Mi CY2004

WELL CONSTRUCTION RECORD 293251
North Carolina - Department of Environment and Natural Resources- Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (aim) (. 424.? Tu Clan sE cERTtFtCATtoNa 2/�
WELL CONTACTOR COMPANY NAME Ti( 74% r C.C11.e�ID,(.c,f /LA, PHONE It f 172-Yd( g
STATE WELL CONSTRUCTION PERMITS ASSOCIATED WQ PERMITS
(if applicable) — at
re)
1. WELL USE ((:heck Applicable Box): Residential iMaircipal/Public O Industrial 0 Agricultural 0
Monitoring ❑ Recovery ❑ Heat Pump Water injection ❑ Other O If Other, List Use
2. WELL LOCATION: / 1,,,�j%�%�
Neatest Town: 114 ,�iiia >«'i ic countyy��_""`• ,11
(Street Name. Cewmmkr, Subdivision, LA No., Bp Cade)
3. OWNER: L nI 5 (.e*'i"
Addres¢'C? i /39
(Street or Route No.)
ike9Slv; •{7 V
oy or Tema Sox Zip Code
Ma coda Those camber
4. DATE DRILLED /—/ S/— 0
5. TOTAL DEPTH:4,G//5
6 DOES WELL REPLACE EXISTING WELL? YES 0 NO
7. STATIC WATER LEVEL Below Top of Casing: yC Ff.
(User if Above Tap of Casing)
8. TOP OF CASING IS / FT. Above Lad Surface'
'flap of eosin toraataard maw below Gad surface oprm a
variance he accordance via ISA NCAC 2C MIL
9. YIELD (gpm): / METIAD OF TEST /4 /!2
10. WATER ZONES (depth): / &-' / /40
O
�ppographic/Land setting m
merge OSlope []Valley OFIatca
(check appropriate box)
I.atitudellongitude of well location
oreuvesooiootedsecomo
Latitude/longitude source:OGPSOTopograph(cinap� '
(check box) c
DEPTH DRILLING LOQ i
From To Formation Description
11. DISINFECTION: Type C CAtr,Lfe Amours `() O L
12. CASING: . Wall Thickness
Dianeta a Weight/Ft. Waist
Depth
From To Ft.
From ‘% To I Ft, to ,f _ U
From 3 5- Tot 6,/li( / 8
13. GROUT: Depth Material Method
From ToFt
/�
From�To 2.> FL 6'Iy P/ihte c
14. SCREEN: Depth Diameter Slot Size Material
From_ To Ft. in. in.
From To Ft in. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
16. REMARKS:
I DO HEREBY CERTIFY
CONSTRUCTIONSTAN
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
ramtbaa sad common road names.
zz'-i
F�gee £14 LL0 1 f`a�
TTHIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C,
, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE
I `
ER Viz=
SIG(WIOF PERSON CONSTRUCTING THE WELL DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 ma Service Center- NC
27699.1636 Phone No. [phone], within 30 days. OW-1 REV, 7/2001

North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
1636 Mail Service Center - Raleigh, N.C. 27699-1636 - Phone [phone]
292363
WELL CONSTRUCTION RECORD
WELL CONTRACTOR- newest Wright WPII Pump Co . Inc
WELL CONTRACTOR CERTIFICATION it 2686
030638 STATE WELL CONSTRUCTION PERMIT#• I esliP Roane
1. WELL USE (Check Applicable Box): Residential © Municipal 0 Industrial n A
Recovery 0 Heat Pump Water Injection n Other ❑ If Other, List Use:
2. WELL LOCATION: (Show sketch of the location below)
Nearest ToWn:.-_PllogIcail - County: MIT„ CHE!r Urr�, r �T�rtSE-�lt.
fl
W oad �a 0 s,�c�mm9FFo Ya�e� eFf RD. OFF F�1Y AS `.iL1 f uIIAI )EKE
DRILLING LOG EPTH
3. OWNER Jnh3FS Ma.From To Formation Description
Address % FREECch11ATIpMg...), 1255 HWY 70 WESTQqF�e 101 246 GRANITEp0 101 MUD GRAVEL
City or tTON State NC 2Zf6Ctld246 247 E
4. DATE DRILLED 1/812004 247 285 GRANITE
5. TOTAL DEPTH 285' �J
6. CUTTINGS COLLECTED YES 0 NO I R
7. DOES WELL REPLACE EXISTING WELL? YES 0 NO r
8. STATIC WATER LEVEL Below Top of Casing: _g^_ FT
(Use "+' if Above Top of Casing)
9. TOP OF CASING IS 'I FT Above Land Surface*
*Top of casing terminated at/or below land surface requires a variance in accor-
dance with 15A NCAC 2C.0118
10. YIELD (gpm)' 311 METHOD OF TEST Air
11. WATER ZONES (depth).111 nn gpm9df-247 n nn ppm
n nn gpm n nngpm
12. CHLORINATION: Type NTH Amount 43
I Monitoring
JUN/ 2 5 zu04-
F
ro
Y �m
N CD.c
'C Crr
-
�+ rn
-y o
If additional space is needed use baclaof foroz
G1 --f
13. CASING: LOCATION SKETCH CO i
Wall Thickness \�
Depth Diameter or Weight/Ft. Material (Show direction and distance from at least two State J
From 0 To 1n+5 Ft 6 1/4 188 GAl .}f_ Roads, or other map reference points) ,.
vel
From To Ft .�
From To Ft IjX&co
14. GROUT:
Depth Material Method
From' n To 2n Ft Cement C_r vit __ty. Flnw
From To Ft
15. SCREEN:
Depth Diameter Slot Size Material
From To Ft in. in
From To Ft in in
From To Ft in in
16. SAND/GRAVEL PACK:
Depth Size Material
From To Ft
From To Ft
Creel We • ❑
g
17. REMARKS.
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RECORDD HAS BEEN
ASS BEEN PROVIDED TO THE WELL OWNER.
SIGNA E OF PERSON CONSTRUCTING THE WELL DATE
Submit original to Division of Water Quality, Groundwater Section within 30 days GW-1 REV. 12/99
FOR OFFICE USE ONLY
Quad No'
Serial No

• 295538
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
t)
/Q Wit CERTIFICATION#�(�
WELL CONTRACTOR (INDIVIDUAL) NAME (prin
• PHONE # t33-468=4440
WEI.I. CONTRACTOR COMPANY NAME Yadkin Well COM an v Inc
STATE WELL CONSTRUCTION PERMIT#
(if applic able)
I . WELL USE (Check Applicable Box): Residentialela Municipal/Public 0 Industrial ❑ Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection ❑ Other 0 If Other, List Use
ASSOCIATED WQ PERMIT#
(if applicable)
2. WELL LOCATION:
Nearest Town: SD bus,. Phi' e County tli
(Street Name. Numbers, Community, Subdi ision, Lot No., Zip Code)
3. OWNER:
Address
City or Town Sta10'' Zip Code
Area axle- Phone number
4. DATE DRILLED ' -
5. TOTAL DEPTH:
6. DOES WELL REPLACE EXISTING WELL? YES$ NO 0
7. STATIC WATER LEVEL Below Top ' of Casing:
_LQf .g) FT
(UseTop
8. TOP OF CASING IS FT. Above Land Surface*
*Top of casing terminated auor below land surface requires a
variance in accordance with ISA NCAC 2C .01 IS.
9. YIELD (gpm): 3 METHOD OF TEST ai r onmn
10. WATER ZONES (depth): 'I~r d 6 r0�--
11. DISINFECTION: Type ea
Amount
12. CASING: Wall Thickness
�r �Diam)e1 or Wei ihti M'
From_�j—_To thO�/FI..SZ' ��--c� i« r� fee,
From To Ft.
From To Ft.
Material Method
13. GROUT: Tepths + r�d Aa4_62W
From__ ToAL_Ft. �r
From To Ft.
14. SCREEN: Depth
From To
From To
15. SAND/GRAVEL PACK:
Depth
To,
To
From
From
Diameter Slot Size Material
Ft. in. in.
Ft . in. in.
Ft.
Ft.
Size Material
Topographic/Land setting
❑Ridge ❑Slope ,NValley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
❑To o ra hic'Map
Latitude/longitude source:❑GPS p b p
(check box) -
DEPTH DRILL_ I
Formation Description
Soil
Vet }rfol k^L,..
ij ( (,rgr; rr_
H l:a.I G.x:ti
/KA
Biser. # Size off IS-,- 63�'
It l-�Y is ,—
•t 2-1734'(iLOCATI_ ON_ SKETCH `r• d 0 i" 6 S01- 6:2
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common road names.
\X
tea
gti.e p
� pL
16. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH I 5A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND HAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
•��� GW-I REV.07/2001
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC [Oa -24 S—
�D3 �__.,..,oioi-7aa_z221. within 30 days. Ann lJnCCjhl

North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
1636 Mail Service Center - Raleigh, N.C. 27699-1636 - Phone [phone]
WELL CONSTRUCTION RECORD
2 95 327
WELL CONTRACTOR' Dewey Wright Well Pump Co
WELL CONTRACTOR CERTIFICATION #: 2686
040161 STATE WELL CONSTRUCTION PERMIT#' Leslie Reece
Inc
1. WELL USE (Check Applicable Box): Residential
Recovery I I Heat Pump Water Injection
Municipal 0 Industrial D Agricultural El Monitoring 0
Other El If Other, List Use'
2. WELL LOCATION: (Show sketch of the location below)
Nearest Town: _pAitcgwu I C County' kslrimaw
•i it1Yaallxrtlials.a9�,'»tN, itP6sPF,a, lraio c1) OFF I-PNY 22
3. OWNER PHIL BROWN
Address of. AAni INFTellkICCO OI floe D n Dnv P7')
' 15HEbrteltbatrdor .. '
City of rBAKER�UILL own State NC 2827pC ae
4. DATE DRILLED 5/10/2004
5. TOTAL DEPTH 245
6. CUTTINGS COLLECTED YES 0 NO I XI
7. DOES WELL REPLACE EXISTING WELL? YES I I NO
8. STATIC WATER LEVEL Below Top of Casing: FO FT
(Use "+" if Above Top of Casing)
9. TOP OF CASING IS 1 FT Above Land Surface*
*Top of casing terminated at/or below land surface requires a variance in accor-
dance with 15A NCAC 2C.0118
10. YIELD (gpm)' 3 METHOD OF TEST Air
11. WATER ZONES (depth): 1 50 corn 1 50oom 178-170
fl fhl pnm l Illppm
12. CHLORINATION: Type HTH Amount df1
DRILLING LOG
From To
n �O
48 63
DEPTH
Formation Description
MUD ROCKS
GRANITE
63 64 QUARTZ
64 178 CRANITE
178 170 SHALE
170 245 CRANITE
13. CASING:
IXI
Wall Thickness
Depth Diameter or Weight/Ft. Material
'= rom 0 To 51 Ft. 8 1/4 .188 GALV
From To Ft
From To Ft
14. GROUT:
Depth Material Method
From 0 To .-20— Ft. _Cement _GrAsity Flow
From To Ft
15. SCREEN:
Depth Diameter Slot Size Material
From To Ft in in
From To Ft in in
From To Ft in in
16. SAND/GRAVEL PACK:
Depth Size Material
From To Ft
From To Ft
If add
ional space is needed use back of form
LOCATION SKETCH
(Show direction and dis
Roads, or other
F .3—�
from at least two State
reference points)
17. REMARKS'
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER.
k
NATURE OF PERSON CONSTRUCTING THE WELL DATE
Submit origi I to Division of Water Quality, Groundwater Section within 30 days GW-1 REV. 12/99
FOR OFFICE USE ONLY
Quad No:
T
O
‘P•
i t)
Serial No.

North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Sec
1636 Mail Service Center - Raleigh, N.C. 27699-1636 - Phone [phone]
WELL CONSTRUCTION RECORD
on
WELL CONTRACTOR. Dewey Wright Well Pump Co
WELL CONTRACTOR CERTIFICATION #: 2886
040190 STATE WELL CONSTRUCTION PERMIT#• Leslie Reece '
295328
Inc.
1. WELL USE (Check Applicable Box): Residential Municipal I I Industrial CI Agricultural CI Monitoring CI
Recovery i I Heat Pump Water Injection 0 Other 0 If Other, List Use:
2. WELL LOCATION: (Show sketch of the location below)
Nearest Town: BAKERSVILLE County MITCHELL
W LSON RD OFF l-IWY 728 OFF HWY 1 QF
(Road Name and Numbers, Community, or Subdivision and Lot No.)
3. OWNER W C RFI L
Address ou un�IL",1,4..^d rn_NycTO
SAKFRSVfYt t oute`Nol
City or Town State
dynyn cl nrl F RD
NC 227Z(1 ode
4. DATE DRILLED 5/7(V2nfld
5. TOTAL DEPTH 1R5
6. CUTTINGS COLLECTED YES El NO X
7. DOES WELL REPLACE EXISTING WELL? YES El NO
8. STATIC WATER LEVEL Below Top of Casing: Aft FT
(Use "+' if Above Top of Casing)
9. TOP OF CASING IS 1 FT Above Land Surface*
'Top of casing terminated at/or below land surface requires a variance in accor-
dance with 15A NCAC 2C.011a
10. YIELD (gpm): 8 METHOD OF TEST Air
11. WATER ZONES (depth): 3.00 Qom87-88 3.00aom 149-150
0.00 Qom 0.0Oaom
12. CHLORINATION: Type NTH Amount a1
DRILLING LOG
From To
nq
DEPTH
Formation Description
nNMT
aA fi7 GRANITF
87
fiR
lag
16n
AR QUARTZ
lag GRANITE
150 PRI F1SPAR
165 GRANITE
13. CASING:
Wall Thickness
Depth Diameter or Weight/Ft.
From n i To d` Ft ` 11R
From To Ft
From To Ft
14. GROUT:
A5n
IXl
Material
n,vrr
Depth Material Method
From n To 711 Ft rpmpnf Gra,Afy Plnw
From To Ft
15. SCREEN:
Depth
From To
From To
From To
16. SAND/GRAVEL PACK:
Depth
From To
From To
17. REMARKS'
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER.
(o-3-d5'
Diameter Slot Size Material
Ft in in
Ft in in
Ft in in
Size
Ft
Ft
Material
If additional space
s heeded use back of form
LOCATION SKETCH
(Show direction and distance from at least two State
Roads, or other map reference points)
(cig
FOR OFFICE USE ONLY
pATURE OF PERSON CONSTRUCTING THE WELL
Submit origin Division of Water Quality, Groundwater Section ,vithin 30 days
GW-1 REV. 12/99
"tp, .fitUAL
DATE
Quad No:
Serial No.

WELL CONSTRUCTION RECORD
North Carolina Department of Environment and
296341
Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (UOD4VIDVAIJNAME (plot) A /2-1 .6- �u /i `i` antPtcanort it? /S�
WELL CONTRACTOR COMPANY NAME Difiet v IN i LL-0, Proms s 044 71 Y-91-98
STATE WELL CUCtTRLCRON PEPMUS--------ASSOCIATED WQ PERMITS
(if ,.Iteable) (iiapplia )
: a
1. WELL USE (Check Applicable Box): Rasident®1 E Mt®apalPublic ❑ Industrial 0 Agticuhural O
Monitoring 0 Recovery 0 Heat Pump WattrInjection 0 Omer 0 If Other, List Use
2
WELL LOCATION: g r pC County �Ct.. / e
Nearest Town: gG�is'�4'G ZXaX
S f.,t../22.° a o-v-to rt'S ' Lc f z 9
(Semi Name. Cemoay, Subdivision. tat No, Zip Code)
3. OWNER: L/tt WLL-
Address elf:, S'NI on_ Q J;µ) A/ lCA i/
(Steen or Rome No.) i3'7 % 7
SP,i t,c t Ne ,,,/ C
Cry orTowo Sate Ep Code
(gzti- 76s- gig/zw
Ara code- Pboae ammo
4. DATE DRILLED - "I
- TOTAL DEPTH- Ii
T Birfiamd setting
ORidge f lope OValley OFlat
(rhea appropriate box)
Iatitndcllongitude of well location
osiroortosamesocondO
Latitude/longitude sonce:OGPSOTopographic map
(chock boa)
DLErni DR WN° LOCI i.
From To Formation Description
b- d t 6;4-4-
AC
, a ,1ot lL
6- Z5"
6. DOES WELL REPLACE EXISTING WELL? YES 0 No lW 9 y - go Ai Adz,
7. STATIC WATER LEVEL Below Top of Casing o%O Ff.
(tha't ifAbase Top ofCafoe)
S. TOP OF CASING 1S / FT. Move Lad Sufscc'
`Tap or mum tvudrad salty Men lad slam sae nsa
marine to acmxdenee M i ISA NCAC 2C AMA.
9. YIELD (gpm): 1V2 METHOD OF TEST/ /`9//Z
/�
10. WATER ZONES (depth): : Py�s. t , >`p D le ',Jo 'ciao
If rg 4. e 32o LOCATION SKETCH
I I . DISINFECTION: Type cipr: ,v a Amount / ' 8 tx ??„ w direction and distance in miles from at least
12. CASING: Wall Titicaca "taco State Roads or County Roads. Include the mad
tat - 410S
C 2 muite,I QdailS
(depth oFametr or woman. se err at maanbere and
nd common mad name!.
From ToFrom "0 To -/ 9/1 �J` SI Lif, at QQ igc u,
From .Y To_43 Et. 4 t/y > 9 i/
13. GROUT: Depth Material Cddhod 2� n
From To Ft. 1 A y `v
From_a___ To yS FL /ive / �/✓i7t�( .. / F iA � '/ S �b zu
14. SCREEN: Depth pmriter Skit Sin Amaral A �i.h -C
From To Ft is in r7 o urn
From To Ft is in. c..o
15. SAND/GRAVEL PACK: Depth Size Material i /V , W"'p
From To Ft.
From To Ft. 17_(,7siyii
t2C
16. REMARKS:
J
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH ISA NCAC 2C, WELL. -
CONSTRUCTION STANDARD'S, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
OF PERSON CONS -WOOING THE WELL DATE
Submit the original to the Division of Water Quality, Groaadwahr StSoa,1636 Mad Service Center -Raleigh, NC
27699-1636 Phone No. (919) 733J121. within 30 days GW-1 REV. 07/2001
f'
e7
p fort

296340
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natal Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (NWVIDUAIJNAME (ytYO TCLS'���t''c F. A./� (:,-;t CER IFlcwnon 0.2/ CO
WELL CONTRACTOR COMPANY NAME &I f J oV ;G.E FROM a J ) Ot-e/S--#)
STATE WELL CGX'STRUCRON PERMITS ASSOCIATED WI) PERMITS
fifappl'cabk) (iifmoliubl)
/ e
1. WELL USE (Check Applicable Box): Residents' H Municipal/Public 0 Industrial 0 Agricultural ❑
Monitoring CI Recovery ❑ Neat Pump Water Injection ❑ Oder 0 If Other, List Use
2. WELL LOCATIO
Neatest Town: Canty /
0-1- 1 cAl,theleiS led
(Shen taint. �� Cway, Subdivision. Lot No. T;Cade)
Topographic/had setting
°Ridge °Slope balky. °Flat
(check apptaptute box),.
Latitude/longitude of well location
3. OWNER: ti T/S t/W H t/ d
Address C R %13 Cd-...e e u+-i -e it LatiRdeflongitude sourcc°GPSOTapographic map
l a Rome Tan) Oink bOx)
a + 4-u ) C 7 9 ?o r DEPTH DRILLING LOG
From To Formation Description
c - ,S m s-f
S - 2 f.1,/uPo�'/lxslL
City orToon Sane Tip Code
(_)- (eS 9 -?//'r
Ares code- Phone member
4. DATE DRILLED 5-/o - ct
5. TOTAL DEPTH: 2 c35
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO CY
7. STATIC WATER LEVEL Below Top ofCminv 20 FT.
(Ua'v-ifAbowTop of Cott
8. TOP OF CASING IS / FT. Above lad Surfaces
`Top *Tessin tair4 Weir ban MN nesse rewires o
mince In umrdat watt ISA NCAC IC JHIt
9. YIELD (gym): /7 METHOD OF TEST n1 rt
10. WATER ZONES (depth) / (yr. 1`1 Ci • 0
(6 „ C >c-, LOCATION SKETCH c..)I I . DISINFECTION: Type C 40,�,u C Amount 8 02 6479 show daman and distance in mils coin Oast
12. CASING: Wall Thielmas two Ste Rout or County Roads. Include the toad
Deb Mama QWeigie t. (Sin( otaebaa and road ownFrom Tor_ Ft i c�Zebu(
Front_1_:_) To 3l FL Yo ! O 'c f tit 1. �
Prom 3/ To 33 Et. C.
13. GROUT: Depth
From To
From C To 7 c
I4_ SCREEN: Depth
From To Ft in. in.
Fran To Ft in. in.
h emu- r
--c
Gr
0
15. SAND/GRAVELPACK:
Depth
From To
From
Material Method
t,fy .aP sh,X 226 tea'4lei
Ft. em , � 'r iiu"t ��LJ
FL gift /Y/2t'IL �,/"
Dimmer Slot Size Mannino
Size Material
Ft.
To Ft.
16. REMARKS:
0
5O1404s !t1
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH ISA NCAC 2C, WELL
CONSTRUCTION STANDARDS, DThAT A COPY OF ThIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
SIGMA
OF PERSON CONSTRUCTING THE WELL DATE
Submit the original to the Division of Water Quality, Groundwater Section,1636 Mal Service Center -Weigh, NC
27699-1636 Phaor Na (919) 733-322i. within 30 days OW -I REV. 07/2001

