Cd CY2005

3 U '7 3 3'7
WELL CONSTRUCTION RECORD
North Carolina-Department of Environment and Natural Resources-Division of Water Quality-Groundwater Section
WELL CONTRACTOR(INDIVIDUAL)NAME (print) '1iya1Z .A-ss CERTIFICATION# ML.; / b
WELL CONTRACTOR COMPANY NAME S 52 W e-'I .Z)r I ���-�--PHONE # �.1.5 I eZ- _'�{/p D S
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable) _ (if applicable)
I. 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' _CountyaJ444X ❑Ridge G}Slope ❑Valley ❑Flat
7/&Z 4/f, —def- (check appropriate box)
(Street Name,Numbers,Community,Subdivision,Lot No.,Zip Code) Latitude/longitude of well location
?. OWNER: IN
lYP'P-+-s• (degrees/minutes/seconds)
Address XS Latitude/longitude source:❑GPS❑Topographic map
(Street or Route No.) (check box)
DEPTH DRILLING LQG
City or Town State Zip Code From To I Formani eseri�tn
in
Area code-Phone number _��(nS I Y_-���
4. DATE DRILLED / - ? /- OS
5. TOTAI.DEPTH: el' IoSI ► �_�
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO Ii-
7. STATIC WATER LEVEL Below Top of Casing:_ -TZ) _FT. n�
(Use"+"if Above Top of Casing)
8. TOP OF CASING IS / �2 FT.Above Land Surface`
'Top of casing terminated atlor below land surface requires a 0 Us p
variance in accordance with 15A NCAC 2C.0118. — -�-
9. YIELD(gpm):_IS METHOD OF TEST ap -
10.WATER ZONES(depth): _ a&5", — — —
LOCATION SKETCH
11. DISINFECTION:Type NTH _ 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__ T o--y32._FL _PVC
From__._To__FL
From To Ft. _
13. GROUT: Depth ,M"ate"rial�.. Method
From_o­'Io .2.0 Ft.�yt�—
From__To Ft.
14. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in.
From To Ft. in. in. JJJP/ RRR o
15. SANDiGRAVELPACK:
Depth Size Material
From To Ft. I I`
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
�f/.�,./JF.r ���/�2�/�f /- ,?If-D.S
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
Submit the original to the Division of Water Quality,Groundwater Section,1636 Nail Service Center-Raleigh,NC
27699-1636 Phone No.[phone],within 30 days. GW-I REV. 07/2001

30 '7336
WELL CONSTRUCTION RECORD
North Carolina-Department of Environment and Natural Resources-Division of Water Quality-Groundwater Section
WELL CONTRACTOR(INDIVIDUAL)NAMES rc
a lac((print) u T e.I� CERTIFICATION'#_.2..�
WELL CONTRACTOR COMPANY NAME i� -ot )1 L� DP• J1 s per` ZMC PHONE # (A?S /-32 31.89
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
if applicable) (if applicable)
I. WELL USE(Check Applicable Box): Residential El" Municipal/Public❑ Industrial❑ Agricultural ❑
Monitoring❑ Recovery ❑ Heat Pump Water Injection❑ Other❑ If Other,List Use
2. WELL LOCATION: ��1/ Topographic/Land setting
Nearest Town: o�+rd' County /• --� Midge BSlope DValley 0Flat
(check appropriate box)
(Street Name,Numbers,Community,Subdivision,Lot No.,Zip Code) Latitude/longitude of well location
?. OWNER: (degrees/minutes/seconds)
Address -Z G IS' t.J.:.LX 14,hl,21) BlGf-sQ• Latitude/longitude source:DGPSOTopographic map
(Street or Route Na.) (check box)
Q...a.a 21 C J 8 15-y s, DEPTH DRILLING LOG
City m Town State Zip Code From To Formation Description
(W)- '75-8-- /'799 D '7d , _}y
Area code-Phone number % G A,5-' —4AA
4. DATE DRILLED—/-e?D- 06
5. TOTAL DEPTH: L l tr'
6. DOES WELL REPLACE EXISTING WELL? YES El NO R9
7. STATIC WATER LEVEL Below Top of Casing: 1740 FT. - 1 r*�+
Z (Use"+"if Above Top of Casing) t..1
8. TOP OF CASING IS //S- FT.Above Land Surface* t -70
*Top of casing terminated atlor below land surface requires a --Iji —451
variance in accordance vith I5A NCAC 2C.0118. — Yr1r
9. YIELD(gpm):_ /%s METHOD OF TEST Qw - -=Nt�
10.WATER ZONES(depth): _ A — — p
LOCATION SKETCH
11. DISINFECTION:Type.AFT N Amount Show direction and distance in miles frora leas,rlc'
12. CASING: Wall Thickness two State Roads or County Roads.Include the roam
Depth Diameter or Weight(Ft. Material numbers and common road n e�,
From_ To_�0 Ft. Piz C. (/)`ar"4-
From__,_To___Ft.
From To Ft. _
13. GROUT: Depth Material Method
Frorn�_To_' ._Ft. �f-UAAJ
From To Ft. - 9-1dn.i..-� a
14. SCREEN: Depth Diameter Slot Size Material QQ -
From To Ft. in. in. - 1
From To Ft. in. in. cc
15. SAND/GRAVEL PACK: ry 1
Depth Size Material
crt
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
0 SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
Submit the original to the Division of Water Quality,Groundwater Section,1636 Mail Service Center-Raleigh,NC
27699-1636 Phone No.[phone],within 30 days. GW-1 REV. 07/2001

V'__
North Carolina-Department of Environment and Natural Resources-Division of Water Quality-Groundwater Section © �
1636 Mail Service Center-Raleigh,N.C.27699-1636-Phone[phone]
WELL CONSTRUCTION RECORD WELL CONTRACTOR: Dewey Wrig415
ht Well Pump Co., Inc.
2687
040633 WELL CONTRACTOR CERTIFICATION#: t�teva Neece
STATE WELL CONSTRUCTION PERMIT#:
1. WELL USE(Check Applicable Box): Residential ❑ Municipal ❑ Industrial ❑ Agricultural❑ Monitoring ❑
Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use:
2. WELL LOCATION:(Show sketch of the location below)
Nearest Town: LENOIR County: CALDWELL
NEW DR. OFF ARTHUR LANE OFF RICHLAND RD. OFF H
(Road Name and Numbers,Community,or ub [vision and Lot No.) DRILLING LOG DEPTH
3. OWNER ARTHUR SHERWOOD From To Formation Description
Address % NORRIS CONSTR. , 1467 BIG HILL RD. 0 108 DIRT/SANDISTN
BOONE (Street or Route No.) NC 28607 108 800 GRANITE
City or Town state Zip Code rd00 803 QUARTZ
4. DATE DRILLED 1/6/2005 803 900 GRANITE
5. TOTAL DEPTH 900
6. CUTTINGS COLLECTED YES ❑ NO
7. DOES WELL REPLACE EXISTING WELL? YES ❑ NO
8. STATIC WATER LEVEL Below Top of Casing: 200 FT.
(Use',"if Above Top of Casing)
9, TOP OF CASING IS 1 FT.Above Land Surface* -
'Top of casing terminated at/or below land surface requires a variance in accor-
dance with 15A NCAC 2 is
10, YIELD (gpm): �'� METHOD OF TEST Air
11. WATER ZONES (depth): 0.50 Mom800-BO'�5 Apo m -
ppm 0.00qprn
12. CHLORINATION: Type Amount If additional space is needed use lack of form
13. CASING: Wall Thickness LOCATION SKETCH
Depth Diameter or Weight/Ft. Material (Show direction and distance from at least two State
Prom 0 To 114 Ft 6 1/8 .350 PVC Roads,or other map reference points)
From To Ft.
From To Ft.
14. GROUT: �T
Depth Material Method
From 0 To 20 Ft. Cement Gravity Flow oo
From To Ft. C
15. SCREEN: n
Depth Diameter Slot Size Material
From To Ft. in. in.
From To Ft. in. in. t '
From To Ft. in. in. (�
16. SAND/GRAVEL PACK: P
Depth Size Material "
0
From To Ft. ( _..1 _
From To _ Ft. y
I
17. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C,WELL
CONSTRUCTION STANDARDS,AND THAT A COPY OF THIS RECORDH_AS BEEN PROVIDED TO THE WELL OWNER.�/�
FOR OFFICE USE ONLY - '` Z:S2=
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.

I
FROM : MORETZ WELL & PUMP FAX NO. : 7044621322 3 Apr. 11 2005 07:08PM P11
309908
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waaernrrlueTolegNarvmoAtawure byre AS3I,Z' 1.. =ETZ eaavxelrwxw�.r vaQc
� tlm„ MORETZ WELL DRILLINGpNy r7041462-1322
eSASi IrtiLL tlhaQRM 'RD wQ TRM61'L/ , ,
1. WELL L)SB(CLb*ApyH061•9"n Reddy dml MlaiolpolBubre o tdoehid a Aps atwol L7 z.
Musho nr O Recovery 17 Flat Pow WOW I:geaton O Odler 17 IlO&w,LMt t1.a
2. t wWIIACATION; r r/,__ // o>t�e�l tft c'
seoacwln., aaenu�SFlbdl+rlea,selTio,i�Cade} La�ade/b�i�taibotw nlooMio. ,_
3. OWld6R: do A-
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4. DATZDRrrrw" ; �
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s. TOTAL
6. Dmwz t,.R8?LAC88Rmmw8LLT Yu LT NO
7. STATIC WATULEVEL bolowT ofCW*.-1Q_ FT.
ttAe"+^itAlow Ttl�dC+tlb�
L TOP OF CASINO 16._._L F?.AbM Lod S~
'41q ataMe6blwre wwb dm lead naMa neaM•
�rlrMtaawuaeaee 1lMN=2c Oatl
9. YmD(�Iejc i�TfiO1�QFTBSf
10.WA7B1L ZONB9(dep�k 700
$bowdiratWaeed �SanstMW
11. WSDWZ=oN:T D1y Atpolmt Iwe State Rode oe O 1loada laeftdo Aft and
tt To�� W mnaban and oomuao rod rilmle►• ..o
14, SClBElt: DIP& blow"
IL
15. SAND/CMVELPACY- iNetaief
Zr_..._..To
16. REMARKS:
Isio cmmjtU=W S?LilY 1NAT AM MT A CW 0F'f=UCORD1tA6 8E ?R0VIDM 70Tn*"l L OWNM
c�1sTRt>ritaaa STANDARDS v -0-5
'strnsaPrRss� aTt�wtlu. nw'L!t
xC
m the D1vWen otwaett QaN7. wuar 8ectlott,spstwelaeta►Ceers*•11aMIlR
Saudthe ori�net OW-1 REV.07=01
rNW1636 pmoo Pte.(919)733=*6"36 4M,

North Carolina-Department of Environment and Natural Resources-Division of Water Quality-Groundwater Section 309106
1636 Mail Service Center-Raleigh,N.C.27699-1636-Phone[phone]
WELL CONSTRUCTION RECORD WELL CONTRACTOR: Dewey Wright Well Pump Co., Inc.
WELL CONTRACTOR CERTIFICATION#: 2791
050052 STATE WELL CONSTRUCTION PERMIT#: Albert Slate
1. WELL USE(Check Applicable Boxl: Residential EK Municipal El Industrial 0 Agricultural Monitoring 0
Recovery 0 Heat Pump Water Injection 0 Other ❑ If Other, List Use:
2. WELL LOCATION:(Show sketch of the location below)
Nearest Town: LENOIR County: CALDWELL
FRANKLIN RD. OFF HWY 90 OFF SETZERS CREEK OFF
IRoad N....nd Numbers.Community,or ubtlivision and Lot No.l DRILLING LOG DEPTH
3. OWNER ROBERT NORRIS From To Formation Description
Address °o JOHNNY NORRIS P. O BOX 40 0 60 DIRT
COIL ETT9�JPtq`�°uta"°l NC 28611 60 BO gHAl F
City or Town tat. ZiP ode BD 116 GRANITE
4. DATE DRILLED 2/14/2005 116 116 CREVICE(IRON 2)
5. TOTAL DEPTH 200 116 165 GRANITE
6. CUTTINGS COLLECTED YES 0 NO 0 165 166 CREVICE NRON .5j
7. DOES WELL REPLACE EXISTING WELL? YES 0 NO 0 166 200 GRANITE `�;,
8. STATIC WATER LEVEL Below Top of Casing: 30 FT.
(Use'',"if Above Top of Casing)
9. TOP OF CASING IS 1 FT.Above Land Surface*
Top of casing terminated at/or below land surtace requires a variance in accor-
dance with 15A NCAC 2 .0118
10. YIELD(gpm): METHOD OF TEST Alr
11. WATER ZONES (depth): 6.00 Apm 116-116 2.00ppm 166-166 e J
0.00 qpm 0.00gpm tJ7
12. CHLORINATION: Type HTH Amount 36 If additional space is needed use back of forrqrd
13. CASING: LOCATION SKETCH
Wall Thickness
Depth Diameter or Weight/Ft. Material (Show direction and distance from at least two State
prom 0 To 85 Ft. 6 113 .350 PVC Roads,or other map reference points) Os
From To Ft. 3
From To Ft.
14. GROUT:
Depth Material Method 'S
From 0 To 20 Ft. Cement Gravity Flow _
From To Ft. - `
cik Y
15. SCREEN:
Depth Diameter Slot Size Material
From To Ft. in. in. a�
From To_ Ft. in. in.
From To Ft. in. in. `'
� 1R Sr s —�
16. SAND/GRAVEL PACK: I`t',.q�
Depth Size Material FIn CIC) C'p(�i?
From To _ Ft.
From To Ft.
17. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C,WELL
CONSTRUCTION STANDARDS,AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER.
FOR OFFICE USE ONLY ( j 34 D
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
Quad No: Submit original to Division of Water Quality,Groundwater Section within 30 days
GW-i REV.12/99
Serial No.

