Av CY2005

W'- ?
North Carolina-Department of Environment and Natural Resources- Division of Water Quality-Groundwater Section 6)
1636 Mail Service Center- Raleigh,N.C.27699-1636-Phone[phone] ¢) 1
WELL CONSTRUCTION RECORD WELL CONTRACTOR: ii2ek'i'r;r`ffghl:VJ eli Fluti Cg lnc.
WELL CONTRACTOR CERTIFICATION#: `6 i
0402=0- STATE WELL CONSTRUCTION PERMIT#: ='bate Reece
1. WELL USE (Check Applicable Box): Residential 0 Municipal ❑ Industrial ❑ Agricultural❑ Monitoring ❑
Recovery El Heat Pump Water Injection ❑ Other ❑ If Other, List Use:
2. WELL LOCATION:(Show sketch of the location below)
Nearest Town: RDri Fl V County: _L,WPv
'`'N'HIA 1 ANF nFF �RP•!FTTF qt' cF nri•J r1�:C sn5
(Roatl Name an umbers, ommunRy,or Subtlrvision and Lot No.) DRILLING LOG DEPTH
3. OWNER loft IR RAY 1/02"TAi From To Formation Description
Address Ft �, a. . ^ 11,,.3 !`1r FT SHAI F
treet or Route No.)
C'RI AND 11R It i GRANEE
City or Town Mate ,Cow
1511 18D Al,F
4. DATE DRILLED 61 160 = 5 rRANITg '•��
5. TOTAL DEPTH 225
6. CUTTINGS COLLECTED YES ❑ NO El
i
7. DOES WELL REPLACE EXISTING WELL? YES ❑ NO ❑ '^
8. STATIC WATER LEVEL Below Top of Casing: 50 FT. -^ f
(Use',"if Above Top of Casing)
9. TOP OF CASING IS FT. Above Land Surface*
Top of casing terminated at/or below land surface requires a variance in actor.
dance with 15A NCAC 2C.0118
10. YIELD (gpm): 40 METHOD OF TEST Air a
11. WATER ZONES (depth)f 00 qpm 15D-16D D ODgpm
0,00 [tern u1]i3flam ._
12. CHLORINATION: Type HT Amount 36 If additional space is needed use back of form
13. CASING: Wall Thickness LOCATION SKETCH
Depth Diameter or WeighVFt. Material (Show direction and distance from at least two State It
From n To 123 Ft. 6 12 3510 R`"- Roads,or other map reference points) �0
From To Ft.
From To Ft.
14. GROUT:
Depth Material Method
From D To e0 Ft. CE-mi Gra'tittr Fli T\
From To Ft.
15. SCREEN:
Depth Diameter Slot Size Materialti 4•w ' �'
From To Ft. in. in. /
From To Ft. in. in. _� / (1 e'
From To Ft. in. in. j `
/ 1 r
s _
16. SAND/GRAVEL PACK: 'c
Depth Size Material ,
From To Ft.
From To Ft.
17. REMARKS:
1 DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C,WELL f'k
CONSTRUCTION STANDARDS,AND THAT COPY OFF THIS
'RECORD,HAS BEEN PROVIDED TO THE WELL OWNER.
FOR OFFICE USE ONLY
SIGNATURE OF PER§ON CONSTRUCTING THE WELL DATE
Quad No: Submit original to Division of Water Quality,Groundwater Section within 30 days
GW-1 REV. 12/99
Serial No.

North Carolina-Department of Environment and Natural Resources-Division of Water Quality-Groundwater Section 307416
1636 Mail Service Center Raleigh,N.C.27699-1636-Phone[phone]
WELL CONSTRUCTION RECORD WELL CONTRACTOR: Dewey VVright Well Pump Co., Inc.
WELL CONTRACTOR CERTIFICATION#: 2687
(340533 STATE WELL CONSTRUCTION PERMIT#: Steve Reece
1. WELL USE(Check Applicable Box): Residential 0 Municipal E] Industrial 0 Agricultural Ei Monitoring
Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use:
2. WELL LOCATION:(Show sketch of the location below)
Nearest Town: BANNER ELK County: AVERY
PRIVATE OR OFF HWY 194 OFF HWY 184 OFF HWY 105
(Road Name and Numers,Community.or Subdivision and Lot No.) DRILLING LOG DEPTH
3. OWNER T&A INVESTMENTS LLC From To Formation Description
Address 1900 SUNSET HARBOR SUITE#1 , 0 40 DIRT
MIAMI BEACILpr Route No.) FL 33139 40 120 GRANITE
City or Town state zip o e 120 123 SHALE
4. DATE DRILLED M12005 123 180 GRANITE
5. TOTAL DEPTH 180
6. CUTTINGS COLLECTED YES EJ NO
7. DOES WELL REPLACE EXISTING WELL? YES 0 NO
8. STATIC WATER LEVEL Below Top of Casing: 20 FT.
(Use'+"if Above Top of Casing)
9. TOP OF CASING IS 1 FT.Above Land Surface*
•Top of casing terminated at/or below land surface requires a variance in accor-
dance with 15A NCAC 2 ,0119
10. YIELD (gpm): du METHOD OF TEST I r
11. WATER ZONES (depth).."U.00 qpm 120-123 0.00ppm —
qpm qpm
12. CHLORINATION: Type HTH Amount 34 If additional space is needed use back of form
13. CASING: Wall Thickness LOCATION SKETCH
Depth Diameter or Weight/Ft. Material (Show direction and distance from at least two State
From 0 To 48 Ft. 13 1/8 .350 PVC Roads,or other map reference points)
From To Ft. / � V © a
From To Ft. `\ Y
14. GROUT:
Depth Material Method
From 0 To 20 Ft.Cement Gravity Flow
From To Ft.
1
15. SCREEN:
Depth Diameter Slot Size Material r=r:
From To Ft. in. in. c->`
From To Ft. in. in.
From To Ft. in. in. o
J r`i
16. SAND/GRAVEL PACK:
Depth Size Material
From To _ Ft. !�!
From To Ft.
17. 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 RECOR941AS BEEN PROVIDED TO THE WELL OWNER.
FOR OFFICE USE ONLY
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
Quad No: Submit original to Division of Water Quality,Groundwater Section within 30 days
GW-1 REV.12/99
Serial No.

North Carolina -Department of Environment and Natural Resources-Division of Water Quality-Groundwater Section' 307423
1636 Mail Service Center-Raleigh,N.C.27699-1636-Phone[phone]
WELL CONSTRUCTION RECORD WELL CONTRACTOR: Dewey Wright Well Pump Co., Inc.
WELL CONTRACTOR CERTIFICATION#:
060029 STATE WELL CONSTRUCTION PERMIT#: esle eece
1. WELL USE(Check Applicable Box): Residential 0 Municipal ❑ Industrial ❑ Agricultural❑ Monitoring ❑
Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use:
2. WELL LOCATION:(Show sketch of the location below)
Nearest Town: PINEOLA County: AVERY
BEAR CREEK RD. OFF HWY 221
(Road Name and Numbers,Community,or Subdivision and Lot No.) DRILLING LOG DEPTH
3. OWNER PETER VAN13EUREN From To Formation Description
Address NST. 9218-1 HY" 105 S. 0 126 DIRT
BANNER '4�°' OUte N°) NC 28604 126 187 GRANITE
City or Town State Zip code 187 188 SHALE
4. DATE DRILLED 1/20/2005 188 240 GRANITE
5. TOTAL DEPTH 240
6. CUTTINGS COLLECTED YES ❑ NO 0
7. DOES WELL REPLACE EXISTING WELL? YES ❑ NO F
8. STATIC WATER LEVEL Below Top of Casing: 80 FT.
(Use"+"if Above Top of Casing)
9. TOP OF CASING IS 1 FT.Above Land Surface*
'Top of casing terminated at/or below land surface requires a variance in accor- _
dance with 15A NCAC 2C.p118
10. YIELD(gpm): 1U METHOD OF TEST Air
11. WATER ZONES (depth)20.00 ppm 187-188 0.0 olpm -
0.00 ppm 0.00mm -
12. CHLORINATION: Type HTH Amount 32 If additional space is needed use back of form
13. CASING: Wan Thickness LOCATION SKETCH - -.-
Depth Diameter or Weight/Ft. Material (Show direction and distance from at least two State
c.om 0 To 135 Ft, 6 116 .350 PVC Roads,or other map reference points)
Front To Ft.
From To Ft. © Q.
14. GROUT:
Depth Material Method
From 0 To 20 Ft. Cement Oravity Flow
From To Ft.
T r.ir,z
15. SCREEN: r 7 ;-1
Depth Diameter Slot Size Material
From To Ft. in. in.
From To Ft. in. in.From To Ft. in. in.
16, SAND/GRAVEL PACK:
Depth Size Material QtV"
From To Ft.
From To Ft. 5
17. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C,WELL
CONSTRUCTION STANDARDS,AND THAT AgCOPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER.
FOR OFFICE USE ONLY ', ` tT'tJ 4s # 1-9 F-a,"r
SkaATURE OF PERSON CONSTRUCTING THE WELL DATE
Quad No: Submit original to Division of Water Quality,Groundwater Section within 30 days
GW-1 REV.12/99
Serial No.

North Carolina-Department of Environment and Natural Resources-Division of Water Quality-Groundwater Section 309078
1636 Mail Service Center-Raleigh, N.C.27699-1636-Phone[phone]
WELL CONSTRUCTION RECORD WELL CONTRACTOR: Dewey Wright Well Pump Co., Inc.
WELL CONTRACTOR CERTIFICATION#: 2686
050025 STATE WELL CONSTRUCTION PERMIT#: Leslie Reece
1. WELL USE(Check Applicable Box): Residential 0 Municipal 0 Industrial 0 Agricultural 0 Monitoring ❑
Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use:
2. WELL LOCATION:(Show sketch of the location below)
Nearest Town: BANNER ELK County: AVERY
LONG VIEW OFF ROCKY PARKWAY OFF SHAWNEE RE)
(Road Name and Numbers,Community,or Subdivision and Lot No.) DRILLING LOG DEPTH
3. OWNER ROBERT INGALLS From To Formation Description
Address % DAVID CONRAD , 100 EMERALD FOREST LANE 0 38 DIRT
BEECH Nftt or Route No.) NC 28604 38 671 GRANITE
City or Town State zip Code 671 672 QUARTZ
4. DATE DRILLED 2116/2005 672 805 GRANITE
5. TOTAL DEPTH 805
6. CUTTINGS COLLECTED YES 0 NO
7. DOES WELL REPLACE EXISTING WELL? YES 0 NO 0
8. STATIC WATER LEVEL Below Top of Casing: 300 FT. f7
(Use"+"if Above Top of Casing) {
9. TOP OF CASING IS 1 FT. Above Land Surface*
Top of casing terminated at/or below land surface requires a variance in actor- N
dance with 15A NCAC 2g.0118
10. YIELD (gpm): G METHOD OF TEST Air +
11. WATER ZONES (depth): 6.00 gpm671-672 0.00gpm O
0.00 opm 0.00opm
12. CHLORINATION: Type HTH Amount 106 If additional space is needed use back of form F-
13. CASING: LOCATION SKETCH
Wall Thickness `
Depth Diameter or Weight/Ft. Material (Show direction and distance from at least t�[
rrom O To 43 Ft. 8 "a .350 PVC Roads,or other map reference ppi q, 1
From To Ft. .11R
From To Ft.
14. GROUT: ��
Depth Material Method y .
From 0 To 20 Ft. Cement Gravity Flow
From To Ft.
15. SCREEN: Y
JQ
Depth Diameter Slot Size Material
From To Ft. in. in. ..
From To Ft. in. in.
From To Ft. in. in.
16. SAND/GRAVEL PACK: -
Depth Size Material
From To Ft. ��
From To Ft.
17. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C,WELL
CONSTRUCTION STANDARDS,AND THAT A COPY OF THIS HAS BEEN PROVIDED TO THE WELL OWNER.
FOR OFFICE USE ONLY � o' 'p� , IQ —'I'S_03-
NATURE OF PERSON CONSTRUCTING THE WELL DATE
Quad No: Submit original to Division of Water Quality,Groundwater Section within 30 days
GW-1 REV.12/99
Serial No.

North Carolina -Department of Environment and Natural Resources-Division of Water Quality-Groundwater Section
1636 Mail Service Center- Raleigh, N.C. 27699-1636-Phone [phone] 3 0 9 0 9 5
WELL CONSTRUCTION RECORD WELL CONTRACTOR: Dewey tiAJriciht'Nell PUMDC9 iGQ
WELL CONTRACTOR CERTIFICATION#: 2686
050030 STATE WELL CONSTRUCTION PERMIT#: Leslie Reece
1. WELL USE (Check Applicable Box): Residential 0 Municipal 0 Industrial 0 Agricultural❑ Monitoring
Recovery E] Heat Pump Water Injection 0 Other 0 If Other, List Use:
2. WELL LOCATION:(Show sketch of the location below)
Nearest Town: PINJI7 1 A - County: Avvov _
r 1T#4'� C"OU('AR PU�I Rn rIFF REAR �RFFK Rr) QFF
(Road Name and Numbers,Community.or subdivision and Lot No.l DRILLING LOG DEPTH
3. OWNER WAIRRPINI " EBB From To Formation Description
Address F 21 n 7 180 R nIFT ANF7
BANNER ry or houte No.l NC 286D4 16n 201 GRANITE
av or Town scats z�a coda 201 202 SHALE
4. DATE DRILLED 1,12712005 202 245 GRANITE
5. TOTAL DEPTH 300 245 246 SHALE
6. CUTTINGS COLLECTED YES ❑ NO ® 246 300 GRANITE
7. DOES WELL REPLACE EXISTING WELL? YES EJ NO 0
B. STATIC WATER LEVEL Below Top of Casing: 100 FT.
(Use"+"if Above Top of Casing) Z
a �-
9. TOP OF CASING IS 1 FT.Above Land Surface* n
*Top of casing terminated at/or below land surface requires a variance in accor- N s,_i
dance with 15A NCAC 2C.0118 Alf
10. YIELD(glom): 25 METHOD OF TEST - j
11. WATER ZONES (depth): 4.00 ppm201 202 21.00ppm 245-246 0
0.00 ppm 0.00ppm us
12. CHLORINATION: Type HTH Amount 41 If additional space is needed use back of formes
13. CASING: Wall Thickness LOCATION SKETCH
Depth Diameter or Weight/Ft. Material (Show direction and distance from at least two State
prom 0 To 166 Ft. 6 A .350 PVC, Roads,or other map reference points)
Frortl To Ft.
From To Ft.
14. GROUT:
Depth Material Method
From 0 To 20 Ft. Cement 4ralvity F',crr
From To Ft.
v
15. SCREEN:
Depth Diameter Slot Size Material
From To_ Ft. in. in.
From To Ft. in. in. -
From To Ft. in. in.
16. SAND/GRAVEL PACK: \XP
Depth Size Material 0\p..
From To Ft.
From To Ft. 41�
17. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C,WELL
CONSTRUCTION STANDARDS,AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER.
o ,moo a-1 S _0�_
=No.—
SIG URE OF PERSON CONSTRUCTING THE WELL DATE
Submit original to Division of Water Quality,Groundwater Section within 30 days
GW-1 REV.12(99

North Carolina-Department of Environment and Natural Resources-Division of Water Quality-Groundwater Section
1636 Mail Service Center-Raleigh, N.C.27699-1636-Phone[phone] 309 09
A 4
WELL CONSTRUCTION RECORD WELL CONTRACTOR: Dewey Wright Well Pump Co., Inc. J
WELL CONTRACTOR CERTIFICATION#: 2686
050031 STATE WELL CONSTRUCTION PERMIT#: Leslie Reece
1. WELL USE(Check Applicable Box): Residential 0 Municipal 0 Industrial 0 Agricultural❑ Monitoring ❑
Recovery 0 Heat Pump Water Injection 0 Other E If Other, List Use:
2. WELL LOCATION:(Show sketch of the location below)
Nearest Town: BANNER ELK County: AV PY
LOT#2 OFF ROSEBORO RD OFF 105
(a Nameand Numbers,Community,or Subdivision and Lot No.l DRILLING LOG DEPTH
3. OWNER ALEXIS WARMATH From To Formation Description
Address % TOM MCNAMARA P.O. BOX 527 0 36 SHALE
BLOWINdPIZbt O1sNO NC 28605 36 121 GRANITE
City or Town state p coda 121 122 QUARTZ
4. DATE DRILLED 1127/2005 122 200 GRANITE
5. TOTAL DEPTH 200
6. CUTTINGS COLLECTED YES 0 NO 0
7. DOES WELL REPLACE EXISTING WELL? YES ❑ NO 0
8. STATIC WATER LEVEL Below Top of Casing: 50 FT.
(Use"+"if Above Top of Casing) S'
9. TOP OF CASING IS 1 FT.Above Land Surface*
'Top of casing terminated at/or below land surface requires a variance in accor- tV ':i`';.
dance with 15A NCAC 2C.011E
10. YIELD (gpm): 10 METHOD OF TEST A r
11. WATER ZONES Wepth):10 00 Rpm 121-122 O.00ppm K
0.00 Apm 0 00gpm
If additional space is needed use back of for
12. CHLORINATION: Type HTH Amount 31r3 _
13. CASING: LOCATION SKETCH
Wall Thickness
Depth Diameter or Weight/Ft. Material 0 S w direction and distance from at least two Slate
From 0 To 41 Ft. 6 1M .350 PVC I� Roads,or other map refereng points)
From To Ft.
From To Ft. IrE�Esc(o�lo
0 6 14. GROUT: �
Depth Material Method
From 0 To 20 Ft. Cement Gravitv FlowO
1q
From To Ft.
15. SCREEN: - J
Depth Diameter Slot Size Material
From To Ft. in. in.
From To Ft. in. in.
From To Ft. in. in.
16. SAND/GRAVEL PACK: © �
Depth Size Material
From To Ft.
From To _ Ft.
17. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C,WELL
CONSTRUCTION STANDARDS,AND THAT�A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER.(A FOR OFFICE USE ONLY f &p, c'
GNATURE OF PERSON CONSTRUCTING THE WELL DATE
Quad No: Submit original to Division of Water Quality,Groundwater Section within 30 days
GW-1 REV.1259
Serial No.

North Carolina - Department of Environment and Natural Resources-Division of Water Quality-Groundwater Section
1636 Mail Service Center-Raleigh, N.C.27699-1636- Phone[phone] 3 0 9 0 9 3
WELL CONSTRUCTION RECORD WELL CONTRACTOR: Dewey Wright Well Pump Co., Inc.
WELL CONTRACTOR CERTIFICATION#: 2686
050044 STATE WELL CONSTRUCTION PERMIT#: Leslie Reece
1. WELL USE (Check Applicable Box): Residential 0 Municipal El Industrial 0 Agricultural 0 Monitoring ❑
Recovery El Heat Pump Water Injection E] Other EJ If Other, List Use:
2. WELL LOCATION: (Show sketch of the location below)
Nearest Town: I INVII I F County: AVFRV
RI l I<LdWG VVAV (1FF RA[JF�FF AI�PTFh(WAY GFF
(Road Name and Numbers, ommunrty,or ub rvision antlT[ o. DRILLING LOG DEPTH
3. OWNER r-cnor_c MACHADO From To Formation Description
Address % cnv CONlcTn 921P-1 HVVY 105 COUTF_I 0 126 FLIRT RANQ
r or Ron[e No.l 126 183 GRANITE
BANNER NC 28804 —
ccy or Town zir,code 183 184 RHAI F
4. DATE DRILLED 2/2/2005 184 222 GRANITE
5. TOTAL DEPTH 240 222 224 SHALE
6. CUTTINGS COLLECTED YES El NO 0 924 240 GRANITE
7. DOES WELL REPLACE EXISTING WELL? YES 0 NO
ETI
8. STATIC WATER LEVEL Below Top of Casing: BO FT.
(Use'."if Above Top of Casing)
9. TOP OF CASING IS 1 FT.Above Land Surface*
`Top of casing terminated at/or below land surface requires a variance in actor- 3 -
dance with 15A NCAC 2C.0118 A .q
10. YIELD (gpm): 40 METHOD OF TEST Air fV
11. WATER ZONES (depth)-l0 00 ppm 183-184 310NMm 222-224 �-
0 0D ppm O.00apm
12. CHLORINATION: Type HTH Amount 32 If additional space is needed use b of fom
13. CASING: LOCATION SKETCH aWall Thickness
Depth Diameter or Weight/Ft. Material `(Show direction and distance from at least two State
From 0 To 133 Ft. a 11e ..350 PVC Jt�W Roads,or other map reference points)
From To Ft.
From To Ft.
14. GROUT:
Depth Material Method
From 0 To 20 Ft. Cement Gravity Floev
From To Ft.
15. SCREEN:
Depth Diameter Slot Size Material \
From To_ Ft. in. in.
From To_ Ft. in. in.
From To Ft. in. - in.
16. SAND/GRAVEL PACK: \Iy K
Depth Size Material I
From To _ Ft. DIY
From To _ Ft. \�
17. REMARKS: wid
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C,WELL
CONSTRUCTION STANDARDS,AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER.
FOR OFFICE USE ONLY
SI ATURE OF PERSON CONSTRUCTING THE WELL DATE .
Quad No: Submit original to Division of Water Quality,Groundwater Section within 30 days
GW-1 REV. 12/99
Serial No.

North Carolina- Department of Environment and Natural Resources-Division of Water Quality-Groundwater Section
1636 Mail Service Center-Raleigh,N.C.27699-1636-Phone[phone] 309097
WELL CONSTRUCTION RECORD WELL CONTRACTOR: Dewey Wright Well Pump Co., Inc.
WELL CONTRACTOR CERTIFICATION#: 2791
050032 STATE WELL CONSTRUCTION PERMIT#: Adbert Slate
1. WELL USE(Check Applicable Box): Residential 0 Municipal El Industrial El Agricultural El Monitoring 0
Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use:
2. WELL LOCATION:(Show sketch of the location below)
BANNER cl . AVE v
Nearest Town: � R County.
LOT 7- S- 9ViPd K RIUER OFF HWY 194
(Road Name and umbers,community,or bubdivisioo and Lot 140.1 DRILLING LOG DEPTH
3. OWNER EARL POWELL From To Formation Description
Address %GREENLEAF SERVICES 1532 LINVILLE FALLS H 0 45 DIRT
LINVILLE' treetor Rout.No.) NC 28646 45 175 LIMESTONE
cry or Town State L,p Code 176 176 CREVICE
4. DATE DRILLED 1/27/2005 176 295 LIMESTONE #
5. TOTAL DEPTH 400 295 296 CREVICE
6. CUTTINGS COLLECTED YES L] NO © 296 310 LIMESTONE
7. DOES WELL REPLACE EXISTING WELL? YES ❑ NO E] 310 355 GRANITE
8. STATIC WATER LEVEL Below Top of Casing: 100 FT. 355 356 CREVICE
(Use",'if Above Top of Casing) 356 400 GPANITE ^I
9. TOP OF CASING IS 1 FT.Above Land Surface*
Top of casing terminated at/or below land surface requires a variance in actor-
dance with 15A NCAC 2C.QL18
10. YIELD (gym): ODVV METHOD OF TEST Air
11. WATER ZONES (depth): 7.00 flpm 175-17b a.00gprn 295-296
B5.00gpm355-355 0.0oppm o
12. CHLORINATION: Type HTH Amount 60 If additional space is needed use baca fora I
13. CASING: Wall Thickness LOCATION SKETCH
Depth Diameter or Weight/Ft. Material (Show direction and distance from at least two Slate
From 0 To 02 Ft. 6 1/8 .350 PVC p� Roads,or other map referen�points)
From To Ft. b,otQ 105 IN
From To Ft.
14. GROUT: GW" re
Depth Material Method
From 0 To 20 Ft. Cement Gravity Flow 4j �u} ,\
From To Ft.
15. SCREEN: K
Depth Diameter Slot Size Materi N�SA
From To Ft. in. in.
From To Ft. in. in.
From To Ft. in. in.. � k
16. SAND/GRAVEL PACK:
Depth Size Material
From To Ft. 9� 'Y
From To Ft.
17. REMARKS: I�
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C,WELL
CONSTRUCTION STANDARDS,AND THAT A COPY
JOF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNE7R.-7
FOR OFFICE USE ONLY (wl� �AG�/ki�Y l / 40
SIGNATURE OF PERSON CONSTRUCTING THE WELL -DATE
Quad No: Submit original to Division of Water Quality,Groundwater Section within 30 days
GW-1 REV.12/99
Serial No.