296338
WELL CONSTRUCTION RECORD
North Carolina - Dcpartnent of Environment and Natural Resources - Division of Water Qality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAIJNAME (mad) O'4/L7,Tur Pik .6 cauncanona 07/Sa
WELL COATRACTOR COMPANY NAME eJ�.rV'i{. ;GO L(/ P (,<- Or: ILA ' non it I 7 'Fi
STATE WELL CONSTRUCTION PERMITS ASSOCIATED M43 PERMITS
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential 0 Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use
2. WELL LOCATIQN
�2ltKPduar. /viM__T -6
(Sum Name. Mambas, Cowman%, sabtvmaa. In NoAte
-
3. OWNER:Tr_b', rnt-4O4ti
Address 3ry C1GLc�CQ�i%.f�
City or Tam r3aee Zip Code
(AI- 7Gy6("W
m Acede- tune amber
r
4. DATE DRILLED 4 -0 9/5.
5. TOTAL DEPTH: yd�
IN 6. DOES WELL REPLACE EXISTING WELL? YES 0 NO 11"
7. STATIC WATER LEVEL Below Top of C'f asatg:. FT.
(UssifAbove Tee etc
8. TOP OF CASING 15 3 FT. Above Land Surface`
Nearest Town:j.t/luc-c/GKG County /- Coty 44�
�, & gj (Saco or Rage_ a y
*Top .fern nosiond astir beimWS neon ..e:cma
prince is aaordaaa: nth ISA NCAC IC Alin.
9. YIELD (gpm): iK METHOD OF TEST fa/ l
10. WATER ZONES (depth): is l Oe41 326''
Tepog apbic/iand setting
Midge OSlope !Walley, OFlat
(cheek appropriate box)
latituddlmgitude of well location
(depeesrmas roomda
Latitmidlongitude source OGPSO Tttpographtc map
(check box)
DEPTH DRILLING LOG
From To Formation Description
-
33 =3-40 -0' 4.44,4ft'
Aar4c4
2 (.;a/�S
r-,
LOCATION SKETCH o
I I . DISINFECTION: Typefige-cc,/ft Amomt 19024378 1 Show dilation and distance in miles from at Fens
Wall Thickness two State Roads or County Roads. heckle the d
or WeiSaVR_ Mtaerial aandtera and common mad names o ,, lc
12. CASING:
Depth Diameter'
From To Ft
From To `3jn F �-'t t _
Fran ttaa!t_P_To
13. GROOM" Depth
From To Ft
From_EZ—To .Z11 Ft fv,ed/ AAniekS
14. SCREEN: Depi .
From To Ft. in. in.
Front__ To Ft in. in.
15. SAND/GRAVEL PACK:
Depth
From To Ft.
From To Ft.
16. REMARKS:
Diana t r Stet Size Msoaial
Size Material
ian DD
eALat
/tee.
1 DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY
��O-FF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
OF PERSON CONSIRIICIINGTHE WELL
DATE
Submit the original to the Division of Water Qeality, Groundwater Section, 1636 Nag Service Center - Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-I REV. 07/2001

2.9'337
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and NaturalatnResauces - Division of Water Quality - CAotmdwater Section
WELL CONTRACTOR (INDMDUAL)NAME (admit)rl.'>'rat XC0 c+I eECER7lFICATIONR Zi v"
WELL CONTRACTOR COMPANY NAME l) L 5'i", e 6 kip tato Z an'" 5 PRONE a S) :52. cf. V ` ie
STATE WELL CONSTRUCTION PERMIT* _ ASSOCIATED WO PERMITS
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential I/ Municipal/Public 0 Industrial 0 Agticulheal
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 IF Other, List Use
2. WELL LOCATION: Nearest
(.iY�.L Q S. N1 ounty mSL&
(Sum Name. NumbersCmrmaohy, Subdivision Let No.. Tq Cade)
3. OWNER: &IX .2((t.c..44v
Address S E oei C 0.264-ei f rLe-t'
�(street or Route e Na)
/v a8 2(/
Cry or Town Sate Zip Code
(704)- 3'eS—rnr^4
Area code- Phase m nn
4. DATE DRILLED 9-2---09:
5. TOTAL DEPTH. C✓1/4.)
6. DOES WELL REPLACE EXISTING WELL? YES T3 NO C-
7. STATIC WATER LEVEL Below Top of Casi
(User Haber* Tap(leasing)
8. TOP OF CASING IS / FT. Above Laad Surface
*bp greasing tesradereel wi r beaw aid algae ..,ares.
visa.= a u=rda.=wlu ISA NCAC 2C.MIIR
9. YIELD (gpm): 0 METHOD OF TEST ,4 /(Z
10. WATER ZONES (depth): (; ��+� , & I ? 0
11. DISINFECTION: Type
12. CASING:
Depth
From To
From 0 To A
Prom (,,/ To (o ?
13. GROUT: Depth
From To
Ftmn12—To 2-
14. SCREEN: Depth
From To
I. t_/._ Amount I •Nos .3`.i,
Wall Thidness
Direr or Weight/Ft. Material
Ft.
_ LL__ % v 2 Ft
Ft. 6- �4/ / jd 9 She
Material Method
FL
Ft 'fi{y<'.Q / /47 44 l
p� Slat Size Maoaial
Ft_ia in.
From To Ft in. is
IS. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
16. REMARKS:
TopoffatrJ nd setting
MopeCIValley Flat
(cheek appapti.0 box)
Latitude/longitude of well location
( )
Latitude/longitude source::lGPS cpographic map
DEPTH
From To
po
DRILLING LOO
Formation Description
(lam+'-p4r�-•ri hoc g
55- 64o cj,2tr-rr7
.,�
LOCATION SKETCH na cr
Show direction and distance in miles from at Si;
two State Roads or Cotmty Roads. Inchidb the io'dd
numbers and eonmwt road cameo.
p cT�r
rtt• yy--4
u/(A J L P!^'/'rAcc-
I DO HEREBY CER FY THAT THIS WELL WAS CONSTRUC(EDIN AACCORDANCE WITH ISA NCAC 2C, WELL
CONSTRUCT! I N ' ANDARDS, AND THATTAA COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
NATUREOF PERSON CONStRUCTINGTHE WELL DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Matt Service Center -Raleigh, NC
27699-1636 Phone No. (919) 733J221, within 30 days. GW-I REV. o7/2001

North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
1636 Mail Service Center - Raleigh, N.C. 27699-1636 - Phone [phone]
WELL CONSTRUCTION RECORD
294192
WELL CONTRACTOR- Dewey Wright Well Pump Co., Inc.
WELL CONTRACTOR CERTIFICATION #• 2797
030156 STATE WELL CONSTRUCTION PERMIT#- Jerry Wilson
1. WELL USE (Check Applicable Box): Residential
Recovery 1 I Heat Pump Water Injection
X
Municipal ❑ Industrial 0 Agritult[ral El Monitoring
Other I If Other, List Use:
2. WELL LOCATION: (Show sketch of the location below)
Nearest Town: BAKERSVILLE County: MITCHELL
PRIVATE DR. OFF HWY143 OFF HWY 10E
(Road Name and Numbers, Community, or Subdivision and Lot No.)
3. OWNER MERCER J. BLANKENSHIP
Address 15 MUIRFIELD DR. ,
ARDEN (Street or Route Nor NC 28704
DRILLING LOG
From To Formation Description
0 30 DIRT/GRAVEL
DEPTH
30 84 GRAVEL
City or Town State Zip Code
4. DATE DRILLED 4/8/2004
5. TOTAL DEPTH 145
6. CUTTINGS COLLECTED YES NO
7. DOES WELL REPLACE EXISTING WELL? YES El NO
8. STATIC WATER LEVEL Below Top of Casing: 15 FT
(Use "+" if Above Top of Casing)
9. TOP OF CASING IS 1 FT Above Land Surface*
*Top of casing terminated at/or below land surface requires a variance in accor-
dance with 15A NCAC 2C.0118
10. YIELD (gpm): 30 METHOD OF TEST Aar
11. WATER ZONES (depth)30.00 ppm84-145 0.00 ppm
0.00 Qom 0.00opm
X
84 145 GRAVEL c
o,
r—
n_
N .;_I
GO
r
CO —
12. CHLORINATION: Type HTH Amount 27
If additional space is needed use back of form
13. CASING: Wall Thickness LOCATION SKETCH
Depth Diameter or Weight/Ft. Material (Show direction and distance from at least two State
F-rom 0 To 84 Ft. 6 1/4 .188 GALV. r Roads, or other map reference points)
From To Ft lip }• lqE
From To Ft. ''`C'ti
14. GROUT:
Depth Material Method
From 0 To 20 Ft Cement Gravity Flow
From To Ft.
15. SCREEN:
Depth Diameter Slot Size Material
From To Ft in in
From To Ft in in
From To Ft in in
16. SAND/GRAVEL PACK:
Depth Size Material
From To Ft
From To Ft
17. REMARKS:
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 P OVIDED TO THE WELL OWNER.
FOR OFFICE USE ONLY
GNATURE OF PERSON CONSTRUCTING THE WELL DATE
Submit original to Division of Water Quality, Groundwater Section within 30 days
GW-1 REV. 12/99
Quad No:
Serial No.

294'794
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (D7DMDUAL)NAat6 ttniat)
`� A 2/ lb 5 4 i L$ CERTIFIunON •, 9) SD
WELL CONTRACTOR COMPANY NAME 3a S..}i t E In1etc b /2thuc1 PHONE It ( 1, L'8
ASSOCIATED WOPERMITS
STATE \YELLfaplicable) PERMIT! or applicable)
(if applicable)
iic 0 Industrial 0 Agricultural ❑
1. WELL USE (Check Applicable Box): Residential pclion V List Use
Monitoring 0 Recovery 0 Heat Pump Water injection 0 Other 0 If Other,
2. WELL LOCATION:
Nearest Town: it/1/eSWifZ
(State Name. Numbers. Community, Subdivision, Lot Na. 29 Code)
3. OWNER: 4.-c/i Arti )1G-e$Le
Address'1 on - Iy (-LSn'far.
\ �r (gem or Ross No.)
Y1 rI v \e7Tt i . S C— ;2.914 l
City cs Town State Zip Code
(Z2S- 1-1")-ss'10-5(-)40
County /)/1�Ge6L
Arm code- Pttoao mmnba
4. DATE DRILLED Z Z 4-
5. TOTAL DEPTH: G 40
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO Ir
7. STATIC WATER LEVEL Below wTaop of ` Above Toe off
S. TOP OF CASING IS / FT. Above Lath Surface
flap of easing terminated as beim land surface .Minis a
varianceIs accordance Me ISA NCAC 2C MILS J I:✓us
9. YIELD (gpm): Pi METHOD OF TEST
10. WATER ZONES (depth): Vs Sraiu G Vo
jopograpl)ic/Land setting
ge (Mope OValley OFiat
(Mode appromiaee hoc)
LatitodellongitUde of well location
(�)
Latitude/longitude source:OGPSOT1opographic map
(deck box)
DEPTH DRILLING LOST
From To Formation Description
11. DISINFECTION: Type C &)K•,de
12. CASING:
Depth Diameter
From 0 To /9 Ft. 6 r/y
Front t9._Tog / FL 614t
From To Ft.
13. GROUT: Depth
From tO To 2.5
Amman 9 oe.:
Wall Midmost
or Weight/ft. Material
Yo
/VlrH Jee
Material
Ft. -)E1
Frtan To Ft
14. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in.
From To Ft in. in.
15. SAND/GRAVEL PACK: Material
Depth Size
From To FL
From To Ft.
�— i' D:.2ft
S
Method
ithreo
0
v<'
LOCATION SKETCH J-
Show direction and distance in miles from at leeest c
two State Roads or County Include thejoad
Roads. -Er?
(;
numbers and common road names. r,
oti 06 a,45s7mf
E'Ae[iMto„, pO
nE
16. REMARKS:
I DO HEREBY CERTI THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION NDARDS, AND THAT A COPY OF This RECORD HAS BEEN PROVIDED TO THE WELL OWNER
. S RE OF PERSON CONSTRUCTING THE WELL
DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center-ItaLeigh, NIG ,
27699-1636 Phone No. [phone], width. 30 days.GW-I REV. 07/21
c� iu
U:UVVFTER SECTION
c ncc!nroA occ'ric

2T7741
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
CERTIFICATION #Y/Sr
WELL CONTRACTOR (INDIVIDUAL) NAME (print)
WELL CONTRACTOR COMPANY NAME
3
,CUTPHONE N aoSEkt
STF VFE WELL CONSTRUCTION PERMIT# ASSOCIATED NW) PERMIT#
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential Q/Municipal/Public ❑ Industrial ❑ Agricultural Q;_
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
Ir-u-11
2. WELL LOCAn JJ
Nearest Town: r'/i11� County ,(ZGyr
jpognphic/Land sethr�g y en r
:IQ
❑Slope [Walley ]Flat i ii
4 t/t4.1,r 4 tevyvy _. /Z7 %- (:`( ,JQ�CICSne)��._ 1 ftc (check appropriate box) ._r `; CD i C_.
/ Yuot No, 5 .wCE, (�, Ile r -
(Strcet Name. Numbers, Community, Subdivision, Lot No., Zip Code) ',�' 7 i i.aGtude/longitude of well locskc� �'
3. OWNER:,f-I1.��^
Address a Ma Cik R n _- —
(Street or Prune No,)
:41 fr oo L?
re c
)-u7'7.
(degrees/minutes seconds) '-"
Latitude/longitude source:❑GPS❑Topographic']
LANci et die) NjC DEPTH
City or Town State Zip Code From To
(rW°)- I �, 1- a- "a 3
Area code- Phone number
4. DATE DRILLED S'
5. TOTAL DEPTH: &O5
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO
7. STATIC WATER LEVEL Below Top of Casing: c-»7 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS I FT. Above Land Surface'
*Top of casing terminated atlor below land surface requires a
variance in accordance with I5A NCAC 2C .0118.
9. YIELD (gpm): r METHOD OFF TEST ,)12411.1
10. WATER ZONES (depth): j 9pit G'-'y Sxn
t I. DISINFECTION: Type(17l0f /dt' Amount S O2
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
From To Ft.
From CO To� Ft. �, its
From iS To 53 7 Ft
13, GROUT: Depth Mhterial Method
From To FL
From To Ft. .1�f PC/lu�a''C
14. SCREE': Depth Diameter Slot Size Material
From To Ft. in. in.
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth
From To Ft.
From To Ft.
16. REMARKS:
Size
Material
(check box)
DRILLING LOG
Formation Description
r=1
�rrC
�•�) - G,t'S 6F/'th4d.
LOCATION SKETCH
Show direction and distance in miles from at least /
two State Roads or County Roads. Include the Joag .,, &t
numbers and common road names. iK't" le
I DO HEREBY CERTIFY THAT T IS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS] D THAT A PY • CORD HAS BEEN PROVIDED TO THE WELL OWNER
IGNATU ET' ERSON CONSTRUCTING THE WELL DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center- Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. G W-I REV. 07/2001

297278
WELL CONSTRUCTION RECORD
North Carolina — Department of Environment And Natural Resources — Division of Water Quality — Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) NEIL CRAFT CER1IFICATION #3114
PHONE # {828) 453-0662
WELL CONTRACTOR COMPANY NAME PITTMAN WELL BORING. LLC
STATE WELL CONSTRUCTION PERMIT # WS 01-00026 ASSOCIATED WQ PERMIT #
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential ❑ Municipal/Public ® Industrial ❑ Agricultural ❑
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use
2. WELL LOCATION:
Nearest Town: SPRUCE PINE County MITCHELL
ETHAN ALLEN RD.
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: TOWN OF SPRUCE PINE
Address 138 HIGHLAND AVE.
(Street or Route No.)
SPRUCE PINE NC 28777
City or Town State Zip Code
(828) — 296-4500
Area Code Phone number
4. DATE DRILLED 05/24/04
5. TOTAL DEPTH: 560
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO
7. STATIC WATER LEVEL Below Top of Casing: 165 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS 2 FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordance with 15A NCAC 2C .0118.
9. YIELD (gpm): 660 METHOD OF TEST 24 HR DRAWDWN
10. WATER ZONES (depth): 470-580
11. DISINFECTION: Type CHLORYTE Amount 5 LBS.
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
From 0
From _
From _
13. GROUT: Depth
From 0 To 20
To 85 Ft. 8" .365 STEEL W/
To Ft DRIVE SHOE
To Ft.
From _
14.SCREEN:
From
From
To
Depth
To
To Ft.
Material
Ft. CEMENT
Ft. SLURRY
Diameter
Ft. in.
in.
Method
PUMPED USING
TREMMY PIPE
Slot Size Material
15. SAND/GRAVEL PACK:
Depth Size Material
From _ To
From To
16. REMARKS:
Ft. _
Ft.
Topographic/Land setting
❑ Ridge ❑ Slope ❑ Valley ❑ Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds) Latitude/longitude source: ❑ GPS ❑ Topographic map
(check box)
DEPTH
From To
DRILLING LOG
From To
LOCATION SKETCH
Show direction and distance in miles from at least
Two State Roads or County Roads. Include the road
number and common names
FROM MARION. HWY. #221 N. LEFT ON
HWY.#226. TO SPRUCE PINE. RT. ON CARTER'S
RIDGE RD RIGHT ON DRIVE ia) #1651. WELL AT
DEAD END. O
7J
03
r
W r':"
f
rJ
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUC 1ED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
'SIGiURE 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

297277
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment And Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) NEIL CRAFT CERTIFICATION #3114
PHONE # [phone]
WELL CONTRACTOR COMPANY NAME PITTMAN WELL BORING. LLC
STATE WELL CONSTRUCTION PERMIT # WS 01-00026 ASSOCIATED WQ PERMIT #
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential ❑ Municipal/Public ® Industrial ❑ Agricultural ❑
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use
2. WELL LOCATION:
Nearest Town: SPRUCE PINE County MITCHELL
ETHAN ALLEN RD.
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: TOWN OF SPRUCE PINE
Address 138 HIGHLAND AVE.
(Street or Route No.)
SPRUCE PINE NC 28777
City or Town State Zip Code
(828)- 296-4500
Area Code Phone number
4. DATE DRILLED 05/24/04
5. TOTAL DEPTH: 560
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO
7. STATIC WATER LEVEL Below Top of Casing: 165 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS 2 FT. Above Land Surface*
"Top of casing terminated at/or below land surface requires a
variance in accordance with 15A NCAC 2C .0118.
9. YIELD (gpm): 660 METHOD OF TEST 24 HR DRAWDWN
10. WATER ZONES (depth): 470-580
11. DISINFECTION: Type CHLORYTE Amount 5 LBS.
12. CASING: Wall Thickness
Diameter or Weight/Ft Material
Ft. 8" .365 STEEL W/
DRIVE SHOE
Depth
From 0 To 85
From _ To _
From_ To_
13. GROUT: Depth
From 0 To 20
From _ To
14.SCREEN: Depth
From _To_
From To
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
Ft.
Ft.
Material Method
Ft. CEMENT PUMPED USING
Ft. SLURRY TREMMY PIPE
Diameter Slot Size Material
_ Ft. _ in. _ in.
Ft in. _ III.
From ___ To Ft. _
Topographic/Land setting
❑ Ridge ❑ Slope ❑ Valley ❑ Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source: ❑ GPS ❑ Topographic map
(check box)
DEPTH
From To
DRILLING LOG
From To
LOCATION SKETCH
Show direction and distance in miles from at least
Two State Roads or County Roads. Include the road
number and common names
FROM MARION. HWY. #221 N. LEFT ON
HWY.#226. TO SPRUCE PINE. RT. ON CARTER'S
RIDGE RD.RIGHT ON DRIVE (a, #1651. WELL AT
DEAD END.
16. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUL I'ED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
/ /.4.7e//0DT1_e ')S/D1ay//
SIGNATURE 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

