Bk CY2005

V
WELL CONSTRUCTION RECORD 308092
North Carolina-Department of Environment and Natural Resources-Division of Water Quality-Groundwater Section
WELL CONTRACTOR(INDIVIDUAL)NAME (print)Mike Tynan CERTIFICATION N 2725
WELL CONTRACTOR COMPANY NAME Probe Technology,Inc. PHONE # [phone]
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
1. WELL USE(Check Applicable Box):Residential❑ Municipal/Public ❑ Industrial❑ Agricultural ❑
Monitoring® Recovery ❑ Heat Pump Water Injection❑ Other❑ If Other,List Use MW-4
2. WELL LOCATION: Topographic/Land setting
Nearest Town: Morganton County Burke ❑Ridge ❑Slope ❑Valley 9Flat
1000 Chain Drive (check appropriate box)
l Street Naae.Nuabers.Comatmitc Subdi,ision_Lot No_Zip Code) Latitude/longitude of well location
N 35 42 5.10 W 81 47 45.72
3. WATNER: Rexnerd (degrees/minutes/seconds)
Address 1000 Chain Drive Latitude/longitude source:®GPS❑Topographic map
(Street or Route No.) (cheek box)
Morganton NC DEPTH DRILLING LOG
City or Town state Zip Code From To - Formation Description
L�-
Area code-Phone number See Geologist's Log
4. DATE DRILLED 02-De-o5
5. TOTAL DEPTH: 25 ft
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO KKI
7. STATIC WATER LEVEL Below Top of Casing: 18 FT. y
(Use"+"if Above Top of Casing) '
8. TOP OF CASING IS 0 FT.Above Land Surface'
*Top of casing terminated at/or below land surface requires a
variance in accordance with 15A NCAC 2C.0118.
9. YIELD(gpm): N/A METHOD OF TEST tl1 'at
10. WATER ZONES(depth): 1*r
LOCATION SKETCH
11. DISINFECTION:Type none Amount Show direction and distance in miles from at least
12. CASING: Wall Thickness - two State Roads or County Roads. Include the road
Depth Diameter or Weight/Ft. Material numbers and common road names.
From 0 To 15 FL 2" Sched 40 PVC
From To Ft. -
From To Ft.
13. GROUTDepth Material Method -
From 0 To 10 Ft. portland cement gravity
From 10 To 13 Ft. bentonite gravity
14. .SCREEN. Depth Diameter Slot Size MaterialFrom 15 To 25 Ft. 2" in. 0.010 in. PVC -
From To Ft. M. in. -r- _
15. SAND/GRAVEL PACK:
Depth Size Material O
From 13 To 25 Ft. #2 silica sand
From To Ft.
16. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C,WELL
CONSTRUCTION STANDARDS,AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
Digitally signed by Micrnei Tynan
Michael Tynan [I CN=Michael Tynan.C=US0=Probe Technology.Inc.
Date.2005 02 25 08.58.35-05'00'
SIGNATURE OF PERSON CONSTRiJCTING THE WELL DATE
Submit the original to the Division of Water Quality,Groundwater Section,1636 Mail Service Center-Raleigh,NC
27699-1636 Phone No.[phone],within 30 days. GW-1 REV. 07/2001

WELL CONSTRUCTION RECORD
309816
North Carolina- Department of Environment and Natural Resources-Division of Water Quality-Groundwater Section
�,.yv
w'ELL CONTRACT'OR(INDIVIDUAL)NAME (print) Gr, Tt�}s+iz L CERTIFICATION# e1�t7
w'ELt.CON-1'RAC`rOR COMPANY NAME S±�c �p06A,NE # ( ) �ZY'Y $
SPATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
I. WELL USE(Check Applicable Box): Residential ga/ Municipal/Public❑ Industrial ❑ Agricultural ❑
Monitoring❑ Recovery ❑ Heat Pump Water Injections 0 other❑ If Other,List Use
2. WELL LOCATION: e4"lZ•IL Topographic/Lan setting .y
Nearest Town: CsI1po _County , . ❑Ridge ❑Slope (Valley ❑Ffa5
{�R. .
!Z C S 2. (check appropriate box) t :y
(Street Name,Num1ben,jCommunity,Subdivision,Lot No.,Zip Code) Latitude/longitude of well location Co s
�/A�!t �K•tti1.6h�
3. OWNER: (degrees/minutes/seconds) /Jl
Address iz/.73 Latitude/longitude source:❑GPS❑Topographic map
(Sven or Rame No.) (check box)
�$O xC" •ac /y DEPTH DRILLING LOG
Gtyom�m.•n t Zip Code From To Formation Description
Area code-Phone number
4. DATE DRILLED 2-& — ©S
5. TOTAL DEPTH: r225'
6. DOES WELL REPLACE EXISTING WELL? YES❑ NO IY
7. STATIC WATER LEVEL Below Top of Casing:AFT.
(Use"+"if Above Top of Casing)
3. TOP OF CASING IS FT.Above Land Surface" eG
`Top of casing terminated at/or below land surface requires a �j �,ZT �L��
variance in accordance with 15A NCAC IC.01 18. i'
9. YIELD(gpm): JX METHOD OF TEST i 119
10_WATER ZONES(depth): l4el" I.?'2 0.1
7 LOCATION SKETCH
11. DISINFECTION:Type CtQfl ily If Amount- OZ. Show direction and distance in miles from at least
12. CASING: 4P1 b" Wall Th K' v�reL two State Roads or County Roads. Include the road
t� — 6epth 6iarta:ter or W;ig tsE Material numbers and common road names.
From-0 _To ti 1 FL (D 1 9/6 0j/` 1���(r,
From��ToL FL 9,l
From To-`��FL r"�(
F
13. GROUT: Depth Material Method
From To Ft-
From L
CREEN: De h FL
14. SCREEN: Depth Diame er Slot Size Material
From To Ft. in. in.
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Size Material6�u,'"
From To Ft.
FTom To Ft- b
I6. REMARKS:
1 DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C,WELL
CONSTRUCTION STANDARDS,AN THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER x�
�M - - it
SIrKATURIE OF#RSON CONSTRUCTING THE WELL DATE
Submit the original to the Division of Water Quality,Groundwater Section,1636 Mail Service Center-Raleig'b;NC i '3 -
27699-1636 Phone No.(919)733-322t,Within 30 days. GW-1 REV.072001

FROM MORETZ WELL & PUMP FAX NO. : 7044621322 Apr. 11 2005 07:07PM P10
30990 '7
VV LL CONSTRUCTION I CQRD
North Carolina.Department ofEnvironlent and Naaual Ras=m-Division of Water Quality-Groundwater Section
wars.CotrMCroA(n wMVAUNAMe tprtaq ASHLEY T. MORETZ Cz=lFwATl0Ny,z5U
WELL CONTRACTOR COMPANY NAME MORETZ WELL DRILLING more FIZ 2.-1322
STATE W914 CONSTRUCTION peRMtra TE11 WQ rlsasllW .
if taeble) (if acclicablal
1. WELL USE(Cluck Applicable Box):Residential CP1'*MU o(wP&ltPublic 0 Industrial 0 Agdculauai 0
Monitoring O Recovery 17 Hcat Pump Water Neetion 0 Other 0 If Other,List U$e
2. WELL LOCATIO T c/Land selling
Npreat� %rQ-\d�I-OL Cyo m « ORidga lope OValley Mot
r,/ a i-ee_ C (dk8& ppmpdat W4
(Sacalloas,Numbeu,Coma»miq.&Mvbloo.WNo,Zip Cade) of wall 1
3. OWNER AQQ./' �/4� fN'A �{
Address ; rl 5l �.:J. .ti Lautude/lougitude soureei P OTopograOUC map
m 4wkbaa)
DRILLING LAM
(worIzes awe zip Cade From TO
_ F/o—JotonDeserip'aaf�
AM Cob.Pence�
4. DATE DRIL1XD - 4"y`
5. TOTAL DEPTH: S
6. DOES WELL REPLACE EXISTING WELL? Y!Ep NO III
7, STATIC WATER LEVEL Below Top of Casing; .FT.
(Wa'W'if whom Top afCaamr)
8. TOP OF CASINO IS FT.Above Land Surfaces
'Top oreatloL farad oiler blow L►t.ar6n ngalras■
vulwa Is weardsaw 114 NCAC 2C A11L 7?/`
9. YIELD(8Am): I METH aOF TE f�
10.WATER TONES(depth):
LOCATION SKETCH
11. DISINFECTION:Type Amount Show direction and distance in miles from at least
12. CASINO: Wall Tlddoxas two State Roads or County Roads.Include the road
ntmbaze and common road names.To / 1 )
From,_,_•,L To Ft,— Sze,
Ftont—To Ft
13. GROUT: Depth Material MmSod
Fl .-To.24"Fc, C_e-AV—JSL A-C
From.,r—To Ft -
14. SCREEN: Depth Diameter Slot Sim Materiel
15. SAND/GRAVEL PACK: ry
D ih Sim Material
C
F 0 tJn
Fmm T
y
16. REMARKS; -
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCIYD iN ACCORDANCE WITH 15A NCAC 2C,WELL - -
CONSTRLV-MON STANDARDS,AND THAT A COPY OF THIS PE00"HAS BEEN PROVIDED TO THE WELL,OWNER
D
SIONATMOF PERSON CONSTRUCTING THE WELL DATE
Sbbmk the orWual to tie Division of Water O4aW-Groundwater Seetlun,1636 MaR Service Center-Raleigh,NC- - -
2109.1636 Pboue No.(919)73J-3221,within 30 days, OW-1 REV.0712001

309581
WELL CONSTRUCTION RECORD
North Carolina-Department ofEnviromnent and Natural Resources-Division of Water Quality-Groundwater Section
WELL CONTRACTOR MWIVIDUAL)NAME (otiat)__NFTT T. PN2IYW. CE nmcATmN A2609
WELLCONTRACIORCOMPANYNAmz RT(XWWFIT. ERTTTTW; M. PHONE of 8281 4��5
STATE WELL CONSTRUCTION PERMIT/ ASSOCIATED WQ PMMM
(if applicable) Of applicable)
1. WELL USE(Check Applicable Box):Residentialll MrnicipATublic❑ Industrial❑ Agricultural O
Monitoring O Recovery ❑ Heat Pump Water Injection O Other O If Other,List Use
2. WELL LOCATION. Topographic/Land setting
Nearest TowxU County_--agg¢ ORidge OSlope Walley OFlat
F!Q-T ueTta4W R-AD (crater anxgniem box)
(SaeetName,Number,Commaulty,Subdivision,Lot Na,Zip Code) Latitudeliongitude ofwell location
3. 0 (AFd7YN H_ TFCFNFtR ( ,� �, ,>
Address 2�5 HAR[�T tT1P Latitude/iongitudc source:OGPSOTopographic map
M71d N1INa of ft GZ3bS5 (�dcbm)
PEA DRILLING LOG
City or T° state Zip cede From To Formation Description
(82$} 437-9M
Ara code•Phone t mnber
4. DATE DRILLED 01 05
5. TOTAL DEPM:
6. DOES WELL REPLACE EXISTING WELL? YES O NO)13
7. STATIC WATER LEVEL Below Top of Casing IQ FT, '
(Uea"+"(f Above Top of Castes) -355
r
S. TOP OF CASING IS 2 FT.Above Land Surface'
Top of astq torm4ated Wor below cod surfm r"utrw a
►artanoe A accordance web 1SA NCAC 2C AIIS.
9. YIELD(gpm).- 2 METHOD OF TEST BV AIR
Gel
10.WATER ZONES(depth): o
LruraTlON SIt`I?TCH �
11. DISINFECTION:Type H-W TAffi Amount 68 Show direction and distance in miles 8om at leas
12. CASING: 0 py Wa Tp(nt� ro
two State Roads or County Roads.Include the ad
From Tom 83 Ft b ig �C numbers and common mad names.
From To it.
From—To Ft �u�Ycv
13. GROUT:
T o s
From_Q_ m_FtT2 t?t
T CUU) t
From To Ft
14. SCREEN: Depth Disaider Slot Size Material
From To Ft,__m. is
From To Ft in. in.
15. SAND/GRAVEL PACK
DepthFrotn— It—
From.—To— size Materialty ��
Ft �� S
16. REMARKS:
qo 4'
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15ANCAC 2C,WELL _
CONSTRUCTION STANDARDS,A THAT ACOPY THUS RD HAS BEEN PROVIDED TO THE WELL OWNER
01-10-05 -
SIGNATURE OF P ON CONSTRUCIING THE WELL DATE -
Submit the original to the Division of Water Quality,Groundwater Section,1636 Mail Service Center-Raleigh It
27699-1636 Phone No.(919)7333221,within 30 days. GW-1 REV.07f4001

OP
WELL CONSTRUCTION RECORD 309579
North Carolina-Department of Bnviromnent and Natural Resources-Division of Water Quality-Groundwater Section
WELL CONTRACTORMOMUUAL)NAME t datl JERRYFIkWE CERTIFICATION s2452
WELL CONTRACTOR COMPANY NAms; [-IICKW w7L IX2IISu (D. PHONE s (82% 324-025
STATE WELL CONSTRUCTION PERNITe aaarrr 2gp ly PERMM
(ifamlicable) flfaenlicable)
1. WELL USE(Check Applicable Box):Residential lI( MmticipaVPublic❑ Industrial O Agricultural❑
Monitoring O Recovery O Heat Pump Water Igection O Other O If Other,List Use
2. WELL LOCATION: TopogrophiclLand setting
NearestToWo: hf7YrWRN County 1?[JRtO; Midge OSlope OValley [Mat
555 T(Y1QN RFFP ST. ( appropriate box)
(SUM Nang Numbers,Cutaway,St"visiw,Lot No.,23p Code) Latimdellongitude of Well location
3. OWNER: XIIJi TA ILE (de ftdmiou"*Conds)
Address _ 555 IM REEF Sr. Latitude/longitude source:OGPSOTopographic map
(Stnath I kR1TM655 (chacic EE
City or Town state DEPTH DRILLING LOG
(�} � Zro Cede From To Formation Description
Ares code.Phone,soaber
4. DATE DRILLED 01-27-05
5. TOTAL DEPTH: 505
6. DOES WELL REPLACE EXISTING WELL? YES O NO
7. STATIC WATER LEVEL Below Top of Casing 47 FT,
(Use'+-if Above Top of Cuing)
S. TOP OF CASING IS 2 FT.Above Land Surface'
`Top training nraMtM attar blew cud sarfeee regabw a t
variam L aft rdowe with ISA NCAC 2C.011t
9. YIELD(gpm): 1 METHOD OF TEST BY AIR TEST p
10.WATER ZONES(depth):
LO -AT10N SKETCH
it. DISINFECTION:Type w 1 TABS Amount 96 Show direction and distance in miles from at least
12. CASING: Wall Thickness two State Rom or
Dq� a�W County Ruda.Lnchnle the road
From 0 Tom 86 It Drew t Weighft_Matmid enr°i>as and common road names.
From To FL P1AS7TC N ��`� �`o//
From To Ft
13. GROUT: Depth Material Method �O
FronLjL_To___2a_FL GBjM R712�
From To Ft
14. SCREEN: Depth Diameter Slot sine Material
From To Fk in. in.
From To Ft. in_, in, ® l
15. SAND/GRAVEL PACK p
Depth Size MaterialT
From To Ft
From To Ft
16. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH ISA NCAC 2C,WELL
CONSTRUCTION STA7DS.AND THAT A COPY OF pffi RECORD HAS BEEN PROVIDED TO THE WIU OWNER
02-02-05
SIGNATURE OF P C0A$TRUCTING THE WELL DATE
Submlt the original to the Division of Water Quality,Groundwater Section,1636 Mail Service Center-Raleigh,NC
27699-1636 Phone No.[phone],within 30 days. GW-I REV.07/2001

WELL CONSTRUCTION RECORD 309574
North Carolina-Department of Environment and Natural Resources-Division of Water Quality-Groundwater Section
WELL CONTRACTOR(INDIVIDUAL)NAME (privrr Neill Pardue CZR.MCATTONd 2609
WELL CONTRACTOR COMPANY NAME Hickory Well Drilling Co. ,Inc. PHONED 8 -324-0035
STATE WELL CONSTRUCTION PERMTro_ ASSOCIATED WQ PERMITI
(if applicable) (if applicable)
I. WELL USE(Check Applicable Box):Residential❑ MunicipaVPubGe D Industrial O Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Iyaction 0 Other 0 If Other,List Use
2. WELL LOCATION: TopographiclLand setting
Nearest Town:Connelly Spri County, Burke ORidge Mope Malley OFlat
South Mountain State Park Avenue (check qpqxido box)
(sneer Nana Nunbaa,Connunhy,S"vi"L«No„zip Code) Latift"ongitode of well location
3. OWNER: N. C. Division Of Parks and Recreation
30 1 South Mtn. State Park Ave. de ateeroo:0 eheea�r)
Address Latitudellongitude sourco:OGPSOTo
(saes«Roue Na)
(�bm) Pographic p
Connelly Springs, N. C. 28612 DEPTH DRILLINGLOG
«Town suue zap code From TO Formation on
82 433-4772 ��°ptt
Amcode-Phome ounbw 6/2005
4. DATE DRILLED
5. TOTAL DEPTH-
6. DOES WELL REPLACE EXISTING WELL? YES O NO a
7. STATIC WATER LEVEL Below Top of Casing. 21 FT,
(Use'4 Above Top if Ab Top of Casino 7
8. TOP OF CASING IS 2 FT.Above Land Surface* Z
'Top of codes Wominshd atl«below lud surhee regain a
variance to secordaoee web ISA NCAC 2C.0113. a
9. YIELD(g(rm): 118 hIMODOFTEST 24 Hour Pump Test
UT-
10.WATER ZONES(depib): 250 Ft. o
2 Lb s. LOCATION SKETCH
it. DISINFECIIOpI:TypeChlorine Amnut Granules Show direction and distance in miles fiomatInd
12. CASING: D q Wall Thick== two State Roads or County Roads.Include the road
From 0 Tom 55 Ft °d orwS Galy. Steel e oft mytterw numbers�co�road .
From To FL /V
From__To FL 3
13. GROUT: Depth Material Method 0(U611'
From 0 To 55 Ft, Cement Grout t`7 v#..\#jq,From To Ft14. SCREEN: Depth Diameter Slot Sim Material �, �From To FL_in, in.
From To Ft—_m in.
15. SANDIGRAVEL PACK 41*4 f
Depth Size Material �y
From To Ft. s From To Ft
16. REMARKS:
I DO HERESY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 1SANCAC 2C,WELT,
CONSTRUCTINN STANDARDS,AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER::,
S19MATURE OF PERSON CONSTRUCTING THE WELL DATE
Submlt the original to the Div101011 of Water Quality,Groundwater Section,1636 Matt Samoa Center-Raleigh,NC
27699-1636 Phone No.[phone],within 30 days. GW-I REV.07/2001

