Town
828-659-1161
Area Code - Phone Number
4. DATE DRILLED 8/31/04
NC
Stale
5. TOTAL DEPTH 220
Zip Code
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO 13
7. STATIC WATER LEVEL Below Top ofCasine: 70 FT
(Us("." If Above Top of Casing)
8. TOP OF CASING IS 2 FT. Above land Surface*
"Top of cueing terminated at/or below land surfsec reclaims a variance in
accordance with 15A NCAC 2C.0118
9. YIELD (gpm): 20 METHOD OF TEST ARDM
10. WATER ZONES (depth): 210
Topographic/Land setting
❑ Ridge ❑ Slope ❑ Valley ® Flat
Latitude/Longitude of well location
35.37.237 / 82.03.011
(degrees/minutes/seconds)
Latitude/ongitude source: E GPS ❑ Topographic map
DEPTH DRILLING LOG
From To Formation Description
0 100 Clay
100 220 Consohdnted Rock
11. DISINFECTION: TYPE HI POCHI.ORITE Amount 8
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
From 0 To 115 Ft. 6 1/4 " SDR 21 PVC
13. GROUT:
Depth
From 0 To 20 Ft.
14. SCREEN
Depth
From NA To
15. SAND/GRAVEL PACK:
Depth
From NA To
16. REMARKS:
Diamel
Ft.
Ft,
oz LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common road names.
Material Method
GRAVEL MIX GRAVITY
Sint Size Material
in. n
Size
Material
1 DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS. AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER.
9/1/04
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

From: Scott & Jo Mn To: Division of Water Quality
Date: 9/13/2004 Time: 6:40:20 PM Page 9 of 10
301"43
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment, and Natural Resources - Division of Water Quality - Groundwater Section
# 2584
WELL CONTRACTOR (INDIVIDUAL) NAME (print) SCOTT GAN77 CERTIFICATION
WELL CONTRACTOR COMPANY NAME CAROLINA WELL DRILLERS, INC.PHONE 4 44(704) Q PERMIT 434-7277
#
STATE WELL CONSTRUCTION PERMIT #(f ASSOCIATEDphcable)
(if applicable) Agricultural 0 Monitoring. ❑
Municipal ❑ Industrial ❑
1. WELL v USE (Check Applicable Residential III Water Injection 0 Other 0 if Other, List Use:
Recovery ❑ Pump
2. WELL LOCATION:
Nearest town: MARION
620 MARLOWE RD MARION
County McDOWELL
(StreetName, Numbers, Community, Subdivision, Lot No,. Zip Code)
3. OWNER PERRY MURPHEY
ADDRESS 564 Paradise Circle
(Street or Room No.)
MARION NC
City or Town State
828-652-8764
Area Code -Phone Number
4. DATE DRILLED 8/25/04
5. TOTAL DEPTH 300
6. DOES WELL REPLACE EXISTING WELL?
7. STATIC WATER LEVEL Below Top of Casing:
(11ec "+^ 1FAbovc Top of Casing)
8. TOP OF CASING IS 2 FT. Above Land Surface"
'Top of easing terminated at/or below land surface requires a variance in
accordance with ISA NCAC 2C 0118
9. YIELD ((pm): 6 ME11101 OF TEST ARD M
to. WATER ZONES (depth): 285
u. DISINFECTION: TYPE HYPOCHLORITE Amount 12
12. CASING:
28752
Zip Code
YES ❑ NO LE
55 FT.
Depth Diameter
From 0 To 62 Ft 61/4"
13. GROUT:
From 0
Depth
To 20 Ft GRAVEL MIX GRAVITY
Wall Thickness
or Weieht/Ft. Material
SDR 21 PVC
Topographic/Land setting
❑ Ridge ❑ Slope ❑ Valley ® Flat
Latitude/Longitude of well location
35.37.990 / 81.57.211
(degrees/minutes/seconds)
Latitude/longitude source: ei GPS ❑ Topographic map
DEPTH DRILLING LOG
From To Formation Description
0 50 Clay
50
300 Consolidated Rock
oz LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common road names. 401r z,
ter. SCREEN
Depth
From NA To
15. SAND/GRAVEL PACK:
Depth
From NA To
16. REMARKS:
Material Method
Diameter
FI, in.
Size
Ft,
Slot Size Material
n
Material
I DO HEREBY CERTIFY THAT I'HIS 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.
9/1/04
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

