He CY2005

WELL CONSTRUCTION RECORD
North Carolina-Department of Environment and�y.ar rral Resources-Divrsi of Water Quality-Groundwater Section s� (•�
WELL CONTRACTOR(INDIVIDUAL)NAME (print) CERTIFICATION# 62
WELL CONTRACTOR COMPANY NAME I m p. LLI'_ PHONE A=5Say- (a_
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(ifepplicablel (ifa plicable)
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: Topogra Land setting
Nearest Town: County ReArd ^fA A� pRidge lope ❑Valley ❑Flat
Read (check appropriate box)
tSuve[Name,Numbers,Community,Subdivision,Lot No.,Zip Code) Latirude/longirude of ell locatpil
,YaSrzS. 6/OSb/9,$is
3. OWNER: N L cf• (degrees/mi[Iftes4,teconds)
Address �0� Latitude/longitude source: GPS❑Topographic map
/ t (Street or Route Na.) (check RI
r//.���`„/-,/ctc�' �'-tc�L///E /11/C� 2g7 / DEPTH DRILLING LOG
City or Town Sure Zip Code From To Formation Description
(64) &7 4V74/ 0 — 21D Drn�
Area code-Phone number w
4. DATE DRILLED �e/z)/5
5. TOTAL DEPTH: 2,� /
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO B
7. STATIC WATER LEVEL Below Top of Casing:2_FT.
(Use"+"if Above Top of Casing)
S. TOP OF CASING IS �FT.Above Land Surface*
'Top of casing terminated at/or below land surface requires a
variance in accordance with I5A NCAC 2C.0118.
9. YIELD(,Tin):— W,d04 METHOD OF TEST A
10.WATER ZONES(depth):�Cf ' �7 O JJ
LOCATION SKETCH
11. DISINFECTION:Type 6 Amount FO '_. Show direction and distance in miles from at least
t'_. CASING: Wall Thickness two State Roads or County Roads.Include the road
Depth Diameter or Weight/Ft. Material numbers and common road names.
Front__(ZTo (10 Ft. 6.A5 2(b,/eLJ P 2.�I,� L ��
- From To Ft. 'Or77U S�• � -
Fronk To Ft.
13. GROUT: Depdi Material Method C /NeyUr �G
From— [L To�Q_Ft.t 'vftC��-FL 2i d4
From To Ft C:t
14. SCREEN: Depth Diameter Slot Size Material t.It
From To Ft. in. in.
Front To Ft. in. in. ul
15. SAND/GRAVEL PACK:
Depth Size Material -
From To Ft.
From To Ft.
16. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C,WELL _
CONSTRUCTION STANDARDS,AND THAT A COPY OF THI CORD HAS BEEN PROVIDED TO THE WELL OWNER
6 Z&:;1 r MIA 7IAS
I AT RE OF E SON ONS UCTING THE WELL IDAFM
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

op .,
WELL CONSTRUCTION RECORD
Noah Carolina-Department of Environment and ral Resources-Divisi of Water Quality-Groundwater Section ✓��� (�
WELL CONTRACTOR(INDIVIDUAL)NAME (print) - CERTIFICATION#Q11 Q
WELL CONTRACTOR COMPANY NAME O I4 It P. LLr PHONE - .1,SQ-S�W�
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable) � (ifapplicable)
1. WELL USE(Check Applicable Box):Residential Li'�Municipal/Public ❑ Industrial ❑ Agricultural ❑
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other,List Use
2. WELL LOCATION: o/oppographic/Land setting
Nearest Town: F(If l kc^ County Gt ^1 @'Ridge ❑Slope ❑Valley ❑Flat
S�a(�DGJ R/t OG p/`t (check appropriate box)
(Street Name,Numbers,Community,Subdivision.Lot No.,Zip Code) Latitude/longirude of w II location
1 7 «� 7i aZ$7
3. OWNER: Lt YtgPS t3 - De^^t'e �� (degrees/minus Seconds)
Address �SXS C44t� 7d Latitude/longitude source: GPS❑Topographic trap
(Street or Route No.)/ (check box)
�1Af"JVf1VD4t /YC oRS778 DEPTH DRILLINGLOG
42�)
City or Town State Zip Code From To Formation Description
( e7 ;1.Z7 YD p,tti�
Area code-Phone number tip (ps Q A1jJ]fgNe
4. DATE DRILLED /Dr 10/etc
5. TOTAL DEPTH:
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO Cd'
7. STATIC WATER LEVEL Below Top of Casing: FT.
(Use"+"if Above Top of8ing)
S. TOP OF CASING IS FT.Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordance with 15A NCAC 2C.0118. rp "�
9. YIELD(gpm):_ 7 METHOD OF TEST'Alol,(' '
10.WATER ZONES(depth): _ 31d' YbD r
LOCATION SKETCH
11. DISINFECTION:Type It ni NG Amount Show direction and distance in miles from at least
12. CASING: Wall Thickness two State Roads or County Roads.Include the road
Depth Diameter or Weight/Ft. Material numbers and common road names.
From_�_To_'W Fi. ✓C
- From To Ft. -From To F 9-ie�h,46
L /
13. GROUT: Depth n Material Method t7
Fromm Tom_FL l 'pIfCPE RJ dA
From To Ft. _
14. SCREEN: Depth Diameter Slot Size Material I
tJt
From To Ft. in. in. p
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Size Material -'
From To FL
From To Ft.
16. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C,WELL
CONSTRUCTION STANDARDS,AA'N/D THAT A,COPY
{OOFF);HIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
SIGN�URE OF PERSON CONSTRUCTING THE WELL - � /WkTE�AS
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. V GW-I REV.07/2001 _

WELL CONSTRUCTION RECORD CJ"
North Carolina-Department of Environment and Nautoral Resources-Divisi of Water Quality-Groundwater Section J� (�
WELL CONTRACTOR(INDIVIDUAL)NAME (print) CERTIFICATION#QZUQs1/J
WELL CONTRACTOR AN NAME �!�SOLI! PHONENSI�i.1,S9-SI-F9ty
STATE WELL CONSTRUCTION PERMIT# J _ ASSOCIATED WQ PERMIT#
(if applicable) / (if applicable)
1. WELL USE(Check Applicable Box):Residential eO Municipal/Public ❑ Industrial ❑ Agricultural ❑
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other,List Use
2. WELL LOCATION- t Topographic/Land setting
Neares[Town: County#y t Al ❑Ridge Cl§lope ❑Valley ❑Flat
(check appropriate box)
(Street Natitiel Numbers,Community,Subdivision,Lot No.,Zip Code) Latitude/longirude of wel}}location
3. OWNER: "A �O(.0$,9-n., (degrees/minut0ec
Address eh Latitude/longitude source:IS GPS❑Topographicmap
(Street or Route No.) (check box)
mc- '2Sf^/9 o`l DEPTH DRILLING LOG
City or Town State Zip Code From To Formation Description
(M)- &42- IV73 D - rid
Area code-Phone number /'2J,�$ 5
. DATE DRILLED 5 —74 !nS. TOTAL DEPTH: / //p � y6 sruN.�c
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO Rr
7. STATIC WATER LEVEL Below Top of Casing: 24 FT.
(Use"+"if Above Top of Casing)
8. TOP OF CASING IS FT.Above Land Surface*
*Top of casing terminated at/or below land surface requires a -
vLe in accordance with IiA NCAC . TO3
9. YIELD(,pm):_[�_METHOD
OF TEST "
10.WATER ZONES(depth): 3#0
LOCATION SKETCH
11. DISINFECTION:Type /V Amount J2/ 2- Show direction and distance in miles from at least
12. CASING: Wall Thickness two State Roads or County Roads.Include the road
Depth Diameter or Weight/Ft. Material numbers and common road names.
From - 0 To-la—Ft. 6,A5 S
From To Ft.
From To Ft.
13. GROUT: Depth n Material Method
From_To '-Q_Ft. l - i kF ,F -u t P i da
Front To Ft. ' I" '-j'
14. SCREEN: Depth Diameter Slot Size Material -
From To Ft. in. in. :=
From To Ft. in. in. -
15. SAND/GRAVEL PACK: CD -
Depth Size - Material rTtto
From To - FE. I '
From To Ft. cJi _4,f
O
16. REMARKS: c.n
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C,WELL
CONSTRUCTION STANDARDS,AND THAT A COPY F -RD HAS BEEN PROVIDED TO THE WELL OWNER
IG ATURE OF PtRSON CONSTRUCTING THE.WELL bATA
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. dW-1 REV-07/200I

WELL CONSTRUCTION RECORD
North Carolina-Department of Environment and Natural Resources-Division of Water Quality-Groundwater Section
WELL CONTRACTOR(INDIVIDUAL) M NA (print) �Rj/�/t/ . LC NEs CERTIFICATION#3M
WELL CONTRACTOR COMPANY NANIEt&9!Q SON r1 A�E1J '1/✓-1 .4o I LLG PHONE&V 2;; 82{914-,
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
1. WELL USE(Check Applicable Box):Residential C3 -�Municipal/Public ❑ Industrial ❑ Agricultural ❑ -
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other,List Use
2. WELL LOCATION: Topographic/Land setting
Nearest Town: '✓;-ey v./k County Mf6dge ❑Slope ❑Valley ❑Flat
Y44.6-t (check appropriate box)
(Sneer Name,Numbers,Communiry,Subdivision,Lot No.,Zip Code) Latitude/longitude of well location
3. OWNER: iJD,,?S m !' /-1 e�CA F-6fAl-I(-.IDb) (degrees/minutesls�nds)
address nM Latitude/longitude source:OUPS❑Topographic map
(Sneer or Route No. (check box)
Skc_u.ItC ItC_ ;g8m DEPTH DRILLINGLOG
Ciryor Town State Zip Code From To Formation Description
913
Area code-Phone number
=4. DATE DRILLED / ' /Z-O.r'
5. TOTAL DEPTH: 5-.<
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO C3
7. STATIC WATER LEVEL Below Top of Casing: rO FT. --.+
(Use"+"if Above Top of Casing)
S. TOP OF CASING IS FT.Above Land Surface"
•Top of casing terminated attor below land surface requires a )
variance in accordance with l5A NCAC 2C.01 18.
CIt
9. YIELD (,,pm): / '/t METHOD OF TEST [g ,
10.WATER ZONES(depth): �IS" I CA
LOCATION SKETCH
11. DISINFECTION:Type C Ems" e Amount ?J' M9 Show direction and distance in miles from at leas[
12. CASING: Wall Thickness two State Roads or County Roads.Include the road
Depth� ww Diameter or Weight/Ft. Material numbers and common road names.
From_0 To._tar Fr. Lit: 5017/ J'✓c r,\ �� 0� I _
From - To Ft.
From To Ft.
13, GROUT: Depth Material �/�Method �,p�-�1� 0-�
From To-�1Z FL /YG E E 7"' I,�
From To F[. 1
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 - Fr. I;Dt`t 2 4
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
y � l!. I- iZ - Ds-
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
Submit the original to the Division of Water Quality,Groundwater Section, 1636 Mail Service Center-Raleigh,NC
27699-1636 Phone No.[phone], within 30 days. GW-1 REV.07/2001

WELL CONSTRUCTION RECORD
North Carolina-Department of Environment and Natural Resources-Division of Water Quality-Groundwater Section
WELL CONTRACTOR(INDIVIDUAL)NAMz.(prior) 'Ag &ly . 'AJae''S� CERTIFICATION 71d r/�",/W&
WELL CONTRACTOR COMPANY NAME/ERW LGSON Is 1JII &E ✓d T[J �LLC� PHONE&2 2f2— p
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
1. WELL USE(Check Applicable Box):Residential fd1 Municipal/Public ❑ Industrial ❑ Agricultural ❑
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other,List Use
2. WELL LOCATION: e��� Topographic/Land setting
Nearest Town: e,+h., A County p�p o:ata... ORidge M'glope ❑Valley ❑Flat
I{i(J w� ear Es+A+es (check appropriate box)
tsae Name,Numb Is,Community,Subdivision,Lca No.,Zip Code) Latitude/longitude of well location
N 35'")0.47tf 1 W o5m, '3'f-.5b I
3. OWNER: _V6f (degmes/minutes/seconds)
Address *; '4" Latitude/longitude source:OGPSOTopographic map
(check box)
(Street or Route NO
ffS/BI/�/e NC AR76lP. DEPTH DRILLING LOG
/p1( c1ay or rows State Zip Code From To Formation Description rt
.Area code-Phone number 71 — Is a
4. DATE DRILLED I — 05 - 05 2 a — 40,9 f-, +eJ
5. TOTALDEPTH: 40
6. DOES WELL REPLACE EXISTING WELL? YES Cl NO 6I1�
7. STATIC WATER LEVEL Below Top of Casing:1_FT.
(Use"+"if Above Top of Casing)
8. TOP OF CASING IS FT.Above Land Surface"
"top of casing terminated atlor below land surface requires a
variance in accordance with 15A NCAC 2C.0118.
9. YIELD (gpm): �5_METHOD OF TEST °(l
10.WATER ZONES(depth):
LOCATION SKETCH
IL DISINFECTION:TypeCit IDel 'N¢.o Amount Dlt � Show direction and distance in miles from at least -=
12. CASING: Wall Thickness two State Roads or County Roads.Include the 1� -�
Depth Diameter or Weight/Ft. Material numbers and common road names. c-)
From Q To--a@_FL In.1a5 R.a1 FVG t�
From - To Ft.
From To F[. 1V o
13. GROUT: Depth Material M�et�h„o�d�
From_[_To �Ft. /YG E f 7"�""7— O�l
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 _ 2 9 �.,U3
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
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
Submit the original to the Division of Water Quality,Groundwater Section, 1636 Mail Service Center-Raleigh,NC -
27699-1636 Phone No.[phone], within 30 days. GW-1 REV.07/2001

WELL CONSTRUCTION RECORD
North Carolina- Department of Environment and Natural Resources-Division of Water Quality-Groundwater Section WELLCONT'lLkCTOR(INDIVIDUAL)NAM (print) ARi,+IV , h kNE���� CERTIFICAT10NN#jl /O
WELL CONTRACTORCOMPANY NAME/:iF, �O/V ' 4'b-4 �✓d TLLLG PHONE FS�PI L*/A�8'f/cam
SPATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
1. WELL USE(Check Applicable Box):Residential 01�MuaicipaVPublic ❑ Industrial ❑ Agricultural ❑
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other,List Use
2. WELL LOCATION: Topographic/Land setting
NcarestTown: A h �.� Crlou ty�e �rro• ❑Ridge CaSlope ❑Valley ❑Flat
(check appropriate box)
(Sneer Name,Numbers,Community,Subdivision,Lot No.,Zip Code) Latitude/longitude of well location
H'3r' STY No�z'
3. OWNER: me� 7-t 5 Yl�.r (degmes/minures�l ��ds)
Address f N ;he g2 Latitude/longitude sDurce:;?PS❑Topographic map
(Sneer m Roue No.) (check box
�1'CAde_{l NL 873 a DEPTH DRILLINGLOG
City or on T Smte Zip Code From To Formation Description
P9)- T J- a97 `7 -�77 .�
Area code Phone number 77 _ YL f/ . C3 _
. DATE DRILLED 1'/(- OS
5. TOTAL DEPTH:_T�,f / t _
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO ff
7. STATIC WATER LEVEL Below Top of Casing: 40 FT. 0 w,
(Use"+"if Above Top of Casing)
8. TOP OF CASING IS FT.Above Land Surface" -
*Top of casin-terminated at/or below land surface requires a
variance in accordance with 15.4.NCAC:C.8118.
9. YIELD(gpm): /I— METHOD OF TEST
10.WATER ZONES(depth): Xb— J
LOCATION SKETCH
IL DISINFECTION:Typeg/a -z Amount Y Ai.4j Show direction and distance in miles from at least
12. CASING: - Will Thickness two State Roads or County Roads.Include the road
Depth Diameter or Weight/Ft. Material numbers and common road names.
From y To YL Ft.4.W,— S.O / s!/,C ^1 , I�(,. -��/
From _ _.To Ft. t l ! t'�t�� 1 F-x,'I 1
From To F[. 1 t�
13. GROUT: Depth Material Method {SD
From_To Ft. /rC E e
From To Ft. 1 �.e-�
14. SCREEN: Depth Diameter Slot Size Material
From in.
From To Ft. hL in. _
15. SAND/GRAVEL PACK:
Depth Size Material
From To - Ft.
From To Fr. J -
16. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C,WELL
CONSTRUCTION STANDARDS,AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER -
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
Submit the original to the Division of Water Quality,Groundwater Section, 1636 Mail Service Center-Raleigh,NC
27699-1636 Phone No.[phone],within 30 days. GW-I REV.07/2001

WELL CONSTRUCTION RECORD
North Carolina-Department of Environment and Natural Resources-Division is Water Quality-Groundwater Section W ELL CONTRACTOR(INDIVIDUAL)NAM (print)_�Bj A-Il CERTIFICATION#311 p
WELL CONTRACTOR COMPANY NAME/LKQG (OA/ I CAJEIZ 41✓rl a LLC- PHONE&9&L5G— /a.
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(i f applicable) (if applicable)
1. WELL USE(Check Applicable Box):Residential I21'Municipal/Public ❑ Industrial ❑ Agricultural ❑
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other,List Use
2. WE LL LOCATION: ''// Topographic/Land setting
Nearest Town: hkn lr"O v�Ile County /rr^/ S' ❑Ridge, lope ❑Valley ❑Flat
t ar OL ✓L 'f S /-cL�' , �— (check appropriate box)
(Streer Name,Numbers,Community,Subdivision,Lot No.,Zip Code) Latitude/tongitude of well location
K 1-' real �zo-s�r�Lr ?rfk+D/'
3. OWNER: ! P H R I�l (degrees/minuteoeconds)
Address LatitudMongitude source:❑"GPS❑Topographic map
//� (S(t�n or Route No.) (check box)
'4x CP 1 e DEPTH DRILLINGLOG
City or Town State Zip Code From To Formation Description
=)- 11)t76- f43 1 p. ,Pr f?st
Brea code-Phone number 3r- D 5,,,/t✓me
4. DATE DRILLED 41. 2•r-D
5. TOTAL DEPTH: 20s-
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO
7. STATIC WATER LEVEL Below Top of Casing: y� FT.
(Use"+"if Above Top of Casing)
S. TOP OF CASING IS�_FT.Above Land Surface-
•Top of casing terminated at/or below land surface requires a
variance in accordance with 15A NCAC 2C.0118.
9. YIELD (,pm): 20 METHOD OF TEST( Glina-R o
10.WATER ZONES (depth): 400
LOCATION SKETCH
11. DISINFECTION:Type Close Amount c6e Show direction and distance in miles from at least
t2. CASING: Wall Thickness two State Roads or County Roads.Include the road
Depth Diameter or Weighl/Ft. Material numbers and common road names.
From To ay Fr. L,lts" rAlZl A7/6 � -}-
From To FL
From To FL ` �l!13. GROUT: Depth Material Method �19C!>°/J 6/vl%>Ile I C
From_To 2 D Ft. lYG E F _,
From To FL f!
14. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in. CD ---
From To Ft. in. in. n
15. SAND/GRAVELPACK; t -_
Depth Size Material
From To Ft O i'
From To Ft. �.
16. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C,WELL
CONS CTION 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 Seetiook,• I¢361Mai1 Service Center-Raleigh,NC -
27699.1636 Phone No.[phone],within 30 days. GW-I REV.07/2001
ry

WELL CONSTRUCTION RECORD
North Carolina-Department of Environment and al Resources-Div's'gq of water Quality-Groundwater Section
���� ('')
WELL CONTRACTOR(INDMDUAL)NAME (print) CERTIFICATION#12 0W
WELL CONTRACTOR COMPANY NAME{Pk1 'c. Mp. PHONE a5yQ'H49(>_
STATE WELL CONSTRUCTION PERMITX JJ __ ASSOCIATED WQ PERMITp
(if applicable)
(ifa plicable)
1. WELL USE(Check Applicable Box):Residential Municipal/Public ❑ Industrial ❑ Agricultural ❑
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other,List Use -
2. WELL LOCATIO _ -
Nearest Town:_ Topographic/Land setting
I'
�� . ,t/'°tp` ❑Ridge ❑Slope Malley 6-t
V ni,I�� "✓_-. (check appropriate box)
(Street Name,Numbers,Community,Subdivision,Lot No.,Zip Code) LatitudeAOngitude of ell location
3. OWNER: P ` i)'d rl tyq( /1V (degrees/min
de 6min Is ?672l1,
Address —y (degrees min s ss�
Latitude/longitude source:211PS❑Topographic map
(Street or Rou`j No.) (check box)
Sl�tyyl / JYC" ,���j DEPTH DRILLING LOG
City or Town State Zip Code From To Formation Description
Area code-Phone number u J S'S
4. DATE DRILLED t/�1L45 —
5. TOTAL DEPTH:_ �f0� 6/5
-SO
6. DOES WELL REPLACE EXISTING WELL? YES El No Cr Cn
7. STATIC WATER LEVEL Below Top of Casing: _Z(2-__FT.
(Use"+"if Above Top of Casing)
S. TOP OF CASING IS � FT.Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordant with 15.4 NCAC 2C.8118.
9. YIELD (gpm): zMETHOD OF TEST_�'g
10.WATER ZONES(depth): Q ' J
// LOCATION SKETCH
11. DISINFECTION:Type ilG(/ /n."L, Amount 9 Z= Show direction and distance in miles from at least
12. CASING: Wall Thickness two State Roads or County Roads.Include the road
Depth Diameter or Weight/Ft. Material numbers and common road names.
From__-&_To .54_FL/,A S Z& s & &p At
- From To Ft. I , i ,N( D l i /i// •
From To FL LL B�t7 J�f
13. GROUT: Depth 'r
P Material Method /— �f
. FromQ To 9 Q Ft• 2 � 2i dA ifsd N e7 rJ f 1(e p
From To Ft. IM
14. SCREEN: Depth a?
Diameter Slot Size Material t t.
From To Ft. in. in, tJt
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To FL
From To Fr.
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
J
V 2-
SIGNATUFt OF PERSON CONSTRUCTING THE WELL DATE
Submit the original to the Division of Water Quality,Groundwater Section, 1636 Mall Service Center-Raleigh,NC
27699-1636 Phone No.(9I9)733-3221, within 30 days. - 1-- GW-1 REV.07/2001 --

WELL CONSTRUCTION RECORD
North Carolina-Department of Environment and Natural Resources-Division of Water Quality-Groundwater Section
WL'LL CONTRACTOR(INDIVIDUAL)NAME(print) ,R41V . &J;NES CERTIFICATION t#�J/"//�
4i�'tpJ/
WELL CONTaAcroR NAhIE COMPANY V S hJE/I 24 7Ad2 y LLC PHONE
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable) — (ifapplicable)
/
1. WELL USE(Check Applicable Box):Residential EK MunicipaVPublic ❑ Industrial ❑ Agricultural ❑ -
Monitnring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other,List Use
2. WELL LOCATI N: topographic/Land setting
Nearest Town: v///c County 11�1aw+ tdge ❑Slope []Valley ❑Flat
A .&I L•Y✓ (check appropriate box)
1Svedt 14,nne,Numbers,Community,Subdivision,Lot No.,Zip Code) Latilude/longitude of well location
N3r'zz.3Jz�,,r7Pxo .g js,,
3. OWNER, h0 (degmes/minumoee onds)
Address— '4�,'Sho Aidee bu,,E Latitude/longitude sotu•ce:f'lGPS❑Topographic map
(Sweet or Route No.) check box
C.C-fCl7�f,�. NC. ��J 73 DRI
, DEPTH ( )
LLING LOG
C. or y own S to Zip Code From To Fo tion Description
$. a 89-99�/ D - z/
.Area code-Phone number 21-Z(. •seii/f1Kt
4. DATE DRILLED /Y-of L6 L
5. TOTAL DEPTH: /e CA-
-/
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO l
7. STATIC WATER LEVEL Below Top of Casing: .16W FT.
(Use"+"if Above Top of Casing)
S. TOP OF CASING IS FT.Above Land Surface'"
'Top of casing terminated at/or below land surface requires a
variance in accordance with 15A NCAC 2C.01I8.
9. YIELD(,,Pm): / METHOD OF TEST�Na a
10. WATER ZONES(depth):_ z5 Ly 370 f J
LOCATION SKETCH
11. DISINFECTION:Type CY., Amount 32 s, Show direction and distance in miles from at least
l2. CASING: Wall Thickness two State Roads or County Roads.Include the road
d
Depth Diameter or Weight/Ft. Material numbers pand common road names.
From To Zd Fr. /26' L/ �r/C.From To FL c
From To Ft. y//'
13. GROUT: Depth Material Method 1dry //elsl �/ ll / /V l. .,
From_,_To�Q_Ft. a,(. E E 'y q
From To Fr. J�
W. SCREEN: Depth Diameter Slot Size Material From To Ft. in. in. _
From To Ft. in. in.
15. SAND/GRAVEL PACK: o
Depth Size Material rT1
From To Ft. c")
I
From To Ft. �.
16. REMARKS: R
cn
1 DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C,WELL
CONSTR CTION 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 Seulon 1436-Mad S!rvicaCeater.-Raleigh,NC
27699-1636 Phone No.[phone], within 30 days. ;. h G _,( REV.07/2001
4 2006

WELL CONSTRUCTION RECORD
�k j}y
North Carolina-Department of Environment and rat Resources-Divisi of Water Quality-GrounAi ter Sectiotf ry WELL CONTRACTOR(INDIVIDUAL)NAME (print) CERTIFIOAT # X1 Do
WELL CONTRACTOR COMPANY NAME&4Ca7 A11C L.l_ I 0"d ,�� -PHONE .,1S Q-ga{Z]�
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERIf IT#
(if applicable)
(ifa plicable)
1. WELL USE(Check Applicable~Box):Rest ential ❑ Municipal/Public ❑ Industrial ❑ Agricultural ❑
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other,List Use -
2. WELL LOCATION*
Topographic/Land setting
Nearest Town: /` �AG County ❑Ridge ❑Slope ❑Valley C�PFLat
(check appropriate box)
tStrect Name,Numbers,Community,Subdivision,Lot No.,Zip Code) Latitude/longitude of tel location c
3. OWN ER: {� (degrees/minutesl Dods) 3�t3Y>0
Address 1- Rout 0.� Latitude/longitudesource: PS❑Topographic trap
(Scree[or Rout of
p ,` (check box)
'end to 6/l r l f� �{ �jg7�/ DEPTH DRILLING LOG
City or T
(�-�o§7 Slate83 Zip Code From To Formation Description
p�rr�P Area code--Phone number
4. DATE DRILLED VA O S
5. TOTAL DEPTH: ' /C
6. DOES WELL REPLACE EXISTING WELL? YES El No
NO L� —2 Y �s
7. STATIC WATER LEVEL Below Top of Casing: je-T _FT.
(Use"+"if Above Top of Casing)
S. TOP OF CASING IS FT. Above Land Surtace*
*Top of casing terminated at/or belmv land surface requires a
variance in accordance with ISA NCAC 2C.0118.
9. YIELD _MET/�HsOD OF TEST IN
10.WATER ZONES (depth): I rA — Q W J
LOCATION SKETCH
It. DISINFECTION:Type Amount & Show direction and distance in miles from at least
12. CASING: Wall Thickness two State Roads or County Roads.Include the road
Depth Diameter or Weight/Ft. Material numbers and common road names.
From__f�_.To_$_Y-Ft. 6.0 ]./t.�u 4tMkAI
- From To Ft. � �Ihtf -ik�� K
From To Ft. 514
`J�AU�
13. GROUT: Depth ,) Material/ Method �� c
From_Q_To9 D Ft.( -Q11 p&tom Q.i r(4 14()fs
From To Ft.
14. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in.
From To Ft. in. in. c7
rn
15. SAND/GRAVEL PACK:
Depth Size Material
1
From To Ft. to
From To Ft CD 4
Lrl
16. REMARKS: - -g
cr
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C,WELL
CONSTRUCTION STANDARDS,AND THAT A COPY OF THIS CORD HAS BEEN PROVIDED TO THE WELL OWNER
SIGN U OF ERSON ONS UCTING THE WELL ATE
Submit the original to the Division of Water Quality,GroundwaterlSection, t636 Mail Service Center-Raleigh,NC
27699-1636 Phone No.[phone],within 30 days. GW-I REV.07/2001
r rr

WELL CONSTRUCTION RECORD
North Carolina-Department of Environment and ral Resources-Divisl of Water Quality-Groundwater Section �� �t [']
WELL CONTRACTOR(INDIVIDUAL)NAME (print) CERTIFICATION SQL
WELL CONTRACTOR COMPANY NAME OWhil r4� L<s- PHONE ".459-HL{9�
STATE WELL CONSTRUCTION PERMIT! ASSOCIATED WQ PERMIT!
(if appllcablel
/ (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:
cJ tt Topographic/Lan�cling
Nearest Town:_V12,0 A County O
❑Ridge ❑Slope Valley ❑Flat
7 Ado (check appropriate box)
tSueet Name,Numbers,Community,Subdivision,LA No.,Zip Code) Latitude/longitude of vyell location
3. OWN At&S'1a .64'zftu J
ER: }' -�— q0�
(degrees/minu stI! seconds)
Address Latitude/longitude source:[RUES❑Topographic map
(Scree[or Route 0.) (check box)
3 DEPTH DRILLING LOG
Ciry or To SA Zip Code From To Formation Description
zo v 3-- Ra ug 0
Area code-Phone number
5. DATE DRILLED --�--
5. TOTAL DEPTH:
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO
7. STATIC WATER LEVEL Below Top of Casing: 20 FT.
(Use"+'if Above Top of Casing)
S. TOP OF CASING IS-�_FT.Above Land Surface`
*Top of casing terminated atior below land surface requires a
variance in accordance with 15A NCAC 2C.0118.
9. YIELD(gpm): I METHOD OF TEST q
10.WATER ZONES (depth): 27Q J
LOCATION SKETCH
11. DISINFECTION:Type 'A P r Amount 1SI 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.
Front To�_Ft. 6,u ],/ v(_
From To Ft. - N.1 go
From To Ft. G17��1A -1
13. GROUT: Depth Material Method / ��
. From_ 0 To9 Q Ft.,(' „C2E .e E1 d f
From To Ft.
14. SCREEN: Depth Diameter Slot Size Material -
From To Ft. in. in. 0
From To Ft, in. in. IT1 `
15. SAND/GRAVEL PACK: c-1
Depth Size Material
From To Ft.
From To Ft. N -
16. REMARKS:
1 DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C,WELL
CONSTRUCTION STANDARDS,AND THAT A COPY OF THIS UCORD HA BEEN PROVIDED TO THE WELL OWNER
yS Ir
SIGNA"OFPE CO STRUCTWG THE WELL— V DWE
Submit the original to the Division of Water Quality,Groundwater.Section, 1636 Mail Service Center-Raleigh,NC
27699-1636 Phone No.[phone], within 30 days. - --- GW-I REV.07/2001

WELL CONSTRUCTION RECORD
North Carolina-Department of Environment and Natural Resources-Division of Water Quality-Groundwater Section WELL CONTRACTOR(INDIVIDUAL)NAM (print) �f/}/� �l CERTIFICATION#31 p/
WELL CONTRACTOR COMPANY NAME ERQIL.SONS A-6fd A-all r j LL PHONEILM2Jeeq_
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
1. WELL USE(Check Applicable Box):Residential O'er Municipal/Public ❑ Industrial ❑ Agricultural ❑ -
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other,List Use
2, WELL LOCATIO
Nearet Town: e,.✓•6�C Topographic/Land setting
p`To ..`County �� "'+ LKidge ❑Slope ❑Valley OFlat
�J (check appropriate box)
(Sneer Name,Numbers,Community,Subdivision,Lot No.,Zip Code) Laurude/longitude of well location
3. OWNER: 1✓?J°2/,c/SS rNaY/.°Z2.OLd
C. (degrees/minutes/seconds)
Address �/ Latitude/longilude source:1TU`PS❑Topographic map
(street or Ro t No.) (check box)
HL DEPTH DRILLINGLOG
City or Town State Zip Code From To Formation Description
drea cede-Phone numbeer/
4. DATE DRILLED Y -r�0� (a)-- �r/f-
5. TOTAL DEPTH: d�6'
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO
7. STATIC WATER LEVEL Below Top of Casing: &0 FT.
S. TOP OF CASING IS (Use"+"if Above'rop of cuing*
FT.Above Land Surface
*Top of easing terminated ar/or below land surface requires a
variance in accordance with 15.1 NCAC 2C.0118.
9. YIELD (gpm): -7 METHOD OF TEST &A ina-&y
10. WATER ZONES(depth): /
LOCATION SKETCH
11. DISINFECTION:Type C/• Amount Re f4-5 Show direction and distance in miles from at least
12. CASING: Will Thickness two State Roads or County Roads.Include the road
Depth Diameter or Weight/Ft. Material numbers and common road names.
From To Lf' FLe,&Z- 6peel
From To FL - acli-n
From To FL
13. GROUT: Depth Material Method ��jYey� t 41�
From._To J Q Ft. /YG E e
From To Ft.
14. SCREEN: Depth Diameter Slot Size Material O
From To FL_in. in,
c�
From To FL_in. in. [
15. SAND/GRAVEL PACK:
Depth Size Material From To Ft. OU1 _,RYA
From To F[.
a
16, REMARKS: -
[DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C,WELL
CONSTRUCTION STANDARDS,AND THAT ACOPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
SIGNATURE OF PERSON CONSTRUCTING THE W4L -- -:;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. OW-1 REV.07/2001

WELL CONSTRUCTION RECORD
North Carolina-Department of Environment and Natural Resources-Division of Water Quality-Groundwater Section WELL CONTILaCTOR(1N DIVlDUAL)NAM (prinQ � CERTIFICATION nd��jj
�
WELL CONTRACTOR COMPANY NAME a/I/,1 ?�' LLG PHONE
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMITtY
(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 LOCATION: Topographic/Land setting
NearrretstTovm: .. ;//c County CKidge ❑Slope ❑Valley ❑Flat
(check appropriate box)
(Sneer Name,Numbers,Comnruniry,Subdivision,Lot No.,Zip Code) Lahrtd ngitude of well location
3. 04VNER: /� / �l erQ-('r (degrees/minutes/seconds)
Address / CKoc it Lf k Ld Latitude/longitude source:EW3PS❑Topographic map
(Street or Route No.) (check box)
01-rep"/`n NC � 9790 DEPTH DRILLINGLOG
City or Town State Zip Code From TO Formation Description
(a)- 1014-63/9 fl 63 !J.
.4tna code-Phone number
4. DATE DRILLED .7-16-or -rSe..sSr4.�
5. TOTAL DEPTH: Joj 61- Y or _6 A
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO
7. STATIC WATER LEVEL Below Top of Casing: S,O FT.
(Use"+"if Above Top of Casing)
8. TOP OF CASING IS�_FT.Above Land Surface"
`Top of casing terminated spur below land surface requires a
variance in accurdanc with 15A NCAC 2C.Mla. p'
9. YIELD(...... - METHOD OF ST �g
10.WATER ZONES (depth): -I .
LOCATION SKETCH
11. DISINFECTION:TypeC/oilnt Amount //Ar, Show direction and distance in miles from at least
12. CASING: - Wa11 Thickness two State Roads or County Roads.Include the road
Depth Diameter or Weight/Ft. Material numbers and common road names.
From To Fr. -rjywe/ /PdG
From To Fr.
From To Fr. led
/'
13. GROUT: Depth Material Method (t�/"5 6 „/�///� �C
From To.�0 Ft. (IrC E `"7is��,'r,rn �'P{'1 Of !l
From To Ft.
I4. SCREEN: Depth Diameter Slot Size Material p
From To Ft.-in. in. rn -
FrOm To Ft. in. in.
15. SAND/GRAVEL PACK: r11 '7
Depth Size Material
From To Fl. '
From To Ft.
4's
16. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH ISA NCAC 2C,WELL
CONSTRUCTION STANDARDS,AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
Submit the original to the Division of Water Quality,Groundwater Section,' 1636 Mail Service Center-Raleigh,NC
27699-1636 Phone No.[phone],within 30 days. - GW-I REV.07/2001
j

hat .
RESIDENTIAL WELLCONSTRUCTIO', RECORD
3 . North Carphm Lhperbnmi of Environmrnt end Nominal Kcsourccs DI1rswn.a W alcr QuaLry
WELL CONTRACTOR CERTIFICATION 0 a .15 7 I
1.WELL CONTRACTOR' I. DISINFECTION. Type Amount
J 0. WATER ZONES Ioeptm
WM CorIndi id�w0 Name From To / U From To
e-n ?%V er Lk)Q)I - �((/Y From To From To
Wall Contractor Company Name From To From To
STREET ADDRESS PO -ps 0)L oP,0 T S. CASINO: Thickness
� Depth Di t Welphl ateral
COSt 1-j01 C r7C (0 From_To /.3 0 Ft
City or Town State / Zq Code From_To Ft
( 1- 695-)200 From To—Ft
Ar"led► Phone number
2.WELL INFORMATION: 7, GROUT'. Depth Matenal Me"
From () To 2,0 Ft.�7�nrkl� ��y11' 7/(
SITE WELL ID a(If apptcaola) r � From To Ft
STATE WELL PERMITS(x app.osaq 0 I Zn (I Y�1L'(l Fro^_ Ta Ft
DNq a OTHER PERMIT a(e applicable) S. SCREEN: Depth Diameter Slot Sae Motional
From_To FI n _ n.
WELL USE(Chock Applicable Box): Resiciontol Water Supply❑ .
f r Fran_ To Ft—In n
GATE DRILLED IZI a�l�5 From_ To Ft_n _ In
i
TIME COMPLETED U� AM❑
9. $AHQ'ORAVEL PACK
3.WELL LOCATION: Depth Sae Matonal
CITY: InC�'11,1SLmUll ��' COUNTY (k' 'iSal From To F(
1 From To Ft.—
From—To—Ft
(Sheet Name N lxra.CommurLxy.Subdivean.Lot No.,Parcel.ZIP Coon)
TOPOGRAPHIC/LAND SETTING: 10. DRILLING LOG
Oig'lopa OVellry OFlet ❑Ridpa ❑Other From To Fo anon D. spoon
(pfMGh appropriate,boa) %" -' /� Fol
d 571� May be indcV=, �D _ If —
LATITUDE 35!7 mioub,scow dr or
LONGITUDE Q�; O all 4(e u) in decimal format Me
Lilatldc-Aongitlde source: OGPS ❑Topographic map
(lopetun of wet m Aor be shown on a USGS tcpo map and
attached to the,form/not AN V GPS) -
a.WELL OWNERt—
OWNER'SNAMESTREET ADDRESS ) UU ('t�Il�✓11 C�� f- Ln
Y I . t 2LcIC N C Z4s73 1
Cry a Town Stet. Zip Code
KqW code: Phone number -
11. REMARKS:
6.WELL DETAILS:
a. TOTAL DEPTH:
b. DOES WELL REPLACE EXISTING WELL7 YES❑ NO❑
ADD NEREaT CERmh iMiiNiS WELL WAS CONSrNUCTED IN AIX.CADANCE
EVE wnN
c. WATER LEVEL Below Top of Casing: FT. IM NCAC]C.WELL ca+srRucnoN STANDARDS AND THAT A coat DF TMa
(UN-�a Abo+e Top d CYnp) RECORD NAS BEEN PRWOECi THE WELL OWNER c�
d. TOP OF CASINO IS 1 FT.Abma Lard Sudan' A-
Top of wnp torrdrutad SVa below Wd surface may require SIGNATURE OF CERTIFIED W ELL CONTRACTOR DATE
a varr nco n socorderwa with 15A NCAC 2C.0118.
3 METHOD OF TEST r RI lT D NAM / �R SON LU
a' YIELD L9W^)� PRINT D NAME OF PERSON CONSTRUCTING THE WE II
Subrnit the oNInal to the Division of Water Quality Within 30 days. Attn: ntormadon MpL, Form GW-la
1617 Mall Service Center-Ralelgh,NC 27699-1617 Phone No.[phone] ext 668. Rev 7105

WELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources-Division of Water Quality
w'ELI.CONTRACTOR(INDIVIDUAL)NAME (print) Bryant Smith
C FRTIFICATION a 2571
WELL CONTRACTOR COMPANY NAME River
Green Ri Well&Pump Company _PHOSE a [phone]
/ ^ OID�S ��
SI'A I'E WELL CONSTRUCTION PERMITa ASSOCIATED WQ PERMI'ra oS
(f applicable) ..., (if applicable) -
I WELL USE(Check Applicable Box): Residential K/Mtmicipal/Public❑ Industrial ❑ Agricultural❑
Monitoring❑ Recovery ❑ Heat Pump Water Injection❑ Other❑ If Other,List Use
2 WELL LOCATION: Topographic/Land setting
Nearest Town:�r-A B(.1V t I I P,. Cotm d-thsclrl 2[Uge ❑Slope ❑Valley ❑Flat
�-r A o J Crn t 11I )c - (check appropriate box)
I fta npr 17R 11 KLl "5--4�lt
(so-eel Name,Numbers, ty, n, p Latitude/l '5 itude of well location
Commum Subdrvuw lul No.,Zip Code) g
11 ��� 'S?tM �9,z"mil SYt[J
3. OWNER: V G �7 P� (degrees/mmuteslaewnde)
Address I S 9 s +�-+11 Latitude/longitude source:P PS❑Topographic map
(check box)
(Street or Route No.)
�r P) yZ, DEPTH. DRILLING LOG _..
tAAalf SOVLJt11� Zap
City or Town S From To Forma[ It rption
tale Code =_ .�
Area code-Phone number AAJr/+
4. DATE DRILLED � " f - �5
5. "fOTAL DEPTH:-� -
o DOE'S WELL REPLACE EXISTING WELL? YES ❑ NO
7. S f A FIC WATER LEVEL Below Top of Casing: FT.
(Use"i"if Above Top of Casing)
S. TOP OF CASING IS�_FT. Above Land Surfaces
•Top of cuing term in aged at/or below land surface requires a O
variance in accord ancr with 15A NCAC 2C.0118
). YIELD(gpm): 2METHOD OF TEST 4;
10. WATER ZONES(depth): LOCATION SKETCH
Amount Show direction and distance in miles from at least
1 1. DISINFECTION:Type two State Roads or County Roads. Include the road
12. CASING: Wall Thickness
Depth Di a eter or Weight/Ft. Material
numbers and common road names.
From To 22- Ft.
From To Ft. Ir Alf' f
From To Ft. fj P�
13, GROUT: Depth Material Method
From_ To30 Ft. SAkR sd-& A4:�t 21 o0 M
From To is
14 SCREEN: Depth Diameter Slot Size Material p ^�
From To Ft.—in. _ in
CIL
From To FL in. _ in,
C 15 SANDiGRAVEL PACK 0C
Depth Size Material =
From To FL
From To Ft.
16. REMARKS.
I DO HEREBY CERTIFY THAT THIS WELL WAS CONST ICTED IN ACCORDANCE WITH 15A NCAC 2C,WELL
CONSTRUCTION STANDARDS,AND THAT A COPY OF IIS REC HAS BEEN PROVIDED"f0 THE WELL OWNER
- tV-o
S GNATU OF PERSON CONSTRUCTING THE WELL DATE
Submit the original to the Division of Water Quality,Attn: Information Management, 1617 Mad Service Center-
Raleigh,NC 27699-1617, Phone No.[phone],within 30 days. w_1 REV. 09/2004
RECEIVED
FEB 07 2006
Asheville Reglonal Office
Aquifer Pm;,aicri _j

WELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources- Division of Water Quality
WELL CONTRACTOR(INDIVIDUAL)NAME (print) Bryant Smith CERTIFICATION s 2571
WELL CONTRACTOR COMPANY NAME —
Graen River Well&Pump Company PHONE a (828)69&1200
_
STATE WELL CONSTRUCTION PERMTT# ASSOCIATED WQ PERMIT# 0 2U�� ��/r
( (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:ZfYLonla. County t "ym-- ❑Ridge 15Wrope ❑Valley ❑Flat
P90 T �ryCf3Yl ld. �(✓-Z (chcck appropriate box)
(Stred Name,N b .Community,Subdivision,Lot No.,Zip Code) Lati[ie/l;ngtN e of well lUCatlon
,fl fay/i 07�C7�20�5� 3/L✓
i. OWNIER: RQXLA .'- U)a.rd (degrees/minutes h ride)
Address �i ) tl 'rtu�c �")e- Latitude/longitude source: PS❑Topographic map
(check box)
(Strict or,14oide No.)
Z�YOY-'10. /.-)� oZfi'2r7o DEPTH DRILLING LOG.
C
Gry or Town state Zip Code From To Formation Description
a (dqG -'74S 7 G
Area code-Phone number
4. DATE DRILLED /
5. TOTAL DEPTH: h L - 3 Rif .
6. DOES WELL REPLACE EXISTING WELL? YES❑ NO Q'
7. STATIC WATER LEVEL Below Top of Casing: FT. -
(Use"✓'if Abwe Top of Caling) _a
8. TOP OF CASING IS FT.Above Land Surfaces
*Top of cuing terminated at/or below land surface requires a
vsriance in accordance with ISA NCAC 2C.011& .f --�-C _
9. YIELD(gpm):_1�._METHQD OF TEST /r i/Z
10. WATER ZONES(depth): 'TX 5 LOCATION SKETCH -
I I DISINFECTION:Type Amount 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 Dia eter or WeighUFl. Material
From To Fl. 1. z e 4
From�2,To 92- Ft. L Z/,/- ,* Pa
From To Ft. C914 (;,�eON+
13 GROUT:19 T Depth S M�kzEfr- h'tethr�pp
From To (7 Ft. J � 3
From To Ft.
14, SCREEN: Depth Diameter Slot Size Material 1 �s
From To Ft. in. _ in. '
. From To Ft.—in. _ in. -v
15, SAND/GRAVEL PACK:
Depth Size Material LpA1� PtnrU4
From To Ft. CCCTTT
From To Ft. 5i
16. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C,WELL
CONSTRUCTION STANDARDS,AND THAT OPY THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
------
SIGNATURE OF PERSON CON STRUCTiNG THE WELLDATE
Submit the original to the Division of Water Quality,Attn: Information Management, 1617 Mail Service Center-
Raleigh,NC 27699-1617, Phone No.[phone],within 30 days. ^ E'VE�W I Iry 09/2004
FEB 0 7 2005
Asheville Regional Office
uifer,_rotection

a rp J'• RESIDENTIAL WELL CONSTRUCTION RECORD
= {�T _
North CaroBne lhperom nl oY Environmrnt and Natural
Kcsours Dnuion oI W nln QualityIFIC N
WELL CONTRACTOR CERTATION
1.WELL CONTRACT I. DISINFECTION: Type #rN Amount
p� I g. WATER ZONES(Depth)
WWI C46tr1kcior(Individual)Name From �J To� From To
�e 2n �Lv(Ir We r\, v �kyL._p From To From To
—
Wall Contractor Company Name
From To From
To
sv
STREET ADDRESS 6OX e. CASINO: Depth r Weight
Material
COS} FIQr. KI From TZ AlLtl7l'`^\ .
City
or Tovm State I Zip Code From_To FI.
I. 693-)200 From To Ft.
Arm code- Phone number
7. GROUT: Depth Material MWhod
2.WELL INFORMATION: �_ �� AAl7 f� B,
From To Ft
SITE WELL ID s(,I appcam) �7 r7 From_To Ft.
STATE WELL PERMITSId appiwde) Q �laC0/0 IA3� From—To Ft
DWO or OTHER PERMIT s(f applicable) 8. SCREEN: Depth Diameter SM Size Material
From_To Ft_n. _ D.
WELL USE(Check Applicable Box): Residem®I Water Supply p From_To Ft—in _ In.
DATE DRILLED 12 - J - O S From_To Ft_m _ in
TIMECOMPLETED WOO AM PM C3- 9. SAND/GRAVEL PACK'
3.WELL LOCATION: . Depth Sae Material
From To Ft.
CITY'. )(-( 6l'lt 01 ••COUNTY From To Ft.
7 2 Z 20L111 (�Tlz Imo+'✓ From To Ft
(Street Name.Nu a.Cammunity.SubdiNrwn,Lot No.,Parcel,Lp Coda)
TOPOGRAPHIC/LAND SETTI G: 10. DRILLING LOG
❑S" OValley ❑Flat idpo ❑OOW From To Formation Dencrpbon
(check appypriate twr) Ma be in do /, — z`1 -
LATITUDE jj 1Li -AA Al minute,aocond.or —2+ti -'� Q
Iat a decmul Iom st 1 •r) - 'S AYF
LONGITUDEM026 r 7w Zj Q - G6sE4 a Le-
Lautudei'longitudesoLtroe: ❑GPS OTopographic map
(bcatbn of we/must be shown on a USGS topo map and
attached AS Voo form/hot U"GPS) -
4.WELL OWNER
OWNER'S NAME I)tyxiiL '��-'^q�� O�
STR C4-'AD0RE:&
cyl,I, �,JC^LDS V)
City or Town Scat. ZipCoda T
X •107 � 'StI7()
Gbc �
Arm cow• Phone number it. REMARKS:
5.WELL DETAILS:
a. TOTAL DEPTH: C L S
b. DOES WELL REPLACE EXISTING WELL? YES❑ NO
r i Do HEREBY CERTIFY TINT THIS WELL WAS CONSTRUCTED�N ACCORDANCE WITH
c. WATER LEVEL Below Top of Casing:,d� FT. Tat Nv.G 2 wELL CONSTRL T1OH ST NONROS AND THAT A CCPY OF THs
(Um-+9ADOW Top dCooing) RECORD HAS BEEN PRO✓DEDTOTH ELL OWN
d. TOP OF CASINO IS�,,// FT.Above lard Surface' J 12 -/ lc:�T
-Top of wing terminated slior below land surface troy require SIGNATURE CYF CE R.TIIFFIIE D W ELL CON I RAC TOR DATE
a variance r
in a000rwna with 1SA NCAC 2C.0118. A)R Y i�N-/r S/Y7 f
e. YIELD(ppm): METHOD OF TEST AIf2 PRINTED E OF PERSON CONSTRUCTING THE WELL
Submit the original to the Division of Water Quality within 30 days. A Infomyti(Igg Ma !V E D F GW-Ia
1617 Mall Service Center-Raleigh, NC 27699.1617 Phone No.(919)733-701 ext 58 Re 7105
FEB V 2006
Asheville Regional Office
Ant lifer D.neeMl....

lN/at fAlllly. Notww
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WELL t.ONSTiRUCTM RECORD Wf LLf fJi m&CT*R:
Y NLL COHMACTM CRRTfFtCATdf!!f
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1. 1MrLttgfO&W 0
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t' RECEIVED
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It$ANDOYlWWPACK: MAR 0 8 2006
98101h f e Maw"
How Ti f. Asheville Regional Office
Ffea!_..., Ts PL� Aquifer Protection
17. RiiRAfrt�
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bZ A
�. RESIDENTIAL WELL CONSTRUCTION RECORD
j Notill Carolina Department of Envirunmeni and Natural 11(murces-Division of Water Quality
'm Own.d�M
WELL CONTRACTOR CERTIFICATION 4 2586
7.WELL CONTRACTOR: f- DISINFECTION:Typo AmountZ
Ashley T. Moretz g. WATER TONES
ff0Well Coniraotor(InoniI Name (
depth�)
y Frtxn ToS7 From To
W VN C D ror Com I OM W P ❑ - 1 1 - -9.• From To From To
panyName Frotn To From To
STREETADDRESS 6159 HWY. 10 West S- CASING: Thioknegaf
Hlckor NC 28602 F rcm 7IXJDepth ter a coal
raFt. /
a Town
Clty 'late Zip Code From_Tom_Ft
04 -_462- 1327 Frwm`Tc,
Area code. Phone numtwr �-
2.WELL INFORMATION: 7. GROUT�- � �Depth Material Method
SITE WELL ID aFtappllcaede) Frorn'7O/J Too�Ft�.�igV,�,7 op
To Ft,
STATE WELL PERMTI-A(ff applleabksj M^�T From�To FL
DWQ or OTHER PERMIT*(if appljcablePS/00/ Q
8. SCREEN: Diameter Slot Size Material
WELL USE(Check APPlicahle Box): Residential Water Supply in. In,
DATE DRILLED_ FfORi
S. . / From To�
TIME COMPLETED /i AMA PI
9. SANDIGRAVEL PACK;
3.WELL LOCATIp/N / Depth Size Material
CITY: I,.-[[ 'ls8 114-m'. COUNTY—
,Fr°'n To Ft
/ From 7I Ft.
Fr�To FL �
(street Neme,N ra,Cvmmunity,SubNwshn,Lot No„PareeL Zip Code)
TOPOGRAPHIC/LAND SETTING:
10.DRILLING LOG
❑Slope ❑VEacy ❑Flat ridge Cotner From To Formation D(eneek appropdeteboxx) } ,,.� A e"tion
LATITUDE J-5 6a&5DA mmit m corAo
0 g .mirdcci s tart or
LONGITUDE a • 3 madedme)Tortaat
LatitudcAongitude source: QGPS ❑To pographic map
(krafion of wel mustoe shown on a USGS topo reap and
atteclwd M this form,,tsar usdrgGPS)
4.WELL OWNER
OWNER'SNAME ✓r _ Qj` -
ST Ei AA9q0RESS S
enderso I¢,
Cily or TpWn State Zip Corse
�}
Areacode- Ptwne number
S.WELL DETAILS: �T
11, REAIARKS:
& TOTAL DEPTH:C,
b- DOES WELL REPLACE EXISTING WELL? YES❑ NO P
C. WATER LEVEL Below Top of Caj �_ I DO HEREBY CERTFYTHATtHIB WEUW"CWfs MTE°M ACC°R°ARCEWM
(Use'+'if Above Top of Coming) RSGORRAC 2C.WELL HAS SEEN PROVIDe�UcrIIou TO THE WELLMW�.�R ETA YOOFTMA -
d. TGP CF CASING lS Ff.Above Land surface, Al � /� —/��— r � -•�"fop of cashg terminated aVar below land surface they require .
a variance in accordance with 15A NGAC 2C,0116. SIGNAT R�LO ERTIFIED WELL CONTRACTOR DATE
e, YIELD(Spm);_ METHODOFTEST �/l/G(ff
PRINTED NAME PERSON THE WELL
Submit the original to the Division of Water Quality within 30 days. Attn:Inf rTii
1617 Mail Service Canter—Raleigh,NC 27699-1617 Phone No.[phone]kxt 566 GW-1a
RECEIVED Rev IM
FES 13 2006
Ed WdSE:90 900E TZ 'uEf EEER9770L 'ONIXC dwnd 8 -n =8014 : WOdJ
Asheville ReglOnal Office
__.-_ AQUifAr Pr^+e :__

WELL CONSTRUCTION RECORD
North Carolina-Dopartment of Environment and Natural Resources-Division of Water Quality-Groundwater Section
WELL CONTRACTOR(nvDlvmUAL)M ME '`><I��Cn G' g g a w CIRM cwTcoN r 2 7?v
WELL CONTRACTOR OOMPAttY N lee i // s rsONE a 2 cD 6 Y9'-o y&o
STATE WELL CONST1WC n0N rERtnlTd ASSOCIATED WQ PERMM
rf liable if iable
1. WELL USE(Chock Applicable Boa):Residential aMunicipal/Public 0 Dial 0 Agricultural❑
Monitoring 0 Recovery 0 Heat Pump Water hyertion 0 Other 0 If Other,List Use
2 WELL LOCA N: / / Topo�d sung
Nearest
Set,,0, [ C 4W 1r Cl Midge ope OValley OFlat
Li a /v/jt /.. " ,T/91Y'r F5T_r2Ss803 (cbKkwpVoneeoz)
(sneer Name,Nambom Canmancy,Sabdivtsioo,Lot No,Zip Code) Latinntrwongitude of well location
1 OWNER:5z/a )04&
Address i Y IN Latitudellwugitude swece: IGPSMopogtaphic map
�J/ (�b,a)
f" A'�7 4L41rr.%/L. /WG 2�$O 3 l DRILLING LOG
City er rown saes Zip code From To Formation Description
Area coda Phone number
4. DATE DRILLED /Z-(a `0 f— -
5. TOTAL DEPTH: 'Z 2 5—
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO
7. STATIC WATER LEVEL Below Top of Casing. Ye'D FT.
(Use'+'ifAbow Top ofC=bW v�
8. TOP OF CASING IS FT.Above Land Surface*
'Top ofcadaa aeaoaated Byer bWw had swAft requires a ��
v rtaare Insaerduee with ISA NCAC 2C.6118.
9. YIELD(gpm): METHOD OF TEST i iH e
10.WATER ZONES(depth):
LOCATION SKETCH
11. DISINFECTION:Type Amount /D oz Show direction and distance in miles from at least
12. CASING: Wall Thidmeas two State Roads or County Roads.Include the road
From To��Ft—= errer W� Materiai numbers d common road names.
Front­�--To Ft_ rt'C
From_To Ft
I3. GROUT: Depth Maftrw Meowd
FmnL--e—T6-24L Ft cevtAre A 1ws _,X y SERQ �5
From To FL
14. SCREEN: Depth Diamener Slot Size Material fn
From To Ft�in. is Material
" L
From_To Ft m. uL c _ 3 m z I,
15. SAND(GRAVELPACK. m n {-
De(xb sire Material m .
F To Ft p
From To Ft N m v o
16. REMARKS: O O rn
cr
100 HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCO ANC WRH 15A NCA '2C,WELL,
CONSTItIJCf1�0/NANDARDS,AND' T A Y OF RECORD HAS "Ma
M WEI I OWNER
SIGNATURE OF PER6oN CONSTRUCTING TIE WELL DATE
Submit the original to the Division of Water Quality,Groundwater Section,1636 Maul Service Center-Raleigh,NC
2709-1636 Phone No.[phone],within 30 days. GW-1 REV.072001

WELL CONSTRUCTION RECORD(0
North Carolina-Department of Environment and Natural Resources-Division of Water Quality-Groundwater Section
WELL CONTRACTOR(I1MMUA14 NAME�tiaU.�I�.�v .� CIRTMICA77ON/ Z 7 S h'
WEt.I.CONTRACTOR COMPANY n /U1 le e t.t)o f�r- �g�R/l_L/7d a�vraonE a 2g& 6 T-oySo
STATE WELL CONSTBUC11on PERwr# ANOCIATED WQ PERNM
If licable 011 d ieable
I. WELL USE(Chock Applicable Box):Residential MunicipaVpubiic 0 Industrial 0 Agricultural❑
Monitoring 0 Recovery 0 Heat Pinup Water Injection❑ Other O If Other,List Use
2. WELL LOCATION-
Nearest
,/ Tglo rJI real setting
Nearest T Lyle L County!6 SO ORidge, &Mope []Valley OFlat
(Smea Name,Numbers.Cammimby,Subdivir ao.La Na,Tap Cwe) Latiwde/loagitude of well location
3. OWNEIU-et 6> ,o
Address ,V AM .C4 verr s/ l/0 LatitudeJlottgitude smtrce:OGP50Topographic map
(Snot err Rome No.) ( a baz)
l9V vZ`/e 6Ir -z% Doi PAU
Cityor Tgwa Soft Zips From To Formation Description
L�
Am undo-Pbow number
4. DATE DRILLED
S. TOTAL DEPTH:
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO Id
7. STATIC WATER LEVEL Below Top of Casing:
8. TOP OF CASING IS " (Use•4-ifAbm Top of Cases)
FT.Above Land Surface
*
'Top of going terminated ader babes Wut or&=rgdrm■ J
varbam Is attorrlsaee WHIR ISA NCAC 2C.a11a. T/I /
% YIELD(Spin):/7- METHOD OF TES 'mel d
10. WATER ZONES(depth):
LOCATION SKETCH
11. DISINFECTION:Type Ci�_ Amount_/0 o z Show direction and distance in miles from at least
12. CASING: Wall ikkt n two State Roads or County Roads.Include the mad
DepthQ� or W ' t. Maul numbers and common road names.
From_,To__IgL Ft P/�L
From`_To-Ft
From,_ Ft
13. GROUT-
De zz;Fl To7z�Pt cd � �aFrom To FL 9•w!-
14. SCREEN: Depth Dissenter Slot Sine Material
From_ To Ft m. aL llr
From To Ft,__in. in. D
15. SAND(GRAVEL PACK: �
FnomTo Ft I�� S
Depth Sim Material
Firm To Ft n
iv
16. REM mARKS:
•"r N
`° 3 m
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C,WELL o
CONSTR11 ON STANDARDS,AND T A OF THIS ORD HAS BEEN PROVIDED TO THE WELL 0 O rn
z a n
SIGNATURE OF P CONSTRUCTING THE WELL DATE
Submit the original to the Division of Water Quality,Groundwater Section,1636 Mail Service Center-Raleigh,NC
27699-1636 Phase No.[phone],within 30 days. GW-1 REV.072001

North Carolina- Department of Environment,Health,and Natural Resources
Division of Environmental Management- Groundwater Section FOR OFFICE USE ONLY
P.O. Box 29535- Raleigh, N.C.27626.0535 QUAD.NO. SERIAL NO.
Phone [phone] Lal. Long. RO
Minor Basin
WELL CONSTRUCTION RECORD Basin Cade
DRILLING CONTRACTOR: 1[j R i �gq�.7 Header Ent GW-1 STATE WELL CONSTRUCTION
Ent
—�
DRILLER REGISTRATION NUMBER: d 13D PERMIT NUMBER:
1. WELL LOCATI (Sh w sket h of the loca'on below) LJ�� �y �11
Nearest Town:,' iN 0 i2 L County: AxFn� /L°
(Road,ConpRnijor Subdivision and tNo.) DEPTH DRILLING LOG
2_ OWNER rI1F/L 7�i`� igd � From To Formation Descriodon
ADDRESS
�/eycys(zSSttree�t"or Route a)/_,
—City or Town Staid ` Zi Cod
3. DATE DRILLED y'S-46USE OF WELL
4. TOTAL DEPTH
5. CUTTINGS COLLECTED YES NO[::]
6. DOES WELL REPLACE EXISTING WELL? YES P NOg
7. STATIC WATER LEVEL Below Top of Casing: FT.
FT.
(Use'+'iF Casing)
8. TOP OF CASING IS 3-77 Bove Land Surtac
Casing Terminated stfor below land surface Is Ilegal unless a varlanea is Issued
In accordance with 15A NCAC 2C .0118
9. YIELD (gpm): — METHOD OF TEST
10. WATER ZONES (depth):
11. CHLORINATION: Type '— Amount If additional space is needed use back of form
12. CASING:
Wall Thickness LOCATION SKETGH_-_.._ -.--�
7 J epth Diamet r or�'eiQhV�F�- Materiiall (Show direction and distanc {g �p� t .9
Fronr�19 TO �_Ft.. r`�- Roads,or other map reffrrenepoints)
From To Ft.
From To Ft. JUN 0 2 2006
13. GROUT:
Depth Material �M
From • S To -� FL QE��� . &�Eh� _sA ertl�t� 1
From To Ft.
14. SCREEN:
Depth Diameter Slot Size �jerial
From 6 To �L Ft� in. CASOZ0 in. / � 6
From To Ft in. in.
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth ///J �/� z Material
From To Ft.
From o Ft
16. REMARKS: L" (}'✓ y /YSV CII�/n
�„ A2 , y
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.
G
ATU E OF CONTRACTOR OR AGENT DATE
GW-1 REV.sm1 Submit original to Division of Environmental Management and copy to well owner.

R e� n .i r
WELL CONSTRUCTION RECORD 6 J F � 6 f
Noah Carolina-Department of Environment an" raI Resources-Divisi of Water Quality-Groundwater Section# 0OIR���� (�
WELL CONTRACTOR(INDIVIDUAL)NAMEE�(prinn CERTIFICATION
WELL CONTRACTOR COMPANY NAMELLC- PHONE#=;a59-
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
I. WELL USE(Check Applicable Box):Residential 2-Municipal/Public ❑ Industrial ❑ Agricultural ❑
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other,List Use
2. WELL LOCATION: �>n Topograc/Land setting
Nearest Town: ��ti �A-c'— County v q J ❑Ridge Slope ❑Valley ❑Flat
Lit/ (check appropriate box)
(Street Name,Numbers,Community,Subdivision,Lot No.,Zip Code) Latitude/longitude of we I location
/ . . � ,1//
3. OWNER: M Qoa� (de grees/minutes/ conds) r
Address N(2- Latitude/longitude source:C3 PS❑Topographic trap
//'' (Srrezr or Rome No.) (check box)
Y7`Grct�P.rSonf/.���L Ayc 2 -q-Z-R DEPTH - DRILLING LOG
City or Town State Zip Code From To Formation Description
Ca�- 77 2- Q 70/ n - /S _ y
Alta code-Phone number
4. DATE DRILLED 1112Iles
5. TOTAL DEPTH:
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO 2�
7. STATIC WATER LEVEL Below Top of Casing: Ida FT.
(Use"+"if Abova Top of Casing)
S. TOP OF CASING IS FT.Above Land Surface*
`Top of casing terminated actor below land surface requires a
variance in accordance with 13A NCAC 2C Al1S. r�pp �J
9. YIELD(gem):_3_METHOD OF TEST J
10.WATER ZONES(depth): y-0
LOCATION SKETCH
11. DISINFECTION:Type C /' ' --C Amount s_ Show direction and distance in miles from at least
11. CASING. Wall Thickness two State Roads or County Roads.Include the road
Depth Diameter or Weight/Ft. Material numbers and common road names.
From Tom Ft. 4, �-5 't_/G,I d.S PN S AJ
From To Ft.
From To Ft. /� (/gyp N ti
13. GROUT: Depth Material Method ,I� " " &I �O d� /V
Fromm To�� FL 2i dC4 yC t A
From To Ft. _ er/�er',S6n Ui j
IY. SCREEN: Depth Diameter Slot Size Material �.. r-
From To Ft. in, in. Cy%
From To Ft. in. in. `
15. SAND/GRAVEL PACK:
Depth Size Material [
From To Ft.
From To Ft.
16. REMARKS: .._..
I DO I{EREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C,WELL
CONSTRUCTION STANDARDS,AND THAT A COPY
OF /THHIIS RECORDHAS BEEN PROVIDED TO THE WELL OWNER
SI7 NAT L OF PERSON CONSTRUCTING THE WELL tDIATE
� C
ran
c�
c_
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-) REV.07/2001

WELL CONSTRUCTION RECORD ' a3 7
Nonh Carolina-Department of Environment and ral Resources-Divisi of Water Quality-Groundwater Section �� (�
\YELL CONTRACTOR(INDIVIDUAL)NAME (prinn CERTIFICATION#QZt['1Qr�(J
WELL CONTRACTOR COMPANY NANIE O I PHONE Aa5R-STlL-
STATE W R
ELL CONSTRUCTION PERMIT# ASSOCIATED WQ PEMIT#
(it apnlicablzl (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: YY / rvial[ sn,#/ Topographic/Land setting
Nearest Town: P—(Y 1cA e� County ❑Ridge ❑Slope ❑Valley 6al't
)v) \Tar/<57' a. 21 (check appropriate box)
tSueer Nome,NUmbers,Community,Subdivision,Lot No.,Zip Code) Latitude/longitude of well location
41
3. OWNER: o[LC S cr Nt� J. [ (degrees/ inu nds)j N
Address :F11 7 ' . Latitude/longitude source: ❑To pographic map
(Street or Route No.) (check box)
F/eLch"'; &C .38'73�, DEPTH DRILLING LOG
City or Town State Zip Code From To Formation Description
(A)- (p50- 30asd 0
Atha cede-Phone number � 7, eAn e Dave
4. DATE DRILLED d 9 �
5. TOTAL DEPTH: !/0 s a � _L�7
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO (�
7. STATIC WATER LEVEL Below Top of Casing:�e FT.
(Use"+"if Above Top of Casing)
S. TOP OF CASING IS_�_FT.Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordance with 15.A NCAC?C.0118.
9. YIELD(gpm):_k METHOD OF TEST-Z161,1; tq
10.WATER ZONES (depth): J
LOCATION SKETCH
11. DISINFECTION:Typed ^rVP Amount�- D j 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 Toad Ft./,,?,S V'C S
From - To Ft From To F"[. /��' u
13. GROUT: Depth Material Method J / N
From_To_a�FI�tGpE�E i r14 Ilea Ilea r 1 -
From To Ft. t
1+. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in. w-
From To Ft. in. in. O
tT
15. SAND/GRAVEL PACK
Depth Size Material f [
From To Ft. L= 1 ;) LuJl:
From To F[.
16. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH I5A NCAC 2C,WELL
CONSTRUCTION STANDARDS,AND THAT A COPY OF THIS ORD HAS BEEN PROVIDED TO THE WELL OWNER
SIGNATU F PERSON CONSTRUCTING THE WELL DATt—
u
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.0712001 - o

C,
WELL CONSTRUCTION RECORD
Nonh Carolina-Department of Environment undd�f. ral Resources-Divtsi of Water Quality-Groundwater Section
WELL CONTRACTOR(INDIVIDUAL)NAME (print) 1 CERTIFICATION WQ /fit(J
WELL CONTRACTOR COMPANY NAME O tf, LLC PHONEO=a:59-R�I9�
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if appl icable) (if applicable)
1. WELL USE(Check.Applicable Box):Residential Municipal/Public ❑ Industrial ❑ Agricultural ❑
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other,List Use
?. WELL LOCATION: //� Topograp�ie/Land setting
Nearest Town(", fyr��(/ v1Y h" County l" ❑RidgeI lope Malley ❑Flat
--SLY r N (check appropriate box)
(Street Name,Numbers,Community,Subdivision,Lot No.,Zip Code) Latitude/longitude of well ocation
3. OWNER: a All/ s/��c (degreesfminute onds)
.Address / e f i Ya Latitude/longitude source:ffOPSOTopographic trap
(Streer m Route No.) (check box)
U DEPTH DRILLING LOG
City or Town - State Zip Code From To Formation Description
(Uk- �7'/- a a 72 - YD
Area code-Phone number
&. DATE DRILLEDws09
3. TOTAL DEPTH: 2QS
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO !7"
7. STATIC WATER LEVEL Below Top of Casing:_aDFT.
(Use"+-if Above Top of Casing)
S. TOP OF CASING IS�_FT.Above Land Surface'
'Top of casing terminated at/or below land surface requires a
variance in accordance with ISA NCAC 2C.0118.
9. YIELD(gpm):—V METHOD OF TEST1101,li
10.WATER ZONES(depth): qa J
70 LOCATION SKETCH
11. DISINFECTION:Type IiJ Amount - 9 2 Show direction and distance in miles from at least
17. CASING: Wall Thickness two State Roads or County Roads. Include the road
Depth Diameter or Weight/Ft. Material numbers and common road names.
Froln_#_Tom_Ft.-LA-..o J , S ft SPPZi j
From - To Fr.
From To Ft. .N
13. GROUT: Depth Material Method
From_D—To �3 0 Ft.
From To Ft.
14. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in. j
From To Fr, in. in.
15. SAND/GRAVEL PACK:
Depth Size Material j
From To Ft. �C7 1 iI Z�D�
From To Ft. 9
16. REMARKS: -
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C,WELL
CONSTRUCTION STANDARDS,AND T T A COPY OF THl RE HAS BEEN PROVIDED TO THE WELL OWNER
A
SIGNATr OF PERSON'CONSTRUCTING THE WELL D
Submit the original to the Division of Water Quality,Groundwater Section, 1636 Mail Service Center-Raleigh,NC C-
17699-1636 Phone No.[phone],within 30 days. GW-1 REV.07/2001
i
f

WELL CONSTRUCTION RECORD
North Carolina-Department of Environment and ral Resources-Divisi of Water Quality-Groundwater Section
%VEIL CONTRACTOR(INDIVIDUAL)NAME (print) CERTIFICATION#,&a 00
WELL CONTRACTOR COMPANY NAME t� .CO 1Will PHONE#&U a5 9-
STATE WELL CONSTRUCTION PERMIT# J ASSOCIATED WQ PERMIT#
(if appl icable) (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 LOCATION: Topographic/Land setting
Nearest T9wn: F/+Yi-6 rv. County ell w ❑Ridge ❑Slope ❑Valley ❑Flat
Alf gcbcar l- 13 (check appropriate box)
(Scree[Name,Num ers,Communiry,Subdivision,Lot No.,Zip Code) Latitude/longitude of ell location
CC _IIJ SL I
3. OWNERG.bx4-I1e/n6WCf- Q— (degmeslmin s)se nds)
Address �t�1�/teuh7 Latitude/longitude source:n3G MnTopographic reap
�� I (Scree`)oY9Rome NoJ (check box)
QYlo�2Yt6N t/ L!G NC ��7Q / DEPTH DRILLING LOG
ciry or so/w�n r1 State Zip Code From To Formation Description
Area code- I number J 60 Ca
4. DATE DRILLED //Z// S647 " 4a /� k
5. TOTAL DEPTH: 3aS / f0 30S �i.aw. J�c
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO
7. STATIC WATER LEVEL Below Top of Casing:_�a FT.
(Use`+^if Above Top of Casing)
S. TOP OF CASING IS FT.Above Land Surface*
"Top ofcasing terminated sour below land surface requires a
variance in accordance with 15A NC.AC 2C.0118.
9. YIELD (gpm):�_IVIETHOD OF TEST A ni.1;0G—&'q
10.WATER ZONES(depth): /r!D ' J J
LOCATION SKETCH
11. DISINFECTION:Type A Amount a Z Show direction and distance in miles from at least
17 CASING: Wall Thickness two State Roads or County Roads.Include the road
Demh Diameter or Weight/Ft. Material numbers and common road names.
From___To—f,�--FI. 4 zl6 Ay
From - To Ft. /O W S.
From To Ft. t� ee -P�c([ F-y
13. GROUT: Depth Material Method rn
From__To �� Q Ft. 0.i Z'ff -g t el dA - --- —p
From To Ft.
I. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in. O
From To Ft. in. in. _
15. SAND.GRAVEL PACK:
Deprh Size Material
From To FL.-
From-To-Ft.
16. RENIARI<S:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C,WELL
CONSTRUCTION ST.ANDARDS,,AN�D�THAT A COPY OF T RE�BEEN PROVIDED TO THE WELL OWNER
SIGN/A1rURE OF PERSO CONSTRUCTING THE WELL I OA�TF
Submit the original to the Division of Water Quality,Groundwater Section, 1636 Mail Service Center-Raleigh,NC r-,
T/699-1636 Phone No.[phone],within 30 days. GW-1 REV.07/2001
c�

WELL CONSTRUCTION RECORD
North Carolina-Department of Environment and ral Resources-Div(si of Water Quality-Groundwater Section
i
WELL CONTRACTOR(INDIVIDUAL)NAME (print) I PA /�
CERTIFICATION# U�/
WELL CONTRACTOR COMPANY NAME OAII PHONE(=;aS
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable) (ifa plicable)
1. WELL USE(Check Applicable Box):Residential Municipal/Public ❑ Industrial ❑ Agricultural ❑
MP
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other,List Use
?. WELL LOCATION: Topography Land setting
Neares[Town: 1{r County e^ A, ❑Ridge WDpe ❑Valley ❑Flat
-- C,2�19e Z— (check appropriate box)
tSueet Name,Nutmbers,Community,Subdivision,Lot No.,Zip Code) Latitude/longitude of well location
1. OWNERMTowh
/ . c.�7� 7 1eYz'JD 476Address (degrees/minul a�/s �ds)
La[imde/longiNdesourte:C3GPS❑Topographic map
?#tt!
(check box)
DEPTH DRILLING LOG
Q��,City or $m�[e1 p Zi Code Formation Description
�.d) ��•,, Oi}�D� P From To P
Area code-Phone number
J. DATE DRILLED—Vp — k-a SS s'anaeSyr7
5. TOTAL DEPTH: _ Z/�$ —/ g S _ 90 149r k
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO
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 at/or below land surface requires a
variance in accordance with 15A NCAC 2C.0118.
9. YIELD(,pm):/k METHOD OF TEST — '
10.WATER ZONES(depth): /7/)
LOCATION SKETCH
11. DISINFECTION:Type W of Amount aZ 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 WeighdFt. Material numbers and common road names.
From To _FL.fj,2.5� .
From To Ft.From
To Ft.
13. GROUT: Depth Material T
n Method
From—fZ_To��F[. fs�eladeynn dl-e�
From To Ft.
:-.. SCREEN: Depth Diameter Slot Size Material �
i
From To Ft. in. in.
From To F[. in. in.
l5. SAND/GRAVEL PACK:
Depth Size - Material _-
From To Ft. v
From To Ft. -
16. REMARKS: _
I DO HEREBY CERTIFY THATTHIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C,WELL
CONSTRUCTION STANDARDS,AND HAT A COPY OF I ORD HAS BEEN PROVIDED TO THE WELL OWNER
SIGN RE OF PER ON CONSTRUCTING THE WELL �-
A
Submit the original to the Division of Water Quality,Groundwater Section, 1636 Mail Service Center-Raleigh,NC
?7699-1636 Phone No.[phone],within 30 days.
GW-1 REV.07/2001

