Md CY2004

3092Q3
WELL USE (Check Applicable Box): Residential 9' S4unicipal/Public 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
WELL LOCATION:
Neaaree,st Town: % 3r6 II County "Ain
ff -A.- (iea,Y 'C
(Street Name, Numbers,b�Community, Subdivision, Lot No., Zip Code)
3. OWNER: (�/72r�G D/ice
Address
(Street or Route No.)
/1/42S ,o /YC 87s 3
City or Town State Zip Code
g9Si- G v 9— 30 9 3
Area code- Phone number
4. DATE DRILLED //'/2
5. TOTAL DEPTH: Z5C
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO 13
7. STATIC WATER LEVEL Below Top of Casing: ke 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): L METHOD OF TEST �DLIJ.J4 -R'4
! 0. WATER ZONES (depth): J
11. DISINFECTION: Type C/6e15pe Amount G/Ais
12. CASING:
eet
Depth
From 0 To 2 d
From To Ft.
From To Ft.
13. GROUT: Depth
From To 20
14. SCREEN: Depth
From To Ft.
From To Ft.
IS. SAND/GRAVEL PACK:
Depth Size
From To Ft.
From To Ft.
Wall Thickness
Diameter or Weight/Ft. Material
Ft. 4,/Zr S�l'L/ avC
Material Method
Ft. CoNCede. 704427415
From To Ft.
Diameter Slot Size Material
in. in.
in. in.
Topographic/Land setting
❑Ridge OSiope OValley ❑Flat
(check appropriate box)
Latitu de/longitude of well location e
AN3r r /. Ytii'vere cle.CV/
(degrees/minutes/seconds)
Latitude/longitude source: ❑GPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From To FoRtation Description
O
/A--eo .S¢.//
47 - L•Is
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.
llkNIte (2ee4 Rq -
11j,42sh.9-/) NC.
Material
16. REMARKS:
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment a
WELL CONTRACTOR (INDIVIDUAL) NAME (print)
WELL CONTRACTOR COMPANY NAMEQ�KC��
STATE WELL CONSTRUCTION PERMIT#
(if applicable)
ural Resources - Division of Water Quality - Groundwater Section ?
BA,N' ` getups)) CERTIFIIC.rATION#J/416
OA/Ws/4Tbziii;6vy�4F-�.e PHONE itiaba 8' n
ASSOCIATED WQ PERMIT%
(if applicable)
1.
7.
a
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL tNj.
CONSTRUC�ION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER ' ?ao
/Z-ot.%=-;
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
FiT

309244
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment a ural Resources <g/1- Division/��/of Water Quality - Groundwater Section Q ''
WELL CONTRACTOR (INDIVIDUAL) NAME (print) '// B. C.tJ,NE'S CERTIFICATION #/)
WELL CONTRACTOR COMPANY NAME/ G6.sCW L(%lf iZil(,Ali J �� a PHONE .�}E-Op/7//0
'94
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential Ir MunicipallPublic 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection ❑ Other 0 If Other, List Use
2. WELL LOCATION:
Nearest Town:/lilvo4
hit rt#Z .La/
County /440-/
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: 1SAi �r
Address 4.1.3 71& /-//d/Nr. f !,�.E/C .
/ ESLH/ At
e'te
a27s3
City or Town State Zip Code
�8)- /,rl9- 3507
Area code- Phone number
4. DATE DRILLED //- //-B y
5. TOTAL DEPTH: Zdce
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO Er-
7. STATIC WATER LEVEL Below Top of Casing: eD FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS / FT. Above Land Surface*
'Top of casing terminated at/or below land surface requires a
variance in accordance with ISA NCAC 2C .0118.
9. YIELD (gpm): 30 METHOD OF TEST.&DLLJJ -R
10. WATER ZONES (depth): 70 ,'r
11. DISINFECTION: Type C/a.-. idc
12. CASING:
Depth - Diameter
From Q To Si Ft. 6./2/
From To Ft.
From To Ft.
13. GROUT: Depth 1
From 0 To A Ft. CONCRGTL ?AG221
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.
Amount P ,460.
Wall Thickness
or Weight/Ft. Material
SJ-et/ wC
Material Method
Slot Size Material
in.
in.
16. REMARKS:
Topo�grphic/Land setting
ORidge DSlope OValley ❑Flat
(check appropriate box)
Latitude/longitude of well location
til3r° s/. 3G3'.rer4!./L. oz?
(degrees/minutefi!aeconds)
Latitude/longitude source: ❑"GPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From To
7.'- 3-7
r
Formation Description
6z
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.
(.aeons- (7 e
MARS /i,91/r ACC
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH I5A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER:
4a- �✓< /1-II-
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
GW-1 REV. 07/2001
27699-1636 Phone No. [phone], within 30 days.

\V:B11- Ct1N IL: t 142'11i- N 1:12 C 0fco
+ m !Di : ill -it ,Ia auralII- ac--la ri,yy'I o��for ualil
^ VV fl Jf . - 7rounq,val r 3tenan o
�1 l IFl l i']`liln a�a0 ., t CoAiiI lIL �r n1✓� Lc/ LCr9 Co ._ „Rays a5Z-j 74,
rn�n¢
-'•! 51':l Ilrh [LI 1111':i .. 'CI,ij)
- �.- 11'i) 1'GRA u7u
p!. a;:ola o I I: cep :al Ief 11 ...�p_,i3,.a.Ba 47 1'In'u9n'ipl
ci7 ❑ L1 aIP:rnp rrr lnicrl iJ Cu,cr 0 IfClhcr, List Llec
--IAc Pres•iwi et t,7fi`r Pe iv."
�Ip �. oJGI
�uvc�raad C'o�i.S�.Serui�es
309245
kll Irt. faI 0
�,� Topogra hie/Land scning
Lal idea Mlopc ❑yallcy DFlar
(chccl IlhPrapriyla aoS)
L41i0.11c/Iony11L1e of well toe3riolr
W_SZysazsi
(dcycc frill w u :rnnq )
- uwJCaongirudc soar PSOro oa
�q /� � , !io,:: n�w, � L p liph;: map
__En 24/.G// � t I c I: DON)73-3 DFPtH
from To Formation nW....:._,:_.
l !o 07 r!S rn 5 CI
o cS\ ELL DE?L CEEXISTIN3WELL? YES ❑ NO J "---
_IsTlC A..1ER LEVELEi claw Top or'Cs,Ina: to FT.
+ U,c"T''ir .13u Top aC,.In_!
_. TOP OF CASin:u l3
r,-----F---� FT Uorc Lail)Surtoct
I+- r r.rn1w.rca ,car cvl.n IJn, rra cz Lr uvw e
L:..ue hn,J'. \C.0 :ICof Id 9
YIELD a $ METHOD 1 L` I
O F'1'tSf �9
=IP
I�i\'iyF EC..? i�liy T}Pc f G LOCATION Si:_Etc:7i
:nlwnl ._-_.� p� !MOW do -action and di3[ance in mi-las from Al I'
air
\ .\t.,
WW1 Inl moss IWO Sr3lc Rouds or Counry Roods. include the road
/'ptn L:a❑l'Y.r Jr \\ - hr:j7 l0tatcrl::1 uulnhora and •1� }
'' 1L Fr. /„ a, S common mild names.
•
?reservif CA'
.3 OR:ior- ,_p,u
Ri-: I
SCREEN 4l-r(Il
EL P.>.CK
cptn
P:
�' NC'—e F!.
� _
D.4mcicr Slot S12c plalcrlal
Fr
Ill
in. in
r
Fr.
Si-c hta2nal
?te,sh4-//,, x. C .
!DC; r,0CC EEY csa fin- THAT This \\'ELL WAS CONSTRUCTED IN ACCOR ANCE WITH 15 AN C.AC 2C, WELL
CLNSTlLJSTIGNST.NDAl'D3,AND THAT A COPY OF THIS lC0kh I HAS
BEEN PROVIDED TO THE WELL OWNER
orsorcovsn,WELL DATE
l
a ill t in: oft ,1a1 CO lrlc un-itiuli at \\•arcr Qualify, Gi'ound,rarcr
:1ci> - SCCrIOn,
alo :taw.; �,. tit I) ,j3 3.; 1, iiirnia 7U days.
f 636 fvlail Service C2nrcr - Raleigh, tie
OW- REV. 07/'1001

309246
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment a Ural Resources - Division�`of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) sCi4A(wf �, �NES CERTIFICATION th3/5Q
WELL CONTRACTOR COMPANY NAME4/ 1 t&sat/ 4/Entte,/GNp) �.0 r PHONE eta) 295'?6
STATE WELL CONSTRUCTION PERMIT# JJ ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
I. WELL USE (Check Applicable Box): Residential Er-Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION: ,/
Nearest Town: /2r-s N//
Cc)l-/C.-/t £Z
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: 7 1-tii el luAa/t
Address - O Bar QbR
County/V.,L:.,
Y/ M. S �e// Row/ V l oil 7v V
City or Town State
Zip Code
Cie- (089- 400 3
Area code- Phone number
4. DATE DRILLED // P --Pt
5. TOTAL DEPTH: ("Or
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO Ei
7. STATIC WATER LEVEL Below Top of Casing: /00 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS 1 FT. Above Land Surface"
"Top of casing terminated at/or below land surface requires a
variance in accordance with ISA NCAC 2C .0118.
9. YIELD (gpm): /0 METHOD OF TEST]/
10. WATER ZONES (depth): 20C
11. DISINFECTION: Type6's- t.
12. CASING:
Depth
From 0 To £//
From To
From To
13. GROUT: Depth
From 0 To an
From To
14. SCREEN: Depth
From To
From To
I S. SAND/GRAVEL PACK:
Depth
From To - Ft.
From To Ft.
16. REMARKS:
Amount / - As.
Wall Thickness
- Diameter or Weight/Ft. Material
Ft. C./Zr"
Ft.
Ft.
Material Method
Ft. CoNCRGIMe. `t7nGPrNq
Ft. T J
Diameter Slot Size Material
Ft. in. in.
Ft. in. in.
Size
Material
Topograyhic/Land setting
❑Ridge OSlope OValley ❑Flat
(check appropriate box)
Latitude/longitude of well location
N37 . s7 SX'N.at - fl 4Yr'
(degrees/minutes/seconds)
conds)
Latitude/longitude source: L3'GPSOTopographic map
(check box)
DEPTH DRILLING LOG
From To Formation Description
D-.PG R,
JG _ v/ //
‘,//- clop
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.
1A-sf Fo'e is ad -
,41rn2s 7ij1l, NC .
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
7,tta - /o - o `(
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC 'r 27699-1636 Phone No. [phone], within 30 days. GW-I REV. 07/200

309248
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment a ural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) ki hi /. LJ.IV?S CERTIFICATION thStila
/
WELL CONTRACTOR COMPANY NAME 14.50Artfk 4rhel/ZajJp, �,Gr PHONE 4. 0S'E`E�(Q4
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
I. WELL USE (Check Applicable Box): Residential La MunicipaVPublic 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION: ''//
Nearest Town:424r) Alli
County /14.4,,son
(Street Name, Numbers, Community, Subdivision, Let No., Zip Code)
3. OWNER: V-pf �i .
Address RA ee,y /993(p
(Street or Route No.
- e ,tg7£i 7
City or town State Zip Code
Egg')- Et OS- 3000
Area code- Phone number
4. DATE DRILLED if
5. TOTAL DEPTH: 70 r
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO.clav
7. STATIC WATER LEVEL Below Top of Casing: LP 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): q METHOD OF TESTE,� "� g3
IC. WATER ZONES (depth): i/VO' J
11. DISINFECTION: Typef7oi, ad
12. CASING:
Depth Diameter
From 0 To Ye Ft. i/Zr int/ "Vt.-
-From To Ft.
From To Ft.
13. GROUT: Depth Material Method
From D To at, Ft. eoNciede. ?au a,;i)y
From To Ft. J
14. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in.
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To - Ft.
From To Ft.
Amount Al A,3,
Wall Thickness
or Weight/Ft. Material
trdgopographic/Land setting
e ❑Slope OValley ❑Flat
(check appropriate box)
Latitude/longitude of well location
A/dr ° r/%4',14' kit1YY 1{ e, /7'
(degreesiminutes»s�eeconds)
Latitude/longitude source: 9-GPS❑Topographic map
(check box)
DRILLING LOG
Formation Description
DEPTH
From To
D-.7J
D.Yf-
-1 Yv rat/f
Yee - 3or •-r.*Af
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.
mp!tN/AiN »4Y.e.Nhd.
MAg s N." .7)(c.
16. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER:
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center- Raleigh, NO:: )
27699-1636 Phone No. [phone], within 30 days. GW-1 REV. 07/26

309255
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment a Ural Resources - Division of Water Quality - Groundwater Section Q �[
WELL CONTRACTOR (INDIVIDUAL) NAME (print) Ide,9.JA�I �, Gi-L'N?S CERTIFICATION tNp/TQ
WELL CONTRACTOR COMPANY NAME4j 44LM/(./����7)fli/7Vity�J L,Cie PHONE jlfY/V� B'pfq 4
STATE WELL CONSTRUCTION PERMIT# JJ ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
I. WELL USE (Check Applicable Box): Residential Cr-Municipal/Public ❑ Industrial ❑ Agricultural ❑
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use
2. WELL LOCATION:
Nearest Town: fir-) III/ County / ,.4ia a
(too/r.ed. Csee.e.c/2,L
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: /?/o&Jc_ !.v tie9 h4
Address /OSG - HA trioed
(Sneer or Route No.)
Ciry or Town State Zip Code
(QOS- a/S- �'-/6e 3
Area code- Phone number
4. DATE DRILLED /©-L'/-otI
5. TOTAL DEPTH: 90f
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO I
7. STATIC WATER LEVEL Below Top of Casing: 66 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 accordange/vith 15A NCAC 2C .0118.
9. YIELD (gpm): Y METHOD 2OFTEST3OW iti.i
10. WATER ZONES (depth): YO' J
11. DISINFECTION: Type ('Yr :At
12. CASING:
Amount TV /cc.
Wall Thickness
Depth - Diameter or Weight/Ft. Material
From 6 To 10 Ft. t./1/ :Berl /''bt _
From To Ft.
From To Ft.
13. GROUT: Depth Material
From 0 To ,2O Ft. CoNCeele.
From To Ft.
14. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in.
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
Method
?Alt tin/ q
DEPTH
From To
D—ser
Topogray hic/Land setting
ORidge slope OValley ❑Flat
(check appropriate box)
Latitude/longitude of well location
001— n 'i%i .:z et "iv/
(degrees/minute�s/ onds)
Latitude/longitude source: ❑GPS❑Topographic map
(check box)
DRILLING LOG
Fotmation Description
ur 2tr /...., -le
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include theroad
numbers and common road names.
Cgoeke-d ate -at
191/9-2`s , • //i A{ Cr
16. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL - -
CONSTRUCTION STANDD ZRDS, AND THAT; COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER Li2tdr,
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
cf
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC-,'k
27699-1636 Phone No. [phone], within 30 days. GW-1 REV. 07/2001 ---
BND

309264
n ILL CJn aiNS)Ju coair.-.Ivv n. VIE. rrr4[s-SCWfS LU // Dp%/�tJY (� ,
cc.J) 9 p,iONC,dRs a5X srttil<
ii CM:U jTRUCfIJN FLIUt II]'S SSOCL.T.QD WQ 1'E:L :IT/I
lic.bl=1
.. +l USE LL'I' L ApplGoblt Box): R.md curial ❑ ei brneneaFPublio ❑ InGuaaial ❑ Agrlculryral ❑ .uo., o':nd 0 Coi.iMie.ry ❑ Hear Pump Water lniecrion 0 Other 0 D'Orher, Lis[ Use
-. il:ffLl LOCATION
Noores, TJn!0/r// ,. Zaire / Courny/24.40.7
WELL CONSTiZWc71ON l:PC01'.D
+ illt wl -r^ - L ,;afuncn6 or Environm.-nr and cal Rte.-sources - DivisionofWarcr Quality - Oroundsvarcr Scc4n o2 ���
OLL \11 t�C yilnllll'IDU...Lj Na AIL' (prioo cal
"A/!n/C S CERTIFICATION >+✓IZ4)
,a_Gn IC.r.➢:, :Wu➢ua, CJO',nlu(IUV Lu baivnion, L.Jr No., Zip coocj
- JiiNCR :- Ers e .:JNErS �,jii
-.: Rocrc
Melo s yr-it MC .. a R7541
.,q or l'c Swc Zip Duo,,
gay- ( R 0/- 7.A fly/
rrw,IDcr
D,,.TE n;ul_r RI) /0 22-tly
S TOTAL DEPTH: )
a. DOES H ELL REPLACE EXISTING WELL? YES 0 NO Pd STATIC WATER !PATER LEVEL Blow Top of Casing: IC FT.
'We "r"'ir.lbovc Top o?Cairn,
O. TOP OF CASING IS FT. Above Land Surface'
Top ur:+ rcrmun ri,l aVur bclu,r IanU SUN. -ACC rcy uirce a
) atc m a::erV', -wilt, C.�C 2C .01 Ili.i. YIELD
1Jd.VIELID c_enll_ 40 METH'OD OF TEST Si,
fal41j �K.q
J J
Topographic/Land selling /
❑Ridge OSlope OVaucy L7FIac
(check appropriate box)
Latitude/longitude of well location
/./ti'' c- Y&j'Aar' 3i S--yr-'
(rlcgrcesjminm�c' cconcls)
Lnutude/longitudesourer; lag gr GPSOTop o�taphic mill)
h ecu: boV
DEPTH DRILLING I.O Cr
From To Formation Description
3s-9L/ 54//
.-
U. 'C TER _ONES Lncpth): sr
L'cprn alifilci or WeighVF,. Material
rr,,m a 10 cal FL -/-i (Mt, 54'C.
ran, To
Fr.
Fro,» To_ Fr.
.3. CROU.1: Dcpd, blarcrnul
Amm___Q_- To- a1Z F[. C'ON
rrota To
Fr.
li. SCREEN Dcptu Diamcrc—
SIX Si2c ((\Imm�al
Frog, To Ft in
S
Fi:.nt -I'o Frin. in.
Imo. S.ThNO.GRR,-;\'EL PACK:
epm Size
Material
r'rb a: hl
From To
DISINFI_L:TION. Type '
C% Amount Y 145,
wail Tn,alu,cas
Fr.
Fr.
erIcrllotl
LOCATION SKETCH
Show direcrion end distance in miles from a[ least
two State Roads or County Roads. include the road
numbers and common road names.
&©IP tAtcuaet -
iyinas jiw /rC.
! CC rnEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH hA NCAC 2C, WELL
CONSTRUCTION S 1-.ND.:.RDS, AND THAT ,Ai COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
SIGNATURE OF PERSON CONSTRUCTINGTHE WELL / L' aZ-O`/
DATE
situ our (Cr Urioivalm me Di eiiion of Warcr Quality, Groundwacel- Seed on, 1636 Mail Service Cenrcr- Raleigh, NC
"1d-Le.io Phone :V p t919) 733.33:1, wirnin 30 days.
CW-I REV. 07/_001 m.

WELL CONSTRUCTIO , ;
Iva:m �,wr:::_ - �_.:; N h.l:. COl',,D
�4rrnlrnr Or Envi oninsn[ ano
H CLL '0,\ 11 • rat Rcsaw cos -Division oPk+arOr
i 1. ilNntl lUU iL) NapiQ QPPIip�-QrOUn
i j IFrmq /' d1Ya [Cr A'GC[iJII ✓_-'ii,N tl 11n CuAap 1'V N.AME'yL� / Nc�G CERTIFICATION _3/
P.11111S - YHONgy41.F 4-,
�------_'.SSOC[A.1 LD WQ 12Nti1Trr
1 =U�L.PPIcnr'flrlic:.hlul
uol.:arm! I-_blc Box) l:csidcmial
0 ! sooL -p' 0 Hcai PumpVUPu61 c
44aref 1Pj ce[j0IJq ❑ ❑ LntlUSR ial Q .gycult-um-al r7Mral
1 "+LL LOC.A-PION: Ogler❑ ]YO[her, Liu Use
El
Ne.s est To[..:l'1%
Zip Cua.
thaTiou
-. D::TE Di<11,1 n
TOT .t. D'E'1'}I: Z ter. —,---
a. DOES 14 ELL 1i:PL,CE EXISTING — WELL? YES 0 Nu [�
'. STATIC WATER LEVEL Eslow Top of Casin
T TICW;,TERLEVELBelowTopor'Casin :
s
TOP OF CASINGlUaT. Aboy eL LTop
and
Suribe
'rap of:zppq r mmaria ao�l nu to f.. c Land Swilled' 'aCc'"
v•: : 'p i C`Or a211ic lrnl: l-. il'cyuifc9J
s' YIELD Idpr„l: �— c1.V l'-C 7C.ul la.
u.4P+TEP�[paj) 'IET1H9DOFTESTJ1h,� r
alcprn): /20 -"+�3
DiSiN11.7.0TION TyP
=: prn
I o
mn, T
GROUT.
Depth
't :l"
!'ranTo-atag..
SCREEN. DFr.
,Frn
From .h3 DiamcrCf
IS. SAND/OR VEL P.kO : F[.—__
aspen
'iv:,-: Sec
----__Po FL From To,
Fr.
-`- .-:mount
Wan ThicRacss
meter or 4Vci
Fc6./Lr rFcrGnal
✓li
F[._
Fr.
Assisi -Jai
Slam Size
in.
In in.
Ylarcl'wl
Mcrnon
Marcrial
309276
❑Rid Opogr hiC/Land sewing
6' lope ❑Valley QFlar
(chock oppropriuro box)
Latitude/lOngimdc of well location
;G
(dcgrccy rmn mc' conGn�) Laumdeilongirude source: ,,..��,,''��
'-'�rs❑ToPJgraphic. Imp
DEPTH (chal: box.)From To u1:fL[f�G 1. Of
rlarion °ascription
s-� 20i
LOCATION SKETCH
Show direcrion and distance in miles from OM Ie sr
Iwo Scare Roads or Counry Roads. Include the road
numbers and common road names,
�o u/e fe nfe/c4?,c 02 ee, fRc/
/44-Rs MY/ A/C .
llJ hicf E51' CER�I'IFl"THAT
:DOhE 5 T THJS WELL 11'AgC
L 1luV CERTIFY
CONSTRUC
TED ,1EllCN,=,000I':D.gNCE 1 OF THIS P C01"_D HAS B WITH E ISA O NCAC 2C, W
7 BEEN PROVIDED TO THEWELLWELL
OWNER
SIGNATURE OF PERSON CONSTn VOTING TH
.:circa meurlgirral COrn: THE WELL 4)-C/-Ott
�y;3,1 DiYi iiJn n[ waterrcr l DATE
u.lo Phony No. [919i 7)3.3._ lrlaliry, Gro undly
I, rrirwa Jd :rrrr Section 1636 Mail Service Camor
dayi.
Raleigh NC
GW-1 REV, 07/2001

6
7. STATIC WATER LEVEL Below Top of Casing: / 7 0 FT.
(Use 8. TOP OF CASING IS �_ FT. Abovife
e Top Sf rf ce
`Top of casing terminated at/or below land surface requiresLand ifa*
ace
variance in accordance with 15A NCAC 2C .0118.
9. YIELD (gpm): .20 METHOD OF TEST G
10. WATER ZONES (depth): — 7---
11. DISINFECTION: Type N 7%1
12. CASING: Amount /3. S—bz.
Wall Thickness
O Depth., Diameter or Weight/Ft. Material
From To it 0 Ft. (< S'DR�I
From To Ft.
From To Ft.
13. GROUT: Depth Material
From T Method
�_Td/5 Ft. �xanCro r Auro
From To Ft.
14. SCREEN- Depth Diameter
From Slot Size
To Ft. in. in,
From To Ft.
15. SAND/GRAVEL PACK: °� in.
Depth
From To
From
16. REMARKS:
To
_Ft.
Ft.
Size
Material
Material
STATE WELL CONSTRUCTION PERMITS/
(if applicable)
309280
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural��tResources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR COMPANY NAME
WELL CONTRACTOR (INDIVIDUAL) NAME (print) ;'rljr i a
CERTIFICATION n
PHONE lefty ‘y3 >417
ASSOCIATED WQ PERMIT#
(if applicable)
I. WELL USE (Check Applicable Box): Residential P Municipal/Public 0 Industrial ❑ Agricultural 0
Monitoring ❑ Recovery ❑ Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION: �/
Nearest Town: MSS 14// County A r1"p
(St Name, Numbers, Commumry. Subdrvtsion. Lo[ No., Zip Code)
3. OWNER: ©rv, )II. C
Address
CCiry or owsor S ?t Zip Code
Area ode- Ph ne number
4. DATE DRILLED /O---L-
5. TOTAL DEPTH: O�
V
DOES WELL REPLACEEXISTING WELL? YES 0 NO C�
ate_
__,Topographic/Land setting
Midge OSlope OValley ❑Flat
(check appropriate box)
Latitude/longitude of well location
Ltififisz
(deg es/minutes/seconds)
Latitude/longitude source: ❑GPSOTopographic map
DEPTH (check box)
DRILLING LOG
From To Formation Description
s9-aer Wane_
LOCATION
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common road names.
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, .4N THAT A COPY OF THIS RECORD HAS
BEEN -----�PROVIDED TO THE WELL OWNER..
v'.22— o "7—
SIGNATURE OF OF PERSON CONSTRUCTING THE WELL
DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, N1„,--
27699-1636 Phone No. [phone], within 30 days.
OW -I REV. 07/SI

309282
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Divisionn�of Water Quality - Groundwater Section /
WELL CONTRACTOR (INDIVIDUAL) NAME (print) i(tr k �"i1�� h CERTIFICATION#(O
WELL CONTRACTOR COMPANY NAME /47�ft.Soa1 iAJrtl ZN ri l(:nq PHONE ftlQ.?) %V3-554e9
STATE WELL CONSTRUCTION PERMIT'S ASSOCIATED WQ PERMIT#
(if applicable) Of applicable)
1. WELL USE (Check Applicable Box): Residential 2 Municipal/Public 0 Industrial 0 Agricultural ❑
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION:
Nearest Town: plower rib
//b
Wog' Liu rot l
(Street Name, Numbers, Community, Subdivision. Lot No., Zip Code)
3. OWNER: Ory (e h-n.2
Address . fir AP e n/w `/22 /'?a(
(Sweet or Rou a No.) /�'des75/
City or Tog` / teJ� ip Code
4. DATE /0 - d(¢ -6�
5. TOTAL DEPTH: '706
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO l� te3
7. STATIC WATER
Area code- Ph ergo
topographic/Land setting
edge ❑Slope OValley ❑Flat
(check appropriate box)
Latitude/longitude of well location
Sf/,sLJRN- -
(degrees/minutes/seconds)
Latitude/longitude source: ❑GPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From To Formation Description
number
County fitsa'setl
LEVEL Below Top of Casing: /00 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS / FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordan`e with ISA NCAC 2C .0118.
9. YIELD (gpm): { METHOD OF TEST ??
10. WATER ZONES (depth): / jr
11. DISINFECTION: Type H 7 f/
12. CASING:
Depth Diameter
From 0 To V02 FL G Y
From To Ft.
From To Ft.
13. GROUT: Depth
From () To 9i1
From To
14. SCREEN: Depth Diameter
From To Ft. in.
From To Ft. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
Amount .27 6z.
Wall Thickness
or Weight/Ft. Material
.SDK2I PVc
Material Method
Ft. ConCro 1-e [-buns)
Ft.
Slot Size Material
in.
in.
16. REMARKS:
/ In c2 p' 5
7r� ,7 Z hR /e
init. 14--
r i
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.
77744 t
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH I5A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE :.
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh NC
27699-1636 Phone No. [phone], within 30 days. GW-I REV.'07/2001

ihnItOci
DATE
3. POT kt. DEPa 1•ir: 3P i
DOS I\ ELL REPLACE EXI—SWELL? YES 0 NO p�
STaT1C \1 ATEp LEVEL 1E'
clone Top of Casing:'FT.
:i. FOP OF i_=.SlNO IS._-_-/__._-.UFTj bo Lve and
SounCee-)
`Cap e1:a:Jao ormurara svur bclafr land sur iVe r)cyui'res afTBCe"'
'. aca urns WWI
n, 15A :N C-AC?C .d] 16.
Ypi
( pnl): -2r_ METHOD OF TEST
a. .TER ZONES L'IVpW): /O/7/ - i
L1j3iiNF-tC.. LION Type
Wsil Thickness
ii..-pin
`a 0 i a /Io Fr
Fr.
FL
.Otr apn'
ml9rcnal
Fr. C'O_____— lemon
from To Fr.
i�. Sr:P=ENS. J;pm — ----��
Di9mcrCr Star Size !' WiYI .Pa'Marcnnl
Fr.
in.
Amount / zer
ri. S INDI„ 113.
n. vr'�-iVEL P.zCK: -
Dtprh Si,c
!' Iani To Fr. Martial
rrow
To_ Fr. ----"
in !CE\IA RKS:
WELL CONSTRUCTION RECORD
NCLIII. 0l1.1a C-p,rmmnr or Environmcnr and rulRi5sau,ocs-
'd Ri L F Imo+. 1 u (1Nlll11DUa1) N.anle iff Division a7 V.'A[Gr eutlli of -
'nnq—44._Zf,_1, N
\i LLL Coo tic} I On 'Odtr.V1 NAAFI I.5. 1'_'r eN2 C i cCJJ•
�1..1 uULl1ON rvt.n tl J•s
WQ P212n1lTu
.. US_ 0:ncinr '-pphcablc Box) RcnidcnQlial Ai„nwipa L'P.,blic ❑ rnduyrrial C] AD:i
11 ' 0 ' 'o\.,tO. q Heat Pump \\'pier injccricn 0 Other 0 If Otter, List Use s` culru ral q
_'. i; _1.: LUC.>. 1•!' Di _
Nss c51 TJv.11:
309284
3 Oil NER.-
Cunry,_-
SabQiruion, Lai I`m. ?ip Coaci
Oroandwarcr Section
cErmF1paSjc3T1oN I3 �'d
P IIONC }s_ asitS!W/
Rego
strring
�Idge ❑Slope ❑Valley QFlat
(chcca appeoprisea box)
Latitude/longinrde of well ioearion
Aar' cfr, S, ,two
(degrccsm inucslscc
Latirudeilongirudo
_n' Rom c No.)— -_-�
eau � rlC 8787
n , DEPTH
Zip
Coo: From
To
nnds)
source: OSL]Topogrdphic mop
(er+n;Ic bo.x)
DRILLING LO it
Formation Description
-may
.See //
LOCATION SKETCH
Show direction and distance in miles from or Ieasr
I+.VU Stale Roads or County Roads. Include the road
numbers and common road names.
/4-4 /Inver' eic v
! DO riELEBY CERTIFY TH+TTHIS WELL WAS CONSTRUCTED M ACCORDANCE
:JI\'3T1tUCl'IOiV S�P.ziV.D:,P,DS, AND THAT A COPY 'RECORD
1 OF THIS 'RECORD HAS BEENWITH PROVIDEDl5A TOTH 2W WELL
0
THE W+ELL 0
.,ti. Y�1,^,,,OWNER
SIGNATURE OF PERSON CONSTRUCT L�'/
MGTHE WELL lw DATE
anaut rn; origmxl ro Ina Divis o
7a3d 1 in o[ Wafer Quatiry, Grp undrrartr Sections 1636 Nail o.i o f n c SILL l" is)) 733.3:
wirnin 3U days. ail SuvWe Cenrar - RaV.�n,
6 lV C.
GW-I REV. 07/2001

