Tr CY2004

WELL CONSTRUCTION RECORD 3 016 0 3
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) Mitchell D. C1Ook. CERTIFICATION 8_ 2043
H 11 r
WELL CONTRACTOR COMPANY NAME 'ECS W.1 a iI1irye itt PHONE 0 (BM 1M-9S91
STATE WELL CONSTRUCTION PERMIT*/ ASSOCIATED WQ PERMIT,*
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential Municipal/Public ❑ Industrial ❑ Agricultural ❑
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use
2. WELL LOCATI N: /� �J..' '
Nea)etTown: CountyLNnOi4 d.m.nQ1
AA.. tral a /• .
(Street Name, N4 tubers, Community, Subdivision, Lot No., Zip Code)
3, OWNER: �ff Ai''iliti1�G)t7 )et121. l/f//W
Address (�
(Street or Route^ o.) rf//O&
City oyly�n'23�aIte Zip Code
Area code- Phone number I,
4 DATE DRILLED yp�,o13 -6`f
5 TOTAL DEPTH l�(OO
6. DOES WELL REPLACE EXISTING WELL? YES ❑ 0 IX
7. STATIC WATER LEVEL Below Top of Casing: FT.
(Use "+" if Move Top of sing)
8. TOP OF CASING IS 2 FT. Above Land Surface'
*Top of casing terminated at/or below land surface requires a
variance In accord with ISA NCAC 2C .0118.
9. YIELD (gpm): METHOD OF TEST hl riw
10. WATER ZONE (dent
I1. DISINFECTION: Type H T H
12. CASING:
Depth
From_ 0 To
From 9aos To
From To Ft.
13. GROUT: Depth
Material
From__ To 20 Ft bra: at
From To Ft.
14. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in.
From To Ft. in. in.
Amount 16 oz
Wall Thickness
or Weight/Ft. Material
Method
P rrf"l
15. SAND/GRAVEL PACK:
Depth
From To Ft
Size Material
From To Ft.
16. REMARKS:
Topographic/Land setting
❑Ridge ❑Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DRILLING LOG
o Formation Description
clay & Sand
granite
DEPTH
From
0
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common road names.
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-1 REV. 07/2001

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) KENNETH R. MCCRARY CERTIFICATION # 2008
WELL CONTRACTOR COMPANY NAME BARKER CONSTRUCTION, INC./BARKER WELL & PUMP PHONE [phone]
STATE WELL CONSTRUCTION PERMIT# 1871 ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
298140
1. WELL USE (Check Applicable Box): Residential El Municipal/Public 0 Industrial 0 Agricultural ❑
Monitoring ❑ Recovery ❑ Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION:
Nearest Town: BREVARD
HWY. 176
County TRANSYLVANIA
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: CHARLES W. ANDERS
Address 91 ANDERS ROAD
(Street or Route No.)
BREVARD NC 28712
City or Town State Zip Code
( 828 )- 885-2128
Area code- Phone number
4. DATE DRILLED FEBRUARY 18, 2004
5. TOTAL DEPTH: 280
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO 133
7. STATIC WATER LEVEL Below Top of Casing: 40 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS 1.33 FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance In accordance with ISA NCAC 2C .0118.
9. YIELD (gpm): 1 METHOD OF TEST TIMED
10. WATER ZONES (depth):
11. DISINFECTION: Type BY PUMP INSTALLER Amount
12. CASING:
Depth
From 0 To 86
From To
From To
13.
GROUT:
From 0
Depth
To 20
Wall Thiclmess
Diameter or Weight/Ft. Material
Ft. 61/8 SDR21 PVC
Ft.
Ft.
Material
CONCRETE
Ft.
From To Ft.
14. SCREEN: Depth
From To
From To Ft. in.
15. SAND/GRAVEL PACK:
Depth Size
From To Ft.
From To Ft.
Diameter Slot Size Material
Ft. in. in.
in.
Material
16. REMARKS:
Topographic/Land setting
❑Ridge ®Slope ❑Valley IJFlat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:0GPSDTopographic map
(check box)
DEPTH DRILLING LOG
From To Formation Description
p
O 40
3 am
m c c-t
�m
CO Sm
PO F
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common road names.
J,wm Ata ia1cd tail . 176
told cunt siku WLL ll- /
Method
POURED ink tie
n„-KUfre�.
F tl/7 ndCti dx�r
On � /± a6otctht
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
�621r00 N'cCi>lcc
SIGNATURE OF PERSO CONSTR
ING THE WELL
2.-.
/DATE
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)6/4V'9 JId / e/lt
WELL CONTRACTOR COMPANY NAM
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable) Of applicable)
I. WELL USE (Check Applicable Box): Residential O' Municipal/Public 0 Industrial 0 Agricultural ❑
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
F .7 '// t- '// / /u.ri
2. WELL LOCATION:�r
Nearest Town:&ovare/ County rforfi �S
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER:At'// &n,f r Address R4 1 pio 42C
(Street or Route No.)
serf Q4rd /1C .R712—
City or Town State Zip Code
(Si)- 44'4�- 2 S% ir
Area code- Phone number
4. DATE DRILLED to—d 4--0 'f
5. TOTAL DEPTH: l/d 4 �N
6. DOES WELL REPLACE EXISTING WELL? YES IO 0
7. STATIC WATER LEVEL Below Top of Casing: CO FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS 7 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): r� METHOD OF TEST ai
10. WATER ZONES (depth): fr 30
11. DISINFECTION: Type Amount
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
From 0 To 7; Ft. to _al_ PLe
From To Ft.
From To Ft.
13. GROUT: Depth
From 0 To ZO
From To
14. SCREEN: Depth Diameter
From To Ft. in.
From To Ft. in.
Material
Ft. feradmi X
Ft.
Slot Size Material
in.
in.
Method
Weed'
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
16. REMARKS:
d
CERTIFICATION #1//
,� PHONE # (tlt ff7/—V4-.0
Topographic/Land setting
❑Ridge ❑Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From To Formation Description
0- 72- citT
'72. - yv� ran >'Te-
n
O •3
LOCATION SKETCH `�
Show direction and distance in miles from at least tA.
two State Roads or County Roads. Include the road
numbers and common road names.
? 76 S. .1.� 509 are
L/ 1 /' hag r. s e- o- / 7r r
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS REC/ORRD HAS BEEN PROVIDED TO THE WELL OWNER'
leAc/
447
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/P/fa/7 Se Bn%//e
WELL CONTRACTOR COMPANY NAMFe/%P frr/-/! LIi/ //13,6•11/1)
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERt\IIT# (if applicable) (if applicable)
CERTIFICATION #7//V-1
PHONE # ( -7Y'— 4&ij
17.
1. WELL USE (Check Applicable Box): Residential Ir Municipal/Public ❑ Industrial ❑ Agricultural ❑
Monitoring ❑ Recovery 0 Heat Pump Water Injection ❑ Other 0 If Other, List Use
2. WELL LOCATI N:
Nearest Town: Wier r.rzee County%aa29
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: C. J • /wry, • S
Address 4 fOtPe 5 f- ito/X e t
(Street or Route No.)
L hap/n S. G
City or Town State
(gall- 7V 9 — 9C47
Area code- Phone number
4. DATE DRILLED 7- / 3 -air
5. TOTAL DEPTH: glaiC iOa
7 ?CV
e3
Topographic/Land setting
❑Ridge ❑Slope ❑Valley ❑EPt
(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- is d,rr-
Zip Code
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO
7. STATIC WATER LEVEL Below Top of Casing: !r7 O FT. it, es, - - /44-
Use "+" if Above Top of Casing)
8. TOP OF CASING IS t- /. FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance In accordance with ISA NCAC 2C .0118.
9. YIELD (gpm): .0 METHOD OF TEST ale
10. WATER ZONES (depth): 3l/17
11. DISINFECTION: Type
12. CASING:
From r1
Depth
To 2t7
From To
From To
13. GROUT: Depth Material
From To 70 Ft.
From To Ft.
14. SCREEN: Depth Diameter Slot Size
From To Ft. in. in.
From To Ft. in in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
Amount
Wall Thickness
Diameter or Weight/Ft. Material
Ft. fi .?h' , 2 I /'/rL
Ft.
Ft.
Method
Material
'Tl/ 4/e/h^
r. a"fl-
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common road names.
2 7C-t) 5 t
Ca.0/e Lake 4'd5~7-oS7`740),e
ni
From To Ft.
16. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH ISA NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS REC S-BEEN PROVIDED TO THE WELL 0WI4ER
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE -
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC?
27699-1636 Phone No. [phone], within 30 days. GW-1 REV. 07/2001
I y 1

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources�- Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME s(print) O/F/J.1 7r"/1 te7// 'e CERTIFICATION 82641,,
WELL CONTRACTOR COMPANY NAME/ /P/Yrl 1/ /�LL�// t �`sin/9 PHONE # 6-24 g
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential 12/Municipal/Public
Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other ❑ If Other, List Use
2. WELL LOCATION:
Nearest Town: iina--errsf
County nan5
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER:
Address
Ef % kin/fete-
927/J
City or Town State Zip Code
Area code- Phone number
4. DATE DRILLED , .- /'-_o°/
5. TOTAL DEPTH: /ii 4
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO ®'
7. STATIC WATER LEVEL Below Top of Casing: Li, FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS 1 FT. Above Land Surface*
`Top of casing terminated at/or below land surface requires a
variance in accordance with 15A NCAC 2C .0118.
9. YIELD (gpm): 2d METHOD OF TEST/z-Gar/
10. WATER ZONES (depth): /en/
(Street or Route No.)
&pi)A,.C( 4r
l 1. DISINFECTION: Type
12. CASING:
Depth Diameter
From d To 1-/!1 Ft. 6
From To Ft.
From To Ft.
13. GROUT: Depth
From 0 Tc2 6' _
From To
14. SCREEN: Depth
From To Ft.
From To Ft.
15. SAND/GRAVEL PACK:
Depth
From To Ft.
From To Ft.
Amount
Wall Thickness
or Weight/Ft. Mjateral
/7> P
Mate ial
Ft. Sa fl In, l
Ft.
Method
Diameter Slot Size Material
in. in.
in. in.
Size Material
16 REMARKS•
Topographic/Land setting
❑Ridge ❑Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DRILLING LOG
Formation Description
DEPTH
From To
EP
el/`rt
jh=/" /maclC�
a/4—//"sir
r- K
n
LOCATION SKETCH
Show direction and distance in miles frorrt leas
two State Roads or County Roads. Include the roaJ
numbers and common road names. A
`g
�76.�`v gee SO"%1
- J %14A Moo "loyit. S
1- ram, /e lr t.eA-t get
/Ql"- ter cr-rt-a /PfY'
L. hr.DQ_LTE$E Y CERI IFY'1W / T THWE
I.
WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WL.
CONSTRUCTION STANDApS, AND THAT A COPY OF THI RE ORD HAS BEEN PROVIDED TO THE WELL O -
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC r.
27699-1636 Phone No. [phone], within 30 days. GW-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) 7/v- e jr/s` // aejj/ f/j�a CERTIFICATION # 47ei1 /
WELL CONTRACTOR COMPANY NAME {'A%Gj'd, I/ LG/,V// r /CL-7'/j7 PHONE # f )
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential 0 Municipal/Public 0 Industrial 0 Agricultural ❑
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
z n
2. WELL LOCATI N: Topographic/Land setting O'—!�'
Near st o_wn: County TVA -tar ❑Ridge ❑Slope ❑Valley ❑F yu
Gr - ltdT (check appropriate box)
Latitude/longitude of well location
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: toA r ifo3 Ott, 1lj
Address _e/ ( 01 % -:DD
(Street or Route No.)
Zt task -a- !a
City or Town State Zip Code
( )-
Area code- Phone number
4. DATE DRILLED C- /r/' c,
5. TOTAL DEPTH: 1"1
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From To Formation Description
®` / a- e�!
7. STATIC WATER LEVEL Below Top of Casing: FT. /3 /Jj -579
(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 jth ISA NCAC 2C .0I18.
9. YIELD (gpm): iO3 METHOD OF TEST a-G .
10. WATER ZONES (depth): fee -
LOCATION SKETCH
11. DISINFECTION: Type 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 ® To �d Ft. 6-4; o i ��� �� �CwLi. r r
From To Ft. /�`at�� �f
From To Ft. /
13. GROUT: Depth Material , Method /� am /%L,I.C!Jrm-
From (r/ To 2r _ Ft. ern./ .t fie9-9,— ..j
From To Ft.ti:.[S/ a
14. SCREEN: Depth Diameter Slot Size Material /�_/ (.i'e
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 I5A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center-Raleigb.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 G WELL CONTRACTOR (INDIVIDUAL) NAME (print) /P4, y Jen7e//i+. CERTIFICATION
¢+#fdi?
WELL CONTRACTOR COMPANY NAMED% rr/ -// 12e // 7" /e..,/, PHONE # (a.:�} O»' 4-c'
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
1
WELL USE (Check Applicable Box): Residential la Municipal/Public ❑ Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other ❑ If Other, List Use
2. WELL LOCATI N: _
Nearest Town: ' p,o.Va r County %rvi22.5"
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: C7ei'e. Z/1/ TA F
Address Doe) Li a
(Street or Route No.)
tbPeUtani_ h C 18912.
City or Town State Zip Code
( )-
Area code- Phone number
4. DATE DRILLED C —0 9
5. TOTAL DEPTH: /0104�
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO
7. STATIC WATER LEVEL Below Top of Casing: 70d FT.
— (Use'-" if Above Top of Casing)
8. TOP OF CASING IS le 9 FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance In accordarl with t5A NCAC 2C .0118.
9 YIELD (gpm):METHOD OF TEST ettw
10. WATER ZONES (depth): $le,
11. DISINFECTION: Type Amount
12. CASING: Wall Thickness
Depth Dmeter or et ht/Ft. fit
From 0 To2 7 Ft. �y i79 1 /�i/
From To Ft.
From To Ft.
13. GROUT: Depth Materr'al
From 0 ToiC Ft. S'affer%:2
From To Ft.
14. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in.
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
Method
i<l
Topographic/Land setting
❑Ridge ❑Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From To Formation Description
/t /e,
S `Tit
d r�
;-i 3 -/ 7,-; melee,
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common road names.
2 76 Frs 5 a a Crr �Ld
a -
0
0
r
h)
0
CJq
16. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH ISA NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT &COPY OF THUS REC9RD1-IAS BEEN PROVIDED TO THE WELL OWNER
ec2 cr y
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-1 REV. 07/2001

0-0
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) Ole/70 It /2 te //ft CERTIFICATION 0 6 //
WELL CONTRACTOR COMPANY NAME/IleNAME/Ile Er ILL L 14"s—// t ge-m/9 PHONE (z
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
I. WELL USE (Check Applicable Box): Residential Municipal/Public 0 Industrial 0 Agricultural ❑
Monitoring 0 Recovery ❑ Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION:
Nearest Town: %' ce/L t'tr-A County 1 or
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: 1�fin i
Address CO (`;4'-(
(Street or Route No.)
City or Town State
( ?q-32-F --7///L
Area code- Phone number 4. DATE DRILLED / —/5_ --61
5. TOTAL DEPTH: %a f O
)e ) 4
Zip Code
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO
Topographic/Land setting o
DRidge ❑Slope ❑Valley rfpt
(check appropriate box) fV
Latitude/longitude of well locatien
(degrees/minutes/seconds) 0-1
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From To Formation Description
-t
7. STATIC WATER LEVEL Below Top of Casing: 3110 FT. /J , f d — ;
r (Use "+" if Above Top of Casing)
8. TOP OF CASING IS /, "J FT. Above Land Surface* h 2 h ---,c ?el
`Top of casing terminated at/or below land surface requires a
variance In accordance with I5A NCAC 2C .0118.
9. YIELD (gpm): 7 METHOD OF TEST OE -� a!l — (4fc
10. WATER ZONES (depth): h_1-c, 4 6-, O C9l1q'trei
11. DISINFECTION: Type Amount
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
From 0 To 2 / Ft. £2-C i `7c
From To Ft.
From To Ft.
13. GROUT: Depth Material
From ® To)LY Ft_"j c 4
From To Ft.
14. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in.
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
Method
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.
�� J7 76...E /� _ /�
A-' -- L2 /�
16. REMARKS:
I DO HE
CONSTR
CTIONgY CERTIFY TH T THIS WELL WAS ED IN ACCORDANCE WITH I5A NCAC 2C, WELL
ST/��IDk4RtbS, THAT A COPY OF THIS TRECORD HAS EEN PROVIDED TO THE WELL OWNER
rl/ � 5 /j�f/l •C (- ,' I. CI
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
2926217
North Carolina-Dcpnrtment of Environment and Natural Resources - Division of Water Quality • Groundwater Section
•WELL CONTRACTOR (INDIVIDUAL) NAME (print) Mitchell Da Cok
WELL CONTRACTOR COMPANY NAME fY 1 nrctr�1-$ p»11 ail-'1rli
STATE.IYELL CONSTRUCTION PERNIITN ASSOCIATED 1YQ PERMIT:
(if applicable) (if explicable)
CERTIFICATION " 2043
PHONE k 823) 369-9591
1. WELL USE'(Check Applicable Box): Residential 3 -Municipal/Public ❑ Industrial O Agricultural 0
Monitoring, 0 Recovery 0 Heat Pump Water Injection ❑ Other 0 1f Other, Llst Use
2, WELL LOCATION:
Nearest Town: Toxaway
Whetstone Gap Rd
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3, OWNER Jackie Hutchinson
Address 4603 Trails Drive
( Street or Route No.)
cuRrasotaa FL 34232
City or Town State Zip Code
941)— 378-3777
Area code- Phone number
4, DATE DRILLED 1-20-04
5 TOTAL DEPTH: 300'
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO
7. STATIC WATER LEVEL Below Top of Casing: 100 'FT,
(Use "*" if Above Top of Casing)
S. TOP OF CASING IS ' 2 FT. Above Land Surface*
"Top of casing, terminated at/or below land surface requires a
variance In accordanfe with 15.4 NCAC 2C .0118.
9. YIELD (gpm): 20 METHOD OF TEST blow
10. WATER ZONES(depth): 100' & 265'
11 DISINFECTION: Type H T H Amount 1 60z
12. CASING: Wall Thickness
Dep'h - Diameter cr Weight/Ft. Material
From 0 To 66 Ft. 6" pvc
From 66' To 70 FL 6" .188 steel
From - To Ft.
13. GROUT: Depth Material - Method
From. O To 20 - Ftb3n-1ite & CsIE± RiiczY3
From To Ft.
14, SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in
From To Ft. in. in.
15, SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
County Transvlvania
Topographic/Land setting
ORidge 0Slope ❑Valley ❑F Iat
(check appropria(e box)
Latitude/longitude of well location
(de3rees/minntts/seconds)
Latitude/longitude source:OGPSOTopographic map
(check box)
DRILLING LOG
Formation Description
clay & sent
68' 300' - granite
DEPTH
From To
0 -68'
LOCATION SKETCH-----:-- :-:
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common road names,
16, REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH I5A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
ems` aa. D. /
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-I REV. 07/2001
DWG GROUNDWATER SECTION

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section/�
WELL CONTRACTOR (INDIVIDUAL) NAME (print/)t'2ich0rd Mc */yp�t+P_�`)ly,, n CERTIFICATIO'Nn#�M
WELL CONTRACTOR COMPANY NAMEBar 'rt3Tisilticl.ten, Inc }slwept f'[(r)(P PHONE # (t29 4i1-77F1'S
STATE WELL CONSTRUCTION PERMIT# 1 5i 1 ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
295415
1. WELL USE (Check Applicable Box): Residential Ir. Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION:
Nearest Town: P)rPYn rd
f)lti Pa on 'Rend
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
CountyTr:111syIVani -
3. OWNER: M n rty Kr i e
Address %3 LiRle° <iVer(nrllp pd.
(Street groute No.)
"%nose 3+c 29766
CityrTown State
as-��IF- r1273
Area code- Phone number
4. DATE DRILLED 5- 2D-04
5. TOTAL DEPTH: c245I
Zip Code
Topographic/Land setting
❑Ridge ❑Slope ❑Valley tat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:OGPSOTopographic map
(check box)
DEPTH DRILLING LOG
From To Formation Description
6. DOES WELL REPLACE EXISTING WELL? YES O NO Er-
7. STATIC WATER LEVEL Below Top of Casing: 40 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS 1.33 FT Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordance with ISA NCAC 2C .0118.
9. YIELD (gpm): 1 .. METHOD OF TEST Timed
med
10. WATER ZONES (depth):
yy pump in.Sbii1er
11. DISINFECTION: Type Amount
12. CASING: Wall Thickness
Depth From 0 To SO Ft. Di eter or Weight/Ft. Material
SDt22I PV C
From
From
13. GROUT:
From 0
To Ft.
To Ft.
Depth Material (� Method
To ` Ft. 00tlarPS It tat
From To Ft.
14. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in.
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Size Material
To Ft.
To Ft.
From
From
LOCATION SKETCH W rc'.
Show direction and distance in miles from at least t
two State Roads or County Roads. Include the road 0)
numbers and common road names.
rro»t z revard +o ke Walnut )-to II ow
-to East Voric +D G. lady 'Road Qork
on ri ht • Go rainviidi
nti l iD old o etc Road on -
}he ri ILt.-Merit - kouici-be a pink-
.0. i,rtherle. mite "Is approx.
ZOyards outOldPoweLf Pd.
tit thhierim hiat ltiELouerlooKara
cree.k.
16. REMARKS: /
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, yELL
CONSTRUCTION STANDARD _ AND THAT A COPY OF IS RECO t HAS BEEN PROVID aJ THE WELL 0 ER
IGNATUR
OF PERSON CONSTRU r ING THE WELL IATE
Submit the 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

29541.2
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print)/B/!'h fil [I(Lb .// �//,t�-,n CERTIFICATION # 421)///0o �J
WELL CONTRACTOR COMPANY NAM Iipve,//AcULIfT/O» i'M/�-erM I ilih PHONE # �) GY /-92
STATE WELL CONSTRUCTION PERMIT# /O 7/ ASSOCIATED WQ PERMI"`T#��'
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential Er-Municipal/Public ❑ Industrial 0 Agricultural ❑
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATIO
Ne est Town: o Coon
/, /brjde et gam- /rQ/2%nu
(Street Name, Numbers, Community, Subdivision, Lot o., Zip Code)
3. OWNER:t A / 112.14 DAd
Address near s'/
fifitreet or RoutpAp4o4
p1144m r&!7x• , �P%0�
City or Town State Zip Code
(127 )- f%4 QO3
Area code- Phone nu ,r^"
4. DATE DRILLED*' 02
5. TOTAL DEPTH: /Sf. '
6. DOES WELL REPLACE EXISTING WELL? YES O Nei ❑
7. STATIC WATER LEVEL Below Top of Casing: DFT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS / e FT. Above Land Surface'
"Top of casing terminated at/or below land surface requires
variance in accordance with ISA NCAC 2C .0118.
9. YIELD (gpm): in METHOD OFTES '9Fond
10. WATER ZONES (depth):
1 L INFE ION: Type Amount
Topogra c/Land setting,
❑Ridge lope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude sotrce:OGPSOTopographic map
(check box)
DEPTH DRILLINGLOG
From To Formation Description
0 v
J
LOCATION SKETCH
Show direction and distance in miles from at (east
12. CASING: Wall Thickness two State Roads or County Roads. Include the road
From
From
14. SCREEN;
From
13. GROUT:
From 0
}
rf?
Depth Di ter or Weight/Ft. atenal numbers and common road names.
To Y �% Ft. _o / J QV
atsxtexi aae jib
From To Ft. ,�(,(Q// /-Jf�(��Q Art Q1 Method 2� G_ ...�.',(., tit-7TG(/"` trio
"owl 7 Gait clad- (lad o..Clcis/
Yale.,vace !a9.
jutte- at }'`40 aizaC
Ajuidtt
To Ft.
Depth A Material
To -9O Ftee/f & itt
To Ft.
Depth Diameter Slot Size Material
From To Ft. in.
From To Ft. in.
15. SAND/GRAVEL PACK:
Depth Size
From To Ft.
From To Ft.
in.
in.
Material
16. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTE
CONSTRUCTION STANDAI DS, AI THAjJ,A COPY OF
at
SIGNATURE
RE
ACCORDANCE WITH 15ANC C 2C, WELL
CORD HAS BEEN PROVIDED TO HE W$LL OWNER
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. GW-1 REV. 07/2001

WELL CONSTRUCTION RECORD
296593
Notth Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) KENNETH MCCRARY
CERTIFICATIONS 2008
WELL CONTRACTOR COMPANY NAME BARKER CONSTRUCTION, INC./BARKER WELL & PUMP PHONE # [phone]
STATE WELL CONSTRUCTION PERMITS 1871 ASSOCIATED WQ PERMITS
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential RI Municipal/Public 0 Industrial ❑ Agricultural 0
Monitoring ❑ Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2 WELL LOCATION:
Nearest Town: BREVARD County TRANSYLVANIA
SOLOMON JONES ROAD
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: JAMES KOLISCH
Address 900 SPANISH OAK DRIVE
(Street or Route No.)
CEDAR MOUNTAIN NC
28718
City or Town State
( 828 )- 884-7666
Area code- Phone number
4. DATE DRILLED ARPIL 14, 2004
5. TOTAL DEPTH: 1000
Zip Code
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO RI
7. STATIC WATER LEVEL Below Top of Casing: 0 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS 1.33 FT. Above Land Surfaces
'Top of casing terminated at/or below land surface requires a
variance in accordance with ISA NCAC 2C .0118.
9. YIELD (gpm): 0 METHOD OF TEST
10. WATER ZONES (depth):
Topographic/Land setting
ORidge ❑Slope OValley HlFlat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:OGPSOTopographicmap
(check box) O
DEPTH DRILLING f OO<___ -
From To Formation De ptid ,,
11. DISINFECTION: Type BYPUMP INSTALLER
12. CASING:
Depth Diameter
From 0 To 47 Ft. 61/8
From To Ft.
From To Ft
13. GROUT: Depth
From 0 To 20
Material
Ft. CONCRETE
Amount
Wall Thickness
or Weight/Ft. Material
SDR21 PVC
From To Ft.
14. SCREEN: Depth
C%^
0 y,
cD
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common road names.
O
J.ton- ,19,avaaL i_ede. 1✓,cct�. 2%
fiat, le_
POURED
Method a Op A t ,( n cn4 mi_ �.Ll
G'1 t q q.1 t nc. a s�l/yaSj
Diameter Slot Size Material
From To Ft. in. in. .12.1A,l,� Q, / 1- L/WD d/1,(,I,(RCIICI.(.t)
el -
From To Ft. in. in. D - tCt / n- (6-0 r to
15. SAND/GRAVEL PACK:
From To Ft.
' a at in,
. alai . i at
Depth Size Material
From To Ft pi ciAttfi
16. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
Ibt-/t/HAAirLAit. (t �I t(.e -t0
SIGNATURE OF PERSON CONSTRUCTING 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

294756
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) RICHARD MCCRARY CERTIFICATION # 2010
WELL CONTRACTOR COMPANY NAME BARKER CONSTRUCTION, INC./BARKER WELL & PUMP PHONE # [phone]
STATE WELL CONSTRUCTION PERMIT# 1871 ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential El Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION:
Nearest Town: BREVARD
MELGLEN FARMS
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
County TRANSYLVANIA
3. OWNER: JAMES L. HEFFEL
Address 2250 ASHEVILLE HIGHWAY
(Street or Route No.)
PISGAH FOREST NC 28768
City or Town State Zip Code
( 828 )_ 862-8481
Area code- Phone number
4. DATE DRILLED MARCH 23, 2004
5. TOTAL DEPTH: 205
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO Ea
7. STATIC WATER LEVEL Below Top of Casing: 30 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS 1.33 FT. Above Land Surface'
*Top of casing terminated at/or below land surface requires a
variance in accordance with ISA NCAC 2C .0118.
9. YIELD (gpm): 40 METHOD OF TEST TIMED
10. WATER ZONES (depth):
11. DISINFECTION: Type BY PUMP INSTALLER Amount
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
From 0 To 80 Ft. 61/8 SDR21 PVC
From To Ft.
From To Ft.
13. GROUT: Depth
From 0 To 20
From To Ft.
14. SCREEN. Depth Diameter
From To Ft. in.
From To Ft. in.
Topographic/Land setting
®Ridge ❑Slope ❑Valley DFIat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:OGPSOTopographic map
(check box)
DEPTH DRILLING LOG
From To Formation Description
O
0;
9 1 n
tom, r
r.
La G
d` Z
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common road names.
i
li/1-40m &randoh' 4
Material Met
Ft. CONCRETE POURED IJPO /X4 °Cce t-
ne.C/CC-uK�
A -End it, Jt
Slot Size Material
in.
in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
tuna-,
16. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH ISA NCA
CONSTRUCTION STANDARDS AND THAT A C Y OF THIS RECO A S BEEN PROVIDED TO T!
/ SIG D NSTRUCTING THE WELL
2C, WELL
WE�L OWNER
ATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-1 REV. 07/2001

294 7 55
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
CERTIFICATION # 2010
WELL CONTRACTOR (INDIVIDUAL) NAME (print) RICHARD MCCRARY
WELL CONTRACTOR COMPANY NAME BARKER CONSTRUCTION, INC.BARKER WELL & PUMP PHONE # f 828) 697-7263
STATE WELL CONSTRUCTION PERMIT# 1871 ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential Igl MunicipaVPublic 0 Industrial 0 Agricultural 0
Monitoring ❑ Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION:
Nearest Town: BREVARD County TRANSYLVANIA
BEARWALL SPRINGS, LOT #G-3
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: MARK CARRUTH HOMES, LLC
Address PO BOX 3188
(Street or Route No.)
CASHIERS NC 28717
City or Town State Zip Code
( 828 )- 743-2016
Area code- Phone number
4. DATE DRILLED MARCH 18, 2004
5. TOTAL DEPTH: 405
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO gl
7. STATIC WATER LEVEL Below Top of Casing: 60 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS 1.33 FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance In accordance with 15A NCAC 2C .0118.
9. YIELD (gpm): 20 METHOD OF TEST TIMED
10. WATER ZONES (depth):
Topographic/Land setting
[Midge ❑Slope ❑Valley ®Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:DGPSOTopographic map
(check box)
DEPTH DRILLING LOG
From To Formation Description
0 c^
t , _2✓
i� t^
0 r�N
C ( Cs'`
11. DISINFECTION: Type 6Y PUMP INSTALLER
Amount
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
From 0 To 114 Ft. 61/8 SDR21 PVC
From To Ft.
From To Ft.
13. GROUT: Depth Material
From 0 To 20 Ft. CONCRETE
From To Ft.
14. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in.
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
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.
LAW- &L2 Ud Alai S'/t&t
Method "{{{��,�tt,J///O lZ ' '/L(fA��t1Q,%C�jV iU.�f�. 281
POURED OIL 62i. G�,WVfl L/Ltv 1 (�LI/Ew/ aWV
y[AnAlp 3.a4cl X . o&LL
/wad enC�rT- , �°at 6x-
16. REMARKS:
I DO HEREBY CERTIFY THAT THIS WEL
CONSTRUCTION STANDARDS, AND
WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
A CO PW OF THIS RECQRD HAS BEEN YROVII)ED TO THE WELL OWNER
dy
DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mall Service Center- Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-I REV. 07/2001