NO
309516
WELL CONSTRUCTION RECORD 3
North Carolina-Department of Environment and Natural Resources-Division of Water Quality-Groundwater Section
,. WELL CONTRACTOR(INDIVIDUAL)NAME (print) JOe7lti (1�U'�.S CERTIFICATION
WELLCONTRACTORCOMPANYNAh1E Yadkin Well Cc6 y Inc. PaoNE # (336 468-4440
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
if licable (ifapplicable)
I. WELL USE(Check Applicable Box):Resident Mtea"unicipal/Public❑ Industrial❑ Agricultural❑
Monitoring❑ Recovery ❑ Heat Pump Water Injection❑ Other❑ If Other,List Use 2. WELL LOCATION: eik47— 312
Topo phI&Land setting
Nearest Town:� 4" 06A County ❑Ridge Slope ❑Valley ❑Flat
444 004 rr (check appropriate box)
(Street Name,Numbers,Community,Subdfvis'9on,Lot No.,Zip Code) Latitude/longitude of well location
3. OWNER. 11-A fig 01j 11t�yQ (degrees/minutes/sewnds)
Address 3 95� 1�w, R�.Q �YiT Ted Latitudellongitude source:❑GPS❑Topographic map
(Saeetor Route No.) (check box)
1--e k 40,1 HG SG yt <_ DEPTH DRILLING LOC.
City or Town State Zip Code From To Formatiog Description
Area code-Phone numbs .Qet
3T.• ,� gV ra
4. DATE DRILLED 9-4,?-G S gi- _ 4a; . t „�
5. TOTAL DEPTH:
6. DOES WELL REPLACE EXISTING WELL? YES ❑ PO
7. STATIC WATER LEVEL Below Top of Casing: 7S X.
(Use"+-if Above Top of Casing) n
8. TOP OF CASING IS FT.Above Land Surface'
`Top of easing terminated■t/or below land surface require a 3
variance In■coordance with ISA NCAC 2C.0111.
9. YIELD(gpm): LA METHOD OF TEST air plIIm Bit SPri al #/ a
10.WATER ZONES(depth): L 5-- 71-' s.-y , OS 3�
Ia
fi 2dJ 2vi-, LOCATION SKETCH
N11. DISINFECTION:TypeJf/ Amo t ctl Show direction and distance in miles from at least
. CASING: Wall Thickness two State Roads or County Roads.Include the road
Depth_ Diameter or Weight/Ft. Material numbers and common road names.
From�LTo 5(�Ft. 1S S R-a INIC
From To Ft
From To Ft. t /JA
13. GROUT: Depth Material Method f
Fro 1u pp Js
mm_To_�Ft Sara.pdt'+aef � /W 1 ,
From To Ft.
14. SCREEN: Depth Diameter Slot Size Material G t I
From To Ft. in. in.
From To Ft. in. in. +
15. SAND/GRAVEL PACK: 1s�
Depth Size Material
From To Ft 1% �Z
From To Ft. r
16. REMARKS: j)
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE"i�I'f'; �SA NCAC 2C,
CONSTRUCTION STANDARDS,AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL R
NATU$TrUF PERSON CONSTRUCTING THE WELL DATE
S
- Submit the original to the Division of Water Quality,Groundwater Section,1636 Mail Service Center-Raleigh,NC c cis -
27699-1636 Phone No.[phone],within 30 days. GW-I REV.07/2001 *
Date site visited 3—zl—aS by JZff_ Permit needed yes no

309 � '7 �
WELL CONSTRUCTION RECORD
North Carolina-Department of Environment and Natural Resources-Division of Water Quality-Groundwater Section
WELL CONTRACTOR MWTVMUAL)NAME CERTIFICATION##2492
WELL CONTRACTOR COMPANY NAME 11Lcm WaL air CE)• PHONE s ( P-324-W35
STATE WELL CONSTRUCTION PERMITS. ASSOCIATED WQ PRRMITN
(if applicable) (if applicable)
I. WELL USE(Check Applicable Box):Residential Munidp&Public❑ Industrial❑ Agricultural❑
Monitoring❑ Recovery O Fleet Pump Water Injection E3 Other❑ if Other,List Use
2. WELL LOCATION: TopogtaphicaAnd setting
NearestTown T TF County CATaELL Midge ❑Slope Malley ❑Flat
GLLNE RMD (cbmk appmpriste boa)
(SueetNane,Number.Canmimay.Sabditidon,Lot NO.zap Code) Latitudellongituda of well location
3. OWNER: lID G• (dosudmimwtseeoo&)
Address Latitudeilongitude source:❑GPS❑Topographic map
27577 (checkbm)
DEPTH DRH LING LOG
91gZ=383 sum tip code From To Formation Description
Ara code-Phase numbs
4. DATE DRILLED rn_ L-0
5. TOTAL DEPTH: �
6. DOES WELL REPLACE EXISTING WELL? YES❑ NO 11 11
7. STATIC WATER LEVEL Below Top of Casing:�Ff.
(Use"+*if Above Top ofCashW
8. TOP OF CASING is 2 FT.Above Lend Surface• `y
'Top of Casing eerataated agar twbw rand surface require a
varlaeee L seecrdeaa with RSA NCAC 2C.0112.
9. YIELD(gpm):_ ) METHOD OF TEST Ry AM -aap
10.WATER ZONES(depth).
LOCATION SKETCH
11. DISINFECTION:Type LUH TABS Amount ti9 Show direction and didtwce in miles from at least
12. CASING: Wan Thickom two State Roads or County Roads.Ienhde the road
Depth Diameter or Weigiuft Material numbers and common road names.
From 0 To 78 Ft_6�L_ GNLV.
From To FL
From FL Depth
13. GROUT: Depth material Method
From___D__T0__2D_FL MC Tr zrt Pm ctd4E OP.
From To Ft,_
14. SCREEN: Depth Diameter Slot Size Material lAl
Fromt To FL_jn. in. >y
Front_ To FL_,in. in.
15. SAND/GRAVEL PACK G'aGi11��V/Gib
From DepthFt. Size Material s .�„t6tj0i ✓
From To FL
16. REMARKS:
I DO HEREBY CERTIFY THAT TH13 WELL WAS CONSIRUCfw im ACCORDANCE WITH ISA NCAC 2C.WELL
CONSTRUCTION STANDARDS.ANDTAATACOPYOFTIUSRECORDHASBEENPROVMEDTOTHEWELLOWNER
y�c
SIGNATURE OF PERSkN CORMUCIING THE WELL DATE
Submit the original to the Divider of Water Quality,Groundwater Section,16M Mdl Service Center-Raleigh,NC
2709-1636 Phone Na(919)733-3221,within 30 days. GW-I REV.07/2Q01 _
I -i u

WELL CONSTRUCTION RECORD 00 3 0 9 5 7 6
North Carolina-Department of Environment and Natural Resources-Division of Water Quality-Groundwater Section
WELL CONTRACTOR(INDWIDUAL)NAME CERTIPICATrON# 2�
WELL CONTRACTOR COMPANY NAME HT(I(WWI rRITT p` M PHONE # I ) 29R-, Xl
STATE WELL CONSTRUCTION PERMITS AssoaATED WQ PERMIT#
fifapplicable) (ifseplicable)
1. WELL USE(Check Applicable Box):ResidentialIX Municipd/Public C) Industrial❑ Agriculbual❑
Monitoring O Recovery O Heat Pump Water Injection O Other 17 If Other,List Use
2. WELL LOCATION. Topogr itic/Land setting
Nearest Town 1HUTR County �L ORidge OSlope Malley l3 lat
27 R BY RD. (ebeck gTropride:box)
(Sneer Name,N=bar,Catnomaay,S*OvidOd,LotNo.,Yip Code) LatiftxMonginSde Of well location
3. OWNER:_RN9F. BRM FY (dexr*WrO o itedwo*nde)
Address 2747 RBY hIAKPIr)M. Latitude/longitude somce:OGPSOTopographic map
SSava or Route No.) (et,cy ba)
I�Ilt, T� 28645 DRI&L )Il`G
City or Town state zip Code From TO Formation Description
( )-828-75U6i6 ,.
Ara code-Phone nuegw -'--
4. DATE DRILLED 02-14-05 5. TOTALDEPTH:�_
[}
6. DOES WELL REPLACE EXISTING WELL? YES O NO Xj
7. STATIC WATER LEVEL Below Top of Casing: 40 Fr, --III
(Un-+"if Above Top ofGunS) - r —
8. TOP OF CASING IS 2 FT.Above Land Surface* '9
'Top ofaehatumbWed ager*Mow Hod sorkee regalm a O ea
variance to amordnes wah 15A NCAC 2C.0118. C.f1
9. YIELD(gpm) 6 METHOD OF TEST BY AIR TEST
10.WATER ZONES(depth):
LOCATION SKETCH
11. DISINFECTION.Type HIIL TABS Amount 56 Show direction and distance in miles fixan at Ienst
12. CASING: Wall Thidtaess two State Roads or County Roads.Include the road
From 0 > or Ar4* t.�t numbers and common mad names.
To Fk YvC
From To Ft
13. GROUT: Depth Material Method
Fro Q_To_�_FL (3IITt Fan /H�pP-Tiv' t/L
From To Ft. .Pi
14. SCREEN: Depth Distorter Slot Size Material //WY 'Ay/ C
From To FLTin. ut,
From__To FL in, is
15. SAND/GRAVEL PACK: w y,
Depth sire Material
From To Ft. j
Front—To—Ft.
16. REMARKS:
1 DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED EN ACCORDANCE WITH ISA NCAC 2G WEIL
CONSTRUC310N STANDARDS,AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO TEIE WELLOWNPR .
02-16-05
SIGNATUREOFPERSON.FONS1RU=NGTHEWELL 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.0712001

+V
North Carolina-Department of Environment and Natural Resources-Division of Water Quality-Groundwater Section 1636 Mail Service Center-Raleigh, N.C.27699-1636-Phone[phone] U n
WELL CONSTRUCTION RECORD WELL CONTRACTOR: Dewey 1/Vriaht Well pUfflpC,,
WELL CONTRACTOR CERTIFICATION#: 2886
050090 STATE WELL CONSTRUCTION PERMIT#: Leslie Reece
1. WELL USE(Check Applicable Box): Residential ® Municipal 0 Industrial ❑ Agricultural❑ Monitoring
Recovery 0 Heat Pump Water Injection 0 Other ❑ If Other, List Use:
2. WELL LOCATION:(Show sketch of the location below)
Nearest Town: t c^I^to County: .r('A! nia.rcl 1
(Road Name an umbers, om munity,or Fkd,R Nr 4,' o. H>'
3. OWNER _R I OIQ NORMAN DRILLING LOG DEPTH
From To Formation Description
Address NATLJAN R RI1RTtlM 7ggg Mpf=pRo D B.7 _rIIRT
St t ute o. —
ity or Town State B7 M it
ip otle S3RAMTF
4. DATE DRILLED 31117119f1nF 141A Alp OfJART7
5. TOTAL DEPTH d11F A10 d to GRAMTF
6. CUTTINGS COLLECTED YES ❑ NO EXI
7. DOES WELL REPLACE EXISTING WELL? YES 0 NO ©
8. STATIC WATER LEVEL Below Top of Casing: fin _ FT.
(Use"+"if Above Top of Casing)
* 70P OF CASING IS 1 ='
Top of casing terminated 118 below land surface requires av variance Surface*accor-
dance with 15A NCAC 2C.0118
10. YIELD (gpm): 0.63 METHOD OF TEST Air
11. WATER ZONES (depth): 0.63 apm 318-319 0 DOaom
0.00 apm 0 OOaom r 12. CHLORINATION: Type HTH Amount 71 If additional space is needed use back of forthay
13. CASING: Ip)I�t
Wall Thickness IVl LOCATION SKETCH
Depth Diameter or Weight/Ft. Material
from D (Show direction and distance from at least two State
To 90 Ft. 8 1/8 .350 PVC _ Roads,or other map ref rence points)
From To Ft. (� �
From To Ft. Q�- ZLYS C# (D
14. GROUT: Ills
� c�•�J �1
Depth Material Method we ` -
From 0 To 20 Ft, Cement Gravity Flory
From To Ft.
15. SCREEN:
Depth Diameter Slot Size Material 9�9
From To_ Ft. in. in. (1 y
From To Ft. _ in. in. V6jl
From To Ft. _ in, in. N
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 , o
CONSTRUCTION STANDARDS,AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER.
FOR OFFICE USE ONLY
Quad No: SIGNATURE F ERSON CONSTRUCTING THE WELL DATE
Submit original to Division of Water Quality,Groundwater Section within 30 days
Serial No. GW-1 REV.12/99

North Carolina -Department of Environment and Natural Resources-Division of Water Quality-Groundwater Section
1636 Mail Service Center-Raleigh,N.C.27699-1636-Phone[phone]
WELL CONSTRUCTION RECORD WELL CONTRACTOR: Dewey Wr.ght Well Pump Co., Inc.
WELL CONTRACTOR CERTIFICATION#: 2881
050083 STATE WELL CONSTRUCTION PERMIT#: Steve Petty
1. WELL USE(Check Applicable Box): Residential © Municipal 0 Industrial 0 Agricultural 0 Monitoring 0
Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use:
2. WELL LOCATION:(Show sketch of the location below)
Nearest Town: LENOIR County: CAI nVVELL
KIRBY MTN RD OFr HWY 321
(Road Nameand Numbers, _Mmu ry,orsubdivision and Lot No.)
DRILLING LOG DEPTH
3. OWNER LEONARD ANDERSON From To Formation Description
Address 3415 ROCKY RD. , 0 27 DIRT
LENOI R (Street or Route N.j NC 28845 27 118 GRANITE
Ity or Town state Zip Lode 116 119 SHALE
4. DATE DRILLED 4/8/2005 119 130 GRANITE
5. TOTAL DEPTH 145 130 132 SHALE
6. CUTTINGS COLLECTED YES 0 NO Fx� 132 145 GRANITE
7. DOES WELL REPLACE EXISTING WELL? YES 0 NO
8. STATIC WATER LEVEL Below Top of Casing: 20 FT.
(Use"+"if Above Top of Casing)
9. TOP OF CASING IS 1 FT.Above Land Surface* a
'Top of casing terminated at/or below land surface requires a variance in accor-
dance with 15A NCAC 2C.0118
10. YIELD (gpm): 18 METHOD OF TEST Air to
11. WATER ZONES (depth): 5.00 qpm 118-119 13.00opm 130-132 p
0.00 QPm 0.000rm cll
12. CHLORINATION: Type HTH Amount 26 If additional space is needed use back of forrig
13. CASING: wall Thickness LOCATION SKETCH
Depth Diameter or Weight/Ft. Material (Show direction and distance from at least two State
prom 0 To 35 Ft. E 1/4 .350 PVC 1�Roads,or other map reference points)
From To Ft.
From To Ft.
14. GROUT: :
Depth Material Method
From 0 To 20 Ft. Cement Gravity Flow Q \
From To Ft.
15. SCREEN: 3,9 �
Depth Diameter Slot Size Material t�' "' l kJ V
From To Ft. in. in. K cY 1.+y M ^ "ccz�z,�
From To Ft. in. in. (UJ
From To Ft. in. in.
16. SAND/GRAVEL PACK:
Depth Size Material From To Ft.
From To Ft. 1 -
17. REMARKS: N
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C,WELL " o
CONSTRUCTION STANDARDS,AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL QMER.
AL
y G
FOR OFFICE USE ONLY ��
SIGNATURE OF PE ON CONSTRUCTING THE WELL DATE
Quad No: Submit original to Division of Water Quality,Groundwater Section within 30 days
GW-1 REV. 12/99
Serial No.

I
WELL CONSTRUCTION RECORD
North Carolina-Department of Environment and Natural Resources-Division of Water Quality-Groundwater SectioOnf �J
I.L5S� CERTIFICATION#
WELL CONTRACTOR(INDIVIDUAL)NAME (print) /
WELL CONTRACTOR COMPANY NAME f\tA.S S t: ( 1 L' 1 k t I r rLQ T y ,"a PHONE # (
ASSOCIATED WQ PERMIT#
STATE WELL CONSTRUCTION PERMIT# (if applicable)
(if applicable)
I. WELL USE(Check Applicable Box):Residential& Municipal/Public❑ Industrial❑ Agricultural❑
Monitoring❑ Recovery ❑ Heat Pump Water Injection❑ Other❑ If Other,List Use
2. WELL LOCATI /y_ nD� n Topographic/Land setting� �
Nearest Town:
County��GL ❑Ridge ❑Slope ❑Valley 19FIat
. (check appropriate box)
Latitude/longitude of well location
(Street Name,Numbers,Community, No.,Zip Code)
Subdivision,
?. OWNER: (degrees/minutes/seconds)
Address Latitude/longitude source:❑GPS❑Topographic map
(check box)
(street or Route No.) q DEPTH DRILLING LOG
From To Forman n Description
City or Town State Zrp Code l7 47 /
Area code-
Phone number/7 S9 —7 02 h-5/
_
4. DATE DRILLED .
5. TOTAL DEPTH: ---- —
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO
7. STATIC WATER LEVEL Below Top of Casing:� LTY
—FT.
! (Use••+"if Above Top of Casing) T
8. TOP OF CASING IS_��.-- _FT.Above Land Surface'
"Top of casing terminated at/or below land surface requires a , _Ln
variance in accordance with 15A NCAC 2C.01Is. y
9. YIELD(gpm): _METHOD OF TEST --"-----
10.WATER ZONES(depth):_ ' /n S _ LOCATION SKETCH
11. DISINFECTION:Type Amount w r,p. Show direction and distance in miles from at least
Wall Thickness two State Roads or County Roads.Include the road
12. CASING: numbers and common road names.
Depth Diameter or Weight/Ft. Material t. K�
From_ To_�2 FL
From---To----Ft. yy
From To Ft.__ LE3!O �LtN7r t C ��
13. GROUT: Depth Material Method /
Frorri--Cl—To IL FL TC111 All -
From__To Ft.
14. SCREEN: Depth Diameter Slot Size Material
From_ To Ft. in. in.
From__To Ft. in. in.
15. SAND!GRAVEL PACK:
Depth Size Material
From To Ft. h, -
From_ To,_._Ft. l
16. REMARKS: v --
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
— eU
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
Submit the original to the Division of Water Quality,Groundwater Section,1636 Mail Service Center-Raleigh,NC
27699-1636 Phone No.[phone],within 30 days. GW-1 REV.07/2001