CO
North Carolina-Department of Environment and Natural Resources-Division of Water Quality-Groundwater Section
1636 Mail Service Center-Raleigh, N.C.27699-1636-Phone[phone] J 0 J 1 0 i'7
WELL CONSTRUCTION RECORD WELL CONTRACTOR: Dewey WrightYVell Pump Co., Inc.
WELL CONTRACTOR CERTIFICATION#: 2791
RM 050060 STATE WELL CONSTRUCTION PIEITM Albert Slate
1. WELL USE(Check Applicable Box): Residential 0 Municipal 0 Industrial El Agricultural 1:1 Monitoring ❑
Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use:
2. WELL LOCATION:(Show sketch of the location below)
Nearest Town: BANNER ELK County: AVERY
BUCKEYE RD. OFF 321 OFF 421
(Road Name and Numbers, ommunity,or Subdivision and Lot No.l DRILLING LOG DEPTH
3. OWNER DARYL G ESTEP From To Formation Description
890 BUCKEYE RD. , 0 2 DIRT
Address
ELK PARKnaetnr Route No.) NC 26822 2 45 GRANITE
City or Town State Zip Code 45 110 QUARTZ GRANITE
4. DATE DRILLED 2117/2005 110 120 QUARTZGRANITE j
5. TOTAL DEPTH 200 120 200 QUARTZGRANITE r
6. CUTTINGS COLLECTED YES 0 NO 0
7. DOES WELL REPLACE EXISTING WELL? YES [] NO 0
8. STATIC WATER LEVEL Below Top of Casing: 40 FT.
(Use"+"if Above Top of Casing) �.
9. TOP OF CASING IS 1 FT.Above Land Surface*
'Top of casing terminated at/or below land surface requires a variance in accor-
dance with 15A NCAC 2C. 118-
10. YIELD (gpm): 10 METHOD OF TEST Aar 1
11. WATER ZONES (depth);10.00 ppm 110-120 O.00ppm '
0.00 porn 0.00Qpm
12. CHLORINATION: Type HTH Amount 32 If additional space is needed use back of for
13. CASING: Wall Thickness LOCATION SKETCH
Depth Diameter or Weight/Ft. Material (Show direction and distance from at least two State
prom 0 To 21 Ft. 9 1/8 .350 PVC u,^(� Roads,or other map reference points)
From To Ft. a:
From To Ft.
14. GROUT:
Depth Material Method
From 0 To 20 Ft. Cement Gravity Flow /1
From To Ft. —"
�\
15. SCREEN:
Depth Diameter Slot Size Material
From To_ Ft. in. in.
JJ �7
From To Ft. in. in.
From To Ft. in. in.
16. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To _ Ft.
17. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C,WELL
CONSTRUCTION STANDARDS,AND THAT A COPYOF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER. C
FOR OFFICE USE ONLY dAe�. X 1Q L :zPR
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
Quad No: Submit original to Division of Water Quality,Groundwater Section within 30 days
GW-1 REV.12/99
Serial No.

31051. i
WELL CONSTRUCTION RECORD
North Carolina- Department of Environment and Natural Resources- Division oof�Water
t,Quality-Groundwater Section �y
w'ELL CON'T'RACTOR(INDIVIDUAL)NAME (print) ra. I ell,A..) 3,-'V CERTIFICATION# �5-9�]0
w'ELI,CONTRACTOR COMPANY NAME if 11-+(-1�LII li� I� 1h ' t.0 PHONE # !, 7
STATE\YELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable) / (if applicable)
I. WELL USE(Check Applicable Box): Residential [I Municipal/Public ❑ Industrial ❑ Agricultural ❑
Monitoring ❑ Recovery ❑ Heat Pump Water Injection❑ Other ❑ If Other, List Use
2. WELL LOCATION: J J� Topoggraa hic/Land setting
NearestTown: �Ik '1�i. -� ` County �t-?,� ❑Ridge IdSlope ❑Valley ❑Flat
2� r'Is.-�y ��r/ (check appropriate box)
(Street Name.Nfuimber�s,,Community, bdivisionn,,yLot No.,Zip Code) Latitude/longitude of well location
3. OWNER: /�f iQll �FNV (degrees/minutes/seconds)
Address f� Latitude/longitude source:❑GPS❑Topographic map
(Scree[or Route No.) (check box)
k �ji-'��J Jl.�� je:?7� DEPTH DRILLING LOG
City or Town State Zip Code From To Formation Descst. I.on
62-5)- 733-6)V
Area code-Phone number
4. DATE DRILLED -
5. TOTAL DEPTH: 2'qc>
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO
7. STATIC WATER LEVEL Below Top of Casing:_AFT. `
(Use"+"if Above Top of Casing)
S. TOP OF CASING IS FT.Above Land Surface" 'p0
`Top of casing terminated at/or below land surface requires a
variance in accordance with 15A NCAC 2C.0118. N
9. YIELD (gpm): METHOD OF TEST .4)ft _
10. WATER ZONES(depth): /Z-l5; �2E)
LOCATION SKETCH
11. DISINFECTION: Type ° Amount C0 eN . Show direction and distance in miles from at Ieast��
12. CASING: Wall Thickness two State Roads or County Roads. Include the rol
Depth� Diameter or%eiiS Et. Mat tat numbers and common road names.
From �
e To FLL Sl ,
From To Ft.
From To Ft.
13, GROUT: Depth . Material Method
From
t� To' FL '�c.YL I y
From To_5, F .
14. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in.
From To Ft. in. in.
15. SAND/GRAVEL PACK: �IkP4e
Depth Size Material ..
From To Ft.—
From—To—Ft. --
16. REMARKS: - z
f
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C WELL
CONSTRUCTION STANDARDS,AND THATA COPY OF TTH�14aa O HAS BEEN PROVIDED TO THE Wli . OWNERS
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 _

CI
10
North Carolina-Department of Environment and Natural Resources-Division of Water Quality-Groundwater Section 14 V
1636 Mail Service Center-Raleigh,N.C. 27699-1636-Phone[phone]
WELL CONSTRUCTION RECORD WELL CONTRACTOR: Dewey WrightlAtell Pump Co. Inc
WELL CONTRACTOR CERTIFICATION#: 2686
050080 STATE WELL CONSTRUCTION PERMIT#: Leslie Reece
1. WELL USE(Check Applicable Box): Residential 'El
Municipal 0 Industrial 0 Agricultural D Monitoring
Recovery E] Heat Pump Water Injection Other D If Other,List Use:
2. WELL LOCATION:(Show sketch of the location below)
Nearest Town: RANNFR FI K County: At1FRY
HICKC'lRY NI 1T C'AP Rf1 [lFF 1Rd f1FF 105
IRoaA Name antl umbers,Commumry,or Sub rvision and Lot M1To.l DRILLING LOG DEPTH
3. OWNER 10SEPH a HEMEEI IND From To Formation Description
Address 2
n 62 nIRT
RANNFR Y-Rome No.) NC` 7R19DA fi7 47 r"PANITF
City or Town FS State Zip ode H F
a7 PA AI
4. DATE DRILLED R11119005 aR 17F CPnhnTF
5. TOTAL DEPTH Inn, 171i 178 coal c
6. CUTTINGS COLLECTED YES El NO ® 17A 205 --
7. DOES WELL REPLACE EXISTING WELL? YES D NO ® f
8. STATIC WATER LEVEL Below Top of Casing: 190 FT. n
— -
(Use"+"if Above Top of Casing) —t t
9. TOP OF CASING IS 1 FT.Above Land Surface*
*Top of casing terminated at/or below land surface requires a variance in accor-
dance with 15A NCAC 2C.0118
10. YIELD(gpm): Q— METHOD OF TEST Air
11. WATER ZONES (depth): 3.00 aom 97-98 7 0oaom 175-176
0.00 Dom 0 00oom
i2. CHLORINATION: Type HTH Amount 31 If additional space is needed use back of form
13. CASING: Wall Thickness LOCATION SKETCH
Depth Diameter or Weight/Ft. Material (Sho erection and distance from at least two State
From 0 To 86 Ft. 8118 spin P'dC V� 'Roads,or other map reference pointsOl
From To Ft. ��' v
From To Ft.
14. GROUT: (� r
Depth Material Method
\� to
From D To 9n Ft. !"'emenf C'ravity Flow 3t8
From To Ft. 1Ir� lam'
15. SCREEN:
Depth Diameter Slot Size Material
From To Ft. in. in.
From To Ft. in. in. - - — -
From To Ft. in. in. .t---'
16. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
i
From To Ft. _
i
17. REMARKS: c�
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C,WELL o
CONSTRUCTION STANDARDS,AND THAT IA�COOPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OVVNER.
FOR OFFICE USE ONLY "u 11D9�0 ( ' A —0-5
NATURE OF PERSON CONSTRUCTING THE WELL DATE
Quad No: Submit original to Division of Water Quality,Groundwater Section within 30 days
GW-1 REV.12/99
Serial No.

North Carolina-Department of Environment and Natural Resources Oivision of Water Quality-Groundwater Section OwlL —
1636 Mail Service Center-Raleigh, N.C. 27699-1636-Phone[phone]
}, 1
WELL CONSTRUCTION RECORD WELL CONTRACTOR: L'evie-."!%fright Vefl Pill-in Co
WELL CONTRACTOR CERTIFICATION#: 2 ?B
STATE WELL CONSTRUCTION PERMIT# Li2die rRfifCe,
1. WELL USE(Check Applicable Box): Residential 0 Municipal 0 Industrial 0 Agricultural❑ Monitorinq--�
Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use:
i
2. WELL LOCATION: (Show sketch of the location below)
Nearest Town: Aatardl=p ct ce County: 4,,PR`-
r +al (= Ft t G= an t c -�
(Road ame an umbers, ommunity.or u3`Tid vs on and Lotol -'
DRILLING LOG PT
3. OWNER - +^t"-rART R i IELF2 LIE— 1r;(( '.HE From To Forma!mDe Hptiei _ '----
Address add CHART (F FI ' F.R Rr,
(Street or Route No.)
for own State Zip Lode
E1 R? c;-tAl
4. DATE DRILLED =t8i2iQC"5 P, ps; RZ rt1_1
5. TOTAL DEPTH 120
6. CUTTINGS COLLECTED YES El NO
7. DOES WELL REPLACE EXISTING WELL? YES O NO 0
8. STATIC WATER LEVEL Below Top of Casing: IQ FT. "}
(Use"d'if Above Top of Casing)
9. TOP OF CASING IS 1 FT.Above Land Surface* 1
`Top of casing terminated at/or below land surface requires a variance in actor- -j
dance with 15A NCAC 2C.0118
10. YIELD(gpm): 40 METHOD OF TEST A' (=3
CA
11. WATER ZONES (depth): 2-LOgCm0 -5: 32.00 7n `!E'- "2 <+gg
�'.IZD gi7m .D'jgGri'i ail
12. CHLORINATION: Type M T H Amount 19 If additional space is needed use back of form
13. CASING: LOCATION SKETCH
Wall Thickness '
Depth Diameter or Weight/Ft. Material (Show direction and distance from at least two State
From 11 To '1 Ft. 8 10 'RR --,Al l+ Roads,or other map reference points)
From To Ft.
From To Ft. `
14. GROUT:
Depth Material Method
From 0 To - Ft. ="rner;i <.;ret-ifv F}ct•� v j -
From To Ft.
15. SCREEN:
Depth Diameter Slot Size Material �a
From To Ft. in. in. 4' 114
From To Ft. in. in. L' _� -� •
From To Ft. in. in.
16. SAND/GRAVEL PACK:
Depth Size Material
From To Ft Y
J
From To Ft.
17. REMARKS:
r
I DO HEREBY CERTIFY THATTHIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C,WELL
CONSTRUCTION STANDARDS,AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER.
FOR OFFICE USE ONLY / I, T _g b _
05
SIGNATURE 0 RSON CONSTRUCTING THE WELL - DATE
Quad No: Submit original to Division o ater Quality,Groundwater Section within 30 days
GW-1 REV.12/99
Serial No.

North Carolina-Department of Environment and Natural Resources-Division of Water Quality-Groundwater Section 3 4 °j
1636 Mail Service Center- Raleigh, N.C.27699-1636-Phone[phone] eD 1
WELL CONSTRUCTION RECORD WELL CONTRACTOR: Oeele i` .a}r.``>` II Pump _u inr:.
WELL CONTRACTOR CERTIFICATION#: 1ti6.1
G5u0G7 STATE WELL CONSTRUCTION PERMIT#: r.teve F'Ctl'J
1. WELL USE (Check Applicable Box): Residential ❑` Municipal❑ Industrial ❑ Agricultural❑ -Monitoring ❑
Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use:
2. WELL LOCATION:(Show sketch of the location below)
Nearest Town: v,t=F,4 ;F! ^ County: a'�.if=R'!
f�RF otiY ra'f Hr'FRR
(Road Name and Numbers, ommuniry,or Su division antl Lot o.l DRILLING LOG DEPTH _
3. OWNER E "FIA tr A 4'R= hPEG From To Formation-Description
Address ' `�l ' +oGtAV'::�o,. ii 70RT
S4 �i - "'JI f1f'•1C_:y`IGS F'1 '.i,_..{it�l 2B 52 MG1Q T-7'
City or Town State Zip Code
- F� `;F1A1 ['
4. DATE DRILLED 119i OO5 5R i'IR C,RAN!T�
5. TOTAL DEPTH 12i 74R IP MI-I-iF
6. CUTTINGS COLLECTED YES ❑ NO ❑ 11p %8 ,RAP,ItTF
7. DOES WELL REPLACE EXISTING WELL? YES ❑ NO
8. STATIC WATER LEVEL Below Top of Casing: } FT.
(Use',"if Above Top of Casing)
9. TOP OF CASING IS 1 FT.Above Land Surface* N`=
-Top of casing terminated at/or below land surface requires a variance in actor-
dance with 15A NCAC 2C.0118 ZiE"
10. YIELD (gpm): :30 METHOD OF TEST Air
11. WATER ZONES (depth): 5.00 QDr" [3 6.'010op 1 1 8-119
O,00 pDm 0.00win
12. CHLORINATION: Type h7`4 Amount 22 If additional space is needed use bpp of f U.rym
13. CASING: wall Thickness LOCATION SKETCH
Depth Diameter or Weight/Ft. Material (Show direction and distance from at least two State
From 'O To 12 Ft. ` 113 35C r`I( `- Reads,or other map reference points)
From To Ft.
r,
From To Ft.
� � I
14. GROUT:
Depth Material Method `. i
From 0 To 20 Ft. Cerren! i�ra'•rihl FVcvr, = ='�:r
From To Ft.
/
15. SCREEN:
Depth Diameter Slot Size Material = j
From To Ft. in. in. `..I.
From To Ft. in. in.
From To Ft. in. in. ( - ---1
c¢ 1
16. SAND/GRAVEL PACK: �C
Depth Size Material
From To Ft. j
From To Ft. I
i
17. REMARKS: �'`
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCbF D ANCE WITH 15A NCAC 2C,WELL
CONSTRUCTION STANDARDS,AND THAT A COPY
�OOFF THIS RE,CCOORD HAS BEEN PROVIDED TO THE WELL OWNER.
FOR OFFICE USE ONLY " " ' Z
SIGNATgf1 E OF PERSON CONSTRUCTING THE WELL DATE
Quad No: Submit original to Division of Water Quality,Groundwater Section within 30 days
GW-1 REV.12/99
Serial No.

3 12 1 er i
North Carolina-Department of Environment and Natural Resources-Division of Water Quality-Groundwater Section
. 1636 Mail Service Center-Raleigh,N.C.27699-1636-Phone[phone]
WELL CONSTRUCTION RECORD WELL CONTRACTOR: D,ave`; `Vri�jutt`lvei Puro.P Co snit
WELL CONTRACTOR CERTIFICATION#: 2278
"50165 STATE WELL CONSTRUCTION PERMIT#: �te''e Pr.c=
1. WELL USE(Check Applicable Box): Residential 0 Municipal❑ Industrial ❑ Agricultural❑ ;Monitoring:❑
Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use: 1
I .
2. WELL LOCATION:(Show sketch of the location below)
Nearest Town: SUGARGR ;= County: AVEP-
AT tPG{NGS Rt OFF s as ' F
(Road Nameand Numbers, ommuniry,or 5ut,drvision end Lot No.) DRILLING LOG aEPTH
3. OWNER rAlh Fi4kA01'S From To Formation Descriptipa-
Address :3707 FLAT SPRI14GS RED 0 7dPT MUQ
beet or Route No.l - � . "- -
PAd�t��. iri<<� G3Cii1 56 [10 G'i?.ANITF
1tyorTown state "Code 210 211 RE[)GIRANITE
4. DATE DRILLED 'u` Al='f%�` 11 21 GRANITE
5. TOTAL DEPTH �A05 270 271 RED. OP.ANI T`=
;771 ;igo GaP,A.I'II TE
6. CUTTINGS COLLECTED YES ❑ NO 0 _
7. DOES WELL REPLACE EXISTING WELL? YES ❑ NO ❑ 3if, --.31 -F -rr?cf'1i7,
8. STATIC WATER LEVEL Below Top of Casing: 2'C FT. 391 ar3 , 117R=a?3 Tc
(Use"+"if Above Top of Casing) C.;w-
9. TOP OF CASING IS 1 FT.Above Land Surface*
"Top of casing terminated at/or below land surface requires a variance in actor- J`
dance with 15A NCAC 2C.0119 ram}---
10. YIELD (gpm): METHOD OF TEST Air -
11. WATER ZONES (depth). D,50 ""210-211 0 50 770 271 t'
00 sAnm 380-'191 0.00vlam
If additional space is needed use back of for '
12. CHLORINATION: Type FiTN Amount 78
13. CASING: Wall Thickness LOCATION SKETCH
Depth Diameter or Weight/Ft. Material (Show direction and distance from at least two State
From To 00 Ft. f 1/5 350 FsV f Roads,or other map reference points)
From To Ft.
From To Ft.
14. GROUT:
t
Depth Material Method /
From n To 20 Ft:
From To Ft.
15. SCREEN: A
rf
Depth Diameter Slot Size Material
From To Ft. in. in.
From To Ft. in. in.
From To Ft. in. in.
16. SAND/GRAVEL PACK: �
Depth Size Material
From To Ft.
From To Ft. �
17. REMARKS:
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.
FOR OFFICE USE ONLY
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
Quad No: Submit original to Division of Water Quality,Groundwater Section within 30 days
GW-1 REV.12/99
Serial No.

yy A
North Carolina- Department of Environment and Natural Resources-Division of Water Quality-Groundwater SectiO 3 ? Y }
1636 Mail Service Center-Raleigh,N.C. 27699-1636-Phone[phone]
WELL CONSTRUCTION RECORD WELL CONTRACTOR: Dewey VMcil-ft V40 R mr Co lr~i-.
WELL CONTRACTOR CERTIFICATION#:
STATE WELL CONSTRUCTION PERMIT#:
r_
1. WELL USE (Check Applicable Box): Residential 0 Municipal 0 Industrial ❑ Agricultural 0 ,Monitoring 0 1
Recovery 0 Heat Pump Water Injection 0 Other ❑ If Other, List Use: `!
2. WELL LOCATION:(Show sketch of the location below)
Nearest Town I tN'01 I County:
. a u u OFF J T VY ,21 ¢ 1ID 5
4oaidN: d RNmNeF oJm:m'`Inny, ...,
or Subdivision and Lot No.) +
DRILLING LOG DEPTH
P.l"-AR rvRr—c• AT I I^.V+I i =r i f From To Formation Descri ti rf• I'
3. OWNER rF p �
Address F' C 1(2+2 "2U'C1 0 7E1 [''IRT
FlSireet orRoute No.) (.it: ;"� 1 Al
ity or Town State Zip Code
121"t 121 QL iARTZ
4. DATE DRILLED 511%j;[t!7i 121 165 GIRNiTE -- - -
5. TOTAL DEPTH 20t 1U5 1,37 OLfART
6. CUTTINGS COLLECTED YES 0 NO El 18' 208 GRANITE
7. DOES WELL REPLACE EXISTING WELL? YES 0 NO 0 n
8. STATIC WATER LEVEL Below Top of Casing: FT.
(Use"+"if Above Top of Casing)
9. TOP OF CASING IS FT. Above Land Surface* Z =
'Top of casing terminated at/or below land surface requires a variance in accor-
dance with 15A NCAC 2C.0118
10. YIELD (gpm): ;5 METHOD OF TEST Par +'
11. WATER ZONES (depth): 3.00 nrcrin?29-121 12,010 ppm 1&5-13? CA
0.00 opm 0.00pc-m
12. CHLORINATION: Type HTL4 Amount 35 If additional space is needed use back of form
13. CASING: Wall Thickness LOCATION SKETCH
Depth Diameter or Weight/Ft. Material (Show direction and distance from at least two State
From O To 75 Ft. f? 1L3 35r' MN�c Roads, or othe¢map reference points)
From —To —Ft.— — — i
From —To —Ft.— — — n�)rr _,>'� f �> ' t•,1`'
1
14. GROUT:
Depth Material Method
From 0 To Ft. ;;Erient Grauty Flctti t
From To Ft. 1
15. SCREEN:
Depth Diameter Slot Size Material
From To Ft. in. in.
From To Ft. in. in. •�
From To Ft. in. in.
16. SAND/GRAVEL PACK:
Depth Size Material
From To Ft. f J
From To Ft.
17. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C,WELL
CONSTRUCTION STANDARDS,AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER.
1S.f7,2 e
FOR OFFICE USE ONLY &/ . �zz
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
Quad No: Submit original to Division of Water Quality,Groundwater Section within 30 days
GW-1 REV.12/99
Serial No.

North Carolina-Department of Environment and Natural Resources-Division of Water Quality-Groundwater Sectior}y
7636 Mail Service Center- Raleigh,N.C. 27699-1636-Phone[phone] Cd - iW
WELL CONSTRUCTION RECORD WELL CONTRACTOR: 23° e" P'_,rr,Ip (o inc
WELL CONTRACTOR CERTIFICATION#: i a
0"0170 STATE WELL CONSTRUCTION PERMIT#: Steve "rice
1. WELL USE(Check Applicable Box): Residential 0 Municipal ❑ Industrial ❑ Agricultural❑ Monitoring ❑
Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use:
2. WELL LOCATION:(Show sketch of the location below)
Nearest Town: itIVE SHiFLC, County: / VERY
FOX Ii1FAP01N RD. [,.Fr SHOEMAKPR 'MF'. OFF: 194 OFF
(Road Name and Numbers,Community,or Subdivision and Lot No.l DRILLING LOG DEPTH
3. OWNER LARR`z SCH-cFS From To Formation Description
Address o E&K COM1iSTR. . 0212_t H,VV 10` _S 0 5.4 C°iRT
-ti a (Sire l or Route No.l
Idv 2'8619 5.4 i5D GRANITE
City or Town State ➢p Code
150 `!?ti1 '7UaRTZ
4. DATE DRILLED 511 J20,35 151 280 GFJ NI'tE
5. TOTAL DEPTH 305 260 2c1 �UAf T?
6. CUTTINGS COLLECTED YES ❑ NO El -'tl'• ''05 '^�° 7P
7. DOES WELL REPLACE EXISTING WELL? YES ❑ NO
8. STATIC WATER LEVEL Below Top of Casing: 40 FT. T:'i
(Use"+"if Above Top of Casing)
9. TOP OF CASING IS 1 FT.Above Land Surface*
'Top of casing terminated at/or below land surface requires a variance in accor-
dance with 15A NCAC 2C.011a '' x
10. YIELD (gpm): 10 METHOD OF TEST Sir ., F
11. WATER ZONES (depth): 2 rr1 prnIE7-1`1 't; 00rt_ , 22u-281.
-".0Q Gpm 3 af_gPn1 ?
12. CHLORINATION: Type Hil-f Amount 5°t If additional space is needed use back o[form
13. CASING: ,I LOCATION SKETCH
Wall Thickness [[�
Depth Diameter or Weight/Ft. Material JS�fiow direction and distance from at least two State
From 0 To CIO Ft. A 'S'8 '=t0 F``�j`' (:t�� Roads,or other map reference points)
From To Ft. t a li i.
From To Ft. I$��
14. GROUT:
Depth Material Method
From ''' To Ft. r212122t C;rrb,,Ay FioAv
From To Ft.
�� C1
15. SCREEN:
Depth Diameter Slot Size Material - I
From To Ft. in. in.
From To Ft. in. in.
From To Ft. in. in.
I >_ I
16. SAND/GRAVEL PACK:
Depth Size Material
From To Ft. l
From To Ft.
17. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C,WELL
CONSTRUCTION STANDARDS,AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER.
FOR OFFICE USE ONLY Jk� 6�J;L_ S--`)`S CAS
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
Quad No: Submit original to Division of Water Quality,Groundwater Section within 30 days
GW-1 REV.12/99
Serial No.