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) RICHARD MCCRARY CERTIFICATION # 2010
WELL CONTRACTOR COMPANY NAME BARKER CONSTRUCTION, INC./BARKER WELL & PUMP PRONE q [phone]
STATE WELL CONSTRUCTION PERMIT# 1871 ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential ® Municipal/Public 0 Industrial ❑ Agricultural 0
Monitoring ❑ Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION:
Nearest Town: BREVARD County TRANSYLVANIA
MIDDLEFORK ROAD
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: RICHARD MICKEWICZ
Address 15 LAZY BOY LANE B-17
(Street or Route No.)
HENDERSONVILLE NC
28792
City or Town State Zip Code
( 919 )- 381-2890
Area code- Phone number
4. DATE DRILLED MARCH 8, 2004
5, TOTAL DEPTH: 505'
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO El
7. STATIC WATER LEVEL Below Top of Casing: 40 Ff.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS 1.33 FT. Above Land Surface`
"Top of casing terminated atfor below land surface requires a
variance in accordance with ISA NCAC 2C .0118.
9. YIELD (gpm): 3 METHOD OF TEST TIMED
10. WATER ZONES (depth):
1I. DISINFECTION: Type BY PUMP INSTALLER
12. CASING:
Depth Diameter
From 0 To 47 Ft. 61/8
From To Ft.
From To Ft.
13. GROUT: Depth Material
From 0 To 20 Ft. CONCRETE
From To Ft.
Amount
Wall Thickness
or Weight/Ft. Material
SDR21 PVC
14. SCREEN: Depth Diameter
From To Ft. in.
From To Ft. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
Method
POURED
Slot Size Material
in.
in.
16. REMARKS:
Topographic/Land setting
®Ridge ❑Slope ❑Valley °Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:OGPS°Topographic map
(check box)
DEPTH DRILLING LOG
From To Formation Description
294753
0
r" G
r �,
LOCATION SKETCH ^� N ;�
Show direction and distance in miles from at least p
two State Roads or County Roads. Include the road o
numbers and common road names. 6`
LAJYIL & th�a,,td tale- J�,L 144rnh -
9 d-a to
6/7g ` P 1Z tkt.Qro
02a & al_ ex_ /ki,
&oar[ Ci72 al w. t.3/jo
ax it. ,uutL a750k-
dad Q tOalauf, ,mod. .
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH ISA NCAC 2
CONSTRUCTION STANDr�$,DS, AND THAT A C9PYQF THJJS RECORD HAS BEEN PROVIDED TO T
SI�AURE PERSON C".-_ UCTINGTHE WELL/AD
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mall Service Center- Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-1 REV. 07/2001

294' 52
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
CERTIFICATION It 2008
WELL CONTRACTOR (INDIVIDUAL) NAME (print) KENNETH MCCRARY
WELL CONTRACTOR COMPANY NAME BARKER CONSTRUCTION, INC./BARKER WELL &PUMP PHONE # [phone]
STATE WELL CONSTRUCTION PERMIT# 1871 ASSOCIATED WQ PERMIT&
Of applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential 1 Municipal/Public ❑ Industrial 0 Agricultural 0
Monitoring 0 Recovery ❑ Heat Pump Water Injection ❑ Other O If Other, List Use
2. WELL LOCATION:
Nearest Town: BREVARD County TRANSYLVANIA
GRAY FOX SUBDIVISION LOT #42
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: DEAN GALLOWAY (MONTY BURRELL-BLOB.)
Address 179 RICH MOUNTAIN ROAD
(Street or Route No.)
BREVARD NC 28712
City or Town State Zip Code
( 828 )_ 877-3082
Area code- Phone number
4. DATE DRILLED MARCH 2, 2004
5. TOTAL DEPTH: 405'
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO El
7. STATIC WATER LEVEL Below Top of Casing: 40 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS 1.33 FT. Above Land Surface*
`Top of casing terminated at/or below land surface requires a
variance in accordance with 15A NCAC 2C Ants.
9. YIELD (gpm): 2 METHOD OF TEST TIMED
10. WATER ZONES (depth):
11. DISINFECTION: Type BY PUMP INSTALLER Amount
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft.
From 0 To 61 R. 61/8 SDR21
From To Ft.
From To Ft.
13. GROUT: Depth Material
From 0 To 20 Ft. CONCRETE
From To Ft.
14. SCREEN: Depth Diameter
From To Ft. in.
From To Ft. in.
15. SAND/GRAVEL PACK:
Depth Size Material
Slot Size
in.
in.
Material
PVC
Topographic/Land setting
ORidge ®Slope ❑Valley OFIat
(check appropriate box)
Latitude longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:OGPSOTopographic map
(check box)
DEPTH DRILLING LOG
From To Formation Description
'y c
i J
N
1 r'
LOCATION SKETCH i al
Show direction and distance in miles from at (east O
two State Roads or County Roads. Include the road 6' o
numbers and common road names.
Solt ga/a td toga & . 64'L(/&t
to Ac1ano�4L ,lum • ah a s
POURED l(.0 .f"f.(,�^ on d to an Road
Meth(Xt P/m xan ,CJAa4461,2)
C9.0 t.Qau) 129 OA, tau ,dubd r c i 'an •
Aitt �
Material
From To Ft.
From To Ft.
16. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH ISA NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A
COPY OFTHISRECORD HAS BEEN PROVIDED TO THE WELL OWNER
��`SL�i v►�{�JoL�,
SIGNATURE OF PERSON CONSTRUCTING THE
LL 3 DA o(1
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-1 REV. 07/2001

WELL CONSTRUCTION RECORD
297144
North Carolina - Department of Environment and Naturalty�Mg'
es - Division of Water Quality - Groundwater Section Q/
WELL CONTRACTOR (INDIVIDUAL) NAME (print) Tr) 1 , `g' �.�flsQ, �r'� / CERTIFICATION* cZ/c Y/
WELL CONTRACTOR COMPANY NAME MR Cr/En� /V (CXeI `' .4 PHONE % 02 /
STATE WELL CONSTRUCTION PERMIT: ASSOCIATED WQ PERMIT*
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential 15 Municipal/Public 0 Industrial ❑ Agricultural 0
Monitoring O Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCHTj IO�N:
Nearest Town: U*C I bYALoar
aS I 1.A1Ce -to" mow /Ue
Topoo aphic/Land setting
County 1 -A-hs t/ I✓KanIG..• ❑Ridge $Slope ❑Valley OFlat
/ !check appropriate box)
(Street Name,`Numbers, Lammuniry, Subdivision, Lot)., rLip Code)
Latitude/longitude of well location
3. OWNER: J.)eh n 1s )'1\1 I(M-e(/( (degrees/minutes/seconds)
Address 1 W 0 ii\iciltuin ytpreiA — 13 49 W' t Latitude/longitude source:OGPSOTopographic map
($treet or RRute No.) '�} E�Ct.C.�'k-�f ee ZO' J 1 �� (check box)
30 DEPTH DRILLING LOG
�x77 rr77�� �/ II,, 22 Zip Code From To Formation Description
(Sag)- / Y J
Area coda- Phone number , /
4. DATE DRILLED (o- 41- D 7
5. TOTAL DEPTH: CV 0
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO gi
7. STATIC WATER LEVEL Below Top of Casing,: (e 0 FT.
(Use "T' if Above Top of Casing)
S. TOP OF CASING IS 1 FT. Above Land Surface*
•Top of casing terminated at/or below land surface requires a
variance in accordance with ISA NCAC 2C .011S. /� r
9. YIELD (gpm): _ l U METHOD OF TEST 14 I r
10. WATER ZONES (depth): ..� (11 3&O/ 53O
City or TownState `
11. DISINFECTION: Type 1-t' T
12. CASING:
Depth
From 0 To 47 Ft
From To Ft.
To Ft.
From
GROUT: Depth _Material Method _
Fr�rom O To Ft. l_52.4- x-2-7,-t'
From .3 To 20 Ft. 7 G...' "ilex -- (�-f 'I" -L��C% Y c^''e%«
3a-art?
L
LOCATION SKETCH I —
Amount t CO Z Show direction and distance in miles frt%n at leas[
Wall Thickness two State Roads or County Roads. Include the road
numbers and common road names.
or lVeieht/F[. Material
5 )f z/ P✓c
SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in.
From To Ft. in. in. //� �/
SAND/GRAVEL PACK: /7t�/
Depth Size Material �C//
From To Ft.
From To Ft.
16. REMARKS:
1 DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH I SA NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE \VELLOWNER
G — Icy •`{
—Tr - !.r, CAA
SIGNATURE OF PERSON CO=JCTNG THE WELL DATE
Submit the original to the Division of Water Quality., Groundwater Section, 1636 Mail Service Center -Raleigh, NC
GW-1 REV. 07i2001
27699-1636 Phone No. [phone], within 30 days.

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) RICHARD MCCRARY CERTIFICATION # 2010
WELL CONTRACTOR COMPANY NAME BARKER CONSTRUCTION, INC./BARKER WELL 8 PUMP pJONE # 1828) 697-7263
STATE WELL CONSTRUCTION PERMIT# 1871 ASSOCIATED WQ PERMITS
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential gl Municipal/Public ❑ Industrial ❑ Agricultural ❑
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION:
Nearest Town: BREVARD
REASONOVER ROAD
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: RICK SCHRODER
Address PO BOX 16359
(Street or Route No.)
GREENVILLE SC
29606
City or Town State Zip Code
( 864 )_ 277-9900
Area code- Phone number
4. DATE DRILLED JUNE 21, 2004
5. TOTAL DEPTH: 305'
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO
7. STATIC WATER LEVEL Below Top of Casing: 160 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS 1.33 FT. Above Land Surface'
"Top of casing terminated at/or below land surface requires a
variance in accordance with 15A NCAC 2C .0118.
9. YIELD (gpm): 20 METHOD OF TEST TIMED
10. WATER ZONES (depth):
Topographic/Land setting
[Ridge ®Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:OGPSOTopographic map
(check box)
DEPTH DRILLING LOG From To Formation Description
11. DISINFECTION: Type aY PUMP INSTALLER
12. CASING:
Depth Diameter
From 0 To 43 Ft. 61/8
From To Ft
County TRANSYLVANIA
Amount
Wall Thickness
or Weight/Ft. Material
SDR21 PVC
C_
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common road names.
9d1J19(,--zone millid to Ili .Eit .Lj L
13. GROUT: TFrom opth Ft. Material Method " Jan_
. ~0 &Ia,,t� e-cntaiitt (211012 . � �
From 0 To 20 Ft. CONCRETE POURED eJan_ Vlt_ Not ±t_r,m�, /`t. dab —
From To Ft. j rt j n cJrt lW ILEA. Rd.
14. SCREEN: Depth Diameter Slot Size Material "`� • „
From To Ft. in. in. clots15. SAND/GRAVEL PACK Ake, 90 e • 1 I l tl 1LV (VW
a r , Jake_ tew (Load —
From To Ft. in. in.
From To Ft. am_ -. '� / /lA-tM et
t/ 42 V t
- Depth Size Material
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 TH REC RD HAS BEEN PROVIDED TO THE
r
SIGNATURE OF PE
ON CONS CTING THE WELL /DA
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-1 REV. 07/2001

WELL CONSTRUCTION RECORD
29rOl n
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) RICHARD MCCRARY CERTIFICATION# 2010
WELL CONTRACTOR COMPANY NAME BARKER CONSTRUCTION, INC./BARKER WELL & PUMP PRONE # 1828) 697-7263
STATE WELL CONSTRUCTION PERMIT# 1871
ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential El Municipal/Public O Industrial ❑ Agricultural O
Monitoring ❑ Recovery ❑ Heat Pomp Water Injection O Other O If Other, List Use
2. WELL LOCATION:
Nearest Town: BREVARD County TRANSYLVANIA
RAINBOW LAKE ROAD
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: DAVID HOLM
Address PO BOX 2458
(Street or Route No.)
BREVARD NC 28712
City or Town State Zip Code
( 828 )- 883-2230
Area code- Phone number
4. DATE DRILLED JUNE 2, 2004
5. TOTAL DEPTH: 165
6. DOES WELL REPLACE EXISTING WELL? YES O NO
7. STATIC WATER LEVEL Below Top of lasing: 30 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS 1.33 FT. Above Land Surface*
*Top of casing terminated ator below land surface requires a
variance in accordance with 1SA NCAC 2C .0118.
9. YIELD (gpm): 10 METHOD OF TEST TIMED
10. WATER ZONES (depth):
Topographic/Land setting
°Ridge ®Slope OValley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:OGPSOTopographic map
(check box)
DEPTH DRILLING LOG. ----
From To Formation Description
o
11. DISINFECTION: Type BY PUMP INSTALLER
12. CASING:
Depth Diameter
From 0 To 77 Ft. 61/8
From To FL
From To Ft.
Amount
Wall Thickness
or Weight/Ft. Material y/ .- Q,/-
SDR21 PVC J- n 6A-fid/td . t (l,tf,¢/ ,/1itefruzit x-
AiC1"7y�c_w°$ tat& Gtla�n.ut#kltocv
Method s�f.L.F-e- lit- C_ l0 nib m ,
POURED_ Q LU.(t l�
a
eJa .,tom elu uk
Alf -toad. &arm arid- 90 iv lowth
J auae- lm t i8h •
13. GROUT: Depth Material
From 0 To 20 Ft. CONCRETE
From To Ft.
14. SCREEN: Depth Diameter
From To Ft. in.
From To Ft. in.
15. SAND/GRAVEL PACK:
- Depth Size
From To Ft.
From To Ft.
16. REMARKS:
Slot Size
in.
in.
Material
Material
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common road names.
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 PROVIDE
D.T0 THE WELL OWNER`
SIG�� ,F PERS d '��2" GNU J(L
NIA/TURE/OFIONSTRUCTINGTHE WELL D�� /
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-1 REV. 07/2001

2968n9
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) KENNETH MCCRARY CERTIFICATION # 2008
WELL CONTRACTOR COMPANY NAME BARKER CONSTRUCTION, INC./BARKER WELL & PUMP PHONE # [phone]
STATE WELL CONSTRUCTION PERMIT# 1871 ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential ® MunicipaVPublic ❑ Industrial ❑ Agricultural ❑
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION:
Nearest Town: BREVARD
OAKWOODS SUBDIVISION, LOT #56
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: DUANE MULLETT
Address PO BOX 275
(Street or Route No.)
PENROSE NC 28766
City or Town State Zip Code
( 828 )_ 226-0039
Area code- Phone number
4. DATE DRILLED MAY 25, 2004
5. TOTAL DEPTH: 1005
6. DOES WELL REPLACE EXISTING WELL? YES O NO ECI
7. STATIC WATER LEVEL Below Top of ("Acing: 500 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS 1.33 FT. Above Land Surface*
"Top of casing terminated at/or below land surface requires a
variance in accordance with 15A NCAC 2C .0118.
9. YIELD (gpm): % METHOD OF TEST TIMED
10. WATER ZONES (depth):
County TRANSYLVANIA
Topographic/Land setting
❑Ridge ®Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPSOTopographic map
(check box)
DEPTH DRILLING LOG
From To Formation Description
11. DISINFECTION: Type BY PUMP INSTALLER Amount
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
To 86 Ft. 61/8 SDR21 PVC
To Ft.
To Ft.
From 0
From
From
13. GROUT: Depth Material
From 0 To 20 Ft. CONCRETE
From To Ft.
14. SCREEN: Depth Diameter Slot Size
From To Ft. in. in.
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Size Material
Method
POURED
From
From
To Ft.
To Ft.
16. REMARKS:
0
r
LOCATION SKETCH co o
Show direction and distance in miles from at ieast=
two State Roads or County Roads. Include the road
numbers and common road names.
romBretvd to.JCe klulu.64'East,
TaKe_ a left on_ l.yda y Loop • T0.
a left on. Gardner Drive- Le -PE
on Top Oaks Lane. A-L end. of
Cul de -sac.
OaKaorck '5 cthd iVIS10n
Lot 451,
Material
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUC. ILD IN ACCORDANCE WITH I5A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
`s W hrJ (Yl e��� ?— LS; Ott
SIGNATURE OF PERSON CONSTRU&NG •
THE WELL DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-1 REV. 07/2001

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and�Natural Resources - Division of Water Quality - Groundwater Section
8��
WELL CONTRACTOR (INDIVIDUAL) NAFf>Y (print)``V,,JD NAIL C �J3/I�LL- CERrIFIC�A;TIOONN',PenJY�Ry�-��
WELL CONTRACTOR COMPANY NAMF r4Jid e. � , i Le 4 Sty
iVy� PHONE # fria2
STATE WELL CONSTRUCTION PERMIT# 7 —1 JS$OCIATED WQ PERMIT# WA/
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential 2 Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCA
Nearest
(Street Name, Numbe Corr i oubdivisim. Lot No., Zip Code)
3. OWNER:o//0
11
Address
#p�
,./.2. 6d f Ul
al Test j t or Route No.)
City or Town State
Area code- Phone number //
4. DATE DRILLED ..Z/'/y/ D 7
5. TOTAL DEPTH- .Z 4 .T
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO 1p
7. STATIC WATER LEVEL Below Top of Casing:
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS / 5 FT. Above Land Surface'
`Top of casing terminated aVor below land surface requires a
variance In accordance with ISA NCAC 2C .0118. •
9. YIELD (gpm): /D THOD OF TEST
10. WATER ZONES (depth): LD t /QS r
11. DISINFECTION: Type a , Amount 5
12. CASING: Wall Thickness
Diameter or Wei t/Ft Material
From p Depth Diameter
Ft. b, #21 fi/'L-
From To Ft.
From_ To Ft.
13. GROUT: Depth �s
From_ To o2Q Ft ! i
From To Ft
14. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in.
From V To Ft in. in.
15. SAND/GRAVEL PACK:
Depth
From /To
From / To
��
298859
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)
PEPTR DRILLING LOG
From To Formation Description
Size
Ft.
Ft.
/c
1r m
y k
'
LOCATION SKETCH
Show direction and distance in miles fi at Feist
two State Roads or County Roads. Inc a th . oad
numbers and common ro . names.
Material
16. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRULLY1) IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STAND A QS, AND THAT A COPY OF THIS HAS BEEN PROVIDED TO THE WELL OWNER
74. / 1 JX •2/1 /D y
SIGNATURE OF PERSON CONSTRUCTING THE WELL DA
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center -Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-1 REV. 07/2001

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) RICHARD D. MCCRARY CERTIFICATION # 2010
WELL CONTRACTOR COMPANY NAME BARKER CONSTRUCTION, INC./BARKER WELL & PUMP PHONE # [phone]
STATE WELL CONSTRUCTION PERMIT# 1871 ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential gl Municipal/Public 0 Industrial ❑ Agricultural 0
Monitoring 0 Recovery ❑ Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION:
Nearest Town: BREVARD County TRANSYLVANIA
HART ROAD
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: DANA AND LISA MCNULTY
Address 663 HART ROAD
(Street or Route No.)
PISGAH FOREST NC 28768
City or Town State Zip Code
( 828 )- 862-3876
Area code- Phone number
4. DATE DRILLED FEBRUARY 24, 2004
5. TOTAL DEPTH: 305
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO 131
7. STATIC WATER LEVEL Below Top of Casing: 100 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS 1.33 FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordance with ISA NCAC 2C .0118.
9. YIELD (gpm): 20 METHOD OF TEST TIMED
10. WATER ZONES (depth):
11. DISINFECTION: Type BY PUMP INSTALLER Amount
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
From 0 To 33 Ft. 61/8 SDR21 PVC
From To Ft.
From To Ft.
13. GROUT: Depth Material
From 0 To 20 Ft, CONCRETE
From To Ft.
14. SCREEN: Depth Diameter
From To Ft. in.
From To Ft. in.
15. SAND/GRAVEL PACK:
Depth
From To
From To
16. REMARKS:
Ft.
Ft.
Method
POURED
Topographic/Land setting
❑Ridge ®Slope OValley °Flat
(check appropriate box)
Latitude/longitude of well location
298141
(degrees/minutes/seconds)
Latitude/longitude sou rce:OGPSOTopographic map
(check box)
DEPTH DRILLING LOG
From To Formation Description
c
CO
N o
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common road names.
FrontP re»arcltaKe Evere .e'Zoaa
+o 14ar+12oad .Turn right in sharp
@ rvtCThePines) Ond.corainue
wit±i l gqgavel e nrLs and male 0.
`-�I"
Slot Size Material lei'C • h at will be -Ehe Pro ier .
in. (o5`S on -the 51\9n•
in.
Size Material
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH l5A NCAC 2C, WELL
CONSTRUCTION STANDARDS, A THAT A COP j' OF PHIS RECORD BEEN PROVIDETO TI WELL OWNER
f
y
OF PERSON C,4STRUCI ING THE WELL DA
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center- Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-1 REV. 07/2001

12. CASING:
299207
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Me tural Resourccs - Diivision of Water Quality - Groundwater Section
WELL CONTRACTOR(INDIVIDUAL) NAME (print) 6) LLI tt t'J AS t4 F.CERTIFICATION / all t
WELLCONTRACIOR COMPANY NAME_RUBEN CALDWELL DRILLING, INC.INC.• PHONE Y�(8 )254-3581
STATE WELL CONSTRUCTION PERMIT/ ASSOCIATED WO PERMIT/ (ifapplicable)(if applicable)
I. WELL USE (Check Applicable Box): Residential VMuoicipaVPublic 0 Industrial ❑ Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATIQN: Nearest Town: 1155it,E, Ni Y 2t1) Count T / $ LUAP3 UJ
'V'CGoI/t KbAb
(Street Name, Number, Community, Subdivision, Lot No., Zip Code)
3. OWNER:
Address
\<A3 4(e cs I --7
1 dA L6 � L o (2S A
�_ s P2 ( 6 (� o
(Street or Route )
I't5Y\Ll.tar' rJC-
..,.,CjryaToo�wr�4--State4's
aloS
Zip Code
Area cods Phone number ,4
4. DATE DRILLED 6— 1 k— O 4
5. TOTAL DEPTH: "a I O '
6. DOES WELL REPLACE EXISTING WELL? YES a NO 0
7. STATIC WATER LEVEL Below Top of Cuing: b FT.
(Use's' If Above Top of Casing)
8. TOP OF CASING IS FT. Above Land Surface'
*Top of cuing terminated at/or below land surface requires
variance le accordance wills w lISA NCAC 2C-0I11.
9. YIELD (gpm)• 4) METHOD OF TEST 'R%6 A 1
10. WATER ZONES (depth):
a6v' — 15 6PM
11. DISINFECTION: Type 1:1TI-1 et D r/ Amount 1/.9..1 b.
<� Wail Thickness
or Weight/Ft.
Sf12al
From 1 To th'1
From To
From To
Ft. DtarAeter
Ft. (�
Ft.
13. GROUT; Depth Materiel Method
From 4 To afl Ft. C-6ll'1bkir Qo02E.D
From To Ft.
14. SCREEN: Depth Dismctcr Slot Size Material
From To Ft. in in.
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
Topographic/Land setting
❑Ridge ❑Slope ❑Valley 2frlat
(check appropriate box)
Latitude/longitude of well location
(depeu/mtmueahecaodr)
Latitude/longitude source:❑GPS❑Topographic rnap
(check box)
DRILLING LOG
O°%J&' sD 1J
C20J\C ao Win
DEPTH
Fr9m / To /
1 s5
RS' — aba
aba'
at-,0' — 31 0
LOCATION SKETCH.
Show direction and distance in miles froma lea.S1
two State Roads or County Roads. Include t ie ropd ;
numbers and common road names. -�
rn
16. REMARKS:
1 DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WFnI ISA NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A P BOF THIS RECRD HAS O , EEN PROVIDED TO T1(E(1;^ I.1.fOWf)ER
•
SIGNATURE OF PERSON CONSTRUCTING THE WELL
DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mall Service Center -Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-1 REV. 07/2001

WELL CONTRACTOR (INDIVIDUAL) NAME (print) Otee.'EK Nt&-h
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
CERTIFICATION # 2436
PRONE # ( (ofo5-J L
S Owl Wee*
WELL CONTRACTOR COMPANY NAME C-\.J,4 Sllitattif .Son'4ea\ -?M 1? Le
STATE WELL CONSTRUCTION PERMIT#
(if applicable)
299337
' ' ASSOCIATED WQ PERMIT#
(if applicable)
1. WELL USE (Check Applicable Box): Residential a Municipal/Public ❑ Industrial ❑ Agricultural ❑ —
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use
2. WELL LOCATION:
Nearest Town:_ . P. 4K rna.n County • faAs...p.ch:ct
old toxouo'\ gtAd
(Street Name. Numbers, Comm pity, Subdivision, Lot No., Zip Code)
3. OWNER: Chod hc."+iti5
Address old
(Street or Route No.
Vi>vnc-d n10
City or Town State
eZ6)- CafcGt
Area code- Phone number
4. DATE DRILLED 5'2%-b4
5. TOTAL DEPTH: :3tis
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO 14
7. STATICWATER LEVEL -Below Top of Casing: _ t+FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS 1 FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordance with 15A NCAC 2C .0118.
9. YIELD (gpm): .2. METHOD OF TEST R:
I0. WATER ZONES (depth):
Zip Code
Topogyphic/Land setting
.❑Ridge (Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location,
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic.rpap
(check box)
DRILLING .,OG
Formation Deseraptten-..---. -
DEPTH
From To
•
}a To Ave. SMct.n
ro 3es Gscw:te
1 I. DISINFECTION: Type ei "\S
12. CASING:
Depth Diameter
From t- \ To 9.11 Ft.__k y_
From To Ft.
From To Ft.
13. GROUT: Depth
From 0 To_o Ft.
From To Ft.
14. SCREEN: Depth Diameter
From To Ft. in.
From To Ft. in.
15. SAND/GRAVEL PACK:
Depth
From To Ft.
From To Ft.
Amount \O
Wall Thickness
or Weight/Ft. Material
itn. into F:C
Material
Cent)*
16. REMARKS:
Method
Po cad
Slot Size Material
in.
in.
Size Material
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads orCounty Roads. Include th3oad Gr.,
numbers and common road names. t--
-a
cf.)
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUC I ED IN ACCORDANCE WITH I5A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
5-27'0=t
lla_ G N r T Fp/� DATE
SIGNAATUREE PE CO STRU
OF PERSON CTING 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

20H50
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Nantrail Resource, - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVXDUAL) NAME (Mai) Its 1...)PSbt CERTIFICATION I art '11
WELL CONTRACTOR COMPANY NAME_ CALDWELL DRILLING, INC. rr�t
PHONE[phone]
STATE WELL CONSTRUCTION PERMIT/ ASSOCIATED WQ PERMIT/
(If applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential DVMunicipaVPublic 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATIASN:
Nearest Town: W1(Lev A JJ
\C\ t , fi_o :AO
County (&4 3Sy 1-Vf4 r3 iA
(Street Name, Numben, Community, Subdivision, La No., Zip Code)
3.OWNER: SDNtS C OSca€�L
Address aVa W4.ST ColdrSJ �t.fE
(Sweet a Routs o.)
Sera(ti,nf&-i JQ & C nr1`303
_City or Town Sute Zip Code
O6b- S - - 4-03
4
Ma coda- Phone number /
4. DATE DRILLED ll l a i /0 4
5. TOTAL DEPTH: \ -'1 0
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO 1r
7. STATIC WATER LEVEL Below Top of Casing: 4 o FT.
(Use'+' if Above Top of Casing)
8. TOP OF CASING IS FT. Above Land Surface•
*Top of cuing lermiasted at/or below Ind scrim requires a
varlaaea In accord”cs with ISA NCAC SC.01I1.
9. YIELD (gpm): 'd D METHOD OF TEST 1:C\ (D - Q 12
10. WATER ZONES (depth): 130 - a o GP r.-•
11. DISINFECTION: Type
12. CASING:
From 1�
� t
From To
From To
13. GROUT; Depth Material Method
From 4 To a Ft. CISlvyj NYC. go C (Le b
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 ❑Va1Iey 01lat
(dark appeopnue box)
Latitude/longitude of well location
(deyerahninuiedsecood,) _
Latitude/longitude source:❑GPS❑Topographic nap
(check box) .»_
DEPTH _
DRILLING LOG
Fro / - (0 Formation Formation Description
( - 13c,
t3o'
i s a o G Prr)
cn
LOCATION SKETCH
g Amount Z. b Show direction and distance in miles f l t at lea'sl
Wall Thickness two State Roads or County Roads. Include the road
or Wei VFt. Material numbers and common road names. -c
snit i pqc
Dhoetcr
Ft. b/ 8
Ft.
Ft.
I
k•Iwy� .2?
6�t�c,-,P,,os_/ (4ArJ
op / 1_
16. REMARKS:
1 DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED M ACCORDANCE WITH ISA NCAC
CONSTRUCTION STANDARDS, AND THAT OPY OF THIS CORD HAS BEEN PROVIDED TO TI
SIGNATURE OF PERSON CONSTRUCTING THE WELL
2C, WELL
WELL QWNER
aa./o
ATE
4-
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mall Service Center -Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-I REV. 07/2001