From: Scott & Jo Ann To: Division of Water Quality Date: 9/13/2004 Time: 6:40:20 PM
Page 8 of 10
WELL CONSTRUCTION RECORD
North Carolina -Department of Environment, and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL)NAME (print) SCOTT GANTT CERTIFICATION # 2584
WELL CONTRACTOR COMPANY NAME CAROLINA WELL DRILLERS, INC. PHNE RONE (704)
Q PERMIT
STATE WELL CONSTRUCTION PERMIT #
(if applicable)
1. WELL USE (Check Applicable Box) : Residential
Recovery ❑ Heat Pump Water Injection ❑
2. WELL LOCATION:
Nearest town: MARION
980 DC JOHNSON RD MARION
(if applicable)
Municipal ❑ Industrial ❑ Agricultural ❑
Other ❑ 1f Other, List Use:
County McDOWELL
(Street Name, Numbers, Community. Subdivision, Lot No.. Zip Code)
3. OWNER HORTON HOME OF RU771ERFORDTON
ADDRESS 342 H W Y 74 BYPASS
(Street or Route No.)
RUTHERFORDTON
City or Town
828-287-3366
Area Code - Phone Number
4. DATE DRILLED 8/23/04
NC
State
5. TOTAL DEPTH 380
28139
Zip Code
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO
El
7. STATIC WATER LEVEL Below Top of Casing: 80 EL
disc "4" If Above Top of Casing)
8. TOP OF CASING IS 2 FT. Above Land Surface*
*Top of easing terminated at/or below land surfnec regimes a variance m
accordance wffi 15A NCAC 20.0118
9. YIELD (gpm): 6 METHOD OF TEST ARDM
10. WATER ZONES (depth): 270
]I. DISINFECTION: TYPE HYPOCHI.ORITE Amount 14
12. CASING:
Depth
From 0 To 60 Ft.
13. GROUT:
Depth
From 0 To 20 Ft.
14. SCREEN
Depth
From NA To
15. SAND/GRAVEL PACK:
Depth
From NA To
16. REMARKS:
Wall Thickness
Diameter or Weight/Ft. Material
61/4" SDR21 PVC
Monitoring 0
Topographic/Land setting
❑ Ridge ❑ Slope ❑ Valley ® Flat
Latitude/Longitude of well location
35.48.906 / 82.01.949
(degrees/minutes/seconds)
Latitude/longitude source: El GPS 0 Topographic map
DEPTH DRILLING LOG
From To Formation Description
0 52 Clay
52
380 Consolidated Rock
or LOCATION SKETCH
Show direction and distance in miles from at least
Iwo State Roads or County Roads. Include the road
numbers and common road names.
Material Method
GRAVEL MIX GRAVITY
Diameter Slot Size Material
Ft. in in.
FL
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.
9/1/04
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

a�
WELL CONSTRUC IO_N RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality . Groundwater Section
WELL CONTRACTOR (INDtvIDVAL) NAME oaten_ ASHLEY T. MOR ETZ
WELL CONTRACTOR COMPANY NAME MORETZWELL DRILLING
STATE WELL CONSTRUCTION PERMITS A60 ASSOCIATED We) PERMTI#
/ (ifarvllcaMe)
1. WELL USE (Check Applicable Box): Residential $A' Municipal/Public ❑ Industrial O Agricultural O
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other R If Other, List Use
rfapplicabla)
2. WELL LOCATION:
Nearest . f 10
GobOµ'c-/�
(Sneer � " beta. Community. Sabel! ., Sot No- zip Code)
3. OWNER: CDqC4tA'vt. idN.st-d,
Address �Z/ , /o.. q
(Street or Route No.) -J �ra
�n rr I4!fen /%/L 9( 55
�Wa1 State Z'oCede
Arm node- Ptnm number
4. DATE DRILLED -Z-12--oy
6. DOES WELL REPLACE EXISTING WELL? YES o 1
7. STATIC WATER LEVEL Below Top of Casing:
(Use •w If Move Top of Ctoiag)
8. TOP OF CASING I5 , FT. Above Land Surface*
'Top of cuing tennauud War bduw land mho require n
Tatham to accordanailtb 0SA NCAC SC MIS.
9. YIELD (gpm): MEfHOD TEST Air l aY �"
I0. WATER ZONES (depth): Z'
11. DISINFECTION: Type /171-n Amount 9 p Z.
12. CASING: Wan Thickness
S. TOTAL DEPTH: a & h
Topogaphic/Land setting
0Ridge =Slope UValey Mat
(don Inman, bps)
,1 tsido o well 1
spa-207 4/
Latitude/longitude source:OGPSOTopogaphie map
(thwack)
Fo
DEM
From To
y6
From 741.0 To �5 / Ft. eta -5Z?1 21 t/
or WekluiPt.
Fronr_To Ft.
From._ To FL
13. GROW& Depth Material
Brea TO.424 .,_ Ft. Mae.
From To Ft
14. SCREEN: Depth Diameter Slot Size
From1 Ft.
1S. SAND/GRAVEL PACK:
Depth Size Material
Ft
Fro
J OCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common road names.
See ,-ti.-f 1 +c..a/c Pi pl p„ r n}n
,wry
N ern
-00 z<
rn
xi C7
3
Co
0
16. REMARKS.
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 1 SA NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND JRAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
301913
CERTIFICATION 2986
PHONE a [phone]
SIGNAT'JRE11 OF PER N CONSTRUC G THE WELL
Submit the original to the Division of Water Quality, Groundwater Section-1636 Matt Service Center - newts, NC
Z7699-1636 Phone No. [phone], within 30 days. GW-1 REV. 07/2001
DA
7d Wd9E:90 700E 0E 'daS EE2TE97702_ : '0N Xdd
dWfd 8 Tsari Z1360W : W021d