North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
1636 Mail Service Center - Raleigh, N.C. 27699-1636 - Phone [phone]
WELL CONSTRUCTION RECORD
040083
riLttrt35,:za
WELL CONTRACTOR Dewey Wright Well Pump Co.. Inc.
4080
WELL CONTRACTOR CERTIFICATION P.
STATE WELL CONSTRUCTION PERMIT#•
Leslie Keece
1. WELL USE (Check Applicable Box): Residential I Xi Municipal 0 Industrial 0 Agricultural n Monitoring 0
Recovery 0 Heat Pump Water Injection CI Other ❑ If Other, List Use.
2. WELL LOCATION (Show sketch of the location below)
Nearest Town: BAKERSVILLE County: MITCHELL
MARBLE MINE RD. OFF H`.W 80 S. OFF MINE CREEK R
(Road Name and Numbers. Community, or Subdivision and Lot No.l
3. OWNER MICHAEL J GALLERY
Address 324 MARBLE MINE P.D.
BAKERSe..Er Route No.l NC 28705
City or Town State Zip Code
4. DATE DRILLED 3/5/2004
5. TOTAL DEPTH 245
6. CUTTINGS COLLECTED YES Cl NO El
7. DOES WELL REPLACE EXISTING WELL? YES 0 NO
8. STATIC WATER LEVEL Below Top of Casing: 100 FT
(Use "+" if Above Top of Casing)
9. TOP OF CASING IS 1 FT Above Land Surface*
*Top of casing terminated at/or below land surface requires a variance in accor-
10. YIELD (gpm)' M THOD OF TEST Air
11. WATER ZONES (depth): • 00 qpm 162-183 0.Doppm
0.00 ppm 0.00gpm
HTH Amount 30
12. CHLORINATION: Type
dance with 15A NCAC 2G.0118
13. CASING:
Wall Thickness
Depth Diameter or Weight/Ft
From 0 To 21 Ft B 1/4
From To Ft
From To Ft
14. GROUT:
DRILLING LOG
From To
0 15
DEPTH
Formation Description
DIRT
15 162 GRANITE
182 183 SHALE
183 245 GRANITE
IXI c
.t t
o
a
c?�
r
i
n
0m
o`er
r rn
rn
If additional space is needed use batik 1 of VW('
a G
LOCATION SKETCH
Material (SF�ow direction and distance from at least two State
.188ble.GALV. `4*Ytv Roads, or other map referencepoints)�"
Ire v
C nJ
Depth Material Method
From D To 20 Ft Cement Gravity Flow
From To Ft
15. SCREEN:
Depth
From To Ft
From To Ft
From To Ft
Diameter Slot Size
16. SAND/GRAVEL PACK:
Depth
From To Ft
From To Ft
17. REMARKS.
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER.
3-30.0,4
in
in.
in
in
in
in
Material A
Size Material
e— Le • 5
dace
F
FOR OFFICE USE ONLY
Quad No:
Serial No.
sre ATURE OF PERSON CONSTRUCTING THE WELL DATE
Submit original to Division of Water Quality, Groundwater Section within 30 days GW-1 REV. 12/99

North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
1636 Mail Service Center - Raleigh, N.C. 27699-1636 - Phone [phone]
293931
WELL CONSTRUCTION RECORD WELL CONTRACTOR: Dewey Wright Well Pump Co., Inc.
WELL CONTRACTOR CERTIFICATION St.2686
040069 STATE WELL CONSTRUCTION PERMIT# Leslie Reece
1. WELL USE (Check Applicable Box): Residential X Municipal 0 Industrial 0 Agricultural 0 Monitoring 0
Recovery I I Heat Pump Water Injection 0 Other n If Other, List Use:
2. WELL LOCATION: (Show sketch of the location below)
Nearest Town:
DRILL DEEPER County: MITCHELL
SPARKS RD. OFF PITTMAN RD OFF PENLAND RD OFF
(Road Name and Numbers, Community, or 5ubdlvision and Lot No.)
JOHN F BRITT/CHERYL CRAIGIE
3. OWNER
Address
432 CHRI STMAS TREE WAY ,
BAKERSi��rt flO01e Nal NC 28705
CO or Town State
4. DATE DRILLED 3/15/2004
5. TOTAL DEPTH 325
6. CUTTINGS COLLECTED YES 0 NO ICI
7. DOES WELL REPLACE EXISTING WELL? YES ❑ NO
8. STATIC WATER LEVEL Below Top of Casing: 30 FT
(Use "+" if Above Top of Casing)
9. TOP OF CASING IS 1 FT Above Land Surface*
*Top of casing terminated at/or below land surface requires a variance in accor-
dance with 15A NCAC 2c.R118
10 YIELD (gpm)' eu METHOD OF TEST Ar
Zip Code
11. WATER ZONES Idepth)30.00 ppm 301-302 0.00ppm
0.00 ppm 0.00ppm
12. CHLORINATION: Type HTH Amount 30
13. CASING:
Depth Diameter
From 0 To 32 Ft 6 1/8
From To Ft
From To Ft
14. GROUT:
1 X1
DRILLING LOG
From To
0 205
DEPTH
Formation Description
OLD WELL
0 0 DRILLED DEEPER
205
301
302
301 GRANITE
302 SHALE
325 GRANITE
r—
c-)
7 0 1
If additional space is needed use baAkDf fo ri
7-s m�
LOCATION SKETCH NZ
Wall Thickness O
or Weight/Ft. Material (Show direction and distance from at least tw�tate
.350 PVC fP-1 Roads, or other map reference pnts)o
ofiLi 19E
Depth Material Method
From 0 To 20 Ft Cement Gravity Flow
From To Ft
15. SCREEN:
Depth
From To Ft.
From To Ft.
From To Ft
Diameter Slot Size Material
in in
in in
in in
16. SAND/GRAVEL PACK:
Depth Size
From To Ft
From To Ft
Material
17. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER.
FOR OFFICE USE ONLY
. so._ 3-30-O 4
Quad No:
Serial No.
SIGNA RE OF PERSON CONSTRUCTING THE WELL DATE
Submit original to vision of Water Quality, Groundwater Section within 30 days
GW-1 REV. 12/99

North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
1636 Mail Service Center - Raleigh, N.C. 27699-1636 - Phone [phone]
WELL CONSTRUCTION RECORD WELL CONTRACTOR: Dewey Wright Well Pump Co., Inc.
WELL CONTRACTOR CERTIFICATION #• 2888
040025 STATE WELL CONSTRUCTION PERMIT# Leslie Reece
299077
1. WELL USE (Check Applicable Box): Residential El Municipal El Industrial 0 Agricultural El Monitoring 0
Recovery 0 Heat Pump Water Injection C Other 0 If Other, List Use•
2. WELL LOCATION: (Show sketch of the location below)
Nearest Town: SPRUCE PINE County. MITCHELL
WALLACE AVE. OFF HUMPBACK MTN RD OFF ALTAPA
(Road Name and Numbers, Community, or Subdivision and Lot No.l
3. OWNER MICHAEL LINVILLE
Address 204 WALLACE AVE. ,
SPRUCE rrNrr Route Not NC 28777
City or Town State
2/3/2004
400
4. DATE DRILLED
5. TOTAL DEPTH
6. CUTTINGS COLLECTED YES NO EX].
7. DOES WELL REPLACE EXISTING WELL? YES C NO
8. STATIC WATER LEVEL Below Top of Casing: 40 FT
(Use "+" if Above Top of Casing)
Zip Code
9. TOP OF CASING IS 1 FT Above Land Surface*
*Top of casing terminated at/or below land surface requires a variance in accor-
dance with 15A NCAC 29.0118
10. YIELD (gpm): M1Ea00PM237-238 Air
1.00ppm 261-381
11. WATER ZONES (depth):OF TEST
p
x
DRILLING LOG ' DEPTH
From To Formation Description
0 39 DIRT
38 237 GRANITE
237 238 QUARTZ
238 261 GRANITE
261 382 QUARTZ
362 400 GRANITE
t
0
CO
Oc
yo
Plc
t.0 to
0.00 ppm 0.00qpm 9
12. CHLORINATION: Type H"fH Amount 72
13. CASING:
Wall Thickness
Depth Diameter or Weight/Ft. Material
From 0 To 43 Ft B 175 .350 PVC
From To Ft
From To Ft
14. GROUT:
If additional space is needed use ba®of ram
LOCATION SKETCH
(Show direction and distance from at least two State
Roads, or other map reference points)
9
Depth Material Method
From 0 To 20 Ft Cement Gravity Flow
From To Ft
15. SCREEN:
Depth Diameter Slot Size Material
From To Ft in in.
From To Ft in in
From To Ft in in
16. SAND/GRAVEL PACK:
Depth Size Material
From To Ft
19E
n 4.
tt
pt
17. REMARKS• © Wrr'e
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.
From To Ft
FOR OFFICE USE ONLY
Quad No:
wSl ATURE OF PERSON ONSTRUCTING THE WELL DATE
Submit origins o Division of Water Quality, Groundwater Section within 30 days
GW-1 REV. 12/99
Serial No.

North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
1636 Mail Service Center - Raleigh, N.C. 27699-1636 - Phone [phone]
299151
WELL CONSTRUCTION RECORD WELL CONTRACTOR: Dewey Wright Well Pump Co . Inc
WELL CONTRACTOR CERTIFICATION #. 2896
040213 STATE WELL CONSTRUCTION PERMIT#: Leslie Reece
1. WELL USE (Check Applicable Box): Residential n Municipal n Industrial El Agricultural fl Monitoring n
Recovery I I Heat Pump Water Injection I Other n If Other, List Use.
2. WELL LOCATION: (Show sketch of the location below)
Nearest Town: RO.rU1 MT"). County' {+4TCI (ELL
dYNICBS.PEZAZPtt'A g. RIcitsY a� air#1 07F HWY 14 DRILLING LOG DEPTH
From To Formation Description
0 101 MLID CRP1rEL
3. OWNER 4,44,Roc onLI r STREET
Address 1005B N TTrVeddT tdNo.1
ctvorTBA4KF?SViLLE state NL
2S27 de
4. DATE DRILLED 5/11/2n0n
5. TOTAL DEPTH 1o0
6. CUTTINGS COLLECTED YES I I NO L:
7. DOES WELL REPLACE EXISTING WELL? YES n NO Q
8. STATIC WATER LEVEL Below Top of Casing: ir0 FT
(Use "+" if Above Top of Casing)
9. TOP OF CASING IS 1 FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a variance in accor-
dance with 15A NCAC 2C.0118
10. YIELD (gpm): an METHOD OF TEST Air
11. WATER ZONES Idepth).1n nn r1pm 15R_1R0 n rin^pm
n nn npm n nngnm
12. CHLORINATION: Type HTH Amount 77
13. CASING:
Depth
strom D To 15Ft 81/q
From To Ft
From To Ft
14. GROUT:
Wall Thickness
Diameter or Weight/Ft. Material
.1 SS
GAIN
Depth Material Method
From D To 9n Ft CpTarf Rravf f PI w.r
From To Ft
15. SCREEN
Depth Diameter Slot Size
From To Ft. in. in
From To Ft in in.
From To Ft in in.
16. SAND/GRAVEL PACK:
Depth Size Material
From To Ft
From To Ft
101 158 GRANITE
15P 1Fg SI-lol E
1Fg 1Q0 GRANITE
i
Leg
If additional space is needed use back of form
LOCATION SKETCH
(Show direction and distance from at least two
Roads, or other map reference points)
17. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER.
FOR OFFICE USE ONLY
. et_t_ 7-3-054
O
Quad No:
Serial No.
Submit orig
NATURE OF PERSON CONSTRUCTING THE WELL DATE
to Division of Water Quality, Groundwater Section within 30 days
GW-1 REV. 12/99

North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
1636 Mail Service Center - Raleigh, N.C. 27699-1636 - Phone [phone]
299147
WELL CONSTRUCTION RECORD WELL CONTRACTOR' Dewey Wright Well Pump C n Inn
WELL CONTRACTOR CERTIFICATION #' 2888
040251 STATE WELL CONSTRUCTION PERMIT#' I Q.lie Reece
1. WELL USE (Check Applicable Box): Residential I vi Municipal I I Industrial ❑ Agricultural ❑ Monitoring ❑
Recovery Heat Pump Water Injection Other ❑ If Other, List Use.
I I
2. WELL LOCATION: (Show sketch of the location below)
Nearest Town: oglrEoct/l l E County. fygTrk-Itt)
I-.lV' amea fl M F CLOT 4.O 1GHES: (.'G? G—i TO FRIVA
1 oatl'�' -'Name and lSurn era, L3mmunity, or Subtlrvision andtot o�-
3. OWNER DAISY M PUThinjL
DRILLING LOG DEPTH
From To Formation Description
Address a272utnry ooa nlnoru n 10 MI OT
( tree r oute of '
Co orTa!V'tERSVILLE state NC 2ER ae 12 Al GRANITE
43 44 SWAT E
4. DATE DRILLED 6/8/2004 4^. 111 GRANITE
5. TOTAL DEPTH CL5 111 112 SWALE
6. CUTTINGS COLLECTED YES ❑ NO I x1 112 425GRANITE
7. DOES WELL REPLACE EXISTING WELL? YES ❑ NO I x
8. STATIC WATER LEVEL Below Top of Casing: Lig FT
(Use "+" if Above Top of Casing)
9. TOP OF CASING IS 1 FT Above Land Surface*
'Top of casing terminated at/or below land surface requires a variance in accor-
dance with 15A NCAC 2C.0118
10. YIELD (gpm): I METHOD OF TEST Ajr
11. WATER ZONES (depth): It Ff1 n.,n+^3-AA 0 F0pprrl 111_1 t')
n nn Rpm
12. CHLORINATION: Type HT-4
13. CASING:
0 rinorrn
Amount 70
Wall Thickness
Depth Diameter or Weight/Ft. Material
`vom p To 24 Ft. 8 1M. .35) PVC '� E
'ror' To Ft
From To FtIN
•
If additional space is needed use back of-fm
14. GROUT:
Depth Material Method
From 0 To ?0_ Ft Cament rrat..}tj Flinn
From To Ft rFMENT GRAVITY RI OW
15. SCREEN:
Depth Diameter Slot Size Material
From To Ft in in
From To Ft. in in
From To Ft in in
16. SAND/GRAVEL PACK:
Depth Size Material
From To Ft
From To Ft
LOCATION SKETCH sO .
(Show direction and distance from at least two State
Roads, or other map reference points)
Q551 �
17. REMARKS: 0
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER.
FOR OFFICE USE ONLY
./&e,t, 7-3 -0 `f
Quad No:
Serial No.
SIATURE OF PERSON CONSTRUCTING THE WELL DATE
Submit origin to Division of Water Quality, Groundwater Section within 30 days
GW-1 REV. 12/99

FL
I x)
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
1636 Mail Service Center - Raleigh, N.C. 27699-1636 - Phone [phone]
WELL CONSTRUCTION RECORD
290533
WELL CONTRACTOR- Dewey Wright Well Pump Co
WELL CONTRACTOR CERTIFICATION #- 2797
040301 STATE WELL CONSTRUCTION PERMIT#• Jerry Wilson
Inc.
1. WELL USE (Check Applicable Box): Residential Municipal El Industrial Agricultural - Monitoring 0
Recovery I Heat Pump Water Injection El Other E If Other, List Use:
X
2. WELL LOCATION: (Show sketch of the location below)
Nearest Town: RAKFRRVII I F County: MITC'HFI I
CANF C:RFFK RD OFF HWy 226 OFF kW,/ 1Q F
(Road Name and Numbers, Community, or Subdonsion and Lot No.)
3. OWNER MARY M DFI LINGFR
Address 6231 MFLROURNE AVE
ORLAND�treet or Route No.l
City or Town State
4. DATE DRILLED 6/28/2004
5. TOTAL DEPTH 1e5
6. CUTTINGS COLLECTED YES 0 NO
7. DOES WELL REPLACE EXISTING WELL? YES NO 0
8. STATIC WATER LEVEL Below Top of Casing: 20 FT
(Use "+' if Above Top of Casing)
9. TOP OF CASING IS 1 FT Above Land Surface*
'Top of casing terminated at/or below land surface requires a variance in accor-
dance with 15A NCAC 2C.0118
10. YIELD (gpm)• 20 METHOD OF TEST Air
11. WATER ZONES (depth):20.00 ppm 165-166 0.00 porn
0.00 ppm 0.00gpm
32Zio od93.51e138
1
12. CHLORINATION: Type HTFf Amount
35
13. CASING:
Wall Thickness
Depth Diameter or Weight/Ft.
Prom 0 To 42 Ft 6 1/8 '+}Fn
From To Ft
From To Ft
14. GROUT:
Material
PVC
Depth Material Method
From 0 To 20 Ft Cement Gravity Floor
From To Ft
15. SCREEN:
Depth Diameter Slot Size Material
From To Ft in. in
From To Ft in in
From To Ft in in
16. SAND/GRAVEL PACK:
Depth Size Material
From To Ft
From To Ft
DRILLING LOG
From To
0 35
35 165
165 166
166 185
i I
DEPTH
Formation Description _
DIRT GRAVEL BOUT DFF - --
GRANITE QUARTZ
GRANITE
GRANITE
C
—
If additional space is needed use bad of form
rn
LOCATION SKETCH =
(Show direction and distance from at least two State
Roads, or other map reference points)
l�\\ ho '
6^
/
tole
17. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS EN PROV THE WELL
L2d9-17
FOR OFFICE USE ONLY
ATURE OF PERSON CONSTRUCTING THE WELL DATE
Submit original to Division of Water Quality, Groundwater Section within 30 days
GW-1 REV. 12/99
Quad No:
Serial No.

North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
1636 Mail Service Center - Raleigh, N.C. 27699-1636 - Phone [phone]
WELL CONSTRUCTION RECORD
299569
WELL CONTRACTOR. Dewey Wright Well Pump Co., Inc.
WELL CONTRACTOR CERTIFICATION #• 2686
040258 STATE WELL CONSTRUCTION PERMIT#• Leslie Reece
1. WELL USE (Check Applicable Box): Residential X Municipal El Industrial I Agricultural I I Monitoring
Recovery Heat Pump Water Injection Other 0 If Other, List Use:
2. WELL LOCATION: (Show sketch of the location below)
Nearest Town: RFD HI! L County: MITCHFLL
BAILEY SETTLEMENT RD OFF HWY 167 N OFF JACK C
(Road Name and Numbers, Community, or Subdivision and Lot No.) DRILLING LOG DEPTH
3. OWNER ELLIS BFNNETT From To Formation Description
Address P.O. BOX 252 , 0 60 DIRT
ERWiN (Street orRoute No.l TN 37650 60 231 GRANITE
City or Town State Zip Code 231 232 QUARTZ
4. DATE DRILLED 6/14/2004 232 305 GRANITE
5. TOTAL DEPTH 305
6. CUTTINGS COLLECTED YES 0 NO El
7. DOES WELL REPLACE EXISTING WELL? YES 0 NO 0
8. STATIC WATER LEVEL Below Top of Casing: 20 FT
(Use "+" if Above Top of Casing)
9. TOP OF CASING IS 1 FT Above Land Surface*
*Top of casing terminated at/or below land surface requires a variance in accor-
dance with 15A NCAC 2C.0118
10. YIELD (gpm)' 1 METHOD OF TEST
1.00 ppm 231-232 0.00 ppm
11. WATER ZONES (depth)
0
W
IV
0.00 ppm
U.UUppm
12. CHLORINATION: Type HTH Amount 57
13. CASING:
Wall Thickness
Depth Diameter or Weight/Ft. Material
Prom 0 To 83 Ft 6 1/8 .350 PVC
From To Ft
From To Ft
14. GROUT:
Depth Material Method
From 0 To 20 Ft Cement Gravity Flow
From To Ft
If additional space is needed use back of form
LOCATION SKETCH
(Show direction and distance from at least two Sta
Roads, or other map reference points) 7
`v
.1```
15. SCREEN:
Depth Diameter Slot Size Material tRT`'�`(J
From To Ft in - in.
From To Ft in in
From To Ft in in
16. SAND/GRAVEL PACK:
Depth
From To Ft
From To Ft
17. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY/OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER.
CA/ , ,%
SI ATURE OF PERSON CONSTRUCTING THE WELL DATE
Submit origina to Division of Water Quality, Groundwater Section within 30 days
GW-1 REV. 12/99
Size Material
47
3,s
FOR OFFICE USE ONLY
Quad No:
f Rajiv
5cif/
ts`s;q..t"-'
Serial No.