WELL CONSTRUCTION RECORD � to = o 5 7
North Carolina-Department of Environment and ral Resources-Divisi of Water Quality-Groundwater Section 00
(�
WELL CONTRACTOR(INDIVIDUAL)NAME (prinq CERTIFICATION#g2_[d
WELL CONTRACTOR COMPANYNAIVIE CD AI IS W611 178taIJUD4P_ LLf^_ PHONE#aaQSSZ- lea—
STATE WELL CONSTRUCTION PERMITA 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: L Topogra��-and setting
Nearest Town: Ffi'1��1ty� County4e 'p^3A N ❑Ridge lope OValley ❑Flat
Dr fs L la(�((�del (check appropriate box)
(Sven[Name,Numbers,Community,Subdivision,Lot No.,Zip Code) Latirude/longitude of well Iocation
3. OWNER:�M�C'.4 �/ J2.I C�¢ ��h�u,��C /Y3S 3037S
r � (degrees/mir tes�/s nds)
Address 2s �//ha `7f�11 Latitude/longitude source:; PSOTopographic map
(Street or Woute No.) f (check box)
)LtSI 1Slj%//P A/P i3 88G V DEPTH - DRILLING LOG
CJ'ry or Town IState Zip Code From To Formation Description
40,9 9 0 — 25 D."ram,(
Aiea code-Phone number .7.5 — Y3 Sa nef�MXJr'
. DATE DRILLED_!l/q�_T
5. TOTAL DEPTH: woo
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO B'
7. STATIC WATER LEVEL Below Top of Casing: tf.5_FT.
(Use"+"if Above Top of Casing)
S. TOP OF CASING IS FT.Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordmt9,with ISA N H D .01 T J J
9. YIELD (gpm):�METHOD OF TEST '
10.WATER ZONES(depth): $0
LOCATION SKETCH
11. DISINFECTION:Type Cti 0/b'tl e Amount��. Show direction and distance in miles from at least
12. CASING: Wall Thicltness two State Roads or County Roads.Include the road
Depth Diameter or Weight/Ft. Material numbers and common road names.
m _
Fro ToL/I Ft. ��,�u eocS
From To Ft.
From To Ft.
13. GROUT: Depth Material Method
�9
From To Ft. i t
J s
I$. SCREEN: Depth Diameter Slot Size Materiel - F,
From To Ft. in. in. '
From To Ft. in. in.
L5. SAND/GRAVEL PACK
Depth Size Material
From To Fr.
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 RECORHAS BEEN PROVIDED TO THE WELL OWNER
(((�9/n t
S GNA RE F PERSON CONSTRUCTING THE WELL D�— ^.
cr.
Submit the original to the Division of Water Quality,Groundwater Section, 1636 Mail Service Center-Raleigh,NC `
27699-1636 Phone No.[phone],within 30 days. GW-1 REV.07/2001

WELL CONSTRUCTION RECORD
North Carolina-Department of Environment and�ya ral Resources-Divisi of Water Quality-Groundwater Section �� ('�
WELL CONTRACTOR(INDIVIDUAL)NAME (print) CERTIFICATION Maa
WELL CONTRACTOR COMPANY NAMELG�(,(bDAI IC 1A_t9 p. LLC PHONE &Uj,,459-HzWta_
STATE WELL CONSTRUCTION PERMIT# J ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
1. WELL USE(Check Applicable Box):Residential MunicipaVloublic ❑ Industrial ❑ Agricultural ❑
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other,List Use
2. WELL LOCATION: Topographic/Land setting
Nearest Town: Zeec&gJ"r Counry�AJ ❑Ridge 9Sl rope ❑Valley ❑Flat
-� p U -11L—$ f!5 cS 44 t 3 (check appropriate box)
(Saen N e,Numbers,Community, ubdivision,Lot No.,Zip Code) LatitudeAongitude of well location
3. OWNER: (degrees/mir?ftes/�e�e�ds)
Address 2) o lL l-{9 Latitude/longitude source: GAPS❑Topographic map
Zc (Snaet or Routed �1 (check box)
1 f'C0N:A �Y C oS�r]9 DEPTH DRILLINGLOG
City or Town State Zip Code From To Formation Description
Area code-Phone number /t'? —17 (N c
&. DATE DRILLED �HIO5 J7
5. TOTAL DEPTH: $e1S ��^ SAS li.rd.'7(L
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO
7. STATIC WATER LEVEL Below Top of Casing: !Ie4FT.
(Use"+"if Above Top of Casing)
S. TOP OF CASING IS�_FT.Above Land Surface*
`Top of casing terminated attar below land surface requires a
variance in accordance with 15A NCAC 2C.0118.
9. YIELD(,pm): l 24 METHOD OF TEST 101.1; l�q
10.WATER ZONES(depth): Aq-r' J
LOCATION SKETCH
11. DISINFECTION:Type C Amount — Show direction and distance in miles from at least
12. CASING: Wall Thickness! two State Roads or County Roads.Include the road
Depth Diameter or Weight/Ft. Material numbers and common road names.
From To_A&--FtL 3.5 Wi,iar
From To Ft. (f LrC� S
From To Ft.
13. GROUT: Depth Material Method
From_D—To_a(,Z Ft. _DnU e� !'"r t n
From To Ft. I ---I
IA. 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 FL—
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 ORD HAS BEEN PROVIDED TO THE WELL OWNER -
V tw /t Dmoo S
- IGN� O PE O CON
STRUCTING ATE —.
Submit the original to the Division of Water Quality,Groundwater Section, 1636 Mail Service Center-Raleigh,NC c.
27699-1636 Phone No.[phone],within 30 days. GW-1 REV.07/2001 c

cFUUci2
WELL CONSTRUCTION RECORD
Nosh Carolina-Department of Environmendand raI Resources-Divisi of Water Quality-Groundwater Section ✓��� ('�
W£d.l-CONT-RACTOR(INDIVIDUAL)NAME (print) CERTIF�'IIC'A�TION#Q�Ir�//Q
WELL CONTRACTOR COMPANY NAME O ' PHONE ggetple4J Q-HT11�
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable) (ifa plicable)
1. WELL USE(Check Applicable Box):Residential Municipai/Public ❑ Industrial ❑ Agricultural ❑
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other,List Use
2. WELL LOCATION:
Nearest Town: F tAV Ie y i'qQ�[ Jr7a/ Topogr is/Land setting
County / ^ ❑Ridge lope ❑Valley ❑Flat
�ZM M r &� (check appropriate box)
(Sueat Name,Numbers,Community,Subdivision,Lot No.,Zip Code) LatimdeAongitude of ell location
N3s ' o � 3 ?8
3. OWNER:_ V RMtT 'qJ P^ (degrees/min sisecon )
Address .-�yNL� m�dl� CL( Latitude/longitude source: S❑Topographic map
(Scree[or Route No.) N (check box)
en .�fsO,p l! �re /t C A$7g' DEPTH DRILLINGLOG
City or Town - State Zip Code From To Formation Description
0c -- 3,5 ( lay
Area code-Phone number ,yn S411- r Xew[
4. DATE DRILLED 2 S S3 S$ �? dl y
5. TOTAL DEPTH: .')OS 73
6. DOES WELL REPLACE EXISTING WELL? YES [T NO ❑
T STATIC WATER LEVEL Below Top of Casing:_?,AFT.
(Use"+^if Above Top of Casing)
S. TOP OF CASING IS FT.Above Land Surface'
-Top ofeasing terminated atlor below land surface requires a
variance in accordance with 15A NCAC 2C.0118.
9. YIELD(gpm): 7 METHOD OF TEST�q
10.WATER ZONES (depth): iDD — d20 J
LOCATION SKETCH
11. DISINFECTION:Type 1W e- Amount 6 na Show direction and distance in miles from at least
12. CASING: Wall Thickness two State Roads or County Roads.Include the road
Depth Diameter or Weight/Ft. Material numbers and common road names.
From_ To_ Zl_Ft, b.95 Z UC 1p/Z1
From To Ft.
From To Ft. /d 1[1 ���01"-
13. GROUT: Depth Material Method 1 gL4q IV"
��
. From_j�_To_��Ft�p YLC.p.E'�E �S I • c
From To /•
Ft. �L{^� '
14. SCREEN: Depth Diameter Slot Size Material CA
From To Ft. in. in. tTl {
From To Ft. in. in.
t
in
I. SAND/GRAVEL PACK: J
Depth Size Material
From Tct Ft. `
From To F[.
16. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C,WELL
CONSTRUCTION STANDARDS,AND THA A COPY OF THI ORD HAS BEEN PROVIDED TO THE WELL OWNER
SIGN TU OFP RSON CONMUCTrNG THE WELL DAV-" �-'
c :
Submit the original to the Division of Water Quality,Groundwater Section, 1636 Mail Service Center-Raleigh,NC
27699-1636 Phone No.[phone],within 30 days. GW-1 REV.07/2001

WELL CONSTRUCTION RECORD
North Carolina-Department of Environment and rat Resources-Divisi of Water Quality-Groundwater Section ��
WELL CONTRACTOR(INDIVIDUAL)NAME (print) CERTIFICATION itz___.....__ I //WELL CONTRACTOR COMPANY NAME O PHONE 9=,159-S�Ita_
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable) (i£applicable)
1. WELL USE(Check Applicable Box):Residential Munieipal/Public ❑ Industrial ❑ Agricultural ❑
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other,List Use
2. WELL LOCATION: . dun— M/t7 Topograpph'c/LandsettIng
Nearest Town: r County �ef S' A/ ❑Ridge mic-pe ❑Valley ❑Flat
833 MDn �Q a/ (`nUf Qom/ (check appropriate box)
(Sueel Name,Numbers,Community,Subdivision,Lot No.,Zip Code) Latitude/longitude ofyyyyeell location
/N.�S' rlbr Y4//�y6Bc'1�i3)G
3. OWNER: 114 11rd A/ DA61 /IP'- (degrees/minu s/sesauds)
Address — - Latitude/longitude source:Eh!r S❑Topographic map
(Sneer or Roue NoJ (check box)
erdr./Ssnr/.7�G /✓C a8r/ DEPTH DRILLINGLOG
city or Town - Stase Zip Code From To Formation Description
l ) �eG17- Co�07 1) — M /a
.Area code-Phone number 31) -S9 on
5. DATE DRILLED l I 7�s S9 — Cr/ Aoc /�
5. TOTAL DEPTH: ,3(�_ �Yc
6. DOES WELL REPLACE EXISTING WELL? YES El NO
7. STATIC WATER LEVEL Below Top of Casing: _FT.
(Use"+"if Above Top of Casing)
3. TOP OF CASING IS�_FT.Above Land Surface*
`Top of casing terminated at/or below land surface requires a
variance in accordance with 15.1 NCAC 2C.0118.
9. YIELD(,pm): /O METHOD OF TEST' - 'q
10.WATER ZONES(depth): ,L3� t J
LOCATION SKETCH
11. DISINFECTION:Type / f G Amount�— Show direction and distance in miles from at least
12. CASING: Wall Thickness two State Roads or County Roads.Include the road
Depth Diameter or Weight/Ft. Material numbers and common road names.
From ,To. _�171.6A-T 716�d.T PocsD
From To Ft. �C &73
From To Ft. e/f dt1-,5cTAV,1 1e
13. GROUT: Depth Material Method
From To , Ft. 11a.[,pi,la
From To Ft.
Ll. SCREEN: Depth Diameter Slot Size Material y >-
1
From To Ft. in. in. rn
-9
From To Ft.—in. in.
15. SAND/GRAVEL PACK: - r
Depth Size Material
From To Ft. Q% �.
From To Ft.
16. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C,WELL
CONSTRUCTION STANDARDS,
_AANNDdTHAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO lT,HHEE/WELL OWNER
!C S 1SA RE Ol R&CNE CTING THE WELL DAB/� . .,. -. ..
Submit the original to the Division of Water Quality,Groundwater Section, 1636 Mail Service Center-Raleigh,NC
17699-1636 Phone No:[phone],within 30 days. GW-1 REV.07/2001
i

M " P '^ ;a
WELL CONSTRUCTION RECORD j -t '
North Carolina-Department of Environment and Natural Resources-Division of Water Quality-Groundwater Section
WELL CONTRACTOR(INDIVIDUAL)NAME (print)KENNETH MCCRARY CERTIFICATION#20D8
WELL CONTRACTOR COMPANY NAME BARKER CONSTRUCTION,INC.lBARKER WELL 8 PUMP PHONE # [phone]
STATE WELL CONSTRUCTION PERMIT# 1871 ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
1. WELL USE(Check Applicable Box):Residential 11 Municipal/Public❑ Industrial❑ Agricultural❑
Monitoring❑ Recovery ❑ Heat Pump Water Injection❑ Other❑ If Other,List Use
2. WELL LOCATION: Topographic/Land setting
Nearest Town: HENDERSONVILLE County HENDERSON KIRidge ❑Slope ❑Valley ❑Flat
BOBS CREEK ROAD (check appropriate box)
(Sheet Name,Numbers,Community,Subdivision,Lot No.,Zip Code) Latitude/longitude of well location
3. OWNER: LINDA STEPP (degroWminutea/seoonds)
Address 1306 OLD US 25 HWY. Latitude/longitude source:❑GPS❑Topographic map
(Streator Route No.) (check box)
ZIRCONIA NC 28790 DEPTH DRILLING LOG
City or Town state Zip Code From To Formation Description
( 828 )- 696-3551
Area code-Phone number
4. DATE DRILLED AUGUST 15,2005
5. TOTAL DEPTH: 705
6. DOES WELL REPLACE EXISTING WELL? YES❑ NO 91
7. STATIC WATER LEVEL Below Top of Casing: 140 FT. --
(Use't"if Above Top of Casing)
8. TOP OF CASING IS 1.33 FT.Above Land Surface'
'Top of cuing laminated aUor below land surface require;a J
variance in accordance with 15A NCAC 2C.011fl a„
9. YIELD(gpm): ''A METHOD OF TEST TIMED ut
10.WATER ZONES(depth):
LOCATION SKETCH
11. DISINFECTION:Type BY PUMP iNSTn UUt Amount Show direction and distance in miles from at least
12. CASING: Wall Thickness two State Roads or County Roads.Include the road
Depth Diameter or Weight/Ft. Material numbers and common road names.
From 0 To 54 Ft. 6118 SDR21 PVC jl wfowf �ZGt-IC2 �r"��6'•
From To Ft.
From To , 1
Ft. ,C1lLD L:Ld. ''
13. GROUT: Depth Material Method �NI.�/LCG.2G /7[/O r�.Lftln
From 0 To 20 Ft. CONCRETE POURED �oQ� d� �, � „vr„
From De Ft. ,Q,.QR / �rx // _ - /Ic/oJO/r/
14. SCREEN: Depth Diameter Slot Size Material J LL///K�%
From To Ft. in. in. ,C,L - 1,� ?�G G S,(
From To Ft. in. in.
15. SAND/GRAVEL PACK: Dk /J-#-
Depth Size Material
Front-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
0gcch a�
SIGNATURE OF PERSON CONSTRUCTING THE OF PERSON CONSTRUCTING THE WELL
Submit the original to the Division of Water Quality,Groundwater Section,1636 Mail Service Center-Raieigb,-NC
27699-1636 Phone No.[phone],within 30 days. GW-1 REV.07/2001

oA
WELL CONSTRUCTION RECORD e F = ;5w
Z I 'to 11 i
North Carolina-Department of Environment and Natural Resources-Division of Water Quality-Groundwater Section
WELL CONTRACTOR(INDIVIDUAL)NAME (print) RICHARD MCCRARY CERTIFICATION#2010
WELL CONTRACTOR COMPANY NAME BARKER CONSTRUCTION,INC.IBARKER WELL&PUMP—PHONE # [phone]
STATE WELL CONSTRUCTION PERMIT# 1871 ASSOCIATED WQ PERNUT#
(if applicable) (if applicable)
1. WELL USE(Check Applicable Box):Residential M Municipal/Public❑ Industrial❑ Agricultural❑
Monitoring❑ Recovery ❑ Heat Pmnp Water Injection❑ Other❑ If Other,List Use
2. WELL LOCATION: Topographic/Lazed setting
Nearest Town: HENDERSONVILLE County HENDERSON ❑Ridge ®Slope ❑Valley ❑Flat
BRICKYARD ROAD (check appropriate box)
(Street Name,Numbers,Community,Subdivision,Lot No.,Zip Code) Latitudeflougitude of well location
3. OWNER: GLENN WOODY
Address 2070 BRICKYARD ROAD de soirce:unx/eeconde)
Latitude/longitude source:❑GPS❑Topographic map
(Street or Route No.) (check box)
HORSESHOE NC 28742 DEPTH DRILLING LOG
City or To" state Zip Code From To Formation Description
( 828 )- 243-1090 Area code-Phone amber
4. DATE DRILLED AUGUST 19,2005
5. TOTAL DEPTH: 765' Inv
6. DOES WELL REPLACE EXISTING WELL? YES❑ NO 91
7. STATIC WATER LEVEL Below Top of Casing: 160 FT.
(Use"+„if Above Top of Casing)
8. TOP OF CASING IS 1.33 FT.Above Land Surface•
•Top ofasing terminated at/or below land surface requires a
variance in accordance with 15A NCAC 2C.011&
9. YIELD(gpm): 2 METHOD OF TEST TIMED c17
10.WATER ZONES(depth): +_1%
LOCATION SKETCH -,
11. DISINFECTION:Type SY PUMP INSTALLER for( Show direction and distance in miles from at least
12. CASING: Wall Thickness two State Roads or County Roads.Inchude the road
Depth Diameter or Weight/Ft. Material numbers and common road names. ,1 From 0 To 73 Ft. 61/8 SDR21 PVC / �.GU- -Q.f-.GLr&
From To Ft. �T
From To Ft. �gQ, �/ Qy(-
13. GROUT: Depth Material Method
From 0 To 20 Ft, CONCRETE POURED
From e Ft.D
14. SCREEN: Depth Diameter Slot Size Material %�^�"'�•
From To FL in. in.
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
16. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C,WELL
CONSTRUCTION STANDARDS,AND THAT A COPY OF RECORD HAS BEEN PROVIDED TO T OWNER
—� SIGNATURE PERS07 UCTINGTHE WELL �ATE
Submit the original to the Division of Water Quality,Groundwater Section,1636 Mail Service Center-Raleigh,NC
27699-1636 Phone No.[phone],within 30 days. GW-1 REV.07/2001

WELL CONSTRUCTION RECORD
North Carolina-Department of Environment and Natural Resources-Division of Water Quality-Groundwater Section
WELL CONTRACTOR(INDIVIDUAL)NAME (print)RICHARD MCCRARY CERTIFICATION#2016
WELL CONTRACTOR COMPANY NAME BARKER CONSTRUCTION,INC./BARKER WELL&PUMP PHONE # [phone]
STATE WELL CONSTRUCTIONPERMITN 1871 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: HENDERSONVILLE County HENDERSON ❑Ridge ❑Slope ❑Valley H1Flat
KING ROAD (check appropriate box)
(Street Name,Numbess,Community,Subdivision,Lot No.,Zip Code) Latitudellongitude of well location
3. OWNER: MARTY MORROW (degrees/minutes/seconds)
Address 37 RUSS DRIVE Latitude/longitude source:❑GPS❑Topographic map
(Street or Route No.) (check box)
EAST FLAT ROCK NC 28726 DEPTH DRILLING LOG
City or Town state Zip Code From To Formation Description
( 828)- 6924859
Area code-Aron number i
4. DATE DRILLED AUGUST 25,2005
5. TOTAL DEPTH: 426
rn •
6. DOES WELL REPLACE EXISTING WELL? YES❑ NO ® rn
7. STATIC WATER LEVEL Below Top of Casing: 60 FT. F
(Use"+„if Above Top of Casing) :.
8. TOP OF CASING IS 1 33 FT.Above Land Surface' .4
-Top of casing terminated zVor below land surface requires a
variance in accordance with 15A NCAC 2C.0118. Cli -
9. YIELD(gpm): 2 METHOD OF TEST TIMED
10.WATER ZONES(depth):
LOCATION SKETCH
11. DISINFECTION:Type SY PUMP iNSTat R Amount Show direction and distance in miles from at least
12. CASING: Wail Thickness two State Roads or County Roads.Include the road
Depth Diameter or Weight/Ft. Material numbers and common road names. I ^ /�1_J'
From 0 To 80 Ft. 61/8 SDR21 PVC JA6M r�Q�p(,Q,t,��(,t l.{„�Q,Q,7-GLF1�/V.000L,{.
From To Ft Ir eJ(Akc a- corn),(/) aAd kd.0
From To Ft. ^.�� ('��Q`e"." � Q�
13. GROUT: Depth Material Method and � Ctbat 3 'J(t-FL 6L
From 0 To 20 Ft. CONCRETE POURED
From To Ft. Ate,
%k�
14. SCREEN: Depth Diameter Slot Size Material .Lte, -N'L
From To Ft. in. in qo° p
From To Ft. in. i L (QO
15. SAND/GRAVEL PACK: lhC:f,UiJ/ 'ed - �"'
Depth Size Material _ 0.0 .#.. aG��
From To Ft. rn
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 O�S RECORD HAS BEEN PROVIDED TO THE WE OWNE
SIGNATURE OF PERSON NSTRUCTING THE WELL DA, ZE
Submit the original to the Division of Water Quality,Groundwater Section,1636 Mail Service Center-Raleigh,NC
27699-1636 Phone No(919)733-3221,within 30 days. GW-1 REV.07/2001

b" 3 1 ne , r
RESIDENTIAL wELLcoNsmuCTIOfN RECORD
3
S � North C¢TobrM Uepafonrnl of tnvironmrnt and Natural Kesourccs Dlymron Lil NSIcr Quably
WELL CONTRACTOR CERTMCATION tt al rJ 1� I
1.WELL CONTRACTOR: I. DISINFECTION. Type / / Amount
g. WATER ZONES lae'ptnl_
WN Co cb-r(kXWAdusJ)N waame m �1 0' From To ,m From To
61--e.n F %ye ' Q0 '� Front To From To
Wed Contractor Company Name From To From To
STREET ADDRESS 'PO R D)< a0 6. CASINO: Thtcarwss
C r Depth/ r Wal ilc—
CQSt Y IQ t �OC-K- K1 C From � Tom7 Ft
City o Town Sated Zp co" From_To Ft
floe I. (693-)2-oo From_To—Ft
Ales aed► PhorM nunbef
7. GROUT: Oapin Material MAW
2.WELL INFORMATION: r
From To_2_0 Ft.
SITE WELL ID a(If aw"Obil) From_ To Ft
STATE WELL PER MITMx appiade) 0 5t n n I n 9 y7 Z From—To Ft
DWO or OTHER PERMIT e(a applicable) 8. SCREEN: Depth Diamerer Sm Size Material
From__To Ft._n. _ n.
WELL 115E(Check Applicable Boxy ResiderrtW Water Supply From_To Ft_n _ n
DATE DRILLED 10 /',, 7 S
11� 'O Fr,,, To Ft_n _ n
TIME COMPLETED Y �� AM D pM`P 9, SAND'GRAVEL PACK
Depth Sae Material
3.WELL LOCATION:
G� � Fron To Ft
CITY: C--a0W01-(A-- COUNTY ✓ Frprn ToFt.
i fm 11 Frn To_ FI
($Veer Neme.Nwnoere.Cammunay, rtron,lot W..Paral.Zip Cooel a
TOPOGRAPHIC/LAND SETTING: 10. DRILLING LOG
OSlope Ovelley &W OR" OOtnw From To Formation De scrpoon
Twat appropriate ooxl hLy be w depot, (..7
LATITUDE D- b. � ? w
LONGITUDE QQgzf3on1 � � er
,310 d 4� n•d0C°°•I Cormat
Lapndei'longitude source: pGPS oTopogyaphlc map
(*No~of ew rrwM a s no,n on a USGS wpo map end
attached to Ow florin I nor USM GPSI
a.WELL OWNER n/ -
OWNER',NAMEa.4--6110 (KC0— i L''S _
STREET ADOR ESS PC, ho f`-1 I -
Town
CCityor
State Zip Cod
c4 r7 7
Ares code• Pnow number 11. REMARKS:
6.WELL DETAILS: ,--
a. TOTAL DEPTH: /TJ
b. DOES WELL REPLACE EXI3nN0 WELL? YES❑ N04
� I DO HEREBY CERTIF'T T T T113 WELL WAS CONSTRUCTED w AOCORDANOE WITN
c. WATER LEVEL Below Top d Cesng: O hM NCAC x.WELL CO+ RU ANOMM AND TKAT A Cc OF TNb
(Ues-+*6 Above Top of Casing) RECORD NAS BEEN R (HIDED TO N WELL O ER �J J
d. TOP OF CASING IS I FT.Atim Lark!Surface'
'Top d wing t.rt Weyo bates I"sos IGfa may I*quire S ATURE F CE RTIFIED WELL CONTRAC TOR DATE
a verfenu n a000rdnce With 1SA NCAC 2C.01I& �,•}L.`
• YIELD l9(xn1: )!� METHOD OF TESTS r _ pRl ED'N r E OF PERSON CONSTRUCTING.TME WELL
Submilt the original to the Division Of Water Quality within 30 days. Attu: knformaton MgL, Form cW-fa
1817 Mail Service,Center-Raleigh, NC 27699.1617 Phone No.[phone] ext 668. Rev 7M

1„N .
RESIDENTIAL WELL CONMIJCTION ECORD
3 =
North Carobm Uepertinent of Environment and Natural Resources Division of water Quabry
JJ1 WELL CONTRACTOR CERTIFICATION a a 5 21
1.WELL CONTRACTOR: I. DISINFECTION. Type Amount
WATER ZONES laepml
//WN Co (kM WOwI)II N� 1a1nr , From Cl To_� From To
LJT-P 2-n ?1 V er wQi1 0 I, From To From To
Wea Contractor Cornpeny Name From To From To
STREET ADDRESS ?� R OX �`U T C CASINO: TMckrwss
C �y r1 Depth Dia I Weight tarml
1 oC From_To Ft PV�-
CRy or Town Smo I zip code From_To Ft
(Rats ,- Gq5-)Leo From_To Ft
Aree rode• Phone number
7. GROUT- Depth Material M
2.WELL INFORMATION: _— '1 i•7 . (0•/ ]
From To Ft C
SITE WELL ID&(d appuNe) II � From To Ft
STATE WELL PERMITNe appkcepel WJL7 loCIR From_ To Ft
DWQ or OTHER PERMIT a(Y appkabw) 8. SCREEN: Depth Damete, Sat Sue Matenal
From_To Ft_n. n
WELL USE(CMck Appl"ble Box): Reeidentol Water Suppty❑ From_ To FI_n in
DATEDRILLED I01ao105- From To FI_n n
TIME COMPLETED 01.30 AM PM)6 e. SANDIGRAVEL PACK
3.WELL LOCATION: Depth Sue Material
,,,�� � _� From To Ft
-
From ITY. �c(-U Lt)a 1.L... COUNT Y�t ,`+[fin / � From To-Ft.
13)(, Q1CQSA_, �TT +a-- --� -�` KO From To Ft
(Str Name.Numoere.Carnmumty.Sub*we .La No Patcal.Lp Cooe)
TOPOGRAPHIC I LAND SETTING: 10. DRILLING LOG
CIS" OValley Olelat ORidge OO6nr From To Formabon,J�ew riptlon
(crack appropnate o«) s U— 5 O ``
May beintk�, S_ '
LATITUDE 3J�L �'}A auaub,eaowlb or r
L 0 I m e decrial Cormat
LONGITUDE QOz 3(n o�•�
LAutude/longitude Sotace: 6'(OPS OTopograptuc map
(bcamn o/we#maw be shown on a USGS rope map and
attecned to a'r tomn/nor wig GPS)
a.WELL OWNER � (
OWNER'S NAME a'1-?+1h Zo
STREETADDRESS POPJC�
f�a W o�Ll A 1 LZ�7e'1�J -a
fCty a To.M N Stan Zp Code t� -
1 D L� I• �9�-4io7-7 U7
~'e code. Prone number if. REMARKS:
a.WELL DETAILS: I
a. TOTAL DEPTH: I S (
b. DOES WELL REPL ACE EXISTING WELL? YES 0 NO l9 _
iDOMERESTCERnI mArT lSwE,LwASCONSr TEOw ACC DANCEWRN
c. WATER LEVEL Below Top o(Caang: FT. rBA NCAC 2C wE,i c ST`iu Tq,STARGwoS AND n T A CCPY or Twks
(Uw'•'Y Above Top of Cuing) RECORD NAS BEEN nR Mo T t E wEtl NER
I.
,y
d. rev of CASING Is ( FT.Above tend surt.p. /Lc,�srJ J
Top of wing terrnrlaled 2Vw below world audeoe"'I requne SIGNATU OF CERTIFIED WELL CONTRACTOR DATE
a�In woordanw with 15A NCAC ZC.0116. ��Vnla3` �mA1-,J
a. YIELD(ppm): METHOD OF TEST 1-'CTf PRINTED NAME OF PERSONL;uNb,RUCHING THE WELL
Submit the original to the Division of Water Quality Within 30 days. Attu: Information MgL, Fwm GW-ta
1617 Mall SO"ICe Center-RaWgh,NC 27699.1617 Phone No.(919)770.701 S ext 568. Rev. 7106

s+rt
t
a;r �0
RESIDENTIAL WELL CONSTRUCTION RECORD
3
S � North Camitu Ueperonrnt of Environment and Natural Kesourccs Dlnslon ul water Quabry
v �1
WELL CONTRACTOR CERTLFICATION N oG Jam' 'J I
1.WELL CONTRACTOR: ` ' '. I. DISINFECTION:Type T Amount
i U(�A-j— , F fM1 J 0. WATER ZONES(oeotn) prA
WON (It"iduani Name Frdm�9�To�� S 9�p't To
6rre_e'—!1 ever W4W ?K7K Fran ' To /pP rj7 rem To
Well Contractor Company Name �1 From To From To
STREETADDRESS 6. CASING: Thickness,
n / Depth Die er Wepht terol
CQS'� ♦' IA TKO C-iC.. ^) �_ oZ D 1 0�tp From To_� Ft. /
City w Town State Zip Code From To Ft
(go—& )• (093—a0() From To F1
Area code- PNorw number
7. O From
D Materiel
Meowd
2.WELL INFORMATION: �To
From To 20 Ft, 59kR6&
A
SITE WELLIDS(dappotw) From To Ft.
STATE WELL PERMITS(a appicaue) 015 10 / From To Ft.
DWo or OTHER PERMIT a(e applicable) 8. SCREEN: Depth Diameter Slot Size Material
WELL USE(Check icabls Box): Reaidemrl Water Suppty p From To Ft. n. _ n.
From To FL_n. _ n.
DATE DRILLED I O ) -7 I O 5 From To Ft in. _ in.
TIMECOMPLETED iI 3D AM�r_ PM a SANDGRAVEL PACK.
3.WELL LOCATION: Depth Sue Material
CITY: ±2xR GAOL l C COUNTY From-To Ft
L G�7/► From To Ft.
A,d �Pflll Wai/ q�0 1'7� From To Ft.
(Street Name.N.mcers.Comm. M.S.bdiNebn.Lot No.,Parcel,Zip Code)
TOPOGRAPHIC/LAND SETTING: 10.DRILLING LOG
❑Slope OValley OFIN ❑Ridge OOther From To F�orm� a�tion DesrsTipDO
(check appropriate
�/
tail Al �Lttt2.1
mLyh�4pm.
LATITUDE 0bAl
minute,eearde e
LONGITUDEU�Z-a,j r 4E � in e dxrwl format d
(atmide/longitudesoLlrce: UlGPS ❑Topographictrap
(ocatbm Of war MUW be&lawn on a USGS tope map and
attached to tlu Awm Y rot uang GPS)
4.WELL OWNER
OWNER'S NAMEE)"ro
'Swsell "?
STREET ADDRESS O K &f)l '
/
MoL.-u�*4in me ��C�d8758
City or Town Stet: Zip Code
Am code- Photo number
11. REMARKS:
5.WELL DETAILS: l
a. TOTAL DEPTH: I.7S
b. DOES WELL REPLACE EXISTING WELL? YES❑ NO
c. WATER LEVEL Below Top of Caskp: ) 1,1 1 DO HEREBY CERTIFY T T THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH
/ FT. 11t W_<X,WELL CONSTRU 'DON STANDARDS.AND THAT A COPY OF THIS
(Use'+'a Abo o Top of Casirp) RECORD HAS BEEN PROVOED TO THE WQO OWNER
d. TOP OF CASING Is_1 FT.Abow Labe Surface* �O '/�-�jr
T terminated of sing teinated stlor below land surface my require SIGNATURE OF CERTIFIED WELL CONTRACTOR DATE
a vansrxv inttv erdance with ISA NCAC ZC.0118.
e. YIELD(gpm): L00 METHOD OF TEST tl� r J/11A+ c ry, 1 TIti..
PRINTE IAME OF PERSON.CONSTRUCTING THE WELL
Submit the original to the Division of Water Quality within 30 days. Attn: Information MgL, Form GW-Ia
1617 Mall Service Center—Raleigh,INC 27699-1617 Phone No.[phone] ext 568. Rev.7/D5

RESIDENTIAL WELL CONMUCTION RECORD
e�•Rj; North Carohna Department of Environment and Natural Resources- Division of water Quabry
1 WELL CONTRACCOR CERTIFICATION N 2
j!e
CONTRACTOR: f. DISINFECTION:Type Amount� g. WATER ZONES(Wpm) �A to
(IndMduFrom G 0 To L 5 � F(LgnTo
� ever Wet �k� From 4o To 97 �"JFrom To
Wail Contracts Conpany Name From To From I To
Imo OX �t) T e. CASINO: Tnlclvarsv
STREET ADDRESS
C 1 �j ` / (� �/ Depth Dia ter WeiyM Material
CQS'� �' IA 1 TKO C-K- 1� Co From Tom Ft
�City or Town SMe Zip Code From_To Fr
ry
lieu I. 693-)Zoo From_To Ft
Mee code- Phone nurtDer
7. GROUT: Depth Material Meaad
2.WELL INFORMATION: From To Z© Ft.5/MA'Y�f� M;y�Ffoo/Z
SITE WELL ID$(,I appcaole) From_To Fl.
STATE WELL PERMITMe appicade) on-180109038 From_To Ft
DWQ a OTHER PERMIT$(i applicable) 8. SCREEN: Depth Diameter Slot Size Matenal
From_To Ft._n. _ el
WELL USE(Chack Appli Iable Nos): Residential Water Supply❑ From_To Fl_n. _ In.
DATE DRILLED 1 o `1 Zf D S From_To Ft_in _ n
TIME COMPLETED 1 2- •-() AM p PA .
9. SAND/GRAVEL PACK
3,WELL LOCATION: Depth Sue Marshal
� �� � +11U From To Ft.
CITY: �L`-�r SV 11 I'Q- COUNTY Fri To Ft.
nwc-��r1 - From To_Ft
(Brest Name.Numoere.Community,NJWtMaan,La No.Parcal.Zip Cope)
TOPOGRAPHIC I LAND SETTING: 10.DRILLING LOG
OSlope ❑Valley OFIM ❑R" ❑Other From To F rma on acnption
(eheak approprmb loot) 'O 3 V
aj' LHM N1Ay�na�.
LATITUDE 3$_ minulo,wowdea
LONGITUDEIaZ-e a 3' cW 0 m a doamul format �� - 5
KO /Of
Lauruide/longitlyde Source: ti�GPS ❑Topograpiuc map
(bcahon of we1 moat be shown on a USGS topo map and
arcached to ON form 7 not usip GPS)
{.WELL OWNER -�
OWNER'S NAME
STREETADDRESS 1Q5t0kZ4e-
City or Twin State Zip Code ca
(ry71�6 . Lot S3Z
Arm code• Pthona number 11. REMARKS .
8.WELL DETAILS: I
a. TOTAL DEPTH: I�S
b, DOES WELL REPLACE EXISTING WELL? YES❑ N()6
I DO HEREBY CERTIFY THAT MIS WELL WAS CONSTRUCTED W ACCORDANCE WITH
c. WATER LEVEL Below d Camp: —FT. 15 NCAC zC.WELL C°NSTRRucTION sr os.AND THAT A cCPv aF this
(Dm-i i ADOm Top d Casing)
HAS BEEN pROJIOED TO THE
d. TOP OF CASINO IS- I FT.Ate+Land Surface' lC7/ Y7
Top of casing teminatad ata below lard sudeoa my require C,CIATURE OF E TIFI WELL CONTRACTOR DATE
a vent nce in so/�oo.�rddance with 15A NCAC 2C.0118.
a. YIEL.D(gpm):�_METMOD OF TEST PRINTED �1 E OF PERSON CONSTRUCTING.,THE WELL
Submit the original to the Division of Water Quality within 30 days. Attn: nformaton Mgt-, Fam GW-la
1617 Mall Service Center-Raleigh, NC 27999-1917 Phone No.[phone] ext 588. Rev.7105

O 18PC ;, 1
RESIDENTIAL WELL CONSTRUCTION RECORD
North Carolina Depervnrnt of Environment and Natural Rcaour S-Dlymion ul Water Quabty
J F �
WELL CONTRACTOR CERTIFICATION N 3 �
1.WELL CONTRACTOR: I. DISINFECTION:Type Amount
,hr U&&T} �J C rn 9. WATER ZONES(Depth)
/VJe1 Mu(kdiW)N m Name From To /f5 From To
yr'! ce. 1 ?(V P r- W k O ' From To From To
Well Cartradar Company Name `, From To From To
STREET ADDRESS p 30X �l) T 6. CASING: TNcknesv
S rr �1 Depth D ter Wa M ler®I
Q` S+ Y IQ t �OCK- K1 C o� 1 oC(O From—v To Ft. U
City a Town State Zp Code From—To—Ft.
(ems I- 693-)z0o FromTo—Ft —
At"Cod► Phone number
7. GROUT: Depth Material �Me�thod'�
2.WELL INFORMATION: From e9 Toj_0 Ft.
SITE WELL ID#(it appllaoe) From_To Ft.
STATE WELL PERMITX(d appliable) From—To Ft
DWQ or OTHER PERMIT a(r applicable) 8. SCREEN: Depth Diameter Slot Sae Material
WELL USE(Check Applicable Box): ResideMoWaterFrom—To_Ft._n. _ In
l W Supply❑ From_To Ft_in _ in.
DATE DRILLED ) I /�S From_To Ft in _ in
TIME COMPLETED I .0 U AM Q PM`{ - a SANO'GRAVEL PACH-
3.WELL LOCATION: Depth Sae Material
, ^ From To Fl.
CITY:�4�R E1.1 U f I - _ COUNTY dU-S�n From To Ft.
Y S 7 LOCI Tt- )U-c- /`/n O a.off- From To Ft.
(Street Name,Numbers,Community,Subdiwaxon,Lot No..Parcel,Zip Code)
TOPOGRAPHIC I LAND SETTING: to. DRILLING LOG
OSlope CVelley ❑Flat ❑RkIW ❑OURN From To Formation Description
3i
(crock atproprure ooc) ,/ NUy be in degrees, _
LATITUDE 13 1 7AJ advance,accord,or
LONGITUDE f7�z c a 5 r 3 1
/7 tj in a decknal format
Laurulde/longitude sou=: �03PS ❑Topographic trap r
fbcafbn of w r must be shown on a USGS el map and
offechod to But form Y not uan9 GPS) J
4.WELL OWNER
OWNER'S NAME fal'-1 S C0. Lin�y
STREET_AD,DR,E��SS 114 C O f o.'t r—
T'C"`�""=�' s 6 0 11 lam) 1J L2 -)Cy Z ��
City o Town State Zip Code
l -21 C6 L)(O'7
Area code- Ph"number it. REMARKS:
5.WELL DETAILS: T
a. TOTAL DEPTH: z Z S
b. DOES WELL REPLACE EXISTING WELL? YES❑ NO pL
/'') IDO HEREBY CERTF n,AT THIS WELL WAS CCHSIRLICTED IN ACCORDANCE WnH
C. WATER LEVEL Below Top of Coati _FT. 15A NC/C 2C.WELL CONSnt CYiON STANW OS.AND THAT A COPY OF THIS
(UN'+i About Top of Call RECORD HAS BEEN PROVIDED TO TH ELl OW NE
d. TOP OF CASING IS FT.Above Land Surface- �7 -
'Top dasin9tarmirlaled aNa below lend surface may require SIGNATURE OFCERTIFIED WE LLCONTRACTOR DATE
a varerta in aocorana Min ISA NCAC 2C.0118. 131
2 y ��- All/ I /
a. YIELD(gpm): METHOD OF TEST t r �1
6
PRINTED NAME OF PERSON CONSTRUCTING THE WELL
Submit the original to the Division of Water Quality within 30 days. Attn: Intormadon M9L, Form GW1a
1617 Mall Service Center-Raleigh,NC 27699-1617 Phone No.[phone] ext 568. ReY 7M5

, vt l
RESIDENTL4L WELL CONMUCTI RECORD l� tV
S
•� i North Carolina Depertrnent ot'Envimnment and Natural Kesources-Division of Water Quality
A r71
WELL CONTRACTOR CERTiF1CAT10N#
1.WELL CONTRACTOR: f. DISINFECTION:Type�{rrl Amount
U{'tp ld- 'Sn" L� g. WATER ZONES(depth)
Well Ckintrackir(Individual))Name r Fromi To m,}_ From To
/
�..71 e'-n �I V P r- W t O ?Ik r KP From To From To
Wall Contract«Company Name m`' From To Fro To
STREET ADDRESS PO OX o-1l0 T S. CASINO: Thickness/
epth DiWeight MIaterial
`cost �OC_K- t\1 L -Z C 7q 6 From / DTo�L R. L « %44
//�i
�• City«Town Slate T ZzipCada From_To Ft—
l..2v J- 693-)20() From—To R.
At"code- Phone number
7. GROUT: Depth Materal McNotl�
2.WELL INFORMATION: From O To,� s��O R. *4-„,
SITE WELL ID/(if applicable) /'� From To Ft
STATE WELL PERMITI(a applicable) 04 1 d nn p V 0 1 5 -I / From_TO Ft.
DWQ or OTHER PERMIT e(k applicable) B. SCREEN: Depth Diameter Slot Size Material
WELL USE(Check Applicable Box): Residential Water Supply O From To A. In. in.
From_To R. in. in.
DATE DRILLED I O I O o S From To R_in. in.
TIME COMPLETED oZ . 0 a AM❑ PM PIL 9. SAND/GRAVEL PACK:
3.WELL LOCATION: J ,,�' Depth Size Material
CITY: � �l..11)I It COUNTY C -s S0Y1 From To Ft.
I! From To Ft.
L,t S CYra L1 ,L,C.� S From To—Ft.
(Streel Name.Numbers.Community, bdrwsion,Lot No..Parcel.Zip Coos)
TOPOGRAPHIC I LAND SETTING: 10.DRILLING LOG
❑S" OValley ❑Fist ❑Ridge OOtlar From To Ftlmnabon Description
(check appropriate Iwx)
LATITUDE �5271 )) "' minute,nw-1.71.
—>
LONGITUDE Q% 2 �� ar n tea, I format
Latitude/longibidesource: QGPS ❑Topographicrnap ni3A"?X-
(bcaton of wN must be shown on a USGS lope map and
aeached to a4w term Ynot usi,g GPS)
4.WELL OWNER D �-
OWNER'S NAME Sohr1 IJI Q Z
STftEET ADDRESS- Aj
Ken
G/C,ky or To
wn f State ZipCode
`7/as y1
Area code• Phone number
11. REMARKS:
5.WELL DETAILS: 't 1
a. TOTAL DEPTH: 37CJ
b. DOES WELL REPLACE EXISTING WELL? YES❑ NO'gl
c. WATER LEVEL Below Top of Caskq: FT. DO HEREBY CERTIFY T T Tws WELL WAS CONSmuCTED INACCOrID,NCE wmr
4 V I'M NCAC]C.WELL CONSmUCno ANDWDs,ANDTMTAC� THIS
(UN•+•k Above Top ofCasng) RECORD HAS BEEN=iDED TD W ELL MNEAR
d. TOP OF CASINO IS I FT.Above Land Surface* ae /0 -//`0 y
,Top of casing terminated at/or below lard surface may raquiro SIGNATURE OF CERT—IF}IE—D ELL CONTRACTOR DATE
a variance kr soco w rden wirn 1SA NCAC ZC.0118.
e. YIELD(gpm): D METHOD OF TEST r
PRINT OF PERSON CONSTRUCTING THE WELL
Submit the original to the Division of Water Quality within 30 bays. Attn: Information Mgt, Fcmn GW-la
1617 Mall Service Center-Raleigh,NC 276994617 Phone No.[phone] ext 568. Rev.7/05

l'Ut 1 Sip;
RESIDENTIAL WELL CONSTRUCTION RECORD
North Carotin Ueperbnent of Envimnmmi and Natural Rmurees Division of Water Quably
WELL CONTRACTOR CERTIFICATION M d h
1.WELL CONTRACTOR: I. DISINFECTION: Type Amount
�V(I A�� yV1(�-l/� g. WATER ZONES(oeotnl l
Wall
LJ I dividw0ff Name "��/ From To I4 sJ �1.Frdo�_To
2-n ?IVPr' W" 0 ? I K/6.� From 190 To 26V '' •F14V" To
Well Contactor Company Name From To- From To
STREET ADDRESS PO R)OX �() 6. CASING: T o'ghtt a
C } ^L� ( r� / Depth Oia tar WapM feral
<as+ hY jQ 1 ^oc-K. K) C � D r7oC l0 From To Ft. 7-
City or Town State Y zip Coda From_To Ft.
(gA 11. 693-)20O From_To Ft.
Area cod► Phase number
7. GROUT: Dean Material Mcleod
2.WELL INFORMATION: From_To .72 19 Ft. SOkAkt/ZA4111- O
SITE WELL ID a(d appcaow) rf From_ To Ft
STATE WELL PERMIT6(a appllceae) O I D n I 'a 1 I From_To Ft
DWO or OTHER PERMIT e(If applicable) 8. SCREEN: Depth D®meler Slot Sao Material
From_To Ft._n. _ n.
WELL USE(Crwck( C/
Appliabllee Sox): Residential Water Supply❑ in
From_To Ft._ . _ n DATE DRILLED / r r3 - &� From_To Ft_n _ in
TIME COMPLETED �;a— AM O PM O- 9. SANOIGRAVEL PACK
3.WELL LOCATIQN: Depth Sae Material
'z( V C C n i Lk From To Ft.
CITY. J/�� A., /t �� COUNTY �J r_6Sc'Y From To Ft.
c'34r Qb1 1 �ee.t(- P.CU From To Ft.
(Street Name.Numbers,Community Subdivision,Lot No.,Parcel,Zip Cosa)
TOPOGRAPHIC/LAND SETTING: 10.DRILLING LOG
p6lope []Valley []Flat ❑Ridge ❑Other From To Fo aton Description
(Ch ;k apprOPmr box) •�Q '/
' l a 0z AJ Maybe degree.
LATITUDE �:t _ iina w.racaidra r�
LONGITUDE=_Z'& 3 I 0- doearul formal
Latirude/longiaxle source: 2 PS []Topographic map -
(kR)eron Cl we/must be drown w a USGS ropo map and
amechsd to mt,arm r me LRNrV GPS)
♦.WELL OWNER
OWNER'S NAME Ve-X-d--" P0.CL _
C' Cre�k k rt
STREET ADDRESS ifI�,i� in
City or Towri Stale Zip Code -
R z' ,- &q?) - L;10
Area code- Pliaw number Ul
ll. REMARKS:
6.WELL DETAILS: .r -
a. TOTAL DEPTH:-5 _
b. DOES WELL REPLACE EXISTING WELL? YES❑ NO 3--- __
I DO HEREBY CERTIFY THAT THIS W ELL WAS CONSTRUCTED IN ACCORDANCE WITH
c. WATER LEVEL Below Top or Crimp:F_FT. 15A NCAC X WELL(DONSIRUC STANDARDS.AND THAT A CCFY OF THIS
(Use'+-6 Ab"Top d CNaig) RECORD HAS BEEN PRO IDED T TIE WELL OWNER
d. TOP OF CASINO IS Fr.AboN Land Surface' r JO-3 -
-Top of acing for mated actor below land surface may require SIG NATUR OF CERTIFIED WELL CONTRACTOR DATE
a varkuice n acccr0aria with 1SA NCAC 2C.011a8/.
e. YIELD(gpm):�_METHOD OF TEST /fir;I Q�.�.r'y" �� ��
PRINTED N E OF PERSON CONSTRUCTING THE WELL
Submit the original to the Division of Water Quality within 30 days. Ann; Information Mgt., Form GW.la
1617 Mail Servloe Center-RaWgh,NC 27699.1617 Phone No.[phone] ext 568. Ray.7/05

Colo r
Rva
sot .
RESIDENTIAL WELL CONSTRUCTION RECORD
North Carolina DeparBnalt of Environmrnt and Nanmil Kcsou,,,, QA it ion•rl N alcr Qualm
1111 a
WELL CONTRACTOR CERTIFICATION N 5 '71
1.WELL CONTRACTOR: 1. DISINFECTION. TYP't Amount
i p. WATER ZONES IDePmi
WN�`u.n Name L From .7` Q To S a' From To
�lrao t��1.1 �1�P( '""ei1 �_ (.(/ Fran To From To
Wag DanBact Cartpany Name From To From 70
STREET ADDRESS �0 DX �U T 6. CASING: Thrcknesv
CC y rr ,y r1 C.
Depth N ter W�gId Material
C Q S1' Y IQ r OC-K- �� O I,Z l0 From ToA,_ Ft City or or Town State T Zip Code Fran_To Ft
(9;66 - / a 5_)Z O 0 From_To FT
Ives code- Phorw nu,Der
7. GROUT. Depth Mawnal MartwQd
2.WELL INFORMATION: From /2 To.292- Ft. �t(�, �QO
SITE WELL ID e(d aoPlici nn r7 From_ To Ft.
STATE WELL PERMITe(a appliaae) n�!(n�1�� OOI I Z-D 5 / Fran_ To Ft
DWO or OTHER PERMIT e(f applicable) 8. SCREEN: Depth Diameter Slot Set Motional
From_To_ Ft n. _ in
_ WELL USE(Check Applicable Bux)'. Residemal Wata Supply er- From_ To Ft_n _ n
DATE OMLLED 10�a(0 k 5 Fran_ To Ft_n _ n
TIME COMPLETED Lt;.3- AMID PMa— I SANDIGRAVEL PACK
3.WELL LOCATION: Depth Sae Motional
� ( Fran To Ft
CITY COUNTY n C k���YSC� From To Ft.
''-,1n ) flI���- ��C ��Ir T,/., from To FI
(fAlraet here.Numoera,CorntruMy,SuodMeron.Lot No,Parcel,ZiP Cooel
TOPOC I LAND SETTING: 10. DRILLING LOG
OSlope ally OFat ORIdW ❑Over From To Fornation Dascrtp0on
(awar avpovnale oral L7 - /0 p
��LATITUDE 6o_!-tP L Ltuaub,wcordaa S�
LONGITUDEQIs2° 35 r 5`6 inadePm.lfarmat 'A6 3 n
LadtudeAongitude source: OGPS ❑Topographic map
(beam,of wee mwf a shown on o USGS topic map are
attached to era form 1001 uenp GPS) --
..1
a.WELL OWNER �
OWNER'S NAME t a'(`^ k) ) Gnes O
STREET ADDRESS to � PI ^�e ("j,o�A.a.0 1,1,gd
,� w v V f.JG Z16173y
Cry a Town Slate Zip Code
,�4s)- �91 - S
Arco code- Plow nuri it. REMARKS:
6.WELL DETAILS: 1
a. TOTAL DEPTH: 5 Q S
b. DOES WELL REPLACE EXISTING WELL? YES❑ NO 4-� _
-� rpp NEREBT CERnE TIATT SWELL WAS CONSTRUCTED IN ACCORDANCE Wmr
or rNa
c. WATER LEVEL Below Top d Caaaq: I y FT. reA NCAc x.WELL ca.sn+ucna+ TANDARDS.AND TWAT A c�+
(UN•+'I AI Top d Camp) RECORD NAS BEEN PN�E D r0 i wEIL OWNER
d. TOP OF CASINO Is I FT.Abine Lend Surf"c" ,ai i/cc Q 10-i
-Top d asuy terminated Wor Wow land uataa may require SIGNATUR OF CERTIFIED WELL CUNT KAi-I DATE
a Weanca n accord,,,,wile 15A NCAC 2C.011 �� 5A'1't Ar
(� METHOOOFTEST �Z Vl4
e. YIELD(ppm): PRINTED N E OF PERSON CONSTRUCTING THE WEII
SuDrnit the original to the Division of Water Quality Within 30 days. Ant: Intortmaoon MQL, FormGW-ts
1617 Mail Service Center-Raleigh,NC Z7699.1617 Phone No.[phone] ext 568. Rev 7105

V WELL CONSTRUCTION RECORD _.
North Carolina-Department of Environment and
�Natural Resou es-Division of Water Quality-Groundwater Section
`�r_
WELL CONTRACTOR(INDIVIDUAL)NAME (print)/��4 y Lti�/!0_r CERTIFICATION
WELL CONTRACTOR COMPANY NAME_Pf" , f '01/ tit—jli�p PHONE # raii) 8•77-YYS
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(ifapplicable) (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• t ��S �Uer Countyt7",cror\ ❑Ridge ❑Slope ClYgrey []Flat
S!k ri/1G/ L fie (of- I& (check appropriate box)
(Stre(I Name,Aumbers,Community,Subdivision,Lot No.,Zip Code) Latitude/longitude of well location
3. OWNER: , !CD$riek (degrees/minutes/seconds)
Address J 50'Py- Ldl(e Qr. Latitude/longitude source:❑GPS❑Topographic map
(Stree(or Route No.) (check box)
It c DEPTH DRILLING LOG
Cityor Town tatq" zip Code From To orm tion Description
(�) �wi —xs0 o � r
Area code-Phone number 20 ftl -'-+1 SCl`l' jd
4. DATEDRILLED 12-33-D1✓� lzo
)l
5. TOTAL DEPTH: 325— �( r
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO 9-�
7. STATIC WATER LEVEL Below Top of Casing: 2 6 FT.
Y (Use"+"if Above Top of Casing)
8. TOP OF CASING IS t FT.Above Land Surface*
-Top of casing terminated atlor below land surface requires a
variance In accordance with 15A NCAC 2C.0118, n
9. YIELD(gpm): -1 METHOD OF TEST I r A&'
10. WATER ZONES(depth):
LOCATION SKETCH
11. DISINFECTION:Typed F _ Amount Show direction and distance in miles from at least
12. CASING: Wall Thickness two State Roads or County Roads.Include the road
Depth Diameter or Weight/Ft. Material numbers and common road names,
From To /Z� Ft. f(v /Y/ ��2[ ✓L fy,itls Q.�`�
From To Ft. ,I tir�b
From To Ft.
13. GROUT: Depth Material Method
From e' Tom_Ft.Co-Cf .
From To Ft.
14. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in.
From To Ft. in. in. \ w
15. SAND/GRAVEL PACK: k N
Depth Size Material
From To Ft. :` / cp
From To FL C�4�---(
16. REMARKS: y
1 DO HE -BY CERTIFY TV THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH ISA NCAC 2C,WELL
CON R CTI N S,AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
Submit the original to the Division of Water Quality,Groundwater Section,1636 Mail Service Center-Raleigh,NC
27699-1636 Phone No.[phone],within 30 days. GW-I REV.07/2001

WELL CONSTRUCTION RECORD
North Carolina-Department of Environment and ral esou s-//Division of Water Quality-Groundwater Section
WELL CONTRACTOR(INDIVI)UAL)NAME (print)
CERTIFICATION#
WELL CONTRACTOR COMPANY NAME /1/���{l�� (0-ell Dt-d!!t/ PHONE #
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
I. WELL USE(Check:Applicable Box): Residential C3-�vlunicipal/Public❑ Industrial ❑ Agricultural❑
Monitoring❑ Recovery ❑ Heat Pump Water Injection❑ Other❑ If Other,List Use
2. WELL LOCATION: / ,Topographic/Land setting
Nearest Town: �/�.f�NtFrSdNr:��. County �n0_1_
Q1,4d !6t1s OW-70 Midge ❑Slope ❑Valley ❑Flat
(check appropriate box)
(Street Name,Numbers,Community,Subdivision,Lot No.,Zip Code) Latitude/longitude of well location
3. OWNER:J�rf ,� p w�f g S
r �� (degrees/minutes/seconds)
Address filc .reel Latitude/longitude source:❑GPS❑Topographic map
(Street or Route No.) (check box)
�` ' sonv'i1i DEPTH DRILLING LOG
City or Town State Zip Code From To Formation Description
(615l)-32y -020
Area code-Phone number y
4. DATE DRILLED 7-tt-Oa 9l € -
5. TOTAL DEPTH: yy'J � — Atlir
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO ®-'
7. STATIC WATER LEVEL Below Top of Casing: 7 'O FT.
r (Use"+"if Above Top of Casing)
8. TOP OF CASING IS FT.Above Land Surface*
`Top of casing terminated at/or below land surface requires a
variance In accordance with 15A NCAC 2C.0118.
9. YIELD(gpm): 2 0 METHOD OF TEST ��l'✓
10.WATER ZONES(depth):
LOCATION SKETCH
11. DISINFECTION:Type W Amount Show direction and distance in miles from at least
12. CASING: Wall Thickness two State Roads or County Roads.Include the road
Depth,w�f� Diameter or etght(Ft. Material numbers and common road names.
From_-_To�Ft. iGt� V 14lixf-
From To Ft.
From To Ft.
13. GROUT: Depth Material Method
Fromm To Zs FU—'Avirff ' fW V— N er
From To Ft. O '
14. SCREEN: Depth Diameter Slot Size Material n
f
From To Ft. in. in. `, ry
From To Ft. in. in. (, / _
15. SAND/GRAVEL PACK: r1l
Depth Size Material
From To Ft. dQf� ll
From To Ft. ��11
16. REMARKS:
1 DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C,WELL
CONSTRUCTION ST ,ANP�7i'PAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
Submit the original to the Division of Water Quality,Groundwater Section,1636 Mail Service Center-Raleigh,NC
27699-1636 Phone No.[phone],within 30 days. GW-1 REV.07/2001

WELL CONSTRUCTION RECORD
North Carolina-Department of Environment and Natural
�Resour es- ivision of Water Quality-Groundwater Section
WELL CONTRACTOR(INDIVIDUAL)NAME (print)I'(y 1a J" -_ �-- CERTIFICATION# TG
WELL CONTRACTOR COMPANY NAME /1Mtrr rIl (Atd st--&01-o^-P PHONE # (01) ".7 --WA
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
1. WELL USE(Check Applicable Box): Residential t' Municipal/Public❑ Industrial❑ Agricultural❑
Monitoring❑ Recovery ❑ Heat Pump Water Injection❑ Other❑ If Other,List Use
2. WELL LOCATION:
Nearest Town:_Ya4& bnw'(G County v` Topographic/Land setting
❑Ridge ❑Slope ❑Valley ❑Flat
(check appropriate box)
(Street Name,Numbers;Community,Subdivision,Lot No.,Zip Code) Latitude/longitude of well location
3. OWNER:',
(degrees/minutes/seconds)
Address 5e ig 24 Latitude/longitude source:❑GPS❑Topographic map
(Street or Route No.) (check box)
lknk.� ,U)(ts DEPTH DRILLING LOG
City or Town State Zip Code From To o [on Descri tion
mi—o- Carr- �r2jZ 6 p
Area code-Phone number S L
4. DATE DRILLED 0� i2
5. TOTAL DEPTH: Xdj
6. DOES WELL REPLACE EXISTING WELL? YES ❑ VO
7. STATIC WATER LEVEL Below Top of Casing: Cto FT.
(Use"+"if Above Top of Casing)
S. TOP OF CASING IS *FT.Above Land Surface —1
-Top of casing terminated at/or below land surface requires a r\i
variance in accordance with 15A NCAC 2C.0118. 4t:_
9. YIELD(gpm): CO METHOD OF TEST i0k /06
r:3
10.WATER ZONES(depth):_ r✓1
LOCATION SKETCH
11. DISINFECTION:Type Amount Show direction and distance in miles from at least
12. CASING: Wall Thickness two State Roads or County Roads.Include the road
Depth Diameter or y Oght/Ft. Material numbers and common road names. 1 V L
From To 61 Ft. L /y StiCL/ v� a 1
From To Ft. 1
From To Ft.
13. GROUT: Depth Material Method Jj
From © To?0 FI.Ccrar.L',v t-IS�^all{!" i #V— fw-
From To Ft.
14. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in. .yv\
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
16. REMARKS:
1 DO HEREBY CERTIFY TH THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C,WELL
CONSTRUCTION S S,AND 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. GWA REV.07/2001

J„a SYATF
RESIDENTIAL WELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources-Division of Water Quality
WELL CONTRACTOR CERTIFICATION# 2 ) "D 9
1.WELL CONTRACTOR: I. DISINFECTION:Type DY I RE Amount a C.G
�— g. WATER ZONES(depth):
�)awte s
Well Contractor(Individual Name �( (/1_ From To From To
FmnI To From To
Well Contrac r Company Name From To From To
1"^c-�, r B. CASING: Thickness)
7Chy
zg�
`/O Depth D�iam� �er Weight Material
C {�� �D From b TD 33 FtUl S to ZIp Code From_To
�=+'-r From To Ft.
Area code- Phone number / 7, GROUT: Depth ' y M
From� V2.WELL INFORMATION: Zh
SITE WELL ID#(If applicable) From To Fl.
STATE WELL PERMIT#(a applicable) From__To Ft.
DWQ or OTHER PERMIT#(if applicable) B. SCREEN: Depth Diameter Slot Size Material
From_Tc Ft. in. _in.
WELL USE(Check Applicable Box): Residential Water Supply From To Ft.—in. _in.
r-
DATE DRILLED�h—�0 `fi From To Ft._in. —in.
rn—
TIME COMPLETED -',��Do AM❑ Pmto S, SAND/GRAVEL PACK:
Material
3.WELL LOCATION: Depth Size
C From To Ft.
CITY
'':II ,, fa-II.(t�tl(� �r COUNTY e ' V ''VI FrDm To FL
"Ve^ ff hJI'�l�- From Tc Ft.
(Street Name,Numbers,Community.Subdlvlslon,Lot NO.,Parcel,ZIp Oode)
TOPOGRAfHIC/LAND SETTING: 10.DRILLING LOG
❑Slope qfValley ❑Flat []Ridge ❑Other From To FOrrr1patio eSDpr�Iptbn
(check appropriate box) �) �� C rL M- 9M..V'
�T1 i�J =tes,
LATITUDE 3 ✓Y " +�T--1j"-�y�- ^��rn
LONGITUDE S /
Latitude/longitude source: (gGPS OTopographic map --
(location of we9 must be shown on a USGS topo map and _
attached to this form Anot using GPS) CD
4.WELL OWNER �(/��!� f
OWNER'S NAME &yJ II y1-A- N.ry!-lA,. (1
STREET ADD ESS C 1093
a
a
City or Town State i Code _
(fax } `lu4 Q3a. 1d
Area code- Phone number 11. REMARKS:
5.WELL DETAILS: Q
a. TOTAL DEPTH: u
b. DOES WELL REPLACE EXISTING WELL? YES❑ NO
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH
c. WATER LEVEL Below Top of Casing: 15 FT: i5A NCAC 2C,WELL CONSTRUCTION STANDARDS,AND THAT A COPY OF THIS
(Use.+.O Above Top of Casing) RECORD HAS BEEN PROVIDED TO THE WELL OWNER. c-
d. TOP OF CASING IS i FT.Above Land Surface' R( mil �A) \ nY� _ _ n. `�
'Top of casing terminated auor below land surface may require SI TURE OF CERTIFIED W EL—L C TRTRACTOR
a variance in accordance with 15A NCAC 2C.0118. T,^ vtes ` ' Uqm�
e. YIELD(gpm): _METHOD OF TEST 6 i( PRINTED NAME OF PERSON CONS RUCTINS THE WELL -
Submit the original to the Division of Water Quality within 30 days. Attn: Information Mgt., a" ,,r Folm GW-la
1617 Mail Service Center-Raleigh,NC 276994617 Phone No.[phone] ext 568. " Rev.7105
1

�s
WELL CONSTRUCTION RECORD
North Carolina-Department of Environment and/A�/yr/'�t��u�/�ra/J-�R//SS ources-Division of Water Quality-Groundwater Section
WELL CONTRACTOR(INDIVIDUAL)NAME ((tJ�rlm) sHAr K.t� {r— CERTIFICATION It �f C
WELL CONTRACTOR COMPANY NAME Ly EirnV/ L✓e/( ,t­/1,-.,r PHONE #
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERNIIT#
(if applicable) (ifapplicable)
1. WELL USE(Check Applicable Box): Residential B_Municipal/Public❑ Industrial❑ Agricultural❑
Monitoring❑ Recovery ❑ Heat Pump Water Injection❑ Other❑ If Other,List Use
2. WELL LOCATIO�I
Nea e-i Town:_ �7'Wtr:;cn�A County 'u`�Efso;� opographic/Land setting
��(s./p C Idge ❑Slope ❑Valley ❑Flat
(Street Name,Numbers,Community,Subdivision,Lot No.,Zip Code) (check appropriate box)
Latitude/longitude of well location
3. OWNER: ��,en I ji
Address j C,n, (degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(Street or Route No.)
9a v,e/ A-1c DEPTH (check box)
Ctlyor own State Zip Code From To DRILLING LOG
F
(3 - to Y—k16G /l t F ,a'on Description
Area code-Phone number -
4. DATE DRILLED 7-I3-0S l d° 0 emu.
5. TOTAL DEPTH:� 110 fit+ f'
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO H�
7. STATIC WATER LEVEL Below Top of Casing: FT.
r (Use"+"if Above Top of Casing)
8. TOP OF CASING IS t FT.Above Land Surface*
•Top of casing terminated attor below land surface requires a n
variance in accordan with 15A NCAC 2C.0I18. y
9. YIELD(gpm): METHOD OF TEST 1r a
10.WATER ZONES(depth):_
11. DISINFECTION:T e "-f'1'� LOCATION SKETCH c i
3P Amount Show direction and distance in miles from at lease
12. CASING: Wall Thickness two State Roads or County Roads.Include the road
Dept Diameter or p,ight/Ft. M` aserial numbers and common road names.
D l
From- _To [[ to Ft. Cs'1
From To Ft.
From To Ft.
13. GROUT: Depth Material Mpthod
From_J _To ZO _Ft.Co�r.
From To Ft.
14. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in.
From To Ft. in. in.
15. SAND/GRAVEL PACK: w` p
From Depth Size Material
To Ft.
From To Ft. "—'��
16. REMARKS: .ogwilv
I DO HEREBY CERTIFY H IS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C,WELL
CONSTRUCTI A S,AND�p A COPY OF THIS CORD HAS BEEN PROVIDED TO THE WELL OWNER
7-13 - �
iUNATURE OF PERSON CONSTRUCTING THE WELL DATE
Submit the original to the Division of Water Quality,Groundwater Section,1636 Mail.Service Center-Raleigh,NC
27699-1636 Phone No.[phone],within 30 days.
GW-1 REV.07/2001

WELL CONSTRUCTION RECORD
North Carolina-Department of Environment and jC�,/.11�r7f��Re rces-Division of Water Quality-Groundwater Section
WELL CONTRACTOR(INDIVIDUAL)NAME
/J(print)_��Ell/7f/}"� y '
WELL CONTRACTOR COMPANY NAME ///FNrr��GJQI� tI— yr�y�p CERTIFICATION N
STATE WELL CONSTRUCTION PERMIT# PHONE # (fpe} 7-4WS7;j
IATED WQ PE
(if applicable) ASSOCIL�IIT# �G�07.I..i�_
(if applicable)
1. WELL USE(Check Applicable Box): Residential C'i`Municipal/Public❑ Industrial❑ Agricultural❑
Monitoring❑ Recovery ❑ Heat Pump Water Injection❑ Other❑ If Other, List Use
2. WELL LOCAT[QN:
Nearest Town: � o Z_ny,+//t County "n; r� Topographic/Land setting
❑Ridge ❑Slope llX'a ley ❑Flat
(Street Name,Numbers,Community,Subdivision,Lot No.,Zip (check appropriate box)
Latitude/longimde Of well location
3. OWNER:�t%A.A i�e'
Address •7S [3yJ/,@r- ,. r p.. (degrees/minutes/seconds)
(Street or Route No Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH City or Town to Zip Code DRILLING LOG
7 From To F rma ion Description
Area code-Phone number /
4. DATE DRILLED
5. TOTAL DEPTH: QlI I io c
6. DOES WELL REPLACE EXISTING WELL? YES❑ NO
7. STATIC WATER LEVEL Below Top of Casing: C w L(Use"+"if Above Top of Casing)
8. TOP OF CASING IS /
FT.Above Land Surface' -----
"Top of casing terminated allor below land surface requires a
variance in accordance with 15A NCAC 2C.0118. —� ---t
ty
9. YIELD(gpm): VL METHOD OF TEST %d i,�- �—
10.WATER ZONES(depth):_ %r �--
11. DISINFECTION:Type— LOCATION
SKETCH
YP H Amount Show direction and distance in miles from at least F
12. CASING: Wall Thickness two State Roads or County Roads.Include the road
Depth Diameter or etght/Ft. Ma�cT terial numbers and common road names.
From To/!7 Ft.tlT
From/r`7 To I I X Ft.fcr 1� sit
From To Ft.
13. GROUT:: DepthMethod
/ Zr
From To20 od From To FL
ia-
14. SCREEN: Depth Diameter Slot Size v
From Material
To Ft. in. in.
From To FL in. in.
w` t
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft. -„
From To Ft.
16. REMARKS: I l ------------7f�
I DO HEREBY CERTIFY TH Hy WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C,WELL
CONSTRUCTI 'FktQA 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

YZ
WELL CONSTRUCTION RECORD
North Carolina-Department of Environment and Nat��uFrFal RpAources-Division of Water Quality-Groundwater Section _
WELL CONTRACTOR(INDIVIDUAL)NAME print) 7t�F'f- 'AAA"r—
WELL CONTRACTOR COMPANY NAME /lf r � CERTIFICATIONN
PHONE R Lt-'r) !'77-
(if applicable)STATE WELL CONSTRUCTION PERMITq ASSOCIATED WQ PERh1ITq C 47AC
cable)
(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 LOCAT ON:
Nearest Town: e rl .S WMI'V4 County >l-a�r•1-S'a— Topographic/Land setting
114 0 T CW dge ❑Slope ❑Valley []Flat
(Street Name,Numbers,Community,Subdivision,Lot No.,Zip Code) (check appropriate box)
I _ Latitude/longitude of well location
3. OWNER: LE-516A ) t $h^f
Address X?tr N1.r�.— c;za.o �.1 (degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
--tI (Street or Route No.)
A ,( �gT40 (check box)
Ctty or Town state DEPTH DRILLING LOG
Zip code From
honer b 3�-7'] To FRrmationDescription
Area code-Phone number _ �!r♦""
4. DATE DRILLED "�?<' t K,
�--
5. TOTAL DEPTH:
6. DOES WELL REPLACE EXISTING WELL? YES ❑�NO ff
7. STATIC WATER LEVEL Below Top of Casing:1_FT.
(Use"+"if Above Top of Casing) Cn
8. TOP OF CASING IS i FT.Above-Land Surface* -+
'Top of casing terminated atlor below lend surface requires a DO
In accordance with ISA NCAC 2C.0119. //��
9. YIELD(gpm):_ if—_METHOD OF TESTA" /J
10.WATER ZONES(depth):_
e Z11T �f LOCATION SKETCH
11. DISINFECTION:T
YP —j Amount Show direction and distance in miles from at least
12. CASING: Wall Thickness two State Roads or County Roads.Include the road
Depth Diameter or Weight/Ft. Material numbers and common road names.
From To (ram Ft.G'iY 50f 2( try
From To Ft.
From To Ft.
13. GROUT: Depth Material Method) 1F�4 fL From_('_To ?' _F[. Cc`c'ri„,J-r"++„wi y.- fY)i�v..LP✓ — —_-.
From
To Ft. L "
14. SCREEN: Depth Diameter Slot Size Material
r
From To Ft, in. in
From To Ft. in. in.
15. SAND/GRAVEL PACK: `u
From Depth Size Material
To FL
From To Ft.
16. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C,WELL
CONSTRUCTION STP&�D THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
SIGNATURE OF PERSON CONSTRUCTING THE WELL
DATE
Submit the original to the Division of Water Quality,Groundwater Section,1636 Mail Service Center-Raleigh,NC
27699-1636 Phone No.[phone],within 30 days.
GW-1 REV. 07/2001

WELL CONSTRUCTION RECORD
North Carolina-Department of Environment and N total Re ur/ces-Division of Water Quality-Groundwater Section
WELL CONTRACTOR(INDIVIDUAL)NAMES (print) jl��t-'lhlr— CERTIFICATION#-.Jio1Jv'
WELL CONTRACTOR COMPANY NAME/r/('rcl, P%4 PHONE # &z�)�(i 'U ,1?
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT# 06')OO Ib(6aA 3
(if applicable) (if applicable)
1. WELL USE(Check Applicable Box): Residential IR"Municipal/Public❑ Industrial ❑ Agricultural❑
Monitoring❑ Recovery ❑ Heat Pump Water Injection❑ Other❑ If Other,List Use
2. WELL LOCATION: Topographic/Land setting
Nearest Town: r County Oe".rx, tdge ❑Slope ❑Valley ❑Flat
(check appropriate box)
(Street Name,Numbers,Community,Subdivision,Lot No.,Zip Code) Latitude/longitude of well location
3. OWNER:
(degrees/minutes/seconds)
Address 43 Latitude/longitude source:❑GPS❑Topographic map
tkY"5 (Street or Route No.) (check box)
/ /11 01�f l 2 DEPTH DRILLING LOG
6t%)ty o��w�_ IAi",
-to I4 zip Code From To omtytt�Description
i r /7 (C 6 r 1'
Area code-Phone number
4. DATEDRILLED jYD
5. TOTAL DEPTH: G ' I" -� C,n 3 54- d
6. DOES WELL REPLACE EXISTING WELL? YES NO ❑
7. STATIC WATER LEVEL Below Top of Casing:
(Use"+"if Above Top of Casing)
8. TOP OF CASING IS_�FT.Above Land Surface*
*Top of casing terminated atlor below land surface requires a
variance In accord anfp with 15A NCAC 2C.0118.
9. YIELD(gpm): Yi METHOD OF TEST ✓B�9 ^�
10.WATER ZONES(depth):
LOCATION SKETCH
11. DISINFECTION:Type[4-ttt 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 L'4 To I k4 Ft. L'If (Im Pa
.Ar.From To Ft. c7
1 —t
From To Ft. N
13. GROUT: Depth Material Method
From <% To 2 G _FL_C` ­ -, —
From To FL
14. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in. 1'
From To Ft. in. in. f
15. SAND/GRAVEL PACK: P dt i BPyas�
Depth Size Material -O
From To Ft.
From To Ft.
16. REMARKS: •
I DO HEREBY CERTI AT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C,WELL
CONSTI;rt l A S,AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
_ ��"/(/���/
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
Submit the original to the Division of Water Quality,Groundwater Section,1636 Mail Service Center-Raleigh,NC
27699-1636 Phone No.[phone],within 30 days. GW-1 REV.07/2001

-
WELL CONSTRUCTION RECORD
North Carolina-Department of Environment and/I]�T tur/al/Res ces/-Division of Water Quality-Groundwater Section
WELL CONTRACTOR(INDIVIDUAL)NAME (print)/ fl f-'f'� %•'v'f y/ CERTIFICATION#
,,v�
WELL CONTRACTOR COMPANY NAME�,/F.r.�� GyC-�l d--� �%�7 PHONE # ' !'
STATE WELL CONSTRUCTION PERMIT# If
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 LOCATI N:
% /, Topogra�/Land setting
Nearest Town:
County �!�l:,.-, D❑Ridge € 15iope ❑Valley ❑Flat
F II (. l- !;L- OL, (check appropriate box)
(Street Name,Numbers,Community,Subdivision,Lot No.,Zip Code) Latitude/longitude of well location
3. OWNER: >tt nar( koo �t{j
Address j,07- (degrees/minutes/seconds)
( Latitude/longitude source:❑GPS❑Topographic map
(Street or Route No.) (check box)
IIhSO�t-V.��p A�(' DEPTH
City or Town State Zip Code From To DRILLING LOG
)_ (.I(, .—(-0 & 0 lJ Fo a 'on Description
Area code-Phone number 01
4. DATE DRILLED
5. TOTAL DEPTH: jai" -fL
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO L7 Sy 5 7 f.c IPA �-
7. STATIC WATER LEVEL Below Top of Casing: '�4a FT. a ye
(Use'+"if Above Top of casing) 7 —crFrtL l�a>
8. TOP OF CASING[S , FT.Above Land Surface• 4 Z 4 (IY J -�r /��n 5
'Top of casing terminated atlor below land surface requires a L<r�) 2d, _f -( <.:"�
variance in accordance with 15A NCAC 2C.0118.
9. YIELD(gpm): J' METHOD OF TEST_jv° -
10.WATER ZONES(depth):
LOCATION SKETCH
11. DISINFECTION: Type 7"tf 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 eight/Ft. Material numbers and common road names.
From-6- To ,-i 7 Ft. L-,!! S (LL( r .
From To Ft.
From To Ft. I {
13. GROUT: Depth Material Method
From---L_To Lo FLC;+ cele " f A' If
From To Ft.
14. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in,
From To Ft. in. _ in. -
15. SAND/GRAVEL PACK:
Depth Size Material -.�
From To Ft.
From To Ft.
DO
16. REMARKS: y- CD
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C,WELL -
CONSTRUCTION STANDARDS,AND TH T COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
SIGNAYURE OF PERSON CONSTRUCTING THE WELL DATE
Submit the original to the Division of Water Quality,Groundwater Section,1636 Mail Service Center-Raleigh,NC
27699-1636 Phone No.[phone],within 30 days. GW-I REV. 07/2001

WELL CONSTRUCTION RECORD
North Carolina-Department of Environment and Natur'a�#l/&esources-Division of Water Quality-Groundwater Section
WELL CONTRACTOR(INDIVIDUAL)NAME (print) {�tl r2 t"
WELL CONTRACTOR COMPANY NAME I i"`-jty f,�c9�-7 CERTIFICATION#
N
STATE WELL CONSTRUCTION PERMIT# ` PHONE #
A SSOCIATEDWQPERMIT#65/gt1IG' 1 l
(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:
Neare t Town: 4. e County cn pographic/Land Setting
d�/twm (rileC Idge ❑Slope ❑Valley ❑Flat
(Street Name, umbers,Community,Subdivision,Lot No.,Zip Code) (check appropriate box)
Latitude/longitude of well location
3. OWNER: 6 d✓.)
Address (degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(Street o Route No.)
/1 (check box)
City or Town tale f� DEPTH DRILLING LOG
—) ` — sy- yS' Zip Co a From To p
4 !`r Forman n Descri tion
Area code-Phone number O 5a ,U.
4. DATE DRILLED 7 L -a j' S'0 Ct o -h/ :a
5. TOTAL DEPTH:-- i �o Le
6. DOES WELL REPLACE EXISTING WELL? YES ClNO L
7. STATIC WATER LEVEL Below Top of Casing: FT.
r (Use'+"if Above Top of Casing)
8. TOP OF CASING IS _FT,Above Land Surface•
"Top of casing terminated allor below land surface requires a
variance in accordanpe with 1SA NCAC 2C.0116.
9. YIELD(gpm): YJ METHOD OF TEST
10.WATER ZONES(depth):_ o
11. DISINFECTION:T e N LOCATION SKETCH
3P —meµ Amount Show direction and distance in miles from at least
12. CASING: Wall Thickness two State Roads or County Roads.Include the road
Depth , Diameter or Weight/Ft. Material numbers and common road names.
From To f✓V' Ft. ` 51121l �C
From To Ft. t '�
From To Ft. t�
13. GROUT: Depth Material Method
From ,P To to Ft.Cau!t_ dam• „(.,n;;� �✓{
From Ft.
De
14. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in. ( 2
From To Ft. in. in. v�
15. SAND/GRAVEL PACK: t�
Depth Size Material
From To Ft.
From To Ft.
16. REMARKS: /
1 DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C,WELL
CONSTRUCCTIII NDA�RD ,AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
if
r SIGNATURE OF PERSON CONSTRUCTING THE WELL
DATE
Submit the original to the Division of Water Quality,Groundwater Section,1636 Mail Service Center-Raleigh,NC
27699-1636 Phone No.[phone],within 30 days.
GW-1 REV.07/2001