CLW '12
North Carolina-Department of Environment and Natural Resources-Division of Water Quality-Groundwater Section
1636 Mail Service Center- Raleigh,N.C. 27699-1636-Phone[phone]
WELL CONSTRUCTION RECORD WELL CONTRACTOR: "f '°'{''�r "'' J t^tp Co'' i ic
WELL CONTRACTOR CERTIFICATION#:
5a0327 STATE WELL CONSTRUCTION PERMITM 12= li2a
1. WELL USE(Check Applicable Box): Residential 0 Municipal E] Industrial El Agricultural EJ hl'0 hiring C _
Recovery E] Heat Pump Water Injection El Other 0 If Other, List Use: -
2. WELL LOCATION:(Show sketch of the location below) A,
Nearest Town: iNVERSHIELI: County: A-VER't' j
DEER O'REEK FALLS OFF BEECH NM1 4 Fr''K,0w"i' OFF 101
(Road Name and Numbers,Community,or Subdivision and Lot No.l
DRILLING LOG DEPIki -
3. OWNER HUMBLE EEH BLDRS. From To Formation De§cl:iption
Address 550 DEER CREEK FALLS CR. C !;T
Ir or Route No.l
B4ut•sE s r� Jt 2'qC 4 120 -RaJ4!T i
iry or Town State Zip Code 120 i 2 i CAJA RTZ. --
4. DATE DRILLED 5/1E''_0;05 121 2313 GRANITE
5. TOTAL DEPTH 4015 230 2 31 Q (. ;T:
6. CUTTINGS COLLECTED YES NO 231 2'.011 r, A°'`TF
7. DOES WELL REPLACE EXISTING WELL? YES [— NO ELI =1D R4I
8. STATIC WATER LEVEL Below Top of Casing: 9U0 FT. .321 '-'),15
(Use"+"if Above Top of Casing) p�
9. TOP OF CASING IS ' FT. Above Land Surface*
'Top of casing terminated at/or below land surface requires a variance in accor-
dance with 15A NCAC 2 .0118
10. YIELD (gpm): ' METHOD OF TEST Air
11. WATER ZONES (depth): 1.00 qpm 120-121 1,DOpprm 2:3t1-"1 t.
QDm'3yU-:w U.100nprrl
12. CHLORINATION: Type HT I' Amount F10 If additional space is needed use back of form
13. CASING: wall Thickness LOCATION SKETCH
Depth Diameter or Weight/Ft. Material (Show direction and distance from at least two State
From 0 To 1< Ft. 0119 -s`D F"-"C Roads, or other map reference points) t\
From To Ft.
From To Ft. rr
14. GROUT: /
Depth Material Method
From 0 To Mr Ft. Ceneent OraNltj Prow
From To Ft.
l�M1ki
15. SCREEN:
Depth Diameter Slot Size Material '�--
From To Ft. in. in.
From To Ft. in. in.
From To Ft. in. in.
16. SAND/GRAVEL PACK:
Depth Size MaterialFrom To Ft. rK
From To Ft.
t.
} a Q
17. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C,WELL
CONSTRUCTION STANDARDS,AND THATA COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER.
FOR OFFICE USE ONLY '�''�'�� Ael� ',!�
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
Quad No: Submit original to Division of Water Quality,Groundwater Section within 30 days
GW-1 REV.12199
Serial No.

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources- Division of Water Quality-Groundwater Section
WELL CONTRACTOR(INDIVIDUAL)NAME
�N((prin�t1)- �IA��✓ ^1Tyl� f CERTIFICATION# 25 q
WELL CONTRACT OR COMPANY NAME ' • 1 T[1he.11 -�� 1 A � 1vJSA PHONE # " `16S'-.aZLtq1
S'f.\'TE\\'ELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
I. WELL USE(Check Applicable Box): Residential B"Municipal/Public ❑ Industrial ❑ Agricultural ❑
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other❑ If Other, List Use
2. WELL LOCATION: A Topographic/Land setting
Nea j,st Town: 'IAtiJA County Aqe_- q EKI'dge ❑Slope ❑Valley ❑Flat
/, �J�t e� ?,-� IA x, `A - - MA-e (check appropriate box)
(Street Name.Numbers,Community,Subdivision,Lot No.,Zip Code) Latitude/longitude of well location
3. OWNER: Pi (degrees/minutes/seconds)
Address a�q o 3 mS i' Latitude/longitude source:❑GPS❑Topographic map
(Stye t or Route No.) (check box)
NQc_v) Ad >� DEPTH DRILLING LOG
City or Toovw"n State Zip Code From To Formation Description
`
P—g71&)- --,Xc1 t---< Doti .1 a
Area code-Phone number SR/'mail
4. DATE DRILLED C._G
R .
5. TOTAL DEPTH:
6. DOES WELL REPLACE EXIS ING WELL? YES ❑ NO LT
7. STATIC WATER LEVEL Below Top of Casing: FT.
(Use'Y'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 accordanre with 15A NCAC 2C.0118.
9. YIELD(gpm): 'G, METHOD OF TEST__Ari G
10. WATER ZONES(depth):_� �e—Tf 3tio _4
LOCATION SKETCH tJ1
11. DISINFECTION: Type o Amount C,CaT Show direction and distance in miles from at st
12. CASING: Wall Thickness two State Roads or County Roads. Include thCLAad
Depth Diameter or Weight/Ft. Material numbers and common road names.
From To t�( Ft. _�tpg.-at PVC. T7
From To Ft.
From To Ft.
13. GROUT: Depth Material Method
From ,2 Tom FL
From To Ft. ( J17
L
14. SCREEN: Depth Diameter Slot Size Material
From To Ft, in. in. tri.y 196. �� -'-� r— �- -"i
From To Ft. in. in.
15. SAND/GRAVEL PACK: o I
Depth Size Material
From To Ft.
From To Ft.
L -
16. REMARKS:
L---------------
1 DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C,WELL
CONSTRUCTION STANDAR S,AND THAT ACD0TYQF T S 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

North Carolina-Department of Environment and Natural Resources-Division of Water Quality-Groundwater Section 1 1 LI 6 2 y
1636 Mail Service Center-Raleigh,N.C.27699-1636-Phone[phone]
WELL CONSTRUCTION RECORD WELL CONTRACTOR: C-ev-,ey' Vynipih: r,4ii Pv-,p Co., In_.
WELL CONTRACTOR CERTIFICATION#: fUS7
O'"021I_'7 STATE WELL CONSTRUCTION PERMIT#: `teve ReeuN
t is
1. WELL USE(Check Applicable Box): Residential El Municipal E] Industrial El Agricultural Monitoring Ei
Recovery Heat Pump Water Injection Other 0 If Other, List Use:
2. WELL LOCATION:(Show sketch of the location below)
Nearest Town: I tN}i/!I I F County: -
�NlytilTF t=,R C1FF' i'IaC=,r"14.1T Frr' '?F!•" �aR^+ '^V • -
(ROddNameantl umoers, ommunity,orSubdivisionandLotNo.l DRILLING LOG I `DEPTH
3. OWNER EOG 'ACKINiii-I i From To Formatioi Description -
Address q... F ) t F k• FI 711 FG I'df+ f-, r ±. "�,:{74F: " P?^. `t FFj
-�treet or out a No l -
I �`artliF Air_" .g63fiS -zg s0 izri4NiI;
City or Town State Zip Code
4. DATE DRILLED `;'+912205 311 R:iO GR..ANITF
5. TOTAL DEPTH ^it
6. CUTTINGS COLLECTED YES 0 NO 0
7. DOES WELL REPLACE EXISTING WELL? YES E] NO 0
8. STATIC WATER LEVEL Below Top of Casing: rt FT. c--
(Use"+"if Above Top of Casing)
9. TOP OF CASING IS 1 FT. Above Land Surface* N
'Top of casing terminated at/or below land surface requires a variance in accor-
dance with 15A NCAC 2C.0118
10. YIELD (gpm): 30 METHOD OF TEST Air l7 r
11, WATER ZONES (depth):31" 00 .PEA 792-801 0.00gprr
n.00 more, t't.Ocwri
12. CHLORINATION: Type HiTH Amount 14' If additional space is needed use back of form
13. CASING: Wall Thickness LOCATION SKETCH
- Depth Diameter or Weight/Ft. Material (Show direction and distance from at least two State �'••�
From 0 To 71Ft. R ?r9 ^y50 Atli` Roads, or other ma reference points)
P P f .i.
From To Ft.
From To Ft. y
14. GROUT: lIj
Depth Material Method
From C, To Ft, }; n..,.o
From To Ft. /
15. SCREEN:
Depth Diameter Slot Size Material
From To Ft. in. in. `
From To Ft. in. in.
From To Ft. in. in. •sl. r `-' `"'�
16. SAND/GRAVEL PACK:
Depth Size Material v�� ���, •a.
From To Ft. `+M"„Sra„ t� ; " •h•
From To Ft.
17. REMARKS:
1 DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C,WELL Cr
CONSTRUCTION STANDARDS,AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER.
FOR OFFICE USE ONLY ��"'"' (•���' " �"7 \ 0 "s
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
Quad No: Submit original to Division of Water Quality,Groundwater Section within 30 days
GW-1 REV.12/99
Serial No.

North Carolina-Department of Environment and Natural Resources-Division of Water Quality-Groundwater Section J 14
6 (;
a
1636 Mail Service Center- Raleigh,N.C.27699-1636-Phone[phone]
WELL CONSTRUCTION RECORD WELL CONTRACTOR: r%av+ / ' :;P f 'f•%e., Ft:'rr 'C'c . ,.c.
WELL CONTRACTOR CERTIFICATION#: 631
=tiU%73 STATE WELL CONSTRUCTION PERMIT#: zt t`"+
1. WELL USE(Check Applicable Box): Residential 0 Municipal ❑ Industrial ❑ Agricultural❑ Monitoting -'
Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use: ,...
C i
i
2. WELL LOCATION:(Show sketch of the location below) v
Nearest Town: I liNyHLLE County: .AVERV C?=, ^,u
PPI VATS DR OFF HW"Y 1f18 e•� �
(Food Name and Numbers,Community,or Subdivision and Lot No.)
DRILLING LOG DEPTH
3. OWNER s,AARK SN21-, From To Formation Description" r
Address 2'0 T.' HGS- .� f., � F 'M!fi' PJ.= r; .,r; L'.R I '
(`treat or oute No 1 1
9(O�aE i' ?St31T a5 a :5 ,:,s.A"ITF
City or Town State Zip Code IF -----
'
4. DATE DRILLED fille!2005 118 1 f t '�h1iTE'
5. TOTAL DEPTH 205 194 IR6 P#4AiE
6. CUTTINGS COLLECTED YES ❑ NO ❑ Bt Ry I' "E ;y
7. DOES WELL REPLACE EXISTING WELL? YES ❑ NO
8. STATIC WATER LEVEL Below Top of Casing: dl' FT. ^n
(Use"+'if Above Top of Casing)
9. TOP OF CASING IS 1 FT. Above Land Surfaces
'Top of casing terminated at/or below land surface requires a variance in actor-
dance with 15A NCAC 2C.0118
10. YIELD (gpm): 1170 METHOD OF TEST +air r,
11. WATER ZONES (depth): 3.00 Qpm 116-1155 g7.30clpm 12d-"i;8
0 00 qpm O.Drupr t
12. CHLORINATION: Type F,"11-{ Amount "D If additional space is needed use back of form
13. CASING: Wail Thickness LOCATION SKETCH
Depth Diameter or Weight/Ft. Material (Show direction and distance from at leas[two State
From Cf To ,1 ryQ Ft. F, 1,2 VVI t (I Roads,or other map reference points)
From To Ft.
From To Ft.
14. GROUT:
Depth Material Method
From Q To Ft. r l!Z1o,-Pf Gr. yit_' ricri%e
From To Ft. /
15. SCREEN:
Depth Diameter Slot Size Material
From To Ft. in. in.
From To Ft. in. in. _../
From To Ft. in. in.
16. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
c9NAF��
17. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C,WELL
CONSTRUCTION STANDARDS,AND THAT A COPY OF THIS REE^CCOO®RD HAS BEEN PROVIDED TO THE WELL OWNER.
FOR OFFICE USE ONLY ` " �` ;�' y— 0
SIGNATURE OF PERS CONSTRUCTING THE WELL DATE
Quad No: Submit original to Division of Water Quality,Groundwater Section within 30 days
GW-1 REV.12/99
Serial No.

North Carolina -Department of Environment and Natural Resources-Division of Water Quality-Groundwater Section 314528
1636 Mail Service Center- Raleigh, N.C.27699-1636-Phone [phone]
WELL CONSTRUCTION RECORD WELL CONTRACTOR: %'ewey v`vriEht VIsli =
WELL CONTRACTOR CERTIFICATION# 2661 _---- `"
STATE WELL CONSTRUCTION PERMIT#: G'eve Pete`
1. WELL USE(Check Applicable Box): Residential 0 Municipal Industrial 0 Agricultural Monitoring, I
Recovery E:] Heat Pump Water Injection 0 Other ❑ If Other, List Use:
2. WELL LOCATION:(Show sketch of the location below) 0
p AAlh"FP c
Nearest Town: t .v County:
WFFf`t-I rPT'�l Rfl C1CF ;=ik iC'Y`o wfl r , Ns:. `FF n I _
�'r oatl Name antl NumOers,PE.m nryor auoo °`^' DRILLING LOG DEPTH _�r'
3. OWNER 'A r 5 0, 0VET EZ PI 7E -rl iGiZ r-cam From To Formation Description_ -_
Address 7�7'1 AEG,^e; A,M,[ P Ct -�7 01RT
rl r PARgreet or Route or t'r7 zn{I t'i, ^7 j25 GR.RNITu - -
City or Town fate Zip Cotle .2F 126 SHAL
4. DATE DRILLED E29412211DE "3PAPaTE
5. TOTAL DEPTH +DF 4Rti 2Pe SHALE7
6. CUTTINGS COLLECTED YES ❑ NO 0
7. DOES WELL REPLACE EXISTING WELL? YES 0 NO 0
8. STATIC WATER LEVEL Below Top of Casing: 125 FT.
(Use '+'if Above Top of Casing) c,;_° "«
f": s
9. TOP OF CASING IS " FT.Above Land Surface*
Top of casing terminated at/or below land surface requires a variance in accor-
d
ance with 15A NCAC 2G0119 �^
10. YIELD (gpm): S METHOD OF TEST
11. WATER ZONES (depth): ? p0 '''^m R"<F_s'R
0.0 re, oar
12. CHLORINATION: Type HTI-i Amount 56 If additional space is needed use back of fo"
13. CASING: Wall Thickness LOCATION SKETCH
Depth Diameter or weight/Ft. Material (S�iow direction and distance from at least two State
From ;; To 32 Ft. 6 !�F. ;e�j;l ,^-'+�f' ^- raj Roads,or other matp}reference points)
From To Ft.
From To Ft.
14. GROUT:
Depth Material Method /,r6
From Il To Ft. ^orr l i;-a�•:b,--f�`rcw 'S
t„G
From To Ft.
9;;
15. SCREEN:
Depth Diameter Slot Size Material'
From To Ft. in. in.
From To Ft. in. in. r/
From To Ft. in. in.
16. SAND/GRAVEL PACK:
Depth Size Material
From To _ Ft.
From To Ft. /C2�C�,�WELL
17. REMARKS:I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A N
CONSTRUCTION STANDARDS,AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER.
FOR OFFICE USE ONLY y
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
Quad No: Submit original to Division of Water Quality,Groundwater Section within 30 days
GW-i REV.12/99
Serial No.

caw
North Carolina- Department of Environment and Natural Resources- Division of Water Quality-Groundwater Section 3 44 ` q
1636 Mail Service Center-Raleigh, N.C. 27699-1636-Phone[phone] 0 J. v $
WELL CONSTRUCTION RECORD WELL CONTRACTOR: f uF*.'1af-itl-s,,-,.W Pun , Cn in,
WELL CONTRACTOR CERTIFICATION#: 2�''�'•
'1501 3 STATE WELL CONSTRUCTION PERMIT#: Stp a Pri•:e — -
1. WELL USE(Check Applicable Box): Residential ❑ Municipal ❑ Industrial ❑ Agricultural❑ Monitoring.
Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use:
2. WELL LOCATION: (Show sketch of the location below) "� II f
Nearest Town: I JPJml ; - County: A'cr2v
��f"�1= t7 �F� �?�E`a^,•"TPr' s��f1-�1r_=.5 � � -
Inoa Name an31�bars,�m u yoi�ub� son nd Lo[ o ,P
DRILLING LOG DEPTH
3. OWNER J�`+)- •) �+ v`trdyca' From To Formation Description
Address '070 =Qr. e� °fir ,1 f_; r-�P-r ._-
9
—C,tvnrT, n,l L EZr S Lestar f bde
Qn
4. DATE DRILLED c!^f,7^DOF a'7
5. TOTAL DEPTH 't".5
6. CUTTINGS COLLECTED YES ❑ NO
7. DOES WELL REPLACE EXISTING WELL? YES ❑ NO
8. STATIC WATER LEVEL Below Top of Casing: 3,5 FT.
(Use"+"if Above Top of Casing)
9. TOP OF CASING IS 1 FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a variance in accor-
dance with 15A NCAC 2C.0118
10. YIELD (gpm): 15 METHOD OF TEST at- = -
11. WATER ZONES (depth):+''• nl1 .,, v0_o •-,?,')PP,,
P Qr. `pn+ 0 OC1t'PP:i
12. CHLORINATION: Type tJ'Tu Amount 71.1 If additional space is needed use back of forml
13. CASING: Wall Thickness LOCATION SKETCH
Depth Diameter or Weight/Ft. Material (Show direction and distance from at least two State
From n To —�eA Ft. e 1,n Roads,or other map reference points)
From To Ft.
From To Ft.
r
14. GROUT:
Depth Material Method ftl'
From To ''n Ft. f ar,-mof ,;a_, P,
From To Ft. _ - 1\� 1.f!
15. SCREEN:
Depth Diameter Slot Size Material
From To Ft. in. in.
From To Ft. in. in. \�.\ Cr
From To Ft. in. in.
16. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft. v El
17. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C,WELL
CONSTRUCTION STANDARDS,AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER.
0 �'`�
FOR OFFICE USE ONLY � JJL�%Y�*''"' � 7 /o (JJ
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
Quad No: Submit original to Division of Water Quality,Groundwater Section within 30 days
GW-1 REV.12/99
Serial No.

North Carolina-Department of Environment and Natural Resources-Division of Water Quality-Groundwater Section OD'I C
1636 Mail Service Center-Raleigh, N.C. 27699-1636-Phone[phone] 3 1 4
WELL CONSTRUCTION RECORD WELL CONTRACTOR:
WELL CONTRACTOR CERTIFICATION#: ZOS7
50222 STATE WELL CONSTRUCTION PERMIT#: St-ye Reece
_ 7 --1 ice)
1. WELL USE(Check Applicable Box): Residential 0 Municipal El Industrial 0 Agricultural 0 Monitdring ,
T
Recovery 0 Heat Pump Water Injection El Other E If Other, List Use:
2. WELL LOCATION: (Show sketch of the location below)
Nearest Town: 1a,L;,^IER El K, County: �g6;4v r
y'1T:�i 1 rti ,d,rrr}�p .ii',I,�:_.1R[l t, ,
'koa a—dFh4 and fSum�ers niFv or�u — on and Lo o� DRILLING LOG DEPTH t
IC
3. OWNER t)IRK ' "Af5Rr AP.' From To Formation Description
Address ra ) Q ra !RT r,
treat or Route o.l _
1"RF {t� t�Rn "„t_, 7T :D `"K7d^ItTF" -
City or Town state "'Alp oaf e 3,c,1 •.j lar. _ 1.:
4. DATE DRILLED_5Pl7ii"DF ? 1 '5C cioia IITE
5. TOTAL DEPTH 9nr 4Fn rya I JA&RTZ (•"y
6. CUTTINGS COLLECTED YES ❑ NO Q S 53 °•n` f.liTF:
7. DOES WELL REPLACE EXISTING WELL? YES 0 NO E] �-
8. STATIC WATER LEVEL Below Top of Casing: , FT.
(Use"+"if Above Top of Casing)
9. TOP OF CASING IS 1 FT.Above Land Surface*
`Top of casing terminated at/or below land surface requires a variance in actor.
dance with 15A NCAC 2C.0118
10. YIELD (gpm): 10 METHOD OF TEST Air
11. WATER ZONES (depth): -1.010 gpm350-354 7.00qprr, 160­153 �
=Vi
0.00 prim O.�OpRtr
12. CHLORINATION: Type H TH Amount 46 If additional space is needed use back of form"
13. CASING: Wall Thickness LOCATION SKETCH
Depth Diameter or Weight/Ft. Material (Show direction and distance from at least two Stale
From n To '7. Ft. 6 Ar° Miri PY,^ Roads,/\other map reference points)
From To Ft. \ y
From To Ft.
14. GROUT:
Depth Material Method
From 11 To -'N1 Ft. "'Pm-nf ;r"J,.. Mr .U,
From To Ft.
15. SCREEN:
Depth Diameter Slot Size Material
From To Ft. in. in. h.
From To Ft. in. in. ✓.� � ; ___r.;,..�. ., _ ( -.,..
From To Ft. in. in. —�- --- -
16. SAND/GRAVEL PACK:
Depth Size Material
From To Ft. )
From To Ft. .� �
17. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C,WELL
CONSTRUCTION STANDARDS,AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER.
FOR OFFICE USE ONLY 2� � P C 4-4 a -' a r) 0
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
Quad No: Submit original to Division of Water Quality,Groundwater Section within 30 days
GW-1 REV. 12/99
Serial No.