301558
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 ❑ Industrial ❑ Agricultural ❑
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use
2. WELL LOCATION:
Nearest Town: MARION County MCDWL
MUD CUT LOOP RD.
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: RONNY & BETTY RENFRO
Address 641 MUD CUT LOOP RD.
(Street or Route No.)
MARION NC 28752
City or Town State Zip Code
(828) - 756-6718
Area Code Phone number
4. DATE DRILLED 08/20/04
5. TOTAL DEPTH: 385
6. DOES WELL 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 1-1/2 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): 30 METHOD OF TEST ARD
10. WATER ZONES (depth):
11. DISINFECTION: Type CHLORYTE Amount 9
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
From 0 To 70 Ft. 6-1/4" SDR.21 PVC
From To Ft.
From To Ft.
13. GROUT: Depth Material Method
From 0 To 20 Ft. QUI{RETE 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
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS AND THAT A COPY OF S RECORD HAS BEEN PROVIDED TO THE WELL OWNER
cf26—fit%
SIGNATURE OF PERSON QONSTRUCTING THE LL DATE
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. #221 N. FROM RUTHERFORDTON. RT. ON
MUD CUT LOOP RD. CROSS RR & STAY LEFT.
APPROX. 2 MILES, 647 ON MAILBOX. DRIVE ION
RT. (a, RED GATE.
Submit the 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

301547
WELL CONSTRUCTION RECORD
North Carolina — Department of Environment And Natural Resources — Division of Water Quality — Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) NEIL 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)
I. 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: MARION
EMMA GRACE RD.
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: TERRY BROWN
Address 179 EMMA GRACE RD,
(Street or Route No.)
MARION NC 28752
City or Town State Zip Code
( ) — NONE
Area Code Phone number
4. DATE DRILLED 08/24/04
5. TOTAL DEPTH: 185
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO
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): 5 METHOD OF TEST ARD
10. WATER ZONES (depth):
County MCDWL
11. DISINFECTION: Type CHLORYTE Amount 3.5
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
From 0 To 70 Ft. 6-1/4" SDR.21 PVC
From To Ft. _
From _ To _ Ft.
13. GROUT: Depth Material Method
From 0 To 20 Ft OU KRETE 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
HWU. #226 N. FROM POLKVILLE. LEFT ON
TATERTOWN RD. LEFT ON EMMA GRACE RD.
179 ON POST ON RT.
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
COTRUC THE WELL
'.,4 VC-0 V
DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center— Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-1 REV. 07/2001

301828
WELL CONSTRUCTION RECORI'
North Carolina - Department of Environment and
pNatural
� Resources -- Division of Water Q'nlity - firocm Water Set: LW:
WELL CONTRACTOR (INDIVIDUAL) NAME (print)��/y-t�O/Y/tf/ t o a // CERTIFICATIOk.AZ& 7 7
WELL CONTRACTOR COMPANY NAME SS/A)a (, /ATP( �, e li �-� t PHONE #
STATE WELL CONSTRUCTION PERMIT# .11F ASSOCIATED WQ PERMIT$
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential H Municipal/Public 0 industrial 0 Agriculcn l
Monitoring 0 Recovery 0 Heat Pump Water Injection ❑ Other 0 If Other, List Use
2. WFI I LOCATION:
Nearest Town: Did Pc,/ County/AC(34 Lie `I
+{
(St Name. Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER:
Address F6
13/4ck y T we ) 2a9r/
City or Town State Zip Code
( )-
Ata code- Phone murtbpc
4. DATE DRILLED 16 "17 - O %
5. TOTAL DEPTH: s0 5- 0 /
6. DOES WELL REPLACE EXISTING WELL/ J NO Gd'
7. STATIC WATER LEVEL Below Top of Casing: /D FT.
(Vatic** if Above Top of Casing)
8. TOP OF CASING IS / g FT. Above Land Surface*
'Top et casting terminated *tier belnw land sorbet requite a
nutmeg S um with ISA NCAC 2C .01It A..... 9. YIELD (gpm): METHOD OF TEST / (I%I eCt
ma
10. WATER ZONES I( epth): % 7 f . 24,en
11 DISINFECTION: Type
12. CASING:
Fmm__, _ TDo D _,
From To
From To
13. GROUT: Depth
From_ f7 _- To_0
From To
14. SCREEN: Diameter
Fro To Ft. in
From To Ft. in
15. SAND/GRAVEL PACK:
Ft.
Ft.
CH. 1. Amount / 0
Wall Thickness
s
or Weight/FL Material
Ft. &, y azj P u
Ft
Ft.
Material
Ft..i(x2.Gt_e
Ft.
Slot Size Material
in.
Material
Tope .Jr, :.hiciLand semnE
['Ridge to Slope ['Valley DFia!
(cheek atpmpriatc box` -.
Lantude/longitude of well location
(dearas/m{muea/ram 1.
Latitude/longitude source:OGPSOTopographtc array
(check bco
FRILLING LOG
Formation Description
DEPTH
From To
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads, Include the road
numbers and common road names.
16. REMARKS:
HE} Y CERTIFY THAT THIS WELL WAS NSTRUCIEI) IN ACCORDANCE WITH 15A NCAC 2C. WE(_.
TION STANDARDS, AND T A Y OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OW'NEk.
SIGNATURE F PERSON CONSTRUCTING THE WELL DA
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Ctnter - halevgh. N(
27699-1636 Phase No. 19191 733-3221. within 31) dav�
(7Ur.1 PPV tli/7td,