WELL CONSTRUCTION RECORD
North Carolina-Department of Environment and
/Natural Ressokirces-Division of Water Quality-Groundwater Section
WELL CONTRACTOR(INDIVIDUAL)NAME (print) b/ri•v If r.
WELL CONTRACTOR COMPANY NAME rr CERTIFICATION( �-I�i-.
STATE WELL CONSTRUCTION PERMIT# —��—PHONE # _ ;r7-<�Y,0
(ifapplicable) ASSOCIATED WQ pERMHT#
(if apolicahl 1
1. WELL USE(Check Applicable Box): Residential ❑ Municipal/Public❑ Industrial ❑ Agricultural❑
Monitoring❑ Recovery ❑ Heat Pump Water Injection❑ Other❑ If Other,List Use
2. WELL LOCATION:
Nearest Town:jjF'V'r l5g , /!r County Topographic/Land ting
❑Ridge ❑Slope alley ❑Flat
(Street Name,Numbers,Community,Subdivision,Lo No.
t ,Zip (check appropriate box)
Latitude/longitude of well location
3. OWNER: L&ld IV, ))i!n. (
Address 15 C Cab crf"/ (degreesminutes/seconds)
Street or Route No.) Latitude/longitude source:❑GPS❑Topographic map
1� Uc,j� DEPTH (check box)
City or Town State Zip Code DRILLING LOG
( 'i y)- (.12 _ )iOo From To Form ion Description
Area code-Phone number 0 �� '��"""'
4. DATE DRILLED `r'2 —Q�9` rU 20
S. TOTAL DEPTH:_ / Z f 2
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO
7. STATIC WATER LEVEL Below Top of Casing:
f (Use"+"if Above Top of Casing) '�--
8. TOP OF CASING IS Z FT.Above Land Surface* —
*Top of casing terminated at/or below land surface requires a variance in accordance with 15A NCAC 2C.0119. nn
9. YIELD(gpm): 2c METHOD OF TEST
10. WATER ZONES(depth):_ N
ILDISINFECTION:Type��TI t LOCATI_ O_ N SKETCH o
Amount Show direction and distance in mules frotlr{alt least,.
12. CASING: Wall Thickness two State Roads or County Roads. Include the road
Depth t eter orfghr/Ft. Ma numbers and common road names.
From Depth
3)S FL
From To Ft
From To Ft.
13. GROUT: Depth Material Met
From1�To 2-0 FL CortC�elL�-.,}yQ�g�---�h�od�p l,.,r.^
From To Ft.
14. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in.
m
Fro To Ft. in. in.
RACK-.
15. SAND/GRAVEL P
Depth Size Material ,� [
From To Ft.
From TO Ft. - - T—
16. REMARKS: pq
1 DO HEREBY CERTIFY THAT THIS WE WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C,WELL
CONSTRUCTION STA A ,ANDF AT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
_ �
IGNATURE OF PERSON CONSTRUCTING THE WELL
DATE
Submit the original to the Division of Water Quality,Groundwater Section,1636 Mail Service Center-Raleigh,NC
27699-1636 Phone No.[phone],within 30 days.
GW-1 REV. 07/2001

WELL CONSTRUCTION RECORD -
North Carolina-Department of Environment and�atural/R_esourcgs-Division of Water Quality-Groundwater Section _
WELL CONTRACTOR(INDIVIDUAL)NAME (printlE
q/ £' CERTIFICATION# 3t'— r'
WELL CONTRACTOR COMPANY NAME�[/7fi�;^ti/l ( �["j' «=y.�.,y.7 �9yy
PHONE #
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT# �<? 1 tom(•,�V.SS���(if a licable (if applicable)
1. WELL USE(Check Applicable Box): Residential Municipal/Public❑ Industrial ❑ Agricultural ❑
Monitoring❑ Recovery ❑ Heat Pump Water Injection ❑ Other❑ If Other,List Use
2. WELL LOCATION:
Nearest Town:_ County ll -,_�s,l T graphic/Land setting
.r imc age ❑Slope '❑Valley ❑Flat
(Street Name,Numbers,Community,Subdivision,Lot No.,Zip Code) (check appropriate box)
1 Latitude/longitude of well location
3. OWNER: ! t'L L ,_
Address - j (degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(Street or Route No.r (check box)
City f Tow Stat p DEPTH DRILLING LOG
} From To
Z�� Z' Code I 1 11 on Description
Area code-Phone number �- --
4. DATEDRILLED �yz1 .,.A/,
5. TOTAL DEPTH:
6. DOES WELL REPLACE EXISTING WELL? YES ❑ No
7. STATIC WATER LEVEL Below Top of Casing: FT.
/ (Use"+"if Above Top of Casing)
8. TOP OF CASING IS_�_FT,Above Land Surface" --
*Top of casing terminated atlor below land surface require a
variance in accordance with 15A NCAC 2C.0I18. f�
9. YIELD(gpm): Z METHOD OF TEST1�+
10.WATER ZONES(depth):_ t
N
11. DISINFECTION:Type LOCATION e
YP r Amount Show direction and distance in miles from aMast
12. CASING: Wall Thickness two State Roads or County Roads. Include thelroad
1 Depth Diameter or a ght/Ft. Material number and common road names.
From To _Ft. , (X
From To Ft.—Y—
From FL
De
13. GROUT: Depth Material Method f
From (� To L.d _FL r eL , "f r[� �• r G
From To Ft.
14. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in.
From To Ft.-in. in.
I5. SAND/GRAVEL PACK: i
From Depth Size Material
To Ft.
From To Ft. R �
16. REMARKS:
I DO HEREBY CERTIFY THAT T IS WE WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C,WELL
CONSTRUCTION STA7t t A COPY OF THIS RECORD HAS BEEN PROVIDED TO T1WELL OWNER,
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
Submit the original to the Division of Water Quality,Groundwater Section,1636 Mail Service Center-Raleigh,NC
27699-1636 Phone No.[phone],within 30 days.
GW-1 REV. 07/2001

WELL CONSTRUCTION RECORD
North Carolina-Department of Environment and TNr[p1 eso cess-Division of Water Quality-Groundwater Section
WELL CONTRACTOR(INDIVIDUAL)NAME (print P '7' �— CERTIFICATION#�I WELL CONTRACTOR COMPANY NAME 1i f' G"-'-e PHONE #
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
1. 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: Topographic/Land setting
Nearest Town: Countyf'�`''1�°+ <';a ❑Ridge ❑Slope ❑Valley ©Fla[
v ,
C("vi^ �.✓:4de1.- CAS ;--ltEf� (check appropriate box)
(Street Name,Numbers,Community,Subdivision,Lot No.,Zip Code) Latitude/longitude of well location
3. OWNER: I'�r 'vi'�r(. 4� Pci'. $ (degrees/minuteslsaonds)
Address /1" y Latitude/longitude source:❑GPS❑Topographic map
11 (Street or Route No.) (check box)
1# 4 A,� - DEPTH DRILLING LOG
City qr Town Stare Zip Code From To ortnatlon Description
( Y ) ?ill—N/9`t 10
Areacode-Phone numberlitres'---
4. DATE DRILLED `h u j
5. TOTAL DEPTH: 30;
6. DOES WELL REPLACE EXISTING WELL? YES CI NO ❑
7. STATIC WATER LEVEL Below Top of Casing: !t FT.
(Use"+"if Above Top of Casing) n
8. TOP OF CASING IS FT.Above Land Surface*
_t
'Top of casing terminated at/or below land surface requires a
variance In accordance with 15A NCAC 2C.0119. -
9. YIELD(gpm): W METHOD OF TEST'I t
10.WATER ZONES(depth):_ r___)
LOCATION SKETCH UI
11. DISINFECTION:Type 141 11 Amount Show direction and distance in miles from at least
12. CASING: Wall Thickness two State Roads or County Roads.Include the road
Depth Diameter or Weight/Ft. Material numbers and common road names.
From To!9lt Ft. V`/(/
From To Ft.
From To Ft. Gf
13. GROUT: Depth Material Method
From G To _Ft.0 awu:K. �'°w..F.u<J'1'��, ..-^- %
From To Ft. ✓ "
14. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in. /
From To Ft. in. in. ,I�d
r+„ni
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
16. REMARKS:
I DO HEREBY CERTIFY T T THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C,WELL
CONSTRUCTION, T A`D S,AND CHAT 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

°M SUTpa V
RESIDENTIAL WELL CONSTRUCTION RECORD
y� North Carolina Department of Environment and Natural Resources-Division of Water Quality
WELL CONTRACTOR CERTIFICATION# 2138
1.WELL CONTRACTOR: f. DISINFECTION:Type chlorine Amount
James W. Camp g. WATER ZONES th):
Well Conhactor.(Ind'ivlduffi ra
)Name Fn To From To
Camp' s Well & Pump CO- Inc- Ram To Fran To
Well Contractor Company Name Fran To From To
STREET ADDRESS P O BOX 429 6. CASING: Thicknesst
Depth Di er Wa'gm Material
Ellenboro NC 28040 From 0 To `l� Ft. 6' SDR21 PVC
City a Town State Zip ode From To Ft
( 828). 453-7322 Fran To Ft
Area code- Phone number
2.WELL INFORMATION: 7. GROUT: Depth Matedal Method
From 0 To 20 Ft Sackrete Hand
SITE WELL ID#(If applicable) From TO Ft
STATE WELL PERMIT#Or applicable) Fran To Ft
DWQ or OTHER PERMIT#(8 applicable) 8. SCREEN: Depth Diameter - Slot Size .Material
_
WELL USE(Check Applicable Box): Residential Water Supply� in.
From To To Ft_in.From Ft_in. _N.
DATEDRILLED Fran To Ft_ln. _in.
TIME COMPLETED__jj-_Q_V AMLt3' PM❑ g, SANDIGRAYEL PACK:
3.WELL LOCATION- Depth size Material
CITY: COUNTY Fran To Ft.
From To Ft.
From To Ft
(Street Name,Numbers.Fanrmunity,SubdMsion,Lot No.,Parcel,Zip Code)
TOPOGRAPHIC I LAND SETTING: 10.DRILLING LOG
❑Slope CiValley 90n5i ❑Ridge ❑Other From o Fonmato Descdptbn
(check appropriate boa) . 0May
LATITUDE mantis corAso
`t,I made; ucoMsst
LONGITUDE, 9' VV madeoimal tormat _
Latitude/Iongitudesource: ❑GPS OTopographicmap
(location of ere/must be shown on a USGS topo map and
attached to this form t not uskV GPS)
4.WELL OWNER
OWNER'S NAME
STREET ADDRESS \ • 0 �I 1
city or Town State Zip Code
( b b
Area code- Phonuye numberEe,
11. REMARKS:
S.WELL DETAILS: qq
a. TOTAL DEPTH:
b. DOES WELL REPLACE EXISTING WELL? YES❑ NO \
I DO HEREBY CERTIFYTNATTHI6 WELL WAS CONSTRUMED IN ACCORDANCE WITHe. WATER LEVEL Below Top of Casing: 1� FT, 15A NCAC 2C,WELL CONSTRUGOON STANDARDS,AND IHATACOPY OF THIS.
(Use'+'d Above Top of Casing) RECORD HAS BEEN PROVIDEOTOTHE WELL OWNER
d. TOP 1p CASING IS 1 FT.Above Land may
rrequire
` \ a� Ar1. I r W � q f L I�._/'1
. 'Top of casing terminated with ISA land surface may require SIG 'BUR OF CERTIFIED WELL CONT CTOR �IJDAATEE
a variance in accordance with 15A NCAC 2C.0118.
^ , � James W. Camp
e. YIELD(gpm):_�METHOD OF TEST L I.LA
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 276994617 Phone No.[phone] ext 568. Rev.7ro5

B �S1A7F ��
A
RESIDENTIAL NVF.LL CONSTRUCTION RECORD -s z
North Carolina Department of EnVironment and Natural Resources-Division of Water Quality
WELL CONTRACTOR CERTIFICATION# aA 4- a if
1.WELL CONTRACTOR: I. DISINFECTION:Type 71 0 ('Amount ) L
@ 6"� CA LOW I_ 1. g. WATER ZgNES(depth):
Wyyy��s11 Contractor(Individual)Name From--O, /L
-iJ - p n LQ W R t� From To
t\ L/y �� -,`�l�l From To From To
Well Contractor CompanyCName � �` � 'gip (,' From To From To
STREET ADDRESS J + ��w L{ \cC1t5tJJT4I> 960 6. CASING: 1 Thic1nlesls/ of�l
A6 1 LL. C. PO O 0 l7 From 4 Depth
�T� Ft. % r Peal tY C.
(f City or Town ,t Statee p Zip Code From To Ft. _
f ag From To Ft.
Area code- Phone number
2.WELL INFORMATION: 7. GROUT: Depth Material Method
SITE WELL ID#(if applicable) From I To NCO Ft. Ce Me, DJ(ZE�
From To_Fl.
STATE WELL PERMIT#fd applicable) From Tc Ft.
DWQ or OTHER PERMIT#('d applicable) 8. SCREEN: Depth Diameter Slot Size Material
WELL USE(Check Appli le B ): Residential Water Supply p From To Ft_in. _ in.
From To Ft. in. in.
DATE DRILLED 1 I Q 0
From To Ft._in. _ in.
TIME COMPLETED 12�, 0o AM[�j PM❑
9. SANDIGRAVEL PACK:
3.WELL LOCATION: -/ Depth Size Material
CITY: tM 11,L nS 4 V��OUNTY 6f6 i�6u`-�+/� tlll From To Ft.
T --o From To Ft.
3 3 O �Os 1 1 C-(6-d S r From—_To Ft.
(Street Name,Numbera.Community,Subtl�asion,Lot No.,Parcel,Zip Co ia)
TOPOGRAPHIC/LAND SETTI G: 10.DRILLING LOG
❑Slope ❑Valley ❑Flat idge OOther From / To
(check appropriate box) 3 / Fof/manon Description
=d-,=ft,=,
V 'LATITUDE 3 _ �r n I I L7 J ' X2 -At ZI -Y DLONGITUDE_ _
Latitude/longitude source: OGPS ❑Topographic map
(location o/wer must be shown on a USGS topo map and
i
attached to this form 7 not using GPS) `
4.WELL OWNER `(� !n� �w
OWNER'S NAME ` O Y� O M 0�
STRI TADDRESS 1 S6 �i(L-IJ�L,�4J00� -Til
�aQ
City or Town 5late Zip Code
( ga -- 9 ao50
Area code- Phone number
5.WELL DETAILS: 11. REMARKS:
C
a. TOTAL DEPTH: J_O /
b. DOES WELL REPLACE EXISTING WELL? YESO NON
C. WATER LEVEL Beim Top of Casing � 1 10 IDO HEREBYCERTWY AT THISIN WELL WAS CONSTRUCTE D ACCORDANCE WrIN
FT THAT
NCAC]C.WELL CONSTRUCTgN STANDARDS,ANDmATACOPYOFTNIS
(Use'+'AAbove Top of Casing) RECORD HAS BEEN PROVIDEDTOTNE WE OWNER. -
d. TOP OF CASING IS FT.Above Land Surface* t I ) OS -
*Top of casing terminated atl r below land surface may require - -- "
a Variance in a/gt/ordance With 15A NCAC 2C.01 1118./� SIGNATURE OF CERTIFIED WELL CONTRACTOR ATE
e. YIELD(gpm): `/Z}. METHOD OF TEST nl l7 'Atl� W ILLI6 I`�AS
PRINTED 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,INC 27699-1617 Phone No.[phone] ext 568. Form GW-1a ` - -
Rev.7/05

(� J ,•
WELL CONSTRUCTION RECORD `, n L
North Carolina-Department of Environment and N rural
�R/eee�source$$$ Ivl/gi9n o Water Quality-Groundwater Section
WELL CONTRACTOR(INDIVIDUAL)NAM(F�J(print) /�/� L /r, /� T
WELL CON COMPANY NAME/ J(/�AlA /4 AI e/ I t I CERTIFICATION#Otw
STATEWELL CONSTRUCTION PERMIT# PHONE #
(if a Ileable) ASSOCIATED WQ PERMIT#
(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 �p 1,,
Nearest OCAT �5 �1 `IV- County '�h�(-S5&� Topo,ra fc/Land setting
❑Ridge ope ❑Valley ❑Flat
(Street Name,Numbers,Community,Subdivision,Lot No.,Zip Code) (cheeckktappropriate box)
�' I,3t o�y,Itu �welJlot;at�t A 31[,09`P
3. OWNER:Atoc
I Nes ,�TJ�__ �� �/- a ^
Address (degrees/minutes/seconds) Va a 3(>
�s� Latitude/longitude source:❑GPS❑Topographic map
(Sir Route No.) ���
SSS — a, (check box)
DEPTH DRILLING LOG
City or Town Suite Zip Code From TO
Formation Description
Area rode-Phone number 1g� /��
4. DATE DRILLED �j�
5. TOTAL DEPTH:
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO
7. STATIC WATER LEVEL Below Top of Casing: �z_FT.
(Use"+"if Above Top of Casing)
8. TOP OF CASING IS FT.Above Land Surface•
*Top of casing terminated at/or below land surface requires a
variance in accorQae wi 15A NCAC 2C.OI Ig.
9. YIELD(gpm): METHOR OF TES'I � 1J
10. WATER ZONES I
1 t LOCATION SKETCH
11. DISINFECTION:Type Amount Show direction and distance in miles from at least
12. CASING: Wall Thickness two State Roads or County Roads. Include the road
Dept Diameter or Weight/Ft. Material numbers and common road names.
From To Ft.
From To Ft.
From To Ft.
13. GROUT: Dept Maleri
T eth
From Z -".
From To Ft.
14. SCREEN' Depth Diameter Slot Size Material
From To Ft. in. in.
From To FL in. in. o
15. SAND/GRAVEL PACK: ul
Depth Size Material
From To Ft.
From To Ft.
16. REMARKS:
I DO
WELL WAS
ELL
CONS HEREBY
CTION STAN ARDS? ND HAT A COPY OFTHISTRECORD HAS BEEN PROVIDED WITH
TO THE C ALL OWNER
Z6 O S
SIGNATURE OF PERSON CONSTRUCTING THE WELL IYATE
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.
F GW-1 REV. 07/2001

WELL CONSTRUCTION RECORD
North Carolina-Department of Environment and Natural Resources-Division of Water Quality-Groundwater Section
WELL CONTRACTOR(INDIVIDUAL)NAME (prin0 RICHARD MCCRARY CERTIFICATION#2010
WELL CONTRACTOR COMPANY NAME BARKER CONSTRUCTION,INC.BARKER WELL&PUMP PHONE # [phone]
STATE WELL CONSTRUCTION PERMIT# 1871 ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
1. WELL USE(Check Applicable Box):Residential M Municipal/Public❑ Industrial 0 Agricultural 0
Monitoring❑ Recovery ❑ Heat Pump Water Injection❑ Other 0 If Other,List Use
2. WELL LOCATION: Topographic/Land setting
Nearest Town: HENDERSONVILLE County HENDERSON ORidge ❑Slope Malley ®Flat
BLOOMINGDALE SUBDIVISION,LOT#2 (check appropriate box)
(street Name,Numben,Community,Subdivision,Lot No.,Zip Code) Latitude/longitude of well location
3. OWNER: ED HOLLAND BUILDERS (degrees/minutes/seconds)
Address 151 JACKSON DRIVE Latitude/longitude source:DGPSOTopograpluc map
(Skeet or Route No.) (check box)
FLETCHER NC 28732 DEPTH DRILLING LOG
City or Town .state Zip Code From To Formation Description
( a28)- 777-6778
Area code-Phone umber
4. DATE DRILLED OCTOBER 11,2005
5. TOTAL DEPTH: 405'
6. DOES WELL REPLACE EXISTING WELL? YES O.NO ® CD
7. STATIC WATER LEVEL Below Top of casing: 60' FT.
(Use"t"if Above Top of Casing)
8. TOP OF CASING IS 1.33 FF.Above Land Surfaces
-Top of casing terminated attor below land surface requires a ,.
variance in accordance with 15A NCAC 2C.0118. r
9. YIELD(gpm): 12 METHOD OF TEST TIMED
10. WATER ZONES(depth):
LOCATION SKETCH
11. DISINFECTION:Type BY PUMP INSTAL eR Amount Show direction and distance in miles from at least
12. CASING: Wall Thickness two State Roads or County Roads.Include the road
Depth Diameter or Weight/Ft. Material numbers and common road names.
From 0 To 93 Ft. 61/8 SDR21 PVC
From To Ft. ,/ y (1'�,-,u��tp�,,
From To Ft. oN 6' /atd— -61G1,0 / � C.�Gm)u
13. GROUT: Depth Material Method [/_ jv r0
From 0 To 20 Ft. CONCRETE POURED �C/-!I /
From To Ft.
14. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in. p? � f /j�p ,
From To Ft. in. in. -_ o
15. SAND/GRAVEL PACK: 01GI,'..
Depth Size Material tain y
From To Ft. 7y
From To Ft.
16. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CO STRUCTED IN ACCORDANCE WITH I SA NCAC 2C, LL
CONSTRUCTION STAND SANWYAT P F THI CORD HAS BEEN P OVIDED TO THE LL O ER
SIGNE ON ONSTR G THE WELL DATE
Submit the original to the Division of Water Quality,Groundwater Section,1636 Man Serbice Center-Raleigh,NC
27699-1636 Phone No(919)733-3221,within 30 days. GW-I REV.07/2001

WELL CONSTRUCTION RECORD
> � I3 - q
North Carolina- Department of Environment and Natural Resources- Division of Water Quality-Groundwater Section
WELL CON'IRACTOR(INDIVIDUAL)NAME (print) CERTIFICATION Ng"03
w ELI,CON I'RAcTOR C'OMPANV NAME / /,Uq PHONE #��L� 3
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PE D11T#
(if applicable) (if ap licable)
1. WELL USE(Check Applicable Box): Residential Municipal/Public ❑ Industrial ❑ Agricultural ❑
Monitoring❑ Recovery ❑ Heat Pump Water Injection❑ Other❑ If Other,List Use
2. WELL LOCAT N: Topogr hic/Land setting
Nearest Town: U1 r ��VI)�County_�A9'��� ❑Ridge lope ❑Valley ❑Flat
(check appropriate box)
(Street Name,Numbers,Community,Subdivision,Lot No.,Zip Code) of nd /10 1 e 1Oc8110
CE fEx6 �_Nc�. _ _ (g � .�'� w lrsv. Q l�9
3. OWNER: _ I (degrees/minutes/seconds) El6V'. a
Address _C 0 �5 VV �� - Ke t Latitude/longitude source:❑GPS❑Topographic map
(She Route No.) I55�'z/ (check box)
m r'HM� DEPTH DRILLING LOG
City or Town State Zip Code From To Formation Description
Area code-Phone number
4. DATE DRILLED
5. TOTAL DEPTH: r
6. DOES WELL REPLACE EXISTING WELL? Yv�j ❑ NO
7. STATIC WATER LEVEL Below Top of Casing: t'0 FT.
(Use"+"u Above Top of Casing)
S. TOP OF CASING IS I FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordance with 15A NCAC 2C.0118.
9. YIELD ZOO � M� %OF TEST -
10. WATER ZONES(depth): �.3 C�((��
LOCATION SKETCH
11. DISINFECTION: Type i Amount Show direction and distance in miles from at(cast
12. CASING: Wall Thickness two State Roads or County Roads. Include the road
Depth Diameter or Weight/Ft. Material numbers and common road names.
From To C Ft.
From To Ft.
From To Ft.
13. GROUT: Depth �Maat is Metho
From To 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: o
Depth Size Material cn
From To Ft.—
From—To Ft.
16. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED 1N ACCORDANCE WITH 15A NCAC 2C,WELL
CONSTRUCTION STANDARD ,AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
SIGNATURE OF PERSON C DATE
RECEIYfI
Submit the original to the Division of Water Quality,Groundwater Section, 6 ail Service Center-Raleigh,NC
27699-1636 Phone No.[phone],within 30 days. GW-I REV.07/2001
JAN 30 2000
Asheville Regional Office
w_..et_- .._._._ _ .._

WELL CONSTRUCTION RECORD
'?, 1. 3 2
North Carolina- Department of Environment and Natural Resource - Division of Water Quality-Groundwater Section //jj
WELL CON'TRAC I OR(IND]VIDL'AL)NAM (print) CERTIFICATION HR&Og
WELL CON1RAC1OR COMPANY NAME 14J WZ11 wbe"WNII PHONE # $r3 t��pLi
STATE s\'ELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable) (if
applicable)
7
1. WELL USE(Check Applicable Box): Residential Municipal/Public ❑ Industrial ❑ Agricultural ❑
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other❑ If Other,List Use
i
2. WELL LOCATI - II'' p Topograp and setting
Nearest Town: v4b Nvllk-•ounty ka ty ❑Ridge ope ❑Valley ❑Flat
(check appropriate box)
(Street Name,Nurnbbers,Co
mmunity,
Subdivision,Lot No.,Zip Code) Lgyt l9�gitndC f Well 1QCyLIO C�
3. OWNER: Ut'VQ� N t7 �1`i , � YU B � 3' (�qL
(degrees/trinules'seconds) a +Sv 1
Address Latitude/longitude source:❑GPS❑Topographic map
ute (check box)
t kit �& �oZ,� DEPTH DRILLING LOG
City or Town State Zip Code From To Formation Description
O _
Area code-Phone number
4. DATE DRILLED Ia l� a�
5. TOTAL DEPTH:
6. DOES WELL REPLACE EXISTING WELL? YESQ NO
7. STATIC WATER LEVEL Below Top of Casing: I FT.
(Use"+"if Above Top of Casing)
8. TOP OF CASING IS FT. Above Land Surface'
`Top of casing terminated at/or below land surface requires a
variance in accordance wi 5A NCAC 2C.0118.
9. YIELD (gpm):1-4. `D MET QD OF TEST 6CA �• l
10. WATER ZONES(depth):
LOCATION SKETCH
11. DISINFECTION: Types 8 Amount Show direction and distance in miles from at least
12. CASING: Wall Thickness two State Roads or County Roads. Include the road
Depth Diameter or Weight/Ft. Material numbers and common road names.
From
To l of ,7 Ft.
From To Ft.
From To Ft.
I3. GROUT: Depth C Mat I ---�Methodl
From To Ft d� •{ c�
From To Ft. 1\{.1
14. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in. U01
From To Ft. in. in. C)
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 15A NCAC 2C,WELL
CONSTRU TION STANDARDS,,AA THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WE L OWNER
/e �S
SIGNATURE OF PERSON CO STRU TE
Sub it the original to the Division of Water Quality,Gr ndwater SfptiAnp163tnaM1aid Service C ter-Raleigh,NC
2 699-1636 Phone No.[phone],within 30 days. h1�'l �7 VV LLUUOODU W-1 REV.07/2001
Asheville Regional Office
A uifer Protection

WELL CONSTRUCTION RECORD U'
North Carolina- Department of Environment and Natural Resources�-Division of Water Quality-Groundwater Section
��ff��
WELL CON'TRACI OR(INDIVIDUAL)NAM (print) R C. CERTIFICATIONA —6—3
WELL CON'l RACTOR COMPANY NAME /W / / PHONE # (Y.2�03-/pa?el3
SPATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERM #
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residentialllel`�Municipal/Public ❑ Industrial ❑ Agricultural ❑
Monitoring❑ Recovery ❑ Heat Pump Water Injection❑ Other❑ If Other, List Use
2. WELL LOCAT N Topogra is/Land setting
Nearest Town: Vf Ito County ❑Ridge fe ❑Valley ❑Flat
A Ls ('�1 M (check appropriate box)
(Street Nam umb//e'-r,ss,Community,Subdivision,Lot No.,Zip Code) Latltu e6/londa f we I IOC O /t
3. OWNER'�dr 'I' �FaMV( _ _ (degrees/minutes/sec)nds) e Icvf- r4 -k�
Address tk33 Q60^yW( d S Lr. Latitude/longitude source:❑GPS❑Topographic map
9(Street or Route (check box)
(J [� 6'y!� DEPTH DRILLING LOG
City or Town State Zip Code From To Formation Description
Area code-Phone number p
4. DATE DRILLED O ��
5. TOTAL DEPT '
6. DOES WELL REPLACE EXISTING WELL? YF NO
7. STATIC WATER LEVEL Below Top of Casing: FT.
(Use"+"if Above Top of Casing)
8. TOP OF CASING IS FT. Above Land Surface*
'Top of casing terminated at/or below land surface requires a
variance in accc,4_4mcafith 15A NCAC 2C.0118. ��y
9. YIELD(gpm): METH OF TES-GqL• 1
10. WATER ZONES(depth): S
LOCATION SKETCH
11. DISINFECTION:Type Amount CZ Show direction and distance in miles from at least
12. CASING: Wall Thickness two State Roads or County Roads. Include the road
Dept Diameter or Weight/Ft. Material numbers and common road names.
From To Ft.
From To Ft.
From To Ft.
13. GROUT: Depth { M ca �ethod� L
From To x=/ Ft.
From To�F 14t 1
0
14. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in. o
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Size Material
Prom 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 'ELL 0 ER
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
RECEIVED
Submit the original to the Division of Water Quality,Groundwater Section, 1636 Mail Servi a Centcr-Raleigh,NC
27699-1636 Phone No.[phone],within 30 days. JAN 3
0 2006 GW-1 REV. 07/2001
Asheville Regional Office

WELL CONSTRUCTION RECORD
North Carolina-Department of Environment and Natural Resources-Division of Water Quality-Groundwater Section Qj WELLCONTRACTOR(INDIVIDUAL)NAh�t r.(print) ` t // CERTIFICATIONO3M
WELL CONTRACTOR COMPAN 1&1/ j LLPHONE@
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(ifapplicable)
(if applicable)
1. WELL USE(Check Applicable Box):Residential 0 Municipal/Public ❑ Industrial ❑ Agricultural ❑
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other,List Use
2. WELL LOCATION:
Neares[Totw:�.t u:/fit Coun . . Topographic/Land setting
�wst � �— ty/ d a., ❑Ridge B'Slope ❑Valley ❑Flat
(check appropriate box)
(Sneer Nome,Numbers,Commmniry,Subdivision,Lot No.,Zip Code) Latirude/longitude of well location
N1raZt/,'T,'7'✓Or;`04 � '
3. OWNER-
0/V er (degrees/minutes/seconds)
Addressr Latitude/longitude source:C36PS❑Topographic map
(Street or Routero.) (check box)
DEPTH DRILLINGLOG
L town Smre Zip Code From To Formation Description
(aS9 y or loll 9-�
- a b- sr !%,-
.�uea code-Phone numbe.I 4. DATE DRILLED S%2`�-D.ti✓ 61- (oos �,,
5. TOTAL DEPTH: 0—Z -
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO
7. STATIC WATER LEVEL Below Top of Casing: /OO FT.
(Use +"if Above Top of Casing)
S. TOP OF CASING IS�_FT.Above Land Surface'"
•Top of casing terminated at/or below land surface requires a
variance in accordance with 15.1 NCAC 2C.0118.
9. YIELD (gpm): I _'M�tE,.T�;-IOD OF TEST jg
10. WATER ZONES(depth): 0D J
LOCATION SKETCH
11. DISINFECTION:Type C/�i M- Amount 70 AKr 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 O To 41 Ft. ✓Z✓ r.,piezl "yr
From - To Ft.
From To FL � / l-
13. GROUT: Depth Material Method /From 0_To„,aD--Ft. lfekfte
From To F[.
14. SCREEN: Depth '
p Diameter Slot Size Material
From To Ft. in. in. o
From To Ft. in. in, 71 _
15. SAND/GRAVEL PACK: n
Depth Size Material 1
CJ1
From To � F[.
From To Ft.
C.It
16. REMARKS: +
=e
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C,WELL
CONSTRUCTION STANDARDS,AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
" A-.r,...' 3�zy or
SIGNATURE OF PERSON,CONSTRUCTING THE WELL - DATE
Submit the original to the Division of Water Quality,Groundwater.Sedtlod, I6_3-6,Mail Service Center-Raleigh,NC
27699-1636 Phone No.[phone],within 30 days.:. GW-I REV.07f2001
29

A r
WELL CONSTRUCTION RECORD
North Carolina-Department of Environment and Natural Resources-Division of Water Quality-Groundwater Section
WELL CONTRACTOR(INDIVIDUAL)NANIF (print) RcALru �j
CERTIFICATION Ad1�
WELL CONTRACTOR COMPANYNAME E c ' ,F/ „er,p2C��i/c/
�+�+ � �— PHONE YLP�1 7reZ
SPATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(ifapplicablel (if applicable)
1. WELL USE(Check Applicable Box):Residential C3�Municipal/Public ❑ Industrial ❑ Agricultural ❑
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other,List Use
2. WELLLOCATI9Y., t. Topographic/Landsettin
.�J�en/a�ra//s[��Town:/'i�✓r tw.y!/�G County-_,Ifudep ay- ❑Ridge [Elope ❑Valley ❑Flat
M tJLd4i I r i
ISwee�N4me,NNw�ers,Comnm�,Subdivision,Lot No.,Zi Code (check appropriate box)
P ) Latimde/lon itude of well location
y� / NN>✓ Zg.�ir worz°zg. vz3'
3. OWNER: F-ltytt'l� ( p �a���� (degreea/minut,Wseconds)
Address Zo 10 Latitude/longirudesource:BIIPS❑Topographicmap
I (Saeet o{ flute No.)
Ct\�I, 'rSeK U 1 (check
C��9� DEPTH DRI DRI
_ LLING LOG
C'ry or To State Zip Code From To Formation Description
(Dl)- � 'L it4 l'4
Area code-Phonc number
4. DATE DRILLED 5. TOTAL DEPTH: ,Y7 f^
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO l�
7. STATIC WATER LEVEL Below Top of Casing: 60 FT.
(Use"+"if Above Top of Casing)
S. TOP OF CASING IS_� FT.Above Land Surface"
`Top of casing terminated atior below land surface requires a
vuriance in accordance with 15A NCAC IC.011 g.
9. YIELD(,pm): /5_ METHOD OF TEST Z&AVp(�
10.WATER ZONES (depth): 70 l -
LOCATION SKETCH
11. DISINFECTION:Typellor�of 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 Weigh[/Ft. Material numbers and common road names.
From O To z5 FL Zs' S X / {P1/G XX �''
. - From - To Ft. U�CL ��'�K9 7"'�E�d��AC-tGb
From To Ft.
13. GROUT: Depth Material Method -�-�e.ndef50Not�(e, WC­
From_
To2Q_Ft. /rG E e `�nr,r�,'ara
From To Ft.
14. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in -
From To Ft. in. in,
15. SAND/GRAVEL PACK: - C?
Depth Size Material I
Gfl
From To - F[. '
From To Fr. t )
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
K G✓.tvtEe- � ��S' ��I
SIGNATURE OF PERSON CONSTRUCTING THE WELL, DATE
Submit the original to the Division of Water Quality,Groundwatdr Section, 0 36 Mail Service Center-Raleigh,NC - -
27699-1636 Phone No.[phone],within 30 days. GW-I REV.07/2001
- Zn

WELL CONSTRUCTION RECORD
North Carolina- Department of Environment and Natural Resources-Division of Water Quality-Groundwater Section
WELL CONTRACTOR(INDIVIDUAL)NAM (print) t
CERTIFICATION#3146
WELL CONTRACTORCOMPANYNAME /V IJ�F/ &yl � LLC PHONE dM 9W&
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(ifapplicable) / ('f ppl'cable)
1. WELL USE(Check Applicable Box):Residential Er Municipal/Public ❑ Industrial ❑ Agricultural ❑
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other,Lis[Use
2. WELL LOCATION:
Nearest Town: ✓Ge e.F County fdSl
� Topo Mope
Land setting
/7[�ii ten ❑Ridge ope ❑Valley OFlat
N ICY S� a 42- (check appropriate box)
(Sweet Nume,Numbers,Community,Subdivision,Lot No.,Zip Code) Lati[ude1longimde of well location
C j� V.?f''V U61� o3s'JJ SYA r
1OWNER: J rl N �JOS—i (degrees/minui al econds)
Address Latitude/longitude source:ZS❑Topographic map
(Street or Route No.) (check box)
't' Q rIq I DEPTH DRILLING LOG
ury or rown State Zip Code From To Fortnation Description
f-250- fo8rl- y471{ b- � l�:�
Area code-Phone number 77-C/j, o h
4. DATE DRILLED 3-16 -or y1 e G,.-tar
5. TOTAL DEPTH: 70�
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO 0�
7. STATIC WATER LEVEL Below Top of Casing: 4/0 FT.
(Use"+"if Above Top of Casing)
S. TOP OF CASING IS�_FT.Above Land Surface-
*Top of casing terminated at/or below land surface requires a
variunce in accordance with ISA NCAC 3C.0118. 9'
9. YIELD(gpm):2_METHOD OF TEST Z/Ul J
10.WATER ZONES (depth): 15b/
LOCATION SKETCH
11. DISINFECTION:Type C(rwi Amount cdr Show direction and distance in miles from at least
12. CASING: Wall Thickness two State Roads or County Roads.Include the road
-D Dept Diameter or Weight/Ft. Material numbers and common road names.
From To �2 Ft. Lf f i ) wG
From - - To FL L� �-I-.cf
From To—Ft. (,
13. GROUT: Depth Material Method
From�To_Z�Ft. /YC E E
From To_FLCe�Jq
l4. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in
From To Ft._in. in.
15. SAND/GRAVEL PACK: r --
Depth Size Material
From To FL t _
From To Ft U7
16. REMARKS: u'1
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C,WELL
CONSTRUCTION STANDARDS,AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
Submit the original to the Division of Water Quality,Groundwater Section, 11636 Mail Service Center-Raleigh,NC
27699-1636 Phone No.[phone],within 30 days. '- GW-I REV.07/2001

s r..
WELL CONSTRUCTION RECORD
North Carolina-Department of Environment and Natural Resources-Division of Water Quality-Groundwater Section
WELL CONTRACTOR(INDIVIDUAL)NAM (print) t CERTIFICATION
WELL CONTRACTOR COMPANY NAME E r !1/✓ LL PHONE(�ol'�taf,?— 4l
STATE WELL CONSTRUCTION PERMITR ASSOCIATED WQ PERMIT7{
(i f appl icable) (if applicable)
1. WELL USE(Check Applicable Box):Residential C3'Municipal/Public ❑ Industrial ❑ Agricultural ❑
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other,List Use
2. WELL LOCATION: Topographic/Land setting
Neare, Town:N ZA / County plkidge ❑Slope ❑Valley ❑Flat
/ r (check appropriate box)
(Street Name,Numbcrs,Connal i Suhdivision,Lot No.,Zip Co e) La1;%d,,/longitude of well location
� ,U3S'zd,YYr;(,ofrt°21 337 t
3. OWNER: >? AN✓OQ (degrees/minute�s/ cords)
Address Latitude/longimde source:❑'GPS❑Topographic map
(Stet(or Ro t9 No.) (check box)
SONUi,r DEPTH DRILLING LOG
City or tpown State Zip Code From To Formation Description
:Arta code-Phunz number
4. DATE DRILLED_
5. TOTAL DEPTH:
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO
7. STATIC WATER LEVEL Below Top of Casing: ee'O _FT.
(Use"+"if Above Top of Casing)
S. TOP OF CASING IS�_FT.Above Land Surface"'
`"fop of casing terminated at/or below land surface requires a
variance in accordance with I5A NCAC 2C.0118. p
9. YIELD(,-pm): S- METHOD OF TESTZ�� �ilf
,
10.WATER ZONES (depth): ZYJ' LOCATION SKETCH
11. DISINFECTION:Type-C— 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 Weighi/Ft. Material numbers skid common road names.
From 0 To " Ft.4 lZf— 1.? / ^It-
From To FL - I hI� 1
From To Ft. C/fGSTN�
li. GROUT: Depth
Material Q To From E , GA elvl //e
From To FL '
14. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in
From To Ft. in. in.
*t
l5. SAND/GRAVEL PACK: C-
From Depth Size Material
TO Ft.
From To Ft. O
Ut
16. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C,WELL
CONSTRU ION STANDARDS,AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
TU Z .z z or
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
4 20006

WELL CONSTRUCTION RECORD
Noah Carolina-Department of Environment andlat rat Resources-Divisi of Water Quality-Groundwater Section �� (�
` WELL CONTRACTOR(INDIVIDUAL)NAME (print) CERTIFICATION#QJA
WELL CONTRACTOR COMPANY NAME� -PHONE .Z, /�
5��SSW
STATE WELL CONSTRUCTION PERMIT# J ASSOCIATED WQ PERMIT#
(if applicable) / _(if applicable)
1. WELL USE(Check Applicable Box):Residential MunicipaUPublic ❑ Industrial ❑ Agricultural ❑
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other,List Use
2. WELL LOCATION: Topo setting
Mope
Neares�tTownTJxr�Le County, y{ �[ ORidge C�7SIope ❑Valley ❑Flat
(el
3�= t p .6 PAD 641 A;a (check appropriate box)
- (Street Name,Numbers,Community,Subdivision,Lot No.,Zip Code) Latir le/longirtlde f well location
3. OWNER: (degrees/r9 utasheconds)
Address - En yoll" j$? Zip Latitude/Ion itude source: v
J (Street or R/Dore No.) g L�rPS❑TOpoa[aphiC map
J_J'](Jp r.SOAfU I lam. (check box)
�I[C_�.�� DEPTH DRILLING LOG
City or Town State Zip Code From To Formation Description
�- ��8 7le7$ �yy t
Area code-Phone number
5. DATE DRILLED '• -- _�C r.�'
S. TOTAL DEPTH:.
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO C�
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 at/or below land surface requires a
variance in accor a ewith l5A NCAC 2C.0118. IT 1
9. YIELD(gpm):I&METHOD OF TEST ni
10. WATER ZONES(depth): xu r JJ
LOCATION SKETCH
11. DISINFECTION:Type !&L& 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 WeighdFt. Material numbers and common road names.
From_._,To 74 Ft. 6.0 From To Ft.
From To Ft.
li. GROUT: Depth n !{Material�I Method
From_ �Q To F[.l Q pFTe
From To Fr. -r-
14. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in.
From To Ft. in. in.
t
15. SAND/GRAVELPACK: �
Depth Size Material t .y
From To FL to
From To Ft. CD
Ln
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
Z 7 C
SIGNAT;IRE 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.0712001

WELL CONSTRUCTION RECORD
North Carolina-Department of Environment and Natural Resources-Division of Water Quality-Groundwater Section
WELL CONTRACTOR(1NDMDUAL)NAME (print)�j� 2
CERTIFICATION
WELL CONTRACTOR COMPANY NANIE E t A.iy LL PHONE v8�81 dJ�FII'f/ram
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
If applicable)
(ifa plicnble)
1. WELL USE(Check Applicable Box):Residential a--Municipal/Public ❑ Industrial O Agricultural ❑
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other,List Use
2. WELL LOCATION: /
Nearest Town:L < i .yI County ao� Topographic/Land setting
��/1 �� tY ❑Ridge ❑Slope ❑Valley C3F1 t
(check appropriate box)
(Street Name,Numbers,Community,Subdivision,Lot No.,Zip Code) Latitude/longimde of well location
3. OWNER: ✓td W�p+y � '�S�9EL imaz'Z� /,ry
Address e� 5? p � (degmes/minutes/seconds)
—R t �iT1L Latitude/longitude source:OOPS❑Topographic map
(Street o5 Route No.) (check box)
2(SoNU.II� p(' S2 ]9 DEPTH DRILLING LOG
uty or sown atg zip Code From To Formation Description
Area code-Phone number
4. DATE DRILLED 6r
5. TOTAL DEPTH: /cfQ' ® - 5— --Ye
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO Er-'
7. STATIC WATER LEVEL Below Top of Casing: /O FT.
(Use'+"if Above Top of Casing)
8. TOP OF CASING IS FT.Above Land Surface`
*'Top of casing terminated at/or below land surface requires a
variance in accordance with 15A NCAC 2C.01 18. �
9. YIELD(gpm):�METHOD OF TEST y 2/0!flr
10.WATER ZONES(depth): 7J—'
LOCATION SKETCH
11. DISINFECTION:TypeC /ie Amount _ Show direction and distance in miles from at least
12. CASING: Wall Thickness two State Roads or County Roads.Include the road
O Depth Diameter or Weight/Ft. Material numbers and common road names.
From To GG Ft. G•✓>-� s`A'Zu /�iiC
From - To Ft.
From To Ft. O 'P l�R S �
13. GROUT: Depth Material Method .�11
From_Q_To 20 Ft. /YC E E
From To Ft. -�-e e-rso14d
14. SCREEN: Depth Diameter Slot Size Material
From To Ft._in. in. -
From To Ft._in. in. ,
15. SAND/GRAVEL PACK
Depth Size Material n
From To - Ft.
From To Ft. �'
r7 f=
16. REMARKS: c n
I DO I4EREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C,WELL
CONSTRUCTION STANDARDS,AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
SIGNATURE OF PERSON CONSTRUCTING THE.WELL _... - DATE
Submit the original to the Division of Water Quality,Groundwater Section, 1634i'Mail Service Center-Raleigh,NC
27699-1636 Phone No.[phone],within 30 days. --
GW-1 REV.07/2001
I .

WELL CONSTRUCTION RECORD
North Carolina-Department of Environment and Natural Resources-Division of Water Quality-Groundwater Section
WELL CONTRACTOR(INDIVIDA UL)NAhI ,(print) t j
zzF,�F^^ CERTIFICATION Aw
WELL CONTRACTOR COMPANY NAME NE y��5az.8y9(�
JJ PHO
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable) (ifapplicable)
1. WELL USE(Check Applicable Box):Residential L7 Municipal/Public ❑ Industrial ❑ Agricultural ❑
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other,List Use
2, WELL LOCATION:
Nearest Town:��tch Coun few Topographic/Land setting
ry ��°" ❑Ridge C31 10pe ❑Valle ❑Flat
r�:�.�o ,a� y
(check appropriate box)
lSneet Name,Numbers,Community,Subdivision,Lot No.,Zip Code) L zde/longitude of well location
3. OWNER: U t YY\C N TI�u 'Z�f/ZV UDe2°t�i C
.Address ��� , f` ) (degrees/minutes/seconds)
Latimde/longitude source:❑6�PS❑Topographic map
1� Street or Route No.) check box
R1 `�� " �8�0�— DEPTH ( DRILLING LOG
Gry or row State Zip Code From TO- I I _ D a 7�J Formation Description
.Area code-Phune number D' `10 11
4. DATEDRILLED%-C)i— ��- �� ��.1«one
5. TOTAL DEPTH: Z%f'
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO Q/
7. STATIC WATER LEVEL Below Top of Casing: 4/0 FT.
(Use"+"if Above"Cop of Casing)
S. TOP OF CASING IS�_FT.Above Land Surface-
`Top of casing terminated at/or below land surface requires a
variance in accordance with 15A NCAC 2C.01 IS.
9. YIELD(opm): /Z METHOD OF TEST
10. WATER ZONES (depth): S r r
LOCATION SKETCH
11. DISINFECTION:Type Amount �L Show direction and distance in miles from at least
l2. CASING: - Wall Thickness two State Roads or County Roads.Include the road
Depth Diameter or Weight/Ft. Material numbers and common road names.
From To -.7/
Frotn To FL
From To FL
13. GROUT: Depth Material J�(t CY1 D�
Method ^ r
From To �Ft. //G ,E E ?1!k •„ra
From To Ft. r"""`l' T`-
14. SCREEN: Depth Diameter Slot Size Material -
Frotn To Ft. in.
in.
From To Ft. in. in.
15. SAND/GRAVEL PACK: r"a
From Depth Size Material
To Ft.
From To Ft. O ,
C ri
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
r-
SIGNATURE OF PERSON CONSTRUCTING THE WELL pgTB
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

6f 9
WELL CONSTRUCTION RECORD
Nordi Carolina- Department of Environment and Natural Resources-Division of Water Quality-Groundwater Section
WELL CONTACPOR(INDMDUAL)NAM! /% / 1 �NF
WELL CONTRACTOR COMP.4NYNAME EQGa/i (nn/A JI/bG// ��� CERTIFICATIONp �
STATE WELL CONSTRUCTION PERMITN 9 L�PHONE
(if applicsblc) ASSOCIATED WQ PERMIT#
(if applicable)
1. WELL USE(Check Applicable Box):Residential O3 Municipal/Public ❑ Industrial ❑ Agricultural ❑
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other,List Use
2. WELL LOCATION: ��
Neatest Town:�:�✓.a v Counry rYtle 1r ro., Topogr�aphic/Land setting
❑Ridge CJSlope ❑Valley ❑Flat
(Saeer Name,Numbers,Cmnmumry,SuMivision,Lot No.,Zip Code) (theca appropriate box)
Latirude/longi[ude of well location
3. OWNER: TTI I /yPf�12.9d-O'
Address S LL 1 „ �IOp J (degrees/minutes/seconds)
1 1 (Surer or Itoltp No.)
ttlt---�`�—' La[itude/longitude source:12tPSOTopographic map
h Cl G1''C L(� U I P _ (check box)
Ury or Cown State nC '��9 DEPTH DRILLING LOG
Zip Code From To Formation Description
�de-Pol7-beSS' 0 - 3r p7
area code-Phonc number -yr.j
4. DATE DRILLED Z— /_. 6.. p,;✓ 3f-- </o ,rle I
5. TOTAL DEPTH: 4� .
6. DOES WELL REPLACE E—WELL? YES C] NO L�
7. STATIC WATER LEVEL Below Top ot'Casing: �/� FT,
" / (Use"+"if Above Top of Casing)
S. TOP OF CASING IS
`Top at casing Wrnnulwod at/or below land surface ove Land Surface*
ce requires a
variance in accordance with ISA NCAC 2C.8118.
9. YIELD(,pm): �z METH9D OF TEST 73/ yl
10. WATER ZONES (depth): .Z� r/t/,d
11. DISINFECTION:Type�'���,:,.� LOCATION SKETCH
Amount Z V J Show direction and distance in miles from at least
l2. CASING: Will Thickness two State Roads or County Roads.Include the road
Q Depth Diameter or Weight/Ft. Material numbers and common road names.
From To Ua Ft.4. Lr S
Prom - _ /-� / wC
TD Ft. i L
From To Ft. A-t,102 �IOrCS T
13. GROUT: Depth Material 1 I Iv/
From Method )1`i
— —To_ Q—Ft /rC E E -4v1,r�,' raY�c�CSoI�1� II L
From To Fr. T�""`3-'"
14. SCREEN: Depth Diameter
From Slot Size Ma[crial ?.'r
To Ft. in. in.
From To Ft. in. o
15. SAND/GRAVEL PACK: in.
Depth Size Material to t
From To F[.
Front To Ft.
O
C.17
16. REMARKS:
1 DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C,WELL .
CONSTRU TION STANDARDS,AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
or
SIGNATURE OF PERSON CONSTRUCTING THE WELL 2 ��
DATE
Submit the original to the Division of Water Quality,Groundwater Section, 1636 Mall Service Center-Raleigh,NC
27699-1636 Phone No.[phone], within 30 days. - - ___
GW-1 REV.07/2001
1

V '
320492
WELL CONSTRUCTION RECORD
North Carolina-Department of EnvironmeZI,,and Res, Divis' n of Wwa�ter tty-Groundwater Sectiioon-�� I
WELL CONTRACTOR(IfgDiV -UAL)NAMME (� � �O� J CTJrrMCATION#��!WELL CONTRACTOR COMPANY NAMB.�1) E(� PRONE # (m(offi-OCIFC)
STATE WELL CONSTRUCTION PERMTT# AcSOCIATED WQ PERMIT#00001111 —`
(if applicable) (if applicable)
1. WELL USE(Check Applicable Box):Residential WMunicipai/Public❑ Industrial ❑ Agricultural❑
Monitoring❑ Recovery ❑ Heat Pump Water Injection❑ Other❑ If Other,List Use
2. WELL LOCATIO
GG el ' MidgeTOpa d setting
Nearest Town:
C�f�tmry idge Mope ❑Flat
/75 94H�/z by ec r7 22 73 Z (check appropriate bar)
(sited Name,Numbers,Commlmity.Subdivision,Lai No,tip code) Latitude(longitade of well location
3. OWNER: '[ NlD Nees e _ (degreesemmnieslseconds)
Address / r �� Latitude/longitude source:❑GPS❑Topographic map
(sweet of Route No.) (check box)
pU G 7 $73 Z DEPTH DRILLING LOG
City or Town State Zip Cade From To Formation Description
Area coda Phone onmher
4. DATE DRU.LED ZU ' -r b5_
5. TOTAL DEPTH, 20 S-
6. DOES WELL REPLACE EXISTING WELL? YES❑ NO 6�
7. STATIC WATER LEVEL Below Top of Casing: ,
��(Use`+^if Above Top of Casing)
8. TOP OF CASING IS FT.Above Land Surface" Tt
`Top of cuing terminated st/or below land surface requires a -
variance In accordance with 15A NCAC 2C.011&
9. YIELD(Win): 7 a METHOD OF TEST_ //!2 m '"
10.WATER ZONES(depth):
LOCATION SKETCH Cn
11. DISINFECTION:Type--jCgWt Amount io o-t, Show direction and distance in miles from at least ,
12. CASING: Wall Thickness two State Roads or County Roads.Include the mad'A
Depth Di or Wd&Tt Material numbers and common ad names.
From_�To &e Ft _ ro SQX2/ 1°UL
From_To Ft
From To Ft
13. > Material
Fro T�o FL4 eer/ Cueo"r From---To Ft
14. SCREEN: Depth Diameter Slot Sim Material
From To Ft in. in. 7 J From To Ft in. in. "" t- trfl�
; L J
15. SAND/GRAVEL PACK V -
Depth size Material
From__CTo Ft.
From—To.—Ft.
16. REMARKS:
'Do HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C,WELL
CONSTRVCTION STANDARDS,PD TH*T A COPY OF S RECORD HAS BEEN PROVIDED TO THE WELL OWNER
� /D-5-crs_ -
SIGNATURE OF MRSON CONSTRUCTING THE WELL DATE
Submit the original to the Division of Water Quality,Groundwater Section,1636 Mai)Service Center-Raleigh,NC
27699-1636 Phone No.[phone],within 30 days. GW-I REV.07/2001 -

4+q,
' RESIDENTIAL WELLCONSTRUCTIon REcoRD
-
�` North Carohna Depertrnrnt of Environmrnt and Natural Kcsourccs Division of W atcr QuaLry
...JJJ WELL CONTRACTOR CERTMCATION N `7 rJ J
1.WELL CONTRACTOR: I. DISINFECTION:Type Amount
�YUa Lct �.rn g. WATER ZONES(depth)
//WN (InOMduag11 Nam r From 130 To /3S� From To
(�2_(1 �IVPr wei1 Ilk/k. From To From To
Well Contractor Company Nam �1 �l From To From To
STREET ADDRESS ?c O7C o+l) T 8. CASINO: Tnicw'ess,
Depth D) t r Wei Material
7C (0 Fram To /iZ Ft !14GLLn/FQst FIAf 'O
City
or Town State r Zip Code From—To Ft.
). 693-)2oo From To R Area code- Phone number
7. GROUT: Depth Material Method
2.WELL INFORMATION: From d To .1 17 Ft.
SITE WELL IDS(ilappcade) q From To Ft.
STATE W ELL PERMITS(a appiwde) o �a2 O 11 I a�/O From To Ft.
DWO or OTHER PERMIT a(it appicabb) 8. SCREEN: Depth Daimler Slot Size Material
From—To Ft._ _ In
WELL USE(Check Applicable Box): Residential Water Supply❑ in .
_ From_To Ft_n. n.
DATE DRILLED It - `! -O f Fran—To Ft n in
TIMECOMPLETED /A 490 AM[y PM❑
9. SAND/GRAVEL PACK.
3.WELL LOCATION: Depth Size Material
From To Ft.
CITY
C z`1 rcChla. /'COUN/TY /� - From To Ft.
15 d u�10.Y" • ' 11 I I IA�f)DC�S Ib✓I - From To Ft.
(Slroet Name. oen.Community.SubdMaion,Lot No.,Parcel,Zip Cade)
TOPOGRAPHIC)LAND SETTING: 10.DRILLING LOG
OS"m OValloy []Flat ❑Ridge ❑Other From To Formation Description
(Chedlt appopnate boX) �� 6 - /7
May te in dcpon, /5' - 5-O .S ,. cJ
LATITUDE Tf72 ZL/f� atinutn,aocorldaa
LONGITUDfi���(' �� in dxurul formal
Lautude/longitudc Source: 29PS ❑Topograpluc tnap
(location of wN must be shown on a USGS iopo map and [�
attached N doe romr Y not uvp CPS) SP .
e.WELL OWNER
OWNER'S NAME J r LL",r_��
STREET ADDRESS Z-(O�:5 [ n .✓+t�r hL�1L�
0L7-q-742-
City a Town State Zip Code
Area code. Pion number
It. REMARKS:
5.WELL DETAILS:
a. TOTAL DEPTH:
b. DOES WELL REPLACE EXISTING WELL? YES❑ NO Cr�
DOREREBY CERTIFY T T 1NIS WELL WAS CONSTRUCTED IN ACCORDANCE Wm"
c. WATER LEVEL Salim Top of Caerv: o _FT. tit NCAC X WELL CCNSTNI TION STANDARDS.ANDTHAT A COPY OF MIS
(Ufa-+'Y Above Top d Casing) RECORD HAS BEEN PROVOED TOT N ELL OWNER
d. TOP OF CASINO IS FT.Above Land Surface-
-Top d acing tenTinated stior below land surface my require �gNp7UR OF CERTIFIED W ELL CONTRACTOR DATE
a variance In ac'clordance wth 15A NCAC 2C.0118. f(J✓�!
e. YIELD(gpm T
): 0 METHODOF TEST_ PRINTED N E OF PE ON CONSTRUCTING THE WELL
Submit the original to the Division of Water Quality Within 30 days. Attn: Information Mgt, Form GW-la
1617 Mall Service Center-Raleigh,NC Z7599.1517 Phone No.[phone] ezt 588. R",Troy

RESIDENTIAL WELL CONSTRUCTION RECORD
3
North Carolina Ut artrnrnt of Environmrnt and Natural Kcsourccs Dives on �l walcr Quahp
111 WELL CONTRACTOR CERTIFICATION 6 2 5 r7 I
1. WELL CONTRACTOR: I. DISINFECTION: Type TJJ� Amount
I�4-k) g. WATER ZONES(aepin) Y
//WM (Individual),Name From G ' To !J©5 From To
L-JT(?te-(1 ?ut/P1' WfO ? ?ket:p From To From To
Ws0 Contractor Company Name �1 From To From _To
STREET ADDRESS Po �OX JkV T 6. CASING: m eiynTNcluwsw
/y+ Depth Diameter Wt Material
FS r7C, � Y �Q r TKO(-IC.. �) �_ o� 1 oC l0 From _ To//l, Ft_t_
City or/Town State I ZIP Code From_ To Ft
( I. 695-)2.00 From To Ft
Art code- Pnorw number
7. GROUT: Depth AMIeMI MetHcA
2.WELL INFORMATION: From © To_Q Ft.SITE WELL ID Ko aw"ve) From To Ft
STATE WELL PERMITge appeoluel O`C /� n�J) I t c I I I ` ( D From_ To Ft
DWO or OTHER PERMIT li applicabN) S. SCREEN' Depth Diameter Slot Sae Maternal
FfOR1- To Ft. n. n
WELL USE(Check Icable Boa): Residerrtrl View Supply Q _ .
,, / From To Ft_n n
DATE DRILLED I i �-I c 5 From_ To Ft
TIME COMPLETED Y U G AM❑ PM Ly'
/` 9. SANLVGRAVEL PACK
3.WELL LOCATION:
(
N�7I: Depth Sae Material
CITY-. ey!Soril", 6COUNTY k154'X- From To Ft
rT
From—To FI.
�I bl 1� 7�1r1� y a From To Ft
IStreat Name.Num e.Cammuruty Subdiwean.La No Parwl.Zip Cooe)
TOPOGRAPHIC I LAND SETTING'. 10, DRILLING LOG
OSape OVMIry OFIat OR" ❑Other From To Formation Deacnpbon
(caeca alpropraa foN) I ��
LATITUDE 3,5��1 3SN mi ual Niacwdlior 3 � 5-!'
//��// .�.
LONGITUDEy�)L' 3L� Z� W iMadecimal fprtntl /OO SPtJ` .) r
IaDtude/longitude source *PS OTopogrephic map
(bcwDn of woo must be drown on a USGS topic,map and
attached to the;form/not us/g CPS)
e.WELL OWNER I "� . ....
V C V
OWNER'S NAME I, IL-P G-rY14��Lt- �YCTt.� �Uyi
STREET ADDRE«?rL 3 i I(I 7at7 c
Cry w Town State Zip Code u
Area woe- Ptwne number
11. REMARKS:
5.WELL DETAILS:
a. TOTAL DEPTH:
b. DOES WELL REPLACE EXISTING WELL? YES❑ NXIO
DD HEREBY CEflm Y THAT MIS WELL WAS CCn5m1uCTED in♦CCOR WNCE wmH
c. WATER LEVEL Below Top Of Casing: FT- AEN WEtn vRp.�OED Tp nSTANWDE WELL REND TMT A CCPr Or TH6
(Use'✓Y Abo a Top of Casing)
d. TOP OF CASINO IS ( FT.Above land Surfac✓
'Top d wing termnated st/w below land surface may require SIGNATU R E OF C E R T I FI E D W E L L CONTRACTOR DATE
a variance n� now A M 1SA NCAC ZC.01^18.
e. YIELD(UP-): , Z- METHOD OF TEST ,Ter
PRINTED NAME OF PERSON CONSTRUCTING THE WELL
Submit the original to the Division Of Water Quality Within 30 days. Attn: Information Mgt.,.. ,... Form GW Is
1617 Mail Service,Center-Raleigh, NC 27499.1617 Phone No.[phone] eat 568. 'J " - Rev 7M

D
x.f RESIDENTIAL WELL CONSTRUCTION RECORD
North Carolina Department of Environment and Narural Kmurccs DWision of water Quality
JJJ WELL CONTRACTOR CERTMCATION N A 7 I
1.WE CONTRACTOR- I. DISINFECTION: Type Amount
�1;3 V aS (7 �v g. WATER ZONES(depth))
Wall
a Contractor Individual)'Name From-1� To�j Q7 From To
Ire—e—n �tV Pr- wei1 �uyl� From To From To
Wall ConexYu Company Name �l From To From To
STREET ADDRESS -PC -P-'0yC 6. CASING: Thickness
Depth Diarpeter Weight M r I
�Gsi � la t fCOCIC a 7� to From_ To IY't Ft �( (t
City or Town Stata Zip Coda From_To Ft.
(2; )- / q5—)2 oo From_To—FI.
At"code- hone number
7. GROUT: Depth Material Method
2.WELL INFORMATION:
From 0 To_2-a Ft. SKC ' .rZ
SITE WELL 101(d appcabia) _ From To—Ft.
STATE WELL PERMITS(e appica to ��J��l� 3� From_To Ft.
DWQ or OTHER PERMIT s(it appicable) 8. SCREEN: Depth Demeter Slot Size Material
From_To Ft.—in. _ n.
WELL USE(Check Applicable Box): Residential Water Supply❑ From_To Ft—in _ in,
DATE DRILLED lJ-'�'D From_To Ft_n _ in.
TIME COMPLETED AM PM C'--
9. SANDIORAVEL PACK:
3.WELL LOCATION: T' Depth Sae Material
CITY. S(MU I` �. COUN From To Ft.
q .p (( � �� From To Ft.
R A46 f C y�(Tn J 'l,�A-X.ui From To Ft
(Street Name,NivnW6.Coamunay. bdMeian,Lad No.,Peace.Zip Cone)
TOPOGRAPHIC/LAND SETTING: 10. DRILLING LOG
❑Slope OV■llay ❑FM ❑Ridge ❑Other From To Fo zbon fsoripbon
(crack app)opnate box) be in�S A Z 'N 11 rW
LATITUDE minutes,secande a
LONGITUDE ZO�'o�/ 3 W in.docanal formal
90 D a
Lautude/longitude source: j�OPS ❑Topographic maP / O 3 SFS AAw, 2-t
(location of we/mint be sheen on a USGS topo map end
attached N&w form/not usip GPS)
4.WELL OWNER (p� C7
OWNER'S NAME_ LP Pyd NZpLtUllde�
S REET ADDRESS Z/O3 Llyuu X L�I Et:A04_a'Z�r rT -
.�r► yns�uli�� I�1C�4 �ti�
City or Tom State Zip Code FJ7
At"code- Phone number
11. REMARKS:
5.WELL DETAILS:
a. TOTAL DEPTH: .S
b. DOES WELL REPLACE EXISTING WELL? YES O NO
� iDO NEREBY CERTIFY T1Mi TNiS WELL WAS GOnSniUCTEO�N ACCORDANCE Wr1H
c. WATER LEVEL Below Top of Csng: FT. 1SA NCAC 2C.WELL CONS UC`hCtv STANDARDS,ANDTHAT A CCPY OF THS
(UH-+-6 Above Top Of Csng) RECORD HAS BEEN PROVOED T97HE WELL OWNER
d. TOP OF CASINO IS FT.Above Lard Surface-
-Top of casing terminated aVor below land surface may require SIGNATURE OF CERTIFIED WELL CONTRACTOR DATE
a ,a no,in accordance with 15A NCAC 2C.0118.
e. YIELD(gpm): —METHOD OF TEST_ F
PRINTE NAME OF PERSON CONSTRUCTING THE WELL
Submit the original to the Division of Water Quality within 30 days. Attn: Information MgL, Form GW-1a
1517 Mal(Service Center—Raleigh,NC 27699-1617 Phone No.[phone] ext 568. ' Rev.7/05

lN' -
x t RESIDENTIAL WELL CONSTRUCTION RECORD
] • North Carolina Ueperbnent of Environment and Natural Kosources Dlvlsion III `A'wer Quality
WELL CONTRACTOR CERTMCATION 11
1.Q0EQ's NTRACTOR:
I. DISINFECTION: Type Amount
�o,� g. WATER ZONES(depth)
l From To C 0 From To
Well (kwbiduW)Narro I
/ 1 I o ? From To From To
=e-4 iVP( wQi1 k/l� From To
Well Contractor Company Name From To
JP 2 () 6. CASINO: Thickness
STREET ADDRESS P'O IL Depth Di.ap+eter W�- Material
�QSt Y �Q t T�OC_K �) a 1 oC From—TO Ft
City or Town Stale Zp C°de
From_-To_Ft.
From_To Ft. --
L���- (Q93-lzoo
Area code- Phew numWr 7. GROUT: Depth Material Method
2.WELL INFORMATION: From Q To�Ft.5'akR�fe �{'�.Z
SITE WELL ID$(if aw l,cabe) �7 From_To_ Ft.
STATE WELL PERMITS(k appimbiO O1 10 01 ( ( 00 1 From—TO--Ft.
DWO or OTHER PERMIT✓kit appicaDk) 8. SCREEN: Depth Demeter SM Size Material
From__To_Fr_in. — n.
WELL USE(Check APpiwbH Box): RaWentel Wales Supply❑ From_To Ft.__wl xi
From_To_FI_In n
DATE DRILLED // -�D - .j
TIME COMPLETED JZ� AM O' PM❑ p, SANDIGRAVEL PACK
-
Depth Sao Material
3.WELL LOCATION: Fran To_ Ft.
CITY:7+�+�=A- 1�11)I de, COUNTY ,1-'" 16ok' From To_Ft.
L.. I - /J,.f From To Ft.
(Street Name.Numbere.C nnunM.SuE°Iwuon.Lot No..Parcel.Zip Cooel
TOPOGRAPHIC I LAND SETTING: 10.DRILLING LOG Formation Description
❑S" ❑Vallay ❑Flat argI ❑ONer From TO
(toxic approDrwte txu) May be in dcF=,
LATITUDE `]23 �6 minWln,aecada or
O� /A (V n a dmutul format
LONGITUD��1y
Lalitude/lottgitude solace: *On ❑Topogral)WC map
(bcancn or we/nxAW be arwwn on a USGS ropo map and
,fwhod no Cw brm I rat usM CPS)
4.WELL OWNER �
OWNER'S NAME
STREET ADDRESS
'cJ ¢ns er'01( e 1JCZ6'74z o
City or Town State Xp Code v
6261- i. g6 - 3171 q
Area code- Phone number 11. REMARKS:
6.WELL DETAILS: ��
a. TOTAL DEPTH:
b. DOES WELL REPLACE E%ISTIING WELL? YES❑ NO B�-
DO HERESY CERTIFY THAT THIS WELL WAS CONSRUMD IN ACCORDANCE W fM
c. WATER LEVEL Below Top c1 Caskv: L D FT. I'M NCAC]C.WELL CONSrRUCT`DH NDARDS.AND THAT COPY OF THIS
RECORD HAS BEE N PROOEDTO Th /ELLOWNE
(Uea••'I Abovit Top d Ceang)
-U
d. TOP OF CASINO IS / FT.Above Land SWINGS'
11 -os^
Top d wing terminated atlor below land suAaGS may require SIGNATURE F CERTIFIED W ELL CONTRACTOR DATE
a varlarae in a de ca,With 15A NCAC 2C.011,8f. t-t 13 y��� 6M F
a. YIELD(gpm): METHOD OF TEST /t,L _ PRINTED NAME OF PERSON CONSTRUCTING THE W ELL
Submit the original to the Division of Water Quality within 30 days. Attn: Intorrnatlon MgL,
Form GW-ta
1617 Mall Service Center-Raleigh,INC 27699-1617 Phone No.[phone] ext 566. Rev.7105

s+q ,
RESIDENTIAL WELL CONSTRUCTION RECORD
< ryJlr
North Ca hna Ucpwnent of Lnvlronmml end Natural Kcsourccs DID wun ill w alcr QuaLry
WELL CONTRACTOR CERTMCATION N
1.WELL CONTRACTOR: • I. DISINFECTION'. Type T� Amount
--� � t
Iv 1 /, p. WATER?ONES loeolm/W" a� uW Name 't—Vl From, To 5�o From To(�rjee- r- WkO From To_ From To
Wall Conuada Company Name From To From Ta
6. CASINO: Thlckrwsv
STREET ADDRESS ISO 130X , �7 r Depth D I` Weigh bilateral
C QSt F)a r 1�OC - KI a g I�7.? IO From To j Fl .Z.l L PE
City or Town Stated Z.p Code From_To Ft
Lpij. 693-)2oO From_To_Ft
Nr code- Phan nunOer 7. GROUT: Depth Material �M/
2.WELL INFORMATION: From To Q FI 5 W-th w
SITE WELL IDA(a appcaoe) From_ To_ Ft
STATE WELL PERMITS(s applwaule) 11 I UU I D Front--- To Ft
DWG a OTHER PERMIT a(e Applicab1e) 8. SCREEN: Depth Damatel Sla See Matenal
From_To_Ft_n. _ in
WELL USE(Chock Applicable Box): Reaidental W9IM Suppty❑ From_ To Ft_n _ n
DATE DRILLED I I-' -Q S From_To Ft__in _ n
TIME COMPLETED 30 AMgsl-�,(' PM 9. SANDGRAVEL PACK
Depth Sue Manual
3.WELL L ATION:
pp Front—To— Ft
CITY: Vi `60UNT SL From ToFt
)7j 7n(j1P�Y11A.1.. From To_Ft
I rset Name, pare.Communay.Suodrelon,La No.Parcel,Zip Coda)
TOPOGRAPHIC I LAND SETTING, 10. DRILLING LOG Formaooyy ewnptl oon
OS" EIVsllry OF1el ❑Ridge ❑OIhW From To l'
(oleo appWrote loos) I*) - /O
I A/ Matteis dictivia.omel,o 5� / y w
LATITUDE �5'ZZ �Z miaub,axadaa /�iG--%�f(J---'-- r 2 _
r " drul format _
LONGITUDE SI.4��GQ p� I aecu 21 t7 — S f1 .PfFuae,
Laolude/longitude solace: c�&S ❑Topographic map ;
(bo~of we/mute be ahcwrl on a USGS loPo map er(I
en&chvd M In.form/nor ua/p GPS)
a.WELL OWNER
OWNER'S NAME
STREET ADDRESS 3�) Lovi f2
}rc-I. &-LA 5 M 0 I
City a Town Sate Zip Cooe
(2 k,. lv k S- 38 s I
Nee oode• Phan number 11. REMARKS'.
6.WELL DETAILS: 1.
a. TOTAL DEPTH: �/
D. DOES WELL REPLACE EXISTING WELL7 YES ElN%6
i DO HEREer CERTIFY TW.T h,1S wEll wAS COnarRDOTED w ACCORDANCE WIT"
c. WATER LEVEL Below Top d CM41g:�FT, ry,rrC.K x.wEll CCr.SrRUCTxrr 0ARDe.ANDTINT A CCPY OE T iS
(UM,i I Abosa Top d Gawp) RECORDINS BEEN PROrCED t0 Tn E�l}l P�'+'nER
d. TOP OF CASING IS FT.Abowl L"Sudaca'
Top c(casing tan noted at/a Dhow land sudeca may require SIGNATUR OFCERTIFIEEDDWELL�C:C)NTRACTOR DATE
a walanw ina000rdanca Wth 15A NCAC 2C.0118. 51 1 `� - "`
• YIELD(9pn): q_METHOD OF TEST�r PRIN NAM OF PERSON CONSTRUCTING THE WELL
Su Drnit the original to the Division of Water Quality within 30 days. Attn: Information Mgt, Form GW 1•
1617 Mail Service Canter-RalNph,NC 27699-1617 Phone No.[phone] ext 568. .' Rev 7105

RESIDENTIAL WELLCONs-rRurnON RECORD
3
North Carolina Lkparanmt oC tnvimnmrnl end Natural KcBourcos Dn'nion ul water Quatry
WELL CONTRACTOR CERTMCATION N o� 5 "7 I
1.WELL CONTRACTOR: I. DISINFECTION. Type 4.1T14 Amount
{bhgaat-� p. WATER ZONES IOepiril
WN C ual)Name, r From 2 as To From To
(ST-_- e-y ?IV P WA 'I From To From To
—
Well Co
ntractor ontractor Company Naar From To From To
STREET ADDRESS 'PC i�J OX �() T 6. CASINO: Thlcknii
�I ! �-7 r1 Depth Dartfelel VV ht Materiel
Eck Y IA r T�O(� K) �_ a o I oC From I To� FI 23 � .I. I�dG
City
or Tavel Starts Zp Code From_ To Ft
(typ�u I. 6g3-J200 From_To Ft
Area Cede- Pharr nUrtDM
7. OROUT'. Depth Material M
2. WELL INFORMATION: e2 �_Q �
From To Ft a.
SITE WELL ID qd applcam) From To A
STATE WELL PERMITS(y apWcaota)06Inc) I o3 73 q From_ To Ft
OWQ or OTHER PERMIT HE applicable) 8. SCREEN: Depth Demeter Slot Size Material
From_ To FI_n. _ in
WELL USE(ClwCk AppiagN Bok): Rasidentol Water Supply 4, From_ To FA—in _ n.
DATE DRILLED 11 1$ Q.S From_ To Ft_in _ n
TIME COMPLETED I 30 AM& PM❑ n170-l_tz yJ
3.WELL LOCATION: Depth � $us nMatenal
From Jr To //JJO Ft q /�
CITY'. -f..l.l de,(SlrylJlllf COUNTY 2 SOY7 From ToFt.
From To Ft
(Street Name.Numcers.Cornmunay,Subd,Werori,Lot No Parcel,Zip Code)
�TOPOGRAPHIC I LAND SETTING. 10. DRILLING LOG
p'S!laq DVri ❑FW I ❑Ridpa DOOrr From 'To For" ton Descnpoon
(dredk appicpNr Om)
a I May be m dagroo. _lr.-]__ .�rL!) 7-
LATITUDE ��I }aa IY11i eo -- y
O / in a aminul(onmat
LONGITUDE OB Z_I8 O( W -
LatnudcAongitude solace: p4'i PS ❑Topographic map c 9
(loceomn of wel nrwl De shown on a USOS(opo map and '1
erteehed N er Aarn r not using GPS)
4.WELL OWNER _ T�
OWNERS NAME
STREET ADDRESS�, A-rI 1nq+O7'1 >`
�;n , 1F_y , 5G9y(�440
Cky or Tam State Zip Code
L�64J. B SS- I'!(o `/
Area code- Phone nunWr
11. REMARKS:
6.WELL DETAILS: r7 _ r
a. TOTAL DEPTH: G 2 S
b. DOES WELL REPLACE EXISTING WELL? YES D NO Fd/
/ I DDNEREBY CERTIFY T TT tS WELL WAS CONSTRUCTED INACCORDANCE Wm'
bw
c. WATER LEVEL Be Top ofC"ing: lip _FT. IM NC/C x.WELL D sTRU 7ON STANDARDS.AND THAT A CORr OF T e
(UN-�MADow Toed Ceaiq)
d. TOP OF CASINO IS - n RECORDMS BEEN RRWOED TOr WELL OWNER
FT.Above land Surface' / aL�
1
'Topdcasuglarrnnatad Wer below WW surface rtry require E OF CERTIFIE D WELL CONTRACTOR DATE
a verrrca in,accordance vii 15A NCAC 2C.011& r
'aJ METHOD OF TEST4r /�;� v/4kJ� 5� 'r�
a. YIELD(gpm)'' PRINTED N E OF PERSON CONSTRUCTING THE WELL
Submit the orlpinal to the DlvWon of Water Quality within 30 days. Attn: Inlorrna Don Mgt, Fotmcw-la
1617 Mall Service Center-Raleigh, NC Z7699.1617 Phone No.[phone] ext 568. J R,',1
2 4
- Rev 7105