299 567
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
1636 Mail Service Center - Raleigh, N.C. 27699-1636 - Phone [phone]
WELL CONSTRUCTION RECORD WELL CONTRACTOR- Dewey Wright Well Pump Co.. Inc.
WELL CONTRACTOR CERTIFICATION #• 2686
040189 STATE WELL CONSTRUCTION PERMIT#• Leslie Reece
1. WELL USE (Check Applicable Box): Residential n Municipal 0 Industrial 0 Agricultural 0 Monitoring 0
Recovery Heat Pump Water Injection Other 0 If Other, List Use•
2. WELL LOCATION: (Show sketch of the location below)
Nearest Town: R.AK=PSVII I F County: MITcHFI I
KS
DRILLING LOG DEPTH
3. OWNER ROBERT PRFTT I 1 VERMAN .IR/AI I FN R PASS From To Formation Description
Address 214 N BL00DWOIST 0 75 DIRT ITF
RAI ElGHIsoeetorRouteNix)NC 97801 75 108
City or Town State Zip Code
PRIVATE DR OFF Z DOG MTN Rn OFF FRFD SPAR
I Road Name and Numbers, ommunity, or Subdivision an Lot No.l
4. DATE DRILLED 6/11/7004
5. TOTAL DEPTH 18�
6. CUTTINGS COLLECTED YES NO
7. DOES WELL REPLACE EXISTING WELL? YES LI NO FT
8. STATIC WATER LEVEL Below Top of Casing: Rn FT
use "+" if Above Top of Casing)
9. TOP OF CASING IS 1 FT Above Land Surface*
'Top of casing terminated at/or below land surface requires a variance in accor-
dance with 15A NCAC 2C.0118
10. YIELD (gpm): 20 METHOD OF TEST Air
x
11. WATER ZONES Idepth)'20.00 ppm 109-109 0.O0gpm
0.00 ppm 0.00ppm
12. CHLORINATION: Type HTH Amount 19
ins ins SHAI E
109 185 GRANITE
If additional space is needed use ba»of farm
o —
13. CASING: Wall Thickness LOCATION SKETCH
Depth Diameter or Weight/Ft. Material
From 0 To 7R Ft 6 1/B 3F0 PVC 1.1
Roads, or other map reference points)
From _ To Ft 4.
�tpvtti � � From To Ft
14. GROUT:
Depth Material Method
From 0 To 20 Ft Cement Gravity Flow
From To Ft
15. SCREEN:
Depth Diameter Slot Size
From To Ft in in
From To Ft in. in
From To Ft in in
16. SAND/GRAVEL PACK:
Depth Size Material
From To Ft
From To Ft
(Show direction and distance from at least two State
17. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER.
FOR OFFICE USE ONLY
,ems 7—ao—act
Quad No:
Serial No.
SIGURE OF PERSON CONSTRUCTING THE WELL DATE
Submit original to Division of Water Quality, Groundwater Section within 30 days
GW-1 REV. 12/99

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
\VEI.1. covriz \C I tW tCS DI\'ID1:11.) N:1 V C (print) Neill Pardue
\\'ELL CON It \Cft)It (t)\IP.\NS SUIP:
STATE WELL CONS( RLCTIO\ PEIL\IIT#
ii anal icblc1
Air Drilling Company
CERTIFICATION # 26OQ
PHONEa(7Oq-872-7614
\S.SOCI. ATED WO I'ERVIIT#
l fannlieablol
I. WELL USE (Check Applicable Box): Residential ❑ Nlunicip:d. Public 21 Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Hem Pump Water Injection 0 O;her ❑ If Other, List Use
2, WELL LOCATION:
Nearest Town: Spruce Pine ; County Mitchell
Rich Knob - Well #2
(Sir_: ,Name. Numbers. Community'. Subdivision, Lot No.. Zip Code:
3. OWNER: Timberline Corp.
AddrSs 17505 West Catawba Ave — Smite 950
Topographic/Land setting
❑Rid ue ❑Slope ❑Valley ❑Flat
(check appropriate box,
Latitudeiloneitude of well location
I decrees: it nine s: secondsi
Litt!wd_ Ii,ngitude source:❑GPS❑Topogr phi_ map
I Street or Route No.) ;check box;
Cornelius, NC 28031 DEPTH DRILLI`GGLOG
City or limn State Zip Code From To Formation Description
( )- 0' 57' Dirt
Area code- Phone number 57' 845' Rock
4. DATE DRILLED 09 11-04
5. TOTAL DEPTH: 845 ft.
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO %]
S di
7. STATIC WATER LE V EL Below Top of Casing: A45 FT. -0 qr©
(Use"+" if Above Top of Casing) ra c7 C�
R. TOP OF CASING IS _ 21 FT. Above Land Surface* se%t^
*Top of casing terminated at/or below land surface requires a �O
variance in accordance with 15A NCAC 2C.0118. —15, Q ▪ n
9. YIELD (gpm): 0 METHOD OF TEST Air t 2 w
10. WATER ZONES (depth): rs.-P
LOCATION SKETCH i n
11. DISINFECTION: Type HTH Amount Show direction and distance in miles from at least
12. CASING: Wall Thickness two State Roads or County Roads. Include the road
Depth Diameter or Weight/Ft. Material numbers and common road names.
From 0 To 57 Ft. 8" Galv.
From To Ft.
From To Ft.
13. GROUT: Depth Material Method
From 0 To 7 FL Grout Pumped
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.
16. REMARKS:
Cf Es I.Juf Cited
I DO HEREB' CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH I5A NCAC 2C. WELL
CONSTRUCTION STANDARDS. AND T AT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
P C(_ i 2 c -4
GNATURE OF PERSON CONSTRUCTING THE WELL DATE
Submit the original to the Division of Water Quality, Groundwater Section. 1636 Mail Service Center- Raleigh. NC
27699-1636 Phone No. [phone]. within 30 days. GW• i REV. 07.20U1

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELT. CONTRACTOR IlNDIVIDLAI.I NAME (print) Neill Pardue CERTIFICATION ft 2609
Air Drilling Company PHONE #[phone]
M ELL CON'I-Rain't COMPANY NAME
srATE \\ T.I.I. CONSTRUCTION PERM era ASSOCIATED MT) PER\lll
(ifanplicnhlei
(if applicable)
WELL USE (Check Applicable Boxy Residential G Municipal/Public N Industrial ❑ Asricultural ❑
Nlonitorine 0 Recovery 0 Heat Pump Water Injection 0 Other 0 II Other. List Use
2. WELL LOCATION:
Nearest Town: Spruce Pine ' County Mitchell
Rick Knob
ISireet Name. Numbers. Community. Subdivision. Lot No. . Zip Code,
3. OWNER:Timberline Corp.
Address 17505 West Catawba Ave.., - Suite 350
I Street or Route No.)
Cornelius, NC 28031
City or Town State Zip Code
l )-
Area code- Phone number
4. DATE DRILLED 09-01-04
5. TOTAL DEPTH: 965 ft.
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO Xl
7. STATIC WATER LEVEL Below Top of Casing: 967 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS 2 i FT. Above Land Surface*
*Top of casing terminated atfor below land surface requires a
variance in accordance with 15A NCAC 2C .0118.
9. YIELD (gpm): 0 METHOD OF TEST Air
10. WATER ZONES (depth):
11
12
Topographic: Land setting
❑Ridee ❑Slone ❑Valley ❑Flat
(check appropriate hnx
Latitude/longitude of well location
1 deuces. ;7. moesGecondsI
Latitude'Inng itude source:❑GPS❑Topographic map
I chock box,
DEPTH DRILLING LOG
From To Formation Description
0' 56' Dirt
56' 965'
DISINFECTION: Type HTH Amount
CASING: Wall Thickness
Depth Diameter or Weieht/Ft. Material
From 0 To 96 Ft. R" Galy.
From To Ft.
From To Ft.
13. GROUT: Depth Material Method
From 0 To 56 Ft Grout Pumped
From To Ft.
14. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in.
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
16. REMARKS: 8" Drive Shoe
Rock
in :....Dr.
�� O
t T—I.
-o �'ri7�
LOCATION SKETCH.......-
00
Show direction and distance in miles from at least ��` I
u+c
two State Roads or County Roads. lncludcthe road ra ▪ 'n
numbers and common road names.
CHESrNti7 6gov6 id
ItZ
a\
0 0
ti
Meg kvo13
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH I_A NCAC 2C. WELL
CONSTRUCTION STANDARDS. AND THAT Y OF�HIS j2ECORD HAS BEEN PROVIDED TO THE WELL OWNER
GG'G
Cm
CO
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
Submit the original to the Division of Water Quality. Groundwater Section, 1636 Mail Service Center - Raleigh, ...
2_7699-1636 Phone No. (919) 733-32' 1, within 30 das. GW-I RE\. 07/200f
L

North Carolina - Department of Environment and Natural Resources - Division of Water Quality
1636 Mail, Service Center - Raleigh, N.C. 27699-1636 - Phone [phone]
Groundwater Section302209
WELL CONSTRUCTION RECORD
040263
WELL CONTRACTOR: Dewey Wright Well Pump Co., Inc.
WELL CONTRACTOR CERTIFICATION #• 2787
STATE WELL CONSTRUCTION PERMIT#- Jerry 'Jerry Wilson
1. WELL USE (Check Applicable Box): Residential X Municipal
Recovery 0 Heat Pump Water Injection 0 Other
Industrial n Agricultural Monitoring Q
If Other, List Use.
2. WELL LOCATION: (Show sketch of the location below)
Nearest Town: ROAN 11TN County MITCHFI I
I-IVVY 781/1d4 OFF 147F
(Road Name and Numbers. Community. or Subdivision and Lot No.)
3. OWNER SONORA S St11 I INS
Address 54 ,OI 1rF RO
RAKFRSVI'IreletFyr Route No.) NC
City or Town State
4. DATE DRILLED R/7fil7nnd
5. TOTAL DEPTH 778
6. CUTTINGS COLLECTED YES 0 NO
7. DOES WELL REPLACE EXISTING WELL? YES El NO IE
8. STATIC WATER LEVEL Below Top of Casing: 7n FT
(Use "+" if Above Top of Casing)
9. TOP OF CASING IS 1 FT Above Land Surface*
crop of casing terminated at/or below land surface requires a variance in accor-
dance with 15A NCAC 2C.0118
10. YIELD (gpm)• 15 METHOD OF TEST Air
11. WATER ZONES (depth).15.00 ODm210-211 0.000Dm
0.00 ppm 0.00pom
12. CHLORINATION: Type HTH Amount 43
FL7n5
ip Code
13. CASING:
x
Wall Thickness
Depth Diameter or Weight/Ft.
From 0 To d7 Ft B 11d 188
From To Ft
From To Ft
14. GROUT:
Depth Material Method
From 0 To �20—Ft PPment Gravity Flow
From To Ft
15. SCREEN:
Depth Diameter Slot Size Material
From To Ft in. in
From To Ft in in
From To Ft in in
16. SAND/GRAVEL PACK:
Depth Size Material
From To Ft
From To Ft
DRILLING LOG
From To
rl �n
DEPTH
Formation Description
1nIRT ROI 11 DFR SAMl1
;n 210 GRANITP QUARTZ
2111 211 C.PAMITP
711 778 @RANI TF
O=r:m
us r-k
�9
ara
p0
v
t1
3
If additional space is needed use back of font
C'
(RAI V
LOCATION SKETCH
Material (Show direction and distance from at least two State
v(\�r`7� . Roads, or other
t
CI _di
17. REMARKS•
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A CO OF THIS RECORD HAS BEEN 9 OVIDED TO THE WELL OWNER.
FOR OFFICE USE ONLY
Quad No•
?/ 2r&p
SigliKTURE OF PERSON CONSTRUCTING THE WELL DATE
Submit origirig to Division of Water Quality, Groundwater Section within 30 days
GW-1 REV. 12/99
Serial No

c
WELL CONSTRUCTION RECORD
North Carolina • Department of Environment and Na
WELL CONTRACTOR (INDIVIDUAL) NAM
WELL CONTRACTOR COMPANY NAME
STATE WELL CONSTRUCTION PERMITp
(if applicable)
300787
Resources - Division of Water Quality - Groundwater Secnor;
CERTIFICATION 4,127
PHONE I
Li-
-ASSOCIATED WQ PERMIT,
(if applicable)
itzetzyst
4/A7
WELL USE (Check Applicable Box): Residential S MumicipalPublic 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATI
N t Town:
(Street ame, Numbe
3 OWNER
Aderes,
77-77
Ara aid- Pboete number/
4 DATE DRILLED p/o2 gin V
TOTAi.. DEPTH:_ T
t DOES WELL REPLACE EXISTING WELL? YES f7 NO if
STATIC V, Ai ER LEVEL Below Top of Casing: Ks FT.
(Use `+" if Above Top of Casine
i i;P I;I LASING IS /, 4 FT. Above Land Surface•
`Top of casing terminated at/or below land sorbet requires a
variance m arwrdance with ISA NCAC 2C .0118.
YIELD i rpm)_ �' METHOD OF TESTjj
Ft TEr_ ZONES (depU.; '' /94 t��a
Couaty,,�Z1Ed� Z
ti
72,
Community, Subdivision, tut No., tipp Code)
(seXS RNo.) A•It
. Av,C. 0fl797
Tows. state Zip Cods
Method .
4 SCREEN Depth Diameter Slot Size Material
Fran. _ To Ft in. in.
Frcm To Ft. in, in.
SAND GRAVEL PACK
Depth Size Material
Frorn_ �� Ft_
Fr,.... F t ' Ft.
tJf cCV-c(Tigit Typt C fl 4/, Amount 9$ trL
Wall Thickness
Depth n Diameter or Weight/Ft MA —,.;al
Tc� y �. _.,,
Dept ✓�/+
`rrcr.To�0 FL
F rein I FL
I REMARKS
Topographic/I.and setting
ORidge OSlope OValley DEF. ta:
(check appropriate box
Latitude/longitude of well location
(degre Wunimttes/socoods)
Latitude/longitude source:OGPSOTopographic map
(check box.
DEPTH DRILLING LOG
From To Formation Description
i9 1,4
ev
LOCATION SKETCH
Show direction and distance in miles from at) asi
two State Roads or County Roads. Include the oad
numbers and common road oar: -
HERE. S CERTIFY THAT THIS WELL. WAS CONSTRUCTED IN ACCORDANCE WITH I SA NCAC 2C. WEL:
E);:it"R; CTION STANDARDS AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
011-20,-4 4a,P i� 8/0V
SIGNATURE OF PERSON CONSTRUL l NNG THE WELL DATE
R,
Submit the original to the Division of Water Quality, Groundwatti 5ecnpn, 1636 Mail Servile C,edter - Raleigh NC
'%ny•;_l pyg Phone Na. (4741 733-3221, within 30 days. I
' --- -- 1_,
V.'-I REV 07/200.
4
pF?
Y

North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
1636 Mail Service Center - Raleigh, N.C. 27699-1636 - Phone [phone]
300846
X
Cd_OR-NATION: Type Amount d3
13. CASING:
Wall Thickness
Depth Diameter or Weight/Ft. Material
0 To 23 Ft ` i! 352 PVC
To Ft
From To Ft
14. GROUT:
Depth Material Method
From 2 To 22 Ft C=r,;e.-' vro;it;
From To Ft
15. SCREEN:
Depth Diameter Slot Size Material
From To Ft in. in
From To Ft in. in
From To Ft in. in
16. SAND/GRAVEL PACK:
Depth Size Material
From To Ft
WELL CONSTRUCTION RECORD
04233P
WELL CONTRACTOR. De:.=_y Wright We!! Pump Co., Inc.
WELL CONTRACTOR CERTIFICATION #. 2665
STATE WELL CONSTRUCTION PERMIT# Le3lie Reese
WELL USE (Check Applicable Box): Residential
Recovery Heat Pump Water Injection
El If Other, List Usi� f gMonitoring Municipal Industrial El Agricultural I I Moni[o
n Other
2. WELL LOCATION: (Show sketch of the location below)
Nearest Town: PAKaPP1nt I P County: 6arTrHFI
PR; vATE OR OFF iOt-i;vSO v CEMETERY RG OFF TOEC
(Road Name and Numbers. Community, or Subdivision and Lot No.}
3. OWNER DAvD B BOOTri
Address 230 tx., nnv STREET
—,Street o. Route No.i
City or Town State
SSr
2910
Zip Code
DRILLING LOG DEPTH
From To Formation Description
0 20 DIRT
20 45 GRANITE
41 42 SHALE
4. DATE DRILLED 711612004 42 225 GRANITE
5. TOTAL DEPTH 22F
6. CUTTINGS COLLECTED YES 0 NO El
7. DOES WELL REPLACE EXISTING WELL? YES C7 NO E
8. STATIC WATER LEVEL Below Top of Casing- 20 FT.
(Use' ' if Above Top of Casing)
9. TOP OF CASING IS 1 FT Above Land Surface*
Top of casing terminated at/or below land surface requires a variance in accor-
dance with 15A NCAC 2C.0118
10 YIELD tgpm)' METHOD OF TEST Ai 17.0
e,
i
Q G
11. WATER ZONES idepth) 2 50 nnm41-L12 0 00orrrn
S vs
u..]._. prn 3.03ppro cAz
If additional space is needed use back organ C)
LOCATION SKETCH
(Stow direction and distance from at least two State
le/ Roads, or other map reference points)
Y 3.
E—s Le•5
From To Ft 4tatetaw
17. REMARKS -
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER.
itt.en 8-1 S- D 9
SIG URE OF PERSON CONSTRUCTING THE WELL
!FOR OFFICE USE ONLY
Quad No
DATE
Submit original to Division of Water Quality, Groundwater Section within 30 days
GW-1 REV. 12/99
Serial No

North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Sec
1636 Mail Service Center - Raleigh, N.C. 27699-1636 - Phone [phone]
WELL CONSTRUCTION RECORD
WELL CONTRACTOR' Dex:e; Wright We!!
on
300851
Punt Co.. Inc.
0-4D32E
WELL CONTRACTOR CERTIFICATION #' 2767
STATE WELL CONSTRUCTION PERMIT#' Derr. Wilson
1. WELL USE (Check Applicable Box): Residential n Municipal n Industrial C
Recovery Heat Pump Water Injection C Other 0 If Other, List Use:
2. WELL LOCATION: (Show sketch of the location below)
Nearest Town: P4KecSlni I P County: lorry -lac! I
`FF I dFp✓; Ritj i 1FF tdS C'1FF kvV''v 1PF
p me a-i umbers, ommunity, or ubdimson and Lot No.!
3. OWNER F
Address 2° GP.tch1 r^Rceu pn
vStreetw r>ute Noy Lc
City or Town State
Ni .28705
p Code
4. DATE DRILLED 7/14irn11u
5. TOTAL DEPTH ?PR
6. CUTTINGS COLLECTED YES D NO
AgricWturaLL.J Monitoring
DRILLING LOG
From To
(1 rin
FO 80
80 81
Si 9Gd
2a tt 76 F
J r 2fiF
7. DOES WELL REPLACE EXISTING WELL? YES 0 NO 0
8. STATIC WATER LEVEL Below Top of Casing' 75 FT.
(Use "+" if Above Top of Casing)
9 TOP OF CASING IS i FT. Above Land Surface*
'Top of casing terminated at/or below land surface requires a variance in accor-
dance with 15A NCAC 2C.0118
10. YIELD (gpm): fin METHOD OF TEST Adr
11. WATER ZONES (depth l + nn anm BD -Pi 57 innDDrn 244_21F
3 00 oom 00 D-room
OHLOPiNATION'. Type Amount 48
13. CASING:
From
Wall Thickness
Depth Diameter or Weight/Ft. Material
To P"-,Ft P ^'a AOn (;LI t
To Ft
To Ft
14. GROUT:
Depth Material Method
From n To ^^ Ft
From To Ft
15. SCREEN
Depth Diameter Slot Size Material
From To Ft. in in
From To Ft in in
From To Ft in in
16. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft
17. REMARKS'
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-‘-/C-Cee0 L�✓�i F--/3-2OC fr
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
Submit original to Division of Water Quality, Groundwater Section within 30 days
GW-1 REV. 12/99
DEPTH ;, i
Formation Description -'
DIRT SA.NIn GRAVct GR
GRANITE
GRANITE
GRAMTF QUARTZ
fRAMIT'F
C ANiTF
Jr. m
-
G7 e
c;
S
If additional space is needed use back bt forrr3:4__
Vn
LOCATION SKETCH IN? v'.1�
(Show direction and distance from at least tv .Statteee4
Roads, or other map reference points)J
I FOR OFFICE USE ONLY
Quad NOE
Serial No

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural((Resources - Divisionisof Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) /' Ipr k %-/ /4 r1 /
CERTIFICATION M. -3r] e,ti
WELL CONTRACTOR COMPANY NAME � o
Afy„span 1tJe I(Dr,//tr( ert PHONE 1CY$-i'91
STATE WELL CONSTRUCTION PERMITM /
ASSOCIATED WQ PERMIT#
(if applicable)
(if applicable)
1. WELL USE (Check Applicable Box): Residential ❑ Municipal/Public ❑ Industrial 0 Agricultural 0
Monitoring ❑ Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION: �a
Nearest Town: ,$pour Mini County N4;1-che.)
(Street Name, Numbers, Communiry, Subdivision, Lot No., Zip Code)
3. OWNER: 4prit ✓ `A;fiche )/
Address 'a SO Jl1&iilow Lark ni/ve
(Street or Route No.)
5pvure. Ping NC aain7
City or Town State Zip Code
Area coda Phone number
4. DATE DRILLED a- ao - d }t
5. TOTAL DEPTH: / SC -
6_ DOES WELL REPLACE EXISTING WELL? YES 0 NO 0
7. STATIC WATER LEVEL Below Top of Casing: /e 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 arcord�a'J� with ISA NCAC 2C .0118.
9. YIELD (gpm): �L_ METHOD OF TEST
10. WATER ZONES (depth): 97 l/i
I I. DISINFECTION: Type )11 / f-f Amount p : (I s'
12. CASING: Wall Thickness
Depth Diameter or Weieht/Ft. Material
From 0 To bl ( Ft.
6 my .188 sited
From To Ft.
From To FL
13. GROUT: Depth /tMaterialMethod
From___, To 2O Ft. etiticrr4 to Tha 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
From To Ft.
From To Ft.
Size Material
16. REMARKS:
Topographic/Land setting
❑Ridge ❑Slope OValley O.Fttt
(check appropriate box)
Latitude/longitude of well location
3S/a y/o4N • 0222e 7/n t'
( grees/minutes/s conds
Latitude/longitude source: Ce16PS❑Topographic map
(check box)
DRILLING LOG
Formation Description
G2fay.. /
6,NO:le-
iCe-n rt;
DEPTH
From To
h /8
LOCATION SKETCH
aoz•Show direction and distance in miles from at lesst
two State Roads or County Roads. Include the td
numbers and common road names. O
tV
O
Spruce Pikle, NC
r
C
CO
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH I5A NCAC 2C, WELL
CONSTRUCTION STANDAE DS, AN THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
SIGNATURIF PERSON CONSTRUCTING THE WELL D Tw' OK
`O
DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center -Raleigh, NC
27699-1636 Phone No. [phone], within 30 days.
GW-1 REV. 07/2001