Dip 3 114 4
WELL CONSTRUCTION RECORD
North Carolina-Department of Environment and Natural Resourcees�l-Division of Water Quality-Groundwater Section
WELL CONTRACTOR(INDIVIDUAL)NAME (print) 0`,' " `J 1,"S _ CERTIFICATION#2`S 7Z
WELL CONTRACTOR cohE?ANY NAk1E Yadkin Well CchpanlC PHONE # (33� 468-4440
ASSOCIATED WQ PERMIT#
STATE WELL CONSTRUCTION PERMIT# (if applicable)
(if licable)
riot/ fi
1. WELL USE(Check Applicable Box):ResidentiaX MunicipaVPublic❑ Industrial❑ Agricultural❑
Monitoring❑ Recovery ❑ Heat Pump Water Injection❑ Other❑ If Other,List Use "
2. WELL LOCATION: TopographicJLand setting
Nearest Town: d l" County ❑Ridge P lope [Walley ❑Flat
r-- (check appropriate box)
(Street Name, umbers, ty. Latitude/longitude itude of well location
Commmi Subdivision,Lot No.,Zip Code) g
OWNER. e r (degreeslminuteslseconds)
Address r Latitudeilongitude source:❑GPS❑Topographic map
(check box)
(Sacetor outeNo.) DEPTH DRILLING LOG
i rc v+ `a r t A� From To Form ion Description
City or Town Smte Zip Code O ��
Ares code-Phone number
4. DATE DRILLED 3-31 05
5. TOTAL DEPTH: /q')
6. DOES WELL REPLACE EXISTING W ELL7 YES❑ p)pr
7. STATIC WATER LEVEL Below Top of Casing: L/d FT.
(Use"+"if Above Top of Casing)
8. TOP OF CASING IS FT.Above Land Surface* :e
'Top of casing terminated atlor below land surface requires a
variance in a,xnrdaace with ISA NCAC 2C.011& #
9. YIELD(gpm):�tv�ETHOD OF TEST aim_ 4/ 07 O 15
10.WATERZONES(depth): �/9 -slam � � �
LOCATION SKETCH
11. DISINFECTION:Tgpe /�tE/ Amount
cups Show direLl
ction and distance in miles from at least
12. CASING: Wall Thickne two State Roads or County Roads.Include the road
Depth Diameter or Weight/FI. Material numbers and common road names.
From -I-ZTo 3J�Ft. 6.1XI— 500 PVC+ Jn1 �lf4f 4�¢aYti
From To Ft, 7 Xa✓i !i/,V, _
From To Ft-
13. GROUT: Depth Material Method !•
From_Togo Ft.So, LiGCx�.Cf
From To FL
14. SCREEN: Depth Diameter Slot Sin Material S 03 -
From To Ft. in. in.
i
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Sin Material �m
Z�
From TO FL
From To Ft.
16. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A N 2C,WELL
CONSTRUCTION STANDARDS,AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
IINr -31- (IS
SIGNA ERSO pHE WELL DATE
Submit the original to the Division of Water Quality,Groundwater Section,1636 Mail Service Center-Raleigh,NC
27699-1636 Phone No.[phone],within 30 days. GW-I REV.07/2001
Date site visited 3--2&,,gs' by 4_ Pemit needed Yes no ✓ a2g

North Carolina-Department of Environment and Natural Resources-Division of Water Quality-Groundwater Section d 312 4 ?J. 5
`�
1636 Mail Service Center-Raleigh, N.C. 27699-1636-Phone[phone]
WELL CONSTRUCTION RECORD WELL CONTRACTOR:
WELL CONTRACTOR CERTIFICATION#:
501i 7 STATE WELL CONSTRUCTION PERMIT#:
1. WELL USE(Check Applicable Box): Residential El Municipal 0 Industrial 0 Agricultural El Monitbring 0 -.
Recovery E] Heat Pump Water Injection 0 Other 0 If Other, List Use:
2. WELL LOCATION:(Show sketch of the location below)
Nearest Town: County: Cr' "Z
4 ✓y ppr_ C,
11io`ad Name and um ers, ommumty,or SuS�iv s on awn ' of o
DRILLING LOG DEPTH:
3. OWNER `zrt"Y= I =LEL-Pr) From To Formation Description -
Address 72- Ir'u' RD -
IStree[or Route No.)
Er):}li I "' {=If 7 ?$5 7 t -"tiT,nLIR7,
Ciryor Town biate Zip Cotle
It',.r., 1136 `r`VHTOUP4 ...TZ
4. DATE DRILLED 4,r17r1,3t05 ±.Fl!3 191M 3RAi(IIiTE
5. TOTAL DEPTH 585
6. CUTTINGS COLLECTED YES 0 NO 0
7. DOES WELL REPLACE EXISTING WELL? YES 0 NO El
8. STATIC WATER LEVEL Below Top of Casing: 150 FT.
(Use'."if Above Top of Casing)
9. TOP OF CASING IS 1 FT.Above Land Surface*
"Top of casing terminated at/or below land surface requires a variance in actor-
dance with 15A NCAC 2C.0118 !d i 44
10. YIELD (gpm): - r$ METHOD OF TEST ,sir i
11. WATER ZONES (depth): O " aDrr 3$5-360 0 00 Drr
0
_ aGm O Q17atrn5
12. CHLORINATION: Type I-f':'1'I Amount 1112 If additional space is needed use back;of form
13. CASING: LOCATION SKETCH
Wall Thickness r
Depth Diameter or Weight/R. Material (Show direction and distance from at least two State
v
From f' To '21 Ft r' UP !�'EQ Roads,or other map reference points) )�
From To Ft. 1 �l
From To Ft. /
I
14. GROUT:
Depth Material Method ,
From To 20 Ft. '-M-nt Or3vih, r=lovv. i •-.I
-
From To Ft. — I
15. SCREEN:
Depth Diameter Slot Size Material
From To Ft. in. in. _
From To Ft. in. in.
From To - Ft. in. in. I
16. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
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 COPY OF THIS RECORD HAS BE,EN PROVIDED TO THE WELL OWNER
FOR OFFICE USE ONLY
SIGN RE 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.

I
112 r '7
North Carolina-Department of Environment and Natural Resources-Division of Water Quality-Groundwater Section
1636 Mail Service Center-Raleigh, N.C.27699-1636-Phone [phone]
WELL CONSTRUCTION RECORD WELL CONTRACTOR: 3 riey CV l:
WELL CONTRACTOR CERTIFICATION#:
L150172 Steve Fe,e&._
STATE WELL CONSTRUCTION PERMIT#:
1. WELL USE(Check Applicable Box): Residential EA Municipal 0 Industrial El Agricultural Womtpryng
Recovery Heat Pump Water Injection 0 Other 0 If Other, List Use:
2. WELL LOCATION:(Show sketch of the location below)
�( J
Nearest Town: LEhdrdP. County f`Ai C'VVEI i i =>� G-1
n' T UR �� tvtCr911 LF pt T -F F;I OF ; 'RE h; 2FG ncy` z __
(ROatl Neme entl Numbers, ommu 'ry,or Subdvision entl Lo[ 0 1 ( ( 1
DRILLING LOG DEPTH
3. OWNER C+'V!C, a CF°:.tOJE From To Formation Description—
Address '44105 C4g4 01J R!CGE RD 0 1:: CiRT SANIC STONE
r R (Street or Route Net t.ci 1)F 4�'] g�(�ITy
iCl��li. 23rf4._ 25
City or Town Tuti, Zip Cede
a19 342 HALE DUAP-7
4. DATE DRILLED /1Sr''DC5 3122 320 GR14f''PTE
5. TOTAL DEPTH 3180
6. CUTTINGS COLLECTED YES E] NO 0 S'
7. DOES WELL REPLACE EXISTING WELL? YES ❑ NO 0 r
8. STATIC WATER LEVEL Below Top of Casing: 6C, FT. a= —
(Use"+"if Above Top of Casing)
9. TOP OF CASING IS 1 FT.Above Land Surface*
*Top of casing terminated at/or below land surface requires a variance in actor- pilr ,✓�
dance with 15A NCAC 2C.0118
10. YIELD (gpm): 10 METHOD OF TEST A:' `
11. WATER ZONES (depth0C'-L10 igjrr 331 `42 0_10"9gpm --`
D 0O pl n D ODtln rt
12. CHLORINATION: Type HTH Amount t1eel If additional space is needed use back of form
13. CASING: Wall Thickness LOCATION SKETCH
ighL/F ss
Depth Diameter or weighVFt. Material (Show direction and distance from at leas$two State.. .
From ', To Ft. - 119 Roads,or other map reference points)
From To —Ft.—
From To Ft. ~�
14. GROUT:
Depth Material Method '
From 0 To "0 Ft. ';:8r0e5' 'Ora" V F]W
From To Ft.
15. SCREEN:
Depth Diameter Slot Size Material, 6
ti
From To Ft. in. in.
From To Ft. in. in.
From To Ft. in. in.
16. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
17. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C,WELL
CONSTRUCTION STANDARDS,AND THAT A COPY OF THIS RECOR�DAJF/ty4S 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.

I
31 f2
WELL CONSTRUCTION RECORD
North Carolina-Department of Environment and Natural Resources-Division of Water Quality-Groundwater Section
WELL CONTRACTOR(INDIVIDUAL)NAME (print) �IA.SAS 6. it CERTIFICATION# --I (J()
WELL CONTRACTOR COMPANY NAME , D u,SSe-t IA.)eAl rI IIt 0�n L Wc PHONE # (C?-V6,3.7—4(ZS
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
1. WELL USE(Check Applicable Box): Residential Municipal/Public❑ Industrial❑ Agricultural
Monitoring❑ Recovery ❑ Heat Pump Water Injection❑ Other❑ If Other, List Use
2. WELL LOCATION: Topographic/Land setting
Nearest Town: County ❑Ridge ❑Slope ❑Valley BfIat
?Za,&,4f5, 7�Iil (check appropriate box)
(Street Name,NufAers,Community,Subdivision,Lot No.,Zip Code) Latitude/longitude of well location
.'. OWNER: (degrees/minutes/seconds)
Address Latitude/longitude source:❑GPS❑Topographic map
(Street or Route No. (check box)
C -W(4,S DEPTH DRILLING LOG
City or Town state Zip Code From To Forman nDescription
Area code-Phone number
4. DATE DRILLED 5— -
5. TOTAL DEPTH: 311Y r - Tr
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO F
7. STATIC WATER LEVEL Below Top of Casing: �S FT.
J (Use'+"if Above Top of Casing) --y —
8. TOP OF CASING IS_/ Z2Z FT.Above Land Surface* — <ll --
*Top of casing terminated atlor below land surface requires a '—
variance in accordance with 15A NCAC 2C.0118.
9. YIELD(gpm):_r_5_METHOD OF TEST a Ov
10.WATER ZONES(depth): ,
LOCATION SKETCH
11. DISINFECTION:Type- Amount j - Cufyy Show direction and distance in miles from at lcasi
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-C Ft. P V(,- R�,K.
From__,_To___Ft. _ p
From To FL _ _
13. GROUT: Depth Materials Method '
From—_y__To 20 FL
From To Ft. _-
14. SCREEN: Depth Diameter Slot Size Material
From_ To Ft. in. in.
From To_ Ft. in. in.
15. SAND.!GRAVEL PACK:
Depth Size Material
From_ To Ft. 1
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 AA COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
Submit the original to the Division of Water Quality,Groundwater Section,1636 Mail Service Center-Raleigh,NC
27699-1636 Phone No.[phone],within 30 days. GW-1 REV. 07/2001

North Carolina-Department of Environment and Natural Resources-Division of Water Quality-Groundwater Section 3146, 3 101
1636 Mail Service Center-Raleigh,N.C.27699-1636-Phone[phone]
WELL CONSTRUCTION RECORD WELL CONTRACTOR: Lto?i-E, '4'r,911A M`=1 Pun1P Co
WELL CONTRACTOR CERTIFICATION if:
0501 e3 Jr, yVilson-
STATE WELL CONSTRUCTION PERMITff: ef
1. WELL USE(Check Applicable Box): Residential ❑ Municipal ❑ Industrial ❑ Agricultural❑ Monitoring _.
Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use: _ I
2. WELL LOCATION:(Show sketch of the location below) t__
Nearest Town: ! FP!C11R County: :-M f i',V 1 !
�;.. f�l t i�c R:1T'C! Rfl (?gip['f}i ` ITT`;r'I • F=F,'��f� Cm C)FC. c"R I -
Inoatl Name and Numbers, ommunny,or Subd ision an or No.) -
DRILLING LOG DEPTH i r
3. OWNER `` I DRED C:RI fAR From To Formation''.Descr,ipm,_ ,
Address 75 7,iRT ai P
ISrree[or Dote No - - _�+
FA,R,.: F-C.,Llt ,
City or Town fate ip ode
+'R 711 `HAI c
4. DATE DRILLED 5•'2 200` 1114 2.I9 %
5. TOTAL DEPTH 2B5 2a9 2.5_ yaA IN;TE
6. CUTTINGS COLLECTED YES ❑ NO ❑ 3g ??: i_stANIT_F
7. DOES WELL REPLACE EXISTING WELL? YES ❑ NO F
8. STATIC WATER LEVEL Below Top of Casing: 3Q FT.
(Use',"if Above Top of Casing)
9. TOP OF CASING IS 1 FT. Above Land Surfaces c t€!
'Top of casing terminated at/or below land surface requires a variance in actor- C ,�:p- +
dance with 15A NCAC 2C.0118 1- *A,—
10. YIELD (gpm): O METHOD OF TEST H'r
11. WATER ZONES (depth): 1.00 pprin 11Q-1 i 1 5.00pprn ;MC-24C'
0.11 ppm 0.10pGm
12, CHLORINATION: Type t1TH Amount '17 If additional space is needed uh ac�grm
13. CASING: LOCATION SKETCH
Wall Thickness .'�
Depth Diameter or Weight/Ft. Material (Show direction and distance from at least two State i
From To 2.0 Ft. 6 1'8 350 PV(. Roads,or other map reference points)
From To Ft.
From To Ft. I
14. GROUT:
Depth Material Method
From U To 20 Ft. '=eman`
From To Ft.
15. SCREEN:
�
Depth Diameter Slot Size Material
From To Ft. in. in.
_ Y 'From To Ft. in. in.
From To Ft. in. in. �
�t
16. SAND/GRAVEL PACK: t�
Depth Size Material
From To Ft.
From To Ft.
17. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCO DANCE WITH 15A NCAC 2C,WELL
CONSTRUCTION STANDARDS,AND THAT A COPY OF THIS RECORD H S BEEN PROVIDED TO THE WELL OWNER.
FOR OFFICE USE ONLY
Quad No: SIGNAL- RE OF PERSON CONSTRUCTING THE WELL DATE
Submit original to Division of Water Quality,Groundwater Section within 30 days
GW-1 REV.12/99
Serial No.

North Carolina-Department of Environment and Natural Resources-Division of Water Quality-Groundwater Section 3 146
1636 Mail Service Center-Raleigh,N.C.27699-1636-Phone[phone]
WELL CONSTRUCTION RECORD WELL CONTRACTOR: Dewcv 0 urrm Co Ir}WELL CONTRACTOR CERTIFICATION#. 17 r r -
056183 STATE WELL CONSTRUCTION PERMIT#: a=rr tylisn
1. WELL USE(Check Applicable Box): Residential El Municipal 0 Industrial 0 Agricultural Monitorihd
Recovery F-1 Heat Pump Water Injection 0 Other El If Other, List Use:
I
2. WELL LOCATION: (Show sketch of the location below)
Nearest Town: [ rJ K. County: FILE•E
�i
Fvi^ � 1
(Rnad ameand Numbers,Community,or Subdivision and Lot olF DRILLING LOG DEPTH-
3. OWNER f,AARIA BRAnSHA'.%• From To Formation Descript11
ion._
Address =�� F3RiArJ EIC11_1C 44A5 BOi IC K' PI-1 , tiff ♦ RT cHAi P - _--
1 trees or Route No.l
i hJCtrm. -. :=HAI w r;n,;;n.u'
City or Town State Zip Code i77 G7 lR fI
Tp
4. DATE DRILLED 5j" ' '005 ^'p 4P.8 GRANITE -'31,JAR71 Z
5. TOTAL DEPTH fiiM 4R5 41R6 GPANITFF
6. CUTTINGS COLLECTED YES 0 NO E� 4R6 51r15 (RA iTF U -
7. DOES WELL REPLACE EXISTING WELL? YES E] NO 0 s- -
8. STATIC WATER LEVEL Below Top of Casing: c'.O FT.
(Use"+"if Above Top of Casing)
9. TOP OF CASING IS 1 FT. Above Land Surface* r�
Top of casing terminated at/or below land surface requires avariance in �
d r
dance with 1 NCAC 2J.01 at/or
YIELD (gpm): � 5 METHOD OF TEST
11. WATER ZONES (depth): rlPm s_t.00gono
0,00 gpm 0,00 qw, : ..
1Z CHLORINATION: Type HTH Amount SS If additional space is needed use back:af f`
13. CASING: Wall Thickness LOCATION SKETCH
Depth Diameter or Weight/Ft. Material (Show direction and distance from at least two State
From Q To 93 Ft. 6 LA .350 PVC Roads, or other map reference points)
From To Ft.
From To Ft. - t
R
14. GROUT:
Depth Material Method
From f1 To li) Ft. °"R:-nelt C-;rasb.F1oN�i �,, i i
From To Ft.
15. SCREEN: f
t41
Depth Diameter Slot Size Material
From To Ft. in. in.
From To Ft. in. in.
From To Ft. in. in. \�
U
16. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
17. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C,WELL
CONSTRUCTION STANDARDS,AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER.
FOR OFFICE USE ONLY
SI TURE OF PERSON CONSTRUCTING THE WELL DATE
Quad No: Submit original to Division of Water Quality,Groundwater Section within 30 days
GW-1 REV. 12/99
Serial No.