C, Quw
L)yy �sw>Fo
s RESIDENTIAL WELL CONSTRUCTION RECORD 32o4,58
North Carolina Department of Environment and Natural Resources-Division of Water Quality
WELL CONTRACTOR CERTIFICATION# 2�Qi(a
1.WELL CONTRACTOR: f. DISINFECTION:Type O':1\A__ Amount
^acc'r A �onRl. 'So.�ttcG
g. WATER ZONES(depth):
Well Contra.1m(Individual)Name
From 7o From__To
sof\ 1-�2 Lac From To From_ To
Awn, any Name From To From_ To
G. CASING: Thiclmessf
STREET ADDRESS M%SS )il!" acci Depth Diameter W�ei9,hl Mlatgnal
y� Fran / To 1.3a FL 6 AI
City a T State -ZiP Code From To Ft.
From To Ft.
€9L a� io<os-aozZ
Area axle- Phone number 7. GROUT: Depth Material Method
2.WELL INFORMATION: From O To_ d
SITE WELL ID#(If applicable) From To_Ft__
From To Ft--
STATE WELL PERMITW applicable)
DWQ or OTHER PERMIT#(if applicable) 8. SCREEN: Depth Diameter SYri S¢e Material
From To FL_in. _in.
WELL USE(Check Applicable Box): Residential Water SUPPIY 2' Fran To Ft_in. _in.
DATE DRILLED­/0"1^z .Fran To Ft.—in. _,in.
TIME COMPLETED 1/ 00 AM❑ PM In 9. SANDIGRAVEIL PACK:
Depth Size Material
3.WELL LOCATION: ✓1�NJr
From To Ft.
COUNTY FrmCITY: NP ✓Su 'I�p _
To Ft.
Fmm To—Ft.
P tdln Cete\� VQ\\eY
(SineM Name.Numbers.CNnmanny.Subdrvnion,lot No..P.rcei,Zip Code)
TpLp� p GRAPHIC/LAND SETTING: 10.DRILLING LOG Formatron Description
t➢��De ❑Valley ❑Flat ❑Ridge ❑Other. From To
(Check appropriate box) }1 - /.�Z7 OV'Lf i3••r d-..
=inLATITUDE 3 nyso
LONGRUDE_ _
Latitude/longitudesource: ❑GPS ❑Topographicmap -_
(location of wall must be shown on a USGS topo map and t 7 r
attached to this form►not using GPS)
4.WELL OWNER Ol
OWNER'S NAME 501AtMetm er'de of w1tc.
STREET ADDRESS \\qV 3
r
A'86 r•\Ne NC SL88oa
City or Towri State Zip Code
($as )- 211"I. 5A_4o
Area code- Phone number I1• REMARKS:
S.WELL DETAILS:
& TOTAL DEPTH: foO/
b. DOES WELL REPLACE EXISTING WELL? YES❑ NO lt;�
} 1 DO HEREBY CERTIFY THAT THIS WELL WAS COMTRUCTED N ACCORDANCE WITH!
e..WATER LEVEL Beim TOP ofCasing: FT' ISANCA 2C,BEEN R(WELL NSTRU TICHEWEDL OWN ERARM nrHATACOPYOFTHIS
RECORD HAS(Use'+'it Above Top of Casing)
d. TOP OF CASING IS / . ,FT•Above land Surface'
-Top of casing terminated at/or below land surface may require SIGNATURE OF CERTIFIED L CONTRACTOR DATE
a variance in accordance with 15A NCAC 2C.0118.
e. YIELD(gpm): METHOD of TEST _.
� PRINTED NAME OF PERSON CONSTRt'JCTiNG THE WELL
Submit the original to the Division of Water Quality within 30 days. Attn:Information Mgt,' y F� -la
J617 Mail Service Center-Raleigh,NC 276994617 Phone No.[phone] ext 568. R

�sw�o
�y0 ,ysa.rs�
S RESIDENTIAL WELL CONSTRUCTION RECORD
' North Carolina Department of Environment and Natural Resources-Division of Water Qualit,
WELL CONTRACTOR CERTIFICATION# 9-A Zto
1-WELL CONTRACTOR: - f. DISINFECTION:Type \� Amount�-
0 P-V C:C\S "P Cv SQ!39 q '-s 9. WATER ZONES(depth):
Well Contractor(Indrodual)Name From To
From_ To
C11 ae Saw t�cS 2s <or tJQ\}\�c 11. ra Fn Tc From__To
Well Contractor Company Name 4
CA Fran To
npnn �1 From To
STREET ADDRESS, `�C7n� \\- o-1 Oct 6. CASING: Thickness/
.5 roc`:•ttG4 - NC Depth Diameter Weight Material
O�tb1t"e� Fran�To LDy Ft.. (n-Li Ll O
"p��Cdy a �Stath .-Zip Code From To Ft.
L52�T - Lok>S-as OZZ From To FL-
2-
Area code- Phase number --
WELL INFORMATION: - 7. GROUT: Depth Material Method
SITE WELL ID"f applicable) Fin—D To _Ft (!f'.Jn¢±,-
From To Ft.
STATE WELL PERMIT#faaPPRcable) From To Ft
DWQ or OTHER PERMIT#(lt applicable) 8. SCREEN: Depth Diameter Slat Size Material
WELL USE(Check Applicable Box): Residential Water Supply❑ From From To Ft_in. in,To Ft._in. in,
_
DATE DRILLED �\- \'l ' 00 rj Fran To FL in. In.
COMPLETED -+� AM O PM V
-9. SAND/GRAVEL PACK:
3.WELL LOCATION: Depth Size Material
CITY: 7-1CrrterSc'nV \Le COUNTY "I{Q,YT arLCSG`C\ From To Ft. -
Frort To Ft
-_ 'Aio3S 3V-XRV Mollx GAY\ rr.\ From To Ft.
(Sheet Name,Numbers,Canmunrty.Subtlmswn,La No.,Parcel,Zip Code)
TOPOGRAPHIC t LAND SETTING 10.DRILLING LOG
Ccslope OValtey ❑Flat ❑Ridge ❑Other From To FOnmatlDl
(check a Description
ppropriate box) -}1 � (Dy Ov Q,C- (�1A'r'd o r)
LATITUDE 3 =ckciml
LONGITUDE - (Dy L105
Latitude/longitude source: ❑GPS -
❑Topographic map �
(Watoon of welt must be shown on a USGS fopo map and -
attached to this fofm d not using GPS)
4.WELL OWNER �
OWNER'S NAME s1C1M e.S W'.\\ •w- CC}oT�R
STREET ADDRESS �b35 S�f�� Min CZc�•
_ ev�ec5�r\v lie, Nc aF IqQ n
City or Tam State Zip Code
Area code- Phone number
A WELL DETAILS: 11. REMARKS: -
a. TOTAL DEPTH: \'dlf3cj
b. DOES WELL REPLACE EXISTING WELL? YES❑ NO 21-1
e..WATER LEVEL Beim Top Of CaSln : — IOO HEREBY CERTFY TTIAT THIS WELL WAS CONSrRtCTED N ACCORDANCE WRR
g FT. 15 NCAC 2C,WELL CONSIRLCC STANDARDS,ANO THAT A COPY OF THS
(Use'+'If Above Top of Casing) RECORD HAS BEEN PROVIDED TO THE WELL OWNER.
d. TOP OF CASING IS_t FT.Above Lard Surface`
'Top d casing terminated onto below land surface may require �-1—\
a variance in accordance with 75A NCAC 2C.Ot 78. SIGNATURE OF CERTIFIED WE ONTRACTOR DATE
e. YIELD(gpm): —METHOD OFTEST ��_r.
-"" -- PRINTED NAME OF PERSON CONSTRUCTING THE WELL
Submit the original to the Division of Water Quality within 30 days. Attn: Information Mgt,
1617 Mall Service Center-Raleigh,NC 276 9 9-1 61 7 Phone No.[phone] ext 568. F m GWaa
JA N 2 4

i.
North Carolina-Department of Environment and N 9=1 Resources-Division of Water Quality-Groundwater Section _
1636 Mag Service Center-Raleigh,N.C.27699-1 64'hone(919)739-3221
WELL CONSTRUCTION RECO D WELL CONTRACTOR: r^_C util I3r'�� ni
WELL CONTRACTOR CERTIF CATION
�,/STATE WELL CONSTRUCTION PERMIT#:
1_ WELL USE(Check Applicable Box): Reside Ual M Municipal❑ Industrial❑ Agricultural❑ Monitoring❑
Recovery❑ Heat Pump Water Inj Sort © Other if Other,Ust Use:
2. WELL LOCATI N: (Show sketch of the location below) r/eh Jp r,SG�)
Nearest Town• P -n v' Count'. /f
\,Jotec �
CEP
(Road Name and Numbers.Community.or Subd Ilion and Lot No.) DRILLING LCC-
'i H
3, OWNER A rt�.�-¢Si 'fr%&rd A - From To Farmeean Description
Address A `1 blev% Hee:e�. c.ve l 93 Duey- L3��1,•n
p-
ro or cue c, oa�7�� —
v, .Jc
1`t
City or Town State Zip Code
4. DATE DRILLED.IL-1��.
5. TOTAL DEPTH 61 yS
6. CUTTINGS COLLECTED YES❑ Cam'
7. DOES WELL REPLACE MSTING WE 7 YES I—I NO _
8. STATIC WATER LEVEL Below Top of C ng: O FT.
(Use-i a e Top of Casing) r3'
9. TOP OF CASING IS FT.Abo e Land Surface-
'Top of easing terminated aVor below land surface r quires a varlancs in seeor.
dance with 1SA NCAC 2C. 11 a
10.YIELD(gpm): METHOD OF T ST
11. WATER ZONES(depth):
12. CHLORINATION: Type r Amount II addi9onai space is needed use tack of form
13. CASING:
LOCATION SKETCH
Wad Thickness
tedal (show direction and distance from at least two Slate
Depth Diameter or eighwL
� Ft. --- Roads,or other map reference points)
From To 43 ,
From To Ft.
From To Ft. IUD >:SS f
14. GROUT: q
Depth Mat riot Method t¢y�-7 z/w
From j To �Ft. _P .e,f ��L--1 (' /� y
From To Ft.
15. SCREEN:
Depth -Diameter of Size Wateria)
rc>d/rr
From To Ft.__ In. —in.
From To FL_— In. _ In.
From To Ft.— In. _In.
16. SAND/GRAVEL PACK:
Depth Size Material
From To—Ft.--
From To FL
17. REMARKS:
100 HEREBY CERTIFY THAT THIS WELL AS CONSTRUCTED 1N ACCORDANCE WITH 15A NCAC 2C,WELL
CONSTRUCTION STANDARDS,AND THA r A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL.OWNER
—ss
FOR OFFICE USE ONLY DATE
Quad No: SIGNATURE OF PERSON CON U G THE WELL
Su odginad to Division of Water Quality,Grow ter section within 30 days GW-1 REV.12Ns
Serial No.
PJ 2 4 a

sea SrAtFu ..
Q RISIDENTIAL WELL CONSTRUCTION RECORD
North Carolina De utment of Environment and Natural Resources-Division of Water Quality
WELL CONTIL CTOR CERTIFICATION#"
1.WELL CONTRACTOR: f. DISINFECTION:Type :\1 _ Amount 1 O
y12SC:CV' Ni . bavJ M g. WATER ZONES(depth):
Wen Contractor(Individual)Name Fran To From__To
�f dt� :ri a1J�QSa 11 o fJ•¢. ,,Ln,fa Fnxn To From To
Web ontractor Company Name 1 From To From To
STREET ADDRESS li4glAf) jj%Z ;ZOCi 6. CASING: Thickness/
Depth Diameter Weight Material
1 t 6 From_�To 3.1 Ft_��
City or (i stow Zip Code From To Ft _
( �e1fS} (pb5- eZ o'LZ Fran To Ft
Aroma cads Phone number
2 WELL INFORMATION:
7. GROUT: Depth Material Method
n�r
Fran�_To O.0 Ft CX1vtQ,t�
SITE WELL ID#(d applicable) From To Ft--
STATE WELL PERMIT#(ii applicable) From To Ft. _
DWQ or OTHER PERMIT#(If applicable) 8. SCREEN: Depth Diameter Sri Stm Material
WELL USE(Check Applicable Box): Resid from To FL_in. _in.Water Supply❑ From To Ft—in. .—in.
DATE DRILLED IV \IO `05 From To Ft_in. ._In.
TIME COMPLETED -3•00 A iO PM/Y g, SANDIGRAYEL PACK:
3.WELL LOCATION: - Depth Size Material _
From To FL _
CITY: l\12f1bef \1f 5ae r11E000 lNEa\atiSol\ From To FL
al.^ Y Y- 1_G Fran To FL .
(Sbe6 Name.Num Te,CarnTnunib'.Subdivision, No..Parcel,ZW Cede)
TOPOGRAPHIC I LAND SETTING: 10.DRILLING LOG
Md�peOVaRW ❑Flat ❑Ridge ❑Other From To FonnaiknDescription
(check appropriate box)
May be in degrees,
LATITUDE 3 _ minutes.seconds or a't �� n+I2� 10tatdon
LONGITUDE in a decimalm forat
——
Latitude/longitudesource: ❑GPS ❑T graphicmap
(bcation of welf must be shown on a USG map and -
attached to this,form frlot using GPS)
4.WELL OWNER
OWNER'S NAME V%O.! G3,1C `•�--
STREETADDRESS nZ FGT CtV X Lix: a
Q. InaQ 4Z ------rT�
City or Town State Zip Code
($-34b>• 5'a- ('dboc (-n
Area code- Phone number
11. REMARKS: ..
5.WELL DETAILS:
a TOTAL DEPTH: "bs
b. DOES WELL REPLACE EXISTING WELL YES❑ NO R -
T DO HEREBY CERTIFY THAT THIS WELL WAS CONSIR'ICIED IN ACCORDANCE Wrn
C WATER LEVEL Below Top of Casing �Q FT, 13A NCAC IC,WELL CONSTRUCnON STANDARDS,"',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.Al ive Land Surface' s -),��
'Top of casing temfinated atlor below land urface may require SIGNATURE OF CE�I IFI wit CO `,C DATE
a variance in accordance with 15A NCA C.0118.
e. YIELD(gpm): 60 METHOD OF T� Vl 21'f 1 C> 1-\. 6 a1J'y e t fa
PRINTED NAME OF PERSON CONSTRUCI lNG THE WELL
Submit the original to the Division of Vater Quality within 30 days. Attn:Information Mgt, Form GW-tor
1617 Mail Service Center-Raleigh,NC 99-1617 Phone No.[phone] ext 568. l+v ) A

From:Scott Gantt To:Stepheme Wlson Date: 1/5/2006 Time.7:48:56 PM Page 3 of
WELL CONSTRUCTION RECORD 1 � Q "
North Carolina-Department of Environment,and Natural Resources-Division of Water Quality-Groundwater Section
WELL CONTRACTOR(INDIVIDUAL)NAME(print) SCOTT GANTT CERTIFICATION#2584
WELL CONTRACTOR COMPANY NAME CAROLINA WELL DRILLERS INC PHONE#[phone]
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
1.WELL USE(Check Applicable Box): Residential ® Municipal ❑ Industrial❑ Agricultural ❑ Monitoring ❑
Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other,List Use:
2.WELL LOCATION: Topographic/Land setting
Nearest town: EDNEYVILLE County HENDERSON ❑Ridge ❑ Slope ❑ Valley Flat
OLD ORCHARD SUBDIVISION Latitude/Longitude ofwell location
(Street Name,Numbers,Community,Subdivision,Lo[No,.Zip Code) 35.24.122/82.19,663
3.OWNER HICKORY NUT DEVELOPMENT CORD (degrces/mulutes/saonds)
ADDRESS POB 276 LatitudeRongitude source:®GPS❑Topographic map
(so-cet or Ronh No.) DEPTH DRILLING LOG
LAKE LURE NC 28746 From To Formation Description
City or Town State Zip Code 0 110 Clay
828-625-0866 110 163 Consolidated Rock
Area Code-Phone Number
4.DATE DRILLED 12/7/05
5.TOTAL DEPTH 163
6.DOES WELL REPLACE EXISTING WELL? YES ❑ NO ED
7,STATIC WATER LEVEL Below Top of Casing: 80 Fr.
Nrc 1'rAbove Top ofcadvB
8. TOP OF CASING IS 2 FT.Above Land Surface•
'Top of casing turnitutrd ovor blow lmd surface nqu rer a vanancc in
accordance with l SANCAC 2C.0118
9_ YIELD(Rpm): 20 METHOD OF TEST ARDM
10.WATER ZONES(depth): 157
it.DISINFECTION:TYPE HYPOCHLORITE Amount 4 oz LOCATION SKETCH
12.CASING: Wall Thickness Show direction and distance in miles from at least
Depth Diameter or Weight/Ft. Material two State Roads or County Roads.Include the road
From 0 To 118 FL 6 1/4" SDR 21 PVC numbers and common road names.
13.GROUT:
Depth Maz ial Method
From 0 To 20 FL GRAVEL MIX GRAVITY
14.SCREEN
.g
Depth Diameter Slot Size Material
From NA To FL in. in. _ -
15.SAND/GRAVEL PACK — —'
Depth Size Material W
From NA To Ft,
O d'
Ol
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.
1/U06
SIGNATURE OF PERSON CONSTRUCTING THE WELL Daze
GW-1 REV.07/2001
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.

WELL CONSTRUCTION RECORD
North Carolina—Department of Environment And Natural Resources—Division of Water Quality—Groundwater Section
WELL CONTRACTOR(INDIVIDUAL)NAME(print)RODNEY ROBBINS CERTIFICATION# 2785
WELL CONTRACTOR COMPANY NAME PITTMAN WELL BORING,LLC PHONE# [phone]
STATE WELL CONSTRUCTION PERMIT#_ ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
1. WELL USE(Check Applicable Box): Residential Municipal/Public 0 Industrial ❑ Agricultural
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other,List Use_
2. WELL LOCATION:
Nearest Town:SALUDA County REND Topographic/Land setting
1079 TRAMMEL GAP RD. ❑Ridge ❑ Slope ❑ valley ❑Flat
(Street Name,Nmnbers,Community,Subdivision,Lot No.,Zip Code) (check appropriate box)
3.OWNER:MARCY WEITZEN Latitude/longitude of well location
Address 1079 TRAMMEL GAP RD.
(Street or Route No.) (degrees/minutes/seconds)
SALUDA NC 28773 Latitude/longmidc source: ❑ GPS ❑Topographic map
City or Town State Zip Code (check box)
28 —749-7575 DEPTH
Area Code Phone number From To
4.DATE DRILLED 11/04/05 _
5.TOTAL DEPTH: 405 DRILLING LOG
6.DOES WELL REPLACE EXISTING WELL? YES® NO❑ From To
7. STATIC WATER LEVEL Below Top of Casing: 40 FT. _
(Use"+"if Above Top of Casing)
8.TOP OF CASING IS 1-1/2 FT. Above Land Surface' LOCATION SKETCH
'Top of casing terminated attor below land surface requires a Show direction and distance in miles from at least
variance in accordance with 15A NCAC 2C.0118. Two State Roads or County Roads. Include the road
9.YIELD(gpm): 3 METHOD OF TEST ARD number and common names
10.WATER ZONES(depth): HWY.#176 TO SALUDA.LEFT AT RR
11.DISINFECTION:Type CHLORYTE Amount 10.5 CROSSING.GO OUT MTN.PAGE RD.LEFT ON
TRAMMEL GAP RD.1 MILE ON LEFT.(1079 ON
12.CASING: Wall Thickness POST(a)DRIVE)
Depth Diameter or Weight/Ft. Material
From 0 To 78 Ft 6-1/4" SDM21 PVC
From_To_Ft.
_ _
From_To Ft. _
13.GROUT: Depth Material Method
From 0 To 20 Ft.OUHOtETE POURED
From_To Ft
14.SCREEN: Depth Diameter Slot Size Material
From_To_Ft._ in. in. CP
n i
From_To_Ft._ in. =
15. SAND/GRAVEL PACK: S
Depth Size Material
From_To_Ft._
From To Fk
16.REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C,WELL
CONS z
TANDARDS,AND THAT A COPY OF THIS RE ORD HAS BEEN PROVIDED TO THE WELL OWNER
�-
6/31GINATURE OF PERSON CONMUCTING THE WELL DATE
Submit the original to the Division of Water Quality,Groundwater Section, 1636 Mail Service Center—Raleigh,NC
27699-1636 Phone No.[phone],within 30 days. GW-1 REV.07/2001

WELL CONSTRUCTION RECORD `
North Carolina-Department of Environment and Natural Resources-Division of Water Quality-Groundwater Section 2Q
WELL CONTRACTOR(INDIVIDUAL)NAM ((print) , I CERTIFICATION w1
WELL CONTRACTOR COMPANY NAME/a=RA f�A�/ / L,�- PHONE �A"87/�
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable)111� - (if applicable)
1. WELL USE(Check Applicable Box):Residential B,Municipal/Public ❑ Industrial ❑ Agricultural ❑
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other,List Use
2, WELL LOCATION:
Neares[Towm:T'snlP� Coun re•r Topograj�hic/Land setting
aFs / ❑Ridge ❑ectope ❑Valley ❑Flat
A�.y(�—j—D • (check appropriate box)
(Suect Name,Numbers,Community,Subdivision,Lot No.,Zip Code) Lati[ude/longilude of well location
S�1OlAJC IJ ti�lcS'.N� /�35� Orr7
3. OWNER: (degmes/minutes/ conds)
Address _ 5 14.Sh .u_//% La[itude/longitude source:00PS❑Topographic map
//� �II (Sweet or Route NoJ (check box)
-.FIP/IQP�SaKu `) e aS79/ DEPTH DRILLING LOG
ctty or Jown State Zip Code From To Formation Description
Area code-Phone number - G, —
4. DATE DRILLED f K-05' 3 —
5. TOTAL DEPTH: &Y- /
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO IY
7. STATIC WATER LEVEL Below Top of Casing: 'e✓J FT.
(Use'+"if Above Top of Casing)
S. TOP OF CASING IS�—FT.Above Land Surface"
"fop of casing terminated at/or below land surface requires a
variance in accordance with 15A NCAC 2C.0118.
9. YIELD(gpm): L METHOD OF TEST
10.WATER ZONES(depth): Z 70
LOCATION SKETCH
11. DISINFECTION:Type C'/o,int Amount 41 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 - 17 To_/I Ft. /2I .SrY/ / A/f_. /J
From To Ft. �) 7 (rid/� �' eLu Pic
From To Ft. rn,� .-ea
13. GROUT: Depth � Material
Method lr, �, d� / KC O
From��To Ft. frG E E q / r'� m
From To Ft. T C-1
14. SCREEN: Depth Diameter Slot Size Material •.
From To Ft, in. in. -
From To Ft. in. in, o
15. SAND/GRAVEL PACK: C-n
Depth Size Material
From—To—- Ft.
From To Ft.
16. REMARKS: -
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C,WELL
CONSTRUCTION STANDARDS,AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
SIGNATURE OF PERSON CONSTRUCTING THEIWHLL DATE
II i i
Submit the original to the Division of Water Quality,Grohnllwatei•Section, 1636 Mail Sea•vicCenter-Raleigh,NC
27699-1636 Phone No.[phone],within 30 days, t GW-I REV.07/2001
k 1 lh r r
r
I

R
WELL CONSTRUCTION RECORD
North Carolina-Department of Environment and Natural Resources-Division of Water Quality-Groundwater Section
WELL CONTRACTOR(INDIVIDUAL)NAM (print) �1Rj h..ry - (�(-J i NES �Qj
CERTIFICATION#a.)6
WELL CONTRACTOR COMPANY NAME Hap �. PHONE&2&26� 4L
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable)
(ifa plicable)
1. WELL USE(Check Applicable Box):Residential 2r�Municipal/Public ❑ Industrial ❑ Agricultural ❑
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other,List Use
2. WELLLOCATIO
Ne4lest Town: -+���..v,f1 e County rr�a Topographic/Land setting
Z-J 71- a ❑Ridge ❑Slope l!T' lley ❑Flat
(Suez[Name,Numbers,Community,Subdivision,Lot No.,Zip Code) (check appropriate box)
ec Lll��titude/longitude of well location
3. OWNER:_C ib ' '!T zJrlror ' er -f-7 '
/n/ hdltl�.4«
Address (degrees/minutes/�se Dods)
(Sneer or Rome No.) Ladtude/longitude source:C3MOTopographic map
(check box)
AC air / DEPTH DRILLING LOG
City or Town State Zip Code From To
Formation Description
Area code-Phone number v
-67
4. DATE DRILLED J -A -o GZ
��
5. TOTAL DEPTH: 2 6 !2 lee_
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO
7. STATIC WATER LEVEL Below Top of Casing: 20 FT.
(Use"+"if Above Top of Casing)
8. TOP OF CASING IS�_FT.Above Land Surface*
'Top ofcuing terminated at/or below land surface requires a
variance in accordance with 15A NCAC 2C.0118.9. YIELD(gpm): h METHOD OF TEST �-phA
10.WATER ZONES(depth): 9r
LOCATION SKETCH
11. DISINFECTION:Type0k I a,- Amount `7 71rh- 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 ames.
From O To 6 7 Ft. ./Ltf 49'2e ��
From - To Ft.
From To Ft. 7 aC f AZAI �
13. GROUT: Depth Material Method �J- �
From--D—To 2D Ft. /rC E ' !Q Q��� `/e A(C
From To Ft. r / !/J��'l� !
14. SCREEN: Depth Diameter Slot Size Material -
From To Ft.—in, in,
From To Ft. in. is n
15. SAND/GRAVEL PACK: I.
Depth Size Material c-n
From To - Ft. a ,. . I
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
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
Submit the original to the Division of Water Quality,Groundwatel•Sectiop $636Aai)Service Center-Raleigh,NC
27699-1636 Phone No.(9I9)733-3221,within 30 days. - --- — -
GW-1 REV.07/2001
n*
r� -

c, n
WELL CONSTRUCTION RECORD
North Carolina-Department of Environment and Natural Resources-Division of Water Quality-Groundwater Section WELL CONTRACTOR(INDIVIDUAL)NAMzf�(print)_ s CERTIFICATION Z/46
WELL CONTRACTOR COMPANY NAMEL L.LC PHONE OgLa�A-Q7/4(p
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable) _ (ifapplicable)
1. WELL USE(Check Applicable Box):Residential 1K Municipal/Public ❑ Industrial ❑ Agricultural ❑
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other,List Use
2. WELL LOCATION: Topogr�pphic/Land setting
Nearest Town: i' /c County L� ❑Ridge L'ISlope ❑Valley ❑Flat
War l ne L d C' (check appropriate box)
(Street Name,NumberYCammuniLy,Subdivision,Lot No.,Zip Code) L timde/]ongitude of well location
3. OWNER: Lam` r l ` ro rn r+�. /y' < (degmes/minutes/seconds)
Address �St Jt )n f Pry Latitude/longitude source:ff PS❑Topographic map
(Street or Route No.) (check box)
n d Pr��r�r't) I r e`I$ DEPTH DRILLING LOG
tag Gry or Town State zip code From To Formation Description
Area code-Phone number
4. DATE DRILLED C—
5. TOTAL DEPTH: LAC: /
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO Er
7. STATIC WATER LEVEL Below Top of Casing: .2D FT.
(Use'+"if Above Top of Casing)
8. TOP OF CASING IS L_FT.Above Land Surface*
"'fop of casing terminated actor below land surface requires a
variance in accordance with 15A NCAC 2C.0119.
9. YIELD(gpm): �Z METHOD OF TEST_
10.WATER ZONES(depth): .0 0 /f/ '
LOCATION SKETCH
11. DISINFECTION:Type �'w�ac Amount 6 fin'. Show direction and distance in miles from at least
12. CASING: - Wall Thickness two State Roads or County Roads.Include the road
Depth Diameter or Weight/Ft. Material numbers and common road names.
From-0—To 211 Ft /&- 1,9etl A/C `�r .
From To Ft. IK o! 5�-
From To Ft. 2,6
13. GROUT: Depth Material Method
From_D—To�. 0 Ft. te /rG E e _ q
From To Ft. -
14. SCREEN: Depth Diameter Slot Size Material -
n
From To Ft. in. in. t
From To Ft. in. in. c.tl
15. SAND/GRAVEL PACK: 0
Depth Size Material cJl
From To - Ft.
From To Ft.
16. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C,WELL
CONSTRUCTINNN STANDARDS,AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
Submit the original to the Division of Water Quality,Groundwater Section, 1636 Mail Service Center-Raleigh,NC
27699-1636 Phone No.[phone],within 30 days. GW-I REV.0712001

WELL CONSTRUCTION RECORD
North Carolina-Department of Environment and tral Resources-Divisi of Water Quality-Groundwater Section
WELL CONTRACTOR(INDMDUAL)NAME (print) U 0
,[� // CERTIFICATION p,(/ /d
WELL CONTRACTOR COMPANY NAME 1 t CO/J (C I {i-'' 19IV ry+p� LLr�PHONE µQa.'t5S�'S�F9r�
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable) (ifa plicable'i
1. WELL USE(Check Applicable Box):Residential Municipal/Public ❑ Industrial ❑ Agricultural ❑ -
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other,List Use
2. WELL LOCATION:
Nearest Town: t- � , Topographic/Landing
7County �r1. ,�i,[./ ❑Ridge ❑Slope 13V'alley ❑Flat
,T7`.�=.� (check appropriate box)
tsi cet Name,Numbers,Community,Subdivision,Lot No.,Zip Cade) LatitudeAtingitude of well location
3. OWNER:_ _ �. ,:*¢ �9 - 3 /�.�//`�.t,•arsrt'��E,IP�"
Address , (degrees/min s/ nds)
GtJN Latitude/longitudesource: PS❑Topographic map
(Snee[or Roue No.) (check box)
DEPTH DRILLING LOG
C[ry or town State Zip Code From To Formation Description
(OK)
Aica code-Phone number
4. DATE DRILLED__ '�" �`� 1^ :Yd:
5. TOTAL DEPTH:_
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO Qe/
7. STATIC WATER LEVEL Below Top of Casing: 4 FT.
(Use"+'if Above Top of Casing)
S. TOP OF CASING IS FT.Above Land Surface"
*Top ofcasing terminated at/or below land surface requires a
variance in accordance wi[h I5A NCAC 2C.011S.
9. YIELD(pm): /A METHOD OF TEST'ANIU, q
10.WATER ZONES(depth):
LOCATION SKETCH
11. DISINFECTION:Type-('{I/(.)ivot.'f Amount 5�-L- Show direction and distance in miles from at least
12. CASING: Wall Thickness two State Roads or County Roads.Include the road
Depth Diameter or Weight/Ft. Material numbers and common road names.
From To.-q"?Ft. 2.1/./o'S �C> '�Zi
From - To Ft. �,CS e /B /a�
From To Ft. ' iQl�e- /
13. GROUT: Depth n_M�,,ate�riiaalr Method lV
From_ To mFt. � Qirfq QNd , rNU"Ile
-
From To Ft.
14. SCREEN: Depth Diameter Slot Size Material 'rn
From To Ft. in. in, n
From To t
Ft. in. in. t.1'i
15. SAND/GRAVEL PACK: _
Depth Ft. Size Material From To UI
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 COPY OF THIS RE H PROVIDED TO THE WELL OWNER -
` � :-�7 -
SIGNA O RS CO RUCTINGTHE WELL TE
Suhntit the original to the Division of Water Quality,Groundwater'Settw,o, r1636 Mall Service Center-Raleigh,NC
27699-1636 Phone No.(9I9)733-3221, within 30 days. GW-I REV.07/2001
� n

WELL CONSTRUCTION RECORD
North Carolina-Department of Environment andVuqraI Resources-Divisi of Water Quality-Groundwater Section
WELL CONTRACTOR(INDIVIDUAL)NAM�E-(print)
WELL CON'ru kCTOR COMPANY NAME `E-p I / /. CERTIFICATION p�s'
STATE WELL CONSTRUCTION PERMIT# 7"-` (�Jt 1- �PHONE A59-Ry?4L_
(if:lpplicablel ASSOCIATED WQ PERMIT#
(ifa plicable)
1. WELL USE(Check Applicable Box):Residential Municipal/Public ElIndustrial ❑ Agricultural ❑
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other,List Use
?. WELL LOCATION: /Nearest Town: n� h¢, County 'i ToPogr c/Land setting
�-27- ) ORidge Slope ❑Valley OFlat
(­Iccl N Numbers.Conunumry,SubJmm sn,Lot No.,Zip Code) (check appropriate box)
Latitude/longitude of wP 11 location
3. OWNER:_ '� -Z .Pl 3S Address J42,
jC r t - f r .� (degrees/minu �s/+ezonds)
// (Street or Route No.) Latin de/longitude source:CfGPSOTopographic snap
70(S2Shoe WC, 2Sr71G2. (check box)
C state DEPTH DRILLING LOG
( ) ry�90 5/ ( (o p Code From To
„t on Description
Formation Area code-Phone number C/ — /S'
4. DATE DRILLED 5. TOTAL DEPTH:___
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO L� -S� ^ n — 4,�,a lye
7. STATIC WATER LEVEL Below Top of Casing:
FT.
8. TOP OF CASING IS�_ (Use•+^if Above Top of Casing) —_
FT.Above Land Surface+ -- -- --
`Top of curing terminated at/or below land surface requires a
variance in accord once with I5A NCAC IC.01I g. --'
9. YIELD (gpm): /.)`/ METHOD OF TEST
10.WATER ZONES(depth):_��� — S w 9
11. DISINFECTION:Type !'l7/0�'irtlC LOCATION
t 7. CASING: �---- Amount 4�? Show direction and distance in miles from at least
Depth
Wall Thickness two State Roads or County Roads.Include the road
Fro Diameter or Weight/Ft. a[enal numbers and common road names.
m
From Ft.� "ifS
From To Ft. f 1
13. GROUT: Depth ill,, /r°t
From Material MethodTom FLU 407` A d o-;1
From To Ft.�_ �L]]//��
14. SCREEN: Depth Diameter Slot Size
From To Material
Ft. in. f l
From To in. C
15. SAND/GRAVEL PACK: PI it]' u1. 1
Depth Ln
From Size Material s,
From To Ft. �— to .
to. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH ISA NCAC 2C,WELL
CONSTRUCTION STANDARDS,AND THAT
Y OF TH[S RECO}�H S PROVIDED TO THE WELL OWNER
SIGNATO OF YI-Xsum CON nUL
THE WELL Z�
DAT
Submit the original to the Division Of Witter-Quality,Groundwater Secho-
27699.1636 Phone No.[phone],within 30 days, C696 1Yillil" dice Center-Raleigh,NC
GW-I REV.07/2001
I _„ 29

WELL CONSTRUCTION RECORD
North Carolina-Department of Environment andjbLuliral Resources-Divist of Water Quality-Groundwater Section
WELL CONTRACTOR(INDIVIDUAL)NAME�(print)
WELL CUNTIL\CTOR COMPANY NAME IFAa� I �y�p CERTIFICATION#�
STATE WELL CONSTRUCTION PERMIT# `BUJ' "'+'(ter PHONE 4,—
(ir applicable) ASSOCIATED WQ PERMIT#
— / (ifa plicable)
I. WELL USE(Check Applicable Box):Residential Ld� 011111111111111
l�
Monitoring ❑ Recovery ❑ Heat Pump Water Injectionn❑tpa Other t❑ IfOther,str List Use Agricultural ❑
2. WELL LOCATION:
Nearest Town: ) County r ire d2 TOpo_�� /Land setting
�.35--�._C�7 .. r l7Ridge C, )pe ❑Valley OFlat
(Street Name,Numbers,Community,Subdivision,Lot No (check appropriate box)
.,Zip Code) La
tirude/longitude of well location
3. OWNER- 'n/ 71 f- n .A'/ I2 F
Address vI CJ —^T----"is- —' ,?,4�LrL6�l���
O (degmes/minutes/ onds)
(Street or Roue No.) Latitude/longitude source: PS❑Topographic map
� ar TowAN /} �fizzg (check box)
Cary rTown State DEPTH DRILLING LOG
l Zip Code From To
Formation�Description
Area code-Phone number _ �� y
5. DATE DRILLED
5. TOTAL DEPTH:_
6. DOES WELL REPLACE EXISTING WELL'? YES ❑ NO 0,/ �s 7. STATIC WATER LEVEL Below Top of Casing: FT
.
S. TOP OF CASING IS — (Use' if Above Top of Casing)
FT.Above Land Surface* -- --__'Top of casing terminated at/or below land surface requires a
variance in accordmree with 15.A NCAC 2C.0118. —'--
9. YIELD (.TIT,): &r, METHOD OF TEST _ q �-
10. WATER ZONES (depth): Cam® t
11. DISINFECTION:Type ('h/pay z LOCATIO_ N SSKETCH1L. CASING: Amount---F Show direction and distance in miles from at least
Depth
Wall Thickness two State Roads or County Roads.Include the road
From Diameter or Weight/Ft. Material numbers and common road names.
m
Fro fo 65 F[. few �5 yC
To Ft. //
From To Fr.
13. GROUT: Depth �3�
From,_ Material Method /
To-.��FFr.r.� 'jlC ve—d.OI A/ CO"t f
From To —� -- _.
14. SCREEN: Depth O `
From ToP Diameter Slot Size Material tT1
Fr m. n
From To in. t
15. SAND/GRAVEL PACK: Ft tn. in. cn
From To Ft.
Depth Size Material c-n
From 7.0 Ft -------
.
l6. REMARKS:
I DO IiEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C,WELL
CONSTRUCTION STANDARDS,AND THAT A COPY OF HIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
SIGN RE F PER N STRUCT[NG THE WELL
27699 Submit the original t the Division of Water Quality,Groundwater Section, 1636 Mail Service Center-Raleigh,NC
276Y9-16315 Phone No.(9I9)733-3221, within 30 days.
GW-I REV.07J2001
29

WELL CONSTRUCTION RECORD
North Carolina-Department of Environment and ral Resources-Divisi of Water Quality-Groundwater Section
WELL CONTRACTOR(INDIVIDUAL)NAM/E (print) CERTIFICATION pQJuUrt
WELL CONTRACTORCOMPANY NAME r .i -<92AI !S Om Mp / / PHONE&=!5$?'S 4—
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicablel (if applicable)
1. WELL USE(Check Applicable Box):Residential - Municipal/Public ❑ Industrial ❑ Agricultural ❑
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other,List Use
2. WELL LOCATION,
Nearest Town: &CL1,41YI Topographic/Landsetting
-- �� County Ci` .O [:]Ridge ❑Slope ❑Valley 9F'la[
S (check appropriate box)
(Street Nome,Numbers,Community,Subdivision,Lot No.,Zip Code) L itudl;/lon nude o� 11 location
3.,JWNER
Address . E t (deg ea/ s/s ��ds)
(Scree[or Rout No 4* Latirude/longitudesource:15 PS❑To pographic map
J (check box)
DEPTYI DRILLING LOG
Qry or Town State Zip Code From To Formation Description
6A0-- ldq 3_ )3--9 __
Area code-Phone number
4. DATE DRILLED­
5. TO T AL DEPTH: S �j /
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO Q `
7. STATIC WATER LEVEL Below Top of Casing: a FT.
(Use"+"if Above Top of Casing)
S. TOP OF CASING IS FT.Above Land Surface'
*Top of casin;terminated actor below land surface requires a
variance in accordance with 15.4 NCAC 1Ga118.
9. YIELD(gpm): l�/1 METHOD OF TEST-21
10.WATER ZONES (depth): ;�/ )S
LOCATION SKETCH
11. DISINFECTION:Type VC Amount //a, Show direction and distance in miles from at least
12. CASING: Wall Thickness two State Roads or County Roads.Include the road
Depth piameter or Weighr/Ft. Material numbers and common road names.
From Ft.
From To Ft. 71 W Lf*
From To Ft.
13. GROUT: Depth Material lIG Method ndt/SohJt��r /'" C _
From_, To�Q FL l ]Yv.
From To Ft.
14. SCREEN: Depth Diameter Slot Size Material
From To Fr. in, in. A
From To Ft. in.
15. SAND/GRAVEL PACK:
Depth Size Material p
From To Ft. L n i
Front To Ft.
16. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C,WELL
CONSTRUCTION STANDARDS,AND TH T A COPY OF THIS JECORD HAS BEEN PROVIDED TO THE WELL OWNER -
IGNATU OF MRSON CONSTRUCTINGTHE WELL D TE
Submit the original to the Division of Water Quality,Groundwater Section, 1636 Mail Service Center-Raleigh,NC
27699-1636 Phone No.[phone], within 30 days. - GW-1 REV.07/2001

WELL CONSTRUCTION RECORD
North Carolina-Department of Environment and ral Resources-Divisi of Water Quality-Groundwater Section
WELL CONTRACTOR(INDIVIDUAL)NAME (print) ' ' ' ^ CERTIFICATION 0 022
WELL CONTRACTOR COMPANY NAME O 1 r��L ,t_I yHONE(,i�,.Z.S 9-ETI r,­
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if op"
licablel
(ifa plicable)
I. WELL USE(Check Applicable Box):Residential Mimicipal[Public ❑ Industrial ❑ Agricultural ❑ -
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other,List Use
2. WELL LOCATION:
Topographic/Land setting
Nearest Town: y Count t! /` ❑Ridge ❑Slope ❑Valley G}Plat
arU'S �r
(check appropriate box)
(Sneer Name,Numbers,Coinmuniry,Subdivision,Lot No.,Zip Code) Latitudellongirude of well location
3. OWNER: �i—tUeA/ {�,(///� t (degreeslminutes/ ponds)
Address �FJS yy ['/��Z_y'e P Latitude/longitude source:20PS❑Topographic map
(Sueer or Route No.) (check box)
SisNV•��lo 1'1C �tf79�- DEPTH DRILLING LOG
City orTown Scam Zip Code From To Formation Description
Cal-t293--!n_ 5-2 _t'L_
Area code-Phone number
4. DATE DRILLED
i. TOTAL DEPTH: .YAY
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO Q"
7. STATIC WATER LEVEL Below Top of Casing: 4;2 _FT.
(Use"+"if Above Top of Casing)
S. TOP OF CASING IS FT.Above Land Surface*
-Top of casing terminated actor below land surface requires a
variance gini): m5 with ISA NCACD .O1 18.
T
9. YIELD (o*pm):_,� METHOD OF TEST '
10.WATER ZONES (depth): I V z 20
LOCATION SKETCH
11. DISINFECTION:Type P U{ Amoun[ 9 3— 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 WeighdFt. Material numbers and common road names.
From-0 To U% Fr. &,a5 24,162 6' l
- From To Ft.
Prom To Ft.
13. GROUT: DepthMaterial Method
From_, To, Q Ft. 2
From To Ft.
14. SCREEN: Depth Diameter Slot Size Material C�
From To Ft. in. in.
From To Ft. in. in. 1 1i
U. SAND/GRAVEL PACK:
Depth Size Material
From To FL colt
From To Fr
16. REMARKS:
I DO IIEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C,WELL _
CONSTRUCTION STANDARDS,AND HA COPY OF THIS CORD HAS BEEN PROVIDED TO THE WELL OWNER
/V $ lA5
SIG ATURE PERS NC STRUCTING THE.WELL /DATE
Submit the original to the Division of Water Quality,Groundwater Section, 1636 Mail Service Center-Raleigh,NC
27699-1636 Phone No.[phone], within 30 days. GW-I REV.07/2001

F P -
WELL CONSTRUCTION RECORD
North Carolina-Department of Environment and [ral Resources-Df Water Quality-Groundwater Section /,
WELL CONTRACTOR(INDIVIDUAL)NAM E (print), I ivisi o CERTIFICATION#1201;,Q0
WELL CONTRACTOR COMPANY NAME t-EPR Lr. PHONE
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(ifapplicablO (ifa plicablel
1. WELL USE(Check Applicable Box):Residential Municipal/Public ❑ Industrial ❑ Agricultural ❑
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other,List Use
?. WELL LOCATION:
I Topogra 'c/Land setting
Nearest Town: Z Jf CO/I f Al County
7Y( pg C1'4 t ❑Ridge lope ❑Valley ❑Flat
�=t--� / �- �A j / (check appropriate box)
(Street Name,Numbers,Community,Subdivision,Lot No.,Zip Code) Latirude/I I itude of t ell location
//t ' S o t o (o �l37
3. OWNER: /1�tPn� GyI�F, (degre0fiiin slseccnds)
Address 4) _( r SiLatitudellongitude source:❑GPS❑Topographic map
T (Sneer or Route Not (check box)
Ilc tJ u DEPTH DRILLING LOG
City or Town State q Zip Code From To Formation Description
4)- '�t�l Z
Atea code-Phane number �xi�ldS✓l'K(.r{
4. DATE DRILLED '74100D R7 U2 ,2, Fr
5. TOTAL DEPTH: 7b5"
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO 0
7. STATIC WATER LEVEL Below Top of Casing:VFT.
(Use"+"if Above Top of Casing)
S. TOP OF CASING IS FT.Above Land Surface*
'Top of casing terminated at/or below land surface requires a
vat IELDe in accordance with UA NCAOD2C.01
OF T ��rrpp�N.t_a^ �.�
9. YIELD(gpm):�_METHOD OF TEST} '
10.WATER ZONES (depth): G
LOCATION SKETCH
11. DISINFECTION:Type Amount /hoe— Show direction and distance in miles from at least
h. CASING: Wall Thickness two State Roads or County Roads.Include the road
Depth Diameter or Weight/Ft. Material numbers and common road names.
Sol Fr. �lS Z LLJ, 5 Pt 5Odz
From To Ft.
Front To Ft. 7�,5 `�(+ .,Q_/�. ^,Q PY24.u.
13. GROUT: Depth Material Method
From_()_To m Ft. � t P 1� 2t'r fro/✓, g- N
Front To Ft. --
14. SCREEN: Depth Diameter Slot Size Material C�
From To Ft. in. in. "t -
From To Ft. in. in. t
15. SAND/GRAVEL PACK: 0% _
Depth Size Material O
From To Ft.
From To
Ft
t
16. REMARKS:
1 DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C,WELL
CONSTRUCTION STANDARDS, AND THAT A CO Y OF T CO .BEEN PROVIDED TO THE WELL OWNER
SIGNAT OF PERS N INSTRUCTING THE WELL DAT
Submit the original to the Division of Water Quality,Groundwater Section, 1636 Mail Service Center-Raleigh,NC .-
27699-163a Phone No.[phone],within 30 days. .. GW-I REV.07/2001

WELL CONSTRUCTION RECORD
Noah Carolina-Department of Environment and ral Resources-Divisi of Water Quality-Groundwater Section ��� ('�WELL CONTRACTOR(INDIVIDUAL)NAME (print) L,dL,J/.6,L(� CERTIFICATION Nala A
WELL CONTRACTOR COMp.SNV NAMES s� ��PHONE ,a59-S�Iq�
STATE WELL CONSTRUCTION PERMIT% J ASSOCIATED WQ PERMIT%
(if applicable) (if plicablel
1. WELL USE(Check Applicable Box):Residential Municipal/Public ❑ Industrial ❑ Agricultural ❑
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other If Other,List Use
_. WELL LOCATION: � JY -5h&) T�pographic/Land setting
Nearest Town: /' County tit idge ❑Slope ❑Valley ❑Flat
' -�S (check appropriate box)
(Street Name,Numbers, amnunity,Subdivision,Lot No.,Zip Code) Latitude/1mlgitude of w 11 location
Az
3. OWNER: 1^ —t.'/'G4Cl�!/ (degrees/minute��leEconds) y�
Address �S/S' �rf-h-r'� Jo„ ( ( Latirude/longiNde sotuce:9;GPS❑Topographic map
'' II (Street or Rowe No.) (check box)
-k+r�r f-%nW \J-li r Yl r �.Q 9 '1 DEPTH DRILLING LOG
City or Town State Zip Code From To FotmatiV,tDescription
�l-_� &K-Dtl7 9 Ill ^ S Ll,n7t
Area code-Phone number � i
4. DATE DRILLED 7/l
5. TOTAL DEPTH: S
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO Q
7. STATIC WATER LEVEL Below Top of Casing:,S'il _FT.
(Use"+"if Above Top of Casing)
8. TOP OF CASING IS FT.Above Land Surface'
'Top of casing terminated at/or below land surface requires a
variance m accordau•e with I5 k NCAC 2C.0118.
9. YIELD (,Tin): METHOD OF TEST - 'q
10.WATER ZONES (depth): Sao ` J
LOCATION SKETCH
11. DISINFECTION:Type Amount /&z-. 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.
From6L'Co 11 Ft.�//
- From To Ft.
From To Ft. dsQ.Ir50/1�y?1��� I�C
13. GROUT: Depth Material�� Method �Y1
From. 0 To_. Ft.
From To FL _
14. SCREEN: Depth Diameter Slot Size Material
From To Ft.
_in. in, ti'Tt
From To n
Ft. in. in.
15. SAND/GRAV EL PACK: �t
Depth Size - Material
From To Ft.
S
From To Fc.
S.
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 I REC RD HAS BEEN PROVIDED TO THE WELL OWNER
SIG RE 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

O
WELL CONSTRUCTION RECORD V
Noah Carolina- Department of Environment and X tral Resources-Divisi of Water Quality-Groundwater Section �� ('�
WELL CONTRACTOR(IN DM DUAL)NAME (print) CERTIFICATION# J(�y�ry /Q
WELL CONTfi kCTOR COMPANY NAME E-150 /6 lC / ' /IN D PHONE",a5 Q-d4q rp_
STATE WELL CONSTRUCTION PERMIT# J ASSOCIATED WQ PERMIT#
(ifapplicable) (ifa plicable)
1. WELL USE(Check Applicable Box):Residential Municipal/Public ❑ Industrial ❑ Agricultural ❑ -
Monitoring ❑ Recovery ❑ Heat Pump Water Injection
n ❑ Other ❑ If Other,List Use
?. WELL LOCATION: �� TopograhcE/Land setting
Nearest Town: e 'tilvt ' /o0u/Uty �' �✓ ❑Ridge p'S'lope OValley ❑Flat
—�$ h ,/ti ) /` 7.(1 (LA/ (check appropriate box)
(Sneer Name,Numbers,Community,Subdivision,Lot No.,Zip Code) ,�/Latitude/lon rude of,well location
3. OWNER: 1 /+� 3.S°/��fPV �i 117g `Z,D� '37'
(degrees/minu asl�� —
Address (o 4 T e.�c-D f— Latitude/longitude source:GOPS❑Topographic trap
(S[ree[or Route No.) (check box)
DEPTH DRILLINGLOG
City or Town
QY) (09 [ate Zip Code From To Formation Description
3-�197� y
Area code-Phone number SS S 546t0 S d•y�C
4. DATE DRILLED 71(V S .h-
K"
5. TOTAL DEPTH: S S / /�[�CL7S Cn''•z'/� ,�
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO Q
7. STATIC WATER LEVEL Below Top of Casing:­­",2�1 ­—FT.
(Use"+"if Above Top of Casing)
S. TOP OF CASING IS FT.Above Land Surface*
'Top of casing terminated at/or below land surface requires a
variance in accordance with 15A NCAC 2C.0118.
9. YIELD (gpm): METHOD OF TEST 'q
10.WATER ZONES(depth): 2SU J
LOCATION SKETCH
11. DISINFECTION:Type 0/�irt Amount Z& z Show direction and distance in miles from at least
12. CASING Wall Thickness two State Roads or County Roads.Include the road
Depth Diameter or Weight/Ft. Material numbers and common road names.
From To kd Ft.�0 a� � /eA 9 / LrV .
. - From To Ft. q 6
From To Ft. \ (S ©/'vv '.t
13. GROUT: Depth n Material Method 't� 0
From (Z_To a Q Ft.t D/ OF, i d 4 ,�
From To Ft.
t
14. SCREEN: Depth Diameter Slot Size Material S
From To Ft. in, in. O
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Size Material -
From To Ft.
From To Ft.
16. REMARKS:
1 DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C,WELL
CONSTRUCTION STANDARDS,AND THAT COPY OF THIS�OHAS BEEN PROVIDED TO THE WELL OWNER
fir/ , //� 7h�c//S
St NAT �R OFSON NSTRUCTINOTHE WELL OAT
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

WELL CONSTRUCTION RECORD
North Carolina-Department of Environment and ral Resources-Divisi of Water Quality-Groundwater Section
WELL CONTRACTOR(INDIVIDUAL)NAME (print
yr—^M CERTIFICATION#
WELL CONTRACTOR COMPANY NAh1EJ I PHONE - 59-5494L-
STATE WELL CONSTRUCTION PERMIT# J ASSOCIATED WQ PERMIT#
(if applicable) (ifa plicable)
I. WELL USE(Check Applicable Box):Residential Municipal/Public ❑ Industrial ❑ Agricultural ❑ -
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other,List Use
2. WELL LOCATION,. // I Topograp4WI,and setting
Nearest Town: wit/f1gjwt& le county / jt� ❑Ridge BSIoope ❑Valley ❑Flat
X�t�K l i441AI ��7'e (check appropriate box)
(Street Name,Numbe ,Cmmnunity,Subdivision,Lot No.,Zip Code) Latitude/longitude of well I cation p
3. OWNER: (degree minutes/ nds)
Address Latitude/longitude.source:136TSOTopographic map
1 (Sneer or Rome No.) (check box)
OI _",S 0/Vf/f*jle- IV(- aqw 2- DEPT14 DRILLING LOG
City or Town State Zip Code From To Formation Description
$!;Z)- (Q93- LeR76
Area code-Phone number Y�
4. DATE DRIL).FD r/11Z1A S _
5. TOTAL DEPTH: J t/yS, _ZS �
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO 0-�-
7. STATIC WATER LEVEL Below Top of Casing: 7,0 _FT.
(Use"+"if Above Top of Casing)
3. TOP OF CASING IS�_FT.Above Land Surface*
*Top ofeasing terminated at/or below land surface requires a
variance in accordance th 15A NCAC 2C.0118.
9. YIELD(gpm): METHOD OF TESTT -RI
10.WATER ZONES(depth): /�. (�O; 2/19
LOCATION SKETCH
11. DISINFECTION:Type A WC Amount �OL Show direction and distance in miles from at least
12. CASING: Wall Thickness two State Roads or County Roads.Include the road
Depth Diameter- or Wei ht/Ft. Material numbers and common road names.
From Q To " FL, D5 Z/`. �S CS Al
- From - To FL
From To Ft.
UT:
13. GROUT: Depth /� Material Method / b (•
From 0 To ,[Z Ft. l ' , EF g
From To F[.
14. SCREEN: Depth Diameter Slot Size Material 7
Frain To Ft. in. in. I
From To Ft. in. in. c-n _
15. SAND/GRAVEL PACK: p
Depth Size Material Ln
From To Ft.
From To FL -_
16. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C,WELL
CONSTRUCTION STANDARDS,AND THAT A COPY OF THI$�RE O EN PROVIDED TO THE WELL OWNER
aalttto/J�/��/// 9�Z/D
Ir
SIGNXTUr OF PERSON-CONSTRUCTING THE WELL DAT -
Submit the original to the Division of Water Quality, PonndwaterSectloti, [036141a1LSer`vice Center-Raleigh,NC v
27699-1636 Phone No.[phone],within 30 days. i j i - -- -- -- GW-1 REV.07/2001 - -
1'� O
L
I

WELL CONSTRUCTION RECORD
North Carolina-Department of Environment and ral Resources-Divisi of Water Quality-Groundwater Section
POWELL CONTRACTOR(IN DIViDU.4L)NAME (print) CERTIFICATION# 1^
WELL CONTRACTOR COMPANY NAME ai5( 0�) ftiLAQP. PHONE NSItB,4S 9'
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(ifapplicable) (ifa plicable)
1. WELL USE(Check Applicable Box):Residential MunicipaVPublic ❑ Industrial ❑ Agriculrural ❑
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other,List Use
2. WELL LOCATION: y / pographic/Land setting
Nearest Town: Count f�zCf't/rs�'—aU� f3Mdge ❑Slope ❑Valley ❑Flat
5" (check appropriate box)
(Street Name,Numbers,Community,Subdivision,Lot No.,Zip Code) i atitude/longitude of well}°,cattiion
p / /V� a 3/r t1[���6!3. OWNER: - /l /4W p/i/t0'. (degrees/minutes/s nds)
Address ���T' �/I /l� iv L> Latirude/longitudesources PS❑Topographic trap
I • (Sneer or Route No.) (check box)
�aI r'Cbrr i; JY C- A279(b DEPTH DRILLING LOG
City or Town State Zip Code From To Formation Description
Yam°)- a v3- y sss o
Area code-Phone number
4. DATE DRILLED 91fh 1Z
S/ —S!� c
5. TOTA r LDEPTH: 6.S 'Y'_ Ski
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO ��
7. STAT IC WATER LEVEL Below Top of Casing:_W FT.
(Use"+"if Above Top of Casing)
8. TOP OF CASING IS�_FT.Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordance with 15A NCAC 2C.01 18.
9. YIELD(gpm): '_METHOD OF TEST 01
10.WATER ZONES(depth): A 00 " J
LOCATION SKETCH
11. DISINFECTION:Type ' Amount ?.,__ Show direction and distance in miles from at least
12. CASING: Wall Thickness two State Roads or County Roads.Include the road
Depth Diameter or Weight/Ft. Material numbers and common road names.
Front_ commonTo_. Ft. /.,�5 JJ(o./A.7 Q J
From_ To Fr
From_ To Ft. �/Q L� /�j �l7 /v/TN
13. GROUT: Depth Material Method
From__,0 To—aD Ft., " R Ei r14 ZI -C6OY t .4 C'
From_ To Ft. _
14. SCREEN: Depth Diameter Slot Size Material -From--To—Ft.—in. in. C7
Front_ To Ft. in. in. IC n _
15. SAND/GRAVEL PACK: t
Depth Size Material Ln _
From_ To Ft. C:) -
From_ To Ft.
-ca
lb. REMARKS: _y
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C,WELL
CONSTRUCTION STANDARDS,AND THAT A COPY
lOOF III REC Ri'fAS BEEN PROVIDED TOO THE
/JLWELL OWNER
A I RE F PERSON CONSTRUCTINGTHE WELL � IDATE
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

WELL CONSTRUCTION RECORD
Nonh Carolina-Department of Environment and rat Resources-Divisi of Water Quality-Groundwater Section �� (�
WELL CONTRACTOR(INDIVI➢UAL)NAM/EE(print) CERTIFICATION#(13jQ 1J
WELL CONTRACTOR COMPANY NAME D/JS PHONE QS9-Sc-{9�
STATE WELL CONSTRUCTION PERMIT# J 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: Topogr is/Land setting
Nearest Town: _County ❑Ridge lope ❑Valley ❑Flat
2 (check appropriate box)
(Street Name,Nunfbgrs,Community,Subdivision,Lot No.,Zip Code) LL Latitude/longirude of well catiotl
3. OWNER: _ TDNCEY'A [A/ 'i- 1.(ln yif� l7�t ai3/10 � �/
(degree mrnute�y/ conds)
Address e->G. 3CG�.— Losi. gSa I� atilude/longitude source:�GPS❑Topographic map
S3 Streai or Route NoJ ��Vt'�/� (check box)
nd t I:If& R'79 a DEPTH DRILLINGLOG
City or Town State Zip Code From To Formation Description
Area code-Phone number / ;Lf
4. DATE DRILLED .ZUQ� 41 _ M Mtn.,-
5. TOTAL DEPTH
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO Er
7. STATIC WATER LEVEL Below Top of Casing:Z_FT.
(Use"+"if Above Top of Casing)
S. TOP OF CASING IS FT.Above Land Surface"
'Top of casing terminated attor below land surface requires a -
variance in accordance with 13A NCAC 2C.0118.
9. YIELD(gpm):_A _METHOD OF TEST'AIat is
10.WATER ZONES (depth): 74 l J
/� � LOCATION SKETCH
11. DISINFECTION:Type Amount-- '— Show direction and distance in miles from at least
12. CASING: Wall Thickness two State Roads or County Roads.Include the road
Depth Diameter or Wei ht/Ft. Material numbers and common road names.
From_ To__Y5 Ft. kS 2AL11U /flrrryi11
- From To Ft
From To Ft
13. GROUT: Depth Material Method
From__To n 0 Ft.0�(i-r-�e
From To Ft. T
14. SCREEN: Depth Diameter Slot Size Material d
From To Ft. in. in. crn"a
From To Ft. in. in. t
15. SAND/GRAVL-LPACK: Ln
Depth Size Material
From To Ft. Lill
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 0 HAS BEEN PROVIDED TO THE WELL OWNER
S NA U OF P94R�M0ZN'CO1,TSTRUQTrNG 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 U ry
WELL CONSTRUCTION RECORD
North Carolina-Department of Environment and at Resources-Divisi )f Water Quality-Groundwater Section /t
WELL CONTRACTOR(INDIVIDUAL)NAME (print) CERTIFICATION#,w
WELL CONTRACTOR COMPANY NAME D I 1 WAII PHONE 0=459-SaW
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMrr#
(if applicable) �� (if applicable)
1. WELL USE(Check Applicable Box):Residential 13 Municipal/Public ❑ Industrial ❑ Agricultural ❑
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other,List Use
?. WELL LOCATION: t Topographic/Land setting
Nearest Town: County Ale, tr ✓ ❑Ridge ❑Slope ❑Valley ❑Flat
K /2 (check appropriate box)
(Street Name,Numbers,Community,Subdivision,Lot No.,Zip Code) Latimde/longimde Of well location
3. OWNER:_ /J(• .G. ��/�6,t9�� tC (degrees/min ea/seconds)
Address /S y �".i.�,ys7 i-a Latitude/longitude source:❑GPS❑Topographic map
(Scree[or Route No.) (check box)
�lc>�C-�Jr•i /Y :2 ?7 1 DEPTH DRILLING LOG
C.CityorTown ASuite Zip Code From To Formation Description
Area code-Phone number
4. DATE DRILLED
lI J
5. TOTAL DEPTH: r 35S /fig — g S GY3tsL`6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO
7. STATIC WATER LEVEL Below Top of Casing:�QP. _FT.
(Use"+"if Above Top of Casing)
8. TOP OF CASING IS�_FT.Above Land Surface'
'Tap of casing terminated actor below land surface requires a
variance in accordance th 15A NCAC 2C.6118. rrpp�
9. YIELD(gpm): METHOD OF TEST-2 - '
10.WATER ZONES(depth): 2/D!
LOCATION SKETCH
11. DISINFECTION:Type Cl•1/94&, C Amount 3 0g,- 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 D To 124r Ft. /.-A$ Zffg s &/CSDeAl / p
From To Ft. �Olt/S I Lew
Front To Ft. �Ca
13. GROUT: Depth Material Method
From�To��I,DFL 'Zy.,,,Q;aa,
From To FL_
14. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in.
From To Ft. in. in. [�
15. SAND/GRAVEL PACK: t-rl
Depth Size Material n
From To Ft. t -
Ln
From To Ft. _
t:
16. REMARKS:
(J1
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C,WELL
CONSTRUCTION STANDARDS,AND THAT A COPY OF THIS RWORD HAS BEEN PROVIDED TO THE WELL OWNER
SIGNA U OF PERSON ONSTRUCTI#JG.'FHF WELL
Submit the original to the Division of Water Quality,Groundwater Section, 1636 Mail Service Center-Raleigh,NC
27699-1636 Phone No.[phone],within 30 days. GW-1 REV.07/2001
i
i

WELL CONSTRUCTION RECORD
North Carolina- Department of Environment and rat Resources-Divisi of Water Quality-Groundwater Section �� (''
WELL CONTRACTOR(INDIVIDUAL)NAME (print) CERTIFICATION#�l[Qi�
WELL CONTRACTOR COMPANY NAME ({�Q t�
��ff PHONE - .'iS 9-�( ]�
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
MWOMMI.(if applicable)
� (ifapplicable)
1. WELL USE(Check Applicable Box):Residential O' Municipal/Public ❑ Industrial ❑ Agricultural ❑
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other,List Use
2. WELL
LOCATION-
Nearest_
Town:
( Topographic/Land sett ingCounty to g 4l ❑Ridge ❑Slope ❑Valley
a
(oI�) . �
(check appropriate box)
(Street Name,Numbers,Community,Subdivision,Lot No.,Zip Code) Latiwde/longitude Of W l location
3. OWNER: Al
20
�Address (degrees/minu syseconds)
— e!S— Latitude/longitude source:OL pS❑Topographic map
(Scree[or Route No.) (check box)
/"ZC 'aIC i /YG :2 9-7 3 a DEPTH DRILLING LOG
City or Town Sate Zip Code From To Formation Description
?9 R-e>a 0 -Area code-Phone number
4. DATE DRILLED {
5. TOTAL DEPTH:_ 1 3 5'S a•S— :TO .�m
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO e� Z7 3f/S _ "�' e
7. STATIC WATER LEVEL Below Top of Casing: Z-oQ_FT.
(Use"+"if Above Top of Casing)
8. TOP OF CASING IS�_FT.Above Land Surface`
*Top of casing terminated at/or below land surface requires a
variance in accordance with ISA NCAC 2C.0118.
9. YIELD(,pm): I.S_METHOD OF TEST110l idl
10.WATER ZONES(depth): 2 f/D— 3 Q J
LOCATION SKETCH •
11. DISINFECTION:Type ^ Amount LOCATION
Show direction and distance in miles from at least
12. CASING: Wall Thickness two State Roads or County Roads.Include the road
Depth Diameter or Weight/Ft. Material numbers and common road names.
From__To_17—Ft.-,(I,2,.J ./ I,�,,//
From To Ft.
From To Ft.
13. GROUT: Depth Material Method '
From To-ajZ Ft.�(j �
From To Ft.
14. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in i• n -
From To t
Ft. in. in. ut
U. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft. - --'i
p»
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 HIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
zU OS
C�y1 ATURE OF P SON£QNS7UCTINGTHE_WE_LL ___ DATE
Submit the original to the Division of Water Quality,Gr undwatee Section, 1636 Mail Service Center-Raleigh,NC
27699.1636 Phone No.[phone], within 30 days. GW-I REV.072001
l � '

WELL CONSTRUCTION RECORD 33 4733
North Carolina Department of Environment and Natural Resources-Division of Water Quality
WELL CONTRACTOR(INDIVIDUAL)NAME (print) Nlthony Bryant Smith CERTIFICATION 0 2571
WELL CONTRACTOR COMPANY NAME (+Ilsori RNar WON&Pump Company PHONE X 693.1200
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
if applicable) if applicable)
1. WELL USE(Check Applicable Box):Residential Municipal/Public❑ Industrial ❑ Agricultural❑
Monitoring❑ Recovery O Heat Pump Water Injection❑ Other❑ If Other,List Use
2. WELL LOCATION: h I Topographic/Land setting
INeaarrest Town: F el County 44t& 'SD 61�dge ❑Slope OVaUcy ❑Flat
wfS bloorain4 Xdupej (check appropriate box)
(Street Name,Nambm,Cdootaunity,Subdivision,Lot No.,Zip Code) Lafi-, e/longitude of well kcatign
3. OWNER: 00A SUM%JRAL (degreWminuwheconds)
Address )IlT wi,000 Y Latitude/longitude source:36PSOTopographic reap
(Street or Nock box)
`�-C.rO�.Q I o i Roust,to)kl C ZN gge, DEPTH (ch DRILLING LOG
City or Town Slaw Zip From To Formation Q�eescription
> 49Z-a mx cane O 1 D A _ C 1, ,
Ames code-Phone number
4. DATE DRILLED 7�s 9�OS
3
5. TOTAL DEPTH: �z5 i `f 5_ S _ x 6. DOES WELL REPLACE EXISTING WELL? YES O NO 9� �iA
7. STATIC WATER LEVEL Below Top of Casing:_L!Ll�F"f. r
(Use"+"if Above Top of Casing)
S. TOP OF CASING IS�_FT.Above Land Surface'
-Top ofcasidg terminated sister below land surfm:requires a {
variance In aaardance with ISA NCAC 2C.01Is.
9. YIELD(gpm):(_METHOD OF TEST_
10. WATER ZONES(depth): 5 991 9
LOCATION SKETCH A
11. DISINFECTION:Type 7" Amount Show direction and distance in miles from at least
12. CASING: Wall Thickness two State Roads or County Roads.Include the road
Depth Dr�tneter or Weight/Ft. Material numbers and common road names.
From_To 3 5 Ft�-_ 774
/�✓L
From 3 5_ To �S— Ft.�( 2114 L✓[/_C_
From To Ft f>Oa-iced adlw7
13. GROUT: Depth Material Method
From JQ To_ZV Ft. 3,f,67stfec A(, TLC
From To Ft C o
14. SCREEN: Depth Diameter Slot Size Material
From To Ft in. in. t !'
From—To—Ft--mi . in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft. AV
16. REMARKS:
I DO HERESY CERTIFY
AN THAT THIS WELL WAS CONS ACCORDANCE WITH I D NCAC 2C,WELL
CONSTRUCTION STANDARDS,AND THAT A COPY OF IS RECO HAS BEEN PROVIDED 1'O THE WELL OWNER
7--49-05--
SIGNATCRE OF PERSON CONSTRUCTING THE WELL DATE
Submit the original to the Division of Water Quality,Attn: loform(atiot>j Mahage(irent� i&17 MGiJ Spryrge Center-
Raleigh,NC 27699-1617, Phone No.[phone],within 30 days REV. 09/2004
i
i

3 J4893
WELL CONSTRUCTION RECORD
North Carolina-Department of Environment And Natural Resources-Division of Water Quality-Groundwater Section
WELL CONTRACTOR(INDIVIDUAL)NAME(print)RODNEY ROBBINS CERTIFICATION# 2785
WELL CONTRACTOR COMPANY NAME PITTMAN WELL BORING,LLC PHONE# (828I-453-0662
STATE WELL CONSTRUCTION PERMIT#_ ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
1. WELL USE(Check Applicable Box): Residential N Municipal/Public El Industrial Agricultural
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other,List Use_
2. WELL LOCATION:
Nearest Town: SALUDA County REND Topographic/Land setting
SOUTH CRESENT DR ❑Ridge ❑ Slope ❑Valley ❑Flat
(Street Name,Numbers,Community,Subdivision,Lot No.,Zip Code) (check appropriate box)
3.OWNER:KEITH RUSSELL Latitude/longitude of well location
Address SOUTH CRESENT DR
(Street or Route No.) (degrees minutes/seconds)
SALUDA NC 28773 Latitude/longitude source: ❑ GPS ❑Topographic map
City or Town State Zip Code (check box)
M8J-778-2190 DEPTH
Area Code Phone number From To
4. DATE DRILLED 0719/05 _
5.TOTAL DEPTH: 405 DRILLING LOG
6. DOES WELL REPLACE EXISTING WELL? YES❑ NO® From To
7. STATIC WATER LEVEL Below Top of Casing: 8l1 Fr.
(Use"+"if Above Top of Casing) T-
8.TOP OF CASING IS 1-1/2 FT. Above Land Surface* LOCATION SKETCH
*Top of casing terminated at/or below land surface requires a Show direction and distance in stiles from at least
vanance in accordance with 15A NCAC 2C.0118. Two State Roads or County Roads. Include the road
9.YIELD(gpm): 4 METHOD OF TEST ARD number and common names
10.WATER ZONES(depth): I-26 W.OFF AT SALUDA EXrr.LEFT ON OZONE
11.DISINFECTION:Type CHLORYTE Amount 10.5 DR GO TO END.RT.ON 176.GO INTO TOWN.
12. CASING: Wall Thickness LEFT ON GREENVILLE RD.CROSS RR TRACKS.
Depth Diameter or Wall
Thickness
Material STAY STRAIGHT.TURNS INTO MTN.PAGE RD.
From 0 Depth
40 Ft Diameter
SDR21 PVC WHEN YOU GO INTO HENDERSON CTY.GO
From_To—Ft— APPROX.2 MH,E&RT.ON LAKE HOSEA RD.
From_To_Ft STAY RT.AT FORK RIGHT AROUND LAKE.
13. GROUT: Depth Material Method RIGHT ON SOUTH CRESENT DR 4 DR ON RT.
From 0 To 20 Ft.OUH{RETE POURED
From_To_Ft
14.SCREEN: Depth Diameter Slot Size Material }
From_To_Ft._ in in.
From_To_Ft._ in. in.
15. SAND/GRAVELPACK:
Depth Size Material r d3
From_To_Ft_
From_To_Ft_ o
Ln
16.REMARKS:
_.. -
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCOR—
DANCE WITH 15A NCAC 2C,WELL
CONS UCTION STANDARDS,AND THAT A COPY OF S RECORD HAS BEEN PROVIDED TO THE WELL OWNER
9 -Z)
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
Submit the original to the Division of Water Quality,Groundwater Section,1636 Mail Service Center-Raleigh,NC
27699-1636 Phone No. [phone],within 30 days. GW-1 REV.07/2001

WELL CONSTRUCTION RECORD
North Carolina-Department of Environment And Natural Resources-Division of Water Quality-Groundwater Section
WELL CONTRACTOR(INDIVIDUAL)NAME(print)RODNEY ROBBINS CERTIFICATION# 2785
WELL CONTRACTOR COMPANY NAME PITTMAN WELL BORING,LLC PHONE# [phone]
STATE WELL CONSTRUCTION PERMIT#_ ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
I. WELL USE(Check Applicable Box): Residential ® MunicipaUPublic Industrial 0 Agricultural
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other,List Use_
2. WELL LOCATION:
Nearest Town:HENDERSONVILLE County HEND Topographic/Land setting
SH VERGLEN WAY-LOT#39 ❑Ridge ❑ Slope ❑Valley ❑Flat
(Street Name,Numbers,Community,Subdivision,Lot No.,Zip Code) (check appropriate box)
3.OWNER: GORDON&DONNA DILKS Latitude/iongtaide of well location
Address SILVERGLEN WAY-LOT#39 _
(Street or Route No.) (degrees/minutes/seconds)
HENDERSONVILLE NC 28739 Latitude/longitude source: ❑GPS ❑Topographic map
City or Town State Zip Code (check box)
8( ZS)-674-8974 DEPTH
Area Code Phone number From To
4.DATE DRILLED 07/13/05 _
5.TOTAL DEPTH: 405 DRILLING LOG
6.DOES WELL REPLACE EXISTING WELL? YES❑ NO® From To
7. STATIC WATER LEVEL Below Top of Casing:—OFT.
(Use"+"if Above Top of Casing)
8.TOP OF CASING IS 1-1/2 FT. Above Land Surface* LOCATION SKETCH
*Top of casing terminated allor below land surface requires a Show direction and distance in miles from at least
variance in accordance with 15A NCAC 2C.0118. Two State Roads or County Roads. Include the road
9.YIELD(gpm): 0 METHOD OF TEST ARD number and common names
10.WATER ZONES(depth): HWY.#64/74A W.FROM LAKE LURE ON HWY.
11.DISINFECTION:Type CHLORYTE Amount 10.5 #64.APPROX.4 MILES.RT.ON SLICK ROCK RD.
CASING: Wall Thickness LEFT ON SILVERGLEN WAY.LOT#39 ON LEFT IN
12. Material CORNER OF EMERALD COVE&SILVERGLE
Depth Diameter or Weight/Ft.
WAY.
From 0 To 90 Ft 6-1/4" SDR21 PVC
From_To_Ft.
_
From_To_Ft 13.GROUT: Depth Material Method
From 0 To 20 Ft.Q1JUCRETE POURED _
From_To Ft
14.SCREEN: Depth Diameter Slot Size Material
From_To_Ft._ in. in. (.n -
From_To Ft._ in. in.
15.SAND/GRAVEL PACK:
Depth Size Material
From_To_Ft J Ai1G
From_To_Ft
16.REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C,WELL
CO CTION STANDARDS,AND THAT A COPY OF S RECORD HAS BEEN PROVIDED TO THE WELL OWNER
SIGNATURE OF PERSO CONSTR CTING 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

W 14886
WELL CONSTRUCTION RECORD
North Carolina-Department of Environment And Natural Resources-Division of Water Quality-Groundwater Section
WELL CONTRACTOR(INDIVIDUAL)NAME(print)RODNEY ROBBINS CERTIFICATION# 2785
WELL CONTRACTOR COMPANY NAME PITTMAN WELL BORING,LLC PHONE# f8281-453-0662
STATE WELL CONSTRUCTION PERMIT#_ ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
1. WELL USE(Check Applicable Box): Residential 2 Mumcipal/Public Industrial ❑ Agricultural El
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other,List Use_
2. WELL LOCATION:
Nearest Town:HENDERSONVILLE County HEND Topographic/Land setting
SILVERGLEN WAY-LOT#39 ❑Ridge ❑ Slope ❑valley ❑Flat
(Sheet Name,Numbers,Community,Subdivision,Lot No.,Zip Code) (check appropriate box)
3.OWNER:GORDON&DONNA DH KS Latitude/longitude of well location
Address SILVERGLEN WAY-LOT#39
(Street or Rome No.) (degrees/minutes/smonds)
HENDERSONVILLE NC 28739 Latitude/longitude source: ❑ GPS ❑Topographic map
City or Town State Zip Code (check box)
L8)-674-8974 DEPTH
Area Code Phone number From To
4.DATE DRILLED 07/14/05
5.TOTAL DEPTH: 425 DRILLING LOG
6.DOES WELL REPLACE EXISTING WELL? YES❑ NO® From To
7. STATIC WATER LEVEL Below Top of Casing: 60 Fr. _
(Use"+"if Above Top of Casing)
8.TOP OF CASING IS 1-1/2 FT. Above Land Surface' LOCATION SKETCH
*Top of casing terminated at/or below land surface requires a Show direction and distance in miles from at least
variance in accordance with 15A NCAC 2C.0118. Two State Roads or County Roads. Include the road
9.YIELD(gpm): 50 METHOD OF TEST ARD number and common names
10.WATER ZONES(depth): HWY.#64/74A W.FROM LAKE LURE LEFT ON
11.DISINFECTION:Type CHLORYTE Amount 11 HWY.#64.APPROX.4 MILES,RT.ON SLICK ROCK
RD.LEFT ON SILVERGLEN WAY.LOT#39 ON
12. CASING: Wall Thickness LEFT IN CORNER OF EMERALD COVE AND
Depth Diameter or Weight/Ft Material SILVERGLEN WAY.
From 0 To 100 Ft 6-114" SDR21 PVC
From_To_Ft_
From_To Ft. Ci
13.GROUT: Depth Material Method A
From 0 To 20 Ft.OUHMTE POURED
From_To Ft
14.SCREEN: Depth Diameter Slot Size Material r— -- -°
From_To_Ft._ is in. I `
From_To_Ft._ in in. --- --, Ul
15. SAND/GRAVEL PACK:
Depth Size Material o
From_To_Ft Lv j
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
e '�IUNATURE OF PERSON CONSTRUCTING THE WELL ATE
Submit the original to the Division of Water Quality,Groundwater Section,1636 Mail Service Center-Raleigh,NC
27699-1636 Phone No. [phone],within 30 days. GW-1 REV.07/2001