WELL CONSTRUCTION RECORD 3 016 0 ;
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) Mitchell D. Cook CERTIFICATION # 2043
WELL CONTRACTOR COMPANY NAME jai $ctlns VVLl Ertl t]rlga Trr PHONE # SPQR) " 9591
STATE WELL CONSTRUCTION PERMIT#
(if applicable)
ASSOCIATED WQ PERMIT#
(if applicable)
I. WELL USE (Check Applicable Box): Residential$ Municipal/Public ❑ Industrial ❑ Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection ❑ Other 0 If Other, List Use
2. WELLLOCATIVJ
Near t Towm/J.de ' _1_, County
Stre Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3, OWNER:
Adds s
r treat o ooyte No.)
City Town a�iR Zip Code
(,tea)- .56
Area code- Phone number
4. DATE DRILLED 8�VT
5. TOTAL DEPTH: f KO
6. DOES WELL REPLACE EXISTING WELL? YES NO,
7, STATIC WATER LEVEL Below Top of Casing: FT.
(Use "+" if Above Top of asing)
8. TOP OF CASING IS 2 FT. Above Land Surface*
'Top of casing terminated at/or below land surface requires a
variance In accord ce with 15A NCAC 2C .0118.
9. YIELD (gpm): METHOD OF TEST hl nw
10. WATER ZON S (dept :
l
SO907
Topographic/Land setting
❑Ridge ❑Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From To Formation Description
0 r clay & sand
c29 o a graxt to
l 1. DISINFECTION: Type H T H
12. CASING:
Depth Di meter
From To Ft.
From To Ft.
From To Ft.
n
Amount 1 F n7,
Wall Thickness
or or Weight/Ft. te
a/Oo
13. GROUT: Depth Material Method
From_ To 20 Ft testate R t a7t I+nFxri
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:
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common road names.
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
e- /B-0y
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)
RICHARD MCCRARY CERTIFICATION # 2010
WF11 CONTRACTOR COMPANY NAME BARKER CONSTRUCTION, INC./BARKER WELL 8 PUMP r ores p [phone]
STATE WELL CONSTRUCTION PERMIT# 1871 ASSOCIATED WQ PERMITP
(if applicable) (if applicable)
301804
1. WELL USE (Check Applicable Box): Residential El Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION:
Nearest Town: BREVARD County TRANSYLVANIA
OFF OF HWY. 280
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: CAROL OWEN
Address 1239 ASHEVILLE HWY.
(Street or Route No.)
BREVARD NC 28712
City or Town State Zap Code
( 828 )_ 877-4442
Area code- Phone number
4. DATE DRILLED AUGUST 24, 2004
5. TOTAL DEPTH: 500
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO El
7. STATIC WATER LEVEL Below Top of Casing: 60 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS 1.33 FT. Above Land Surface'
'Top of casing terminated at/or below land surface requires a
variance In accordance with ISA NCAC 2C .0118.
9. YIELD (gpm): 2 METHOD OF TEST TIMED
10. WATER ZONES (depth):
Topographic/Laud setting
ORidge ®Slope OValley °Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:OGPSOTopographic map
(check box)
DEPTH DRILLING LOG
From To Formation Description
11. DISINFECTION: Type BY PUMP INSTALLER Amount
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
From 0 To 80 Ft. 61/8 SDR21 PVC
From To Ft.
From To Ft.
13. GROUT: Depth
From 0 To 20
Material
Ft CONCRETE
From To Ft.
14. SCREEN: Depth Diameter
From To Ft. in.
From To Ft. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft
Slot Size
in.
in.
RPF,jWtecb,)
a, ./04 D
/ a SFC
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.
Lila , &Wald tt le c . ssa
,tt060a. t „eaz8 &. c agi
vacci
�/'/,Q�(��[. , at3(o tar_-/h[/�ta.�X 6n(-
Material - / " . e'"✓ t 4
C♦iCr.t,.t- //�
Method
POURED
16. REMARKS:
1 DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN AC RDANCE WITH I5A NCAC 2C, WELL
CONSTRUCTION STANDARDS AND THAT A COPY OF THIS RECOHAS BEEN PROVIDED TO TLL WN 9WNER
INSTRUCTING THE WELL //DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Se
27699-1636 Phone No. [phone], within 30 days.
ice Center - Raleigh, NC
GW-1 REV. 07/2001

WELL CONSTRUCTION RECORD
North Carolina Department of Environment andNatural Resources Division oter Qua
WELL CONTRACTOR (INDIVIDUAL) NAME (print) KENNETH MCCRARY
CONSTRUCTION, INC./BARKER WELL 8 PUMP
WELL CO`: T �:C; OP. CO.'.^,`.v.^., NAME BARKER
301
ty - Groundwater Section
CERTIFICATION # 2008
PEONS # 1828) 697-7263
STATE WELL CONSTRUCTION PERMIT# 1871 ASSOCIATED WQ PERMIT# (if applicable)
(if apprcabte)
i. WELL LSF. (Check Applicable Box): Residential Ea Mtmicipal/Public 1 industrial 0 Agricultural 0
.?'at Injection `; Other i Other, , List Use
1) K::CQ':.,: j i ; :....., Puny ,.y.. ... _- _ - .. o..
2. WELL LOCATION:
Nearest Town: BREVARO County TRANSYLVANIA
LIPPER GLADE
CAPPS ROAD
!Street Name. Numbers. Community. Subdivision. tot No.. Zip Code)
3. OWNER. 4 .NEIHWALKER
Address CAPPS ROAD
(Stud er Rome No.)
B, EVARD ,.
City or Town Stott Zip Cr,,ir
( 828 )- 884-8468
Area naie- +'no,w number
4. DATE DRILLED JULY 28, 2004
5. TOTAL DEPTH: 205'
O. DOES WELL REPLACE EXISTING WELL? YES D NO !�
7. STATIC WATER LEVEL Bctoa Top of Casing: 20 FT.
Use ' if Above Top of Casing)
8. TOP OF CASI C, IS ._d FT. Above. Land Surface'
*Top of casing terminated al'nr below land surface requires a
variance in accordance with 15A NCAC 2C .0118.
9. YIELD (g;m): 20 M... HOD OF TEST
T TIMED
10. WATER ZONES (depth):
11. ::*s eiC.Lii_ ..-ype,... .,. . .,-... L:ii
12. CASING: Wall Thickness
Depth Diameter er WeigheTt. Material
Flom 0 To 1 Ft. C G
From To Ft.
From To Ft.
13. GROUT: -Depth Material
From 0 To 20 Ft. CONCRETE
From To Ft.
14, 1..I.ICLEI<: U Jpth ' I
From To Ft_
FromTo Ft.
15. SANDICRAVEL PACK:
Depth Size Material
From To Ft.
Topographic/Land setting
❑Ridge ❑Slope (Valley glFlat
(check approtmiare box)
! atirude.floneitude of well location
(ae orroratesh.mond>)
I atitudelongitnde sou ce:OGPSDTopographic map
(check box)
^FT`r. DRILLING LOG,_..-_
Fr&nn To Formation Description
POURED
Si.;: Size Niat. riai
in. in.
in. in.
From io Ft.
16. REMARKS:
LOCATION SKETCH
.rst_.- :n—la; from atlea-
two State Roads or County Roads. Include the road
numbers and common road names.
9
J,tert &weak 4e14_ Lhwtj (o
W.
dab t 0. U t)L_
ideAocc.
aAnk • Jack_ Lc a
k{L#s -
iDO ITRE- cr-R1a ' WELL vi.XN GUNS i L"
ULTE .a.Lv OILU-L WITT; I atiiLALiC WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS RFFN PROVIDED TO THE WELT. OWNER
r
►M�C/i(,r, R.(
SiCiiwATURE OF PERSON CONSTRUC tG THE WEL1
Submit the or ignal to the Division of Water Quality, Groundwater Section, 16636 Mail Seniee Center - Raleigh, NC
2 6 i-1136 Phonic No. (i9) 733 3221. within 30 days.

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) KENNETH MCCRARY
30-0773
CERTIFICATION # 2008
WELL CONTRACTOR COMPANY NAME BARKER CONSTRUCTION, INC./BARKER WELL 8 PUMP PHONE # [phone]
STATE WELL CONSTRUCTION PERMIT# 1871 ASSnCIATED WQ PERMIT#
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential El Municipal/Public ❑ Industrial ❑ Agricultural ❑
Monitoring ❑ Recovery O Heat Pump Water Injection O Other ❑ If Other, List Use
2. WELL LOCATION:
Nearest Town: BREVARD
STRATFORD FOREST, LOT#12
Comity TRANSYLVANIA
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: HOSEA BALOUEGA
Address 2730 RUTHERFORD COLLEGE ROAD
(Street or Rome No.)
CONNELLY SPRINGS NC 28612
City or Town State Zip Code
( 828 )- 879-1110
Area code- Phone number
4. DATE DRILLED JULY 7, 2004
5. TOTAL DEPTH: 330
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO
7. STATIC WATER LEVEL Below Top of Casing: 40 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS 1.33 FT. Above Land Surface*
*Top of casing terminated at/or below land surface require a
variance in accordance with 15A NCAC 2C .011&
9. YIELD (gpm): 5 METHOD OF TEST TIMED
10. WATER ZONES (depth):
Topographic/Land setting
ORidge ®Slope OValley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:OGPSOTopographic map
(check box)
DEPTH DRILLING LOG
From To Formation Description
1 I. DISINFECTION: Type BY PUMP INSTALLER Amount
12. CASING: Wall Thickness
Depth
From 0 To 57 Ft.
From To Ft.
From To Ft.
13. GROUT: Depth Material
From 0 To 20 Ft. CONCRETE
Diameter or Weight/Ft. Material
61/8 SDR21 PVC
From To Ft.
Method
POURED
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.
O r�
t ▪ t2a
Fin
0' C
�t0
S
rn NCJ
t^z
LOCATION SKETCH W cmi
Show direction and distance in miles from at leg
two State Roads or County Roads. Include the road
numbers and common road names.
&Watt pp 2ft dad
. c) Q in-Zo
1: t fitatAt
~i Aka,tD Lit#/ZOrc
Ea_ S24-z-
9f.t tzt'S2'0t/di" AS•
C
16. REMARKS:
1 DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH I5A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
)COWL /t4- tiC°, tnwt t t� q y
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center- Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-1 REV. 07/2001
+l1

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) RICHARD MCCRARY CERTIFICATIor}A 0 4•
WELL CONTRACTOR COMPANY NAME BARKER CONSTRUCTION, INC.BARKER WELL & PUMP PHONE # f828)13b
STATE WELL CONSTRUCTION PERMIT# 1871 ASSOCIATED WQ PERMIT./
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential ® Municipal/Public ❑ Industrial 0 Agricultural 0
Monitoring 0 Recovery ❑ Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION:
Nearest Town: BREVARD
OLD QUEBEC ROAD
County TRANSYLVANIA
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: EDDIE & DORIS SEARCY
Address PO BOX 387
(Street or Route No.)
ROSMAN NC
28772
City or Town State
( 828 )- 862-4958
Area code- Phone number
4. DATE DRILLED JULY 1, 2004
Zip Code
5. TOTAL DEPTH: 165'
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO El
7. STATIC WATER LEVEL Below Top of Casing: 30 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS 1.33 FT. Above Land Surface'
'Top of casing terminated actor below Lend surface requires a
variance in accordance with ISA NCAC 2C .0118.
9. YIELD (gpm): 30 METHOD OF TEST TIMED
10. WATER ZONES (depth):
LOCATION SICETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common road names.
Lkoirc ` AuJa,coL tit .l t .
6lc&LAt.. soma AzgAL ax
TopographicfLand setting
❑Ridge ❑Slope ❑Valley IDFlat
(check appropriate box)
Latitudefongitude of well location
(degrees/minutes/seconds)
Latitude/onginuie source:❑GPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From To Formation Description
Arm,
11. DISINFECTION: Type BY PUMP INSTALLER Amount
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
From 0 To 33 Ft. 61/8 SDR21 PVC
From To Ft.
From To Ft.
13. GROUT: Depth Material Method �7� �.fJ—�� �2�7
From 0 To 20 FL CONCRETE POURED C]1 P� 6 iQ�.Q0.d From To Ft. U Q ,�D
14. SCREEN: Depth Diameter Slot Size Material ���/���y_ '
From To Ft. in. in. '�•� O - /%— "' • /� 14. L e �c�k� t p
From To Ft. in. in. /I.C. AL at nta t6 �-w-�G`(.
15. SAND/GRAVEL PACK: 0!/tf Ip L&�_
Depth Sze Material �J p ,�� /�`"""
From To Ft. j3tx ct 4Lcc PAS .
From To Ft.
16. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH I5A NCAC 2
CONSTRUCTION STANDARDS. Al P THAT PY OF THIS RECORD j flEEN PROVIDED TO TH
SIGNA1
ERSON
Cl))ISTRUCTING THE WELL
7
WE L
WEL OWNER
DATE
GZ/
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center- Raleigh, NC
r , I --
27699-1636 Phone No. [phone], within 30 days. faW 1-�EEV,tl7/2001

WELL CONSTRUCTION RECORD
North Carolina - Deparnnent of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (prhtt) KENNETH MCCRARY
CERTIFICATIONS 2006
WELL CONTRACTOR COMPANY NAME BARKER CONSTRUCTION, INC./BARKER WELL 8 PUMP PHONE S j 828) 697-7263
STATE WELL CONSTRUCTION PERMITS 1871 ASSOCIATED WQ PERMITS
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential RI Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION:
Nearest Town: BREVARD
County TRANSYLVANIA
WALNUT HOLLOW ROAD
(Street Name, Numbers, Conuntmity, Subdivision, Lot No., Zip Code)
3. OWNER: JAMES THOMAS VORIS, JR.
Address RT. 1, BOX 231
(Street or Route No.)
BREVARD NC 28712
City or Town State Zip Code
( 828 )_ 862-4249
Area code- Phone number
4. DATE DRILLED JUNE 25, 2004
5. TOTAL DEPTH: 205
6. DOES WELL REPLACE EXISTING WELL? YES O NO RI
7. STATIC WATER LEVEL Below Top of Casing: 20 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS 1.33 FT. Above Land Surface*
'Top of casing terminated at/or below land surface requires a
variance in accordance with 15A NCAC 2C .0118.
9. YIELD (gpm): 30 METHOD OF TEST TIMED
10. WATER ZONES (depth):
11. DISINFECTION: Type BY PUMP INSTALLER Amount
12. CASING: Wall Thickness
Depth
From 0 To 83
From To Ft
From To Ft.
13. GROUT: Depth
From 0 To 20
Diameter or Weight/Ft. Material
Ft. 61/8 SDR21 PVC
Material
Ft. CONCRETE
From To Ft.
14. SCREEN: Depth
From To Ft.
From To
Ft.
15. SAND/GRAVEL PACK:
Depth
From To Ft.
Diameter Slot Size
in. in.
in. in.
Material
Size Material
From To Ft.
16. REMARKS:
Topographic/Land setting
ORidge ®Slope OValley ❑Flat
(chock appropriate box)
Latitude/longitude of well location
(degreewminutes/seoonds)
Latitude/longitude source:OGPSOTopographic map
(check box)
DEPTH DRILLING LOG
From To Formation Description
LOCATION SKETCH
Show direction and distance in miles from at leant.,
two State Roads or County Roads. Include the road
numbers and common road names.
p O
trl
Litont 25.f ocmaz tale_ Zl4atad-
Caaf i . silo 3 % ,Z.LLP!
Prc,6 (2 t'znfi / ead , 471L,Qv
at- tiA,C:9 kiht /7 ,ezt
j, lz2. e 17c4 .-i2Cat7eL .
1 DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH I5A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
\-14/10/u/t7L_ , , K/rjtjaAc
SIGNATURE OF PERSON CONSTRUCTING
IL- 2- -04
DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mall Service Center - Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. - GW-1 REV. 07/2001

WELL CONSTRUCTION RECORD
300761
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) RICHARD MCCRARY
WELL CONTRACTOR COMPANY NAME BARKER CONSTRUCTION, INC./BARKER WELL & PUMP
STATE WELL CONSTRUCTION PERMED 1871 ASSOCIATED WQ PERMITT#
(if applicable) (if applicable)
CERTIFICATION # 2010
PHONE # [phone]
1. WELL USE (Check Applicable Box): Residential I Mumicipal/Public 0 Industrial 0 Agricultural ❑
Monitoring ❑ Recovery 0 Heat Pump Water Injection ❑ Other 0 If Other, List Use
2. WELL LOCATION:
Nearest Town: BREVARD County TRANSYLVANIA
LAKE TOXAWAY ESTATES, LOT #30-R
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: LAKESIDE MTN. LLC (HAMMERSMITH HOMES, CONTRACTOR)
Address PO BOX 13178
(Street or Route No.)
GREENSBORO NC 27415
City or Town State Zip Code
( 336 )- 669-7147
Area code- Phone number
4. DATE DRILLED JUNE 30, 2004
5. TOTAL DEPTH: 605
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO El
7. STATIC WATER LEVEL Below Top of Casing: 80 FT.
(Use "+" if Above Top of Casing)
S. TOP OF CASING IS 1.33 FT. Above Land Surface*
'Top of casing terminated at/or below land surface requires a
variance in accordance with ISA NCAC 2C .0118.
9. YIELD (gpm): 3 METHOD OF TEST TIMED
10. WATER ZONES (depth):
11. DISINFECTION: Type BY PUMP INSTALLER Amount
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
From 0 To 43 Ft, 61/8 SDR21 PVC
From To Ft.
From To Ft.
13. GROUT: Depth Material
From 0 To 20 Ft. CONCRETE
From To Ft.
14. SCREEN. Depth Diameter Slot Size Material
From To Ft. in. in.
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
Topographic/Land setting
ORidge ®Slope OValley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:OGPSOTopographic map
(check box)
DEPTH DRILLING LOG
From To Fomiation Description
O
7 m
G
i fir'
Z thy_
t+? �A
r
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common road names.
JX0, z Sovaital t-Sc82uia)
aiLd± aai &cL.
MethodPOURED &y&c L /A idxiic-
.e� 02it &
°Yet ,3o-R
16. REMARKS: PHONE NUMBER LISTED ABOVE IS FOR THE PROJECT MANAGER, JOEL HENDERSON.
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A N AC 2C, WELL
CONSTRUCTION STANDARDS,/'AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED O THEE WELL OWNER
y/G NA OF ONSTRUCT[NG THE WELL 7 GotE2- 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

\\'ELL CONSTRUCTION RECORD
300667
, North Carolina - Deparunent of Environment and Natural
{Ryessourcees - Division of Water Quality' - Groundwater Sections �l
N'ELLCO\TRACTOR(INDIVIDUAL)NA)IE (print) JD Ir IC-Ca.✓7. ^ CERTIFLCATION# c____
\t ELL CONTRACTOR CO\IPA\vNAME AR'A green.-, f7reS 1 IL/ PH ON * (VA r Z S-S U
STATE V. ELL CO\STFL'CTIOS PE RMIT; ASSOCIATED U
(if aadicable)
(if applicable)
WELL USE (Check Applicable Box): Residential AlunicipaUPublic ❑ Industrial ❑ Agricultural ❑
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other ❑ It -Other, List Us:
2. \`.'ELL LOCATION
Nearest To«n: LAI:CTDYAC(�iCount
keyl.. r A
Nu:n:eri. Cc ..mu-i:.. S• division, Lott Nad Zip Co(!)
3. OWNERr R j' P- here L7r-
Taalle.,)
i�-/ kAWrJCa87'/7
4. DATE DRILLED G —/0 O 7
5. TOTAL DEPTH: GO
c. DDES \YELL REPLACE EXISTING WELL? YES ❑A{\'0]
7. ST.ATIC WATER LEVEL Below Top orCasi;ie: /O V FT.
lLie `!' if Abo.a Top orCasiz_'i
S TOT' OF C:\S! NG IS j FT. Above Lane Surface'
-1 r. c;rr.....,. d a:.'ur bay„ lend surf:: require, a
NCAC 2C.Of IS.
i_-.7:. • 2 '-'ETHOJ 9F TEST
L2. , .'. T cS ZONES (?_p:h). 300
P0
11 D S :FECTPD\ Tyre H- H Ar.a�l3oz
Tnckne.. '
0 T: /3S Ft.(7Yr{ SDKZ%
T; Et
CAS yC-:
To Ft
(2. )_ D:,-:- ,:a:or
rr.)7- 0 T ., F;;Ee-'%'1O
Fnii: a- T: Q O Ft t--a..1-
14 SCREE \: Der:k an nei So: Sin. Maier..-::
Fr::- To F, ic. in
Fr:n: To Ft. in. in.
I:. SA\D G°_a\'EL PACK
D:piii Sze ML::ria:
Roc, To Ft
Frcn' To Ft.
Topographic'Land setting
❑Ridge ❑\'alley ❑Flat
(check apprapriate box)
Latitude'bongitude of well location
(dents ininutts:sccords)
Latimde'longitude souse:❑GPS❑Topographic nap
(:i::;k box)
DEPTH DRILLING LOG
From To Formation Description
/30 --j
100 —302-
c O—S�Z
y2- —600
0
ct
T� r..-..
r.
Shy.\ d: ctior. ari di;:an:e ir. r..i!es fr.:a a: Iea��j n,
t.,o S:ate Reads or Co.::::': Roc:1s. lnzlc_'e the rose �r
CO C
\;`y-,:• r.un1Jecs an.'. commonr:.'. r.a GeS. 1-_
(BUG r �n
n
16 RE)! A.P.KS
LOCATION SKETCH
uJ p vi w =
3 Mice.
CECT!F'f THAT TH!S WE.. .'STRLCTED IN ACCOiLDA\"CE WITH. ISA NCAC 22C, \ELL
C'S\ST9._CTIO\ STANDAF, -.... THAT A COPY OF THIS P=CORD HAS BEEN F:.J\'IDED TO THE WELL O.".V_R
5. L.,=.T:EOFPE ON TP:CT!`:0TH:E\.-ELL i DATE``'�
S,, r,:: t:: ori�
2 69: I5_ c Pl:,r.
raltothe Di‘ isionor\\titerQua:it\,Ground'•i:e-Section.. 1536?ItiIS:-\iceCen:er-Ri'eigh,NC
No. (919t 7333231, ithin 30 da)s, GV'.-I REV. 0722200: _

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) 'l�Q.4CctCO. 1te(a41o_i.M tCS CERTIFICATION aiVii
WELL CONTRACTOR COMPANY NAME Sh *4IIr et t 4So tau uxic—_PHONE# SO) (obl-Int
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT@
(if applic- lee), - (if applicable)
1. WELL USE (Check Applicable Box): Residential Pit Municipal/Public ❑ Industrial ❑ Agricultural ❑
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL. LOCATION:
Nearest Town Rosy-v..4N County -Tro..,<(va..te`
rJan Q' Ml+. 200d .22,`l'12
(Street Nar,e. Numbers, Community, Subdivision. Lot No., Zip Code)
3. OWNER: Le•..:3 01a2
Address Pea (Inv 549
Re
(Street or Route No.)
City or Town State
n 2-
Zip Code
412A)- MBS- 235°a,
Arca code- Phone number
4. DATE DRILLED `t- 3-1I)- C'-
5. TOTAL DEPTH: 505
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO !�
7. STATIC WATER LEVEL Below Top of Casing: 90 FT
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS ' FT. Above Land Surface`
'Top of casing terminated at/or below and surface requires a
variance in accordance with 15A NCAC 2C .0118.
9. YIELD (gpm): 2 METHOD OF TEST Rz3
10. WATER ZONES (depth):
11. DISINFECTION: Type 117t1S
12. CASING:
Depth Diameter
From }1 To (en Ft. Co 74
From To Ft.
From To Ft.
13. GROUT: Depth Material Method
From 0 To 20 Ft. GE.ncna _oovted
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
Amount I" -
Wall Thickness
or Weight/Ft. Material
# n piastre
From To Ft.
From To Ft.
16. REMARKS:
Topographic/Land setting
❑Ridge G lope ❑Valley ❑Flat
(check app ropriale box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From To Formation Description
}♦ ba civet Oscan.,
(Do 5e 5 la canoe
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common road names.
1 DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
SJ ate.... 4 26 -09
SIGNATURE OF PERS t CONSTRUCTING THE WELT, DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-1 REV. 07/2001

3 W 59
WELL CONSTRUCTION RECORD
North Carolina - Deparnnent of Enviromnent and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (prtat) RICHARD MCCRARY CERTIFICATION# 2010
WELL CONTRACTOR COMPANY NAME BARKER CONSTRUCTION, INC./BARKER WELL & PUMP pHONE # [phone]
STATE WELL CONSTRUCTION PERMIT# 1871 ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential IBA Municipal/Public ❑ Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION:
Nearest Town: BREVARD County TRANSYLVANIA
EX SOIL ROAD
(Street Name, Numbers, Comnmunity, Subdivision, Lot No., Zip Code)
3. OWNER JOAN RUST - MOSSER CONSTRUCTION, BUILDER
Address 19 DOUBLE RIDGE ROAD
(Street or Route No.)
PISGAH FOREST NC 28768
City or Town State Zip Code
( 828 )_ 884-9356
Area code- Phone number
4. DATE DRILLED OCTOBER 13, 2004
5. TOTAL DEPTH: 145'
6. DOES WFII REPLACE EXISTING WELL? YES 0 NO
7. STATIC WATER LEVEL Below Top of Casing: 20 FT.
(Use ^+" if Above Top of Casing)
8. TOP OF CASING IS 1.33 FT. Above Land Surface*
'Top of casing terminated at/or below land surface requires a
variance in accordance with 15A NCAC 2C .811a.
9. YIELD (gpm): 30 METHOD OF TEST TIMED
10. WATER ZONES (depth):
Topographic/Land setting
[Midge ®Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/mimues/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From To Formation Description
11. DISINFECTION: Type ST PUMP INSTALLER Amount
12. CASING: Wall Thickness
From 0
From To
From To
13. GROUT: Depth
From 0 To 20
Depth
To 50
From To
14. SCREEN: Depth
From To Ft. in.
Ft.
Ft
Ft.
Material
FL CONCRETE
Diameter or Weight/Ft. Material
61/8 SDR21 PVC
Ft.
Diameter
POURED
t
o •
cPC
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common road names.
(J&fl /101r01f G9141't
1Grt aad•
Method d,i zu' -, £xcL
el It itg eta rO•td,
Slot Size Material
in.
in.
From__ To Ft. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To FL
16. REMARKS:
42 . j /G [< & GL OX
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUC 1 hU IN ACCORDANCE WITH I5A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THA7A COP TIES CORD HAS BEEN PROVIDED TO THE
c �
PERSON C
UCITNGTHE WELL
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-I REV. 07/2001
•

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) RICHARD MCCRARY CERTIFICATION # 2010
PHONE # [phone]
WELL CONTRACTOR COMPANY NAME BARKER CONSTRUCTION, INC./BARKER WELL & PUMP
STATE WELL CONSTRUCTION PERMIT# 1871 MeticIATED WQ PERMIT/1
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential El Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection ❑ Other ❑ If Other, List Use
2. WELL LOCATION:
Nearest Town: BREVARD County TRANSYLVANIA
PARKWAY ROAD
(Street Name, Numbers, Conaoonity, Subdivision, Lot No., Zip Code)
3. OWNER: NANCY ANDERS
Address 552 PARKWAY ROAD
(Street or Route No.)
BALSAM GROVE NC
City or Town Slate
( 828 )_ 884-6399
Area code- Phone number
4. DATE DRILLED OCTOBER 29, 2004
5. TOTAL DEPTH: 145'
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO RI
7. STATIC WATER LEVEL Below Top of Casing: 30 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS 1.33 FT. Above Land Surface*
`Top of using terminated at/or below land surface require a
variance In accordance with 15ANCAC 2C .0118.
9. YIELD (gpm): 15 METHOD OF TEST TIMED
10. WATER ZONES (depth):
28708
Zip Code
Topographic/Land setting
®Ridge ❑Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutestsemnds)
Latitudellongitude source:❑GPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From To Formation Description
11. DISINFECTION: Type BY PUMP INSTALLER Amount
12. CASING: Wall Thickness
Diameter or Weight/Ft. Material
To 56 Ft. 61/8 SDR21 PVC
From 0
From
From
13. GROUT: Depth
From 0 To 20
From
14. SCREEN:
Depth
To Ft.
To Ft.
From
From To Ft. in.
Material
Ft. CONCRETE
To Ft.
Depth Diameter Slot Size
To Ft. in. in.
in.
Method
POURED
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
16. REMARKS:
v0
LOCATION SKETCH
Li ant ett a fa tart- 64749
a day a ire- Pt aide?
`toad # c at 0- Vitt
,tyx/- &pare to
Material aat ifea -rn %/it-
�. . % t
rrt!92c_t
r? j
Show direction and distance in miles from at least • -
two State Roads or County Roads. Include the read U?It
numbers and common road names.
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUC 1EU IN ACCORDANCE WITH 15A NCAC
CONSTRUCTION STANDARDS, THAT COP OF RECORD HAS PROVIDED TO T
q7 e A�SIGNA OF PERSON (j6 STRUCUNG THE WELL /
C, WFI.I
k-7'Z/ R Y
DATE
Submit the original to the Division of Water Quality, Groundwater Section,1636 Mali Service Center - Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-1 REV. 07/2001