North Carolina -Department of Environment and Natural Resources-Division of Water Quality-Groundwater Section 0 3 5 3 1 S
1636 Mail Service Center- Raleigh, N.C.27699-1636-Phone[phone]
WELL CONSTRUCTION RECORD WELL CONTRACTOR: L'e°reff 't'�R` 11 Fur"IP C0 ,
WELL CONTRACTOR CERTIFICATION#: 26E 1
G50175 STATE WELL CONSTRUCTION PERMIT#: =te4C P=bY
1. WELL USE(Check Applicable Box): Residential 0 Municipal 0 Industrial 0 Agricultural 0 Monitoring 0
Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use:
2. WELL LOCATION:(Show sketch of the location below)
Nearest Town: LENOIR County: "LGt'd'x'ELL
PVT. QR OFF SR 1790 BRUSH NiTNI. RO. OFF HV" 90 0
(Road Name and Numbers,Community,or Subdivision and Lot No.) DRILLING LOG DEPTH
3. OWNER DAVID A.BEW ATH'v' From To Formation Description
Address 't11FEiTf-!Nt'if?t,1.4�.i 'iFU t.+�t.k-S izOFK RD 11 2J L'?!RT
LEhi�R ( treetor hours,No,; NC 2SC45 25 55 GRANITE
City oror Town State Zip Lode
55 57 •:H. i F _
4. DATE DRILLED 7V2005 57 140 GPANlTE
5. TOTAL DEPTH 205 1d0 142 SFL..LE
6. CUTTINGS COLLECTED YES 0 NO 0 142 185 L'RAPJ T=
7. DOES WELL REPLACE EXISTING WELL? YES 0 NO 0 185 167 SHALE
8. STATIC WATER LEVEL Below Top of Casing: 20 FT. 187 21135 GRANITE r--��
(Use'+"if Above Top of Casing) �r-
9. TOP OF CASING IS 1 FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a variance in actor- -.
dance with 15A NCAC 2C.0118
10. YIELD (gpm): +.G METHOD OF TEST str
s$i
11. WATER ZONES(depth): 5.00 gpm 55-`r'7 2-R6ppm 140-142
82 00 ppm 185-187 0 Goppm
12. CHLORINATION: Type HTH Amount 39 If additional space is needed use back of form
13. CASING: wall Thickness LOCATION SKETCH
Depth Diameter or Weight/Ft. Material )�/�i-ow direction and distance from at least two State
From 0 To � 1 I_0 Ft. 5 .i5n PVCN Roads,or other map reference points)
From To Ft.
From To Ft.
14. GROUT:
Depth Material Method L
From n To 20 Ft. 'Oerrient vrasrty Flow fit'
From To Ft.
15. SCREEN: �: ,ui(
Depth Diameter Slot Size Material
From To Ft. in. in. -
From To Ft. in. in.
From To Ft. in. in.
16. SAND/GRAVEL PACK:
Depth Size Material
h
From To Ft. t
f
From To Ft. ryj tl NG)'x7 r
�., F1u FawxG
17. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C,WL
CONSTRUCTION STANDARDS,AND THAT A COPY OF THIS RECORD HJ BEEN PROVIDED TO THE WELL OWNER.
FOR OFFICE USE ONLY "
SIGNATURE OF PERSOW60NSTRUCTING THE WELL DATE
Quad No: Submit original to Division of Water Quality,Groundwater Section within 30 days
GW-1 REV.12199
Serial No.

North Carolina-Department of Environment and Natural Resources-Division of Water Quality-Groundwater Section
1636 Mail Service Center- Raleigh,N.C.27699-1636-Phone[phone]
WELL CONSTRUCTION RECORD WELL CONTRACTOR: l ervey` vnght V`'eli Pump `o '"c'-
WELL CONTRACTOR CERTIFICATION#: 2681
L150280 STATE WELL CONSTRUCTION PERMIT#: Steve Fetty
1. WELL USE(Check Applicable Box): Residential Q Municipal ❑ Industrial 0 Agricultural 0 Monitoring E] _
Recovery F-1 Heat Pump Water Injection E] Other ❑ If Other, List Use:
2. WELL LOCATION: (Show sketch of the location below) - -_
Nearest Town: LE NO!R County: CALD'r/VElL
L TTL E ROCK CANYON RD. OFF WHITE ROCK RD. rrF
(Road Name and Numbers,Community,or Subdivision and Lot No.) _.'.l
DRILLING LOG DEPTH
3. OWNER DC')'AZD L GRAY From To Formation Description
Address 3.541 KENNECtY HOME RE) 0 ,5, MIRT
_4GRAt,I a_ et or Route No.) r.7C' 2•a'ts51 45 62 3PATNITE
City or Town State Zip Code
t;2 63 St-TALE _. ... r
4. DATE DRILLED 6 22/2005 63 27�1 GRANITE
5. TOTAL DEPTH 305 27`J 272 A" •r
6. CUTTINGS COLLECTED YES 0 NO 0 272 345 CsRAfLITE
7. DOES WELL REPLACE EXISTING WELL? YES EI NO
B. STATIC WATER LEVEL Below Top of Casing: 20 FT.
Use"+"if Above Top of Casing)
9. TOP OF CASING IS 1 FT.Above Land Surface*
'Top of casing terminated at/or below land surface requires a variance in accor-
dance with 15A NCAC 2C.0119
10. YIELD (gpm): 20 METHOD OF TEST Rir
11. WATER ZONES (depth): 1.00 porn62-63 19.00gpm 270-2 2
0 00 pom 0.00mm
12. CHLORINATION: Type I"TrH Amount 53 If additional space is needed use back of form
13. CASING: Wall Thickness LOCATION SKETCH
Depth Diameter or Weight/Ft. Material (Show direction and distance from at least two State
From O To 50 Ft. 6 '118 . � r'�VC�� ; Roads,or other map reference points)
From To Ft.
From To Ft.
14. GROUT: �}
Depth Material Method
From 0 To 20 Ft. Cement Sraviit% Flo1•v play vt,c>u°';
From To Ft. Fol
15. SCREEN:
tb J.
Depth Diameter Slot Size Material
From To Ft. in. in.
From To Ft. in. in. T ;-
From To Ft. in. in.
16. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.17. REMARKS: �.�.
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCO R NCE WITH 15A NCAC 2C,WELL
CONSTRUCTION STANDARDS,AND THAT A COPY OF THIS
SRRECORD
HAS BEEN PROVIDED TO THE WELL OWNER.
FOR OFFICE USE ONLY
SIGNATURE OF PER ON CONSTRUCTING THE WELL DATE
Quad No: Submit original to Division of Water Quality,Groundwater Section within 30 days
GW-1 REV. 12/99
Serial No.

North Carolina-Department of Environment and Natural Resources-Division of Water Quality-Groundwater Section G)
1636 Mail Service Center-Raleigh, N.C.27699-1636-Phone[phone] x
WELL CONSTRUCTION RECORD WELL CONTRACTOR: Dewey Vrrlghlt x'4'ell Punnp Cs ,
WELL CONTRACTOR CERTIFICATION#: 58"
050325 STATE WELL CONSTRUCTION PERMIT#: SteyE Petty
1. WELL USE(Check Applicable Box): Residential ❑ Municipal❑ Industrial ❑ Agricultural❑ Monitoring ❑
Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use:
2. WELL LOCATION:(Show sketch of the location below)
Nearest Town: RI OWING RQC'K _ County: _Al DIA171 I
DL1FFO tBF?C 7FF H
oRty,or5uR
#" Rff_b m son
DRILLING LOG DEPTH
3. OWNER BOB VUA7iS/JEFF JONES From To Formation Description
Address 0A MOD RNW RKS L C 858'' PALLJEP PARK ,'"_' Rf 0 25 r r'•P7
SARA5r.7,Hee,or Route No.) FL 34+238 25 23 CRA[Ii E
CN or Tcwa stare rP oae g.2 84 SHple
4. DATE DRILLED 7/12120L15 84 E05 GRANITE: UULKZ
5. TOTAL DEPTH 505
6. CUTTINGS COLLECTED YES ❑ NO EJ
7. DOES WELL REPLACE EXISTING WELL? YES ❑ NO
8. STATIC WATER LEVEL Below Top of Casing: =0 FT.
(Use"+"If Above Top of Casing)
9. TOP OF CASING IS 1 FT.Above Land Surface*
-Top of casing terminated at/or below land surface requires a variance in accor-
dance with 15A NCAC 2C.0118
10. YIELD (gpm): .1 METHOD OF TEST `-'r
11. WATER ZONES (depth): -1.00 ppm83-84 0.00ppm
0.00 opm 0.00opm
12. CHLORINATION: Type HTH Amount 64 If additional space is needed use back of form
13. CASING: Wall Thickness LOCATION SKETCH
Depth Diameter or weightlF[. Material (Show direction and distance from at least two State
From 0 To 32 Ft. a 1.'B .35_ PVC Roads,or other map reference points)
From To Ft. Lito'Ir
From To Ft.
14. GROUT:
Depth Material Method' f
From 0 To 20 Ft. Cement Oravity Flow .........�-- / r
From To Ft.
15. SCREEN:
Depth Diameter Slot Size Material n\
From To Ft. in. in.
From To Ft. in. _ in.
From To Ft. in. in. +`
16. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
17. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C,WELL
CONSTRUCTION STANDARDS,AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER.
FOR OFFICE USE ONLY JJ
SIGNATURE OF PERSON.GONSTRUCTING THE WELL DATE
Quad No: Submit original to Division of Water Quality,Groundwater Section within 30 days
GW-1 REV. 12/99
Serial No.

'
1
North Carolina-Department of Environment and Natural Resources-Division of Water Quality-GroundwaterV Sechon 0 .L � � t
1636 Mail Service Center-Raleigh,N.C. 27699-1636-Phone[phone]
WELL CONSTRUCTION RECORD WELL CONTRACTOR: Gevmv`.vHCM I vE+l
WELL CONTRACTOR CERTIFICATION#: L
0031` STATE WELL CONSTRUCTION PERMIT#: Ste:e t-etty
1. WELL USE(Check Applicable Box): Residential El Municipal E] Industrial 0 Agricultural 0 Monitoring 0
Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use:
2. WELL LOCATION:(Show sketch of the location below)
Nearest Town: L EN01R County: CALD'AELL
'e"y lrLi_ilFt OFF LEV RD pFF l pl_ ,1 KNOB RD 'OFF HV�d�(
iFnad Name and Numbers, ommumty,or�`ub rvision and Lot o.) DRILLING LOG DEPTH
3. OWNER BBB ',vyA'TS'rJEFF JONES From To Formation Description
Address °6 MOpERF"NQR4�S LLO 8f82 FALMERrs ri(?t; C ;F n)cr
aA $��� -yree[or Poute No., FL 130 CiRAIATE
ity or awn tale Zip ode 130 !31 QUARTZ
4. DATE DRILLED T'20/2005 131 %P' ORANITE
5. TOTAL DEPTH 705 ct4 C135 SH.ALFJQUfART'_ ',
6. CUTTINGS COLLECTED YES El NO 0 E65 705 R.4"di C
7. DOES WELL REPLACE EXISTING WELL? YES 0 NOEEI
8. STATIC WATER LEVEL Below Top of Casing: FT.
(Use',"if Above Top of Casing) G 1
9. TOP OF CASING IS 1 FT. Above Land Surface* N -
'Top of casing terminated at/or below land surface requires a variance in actor- -
dance with 15A NCAC 2C.0118
10. YIELD(gpm): S METHOD OF TEST A1r c31
11. WATER ZONES (depth): 0.50 ppm 1�1-131 7.50Apm 664-665
0,00 cipm 0,00ppm
12, CHLORINATION: Type 114TH Amount 113 If additional space is needed use back of form
13. CASING: Wall Thickness LOCATION SKETCH
Depth Diameter or Weight/Ft. Material ' fl5how direction and distance from at least two State
From 0 To 42 Ft. i 31/8 i�.,..SO V �s'Uc Roads,or other map reference points)
From To Ft.
From To Ft.
14. GROUT: II
Depth Material Method /
From 0 To 29 Ft. Cement Gravity Flor+f ` )
From To Ft.
15. SCREEN:
Depth Diameter Slot Size Material
From To Ft. in. in.
From To Ft. in. in. r..--��'
From To Ft. in. in.
Esc
16. SAND/GRAVEL PACK: ! �y
Depth Size Material `t it \
From To Ft. -
From To Ft. -
� S lIv
17. REMARKS: ACCORD\1' Vic'
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ANCE WITH 15A NCAC 2C,WELL
CONSTRUCTION STANDARDS,AND THAT A COfPYY`J�OFF�rTH.I.S RECORD H BEEN PROVIDED TO THE WELL OWNER.
FOR OFFICE USE ONLY
SIGNATURE OF PERSOMICONSTRUCTING THE WELL DATE
Quad No: Submit original to Division of Water Quality,Groundwater Section within 30 days
GW-1 REV.12/99
Serial No.