C�.��
1 A&F WELL DRILLING
AND PUMP SERVICE,INC.
i hitl a e1 E�rra•wneM end Maliwar Roreueos.DWr116r 61 WOW Overly.(Iroundwater Seetlor811 Hwy. Business 74
RNefp1�M.C.4J�fFt636-iNwey19111733.3221 - Bostic, NC 28018
WELL CONSTRUCTION RECORD wELLcoNTRAcTOR: 828-247-1773
WELL CONTRACTOR CERTIFICATION t: oZ I�5
r-,ESTATE WELL CONSTRUCTION PERMITa:
1. WELL U8E La"Apt eu) Re"rltlatt�a mmkIpol El AgdmIlural 0 Mof4la inq❑
Afta+y U Hold Punv W&'*r k4wvon ❑ Oam"0 It ONa,Uri Use:
2. WELL LOCATKNt(Slow N1Nd1 of" bon below)
Nwlni Town r 4 t i—4 cwsy._/P /f/�_G 5,
IrewallonneaM/�N�wrlore,panaaft.w adidrraen and La Wit DRiLLXN(i LOG DEPTH
3. OWNER ._LS Li`J/l..A` /a ` Frye To fama7►+Daae.lpea+
"Dar••• {
�j � eTi�6yv
+. DATEY DMLED Jv—�-5
6. TOTAL DEPTH -- : .-7T ;
6. CUTTIINIGSCOLLECTED YtESO NOO,
7. DOES WELL REPLACE EXISTING WELL? YES0 NO[El
S. STATIC WATER LEVEL 8dkatr Tap at CMakm. FT �.
PLO
IVw4lAho re TepMCaM�41 it3
D. TOP OF CASM�G Ig I y FT.Above Land&xbm-
'TeP M eeabh larnfia*d eVor below Iasi aarlRe I- a a vwbmw M aaaao-
along►TAk MIA malke a6 A-yl ^
10. YIEL4(ypm): MMM OF TEST f i Z u+
11.WATER zOM fib 5-
---g-
12. CNLORINATXON: Typo Lu f AMOW If addMmW toga Y mded w bad or Wm v.
13. CASING: K t
} �[G WoTraoma LOC TXa�XsXt9MD"I <� n
"AFL—To:9FL W «..��.,� ($ naUMirfddsWrpinmpNa.moStarerJ.J
Ffam � t �' Roede.aawerrraprMweeeei+�! �5 n/D�x;C!
Frain To
From To_._... FL h
t It. GROUT:
From h-*-.TDpw G FL-�>and t6 jj
Ff"n To FL o
15. SCREEN:
Oplh Dlamatar Slot Ske MAW"
From Tom_Ft in. kr - r .
From T9_._FL_ ku in
1'Mm To FL_.. In r �
16. SANDIGRAVELPACK: i
Slte GAaMIXM ���
From
from Ta FL
1T. REMARKS: A� c isrfJ6 �-
100IMREBYCERTIFYTHATTHISWELL WAS CONSTRUCTWINACCORDANCEWITN115^ NCAC2C.Y/ELL
=4TRUMM ETANDAM AM THAT ACM OF THIS RECORD MS OEM PROVIDED 107W YIEI.L 0N1+EA-
FOR OFFICE USE ONLY
O"dit IMMANKOFPERMMCONKTRM MDTNEWM 0011
lk&A**w is wdmdwaw Ou".OWWRAa III="a11Ne 79 toys
so"0116 �..� 6ea/7EY.IM

WELL CONSTRUCTION RECORD 0 3 11
North Carolina Department of Environment and Natural Resources-Division of Water Quality
WELL CONTRACTOR 11NDIVIDUAL)NAME (print) Neill Pardue CERTIFICATION# 2609
WELL CONTRACTOR COMPANY NAME Air Drilling Company PHONE # U04 872-7614
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
11100111 (if applicable) (if applicable)
1. WELL USE(Check Applicable Box):Residential 0 Municipal/Public❑ Industrial❑ Agricultural❑
Monitoring❑ Recovery ❑ Heat Pump Water Injection❑ Other❑ If Other,List Use
2. WELL LOCATION: Topographic/Land setting
Nearest Town: Morganton County Burke []Ridge OSlope OValley OFlat
South View Blvd. — Lot #35 (check appropriate box)
(3UCCt Name,Numbers,Community,Subdivision,Lot No.,Zip Code) Latitude/longitude of well location
3. OWNER: Tom Jodway (degrees/minutes/seconds)
Address P.O. Box 313 Latitude/longitude source:OGPSOTopographic map
(Street or Route No.) (check box)
Rutherford College, NC 28671 DEPTH DRILLING LOG
Gry or Town Sate Zip Code From To Furmation Descriprion
L- Or 82' Dirt
Area codJMP ne somber 82 t 3O5 r Rock 4. DATE DRILLED 05-02-05
5. TOTAL DEPTH:—=-ft --
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO 91 —
7. STATIC WATER LEVEL Below Top of Casing: 50 FT.
{
(Use"+^if Above Top of Casing) S
8. TOP OF CASING IS 21,, FT.Above Land Surface*
'Top of casing terndnated at/or below land surface requires a
variance in accordance with 15A NCAC 2C.0118.
9. YIELD(gpm): 7 METHOD OF TEST Air O
10.WATER ZONES(depth): 287 ft.
LOCATION SKETCH
11. DISINFECTION:Type HTH Amount Show direction and distance in miles from at least
12. CASING: Wall Thickness two State Roads or County Roads.Include the road
Depth Diameter or Weight/Ft Material numbers and common road names.
From 0 To 82 Ft. PVC
From To Ft.
From To Ft.
13. GROUT: Depth Material Method StwIN VIEW BLPD,
From 0 To 20 Ft, Grout Poured
From To Ft.
14. SCREEN: Depth Diameter Siot Size Material (�
From To Ft. in. in.
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
�n
16. REMARKS: ��
I DO HEREBY CERTIFY THAT TIES WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C,WELL
CONSTRUCTION STANDARDS,AND TWA COPY QF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
/9 1 J
r� -t'� 5 a os
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
Submit the original to the Division of Water Quality,Attn: Information Management]1617 MaR Service Center.-
Raleigh,NC 27699-1617, Phone No.[phone],within 30 days. -"------ -- -
GW-1 REV.09/2004

North Carolina Department of Environment and Natural Resources-Division of Water Quality-Groundwater Section
1636 Mall Service Center-Raleigh,N.C.27699-1636-Phone[phone] yy11
WELL CONSTRUCTION RECORD WELLCONTRACTOR: —
WELL CONTRACTOR CERTIFICATION # : x�4`/
STATE WELL CONSTRUCTION PERMIT# :
v1EI.:. USE (Check Applicable Box): Residential Municipal ❑ Industrial❑ Agricultural ❑ Monitc, c l-
Recovery ❑ Heat Pump Water Injection Other If Other, List Use.
LOCATION hcw sketch of the location below) /3 �� r�
Nearest town. Oh3 N/JTa•17 County. ^'
'Road Name and'Numbers.Communit}yc,or Subdivision and Lot No DRILLING LOG DEPTH
OWNER /�L,( Y "C/4 6h&,,,C.h From To Formation Descrcoo,
e's 3gc,6 y��Nss [H ��d _
7a, o—I i�rhv0 I
;Ty or Town _ State Zip Code
a DATF DRILLED _0 J
5 TC,,TAI- DEPTH //I -
6 CUTTINGS COLLECTED YES L 1 NO© 4 --
DOES WELL REPLACE EXISTING WELL? YES NO® _
n. ST4-IC WATER LEVEL 9e!ou, Top of Casing LFT . -?_ 1Z
_ (Use"+" if above Top of Casing) -mac 2
9 TOP OF CASING IS �b FT. Above Land Surface' N
'top of :asng terminated at/or be',, lan.,1 sur'ace requires a variance in axoo-
dance with '.5A NCAC 2C.0118
IC. vSll-D (GPM): *f IFTHOD ttr- TEST ,Qt71L.E'h
. . -oT[R7.ONES !dF(rthl .__ ..._
! iil.CRINATION. Type r'' Amount L If additional space is needed use back of form
'.",RING. Wall Thickness
Depth Diameter or Weight/Ft Material
To Ad ct I OCATION SKETCH
(Show direction and distance from a' least two Sate
m To Ft
Roads. or other map reference points)
c,* To
14 uROUT
Depth Uaterial Method
From To Ft.
From TO Ft -
` SCREEN.
Depth Diameter Slot.Size Material -
-nm _ To H
To Ft in. in-
cnm _ To Ft in. in -
1F SAND/GRAVEL PACK: _
Depth Size Material
To Ft
To Ft
:' '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 OWNFP.
FOR OFFICE USE ONLY r FJL / Cr /�1 Z/ -/5 -d .5—
Quad No. SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
Serial No Submit original to Division of Water Quality, Groundwater Section within 30 days
GW-1 RE`! '7'99

North Carolina.Department of Environment and Natural Resources-Division of Water Quality-Groundwater Section 9 (
1636 Mail Service Center- Raleigh,N.C.27699-1636-Phone [phone]
WELL CONSTRUCTION RECORD WELL CONTRACTOR: Da'icv 'y",,nSh`-`°''ill Fum Ifo
WELL CONTRACTOR CERTIFICATION#: 1-tt87
L't'r11 25 STATE WELL CONSTRUCTION PERMIT#: -teve <'Eeoe
1. WELL USE(Check Applicable Box): Residential ❑ Municipal ❑ Industrial ❑ Agricultural❑ T Monitoring
Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use:
I '
2. WELL LOCATION:(Show sketch of the location below)
Nearest Town: HI ('DSO , County: HLIFN
=k.11c3' SP.?;TH ST OFF -) d L" di:ST1A 'F PUR.FE S
(Road Name and Numbers,Community,or Subdivision and Lot No.l _
DRILLING LOG DEPTH
3. OWNER i=RPY Ho GLER From To Formation Description
e P AUL M;lLL_R , 17 3 li Lr''.NE 5c [ 3aT _
Address 3 � '-� -
t (Street or Route No 1 U iE ( _
HLipS ,t v 2503a 55 'S =p'. t l it
City or Town State Zip Code -.� . t� ®•L� ..:
4. DATE DRILLED Fi,"L?'2�3i:`; r"6 2C.03 z4i',I9'CG -
5. TOTAL DEPTH =UU
6. CUTTINGS COLLECTED YES ❑ NO
7. DOES WELL REPLACE EXISTING WELL? YES ❑ NO
8. STATIC WATER LEVEL Below Top of Casing: OU' 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 2Q;0118
10. YIELD (gpm): '' METHOD OF TEST s t
11. WATER ZONES (depth): a.00 Cprn T 6-'8 v.t101gP"`' s�
0,00 pprrr 0'120 Ftr(
12. CHLORINATION: Type HTH Amount o? If additional space is needed use backer f�f orm
13. CASING: Wall Thickness LOCATION SKETCH
Depth Diameter or Weight/Ft. Material (Show direction and distance from at least two State
zt A:_t;` ts)To Ft. Roads,or other map reference k ¢k '
From - P of0/
From To Ft.
From To Ft.
14. GROUT: J''i
Depth Material Method
From - To
From To Ft.
15. SCREEN:
Depth Diameter Slot Size Material
From To Ft. in. in. a`
From To Ft, in. in. r ci (v Vc-i
From To Ft. in. in.
16. SAND/GRAVEL PACK:
Depth Size Material ,\
From To Ft. t
From To Ft.
17. REMARKS: \ C
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C,WELL
CONSTRUCTION STANDARDS,AND THAT A:20F T S RECORD�(H,A/S BEEN PROVIDED TO THE WELL OWNER.";,-•
421
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.

� 10 � `f1
WELL CONSMU—CTION RECORD
North Carolina-Depa
rtment Of Environment and Natural Resources-Division of Water Quality-Groundwater Section
/ O�t G<�
WELL co.NTRACroa.uNniviDuAL)NAME (print) O CERTIFIC�A/TION
�i^ PHONE a (/�/
WELL CONTRACTOR COMPANY N —
WQ ERNlrr#
P
STATE WELL CONSTRUCTION PERMTTII �A if 550CIATED livable -
if livable -
1. WELL USE(Check Applicable BWO:Residential MunicipaUPablic❑ Industrial❑ Agricultural❑
Monitoring❑ Recovery O Heat Pump Water Injection❑ Other❑ If Other,List Use
2. WELL LOCATION: Topographio/Landsetting � r''
NearestTowa D��w«/ " County U RA ❑Ridge 13slwe ❑Valley OFIat N
(ebeck appropriate box)
Latitudirong Ainide of well location
et ona . cr
(Sue N Number.Co mmvaiih Subdivision,I No.,uv Code) ry
(depeestmiwtes/aemnda) : o
3. OWNER Z e� Latitudelo tude sOmce:CJGPSOTopographic t�
Address � (chockbox)
(StreetpnRmaeNo.) •-., G �� DEM DRILLING LOG
From To FormationDescriptign
Chyor Town asset Z)p Cie #
Area coda-Phone mmmber -- ----- a 1;7
4. DATE DRILLED
5. TOTAL DEPTH: -
? YES❑ N0
6. DOES WELL REPLACE EXISTING WELL �3 '
7. STATIC WATER LEVEL Below Top of Casing: —FT• o
(Use"+"if Above Top of Caning) —,_
S. TOP OF CASING IS TLt—FT.Above Land Surface° a
"Top of enl g terminated enter below land surface mquLm a _
variance insecordance with HANCAC2C.011a.
y YIELD(gpm); METHOD OF TEST,^
10.WATER ZONES( epth): rTION SI`F(CH_
11. DISINFECTION:Type Amount Show direction and distance m miles from at least
Wall I ess two State Roads or County Roads.Include the road L�U !W
12, CASING: numbers and common mad names. !-+
`� Depth Diisam�etw or WeightTt. Material \
From"Y( -Tn L Ft.—Bue'— G1I r —
FronL _To--Ft �J L la
From -De t
13• F Material method
From Tom/ lLFt I
Fromm Te Ft
14. SCREEN: Depth Diameter Slot Sim Material
From To FL in. in.
Front To Ft in. in.
15. SANDIGRAVELPAArCIL-Depth Siu Material
Frolns4
From-.._ To Ft.
r
16. REMARKS:
1 DO HEREBY CERTIFY
THAT THTS WELLWAS GONSTRUCfED 1N ACCORDANCE WITH 15A NCAC 2C WELL
CONS ON STANDARDS,AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
� � ✓ 2 LV e,
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
Submit the original to the Division of Water Quality,Groundwater Section,1636 Mail Service Center-Raleigh,NC
216WI636 Phone No.[phone],Within 30 days. GW-1 REV.0712001

U!�A zD Q f
WELL CONSTRUCTION RECORD
North Carolina-Department of Environment and Natural Resources-Division of Water Quality-Groundwater Section
WELL CONTRACTOR(INDIVIDUAL)NAME (print) `/atL-Az y E//��L�I�U%S CERTIFICATION
,vrUj S' LJ c.GL L/��Ll/
WELL CONTRACTOR COMPANY NAMED �r PHONE # 0-1
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT# _.
(if applicable) � - (if applicable)
� --
1. WELL USE(Check Applicable Box):Residential(3 MunicipaUPublic❑ lndustrial❑ Agricultural❑
Monitoring❑ Recovery ❑ Heat Pump Water Injection❑ Other❑ If Other,List Use v
-o
2. WELL LOCATION: TcWMphiiuLaad setting
NearestTown:14A,049yTN County V Midge ❑Slope ❑Valley ❑Flat cNi
(ehe&appropriate box)
(SuedNamr,Numbers,Community,Subdivision,Lot No,Zip Code) Latitude/longitude of well location o -
3. OWNER: /�� (degreearnumueslaeeonde) ';
Address %,< SELCaLf Latitude/longitude source:❑GPS❑Topographic map
(Sure:or Route No.) (checkbox)
�4 ; DEPTH DRILLING LOG
City or Town sere Tip Code From To Formation Descripti
Am code-Phone comber
4. DATE DRILLED i
5. TOTAL DEPTH:
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO4E�
7. STATIC WATER LEVEL Below Top of Casing:., FT. w f-
� /�/ (Use"+"if Above Top of Cg asin
8. TOP OF CASING IS FT.Above Land Surface'
'Top of cadoe terminated atfor below land surfsee requires a
variance in accordance with 15A NCAC 2C.011L
9. YIELD(Spin): ,�Z METHOD OF TEST
10.WATER ZONES(depth):
LOCATION SKETCH
11. DISINFECTION:Type Amount Show direction and distance in miles from at least
12. CASING: Wall Thickness two State Roads or County Roads.Include the road f y�Qti
__ //� Depth Diameter Or We(gbVFt. Material numbers and common road names.
Front-4
To.-�-rX Ft_.,�— T 1
From_To Ft 9
From Tc Ft 2 14
13. GROUT: Depth Material Method G�G L
Frotn_�To,�lL Ft�6.t�G/l�� L'
From To Ft - q
14. SCREEN: Depth Diameter Slot Size Material (U(_y
From To Ft in. in.
From To Ft in. in.
15. SAND/GRAVEL PACK: 77��
Depth/r Size Material DL'!1,k V
Frain 6 ToL�Ft. VL �O Q� ✓ c v!, f v ,�
From To Ft. 1 u
16. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C,WELL N�
CONS ON STANDARDS,AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
-�'
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
Submit the original to the Division of Water Quality,Groundwater Section,1636 Mail Service Center-Raleigh,NC
2769 9-163 6 Phone No.[phone],within 30 days. GW-1 REV.07/2001

Noah Carolina-Department of Environment and Natural Resources-Division of Water Quality- Groundwater S6ctton
1636 Mail Service Center-Raleigh, N.C.27699.1636-Phone(91S)733.3221
WELL CONSTRUCTION RECORD WELLCONTRACTOR: Lje Ze aR/G'lsNi
WELL CONTRACTOR CERTIFICATION#: .2 GSL
, STATE WELL CONSTRUCTION PERMIT#:
1. WELL USE(Check Applicable Box): Residential M.Ii" Municipal [l Industrial❑ Agricultural❑ Mgfitoring❑ "
Recovery❑ Heat Pump Water Injection ❑ Other If Other, List Use:
2. WELL LOCATIQ�((sSh/�o�etRh of the location below) ry —
Nearest Town: ``//__�L,1ri a( County.
(Road Name Numberst mm igy,or Subdivision and Lot No.) DRILLING LOG DEPTH
3. OWNER O e From To Formation Description —
Address ) ��
treetor cote �sy
AJP�
Cityor Town State Zip Coca
I. GATE DRILLED .� 19• a '7/, v
5. TOTAL DEPTH T :au t
5. CUTTINGS COLLECTED YES C1 NO�'� "`-
DOES WELL REPLACE EXISTING WELL? YES �I NO lQ� cl
STATIC WATER LEVEL Be!ew Top of Casing: Fr. r.
// ,,
(Use':It Above Top of Casing)
TOP OF CASING IS 41 FT. Above Land Surface"
o or casing terminated atJor below land surface requires a variance in seeor-
.-.-.n:with ISANCAC2C.01 6
'!ELD(gpm): METHOD OF TEST
VATER ZONES (depth):
OHLORINATION: Type ! Amount v If additional space is needed use back of form
CASING:
Wall Thickness LOCATION SKETCH
Depth' Q Diameter ar weipnVF�I. Maatterial� (Show direction and distance from at least two State
m _To u -r Ft. Roads,or other map reference points)
m To Ft.— /�+�/ �y
m —To— Ft. -3
C UrT: r_
��ryr] Depth Material Method To Ft. kilc
m — To Ft. (j'J
;SEEN: Q
Depth Diameter Slot Size Material
-m —To— Ft — in. in.
m To_Ft. in. in. as RR
=m To_Ft. in. in.
101GRAVE:.PACK:
Depth Size / �Ma/tefrial WY ?a _4e
m To Ft. a�+G/� C C
In To Ft.
:rdARKS:
J HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 20,WELL
INSTRUCTION STANDARDS.AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER.
OFFICE USE ONLY
-:-ac No: S149ATURE OF PERSON CONSTRUCTING THE WELL DATE
Submit original to Division of Water Quality.Groundwater Secticn within 30 days
Serial No. OW-1 REV. 12/99