309289
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division/�lof Water Quality - Groundwater Section -�
WELL CONTRACTOR (INDIVIDUAL) NAME (print) iVinr r k fi'/in r% CERTIFICATION #. �p�
fp
WELL CONTRACTOR COMPANY NAME Feria said WGll Zlralf,ng PHONE Nat) % Y.i- 2547/7
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential I Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION:
Nearest Town: Mays Li: it
Co Won, Tgo,4 dha{ k Bede pd,
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER:
Address
County Mwd;sod
e<C - Lind8
•O. Wel -3MI
Street or Route No.)
Mtn m Hill MP4275/
City or Town State Zip C e
(B . ?n g 9. - aS 1S
Area adz- Phone number
4. DATE DRILLED / D e2 Si Dl
5. TOTAL DEPTH: r2 8s
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO Ir
7. STATIC WATER LEVEL Below Top of Casing: as 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 accordago with ISA NCAC 2C .0118.
9. YIELD (gpm): a METHOD OF TEST ? /7
10. WATER ZONES (depth):
11. DISINFECTION: Type 7f/
12. CASING:
Depth
From 0 To aa. Ft.
From To Ft.
From To Ft.
13. GROUT: Depth Material Method
l
From C) To all Ft. t riC re 1-e PO Lx ceA
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.
Diameter
Amount L/ 64'
Wall Thickness
or Weight/Ft. Material
SDR. 21 I /it
16. REMARKS:
Topographic/Land setting
a'Ridge OSlope OValley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/secands)
Latitude/longitude source: ❑GPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From To Formation Description
0 / 0 5and 6ton.e-
�z as
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Includethe road
numbers and common road names. r--
y't anAis Wall, NC
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH I5A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND TH T A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
etc
— fa a/— o
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC1=
27699-1636 Phone No. [phone], within 30 days.
GW-1 REV. 07 /20011-
111
NZ'
1V

3U9Z�b
WELL CONSTRUCTION RECORD
"+orLc of _ - pc.p rmlcol of Environnicnc end - ral Ras:n rcos - Division of Water Quo
\1 �! L\11.:."r r. JNuL\'1DU.,11NwiliL rprinq r
-�a_ .aAr ,al a ubaB �.,Y1 rv.-ale /er 14.50ws al/ LDel///N `6 •
14.1
L Cc sl l ucrloiri eaKai I'r* c�JJ
..- .aSSOCIATPD }y (1 P aim 1To
t e:pplic4Na)
ry Orounnwarer Sccrion
CERTWICATioN >ral_9d
PnoNg (Rag a52'-7411 „,
=.pplioabla Box): Resid ontial .
ca.tcruh L ion cape O1:11 1- ❑ 1neUstriul 0 Agricultural 0
Roaovcry ❑ Hsi Pump lA�alcr Lljccrion 0 prher 0 ]f Od1er. List Use
.L LOCATION'.
N catcsf TO,HI'. /'%x+s 4ij
//�. .../ram Ad.
umnwnny, Subdiv sion, Lot rW., Zip Coat)
J,Y SER
oaf;:° 'lo• ;' Zip Cud,:
4c. ,-auc- Pnou= n0nleGr -
,D-ATE DR;LL n ts� Z7 wy
POT+1.
DOE 11 ELL REPLACE EXISTING WELL? YES 0 No (�
STATIC WATER LEVEL Below Top of Casing: U� FT.
( Use "r' it .ioatc Tap orCs in 1
3. TOP OF CASING IS FT.
Above
tsoLand 54r1'aCc"
�� lJp °t �"'°'� I:tmm-+rye dCur pcluw land xu rryeC ray ui rcxri-Lu
" 'c 'r�'r'srSsI'p,1rit4 1iA NCAC ]C .011s.
- Y1ELiJ LpJll): /L METHOD OF TEST
id. 1F-.TER_oiNES tacpin)_
DISINFECTION T,rpe� /
Wail Thiclalcas
fJ Co i- / Et i ✓G
County /.74;i1 rm"
r'�'pi0 or Wright/Ft. Material
Fr"L__Q-_ La. srcnal
.�12 Fr. �'ON
From_ RI
Ff.�_
I+. SCREEN. D:prlt Diameter
Fro,il T Six Size
Pc in.
Picini lb in.
Picini S;.ND,,v'FL--__In. in.
. l`', V EL HACK: ..
C. pm
rra: To
Frain Tp
Frmr:Po
From Po _
.3. CROUP Dcpoi
al -atonal
Ft.
Fr.
Si=c Yls[enal
141a[crinl
Topographic/Land scrring
Ridge ❑Slope ❑Valley ❑Flan
(check appropriate box)
Larirude/loogimde of well location
Pjr°Ns:rc , '..,.,t.,o s— Zip'
(dcgrccs mimic� +'conds)
Laumileilongicude source: 12GPS❑Topographic map
DEPTH
From To
D' 62
ba-67—
(encG: bu,N)
DRILu_...____N_ LOG
Formation Description
LOCATION SKETCH
Show clirccrion and distance in miles from ar least
ovo Stare Roads or Counr Roads. Include the road
numbers and common road names. �
/7' g P-C' .
mtzsha '. NC .
DO dEREBy CERTIFY I'H;+TTHIS WELL WAS CONSTRUCTED CN ACCORDANCE WITH hA NCAC 2
:DINSTRUCTION STANDARDS, AND TH.AT.A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE L• WELL
WELL OWNER
.
7 Y`.
SIGN- DATE ,TUBE OF PERSON CONSTRUCTINGTHE WELL �� E 7 ` O7
E
'uouut Ln; Liriginal ra Inc DiviiiQn of Warer Quality, Groundwater Section, 1636 Mail Sorvia2 Canter- Raleigh, NC
'069-16u ethnic :V O. r"l9) 733.3221, rrirllin 30 days.
GW-I REV.07/^_001

309326
WELL CONSTRUCTION RECORD
Navin Carolina - Dcpernitnr of Enviremncnr and rah Resources - Division of Water - � Quality - Groundwater Scrim\
VA LLL CON I. 1 2sor LNDIA9DU. l NAME ) tpp A
i .t+Ip, 1ptl / ( a 1��1I✓G S CERTIFICATION A.�I�f
LLL lJlrr 'rJll J11P.ANl'N-a.11E Terjk,Scv. ,f /i. C// ➢ei'/',ry. Co , PHONE gdrtl p5 a4a�
butt_ \r butt_ ON.SI nuCTION ecriatl'ra ASSOCIATED WQ TILIWiTv
iir]upllcable)
.. l:..ulu
. F4ELL LI SE LChsk Applicable Boa): Residenriul ❑ AYiunioipaI'Public ❑ Induerriul ❑I Agrictilrural 0
usmz,mrm3 D. Rccorcry 0 Heal Pump Water Injocrion 0 Other 0 If Orher, Liar Use
2. ELL LOCATION'.
N.aresr Town: Arr:-'144
�✓. Se.r/i 409 Z.!
,Szen Rjo; Nurtmcrs, Ca,nm witty, Subdi vuiun, Lot No., Zip cocci
owNEr.: 2.' Fad
.aarc_,
Countyy /I {0'1
l t 'ek-
/Y142811a//u`a Route C
cr Ta„ r, a t ? r3
t
x?S- if99- 37/ Zip Code
OWnbcr
-t. DATE DRILLED 7-4j -cm
TOTAL DEPTH: ZZC
C. DOES WELL REPLACE EXISTING WELL? YES 0 NO12(
7. STATIC FY.ATER LEVEL Below Top of Casing: G FT.
(Use ". irAbove Top or Cx,inyl
Si TOP OF CASING 1S FT. Above Land Surface
'Top or avn; torn inyttd a our bclutr Jana surface requires u
rr,au« m accuraaucc with lid NCAC IC.Ol is.
9 YIELD (Spin: /L METHOD OF TEST Bbilierrg •Krq
10. WATER ZONES (depth): /0b J .J
Zopographic/Land scaing
ge OSlope ❑Valley ❑Flay
(check eppropriarc box)
Larirude/longinrde of well locarion
girt N1, 4cit i/tee 17, (,)'
(deareesrminutcu cconcls)
LoLimdeilongirude source: L3'G PSOTopographic map
(cheek Dux)
DEPTH DRILLING LOG
From To Formation Description
b`
VV - .22f e.,,- f,
DISINFEC'T!O[v '1'7FCC1( eys_ /p h5;
Amount
'SrCd u': Wall Thickness
Dapm Disrnoler or Wciyhr/Ft. haartrial
Front To hi? Ft. G. lL- s.'ez, /$ic
Fran
To Fr.
From To Fr.
3. GROUT: Depth Maverist
Fro ui_Q To f_ Fr. CONC2efe
From To Ft.
n-Ictnod
i. SCREEN Dcpm
Diamclu Slot Size Material
From To Frin. in.
Ficiln To Fr in. in,
n. SAND:GRAVEL PACK:
Depot
From To Fr.
From To Fr.
I0i. RENLARIVE:
Size
Marcrial
LOCATION SKETCH
Show direction and distance in miles from at least
two Stare Roads or County Roads. Include the road
numbers and common road names.
)3 ¢'1 W.'rd 36u1p-Ca are 141.
y114-25 kW/I, /YC .
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED [N ACCORDANCE WITH laA NCAC SC, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
SIGNATURE OF PERSON CONSTRUCTINGTHE WELL DATE
- vy
D
Suomi( rite ori;inal to the Division o[ Water Quality, Groundwater Section, 1636 Mail Service Cenrcr - Raleigh, NC
3?d99-io3o Phone No. [phone], within 30 days.
GW-I REV, D7/2001''
`/�.s. ..
C.7
C"

WELL CONSTRUCTION RECORD
Pmrm C of-r - Dep,rm,cnr of Environment and ral Resources - DivisionofWacer Qualiry - Oroundwarer Seenon
,I eLL CONTI u' O( lb UI!'I DUAL) NAME (print./j(print./.f jgL✓/ /ill /4five S CERTIFICATION 1�1�Lib
, ELL CON I CT Or. CONIPnNY NAME cerk.ESCW:S (�/t;`J D,p//tipei g�r4l PHONE aS It f1dr'-ZWt„
S'1 il'L 1, ELL EoNSTRUCTION PERAtITa .ASSOCIATED WQ PYluuTu
iir:[uoliublcl
309327
I. WELL USE uOncoic Applicable Box): Residential EC!' AIunitipcUPubrio ❑ Industrial 0 Agricultural ❑
ilonuaring 0 Recotery 0 Hear Pump Water Injection 0 Other 0 If Other, List Use
2. IIELL LOCATION:
Ncsr-sr Town:/ --y/�// v'
�v.:t/S.. q--r0 / /t s £.
,3aecN.,nm, Numo: rs. Conn oniry, Suba via ion, Lot No., Zip Code)
C'WiER: rut tb P -//ew
8a)- 6 ,9- =is y
Po or; OWnDcr 6 - 44,
DATEDO.LED 7-h/•Qa 4'. L4s
_. TOTAL DEPTH: 2YC
o. DOES WELL REPLACE EXISTING WELL? YES 0 NO
STATIC W.LTER LEVEL Below Top of Casing: 8-0 PT.
/
(Utt"j"'ir .A bore Top urCsmng)
S- TOP OF CASING IS FT. Above Land Suriaec"
',Mop or :am; rum uu rca pour bcluw land surf -Act rct)L iLCS a
.ns ut. m ..corQ , •o with Iid NCAC 2C.011s.
9. YIELD (gpml: J0 METHOD OF TEST 8btii ai •K.,
IC. WATER. ZONES ideplf): 11r"•
County Mere-% v
/a dc 1.4..Ndsw2�S�41
h19-ash4.1/ .rR, NC ax7s3
Zip Codc
i . DISINFECTION: Tyne' Op4:vc.
._. C.vFIYu-
Dcpm Diameter
Fr)1n 0 To44 Fr. 4"-./2r
From To Ft.
1Om To Fr.
13. GROUT: Dmin Nlurcnal
Amount /Z /CSS
Wall Thickness
nr WpighuR. Material
SDNu Aft
FroLn fl .- To_aa_ Fr. (ONC2C%=
From To Fr.
isr- SCREEN: Depot Diameter
Prom '1'o Ft. in,
Frain •Po Fr.
ul.
!i. SAND,ORAVEL PACK;
Depot Site Nlarenal
From To Fr.
From To Fr.
Nlcrllod
Slot Sicc blurcrial
in.
in.
lo. REBD;ELKS:
,,,TopographiciLand setting
Midge ❑Slope OYallay ❑Flat
(check nppropda[e bo)0
Lutirude/longintde of well location
N id-147. 4153 " von' . ii s-rd
(dcgrtcvminutovscCOnos)
Latirudwlongirude source: a6PSI:Topographic map
(Cheek bog)
DEPTH DRILLING LOG
From To Formation Description
Fi -6t D,'/
Sled
LOCATION SKETCH
Show direction and distance in miles from or loose
two Stare Roads or County Roads. Include the road
numbers and common road names.
,557L6J:ii 4sw`-Pt 2 d5elea .
rylCas110-1/ . A/C
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH liA NC.AC 2C WELL
CONSTRUCTION�STANDARDS, AND THAT .A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
34;, /{,-zi.,-,r- 7— /y- pc/
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
Summit me orivinal to the Division oY Water Quality, Groundtyucer Section, 1636 Man Service Center- Raleigh, NC -=
?699-163o Phone No. [phone], rrirhin 30 days.
GW-I REV.07/^00Er.; g
•- 01

ASSOCIATED WQ PERMIT#
WELL USE ('fa.•licable)
(Check Applicable Box): Residential 0 Municipal/Public
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 0 Industrial ❑ Agricultural ❑
2. WELL Other 0 If Other, List Use
LOCATION:
Nearest Town: a i
County Maw
(Street Name, Numbers, Community, Subdivision, Lot No.,Zip Code)
3. OWNER:
Address
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources -
WELL CONTRACTOR (INDIVIDUAL) NAME Division
WELL CONTRACTOR(print)
COMPANY NAME
STATE WELL CONSTRUCTION PERMIT#
(if a..licable)
o n State --�:
At ea code- PI ne number
4. DATE DRILLED_
�q
S. TOTAL DEPTH:�an o y
6. DOES XIST� IN W WELL? YES ❑ NO Er-.3=�_
S. TOP OF CASING IS (Use + Above
*Top of casing terminated at/or r�land surface erequires arface*
variance in accordance with ISA NCAC 2C .0118.
9. YIELD (gpm)
0 WATER ZONES (depth): NIETHOjOF TEST
11. DISINFECTION: Type ir' 7- nt
12. CASING: �---�` Amount
(
City or To
Zip Code
WELL REP c c
7. STATIC WATER LEVEL Below Top of Casing: Casing)
Above Top of Casing)
10.
From-_Q_ Topth
From To
�
From To
13. GROUT: Depth
From__� To
Ft. c., P d
From To—�.SdC¢�
14. SCREEN: F[.—_
Depth•
From To
From To
IS. SAND/GRAVEL PACK:
Depth
From To
From To
6Z.
3-i `16
of Water Quality - Groundwater Section
CERTIFICATION #
PHONE ef) /a 97 /p
Topographic/Land setting
Qi�idge ❑Slope OValley ❑Flat
(check appropriate box)
Latitude/longitude of well I9catio
32sro/3` 11-083, rJr-T-..%
(degrees/minutes/seconds)
Latitude/longitude source: OGPSOTopographic map
(check box)
DRILLING LOG
Formation Description
DEPTH
From To
16. REMARKS:
Method
Wall Thickness
Diameter or Weight/Ft. Material
Ft._�
Ft.
Material
et o
Ft.
Ft.
—<
LOCATION SKETCH
CD
Show direction and distance from at least
two State Roads or County Roads. Include the road`,
numbers and common road names.
Diameter Slot Size e
Mare
F[in riat--' . t, t- - 7FV
n.
n.
Ft. in. -- - —_ L l� n
Size I„ I / 1 1
Material i 1 2005 I'--
171�
[DO HEREBY
IOHECERTIFY THAT THIS WELL WAS CONSTRUCTED IN
CONSTRUCTION STANDARD 4N a THAT A COPY O❑ THIS RECORD ACCORDANCE P WITH 15A--- NCAC 2C, WELL THE O
WIVER
COPY OF HAS BEENPRnsr�r��--
SIGNATURE OF PERSON CONSTRUCTING THE WELL
Submit the original to the Division of Water DATE 0
27699-1636 Phone No. (919) 21 within 30 aysty, Groundwater Section, 1636
C
Mail Service Center - Raleigh,
GW-1 REV.07/202001

PC Vic, Ire_
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED M ACCORDANCE WITH ISA NCAC 2
CONSTRUCTION STANDARDS, A I THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO
C. WELL
/ / THE WELL OWNF,g-
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water
WELL CONTRACTOR (INDIVIDUAL) NAME (print) r QDatttY -Groundwater Section
V! �j I , '9
WELL CONTRACTOR COMPANY NAME —�t—l— CERTIFICATION #.{ .�
SPATE WELL CONSTRUCTION PERMIT# 1 PHONE (pPcI'y/, y7_ q`�9
(if ap•licable) ASSOCIATED W
Q PERMIT#
1 Monitoring (Check
heckApplicable Box): Residential Municipal/Public ., Industrial ❑ Agricultural 0
Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION:
Nearest
tT od :Jhnr U'll —� M,. County °
,E' f
(Street Name, Numbers Community ry, Subdivision, Lot No., Zip Code)
3. OWNER:
Address
Cory or Town State
Zip Code
Area code-
Phone number
4. DATE DRILLED 9 - z9-
5. TOTAL DEPTH:_/ pp ----
6. DOES WELL REPLACE EXISTING YES 0 NO
7. STATIC WATER LEVEL Below Top of Casing: —_FT.
8. TOP OF CASING IS (Use.. if Above Top of Casing)
*Top of casing terminated at/oland suFT. rface a requiove res aSurface*
variance in accordance with ISA NCAC 2C .0118.
9. YIELD (gpm),
10. WATER ZONES (depth): METHOD OF TEST__ /Pt,___
-s8r•
11. DISINFECTION: Type /-/ 7
12. CASING: �— Amount
Depth Diameter _ Wall Thiclmess
D or Weight/Ft. PYC-
Material
From_Q To
From
To Fr
From To Ft.
13. GROUT: Depth
From___ To Material Method
From
TFt.
14. SCREEN: Depth
From Diameter Slot Size
To
az.
From Ft. in.
15. SAND/GRAVELTo FL n.
PACK:
Depth Size
From To
Ft.
From
To Ft.
16. REMARKS:
in.
Material
Material
(ifa• plicable)
310823
Topographic/Land setting
❑Ridge ❑Slope OValley ❑Flat
(check appropriate box)
Latitude/longitude of well location
45/31/ssA e / ! s!
(degrees/mmutesiseconds)
Latitude/longitude source: aP,PS❑Topographic map
DEPTH (check box)
From DRILLING To
a a�
Formation Description
Ft.4:v 1 4- SAnVow-
LOCATION NN SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common road names.
SIGNATURE OF P SON CONSTRUCTING THE WELL - - Submit the original to the Division of Water Quality,DATE
27699-1636 Phone No. (919) Divisi21, within 30 days. Groundwater Section, 1636
Mail Service Center - Raleigh, N `/!
GW-1 REV. 07/20c l
c
{

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water uali
WELL CONTRACTOR (INDIVIDUAL NAME Q ty -GroundwFIC TIONn
(Print!_ WELL CONTRACTOR COMPANY NAME CERTIFICATION p.
te
STATE WELL CONSTRUCTION PERMIT#l I �7
PHONE jtlF.:YI %Y7 - c%
(if applicable)
ASSOCIATED WQ PERMIT/1
(if a licablel
I. WELL USE (Check Applicable Box)' Residential ❑
Agricultural CZ --
Monitoring
Municipal/Public 0
310825
0 Recovery 0 Heat Pump Water Injection ❑Industrial List
0
Other 0 If Other, LisUse
2. WELL LOCATION:
Nearest Town: ri v / County P1na do II
r h^as t >* d l iL d —--
(Street Name, Numbers, Community,
ry, Subdivision, Lot No., Zip Code)
3. OWNEs- �„ . +:
Addre . a_'�
u
��.f-�
- -•
or Route No.)
City or Town
Arerff - Phone number
4. DATE DRILLED
5. TOTAL DEPTH: , `�6_� S • __
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO [-
7. STATIC WATER LEVEL Below Top of Casing: (p
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS � FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordance with I5A NCAC 2C .0118.
9. YIELD (gpm): --�_ METHOD OF TEST —`�i� rm 10. WATER ZONES (depth):--
Code
II. DISINFECTION: Type fH 7'4/
12. CASING: '—�— Amount c3" 6z.
Depth
From_Q To ja
From To
From To
13. GROUT: Depth
From__ To_a
From To
14. SCREEN: Depth
From To
From To
I5. SAND/GRAVEL PACK:
Depth
From To
From
16. REMARKS:
Wall Thickness
Diameter or Weight/Ft. Material
Ft.__12431 V L
Ft.
Material
Ft. Win_ C__ e _
Ft.
Diameter
Ft. in.
Ft. in.
Size
Ft.
To Ft.
PMethod
,rp
Slot Size Material
in.
in.
Material
pographic/Land setting
idge ❑Slope OValley ❑Flat
(check appropriate box)
Latitude/ionimde of well locatio
)
(degrees/minutes/seconds)
Latitude/longitude source: G@r-S❑Topographic map
(check box)
DRILLING LOG
Formation Description
DEPTH
From To
a3..J
LOCATION SKETCH
H ---0
Show direction and distance in miles from at ISis}
two State Roads or County Roads. Include the road
numbers and common road names.
m a..sesk//, we
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH
CONSTRUCTION STANDARD AND HAT A COPY OF THIS RECORD HAS BEEN PROVI
SIGNATURE OF PERSON CONSTRUCTING TFIE WELL
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail
27699-I636 Phone No. [phone], within 30 days.
I5A NCAC 2C, WELL
DED TO THE WELL OWNE11.
dam-01
DATE
Service Center - Raleigh, N
GW-1 REV. 07/20
w
CD
O
C-1

310830
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water WELL CONTRACTOR (INDIVIDUAL) NAME /1 // Quality
-Groundwater Section
!�� �' Ft!
WELL CONTRACTOR COMPANY NAME (Print) CERTIFICATION #32261
STATE WELL CONSTRUCTION PERMIT#
t ' 1 PHONE 0/41 ‘513 —%51117
(if applicable)
ASSOCIATED WQ PERMIT#
(if applicable)
1. WELL USE (Check Applicable Box): Residential Municipal/Public 0 Industrial 0 Agricultural ❑
Monitoring 0 Recovery 0 Heat Pump Water Injection ❑ Other 0 If Other, List Use
2. WELL LOCATION: '/
Nearest Town:�fg 1 ��
-�--.____ County QLp
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER:
Address
ity or Town Stater Z Code
IR eta Ft 9- 53�5
Area ode- Phone number —�
4. DATE DRILLED
5. TOTAL DEPTH:
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO I —
7. STATIC WATER LEVEL Below Top of Casing: O FT.
(UsCasing)
8. TOP OF CASING IS �— F .A T. if L Above andTop S
*Top of casing terminated at/or below land surface requires arface*
variance in accordan a with ISA NCAC 2C.0118.
9. YIELD (gpm): METHOD OF TEST_ & 4 p
10. WATER ZONES (depth): _� S/� �-'--
11. DISINFECTION: Type H 7 F/ Amount%`- aL.
12. CASING:
Wall Thickness
O To_ Depth.... Diameter or Weight/Ft. aterial FromFt _ Staid
� ^ I
From To Fr. Y+4-=a-
From To Ft.
13. GROUT: Depth Material
From,_,Q_ To F
Ft. �nCca
From
To Ft.
14. SCREEN: Depth Diameter Slot Size
From To Material
F[. in. in.
From To Ft. in.
15. SAND/GRAVEL PACK: in.
Depth Size Material
From To Ft
From To Ft.
16. REMARKS:
1_, Method
opographic/Land setting
dge ❑Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude 9f well IocaLion
(degrees/min utes/secu
Latitude/longitude source: ❑GPS❑Topographic map
(check box)
DRILLING LOG
Formation Description
DEPTH
From To
D d
o
LOCATION N SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common road names.
Yila.“1, wc(i, r
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, _w D TWAT A C PY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL 0
SIGNATURE OF PERSON CONSTRUCTING THE WELL _/zr�De-
DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleig
27699-1636 Phone No. [phone], within 30 days.
GW-1 REV. 0
7
3
C-
r

Depth
From To tro Ft.
To Ft.
From To Ft.
13. GROUT: Depth
From_� To Material
From �!) Ft. Cp��-�
To Ft.
14. SCREEN: Depth Diameter
From To Ft. in.
From To Ft.
IS. SAND/GRAVEL PACK: m
9/
From
From
Depth
To_
To
Ft.
Ft.
310831
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water WELL CONTRACTOR (INDIVIDUAL) NAMEQuality -Groundwater Section
WELL CONTRACTOR COMPANY NAME (print) CERTIFICATION #ei
•
STATE WELL CONSTRUCTION PERMIT# t 1 PHONE btP1ae _9yL7/q
(if ap liable) ASSOCIATED WQ PERMIT#
(ifa plicable)
I. WELL USE (Check Applicable Box): Residential 1 Munici'ayPublic 0
0 PIndustrial 0 Agricultural ❑
Monitoring 0 Recovery 0 Heat Pump Water Injection
Other 0 If Other, List Use
2. WELL LOCATION:
Nearest town:S,r � ��
--__ County '�ia✓ri : c o
AL
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER:
Address
City or Town Skate
T'P Code
CL 1i 7' Ca5
'ea code- Phone number
4. DATE DRILLED _ `_0
5. TOTAL DEPTH:
6. DOES WELL REPLACE EXISTING WELL? YES '❑�y NO�aI3�'! 7. STATIC WATER LEVEL Below Top of Casing:
8. TOP OF CASING IS (Use ^+ if Above Top of Casing)
*Top of casing terminated at/olad surface erequidres Surface*
variance in accordance with 15A NCAC 2C .0118.
9. YIELD (gpm):2_ METHOD OF TFST �i a2j
10. WATER ZONES (depth):
I I. DISINFECTION: Type f/
12. CASING: H'T -- Amount Dz.
Wall Thickness
From_ 0 Diameter or Weight/Ft. Material
is-' Sqg �l PVC.
PMethod
n •�
Slot Size Material
in.
in.
Size Material
topographic/Land setting
ge OSlope OValley ❑Flat
(check appropriate box)
Lati de/lo igitude of wel local n
degrees/minutes/sec ds
SOTopographic map
(check box)
DEPTH DRILLING LOG
Fo
From To
ation Description
LOCATION N 4
Show direction and distance in miles from at least e j
two State Roads or County Roads. Include the road
numbers and common road names.
mad i& 2n He► h15
mars Win c
16. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH ISA NCAC 2 ->�— �Jh�7 P
CONSTRUCTION STANDA �� n
S, A�ID .4 COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNFIRn L
_ C
SIGNATU E OF PERSON CONSTRUCTING THE WELL ... DATE
27699-1636 Phone No. [phone], within 30 ay
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh,
GW-I REV. 07
ru
0
c>
1