North Carolina-Department of Environment and Natural Resources- Division of Water Quality-Groundwater Section e3
1636 Mail Service Center-Raleigh,N.C.27699-1636-Phone[phone]
WELL CONSTRUCTION RECORD WELL CONTRACTOR: Dewey t'"nq tt'A!ET F'i.Irrip Co., 'no.
WELL CONTRACTOR CERTIFICATION#:
ev'd1
0503241 STATE WELL CONSTRUCTION PERMIT#: Ste''y r e45'
1. WELL USE(Check Applicable Box): Residential ❑ Municipal ❑ Industrial ❑ Agricultural❑ Monitoring ❑
Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use:
2. WELL LOCATION:(Show sketch of the location below)
Nearest Town: LE.NOIR County: CALDWELL
t✓ELL#2 OFr f EV. ZD tFF Kcl CKY IN 9 :R'D ��FF H
(Road ameantl umbers,Communiry,or udivisionandLotNo.l DRILLING LOG DEPTH
3. OWNER 9'79 'WATTS,`.JEFF Jt0f ES From To Formation Description
Address t' c1EFR^1e^.rORF L C 8" �'A ,I P PAPr
,� {reef or Route Na.) l FL . 's6 �� E2 + pAANI'E
City or Town A� H State lode !37 {sR u.PdITE
4. DATE DRILLED -V18;2006 "30 131 SHALE
5. TOTAL DEPTH 5^5 t21 33 L5 GRANITE
6. CUTTINGS COLLECTED YES ❑ NO ❑ 340 342, cuAl F
7. DOES WELL REPLACE EXISTING WELL? YES ❑ NO ❑ �!a 5n5 !-:Gr,nIl11=
8. STATIC WATER LEVEL Below Top of Casing: 140 FT.
(Use","if Above Top of Casing)
9. TOP OF CASING IS ) FT. Above Land Surface*
*Top of casing terminated at/or below land surtace requires a variance in accor-
dance with 15A NCAC 2C.0118
10. YIELD (gpm): 19 METHOD OF TEST Air
11. WATER ZONES (depth): 1,00 porn82-83 1.00ppm 13C+-131
4 DG prim 34 0-42 G.GOcaprn
KITH If additional space is needed use back of form
12. CHLORINATION: Type Amount 7,5
13. CASING: Wall Thickness LOCATION SKETCH
Depth Diameter or Weight/Ft. Material (Show direction and distance from at least two Stale
From O To =1 Ft. P 1!B Roads,or other map reference points) r
From To Ft.
From To Ft.
14. GROUT:
Depth Material Method
From 0 To 20 Ft. Cement Gravity I'loyvI
From To Ft. 1
15. SCREEN: �
Depth Diameter Slot Size Material
From To Ft. in. in.
From To Ft. in. _ in.
From To Ft. in. in. .�'�°�/' \r� -
16. SAND/GRAVEL PACK:
Depth Size Material `AL k �� f)
From To _ Ft. 1k511-3
From To _ Ft.
17. REMARKS: '\
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH)5A NCAC 2C,WELL
CONSTRUCTION STANDARDS,AND THAT A COPY
OOFFTHIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER.
FOR OFFICE USE ONLY S"_—� J��
SIGNATURE OF PERSOWCONSTRUCTING THE WELL DATE
Quad No: Submit original to Division of Water Quality,Groundwater Section within 30 days
GW-t REV.12/99
Serial No. _

WL'LL l:V1V.l11CU1;11 � !r KJN:I:Vltl)
North Carolina-Department of Environment and Natural Resources- iviSi,o1/►of Water Quality-Groundwater Section
WELLCONTRACrOR(INDIVEDUAL)NAME (print) ILOel �(K!C CERTIFICATION 077 ,l,
WELL CONTRACTOR COMPANY NAM &- P e &. PHONE N f 1���._�7
STATE WELL CONSTRUCTION PERMrr# A�9 Y67(7
CIATED WQ PE 0
(if applicable) (if gplicabie)
1. WELL USE(Check Applicable Box):Residential Br'Municipal/Public❑ Industrial❑ Agricultural❑
Monitoring❑ Recovery ❑ Heat Pump Water Injection❑ Other❑ If Other,List Use
2. WELL LOCATT N:
N st Town: County Topo c/L and setting
❑Ridge 18Siope ❑Valley ❑Flat
Z (Q
(Snot Name,Numbers,C Acid stumpof �)
0°'mn01ty'�'�iv 0°'�1'iO'Zip�) Latinde/longitude of well location
3. OWNER: ' ^ (tle)petaJmimttes/secwde)
AddressAV/s i, , . i yti LatitudeAongit de sotsce:❑GPS❑Topographic map
(Street or Rome No.)
/1u �/ (check box)
City or Town state Zip ( 5 DEPTHDRII T ING LOG
From To Formation Description
Am code-Plane rnm
4. DATE DRILLED
5. TOTAL DEPTH: SG —/ f:?.
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO WS o
7. STATIC WATER LEVEL Below Top of Casing: FT.
(Use-+-if Above Top of Casing) -
S. TOP OF CASING IS FT,Above Land Surface'
'Top of casing terminated Wor below land surface requires a
variance in accordance with 15A NCAC 2C.011& ` O
9. YIELD(gpm):-Z�METHOD OF TESTJ.m e a(
10.WATER ZONES(depth):
LOCATION IL CH
11. DISINFECTION:Type CC Amount /7 0 Show direction and distance in miles from at least
12. CASING: Wall Thickness two State Roads or County Roads.Include the road
From_� or Wei tit Material numbers and common road names.
To-20 Ft
From To FL
From TO Ft
13. GROUT: Depth M Mvdzod
e
From, To 2.O FtC /'t' wet ?
From To Ft
14. SCREENr:,,/ Depth Diameter Slot Size Material
From__ !!J To FL in, in, t�-----.11
From..T To,-Ft in. in.
15. SAND/GRAVEL PACK:
From�Depth Sim Material �.
To Ft.
From To Ft. (�/-
16. REMARKS:
I DO HEREBY CERTIFY THAT=OF
NSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C,WI:T.L
CONS ON STANDARD OF THIS RD HAS BEEN PROVIDED TO THE WELL OWNER
_ Z _ 0
S 71CONSIRUCITNG THE WELL DATE
Submit the original to the Division of Water Quality,Groundwater Section,1636 Mail Service Center-Raleigh,NC
27699-1636 Phone No.[phone],within 30 days. - GW-1 REV.07/2001

I
tRESIDENTIAL WELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources-Division of Water Quality
WELL CONTRACTOR CERTIFICATION# 7 5 A 6
I.WELL CONTRACTOR: t. DISINFECTION:Type Amount I?
Ashley T. Moretz g. WATER ZONES(depih):
Well Contracla(InolWouat)Name From i 9STp,�dO From 7p
M )—11z W P 1 1 Dr 1 1 1 i n 9 From 7o From 70
Well Contractor Company Name From To Fran To
STREET ADDRESS 6159 HWY . 10 West 6. CASING: Thickness/
Hickory NC 28602 Fro -2O Tph
t ZFt." M 'G
Clty a Town State Zip Coda�� Fr011 To Fl,
7( Q4 J___ 4(j2— 1 From Ft
Area Dodo Phdfe number
2.WELL INFORMATION: 7, GROUT: ^Depth Material Method.
SITE WELL ID#(if applicable) FromTO{/ To�Ff. as
FmmI_To Fl.
STATE WELL PERMIT#(d applicaNe) -Al 17 From To Ft.
DWQ Or OTHER PERMIT#(it applicable) /1/%7 a. SCREEN: Depth Diameter Slot Size M ia)
WELL USE(Check Applicable SPA); Residern ia)Water Supply p From
9' ,2 S-0. Fla To F In. � C1
DATE DRILLED d. From _TOTE Ft _
TIME COMPLETED _ 6 r�� AM�PMD �-
9, SAND/GRAVEL PACK:
3.WELL LOCA ON: Depth Size Material
CITY: p� etS ofCOUN7Y4lC- F 1.
CIWe fo Ja dr Frdn TO
(Sheet None,Nurnorim Canmuirl SMDdiNsbn,LW Np„pi Zip
TOPOGRAPHIC I LAND SE�1ryyNG: 10.DRILLING LOG
QSPpe pvaltey ❑Fiat MKIW OOfber From To F iTn n De
(check aPPoPngbbW Des to
T— 22 .l`r Ej01 rG
!! 9 MayLATfrUDE 3 • /LONGITUDE$ L !.yo/
Latitudelongival sole 04"IfS ❑Topographic reap
(location of we&must be shown on a USGS topo map and n
attached to this form rnu us nit GPS)
a.WELL OWNER /J 1
OWNER'S NAME�/�Ae—070TWA— W
STREET ADDRESS
�r _ Yin
City or Town Stale Zip code
�—}
Area code, Phane number
11. REMARKS:
5,WELL DETAILS:
a. TOTALDEP7H: /
It, DOES WELL REPLACE EXISTING WELL? YES❑ NO W
_ DOHEREBY CERTIFY TNATTNIS WELL WAS CONSTRUCTED N ACCORDANCE W ITN
c. WATER LEVEL Below Top of Casing: O FT- I'M NCAC 2C,WELL CONSTRUCTrON$TANDARPS.AMP THATA COPY OF THIS
(Use'."d Abwe Top of Caeing) RECONO NAB eEN PROVIDED TOTHE WELL OWNER
d. TOP p CASING IS FT,Atsu Land ayrequir .I1 �'73-Ox
'Top d casing terminated WUw babes land 2C'Oi may require SIGNATURE ER IFIEC W ELL CON RACTOFR w DATE
a variance in a�yq/d�ance with 15A NCAC 2C.011 1 /� � p/�`/�
e. YI6tD(gpm)�_/,a( --METHOD OF TEST I1 I II'Z�It ✓ ,+ '"T2/ t y4
PRINTED NAME 9F PERSON CONSTRUCTING THE WELL
Submit the original to the Division of Water Quality within 30 days A#n.-lnforg+atlon mgiL
1617 Mail Service Center-Raleigh,NC 27669-1517 Fhone NO,(e18)7337015eAt 568. Form GW-ter
Rev.7105
Sd WFi9T :90 S00Z 02 'daS ZZ£TZ97b0L 'ON XHd dWfld 8 i-13M Zl3NOW WONJ

r WELL CONSTRUCTION RECORD
j c-North'Carolina-Department of Environment and Natural Resources-Division of Water Quality-Groundwater Section
i1 L W ELIJCONTRACTOR(INDIVIDUAL)NAME (priuQ� � 4/ W A 1<><�(w Mn CERTD7CATION# J O 36
14, HELLICON'iRACTORCONIPANYNAbIE Yadkin Well CanPanY Inc. _PHONE # [phone]
� STA WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMrr#
tom", I{if applicable) if applicable) -
� v 1
I. W f.L t)SE(Check Applicable Box):Residential fi3l-'MunicipaVPublic❑ Industrial❑ Agricultural❑
i _=Momtorirtg❑ Recovery ❑ Heat Pump Water Injection❑ Other❑ If Other,List Use
� _
!-------2:—W ELL LOCATION: TO �P hic/Land setting
Nearest Town: (BAoty County. ❑Ridge I�Slope ❑Valley ❑Flat
Go l3 Lga, l�r.lh 2 a (check appropriate box)
(Street Namc,Nuurn n,Community,,Subdivision,Lot No.,Zip Code) Latitude/longitude of well location
3. OWNER: Sill C e (degrees/minutes/seoonds)
Address -O 9 Z L �� P1 Latitude/longitude source:❑GPS❑Topographic map
(Street orRobe NoJ (check box)
L Cn ui f^ AIC . Z % �� DEPTH DRILLING LOCr
City or Town state Zip Code From To , Formation Description
( - _75_K- J 46S C) — NS o ` _:
Area code-Phone number �J„[t— /82 -0f }(,
4. DATE DRILLED
5. TOTAL DEPTH:
6. DOES WELL REPLACE EXISTING WELL? YES❑ NO We —t
7. STATIC WATER LEVEL Below Top of Casing: -�40 _FT. ,,.,, -
(Use"+"if Above Top of Casing)
8. TOP OF CASING IS I FT.Above Land Surface*
*Top of casing terminated at/or below land surface require a —
variance in accordance with 15A NCAC 2C.011& ^3
9. YIELD(gpm): .2 d METHOD OF TEST air pump Ri t gpri al # size off
10.WATER ZONES(depth): /�7 ��ao, .T02TS — /01 U
LOCATION SKETCH
11. DISINFECTION:Type HTH At otmt 1 COPS Slow direction and distance in miles from at least
12. CASING: Wall Thicknbss two State Roads or County Roads.Include the road
Depth Diameter or weight/Ft. Material numbers and commgn road names. �,
From t To f0 Ft. 1J s®�-11 PUZ 11 T_�` ���k X
From To Ft. WU
A)+V�
From To Ft. Lim
13. GROUT: Depth Material Method .1• oy� `u.41�7
From D To 3 Ft./yc.,f �. ,Yt f/ .14
From 3 To .2 4 Ft. Btn�on:><t. 4M
14. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in. ('kLaj
From To Ft. in. in.
15. SAND/GRAVEL PACK: 40.JDepth Size Material1
From To Ft.
From To Ft.
((��
/ k1 II (stldwcli I W�Ikr)
16. REMARKS: �t �b :6ir& DYun' Wtt w d;i/c •-L K
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C,WELL
CONSTRUCTION STANDARDS,AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
Submif the original to the Division of Water Quality,Groundwater SectioD,1636 Mail Service Center-Raleigh,NC
27699-1636 Phone No.[phone],within 30 days. GW-1 REV.07/2
Date site visited �'-. o-o r by b5t3 Permit needed yeses (1 y
del," B ��
well

ca
WELL CONSTRUCTION RECORD J `d
Nord,Carolina-Depastruent of Environment and Natural Resources-Division of Water Quality-Groundwater Section
wzLLcoNTRACroa(amtvmoAUNAxEbri.q JE[W WCKM CMMCanOna2452
wzLLCoN ItAcroiaCompAtarNAsu 12aMWEIT. I32 LUU (D. Paom a (8A 324•0035
STATIC wBdd,CONMUCTION PE112111" ASSOCIATED WQ PICIUM9
(ifapplitebk) Gfamiiceme)
1. WELL USE(Check Applicable Box):Residentialig MunicipaliPublic D Industrial❑ Agricultural❑
Monitoring O Recovery D Heat Pump Water Injection O Other O MOther,Liu Use
2. WELL LOCATION: TopogrWhica-md settiDg
NearedToom- IMIR County CflI1x+ZrT-I, DRidge DSlope OVallay OFlat
9777 SEMIS ME Ell_ (raedc bent)
(Sued Name,Nmobv%Commimay.Subdivisiao.la No.,Zip Code) Latitude/longitude of well location
3. OWNER F�1�f13>&tkPII�)3tIT(E (agreerr.imsdseooads)
Address 2777 SFI7FRS J+P ice. Ladmdenougii de sot rtocco 3PSOTopognphic map
PP ( �
City or Tom Sun zip Cods From To Formation Description
62 )' 797-1164
Arnwda•Phone aambar
4. DATE DRILLED 07 25-05
5. TOTAL DEPTH
6. DOES WELL REPLACE EXISTING WELL? YESIM NO ❑
7. STATICWATERLEVELBeIowTOpofCesng•. 80 1•T. C
(Use-+-if Above Top of(>diov
8. TOP OF CASING IS 2 FT.Above Lard Surface'
*Top of Coming m`aardsOwbdwrladaarfawa rgsa+se
varira■amaeWa adtb ISANCAC=C.N1i -�
9. YIELD(gpm): 1•5 METHOD OFTEST SY AIR IFSI en
10.WATER ZONES(depth): LOCATION SKETCH
11. DISINFECTION:Type jM 7YIRS Amount 89 Show direction and distaone in haiku from at hest
12. CASING: Wall 7likkaam two State Roads or County Roads.Include the road
nimpauff W Bombers said mad minas.
Fromm 0 To�-:qi A �d w EW
From_To FL /1
From—To FL
13. GROUT: Depth Material Method IiZ) 14�
Front_Q_T0_-20—FL GR TT R71WD
From To FL
14. SCREEN: Depth D'nmeier dot Sias Material
From To Ft.—jn. in.
From_ To Ft._in. in. Jp(//
15. SAND/GRAVELPACK two
P Sin Material r
From_ To Ft
From To FLU
16. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH ISA NCAC 2C,WELL
CONSTRUCTION STAND AND THAT A COPY OF THIS RECOffi HAS BEEN PROVIDED TO THE WELL OWNER
07-27-05
TURN OF PERSON CONSTIKFIT140 THE WELL DATE
Submlt the original to the Divhdon of Water Quality,Groundwater Section,1636 Mail Service Center-Raleigh,NC
2709-1636 Plane Net(919)733-Mi,within 30 days. GW-1 REV.07/2001