WELL CONSTRUCTION RECORD
North Carolina-Department of Environment and Na Resources-Division of Water Quality-Groundwater Section
WELL CONTRACTOR(INDIVIDUAL)NAME (print) q/J&, CERTIFICATION*ik �
WELL CONTRACTOR COMPANY NAME 404el-15 k'1�: R. O e96 PRONE # f7-4Q-P4 �y-
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
if applicable) (if applicable)
1. WELL USE(Check Applicable Box):Residential 0--Municipal/Public❑ Industrial❑ Agricultural❑
Monitoring❑ Recovery ❑ Heat Pump Water Injection❑ Other❑ If Other,List Use
2. WELL LOCATION: TopogWhic(Land setting
N Town: rnaR �t'§ /6.1 County--R-? ' ❑Ridge ❑Slope ❑Valley ❑Flat
lue I nP (check appropriate boa)
(S�-Illamq--mb
N-umbeem Communiitty,subdivision,Lot No,Zip Code) Latitude/longitude of well location
3. OWNER: ZAMC'S 1�d4, (deped/mimdealseconds)
Address 1,912L Pgs 10AIC I.nl Latitude/longitude source:❑GPS17Topographic map
(sveeta No.) (chockbmt)
�o.uN SPs c PC 3li;� t Z DEPTH DRILLING LOG
City or Town state tip Cade From To Formation Description
06
Ares code-Phone number r{d — S/G" W i+ —en
4. DATEDRILLED In -QQ- L y
5. TOTAL DEPTH: '/0°
6. DOES WELL REPLACE EXISTING WET L2 YES❑ NO El-
7. STATIC WATER LEVEL Below Top of Casing: /O a FT. ,.
(Use"+"ifAbove Top of Cuing) =0 4
8. TOP OF CASING IS FT.Above Land Surface'
-Top of easing termloated 01or below land surface required a m
variance in sceordsoee with 15A NCAC 2C.0118. �y
9. YIELD(gpm): -? METHOD OF TEST
10.WATER ZONES(depth):
LOCATION SKETCH
11. DISINFECTION:Type /f 7/6! Amount / sr °Z Show direction and distance in miles from at I
12. CASING: Wall Thickness two State Roads or County Roads.Include the
Depth Dip2eter or Weight/Ft. Kderial numbei and common road names.
From f Tom Ft F1—A 1 C ' h
From To Ft
From To Ft
13. GROUT: Depth Meted a
From D To 02 d Ft A , /Yl •kN..
From To Ft t�
14. SCREEN: Depth Diameter Slot Size Material
From To FL in. in. Z
From To Ft in. in.
15. SAND/GRAVELPACK:
Depth Sim Material
From To Ft.—
From—To—Ft.
16. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C,WELL
CONSTRU ON S/T�AND S,AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE N
cn
Submit the original to the Division of Water Quality,Groundwater Section,1636 Mad Service Center-RaleigI4 NC
27699-1636 Phone No.[phone],within 30 days. GW-1 REV;0712001 -
i� o

308505
WELL CONSTRUCTION RECORD
North Carolina—Department of Environment And Natural Resources—Division of Water Quality—Groundwater Section
WELL CONTRACTOR(INDIVIDUAL)NAME(print)RODNEY ROBBINS CERTIFICATION# 2785
WELL CONTRACTOR COMPANY NAME PITTMAN WELL BORING,LLC PHONE# [phone]
STATE WELL CONSTRUCTION PERMIT#_ ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
1. WELL USE(Check Applicable Box): Residential ® Municipalftblic ❑ Industrial ❑ Agricultural ❑
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other,List Use
2. WELL LOCATION:
Nearest Town: MORGANTON County BURKE Topographic/Land setting
5650 VERNON SMITH DR ❑Ridge ❑ Slope ❑ Valley ❑ Flat
(Street Name,Numbers,Community,Subdivision,Lot No.,Zip Code) (check appropriate box)
3. OWNER:COSONDRA REEP Latitude/longitude of well location
Address 5650 VERNON SMITH DR
(Street or Route No.) (degrees/minutes/seconds)
MORGANTON NC 28655 Latitude/longitude source: ❑ GPS ❑Topographic map
City or Town State Zip Code (check box)
(S� —433-8455 DEPTH
Area Code Phone number From To
4. DATE DRILLED 02/14/05
5.TOTAL DEPTH: 365 DRILLING LOG
6. DOES WELL REPLACE EXISTING WELL? YES❑ NO® From To
7. STATIC WATER LEVEL Below Top of Casing: 60 FT.
(Use"+"if Above Top of Casing)
8.TOP OF CASING IS 1-1/2 FT, Above Land Surface* LOCATION SKETCH
*Top of casing terminated at/or below land surface requires a Show direction and distance in miles from at least
variance in accordance with 15A NCAC 2C.0118. Two State Roads or County Roads. Include the road
9.YIELD(gpm): 20 METHOD OF TEST ARD number and common names
10.WATER ZONES(depth): FROM POLKVH.LE.GO UP HWY.#226 N.RIGHT
ON DYSERTSVILLE RD.GO APPROX.8 MILES.
11.DISINFECTION:Type CHLORYTE Amount 9.5 LEFT ON JOHN REEP RD.RIGHT AT EACH FORK
12. CASING: Wall Thickness NEW SINGLE WIDE ON LEFT IN FIELD.
Depth Diameter or Weight/Ft. Material
From 0 To 60 FL 6-1/4" SDR21 PVC
From_To_Ft.
From T: To_FL_
13. GROU Depth Material Method
From 0 To 20 Ft.QUIKRETE POURED
From_To_Ft. 22
14.SCREEN. Depth Diameter Slot Size Materialco
t
From To_Ft._ in. in.
From To_Ft._ in. in. N
15. SAND/GRAVEL PACK:
Depth Size Material
From_To_FL_
From To FL
16,REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C,WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
SIGNATURE OF PE ON CONSTRUCTING THE WELL DATE
Submit the original to the Division or Water Quality,Groundwater Section,1636 Mail Service Center—Raleigh,NC
27699-1636 Phone No. [phone],within 30 days. GW-1 REV.07/2001

WELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources-Division of Water Quality
WELLCONTRACTOR(A1DIvmUAL)NAME (print) games W. Camp, .Tr- CERTIFICATION# 71'1R
WELL CONTRACTOR COMPANY NAME Camp' s Well & pimp rri Tnr PHONE # (R 71a dS'2_7322
STATE WELL CONSTRUCTION PERMITI{ ASSOCIATED WQ PERMIT#
(if applicable) (if applicable) /
1. WELL USE(Check Applicable Box):Residential ❑ Municipal/Public❑ Industrial❑ Agricultural ud
Monitoring❑ Recovery O Heat Pump Water Injection❑ Other 0 If Other,List Use
2. WELL LOCATIO I: Topographic/Laanfl setting
Nearest Town: 10 r� County f.(,.Y pRidge ❑Slope Walley OFlat
3 4!61 i �T e Y y y p (check appropriate box)
(Street Name,Numbers,Conorno(nity,Subdivision, t No.,Zip Code) Latitudellongitude of well location
3. OWNER: IV C. Loilo Ilfe n (degrees/minutes/seconds)
Address _5TIT Fi5 k RAtcheYJ e Latitude/longitude source:OGPSOTopographicmap
(gtreet or Rou1e No) (check box)
�o YAan'ho rV ICI c- a S G 5S DEPTH DRILLING LOG
��/aC,rty or ovm State Zip Code From To Forma ion Description
(S C4S) '7-.39'1 6o Sand G�a
Ana coda Phone number
4. DATE DRILLED OY(50 1 a ✓c c
5. TOTAL DEPTH: O
6. DOES WELL REPLACE EXISTING WELL? YES O NO G
7. STATIC WATER LEVEL Below Top of Casing: ;y
(Use"+"if Above Top of Casing)
8. TOP OF CASING IS 1 FT.Above Land Surface* J
-Top of casing terminated aUor blow lend surface requires e
variance in accordance with ISA NCAC 2C.0118. tin L
9. YIELD(gpm): 5-0 METHOD OFTEST A IR
10.WATER ZONES(depth): /LC
LOCATION SKETCH
11. DISINFECTION:Type rh 1 nr;r,a Amount 11Y Show direction and distance in miles from at least
12. CASING: Wall Thiclmess two State Roads or County Roads.Include the road
Depth Diameter or Weight/Ft. Material numbers and common road names.
From 0 To 4e0 Ft. 1; 1 1 EDR71 p yr
From To Ft.
From TO Ft. -
13. GROUT: Depth Material Method
From_0 To2O_Ft- NPa} ram ant Hand
From To Ft.
14. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in.
i _ o.Mori
From To Ft. in. in.
15. SAND/GRAVEL PACK:
a
Depth Size Material
From To Ft.
From To Ft. [ IS� 1..1OT e
16. REMARKS: /�Je
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
IGNATURE gF PERSON C STRUCTING THE WELL DATE
Submit the original to the Division of Water Quality,Attn: Informatioui IVI�a eiigEut,1,617Mail ServicePepter-
Raleigh,NC 27699-1617, Phone No.[phone],within 30 days. ! , i --_ -
J. L-
-I ��, GW i RE .09/2004
+ IJ L JUN 2 7 2005
ASnc Vi It H'r 61 J�dr ri-t;c� J

WELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources-Division of Water Quality --
WELL CONTRACMR(1NDIVIDUAL)NANIE (print) aames W. Camp, JT- CERTIFICATION N 7138
wELLCONTRACTORCOMPANYNAME ramp' s well P. Plimp Cn_ Tnn_ PHONEHf87Bt 451_7322
STATE WELL CONSTRUCTION PERAITT# ASSOCIATED wQ PERM1Ttt
if applicable) - (if applicable) /
1. WELL USE(Check Applicable Box):Residential❑ Municipal/Public❑ Industrial❑ Agricultural 6d
Monitoring❑ Recovery ❑ Heat Pump Water Injection❑ Other❑ If Other,List Use
2. WELL LOCATI Topographic/Lao setting
Nearest Town: ✓ ri Coun Y ❑Ridge ❑Slopegralley ❑Flat
'/i I'-)(q- Ej4k Ma G k e ✓C- . (check appropriate box)
(Street Name,NuAmben,Community,Subdivision,LotNo.,Zip Code) Latitude/longitude of well location
3. OWNER: I\I ��- �,' �I�e (degmes/minutes/seconds)
Address I i s I2 -che r�/ �e . _ Latitude longitude source:❑GPS❑Topographic map
treU or Ro�``�`No.) / (check box)
MDYaart l N -46S�7 DEPTH DRILLING LOG
City o Town Smte Zip code From To Forma'on Description
( Rr/-3971 �o
Area wde-P tone number
4. DATE DRILLED �j- �i - S D O C'ONSa i .cf�rl ✓O&k
5. TOTAL DEPTH: v 02
6. DOES WELL REPLACE EXISTING WELL? YES❑ NO G
7. STATIC WATER LEVEL Below Top of Casing: FT. r 'i
(Use"-P'if Above Top o Cuing)
8. TOP OF CASING IS 1 FT.Above Land Surface*
-Top of casing terminated atlor below land surface requires a --C7—r
variance In accordance with 15A NCAC 2C.0118.
9. YIELD(gpm): 60 METHOD OF TEST ATR
10.WATER ZONES(depth): I '/c
LOCATION SKETCH
11. DISINFECTION:Type rh 1 nri nA Amount CT Show direction and distance in miles from at least
12. CASING: Wall Thickness ' two State Roads or County Roads.Include the road
Depth Diameter or Weight/Ft. Material numbers and common road names.
From__Q_To 0 Ft. 6 11 GDR 1 _nvn
From To Ft.
From To Ft.
13. GROUT: Depth Material Method
From 0 To 2Q Ft. Npat rpmpnt Hand
From To Ft. or n
14. SCREEN: Depth Diameter Slot Size Material N / I$ I
From To Ft. in. in. d1-/ � t /
From To Ft. in. in. ><y. _
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft. 1
l-I5�H0.1c�PV'/
16. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C,WELL
CONSTRUCTION STANDARDS,AND THAT A COP OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
�SIGNAOFERSON ONSTRUCTING THE WELL DATE
Submit the original to the Division of Water Quality,Attn:Informatio � uaow lit;1617 Mail e7lee Center-
Raleigh,NC 27699-1617, Phone No.[phone],within 30 days - -r --- ---' ,
GW-I REV.09/2004
7
JUG`; 2
L
71
, 1

"CRETZ WELL & PUMP FAX NO. : 7044621322 Jun. 21 2005 02:15PM P1
W=,CQNMC=RECORD
';�Gafoiha-Depattmem of$mironruart and Natutat Retomcea-Divkiou of Wekr tZaaUq Gfoaodwataf Seotioa
L.-ONTxwcr4=ON*movnL4NAMS &I%* ASHLEY T. MORET2i cs�rrtplc�twnalSflS
crrrrts+-roaccest�t+Yxwzws MORETZ WELL DRILLING tstorm a jg_40�6 -1322
iUL CONSTRPCli0t1?11I M M Tko WQ1li<RDRTN
(itasot m"A tifaooi1e01s)
WON
L1F«1C7uxkApplkabie t Redd eutid{r MmkipaVf'ubS*C] IodusdW 13 Agtioo$unl Ci
Cl 'Recevery 0 Mao Pump Water Neetim O Odux 0 If Other,List rt..
T•:.IACA��T� I ��/"[��
:i TaW( I AA�O/� as m3lloop ova"
Abe mr- Oba* 11 it I bm)
l etl�maNumbe+ Cbnanm da►IaeNa»9pCoEe) -.1 to2�W� O,J� YY/ f /
3. OWNHR 1/eri �l AJ 7 71 aV
Address LANeodallmngituds soutee: opogaspbk map
caa x ®we F ' _F a[fr dam
Pic
70TA,L DRPTH:- c3
M W$Li RM ACE E)MHVG WSLL7 YES 0 NO Wr??
f7TA7IC WATER LEVEL Below Top of Cming;- --FT C
(Ur"i"IfAbev�Tap othdap _ _
^T:%4Z!NO IS FT.Above Laud SurWe ..,
rset�w d` .eeotr IU MCCAC SC �9 dros a --- ---�
^ Y1ELD(DPm) METHOD OF BST ;r e 'E'
dATML ZONES(depth): —
":'4:�.t✓-^AN: Amount Shr/w direoti!A and *CM st WW
tVa111hit 2 two Silos Roads or County Radr.Ioeioda tba rod
. . ,'-,;: � DPW
numbers and comatou road tumor.
r;'t"m4 To Ft
;. ORMT: POPI
Muesid
T D >^t_Li�2'
psoFTo FL� A:_
14. SCREEN: ixamaoec Sint Sire Material -.
T in
T
g , VFt
BLPACK
�� $he Matarhl
?to To
g�Lp,RKS:
: Y THAT TMS VM.L WAS COIWRUC rED 1N A CB VM715ANCAC ZC.Wl�
ART F
S-ANDARDS,AND THAT ACOFY OPrM RBCORA 1t"BW PROVMMToTM74MLOW M
i
..,.e w2 r DATE
SIGoiATt1R8 N tVti@"Ticiic:iuvw+„a..�.-.. --
— .^ .- :aeR na the DAvislon of Water Qaa9ly,(3roandw3<ar 5st4014 lsat Merit S.rvica COW 1 REV 47N12001
d bs r:No.(919)TW221,wttble 30 days

_==TZ WELL & PUMP FAX NO. 7044621322 Jun. 21 2005 02:15PM P2
WELL CONS CUCTION_RECORD IC J
c v a~1tnx+Deprsttaenl of Euvironmentand Natural Resources-Division of Water Qwlity-GmaadwaW Section
WgLLC0 Mpr*MQAL)NAM Q q ASHLEY T. MORETZ CERTNICA ONd,_2d&6
WRLL C0NTAAM0RC01MrANYtYAm MORET'Z WELL DRILLING raoNz a L04AL2- 22
-;.,^carts caamtltcrlol+estaala ocu'rau WQra�aaxrra
f Nis
if
i. WELL USE(CheaR Applicable Bmt):Residential Municipal/Public 13 Industrial❑ Agrie WxW O
Motutodag C] Rww wy a Host pomp Water injection 0 Other 0 If Other,List Uwe
2. WELLLOCATIOr' /lopograpbiclLandsNbng
NescestTo lI pkidp Mops C]Vapey C]Flat
(SnadNam0.Nunbom Cealmaa M waedlvlswa,ldNG.Zip Cob �s Ycesilcae s
3. OWNER
ArewA Latitude/longitude sotued PSQTopogMAk map
(etwd:tm0
49
�� al ""
FTera Sea. Z.b,tbee �TQ _ op p ,ion
Meatad►FiwoeaembM� /"'�� •"�G-f7"rl 4
4. DATE DRILLM ~ 6 r
5. TOTAL DLe M
< 7'^?S a+FP.LL REPLACE EXISTING WELL? YES NO
STA IC WATER LEVEL Below Top of Caring:
S. TOP OF CASINO IS__,L_!7r.Above Len Sn a ss
"[sae of arrastwwlxaeMWw%* laid A. r,,b ■
valuer V scan wne MA NCAC 1C Atlt . . N i
)• METH OFTBST 5
1;. DISFNFECTION:Type ArnonM Show direction and distinct in miles homileese
12. CASING: WaR T}drimes two State Roads or County Roads.Include the ma&s
FrotQ� To Ft ��L/ PyG mambas and common mad names. )
—TO �' J�+C• ,CA.`f"i e}' ���r7'N.cLe.
From TO.
13. GROUT;. Material blethod
at*�c1
FtoM To Ft
14. SCREEN: Depdt niameter Slot size Matm,el
�70
Y t= in
is. GRAV�EL ACK: _
DIP& Size Material
Fro
Ftaq�,, To
I AO M.M CERTIFY MT T=WELL WAS CONStRUCPED IN ACCORDANCE WITH ISA NCAC 2C,WELL
CONSTRUCTION STANDARDS.AND THAT A COPY OF THIS RECORD W BEEN PROVIDED TO THE WELL OWNER
SIGATUM OF PERSON CONSTRUCTM THE WELL DATE
Submit the orI&AI to the Divlwlon of Water Quality,Groundwater Section,16M Mau Sa vice Center.Rawsk NC
-•'-�54-1a1a rawae Na ply 733-SEZt,within 30 days. Q1 REV.07/2001

"CRETZ WELL 8 PUMP FAX NO. : 7044621322 Jun. 21 2005 02:16PM P3
WULCQNffUM0 REC4Q
=.a Carolina•Depaft tK of Bm komneht and Natatd Reaomtea•Division of Weer Quality•Oromtdwater Section
ratan.CWMP^Cc0fcaltrotVWVA.)NAMam4 ASHLEY x� hL$ETZ Cvry tC4TmN#-Zi c
% s=C0ffMACrQRC0MPAXY'gA ae ISORETZ WELL DRILLING raoNZ a E04A62-13 2
STATRWPLI,CONSTAVMONPI re �ern3A"mwQl7Ra¢'te
rifamitomNl (dr 0",
?. WBLL USB(QmkAMUCabte BOA:Ruk%vdal p/mmkipaU *ft E3 lodeoWd O ApWalmtd O
N'.o bX t4 4 Recovtrry 0 Heat Pomp WOW Itgactioe Ca Omw(3 If Omer,Lit Uetti,.,,
?-:xl.i.LOCATFON• I ?opp�ielllad�t '
:�Cs�aat'�vrd• a allT t �h������ pgldye �Siope DVaUey
njA. itoe/ iti8. (tmaatrapCp 1 WK)
:`xalJuae.Nr,b�m,Caroermiq.edt6.iaao.rexa coa.) ,�L.aq' ��,,,,�t,,,,ofwpll, / 7D. O�J�
'''� --:_� Ladmdenott�a� ope�pbio�
n � DIM
tStytu lade Caen F y T2 ' Pgsno�tlon
�-iewMPheaeaateltr �
LEA���� • � /
ROBS Wp.I,RHPLACBE7C[b7JN0 WELL? Y8S IXNO G "
STATIC WATER LBM Below Top of CWW. -Q 1 T, - _-
(u.•4-uAbow Tnp dCmW -P
3. TOP OF CASINO is FT.Above Land SorACC'
+M1bp elewaK twdrl�a fMtet Mlsr lre sLe�w4dta• 4
r.aeleppee�lSArtCAczc �'r7�r
9. Y=(gn*-. pT6sT
_�--
10.WATER ZONES(depmr O` 360
11. DISNiFkCfION:Typo Amamt n Stwo tab Ronda or lebm At road
lend
:I. CASINM Wan 7%kbola
p # �/_�uomi>aa atod comm ro on ad mea mLL
To Ft. .S�i ��•7a.�2r �d�`3i7�
ITROtTf• AaerorW Madt"A� /
v":� l tgz>t Dlamete< Slotske Mau
1 �
F T =, 1
is. SAXWORAVBLFACIL,
To
I DO MIMY CERTIFY THAT WUZ WAS CONSrpj% 'HD IN ACCORDANCE WITEI ISANCAC 1C.W!C•L
,0F;Tk=j0NSTANDARDS,AND TAOOPYOPTHlSRk1CORAHAS9EbNPROV$]SDI
'— SICEVA OP PF.e&pN CONtI'fRtJCT1N0 TiiB VJESd.. DATE
Sabmk the orlylnal to We Diem of Vihtet Qeatity,r3roandwatu Seetlety Srx16 Man Sella COW 1 REV.07/2001
17N91636 PMNe Na(910)73"2211 wak 39 d"L