WELL CONSTRUCTION RECORD
North Caroline Department of Environment and Natural Resources- LTvaion of Water Qwhp
it El I ('ON"[RAC l OR(INDIVIDUAL)NAME (print) Bryant Smith _ CER IFI(At ION a 257-
I(I I.rO vl'KACrOR('OMiPANY NAME Careen River Well 8 Pump Company - PFlp�4 K 691i200
itv11 W ELT,CONS'CRUCHON PERMIT# _ASSOCIATED WQ PERMI'14 Q 1QU)Q��-
(if apph able) (it applicable)
WI(IA USE(Check Applicable Box): Residential Municipal/Rublic ❑ Industrial ❑ Agricultural ❑
:1,nuwnng ❑ Recoven ❑ Heat Pump Water Injection ❑ Other ❑ I I Other, I Isl I
,. I u( :A flON v 10 it ho Laud setting
ul esl lAlln -Ptif- U lie; Cow
u} ysdn ❑Rldgc Bzpe ❑valley ❑flat
2-LK ✓1/'�e al II'tie, to/1 9-r5 rKi (ehc,k appropnatc box)
in vcl me.Nw ben.Community,Sobdivuion,Lot No..Zip Code) Latllude/lont+llude of Well locanOn
�l(I: GuLlc�a� c I
VY4 d g e n,mutcn evconh)
.Iuress POBOY_ 22. _ I.nnindC/Ion iludc aloe— _- __ _ 65❑lbpogaiphil final.
Ilv'a ar Routr�No I ehwk tux)
� 1 tL1Q��Cz87 '1 -- - -- l"1t�0 nn 3Ltc I-( )(,m I
o I smt !i Coda Dru ,� Pormnuon Ucun nl
4f�S 71(0
i a od Phon number
) 1 ul�I l Ll� 4lglos (�_ 4�14 r4ZL
x it 5 WI I I RI PI.AC.E EXISIINU WELL.'. YES LY NO El
L
--
5
�.:\JK WAll-:RL WEL. Below To ol-Casin - --- -----""-
P g FL
(Use ',"if Above'I'op of Casing) - " -- -----
9
_ItP OF CASINO IS I Pl. Above Land Surface* ---- - --
lop of caring terminated aUor below land err face rega res a — ---.-- ----- - ------- �9
b accordance with 15A N('AC 2('.0118,
I11OU OF TEST
-
- - — IciNv�i�>Nsh, I-( trl --
� iINI I IIUN. I cpr__tJ"( Jf_ Amu(ml Shots duecUon uud distance m lades liontC ICn.�'
\SINU Wall 'thickness two State Roads or County Roads IncludoM- r iun
Depth Diameter ur WeigltUFt. Material numbers and common road nanies
11,_ it) 701 1. � �l P✓c,
70 t[a It
_ G_
il.l tl'T Ucpth Ma tie Mal MethuQ
-o--_ I Sa4Kkktj- - • aL Poo.-
1�
r ronl To Ft
kI'_I-.N Ihplh Diameter Slot Size Material
III O f I in tit
Deputy S¢- Materuil
111 - - -.I' __. Pt. S ..
s-
:i15; rli. IlYIIIAI IHISIALL1 WASC(,N h
I RUC I LI)IN ACCORDAN( I µ'11 'C WI:I.I.
-t. IIUN ^,ANDARI)S. qND lliAI A COPY -TEAS RECURD HAS lilI N PRub'Inl it lu I III. WI-I I. UR'NI k
L�/[���jf�' �J- 6 -9 -0 S
SIGN tlK 1RE OF PERSON CONS"1'R UC'I ING I III N I I I DA I I
lun lit il the origina] ni the Dis'ision of Water Qualih, Arun. Information-M ana gene it t-, lot-=Vvtl Service( sYt ter
Ica 1, h, xC 2-6)9-161". RhoneNu_(919)"33-7015,with in 30 dale
AUG 9 2W5 I_._.1''

WELL CONSTRUCTION RECORD
North Carolina De c*Department of Environment and Natural Resources-Division of Water Quality
WELL CONTRACTOR(INDIVIDUAL)NAME (print) Bryant Smith
WELL CONTRACTOR COMPANY NAME Green River Well B Pump Company CERTIFICATION#2571
S'1'A I'E W ELL CONSTRUCTION PERMIT# PHONE # [phone]
(if applicable) ASSOCIATED WQ PERMIT# C5l 0 o
(f applicable)
I WELL. USE(Check Applicable Box): Residential �Muuieipal/Public ❑ Industrial ❑ Agricultural ❑
Monitoring ❑ Recovery ❑ Heat Pump Water Injection❑ Other❑ If Other,List use
VItL1, LOCA I ION
Nearest-lown `�neyutikf- Coumty. 14.�.P.e�t.�son Topogra is/Land setting
1D��a r�tt k 6th il1Q L� Midge lope ❑Valle '
U y ❑slat
.Communrry,subdivision,Lot No.,Zip Code) (check appropriate box)
T La itud�e)/lo.ngilude of well location
OWNER:-Wed 1 /itY.»E. �11�rLL�ll c35 L`1( • Lit, ' A/ Ll`d z ' i�' Otd
Address 7-24O 1�Cf12nC10. 71tr (degrees/mantes/seconds)
1I . � (So-eer or Route No.) LantudeAongitude source:E3(!pS❑Topographic map
s0-no i 11'e ♦t 7 C t 1 DEPTH (check box)
h T Suite zip code DRILLING LOG
828 } /„4/ - ZO 3 3 From /To, Formation Description
:\tea code-Phone number —�-�f d Pi r 7-
a. DA'iF DRILLED C-' �— rJ _y_=�3�_- ,-
'IYJIAL DF.PTH:_�_ - O�
z Siii Z o
o DOFS WELL REPLACE EXISTING WELL? YES ❑ NO 2—
S I A I'IC W AI"ER LEVEL Below Top of Casing _ 20 FT.
S IUP OF CASING IS I (Use"' "if Above Top ofCasing)
FT. Above Land Surface-
-I rip nfcasing terminated at/or below land surface requires a
variance in accordance with 15A NCAC 2C.0118. _
YIHLD(gpin) 15 NE'l--IOD OF TEST- !4('t r- --
u W V LR ZONFS(depth): A 2 —
00
LUCAI ION SKEFCH
UISINFECFION-TyI 1e dY�� _ _
L' CASING ri 1 171 Ar6ount Show direction and distance in miles from at least
Wall Thickness two State Roads or County Roads. Include the road
Depth Dieter or Wei¢hVFt. Wterial numbers and common road names.
I rom To Ft.
lrrumToFt
Prum1i�_To CIVD Ft
GROUT: lY9 r"4
Depth Material Method C
Front d To_3_�Ft. S _L._�_�[_ C
t
Prom To Ft. �_ n
14 SCREEN: Depth Diameter Slot Size
Fnmi To Material ,
Ft._in. iin
n /1 n V
191�lfw'C' 1, <�
Prom To Ft._in_ —
i5 SA V
ND/GRAEL PACK. —_ m_ — �'� V
g�
Depth Size Material
Ih�um_ Tn Ft ;
I-ron' "fo Ft.
t it, KIfMARKS. �
dw IILREBT CER"I'II 1'THAT THIS WELL WAS CONSIRUCPED IN ACCORDANCE Wi l H 15A NCAC 2C, WFLI.
�('NS I RUC'HUN STANDARDS.AND"THAT A COPY L I HIS R'CORD HAS BEEN PROVIDL:D 10 THE WELL OWNER
--o _ t( 10 -6Q -
G AMU—RE OF PERSON CONSTRUCTING THE WELL, A
DATE
Submit the original to the Division of Water Quality, Attn: Information Management, 1617 Mail Service Center-
Raleigh,.NC 27699-1617, Phone No.[phone],within 30 days.
GW-1 REV_ 09/20(i4
_i t

WELL CONSTRUCTION RECORD V
North Carolina Department of Environment and Natural Resources- Division of Water Quality
W1,1,I.CON"FRAC'rOR(INDIVIDUAL)NAME (print) Bryant Smith CERTIFICATION#2571
WELL CONTRACTOR COMPANY NAME Green River Well&Pump Company PHONE # [phone]
SPATE WELL CONSTRUCTION PERMIT# ASSOCIATI9 WQ PERMIT# O 5I Z G I
(if applicable) (ifapplicable)
vA FLI. USE: (Check Applicable Box). Residential 2--�Municipal/Pubhc ❑ Industrial ❑ Agncultural ❑
Monaoruig ❑ Reeovery ❑ Heat Ptanp Water Injection ❑ Other❑ It Other, List Use"
WELL LOCAI ION Topographic/Land setting
Nearest Mown- o-nOltt<C County d-�,YSa7U ❑Ridge RSllope ❑Vallev ❑Flat
0E L o i.l S O kQ R C� J� Y'A 0 I S d7VU I I e. (check appropriate box)
(Sct,et Name,Numbers.Community,Subdivuioq IAt No.,Zip Code) Latitiijde/IoWitude f will',cal,)n
r J 3s�l )�!V Q�n�
I OWNER:SuSau_ LLEr' (degrees/mantes/seconds)
Address ?O Qov `No 3 Latitude/longirude source:❑GPS❑Topographic map
(Street or Route No) (check box)
DEPTH DRILLING LOG
City or Town sure _ Zip Code From To F onn lion Description
1828 )_ er-90 ' a(O 5 C�
�rca code-Phone number �5 __ 104.IL`
I DA'I F:DRILLED
i. "FOTAL DEPTH. ,:iLFSr
o. 1X)LS WELL REPLACE EXISTING WELL? YES O I O Er
7 5 rA I-IC WAFER LEVEL Below Top of Casing: eO FT.
(Use"+"if Above Top of Casing)
S FOP OF CASING IS FT. Above Land Surface-
I up of,.sing term in and aUor below land surface requires.
variance in acmrdante with ISA NCAC 2C 0115. --- --
Y'll[LD(gpm) S:�-�' MCH q ODF."FESI All' -
I u. VA IFR ZONES(depth): g5
LOC:A 110N SKETCH
1 1 UISINEEC'IION-Type HAmount Show direction and distance in miles from at least
I' L ASING. Wait rrhickmess two State Roads or County Roads. Include the road
Depth Diameter or W ight/Ft, ate al numbers and common road names-
Prom-�To _Ft C 4
From To Ft.
13. GROUT: Depth Material. Method w a
Iionr To Ft. 3nk71w�r_ MryLLPCio/� ©Jt
I rom To Ft.
141 SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in. Q�� A
I rom "Fu Ft. N. in. �" / " Lv t L
I5 SAND/GRAVEL PACK: : h C= w
Depth Size Material ��
I rum To Ft. , -"`� _
Prom_ To_ P[. — _ �/' CAA
m1
r., i.I(MARKS.
I Ix) HLREBY CER IIPY IILA I PHIS WELL WAS CONS I RIAIED IN ACCORDANCE:WI I H 15A NCAC 2L WELL
coNSTRUCr1ON S"IANDARDS.AN THAT ACOPY OFT R" HAS BEEN PROVIDE ITIY)THE WELL OWNER
- -
IGNATU E OF PERSON CONSTRUCTING-r FIL WELI. DA I E
Submit the original to the Division of Water Quality,Attn: Information Management, 1617 Mail Service Center-
Raleigh,VC 27699-1617, Phone No.[phone],within 30 days.
GW-1 REV. 09/2004

WELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources- Division of Water Quahry
WE'IA,C'ONTRACI'OR(INDIVIDUAL)NAME (print) Bryant Smith _.. CFR'I IFICATION a 2571
N'ELI.t'ON'IRAC"I OR COMPANY NAME: Green River Well&Pump Company pin)NE a 828 1693-1200
S l a I WELL CONSTRII("IION PERMII'a ASSOCIATED WQ PERYII 1 e QT IOQ)v51--`—
(it applicable) Ot applicable)
1 W FLL. USE(Check Applicable Box): ResidentiallB"'Mtmicipal/Pubhc ❑ Industrial ❑ Agricultural ❑
.Momlonng ❑ Recovery ❑ Heat Pump Water injection❑ Other❑ If Other, I.ul I
WILL LOCATION Topographic/Land setting
Neures-trfuwln4-/L( Cotm 4ALd"S( le J .� 21ni ge ❑Slope ❑Valley ❑Flat
O STI�I C--f�A�<�- Ill'f� ��(1✓1()ll(J Ilk—
(check appropriate boa)
ISUect Nara ,Number,Community,Subdivision,Lot No.,Zip Code) Latitude/longitude of well location
G 36° a7 ' 4?A' 0926 s23' 01u)
OWNER: ' L�n Idegreerrmumtcrneconds)
Address ) 5Q Cr N l Latitude/longitude source'Er6pso'Fopographlc map
_ (SUeel or NuJ Icheck box)
_ I YU0�1 uc 991i z' DEP'I11 DRILLING; LOG
City oP�f Sure Zip Code From To Formation Description
AAT - B6 —SSl09 --
.V.code.Phone number S' G
• a UA'I'E DRILLEED 4!]0/14-'6S
> 101 AI, DFRI 1-1 _1' S
I, iX)I(S WP:LI. RIIPIACE EXISTING WELL.? YES ❑ NO 9-
�: Ally WI AIIIR LFVFL Belov% "lupol Casing FT - -
(Urc"•"it Above l op o(Caring)
i I )POI CASIN(; IS E-C. Above Land Surface' -
-rup of caring terminated aUor below land surface requires a _— -- -- -- -- --"" - ---
.arianee in accordance with ISA NC'AC 2C 0118. ------ - - - - -
•1 Y1111)(gpm) __2 bIEEH IOD OF I'ES I Air ---_
1 u VA I FR AONFS(depth). G 5 Z _
I_UCAIIUN SKETCH
I I UISINFECIION. type EAT tt Amount Show direcuon and distance in miles from at least
12 LASING Wall Thickness two Stale Ruuds of County Roads. Include the road
/ Dept Djaryeter or>z e;`�Ft. Material numbers and common road names.
Pronit To Ft. /=9p� 1
I rom I-u Ft_ 2 I•L
I roln l-o Ft. -
I1 (i KOUT Depth Material Method
From__ 1-o Ft_ .S / t i :V
From Tn Ft. G <
14 SCREEN Depth Diameter Slot Size Material
I'rom e72_To Ft. in. III
I i,ml To Ft. in - in 1
I:A.N'D47RAV'I I. PACK �� c��J O
Daplh S,za Mutvnld \ c_n
.. Ah Ib t JVV -
i„ilk,
1n i&MARKS
x� HL1,'Fl3Y 11K1111' 1[[At P HIS WEII AS CONS I RUCTLD IN ACCUKDANOW 11111ANCA( 2C WI'.I-1.
RliCI'ION 'I DARDS. ANDIHA ACUPY ]HIS RLCORD HAS I LLN I'KDVIDI(1) lit bill WELLOWNI'.R
- - --
SIGNATURE OF PERSON CONSIRUCTING I TIE WELI. DA Ili
Submit the original to the Division of Water Quality,Attn: Information Management, 101 Vail Service(enter -
Raleigh,NC 2 7 699-1 61 7, Phone Nu. [phone],within 30 days.
G N-'-I IO-V 09/2u04
"iy,,h, II;J -

WELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources- Division of Water Quality
WELL CONTRACTOR(INDIVmUAL)NAME (print) Bryant Smith ___ ('ER I IFICATION n 2571
w'F:I.I. ('ON"rRAc i oR COMPANY NAME Green River Well&Pump Company PHONE n [phone]
Sr:x I'I.WELL CONSTRUCTION PERMITN ASSOCLA'r EDWQPERMITa -24 E I
(if applicable) / (if applicable)
I Wl3LL USE(Check Applicable Box): Residential Id' MlmicipaUPublic ❑ Industrial ❑ Agricultural ❑
Monitoring❑ Recovery ❑ Heat Pump Water Injection❑ Other❑ If Other,List Use
WELL I,OCAIION. topographic/Land setting
Nearest Town' l.J°t.Ct_. County OA [9RIdge ❑S]ope ❑Valley ❑Flal
h �(fk�� (check appropriate box)
I Stroct Nam,M nbrn,Community, ubcivuion,Lol No.,Zip Code) Latitude/longitude of well location
1) {� /� a5° i'7' 0zti! oSa° 36' Zz0
l)WNER `'nn15 r� S�.�'l4:rJr C'rr I degrecsirromocs/seconds)
Address 0 ja°r)031 Latitude/longitude souloc RK S❑'Topographic map
(street or Route Nu.) )chec),box)
t+Vkj"'-1Jc ass lAq DFPIII DRILLING LOU
City or'I'own Suite Zip Code From l o I oration Description
BZB rg I- 433 � 0 3 0 _
\rcode-Phone numbs A 0
a DAIFDRIILED 1413/05-
1 01 Al DEM H 4 nA a ��-
I WI S WELL It11PLACE 6X1S PING WELL) YES ❑ NO 8'
i'l A I [C WA I'1.R LF VEL Below I op of Casing: I I'
(Usti","if Above'1'op of Casing) —--� ----
S 101'OF CASING IS Ff. Above Land Surface'
1'up of casing terminated slow below land surface requires a
.ariance in accord an cc with ISA NCAC 2C.0118. A
YIFLD(gpm) I METHOD OFTES'I At Y"
I U W'ATER ZONES(depth) 1 4�r ---
LUCAIION SKLSICH
It DISINFEC`IION. hype H-T(+ Amount Show direction and distance inmilesfrom at least
1; CASING'. Wall Thickness two Stale Roads or County Roads. Include the road
Depth Diartlpter or Weight/Ft. Material It bers and common road names.
I runt 6 To q O Ft. 6 2?c
Fnnn_�f Tu_ Ft.��1. 7I.0 ✓G
from_ l'o Ft. -�
II UKOUT Ikpth Material Method
P roln _� ho�o 1'l. - k�[oY-
lion) Tu F't.
14 SCREEN Depth Diameter Slot Size Material {` ;
f ronl Tu 1,' in _
17 tin FI m_ lb in / s
.AND/GRAVPI. PACK
Depth Size Material J
i will lb Ft —"
froln Tn FtREMARKS VJJ0 pJj Ra��
p o v
71
i [xi IIISkl:BY CERTIFY I HA THIS WELL WAS CONS'I'RUCfE 1)IN ACCOR DA NC F. Willi 1 sA NC AC 2C. WF1,1
t-UNS'I RUC I'IUN STANDARDS.AND THAT POOPYOFTHIS RECORD HAS 13111 N PROVIDI.0 IU IIIL WELL OWNER
� I L
SIGNATURE OF PERSON CONSTRUCTMG THE WG:LI. DA�I'
Submit the original to the Division of Water Quality, Attn: Information Management, lot' Msil Service Center
Raleigh, NC'2 7 699-1 6 1 7, Phone No. [phone],within 30 days _ -
� UW-I ILl(b ny/?uu4

D I ;k ;, " 3
WELL CONSTRUCTION RECORD DIP
North Carolina Department of Ei viromnenl and Natural Resources-Division of Water Quality
WELL CONTRACTOR(INDIVIDUAL)NAME (print) Anthony Bryant Smith CERTIFISC�AcT�ION a 2571
WELL CONTRACTOR COMPANY NAME Green River Well&Pump Company PHONE a r041603-,1200. /
SPATE WELL CONSMUCTION PF-RMff# ASSOCIATED WQ PERMIT# (O 00/0 `/'0 0 L`i
(if applicable) (if applicable)
I. WELL USE(Check Applicable Box):Residential fr Mtmicipal/Public❑ Industrial ❑ Agricultural ❑
Monitoring❑ Recovery ❑ Heat Pump Water Injection❑ Other❑ If Other,List Use
2. WELL LOCATION: 1 Topographic/Laandetting
Nearest Town:-ru 0 County HC_V &'rS4J5'i ❑Ridge ❑Slope Bl'itiley ❑Flat
T.3Q pdlours i Z.ireontt� l.)C" z a SO (check sppropriste box)
(Street Nana,Numbars,Cammrwty,Subdivrwn,Lot No.,Zip Code) Latlfude/IOngi[ude of well location
to
Cliryoll Levi 3s° i0 ' 57IJ 092e2 ' 33cL)
3. OWNER: (dcgraes/minules/seconds)
Address ic;7 AMer5 Latitude/longitude source:LRC'RS❑Topographicmap
(Strad or Route No.) (check box)
Zcrton(�1 K)C.Z '$nc)b DEPTH DRILLING LOG
C/y Towa State Zip Code From To Formation Description
(8 } 7ogz 9983 rea aJ- - 30( }0 7 L,
A Phone number - `' ) I�Oe.ati
4. DATE
DRILLED 4Il S 1os
5. TOTAL DEPTH: a6 '
6. DOES WELL REPLACE EXISTING WELL? YES OKNO ❑
7. STATIC WATER LEVEL Below Top of Casing:_Y5 FT.
(Use"--if Above Top of Casing)
8. TOP OF CASING IS_�_FT.Above Land Surface•
-Top of casing tersainatd attor below land surface requires a
variance in accordance with ISA NCAC 2C.01 I&
9. YIELD(gpm): 7 METH(��SF�'EST�_
10. WATER ZONES(depth): [[ LOCATION SKETCH
11. DISINFECTION:Type f jTtf Amount Show direction and distance in miles from at least
12. CASING: Wall Thiclmess two State Roads or County Roads. Include the road
Depth gg��JJ%%%%%%ryryryryryryeter orWeight/Ft. Materialp numbers and common road names.
From To�F. r
From To Ft. 2/,L p i/C.
From To FL
13. GROUT: Depth Material Method/����
From To�Ft. .S, &4_r� ;t Lie
From To Ft
14. SCREEN: Depth Diameter Slot Sim Material -
From To Ft. in. in. Gf� _
From To Ft in. in. C�j Q
15. SAND/GRAVEL PACK: t--
Depth Size Material
From To Ft. — '7
From To Ft. o
c.rl '
16. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C,WELL
CONSTRUCTION STANDARDS,AND THAT A COPYJ THIS PERqRD HAS BEEN PROVIDED TO THE WELL OWNER
SIGNATME OF PERSON CONSTRUCTING THE WELL DATE
Submit the original to the Division of Water Quality,AM: Information Management, 1617 Mail Service Center-
Raleigh,NC 27699-1617, Phone No.[phone],within 30 days
GW-1 REV.09/2004

WELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources-Division of Water Quality
WELL CONTRACTOR(INDIVIDUAL)NAME (print) Anthony Bryant Smith CERTIFICATION p 2571
WELL CONTRACTOR COMPANY NAME Green Rhea WON d PUMP CgnpanY PHONE # [phone]
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT# O I o b I -)S4-
(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: l)I I t° County &—kscx ❑Ridge Mope R alley ❑Flat
30 5 le ep i�I i i use,0e mdaKon u tlk,,J C 2 8/N z (check appropriate box)
(Saw Name,Nome Community,Sul Lot No.,Zip Code) Latitude longitude of well location
zna�t nonI QU. ' ,& P-Oct
3. OWNER: S ukkqe.0 rl Lema.r4 Try (degreea/minulp/seconds)
Address Latitude/longitude source;l3C'I''S❑Topographic map
r (S or Roore No.) (chock box)
ZQS} 4 C 00-1 DEPTH DRILLING LOG
Cay or Town stare Zip Code From To Formatio Descripti
( �9n- a5s9 - �a
Asv+coda Phom number
4. DATE DRILLED Ly(Z 2/0S
5. TOTAL DEPTH: 165'
6. DOES WELL REPLACE EXISTING WELL? YES❑ NO 2"
7. STATIC WATER LEVEL Below Top of Casing:__IeO FT.
(Use"t"if Above Top of Caring)
8. TOP OF CASING IS I FT. Above Lard Surface*
-Top orcasing t"Insted al/or below land surface requires a
variance in aecerdauce witb ISA NCAC 2C.01 HL
9. YIELD(gpm): 10 METHOD OAST At r
10. WATER ZONES(depth): / It,5
LOCATION SKETCH
11. DISINFECTION:Type HT Amount Show direction and distance in miles from at least
12. CASING: Wall Thickness two State Roads or County Roads.Include the road
Depth Di ter or Weight/Ft. Material numbers and common road names.
From Tome O t. � �� F�
From To Ft. �� •,,
From TO Ft. t'r
�fl J
13. GROUT: Depth Material Method
From To­J,0 Ft. 5,4kF, /VlT p
From To Ft.
14. SCREEN: Depth Diameter Slot Size Material t1�n
From To Ft in. in. — ,=±
From To F[ in. in. ' �VUCD 14
15. SAND/GRAVEL PACK: c� cn
Depth Size Material
From To Ft. 43
From To Ft.
16. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C,WELL
CONSTRUCTION STAND S,AND THAT A CORWOF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
C -z3 -os
NATURE OF PERSON CONSTRUCTING THE WELL DATE
Submit the original to the Division of Water Quality,Attn: Information Management,.1617 Mail Service Center-
Raleigly NC 27699-1617, Phone No.[phone],within 30 days
,GW-I REV. 09/2004

WELL CONSTRUCTION RECORD
North Carolina-Department of Environment and Natural Resources-Division of Water Quality-Groundwater Section
WELL CONTRACTOR(INDIVIDUAL)NAME (print)RICHARD MCCRARY CERTIFICATION#2010
WELL CONTRACTOR COMPANY NAME BARKER CONSTRUCTION,INC./BARKER WELL&PUMP PHONE # [phone]
STATE WELL CONSTRUCTION PERMIT# 1871 ASSOCIATED WQ PERMIT#
(if applicable) (if applicable) _
1. WELL USE(Chedt Applicable Box):Residential M Mur icipal/Public❑ Industrial❑ Agricultural❑
Monitoring❑ Recovery ❑ Heat Pump Water Injection❑ Other❑ If Other,List Use
2. WELL LOCATION: Topographic/Land setting
Nearest Town: HENDERSONVILLE County HENDERSON ❑Ridge ®Slope ❑Valley ❑Flat
JUBILATION DRIVE (check appropriate box)
(Street Name,Numbers,Community,Subdivision,Lot No.,Zip Code) DatitudeAongitude of well location
3. OWNER DAVID&DIANE GANN (degrees/minutes/seconds)
Address 34 JUBILATION DRIVE Latitude/longitude source:❑GPS❑Topographic map
(Street or Route No.) (check box)
HENDERSONVILLE NC 28791 DEPTH DRILLING LOG
City or Town State Zip Code From To Formation Description
( 828 )- 891-3364
'a
Area code-Phone number t`9
4. DATE DRILLED JUNE 9,2005
5. TOTAL DEPTH: 245' t�
6. DOES WELL REPLACE EXISTING WELL? YES❑ NO KI
7. STATIC WATER LEVEL Below Top of Casing: 40' Ff.
(Use"+'if Above Top of Casing)
8. TOP OF CASING IS 1.33 FT.Above Land Surface*
*Top of rasing terminated at/or below land surface requires a Ln
variance in accordance with 15A NCAC 2C.0118.
9. YIELD(gpm): 10 METHOD OF TEST TIMED
10.WATER ZONES(depth): LOCATION SKETCH
11. DISINFECTION:Type BY PUMP INSTALLER Amount Show direction and distance in miles from at least
12. CASING: Wall Thiclmess two State Roads or County Roads.Include the road
Depth Diameter or Weight/Ft. Material numbers and common road names. �_ O ,,,�r�/ vv��
From 0 To 73 Ft. 6118 SDR21 PVC jx0m gvzlfp[(�/��p✓/.Gf.t.C�Ly2 Aa4i& `7f.Uf�7•t�
From To FL vu0-iO d/.�t rs/Z A,,U. '&AZI L .
From TO Ft. '"
13. GROUT: Depth Material Method
From 0 To 20' Ft, CONCRETE POURED
From To Ft.
14. SCREEN: Depth Diameter Slot Size Material /lf7Qd.
From To Ft. in. in. 1
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft. /
16. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS ONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, LL
CONSTRUCTION STANDARDS,AND T P THI CORD HAS BEEN PROVIDED TO T W LL 0 R
SIGNATUNFOF PERSON CONS CT HE WELL ATE
Submit the original to the Division of Water Quality,Ground w.6 h Section,1636(Mail Service Center-Raleigh,NC
27699-1636 Phone No.[phone],within 30 days. - — _" GW-1 REV.07/2001
AUG 9 2005
gRqllfa il`�.;^rrr ..ECfIgN
ASHEu'i', t HPGVJ�, ml—rim-

WELL CONSTRUCTION RECORD
North Carolina-Department of Environment and Natural Resources-Division of Water Quality-Groundwater Section
WELL CONTRACTOR(INDIVIDUAL)NAME (print)KENNETH MCCRARY CERTIFICATION#2008
WELL CONTRACTOR COMPANY NAME BARKER CONSTRUCTION,INC./BARKER WELL 8 PUMP pfIONE # [phone]
STATE WELL CONSTRUCTION PERMIT# 1871 ASSOCIATED WO PERMIT#
(if applicable) (if applicable)
1. WELL USE(Check Applicable Box):Residential ® Municipal/Public❑ Industrial❑ Agricultural❑
Monitoring❑ Recovery ❑ Heat Pumpr Water Injection❑ Other❑ If Other,List Use
2. WELL LOCATION: Topographic/Land setting
Nearest Town: HENDERSONVILLE County HENDERSON ❑Ridge ❑Slope ❑Valley H]Flat
64 W.,PAST BROYLES ROAD-#3516 (check appropriate box)
(Street Name,Numbers,Community,Subdivision,Lot No.,Zip Code) Latitude/longitude of well location
3. OWNER: JULIUS SZAKALY (degrees/mumatesiseconds)
Address 3516 BREVARD ROAD Latitude/longitude source:❑GPS❑Topographic map
(Street or Rome No.) (check box)
HENDERSONVILLE NC 28791 DEPTH DRILLING LOG
City or Town State Zip Code From TO Formation Description
CUD-)- 891-9328
Area code-Phone number
4. DATE DRILLED JUNE 23,2005
5. TOTAL DEPTH: 330' "y
6. DOES WELL REPLACE EXISTING WELL? YES❑ NO 91
7. STATIC WATER LEVEL Below Top of Casing: 30' FT. r "W"
(Use`+"if Above Top of Casing) C "
8. TOP OF CASING IS 1.33 FT.Above Land Surface* r
'Top of casing terminated at(or below land surface requires a a.
variance in accordance with 15A NCAC 2C.0118.
9. YIELD(gpm): 3 METHOD OF TEST TIMED en---
10.WATER ZONES(depth): c11 m
LOCATION SKETCH
11. DISINFECTION:Type 6Y PUMP INSTALLER 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. 6
From 0 To 103' Ft. 6118 SDR21 PVC �,,,„„ .J�,,,, _ & InliUa) to y
From To Ft. OJ?Owf ri c /V eJ It x�/���m lain �l
tkut
From To Ft. 'T au
n ' Q
13. GROUT: Depth Material Method r f W 1;Q�C..,CJ/1.f7�.W�
From 0 To 20' Ft. CONCRETE POURED `✓'V�q7 D
From TO Ft. NY� ('rL
14. SCREEN: Depth Diameter Slot Size Material h�l� /1 ,,,,
From To Ft. in. in. J �.J rrnn Wun �-Bt
From To Ft. in. in. I�Q CA
15. SAND/GRAVEL PACK:
Depth Size Material
From TO Ft.
From To Ft.
16. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C,WELL
CONSTRUCTION STANDARDS,AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
kv, L -
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
Submit the original to the Division of Water Quality,Grgimdwag{F SBEtiop,lk$6 Mail ervice Center-Raleigh,NC
27699-1636 Phone No.[phone],within 30 days. - --- -- GW-1 REV.07/2001
AUG 9 2005 L
i
GR0XI IM'YTFn SECTION
ASHE6'il I L HFGiJi� a-KC:

WELL CONSTRUCTION RECORD * � -s
North Carolina-Department of Environment and Natural Resources-Division of Water Quality-Groundwater Section
WELL CONTRACTOR(INDIVIDUAL)NAME (print)KENNETH MCCRARY CERTIFICATION#2008
WELL CONTRACTOR COMPANY NAME BARKER CONSTRUCTION,INCJBARKER WELL 8 PUMP PHONE # [phone]
STATE WELL CONSTRUCTION PERMIT# 1871 ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
1. WELL USE(Check Applicable Box):Residential M Mwricipal/Public❑ Industrial ❑ Agricultural❑
Monitoring❑ Recovery ❑ Heat Pump Water Injection❑ Other❑ If Other,List Use
2. WELL LOCATION: Topographic/Land setting
Nearest Town: HENDERSONVILLE County HENDERSON ®Ridge ❑Slope ❑Valley ❑Flat
PEACEFUL VIEW ESTATES,LOT#2 (check appropriate box)
(Street Name,Numbers,Community,Subdivision,Lot No.,Zip Code) Latitude/longitude of well location
3. OWNER: JEFFREY L.HARVEY (degrees/minutes/seconds)
Address 263 LAMB MTN.ROAD Latitude/longitude source:❑GPS❑Topographic map
(Street or Roue No.) (check box)
HENDERSONVILLE NC 28792 DEPTH DRILLING LOG
City or Town State Zip Code From To Formation Description.
( 828)- 606-7719b
Area code-Phone number
4. DATE DRILLED JUNE 30,2005
5. TOTAL DEPTH: 480' C
6. DOES WELL REPLACE EXISTING WELL? YES❑ NO IKI
7. STATIC WATER LEVEL Below Top of Casing: 30' Fr.
s
(Use"+"if Above Top of Casing)
8. TOP OF CASING IS 1.33 FT.Above Land Surface*
•Top of easing terminated at/or below land surface requires a C_n
variance in accordance with 15A NCAC 2C.0118.
9. YIELD(gpm): 3 METHOD OF TEST TIMED _..
10.WATER ZONES(depth):
LOCATION SKETCH
11. DISINFECTION:Type BY PUMP INSTALLER 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. I,- �
From 0 To 56' Ft. 61/8 SDR21 PVC WWI
From To Ft bid. Q.
From To Ft.
13. GROUT: Depth Material Method A t�Q
From 0 To 20' Ft. CONCRETE POURED
From Ft.De
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 F[.
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
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE—�
Submit the original to the Division of Water Quality,Gro - SIb fe a ter-Raleigh,NC
27699-1636 Phone No.[phone],within 30 days. !, �� l'J L� li r -1 REV.07/2001
Ili i
AUG 9 2005
I
f,ROIINM-IPTFr SECTION
ASHFVII I t o-rill

WELL CONSTRUCTION RECORD
North Carolina-Department of Environment and Natural Resources-Division of Water Quality-Groundwater Section
WELL CONTRACTOR(INDIVIDUAL)NAME (print)KENNETH MCCRARY CERTIFICATION#2008
WELL CONTRACTOR COMPANY NAME BARKER CONSTRUCTION,INC./BARKER WELL&PUMP PHONE # [phone]
STATE WELL CONSTRUCTION PERMIT# 1871 ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
1. WELL USE(Check Applicable Box):Residential M Municipal/Public❑ Industrial ❑ Agricultural❑
Monitoring❑ Recovery ❑ Heat Pump Water Injection❑ Other❑ If Other,List Use
2. WELL LOCATION: Topographic/Land setting
Nearest Town: HENDERSONVILLE County HENDERSON ElRidge ❑Slope ❑Valley ❑Flat
PEACEFUL VIEW ESTATES,LOT#3 (check appropriate box)
(Street Name,Numbers,Community,Subdivision,Lot No.,Zip Code) Latitude/longitude of well location
3. OWNER JEFFREY L.HARVEY (degrees/minutes/seconds)
Address 263 LAMB MTN.ROAD Latitude/longitude source:❑GPS❑Topographic map
(Street or Route No.) (check box)
HENDERSONVILLE NC 28792 DEPTH DRILLING LOG
City or Town State Zip Code From To Formation Descripti
8( 28 )- 606-7719 ry
Area code-Phone number
4. DATE DRILLED JUNE 27,2005 t�
5. TOTAL DEPTH: 455'
6. DOES WELL REPLACE EXISTING WELL? YES❑ NO El L
7. STATIC WATER LEVEL Below Top of Casing: 29 FT. Ad
(Use-+-if Above Top of Casing)
S. TOP OF CASINO IS 1.33 FT.Above Land Surface' L a
'Top of casing terminated at/or below land surface requires a
variance in accordance with 15A NCAC 2C.0118.
9. YIELD(gpm): 20 METHOD OF TEST TIMED '
10.WATERZONES(depth):
LOCATION SKETCH
11. DISINFECTION:Type BY PUMP INSTALLER Amount Show direction and distance in miles from at least
12. CASING: Wall Thickness two State Roads or County Roads.Include the road
Depth Diameter or Weight/Ft. Material numbers and common road names.
From 0 To 39' Ft. 6 1/8 SDR21 PVC
From TO Ft.
Fro ril To Ft. Ar
13. GROUT: Depth Material Method ,t- /,, o
From 0 To 20' Ft. CONCRETE POURED I/rt--�.� � B� x`-r'
From To 4-�-0�Ft. l�
14. SCREEN: Depth Diameter Slot Material "�7�7 (,_JC-Gs
From TO Ft. in. in.From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft. /
From To Ft.
16. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C,WELL
CONSTRUCTION STANDARDS,AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
Submit the original to the Division of Water Quality,Gr (1H S enter-Raleigh,NC
2/6�9-f636 Phone No.[phone],within 30 days. r�. E' �� Ly V 'L�- GW-1 REV.07/2001
ij
'. AUG 9 2005 U
f,RHUNNI'I"Tpr PdCTMN -
�� rtallh

314390
WELL CONSTRUCTION RECORD
North Carolina-Department of Environment and Npaah,ot v.-^••--- n:..:.t....of Water Quality-Groundwater Section �(
WELLCONTRACTOR(INDIVIDUAL)NAME (prtat) OIa.--�—� r+ 00 ASN CrRTIPICATIONa a� `
WELLCONTRACTOR COMPANY NAME REUBEN CALDWELL DRILLING, INC. PIIONA::8 1254-3581
STATE WELL CONSTRUCTION PERMITa_ 1537 AMOCIATED WQ PERMrT►
ifa litable ifa licable - .- -
1. WELL USE(Check Applicable Box): Residential GI Municipal/Public ❑ Industrial ❑ Agricultural❑,".
Monitoring ❑ Recovery ❑ Heat Pump Water Injection❑ Other❑ If 0thcr,List Use
2. WELL LOCATION: Topographic4-and settin
Nearest Town: C-LETCA6I- County- r-30i45eN ❑Ridge ❑Slope ❑Vallcy �JFlat
L� +s a1 ►< I G S w r• fJ f,I LL S (6ck appropriate box)
(Stseel Name,N�um/beq Cammuniry,,/Subdivision,tit No.,Zip Code) LatitudrAongitude of well location
3. OWNER: Y Lo . 7 M/ (K' 14/-or-) I- tJ
(deyse✓mitwtu/secoods)
Address S U I k- I- �!T S7. LatitudcAongitude souse:❑GPS❑Topogiaphib map -
(Slscctef Route No.) (chock box)
k�Ai D it Asa 3 V I�� r N c- DEPTH DRILLING LOG
p�SItyorTown.( Sta,e i Zip Code From t To Fo tioon "eseriptioR
l.A3fU- U �J 137r-iJ'.:(LQ- yU
Area code-Phone n=bcr I — 1 / l-T
�O
4. DATE DRILLED 65
p ! t(lC� _ s
5. TOTAL DEPTH: 3 O 14:2 ! — c C, R-A N i
6. DOES WELL REPLACE EXISTING WE'LL? YES ❑ NO i
7. STATIC WATER LEVEL Below Top of Casing: 4-0 FT.
(Usc-.-if Above Top of Cuint)
8. TOP OF CASING IS - FT.Above Land Surface*
•Top of cuing laminated at/orbelow land surface requlru
0
rarlmce In aecerdmc,ap Itb ISA NCAC 2C.0111. n `
9. YIELD(gpm): V:) METHOD OF TEST
10. WATER ZONES(depth): 1 4-o t 1
LOCATION SKETCH
11. DISINFECTION:Type L TH D b Amount C Show direction and distance in miles from at)east
12. CASING: Wall Thickness two State Roads or County Roads. Include the road
1 Depth Ft Di ter or filth I. y1re numbers and common road names.
_
From To f4Sl
From To Ft.
From To Ft
13. GROUT: Depth Material Method
From -1 To Ft. Urr �o
uN•f U2�D ig
From To Ft.
14. SCREEN: Depth Diamcter Slot Sim Material
From To Ft. in. in. �CIjSWCc+p
From To Ft. in. in. P M
15. SAND/GRAVEL PACK: 1LL
Depth Sim MaterialFrom To Ft. rr� 9
From To Ft.
16. REMARKS:
I DO HEREBY CERTIFY TIIAT THIS WELL WAS CONSTRUCTED IN ACC RDANCE W1TTI 15A NCAC 2C,WELL
CONSTRUCTION STANDARDS,AND TIIAT A COPY O TTBS CORD IIAS EEN PROVIDED TO THE VfELL O R
cPxv\ Iae
SIGNATURE OF PERSON CONSTRUCTING TI3E WELL DArE
Submit the original to the Division of Water Quality,Groundwater Section,1636 Mall Service Center-Raleigh,NC
27699-1636 Phone No.[phone],within 30 days. GW-1 REV.07/2001

WELL CONSTRUCTION RECORD
North Carolina-Department of Enviromnent and N�aQ�/g/e Resonccn -D a/ion of ater Quality-Groundwater Section
WELL CONTRACPOR(UMVmUAL)NAME (Print) /!!I PIS C.— K, Z5—3� �J'�
// L_�� /� CER'RFIGIION�/
WELL CONTRACTOR COMPANY NAMEa 4;- P/ L��F!`��402. PHONE / 2 Y 'O�O
STATE WELL CONSTMMON PERNM Aae 'IATED KrQ
(if applicable) (if9ohic ble)
1. WELL USE(C heck Applicable Box):Residential Rr/Muuoicipal/Public❑ Industrial O Agriculh¢a1❑
Monitoring O Recovery O Heat Pump Water Injection O Other O If Other,List Use
2. WELL LOCATIO �s�
Nearest Town I�` C� County !./ Pi'SCty Midge OS OValley Met
vnaphi�setting
1�5� p7rf Z 73Z (durJcWPmpd tehuz)
(strtftNnme•Nueba Caeesme* Ubffi°° Iallo»MpCaft) LatinsItAongintdeof well location
3. OWNER- zd a /7Fif� /9r,IV (, ,,a,ID, ,, y
Address ,rT_j wLc✓t .9 - MMIS
Latitudellongitude sotnce:OGPSOTopographic map
flc i. iue- 28737 ce�rk hcac)
DEPTH MUM `
City a Town Soft
�} T4'Cade From To Formation Description
Area code.Phom number .
4. DATE DRQ
S. TOTAL DEPTH: ti D S- �
6. DOES WELL REPLACE EXISTING WELL? YES WNO O '— —
7. STATIC WATER LEVEL Below Top of Casing: /yc7 FT•
, (Ux"h"ifAbMe Top of CamkV)
L
S. TOP OF CASING IS—"FT.Above Land Surface+
'TOP Ofcastes terminated allw helew Is"sar6ee require`a C
TuiaOee heaemrdavee wrth 1SA NCAC 2C.0118. / Pa
-
9. YIELD Wnt):___Z___METHOD OF TEST i i e w
10.WATER ZONES(depth)
LOCATION SICFI CH ut
11. DISINFECTION:Type Amount /D o2 Show direction and distance in miles from at least
12. CASING: Wall Thickhns two State Roads or County Roads.Include the road-
or numbers and msnon road[lames.
From {�To Z Ft M 27 G we/`�
From—To Ft
From To Ft t
13. GROUT: Depth Meow 4e
`? N
From_ To_Z�Ft-6 t J
From Tc Ft
14, SCREEN: Depth Diameter Slot Size Material
From To Ft in in. h
From To RL )n. in.
15. SAND/GRAVEL PACK.
Depth Size Material J
FromL-�To FL
From To Ft
16. REMARKS:
1 DO HEREBY CER THAT THIS WELL WAS CON CPED IN ACCORDANCE WITH 15A NCAC 2C,WELL
CONSTRUCTION MS.AND THA THIS HAS BEEN PROVIDED TO THE WELL OWNER -
_ - P•J
SIGNATURE OF PERSONCqRSTRUMNG THE WaL DATE o

il,
o 3
WELL CONSTRUCTION RECORD
North Carolina-DcparWwnt of Environment and Nahn+l R.._.._-. �; ;,;��
(r tf Water Quality-M' Groundwater Section
WELL CONTRACTOR NAME (p,1et) IJ fit.-t..je aJAcf5JI
WELL CONTRACTOR COMPANY NAME RF.UDEN CALDWELL GRILLING, INC CERTIrrFlICATION0
STATE WELL CONSTRUCTION PERMIT• I53 , PIIONCY 8 59-3581
ife liaable OCIATED WQ PERAIITV
ife liable
1. WELL USE(Check Applicable Box): Residential O MunicipaVPublic❑ Industrial❑ Agricultural ❑
Monitoring O Recovery ❑ )teat Pump Water Injection❑ Other O If Othcr,List Use
2. WELL LOCATION:
Nearest To wn: V L F--�C € a- . County ToO
Cn1JG L ;K JLand setting3w j_A :2vt CAf�$
Midge 02Slope ❑Valley Mat
(Street Nam ,N mben,Cemmwtry,Subdmnon,la NO.lip C-- (�k app Wriue box)
Latitude/longitude of well location
3. OWNER: J . _ eiAVIs
Address 1 ?i f� O,r-s a ) (eeyeuimieat�,em„d,)
( n (,street«Rowe No.) LetitudcAongitude source:❑GPS❑Topographic nap
1 i3 PJ t(�.�31�p1J:)t L.lg (or— (check box)
City or sown St.,. Zip Code DRILLING O
Fro)n Two / Forli n Description
Ara coda Pbotu ownber 1 r O �3+ v{'-Dc DJ
4. DATE DRILLED f( - { -O°j' '1 7 a i o` (L *J i t`L
S. TOTAL DEPTH:_ 3 1 C, _ _`10 g-✓` V 1(:,4r a 5 'PM
W
6. DOES ELL REPLACE EXISTING WELL7 YES ❑ NO LI/ r - Z i C Q� A ro tT lr `
7. STATIC WATER LEVEL Below Top of Casing: (; o FT 3
8. TOP OF CASING IS (use jrAbowToporCacina)
•Te FT'Above Land Surface• ------__
F efeula E larminated aver bete.land ead.ta rrqulro a
variance to aererduea with ISA NCAC 2C.011e. p --
9. Y113LD(gpm): a METIIOD OF TEST P-1,G A I
10. WATER ZONES(depth):_q-7 I - a, V -- -- -
11. DISINFECTION:T �"fli 0 LQCATION SKETCH
=~.
)'Pe Amount Z Show direction and distance in miles from at leasri.
12. CASING: Wall Thickness two State Roads or County Roads, include the road's
Depth 3 D, Ier or Weight/Ft. M Ltd numben end common mad name .
From 4 To FL SDI bl Q `
From To Ft.
From To Ft.
13. GROUT* Depth Mnerid Method --j $3YAbrf N C ,
From -aZ Ft. Lk3- \$ti"r pz)J!1-�
To Ft.
14. SCREEN: Depth Diameter Slot Sire
From To Ft. in. Material ?ran, �, i
Front To Ft in
. in. . ,.. Ov'+
IS. SAND/GRAVEL PACK: in.
From Depth Sire Material 1.;0• /r
From To Ft. _�1a W A 2rJ e;A
16, REMARKS:
I DO HEREBY CERTIFY TI(ATTIIIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH ISA NCAC 2C,WC•t1_
CONSTRUCTION STANDARDS,AND THAT A COPY OF TIHIS RECORD 1i EGN PROVIDED TO THE WF .L L ER
�Q X L SIGNATIJREOFPCRSONCONSTRUCTINGTIIE WELL DAY
Submit the original to the Division of Water Quality,Groundwater Ser/lon, 1636 ALIT Service Center-Raleigh,NC
27699-1636 Phone No.[phone],within 30 days.
cwa REV.07n001

0�
31a n �,
WELL CONSTRUCTION RECORD
North Carolina-Department or Environment and Nahrr.i o•_....�_. n:..:.:��
WELL CON TRAC (pl.0 �1\...L��X
TOR(INDIVIDUAL)NAMC W\\ A 5"14�r Water Qtlahty-GRTIFIC water Section
e
WELL CONTRACTOR COMPANY NAME RF.UBEN CALDWELL DRLLLING, INC CCTItICATIONa
TI �17
STATE WELL CONSTRUCTION PERMTfa 15-17 tiloNLrPY t3 54-3581
ira licable OCIATED WQ PERAfrro
ifa liable
1. WELL USE(Check Applicable Box): Residential Municipal/Public eVl'ublic [I Industrial Elq
Monitoring❑ Recovery ❑ Heat Pump Water Injection❑ Other❑ IrOther, List Use Agricultural❑
2. WELL LOCATION:�]
Nearest Town: Cout}ty l l�`Ai D �;z, Topog96bic/L ind setting
v1 T ❑Ridge jz1ope Malley ❑Flat
(Street Nun .Nu ben.Commwtry,Subdmnon,[a Ne.,Zip Cads) feh k.plvoprfue box)
Lelitude/longitude orwell location
3. OWNER: J A-,ig- 1 ,3 C -
Address C,J g G o, F1 /devesra w e/ae mPS❑Tes) p
pographic
t (street ar Rout<No.) p�j Latituddlongilvde
ASk souree:❑Go raE3V L O� C 00 G�j (chakboa)
Larty or Tow�t stue o Zip Code FroDEPTiTo / DRIL IN O
— ) ^ 3 Fo lion Description rea t A coda Phone ntunber ' O �� $-
4. DATE DRILLED
S. TOTAL DEPTH: S l u -/
6. DOES WELL REPLACE EXISTING WELL? YES f7 —!
7. STATIC WATER L13VEL.1Below Top orCasing: � 0
8. TOP OF CASING IS 1
(Um aif Abom Top o
•Topof trml.atrd.Vta Fr.Above Land
Surface-
" Cuina)
---�— -
to accordant
ccr d.aeM ad .rf.c e �.gjv iru say.danntA NCAC 1C.01 it.9. YIBLD(gpm):� hTIODOFTET t6 M'H i p-,,---
10. WATER ZONES(depth):_ U — N
- -
--
I L DISINFECTION:Type n 1.00ATIO_ M KI CH o
12. CASING: Fount Show direction and distance in miles from
Wall Thickness two State Roads or County Roads. Include east "
�Pth q ) D)' ter or tyaghVFL a�erid numbers and common mad names ' road,-
De To T FL b �()Z VVC
From To Ff. r--. 0JW1 A)G
From To FL __ G,4(i
13. GROUT Dcp Material = '
From To L Ff. Mil [hod
I _
From D�— �2`� I � /1 fL
To Ft. lJ f ��I f 2�r' i 14. SCREEN: Depth Diameter Slot Sim
From To Material IT
in. in.
From To Ft. in. -
IS. SAND/GRAVEL PACK: in. I H - �j ibo�l/L1G
Depth Sire Material - .. ... Lo Jr•.•CZ From To Ft.
From To Ft ---- — ,r+
16. REMARKS: i�K 9-O G n
I DO HEREBY CERTIFY TIIATTItIS WELL WAS CONSTRUCTED IN ACCORDANCE WMI 15A NCAC 2 WE
CONSTRUCTION STANDARDS,AND THAT A COPY OF IS REC RD I IAS VIEN PROVIDED TO TILE OWNER
TI
(IV7�1/�f �i
SIGNATURE OF PERSON CONSTRUCNG Tfit!
.LLD TE
Submit the original to the Division of Water Quality,Groundwater Section, 1636 Afa1I Service Center-Raleigh,NC
27699-1636 Phone No.[phone].within 30 days.
Gwa REV. o7n001

----- - 316 8 7
asHFvll I t hFui ;,; � �= N *ELL CONSTRUCTION RECORD
North Carolina- Department of Environment and Natural Resources-Division of Water Quality-Groundwater Section
WELL CONTRACTOR(INDIVI DUAL)NAME (print) \`C:-t:� 4IP 4+b. -� �"s < S CERTI:-ICATION4—'LL-k3o
WELLCONTRACTORCOMPANV NAME o ac5 oaw \ PHONEkj8 S-a�LZ
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable) -/ (if applicable)
I. WELL USE(Check Applicable Box):Residential Municipal/Public O Industrial ❑ Agricultural❑
Monitoring❑ Recovery ❑ Heat Pump Water Injection ❑ Other❑ If Other,List Use _
2. WELL LOCATION: Topo_gr hic/Land setting
NearestTown:'I­le deetiorr, 'A\e_- County rlena9 SnrA ❑Ridge GTSlope ❑Valxy ❑Flat
R P 'C\T� e_ 2P,79 Z (check appropriate ton)
(Street Name.Numbers,Community.Subdivision,Lot No.,Zip Code) Latitude/longitude of w:;il location
3. OWNER: SCFQ oeyr Teo+rtkt (degrees/minutes/securds)
Address _��o, 4ALN';2k La' ,' Latitude/longitude source:❑GPS❑Topographic map
(Street or Route No.) (check-xr;:)
`k'k�49vso1)Y,Ilt F1C �$ 7ij � DEPTH DRILLING LOG
City or-rown State Zip Codc From To Fort nc.tion Description
(Azb)- l09'-I- kil9zo `71S s.- �w d-en
Are-,code-Phone number -
4. DATE DRILLED 9- -,5'O S ]5 07 15 _�i1gn f f
5. TOTAL DEPTH: 095 / ---
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO lil
7. STATIC WATER LEVEL Below Top of Casing: ` O FT.
(Use"+"if Above Top of Casing) _
8. TOP OF CASING IS \ FT-Above Land Surface*
*Top of casing terminated at/or below land surface requires a Cr1 �
variance in accordance with ISA NCAC 2C.0118. ----�-- +.
9- YIELD(gpm): It METHOD OF TEST RI'CA
10. WATER ZONES(depth): V LOCATION SKETCH
O
1 L DISINFECTION:Type o'.. < Amount l3 Show direction and distance in rni es from at IUM -.1
two State Roads or County Roads. Include the road -_
12. CASING: Wall Thickness
Depth Diameter o�rnWeight/Ft. Material numbers and common road nam--F.
From 'r To '1.5 Ft- `
._�
From To Ft.
From To Ft. ��- 3
13. GROUT: Depth Material Method
From_. 0 TO do Ft. C 2met-F.rSs!Z4d— $
From To Ft. W
14. SCREEN: Depth Diameter Slot Size Material A
From To- Ft. in.
From To Ft. in. in- pen Its ylVan;o, R
15- SAND/GRAVEL PACK: d
Depth Size Material
From To Ft. (d Reece R.d
From To Ft
16. REMARKS:
I DO HEREBY-CERTIFY THAT THIS WELL-WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2(','VELL
CONSTRUCTION STANDARDS;AND THAT A COPY F THIS RECORD HAS BEEN PROVIDED TO THE WFLL OWNER
`-7- aS O
SIGNATUR OF PE SON CONSTRUCTING THE WELL DATE
Submit the original to the Division of Water Quality,Groundwater Section,1636 Mail Service Center-Raleigh,NC
,__ _ GW-1 REV.07/2001

3 1
\� A - 0
WELL CONSTRUCTION RECORD �. `' J_ i k `
North Carolina-Department of Environment and N to Rego - 'v/Ion o Water Quality-Groundwater Section
WELL CONTRACTOR(1NVIVroUAL)NAME (print 'F'1 L.- CERTMCCAyTI{ON#
WELL CONTRACTOR COMPANY NAME Y,; L tiC' PRONE #
STATE WELL CONSTRUCTION PERMrr# ---OCIATED WQ P
01100111011 ifapplicable) if licable
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: r- Z g
Nearest Town• 4 s 'c✓ Cody 6 ❑Ridge S❑ lope ❑Vallsc❑Flat
J/ (u/' >'S Ai/t>iy�/ ?R7/> '3 (Ch«kapraopriatebox)
(Street Name.N—beM Community,Subdivision,lot No..tip Code) Latitudellongitude of well location
3. OWNER: / tcilf �J4/t�i/KS ( mtonodsecmdr)
Address / �5 Latitude/longitude source:❑GPS❑Topographic map
(street sir Route No.) _ (check boot)
'!1, PcJ PC -z-F DEPTH DRM ING L�
City or Town stare zip Code From To Formation Description
L—)-
Ama code-Phone nombex
4. DATE DRILLED L"2.3 '62�; y ">
5. TOTAL DEPTH: 77—7
6. DOES WELL REPLACE EXISTING WELL? YES NO er-
7. STATIC WATER LEVEL Below Top of Casing: FT.
S. TOP OF CASING IS /Nx"+�if�m Top of Casing W
FT.Above Land Surface'
Top of eating terminated atfor below land smiace regatrea a
v "Ree OF h 15A NCAC 2C _-
9. YIELD
D(gp m : METHOD OF TEST i <?t
10.WATER ZONES(depth):
LOCATION SKETCH
11. DISINFECTION:Type Amolmt /C� 'z Show direction and distance in miles from at least
12. CASING: Wall Thickness two State Roads or County Roads.Include the road
>},� DeP jaaryeter �t If3are numbers and common road names.
Fro To 0 Ft tc/5/
From_To Ft
From To Ft
13. GROUT: Depth Material M j
From To�C Ft .e C F P L x" l h \�
From To Ft
14. SCREEN: Depth Diameter Slot Sim Material =7 �,
From To Ft in. in. \
From To Ft in. in. 'i1
15. SAND/GRAVEL PACK:
Depth Sim Material
From To Ft.
From To Ft.
16. REMARKS:
I DO HEREBY ERTIFY THAT THIS WELL W!COPOF
UCTED IN ACCORDANCE WITH 15A NCAC 2C,WELL
CONSTRU N STANDARDS,AND AHIS RD HAS BEEN PROVIDED TO THE WELL OWNER
/ ,
SIGNATURE OF PERSON NSTRUCTING 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

A 1'
W1SLL 4-uMb1KUl:l1111V 1ZL;C:Ulill r U 4
North Carolina-Department Of Environment and Natural Resources- J�of Wateri
WELL CONTRACTOR / A Quality-Groundwater tar Section
(INDIVIDUAL)NAME (Print) /Ld�'1 L� CERTIFICATION p?7 .
WELL CONTRACTOR COMPANY NAMEGL—Je ebydfee P.
PHONE p �,�,r�y9�-�yo
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ P
(ifapplieable) p
(if applicable)
1. WELL USE(Check Applicable Box):Residential Mr"'M>micipal/Public❑ Industrial❑ Agricultural❑
Monitoring❑ Recovery ❑ Heat Pump Water Injection❑ Other❑ If Other,List Use
2. WELL LOCATI N:
Nearest Town: u l t Tope c/Land setting
/// r6&6cit ��7 7� 2�a MidgeuSlope Malley OFlat
(Sheet NamS Numbers,Caaummity,Subdivedon,Lot No.,Zip Code) (check appropriate boot)
Iatimde/longitude of well location
3. OWNER: /�/� " Spy
Address ,/I not tH I'ttP (degees/mmutes/seconds)
''// / ( 'orRmdeNo.) Latitude/longitude source:❑GPS❑Topographicmap
HCr�a/Sorl u.`(/t 9u76 7 DEPTH (e6akbns)
City or Town Shoe Zip Code From To FLING LOG
(_} Formation Description
Am Cade-Phone manber
4. DATE DRILLEDS`I7—Og,—
5. TOTAL DEPTH: RZ5 t
6. DOES WELL REPLACE EXISTING WELL? YES❑ NO
7. STATIC WATER LEVEL Below Top of Casing FT.
8. TOP OF CASING IS / (UN-+-if Above Top of Casing)
FT.Above Land Surface*
'Top of eaalag terminated at/or belowland mrfsce require,a
variance in soeordan 1SA NCAC 2C.011&
9. YIELD(gpm): METHOD OF TEST•%
10.WATER ZONES(depth):
11. DISINFECTION:T N CH
YPe Amount /0 M L Show direction and distance in miles from at least
12. CASING: Wall Thickness two State Roads or County goads.Intl de the road
Fro-.1 Ft or Wei 't M numbers and common road names
From To
From To Fk
13. GROUT: { Depth /�Material
From _TO
From To Ft
14. SCREEN: Depth Dice Slot Sim Material
From To Ft in, in. /
From To Ft m. in / 4,0
15. SAND/GRAVEL PACK
Depth Sim Material
From To Ft.
From To Ft.
16. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C,WELT,
CONS ION STAND eCT A CppypF 71�S RECORD HAS BEEN PROVIDED TO THE WELL OWNER
C
SIGNATURE PERSON MNSTRUCI7NG THE WELL 7-D5
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

J6146
WELL CONSTRUCTION RECORD W "
North Carolina Department of Environment and Naural Resources-Division of Water Quality
WELL CONTRACTOR(INDIVIDUAL)NAME (print) Anthony Bryant Smith CERTIFICATION 0 2571
WELL CONTRACTOR COMPANY NAME Green River Wel 3 Pu rnp Cornparry PHONE a 6281 SB11200
STATE WELL CONSTRUCTION PERMTTO ASSOCIATED WQ I-M MITO _'7()f h 2 7.S
(if applicable) — (if applicable)
1. WELL USE(Check Applicable Box):Residential(d/Mumcipal/Public❑ Industrial ❑ Agricultural❑
Monitoring❑ Recovery ❑ Heat Pump Water Injection❑ Other❑ If Other,List Use
2. WELL LOCATION: Topographic/Land setting �
Nearest Town: ZI u0 Courity�0 ❑Ridge ❑Scope ❑Valley setting
:J 100 Bf ra Pi `Yl= n Zireon ick ►JCS (check appropriate box)
(Strout Name,Nrmbors,Community,Subdivision,Lot No.,zip Code) Latitude longitude of well location
(� 35° 1�1 ' 14N m z0�9 ' o'7fJ
3. OWNER:,4JA � VP(.t) 1 e! V-{ (degreearmmuw/seconds)
Address 1038 1-'"L1GrI_2 . Latitude/Iongitudesource:BGrPS❑Topographicmap
(Stroel ce Ro No.) (chock box)
i Kt�f VScytu lilt I�Car673Cj DEPTH DRILLING LOG
City or Town State r Zip Code From T Formation Description
AA). 10gf.-99rfL1
Am code-Phone number
4. DATE DRILLED g I t I D5
5. TOTAL DEPTH:
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO Q­ rn
7. STATIC WATER LEVEL Below Top of Casing: Fr.
�—
(Use" "if Above Top of Casing) i -
8. TOP OF CASING 1S 1 FT.Above Land Surfaces —
-Top of cuing terminated a✓or below lead surface requires a
variance in accordance with ISA NCAC 2C.011&
9. YIELD(gpm):Ji METHOD OF TEST
10.WATER ZONES(depth): .Z 0-rf
LOCATION SKETCH
11. DISINFECTION:Type__±{T i-4 Amount Show direction and distance in miles from at least
12. CASING: Wall Thiekneaa two State Roads or County Roads. Include the road
Depth iatpeter ffohtlft �C numbers and common road names.
From To K Ft `!
From To Ft. C—
From To Ft.
13. GRO�Dep � M� ptari Meth �N�4C��
From To FL S gkitn /H. )F
From To Ft.
14. SCREEN: Depth Diameter Slot Size Material
From To Ft in. in. p
From To Ft.—mi. _ in. 1
15. SAND/GRAVEL PACK:
Depth Size Material }
From To Ft. ",
From To Ft. 7C r
M,
16. REMARKS:
1 DO HEREBY CERTIFY THAT THIS WELL WAS C NSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C,WELL
CONSTRUCTION STANDARD AND THAT A CO OF THIS CORD HAS BEEN PROVIDED TO THE WELL OWNER
SI ATURE OF MCSON CONSTRUCTING THE WELL DATE
Submit the original to the Division of Water Quality,Attn: Information Management,1617 Mail Service Center-
Raletg)t,NC 27699-1617, Phone Nc,[phone],within 30 days.
cw-I REV.0912004

WELL CONSTRUCTION RECORD ""' 3161145
North Carolina Department of Environment and Natural Resources-Division of Water Quality
WELL CONTRACTOR(INDIVIDUAL)NAME (print) Bryant Smith CERTIFICATION#2571
WELL CONTRACTOR COMPANY NAME Green River Well&Pump Company —PHONE # [phone]
STATE WELL CONSTRUCTION PERMIT# ASSOCIATEDWQPERMITa OSIO01D 3(a3 �
(if applicable) (if applicable)
1. WELL USE(Check Applicable Box):Residential B'IN[ulmcipal/Public ❑ Industrial ❑ Agncultural❑
Monitoring❑ Recovery ❑ Heat Pump Water Injection❑ Other❑ If Other,List Use
2. WELL LOCATION; Topographic/Land setting
Nearest Town: rh i I S )µme County. V?L R<dge ❑Slope ❑Valley ❑Flat
of P P e Tra i ll M 1111 C ff Or I i G (chock appropriate box)
(Street Name,Numbeh,Community,Subdivision,Lot No.,Zip Code) Letitude/longimde Of welllocatlPn
3. OWNER: 4'i-Ql1 Jark&on (degtea/mmutm/soconds)
Address nrs a.', 1 erS�I�C� Latitude/longitude source-3GPS❑Topographic map
(Street or Route No.) (chock box)
k-k)CLA nC a 8 7(2- DEPTH DRILLING LOG
City or Town State Zip Code From To Formation sCnption
g( 28 )- 553- #0
Area code-Phone number
. DATE DRILLED 5 S�—`I—OIL—
. "TOTAL DEPTH:
6, DOES WELL REPLACE EXISTING WELL? YES ❑ NO l— rri
7. STATIC WATER LEVEL Below Top of Casing: '4tD• FT. �-
(Use"+"if Above Top of Casing) �-
8. TOP OF CASING IS ! FT.Above Lard Surfaces .n
*Top of easing terminated atlor below land surf+«requires a
variance in accordeneewith ISA NCAC 2C.011& -�
9. YIELD(gpm): _METHOD OF TEST t
10. WATER ZONES(depth): SF$—
LOCA"LION SKETCH
11. DISINFECTION:Type /.q 7H Amount Show direction and distance in miles from at least
12. CASING: Wall Thickness two State Roads or County Roads. Include the road
Depth Di ter orweight/Ft. Material numbers and common road names.
From ® To��Ft= A1,L eyr,
From To Ft.
From To Ft.
13, GROUT: Depth Material Method Q D�✓d'� \
From O To 20 Ft. �'ak�rcfi. Mry
From To Ft ft
14. SCREEN: Depth Diameter Slot Size Material 10,
From To Ft. in. in. �7p
From To FLin. in. � 9 F
15 SAND/GRAVEL PACK:
Depth Size Material '✓�
From To Ft.—
From—To—Ft.
16. REMARKS: -
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTR CTED IN At
Willi 1 iA NCAC 2C.WELL
CONSTRUCTION STANDA ,AND THAT A COPY OF IS RECORD HAS BEEN PROVIDED TO THE WELL O[W'—NER
SICO(ATURE OF PERSON CONSTRUCTING THE WELL DATE
Submit the original to the Division of Water Quality,Attn: Information Management, 1617 Mail Service Caner-
Raleigh,NC 27699-1617, Phone No.[phone],within 30 days.
. GW-I REV. 09/2004

WELL CONSTRUCTION RECORD 0` 316143
_ North Carolina Department of Environment and Natural Resources-Division of Water Quality
WELL CONTRACTOR(INDIVIDUAL)NAME (print)_Anthony Bryant Smith CERTIFICATION#2571
WELL CONTRACTOR COWANY NAME Green River Well&Pump Company PHONE # { )693-1200
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable) /• (if appiiceNe)
l. WELL USE(Check Applicable Box):Residential$ Municipal/Pubhc❑ Industrial❑ Agncu ltural❑
Monitoring❑ Recovery ❑ Heat Pump Water Injection❑ Other❑ If Other,List Use
2. WELL LOCATION: Topographic/Land setting
Nearest Town: County ,�'>l OfQge ❑Slope ❑Valley ❑Flat
! aV t (. r+l3 "r�1 2r� _�u A AC4M t)i t 1Y. NL (cheek appropriate bin)
(Shed Nama,Numbers,Community,Subaivisi lot No.,Zip code) �Z g7 SL
LatiVcerai udoeof well location
3s "J 0 7
3. OWNER: N CK u
s7W
(degme/mmutes/seconds)
Address 31 2 Latitudetiongitude source:06PS❑Topographic map
(Stetm Router,asQ_) (cheek box)
A aA e3 JI A C QV\I J l t', /J L 9179Z DEPTH DRILLING LOG
city or Town
&8rate Zip Code From To F tion Description
r z ¢ fC�- 8 I O — _
Ate Bodo-Phone camber
4. DATE DRILLED 7 1 it ka � tc
5. TOTAL DEPTH: 70 FL' G =-
6. DOES WELL REPLACE EXISTING WELL? YES❑ NO 8�
7. STATIC WATER LEVEL Below Top of Casing:_2LyD FT.
(Use"+"if Above Top of Cuing) rr1
8. TOP OF CASING IS�_FT.Above Land Surfaces s
-Top of casing terminated st/m below land surfue requires a t
vviana in eororduc�y�w�ith 15A NCAC 2C.0I I&
9. YIELD(gpm):_JL�METHOD OF TEST f Ai r-
10.WATER ZONES(depth): 3 s cst
LOCATION SKETCH as
11. DISINFECTION:Type r Amount Show direction and distance in miles from at least
12. CASING: Wall Thickness two State Roads or County Roads.Include the road
Depth �j etm or WeighUFt. Material numbers and common road n nes.
From / To.�}�Ft G_ z/,c
From To Ft.
From To Ft
13. GROUT Depth kA- A
From To Ft. 9 M: ,Q, i— j
From To FL 3 r17�
14. SCREEN: Depth Diameter Slot Size Material 3
Frnm To FL in. _ in. .� 5'��do
From To Ft in. in.
15. SAND/GRAVEL PACK:
Depth Size Material p J..
From To Ft "rz O
From To Ft A fit
16. REMARKS: 41
u
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED ACCORDANCE WITH 15A NCAC 2C,WELL
CONSTRUCTION STANDARDS,AND TW A COPY OF THIS RD HAS BEEN PROVIDED TO THE WELL OWNER
SIGNATURE 05PERSON CONSTRUCTING THE WELL DATE
Submit the original to the Division of Wafer Quality,Attn:Information Management,1617 Mao Service Center-
Rateigis,NC 27699-1617, Phone No.(919)733-704 within 30 days.
GW-1 REV.09Q004

J t� 34P
WELL CONSTRUCTION RECORD
DA
North Carolina Department of Environment and Natural Resources-Division of Water Quality
WELL.CONTRACTOR apiDMIVIOUAL)NAME (prig Anthony Bryant Smith CERTIFICATION a 2571
WELL CONTRACTOR COMPANY NAME Gillen RNer Weer 6 Peep C.onpany PHONE P (A 603-1200
SLATE WELL CONSTRUCTION PERMITe ASSOCIATED WQ PERMITa Cl IOU I I O 3O�
(if applicable) (if applicable)
1. WELL USE(Check Applicable Box):Residential QL Municipal/Public❑ Industrial ❑ Agricultural❑
Monitoring❑ Recovery ❑ Heat Pimtp Water Injection❑ Other❑ If Other,List Use
2. WELL LOCATION: Topographic/Land setting
Nearest Town: �u O.J G County d-"SCYI EfRidge ❑Slope ❑Valley ❑Flat
04-F Ef t �Uy--cj0 1J C_ (chock aPPro"k box)
(Sired Name,Numbers,Coow,m ,ity,Subdivision.Lot No. Zip Code) Latitude longitude of well location
3�` 13' 0
t,/3 Ogg` $ U �lt
3. OWNER: kA-I.JV)e�rh g (A (dcgrodmmmnheconds)
Address Po (boic: a4J. Latitude/longitude source:20PS❑Topogmphicmap
(Skeet or Route No.) (chock box)
1 til .e 40. Ili L Z7r7cK� DEPTH DRILLING LOG
Ciry es Town Suits Zip Code From To Formation Description
TZ (d13 -SCc'I L O /� 401YZ I'
Amer coda Phone _ 1.r L�J`
4. DATE DRILLED
Si ED $ � OS
5. TOTAL DEPTH: '
6. DOES WELL REPLACE EXISTING WELL? YES❑ NO B'� �—
m
7. STATIC WATER LEVEL Below Top of Casing: 00 FT. v
(Usc"+"if Above Top of Casing)
8. TOP OF CASING IS�_FT.Above Land Surfaces
'Top of casing urulaMW War Wow lead ssrfu requires a y®
varies"V secordeaoe with ISA NCAC 2C.011a
9. YIELD(gpm): ,r7o METHOD OF TEST(it
10. WATER ZONES(depth):
LOCATION SKETCH
11. DISINFECTION:Type Amount Show direction and distance in miles from at least
12. CASING: Wall Thickness two State Roads or County Roads. Include the road
r Depth , Di to or Weight/Ft. Material numbers and common road names.
From To_�L Ft !. L
From To Ft
From To Ft
Mraria13. GROUT: Depth
Fromm To-',Q_Ft. �M � �Ml
From To Ft nn
14. SCREEN: Depth Emote, Slot Size Material IL�'
From To Ft. in. in. ty
From To Ft_in. in. C
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft. C7
16. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C,WELL
CONSTRUCTION STANDARDS,AND HAT A COPY OF THIS CORD BEEN PROVIDED TO THE WELL OWNER
SI ATURE F PERSON CONSTRUCTING THE WELL DATE
Submit the original to the Division of Water Quality,Attn: Information Management, 1617 Mail Service Center-
Raleigp,NC 27699-1617. Phosse No.[phone],within 30 days.
- GW-1 REV.09/2004

WELL CONSTRUCTION RECORD 0
l
North Carolina Department of Environment and Natural Resources-Division of Water Quality ur
WELL CONTRACTOR(INDIVIDUAL)NAME Wiut) HOMY Bryant Smith CERTIFICATION 0 2571
WELL CONTRACTOR COMPANY NAME CarOW PAW WON&Pump Cgrpany PHONE# - 693.12OD
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT# O 3 Z
(if applicable) If applicable)
1. WELL USE(Check Applicable Box):Residential EdlMunicipal/Public❑ Industrial ❑ Agricultural❑
Monitoring❑ Recovery ❑ Heat Pump Water Injection❑ Other❑ if Other,List Use
2. WELL LOCATION: Topographic/Land setting
Nee at Town: county_4-killers, ❑Ridge ❑Slope ❑Valley Cat
c649 rntd Mleen �1l (chock appropriate box)
(So"Name,Number,Cammuaity,SubdiviDiDa,Lot No.,Zip Code) Lafin)de/IollgitUde of well location
T /� 37 is f f' t�/IJr9b_ 2 kr ata//
3. OWNER: IJ a-#Ii t'_I ALKie*--5 (degmWminutes/soconh)
Address $'6 Q' M .,J A41,eli Ae Latitude longitude source: map
+
(Streete,Rome No.) (check box)
�-(g'na-u,1mUtIIP;1jC-2-IL-
5Z DEPTH DRILLING LOG
6 z'ay or Tow. $4-surer ZIP Code From o Formation Description
t-27ar �4 �— U$—
Am coda-Pbole numbe,
4. DATE DRILLED qIZ23 o
5. TOTAL DEPTH:
6. DOES WELL REPLACE EXISTING WELL? YESrf O 23
7. STATIC WATER LEVEL Below Top of Casing: X FT. _
(Uro" "if Above TopofCeaing)
S. TOP OF CASING IS_�FT.Above Land Surface*
'Top of caelag teraioaled War below land ourfaee require,■ i --
vrinnce in accordance with ISA NCAC 2C.01I&
9. YIELD(gpm):—_METHOD OF TEST r Ai� p
10. WATER ZONES(depth): J It tit
LOCATION SKETCH
11, DISINFECTION:Type k T H 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 Waight/Ft. Material numbers and comm m on road names..
From To,/d FtT � './y L
From To Ft.
From To Ft
13. GROUT: Depth Material Meth �1
From To FL-5,* � Kxx00'
From To Ft
14. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in. D
From To FL—mi . _ in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft
16. REMARKS: Sfi/L_r11 y ' l;.r�� P,'a� �..;tti A,4c kF l2 !SD ' ;v y; t; w,�l l
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C,WELL
CONSTRUCTION STANDARDS,AND THAOA COPY g 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,Attn: Information Management, 1617 Mail Service Center-
Raleigh,NC 27699-1617, Phone No.[phone],within 30 days.
GW-1 REV. 09/2004