North Carolina -Department of Environment and Natural Resources-Division of Water Quality-Groundwater Section 314676
1636 Mail Service Center-Raleigh, N.C.27699-1636-Phone[phone]
WELL CONSTRUCTION RECORD WELL CONTRACTOR: De"wey'vr'iight W!; rump Co . Inc.
WELL CONTRACTOR CERTIFICATION#: 2137
050212-1 STATE WELL CONSTRUCTION PERMIT#: Steve Reece
1. WELL USE(Check Applicable Box): Residential 0 Municipal 0 Industrial 0 Agricultural E] I Momtoripg--Ea-
Recovery 0 Heat Pump Water Injection Other D If Other, List Use: �_ r
2. WELL LOCATION:(Show sketch of the location below) I �,
Nearest Town: LfNJVII.I F County: #VER'yIL
�7
K1RIUhTE RCl OFF t HFSTF.1i fT RI-`. FF C;RAfi;Y ('i?EEK Vim. -
IaoatlNamean umbers, ommunity,or Subsion and Lot NO.)
DRILLING LOG DEPTH
3. OWNER SOB fJ!CKlPJNO^J From To Formq6on ascription --
Address % FULLER&FULLER !N-". . P.'O. WDX 785 9 RO DIRT
LiN"lLLLC7�treatorRouteNo.1 NIC 28646 RO 100
CRy or Town state Zip ode - —,�
1 Llp 101 QUAD. f i!
4. DATE DRILLED 6/812005 401 8,15 GRAP•iT�
5. TOTAL DEPTH 895
6. CUTTINGS COLLECTED YES O NO 0
7. DOES WELL REPLACE EXISTING WELL? YES 0 NO 0
8. STATIC WATER LEVEL Below Top of Casing: 30 FT.
(Use"+"if Above Top of Casing)
9. TOP OF CASING IS 1 FT. Above Land Surface*
Top of casing terminated at/or below land surface requires a variance in actor-
dance with 15A NCAC 2C.0118
10. YIELD(gpm): 0 25 METHOD OF TEST Air
11. WATER ZONES (depth): 0.26 aarn 100-101 0 00apn?
r 00 Dom 0,00opm
12. CHLORINATION: Type HTH Amount 1416 If additional space is needeatD_se bait of form
13. CASING: LOCATION SKETCH
Wall Thickness
Depth Diameter or Weight/Ft. Material (Show direction and distance from at least two State 1
From 9 To _�15 Ft. 9 119 15.9 PV'- Roads,or other map reference points)
From To Ft. �.
From To Ft.
14. GROUT:
Depth Material Method ( 1u( U
From +1 To ",,n Ft. 'Frrn-nt Gravih+ Fiaw
From To Ft.
15. SCREEN:
Depth Diameter Slot Size Material Lti
From To Ft. in. in. ,r-•�
From To Ft. in. in.
From To Ft. in. in. '
16. SAND/GRAVEL PACK: t'.`1'
Depth Size Material \ '} •�-. , �+x �
From To Ft. a�.
1
From To Ft.
r rQ�L�
17. REMARKS: a .
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 BE7ROVIDED TO THE WELL OWNER.
FOR OFFICE USE ONLY
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
Quad No: Submit original to Division of Water Quality,Groundwater Section within 30 days
GW-1 REV.12/99
Serial No.

� 314 �3 �
5
North Carolina-Department of Environment and Natural Resources-Division of Water Quality-Groundwater Section
1636 Mail Service Center-Raleigh,N.C.27699-1636-Phone[phone]
WELL CONSTRUCTION RECORD WELL CONTRACTOR: f e4,eV tiigr,,,t «`ell Pismo Co . :' r
WELL CONTRACTOR CERTIFICATION#: 2Fi97
050181 STATE WELL CONSTRUCTION PERMIT#: Stste Reece
1. WELL USE (Check Applicable Box): Residential E0 Municipal ❑ Industrial ❑ Agricultural❑ Monitoring ❑
Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use:
2. WELL LOCATION:(Show sketch of the location below)
Nearest Town: AAn1NF1P F1 K County: At'PPV
ill 1T9A(-K I.ANF OFF t;l 11 RfdARQ I AN P OFF DOBBINS R
(Road Name and Numbers,Community,or Subdivision and Lo[No.
DRILLING LOG DEPTH
3. OWNER W CLIFF FLDFP From To Formation Description
Address 215 OORP-.INIS RE) n 71", DIRT
" ee or Route Ne.l
. .. rd.JFPr f tl fJC ?"St9W 7n 1%0 c�F2ANITF
iiyor Town state Zip Code
120 17R >;l-iAI F
4. DATE DRILLED Rtd9/00.5 t_�R 1h(1 GIRANITP
5. TOTAL DEPTH 125 415n iF.R GHAI F
6. CUTTINGS COLLECTED YES ❑ NO ® 151 P5 GC?Af%
7. DOES WELL REPLACE EXISTING WELL? YES ❑ NO 0 "f
8. STATIC WATER LEVEL Below Top of Casing: 52 FT.
(Use"+"if Above Top of Casing) �—
C
9. TOP OF CASING IS 1 FT.Above Land Surface*
Top of casing terminated at/or below land surface requires a variance in actor-
dance with 15A NCAC 2C.0118
10. YIELD (gpm): 15 METHOD OF TEST Air
11. WATER ZONES (depth):13 00 Own 120 12.a 2,(in corn g5t1-15:3
n 00 onrn n 00banm
12. CHLORINATION: Type t-I1H Amount i7 If additional space is needed use bac .- f form
13. CASING: Wall Thickness LOCATION SKETCH
Depth Diameter or Weight/Ft. Material (Show direction and distance from at least two State
From n To —$Ft. 9 1eR 3.10 PVC Roads,or other map reference points)
From To Ft.
From To Ft.
14. GROUT: \�1
Depth Material Method
From it To 20Ft. Cement C:ravfhl Plow
From To Ft.
15. SCREEN:
Depth Diameter Slot Size Material
From To Ft. in. in.
From To Ft. in. in. -r00---
From To Ft. in. in. iAikiSL _-
16. SAND/GRAVEL PACK:
Depth Size Material
From To Ft. v
From To Ft. -
4�i�
17. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WIYH 15A NCAC 2C,WELL
CONSTRUCTION STANDARDS,AND THAT A COPY
YYcOF THIS RECORD HA$,BEEN PROVIDED
/TO,THE WELL OWNER. w Y
FOR OFFICE USE ONLY �' ! f? QG1Z
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
Quad No: Submit original to Division of Water Quality,Groundwater Section within 30 days
GW-1 REV.12/99
Serial No.

Aw
North Carolina-Department of Environment and Natural Resources-Division of Water Quality-Groundwater Section -11. 4673
1636 Mail Service Center-Raleigh,N.C.27699-1636-Phone[phone]
WELL CONSTRUCTION RECORD WELL CONTRACTOR: Dewey Wnrlht yVeli Puma Co., Inc,
WELL CONTRACTOR CERTIFICATION#: 2687
060213 STATE WELL CONSTRUCTION PERMIT#: Steve Reece
1. WELL USE(Check Applicable Box): Residential T Municipal ❑ ,Industrial ❑ Agricultural❑ Monitoring ❑
Recovery ❑ Heat Pump Water Injection Other ❑ If Other, List Use:
2. WELL LOCATION:(Show sketch of the location below)
Nearest Town: IrJVFRSHipr! n County: .6VPPY
oa ameandNumbers, ommumty,or u�b ivismnan Lot ! v— DRILLING LOG 4EPTH
3. OWNER f0LJNRt1F (-ORiFY/Cf-f.ARI PR, FIJI.I PR From To Formation Description
Address qr
I q)I l FeIoStre oute No.l
n
e[F! n r
f! 'j 'Lj ni(, ?aZ� ti 4 �7en L, :-_RAnl1T
rtyor Town State ip Code
?An ?as of sARr
4. DATE DRILLED 8111201/5 ?61 2f1F CR4All TP F��S
5. TOTAL DEPTH 111F 8nF 6nF IflART7 rs
6. CUTTINGS COLLECTED YES ❑ NO 0 ^D° 96F QL upL R
7. DOES WELL REPLACE EXISTING WELL? YES ❑ NO ❑ r c
8. STATIC WATER LEVEL Below Top of Casing: Ail FT.
(Use"+"if Above Top of Casing)
9. TOP OF CASING IS 1 FT.Above Land Surface*
Top of casing terminated at/or below land surface requires a variance in accor-
dance with 15A NCAC 2C.8118
10. YIELD (gpm): 100 METHOD OF TEST Air
11, WATER ZONES (depth): 1 00 acm260-263 99 OOaom
0.00 porn 0 00aom
12. CHLORINATION: Type HTH Amount 95 If additional space is needed use hack of forme
13. CASING: Wall Thickness LOCATION SKETCH
Depth Diameter or WeighVFt. Material (Show direction and distance from at least two State
From n To LEA Ft. A 119 188 sA.l_V Roads,or other map reference points)
From To Ft.
From To Ft.
14. GROUT: l�
Depth Material Method
From 0 To 20 Ft. Cement tjraN FIaI•x
From To Ft.
15. SCREEN: ('
Depth Diameter Slot Size Material
From To Ft. in. in.
From To Ft. in. in.
From To Ft. in. in. �c�
16. SAND/GRAVEL PACK:
Depth Size Material r �I�! htLIle �Jr
From To Ft.
From To Ft.
17. REMARKS: lY
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC C,WELL ^'
CONSTRUCTION STANDARDS,AND THAT CO Y OF THIS RECORD S.BEENPRO-V1DED TO-THEWELL OWNER. �t:f
FOR OFFICE USE ONLY
SIGNATURE OF P0, CONSTRUCTING THE WELL 1 DATE
Quad No: Submit original to Division of Wa@r t'ality,Groundwater Section within 30 days
GW-1 REV.12/99
Serial No.

North Carolina-Department of Environment and Natural Resources-Division of Water Quality-Groundwater Section
1636 Mail Service Center-Raleigh,N.C. 27699-1636-Phone[phone]
WELL CONSTRUCTION RECORD WELL CONTRACTOR: Csiotev ti"«`right*OVaa I Purrlr Co. 1nlc:-
WELL CONTRACTOR CERTIFICATION#: 1Pi91
050273 Steve F2eene
STATE WELL CONSTRUCTION PERMIT#: -
1, WELL USE(Check Applicable Box): Residential E� Municipal ❑ Industrial ❑ Agricultural❑ Monitoring ❑
Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use:
2. WELL LOCATION: (Show sketch of the location below)
Nearest Town: BANNER ELK County: o%-"EP
EAGLE NEST OFF Hb`JY 19d F� 1 4 rF� " 15
(Road Name antl Numbers,Community,or Subdivision and Lot No.l
DRILLING LOG DEPTH
3. OWNER EAGLES NEST
From To Formation begcription
Address 2120 TYNECASTLE R[' t DIcT
BANNER1—rLr O' O1SeNo1 INC 22604 75 98 GRANITE
City or Town state zp Ode 98 101 SHALE
4. DATE DRILLED 6.`23 2005 101 360 GRANI
5. TOTAL DEPTH 465 360 365 QUARTOTK
:.
6. CUTTINGS COLLECTED YES ❑ NO 0 365 485 GRANI!T
7. DOES WELL REPLACE EXISTING WELL? YES ❑ NO ❑
8. STATIC WATER LEVEL Below Top of Casing: 20 FT. czr:
(Use"+"if Above Top of Casing) r !f,'.) .^f
9. TOP OF CASING IS FT.Above Land Surface* '
`Top of casing terminated at/or below land surface requires a variance in actor- "� g
dance with 15A NCAC 2C.0118
10. YIELD (gpm): 10 METHOD OF TEST Air
11. WATER ZONES (depth): 5.00 APM98-101 5.00pprn 60-s65
0,00 ppm 0.00oprn
12. CHLORINATION: Type 14TH Amount 122 If additional space is needed use back of form
13. CASING: LOCATION SKETCH
Wall Thickness (�
Depth Diameter or Weight/Ft. Material (Shmv(direction and distance from at leas�.twky�State '1t.
/
From 0 To 85 Ft. 6 1/8 .150 PWI I Ct tilEll�� Roads,or other map reference points)'
From To Ft. I Utz'
From To Ft.
14. GROUT:
Depth Material Method 'MI /2X)
From 0 To 30 Ft. Cernerlt Gradt4 Flovr ` ��
From To Ft. `^ �/
cC�
15. SCREEN: 9�
Depth Diameter Slot Size Material
From To Ft. in. in.
From To Ft. in. in. A)
From To Ft. in. in.
16. SAND/GRAVEL PACK:
Depth Size Material \
From To Ft.
From To Ft.
M ai
17. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C,WELL
CONSTRUCTION STANDARDS,AND THAT A COP OFTHIS RRECORD AS BEEN PROVIDED TO THE WELL OWNER.
FOR OFFICE USE ONLY
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
Quad No: Submit original to Division of Water Quality,Groundwater Section within 30 days
GW-1 REV.12/99
Serial No.

0 " g
North Carolina-Department of Environment and Natural Resources-Division of Water Quality-Groundwater Section 0 1 e1
1636 Mail Service Center-Raleigh,N.C.27699-1636-Phone[phone]
'
WELL CONSTRUCTION RECORD WELL CONTRACTOR: Dewey e,reihtv Vel! Pump Co.. Inc.
WELL CONTRACTOR CERTIFICATION#: 287
05G268 STATE WELL CONSTRUCTION PERMIT#: Steve Rea_ce
1. WELL USE(Check Applicable Box): Residential Eli] Municipal❑ Industrial ❑ Agricultural❑ Monitoring ❑ -
Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use:
2. WELL LOCATION:(Show sketch of the location below)
Nearest Town: I`IVif L — County: nVERY
5Tr'trER R!DGE "✓'rr' I E' RC:. 7FF 1 C7F= 1
( oad Name and Numbers, ommuniry,or ubdiv Ion and Lot No.l DRILLING LOG DEPTH
3. OWNER MnI)GPIR I< l,af C)Rq From To Formation Description
Address " r pig f 611 I dPT
trees or oute No.l r;RANIl FCi_(,, -
r e.li. 2.cT17 °Il 10'1 _.
eny or Town State Zip Code 1n0 104 gHAI F - ---
4. DATE DRILLED R%22"200_o .Ft1 9cy =,RAN17 _
5. TOTAL DEPTH 41 Hfl,— nn aR3 .I?Ar:orc
6. CUTTINGS COLLECTED YES ❑ NO ❑ IQ; 4A5 cn
7. DOES WELL REPLACE EXISTING WELL? YES ❑ NO 0 �oq l3R i' 1AR�7
of
8. STATIC WATER LEVEL Below Top of Casing: f`0 — FT. —�-
(Use"+"if Above Top of Casing)
9. TOP OF CASING IS 1 FT.Above Land Surface* j
'Top of casing terminated at/or below land surface requires a variance in accor-
dance with 15A NCAC 2C.0118 --
10. YIELD (gpm): 7 METHOD OF TEST Air
11. WATER ZONES (depth): 0.25 apm 1011-104 0-75pIpm 290-393 Ln
6.t717 opm435-438 0.0'amm
12. CHLORINATION: Type HTH Amount 79 If additional space is needed use back of forme
13. CASING: Wall Thickness LOCATION SKETCH
Depth Diameter or WeighVFt. Material (Show direction and distance from at leas[two Stale
From 0 To 36 Ft. 5 118 350 FVO f, Roads,or other map reference points)
From To Ft. * jC✓ ij '�
From To Ft. It �\
14. GROUT:
Depth Material Method �j
From 0 To 23 Ft. Cement Gravity rims
From To Ft. ,1-
15. SCREEN: IC'
Depth Diameter Slot Size Material pot loll, � �
From To Ft. in. in. If�cx'6
From To Ft. in. in. _
From To Ft. in. in. IF(Ktir a '
i y J
16. SAND/GRAVEL PACK: RIU
`li`�"'
Depth Size Material v
From To Ft.
From To Ft. y�
17. REMARKS:
1 DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2 WELL
CONSTRUCTION STANDARDS,AND THAT A COPY THIS RECORD HA BEEN PROVIDED TO THE WELL OWNER.
FOR OFFICE USE ONLY 2"--2 i-q— G a l_ `t ! l l oj
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
Quad No: Submit original to Division of Water Quality,Groundwater Section within 30 days
GW-1 REV.12/99
Serial No.

1636 Mail Service Center-Raleigh, N.C.27699-1636-Phone[phone] on of Water Quality-Groun wa r Section
WELL CONSTRUCTION RECORD WELL CONTRACTOR: LNywpy :°=°Ii�,t'tti ;i r-,J1r;pCo
3502y6 WELL CONTRACTOR CERTIFICATION#: 2576
STATE WELL CONSTRUCTION PERMIT#: 'e 'roe
I. WELL USE(Check Applicable Box): Residential r
Municipal Q Industrial Agricultural Monitoring El
Recovery E] Heat Pump Water Injection 0 Other 0 If Other, List Use:
2. WELL LOCATION:(Show sketch of the location below)
Nearest Town: 9At,IfJPE FI u r))L r County: A !✓FY
t .,p
l'
IRoad Name antl Numbers, ommvni,y or Subdivision and of No.l -
3. OWNER CARL SHELL DRILLING LOG DEPTH
Address P O E'-X 1&d From To Formation Description. -
<
p'C,gRtr.ot or Route N ) - Q 71
Ciry or own tir ^• -7 +(1 y`r3 T
State iP Code gD (iFdAf�iITF - -
4. DATE DRILLED 6/16M05 9C RED QPL '"F
5. TOTAL DEPTH 105 92 105 rp
6. CUTTINGS COLLECTED YES 0 NO []
7. DOES WELL REPLACE EXISTING WELL? YES 0 NO 0
8. STATIC WATER LEVEL Below Top of Casing: 20 FT.
fuse"+"if Above Top of Casing)
A
9. TOP OF CASING IS 1 FT. Above Land Surface*
Top of casing terminated at/or below land surface requires a variance in actor.
dance with 15A NCAC 2C.0118
10. YIELD (gpm): 20 METHOD OF TEST •AVr '"
11. WATER ZONES (depth)20 00 gpm90-92 0 Goopm 1
) F
U 00 porn 0 0n€pm � a
12. CHLORINATION: Type HTH Amount 18 If additional space is needed use back of form':
13. CASING:
Depth Wall Thickness LOCATION SKETCH
From -IP Diameter or Weight/Ft. Material (Show direction and distance from at least two State
To T5 Ft. 6 1rS . i50 -'VC <
From To Ft. :LtL'��L`l Roads,or other map reference points)
From To Ft.
14. GROUT:
Depth Material Method
From -9 To 20 Ft. Cement Gravif t FIo1v " a
From To Ft. -
15. SCREEN:
Depth Diameter Slot Size Material
From To Ft.
in. in. (ti
From To Ft. _ in. in. —"'—'
From To Ft. _ in. in. U'
16. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft ° Li
J� tit
17. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C,WELL
CONSTRUCTION STANDARDS,AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL O NER.
FOR OFFICE USE ONLY
Quad No: SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
Submit original to Division of Water Quality,Groundwater Section within 30 days
Serial No. GW-1 REV. 12/99

n Carolina-Department of Environment and Natural Resources-Division of Water Quality-Groun atbyG er Section - 16 2 4 7
d Mail Service Center-Raleigh,N.C.27699-1636-Phone[phone]
DELL CONSTRUCTION RECORD WELL CONTRACTOR: De ey +'r'rk-p t >Vea Puiwl+ ^o., inc
WELL CONTRACTOR CERTIFICATION M `667
060391-2 STATE WELL CONSTRUCTION PERMIT#: `'te4e Re=_oe
1. WELL USE(Check Applicable Box): Residential 0 Municipal ❑ Industrial ❑ Agricultural❑ Monitoring ❑
Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use:
2. WELL LOCATION:(Show sketch of the location below)
Nearest Town: BANNER ELK County: A'ERV
EAGLES NEST OFF 194 OFF 184 GFF ?05
(Road Name and Number.,Community,or Subdivision and Lot No.)
) DRILLING LOG DEPTH
3. OWNER CRA1G F'L4TH j (�"ri �F,' �/f,ri- From To Formation Description
Address 2120 TYNE CA8?1_E1 l°+"' 0 3 DIRT
BANNER `e�or Route No.l JC i8�04 3 418 GRANiTE
City or Town State Zip Code
19 24 SHALE
4. DATE DRILLED 81fl12005 24 120 GR4NITE
5. TOTAL DEPTH 425 120 123 'HALE
6. CUTTINGS COLLECTED YES ❑ NO ❑ 12.3 125 GRAN!TE CC'
7. DOES WELL REPLACE EXISTING WELL? YES ❑ NO ❑ cry
8. STATIC WATER LEVEL Below Top of Casing: 120 FT.
(Use"+"if Above Top of Casing)
9. TOP OF CASING IS ' FT. Above Land Surface
Top of casing terminated at/or below land surface requires a variance in actor- C:)-',y
dance with 15A NCAC 2C.0118 r n t p
10. YIELD (gpm): 12 METHOD OF TEST Air
11. WATER ZONES (depth):
12.00 ppm 120-123 0.00ppm
0.CO mom O.UOAPM k,ail
12. CHLORINATION: Type HTH Amount L94 If additional space is needed use back of form
13. CASING: Wall Thickness LOCATION SKETCH
Depth Diameter or Weight/Ft. Material (Show direction and distance from at least two State
From 0 To 43 Ft. 6 1id IBE G.ALV Roads,or other map reference points)
From - To Ft. vtrt."�,,
From To Ft. `t�, '-�
14. GROUT:
Depth Material Method From 0 To 20 Ft. Cement Gravity Flow
From To Ft. v?
15. SCREEN: '
Depth Diameter Slot Size Material
From To Ft. in. in. Y
Cuu.
From To Ft. in. in. ------
From To Ft. in. in. -----`
16. SAND/GRAVEL PACK: _
Depth Size Material \
From To Ft. ;
From - To Ft. �uV
17. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE-WITH 15A NCAC-2C,WELL "
CONSTRUCTION STANDARDS,AND THAT A COPY OF THIS RECORDH'QJS BEEN PROVIDED TO THE WELL OWNER.
FOR OFFICE USE ONLY A-zds ' V I r `'' c� © 5-
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
Quad No: Submit original to Division of Water Quality,Groundwater Section within 30 days
GW-t REV. 12/99
Serial No.

North Carolina-Department of Environment and Natural Resources-Division of Water Quality-Groundwater Section 3 1 62 4 51,
1636 Mail Service Center- Raleigh,N.C.27699-1636-Phone[phone]
WELL CONSTRUCTION RECORD WELL CONTRACTOR: Deiqey yifi)gtt,'ae Pui-ap _'s , Irtr_
WELL CONTRACTOR CERTIFICATION#: 2687
058498 STATE WELL CONSTRUCTION PERMIT#: Steve Reece
1. WELL USE(Check Applicable Box): Residential 0 Municipal 0 Industrial 0 Agricultural 0 Monitoring 0
Recovery 0 Heat Pump Water Injection 0 Other 0 If Other,List Use:
2. WELL LOCATION:(Show sketch of the location below)
Nearest Town: BANNER ELK County: A"ERY
LOT C- 17 OFF EAGLES !VEST OFF HW,! 194 OFF 194 OF
IRodd Name and Numbers,6ommunity,or Subdivision and Lot No.)
DRILLING LOG DEPTH
3. OWNER THE LODGES AT EAGLE NEST From To Formation Description
Address BE JOHN TURSHION LLC , 2120 TYNECASTLE HvVi 0 18 QIRT
BANNER Leeror Route Not NIC 28604 18 W GRANITE
ity or Town 1S state Zip Code 30 34 SHALE
4. DATE DRILLED 8118/2005 3:7 357 GRANITE
5. TOTAL DEPTH 405 357 360 GR04ITE
6. CUTTINGS COLLECTED YES 0 NO 0 360 405 I.P,*IITE
7. DOES WELL REPLACE EXISTING WELL? YES 0 NOEL] y
8. STATIC WATER LEVEL Below Top of Casing: 20 FT.
(Use"+"if Above Top of Casing)
9. TOP OF CASING IS 1 FT.Above Land Surface*
•Top of casing terminated at/or below land surface requires a variance in accor-
dance with 15A NCAC 2C.0118
10. YIELD(gpm): 25 METHOD OF TEST Air �I!'
11. WATER ZONES (depth)15.00 porn 30-34 10.00ppm 357-36D
0.00 APM 40.0own r ;•
12. CHLORINATION: Type HTH Amount 76 If additional space is deeded use back of form"-:rld
13. CASING: Wall Thickness LOCATION SKETCH
Depth Diameter or Weight/Ft. Material (Show direction and distance from at least two State 1
From 0 To G4 Ft. 8 1,/4 186 Gj°LLr Roads,or other map reference points)
From To Ft.
From To Ft.
14. GROUT: lk�
Depth Material MethodFrom C To i0 Ft. Cement Gravit<7 FlawFrom To Ft. '�
15. SCREEN: ,,/'v'Y� I?q
Depth Diameter Slot Size Material
From To Ft. in. in.
From To Ft. in. in. li
From To Ft. in. in. re>-
e
16. SAND/GRAVEL PACK:
Depth Size Material
c
From To Ft. - -
From To Ft.
17. REMARKS: !' /
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED INACCORDANCE WITH 15A NCAC 2C,WELL c�- 7A
CONSTRUCTION STANDARDS,AND THAT A COPY OFT� HIS RECORD`FJS����ROVIDE�OT��WELL�TWN
FOR OFFICE USE ONLY -�
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
Quad No: Submit original to Division of Water Quality,Groundwater Section within 30 days
GW-1 REV.12/99
Serial No.