`iCRETZ WELL & PUMP FAX NO. : 7044621322 Jun. 21 2005 02:18PM P5
�a ,CON=CMN RECb$�
mtlim-Dwic mt of EmkonmAnt and Namil Raoataa-DhWau of Wafer Qa ft-Gronndwuoe Secdoe
V, u=CONTRACU epe WWVAWrueea ryag AS LEY T. MORETZ moNo 2SA6
•-, .;.cwjxAcTmccmrAn Now MORETZ WELL DRILLING sons a dOtsA62-1322
Vs o CONCUWCRO!(MainAIR =WO MULMPPB
-- +.cIT ir °i ntroetsxhl.1
Now
arr-LL USE(Cheek Applicable Ba*R=Mcmdal H Ma*l pWuM E3 ioduMW Cl Ag t=Wutd CI
Mordtoting O Recovery C] Hwt Pmop Waeer bgeotion O Odxr� If Odiar,Lset Veep
VrlRm LOCATION dI ap�
AoTl s f �NfMtwv Como RVsAey DPW
e C (Aeak�rapMkbap
Name.N beh.Ca�mwiN. bdoo.Iae Ne..�PCode) O 0� a S-O/� W
Ad&mL�mddloagMude aamoxneSaTopoSeepbk map
Cigor'fw Brie �oee. T FDOeCd -'a
Anreal►F6opamaoeer � 7
♦. DATE ARU IAA ' a+
77
�. ^OSS WELL RULMX mawmG vnmv YU u�orrO
?—\rC NATBR LSVM Bdow Top of CMWF / d��•
(Iha�+*ItAbew7b►ddde4l
a". TOP OF CAMO IS PT.Abow Lad 9urfimy o
'TMafaaaM�{e�a+daabedlmw- c3cml&
varersAaaeo SeA NCAC 2C JBeL.
METHOD
i:.. p13RiFEC1'1O1'1: Amowt Sbow dieectionaad4 ftm at W*
IK CASINO: Wau nidmae two Sam Raadt or Couuty Rasde Include Iba row
mmibaeead couuom road A m/ L 1
Sa
From To F
�m mmorw
OROUToD T 0 Ft
ouI
rr P To Ft
m, SCLUNe Depm DSamamr mat Sias D¢aer+al
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v� o Pt
M SFANDMAVELF sm
From—
oRt.L...-,.To
TSMA.RRS:
I DO IMMY CUTSFYTHAT1TI13 WELL WAS CONSMIIC bD IN ACCORDANCE WITH.SSA/
bNSTRLICI70K STAN �NCAC 2C,K7SLL.
W
! �S, THAT A ODFY OF 7MS RECO0&"S OW PROVMD7
--- SI
Or P[3RSON O M WELL UATB
s:�i:Yii4 01 FSua1 EO RM IH A Water Q9a0h.(lr�°dwarer SeGkry 163E MaI18etMm Cea -Reld{M I4C
;t?44R1636 PhsBe No.(91�1333231,WhAI�36 dwyB�
OW-I R8V.0T/20111

V U ti r/
WELL CONSTRUCTION RECORD
' -t- as � �
North Carolina-Department of Environment and
/NaturaljReso ces- Division of Water Quality-Groundwater Section
WELLCONTRACTOR(INDIVIDUAL)NAME (print) a1.11Q'p TLt-55e(I CERTIFICATION#_ ,3/
WELL CONTRACTOR COMPANY NAME�f S e t/ I.tIP-I -ll i,, I Ina( .l NI C PHONE # (QJ?tDs;?15Gi TI;
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERDIIT#
(if applicable) (if applicable)
I. WELL USE(Check Applicable Box): Residential [9' Municipal/Public ❑ Industrial ❑ Agricultural ❑
Monitoring❑ Recovery ❑ Heat Pump Water Injection ❑ Other❑ If Other, List Use
2. WELL LOCATION: yy�� Topographic/Land setting.,�.
Nearest' ocm: p? County G67.lt.S'� ❑Ridge ❑Slope ❑Valley L76lat
.., pl r, (check appropriate box)
(Street am(( o
e,Numbeer/rs,Community,Subdivision,Lot No.,Zip Code) Latitude/longitude of well location
?. OWNER ��
: -yj o4AL40 (degrees/minutes/seconds)
Address O 's((, ,[j topp �� Latitude/longitude source:OGPSOTopographic map
(Street or5tautee `.} - (check box)
}�tly -,�`� DEPTH DRILLING LOG
Cityor Ten ante Zip Code From To Formation Description
1331d C S—�L -!� [L—q a _d4�%t
Area code-Phone number 3r-/
4. DATE DRILLED-&- S- O- --
5. TOTAI.DEPTH: i LZS Z
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO � --
7. STATIC WATER LEVEL Below Top of Casing: 17iFT. --
(Use"+"if Above Top of Casing)
8. TOP OF CASING IS_L�2 FT.Above Land Surface* — --
*Top or casing terminated atlor below land surface requires a —
varimmc in accordance with 15A NCAC 2C.0 118.
9. YIELD(gpm): 5 _METHOD OF TEST
10. WATER ZONES(depth):
LOCATION SKETCH
11, DISINFECTION: Type-_ !S_}� Amount 1 Show direction and distance in miles fro��Jt�at lzzs'
12. CASING: Wall Thickness two State Roads or County Roads. IncluQ the rdar#1
Depth Diameter Lot Weight/Ft. Material numbers and common road names.
,v
From__D.__To_.—_QL_Ft. / c�--
From _ To FL o
From To Ft.
13. GROUT: Depth Material "Method p
From�t -_To;2/g Ft.�From To Ft.
a /
14. SCREEN: Depth Diameter Slot Size Material
From_ To Ft. in. in. j 7hjca,
From To Ft. in. in.
15. SAND./GRAVEL PACK:
Depth Size Material From To FL
From To Ft._ OCo�
16. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C,WELL
CONSTRUCTION STANDARDS,AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
SIGNATURE OF PERSON CO i I'F (,�Ilhsl THE WELL`r ATE J y tp
i
Submit the original to the Division of Water Quality,Gro ter Section,1636 Mail Service�Rhter-Raleigh,NC
27699-1636 Phone No.[phone],within 30 days. �� 1 ;�'��i `-�GW-1 REV.07/2001
rN I

V
WELL CONSTRUCTION RECORD
North Carolina-Department of Environment and Natural J rcResources-Division of Water Quality-Groundwater Section
WELL CONTRACTOR(INDIVIDUAL)NAME (print)(1! 1U/l ? 1\1t56Ca CERTIFICATION#,;Za3l
WELL CONTRACTOR COMPANY NAME X tL 55 P_11 LeJ 12-( I DV1 II Li—A PHONE #
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
1. WELL USE(Check Applicable Box): Residential 1Gk' Municipal/Public ❑ Industrial ❑ Agricultural ❑
Monitoring❑ Recovery ❑ Heat Pump Water Injection❑ Other❑ If Other,List Use
2_ WELL LOCATION: o Topographic/Land setting
Nearest Town: J County ./] tnwf�.,_ _ ❑Ridge @Shope ❑Valley ❑Flat
111L I, J .S L a 9(0JJr (check appropriate box)
(Street Name,,Numbers,
�Com/muuniity,Subdivision,Lot No.,Zip Code) Latitude/longitude Of well location
?. OWNER: l/_'L+21LT"t/� (degrees/minutes/seconds)
Address �y `A L, / 9 S Latitude/longitude source:❑GPS❑Topographic map
(Street or Route N0 _ (check box)
DEPTH DRILLING LOG
City or Te�� State Zip Code From T Form Description
(Xb3 ' o so� r�C9L/�
Area code-Phone number ✓NJZ/.C.-
4. DATE DRILLED&—�2, —C)J
5. TOTAI, DEPTH:_,06 1
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO EkY
7. STATIC WATER LEVEL Below Top of Casing: FT.
(Use"+"if Above Top of Casing) -
8. TOP OF CASING IS—1 L FT. Above Land Surface* —'--
*Top orcasiag terminated at/or below land surface requires a variance in in accordance with 15A NCAC 2C.0118. -
9. YIELD(gpm):_4 _METHOD OF TEST Q.bV _ __ _.
10. WATER ZONES(depth):—,SO _ _ O e+ _
LOCATION SKETCH
11. DISINFECTION:Type__&T4 Amount 6.4,,,,Show direction and distance in miles from at lent:
12. CASING: Wall Thickness two State Roads or County Roads.Include the-load
Depth Diameter or Weight/Ft. Material numbers and common road names.
From__40_1 o_�A Ft. b'L
From Tea____ Ft.
From To FL_—
13. GROUT: Depth Material Method
From�__ ion'6 _Ft.
From To___Ft.
14, SCREEN: Depth Diameter Slot Size Material µJ/�
From_ "Io Ft. in. in.
From_ To_ _Ft. in. in.
15. SAND./GRAVEL.PACK:
Depth Size Material \
From-_ —To____Ft.
_. T Fromo__FU_
I6, REP.IARKS:___
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C,WELL
CONSTRUCTION STANDARDS.AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
•��' SIGNATURE OF PERSON CONS _U, T-IIt4.THE WELL. DATE
Submit the original to the Division of Water Quality,Grou 'J after SeFt t1,1636 M 14$ INC
ervice Center-Raleigh,
27699-1636 Phone No.[phone],within 30 days. �4L '• '�" '') GW-I REV. 07/2001

V � t
ri
WELL CONSTRUCTION RECORD
North Carolina-Department of Environment and Natural Resources-Division of Water Quality-Groundwater Section
//� // 7
WELL CONTRACTOR(INDIVIDUAL)NAME (print)l11/Oe ICI-C-SSP G� CERTIFICATION/0 e;L 3
WELL CONTRACTOR COMPANY NAME�U-5Se. i1 )10�' Trr 11••A NC' PHONE #
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(inapplicable) (if applicable)
I. WELL USE(Check Applicable Box): Residential 93� Municipal/Public ❑ Industrial ❑ Agricultural ❑
Monitoring ❑ Recovery ❑ Heat Pump Water Injection❑ Other❑ If Other, List Use
2. WELL LOCATION:"" " � � Topographic/Land setting
Nearest Town:�y�r y _County ❑Ridge 1XIope ❑Valley ❑Flat
/VC' 1$ S fj� 1.SS (check appropriate box)
(Street Name,NNuu�]mbbers,,Community,Subdivision,Lot No.,Zip Code) Latitude/longitude of well location
OWNER:_J 'ViLGC� 'n� (degrees/minutes/seconds)
Address ' ' S Latitude/longitude source:OGPSOTopographic map
(St r et or Route No.) (check box)
DEPTH DRILLING LOG
Cuv or wn State Zip Code From To Formation Description
(• AL9J-2D_--S -0
Area code-Phone numberQ
4. DATE DRILLED
5. TOTAL DEPTH: _
6. DOES WELL REPLACE EXISTING WELL? YES O NO 2
7. STATIC WATER LEVEL Below Top of Casing: & S FT. _
/ (Use"+"if Above Top of Casing)
8. TOP OF CASING IS�1.�._FT. Above Land Surface* — --
"Top of casing terminated at/or below land surface requires a —(n —'—
variance in accordance with 15A NCAC 2C.0118. — CD --
9. YIELD m :_ 1,5 METHOD OF TEST ai6V
10.WATER ZONES(depth):
LOCATION SKETCH
11. DISINFECTION: Type_ T u Amount Show direction and distance in miles from at least
12. CASING: Wall Thickness two State Roads or County Roads. Include the road
Depth Diameter or Weight/Ft. Material numbers and common road names.
From_)_ FL_ P v c gA,�
From To FL
From To FL _
13. GROUT: Depth Material Method I T%
From-0 __ To .20 FL�a
® 5 �VUS
From___To _Ft.
14. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in.
From_ To_ _Ft. in. in. $Y'.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft._
16. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C,WELL
CONSTRUCTION STANDARDS.AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
7
SIGNATURE OF PERSON CO}4$#ftGTINi("i TH;E WELL r,.,•,I DATE
Submit the original to the Division of Water Quality,Groalgdwater Section,1636 Mail Servi OCenter-Raleigh,NC
27699-1636 Phone No.[phone],within 30 days. ill A I���t I ; IqW-I REV.07/2001
u

WELL CONSTRUCTION RECORD
North Carolina-Department of Environment and Natural Resources-Division of Water Quality-Groundwater Section��y�
\t'ELLCONTR.ICI'OR(INDIVIDUAL)NAME (print CERTIFICATION
WELL CONTRACTOR COMPANY NAME 'J 6� - GLID 666 PHONE #
STATE WELL CONSTRUCTION PERMITS ASSOCIATED WQ P RMITa
(ifapplicablc) / (ifapplicable):
I. WELL USE(Check Applicable Box):Residential[d' Municipal/Public❑ Irl'stria)❑ Agricultural❑
Monitoring❑ Recovery ❑ Heat Pump Water Injection❑ Other❑ If Other,List Use
2. WELL LOC.4TI0 & , j� ATopographic/Land setting `a
Nearest Tow.: 1 f� County. Topographic/Land
❑Slope ❑Valley ❑Flat
_T2�'7 j. , Cet'4e, V)f" (chmitappropfiambox) G „�
(Street Nano.Numbelrs.Community,Subdivision,tAI No..Zip Code) Latitude/longitude of well location
3. OWNER: �1_ h Am-1 !/1/�.(aLL (degrecs/minutes/saonds) ,may
Address Latitude/longitude source:.❑GPSOTopoL<bhicMap
Street or Ronan No.) (check box) .a
M,.nfC¢ 61 f jv s�Tly-vJ�J DEPTH DRILLING LOG
City or Town State Zip Code From To Formation Description
( 1 ✓a4z.- -;1> r
Arco code.Phone number,_
4. DATE DRILLED
5. TOTAL DEPTH:
G. DOES WELL REPLACE EXISTING WELL? YES❑ NOW --
7. STATIC WATER LEVEL Below Top ofCasing: �ea Fr.
(UM"+^if Above Top of Casing)
S. TOP OF CASING IS FT.Above Land Surface"
*Top otewint termtmeted at/or betaw land surtate repuirca a
variance in sonrdance with 15A NCAC 2C.011&
9. YIELD(gpm): a METHOD OF TEST k4>/z
10. WATER ZONES(depth): l y i z. 2,i
LOCATION SKETCH
11. DISINFECTION:Type P&r,. a Amount Show direction and distance in miles from at least
12. CASING: Wall Thickness two State Roads or County Roads.Include the road
Depth Diameter or WcightlPt. Material numbers and common road names.
From To Ft.
From r,) ToCLFt. �buti
Frorr' 4� Tom[_Ft. 6 Ail
� I
13. GROUT: Depth Material eta thud
From To Ft.-
From &; To 9i, FLU
14. SCREEN: Depth Diameter Slot Six Mat 'al
From To Ft. in. in.
From To Ft, in. in.
15. SAND/GRAVEL PACK:
Depth Sim Material
From To Ft. <j
IG. REMARKS:
I DO HEREBY CERTIFY THA I WELL WAS CO3WMUCTED ly ACCORDANCE WITH 15A NCAC 2C, -LL
CONSTRUCTION STANDAR D THAT A CO Y OF IS BEEN PROVIDED TO THE WELL OWNER
'-JSIbAATUkE OF PE CONSTRUCTIK THE WELL DATE
Submit the original to the Division or Water y _
Quality, NC
27699-1636 Phone No.[phone],within 30 days. i G W-1 REV.07/2001
r�

(J 3 v_
WELL CONSTRUCTION RECORD
North Carolina-Department of Environment and Natural Resources-Division of Water Quality-Groundwater Section
W ELL CONTRACTOR(INDIVIDUAL)NAME (print) G`Ayc-4 il,,Sly['.E CERTIFICATION
v1'ELI.CONTRACI'ORCOMPANYNAME G PHONE #
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WO P a11Ts
(if applicablel (if applicable)
I. WELL USE(Check Applicable Box):Residential Q/Municipal/Public❑ (ndustrial ❑ Agricultural❑
Monitoring❑ Recovery ❑ Heat Pump Water Injection❑ Other[] If Other,List Use
r
2. WELL LOCATION: TopoB8rr3pphic/Land setting
Nearest Town: Z?14-17 to ' ,-CJ County dae2 k ❑Ridge 63SIope ❑Valley ❑Flat'-`
yC• ' ?///I'dY 3 P6 (check apprapriate boa) V `
(Sircm Nana.Numbers,Community,Subdivision,!.m Na,Zi Code) Latitude/longitude of well lociaon
r� �1 e r•Y.,
3. OWNER:_ f�![otiu� ,],I3vX., ,-, `-
(degrecs/minutes/sceomis)
Address /c✓4.i ('ltnyb-F f"rat,+ fe.t[3rJ. Latitude/longitudesourcc:❑GPS❑Topog�aphi lap
l'Strec/t or Rome No.) (check box) Ln
��b2�.•,d,+h�vc�yU(f_ DEPTH DRILLING
city or can Smte Zip code From To Formation Description
Ar code-Phma:number �J—
t. DATE DRILLED S 2 4-n5
5. TOTAL DEPTH: 9 S1�S� /zC._
6. DOES WELL REPLACE EXISTING WELL? YES❑ NO Q/
7. STATIC WATER LEVEL Below Top of Casing: jjj2 FT.
(Usc"+�if Above Top of Casing)
8. TOP OF CASING IS 4—FT.Above Land Surface* Ztf� 1 _
Top of costs&tenalnated atfor below land surface requires a
variance is accordance with t5A NCAC 2C.011&
9. YIELD(gpm): =20 METHOD OF TEST /f'L
10. WATER ZONES(depth): �
LOCATION SKETCH
11. DISINFECTION:Type=6-°fR{9 Amount 7- Show direction and distance in miles from at least
12. CASING: Wall Thickness two State Roads or County Roads.Include the road
Depth Diarrtcter or weigt»)Pt. Matc'a) numbers and common road names.
From To /c2 8 FL (2&
From JP To &1 Ft.—Tj
From/2 y To 1:3(-j Ft. 1P R /_✓ f
13. GROUT: Depth M Icrial Method !rA
From To Ft. ✓fC)"z
From G To_ao Ft. &A Oe,i f/,
14. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in.
From To Ft. in, in.
15. SAND/GRAVEL PACK:
Depth Size Material 1
From_ _ To FL_ IVJ
From To Ft.
16. REMARKS: t
7
1 DO HEREBY CERTIFY THAT IS LL WAS CO, RUCTED IN ACCORDANCE WITH 15A NCACti L
CONSTRUCTION STANDARDS, HAT A COP ORD HAS BEEN PROVIDED TO THE WELL OWNER'
-OF P ON CONSTRUCTING THE WELL.-- -- ---- DATE
Submit the original to the Division of Water Quality,Ground Ve)'ISieetiq'-R 35.Mail Service Center-Raleigh,NC
27699-163 s. '6 Phone No.[phone],Within 30 days. �'' ��'�
Y � . ,..,. GW-1 REV.07/2001
1