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resourc
WELL CONTRACTOR (INDIVIDUAL) NAMEE(print;
WELL CONTRACTOR COMPANY NAME tip?
- Division of Water Quality - Groundwater Section T
CERTIFICATION o_____3
PHONE #
(�Cn43-9�
STATE WELL CONSTRUCTION PERMTT# ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential COY Municipal/Public 0 Industrial ❑ Agricultural 0
Monitoring Cl Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WFT.T LOCAMN:C L
Nearest Town: As1/4lslati e� .brCounty ig/'i AI,Sy AUgsm1 A
Svii-
(Street Name, Number, Community, Subdivision, let No, Tip Code)
3. OWNER: S•
(3+
Address % A3 5ho,ZE, Dr,
lAtitTya ri er ee) cg$ Z n
City or Town State tip Code
Area code- Phone number
4. DATE DRILLED /O- / 6 ' U
Topographic/Land setting
Age ❑Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(cheek box)
DEEP I DRILLING LOG
From To Formation Description
5. TOTAL DEPTH: ,S 5
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO 1;1/"..
7. STATIC WATER LEVEL Below Top of Casing: 10 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS 1 FT. Above Land Surface*
'Top of easing terminated at/or below land surface requires ■
9. YIELD (gpm)• 150 METHOD OF TESTGA/. cottismier
10. WATER ZONES (depth): ,7?0
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common road names.
variance hs accordance with ISA NCAC 2C .0118.
11. DISINFECTION: Type 114,C5IP. 147 Amount 22
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft Material
From O To Ft
From To Ft
From To Ft.
13. GROUT: Depth Method
From To FtQbh Cggri t6o.r.
From To Ft
14. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in.
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
CD
HAJV. 656
.5hoc ,Dr.
16. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTh#7CTION ST ARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
S ATURE 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
304413
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL. CONTRACTOR (INDIVIDUAL) NAME (print) James B. Brown
WELL CONTRACTOR COMPANY NAME Hedden Brothers Well Drilling, Inc
STATE WELL CONSTRUCTION PERMITS ASSOCIATED WQ PERMITS
(if applicable)
(if applicable)
CERTIFICATIONS 2045
PHONE [phone]
I. WELL USE (Check Applicable Box): Residential 0 Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery ❑ Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATIO
N est Town:
(Street Name, Num
3. OWNER:
Address
,fin;
Coun
Community Subdivision, Lot o., Zip Code)
(pas
for RmismNa.)
7f�
City- g"��Yior to77 Zip Code
97rn-
Area code- Phone number ^,
4. DATE DRILLED /7 '
5. TOTAL DEPTH: '70 a f
6. DOES WELL REPLACE EXISTING WELL? YES p
7. STATIC WATER LEVEL Below Top of Casing: C) FT.
(Use "+" if Above Top of asing)
8. TOP OF CASING IS 2 FT. Above Land Surface*
*Top of easing terminated at/or below land surface requires a
variance In accordant with ISA NCACi2C .0118.
10. WATER(ONES (depth): °Von 9 iaO f
F„TBLOW
11. DISINFECTION: Type H T H Amount 16oz
12. CASING: Wall Thickness
Depth Diyneter or Weight/Ft, Material
From To Ft.
From To Ft.
From To Ft.
13. GROUT:
From 0
gentoR
/
lL
Depth Material Method
To 20 Ft. benonite 6 cement pumped
From To Ft. .
14. SCREEN: Depth Diameter Slot Size Material
From To Ftin. in.
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Size - Material
To Ft.
To Ft.
Front
From
Topographic/Land setting
Wiact-'❑Ridge ❑Slope Malley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
DEPTH (cheek box)
DRILLING LOG
Fro jl°/ / Formation Description
clay 8 sand
granite
LOCATION SKETCH
Show direction and distance in miles from at (east
two State Roads or County Roads. Include the road
numbers and common road names.
C.J
O
o)
16. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED 1N ACCORDANCE WITH I5A NCAC 2C, WELL
CONSTRUCTION .9'1'ANbARDS, AND THATsUCOPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
-off
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
Submit the of(ginal 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
Notth Carolina - Department of Environment and Natural Resources - Di'vision of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (Fmist) RICHARD MCCRARY CERTIFICATION # 2010
PRONE # 028) 697-7263
wELL CONTRACTOR COMPANY NAME BARKER CONSTRUCTION, INC/BARKER WELL & PUMP
STATE WELL CONSTRUCTION PERMIT# 1871 ASSOCIATED WQ PERMIT#
{if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential E0 Municipal/Public ❑ Industrial 0 Agricultural 0
Monitoring 0 Recovery C1 Hcat Pump Water injection 0 Other ° If Other, List Use
2. WELL I ()CATION:
Nearest Town: BREVARD
LAUREL HILLS, LOT it233
(Street Name, Numbers, Community, Subdivision, Lot No., Zap Code)
County TRANSYLVANIA
3. OWNER: COLEY DODD
Address 299 LOOKOUT DRIVE
(Street or Route No.)
PISGAH FOREST NC 28768
City or Town State Zip Code
( 828 )_ 275-5889
Area code- Phone number
4. DATE DRILLED OCTOBER 24, 2004
5. TOTAL DEPTH: 285
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO R1
7. STATIC WATER LEVEL Below Top of Casing: 3U FT.
(Us "t" if Above Top of Casing)
8. TOP OF CASING IS 1.33 FT. Above Land Surface'
flop of casing terminated at/or below land surface requires a
variance in accordance with 15A NCAC 2C.01I8.
y. YIELD (gpm); 30 ME'I BOD OF'I EST TIMED
10. WATER ZONES (depth):
Topographic/Land setting
&RRidge °Slope °Valley °Flat
(check appropriate box)
Latitude/longitude of well location
(degrwsiminutesheeoatis)
Latitude/longitude source:0GPS0Topographic map
taw* box)
DEPTH DRILLING LOG
From To Formation Description
11. DISINFEC IION:'type BY PUMP INSTALLER Amount
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft Material
From 0 To 67 Ft. 6118 SDR21 PVC
From To Ft.
From To Ft
13. GROUT: Depth Material
From 0 To 20 Ft. CONCRETE
From To Ft.
14. SCREEN: Depth Diameter
From To Ft. in.
From To Ft. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
LOCATION SKETCH O
Show direction and distatwc in mites troutcitasi
two State Roads or County Roads. Include the roan
numbers and eormron road names. 9/ p
6x.S 01)(e„61
Method X l aQ e• lit& a_ ,,, 4 fat
POURED �i6 ats-OZZ/L///(__Q 4, Z/mt-.). S G
Luc
QC/at
�
Slot Size Material
in.
in.
16. REMARKS:
I DO HEREBY CERTIFY THAT THIS
CONSTRUCTION STANDARDS,
LL WAS CONSTRUCIEU IN ACCORDANC WITH 15A NCAC 2C, WELL
PROVIDED TO THE WELL$WNER
OPY OF Tins R$CORD
TUBE OF PERSON CON
UCTING THE WELL
T1
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. U W-i KEY. 0712001

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Grou dwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (plat) RICHARD MCCRARY CERTIFICATION # 2010
WELL CONI'RACI'OR COMpANY NAME BARKER CONSTRUCTION, INCJBARKER WELL & PUMP
STATE WELL CONSTRUCTION PERMIT# 1871 ACSMIATED WQ PERMIT#
(if applicable) (if applicable)
PHONE # f 828) 697-7263
1. WELL USE (Check Applicable Box): Residential El Municipal/Public ❑ Industrial ❑ Agricultural ❑
Monitoring ❑ Recovery 0 Heat Pump Water Injection 0 Other ❑ If Other, List Use
2. WELL LOCATION:
Nearest Town: BREVARD County TRANSYLVANIA
WHETSTONE GAP, LOT # 60
(Street Name, Numbers, Community, Subdivision, Lot No., tip Code)
3. OWNER: RONAID AND DEBBIE ATKINSON
Address 8604 WEAVER COURT
(Street or Rase No)
LAUREL MD 20707-2797
City or Town Sure Tap Code
( 301 )- 490-4170
Area code- Phone number
4. DATE DRILLED NOVEMBER 8, 2004
5. TOTAL DEPTH: 405
6. DOES WELL REPLACE EXISTING WFII ? YES ❑ NO K1
7. STATIC WATER LEVEL Below Top of Casing 200' FT.
(Use "+" if Alamo Top of Casing)
8. TOP OF CASING IS 1.33 FT. Above Land Surface'
'Top et easing tenahusted atfor below land surface requires a
variance In accordance with ISANCAC 2C Lena
9. YIELD (gam): 12% METHOD OF TEST TIMED
10. WATER ZONES (depth):
Topographic/Land setting
®Ridge ❑Slope Malley ❑Flat
(check appropriate box)
Latitude/longinde of well location
(degrees/mimtocs/aeconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From To Formation Description
11. DISINFECTION: Type BY PUMP INSTALLER Amount
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft Material
From 0 To 21 Ft_ 61/8 SDR21 PVC
From To Ft
From To Ft.
13, GROUT: Depth Material
From 0 To 20 Ft. CONCRETE
From To Ft.
14. SCREEN: Depth Diameter
From To Ft in.
From To Ft is
15. SAND/GRAVEL PACK
Depth Size
From To Ft.
Fromt__To Ft.
16. REMARKS:
Method
Slot Size Material
in.
Material
O
rvi
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the mad
numbers and common road names.
Juin Q is& faci,4// (oillcle[t.
a k d' a' , OEcw
POURED clop ...., at an daft)
th-it,oa..d. Ts. J.tuv7L
U nerill) ortICJ
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C
CONSTRUCTION STANDARDS.AND THAT A (.:C2¢Y OF THI - CORD : EEN PROVIDED TO THE j(
LL
1
SIGMA'
OF P
UCTING THE WELL
A
Submit the original to the Division of Water Quality, Groundwater Section,1636 Mail Service Ceti - Raleigh, NC
27699-1636 Phone No. [phone], within 10 days. GW-I REV. 07/2001

WELL CONSTRUCTION RECORD
Notch Carolina - Department of EnvitJlID..nt and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR ONDIVIDUAL) NAME (print) RICHARD MCCRARY CERTIFICATION # 2610
WELL CONTRACTOR COMPANY NAME BARKER CONSTRUCTION, INC./BARKER WELL 8. PUMP
STATE WELL CONSTRUCTION PERMIT# 1871 ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
PRONE # ( 628) 697-7263
1. WELL USE (Check Applicable Box): Residential Ed Municipal/Public 0 industrial 0 Agricultural 0
Monitoring ❑ Recovery G Heat Pump Water Injection ❑ Other i3 If Other, List Use
2. WELL LOCATION:
Nearest Towel: BREVARD
LAUREL HILLS, LOT #23
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: COLBY DODD
Address 299 LOOKOUT DRIVE
County TRANSYLVANIA
(sheet or Rome Na)
PISGAH FOREST NC 28768
City or Town State Lp Code
( 828 )- 275-5889
Area code- Piero numbs
4. DATE DRILLED OCTOBER 24, 2004
5. TOTAL DEPTH: 285'
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO FSl
7. STATIC WATER LEVEL Below Top of Casing: 30 FI'.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS 1.33 FT. Above Land Surface'
*Top of casing terminated attor below land surface requires a
variance in accordance with ISA NCAC 2C .011s.
9. YIELD(gpm): 30 MEI HODOF 1ES1 TIMED
10. WATER ZONES (depth):
Topographic/Land setting
®Ridge ❑Slope °Valley OFlat
(ebeck appropriate box)
Latitude/longitude of well location
(debrrodminues/seo nda)
Latitude/longitude source:0GPSEITopographic reap
(dud. box)
DEPTH DRILLING LOG
From To Formation Description
1I. DISINFECI ION: Type BY PUMP INS Mali Amount
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft Material
From D To 67 Ft. 6118 SDR21 PVC
From To Ft.
From To Ft.
13. GROUT: Depth Material
From 0 To 20 Ft. CONCRETE
From To Ft.
14. SCREEN: Depth Diameter
From To Ft. in.
From To Ft. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
Method
POURED
Slot Size Material
in.
in.
16. REMARKS:
LOCATION SKETCH d� ,
Show direction and distance in macs f�aiomust
two State Roads or County Roads. Include the roa
numbers and cntiunon road names.
p(Q4f2 'n2d. dale Q Jeitit at
(Ai
a
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUC fED IN ACCORDANC
CONSTRUCTION STANDARDS, • 1 i T fyCOPY f)FR�'arCORD . • "'
ERSON CON
WITH I3A NC AC 2C, WELL
PROVIDED TO THE WELL 6WNER
UCTING THE WELL
DAIS
Submit the 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 - IAyaitu,ait of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (prbt) RICHARD MCCRARY CERTIFICATIONS 2010
WELL CONTRACTOR COMPANY NAME BARKER CONSTRUCTION, INC /BARKER WELL & PUMP
PHONE # [phone]
STATE WELL CONSTRUCTION PERMITS 1871 ASSOCIATED WQ PERMITS
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential El Municipal/Public ❑ Industrial ❑ Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other ❑ If Other, List Use
2. WFI 1 LOCATION:
Nearest Town: BREVARD
WHETSTONE GAP, LOT 160
(Street Name, Mambas, Community, Subdivision, Lot No., Tip Code)
County TRANSYLVANIA
3. OWNER: RONALD AND DEBBIE ATKINSON
Address 6604 WEAVER COURT
(Street or Rase No.)
LAUREL MD 20707-2797
Citya Town State hp Code
( 301 ).. 490-4170
Area code- Phone number
4. DATE DRILLED NOVEMBER 8, 2004
5. TOTAL DEPTH: 405
6. DOES WELL. REPLACE EXISTING WE.I7? YES 0 NO KI
7. STATIC WATER LEVEL Below Top of Casing. FT.
(Use `+^ if Above Top of Casing)
8. TOP OF CASING IS 1.33 FT. Above Land Surface'
'Top oteasing terminated atlor below land surface requires a
variance h aceudffim with ISA NCAC 2C MIL
9. YIELD (gpm): 12K METHOD OF TEST TIMED
10. WATER ZONES (depth):
Topographic/Land setting
®Ridge ❑Slope ❑Valley ❑Flat
(check appmpriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude sowce:❑GPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From To Formation Description
11. DISINFECTION: Type BY PUMP INSTALLER Amount
12. CASING: Wall Thiclmcss
Depth Diameter or Weight/Ft
From 0 To 21 FL 61/8 SDR21
From To Ft.
From To Ft.
13. GROUT: Depth Material
From 0 To 20 Ft, CONCRETE
From To Ft.
14. SCREEN: Depth Diameter
From To Ft. in.
From To Ft
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft
From. To Ft.
Slot Size
it
Material
PVC
Cr) 40
t^t
C2
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.
ttom 6uctud u U e elt.
Ua1ccz Q 1 ' //Q%Z
POUREMetD gUQQ# • �.5-i(.(.�� /Lc�{p�r- �7 lob)
Material Ye ow aI7t0 135 e,nQFMAQ
-A-ca d %s . J.1.1,wri ' ' and
Xa ox. su(ti- Mo Mid- D� �p t . � . �ot
I
gap 4 -1k60
16. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH ISA NCAC 2C
CONSTRUCTION STANDARDS,AND THAT A C,Q1Y OF THE CORD t EEN PROVIDED TO THE
/777
SIGNATURE OF PER
CO ' UCTING THE WELL
Submit the original to the Division of Water Quality, Groundwater Section,1636 Mall Service Cun(kr - Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-1 REV. 07/2001

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) KENNETH MCCRARY CERTIFICATIONS 2008
306170
WELL CONTRACTOR COMPANY NAME BARKER CONSTRUCTION, INC./BARKER WELL & PUMP PRONE, S [phone]
STATE WELL CONSTRUCTION PERMITS 1871 ASSOCIATED WQ PERMITS
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential HI Mu nicipalPublic ❑ Industrial ❑ Agricultural ❑
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use
2. WELL LOCATION:
Nearest Town: BREVARD
GREENVILLE HIGHWAY
County TRANSYLVANIA
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER DONALD JACQUES
Address 7 TARAH LANE
(Street or Route No.)
PISGAH FOREST NC 28768
City or Town State Zip Code
( 828 )_ 553-2678
Area code- Phone number
4. DATE DRILLED DECEMBER 12, 2004
5. TOTAL DEPTH: 155'
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO RI
7. STATIC WATER LEVEL Below Top of Casing: 20 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS 1.33 FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordance with 15A NCAC 2C .0118.
9. YIELD (gpm): 25 METHOD OF TEST TIMED
10. WATER ZONES (depth):
Topographic/Land setting
❑Ridge 0Slope ❑Valley ElFlat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds) Latitude/longitude source:❑GPS❑Topographic tnap
(check box)
DEPTH DRILLING LOG From To Formation Description
11. DISINFECTION: Type BY PUMP INSTALLER Amount
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
Lit
CO
t�
'4i rt3
"UV;
L�l G
rns
LOCATION SKETCH
Show direction and distance in miles from at last �r
two State Roads or County Roads. Include the road
numbers and common road names.
From 0 To 33 Ft. 61I6 SDR21 PVC t,�it.Q 13tub-HLr/
From To Ft. z' `^-��
From To Ft. tAht fithi .�-eR.. ALL,( • 4-6(. •
13. GROUT: Depth Material Method S� (/ �pp��,�� ��///QQ///�����
From 0 To 20 Ft, CONCRETE POURED ft uJ ,&WJit, d2 t
From Toe Ft. ' D '-'-^_'_' f iR_ ./
14. SCREEN: Depth Diameter Slot Size Material Oita l.' xj'
From To Ft, in. in. 3)i3OAat- 7 t,kke� •
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Size Material
To
To
From
From
16. REMARKS:
Ft.
Ft.
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
SBBEEN
tP�R�OtVIIDED TO THE WELL
1OWNER
Vie) C
SIGNATURE OF PERSON CONSTRUCTING THE WELL i� DATE J _
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-1 REV. 07/2001

WELL CONSTRUCTION RECORD 3 [l 6 1 6 9
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) RICHARD MCCRARY CERTIFICATION # 2010
WELL CONTRACTOR COMPANY NAME BARKER CONSTRUCTION, INC./BARKER WELL & PUMP
STATE WELL CONSTRUCTION PERMIT? 1871 ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential 181 MunicipaVPublic 0 Industrial 0 Agricultural 0
Monitoring ❑ Recovery 0 Heat Pump Water Injection O Other ❑ If Other, List Use
2. WELL LOCATION:
Nearest Towle BREVARD
PHONE # [phone]
BRUCENE DRIVE, LOTS 5 & 6
(Street Name, Numbers, Com/nunity, Subdivision. Lot No., Zip Code)
3. OWNER: LEWIS AND ROBIN COWART
Address 781 SHOAL CREEK ROAD
(Street or Route No.)
BALSAM GROVE NC 28708
City or Town Stale Zip Code
( 828 )_ 553-9515
Area code- Phone number
4. DATE DRILLED DECEMBER 22, 2004
5. TOTAL DEPTH: 305
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO
7. STATIC WATER LEVEL Below Top of Casing: 100 FT.
(Use `1-" if Above Top of Casing)
8. TOP OF CASING IS 1.33 FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordance with ISA NCAC 2C .0118.
9. YIELD (gpm): 7 METHOD OF TEST TIMED
10. WATER ZONES (depth):
County TRANSYLVANIA
11. DISINFECTION: Type
12. CASING:
Depth
From 0 To 148
From To
From
13. GROUT:
From 0
BY PUMP INSTALLER
To
Depth
To 20
Diameter
Ft. 6 1/8
FL
Ft.
Material
Ft. CONCRETE
Amount
Wall Thiclmess
or Weight/Ft. Material
SDR21 PVC
From To Ft.
14. SCREEN: Depth Diameter
From To Ft. in.
From To Ft. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
Slot Size
Topographic/Land setting
❑Ridge ®Slope OValley °Flat
(check appropriate box)
Latitude/longitude of well location
(degreearminutes/seconds) ..
Latitude/longitude source:OGPSOTopographic map
(check box)
DEPTH DRILLING LOG
From To Formation Description
O
Method
POURED
Material
in
16. REMARKS:
r.�
J
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers andsonm on road names.
� ,/la& 40f4n to fltt-s Vzec ycc✓S.
L%/,,Ileax- ex C�vctc ilOsz L.
LJQJL 2 OCt n 41.. oaG cwt.
GG(�1G,4ie. at cd ceeit iota -ti-
t
. Ata.a 4touilit
kind ith" .zoa€ ,caletz .r-
" r1
m
CO
c,._,
Lr>
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRULTED IN ACCORDANCE WITH 15A NCAC 2C, WF
CONSTRUCTION STANDARDS, AND THAT A COPY 0 THIS ORD HAS BEEN PROVIDED TO THE WE O W N
'/�i.�l. � /fl-J
SIGNATURE OF PERSON CONS CTING THE WELL
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mall Service Center - Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-1 REV. 07/2001

Depth Diameter
From 0 To 113 Ft. 61/8
From To Ft
From To Ft.
13. GROUT: Depth
From 0 To 20
From To
14. SCREEN: Depth
From To
From To
15. SAND/GRAVEL PACK:
Depth
From____To
From To
County TRANSYLVANIA
Material
Ft. CONCRETE
WELL CONSTRUCTION RECORD (I m3 0 616 6
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Gondwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) RICHARD MCCRARY CERTIFICATTON # 2010
WELL CONTRACTOR COMPANY NAME BARKER CONSTRUCTION, INC./BARKER WELL & PUMP PHONE # f828) 697-7263
STATE WELL CONSTRUCTION PERMIT# 1871 ASSOCIATED WO PERMIT#
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential El Mumicipal/Public El Industrial O Agricultural CIMonitoring O Recovery El Heat Pump Water Injection ❑ Other 0 If Other, List Use
2. WELL LOCATION:
Nearest Town: BREVARD
OFF OF HIGHWAY 215
(Street Name, Numbers, Community, Subdivision, Lot No, Zip Code)
3. OWNER: MICHAEL & AVONDA STREETER
Address 1201 MAPLE STREET
(Street or Rowe No.)
COLUMBIA SC 29205
City or Town State Zip Code
( 803 )_ 929-5116
Area code- Phone number
4. DATE DRILLED DECEMBER 27, 2004
5. TOTAL DEPTH: 280
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO El
7. STATIC WATER LEVEL Below Top of Casing: 60 FT,
8. TOP OF CASING IS i.33 (Use w^ if Above Top of Casing)
FT. Above Land Surface
`Top of casing ternlnated at/or below hind surface requires a
variance in accordance with 15A NCAC 2C .0118.
9. YIELD (gpm): 8 METHOD OF TEST TIMED
10. WATER ZONES (depth):
11. DISINFECTION: Type BY PUMP INSTALLER Amount
12. CASING: Wall Thickness
or Weight/Ft. Material
SDR21 PVC
Topographic/Land setting
❑Ridge ®Slope [Valley [Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:f]GPSOTopographic map
(check box)
DEPTH DRILLING LOG
From To Formation Description
Method
POURED
Ft.
Diameter Slot Size Material
Ft. in in.
Ft. in. in.
Size
o Ft.
Ft.
Material
C:
ro
r
LOCATION SKETCH
Show direction and distance in [Hiles from at least
two State Roads or County Roads. Include the road
numbers and common road names.
Jit onx&uf ud s a 3.3 nab.,
r4'� 64 ors , ' ..2L5 j
on Milt (94±s a Ede.
0115 qz 1 62ict Trail
Qa m. Iced pa.axxcd ,o a. L
rode, a e_D e z > /IAGi.cl.
16. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH ISA NCAC 2C,
CONSTRUCTION STANDARDS, AND THAT A COP;OF S RECORD HAS BEEN PROV 1 a a a THE /
aff
SIGNATURE OF PERSON CONSTRU - G THE WELL ))/1TE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mali Service Center - Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-1 REV. 07/2001
C
"1r1
m

WELL CONSTRUCTION RECORD09\9 3 0 616 5
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) RICHARD MCCRARY CERTIFICATION,/ 2010
WELL CONTRACTOR COMPANYNAME BARKER CONSTRUCTION, INCJBARKER WELL & PUMP piton g [phone]
STATE WELL CONSTRUCTION PERMIT,/ 1871 ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential ID Municipal/Public 0 Industrial 0 Agricultural ❑
Monitoring ❑ Recovery 0 Heat Ptunp Water injection ❑ Other ❑ If Other, List Use
2. WELL LOCATION:
Nearest Town: BREVARD
LAKE HONDAH, LOTS 1 8 2
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: TERRY HALL
Address 180 SASSAFRAS LANE
(Street or Route No.)
CEDAR MOUNTAIN NC 28718
City or Town State Zip Code
( 828 )_ 862-5508
Area code- ?bone munber
4. DATE DRILLED DECEMBER 8, 2004
5. TOTAL DEPTH: 345
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO 13
7. STATIC WATER LEVEL Below Top of Casing: 40 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS 1.33 FT. Above Land Surface*
`Top of casing terminated at/or below land surface require a
variance In accordance with 15A NCAC 2C .0118.
9. YIELD (gpm): 4 METHOD OF TEST TIMED
10. WATER ZONES (depth):
Topographic/Land setting
®Ridge ❑Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From To Formation Desaption
C11
L
11. DISINFECTION: Type BY PUMP INSTALLER Amotmt
12. CASING: Wall Thickness
Depth Diameter
0 To 68 Ft. 6118
From To Ft.
From To Ft.
13. GROUT: Depth Material
From 0 To 20 Ft. CONCRETE
From
County TRANSYLVANIA
or Weight/Ft. Material
SDR21 PVC
From To Ft.
14. SCREEN: Depth Diameter
From To Ft. in.
From To Ft. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
Method
POURED
Slot Size Material
in.
in.
ro
W
N
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common road names.
titontbkruicuct>a76 ifaLth.
to Ea. t- /2d . 11 a
ea,a t Iva mcct v auto
to
,.atte-Yed ik '/ oadU cnc Qr YZ
nut"- esPi-Q7'td.�A._ ht.1ld'utsion .
bit kw i in _ Into o ,(,fa.(,�.,Ztf.vt_
Lt.c. o(.c.u.(itha .. 0
16. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WE
CONSTRUCTION STANDARDS, AND THAT A COP F THIS RECO BEEN PROV ED TO THE WE O
IGNATURE O RSO_DLCONSTRU
/% / /YA2 WELL DA
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mall Service Center - Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-1 REV. 07/2001
Cn

From To
From To
13. GROUT: Depth
From 0 To 20
(Street or Route No.)
HORSE SHOE NC
City or Town State
Area code- Phone mutter
4. DATE DRILLED NOVEMBER 19, 2004
5, TOTAL DEPTH: J405
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO
KI
7. STATIC WATER LEVEL Below Top of Casing: 100 FT.
8. TOP OF CASING IS 1.33 (Use "+" if Above Tor of Casing)
FT. Above Land Surface*
`Top of casing terndnated at/or below land surface requires a
variance In accordance with 1SA NCAC 2C ,9118.
9. YIELD (gpm): 5 METHOD OF TEST TIMED
10. WATER ZONES (depth):
11. DISINFECTION: Type BY PUMP INSTALLER Amount
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft Material
From 0 To 87 61/8 SDR21 PVC
From To
14. SCREEN: Depth
From To
From To
15. SAND/GRAVEL PACK:
Depth
From To
From To
16. REMARKS:
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water
WELL CONTRACTOR Quality. Groundwater
(INDIVIDUAL) NAME (print) KENNETH MCCRARY CERTIFICATION # 2005
WELL CONTRACTOR COMPANY NAME BARKER CONSTRUCTION, INCJBARKR WELL & PUMP PHONE # [phone]
STATE WELL CONSTRUCTION ?EMU1871
(if applicable) ASSOCIATED WQ PERMIT#
(if applicable)
306163
1. WELL USE (Check Applicable Box): Residential 181 Municipal/Public 0 Industrial CI Agricultural 0
Monitoring 0 Recovery CI Heat Pump Water Injection El Other 0 If Other, List Use
2, WELL LOCATION:
Nearest Town: BREVARD
MELOLEN FARMS ROAD
County TRANSYLVANIA
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER CALEB MCCARSON
Address PO BOX 251
28742
Zip Code
Ft.
Ft.
Ft.
Material
Ft. CONCRETE
Ft.
Diameter Slot Size
Ft. in. in.
Ft. in. in.
Size
Ft.
Ft.
Method
POURED
Topographic/Land setting
®Ridge OSlope OValley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/WOWS) - -
Latitude/longitude source:OGPSOTopographic map
DEPTH (check box)
DRILLING LOG
From To Formation Description
—0
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common road names.
boa B /e atic L,-. a/BD.
,ze lc�, .zrrrvxo
as rut O � ce1)c CCC��2 `z 2at_
r/ acn4
2f 'A tut dt arc 4 itc. .
Material
Material
SIGNATURE OF PERSON CONSTRUCTING THE WalI, I _ " _�/
DATE
Submit the original to the Division of Water Quality, Groundwater Section,1636 Mail Service Center- Raleigh, NC
27699-1636 Phone No. [phone], within 30 days.
GW-1 REV. 07/2001
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WFt F
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
)44.7)..wLa_471(. iAncyCc 1

305709 Ck
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) James B. Brown
WELL CONTRACTOR COMPANY NAME Hedden Brothers Well Drilling, Inc
STATE WELL CONSTRUCTION PERMIT#
(if applicable)
CERTIFICATION q 2045
PHONE # [phone]
ASSOCIATED WQ PERMIT#
(if applicable)
1. WELL USE (Check Applicable Box): Residential 0 Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATIO
Near�ps/ Town
CountyLkileg4 [Q
(Street Name, NumbCommunity, Subdivision, Lot No., Zip Code)
3. OWNER:
Address
(Stresqr Route No.)
ry o To -7 State Zip Code
K`�•�- l0 ' 1 /Q
Area code- Phone number ` -
4. DATE DRILLED 11 / O7
5. TOTAL DEPTH: V
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO 0
7. STATIC WATER LEVEL Below Top of Casing: /)SO FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS 2 FT. Above Land Surface"
*Top of cuing terminated at/or b low land surface requires a
variance In accordanff skith 1SA NCAC 2C .0118.
9. YIELD (gpm): ' D THOD OF TEST BLOW
10. WATER ZONES (depth): 15a ui
Cad
11. DISINFECTION: Type H T H
12. CASING:
From 0
From
From To
13. GROUT: Depth
From 0 To 20
From To
14. SCREEN: Depth
From To
From To
Depth
To 4-4.1 Ft.
To Ft.
Ft.
Amount 16oz
Wall Thickness
D/ameter or 18ipht/Ft. �e
(p lid
Material
Ft, benonite 8 cement
Ft. .
Diameter
Ft. in.
Ft. in.
15. SAND/GRAVEL PACK:
Depth
From To Ft.
Method
pumped
Slot Size Material
in.
in.
Size - Material
From To Ft.
Topographic/Land setting
❑Ridge ❑Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH DRILLING LOG
Fro L» TQ , , 4 Formation Description _ -
clay & sand
granite
LOCATION SKETCH
Show direction and distance in miles from at (east
two State Roads or County Roads. Include the road
numbers and common road names.
16. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH I5A NCAC 2C, WELL
CONSTRUCTION STA. e • a S, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
1 r l/-/rZ'OS
SIGNATU OF PERSON CONSTRUCTING THE WELL DATE
Submit the or nal 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

307207
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME(Print) /9/feel e- ,HALO des 1t� CERTIFICATION it Z7g9
WELL CONTRACTOR COMPANY NAMESLJG�{ts.;#-T'ee Weal np: I (:#i 9 PRONE # ( A(e49-ONpo
STATE WELL. CONSTRUCTION PERMED ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential tVMtmicipal/Public 0 Industrial 0 Agricultural ❑
Monitoring 0 Recovery ❑ Heat Pump Water lnjection 0 Other 0 If Other, List Use
2. WELL LOCATISN: -!
Nearest Town:. '0; . County//s44S1Il1/1)49
316 (an! / di
flay, re e Rd 2%7/2--
(Street Name, Numba ers,tommunity,Subdivision, Lot No., Zip Code)
3. OWNER: C,f Cl/ �j�'jJ C C il/
Address ?4/joa €44 Cnue Rr✓
,Stet a aaa&aee No.)
nPofrc{ Ni, 7$7/7.,
City or Town State Zip Code
( )-
Ana code- Phone numbs
4. DATE DRILLED / Z - - O r
5. TOTAL DEPTH: ?a
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO C9'
7. STATIC WATER LEVEL Below Top of Casing: Ct FT.
(Use '+' if Above Top of Casing)
8. TOP OF CASING IS Re, FT. Above Land Surface'
'Top of casing terminated at/er below land surface requires a
variant in accordance with 15A NCAC 2C -MIL/ —�---
9. YIELD (gpm): j METHOD OF TEST / / 47 Loaf
10. WATER ZONES (depth): 426 /C S
opographic/Land setting
idge ❑Slope 0Valley ❑Flat
(check apptoptiate lox)
Latitude/longitude of well location.
(de,miuutesrs)
Latitude/longitude source:❑GPSElTopograaphic map
(check box)
DRILLINIG OG i
Formation D9$ription t.
DEPTH
From To
0
Ca
Cr
rvic
LOCATION SKETCH
11. DISINFECTION: Type cc, of Amount /n 0 Z Show direction and distance in miles from at least
12. CASING: Wall Thickness two State Roads or County Roads. Include the road
Depth Di or Weight/Ft al numbers and commonmoro names.
From To //O Ft 647 SINZI VO iVtie
LI
From To Ft.
From To FL
were13. GROUT: Depth Material od ,
From_, To to Ft Cox, e f �eux
From To Ft
14. SCREEN: Depth Diameter Slot Size Material
From To Ft in. in.
Fro To Ft. in. in.
15. SAND/ VEL PACK:
Depth Size Material
To Ft.
To Ft.
Front
From
iiirre4 car
N5
05�
16. REMARKS:
1 DO HEREBY CERTf1FY THAT THIS WET 1 WAS CON t.t r-u IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTit]N jtrANDARDS, AND THAT A QbPY OF S RECOIz,� HAS BEEN PROVIDED TO TIIE WFI I OWNER
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
27699-1636 Phone No. (919) 7333221, within 30 days. GW-1 REV. 07/2001