WELL CONSTRUCTION RECORD 301826
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Stator,
WELL CONTRACTOR (INDIVIDUAL) NAME (print) /C(Q / CERTIFICATION #79)71
WELL CONTRACTOR COMPANY NAMEtSfjtet ° eet-Ter List L"t- ..141(6PHONE * 82&L .(- j5)0
STATE WELL CONSTRUCTION PERMIT* • 2 ///ei ASSOCIATED WQ PERMTT*
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential IJ Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION: ,
11/
Nearest Town
(Street Name, N
3. OWNER: //
Address
4�J) County mead
f� pi> zS 7fl
ben, Canmuoity, Subdivision, Lot No., Zap Code)
S "D hi ,,P/ ly)
ary (Sine or Route �v No.)
M/9/1/2S 75 Z
c22)- � 72a Zip Code
City or Town State
Arca code- Phone numbek
4. DATE DRILLED -O ' /3 - o q
5. TOTAL DEPTH: 2 Z S'
6. DOES WELL REPLACE EXISTING WELL? YES CIO N0
7. STATIC WATER. LEVEL Below Top of Casing: tic)a FT.
0(Use "-I" if Above Top of Casing)
8. TOP OF CASING IS ! ^fr FT. Above Land Surface"
'Top of casing terminated at/or below land surface requires a
vartaace is accordance with ISA NCAC 2C .0118. ...>>
9. YIELD (gpm): ro METHOD OF TEST p �_
0. WATER ZONES (depth): / 7 S� - /QS`
1. DISINFECTION: Type C /1 /�!.
2. CASING:
From_tZ To / 6 O Ft (rl %y
From To Ft
From To Ft.
3.GROUT
Amount 71j e2
Wall Thirdmess
ter or Weight/Ft. Material
spie z / p U t
From 0 ToTDepth
Ft. —
From To Ft.
4. SCREEN: Depth Diameter
Frortt_____. To Ft in.
From To Ft
5. SAND/GRAVEL PACK:
Slot Size Material
in
in. in.
Depth Size Material
From To Ft.
From To Ft.
5. REMARKS. / ' s7tt°e/ 51ce
DO HEREBY CERTIFY THAT THIS WELL
ONSP6RUCTION STANDARDS
•
SIGMA
Topo in/Land setting
Midge Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(ms)
Latitude/longitude source:❑GPS❑Topographic map -
(rMrk box)
DRILLING LOG
Formation Description
DEPTH
From To
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and road names
atri u mice S%iff
AS CONSTRUC1U) IN ACCORDANCE WITH 15A NCAC 2C, WELL
COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
OF PERSON CONSTRUCTING THE WELL DATE
tibmit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh. NC
7699-1636 Phone No. [phone]. within 30 days.
f_vI; n CI 1Yt flan,

301825
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Na
WELL CONTRACTOR (INDIVIDUAL) N — (print)
WELL CONTRACTOR COMPANY NAM
STATE WELL CONSTRUCTION PERMITS,
(if applicable)
y/si
Resources - Division of Water Quality - Groundwater Section
f
L_ CERTIFICATION rig./77
ONE / Gy- °yea
(14
ASSOCIATED WQ PERM T#
(if applicable)
I. WELL USE (Check Applicable Box): Residential tit Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection ❑ Other 0 If Other, List Use
2. WELL LOCATION: La
it t
Nearest Town: Colin
'Se ,.2274'z
(Street Name,, Niunbers, Community, Subdivision, Let No., tip Code)
3. OWNER: J..).. L • gP�i
Address 3�` 6 .1 iaL"
7>11�v .0
(Street or Route °)
City or Town State
eL ll%V
Zip Code
('
Ana code- Phone number 4.7
4. DATE DRILLED JS 9/ O V
5. TOTAL DEPTH: O.1
6. DOES WELL REPLACE EXISTING WELL? YES O NO
7. STATIC WATER LEVEL Below Top of Casing: o n FT.
(Use "+" if Above Top of Casing)
S. TOP OF CASING IS / -5 FT. Above Land Surface*
flop of casing terminated at/or below land surface requires a
variance in accordance ISA NCAC 2C .0118.
• METHOD OF
10. WATER ZONES (depth): YO.5 r
11. DISINFECTION: Type ,
12. CASING:
From To th /OS Ft to
From To FL
•
9. YIELD (gpm). TEST / #ni'
Amount
Wall Thickness
or Weight/Ft
57-,eL
From To Ft.
13. GROUT: Depth Material
From 0 To a t Ft. %enst,..V
From To Ft.
14. SCREEN: a .th Diameter
From To Ft. in.
From To Ft. in.
15. S • GRAVEL PACK
Size Material
t.beV Method
L
Slot Size Material
in.
in.
From
From
16. REMARKS:
To
To
Ft.
Ft.
- Topographic/Land setting
❑Ridge PISlope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:OGPSOTopographic map
(check box)
DRILLING LOG
Formation Description
DEPTH
From To
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common road names.
L
I DO HEREBY CERTIFY THAT THIS WFI f WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND JIi4T A COPY OF THIS RECORD HAS6EEN PROVIDED TO THE WELL OWNER
>GN RE e
S A OF PERSON CONSTRUCTING THE WELL
ATE
pf
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center -Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-1 REV. 07/2001