V 3 15 2 FJ 7
WELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources-Division of Water Quality
WELLCONTRACrOR(WDIVD)UAL)NAME (print) .3am R W ramp , Jr CERTIFICATIONN 713
wELLCONTRACfORCOMPANYNAmx Cramp' s Well & Pump Cn r Tnrr PHONE k 628 AS't 72Z2
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMM
(if applicable) (if applicable)
1. WELL USE(Check Applicable Box):Residential'p,-T4unicipal/Public❑ Industrial ❑ Agricultural❑
Monitoring❑ Recovery ❑ Heat Pump Water Injection❑ Other❑ If Other,List Use
2. WELL LOCATION: Topographic/Land setting
w : Coun
Ty' ❑Ridge ❑Slope l)�Iley
Neaz To ❑Flat
�R-M d. (check appropriate box)
(Strut Name,Narnbds,Community,Subdivision,Lot No.,Zip Code) Latitude/longitude of well location
3. OWNER: ' de source:utes/PSE]s)
Address � �� , b Latitude/longitude source:❑GPS❑Topogmphicmap
Street or Route No.) i (check box)
N ��. 5 DEPTH DRILLING-LOG
City State Zip code From TO Fo nation Description
A code-Phone mother U
res
4. DATE DRILLED
5. TOTAL DEPTH:
6. DOES WELL REPLACE EXISTING WELL? YESp NO C�
7. STATIC WATER LEVEL Below Top of Casing:�_FT.
(Use"+"if Above Top of Casing) C
8. TOP OF CASING IS 1 FT.Above Land Surface" ----- -1,
-Top of casing terminated atlor below land surface requites a �• "�
varisuce in accordance with 15A NCAC 2C.011& -+
9. YIELD(gpm): _Cj _METHOD OF TEST W i r
10.WATER ZONES(depth): 2 b i) "
LOCATION SKETCH
11. DISINFECTION:Type h,hnr i n a Amount C 1 &4 Show direction and distance in miles from at least
12. CASING: Wall Thickness two State Roads or County Roads.Include the road
Depth Diameter or Weight/Ft. Material numbers and common road name&.
From___0_To66—Ft. 6 1 /4 Srlr 21 nvr, - CU
From To Ft.
From To Ft. -
13. GROUT: Depth Material Method -
Fmm__D_To2p_Ft. Neat_ C'ament liana V'
From - To Ft.
14. SCREEN: Depth Diameter Slot Sim Material '"`
From To Ft. in. _ in. 16 ^'
From To Ft. in. in.
15. SAND/GRAVEL PACK: ✓�'��lr
Depth Size Material
From To Ft.—
From—To—Ft.
16. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C,WELL
CONSTRUCTION TANDARDS,AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
O'
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
Submit the original to the Division of Water Quality,Attn: Information Management,1617 Mail Service Center-
Raleigh,NC 27699-1617, Phone No.[phone],within 30 days.
GW-1 REV.09/2004

CN 3 8 �
WELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources-Division of Water Quality-
WELL CONTRACFOR(INDIVIDUAL)NAME (print) JamPc w ramps Jr_ CERTIFICATION#
WELL CONTRACTORCOMPANYNAME camps Well & Pump co- , Tri, PHONE # R7Q d53_7322
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
1. WELL USE(Check Applicable Box):Residential t'Municipal/Public❑ Industrial❑ Agricultural❑
Monitoring❑ Recovery ❑ Heat Pump Water Injection❑ Other❑ If Other,List Use
2. WELL LOCATION: - Topographic/Land setting
Nearest own: W1 .� _County dge ❑Slope ❑Valley ❑Flkat
)lotY n-t �in r✓l (check appropriate box)
(Street Name,Numbers,Community,Subdivision,Lot No,Zip Code) LatitudcAongitude of well location
3. OWNER: -
(degrecs/ntinutes/sewnds)
Address Y WIP rL Latitude/longitude source:❑GPS❑Topographicmap
\�1 (Streetorlou No.) a (check box)
I' 10YQ0.RfnA C D oh DEPTH DRILLING-LOG
City or Town sec Zip code From To Formatio t Des ipti
Area code-Phone number (,
4. DATE DRILLED
5. TOTAL DEPTH: I S
6. DOES WELL REPLACE EXISTING WELL? YE5 NO ❑
7. STATIC WATER LEVEL Below Top of Casing: U FT.
(Use"+^if Above Top of Casing)
8. TOP OF CASING IS 1 FT.Above Land Surface• -
-Top of wing teratinated atlor below land surface requires a
variance in accordance with 15A NCAC 2C.011S.
9. YIELD(gpm): _METHOD OF TEST r1ir ry
10.WATER ZONES(depth): bD _`�p V
LOCATION SKETCH p
11. DISINFECTION:Type Ch.irtri na Amount Show direction and distance in miles fromWleast,—
12. CASING: Wall Thickness two State Roads or County Roads.Include the road"-
Depth Diameter or Weight/Ft. Material numbers and common road names. ..
From_p_ToFt. Fi 1 /4 GAr 71 Px7C
From To Ft.
From To Ft. -
13. GROUT: Depth Material Method
From_Q__To_2.0__Ft. Neat Cemant Hand
From - To Ft.
14. SCREEN: Depth Diameter Slot Sin Material C
From To Ft. in. in.
From To Ft. in. in.
15. SAND/GRAVEL PACK: (�
Depth Sin Material
From To Ft.-
From—To—Ft.
16. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C,WELL
CONSTRUCTION STANDARDS,AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
SIGN TURE OF PERSON CONSTRUCTING THE WELL DATE
Submit the original to the Division of Water Quality,Attn:Informiltion Management,1617 Mail Service Center-
Raleigh,NC 27699-1617, Phone No.[phone],within 30 days. - -
GW-1 REV.09/2004
I

North Carolina -Department of Environment and Natural Resources-Division of Water Quality-Groundwater Sectidfi q
1636 Mail Service Center-Raleigh,N.C.27699-1636- Phone[phone] J `1 6 2 6
WELL CONSTRUCTION RECORD WELL CONTRACTOR: Deajey 4h'rtq:1t yVej! )`'umo Co I
WELL CONTRACTOR CERTIFICATION#: 2381
5Q3 i6 STATE WELL CONSTRUCTION PERMIT#: Stet-e Ge V
1. WELL USE(Check Applicable Box): Residential El Municipal 0 Industrial 0 Agricultural 0 Monitoring El
Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use: -
2. WELL LOCATION:(Show sketch of the location below)
Nearest Town: FINEOLA County: BURKE
rn
&NGERCAKE RD OFF 161 GFF 105 5:221
(Road Name and Numbers, ommunity,or Subdivision and Lot No.) DRILLING LOG DEPTH rv.
3. OWNER ,30Hd C BEACH. JR From To Formation—DescriptidT
Address 7115 GING{�tERCAKE RE) 0 55 DiFZT v
,-3EA'LANffmbt or Route No.) INC ?8657 55 82 GaF,ANITE =? -
City or Town State zip ode 82 63 Sl L.ES _
4. DATE DRILLED /24120,35 33 130 '.3ia?NI1Z. - -
5. TOTAL DEPTH 'td5 130 '131 SkALE
6. CUTTINGS COLLECTED YES 0 NO 0 131 1415 GRANT) E z
7. DOES WELL REPLACE EXISTING WELL? YES 0 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* 7104
"Top of casing terminated atlor below land surface requires a variance in accor-
dance with 15A NCAC 2C.0118
10. YIELD (gpm): 60 METHOD OF TEST Air
11. WATER ZONES (depth): 2`00 RPm82-83 57 00ppm
0 00 qPm 0.00;lpm _
12. CHLORINATION: Type HTH Amount 22 If additional space is needed use back'of'forril?
13. CASING: Wall Thickness LOCATION SKETCH
Depth Diameter or Weight/Ft. Material (Show direction and distance from at least two State �t
From 0 To 60 Ft. 6 118 '"z50 PVC Roads,or other map reference points)
From To Ft. �\\ fit) G ,4
From To Ft. ! „^� ` -� a'
vi
14. GROUT:
Depth Material Method yk FU��
From 0 To ilk Ft. Cement Gratity Flour �' Ct \'14'
From To Ft. � x 4
r
15. SCREEN:
Depth Diameter Slot Size Material
From To Ft. in. in.
From To Ft. in. in.
From To Ft. in. in. dL
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 JAS BEEN PROVIDED TO THE WELL OWNER.
FOR OFFICE USE ONLY G� b` —1 0
'
SIGNATURE OF PERS�R 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 -F
kvv �<
WELL CONSTRUCTION RECORD V_
North Carolina-Department of Environment and Natural Resources-Division of Water Quality-Groundwater Section
WELL CONTRACTOR(INDWMUAL)NAME (pri CERTIFICATION p 2
WELL CONTRACTOR COMPANY NAME--amaunumFRU rT RE m PHONEY &R 1 324-oa35
STATE WELL CONSTRUCTION PERMITY ASSOCIATRD WQ PERMITN
(ifa0blieable) - - (ifapplicwlAe
aIw
1. WELL USE(Check Applicable Box):Residential Municipal/Public O Industrial O Agricultural O
Monitoring O Recovery O Heat Pump Water Injection O Other O If Other,List Use
2. WELL LOCATION: TopographidLand setting
Nearest Town: County 1 Mdge OSlope OValley Mat
2962 C11)FTiF AM (chwkapprWp tebox)
(Street Name.Numbm,Cwaiuoay.SWbdivisioa.Lot No.,TV Code) Latitude/longitude of well location
3. OWNER: C[RTS JACKM (daye«Jmkuft5 ecaadr)
Address 2918 C(xIFTIE AVE. Latitudeliongitade source:OGPSCITopographic map
(SmxcaAoote No.) (ebadcbmQ
nr. 9Arnl;5 DEPTH
Cp«Tma Stab rip Code F m To Formation Description
( 828). 712-44�
Area code-Photo aumber06 17-05
4. DATE DRILLED
S. TOTAL DEPTH:-- s
6. DOES WELL REPLACE EXISTING WELL? YES O NO in%
7. STATIC WATER LEVEL Below Top of Casing 40 PT• `?
(U,eV i[AbwsTap dCwhW .-+
8. TOP OF CASING IS 2 FT.Above Land Surface' r�
"Tp of easMa t«alaatM aV«beMu'hud sarfaa MaWa a O :�
.wb�IELD g xe): 6 with 1 METHOD OF TEST BY AIR�T ^
9. YIELD(gpm): cn
10.WATER ZONES(depth): I rx'ATION SKETCH
11. DISINFECTION:Type T� Atrouru 44 Show ditedion and distarrce in Mika from at least -'
12. CASING: Wall'Ihidmew two State Roads or County Roads.Include the road
DqAh Diameter oo�WetghtlFL �?C numbers and common road names.
From 0 To 1I Fk A
From To Pt
From To Ft.
13. GROUT: Depth
From 0 To � Fk (�
From—TQ-
14. SCREEN: Depth F Diameter Slot Size Material ©� X
From_ To Ft.___—in. in.
From To Ft__in.
15. SAND/GRAVEL epth DSize material
Depth
From TO Ft
Fro^+ To Ft.
16. REMARKS:
i DO HEREBY CER , THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH ISA NCAC 2C,WELL
CONSTRUCTION ST ARDS,AND THAT A COPY OF TEU RECORD HAS BEEN PROVIDED TO THE WELL OWNER
�A�SIG/N�ATURP
PERSON kNMfJCrING THE WELL DATE
Submit the original to the Division of Water Quality,Groundwater Section,1636 Mail Swlee Center-Raleigh,NC
2709-1636 Phone No.[phone],within 30 days. OW-1 REV.072001

61 9 n n
WELL CONSTRUCTION RECORD
North Carolina-Department of Eavkoement and Natural Resoumm-DMsion of Water Quality-Groundwater Section
WELI.00NTRACT0R(0W1VWVA14NAKE IMLPAIELE CERTIMA910N#2§
WELL COMRACTOn COMPANY NAME HT(IM Wh7I fRIII1IE(M PAONS s (R•IRI �L 35
STATE WELL CONSTRUC WN PZRMMM A--.Tan WQPwtrnri .
(if applicable) (ifaPplicable)
1. WELL USE(C3e*Applicable Box):Residential MK M=WTaWublic❑ Wdostrial D Agriculhual D
Monitoring D Recovery D Heat Pure Water Injection D Other D If Od W.Lin Use
2. WELL LOCATION: Topogrgphk4Andsdfiog
Nearest Town: HQI� County Oltidge DSlope DVaHey Mt
(ebxk epprag — bm0
(Sheet Naam,NumbeMCMMtdW:tvbaty1310 10 NO,Zip Coae) LatitudeAonginideof well location
3. OWNER: C.E. KR S (�)
Address I7) L✓✓• Ladiumnorrgh I aozecerElGPSDTopoVvphic map
(Seactwitaaeft) (elr'ttA) IIMt(:rn[_
Huff ttY4, NC 2B6 ip P&FIIi rmat�-
2 )�rWT7P 4e, rW Cone Fri To Fo�ticn DexripMron
Arm code-Pbae mmbm -.
4. DATE DRHLE() D5-2D-05 f
5. TOTAL DES j
6. DOES WELL REPLACE EXISTING WELL? YES D NO M -.
7. STATIC WATERIEVEL Below TOP ofCasmg:�(/ L FT. c
(Use w if Abaft Top ofCe"
g. TOP OF CASING IS 2 --FT.Above Land Surface* C)
7y etesiaa teralo4d srhrbebsr W1 uafees rpaM■
aarLee L aeminawab 15ANCAC 2C A11L
9. YIELD(Wag):_I METHOD OF TBST ff AZ U
10.WATER ZONES(depth).
LOCATION SKETCH
11. DISII*WnON:Type_ FiIH TARS Amount Simw direction and dipmee in miles ham at least
12. CASING. Watt Thtdmas two state Roads W County Roads,hachde&a road
Depth F W Wa Ic
Front G a mbers and common road names.
To 124 j,/
From—To—Ft— Al
Fromm-To Ft in L{wo,! a
13. GROUT: Depth Material Method /}yE,
From_9.._To�FL-GXL HIM
From To Ft
14. SCREEN: Depth Diameter Slot Sin Material U/
From To Ft ie is,
From—TO—Ft—in- in.
15. SAND/GRAVELPACK yja g� NtuY 70
Depth Size Material
From To Ft s
From- To Ft
16. REMARKS:
I DO HEREBY CERTIFYTHAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH ISANCAC 2C,WELL
CONISTRUCIION STANDARDS.AND THAT AC COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
.p
i r ,
SMATUR4 OF PERSON CONS1RUCfiNG THE WELL DATE
Submit the original to the Division of Wager Quality,Groundwater Section,1636 Mail Service Center-Rdelg4 NC
276994636 Phone No.M*733 3Y21,within 30 days. GW-I REV.07/2001

WELL CONSTRUCTION RECORD
North Carolina-Deparhaent of Environment and Natural Resources-Division of Water Quality-Groundwater Section
WELL CONTRACTOR(MWMUAL)NAME (Pr'jU NMI PARTIIF CERTMCAT10N0�_
WELL CONTRACIOR COMPANY NAME_ HIUM G7FII lTuLITNi GD. PnONE 0 f 2$ 324-0a35
SPATE WELL CONSTRUCf10N PP.RMITO ASSOCIATED WQ PERMIT#
fifacpliable) fifa0p)icable)
1. WELL USE(Check Applicable Box):Residential EK Municipal/Public E3 Industrial O Agricultural❑
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other O If Otbef,List Use
2. WELL LOCATION: Topographic/land setting
Nearest Town. (MFITY SPRTMS County 1412((R CRidge dope []Valley OFlat
6697 N7 N TAR-RD_ (d *app apdosbox)
(Shed Name,Nnmben,Caamimipr.subdivision,Let No,4 Cads) Latituddlongidide of well location
3. OWNBR FIY)TF FRAN(I TN ( )
Address "7 N1W TATT,RD, Lathaddlorwtude aaece:DGPSOTopogmphic map
RtrSRII , N 2 ebetkboa)
QN� DEPTH DRILLING
CaywTwm SWe ziipCc& From To FormtioaDeacription
(�$} x17-7777
Arescodo-Pbmnombr
4. DATE DRILLED 05 44-45 a
S. TOTAL DEPTH• 420 °
6. DOES WELL REPLACE EXISTING WELL? YES O NO E r
7. STATIC WATER LEVEL BeIowTopofCNW
(Use-+-ifAbm TepefComing)
S. TOP OF CASING IS_2 FT.Above Land Surface'
`7'eP ereaigurrreM vVrbelew Inds 0 egehre o
vrlr Is rmdeau wttb ISA NCAC 2C.011L
9. YIELD(gpm):_79-METHOD OF TEST E AIR JEST
10.WATER ZONES(depth): LOCATION SKETCH
11. DISINFECTION:Type FEB TARS Amok 71 Show dirasion and distance in miles 8om at least
12. CASING: Wan'lhictoma two State Roads or County Roads.Include the road
Dm� D� or .Weijilg MURW numbers and common coed names.
From 0 To Ft bx' PIC PLASTIC
From To Ft !V
Fro=` To Ft yLA
13. GROUT: Depth Materiel Method
Front_ 0 Tom_Ft (3d 7TT FO RED
From To Ft t
14. SCREEN: Depth Dieme w Slat Size Material 6P
From. To Ft_ia in
From To Ft in. (_. /JO�M Mt(
IS. SANDIGRAVEL PACK.
Depth Sim Material 1M. (cap
Frost To Ft
Frorr__To Ft
16. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 1SA NCAC 2C.WELL
CONSTRUCTION STANDARDS T A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
05-Or05-
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
Submit the origl to the Division of Water Quality,Groundwater Section,1636 Mail Service Center-Rateigh,NC
276WI636 Phone No.[phone],within 30 days. GW-1 REV.07/2001