WELL CONSTRUCTION RECORD 3 1 6 1 1 0
North Carolina Department of Environment and Natural Resources-Division of Water Quality
WELL CONTRACTOR(I NDIVIDUAL)NAME (print) Bryant Smith — - CERITFIC.ATION#2571
WELL CONTRACTOR COMPANY NAME Green River Wall&Pump Company —PHONE TONNE a (928)6(9�3C12200
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
I WELL USE(Check Applicable Box) Residential` /MunicipaVPublic ❑ Industrial ❑ Agncultural ❑
Monitoring❑ Recovery ❑ Heat Pump Water Injection❑ Other❑ If Other,List Usc
2. WELL LOCATION Topographic/Land setting
Nearest Town: r) 0.., Court lUd.I24$Q7L� ❑Ridge ❑Slope ❑Valley B Iat
L g( Rf4 L.D+-F a,,,o , (check appropriate box)
(Street N e,Nmnbm,-Cool unity,Subdivision,Lot No.,Zip Code) Latitude/lon dude Of well location
3 OWNER: Yl.l,CTl -BI�1Y -� 33"`�zgr fly,./c' on )
(degrcea/mmutes/eccond.
Address Latitude/longitude source.QGPSOTopographic map
(Street or Route Np.) ! 1 (check box)
DEPTH DRILLING LOG
city or T07; ,�s�t�gd8. Zip Code From Fo qn Description
Area code-Phone number _ pt
4 DATE DRILLED{ -2C -05 l�0
5 101'AL DEPTH.
6 DUES WELL REPLACE EXISTING WELL? YES ❑ NO fey
? STAIIC WATER LEVEL Below Top of Casing. 2, j FT. C/)
(Use-+"if Above Top of Casing)
S. -TOP OF CASING IS�_FT. Above Land Surface' .e
•Top of casing terminated at/or below land surface requires a I —�
variance in accordance with ISA NCAC 2C.0118. '
/ YIELD(gpm): METHOD OF TEST oilZ
I U. WATER ZONES(depth): at LOCA hION SKETCH
i I. DISINFECTION:Type jjTly Amount Show direction and distance in miles from at least
12. CASING: Wall Thickness two State Roads or County Roads. Include the road
To
Dia eter or Weight/Ft. Material numbers and common road names.
From To Ft ekf=
From1Q1 To (O FL
From To Ft.
I± GROUf Depth Material
Method_
From To""Ft.
From To Ft. Ly
14. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in. t '
From To Ft, in. in.
15 SANU/GRAVEL PACK.
Depth Size Material
From To Ft.
From To Ft.
Ib REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL W CONSTRUCTED 1N ACCORDANCE WITH 15A NCAC 2C.WELL
CONSTRUCTION STANDARDS,AND THAT A PY OFT S RECORD HAS BEEN PROVIDED 1'D THE WELL OWNER
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
Submit the original to the Division of Water Quality, Attn: Information Management, 1617 Mail Service Center-
Raleigh,NC 27699-1617, Phone No.[phone],within 30 days.
GW-1 REV 092004

q
3 1 fs' V0 5 8
I S RESIDENTIAL WELL CONSTRUCTION RECORD
�. North Carolina Department of Environment and Natural Resources-Division of Water Quality
WELL CONTRACTOR CERTIFICATION#
1.WELL CONTRACTOR: f. DISINFECTION:Type Amount
6 I L-%- 'E- f g. WATER ZONES(depth): /
Well Contractor(Indwldual)Name From To Y`t' .A
.` EEEE
// � From To
C) From To From To
Well Contractor Company Name ) � ( It From To
3 I w 1-t3)t'�,S It3P- From To
STREET ADDRESS e. CASING: Thickness/ Wort.
ASA@ad *�a tJC a8 S a to Fram�_DePI i Qi eter SD 1 . VI
To 5 Ft.
City or Tam State Zip Code Fran To Ft.
3 J�1 _
From To_Ft.
Area code- Phone number —'-
2.WELL INFORMATION: 7. GROUT: Depth Material {� Method
SITE WELL ID#(if applicable) Fran_TD qo FL 114 yM
From To_Ft.
STATE WELL PERMIT#(if applicable) Fran To_Ft.
DWQ or OTHER PERMIT#(if applicable) 8. SCREEN: Depth Diameter Slot Size Material
WELL USE(Check Appfi le Bo : Reesidential Water Supply V From" To_FL—in- __ in.
DATE DRILLED ( J Q (0 5 From To_Ft. in. _ in.
From To Ft._in. _ in.
TIME COMPLETED Z• C AM p PM
9. SAND/GRAVEL PACK:
a.WELL LOCATION: ty C l Depth Size Material
CITY: rn L L-L-S d�- COUNTY ��W,�E(L$o� From To_Ft.
Fran To__Ft.
l CT ! 11 KAC �? [) �nRmS From To Ft.
(Street Name.Numbers. ranmunrly,Subdixsion,Lot No.,Parcel,Zip Code)
TO/POGRAPHIC/LAND SETTING:
Q61ope ❑Val 10.DRILLING LOG
ley pFlat ❑Ritlge ❑other From,, To o F rmatio Descnpl10(check appropriate box)
LATITUDE 3 — May he in deem, i v D
minut�,SCCOM$or -- 3 Q D awl
LONGITUDE in decimal fomlat
Latitude/longitude source: ❑GPS OTopographic map
(IDcation of we0must be shown on a USGS topo map and
attached to this form 1 not using GPS)
4.WELL OWNER ( rn
OWNER'S NAME � J A m-IS S V 2 S 1 N
SJjRR!EET ADDRESS C3 F S`[
jQC 6V79a o
City or Town State Zip Code -
t x >_ toil a - «+ I
Area code- Phone numbw
S.WELL a. TOTALTAILS:DE DEPTH: _ils5 ( 11. REMAItICg;-- C&8
b. DOES WELL REPLACE E%ISTING WELL? YES❑ NOb
C. WATER LEVEL Below Top of Casing: ® FT I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED N ACCORDANCE WITH
1SA NCAC]C.WELL CONSTRUCTIDN STANDARDS.AND THAT A COPY OF THIS
(Use-t-tl Above a�of CaaIng) RECORD HAS BEEN PROVIDED TO THE WELL OWNER.
d. TOP p, CASING IS FT.Above Land Surface- I G C
'Top of casing termirlaled aVor below land surface may require ,t7 "�- f t�(M7✓�/ ✓ J
a variance in accordance with 15A NCAC 2C.011118 ( �,1 p SIGNATURE OF CEGGRTIFIED WELL CONTRACTOR ATE
e. YIELD(gpm): c'� METHOD OF TEST 416� NiR- 67 L.Lr1D NAC 14
PRINTED NAME OF PERSON CONS RUCTIN7 NG THE WELL
Submit the original to the Division of Water Quality within 30 days. Attn: Information Mgt.,
1617 Mail Service Center-Raleigh,NC 27699-1617 Phone No.[phone]ext 568. Form GW-1a
Rev.7105

�� 34 w
WELL CONSTRUCTION RECORD V� " " ( d `
North Carolina Department of Environment and Nanral Resources-Division of Water Quality
WELL CONTRACTOR(INDIVIDUAL)NAME (prfaQ Anthony Bryant Smith CERTIFICATION O 2571
WELL CONTRACTOR COMPANY NAME Green RNm Wan&Pump Company PHONE O (Y2:4 693-1200
STATE WELL CONSTRUCTION PERMITO AS SOCIATEDWQPERMITO L15 /90) 6994S'
(if applicable) / (if applicable)
I. WELL USE(Check Applicable Box):Residential g MtnicipaltPublic ❑ Industrial ❑ Agricultural❑
Monitoring❑ Recovery [] Heat Pump Water Injection❑ Other❑ If Other,List Use
2. WELL LOCATION: I � �phic/Land settingNearest Town: J { Cmry dge ❑Slope ❑Valley O Flat
1try,/AQ t nfr S�gA 0ysimo1I(P P(.. (check appropriate box)
(Street Nam Numben.Coa m airy,Sube iv:in t No.,tip Code) --i LatitudM ngitude of well location a ,
3. OWNER:( '1'1]1C&, e to I AC-L 9 s ta-I� ' '� Z3 sN 4 O$2a 19 2zLj
I (degreea/mmuta/eeconde)
Address
—fi-t - 1
(check(1 ne. Latitude/longitude source:OGPSOTopographic map
(fin box)
M orcy� (li71 DEPTH DRILLING LOG
City or IV" stad Zip Code From To
Forma tipn.4rr ption
4ffl�r-�eD3 Cj
Am code-Fuenc samba O
4. DATE DRILLED_ -W '01= tiR
5. TOTAL DEPTH: 3tf S
6. DOES WELL REPLACE EXISTING WELL? YES O NO
7. STATIC WATER LEVEL Below Top of Causing:--e-0 FT. '
(Use" "if Above Top of Cuing)
8. TOP OF CASING IS�_FT.Above Land Surface• FM
-Top of cuing terminated War below land aurfaw requires a �r
variance In accord ao with ISA NCAC 2C.0I1&
9. YIELD(gpm): METHOD OF TEST -111 1 r"
10. WATER ZONES(depth): O /Gym
y� - .2 S- rL e1 m LOCATION SKETCH -
11. DISINFECTION:T —�nt Show direction and distance in miles from at least
12. CASING: Wall Thickness two State Reads or County Roads.Include the road
Depth Di to or Waight(Ft. Material numbers and common road names.
From_LTo,/_Z Ft__r '27_2 pac—
From To Ft.
From To Ft 4
13. GROUT: Depth nal Meth
From Tom c7 FL�
From To Ft
14. SCREEN: Depth Diameter Slot Size Material �l
From To Ft. in. in.
From To Ft_in. _ in. C!1„the�� RD 4
15. SAND/GRAVEL PACK: f. I` CJ'
Depth Size Material \
From To Ft.
From To FL
16. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUC D IN ACCORDANCE WITH 15A NCAC 2C,WELL
CONSTRUCTION STANDARDS,AND THAT A COPY OF THI ORD HAS BEEN PROVIDED TO THE WELL OWNER
2 - / - 05—
SIGNkrURE OF PERSON CONSTRUCTING THE WELL DATE
Submit the original to the Division of Water Quality,Attn: Information Management, 1617.Mail Service Center-
Rakdgie,NC 27699-1617, Phone No.[phone].within 34_days. ------ -- . -
GW-I REV. 09/2004

WELL CONSTRUCTION RECORD lJ`�` - 'j � r'z
North Carolina Department of Environment and Natural Resources-Division of Water Quality
WELL CONTRACTOR(INDIVIDUAL)NAME (print) Anthony Bryant Smith CERTIFICATION#2571
WELL CONTRACTOR COMPANY NAME Green River Well&Pump Company PHONE # ( )693-1200
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT# OSI Ato 109d
"applicable'
(if applicable)
1. WELL USE(Check Applicable Box):Residential Q"Municipal/Public❑ Industrial❑ Agicultural❑
Monitoring❑ Recovery ❑ Heat Pump Water Injection❑ Other❑ If Other,List Use
2. WELL LOCATION:
�4�arest Town: f d U t lie Cc ty + u O(Q/St n Topographic/Land setting
U&I0) -✓loll C s1A e5 ak 0 OfUdge ❑Slope Malley ❑Flat
S 011 l I4f ( (check appropriate box)
(Street Name,'t au ben,Community,Subdrvn,on,Lot No.,Zip Code) La"e/longitude of well location
r t
3. OWNER: t ; . cy-F-S' cles 35 23' S7Al ag2O 11?.?31-)
Address (degraea/minuW/seconds)
q
�t I� n✓1P Latitude/longitude source:❑GPS❑Topographic map
(Street at Route No.) (check box)
n rC IJC o�R(o SS DEPTH DRILLING LOG
Cry tV Town-Sute Zip Code From To Formatio DOscri tion
��_4't)S" �l003
Area code-Phone ou,nber
4. DATE DRILLED
5. TOTAL DEPTH: e:R'A 15,
6 _
6. DOES WELL REPLACE EXISTING WELL? YES❑ NO
7. STATIC WATER LEVEL Below Top of Casing: 40 FT.
(Use"+^if Above Top of Going)
8. TOP OF CASING IS ( FT. Above Land Surface'
•Top of easing terminated attor below land surface requires a la
variance in accordance with ISA NCAC 2C.011& ...-t
9. YIELD(gpm): .'�ME�THOD OF TEST
a Qy Act f t �
10. WATER ZONES(depth):— 5
�GDa ,K p LOCATION SKETCH O
11. DISINFECTION: Type }�—C-#i ount Show direction and distance in miles from(d{least '^'1
12. CASING: Wall Thickness two State Roads or County Roads.Include the road.-ry;
Depth Di eter or Weight(Ft. Material numbers and moron road names.
From To l,l Ft
From To Ft.
From To R
13. GROUT: Depth Material Method
From To_Z�Ft. 6"d , AnEr M7�Z T
From To Ft
14. SCREEN: Depth Diameter Slot Size Material
From To Ft—in. _ in. /�
From To Ft. in, in. 1. 4)�j,�v�
15. SAND/GRAVEL PACK: j
Depth Size Material Esf t.
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 OPY OF HIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
Submit the original to the Division of Water Quality,Attn: Information Management, 1617 Mail Service Center-
RAleiglt,NC 27699-1617, Phone No.[phone],within 30 days.
GW-1 REV.09/2004

WELL CONSTRUCTION RECORD C� �` " i a' P
North Carolina Department of Environment and Natural Resources- Division of Water Quality
WELL CONTRACTOR(INDIVIDUAL)NAME (print) Bryant Smith CERTIFICATION M 2571
WELL CONTRACTOR COMPANY NAME Green River Well&Pump Company PHONE N /(8,,29)693-1200
STA TE WELL CONSTRUCTION PERMITN ASSOCIATEDWQPERMITa
(if applicable) (if applicable)
I WELL USE(Check Applicable Box): Residential L9__�Murticipa/Public ❑ Industrial ❑ Agncultural❑
Monitoring O Recovery ❑ Heat Pump Water Injection❑ Other❑ If Other,List tJse_ _
2 WELL LOCATION. Topographic/Land setting
Nearest Town: mono !2 County_ikt'_l^Y�(Ap"lr��j ❑Ridge ❑Slope galley ❑Flat
1 2A'3 N Q e 9d I d0/C6Y711 j//Q /(_.Zg [7.� (check appropnaw box)
(Street Name,Numbers, unity,Subdivuion,Lot No.,Zip Codc) Lall al longitude of well location
3��:�x r 39�✓ opozo ,ly )
1. OWNER: e. l �.. (degr mmumaAeaonds)
Address 5 kwii*r ©YiUE� Latitude/longitude source:Q6PSOTopographic map
(Street orRauh;No.) (check box)
+ rl as Svr\l2 t I I?1 I3 �rC 3y DEPTH DRILLING LOG
City or Town scam Zip Code From To Formation L�escnRtion
e� Phone nu -to o b Z —L =' � d c /�r
Area code-Phor¢number
4 DATE DRILLED ?' O5-
5. TOTAL DEPTH: 1575 —�,2 D bROc1s
b DOES WELL REPLACE EXISTING WELL? YES ❑ NO 9_ die')
1
? S I ATIC WATER LEVEL Below Top of Casing: 20 Fl.
(Uae"�"SAboveTopofCasing) -- ';`y
,i I OP OF'CASING IS L FT. Above Land Surface•
•'1'up ofcasing terminated atior below land surface requires a
variance in accordance with 15A NCAC 2C.0118. —
9. YIELD(gpm) a0 METHOD OF TEST LQ, r2 — �_--
1 U. WA f ER ZONES(depth): �'y 5 �n —1 '"
.O
00 _ ICAIION SKETCH Q%
I 1 DISINFECTION: Type AmC( t Show direction and distance m miles fro i at lepst
12 CASING: Wall Thickness two State Roads or County Roads. Incl the tad
Depth Diameter or Weight/Ft. Material numbers and common road names _
Irrom To;21 Ft. Z:k for (-
From To Ft.
From To Ft. ��� L
13 GROUT: Depth Material Method
From 19 To :2jLFt. 5 r�
From To Ft. V
14. SCREEN: Depth Diameter Slot Size Material N
From To Ft. in. in. .
From To Ft. in. in.
15 SAND/GRAVEL PACK:
Depth Size Material Q
From To Ft �7
From To Ft.
Rol
16. REMARKS. ----. -
I DO HEREBY CERIIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WIIIf 15A NCAC 2C, WELI,
CONSTRUCTION STANDARDS,AND THAT A COPY OFT S RECO HAS HELN PROVIDI`D TU 1I11 WELL OWNER
va�_ g ' -C14—
SIGNAT4KE OF PERSON CONSTRUCTING THE WELL DATE
Submit the original to the Division of Water Quality,Attn: Information Management, 1617 Mad Service Center-
Raleigh,NC 2 7 699-1 61 7, Phone No.[phone],within 30 days. —v— —"-- "
' CiW-I REV 09/2004
i

am 3 1
RESIDENTIAL WELL CONSTRUCTION RECORD
North Caroline Lkpertrn=t of Environment and Natural Kcsounxs-Division of water Quality
WELL CONTRACTOR CERTIFICATION N 45 r j
1.WELL CONTRACTOR: ` 1 , f. DISINFECTION: Type it Amount
'j�>III IACa.Akt SI-Y1 T9l) g. WATER ZONES(aeptn)
Wall Oftrachor(Individual)'Name Fran /SS— To /fG From To
Gr2_e=-n �,y e r- W 1!l� o ?u y„P From To From I To
Well Contraaa Company Name `' From To From To
STREET ADDRESS �G )OV- �l) T 8. CASING: Thickness,
q Depth DIa er Weigel to el
C 45t IQ fi �Ql-IV. �) C o� I,� Fran To 1. Ft
City or Timis State r Zip Code From To Ft.
( I-_ rp93-)Z00 From To—Ft.
Ara code- Phone number
7. GROUT: Depth Material Method
2.WELL INFORMATION: From L To Ft. 24' t Z{
SITE WELL ID C.f applx:aole) From To Ft
STATE WELL PERMITe(eappkcabre) 651a01I0 From To Ft
DWO or OTHER PERMIT a(a appkcabe) 8. SCREEN: Depth Demetar Slot Size Material
WELL USE(Check Appliable Box). Residem®I Water Supply U]/ From_To Ft._n. _ n.
From To Ft. n. in
DATE DRILLED �I�10 5 From_ To Ft n in
TIME COMPLETED L 2 1 DO AM p--PM p
9. SANWORAVEL PACK.
3.WELL LOCATION: ,, Depth See Material
CITY: �0.-P��5 COUNTY Oer-delI Fran To Ft.
" � ff __ __ ` From To Ft.
1�u1,x�L,, 1S7-4A1c {���'�C{�e-r Ica From To Fl.
(Sreol Name.Numtera.Communay,Subdmsion,La No..parcel.Lp Code)
TOPOGRAPHIC LAND SETTING: 10. DRILLING LOG
❑Sege OValey ❑Flat O'kidge OOmer From To Formation Description
(check eppdopnae box) �( d
LATITUDE 5caa' o-I e2/v minute indp�i or 22 DIY
LONGITUDE
r r id ✓ M a�unal Ibri V
LatitudeAongitude solace: pQPS OTopograpluc trap -w
(location of who nwW be shown on a USGS torpid map and
attached to this tom,%nor us V GPS)
D
e.WELL OWNER —+
I I
OWNER'S NAME n t CS c �'�M III GtAtn4e:l -
STREET ADDRESS 300 'I h ce- I—
Pc� ►3 c, a 16 o3 CA
City or Town State Zip Code =-
Lgz�. lotcl - 09� 8 _
Area code- Phae number
11. REMARKS:
5.WELL DETAILS: Q
a. TOTAL DEPTH: -
b. DOES WELL REPLACE EXISTING WELL? YES❑ NVL.I
I DO HEREBY CERTIE rHAT THIS WEll WAS Cp+STRUCTED IN ACCORDANCE WmH
c. WATER LEVEL Below Top of Csng: FT, LaA NCM.X.WELL consrRLxTxn+ NwRDS AND THAT A C Y Dr THAs
(Use y E ADoAe Top of Csng) RECORD INS BEEN RROYOED roTN ELL OWN
d. TOP OF CASING IS FT.Abuse Lard Surface• / p/'/(7-lnS
"Top of casing temrinated aVa belov land surface may require SIGMA URE CERTIFIED WELL CONTRACTOR DATE
a varience In accordance v.8h 15A NCAC ZC.oi 1 a.
e. YIELD(9pm): I METHOD OF TESTA, r
PRINTE NAME OF PERSON CONSTRUCTING THE WELL
Submit the original to the Division of Water Quality within 30 days. Attu: Information MgL, Form GW-la
1617 Mall Service Center-Raleigh,NC 27699-1617 Phone No.[phone] ext 568. Rev 7/05

V Ir d
PM( .
RESIDENTIAL WELL CONSTRUCTION RECORD
ryryyy ii
North Carolina Department of Envimnmrnt and Natural Hcsourus DWisan tR water Quality
�:
WELL CONTRACTOR CERTIFICATION N �(5 2
1.WELL CONTRACTOR: I. DISINFECTION:Type f Amourn
g. WATER ZONES(oeptn) L
Wall Cophtlector vl (pMiiclual)Name From To I'm From po
ree-n ?1VPr' kJ" Ll/ From To From To
C F
Well Contrada Company Nana From To From To
STREET ADDRESS Imo�0C a0 T 5. CASINO: TMcknesv
C "'� Dean Lye er w_egM ur®I
CQS+ Y �At From _To $F0 L (�
City or Town Sate Zip Code From_To Ft.
�- (o93-)2oo From_To_Ft
At"coda- Phone numDw
7. GROUT: Dean Material Method
2.WELL INFORMATION: From /2 To_2_(Z FI SHE
SITE WELL ID Nil spasm) From_To Fl.
STATE WELL PERMITe(w appocame) From—To Ft.
DWQ or OTHER PERMIT Sir applicable) g. SCREEN: Depth Dnmear Slot Size Matenal
From_To Ft._w+. _ In
WELL USE(Chock///pp{{�'jjlllc es able Box) Residential Walter Supply O From_To Ft_n In
RI _ .
DATE DLLED 'p� ,Z 1)/�-� From_To Ft_ai _ M
TIME COMPLETED L O U AM❑ PMpa p SANDIGRAVEL PACK
3.WELL LI ATION: �I Dean Sae Matenal
COUNTY
CITY: C.-(J h�� 1 ' I G aso From To Fi.
7 I From To Ft.
�
L /LD (7rq Ad Cjak-s yjC cL. From To_FI
(Stf reel we,Nu DSYS,Cornmurwly.ww-d aicn,Lot No..Parcel,Zip Cooe)
TOPOGRAPHIC LAND SETTING: 10. DRILLING LOG FV�f abo �¢�C
[�Srlopa OVaack awropr Ble DOX) �06Lsr F� i�o Vey
l Tlty
n
May be in degrees. 5 /f O I
LATITUDE -7 3Q �oN minuln.wournda or - S
wl a LONGITUDF doetrual format
r II �' - -
Lautude/longiuAc Source: ErGPS ❑Topograptuc map X
(poem of we1 must be shown on a USGS repo map end
atraehw N um Roan Y not usM GPS)
a.WELL OWNER R, 7
CDOWNER'S NAME s t✓V l�'eYs
STREET ADDRESS O 1 +-sr
(i jc� a
City or To^^�O DState Zp cod. -
AT"cede- Phone numbw 11. REMARKS:
6.WELL DETAILS: I
a. TOTAL DEPTH:
b. DOES WELL REPLACE EXISTING WELL7 YES❑ NO)�-
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED N ACCORDANCE W TTH
c. WATER LEVEL Below Top of Caurg:_,_ED,FT. ISA NCAC X.WELL CONSTRUCTION STANDARDS.AND THAT A 00P OF THIS
(UN'+*I Above Top d Camp) RECORDHAS BEEN PROrOED TO THE W ELL OWNER/
d. TOP OF CASING IS ( FT.Above Lard Surface' /'S /Z !y "'Z/-o
-Top dining tom ed oft below land surface my require SIGNATURE OF CERT�IFI"E D WELL CONT RACTOR DATE
a wrlanc,oraccoroer wtlh 15A NCAC 2C.0116. rn I
a. YIELD(pgn): METHOD OF TEST !/� — PRINT NAME OF PERSON CONSTRUCTING THE WELL
Submit the original to the Division of Water Quality within 30 days. Attn.:Intormabon MgL. Form GW-19
1617 Mall Service Center-Raleigh, NC 27699-1617 Phone No.[phone] eat 568. Rev 7/05

RESIDENTIAL WELL CONmucriON RECORD
North C hna Ucperbnant of Envimnmrnl and Natural Kasou=s-Division of w atcr(1uaLry
WELL CONTRACTOR CERTWICATION N ; "S '7 1
1,WELL CONTRACTOR: I. DISINFECTION:Type �Ji� Amourn
rU"J— S W I( 9. WATER ZONES(depth) RA
Wei Contractor(Individual)No" L From To 14C `SFrom To
(Sre_e-n �ivPr W(Individual)
0 0 sky Fronn I*16 To W afYFmm To
Well Conoat%a Company Noma �1 From To From To
STREET ADDRESS PC) 13 OV- 0,U T 6. CASING: TMukness,
C L r7 �1 / Depth to tot Weight Moteral
CQS-� Y IA fi 1O C.)C-. K) �. o� 0 1 d l0 Fromi_To Ft V /�
City or Town State Zip Code From_To Ft
6 9 3-1Z o o From To Ft
Aran code- Phone number
7. GROUT: Depth Materialm � / A Moio
2.WELL INFORMATION: L�L��-`Fro To Ft. 7
SITE WELL ID e(d appaade) From_To Ft
STATE WELL PERMITe(e apphceole)eq Tl OOI U 93 2I? From To Ft
DWQ or OTHER PERMIT e(i appWablo) B. SCREEN: Depth Domeier Slot Size Material
From_To FL_n. _ n.
WELL USE(Check Applicable Box): Residental Water Supply O From To Ft_in _ n
DATE DRILLED 91,91) r From in
To Ft in _
TIME COMPLETED r b AM❑ PM LXy/ 9. SAND/GRAVEL PACK.
3.WELL LOCATION: / _ Depth Sae Material
C I - - U j 1 1 From To Ft
)IC��ITY. ta/AYM Il - f.COUNTY �� prprn To Ft,
LID IS, GT-Gl.0 A ©LI.AvLs -]L')Ytu-c From To Ft
(Stroel Name.Numbers.Community,Subckm a .La NO..Parcel.Zip Cone)
TO/PPOGRAPHIC/LAND SETTING. 10. DRILLING LOG -
Q,blopo ❑Volley OFMt ❑Ridge DOIMr From To F rmation Wrtpuon
(check appropriate OOe) od hi
��
a J. May be in degrees. h
LATITUDE �$�`�� minub,ecwrdees a l
LONGITUDE a';If 19, of a-L<) m a docmiel format
Laurude/longittde Sauce. ❑GPS ❑Topographic reap L�
(bcatbn of wa/must be shown on a USGS bpo map and
atbcnad to rm roan 7 rat usev CPS)
e.WELL OWNER �J
OWNER'SNAME leS C7LI I I Ql'S -A�1 C) '
f3F
STREET ADDRESS IAID OCLIC- a4kd ti-t( IS lam"'
mow&-t-- ti►C_ a"6'7a 9
Cky or Town State Zip Code
Arm code- Pram number
11. REMARKS:
6.WELL DETAILS:
a. TOTAL DEPTH:
b. DOES WELL REPLACE EXISTING WELL? YES❑ NLTp
1 WHEREBY CER`h Y MAT THIS WELL WAS CONSTRUCTED iN ACOCRUANCE WrTH
c. WATER LEVEL Below Top of Cooing: /.S FT. IM NCAC x.WELL consmuCrgN STANDARM AND ricer A OOvY of THIS
(Ufa,+-/Above Top d C»ng) RECORD HAS BEEN PRovO D TO WELL OWNER
d. TOP OF CASING IS ( FT.Above Land Surface' 9"1y-C�s
'Top d cesing tomillated 50or below land surface my require SIGNATUR MF CERTIFIED WELL CONTRACTOR DATE
a voranu in+ aence with 15A NCAC 2C.0118.
e. YIELD(gpm) 1 METHOOOF TEST PRINTED NAME OF PERSON CONSTRUCTING THE WELL
Submit the original to the Division of Water Quality within 30 days. Attn: Informatlon Mgt., Form GW-1a
1617 Mail Service Center-Raleigh,NC 27699-1617 Phone No.[phone] ekt 588. Rev 7105

3 B ( v xLL (
RESIDENTIAL WELL CONSTRUCTION RECORD
S T
North Carohna lXpartment of Environment and Natural Resources-Divmon of water Quabty
$'A
WELL CONTRACTOR CERTIFICATION a pl 5 ?
CONTRACTOR' I. DISINFECTION:Type H T rt Amount
g. WATER ZONES(depth)
J (Individual)W)No w From J'tV To Ilb From To
(jT-e_e-,n ��U fir- kO �((yy.LD Fran To From To
Wall Contieuta Company Nanr 7 From To From To
STREET ADDRESS is SOX diU T 6. CASING: Thickness
C _ �j / L r-T �7 / Depth ,�/ D� Item Weight M�ryh
Fat 5+ l- ]a t izo C"K-. K) (� & I oC lC+ From Tom Ft
City or Term State I Zip Cade From To Ft.
(pc6 1- /_q 2_)z U O From—To Ft
Area coda- Pfwna number
7. GROUT: Depth Ma({penal Method
2.WELL INFORMATION: z O Ft CA'aMf rj' ,�rL ,
From To ✓ R �JA�o0e
SITE WELL IDa(il apoiatae) !1 / From To Ft
STATE WELL PERMITS(x appnce LJ bie) .S I!;, l 0 91a l!J From—To Ft
DWQ or OTHER PERMIT e(e applicable) 8. SCREEN: Depth Diameter SM Sea Malarial
From_To Ft.
WELL USE(Chock Iwble Box): Residem ❑ol Water Supply in n.
From in_ To Ft
DATE DRILLED 2-(.D US From To Ft n n
TIME COMPLETED 5:co AM❑ PM}�..
9. SAND/GRAVEL PACK:
3.WELL LOCATION: y� From Depth See Matenal
CITY t-" C: C W0.'� COUNTYt ) To Ft.
p rl O ..-..._To_Ft.
O SC�7/1 LLl.tl. Oe IYC1r �Q /Z/ From—To—Ft
(Street Name,Numtxxa.COM . SUtdINaUn.ld Fb..Pa ., i� coci )
TOPOGRAPHIC/LAND SETTING: 10. DRILLING LOG
❑Sbpa ❑Valley ❑Flat ❑RR7pa OOtlwr From To Formation Description
(ctnxR appj coeboa) — 3D
�Q rA,I May be m degree,
LATITUDE ��4..J4Ly—y loj 39,v mtinale,eowrdea �n - L �
WpCA-
LONGITUDEyg2e j(o' ma dminal Tomnat LD — 61
Laritude/longiwde source: aCIPS ❑Topographic reap --
(boetron of war moor be shown on a USGS tupo map and
attached m Ow form Y not uvg GFS1 _
4.WELL OWNERrr
OWNER'S NAME
STREET ADDRESS PG )K. SEi3
t,-oLIB t � Cz4'7a-9 0
City a Town State Zip C d.
I <%- SgI -4ag
Arse code• Phone number ."`
11, REMARKS:
8.WELL DETAILS:
a. TOTAL DEPTH: -7 S
b. DOES WELL REPLACE EXISTING WELL? YES❑ NO L3'
DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDNNCE W nH
c. WATER LEVEL Below Top of Casing: I H h FT. to NCAC K.WELL C ETR C s NDARDS AND THAT A CO'Y Or THE
(UN-+'I Above Top of Cooing) RECORD HAS BEEN PROVIDED TOT. ELL OWNER
d. TOP OF CASINO IS t FT.Above Lard Surface' j(/,G�
-Top of casing tarrrinaled aaa babes lend surface moy,wwe SIGNATURE 6F CERTIFIED WELL CONTRACTOR DATE
a variance in accordance,with 15A NCAC 2C .0118, �/ Q��
a. YIELD(9pm): cJ METHOD OF TEST N Lr
PRINTED OF PERSON CONSTRUCTING THE WELL
Submit the original to the Division of Water Quality within 30 days: Attn: Information MgL, Form Gw.la
1617 Mall Service Center-Raleigh,NC 27599-1617 Phone No.(919)77!7-7015 ext 568. ReY 7/05

RESIDENTIAL WELL CONSTRUCTION RECORD
North Carobra Dcparbncnt of tnvrmnment and Natural Retiources Diviswn of watcr Quabry
WELL CONTRACTOR CERTMCATION N rat 5
1.WELL CONTRACTOR: I. DISINFECTION: Type Am t
� ourr,r11(AMI �✓n 4 1 `r�' ¢ WATER ZONES(oapth) � IR/7or
/Ww (Individual))Nlame r From q0 To /Q� From To
�1re_een ?1,JPt- we11 ?k/F� From 3 yB To 3Yh From To
Well Contractor Company Name �1 From To From To
STREET ADDRESS F�� i ox. 1, U T 6. CASING: Thickness,Diaryolor �WeigM wteirral
ASt ♦ �A t 1�0(IC �1 a I oC l0 From T Ft
Ft
City or Town Stria zip Code From I. �� r �
* - b93-)za0 From To Ft
Arne Cod► Phone numrWr
7. GROUT: Depth Material � ��Metn2oO�
2.WELL INFORMATION: From O To Ft. s /Z
SITE WELL 10 s(il appcam) 7._l!!�5i�l C/ From_To Ft
STATE WELL PERMITS(e V ap0eceble) I C.nn 111-7d S From_To Ft
DWQ or OTHER PERMIT e(7 applicable) 6. SCREEN: Depth Diameter Slot Size Material
From_To Ft._n. _ in.
WELL USE(Check Applica�by�yleBoz): Residerdal Watw Supply From_To Ft._n _ in
n .
DATE DRILLED 7�;t♦ D -'057 From_To Ft m in
TIME COMPLETED lI i ad AM Cr-PM❑ n� J
9. t1AND/GAA.1lii.PACK'. /'
3.WELL LOCATION: Dept See tens,)
CITY: ��-I+- .� COUNTY_Lk (,(�'Su71 From To Ft.� IV
1-� �(Imo, p k '7� From To Ft.
4( 2 FCLIII( y-se-La-YIe- Or) '/ J From To Ft
(Street Name.Numbers.Community.Subdmaion.Lot No.Parcel,ZIP Coot)
TOPOGRAPHIC I LAND SETTING: 10.DRILLING LOG
OSlopa M4a1ley ❑Flat OR" OOther From �Tto^ Fomnayto acripton
(check approprate Doc)
�r / in a be on l forma
LATITUDE -+J r D M miruum,wwrrh u
LONG)TUOEO�1j' 413W madOC°m'I truss,)
Latitude/longitude source: wQPS OTopographic rnap
(locanbm a7 war must be shown on a USGS Npo map and
attached to rho Joan,%not ua V GPS)
4.WELL OWNER en
_
OWNER'S NAME
ST5"T ADDRESSLh
) 773
CYy or Town Stale Zip Code
Area code- Phone numWr
11. REMARKS: ,.
6.WELL DETAILS: p _
a. TOTAL DEPTH: p S
b. DOES WELL REPLACE EXISTING WELL? YES O NO aV'
r
WNERESYCERnE THATn,iSWELLWASCONSTRUCTEDiNACCARDANDEWr1N
c. WATER LEVEL Below Top ofc3 Camp: O FT. rM N X WELL ca+smucTroN NoARos.AND TNAT A c 'of*Ina
(Ufa'+'6 Above Top ofCaearv) RECORD NAS SEEN PROVIDED i0 T ELL OW ER 1 q. .�]c
d. TOP OF CASINO IS L FT.Above Lard Surface' / -1/ r✓—
'Top d casur9 tertrinated Wor below lard surfaw may require SX�1ATURE F CERTIFIED WELL CON RAC TOR DATE
a variance n axordanca with iSA NCAC 2C.0118. ! /
r �RyAAJ 0M 'r�2
a. YIELD(gpm):�_METHODOF TEST PRINTED N E OF PERSON CONSTRUCTING THE WELL
Submit the original to the Division of Water Quality within 30 dayS, Ann: Intormiabon MgL, Form GW-la
1617 Mall Service Canter-Raleigh, NC 27699.1617 Phone No.(919)3334015 ext S68. - Rev 7M
i

WELL CONSTRUCTION RECORD
North Carolina-Department of Environment and Natural Resources-Division of Water Quality-Groundwater Section
WELL CONTRACTOR(INDIVIDUAL)NAME (print)RI CHARD MCCRARY CERTIFICATION#2010
WELL CONTRACTOR COMPANY NAME BARKER CONSTRUCTION,INCJBARKER WELL&PUMP PHONE # [phone]
STATE WELL CONSTRUCTION PERMIT# 1871 ASSOCIATED WQ PERMIT#
(if applicable) (if apllicable)
1. 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: Topogrdphic/Landsetting
Nearest Town: HENDERSONVILLE County HENDERSON ❑Ridge El Slope ❑Valley ❑Flat
BLUE RIDGE ESTATES (check appropriate box)
(Sheet Name,Numbers,Community,Subdivision,Lot No.,Zip Code) Latitude/longitude of well location
3. OWNER: JONATHAN MOORE (degrees/minutes/uconds)
Address 720 WEST PINE STREET Latitude/longitude source:❑GPS❑Topographic map
(Shed or Route No.) (check box)
HENDERSONVILLE NC 28739 DEPTH DRILLING LOG
City or Town Sure zip Code From To Formation Description
( 828)_ 697-7188
Area code-Phone number
4. DATE DRILLED SEPTEMBER 21,2005 .3
5. TOTAL DEPTH: 386
6. DOES WELL REPLACE EXISTING WELL? YES❑ NO EI
7. STATIC WATER LEVEL Below Top of Casing: 20 FT. i
(Use`+„if Above Top of Casing)
8. TOP OF CASING IS 1.33 FT.Above Land Surface*
-Top of easing terminated at/or below land surface requires a _
variance in accordance with ISA NCAC 2C.0118.
9. YIELD(gpm): 30 METHOD OF TEST TIMED
10.WATER ZONES(depth):
LOCATION SKETCH
11. DISINFECTION:Type sY PUMP wsrn[rt:R Amount Show direction and distance in miles from at least
12. CASING: Wall Thickness two State Roads or County Roads.Include the road
Depth Diameter or Weight/Ft. Material numbers and common road names.
From 0 To 33 Ft. s 1/8 SDR21 PVC � 1�M 1 f„..J„a i„W.„n d n * 0 �5 ,( '
From To Ft. �J✓Vn7JX./ruxs.i.tQ/iLuuw-{�c��GC��2���CJ
From To Ft.
13. GROUT: Depth Material Method J/�Q.
From 0 To ZO Ft. CONCRETE POURED J�a u(.c(J LJx t•C.L I
From To Ft.
14. SCREEN: Depth Diameter Slot Size Material ^m 0 .
From To FL �in. in. /+.c-aw
�11,[Cb
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Size Material elrx- Aq_ lt�tf{If..L.
From-To-Ft.-
From-To-Ft.
16. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C,WE L
CONSTRUCTION STANDARDS,AND THAT A COPY OF TH RECORD HAS BEEN OVIDED TO THE WE OWN
. 6Sr
�IGNATURE OF PERSON CON TRUC THE WELL ATE
Submit the original to the Division of Water Quality,Groundwater Section,1636 Md1.5ervice Center-Raleigh,NC
27699-1636 Phone No,(919)7333221,within 30 days. _. GW-1 REV.07/2001

G� h 9 �b c., t. 9� -t t. li
WELL CONSTRUCTION RECORD
North Carolina-Department.of Environment and Natural Resources-Division of Water Quality-Groundwater Section
WELL CONTRACTOR(INDIVIDUAL)NAME (print)RICHARD MCCRARY CERTIFICATION#2010
WELL CONTRACTOR COMPANY NAME BARKER CONSTRUCTION,INCAIARKER WELL&PUMP PHONE # [phone]
STATE WELL CONSTRUCTION PERMIT# 187 ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
l. 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: Topographic/Land setting
Nearest Town: HENDERSONVILLE County HENDERSON ❑Ridge ❑Slope ❑Valley RlFlat
OLD ORCHARD SUBDIVISION,LOT#35 (check apIworniate box)
(Sues Name,Numbers,Community,Subdivision,Lei No.,Zip Code) Latibide/longitude of well location
3. OWNER: CAROLINE J.EDWARDS (degrees/mimrtcs/soconds)
Address PO BOX 187 Latitude/longitude source:❑GPS❑Topographic map
(Sheet or Roate No.) (check box)
HARRIS NC 28074 DEPTH DRILLING LOG
City or Town state Zip Code From To Formation Description
U-
Area code-Phone mnsber
4. DATE DRILLED SEPTEMBER 16,2005
5. TOTAL DEPTH: 426
6. DOES WELL REPLACE EXISTING WELL? YES❑ NO
7. STATIC WATER LEVEL Below Top of Casing: 40 FT.
(Use"t^if Above Top of Casing) --/
8. TOP OF CASING IS 1.33 FT.Above Land Surface•
'Top orcasing terminated attor below land surrace requires a Qy
variance in sccordance with 15A NCAC 2C.0118.
9. YIELD(gpm): 4 METHOD OF TEST TIMED C:) '
10.WATER ZONES(depth):
LOCATION SKETCH
11. DISINFECTION:Type BY PUMP iNSTn UER Amount Show direction and distance in miles from at least
12. CASING: Wall Thickness two State Roads or County Roads.Include the road
Depth Diameter or Weight/Ft. Material numbers and common road names.
From 0 To 42 Ft. 61/8 SDR21 PVC
From To FL 1 ULJI(1X 1/VrC(lei C L(AJL� oY G C/r
From To Ft. k-' -- �-
13. GROUT: Depth Material Method 12 � �
From 0 To 20 Ft. CONCRETE POUREDm' _ ! ,, ' '
From To Ft. Q��u_C,Ayt�pt &d dui�n r
14. SCREEN: Depth Diameter Slot Size Material yp��
From To Ft. in. in. 0�-1- 4r JJr.
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Size Material
Front—To—Fr-
From—To—FL
16. REMARKS:
1 DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH ISANC 2C,WELL
CONSTRUCTION STAN A'ND/THAT A C PY F THIS CORD HASqN PROVIDED T E ` L OWNER—
rvl�
SIGNATURE OF PERSON CO; CTING THE WELL ATE
Submit the original to the Division of Water Quality,Groundwater Section,1636 Mail Service Center-Raleigh,NC
27699-1636 Phone No.[phone],within 30 days. _ GW-1 REV.07/2001

WELL CONSTRUCTION RECORD
North Carolina-Department of Environment and Natural Resources-Division of Water Quality-Groundwater Section
WELL CONTRACTOR(INDIVIDUAL)NAME (prlw)RICHARD MCCRARY CERTIFICATION#2(110
WELL CONTRACTOR COMPANY NAME BARKER CONSTRUCTION,INCAMI ER WELL&PUMP PRONE, # [phone]
STATE WELL CONSTRUCTION PERMIT# 187 ASSOCIATED WQPERMITN
(if applicable) (if applicable)
1. WELL USE(Check Applicable Box):Residential® Mmdcipsl/Public❑ Industrial❑ Agricultural❑
Monitoring❑ Recovery ❑ Heat Pump Water Injection❑ Other❑ If Other,List Use
2. WELL LOCATION: Topographic/Land setting
Nearest Town: HENDERSONVILLE Coumty HENDERSON ❑Ridge E3Slope ❑Valley ❑Flat
LITTLE BEARWALLOW ROAD (check appropriate box)
(Shod Namq Numben,Community,Subdimion,Intl No.,Zip Code) Latitudellongitude of well location
3. OWNER: HERRON MACDONALD (degrees/miautm/exonds)
Address 1220 LITTLE BEARWALLOW ROAD Latitude/longitude source:❑GPS❑Topographic neap
(Sheet or Route No.) (check box)
GERTON NC 28735 DEPTH DRILLING LOG
City or Town state zip Coda From To Formation Description
( 828)_ 6254407
Area coda Phone number
4. DATE DRILLED SEPTEMBER 15,2005 -
5. TOTAL DEPTH: 420' CD
6. DOES WELL REPLACE EXISTING WELL? YES❑ NO
7. STATIC WATER LEVEL Below Top of Casing. U FT. Ei
(Use" -if Above Top of Caring) t =3
S. TOP OF CASING IS 1.33 FT.Above Land Surface*
-Top of asingterminated at/or below land surface requires a
variance in accordance with 15A NCAC 2C.011& 't-
9. YIELD(girm): o METHOD OF TEST TIMED
10.WATER ZONES(depth):
LOCATION SKETCH
11. DISINFECTTON:Type BY Pl1MP INSTALLER Amount Show direction and distance in miles from at least
12. CASING: Wall Thickness two State Roads or County Roads.Include the road
Depth Diameter or Weight/Ft. Material numbers and common road names.
From 0 To 47 Ft. 61/8 SDR21 PVC JAM 1�n,a_CV �nCC.. U,(YC_ .t
From To Ft. � �f,,v6_ I nu ayxJ tti - J o,^, � Q 6
6"1��C�G�t(O�J�.��c..
From To Ft. /r �O, L 16 /oLpiU�OYJU.�. �
13. GROUT: Depth Material Method µ.{l(�
From 0 To 20 Ft, CONCRETE POURED v f L n A ,_ ,
From To FL t.�-x-c-6K,f/ �,IIL. f�taf
14. SCREEN: Depth Diameter Slot Sim MaterialGL-
From To FL—in.n. in. /i j I ,_ _//' , . 6wA�CLQ-�(!-w /V.0 From To Ft. in. in. _JC�t/f-C o��tY.C..
15. SAND/GRAVEL PACK: ��� „�„,!
AK *L&
Depth Size Material �l/.D 7� u�/LC.L `RU V d�-
From To Ft a 0C )
From To Ft.
16. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C,WELL
CONSTRUCTION STAND AND THAT A COPY OF THIS ORD HAS BEEN PROVIDED TO THE LL O ER
SIGNATURE OFPEVSON CON;p&&TiNG THE WELL DATE
Submit the original to the Division of Water Quality,Groundwater Section,1636 Mai Service Center•Raleigh,NC
27699-1636 Phone Na(919)7333221,within 30 days. __ GW-1 REV.0712001

WELL CONSTRUCTION RECORD
North Carolina-Department of Ettvironment and Natural Resources-Division of Water Quality-Groundwater Section
WELL CONTRACTOR(INDIVIDUAL)NAME (print)RICHARD MCCRARY CERTIFICATION#2010
WELL CONTRACTOR COMPANY NAME BARKER CONSTRUCTION,INCH ARKER WELL&PUMP PHONE # [phone]
STATE WELL CONSTRUCTION PERMIT# 1871 ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
1. WELL USE(Check Applicable Box):Residential® MunicipaUPublic❑ Industrial❑ Agricultural❑
Monitoring❑ Recovery ❑ Heat Purnp Water Injection❑ Other❑ If Other,List Use
2. WELL LOCATION: Topographic/Laud setting
Nearest Towm HENDERSONVILLE County HENDERSON ❑Ridge ®Slope ❑Valley ❑Flat
CLOVEN CLIFFS,LOT#2 (check apprapiate box)
(Sheet Name,Number,Community,Subdivision,Lot No.,Zip Code) Latitude/longitlale of well location
3. OWNER: RICHARD&KAREN ALEXANDER
(degrees/mirurtu/eeconde)
Address 29 CARMEN HILL ROAD Latitude/longitude source:❑GPS❑Topographic map
(Sheer or Route No.) (.heck box)
BROOKFIELD CT 06804 DEPTH DRILLING LOG
City or Town State zip Code From To Formation Description
( 203)_ 775-6902 -
Am code-Phone mauber
4. DATE DRILLED SEPTEMBER 8,2005
5. TOTAL DEPTH: SON O J
6. DOES WELL REPLACE EXISTING WELL? YES❑ NO 91 �,,.4
7. STATIC WATER LEVEL Below Top of Casing: 20 FT. -
(Use w if Above Top of Casing)
8. TOP OF CASING IS 1.33 FT.Above Land Surface'
O
-Top of casing laminated aUar below land surface requires•
variance in accordance with 15A NCAC 2C.011&
9. YIELD(gpm): 20 METHOD OF TEST TIMED
10.WATER ZONES(depth):
LOCATION SKETCH
11. DISINFECTION:Type BY PUMP INSTALLER 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
snames.
From 0 To 32 Ft. s 1/8 SDR21 PVCFrom ToTo Ft.
From To Ft.
13. GROUT: Depth Material Method �j� Qi A
From 0 To 20 g(. CONCRETE POURED ,L
From To Ft. �t�-.�/kf/I�l!/�GLD?L����f Q //•p0
L75
G
14. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in. � - p,
From To Ft. in '
in. v ali (1 Q( -'xdC-
15. SAND/GRAVEL PACK: CGCY�
Depth Size Material
From To Ft.-
From-To-Ft. OZ��
16. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C,WELL
CONSTRUCTION STANDARDS D THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WEL ER
i
6 G
S NATURE OF PERSON C'9WIRUCTING THE WELL A
Submit the original to the Division of Water Quality,Groundwater.Section,-}636 MOSestce Center-Raleigh,NC
27699-1636 Phone No.(919)7333221,within 30 days. GW-1 REV.07/2001
__ I

WELL CONSTRUCTION RECORD s
North Carolina-Department of Environment and Natural Resources-Division of Water Quality-Groundwater Section
WELL CONTRACTOR(INDIVIDUAL)NAME (print)RICHARD MCCRARY CERTIFICATION#2010
WELL CONTRACTOR COMPANY NAME BARKER CONSTRUCTION,INC.IBARKER WELL&PUMP PRONE # [phone]
STATE WELL CONSTRUCTION PERMIT# 1871 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: HENDERSONVILLE County HENDERSON []Ridge E7Slope ❑Valley ❑Flat
MOUNTAIN LAUREL LANE,LOT#1 (check appropriate box)
(Sheet Name,Numbers,Community,Subdivision,Lot No.,Zip Code) Latitude/longitude of well location
3. OWNER: TRAVIS COOKE (degrou/mirmtcs/secoods)
Address 58 WINDING OAK DRIVE Latitude/longitude source:❑GPS❑Topographic map
(Shea or Ronte No.) (check box)
ARDEN NC 28704 DEPTH DRILLING LOG
City or Town state zip Code From To Formation Description
( 828)- 68"119
Area code-Phone m®ber
4. DATE DRILLED SEPTEMBER 7,2005 -
5. TOTAL DEPTH: 2'
6. DOES WELL REPLACE EXISTING WELL? YES❑ NO
7. STATIC WATER LEVEL Below Top of Casing: 20 FT. n
(Use"+"if Above Top of Casing)
8. TOP OF CASING IS 1.33 FT.Above Land Surfaces
'Top of casing terminated at/or below land surface requires a Vv -
variance in accordance with 15A NCAC 2C.011S. E3
9. YIELD(gpm): 50 METHOD OF TEST TIMED Cn
10.WATER ZONES(depth):
LOCATION SKETCH
11. DISINFECTION:Type sY PUMP iNsrutER Amount Show direction and distance in miles from at least
12. CASING: Wall Thickness two State Roads or County Roads.Incluude the road
Depth Diameter or Weight/Ft. Material numbers and common road names.
From 0 To 71 Ft. 61/8 SDR21 PVC A�fl
From To Ft. �.,7 � ,/ ZCy,1(tlY/"(/y�K/CGl6tpyQ
From To Ft. `r`�/� " �' JJ �
13. GROUT: Depth Materiel Method �IQ(xyG( , ��yL�
From 0 To 20 Ft. CONCRETE POURED al '
From To Ft. "^k&d� un �"
14. SCREEN: Depth Diameter Slo �ls"
t Size Material "l . �j �.¢.,.Oil(d
From To Ft. in in. �-ll..
From—To—Ft.—in. in. /
15. SAND/GRAVEL PACK: #
Depth Size Material
From To Ft.-
From—To—Ft
16. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2 WE
CONSTRUCTION STAND S,AND THAT A COP OF THIS RECORD HAS BEEN PROVIDED TO III OWN R
�lq 7 r 17
SIGNATURE OF PERSONQRSTRUCTING THE WELL DATE
Submit the original to the Division of Water Quality,Groundwater Section,1636 Mail Service Center-Raleigh,NC
27699-1636 Phone Na(919)733 3221,within 30 days. GW-1 REV.0?V2001

WELL CONSTRUCTION RECORD
North Carolina-Department of Environment and Natural Resources-Division of Water Quality-Groundwater Section
WELL CONTRACTOR(INDIVIDUAL)NAME (print)RICHARD MCCRARY CERTIFICATION#2010
WELL CONTRACTOR COMPANY NAME BARKER CONSTRUCTION,INC.BARKER WELL 8 PUMP PHONE # [phone]
STATE WELL CONSTRUCTION PERMIT# 1871 ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
1. WELL USE(Check Applicable Box):Residential® MunicipaYPubho❑ Industrial❑ Agricultural❑
Monitoring❑ Recovery ❑ Heat Pump Water Injection❑ Other❑ If Other,List Use
2. WELL LOCATION: Topographic/Land setting
Nearest Town: HENDERSONVILLE County HENDERSON
GAP CREEK ROAD Mdge ®Slope Malley OFlat
(check approprute box)
(Street Name,Numbm,Community,Subdivision,Lot No.,Zip Code) Latitude4ongitude of well location
3. OWNER: TROYA.MCMURRAY
(degrces/mioutea/seconds)
Address 29 LIVELY ROAD Latitude/longitude source:OGPSOTopographic map
(Street or Route No.) (check box) _.
EAST FLAT ROCK NC 28726 DEPTH DRILLING LOG
cdy or Town State 2i Code Formation Description
9( 281- 691-9859 p From To p
Area code-Phone number
4. DATE DRILLED SEPTEMBER 1,2005
5. TOTAL DEPTH: 365
6. DOES WELL REPLACE EXISTING WELL? YES O NO El
7. STATIC WATER LEVEL Below Top of Casing: 20 FL -,
(Use"+"ifAbow Top of Casing) O� <
8. TOP OF CASING IS 1.33 FT.Above Land Surface'
'Toper casing terminated aVor below land surfacerequires a Lit -,,4
variance in accordauce with 15A NCAC 2C.011R -
9. YIELD(gpm): 4X METHOD OF TEST TIMEb
10.WATER ZONES(depth):
LOCATION SKETCH
11. DISINFECTION:Type aY PUMP INSTALLER Amount Show direction and distance in miles from at least
12. CASING: Wall Thickness two State Roads or County Roads.Include the road
Depth Diameter or Weight/Ft. Material numbers and common road names.
From 0 To 113 Ft. 61/8 SDR21 PVCFrom_To-
F ore To Ft a s d ,�tL,IC.Q,-L40 Ptt L(J, Ap,Y(yj eCY.LCI,v
13. GROUT: Depth Material Method
From 0 To 20 Ft. CONCRETE To Ft. m POURED
I
From UBI C 14. SCREEN: Depth Diameter Slot Size Material E� h jl/ lt�C �,ewL//��c
From.-To-FL in. in.
From To Ft. in. _ is
15. SAND/GRAVEL PACK: �,, _2
Depth Size Material I�LIY.IL
From To Ft. 'Q/�,�(�,�[
From To FL ;�/ I/t& �LGU d• P "/a dy
16. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C WELL ---
CONSTRUCTION STANDARDS,AND THATA COPY OF THIS RECORD HAS BEEN PROVIDED TOT L OWN�.12-
0 2. �f
SIGNATURE OF PERSON C STRUCTING THE WELL DATE
Submit the original to the Division of Water Quality,Groundwater Section,1636 Matt Service Center-Raleigh,NC
27699-1636 Phone Na(919)733,3221,within 30 days. GW-1 REV.07/200

WELL CONSTRUCTION RECORD
North Carolina-Dcpartmenl of Environment and Nahiml D......_.__ .,;,,;,;��
11 n`!/Wa4r Quality-Groundwater Section
WELL CONTR A
ACTOR(INDIVIDUAL) (pat)- �l } I, L e N� S-id a-r,
WELL CONTRACTOR COM PANY NAM[ REUHEN CALDWELL DRILLING, IN(;, CERT/PICATIONa
STATE WELL CONSTRUCTION PCRM ITa
1537 ruoNL4�8 1 54-3581
ifs lieable AccOCIATLD WI)PLRAfrr#
ifs licable
L WELL USE(Check Applicable Box): Residential Munici
Monitoring❑ Recovery ❑ peVl'ublic El Industrial ❑ Agricultural ❑
!feat Pump Water Injection❑ Other❑ IrOther,List Use
2. WELL LOCATION:
Nearfst Tr County !J flc l�$Cnl TOp°graopc ov setting /
e5
L,A.�tc�e q p ❑Ridge ❑Slope ❑Valley let `,!
(Strtet Name,Numbers,Cotnm"iry.Subdivhiw,W No,lip Code) (�k aPWupricte boa) -O _A,.
0 o Lalitudellongitude of well location
N
ist
3. OWER:_ 5 A) A leg a c59--r I c S
Address _ lS Lgn3 q a (depeea/misulea/eeWndr)
Strtetn Raw of i.elitudellongitude source:❑GPS❑Topog phic a
�LE-rf;' r P � rz g, -7 3 -;a (check
(check box) ,
nyor Town s Zip Code 12EPTII DRIL fN O c"'i
Fro ,Tao p i Fo ion Dpncri tion
Arta coda Phons number — 4 R ©rrr�'�k ELM
4. DATE DRILLED © Jr ON (T�
S. TOTAL DEPTH: In rF j)C g ` (�M
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO ° G �l T
7. STATIC WATER LEVEL Below Top of Casing: ► a*o FT. _ iICE t
(Urn-#-if Above Top of Cuinv
in
8. TOP OF CASING IS FT. Above Lend Surface. ---------
•Top afculaa lermlealed atfer blaw lud surface requires a
verisan la acvrdsan� wits ISA NCAC 2C.OIta.
1
9. YIELD(gpm):--.--_() METHOD OF TEST IG-- I(...�
10. WATER ZONES(depth): aao e , M
LOCATIO_ N SKFTC11
11. DISINFECTION:Type "Thl—Cl.6 Amount Show direction and distance in miles from at least
12. CASING: Wall 77ticknns two Stale Roads or County Roads. Include the road
Depth Dyircr or We hh L Mucrial numbers and common road names.
From 1- To cJ 3 Ft. O (8 tJKo(,�
From To Ff.
From To Ft.
13. GROUT: Depth Msteriat ethod
LraAC
FmRr To &-D FL U3MA't1T P MQR&w)
From To Ft.
14. SCREEN: Depth Diameter Slot Sire Material /
From To Ft. in. in.
From To Ft. in. in c
15. SAND/GRAVEL PACK: �`a0 VAr}u7wCD
From Depth Sire Material
To Fc GyZ.A 0G 6 A.b
From To Ft. �M
16. REMARKS:
I DO IIEREfY CERTIFY THATTIIIS WELL WAS CONSTRUCTED IN ACCORDANCE WTTII 1 SA NCAC 2C,WELL
CONSTRUCTION STANDARDS,AND THAT A COPY OFTMS RECORD ItAS DEEN pt(OVIDED T@ TIM WE O R _ m
r,
SIGNATURE OF PERSON C NSTRUCDNG THE WELL DATE ins
rn --
Section, I636 Mall Service Cooler-iLlefgh,NC
Submit the original to the Division of Water Quality,Groundwatero
27 6 9 9-163 6 Phone No.[phone],within 30 days,
GW-1 REV.07/2001 CD

01 315619
WELL CONSTRUCTION RECORD
North Carolina—Department of Environment And Natural Resources—Division of Water Quality—Groundwater Section
WELL CONTRACTOR(INDIVIDUAL)NAME (prim)RODNEY ROBBINS CERTIFICATION# 278$
WELL CONTRACTOR COMPANY NAME PITTMAN WELL BORING,LLC PHONE# [phone]
STATE WELL CONSTRUCTION PERMIT#_ ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
I. WELL USE(Check Applicable Box): Residential 0 Municipal/Public ❑ Industrial Agricultural El
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other,List Use_
2. WELL LOCATION:
Nearest Town: ZIRCONIA County BEND Topographic/Land setting
1119 BELL MTN.RD. ❑Ridge ❑ Slope ❑Valley ❑Flat
(Sheet Name,Numbers,Community,Subdivision,Lot No.,Zip Code) (check appropriate box)
3. OWNER FREDA METCALF Latitudellongitude of well location
Address 1119 BELL MTN.RD.
(Street or Route No.) (degrecda inutes(seconds)
ZIRCONIA NC 28790 Latitude/longitude source: ❑GPS ❑Topographic map
City or Town State Zip Code (check box)
8(�—692-5862 DEPTH
Area Code Phone number From To
4.DATE DRILLED 08/03/05 _
5.TOTAL DEPTH: 205 DRILLING LOG
6. DOES WELL REPLACE EXISTING WELL? YES❑ NO® From To
7. STATIC WATER LEVEL Below Top of Casing: 20 FT,
(Use"+"if Above Top of Casing)
8.TOP OF CASING IS 1-1/2 FT. Above Land Surface* LOCATION SKETCH
*Top of casing terminated atlor below land surface requires a Show direction and distance in miles from at least
variance in accordance with 15A NCAC 2C.0118.9. YIELD(gpm): 10 METHOD OF TEST ARD Two State Roads or County Roads. Include the road
number and common names
10. WATER ZONES(depth): I-26 W.FROM COLUMBUS.EXIT RT.ON#54
11.DISINFECTION:Type CHLORYTE Amount 4.5 (HWY,25)GET OFF ON EXIT#5.TURN LEFT.
12. CASING: Wall Thickness APPROX. 1-1/2 MILES.LEFT ON S.LAKE
Depth Diameter or Weight/Ft Material SUMMITT.THIS TURNS INTO BELL MTN.RD. 1.4
From 0 To 70 Ft 6-1/4" SDIL21 PVC MILES ON LEFT.
From_To_Ft_ 0,
From To Ft _
13. GROUT: Depth Material Method rt i ;d
From 0 To 20 Ft.OUIKRETE POURED v
From To_Ft ry ry
14.SCREEN: Depth Diameter Slot Size Material From_To_Ft._ in. in. CM
From_To_Ft_ in. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From_To_FL_
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
✓/J 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

o
WELL CONSTRUCTION RECORD
North Carolina—Department of Environment And Natural Resources—Division of Water Quality—Groundwater Section
WELL CONTRACTOR(INDIVIDUAL)NAME(print)RODNEY ROBBINS CERTIFICATION# 2785
WELL CONTRACTOR COMPANY NAME PITTMAN WELL BORING,LLC PHONE# [phone]
STATE WELL CONSTRUCTION PERMIT#_ ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
1. WELL USE(Check Applicable Box): Residential 0 MuniCl al/Public 0 Industrial El AgriculturalEl
Monitoring ❑ Recovery [IHeat Pump Water Injection Other ❑ If Other,List Use
2. WELL LOCATION:
Nearest Town: HENDERSONVILLE County HEND Topo phicA and setting
45 HARPER MEADOWS WAY ❑Ridge u Slope ❑Valley El Flat
(Street Name,Numbers,Community,Subdivision,Lot No.,Zip Code) (check appropriate box)
3.OWNER:RAY GASPERSON Latitude/longitude of well location
Address 45 HARPER MEADOWS WAY
(Street or Route No.) (degrees/mmines/seconds)
HENDERSONVILLE NC 28739 Latitudellongitude source: ❑ GPS ❑Topographic map
City or Town State Zip Code (check box)
(828)—863-4913 DEPTH
Area Code Phone number From To
4.DATE DRILLED 08/10/05 _
5.TOTAL DEPTH: 405 DRILLING LOG
6.DOES WELL REPLACE EXISTING WELL? YES❑ NO® From To
7. STATIC WATER LEVEL Below Top of Casing: 80 FT. _
(Use"+"if Above Top of Casing)
8.TOP OF CASING IS 14/2 FT. Above Land Surface* LOCATION SKETCH
*Top of casing terminated actor below land surface requires a Show direction and distance in miles from at least
variance in accordance with 15A NCAC 2C.0119. Two State Roads or County Roads. Include the road
9.YIELD(gpm): 3 METHOD OF TEST ARD number and common names
10.WATER ZONES(depth): I-26 W.FROM COLUMBUS.EXIT ON HWY.64 E.
11.DISINFECTION:Type CHLORYTE Amount 10.5 GO PAST TRIANGLE STATION&LEFT ON
HOWARD GAP RD.RT.ON ZEB CORN RD.RT.ON
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft Material N.CLEAR CRK RD.LEFT ON HARPER MEADOWS
From 0 To 80 Ft 64/4" SDR.21 PVC
From_To_Ft_ '*
From To—Ft— _
13.GROUT: Dept Material Method cn
From 0 To 20 Ft.OUHMTE POURED r
From To_Ft i
14.SCREEN: D ^�epth Diameter Slot Size Material
From_To—Ft.— in. in. o z
From_To_Ft._ in. in. L
15. SAND/GRAVEL PACK:
Depth Size Material a
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 CO Y O THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
SIGNATURE OF PERSON CONSTRUCTING THE WEM 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

a
DO
WELL CONSTRUCTION RECORD
art,lino -Department of Los ironment and Natural Reso�urces- Division of Water Quality-Groundwater Section
VAtl.l t (tNIRk( MR(INUTAIDLAL)N:AAIE (print)- _ �- ,-J uV
/l -� _.. CERTIF'ICA7'IUN#
tV.LI ((l\f R:A(MR C'OMPAN\ \:Olt; C,.('e,e,')f. �is,`Xs `,_-- PHONE # , LLtA 0
\i AIf %%t.I.I (()NS IRUCTION PER NI Ilk "tom_---- - P'.--.—_. _ 455UC I4TEUWQ Pt:RJ71'1#
t if applicable)
h(applicable)
V4 11 1. I;SI-. I( heck Applicable Box): Residential Q� Municipal.'Public ❑ Industrial O Agricultural ❑
\it.mtnrine ❑ Recovery ❑ Hcat Pump Water Injection ❑ Other❑ If Other, List Use
_. A\lCLI. I OCAT[ON
:
Near"rfattn: F-C✓\ _ County v�(1 (-'Cr) Topographic/Land Setting
_J_\t •l-t Ir �rl(j`p 2cf ❑Ridge ❑Slope ❑Valley �t
`i'« �num. ',umbers.(nntmwuh�uhd in,inn.Lit 10_7ip(bdrl tcheck appropnate boa)
Latitude longitude of well location
;. ON% 1v1R _C1 --
itlGrlc, �Ss: .2d� —' (degrees minutes,seconds)
IStm<to --ul,4n" _ Latitude:longitude source:OGPSOTopograph is map
:
. DEPTH DRILLING LOC
1 rr, loan State lip('rxic From To
_ Formation Description
le PLooe i-ember
Ida os-_ - --
\ II DRILLED S_- \D - Off_--_-- _-- H
I DEPT H _aa_ -- --
!.
1( WA"IT R LEVEL Beioa Top of Casing: FT. ---- —
ILsc-' i(Aboac Tupot(asmg)
T(A'UI ( ASING IS _�
' FT. .46ove Land Surface' --- ----- -- _
'I op of casing terminated aVor belua land surface requires a
,ariance in accordance with 15A N('AC 2C.I)1I8. --- _ --
i. SI1_LD (gpml:_ A O METHOD OF TEST Zl'1✓3_ __.—_ —
U 'A 1TI-R ZONESldepth): �0 .
_ --- LO('ATION SKL-TC'H
.. I)IS1AI"f_( 7K)N: IN pe .Amount_ __ Show direction and distance in miles from at least
Wall I hicknc,s tvvo State Roads or County Roads,Include the road
Depth Diameter or %eight Ft. Material numbers and common road names.
Fran•: Q To IS L Ft..
F rom Tow -- fo Ft.
Fo Ft. -
( RUI.T I)epth Vfmondl
F o
_ yq C
rm TD Method G7X — F � � '
ry
F nor._ To F4._- _-
l. Sl Rf I.S Ucpth Diameter Slot .Sin N1atcrial CD
"T"o Ft. titin. Ul
_. To—_--- Ft —_m. in.
Depth Si/cMaterial
_To_—. _ Ft.
To_-
At4RKS
t( Il Itl ly} ( F R I I F Y I I LN F TH IS AS CONS"IR1i(TED IN ACCORDANCE Ak I If 1 I,A NCAC 2C,Wk ELL
t ' ,Al lit ( IiUN ST\NDA RDS. ANDI-HAT:AC'Op)"OFTIHSRF(OR1)HASREEN PROVIDED TO THE WELL OWNER
1 Cl O j
SI(iN:ATURE OF I'ERS _OKSIR" TINE fHL NEI.I_
DATE
Submit the original to the Division of Rater Quality,Groundwater Section, 1636 Mail Serrice Center-Raleigh,NC
27699-1636 Phone Nn.[phone].o'ithin 30 dacs.
GW-I REV.072001

ow 31611r; 8
i i
WELL CONSTRUCTION RECORD
North Carolina-Deparmicut ofEnvuonment and Natural RQesoaa -Division of Water Quality-Groundwater Sectti�io°�n��{
- - WELL CONTRACTOR(INDrADUAL)NAME (print � t?- CERr1FICCA��TION/9pA�C 6 3
WELL CONTRACTOR COMPANYNAME_IhYtJPS1PIC Pr� E1 , pgpNEa &W GQ- 7ap(�p�r
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMITd
rf licabhs Of licable
1. WELL USE(Check Applicable Box):Residential Municipal/Public D Indushial D Agicuitmal D
Momtmmg D3Rwo�verry D Heat PmDp Water hiaMon D Othc D If OdM List U�
2. Nearest VAELL W
wm�l7 Nk To 11 + County ��Pb►c/7.and setting
age DSlopc Malley Mat
(dedcapptapmeebea)
(sacaName.N+m6cs.00MMMhY.sv>dmdon.LAND.ZpCode) Latitudellongiwdeof well location
3. OWNER: E r W i it i Nms ( "Waeeoadt)
Addh= R&I
,,..?? `` O (�. Latitu&Aongihrde source:OGPSDTopograpbic map
Et.1DE�5dN V N C a p �' DEM ( DRILLING LOG
City wTbm Sore Zip Code From To Formation Description
Ala code Phase noder 121,(6 S 4. DATE DRILLED
5. TOTAL DEPTH
6. DOES WELL REPLACE EXISTING WELL? YES NO
7. STATIC WATER LEVEL Below Top of Casing:�FT.
(Use'4-H Abme Top of QsW
S. TOP OF CASING IS FT.Above Land Surface•
'Top ofeadag tendMN bebw land regdroa
varlaaft(am)Maacewab ISANCACZCAl1R ( „ n—
9. Yffi.D _�_METHOD O M�'�=W
10.WATER ZONES(depth):—5 ) r 3 Q
LOCATION SKETCH
11. DISINFECTION:Type Amount Show direction and distance in miles from at least
12. CASING: Wall Thickness, two State Roads or County Roads.Include the mad
Dq Diameter or wei&wt. Material munbers and common road names.
From To Ft
From_To Ft
From To Ft G MfN . 77
13. GROUT: Material �M'ediod� 4 ,,` ,
From To Ft Ye �a 1 CGi
From To Ft 1 '4
14. SCREEN: Depth Diameter Slot Sim Material
From To Ft vt_ in.
From To Ft in. in.
15. SAND/GRAVEL PACK: C:�
Depth Size Material ul
From To Ft
From To Ft
16. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C.WELL
ON ST,iID7,RD�A�I�ID THAT A COPY OF THIS RECORD HAS BEEN PROVIDID TO THE OWNER
SI(TtA1VRBOFPERSONCONSTRUCIINGTHBWELL ATE
Submit the original to the Division of Water Quality,Groundwater Sectien,16M Mail Service Gender-Raleigh,NC
27094636 Phone No.[phone],within 30 days. GW-I REV.0712001

WELL CONSTRUCTION RECORD (0 3162 0 0
North Carolina Departinent of Environment and Natural Resource;- Division of Water Quality
N\CLL('OSDt]("IOR(INUIN Jut.Nl.t N.%NIF. (prino MARK GETTYS ('1!Rl'ltl(_V'IONp2345
COSIIiNc'lOR(t)NutNNv N.(Sit: GEOLOGIC EXPLORATION,INC. PRONE * 7( 04)872-7686
SA A I L gFLL CONS'1 RI("I ION PERU[JAF .\5N(K l.\I 1 1)NQ PER\ll14
(il'applicahle) (il'applicahlet
I. WELL USE 4Chcek applicable Box): Residential ❑ Municipal;Public❑ Industrial ❑ .Agricultural ❑
Ntonilorin_IN Recoecn- ❑ Heal Pump Watcr Injection❑ Other❑ If Other.List I"se
2. 1FELL LOCATION: Topographic%Land setting
Nearest Tom n: PENROSE CounnHENDERSON ❑Ridge ❑Slope ❑Valley ❑Flat
78 JETER MTN ROAD - I<hcck.gyvrgxiulc N.\t
Ukcct Nutw.Nuu Im,Canamma�.sal•�in iei.n_t w No-/q+C.ulel Latitude'10R."it(Ide of well location
. . ON\NER: WELLSNURSERY
AcWress 78 JETER MIN.ROAD Latitude 10112itudc Source:❑GPS❑Topographic map
:Suww Rma,Vo.l idicck bo\1
PENROSE NC _ _ DEPTH DRILLING LOCI
From To Formation Description
0.0 5.0 TAN SANDY CLAY
Iqun:c uumler 5.0 20.0 TAN SILTY SAND
a. DATE DRILLED 07/05/05 20.0 30.0 GREY/ ROWN SANDY SILT
5. TOTAL DEPTH: 30.OFEET
6. DOES WELL REPLACE EXISTING R ELL? YLS❑ NO f
7. STATIC WATER LEVEL Belm\ Top of Casing: 22.0 FT. (n
S. TOP OF CASING IS 0.0 FT.Abo\c Land Surface"
"lop of caning terminaled atior Ireton land surface requires a I -
sarlanrr in acnndaecr With N.\NC',\('?C.III IR.
\D -
0. YIELD(epm):N/A A[ETHODOFTGSTN/A
10. ADATER ZONES(deplhl: N/A
LOCATION SKETCH
11. DISINFECTION: TNpcN/A Amount Slum direction and distance in miles from at least
12. CASING: A-all'I hickness neo State Roads or County Roads. Include the road
Depth Diameter ur\Cei_h(l t. Material numbers and common road names.
From 0.0 TOZ0.0 rt. 21NCH SCH.40 PVC
From To Ft. ;
From To Ft.
13. GROUT: Dcplh Material Melhod w
From 0.0 TO 16.0 Pt Portland betnonite Slurry
From To Ft.
14. S('REA:: l -p#8 �)'inietcr OSIirtSiie PVlatcrial
From To 'O LL' in. ' 10 in. C
From To Ft. in. in.
15. SAND GRAVEL PACK:
18.0 I)cpIA10.0 2046 FINE SWIY,`}4`ISAND SITF
From To Ft.
From To Ft.
16. REMARKS: MW-1 BENTONITE SEAL FROM 16.0 TO 18.0 FEET.
t DO I II:RLBY( I R I II Y 1I IA I II IN W1.1-I_VAS(ONS I RI CiLD IN;V('('ORDAV1.WITH 15A\CAC A. A1T1.1.
COASI"RI ( I ION STA\DARDS.AAD TI IA I A C OPl"Of- 9SA2L.('ORD IIAS BEEN PRIAlDED TO I I U. A ELL 011NIiR
N16NA fI RE h 19_ICNON C(YeS I RI I(-I IN l I1F.11'I:LL DA I C
Submit the original to the Divisian of Water Quality-Um.- Information Management, 1617 Mail Sea ice Center-
Ralcigh,N('27699-1617. Phone No•(9191733.74115,m ithin 30 date.
6W-I REV.4R)2004

J
WELL CONSTRUCTION RECORD YD
North Carolina Department of Environment and Natural Resources-Division of\Water('Duality
%1 LEE(Os R V I OR(INDI\u)1 ALI\.\\IL (prino MIKE MCCONAHEY (7-:R rIt(.\rR)\x 2402
N%EELCO\IR.\("ioRtO\le\\A \.\\a: GEOLOGIC EXPLORATION.INC. pu<e\E a 7704)872-7686
%,IAIE\\El.l.CO\SIRI("llO\I'ER\lt 4 (\\(K'IA I EDq Q PER\II IS
(il'applicahlcl 61 applicable)
I. 11"ELL OSE(Check Applicable Box): Residential ❑ Municipal Public❑ Industrial ❑ Aerieultural❑
Monitoring N Recovery ❑ Hcat Pump Water htjcetion❑ Other-0 IfOthcr.List t Esc
2. VAELL LOCATION: p
Nearest Tow 1 il
n: PENROSE CbuMtcHENDERSON _ ❑Ri ol ❑Slope ❑Vaogryihic'Land setting
❑Flat
ttine
78 JETER MTN ROAD _ _ -__- rclae6 apl.rn 0\*twe fuel
(NIrcct Nam,Nmnl.crs.(ornnaa 11_Sandi "I"., I Nu_/11,6le) Latitude hlil,'llUsIC Of NCII loCan011
3. Ol\NCR: WELLS NURSERY
Address 78 JETER MTN.ROAD Latitude longitude source:❑GPS❑Topographic neap
Ist:cd or Ruu4,Na.i
1 c!rcc yo\)
PENROSE NC_ _ DEPTH DRILLING LOG
c in o+T+nln state i�;,r.,l: from To Formation Description
( I- 0.0 1.0 Tan/brown/orange silty sand
1.0 10.0 Tan/orange sandy silt
7. DATEDRILLED07/13/05 10.0 20.0 White/grey/orange sandy silt
5. TOTAL DEPTH:38.0 FEET 20.0 38.0 White/orange/tan silty clayey sand
6. DOES \N ELL REPL%CE EXISTING \YELL? A'LS❑ NO IX Weathered rock 3
7. STATIC WATER LEVEL Bclow Top of Casing: 26.0 FT.
i I x_*-d:\L.n i 1'up ul C'aar:g I (n
S. TOP OF CASING IS 2.5 PT. Abo%c Land Surface*
"I op ofcashu!terminated m/or heluu land surface requires a t
"Hance in accordance ahh lt.t\('_\('2(C Olin.
9. YIELD(gpnl):N/A METHOD OF TEST N/A
10- \\-.ATER ZONES(depth): N/A C7
Lit
LOCATION SKET('H
11. DISINFECTION:Typegl»ount Shim direction and distance in miles from at least
12. CASING: \\`all Thickness two State Roads or County Roads. Include the road
Depth Diamcier or U'ciela:l t. Tlalerial nunihels and common road names.
From 0.0 To 3.0 rt. 2INCH SCH.40 PVC
From To Ft.
From To rt.
13. GROUT: Dcpth Aiaterial biCdlnd v
From 0.0 To 17.0 ri. Portland hentonite Slurry
From To R.
14. SCRE Q: DoL 10 I)bamctcr O�ha Size PV lalerial
From To SB' It.' in. 0 in. C
From To Ft. ill.
15. SAND GRAVEL PACK: "I . Rc
21.0 Ocl"t 8.0 2M6 FINE SWWAAND .S l Prom To Ft.
From To Ft.
16. REMARKS: MW4 BENTONITE SEAL FROM 17.0 TO 21.0 FEET.
I DO lll'.RI-BV C IiRTIl-1'TI IA I T 1I11%VWI(I.L %\AS('ONS IRt C l r.D LN.-A('('ORD.ANCP:NTI 1115.A NCAC'2C.111i 11.
(ONS IRl Z"IION ST.A'vD\RDS.,1ND I I1:AT:A(f,R' '( [Ills Rl..CORD IIAS BLFN PROVIDED 10 THpL 11 ITL OWNER
VI(.N V B.III 011EI'I.R C(INSIRI I('TIN(+ IIll:R'I:I_I. SL
Submit the original to the Di%isian of Water Quality Attn: Information Management, 1617\tail lien ice(enter-
Ruleilth.NC 27699-1617. Phoue\o.(9l9)733-7(I li,a-ithin 30 days.
G\V-I REV.09 2004