311368
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division#of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) i •/r c k 416 In CERTIFICATION - z�y�
fp/q
WELL CONTRACTOR COMPANY NAME • fre ro, L. so al1 ( T c' i ll,�g PHONE Wpm) 6Y3 'i}4i/
ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
STATE WELL CONSTRUCTION PERMIT#
I. WELL USE (Check Applicable Box): Residential ® Municipal/Public 0 Industrial 0 Agricultural ❑
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION:
earytTown: Magi ha// "" County M.QAISOi
dui/e keel , d.
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: l9TCiShf}
Address /CAI 9 [
(Rou No.)
City
or Town Slate
a- /.V9- 4369
Area code- Phone numbe
4. DATE DRILLED eY tho 0
se
_luau 'tnaoit
P7"
p Code
5. TOTAL DEPTH:
6. DOES WELL REPLACE EXISTING WELL? YES'L 0 NO (y -
7. STATIC WATER LEVEL Below Top of Casing: 7 0 FT.
/ (Use "+" if Above Top of Casing)
8. TOP OF CASING IS / FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordance with 15A NCAC 2C .0118.
9. YIELD (gpm): /O METHOD OF TEST /7
10. WATER ZONES (depth):
11. DISINFECTION: Type /9 711 Amount
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. gaterial
From 0 To 36 Ft. Gir sin 7/ ryc
From To Ft
From To Ft. _
13. GROUT: Depth Material Method
From 0 To 9/1 Ft. 1.bnCro Ee PQtAC2J
From To Ft.
14. SCREEN' Depth Diameter Slot Size Material
From To Ft. in. in.
From To Ft. in. in.
OZ-
15. SAND/GRAVEL PACK:
Depth
From To Ft.
From To Ft.
Size Material
Topographic/Land setting
aKidge OSlope [Walley OFlat
(check appropriate box)
Latitude/longitude of well location
3S/ I? /7rJ - 02,03/6 3W
degrees/minutes/seconds)
Latitude/longitude source: ❑GPS❑Topographic map
(check box)
DRILLING LOG
FoSmation Description
DEPTH
From To
6
q
W
O
cn
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common road names.
telelle.datmteveroa.W
16. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED [N ACCORDANCE WgH I5A NCAC 2C, WELL.
CONSTRUCTION STANDA4DS, AN THAT A COPY OF THIS RECORD HAS BEEN PRO VIDED:TO THE WELL 0
' P-(6-07
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-I REV. 07/2001

i
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section �---tt ��99��
WELL CONTRACTOR (INDIVIDUAL) NAME (print) eVia c k /414 \ CERTIFICATION #__ fp
WELL CONTRACTOR COMP.ANYNANIE /r.)Ai seal Well Zlc(I((nq PHONE (,41 le Y.3 '91r/
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable)
(if applicable)
1. WELL USE (Check Applicable Box): Residential Municipal/Public ❑ Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION:
Nearest Town: friar$ital
County Pt s5A1
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: The- ult]l ker
Address /7/ 4- jgs/f Vt. cwd
(Sneer or Route No.) oi
C or Town I State ip Code
(—)-
Area code- Phone number
4. DATE DRILLED
S.TOTAL DEPTH:
6. DOES WELL REPLACEXISTING WELL? YES 0 NO
7. STATIC WATER LEVEL Below Top of Casing: _D FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS J FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordance with ISA NCAC 2C .0118.
9. YIELD (gpm): METHOD OF TEST r; 5
10. WATER ZONES (depth):
��11 Topographic/Land setting
l Ridge ❑Slope OValley ❑Flat
(check appropriate box)
Latitude/longitude of well location
'i5ly,31r17N-nta�FV
(degrees/minutes/seconds)
Latitude/longitude source: ❑GPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From To Formation Description
(C 20 /l
al fie
70
I1. DISINFECTION: Type N %f/
l2. CASING:
Depth Diameter
From_0 To 90 Ft. 6
From To Ft.
From To Ft.
13. GROUT: Depth Material Method
From O To a!) FL ConcroIn* p a ed
From To Ft.
14. SCREEN: Depth Diameter Slot Size
From To Ft. in. in.
From To Ft. in. in.
IS. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
Amount oz.
Wall Thickness
or Weight/Ft. Material d/ Ste Pvc
1 .t
(.) 121
rn
Ul
LOCATION SKETCH
Show direction and distance in miles from at least _4
two State Roads or County Roads. Include the road
numbers and common road names.
aMy1(, 2
Material �
16. REMARKS: _.
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITI}IA NCAC 2C, WELL
CONSTRUCTION STANDARDS,, AND T AT A COPY OF THIS RECORD HAS BEENPp(OVIDED TOfITIR-WELL OWNER
rad-''' a
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-I REV. 07/2001

r"17
all a 1 ,
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section --�� --�� ��99��
WELL CONTRACTOR (INDIVIDUAL) NAME (print) / 46, c k 416 N CERTIFICATION #_1p
WELL CONTRACTOR COMPANY NAME f'C.0 G/sn a) tAi 611 11ri lI.ng PHONE Ian%V3 -i,41
STATE WELL CONSTRUCTION PERMIT# / ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
I. WELL USE (Check Applicable Box): Residential If 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: Mac tka/7 County NinA iGez
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3.OWNER: Zam-n. f Chac,alec Address /o44 A Liar 2L tclef2itrl2
big
or RLute No.) �I load
Pet
Qiqj GO/ /W' 4 t97.51
City orT State Zip Code
ea- 4 i9-//yO
Area code- Phone number
4. DATE DRILLED 9 - ) -
5. TOTAL DEPTH: . n5
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO I-Y
7. STATIC WATER LEVEL Below Top of Casing: GO FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS / FT. Above Land Surface'
*Top of casing terminated at/or below land surface requires a
variance in accordance with I5A NCAC 2C .0118.
9. YIELD (gpm): S- METHOD OF TEST
10. WATER ZONES (depth): /0S
11. DISINFECTION: Type f% Tf-
l2. CASING:
Depth Diameter
From © To 30 Ft. 6T
From To Ft.
From To Ft.
l3. GROUT: Depth
Material
From_ To 9 l7 Ft. thnG r'o i-P
Amount 2 ei7c5- Oz.
Wall Thickness
or Weight/Ft. Material
14DRr1.I PYG
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.
Size
Topographic/Land setting
❑Ridge ❑Slope [Walley 6F1et
(check appropriate box)
Latitude/longitude of well loc ion
3s/saa>J 3-6867/3qW
(degrees/minutes/seconds)
Latitude/longitude source: ❑GPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From Do Formation Description
e 0
>/ Oar
R (8
t!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.
Method �/
PO used c1YI � ACC'
Slot Size Material
in.
in.
Material
c
16. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH I5A NCAC 2C WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN.PROVIDED-TO:THE WELL OWNER
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-1 REV. 07/2001

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) i'//t r k
Alt t h CERTIFICATION *Oa
WELL CONTRACTOR COMPANY NAME be�T---. nl Jt11 Tr-
1(Ilfaa, ___ _ PHONE iY$"t} (o Y3 -9jt/7
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential CVMunicipal/Public ❑ Industrial ❑ Agricultural ❑
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use
2. WELL LOCATION:
Nearest Town: tt., 11,11 County Mad i:s a1J
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: SE c,
Address e f i n on (e ✓L ' giro LOJSZL if
tteet or Route No.)
%n ato. Yid r:;k 4/is!
City or Town State Zip Code
99oL
Area code- Phone number
4. DATE DRILLED 9-07i- QV
5. TOTAL DEPTH: 3o
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO ("
7. STATIC WATER LEVEL Below Top of Casing: ia. 0 FT.
(Use "+" if Above Top of Casing)
S. TOP OF CASING IS / FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordance with ISA NCAC 2C .0118.
9. YIELD (gpm): 3 METHOD OF TEST Rrci
10. WATER ZONES (depth): / 6 ,C
11. DISINFECTION: Type f/ %f/
12. CASING:
Depth Diameter
From 0 Tom Ft. 4, -7
From To Ft.
From To Ft.
13. GROUT: Depth
From 0 To an
Amount /D
64.
Wall Thickness
or Weight/Ft. Material
CDR. 01 vr.—
Material
Ft. ConC ro Ee
Method
PO cAr20
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 OSlope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
mS/rv/so w- otajs//r
S;� degrt✓
fees/minutesisecon ovisk/gr
source: ❑GPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From To Formation Description
o car
le le 70 5�s
hale-
ca
�i
{
D
—C C.1
LOCATION SKETCH O rp
Show direction and distance in miles from atdJist
two State Roads or County Roads. Include the road
numbers and common road names.
fXoL1 HL1L, t.
16. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
--- tc2 ay
IGNATURE OF PERSON CONSTRUCTING THE WELL DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-I REV. 07/2001

WELL CONSTRUCTION RECORD
Noah Carolina - Department of Environment and Natural Resources - Division/��of Water Quality - Groundwater Section
/-{ �9�
11+ bn CERTIFICATION # -� ._
WELL CONTRACTOR (INDIVIDUAL) NAME (print) r'flt rL WELL CONTRACTOR COMPANY NAME Art r7z, 50 a) Well INC; I1.n7 PHONE W' 60 V3 "%VIp
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential el MunicipaUPublic 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection ❑ Other 0 If Other, List Use
2. WELL LOCATION:
Nearest Town: lilacs let l/
Nyl110,0 'meek
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: , /42,
Address y/9/An eared
( neet of Route No.)
County Pietrii.s4
rr1a- ., N0. 01A753
Ory or Town State Zip Code
84,43)- z 19- 9339 a
Area code- Phone number
4. DATE DRILLED 2/-0V 4(
5. TOTAL DEPTH: d [l C ( (o
6. DOES WELL REPLACE EXISTING WELL'? YES 0 NO
7. STATIC WATER LEVEL Below Top of Casing: #'5 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS / FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordance with I5A NCAC 2C .01 IS.
9. YIELD (gpm): (Q METHOD OF TEST
10. WATER ZONES (depth): / S c t
Amount 'f%
11. DISINFECTION: Type f!
12. CASING:
Depth
From 0 To 70 Ft.
From To Ft.
From To Ft.
Topographic/Land setting
[7�idgE ❑Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
/SSA/ot(nJ080L%x /x 2
(degrees/minutes/second)
Latitude/longitude source: ❑GPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From To Formation Description
ao
4
cer
Clef
14
70 a-na, Lem
L]
LOCATION SKETCH s
oz. Show direction and distance in miles from ast
Wall Thickness
Diameter or Weight/Ft. Material
(e '$ s-tn, yt p v L-
13. GROUT: Depth
From O To 9/3 Ft.
From To Ft.
Material
A'nG r Fe
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
l
PC, r.2J
Slot Size Material
in.
in.
16. REMARKS:
two State Roads or County Roads. Include the road
numbers and common road names.
ty(aajta.kt Kee.
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDAR/RDDS, AND THAT A COPY
OF
THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
!PERSON CONSTRUCTING THE WELL DATE - OV
SIGNATURE2
0OF
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center- Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-1 REV. 07/2001

4. DATE DRILLED 7-a
5. TOTAL DEPTH: { �'
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) ',Ili r E` /4/It Y1 CERTIFICATION # a&
WELL CONTRACTOR COMPANY NAME f llru sod Weil Zl c- (IL.n7 PHONE Won ro Y3 —1,4/
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable)
(if applicable)
311361
1. WELL USE (Check Applicable Box): Residential 0 Municipal/Public e" Industrial ❑ Agricultural 0
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use
2. WELL LOCATION:M
Nearest Town: / en( 1 l,'P/ County m,/, 6061
%o/$ /.,44
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: /k
Address 0 . gar?
(StT eet or Route Ne.)
fie -4 nil.
Cit}4pr Town State Zip Code
- A.f/-/sag
ea ode- Ph ne number
041'
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO
7. STATIC WATER LEVEL Below Top of Casing: /5-0 FT.
/ (Use "+" if Above Top of Casing)
8. TOP OF CASING IS L 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 ? / 5
10. WATER ZONES (depth): 3".
11. DISINFECTION: Type
12. CASING:
From d
From
From
13. GROUT:
From (3
From
14. SCREEN:
From
From
15. SAND/GRAVEL PACK:
Depth
From To
From To
H 7 f/ Amount c,2 j
Depth
To 3S— Ft.
To Ft.
To
Depth
To 90
To
Depth
To
To
16. REMARKS:
6L.
Wall Thickness
Diameter or Weight/Ft. Material
2-C ?Yc
Ft.
Material Method
Ft. Concro Ee }DouCexi
Ft.
Diameter Slot Size Material
Ft. in. in.
Ft. in. in.
Size Material
Ft.
Ft.
Topographic/Land setting
❑Ridge ❑Slope ❑Valley ❑Flat
(check appropriate box)
Latt de/longitude of welllocation
357S4A7 w 0173cArind
(degrees/minutes/seconds)
Latitude/longitude source: 13PiPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From To Formation Description
e er etwi
t.. f�4 �
&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.
((idly otacuLei
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH I 5A NCAC 2c, WELL
CONSTRUCTION STANDARDS, 3ND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TOTHE WELL OWNER
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE-
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
GW-1 REV. 07/2001
27699-1636 Phone No. [phone], within 30 days.
C )

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section �p
WELL CONTRACTOR (INDIVIDUAL) NAME (print) .42 c k 416V\ CERTIFICATION # k94
WELL CONTRACTOR COMPANY NAME / K�....Sa:J us. 7.11 hr l/.ne) PHONE Wc41 IV3 '%}fir/
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable)
(if applicable)
311357
1. WELL USE (Check Applicable Box): Residential l7 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: Mars K:U(
W "do.nel
Name,Nm ers, ommuniry,
%�.aai' o4
Subdivision,
(Street Lot No., Zip Code)
3. OWNER:
Addressn(-
Ciry or Town State 'Zip Code
Area code- Phone number d
4. DATE DRILLED Z' $ ^ O r
5. TOTAL DEPTH: 4 66 `
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO
7. STATIC WATER LEVEL Below Top of Casing: 3 G FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS / FT. Above Land Surface*
Topographic/Land setting
l9R'ilje ❑Slope OValley ❑Flat
(check appropriate box)
O7
Latitude/longitude off rw.ell location
c�r/f Ari%- .'7Jo/ljol )
(degrees/minutesseconds)
Latitude/longitude source: 1:1t.,PS❑Topographic map
(check box)
DEPTH DRILLING LOG
From �Tov Fot3t}ation Description
CGAw
*Top of casing terminated at/or below land surface requires a
variance in accordance with ISA NCAC 2C .0118.
9. YIELD (gpm): I eQ METHOD OF TEST
10. WATER ZONES (depth): ,?44V 4 do21
11. DISINFECTION: Type f'/ 7/,
12. CASING:
Amount r; -5-6L'
Wall Thickness
Depth Diameter or Weight/Ft. Material
From 0 To 8-2 Ft._4 v stilt -ELL rve
From 3 To ND Ft. 4:y . !Pr rcidf
From To Ft.
13. GROUT: Depth q,�Material Method
1
From O To a!) Ft. WnCro FP Pnt kre
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.
F/ 76—a t! shr.b{
c/e1.
4
S•
LOCATION SKETCH Coil
Show direction and distance in miles from at least d
two State Roads or County Roads. Include the road 1
numbers and common road names.
ytaf. y ,-.
16. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH ISANCAC,2C, WELL
CONSTRUCTION STANDARDS, ANDTHATA COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER.
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-1 REV. 07/2001

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section ''qq
WELL CONTRACTOR (INDIVIDUAL) NAME (print) r ilN r i 416 in CERTIFICATION # et�
WELL CONTRACTOR COMPANY NAME "1'[r�”soa) inkell Zlrii(,n2 '41 PHONE @ fVZi 3-9Y/
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
311356
1. WELL USE (Check Applicable Box): Residential IV/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: Mars I-1 i I1 County Mari tsobb(
gat gal ssIp 9o9
(Street Name, N LinkCIS, Community, Subdivision, Lot No., Zip ode)
3. OWNER: O(Vj(/E 9 /
Address 46.E .�,(/yLt,/jd.l i6%72.4f I� dad.
(S rCM ur/i 2
QAOs
' Ciy or Tow State' Zi Code
(.8213 L Pt-
.Area de- Phone number '!
4. DATE DRILLED 7- 7-07
5. TOTAL DEPTH: litC 1
6. DOES WELL REPLACE EXISTING WELL'? YES 0 NO
7. STATIC WATER LEVEL Below Top of Casing: SO FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS / FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordance with 15.A NCAC 2C .0118.
9. YIELD (gpm): / METHOD QF TEST /Nivp.
0. WATER ZONES /V
1 (depth):
11. DISINFECTION: Type
12. CASING:
/A
/' 7f-/ Amount Ter 04-
Depth
From 0 To (ol Ft.
From To Ft.
From To Ft.
13. GROUT: Depth
From O To !) Ft.
Wall Thickness
Diameter or Weight/Ft. Material
b Y soft at PVC
/��� Material
thnC ro 1-e
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.
PMethodlj
o tICECJ
Slot Size Material
in.
in.
16. REMARKS:
__`` Topographic/Land setting
✓�tRidge ❑Slope OValley ❑Flat
(check appropriate box)
Latitude/longitude of well location
3C/SY/af a1- ofa aV942W
(degrees/minute seconds)
Latitude/longitude source: ❑GPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From To
0 2U
`LPL 6 44
Formation Description
CI sly
5 and! don.
Crraw,.c- 'c
Y `r
—C h
w
O
LOCATION SKETCH :3
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common road names.
yPCa .Q. 74' LL, /tie
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDAN(;EWITH I5A NCAO2C, WELL
CONSTRUCTION STANDARDS A THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO. THE WELL OWNER "'t /-biz` - 7-2-)7' CV
SIGNATURE F PERSON CONSTRUCTING THE WELL DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-1 REV. 07/2001

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural���ttResources - Division of Water Quality - Groundwater Section �--rr ��qq
WELL CONTRACTOR (INDIVIDUAL) NAME (print) rVA r i' ,4itn l'l CERTIFICATION#307.(Y4/p
WELL CONTRACTOR COMPANY NAME ire rip.., 50 a1 Uiell INrf1I:, PHONE itsl:i7 %a V3-2Yet
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
I. WELL USE (Check Applicable Box): Residential id Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other ❑ If Other, List Use
2. WELL LOCATION: :
/ /a Nearest Town: 'rs i-1 t
C'oo he Lre.e.le
County t4110.8i eon
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: 301 rn
Address .46 a A-106:14• 0w4 `{Zdd
yy�(Sneet or Route No.)
etd ,a. `f 1 Lill �� a` P161
k City or Town Statelip Code
( ))Y)- 658 - D l:i
Area code- Phone number
4. DATE DRILLED 7-a-o.
5. TOTAL DEPTH: ,305
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO I-
7. STATIC WATER LEVEL Below Top of Casing: 170 FT.
/ (Use "+" if Above Top of Casing)
8. TOP OF CASING IS L FT. Above Land Surface*
"Top of casing terminated at/or below land surface requires a
variance in accordance with I5.A NCAC 2C .0118.
9. YIELD (gpm): e METHOD OF TEST RIT
10. WATER ZONES (depth): a or
II. DISINFECTION: Type
12. CASING:
From 0
From
From
/717f/
Depth Diajrteter
To 72 Ft. 6y
To Ft.
To Ft.
Material
Ft. eonGro
13. GROUT: Depth
From 0 To 9CI
Amount /l
Wall Thickness
OZ.
or Weight/Ft. Material
jtkzl pVC-
From To Ft.
14. SCREEN: Depth Diameter
From To Ft. in.
From To Ft. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
Method
PO Lare-d
Slot Size Material
in.
in.
16. REMARKS:
Typographic/Land setting
Idge OSlope OValley ❑Flat
(check appropriate box)
Latitude/longitude of well location
L/saja o N- 08.2/ 77.7 la s d
(degrees/minutes/seconds)
Latitude/longitude source: ❑GPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From To Formation Description
0 aO C/ iy
�( 7O SR/l�Stan..
e7/ q ."t
r.J
ut
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.
ire
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH I5A NCACZC:WELL -
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
7Ce,t e 7-5
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) illlt r Jr A-iti nl CERTIFICATION #3-2, ��99(p/q
WELL CONTRACTOR COMPANY NAME Y,b$o al W GI I 1 r: I/;(q PHONE f�rr) 6o Y.3— 2Y/
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential I Municipal/Public 0 Industrial ❑ Agricultural 0
Monitoring 0 Recovery ❑ Heat Pump Water Injection 0 Other ❑ If Other, List Use
2. WELL LOCATION: I
Nearest Town: MAes1,ad County Meldi.4r1li(
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: �� qrncc G:; iil-r n
Address /`/08 Arn nonla aia,uth T oed
(Street or Route No.)
0.4 /3A n J. A/c- .3 g y, "?
ty or Town State Zip Code
feReP.1.6Y9-.7998
Area code- Phone number ill
4. DATE DRILLED J - /3 ` 6 V
5. TOTAL DEPTH: 1/265
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO C -
7. STATIC WATER LEVEL Below Top of Casing: 510 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS / FT. Above Land Surface"
*Top of casing terminated at/or below land surface requires a
variance in accord ce with ISA NCAC 2C.011a.
9. YIELD (gpm): _S� METHOD OF TEST /1
10. WATER ZONES (depth):
11. DISINFECTION: Type f' 7i/ Amount q
12. CASING:
Depth' / p Y' From 0 To / Ft.
From To Ft.
From To Ft.
13. GROUT: Depth Material Method
From_13To a!) Ft. Ccncro f-e Pour 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
at.
Wall Thickness
Diameter or Weight/Ft. Material
6 -p s0-0 I P vc
From To Ft.
From To Ft.
topographic/Land setting
edge OSlope OValley ❑Flat
(check appropriate box)
Latin e/lo itude of well to ation
�56P5[tJ /f8 30"Lt (/
source: GPS❑To o ra
(degrees/min s/secon )
Latitude/long p g phic map
(check box)
DEPTH DRILLING LOG
From To Formation Description
Latitude/longitude
W :7
q
LOCATION SKETCH Ut
Show direction and distance in miles from at least fril
two State Roads or County Roads: Include the road:
numbers and common road names',
A a,LI , NC
16. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH I5A NCAC 2C, WELL
CONSTRUCTION STANDARDS AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center- Raleigh, NC
27699-1636 Phone No. [phone], within 30 days.
GW-I REV. 07/2001

WELL CONSTRUCTION RECORD
292719
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) Neill Pardue CERTIFICATION # 2609
WELL CONTRACTOR COMPANY NAME Air Drilling Company PHONE #1704I-872-7614
STATE WELL CONSTRUCTION PERMIT/0 ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
2
WELL USE (Check Applicable Box): Residential re.; Municipal/Public ® Industrial ❑ Agricultural ❑
Monitoring 0 Recovery 0 Heat Pump Water Injection ❑ Other 0 If Other, List Use
WELL LOCATION:
Nearest Town: Mars Hill
Running Cedar
County Madison
(Street Name. Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER:
Address
Bald Mountain Development Corp.
1200 Riverplace Blvd. - Suite 902
(Street or Route No.)
Jacksonville, FL 32207
City or Town State Zip Code
( )-
Area code- Phone number
4. DATE DRILLED 01-13-04
5. TOTAL DEPTH: 1200 ft.
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO XI
7. STATIC WATER LEVEL Below Top of Casing: 500 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS 2 i FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance In accordance with 15A NCAC 2C .0118.
9. YIELD (gpm): 1 METHOD OF TEST Air
10. WATER ZONES (depth): 1189 ft.
I I. DISINFECTION: Type HTH Amount
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
From 0 To 52 Ft. 10" Steel
From To Ft.
From To Ft.
13. GROUT: Depth Material Method
Grout Poured
From 0 To 52 Ft.
From To Ft.
14. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in.
From To Ft in. in.
I . SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
16. REMARKS: 10" Drive Shoe
Ca
Topographic/Land setting
❑Ridge ❑Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From To Formation Description
0' 52' Dirt
52' 1200' Rock o
I
CD
r c_
rn
CO orn
zrn
1 vrn
T am
./>o
'IC
ern
"1
%D o
Show direction and distance in miles from at leastz
two State Roads or County Roads. Include the road
numbers and common road names.
LOCATION SKETCH
e\
r
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, .WELL
CONSTRUCTION STANDARDS, AND TH A COPY F THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
tr
SIGNATURE OF PERSON CONSTRUCTING THE WELL
1-13-Ot-1
DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center- Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-I REV. 07/2001

296088
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and N Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAM (print) OW'tatted-nip
N/e. &gLL
WELL CONTRACTOR COMPANY NAACP �/ADS D tl- j —
STATE WELL CONSTRUCTION PERMIT# /fl ASSOCPERMITS,
(if applicable) (if applicable)
CERTIFICATION #I4971
PHONE # 99-
4 D4/b'D
1. WELL USE (Check Applicable Box): Residential 6g Municipal/Public ❑ Industrial ❑ Agricultural ❑
Monitoring 0 Recovery ❑ Heat Pump Water Injection ❑ Other 0 If Other, List Use
2. WELL LOCA
Nearrst,Tp
(Street Name, Numbers,
3. OWNER
Address'' Aid
County ac eLz#c
�Fs7S3
unity, Subdivision, Lot No., Zip Code)
( or Route No.)
71/ /1/C.
City or Town State
Area code Phone number
4. DATE DRILLEDV
V
5. TOTAL DEPTH: re26.rj'
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO S
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 requires ■
variance in accordansp with 1SA NCAC 2C .0118. •
9. YIELD (gpm): r7 METHODDI FTEST I #ffi
10. WATER ZONES (depth): n% /ys
-!'
e/So'
11. DISINFECTION: Type P. . N. i/. Amount 9 °L'
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft Waist
From /t To 4 fO Ft G $e /t // (vac_
From To Ft
From To Ft
13. GROUT: Depthsterial Method ,
FroTo e.Z Ftf snip it (Altar
From— To Ft
177513'
Zip Code
14. SCREEN: Depth Diameter
Fro o Ft in.
Fro To Ft in.
15. SAND/GRAVEL PACK:
th Size
From To Ft.
From To Ft.
16. REMARKS:
Slot Size Material
in.
in.
Material
Topographic/Land setting
❑Ridge 64,Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds) ' -
Latitude/longitude source:❑GPSgTopographic map
DEPTH,
From To
DRILLING LOG
Formation Description
LOCATION SKETCH
Show direction and distance in miles from at least O
two State Roads or County Roads. Include the road rs
numbers and common road names.
4i
,3//S
(I�'P
O
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND TH4 COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
a- -S (g4 Sj.../ 0�
SIGNATURE OF PERSON CONSTRUCTING 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

6. DOES WELL REPLACE EXISTING WELL? YES-Cj NO j52
7. STATIC WATER LEVEL Below Top of Casing: th FT.
„ruse "+" if Above Top of Casing)
8. TOP OF CASING IS 1i -5 FT. Above Land Surfaces
'Top of casing terminated at/or below land surface requires a
variance in accordance th 1SA NCAC 2C .0118.
(gpm):ME OD OFTE
1
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and/lj`jJ�tural Resources - Division�rof Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL 1NNAMX L(print) ,Pi NAt / C eau._ CERTIFICATION xil77
WELL CONTRACTOR COMPANY N JC�:/�r
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
296087
atAAitiZr (t.ta4' +l*t V PHONE M 12.t s%�-AS_S7�
VVV YYY •'/ u
I. WELL USE (Check Applicable Box): Residential I Municipal/Public 0 Industrial 0 Agricultural ❑
Monitoring 0 Recovery 0 Heat Pump Water Injection ❑ Other 0 If Other, List Use
2. WELL LOCAT O)
N� Town: f///, : County
d err A Lw - Aa i 4444.44gzf)
(Street Name, Numbers, Community, f idivisioo. Lot No., Zip Code)
3. OWNER:Fa4j` " ',
Address /5�3 mti1«
,(Ssr Rome No.)
City or Town State Zip Code
Area code- Phone number
4. DATE DRILLED W..2 Sid Y
5. TOTAL DEPTH:
Topographic/Land setting
ORidge Slope OValley OFlat
(check appropriate box)
Latitude/longitude of well location
( hninnres/seconds)
Latitude/longitude source:OGPS❑Topographic map
(check box) DEPTH DRILLING LOG
From To Formation Deal -TO -on
9. YIELD (STT�Gss7P
0. WATER ZONES (depth): 3D) 'S
11. DISINFECTION: Type C /4. /I/ Amount
Wall Thiclmess
or Weight/Ft 1peifr
12. CASING:
Depth
Frorrt� To /'s Ft.
From To Ft.
From To Ft
13. GROUT: Depth Material a From Q To Ft fvn2e.Q/
From To Ft
14. SCREEN: Depth Diameter Slot Size Material
From o Ft in. in.
Fro To Ft. in. in.
15. SAND GRAVEL PACK:
th Sir Material
From To Ft.
Fro To Ft.
jac
16. REMARKS:
r
N
�J r
LOCATION SKECCI; H r
Show direction and distance in miles from at lst
two State Roads or County Roads. Inc�lu�eue�thyenad
numbers and common road names. G.
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH I5A NCAC 2C, WELL
CONSTRUCTION STANDARDS, At3DtTHAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
NSTRUCITNGTRUCTING THE WELL DATE
SIGNATURE OF PERSON
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-1 REV. 07/2001

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and
WELL CONTRACTOR (INDIVIDUAL) NAM (print)
WELL CONTRACTOR COMPANY NAME
STATE WELL CONSTRUCTION PERMIT#
(if applicable)
296081
Resources - Division of Water Quality - Groundwater Section
PERMITS/
�A ��
N/1 ASSOCIATED
(if applicable)
n List IFICATIONif,2 /J 7
itN ,-)
WQ
'U h' (7 G�9DYSO
�i'
1. WELL USE (Check Applicable Box): Residential ® Municipal/Public 0 Industrial 0 Agricultural ❑.
Monitoring 0 Recovery 0 Heat Pump Water Injection ❑ Other 0 If Other, List Use
2. WELL LOCATION:
Nearesi Town_
(Street Name, Numbers,
3. OWNER: /////7
Address 55/9.6',3'z
y
unity, Subdivision, lot No., Zip Code)
gnr. 444zLA Vie.)
City Town State Zip Code
(7K )- or Town
Area code- Phone numbery
4. DATE DRILLED iC D
5. TOTAL DEPTH: / Q C i
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO El
7. STATIC WATER LEVEL Below Top of Casing: /.'L. FT.
(use -4- if Above Top of Casing)
8. TOP OF CASING IS L 3— FT. Above Land Surface*
'Top of casing terminated at/or below land surface requires a
variance in accordancep with ISA NCAC 2C .0118.
9. YIELD (gpm): 22 MET OD OF TESTt z2
10. WATER ZONES (depth): KS t
11. DISINFECTION: Type a. H. # Amount % �% el-
12. CASING: Wall Thiclmess
Depth Diameter or
From /7 To .S,S Ft 4 , - 02/ t l 4L'
From_ To Ft
From To Ft
13. GROUT: Depth Material Method,
From_ To NI 0 Ft ��4me< I A1,Y K4-42,
From To Ft
14. SCREEN: Depth Diameter Slot Size Material
From To Ft in. in.
Fro To z.
Ft in. in.
15. SAND GRAVEL PACK:
th Site Material
From To Ft.
From To Ft.
16. REMARKS:
a 8'75_9
Topographic/Land setting
❑Ridge ❑Slope ®Valley OFlat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Tapographic map
(check box)
DEPTH DRILLING LOG
From To Formation Description
N
J
s -1
r
LOCATION SKETCH o
Show direction and distance in 'les Sn at'JAast
two State Roads or County Ro ' . Include the mad
numbers and common road u s.
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
DA
SIGNATURE OF PERSON CONS
/UUCCPING 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

294955
WELL CON 'MCC LION RECORI2
tjtp�on a(N aler U0111(» . ;.8vund\.ut t Je.!Ior
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,.. r.,i ,.,, ,_ .::. .: \ Li HCYI Ps rty. \, Y,cr in;:iUun !.2 :- - _.
TLnOg nyhic Land •etung
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037 6'�+
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sik _z$s►ct 3
s.e oX �n
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6 i?JL'S \t ELI. REPLACE EXISTING Ktl 1,- \F; -
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29"Insol
North Carolina - Department of Environment an Qerr CERTIFICATION # a`+ -`to
cK }{4 Aiti �a Q1 �
WELL CONSTRUCTION RECORD
d Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL)NAME (print)
o (
,, a'Son Nev\�`�±m >nC PHOCIE # {�_ ____(__--o$ i �2L
,v£l,I,CO�rAACTORCON:PA1tV C1AN1E CV�Q `-"�w'��'e�
STATE WELL CONSTRUCTION PERMIT#. _ ._ . ASSOCIATED NV PERMIT#
(if applicable) - (ifapplictble) ,
I. WELL USE (Check Applicable Box) Residential IS Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat I ump Water Injection 0 Other 0 If Cther, List Use
2. WELL LOCATION:
Nearest Town: Slot •Net:n ' County P Irkarheo.,
Jt inp`` Q.tgtt4 aer/.-1
(Street Name. Numbers. Community. Subliivis ,n, Lot No-. Zip Code)
3. OWNER: V.e.tna, t.,cav•-5
Address 165av liw.y acg
(Street or RoYe No.)
J Zip Code
City or Town State
(Y2i)- (22- '751a
Area code- Phone number 04
4. DATE DRILLED
H Ho5
TopogrrE{hic/Land setting
❑Ridge I3Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/secon is)
Latitude/longitude source:❑GPS❑Topographic map
(check be-t) - _
DEPTH DRILLING LOG
From To Formation Uescnp"I—.or
Thr
9X
5. TOTAL DEPT : — -
6 DOES WELL REPLACE EXISTING WELL? YES 0 NO St
7. STATIClVATERLEVEL-Below Top ofCboieO
FT.
(Use' *'� if Above Top of Casing)
8. TOP OF CASING IS t FT. Above Land Surface`
`Top of casing terminated at/or below land surface requires a
-variance in accordance2.ceMETHOL
with IS1ANCAC 2C TEST___Cat___--
S.
9. YIELD (gpm): _— Rat___--
10. WATER ZONES (depth):
t I. DISINFECTION: Type ca\S — Amount EC
Wall Thickness
12- CASING:
Depth Diamel:r or Weight/Ft.
From t \ To ai Ft.____La_4
i* 2\
From To Ft. _
From To Ft..
13. GROUT: Depth
From O To ao Ft.
From To Ft.
14. SCREEN: Depth Diameter Slot Size
From
To Ft. !o. in.
in.
From To Ft. :n.
15. SAND/GRAVEL YACN: Material
Depth Size
From To Ft. —
From To Ft.
Material
Ce-ane
Material
?i45t
Method
Material
Over esecat•
1(e5 Groan: re
LOCATIONSKETCr1
Show direction and distance in mi'.cs 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 ACCORDANC WITH I5A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THP F A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
4.4
SIGNATUI E OF PERSON CO
c t, tt a ,,: f t.. tt,o nivicinn r,f N ater Onaliti—G
RUCTING THE WELL
DATE
wat ection 1636 Mail Service Center - Ralei
h. NC