O
WELL CONSTRUCTION RECORD
North Carolina-Department of Environment and Natural Resources-Division of Water Quality-Groundwater Section
WELL CONTRACTOR(INDIVIDUAL)NAME (print) (�� R I, l� CERTIFICATION# v2., /
WELL CONTRACTOR COMPANY NAME LL_-.SC- (I Ly'P_0 h I I n< I. PVC PHONE #
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
I. WELL USE(Check Applicable Box): Residential M"Municipal/Public ❑ Industrial ❑ Agricultural ❑
Monitoring❑ Recovery ❑ Heat Pump Water Injection ❑ Other❑ If Other, List Use
2. WELL LOCATION: r Topographic/Land setting
Nearest Town: County O.Z't ,ea. fKidge ❑Slope ❑Valley ❑Flat
(check appropriate box)
(Street Name,Numbers,Community,Subdivision,Lot No.,Zip Code) Latitude/longitude of well location
.'. OWNER:_ (degrees/minutes/seconds)
Address .4 !3 �L 2[ Latitude/longitude source:DGPSOTopographic map
c (Street or Roue.No.) (check box)
N
`Y1 L' DEPTH DRILLING LOG
Citvor Town State Zip Code - From To Formation Description
( -- 9,«l - .2 R G��— 70� cici t
Area code-Phone number
4. DATE DRILLED_
5. TOTAI.DEPTH:_3
6. DOES WELL REPLACE EXISTING WELL? YES D NO F3' rn
T STATIC WATER LEVEL Below Top of Casing: 470 FT. — rri �_-
I (Use"+"if Above Top of Casing)
8. TOP OF CASING IS i FT. Above Land Surface* N --
"Top olcasing terminated at/or below land surface requires a ---
variance in accordance wins 15A NCAC 2C.0118.
9. YIELD(gpm):. METHOD OF TEST Q-t lz
10. WATER ZONES(depth):
LOCATION SKETCH
11, DISINFECTION:Type_j4 T H Amount I -CA?.1.2z Show direction and distance in miles from at leasr
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 (I To_--!7Jr Ft, PVC' "
From _To Ft. /
Prom To Ft. _ _
13. GROUT: Depth Material Method
Fromm—__ To_.k FL Jndyyyi(�
From_ _To_ Ft.
14. SCREEN: Depth Diameter Slot Size Material
From_ To Ft. in. in.
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From_ To _FU
From To FL_ O
16. REMARKS:
1 DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED 1N ACCORDANCE WITH l5A NCAC 2C,WELL
CONSTRUCTION STANDARDS.AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE'
Submit the original to the Division of Water Quality,Groundwater Section,1636 Mail Service Center-Raleigh,NC
27699-1636 Phone No.[phone],within 30 days. GW-1 REV.07/2001

n
310J3a
WELL CONSTRUCTION RECORD
North Carolina-Department of Environment and Natural Resources- Division of Water Quality-Groundwater Section
WELL CONTRACTOR(INDIVIDUAL)NAME (print) C lyd sE CERTIFICATION# )L231
�7
WELL CONTRACTOR COMPANY NAME t tt s'�o LI f,Ie.IL 17 r, ll n� 1.Nc- erloNe # (r43 'In.i3-.365'8
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable) _ (if applicable)
1. WELL USE(Check Applicable Box): Residential R"Municipal/Public ❑ Industrial❑ Agricultural ❑
Monitoring❑ Recovery ❑ Heat Pump Water Injection ❑ Other❑ If Other,List Use
2, WELL LOCATION: Topographic/Land setting
Nearest Town: 41IJ-4-_�1.J County ❑Ridge lope ❑Valley ❑Flat
3IL' (check appropriate box)
(Street Name,Numbers,Community,Subdivision,Lot No.,Zip Code) Latitude/longitude of well location
3. OWNER- s 7U degrees/minuteslseconds)
Address ��; Latitude/longitude source:OGPSOTopographic map
(Street or Ro to No.) (check box)
r, DEPTH DRILLING LOG
City or Town State Zip Code - From To Formation Description
(8 ) '7A r� - l 43 ! 47 f �� 7
Area code-Phone numberZ'
4. DATE DRILLED��(o
5. TOTAL DEPTH: 4 aO
6. DOES WELL REPLACE EXISTING WELL? YES O NO C3
7. STATIC WATER LEVEL Below Top of Casing: 40 FT. --m
J/ (Use"+"if Above Top of Casing) -0
8. TOP OF CASING IS_J Z FT. Above Land Surface* ---------
*Top of casing terminated at/ur below land surface requires a
variance in a.cordance with 15A NCAC 2C.0118. - ---
9. YIELD(gIi_ _METHOD OF TEST &af1.
10.WATER ZONES (depth):_. 4 20 f --
LOCATION SKETCH
11. DISINFECTION: Type-_J±j 'f Amount /3._ „ Show direction and distance in miles from at least
12. CASING: Wal(Thickness two State Roads or County Roads.Include the road
Depth Diameter or Weight/Ft. Material numbers and common roa tames.
From__To___4_7_Ft. VC_ �� I/ { .
From___To—_—_Ft.
From To Ft. _ _
13. GROUT: Depth Material Method
From__0 To FL T,liwLe
From To Ft. _. a,� .H�,`yrl. OA 41N,
14. SCREEN: Depth Diameter Slot Size Material t
From_ To Ft. in. in.
Front__To_ _Ft. in. in.
15. SAND/GRAVEL.PACK:
Depth Size Material tx
From_ To _Ft.-
From.—To—FL_ "O
I
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
CA
✓ V SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
Submit the original to the Division of Water Quality,Groundwater Section,1636 Mail Service Center-Raleigh,NC
27699-1636 Phone No.[phone],within 30 days. GW-1 REV. 07/2001

North Carolina-Department of Environment and Natural Resources-Division of Water Quality-Groundwater Section 6� T. 0 `?. (i !'
1636 Mail Service Center- Raleigh, N.C. 27699-1636-Phone [phone] 5 1 0 U et
WELL CONSTRUCTION RECORD WELL CONTRACTOR: Dewe'v'`'+rght`010 V-'-iTno CO., In'-,
WELL CONTRACTOR CERTIFICATION#: 2k2'
050r;9Z ' STATE WELL CONSTRUCTION PERMIT#: -ite'e Ply -_
1. WELL USE(Check Applicable Box): Residential EA Municipal E] Industrial El Agricultural ElMonitoring E
Recovery 0. Heat Pump Water Injection Other 0 If Other, List Use:
r�
2. WELL LOCATION: (Show sketch of the location below) _
Nearest Town: RI f-WVtN; County: rrAi L.,.R. I
v14`rNatN and nrRFr. Att[i F'
(Roatl Name Numbers,Community,or 8ubdimsion and Lot No.l ri
DRILLING LOG DEPTH.
3. OWNER SAr,rd F r'GFF�s =,7,4 iFes, ' (" From To Formation Description
Address °'„ F7011a.dOCK raMi Nt R!-. n 0..11 r}I,RT
y nlry�I��ISheet or 'oute No.�
i=F�...�r, /, JF.' 'T
City or Town i §tate ip one
L.9 CIF
4. DATE DRILLED7tannn ,F. - 1�;1•C� ;.,I ,eiE;,-,
5. TOTAL DEPTH of IF
6. CUTTINGS COLLECTED YES E] NO _ f
7. DOES WELL REPLACE EXISTING WELL? YES 0 NO F71
8. STATIC WATER LEVEL Below Top of Casing: ,9n FT. o- if
(Use"+"if Above Top of Casing) _ �y�''
9. TOP OF CASING IS ± FT.Above Land Surface --�7,-.
Top of casing terminated at/or below land surface requires a variance in accor-
dance with 15A NCAC 2C.0118
10. YIELD (gpm): METHOD OF TEST Ai, _C ;^ .
11. WATER ZONES (depth): 2I00nrav,S1.Wii ti0I.n,I-'
In On n rn
12. CHLORINATION: Type HTi-i Amount 14 r If additional space is needed use back gtSform
13. CASING: Wall Thickness LOCATION SKETCH
Depth Diameter or Weight/Ft. Material (Show direction and distance from at leasttwo State
From g To p5 Ft. t' t^ Roads,or other map reference points)
From To Ft.
From To Ft.
14. GROUT:
Depth Material Method
From To _Ft. =gpi:H;erit
From To Ft. '
�� Y 1
i� :v1 � i C•.
15. SCREEN:
Depth Diameter Slot Size Materi� l�
From To Ft. in. in.
From To Ft. in. in.
From To Ft. in. in.
16. SAND/GRAVEL PACK: 4—
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 yREECCORRDDCHAS BEEN PROVIDED TO THE WELL OWNER.
FOR OFFICE USE ONLY "� ,r' 4!:t �
SIGNATURE OF PERSO CONSTRUCTING THE WELL DATE
Quad No: Submit original to Division of Water Quality,Groundwater Section within 30 days
GW-1 REV.12/99
Serial No.

North Carolina-Department of Environment and Natural Resources-Division of Water Quality- rour Section
FS Gi r,
1636 Mail Service Center-Raleigh, N.C. 27699-1636-Phone[phone] pp t jf h.
WELL CONSTRUCTION RECORD WELL CONTRACTOR: i c r '' iisa 'w"rel Pu to =i rc
- WELL CONTRACTOR CERTIFICATION#:
0505 -D STATE WELL CONSTRUCTION PERMIT#: Steve f Ky'
1. WELL USE(Check Applicable Box): Residential 12 Municipal 0 Industrial 0 Agricultural0 Monitoring 0
Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use:
2. WELL LOCATION: (Show sketch of the location below)
Nearest Town: Litt iFt County: tCALC WF L
:rTiE8 iN 7-HE BiS.1F S AT Nt,�jLSON _K C FF }4}( ;; P
(aoadName and Numbers,Community,or Subdivision and Lot No.) DRILLING LOG DEPTH
3. OWNER CH AL) GF?.AGG From To Formation Description
Address AM C0LLE7TSV!LLF.Ri L( FAO ^i( i'
�r arg!ute NoJ
r'(�i.LEilj.mv�15 L-L' '`J('_ iR:11 t�C, 20 &YCjarjiTE
C ity ar Town state Zip Cdd.
120 121 ':LrI:LE
4. DATE DRILLED I1128,2011+~ ^21 Lfi:;ll At.�i!Tc
5. TOTAL DEPTH ?"-F: _ .?r,;? „r3 =1gfr',/F.
6. CUTTINGS COLLECTED YES 0 NO 0 7(t; ;'tf1 iR<t(:IfT
7. DOES WELL REPLACE EXISTING WELL? YES 0 NO 0 "n - ` ;;Ioa4 P
8. STATIC WATER LEVEL Below Top of Casing: ^11 FT. r,
(Use 4"if Above Top of Casing)
S
9. TOP OF CASING IS FT.Above Land Surface" ^
at
/or Top of casing terminatedt/or below land surface requires a variance in accor-
dance with 18A NCAC 8 --
10. YIELD (glom): 0" METHOD OF TEST Mir 77 t is
11. WATER ZONES (depth): 'i.S'O agm 120--141 15.LID aarn `OLI <CC "I
4,1 OC aum21'0-225 0.030arr, `
12. CHLORINATION: Type HT Amount 4' If additional space is needed use backrelPfOrrll.
.»s
a
13. CASING: LOCATION SKETCH
Wall Thickness _
Depth Diameter or Weight/Ft. Material (Show direction and distance from at least two State c�
From C To fr� ° R 511 Roads,or other map reference points)
From To Ft. �„,[w'ry`�
From To Ft. w
14. GROUT:
Depth Material Method From 0 To '40 Ft. C",m nt
j
From To Ft._
\.
15. SCREEN: \j
Depth Diameter Slot Size Material
a
From To Ft. in. in.
From To Ft, in. in. w-a
From To Ft. in. in.
16. SAND/GRAVEL PACK:
Depth Size Material CC
From From To Ft.
From To Ft
17. REMARKS: �y LY '—
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A N C 2C,WELL
CONSTRUCTION STANDARDS,AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER.
FOR OFFICE USE ONLY
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
Quad No: Submit original to Division of Water Quality,Groundwater Section within 30 days
GW-1 REV. 12/99
Serial No.

u
North Carolina- Department of Environment and Natural Resources-Division of Water Quality-Groundwater Section ,
1636 Mail Service Center-Raleigh, N.C.27699-1636-Phone[phone]
WELL CONSTRUCTION RECORD WELL CONTRACTOR: v I- ft,t zrt.rei; R.irri, --n. !r,c
WELL CONTRACTOR CERTIFICATION#: 2681
0,105S4 STATE WELL CONSTRUCTION PERMIT#: St-1,-e P"ih'
1. WELL USE(Check Applicable Box): Residential Municipal D Industrial 0 Agricultural El Monitoring 0
Recovery 0 Heat Pump Water Injection Other 0 If Other, List Use:
2. WELL LOCATION: (Show sketch of the location below)
Nearest Town: I cr,ln;p County: 1-e1 1�iM I
Whoa h 3TT>I (f Q i29
tJame and Num ers, ommumtV,or Subdv,aon and Lot No.l DRILLING LOG DEPTH
3. OWNER ZIZIA'J erii ;; K From To Formation Description
Address E3Cil it eTor��n
�treute No.l
City or Townl
4. DATE DRILLED T€
5. TOTAL DEPTH lns .i2a ^a-r rk€
6. CUTTINGS COLLECTED YES El NO C
7. DOES WELL REPLACE EXISTING WELL? YES E] NO 0 ---t
8. STATIC WATER LEVEL Below Top of Casing: ,ff FT.
(Use"+"if Above Top of Casing);
9. TOP OF CASING IS 4 FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a variance in actor-
dance with 15A NCAC 2C.0118
10. YIELD(gpm): r' METHOD OF TEST Air
ll. WATER ZONES (depth): 2tlr` w .1115-;1? dAr1 rt, n 4, !1-1AI
`1 (ll i .en'rt i1 '1^(trrf. r
12. CHLORINATION: Type Hlrl Amount 22 If additional space is needed use back-61i form:`-
13. CASING: Wall Thickness LOCATION SKETCH
Depth Diameter or WeighUR. Material (Show direction and distance from at least two State
From .T To Ft.0_ :_'; r Roads,or other map reference points) 7
From To Ft.
From To Ft. �XJ
14. GROUT:
Depth Material Method ?7� rU
From n To _ _Ft. r .rt1,;1#
From To Ft.
15. SCREEN: �, �JIJ A'I'ti
Depth Diameter Slot Size Material ''(}
From To Ft. in. in. _ ;.�-� � rJ
n
From To Ft. in. in.
From To Ft. in. in.
co
16. SAND/GRAVEL PACK: N t=
Depth Size Material
From To Ft. I }
From To Ft. f{!
17. REMARKS: 0 ,�,c� -
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C,WELL
CONSTRUCTION STANDARDS,AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER.
FOR OFFICE USE ONLY �'^ ✓a
SIGNATURE OF PERSON CO TRUCTING THE WELL DATE
Quad No: Submit original to Division of Water Qualit ,Groundwater Section within 30 days
GW-1 REV.12/99
Serial No.

North Carolina-Department of Environment and Natural Resources-Division of Water Quality-Groundwater Section r s ,+� •'- 7
1636 Mail Service Center-Raleigh, N.C.27699-1636-Phone [phone] v t
WELL CONSTRUCTION RECORD WELL CONTRACTOR: DF.r,ey'f'JghtY'Veil Fun,,p Ca , !--o
WELL CONTRACTOR CERTIFICATION#: 297S
1513''53 STATE WELL CONSTRUCTION PERMIT#: Stave Fr5oe
1. WELL USE(Check Applicable Bozl: Residential 0 Municipal 0 Industrial 0 Agricultural Monitoring 0
Recovery 0 Heat Pump Water Injection 0 Other ❑ If Other, List Use:
2. WELL LOCATION:(Show sketch of the location below) ..
Nearest Town: I P-Nir+lp County: C -+s LL'EI i
�r..ih^r �-t ��� Mr'f4 �4'C`�t t Fes,../l' F G•c1 i 1�— rF
1fSoaTRame ai3Fumbers,C'ommunrty,or"S on'a N..) ~
DRILLING LOG DEPTH
3. OWNER __141,617tj 71 4PVF` From To Formation Description
Address No-1 r-�lFa
To
IS`tr t o TFouta
hlt G +. 1
Gty or n State •'Lip Cotle -
4. DATE DRILLED --'a1r2:7itlF c•t,A ,+,C'c; -
5. TOTAL DEPTH n6"
6. CUTTINGS COLLECTED YES 0 NO 0
7. DOES WELL REPLACE EXISTING WELL? YES 0 NO 0
8. STATIC WATER LEVEL Below Top of Casing: 10 FT. - 0
(Use"+"if Above Top of Casing) O
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): 1 METHOD OF TEST aor
11. WATER ZONES (depth): 1.17U cipm,324-:32 a O.00l:1
0.13[1 aom 0+00aUm
12. CHLORINATION: Type ETI4 Amount 73 If additional space is needed use back of form
13. CASING: Wall Thickness cIq LOCATION SKETCH
Depth Diameter or Weight/Ft. Material (Show direction and distance from at least two State -From To — Ft._i,_,G SFr_ Pl Icr^ Roads,or other map reference points)
From To Ft.
From To Ft.
V
14. GROUT: -
Depth Material Method
From 0 To ---� Ft.;'qpc,,_-,f
From To Ft. tv
15. SCREEN: Depth Diameter Slot Size MaterialU/From To Ft. in. in. `'e" r
From To Ft. in. in.
From To Ft. in. in.
�.g
16. SAND/GRAVEL PACK:
Depth Size Material ----�
From To Ft. "y'"-" • i
From To Ft.
17. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDAANNCE WITH 15A NCAC 2C,WELL
CONSTRUCTION STANDARDS,AND THAT A C PPYY OF-THIS
� RECORD HAVBEEN PROVIDED TO THE WELL OWNER.
FOR OFFICE USE ONLY
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
Quad No: Submit original to Division of Water Quality,Groundwater Section within 30 days
GW-1 REV.12/99
Serial No.