307184
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Divisionvof Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME 1 (prior) Q/7h/ C /, A/ CERTIFICATION ar� 7,
WELL CONTRACTOR COMPANY NAMES W tt% 1Jh./ (Q p: ( (r As PHONE # jt211A -0441, i
STATE WELL CONSTRUCTION PERMrr# ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential a Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring ❑ Recovery ❑ Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATIQN:
Nearest Town:11 r r U
53 / �bn es^_- M 2 7 5/ 7
(Street Name, Numbers, Cammtmity, Subdivision, Lot No., Zip Code)
3. OWNER: 1 I U e /3 �'`�� (degrees/minutes/seconds)
acoods)
_MOW ' Address CV
I tfre %4// Latitude/longitude source:❑GPS❑Tapographic map
Topographic/Lantj,aetting
❑Ridge ❑Slope Malley ❑Flat
(check appropriate box)
Latitudetlongitude of well location
hat re m a r N L z 0 7g 7 pRILLING LOG
City or Town S Zip Code Formation Description
(Street or Route No.) (check box)
DEPTH
From To
Area code- Phone anmber
4. DATE DRILLED/ Z`3-07
5. TOTAL DEPTH: I Z 5
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO 1Z
7. STATIC WATER LEVEL Below Top of Casing: 2,C)' FT.
/ / (Use"+" if Above Top of Casing)
8. TOP OF CASING IS to FT. Above Land Surface"
'Top of cuing terminated at/or below land surface requires a
variance In aetordace with ISA NCAC 2C AII6. _—,
9. YIELD (gpm): ZO METHOD OP E /i /ySY
') T
10. WATER ZONES (depth): gin
11. DISINFECTION: Type C j i/ e Amount / if, o 2.
12. CASING: Wall Thickness
D
From To Ft / % 5/.1 2/ t Pan
th
From To Ft.
From To Ft.
13, GROUT: Depth Material tt#�ethod
Fro To 20 FVOAG/t C Wertitjy
From To Ft
14. SCREEN: Depth Diameter
From To Ft. in.From / To Ft. in.
15. SAND/GRAVEL PACK:
Depth Size Material
Slot Size Material
in.
in.
From To Ft.
From / To Ft. // ` 7 a/�
16. REMARKS:.IL / &% r N W M'tr % (A17 q/ 0u 4e/ 7;l4 le i" � � , /! / eitick //
I DO HEREBY CERTIFY THAT THISWELLWAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARD Al r T A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
-
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
LOCATION SKETCIj tV ;
Show direction and distance in miles froai�t leastd
two State Roads or County Roads. Includ roe
numbers and nroad :r.o.CO crt
Submit the 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

30'7268
WELL CONSTIRIICITON\\--RECORD
• D,\ Groundwate10NeOn
North Carolina � Department of Envirorun rnl and Natural Res ousem •Division of Water Quality "Groundwater Section t�1$�J�
WE LL Co tic RA Cr O R (rWMD UAL) N AM E (prier) ATI (eQ��HLe/V
(L'.f\tall\PAmo C^ rscoxEa �y—,
WELL CONTRACTOR COMPANY NAME ASSOCUTLD wQ PERMIT/
ITa
STATE ewe LLfa lice is ON PERMRa ifa liable
irn licablc
cultural 0
WELL USE (Check Applicable Box): Residential CrMunieipaVPl blie O IndusLial 0/ Agri—=—
Monitoring 0 Recovery 0 Heat Pump Water Injection ❑Jther 0 If Other,
2. WELL LOCAT19N
f1\ \Ys
(sired Neme. Numbcn. Community. Subdrnnon, Inl No., Z)p Cede)
3. OWNER: la.1 4 tL \Ycx-
Address '7ako -Igo,rC
Rak
(Suroet or Rowe No.)
}a-,• kc �otaaA rs I I X .
City or Town Stitt
(Ysaic). BSN —105
Area Bodo- Phone number
4. DATE DRILLED I \-J\a-C"'1
5. TOTAL DEPTH,: oi'\S
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO I
7. STATIC WATER LEVEL Below Top of Casing: • (0 F .
Wee '•." It Above Top of Culna)
8. TOP OF CASING I5 I FT. Above Land Surface'
'Tap of rule( termin Bird atior below lead sedate requlrez a
♦u4net In aeoerdtnet with ISA NCAC IC .ot16.
9. YIELD (gpm): i METHODOFJEST (-1l
10. WATER ZONES (depth):
Nearest Town:
County l tr Calf\
e7{� 1
. Zip Code
II. DISINFECTION: Type IXT t-F
' 12. CASINO:
Depth
From / To Ft.
From _) I_ To 3 3 Ft.
From To Ft.
13. GROUT: Depth • . Material ..
Front Q To 2 Z? Ft. S 7Fk/Zell/z.
From To Ft.
14. SCREEN: Depth Diameter
From To Ft. in.
From To Ft. in.
15. SAND/GRAVEL PACK.
Depth Sire Material
Topographic/Land setting .
❑Ridge ❑Slope argley
(ebeck appropriate Ian)
Latitude/ton tudeofwelllocation
350 a^ ��x� sy0CSW
(derns/miauteaneeeeA) hIe
LatitudeAongitudesource:OGPSOTopograp map
(cheekboz) "
n nitlea I_GG
Fot3rution Description
DEPTH
From To
D— /C
/l7 — 2 0
26 • .05 •
LOCATION SKETCH
Amount Show direction and distance in miles from at least
Wall Thickness two State Roads or County Roads. lnelisde the road
or elglst/FL atenal numbers and common road names.'
a,/; C vc.
w
Meth
PC/ i-lickse
Slot Size Material
in.
in.
From To Ft.
From To Ft.
16. REMARKS:
I DO HEREBY CERTIFY THAT THIS WFI I WAS
CONSTRUCTION STANDARD. AND THAT A C
NSTRUC7ED R! ACCORDANCE WITH 1 5A NCAC 2C, LL
OFF RECORD HAS BEEN PROVIDED TO THE WELL OWNER
TU
SI ATURE OF PERSON CONSTRUCTMO THE WELL- DATE
S bmlt the original to lb a Division of Watt? Quality, Cronndeater Seetlon, 1636 Mill $p-4ce Ceet(eet' MatIVh N
2?69¢I636 Phone Ne. [phone], within 30 days. rGvl'•F74

309217
STATE WELL CONSTRUCTION PERMITS/
(if applicable)
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment a ural Resources - Division of Water Quality - Groundwater Section ? �[
WELL CONTRACTOR (INDIVIDUAL) NAME (print) Idis,4Al . ZulA1P 5 CERTIFICATION�i1J/016
WELL CONTRACTOR COMPANY NAME#$ JZ/L&SUWU&fs�)7.eJ/Lv u,.,x PHONE 01,p1.152-51(fd
11 ASSOCIATEED WQ PERMITS/
(if applicable)
I WELL USE (Check Applicable Box): Residential fd" Municipal/Public ❑ Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION:
Nearest Town: Ci•'r-:r(
Card r _JZ
County1;445-i&t4 e.
(Street Name, Numbers, Community,, ^Subdivision, Lot No., Zip Code)
3. OWNER: SOtiNJ tera ho4uC0S.g. I-1ousituG
Address .a % 3 Qs istar7/e /fete r
�// (Street or Route No.)
!7ienderSoNfti7/e. 2&79/
City or Town State Zip Code
(La- (e27-afl3
Area code- Phone number
4. DATE DRILLED /2 - Zz - 0'4
5. TOTAL DEPTH: 2ar
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO
7. STATIC WATER LEVEL Below Top of Casing: 4/0 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS / FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordance with I5A NCAC 2C .0118.� -R "J
9. YIELD (gpm): /) METHOD OF TEST1� le
10. WATER ZONES (depth): /a'
11. DISINFECTION: Type ('/o.-s"#L Amount Q J 53
i2. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
From O To //0 Ft. 4✓er .!szt?/ /'tiC
Ft.
Ft.
From To
From To
13. GROUT: Depth Material Method
From D To a.O Ft. CONCeeJe. ?nu ¢t v5
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
@Midge ❑Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
05fL`.J7.r,SY'
(degrees/minutes/seconds)
Latitude/longitude source:lEMPS❑Topographic map
(check box)
DEPTH DRILLING LOG
F_rRm To Formation Description
/as- - NO S /Sfi>ri
//O - 2'r „ •le
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common road names.
&-a-/ C..re_et / 7,eua/i
1v
T sAisyivaN�aCo""`rE`I c.
16. REMARKS:
1 DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH I5A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THEpWELL OWNER
SIGNATURE OF PERSON CONSTRUCTING THE WELL ! DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-1 REV. 07/2001

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment a ural Resources - Division�/of Water Quality - Groundwater Section ? �[
WELL CONTRACTOR (INDIVIDUAL) NAME (print) ieri%/1J! lc, itllivAS/� CERTIFICAT�ION Jh.1/440
CTOR COMPANY
STATE WELLRCONSTRUCTION PERMIT#
a� ti/a //'1Dz//L,up, 4LCr PHONE WYNIa B' $q/4
WELL (if applicable) ASSOCIATED WQ PERMIT#
(if applicable)
1. WELL USE (Check Applicable Box): Residential 0 MunicipaUPublic 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION:
Ne rest T9ow'n: 'e
kt,
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER:�,.�,.,,-..r....' e
Address
County TY...a y/✓:v,f
I1G.o: i/ /i y
(Street or Route No.) 7
grin-south'//r Aft Q 879/
City or Town State Zip Code
EaN)- OR 7- Q RR_3
Area code- Phone number
4. DATE DRILLED /2-/7 -ey
5. TOTAL DEPTH: /rr
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO
12r-
7. STATIC WATER LEVEL Below Top of Casing: Q5 FT.
3. TOP OF CASING IS / (Use "+" if Above Top of Casing)
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): /f' METHOD OF TEST
10. WATER ZONES (depth): 9s"
11. DISINFECTION: Type ( k rAA-
I2. CASING:
r Depth
From_ To %,Y
From To
From To
13. GROUT: Depth
From D To AO Ft. CoNC26#e.-
From To Ft.
14. SCREEN: Depth Diameter Slot Size
From To Ft. in. in.
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Size
From To - Ft.
From To Ft.
Amount le 1 Nhk
Wall Thickness
Diameter or Weight/Ft. Material
Ft. &IL' SJzz/ A'c-
Ft.
Material Method
?nu 2/N J
Material
16. REMARKS:
Ft.
Material
309221
Topographic/Land setting
❑Ridge dope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
NIV"/r.767' wnrz- Sr, VI/'
(degrees/minutey,�ateeconds)
Latitude/longitude source: rGPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From To Formation Description
v7J .
n - 76- Ski/
di
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.
(ve .PcL
rtva�t% /VG
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH ISA NCAC 2C, WELL '.
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
21-€4-, 2 2/a
SIGNATURE OF PERSON CONSTRUCTING THE WELL
/2- otI
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

y., = 1. I• c /
Ttl.�:�/^,.Q� _c:1L.:ac ��
1 i�.i1E ij:Vl
- 0T.� Liti•P :
LjGES 4 EL L. Nit FLACE EXISTING WELL? YES 0 fi:)
r-.TIC41 LEVEL Ficlo\vTop ofCa a3i_ 1�—
IU1'G1 C-SINGIS W. ..b Loc'nd Sr .,
1,p;1,_:,u 1_rtnma r FT -T'" ra Yc Land S urlStc
.. 'a aV5: Gcl 1 land _hi r ri ci r.•l ulrcai
��al WWI U.i :VI'" ?C .W 15.
1''�L,I 1 1 i 1.
—__SIE T HOD OF TEST r I — ,A.'TLl1 V1v=-,LCpLflb ____ _ -_.h______• �9
DISJNFeClClis T)pe c, LOCATION! CH
TDpogn Lc/Land seaing
L1Ridgc SI po IDVsllcy ❑FLr1
(chuck .Ippl'ap nmc hos)
LaliNdc/Iongi nlde of well location
tocgrcc;rninurcl 10.211-2
mngz) 33/ f
ie
Leurude longin,dc sour PS OTopograpllit nth p
Lchcol: uosi
DFp fFl
FromDRILLINGC
To Formation Description
S ti
:1
. J., ill2LuT
DiSIDcrer
Ia�Fi.-lftj.—
_ m:r
Fr
FL._
B�111
3rcnal
fl'IcnlOil
..h:; 1v I.irecnon and distance in miles full ar 'cast:
1Y lll Til lumse tan
Sfne Roads or County Roads. Include the coal
or\`.. h,:Ft. Prrarn:d uurnLecs and common rod names.
::r,),cL_ I o12L, Fl. ra&,—
SC EN
^ro,i1
rpn,
Po vn_1,t%
Jioincicr Slat 'S i2c _.---
Ft .r151
of in.
Ft In u1.
Fr
Ft
\-1]tnna1
se_#ct mikev.`�L, LAacv h
#4M de,soNCewi
!.; REM R.I::S.
O riERBE CERTIFY 'THAT THIS WELL 4 ,*S CONS RLicari
C �1tSTlL,CT1..,vsl-.ND.�1DS THATa.NDfM?.CCO"'
A COPY' OF THIS RL Y; SEEN P WITH PR15AOVIDED
N TJI WELL
\
�i.I D Fl.a,S' !SEEN FR04/1DED TO THE 1M1ELLLOWNER.
VN
.: .� 'ri' ❑ J1 al Pk II 1 -:lcr 101.�:,., , "L� P CPyb ie L3 In4U9n'Iu1 L�
COIC) 0 II Olhcr Li>r Us .=,gncl,lnu al q
1e
...:.: .ti•:..:.:I::Ii::ll: L.
.C4 Zip
-L`fQ
na
yC1)NSTR.LICr1ON RreOiRD
1,1,„, , in -•um. 1and N:':1,,1 II F-l:,ivi% 1 s1'1Varcr
, CL 1 .:1 t L11.10u 1 Y. \LiiC tin `./' /'y4y1211:•r`1. r�+/y1l 1-1:5• Quality
l " 11r-.:1 1..11 L'fers o�r _ /1 /✓V l 01 1/
'£ •4LLel1. •��'Llr iY�.�_
e1LL: 1 VQiEi.Ah119-„
309274
010011alY4Ldr SGClio11
CLl ivi C.TION r+2oa0
RE 0 [(SON oivsrruCTINQTrlE were 2 0
StiJ ua rn; ocl uw ru the Dr Lion of \yarn• l D,1^g
'7"7 o G uri;; ,1 t it Lualily Gruundlrarce Sccrion, Iv3u
73a 3:21, rri[Ilin 30 da)'g, &l ail Snrvicr atGict
pyle,gq, NC i

R'L I CON c3 JCI-11)N4 R.1“Th0112.)
1 p. qa 6 y 0 CE.0.1'1F40.i.TION
I've) eEfentri
_PHONe
De_711 '
Atiallanni
•
. L .ree lociiNn-Ul 0 gricuin,r4i
90 0 Ne:41 Pulitp
—
N, . .. oc.s,
<1‘. ere
7e.1-7
sk.,‘
D;:ur
i-)RP ki
ELL REPLACE EXISTING • WELL? YES 0 NO
SI'sTIC ‘ri 4..ITI1 LEVEL Bc IOW l'Op Of C2::iteib):0f
.S 13e CI, CRSINC IS 1______ FT .4 bolt .14.1.ria
I'
lop
i ddia.Idd Li. 4.:Lidr4411.i.:11..111 iddi..NC,C-.20- in id
9 'I IELD ,,r71,1,1 ______Lt szonIETI-109 OF TES 11442_•1<trin
i 0 o s r ER
. ! ORSENFEC.O.Cni r p — LOCATION SKETC'H
:1 CASING
W411 l'hielim“s
nii,„thil _Ilia_ Show difee110114tid Jislance in lin Rs 401114f le..asr
icciln two Sute Roads or County Roads. Inelude ilk roail
firiornici or wz,siiii:Fr. N.i.",-,.,,j nianbc-N anil common ro:id misne.S.
i':]_ .
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DRILLING' LOC1
131•Orno Fon-nacionDscription
S CIN.A • !RE OlFEfLjpj CONSTRUCTING THE WELL
i“.Qtan: Lac.' ori ro cri,L• a( GrounthirSccrion,
ia:1611c (91:q) 73J-37.:1, wicli in u a3ys.
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To Ff.
I3 iZ.EJN,L.A.RKS
1 Di her:El-1Y cERrtryTHATTHIS WELL 4VAS CONSTRUCTED IN ACCORDANCE WITH I 5A NCAC 2C, WELL '
CONSTRUCTION STANDARDS', AND THAT A Copy OF THIS IMECORA) HAS BEEN PROVIDED TO THE WELL OWNER
• :._
1636 /Wail SGfYi4 kaltig147;N:i2
CJ \\19 REV. 074200

6. DOES WELL REPLACE EXISTING WELL? YES 0 NO
7. STATIC WATER LEVEL Below Top of Casing: d ¥ 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 accordance with ISA NCAC 2C .0118.
9. YIELD (gpm): 2 METHOD OF TEST a/ /'
10. WATER ZONES (depth): id" "
I1. DISINFECTION: Type
12. CASING:
Depth Diameter
From C To `SO FL C:,/ i7
From To Ft.
From To Ft.
13. GROUT: Depth Material
From e'l To.J.a' _ Ft. _ atriin,",t
From To Ft.
14. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in.
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Size Material
Amount
Wall Thickness
or WWeight/Ft. Material
/ ti�G
Method
From To Ft.
From To Ft.
16. REMARKS;
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) Cleft y9 5 f l%ff/t< CERTIFICATION #2C'l /
PHONE # Neil 'Y'7 -4'4/o'C
WELL CONTRACTOR COMPANY NAME/'eft/ // e//t' Pump
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential Id" Municipal/Public 0 Industrial 0 Agricultural ❑
Monitoring ❑ Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION: Nearest Town: ge -5:nj.Xn County net 11
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: Sin �f
Address <//i 64/ et, f I 4' L
(Street or Route o)
(Andexue of j,29;ZO
City or Town State Zip Code
( )-
Topographic/Land setting
DRidge ❑Slope DValley ❑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
Area code- Phone number Ci -
4. DATE DRILLED /2' 0 '-C"7/y
5. TOTAL DEPTH: % 6e I3/ "5 p1
,,r r
ac;
C
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common road names.
/ycf 4 O/d) cx.va-y - 4
% a, m-J 274- L PelIca i wr/ ,
1/2
%' end c -
I "DO HEREBY. CERTIFY WHAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANI3ARIDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
Submit the original to the Division of' Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-1 REV. 07/200 i �:;(

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (prinij& /E/i/, St°i,nte//d CERTIFICATION #.2-59/
WELL CONTRACTOR COMPANY NAME / le,",-,.//ire//P/4-t.Myd PHONE # f $t} "t 7"7 44 t-
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
WELL USE (Check Applicable Box): Residential le Mu ticipal/Public 0 Industrial 0 Agricultural ❑
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATIQI4:
Nearest��.st1Town: <91).fr rcr./ County /ta •
.V5
aocrr 11"7 Per
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: t/C1CA `j<n
Address /Ov tatted civica��i�n(Sii et or Route o.) join_
14<n Jo-
City or Town State
('al- - f .t7
Zip Code
Area code- Phone number
4. DATE DRILLED //' a -C'y
5. TOTAL DEPTH: 9-r/<7�
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO
7. STATIC WATER LEVEL Below Top of Casing: cC FT.
(Use"+" if Above Top of Casing)
8. TOP OF CASING IS , FT. Above Land Surface*
*Top of casing terminated atlor below land surface requires a
variance in accordance with 15A NCAC 2C .0118.
9. YIELD (gpm): ? METHOD OF TEST//
10. WATER ZONES (depth): _ / to'
11. DISINFECTION: Type
12. CASING:
Depth Diameter
From 0 To -7 4 Ft.
From To Ft.
From To Ft.
13. GROUT: Depth Material
From el. To C7 c:% Ft.
From To Ft.
Amount
Wall Thickness
or Weight/Ft. Material
97/
14. SCREEN: Depth Diameter
From To Ft. in.
From To Ft. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
Topographic/Land setting
❑Ridge ❑Slope ❑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
jrr — 47,5 r..-./,4>
Z �?
LOCATION SKETCH ut
Show direction and distance in miles from at least'=
two State Roads or County Roads. Include the road+
numbers and common road names.
ca t/1G !'1//' �L ,r f/ 4goaa7 ,44//Ois
Method
Slot Size Material
in.
in.
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 REC RD HAS BEEN PROVIDED TO THE WELL OWNER
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC.'
27699-1636 Phone No. [phone], within 30 days. GW-I REV. 07/2001

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources-,tDivision of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print)& /r/9n 5 en / toNf CERTIFICATION Cie; /t,
WELL CONTRACTOR COMPANY NAME/P-J rs`// L'+'�f// '/Lfrn>7 PHONE # ai4- S' 77' 9"/.5!'
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential Et Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use r'
2. WELL LOCATIQN:
Nearest Town:b re Vie ` cd
County/1;70.w 3
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER:2 //0 is in
Address / tG,t z. 5 Y�
fi�7 (Street orr Route No.)
re t—t' 4.251 4
City or Town State
( !/jgty ei 55 C/ L /
Area code- Phone number
4. DATE DRILLED/2 - /h -Ozi
5. TOTAL DEPTH: 7 der✓
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO V!'
7. STATIC WATER LEVEL Below Top of Casing: ' 2 FT.
(Use"+" if Above Top of Casing)
8. TOP OF CASING IS 1 .'7 FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordance with ISA NCAC 2C .0118.
9. YIELD (gpm): /�7 METHOD OF TEST
10. WATER ZONES (depth): 12-C L7
Zip Code
11. DISINFECTION: Type Amount
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
From Q To' / Ft.
From To Ft. �L
From To Ft. enCie va/L it 9hrc,.-s-. ,73t u. L CZ-,
13. GROUT: Depth Material Method ff /
From 0 To-10 Ft. /C7 Ga%p-d -3u— Zyja
From To Ft.
14. SCREEN:
Topographic/Land setting 0
❑Ridge 0Slope ❑Valley ❑Flga
(check appropriate box) L%
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From To Formation Description
(J •-
�d a -,7‘./7
LOCATION SKETCH
Depth Diameter
From To Ft. in.
From To Ft. in.
15. SAND/GRAVEL PACK:
Depth Size
From To Ft.
From To Ft.
16. REMARKS:
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common road names.
6 /fn7 Ce7r/i/re/fy ean,17 P/1
Slot Size Material
in.
in.
Material
/ems r
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN AC 9I D,ANErE WITH ISA NCAC 7c WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RECORD- Pf3 BEEN-P4OVIDE TOITHE WELL OWNER
SIGNATURE OF PERSON CONSTRUCTING THE WELL - ", r'r DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center -Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-1 REV..07/2001

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) 6 /rir /) Sr>n true CERTIFICATION', GG'//
WELL CONTRACTOR COMPANY NAME/ICft'/1 /4/i// /- n/.7 PHONE it 673 -7 7/
STATE WELL CONSTRUCTION PERMIT', ASSOCIATED WQ PERMIT', (if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential El/Municipal/Public 0 Industrial 0 Agricultural 0 L ,
Monitoring ❑ Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
7.4
2. WELL LOCATION:��+
Nearest Town: A:, indm n
County Gip /f'S
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER f cif/ /G:rtr,r/y
Address /-14 get 15rc/ G./{r
(Street or Route No.)
4446- ,E' Jw crr_ y .1"-
City or Town State
("'S- Cie/._ j� A/Cc'
Zip Code
Area code- Phone number
4. DATE DRILLED / ,2 _ z 'y c3'
5. TOTAL DEPTH: 'a Y c"
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO I
7. STATIC WATER LEVEL Below Top of Casing: 'j o FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS f /7 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): / el METHOD OF TEST Ce-i' /-
10. WATER ZONES (depth): _Lee;/
11. DISINFECTION: Type Amount
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
From C1 Tolio Ft. C.;1 h —
From To Ft.
From To Ft.
13. GROUT: Depth Material
FromC1 To Lie:" Ft. e-t -/m,y
From To Ft.
14. SCREEN: Depth Diameter
From To Ft. in.
From To Ft. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
Method
pet
Slot Size
in.
in.
Material
16. REMARKS:
Topographic/Land setting o
❑Ridge ❑Slope ❑Valley ❑FIB
(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
L7 . t�
/Ltz et-) i. r
/ /4r ._
h
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` 1`Qs r Shcr& /k
I DO HEREBY CERTIFYTHAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL 0
SIGNATURE OF 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.r(919) 733-3221, within 30 days. GW-1 REV. 07/2001

4
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment Natural atural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME((print)htr Cffj9 f ti/Le�/7/e CERTIFICATION#.2Elf01
/t
WELL CONTRACTOR COMPANY NAME l err" /1 L1/,0J/ r/i �sv,7 PHONE # P3r,1)' ',3Ti" 119 i)
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential 6LI Municipal/Public ❑ Industrial ❑ Agricultural 0
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use
2. WELL LOCATION:
Nearest Town:fie S inch; County �i iz, l'S
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: L /'l` ��.iT�'S
Address /1/7 /
(Street or Rpute No.)
/Jrr t14 J Fi' °y 2 71C
City or Town State Zip Code
(V+ 7n
Area code- Phone number
4. DATE DRILLED /)- -1 --erg/
5. TOTAL DEPTH: !'G'
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO
Topographic/Land setting
❑Ridge ❑Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From To Formation Description
Gr
e,/5 h S<f�olrinr:/1
7. STATIC WATER LEVEL Below Top of Casing: / el FT. in
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS '2 FT. Above Land Surface'
*Top of casing terminated at/or below land surface requires a
variance In accordance with ISA NCAC 2C .0118.
9. YIELD (gpm): 6C METHOD OF TEST
10. WATER ZONES (depth): ll'
11. DISINFECTION: Type Amount
12. CASING: Wall Thickness
or Weight/Ft. Material
Depth
From G7 To
From To
From To
Diameter
Ft. 6,5 )6r
Ft.
Ft.
13. GROUT: Depth Material Method
From et To v''G' Ft. caenrCh;`X p6'Idr'
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
To Ft.
To Ft.
From
From
Material
C
t-)
LOCATION SKETCH qq
Show direction and distance in miles from aUttast
two State Roads or County Roads. Include the road --;i
numbers and common road names.
16. REMARKS:
IDO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RE QRD HAS BEEN PROVIDED TO THE WELL OWNER '.
2 c7 3 7
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. 07/7001

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Divisionsof Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) 6/P/70 4PJjjB//C- CERTIFICATION ti 0',f
WELL CONTRACTOR COMPANY NAME e/'/t/ // LZ >I' // f /'rh>ri.rJ PHONE # ('r
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential Er—Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other ❑ If Other, List Use
2. WELL LOCATI
Nearest Town: /#/BYr1r4' County Tarn:,
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
Topographic/Land setting
[Ridge ❑Slope ❑Valley 0Flat
(check appropriate box)
Latitude/longitude of well location
3. OWNER: le.0 7. riles S P/- (degrees/minutes/seconds)
Address Latitude/longitude source:❑GPS❑Topographic map
(Street or Route No.) (check box)
DEPTH DRILLING LOG
City or Town State Zip Code From To Formation Description
(—)-
Area code- Phone number
4. DATE DRILLED / 2 ' /E>-O L/
5. TOTAL DEPTH: 2. 5 6' /6'4' tC 431./ //
CI— Olt 7-
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO
7. STATIC WATER LEVEL Below Top of Casing: lie FT. g -i1 `fl'
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance In accordance with ISA NCAC 2C .0118.
9. YIELD (gpm): /C M T OD OF TEST-w
10. WATER ZONES (depth): /&' ft.c
11. DISINFECTION: Type Amount
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
From d To 5C Ft. Cr . 2:5- ,; -/ ??-
From To Ft.
From To Ft.
13. GROUT: Depth Material Method
From CC To Dept.,
el Ft. 2-atz-In ;f /7e'ur-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.
O
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common road names.
16. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER,
-/v-- 5
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-1 REV.07/2001

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) ai//eon pe /Ci?ate CERTIFICATION 82
/
WELL CONTRACTOR COMPANYNAME/ BPI/ /IGi'e// / A,»j PHONE 8 In t77' YYj d
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential 43 Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION:
Nearest Town: fees ,an
County 72a4
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: Dar,i L 7Eea.*,
Address f4fl / j »' J�J�DPi'v e_
�yy� (Street or Route No.)
"//fir gig i %' L
11 la,
City or Town State Zip Code
(wit(- Eli• -Oa 99-
Area code- Phone number
4. DATE DRILLED /0 -.2 Y-et y
5. TOTAL DEPTH: 1 h C
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO
7. STATIC WATER LEVEL Below Top of Casing: FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS FT. Above Land Surface'
`Top of casing terminated at/or below land surface requires a
variance In accordance with ISA NCAC 2C .0118.
9. YIELD (gpm): rat METHOD OF TEST al /^
10. WATER ZONES (depth): '19d
11. DISINFECTION: Type Amount
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
From 0 Tol6 Ft.l±✓' r2-/ /gl/G
From_a_To, 7 Ft. ,r ,In- 57"
From To Ft.
13. GROUT: Depth Material Method
From b To etker Ft.
From To Ft.
14. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in.
From To Ft. in in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
Topographic/Land setting
❑Ridge ❑Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From To Formation Description
n
cJ7
LOCATION SKETCH
Show direction and distance in miles from at (east
two State Roads or County Roads. Include the road
numbers and common road names.
Cy_ ? t/ -41-tom+-
f// S er "oh . 702;44'
Q%Zl3oy
16. REMARKS:
1Db HEREBY -CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED�(TO THE WELL OWNER.:
.4 /YY...j/ter.Gvl/�"
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE .,
' Submit.the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center -Raleigh NC:
27699hb36-PhoneNa.(91.9)733-3221,within 30days. GW-1 REV. 07/2001