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality
WELL CONTRACTOR (INDIVIDUAL) NAME (print) rVia r /'-l" �ir ✓�
WELL CONTRACTOR COMPANY NAME f'lr/v Son)
STATE WELL CONSTRUCTION PERMIT#
(if applicable)
dell 11r,11.`ne
302826
Groundwater Section ---, �9�
CERTIFICATION #,er'- (
PHONE tan%V3 —1p54
ASSOCIATED WQ PERMIT#
Of applicable)
1. WELL USE (Check Applicable Box): Residential ❑ Municipal/Public ❑ Industrial ❑ Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION:
Nearest Town: -301ker.s i //e County Mt4C.\-.e i/
CAN? Cr?4 2J. ?vl ercv:lls
(Street Name, Numbers, Community, Subdivision,
Lot� �R
No., Zip Code)
WNE
3. Oddress 00
�7)Iyvtvn,-)-t}dJi
-- (Street or Route No.)
.� vue.?Ire '11
City or Town Stale
(12% -7 to 5- 7010
Area code- Phone number 4. DATE DRILLED 4, a20
5. TOTAL DEPTH: la
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO E.--
7 STATIC WATER LEVEL Below Top of Casing: 2D FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS / FT. Above Land Surface*
*Tap of easing terminated at/or below land surface requires a
variance in accordance with ISA NCAC 2C .0118.
9. YIELD (gpm): � METHOD OF TEST R
10. WATER ZONES (depth):
11. DISINFECTION: Type
12. CASING:
Depth
From To e 3
From To
From To
13. GROUT: Depth
From_CTo 9O Ft.
From To
14. SCREEN: Depth
From To
From To
15. SAND/GRAVEL PACK:
Depth
From To Ft.
From To Ft.
a�777
Zip Code
7 f/
Amount
Wall Thickness
DiEneter or Weight/Ft. Material
Ft. tfr ief
Ft.
Ft.
Material 7� Method
anICra 1-e POuC' .
Ft.
Diameter
Ft. in.
Ft. in.
16. REMARKS:
Size
Slot Size Material
in.
in.
Material
Topographic/Land setting
ORidge OSlope OValley '8'ltilat
(check appropriate box)
Latitude/longitude of wel) locati
'/oi /ob pi- OPo-c$ 3
("degrees/minutes/seconds)
Latitude/longitude source: CgdPSOTopographic map
(check box)
DEPTH DRILLING LOG
From ,TTo Fopnation Description
(tnv e4
rani tc,
G I G J gro-.,At-e--
n
r
n
LOCATION SKETCH
1
CA
Show direction and distance in miles from at least
two State Roads or County Roads. Include the tog,
numbers and common road names. 0
Can Cvk. 12c1.
13ates v t \ t , fC-
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH I5A NCAC 2C, WELL
CONSTRUCTION STAANDDAA S, A THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
CJ'1
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center -Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-1 REV. 07/2001

North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
1636 Mail Service Center - Raleigh, N.C. 27699-1636 - Phone [phone]
WELL CONSTRUCTION RECORD
040454
304142
WELL CONTRACTOR. Dewey Wright Well Pump Co., Inc.
WELL CONTRACTOR CERTIFICATION #• 2797
STATE WELL CONSTRUCTION PERMIT#• Jerry Wilson
1. WELL USE (Check Applicable Box): Residential
Recovery I I Heat Pump Water Injection
x
Municipal 0 Industrial 0 Agricultural 0 Monitoring 0
Other I I If Other, List Use-
2. WELL LOCATION: (Show sketch of the location below)
Nearest Town: BAKERSVILLE County MITCHEI L
FORK MTN RD. OFF 228 OFF 18E
(Road Name and Numbers, Community, or Subdivision and Lot No.)
3. OWNER DARIUS PETERSON
Address 1150 FORK MTN. RD.
BAKERSVSLttr Route No.) NC 28705
City or Town State
4. DATE DRILLED 9/3/2004
5. TOTAL DEPTH 705
6. CUTTINGS COLLECTED YES 0 NO
Ixl
Zip Code
DRILLING LOG
From To
0 32
32 55
55 56
56 705
DEPTH
Formation Description
PJRT SHALE LIMESTONI
GRANITE
GRANITE
GRANITE QUARTZ
7. DOES WELL REPLACE EXISTING WELL? YES El NO El
8. STATIC WATER LEVEL Below Top of Casing: 80 FT
(Use "+" if Above Top of Casing)
9. TOP OF CASING IS 1 FT Above Land Surface*
*Top of casing terminated at/or below land surface requires a variance in accor-
dance with 15A NCAC 2C.0118
10. YIELD (gpm)' 0.25 METHOD OF TEST Air
11. WATER ZONES (depth)' 0.25 ppm35-35 0.00ppm
0.00 ppm 0.00ppm
12. CHLORINATION: Type NTH Amount 124
13. CASING:
Depth
prom 0 To
otr
From
14. GROUT:
Diameter
47 Ft 8 1/8
To Ft
To Ft
Wall Thickness
or Weight/Ft. Material
.350 PVC
Depth Material Method
From 0 To 20 Ft Cement Gravity Flow
From To Ft
15. SCREEN:
Depth Diameter Slot Size Material
From To Ft in in
From To Ft. in in
From To Ft in. in
16. SAND/GRAVEL PACK:
Depth Size Material
From To Ft
From To Ft
If additional space is needed use back of form
LOCATION SKETCH
(Show direction and distance from at least two S
Roads, or other map reference points)
St
c)..Acp
wca
rT1•
-
17. REMARKS' ne re,
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C WELL 7C ckiNej
CONSTRUCTION STANDARDS, AND THAT A COP THIS RECORD HAJ.BEEN RROVIDED TO THE WELL OWNER.
FOR OFFICE USE ONLY
Quad No'
ATURE OF PERSON CONSTRUCTING THE WELL DATE
Submit original to Division of Water Quality, Groundwater Section within 30 days
GW-1 REV. 12/99
Serial No.

304141
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
1636 Mail Service Center - Raleigh, N.C. 27699-1636 - Phone [phone]
WELL CONSTRUCTION RECORD
WELL CONTRACTOR. Dewey Wright Well Pump Co., Inc.
WELL CONTRACTOR CERTIFICATION #: 2797
040421 STATE WELL CONSTRUCTION PERMIT#• Jerry Wilson
1. WELL USE (Check Applicable Box): Residential In Municipal ❑ Industrial ❑
Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use'
2. WELL LOCATION: (Show sketch of the location below)
Nearest Town: BAKERSVILLE County. MITCHELL
FORK MTN.RD. OFF HWY 261/228 OFF 19 E OFF 194 OF
(Road Name and Numbers, Community, or Subdivision and Lot No.)
3. OWNER LLOYD GARLAND
Address 9987 HWY 228 NORTH .
BAKERSAtitr Route No.) NC 28705
City or Town State Zip Code
4. DATE DRILLED 8/31/2004
5. TOTAL DEPTH 500
6. CUTTINGS COLLECTED YES ❑ NO
7. DOES WELL REPLACE EXISTING WELL? YES ❑ NO El
8. STATIC WATER LEVEL Below Top of Casing: 100 FT
(Use "+" if Above Top of Casing)
9. TOP OF CASING IS 1 FT Above Land Surface*
*Top of casing terminated at/or below land surface requires a variance in accor-
dance with 15A NCAC 2C.011B Air
10. YIELD (gpm). 1.13 METHOD OF TEST
11. WATER ZONES (depth). 1.13 ppm475-476 0.00ppm
0.00 ppm 0.00ppm
Agricultural ❑ Monitoring
DRILLING LOG
From To
0 15
DEPTH
Formation Description
DIRT
15 30 SHAD F GRANITF
30 475
475 500
GRANIT of form
GRANITE
I xl
12. CHLORINATION: Type HTH Amount 78
13. CASING:
Depth
From 0 To
From To
From To
14. GROUT:
From
From
Diameter
42 Ft 8 1/8
Ft
Ft
Wall Thickness
or Weight/Ft. Material
.350 PVC
Depth Material Method
0 To 20 Ft Cement Gravity Flow
15. SCREEN:
From
From
From
To Ft
Depth Diameter Slot Size Material
To Ft in in
To Ft in in
To Ft in in
16. SAND/GRAVEL PACK:
Depth
To
To
From
From
Ft
Ft
Size Material
If additional space is needed use back of form
0
LOCATION SKETCH
(Show direction and distance from at least two State
Roads, or other map reference points)
I I t
3 fi
a
41.1
17. REMARKS.
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2 WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BE N PROVIDED TO THE WELL OWNER.
H/E . 2fO rf
NATURE OF PERSON CONSTRUCTING THE WELL DATE
Submit original to Division of Water Quality, Groundwater Section within 30 days
GW-1 REV. 12/99
a
Cit et"
FOR OFFICE USE ONLY
Quad No:
-' p

North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Sec
1636 Mail Service Center - Raleigh, N.C. 27699-1636 - Phone [phone]
WELL CONSTRUCTION RECORD WELL CONTRACTOR -
on
OILD
304140
Dewey Wright Well Pump Co., Inc.
WELL CONTRACTOR CERTIFICATION #• 2797
040162 STATE WELL CONSTRUCTION PERMIT* Jerry Wilson
1. WELL USE (Check Applicable Box): Residential n Municipal El Industrial Agricultural n Monitoring D
Recovery I Heat Pump Water Injection 0 Other n If Other, List Use.
2. WELL LOCATION: (Show sketch of the location below)
Nearest Town: BAKERSVILLE County MITCHELL
NORA LANE OFF CANE CREEK RD. OFF 228 OFF 19E
(Road Name and Numbers, Community, or Subdivision and Lot No.)
3. OWNER CHARLES CRAIG
Address % MOUNTAINEER BLDRS.. P.O. BOX 572
BAKERS',MMLEr Rou1e No.) NC 28705
City or Town State Zip Code
4. DATE DRILLED 9/25/2004
5. TOTAL DEPTH 485
6. CUTTINGS COLLECTED YES 0 NO n
7. DOES WELL REPLACE EXISTING WELL? YES 0 NO
8. STATIC WATER LEVEL Below Top of Casing: 80 FT
(Use'+" if Above Top of Casing)
9. TOP OF CASING IS 1 FT Above Land Surface*
'Top of casing terminated at/or below land surface requires a variance in accor-
dance with 15A NCAC 2C.0118
10. YIELD (gpm)' 3 METHOD OF TEST Air
11. WATER ZONES (depth) 0.75 ppm 370371 2.25ppm 448 448
0.00 ppm 0.000pm
12. CHLORINATION: Type HTH Amount 85
DRILLING LOG
From To
0 32
32
370
371
448
449
DEPTH
Formation Description
DIRT SHALE GRANITE
370 GRANITE QUARTZ
371 GRANITF
440 GRANITE QUARTZ
449 GRANITE
465 GRANITF QUARTZ
13. CASING:
Depth Diameter
From 0 To 40 Ft 8 1/8
F-r'm To Ft
From - To Ft
14. GROUT:
Ixl
Wall Thickness
or Weight/Ft. Material
.350 PVC
Depth Material Method
From 0 To 20 Ft Cement Gravity Flow
From To Ft
15. SCREEN
Depth Diameter Slot Size Material
From To Ft
From To Ft
From To Ft
16. SAND/GRAVEL PACK:
Depth
From To Ft
From To Ft
in in
in in
in in
Size Material
If additional space is needed use back of form
LOCATION SKETCH
(tow direction and distance from at least two State
% Roads, or other map reference points)
t
Q
t
£
Can %1eeKO
17. REMARKS. Secs' e,
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPF THIS RECORD HASSEEN PRQVIDED TO THE WELL OWNER.
FOR OFFICE USE ONLY
sd
/Ovj/ N2oy
SIQ3FATURE OF PERSON CONSTRUCTING THE WELL DATE
Submit original to Division of Water Quality, Groundwater Section within 30 days
GW-1 REV. 12/99
Quad No'
Serial No.

WELL CONSTRUCTION RECORD
303319
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Sectiong�
WELL CONTRACTOR (INDIVIDUAL)NAME (print) `YU S ILt24C CERTIE1CATIONN ySai9l�S- /n 'np
WELL CONTRACTOR COMPANY NAME 1 /(l//7 ("..LE-e-it PHONE # ( )Ti�T kY-4e1S3 7+
STATE WELL CONSTRUCTION PERMITS _ASSOCIATED WO PERMIT,
(if applicable) (if applicable)
I. WELL USE (Check Applicable Box): Residential 11/jvltmicipaUPublic ❑ Industrial ❑ Agricultural 0
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other 0 If Other, List Use
2. WELL LOCATI N:
Nearest Town: �'�:tniXlt�-Cl County.
Cratiles( At - <',r0w Katie.
(Street Name. Numbns, Comelmity, Subdivision, tat NR, rip Code)
3. OWNER: d' &nn Q 4e4,-.A✓c
Address 3 / e--e9 &7 szte
-(Sues or Route No.)
City or loam State
(82S 76c- b C c
Area code- Phase a�g.,
4. DATE DR111 FD 15-8'O
5. TOTAL DEPTH: 906 VA!
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO EV
7. STATIC WATER LEVEL Below Top of Casing:
(Use ^+" if Above Top of Cimg)
8. TOP OF CASING IS / FT. Above Land Surface'
'Top Mang tension! alter below lad aria ragas a
varina i aewrdan a adta ISA NCAC 2C MIL
9. YIELD (gpm): 'S METHOD OF TEST
10. WATER ZONES (depth): 3 S'PE" Gu 3 S D
y► Code
Topographic/Land setting
ORidge ❑Slope ❑Valley °Flat
(check appropriate box)
Latitude/longitude of well location
(aepas/numrusneconds)
Latitude/longitude source:❑GPS°Topographic map
tduxk box)
DEPTH DRILL)NO LOG
From To Formation Description
II. DISINFECTION: Type lt 4.4914Nt Amount 902
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Ma$rial
From To Ft
From To Ft=-
From Le p 3 Ft.
— I1 GROUT: Depth renal Method
From To Ft— — /)
From_ To ?.� Ft_ { 1 �
rallarail
14. SCREEN: Depth D. Slot Size Material
From To Ft in. in.
From To Ft in. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
16. REMARKS:
I DO HEREBY CERT
CONSTRUCTION SL
0-SS
c
Per -
Qtn.�s-4 )ite -
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common road names.
1 rwwa or.
c
IC
»t'
a sIn -'-
THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH I5A NCAC 2C, WELL
DARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
147
S1Ti1(IATUREOF 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. 072001,'
C

WELL CONSTRUCTION RECORD
303318
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL)NAME (prior)
c rincanoNA.,-ci S^V
WELL CONTRACTOR COMPANY NAME SCSI/ CZ. Ld C -ettY4..l:r.) PHONE i 7
( i '�"YS-‘,2
STATE WELL CONSTRUCTION PERMITS ASSOCIATED WO PERMIT?
(if ,,licable) (if 't hrable)
I. WELL USE (Check Applicable Box): Residential Cr Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection ❑ Other O If Other, List Use
2. WELL LOCATION:
Nearest To 5,44tX44Afe
Piss
(Sire, Name. Numbers, Community, Subdivision, Lot No.. rm Code)
3. OWNER: ov-vin cx—R::;MN NI v.
Address n . % c /.
Sven of Rowe Na)
CtkrP I\Q ) t�1C
City or Town Slate
')+� rJ -
Area cede- Plume number
4. DATE DRILLED if /O-n`/
5. TOTAL DEPTH: '/05
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO (iY
7. STATIC WATER LEVEL Below Top of Casing: co FT.
(Use "a' if Above Top of Casing)
8. TOP OF CASING IS / F. Above laid Surface'
flop of casing t War bdew land sw ce regain m
variance in accordance wfb ISA NCAC 2C Alta. /
9. YIELD (gpm): 7 METHOD OF TEST Sf76d
10. WATER ZONES (depth): 2c/,.r, /y 38v
County hi; 4e1.alui
%Zip tenq I
I I . DISINFECTION: TypeA_t�.ccttr..t
12. CASING:
Depth
From To
From b To3I
From 2 / To ? 3
13. GROUT: Depth
From To
From To 33
14. SCREEN: Depth
From To
jopographictfand setting
dge OSlope OValley OFtat
(check appropriate tax)
Latitude/longitude of well location
/ (de8eeskairmedseconds)
Latitude/longitude source:OGPSOTopographic map
hank box)
DRILLING LOG
Formation Description
DEPTH
From To
E7 249 O,Ril2
zo- yoC Gy2.Iru
cv'
o Gm
® �G
0
In
ao
IT
LOCATION SKETCH ..
Amount a i e 73SA Show difection and distance in miles from at least o2�
Wall Thidmess two State Roads or County Roads. Include the roam r` 1"
Diameter or weight/FL Material numbers and corimton mad Homo.
FL
FLW /10
Ft. jhp
b:litl
FL
FL *.7, V /
Diameter Slot SizeMaterial
Ft. is in.
oymiAnikviv
�tul~'1 rf0 j , Ar ^ 'Noat
tee
Method rr"' f40a/ Q
Yl0
1
From To FL in. in.
15. SAND/GRAVEL PACK:
Depth
From To FL
From To Ft.
16. REMARKS:
Size Material
>v 0,446e,4gs electe
O
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH ISA NCAC 2C, WELL.
CONSTRUCTION STANDARDS,�q(N D THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER---
-1711
SIGNAIU 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. 072001
ce'

WELL CONSTRUCTION RECORD
303317
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (prim) (q/f1L Ti1s1;Cr CERTIFICATION 1169 5-C9
WELL. CONTRACTOR COMPANY NAME j(,r S4 It E we(1 D r 1 K" I" PHONE $ ( ) ?erg' (i Y p
STATE WELL CONSTRUCTION PERMITS ASSOCIATED WQ PERMITS
(if applicable) (if applicable)
I. WELL USE (Check Applicable Box): Residential V MunicipaVPublic 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heal Pump Water Injection 0 Other 0 If Other, List Use
2 WELL LOCATION:
Nearest Town:
(Street Name, Numbers, Community
3. OWNER:
Address a
dekeja
er Pour
�tj���CrywT Sue �✓
( 2g)- j rd 2,7 6,
Area code- Phone number
4. DATE DRILLED 9-1/-Oy
5. TOTAL DEPTH: a 25
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO Lt
7. STATIC WATER LEVEL Below Top of Casing:
(Use "+" if Above Top of Caring)
8. TOP OF CASING IS FT. Above Land Surface'
County
,V$?OS
Z)p Cde
'Top of caving terminated atry below land slam remora a
variaate la accordance with 15A NCAC 2C MIS. �%•
9. YIELD (gpm): /C) METHOD OF TEST
10. WATER ZONES (depth): /Ocj/O..r P /lpc9'
11. DISINFECTION: Type (:flr idea
12. CASING:
Amourd 602 93%
Wall Thickness
Depth Diameter or WeighYFt Material
ROM To Ft
From a To 4'4 FL Co 4/ `%
From yei To 6/ Ft.
13. GROUT: Depth Material
From To FL
Method
Frorn _ To Z Z- FL P(iadoetfc/ cbtotle /
14. SCREEN: Depth Diameter Slot Size Material
From To Ft. in.
From To Ft. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
in.
in.
16. REMARKS:
Topographic/Land setting
DRidge USlope OValley 0Flat
(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
rt7� Sy 4/i"Gt�1
qv_ Z Z Z Cr.GAxAZ�
r.
;1
C
-- n
o 1a:c
....-t --I
tJ Q O
trfn
LOCATION SKETCH -13 j
Show direction and distance in miles from at least)�o
two State Roads or County Roads. Include the roag to CD
and common mad rr C
numbers
a
1 DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH I5A NCAC 2C, WELL
CONSTRUCTION STANDARDS, ;a D THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
SIGNATU
OF PERSON CONSTRUCTING THE WELL DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-I REV. 07/2001