297 7n0
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources Division of Water Quality GroCERundwater
Section c ay"3fo
WELL CONTRACTOR (INDIVIDUAL) NAME (print) rAfl (ofo_4310 2
a > PHONE # �--- �
WELL CONTRACTOR COMPANY NAME (\ Q �` ASSOCIATED WQ PERMIT4 --
STATE WELL CONSTRUCTION PERMIT# _ if a licrble)
(if applicable)
I. WELL USE (Check Applicable Box). Residential ® Municipal/Public ❑ Industrial 0 Agricultural 0
Monitoring ❑ Recovery ❑ Heat rump Water Injection ❑ Other 0 If Other, List Use__�—
Topographic/Land sztung
❑Ridge @Slope ❑Valley DFlat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconis)
Latitude/Icdgitude source:❑GPS❑Topographic map.
(check b¢:)
DEP"-H QFIi kING LOG
To Formation Dese tptint
2. WELL LOCATION: County f.
Nearest Town: • -
!jro..ndv:¢ W
(Street Name. Numbers. Community. Subdivis on, Lot No.. Zip Code)
3. OWNER: find flndecgan (�u \d¢ts
Address B 21151
(Street orRouteNo.)
State Zip Code
City or Town
(24)- aosGske
Area code- Phone number
4. DATE DRILLED'_
5. TOTAL-
6. DOES WELL REPLACE EXISTING WELL? f Casing:
CI NO
7. STATIC WATER LEVEL -Below Tor }of AboveTopofCasing)
8- TOP OF CASING IS 1 FT. Above Land Surface*
*Top of easing terminated at/or below land surface requires a
variance in accordance with 15A NCAC 2C .11118.
9. YIELD (gpm): METHOD bF TESTS — _
10. WATER ZONES (depth):
\�_.__— Amount %
11. DISINFECTION: Type�r�a- Wall Thickness
12. CASING: Depth Diamet>r or Weight/Ft. Material
,
To 2\ FL�I
To
9o_
13 Depth
To 2-0
To Ft. Material
Depth Diameter Slot Size
To Ft.
i in.
�_
Ft. in.
From fi' \\
From
From
GROUT:
From 0
From
14. SCREEN:
From —
From To
15. SAND/GRAVEEL TACK' Size Material
Depth
From To Ft.
From To Ft.
tett
Ft.
Ft. —
Mat :rial Method
Ft. Ce-nisn+ —��
From
C
a\ QVZC t]�r�Cdon -
rn
LOCATION SKETCH
Show direction and distance in mi !.cs from at least
two State Roads or County Roads. Include the road
numbers and common road names.
16. REMARKS: WELL
:- WITH I5ANCAC2`C . WELL OWNER
I DO HEREBY CERTIFY THAT THISN WELL WAS OF THIS RE IN AD HAS EC:
CONSTRUCTION STANDARDS, AND THA T A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE t- y
� DATE
SIGNATUF E OF PERS CONSTRUCTING THE WELL
,NC
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Centerr1 - RRaleigh,
27699-1636 Phone No. [phone], with 30 days. GWEV. 0
C)

297538
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and mane Resources - Division of Water Quality - Groundwater Section .e
WELL CONTRACTOR (INDIVIDUAL) NAME (print) `)'-L'c tJ AS 14 CERTIFICATION all `J ` I
WELL CONTRACTOR COMPANY NAME_ REUBEN CALDWELL DRILLING, INC. Q28 .?54-3581
PHONE
STATE WELL CONSTRUCTION PERMITS ASSOCIATED WQ PERMITS
(if applicable) (if applicable)
I. WELL USE (Check Applicable Box): Residential IB" 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: AA tl U H A L..)— County MA A 131 S x !3
LJ-AA-.NUT C6t,Ge
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER:
U Lb t...)\.5
Address CO Art' s%)L ()(ty.[T
(Street or Route No.)
ASt-k6'/t I� rJC-
2flo5
ity or (sai). Wn�Jg-sal 3¢ Zip Code
Area coda Phone number
4. DATE DRILLED
b/ID/a4
5. TOTAL DEPTH: 4-5666
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO
7. STATIC WATER LEVEL Below Top of Casing: 4S 0 FT.
(Use "t" if Above Top of Cuing)
8. TOP OF CASING IS �- FT. Above Land Surface'
'Top of cuing terminated at/or below had surface requires a
variance In accordance with ISA NCAC 2C .01111.
9. YIELD (gpm): a -a METHOD 9F TEST i-I G - f1 i(L
10. WATER ZONES (depth): •t- t © - a O G Pre%
Topographic/Land setting
❑Ridge ❑Slope OValley SDlat
(check appopriue box)
Latitude/longitude of well location
(degsc&minuteshaonds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DRILLING LOG
Formation Description
6J{32(S oft -Dee.)
C92AN l 1 G
DEPTH
From,' a3 •
al`- 4(O'
4io
410 - 4-So'
11. DISINFECTION: Type
12. CASING:
Depth
From a. To a6 Ft.
From To Ft.
From To FL
13. GROUT: Depth
From 1" To Ft.
From To
14. SCREEN: Depth
From To
From To
15. SAND/GRAVEL PACK:
Depth
From To
From To
Cted cc- 9-0 Ger,
CL
ry
LOCATION SKETCH
°Amount O Show direction and distance ' miles fron)"jt least =
Wall'Ihickness two State Roads or County Rads. Includeelhe read.,,-
Dater or W t/Ft,,Material numbers and common road es. w r
b'l4" .to' •c7T�E31— o
Moa5-
CMen'u3r')T (o'- -e
fD
Ft.
Diameter
Ft. in
Ft. in.
Size
Ft.
Ft.
Slot Size Material
in.
in. (�
Material (Y
aS
/O
(N A I,t3oT
16. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH ISA NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THA COPY CrIEEN PROVIDED TO Tf{EWE� O9E
aD
SIGNATURE OF PERSON CONSTRUCTING THE WELL BATE
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. 07/206i

uFiL,C:ON S'fRUCI
IFEr_•oxu 297634
J , m of V. it Uddllty •arc undo Eel Senor Q--
\\111.1I'\fall ION llSYl\IY\♦1,\\>IL 'print) 11� ��'.........777
Hilt ,1\,A\l 1f,k(IIAIPINN \\Nl. � l‘sise,YCR NiI• __ .. ._ ...
1 \% OI.1%.)11 N�
.I, \.I v111 (,1\nIN1111(t>Yh.N\II In ., ,J. 4:11))4l
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ItAKII'e^ \•^IIJI

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Na
WELL CONTRACTOR (INDIVIDUAL) NAMF1print)
WELL CONTRACTOR COMPANY NAME
STATE WELL CONSTRUCTION PERMrrft .47 Q
(if applicable)
(if applicable)
298861
Resources - Division of Water Quality - Groundwater Section
CERTIFICATION 11-9 77
PHONE a if
.%�C f/9 O U
ASSOCIATED W PERMIT# 4//Ey
1. WELL USE (Check Applicable Box): Residential sirMunicipal/Public ❑ Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION:
Nearest Town:
county7iin
%,9
(Street Name, Numbers, Community, Subdivision, Lot No., rip Code)
3. OWNER: / / �C
Address earl C/ t.-Cp
71d� No.)
76?. ,z''7673
Stale Zip Code
City or Town
Mn code- Phone number
4. DATE DRILLED e-2,N7/) y
5. TOTAL DEPTH: sP C
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO
7. STATIC WATER LEVEL Below Top of Casing: XI ® FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS A —5- FT. Above Land Surface'
'Top of casing terminated at/or below land surface requires a
variance In accordance with ISA NCAC IC .0118.
9. YIELD (gpm): //7 METIJO OF TF$T ' lD
10. WATER ZONES (depth): / `�
11. DISINFECTION: Type e- / Amount
12. CASING: Wall Thickness
tr) To o e y r or W�eighUFt
From A1agetiat
ea- FL
From To Ft
From To Ft
13. GROUT:Depth
From�L To 1 Ft ! Dc�
From To Ft
14. SCREEN: Depth Diameter Slot Size Material
FroFt in. in.
From / To Ft in. in.
15. SAND/GRAVEL PACK:
Depth
From /To Ft.
From To Ft.
16. REMARKS:
Size Material
Topo�pPhic/Land setting
❑Ridge OValley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From To Formation Description
Show direction
two State Roads
numbers and co
sE
a rn�
rn
ma
IV -t
distance in miles from at least
r County Roads. Include the road
n road names.
1--/-
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUl,1h1) IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, ANT) THAT A COPY OF THIS RECORD HAS PROVIDED TO THE WELL OWNER
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-I REV. 07/2001
® .

298856
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and N� Resources - Division of Water Quality - Groundwater Section 7
WELL CONTRACTOR (INDIVIDUAL) NAM (print)g�I.QQ/ / e BEM- L CERTIFICATION / � / 7
WELL CONTRACTOR COMPANY NAME A%/Lr �I fA I (-PZ PRONE r{-6/�7 9 Ogre)
STATE WELL CONSTRUCTION PERMIT/I N /f _ASSOCIATED WQ PERMIT7/ p /i/// H"
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential 10 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 wit: 77,�% lCounty,ru
C ,177.S3
(Street Name, Numbers, Canmunity, Subdivisiy), Lot No., Zij Code)
3. OWNER: // J
Address D f> / cn e Ad
ec
///l (�LLG/ /V , o) oC O 7573
City or Town State Zip Code
Area code- Phone number
4. DATE DRILLED .4 /
5. TOTAL DEPTH: —IA 5`
6. DOES WELL REPLACE EXISTING WFIJ ? YES 0 NO i&
7. STATIC WATER LEVEL Below Top of Casing: 1j FT.
(Use "+' if Above Top of Casing)
8. TOP OF CASING IS ,C _ FT. Above Land Surfaces
"Top of casing terminated at/or below land surface requires a
variance in accordance with 1SA NCAC 2C .6118. •
9. YIELD (gpm): /77 METHOD OF_WI
10. WATER ZONES (depth): ,.,.2 2
Topographic/Land setting
❑Ridge Q9slope OValley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPT$ pRB.LING LOG -
From To Formation Description
11. DISINFECTION: Type l � f% /i
12. CASING:
Depth From T% ToY6
From To
From To
13. GROUT: Depth
From D To D Ft
From To Ft
14. SCREEN: Depth Diameter
From o Ft in.
From To Ft. in.
15. SAND RAVEL PACK:
Ft.
Ft
Ft
meter
Amount n 4L__
Wall Thirknecs
or Weight/Ft
Slot Size Material
in.
in.
Size Material
From o Ft.
T
From To Ft.
16. REMARKS:
LOCATION SKETCH - 'rrn
Show direction and distance in miles rr Mast
two State Roads or County Roads. • ' de & road
numbers and common road names.
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH I5A NCAC 2C WELL
CONSTRUCTION STANDARDS, AND jHr),T A COPY OF THIS RE ORD HAS BEEN PROVIDED TO THE WET T OWNER
1/4s
SIb1iATURE OF PERSON CONSTRUCTING THE WELL DATE
0
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-1 REV. 07/2001

298283
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and � Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAM�7(print)U(l/f/f//C 8AL 2, CERTIFICATION
4-1/.4"," t 7
WELL CONTRACTOR COMPANY NAME-/Gleteri) / L/ 2O/d' k ltheit� PHONE # �1 /4/7-09ea
STATE WELL CONSTRUCTION PERMIT# 1U /1 ASSOCIATED WQ PERMIT# , gr
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential. Municipal/Public 0 Industrial ❑ Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATIO
Nearest Town:
County.
/7(»- .2 l'7 5
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Codc)
r i
3. OWNER:
J
Address -
777a2;1
S�qy� Route No.)
C'.
City or Town State Zip Code
Area code- Phone number /—
4. DATE DRILLED '
5. TOTAL DEPTH: fr.)_S`
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO
7. STATIC WATER. LEVEL Below Top of Casing: /_'S FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS / C FT. Above Land Surface'
'Top of casing terminated at/or below laud surface requires a
variance in accordance with 15A NCAC 2C .011S.
9. YIELD (gpm): _ 3 G METHOD OF TEST%Gri7O
10. WATER ZONES (depth): / 5.1, ' / lc l
11. DISINFECTION: Type .44 /l. Amount
12. CASING: Wall Thickness
Depth or Weight/Ft. Material
From_ To Ft -. / jn/J
From To Ft
From To Ft
13. GROUT: Depth Material ,� // Method ,
From�_To ,.-2C),.-2C)Ft /Oa7/ZseS'Lei_0f iA
From To Ft
14. SCREEN: Depth Diameter Slot Size Material
Fro To Ft. in. in.
From To Ft in. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From / To Ft.
From / To Ft.
16. REMARKS:
CO 7
Show direction and distance in miles from I leas = -
two State Roads or . unty Roads. Includertik • ad
numbers and co„ „on road names.
Topographic/Land setting
%Ridge ❑Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box) _
DEPTH DRILLING LOG
From To Formation Description
0
t.1
rn
LOCATION SKETCH _
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUL IEu IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, T A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE OWNER
2 I 'i i0 1 / /n 5/
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center -Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-1 REV. 07/2001

29 Sfl
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and N/a� ral Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAMh(print)p(�l.1 Y At*/r" 8,1 L L �I CERTIFICATION #, 9 g77
WELL CONTRACTOR COMPANY NAME .CN,I4 ov.7i/AA-4.L /.l .J JP 4/Mi(y- PHONE 0
STATE WELL CONSTRUCTION PERMIT# /1f ASSOCIATED WQ PERMITS 1///¢
(if applicable) (if applicable)
I. WELL USE (Check Applicable Box): Residential fa Municipal/Public 0 Industrial 0 Agricultural ❑
Monitoring ❑ Recovery 0 Heat Pump Water Injection ❑ Other ❑ If Other, List Use
wn:�
(Street Name, Numbers, Common
City or Town State
(
Area code- Phone number
4. DATE DRILLED //% / /) 7
5. TOTAL DEPTH: .2 C
6. DOES WELL REPLACE EXISTING WELL? YES '04 NO 07. STATIC WATER LEVEL Below Top of Casing: 90 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 accordan with 1SA NCAC 2C .0118. 9. YIELD (gpm): METIJOD O3 TEST
10. WATER ZONES (depth): / C 5i F� l
11. DISINFECTION: Type 71g /i. /i Amount V
12. CASING: Wall Thickness
Depth or Weight/Ft.
From To r/J Ft -ift44
From To
County______
t . 1-P'7S"�
ubdivision, Lot No., Zip Code)
Ft.
From To Ft
13. GROUT:,/Depth
From C To . 7 /% Ft.
From To Ft.
Zip Code
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 >$ISlope OValley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(d ds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DRILLING LOG
Formation Description
DEPTH
From To
Show direction and
two State Roads o
numbers and co
ce in miles from at least
County Roads. Include the ma
on road names.
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH I5A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE OWNER
ter-? 2 &
SIGNATURE OF PERSON CONSTRU G THE WELL DA
C
Col
Submit the original to the Division 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. OWNER:
Address
298300
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and watural Resources - Division of Water Quality - Groundwater Section WELL CONTRACrORONDIVIDUAL)NAME (prta) 6i L;LI ( Nt4 S T( CERTIFICATIONS a-1—1 1
wELLCONTRACTORCOMPANYNAME_RF.UBEN CALDWELL DRILLING, INC. rHONE48 )54-3581
STATE WELL CONSTRUCTION PERMITS ASSOCIATED WQ PERMITS
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential W 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: MA(2-S HILL County i1'\ 1h ti S eN
ZL( —cRe� ir�n-1:)
(Street Name, Numbers, Community. Subdivision, Lot No, Zip Code)
D,"Vt 'La,tIS
� _ o - U �x a o'
l A�� , (Street or Rout No,J� 1 S A
IN j L L (�) `Y-
C ity or Tow�t 6 State ` Zip Code
�0 5�
(8Q)
Area code- Phone number / /
� 4. DATE DRILLED ' a
5. TOTAL DEPTH: l 1 0 -
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO
7. STATIC WATER LEVEL Below Top of Casing: *0 FT.
(Use "4" if Above Top of Casing)
8. TOP OF CASING IS 1 FT. Above Land Surface'
•Top of cuing terminated atror below lead surface requlru a
variance In accordance with ISA NCAC 2C.0111.
R b — A I IN
9. YIELD (gpm): a-0 METHOD OF TEST
10. WATER ZONES (depth): \ \0 �` �o ('�/Ph /
11. DISINFECTION: Type I" I )l '4O/c•Amount Y3. I iD -
12. CASING: Wall Thickness
A Depth .DC) �bFLaj t. Material
From To
From To
From To
13. GROUT:, Depth Material , Method
From 1 To ,A. -0 Ft. CEMtEsNc SD`d. €Dr.
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
Ft. 1
Ft.
Ft.
16. REMARKS:
Topographic/Land setting /
❑Ridge ❑Slope ❑Valley '2Flat
(check appeoprima box)
Latitude/longitude of well location
(deaeealmimncehecenda)
Latitude/longitude source:❑GPS❑Topographic map
(chock box)
DEPTH DRILLING f.00
Fro To / ForrntLo estscjiptiont3
0,5'— IIb'
\e'
1'
(; pAN, ye:AA-Arm
rho pM
(., 2A 1- -rF,
C ▪ c'-,
N `=
di
LOCATION SKETCH -----'
Show direction and distance in miles from at l st n
two State Roads or County Roads. Include theaad ram„';
numbers and common road names. w
O
Cs z
111
a13
�3 .,e4
c Necaiy‘P
(,35
.a,
. ek.T(L$
e,A51tr
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH ISA NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT {COL Pl(�OF THIS`jiECORD HAS BEEN PROVIDED TO T( t NER
SIGNATURE OF PERSON CONSTRUCTING THE WELL, / DA
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center- Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-1 REV. 07/2001

297911
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and manual Resources -Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAM C (prior) 6 l 1-.�-� �. -hi on S N CERTIFICATION a awl 1 1
WELL CONTRACTOR COMPANY NAME _I EUBEN CALDWELL DRILLING, INC. PHONEYi8 )54-3581
STATE WELL CONSTRUCTION PERMITS ASSOCIATED WQ PERMITS
(if applicable)
(if applicable)
I. WELL USE (Check Applicable Box): Residential IE MunicipaVPublic ❑ Industrial ❑ Agricultural
Monitoring 0 Recovery ❑ Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION:
Nearest Town: Mw(cSCounty AAAb So
t3EAR cREeKt, RoAc.
Name, Numbers, Community. Su 'vision, (Street ty, on, Lot No., Zip Code)
3. OWNER: C- lK . nil /EA
Address .6'S 5c.g4 rJt571"
.2)-4 trig (Svxtp{Rows Na.) U
City or Town Suit Zip Code
(954)_ 9a3- 3a1 $
Area code- Phone number 4. DATE DRILLED a/5 / O 4
5. TOTAL DEPTH: 1 O \ 0
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO E)
7. STATIC WATER LEVEL Below Top of Casing: I & o FT.
(Ma "+" If Above Top of Cuing)
8. TOP OF CASING IS 3.- FT. Above Land Surface*
Top of cuing terminated atfor below lead surface requires ■
variance In semrdanea wit► ISA NCAC 2C.01t1.
9. YIELD (gpm): Va METHOD OF TEST 2 tG - A 1 R
10. WATER ZONES (depth): 16 o - 1/3. G P n--
11. DISINFECTION: Type
12. CASING:
ru
c
Depth ;)iaquler
From a- To `1 D Ft.
From To Ft.
From To Ft.
13. GRmUT.7• TTo Depth
•��� T ,eo P
-7-0 Ft. I
From To Ft.
14. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in.
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
Amount 1
Wall Thickness
or Weight/Fl. Material
sbRat Q.(
16. REMARKS:
Topographic/Land setting
❑Ridge ❑Slope OValley I9FIat
(clock appropriate boa)
Latitude/longitude of well location
(depeuhnlmneafacoods)
Latitude/longitude source:❑GPS❑Topographic map
(clack box)
DEPTH DRILLINGI.Oti
Prim, _ To / Fom'ation Description
65 ovEK3v2cEr1
,5'- 1bo '
GRA/ 1 GR/+Nt
Va GP inn
C-,Ray' C-z PI I -I E
r- o
r
51.
.1
min
�-a
CO m
-T1
LOCATION SKETCH s m
Show direction and distance in miles froni)t teal
two State Roads or County Roads. Includesthe roil
numbers and common road names. (n a
z
Le icv6-ry2 rlw,i
0
a.s
S Tn,R LI F C
torah S
CRtceK-
3n-
E fAuoe(L
a-8A 0
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT OPY OF THIS CORD HAS BEEN PROVIDED TO THE WELL O R
7\ ,a71 6 0 4-
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mall Service Center -Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-1 REV. 07/2001

so El t-JZ a1
Name, Numbers,
C unity,
OWNER: 'V A ra F(L-rl r tQ l o3
4-5D NW`/9Ia P' (LSLeiAL.L
TA A R S FIA (Street or R NC - `a� c l `S3
299208
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and M.hval esources - Diivision of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) ) List (.1 A . i4 CERTIrFiICATION/ all
WELL CONTRACTOR COMPANY NAME_RF.UBEN CALDWELL DRILLING, INC. PHONEY?(B )54-3581
STATE WELL CONSTRUCTION PERMITS ASSOCIATED WQ PERMIT/
(ifapplicable) (if applicable) —/
I. WELL USE (Check Applicable Box): Residential 0 MunicipalPublic 0 Industrial 0 Agricultural lS"
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION:
Nearest Town: M ARS K A LL
County ►'j\015orA
Subdivision,
(Street Lot No, lip Code)
Address
City or Town State Zip Code
(%MSS- bsb- as3q
Area coda- Phone number
4. DATE DRILLED 6 — t % — O
5. TOTAL DEPTH: 330 '
6. DOES WELL REPLACE EXISTING WELL/ YES 0 NO
7. STATIC WATER LEVEL Below Top of Casing: (o a FT.
Wu `a' if Above Top or Casing)
8. TOP OF CASING IS A FT. Above Land Surface
'Top or cuing lermlaa led at/or below Ind scrim requires •
variance In accordance with ISA NCAC IC .011a.
9. YIELD (gpm): 3t7 METHOD^OF TEST RAG - A t,
10. WATER ZONES (depth): & € b ' — —Se C7 (� M
11. DISINFECTION: Type fJ t K `toe/ Amount Vo— ( b
12. CASING:
Depth
From , To —1 5
From To
From To
13. GROUT: Depth
From To a D Ft.
From To
14. SCREEN: Depth
From To
From To
15. SAND/GRAVEL PACK:
Depth
From To
From To
Wall Thicknessor Weight/Ft. Y a11 �e
ler
Ft. SOP -a
1
Ft.
FL
Material
Ft.
Diameter
Ft. in.
Ft. in.
Method
et 0(2410
Slot Sire Material
in
in.
Size Material
Ft.
Ft.
pographic/Land setting
�kldge ❑Slope ❑Valley ❑Flat
(check appopriete box)
Latitude/longitude of well location
(depecahnlat,tce/secaods)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH DRILLING LOQ
Frqm ( ToI O
ascot
fgo 330'
FormationDescription
;LA iT
CAtdtce - 3t GPo'
LOCATION SKETCH VI
Show direction and distance in miles from atieast:: '.
two State Roads or County Roads. Include th .road'
numbers and common road names. .,,
}ik) al'J F
c;1
3
us (9-a3
16. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH ISA NCAC 2C,
CONSTRUCTION STANDARDS, AND TH T A COPY OF ml RRECORD HAS BEEN PROVIDED TO WE
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

299247
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and *hand Resources ^ -Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (pr(print).' e> 1 LL 1 d /) iA $ u CERTIFICATION a al 1 I
WELL CONTRACTOR COMPANY NAate_REU➢EN CALDWELL DRILLING, INC. PHONEQ%8 254-3581
STATE WELL CONSTRUCTION PERMITS ASSOCIATED WQ PERMITS
(if applicable) (if applicable)
I. WELL USE (Check Applicable Box): Residential 6/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: P\ t12Si4A LL County rn 41 Q I S 0 (J
&urJ'rileft LOWN (loAp
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: Garr-)i(Si2—
Address `„t4 o C,t4 A P t✓ 1- N (LL an AD
(Sines ar Rows No.)
MWr�sNA)_� NC_ as'753
(,
try or Town Stare Zip Code
(gad_ SG —sat$
� _ 0
S. TOTAL DEPTH: 'Y 3 D
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO 63/
7. STATIC WATER LEVEL Below Top of Cuing: Sl 0 FT.
(Us. `+' i( Above Top of Caring)
8. TOP OF CASING IS - FT. Above Land Surface
*Top of cuing lermloated at/orMow bw lead earfau requires a
variance to accerdeacy wlrh ISA NCAC IC .0111.
9. YIELD (gpm): a- METHODF TEST
CO)Ti
10. WATER ZONES (depth): t I
Area code- Phone number
4. DATE DRILLED
I I. DISINFECTION: Type
12. CASING:
,( Depth
From .S To 1.0
From - To
�LLCD- AtR-
Amount
Meter Wall Thickness Material(i
Ft. 47'/gSD12- 1Weight/Ft. t
Ft.
From To Ft.
13. GROUT/ Depth
From___-_tn To oa 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.
Mal
, Method
re ,
Slot Size Material
in.
in.
Material
Topographic/Land setting
❑Ridge ❑Slope ❑Valley 6Flat
(check appropriate box)
Latitude/longitude of well location
(depadmtmneshecmds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPpi DRILLING LOG
Fr.m To . Fo tion J f� uittQe3 13
�L. a C y (244 6
1 O' ' f V ICAr i;2Pt"�
►540'-43o c z' -ate
LOCATION SKETCI{ --
Show direction and distance in miles=trnm at least
two State Roads or County Roads. In8rde the mad
numbers and commop m�g9d� es. 0_,hIW7
`jar 9491b
)A M
Atr'
16. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH ISA NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COP E. it RECORIS((AS 6FEN PROVIDED TO THE WELL OWNE
\1ov�11e1�\ 6 ai- o
SIGNATURE OF PERSON CONSTRUCTING THE WELL
DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center -Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-I REV. 07/2001

300047
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and NMlral Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAM6(print)
WELL CONTRACTOR COMPANY NAME 21?/.
STATE WELL CONSTRUCTION PERMTTN N. 0.
(if applicable)
l
ASSOCIAfla WQ YERMITit
(if applicable)
CERTIFICATION pert 571 -_ - -
PHONE n --
g2fiht �9-'o
c
2. WELL LOCATION:
Nearest Town:
1. WELL USE (Check Applicable Box): Residential le Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
v
Topographic/Land setting ra
ORidge %Slope ❑Valley ❑Flat 2
(check appropriate box)
Latitude/longitude of well location
ComililnaeSet-
g
(Street Name, Nupthers, Community, Subdivision, Lot Na., Zip Code)
City Town State
$442g
Area code- Phone number
4. DATE DRILLED 4719/6 r/
5. TOTAL DEPTH: 3 y S
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO 2
7. STATIC WATER LEVEL Below Top of Casing: �.Z t FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS / _S FT. Above Land Surface*
`Top of casing terminated at/or below land surface requires a
variance in accordance with 15A NCAC 2C .0118.
9. YIELD (gpm):. S METHOD OF TESL nr.
10. WATER ZONES (depth): ,"90 / o25S t
3. OWNER: �i itid i�'/ U'1 tee./
Address r7/.�✓ ��/
(S Route No.)
a-1 /I/_ e. .287.s3
Zip Code
11. DISINFECTION: Type e-n.
12. CASING:Depth at,
ter
From7 To veil 0
From To Ft
From To Ft.
13. GROUT: Depths/ qM
From [/ To 0( 0Ft pare-i e. Lilitvirdp,
From To Ft.
14. SCREEN: Depth Diameter Slot Size Material
From To Ft in. in.
From To Ft. in. in.
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box) C
DEPTH. EIRILLW, LOG
From To Formation Descrion
Pa ...-m
CON
4.14 r„
2 -o mD
cep to �o
O ^r
w
Amount " Show direction and distance
Wall Thickness two State Roads or County Ro
or Weigh t WI numbers and common road
15. SAND/GRAVEL PACK
Depth
From To
From To
16. REMARKS:
Size Material
Ft.
Ft.
14 4 et
miles from at least
. Include the road
1.0
I DO HEREBY CERTIFY THAT THIS WFf f WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WFI I
CONSTRUCTION STANDARDS, AND THA .A -COPY OF THIS RECORD BEEN PROVIDED TO THE WELL OWNER
DATE
SIGNATURE OF PERSONWNSTRUCT1NGWELL
,O tc)
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-1 REV. 07/2001