WELL CONSTRUCTION RECORD 1 r n
North Carolina-Deputment of Euvhonment and NaftM Resources-Division of Water Quality-Groundwater Section
WEMC0NTRACr0R(UfDWM9A14NA= (FAMIL JHW kgKM c8R mcATloNs 2452
WELLcoriTRACr0RC0atrANYNAM3C WNW ML MulRu(I). rnoxs a (828) M4-0035
rrATR wru.coNsTRucrwN PEW&M ASSOCIATED wQ PzRmnw
(if applicable) Gfawlicable)
1. WELL USE(Cbmk applicable Box):Residental0M Monicipal/Public O htdttsh iat❑ Ag icultmat a
MonitmU G Recpvery a Heat Pump Water Injection O OdW o If()that,List Use
2. WELL LOCATION: TopogtaphidLsnd setting
Nearest Town: County ME- ORidge 17Slopa Malley EMI
5555 JCIN RFFP ST. (dock appegniale>m)
(stage Meek NweW&CWW=MtyWJ&vieMUXNaZip 00&) LatitudNlongitudeof wen location
3. 0 MCI UE tdeeoaa+ )
Add XII9 RIII' T. Latitude/lwtgitade som=1]GPSQTopoBtapluc map
(SueetwitauroNe.) (cbeckbox)
M1 -AM. CC 28655 DEPTH DBE LOG
amoe> .Sete rvOD& From To FotmadouDcamiption
Arta coda Phase m obw
4. DATE DRILLED U-.2A-{)5
5. TOTAL DEPTH• 9()5
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO M(
or
7. STATIC WATER LEVEL Below Top ofC=bW. _
(Use"+-if Above Top d'Cri.g) c�
8. TOP OF CASING IS 2 _FT.Above Land Sudke'
wrap oreadnea olmidawnaawtwswhnraraa a 4
warlawee i aoreiaaa wn 0A NCAC2C MIS.
9. YIELD(gpm):__1__METIIOD OF TEST RP ATR MEr ut
10.WATER TONES(depth): LOCATION SKETCH `1
11. DISINFECTION:Type Amotmt Show ditectim and distswe in miles from at kart'
12. CASH. wan Thidmem two state Roads or County Reads include the road
Depth Diamear orweigbM Mneng n»bers ntd txmmon road names.
From_Q_T._1CQ_Ft,-6E!— PVC_ AASTf(' A/
Front To FL
From To Ft ito
13. GROUT, Depth Material Method
Fromm 0 Tom_FL lR 7 Tf' A 112F11
Fmm To Ft 1YlORCTAui6n�
14. SCREEN: Depth Dismdw Slat Sin Mantra[
From__To Ft in. in.
From To Ft.---- in. in. a <
15. SANDIGRAVELPACK: xj 7,
Dmd+ size Material F
From To Ft—
Front—To—Ft
16. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH ISA NCAC 2G WELL
CONSTRUCTION STANDARDS, THAT A COPY OF THIS RD HAS BEEN PROVIDED TO THE WELL OWNER
h . f/c/I IL4/ 08-2M5
S OF PERSON UCM THE WELL DATE
Submit the original to the Dividen of Water Quality,Groundwater Section,1636 Malt Service Center-Raleigh,NC
27699-1636 Plane No.(919)733,3221,within 30 days. OW-1 REV.07/2001

DIM
WELL CONSTRUCTION RECORD
North Carolina-Department of Environment sad Natural Resources-Division of Water Quality-Groundwater Section
wELLCONTEACToA AL)ROM bd4 JHWWW - CERTWICATIONd 2452
WELL coNTRAcrox cowANY NAMX Fif(TdRY I.FI7 IRTI7 TN: (Tl rHONE s tR7F?i �4�YR5
STATE WELL CONSTRUCTION PRPN d A—MATrD WO PIMINTn
(if applicable) ftfspplitable)
1. WELL USE(Check Applicable Box):Resldentia0l MunicipallPublic 0 Industrial 0 Agricultural 0
Moultorutg 0 Recovery 0 Meet Pump Warr hyectien 0 Other 0 If Oates,List Use
2. WELL LOCATION: Tupographic/Land silting
NnrestTown Ctwnty DRidge dope Malley OFIat
]345 MP. (dedcappopiatabat)
(Socet Nwabas,cartmuoaa,,sataivauW4 L4DtNo,Zip Code) LatitudeJlongitade of well location
3. OWNER E12k1 TA[iCTN ( )
Address 1 U9 MT WArI 1S i1RTW- LatinrddlongimdC sooree:� opogMphic map
bmO
MIdC P a NC2 Rauft �5_ D13M n902191M
C War Tessa Sur Zip Cads Front To FormadoaDescription
Atca cads-Fame romber
4. DATE DRHJJW Q ?kQ5
5. TOTAL DEPTH- 3D5
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO xS
7. STATIC WATER LEVU Below TOP OfCSSing: `s _FT- �
(laa"r"ifAbow Top ofCaroa) C
g. TOP OF CASING IS 2 FT.Above Land Surface*
re
•Tap orcaai rar
g rlamad aver bdw road wrb"zeq ea O '•7
aartaate in rnriaaee wM ISA NCAC3CAtIi „
9. YIELD(gpm): 2 METHOD OF TEST SY AIR ME
t0.WATER ZONES(depth):
LOCATION SKETCH
11. DISNffECHON:Type NTR TARS Amount 54 Show direction and distance in®Its flan at least
12. CASING: Wan Thickness two State Roads or County Roads.btcluda the road
D!V" or Weil R Material numbers and common mad manes.
Ftom�T_j -_Ft ' PGC FfAS11C )v
From To Ft
From - To Ft t- VI/
13. GROUT: Depth Material Method
(1 To�2(L_FLf B3Z MRFD
Front To Ft14. SCREEN: Depth Diameter Slat Sift Malarial WFrom To Ft_io. in. lld74fMOA/fFrom To FLim in15. SAND/GRAVELPACK Stan Mrtaiat> �
From To Ft.
From To FL M j /YlElltxWS L
16. REMARKS:
I DO HEREBY CERTIFY THAT THiS WELL WAS CONSTRUCTED IN ACCORDANCE WTM 15A NCAC 2C,WELL
CONSTRUCTION STAND S,ArD THAT A COPY OF TMS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
i c9 �re/ o (l 0&-25-05
MATOREOF PERM CONSTRUCTINGTMWELL DATE
Snbrmt the original to the Divtdon of Water Quanty,Groundwater Swdou,1636 Man servdee Center-Rddgb,NC
27699-16M Phone No.[phone],within 30 days. GW-1 REV.07t2001

_WELL CONSTRUCTION RECORD
North Carolina-Department of Environment and Natural Resources-Division of Water Quality-Groundwater Section
WELL CONTRACTOR(INDIVIDUAL)NAME (Fria' JEER GIAZ E - C=TIFICATIONa 5
wELL CONTRACTOR COMPANY NAME uiaM M ERU l ua m _ PRONE A � 396-59
STATE WELL CONSRRUC1.10N PERNM TED WQ PERMITM
(if applicable) Of sopliaable) 11111111100
1. WELL USE(Check Applicable Box):Reddonu4Q MmiicipaliPubhe❑ Industrial❑ Agricultueal❑
Monitoring D Recovery D Hest Pump Water ht OW=D Other D If Other,List Use
2. WELL LOCATION: Topographic/Land setting
Nearest Town VAi i , _County BUM 'Ridge OSlope OYalley 'Flat
3584 IIIQi PEAK 1AiT -- — (dbeekeppmpriareba4
(StreetN.me,Nambeo,Cantu miry.tAAdM=A,LatNa,rip Code) Latitudo/longitude of well location
3. O [AVID T 11AVICILS (a�eeJmrvemr>ae�a�)
Address Latitudenongit de smace:OGPSOTopographic map
(stratar Ro.t.Na) (dw*bm)
Ai(ffPN� N( �F3t�7 Dam D&HL2U=
Cltyw` sto ZWCO& From To ForwtionDescription
Arta code-Pbme aunbw
4. DATE DRILLED
S. TOTAL DEPTH�5
6. DOES WELL REPLACE EXISTING WELL? YES O NO
7. STATICWATERLEVELEelow Top ofCesing: 1� F1• "`,
(Un N-ifAbova Top of Coins) ..-'
8. TOP OF CASING IS 7 FT.Above Land Surface
`'TaP.feaMstw=hww*vwb@bwimd..r0 , rapbrrs
.+rr ee pm 15
9. YIELD(gpm): METHOD OF TEST ff AIR
10.WATER ZONES(depth):
LOCATION SKETCH
11. DISINFECTION:Type IM Dffi Amount 47 Show direction and distance in miles from at least
12. CASING: Wall Tbickwas two State Roads as Canty Roads.Include the mad
Depth Diameter or Weight R Material numbers and common road names.
Fromt -Q-_TQ-2L .FL 'L M_
PLASIX
From_ To Ft NlfQ
From To Ft
13. GROUT:' Depth20 Ft GUTM VjEL rZD,
From To
From To FL �, /{/C�t PEA/G VauEy
14. SCREEN: Depth Diameta Slot Size MaterW E
From To FL__in in
From To Ft Win. in.
15. SAND/GRAVELPACK:
Depth Sim Material
From To FL S A\ 0 '#VjEjV
From- To Fla
16. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 1SA NCAC 2C,WELL
CONSTRUCTION STANDARDS,ANDPIAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
pMAMLO OF PERSON CONS19UCTWO THE WELL DATE
Submit the original to the Division of Water Quality,Groundwater Section,1636 Mail Service Center-Ra►eigb,NC
27699-1636 Phone No.[phone],within 30 days. GW-1 REV.07/2001

r,
WELL CONSTRUCTION RECORD
North Carolina-Department of Environment and Natuol Resources-Division of Water Quality-Groundwater Section
WELL CONTRACTOR(R WInUAL)NAME (pree0 Imo,PATS CF.ATMCATIoN s 2609
WELL CONTRACTOR COMPANY NAME HT(14W WF1I rRTH HC (D PHONE a fR2F31 32 -11735
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMnW
(if applicable) (if applicablei
1. WELL USE(Check Applicable Box):ResidentisIll Municipal/Pu 11C O lndustrlsl❑ Agricultural O
Monitoring❑ Recovery O Heat Pump Water Injection O Other O If Other,List Use
2. WELL LOCATION. TopographkAmd setting
Nearest Town: M7 ZNM County aHE CMdge OSlope OVaney [Mat
PTNF IRW t XTT (pbedt Mpopriost W4
(sheet NUM Nambuk Canmudty,Subdivision,Lot No.,ZIP Cam) I.atitudcAongitude of well location
3. 0 WNER T RRV Fl—FMfAY ( / )
pad y ?s3<YI i Ai I217. Fl R�Z M Latitudd)ongitude sou=E)GpSOTopogmphic map
�,)NC 28655 iEffii (dasPaR1
noa) TINGTfx;
City of Town Stan zip Code From To Formation Description
Meecode-Phone ember
4. DATE DRILLED 06-03-05
S. TOTAL DEgn. 240 E°
6. DOES WELL REPLACE EXISTING WELL? YES O NO
7. STATIC WATER LEVEL Below Top of Casing 60 FT. a
(Um-+-if Above rap afCaw _
S. TOP OF CASINO IS 2 FT.Above Land Sarfacea w
*Top of cadet ternintei War below land anba fequka a O ^7
sauce`aeavda whh ISA NCAC 2C.011R
9. YIELD(gym): 60 METHOD OF TEST131(AIR=
10.WATER ZONES(depth):
LOCATION SKRTCH
11. DISINFECTION:Typed TnRS Amount 38 Show direction and distance in Hiles from at k ast''-'
12. CASING: Wan Thidmess two state Roads or County Roads.Include the road
Depth t�CWeigbt/Pt �IC members and common road Hamra.
�- u
From 0 T 60 Ft �fllJ �
From Tc Ft
From To FL
13. GROUT: Depth Material Method
From To--21_Ft (3UI Faun
From To Ft �lElti r r
14. SCREEN: Depth Diameter Slot Sin Material
Front_ To Ft_in. in
From To Ft—in. in.
15. SAND/GRAVELPACK:
Depth Size Material
From_ To Ft—
From—To—Ft.
16. REMARKS:
I DO HEREBY CERTIFY THAT THiS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 1SA NCAC 2C,WELL
CONSTRUCTION STANDARDS THAT A COYY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
�, 06-06-05
SIGN
ATURE O ERSON-CONSTRUCTING THE WELL. DATE
Submit the original to the Dlvislon of Water Quality,Groundwater Sudan,1636 Man Service Center-Raleigh,NC
276WI636 Phone No.[phone],within 30 days. OW-1 REV.07/2001

3 CSv CJ
WELL CONSTRUCTION RECORD
North Carolina-Department of Eavn==N t and Natural Resources-Division of We" -Groundwater Section
WELL CONTRACTOR OMWIDUAL)NAME (IN 7G4W TTn'�ViAtG _ CERTIFICATION#-242_
WELL CONTRACTOR COMPAlYY NAME
1ILCM WRL ERULM (D. PRONE # f ) 828'324-W3J
STATE WELL CONSTRUCTION PERMITS TED WQ PERMIT#
(if applicable) Uapplicable)
1. WELL USE(Check Applicable Box):Resid=MW R( MimicipaUPu k O bld UMW O Agricultural O
Monitoring❑ Recovery O Heat Pump Wad bilection O Other O If Other,L U Use
2. WELL LOCATION: Topographicland setting
Nearest Town 2191Y SP M County BUM ORidge OS►Ope []Valley OFlat
6544 QED GUK ER. (aheckWwpuatebox)
(sasxNaawkNmben.CmIZU01 .&AffiVW0V6 Lot Na.Zip Code) LatitaldloogibAcof well location
3. OWNER 1�'TAYLCSZ
Address ( D CI27�C LatitudeAongitude somce:EWSOTopographic map
(Seat ar Raga No.) (ataxic boa)
llNjY SMIMS, nr 2ffil DEPTI1 29iLT.M21M
City wTarn stem zVCoft From To Formation Description
L828� 397-4314
Ara axis-Phone aamber..-14-05 --
4. DATE DRILLED U4
5. TOTAL DBPTII•2
6. DOES WELL REPLACE EXISTING WELL? YES O NO �K —
7. STATIC WATER LEVEL Below Top of Cuing'. 50 FT. C=
(Uw-+- fAbow TxpofC8"
S. TOP OF CASING IS 2 FT.Above Land Surface* o "
*TQP of eedaa twmtaaM aVw bokw lmd saeiaa regaea a �
varMaa`aaoreaaea was ISA NCAC 3C.e11e. —'�-
9. YIELD(Mm): 4 METHOD OF TEST ]3Y A1R=
10.WATER ZONES(depth): i�±f ATION SItR TCH
Il. DISINFECfiON:Type_ [ '1 Amomd 41 Show&action and ifistsia in miles fi0m at least
12. CASING: Wall Thieb+ two Side Roads or County Ronda.biclude to road
Depth Diameter or WeigMJFt Material numbers and common road names.
FroatIl__To .a FL 'mil' Ar. - pr AqTr.
From,_ To FL
From To Ft.
13. GROUT: Depth Material Method
From.._ 0 To 20 FL_% _ -_ �y�
From To Ft. - V r /�`/J E;�T
14. SCREEN: Depth Diameter Slur Size Mamiei CA/ \, Q C
From To Ft.�lt m � ,)
From Tc Ft,_.�n• in. MOM 4)[L V_
15. SAND/GRAVELPACY
Depth Size Material U/B .'�
Front_ - To Ft \
panty. To Ft G-v<J Cd%,i)R.'� n
- fa� 'r
16. REMARKS:
I DO HEREBY CERTIFY THAT70S WELL WAS CONSTRUCTED IN ACCORDANCE WTT11 ISA NCAC 2C.WELL
CONSTRUCTION STAND AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WEMOWNER
�t A,4 d,/1, , / ( 04-21-05
SI ATURE OF P UCHNG THE WELL DATE
Submit the original to the Division of Water Quality,Groundwater Section,106 Mai!Service Center-Raleigh,NC
2709-1636 Phone No.(919)7333221,within 30 days. OW-1 REV.07/2001

W'
WELL CONSTRUCTION RECORD
North Carolina-Department ofBnvircumem and Natural Resources-Division of Water Quality-Groundwater Section
WELLCON71RACPOR(INDWIDDA411AME ( W).. J113tYWkT(M CERTIF1cATIONa2452
WELL CONTRACTOR COMPANY NAME, H(QU;Y 1011. ERT_T_I�: M. PRONE • d?7R) 324-TY135
STATE WELL CONSTRUCTION PERMITY ASS0C1ATED WQ PERM1 1T
(if applicable) (if applicable)
1. WELL USE(Check Applicable Box}Ra ddentialAX MimicipalMublic❑ industrial❑ Agricultural O
Monitoring❑ Recovery O Beat Pump Water hgection O Otber O If Other,List Use
2. WELL LOCATION: Topogmpluc/Land setting
Nearest Town: MIYAIRN County 14HKF ORidge 13Slope OVallay OFlat
5931 IS M 614 (d1wk ip WIsre boa)
(Street Name,Numwa,Caewuoay.sab&vhI ,LutNo.tiptxae) Laiitudalloggitudeof well location
3. OWNER: [+711IPRD PATRN (�)
Address 55.31 1N RE 64 Iatitudellongitade souice:OGPSOTopogmphic map
H&M o28655 (chWDRI
gFps'j; DRILLING LOG
City w Toes Stalo zip Code From To Formation Description
( 584-1072
Area code-Ptme m®ber
4. DATE DRILLED 04 26-05
5. TOTAL DEPTH, 2Z a
6. DOES WELL REPLACE EXISTING WELL? YES O NO EK c
7. STATIC WATER LEVEL Below Top of Casing: ) FT.
(User-+-ifAbeve Top ofCatku) C:)
S. TOP OF CASING IS 2 FT.Above Land Surface'
-Tap of casing terminated*Vw below lud swim r"uI a a
varAm to acoerdaaee wah ISANCAC 2C.611R -
9. YIELD(gpat): 15 METHOD OF TEST IMAM AIlt"TEST
10.WATER ZONES(depth):
LOCATION SKETCH
11. DISINFECTION:Type UB Tt)SS Amount 45 Show direction and distimoe in miles from at least
12. CASING: Wall 7bicimen two State Roads or Conroy Roada.Include the road
Depht D. or Weigla!!gt Material numbers and common mad names.
From 0 To 106 Ft 14 FX PIASITC
From To Ft N
From_To Ft,- S yfi
13. GROUT: material Method
From 0 Depth
MLF 'N`
From To Ft._,
14. SCREEN: Depth Dluaeter Slot Size Material mwy ,6�4 /C
From To Fk--m. m. W /jwWp� ,rJdG
From To Ft in. in.
15. SAND(GRAVELPACK:
Depth size Material y. p
From To Ft �` s
From_To Ft
16. REMARKS:
1 DO HEREBY CERTIFY THAT THIS WELL WAS CONSTR.UCIED IN ACCORDANCE WITH 15A NCAC 2C,WELL
CONSTRUCTION STANDARDS,AND MT A COPY OF THIS YmmHAS BEEN PROVIDED TO THE WELL OWNER
(A-28.05
SIGN TUREOFPERSON NC0CTING THE WELL DATE
Submit the original to the Division of Water Quality,Groundwater Section,1636 Mail Service Center-Raleigh,NC
27699-1636 Phoer No.[phone],within 30 days. GW-1 REV.07fMI

sY F C n T ita
WELL CONSTRUCTION RECORD
North Carolina-Department of F.nvkow=t and Natural Resourew-Division of Water Quality-Groundwater Section
WELL CONTRACTOR MO VIDUAL)NAME (prtat) 1M. PAPZIE CERTIFICATION# 2§92
WELL CONTRACTOR COMPANY NAME Nl(11(IN WWII. ERT1I IM QQ. PNOr7E # f ) B2f3-324=Qa35
STATE WELL CONSTRUCTION PERMftY ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
aa�w�
1. WELL USE(Check Applicable Box):Residential HK MunieipakPublic 17 Industrial❑ Agricultural❑
Monitoring O Recovery 13 Heat Pump Water lajoctim O Other O If Other,List Use
2. WELL LOCATION: Topogmphic/Land getting
Nearest Town: Q2NFT I V SPRM_County i ORidge OSlope Malley OFlat
9Y45 PFRT PMTN M- (deck gptoprime box)
(Sweet Name,Numbue,Community,Subdrvw^Lot No,zip Cale) Latituddlongitude of well location
3. Ournllrx 13T17y IdCEIA&N ( )
Address V49 PFRSTMMN id). LataudrAongitude source:QGPSOTopographic map
�1NMaSMM, NC 28612 Room No.) (deckbunI
I2� DRILLING LOG
CdywTmu Stet tip Cale From To Formation Description
(89A 1 07-Sal Y )
code-Phow dumber r'
4. DATE DRJL ED 05-02-05
5. TOTAL DEPTH 345
6. DOES WELL REPLACEEXIST)NG WELL? YES O NO 17 FR
7. STATIC WATER LEVEL Below Top of Casing: I FT. r�
(Un-+-if Above Top of Cuing)
S. TOP OF CASING IS 2 FT.Above Land Surface•
`Top of wing twodmod jWw belsa Nod surface requbw a n -
varisnmts suord""Walk im NCAC 2C.0110.
9. YIELD(gpm):_ 2 METHOD OF TESTj)LAIR 7FSf =.-+
10.WATER ZONES(depth):
LOCATION SKETCH
11. DL41N FECITON:Type H TNiS Amount G4 Show direction and distseax in miles from at least
12. CASING: Wail Thictates two State Roads or County Roads.Include the road
Depth orweightl;L Material numbers and common road names.
From 0 To �+ Ft. M PLASTIC
From_To Ft /Zl�RdgN �� l �U
From_To Ft —
13. GROUT: Depth Material Matbod
From_0._T6-2 _FL(Rf7lr 1"EM WEG6
From To FL— Ai �8
14. SCREEN: Depth Diameter Slot Size Material W
From To Ft---m. in. a
From—To—Ft—in. in.
15. SAND(GRAVEL PACK I"'b
Depth Size Material
From__.._To Ft. s
From__To Ft
16. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACOORDANCE WITH 15ANCAC 2C,WELL
CONSTRUCTION STAN�OARDS,AND THAT A COPY OF THIS RDHASBEENPROVIDEDTOTHEWELLOWNER
05-05-05
SIGNATURE OF PERSON COkarRUCIING 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.0712001