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources�- Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) ✓ ?x? ( fr1 ) ,/ ✓,OS % CERTIFICATION(Si .3) 13
WELL CONTRACTOR COMPANY NAME -� N SD/ 4 (.-._i—f -' l ^i rr� / i ✓C PHONE i (�O) /ati- 9 /r
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable)
(if applicable)
I. WELL USE (Check Applicable Box): Residential l Municipal/Public 0 Industrial ❑ Agricultural 0
Monitoring 0 Recovery ❑ Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION: }���� ��"
Nearest TRwn: Spru c... / i t'1n County__ c=1
urru.-Hre Cie rig( 4-cry
(Street Name. Numbers, Community, Subdivision, o" Zip Code)
3. OWNER: .E;r9h�p Sary S
Address t- 17 Vf rrR tic CT, t nal/
(Street or goute No.) g 9sT i l
Sarvre P-nQ N
City or Town State Zip Code
(£sue-7/n` �� g..l1- bit
code- — 4. DATE DRILLED j�QO
5. TOTAL DEPTH: 62 ST s `— /VOW
AreaPhone number
6. DOES WELL REPLACE EXISTING WELL? YES IE NO 0
7. STATIC WATER LEVEL Below Top of Casing: `eo 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. ; Y
9. YIELD (gpm): Li METHOD OF TEST
10. WATER ZONES (depth): hy % ?C O Gr^
)Gnf b -9 y j— LOCATION SKETCH t =nnr�
11. DISINFECTION: Type - A /nr uv 7 Amount f a n 9? % Show direction and distance in miles from atast ;v2"
12. CASING: Wall Thickness two State Roads or County Roads. Include the -load -v
Diameter or Weight/Ft. Material numbers and common mad names. 0 O
FL /�, l/y /D P l'c oil fi
Ft. 6'AY .In « u • 't 2 �
From To Ft. a
o mco o
t� c'I
Topographic/Land setting
Midge ❑Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From To Formation Description
n - lc D,'r t
/ S-- a S"
(fO/ - OM'S- ,ran i 'l'C
; S trey
Depth
From To 5 3
Prom To .Sjr
303316
13. GROUT: Depth Material Method I
From b To C Ft. .a f l four-4-d
From To Ft.
14. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in.
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth -Size Material
From To Ft.
From To Ft.
16. REMARKS: /L L'I.t-L b.-ate
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION'sXANDARDS, AN pf Hf'✓�A ti�OPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
/i- 7-ate
DATE
;-(k
SIGNATURE OF PERSON CONSTRUCTING THE WELL
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center -Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-1 REV. 07/2001
U

WELL CONSTRUCTION RECORD
303315
North Carolina - Department of Environment and Natural Resources -- /Division of Water Quality - Groundwater Section ,-�1
WELL CONTRACTOR (INDIVIDUAL)NAME (prim° �,tAr Lf S� S` iCC y' CERTIFICATION &9 jiC r/
WELLCONTRACTOR COMPANY NAME 1` J S4'i S6 -'ee-1 Dr)`mot+•*j PROBEa f ) 7Z i%/IT-4I40
STATE WELL CONSTRUCTION PERMrI'a ASSOCIATED WQ vutmni
(if 'cable) (if .'Li, icable)
I. WELL USE (Check Applicable Box): Residential P1 Municipal/Public 0 Industrial 0 Agricultural ❑
Monitoring ❑ Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION
iriA
Nearest Town: �f�,�,
.
County 41 r'-'
(Store Name. Numbers, Community, Subdivision, lit No.,rTp Code)
3. OWNER: AP41e- (i'rt0
if
Address S 2€ F N at: s& L. A.4-e
�sveet or Route
2Q7os
Cu), or Town Snte Zip Code
ees } 7GG •- 02 CU
Am code- lime amber
4. DATE DRILLED®L ,, /(p , C '/
5. TOTAL DEPTH: 4o c
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO CV
7. STATIC WATER LEVEL Below Top of Casing. I/O FT.
(Ilse "+' if Above Top of Casing)
8. TOP OF CASING IS / FT. Above Land Surfaces
'Tap of easing Iwudm ed Wow bow land :Mace news a
variance Y atwrdaaa wide ISA NCAC 2C .61ia.
9. YIELD (gpm): 2 METHOD OF TEST lit In
10. WATER ZONES (depth): 7S`Isat 6 3 A/D
Topo 9kiv/Land setting
❑Ridge &rope Walley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(cieS«rJrnim isecoruh)
Latitude/longitude source:❑GPS❑Topographic map
tcba box)
DEPTH DRILLING LOG
From To Formation Description
A,tir t4
0— lfo
II. DISINFECTION: Type e.to,C.A•'-e Amount 02
12. CASING: Wall Thickness
DDiem";
From O To Depth
Ft (a Vor C/gohuR Material
Fro...:_ Tom Ft G� No P l/ e
From % a 6' To / HD Ft. 4 4d / 2.9 (
13. GROUT: Depth Material Method
From To Ft y�
Frotn—�To 20 Ft rP 1 _�Y�A VLYL •
14. SCREEN: Depth ptaatrSlot Sim e�erial
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 TJ�AAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH ISA NCAC 2C, WELL
CONSTRUCTION STANDMDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER _.
C cr)
LOCATION SKETCH C
Show direction and distance in miles froniS least p :�
two State Roads or County Roads. Include -die road -moo;
;rumbas and common road names. tV
rrl
Qp
z<_
%C)
sN
INGLaA
tiAmi
c
zz'
v SleNATi;RE OF PERSON CONSTRUCTING THE WELL DATE
/ Sfcace
1;4c_
Submit the 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

C-v 3p330'7
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
%ELL CONTRACTOR (IND1YIDUAt4NAME oaten (y4 2 ►-(tb, . S Qi-i Cr CERTIFICATION a �' S
WELL CONTRACTOR COMPANY NAME 3 ()--` It.c 't r-1 el r'. u , j..t ittoteE a ( ) 72 c/" ra
STATE WELL CONSTRUCTION PERMITS ASSOCIATED WQ PERMITS
(if a,plitabk) (ifappliable)
I. WELL USE (Check Applicable Box): Residential VMaoicipal/Public O Industrial 0 Agricultural 0
Monitoring 0 Recovery O Heat Pump Water htjec1iou 0 Other 0 If Other, List Use
2. WELL LOCATION;
Nearsst T
�a,my /hi/c%L
(Sine Name. Nombca, Community. .S 'tbi. toe No, LPCode)
3. Address qy A-A/L9 ~ � J ex0,k d
_OA sz Yv C-2.S749
City at Tem
re Cade
(E2B-__4/ 47- 0 OCa A.11 ti 966-892i,
Am code- flat amber ��-
4. DATE DRILLED '7- 2 - O `7
� (90
Topo�phidiand setting
ORidge (Slope °Valley ['Flat
(cheek apprapita box)
Latitude/longitude of well location
c�P. (deer`)
Latitude/longitude source:OGPSOTapographic map
(desk box)
DEPTH DRIILINO LOQ
From To Formation Description
Q- 77 4/2➢`
S. TOTAL DEPTH n
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO fsl� 37
7. STATIC WATER LEVEL Below Top of Casing FT.
(Uaa'v' if Mow Top of Casing)
8. TOP OF CASING IS FT. Above Ind Surface"
*Top efeooiaa tenanted oiler Wow Mad sets reora
variance k atmtiaom Ida ISA NCAC TC Lilt
9. YIELD (gpm): METHOD OF TEST
10. WATER ZONES (depth):
I 1 _ DISINFECTION: Typ(hijtt A..& Amor f O
12. CASING: . Wall Nudeness
Dept D'umeaer or Weight/Pt. Merin]
!D<t'D0 6�jE'ia'N t—e
From To Ft
From D To 3 C Ft
From 3S To ' '% FL CD /Y I
13. GROUT: Depth Material
Froth_ To
Vi
1:.aNl
Method
Ft L ' j�
From_a__ To_, . Ft yet / ,Paireed
14. SCREEN: pDe�p�t'' p� skot Sim Merc+ial
From To FL in in
Fraq_To Ft in. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To FL
From To Ft.
7
O t
LOCATION SKETCH C)
Show direction and distance in miles from at 41
two State Roads or Cotmty Roads. Include thinned
om. nbera.. and talesman road tames.
kit L.'N-LeS141,1--z.
tP
�1 tJ7 70
J, j444-►L `Ic
16. REMARKS:
I DO HEREBY CERTIFY THAT THI "' WAS CONSTRUCTED IN ACCORDANCE WITH ISA NCAC 2C, WELL
CONSTRUCTION STANDARDS, _: t +HAT A OF THIS RE,CORD HAS BEEN PROVIDED TO THE "WELL OWNER
sf i
CONSTRUCTING THE WELL DATE
Submit the original to the Division of Water Qrafty, Groundwater Section,1636 Mad Service Center- Raleigh, NC ^)
27699-1636 Phone No. [phone], within 30 days. G W-I REV_ 07/2001
0

WELL CONSTRUCTION RECORD
3.03334
North Carolina - Dcpanment of Environment and Natural ResourcesGroundwater
- Division of Water Quality - Secties
WELL CONTRACTOR (INDIVIDOAL)NAME (W`t) GA rtj 7ujf'vr csennovnon. /5
WELL CONTRACTOR COMPANY NAME TS u'S} i C E VV e uc iJ rr L-G is; G PHONE • f ) %-Z4-ii.'ig
STATE WELL Ce STRUCneN1 PtRMrra ASSOCIATED WO PERMRY
(if applicable) (if applicable)
I. WELL USE (Check Applicable Box): Rssdesnia) WMmicipal/Public O Industrial O Agricultural U
Monitoring I] Recovery 0 Heat Pump Water Injection O Other 0 If Other, List Use
2. WELL LOCATIQN• Q t
Nearest Tbwu: J„ Il l -P S} ..'h County (A ,'i1 "'k
Cn.o. 2/ A. Aj-C-
(Sten Name. Number; Cmiue ' , S.bSvSaa tat No.reCode)
3. OWNER: Te m , Ai Ai
Address P r3e 7 oY
L i il I-e Su i rsuss tier) 92 7 V 5-
-City arTwn Slue Ty rode
(bar)- 7495--2/79
Area oda Pb... sobs
4. DATE DRILLED ih-I - v te
5. TOTAL DEPTH•. too
6. DOES WELL REPLACE EXISTING WELL? YES O NO O- '
7. STATIC WATER LEVEL Below Top Of( _FT.
(Use ^ems if Above Up et°dog)
8. TOP OF CASING 1S / FT. Above lad Surfaces
flap .rmathw ewaL.ard aslw asks lad seine e...e •
•aisam 1M ea ISA NCAC IC Alit
9. YIELD (gar): I z METHOD OF TEST 14 /'t
10. WATER ZONES (depth) )11, via, 67 r s`A
.„,,Topographic/Land setting
Midge °Slope Malley Mat
Newt sprawls&bee)
latieoddkagitude of well location
(demeeshoimatalseeones)
Latitude/longitude tearer OGPS0Topographic map
(Madam.)
AEYr a DRIILINO LOG
From To Formation Description
0 10 Z Br`i2-f-
Cr /CAW, zs-
P
O cur.
.. _,,.,t
® r'
til
cG t C
LOCATION SKETCH N a"=1
I I. DISINFECTION: Type (1..t iati-C. AMOR d o i' 792, Show direction and distance in it ROM at Raged
12. CASING: . Wall Thiduas two State Roads (*.County Roads Include the rogi
Depth maw er eridg a pt pen nombera and a MMIE= Toed Creaser.
From To Ft.
Frolt_il __To_
!n R r1lJ
13. GROUT: Depth Meded
From To Ft
From__(_ To 73 FL tLrlr..P % AvmAPci
14. SCREEN: Depth D� Slot Sue Maria/
From To Ft in. ia.
From__ To Ft is in.
15. SAND/GRAVEL PACK:
Depth Size Msamial
To Ft
To Ft.
Fran To -
From
From
2 24 -A
j po.
c
woii
16. REMARKS:
I DO HEREBY CERTIFY 1
CONSTRUCTION STAND
T THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH ISA NCAC 2C, WELL
AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
SIGNATURE e; PERSON CONSTRUCTING THE WELL
DATE
Submit the original to the Division at Water Quality, Groundwater Section,1636 Marl Sat Caner - RYei f►, NC
27699-1636 Phone W. [phone], within 30 days. GW-I REV. 070001
7:71-

393336
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR w DWIDUAI9RAME (pet) Si A (L,'`YFI." : CERTInCA71Ma/4ISL
WELL CONTRACTOR COMPANY NAME Jo•S—. C :Q1 moms of )9°ry 4S4tn
STATE WELL CQ,'STaVrnoN pawn ASSOCIATED WO r6RMr14-
(ifapplicable) (iifappliahle)
1. WELL USE (Check Applicable 8o:): Residential IVMmncipal/Pohlic 0 Industrial 0 Agi ahmal0
Monitoring 0 Recovery 0 Heat Pump Wad Injection 0 Odn 0 If Othts, List Use
2 WELL LOCATIOtt 1
w Neest Town: Ai VOL WZ County M r:44.0
(:rAlac v Gitt/c fo.t'O /mod
(Shur Name. Nambea. Cammaj Sabtedoa. tat No., Zip Cade)
3. OWNER: C4.eiQP Sot Litt); F/L
Address IPO 113o}c ? Ij
(Street Roulette.)
1 • Nf< S,.a;fv4t!AA.S not
Gty loom St t
( 9) 5n- &MT
e28 7yg
We Code
Topog ic/ and setSg
tea, OFDa
(cloak appends boa)
latitude loogiwde dwell Makin
(dedaeshoirmad+eomde)
Latitudelongiwde solrccOGPSOTopogaphic top
newt box)
DR)LUNO LOG
Formation Description
DEPTH
From To
Area cadge non saw n J — 7C 0 i it- s
DR 4. DATE MULLED 10- el- C 4
LLEN
5. TOTAL DEPTH- 40 70 ' I R _- (ivi -
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO )9. (2 S P bier
7. STATIC WATER LEVEL Below Top ofC.Sg . FT. % .. 4
761
(User if Above Too of Cant .
8. TOP OF CASING 1S I FT. Above laad Swface'a
flop Kara aaeern eed Wow balm bed serf see a.ipara+.
runner /a accordance was ISA NCAC 2C AM
9. YIELD (gpm): 625- METHOD OF TEST / /1
10. WATER ZONES (depth): 7 +" ceprn 0
I I. DISINFECTION: Type 41.c ("\ N Z
12. CASING: Depth !Fawner
From_ To Ft.From Q . To 7C Ft, 1w Y'
77
CGen
n
m
j(o s- LOCATION SKETCH CI _,fit
on
Ammo '�i C , 7 t 7r Sow direction and distance in Riles frign at leap
Wall Thickness two State Roads a Canny Roads. lava the o'
or WRIIIIVR. Noon ve.nLaa and aura. ere toad mann -p
CA/ NQ
ti
FsR �,t,,. To=7iL_ Ft. _till i e ik Cent_
13. G•�.,maui Method
From__ To Ft
Fmot < To 't= FL� i f.c t
14. SCREEN: Depth Diamwlir Slat Se Malarial
From To Ft�ja in.
From To Ft in. is
IS. SAND/GRAVEL PACK
Depth Size Material
To Ft.
To FL
Dili£,! fteA.( M
From
From
16. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH ISA NCAC 2C, WELL
CONSTRUCTION STANDARDSAND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
PERSON CONSIRUCIINGTHE WELL
DATE
rn
Submit the original to the Division of Water Quality, Grooadwater Section,1636 Mall Service Cater - PYeigh, NC
27699-1636 Phone No [phone], within 30 days. GW-1 REV. 0712001

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natur 1 Resources - /t--SON Division of Water Quality - Groundwater Section
nn
G✓
WELL CONTRACTOR (INDIVIDUAL) NAME (print)
�/ I /D X 0 eCERTIFICATION #,SQ
WELL CONTRACTOR COMPANY NAME ,Qrgs4-1e/f RA,// D%/ ///IV, PHONE # �.� 402*
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT/4
(if applicable) (if applicable)
303101
I. WELL USE (Check Applicable Box): Residential fr Municipal/Public ❑ Industrial 0 Agricultural ❑
Monitoring 0 Recovery ❑ Heal Pump Water Injection 0 Other 0 If Other, List Use P/1,'c4v {.t
2. WELL LOCATION: Syr
Nearest Town: ac-e e:we County Adr /Chit
31y -j'd1A--e
(Street Name. Numbers, Community, Subdivision, Lot No.. Zip Code)
3. OWNER: Adre,Orel niQ ,9
Address 3vs, ier„.c' -
�I.Sv�et Route Not R,8
ity or Town State Zip Code
( )-
Area code- Phone number
4. DATE DRILLED i "/9 —0 3
5. TOTAL DEPTH: 200
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO Be
7. STATIC WATER LEVEL Below Top of Casing: 0 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS / FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordance with ISA NCAC 2C.0118. ,,//
9. YIELD (gpm): ® q- METHOD OF TEST r r
10. WATER ZONES (depth):
11. DISINFECTION: Type
12. CASING:
Depth
From f To 7 /
From To
r_Amount
Wall Thickness
or Weight/Ft.
Ft.
Ft.
Diameter
From To Ft.
13. GROUT: Depth
From 0 To SZO Ft.
From To Ft.
14. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in.
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
Material
JO/42/ A'e
Topographic/Land setting
(Midge ❑Slope OValley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DRILLING LOG
Formation Description
DEPTH
From To
m- 4v redel,'",c
�l - f 4 t f�.as„'tl3 It//tr"{e.02c
Method
Material
Cl
F Gcn
-nrm
LOCATION SKETCH t-4 -,pa
Show direction and distance in miles from at leas o—
two State Roads or County Roads. Include the road m©
numbers and common road names.cp—
CO 0
ZzJ
W (.60
C nr
16.REMARKS:
I DO HEREBY CE IFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH I 5A NCAC 2C, WELL
CONSTRUCTIO STANDARDS, TH T A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
/—/#/-03
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. 1919) 733-3221, within 30 days. GW-I REV. 07/2001
•

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural
Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) [Gttiz+ r7% tJO/'e QLCt CERTIFICATION Pad6O/G
WELL CONTRACTOR COMPANY NAME /''4'jEi C(/ hf;// 4 i //.Lt-5 PHONE #OW) yea-zGa2
STATE WELL CONSTRUCTION PERMIT(' ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
303098
1. WELL USE (Check Applicable Box): Residential Municipal/Public ❑ Industrial 0 Agricultural 0
Monitoring ❑ Recovery ❑ Heat Pump Water Injection 0 Other 0 If Other, List Use "/" Gq /E
2. WELL LOCATION y� /
Nearest Town: P411.!^yt-' // County A /cic//
/o.:x 4/e
(Street Name. Numbers. Community, Subdivision, Lot No., Zip Code)
3. OWNER: /kid Coln/Q4"l C0.4"5'3.
Address 5r(a repk ft3h%.
j (St[e�t or Routg No,) ^r7`r
_QK/lwttlC�..C_ 4SJrII f N Cr �( E-lJ
City or Town State Zip Code
( )-
Area code- Phone number �q 7
4. DATE DRILLED r 2J C I'
5. TOTAL DEPTH: 6OO
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO Cis'
7. STATIC WATER LEVEL Below Top of Casing: tag G FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS r FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordance with 15A NCAC 2C .0118.
9. YIELD (gpm): 4 METHOD OF TEST
10. WATER ZONES (depth): 00- _ Pig /ciae4
II. DISINFECTION: Type //y£% Amount a of
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
Fromf To LZci Ft. `' 7Ai /it a/v
From To Ft.
From To Ft.
13. GROUT: Depth Material Method
From 0 To , L Ft. 4Gvef Y' fBLen rr/'
From To Ft.
14. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in.
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
16. REMARKS:
Topographic/Land setting
Midge OSlope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From To Formation Description /
3 ems`/ raArrt? /e
o sl z:''7 9e r p te�j
,257 GOG
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.
/x 0 Grn
C' —n
5=.i�ias
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS. AND THAT A COPY DE THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
SIGNATURE OF PERSON
STRUCTING THE WELL DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center- Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-I REV. 07/2001
rn—
rn
v:3m
�O
1 —
a oc'
p a0
W rna

303094
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of �Wsater Quality - Groundwater Section
r
WELL CONTRACTOR (INDIVIDUAL) NAME (print) /(cA- ve'9'4 ;/.%atveb.., CERTIFICATIONifr2It
\\'ELI. CONTRACTOR COMPANY NAME g 16/9/1p/�/ . 4.4y PHONE# fa/3 /.f30FGc.
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WO PERMITS/
(if applicable) (if applicable)
I. WELL USE (Check Applicable Box): Residential r/Y Municipal/Public ❑ Industrial ❑ Agricultural ❑
Monitoring 0 Recovery 0 Heat Pump Water Injection ❑ Other 0 If Other, List Use
2. WELL LOCATION:
Nearest Town: /✓aAir^".""/,/I.; County il`?/7c/rz//
,Cr,t Af
(Street Name. Numbers. Community. Subdivision, Lot No., Zip Code)
Al
3. OWNER: 'Plou,
Address /99 tack in
(Street or Route No.)
Jonc3.j)6aO41, 7/t 77ia59
City or Town State Zip Code
( )-
Area code- Phone number
4. DATE DRILLED dj-O 4'
5. TOTAL DEPTH: ci b
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO F3'
7. STATIC WATER LEVEL Below Top of Casing: / 0 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
9. YIELD (gpm): 3 ,' METHOD OF TEST AO
10. WATER ZONES (depth): re-f'7 w/
5 3-J r,1:5"re
11 DISINFECTION: Type //% /'{ Amount /TCi X
12. CASING: Wall Thickness
Depth Diameter or Weieht/Ft. Material
From To aa?? Ft. G 4 /ZS
From To Ft.
From To Ft.
13. GROUT: Depth Material Method
From 0 To "Cs Ft. 11r;%e ,%fie go(rrad
From To Ft.
14. SCREEN: Depth Diameter Slot Size Material
From To Ft, in. in.
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth
From To Ft.
From To Ft.
Size
Material
Topographic/Land setting
ORidge ❑Slope Malley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DRILLING LOG
Fpppprmation Description
)rot. r/S
ne
/'O.t.+ r f .
DEPTH
From To
s'-
37 - Yc
5r0 - YY
9�- 3a3
3a AA
383'-yvv
fcticeit
fre
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.
,„(re
JJar.'
ar.
3;"v
16. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS. AND THAT A COPY 0 THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
SIGNATURE OF PR(SON CONSTRUCTING THE WELL d DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center- Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-1 REV. 07/2001