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Na
WELL CONTRACTOR (INDIVIDUAL) NAM (print)
300046
Resources - Division of Water Quality - Groundwater Section
[� _CERTIFICATION Ili S
WELL CONTRACTOR COMPANY NONE sit 1164/9-a (D
STATE WELL CONSTRUCTION PERMIT# /i� ASSOCIATED WQ PERMIT# I YY
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential N Municipal/Public ❑ Industrial ❑ Agricultural ❑
Monitoring ❑ Recovery 0 Heat Pump Water Injection ❑ Other 0 If Other, List Use a
2. WELL LOCA:
Nearest Town:: mCounty.01-
2%%GLyl) }/ _2 87 S-S
(Street Name, Numbers, Community,un�¢�Subdivision, Lot No., Zip Code)
3. OWNER:thy_enti,"
A-u,4Y .
Address o e - to
(Street or Route No.
732rkk/t'y #t20 7/
City or Taub State Zip Code
Areacode- Phone number S 9 / t) /
4. DATE DRILLED U�
5. TOTAL DEPTH: A C
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO JX
7. STATIC WATER LEVEL Below Top of Casing: 17/3 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS / _S FT. Above Land Surface`
'Top of casing terminated at/or below land surface requires a
variance In accordance with 15A NCAC 2C .0118. •
9. YIELD (gpm): J METHOD OF TEST-22*I
10. WATER ZONES (depth): /.% /
11. DISINFECTION: Type (', /1 H
12. CASING:
From To From.? To Depth,/0 Ft /o il(
Ft
Ft
From To
13. GROUT: Depth
From_0_ To 020 Ft
From To Ft
14. SCREEN: Depth Diameter Slot Size Material
From To Ft in. in.
From To Ft. in. in.
15. S /GRAVEL PACK:
Amount /H Oz'
Wall Thickness
or Weight/Ft Material
#t-27
i
ivfaterial
Size Material
From o Ft.
From To Ft.
16. REMARKS:
Topographic/Land setting v
ItaRidge OSlope ❑Valley ❑lat
(checkappropriaieb6X) o
Latitude/longitude of Well location
(degrees/minutes/
Latitude/longitude source:❑GfS❑Topographic map
DEPTH
From To
DRILLING LOG
Formation Description
LOCATION SKETCH
Show direction and distance in miles from at lggst
two State Roads or County Roads. Inclut the dad
numbers and co r r ... r names.Ora
F _
0irr
o�
tT nrn
o
Fi
n
rn c,
tnz
ma
—D
W
O
GO
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUE ll;D IN ACCORDANCE WITH 15A NCAC 2C, WFI I
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
s%s/o r
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-1 REV. 07/2001

301830
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Cirotrndwaeer sec ne.•. S
WELL CONTRACTOR (INDIVIDUAL) NAME (print)
(prin.t) -RQfl-.%1,./�"?� ! f1 A �►7/1 CEETDRCAAT�IO�N * 2 (t 7o2,
WELL CONTRACTOR COMPANY NAME t )(J to _W.[3_I ci__jdG.{,�1-LA ._y..L-/JC.. PHONE 6 p�+_L<&t%A U
STATE WELL CONSTRUCTION PERMIT*
(if applicable)
eripa
ASSOCIATED WQ PERMIT*
(if applicable)
1. WELL USE (check Applicable Box): Residential 2( Municipal/Public 0 Industrial ❑ Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WFI I LOCATION: rt /
Nearest Town: m%iia5 Ag6I vet County jaijw,v
(Street Name, Numbers, Csnmaniry, SubdiviAn4 Lac No., Tip Code)
3. OWNER: S!► �i�I{20lN J P/a
Address _Ci27 /tr�wi.i I.ae+►t
4. DATE DRILLED _
5. TOTAL DEPTH: ZO ti a
6. DOES WELL REPLACE EXISTING WFI I ? YES 0 NO
7. STATIC WATER LEVEL Below Top of Casing: Z 0 FT.
a Nu "+^ if Above TT of Casing):.
S. TOP OF CASING IS 0 FT. Above Land Surface'
"Top of easing tennis: fed area below food satiate winces a
variance le accordance with ISA NCAC 2C .0118.
9. YIELD (gpm): so METHOD OF TEST / / %lt d_
10. WATER ZONES (depth):
11 DISINFECTION: Type_e a Amount.,. /) Q W.
12. CASING: D Wall Thidmess
ncia__ D a �r t-Weight/Ft MaterialOZ.
Depth
FroTo Z Ft �( U G
From To Ft _ -
From_ To Ft
13. GROUT: Depth Material
From____ To 2_0 Ft Li GA totem c,
From To Ft
14. SCREEN: Depth Dimneter
Front_ To Ft in.
From , To Ft. in.
15. SAND/GRAVEL PACK.
Depth Size Material
I
�/Sweet "Al
r l No.)
intier Z$7t 3
City or TOW State Zip Code
(— 4
Mee code- Pbme alum
a ZD-ay
From To _ Ft.
From To Ft.
Tapo�Phic/Land setting
LURidge CSSlope ❑Valley OFiat
(clock appropriate box l
Latitude/longitude of well location
(aeE+a✓mimitesiwmai)' ;
latitude/longitude source:❑GPS❑topograpltic map
(check bos�s—
DEPTH PR1LLING T (Xi
From To Fe lion Description
Mt..tn
cot f *4
Slot Size Material
is
in.
16. REMARKS. WW1"--5/RV/_lL[/_ig__A!'a
xel
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.
4
i DO HEREBY CERTIFY THAT THIS WELL WAS CONS 1 R 'C 1 h1) IN ACCORDANCE WITH I5A NCAC 2C. WFI
CONSTRUCTION fl' NDARDS, J3ID THAT COPY (� HiS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
Q-zd-may
SIGNATURE OF PE
N CONSTRUCTING THE
DATF
Submit the original to the Division of Water Quality, Groundwater Section, Id 36 Kali Service Center - Raleigh, 1Nc.
27699-1636 Those No. [phone], within 30 days. OW- i REV. 07/2Ot:

301829
WELL CONSTRUCTION RECOR.i:
}drat Carolina - Depachent of ,nviromrleitt and Natural Resources - 9i tsmofrr of Water Quality t ^ cuneiwu-c o�rzp-- �+ �/
"ELL CONTRACTOR (INDWIDt3AL) NAME (privii. /�e�f}�-.__ C )1RQCrf leg_ . T/�.__ CERTIFICATION rr A.7 3
WELL CONTRACTOR COMPANY N=AML S&c*XwA 1 er :NC -(.Lam' /l:A' . PHONE # ft",.1CJ _l..DIJ
STATE WELL CONSTRUCTION PERMFTD
14 .ASSOCIATED WO PERMLI ..-.__. _ ._..
of gpiicable) !lf applicable!
WELL. USE. (Check Applicable tB..oxl_ Residential Iffi 'Jlunicipai x'uI ti C 0 Industrial ❑ Agricuin:xai L
Monitoring 0 Recovery [J Heat Pump Water Injection C_i Other 0 if Other, List 'Use__
'WELL L.t in fi ./
N CY"t rest ownnl,/�/ _ Count
S^acc Name, Nmrrbcn. Conunmtir. Sundineoc, Lot No. lip Coco',
pMdisoou
OWNER:. ry(C/e_— Why
rk dire,:. &y _,B4rl -
{$trcet at No"}
yNtit,/1.!/J/ l4i G 28
City or Town S Lw Code
qrm code- Phone rflunta
• L&TEE DIt2I.c EL --�_,/ 00
---q
' TOTAL DEPTHz,Y,4..
t. DOES WELL L REPLACE e ,.IS T ING WELL? YE�DNr .
- ▪ s r tic W M! LE' EL eiow lop of Casing."`-i.
„ t;isr y" of Above Top of Casing;
Ott Of CASING t3 �.� P`I. Above Land Surface.
-lop ap of casing rermtatted etier babes ILA swine requires I
.-srfaocc In irecordarith 15A NCAC 2C MTh. //
9 YIELD (gpm}: METHOD OF TEST_ /_M"
_ Y,C�_.....
v WATER ZONES (depth!. i-ys 3ola
- . DISINFECTION: Type CAmotmt Jan
Wall. Thickness
Diameter or Weipktit_ Maleri&
brood
rum__
DR 01;2 Depth
a
4 SCREEN-- Depth
C"
SAL +Is -'GRAVE,_ PACK.
Depth
riolf
IOU)
iEREH7 CERTI
CONSTRUCTION ST
Slot Size ivtatrrct
IT)
Ntalorw-
TopogrhehiciLand setu4
DRidge pe OVafley CEla
febcot appropriate Pox
Latitude longitude of well location
r«g,eesrminnteA, adr;
Lautud&'longitude source:DGPSTI opograpttu „rat
(check tor
trfit 'i_ ri`
Formation I -reset -woo(
QFP1'H
From Tr,
A CO
Si%p _ F� F?c,
i 44,At 8
el F
LOCATION SKETCH
direction and distance in miles from a: teas:
two State Roads or County Roads. Include the mad
numbers and c6D1 xmt cfname:..
lt
I THIS WELL WAS CONSTRU TE.D TN ACCORDANCE WITH I5A NC:AC 2C. WE .
ADS, AND Ti-LA C PY OF rtjS RECORD SAS BEEN PROVIDED TO THE WELL OWINF
SIONA LURE OF PERSON CON`
T! C THE WE_
9
!;ATE
N ut:rnit the nrigira1 to the Division of W-Ater Quality. Groundwater Section)
Xlleftlitxte, Ptioxic Vr.:.41"!' i_3G2.1.. within 30 n:4%:.
i .t, Nia11 'errs

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment
WELL CONTRACTOR (INDIVIDUAL) NAMFs (print)
WELL CONTRACTOR COMPANY NAME. -1-1 l.// t N
/Y/?
STATE WELL CONSTRUCTION PERMIT#
(if applicable)
301821
and Resources - Division rof Water Quality - Groundwater Section
�7/�
)�f � gHAL CERTIFICATION th+�b 7
J.,tYr u1 e-69etc ' e-e rnoNE # fialga rf--o YI
ASSOCIATED WQ PERMIT# N//9
(if!tplicable)
1. WELL USE (Check Applicable Box): Residential ) Mtnucipal/Public 0 Industrial 0 Agricultural ❑
Monitoring 0 Recovery ® Heat Pump Water jection ❑ Other 0 If Other, List Use
o
2. WELL LOCATION: ` aunty/%Lu�GIt�
Nearest ,
a17,-3
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: /.%S
Address 7SZ C.J
(Street a. Route No.)
City or Town State
Mncode- 7 ` 7
4. DATE DRILLED
7 D 0
5. TOTAL DEPTH: le -T
6. DOES WELL REPLACE EXISTING WELL" YES 0 NO R
7. STATIC WATER LEVEL Below Top of Casing: eZ 4 FT.
(Use No' if Above Top of Casing)
8. TOP OF CASING IS 2-3 FT. Above Land Surface*
'Top of casing terminated at/or below land surface requires a
variance In accordance with ISA NCAC 2C .0118. •
9. YIELD (gpm): 317 METHOD (1%�L F STis-r1
10. WATER ZONES (depth): fee 'S "U t
Zip Code
11. DISINFECTION: Type /
12. CASING:
Depth
From & T'VD Ft.
From To Ft
From To Ft
13. GROUT: Depth
From_? To Idea Ft
From To Ft
14. SCREEN: Depth Diameter
From_ -To Ft in.
g. /I. Amount r % CL
�r Wall Thickness
Di or *e%UFt Material
Fro To Ft. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From /`fo Ft.
From / To Ft.
Slot Size Material
in.
in.
16. REMARKS:
Topographic/Land setting
AQRidge ❑Slope OValley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/tninutasiseconds) ..
Latitude/longitude source:❑GPS❑Topographic map
(check box) L.-.._..: _._.
DEPTH
DRILLING LOG
From To Formation Description
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common mad names.
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDAi;DS D THAT A COPY OF THIS RECORD EEN PROVIDED TO THE OWNER
422--- f/6t
•
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

300'786
WELL CONSTRUCTION RECORD)
North Carolina - Department of Environment and
WELL CONTRACTOR (INDIVIDUAL) NAME
WELL CONTRACTOR COMPANY NAME
STATE WELL CONSTRUCTION PERMITS I.� ASSOCIATED WQ PERMITe
(if applicable)
tural Resources - Division of Water Quality - Groundwater Senior
CERTIFICATION lia2 2
ONE I
(if applicable)
f
1. WELL USE (Check Applicable Box): Residential Q Mtmicipal/Public ❑ Industrial 0 Agricultural bi
Monitoring 0 Recovery 0 Heat Pump Water Injection ❑ Other ❑ If Other, List Use
2. WELL LOCATION
;Town:
County
el 87S 3
(Street N e, Numbers, Gtmmunity, Subdivision, Lot No., Tip Code)
3 OWNER
Address
(S . or Route No.)
�/Y'e . ta2R7,c3
City or Town State Zip Code
Area code- Phone number
4 DATE DRILLED G .2 i/o y
5 TOTAI. DEPTH p S
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO R
7 STATIC WATER LEVEL Below Top of Casing: /% ar FT
(Use "+" if Above Top of Casing)
6 TOP OF CASING IS / $ FT. Above Land Surface'
'lop of casing terminated at/or below land surface requires a
variance is accordance with 15A NCAC 2C .0118.
9. YIELD (gpm): / METHOD OF TEST / „ ,
1(' WATER ZONES (depth;- fr7
ed
'. i DISINFECTION: Type C. /f N Amount /8
12 CASINO Wall Thickness
Depth ter or Weight/Ft
From 0To 9.j Ft 4i.2/
From._______
From To Ft.
GPOL-1 Deptt
From_ n To o2n Ft.
From To Ft.
14. SCREEN Depth Diameter
From To Ft. in.
From To Ft. in.
15. SAND/GRAVEL PACK.
l
ratenaaa
From
From
6 REMARKS
Ft.
Ft.
Material
Qv L
ethou
1a-
Slot Size Material
in.
in.
Size Material
Topographic/Land setting
"Ridge ❑Slope ❑Valley :Flat
(check appropriate box
Latitude/longitude of well loc;Anon
(degree /mivutevaeconds,
Latitude/longitude source:❑GPS❑Toplographtc nia ' '
(check box., L
PRILLING LOG
Formation Description
r,
pEPTH
From To
To. gi
tJ n'
rt/
C
Show direction and di . ce in miles from at least talk
two State Roads or Co 1tty Roads. Include the Tad 0
numbers and comma • road nam
1 DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH ISA NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND T A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
S1GNA UufRcEE OF PERSON CONSTRUC't'MG 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-1 REV 6::20('

300733
WELL CONSTRUCTION RECOIL=
33. Y7 tY i . :.2. iiYcY 1.1c-parratatar of L-n-oyontpedd and - wm
tura; Resuees Iiivion ot Water Quam' (-Poural.t.ao:: Se, rrl,
Vi; i Ce N I i, A i. 7YOPY 31Nret‘ 31)3.' 3%.1 )NAM e rprtzt , AIN .CB 81-/„. ___ ____ _ r 113:)i St 'I.
iCACT OR C ONIPA NI NA/Vik. - - - -44.14e/Moadeeraegri 4 isfirAa,409; -13 i ,..1_ CUNSTRI.CTION PLR-MIER ASSOCIATED Yr() PE/12.T.Ii:
tit aotOora-i:e,
fit appl).--irto.
st% - hej. -pI!4dc BOX RtSidelliled MunicmaliPublr.: D Industrial Et Agri: tdrural
-Int-rirC Reco%Lt‘ 0 Heat. 'Pinup Water Injection 0 Other D If (,)-the-r Lon 1.s.
I
\eaor• • /owl Cun
det4t.erkt.,
opographl.....:. Se;LIT!:
Pikirigt adopt Dvan”, 3:: :
fahee.k aerie -I -try a, :are e N1-1,73: Crnun,r; Sandiv4..c.r. Litt NC. ZIP Cr, 1-4itlitkit.101111.71.13;cf we:. toot .7
vt,
- • -
/9
•
,.-•--- ---•-._-_-_-__
tetta.t.....lat,..tatet,
avit2.thydt St.Ipet..Y.7 Y SLJ 020gral,Ty:; Cr
7a114140,:e,- .S77,..5"13 rtlet.t
—LPL.
JaAtta4ted
tap< vt _and
Veal. lincia.e,.
Yo 4,7 it
teena.W uthissay
Maittp-.•
Y. • '
A COP Thlf. C7..,R,)1:ed..• Pli!..,cwi.1) o? 1.•‘<rs
-5nrie-e----4a9. 17-/Y/17. .
1.7Y,N fStyr Of VP 2.tet ‘,./OZHT- Gr01111thfil ro-,"“ Nlyd ‘4(nt,,
•
r)/2.7!:
1•1 Y., SLIP" R .Y. 2:, /7, ..2t.y, :tic Iva,
ritiT 4,1" 3 rt:a.- 11411,-:

3007'79
WELL CONSTRUCTION RE('010,
ditch, thaparulatn: LIT Environment and
w ELI. CONTRACTOR (INDIVIDUAL) NANI !print
RAT-TOD COM PAN1 NANIL
i1 4LL CONSTRUCTION PERMTTh
tura, Rescagera rIT TA ate: Ou.s1(1'. tttuurilwat(
MN 84L _ -
,_ ER 41 LON 1457_21
- 421Se/NeddelPa#61"" ir.ZU
ASS(TCIA IED WQ PERNIDT
1:faril('::::.atT(( •
Of; appLable
(Cheek Appnralik fiom Residential k Ithuncipalititihh: 0 Mile -stria': LiNI r Elm ERecover:, D Ht3; Pump Water It t1un 0 Other fl If Chthr.
aralar"
crun,tm- Subrtins,o1; Jut br Zir oat
_li
7,Q44149;21°cs 4Z 7453
47.3 y
ts--1
IoN)graphl. Land seriir„i
Dairdg,
TrIni-
Larriudi 'in:Irv-runt of wed'
;otg,:ters-irtui,;...sean;a-
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•-•

WELL CONSTRUCTION RECORD
300402
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME R
'(pri3tnt)., s`• CERTIFICATION# raV1.' `
WELL CONTRACTOR COMPANY NAME('1>.V �r� �tr et.M ` "` t4' *. a a^q�.. PHONE # f�E) 255 7'8e
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable) (if alicable)
I. WELL USE (Check Applicable Box): Residential Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery ❑ Heat Pump Water Injection ❑ Other 0 If Other, List Use
2. WELL LOCATION:
Nearest Town: '40s-s1k: EE County /Act,& _S0z1
a`180 ia,aec' &c.h^:ev'ti C-,resen taste 2A751
(Street Name. Numbers. Community. Subdivision. Lot No.. Zip Code)
3. OWNER:.,W. 00
Address j'o A 1512
(Street or Route No )
Men 1E, (t . NC -
City or Town State
(92P,)-1ot9 44 65
"P.F}75-It
Zip Code
Area code- Phone number
4. DATE DRILLED 1-'7- Ock
5. TOTAL DEPTH: Nos
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO
7. STATIC WATER LEVEL Below Top of Casing: lo0 FT.
(Use "+„ if Above Top of Casing)
S. TOP OF CASING IS t FT. Above Land Surface`
`Top of casing terminated at/or below land surface requires a
variance in accordance with ISA NCAC 2C .0118.
9. YIELD (gpm): 5 METHOD OF TEST R'q
10. WATER ZONES (depth): Cl
11- DISINFECTION: Type t', 0.5
12. CASING:
Depth
From tk To tick Ft.
From To Ft.
From To Ft
13. GROUT: Depth
From 0 To a-c Ft.
From To
14.
Amount tc
Topo�g_�rrphic/Land setting
DRidge E3Slope DValley DFlat
(check appropriate box)
Latitude/longitude of well location
(degrees/m i nutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From To Formation Description
}t ` 4 over sstiic
Wall Thickness
Diameter or Weight/Ft. Material
6=N �k 1Y pie st;c
Material
C.zfriers
Ft.
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
parsed
Slot Size Material
in.
in.
otac."11*z
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.
CO Gi
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
1l aro tt -.. Ikon 4, ib115 '3- 1 or
SIGNATURE OF PERSON NONSTRUCTING 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

3(491
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) jJQSV%ca. 16tc4h 9na.a.rtS CERTIFICATION# aaWilsa
WELL CONTRACTOR COMPANY NAME Q eir 4 ntt-_'•_a� PHONE # SLY) (.C,S tflt
STATE \YELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable) (if applicableL
I. WELL USE (Check Applicable. Box): Residential f ' Municipal/Public O Industrial ❑ Agricultural 0
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use
2. WELL LOCATION:
Nearest Town: Set Sr. wae.3 County Mad t as"
14ft 14asae .Moon 'Rosa 21,743
(Sired Name. Numbers, Communitvv. Subdivision, Lot No., Zip Code)
3. OWNER: Eden;• W;%%I snse
Address 148 'Heuacd /Nooee axed
(Street or Route No_)
'Set :Srer seaS, Arc
City or own State
(Jill- 2.1i 8%in
Area code- Phone number
4_ DATE DRILLED T 2 % oa
5. TOTAL DEPTH: ;AS 'Zl 045 6tsaaat
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO C3
Topographic/Land setting
ORidge CQlope OValley OFlat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:OGPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From To Formation Description
car it eves cracks
7. STATIC WATER LEVEL Below Top of Casing: tea FT.
(use-4-- if Above Top of Casing)
8. TOP OF CASING IS % FT. Above Land Surface*
'Top of casing terminated at/or below land surface requires a
variance in accordance with ISA NCAC 2C .0118.
9. YIELD (gpm): 30 METHOD OF TEST R'
10. WATER ZONES (depth): d
11. DISINFECTION: Type 13 l%S Amount
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
From 4t To .Z4 Ft. (a 4 tf zx plosh.Y
From To FL
From _ To Ft.
13. GROUT: Depth Material Method
Fromm To It Ft. CR,w.as 4ea.ted
From To Ft.
14. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in.
From To Ft. in. in.
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common road names.
c
O o
Gam,
N a
Wrpm �O
r•n
70 en
0 enen a
15, SAND/GRAVELPACK:
Depth Size Material 07 Z
From To Ft.
From To Ft.
16. REMARKS:
WELL CONSTRUCTION RECORD
Arm S
Zip Code
DMt,isft lia
Ot
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
.U; ``
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
'�• 1, • Ott

001/00E,
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) )]QC not 'Amont. Satisma7yt CERTIFICATION# aM%G
WELL CONTRACTOR COMPANY, NAME Ltt A 4wu . S t 'boa iaeTee- PHONE # fiat)) (o .4-Zest
NVELL ELL CONSTRUCTION PERMIT# C Su # ?mat
ASSOCIATED WQ 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 ❑ Other 0 If Other, List Use
2. WELL. LOCATION:
Nearest Town: tie! 3p atj County Maxi ttSew
I, b.lq Maim deg . 2974;
(Si ee Name. Numbers. CVmaunity. Subdivision. Lot No.. Zip Code)
3. OWNER: l.:nd0. G: Wit....
Address t71bt, tIW peq
(Street or RoutrNo.)
'Hot Sp:04A wtc 29' qt
City or man State Zip Code
(B38i (32a- 3a
Arca code- Phone number
4. DATE DRILLED '7- 8t' OM
5. TOTAL DEPTH: 3M5 /
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO Er
7. STATIC WATER LEVEL Below Top of Casing: AO FT.
(Use "+' if Above Top of Casing)
8. TOP OF CASING IS t FT. Above Land Surface*
'Top of casing terminated at/or below land surface requires a
variance in accordance with 15A NCAC 2C .0118.
9. YIELD (gpm): 20 METHOD OF TEST MI
10. WATER ZONES (depth):
Topographic/Land setting
DRidge CAIope ❑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
}♦ a3 Aver a..e..-
SS stt
(a ce-nt*e
LOCATION SKETCH
I I. DISINFECTION: Type Q; t%s Amount Show direction and distance in miles from at least
12. CASING: Wall Thickness two State Roads or County Roads. Include the raad
Depth Diameter or Weieht/Ft. Material numbers and common road names0 . 5_
From 4% To .55 Ft. toy a'st fIlosit C ac
From To Ft.70.
c n
C.
From To Ft. 0 Z
13. GROUT: Depth Material Method tit, �'-i
rn
From 0 To to Ft. C.Fvatna. pouted (a ?-
From To Ft. T. mom
14. SCREEN: Depth Diameter Slot Size Material _ LC
From To Ft. in. in. O I;;—
rom To Ft, in. in.
15. SAND/GRAVEL PACK'
Depth Size Material
From To Ft.
From To Ft.
16. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS. AND
� THAT A COPY�OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
D *taii It ^+aam.1 ' '1tF PI' 2 %. 04
SIGNATURE OF PERSOf CONSTRUCTING THE WELL DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center- Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-1 REV. 07/2001
5
r c.
bIr G _

WELL CONSTRUCTION RECORD
300489
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) t")(2trtes. Wean Scams/tt CERTIFICATION# .'i�1a4
WELL CONTRACTOR COMPANY NAME e-lyde betafPrtS '4 ten tacit 160_ _Zw- PHONE ate) fe65-2ftt
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable) - (if applicable)
I. WELL USE (Check Applicable Box): Residential « Municipal/Public 0 Industrial ❑ Agricultural ❑
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other ❑ I Other, List Use
2. WELL LOCATION:
Nearest Town: 14o4 S?M.nic County Ntndtge..
aliC
(Street Nmr,e. Numbc - Communih. Subdivision. Lot No.. Zip Code) at
3. OWNER: '$ aRtt Ltv:e_
Address 4421b 1.4; %%Ps Qoa a
(Street or Route No.)
Cave_ Ch Ate 2852%
Cin or Town a State Zip Code
(a5l (*3'3 onM°1
Arc: code- Phone number
4- DATE DRILLED ri' 2270A
s TOTAL DEPTH: 4/5
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO
i. STATIC WATER LEVEL Below Top ofCasin_: 20 FT.
(Use "s' if Above Top or Casing)
8. TOP OF CASING IS FT. Above Land Surface*
'Top of casing terminated at/or below land surface requires a
variance in accordance with 15A NCAC 2C Ail18.
9. YIELD (epm): 20 METHOD OF TEST 14:ot
I0. WATER ZONES (depth): d'
I I. DISINFECTION: Type Q;i%S Amount
12. CASING: Wall Thickness
Depth Diameter or Weight/Et. Material
From Tot\__ Ft_ (o . tit% T •Y
From To Ft
FromTo Ft.
13. GROUT: Depth Material Method
From O To 2ta Ft. GF.nt s p0vrttea.
From To Ft.
14. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in.
From To Ft. in. in.
IS. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
16. REMARKS:
Topographic/Land setting
❑Ridge l lope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From To Formation Description
2\ "5
ant rteatte^
b csnt4-t
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common road names.
O a
▪ nz
N o-C
'— 7G
▪ nets
—
0
t,
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH I5A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
17- $2- OM
DATE
iS finis fe 'Aaastillf
SIGNATURE OF PERS CONSTRUCTING THE WELL
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
Tu 10 tf26 Dt..,-.. n•,, rout 022 mai ...MIL. '+0 rtnye GW-1 REV. 07/2001
611
,.Tnrrr.TTr'rTnxr n>crnnn

-r DATE DRILLED `/-/r- oil
County McC 5'on
5. TOTAL DEPTH: 3(ip /
a. DOES WELL REPLACE EXISTING WELL YES. y7 NO 13"
STATIC W ;TER LEVEL Below Top or Casino: Vo FT.
nin
e se' 'r"If nbovc Top of Caamg)
S. TOP OF CASING IS FT. Above Land Surface'
'Top or oaant rcrmuu lea aCur below lino surface ray uires a
rar,anee to uso'sauee with 15A :NCAC 2C.01 la.
9. YIELD isprr]): hirETHO,D OF TEST 3%/ap
10. WATER ZONES Ldeprh): / 7r 3ro' '�
It. DISINFECTION Type'/O Q
P1Nt Amount %� /�
I_ . C.ksrNo: Wail Thickness
Depth Diameter or WeiOnIFt. Murerial
From-, To /Cle Ff .IV '
Fran To F,
Fmin To Fr.
13. GROUT: Depth e� Material hlen ed
Fccov1 _-0,_ To�Fr.
GONCBGf✓ Pi.„---
Nom To Fl 1
I. SCREEN: Dcpnl Diameter Sloe Size i&lurerial
From To Ft. -
in. In.
Fio,n "Do Ff. in.
in.
15. Sr.INDrORAV EL PACK:
Depth Sias Material
From - ro Fr.
From To Fr
SDti I Pvt.
Id- REMARKS:
WELL CONSTRUCTION RECORD
Norm Carahna . Dcpsrm]enrof Environment and rat Resources - Division of Water Quality - Oroundwarer Section
\1 DLL CONTit.cr012 (LINDEVIDUAL) NAML (pruu) Itr4N if. a Ji n/C S CCIRTIFICATION A3I R)
\\ ELL iO,,1'RtiTJn CUb1FANY a: ME' re t r cSONS
�J Lief/ P:/ /li%vct CO • r,iona +sEdg 25f1-5/4.
STnI'L' 14tLL CONSTRUCTION FGRnIlT'r. ASSOCIATED WQ ITtrIUNITtr
fit u:plicablel
302912
I. WELL USE \Check Applicable Box): Residential I�lviunicipeL'Public ❑ Industrial 0
:Monitoring 0 Rcrocery 0 Hear Pump Water lnicerion 0 Other 0 It Other, List Use
2. N: ELL LOCATION: ��
Nearest Town' cites f�'
s.
,Sae Norio, Numocrs, Connumry, Sub ”ion, Lot No., 'Zip Cudc)
3 Ol.\'NErR y (11a'141//l'�i yf -/�
idres_ tl.3 Dcnn .l Y1'1�CN'!/ s oY
\Sneer ar Raurc No.)
Leices+er ivceartris
'up or Tt,r, State Zip Coot
$Z�I tot3-(o2.5(o
?lei isac- ?Ilona IW marl'
/r/7- /rL
gricul coral 0
opographic/Land serting
ridge ❑Slope ❑Valley ❑Flat
(check nppoopriare box)
Latitude/Ion gimde of well Ice' Lion
N3ri - vz'WoreLIZ„J73
(dcgrecxminmca,s onds)
Ladrudeilongirude source: 06PSOTopographic map
tchcck Dux)
DRILLING LOG
Formation Description
%/?'"P
�n Leh J l<'r-
DEPTH
Ijom To
/'17
/rL- 34/b
0
LOCATION SKETCH WC)
Show direction and distance in miles from ar leas!OQ
two Stare Roads or County Roads. Include the rZi coet-
numbers and common road names. �7a
o
N to
cn
1' 3nmaid /flalhis
teicesf-ev, NC
I DO HEREBY CERTIFY THATTHIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH t5A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
SIGNATURE OF PERSON CONSTRUCTINGTHE WELL
DATE
Sunnlir frte oriental Co the Division of Water Quality, Groundwater Section, 1636 mail Service Center -.Raleigh, NC
Fhonc No. 1919) 73D-3221, within 30 days.
GW-I REV. 0/2001