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and N
WELL CONTRACTOR (INDIVIDUAL) NAM (print)
WELL CONTRACTOR COMPANY NAME
STATE WELL CONSTRUCTION PERMIT#
(if applicable)
Resources - Division of Water Quality - Groundwater Section
CERTIFICATION ssn77
lion x ga6yy-ovta
ASSOCIATED WQ PE
(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:
town: County,-
Ant.if m,272St
(Street Name, Numbers, Cornmunity, Subdivision, I.ot No., Zip Code)
3. OWNE
Addre
Sweet or Route
//rLK.GBc N•C•o) h20 3-2_
City or Town State Zip Code
( i
Area code-0r js/ 0 y
4. DATEEDRILLED
ED
5. TOTAL DEPTH: 3 as'
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 AZ FT. Above Land Surface*
'Top of easing terminated at/or below land surface requires ■
variance in accordance with ISA NCAC 2C .0118. •
9. YIELD (gpm): J/7 METHOD OF TEST lYC.stO
10. WATER ZONES (depth): / 3 r .2 9S'
11. DISINFECTION: Type C, i% 11. Amount 9 oz-
12. CASING: Wall Thickness
Depth ` Di or Weight/Ft
From 0 To 95 Ft 7W�j Ma C
From To Ft.
From To Ft
13. GROUT: Depth
From_, To et C r7 Ft.
From To Ft
14. SCREEN: Depth Diameter Slot Size Material
Fromcdi o Ft in. in.
From / To Ft in. in.
15. SAND/GRAVEL PACK
Size Material
From 'o Ft.
From To Ft.
16. REMARKS:
Topographic/Land setting
(i.Ridge ❑Slope Malley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topograhic map _
(check box)
Formation Description
DEPTH
From To
0
Show direction and distanin miles from at least MO"°
two State Roads or Coun Roads. Include the reedit
numbers and common ro , names.
I DO HEREBY CERTIFY THAT THIS WETS WAS CONSTRUL1ht) IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AT)IBTf ST A COPY OF THIS RECORD H,AS PEEN PROVIDED TO THE WELL OWNER
��'(fee, it
Sl A OF PERSON CONSTRU
G THE WELL
le/Ol
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

301820
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and N Resources - Division of Water Quality -
WELL CONTRACTOR (INDIVIDUAL) NAM (prlat)
WELL CONTRACTOR COMPANY NAME J e•fellSo
STATE WELL CONSTRUCTION PERMIT#
(if applicable)
4f/ 4
ASSOCIATED WQ PERMIT#
(if applicable)
Groundwater Section
�J
CERTIFICATION OK O 7/
BONE
1. WELL USE (Check Applicable Box): Residential DI Municipal/Public ❑ Industrial 0 Agricultural 0
Monitoring ❑ Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION:
Nearest
�To ,14 76 t
(Street Name, Numbers, Conummity, Subdivision, Lot No_, Zip Code)
3. OWNER:/.., (�YctiN�f /10' Address ��,��
City or Town Sty Zip Code
Area code- Phone number
7/i
TOTAL DEPTH: 0,S '
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO pa
7. STATIC WATER LEVEL Below Top of Casing: /.5� FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS 1 .6 FT. Above Land Surface'
'Top of casing terminated at/or below land surface requires a
vurance in accordance with ISA NCAC 2C .0118.
9. YIELD (gpm): /s ME�T�H" OD OFT�ES�T -- t rrt it
10. WATER. ZONES (depth): J.S r / 0 I
/75
11. DISINFECTION: Type P. /,l. f1 Amount 7* 0
12. Wall Thickness
4. DATE DRILLED99/0'5.
CASING:
Depth
From_ To itt
From To
From To
Diameter W UFt
Ft �i f/
Ft
Ft
led
13. GROUT: Depth �latenal
From a To tD b Ft %vrJ�t 1. trice
From To Ft.
14. SCREEN: Depth Diameter Slot Size Material
From To Ft in. in.
From From-To
Ft in. in.
15. SAND/GRAVEL PACK
Depth Size Material
From jfo Ft.
From / To Ft.
16. REMARKS:
Topographic/Land setting
❑Ridge ❑Slope 1$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 Deebription
LOCATION SKETCH
L Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
i , numbers and common road names.
✓�i'ui p
1 DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH I5A NCAC 2C, WELL
CONSTRUCTION STANDARDS „A1 THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
SIGNATURE OF PERSON CONSTRUCTING THE WELL
9/o y
DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mall Service Center -Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-1 REV. 07/2001

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and
WELL CONTRACTOR (INDIVIDUAL) N
WELL CONTRACTOR COMPANY NAM
STATE WELL CONSTRUCTION PERMITS/
(if applicable)
(prim
301819
Resources - Division of Water Quality - Groundwater Section
. l -,� /7�/L L - n CERTIFICATION api b 22
• i i 'Lie/ Y'd<2a s-c 7&CPHONE # f$__
, �' 4 ASSOCIATED WQ PERMIT# a/!7
(if applicable)
1. WELL USE (Check Applicable Box): Residential Oil Municipal/Public 0 Industrial ❑ Agricultural 0
Monitoring ❑ Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION:
NeareTown: tmty
r to .28 7S't-
(Stre t Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: 7ilrifl (��w.c�j
Address .* qs ts.a)
(Street or Route No.)
721‘24.413AT. c. plg?SZ
C' or Town Sty tip Code
9,2y—iaaa
Area code- Phone number
4. DATE DRILLED 7/2 %/D «
5. TOTAL DEPTH: .3 ycS
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO 1$
7. STATIC WATER LEVEL Below Top of Casing: %S FT.
(Use `+" if Above Top of Casing)
8. TOP OF CASING IS 1. s FT. Above Land Surfaces
'Top of casing terminated atMr below land surface requires a
variance in aecordanc wlth ISA NCAC 2C .011&
9. YIELD (gpm): 7 METHOD OFTEST7 nt,
10. WATER ZONES (depth): l 7 S r 3S
11. DISINFECTION: Type L'. V A< Amotmt /t.2at-
12. CASING: Wall Thickness
or Weir/Ft ��
From 0 To G D Ft._ #.2 _bt
From To Ft.
From To Ft.
13. GROUT: Depth Material
From_ To o2D Ft
Method
fA taX
Topographic/Land setting
❑Ridge ❑Slope $Valley ['Flat
(check appropriate box)
Latitude/longitude of well location
(degteWmmuadseoonda) .
Latitude/longitude source:❑GPS❑Topographic map
(checkbox)
DEPTH DRILLING LOG
From To Formation Description
Show direction
two State R
numbers and
SII0►�6/�
From To Ft ,0°
14. SCREEN: Depth Diameter Slot Size Material 0
From To Ft. in. in.
Frorn To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From o Ft.
From To Ft.
16. REMARKS:
A
.4.
C Fy9
Q174
LP co
d distance in miles from at least
or County Roads. Include the road
mmon road names.
I DO HEREBY CERTIFY THAT THIS WFI I WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STAND AND THAT A COPY OF TtIIS RECQIW HAS BEEN PROVIDED TO THE WELL O'
5
SIGNATURE RSON COCI7NG THE WELL 7DATEa7/°
Submit the 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