WELL CONSTRUCTION RECORD
North Carolina-Department of Environment and Natural Resomoes-Division of Water Quality-Groundwater Section
WELL CONTRACTOR(INDIVIDUAL)NAME (prino NMT PARf71F. CF.RT6ICAT10N#�_
WELL CONTRACTOR COMPANY NAME ii(QM WELL MU12C m. PHONE # (� 324-00.35
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable) (if 110PH able)
1. WELL USE(Check Applicable Box):Residential EK MuoicipaliPublic 0 Industrial 17 Agricultural❑
Munitoriog 0 Recovery 0 Heat Pump Water Injection Ll Other 0 If Other,List Use
2. WELL LOCATION: T%mgraphic/Land setting
Nearest Town: MEIY SPRTnYfi County HIlf2T Mdge Mope Malley OFlat
6697 NMW T ATT iln (vhwk qVmpdm box)
OttedNam%NumbcfkCamounhyS6dinutut,Let No.,T,Pcbae) Latitmdeilongitudeof well location
3. OAR• �7F TN (depsee/aanalaeetadr)
Address Efi97 WFW T ATi,T)_ Latituddtongitude somce:MPSEITopographic map
(Stmet a Roma Na.)
ebWkbM0
(T1�&ILY ,11HIT , NO 28612 )ZF,pTEI DRIL t* LOU
City atTma stm zipCak From To Formation Description
($2$} '2Q7_7777
Ara cods-Phan mmr6er
4. DATE DRILLED 05-04-05
5. TOTAL DEPTH: 420
6. DOES WELL REPLACE EXISTING Will YES O NO EK
7. STATIC WATER LEVEL Below TOP OfCesiag f?() FT.
(Un-F-it Abovs Top of fYeivS)
g. TOP OF CASING IS 2 FT.Above Land Smfm *
+Tep efcalogarawted atler ba:aw IaN aarAea rga4a a �*
.,rfa.Qb.a�.�.raktsANCAcsc.atts. ='
9. YIELD(gpm): 79 METHOD OF TEST SY Aj 3EZ
10.WATER ZONES(depth): ^
LOCATION SKETCH
It. DISINFECTION:Type HTN TARS Amount 71 Show direction
d distance in miles from at least a
12. CASING: Wan Thiekaam two State Roads or County Ronda.Include the road
D,,h gI00 AA Material numbers and common road names.
From 0 To Ft
From To FL H y 41p
Fromt__To Ft
13. GROUT: Depth Material Method
From 0 T0-- 90 _Ft-GUn Fam
From Tc Ft 6 cv
14. SCREEN: Depth I)iameMi Slot Size Material !�
From To Ft in is
From To Ft._in. in. N� rtiuuf�
15. SAND/GRAVEL PACK
Depth Size Material LINL (LP
From To Ft s
F"w__To Ft
16. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C,WELL
CONSTRUcnO tN STANDARDS T A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
f 05-05-- —
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
Submit the origi /to the Division of Water Quality,Groundwater Section,1636 Mail Service Center-Raleigh,NC
27699-1636 Plane No.[phone],within 30 days. OW-1 REV.07/2001

`CRETZ WELL & PUMP FAX NO. : 7044621322 Aug. 29 2005 07:39PM P1
WELL CON&WC�70 RECORD
North Carolina.Deparhceat of Envir0=Cnt and Natural Reaomces-Division of Water Quality-Clroundwarm Section
wttLLcoxmcrolt miD1vmuAL)NAMC &w ASHLEY T. MORETZ cal aicATmo 2586
wmzcoNTRACIORCompANYNAM6 MORETZ WELL DRILLING PHONE g(7041462-1322
.SSATB WUA,COMMOC110N PBRaA7:a OCIAT=WQ PERM1Te
if lipbk rP ikable
1. WELL USE(Check Applicable Ens):Residential MnaiaipaVPublie 0 Industrial 0 Agricultural p
Monitoring 0 Recovery 0 Haar Pump Water Lgection 0 Other 0 if Other,List Use
2 WELL L4DCATION: J �d setting
IFUdge dDSlopeig*gm Mampdm lley [Plat
MWHaw.NumboMC uatry.sabdivttfee Ex No.ZipCo&) (� �1
3. o ,t ism ovs,%�/ i2v�!�✓✓ —& 37lY171�/
Address ` e,r.ac �r Latitudallonsioxic source:at (ah"k 0T og��p p
Ib
IjW
�at llewa To , For ietion prim
Ataaoada Pbom weber ~
4. DATEDRII.i 7 . 10 /
s. TOTAL D aL
6. DOSS WELL RBPLACS EXISTING WELL? YES Q NO
7. STATIC WATER L13VEL Below Top ofCasing:.,,`Sj2
8. TOP OF CASING 13--L—Fr.Above Land Sor&ca• '
*'lop efnrka lrmlow d SVW allow Lad swbee requim a
Par1000 la semrdaWs I"NCAC 2C Alit. •-1 -
9. YIELD(gpm): METHOD OF TEST
10,WATER ZONES(depth)- UGD,
LS2 An6 s SL }T
11. DISINFECTION:Type Amount go Z Show daeetion and&sta ecs is miles from at least
It CASING: Wall7hioimm two State Roads or Onoty Roads.Include the road
1_ TDepthwj2 DiFmpyr *rW' numbers and common/load names
pro
FroaL _.!_To FAT Ti Trn je 10,ei9i�Wbe
Froimt-.m—Ttt Ft
13. GR�Ol1T.�• ,/� =��
F �� Matmial Method
To Ft
14, SCREEN: Dbuider Slot Svc Material
T in.
To
IS, VEL PACIG
Sias Material
T
F To �iz
16. REMARKS:
i DO HERESY CERTWV THAT TITS WELL WAS CON=UMD IN ACCORDANCE WrrH ISA NCAC 2C,WgL
C0NFMUCn0N STANDARDS.AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO T"ll WELL OWNER
SI. lA1SJpj PEAS CONSTRUCnNO W� DATIi
Somali;the original to the Division of Water Quality,Groundwater Section,16%Mall Svvlr4 Center-Ratotah,NC
27699.16M thew No.(919)7313221,within 30 days. OW-1 REV.07/2001

MORETZ WELL & PUMP FAX NO. : 7044621322 Aug. 29 2005 07:45PM P10
3 c'
WELL CONSTRUCTION RECORD_
North Carolina-Depatpnent of Ewhmmi and Natural Resources-Division of Water Quality-Groundwater Seaiou
WZLLCONTRACT0ROMDMDUAL)NAM& rmian ASHLEY T. MORETZ CCRTIFICAT10Ns-21jj
wgmcoNTRAcroscoMPANYNAW MORETZ WELL DRILLING mon s t704A62-1322
STATE WILL CONatltucTION►Lttatl'fN 3'Bu WQ MRMM
111 (if aeslia lol rfaaoliub )
L WELL USE(Chmk Applicable Box):Residcntial VMunicipaUPublic 0 Induatria)Q Agticulauat 0
Mopitoring 0 Recovery 0 Had Pump Water lojoct m O Other El If Other.List use
2. WELL LOCATION T d
satftS
Neared 0 raliarl�p Coymy 46L rho— CM* lope 13VaU FW
(dim* 2 rapdueai
(saseeName,NamMn,Cd %w/ 27pCada)ot ROelO No.) ' f Wall
3. o i �IV 1oa ', $$g`✓
Address ( e )
aweongtude ae opogtaphic map
�,d1G �sbsc- «>4
DMnU nRnr.nlG,nr:
city; �° Code ____ F ^To © r Fo oa ttliptbn
Atall�oodppaega aWn61r
4. DATE DRILLED - �D'.. OD
S. TOTAL DBPTE-
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO h/ ------
7. STATIC WATER LEVEL Below Top of Casing �Q pl
(uw•wSAboverapof0miokl
S. TOP OF CASINO IS_�FT.Above,Land Surface« -
�ropetwtrs�.e>a�aro..a�.amrw�w... w -
rMtaaa bxcmfieawaatSANCAC2c.altL p /- O ^
9. YD3LD(ipm):'_ 3 M13THOD OF TEST /-A1Y
10.WATER ZONES(depth): 170' ur
11. DISINFECTION:Type Ani Show ft"m and distsma in miles 6om at least
11 CASINO: WWII s7lddme" two State Roads or Conty u Roads Ihohde the ro/ad /A o. � numbers and commoj road �` / ,W/�,7]ka e
From- -__To le- tL: C
From—To Ft
13. GROUT
10—
Froth,„To FL ^
14. SCREEN: Diameter Sign yI
atimial
F o
F T •n. ia.
is. GRAVELY
Sim axial
Frm To �:7 Id. REMARKS:
1 DO REMY CERTIFY THAT THIS WELL WAS CONtiIRL)MM IN ACCORDANCE WM 1SA NCAC 2C WELL
CONSTRUCTION STANDARDS.AND Tl T A COPY OF THIS RECORD HAS$ESN Pi To THE L WkL' L OWNER
O
ONA PPY3ES01ICONSIRUCIINOTHEWW'L DATE
Sunni the orh ftsl to the Dh ision of Water Qeanty,Groundwater Seedoti,1636 Man Serwlea cemn•-Ratdta.Nc
2760-104 Phone NO.019)7333221,wkbla 30 days
OW-1 REV.07noo1

WILL
QNS1RUCHQN RECORD
North Ceram-Deparko(ofBnvironolog and Natural RwDur ea-DMilon of Water
WELL CONTRACTOR(aN IMVAL)NAME tDr4O t�'RT nn�r� (2aBhty-O[oVodwatp'SeetieR
WZMCONTRACTORCOt&ANYNAM& CaRMCAT1ON UEM—
STATZ WALL C0NrMVCn0N pEna" m PBONN a a)�9
Tao WQ PSEMM
d Ecatbk
1. WELL USE(Cheot Applicable Bout Reddomfiti EX Moultariog O Recovery O Heat Pump Water hVocfm Q3�Otheer a IfO&W.Lin( eu1Wni 13
2. WELL LOCATION:
Nwreet Town: MWAMM
counlyr )� Midge CiS���OVall g
Nemtear,Ceoemhx S"V6ioe,i MQ6 Za Cade) (shed VF8pd.p0 too
3. OWNER CI.ZE E. b kn 1d 4rFd i� �e of wen location
Addreaa 1f 9 .
Ld �)u Q pox'phic1NC2& 55
CkYWTMM Soft
ZIP cub DME
From To F
4. TOTAL
ps ��
S. TOTAL DEPTH: 3J�—""' _
6. DOES WELL REPLACE '---
7. STATIC WATER LRVEL TO Caaiog `? �O NOW -- o
& TOP OFCAMMIS 2 ry'e0''*RAeo.eropefC jW - —
'rep erer.eee.t..eeaavrrar.W Above. Land Sur&.*
�.rieee lo.eee.dmm wtl l3A +.v.ha•
9. Y1ELD(gpm); NCAcaC.alBt
10.WATER ZONES(d SOD OF TFS7gt o
1I. DISDUMCnON: Flru renc LQCATTON ci[pTnv
12 CASINO: Depth 44mm Sh dsxti at mdd anon m miW from at kart
gToDmonkrPvt PMamd LASITC 'and delude the mad
�_T=_
13. OROFrouL- -Tom N
i
Fes_Tom_ mod ..\t
14. S To Ft—
From T 1> Sbt Sim
Mmmild ip11 B
From_.To Ft--_"1 L
15. SANDIORAVEL PACK
F,�T°epth _�_ Materiel
16. REMARU.
IDOHEREBYCERTWYTBATTIBS WEM WAS
CONSIRUCnON STANDARDS,AND THAT COPoyloF M A��ANCB W1TH 15A NCAC 2C,WEtl,RECORD HAS BEEN PROVIDED TO TH8 WELL pWNER
SKafATURBOFP U O 1 05-05
Submit the orlow to the 11:11113 WELL DATE
2709-1636 Phone Na(919)733322 wi Water
wkWR 30 days.
Groundwater section,16M y"B"d-Ceokr-Rates NC
OW-I REV.07M]

North Carolina-Department of Environment and Natural Resources-Division of Water Quality-Groundwater Section
u 5
_ 1636 Mail Service Center-Raleigh, N.C. 27699-1636-Phone[phone]
WELL CONSTRUCTION RECORD WELL CONTRACTOR: ewey V"Ingi-t'V`V0 ,^1.!r-np Co. Irt.;
WELL CONTRACTOR CERTIFICATION#: 3iS
STATE WELL CONSTRUCTION PERMIT#: Steve Fnee
1. WELL USE(Check Applicable Box): Residential E2 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: r1tir'.qen0pc County: wit TREE
"a
oa ame andumbers,Corr!rrmmty,or Subdivision antl Lot No.l
DRILLING LOG DEPTH
3. OWNER !-V-)gr1Y GA01 glNin From To Formation Description
Address 9iidd (;L,RRIcR Aw. 0 "� mil RT
�$Freet or i�oute`N.
P.iF��rLhAi t p!4 r�1: 77 7F 1r(1 (=f:�4tyi l"�
City or Tow State dip oo`� 'e
5n 1711 21RAN1117
4. DATE DRILLED in r2nr:, +51 a^g r 4'Afdl'r
5. TOTAL DEPTH �x _ 178 •7P. y`11AP77
6. CUTTINGS COLLECTED YES ❑ NO El _ I"-p 208 GRANITE
7. DOES WELL REPLACE EXISTING WELL? YES ❑ NO FT-1 4
8. STATIC WATER LEVEL Below Top of Casing: 2CI 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.0118
10. YIELD (gpm): 30 'METHOD OF TEST
11. WATER ZONES (depth): F 71,11pFmJ7F:47y ,
n t;n qpm n n'lgpre
12. CHLORINATION: Type =i7!-1 Amount 7.Q _ If additional space is needed use back of Sdrm
13. CASING: Wall Thickness LOCATION SKETCH
Depth Diameter or Weight/Ft. Material (Show direction and distance from at least two State J
From n To � 440 =Fa Ft.'+ ct%'C �y
— Roads,or other map reference points)
From To Ft.
From To Ft. 0
14. GROUT: U
Depth Material Method /
From 2 OF-akAy F104 To --�._Ft. r_.,r,,F+ 1
From To Ft.
15. SCREEN:
xr'(e,r ilk
Diameter Slot Size Material fl
From To Ft. in. in. t\
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: c;'a,_� /cSplly tt!
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C,WELL
CONSTRUCTION STANDARDS,AND THAT A CotY 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.

"h a ]�
RESIDENTIAL WELL CONSTRUCTION RECORD
1q� r
North Carolina Department of Environment and Natural Resources-Division of Water Quality
WELL CONTRACTOR CERTIFICATION# e,2J3/
1.WELL CONTRACTOR: I. DISINFECTION:Type t/- rH Amount
I
✓L/I L' 2 LL S 5 e l g. WATER ZONES(depth):
Well Contractor(Individual)Name From r/D , To -Z;26 From To
Ew5se11 a e- " :7 rr // )I 1 h' e From To From To
Well Contractor Company Name From To From To
I
STREET ADDRESS jV_ / � pU / A Z/ 6. CASING: Thickness/
Depth Diameter Weight Material
✓/D f S` [/Y /�e N 5 5 / Fromm To_?_�_Ft.
City or Town State Zip Code From To Ft.
-3 f` R 9 From To Ft.
Area code- Phone number
2.WELL INFORMATION:
7. GROUT: Depth Material Method
SITE WELL
Ft.
E WELL ID#(if applicable) From To Ft.
STATE WELL PERMIT#(if applicable) From To Ft.
DWQ or OTHER PERMIT#(if applicable) 8. SCREEN: Depth Diameter Slat Size Material
WELL USE(Check Applicable Box): Residential Water Supply LTA From To Ft.—In. _ in.
From To Ft._im _ in.
DATE DRILLED From To Ft—in. _ in.
TIME COMPLETED I/ AM Br PM
9. SAND/GRAVEL PACK:
3.WELL LOCATION: Depth Size Material
0 From To Ft.
CITY: e_p,f'� ,.,," COUNTY liLr Fran To Ft.
L..�i,/vt ipy✓ ///,T • ,LKL y'f /4� From To Ft.
m(Street Name.Numbers,Comunity.Subdivision,lot No.,Parcel,Zip Code)
�T�OOPOGRAPHIC/LAND SETTING' 10.DRILLING LOG
TJalope pValley ❑Flat ❑Ridge ❑Other From To Formation Description
(check appropriate box) '
LATITUDE 3 D May be in degees, 0 _c j� , fk.
—/✓ s� 'u'�' U 6 minutes,seconds orS ---/
LONGITUDE_LL) ` .�9. 1p�.� in a decimal format
Latitude/longitude source: e/iGPS ❑Topographicmap
Mcatlon of we#must be shown on a USGS topo map and - C7
attached to this form if not using GPS)
4.WELL OWNER IRA
OWNER'S NAME--5/?O,)/' Q5./Jj
STREET ADDRESS /376
tr
lQ k-B 3� YI Z
City a Town State Zip Code
O
Area code- Phone number
11. REMARKS:
5.WELL DETAILS: ,a1
a. TOTAL DEPTH: o(c2S
b. DOES WELL REPLACE EXISTING WELL? YES❑ NO 2r-
of Casing: I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH
c. WATER LEVEL Below Top g 76 FT. 15A NCAC2C WELL CONSTRUCTION STANDARDS.AND THAT A COPY OF THIS
(Use"+•if Above Top of Casing) RECORD HAS BEEN PROVIDED TO THE WELL OWNER.
d. TOP OF CASING IS / /y FT.Above Land Surface` 9 �QS*Top of casing terminated aVor below land surface may require SIGNATUR OF CERTIFIED WELL CONTRACTOR DATE a variance in accordance with 15A NCAC 2C.0118.
e. YIELD(gpm): _METHOD OF TEST LdGv �SSe-(�
PRINTEb NAME OF PERSON CONSTRUCTING THE WELL
Submit the original to the Division of Water Quality within 30 days. Attn: Information Mgt.,
1617 Mail Service Center—Raleigh,NC 27699.1617 Phone No.[phone] ext 568. Form OW-la
Rev.7105