30294t
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section 7
WELL CONTRACTOR (INDIVIDUAL) NAME (print) Mar k Allen CERTIFICATION # 7aef
WELL CONTRACTOR COMPANY NAME C
/ Gxryv We I ` bfr Ill /�§ PHONE � V41 L.Pl3" 90/f
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
I. WELL USE (Check Applicable Box): Residential ' Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATIO : //
Nearest Tffn erS Hi II County /► owLSCi✓
4 p✓Iburyer ci
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: hen 0&',spun
Address 151 Me/6tos "aiic Drive
(Street or
/aYS H�aI N aX754/
City or Town State Zip Code
(?)71- (0 R9 - 2195
Area code- Phone number
4. DATE DRILLED .0 C
5. TOTAL DEPTH: 3nn0
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO Cd^
7. STATIC WATER LEVEL Below Top of Casing: -24.) FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS ) FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordance ith 15A NCAC 2C .0118.
9. YIELD (gpm): METHOD OF TEST
10. WATER ZONES (depth): ' / it
/9 t5
11. DISINFECTION: Type Z1/ Amount oa -ok a Z,
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. �'attenal
From 0 To .rO Ft. (a it? DR. G/ _jam.
Topographic/Land ss tting
ORidge ❑Slope Palley ❑Flat
(check appropriate box)
Latitude/longitude of we loca 'on
1C/49/spa - 0 &I- ar n y/
(degrees/minutes/seconds)
Latitude/longitude source: 136PS❑Topographic map
(check box)
DRILLING LOG
From To Formation Description
0 GA—
€- Or
DEPTH
From To Ft.
From To Ft. Ham burger Rd.
13. GROUT: Depth Material // Method / �.y� I' `
From O To 2 0 Ft. Coda ttom- ?D t.vf-e-Gl f f I a%5 Mitt / V C 6
From_ To Ft.
14. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in.
From To Ftin. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
Gm
"'trn
v
0d
LOCATION SKETCH I �
Show direction and distance in miles from at 16/at o 0
two State Roads or County Roads. Include tinged na
numbers and common road names. o�
xo
N mJ
0 n
16. REMARKS:
1 DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH I5A NCAC 2C, WELL -
CONSTRUCTION STANDARDS, AND THAT 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

31ONe‘TLIRt OF PERSON CONSTRUCTING THE WELL
Sup llllt the ori;in71 ro rtte Division of 1V'orer (2uahry, Groundwnrer Scion,
7269E-1oLo Phone rvo. (i-U) 735.3221, leitnia 3U days.
WELL CONSTRUCTION RECORD 3 0 2 8 9 6
Norm C:rol n Deparm enro f Environment and - rul Rtesources - Division of Water Quality - Groundwater Section
\1 LLL CQ\71 a '1 Or. itnui\ UM-) NAME ipnni)
�� C.w �� /. /�, 1.C%/Y� S CERTIFICATION 3,148)
w4LL izo�Vrs_k z"cJI: co3„fr aNy N.-..11t fec./w.0/ S Gli`/ 7).e///, /✓q L , . PHONI2 sRs a5rt'-Y %.
sr.Aru IF CLL ooNsTaucrroiv PERM ITw. J ASSOCIATED WQ PERMIT)/
J (if >np ht�dle'i
W' ELL us rchcclo =ppli.ebl� Bo) Reurideniiet El 1\iuni:ip0U'Public 0 inaRsrrial 0 Agricr,lrurnl 0
.uoaitaring ❑ Recovery 0 Hear Pump Water lnjecrion ❑ Other ❑ If Other. List Use
2. WELL LOCATION:/�.�
Lores( Town: / / e/ /� /I County /t%abon
nr/4:.,n 4.1 2L weir /qw'e(
Comm umry, 3ubdi v ni mL Lot NO.. Zip Cdcl
3 OWNER. VIVA' Sf 9e1�
Address a'7gq mcheoK Yovk.Ropd__
1Snccr or Route No.)
Moir VII I nc B,54
'ay or Tmvn Spire Zip Code
alra'- (c$q- 505$
?at roc- PROM oumoce
-l. DATE DRILLED Cam- 2e'-ot(
_. TOTAL DEPTH: 3vr
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO Q
7. ST..TIC WATER LEVEL Below Top of Casino: Lx FT.
iU,e'Y'-it Abone Top of Drains)
S. TOP OF CASING IS FT. Above Land Surface'
'Top or song r: mulatto zoo r betas land su rtact rcyuirts a
=riaucc w e.oramuc writ ISA NCAC 2C.Ul1e. y 5. YIELD (pm). /C METHOD OF TEST 3$w411 •K.'J
M.WATER ZONES (depth): 7/0' J
I1. DISINFECTION: Type
c..*srNci:
Dcprn
From___, To Tr -
From Do
From To
I✓/OILret .rkmounr
Wall Thicjancs
or We,ghUFr. Material
Sr -DI tI V✓L
Diernmr
FE L t
Ft.
Fr
iS. GROUT: Dcprh Material
hlCciloil
—
Fr rt:_-.Q._ To.1Z Fr. C�jy(' `io
iron, To Ft.
l-. SCREENDean Diameter Slot Si2c hlutcrral
From, To Fr. in.
in.
From' To Fr in.
15. SAND/GRAVEL PACK: m.
_ Depth Sill
From ro Fr.
From To Ft.
0 REM ARKS
r.larn',al
Topographic/Land stains
❑Ridge LYS lope ❑Valley ❑Flat
(check eppropriete box)
Latitude/longitude of well location
/✓7r' r&. Irr'I/o$-t' 3/.
(ocgreca-m inuresuscconds)
Larirudeilongitude source: C�GPSOTopographic map
(Cheek Dug)
DEPTH DRILLING LOG
From To Formation Description
D-73
%r So dt
6
LOCATION SKETCH
Show direction and distance in miles from at lea30
Iwo Stale Roads or County Roads. Include the ro
numbers and common rood names.
O
-Puyic IQ.C/yl Fork Rd.
%Icu-.i H-i ll, NC
DO HEREBY CERTIFY TH+.TTHIS 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
72..
S ' Zr- o�
DATE
1636 Mail Serviee Cenrcr - Raleigh, NC
OW- l REV. 07/2001

302883
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural�Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) /i'IC, r
lef
WELL CONTRACTOR COMPANY NAME
/4 Pi CERTIFICATION # 3c) J�V
1rJ 21117
jStill
j PHONE ({ )0 `. •/ 91/2y
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential l�J MunicipaUPublic ❑ Industrial ❑ Agricultural ❑
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use
2. WELL LOCATION: Nearest Town: /4// SprLnc,s County M9j.Jei1
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER:
Address �O , Frn-k cad
(Street or Rou of
M City or Town State Zip Code
)- Co22-1ICI Z
Area code- Phone number 4. DATE DRILLED /� T r
5. TOTAL DEPTH: 3
6. DOES WELL REPLACE EXISTING WELL? ❑ NO B"
7. STATIC WATER LEVEL Below Top of Casing: ?-5 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS / FT. Above Land Surface'
'Top of casing terminated at/or below land surface requires a
variance in accordance with 15.A NCAC 2C .0118.
9. YIELD (gpm): QO METHOD OF TEST /, •
10. WATER ZONES (depth): aQ6''
11. DISINFECTION: Type
12. CASING:
—act.
YES
Depth
From 0 To $7 Ft.
From To Ft.
From To Ft.
13. GROUT: Depth
From .0 To dU Ft. `I;Rtf?-IP kurid
Diameter
6 iv
71 11 Amount - : I
Wall Thickness
oght/F[. material
vL
From To Ft.
14. SCREEN: Depth Diameter Slot Size Material
Topographic/Land setting
E_Zidge ❑Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/Ion itude of well location
36-71 449 %ga N- c-Y�-%6`YtB-2, -I,
(d reesiminutesisecon s)
Latitude/longitude source: ❑GPS❑Topographic map
(check box)
DRILLING LOG
Formation Description
DEPTH
From To
D Sd
7/ Ca
;' 5<.
O_
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road g
numbers and common road names.
Material
PQUA'1413 Fork Road
Method Not Spnng5, 'Cc
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 ISA NCAC 2C, WELL —
CONSTRUCTION STANDAR S,ANNjj,; THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
`%%%%�C SIGNATURE OF PERSON UCT[NG THE WELL - S._-T ' .2� "D
Submit the original to the Division of Water r 1 --:
Quality, Groundwater Section, 1636 Mail Service Center -Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-I REV. 07/2001
OCT 2 2 2004
V A I netiLF
p,.

WELL CONSTRUCTION RECORD
r and Csml n- Dcparmvanl or Envrtonmcnr and rat Rcsourcos - Division of Water Quality
\1 CLL. CONTI t 'l dr: draU '1DUaL1 NAI\1Grr(prnl[1 .D IZi» Hj _ /TA_ dye 5 /'
\.¢LL c3,,NIIIAc-ron CO,u P.,n\- NA-111e te'rjitc50NS �1�1� �/2i /fI %.t `G .
��JJ Assocl,TCD w4 Giu,1LY'u
I Ii Lnplicl,blel
v 1L \FELL CON 3l'I:UC'i lorI FE1:hI1T-
302882
- Groundwarer Section 22 ``LLq
CERTIFICATION a...�I Tb
YHONfi IRa01 asst./wet,
'rF ELL LISE tCIicol: Appliocble Box): I<ca identiel L'J i\i uaileipa L'P ublie ❑ Indu5n-ial 0 Agrietdmral 0
ML,niwrlug 0 Recovery ❑ Hesl Pump \later Injccrion ❑ Other 0 If Other, List Use
2. WELL LOCATION:
Nearest Town"--,, 4 /✓
County- i icdir ti
1:o-c:, Numc, :Vun oc c', Con'I,numry, Subaivuion, Lot IYc., Zip Coon)
_ 0\> iNIiF T[Jnt%`7 TYei,Z.G•--
._.aoress yg) ( 4. Ffre. Rd•
farglC.II nagliourcN , a iss
Cr,1or Tou Sum
• (ASS -11613
-�ca raac- Nnonc ounloc
, DAATE DRILLED 9 - i Ot{
Zip Coon
TOTAL DEPTH: 21.
r _ /
DOES WELL REPLACE EXISTING WELL'? YES 0 NO L7
7_ STATIC WATER LEVEL Eclow Top of Casuno: $O FT.
time "T"f Sbova Top of Camnsj
3. TOP OF CASING IS / FT. Above Land Sunace^
lap or 111lcrmulsr o t r bclu r Intl so rr> ce requires a
• naocc naccarac wirti SA NCAC _C .01 Is.
HELD (pm: /L METHOD OF TEST t
w WATER ZONES 1ucpth): aairS' 7J7-
i
. DISINFECTION: Type( J pJ✓e, Amount 7 he4s
._. CASINO: Wall Thickness
DI 0-nett! or WeighdF(. N4urelial
Fe, G./e 7.f.aC21 /'✓L
Ft.
Fr.
.3. a BOUT' Depll^l rvlarcriul
FE:DU1,__0_ I O p
FLOW To FL.
Dcpen
rroar 0 To r2
Frm'n Lo
From To
Ft. COArePeM
a/IcrlloO
SC1'.EEN: Dcprh Dial -rick -a- Sloe Size Nlarerlal
From To Fc. in
in
.iu1111 To Ft in.
m
I;. S=.NDORS.VEL YACK:
Dep111 SULC Ylatenul
Fro:II " To Ft.
Front To Fr.
Topo�gr)»phio/Land setting
❑Ridge L9SIope °Valley ❑Flat
(check oppropriarc box)
Latirude/longinlde of well location
N7r' ,rt. 77D'vorz,° J$ 7s7
(oegree;minutcuscconcls)
Lolirudeilongitude source: e'GPSDTopographic map
(Cheek box)
DEPTH DRILLING LOG
From To Formation Description
ct9 SZ a;r
t
b
LOCATION SKETCH
Show direction and distance in miles from at least Z•
two State Roads or County Roads. Include the road numbers and common road names.
last Fan Rd.
Min Mil, r7C
DO BEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH I5A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
Saunter rat tirielllal to Inc Division of Water Quality, Groundwater Section, l63e Mail Service Center- Raleigh, NC.:
270-lo3o Pnonc No. (919) 733.3:21, within 30 Days,
GW-I REV, 07/200I
.▪ D

302871
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section c
WELL CONTRACTOR (INDIVIDUAL) NAME (print) /lar k Al/en )) CERTIFICATION # 3wgRtl' 4
WELL CONTRACTOR COMPANY NAME /--ery 4fOAl Well Dr ,/ r,- PHONE OPII ZSd - 99Vy
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 LOCATION:
Nearest Town: ACC ✓e
/1
County JrEIA,.004
nfb (Street Name, Nu ers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: Setcnaj C/inni/e'
Address & R Tr" L" 8r. 1
(Street or oute No.)
MA-t hn-u /r 7S3
City or Town State Zip Code
gaY)- 44.9. //7a
Area code- Phone number �t//� od/
4. DATE DRILLED a� - 0/' 4
5. TOTAL DEPTH: 6a -
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO
7. STATIC WATER LEVEL Below Top of Casing: SD FT.
/ (Use "+" if Above Top of Casing)
8. TOP OF CASING IS / FT. Above Land Surface*
`Top of casing terminated at/or below land surface requires a
variance in accordancet with�15A NCAC 2C .0118.
9. YIELD (gpm): r METHOD OF TEST R :9
10. WATER ZONES (depth): 5 c3S
11. DISINFECTION: Type 7*/
12. CASING:
Depth Diameter
From 0 To /• 0 Ft. 6. LY
From To Ft.
From To Ft.
13. GROUT: Depth Material Method
From 0 To t90 Ft. Anc ?c c re tured
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.
Amount 7y.
Wall Thickness
or Weight/Ft. Mpterial SD/L-a)fr'YL toue eel .
CoccA.r�7 •yy
/ i-rs M a N-C.______ .
From To Ft.
16. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, .4 D fHHAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER,
O�7/
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
Submit the original to the Division of Water Quality, Groundwater Section,
27699-1636 Phone No. [phone], within 30 days.
1636 Mail Service Center Raleigh, NC
GW-I REV.-07/2001
Topographic/Land setting
Fditidge ❑Slope OValley ❑Flat
(check appropriate box)
Latitude/longitude of well location
r35/09/YzK - D%a/ v0
degrees/minutes/s€condsf
Latitude/longitude source: ❑GPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From To Formation Description
(ski
'fed S)ta.ly.
CI c m
r -+In
m
En z rn
�I -q
I 7:2t7
o--
m
LOCATION SKETCH a*
at Show direction and distance in miles from at least op
two State Roads or County Roads. Include the road O c
N
numbers and common road names. '0 ro
E.P>
rr
6a5
e

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
/ � WELL CONTRACTOR (INDIVIDUAL) NAME (print) .- /4 rT CERTIFICATION
WELL CONTRACTOR COMPANY NAME feet, inn
STATE WELL CONSTRUCTION PERMIT
(if applicable)
IN) el I lDr;llin( (C; PHONE fer )lift?
ASSOCIATED WQ PERMIT#
(if applicable)
I. WELL USE (Check Applicable Box): Residential EY-Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION:
Nearest Town: /%r.s ka i i County N1a4 Jso n
!r tksr7 !ot /2d-
(Street Name, Numbers, ommunity, Subdivision, Lot No., Zip Code)
3. OWNER: ',entity4/FinJ
Address aid /71,'c.dory L09 Pr�.
297f3
City or Town State Zip Code
(Street or Route No.)
gfl 10S6- 3737
Area code- Phone number
4. DATE DRILLED 3-oL - 097
5. TOTAL DEPTH: Son
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO 13-
7. STATIC WATER LEVEL Below Top of Casing: ii0 FT.
( Use •'+" if Above Top of Casing)
S. TOP OF CASING IS / FT. Above Land Surface*
`Top of casing terminated auor below land surface requires a
variance in accordance ith 15A NCAC 2C .0118.
9. YIELD (gpm): METHOD OF TEST J
10. WATER ZONES (depth):
11. DISINFECTION: Type H 71 /I Amount
12. CASING:
Depth Diameter or Weight/Ft. Material
From To 93 Ft. bSy _ot.a,( D✓G
From To Ft.
From To Ft.
13. GROUT: Depth Material Method
From .Q To N20 Ft. eencezio Thu reC/
From To Ft.
14. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in.
From To Ft. in. in.
I.. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
Topographic/Land setting
age OS lope OValley ❑Flat
(check appropriate box)
Latitude/longitude of well location
3s7/605/2Va (iBa4Yo/A Q la)
(degreesiminutes/ econds)
Latitude/longitude source: ❑GPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From To Formation Description
020 aryat flawe_
t 37 eSho-lr_
8 rG Z �'zray.; la-
k (j Y�✓l/'C�
W
v
0373
rrl
-C —C)
n -n2
f1
0
LOCATION SKETCH I o--
p ; 1) 53 LZShow direction and distance in miles from attlleast mmir
Wall Thickness two State Roads or County Roads. Include toad ._t0
numbers and common road names. 0 co
o
/{:ckory 107 RAI - .a+
10 3h:Il, /UC.
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
abr
SIGNATURE OF PERSON CONSTRUCTING THE WELL
3-aG. -cv
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. 01)2001

30286�
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality
WELL CONTRACTOR (INDIVIDUAL) NAME (print) 1t' icar IC /r-/ fit an
WELL CONTRACTOR COMPANY NAME ryr ern Well-pet/ilea, CC'
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
Groundwater Section
CERTIFICATION
h31216
PHONE (a 1L5'S —77 y
1. WELL USE (Check Applicable Box): Residential I " Municipal/Public ❑ Industrial ❑ Agricultural ❑
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use
2. WELL LOCATION:
Nearest Town: .1 County flal,60
J
Sac n5 Cork / l?rl.
(Street Name, NumS'ers, Community, Subdivision, Lot No., Zip Code)
3. OWNER:TPA1N �ecku eiAA
Address /200 ilea ra!Ng Fa iA lei.
(Street or Route No.')
fiat 5 g,;v5S n c a27Y3
City or Town State Zip Code
(Yfli- 6 ss-9a76
Area code- Phone number
4. DATE DRILLED V— 077- O sF
5. TOTAL DEPTH: a(aC
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO I8�
7. STATIC WATER LEVEL Below Top of Casing: SO FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS / FT. Above Land Surface*
`Top of casing terminated at/or below land surface requires a
variance in accordan e with 15.A NCAC 2C .0118.
9. YIELD (gpm): METHOD OF TEST
10. WATER ZONES (depth): tyect
11. DISINFECTION: Type f'l i Li
12. CASING:
Depth
From 0 To tC Ft.
From To Ft.
From To Ft.
13. GROUT: Depth Material 'g Method
From D To ViD Ft. �v7Cev4 r ]Vo rued
From To Ft.
14. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in.
From To Ft. in. in.
IS. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
Diameter
'Y
Topographic/Land setting
Rttilige OSlope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
.35f yi9lltJ - era/ r•"- pb'w
(degreesiminutes/s nods)
Latitude/longitude source:
DEPTH
From
//
�l
To
/0
PS❑Topographic map
(check box)
DRILLING LOG
Formation Description
Y
errianire
St"
Cr'
Tn
�l -O
7:3'
oP
n
LOCATION SKETCH ar
Amount p C 1) s 3 4 flow direction and distance in miles from at lee a
Wall Thickness two State Roads or County Roads. Include the rordd
or Weieht/Ft. Material numbers and common road names. rn i p
SDha) Pvc ?Oa For
rf'�9 I O
Hof
SF,. / fri .
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
02•7 0�
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. G W-1 REV. 07/2001

WELL CONSTRUCTION RECORD
N In Carolina Ccpermunr of Environment and rat Resources - Division of Water Quality - Groundwater Section
2
11 ELL CONTI i C rid (tNOl\1DU,al) N+MIL (prlo c) N q ION a�
/� ,- G! / Gw S CERTIFICATION /qb
HELL CONTRA,: on CurF.iNY N. in cerj�ISoNi L.(fe// 9.t7/'///ryj Cci . thews t$dgi a5r s' 4_
STrrn 1)r LL CON.9TRU CT LON FERntITa
aS'SOCIA'VED W Q P .RMno
ii ',pplicoblcl
WELL LIEF LCbcck Applicable Box): Resiaeniial e Munic:ipaL'Public ❑ Industrial 0 Agriculnlral 0
\Loniroring 0 Recovery 0 Heat Purnp Water Injection 0 Other 0 it Other, List Use
2. WELL LOCATION:
Town-/4%.3•l //
14 Le .e%
County //74-/5i
,Seca N.m:, :Nam tern, Community, Subdi ns ion, Lot No., Zip Coon)
3. OWNER- 11CfYtald Kn!� ht
Adnr.ss 2(od SiGkel+t1 Raid
IS ncct or Route No.)
Orate ebLrq NY 16964
' Town SWic Zip Coat
,Sim "5_5$- y 11
Vfa Ndc- Vtione OWriDer
-r. DATE DRILLER 4- -041
FOT.,.LDEPTH Zof'
o. DOES WELL REPLACE EXISTING WELL? YES ❑ NO Pf
7. STATIC WATER LEVEL Below Top of Casing: (ve) FT.
tu;o' 'T"-ir nboyc Top of Cssm_I
S. TOP OF CASINO IS ' FT. Above Land Surface'^
`'op at Kiln; terminated ?Cur bcluly lAnd Surface requires u
rariaut, in sec ors,ate with 15d NCAC 2C .0.11e.
s'. YIELD (ggpml• ?O N'IETH»D OF TEST Bbtlirq ego:,lu. WATER ZONES (depth): /d/% J
ii, DISINFECTION Ty peel /ORriv ..
CASINO:
From 0
Frmn
r0UR
3. GROUT:
Froln p
From
SCREEN.
Amount C fch
Wall Thickness
Pcpm - Diameter or W,ighrFi. Material
To 4ide Fr./ Jed
—
To Fr.
To Fr.
Sian, />vc
Dcph Material Method
To a Ft. Cene..2efie /e.-.,n,
To F't.
Dcpra Diameter Slot Size Material
To
From Ftin. in.
F:com To F1in. in.
l.i. SA.iNDiQR-,VELPACK:
Deprr, Size Material
From - To Fr.
From To Ft
lo. REMARKS:
DEPTH
From To
n S/o'
y,6
Topogra hie/Land setting
❑Ridge OS -lope ❑Valley ❑filar
(check appropriate box)
Latitude/longinlde of well location
N3s'sV, ai/'ern' V2Of3d
(degrees; rmnwcs; seconds)
Latitude/longitude source: CAPS❑Topographic map
(cntel( bus)
DRILLING LOG
Formation Description
0
LOCATION SKETCH I
Show direction and distance in miles from at IcaGP
two State Roads or County Roads. Include the ro$
numbers and common road names.
0
12ieciten/ 3r• Iid.
Mayshail, nc
DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH UA NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
-24 et/..IL") � z/-
SIONATURt OF PERSON CONSTRUCTING THE WELL DATE
Sunuui Inc original to ins Division of Water Quality, Groundwater Section, lo36 Mail Sery
37u99-l.63o Phone ./0.(919) 7J3-ii 1, wirnin 3d days.
Center - Raleigh, NC
GW-I REV. 07/2001

WELL CONSTRLJCT1ON RECORD
Copxtmrnr of Environment and rut Resources - Division of Water Quality - Groundwater Section
^j i mLI CO:NTI 1 O1: ihYbl YlUUu) Nnl Al: ipnnn � � II �p.TI
i � C¢RTIF1lON A...�/`�T
LONrIn.cvon CL,11F=NY N "11L Pi�%u-soir.$ �e// Dz../ C_a . PHDNj £BJXi 057 Y= tq
!_
J ASS OC LAT2D WQ 1.'LJRA'11Tu
if :p p tic ob lc)
1FfLL Liil.i l'r:U CTIJN Fnl:fi tl]n
302845
41 ELL USE LClic.!c -.ppGr,:,bla Box)' fttaiuential EI 1\iu.,icipoUPuulic ❑ industrial ❑ Agrictdmral ❑
1w LLlmnu5 0 liceo<ery 0 Hur Pump Water Injection 0 Other 0 If Other, List Use
2 ELL LOCATIOLOCATION.N/
Nc-_rest Town nes
?ay Gto" (oi,e
,-_cct N.mm, NipTOc ri, Community, Si bdi noion Lot No„ Zip Coons
-. OWNER.
14res-
ISocct or Morn
WfavpLvitte YIL
LA err To., SOLO
1St2.?,-43Cre,
-_ _ .ax- Inor2 oanmcr
DATEDnirrn y'25•oN
5 TOTAL DEPTH 20 s-
County /la. 50n
Zip Coat:
Topo�grap�hic/Land setting
❑Ridge L75lope ❑Valley DFlac
(check appropriate box)
Latitude/longitude oP welLlocarion
/vic`,s /. eft- 'h/0kt /. 72S'
(degrees; m intdcconns)
Latitude/longitude source: L4 'PS❑Topographic map
tuheek bux)
DRILLING LOG
From Formation Description
Sit a
tt
DEPTH
To
/S - 2,1
2N - to r
a. DOES WELL REPLACE EXISTING WELL? YES 0 NO B'
ST.ATIC WATER LEVEL Snow Top of Casing: t(O FT.
,Use Fr" if Abavc Top of Coam_)
TOP OF CASING IS / FT. Above Land Surface'
"Fop or :5r ui; (al -Malaita lour bctuw Ianp Su rrz et re9 wires a
r m aceorsirJ,,Cc wi10 tin :NOAC:C .011e. 2
5 YIELD t_pmi: S` METHOD OF TEST B%(lJitrg 9
to. WATER ZONEStUeph): /3o t, �4 0 /
DISINFECTION. Type( /02rive. Amount 7 #d<5
2 CASING: Will Thickness
Dcpin Diamemr or We ighl/Fr. kaaronal
From 1J To 24 Ft l,/Lr 5OLD A'c
From To Ft.
From To Fr.
GROUT Depth Niarcn]I &Icmod
.,gym Q To c"10 Ti. CCnerle Rea ---,At
Itodl To Ft.
I,. SCREEN- Depn! Diarnncr Slot Si2c tlla¢nal
Frain To Ftin. in.
From Fo Ft. in.
n. FANS./GRAVEL PACK:
DcpR. S12C Material
To
from To
Ft.
Ft
to REMLARit_S:
0
0
cA
LOCATION SKETCH
Show direction and distance in miles from or leastp
two State Roads or County Roads. Include the rooms.
numbers and common road names. 01
Top l a.R Cov e
Moss Hiu,nc
DO HEREBY CERTIFY THATTHIS WELL WAS CONSTRUCTED EN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
11- 2S -Ot/
SIGN. TURF OF PERSON CONSTRLICTINO THE WELL DATE
Sun alit tnc ori;ivat to the Division et \Y titer Quality, Ciro undw'a ter Section, t636 Mail Service Center- Raleigh, NC
2u5,-16io Pnonc INo. (91F) 733-n 1, ivirhin 9u days. G W-I REV. 0/2001
c0
."1;•r1
1PO G
�ri
73O
—a
—.—
O0
CD 0
Inn

302834
WELL CONSTRUCTION RECORD
Norm aecolkoo - Department of Environment and - eel Resource- - Division of Water Quality - Groundwater Section
(\ ELL OOVL.�CFO'INDIVIDUAL') NA t. 'INDIVIDL') NIL (pin' 0it. ALLe.S CERTIFICATION R3I .
v,E'LL:ohrl�Actron CONIP--NY Nnn1E f r t sonS Ulej/ pp/ i11/✓ Co . pxoNE lag 35A7` 14_
ASSCCr.4:PED WQ P 1Ur11Tll
lir.-ipplicublei
31m. re WELL CONSTUUCTION FERniiTH
I..cl:.
I. 4Y ELL USE (.:heel: ?.pplieeble Lox): Residential 0• Nivaieip,UPriblic 0 industrial 0 Agriculrural 0
htanitaring 0 Reeovety 0 Hear Pump Water Injection ❑ Other ❑ If Ocher, List Use
2. WELL LOC.ATI;JN:
Nearest( Tonne-ye/ter
the-/e ten ci eci
Co un lt>/..Pc-rXya9
, Lacct beaus, Nanrocre, Community, 3uboivrsion Lot No., Zip Cade)
DI3 N5 Calvin Ainsworth
SS a (l rk's Rr. Rci •
Le i c�s+Qyuccrn cure Na) a87q %
Lan a/Toen State
f2.21-(4$"'CIZAD
roar- Phone numocr
4. D--TE DRILLED
Zip Code
�. TOTAL DEPTH: iaer
O. DOES WELL REPLACE EXISTING WELL? YES Q NO E✓
7. STATIC WATER LEVEL Below Top of Casing: a FT.
iu;e `. ^ii Above Top or Cs„ng)
S. TOP OF CASING IS / FT. Above Lend Surface -
"Tee or cerminamh poor bcluw lino Cu rt et rcq wires
asrune.m a:acre:4n. with I>i NC..0 IC.011S. y
9. YIELD (apml: O METHOD OF TEST B4W/raj •grtq
tO. WATER ZONES (depth): /ZO/ - remo
II DISINFECTION: Types'%Opii,.c,
IS. C SFNG.
Depth
Frun 0 To AI
Amount G A-u
Wall Thickness
or WciehriFt. A-iaceriol
Fr. - r4t'i/ Ae'c
From 1-o FL.
From 'lo Fr.
:3. OROLIT: Depth
Front O .1.3 ao
From To
SCREEN Depm
From To
Frein To
iS. SA.ND:GRAVEL PACK.
Depth Size Material
6ciurnsIcr
i
Material 7cthon
FI. C2nd%
F t.
Topo6 aphis/Lan seeing
❑Ridge OSlope \Valley ❑Flat
(check appropriate box)
Pir�tufie// zrn / of �me beacon/)
421
(dcgrees;minutcpronds)
Letirude(longirude source: I?UPSOTopogrephic map
tchcck box)
DRILLING LOG
Formation Description
DEPTH
From To
0-Zr
Lj-- 3,T
.Ss'•�9�u+f
LOCATION SKETCH
t9
Show direcrion and distance in miles from at lea,
two State Roads or County Roads. Include the rr1d
numbers and common road names.
C)ark,'s Br. Rd.
Leit_ est-eI-, nc
Diemcicr Slot Si?c lblutnial
Ff in. In.
FI in. in.
From To H.
From To Ft
to. REMARKS.
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH Liek NCAC 2C, WELL
CONSTRUCT' N STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER.._ _
SIGNATURE OF PERSON CONSTRUCTINO THE WELL DATE
3uomir the original to the Division of Werer Quality, Groundwater Section, 1636 Mail Service Center -Raleigh, NC
:11699-1o3o ?ileac No. 019) 733-3221, irlrhin 3U airy;. GW-I REV. 07/2001