North Carolina-Department of Environment and Natural Resources-Division of Water Quality-Groundwater SA" 16, rr 4 6
1636 Mail Service Center-Raleigh, N.C.27699-1636-Phone[phone]
WELL CONSTRUCTION RECORD WELL CONTRACTOR: Dewey V,'rght Well F'urrp Cc, . Inc.
WELL CONTRACTOR CERTIFICATION#: 21587
050492 STATE WELL CONSTRUCTION PERMIT#: `>eve Rece
1. WELL USE(Check Applicable Box): Residential 0 Municipal 0 Industrial 0 Agricultural❑ Monitoring 0
Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use:
2. WELL LOCATION:(Show sketch of the location below)
Nearest Town: INVERSHIELD County: •'*'ERA`
LOT C-19 OFF EAGLES NEST OFF 194 OFF 184 TOFF 105
Mood Name and Numbers,Community,or Subdivision and Lot No.)
DRILLING LOG DEPTH
3. OWNER THE LODGES AT EAGLES NEST From To Formation Description
Address 2120 TYNE dY 0 '0 DlQT
BOONS `f beet or Ro ae No-1 C 28007 70 30 GRANITE SRJ`!s! ROC[
City or Town State Zip Code .130 133 SHALE
4. DATE DRILLED W17`2005 133 430 GRANITE
5. TOTAL DEPTH 500 130 433 SHALE
6. CUTTINGS COLLECTED YES 0 NO 0 433 500 GR.AP!!TF_
7. DOES WELL REPLACE EXISTING WELL? YES [—] NO 0
8. STATIC WATER LEVEL Below Top of Casing: 00 FT.
(Use"4"if Above Top of Casing) ,p.,
^—
9. TOP OF CASING IS 1 FT.Above Land Surface* - 1
Top of casing terminated at/or below land surface requires a variance in actor-
dance with 15A NCAC 2 9118 „�
10. YIELD (gpm): �,3 METHOD OF TEST 41r
11. WATER ZONES (depth): 4,00 qpm 70-130 4@.00 Qpm 133-S 30 , i,
0-00 tlpm 0 00gpm
12. CHLORINATION: Type HT Amount 90 If additional space is needed use back of forme"=
13. CASING: Wall Thickness LOCATION SKETCH
Depth Diameter or Weight/Ft. Material (Show direction and distance from at least two State '1
From n To 77 Ft. 5 1/8 .350 PVC � Roads,or other map reference points)
From To Ft.
From To Ft.
14. GROUT:
Depth Material Method
From 0 To e0 Ft. ' en_1Erlt Grayuy Fio'se
From To Ft.
15. SCREEN:
Depth Diameter Slot Size Material
From To Ft. in. in. ,
From To Ft. in. in.
From To Ft. in. in. ia
16. SAND/GRAVEL PACK: p
Y.
Depth Size Material
From To Ft. j
From To Ft.
17. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C,WELL \�
CONSTRUCTION STANDARDS,AND THAT A COPY OF THIS RECO HAS BEEN PROVIDED TO THE WELL OWNER.
FOR OFFICE USE ONLY
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
Quad No: Submit original to Division of Water Quality,Groundwater Section within 30 days
GW-1 REV.12/99
Serial No.

North Carolina-Department of Environment and Natural Resources-Division of Water Quality-Groundwater Section
1636 Mail Service Center- Raleigh, N.C. 27699-1636-Phone[phone] L) J
WELL CONSTRUCTION RECORD WELL CONTRACTOR: D9Wr9`+V11ligi1t Well PLlrt',D CO
V8
WELL CONTRACTOR CERTIFICATION#: `"
^~'1"�4 STATE WELL CONSTRUCTION PERMIT#: Stfa'�e PTr—'tce
1. WELL USE (Check Applicable Box): Residential 0 Municipal ❑ Industrial ❑ AgnculStiral L,_I Monitoring
Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use: J
2. WELL LOCATION:(Show sketch of the location below)
Nearest Town: BOONE County: AVER`,'
HUCKL-, BERRY LANE OFF ih'ILE) APPLE OR OFF 221
(Road N.rnti.nd Numbers,Community,or Subdivision and Lot No.) DRILLING LOG = ,.DEPTH
3. OWNER GUY 5TAVOLA From To I Fo`rmatich0escrlption
Address % BURCHELL CONCT . PO BOX 19611 0 15 DIRT
B'OONE (Street or Route No.) Nc 42130] 1 r3 240 GRARIlTE
City or Town tare Zip Code 2401 241 QUARTZ
4. DATE DRILLED 1.`1]12G05 24": 235 GRANITE
5. TOTAL DEPTH 3S5 2Fu 46g QUAR;L
6. CUTTINGS COLLECTED YES ❑ NO ❑ 29151 '05 3R N1"E s
7. DOES WELL REPLACE EXISTING WELL? YES ❑ NO
8. STATIC WATER LEVEL Below Top of Casing: 801 FT.
rn'
(Use","if Above Top of Casing)
9. TOP OF CASING IS FT.Above Land Surface* ic.
"Top of casing terminated at/or below land surface requires a variance in accor.
dance with 15A NCAC 2C.0118
10. YIELD (gpm): METHOD OF TEST Air
11. WATER ZONES (depth): 1,00 ppm24C1-241 2,00opm 2?r2215. mR
0.00 ppm 0.00ciprin
12. CHLORINATION: Type fiTH Amount 46 If additional space is needed use back of f-01
13. CASING: Wall Thickness LOCATION SKETCH
Depth Diameter or Weight/Ft. Material (Show direction and distance from at least two State
From -I To 23 Ft. 6 1A 168 „A,LV Roads,or other map reference points)
From To Ft.
From To Ft.
14. GROUT:
Depth Material Method
From To tir Ft. .'erncri' _ra0tJ Fiat.
From To Ft. rQV�
15. SCREEN:
Depth Diameter Slot Size Material °f
From To Ft. in. in.
From To Ft. in, in. / a
From To Ft. in. in.
16. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
t'
0
17. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C,WELL \
CONSTRUCTION STANDARDS,AND THAT A CO Y OF THIS RECOR.Q HAS BEEN PROVIDED TO THE WELL OWNER.
a
FOR OFFICE USE ONLY
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
Quad No: Submit original to Division of Water Quality,Groundwater Section within 30 days
GW-1 REV. 12/99
Serial No.

DAID
North Carolina-Department of Environment and Natural Resources-Division of Water Quality-Groundwater Section ry a q
m
1636 Mail Service Center-Raleigh, N.C.27699-1636-Phone[phone] � �E �',� ;
WELL CONSTRUCTION RECORD WELL CONTRACTOR:
r}0'etiey gh:k "e6i P ; '2p L, _ fn^
WELL CONTRACTOR CERTIFICATION#: 2667
STATE WELL CONSTRUCTION PERMIT#: `fe°ia Peace
1. WELL USE(Check Applicable Box): Residential ❑ Municipal ❑ Industrial ❑ Agricultural❑ Monitoring ❑
Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use:
2. WELL LOCATION:(Show sketch of the location below)
Nearest Town: BAPJNER ELK County: AVER`;'
LlT L-2 , —43LES NEST OFP 164 OFF 1.94 OFF '05
(Road Name antl Numbers,community,or ubdrvision and Lot No.l
DRILLING LOG DEPTH
3. OWNER THE'LODGES AT EAGLE NEST From To Formation Description
Address r ' I r' '� "' vr. ncr e u t,v n De RT
BE jOH`d TURSHION L.Lv xtd,T„ IEal ..r, .
o Route o.l '88Lk1 4 P42 GRAj`jiTE
8,4NNER isL l'"
o.To n bode Zip Code 042 845 SHALE
4. DATE DRILLED 8t26/2005 945 890 GPAN`IE
5. TOTAL DEPTH 895 890 895 'HALE
6. CUTTINGS COLLECTED YES ❑ NO O
7. DOES WELL REPLACE EXISTING WELL? YES ❑ NO
8. STATIC WATER LEVEL Below Top of Casing: 233 FT.
(Use"+"if Above Top of Casing) - - -
9. TOP OF CASING IS 1 FT. Above Land Surface* ry
'Top of casing terminated at/or below land surface requires a variance in actor- - 01
dance with 15A NCAC 2Q.0118
10. YIELD (gpm): 0 METHOD OF TEST Air ^' _
11. WATER ZONES (depth)20.00 ppm942-e45 30.00upm E5 i
0.00 i7Pm J UOpGm
12. CHLORINATION: Type HTH Amount If additional space is needed use back of form
13. CASING: LOCATION SKETCH
Wall Thickness
Depth Diameter or Weight/Ft. Material (Show direction and distance from at least two State
From O To 22 Ft. Pa 13 350 PVC �.: Roads,or other map refs ence points) ;�•P
s 9
From To Ft.
From To Ft.
14. GROUT:
Depth Material Method
From
From
15. SCREEN: �
Depth Diameter Slot Size Material `�.��` tl
From To Ft. in. in.
From To Ft. in. in. t
r�
From To Ft. in. in.
�\.S
16. SAND/GRAVEL PACK: f 1A
Depth Size Material '`
From To Ft. f
From To Ft.
17. REMARKS: �# L
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.
} HI
FOR OFFICE USE ONLY �' - aV �- ' /4 0 ;
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
Quad No: Submit original to Division of Water Quality,Groundwater Section within 30 days
GWA REV.12/99
Serial No.

lam'w
North Carolina-Department of Environment and Natural Resources- Division of Water Quality-Groundwater Section
1636 Mail Service Center-Raleigh, N.C.27699-1636-Phone[phone] a 1 ' 9 11 9
d 9
WELL CONSTRUCTION RECORD WELL CONTRACTOR: De,4eY V/right :'`ell Fume C o., Inc.
WELL CONTRACTOR CERTIFICATION#: 2587
uB05` D STATE WELL CONSTRUCTION PERMIT#: Steve Reece
1. WELL USE(Check Applicable Box): Residential 0 Municipal E] Industrial 0 Agricultural 0 Monitoring
Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use:
2. WELL LOCATION:(Show sketch of the location below)
Nearest Town: BANNER ELK. County: "VERY
LOT#2C, OFF BAGELS NEST OFF 101 OF 164 OFF 106
(aoad Name and Numbers,Community,or TuMbd7vision and Lot o.) DRILLING LOG DEPTH
3. OWNER IHE LODGES AT EAGLES NEST From To Formation Description
Address 2120 TY?dECASTLE !Pe^ Y 0 5 "J+RT
BANNERM,or oute Na tic 26504 5 240 GRA(�1r4}TiT)E
City or own rate Zip ode 240 244 !sUAIRTZ
4. DATE DRILLED Sl;1120C15 214 425 GRACJITE
5. TOTAL DEPTH 425
6. CUTTINGS COLLECTED YES 0 NO 0
7. DOES WELL REPLACE EXISTING WELL? YES 0 NO 0
8. STATIC WATER LEVEL Below Top of Casing: 200 FT.
u
(Use"+'if Above Top of Casing) -
9. TOP OF CASING IS 1 FT.Above Land Surface*
`Top of casing terminated at/or below land surface requires a variance in accor.
dance with 15A NCAC 2C.gg118
10. YIELD (gpm): 1U METHOD OF TEST Aar
11, WATER ZONES (depth):f0.00 porn 240-24`t 0.00pprn -,
0.00 ppm 0 Wow
12. CHLORINATION: Type F' Amount 46 If additional space is needed use back of form
13. CASING: LOCATION SKETCH
Wall Thickness `
Depth Diameter or Weight/Ft. Material (Show direction and distance from at least two State
From 0 To 22 Ft. 6 1(9 .350 r"YC Roads,or other map reference points) p�
l
From To Ft. :tU (K �
From To Ft.
14. GROUT:
Depth Material Method 'j
'f-t'P"El
From 0 To 20 Ft. t Gra ify Flow ,\
From To Ft.
15. SCREEN:
Depth Diameter Slot Size Material 'f!-+ fr7��"
Y
From To Ft. in. in. f'; -r f; C-/k .K•/ �.y
From To Ft. in. in. �•/.,
From To Ft. in. in.
d
16. SAND/GRAVEL PACK: x fry
F ._ z
Depth Size Material <I' t/,,�f
From To Ft.
From To Ft. / \�
17. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C,WELL
CONSTRUCTION STANDARDS,AND THAT A COPY OF
THIS REC/Oj�RpJHAS BEEN PROVIDED TO THE WELL OWNER.
FOR OFFICE USE ONLY 's— SR C `C y 0 }
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
Quad No: Submit original to Division of Water Quality,Groundwater Section within 30 days
GW-1 REV. 12/99
Serial No.

,fi . 9 '-1 7
North Carolina-Department of Environment and Natural Resources-Division of Water Quality-Groundwater Section 0 f
1636 Mail Service Center- Raleigh, N.C.27699-1636-Phone[phone]
WELL CONSTRUCTION RECORD WELL CONTRACTOR: �e°ney'vgi Ivit ^"ai f'Umilo Co i 71c
WELL CONTRACTOR CERTIFICATION#: d`
„v04�F STATE WELL CONSTRUCTION PERMIT#: Stcyve Rpe`=e
1. WELL USE(Check Applicable Box): Residential EE Municipal 0 Industrial E] Agricultural❑ Monitoring 0
Recovery 0 Heat Pump Water Injection 0 Other D If Other, List Use:
2. WELL LOCATION:(Show sketch of the location below)
Nearest Town: BANNER ELK County: AVEP
L(-'T#L-19 EAGLES P3EST OFF 194 OFF 'f 64 OFF 105
(Road Name and Numbers,Community,or Subdivision and Lot No.) DRILLING LOG DEPTH
3. OWNER THE LODGES AT EAGLE NEST From To Formation Description
Address EE JC-HN TURtSHION LLC , 2120 T4'NEC;A.STLE t-NIVY 0 n E lRT
EpF�P1E� ttTAornoun, o.) t,(C 28604 d 110 3P,ANITE
atyormwn 21 state IP ode ;0 113 SHALE
4. DATE DRILLED SI221200 13 505 GRANITE -
5. TOTAL DEPTH
6. CUTTINGS COLLECTED YES E NO 0
7. DOES WELL REPLACE EXISTING WELL? YES 0 NO 0
8. STATIC WATER LEVEL Below Top of Casing: 6C' FT. -
(Use"+"if Above Top of Casing)
9. TOP OF CASING IS FT. Above Land Surface*
`Top of casing terminated at/or below land surface requires a variance in accor-
dance with 15A NCAC 2C 011E
10. YIELD (gpml: 3 METHOD OF TEST Air ^: -
11. WATER ZONES (depth): 3,00 Apm 11.0-1IS 0.16ppm 4�
0.00 Cprr1 I�.'70aprn -
Hi H t 2 If additional Space is needed use back of form --
12. CHLORINATION: Type Amount p - --
13. CASING: Wall Thickness LOCATION SKETCH
Depth Diameter or Weight/Ft. Material (Show direction and distance from at least two State h
From To L Ft Roads,or other map reference points)
From To Ft
From To Ft.
14. GROUT:
Depth Material Methodr]
From 0 To 20 Ft. Ccment orati'tf ploy" /
From To Ft.
15. SCREEN:
Depth Diameter Slot Size Material
From To Ft. in. in. /
From To Ft. in. in.
From To Ft. in. in. �,.�- _eI
16. SAND/GRAVEL PACK: L"
Depth Size Material 1
From To Ft. v`
From To Ft.
k:J fv 't
L
17. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C,WELL
CONSTRUCTION STANDARDS,AND THAT COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER.
FOR OFFICE USE ONLY ` L ' <7 7 - 0-5
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
Quad No: Submit original to Division of Water Quality,Groundwater Section within 30 days
GW-1 REV. 12/99
Serial No.

North Carolina -Department of Environment and Natural Resources-Division of Water Quality-Groundwater Section
1636 Mail Service Center-Raleigh, N.C.27699-1636-Phone[phone]
`d f
WELL CONSTRUCTION RECORD WELL CONTRACTOR: Dewey Wright Well Fournp Co., In-,
WELL CONTRACTOR CERTIFICATION#: 2162/
05039 I ? STATE WELL CONSTRUCTION PERMIT#: S9v=_ Reeve
1. WELL USE(Check Applicable Box): Residential Municipal ❑ Industrial 0 Agricultural 0 Monitoring 0
Recovery 0 Heat Pump Water Injection Other ❑ If Other, List Use:
2. WELL LOCATION: (Show sketch of the location below)
Nearest Town: BANNER ELK County: AVERY
E4 "L NEST /FF MJY " FF 1 x4 OFF 105
IRoatl Name an Numbers,Community,or Subtlry sion antl Lot No.)
DRILLING LOG DEPTH
3. OWNER _CR4iG F'L.e.TH "` (�s h'ec.r
From To Formation Description
Address 2120 T'!NE CASTLE Wdr 0 a0 CURT
,E.4M1iNER a or RouteNo.l I,4C 26804 10 36 GRANITESk-tALF,
City or Town rate Zip Code 36 43 FHALE
4. DATE DRILLED B,212005 43 625 -GRANITE
5. TOTAL DEPTH 825
6. CUTTINGS COLLECTED YES 0 NO 0
7. DOES WELL REPLACE EXISTING WELL? YES 0 NO 0
8. STATIC WATER LEVEL Below Top of Casing: 30 FT. rn =
(Use','if Above Top of Casing)
9. TOP OF CASING IS 1 FT.Above Land Surface*
'Top of casing terminated at/or below land surface requires a variance in accor- ---
dance with 15A NCAC 2 .07 8
10. YIELD(gpm): t�.2 METHOD OF TEST A r o
11. WATER ZONES(depth): 0.25 pprn 3843 0.00pprn
3.00 tlpm 0.0000m
12. CHLORINATION: Type HTH Amount 118 If additional space is needed use back of form
13. CASING: LOCATION SKETCH
Wall Thickness
Depth Diameter or Weight/Ft. Material (Show direction and distance from at least two State
From 0 To 24 Ft. Et 13 350 Roads,or other map reference poin )
From To Ft. )
From To Ft. tt-t`e �
14. GROUT: /
Depth Material Method /
From 0 To ?0 Ft. lC�ernary¢ Gr.g+,ity Flow
19
From To Ft. ,•
s
15. SCREEN: � a,`v
Depth Diameter Slot Size Material
From To Ft. in. in.
From To Ft. in. in. A
From To Ft. in. in. i
16. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft. h�
17. REMARKS: ICS W
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C,WELL
CONSTRUCTION STANDARDS,AND THAT A COO(PY OOF�7FF�THIS RECORD HAS BEEN PROVIDEDTO THE WELL OWNER.
��'��—
FOR OFFICE USE ONLY "^' J ? —/; — 0
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
Quad No: Submit original to Division of Water Quality,Groundwater Section within 30 days
GW-1 REV.12/99
Serial No.

JP
lam' ( 63
North Carolina-Department of Environment and Natural Resources Division of Water Quality-Groundwater Section
1636 Mail Service Center-Raleigh, N.C.27699-1636-Rhone(9191 733.3221 l `�
WELL CONSTRUCTION RECORD WELL CON TRACTOR: v Y'" =^ K4r
WELL CONTRACTOR CERTIFICATION#: 270',
t'.6'e7526 STATE WELL CONSTRUCTION PERMIT#: .:erty %°eSiam
1. WELL USE(Check Applicable Box): Residential 0 Municipal El Industrial L] Agricultural❑ Monitoring
Recovery El Heat Pump Water Injection 0 Other E] If Other, List Use:
2. WELL LOCATION: (Show sketch of the location below)
Nearest Town: t 'r yi;I County: a,„ER'y
c.1>tr,+ • 91� Z7
173oatl Name aoo N tubers, ommunitY,or Subdivision and Lot No.)
DRILLING LOG DEPTH
3. OWNER S 1=I 1lNrr.^,A; From To Formation Description
Address i'o r- c a , 11 r,l F' cuy,; ._
tree1 or aoute b. ^ .•
p�CUIf LC.�. , M1!i' 'tn'�,-y�� 'j Gfl :'�N fn!•1iTF' C':4k! != G;.I is:i:1
coy or Town State :tip oC de
4. DATE DRILLED Zi^'.linCS '+°! 1fig t--;PAN1TF ('d;::F."7
5. TOTAL DEPTH ;�df1 _ ^56 1FF U-iAl
6. CUTTINGS COLLECTED YES [_1 NO 0 1�R :, O FSR haTF
7. DOES WELL REPLACE EXISTING WELL? YES NO Q
8. STATIC WATER LEVEL Below Top of Casing: ;"I FT.
(Use"+"if Above Top of Casing)
9. TOP OF CASING IS n FT. Above Land Surfaces
*Top of casing terminated at/or below land surface requires a variance in accor-
dance with 15A NCAC 2C.0118
10. YIELD (gpm): .M METHOD OF TEST Air
11. WATER ZONES (depth): 3 (10, gpr',0:'1-P, ?',' Ft'1rr 1 F,11Fie,
(1 nrl,pam n rnppnr,
12. CHLORINATION: Type .L.'TIi Amount '1 If additional space is needed use back of form
13. CASING: Wall Thickness LOCATION SKETCH
Depth Diameter or Weight/Ft. Material (Show direction and distance from at least two State
From To �R Ft. ojz ,i,,,4'P Roads,or other map reference points)
From To Ft. ALa� Ufty�x f�C1
From To Ft.
14. GROUT:
Depth Material Method
From To ?n Ft. .;';,,tz �t Fio t j
From To Ft.
15, SCREEN:
Depth Diameter Slot Size Material
From To Ft. in. in. ,
From To Ft. in. in.
From To Ft. in. in. aS�rt '
16. SAND/GRAVEL PACK:
Depth Size Material LX�"� ck a
From To Ft.
From To Ft. 'A.�'J.,(• 1�
17. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2CL WELL1e
CONSTRUCTION STANDARDS,AND THAT A COe�rY OF TtAS RECORD HAS BEEN PROVVPED TO THE WELL OWNER
FOR OFFICE USE ONLY
Quad No: ,•^ NATURE OF PERSON CONSTRUCTING THE WELL- DATE
Submit original to Division of Water Quality,Groundwater Section within 30 days
GW-1 REV. 12/99
Serial No.