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Natural Resources - Division of Water Quality Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) Glt/aa �$pteCERTIFICATION#.02L%/1/
e1
WELL CONTRACTOR COMPANY NAME,M %r%'i'// ire", AZ", PHONE # (Sj S r/ "/f s/ 0
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential Ira' Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery O Heat Pump Water Injection ❑ Other 0 If Other, List Use
2. WELL LOCATION: /
Nearest Town:1), e ret Countyils.15
j44,-sit of Cr,n,,E J
(Street Name, Numbers, Cod;munity, Subdivision, Lot No., Zip Code)
3. OWNER:�i/Jh ;.I,/as
Address /Q /Gcdlr/ ts4 t C
(Street or Route No.)
a -ILJA-P g /7 C a-87/2_
City or Town State Zip Code
74 s
Area code- Phone number
4. DATE DRILLED j j 7"C4r
5. TOTAL DEPTH: / get
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO
7. STATIC WATER LEVEL Below Top of Casing: 9 (1 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS / ,lj~ FT Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance In aecorduce with ISA NCAC 2C .0118. x
9. YIELD (gpm): i 1! METHOD OF TESTCZ-/ I''
10. WATER ZONES (depth): � d
l 1. DISINFECTION: Type Amount
12. CASING: Wall Thickness
Depa Diameter
From C1 To.:70_ Ft.64'
From To Ft.
From To Ft.
Topographic/Land setting
DRidge OSlope OValley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:OGPSOTopographic map
(check box)
DEPTH DRILLING LOG
From To Formation Description
Ca "�3 'v7-
c-
O
r7
01
LOCATION SKETCH
Show direction and distance in miles from at (east`''
two State Roads or County Roads. Include the road
or '
Weight/Ft. aterial numbers and cpmmon road names.
.2a ' j2 77�—
Kit.1,( T
13. GROUT: Depth Material
From cl ToP, Ft.5 00409,
From To Ft
Method
14. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in.
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
I6:" RXMARKS:.
7 DOHEREBYCERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH ISA NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS REC9RD VAS BEEN PROVIDED TO THE WELL OWNER
SIG
ATURE 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) } S (' kW,"Seer/ e//e CERTIFICATION #.Ta"/./
WELL CONTRACTOR COMPANY NAME/"" J r'/7Ji77 /140// f /11-n .7 PHONE # 18;;;/3- /« j
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential L=-t' Municipal/Public ❑ Industrial ❑ Agricultural ❑
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use
2. WELL LOCATIONj: /
Nearest Town: %G1e$5/.,"vie County />izi+z5
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: 1 t i/te/• eij Y et
Address PO 43 �y6{/
(Street or Route No.)
City or Town State Zip Code
Area code- Phone number
4. DATE DRILLED I t., f C9 Y
5. TOTAL DEPTH: 70,9
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO
7. STATIC WATER LEVEL Below Top of Casing: tieve FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS " FT Above Land Surface*
`Top of casing terminated at/or below land surface requires a
variance In accordance,Lv'uh ISA NCAC 2C .0118.
9. YIELD (gpm): h METHOD OF TESTO/
10. WATER ZONES (depth): 5 c'eV
11. DISINFECTION: Type
12. CASING:
Depth Diameter
From C To �e" Ft. c,%9
From To Ft.
From To Ft.
13. GROUT: Depth Material
From CV To 77 Ft. -leziokinz i.0
From To Ft.
14. SCREEN: Depth Diameter
From To Ft. in.
From To Ft. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
Amount
Wall Thickness
or et ht/Ft. Material
Method
Slot Size Material
in.
in.
16. REMARKS:
Topographic/Land setting
❑Ridge ❑Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From To Formation Description
0 4i `e/
/P e'
7e/4
ez7/'r�
e 7/
'tan re -
LOCATION LOCATION SKETCH C l
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common road names.
6 9 t-ve y y Lao r' Terms,
rz51 1 DQMHEREBY CERTIFY AT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
4-`EOl`i` 5TR'UCTION,STAND$RDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
rI 447
Vvi,. : , SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
Submit the original tijhe Division of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, likc2
$76991-4636,Phg»eNo),y919) 73 -3221, within 30 days. GW-1 REV. 0740031
rlo"'E\illr iN vr,:Al t,-i,..E J j�

6 4,
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and
�Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME�(print)S7/e/J/y 9p�y/mil/e CERTIFICATION #.2U//
WELL CONTRACTOR COMPANY NAME/ • E'/n .07/ %/�'p'`y- J *s12- PHONE # f fir 3r 7J — Zy
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable)
(if applicable)
1. WELL USE (Check Applicable Box): Residential Br Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other ❑ If Other, List Use
2. WELL LOCATION1: �-
Nearest Town: efy�C! n County,ztH'S
2 7, // nefie Oo a Ca.ir9`eil� P w
(Street Name, Numbers, C mmunity, ubdivision, Lot No., Zip Code)
3. OWNER: /%nets J nit Aord-
Address p�7'� t fl4d (Fir
�(Street or thine Nol
tAiibwtw_t n c 28 1/3
City or Town State Zip Code
( i moor7s'3 yc, 4e
Area code- Phone number
4. DATE DRILLED /1 / "O c/
5. TOTAL DEPTH: 11C
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO
7. STATIC WATER LEVEL Below Top of Casing: 9O 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): Led METHOD OF TESTa,i"
10. WATER ZONES (depth): SZ f
11. DISINFECTION: Type Amount
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
From 0 To .7/' Ft. C , 7- / 171,-�
To Ft.
To Ft.
Depth Material Method
To 2 o' _ Ft._ na »a, ct. fpis-r
From To Ft.
14. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in.
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth
From To Ft.
From To Ft.
From
From
13. GROUT:
From e?
Size Material
16. REMARKS:
Topographic/Land setting
DRidge ❑Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From To Formation Description
�v-6;
6A —11e
gnr�
e,/an Tt.
n
LOCATION SKETCH
Show direction and distance in miles from.* least,,
two State Roads or County Roads. Include the roan
numbers and common road names
fla c La-97 Crop �-
�j�.- _ / j S,Li--a/r top17
t f 2nca7h
fa7'' togo/, �i . /
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 AS B N PROVIDED TO THE WELL OWNER
, n,
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-1 REV,'07/2001

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) C/F/J» cedete//e CERTIFICATION # •Zd %/
WELL CONTRACTOR COMPANY NAME, LYtj,' 1 f 12.7 , // i` %e1 z7 PHONE # 07-4- �j7j fy y . �y
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PEILMIT#
(if applicable)
(if applicable)
1. WELL USE (Check Applicable Box): Residential If7 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: s4"ts z. 4'
her tis e ton,
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER:. of %3nj,d7,,-„•
County 7eidtnt
Address 7 Al Syr+; P_
(Street or Route No.)
City or Town State
y
2-
(Sr'y)- 1` S3 - '1 2 ' j
Area code- Phone number
Zip Code
4. DATE DRILLED /C/- 2d -cry
5. TOTAL DEPTH: CtyC/
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO
7. STATIC WATER LEVEL Below Top of Casing: `Tees/ FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS /'o FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordance with ISA NCAC 2C .0118.
9. YIELD (gpm): 1 METHOD OF TEST z t
10. WATER ZONES (depth):
Topographic/Land setting
❑Ridge ❑Slope ❑Valley [Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From To Formation Description
© -'%/47
11. DISINFECTION: Type
12. CASING:
From a
From
From
13. GROUT:
From
Depth Diameter
To 9/9 Ft. 6
To Ft.
To Ft.
Depth Material
To :?lr Ft. 9r,.a,4n ' A
From To Ft.
14. SCREEN: Depth Diameter Slot Size
From To Ft. in. in
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
Amount
Wall Thickness
or Weight/Ft. Material
Method
/0/7Ys-r c_
1G. REMARKS:._.
Material
ram
S7
r!1
C
O
LOCATION SKETCH CTI
Show direction and distance in miles from at least*
two State Roads or County Roads. Include the road
numbers and common road names.
/e��I�rfll c"ia562110,E
1.-ar77
t DO- HEREBY -CERTIF,Y THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH l5A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER-.
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC.
29699-4636- Phone .No.i(219) 733-3221, within 30 days. GW-1 REV. 07/2061

9 t
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME
� (print) G/ lr'/f ✓/ 6JA tea? //
WELL CONTRACTOR COMPANY NAME) �e/4 (/ 24'? // fr Rios
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable) / (if applicable)
1. WELL USE (Check Applicable Box): Residential 113' Municipal/Public ❑ Industrial ❑ Agricultural ❑
Monitoring ❑ Recovery ❑ Heat Pump Water Injection O Other ❑ If Other, List Uset�
2. WELL LOCATIAN /
Nearest Town: firebararc
County (fa4 5
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: LOAh /-9ari A5
Address / Pos,> fivr'r C,rc/e
(Street or Route No.)
P.5ga4 / teltAZ6 2'. 7it-
City or Town State Zip Code
tiff 1,-CfC0
Area code- Phone number
4. DATE DRILLED /L' .. dj'- 0 fr
5. TOTAL DEPTH: 'co y-
6. DOES WELL REPLACE EXISTING WELL? YES O NO DV-
7. STATIC WATER LEVEL Below Top of Casing: 'i - L' FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS y— FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordance with ISA NCAC 2C .0118.
9. YIELD (gpm): L/ METHOD OF TEST rf/ i
10. WATER ZONES (depth): "i,l G''
11. DISINFECTION: Type Amount
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
From t'A To Al 4 FLU i ..1--/ e6-�
From To Ft.
From To Ft.
Depth Material Method
To di c/ _ Ft. 5,nda, e 176 ty ('
From To Ft.
14. SCREEN: Depth Diameter Material
From To Ft. in.
From To Ft. in.
15. SAND/GRAVEL PACK:
Depth Size
From To Ft.
From To Ft.
13. GROUT:
From Y/
16. REMARKS:
Slot Size
in
in.
Material
CERTIFICATION # .2 Ui
PHONE # (51.1 `D?7— Jx 1, G^i
Topographic/Land setting Ca
❑Ridge ❑Slope ❑Valley ❑FIB '4
(check appropriate box)
Latitude/longitude of well location 0
[J-t
(degrees/minutes/seconds)
Latitude/longitude source:OGPSOTopographic map
(check box)
DEPTH DRILLING LOG
From To Formation Description
-71a J,'rT
1G'di
"4-'61- -s;:-
e, //
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common road names.
& t- L yc6y L� c't fps
fiz;.. a'a bra-v a / 06i-e h so for
S Try Tin, tient-0 h "/ flier k/ /s hen.
GO /of
1 DO HEREBY CERTIFY TFTAT1'I- S WELL WAS CONSTRUCTED IN ACCORDANCE WITH I5A NCAC 2C WEL
CONSTRUCTION STANDARDS, Alf,ID THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OrWH$R
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
SRbnitt the original to the, Qlvision df Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
27699-1636 Phone No. (919) 7i3=3Tn; within 30 days. GW-I REV, 07/2,001

3 I 2
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAM,Ey(print)6 Je»A JBh feL/e- CERTIFICATION# 7////
WELL CONTRACTOR COMPANY NAME/ rerr,/// W4t//t Pm n PHONE # $fl �l'Y741d
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential E7 Municipal/Public 0 Industrial 0 Agricultural ❑
Monitoring ❑ Recovery ❑ Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATI N: Z j )
Nearest Town: nvetr1i County zi g
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER:Q,r.✓/ toe Jens,i/��
Address
d� (Street or Route No.)
// S_ fane9% fr'- 217cI
City or Town State Zip Code
( 7/- 954—cfl0 '
Topographic/Land setting
❑Ridge ❑Slope ❑Valley ❑Flat tz r
(check appropriate box) G
Latitude/longitude of well location
'1
(degrees/minutes/seconds) C.
Latitude/longitude source:❑GPS❑Topograp map ---
(check box) rde{
DEPTH DRILLING LOG
From To Formation Description
Area code- Phone number Q — qb
4. DATE DRILLED 17- AO --or
5. TOTAL DEPTH: vn 4 V le o
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO
7. STATIC WATER LEVEL Below Top of Casing: FT. lj - -s./r/D
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS 1.2"-- FT. Above Land Surface'
*Top of casing terminated at/or below land surface requires a
variance in accordance with ISA NCAC 2C .0118.
9. YIELD (gpm): 2 METHOD OF TEST tx, `'!O
10. WATER ZONES (depth): 96/0.
11. DISINFECTION: Type
12. CASING:
Depth Diameter
From (7 Tot- Ft.672'4
From To Ft.
From To Ft.
Amount
Wall Thickness
or Weight/Ft. Material
2 / Prime-
13. GROUT: Depth Material
From O To9er Ft nxt�f
From To Ft.
14. SCREEN: Depth Diameter
From To Ft. in.
Method
j%aet- r'
Slot Size Material
in.
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
16. REMARKS:
O
d
£/Or/-4/2O
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.
Et,%7 1 j/gmsoa
/174 grw on.*-/ 07
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH ISA NCAC 2C, WELL
—£ONSTRUCTIONSTANDARDS, AND
THAT A COPY OF THIS RECORD
HAS BEEN PROVIDED TO THE WELL O'RKER
(*real(
/o
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
;7699-1636Phone No. [phone], within 30 days. GW-1 REV07t2001.

9 . 'a et .L r: 1')
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources
WELL CONTRACTOR (INDIVIDUAL) NAME (print/e'/%1 Sen 11-P
WELL CONTRACTOR COMPANY NAME%/Pn// // LUP// t
- Division of Water Quality- Groundwater Section'
/(i CERTIFICATION tAez, nip
PHONE it i7S.kt 4'77 2/L/�j d
STATE WELL CONSTRUCTION PERMITS ASSOCIATED WQ PERMIT',
(if applicable) (if applicabig)
1. WELL USE (Check Applicable Box): Residential g]�Municipal/Public Industrial ❑ Agricultural 0
Monitoring ❑ Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
��i/��t>
2. WELL LOCATION: T
Nearest Town: 09mnn County /f -ln is
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER:eife €ttjrlrov f /,gy T , in k
Address,3j9s -jOf ova
45e
(Street or Route No.)
Toft$r d,d'.�/, 1� c a FOLIO
City or Town State Zip Code
Area code- Phone number
4. DATE DRILLED 9-2 9'-az/
5. TOTAL DEPTH: 4c.o
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 / A FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance In accordance with ISA NCAC 2C .0118.
9. YIELD (gpm). 2 METHOD OF TEST // it
10. WATER ZONES (depth): $"O
11. DISINFECTION: Type Amount
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
From d To C6 Ft. G..7 .,7-i P1%i
To Ft.
From
From To Ft.
13. GROUT: Depth Material Method
From O To 2e," Ft. ryi...,/i/,::f
From To Ft.
14. SCREEN' Depth Diameter Slot Size Material
From To Ft. in. in.
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
16. REMARKS:
�e) IDO I EAT
!� LDNJ
2 7 '005 I4 ,1 I SI NATURE OF PERSON CONSTRUCTING THE WELL DATE
-SUIPzgt-thetgc+.�g+oa1Jto thei Division o[ Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, hie
27699.1636Phurie$n. (9191733-3221, within 30 days. GW-1 REV. 07 of
Topographic/Land setting
[Midge ❑Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPSOTopographic map
(check box)
DEPTH DRILLING LOG
From To Fo ti Description
d-.2o
-�ifyii" C.iran.'J ci
rl r �
C "<
—
o a
LOCATION SKETCH p
Show direction and distance in miles frhfti at Ie'ijt
two State Roads or County Roads. Include the mad
numbers and common road names.
61t a t/ � f' Pst
eire tr"r3 %rote %
P�„�r n fra- -h; re_ /'sr5
z9 C/ a pp /e_
AT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
S, AND THAT A COPY OF THIS ORD HAS BEEN PROVIDED TO THE WELL 0'
�A 9 jq

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) Clio ��� e/�� CERTIFICATION #0 en/
WELL CONTRACTOR COMPANY NAME /
/ f Cr'%/'l 71' /4;;‘•/nrJJ PHONE # ryas- 577 "—g4L7
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable)
(if applicable)
1. WELL USE (Check Applicable Box): Residential Fr Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATI N: /
Nearest Town: • O4j/Yl/).,y County err vj
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
Topographic/Land setting
❑Ridge ❑Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
3. OWNER: 71- P ic e (degrees/minutes/seconds)
Address it 'S.l a?_(,L.7 Latitude/longitude source:❑GPS❑Topographic map
(Street or Route No.) �j (check box)
02 � / '' DEPTH DRILLING LOG
City or Town tate Zip Code From To Formation Description
Area code- Phone number
4. DATE DRILLED 9-% 7--0 c/
5. TOTAL DEPTH: 186--
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO
7. STATIC WATER LEVEL Below Top of Casing: lac} FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS V— 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): /O O METHOD OF TEST !L /r
10. WATER ZONES (depth): %61/2
zP le,
lam'- la
e hr r
4/r - O fi- 0 /4.1 le-
f.—
Z
LOCATION SKETCH
11. DISINFECTION: Type Amount Show direction and distance in miles frig at lean
12. CASING: Wall Thickness two State Roads or County Roads. Inclu a the r4d
Depth ,Diameter or�y7reijht/Ft. Maenal numbers and common road names. -a
From O To6E! Ft.G ? I /O / /p/t"�� y
6-i/_ /6, /x//,r A/ -
From To Ft. � /
From To Ft. �y1 '77J
13. GROUT: Depth Material Method ©O %/td/9ada G�/`�
From 47 To2& _ Ft. 5av2n. %ow--./ From To Ft. G¢ /
de Set .. 14"2(c- )9."//
14. SCREEN: Depth Diameter Slot Size Material L
From To Ft. in. in. def' ar'ciics
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
16. REMARKS:
1 I L1� III BYY E �I `THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
Rp$„AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
1, / eivi Sp r fe//e 9 ? 7�d y
= ' 1U05 ', L. SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
-Sg4,n5(t thee{iginal Lathe Division of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
t7Op-1636t$hone'Nd!C5i9) 733-3221, within 30 days. GW-1 REV. 07/2001

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources-LDivision of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) %/P/>rl qh /Pf'//t CERTIFICATION #21///
WELL CONTRACTOR COMPANY NAME Via i^/-j'// ki/f// t %1t/7 ' PHONE # JQ2/
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential Fd' Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other ❑ If Other, List Use
2. WELL LOCATION: -�
Nearest Town: 7q n2►�r County /ran 4
(Street Name, Numbers, Community, Subdivision, LotfNo., Zip Code)
3. OWNER: /Pratte/C esa//
Address a-.io / 1 toff 02,4- Ca./1 nest
sy (Street or Rout o.)
/rl Y erltirz t� � � 4 7V X
City or Town State Zip Code
(tf g;4'2 -
Area code- Phone number
4. DATE DRILLED `f i 1 " C%9
5. TOTAL DEPTH: / U 4
6. DOES WELL REPLACE EXISTING WELL? YES 0
7. STATIC WATER LEVEL Below Top of Casing: 4'!/# FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS "7— 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 tZt*'✓
10. WATER ZONES (depth): t'/�
Topographic/Land setting
❑Ridge ❑Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From To Formation Description
O -/ta >,T
NO
;I!-' . 9d !-
11. DISINFECTION: Type Amount
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Mate ial
From 0 To ?!/ Ft.�z/ s21 fi/•,,,rhhh�-in
From To Ft. �T -6 -ii's �.*-G-
From To FL �,{ : j1 _ _ // / c�z ,_, ,,�
13. GROUT: Depth Material Method /t2:&; �4^ �sS`..`../n /
From 0 To 2 4 FL` rt r r/ _ ,
From To Ft. *"cie0Gen1 N -e✓. /4i
14. SCREEN: Depth Diameter Slot Size Material /�
From To Ft. in. in. a1378'Ct'✓�o<Ct/1.Gc J-'i--`te- �/�"
From To Ft. in. in. `O�'"`L"
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
47A4/1---
"41
8
sal
J
1
ast ?
e road:':?
wt
r"s
16. REMARKS:
LOCATION SKETCH
Show direction and distance in miles from a
two State Roads or County Roads. Include t
numbers and common road names.
I DO HEREBY CCRtf ?- RbT-THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C WELL !
CQ STRUCTION ST�i.')]ARDS, AND THAT A COPY OF THIS ORD HAS BEEN PROVIDED TO THE WELI. OWNER
/I , i I I SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
--. .Submit the original t0 the Division of Water Quality, Groundwater Section, 1636 Mail Service Center- Raleigh, NC
27699-1636 Phone;Ngr-C919) 7t33-3221, within 30 days. GW-1 REV.:07/2001

S 1 r
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME
(print) G/ e/7/J p///ief e CERTIFICATION # 2 ae
WELL CONTRACTOR COMPANY NAME/ ! Pn/ // /yt// t/CL�JJ�7 PHONE # fjrftt Lt3- 77 - / G/4
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable) i (if applicable)
1. WELL USE (Check Applicable Box): Residential ® Municipal/Public 0 Industrial 0 Agricultural ❑
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATI
Nearest Town: 45ZVc /7 County //'tYniS'
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: 00P7/ COi2°/
Address 4'7.4' It'N 4'
S (Street or R }e No.) q
Groh/r•e /vim y
7
City or Town State Zip Code
sj)-
(` 7f- %2-cq
Area code- Phone number
4. DATE DRILLED 5''" / 9 `c'
5. TOTAL DEPTH: / 76'
6. DOES WELL REPLACE EXISTING WELL? YES 13NO ❑
7. STATIC WATER LEVEL Below Top of Casing: / v FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS or FT. Above Land Surface*
"Top of casing terminated at/or below land surface requires a
variance In accord ce with 15A NCAC 2C .0118.
9. YIELD (gpm): 0 METHOD OF TEST air
10. WATER ZONES (depth): /"t/ 74' ! 65-O'
11. DISINFECTION: Type
12. CASING:
From
From 7o
Topographic/Land setting
❑Ridge ❑Slope ❑Valley ❑Fla
(check appropriate box)
Latitude/longitude of well location Ca
r+.
71
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From To Formation Description
a-/O
/a 70
7a -/4'e'
Jho-/4Cr
LOCATION SKETCH
Amount Show direction and distance in miles from at least
Wall Thickness two State Roads or County Roads. Include the road
d Depth _ Diameter or Weight/Ft. teal numbers and common road names. �y
To 17 _ Ft. ts, .r.i/ 1L1, , Z aer .t 2
To r7 el Ft. 6',74 . it"`i 7r �n - / �/T ��JJ1
From To Ft. 11rt/7vald zr/ 77tid st--/'.if!?n.'t-`C�-
13. GROUT: Depth Maten 1 Method 4 tt�/
From d To `.7-� Ft. /aC t+t jl6'fi/ OL//�
From To Ft. at
14. SCREEN:
5
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. REIViARKSiF-._ .. .__
I DO HEREBY CEWTJP((',',IHAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STA}JIJt1RDS, AND THAT A COPY OF THIS RE ORD HAS BEEN PROVIDED TO THE WELL OWNER'.
U N ? - 7 /r0 9
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
_ Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center -Raleigh, NC
27699-1636 PhoneN6`.1919) 733-3221, within 30 days. GW-1 REV. 0772001

3 1-
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural esources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print)/70N f�.esm�Cir'>N CERTIFICATION # 3�i/C/
WELL CONTRACTOR COMPANY NAME "I77Fi2R
PHONE #
r z
STATE WELL CONSTRUCTION PERMIT# / ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
1
WELL USE (Check Applicable Box): Residential �Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION:
Nearest
N✓I�LL/VF IIII�
CountyTzwr/vsrivaNJ.y .
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: n>11c 4--riv a s
Address
(Street or Route No.)
City or Town State
(n»
Area code- Phone number
4. DATE DRILLED �— 3— e 4/
5. TOTAL DEPTH: C O sr6. DOES WELL REPLACE EXISTING WELL? YES ISKO ❑
7. STATIC WATER LEVEL Below Top of Casing: ,CT) 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): J5 METHOD OF TEST f v t&u/.J
10. WATER ZONES (depth): _ 3-ra — �✓ 70/%
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Inc de the road
numbers and ommon road names.
11. DISINFECTION: Type
12. CASING:
Depth
To ,$3
From
From
0
Zip Code
C H6 pN/SV�
Diameter
Ft.6 iv
To Ft.
From To Ft.
13. GROUT: Depth aterial
From so To 2V - Ft._
Amount
Wall Thickness
or
Weight/Ft. Material
Io0 WNLf S7LF_/
From To Ft.
14. SCREEN: Depth Diameter
From To Ft. in.
From To Ft. in.
15. SAND/GRAVEL PACK:
Depth Size
From To
From To
fn' I PO
n
I DOLIIERLBY C T{f i- AT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION ST4V A�tDS, AND THAT A THIS RD HAS BEEN PROVIDED TO THE WELL OWNER
'' JUN 2 7 2005 it j`; e- o _�<
i SIGNA URE OF PER N CONSTRUCTING THE WELL DATE
9I3;( the dri T aLto the Division of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
- 27694166 hene-14 494Aj 733-3221, within 30 days. GW-1 REV. 07/2001
Ft.
Ft.
Method
ynrx<�2
Slot Size Material
in.
in.
Material
V ;
Topographic/Landting
❑Ridge ❑Slope Malley ❑Flat.
(check appropriate box) 0 0
01 �s
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From To Formation Description
0 — /cu ✓ _C•2
?r, — ✓sGaw g .e1F
/S3 S7S is r/lNliY
Yi L
L vP
v
G G/7.Oc.
E

l A
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment andNatural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME
(print)6 /r>44 �j e4Jte//,o_ CERTIFICATION�TI
WELL CONTRACTOR COMPANY NAME/ J L' `j �/ ��idto// t4' PHONE # (Vp)G'[(0
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): ResidentiaMunicipal/Public ❑ Industrial 0 Agricultural ❑
Monitoring ❑ Recovery ❑ Heat Pump Water njection 0 Other 0 If Other, List Use ,t
2. WELL LOCATION:
Nearest Town:' ernan.
County 2/1.9.i 9ft.va./.n.
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: TBpC ,& tr../J) /�
Address '� ?i %)s:4.�.>A�A' N(�
City or Town State Zip Code
( )—
Area code- Phone number
4. DATE DRILLED "7- 2 7 -a Q
5. TOTAL DEPTH: / $ D /y fj / tilt
Topographic/Land setting C
❑Ridge ❑Slope ❑Valley 0
(check appropriate box) o
Latitude/longitude of well location
0
clt
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map,
(check box)
DEPTH DRILLING LOG
From To Formation Description
0-- tih
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO
7. STATIC WATER LEVEL Below Top of Casing: la FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS 9" FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance In accordance with 15A NCAC 2C .0118.
9. YIELD (gpm): Me METHOD OF TEST 4 /
10. WATER ZONES (depth):1N0 — / 70
11. DISINFECTION: Type Amount
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
From 0 To 6d Ft. et.1-6J , I4i'?f e s/
From To Ft.
From To Ft.
13. GROUT: Depth Material Method
From aTo 2� Ft.
From To Ft.
14. SCREEN: Depth Diameter
From To Ft. in.
From To Ft. in.
15. SAND/GRAVEL PACK:
Depth Size
From To Ft.
From To Ft.
16.-REMARKS:
Slot Size Material
in.
in.
Material
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common road names.
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH ISA NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RECORDEEtV PROVIDED TO THE WELL OWNER'
'li 2 7 'ri05
L, 1
% 7') 7- t✓-%
SIGNATURE OO PERSON CONSTRUCTING THE WELL DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-1 REV. 07/2001

n
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section�7
WELL CONTRACTOR (INDIVIDUAL) NAME (print) S 7 "%P/.��h/pq ����L' CERTIFICATION #id,/
WELL CONTRACTOR COMPANY NAME^ P// j/ Ati/ /// 211/4/b ?7 PHONE # VI $ 7 1/�//s;?"
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable)
(if applicable)
1. WELL USE (Check Applicable Box): Residential l Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery ❑ Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCAT�I
Nearest Town:7171'4-'24zA/ County Ti'2n�
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER:lAte tle5
Address Ard:C /*d/
Street or R6Lte No.
"City or Town State Zip Code
( )-
Area code- Phone number 4. DATE DRILLED-,-%_ —c Y
5. TOTAL DEPTH: i/o's
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO
Topographic/Land setting r✓
❑Ridge ❑Slope ❑Valley ❑F%
(check appropriate box)
Latitude/longitude of well locatioa
rrs
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map""1
(check box) ;
DEPTH DRILLING LOG
From To Formation Description
7. STATIC WATER LEVEL Below Top of Casing: FT. I90 '-'014
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS Ze2 FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accords c with I5A NCAC 2C .0118.
9. YIELD (gpm): METHOD OF TEST 421.4-v
10. WATER ZONES (depth):
11. DISINFECTION: Type
12. CASING:
Depth Diameter
From B To /7d Ft.6',2f1
From /10 To/33 Ft.AC24
From To Ft.
13. GROUT:
From 0
Amount
Wall Thickness
or'Weight/Ft. Material
%
.f84r cr
Depth Material
To7o' Ft.(0.43__
From To _ Ft.
14. SCREEN' Depth Diameter Slot Size Material
From To Ft. in. in.
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
Method
16, REMARKS:
1 DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL ];
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
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.
ienuldea 2 iso on
-4-10/
r-iir„ O4
.a.tr-o .1242 ,Ica,
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 Natu
WELL CONTRACTOR (INDIVIDUAL) NAME (print)
WELL CONTRACTOR COMPANY NAME a7.r/A:47,e27, /ezf: 12'•
STATE WELL CONSTRUCTION PERMIT#
(if applicable)
ASSOCIATED WQ PERMIT#
(if applicable)
esources - Division of Water Quality - Groundwater Section
CERTIFICATION # 7/9Y
PHONE # PO?)vre yaD
1. WELL USE (Check Applicable Box): Residential kJ Municipal/Public 0 Industrial 0 Agricultural ❑
Monitoring ❑ Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION:
Nearest Town s?.?CVAez.) County? ails i_'s_J_d!
Wa//.ayi) /?/S. 4.
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: /459. " irq sr
12
Address 115 iPt!
(Street or Route No.)
ni) FlC 2Yt►2
City or Town State Zip Code
( 5tere-
Area code- Phone number
4. DATE DRILLED '7//6 04/
5. TOTAL DEPTH:
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO �yb'
7. STATIC WATER LEVEL Below Top of Casing: !J O FT.
/ (Use "+" if Above Top of Casing)
8. TOP OF CASING IS / FT. Above Land Surface'
•Tap of casing terminated at/or below land surface requires a
variance in accordance ith I5A NCAC 2C .0118.
9. YIELD (gpm): METHOD OF TEST T.yr'ffi/Yiie4✓
10. WATER ZONES (depth): /6/) — C/O
opographic/Land setting
dge ❑Slope ❑Valley ❑Rl
(check appropriate box)
.
Latitude/longitude of well locatioa..
0
(degrees/minutes/seconds) O
Latitude/longitude source:❑GPS❑Topograpft1c ma
(check box)
DEPTH DRILLING LOG t-:.+
From To Formation Description
Y2 t 7
11. DISINFECTION: Type c.Yz. Amount
12. CASING: Wall Thickness
Depth Diameter or eight/Ft.z-�� Material
To 6 Ft. i>�
To Ft.
To Ft.
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the roadio
numbers an'- own road naes.
From e) �/r /z 4'!�% get.>
From
From
13. GROUT: Depth Moerial
From CS To_20 Ft. -1 ,��/2' Z,,. rx Att ate
From To Ft.
14. SCREEN' Depth Diameter Slot Size Material
From To Ft. in. in.
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
16. REMARKS:
Method
I D0 HEREBY CERTIFY THAT THIS WELL W
CONSTRUCTION STANDARDS, AND T
CONSTUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
COPY :' - RECORD AS BEEN PROVIDED TO THE WELL OWNER
7 /6-- 3/
DATE
✓'��
'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