303107
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and NaturalyuResources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) ^e✓iri/ Mier
n.L, CERTIFICATION# 92526
WELL CONTRACTOR COMPANY NAME St J.rjeZ/ kJe-( .0,'; //NI/„ PHONE # (#1;22) P,03.--442
STATE. WELL CONSTRUCTION PERMIT#
(if applicable)
ASSOCIATED WQ PERMIT#
(if applicable)
I. WELL USE (Check Applicable Box): Residential Bunicipal/Public 0 Industrial 0 Agricultural ❑
Monitoring ❑ Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use `r: ✓o rt
2. WELL LOCATION:
Nearest Town: YY 6e-Vet,
(Street Name Hunters, Community. Subdivision, Lot No.. Zip Code)
County ,fl /-44
3. OWNER: Soh Ca/
Address IO CAt/1S //0//ow .
( reet or ou%e No.)
N ke tSJr t •(- , Sio.5-
City or Town State Zip Code
( )-
Area code- Phone number
4. DATE DRILLED /f —/S—o u
5. TOTAL DEPTH: Sot 0
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO 8'
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 I5A NCAC 2C .0118.
9. YIELD (gpm): / _ METHOD OF TEST
10. WATER ZONES (depth): /O.f — /0 f /Sa /
II DISINFECTION: Type //Tnt
12. CASING:
Depth
From "1 To 7?
From To
From To
13. GROUT: Depth
From d To 620
From To
14. SCREEN: Depth
From To Ft. in.
From To Ft. in.
15. SAND/GRAVEL PACK:
Depth
From To Ft.
From To Ft.
Diameter
Ft.
Ft.
Ft.
Amount 3o!'
Wall Thickness
or Weight/Ft. Material
,meal
``Material Method
Ft. ACnrly./r "earl/
Ft.
Diameter Slot Size Material
in.
in.
Size Material
16. REMARKS:
pographic/Land setting
etnii;T:ge ❑Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/ninutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From To Formation Description
0 — d'z ^ eriett
3.2 — /es' jeer- i to
/or- / 6 9 .1-4e%re R
/09-3a0 f•yreti; r
LOCATION SKETCH
Show direction and distance in miles from at Iefir&
two State Roads or County Roads. Include the rtj
numbers and common road names. cit
�w /C"^'
/n
0 GAr/e•
rY fro idAreer7,,/1
f./ Lean hi Jl
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH I5A NCAC 2C, WELL
CONSTRUCTION STAJ 'DARDS, 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. 07/200'1

303105
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division/Jof Water Quality - Groundwater Section/
WELL CONTRACTOR (INDIVIDUAL) NAME (print)�jj,O tr/.'j �}^Ard.. e-/ / CERTIFICATION(tP2"41
WELL CONTRACTOR COMPANY NAME Sty( f!f/fi(! �e/LAIr l/leniJ PHONE # (g2?) 332(p
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
I. WELL USE (Check Applicable Box): Residential le Municipal/Public 0 Industrial ❑ Agricultural ❑
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other 0 If Other, List Use
2. WELL LOCATION: / ! `/
Nearest Town: pest'6;410v County ,�lrier[�cf
(Street Name. Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER:
Address
Mock So I ies
(p24t, go/ 221, 5
kl°LSor�(iteet w;Ro`rut` No.) c9rit a5
City or Town State Zip Code
(I21)- 2„5-9re1r
Area code- Phone number
4. DATE DRILLED 2''6' ea 9-
5. TOTAL DEPTH: ,2 go
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO l'
7. STATIC WATER LEVEL Below Top of Casing: ¥O FT.
( Use "+" if Above Top of Casing)
8. TOP OF CASING IS /I FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordance with ISA NCAC 2C .0I18.
9. YIELD (gpm): /.5' METHOD OF TEST A
10. WATER ZONES (depth): ,O ^ 7 S S $e/
l to j S /o, y?/
I I. DISINFECTION: Type //rf{ Amount Soy
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. %fterial
From -*/ To 5 C Ft. 14 .spat/ ire
From To Ft.
From To Ft.
13. GROUT: Depth Material Method
From b To 6,70 Ft. CcmV..f- 20entQ
From To Ft. i/
14. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in.
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
16. REMARKS:
Topographic/Land setting
Midge OSlope 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
70 �f 0
90 - 9�S'
'-/
',or/9
/)5
Formation Description
✓ ,'42;y
G/i rr rr
r y"art. lie
tql.e- nit tb
P
LOCATION SKETCH O cm
Show direction and distance in miles from at lastrrS'tq
two State Roads or County Roads. Include the roa. 73L
numbers and common road names. -uurn
o(;)
men
Z
"ta
▪ Z• �
W u.,*a
c:
4e,t4. "Pi an,
84i /Milos
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH I5A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A CO Y OF HIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
2- 4 #
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.1919) 733-3221, within 30 days. GW-1 REV. 07/2001

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division//of Water Quality - Groundwater Section
9
WELL CONTRACTOR (INDIVIDUAL) NAME (print) /v ;/VAO i irefvfO/b CERTIFICATION #✓— %G
WELL CONTRACrORCOMPANY NAME b K(reel/ P4/{ //A+'//i ic.5 PHONE #(aA.M=73/7og
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
I. WELL USE (Check Applicable Box): Residential L9•-• Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection ❑ Other 0 If Other, List Use i/r /✓ak.
2. WELL LOCATION: /
Nearest Town: tee IlerJde v.'County At filed
/ioAKAid- R6
(Street Name. Numbers, Community, Subdivision, Lot No.. Zip Code)
3. OWNER: La-(t,L,- MG0+16-4C u-J (i)1 -,-i_ )
4
5
6
7
Topoggrap /Land setting
❑Ridge ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Address Vet ° jr.no.r,-.t etc!
�— Latitude/longitude sourcesflGPS❑Topographic map
(Met or Route No.) (check box)
' C' ��7 77 DRILLING LOG
City or Town State
( )-
Area code- Phone number
DATE DRILLED 3 ri_c
DEPTH
Zip Code From To Formation Description
0— /o /t eeigel'A JL
TOTAL DEPTH: 909'00
DOES WELL REPLACE EXISTING WELL? YES ❑ NO IT -
STATIC WATER LEVEL Below Top of Casing: a a FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS / FT. Above Land Surface*
'Top of casing terminated at/or below land surface requires a
variance in accordance with ISA NCAC 2C .01 I8.
9. YIELD (gpm): O METHOD OF TEST
10. WATER ZONES (depth): fir {yid
3 cs,r 02 9 94 /
I I. DISINFECTION: Type !/Y( 1 Amount .907
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
From / To 8,r FL 6 /8 d' (yell
Ft.
Ft.
From To
From To
13. GROUT: Depth
From D To 120 Ft.
From To Ft.
14.
Material Method
Gcnes-f 0 cum
SCREEN: Depth Diameter
From To Ft. in.
From To Ft. in.
15. SAND/GRAVEL PACK:
Depth Size Material
Slot Size Material
in.
in.
From To Ft
From To Ft
16. REMARKS: 10 R Soo .f- dA
/0 Cfe 'ro"G[ 110t9/olh1r,
$E7 f0 o no,. e le-
r
t /,'-1 .- 4-erne tl
en. r i
�1s
3o5. 307 ✓erere, PetK
9e—?3
15 5o6"
362 ilo yea f vf!
LOCATION SKETCH
Show direction and distance in miles from atgast
two State Roads or County Roads. Include the rad
numbers and common road names. �1
1
CO
�a>jt/ n/r/o/AnCIce (t.74 c.
1
gee //trio//c
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTN STANDARDS. AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER_.
3-L- v4
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) a-NI/LT4 ✓0.1c6,ti CERTIFICATION #y(667
WELL CONTRACTOR COMPANY NAME sere S tent a k'7 D6AY/Zkyj PHONE # (9)3d 044
SLATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT# c
(if applicable) (if applicable)
I. WELL USE (Check Applicable Box): Residential ge Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List User ltt.
2. WELL LOCATION: �/
Nearest Town: aq.K ir.6r.i i/c County Mt1 4 art/
(Street Name. Numbers. Community. Subdivision, Lot No., Zip Code)
3. OWNER:
Address
4
5
6
7
/z{l U IJa le If Ed
(Street or Route No.)
[3ak enc.,1 c- 7UC_
ily or Town State
( 692 a Wet
Area code- Phone number
DATE DRILLED 3�'S'-C� `f-
a87o5-
Zip Code
TOTAL DEPTH: i`2y
DOES WELL REPLACE EXISTING WELL? YES 0 NO e
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 15A N'CAC 2C .01I8.
9. YIELD (gpm): 0.1 - METHOD OF TEST /41iiet
10. WATER ZONES (depth): 7S7 3O e
1 I. DISINFECTION: Type rrh'
12. CASING:
Depth Diame)er
From —1 To ib Ft. /a y
From To Ft.
From To Ft.
13. GROUT: Depth Material Method
From 0 To Dart) Ft. Caen,/ Qa n•ntc
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 P-02
Wall Thickness
or Weight/Ft./Material
SPA "PC
16. REMARKS:
Topographic/Land setting
aiidge ❑Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degreeshninutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From To Formation Description
4 — 1.2_ r care bn,.1sn4 s/
Got - [7r v�0
7s- Sp rolaw.tasstr.,�
LOCATION SKETCH
Show direction and distance in miles from at lest
two State Roads or County Roads. Include the And
numbers and common road names. 9
11/-p1e
A-f
ea
tt/,OQ" 9 /cfi///.P0
Ze�r•^a,,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 RECO
HAS BEEN PROVIDED TO THE WELL OWNS
SIGNATURE OF PERSON CONST(ti1CTING THE WELL DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-1 REV. 07/2001

North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
1636 Mail Service Center - Raleigh, N.C- 27699-1636 - Phone [phone]
304714
WELL CONSTRUCTION RECORD WELL CONTRACTOR- Dewey Wright Well Pump Co., Inc.
2007
040588 WELL CONTRACTOR CERTIFICATION A. Steve Reece
STATE WELL CONSTRUCTION PERMIT#•
1. WELL USE (Check Applicable Box): Residential [X1 Municipal ❑ Industrial ❑ Agricultural ❑ Monitoring El
Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use.
2. WELL LOCATION: (Show sketch of the location below)
Nearest TTo BURNSVILLE Countryty MITCHELL
AITAPASS CH OF tiUU ND. UFF AL I AYASS RD. OFF OF
3. OWNER
(Road Name and Numbers, Community, or Subdivision and Lot No.)
DAVID C BURLESON
Address b68 STEWARL RD. ,
BAKERSV1tttr Route No.) NC
28/05
City or Town State
4. DATE DRILLED 11/4/2004
5. TOTAL DEPTH 600
6. CUTTINGS COLLECTED YES ❑ NO r<1
7. DOES WELL REPLACE EXISTING WELL? YES JI NOExl
Zip Code
8. STATIC WATER LEVEL Below Top of Casing• FT.
(Use "+" if Above Top of Casing)
9. TOP OF CASING IS 1 FT Above Land Surface*
*Top of casing terminated at/or below land surface requires a variance in accor-
dance with 15A NCAC 2nq.0119 E gr Air
10. YIELD (gpm): MEaS ppm 55 5b3
11. WATER ZONES (depth): 0.00 ppm
.00 ppm
DRILLING LOG DEPTH
FromD To
98 DIRFormation Description
18 550 GRANITE
550 553 QUARTZ
553 600 GRANITE
u.uUApm
12. CHLORINATION: Type HIH Amount 11!
13. CASING:
Wall Thickness
Depth Diameter or Weight/Ft. Material
From 0 To 26 Ft 8 1/13.350 PVC
From To Ft
From To Ft
14. GROUT:
Depth Material Method
From 0 To 20 Ft Cement Gravity Flow
From To Ft
15. SCREEN:
Depth Diameter Slot Size Material
From To Ft in in
From To Ft in in
From To Ft in in
16. SAND/GRAVEL PACK:
Depth
From To Ft
From To Ft
Size
If additional space is needed use back of form
LOCATION SKETCH
(Show direction and distance from at le two State
Roads, or other map reference poiglO
N
RI"+a-Pass Rol .
c I 1
h �I
Material
3,h
17. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RECORD PROVIDED TO HE WELL OWNER.
/`/WeLC•— i YJt / 1 7 t l
FOR OFFICE USE ONLY
ear
ft
Quad No:
Serial No.
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
Submit original to Division of Water Quality, Groundwater Section within 30 days
GW-1 REV. 12/99

North Carolina - Department of Environment and Natural Resources - Division of Water Quality-1G%oundwater Section 3 0
1636 Mail Service Center - Raleigh, N.C. 27699-1636 - Phone [phone]
WELL CONSTRUCTION RECORD WELL CONTRACTOR.
040604-2 STATE WELL CONSTRUCTION PERMIT#: Leslie Reece
1. WELL USE (Check Applicable Box): Residential El Municipal 0 Industrial CI
Other ❑ If Other, List Use.
Recovery 0 Heat Pump Water Injection CI
2. WELL LOCATION: (Show sketch of the location below)
Nearest Town: SPRUCE PINE
HOPSON RD. OFF 261/226 OFF 19E
County MITCHELL
(Road Name and Numbers, Community, or Subdivision and Lot No.l
3. OWNER DUNE PHILLIPS
Address % DANNY PHILLIPS , 1029 HOPSON RD.
BAKERSVfLrtEr ROote "Q.) NC 28705
6402
Dewey Wright Well Pump Co., Inc.
WELL CONTRACTOR CERTIFICATION #• 2686
Agricultural - 11�VIohitAi�ng.�'�I
DRILLING LOG
From To
0 93
93
144
4. DATE DRILLED 12/7/2004 144
5. TOTAL DEPTH 165
6. CUTTINGS COLLECTED YES El NO
7. DOES WELL REPLACE EXISTING WELL? YES El NO
8. STATIC WATER LEVEL Below Top of Casing: SO FT
(Use "+" if Above Top of Casing)
9. TOP OF CASING IS 1 FT Above Land Surface*
'Top of casing terminated at/or below land surface requires a variance in accor-
dance with 15A NCAC 2cr.g118
10. YIELD (gpm): lU METHOD OF TEST Alr
11. WATER ZONES (depth12° 00 ppm 144-145 O.000pm
0.00 ppm 0.000Dm
City or Town State Zip Code
I XI
I xl
JAN 2 5 2005
'D0PT1h1.
Formation Description
MUD GRAVEL
144 GRANITE
145 SHALE
165 GRANITE
12. CHLORINATION: Type HTH Amount 27
13. CASING:
Wall Thickness
Depth Diameter or Weight/Ft. Material
Groin 0 To 97 Ft 6 1/4 .188 GALV
Lrom To Ft
From To Ft
14. GROUT:
From
From
15. SCREEN:
From
From
From
Depth Material Method
0 To 20 Ft Cement
To Ft
Depth
To
To
To
Gravity Flow
Diameter Slot Size Material
Ft in
Ft in.
Ft in
in
in
in
If add
ional space is needed use back ot4orm
N
LOCATION SKETCH W
(Show direction and distance from at least two State
Roads, or ther map reference points)
7
�,
Vv,e-1 .1 -
$
16. SAND/GRAVEL PACK:
Depth Size Material
From To Ft A
From To Ft V'
V
17. REMARKS' IQV
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.
FOR OFFICE USE ONLY
Quad No
�-e i-6 -03
Serial No
SJ$NATURE OF PERSON CONSTRUCTING THE WELL DATE
Submit original to Division of Water Quality, Groundwater Section within 30 days
GW-1 REV. 12/99

fa -
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
1636 Mail Service Center - Raleigh, N.C. 27699-1636 - Phone [phone]
306403
WELL CONSTRUCTION RECORD WELL CONTRACTOR- Dewey Wright Well Pump Co., Inc.
WELL CONTRACTOR CERTIFICATION #- 2686
040604-1 STATE WELL CONSTRUCTION PERMIT#• Leslie Reece
1. WELL USE (Check Applicable Box): Residential LI Municipal 0 Industrial CI Agricultural I I Monitoring El
Recovery FT Heat Pump Water Injection CI Other 0 If Other, List Use-
2. WELL LOCATION: (Show sketch of the location below)
Nearest Town: SPRUCE PINE County: MITCHELL
HOPSON RD. OFF 261/226
I Road Name and Numbers, Community, or Subdivision and Lot No.)
3. OWNER JUNE PHILLIPS
Address % DANNY PHILLIPS . 1028 HOPSON RD.
BAKERS\CLtt Route No.l NC 28705
City or Town State Zip Code
4. DATE DRILLED 12/3/2004
5. TOTAL DEPTH 185
6. CUTTINGS COLLECTED YES 0 NO El
L
N
DRILLING LOG DEPTH-: 0,
From To Formation Description taa
0 122 MUD SAND
122 135 GRANITE
135 138 SHALE
136 185 GRANITE
7. DOES WELL REPLACE EXISTING WELL? YES 0 NO Ei
8. STATIC WATER LEVEL Below Top of Casing: 40 FT
(Use "+" if Above Top of Casing)
9. TOP OF CASING IS 1 FT Above Land Surface*
*Top of casing terminated at/or below land surface requires a variance in accor-
dance with 15A NCAC 2C.0118
10. YIELD (gpm): 10 METHOD OF TEST fir
11. WATER ZONES (depth)•10.00 ppm 135-136 0.00 ppm
0.00 ppm 0.00ppm
C-.
12. CHLORINATION: Type HTH Amount 26
13. CASING:
Wall Thickness
Depth Diameter or Weight/Ft. Material
From 0 To 128 Ft 6 1/4 .188 OALV
From To Ft
From To Ft
14. GROUT:
From
From
Depth
0 To 20
15. SCREEN:
Material Method
Ft Cement Gravity Flow
To Ft
Depth Diameter Slot Size Material
From To Ft in in
From To Ft in in
From To Ft. in in
16. SAND/GRAVEL PACK:
Depth Size Material
From To Ft
From To Ft
17. REMARKS-
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER.
If additional space is needed use back ntlorm
LOCATION SKETCH N
(Show direction and distance from at least two State:
Ro.wy, or other map reference points)
a� cc .
Qe 4 `9 a
lifrox. R1• et
qs
U
FOR OFFICE USE ONLY
Quad No
vcv
{ /-6-05
SIG URE OF PERSON CONSTRUCTING THE WELL DATE
Submit original to Division of Water Quality, Groundwater Section within 30 days
GW-1 REV. 12/99
1777
• TIT
Serial No

North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
1636 Mail Service Center - Raleigh, N.C. 27699-1636 - Phone [phone]
WELL CONSTRUCTION RECORD
040588
305989
WELL CONTRACTOR- Dewey Wright Well Pump Co., Inc.
WELL CONTRACTOR CERTIFICATION #• 286/
STATE WELL CONSTRUCTION PERMIT#- Steve Reece
L F.
1. WELL USE (Check Applicable Box): Residential I XI Municipal ❑ Industrial ❑ Agricultural ❑ Monitoring P-11y al;`•
Recovery ❑ Heat Pump Water Injection I I Other ❑ If Other, List Use.
2. WELL LOCATION: (Show sketch of the location below)
Nearest Town: SPRUCE PINE County- MITCHELL
MINE CRK RD. OFF 228
(Road Name and Numbers, Community, or Subdivision and Lot No.)
BAN 3 1 2005
. cv,.1 is ;i(.:,Iiii^t
3. OWNER JOHN E REAVES DRILLING LOG DEPTH 'I I: '':,�.;I; i(z.;r^
From To Formation Description
Address 234 REID AVE. , 0 5 DIRT
PORT ST s5O ROO1e "° l FL 32458 5 48 GRANITE
City or Town State Zip Code 48 50 QUARTZ
4. DATE DRILLED 11/9/2004 50 500 GRANITE
5. TOTAL DEPTH 500
6. CUTTINGS COLLECTED YES ❑ NO El
7. DOES WELL REPLACE EXISTING WELL? YES ❑ NO El
8.. STATIC WATER LEVEL Below Top of Casing: 10 FT
;-H (Use "+" if Above Top of Casing)
9. TOP OF CASING IS 1 FT Above Land Surface*
*Top of casing terminated at/or below land surface requires a variance in accor-
dance with 15A NCAC 2914118
10. YIELD (gpm)• METHOD OF TEST Air
11. WATER ZONES (depth)10.00 gPm48-50 0.00ppm
0.00 opm 0.00ppm
12. CHLORINATION: Type HTH
13. CASING:
Amount 8S If additional space is needed use back of form
Wall Thickness
Depth Diameter or Weight/Ft. Material
From 0 To 21 Ft 81/8 .350 PVC
From To Ft
From To Ft
14. GROUT:
Depth Material Method
From 0 To 20 Ft Cement Gravity Flow
From To Ft
15. SCREEN:
Depth Diameter Slot Size Material
From To Ft in in
From To Ft in in
From To Ft in. in
16. SAND/GRAVEL PACK:
Depth Size Material
From To Ft
From To Ft
LOCATION SKETCH
(Show direction and distance from at least two State
Roads, or other map reference pdf%s) n
17. REMARKS -
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER.
FOR OFFICE USE ONLY
Quad No'
4. /), - if - O
Serial No
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
Submit original to Division of Water Quality, Groundwater Section within 30 days
GW-1 REV. 12/99