'aa a
North Carolina-Department of Environment and Natural Resources-Division of Water Quality-Gr dwater Section t9 6
1636 Mail Service Center- Raleigh, N.C. 27699-1636- Phone [phone]
WELL CONSTRUCTION RECORD WELL CONTRACTOR: rle1YL` v`'"i' }`"''="" '-Imp t i•.=
WELL CONTRACTOR CERTIFICATION#: Z'='f
STATE WELL CONSTRUCTION PERMIT#: ,_,elf,
1. WELL USE(Check Applicable Box): Residential ❑ Municipal ❑ Industrial ❑ Agricultural ❑ Monitoring ❑
Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use:
2. WELL LOCATION: (Show sketch of the location below)
Nearest Town: RANNER El K County: '�IER
11a �NTR'h`M1FAnCy1.�.rR f�CF t=1 firf,.�.<, tr t1- FryQ"1n._ t3FF
(Reatl Name antl Numbers, ommunity,or Subtlrvision antl Lot No.)
DRILLING LOG DEPTH
3. OWNER —R( f0 I t' From To Formation Description
Address N FiS n
-y 1) f,n , , ... T.
i^r, '74P^7 fl3 91F i-F?,r fd;"= SiF?.AI
City or Town State Zipcotle
OF OR
Si-{ALF�
4. DATE DRILLED T125041015 Iij�j 1110 Is;ZwgiT-i' QLJ.,k4r-21
5. TOTAL DEPTH d')5 _ a qn i q ry _;r Al G
6. CUTTINGS COLLECTED YES ❑ NO ❑ _ �,�1 C^� +:,-?ify(TE
7. DOES WELL REPLACE EXISTING WELL? YES ❑ NOFTI
8. STATIC WATER LEVEL Below Top of Casing: 4n FT.
(Use'•+"if Above Top of Casing)
9. TOP OF CASING IS 1 FT. Above Land Surface*
Top of casing terminated at/or below land surface requires a variance in accor-
dance with 15A NCAC 2C.0119
10. YIELD(gpm): 11 METHOD OF TEST Air
11. WATER ZONES (depth): JQ +wr^ir!i­1it
Q.00 aarr• D ^ cr�•m
12. CHLORINATION: Type F471-I Amount 76 If additional space is needed use back of form
13. CASING: Wall Thickness LOCATION SKETCH
Depth Diameter or Weight/Ft. Material (Show direction and distance from at least two State
From 7s To — , Ft, h t !~ °54 pwt Roads, or other map reference points)
From To Ft.
From To Ft.
14. GROUT: If,yfS
(
Depth Material Method
From n To �'t5 Ft. ."trylap} !�,,�r;i;><wyct,,,y
From To Ft. r ,
15. SCREEN:
Depth Diameter Slot Size Material
i
From To Ft. in, in.
From To Ft. in. in.
r v
From To Ft. in. in.
16. SAND/GRAVEL PACK:
Depth Size Material �f,••c{ " \ rp `��
�1- 4
From To Ft.
From To Ft.
17. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C,WELL
CONSTRUCTION STANDARDS,AND THAT A COPY OF THIS RECORD HAS BEEN PR0VIDED TO THE WELL OWNER
...r j��
FOR OFFICE USE ONLY f
ATURE OF PERSON CONSTRUCTING THE WELL DATE
Quad No: r_. ULl;`�ubmii to Division of Water Quality,Groundwater Section within 30 days
-' GW-1 REV.12199
Serial No.
fi .,

North Carolina- Department of Environment and Natural Resources-Division of Water Quality-Groundwater Section
1636 Mail Service Center-Raleigh, N.C.27699-1636- Phone[phone]
WELL CONSTRUCTION RECORD WELL CONTRACTOR: Wrighteeea:t P.;—, taco_ Ir1c_.
WELL CONTRACTOR CERTIFICATION#: ,01
050"4F2 INSTATE WELL CONSTRUCTION PERMIT#: SteaS Reiice
1. WELL USE (Check Applicable Box): Residential R Municipal 0 Industrial 0 Agricultural❑ Monitoring El
Recovery 0 Heat Pump Water Injection Other 0 If Other, List Use:
2. WELL LOCATION: (Show sketch of the location below)
Nearest Town: !"tcnn;.;FF County:
Iftoad Name and Numbers,Commumig or Subtlmision and Lot No.l
DRILLING LOG DEPTH
3. OWNER I if,aD,L, 5hd111-" From To Formation Description
Address :2:7RP, i Infi:li i F Gkr� ;� � ' {,+trr.� 71 AF, 1')!t7�'"
f mil. yf.,l�,or Routee o�' ]
City or To State eLotl� e sA �� CIP L Nij 1r
P P'ki A C!)ART-1
4. DATE DRILLED QLMI h^IOEi pp 71i; 17zE A it IF
5. TOTAL DEPTH ::t iR _ ?Ffi '.5e QI;AR77 -
6. CUTTINGS COLLECTED YES D NO 0 _ %5p
7. DOES WELL REPLACE EXISTING WELL? YES E] NO
8. STATIC WATER LEVEL Below Top of Casing: :'17 FT.
(Use"+"if Above Top of Casing) �.i
9. TOP OF CASING IS 'I FT.Above Land Surface*
*Top of casing terminated at/or below land surface requires a variance in accor-
dance with 15A NCAC 2C.0118
10. YIELD (gpm): 7 METHOD OF TEST Air
11. WATER ZONES (depth): ( 011 .,p—fid_PiF
;1 fllt nnnT A
12. CHLORINATION: Type L4T4-I Amount R 7 If additional space is needed use back of form
13. CASING: Wall Thickness LOCATION SKETCH
Depth Diameter or Weight/Ft. Material (Sb w direction and distance from at least two State
From ^ To _ a Ft. j ii t IZia 4.1 1, �F;.L� Roads,or other map reference points)
From To Ft. t0
From To Ft �' A
14. GROUT:
Depth Material Method ; �' --�
From (1 To �'.1�_Ft. f"�+rnFrt4 =.r::v fir Finxu (� r--';
From
15. SCREEN: \�
Depth Diameter Slot Size Material
From To Ft. in. in.
From To Ft. in, in. .a
From To Ft. in. in.
u
16. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft. ,�
E
17. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C,WELL
CONSTRUCTION STANDARDS,AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER.
FOR OFFICE USE ONLY /G
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
Quad No: Submit original to Division of Water Quality,Groundwater Section within 30 days
GW-1 REV.12/99
Serial No.

f r
North Carolina-Department of Environment and Natural Resources-Division of Water Quality-Groundwater Section
1636 Mail Service Center-Raleigh,N.C. 27699-1636- Phone[phone]
WELL CONSTRUCTION RECORD WELL CONTRACTOR: °yeeY `v'?'is:.flt'vk'8i! PQIT,p CO.,
WELL CONTRACTOR CERTIFICATION#:
'Or,01151 STATE WELL CONSTRUCTION PERMIT#: -- ✓C �1.�..
1. WELL USE(Check Applicable Box): Residential EZ Municipal 0 Industrial 0 Agricultural El Monitoring 0
Recovery 0 Heat Pump Water Injection El Other 0 If Other, List Use:
2. WELL LOCATION: (Show sketch of the location below)
Nearest Town: n County: AVER,
! ^T r_a r1i-c 'LA.1 r-,�F ^�g nit tit4j
IRoaa Name and Nnmdars, ommun¢y,or ubdivleton and Let No.) DRILLING LOG DEPTH
3. OWNER 16-17 1 ;Dr- :,;AT P.A EC, Nl=,'�" From To Formation Description
Address r. I4A,f I~ 'T t'1 ^T
( j a for Raute No I
Qry or Town State ,'iplod
'::ii qjn r7�n t"_{rA^n17
4. DATE DRILLED t"++"ct r rt5 61 n'7 1'11;uofVrr-
5. TOTAL DEPTH �nr�: _ yid c:y.t , c
6. CUTTINGS COLLECTED YES [_1 NO El _ i��1
7. DOES WELL REPLACE EXISTING WELL? YES U NO 10 - *.
8. STATIC WATER LEVEL Below Top of Casing: : FT. ,ry '
(Use',"if Above Top of Casing) Efi!
9. TOP OF CASING IS ? FT. Above Land Surface*
Top of casing at/
or
terminated or below land surface requires a variance in actor- L+1
dance with 79A NCAC terminated
2C.0118
at/
10. YIELD (gpm): -m METHOD OF TEST
11. WATER ZONES (depth):1h Oil qrrn f. -iE9
12. CHLORINATION: Type` 1-1134 Amount A=` If additional space is needed use back of forrEV '
13. CASING: Wall Thickness LOCATION SKETCH
Depth Diameter or Weight/Ft. Material (Show direction and distance from at least two State
From w To rS Ft. i,;.9 py Roads,or other map reference points)
J
From To Ft. j,./
From To Ft.
14. GROUT:
Depth Material Method i
From n To "I Ft. r_r;P.
From To Ft. ,L
15, SCREEN:
Depth Diameter Slot Size Material
From To Ft. in. in. / y
From To Ft. in. in.
l
From To Ft. in. in.
16. SAND/GRAVEL PACK:
Depth Size Material "'1fT ;�-�..,,,,
From To Ft. ./(C_
From To Ft.
17. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C,WELL
CONSTRUCTION STANDARDS,AND THAT A COPY OF THIS RE�RD HAS BEEN PROVIDED TO THE WELL OWNER.
FOR OFFICE USE ONLY �) 7� r'tl-u-
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
Quad No: Submit original to Division of Water Quality,Groundwater Section within 30 days
GW-1 REV. 12/99
Serial No.

North Carolina- Department of Environment and Natural Resources-Division of Water Quality-Groundwater Section 3 -1 8 I ;c
1636 Mail Service Center-Raleigh, N.C. 27699-1636-Phone[phone]
WELL CONSTRUCTION RECORD WELL CONTRACTOR: Ge'`''ey VV='Qht`' e!i Pump C"o. Inn,
WELL CONTRACTOR CERTIFICATION#: 26Sr.
107G51 a STATE WELL CONSTRUCTION PERMIT#: E�teve reecie
1. WELL USE (Check Applicable Box): Residential 0 Municipal 0 Industrial E Agricultural❑ Monitoring 0
Recovery EJ Heat Pump Water Injection El Other E] If Other, List Use:
2. WELL LOCATION: (Show sketch of the location below)
Nearest Town: County: AWW-'z,:'
�T .. cc r.c } n
aoatl ame an umbers, ommuniry,or a tlrvision an of N.
DRILLING LOG DEPTH
3. OWNER a T Et .; FC °•l am From To Formation Description
Address S!„ i-R!4i-­PAT eATHl C'^"'^'-`;f.�r.,.., Tt � wA,iV t, .:.us F-''!O
Istre t 'r Route N'o.l
"4F{M ?L1 ^^•1 ':C?i:"'.T'�'
GtY or Sta Town te ip
ce
4. DATE DRILLED S ;-Ipie IPt1Psl Ti=
5. TOTAL DEPTH gol-I _ CAR Rlrli1 C4 14p.177
6. CUTTINGS COLLECTED YES El NO D
7. DOES WELL REPLACE EXISTING WELL? YES EJ NO 0 W
8. STATIC WATER LEVEL Below Top of Casing: r FT.
(Use 4"if Above Top of Casi ng)
9. TOP OF CASING IS FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a variance,n accor-
dance with 15A NCAC 2C.0118 L �_
1 . YIELD METHOD OF TEST .. ,11 ZOO. WATER ZONES(depth): F itn +. - -ac;a 1F I'+11,�y; ']7•'i-$cil
n nn r,, ^nrrp_n
12. CHLORINATION: Type 1­41!14 Amount f>e2 If additional space is needed use back of fold
op-
13. CASING: Well Thickness LOCATION SKETCH t
Depth Diameter or Weight/Ft. Material (Show direction and distance from at least two State \
From f.+ To __fir Ft. ;A,.. ° I''J-= P .- P _
Roads,or other ma4 reference points) ^ }
From To —Ft. },�d
From To Ft. 1- -- - — —"'_"_' / _ ,tD
f N
14. GROUT:
Depth Material Method } '
From n To 20 Ft.
From To Ft.
i
15. SCREEN:
Depth Diameter Slot Size Material
From To Ft. in. in. i,.,r:.�V
From To Ft. in. in.
From To Ft. in. in. �"�:.,,,_
16. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
l,C� ! �'
%1
17. 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 RECDRD HAS BEEN PROVIDED TO THE WELL OWNER.
FOR OFFICE USE ONLY — ^ �h ��'] f0 ? V
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
Quad No: Submit original to Division of Water Quality,Groundwater Section within 30 days
GW-1 REV. 12/99
Serial No.

�p ,1
North Carolina-Department of Environment and Natural Resources- Division of Water Quality-Groundwater Section 0
F{f s 3r 'J
1636 Mail Service Center-Raleigh, N.C. 27699-1636-Phone[phone]
WELL CONSTRUCTION RECORD WELL CONTRACTOR: Dey eV srrctl!,,t>e±i -uma '� . ?nc
WELL CONTRACTOR CERTIFICATION#: 21
'•Ipu55rj STATE WELL CONSTRUCTION PERMIT#: -tw' R2E'ra
1. WELL USE(Check Applicable Box): Residential Municipal ❑' Industrial ❑ Agricultural❑ Monitoring ❑
Recovery ❑ Heat Pump Water Injection Other ❑ If Other, List Use:
2. WELL LOCATION: (Show sketch of the location below)
Nearest Town:
21111.41ZR =l k" County:
�i' -pJcc• , -t r.cE+"\Y u-� "'frr, rya r'�r_� �84 11F
'woad ame and t'umb�,9`ommunity,or�ulitlimsion and Lot fJo.
DRILLING LOG DEPTH
3. OWNER T c T From To Formation Description
Address gv� r'!4,oi A Pf Tw 11 1 vrjr-,- E -;Syy G ay rrtc�T
13tcalreet,rode No.l�' r,^•
city or Town State yzip code
4. DATE DRILLED �22 "-PI `=d�Lt11T-
5. TOTAL DEPTH 'la 'ton 40. r7o!PR 1`7
6. CUTTINGS COLLECTED YES ❑ NO ❑ 'n 6Eo D1 ;ART,
7. DOES WELL REPLACE EXISTING WELL? YES ❑ NO ❑ n-tt 79. Ga .!rT�
8. STATIC WATER LEVEL Below Top of Casing: I FT.
^a
(Use',"if Above Top of Casing)
9. TOP OF CASING IS 1 FT.Above Land Surface*
*Top of casing terminated at/or below land surface requires a variance In accor-
dance with 15A NCAC 2C.0118
10. YIELD (gpm): M METHOD OF TEST tkir
11. WATER ZONES (depth) .i 0"1 ^ rn td11 "1 00 rn 4 1 :-,^-,Ll,'_.
12. CHLORINATION: Type ErH Amount 112 If additional space is needed use back of form
13. CASING: Wall Thickness LOCATION SKETCH
Depth Diameter or Weight/Ft. Material (Show direction and distance from at least two State
From lit To n 4 Ft. 541. 299 —P- fj;-- I Roads,or other map reference points) �(
From To Ft. �t1c' f 1�yF
From To Ft.
14. GROUT:
Depth Material Method rvk
From _ a To _•,C Ft. 4`_.1,g-1
From To Ft.
15. SCREEN: .. — G'� I.
Depth Diameter Slot Size Material ---
From To Ft. in, in. hK>.i j
From To Ft. in. in. � -
From To Ft. in. in.
16. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
17. REMARKS: \
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C,WELL
CONSTRUCTION STANDARDS,AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER.
��11 .1
FOR OFFICE USE ONLY '�h (�Y'�' �•'�F—�llr
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
Quad No: Submit original to Division of Water Quality,Groundwater Section within 30 days
GW-1 REV.12/99
Serial No.

North Carolina-Department of Environment and Natural Resources-Division of Water Quality-Groundwater Section 0 k r
1636 Mail Service Center-Raleigh, N.C.27699-1636-Phone[phone]
WELL CONSTRUCTION RECORD WELL CONTRACTOR: r?e"'ve`r`fdrlpltt'e`deli Ftmp Co, In .
WELL CONTRACTOR CERTIFICATION#: 2087
0.50538 STATE WELL CONSTRUCTION PERMIT#: Steve R'eeC?
1. WELL USE (Check Applicable Box): Residential EZ Municipal 0 Industrial 0 Agricultural Q Monitoring Q
Recovery El Heat Pump Water Injection 0 Other 0 If Other, List Use:
2. WELL LOCATION: (Show sketch of the location below)
Nearest Town: Rid"IbiCR Fi it County: AVr,7V r
i hT s4f_71�i FAf-',I ,^-n � �r--t"4�-C i"11�Sr,- •n,t /-,CC ,OF
Idoatl Name and Numbers, ommunity,or"Subdrvsmn and Lo[No.) '
DRILLING LOG DEPTH
3. OWNER l't.IP i�1nr-_,c5 4-r 61�;�! E,: -mE aT From To Formation Description
Address_ .,a"'L r:,p•t�`'perr F uynr
TS'Ereet'or FYouTe,V
ldWRR 21=14 ^"' ^o G 00 a^AhOTc
Gty or To State '�p otle
4. DATE DRILLED �r�•- ^nnT ^n 2­0 }
S. TOTAL DEPTH C45 it
6. CUTTINGS COLLECTED YES El NO ;p,,r.1ITF
7. DOES WELL REPLACE EXISTING WELL? YES E�J NO EZ
8. STATIC WATER LEVEL Below Top of Casing: -yin FT.
(Use"+"if Above Top of Casing)
9. TOP OF CASING IS I FT. Above Land Surface* r.
*Top of casing terminated at/or below land surface requires a variance in actor- .� )
dance with 15A NCAC 2C.0118
10. YIELD (gpm): T! METHOD OF TEST Air r
11. WATER ZONES (depth):20 M !err" 1'-'=>=i ^. (i'lnnrr
OR pnm D nfinnm c!
12. CHLORINATION: Type HIP. Amount Q1 If additional space is needed use back oli fo-"
13. CASING: Wall Thickness LOCATION SKETCH u'
Depth Diameter or WeighUFt. Material -.. lShow direction and distance from at least two State
From n To _gyp Ft. I r,at P"a Roads,or other map reference points) r
From To Ft. )US J
From To Ft. %i^�n`A_-
14. GROUT:
Depth Material Method
From n To Ft. - r-a,.,.'
20 � gjeat �- t��
From To Ft.
15. SCREEN:
Depth Diameter Slot Size Material
From To Ft. in. in. t([
From To Ft. in. in.
From To Ft. in. in. Md ve/9�1
"Fe /
16. SAND/GRAVEL PACK:
Depth Size Material
From To Ft. /
From To Ft.
17. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C,WELL
CONSTRUCTION STANDARDS,AND THAT A COPY OF THIS
-RECORD
rJAS BEEN PROVIDED TO THE WELL OWNER.
FOR OFFICE USE ONLY
C1 / ca1 U1_.IJt �d E - 0
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
Quad No: Submit original to Division of Water Quality,Groundwater Section within 30 days
GW-1 REV.12/99
Serial No.

North Carolina-Department of Environment and Natural Resources-Division of Water Quality-Groundwater Section C%
1636 Mail Service Center-Raleigh,N.C.27699-1636-Phone [phone]
WELL CONSTRUCTION RECORD WELL CONTRACTOR: 17 r
WELL CONTRACTOR CERTIFICATION#: 687
STATE WELL CONSTRUCTION PERMIT#: 'Sfr.y.B! Reece
1. WELL USE(Check Applicable Box): Residential 0 Municipal El Industrial 0 Agricultural 0 Monitoring El
Recovery 0 Heat Pump Water Injection E] Other 0 If Other, List Use:
2. WELL LOCATION:(Show sketch of the location below)
Nearest Town: H WPRSN1P:lr, County: alfLr':
oa'd�9amea 8'7um6ers,L'ommumty,or sub ivision ano'TowoJ DRILLING LOG DEPTH
3. OWNER r,-jr= I ;E ES :,T;--A_2 73 VEST From To Formation Description
Address .7,t'?i?'r,:n 1'-"��?c. ,� i-.rt:+n: ,? �'• t'tl Ca.T
Street or fT•ovte IToJ
rIc rLlr r. �cf ,^ 9l 1 cr4 't'fE
City or I own State 2ip botle
4. DATE DRILLED
5. TOTAL DEPTH 7"R R24 ,:�t,i4po -
6. CUTTINGS COLLECTED YES D NO C a 'h "5
— Cy�'n
7. DOES WELL REPLACE EXISTING WELL? YES E] NO LEI
8. STATIC WATER LEVEL Below Top of Casing: Ici FT. i4
(Use"+"if Above Top of Casing) '
9. TOP OF CASING IS 1 FT. Above Land Surface*
Top of casing terminated at/or below land surface requires a variance in actor-. r }
dance with 15A NCAC 2C.0118
10. YIELD (gpm): 5D METHOD OF TEST Air
11. WATER ZONES (depth): fi Rr'r tYy^1rrJ%ii_�'I'2 ,+�, (("tfinrrr ;"2 '+p
12, CHLORINATION: Type rif?-I Amount 1EQ If additional space is needed use back'df form
13. CASING: Wall Thickness LOCATION SKETCH
Depth Diameter or Weight/Ft. Material (Show direction and distance from at least two State (
From n To R Ft.�,'2 �50 ='y'" Roads,or other map reference points) rv�
From To Ft. 4-Afn's- _ _ i
From To Ft. H
taw
14. GROUT:
Depth Material Method
From_ p To 2g Ft. .gogg---,—cit rfi;,4,
From To Ft.
15. SCREEN:
Depth Diameter Slot Size Material
From To Ft. in. in. '
From To Ft. in. in.
From __To Ft. in. in.
16. SAND/GRAVEL PACK:
Depth Size Material 5-.
From To Ft.
From To Ft. ..Ke
17. REMARKS: "� �•-----� \�
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C,WELL
CONSTRUCTION STANDARDS,AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER.
�C �,e,�_
FOR OFFICE USE ONLY =` �- 6", �71 G{ Al^
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
Quad No: Submit original to Division of Water Quality,Groundwater Section within 30 days
GW-1 REV. 12/99
Serial No.

F. .•
North Carolina-Department of Environment and Natural Resources-Division of Water Quality-Groundwater Section p 1 -
1636 Mail Service Center-Raleigh, N.C. 27699-1636- Phone[phone]
WELL CONSTRUCTION RECORD WELL CONTRACTOR: a ', §i';i, rF'aNli ^;.:r+'•a r ;} , :.r
WELL CONTRACTOR CERTIFICATION#: '-6A7
0123 STATE WELL CONSTRUCTION PERMIT#: t'teiy
1. WELL USE(Check Applicable Box): Residential 0 Municipal ❑ Industrial 0 Agricultural 0 Monitoring ❑
Recovery 0 Heat Pump Water Injection Other El If Other, List Use:
2. WELL LOCATION:(Show sketch of the location below)
Nearest Town: 5,4VERSHIELD County: 4.4E*t 1
_C?7 4 113 C'!FP Or"' RLE Khff P (iF'F Ri VF R i-L.'i'.I 0-P FUC,
1 oadNameandNumbers,Community,or Subdivision and Lot No.) DRILLING LOG DEPTH
3. OWNER A,-V'tEN17E 0 K!NQ li From To Formation Description
Address r
for Route No.!
FAPIh rj �'. /..�. -.i�P,lin -yen fir,f1 n ..:`VITF.
city or Town state Zip code
4. DATE DRILLED 42`1 125 3'1^
5. TOTAL DEPTH !1486 _
6. CUTTINGS COLLECTED YES 0 NO F� 8
7. DOES WELL REPLACE EXISTING WELL? YES EJ NO Q
8. STATIC WATER LEVEL Below Top of Casing: 1£•f FT. m
(Use',"if Above Top of Casing)
9. TOP OF CASING IS 1 FT.Above Land Surface* oA
'Top of casing terminated at/or below land surface requires a variance in accor-
dance with 15A NCAC 2C.0118 -
10. YIELD (gpm): METHOD OF TEST '
11. WATER ZONES (depth): �3•uQgpmalt7-�"92 ;^.!C!)pa+1�
12. CHLORINATION: Type Amount F5".r If additional space is needed use back of form
13. CASING: LOCATION SKETCH
Wall Thickness .t l�
Depth Diameter or Weight/Ft. Material (Show direction and distance from at least two State t.
From i1 To rt'%Ft. E. 14w '1l�rl pyr, }i Roads,or other map reference points) 0
From To Ft.
From To Ft. 'tJ1
14. GROUT: r
Depth Material Method
From ^ To 7i i Ft. '"Prnpnt 13rakr N Flnv:
From To Ft. / A. `
77
15. SCREEN:
Depth Diameter Slot Size Material..._
From To Ft. in. in. ��-
From To Ft. in. in.
From To Ft. in. in. •+y. 1� --,�_I I+-
16. SAND/GRAVEL PACK: / r
Depth Size Material "
From To Ft.
From To Ft.
17. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C,WELL
CONSTRUCTION STANDARDS,AND THAT A COPYJQF THIS RECORD HAS BE15� PROVIDED TO THE WELL OWNER.
FOR OFFICE USE ONLY �/, "' y ��
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
Quad No: Submit original to Division of Water Quality,Groundwater Section within 30 days
GW-1 REV.12/99
Serial No.