WELL CONSTRUCTION RECORD
North Carolina-Department of Environment and Natural Resources-Division of Water Quality-Groundwater Secti��oo�n��S---
WELL CONTRACTOR(INDIVIDUAL)NAME (print) +/ '� CERTIFICATION#�Q
WELL CONTRACTOR COMPANY NAME �tJ` iCrL P�'C @ 'i c,L•, �1-.,_PHONE # L ) 72SL 9S�8
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(ifa ticable) (if applicable)
I. WELL USE(Check Applicable Box): Residential[sY Municipal/Public ❑ Industrial❑ Agricultural❑
Monitoring❑ Recovery ❑ Heat Pump Water Injection❑ Other❑ If Other,List Use
2. WELL LOCATION: /� Topographic/Land.setting
Nearest Town: U��rt kt 71e Count_ Cam'4/ r-G ❑Ridge ❑Slope IffValley ❑Flat
&Jr J/6 V 11J: M 41U4 )ZZ I (check appropriate box)
(Street Name,Numbers,Community,Subdivision,tat No.,Zip Code) Latitudellongitude of well location
3. OWNER: (/ ' �iC���/�$Q/�1
Address p 0A1 de source(degreesha:utes/seconds)
---�.9 �/ (/ `� Latitude longitude source:❑GPS❑Topographic map
(Street or Route No.) / ((check box)
v`v/dt(I lLIS , '99�r DEPTH DRILLING LOG
City or Town state Zip Code From To ForrnationDescription
(4 2
Area code-Phone number
4. DATE DRILLED /0'"Z� oS
5. TOTAL DEPTH: d.2S-
6. DOES WELL REPLACE EXISTING WELL? YES❑ NO CY
7. STATIC WATER LEVEL Below Top of Casing:—3L—FT.
(Use"+"if Above Top of Casing) �--!
8. TOP OF CASING IS FT.Above Land Surface• 4/n 1 7 2
Top of casing terminated at/or below land surface requires a
variance in accordance with 15A NCAC 2C.0118.
9. YIELD(gpm):_P�5"' METHOD OF�EST /O/�
10. WATER ZONES(depth):_$3�Y.� dO
/aoid Z20 - LOCATION SKETCH
11. DISINFECTION:Type C A�y ,:ti-P Amount $ 6Z- Show direction and distance in miles from at least
12. CASING: Wall Thickness two State Roads or County Roads.Include the road • r
Depth Diameter or Weight/Ft. Material numbers and common road names.
From To Ft.
From_ To Ft.
From­5 To Ft.
13. GROUT: Depth aten ethod �,C
From To Ft. k�76f�
From___Q_Tom Ft
14. SCREEN: Depth Diameter Stot Size Material 1� r_
From To Ft. in. in.
From To Ft. in. in.
15. SAND/GRAVEL PACK: W
Depth Size Material
From To F[. a�'t
From To Ft.
16. REMARKS: e
1 DO HEREBY CERTIFY AT THIS WELL WAS CONSTRUCTED 1N ACCORDANCE WITH 15A NCAC 2C,WELL
CONSTRUCTION ST ARDS,AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
GNATU F PERSON CONSTRUCTING THE WELL DATE
Submit the original to the Division of Water Quality,Groundwater Section,1636 Mail Service Center-Raleigh,NC
27699-1636 Phone No.[phone],within 30 days. GW-t REV.07/2001

Nori!` !:arnlina Department of Environment and Natural Resources-Division of Water Quality-Groundwater Section r
1936 Mau Service Center.Ralelgh,N.C.27699-1636-Phone[phone] — -
WELL CONSTRUCTION RECORD WELL CONTRACTOR: L ��^
WELL CONTRACTOR CERTIFICATION # : 3 C'11 4^
STATE WELL CONSTRUCTION PERMIT #
USE (Check Applicable Box). Residential L�Jr�-�- Municipal ❑ Industrial❑ Agricultural ❑ Mon tr,,oc i.^1
Pecovery ❑ Heat Pump Water Injection ❑ Other If Other, List Use
-)CATION Show sketch of the location belowi �"
^s! invio. ryl c t A r IS A-D� Cou my 13�^ r k e-
�3S3S �lJcvrlS Ut:R12d. lnrllk! �niIivl) 1C o? $fi /:L
-end vamc rand Numhers Community. or Subdivision and Lot 4c, r DRILLING LOG DEPTH
OWNER 1 L1G:-Nn S lij f w 12 N From To Formation Descrona-
Andress N 124 R7 I k v� I It l�cJ
. lSreel Or HOU
te NO ,
Ki �O
't kv nr Town State Zip Code
n IIATF DRILLED /! -/0 .-e
^'AI DEPTH
-TINGS COLLECTED YES Q NOF�gr
=)t'IFS WELL REPLACE EXISTING WELL? YES NQT�T _
': WATER LEVEL Below Top of Casing: L, 3 'FT .
(Use" ' if above Top of Casing)
' „ASING IS FT. Above Land Surface-
_, ;asmg terminated at/or below land surface requires a variance in accor-
-lan w-th 15A NCAC 2C.0118
iGPM) I GIs METHOD OF TEST -
. , Q 7ONES (depth)
- GI'IATION TVpe Amount If additional spaceis needed use hark or form
Walt Thickness
Depth r Diameter or-Weight/Ft Material
to ?CG' t f• r ' 7.G 11LNt,t LOCATION SKETCH
„n To pt (Show direction and distance from at least two :ata
to ct Roads, or other map reference points)
T
Depth Material Method
To Ft
• To Ft CD -
Ic 'MCP:=Fly n
Depth Diameter Slot.Size Material nJ
O
c N in n
O
To Ft in. in can -
To Ft in in.
AN`LGRAVEL PACK: --
Depth Size Material
T, Ft
To Ft
PFMARKS
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 OWNFF.
c'OR OFFICE USE ONLY _'f•e � !�, /� ,,,� �� j<r ._ ; r j"—
Quad No. SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
Serial No Submit original to Division of Water Quality.Groundwater Section within 30 days
GW-1 REV 1 'rIo

4ye �SfAl�v n y/L1 '/�I
' r: - - - RESIDENTIAL WELL CONSTRUCTION RECORD
' North Carotin Department of EnvMmmeat and Natural Resources-Division of Water Quality
WELL CONTRACTOR CERTIFICATION#
1-WELL CONTRACTOR: f(�� f. DISINFECTION:Typo Cnn ra' Amount
Qom'P S 1� QS 9. WATER ZONES(depth):
W1enA Contractor(IndrvMuan Nave /� _
D i LprY•l Fran To From To
<.Well Contractor Cornpany Name 0-'— From To
nn c Fran To From To
STREET ADDRESS BCJ'I 71 jar-, , 6. CASING:
/� / rat y
�Cityarrwm brine C9 From (/ D� _Ft. D� �/;�t
Tip Code From To FL
( 704> 53�(-5515 Fmn To Ft. —
Ama code- Phone number
3.WELL INFORMATION: 7. ;GROUT: Depth Lpterw Method
WELL ID#(Xapprlcabk) Z To Z �6 ZFk _f'tc4
From To Ft
STATE WELL PERNOT#(rapparabk) From To Ft
DWQ aOTHER PERMIT#fd applicable)
S. SCREEN: Depth Dwmeta Slot Sae Malerd
WELL USE(Check Applicable Box): Residential Weser Supply❑ From To FL,_,_in —in.
DATE DRILLED_ L Frarll TO Ft.--m _In.
—TIME COMPLETED /_ a.'NS AM PM Lys From To Ft__M. _in.
3.WELL LOCATION: I1 S. SAND/GRAVEL PACK:
CITY' l��,le 14 Y'a. COUNTY 13U I" From Depth
To FL size Maww
U�y � From To FL
(Street Name.Numbers,Comm From 1 FL
d1:Subd.ka Lot No..Pw.L 2rp Code)
TOPOGRAPHIC/LANDS NG:
13Slope oVatley E3Rat Wge 00aw 10.DRILLING LOG
(check appraise box) m From+ To orntron Description
LATITUDE 3 !nmutmel 1'
Pat
LONGITUDE inadavmlfommt L(b — 7G
Latitude/longitude Solace: ❑GPS OTopographic map
fknealmn of we#must be shown on a USGS topo map and
attached to flue form roof using GPS) _
,L WELL OWNER
OWNER'S NAME - :�
�C.mert3n + Lt`u�I�c.. t-risp _
STREET ADDRESS 111n L\-t
Cnty a Town ffie � _Zip Code
( t_
Area code. Phase number
5.WELL DETAILS: / 11. REMARKS:
a. TOTAL DEPTH: /6
b- DOES WELL REPLACE EXISTING WELL?�7YES❑ NO MI
c WATER LEVEL Bdmv Top of CmhV.. 6 (J FT I DO HERESY CEmFY7HAT7m5 WELL WAS CONSTRUCTED N ACCORDANCE WmI
(Use'+'6AhomT OTC IS•NCAC ZC.BELLCa15mO TnON STANDARDS.AND7HATACOPYOFlhaS OP �In9) RECORD f1AS BEEN PROVIDE0707NEWELL OWNER.
d. TOP OF CASING IS�_FT Above Land Surf,
- •Top of ca$mg to n"WW aVa belay land surface may require —//�,rn�I✓/ y1+j®'QJ it
-- '�QG'
a variance in accordance with 15A NCAC 2C.01 11118. / SI NATURE OF CERTIFIED WELL CONTRACTOR DATE J
e. YIELD(9PmT�_,METHOD OF TEST t (,v z a e `7 e
PRINTED NAME OF PERSON UUNSTRUCrNG THE WELL
Submit the original to the Division of Water Quality within 30 days. Attn:Information Mgt,1617 Mail Service Center—Raleigh,NC 27699-1617 Phone No.[phone] ext s66. Form GW-1a
Rev.7A5

WELL CONSTRUCTION RECORD C
North Carolina `
ofEnvaorrmmt and N �� of Water
��� Quality-GrotmdwigrO s ;
WELL CONTRAC2'Olt(EtD1YIDOAL)NAME •N/% -<:t,Y l �S`t�ti� ..
CLYTIBICA7'mN#-�3* - ;
WV.L CONTRALTO@ COaII ANY NAM* 'te , a +✓ t N rHONE a 1l � j
STATE WELL ComrmCTIoN PER11IIT/ •�OCTATEp WQ pEgDQ•ly
fifarrelieable) ofapoliable)
I. WELL.USE(Cheek Applicable Box):Residential WMooicipal/Public 0 Indtstrial p
AJRrculttaat❑
Momtormg O Recovety ❑ Heat Pump Water hVeetten❑ Other o If other,List Use
2. WELL LOCATION:
Nearest Town: ' ' i- [m ✓ cow_ tAr k-� T�g"sPhidLand setting
0' tidge OSh1Pe Malley Mat
(Stmet Nauk NUMbcm C=m=ty,Subdivisioo.`Iot No.,Zip Code) (check•Dproptiem box)
Latitude/longitude of well location
3. OWNER
Address
or Rowe l .-e-- Latimdei:ongiwde soutce:OGPSQTopograPhic map
(dwk box)
cs'y err state zm Code DEPTH 12RILI WA LOG
Ir - f, n From To Formation Description.
Am oode•Phooe m®ber
4. DATE DRILLED
5. TOTAL DEPTH: / _
6. DOES WELL REPLA •EXISTING WELL? YES ❑ NO M
7. STATIC WATER LEVEL Below Top of Casing: F I,
(1Ae-+-ifAboro Top of Casing)8. TOP OF CASING IS�_FT-Above Land Surface- Ji
•Top of eedug teruJuabed atlw below laud surface regWm a
VIC11 oe in wnh 15A NCAC 2C.013L
9• YIELD(lpm): METHOD OF TEST
10. WATER ZONES(depth): �Sf
LOCATTON KET('H
11. DISINFECTION:Type Amount Show direction and distance in miles from at least
12. CASING: Wall Thickness two State Roads or County Roads.Include the road
From 1 Diameter or Weights ,bbumg numbers and common road names.
� �Ft�
m e-- _�From__To Ft IV To Ft
13. GROUT: Depth Material Method t l
From �D -To Ft ,r.
From / To Ft cl 9✓ J�� \fit �t
14. SCREEN: Depth DiLanoter Slot Size materialFrom To FL '4!m. uL
From To FL in. �,
15. SANDIGRAVEL PACK. {r
Depth Sim Material �Mv�
From To FL /'Ipis,�,4,p/
From To FL
HA, l
16. REMARKS:
'DO HEREBY CERTIFY THAT THIS WELL WAS CONSI•RUC M IN ACCC RDANCE WrM 15A NCAC 2C•WELL
20NSTRN STANDARDS.AND THAT A COPY OF THIS RECORD Hr S BEEN PROVIDED TO THE WELL OWNER
SIGNATURE OF PERSON CQNSTR
` 1 lW D ATE
5 ubmit the original to the Division of Water Quality,G undwater Srction.1636 Mail Service Center_Raleigh NC
•7eoo_�g�Sp.o„tvc. oro�+�a_;�_,,•vithin '0days• MAR 08 2006 - •-- -
.1w-- i,r1VV:
Asheville.Regional Office
Aquifer Protection

WELL CONSTRUCTION RECORD v
North Carolina-Department of Environment and Natural Resources-Division of Water Quality-Groundwater Section
WELL CONTRACTOR(INDIVIDUAL)NAME (Print) NEIIL PARLIIE CERTIFICATION# 260�-
WELL CONTRACTOR COMPANY NAME t)T(7(W WEI I. LETH Tt\Y; (D. PHONE # R281 324-W35
STATE WELL CONSTRUCTION PERMIT# —ASSOCIATED WQ PERMIT#
(if applicable) (if lieabIg '
t mat t rt tss t� z n
1. WELL USE(Check Applicable Box):ResidenulaT ] MunicipaUPublic❑ Industrial[3 Agricultural❑
Monitoring O Recovery ❑ Heat Pump Water Injection❑ Other D If Other,List Use
2. WELL LOCATION: Topographica-and setting
Nearest Town: lam' IM County BLW ❑Ridge OSlope Malley C317Iat
RAY'.'; PATRY AVF._ (che*appropristee-)
(Shen Nerve.Number.Community,Subdivision,Lot No.,Zip Code) Latitude/longitude of well location
3. OWNER H24YMeIV Q%IR[JCIZQV Q12P. (aegma/minueeaWmoo s)
Address 1CM YIN lYi RT TN;1,14Y Latitude/longitude source:OGPSOTopogtaphic map
(Strad or Rotft No.) ON*box)
S4XCI , PA 16056 DEPTH DRILLING LOG
City or7o Suss zip Code From To Fommtion Description
Area code•Phone amber
4. DATE DRILLED 10-17-05
5. TOTAL DEPTH;. 225
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO 0(
7. STATIC WATER LEVEL Below Top of Casing. '-FT.
(Use-+-if Above Top ofQvins)
8. TOP OF CASING IS 2 FT.Above Land Surface•
`Tep of cadive termtnated iWw below land Sadao regnbes a
varWm ha scawda wab 1SA NCAC 2C.911L
9. YIELD(gpm):_ 3D _METHOD OF TEST BY AIR=
10.WATER ZONES(depth):
LOCATION SKETCH
1 I. DISINFECTION:Type HTH TABS Amount 47 Show direction and distance in miles from at least
12. CASING: Wall Thickness two State Roads or County Roads Include the road
w rx Wu' al mtmbets and common road names.
mroeter
From O To- NEc 5� Ft. �u v• �u U/ed(i
From To Ft
From To,—Ft
13. GROUT: Depth Material Method h�R)r5 D91/2
From —Ft ( ]Tf 1TIA2FT) + {11 ev y!{VE.
From To Fr. Co CH 9i'Ec 'ev,
14. SCREEN: Depth Diameter Slot size Material s H a?O
From To Ft-in. in. --
From To Ft. in. in. �� pyfSAP7ut %
15. SAND/GRAVEL PACK:-
Depth Size - Material
From To Ft
From To Ft.
16. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE W)TH I SA NCAC 2C,WELL
CONSTRUCTION STANDARDS,AND THAT A COP)(OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
0Y/Ihii iiz� (r11 10-27-05
SIGRATL)RE OF PhRSONICONSTRUCTINGTHEWELL DATE
Submit the original to the Division of Water Quality, oundd tt S t�ein 1636 a e Center-Raleigh,NC
276WI636 Phone No.[phone],within 30 days. �`l;E f VIE D GW-1 REV.07/2001
FEB 13 2006
Asheville Regional Offl(�
b rYnte o._o__.:__

WELL CONSTRUCTION RECORD
North Carolina-Depatlrnent of Environment and Natural Resources-Division of Water Quality-Groundwater Section
WELL CONTRACIOftM(D1VIDUAL)NAME (Friel) (EQl.FAME CEKrMCAnoNN Z,
WELL CONTRACTOR COMPANY NAME NT(TTW W I MIT Thr M PHONE a tom) 324-0035
STATE WELT,CONS SLUC110N PEIWTTa TEDWQPERMPr#
(if applicable) Cif applicable)
1. WELL USE(Check Applicable Box):Residential EK Municipal/Public O Industrial O Agricultural❑
Monitoring Q Recovery ❑ Heat Pump Water Itriection O Other❑ If Other,List Use
2. WELL LOCATION: Topogtaphio/Land setting
Nearest Tow County HEE El idge 0Slope Malley Mat
2543 HAM HI11,RD. (daxbappmp mb box)
(saeaNsmA,Nambe Ca Meft,966viiae,latft.MpCade) Latitude/lougitude of well location
3. OWNER IJ I�& IIA T iTPI V- I imim taftwoous)
Addnm 2543{SE1� NC1M EMT.RD, Latituddlongilude soara:OGPSOTopographic map
HI(ld , EN DEPTH ( DRILLING LOG
CayarTe sum TACO& From To Formation Description
(�$} 345 1476
Am codes place mmbw -
4. DATE DRILLED 10-24-05 -,
5. TOTAL DRY 24
6. DOES WELL REPLACE EMfING WELL? YES 0 NO II
7. STATICWATERLEVELBdowTopofCadng 7() FT-
(Uw'W'irAbme Tcp0fCaaiea) O
S. TOP OF CASING IS 2 FT.Above Land Surface' >
�Top efeaadgtrwivad xUw tdlm 6d awbes regdro a
wadaaee in acowd a wRa ISA NCAC 2C A11L
9. YIELD(gpm): 7 METHOD OF TEST 13Y�_
10.WATER ZONES(depth): LOCATION SKETCH
11. DISINFECTION:Type (jaj Amount 47 Show direction and distance in miles from at least
12. CASING: Wall hickness two State Roads or County Roads.Include the mad
Depth or Waighm Material numbers and cow road names.
From O To Ft A� PLASM
From—To Ft FroRt_To Ft CA f [L�
13. GROUT: Depth Material Method ® 1Z� N 1(V
From—D—TO-2Q_Ft Cad'TTT 1YTEM
From_—To Ft -
14. SCREEN: Depth Diameter Slot Sim Material w �uµl�LLs /�illZy
From To Ft is in.
From To Ft'—io in.
15. SAND/GRAVEL PACK: dqw NW `JO
Depth Sim Material ff/GQEQk`r'S
From To Ft
Fron__Tc Ft
16. REMARKS:
I DO HUMY CERTIFY THAT THIS WELL WAS CONSTRUCM IIf ACCORDANCE WITH 1SANCAC 2G WELL
CONSTRUCRON STANDARDS AND THAIT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
SIGMA O ERSONCONSTRUMNOTHEWELL DATE
Submit the original to the Division of Water Quality,Grqundwa�r �f36sisW Service ter-Raleigh,NC
27699-106 Phone No.[phone],within 30 days ! YY CC LLJJ W-1 REV.07/2001
J FEB 13 2006
j Asheville Regional Office
Am iifnr DrMeM:....