301818
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and N turall/Re/sources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) D/Y /I / C. l "4 2- �� 2-CERTIFICATION N 7CATION d 77
WELL CONTRACTOR COMPANY NAME,LAJ '.Y k frot w.y' LK.(PBONE ,r (;1S S�Q OM
V STATE WELL CONSTRUCTION PERMr1rF /� H ASSOCIATED WQ PERMITS,/i
(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. I
Nearest Town: County"// o0
ao99,S Gf� LWd sszsn
(Street Name, Numbers, Community, Subdivision, Tat No., Zip Code)
3. OWNER:1. 2),Gt
Address D 9y ,tv 04.6217/040 �al
(Street or Route No.)
City or Town Stye Zip Code
Area coda Phone number j
4. DATE DRILLED de A.
5. TOTAL DEPTH: So S
6. DOES WELL REPLACE EXISTING WELL? YES ■ NO
7. STATIC WATER LEVEL Below Top of Casing: 900 FT.
(Use'+^ if Above Top of Casing)
8. TOP OF CASING IS /...5 FT. Above Land Surface*
'Top of casing terminated attor below land surface requires a
variance V accordance with ISA NCAC 2C .011&
9. YIELD (gpm): / METHOD OF TEST T�Iist
10. WATER ZONES (depth): 294 Yi r
11. DISINFECTION: Type Lr. /Z f1.
12. CASING:
Depth/
From( To to b Ft
From To Ft.
From To Ft.
13. GROUT: Depth
From 0 To of D Ft.
Amount it s 07-
Wall Thickness
or Weigbt/Ft Material
/
C
From To Ft.
14. SCREEN: Depth Diameter Slot Size Material
Fro To Ft. in. in.
From To Ft. M. in.
15. SAND/GRAVEL PACK
Size Material
From Ft.
From / To Ft.
Nat? µ1-8.P.P -.1ute
16. REMARK
(
Topographic/Land setting
❑Ridge ❑Slope ❑Valley gnat
(check appropriate box)
Latitude/longitude of well location
(degRdminues/axmds)
Latitude/longitude source:❑GPS❑Topographie map
(check box) 4_...�..-.
PRJLLING LOG
Formation Description
DEPTH
From To
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common mad names.
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS,Zt
A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
-f, aae.7/23/o V
SIGNATURE OF PERSON CONSTRUCTING THE WELL ATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mall Service Center - Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-1 REV. 07/2001
ease