W31 � rer f�' r e* e)
WELL CONSTRUCTION RECORD
North Carolina-Department of Environment and Natural Resources-Division of Water Quality-Groundwater Section
WELL CONTRACTOR(INDIVIDUAL)NAME (print) RICHARD MCCRARY CERTIFICATION#2010
WELL CONTRACTOR COMPANY NAME BARKER CONSTRUCTION,INC./BARKER WELL&PUMP PHONE # [phone]
STATE WELL CONSTRUCTION PERMIT# 1871 ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
1. WELL USE(Check Applicable Box):Residential M Municipal/Public❑ Industrial❑ Agricultural❑
Monitoring❑ Recovery ❑ Heat Plump Water Injection❑ Other❑ If Other,List Use
2. WELL LOCATION: Topographic/Land setting
Nearest Town: HENDERSONVILLE County HENDERSON
❑Ridge ❑Slope ❑Valley H1Fla[
OLETA ROAD OFF OF UPWARD ROAD (check appropriate box)
(Street Name,Numbers,CommuniTy,Subdivision,Lot No.,Zip Code) Latitude/longitude of well location
3. OWNER: KIRK MCMURRAY
(degrees/minutes/seconds)
Address 5220 HOWARD GAP ROAD Latitude/longitude source:❑GPS❑Topographic map
(Street or Rome No.) (check box)
FLAT ROCK NC 28731-7781 DEPTH DRILLING LOG
City or Town State Zip Code From To Formation Description
( 828 )- 692-3468
Area code-Phone number
4. DATE DRILLED JULY 21.2005
5. TOTAL DEPTH: 1205'
6. DOES WELL REPLACE EXISTING WELL? YES❑ NO ® -
7. STATIC WATER LEVEL Below Top of Casing: 100 FT. _ 3
(Use`+"if Above Top of Casing)
8. TOP OF CASING IS 1.33 ra
FT.Above Land Surface* ,..�
'Top of casing terminated at/or below land surface requires a 0
variance in accordance with 15A NCAC 2C.0118. c=
9. YIELD(gpm): VA METHOD OF TEST TIMED can
10.WATER ZONES(depth):
LOCATION SKETCH
11. DISINFECTION:Type BY PUMP INSTALLER Amount Show direction and distance in miles from at least
12. CASING: Wall Thickness two State Roads or County Roads.Include the road
Depth Diameter or Weight/Ft. Material numbers and common road names.
From 0 To 40' Ft, 61/8 SDR21 PVC jto& /l�y� ,Q 1O1n��.
From To Ft. rUf I( 4� L N�-e.t-µ^+xxiCGI.
13. GROUT: Depth Material Method n`nh
From 0 To 20' Ft. CONCRETE POURED
From To Ft.
14. SCREEN: Depth Diameter Slot Size
From To Ft. in. in.To Ft.
From in. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
16. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NC C 2C, LL
CONSTRUCTION STANDARDS, T COPY O THIS RECORD HAS BEEN PROVIDED T THE L OWNER
r
SIGNATURE up FERSO FRUCIING 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

O C �-;
WELL CONSTRUCTION RECORD J 1 es vn ' '4
North Carolina-Department of Environment and Natural Resources-Division of Water Quality-Groundwater Section
WELL CONTRACTOR(INDIVIDUAL)NAME (print)KENNETH MCCRARY CERTIFICATION#2008
WELL CONTRACTOR COMPANY NAME BARKER CONSTRUCTION,INC./BARKER WELL&PUMP PHONE # [phone]
STATE WELL CONSTRUCTION PERMIT# 1871 ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
1. WELL USE(Check Applicable Box):Residential M MunicipaVPublic❑ Industrial ❑ Agricultural❑
Monitoring❑ Recovery ❑ Heat Pump Water Injection❑ Other❑ If Other,List Use
2. WELL LOCATION: Topographic/Land setting
Nearest Town: HENDERSONVILLE County HENDERSON ❑Ridge ®Slope ❑Valley ❑Flat
PEACEFUL VIEW ESTATES,LOT#9 (check appropriate box)
(Street Name,Numbers,Community,Subdivision,Lot No.,Zip Code) LatitudcAongitude of well location
3. OWNER: JEFFREY HARVEY
(degrees/minutes/seconds)
Address 263 LAMB MOUNTAIN ROAD Latitude/longitude source:❑GPS❑Topographic map
(Street or Rome No.) (check box)
HENDERSONVILLE NC 28792 DEPTH DRILLING LOG
City or Town State Zip Code From To Formation Description
8( 28)- 693-2273
Area code-Phone number
4. DATE DRILLED JULY 13,2005
5. TOTAL DEPTH: 280'
6. DOES WELL REPLACE EXISTING WELL? YES❑ NO IKI
7. STATIC WATER LEVEL Below Top of Casing: 29 FT. --?
(Use"+"if Above Top of Casing)
8. TOP OF CASING IS 1.33 FT.Above Land Surface*
*Top of casing terminated at/or below land surface requires a
w
variance in accordance with 15A NCAC 2C.0118.
9. YIELD(gpm): 20 METHOD OF TEST TIMED O
10.WATER ZONES(depth):
LOCATION SKETCH 3
11. DISINFECTION:Type BY PUMP INSTALLER Amount Show direction and distance in miles from at least `
12. CASING: Wall Thickness two State Roads or County Roads.Include the road
Depth Diameter or Weight/Ft. Material numbers and common road names.
From 0 To 52 Ft. 6118 SOR21 PVC
From To Ft gyp " 7 From To Ft. zl��•
13. GROUT: Depth Material Method
From 0 To 20' Ft. CONCRETE POURED
From TO Ft. ,�L �r.CQ_ /C.IJG(R. �/_
14. SCREEN: Depth Diameter Slot Size Material VA J
� .
From TO Ft. in. in.
From To Ft. in. in. A`9 zf A j1� oe-
15. SAND/GRAVEL PACK: Cho (.6GGP�L.L O_ _ (�"
Depth Size Material
From To Ft.
Front-To Ft. �0/
16. REMARKS: 10I !/YI �IiP,[f fJr r`lu �s.n-,o
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
1':¢wvu,, txk
SIGNATURE OF PERSON CONSTRUCTING THE WB= TE
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

O1C
v n ,A, 7
ti
WELL CONSTRUCTION RECORD e i
North Carolina-Department of Environment and Natural Resources-Division of Water Quality-Groundwater Section
WELL CONTRACTOR(INDIVIDUAL)NAME (print)KENNETH MCCRARY CERTIFICATION#2008
WELL CONTRACTOR COMPANY NAME BARKER CONSTRUCTION,INC./BARKER WELL&PUMP PHONE # [phone]
STATE WELL CONSTRUCTION PERMIT# 1871 ASSOCIATED WQ PERMIT#
if applicable) (if applicable)
1. WELL USE(Check Applicable Box):Residential® Mtmicipal/Public❑ Industrial❑ Agricultural❑
Monitoring❑ Recovery ❑ Heat Pump Water Injection❑ Other❑ If Other,List Use
2. WELL LOCATION: Topographic/Land setting
Nearest Town: HENDERSONVILLE Cntmty HENDERSON Midge ®Slope ❑Valley ❑Flat
EVANS ROAD (check appropriate box)
(Sheet Name,Numbers,Community,Subdivision,Lai No.,Zip Code) Latitudellongitude of well location
3. OWNER: LEE&JEAN FEARS(JEFF LAUFFER-CONTRACTOR) (degrees/minutes/seconds)
Address 51 IVES FARM LANE Latitude/longitude source:❑GPS❑Topographic map
(Sheet or Route No.) (check box)
HENDERSONVILLE NC 28739 DEPTH DRILLING LOG
City or Town state Zip Code From To Formation Description
E( 28)- 691-0612
Area code-Phone number
4. DATE DRILLED JULY 15,2005
5. TOTAL DEPTH: 405'
i
6. DOES WELL REPLACE EXISTING WELL? YES❑ NO gi
7
7. STATIC WATER LEVEL Below Top of Casing: 30 FT.
(Use"t"if Above Top of Casing) _
8. TOP OF CASING IS 1.33 FT.Above Land Surface•
'Top of casing terminated atlor below land surface requires a
variance in accordance with 15A NCAC 2C.811S. O
9. YIELD(gpm): 8 METHOD OF TEST TIMED
10.WATER ZONES(depth): C-n
LOCATION SKETCH - --3
11. DISINFECTION:Type err PUMP INSTALLER 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. 0 ,
From 0 To 75 Ft. 6118 SDR21 PVC ZGGC(.J From To Ft pT �dJ
From To-De Ft (toad �� a- s lq- &
13. GROUT: Depth Material Method - / "J"7
From 0 To 20 Fl, CONCRETE POURED
From Ft.De 14. SCREEN: Depth Diameter Slot Size Material
From To Ft. in.
From To Ft. in- in /�C -R-
15. SAND/GRAVEL-PACK:
Depth Size Material
From To Ft.
From To Ft.
16. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C,WELL
CONSTRUCTED STANDARDS,AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
SIGNATURE OF PERSON CONSIMUCTING THE WELL DATE
Submit the original to the Division of Water Quality,Groundwater Section,1636 Mail Service Center-Raleigh,NC
27699-1636 Phone No.[phone],within 30 days. GW-1 REV.07/2001

WELL CONSTRUCTION RECORD DP
North Carolina-Department of Environment and Natural Resources-Division of Water Quality-Groundwater Section
WELL CONTRACTOR(INDIVIDUAL)NAME (print)RICHARD MCCRARY CERTIFICATION#2010
WELL CONTRACTOR COMPANY NAME BARKER CONSTRUCTION,INC./BARKER WELL&PUMP PHONE # [phone]
STATE WELL CONSTRUCTION PERMIT# 1871 ASSOCIATED WQ PERMIT#
MUNI (if applicable) (if applicable)
1. WELL USE(Check Applicable Box):Residential® Municipal/Public❑ Industrial D Agricultural❑
Monitoring❑ Recovery ❑ Heat Pump Water Injection❑ Other O If Other,List Use
2. WELL LOCATION: Topographic/Land setting
Nearest Town: HENDERSONVILLE County HENDERSON DRidge ®Slope []Valley DFlat
SKY LAKE ESTATES,LOTW2 (check appropriate box)
(Shut Name,Number,Community,Subdivision,Len No.,Zip Code) Latitude/longitude of well location
3. OWNER: STEVE KILPATRICK (degrees/numutea/aeconds)
Address 2721 SUGARLOAF ROAD Latitude/longitude source:DGPSOTopographic map
(Shut or Route No.) (check box)
HENDERSONVILLE NC 28792 DEPTH DRILLING LOG
City or Town state Zip code From To Formation Description
( 828 } 891-7416
Area code-Phone number
4. DATE DRILLED AUGUST 31,2005
5. TOTAL DEPTH: 185
6. DOES WELL REPLACE EXISTING WELL? YES D NO
7. STATIC WATER LEVEL Below Top of Casing: 8V FT.
(U
8. TOP OF CASING IS 1.33 F
FT.. of Above Top of Above Land Surface*Casin
-Top of casing tcmivated at/or below land surface requires a
variance in accordance with 1SA NCAC 2C.0118.
9. YIELD(gpm): 50 METHOD OF TEST TIMED
10.WATER ZONES(depth):
LOCATION SKETCH
11. DISINFECTION:Type 9Y PUMP 1NSTq LER Amount Show direction and distance in miles from at least
12. CASING: Wall Thickness two State Roads or County Roads.Include the road
Depth Diameter or Weight/Ft. Material numbers and common road names.
From 0 To 40 Ft. 6 1/8 SDR21 PVC AADM 11,,,_ ,-. ,_ratd t„
From To Ft. L� 4VJU"(Ll1LLLlJ'wuXXX-
From To Ft. {Q Q
13. GROUT: Depth Material Method /��. [_,,_ p �� ,f �.,, Q�
From 0 To 20 Ft. CONCRETE POURED �Wd .TJLll-F b wn-tti-.Lr_L _
From De Ft. oLn& Dart W �L
14. SCREEN: Depot Diameter Slot Size Material at `�f,"p
From To FL in. in. a.-lt,tlLl/-- 0077LL /u{S,[t,t,.
From To FL in. in. 0 0
15. SAND/GRAVEL PACK:
Depth Size Material ,1`lf�/1Aic
�>
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 LL 9KNER
SIGNATURE OF PERSON�7RUCTING 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-) REV.07/2001

WELL CONSTRUCTION RECORD
North Carolina-Department of Environment and Natural Resources-Division of Water Quality-Groundwater Section
WELL CONTRACTOR(INDIVIDUAL)NAME (print)KENNETH MCCRARY CERTIFICATION#2008
WELL CONTRACTOR COMPANY NAME BARKER CONSTRUCTION,INC./BARKER WELL&PUMP pHONE, # [phone]
STATE WELL CONSTRUCTION PERMIT# 1871 ASSOCIATED WQ PERMIT#
(if applieabla) (if applicable)
1. WELL USE(Check Applicable Box):Residential M MunicipaltPublic❑ Industrial❑ Agricultural❑
Monitoring O Recovery ❑ Heat Pump Water Injection❑ Other O If Other,List Use
2. WELL LOCATION: Topographic/Litnd setting
Nearest Town: HENDERSONVILLE County HENDERSON ORidge ❑Slope Malley 91171at
BRANNON ROAD (check appropriate box)
(Street Name,Numbers,Community,Subdivision,Lot No.,Zip Code) Latitude/longitude of well location
3. OWNER: SHANE PAYNE(MARSHALL MATTHEWS-BLDR) (degrae/minutealsecmrde)
Address 174 MONTFORD AVENUE Latitude/longitude source:OGPSOTopographic map
(Sheet or Rome NO.) (check box)
ASHEVILLE NC 28801 DEPTH DRILLING LOG
City or Town state Zip Code From To Formation Description
( 828)_ 779-8671
Area code-Phone number
4. DATE DRILLED AUGUST 5,2005
5. TOTAL DEPTH: 180
6. DOES WELL REPLACE EXISTING WELL? YES O NO 91 rn
7. STATIC WATER LEVEL Below Top of Casing: 20 FT. D
(Use'4^if Above Top of Casing) 1
S. TOP OF CASING IS 1.33 FT.Above Land Surface'
-Top of caring twminated aVw below land surface requires a O - -
vwiance in accordance with 1SA NCAC 2C.011& ,
9. YIELD(gpm): 25 METHOD OF TEST TIMED
10.WATER ZONES(depth):
LOCATION SKETCH
11. DISINFECTION:Type m'PumP IasTA R 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. p
From 0 To 70 Ft. 6118 SDR21 PVC A �'J2L�2tLI)t(t e( L2
From To Ft
From To Ft.
13. GROUT: Depth Material Method JaVM,0,(. JA.Lt a o>v
From 0 To 20 Ft. CONCRETE POURED ,�j� !� _ate ao 3
From To Ft. /:1 �C.IJ ��dd
14. SCREEN: D.ptb Diameter Slot Size Material
From—To—FL—ill. in
From—To—FL—in. in. _ 02 T
15. SAND/GRAVEL PACK: ��, 4nof Stt
Depth Size Material
From To Ft. '
From To Ft
16. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C,WELL
CONSTRUCTION STANDARDS,AND THAT A COPY OF TTMS��"RECOORRD��H`,AASS BEEN PROVIDED TO THE WELL OWNER r
SIGNATURE
ON CONSTRUCTING E WELLDATE S .O�I
Submit the original to the Division of Water Quality,Groundwater Section,1636 Matz Service Carter-Raleigh,NC
27699-1636 Phone No.[phone],within 30 days. GW-1 REV.07/2001

WELL CONSTRUCTION RECORD
North Carolina-Department of Environment and Natural Resources-Division of Water Quality-Groundwater Section
WELL CONTRACTOR(INDIVIDUAL)NAME (print)_ 6/e- CERTIFICATION#
WELL CONTRACTOR COMPANY NAME /'/^Yi �� Jf' cifJ t7 PHONE # 6as 4- 77l
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMITS
(if applicable) ifa licable
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 Toown: rA rA County ftP,,,->%rr ,.z ❑Ridge ❑Slope ❑Valley 0171ie
(mil � /-C2fwrH�Y �(j/»r _ (check appropriate box)
(Street Name,Numbers,Community,Subdivision,Lot No.,Zip Code) Latitude/longitude of well location --
3. OWNER4 i l/d 71 4i (degrees/minutes/seconds) C�
Address 6'7 /�iri.n r�� t";lln 1 - Latitude/longitude source:❑GPS❑Topograplficlmap
(Street or Route No.) (check box) -A
DEPTH DRILLING LOG
Cary or sown Mate zip Code From To Formation Description
Area code-Phone number LLL. wv
4. DATE DRILLED /i - h
5. TOTAL DEPTH:
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO
7. STATIC WATER LEVEL Below Top of Casing:AFT.
(Use"+"if Above Top of Casing)
8. TOP OF CASING IS — FT.Above Land Surface"
'Top of casing terminated attor below land surface requires a
variance in accordance with ISA NCAC 2C.0118.
9. YIELD(gpm): 'yh METHOD OF TEST,
10.WATER ZONES(depth):Jai l
LOCATION SKETCH
11. DISINFECTION:Type Amount Show direction and distance in miles from at least
12. CASING: Wall Thickness two State Roads or County Roads.Include the road
Depth Diameter or Weight/Ft. Material numbers and common road names. p
From_,,�! _To/4/LT Ft. g< 7� -�-� E�"� �'c/ 64� .mot✓ r' � /'
From To Ft.From To Ft. 6"� ✓,n,rg�ri" �` _. .. _ I
13. GROUT: Depth Material Method i
From Ll Tom_F[._jstA-t�arr Lr
From To Ft. l
14. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in. f!
From To Ft. in. in.
15. SAND/GRAVEL PACK: 'mil
Depth Size Material ,v
FrorrL To Ft. ® C:
From To Ft.
16. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUr, TEN,ACCOR(3ANCE WITH 15 NCAC 2C,WELL
CONSTRUCTION STANDARDS,AND THAT A COPY OF TH1$ t; RD AS$EEA1 PRQVIDDo TO THE WELL OWNER
Of
SIGNATURE OF PERSON C S RUCT y11'I-t 1`'E NUJ DATE
Submit the original to the Division of Water Quality,Ground*atel•Section I.0,3(c_)11giLS€fvice Center-Raleigh,NC
27699-1636 Phone No.[phone],within 30 days. 'GW-1 REV.07/2001

0�lp
WELL CONSTRUCTION RECORD
North Carolina-Department of Environment and Natural Resources-Division of Water Quality-Groundwater Section
WELL CONTRACTOR(INDIVIDUAL)NAME (print f��r//A4. — g- zL _ CERTIFICATION#31 rG--
WELL CONTRACTOR COMPANY NAME 010
10 r` /P'HONE #
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PE�l
(if applicable) (if applicable) �—
" I 1. WELL USE(Check Applicable Box): Residential iJ�Municipal/Public❑ Industrial❑ Agricultural❑
Monitoring❑ Recovery ❑ Heat Pump Water Injection❑ Other❑ If Other, List Use _ !
2. WELL LOCATION: C_
opographic/Landsetting
arest Town: County-4 r a � tdge ❑Slope ❑Valley ❑F lat
- 1ek' - 1_t L'.�
z
(check appropriate box) i r' 1
(Street Name,Numbers,Community,Subdivision,Lot No.,Zip Code) Latitude/longitude of well locationr-
r a
3. OWNER:�k'!� - (degmes/minutes/sewnds) CD C=,
Address _F,D- 8,1s, 4190 Latitude/longitude source:❑GPS❑Topographic map`'" Gib
(Street or Route No.) (check box) j
IcLt+r Zo N-2 3 Z DEPTH DRILLING LOG
city or Town State Zip Code From To Formation Description
(`6Lwr - vk -1777 6 IC p)rd
Area code-Phone number -
4. DATE DRILLED U—LT"
2 r
5. TOTAL DEPTH: 70—
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO El/ �� 4lr
7. STATIC WATER LEVEL Below Top of Casing: q0 FT. 3{( Q ec
(Use"+"if Above Top of Casing)
8. TOP OF CASING IS�_FT.Above Land Surface•
*Top of casing terminated at/or below land surface requires a C
variance in accordan c with 15A NCAC 2C.0119.
9. YIELD(gpm): METHOD OF TEST/1A_
10.WATER ZONES(depth):_
LOCATION SKETCH C5 a
Cn
11. DISINFECTION:Type f-/T-µ Amount Show direction and distance in miles from at least;,'
12. CASING: Wall Thickness two State Roads or County Roads.Include the roa,T
Depth Diameter or Weight/Ft. aterial numbers and common road names. '
From To >0 Ft. te'� S0221Y v
From To Ft. t"`-"
From To Ft. '
13. GROUT: Depth Material Method
From___To"�_Ft._Cv,­y etc M"X4 "
From To Ft.
14. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in.
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.-
From—To—Ft.
16. REMARKS: 4.0(
I DO HEREBY CERTIFY T THIS WELL W NSTRUCTED TNACCORDAN E WITH 15A NCAC 2C,WELL
CONSTRUCTION S D ,AND THAT p� OF THIS RECORD HAS B R PROVIDED TO THE WELL OWNER
L1 JUN 21 2JC '. ; -Z7 _fir
SIGNATURE F PERSON CONSTRUCTING THI WELT, ATE
Submit the original to the Division of Water Quality,Groundwater Section,1636"Mail Service Center-Raleigh,NC
27699-1636 Phone No.[phone],within 30 days. GW-1 REV.07/2001

WELL CONSTRUCTION RECORD
North Carolina-Department of Environment and N rural Re rces-Division of Water Quality-Groundwater Section
�
WELL CONTRACTOR(INDIVIDUAL)NAME
(p(priint),, '-ell
/ .—k/��.� ,I CERTIFICATION#�`,=J,''
WELL CONTRACTOR COMPANY NAME_Ar It �^'L"l� s�F"`°"^/ PHONE # (B2�c)—K I'I"�TJIJ
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT# ('�(.A V
(if applicable) (if applicable)
1. WELL USE(Check Applicable Box): Residential 93--Irunicipal/Public❑ Industrial ❑ Agricultural❑
Monitoring❑ Recovery ❑ Heat Pump Water Injection❑ Other❑ If Other,List Use
� L -C
2. WELL LOCATION: 'i opographic/Land setting
Ne9t��e�stTown: C4ot.xtk County N t-San ldge ❑Slope ❑Valley ❑FJO '
1"'v� �VolIr pe�xG� (check appropriate box)
(Street Name,Numbers,Community,Stulbdivissiion,Lot No.,Zip Code) Latitude/longitude of well locatiorS
3. OWNER:JLIit6� L")e-ML1dVYe1'Z'0� (degrees/minutes/seconds)
Address &_&c M Latitude/longitude source:❑GPS❑Topographic map
(Street or Route No (check box)
P � lvC 21111 DEPTH DRILLING LOG
City or Town �} Zip Code From To Fon 'en Description
awl - o �e r -
Area code-Phone number '7 p
4. DATE DRILLED (( d ) _ 7(+
5. TOTAL DEPTH: -/ Tut
6. DOES WELL REPLACE EXISTING WELL? YES NO [El c-
7. STATIC WATER LEVEL Below Top of Casing: FT. C=
(Use"+"if Above Top of Casing)
8. TOP OF CASING IS FT.Above Land Surface*
-Top of casing terminated at/or below land surface requires a
variance In accordance with ISA NCAC 2C.0118. ON
9. YIELD(gpm): -1 METHOD OF TESTP LVr ✓ o C4='
10.WATER ZONES(depth):
LOCATION SKETCH
11. DISINFECTION:Type 4T 14 Amount Show direction and distance in miles from at least
12. CASING: Wall Thickness two State Roads or County Roads.Include the road- —
t� Depth Diameter or Weight/Ft. Material numbers and common road names.
From l% Tom Ft. rc 1� 50'L( pt/c-
From To Ft.
From To Ft.
13. GROUT: Depth Material Method
From C To L a -Ft._ C V-cfch, ryti 4j
From To Ft. r1 _
14. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in. j -/
From To Ft. in. in.
15. SAND/GRAVEL PACK: •f" 1C fF��^
Depth Size Material rQ
From To Ft.
From To Ft.
rAk
16. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WA HI
CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C,WELL
CONSTRUCTIO S S,AND�THeL'li iAf i)PY OFTS RECORD HAS BEEN PROVIDED T THE WELL OWNER
_ GL`wwI �
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
Submit the original to the Division of Water Quality,Groundwater Section,1636 Mail Service Center-Raleigh,NC
27699-1636 Phone No.[phone],within 30 days. GW-I REV.07/2001

WELL CONSTRUCTION RECORD
North Carolina-Department of Environment and Natural Resources-Division of Water Quality-Groundwater Section
WELL CONTRACTOR(INDIVIDUAL)NAME (print)v/e//!J 5e4lellr CERTIFICATION#7��/
WELL CONTRACTOR COMPANY NAME.l`/�'�r>"�� LyPI/t om_PHONE # CpVA 57 I
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQPERbIITN
(if applicable) ifa licable
I. WELL USE(Check Applicable Box): Residential ff Municipal/Public❑ Industrial Agricultural❑
Monitoring❑ Recovery ❑ Heat Pump Water Injection❑ Other❑ If Other,List Use
2. WELL LOCATION: / Topographic/Land setting
Nearest Town:_ County r- /'r ❑Ridge ❑Slope ❑Valley ❑Flat
z7 (check appropriate box)
(Street Name,Numbers,Community,Subdivision,Lot No.,Zip Code) Latitude/longitude of well location
i�3. OWNERJ P'X'(y.U"C. -e l.:T"> ,0 (degrees/minutes/seconds)
Address Latitude/longitude source:❑GPS❑Topographic map
(Street or Route No.) (check box)
/JrG DEPTH DRILLING LOG
City or Town State Zip Code From To Formation Description
a'e
Area code-Phone number .- /�
4. DATE DRILLED h /%'dh k
5. TOTAL DEPTH:_ �f0 /
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO f�
7. STATIC WATER LEVEL Below Top of Casing: "7 FT. s)'p._ �rSO z�J�n fL,
(Use"+"if Above Top of Casing)
8. TOP OF CASING IS FT. Above Land Surface* _
`Top of casing terminated at/or below land surface requires a
variance in accordance with ISA NCAC 2C.0113.
9. YIELD(gpm): 4f ' METHOD OF TEST e7 P c7
10. WATER ZONES(depth): 19-�A7
LOCATION SKETCH
11. DISINFECTION:Type Amount Show direction and distance in miles from at least"'
12. CASING: Wall Thickness two State Roads or County Roads.Include the road
Depth Diameter or Weight/Ft. Material numbers and common road names.
From 0 To-ZL—Ft. 6'Jh' Jj'S yrl
From To Ft. r (f I= ' � Can n oA to
From To Ft.
13. GROUT: Depth Material Method
From_t!,-� T6Z4�L­Ft,_
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. i J
From To Ft. �J
16. REMARKS:
csz
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C WELL r
CONSTRUCTION STANDARDS,AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
SIGNATURE OF PERSON CONStRUCTDTF / - 1t
h DATE
e
Submit the original to the Division of Water Quality,Groundwater Section,1636Mail Service Center-Raleigh,NC
27699-1636 Phone No.[phone],within 30 days. - GW-I REV. 07/2001

WELL CONSTRUCTION RECORD
North Carolina-Department of Environment and N rural Reso ces,Division of Water Quality-Groundwater Section
WELL CONTRACTOR(INDIVIDUAL)NAME (print) 6 l:—kce CERTIFICATION
WELL CONTRACTOR COMPANY NAME� st/TTTTT// L"1�l 9-w.-•��1 PHONE # fYA1 h''17— ij�i
STATE WELL CONSTRUCTION PERMIT# ( ASSOCIATED WQ 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.'O//N: Topographic/Land setting
Nearlestt Town: ry6vC�Ng•a�u� County IL-fetrrcn ❑Ridge ❑Slope ❑Valley ❑Flat
L,4* 76 644, t.f(,< (check appropriate box)
(Street Name,Numbers,Community,Subdivision,,Lott No.,Zip Code) Latitude/longitude of well location
3. OWNER:Ja, ,�- I� ni J&l L--L!:�t< (degrees/minutes/seconds)
Address qrk< w< G- au- f3- n''.-..•n Latitude/longitude source:❑GPS❑Topographic map
(Street or Route No.) (check box)
6L 16117 DEPTH DRILLING LOG
c ry or�w� s zip code From To Forn ation Description
Area code-Phone numbqr/ /v /� 'F
4. DATE DRILLED
5. TOTAL DEPTH: tc 71CP, ttl r� a
lC. wy
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO L-r
7. STATIC WATER LEVEL Below Top of Casing: u c o FT.
t (Use"+"if Above Top of Casing)
8. TOP OF CASING IS t FT.Above Land Surface* x
-Top of casing terminated attor below land surface requires a _
varlancein accorAluncewith ISANCAC2C.0118.
9. YIELD(gpm): METHO OFTEST
10.WATER ZONES(depth): `70`W "2 Vo"
LOCATION SKETCH
11. DISINFECTION:Type rLTM- Amount Show direction and distance in miles from at least i7.
two State Roads or County s
12. CASING: Wall Thickness ty Roads.Include the road
Depth(g,4 Diameter or Weight/Ft. Material numbers and common road names.
From 6 Tom Ft. t<q 3 2 d '�
From To Ft.
From To FL
13. GROUT: Depth Material Method /
From Poi To 10 _FL_CLif�LcLJI ` 2
From To Ft.
14. SCREEN: Depth Diameter Slot Size MaterialLrj
From To Ft. in. in. \ _ E
From To Ft. in. in. 1
15. SAND/GRAVEL PACK:
Depth Size Material ��d ��'•--- v —I
From To Ft.
n> '�From To Ft. o
16. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C,WELL!
CONSTRUCTION,
, ST /� AND THAT COPY OF THIS RECORD HAS BEEN PROVIDED TO/THE WELL OWNER
�— SIGNATURE OF PERSON CONSTRUCTING THE WELL ' DATE
Submit the original to the Division of Water Quality,Groundwater Section,1636 Mail Service Center-Raleigh,NC
27699-1636 Phone No.[phone],within 30 days. GW-1 REV.07/2001

WELL CONSTRUCTION RECORD
North Carolina-Department of Environment and Natural Resources-Division of Water Quality-Groundwater Section
WELL CONTRACTOR(INDIVIDUAL)NAME
(print)r(7./"/1 rll�i'7��[����L CERTIFICATION
WELL CONTRACTOR COMPANY NAME1[!eI' .,`/J �G& YA-/!-LA-is-1,7 PHONE # (40yfT77'Z/Owd
i
STATE WELL CONSTRUCTION PERMIT# ' '7/ h 7 ASSOCIATED WQ PERMMIT#
(if applicable) ifapplicable)
I. 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: /� e�/, pel l County I j- ❑Ridge []Slope ❑Valley ❑Flat
/ 7 Gvf (check appropriate box)
(Street Name,Numbers,Community,Subdivision,Lot No.,Zip Code) Latitude/longitude of well location
Su
3. OWNERrg/n.a ts{1e-a (degrees/minutes/seconds)
Address Z y7 Co�rl,r�1 ff - Latitude/longitude source:❑GPS❑Topographic map
(Street or Route No.) (check box)
S�Isn t S C �q?-- DEPTH DRILLING LOG
City or Town State Zip Code From To Formation Description
( to-. 4Irid'/—*1 i>
Area code-Phone number �, ���i- •r
4. DATE DRILLED /7 '��-616�J J ' h
5. TOTAL DEPTH: 5 Uh'
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO f- T_
7. STATIC WATER LEVEL Below Top of Casing:AFT. y- l yp
i gel r
(Use"+"if Above Top of Casing) -
8. TOP OF CASING IS r FT.Above Land Surface* --`�-- '
-Top of casing terminated at/or below land surface requires a
variance In accordance with 15A NCAC 2C.0118. ..-
9. YIELD (gpm): 2 METHOD OF TESTr' e o 'I
10.WATER ZONES(depth):
LOCATION SKETCH crt
21
11. DISINFECTION:Type Amount Show direction and distance in miles from at least
12. CASING: Wail Thickness two State Roads or County Roads.Include the roads'
Depth Diameter or Weight/Ft. tsMItaai naall numbers and common road names.
Fromm To 9 "� Ft. �e %vv y ,j• Ce`/,ol'. / o
Fromm Si3 To%Ut! Ft.(:�h r.M w
From To Ft. y ry
13. GROUT: Depth Material Method
Fromm To o4C;' _Ft.
From To Ft. - - -
14. SCREEN: Depth Diameter Slot Size Material --
From To Ft. in. in. i � r=
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Size Material t 'I
v _
From To FL —'
From To F[. o
16. REMARKS: ^!
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH I5A NCAC 2C,WELIi
CONSTRUCTION STANDARDS,AND THAT AA�JC�OPPY OF THIS RECORD HAS BEEN PROVIDED TELTHE WELL OWNER -
SIGNATURE OF PERSON CONSTRUCTING THE WELL DJkTE
Submit the original to the Division of Water Quality,Groundwater Section,1636Mail Service Center-Raleigh,NC
27699-1636 Phone No.[phone],within 30 days. GW-1 REV. 07/2001

WELL CONSTRUCTION RECORD
North Carolina-Department of Environment an atural Resources-Division of Water Quality-Groundwater Section
WELL CONTRACTOR(INDIVIDUAL)NAME (print) CERTIFICATION#3tljG
WELL CONTRACTOR COMPANY NAME mTrrll IL-1 PHONE # (Sf Z 1-7'A'A
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT# IU 5-f-If
(if applicable) (if applicable)
1. WELL USE(Check Applicable Box): Residential L9_ Municipal/Public❑ Industrial ❑ Agricultural ❑
Monitoring❑ Recovery ❑ Heat Pump Water Injection❑ Other❑ If Other,List Use
2. WELL LOCATION: Topographic/Laandsetting
Nearest Town: terT.uFS County env_rs ... ❑Ridge ❑Slope 2'Valley ❑Flat
�f i� t.'FlF7 (check appropriate box)
(Street Name,Nu tbers,Community,Subdivision,Lot No.,Zip Code) Latitude/longitude of well location
((
3. OWNER: vd fa/ ikb — (degrees/minutes/seconds)
Address ::50 !v„fZQC,&-t. .41 Latitude/longitude source:❑GPS❑Topographic map
(Street or Route No.) (check box)
lKcv.4. �l(G- DEPTH DRILLING LOG
City or Town State Zip Code From To 5 Ofmation Description
Area code-Phone numbei_ /pd
4. DATE DRILLED
5. TOTAL DEPTH: WYf iZr
6. DOES WELL REPLACE EXISTING WELL? YES P NO i;F-
7. STATIC WATER LEVEL Below Top of Casing: 2 d FT. C
(Use"+"if Above Top of Casing) --
8. TOP OF CASING IS t FT.Above Land Surface* o
"Top of casing terminated at/or below land surface requires e
variance in accordance with 15A NCAC 2C.0115. ® A
9. YIELD(gpm): 'bf METHOD OF TEST k&4w
10.WATER ZONES(depth):
L LOCATION SKETCH j
11. DISINFECTION:Type /7 Amount Show direction and distance in miles from at least
12. CASING: Wall Thickness two State Roads or County Roads.Include the road
Depth Diameter or Weight/Ft. Material numbers and common road names.
From To /Y4 Ft. Gt� .SOQ1/ -G
From To Ft.
From To Ft.
13. GROUT: Depth Material Methof
From 0 Tom_FL CO O° Cre/- ` E a.✓ i,
From To Ft.
14. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in.
From To Ft. in. in.
15. SAND/GRAVEL PACK: " 1
a/
Depth Size Material
From To Ft.
From To Ft. t✓° Qg
16. REMARKS: r
_r
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C WE L
CONSTRUCTION T ARDS��D THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELUOWNER z �
SIGNATURE OF PERSON GON$TRUCTINGTHE WELL ` DATE ! v ,
J
4 LS ,ZOQV ' ice Center Ra1etghp NC a
27699-1636 Phone No.[phone] within 30 days. o i GW I R l4 '7,/2001� C
' �erw L
Submit the original to the Division of Water uyli 1 roundwater Section 1636 Mail y
1 c

WELL CONSTRUCTION RECORD
North Carolina-Department of Environment and N I Re ources-Division of Water Quality-Groundwater Section
WELL CONTRACTOR(INDIVIDUAL)NAME/[(print)' 1 r /, n r f ERTIFICATION#�/J L%
WELL CONTRACTOR COMPANY NAME L YIPJY'tll L.-ed r,��rmd' v —PHONE it
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
if applicable) (ifapplicable)
B�
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: 14111144GIr- County 14,Wt.-rc , 12Rf'i-dge ❑Slope ❑Valley ❑Flat
(check appropriate box)
(Street Name,Numbers,Community,Subdivision,Lot No.,Zip Code) Latitude/longitude of well location
3. OWNER: Eritt, L,/4Lgh4r' (degrees/minutes/seconds)
Address pd. 6a� Latitude/longitude source:❑GPS❑Topographic map
Er fah (StrV Route No.) 7,0al DEPTH (check box)
t0 DRILLING LOG
city or Town State zip Code From To IF^�Iormat' n Description
)- Go(,,-YWU D 4i7 Iy`�
Area code-Phone number / YZ
4. DATE DRILLED 5 3(`a f 1 t 3
5. TOTAL DEPTH: Lf
E
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO 2-' Gc( N2a'
7. STATIC WATER LEVEL Below Top of Casing: FT.
t (Use"+"if Above Top of Casing) L
8. TOP OF CASING IS FT.Above Land Surface'
n
.Top of casing terminated at/or below land surface requires a t
variance in accordance with 15A NCAC 2C.0118. Q/�
9. YIELD(gpm): METHOD OF TEST!t•rQ1✓
10.WATER ZONES(depth): (Ey' cl)
LOCATION SKETCH
11. DISINFECTION:Type H T11 Amount Show direction and distance in miles from at least
12. CASING: Wall Thickness two State Roads or County Roads.Include the road
Depth Diameter or Weight/Ft. Material numbers and common road names.
From ( To 5L Ft. a rrN SM L( UC
From To Ft.
From To Ft.
13. GROUT: Depth Material Method
From__To 80 _Ft.�t°�94n,%e PO 14•
From To Ft. p.7 �F✓ �
14. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in. q S4"
From To Ft. in. in. (f t([rV'
15. SAND/GRAVEL PACK: / 0.
Depth Size Material t
From To Ft. t
From To Ft. y
16. REMARKS:
I DO HEREBY CERTIFY THA WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C,WELL��cop�` --
CONSTRUCTION A S AND THA COPY OF THIS RECORD HAS BEEN PROVIDED TO THE
IF PE ��
SIGNATURE R q N'ONSTRUCTING,THE WELL i DATE
Submit the original to the Division of WaterQuality,
I tl µ N41
Quay i, roundwater Section,1636 hi ' iervice Center-Ralei G- �
27699-1636 Phone No. 919 733-3221,within 30 da s 1 1 . s i
( ) Y � � ti GW-I REV. E7!`NOI 0 _!

WELL CONSTRUCTION RECORD
North Carolina-Department of Environment and N rural R urrces-Division of Water Quality-Groundwater Section _
WELL CONTRACTOR(INDIVIDUAL)NAME (/p�rint), /�e,S�l�fr CERTIFICA710N# )�s
WELL CONTRACTOR COMPANY NAME A L-r�, d Cll b­� PHONE #
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT# CN5�OP1OLL42—
(if applicable) (if applicable)
S/
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 ting
NearestTown:Mi1/s ,4Kr- County ULA/a_,go.-.. ❑Ridge ❑Slope BValley ❑Flat
AA#a f�{ (check appropriate box)
(Street Name,,CNumbers,Community,Subdivision,Lot No.,Zip Code) Latitude/longitude of well location
3. OWNER: KrL b—L'JAIIf' (degrees/minutes/seconds)
Address Ub rvlJls 'vr Latitude/longitude source:❑GPS❑Topographic map
''rr
(Street or Route No.) (check box)
40,, e.5�0� r co 2 tr?L{z DEPTH DRILLING LOG
City or Town State Zip Code From Formation Description
(laib')- t-,ou—t/eid l
Area code-Phone number O
4. DATE DRILLED
5. TOTAL DEPTH: 'L C(F f
6. DOES WELL REPLACE EXISTING WELL? YES B"NO ❑ Icy q3
7. STATIC WATER LEVEL Below Top of Casing: FT.
(Use"+"if Above Top of Casing) Lt--
8. TOP OF CASING IS ( FT.Above Land Surface*
`Top of casing terminated attor below land surface requires a '
variance In accordance with 15A NCAC 2C.0118.
9. YIELD(gpm): 10 METHOD OF TEST
10.WATER ZONES(depth):_ -1 a' Ufg- '
LOCATION SKETCH
11. DISINFECTION:Type NT-f>t 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 nam s From O To_qjj�_Ft. fl`!� S(1/.2,1
From To Ft.-
From To Ft.
13. GROUT: Depth Material Method = S ) C I �S;�
From O To 2y _Ft_cdnerel2tf .'Ie,{ c/ z
From To FtAe,4 .'lie
14. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in.
From To F[. in. in.
15. SAND/GRAVEL PACK: ;,
Depth Size Material
From To Ft. ..
From To Ft.
16. REMARKS:
✓�tt
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C,WELL
CONSTRUCTION STAVD4A D THAT A COPY OF THIS RECORD HAS BEEN PROVIDED Tr or -UWNEA�
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE I L�
t 1
Submit the original to the Division of Water Quality,Groundwater Section,1636 Mail ServtgeCenper-Raleigh,NC
27699-1636 Phone No.[phone],within 30 days. i G / 1 REV. 07/2001
r , in,'1L° Tf� AEOTION

is
WELL CONSTRUCTION RECORD
North Carolina-Department of Environment and/Natatjur RfP��1L/1�ces-Division of Water Quality-Groundwater Section
WELL CONTRACTOR(INDIVIDUAL)NAME (print) /+ I 4 CERTIFICATION#�!r/��
WELL CONTRACTOR COMPANY NAME /, e"frti Z"2 1Y F'-77 '7e/�ff
PHONE #
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
1. WELL USE(Check Applicable Box): Residential Er-`Municipal/Public❑ Industrial ❑ Agricultural❑
Monitoring❑ Recovery ❑ Heat Pump Water Injection❑ Other❑ If Other,List Use
2. WELL LOCATION:
Nearest Town:��C'vlxzCnaz¢�le County Topographic/Land
4?rvk,301 setting
�dge ❑Slope ❑Valley ❑Flat
(check appropriate box)
(Street Name,Numbers,Community,Subdivision,Lol No.,Zip Code) Latitude/longitude of well location
3. OWNER: "e- 51`^ICY (degmes/minutes/seconds)
Address 9Ifu rvy,:,/,.�'T-,L Latitude/longitude source:❑GPS❑Topographic map
(Sweet or Route No.) (check box)
DEPTH DRILLING LOG
City or Town State zip Code From To F rmalion Description
(-)-�6 (U
Area code-Phone num er
4. DATE DRILLED f f
5. TOTAL DEPTH: 74,
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO ❑
7. STATIC WATER LEVEL Below Top of Casing:_5 ev- FT. —�
I (Use'W'if Above Top of Casing) .�
S. TOP OF CASING IS 1 FT.Above Land Surface*
'Top of casing terminated at/or below land surface requires a
variance in accordance with 15A NCAC 2C.8118.
9. YIELD(gpm): 2_ METHOD OF TEST • +^��" rn +
10.WATER ZONES(depth):_ i
LOCATION SKETCH
11. DISINFECTION:Type t'/-/ 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 WeighVFt. hiaterial numbers and common road names.
From G To O Ft, itIIf 5OR2t f'G
From To Ft.
From To Ft.
13. GROUT: Depth Material Method
From v To C L FL CC,1CF-4f.
From To Ft.
14. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in.
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
16. REMARKS:
1 DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED,IN ACCORDANCE WITH 15A NCAC 2C,WE
CONSTRUCTIO/ly SST D RES,AND THAT A COPY OF THIS RECORD HAS PEEN PROVIDED TO THE WELL - R 1
SIGNATURE OFPE SON CONSTRUCTING THE WELL ✓ DATE o � "
-i C:)
Submit the original to the Division of Water Quality,Groundwater Section,1636 Mail Service Center-Ral C
27699-1636 Phone No.[phone],within 30 days. .- GW-1 RE .b7/2001

WELL CONSTRUCTION RECORD
North Carolina-Department of Environment and Natural Resources-Division of Water Quality-Groundwater Section
WELL CONTRACTOR(INDIVIDUAL)NAME (print)KENNETH MCCRARY CERTIFICATION#2008
WELL CONTRACTOR COMPANY NAME BARKER CONSTRUCTION,INC./BARKER WELL&PUMP PHONE # [phone]
STATE WELL CONSTRUCTION PERMIT# 1871 ASSOCLITED WQ PERMIT#
(if applicable) (if applicable)
1. WELL USE(Check Applicable Box):Residential M Municipal/Public❑ Industrial❑ Agricultural❑
Monitoring❑ Recovery ❑ Heat Pump Water htjmtion❑ Other❑ If Other,List Use
2. WELL LOCATION: TopographidLand setting
Nearest Town: HENDERSONVILLE County HENDERSON ❑Ridge ®Slope ❑Valley ❑Flat
BENNETTA LANE (check appropriate box)
(Street Name,Numbers,Community,Subdivision,Lot No.,Zip Code) LatitudeAongitude of well location
3. OWNER PEGGY GARTER (degrees/minutes/seconds)
Address PO BOX 568 Latitude/longitude source:❑GPS❑Topographic map
(Street or Rome No.) (check box)
HENDERSONVILLE NC 28793 DEPTH DRILLING LOG
City or Town State Zip Code From To Formation Description
8�2S- 692-7299
Area code-Phone number
4. DATE DRILLED APRIL 29,2005
5. TOTAL DEPTH: 280' L rn
6. DOES WELL REPLACE EXISTING WELL? YES❑ NO ® t= '
7. STATIC WATER LEVEL Below Top of Casing: 20' FT. —(Use"+"if Above Top of Casing) :j
S. TOP OF CASING IS 1.33 FT.Above Land Surface'
•Top of casing terminated atlor below land surface requires a
variance in accordance with 15A NCAC 2C.0118.
9. YIELD(gpm): 7Y. METHOD OF TEST TIMED
10.WATER ZONES(depth):
LOCATION SKETCH
11. DISINFECTION:Type aY PUMP INSTALLER 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. ry�
From U To 133' Ft, 6 1/8 SDR21 PVC
From To FL
From TO Ft.
13. GROUT: Depth Material Method O„ ♦ �r ®.� C-i
From 0 TO 20' Ft, CONCRETE POURED uCc ��, � �-^-'
From To Ft. a�,
14. SCREEN: th Diameter Slot Size Material P r q /
From To Ft. in. in. GL [ (�
From TO Ft. in. in. ^ ,( at
15. SANOGRAVEL PACK:
Depth Sin Material tYtw .�/l ✓'�'
From To Ft.—
Frorn—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 B N PROVIDED TO THE LL OWNER
SIGNATURE OF PERSON CONSTRUCTING THE LL DATE
Submit the original to the Division of Water Quality,Groundwater SeGtj 16 Afail Sdrvlce Centtr-Ralejgb,NC
27699-1636 Phone No.[phone],within 30 days. t - - GV f-1 REY.97/2001
L —_

WELL CONSTRUCTION RECORD
North Carolina-Department of Environment and Natural Resources-Division of Water Quality-Groundwater Section
WELL CONTRACTOR(INDIVIDUAL)NAME (print) RICHARD MCCRARY CERTIFICATION#2010
WELL CONTRACTOR COMPANY NAME BARKER CONSTRUCTION,INC./BARKER WELL&PUMP PHONE # [phone]
STATE WELL CONSTRUCTION PERMIT# 1871 ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
1. WELL USE(Check Applicable Box):Residential M Municipal/Public❑ Industrial❑ Agricultural❑
Monitoring❑ Recovery ❑ Heat Pun T Water Injection❑ Other❑ If Other,List Use
2. WELL LOCATION: Topographic/Land setting
Nearest Town: HENDERSONVILLE County HENDERSON ®Ridge []Slope ❑Valley ❑Flat
WEST POINT SUBDIVISION,LOT#1 (check appropriate box)
(Sheet Name,Numbers,Community,Subdivision,Lot No.,Zip Code) Latitude/longitude of well location
3. OWNER MOHAMMED ABUADAS (degrees/minutes/seconds)
Address 149 BROOKSIDE CAMP ROAD Latitude/longitude source:❑GPS❑Topographic map
(Streetor Route No.) (check box) - -
HENDERSONVILLE NC 28792-0703 DEPTH DRILLING LOG
City or Town State Zip Code From To Formation Descriptio6
8( 28 )- 693-9549 J
Area code-Phone number m
4. DATE DRILLED MAY 4,2005
5. TOTAL DEPTH: 505'
6. DOES WELL REPLACE EXISTING WELL? YES❑ NO Rl
7. STATIC WATER LEVEL Below Top of Casing: 40' FT. O
(Use-+^if Above Top of Casing)
8. TOP OF CASING IS 1.33 IT.Above Land Surface' YI
•Top of casing terminated allor below land surface requires a
variance in accordance with 15A NCAC 2C.011& `
9. YIELD(gpm): 8 METHOD OF TEST TIMED
10.WATER ZONES(depth):
LOCATION SKETCH
11. DISINFECTION:Type BY PUMP INSTALLER Amount Show direction and distance in miles from at least
12. CASING: Wall Thickness two State Roads or County Roads.Include the road
Depth Diameter or Weight/Ft. Material numbers and common road names.
From 0 To 51' Ft. 61/8 SDR21 PVC �/x
From To FL �S w �CL� �Y�Ctd.2i
From To Ft.
13. GROUT: Depth Material Method n q
01
m
From 0 To 20' F[. CONCRETE POURED De �[ nn JJ /�,{,
Fro De Ft. }�}�� KGc• KJf) /
14. SCREEN: Depth Diameter Slot Material l
From To FL in. a— ��_ae h � 1-B•From To Ft. in. in. l _ya.� f F.u.. 0 YL.t.1��-
15. SAND/GRAVEL PACK: /
Depth Size Material 2. / - Pd _.1.
From To Ft. G�-� #t!//IU� fU,C(ALGGL6t
From To Ft.
16. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C,,WELL
CONSTRUCTION STANDARDS, THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE LL
6
SIG ATURE OF PPRSCN CONSTRUCTING THE WELLA
original ( ) Quality, eL'ti g,1636 Mail Service Center-Raleigh,NC
Submit the on nal to the Division of Water ah Groundwater S o
27699-1636 Phone No. 919 733-3221,within 30 days. GW-1 REV.07/2001
s�2Vr. _
I L.
I
c

31 ;
WELL CONSTRUCTION RECORD
North Carolina-Department of Environment and Natural Resources-Division of Water Quality-Groundwater Section
WELL CONTRACTOR(INDIVIDUAL)NAME (print)KENNETH MCCRARY CERTIFICATION#2008
WELL CONTRACTOR COMPANY NAME BARKER CONSTRUCTION,INC./BARKER WELL&PUMP PHONE # [phone]
STATE WELL CONSTRUCTION PERMIT# 1871 ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
1. WELL USE(Check Applicable Box):Residential® Municipal/Public❑ Industrial❑ Agricultural❑
Monitoring❑ Recovery ❑ Heat Pump Water Injection❑ Other❑ If Other,List Use
2. WELL LOCATION: Topographic/Landwtting
Nearest Town: HENDERSONVILLE County HENDERSON ❑Ridge ®Slope []Valley ❑Flat
BEECHWOOD LAKES ESTATE (check appropriate box)
(Street Name,Numbers,Community,Subdivision,Lm No.,Zip Code) Latitude/longitude of well location
3. OWNER SALLY STURDEVANT
:utes/sewnds)Address Latitude/longitude source:❑GPS❑To pographic map
(Street or Route No.) (check box)
HENDERSONVILLE NC 28793 DEPTH DRILLING LOG w.a
City or Town state zip Code From To Formation Description ]
( 828 )_ 890-0685
Area code-Phone number
4. DATE DRILLED MAY 3,2D05 C -<
5. TOTAL DEPTH: 780' z
6. DOES WELL REPLACE EXISTING WELL? YES❑ NO 91
7. STATIC WATER LEVEL Below Top of Casing: 20' FT. o
(Use"+-if Above Top of Casing)
8. TOP OF CASING IS 1.33 FT.Above Land Surface*
•Top of casing terminated at/or below land surface requires a t variance in accordance with 15A NCAC 2C.0118.
9. YIELD(gpm): 30' METHOD OF TEST TIMED
10.WATER ZONES(depth):
LOCATION SKETCH
11. DISINFECTION:Type aY PuMP INSTALLER Amount Show direction and distance in miles from at least
12. CASING: Wall Thickness two State Roads or County Roads.Include the road
Depth Diameter or Weight/Ft. Material numbers and common road names.
From 0 To 55' Ft. 61/8 SDR21 PVC Jum , / /I 1/
From To F[. AA(( �y6J !Y!.-[—ll7V/I
From To Ft. aS/V• ( l�_�-/.y�l(7�t
13. GROUT: Depth Material Method /I�
From 0 To 20' Ft. CONCRETE POURED eu.l
V.�.INh ) -a�.d/ .¢._ H-NGI/U/(A
From To F[. r,/'(•1./A �1 i t r np . �,A
14. SCREEN: Depth Diameter Slot Size Material •X,"1^/"' vLU ,�Jw_�UN c- L-ot�,
From TO Ft. in. in. �I J_WY� ,(.I(� / 11 /.
From To F[. in. in. I�
15. SAND/GRAVEL PACK: -IU ICJ
Depth Size Material , do ��L � n „ Q„ , .L, / �1
From To Ft. �C! ,� �C-Ll-1cXd ,C,U ` J
From To FL A)0J,^,.., kt , )6L jj ix�
16. REMARKS: �-�.L1I2d U 6>".
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
P � _
SIGNATURE OF PERSON CONSTR G T ._ --ApTR
r ' f ,
Submit the original to the Division of Water Quality,Groundwater Seed o ,14 U eater RaTwgh NO
27699-1636 Phone No.[phone],within 30 days. ! r- GW-1 REV.07/2001

WELL CONSTRUCTION RECORD
North Carolina-Department of Environment and Natural Resources-Division of Water Quality-Groundwater Section
WELL CONTRACTOR(INDIVIDUAL)NAME (print)KENNETH MCCRARY
CERTIFICATION#2006
WELL CONTRACTOR COMPANY NAME BARKER CONSTRUCTION,INC./BARKER WELL 8 PUMP PHONE # [phone]
STATE WELL CONSTRUCTION PERMIT# 1871 ASSOCIATEDWQ PERMIT#
(if applicable) (if applicable)
1. WELL USE(Check Applicable Box):Residential KI Municipal/Public❑ Industrial❑ Agricultural❑
Monitoring D Recovery ❑ Heat Pump Water Injection❑ Other D If Other,List Use
2. WELL LOCATION: Topographic/Land setting
Nearest Town: HENDERSONVILLE County HENDERSON ®Ridge ❑Slope DValley DFlat
THRASHING ROCK ESTATES,LOT#15 (check appropriate box)
(Street Name,Numbers,Community,Subdivision,Lot No.,Zip Code) Latitude/longitude of well location
3. OWNER: KENDRA ALLISON (degrees/minutes/seconds)
Address 137 LONG JOHN DRIVE Latitude/longitude source:OGPSDTopographic map
(Street or Rome No.) (check box)
HENDERSONVILLE NC 28791 DEPTH DRILLING LOG
city cr Town state Zip code From To Formation Description
( 828)- 693-6768
Area code-Phone number
4. DATE DRILLED MAY 12,2005
5..TOTAL DEPTH: 280'
6. DOES WELL REPLACE EXISTING WELL? YES D NO R)
7. STATIC WATER LEVEL Below Top of Casing: 100' FT,
(Use-+^if Above Top of Casing) (_
8. TOP OF CASING IS 1 33 FT.Above Land Surface"
'Top of casing terminated atior below land surface requires a r n
variance in accordance with 15A NCAC 2C.0118. -
9. YIELD(gpm): 15 METHOD OF TEST TIMED r n
10.WATER ZONES(depth):
LOCATION SKETCH
11. DISINFECTION:Type BY PUMP INSTALLER Amount Show direction and distance in miles from at least
12. CASING: Wall Thickness two State Roads or County Roads.Include the road
Depth Diameter or Weight/Ft. Material numbers and common road names.
From 0 To 44' Ft. 61/8 SDR21 PVC From To Ft �
�j/Wf,t%
From To Ft. -}/p
13. GROUT: Depth Material Method "" AL&
From 0 20' Ft. CONCRETE POURED
From To Ft. t'c..
&4 . -
14. SCREEN: De Depth Diameter Slot Size Material
From To Ft. in. in.
From To Ft. in. in. Pd.
15. SAND/GRAVEL PACK:
Depth Size Material 1.
From To Ft.
From To Ft. 5
16. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUC IN ACCORDANCE WITH 15A NCAC 2C,WELL
CONSTRUCTION STANDARDS,AND T A COPY OF RE '0 HAS BEEN PROVIDED TO THE WELL OWNER
C�
SIGNATTJRE OF PERSON ONSTRUCTING THE WELL I �� !, —_ 7E
Submit the original to the Division of Water 'Quality,Groundwater Section,163K Ma� crvrce Center Raleigh,NC
27699-1636 Phone No.[phone],within 30 days. J Iq GW-1.,RE}{t Q7/2(Ifll

WELL CONSTRUCTION RECORD W
North Carolina-Department of Environment and Natural Resources-Division of Water Quality-Groundwater Section
WELL CONTRACTOR(INDIVIDUAL)NAME (print)KENNETH MCCRARY CERTIFICATION#2008
WELL CONTRACTOR COMPANY NAME BARKER CONSTRUCTION,INC./BARKER WELL&PUMP PHONE # [phone]
STATE WELL CONSTRUCTION PERMIT# 1871 ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
I. WELL USE(Check Applicable Box):Residential® Municipal/Publie❑ Industrial❑ Agricultural❑
Monitoring❑ Recovery ❑ Heat Pump Water Injection❑ Other❑ If Other,List Use
2. WELL LOCATION: Topographic/Land setting
Nearest Town: HENDERSONVILLE County HENDERSON ❑Ridge ❑Slope ❑Valley ElFlat
VALLEY VIEW ROAD (check appropriate box)
(Street Name,Numbers,Community,Subdivision,Lot No.,Zip Code) Latitude/longitude of well location
3. OWNER: JACK NESBITT (degrees/minutes/sewnds)
Address 3340 BUTLER BRIDGE RD. LatitudeAongitude source:❑GPS❑Topographic map
(Street or Route Na) (check box)
FLETCHER NC 28732 DEPTH DRILLING LOG
City or Town state Zip Code From To Formation Description. i
8( 28)_ 891-8339
Area code-Phone number C_
4, DATE DRILLED MAY 13,2005 C =C
5. TOTAL DEPTH: 280'
6. DOES WELL REPLACE EXISTING WELL? YES El NO El �.t
7. STATIC WATER LEVEL Below Top of Casing: 20' FT.
(Use`+-if Above Top of Casing) O
cfl
8. TOP OF CASING IS 1.33 FT.Above Land Surface'
-Top of casing terminated attor below land surface requires a a'variance in accordance with 15A NCAC 2C.0118.
9. YIELD(gpm): 4 METHOD OF TEST TIMED
10.WATER ZONES(
LOCATION SKETCH
11. DISINFECTION:Type aY PUMP INSTALLER Amount Show direction and distance in miles from at least
12. CASING: Wall Thickness two State Roads or County Roads.Include the road
Depth Diameter or Weight/Ft. Material numbers and common road names.
From 0 To 174' Ft. 6118 SDR21 PVC
From To FLi���_eln ��Q��U /t
From To Ft. '7 CIK.0
13. GROUT: Depth Material Method OrL #WAoCd�From 0 To 20' Ft. CONCRETE POURED er
From TO Ft.
14. SCREEN: Depth Diameter Slot Size Material max,
�
From To Ft. in. in. UCt}�fGICL
From TO Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Size Material /ItA, ( /♦,(,[�L�.
Frorn-To Ft. (, _ `Cy (� _
From To Ft. I DO U4-�.Q.CP�.D/.tt.(,-)
16. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C,WELL
CONSTRUCTION STANDARDS,AND THAT A,,COPY OF�THIS/RECORD HAS BEEN PROVIDED TO THE WELL OWNER 7
SIGNATURE OF PERSON CONSTRUCTING THE WELL ATE
Submit the original to the Division of Water Quality,Groundwater Seetion,-1636 Mail Service Center-..Raleigh,NC
27699-1636 Phone No.[phone],within 30 days. r.� 6W i RE!V:.07/2001
�F _-
`I J U N 2 7 2005
s
i

WELL CONSTRUCTION RECORD
North Carolina-Department of Environment and Natural Resources-Division of Water Quality-Groundwater Section
WELL CONTRACTOR(INDIVIDUAL)NAME (print)KENNETH MCCRARY CERTIFICATION#2008
WELL CONTRACTOR COMPANY NAME BARKER CONSTRUCTION,INC./BARKER WELL&PUMP PHONE # [phone]
STATE WELL CONSTRUCTION PERMIT# 1871 ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
1. WELL USE(Check Applicable Box):Residential® Mtnicipal/Public❑ Industrial❑ Agricultural❑
Monitoring❑ Recovery ❑ Heat Pump Water Injection❑ Other❑ If Other,List Use
2. WELL LOCATION: TopographidLand setting
Nearest Town: HENDERSONVILLE County HENDERSON []Ridge []Slope ❑Valley KIFlat
GAP CREEK ROAD (check appropriate box)
(Street Name,Numbers,Community,Subdivision,Lot No.,Zip Code) LatitudeAongitude of well location
3. OWNER: DIANE THIESSEN (degrees/minutes/seconds)
Address 315 FORESTBROOK ESTATE DRIVE Latitudellongitude source:❑GPS❑Topographic map
(Sheet or Rome No.) (cheek box)
BLACK MOUNTAIN NC 28711-9673 DEPTH DRILLING LOG
City or Town State Zip Code From To Formation Description
8( 28)- 669-0698
Area code-Phone number
4. DATE DRILLED MAY 18,2005 >?'
5. TOTAL DEPTH: 205'
6. DOES WELL REPLACE EXISTING WELL? YES❑ NO ® L '
7. STATIC WATER LEVEL Below Top of Casing: 10 FT.
(Use"+"if Above Top of Casing)
8. TOP OF CASING IS 1.33 FT.Above Land Surface*
*Top of using terminated atfor below land surface requires a r,
variance in accordance with 15A NCAC 2C.011& C.n
9. YIELD(gpm): 2d METHOD OF TEST TIMED
10.WATER ZONES(depth):
LOCATION SKETCH
11. DISINFECTION:Type By PUMP INSTALLER 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. - 2
From 0 To 83 Ft. 6 1/8 SDR21 PVC J�2 tAOJ�( u-K2 e75
From To Ft. A� ,0 ���tL2,(.O{{{��� �/i act �[
From
13. GROUT: Depth Ft Material Method kjkwK- v OJ& rCYA.CA� J(.� lea(.
From 0 To 20' Ft. CONCRETE POURED Q AOOA;6 0"40 Iffo
n J $
From Ft.De
14. SCREEN: Depth Diameter Slot Size Material ,L lit rlL�
From To Ft. in. in.
From To Ft. in. in. i/A
15. SAND/GRAVEL : at SS/
Depth Size Material
Front—To—FL—
From—To—Ft. y/!`7S1N�.
�i/f 477
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
3y'I CGn- ",� . -- ? o
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
Submit the original to the Division of Water Quality,Groundwater Section1636 Muff Service Center-Raleigh,NC
27699-1636 Phone No.[phone],within 30 days. OW-1 REV.07/2001
J U N 2 7 200b
I
,J i

? V
WELL CONSTRUCTION RECORD
North Carolina-Department of Environment and Natural Resources-Division of Water Quality-Groundwater Section
WELL CONTRACTOR(INDIVIDUAL)NAME (print)RICHARD MCCRARY CERTIFICATION#2010
WELL CONTRACTOR COMPANY NAME BARKER CONSTRUCTION,INC./BARKER WELL&PUMP PHONE It [phone]
STATE WELL CONSTRUCTION PERMIT# 1871 ASSOCIATED WQ PERMIT#
(if applicable)
(if applicable)
1. 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.
Nearest Town: HENDERSONVILLE County HENDERSON Topographic/Land setting
HYDE WELL ESTATES,LOT#18 BlRidge ❑Slope ❑Valley ❑Flat
(check appropriate box)
(Street Name,Numbers,Commw,ty,Subdtv�smo,Lot No.,Zip Code) Latitude/longitude of well location
3. OWNER: DAVID PRYOR
Address 670 SALISBURY ROAD (degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(Street ute No.) (check box)
HENDERSONVILLE NC
Ro 28792 DEPTH DRILLING
Cny or Town State ZIPCode Formation Description L828 )_ 712-8886 From To p6on
Area code-Phone number
4. DATE DRILLED MAY 18,2005
5. TOTAL DEPTH: zast
6. DOES WELL REPLACE EXISTING WELL? YES❑ NO ®
7. STATIC WATER LEVEL Below Top of Casing: 40' F'. "<
(Use"+-if Above Top of Casing) _
8. TOP OF CASING IS
1.33 FT.Above Land Surface* u7
-Top of casing terminated atlor below land surface requires a -
variance in accordance with 15A NCAC 2C.011& c�
9. YIELD(gpm): 2U METHOD OF TEST TIMED
10.WATER ZONES(depth):
LOCATION SKETCH
11. DISINFECTION:Type By PUMP INSTALLER Amount Show direction and distance in miles from at least
12. CASING: Wall Thiclmess two State Roads or County Roads.Include the road
Depth Diameter or Weight/Ft. Material numbers and common road names.
From 0 To W Ft. 61/8 SDR21 PVC
m
Fro To
�avyxa�c�L, 3//fhti[c
13. GROUT: Dep h FL Material Method q aqd /ed.O Z4kft lie
From 0 To 20' Ft, CONCRETE POURED Q,J
From To FL (_ f/�O
14. SCREEN: Depth Diameter Slot Size Material � K(t��From To Ft. in. in. eVQ� KGC, ,QQQ7,vp��f(!�G
From dQ
To Ft. in. in. �
15. SAND/GRAVEL PACK:
Depth Size Material du"A>
From To Ft. ,r,
From To Ft. /"�Z& � auz-�— e'
16. REMARKS: ��'Ao�4(,4Zl44 �6t -
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C,>VELL
CONSTRUCTION STANDARDS,ANDRIAT A COPY OF Tf,11,&RECORD HAS BEEN PROVIDED TO THE LL
SIGNATURE OF PERSON,�qN§PWCIING THE WELL DATE
Submit the original to the Division of Water Quality,Groundwater Sectign,1636 Mail Service Ceutpr ,Rateigb,NC
27699-1636 Phone No.[phone],within 30 days. .GW4 qs,V 07/2001
JUN 2 7 2005 `
i
ac I L i-_"i J

s> u
WELL CONSTRUCTION RECORD -
North Carolina-Department of Environment and Natural Resources-Division of Water Quality-Groundwater Section
WELL CONTRACTOR(INDIVIDUAL)NAME (print)KENNETH MCCRARY CERTIFICATION#2008
WELL CONTRACTOR COMPANY NAME BARKER CONSTRUCTION,INC./BARKER WELL 8 PUMP PHONE # [phone]
STATE WELL CONSTRUCTION PERMIT# 1871 ASSOCIATED WQ PERMIT#
(if applicable)
(ifapPlicable)
1. 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:
Nearest Town: HENDERSONVILLE County HENDERSON TDpographic(Land setting
SUMMIT LANDING LOT#2 ®Ridge ❑Slope ❑Valley ❑Flat
(check appropriate box)
(Street Name,Numbers,Communit n
y,Subrfimu ,Lot No.,Zip Code) LatitudeAongitude of well location
3. OWNER: MICHAEL WASHBURN
Address 402 STATION 12 STREET (degrees/minutes/seconds)
Latitudellongitude source:❑GPS❑Topographic map
(Street Rome No.) (check box)
SULLIVANS ISLAND SC
29482 DEPTH DRILLING LOG
Ciry or sown Smte Zip code From To Formation Description
( 843 )- 883-9336
Area code-Phone number
4. DATE DRILLED MAY 23,2005 - ;
5. TOTAL DEPTH: 505'
6. DOES WELL REPLACE EXISTING WELL? YES❑ NO ® "?
7. STATIC WATER LEVEL Below Top of Casing: 50' -z
(Use"+-if Above Top of Casing)
8. TOP OF CASING IS 1.33 FT.Above Land Surface' to
*Top of rasing terminated at/or below land surface requires a ram ,;
variance in accordance with 15A NCAC 2C.0118. t.fl
9. YIELD(gpm): 5 METHOD OF TEST TIMED _
10.WATER ZONES(depth):
LOCATION SKETCH
11. DISINFECTION:Type BV PUMP INSTALLER Amount Show direction and distance in miles from at least
12. CASING: Wall Thickness two State Roads or County Roads.Include the road
Depth Diameter or Weight/Ft. Material numbers and common road names.
From 0 To 57 Ft. 61/8 SDR21 PVC - t/Lj"O Y ��, 1_ //
From To FL .95-1 �Or2G�
Front_To Ft.
13. GROUT: Depth Material Method &; . aU r[
From 0 To 20' Ft. CONCRETE POURED
Front To Ft. z(atd'nnt'�'' Zj .c�WU/l210�7.�'
14. SCREEN: Depth Diameter Slot Size Material �D C&)_' Zlii,i/vd ,/
From To FL in. in.
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To FL
16. REMARKS:
v L6f
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
l� YYIeC���I IDS L7 OJ"
SIGNATURE OF PERSON CONSTRUCTING THE WELL V DATE
Submit the original to the Division of Water Quality,Groundwater Set r36 tgliT qe q_ --
27699-1636 Phone No.[phone],within 30 days. L�� l_'': [I QW- C
� 'i �, 11 _, � �V- /2001
rl)L'', J U N 27 2005 ��

WELL CONSTRUCTION RECORD Ilf`"J(V
North Carolina-Department of Environment and Natural Resources-Division of Water Quality-Groundwater Section
WELL CONTRACTOR(UNDR4DUAL)NAME (print)RICHARD MCCRARY CERTIFICATION#2010
WELL CONTRACTOR COMPANY NAME BARKER CONSTRUCTION,INC.IBARKER WELL&PUMP PRONE # [phone]
STATE WELL CONSTRUCTION PERMIT# 1871 ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
I. WELL USE(Check Applicable Box):Residential® Mtmicipal/PUblic❑ Industrial❑ Agricultural❑
Monitoring❑ Recovery ❑ Heat Pump Water Injection❑ Other❑ If Other,List Use
2. WELL LOCATION: Topographic/Land setting
Nearest Town HENDERSONVILLE County HENDERSON ®Ridge ❑Slope ❑Valley ❑Flat
DAVEY BRANCH ROAD OFF OF NORTH MILLS RIVER (check appropriate box)
(Street Name,Numbers,Community,Subdivision,Lot No.,Zip Code) Latitude tingitude of well location
3. OWNER HERMAN McCALL (degrces/minums/seconds)
Address 164 SPIREA DRIVE Latitude/longitude source:❑GPS❑Topographic map
(Street or Rome No.) (check box)
WAYNESVILLE NC 28786 DEPTH DRILLING
City m Town state Zip Code From To Formation Description
. t
B( 28 )- 891-7410 -^m
Area code-Phone number
4. DATE DRILLED MAY 24,2005
5. TOTAL DEPTH: 365' r '
6. DOES WELL REPLACE EXISTING WELL? YES❑ NO ® ^_
7. STATIC WATER LEVEL Below Top of Casing: 40' FT. Ln
1
(Use"+"if Above Top of Casing)
8. TOP OF CASING IS 1.33 FT.Above Land Surface* O
-Top of casing terminated at/or below land surface requires a =
variance in accordance with 15A NCAC 2C.0118.
9. YIELD(gpm): 5 METHOD OF TEST TIMED �t9
10.WATER ZONES(depth):
LOCATION SKETCH
11. DISINFECTION:Type BY PUMP INSTALLER 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.
4�From 0 To 86 Ft. 6118 SDR21 PVC /t0II2 Q � ,r,;/Ds1 �V'
From To FL a8D �• �L� Q ��A {tI,.QQA
From To Ft.
13. GROUT: Depth Material Method ,C.UJLL ) OQJ . .alp 3.
From 0 To 20' Ft. CONCRETE POURED CL\ � �t4-�� Z&Ag- •
From To FL � ��ll ) �/QQ -- //�
14. SCREEN: Depth Diameter Slot Size Material h/,Cf�t/)'L 2� rU/CQl2C-J"c
From To Ft. tO 74 in. 11t� /
From To Ft. in. in. �Il( -•/ryl
15. SAND/GRAVEL PACK: XJ/Re�/�--
Depth Size Material
From To Ft.
From To Ft.
16. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC/C,W
L
CONSTRUCTION STANDARDS,AND T'ir1AT OPY S RECORD S BEEN PROVIDED TO),HE WE OMWER
SIGNATURE OF PERSON CONSTRUC THE WELL DATE
Submit the original to the Division of Water Quality,Groundwater Section 163E Ngsil"cc Center-Raleigh,NC
27699-1636 Phone No.[phone],within 30 days. �i,.; r-- - —GW-1 REV.-0712001JUN
asr

l�
WELL CONSTRUCTION RECORD
North Carolina-Department of Environment and Natural Resources-Division of Water Quality-Groundwater Section
WELL CONTRACTOR(INDIVIDUAL)NAME (print)RICHARD MCCRARY CERTIFICATION#
2010
WELL CONTRACTOR COMPANY NAME
BARKER CONSTRUCTION,INC.IBARKER WELL&PUMP PRONE # [phone]
STATE WELL CONSTRUCTION PERMIT# 1871 ASSOCIATED WQ PERMIT#
(if mmlicabte) (if applicable)
1. 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: Topographic/Land setting
Nearest Town: HENDERSONVILLE County HENDERSON Midge ❑Slope ❑Valley Mat
(check appropriate box)
PATTY CHAPEL ROAD
(Street Name,Numbers,Community,Subdivision,Lot No.,Zip Code) Latitude/longitude of well location
3. OWNER: THOMAS LUGAS (degre sorumnu/secoads)
207 LINDA VISTA DRIVE Latitude/longitude source:❑GPS❑Topographic map
Address (check box)
(Sucet or Rome No.) DEPTH DRILLING LOG
HENDERSONVILLE NC 28792
City or sown S Zip Code From TO Formatim Description"t
ate P %}
( 828 )_ 696-5421
Area code-Phone number
4. DATE DRILLED MAY 27,2005
5. TOTAL DEPTIL 205' _
6. DOES WELL REPLACE EXISTING WELL? YES❑ NO M n
7. STATIC WATER LEVEL Below Top of Casing: 60' FT.
(Use`+"if Above Top of Casing)
8. TOP OF CASING IS 1.33 FT.Above Land Surface
-Top of using terniusted st/or below land surface requires a
variance in accordance with 15A NCAC 2C.0118.
9. YIELD(gpm): 20 METHOD OF TEST TIMED
10.WATER ZONES(depth): LOCATION SKETCH
11. DISINFECTION:Type BY PUMP INSTALLER Amount Show direction and distance in miles from at least
12. CASING: Wall Thickness two State Roads or County Roads.Include the road
Depth Diameter or Weight/Ft. Material numbers and common road names.
From 0 To 75 Ft. 6 1/8 SDR21 PVC JAW „/o,f,r,n,/�µ,�,(�
From To FL �T/wr,c Lsvry /V�r^�"�'�' '�
From To Ft. GY-:J
13. GROUT: Depth Material Method ✓ (✓�. n �
From 0 To 2V Ft. CONCRETE POURED
From De
Ft.
14. SCREEN: pth Diameter Slot Size Material
From To FL in. in. 01/1'7
From To Ft. in. in G( -( -& 3 h(.i.�..�, / lG l�
15. SAND/GRAVEL PACK:
Depth Size Material \� ). -n _ /
From To Ft. �1 h dKrf.�
From To FL / , _ /)ram
16. REMARKS: -/(� (1lN
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2 ,WELL
CONSTRUCTION STANDARDS,AND T A COP OF THIS RECO HAS BEEN PROVIDED TO Ty_ LL WNER
SIGNATURE OF PERSON CONSTR G THE WELL DATE
Submit the original to the Division of Water Quality,Groundwater Seftl 1636 NidI Scrvire Gape(- NC
27699-1636 Phone No.[phone],within 30 days. GW I' 7/2001
JUN 27 200'
r(j�I1N�h'r'iF� SECTION
' ASHEViI i t NF(AJ;��' i!-rICE__�

co 11322 �'
VVET—i•C_ONSTRUMON RECORD
NwUr Carolina-Depntrucat ofBnvhoamrot and atmal Reso»rc�eas�Di ' ' of Wadi Qndity-Grmmdwater so
- wua.CotNMCro QKVwnw WxAaa WT _ cokTmcwaaN `b
WULCOMTACrORCOD&ANYMMEf4 f14t Y P rasa s�a
srATswz[a.coNaRUCQ0trsitears M IMF
0000000
1. WELL USE(Check ARAkable Hook):Reaidea<id Mnoic%pUFoblic 0 bdo*al 0 Agicullwal O
Moddorio8 0 Recavery 0 Heat Pump wader btjedion 0 Other 0 NOthey Lint Ux
2. WELLLOCA ai 1 !� 7f6 (I.
l i> rl fCowy � Will t
ya,0 OFl
( a
O`mre VN.mdneo�� .se5m wo. taNaTOC Laduml&1aostode of wan bd=ol
3. OWNER_ fiA �J E►l (A)
Add= 1 i Latimdwlaa&Wo a aarce:DOPSOTopogaphic nmp
.5k (ANkl0°°k°M�.) �8� n� (daat6
DAR
ir�* .nun rm
orrown stet Zip Code From To Formation Description
Akecadspamsaombsr /a �,�
4. DATE DRILL
3. TOTAL DEPTH-
6. DOES WELL REPLACE EaSf1NG WELL? YES 0, NO
7. STATIC WATER LEVEL Below Top of Casing�1.
(Use w'VAhm repofCubit
8. TOP OF CASING IS FT.Above Land Sur&=*
'TapetesdgtsaI I sMradew bull wAesnpdra■
ra dwa b 15APCAC=C J118.
9. YIB<.D(gro):� 1M HOD OF TB '� • l LOCATION�—
10.WATERZONES(depth): `
11. DISINFECTION: Amoant Show direction sod distance mmilea fides at leant
12. CASINO* VIA T6idmeas- . two Stele Roads or Cosoty Roads.Iorlode do road
Depth Dinedw w Wc*W t Missed numbers and common road=in=
F�To�Ft, 'I ( Y 1 y
Frow_To Ft
RF O�To Ft
13. GROUT:
Fr�To `l
Frou�...�._To�LZPt� 1,13
.
14. SCREEN: Deph Diameter SWSW Menial can
FronL—Ta Ft,_in in.
From_To FL_io. in.
15. SAND/ORAVELPACK: -
Deph Size Mllww --
Frog To Ft
Froox—To Ft
n
16. REMARKS. e
I DO HERESY CEiRTWY THAT THL4 WELL WAS CONSTRUCTED IN ACCORDANCE WITH ISANCAC 2C,WELL_
ST AND THAT ACOPY OF THIS RECORD HAS EEEI4 PROVIDED TO THB WELL OWNER
SsbmiSKIMTUREOF PERSON CONSTRUCTING THE WELL bAlE
the®rwsa to the DM&n of Water QaaRly,Groundwater Seetbn416M Man Service Ceomer-Rddth,NC
2709-1636 Pheae No.(919)UMMI,wkhios 30 days. GW-1 REV.07/2001