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division�of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAMEe(print) ga np i e «f// CERTIFICATION #7 2., 7
WELL CONTRACTOR COMPANY NAME 7WeeT/wi/,r vol/'9 ,UflIP .4 PHONE a en 6 gt"Ono
STATE WELL CONSTRUCTION PERMITS AeSOCIATED WQ PERMITS
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential �( 1unicipal/Public 0 Industrial ❑ Agricultural ❑
Monitoring 0 Recovery ❑ Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION: I /
Nearest Town: i4i4#ShInf County ith /.iON
(Street Name. Numbers, Community, Subdivision, fat No., Zip Code)
3. OWNER: Pi [ �9 Sp at F/r' wei-s
Address 71 if r A it /s
City or Town State Zip Code
Men code- Phone o�
4. DATE DRILLED ' Z 7 ' 0 7 `,
5. TOTAL DEPTH:
6. DOES WELL REPLACE EXISTING WELL? YE❑ NO V
7. STATIC WATER LEVEL Below Top of Casing: a FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS 1. 5 FT. Above Land Surfaces
`Top of easing terminated at/or below land surface requires a
variance is accordance with ISA NCAC 2C .0118. /
9. YIELD (gpm): j METHOD OF TEST / f Nf L er
10. WATER ZONES (depth):
11. DISINFECTION: Type G. N.
12. CASING:
FromFTo�5 a Ft
From__ To
From To
13. GROUT: Depth
From if To Z O
From To Ft.
14. SCREEN: Depth Diameter
From f To Ft. in.
. Amount /m
Ir
Wall Thickness
Topoghic/ and setting
ORidge Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude soume:❑GPS❑Topographic map
(check box)
DRILLING LOG
Formation Description
DEPTH
From To
7-
LOCATION SICETCI; c ?
O a Show direction and distance in miles from at leash
two State Roads or County Roads. Include the road?
numbers and common road names.
fOR 21 pu
Ft
Ft.
Material
FtCe4oe ft
Fro To Ft. in
15. SAND/G VEL PACK:
Depth Size Material
From To Ft.
From To Ft.
16. REMARKS:
Melhod
WC mix
Slot Size Material
in.
in.
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTR ON STANDAR12S, AND THA�COP S RECORD HAS BEEN PROVIDED TO
ATURE OF P
CONSTRUCTING THE WELL
er or Weight/Ft.
Submit the original to the Division 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) at e �19!/
CERTIFICATION # 2277
WELL CONTRACTOR COMPANY NAME SWtert/2�1./et` ts3e//4 Pump The PHONE # �o
STATE WELL CONSTRUCTION PERMIT# I -( /� ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential iMunicipal/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: Co ff'f /d i 5oN
5-5` W R ZR7s7
(Street Name. Numbers, Ccamunity, Subdivision Lot No„ Ti Code)
3. OWNER:Jflh//tfl Yerse% J
Address 23. to f/45 54 14d� R
(Street a Route No.)
mAn A// Jv<. 227s 3
dem F4 - 20(6 Zip Code
Area code- Place number
4. DATE DRILLED Q 1 Q- n Y
5. TOTAL DEPTH: / b r /
6. DOES WELL REPLACE EXISTING WELL? YES ❑ENO 13"
7. STATIC WATER LEVEL Below Top of Casing: 2 FT.
(Use "+" if Above Top of Casing)
S. TOP OF CASING IS /. 4 FT. Above Land Surface*
"Top of casing termLated Wa below bad surface requires a
variant la accordance with ISA NCAC 2C .011L ;
9. YIELD (gpm): 'L. S METHOD OF TEST //!n t
10. WATER ZONES (depth): (p 0
•
Qf ice
11. DISINFECTION: Type CH H.
12. CASING:
Depth a
Fro To3.Q_ Ft
Fro To Ft
From_ To Ft.
13. GROUT: Depth Material
Fro To 21)a FtrettC#C6.je
From To Ft
14. SCREEN: Depth Diameter Slot Size Material
From To Ft in. in.
From To Ft. in. in.
15. SAND/ VEL PACK:
Depth Size Material
Amount ID D 2
Wall Thickness
or Weight/Ft Material
5DR2i PO C
Topoc/Land setting
Midge alSlope ❑Valley ❑Flat
(chock appropriate boa)
Latitude/longitude of well location
(destedmimtm/s)
Latitude/longitude source:❑GPS❑Topographic map
(cheek box)
DEPTH DRILLING LOG
From To Formation Description
From / To,
From [/ To
16. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRU N STANDARDS, AND THAT COPY IS RECORD HAS BEEN PROVIDED TOTHEW! L OWNER
q-i
Ft.
Ft.
N
- ca
LOCATION SKETCIi 3 n •�
Show direction and distance in miles from at lease fr
two State Roads or County Roads. Include the road
numbers and • mmon ro: • s.
(A%
tr/zo
tOit.
wq/mu., Art IAla
/ •a: /e to -ills Oriel
ID/uf4s
to) ,Ui lar'h
SIGMA TE OF P1iON 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

ztobo
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) R6 n C f.PA/ l CERTIFICATION # Z a s
77
p
WELL CONTRACTOR COMPANY NAME Swr►E T' LLI/4 C/� ()all1 Roy Mr. PHONE # )Z�pq0
STATE WELL CONSTRUCTION PERMITS I ASSOCIATED WQ PERMITS
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential l2 Manicipal/Public 0 Industrial Cl Agricultural 0
Monitoring ❑ Recovery 0 Heat Pump Water Injection 0 Other Cl If Other, List Use
2. WET I LOCATION:
Nearest Town: 1,4 :: County,
too tii , $ limey f l 2$
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER:N*1y rig Ii►S/y
Address lot r / s l i ai1
errata Route No.)
r 23 City or Town See
OAS} LU - tar.%
Mee code- Phone number
4. DATE DRILLED 9'/0' O 9
5. TOTAL DEPTH: II') i A
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO lir-
7. STATIC WATER LEVEL Below Top of Casing: /t A FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS A f FT. Above Land Surfaces
`Top of casing terminated Wor below land surface require a
variance In accordance with 15A NCAC IC .011& -f-,
9. YIELD (gpm): / /) METHOD OF TEST / r /4 C
10. WATER ZONES (depth): /O I
11. DISINFECTION: Type CR./1. Amount /o e,
12. CASING: th Dgeta Wall Thickness
From To � Ft. L i4i sink Weight/Ftor VC.
From To Ft.
From To Ft
13. GROUT:
Fro
From
14. SCREEN:
Fro
Fro
15. SAND/GtAVEL PACK
th
From To
From
Zips
Depth Material
To 2.0 Ftf6eJlta [
To Ft
eiagls4111
od
Depth Diameter Slot Size Material
To Ft in. in.
To Ft. in. in.
Size Material
Ft.
To Ft.
16. REMARKS:
Topo c/Land setting
❑Ridge lope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
( Wmmuteshecoods)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DRILLING LOG
Formation Description
DEPTH
From To
i r
G
LOCATION SKETCH
Show direction and distance in miles from at l
two State Roads or County Roads. Include the
numbers and co road names.
aA)
tr/po
/D ovhsts ro%AT Arno ci;
/Abele (.AsIds Bnispc
1 DO HEREBY CERTIFY THAT THIS WELL WAS CON ' ' UCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRU( N STANDARDSeD THAT COP a THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
9/iol°y
DATE
GNATURE OF ' +.ON CONSTRUCTING THE WELL
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-1 REV. 07/2001

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources
/-7Divts oLn-of Water Quali - Groundwater Seem:.
WELL CONTRACTOR (INDIVIDUAL) NAME (p�rinTt) LL eft" ` JAro des ie. CERTIFICATION t tr_ff
W ELL CONTRACTOR COMPANY NAM CJ WA�Tte ( P: l ri ny PHONE r (1221(243 4470
STATE WELL CONSTRUCTION PERMTra 4/At ASSOCIATED WQ PERMIT./
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential f0 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 st owns a: ,�f/� . Co ty
AsoTw�Y.l esy Jezet
(Sneet Name, Numbers, Community, Subdivision, Lot No., Zip Code)
i. OWNER: �f�y / /
.Address- - . 6 W i /3 ,5 -rn--
(;fie No
fr.� `O : c
3,3 3 0 4i
Zip Code
area code Phone number
4. DATE DBRILLEDJQ *ea' o y_
5. TOTAL DEPTH: 1.24.5"
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO X
7. STATIC WATER LEVEL Below Top of Casing: 9b FT.
(Use "r^ if Above Top of Casing)
8, TOP OF CASING IS l .J FT. Above Land Surface"
'Top of casing terminated at/ur below land .orftce requires a
variance In accordance h ISA NCAC 2C .0118. •
9. YIELD (gpm): METHOD OF TESTlaceesJ _
10. WATER ZONES (depth): ../ ' ..2on
11 DISINFECTION: Type_
12. CASING:
Dep
From. Tot S t
From To
From To
13. GROUT: Depth
From_ lb To t
C.c. i9 Amount - (It
Wall Thickness
ter or Weight(FL al
FL G b "2/ vc_
FL
at
FL
Material
M„ _ethos
Ftilisteat
From To FL
14. SCREEN: Depth Diameter Slot Size Material
From Ft. in. in.
From / To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth
From Ft.
From To FL
16. REMARKS:
Size Material
Topographic/Land setting
❑Ridge ❑Slope ❑Valley 91F'iat
(check appropriate boa)
Latitude/longitude of well location
( ealminumtsermda)
Latitudeflongitude soerce:❑GPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From To Formation Description
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common road names.
I DO HEREBY CERTIFY THAT THIS WFI I WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
'�. S IS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
o �29 6
CONSTRUCTION STANDARDS, 9 `I i)tHAT A CO...O
ERSON COhi IItifCTING THE WELL DATE
SIGNATURE 0
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
27699-1636 Phone No, [phone], within 30 days. GW-1 REV. 0712GOI

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Nq'tutl
Resources - Divissi n of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (Print) r'/Gh C t/4Cate 5 7R CERTIFICATION #Z7E?
WELL CONTRACTOR COMPANY NAM
STATE WELL CONSTRUCTION PERMI # ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
303806
a 1ati f1nT..11s� ___ PRONE # MaKatiCi-Oint
I. WELL USE (Check Applicable Box): Residential E MunicipabPublic C7 Industrial ❑ Agicultural 0
Monitoring D Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
WELL LOCATION:
Nearest Town: �!
2731 C .yr�
(Spat Nwre, Num , Canon ay, Subdivision, La No., Zip re.)
3. OWNER:J.1/9/k/
Address...17i
(ayset a x urs no.)
O i Sp�ifr ps N C.
City flown / Stan
a
287s-3
Zips
Ann coda- Plume mmba
4. DATE DRILLED /V
5. TOTAL DEPTH: 36 5
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO L�
7. STATIC WATER LEVEL Below Top of Casing: / 9^ FT.
(Use "+" if Above Top of Casing)
S. TOP OF CASING 15 AC FT. Above Land Surface'
'Top of canoe terminated War below land surface requirea a
variance la accordance with ISA NCAC 2C
9. YIELD (gpm): 5 METHOD OF TEST ./ r me
10. WATER ZONES (depth):
Topo ./%.and setting
❑Ridge lope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degreo/minutaisecnnds)
Latitude/longitude source:❑GPS❑Topographic ma
(cb.nk box)
DRILLING LOG
Formation Description
DEPTH
From To
I L DISINFECTION: Type C r H-M_ Amount /D o
12. CASING: wall Thickness
Depth ex or Wet aka Material
Fromfit To 30 FLS0 ) Pile
From_ Tov
From To
13. GROUTS/ Depth
From. fl/ To 20
From To
14. SCREEN: Depth
From To Ft In.
From To Ft. in.
15. SAND/G .VEL PACK:
Depth Size
From To___. Ft.
From,_. To _w Ft..
16. REMARKS:
Ft
Ft
FLrorx_ w� x
Ft
Diameter Slot Size Material VN)
p
LOCATION SKETCH.
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbe. : , . common road names.
tn.
in.
Mari l
qC
fd
//'N i/a/SIN$)
'(s I riE
I DO HEREBY CERTIFY THAT' THIS WFI I WAS
CONSTRtYC:)DONSTANDARDS, ' t� TA
NSTRUL IED IN ACCORDANCE WITH I5A NCAC 2C, WELL
Y OF THIS ' CORD HAS BEEN PROVIDED TO THE WELL OWNER
SIGNATURE OF PERSO
/o-ts-oy
ONSTRUCTING THE WELL DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-I REV. 07/2001

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section WELL CONTRACTOR (INDIVIDUAL) NAME (priatt1f)Jhen C Rat bells Tip CERTIFICATION #zn( y
WELL CONTRACTOR COMPANY NAME$W 9P I ►Af 41.4t11 W G// 9 ran 10 .liar PHONE # riiZ2 2t o f$O
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT*
(if applicable) (if applicable)
I. WELL USE (Check Applicable Box): Residential Er Municipal/Public ❑ Industrial 0 Agricultural 0
Monitoring 0 Recovery O Heat Pump Water Injection ❑ Other 0 If Other, List Use
Countyy c
St 'SS
(Street Name, Numbers, Cammtmity, Subdivision, Im No., Tap Code)
3. OWNER:
Address
City or Town
Am code- Phone number
4. DATE DRILLED /0 ^7 ^O
5. TOTAL DEPTH: if 0 i
6. DOES WELL REPLACE EXISTING WELL? YES O NO lee
7. STATIC WATER LEVEL Below Top of Casing: $ 0 " FT.
(Use"f" if Above Top of Casing)
8. TOP OF CASING IS /07 FT. Above Land Surface*
'Top of casing terminated st/or below land surface requires a
variance in accordance with ISA NCAC 2C MIL9. YIELD (gpm): 2 O METHOD OF MET
10. WATER ZONES (depth): O t1 O
ie✓ 4s
Cis) �stz
State Zip Code
11. DISINFECTION: Type t. /l. N . Amount I O CZ.
12. CASING: Wall Thickness
Depth tMaterial
From � To--f4-O—Ir. bat7 Ft z/ P Vc
From To Ft.
From______ To Ft
13. GROUT:�{ Depth Material
From V� To 2 0 FtCOncse/e
From To Ft
14. SCREEN: Depth Diameter Slot Size Material
Fro To Ft in. in.
From To Ft in. in.
15. SAND/G VEL PACK
Depth Size Material
From
From / To
To
16. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN A'
CONSTRN STANDARDS, AND 'fjjpT/A COPY Q '' THIS RE
SIG1gAfURE OF PERSON CO$'STRUCTING THE WFI I
Topo c/Land setting
Midge Slope Malley OFlat
(check appm-riatc box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:OGPSOTopograpbic map
(check box)
DEPTH DRILLING LOG
From To Formation Description
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. , chide the road
and common to names. vets
CORDANCE WITH I5A NCAC 2C, WELL
HAS BEEN PROVIDED TO ��
DATE
I
H
r
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center -Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-1 REV. 07/2001

11. DISINFECTION: Type 41 Fi fib /a Amount 1/a I L
12. CASING: D� pq Wall Thickness
i To '11° (oo'/K` or
vet. Material
From To �1 Ft.
From To Ft.
From To Ft.
13. GROUT:( Depth Material Method
From To ace FL C-emS I PooJRe
From To Ft.
14. SCREEN: Depth Diameter Slot Sim Material
From To Ft. in. in.
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Size hiatenal
From To Ft.
From To Ft.
16. REMARKS:
3. OWNER:
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and *t•n,,nl Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (prt.t) ? ,,'�-(G ^NAS R CERTIFICATION a,—
WELL CONTRACTOR COMPANY NAME _REUDEN CALDWELL DRILLING, INC- PRoNE4?f8 254-3581
STATE WELL CONSTRUCTION PERMIT/
(if applicable)
ASSOCIATED WQ PERMIT/
(if applicable)
1. WELL USE (Check Applicable Box): Residential H 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: ONIg2-S(df1t-1- County A"- ADiSor.
\b41 WALNv-r ct2eeV (Lamb
(Street Name, Number., Community, Subdivision, 10 No., Zip Code)
£tAIA IRA tv1SC `� Address I64-1 LA) ►�1.,T Ot ct�-e "K EGAD
MARS(RLL ,jC-No, a-8g1sS
Ba8>
Cit-y a Town S Zip Code
b 4-a - U%g a
4. DATE DRILLED SArea coda- Phone number / O
a 4
3. TOTAL DEPTH: a5 O
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO 00
7. STATIC WATER LEVEL Below Top of Casing: 4- a FT.
(Us. -.- if Above Top of Glint)8. TOP OF CASING IS 1 FT. Above Land Surface*
*Top of gulag t.nolaated aUor below lad scrim nooks/ a
variance In ace.rd.}r. RIM ISA NCAC IC .011/.
9. YIELD (gpm): a t MET11O O/F TEST g-IG r A I R'
10. WATER ZONES (depth): 10So GP M
J OCATION SKFTQ)i (31 -{-
Topographic/Land setting
❑Ridge ❑Slope ❑Valley QFlat
(cheek appropriate boa)
Latitude/longitude of well location
(deyeearyniro,tea/aecooda)
Latitude/longitude source:❑GPS❑Topographic map
(chock boa)
DEPTH DRILLING LOG
From - To Formation
v V �pn,
(5u(wt0J
1-1
1
tco
0 Ch(=Ar117-
(Ksdl GPI
a o (,R.A 1-c
0
1
Show direction and distance in miles frnrm.t leastcm-s-stX
two State Roads or County Roads. Includaahe roateena�,y�
numbers and common road names. C..?'F�'. l
Litt) LW U T CR6 C r'1'
i
S- O
M
1 DO REREBY CERTIFY TRAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WiTTi ESA NCAC 2C, WELL
CONSTRUCTION STANDARDS. AND tAT A gilt OF T)RECORD HAS BEEN PROVIDED TOfai7o
WEO It
I1
SIGNATURE OF PERSON CONSTRUCTING IRE WELL. DATE
Submit the original to the Division of Water Quality. Groundwater Section, 1636 Mall Service Center -Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-1 REV. 07/2001

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and IQ • ritrA Resources - Division of Water Quality - Groundwater Section
WELL CONTRA CT OR (INDIVIDUAL) NAM[ (prtat) ) LC4,$ N CERTIFICATION /a-171
WELL CONTRACTOR COMPANY NAME_REU DEN CA LDWELL 193tILLINC, INC. PNONL438 54-3581
STATE WELL CONSTRUCTION PERM IT/ ASSOCIATED WQ TERMITE
(if applicable)
(if applicable)
1. WELL USE (Check Applicable Box): Residential 0 MunicipaVPublic 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
3. OWNER. /�
Address 1' - V -ti Io c
(Suet of Routs No.)
IcAgyoAtc5\1 oc ag1oq
2. WELL LOCATION:
Nearest Town: On AR l� ILLCounty Mtied Sc?
G�LAs�IAV‘'e,t&) rj�A.0
(Sneer Name, Numbers. Community, Subdivision, Lot No., hp Code)
Eli tJ G A (Le 'CaJ
try or Town a—�aStale oo Zip Code
'
Arm code Phone number
4. DATE DRILLED 't e $ I t
5. TOTAL DEPTH: 3 1 0
6. DOES WELL REPLACE EXISTING WELL/ YES 0 NO 'Id
7. STATIC WATER LEVEL Below Top of Casing: '1 O FT.
Nee -Cif Above Top of Cuing)
8. TOP OF CASING IS FT. Above Land Surface
'Top of casks iermleatsd aUor bile. lead serfage requites a
varleau In aceardems Ub 15A NCAC IC .01111.
9. YIELD (gpm): METIIop, OF TEST R(G _ �) 2
10. WATER ZONES (depth):,1 f' I s; -L S Geer\
11. DISINFECTION: Type RT11 ���`% Amount Yet (
12. CASING: Wall Thickness
1 T °`n` hSo Dp)e Seri rt. Wit
From
From To
From To
13. GROUT: Depth Material
From 4- To ago Ft. Z.trf+ l3))T
From To Ft.
Oo 3ett
14. SCREEN: Depth Diameter Slot Sire Material
From To Ft. in. in.
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Sire Malenal
From To Ft.
From To Ft.
16. REMARKS•
/ 7'opogaphic/ and setting
t Ridge ❑Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(dreatAnimsuaraecoods)
Latitude/longitude source:❑GPS❑Topographic map
(chock box)
PEPTI! DRILLING LOQ
Frgm/ T / Fo lion escri Lion
15:_� n fcq e-Z
6Fao..)k r
) O �(cfs—l� beM
1�c`-- ��ic' G62.." rna
O
r
C) am
urn
),OCATION SKFTQI ci'o
Show direction and distance in miles frorgsat lease
two State Roads or County Roads. Induct -Abe roarb
numbers and common road names. O
�o
tr
O ,
I DO HEREBY CERTIFY THAT THIS WELL WAS CONS I RUCIYD IN ACCORDANCE WITII 15A NCAC 2C, WELL.
CONSTRUCTION STANDARDS. AND THAT A OPY t Ti1IS RERD l IAS BEEN PROVIDED TO TiWELL INNER0� 04
DATE
SIGNATURE OF PERSON CONSTRUCTING
IIE WELL
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Malt Service Center- Raleigh. NC
27699-1636 Phone No. [phone], within 30 days. GW-I REV.-07/2001

(B3a)- (4 d9O f Arca code- Phone number
4. DATE DRILLED If-�—
5_'TOTAL DEPTH: ?
6. DOES WELL REPLACE EXISTING WELL? YES O NO
7. STATIC WATER LEVEL Below Top of Casing: pp
R. TOP OF CASING IS (Use + if Above Top of Casing)
FT. Above Land Surface*
'Top ortasing terminated at/or below land surface requires a
variance in accordance with 15A NCAC 2C .0118.
9. YIELD (gpm): :2 o METHOD OF TEST
10. WATER ZONES (depth): �l —
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section ctet.X �at_
WELL CONTRACTOR (INDIVIDUAL) NAME (print)
J.� '►letit, .=ca
'YELL CONTRACTOR COMPANY NAME _.i. $Act4. 3e CERTIFICATION # eTtl3V
+twtcs v
STATE WELL CONSTRUCTION PERMIT# PHONE # afrayf,q_ 2etZ
(tfa ?licable) _ ASSOCIATED WQ PERMIT#
(ifa licable
1. WELL USE (Check Applicable Box): Residential 1r Municipal/Public O Industrial O A
Monitoring ❑ Recovery ❑ Heat Pump Water Injection O Other ❑ If Other, List Use gncultuml El2. WELL. LOCATION:
Nearest Toxin: _ j�f tirqk ' 1/ County
(Street biamt. Numbers, Community, Subdivision. Lot No., Zip Code)
3. OWNER: .i a Fe
Address S5 R �r t-.t
(Street or Route No.)
__MI
L Lvnk M a07 i
City or lown Stale
Zip Code
id
1 I. DISINFECTION: Type
12. CASING:
Depth
From i% To 67
From To
From To
13. GROUT: Depth
From O To 20
From To
14. SCREEN: Depth
From To
From To
15. SAND/GRAVEL PACK:
Depth
From To
From To
16. REMARKS:
p; lt3 Amount /s
Wall Thickness
Diameter or Weight/Ft. Material
Ft.
Ft.
Ft.
Material
Ft. Gene a
Ft.
Diameter
Ft. in.
FL
Size
Ft.
Ft.
=i pastor_
Slot Size
in.
in.
Material
Method
po..eed
Material
304876
Topographic/Land setting
ORidge lrAlope OValley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPSOTopographic map
DEPTH (check box)
DRILLING LOG
From To Formation Description
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common road names
to 'it
cc.,
cm
O rim
03 so
_IC
a7 rF:P1
5
0U1
n
l /)91ns r,
1 DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
SIGNATURE OF PERS6 1 CONSTRUCTING THE WELL
'' f -"
DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center -Raleigh, NC
27699-1636 Phone No. [phone], within 30 days.
GIN-1 REV. 07/2001

305t792
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natnzal Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAMEG�(print)Tlilinen c giro S5 TR CERTIFICATION # Znr
WELL CONTRACTOR COMPANY NAMESS I01-1.1414: ee itkit 1)0: I Ii fis PHONE # eitat(ec -OH4O
STATE WELL CONSTRUCTION PERMIT" ASSOCIATED WQ PERMIT#
(if applicable)
� (if applicable)
1. WELL USE (Check Applicable Box): Residential QY 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 Tov j27 rS/,t// Countya/i' /
27o s/Re//n ten Jew Rd ZT175 3
(Street Name, Numbers, unity, Suydivisi Lo[ No '
3. OWNER: RO 6P/r r
Address 70
/
eX
Zip Code)
✓i/Rrs4iy/%`er NC 2t7r3
City or Town State Zip Code
( )-
Ares code- Phone number
4. DATE DRILLED // -// - 0 y
5. TOTAL DEPTH: (.la 5
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO Re---
7. STATIC WATER LEVEL Below Top of Casing: (90 FT.
(Use "+- if Above Top of Casing)
8. TOP OF CASING IS �• S FT. Above Land Surface"
`Top of casing terminated suer below land surface requires a
variance in accordance with ISA NCAC 2C .0118.
9. YIELD (gpm): 7 METHOD OF TEST / / .y, Yoe
10. WATER ZONES (depth):
(, LOCATION SKETCFL
I I. DISINFECTION: Type � Amount /0 0 2. Show direction and distance in miles from at I
12. CASING: Wall Thickness two State Roads or County Roads. Include the road
From 0 . To 0 Ft /i Ylku S, Diameer a Wedght/Ft Patgal
numbers and common , ad names.
From To Ft
From To Ft
13. GROUT: / Depth Material
From %�9,j To JC% Ft fti7cone
Ft
14. SCREEN: Depth Diameter
Topogryhic/L.and setting
❑Ridge Inglope °Valley °Flat:
(Mick appropriate box)
Latitude/longitude of well location.
-
(degrees/mimes/seconds)
Latitudetlongitude source.DGPS°Topogragbic map
(cheek box)
PULLING LOG
Formation Description
Dj'TFj
From To
From To
From # To Ft.
From To Ft.
15. SAND/GRAVEL PACK:
Slot Size Material
in. is
in. in.
Depth Size Material
From To Ft.
From To Ft.
16. REMARKS:
I DO HEREBY CERTIFYExTHAT THIS WELL WAS CO
CONSTRUCTIoANDARDS AND`/74A.c
SIGNATURE OF P
2/z
STRULrED IN ACCORDANCE WITH 15A NCAC 2C, WELL
OF 1111 CECORD HAS BEEN PROVIDED TO THE WELL OWNER
CONSTRUCTING THE WET 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

akti
3057817
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and1 Resources - ivisi n of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (•prirint)) VI (1W G jl? « 165 72 CERTIFICATION x 2.7E t/
WELL CONTRACTOR COMPANY NAMB5WOC-1W#Ttt Wei[O(: t fl CH— PRONE k y'raMaIW-OtdFCl
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT*
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential Vt Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection ❑ Other 0 If Other, List Use
2. WELL LOCATION:
,,� L/ //
Nearest Town: ••'T �/ ! unty A)
no C41,400 �/ 1�tk to 2 753
(Street Name, Numbers, unity, Subdivision, Lot
�No., Zip Code)
3. OWNER:/CG/✓Gv,I ikO/`# 4 getAddress 9 ZO C Ga,UtY fiL't[ g
lain it (Sup-et
9 2875-3
City or Tmvn Static Zip Code
Area code- Phone number
4. DATE DRILLED // OJ -td
5. TOTAL DEPTH: 2,0 5' r /
6. DOES WELL REPLACE EXISTING WELL? YES NO F
7. STATIC WATER LEVEL Below Top of Casing: 'S FT.
r„ (Use "+" if Above Top of Casing)
8. TOP OF CASING IS lr5 FT. Above Land Surface'
*Top of casing terminated atlor below land surface require a
variance in accordance with ISA NCAC 2C .0118.
9. YIELD (gpm): Jr METHOD OF TEST/ fl4 CO
10. WATER ZONES (depth):
11. DISINFECTION: Type CC /7
•
12. CASING:
Depth Di
From, gr Tom Ft
From__ To Ft
From To Ft
GROUT: Depth Material
From 0 To IC)
Amount /4 aT
Wall Thickness
or
5Lr4 t
latirrial
Ft. rAKG/elo/P
Topographic/Land setting
Midge ❑Slope Malley 'Wirt
(check appropriate box)
Latitude/longitude of well location
(dewreeemmuteslseeonds) c
Latitude/longitude source:❑GPS❑Topograpljic map
(check box)
DRILLING LOG
Formation Description
DEPTH
From To
v
LOCATION SKETCH In t]
Show direction and distance in miles from 7t iea
two State Roads or County Roads. Inclu eeethe ill
numbers and common mad names. . ¢
M od
.1 VF /*/ X
From To Ft
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
16. REMARKS:
_Nyu1 25 70
no
I DO HERE Y CERTIFY THAT THIS WFI I WAS CONSTRUCTED IN ACCORDANCE WITH 15ANCAC 2C, WELL
CONSTR ION STANDARDS, T A C Y OF THIS CORD HAS BEEN PROVIDED TO THE WELL OWNER
3—Or
SIGNA 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. (9191'733-3221, within 30 days. GW-I REV. 07/2001
7.71

305'786
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and atural Resources - Division of Water Quality - Groundwater Section
�,
WELL CONTRACTOR (U4DIVIDUAL) NAME (pr�inTt). (inn/ r 0.41 CERTIFICATION MtCp�.LLL!
WELL CONTRACTOR COMPANY NAM�Cj1w4-Ter (Lk (A0: 1 (tf1,5 PHONE a (f2.s?1(o 1'a117Q
STATE WELL CONSTRUCTION P£RMTT8 ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential IY Municipal/Public ❑ Industrial ❑ Agricultural ❑
Monitoring 0 Recovery 0 Heat Pump Water Injection ❑ Other 0 If Other, List Use
2. WELL LOCATION:
Nearest Town: Dr
1 s`7 /Qy! nser4a L3i"�.tlf ty"n 7
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
r
3. OWNER: E4OM /pp R/S3
Address 95-7 i 0San Di4yr(in A k' /
or Route No.)
frier `i, NG 2675\3
City or Town State Zip Code
( )-
Area code- Phone number
4. DATE DRILLED ��' O V
5. TOTAL DEPTH: 2 O) t _ / REtREC
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO Pr..-
7. STATIC WATER LEVEL Below Top of Casing: ) p FT.
E.---.(Use "t" if Above Top of Casing)
,
8. TOP OF CASING IS . 7 FT. Above Land Surface"
*Top of casing terra/sated at/or below land surface requires a
variance la acaordaneswith ISA NCAC 2C .0118. r —+---
9. YIELD (gpm): F. METHOD OF TEST) i m e
10. WATER ZONES (depth):
TopogcaglaWLand setting .;
ORidge OSiope OValley ClFlat
(check appropriate box)
Latitude/longitude of well location::.:
(degreerJmmuses/axonds)
Latitude/longitude source:OGPSOTopographic map
(check box)
DRILLING LOG
Formation Description
DEPTH
From To
11. DISINFECTION: Type (C. 6I.
12. CASING:
From__ _ 61 mew -
From To Ft
From To Ft.
13. GROUT:_ DepthoMaterial 1`4
Fro_m`%A` To 20 Ft. copier e f C M7 Q mm i)C
From To Ft.
14. SCREEN: Depth Diameter Slot Size Material
From To Ft in. in.
From To Ft in. in.
15. SAND/G VEL PACK:
Depth
From / To Ft.
From To Ft.
LOCATION SKETCH.
Amount /0 O Z Show direction and distance in miles from at least
Wall Thickness two State Roads or County Roads. Include the road
�t� FLAW
j Weight/Ft uRd numbers and common road names.
To _
0
16. REMARKS:
Size Material
I DO HEREBY CERTIFY THAT THIS WELL WAS
CONSUCTION STEWARDS, AND
T
n
SIGNA aF PERSON CONSTRUCTING THE WELL
NSIRUC fEDINA ORDANCE WITH 15A NCAC 2C, WELL
Y OF THIS RECORD HAS BEEN PROVIDED TO THE WELT OWNER
/—/DAT—Eay
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center -Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-1 REV. 07/2001