(if applicable) (if applicable) N/�
1. WELL USE (Check Applicable Box): Residential $ Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery ❑ Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WF1.f LOCA
Nearest
77 n
(Street Name, Numbers, Conran Subdivision,
3. OWNER:
Address
(Street or Route Na /� p
2'nt 41A iV ? . e.G O 7.5"
301816
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and tural Resources - Division of Water Quality - Groundwater Secaor �j
WELL CONTRACTOR (INDIVIDUAL) NAMEQ9 (print) /9 /1/p ///I / G B)9 L L CERTIFICATION #J P7/
WELL CONTRACTOR COMPANY NAME .O .424 �r rwa)L , f�.Q1y V- PHONE # IS
S%Q S S�R(�
STATE WELL CONSTRUCTION PERMIT#
County {g edema,
reard
Zip G2.OJ- /A T y- G y 7 - Code
V
City or Taw Stare
Area coda Phone number
4. DATE DRILLED 7/.2L1/o «
5. TOTAL DEPTH:
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO IS
7. STATIC WATER LEVEL Below Top of Casing: 7C. FT.
(use "+" if Above Top of Casing)
8. TOP OF CASING IS / S FT. Above Land Surfaces
'Top of casing terminated at/or below land surface requires a
variance la aemrdaace with 15A NCAC 2C .0118.
9. YIELD (gpm): 3 METHOD OF TEST %iAa,r i
10. WATER ZONES (depth): Vie' JOt'
1//),
ASSOCIATED WQ P RM1T#
11. DISINFECTION: Type
12. CASING:
Depth
Franca_ To _ ? /S
From__ To
From To
13. GROUT: Depth
From O To a D
From To
14. SCREEN: Depth
Frorm-- To
Fro / To
15. SAND/GRAVEL PACK
Depth Size
From To Ft.
From To Ft.
C „fr! /A/.
Diameter
Ft G #j
Ft
Ft
Ft.
Ft
Amount 9 el —
Wall Thickness
or Weight/Ft Material
rial
IXe'K�+>• Luba
Diameter
Ft. in.
Ft. in.
16. REMARKS:
Topographic/Land setting
°Ridge °Slope Valley DF1at
(check appropriate box)
Latitude/longitude of well location
(degees-mimrteuse )
Latitude/longitude source: DGPSOTopographic map
DEPTH
From To
pRII.Y,ING LOG
Formation -Description
Akk--,
�FO
iOr!
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.
Slot Size Material
in.
in.
Material
I DO HEREBY CERTIFY THAT THIS WE.I 1 WAS CONSTRUC It.D IN ACCORDANCE WITH l5A NCAC 2C WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
712/7o y
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-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) J ama $ w
WELL CONTRACTOR COMPANY NAME
STATE WELL CONSTRUCTION PERMIT#
(if applicable)
ramp' G Wa1 1
Cainp, Jr
R Pump f'n T n r
ASSOC1ATED WQ PERMIT#
(if applicable)
302053
CERTIFICATION # 7 1 ' A
PHONE a$7R) ds-t_7322
1. WELL USE (Check Applicable Box): Residential t Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION: ,r� RR�
ear st Town: County cmf �. )Ql.tt X
3�'o
(Street Name, Numbers. Community, Subdivision, Lot No., Zip Code)
3.' OWNER:3 " `�, 1' (IAIAV`MI—
Address 1?3 ('Acce-des Par kv),/
(Soect Route No.)
NeJoa IBC
City or Town Stare Zip Code
c94- 49I 944o
Area code- Phone numb
4. DATE DRILLED I' a_oLA
5. TOTAL DEPTH: 0 S
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO tit
7. STATIC WATER LEVEL Below Top of Casing: ). 0 FT
(Use "+" if Above Top o1 Casing)
8. TOP OF CASING IS 1 FT. Above Land Surface*
'Top of casing terminated actor below land surface requires a
variance In accords ce with 15A NCAC 2C .0118.
9. YIELD (gpm): METHOD OF TEST
10. WATER ZONES (depth): 12b
Dix
11. DISINFECTION: Type rh 1 nri n a Amount CL(e
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
Froat_q To �il Ft. 6 1/ 4 c np„2 1
From______ To Ft.
From To Ft.
PVC
13. GROUT: Depth Material Method
From p To 20 Et. Neat Cement Harr.,
From To Ft.
14. SCREEN: Depth Diameter
From To Ft. in
From To Ft, in.
15. SAND/GRAVEL PACK:
Depth Size -Material
Slot Size Material
in,
in,
From To Ft.
From To Ft.
Topographic/Land setting
03kIdge ❑Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From FormationDe ription S
SS 2 tl S bp.,. D
rJ
N
N
5 OCATION SKETCH ar
Show direction and distance in miles from at 1eaa
two State Roads or County Roads. Include the rota
numbers and common road names.
eP
16. REMARKS:
1 DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH I5A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THCOPY OF THIS RECOR,D HAS,$EEN PROVI) D TO THE WELL OWNER
SIGNA
OF PERSON CONSTRUCTING THE
q+04
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
3►