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
CERTIFICATION # ;1li1%
WELL CONTRACTOR COMPANY NAME�%}a £TJ// in/7tJ e»z/y PHONE # err,- 94'J e2
STATE WELL CONSTRUCTION PERMIT# ASSOCIATEDWQ PERMIT#
(if applicable) (if applicable)
WELL CONTRACTOR (INDIVIDUAL) NAME (print) 6 ,0r7f1 JP» IMP/Ze
1. WELL USE (Check Applicable Box): Residential [-Y Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATI N:
Nearest Town: n..
County/24'n 5
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: / Ottei, dire//
Address ,n /i't• //r^r %'-e-
k_t. (Street or Route No.)
v`G 41
City or Town State Zip Code
4.
5.
6.
7.
a�17yr
Area code- Phone number
DATE DRILLED 9'-?/ - c74'
TOTAL DEPTH: ,lit
DOES WELL REPLACE EXISTING WELL? YES 0 NO
v
STATIC WATER LEVEL Below Top of Casing: /4 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS 7— 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): 21 METHOD OF TEST obi
10. WATER ZONES (depth): / '� h
11. DISINFECTION: Type
12. CASING:
Depth Diameter
From © To 4-/, Ft. /IP
From To Ft.
From To Ft.
13. GROUT: Depth
From d To`d e9
From To Ft.
14. SCREEN: Depth Diameter
From To Ft. in.
From To Ft. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
16. REMARKS:
iterttEr"ES
C01<( ,TRUC'i4ON fST
Amount
Wall Thickness
or Weight/Ft. Mate ial
. 2/ / t?"'
Material Method
Ft_Saas//p !it pdze. 1-
Slot Size
in.
in.
Material
r--
Topographic/Land setting
❑Ridge ❑Slope ❑Valley ❑Elat
(check appropriate box) 0
Latitude/longitude of well locatiQ
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic niz
(check box)
DEPTH DRILLING LOG
From To Formation Description
d �h
etert
A - 1G1 S'an e e
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common road names.
S 75`/ K: m 9/; /,er Art
�inor Pre ir+ t'ST ©ff; ea_
'%21(4i /a IVe'Se' eif Est/IT r i
THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH I5A NCAC 2C, WELL' '`.!
S, AND THAT A COPY OF THIS RECO EEN PROVIDED TO THE WELL OWNER
,—� %— - °y
JUN 2
9(1a' , 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-P)loneNoc(949) 733j-3221, within 30 days. GW-1 REV, 07/2001

qp.) 'J
a 1 !d 'i
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) (j�PJI/a D e.a tete CERTIFICATION # 2e161
WELL CONTRACTOR COMPANY NAME„I7P/// /l ltieli f )//fin 7 PHONE # (5- Y - 371- 171170
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable) / (if applicable)
1. WELL USE (Check Applicable Box): Residential �" Municipal/Public 0 Industrial 0 Agricultural ❑
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
e'a
2. WELL LOCATI /
Nearest Town: i'nn-r/><
County jro'inS
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER&en/A 'N%/s; /
Address 94(r)
treet or Route No.)
kitrwalAir °Za
City or Town State Zip Code
( )-
Area code- Phone number
4. DATE DRILLED 9- 3O " G/ ('
Topographic/Land setting_
❑Ridge ❑Slope ❑Valley [gat
(check appropriate box)
Latitude/longitude of well locatie
tos
C
(degrees/minutes/seconds) (Jt �q
Latitude/longitude source:❑GPS❑Topographic rf
(check box)
DEPTH DRILLING LOG
From To Formation Description
5. TOTAL DEPTH: 7 ci
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO t�
7. STATIC WATER LEVEL Below Top of Casing: 26' FT. / e ,j1-'�-
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS 7-- 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): "2-,5 METHOD OF TEST r? r/^
10. WATER ZONES (depth): /'yr/
11. DISINFECTION: Type Amount
12. CASING: Wall Thickness
Depth Diameter _ or Weight/Ft. Material
From Cd To,- / FL 6.1.2,$ , lWi ri t
From To Ft.
From To Ft.
13. GROUT: Depth Materi
From fi' To%'t? - Ft.
From To Ft.
Method
14. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in.
From To Ft. in. in.
I . SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
16. REMARKS:
ft'J) .126 9fiaM
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common road names.
2 7 ' GTcr/,`5 /elites A,
�gleert theft)
fir >d7 cv/) !ef*
IDO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH ISA NCAC 2C, WELL -` I
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RECORD H S BEEN PROVIDED TO THE WELL OWNER
reir
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 RE''; 07/2001

STATE WELL CONSTRUCTION PERMIT#
ASSOCIATED WQ pEILMIT#
(if applicable)
(if applicable)
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) 61e , 6-en tr°�OiG
r CERTIFICATION q fir///
WELL CONTRACTOR COMPANY NAME / y/B/J^/// y4e//7-Pztn?2 f PHONE q (Si�A'%/'VV40
1. WELL USE (Check Applicable Box): Residential PI Municipal/Public ❑ Industrial 0 Agricultural 0
Monitoring O Recovery O Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION: _
Nearest Town: %_c, o znyr,.I Count
y lram5
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER:t4 annaa
Address istee- 2.‘docare 24,
O, treet or Route No.)
%h s 3'5 6 v
City or Town State Zip Code
(V_W- `3.99. ^ '1/ 0.
Area code- Phone number
4. DATE DRILLED S`'S —ay
5. TOTAL DEPTH: 2. eiU
Topographic/Land setting
ORidge ❑Slope ❑Valley OFlat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:OGPSOTopographic map
(check box)
DEPTH DRILLING LOG
From To Formation Description
O-/0
6. DOES WELL REPLACE EXISTING WELL? YES ONO f
7. STATIC WATER / Ira
LEVEL Below Top of Casing: FT.
(Use "-Fs' if Above Top of Casing)
8. TOP OF CASING IS
FT. Above Land Surface*
`Top of casing terminated at/or below land surface requires a
variance In accordance with 15A NCAC 2C .011E.
9. YIELD (gpm): /4 METHOD OF TEST e v-
10. WATER ZONES (depth): _/ $'O
11. DISINFECTION: Type Amount
12. CASING:
Depth
From 0 To22
From To
From To
13. GROUT: Depth
From d To 2O -
From To
14. SCREEN: Depth
From To
From To
15. SAND/GRAVEL PACK:
Depth
From To
From To Ft.
16. REMARKS:
Wall Thickness
Diameter or Weight/Ft. Material
Ft. G . 2/ Pre -
Ft.
Ft.
Material
Ft.4 e_g4 z. Q
Ft.
Diameter Slot Size Material
Ft. in. in.
Ft. in. in.
Method
Size
Ft.
I DO HEREBY CERTIFY THAT TH
CONSTRUCTION STANDARDS,
Material
TRUC
LOCATION SKETCH
Show direction and distance in miles from at (east
two State Roads or County Roads. Include the road
numbers and common road names.
a21/4- C
7r
IN ACCORDANCE WITH I5A NCAC 2C, WELL
CORD HAS BEEN PROVIDED TO THE WELL 0
IGNATURE OF PERSON CONSTRUCTING THE WELL DATE
E
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center -Raleigh, NC
27699-1636 Phone No. [phone], within 30 days.
GW-1 REV. 07/2001

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and NaturalResources - Division of Water Quality - Groundwater Sectionti
WELL CONTRACTOR (INDIVIDUAL) NAME (print) C7(b'%J/st 'Sr-) fl fi CERTIFICATION #Sb I
WELL CONTRACTOR COMPANY NAME
(,"y,��(� 11__I POMP
ERT
I'IFQQ)U 'Vtt� s- TO%✓l/ GO. PHONE
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable)
(if applicable)
%_ 1. WELL USE (Check Applicable Box): Resident
Monitoring ❑ Recovery 0 Heat Pump Watei/Injection ❑ Other 0 If Other, List Use
2. WELL LOCATI N:
t‘Ii rest Town: .feLs-� County/atai
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER:
Address /jke-
Qa/ / (Street or Dote No.)
City o Town State
Area code- Phone number
4. DATE DRILLED / - 9• d
5. TOTAL DEPTH: /$"d
6. DOES WELL REPLACE EXISTING WELL?
7. STATIC WATER LEVEL Below Top of Casing: FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance In accordance with ISA NCAC 2C .0118.
9. YIELD (gpm): d METHOD OF TEST Q.62v
c110. WATER ZONES (depth): i
/
Zip Code
11. DISINFECTION: Type
12. CASING:
Depth Diameter
From 0' To 7 Ft. 6-4-
From
To Ft.
From To Ft.
Depth Material
Tr?4) Ft a-fle l{
From To Ft.
14. SCREEN: Depth Diameter
From To Ft. in.
From To Ft. in.
15. SAND/GRAVEL PACK:
Depth Size
From To Ft.
From To Ft.
13. GROUT:
From 0
Amount
Wall Thickness
or Weight/Ft. Material
P1c
16. REMARKS:
p) Method
-ro oat-0
Slot Size Material
in.
in.
Material
R) l YYic�
Municipal/Public 0 Industrial 0 Agricultural 0
Topographic/Land setting
❑Ridge ❑Slope ❑Valley ['Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From To Formation Description
YES ❑ NO 15 e 1)"d���
0
n
—1
tV
LOCATION SKETCH o
Show direction and distance in miles from at least;
two State Roads or County Roads. Include the road
numbers and common road names.
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH ISA NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-I REV. 07/2001

WELL CONTRACTOR COMPANY NAME `h ,EflnrC[ �.vi�c. f PHONE # 024 Q'77-4”y-43
STATE WELL CONSTRUCTION PERMIT# s2:r . ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
I. WELL USE (Check Applicable Box): Residential t rinicipal/Public 0 Industrial ❑ Agricultural ❑
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION:
Nearest Town: /2o si,,.si./ County rieo icy, ' r,.
i27->
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: fl .tz,s..i G e,�
Address 9 it awe. o... ,, r c e .
(Street or Route No.)
City or Town State
(R25?)- S' 9-7 - 7/9)
Area code- Phone number
4. DATE DRILLED ?/2 - ja v
5. TOTAL DEPTH: SOS'
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO CYO �o
7. STATIC WATER LEVEL Below Top of Casing: 6 0 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS / FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance In accordance ith 15A NCAC 2C .0I18.
9. YIELD (gpm): _ METHOD OF TEST �.?/,'40/.0/
10. WATER ZONES (depth): r ya — c.joo .c
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) A;?.2 o %(qM co' rn�I CERTIFICATION#3/e!r
jorpographic/Land setting
ridge DSlope ❑Valley DFlat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From To Formation Description
— Sr) 502-rz:T
ro- 6o
—Soj"
2 '"772 .
Zip Code
11. DISINFECTION: Type c #,'coin s Amount
12. CASING:
13
14. SCREEN' Depth Diameter Slot Size
From To Ft. in. in.
From To Ftin. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
G.arx..rrfl
G.e.vvsT�
O
t7
r
LOCATION SKETCH
Show direction and distance in miles from at leasi
two State Roads or County Roads. Include the road
Depth Diameter or Weight/Ft. Material numbers an .. on road rames.
From n To C o Ft. F '. , c 2/
From To Ft.
From To Ft.13
GROUT: Depth Material
From o To 2 o Ft.
From
Wall Thickness
To Ft.
yy3
16. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND TCOPY # YyS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
IGNATURE 0 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. 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
j(print)& /PQf 5en/P/`.—
WELL CONTRACTOR COMPANY NAME/ ZF/A/// iyp/7 r�28,]
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable)
(if applicable)
CERTIFICATION # 21, /
PHONE # 15J'i'9'77 '93,00 U
1. WELL USE (Check Applicable Box): Residential M1 Municipal/Public 0 Industrial 0 Agricultural ❑
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATIQN:
Nearest Town: ',rain -
C
ounty tram; 9
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER:%% n 6-0,Aare, Jr"'
Address /// % icon ,nd/L Ss'
(Street or Route No.)
Po; lL JA. the 30,2c
City or Town State Zip Code
( )-
Area code- Phone number
4. DATE DRILLED 3'AO -Ct
5. TOTAL DEPTH: Arco
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO ®--
7. STATIC WATER LEVEL Below Top of Casing: FT.
— (Use "+" if Above Top of Casing)
8. TOP OF CASING IS FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance In accords a with ISA NCAC 2C .0118.
9. YIELD (gpm): 2 METHOD OF TESTal-4-•
10. WATER ZONES (depth): y60
11. DISINFECTION: Type
12. CASING:
Depth Diameter
From 0 To 5 l Ft.64
From To Ft.
From To Ft.
13. GROUT: Depth
From O To, C
FromTo
Amount
Wall Thickness
or Weight/Ft. Material
Pf-�
Topographic/Land setting
❑Ridge ❑Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From To Formation Description
0 41er
Rio 5'EO�v
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.
6'v.�ue.04:4 ,_ 4.-„AkeA
/, yI22-0e7n
Material Method
Ft. Ook-adoettii
Ft.
14. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in.
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
16. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUmoN STANDARDS AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center- Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-1 REV. 07/2001

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Sectione0
WELL CONTRACTOR (INDIVIDUAL) NAME (print) &/tn4 C1,77c l/e
WELL CONTRACTOR COMPANY NAME/ I1O/ir,/ // Lre/% 9",4ry,,0
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMMIT#
(if applicable)
(if applicable)
7
CERTIFICATION#/7 7
PHONE # (9 f77-4/Vq
1. WELL USE (Check Applicable Box): Residential Er/Municipal/Public 0 Industrial ❑ Agricultural 0
Monitoring ❑ Recovery ❑ Heat Pump Water Injection 0 Other 0 If Other, List Use
2 WELL LOCATI N: �
Nearest Town: 7� County n/
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER:
Address
(Street or Route No.)
c6 /VC--
City or Town State
Zip Code
(Vif)- 5/67' -
Area code- Phone number
4. DATE DRILLED /';O-C4'
5. TOTAL DEPTH: 1 iQ - by-0
,opographic/Land setting
tdge ❑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
From To Ft. in
From To Ft. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO 8-
7. STATIC WATER LEVEL Below Top of Casing: FT. lh) _ 2 a/Q
(Use "h" 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): 2- 4 METHOD OF TEST
10. WATER ZONES (depth): / %0
11. DISINFECTION: Type Amount
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
From 0 To Sir Ft. 6 • 7 2 /0"-C
From To Ft.
From To Ft.
13. GROUT: Depth Material Method
From 0 To a CU Ft. is.,'r.Lshek. ,ti..r.
From To Ft.
14. SCREEN: Depth Diameter Slot Size Material
in.
in.
O
n
N
LOCATION SKETCH
Show direction and distance in miles fro,�t least
two State Roads or County Roads. Include the road
numbers and common road names.
GyYi�ie� sir / Jea-rt-
16. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED M ACCORDANCE WITH I5A NCAC 2C, WELL
CONSTRU, TION STANDARDS, AND THAT A OPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
7L4 3Lpt�.� %I/ /—/ /9 lY%
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) NAM,�tE(print)G/O) /J S tontt//e- CERTIFICATION #2 G'//
WELL CONTRACTOR COMPANY NAME / / ?if/ // ///'ef/ t/r'e,L. 7//9 PHONE # (524 77 ' �jJeClj
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential Z.—Municipal/Public 0 Industrial ❑ Agricultural 0
Monitoring 0 Recovery ❑ Heat Pump Water Injection ❑ Other 0 If Other, List Use
2. WELL LOCATION:.yNearest Town: Town: A.-erj-nz,7.1,.- County //''rer
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: tare %'G /J e—
Address ' 0 l .())e '1 (4.
(Street or Route No.)
114A)/`sL NIL
City own ?�. State
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO (
Zip Code
ors )-
Area code- Phone number
4. DATE DRILLED L/'/f O i
Topographic/Land setting
❑Ridge ❑Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From To Formation Description
//?
5. TOTAL DEPTH: 5 C S� //6 -'L;y
7. STATIC WATER LEVEL Below Top of Casing: 'JC'G7 FT.-,c/e/-- y7G2
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS J '0 FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance In accordsma with ISA NCAC 2C .0118.
9. YIELD (gpm): 9a/ METHOD OF TESTCZt
10. WATER ZONES (depth): '7(YU'1 4/70
11. DISINFECTION: Type Amount
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
From 0 To /✓"c' Ft. 66 . ) / f3/4r
From / 1U To /.ih — Ft 6 i / 5'i sr
From To Ft.
13. GROUT: Depth Material Method
From e7 To 9 Z7 Ft. ./d fie* i-
From To Ft.
14. SCREEN: Depth Diameter
From To Ft. in.
From To Ft. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
Slot Size Material
in.
in.
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and po on roa names.
7e3
16. REMARKS:
1 DO HEREBY CERTIFY THAT THIS WELL WAS
CONSTRUCTION STANDARDS, AND THAT A Ct
SIGNATURE 0
ANCE WITH ISA NCAC 2C, WELL
BEEN PROVIDED TO THE WELL OWNE
t_
Q
RSON CONSTRUCTING THE WELL DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center -Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-1 REV. 07/2001

7. STATIC WATER LEVEL Below Top of Casing: P•O FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS I r'f FT. Above Land Surface*
•Top of casing terminated at/or below land surface requires a
variance In accordance with 15A NCAC 2C .0118.
9. YIELD (gpm): 7-C3 METHOD OF TEST a'-+-
10. WATER ZONES (depth): / 7 f'
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print)61e,/ e///t"e/4d-
WELL CONTRACTOR COMPANY NAME/ le/I/ // ire,/ /' Pest-j/g
CERTIFICATION # .2 O
PHONE # (wet j 1 -/j/Vh
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
I. WELL USE (Check Applicable Box): Residential t 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: /€dniz-..-ram County//r-rry//%J
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: an 2 a%p&6z..rrtL
Address fhb (49
L (Street or Route No.)
1-6193.14 plc 22-9Y�
City or Town State Zip Code
625S.J- Huh • 41-0-
Area code- Phone number
Topographic/Land setting
❑Ridge ❑Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From To Formation Description
4. DATE DRILLED 9 --O S/
5. TOTAL DEPTH: <4'0
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO ®."--
11. DISINFECTION: Type
12. CASING:
Depth
From ® To'/U
Fromi To 97
From To
GROUT:
From Cr
Amount
Wall Thickness
Diameter or Weight/Ft. Material
-47
Ft6� ,/Ir.!" .2--or
Ft.
13. Depth Material Method
Toted _Ft.4irz..A ' ,z
From To Ft.
14. SCREEN• Depth Diameter Slot Size Material
From To Ft. in.
From To Ft. in.
in.
in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
�}4-/74
i4.0-
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common road names.
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 I
171
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-1 REV. 07/2001

From
From
From To Ft.
13. GROUT:
From d
From To
14. SCREEN: Depth
From To Ft.
From To Ft.
15. SAND/GRAVEL PACK:
nA
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME
(print)V/47/J/% Senph//�
WELL CONTRACTOR COMPANY NAME/let,- / J// U' '//
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
CERTIFICATION it
2UL/
PHONE # (7/ D r
1. WELL USE (Check Applicable Box): Residential ®' Municipal/Public ❑ Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other ❑ If Other, List Use
2. WELL LOCATION: /
Nearest Tpwn: /`�ics2ne-... County 1:-En.. 4'
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: eft CD/et
Address O!D 72frrin£gn6..�,�
(Street or Rote No.) qre /
City or Town State Zip Code
(�t9) 53'43'9-,775
Area code- Phone number
4. DATE DRILLED ?:ate'
5. TOTAL DEPTH: 30."
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO
Topographic/Land setting
❑Ridge ❑Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From To Formation Description
-30 d...rrt
7. STATIC WATER LEVEL Below Top of Casing: 70 FT. 4»? _ -,d4
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS r FT. Above Land Surface*
*Top of casing terminated actor below land surface requires a
variance in accordance with ISA NCAC 2C .0118. _
9. YIELD (gpm): %-'• METHOD OF TEST Os`✓
10. WATER ZONES (depth): _I $'D
I I. DISINFECTION: Type Amount
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
® To 1-0 Ft. 6./ flrc-
ire, To h 5` FL /ter ./` t' SJ—
Depth Material
To a&4
Ft.
Diameter
in.
in.
From
From
Depth Size
To Ft.
To Ft.
16. REMARKS:
Method
Slot Size Material
in.
in.
Material
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common road names.
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH ISA NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OAF —THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
0
crt
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) C /P//// pn%f"r��iG
WELL CONTRACTOR COMPANY NAME / le /t / // /i/j ®// rite .0y7
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable)
(if applicable)
CERTIFICATION #.2 0 / /
PHONE # (9/4 g1%— 41701.1(
1. WELL USE (Check Applicable Box): Residential IB" Municipal/Public ❑ Industrial ❑ Agricultural ❑
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use
2. WELL LOCATION:�
Nearest Town: -p`"
County /tam'i
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: ac.-/- ,r%mr✓i
Address
(Street or Route No.)
City or Town State Zip Code
(WIT- ssfs — - 4sr,
Area code- Phone number
4. DATE DRILLED "' 0 9
5. TOTAL DEPTH: 4 dh
6. DOES WELL REPLACE EXISTING WELL? YES NO
7. STATIC WATER LEVEL Below Top of Casing: /h_FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordance with 15A NCAC 2C .0118.
9. YIELD (gpm): 3 - METHOD OF TEST a-44
10. WATER ZONES (depth):
11. DISINFECTION: Type
12. CASING:
Topographic/Land setting
DRidge ❑Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:DGPSDTopographic map
(check box)
DEPTH DRILLING LOG
From To Formation Description
0 -
/O /j`r c/
Depth
From !: To /'!a Ft
From To Ft.
From To Ft.
13. GROUT: Depth Material
From 0To 76a Ft. /xrr%na
From To Ft.
14. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in.
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
Diameter
Amount
Wall Thickness
or Weight/Ft. Material
Method
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common road names.
W ,/5T /794 «
/ �-�//!/
16. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH ISA NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
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

DP°
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) G/ p„,7 $ in nvie CERTIFICATION #7C9//
WELL CONTRACTOR COMPANY NAME/47t;/t-�3I_" L L l�G�/ L < j- /ie / PHONE # f529'4/-7 7 " 1/9-,
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential LN' Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other ❑ If Other, List Use
2.. WELL LOCATION:Oy�
Nearest Town: /�r� t-cw.r County jrurr+ 5
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: SY S t uu OUv
Address (bQaYNCLi1
(Street or Route No.)
City or Town State Zip Code
( Area code- Phone number_
4. DATE DRILLED h ' 6 -0 9
5. TOTAL DEPTH: COz/J
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO
7. STATIC WATER LEVEL Below Top of Casing: 40-0 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): 10 METHOD OF TEST
10. WATER ZONES (depth): '/6O — 7 6 0
11. DISINFECTION: Type
12. CASING:
Depth Diameter
From 49 To 'pp Ft. /7d5
From To Ft.
From To Ft.
13. GROUT: Depth Material
From ( To-d Ft.
Amount
Wall Thickness
or Weight/Ft. Material
From To Ft.
14. SCREEN: Depth Diameter
From To Ft. in.
From To Ft. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
Method
Slot Size Material
in.
in.
16. REMARKS:
Topographic/Land setting
: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
-,et0-3���i
Leh —4 C'
6Go -f�"�"
G�Ktmi�:
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 `/e 9/2nted/
.2ri Ye -en/ p-is if neLd7Q
Cr,
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH I5A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
1 TAP. URE OF PERSON
SIG CONSTRUCTING THE WELL DATE
cJ y
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center- Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-1 REV. 07/2001

6. DOES WELL REPLACE EXISTING WELL? YES O NO
7. STATIC WATER LEVEL Below Top of Casing: / 70 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS j — FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordance with 15A NCAC 2C .0118.
9. YIELD (gpm): 6 METHOD OF TEST re,
10. WATER ZONES (depth): / 7'O
11. DISINFECTION: Type Amount
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. terial
From l% To ?', Ft. ff* r2/ `_
From To Ft.
From To Ft.
13. GROUT: Depth Materia} Method
From 0 To 50 Ft.,„2.t� init ,.2•7ri/z
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:
4. DATE DRILLED 12-- /3 "Cly
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and/ Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME,(print)ft e yl///7 $2aon / e</e CERTIFICATION # �l✓`�
WELL CONTRACTOR COMPANY NAMFA F/`/+7 %! 11 // t/C./l1/� PHONE # 112* c3. -LK '/4 Q
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable)
(if applicable)
1. WELL USE (Check Applicable Box): Residential Ifd' Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring O Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATIO_7td: 7_7
Nearest Town:wn: 91_ County /fC1//y
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
Topographic/Land setting
❑Ridge ❑Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
3. OWNER: / eJ/i2- /3� y_rh (degrees/minutes/seconds)
Address Latitude/longitude source:OGPSOTopographic map
(Street or Route No.) f (check box)
ZC� HID N L d 71 �� DEPTH DRILLING LOG
City or Town State Zip Code From To Formation Description
(C6$.)- ,2;26'- 3/4'J- g
Area code- Phone number Q _ / a
5. TOTAL DEPTH: '/%/i /21.J
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.
/ 75- : yiezi / red
1 DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RE♦COO HAS BEEN PROVIDED TO THE WELL OWNER
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-1 REV. 07/2001

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) 6/eli/./ dly % 6//a CERTIFICATION if 2�47
WELL CONTRACTOR COMPANY NAME 11 6 /'/./ /7 L'P F// t / isitve PHONE # (yl]/z'- ?>
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
1
WELL USE (Check Applicable Box): Residential El Municipal/Public ❑ Industrial ❑ Agricultural ❑
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use
2. WELL LOCATION:
Nearest Town: 7,9,'-t' an-/ County /fer 4'
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: Captors fiu:tan
/
Address 93 /y'ez.ce i C"c". e �el-
(Street or Route No.)
Seen ter
City or Town State Zip Code
( /7)- 77.4 f7 i
Area code- Phone number_
4. DATE DRILLED 5 ' /4 -'el =l
5. TOTAL DEPTH: f i e>
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO
7. STATIC WATER LEVEL Below Top of Casing: /'5 7/ FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS !, 4 FT Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance In accorda9gqce with ISA NCAC 2C .0118.
9. YIELD (gpm): 6' METHOD OF TEST eZZn
10. WATER ZONES (depth): 'i fr / 42
11. DISINFECTION: Type Amount
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
From EJ To 6e, Ft. et;3%�
From To Ft.
From To Ft.
GROUT:
From
13. Depth Material Method
To NZa Ft. ners,.i.ei . 7flowm -.
From To Ft.
14. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in.
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft
16. REMARKS:
Topographic/Land setting
❑Ridge ❑Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From To Formation Description
of aka dt
Er.-3 �gv
i7.rs — `/�,G, :arserne4'
''' /
99c9 6 3�
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common road nameq.
- ry
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-1 REV. 07/2001

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural//�Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) F>C.a amen/ irin lrO.T- CERTIFICATION # 3/‘.4/
WELL CONTRACTOR COMPANY NAME 9FA'RXCG 2C/FL e t O ca0+4A PHONE # Np FY7' - z/ySG
STATE WELL CONSTRUCTION PERMIT# /2 Z ASSOCIATED WQ PERMIT#
(if applicable)
(if applicable)
1. WELL USE (Check Applicable Box): Residential 4VMunicipal/Public 0 Industrial ❑ Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION:
I APi4NlIt,
Nearest Town: i2 u rM.v ell County
Aic
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code) ago__
pographic/Land setting
idge ❑Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
3. OWNER: Q r�/G
y �4 (degrees/minutes/seconds)
Address /.59 S 6dArA/449'roei".47 Latitude/longitude source:❑GPS❑Topographic map
(Street or Route No.) (check box)
atoa it e_ a% V/2- DEPTH DRILLING LOG
City or Town State Zip Code From To Formation Description
42.0- 0 - 2D sosra?
Area code- Phone number
4. DATE DRILLED S— le— 0 2 0 — .04i41—r7:49
5. TOTAL DEPTH: 16'S
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO r
7. STATIC WATER LEVEL Below Top of Casing: 20 FT. ^ ��S
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS � FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance In accordance with 15A NCAC 2C .0118.
9. YIELD (gpm): /2 METHOD OF TEST ze..67 44/
10. WATER ZONES (depth): '70 — go.<.f-
11. DISINFECTION: Type
12. CASING:
Depth
From O To 90
From To
From
To
Amount
Wall Thickness
Diameter or Weight/Ft. Material
Ft. /'%v ,y.P off/ `?r/f
Ft.
Ft.
13. GROUT: Depth Mjiterial
From ei To to Ft.,(S4ie.et/
From To Ft.
14. SCREEN:
From
From
Depth Diameter
To Ft. in.
To Ft. in.
15. SAND/GRAVEL PACK:
Depth
From To Ft.
From To Ft.
16. REMARKS:
G.e.q/r/s7�
n
n
LOCATION SKETCH N
Show direction and distance in miles from efleast=-`
two State Roads or County Roads. Include k�l road.-
numbers and common road names. v�
Method
jnZ'XI/''d/r
Slot Size Maten
in.
in.
Material
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED
CONSTRUCTION STANDARDS, AND THAT Y OF T
G/Zi EA/ .„?.0
ACCORDANCE WITH ISA NCAC 2C, WELL
HAS BEE " OVIDED TO THE WELL OWNER
S �6
SIGNATURE OF PERSON fl NSTRUCTIN 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) NAM/E(print)O hen/ P// /6 7e7/e CERTIFICATION#.2l/7/
WELL CONTRACTOR COMPANY NAME/ len.-,//JV/// f�CL/IY/J
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable) —/ (if applicable)
1. WELL USE (Check Applicable Box): Residential Fd Municipal/Public ❑ Industrial ❑ Agricultural 0 Monitoring O Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATI /
Nearestt Town: Ot P!/cZto% County bra- n5
A%''4 b\Ipoq
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER:fr m, !ti//San
Address Line- r^y4,yf%
(Street or Route No.)
Ree4Ai .�L p(2
(SA)
orTownstate Zip Code
( bra)- 123- li)(o(
Area code- Phone number
4. DATE DRILLED '—Z7- -ay
PHONE # (-' 1' %1 --y`//6#
Topographic/Land setting
❑Ridge ❑Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:OGPSOTopographic map
(check box)
DEPTH DRILLING LOG
From To Formation Description
O Rio
5. TOTAL DEPTH: /rer �lO-Co
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO "air
7. STATIC WATER LEVEL Below Top of Casing: /Or FT. Gam_ yelp
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS 1 FT. Above Land Surface`
"Top of casing terminated at/or below land surface requires a
variance In accordance with ISA NCAC 2C .0118.
9. YIELD (gpm): 2 METHOD OF TEST t-i
10. WATER ZONES (depth): `/94
11. DISINFECTION: Type Amount
12. CASING: Wall Thickness
Dept Diameter or Weight/Ft. Material
From 0 To 1.49 Ft4","trot g4
From To Ft.
From To Ft.
13. GROUT: Depth Material Method
From 0 To00 Ft./k$44,4ntiC de-P,. er>,_
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.
'y `' corn
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers ndc�road
names.PlicA-te4•40,4C
0
0
no
0
16. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WA CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSN STANDAWS, AND Tj�a.• Y OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
/17
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. i } GW-1 REV. 07/2001