North Carolina-Department of Environment and Natural Resources-Division of Water Quality-Groun— dwater Section cd a, Q F' R
1636 Mail Service Center- Raleigh, N.C.27699-1636-Phone[phone]
WELL CONSTRUCTION RECORD WELL CONTRACTOR: C:ev.ey V,`rghi vVeil Pump Co., Inc
WELL CONTRACTOR CERTIFICATION#: 2878
050_+72 STATE WELL CONSTRUCTION PERMIT#: Steve Pnce
1. WELL USE (Check Applicable Box): Residential 0 Municipal 0 Industrial 0 Agricultural 0 Monitoring 0
Recovery D Heat Pump Water Injection 0 Other 0 If Other, List Use:
2. WELL LOCATION: (Show sketch of the location below)
Nearest Town: i FNOIR Co u nty:'t"AI rj,iy l I
laoatl ame and Numbers,, ommumty,oror Subtlivision antl Lot No.l
DRILLING LOG DEPTH
3. OWNER .!AFvic FUL1 LSr�7,r�r From To Formation Description
Address ?E r aLc NELT(7".] . P.0 F30x 1502 0 11b C1RT
t street orRnntoNo.) IR 2684i5 11q 195 :3RANITF
City or Town - state ""co' 195 196 G�PA,Pll TE
4. DATE DRILLED 21412115 1 C16 220, GrIAN11TF
5. TOTAL DEPTH ARR _ 291 2P, _ L'ARTZ
6. CUTTINGS COLLECTED YES 0 NO `'P, 305 GRANITP
7. DOES WELL REPLACE EXISTING WELL? YES E::1 NO Edl
8. STATIC WATER LEVEL Below Top of Casing: Ifirl FT. rI -
(Use"+"if Above Top of Casing)
9. TOP OF CASING IS 9 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): 5 METHOD OF TEST :4ir ol
11. WATER ZONES (depth): 1 nn pnr•,195-490 4 00 onni 291-2k?�;
0,00 csom 0.00aom
12. CHLORINATION: Type P7H Amount 41 If additional space is needed use back of fdrm
4
13. CASING: LOCATION SKETCH
Wall Thickness At
Depth Diameter or WeighVFt. Material uUt(Show direction and distance from at least two State
From r7 To ';:�5 Ft. F1 IZe 35D per;(`` f Roads or other map reference points)
From To Ft. �1YC�r.. ,' ,y .. nw
From To Ft._ R�
R
14. GROUT: ,) be
Depth Material Method
From f1 To 2f Ft.�'���=cn+
tc
From To Ft.
15. SCREEN:
Depth Diameter Slot Size Material � �^
From To Ft. in. in. jq
From To Ft. in. in. PC 1
From To Ft. in. in.
16. SAND/GRAVEL PACK:
Depth Size MaterialE,"'S
From To Ft. CR� �,
From To Ft. I`�+
17. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C,WELL
CONSTRUCTION STANDARDS,AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER.
FOR OFFICE USE ONLY 4 �' � 4— &
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.

a..+SrARo
W f �
ti D 9 d i
RESIDENTIAL WELL CONSTRUCTION RECORD
- North Carolina Department of Environment and Natural Resources-Division of Water Quality
28 r 3 OW75
WELL CONTRACTOR CERTIFICATION#
1.WELL CONTRACTOR: I. DISINFECTION:Type HTH Amount 59
STEEE PRICE
Well Contractor(Individual Name) 9• WATER ZONES(depth):
DEVVE'r WRIGHT WELL &PUMP CO., INC From ?:♦7 To 3Gi From 74Alrr) Tod'1
From fi111 To 1311 From ?4F To748
Well Contractor Company Name From To From To
STREET ADDRESS P- 0- BOX SIC'' 6.CASING: Thickness/
BOONE NC 28607 Depth Diameter Weight Material
From 0 To 120 Ft. 61/8 .188 GALV
City or Town State Zip Code From To Ft.
( 828 )- 264-2651
Area code-Phone number Ft.
From To
7.GROUT: Depth Material Method
2.WELL INFORMATION: From 0 To 20 Ft.!Camerlt Gravity Flow
SITE WELL ID#Iif applicable) From To Ft.
STATE WELL PERMIT#(if applicable) From To Ft.
DWQ or OTHER PERMIT thin applicabie) &SCREEN: Depth Diameter Slot Size Material
WELL USE(Check Applicable Box): Residential Water Supply From To Ft. in. in.
DATE DRILLED 11/18/2005 From To Ft. in. _in.
TIME COMPLETED 11:30 AM❑ PMn From To Ft._in. in.
3.WELL LOCATION:
9.SAND/GRAVEL PACK:
Ow. LENOIR Cn Depth Size Material
COUNTY
LD.`:ELL From _To Ft.
,AT FISH F4.RM OFF INDIAN GRAVE From _To Ft.
(Street Name,Numbers,Community,Subdivision,Lot No.,Parcel,Zip Code) From -
To Ft.
TOPOGRAPHIC/LAND SETTING: 10.DRILLING LOG
A Slope D Valley ❑Flat O Ridge Ll Other From To Formation Description
(check appropriate box) U 114 DIRT
May be in degrees,
LATITUDE 3 36.20860 minures,seconds or 114 �< GRAN(FE
LONGITUDE 081.716650 in a decimal format $31 183 QUARTZ
Latitudellongitude source: Q4 I ❑Topographic map
(location of well must be shown on a USGS topo map and -
attached to this form if not using GPS)
4.W ELL OWNER :
OWNER'S NAME LLIAM 'WHITE, JR. idyl"
STREET ADDRESS 1815 HWY 268 ,
LENOIR NC 28645
City or Town State Zip Code
("( 828) 758-4456
Area code-Phone number --
5.WELL DETAILS: 11.REMARKS:
a. TOTAL DEPTH: 905 0.5 GPM 382 - 383 0.5 GFhA 470-471
b. DOES WELL REPLACE EXISTING WELL? YES❑ NO'I 2 GPM 610- 611 3 GFtn' 745 - 745
0 GPM - D GPM -
c. WATER LEVEL Below Top of Casing: 5 FT. I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH
(Use"+"if Above Top of Casing) 15A NCAC 2C,WELL CONSTRUCTION STANDARDS,AND THAT A COPY OF THIS
RECORD HASBEEN PROVIDED TO THE WELL OWNER.
d. TOP OF CASING IS 1 FT.Above Land Surface*
'Top of casing terminated at/or below land surface may require
a variance in accordance with 15A NCAC 2C.0118 SIGNATURE OF CERTIFIED WELL CONTRACTOR DATE
e. YIELD(gpm): 6 METHOD OF TEST Air STEEE PRICE
PRINTED NAME OF PERSON CONSTRUCTING THE WELL
Submit the original to the Division of Water Quality within 30 days.Attn:Information Mgt., Form GW-1a
1617 Mail Service Center-Raleigh, NC 27699-1617 Phone No.[phone] ext 568. Rev.7/05

~ RESIDENTIAL WELL CONSTRUCTION RECORD j
North Carolina Department of Environment and Natural Resources-Division of Water Quality
' WELL CONTRACTOR CERTIFICATION N 2879 t15WI A-1
1.WELL CONTRACTOR:STEVE PRICE f. DISINFECTION:Type HTH Amount
g. WATER ZONES(depth):
Well Contractor(Individual Name) FW HOLE To From To
DEVVEY` YRiGHT WELL &PUMP CO., INC.
From To From To
Well Contractor Company Name From To From To
STREETADDRESS P. O. SOX 308 6.CASING: Thickness/
EGONE NC 28607 Depth Diameter Weight Material
From 0 To 26 Ft. 61/8 350 PVC
City or Town State Zip Code
( :828 )- 204--21551 From To Ft.
From To Ft.
Area code-Phone number
].GROUT: Depth Material Method
2.WELL INFORMATION: From 0 TO 20 Ft.Cement Gravity Flouv
SITE WELL ID#(if applicable) From To Ft. .. taut-l'aC{ :Oil
STATE WELL PERMIT#(a applicants) From To Ft. e iTF'lt
DWQ or OTHER PERMIT#(it applicable) _ &SCREEN: Depth Diameter Slot Size Material
WELL USE(Check Applicable&qA Residential Water Supply From To Rini. in.
DATE DRILLED 7 9UlZL7 From To Ft. in. in.
TIME COMPLETED AM❑ PM6 From To Ft. in. in.
9.SAND/GRAVEL PACK:
3.WELL LOCATION:
LENOIR CALOVVELL Depth Size Material
CITY: COUNTY From To Ft.
MILLERS CREEK RD. OFF HVrY 80 OFF 18 OFF 32 From To Ft.
(Street Name,Numbers,Community,Subdivision,Lot No.,Parcel,Zip Code) From_ To Ft.
TOPOGRAPHIC/LAND SETTING: 10.DRILLING LOG o
❑Slope ❑Valley ❑Flat ❑Ridge ❑Other From TO Formation DescriptlK) --
(check appropriate box) 0 21 - DIRT
May be in degrees, 1-a
LATITUDE 3 minutes,seconds or '21 6C5 GR✓`<hd11E t;,T s
LONGITUDE in a decimal format
Latimde/lougitude source: ❑GPS ❑Topographic map
S
(location of well must be shown on a USGS topo map and
attached to this form if not using GPS)
4.WELL OWNER
OWNER'S NAME SALVATORE KULINSKI
STREETADDRESS '� t' "
EEK
LENOIR -; Zdb40b
City or Town State Zip Code
-
(8( 23) )- 754-7713
rt
Area code-Phone number
5.WELL DETAILS: 11
a. TOTAL DEPTH: 605 0�5F2`f HOLE- 0 GPM -
b. DOES WELL REPLACE EXISTING WELL? YES❑ N610 U GPM, P'
C. WATER LEVEL Below Top Of Casing: Fr. I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH
(Use"+"if Above Top of Casing) 15A NCAC 2C,WELL CONSTRUCTION STANDARDS,AND THAT A COPY OF THIS
RECORD HAS BEEN PROVIDED TO THE WELL OWNER.
d. TOP OF CASING IS 1 FT.Above Land Surface- 7 '
"Top of casing terminated at/or below land surface may require
a variance In accordance with 15A NCAC 2C.0118 SIGNATURE OF CERTIFIED WELL CONTRACTOR DATE
e. YIELD(gpm): 0 METHOD OF TEST Air STEVE PRICE
PRINTED NAME OF PERSON CONSTRUCTING THE WELL
Submit the original to the Division of Water Quality within 30 days.Attn:Information Mgt., Form GW-1a
1617 Mail Service Center-Raleigh,NC 27699-1617 Phone No. [phone] ext 568. Rev.7/05

m STAR
RESIDENTIAL WELL CONSTRUCTION RECORD
✓.� North Carolina Department of Environment and Natural Resources-Division of Water Quality
e« �' WELL CONTRACTOR CERTIFICATION Jf 2878 050614
I.WELL CONTRACTOR:
STEVE PRICE f. DISINFECTION:Type �11 f Amount 8
g. WATER ZONES(depth):
Well Contractor(Individual Name 55-56 "'71r3/9
DEW bYRIGHT bVEIL &PUMP +'O0 INC. From To Front To
From To From To
Well Contractor Company Name From To From To
STREETADDRESS P. O. BOx 308 6.CASING: Thickness/
BOONE NC 23007 Depth Diameter Weight Material
From 0 To 2' Ft. 51/8 350 PVC
City or Town State Zip Code From To Ft.
( 828 ) 264 2651 From To Ft.
Area code-Phone number 7.GROUT. Depth Material Method
2.WELL INFORMATION: From 0 To 70 Ft.Cement Gravity Flow
SITE WELL ID#(f applicable) FromTo Ft.
STATE WELL PERMIT#(If applicable) From TO Ft.�� ment Gravtt�, ov.
DWO or OTHER PERMIT#(if applicable) a� &SCREEN: Depth Diameter Slot Size Material
WELL USE(Check Applicable 1 1 114 12 00
Box: Residential Water Supply Cy From To Ft. in. in.
DATE DRILLED rr,, From To Ft._in. in.
TIME COMPLETED AM❑ PM6 From To Ft. in. in.
3.WELL LOCATION:
9.SAND/GRAVEL PACK:
LENOIR CA.LDWELL Depth Size Material
CITY: COUNTY From_ To Ft.
MILLERS CREEK OFF HWY 90 OFF 18 OFF 321 From _To Ft.
(Street Name,Numbers,Community,Subdivision,Lot No.,Parcel,Zip Code) From _To Ft.
TOPOGRAPHIC/LAND SETTING: 10.DRILLING LOG
rtl1
❑Slope ❑Valley ❑Flat ❑Ridge ❑Other From TO Formation Descri on
(check appropnete box) 0 17 DIRT t 7
May be in degrees, 1 �r GRANITE '
il
LATITUDE 3 minutes,seconds or
in a decimal format 55 56 GRANITE
LONGITUDE rJ
Latitude/longitude source: ❑GPS ❑Topographic map 56 370 GRANITE ss
(location of well must be shown on a USGS topo map and 370 371 QUARTZ
attached to this form if not using GPS) Pi irjJ G- I,
4.WELL OWNER
OWNER'S NAMESALVATORE KULINSKI
STREET ADDRESS 14 38 MI LLEFSCREEK RD. +` -
LENOIR NC 2BE45
City or Town State Zip Code _
(8( 28) ) 381-8248
£ t
Area code-Phone number
5.WELL DETAILS: 11 REnzaxxS•
a. TOTAL DEPTH: 405 U.5(3Ynn 55-56- 0.5 GPM 370-371 -
b. DOES WELL REPLACE EXISTING WELL? YES❑ NCrQ '" G -
c. WATER LEVEL Below Top of Casing: 20 Fr. I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH
(Use"+"if Above Top of Casing) 15A NCAC 2C,WELL CONSTRUCTION STANDARDS,AND THAT A COPY OF THIS
RECORD HAS BEEN PROVIDED TO THE WELL OWNER.
d. TOP OF CASING IS 1 FT.Above Land Surface"
'Top of casing terminated at/or below land surface may require
a variance in accordance with 15A NCAC 2C.0118 SIGNATURE OF CERTIFIED WELL CONTRACTOR ' DATE
e. YIELD(gpm): 1 METHOD OF TEST Par STEVE PRICE
PRINTED NAME OF PERSON CONSTRUCTING THE WELL
Submit the original to the Division of Water Quality within 30 days.Attn:Information Mgt., Form GW-ta
1617 Mail Service Center-Raleigh, NC 27699-1617 Phone No. [phone] ext 568. Rev.7/05