WELL CONSTRUCTION RECORD
302044
North Carolina - Department of Environment and Narural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) 7 are e s b' Cawe J>
-
CERTIFICATION S 71 i 8
WELL CONTRACTOR COMPANY NAME (lamp' s Wr 11 R Pnrnp Cn Tnn PHONE S$47R) d5"i-'7322
STATE WELL CONSTRUCTION PERMITS ASSOCIATED WQ PERMITS
(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
Neare
Arp1-
e �5 ry� Rea .
(Stint Name, Numbe*, Community, Subdivision, Lot No., Zip Code)
3.'OWNER: /11a r1r1a )- v151�e7y1
Address CIP vi5 I e y R 1
(Streetw cute N6)
/Y a r 1'v lA !V C
City or Town State Zip Code
Ares coda- Phone number A
4. DATE DRILLED 71 Ti 4-0 45. TOTAL DEPTH: Imo, /
6. DOES WELL REPLACE EXISTING WELL? YES (]I' NO 0
7. STATIC WATER LEVEL Below Top of Casing: Z0 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS 1 FT. Above Land Surfaces
'Top o(casing terminated actor below land surface requires a
;variance In accordance with 15A NCAC 2C .0118.
9. YIELD (gpm): ,'GO METHOD OF TEST n i r
10. WATER ZONES (depth): 75
11. DISINFECTION: Type C'h 1 nri na Amount 1 C-ftt
• 12. CASING: Wall Thiclmess
Depth; Diameter or Weight/Ft.
From_0_ To J.r7 Ft. b 1 / 4 cDA21
From To Ft.
From______ To Ft.
13. GROUT: Depth
From_ To • "2 0 Ft.
From To Ft.
14. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in,
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
County Mc Ic DO Midi
Material
PI at Cement
Material
PVC
Method
Hand
Topographic/Land setting
DRidge ❑Slope arrValley OFlat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check boa)
DEPTH DRILLING LOG
From To Formation Description
G 5 J 'net t oig rcaue.I
' 5 1-PYtsc,lidate el rrri�'
16. REMARKS:
Xp
5
1 OCATION SKETCli 30
Show direction and distance in miles from at leas
two State Roads or County Roads. Include the read
numbers and common road names.
D
fit nslel
1-
SiAleti
5 `��I�"vYe
Gem
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THPy COPY OF THIS RECO HAS,, EEN PROVTO THE WELL OWNER
C 6 I/l/ - (z0/1- (i - 9 - IC-0 4
SIGNATUR&'IOF PERSON CONSTRUCTING THE
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
Nonh Carolina - Deparnnent of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) James r•r Camp Jr CERTIFICATION # 21 'I R
WELL CONTRACTOR COMPANY NAME Pa NI Wa11 & Piimp Cn Tnc PHONE it 81 ) d51_7"j22
STATE WELL CONSTRUCTION PERMIT'# ASSOCIATED WQ PERMIT#
(if applicable) • (if appli cable)
1. WELL USE (Check Applicable Box): Residential V Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
WELL LOCATION:
Nearest kiS Town:iO )7 i U 1 CountY C p Maud
(Sueei Marne, Numbers, Community, division, Lot No., Zip Code)
3. OWNER: v/M` kJ) f .1�
Address us a. .[..fl ce'IAAA-
(S eta Rousabonsat
r1 S.0 �C1UQ�
City or Town State Zip Code
(R 1; )- 211, 3 ti 'N
Area code- Phone number
4. DATE DRILLED • \ 0 t_1
5. TOTAL DEPTH: b S
6. DOES WET I REPLACE EXISTING WELL? YES 0 NO
7. STATIC WATER LEVEL Below Top of Casing: 4 S 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 1SA NCAC 1C .0118.
9. YIELD (gpm): S 0 METHOD OF TEST Air
10. WATER ZONES (depth): 1q 0
11. DISINFECTION: Type rhlnrina
12. CASING:
Depth Diameter
From 0 To 13 3 Ft. 6 1/ 4
From To Ft.
From To Ft.
13. GROUT: Depth
From 0 To '2 0 Ft.
From To Ft.
14. SCREEN: Depth Diameter
From To Ft. in
From To Ft. in.
15. SAND/GRAVEL PACK:
Depth Size
From To Ft.
From To Ft.
Amount It
Wall Thickness
or Weight/Ft. Material
'DF21 PVC
Material
Neat Cement
16. REMARKS'
Method
Slot Size Material
in
in.
Material
Topographic/Land setting
12 dge ❑Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degreea/minures/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check boa)
PFPTR DRILI 1NG LOCI
From To 0 33 Desc rmati n Desc 'ption
1
13 3 6 0 AL)
ors
"O
a
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.
ryi
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A PY OF THIS RECORD HAS/ BEEN PROVID TO THEE WELL OWNER
L
SIGNATURE 9 PERSON CONSTRUCTING THE W�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
CO 302045
p* e-
-tlrn
"O °
Cr"'O0
rrtrri
a2
CD 0
ga

300'7S3
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and N Resources - Division of Water Quality - Groundwater Sectiot.
WELL CONTRACTOR (INDIVIDUAL) NAM (print) Af C N q.: L CERTIFICATION Ppd 77
tea) 'eat a I!p Irt iO '� a
ASSOCIATED W fit
WELL CONTRACTOR COMPANY NAME
STATE WELL CONSTRUCTION PERMIT',
(if applicable)
47/47 Q
(if applicable)
1. WELL USE (Check Applicable Box): Residential Q Municipal/Public 0 Industrial 0 Agricultural O
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
(Street Name, Numbers, Community, Subdivision. Lot No., Zip Code)
3 OWNER
Addres_
. (Street or Route No.)
City or To State Zip Code
Area code Phone mtmbe=
4 DATE DRILLED �i/30.D7
5 TOTAL DEPTH: _2!/S
h DOES WELL REPLACE EXISTING WELL? YES U❑ NO tic7. STATIC WATER LEVEL Below Top of Casing: 4 .J FT.
(Use "+" if Above Top of Cuing:
d TUP GI CASING IS I S FT. Above Land Surface'
'Top of casing terminated aNar below Iand surface requires s
variance in aeeordanct with ISA NCAC 2C .011a.
9. YIELD (gum): S METHOD OF TEST /.4►rl P
IL V. ATER ZONES (depth:: liee'r /
12
DISINFECTION: Type ( f/ 4. Amount
CASING: Wall Thickness
�Depth Diametric r2Weight/Ft eC
Fromy) To !9 F:� 'rl
From To Ft
Fron. _ To Ft.
prm Toe �y Mare_ dales
From � To oC f) FL /�,is�8
From To Ft.
14 SCREEN. Depth Diameter
From Ft. in.
Fromm Too Ft. in.
15. SAND/GRAVEL PACK.
Depth Size Material
From Ft.
Frorn To Ft.
/t ethod
Slot Size Material
in.
e REMARKS
Topographic/Land setting
❑Ridge $Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degreedmimrt eciaeconds
Latitude/longitude sotrce:❑GPS❑Topographic map
(check box:
DRILLINt�QOI-;
Formati�.De on
en
G Get"
rr
DEPTH
From To
LOCATION SKETCF
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common road names.
I DO HEREBY CERTIFY THAT THIS WFI 1 WAS CONSTRUCTED IN ACCORDANCE WITH ISA NCAC 2C, WELL
CONSTRUCTION ST n ' a S, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
S1
ATURE OF PERSON CON
GTHir}Vat
op
Submit the original to the Division of Water Quality, Groundwaer'Section, 1636Mail Senice Center, -Raleigh NC
27694-1636 Phone No. [phone], within 30 days. 1 ' C Pq ° 1 t i!_ i S=1 REV 071200,