North Carolina-Department of Environment and Natural Resources-Division of Water Quality-Groundwater Section n n.
1636 Mail Service Center-Raleigh, N.C.27699-1636-Phone[phone] J -LWELL CONSTRUCTION RECORD WELL CONTRACTOR: Cte"ey igh" ate! Purnr 'o.
WELL CONTRACTOR CERTIFICATION#: c667
n`r0S STATE WELL CONSTRUCTION PERMIT#: Ebeye R+2ECF
1. WELL USE(Check Applicable Box): Residential ❑ Municipal ❑ Industrial ❑ Agricultural❑ Monitoring ❑
Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use:
2. WELL LOCATION: (Show sketch of the location below)
Nearest Town: t" County: � ZEE
�:a4�;[•`,I Y F�f•,1F nFF op gr5r., hhp pn ��F "G'4 r)F'- 13
IRoa Name antl Numbers,Community,or ubdrvision an of Not—j
DRILLING LOG DEPTH
3. OWNER Lit Yl2 k• r'i 1FE7N' From To Formation Description
Address ,r rt t F'P C. c,6 QI:''T
reef or Route No.l
q,- IS5 CRAN;!rE
City or Town State Zip Code 1-;5 61_3 —QUAR'.i7 •i
4. DATE DRILLED 'ii.^iii i 138 60 GRA':Jf;TF
5. TOTAL DEPTH 'eI _
6. CUTTINGS COLLECTED YES ❑ NO
7. DOES WELL REPLACE EXISTING WELL? YES ❑ NO ❑
8. STATIC WATER LEVEL Below Top of Casing: ^0 FT.
(Use"+"if Above Top of Casing)
9. TOP OF CASING IS FT. Above Land Surface* cJs
Top of casing terminated at/or below land surface requires a variance in accor-
dance with 15A NCAC 2C.0118 -
10. YIELD (gpm): 60 METHOD OF TEST Aar
11. WATER ZONES (depth):Sn.00 Vo•� 1'51-4. R 0.CGann1
3900 raom ry 00Aorn
12. CHLORINATION: Type MtH Amount Z^ If additional space is needed use back of form c..
13. CASING: r-•' LOCATION SKETCH
,
Wall Thickness V ' IC
Depth Diameter or Weight/Ft. Material ',tl�o (Show direction and distance from at least two Stag
From To 64 Ft. r, I.,p �, Roads,or other map reference points)
From To Ft. ,
From To Ft.
14. GROUT: ____
Depth Material Method �!~ �) --- ��
I
From *a To 'NI Ft. '•CItA1=r,!T
From To Ft.
15. SCREEN: a �
Depth Diameter Slot Size Material
From To Ft. in. in. I t
From To Ft. in. in. a�
From To Ft. in. in.
h
� l l-
16. SAND/GRAVEL PACK:
Depth Size Material r 4.`vCY•tC(
From To Ft y _•'r'� i_. ( "
From To Ft. lid
17. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C,WELL
CONSTRUCTION STANDARDS,AND THAT COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER.
1
FOR OFFICE USE ONLY -2S
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE r
Quad No: Submit original to Division of Water Quality,Groundwater Section within 30 days 1.
GW-1 REV. 12/99 c
Serial No. � '�

k I
North Carolina-Department of Environment and Natural Resources-Division of Water Quality-Groundwater Section
1636 Mail Service Center-Raleigh, N.C. 27699-1636-Phone [phone]
WELL CONSTRUCTION RECORD WELL CONTRACTOR: E tr`. ''*' is' 'vVeil Ptzr,, v'a Inc
WELL CONTRACTOR CERTIFICATION#: 7g3'
050501 STATE WELL CONSTRUCTION PERMIT#: `3tev" Rage
1. WELL USE(Check Applicable Box): Residential EZ Municipal ❑ Industrial ❑ Agricultural❑ Monitoring ❑
Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use:
2. WELL LOCATION: (Show sketch of the location below)
Nearest Town: BAT'4NF_R ELK County: 4VE V
aVi'[iR. iFE EL:K La.^,tt10l 1cu: iFF 106
(Road Name antl Numbars,Community,or Subdion and Lot No.)
DRILLING LOG DEPTH
3. OWNER C'�ROL OLLis
From To Formation Description
Address h BRAD CRUMLEY v' 4 3r; C 2'i0 i'T GRr„i TE ROCK�O . n � n q; r- � _�
IS[ep or Route No.l ,..
G, G'� rr 1 _
- _ GtYorTown�!+�_ L':L State JZiP�de t.=� 1Sn '=RA(VI 1rSAt`Ju31ONE
i:i2 141 _SHAI P
4. DATE DRILLED 11 25i25Q5 141 +`il ^,RANITE CY 4,FT-,
5. TOTAL DEPTH r^` _ 10 ,F." 4NAI +-
6. CUTTINGS COLLECTED YES ❑ NO ❑ R5 sn� -ri nr r;n,
7. DOES WELL REPLACE EXISTING WELL? YES ❑ NO
8. STATIC WATER LEVEL Below Top of Casing: ',fl FT.
(Use'+"if Above Top of Casing) - -
9. TOP OF CASING IS 1 FT.Above Land Surface* -
Top of casing terminated at/or below land surface requires a variance in accor-
dance with 15A NCAC 2C.0116 `
10. YIELD (gpm): 3O METHOD OF TEST 4-Jr _
11. WATER ZONES (depth):2100 own I`S- 14 1" nls prr 18i-164 0
0.00 Oro") 0 000pr":
rA
12. CHLORINATION: Type HTil Amount 39 If additional space is needed use back of form - -
13. CASING: LOCATION SKETCH
Wall Thickness
Depth Diameter or Weight/Ft. Material (Show direction and distance from at least two State ,y)
From 0 To "'f Ft. R 4k4 'RA c'±a1 4"j G Roads,or other map reference poin s) '
From To Ft.
------�'------ I %.
From To Ft.
14. GROUT:
Depth Material Method `:
From ^ To ?�' Ft. ("s:rnnrr r�r nur, : R^'f �
From To Ft. _ !
15. SCREEN:
Depth Diameter Slot Size Material Y; O-)
From To Ft. in. in.
From To Ft. in. in. - t `
From To Ft. in. in. �.
16. SAND/GRAVEL PACK:
Depth Size Material
i 1
From To Ft.
From To Ft.
17. REMARKS: tOJ
1 DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C,WELtL C
CONSTRUCTION STANDARDS,AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER.
( I l
Jt
FOR OFFICE USE ONLY � '` '�"' r /VMi
SIGNATURE OF PERSO CONSTRUCTING THE WELL DATE
Quad No: Submit original to Division of Water Quality,Groundwater Section within 30 days
GW-1 REV.12/99
Serial No.

320499
WELL CONSTRUCTION RECORD
North Carolina-Department of Environment and Rteaoure /Bivls./ybn of Water ity-Groundwater Section
WELL CONTRACTOR(INDIVIDUAL)NAME (ptiat) --(77--// /l O^^G.IC'S CSRTIFiCAT10N#G/ U
WELL CONTRACTOR COMPANYN woo— w l ej QIt:11,A9 PHONE
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMr U -
if applicable) ifapplicable)
I. WELL USE(Check Applicable Box):Residential Mtnticipal/Public❑ Industrial ❑ Agricultural❑
Monitoring❑ Recovery ❑ Heat Pump Water Injection❑ Other❑ If Other,List Use c
2. WELL LOCATION: Topogispbfc/Land setting
Nearest Town:01 S i`/ti /t County (! /' ❑Ridge gOSlope [ Valley ❑Flat
3 ZI arm (decltapp-ptwubox)
(Strut N,me,Nu ber;Community,Subdivision,Lot No,25p Code) LatitudeAcingitade of well location
3. OWNER:_Mfla �i'KW#i (desx-smiouma/secoom) _
Address swe�f a — Latitude/longitude source:❑GPS❑Topographic map
or Route No.) (dmr box)
1.31.ai'rr S U /V C 2 FI 75` Z DEPTH DRILLING LOG
City m Town state Zip Code From TO Formation Descriptiot;
Arta code-Phone number
4. DATE DRILLED
5. TOTAL DEPTH: ZO5-
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO 8�
7, STATIC WATER LEVEL Below Top of Casing: 66D FT.
/, (Usc"+"if Above Top of Casing ,
8. TOP OF CASING IS FT.Above Land Surface" n
'Top of cuing tereninued war below land surface require a
vartmee in accordance with 1SA NCAC 2C.011S. m
9. YIELD(gpm):_ 6 METHOD OF TEST T;P"ez
10. WATER ZONES(depth): n
LOCATION SKETCH
11. DISINFECTION:Type Amount /C e) t Show direction and distance in miles from at least
12. CASING: Wall Thickness two State Roads or County Roads.Include the road
Depth
To m�_ /o O _� mOR 2/t Material numbers and common road names.
Fro Ft S U L
From To Ft
From To Ft
13. GROUT: Depth Material od
Front_ Tom_Ft
From To FL
14. SCREEN: Depth Diameter Slot Size Material
Z° r
From_To Ft in, in.
From To Ft in. in.
15. SAND/GRAVEL PACK NO 6
P
Depth Size Material NO -
Frorn_�To Ft.
From To _ Ft a/
16. REMARKS:Z-4/A IS!,/ 0g� Jam/ LAJ/Qlee
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C,WELL
CONS? [ON STANDARD =ACOP Y�OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
r , -/,/ /CP-Z5 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 CONSTRUCTION RECORD
North Carolina-Department of Environment and Resourc -Divis. n of Water
WELL CONTRACTOR(INDIVIDUAL)NAME (print) �� /l./Q� i
WELL CONTRACTOR COMPANY N:CV uj A-T 'e t JtJ 1 J rt�_
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PLRMIM
(if applicable)
if livable
I. WELL USE(Check Applicable Box):Residential Municipal/Public❑ Industrial
Monitoring❑ Recovery ❑ Heat Pump Water Injection❑ Other O If Other,List I
2. WELL LOCATION: Topogn
Nearest T o wn:3W11 5 Ul t' County (! /' EIRid e EV
SW t- �O� cy RW 28 75`z (She
(Street Nam4 Numbem Cootmum%Subdivision,Lot No,Zip Code) Latitude/lin
3. OWNER: Ato �;�rt wow (�
Address 9 SWee aZ/ Latitude/longitudesc
or Route No.)
rA S (it r_ /1J C 2 Fl 75` Z. DEPTH
City or Town State Zip Code From To
Am code-Phone number
4. DATE DRI LLED
5. TOTAL DEPTH: Z 05-
6. DOES WELL REPLACE EXISTING WELL? YES 17 NO E�
7. STATIC WATER LEVEL Below Top of Casing: Z
— Z-61FT.
Use'+'if Above Top of C-ma)
S. TOP OF CASING IS ( FT.Above Land Surface•
`Top of rasing terminated mfor below land surface requires a
Yariance to aetordance with 1SA NCAC 2C.OIIL
9. YIELD(gpm):_ 6 METHOD OF TEST T f
10. WATER ZONES(depth):
11. DISINFECTION:Type Amotmt /D Q- Show direction and
12. CASING: Wall Thickness two Stare Roads or t
Depth Di or wcigia/Ft Material numbers and commt
FroaL TO-4-0-Ft. S Z u G
From—To FL_
From,_To Ft
13. GROUT: Depth Materialf hr'E t i"
_ m_FtCrCI'C� �From To
From To Ft
I4. SCREEN: Depth Diameter Scot Size Material
From_4—To Ft in. in.
From To Ft in. in.
15. SAND/GRAVEL PACK
FromDepth Size Material
^To Ft.
From To Ft. /�
16. REMARKS:jr/5 f4��t! T wne"--y rSf t./ 0
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 1:
CONSTA ION STAANDAR�D , T A COP F THIS RECORD HAS BEEN PROVIDE
SIGN TUREO PERSON CONSTRUCTING THE WELL
Submit the original to the Division of Water Quality,Groundwater Section,1636 Mail S
27699-1636 Phone No.(919)733.322I,within 30 days.

N`1- 320497
WELL CONSTRUCTION RECORD
North Carolina-Department of Environment and a Resourc � �Divisj6n of Water Quality-Groundwater Section
�Q
WELL CONTRACTOR(INDIVIDUAL)NAME (print) 1.7-f- oS CERTIFICATION#Gl U
WELL CONTRACTOR COMPANY NAMS�jZ, #OeTecl Utj I Oct:I I,Lam_PHONE # SM(e49-o48o
STATE WELL CONSTRUCTION PERMTIV wecOCIATED WQ PERMriYi
ifapplicable) ifapplicable)
1. WELL USE(Check Applicable Box):Residential MunicipaUPublic D Industrial ❑ Agricultural D
Monitoring D Recovery ❑ Heat Pump Water Injection❑ Other❑ If Other,List Use
2. WELL LOCATION: �opographic/Land setting
Nearest Town: �_County C/i dge !]Slope ❑Valley DFIat
I sfw pP>< No/ow L (check apaoptiaebas)
(Steel Name,Number,Con munity,Subdivision,Lot No,Zip Code) Latitude longitude of well location
3. OWNER:L/NP T/Y1 el' (degen minams second,)
Address 1 ` I SweY o W Latimdellongitude source:DGPSDTopographic map
or Route No.) (check box)
Bye-15W% Ltrcet hlG i'F 75'-2 UPTH DDELLING LOG
City or Town Some Zip Cade From To Formation Deseriptioq
Area coda Phone number
4. DATE DRILLED /O —Z�/-o5^
5. TOTAL DEPTH: 3 o 5
6. DOES WELL REPLACE EXISTING WELL? YES O NO
7. STATIC WATER LEVEL Below Top of Casing:_ V FT.
/r
"Far.
if Above Top of Casing)
& TOP OF CASING IS e'FT.Above Land Surface"
`Top of casing termtuated st/or below land surface requires a
variance in accord ISA NCAC 2C.OIIS. n '
9. YIELD(Spin): METHOD OF TEST_ rZ r Pcr�
10.WATER ZONES(depth):
LOCATTON SICFTCH �t
11. DISINFECTION:Type Amount /D o 7 Show direction and distance in miles from at least
12. CASING: Wall Thickness two State Roads or County Roads.Include the mad
Depth Diamater or Weight/Ft. Material numbers and common mad names.
From_t_To_Z('Z Ft. to f y SpR 2 U L
From To Ft I�
13. GROUT: Depth Material Mid �J
From_ To 7-6 Ft j, we r y
From To Ft
14. SCREEN: Depth Diameter Slot Size Material Ito
From_To Ft in. in. •
From To Ft. in. in.
15. SAND/GRAVELPAC De K
Depth Size Material
From,__To Ft. vJ
G
From To Ft.
16. REMARKS:
I DO HEREBY qFRT1FY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C,WELL
CONSTRU N STANDARDS,AND A COP F THIS RD HAS BEEN PROVIDED TO THE WELL OWNER
D-2 -c's�
SIGNATURE OF PERSON abNSTRUCTING 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

" RESIDENTIAL WELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources-Division of Water Quality
�W+*w°'� ^<687 SD545507-1
WELL CONTRACTOR CERTIFICATION#
1.WELL CONTRACTOR: f. DISINFECTION:Type HTH Amount 30
STEVE REECE
g. WATER ZONES(depth):
Well Contractor(Individual Name) Rom170-1 73 To From To
-
From-WRIGHT WELL &PUMP CO- INC,
From To From To
Well Contractor Company Name From To From To
STREET ADDRESS P. O. BOY 308 6.CASING: Thickness/
BOONE NC 28607 Depth Diameter Wei ht Material
From 0 TO 44 Ft. 81;8 .S58 PVC
City or Town State Zip Code From To Ft.
( 828 )- 264-2651 From To Ft.
Area code-Phone number
7.GROUT: Depth Material Method
2.WELL INFORMATION: From 0 TO 20 Ft.Cement Gravity F!ow
SITE WELL ID#pf applicable) From TO Ft.
STATE WELL PERMIT#fdappiicable) From To Ft.`�_
emlent Graor, low
DWQ Or OTHER PERMIT#(ff applicable) B.SCREEN: Depth Diameter Slot Size Material
WELL USE(Check Applicable Box): Residential Water Supply 1 From To Ft. in. in.
DATE DRILLED 11&200-3 From To Ft. in. in.
TIME COMPLETED AM❑ PM L'J From To Ft. in. in.
3.WELL LOCATION: 9.SAND/GRAVEL PACK:
BLOWING ROCK ,AVERY Depth Size Material
CITY: COUNTY From To Ft.
PILOT RIDGE RD. OFF 221 OFF BUSINESS 321 From _To Ft.
(Street Name,Numbers,Community,Subdivision,Lot No.,Parcel,Zip Code) From To Ft.
TOPOGRAPHIC/LAND SETTING: 10.DRILLING LOG
❑Slope O Valley D Flat O Ridge O Other From To Forfnation Description "t
(check appropriate box) C 37 DIRT SKO E
May be in degrees, �7�7J
Utl LATITUDE 3 minutes,seconds or `
LONGITUDE in a decimal format
Latitude/longitude source: ❑GPS ❑Topographic map
(location of well must be shown on a LEGS topo map and E.-
attached to this form if not using GPS) -p
4.WELL OWNER
OWNER'S NAMEDALE C POPE
STREET ADDRESS P.O. B'JC 8r 1
LINCOLNTON NC 28023
City or Town State Zip Code t
Area code-Phone number
5.WELL DETAILS: 11.REMARKS:
a. TOTAL DEPTH: 245 3 GPM 170-173- 0 GPM -
b. DOES WELL REPLACE EXISTING WELL? YES❑ NOYO 0 GPM - -
C. WATER LEVEL Below Top Of Casing: 100 FT. I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH
(Use"+"if Above Top of Casing) 1 SA NCAC 20,WELL CONSTRUCTION STANDARDS,AND THAT A COPY OF THIS
RECORD HAS BEEN PROVID DTO THE WELL OWNER.
d. TOP OF CASING IS 1 FT.Above Land Surface` I r q��`Top of casing terminated at/or below land surface may require A"f U "!
a variance in accordance with 15A NCAC 2C.0118 SIGNATURE OF CERTIFIED WELL CONTRACTOR DATE
e. YIELD(gpm): `$ METHOD OF TEST Air STEVE REECE
PRINTED NAME OF PERSON CONSTRUCTING THE WELL
Submit the original to the Division of Water Quality within 30 days.Attn:Information Mgt., Form GW-1 a
1617 Mail Service Center-Raleigh,NC 27699-1617 Phone No.[phone] ext 568. Rev.7/05

320498
WELL CONSTRUCTION RECORD
North Carolina-Department of Environment and a ,/,R�� ourc 'es Divis n of Water tty-Groundwater Section
WELL CONTRACTOR(INDIVIDUAL)NAME (print) r!l 740do i CERTMCATION#��%
WELL CONTRACTOR COMPANY NAME f1.�A-T'E� t�tJ� �(I. ��A PRONE # &k4,49-ONT0
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if a livable ifapplicable)
1. WELL USE(Check Applicable Box):Residential Muaicipal/Public❑ Industrial❑ Agricultural❑
Monitoring❑ Recovery ❑ Heat Pump Water Injection❑ Other❑ If Other,List Use
2. WELL LOCATION: Topol�d setting
Nearest To": AA&�73_V'i�� County tD� ❑Ridge lope []Valley (]Flat
-Z ittRY' a !� ?87/i/ (ebeck appropriate box)
(Street Name,Numbers,Community,Subdivision,Lot No.,Zip Code) Latitude cingitnde of well location
3. OWNER:Wl&&t° f�lf9J7ssi' (degrew/nunu+eyseconds)
Address Z M111AA F,'ff LatitudeAengitude source:❑GPS❑Topographic map
/ w Route No.) (cbock box)
15w,0S%Jr'` tt get nrL 7R7/y DEPTH DRILLING LOG
City or rows State Zip code From To Formation Description
Alp code-Phone number
4. DATE DRILLED /O-Z-Z-OS
5. TOTAL DEPTH: / %S
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO C-
7. STATIC WATER LEVEL Below Top of Casing:�f�FT.
(Use'+^if Above Top of Cuing)
8. TOP OF CASING IS FT.Above Land Surface"
-Top of cuing termteated Wor below laud surface requires a
variance in aecordmee wins 15A NCAC 2C.ol l& /
9. YIELD(gpm):_ 151 METHOD OF TEST a ,-d
10. WATER ZONES(depth):
LOCATION SKETCH
11. DISINFECTION:Type Amount /D a z Show direction and distance in miles from at least
12. CASING: Wall Tbiclmess two State Roads or County Roads.Include the road
Depth�— 'aigcter orS� t Mgur numbers and con road names.
Fro To t� Ft y 2 _�j e- tYL
From To FL
From To Ft
13. GROUT: Depth Material MFthod m
From_ Tom_Ft C le Wef A+r'
From To Ft 't: o
14. SCREEN: Depth Diameter Slot Size Material
From To Ft in, in.
From To Ft. in. in.
15. SAND/GRAVEL PACK u
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
CONS'fIFU/A�STANDARD THAT
COP�THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
/D —ZZ'D�
SIGNATURE OF ON CONSTRUCTING THE WELL DATE
Submit the original to the Division of Water Quality,Groundwaier'Seetiiln,T636 Mail Service Center-Raleigh,NC
27699-1636 Phone No.[phone],within 30 days. GW-1 REV.07/2001

�diA AArl:o
1 G 19 k
- 4 RESIDENTIAL WELL CONSTRUCTION RECORD n 1
North Carolina Department of Environment and Natural Resources-Division of Water Quality
ea WELL CONTRACTOR CERTIFICATION# 2087 0506M
1.W ELL CONTRACTOR:
STEVE REECE I. DISINFECTION:Type HTH Amount 64
Well Contractor((Individual Name g• WATER ZONES(depth):
DE'YEY IVRIGHT 4'4' L &FUAP CO., 1NC. Frorr1t40 144 To From To
From To From To
Well Contractor Company Name From To From TO
STREET ADDRESS r. `)' 2ri 3 11^-Q 6.CASING: Thickness/
BOONE NC 28607 From 0 Depth 62 Ft. D6 1 meter Weight Material
PVC
City Or Town State Zip Code From To Ft. UU
( S2Fs ) &1-2651 From To Ft.
Area code-Phone number
7.GROUT: Depth Material Method
2.WELL INFORMATION: - From 0 To 20 Ft.CernLrit Gravity Flow
SITE WELL ID#pf applicable) From To Ft.
STATE WELL PERMIT#(d applicable) From To Ft.
Cement Gravity Flow v
DWO or OTHER PERMIT#(if applicable) &SCREEN: Depth Diameter Slot Size Material
WELL USE(Check Applicable Box): Residential Water Supply From To Ft. in. in.
DATE DRILLED 11/112005 From To Ft. in. _in.
TIME COMPLETED AM❑ PM ] From To Ft.—in. in.
3.WELL LOCATION:
9.SAND/GRAVEL PACK:
LINVILLE AVERY Depth Size Material
CITY: COUNTY From To Ft.
LOT#21 OFF CUB COURT OFF BLACKBEAR TRAIL From _To Ft.
(Street Name,Numbers,Community,Subdivision,Lot No.,Parcel,Zip Code) From _To Ft.
TOPOGRAPHIC/LAND SETTING: 10.DRILLING LOG
❑Slope ❑Valley ❑Flat ❑Ridge ❑Other From To Formation Description -
(check appropnate box) 0 55 DIRT SHALE
May be in degrees, GRANITE
. .7
LATITUDE 3 minutes,seconds or
LONGITUDE _ in a decimal format 140 A SHALE
Latitude/longitude source: El CPS ❑Topographic map
144 W-S GRANITE
(location of well must be shown On a USGS topo map and
attached to this form if not using GPS)
4.WELL OWNER
OWNER'S NAME E &K CONSTR ^'
STREET ADDRESS 9218-'1 HVVY 105 S. , Wa.
BANNER ELK; NC 28604
City or Town State Zip Code
(a( 29) )_ 26G-2194
Area code-Phone number
5.WELL DETAILS: 11.REMARKS:
a. TOTAL DEPTH: 365 3 GPM 140-144 - 0 CI Plvt -
b. DOES WELL REPLACE EXISTING WELL? YES❑ NO)b 0 GPhA - 0 GPM -
c. WATER LEVEL Below Top of Casing: 50 FT. I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH
(Use"+"if Above Top of Casing) 15A NCAC 2C,WELL CONSTRUCTION STANDARDS,AND THAT A COPY OF THIS
RECORD HAS BEEN PROVID 0THE WELL OWNER.
d. TOP OF CASING IS1 FT Above Land Surface`
Top of casing terminated at/or below land surface may require
a variance in accordance with 15A NCAC 2C.0118 SIGNATURE OF CERTIFIED WELL CONTRACTOR DATE
e. YIELD(gpm): 3 METHOD OF TEST Air STEEE REECE
PRINTED NAME OF PERSON CONSTRUCTING THE WELL
Submit the original to the Division of Water Quality within 30 days.Attn:Information Mgt., Form GW-1a
1617 Mail Service Center-Raleigh,INC 27699-1617 Phone No. [phone] ext 568. Rev.7/05