CtiCZ
To
To
13. GROUT{• Depth
From 1 To 040
From To
14. SCREEN: Depth
From To
Front To
15. SAND/GRAVEL PACK:
Depth
From To
From To
II. DISINFECTION: Type lit '10
12. CASING:
Depth, S� etter
From :L To S Ft. ID
From Ft.
Front Ft.
365802
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and IJ•rnr l Resources -^ Division of Water Quality - Groundwater Section
WILL CONTRACTOR (INDIVIDUAL) NAM a (print) I,J\{�.Lu±ASr4 CERTIFICATION, al—
WLLLCONTRACroRCOMPANYNAMIHF.UDEN CALDWELL DRILLING, INC. THONL47(8 754-3581
STATE WELL CONSTRUCTION PERMITS ASSOCIATED WQ PERMITS
(if applicable) / (if applicable)
I. WELL USE (Check Applicable Box): Residential"@" Municipal/Publie 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION:
Nearest Town: At.S 411_L
o)-b 4WJ sia3
(Strees Name, Numbers, (Immunity, Subdivision, Los No Zap Code)
3. OWNER:
Address if
1% County AB S oS)
�Au t C �tt
/Vi oroTt Ct hLt
(Sired a Route No.)
��CAV6GJILLt Nc
(Cr et
9-8lg`1
S
tyor Town 5-S56-l9 Zip Code
()-
Area coda Phone number
4. DATE DRILLED
5. TOTAL DEPTH:
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO
7. STATIC WATER LEVEL Below Top of Casing: FT
Nu -+- i(Above Top of Cuing)
8. TOP OF CASING IS FT. Above Land Surface'
•Top ofculog trrmluted ,tor below Ind serfue requires •
varieties Is accardaacA with ISA NCAC IC.alta.
9. YIELD (gpm): i METHOD OF TEST, �
16 (G ` Al (L-
10. WATER ZONES (depth): o r a (n' ry�
— r3Va, Gee"
o Amount
Wall Thickness
or Wcitht/Ft. Material
•
Topographic/Land setting
❑Ridge ❑Slope ❑Valley VIM
Wank appropriate box)
Let i tude/longitude of well location
Neamea/miesu aheemdQ
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DRILLING LOQ
0 Fo qpo�� vDescriiti�ipt' n
tr((d3 2A
`rat N L">r �i
o Kk- a G PrL
DEPTH
Frqm / To /
—
3D r— 16 6'
6
16bt— Sift'
Igo'tita
3Xof `to'
1 S`(t3ry
Ft. CMaterial Method
ic Walt)( j90 Lite L)
Ft.
Diameter Slot Stu Material
Ft. in. in.
Ft. in. in.
16. REMARKS:
Size Material
Ft.
Ft.
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the mad
numbers and common mad names.
Se—ttN CitetrIC-.
G
We
RECEIVED{DERRIDINO
AQUtPER@ROTECTION SECTION
DEC 17 2004
I DO HEREBY CERTIFY THAT THIS WELL WAS C
CONSTRUCTION STANDARDS, AND THAT A CO
4STRUCTED IN A
OF TIllS RECO
CORDANCE WITIf ISA NCAC 2C, WELL
IAS D FjEN PROVIDED TO THE WELL OWNER
SIGNATURE OF PLRSON CONSTRUCTING 'DIE WELL
DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mali Service Center- Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-1 REV. 07/2001

307718
North Carolina Department of Environment & Natural Resources
Division of Water Quality - Groundwater Section
1636 Mail Service Center
Raleigh, NC 27699-1636 Phone: [phone]
WELL CONSTRUCTION RECORD
DRILLING CONTRACTOR: Ilfroe (d✓ Gar/% sr Vr('s
STATE WELL
CONSTRUCTION n �' a/
DRILLER CERTIFICATION NUMBER: ..2 / b PERMIT NUMBER:
FOR OFFICE USE ONLY
QUAD NO. SERIAL NO.
Lac Long. RO.
Minor Bain
Basin Code
Header Ent
GW-1 Ent.
1. WELL LOCATION: (Show sketch f the location below)
Nearest Town: Hot 5pr; ty. County: iwadc0/7
(Road.�pCo munity, o�rk�/ttbdivision and Lot No.)
2. OWNER Re /?tt'• .7r1rf1,CrCzen--
ADDRESS 6 g� L,,t /q pity Oz-t •
(Street or Route No.)
dZ A j3-
7yf
City or Ttr Zip Code
3. DATE DRILLEDAh/E OF WELL /Poe
i. TOTAL DEPTH $0,c
5. CUTTINGS COLLECTED YES ❑ NO E /
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO P�
7. STATIC WATER LEVEL Below Top of Casino: p 0 IT.
(Use " + " if Above Top of Casing)
8. TOP OF CASING IS* I FT. Above Land Surface*
'Casing Terminated at/or below land surface is illegal unless a variance is issued
in accordance with 15:4 NCAC 2C .0118 9. YIELD (Pm):2, METHOD OF TEST Aft_
ft_
10. WATER ZONES (depth): I en a noel 4 r
DEPTH DRILLING LOG
From To
Formation Description
0412.5u12en
11. CHLORINATION: Type Amount Q a . If additional space is needed use back of form
12. CASING: '/ d v
From1 Death Wall Thickness
,p Dep' Ft. isMeter .y ctit/Ft_ ray. ial
From To o 7� Ft NIh,��/! r ,LOCATION SKETCH
From To Ft. (Show direction and distance from at least two State
Roads, or other map reference points)
13. GROUT: v €11
Depth Material aNtetbpd
From To 2 / Ft. (ier7r r X
From To Ft,
14. SCREEN:
Depth Diameter Slot Size Material
From To Ft. in. in
From To Ft. - in. in
From To Ft. in. in
15. SAND/GRAVEL PACK
Depth Size Material
From To Ft.
From To Ft.
16. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION ST.ANDARDS, AND THAT A COPY OF THIS RECORD HA� BEEN PROVIDED TO THE WELL 0
.9/9f

307
DRILLING CONTRACTOR:
North Carolina Department of Environment & Natural Resources
Division of Water Quality - Groundwater Section FOR OFFICE USE ONLY
1636 Mail Service Center QUAD NO. SERIAL NO.
Raleigh, NC 27699-1636 Phone: [phone] Lat. Lond. RO
Minor Basin
Basin Code
WELL CONSTRUCTION RECORD Header Eno. Ow- I Eat.
/uf//e/tuelf % r zwi`L5
STATE WELL
CONSTRUCTION DRILLER CERTIFICATION NUMBER: r) 5 96 PERMIT NUMBER:
1. WELL LOCATNN: (Shom sketch of the location belowL
Nearest Town: ISf /lQ5 county:ma v l 10F Sat)
(Road, o unity, or •.ubdivision and Lot No.)
2. OWNERADDRESS
(Street (Street or Route No.)
f)c-fit, / PLe 37 L/y -/
City or Town �/S_/c Zip Code
DRILLED
3. DATE DRILLED 5/t�' OF WELLHOu5°
4. TOTAL DEPTH 666 /
5. CUTTINGS COLLECTED YES 0 NO lY /
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO C➢�
7. STATIC WATER LEVEL Below Top of CasingCasing$112117 FT.
8. TOP OF CASING IS / ' FT. Above Land Surface•
'Casing Terminated atior below land surface is illegal unless a variance is issued
in accordance with 154 NCAC 2C .0118
9. YIELD(gpm): _ �J� METHOD OFTESTP/7
10. WATER ZON€S{Idepth):
11. CHLORINATION: Type Amo
12. CASING:
0Z
W II Thickness
_ 1 De t�i], eter Or WeiohUFt. I. ial
From 1 To ✓✓ . Ft.
From To FL
From To Ft.
13. GROUT:
^ Depth MgtereidnJ pry
From L' To . Ft. (••efn �I'
From To FL
14. SCREEN:
Depth Diameter Slot Size Material
From To FL in. in
From To FL in. in
From To Ft. in. in
15. SAND/GRAVEL PACK
Depth Size Material
From To Ft
From To FL
16. RENLARKS:
DEPTH DRILLING LOG
From To Formation Description
0 31 CveQ8uo?Pen
3 / 446 Ran;>4- _
(Use " +" if Above Top of Casing) co
Da
If additional space is needed use back of form
LOCATION SKETCH
(Show direction and distance from at least two State
Roads, or other map reference points)
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWN�
Q2roid 9 iIIkbri►j' 17
crru ATrmr !It rnrlrro•rrnn no.rrwrr en -re,

0"- 307700
North Carolina Department of Environment & Natural Resources
Division of Water Quality • Groundwater Section
1636 Mail Service Center
Raleigh, NC 27699-1636 Phone: [phone]
WELL CONSTRUCTION RECORD
DRILLING CONTRACTOR: / wit Cs, we V
CONSTRUCTIONS �/
DRILLER CERTIFICATION NUMBER: <.
STATE WELL
PERMIT NUMBER:
FOR OFFICE USE ONLY
QUAD NO. SERIAL NO.
Lat. Long. RO.
Minor Basin
Basin Code
Header Ent. G W I Ent.
I. WELL LOCATION: (Show sketch of the location below)
Nearest Town: Ate it4If County: /f -ssi,1S
(Road Community, or Subdivision and Lot No.)
2. OWNER k,Ctee l• agoI !—
ADDRESS V-7-4, J h, 4.104 j e4
(Street or Route No.)
tAL 4 J) I ( Se,
City or Town Statn
Zip Code
3. DATE DRILLEI�D/OJ ctr USE OF WELL laze,
d
4. TOTAL DEPTH S
5. CUTTINGS COLLECTED YES 0 NO 0'
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO‘2*------
7. STATIC WATER LEVEL Below Top of Casing: FT.
(Use " + " if Above Top of Casing)
8. TOP OF CASING IS 4- ( FT. Above Land Surface*
'Casing Terminated atior below land surface is illegal unless a variance is issued
in accordance with ISA NCAC 2C .0118
9. YIELD (gpm): / f METHOD OF TEST
ID. WATER ZONES (depth): `t DS
II. CHLORINATION: Type Amount
12. CASING:
A
Wall Thickness
Depth Diagmeter Or Weight/Ft. Material
From *) To W D FL Ar9 I FOC
From To Ft.
From To Ft.
13. GROUT:
Depth
From To 00 Ft
From To Ft.
Material Nj;i tllgd
/t1 Y
14. SCREEN:
Depth Diameter Slot Size Material
From To Ft. in. in
From To Ft - in. in
From To Ft in. in
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft
From To Ft
16. REMARKS:
DEPTH DRILLING LOG
From To
0 L/a
LID
Formation Description
OCI&�bvceioos
2S 5loe/74t
3
If additional space is needed use back of form
F
LOCATION SKETCH
(Show direction and distance from at least two State
Roads, or other map reference points)
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER.
1ho» J /d n / ii e /D -75- odv
CyrNIA TrmC nrr`rIIUTD Ar'rnn no e! M,. TIon,

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and rural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) N (print)t, /0 A0/ I G1 ,� .n$IiL L CERTIFICATION r?8 %7
WELL CONTRACTOR COMPANY NAMFJ j J& 4614111 PHONE ,r(��r19•t Z an 5"Jb
STATE WELL CONSTRUCTION PERMTM /1//%Q— ASSOCIATED WQ PERM TO /�/" F
(if applicable)
(if applicable)
296087
1. WELL USE (Check Applicable Box): Residential ii Mtmicipal/Public ° Industrial Cl Agricultural °
Monitoring 0 Recovery ❑ Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCA Of
Neaµ�tTown: SSAeC a _. 2, County,
ac+. JR,A. Aa ..t.1 ',CA.' cue .sflf)
(Street Name, Numbers, Community, Obwvuioe, Lot No, 2)p Code)
3. OWNER: e��
Address •J SS Leese&
City or Town State Zip Code
Met code- Pine number /
4. DATE DRILLED 7/72 J5j//� Y
5. TOTAL DEPTH: 7'S
6. DOES WELL REPLACE EXISTING WELL? YES, Q NO JRl
7. STATIC WATER LEVEL Below Top of Casing: A FT.
u "+" if Above Top of Casing)
8. TOP OF CASING IS /...5FT. Above Land Surface'
*Top of casing terminated ator below land surface requires a
variance In accordance 1SA NCAC 2C .0118.
9 YIELD (gpm): MEJJIOD OFTyST H
4" O
10. WATER ZONES (depth): D
11. DISINFECTION: Type ('. /4. //l
12. CASING:
Depth From 0 To Ft
From To Ft
From To Ft
13. GROUT: Depth
From_PTo va2f)Ft
From To Ft
14. SCREEN: Depth Diameter
Fro o Ft in.
Fro To Ft__in.
15. SAND GRAVEL PACIC
th Size Material
Fro Ft
m' To
Fro To
Amount h.
Wall Thickness
or Weight/Ft
#J/
Topographic/Land setting
°Ridge 110S1ope °Valley °Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:CGPSDTopographic map
(check box)
PEPTH DRILLING LOG
From To Formation Description
r
N
LOCATION SKETCH 3
S oz. Show direction and distance in miles frotnat least
two State Roads or County Roads. Inclu& the70ad
Mgal numbers and common road names.
e.
Slot Size Material
in.
in.
16. REMARKS:
Ft.
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUL IF) IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, Atp rHAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
SIGNATURE OF PERSON LrtSNSTRUCTING 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

309232
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment a ?? ��[[
WELL CONTRACTOR (INDIVIDUAL) NAME (print),1LiR�N"� fi. �i /VAS CERTIFICATION'gISSN°
WELL CONTRACTOR COMPANY NAME�JI t4SO» [.(,/a/)7zl'Ji N 1 LLGe PHONE pq.}ur Z58'Bg9 Fz
STATE WELL CONSTRUCTION PERMIT# JJ ASSOCIATED WQ PERMIT#
(if applicable) — (if applicable)
I. WELL USE (Check Applicable Box): Residential IG/ MunicipaUPublic 0 Industrial 0 Agricultural ❑
Monitoring ❑ Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
ural Resources - Division of Water Quality - Groundwater Section
2. WELL LOCATI N:
Neat Town: [.-d / /1 County/V, o".
CL'ge tie( /&I
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: 1o/✓d'i't �,e,-%F;;„
Address /a/ S r eMw / 7,, 2-/.
(Street or Route No.)
fi7 .e572/,Y/ .re . tR7r 5,-
City or Town State Zip Code
((?Si- b 8 9-ems -.
Area code- Phone number,
4. DATE DRILLED it "2C-cLE
5. TOTAL DEPTH: Zt
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO 3
7. STATIC WATER LEVEL Below Top of Casing: `10 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS / FT. Above Land Surface*
*Top of casing terminated aVor below land surface requires a
variance in accordance with ISA NCAC 2C .0118. pp
9. YIELD(gpm): `e METHOD OFTESTNOWtVit1 q
10. WATER ZONES (depth): cr ./ /TO' JJ J
11. DISINFECTION: Type00,' -te
12. CASING:
0 Depth
From To Z- Ft. h/zrtameter
From To Ft.
From To Ft.
13. GROUT: Depth
From 0 To At)
From To
14. SCREEN: Depth
From To
From To
15. SAND/GRAVEL PACK:
Depth
From To
From To
Amount J0 ,.S,
Wall Thickness
or Weight/Ft. Material
5/4/l,/
Material
Ft. CoNcede.
Ft.
Method
?Al16/;V q
Diameter Slot Size Material
Ft. in. in.
Ft. in. in.
Size Material
Ft.
Ft.
Topographic/Land setting
ORidge slope OValley ❑Flat
(check appropriate box)
Latitude/longitude of well location
Pr" </7.A9e ✓ttn"4. G
(degrees/minute�% er onds)
Latitude/longitude source: 0 PS❑Topographic map
(check box)
DRILLING LOG
Formation Description
DEPTH
From To
0 - /Y
4-- 21 ,Sr•..r/t/r�+t
3 - .tor C..4: 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.
T ,//r-ty EeA--tear
/ji%as W1'/,NC
16. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH I5A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNE
a, 7� � //-Zr-
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center- Raleigh, NC 1
27699-1636 Phone No. [phone], within 30 days. GW-1 REV. 07/200?I'
rt

Sa&__- 9' syy—
\vr'IL' 1_-'I�/N}�,'FIRI IL'=1.11�N Rt7C.ORD
UI ..(li1 I n.,-t n_J"+/V6�J ,r,.cs-Div ioj�i�i rcr -
W N Quillil - l]f011rtd19d1 i Bicijoli nr'�
INDI1 IL., V \I y.r 0 U�R j(.� �� <,.�,.� ,_ p ,/ /' CC1 IlFlCiTlOnr
�i1 •�. liY 11' ,Y 1I12 L t� �>tY<.� ( ��YHDm« y�IRS a 5 fl-�'VLc..
.5bS CI r L:I 1YQ ('URm ITu
L C r l' N P G Y •111 Tn
pl.a::cla E i I -e;o_
) LD
309236
ip..UP uli,: ITJ IIIJufrtial L7 A.OLlculnlral Q
1111,1<h I I.J Cher U II Llloci Liit LLc
r�14ATA0// Maid/ row
G,Wie p'sive
=r Ra.„,Yu1
_,/niabkj/ xc a�%S3 DEPTH
From To
.,: t: D 1 -1 A4iy/»'1
ELL REPLACE EXISTING WELL? YES Q NO II _
_Y.;TIC 11.-:!_F.. LEVEL Eioluvr Top or'C,sln,: _-24____1:1•.
j1,.`.. ; (ADalc fop uCCa. . p :, F CAS E EMS IS _.__I___— ET
'nlula l:a:eur LN E. lua .ol is a rul MlrGa U
9 V IEI , i. __� -_ iIIETHnD Or•'as 1%Lit] iljry�-.73 ----
11.+.1 ?'j�'L; h'E�t,lcpinl. e1/C' t _.-__-----
Topogr- hiciLund setting
C RIdgc OrEIRL.pc DVallcy QPla.t
(chcrl: .IPfraprian bo. )
Lolinldc/longii,de of vcll tocon
d/ Sr ver. 067cvo81u y7,ro qj '
(Jcprcc 'rr:inur-cundc)
Lw(uJc;lougiruJc sour efr5SOTopoaraphic map
(Gleelc bU$I
DRILLING LOG
Honor en Doseriptioa
U$_FL`f.L-S
FI.
s :JUT
] 7n
IJ -.YF: `.'I`11. ... '—..,,.,� 1 „ LOCATION Sk_FPCH
- F'4le.tr .CCS__ Amount �102_Shaw iGrnt•rion nod d tank in miles from a[ I,:;hr
W.JI r l r I'Itci3 nc,xn Iwo StAI�. Ronda or County Roads, Include the road
Iwo
Jr 1V.. 1 ;1 .
FI. unlnhd'3 and common [Gild names.
//3 --
!J
---�.G ' ^ cn al ititcu )U
F(. �—�Q�feu
U
M.
•CLI
ffJot
. ;eh'. re
n- ;AND .3I.ti-.A'ELP-A.CK
Po
Dralllcl:r Slot OI1 i11 a[rrGl
Ftia, in
FI_
Alal3rlal
i 03 rLU EE\ CERTIFY TH `TTWS \YELL WAS CONS1IiUCFED EN ACCORD:,NOH WITH ISA NCAC 2C,
CCLJSTP,UCTION S1 ':VDAl'DS ANOTHAT A CONY OF THIS I ECOI,D HAS BEEN PROVIDED TO THE WELL
OWNZR
RSON CON3TRUCTIINOT LL
vA7
3L.o mil r rn:anJI;iuu1roEno Wtloion of Warr/ Qualiry, CrouildllaLcr Spoqun, 1636 A9ail Service Ccnror-Rnlelgd,ry�,
rc 7 Iear tinrr yi tyly) 73� 3.71, whit in 3d dap'.
GW-I REV. 074200I
_IV L3J:

309239
VI- PIA Ct)N TI:I IC'ill) N Li 'CO1 D
... ul `i t',I , -ru .'J Iv•wr;+l f .,.r..• l7ri, of\Y for Cualiof- OrounaldNr Section
ci \, me eb6by w -V�dfLlf} �,C1I11F1C,1•lON to-20aS
� _ 0< IiF -.Ay Y-mi.' ferszCSowS �.C!P,L/ 1Lz/Lil✓Q Co . rnorv4 A-3A aS u.�_,.Ltc4..
. - .0 .nt=It.rtLl=i
C i I c,i ,I {d , i iLP, bj. U urchin' iul 0 - rlct,lrtrral 0
-_ ry ❑ If 1r -np ter lore, IJ l: alci ❑ L' cgher• List Wt..
(l JAi
SAir
6,� /tiG
3+Iba
Cowtrv. y--
I , 'iI) c-I J:I
_ roS S
d 6 a677
iV01
Pj1U r�/i%l iVr 2 pr1X7
Sk-i:5!5 3t!t 6" From To
97 - Sz.
. .,.:u ; cln011
D_ IJ E,_ Ft a C to ul'�/�p
Hcpm C61ncn.r Sloe Size INntanll
r'waI 'r-. Ft.
ill m.
I'I. In. tu.
IP <ND: Ci:�.=.1i EL I' AC _"—'_
-"I';II S;xc 1lit.rul
a.r' I - Ft.
rrol, l 1': Ft.
r t�
Far' t�r!'1_h' c —��- ��fC
Topogr. is/Land serting
ORidgc SIc,pe ❑Valley L71-)zt
(ibreI: .,Gpmp,iuft bol.)
Lalinlde/longitude of ell Location
N 3S • V%l RL' Cvng2 d�/-71-36
(icelec mina
L,iutudr;lougiiudc soar e: 13'uYS 0Topoaraphic mtlp
tchc1I box)
DRF N DRILLING LOCI
Fonnlrion Dccription
D1�7-
�oC%C
1 LE ILLIL CEEXISTINGWELL? YES U NO• L'J
f _1'i� 1,..!r:;rEVELEidowTopor'C„ins:
Wsc iinoitc Top ur Cam.*.
_. a' OF CASINO IS -
,r:p. F'P. =.bout -]aid sui'tai E"
'I :.:L lly rPm ul]raa AVur bclu,r I411:1 of is rci)YIrcS u
YIELD D , ,_ i41ETNN9D OF TES l 3 »La. AIERRDNES tit
araNl��
LOCATION SJCEl'CH
I! Iri c' I`1i' pi,pcClO �' �� Knloui1L 3py Show direction and distance in miles from at Icasr
Liu
W:AI I hl-lyncii ONO ' SCah. Rotlds or Gothic), Roads. Juchlde the rood
i¢pfn )_ 4lneiY 5, '1 ou1t 0 l.ucna uumhcrs and common rotld IlanIleS.
...:1.--0-__ i._52_ Fr_�t2,�_ 3L1e. A5 A/c SDRA/ /- �I
...,,l1 r.;_ Ft. _—_ ENd 6f UTTlC r NC-
IN95tcnal P
j')?,4rtS `1A // KC.
D i6 rc51 CFRI IFY Th+PTHIS WELL 41 3.2 CONSTRUCTED IN ACCORDANCE +afI L:i'17.. v S1.:N-TDS AND THAT A COPY OF THIS RECORD HAS HEti N PROVIDED TO THE WELL OWYNER
3 uN..xns l urp rgo3N CONSTRUCTINGI'H E. WELL
D.\T�
3,. ullt rn; on dual m tna phi iiu11 3 \Yarc(' Quality, Grown d - l:cr Scotion, 1636 Mail Sd'viec C,:nrcr- l:aleign, 1vC'.
't .o ; Moult tr. I -II )) 7333 21, mill in 3t1 na)•i.
OW-1 REV. 07/200-1-,

3 9 2 4 t)
W1-L1 CTCN.Fvu
- aii.) N.,Fui Ci“ - Diyin i Waior Qpoi - Orounclwalcr ',71:11:s011
‘ 12 Li_ 32,3N s Da.3:13.sa aNsal IL'.sALs Assi‘si eb &by 0 11L-5 C'CIZTWICATION S
's 3.3N: L iOj i -.11 rerj....Sofi.:1 Lidij Dzi_11417,t5 . etioric 2,38S z-zity4,
-.r e I I l'N S.3 a I 431' D W Pr.D..6 I ETU
. LEj ILp.4uPpmic ITO toapiirrwi 0 AsincuicurAl 0
:cso's 0 11.7.3i Pump 'A oloi lilsoossOn 10 OIicr Lk Itittlicrt List bist
I 'Otis:
C4rdia// CD/4ty44440
---M
AC Pr:serve at hilt& _alit&
cv.-1,7)
r_uices
1.2,P (0 5 Hui, a6- 70
Pis 9.5"1/471
P.121t.:CLS A /2_iPTH
In Lo
5 13 i A_L. DSP FH
OS
------1442e-
3.5E5 1\ ELL Pi:PLACE EXISTING WELL? YES' 0 NO Li-----
s-trt-ric vi.=.1:12-a LEVEL &low Top of Casmw q0 FT
. co,c Id1 of C.tramt.t)
_I_____ FT A DOND EN.lit2 Spili,:c5'
ur DcluIr laud n4 iti“ rcquircs u
5A NICAC 2C .01 Is
METHOD OF TES r )31,041,1 fa,2 p_i
OfS,ILL.
33P .Ols CAF:Th0 IS
JLi4I4rflhx1'4 Os
YIELC 7a9
s.TER.S:CNE:s t.,:cpu)):
C3n1 Co_ FL.
0 Fijak.5_ Ath15 -t
-rhea.eSertifr
F.
.3 JIIICLiM1e---S
t IY1c1113i1
4
)141/1
(
11 / 2,24.
LOCATION SKETCH
.1 015:NI5L: 7t0i5i Cif Kffici / ?pa clmocpon and distance n iniks from AI leas)
Wan Ibid,ncii two State Ron,1 or Counry aCnuis Include the rMILI
Drilm‘ter or `.11;:i0f Pt etaic.1141 tom -Mom )ind common rood runte.i.
From , To
35
33 0'0
1.4#1:o 1,11.31416 DEW'
pogniphiciL))/td seffing
y
(thcCIC. .eptiroprialt box)
L4firuckilorigiro1c of well location
pti 35 'cis, etz;44,05n/t7,
tict4 (CC S.'(fililutcSISccOflas)
30LtrOO: eitt)SIDTOpogislphsC rim
toli‘ag DON)
DRILLING LOG
Formation
40 —
bt/cP
I
Fat to U sNI---/--
Fccnit.. 1..s EL
I, c'.CP RFN 0.7i.cn pi:ants:lc( Slar SI2o 6kilosLa
Fisk-ls i C Fr n. in.
Fl III. 1.11
I:, c-;A15: n:C.iks.`,' EL P *OK:
Dcpin
ru
Fmot L.I_
3 1E6IAR_D-3:
U4T 14Li-11
03 n&EB EariFY THATTHIS WELL WAS CONSTRUINTEDACCORL.-).NCE WITH 13 NCAC 2C, WELL
NS ST.-..NDARIDS, AND THAT A Copy OF THIS IZSCORT) HAS BEEN PROVIDED To THE WELL OWNER •
S R..Ort CONSTRUCTING' THE WELL
Lflc uiii141 ro tn 0.111.•;ion \\ 41cr Qt.)licy, Gro wii j‘i 1:,h• S“criu a, 1636 Mo ISCPYi0cn04. - RJei, NC
:JF-4o3o FIioo Ao. t91:)) 733-3121, nirnin 30 Luys.
OW -I REV. 07/2001
p

FLOC'
LEM A Ric._ S :
Le: n Lecpito.
\ 1- Ittl ILTTIC)N R,17!CORD
- 1:11‘11.79iI-11.7.4-il 411J 19 -Oiypr;.E.Lq Walor Qudliry - GrOurinveScetion dIct
L1 CLL.:Cr\ \ geby t--ort-i-} ofi!f•-rivitirion n,2023
N C ferscsonCI vit3g3 a577Zr74,
uocricqi 4'a C I .4: l' 1:1 11)(..) PURA ifno
309242
InJw.irr1 fl A.bniEniniro 0
; 2 ..7N LEun Difici 0 h'Cnlicr. Lii 1_12-nr,
ArtSAa if co insar-Ci DA/
‘t_h_c Pre_seeve or P Z.,.y2ticAtvz_
.. •
Fr -Sitar" ee--)0/VS Cealit
)
_/12_ 44e5ALW ArC e? 7S
zip
, .
go) k 6 g_ em-qy
of,L,
far Lvp
E 31/4)ES ELL 1,2PLACE EXISTING WELL? YES LI No
ATEn LEVEL Bc.13W Top of 300 FP.
tUic Apo,: Tun uN24.,n,,,
C.-;.SINJ IS Abort Liao Sur6c4.7
2,1n4 5C,or Dcl“w Liij ui rr uciiinr“
\rah 5:". 20 .ul is.
IEL; nIETELOID OE TEST..abithStyZeli.
Topogrni, ielad Lnsewing
CIRIdge 031cape 01/2/411cy OF141
lehc“1:p apfit topria box)
L.Lticudd/longaucle of well I....
L,imicicildogitLidc source: CLI)SOTopoLaraphic reap
owe': box,
DI:ELLEN° LOG
Forrnacion Description
y Yx, igeev 7K2(
P'11-1
Flom To
0 —trd
Y5 - S3
5..1z —4DS
3
LOCATION SKETCH
DES:NFE:CitCri\ T‘spc:CL22.4;Kinount clifetiOn nd diinthee in rnik froth 41
L2 C.CIN3
'Enidolci3 IWO Stte Roads of Collars, Roods. Include Lhd rood
4.5;;3111 jf Wc.01,-Ft 'and Common road names.
:•13:11
1%,C-3 Ff._4_ aik./A3 a/C 5.DAA/
Cc:
,,,.._,F I. aft!
2
NC
., ,ui D,T(EL - MUicicil racifiOn
:,.310---(0,_ 13—a1C2_,_ Fc.—Ct2e(aCa too etilt ,..coili 1, FL
i-r 5CFRITN Cicp‘n DwinElcc Slot ':Th'c. M A LritLII
610A: T.: Fr.
—____ • ttl. ifi.
i:Le.r6 IQ FL
S \ EL PA.CK:
SE4c 41.C.Fial
FL
ae_se rut
iyUtash-f-14 A<C
DO riSREBy CETIFTHWf15 WELL w.s CONSTRUCTED UN ACCOEDThCE WITH I5ANCAC2c, WELL
LA:NS TFOCTI3N &REIS, AND TI-1*T A Copy OF THIS 11E00E:1) I -RE FILEN PROVIDED TO THE WELL OMME:11.
,t/
S
RSQE.I CONSTRUCTLICr 11-1E WELL ID:.-VTE
U IU/ U1 rttu1 tO tne Diti or w (cr QuAliry, Grunnthi ;Arc!' Sccrion, 63 6 Mall , Servier Ccnicr - Croh-Nio Hion00 733.322yirnin 3L34
?ft:
G W- I REV. 07/2001