C)
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
1636 Mail Service Center - Raleigh, N.C. 27699-1636 - Phone [phone]
WELL CONSTRUCTION RECORD
040578
WELL CONTRACTOR. Dewey Wright Well Pump®. Inc.
WELL CONTRACTOR CERTIFICATION #• 2887
STATE WELL CONSTRUCTION PERMIT#• Steve Reece
t,
WELL USE (Check Applicable Box): Residential n Municipal El Industrial ❑ Agricultural I �1 Mohitofinget,
Recovery n Heat Pump Water Injection ❑ Other ❑ If Other, List Use -
2. WELL LOCATION: (Show sketch of the location below)
Nearest Town: BAI4ERSVILLE County: MITCHELL
JOHNSON CEMETERY RD. OFF TOE CANE RD. OFF LOA
(Road Name and Numbers, Community, or Subdivision and Lot No.)
3. OWNER JAMES W. POSTON
Address 378 RIVERVIEW DR. ,
BAXERS\$ tter ROV1e N°NC 28705
City or Town State
JAN 31 2005
DRILLING LOG
From To Formation Description
0 15 DIRT
190 GRANITE
193
4. DATE DRILLED 11/15/2004 430
5. TOTAL DEPTH 500 433
6. CUTTINGS COLLECTED YES ❑ NO 0 500
7. DOES WELL REPLACE EXISTING WELL? YES ❑ NO 0
8. STATIC WATER LEVEL Below Top of Casing: 200 FT
(Use "+" if Above Top of Casing)
9. TOP OF CASING IS 1 FT Above Land Surface*
"Top of casing terminated at/or below land surface requires a variance in accor-
dance with 15A NCAC 2C.0118
10. YIELD (gpm)• 2 METHOD OF TEST Air
Zip Code
11. WATER ZONES (depthl• 1.00 room 180-193 1.00ppm 430-433
0.00 ppm 0.00gpm
12. CHLORINATION: Type NTH Amount 80
13. CASING:
Wall Thickness
Depth Diameter or Weight/Ft. Material
From 0 To 24 Ft 81/8 .350 PVC
zrom To Ft
From To Ft
14. GROUT:
Depth Material Method
From 0 To 20 Ft Cement Gravity Flow(
From To Ft
15. SCREEN:
Depth Diameter Slot Size Material
From To Ft. in in
From To Ft in in
From To Ft in in
16. SAND/GRAVEL PACK:
Depth Size Material
From To Ft
From To Ft
15
190
183
430
433
SHALE
GRANITE
SHALE
GRANITE
If additional space is needed use back of form
LOCATION SKETCH
($lriqw direction and distance from at least two State(,
J7\�` Roads, or other map reference points)
`1.3
W'
17. REMARKS. "'sue antilesq
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 EEN PROVIDED TO THE WELL OWNER.
FOR OFFICE USE ONLY
Quad No'
/01—/O— ©y
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
Submit original to Division of Water Quality, Groundwater Section within 30 days
GW-1 REV. 12/99
Serial No

North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
1636 Mail Service Center - Raleigh, N.C. 27699-1636 - Phone [phone]
WELL CONSTRUCTION RECORD
040589
305991
WELL CONTRACTOR Dewey Wright V'rreii Pump Co.. Inc.
WELL CONTRACTOR CERTIFICATION #: 1tltl!
STATE WELL CONSTRUCTION PERMIT#: bteve F ee¢e
1. WELL USE (Check Applicable Box): Residential U Municipal ❑ Industrial ❑ Agricultural LANMeaiorOSEI
Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use:
2. WELL LOCATION: (Show sketch of the location below)
Nearest Town• BAKERSVILLE
CANE CREEK RD. OFF 226 OFF 1 gE
County MITCHELL
(Road Name and Numbers, Community, or Subdivision and Lot NO
P
DRILLING LOG DEPTH
3. OWNER MICHAEL I SUTHERLAND From To Formation Description
Address P.O. BOX 88 , 0 20 DIRT
BAKERSV'$tttr Route Nei NC 28705 20 38 GRANITE
City or Town State Zip Code 38 40 SHALE
4. DATE DRILLED 11/16/2004 40 55 GRANITE
5. TOTAL DEPTH 100 55 58 QUARTZ
6. CUTTINGS COLLECTED YES ❑ NO 0 58 100 GRANITE
7. DOES WELL REPLACE EXISTING WELL? YES ❑ NO 0
8. STATIC WATER LEVEL Below Top of Casing: 20 FT
(Use "+" if Above Top of Casing)
9. TOP OF CASING IS 1 FT Above Land Surface*
*Top of casing terminated at/or below land surface requires a variance in accor-
dance with 15A NCAC 2C.8118
10. YIELD (gpm). 12 METHOD OF TEST 'ar
11. WATER ZONES Idepth):10.00 gpm38-40 2.004pm 55-58
0.00 Rpm 0.00ppm
12. CHLORINATION: Type HTH Amount 18
If additional space is needed use back of form
13. CASING: LOCATION SKETCH
Wall Thickness
Depth Diameter or Weight/Ft. Material (Show direction and distance from at least two State
From 0 To 26 Ft 6 1/8 .350 PVC Roads, or other map reference poirs)
From To Ft _ la ai
From To Ft. ."
1
W
14. GROUT:
From
From
15. SCREEN:
Depth Material Method
0 To 20 Ft Cement Gravity Flow
To Ft
Depth Diameter Slot Size Material
From To Ft in. in
From To Ft. in in
From To Ft in in
16. SAND/GRAVEL PACK:
Depth Size Material
From To Ft
From To Ft
17. REMARKS.
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RECORD AS BEEN PROVIDED TO THE WELL OWNER.
C
i
J
LS"
Cs
FOR OFFICE USE ONLY
Quad No'
f & /a -/0 -©
Serial No
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
Submit original to Division of Water Quality, Groundwater Section within 30 days
GW-1 REV. 12/99

#11
JAN 31 2005
r
30623
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) Neill Pardue CERTIFICATION # 2609
\ELI.CONTRACTOR COMPANY NAME Air Drilling Company PHONE#[phone]
5LCEE WELL CONSTRUCTION PERMIT# :\SSOCIATED WQ PERMIT#
(if applicable) (if applicablei
I. WELL USE (Check Applicable Box): Residential 0 Municipal/Public 29 Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection ❑ Other 0 If Other, List Use
2. WELL LOCATION:
Nearest Town: Spruce Pine
Rich Knob — Well #5
County
Mitchell
(Street Name. Numbers, Community. Subdivision, Lot No.. Zip Code)
3. OWNER:
Address
Timberline Corp.
17505 W. Catawba Ave. Suite 350
(Street or Rowe No.)
Cornelius, NC 28031
Coy or Town State Zip Code
( Area code- Phone number
4. DATE DRILLED 11-4-04
5. TOTAL DEPTH: 1,165 ft.
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO r
7. STATIC WATER LEVEL Below Top of Casing: 100 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS 2 z FT. Above Land Surface'
*Top of casing terminated at/or below land surface requires a
variance in accordance with 15A NCAC 2C .0118.
9. YIELD (gpm): 12 METHOD OF TEST Air
10. WATER ZONES (depth): 698' - 6 GPM
940'-6 GPM
II. DISINFECTION: Type HTH Amount
12. CASING: Wall Thickness
Depth Diameter or Weight'Ft. Material
From 0 To 55 Ft. 8" Galv.
From To Ft.
From To Ft.
13. GROUT: Depth Material
From 0 _ To 55 Ft. Grout
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
Method
Pumped
From To Ft
From To Ft.
16. REMARKS: 8" Drive Shoe
Topographic/Land setting
❑Ridge ❑Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
Idegrees/minwes, seconds)
Latitude/longitude source:OGPSOTopographic map
(check host
DEPTH DRILLING LOG
To Formation Description
55' Dirt
55' 1165' Rock
From
0'
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the roar
numbers and common road names. ri4
4
C h e51 7a
6/Erie Rd
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH I5A NCAC 2C. WELL
CONSTRUCTION STANDARDS, AND THAT B( COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
• .,i
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-1 REV. 07/200I

C'Pr
North Carolina Department of Environment Si Natural Resources
Division of Water Quality - Groundwater Section
1636 Mail Service Center
Raleigh, NC 27699-1636 Phone: [phone]
WELL CONSTRUCTION RECORD
DRILLING CONTRACTOR:
Tyr, we 4/ Mai' r75
STATE WELL
CONSTRUCTION r�
DRILLER CERTIFICATION NUMBER: / 5 9( PERMIT NUMBER:
1. WELL LOCATION: (Show sketch of the location belay;,)
Nearest Town: �j''ake-ci t'kt County: ' tC%e /f
QUA) NO.
Lat.
Minor Basin
Basin Code
Header Ens
307671
FOR OFFICE USE ONLY
SERIAL NO.
Long. RU.
OW.I Ent.
DEPTH
(Road community• or Subdivision and Lot No.) From To
2. OWNER J OH$7 ta//'t`e/1
ADDRESS
(Street or Route No.)
City or Town (}St Zip Code
3. DATE DRILLED % 4 I S`�oF WELL�i U$O
4. TOTAL DEPTH /43-
5. CUTTINGS COLLECTED YES 0 NO L4�
6. DOES WELL REPLACE EXISTING WELL? YES C NO
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'
'Casing Terminated at/or below land surface is illegal unless a variance is issued
in accordance with 15A NCAC 2C .0118
9. YIELD (gpm): /0METHOD OF TEST
10. WATER ZONES (depth): /
11. CHLORINATION: Type Amount i1/°
Wall Thickness
12. CASING:
41
DRILLING LOG
Formation Description
6mfl- e
co
II -additional space is needed use back of form
From+
Ton:4410
ter O t' hUFt."Orly
From To Ft. LOCATION SKETCH
From To Ft (Show direction and distance from at least two State
Roads, or other map reference points)
13. GROUT:
Depth Material
From 2-0Ft.Lent awl T
From To Ft.
14. SCREEN:
Method
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 STANDARDS, AND THAT A COPY OF THIS RECO HAS BEEN P OVIDED TO THE WELL OWNEA
p o n° p 1 Old rt►s' 0 °Ct
cirM A TrtD C nr r nUTD A l`T(l, 11D a r rMT n a Tr

DRILLING CONTRACTOR: rtjth we.4-t''<<t`r3
STATE WELL
North Carolina Department of Environment & Natural Resources
Division of Water Quality - Groundwater Section
1636 Mail Service Center • FOR OFFICE USE ONLY
QUAD NO. SERIAL NO.
Raleigh, NC 27699-1636 Phone: [phone] Lat. Loos. RO.
Minor Basin
WELL CONSTRUCTION RECORD Header EnEnt
t
t.. ..p e GW.l Ent.
it;
72
CONSTRUCTION 2
DRILLER CERTIFICATION NUMBER: PERMIT NUMBER:
1. WELL LOCATION://��Show sketch of the location bye�l,o�w),L
Nearest Town: IJQ tZ ✓ilto County: all kg-
` co A r.- e e /K . DEPTH DRILLING LOG
(Road, Community, or Sc Sd''vision and Lot No.) From To
2. OWNER SH fit ley Ye o%)
ADDRESS
re or RS iku No.)J
City or Town
3. DATE DRILLED
4. TOTAL DEPTH. !q
5. CUTTINGS COLLECTED
State Zip Code
SE OF WELL,*USe
YES 0 NO
6. DOES WELL REPLACE EXISTING WELL? YES CINO
7. STATIC WATER LEVEL Below Top of Casing: 70 FT.
L / (Use " + " if Above Top of Casing)
8. TOP OF CASING IS ( FT. Above Land Surface
'Casing Terminated atior below land surface is illegal unless
in accordance with I5A NCAC 2C .0118 y�
9. YIELD (gpm): 7 METHOD OF TEST 1\/
10. WATER ZONES (depth): 3J Q
11. CHLORINATION: Type
12. CASING:
rJ
. D
From /_Lr To.h 4" Ft.
From To Ft
From To Ft.
I3. GROUT:
Formation Description
705' O f,fren
rn
w
co 9
O r
Amount If additional space is needed use back of form
Wall Thickness
Did er Or 1Yei" tt/Ftite jai
7
Depth //1� MateriatI,,��� (tad
From To G-L/ Ft c Q✓rQ(Ir
12.
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
LOCATION SKETCH
(Show direction and distance from at least two State
Roads, : other map reference points)
(")
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 OWNE
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T•mi.

lid
3. OWNER:
Address
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resource - Division of Water uali
WELL CONTRACTOR (INDIVIDUAL) NAME (print) /(qrMM `� Q ty -Groundwater Section
�
WELL CONTRACTOR COMPANY NAME er CERTIFICATION #1
STATE WELL CONSTRUCTION PERMIT# PHONE 6Y )G Pd -�es('p
(f ASSOCIATED WQ PERMIT#
(ifa licable)
E
1. WELL USE (Check Applicable Box): Residential r 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: SDs“— County Topographic/Land setting
( d-�_
❑Ridge f9S�lope OValley ❑Flat
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code) (check appropriate box)
Lati de/pgitude of well location
t app linable)
( City o rat
O crates,
ip Code
Area c de- one number
DA
4. TOT L DEP H:
5. TOTAL DEPTH: j
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO [Y
7. STATIC WATER LEVEL Below Top of Casing: yam,
(Use "+" if Above Top of
_
8. TOP OF CASING IS
FT. AboveLand Surface*"Top of casing terminated at/or below land surface requires a
variance in accordance with ISA NCAC 2C .0118.
9. YIELD (gpm): _a_ METHOD OF TEST: q
10. WATER ZONES (depth): a y3 , -`7�--
11. DISINFECTION: Type
12. CASING: Amount_ Wall Thickness
F O Diapeter or Weight/Ft. Material
From 0 To__ Ft��
From To FI ,t'--'?, �t Y!�
From To Ft
13. GROUT: Depth
From Materia)
From—� To�� Ft . Lroncre, �/ nMethod
out
To Ft.
14. SCREEN: Depth Diameter
Size Material
From To Ft. Slot
Fromin. —_ in.
To Ft in.
15. SAND/GRAVEL PACK: in.
Depth Size Material
From To Ft.
From To
Ft.
16. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTIONSTA DS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
grees/minutes/seconds)
Latitude/longitude source: aidPS❑Topographic map
DEPTH (check box)
From DRILLING LOG
To Formation Description
YL- — p
310828
omiMi
0
LOCATION SKETCH -a,�' l
Show direction and distance in miles from a in - _-
two State Roads or County Roads. Include t ert?a4d
numbers and common road names.
SIGNATURE OF PERSON CONSTRUCTING THE WELL
Submit the original to the Division of WaterDATE
Quality,ysGroundwater Section, 1636 Mail Service Center - Raleigh, NC
Submit
t h gthe 3-J2o, d
GW-1 REV. 07/2001

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section �----,, ''99//
WELL CONTRACTOR (INDIVIDUAL) NAME (print) JlRc % -11, h CERTIFICATION #_,_p/
WELL CONTRACTOR COMPANY NAME f'er2 i. se al 1AJLI I 11 t•i I I/mc, PHONE W I73-iYer/p
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential V Municipal/Public 0 Industrial 0 Agricultural ❑
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION:
Nearest Town: ,np/ul,C, iiroc'. County MitCANE.
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: MAy/4fl J 1-100
Address So r�IinifiYh Lf.1.V.
Street or Routs No.)
p/tan "MI , jil
Cityor To to ZipCode
t?$)- 7/a.s- 70/O
4am'
Area code- Phone number (�
4. DATE DRILLED /)- 3—O
5. TOTAL DEPTH: 620 (5-
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO IrY
7. STATIC WATER LEVEL Below Top of Casing: FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS / FT. Above Land Surface*
*Top of casing terminated actor below land surface requires a
variance in accordance with 15A NCAC 2C .0118.
9. YIELD (gpm): e2 lD METHOD OF.T ST ety
10. WATER ZONES (depth): /1)6
11. DISINFECTION: Type f/ 7//
12. CASING:
Depth Dipeter
From 0 To 6 Ft. 6
From To Ft.
From To Ft.
Amount J
Wall Thickness
or Weight/Ft. Material
SDd+-.21 4
13. GROUT: Depth Material
From__£ To 9!3 Ft. LAC ro 1-e
From To Ft.
14. SCREEN: Depth Diameter
From To Ft. in.
From To Ft in.
oz.
Method
Po t.. real
Slot Size Material
in.
in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
16. REMARKS:
ttdopographic/Land setting
ge ❑Slope OValley ❑Flat
(check appropriate box)
Latitude/longgitudeofwell location
3s1�� Ytd 3J - a8ie�
(degrees/minutes/secon s)
Latitude/longitude source: ❑GPS❑Topographic map
(check box)
DRILLING LOG
Formation Description
DEPTH
To
o15— C/A,
2
=t
Show direction and distance in miles from at least
two State Roads or Couhty Roads: Include the road
numbers and common road names.
LOCATION SKETCH
C,7cuce pine 11{ C.
Cfl
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, ND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
/J r 3 -
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

wi
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section ��99//
WELL CONTRACTOR (INDIVIDUAL) NAME (print) , r E- A -I t ✓l CERTIFICATION#a2 a'
WELL CONTRACTOR COMPANY NAME Fer13tr,goai &GII Ilc/ll.ng PHONEFc GV3 -95'!
STATE WELL CONSTRUCTION PERMIT# / ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential 4 MunicipaUPublic 0 Industrial 0 Agricultural ❑
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION: /
Nearest Town: R d 1*1/ County P'l.G6/ah411
1)ey onnr ; 6CSY
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: 'Z€Po/ w 11Y6o-D.�
Address j '/tQ MtJACfnsy2esaxr)) Rd.
(Street or Route No.)
I 3//n/to.'t/ Aff..' AYVO
Zip Code
City or Town State
Area code- Phone number
4. DATE DRILLED II --S " 0 `%
5. TOTAL DEPTH: Qi/o
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO
7. STATIC WATER LEVEL Below Top of Casing: JO FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS / FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordance with ISA NCAC 2C .011S.
9. YIELD (gpm): a METHOD OF TEST Wet
10. WATER ZONES (depth): VS- ' -a— -don
11. DISINFECTION: Type /y 7f/ Amount 6Z.
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
From D To e2/ Ft. In 9 sink a I PVC
From To Ft.
From To Ft.
13. GROUT: Depth Material Method
From6 To 9n Ft. Conero 1-e
From To Ft.
14. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in.
From To Ft in. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
Topographic/Land setting
❑Ridge ❑Slope Wiley ❑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 Cho } . • 8�re,
/l .l I 7-
ad-
_s
3
fl
14i
— f
O it
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.
Po t-treci 6- a a Ma-
6/
Pio t c t2-ex.,, He
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
/,Ce df :
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
'?3
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center- Raleigh, NC z--3
27699-1636 Phone No. [phone], within 30 days. GW-1 REV. 07/2001 `�'

3t1w
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resou%rr s�-yDivision of Water Quality - Groundwater Section [� 9
WELL CONTRACTOR (INDIVIDUAL) NAME (print t / a...r DVS V" CERTIFICATION #�n/���G
WELL CONTRACTOR COMPANY NAME IL/15 tiSG.v 14.3t"J PHONE KY78 CO f°7.7"9 i
STATE WELL CONSTRUCTION PERMIT# O ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
I. WELL USE (Check Applicable Box): Residential sr Municipal/Public ❑ Industrial ❑ Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATIO ��//
Nearest Town: n 41yc [aat4ountylC'_/12li
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: �(1t,�J//
Address t�. a 2cd / 3
(Street or Roue MA)
2,. /Ilfir,.
City or<) OI J? L / Zip Code
}r
Area code- Phone number
4. DATE DRILLED _ /�-
5. TOTAL DEPTH:
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO .0:3
7. STATIC WATER LEVEL Below Top of Casing: b FT.
#4.., (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 I5A NCAC 2C .0118.
9. YIELD (gpm):. %(1%1 MET1i0D OF T$S�2ie)
10. WATER ZONES (depth):
Topographic/Land setting
Ridge ❑Slope OValley ❑FIat
(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
11. DISINFECTION: Type Amount
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
From 1% To ICJ Ft._
From To Ft.
From To Ft.
13. GROUT: Depth Material
From To Ft.
From To Ft.
14. SCREEN' Depth Diameter
From To Ft. in.
From To Ft. in.
IS. SAND/GRAVEL PACK:
Depth Size Material
JQ 26
Slot Size
in.
in.
From To Ft.
From To Ft.
16. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED
CONSTRJ,CTION STANDARDS, AND THAT A COPY OF
a
v
C-)
O
Ir
LOCATION SKE : H
Show direction and distance in iles from at least
two State Roads or County Roat s-Include the road
numbers and eommon road navies.
CORD HAS BE
SIGNATURE OF PERSON CONSTRUCTING THE WELL
WELL
Fig WELL OWNER
/1-) Z-ofl
DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-1 REV. 07/2001
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