Nkc
WELL CONSTRUCTION RECORD ��//
North Carolina - Department of Environment andNatural Sec
Resources - Division of Water Quality - Groundwater tion
74, WELL CONTRACTOR (INDIVIDUAL) NAME n(print)fit- nja 1- •%S L./i t-Pk./"A RTIPICATIoN# /2-2--
0.14 S' /
WELL CONTRACTOR COMPANY NAME `l'
)fit- - PHONE # «) fbT%-4"{3D
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residentiakt Municipal/Public I: Industrial 0 Agricultural ❑
Monitoring 0 Recovery 0 . Heat Pump Water nlection 0 Other ❑ If Other, List Use
2. WELL LO
Nearest Town:
County rtenz..17.----
LQISaw 1/44or,Q5
(Street Names Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER:_as.&
Address t m1o,tt_ milk). '
t Uedf7J)
(Street or Route No.)
City gr Town State Zip Code
Area code- Phone numb
4. DATE DRILLED / 4/
5. TOTAL DEPTH: D
Topographic/Land setting
❑Ridge ❑Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From To Formation Description
— 4'O
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO IC
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): 7CJ METHOD OF TEST 0.e-.
v10. WATER ZONES (depth): /Ae
11. DISINFECTION: Type 1,i.11 k Amount
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
From d To 60 Ft.6. — P
From To Ft.
From To Ft.
13. GROUT: Depth Material /� Method
From C9 MAC_ Ft.>tan( 941(Zcn
From To Ft.
14. SCREEN: Depth Diameter Slot Size Material
From To in.
From To in.
15. SAND/GRAVEL PACK:
From
From
Depth
To
To
Ft. in.
Ft. in.
Size
FL
Ft.
Material
9- 4,.,e.e7
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common road names.
16. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTIO}Q STANDARDS &ND THAT AOPYJJF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
/-%-dv
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) /—/,7 n n v / CERTIFICATION is 4,
WELL CONTRACTOR COMPANY NAME z `Zap.-�� �;...„", PHONE it fpe2 6i Rao—c.uso
STATE WELL CONSTRUCTION PERMIT# /d.�Z ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential (9� Municipal/Public 0 Industrial ❑ Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION:
Nearest Town: vet? c;•aRq County r,r r 4-1444 i*vlr3
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: trYi/-'wlz✓.F.P �,?A, rC/14,-erect
Address Comic/.41/2.e
(Street or Route No.)
c
City or Town State Zip Code
(a2sJ- Tr r✓i — £/.252
Area code- Phone number
4. DATE DRILLED 1 /i ?/0 ezi
5. TOTAL DEPTH: n c �
6. DOES WELL REPLACE EXISTING WELL? YES L9�NO 0
7. STATIC WATER LEVEL Below Top of Casing: e 0 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS / FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance In accordance with 15A NCAC 2C .0118. /J
9. YIELD (gpm): /6 METHOD OFTEST,./llc'eet'vywY'
10. WATER ZONES (depth): ?YO - 2 4`O r/'
opographic/Land setting
tdge ❑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
- 96 saris -- fir"ro4K-�
90 - ijf7 Ta.o.ssrre-
no - gist 6.-e.r',waerE
11. DISINFECTION: Type
12. CASING:
Depth
From e) To j/15
From To
From To
Amount
Wall Thickness
Diameter or eight/Ft. Material
Ft. 6 %y / J✓c,
Ft.
Ft.
13. GROUT: Depth Material
From f7 To u2 0 Ft._ /.,(.-I,e-,7
From To Ft.
14. SCREEN: Depth Diameter
From To Ft. in.
From To Ft. in.
15. SAND/GRAVEL PACK:
Depth Size
From To Ft.
From To Ft.
16. REMARKS:
Method
Slot Size Material
in.
in.
Material
O
LOCATION SKETCH
Show direction and distance in miles fro@t lea t
two State Roads or County Roads. Include the rda i
numbers and common road names.
µr M
I DO HEREBY CERTIFY THAT THIS WELL WA CONSTRUCTED IN ACCORDANCE WITH ISA NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND TH COPY O1 1RE.0HAS BEEN PROVIDED TO THE WELL OWNER.
DATE
/ GN
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

(2Y5)
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment an'dd h SNatural Resources -- Division of' Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print✓/Baea/1'o'/e CERTIFICATION #2.0
WELL CONTRACTOR COMPANY NAME /hle/tiabrP///"%rr/r?p PHONE # (f er%y—VY6,
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential it Municipal/Public 0 Industrial ❑ Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION:
Nearest Town:— County Pang
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: `',y ,' /t f /Sin/'
Address /17, (07
(Street or Route No.)
Ca54/e/5 ire-- ,$7/7
City n Town State Zip Code
_ yY /
Area code- Phone number
4. DATE DRILLED 1 `/ -0 it
5. TOTAL DEPTH: 1/2-4
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO
B
c-0
Topographic/Land setting NJ
❑Ridge ❑Slope ❑Valley ❑FE
(check appropriate box) O
Latitude/longitude of well Iocatiotrial
(degrees/minutes/seconds) --
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From To Formation Description
7. STATIC WATER LEVEL Below Top of Casing: 1 O FT. -9 — Ill
r� (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): METHOD OF TEST aim
10. WATER ZONES (depth):
11. DISINFECTION: Type
12. CASING:
Depth Diameter
From t7 To Ft. cc
From To Ft.
From To Ft.
13. GROUT:
From
Amount
Wall Thickness
orWeight/Ft. Material
S
Depth � Mate 'al
To5-0 Ft. �ic9✓7f�/!72!/I/.
From To Ft.
14. SCREEN: Depth Diameter
From To Ft. in.
From To Ft. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
Method
Slot Size Material
in.
in.
iMA-trirak
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common road names.
C 9 t7e/t207-171—'12
7�I � `der/ 6
/%L�G/i ��/�j11
16. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-1 REV. 07/2001

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and
/k/
Natural/Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME
(print/)/,iRib 1-7.i
/io/GL / te/Vj)' CERTIFICATIONp'�(r�//de
WELL CONTRACTOR COMPANY NAME IA51 /�[,fA/nl SC``�1Er (JS'K)D / / PHONE # '/5-0
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PEANUT/4
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential lEI Municipal/Public ❑ Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION: 9
Nearest Town: 'd-max rir�/V /�z County r _
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER n.. -t"
Address i'Y9( Qcerld(Lc t i.A
(Street or oute No.)(9-
City or Town State Zip Code
( )-
Area code- Phone numb r
4. DATE DRILLED/ —,�'r,oC/
5. TOTAL DEPTH: '1'p5
6. DOES WELL REPLACE EXISTING WELL? YES O NO
Topographic/Land setting
ORidge ❑Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:OGPSOTopographic map
(check box)
DEPTH DRILLING LOG
From To Formation Description
7. STATIC WATER LEVEL Below Top of Casing: ice? FT. ne:2— yosc
(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 accords a with ISA NCAC 2C .0I18.
9. YIELD (gpm): A4%) METHOD OF TEST al- '
10. WATER ZONES (depth): O2' 9'O
I1. DISINFECTION: Type
12. CASING:
Depth Diameter
From O To 4fc6- Ft. (57
From To Ft.
From To Ft.
13. GROUT: Depth Material Method
From CY Togs] _ Ft. ../1a�rmosri ,a,......„
---
From To Ft.
14. SCREEN' Depth Diameter Slot Size Material
From To Ft. in. in.
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Size Material
Amount
Wall Thickness
or Weight/Ft. aterial
PC---
From To Ft.
From To Ft.
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common road names.
47 C& Ca .& 457Y7-ay
CZ)
U7
16. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH I5A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT
A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE
(WELL
OWNER
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
Submit the original to the Division of Water Quality, Groundwater Section,0636 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) fi/ia,i r+�a H nZt7»4V CERTIFICATION #>/e/%
WELL CONTRACTOR COMPANY NAME 7hlr-/j/IIf e re rto ✓:+-t /-) PHONE # gjCa ,Q'Jj.-4/1/5-6
STATE WELL CONSTRUCTION PERMIT# / ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential qY Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection ❑ Other 0 If Other, List Use
2. WELL LOCATION:
Nearest Town: ' : c Lv,etdt County r'Xr> y/6 /aeni
<S'!!srA; irel)Fcr Cig,Z/P/S`
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: kind s
Address (o(i P4sa Lc». - Yonrt
Pt
(Mgr RouteeNo.)
or Town. State Zi Code
Area code- Phone number
4. DATE DRILLED S -/7- C) V/ rl_ -
5. TOTAL DEPTH: s e.S.- /
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO 13 '/ yn•
7. STATIC WATER LEVEL Below Top of Casing: ¶tZ) FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS f FT. Above Land Surface*
"Top of casing terminated at/or below land surface requires a
variance In accordance with ISA NCAC 2C .0118.
9. YIELD (gpm): a %z METHOD OF TESTTi9.14lkt/A/
10. WATER ZONES (depth): /yQ - /9c)Acii
opographic/Land setting
dge ❑Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DRILLING LOG
Formation Description
(e,S)- .sr'/- re
11. DISINFECTION: Type Amount
12. CASING: Wall Thickness
Depth Diam�ter or Weight/Ft. Material
From �i To etc/Ft. , /i' �,sr_J/ jof7G
From To Ft
From To Ft.
DEPTH
From To
C,._ is
0
C)
--t
IV
LOCATION SKETCH
Show direction and distance in miles frottnt least:
two State Roads or County Roads. Incluihe road
numbers and common road names.
13. GROUT: Depth Material Method
From CS To :? r) Ft. < -,,gt r 'X-c>/aea;2
From To Ft.
14. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in.
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Size Material
To Ft
To Ft.
From
From
16. REMARKS:
4
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT tycf ' OF THj$-IjE ORD HAS BEEN PROVIDED TO THE WELL OWNER
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
Submit the original to the Division of' Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-1 REV. 07/2001

(t r- 966-4-t S<r 6' 8 Svo a .5
4. DATE DRILLED '' 2 f "L19
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division.jof Water Quality - Groundwater Section
/e. 14
WELL CONTRACTOR (INDIVIDUAL) NAME (print)6S'h{? iebi ' CERTIFICATION # Atl2.01
WELL CONTRACTOR COMPANY NAME /I e,nr;/l fi/r j7
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
PHONE # (S l •7/ "1d1/5 -
1. WELL USE (Check Applicable Box): Residential VMunicipal/Public ❑ Industrial 0 Agricultural ❑
Monitoring ❑ Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION: /
Nearest Town: fif YL'rVr/-�iY
County /lath 't
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: 1>\e LL U art or-\
Address 1 1�
_ (Street or Ron
L(k 1(_,ycai,tat1
City or Town State/ ZiY Code
Area code- Phone number
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO Li
7. STATIC WATER LEVEL Below Top of Casing: di /7 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS t h FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordant with ISA NCAC 2C .0118.
9. YIELD (gpm): `i METHOD OF TEST
10. WATER ZONES (depth): J5C7 " 2 f 2 /C.- 6j
11. DISINFECTION: Type
12. CASING:
Depth Diameter
From CJ To f'15 Ft. 6.1%
From %en To /'f %' Ft. C i
From To Ft.
13. GROUT:
From el
From
14. SCREEN:
fnt Kaaa
)\ ae7y--7
Amount
Wall Thickness
or Weight/Ft. Material
s)/ //kr-
r/n S%
Depth Material
To 7/) Ft.:ani 4sLL-X
To Ft
Depth Diameter
From To Ft in.
From To Ft. in
I . SAND/GRAVEL PACK:
Depth Size Material
5. TOTAL DEPTH: 241,5 op -me
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)
DRILLING LOG
Formation Description
DEPTH
From To
et -Re
/`/d'3h -5
Method
Slot Size Material
in.
in.
From To Ft.
From To Ft.
16. REMARKS:
4012.-22
et/
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common road name .
./t
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH ISA NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF HIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center -Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-1 REV. 07/2001

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and
// Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) (1/4iri 1 ,7 P/p 7P//+e CERTIFICATION # 10 //
WELL CONTRACTOR COMPANY NAME Q/i"/ !/ tr,0// t /!L/ft!J PHONE # JSi/ c77 " 1/Z//Z D
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED//W,, WQ PER1',tIT#
(if applicable)
_/ (if applicable)
I. WELL USE (Check Applicable Box): Residential Pd Municipal/Public ❑ Industrial ❑ Agricultural ❑
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION: /
Nearest Town: /'PL 4./t County //2l j %
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3.OWNER:
ST?G.'P /Yhp[,4B
Address OH Elfl rPxr an/
(Street or Route No.)
PfJa rz./i;l 4'9.2
City or Town State Zip Code
('J,1*- te— 1 /'/ 3-
Area code- Phone number_
4. DATE DRILLED 4 -
5. TOTAL DEPTH: 745 ` co _
Topographic/Land setting
❑Ridge ❑Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:DGPSI]Topographic map
(check box)
DEPTH DRILLING LOG
From To Formation Description
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO Er
7. STATIC WATER LEVEL Below Top of Casing: ./zome, FT. /,ye ._ xey/
2 (Use "+" if Above Top of Casing)
S. TOP OF CASING IS �Y FT. Above Land Surface*
`Tap of casing terminated at/or below land surface requires a
variance In accordance with ISA NCAC 2C .0118.
O 6G' cLt az�
9. YIELD (gpm): / MEJHOD OF TESTcttw
10. WATER ZONES (depth): 2.
11. DISINFECTION: Type Amount
12. CASING: Wall Thickness
Depth Diameter_ or Weight/Ft. Material
From 0 To '71 Ft, re.15,7/ lilt
From To Ft.
From To Ft.
13. GROUT: Depth Material
From a To..- i' Ft.,,,kviirfaftri
From To Ft.
14. SCREEN: Depth Diameter
From To Ft. in.
From To Ft. in.
15. SAND/GRAVEL PACK:
Depth
From To Ft.
From To Ft.
16. REMARKS
Slot Size
in.
in.
Size Material
Method
Material
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common road names.
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,
e4
SIGNATURE OF PERSON CONSTRUCTING THE WELL
67- ,23 , Cildfr
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) 0/ Pi/ J) �7 pp / e/Jt CERTIFICATION #/odr/,J WELL CONTRACTOR COMPANY NAMEen // /fie!/ rJCJLJ?/ b¶J PHONE # JS ' + e)
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential El Municipal/Public ❑ Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATI N: /
Nearest Town PVc/e{ County 7;a41-1/4
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER:5/14JP/ Slet7/
Address 2- / /(5',/de Dp;
(5ireet or Route No.)
bit tcnerar /rc
2 45 76 7
City or Town State Zip Code
(WO-4i7—gt/7
Area code- Phone number
4. DATE DRILLED LC"2 4 y
5. TOTAL DEPTH: 2 �jr e,
6. DOES WELL REPLACE EXISTING WELL? YES NO ❑
7. STATIC WATER LEVEL Below Top of Casing: la FT
(Use'+" if Above Top of Casing)
S. TOP OF CASING IS FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance In accordance with 15A NCAC 2C .0118.
Topographic/Land setting
❑Ridge ❑Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From To Formation Description
ce -t ice,
9. YIELD (gpm): C METHOD OF TESTQ,v*l
10. WATER ZONES (depth): 2 /C-2614 I
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common road names.
11. DISINFECTION: Type
12. CASING:
Depth
From (.7ToG`/
Amount
Wall Thickness
Diameter or Weight/Ft. Va eria!
Ft.(' . iz 7 / e %
Tog Fromet! ToFt, / 17/7 -
From To Ft.
13. GROUT: Depth Material
From C Tc 20J Ft. ge7,42.47J/.r
From To Ft.
14. SCREEN' Depth Diameter
From To Ft. in.
From To Ft. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft
From To Ft.
Method
/�r.-r
Slot Size Material
in.
in.
16. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH ISA NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
-vy
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-I REV. 07/2001

(09
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment 7
and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME�(print)CO /Pif :J eniPt % CERTIFICATION #�t%[�
WELL CONTRACTOR COMPANY NAME/ /LAJ/217 6te// f #'2 2j� PHONE # ( rS7 y"e/ej-1j
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential VMunicipal/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:Si-viol.-
County4iton
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER:J,
Address d
(Stree or Route No.)
City or Town State Zip Code
(786)- h 5'q— va3S'
Topographic/Land setting
❑Ridge ❑Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From To Formation Description
Area code- Phone number V - ' a
4. DATE DRILLED eW 6'• '3 OdY
5. TOTAL DEPTH: /%O
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO
7. STATIC WATER LEVEL Below Top of Casing: 719 FT.
(Use "+' if Above Top of Casing)
8. TOP OF CASING IS 2"-- FT. Above Land Surface*
•l'op of casing terminated at/or below land surface requires a
variance in accordan ith 15A NCAC 2C .01I8.
9. YIELD (gpm): e_ �� METHOD OF TEST 2La+'
10. WATER ZONES (depth):
11. DISINFECTION: Type
12. CASING:
Depth Diameter
From ® To q0' Ft. 6. J4
From To Ft
From To Ft.
Amount
Wall Thickness
or Weight/Ft. aterial
13. GROUT: Depth Materiel
From 0 ToAQ Ft.,/�/ j�i�i
From To Ft.
14. SCREEN: Depth Diameter
From To Ft. in.
From To Ft. in.
15.SAND/GRAVEL PACK:
Depth Size Material
Method
Slot Size Material
in.
in.
From To Ft.
From To Ft.
16. REMARKS:
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common road names.
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT
��ACOPY OF THIS RECORD HAS BEEN PROVIDED TO
THE WELL OWNER...
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-1 REV. 07/2001

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME
e/Jf
� (print)G/
WELL CONTRACTOR COMPANY NAME/ (Oflh/"/i e// *Awl
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable) / (if applicable)
1. WELL USE (Check Applicable Box): Residential Ef Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION:
Nearest County //jrn ..
( c4-Ic Ccey lc
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNERSnrq 6227/Je2,Xe/
Address G1,G r(A4-1 et -
(
Street or Route No.)
re?..'Qt;7E /yr-
City or Town State Zip Code
( ) Y-r7- 4 T)
Area code- Phone number
4. DATE DRILLED % -47 9
5. TOTAL DEPTH: `d,
CERTIFICATION # 7-0i/
PHONE # (S4.4 `f7'% ' z/7242.2
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)
DRILLING LOG
Formation Description
DEPTH
From To
-
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO _ 5'd
7. STATIC WATER LEVEL Below Top of Casing:' -d FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance In accordance with ISA NCAC 2C .0118.
9. YIELD (gpm): 10-- METHOD OF TEST al-V
10. WATER ZONES (depth): 5 O
11. DISINFECTION: Type Amount
12. CASING: Wall Thickness
Depth Di meter or Weight/Ft. Material
From el Togo Ft.e '7/ J'Yr
From To Ft
From To Ft.
13. GROUT• Depth Material Method
From 0 To.g'9 _ Ft.9-..c0Yet z/>Fr2>-".
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.
t14a�lYLH.T!
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common road names.
a—fb"1
'[o d n
16. REMARKS:
1 DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH ISA NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND ATHATrA COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mall Service Center - Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. G W-1 REV. 07/2001

r
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) Cle/70 Ces tete— CERTIFICATION # 2e/ /
WELL CONTRACTOR COMPANY NAME/it/7I%/ Ire// %-Accry,n
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable)
(if applicable)
PHONE # fin g.7
1. WELL USE (Check Applicable Box): Residential Q" Municipal/Public ❑ Industrial 0 Agricultural ❑
Monitoring ❑ Recovery 0 Heat Pump Water Injection 0 Other ❑ If Other, List Use
2. WELL LOCAT N:
Nearest Town:fsrair`
n1 v (4 Lr
County /OAS
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: tS oi#-z
Address 1 yy LI'11Ire. (tio
( beet or Route No.)
City or Town State
Zip Code
( - ?fl-9o797
Area code- Phone number
4. DATE DRILLED 37/ -a if
Topographic/Land setting
❑Ridge ❑Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From To Formation Description
a' -a dv:�
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO 1:tr---S
7. STATIC WATER LEVEL Below Top of Casing:'�O FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS 1-- FT. Above Land Surface*
'Top of casing terminated at/or below land surface requires a
variance In accordance with ISA NCAC 2C A118.
9. YIELD (gpm): if— METHOD OF TEST
10. WATER ZONES (depth): >d T / 90
5. TOTAL DEPTH: Ito -6°C- /iv
l 1. DISINFECTION: Type
12. CASING:
Depth
From O To C
From To
From To
13. GROUT: Depth
From d Tom
From To
14. SCREEN: Depth
From To
From To
15. SAND/GRAVEL PACK:
Amount
Wall Thickness
Diameter or Weight/Ft. MaterialFtL*
Ft.
Ft.
Material Method
Ft.4,e2en �,nz
Ft,
Diameter Slot Size Material
Ft. in. in.
Ft. in. in.
Depth Size Material
From To Ft.
From To Ft.
16. REMARKS:
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common road names.
S •C 4ZWZJizet70 * ii
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
/—oY
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-1 REV. 07/2001

13. GROUT:
From p
From To Ft.
14. SCREEN: Depth Diameter
From To Ft. in.
From To Ft. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Reso?rces - Divisign of Water Quality - Groundwater Section / �/
WELL CONTRACTOR (INDIVIDUAL) NAM1gn'(print) smc0^ A-A1( 6N1p /_ CERTIFICATION #?1Y-1
WELL CONTRACTOR COMPANY NAME Meadttf f_ W1=(L � Uhl L.O, (NC-. PHONE # (TM M.C(O°
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable) tom, (if applicable)
1. WELL USE (Check Applicable Box): Residential,laLD1unicipal/Public 0 Industrial ❑ Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION:
Nearest Town:lEOsr2 i1Aji7
tA6aeJ 5a.4aS
County UTAt35
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: Sih4i cSVvtM
Address (, 21Jd2d164
(Street or Route No.)
Whit SC �►a
( tty or. Townun 3_1SgtatC Zip Code
rea c Ae- Phone number .
4. DATE DRILLED 3-5 ri`1
5. TOTAL DEPTH: t G r
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO 0
7. STATIC WATER LEVEL Below Top of Casing: 9-0 FT.
I (Use "+" if Above Top of Casing)
8. TOP OF CASING IS l!a 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): t'( METHO» OF TEST Pig— &Loa \
10. WATER ZONES (depth):
11. DISINFECTION: Type Amount
12. CASING: Wall Thickness
From 0
Depth 10 Dii meter ,00r�Weight/Ft. Material
To UFt. Jyi. -( £G
From To Ft.
From To Ft.
Topttj, M_Material / ,� Method
Slot Size Material
in.
in.
16. REMARKS:
Topographic/Land setting
❑Ridge ❑Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From To Formation Description
Q �O 0(27
So- 1 bc; 46ctignr✓
t-j
n
--a
0
u+
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common road names.
I DO HEREBY CERTIFY T W L Wb1S CONSTRUCTED M ACCORDANCE WITH I5A NCAC 2C, WELL
CONSTRUCTION STAND , A*v"t ArY/,�, COPY F THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
SIGNATURE OF PERSON CONSTRUCTING THE WELL
DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-1 REV. 07/2001

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and,( Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME
y(print)/ /to%'/j 1/ U/c// f iitenn CERTIFICATION #2(97/
WELL CONTRACTOR COMPANY NAME/ jor/-// /,/,C// j'/CL1ft7t7 PHONE #'$JJ'"yCr>'rC-
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential 0 Municipal/Public ❑ Industrial 0 Agr4 ultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other ❑ If Other, List Use
2. WELL LOCATION:�""
Nearest Town: /cjow77vz+—
County /1-in
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER::f/m Lnrt9/lz
Address /� /Y} Sra��,>iiY /'✓�
(Street or Route No.)
City or Town State Zip Code
( 5)- 971-- 4v76"e",
Area code- Phone number
4. DATE DRILLED *7' ,g 69
5. TOTAL DEPTH: /O/i
6. DOES WELL REPLACE EXISTING WELL? YES NO ❑
7. STATIC WATER LEVEL Below Top of Casing: FT
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS 2 FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordance with ISA NCAC 2C .0118.
9. YIELD (gpm): /i O METHOD OF TEST z
10. WATER ZONES (depth):
Topographic/Land setting
❑Ridge ❑Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:OGPSOTopographic map
(check box)
DEPTH DRILLING LOG
From To Formation Description
— /1,4, '`tt77.4-ed
11. DISINFECTION: Type Amount
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
SS --From 1' Tt1 / Ft.#
From O TOStT Ft./r 12/ f/��%
From, -3' To 7 </ Ft. ,C9 # in 9%
13. GROUT:
From 0
Depth Material . Method
To Ft. /ir?nannf7i- ��I j/c,-_ .�2"f
From To Ft. Y ��a��.
14. SCREEN: Depth Diameter Slot Size
From To Ft. in. in.
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common road names.
Material 0�__ e_e
16. REMARKS:
1 DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RE ORD HAS BEEN PROVIDED TO THE WELL OWNER
- - , --Z 9 -�
SIGNATURE OF PERSON CONSTRUCTING THE WELL
DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. _.. - GW-1 REV. 07/2001

304256
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) RICHARD MCCRARY
CERTIFICATION # 2010
WELL CONTRACTOR COMPANY NAME BARKER CONSTRUCTION, INC./BARKER WELL 8 PUMP ppjHIr # [phone]
STATE WELT CONSTRUCTION PERMIT# 1871 ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential El MumicipaVPublic ❑ Industrial 0 Agricultural ❑
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other 0 If Other, List Use
2. WELL LOCATION:
Nearest Town BREVARD County TRANSYLVANIA
CATIYS CREEK CHURCH ROAD
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: HABITAT FOR HUMANITY-TRANSYLVANIA COUNTY
Address PO BOX 1071
(Street or Route No.)
BREVARD NC 28712
City or Town State Zip Code
( 828 )_ 884-3464
Area code- Phone number
4. DATE DRILLED OCTOBER 8, 2004
5. TOTAL DEPTH: 345
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO El
7. STATIC WATER LEVEL Below Top of Casing:
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS 1.33 FT. Above Land Surface*
'Top of easing terminated actor below land surface requires a
variance in accordance with 15A NCAC 2C .9118.
9. YIELD (gpm): 5 METHOD OF TEST TIMED
10. WATER ZONES (depth):
11. DISINFECTION: Type IN PUMP INSTALLER Amount
12. CASING: Wall Thiclmess
Depth Diameter or Weight/Ft. Material
From 0 To 108 Ft 61/8 SDR21 PVC
From To Ft
From__ To Ft.
13. GROUT: Depth
From 0 To 20
From To
Topographic./Land setting
❑Ridge ®Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From To Formation Description
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common road names.
J,Gog Attattai ,l. i65/
Idea-
L'�,f�/ /Ate �4', /zit
Material Method eat 6' OS ik.,L/f-Z. d�itea
Ft
Ft. CONCRETE POURED 1,�. O eW,,��'/_,_
Slot Sizc Material L� A l0.7liCi CN-e,tL
is j,�Z 4.1, •
ea�f [ 9l�ctfi-j
eCleta
14. SCREEN: Depth Diameter
From To Ft. is
From To Ft. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To FL
16. REMARKS: THIS IS WELL #1 OF 2 THAT WAS DRILLED ON SAME PROPERTY. BOTH WELLS WERE INDENTICAL.
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15 NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND OPY�OF' THIS RECORD HAS BEEN PROMO TO.THE WELL OWNER
SIGNATURE OF
'%S /6(�
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
rri

3O4251
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) RICHARD MCCRARY
CERTIFICATION 2010
WELL CONTRACTOR COMPANY NAME BARKER CONSTRUCTION, INC. BARKER WELL & PUMP PHONE# [phone]
STATE WELL CONSTRUCTION PERMIT# 1871 _ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential 03 Municipal/Public 0 Industrial 0 Agricultural [
Monitoring 0 Recovery ❑ Heat Pump Water Injection 0 Other [ If Other, List Use
2. WELL LOCATION:
Nearest Town: BREVARD
CATHEYS CREEK CHURCH ROAD
County TRANSYLVANIA
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: HABITAT FOR HUMANITY-TRANSYLVANIA COUNTY
Address PO BOX 1071
(Street or Route No.)
BREVARD NC 28712
City or Town State Zip Code
( 828) 884-3464
Area code- Phone number
4. DATE DRILLED OCTOBER 12, 2004
5. TOTAL DEPTH: 345
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO El
7. STATIC WATER LEVEL Below Top of Casing: 30 FT.
(Use "+" if Above Top of Casing)
8- TOP OF CASING IS 1.33 FT. Above Land Surface*
*Top of easing terminated at/or below land surface requires •
variance in accordance wdh 15A NCAC 2C .01lt
9. YIELD (gpm): 5 METHOD OF TEST TIMED
10. WATER ZONES (depth):
11. DISINFECTION: Type BY PUMP INSTALLER
12. CASING:
Depth Diameter
From 0 To 108 Ft. 61/8
From To Ft
From To Ft.
13. GROUT: Depth
From 0 To 20
Material
Ft. CONCRETE
From To Ft.
Topographic/Land setting
[Ridge ®Slope [Valley [Flat
(check appi,,puat box)
Latitude/longitude of well location
(degrees/initiates/seconds)
Latitude/longitude source:[GPS[Topographic map
(check box)
DEPTH DRILLING LOG
From To Formation Description
J
i
LOCATION SKETCH
Amount Show direction and distance in miles from at least
Wall Thickness two State Roads or County Roads. Include the road
or lFL Material numbers
SDR21 PVC 7ea[(,d oay. G#G/ iv MICA- /Cli t• ,)
//c- /tea'(- (. (atat:l
d
szarnl
iLI olds � LvCz _
;4,— ,x&e-e
/0.%1:6 .G[ Ste
L aC°Lc. `jcceL oaf
14. SCREEN: Depth Diameter
From To Ft in.
From To FL in.
15. SAND/GRAVEL PACK:
Depth
From To Ft.
Method
POURED
Slot Size Material
in-
in -
Size Material
From To Ft.
16. REMARKS: THIS IS WELL #2 OF 2 THAT WAS DRILLED ON SAME PROPERTY. BOTH WELLS WERE INDENTICAL.
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND »TAT A CO OF THIS RECORD HAS BEEN PROVIDED TOJ4IE WELL OWNER
1/ SIGNATURE OF SON CONSTRUCTING THE WELL
ATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW- I REV. 07/2001
,