��ys-F„a 51AiFo-
g RESIDENTIAL WELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources-Division of Water Quality
�Quv.�•
_. WELL CONTRACTOR CERTIFICATION# —4-M I
1.WELL CONTRACTOR: I. DISINFECTION:Type " Amount, a j/
L V/U 1P LL S 5 L g. WATER ZONES(depth):
Well Contractor(Individual)Name From -5—D To From To
f\21NC From To From To
Well Contractor Company Name ;7 From To From To
STREET ADDRESS o(�7 /`bArf✓�tiL re fly/ 6. CASING: Thickness/
� ' Depth Diameter Weight Mates I
NO' .2568/ From o To —9 Ft.
/ City or Tovm State Zip Code From To Ft
From To Ft
Area code- Phone number
2.WELL INFORMATION:
7. GROUT: Depth Material Method
From V To 90 Ft-
SITE aE7r��
WELLID#(ifapplicable) From To Ft T
STATE WELL PERMIT#(8 applicable) From To Ft.
DWQ or OTHER PERMIT#(if applicable) 8. SCREEN: Depth Diameter Slot Size Material
WELL USE(Check Applicable Box): Residential Water Supply 8.1 From To Ft.—in. _ in.
q �r From To FL—in. _ in.
DATE DRILLED From To Ft—in. _in.
TIME COMPLETED AI AM❑ PM i!�—
9. SANDIGRAVEL PACK:
3.WELL LOCATION: Depth Size Material
COUNTY
, OO From To Ft
FrDrp Tc Ft
CITY:,,,`/p) J�ILibInN �r o K
l] & o From To Ft
(Street Name,Numbers,Community.Subdivision,Lot No.,Pamel,Zip Code)
TOPOGRAPHIC/LAND SETTING: 10.DRILLING LOG
❑Slope (jValley ❑Flat Midge ❑Omer From To a F nDescriptiion
(check appropriate box) 1) S�
y�Q _„. ;2 t May be in condsdegrees,
LATITUDE 3 s,7.� s1� minute;seconds or +
LONGITUDEJi24TI �L, ,�R�Y mad«imal format _
Latitude/longitude source: I ftPS ❑Topographic map
(bcabon of well must be shown on a USGS topo map and
attached to this form I/net using GPS) CD
4.WELL OWNER ^
N
OWNER'S NAME C:)
STREV ADDRESS r _
Q �
Ciittyorr Tmn SSttatee Zip Cade
Area code- Phone number
5.WELL DETAILS: 11. REMARKS:
a. TOTAL DEPTH:
b. DOES WELL REPLACE EXISTING WELL?fYYEES❑ NO C�
C. WATER LEVEL BeIowT Of CaSln : I DO HEREBY CERTIFY TUT THIS WELL WAS CONSTRUCTED N ACCORDANCE WRH
g �7 _ FT. 1SA NCAC 2C,WELL CONSTRUCTON 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
FT.Above Land Surface* _���
'Top of casing terminated With below land surface may require SIGNATU OF CERTIFIED WELL CONTRACTOR / DATE
-
a variance in accthdance with 15A NCAC 2C.0118. /' J
e. YIELD(gpm): IS METHODOFTEST U&V' l t i14( P tIS SP II
VKIN I LIM 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. Fwm GW-la
Rev.7/05

Q RESIDENTIAL WELL CONSTRUCTION RECORD
•?y� North Carolina Department of Environment and Natural Resources-Division of Water Quality
WELL CONTRACTOR CERTIFICATION# 2620 coj-00
I.WELL CONTRACTOR: f. DISINFECTION:Typo ttiTH Amount -
LEELIE REECE g.Well Contractor(Individual Name) From
WATER ZONES(depth):
From 75 To 76 From To 13
GE4NF-v 7s,'ppC;HT`«%cLLf -Ut,dr L't�. .I,K. From To From To
Well Contractor Company Name _ From To m Fro To
B'v'-'STREET ADDRESS ~• �� '-'� B.CASING: Thickness/
BOONS 7 Depth Diameter Weight Material
From 0 To tj2 Ft. = 0
P111-
City or Town State Zip Code From =1 To U Ft.
(Areacode)- Phonnee number 1 From To Ft.a -
7.GROUT: Depth Material Method
2.WELL INFORMATION: From Q To -'C
SITE WELL ID#(if applicable) From To Ft.
STATE WELL PERMIT#(K applicable) From To Ft.
DWO or OTHER PERMIT#(napplirable) &SCREEN: Depth Diameter Slot Size Material
WELL USE(Check Applicable Box): Residential Water Supply O From To Ft—in. in.
DATE DRILLED From To Ft. in. in.
TIME COMPLETED AM❑ PM 11 From To Ft. in. in.
3.WELL LOCATION:
9.SAND/GRAVEL PACK:
Depth Size Material
CITY: =R'JArd pv-',i!NTAj!%1 COUNTY -4,LLY41 e:LL From_To Ft.
F Ea3Y ='EEK OFF HLraHE'S 341 Ft r v r= C 2 From TO Ft.
(Street Name,Numbers,Community,Subdivision,Lot No.,Parcel,Zip Code) From To Ft.
TOPOGRAPHIC/LAND SETTING: 10.DRILLING LOG
G�Slope O Valley 0 Flat O Ridge O Other From To Formation Description
(check appropriate box) p ,3 DIRT
May be in degrees,
LATITUDE 3 �f^ minutes,seconds or aF 4fi!TE
LONGITUDE I]i82 1GR1:10 in a decimal format
Latitude/longitude source: 3 GPS ❑Topographic map r• '.81 GR&f., P
(location of well must be shown on a USGS topo map and 1;5 le2 QUARTZ 1 �"
attached to this form if not using GPS)
4.WELL OWNER
c
OWNER'S NAME`TE",IE E BUPL_c�, -fl
STREET ADDRESS-'-'S IREAS-YCr=EFF,, RD. r�-
c"p,4.L:�_ pSdal L^' r,.l(-. sue.j5
City or Town State Zip Code
1
Area code-Phone number s
5.WELL DETAILS: 11.REMARKS:
a. TOTAL DEPTH: 2 GRr l 75- '�,
b. DOES WELL REPLACE EXISTING WELL? YES❑ NO O I SPry 0 GPM
11 GIPNII 11 GPdA
c. WATER LEVEL Below Top of Casing: -"!' FT, I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH
(Use••+'•if Above Top of Casing) 15A NCAC 2C,WELL CONSTRUCTION STANDARDS,AND THAT A COPY OF THIS
RECORD HAS BEEN PROVIDED TO THE WELL OWNER.
d. TOP OF CASING IS I FT.Above Land Surface' r 7 (' t
'Top of casing terminated at/or below land surface may require 'V-{y 0'-vy' �j, t ,� 1 ( �7 �1/(�
a variance in accordance with 15A NCAC 2C.0118 SIGNATURE OF CERTIFIED WELL CONTRACTOR DATE
e. YIELD(glarl F METHODOFTEST +'It- L.ESLiE REEC-E
PRINTED NAME OF P
CEIV
Submit the original to the Division of Water Quality within 30 days.Attn:Information t g ., Form C N-1a
1617 Mail Service Center-Raleigh,NC 27699-1617 Phone No.[phone] ext 568. Rev.7/ 5
FEB 13 2006
Asheville Regional Office
.,:; . o. ..�: ...

op
WELL CONSTRUCTION RECORD
North Carolina-Department of Environment and Natural Resources-Division of Water Quality-Groundwater Section
WELL CONTRACTOR(IgDINIDUAL)NAME (print) NF'iTT.PARL(L;' CERTIFICATION6 22609
WELL CONTRACTOR COMPANY NAME HICI tY WHIT ERMIN3 (D• PHONE i tR7R) ML-OM5
STATE WELL CONsmucnON PERMIT/ ASSOCIATED WQ PERNM
CVapplicable) Cif applicable)
1. WELL USE(Check Applicable Box):Residential MumcipaliPublic 0 ladustrial❑ Agricultural E
Monitoring 0 Recovery ❑ Had Pump Water Injection 0 Other❑ If Oil=,List Use
2. WELL LOCATION: TopogtWhiclLamd setting
Nearest Town IRU1R County C'ATiSML O idge OSlope Walley Flat
2260 SEI4ME WkY (cb=kaypvp,iaayur)
(SueallmomNombom Cm®mrty.SLbdivisioq l.otNo.,Zip Co&) Latitmdcamngihide Of well location
3. OWNER JASM RAM ( fthimad )
Address 2250 M=WE Latitudellougilude source:11GPSOTopographic map
(ShetorRonm No.) (chockbox)
TFNITRt IC 2864 D)?PM DR1111HOLOG
or M7885 State tip Code From To Formation Description
Amu code-Phone number _
4. DATE DRIIZED 34)9
5. TOTAL DEPTH:
6. DOES WELL REPLACE EXISTING WELL? YES CM40 0
7. STATIC WATER LEVEL Below Top of Casing: 15 FT,
(Use+"ffAbm TopofCm;hW
8. TOP OF CASING IS 2 FT.Above Land Surface'
`Top of adaE ommiuted a7or below hunt s uft"requ1 n a
varBaa to aearduee wale LSANCAC W AHL
9. YH:LD(gpm): 3 METHOD OF TM_nL AIR�r
10.WATER ZONES(depth):
LOCATION SKETCH
11. DISINFECTION:Type Eq TAffi Amount 103 Show direction and distance in miles from at least
12. CASING: Wall Thidmeas two State Roads or County Roads.Include the road
Depth Diameter or Weigbt/FL Material numbers and common road names.
From p_To126--Ft.-LP, rATAI cZMV /
From To Ft
Frorq_To Ft (�Y uML ULh/
13. GROUT: Depth Material Method
From To—, Ft (DTI Fam
From To Ft Z G�A���
14. SCREEN: Depth Diameter Slot Size Material
From_To Ft in in. W
From—To Ft_in in. �
15. SANDIGRAVELPACK:
Depth size Material �
From To Ft
From To Ft S e_D
0
16. REMARKS: �' N
_ -n rn
rn
I DO HfiREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C"WELL 0
CONSTRUC110N STAND AND THAT COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL 0 r' m
SIGNA ERSON CONSTRMVIED DATE �, rn v
Submit the original to the Division of Water Quality,G�om sdwat�Sgdt io "fa Center- I -I- l
27699-1636PhoneNo.(919)7333221,within30days. I �C�6 11 LUUU GW-I REV. 12 1�1
Asheville Regional Office
_ ,--A2uifer Protection

3
r^
S RESIDENTIAL WELL CONSTRUCTION RECORD
L
North Carolina Department of Environment and Natural Resources-Division of Water Quality -"
WELL CONTRACTOR CERTIFICATION#
1.WELL CONTRACTOR: f. DISINFECTION:Type F{
STEVE PRIDE TN Amount 3`
iO g. WATER ZONES(depth):
Well Contractor(Individual Name) Front 60-151 To From +~ -1 a7 To
C�EsP?EY INRIGHT�tdELL A PUP,AP CO- IF•iC.
From To From To
Well Contractor Company Name From To From To
STREETADDRESS P. 0. Jun _Ke 6.CASING: Thickness/
e0011E NC 28607 Depth Diameter Weigght Material
From 0 To 'G'3 Ft. 61'8 .350 PVC
City or Town State Zip Code From To Ft.
( 329 )- 264-2651 From TO Ft.
Area code-Phone number '-
7.GROUT Depth Material Method
2.WELL INFORMATION: From O To 23 Ft.CamEnt 3rsylt'� ^;m"
SITE WELL ID#ff applicable) From To Ft._
STATE WELL PERMIT#lf applicable) From To Ft.' erneni 6F„atv F0l­
DWO or OTHER PERMIT#(napplicablel &SCREEN: Depth Diameter Slot Size Material
WELL USE(Check Applicable Box): Residential Water Supply E�3 From To Ft. in. _in.
DATE DRILLED 1119,'2005 From To Ft. in. in.
TIME COMPLETED AM❑ PM ] From To Ft. in. in.
3.WELL LOCATION:
9.SAND/GRAVEL PACK:
Depth Size Material
CITY: LEtiVIR COUNTY �'AL611rCLL From To Ft.
PIBBS LANE OFF 321 A. OFF MISSION RD. OFF 32 From _TO Ft.
(Street Name,Numbers,Community,Subdivision,Lot No.,Parcel,Zip Cotle) From To Ft.
TOPOGRAPHIC/LAND SETTING: 10.DRILLING LOG
❑Slope ❑Valley ❑Flat ❑Ridge Ll Other From To Formation Description
(check appropriate box) 0 9A D'F'T
May be in degrees,
LATITUDE 3 minutes,seconds or 94 1eO Gr 6,NITE
LONGITUDE in a decimal format 150 151 QUARTZ
Latitude/longitude source: ❑GPS ❑Topographic map 151 185 GRANITE _
(location of well must be shown on a USGS topo map and 1SS 157 Q1ULRTZ
attached to this form if not using GPS) 117 2- GR.SNITE
4.WELLOWNER
OWNER'S NAME BOONE & "Ci., INC.
STREET ADDRESS P.O. BOA;470 ,
LENOIR f"IC 28645
City or Town State Zip Code
(8( 28) l- 72&9180
Area code-Phone number
5.W ELL DETAILS: 11.REMARKS:
a. TOTAL DEPTH: 2135 2 GPM 150-151 - IS S uF h i 1 c_.:87 _
b. DOES WELL REPLACE EXISTING WELL? YES❑ NO' ] 0 GPM - 0 OP A -
c. WATER LEVEL Below Top of Casing: 50 FT. I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH
(Use"+"if Above Top of Casing) 15A NCAC 2C,WELL CONSTRUCTION STANDARDS,AND THAT A COPY OF THIS
RECORD HAS BEEN PROVIDED TO THE WELL OWNER.
d. TOP OF CASING IS 1 FT.Above Land Surface'
'Top of casing terminated at/or below land surface may require
a variance In accordance with 15A NCAC 2C.0118 SIGNATURE OF CERTIFIED WELL CONTRACTOR'" DATE
e. YIELD(gpm): `O METHOD OF TEST Adr STEEE PRICE
PRINTED NAME OF PERSON CONSTRUCTING THE WELL
Submit the original to the Division of Water Ouality within 30 days.Attn: Information Mgt., Form GW-1a
1617 Mail Service Center-Raleigh,NC 27699-1617 Phone No.[phone] ext 566. Rev.7/05

WELL CONSTRUCTION RECORD
North Carolina•Department of Environment and Natural Resources-Division of Water Quality-Groundwater Section
WELLCONTRACTOR(INDWIDUAL)NAME (prixt) 1M P1RIE CERTIFICATIONS
WELL CONTRACTOR COMPANY NAME HTGM WFIT rRTT I RU CL). PHONE s f 1 828-324-0035
STATE WELL CONSTRUCTION PERMITS ASSOCIATED WQ PERMITS
(ifapulicable) (ifawlicable)
1. WELL USE(Check Applicable Box):Residential& MunicipsliPublic❑ Ladustrial 0 Agticuldual❑
Monitoring G Recovery O Heat Pump Water 14jedion 0 Other 0 If Other,List Use
2. WELL LOCATION: TopoglaphidL end setting
Nearest Town: LMIR County 2!M MUdge OSlope Malley OFlat
1973 = PLACE (ct *gptopriambox)
(SuadNam%Nmnbers,CoomunflN vic IANo„ZIP Cade) Latiludellongitudtof well location
3. OWNER EiaHIi ACiOI� ( —
Address Latitude/ioaWtude sommC)GPSOTopographic map
(Suns ar Roam No.) (aw*>m)
TEtLMI W 2ffi5;Cw DEPTH DRILLING
G—� R7R-75R-2432 From To Formation Description
Ara Bodo-Phone nmau
4. DATE DRILLED mi--tl
Y 5. TOTAL DRL-!a3 -`—
6. DOES WELL REPLACE WaS ING WELL? YES 0 NO)b
7. STATIC WATER LEVEL Below TOP of Casing 60 FT, a
(Un NP If Above Tap ofCssbW G7
8. TOP OF CASING IS Z FT.Above Land Surface* w -
-Top of sashes meaMa W atlw bamw Wes swam ngdm a ^;r
variaaeem umsametwn 15A NCAC 2C.911S.
9. YIELD(gpm): -) MBTHOD OF TEST BY AIR TEST C
10.WATER ZONES(depth):
LOCATION SKETCH
11. DISQQFECTION:Type Amomat 47 Show direction sad distance in miles from at lcaW
12. CASING: Wall Tldcimeas two State Roads or County Roads.Include the road
p t� WeigbM numbers and common road names.
�� Tz0 0 0 Ft b F�C HASl'1G /
From To FL /y
From To FL
13. GROUT: Dep$ materialMethod
Fronts To_2L—Ft. (M ECURED 3T2
From_To Ft C
14. SCREEN: Depth Diameter Slot Size Material
From To FL---in- in.
From To Ft---jn. in. (Zp.
15. SAND/GRAVEL PACK:
Depth Size Material
From_To-Ft.-
From-To-FL
16. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH ISA NCAC 2C,WELL
CONSTRUCTION STANDARDS,AND THAT A COPY 9F THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
06-06-05
SIGNATURE OF P ON cofanucnNG THE WELL DATE
Submit the original to the Division of Water Quality,Groundwater Section,1636 Man Service Center-Raleigh,NC
276WI636?hone No.[phone],within 30 days. - OW-I REV.0712001