* 320968
T S RESIDENTIAL WELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources-Division of Water Quality
WELL CONTRACTOR CERTIFICATION# 2687 050627
1.W ELL CONTRACTOR:
STEVE REECE f. DISINFECTION:Type I ffH Amount 59
Well Contractor((Individual Name g• WATER ZONES(depth):
DE`JVEY Individual Name)
&.PUMP CC) , INC. From 66 To 67 From 240 To 245
From To From To
Well Contractor Company Name From To From To
P. n. gnx 308
STREET ADDRESS 6.CASING: Thickness/
BOONE NC 28207 Depth Diameter Wei ht Material
`' Ft.
City or Town
From 0 To 6 6118 .358 PVC
State Zip Code
( 828 )_ 264-21551 From To Ft.
Area code-Rhone number From To Ft.
2.WELL INFORMATION: 7.GROUT: Depth Material Method
From 0 To 20 Ft.Cement Gravity Flow
SITE WELL ID#fit applicable) FromTo Ft.
STATE WELL PERMIT#(rc applicable) From To Ft.Ce�f'i raw't1 (0a0
DWQ or OTHER PERMIT#(it applicawe) &SCREEN: Depth Diameter Slot Size Material
WELL USE(Check Ap licable Box: Residential Water Supply From To Ft.—In. _in.
DATE DRILLED �11/22 200
yyr� FromTo Ft.—In. in.
TIME COMPLETED AM❑ PM L'J FromTo Ft. in. _in.
3.WELL LOCATION: 9.SAND/GRAVEL PACK:
CITY: ELK PARK COUNTY AVERY Depth Size Material
From -To Ft.
CURTIS CREEK RD. OFF 1W From _To Ft.
(Street Name,Numbers,Community,Subdivision,Lot No.,Parcel,Zip Code) From _To Ft.
TOPOGRAPHIC/LAND SETTING: 10.DRILLING LOG
❑Slope ❑valley ❑Flat ❑Ridge O Other From To Formation Description
(check appropriate box) 0 55 DIRT SHALE
May be in degrees,
LATITUDE 3 minutes,seconds � �-_ - J uI UC -
LONGITUDE in a decimal formato`�— U
Ladtude/lon nude source: ❑GPS ❑To 4�—
B pographic map
(location of well must be shown on a USGS topo map and 240 245 QUARTZ
attached to this form if not using GPS)
r-+
4.WELL OWNER yam,
OWNER'S NAMEC'REG S PETERSON
STREET ADDRESS
t
ELK PARR;
City or Town State Zip Code vZ
(8( 1$)�_ 733-3725
Area code-Phone number
5.WELL DETAILS: 11.REMARKS:
a. TOTAL DEPTH: 305 2 GPIA 66- 67 1 GFM 240- 245
b. DOES WELL REPLACE EXISTING WELL? YES❑ NO�J 0 GPM - 0 GPM
C. WATER LEVEL Below Top of Casing: 10 FT I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH
(Use"+"if Above Top of Casing) ISA NCAC 2C,WELL CONSTRUCTION STANDARDS,AND THAT COPY OF THIS
1 RECORD HAS BEEN PRO???��� D TO THE WELL OWNER.
d. TOP OF CASING IS FT.Above Land Surface*
reach � ��� /J
Top is casing terminated with below land surface may require
a variance in accordance with 15A NCAC 2C.0118 SIGNATURE OF CERTIFIED WELL CONTRACTOR DATE
e. YIELD(gpm): 3 METHOD OF TEST Air STEEE REECE
PRINTED NAME OF PERSON CONSTRUCTING THE WELL
Submit the original to the Division of Water Quality within 30 days.Attn:Information Mgt., Form GW-1 a
1617 Mail Service Center-Raleigh, NC 27699-1617 Phone No. [phone] ext 568. Rev.7/05

.,a SrATj
S RESIDENTIAL WELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources-Division of Water Quality
�a m' WELL CONTRACTOR CERTIFICATION# 2887 (150597
1.WELL CONTRACTOR: f. DISINFECTION:Type HTH Amount 113
STEVE REECE
g. WATER ZONES(depth):
Well Contractor(Individual Name 1 From 14 15 To From To
DEYVEY VdRIGI-IT JdELL PUMP CO- !NC.
From To From To
Well Contractor Company Name From To From To
STREET ADDRESS P. �` BOX 3G'k3 6.CASING: Thickness/
BOONE NC 28607 0 Depth 13 Diameter Weight P Material
From To Ft.
City - Town State Zip Cade From To Ft.
(Area
c )_ cEi4-Gnum From To Ft.
Area code-Phone number
7.GROUT: Depth Material Method
2.WELL INFORMATION: From 0 To 20 Ft.Cement Gravity Flow
SITE WELL ID#(napplicabie) From To Ft.
STATE WELL PERMIT#(ir applicable) From To Ft.1 ement Gravl Ral-IDYdI-Iow
DWO or OTHER PERMIT#(if applicable) &SCREEN: Depth Diameter Slot Size Material
WELL USE(Check Applicable Box1: Residential Water Supply FromTo Ft. in, in.
DATE DRILLED 91/1//200
}}�� From To Ft. In. in.
TIME COMPLETED AM❑ PM6 From—To Ft. in. _in.
3.W ELL LOCATION:
9.SAND/GRAVEL PACK:
CITY: LiNVILLE COUNTY .AVERY Depth Size Material
From To Ft.
ROSEBORO RE). OFF LINVILLE AVE. 105 From To Ft.
From _To Ft.
(Street Name,Numbers,Community,Subtlivision,Lot No.,Parcel,Zip Cotle)
TOPOGRAPHIC/LAND SETTING: 10.DRILLING LOG
❑Slope O Valley ❑Flat 0 Ridge ❑Other From TO Formation Description
(check appropriate box) 0 30 DIRT
May be in degrees, -44 GRANITE
-
LATITUDE 3 minutes,seconds or
LONGITUDE in a decimal format 44 45 QUARTZ
LatitudMongitude source: ❑GPS ❑Topographic map 45 585 GRANITE -
(location of well must be shown on a USGS topo map and
attached to this form if not using GPS) r_
4.WELL OWNER -
OWNER'S NAMETHOMAS BUNN I-
°ro PARDIGM BLORS. , 8582 HKY 105
STREET ADDRESS
BOONE NC 28607
r"1 ryr
City or Town State Zip Code
f 3l `8) 1- 964-0018
Area code-Phone number
S.WELL DETAILS: Mq]tgg
a. TOTAL DEPTH: 585 III GPM 45 0 GPM -
b. DOES WELL REPLACE EXISTING WELL? YES❑ NA ] 0 GPM PM - GPM
-
c. WATER LEVEL Below Top of Casing: 30 FT. I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH
(Use"+"if Above Top of Casing) 15A NCAC 2C,WELL CONSTRUCTION STANDARDS,AND THAT COPY OF THIS
RECORD HAS BEEN PROVID D TO THE WELL OWNER.
d. TOP OF CASING IS 1. FT.Above Land Surface*
'To of casing terminated aVor below land surface may require A
a variance in accordance with 15A NCAC 2C.0118 SIGNATURE OF CERTIFIED WELL CONTRACTOR DATE
e. YIELD(gpm): �' METHOD OF TEST Air STE',+E REECE
PRINTED NAME OF PERSON CONSTRUCTING THE WELL
Submit the original to the Division of Water Quality within 30 days.Attn:Information Mgt., Form GW-la
1617 Mail Service Center-Raleigh,NC 27699-1617 Phone No.[phone] ext 568. Rev.7/05

I
RESIDENTIAL WELL CONSTRUCTION RECORD 09 f a:
/ North Carolina Department of Environment and Natural Resources-Division of Water Quality
�a ate' WELL CONTRACTOR CERTIFICATION# 2687 05M20
1.WELL CONTRACTOR:
STEVEREECE f. DISINFECTION:Type HTrI e,Amount
Well Contractor(Individual Name) g• WATER ZONES(depth):
DEWEY 'ARIGHT'A/ELL &PUMP CO., INC. FronW-44 To From—To—
Well Contractor Company Name
From To From To
P 0. BOX 308 From To From To
STREET ADDRESS 6.CASING: Thickness/
HOONE NC 26607 Depth Diameter Weight Material
From 0 To 52 Ft. 61f8 .35J PVC
City or Town State Zip Code
( 828 )_ 264-2651 From To Ft.
Area code-Phone number From To Ft.
2.WELL INFORMATION: 7.GROUT: Depth Material Method
From (I To L0 Ft.Cement GraYit; Flow
SITE WELL ID#(If aPPIt bie) From To Ft.
STATE WELL PERMIT#(if applicable) From TO Ft.��,-emetlt vrtiv7 iJv{
DWQ or OTHER PERMIT#ff applicable) &SCREEN: Depth Diameter Slot Size Material
WELL USE(Check Ap licable Box: Residential Water Supply FromTo Ft. - in. in.
DATE DRILLED �10/31/200
From To Ft.—in. _in.
TIME COMPLETED AM❑ PM 6 From To Ft. in. in.
3.WELL LOCATION: 9.SAND/GRAVEL PACK:
CITY:
BANNER ELK COUNTY 'AVERY Depth Size Material
From To Ft.
BARLOW RD OFF CURTIS CREEK OFF i-Vx1Y 107 From _To Ft.
From—Jo-Ft.
(Street Name,Numbers,Community,Subtlivision,Lot No.,Parcel,Zip Cotle) -T
TOPOGRAPHIC/LAND SETTING: 10.DRILLING LOG
❑Slope ❑Valley ❑Flat ❑Ridge ❑Other From To Formation Description
(check appropriate box) 0 45 DIRT SHALE
May t in degrees, — --
LATITUDE 3 minutes,seconds or114
LONGITUDE _ in a decimal fnnat
LatitudeAongitude source: ❑GPS ❑Topographic map > 6ft.RNRE yie
(location of well must be shown on a USGS topo map and
attached to this form if not using GPS) .
4.WELL OWNER.;
OWNER'S NAMEEDWARO O RICE
STREET ADDRESS
FT LAUDERD. FL 3 3
City or Town State Zip Code
(( 854) t 56&5916 ; t
Area code-Phone number 01
5.WELL DETAILS: _ � �g
a. TOTAL DEPTH: r05 qRNI]D NW1 11� -5+44 0 GPM -
b. DOES WELL REPLACE EXISTING WELL? YES❑ NC�J
c. WATER LEVEL Below Top of Casing: 400 FT. I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH
(Use"+"if Above Top of Casing) 15A NCAC 2C,WELL CONSTRUCTION STANDARDS,AND THAT A COPY OF THIS
1 RECORD HAS BEEN PROVIDED TO THE WELL OWNER.
d. TOP OF CASING IS FT.Above Land Surface* ��, ^T
Top of casing terminated with below land surface may require �J�2.'p` C( —`LEI QJ
a variance In accordance with 15A NCAC 2C.0118 SIGNATURE OF CERTIFIED WELL CONTRACTOR DATE
e. YIELD(gpm): 'I METHOD OF TEST Air S i EVE REECE
PRINTED NAME OF PERSON CONSTRUCTING THE WELL
Submit the original to the Division of Water Quality within 30 days.Attn: Information Mgt., Form GW-1 a
1617 Mail Service Center- Raleigh,NC 2.7699-1617 Phone No.[phone] ext 568. Rev.7/05

WELL CONSTRUCTION RECORD
North Carolina-Department of Environment and Naturat Resources-Division of water Quality-Groundwater NT Sectioon�n, `
TELL CORACTOR(INDIVIDUAL)NAME (prbt) 1 _ CERTIFICATION#�y0
WELL CONTRACTOR COMPANY NAME � PHONE f am':V-�SYd�
STATE WELL CONSTRUCTION PERMIT# IATED Wo PE rnl
(ifapplicable) (ifapplicabk)
1. WELL USE(Check Applicable Box):Residential"unicipat(Public❑ industrial❑ Agricultutal❑
Monitoring❑ Recovery ❑ Heal Pump Water Injection❑ Other❑ If Other,List Use
2. WELL LOCA- . y Topgra*ctLand stetting
Count
Neatest Town:: ((ff (!c// Midge [l�5Io pe ❑Valley ❑Flat
`� 4 (Check awwpriam bor)
(Strecl Naote,Numbers,Cmunuaay.Subd' ow,Lot No..Zip Code)
Latitude/longitude of well location
3. OWNER: (dagreelftn"Mte�a�)
Address : Z ? G, )e/ Latitudellongitude sotrce:❑GPSOTopographicCromp
rr'� IStrcet«Rome No.) (cbeckbox)
rCitywTC%_r(� ZE6) DEPTH DRILLING LOG
cny«Tnaro Stma From To Formation Description
(_)- s??2—Z.�fS`�4�GiGjztpcoae P .
Area code-Phaee number Rr1 — 50 A)�
4. DATE DRILLEDIP-/U- Obi
5. TOTAL DEPTH: /IaS"
6. DOES WELL REPLACE EXISTING WELL? YES❑ NO C3/ 74 1 .
7, STATIC WATER LEVEL Below Top ofCastalp_.Yo FT_ —
(t sc-+-ifAbose Top ofCning) �r
S. TOP OF CASING IS r FT-Above Land Surface* _X19 7 t
"r um isOf�imman w�WisANNCCACZC.#e 118. re..ieee.
9. YIELD(gpm): Jr±_METHOD OFT CST //-c
10. WATER ZONES(depth): �-
t-OCAT70N SKMH
11. DISINFECTION:Type( g/ K Alt unt �_ Show,direction and distance in miles from at Last
12. CASING: Wall Thickwas two State Roads or County Roads. Include the road
Depd' Dtamcter «Welawrt. Material Tarnimm and common road runes.
From To Ft.From,=TO 1 b2 Ft. lv 6
From To�_FL� �
13. GROUT: Depth Material i�;diod Q C
From To Ft. ik-
From N: Tom Ft.� `q
14. SCREEN: Depth D' of Slot Size Material
Fran To FL in. in. `(
From w
To FL in. in
15. SAND/GRAVEL PACK:
Depth Siff MaterialLl _l
From ,_To Ft. a .s
FTom TC Ft. .
16, REMARKS:
1 DO HEREBY CER FY THATTHIS WELL WAS CONSTRUCTED 1N ACCORDANCE WITH I5A NCAC 2C,WELL
CONSTRUC710 ANDARDS,AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER' ,
IGNATURE OF PERSON CONSTRUCTING THE WELL DATE
Submit the original to DIVISION of Water Quality,Groundwater Seetion,1636 Mail Service Center-Raleigh,NC
-7?T
Z7699-106 Phanc Na,(919)733 I,within 30 days. 3
GW-1 REV.07/2001
ii
t

a.+ STArro rA ,
, i fb 2b
4 RESIDENTIAL WELL CONSTRUCTION RECORD�p
North Carolina Department of Environment and Natural Resources-Division of Water Quality
WELL CONTRACTOR CERTIFICATION#
1.W ELL CONTRACTOR: HTH
S r E'VE F.EECE f. DISINFECTION:Type Amount '`1
Well Contractor(Individual Name g• WATER ZONES(depth):
DEk' E'r V `RIGHT k"dE I ,pL1!.,,iF C.J., ;FJr.: From a To'4>'
a From To
Well Contractor Company Name From To From To
p 0, E,0 Y,'1`,,-3 From To From To
STREET ADDRESS6.CASING:
Thickness/
S'00fdE NI-7- 2H07 Depth Diameter Weight Material
From I1 To 21 Ft. 0114 ^P_.r_,• &ALV
Zip City or Town State Zi Cd
_ r_�y1_rr�?;j From TO Ft.
( ) From To Ft.Area code-Phone number
2.WELL INFORMATION: 7.GROUT: Depth Material Method
From=) To 2� Ft.Cement
SITE WELL ID#(d applicable) FromTo Ft.
STATE WELL PERMIT#(n applicable) From—To Ft. _.- z-1:
DWQ Or OTHER PERMIT#(a applicable) S.SCREEN: Depth Diameter Slot Size Material
WELL USE(Check Ap Ucakl@_,fiqX): Residential Water Supply<Y] From TO
DATE DRILLED �L,t:/tL�CO
FromTo Ft. in. in.
_ Ft.—in. _in.
TIME COMPLETED AM❑ PM-6 FromTo Ft.—in. _in.
&WELL LOCATION: 9.SAND/GRAVEL PACK:
CITY: E`.,4l-1NE7, Ei_I-1 ,.;,'irE'={`;' Depth Size Material
COUNTY From _To Ft.
EAGLES NEST OFF `-f.""''•.i 131 C�FP IF--d OFF ..n5 From _TO Ft.
(Street Name,Numbers,Community,Subdivision,Lot No.,Parcel,Zip Code) From__To_Ft.
TOPOGRAPHIC/LAND SETTING: 10.DRILLING LOG
❑Slope ❑Valley ❑Flat ❑Ridge 13 Other From To Formation Description
(check appropriate box) 9 'C' DIRT
Maybe degrees, _
LATITUDE 3 minutes,seconds or
LONGITUDE in a decimal format
Latitude/longitude source: ❑CPS Cl Topographic map
(location of well must be shown on a USGS topo map and ...-..
attached to this form if not using GPS) ..�
4.WELL OWNER _
OWNER'S NAME LODGES AT EAGLES NEST
STREET ADDRESe 1 1-11-1 r n , ��_,� I r l t'en�.L rs:..r -�
GANN4ER EI i rah,_ CCI
C:y or Town State ip Code '
Area code-Phone number
5.WELL DETAILS:
i 05 I1.RE�f�IppRRS:
a. TOTAL DEPTH: �`' , rvtt-'h940 - Gt4 f? ptl _
b. DOES WELL REPLACE EXISTING WELL? YES❑ NCXJ 'J s ';A -
c. WATER LEVEL Below To of Casing:
P FT. I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH
(Use"+"if Above Top of Casing) 16A NCAC 2C,WELL CONSTRUCTION STANDARDS,AND THAT A COPY OF THIS
1 RECORD HAS BEEN PROVIDED TO T�IC WELL OWNER.
d. TOP OF CASING IS FT.Above Land Surface' 1
Top of casing terminated aVor below land surface may require
a variance in accordance with 15A NCAC 2C.0118
SIGNAT'l�Fi�bF CERTIFI•D WELC CONTRACTOR r DATE
e. YIELD(gpm): - METHOD OF TEST STEVE REECE
PRINTED NAME OF pp
Submit the original to the Division of Water Quality within 30 days.Attn:Info ationTAF C E I V E D
1617 Mail Service center- Raleigh, NC 27699-1617 Phone No. (919)733-701 ext SN. , Form W-1 a
FEB 13 2006 Rev.7 05
Asheville Regional Office

F�SrAT(a
Q RESIDENTIAL WELL CONSTRUCTION RECORD
_ North Carolina Department of Environment and Natural Resources-Division of Water Quality
WELL CONTRACTOR CERTIFICATION#
2687 tlz"u1624
1.WELL CONTRACTOR:
f. DISINFECTION:Type HTH Amount
c3TE VE TEE E g. WATER ZONES(depth):
Well Contractor(Individual Name)
Ea"+FY w 'RIGti 44'tLL d, F'Uk.9P i_n . !tw..:. From E0 To 53 From :40To're4
From '03 7DI'M From To
Well Contractor Company Name From To _ From To
STREET ADDRESS F 2D PDX 13
6.CASING Thickness/
p,; - Depth Diameter Weight Material
oCViJE d�- """�'7 From To 633 Ft. Ci 1`0 ..,.50 PVC,
City or Town State Zip Code From To Ft.
( B22 )- 264-2b5l From To Ft.
Area code-Phone number
2.WELL INFORMATION: ?.GROUT Depth Material Method
From 0 To 20 Ft.+'errl,=_n{ ;-'ay't: ROt,y
SITE WELL ID#(if applicable) From To Ft.
STATE WELL PERMIT#pl applicable) From To Ft.C2mani, ^:.ri'ib '.'-10+'✓
DWQ or OTHER PERMIT#(inapplicable) &SCREEN: Depth Diameter Slot Size Material
WELL USE(Check Applicable Box): Residential Water Supply 0 From To Ft._in. _in.
DATE DRILLED lL?..PZD+OS FromTo Ft. in. _in.
TIME COMPLETED AM❑ PM.Q From—To Ft. in. in.
3.WELL LOCATION:
9.SAND/GRAVEL PACK:
Depth Size Material
CITY: E.-�,fdPd13?-. ELF. COUNTY A�''ER`/ From To Ft.
HWr lad OFF 154 OFF 105
From _To Ft.
(Street Name,Numbers,Community,Subdivision,Lot No.,Parcel,Zip Code) From _To Ft.
TOPOGRAPHIC/LAND SETTING: 10.DRILLING LOG
❑Slope 0 Valley ❑Flat O Ridge O Other From To Formation Description
(check appropriate box) fj so DIRT
May be in degrees,
LATITUDE 3 minutes,seconds or TO 50 SRr44ITE
LONGITUDE in a decimal format CD 53 sHA1E
LatitudeAongitude source: ❑GPS ❑Topographic map 53 -40 GRANITE
(location of well must be shown on a USGS topo map and 240 2Ad QUARTZ
IZ
attached to this form if not using GPS) 244 'L1 ^.?4NITE + �.
4.WELL OWNER 01 QUARTZ 4
OWNER'S NAME L!�D�F",�+i'=+.c�i "I�-eT 7'3 17RP:N!TE -r1;^_
STREET ADDRESSr'-=C �.1,_PLATR 2t<il T"'+'f,ECASTLE Hs'°�Y r `
,rr
7
R4fJh!�R F!4 7,r
City or Town State Zip Code
( '72271 )- 04-6700 cj
Area code-Phone number
5.WELL DETAILS: 11.REMARKS:
a. TOTAL DEPTH: 9015 2 GFH 60- C3 3 3er.-1 24' _ 2 j
In. DOES WELL REPLACE EXISTING WELL? YES❑ NCU P. 0PNA 7 Q 0- 701:3 U GFS_rt
c. WATER LEVEL Below Top of Casing: -DC FT. I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH
(Use"+"if Above Top of Casing) 15A NCAC 2C,WELL CONSTRUCTION STANDARDS,AND THAT A COPY OF THIS
RECOR HAS BEEN PROVIDEDTOTHE ELLOWNER.
d. TOP OF CASING IS FT.Above Land Surface`
`Top of casing terminated at/or below land surface may require Lam... f Z} n
a variance in accordance with 15A NCAC 2C.0118 SIGNATURE OF CERTIFIED WELL CONTRACTOR DATE
e. YIELD(gpm): 7 L METHOD OF TEST ''• C'T-V-= REECE
PRINTED NAME F PERSON CONSTRUCTING THE WELL
Submit the original to the Division of Water Quality within 30 days.Attn:Info mation Mgt., For GW-1 a
1617 Mail Service Center-Raleigh, NC 27699-1617 Phone No.(919)733-70 15 ext 568FEB 13 2006 Rev. 105
Asheville Regional Office
t Anttifcr Prntenfinn