WELL CONSTRUCTION RECORD
Nor16 Comlina-Depatment ofEavuoum ut and Natural Raonrc -Division of Water Quality-Groandwater Section
- watt.c0MMCro MWFMUA4T Mc caarranc-moN#2 2Q
watts XfMCroacoat MYNAKE �t t� ' �? i Ipjwm a
SPATEWXLLCONS'rR ___A8$0MMW WQ
If IICab10 If 0
1. WIE.L USE(Check Applicable Bmc)-R=kkzdi l Muuic�aUPublic O Iodo*W D Aid[3
Mmamiog O Recovay 13 Hat Pomp Water Lgcdim 13 Od w O NOther;Lo[Jae
7- WEId LOCATI 11 n��� Topopmbiouud setting
Nearost T E _Court 1� pM!dv CISlops ppil(ay t
i (beboppmpehYbm*
(SewtNamRNsmbesy Sdaasisim,idNa,2tp Cods) - I.dmddlm®tods ofTm location
3. o
Addrpa C t 1 '•� Latiftwoogidde aaaea0(ipSQfopographic map'
DEPIM
CkyorTma sere ZIP Code From To FamationDemmkidon
L)-
AcRcod 7—,— -
4. DATE DRILLED
5. TOTAL D r
6. DOES WELL REITACBEKISTING WELL? NO
7. STATIC WATER LEVEL Below Top of Casing
(Um-+-ffAbae TupedCmdW
S. TOP OF CASING IS FT.Above Land Surface-
'Tsp sredaaissi I atw Ydow tend swim nq I a
�w1�m Y amwdmeewdD 15ANGC2C A118.
9. YIELD(ga): 1'n _MEfHOI ,OF TE3I� I .Wn
10.WATER ZONES(depth): 0 IDCAnON SKETCH
11. DISINFECTION:Type Ir\ AmomR __ Show d'nectim and d sham in unies fTam at bast
12. CASDiG: wan ibirlmen. two State Roads or County Rods,htchmie the mad
Depth Dimmers orWeWs*L Maadd am bas�an!d common road names.
Fro�To�F1 G Wy rp t�J ;��p
F To Ft�.. BONNE lZ --(PrM I�v�
13. GROUT: DmpdL of
F To i �
n
14. SCREEN: Depth Dlmesw SlotSa Mee®d �
FroaL_To FC.b in.
Ftoux—To Ft•___in. in. C)
15. SANDIGRAVEL PACK: CA
Dq%h Sloe bilw l
FrmL_To FL
From To Ft
16. REMARKS:
I DO HEREBY CLRTIFYTHAT THm WELL.WAS OONSI'RUcm IN ACCORDANCE wnH ISANCAC 2C,wal.
UMION ST$WjLRDS,AND THAT A COPY OFTMS RECORD HAS BEEN PROVn3EDT0 OWNER
' 1 �
samA OF PERSON CONSTRucnNo THE WffiL DAIE
Sabm[t the original to the Dividun of water Quality,Groundwater Section,16M Man Service Ceaeer-Rddgb,NC
2709-1636 Pbm No.(9M 73333t1,within 30 days. GW-1 REV.07n001

IN C-l
WELL CONSTRUCTION RECORD
North Carolina-Department of Environment and Natural Res o es-.Division of Water Quality-Groundwater Section
WELL CONTRACTOR MI)TVIDUAL)NAM (print L CERTMCATIION#$�3
WELL CONTRACTOR COMPANY NAME ) _ V c l �(()'`e PHONE # �03
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ RMIT#
ifapplicable) ifapplicable)
1. WELL USE(Check Applicable Box):Residential Municipal/Public❑ Industrial❑ Agricultural❑
Monitoring❑ Recovery ❑ Heat Pump Water Injection❑ Other❑ If Other,List Use
2. WELL LOC ON: Topogtaphic/Land setting
Nearest Tow�t County � ❑Ridge ❑Slope galley ❑Flat
�i i oC l X<-O-M 1-C. (ahaxapproptuubo:)
(Street Name,Nomber*Cc tmmtity,Subdivision,Lot No,Tip Code) Latitude/longitude of well location
3. OWNER: - t (de&eedmtmanheemds)
Address ) LatitudcAongitude source:❑GPS❑Topographic map
)a n (ehedk box)
DE
IVC- as�-�3� LFEDEPTHDRII.LING LOG
Cityor7owa state tip code From To Formation Description--
Area coda Phme mm 1
4. DATE DRILLED
5. TOTAL DEPTH: - I
6. DOES WELL REPLACE EXISTING WELL? YE& NO
7. STATIC WATER LEVEL Below Top of Casing: FT.
(Use-+"if Above Top of Casing) `
8. TOP OF CASING IS FT.Above Land Surface'
'Top of cuing terminated atfor below land surface requires a
variance to accordance 15A NCAC 2C.0115
9. YIELD(gpm): METHOD OF TEST
10.WATER ZONES(depth):
LOCATION SKETCH
11. DISINFECTION:Type Amount Show direction and distance in miles from at least
12. CASING: Wall Thickness two State Roads or County Roads.Include the road
Depth Diameter or Weight/Ft Material numbers and common road names. _
From To Ft
From Tc Ft
From Tc Ft
13. GROUT: Depth Material 'Method
From To Ft L� a3,�-- i 7
From To FtiL�-t- °�1 N 0
0
14. SCREEN: Depth Diameter Slot Size Material F'
From To Ft m. in. o
From To Ft in. in. CA
15. SAND/GRAVEL PACK'
Depth Size Materials
From To Ft.-
From—To—Ft.
16. REMARKS:
I DO HEREBY CERTIFY T THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH I SA NCAC 2C,WELL
CONMUCTION STAND 3S,AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
SIGNATURE OF PERSON CONSTRUCTING THE WELL A
Su rnit the original to the Division of Water Quality,Groundwater Section,1636 Mail Service Center-Raleigh,NC
27699-1636 Phone No.[phone],within 30 days. GW-1 REV.07/2001

WELL CONSTRUCTION RECORD
North Carolina-Department of Environment and Natural ResourFes-//Division of Water Quality-Groundwater Section
WELL CONTRACTOR 6"IVIDUAL)NAM (priat L 4 CERTIFICATION� �G�__
WELLCONTRACTORCOMPANYNAME �r. PRONE # �•'���_
STATE WELL CONSTRUCTION PERMITS OCIATED WQ PERRfffj—
(ifapplicable) ifapplicable)
1. WELL USE(Check Applicable Box):Residential MunicipaUPublic❑ Industrial❑ Agricultural❑
Monitoring❑ Recovery ❑ Heat Pump Water Injection❑ Other❑ If Other,List Use
2. WELL LOCATI N: , ( topographic/Land setting
NeareTytTown: �� County ' I .���i dge ❑Slope Malley ❑Flat
V �1 1 AZtA (chock mwWrhoebox)
(SbWN=e.Nmbcis.Cemm-itY.Sub&nmn,LptNo.,tip code) Latitude/longitude of well location
3. OWNER: Ar 5Or,/4 G ' k✓f35 (depeevtoin o seconds)
Address Latitude/longitude source:❑GPS❑Topographic leap
(dwk boa)
DEPTH DRILLING
City err Tower store tip Cade From To FormationDescriplit
Area oode Phone comber f/ i�
tJ
4. DATE DRILLED t� �iT
5. TOTAL DEPTH:
6. DOES WELL REPLACE EXISTING WELL? YE NO UKr,
7. STATIC WATER LEVEL Below Top of Casing: • FT. cJt
(Use"+"ifAbove Top of Cesmg) ,•al
8. TOP OF CASING IS FT.Above Land Surface'
`Top of easing terminated at/or below land surface requires a
vartaate in accord with 15A NCAC 2C.0I18.
9. YIELD(gpm): a MET QD OF TES
10.WATER ZONES(depth): `✓m[�
LOCATION SKETCH
11. DISINFECTION:Type Amount Show direction and distance in miles from at least
12. CASING: Wall Thickness two State Roads or County Roads.Include the road
Depth Diameter or Weight/Ft Material numbers and common road names.
From To FL L
From_To Ft r M
From To Ft �N 1
13. GROUT:
From_T Ft Un f `Ct nit O�J
From To Ft 14 p !U E5t.
14. SCREEN: Depth Diameter Slot Size Material —'
From To Ft.---M. in.
Form To FL in. in.
15. SAND/GRAVEL PACK: n
Depth Size Material
From To Ft.—
From—To—Ft.
16. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C WELL
CONS CTION STAMW DS 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 Mad Service Center-Raleigh,NC
27699-1636 Phone No.[phone],within 30 days. GW-1 REV.07/2001

WELL CONSTRUCTION RECORD
North Carolina-Department of Environment an Nauaal Resour ea-Division of Water Quality-Groundwater section
- WRIL CONTRACTOR MMMOVAL)NAME brbdlt CtOtl7riCATlox `sod 6C
WRLLCONTRACfoRCOWANYNAalBJ.3.(1►Z A o ;l C � ram 0
STATE wRLL CONS[Rucnox PERMITO TZD WQ PUMTs
d rf
1. WELL USE(Check Applicable Bo:):Residential MmicipaUPrrblic D industrial D Agricnidaal D
Momtormg D Recovery ❑ Hed Pump Water 14ection D Other D MOthers List Use
2 WBLL LOCA ON: p
�Tgwn , � �} Wl Top
Setting
Wity 1 �A 'Et� ��, r (�, I, ba) OFlat
Cummti i%Saemi°m,UtNo,�Code) I daofweEloratiou
E 3. OWNER: _ . (dagnretaadmimaheeeadr,
Address LattudenonSnude s-ace:00PS1 ropographic map
e� �,��� � `D�1GLOG
City mToam SWe rip Code From To FozmetionDescriptionAm Nd
. .___.._. .�
C 1
4. DATE DR1LL)�
5. TOTAL DMyM-
6. DOES WELL REPLACE EXISTING WELL? j�Q NO— _
7. STATIC WATER LEVEL Below Tor of Casing:
(Use-4-if Af mra Top ofCmb W
S. TOP OF CASING IS FT.Above Lard Surface*
crap of entaa Urea atW helm Iud aarhm aogvAz a
.arfoeer With 15ANCAC2CA1u. ���(
9. YIELD(� METHOD OF TEST
Io.WATERZONES C
_ —
11. DISINFBC7ION:Type Amauat KETCH
Show direction and&stenos is miles from at least f`
11 CASING: WonThidmesa_ two state Ron&orCoturtyRowls.Inchulaf rood —
Ft
Diensd r orwet&n Matmal m nibets and common road names.
Fr«r'--T° V�l 19 1
From_To Ft , f
13. GRO�To Ft �� A VEM From To
From_TooPk!214Iv", ce
14. SCREEN: Deph Diameter Slot Sias Material Z n
From—To Ft m. in. r "r
Fro- To Ft..n in.
15. SAND/ORAVEL PACK: cc n
Dep& Sun Material ry
From-_To Ft.-
From—To— Ft
16. REMARKS:
i DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15ANCAC 2C,WELL
UCTLON STONPARDS,AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO TIRE WELL WNER
smxAhmoFpERsoNcoNmmjcnNanmwELL DATE
Submit the erlglnd to the Division of Water Quality,Groundwater Seetlon,16M Man Service Center-Raleigh,NC
2709-1636noneNo.[phone],within 30 days. GW-I REV.07n001

WELL CONSTRUCTION RECORD
North Carolina-Department of Environment an4 Natural Res urn s- vision of Water Quality-Groundwater Section
WELL CONTRACTOR(INDIVIDUAL)NAM (Print FI t' � � l ) CERTIFICATION
WELL CONTRACTOR COMPANY NAME 1 U I < PRONE # (9 693.. P.3
STATE WELL CONSTRUCTION PERMTT# ASSOCIATED WQ P
ifapplicable) ifapplicable)
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: Topoo/Land setting
Nearest o • County fC3kI ❑Ridge QSlope ❑Valley ❑Flat
Lc� & (check appropriate bm)
(street Name,NTnmabeaA,dinununity,Subdivlaion,cut No.,Zip Cone) Latitude/longitude of well location
3. OWNER: L J�I� �i SI (Ilezx men uwlu)
Address Latitudetlongitude source:❑GPS❑Topographic map
f 17f ti`s�Ny4 k I� 3 ) (chock DRILLING LOG
CitymTown sure tip Code From To Formation Descriptiob ) j
Am code-Phone a®ber �G
4. DATE DRILLID
5. TOTAL DEPTMITEi ==
6. DOES WELL REPLACE EXISTING WELL? YES❑ NO
7. STATIC WATER LEVEL Below Top of Casing:AL----FT.
(Use N+"if Above Top of Casing)
8. TOP OF CASING IS FT.Above Land Surface-
-Top of easing terminated over below land surface«0uha a
variance to aceorda mItith 1SA NCAC 2C.0118. _�', `ny�-r{ --
9. YIELD(gpm):�—MEWD O �/ST W J V 1vC71 r`
10.WATER ZONES(depth): � 1°�TolU - —'
} LOCATION SKECM _—
11. DISINFECTION:Type _ Amount
Show direction and distance in miles fibm at least""
12. CASING: Wall Thickness two State Roads or County Roads.Include the road
Depth Diameter or Weigilt/Ft. Material numbers and common road names.
From To�aFt CID \ ��
Fron_To Ft i D�J
From To Ft
13. GROUT: Depth z Material Mexh tj
From ToyL Ft U
From To-L�Z:_Ft J c
14. SCREEN: Depth Diameter Slot Size Material 2
From To Ft in. in. �
From To Ft in. in. v
15. SAND/GRAVEL PACK: cc n
Depth Size Material
From To Ft.
From Tc Ft
16. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH I SA NCAC 2C,WELL
CONS ON STANDARD ,AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE OWNER
C SIGNATURE bF PERSON CONSTRUCtING THE WELL DATE
Sub Ztheginal to the Division of Water Quality,Groundwater Section,1636 Mail Service Center-Raleigh,NC
27699-1636 Phone No.[phone],within 30 tdays. GW-1 REV.07/2001

WELL CONSTRUCTION RECO Ow 4 `) 13
North Carolina Department of Environment and Natural Resources-Division of Water Qwhry
WELL CONTRACTOR(INDIVIDUAL)NAME (print) Bryant Smith CERTIFICATION#2571
WELL CONTRACTOR COMPANY NAME Green River Well&Pump Company PRONE # [phone]
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT# 05 I UOIOS a�Z
(if applicable) (if applicable)
1. WELL USE(Check Applicable Box):Residential[/Mur icipal/Public❑ Industrial ❑ Agricultural❑
Monitoring❑ Recovery ❑ Heat Pump Water Injection❑ Other❑ If Other,List Use
2, WELL LOCATION: I'. Topographic/Land setting
Nearest Town: County Midge ❑Slope 011iigHey ❑Flat
LAtlCC YybA-in Lane, I (chock appropriate box)
(Street Nam----e,rrN��umben,Communniit�ty,Subdivision,Let No.,Zip Code) Latitude/1o11gitude of well location
3. OWNER:uvhn D• T- )e-) 35 vald aYnds)
(degreea/mvtutes/seconds)
Address b eA--CJatycli Latitude/longitude source: 36PS❑Topographic map
1 I- , . (Street or RoueNoJ (check box)
FF��O�NSWIt)Il(2 �L 2�Sr139 DEPTH DRILLING LOG
City or Town State
Zip Code Fro T Form 'on Description
g( 28 } L?7-`I-gi I 1 - /
Area coda Phone numbs �1 _ Q
4. DATE DRILLED 7 — C
5. TOTAL DEPTH: 7, c05 — _ —
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO 21�
7, STATIC WATER LEVEL Below Top of Casing:__3_0_FT. -
(Use-1"if Above Top of Cuing)
S. TOP OF CASING IS i—FT.Above Land Surfaces
'Top of casing terminated atf r below land surface requires a
varimce in accordance with 15A NCAC 2C.0118. t
9. YIELD(gpm): I METHOD OF TEST sft'A. n'y
10. WATER ZONES(depth): ly 5— a
LOCATION SKETCH (_n •n
1 l. DISINFECTION:Type Amolmt Show direction and distance in miles from at least
12 CASING: Well Thickness two State Roads or County Roads. Include the road'
Depth Diameter or Weight/Ft. Material numbers and common road names.
From—
rom To Ft. (, z7 (/L J�( ��,..
From�To�Ft. mil. G l UG X��
ry
From To FL
13, GROUT: Depth Material Metho f\) kl 1
From O Tom Ft. 5RkV1rt& A (� Ic t'
From To Ft. J
14. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in. of q.
From To Ft. in, in.
15. SAND/GRAVEL PACK:
Depth Size Material r7v
From To Ft. 'Ilse
From To Ft. ''77
16. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS NSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C,WELL
CONSTRUCTION STANDARDS,AND THAT A C Y OF THIS ECORD HAS BEEN PROVIDED TO THE WELL OWNER
NATURE OF PERSON CONSTRUCTING THE WELL DATE
Submit the original to the Division of Water Quality,Attn: Info rotatiop_Mauagemcnl,.1617.Mad Semi"Center-
Raleigh,NC 27699-1617, Phone No.[phone],within 30 days
G*-I REV. 09/2004
li

WELL CONSTRUCTION RECORD 0_�o 3 14 i'
North Caroline Department of Environment and Natural Resources-Division of Water Quality
WELL CONTRACTOR(INDIVIDUAL)NAME (prime) AnOwrty Bryant Smith CERTIFICATION N 2571
WELL CONTRACTOR COMPANY NAME Groan River Well 6 Pump Cor� PHONE N ()f2bi 693.1200
STATE WELL CONSTRUCTIONPERMITN ASSOCIATED WQPERMITN 0.7 1Q0 J 0(OoZ O6
(if applicable) (if applicable)
1. WELL USE(Check Applicable Box):Residential W/Municipal/Public❑ Industrial ❑ Agricultural❑
Monitoring❑ Recovery ❑ Heat Pump Water Injection❑ Other❑ If Other,List Use
2. WELL LOCATION: Topographic/Land setting
Nearest Town: County GS/U/vI Midge Mope Malley at
l b(P V011 V )24 r err y i 1 I -�- o��D /3 F (check appropriate boa)
(Street(Streot N�rmbvs,Community,Subdivision,Lot No., rpZ Gedc) Latitudellongitude of well location
3. OWNER: &, f:40DY(G� 35° )7 ' 331c! Ddo) 331391J
(dcgeees//mimWh b)
Address ER fat GU r=d J Latitude/longitude source:91CPS❑Topographic map
(Stroce br Route No.) (check boa)
s o-n U i t 6e, Nc a i g 3 9 DEPTH DRILLING LOG
City or Town Soto zip Code From To Fo lea ' n ❑ption
Area Dods-Phone numbs / ��-
4. DATE DRILLED 7 1�10S' ti IS— _ Z 6-
5. TOTAL DEPTH: 51)5t S-_ �0,�
6. DOES WELL REPLACE EXISTING WELL? YES❑ NO GY
7. STATIC WATER LEVEL Below Top of Casing: 20 FT. -
(Use"+"if Abovc Top of Casing)
8. TOP OF CASING IS FT.Above Land Surface*
'Top of easing twashi nle i atror below land surface requires a in
variance is aorordmm with ISA NCAC 2C.011S,
9. YIELD(gpm): I a METHOD OTEST R") r-- r
10. WATER ZONES(depth): �$7
LOCATION SKETCH ,.,,
11. DISINFECTION:Type Amotmt Show direction and distance in miles from at least
12. CASING: Wall Thickness two State Roads or County Roads.Include the road ,
Depth Di eter or Weight/Ft. Materiel numbers and common road names.
F_T To F. �
From To FL tJL o� 'CJ
From To FL
13. GROUT: Depth Material Method
From To_ 0 Ft. � A(
From To FL
14. SCR Depth Dieter Slot Size Materiel o EEN: am From TO FL in. in.
From Tc FL—in. in. �]
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
16. REMARKS:
1 DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C,WELL
CONSTRUCTION STANDARDS,AND THAT A COPY OWISREC RD HAS BEEN PROVIDED TO THE WELL
yOWNER
SIGNATUREODFPERSON CONSTRUCTING THE WELL DATE
Submit the original to the Division of Water Quality,Attn: Information Management, 161'7 Kirf-IerNicc-Genter-
Raleigh,NC 276994617, Phone No.[phone],within 30 days
IREV.09/2004
5' 2 3 'nC)5

WELL CONSTRUCTION RECORD j 14 "( 10
North Carolina Department of Environment and Natural Resources-Division of Water Quality
WELL CONTRACTOR(INDIVIDUAL)NAME (print) Bryant Smlth CERTIFICATION#2571
WELL CONTRACTOR COMPANY NAME Green River Well&Pump Company PHONE k (828)69t3-112000
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT# 0 41 10 111111
(if applicable) (if applicable)
1 WELL USE(Check Applicable Box):Residential M/mimicipal/Public❑ Industrial ❑ Agricultural❑
Monitoring❑ Recovery O Heat Pump Water Injection O Other❑ If Other,List Use
2. WELL LOCATION: Topographic/Land setting
Nearest Town: J- - dr^A�k-- rylotl(,-C1�LoumIty^,' —� r�aysrrxJ [3ftdge ❑Slope ❑Valley OFlat
333 tr.40..►tlrC��"�f. +-FF Ja�.Q/'SCytUII IGNLa�731 (check appropriate box)
(Street Name,Numb*,,Community,Subdivision,Lot No.,Zip Code) Lattude/longl[Ude of well location
3sbJ�'z9n/of4�° o�scL41
3. OWNER: 4�ir7t�-t•e,Shvvla..�t� (degrees/minutesheconds)
Address 333 IL0.U10.QeL vesTpr Latitude/longitude source:CR6PS0Topogmphicmap
1 _ ($trCt or RoMc No.) (check box)
6 �0. J(JY�l1 1IGPr L C Zg�j39 DEPTH DRILLING LOG
City tit Town state zip code From To Formation Description
c8lQ9f 351 I D - a
Area codo-[Lone number
4. DATE DRILLED �� "a5. TOTAL DEPTH: � _
6. DOES WELL REPLACE EXISTING WELL? YES O NO &K,
7. STATIC WATER LEVEL Below Top of Casing: PT. r
Nee"+"if Above Top of Caning)
S. TOP OF CASING IS I FT.Above Land Surface' n
'Top orcuing terminated at/or below land surface requires a L h
C
variance in aecordasce with lSA NCAC 2C.Ol ld �j q
9. YIELD(gpm): METHOD OF TEST //t 1 '•
10. WATER ZONES(depth): /4 ti- /.S D^
° LOCA1-1 ON SKETCH
11 DISINFECTION:Type Amount Show direction and distance in miles fr9at lest
12. CASING: Well Thickness two State Roads or County Roads. Include the raIJ
Depth Diameter or Weight/Ft. Material numbers and common road names.
From / To i Ft Pole-
From z' f To__f f_Ft. 6 2 1.f
From To FL CRAB R . /Cy
13, GROUT. Depth M to al Method
From To_7 O Ft.
From To FL
14. SCREEN. Depth Diameter Slot Size Material t`
From To Ft. in. in.
From To FL m, in. 0
15, SAND/GRAVEL PACK:
Depth Size Material
From To Ft. yi
From To Ft.
16. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WI I'll 15A NCAC 2C,WELL
CONSTRUCTION STANDARDS,AND THAT A C WY OF THIS RECORD HAS BEEN PROVIDED'fO THE WELL OWNER
`/ 7Z-7
GNATURE(TFrEgSON CONSTRUCTING THE WELT. DATE
Submit the original to the Division of Water Quality,Attn: Information Management, 1617 Mail Service Center-
Raleigh,NC 27699-1617, Phone No.[phone],within 30 days - - -----
I Q
IREV. 09/2004
AUG 23 2005 �i
1

WELL CONSTRUCTION RECORD 307260
North Carolina-Department of Environment and ryNatural Resources-Division of Water Quality-Groundwater Section
WELL CONTRACTOR(INDIVIDUAL)NAM��tE IFI
(print) ufllrtrl-� lrvtt}fl CERTCATION k�i + r
�
WELL CONTRACTOR COMPANY NAMEGC- n 'wee— WkAk 01rNA�PHONE k (Se1Ylt�'3'I aCO
STATE WELL CONSTRUCTION PERMTTk ASSOCIATED WQ PERMrrk�1O70t�49DQ
(if applicable) (if applicable) I-,LA Tl-10\g(O�IIC]
1. WELL USE(Check Applicable Box):Residential O ­Municipal/PubHC❑ Industrial❑ Agricultural❑
Monitoring❑ Recovery 0 Heat Pump Water Injection❑ Other 0 If Other,List Use
2. WELL LOCATION: Topographic/Land setting
Neatest Town: County (e nAe rcry. ORidge ❑Slope [91alley Wrat
(cheek approprieta bmc)
(Sheet Name,Num Community,Subdivision,lot No.,Zip Code) Latitudellongitude of wcU location
3. OWNER:IAhkpAnm.. \bn-Il,rer� llt�I :r EJ (deuws/mmutestseoonds)
Address � Da. Latitude/longitude source:MdPSOTopographic map
(Soeetor Route No.) (check box)
N„rAL6 fry,�RPn45 sG DEPTH DRILLING LOG
ciryya Town 1 crate zip code From _ CTo Fo tsti n ceiption
z 3)- r, Aa- 1 alccl 0
Am code-Phone mnaba
4. DATE DRII.LED 1 - 11'CSa �Igbt/g
5. TOTAL DEPTH: SD 5
6. DOES WELL REPLACE EXISTING WELL? YES O NO 2�
7. STATIC WATER LEVEL Below Top of Casing: J FT.
(Use' "if Above Top
8. TOP OF CASING IS I FT.Above Land Surface*
`Top of easing terminated•tior bebw land smtaee regnirn a
variance is setordanatth 15A NCAC 2C.a11R tTri
-$
9. YIELD(gpm): METHOD OF TEST A 11Z
10.WATER ZONES(depth): /0 0 — Al oQ/o M
t7 — LOCATION SKETCH - -
11. DISINFECTION:Type NT1-1 Anib6nt Show direction and distance in miles frot)tiit leases
12. CASING: Wall Thickness two State Roads or County Roads.Inclu
Depth D' er or Weight/Ft. Material numbers and common oad names.
From­-1- To�Ft. �. P E A
From-.[µme To—a-,`L— FL t
From To Ft. 6
13. GROUT: Depth Male nal —_ Meth
From JQ To-2-V Ft. 5 I r-
From To Ft. �O
14. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in. !
From To Ft.----in. in.
15. SAND/GRAVEL PACK:
Depth six Materialf,
Fro�_To Ft. Rd
Front—To Ft.
16. REMARKS:
I DO HEREBY CERTIFY T14AT THIS WELL WAWONSTRU5TED IN ACCORDANCE WITH ISA NCAC 2C,WELL
CONSTRUCTION STMDARDS,AND THAT A OPY OF INS RECORD HAS BEEN PROVIDED TO THE WELL OWNER j
j - 13 -OS _
RE OF PERSON CONSTRUCTING THE WELL DATE 2-
Submit the original to the Division of Water Quality,Groundwater Section,1636 Man Service Center-Raleigh,NC
- 27699-1636 Phone No.[phone],within 30 days. GW-1 REV.072001
•_n

307261
WELL CONSTRUCTION RECORD
North Carolina-Department of Environment and Natural Resources-Division of Water Quality-Groundwater Secti�oInn�7--I�
^R���,, 1 , --�.11, CERTMCATION ap�a
WELL CON77tACTOR(INDI,'IDUAL)NAME (print)y11�L1
n�t T WaAk G. CLMe �, mice,�aaagD
WELL CONTRACTOR COMPANY NAME n ' .—PHONE N anylao18315�_
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMITa
(if applicable) (if applicable)
1. WELL USE(Check Applicable Box):Residential l( Municipal/Public❑ Industrial❑ Agricultural❑
Monitoring❑ Recovery ❑ Heat Pump Water Injection❑ Other O If Other,List Use
2. WELL LOCATION: Topogmphic/Land setting
Nearest Town: FdYIP i County-At � ORidge Mope OValley IiFlat
(check appropriate bax)
(Street Name,Nato Community,Subdivision,Lot No.,ZIP Code) LatitudellOa fade Of well lo t�ation
3TC
3. OWNER: M—O,\Q�SL7r-1 (dapx tinani s/xmam)
Address LatitudeAtingitude source:[WS❑Topographic map
{Street or Rwte No.) (check box)
l k @71aD DEPTH DRILLING LOG
Citycr Town Some Zip Code From To Formation
Am code-Phoronumber
4. DATE DRILLED
5. TOTAL DEPTH: moo'
6. DOES WELL REPLACE EXISTING WELL? YES❑ NO E( �1
7. STATIC WATER LEVEL Below Top of Casing: FT.
(Use"+"if above Top of Casing)
8. TOP OF CASING IS FT.Above Land Surface* rn
-rop of easing terminated attar below land surface requires a itt
variance in accordance with ISA NCAC 2C.011a.
9. YIELD(gpm):I_ME OD OF TEST 1R m
10.WATER ZONES(depth): /�J,5 12, Q 09M
LOCATION SKETCH tJt
11. DISINFECTION:Type AmountShow direction and distance in miles from at least
12. CASING: Wall Thickness two State Roads or County Roads include the road
Depth D I' er our Wei$�UFt. y¢atyrial numbers and common road names.
To Ft. ,{ 1.oLn'
Fro To Ft_T —LCCL_
From To Ft.
13. GROUT: Depth Material Mmethod
FromQTo_�fL Ft. $�/ > tic
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. Nor
-l
From—To Ft.
16. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C,WELL
CONSTRUCTIODARDS,AND THA COPY OF HIS RECORD HAS BEEN:PROVIDED TO THE WELL OWNER -
,I G "-49
SIGNATURE OF PERSON CONSTRUCIING THE WELL DATE
Submit the original to the Division of Water Quality,Gronndvmter Section,1636 Man Service Center-Ralelgh,NC 1
27699-1636 Phom No.[phone],wjthin 30 days. GW-j REV.07/2001 Co V
o C:
cat

0_1
307646
WELL CONSTRUCTION RECORD
North Carolina-Department of Environment and Natural
Rlesourc Division of Water Quality-Groundwater Section
/�2
WELL CONTRACTOR(INDrA UAL)NAM (print F-»�gpy r C�1 i 1 CERTIFICpA�TdION SI a-
WELLCONTRACTORCOMPANYNAME I I17J �\ �4 AIc�1 lI l� CI PHONE # lovw)C93_
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PER6BT#
ifapplicable) ifapplicable)
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: 1 T d setting ='
Nea s ow``n11:��' � County��t 6172Y`t�l F ❑Ridge lope ❑Valley ❑Flat
'LL1 —Ap� (check appropriate box)
(Sum Namr,NurumnbbeM Cor6eniry,Subdiimoo,Lot No.,Tip Code) Latitude/Iongitude of well location
3. OWNER:
Address q r. LatitudeAongitude source:❑GPS❑Topographic map
�>LF (sheetN 01 �g Ty / DEPTH (check DRILLING LOG
City or Town state tip Code From To Formation Description
Area code-P600e camber
4. DATE DRILLED I't
5. TOTAL DEPTH:
6. DOES WELL REPLACE EXISTING WELL? YES�NO Q
7. STATIC WATER LEVEL Below Top of Casing:J O FT.
(Use"+"if Above Top ofCasiog)
8. TOP OF CASING IS FT.Above Land Surface'
'Top of easing terminated atlor below land sorltm requires a
variance to aeeordao th 1SA NCAC 2C.0113. , ' I
9. YIELD(gpm): MET IO D OF TE� L ��I
10.WATER ZONES(depth):
LOCATION SKETCH
11. DISINFECTION:Type Amount Show direction and distance in miles from at least
12. CASING: Wall Thickness two State Roads or County Roads.Include the road
Del Diameter or Weight/FL Material numbers and common road names.
From
Q_To Ft r�
From Tc Ft C>J�
From To Ft l
13. GROUT: Depth M
From To FtCJSkJ From To Ft .v
14. SCREEN: Depth Diameter Slot Size Material
From To Ft in, in.
From To Ft in. in.
15. SAND/GRAVEL PACK:
Depth Size Material -rr
From To Ft. <
From To Ft.
16. REMARKS: Cal
07
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C,WELL
CONSTRUCTION STAND ,AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
Submit the original to the Division of Water Quality,Groundwater Section,1636 Mail Service Center-Raleigh,NC
27699-1636 Phone No.[phone],within 30 days. GW-I REV.07/2001

307644
WELL CONSTRUCTION RECORD
North Carolina-Department of Environment and /NatfmalnResou�rcGp/ Division of Water Quality-Groundwater Section
/T p
WELL CONTRACTOR(INDIVIDUAL)NAME (pr M), /1,-�^t e W C�/ 7� CERTIFICATION
WELL CONTRACTOR COMPANY NAME Q�(i'I I'tC./"11��I I.L I JJr��_PHONE a ��u)663-
STATE WELL CONSTRUCTION PERMM ASSOCIATED WQ PEE24M
if livable if livable
1. WELL USE(Check Applicable Box):Residential Municipa"ublic 0 Industrial❑ Agricultural 0
Monitoring❑ Recovery ❑ Heat Pump Water Injection 0 Other❑ If Other,List Use
z
2. WELL LOCATIC(I.,,�0 4 Topoa/Land Setting
N� M d I aunty 6(/� pRidge lope ❑Valley
OFlat
(Street Name.Numbers,Community,Subdivision,lot)No.,,Zip Code) g� r Latitude/longitu of ll)location
3. OWNER:-- OWEI ( miauasleeeotrds) -
Address _� t Latitude/longitude souroe:MPSOTopographic map
(cheek box)
DEPTH DRILLING LOG
City«Town stag tip Code From To Formation Description
Asa code Plume comber
4. DATE DRILLED
5. TOTAL DEPTH:
6. DOES WELL REPLACE EXISTING WELL? YES NO
7. STATIC WATER LEVEL Below Top of Casing: �Q 5 FT.
(Use'+"if Above top of Casing)
S. TOP OF CASING IS FT.Above Land Surface*
-Top of easing terminated st/«below land surface requires a
valance lo(gpactor d�pce�lth iSA NCAC 2C A118. � Cc i
9. YIELD m :�METHOD Q�TES 1.
10.WATER ZONES(depth): 10, �5 5�C)
LOCATION SKETCH
11. DISINFECTION:Type�L Amount Show direction and distance in miles from at least
12. CASING: Wall Thickness two State Roads or County Roads.Include the road
Dep � Diameter or Weight/Ft Material numbers and common road names.
From To Ft ! t"
From,__To Ft ( /
From To Ft
13. GROUT: Depth r^
From To FQ ME7t C
From To Ft
14. SCREEN: Depth Diartteter Slot Size Material
From To Ft in. in a
From To Ft in. in.
15. SAND/GRAVEL PACK:
Depth Size Material f-l
From To Ft. W -y
From Tc Ft.
16. REMARKS: o
I DO HEREBY CERTIFY T THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH I SA NCAC 2C,WELL
CONSTRUCTION ST S,AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL 0)IWNNER_
SIGNA OF PERSON CONSTRUCTING THE WELL DATE
Submit the original to the Division of Water Quality,Groundwater Section,1636 Mail Service Center-Raleigh,NC
27699-1636 Phone No.[phone],within 30 days. GW-1 REV.07/2001

From:Scott Gantt To:Stephenie Wilson Date:2/21/2005 Time:12:57:44 PM Page 4 of 9
V L )
WELL CONSTRUCTION RECORD 307658
North Carolina-Department of Environment,and Natural Resources-Division of Water Quality-Groundwater Section
WELL CONTRACTOR(INDIVIDUAL)NAME(print) SCOTT GANTT CERTIFICATION#2584
WELL CONTRACTOR COMPANY NAME CAROLINA WELL DRILLERS,INC.PHONE#[phone]
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
1.WELL USE(Check Applicable Box): Residential ® Municipal ❑ Industrial❑ Agricultural ❑ Monitoring ❑
Recovery ❑ Heat Pinnp Water Injection ❑ Other ❑ If Other,List Use:
2.WELL LOCATION: Topographic/Land setting
Nearest town: BAT CAVE County HENDERSON ❑Ridge ❑ Slope ❑ Valley ® Flat
OLD PLACE RD OFF MIDDLEFORK RD Latitude/Longitude of well location
(Street Name,Numbers,Community,Subdivision,LotNo,Zip Code) 35.28.326/92.19,520
3.OWNER HICKORY NUT DEVELOPMENT CORP (MOUSETTE JOB) (degrees/minutes/seconds)
ADDRESS POB 276 Latitude/longilude source:®GPS❑Topographic map
(Street or Route No.) DEPTH DRILLING LOG
LAKE LURE NC 28746 From To Formation Description
Cityorrovon State Zip Code 0 17 Clay
828-625-0866 17 400 Consolidated Rock
Area Code-Phone Number
4.DATE DRILLED 1/5105
5.TOTAL DEPTH 400 '
6.DOES WELL REPLACE EXISTING WELL? YES NO ® —r'1 {
7.STATIC WATER LEVEL Below Top of Casing: 15 IT, Fri
(Ua"+^IfAbove Top ofCam,g) Co
8. TOP OF CASING IS 2 FT.Above Land Surface- lD
+Top of cosim tmnmatcd at/or below Imd swfacc rcquvcs a vmim c in
accordance wine 15A NCAC 2C.0118 F,
9. YIFI (gpm): 5 METHOD OF TEST ARDM ;2 .
la.WATER ZONES(depth): 375 4 -
it.DISINFECTION:TYPE HYPOCHLORITE Amount 18 0. LOCATION SKETCH
12.CASING: Wall T1lickness Show direction and distance in miles from at least
Depth Diameter or Weight/FL Material two State Roads or County Roads.Include the road
From 0 To 26 FL 6 114" SDR 21 PVC numbers and common road names.
13.GROUT:
Depth Material Method
From 0 To 20 FL GRAVEL MIX GRAVITY
14.SCREEN _
Depth Dianeter Slot Sim Material
From NA To FL in in.
Is.SAND/GRAVEL PACK: � --
a
Depth Size Material
From NA 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.
��� 1110105
SIGNATURE OF PERSON CONSTRUCTING THE WELL Dale
GW-1 REV.07l2001
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.

V ' — j U I V V
North Carolina Department of Environment& Natural Resources
Division of Water Quality-Groundwater Section FOR OFFICE USE ONLY
1636 Mail Service Center QUAD.NO, SERIAL NO.
Raleigh,NC 27699-1636 Phone: [phone]_95 Lac Lon RO
Minor Buin
Basin Code
WELL CONSTRUCTION RECORD Header Ea., Gw-I En,.
DRILLING CONTRACTOR: i(/14 _
STATE WELL
CONSTRUCTION
DRILLER CERTIFICATION NUMBER: PERMIT NUMBER:
I. WELL LOCATION: (``Show sketch of the location below)
Nearest Town: _County: ae:✓ S Pl-
- DEPTH DRILLING LOG
(Road,Community,or Subdivision and Lot No.) From To Formation Description
2. OWNER y r r v
ADDRESS i4•cSro
(Street or Poute No.)
at""46"utr at. a87�'� 65 lAn
City or Torn State Zip Cede
3_ DATE DRILLEWt27 S USE OF WELL
4. TOTAL DEPTH )(..
5. CUTTINGS COLLECTED YES O NO Da ' -
6. DOES WELL REPLACE EXISTING WELL YES 0 NO gii
7. STATIC WATER LEVEL Below Top of Casing: 0 _FT. —
(Use"+"if Above Top of Casing)
S. TOP OF CASING IS FT.Above Land Surface*
—q�--
•Casing Terminated atior below land surface is illegal unless a variance is issued —ca-----L
in accordance with 15A NCAC 2C.0118 --
9. YIELD(-pm):- OIETHOD OF TEST co --
10.WATER ZONES(depth):
11.CHLORINATION:Type Amount If additional space is needed use back of form
12.CASING:
Wall Thickness _
Dept Diafneter Or R'eight/Ft. Waterial
From�—To FL /-T W
ulf
From To Ft. LOCATION SKETCH
From To FL (Show direction and distance from at least two State
Roads,or other map reference points)
13.GROUT:
Depth Material Material Method
�y
From To VOFL Ga.uati h/ ,-P t-
From To FL
� a,atP
14. SCREEN:
Depth Diameter Slot Size Material
From To Ft in. in.
From To Ft. in. in. �cWC,r�S�
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To FLFrom—To— FL
6�
tS.
16. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH I5A NCAC 2C,WELL
CONSTRUCTION STANDARDS,AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
Tr'U A Tr(4 r(,C!CVWU DAf-rI fa 11O •1CAT n TC

WELL CONSTRUCTION RECORD 3 0 8 8 8
North Carolina-Department of Environment and Natural Resources-Division of Water Quality-Groundwater Section
WELL CONTRACTOR(INDIVIDUAL)NAME (print)KENNE7H MCCRARY CERTIFICATION#2008
WELL CONTRACTOR COMPANY NAME BARKER CONSTRUCTION,INCJBARKER WELL 8 PUMP PRONE # [phone]
STATE WELL CONSTRUCTION PERMIT# 1871 ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
1. WELL USE(Chink Applicable Box):Residential M Municipal/Public❑ Industrial❑ Agricultural❑
Monitoring❑ Recovery ❑ Heat Pump Water Injection❑ Other❑ If Other,List Use
2, WELL LOCATION: Topographic/Land setting
Nearest Town: HENDERSONVILLE County HENDERSON ®Ridge []Slope ❑Valley ❑Flat
RIVER RIDGE,LOT#3 (check appropriate box)
(Street Name,Numbers,Community,Subdivision,Lot No.,Zip Code) Latitude/longitude of well location
3. 0 WNER: JEFFREY BARRINGTON (degrees/minutes/seconds)
Address 162 CHURCH STREET LatitudeAringitude source:❑GPS❑Topographic map
(Street or Rome No.) (cheek box)
RIDGEVILLE SC 29472-8027 DEPTH DRILLING LOG
City or Town State Zip Code From To Formation Description
( B43 ). 871-9710
Area code-Phone nomber
4. DATE DRILLED JANUARY 5,2005 GM
5. TOTAL DEPTH: 605' rtrn
6. DOES WELL REPLACE EXISTING WELL? YES❑ NO 91 ,
7. STATIC WATER LEVEL Below Top of Casing: 135' FT. f9 o p
(Use"+"if Above Top of Casing) t ��-
8. TOP OF CASING IS 1.33 FT.Above Lard Surface"
•Top of casing terminated War below land surface requires a y
variance in accordance with lSA NCAC 2C.01IS.
9. YIELD(gpm): 1`h METHOD OF TEST TIMED ad
10.WATER ZONES(depth):
LOCATION SKETCH .pC! �¢
11. DISINFECTION;Type er PUMP iNsrut a Amount Show direction and distance in miles from at least—
two State Roads or County Roads.Include the road
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material numbers and c�om�m�on,�ro�and names.
From 0 To 74 Ft. 61/8 SDR21 PVC J/t•�lyf,A IL/`Lc�.j-!7/'LLCtj� ,�""" '
From To Ft lr((ph--'tOUcuoc�dp�' � �
From To Ft. i'KA�2a� J(.liV1 LR� a(,
13. GROUT: Depth Material Method / - ) �
From 0 To 20 Ft. CONCRETE POURED ,1/ L�11• �rx
J^n^ �f" ,
From To Ft. _ 1/.t,LLL� Utx.tcn+•d' "�/!•l
14. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. In - -t 7tCL 7 /L m.L
From To Ft. m. in KJ)•�a.Wv.,,••t- /1L� ' ' ,.,, 1. � U fLLU
15. SAND/GRAVEL PACK: A (I ,t,. 3' VILI.Q �• .�
Depth Size Material 01
From To Ft.
From To Ft. - 0
16. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C,WELL
CONSTRUCTION STANDARDS,AND THAT A COPY OF THIS
RECORD HAS BEEN PROVIDED TO THE WELL OWNER
SIGNATURE OF PERSON CONSTRUCTING 0112 WELL DATE
Submit the original to the Division of Water Quality,Groundwater Section,1636 Mail Service Center-Raleigh,NC
27699-1636 Phone No.(919)7333221,within 30 days. GW-1 REV.07/2001

DO
WELL CONSTRUCTION RECORD 3 0
North Carolina-Department of Environment and Natural Resources-Division of Water Quality-Groundwater Section 8 8 �a
WELL CONTRACTOR(NDMDUAL)NAME (print)RICHARD MCCRARY CERTIFICATION N 2010 (/
WELL CONTRACTOR COMPANY NAME BARKER CONSTRUCTION,INC./BARKER WELL&PUMP PHONE # [phone]
STATE WELL CONSTRUCTION PERMIT# 1871 ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
1. WELL USE(Check Applicable Box):Residential® MunicipaMblic❑ Industrial❑ Agricultural❑
Monitoring❑ Recovery ❑ Heat pump Water Injection❑ Other❑ If Other,List Use
2. WELL LOCATION: Topographic(Land setting
Nearest Town: HENDERSONVILLE County HENDERSON glRidge ❑Slope ❑Valley ❑Flat
BLUE SKY LANE (check appropriate box)
(Sheet Name,Numbers,Community,Subdivision,Lot No.,Zip Code) Latitade/longitudc of well location _
3. OWNER CLARK SMITH (degreea/minutes/secwds) r-
Address 547 BUENA VISTA LANE Latitude/longitude source'-MPS❑Topographic map -
(Street or Rome No.) (check box) -
HENDERSONVILLE NC 29791 DEPTH DRILLING LOG
City or Town State Zip Code From TO Formation Description _
( 828)_ 698-1980
Area code-Phone number
4. DATE DRILLED JANUARY 12,2005 �r`3rt
5. TOTAL DEPTH: 325 _ 'nnn
6. DOES WELL REPLACE EXISTING WELL? YES❑ NO gl
7. STATIC WATER LEVEL Below Top of Casing: 120 FT. y o O
(Use"+"if Above Top of Casing)
8. TOP OF CASING IS 1.33 FT.Above Land Surface* aD 4rn
-Top of casing terminated atior below land surface requires a ry
variance in accordance with ISA NCAC 2C.0118.
9. YIELD(gpm): 12 METHOD OF TEST TIMED t Z
10.WATER ZONES(depth): 00
LOCATION SKETCH OD
11. DISINFECTION:Type BY PUMP INSTALLER Amount Show direction and distance in miles from at least
12. CASING: Wall Thickness two State Roads or County Roads.Include the road
Depth Diameter or Weight/Ft. Material numbers and common road names.
From 0 To 48 Ft. 6118 SDR21 PVC JU/17
From To Ft. j g4 rt I,�, .Lf2
From To Ft. �/ "`-.'7f C
13. GROUT: Depth Material Method pcd/2,c .//Z 4rY.k7/R
From 0 To 206 Ft CONCRETE POURED
From TO Ft. Pa d �� � ^ „ zat
14. SCREEN: Depth Diameter Slot Size Material �(�
From To FL in. in. �.ilA/K. /2.� `(�cc0`3u-t-
From To Ft. in. in / Q
15. SAND/GRAVEL PACK: ���---/// /t 'teee-ZZZ u
Depth Size Material C.�•L-
From To Ft. �/Qa vy) �LC/ � LCQQ
From To Ft. -
(prt 017L(m7rxrd�
16. REMARKS: 400 O —
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C,WEL
CONSTRUCTION STANDARDS,AND THAT A COPY OF S RECORD HAS BEEN PROVIDED TO T L WNE$
XGNATURE OF PERSON CO CHNIG THE WELL DATE
Submit the original to the Division of Water Quality,Groundwater Section,1636 Mail Service Center-Raleigh,NC
27699-1636 Phone No.[phone],within 30 days. GW-I REV.07/2001

WELL CONSTRUCTION RECORD t7 0
North Carolina-Department of Environment and Natural Resources-Division of Water Quality-Groundwater Section 8 t�
WELL CONTRACTOR(INDIVIDUAL)NAME (print)RICHARD MCCRARY CERTIFICATION#2010
WELL CONTRACTOR COMPANY NAME BARKER CONSTRUCTON,INC.BARKER WELL&PUMP pf[ONE # (a28) 697-7263
STATE WELL CONSTRUCTION PERMIT# 1871 ASSOCIATED WQ PERMITH
(if applicable) (if applicable) mmommommonoo
I. WELL USE(Check Applicable Box):Residential® Municipal/Public❑ Industrial❑ Agricultural❑ _
Monitoring❑ Recovery ❑ Heat Pump Water Injection❑ Other❑ If Other,List Use
a
-r7
2. WELL LOCATION: Topograpitic/Land setting
Nearest Town: HENDERSONVILLE County HENDERSON ®Ridge ❑Slope ❑Valley ❑Flat
FOXWOOD SUBDIVISION,LOT#17 (cbeck appropriate box)
(Street Name.Numbers,Commwity,Subdivision,Lot No.,Zip Code) Latitude/longitude of well location:
3. OWNER: MYKOLAKONKO (de greestminutestsecwds)
Address 102 E.BLUE RIDGE ROAD LatitudeAtingitude source:❑GPS❑Topographic map
(Street or Roate No.) (check box)
EAST FLAT ROCK NC 28726 DEPTH DRILLING LOG -
City or To" Stare Zip Code From TO Formation Description
b( 28). 694-1290
Area code-Phone number r^
4. DATE DRILLED JANUARY 18,2005 Qw �'itm
5, TOTAL DEPTH: 505' 1"
6. DOES WELL REPLACE EXISTING WELL? YES 11 NO 91
7. STATIC WATER LEVEL Below Top of Casing: 100 FT. .r p
(Use"+"if Above Top of Casing)
8. TOP OF CASING IS 1.33 FT.Above Land Surface*
*Top of casing terminated atlar below land surface requires a
variance in accordance with 15A NCAC 2C.011&
9. YIELD(gpm): 4 METHOD OF TEST TIMED t7 too
10.WATER ZONES(depth): t r
L0CATION SKETCH
11. DISINFECTION:Type ev PUMP INSTALLER 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 DR1 Weight/Ft. Material numb col 1 common uo names. �
From 0 To 54 Ft 61I8 SDR21 PVC ee.JAT(�. Y-+Y�t�u�
From To Ft &5-Y okth -tD j'U(.(l'I,tain )4OrAk.
From To Ft ji 4, [L) Q{ McIA/I'(taLn Rd- ,do
13. GROUT: Depth Material Method 1� o-
From 0 To 20T Ft CONCRETE POURED A-O t5p ,4� .Ncl�- - � � UWO--/-"
From To Ft 61LCLl^�� Q fU . JWIYL�L� L/n171P�
14. SCREEN: Depth Diameter Slot Size Material Liu JoY ciao(
From To Ft, in. is n �L1
From To Ft in. in. 10 44j-
15. SAND/GRAVEL PACK: ,( L
Depth Size Material c7L C7 l.WC��.u'
From To Ft �r� # 7
From To Ft.
16. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC�C,WELL
CONSTRUCTION STANDARDS,AND T A COPY O RECO BEEN PROVIDED TO WNER
�Q
SIGNATURE O ERSON ONSTRU THE WELL DATE
Submit the original to the Division of Water Quality,Groundwater Section,1636 Mail Service Center-Raleigh,NC
27699-1636 Phone Na(919)733-3221,within 30 days. GW-I REV.07/2001

cW
WELL CONSTRUCTION RECORD 30 �y
North Carolina-Department of Environment and Natural Resources-Division of Water Quality-Groundwater Section
WELL CONTRACTOR(INDIVIDUAL)NAME (priot)KENNETHMCCRARY CERTIFICATION#2008 7
WELL CONTRACTOR COMPANY NAME BARKER CONSTRUCTION,INCJBARKER WELL&PUMP PHONE # [phone]
STATE WELL CONSTRUCTION PERMIT# 1871 ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
1. WELL USE(Check Applicable Box):Residential M Municipal/Public❑ Industrial❑ Agricultural❑
Monitoring❑ Recovery ❑ Heat Pump Water Injection❑ Other❑ If Other,List Use
�n
2. WELL LOCATION: TopographidLand setting
Nearest Town: HENDERSONVILLE County HENDERSON ❑Ridge []Slope Malley glFlat Fa =-
BRANNONROAD (check appropriate box)
(Street Name,Numbers,Community,Subdivision,Lot No.,Zip Code) Latitude/longitude Of well location -
3. OWNER DALE KIMBRO (degees�minutes/seands) - '
Address 320 COMET DRIVE Latitude(longitude source:❑GPS❑Topographic map
(Street or Route No.) (check box)
HENDERSONVILLE NC 28791 DEPTH DRILLING
City or Town State Zip Code From TO Formation Description Gm
8( 28)- 674-7873 rG�jy =rt
Area code-Phone number
4. DATE DRILLED JANUARY 19,2005 sytQ
5. TOTAL DEPTH: 505' 1 p
6. DOES WELL REPLACE EXISTING WELL? YES❑ NO 91 a
7. STATIC WATER LEVEL Below Top of Casing: 200 FT. .p ntya
(Use"+"if Above Top of Casing)
otj
8. TOP OF CASING IS 1.33 FT.Above Land Surface" y,
`Top of casing term tested atlor below land surface requires a O ttP 9P
variance in acardance with 15A NCAC 2C.0118.
9. YIELD(gpm): 3 METHOD OF TEST TIMED
10.WATER ZONES(depth):
LOCATION SKETCH
11. DISINFEC FION:Type BY PuMP INSTALLER Amok Show direction and distance in miles from at least
12. CASING: Wall Thickness two State Roads or County Roads.Include the road
Depth Diameter or Weight/Ft. Material numbers and common road names.
From 0 To 109 Ft. 6118 SDR21 PVC (�
From To Ft. ��p�>7� 2p(.
From To Ft �a u" CO-)CJ()rt�UW L
13. GROUT: Depth Material Method a L�� 0)11a..a� ' oo Ro- x
From 0 To 20 Ft. CONCRETE POURED �^Yrvi4w *0 Van�.-�V-ud. -n=.
From To Ft. �f'Wi/�ft� � CPO- t I t!.(.LA_.�c,t- mo--�vd-C
14. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in
From To Ft. in. in U1.ft�
15. SAND/GRAVEL PACK: UYLQULt q
Depth Size Material
From To Ft. a q,(s •�Q
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
✓Y1 t.Gt - 1 ,--t �- 6
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATET—
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
308145
WELL CONSTRUCTION RECORD
North Carolina-Department of Environment and�N((pt/tom/a�1 Resources- ivision of Water Quality-Groundwater Section
WELL CONTRACTOR(INDIVIDUAL)NAME f (�pi�ta�t).�/- I L/G{�I eS ✓/� CERTIFICATION#-2.W
WELL CONTRACTOR COMPANY NAMB.�11S � 21�1e.1 "0:11 s n O PHONE # &kfe��Q
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT*
if livable if licable
1. WELL USE(Check Applicable Box):Residential MM r cipal/Public❑ Industrial❑ Agricultural❑
Monitoring❑ Recovery ❑ Heat Pump Water Injection❑ Other❑ If Other,List Use
2. WELL LOCATIO ��trE/X//xoh TopoBraphic11==4A6ting
Nearest7 Town:tN / C 'In�Y 87 ❑Ridge (check pe alley ❑Ftat'_
�! T.�� +Pptopriait box)
(Sued Narne,Numbers,Community,Subdivision,Lot No.,zip code) LatitudOongihide of well location -
3. OWNER: lye /� G (dcgreeeestmimuestsemex1s)
Address 3` 1k Ci'/te/ $T Latitude4ongitude source:❑GPSOTopographi6 map
sn« (checkb�e 7S2:9 DEH DRiL LING LOG
City or roam state zip code From To Formation Description
C__J-
Arn code-Phan;number _
4. DATE DRILLED
5. TOTAL DEPTH: g O 5
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO
7. STATIC WATER LEVEL Below Top of Casing: ' FT.
(Uac"+"if Above Top of Casing)
8. TOP OF CASING ISEA
FT.Above Land Surface'
`Top of easing termtaated now below land sorfece roquim a
variance in accordance with ISA NCAC 2C.011& -�
9. YIELD(gpm):_. _I _METHOD OF TEST rto I- 1/
10. WATER ZONES(depth): O
LOCATION SKETCH
IL DISINFECTION:Type CC Amount /Q y 2 Show direction and distance in miles from at leaZ
12. CASING: Wall Thickness two State Roads or County Roads.Include the road
Depth or Weight/Ft. al numbers and common road names.
From_ U/ To —Ft,l $jftQ 2/ (9C
From To FL
From /// To Ft.
13. GROUT- Depth Material M
Fra To -2(Z Ft. C'O It l C U�p
From To Ft r r
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. n
From To C C
16. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTE41N ACCORDANCE WITH 15A NCAC 2C,WELL
CONSTRUCTION ST ARDS,AND THAT A CO F THIS CORD BEEN PROVIDED TO THE WELL OWNER
_11_C95
SIGNATURE OF PERSON CONSTPACTING 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.0712001

OP
30814
4
WELL CONSTRUCTION RECORD
North Carolina-Department of Environment and Natural Resources-Division of Water Quality-Groundwater Section 9
WELL CONTRACTOR(INDIVIDUAL)NAME (print) �n.&� /7 11 CERTIFICATION#GO ! 7
WELL CONTRACTOR COMPANY NAM,%"T(�t9gi ll ka( 0 o: 1 (t n a PHONE # (Stpltetl4-�N80
STATE WELL CONSTRUCTION PERMTI# ASSOCIATED WQ PERMIT#
ifapplicable) ifapplicable)
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: � opogfap hic/Land setting
NeartTown: LDtdge ❑ ope Malley ❑ 7aun &A4S
iC 9se- EVA (check appmprism tax)
(Street Name,Numbers, nCo nonitN Subdivision.Lot No.,Zip Cade) Latitude/longitude of well locatiop
3. OWNER: fo-ekl/& laLO ely (degt_eslminUbwseconds)
Address 393 ZAJad Si/may �A�— Latitude/longitude source:❑GPS❑Topographic map
,lam. ' (ckcck box)
i"G DRILLING LOG
City or Tmvu Soot zip Code From To Formation Description
Ain codo-Plume number
4. DATE DRILLED :!?__0
5. TOTAL DEPTH: ZZ,i
6. DOES WELL REPLACE EXISTING WELL? YES❑ NO
7. STATIC WATER LEVEL Below Top of Casing:
(Use"+"if Above Top of Casing) ail
8. TOP OF CASING IS 1,- FT.Above Land Surface*
'Top of casiag terminated atlnr below read surface requires
variance in accordance with ISA NCAC ZC.0118.
9. YIELD(gpm): /0 METHOD OF TEST 2 t
10. WATER ZONES(depth):
LOCATIONI iMCH N
11. DISINFECTION:Type C C 6f Amount /0 O-? Show direction and distance in miles from at leasiR
12. CASING: Wall Thickness two State Roads or County Roads.Include the 14
a( z0 kC I)rer�ter orc�'` t Material mbers and common road names.
From To Ft/N tJgy�,t �-
From,_To FL_
From To Ft
13. GROUT: Depth Material Method
From To20 Ft 'O t / t e1�X
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 f\
From To Ft. tl S O
From�To Ft.
16. REMARKS: /
1 DO HEREBY C FY THAT THIS WELL WAS CONSTRUCTED IN CCORDANCE WITH 15A NCAC 2C,WELL
CONSTRU( 10 S ANDARDS,AlR THAT A COPMOES 7 HAS BEEN PROVIDED TO THE WELL OWNER
- - O
SIGNATURE OF PEFISON CONMUCTING THE WELL DATE
Submit the original to the Division of Water Quality,Groundwater Section,1636 Mail Service Center-Raleigh,NC
27699-1636 Phone No.[phone],within 30 days. GW-I REV.07/2001

307461
WELL CONSTRUCTION RECORD
North Carolina—Department of Environment And Natural Resources—Division of Water Quality—Groundwater Section
WELL CONTRACTOR(INDIVIDUAL)NAME(print)RODNEY ROBBINS CERTIFICATION# 2785
WELL CONTRACTOR COMPANY NAME PITTMAN WELL BORING,LLC PHONE# [phone]
STATE WELL CONSTRUCTION PERMIT#_ ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
1. WELL USE(Check Applicable Box): Residential ® Municipal/public ❑ Industrial ❑ Agricultural ❑
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other,List Use
2. WELL LOCATION:
Nearest Town:HENDERSONVILLE County REND Topographic/Land setting
WILLARD LANE ❑Ridge ❑ Slope ❑ Valley ❑Flat
(Street Name,Numbers,Community,Subdivision,Lot No.,Zip Code) (check appropriate box)
3. OWNER: TANYA DAY Latitude/longitude of well location
Address 151 WILLARD LANE
(Street or Route No.) (degrees/minutes/seconds)
HENDERSONVILLE NC 28792 Latitude/longitude source: ❑ GPS ❑Topographic map
City or Town State Zip Code (check box)
L8)—778-8911 DEPTH
Area Code Phone number From To
4. DATE DRILLED 01/12/05
5.TOTAL DEPTH: 405 DRILLING LOG
6.DOES WELL REPLACE EXISTING WELL? YES❑ NO® From To
7. STATIC WATER LEVEL Below Top of Casing: 60 FT.
(Use"+"if Above Top of Casing)
8.TOP OF CASING IS 1-1/2 FT. Above Land Surface* LOCATION SKETCH
*Top of casing terminated attor below land surface requires a Show direction and distance in miles from at least
variance in accordance with 15A NCAC 2C.0118.9. YIELD(gpm): 4 METHOD OF TEST ARD Two State Roads of County Roads. Include the road 10. WATER ZONES(depth): number and common namesHWY.#26 W.TO HENDERSONVH.LE.RIGHT
11.DISINFECTION: Type CHLORYTE Amount 10.5 ON 64 L APPROX. 1/2 MILE,LEFT ON HOWARD
12. CASING: Wall Thickness GAP RD.APPROX.2 MILES.RIGHT ON ZED CORN
Depth Diameter or Weight/Ft. Material RD. GO TO STOP SIGN. RIGHT ON N.CLEAR
From 0 To 70 Ft. 6-1/4" SDR.21 PVC CREEK RDw 18f LEFT ON MCMINN RD.LEFT ON
From_To_Ft._ WILLARD LANE.LEFT AT FORK.
From_To_Ft.
13. GROUT: Depth Material Method
From 0 To 20 Ft.OUH{RETE POURED
ui
From_To Ft.
14.SCREEN: Depth_ Diameter Slot Size Material ry
From_To_Ft._ in. in.
From_To_Ft. in, in. ;
15. SAND/GRAVEL PACK:
Depth Size Material
From_To_Ft.
From_To_Ft. ^_
16.REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C,WELL
CONSTRUCTION STANDARDS,AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
/a , Y�f111-- l / 2 .0 �
SIGNA OF PERSON CONSTRUCTING THE WELL DATE
Submit the original to the Division of Water Quality,Groundwater Section,1636 Mail Service Center—Raleigh,NC
27699-1636 Phone No. [phone],within 30 days. GW-1 REV.07/2001

WELL CONSTRUCTION RECORD
3099 '75
North Carolina-Department of Environment and Natural Resources-Division of Water Quality-Groundwater Section
WELL CONTRACTOR(INDIVIDUAL)NAME (print)RICHARD MCCRARY CERTIFICATION N 2010
WELL CONTRACTOR COMPANY NAME BARKER CONSTRUCTION,INC./BARKER WELL&PUMP PRONE N [phone]
STATE WELL CONSTRUCTION PERMIT# 1871 ASSOCIATED WQ PERMIT#
(if applicable) (if applicable) 1011
1. WELL USE(Check Applicable Box):Residential 13 Municipal/Public❑ Industrial❑ Agricultural❑
Monitoring❑ Recovery ❑ Heat Pump Water htjection❑ Other❑ If Other,List Use
2. WELL LOCATION: Topogmphic/Land setting
Nearest Town, HENDERSONVILLE County HENDERSON ElRidge []Slope ❑Valley ❑Flat
ANNE MOUNTAIN ESTATES,LOT#22 (check appropriate box)
(Street Name,Numbers,Community,Subdivision,Lot No.,Zip Code) LatitudcAongitude of well location
3. OWNER PAT AND MARTHA BALLARD (degrees/minutes/seconds)
Address 797 GARDENDALE DRNE Latitude/longitude source:❑GPS❑Topogmphic map
(Strut or Route No.) (check box)
COLUMBIA Sc 29210 DEPTH DRILLING LOG
City or Town State Zip Code From To Formation Description
8( 03 )- 772-5227
Area code-Phone number y
4. DATE DRILLED MARCH 24,2005 r,,,l•
5. TOTAL DEPTH: 505' rzi
6. DOES WELL REPLACE EXISTING WELL? YES❑ NO 91 -
7. STATIC WATER LEVEL Below Top of Casing: 640 FT. _ im
(Use"+"if Above Top of Casing) rQ
8. TOP OF CASING IS 1.33 FT.Above Land Surface*
*Top of casing termhrated attor below land surface requires a - -IS)
variance in accordance with 15A NCAC 2C.0118. Ln
9. YIELD(gpm): 15 METHOD OF TEST TIMED
10.WATER ZONES(depth):
LOCATION SKETCH
IL DISINFECTION:Type BY PUMP INSTALLER 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. �y (�
From N/A To Ft. �¢,to/11- xJ�(Il/16(D.n�.L��g��✓.I.I j-Q ,(,(A,d..¢_Ud
From To Ft o2-doh -aaka- a. be)al f.
From To Ft.
13. GROUT: Depth Material Method �_Q(,(,(-Q �OQD� • a (L) at
From To Ft. `
From To Ft.
14. SCREEN: Depth Diameter Slot Size Material C�) V lu-O ja/1I'�Q.�d2tf/µlu.vl r
From To Ft. in. in,
From To Ft& in. in. JGou.-
15. SAND/GRAVEL PACK: Z
Depth Size Material '
From To Ft.
From To Ft.
16. REMARKS: Well was originally 640'deep. We went back in and drilled an additional 505'making total depth of 1,145'. _.
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRU TED IN ACCORDANCE WITH 15A NCAC 2C,WELL
CONSTRUCTION STANDARDS,AND T A PY OF S RECORD HAS BEEN PROVIDED 7TOi[4E W.F.LL,
b
SIGNATURE OF PERSON ON G THE WELL DA _.�
Submit the original to the Division of Water Quality,Groundwater Section,1636 Mail Service Center-Raleigh,NC
27699-1636 Phone No.[phone],within 30 days. GW-I REV.07/2001 - -

WELL CONSTRUCTION RECORD 309971 9971
North Carolina-Department of Environment and Natural Resources-Division of Water Quality-Groundwater Section
WELL CONTRACTOR(INDIVIDUAL)NAME (print)KENNETH MCCRARY CERTIFICATION#2008
WELL CONTRACTOR COMPANY NAME BARKER CONSTRUCTION,INC.IBARKER WELL&PUMP PRONE # [phone]
STATE WELL CONSTRUCTION PERMIT# 1871 ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
1. WELL USE(Check Applicable Box):Residential® MunticipaMblic❑ Industrial❑ Agricultural❑
Monitoring❑ Recovery ❑ Heat Pump Water Injection❑ Other❑ If Otter,List Use
2. WELL LOCATION: TopogtaphWLand setting
Nearest Town: HENDERSONVILLE County HENDERSON ®Ridge []Slope ❑Valley ❑Flat
SAM KING ROAD (check appropriate box)
(Street Name,Numbers,Community,Subdivision,Lot No.,Zip Code) Latitude/longitude of well location
3. OWNER VAN KUSSROW(STEVE KING-CONTRACTOR) (degrees/minutes/seconds)
Address PO BOX 401 Latitude/longitude source:❑GPS❑Topographic map
-
(StreetorRouteNo.) (check box)
FLAT ROCK NC 28731 DEPTH DRILLING LOG '
City or Town suite Zip Code From TO Formation Description A
8( 28 )- 779-2221
Area code-Phone number T>
K
4. DATE DRILLED MARCH 3,2005 a
5. TOTAL DEPTH: 180
6. DOES WELL REPLACE EXISTING WELL? YES❑ NO El N
7. STATIC WATER LEVEL Below Top of Casing: 20 FT. o `'
(Use"+-if Above Top of Casing) LA
8. TOP OF CASING IS 1.33 FT.Above Land Surface;
*Top of casing terminated at/or below land surface requires a
variance in accordance with ISA NCAC 2C.011#.
9. YIELD(gpm): 20 METHOD OF TEST TIMED
10.WATER ZONES(depth):
LOCATION SKETCH
11. DISINFECTION:Type By PUMP INSTALLER Amount Show direction and distance in miles from at least
12. CASING: Wall Thickness two State Roads or County Roads.Include the road
Depth Diameter or Weight/Ft. Material numbers and common road names.
From 0 To 82 Ft. 6 114 .185 STEEL /ern
From To Ft
TO
From
13. GROUT: Depth Ft.
Material Method � aF,�iv
From 0 To 20 Ft. CONCRETE POURED SIX / t n^ , ,
.u-
From TO FL //pp GV t.�ttram
14. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in.
From To Ft. in. in.
15. SAND/GRAVEL :
Depth
D Size Material
From TO Ft.
From To Ft.
16. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 1 SA 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 GO _-
27699-1636 Phone No.[phone],within 30 days. GW-I REV..07/20K,
CD

I A&F WELLD"'LL'NG
LDRILLING ` _�
310 0 01AND PUMP SERVICE,INC.
Mann CsfoLw-C. of Emtwo"614 and N.Rwo R.wu,6,.Omsmm or wow ousW.amundwam SKgon 911 Hwy.Business 74
ISM MIA tle 4m�RWifb,N.C.2?6MIM-Flme(fill 783-=l Bostic, 1C 28018
828-2.7 1773
WELL CONSTRUCTION RECORD WELL CONTRACTOR: _� 'FF
WELL CONTRACTOR CERTIFICATION f:_. o �
STATE WELL CONSTRUCTION PERMITS:
1. WELL USE pack Apot*W soy:RealdeMilS 19f Municipal[) tndustrld[] AW"urel MOnOodn 0
AwavwyLj Heat Pump Waist Ir4awn❑ OSIer(, It OSMt,Uri Ws:
2- WELL LOCATION.(Show//ekelCtl oI Y1e below)
NgreNTawc �f.4'flF.+ s;,y. !J• //� ;,,,,y fn,'!/c ✓t5->.{J IJi %/.vim
OWN
ER
NssW dNunaws. ..a.ed.IaW+awLaaoj DRILLING LOG - DEPTH
$- OWNEi1 Fow To Fomaan owsc* cn
Addnae
C 1
avorTam al.r
DovuiO
4. GATE DEPTH
O. TOTAL dEPTH
s. cvrrm3 coLLECTED YES NO[�
7. OQEs WELL REPLACE EXISTING WELLA YES p NOEE(
s. STATIC WATER LEVEL Oelaw TOP OI Cnknl. FT. a
s. TOP OF GASWfIV 19 'b I FT.Above Lind Surteca' o
'f.F.I.•MM lannkMd WOr Mlew loafsurwof-t . rari.nw er«aw-
donu*MI"A NCAC ao A" `--"'—""'--
m Ytow(opn . 2�=METNOD OF nsl i r
11.WATERZONES{d@PV4 ,'+ ZS - —
12. CHLORINATION. Type P,_c;I ;c t1` AnaaM uaaditow$PONYnmw use bsek91Ivm
13.CASING: J
wrtMdmsa I OCATIQNS!(EjCI; ( �
ownew ortVMpIWFL AM MAW wocoan aid d�Nanof bag I'm SIFIs �
FMn�_—TTpO��FR J.01/4" ...� S.C� Roeds.gr antP�tatwo"POO! ��
F94M TO FL,
From To_ FL �P
T,- , , ' M
Fear To.:_:.�FL �� I>��CUCC.I-
Fran TO FL c
1S. SCREEN. `�
Depth owml r swt Sias Metsdfl 5 r/
From To - Ft.._.^. In. _ K
From To FL_ IIL —in
Prom To F1._,. in. —In. "
16. SANMF$AVEL PACK: h
Depth Slss Maio"
Flom To PL_.
Ftfm To FL� .- --
17. REMARKS: -
100HIEREOY CERTIFY
THAT
Ties
WEU.WAS CONSTRUCTEDINJICCOROWiC6VAMiSA 11CACtC.Y/ELL
cONSTRuMM STANDARDS.ANO THAT ACOPY OF HtiS OEM pIKM EO 10IK♦j%LL OANEP_
FOR OFFICE USE ONLY -- Doll
11sofNa $*N UMOFFERWHCONSTRUCIMd1NEWf
>ItliF4mor tis0MAwletww ou .omu+awraiora+wRhh79Csys LettAv.I.n
saw Ik �

WELL CONSTRUCTION RECORD
North Carolina-Department of Environment and Natural Resources-Division of Water Quality-Groundwater Section
WELL CONTRACTOR(INDIVIDUAL)NAME (print)KENNETH MCCRARY CERTIFICATION it 2008
WELL CONTRACTOR COMPANY NAME BARKER CONSTRUCTION,INC./BARKER WELL&PUMP PHONE # [phone]
STATE WELL CONSTRUCTION PERMIT# 1871 ASSOCIATED WQ PERMIT#
(if applicable) (if applicable) _
I. WELL USE(Check Applicable Box):Residential® Municipal/Public❑ Industrial❑ Agricultural❑
Monitoring❑ Recovery ❑ Heat Pump Water Injection❑ Other❑ If Other,List Use -
'i
zs
2. WELL LOCATION: Topographic/Land setting
Nearest Town: HENDERSONVILLE County HENDERSON ®Ridge ❑Slope ❑Valley ❑Flat -
LAMPLIGHTER,ESTATES,LOT#2 (check appropriate box)
(Street Name,Numbers,Continently,Subdivision,Lot No.,Zip Cade) Latitude/longitude Of well location
3. OWNER: TODD GOSNELL (degrces/minutestseconds)
Address 140 TABOR ROAD EXT. LatitudeAongitude source:❑GPS❑Topographic map
(Street or Route No.) (check box)
FLAT ROCK NC 28731 DEPTH DRILLING LOG
City or Town State Zip code From TO Formation Description
8( 28 )- 696-2500
Area code-Phone number
4. DATE DRILLED JANUARY 28,2005
5. TOTAL DEPTH: 780 n
6. DOES WELL REPLACE EXISTING WELL? YES❑ NO ® O
7. STATIC WATER LEVEL Below Top of Casing: 60 FT. _
(Use"+"if Above Top of Casing)
�il
8. TOP OF CASING IS 1.33 FT.Above Land Surface*
'Top of casing terminated atfor below land surface requires a
variance in accordance with 15A NCAC 2C.011&
9. YIELD(gpm): h METHOD OF TEST TIMED pt ;•'
10.WATER ZONES(depth):
LOCATION SKETCH
11. DISINFECTION:Type BY PUMP INSTALLER Amount Show direction and distance in miles from at least
12. CASING: Wall Thickness two State Roads or County Roads.Include the road
Depth Diameter or Weight/Ft. Material numbers and common road names.
From 0 To 53 Ft. 6118 SDR21 PVC 6-4�XaX r f�A-��
From To Ft. �76 ✓i2 ( ( �{�,[-�/..l�Gt.
From TO Ft.
13. GROUT: Depth Material Method
From 0 To 20 Ft. CONCRETE POURED
From To Ft.
14. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in.
From To Ft. in, in.
15. SAND/GRAVEL PACK: ( � �L -
Depth Size Material
From To Ft.
From To Ft.
16. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C,WELL
CONSTRUCTION STANDARDS,AND AT A COPY OF TTRS 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

3 � 8581
WELL CONSTRUCTION RECORD
North Carolina-Department of Environment and Natural Resources-Division of Water Quality-Groundwater Section
WELL CONTRACTOR(INDIVIDUAL)NAME (print)RICHARD MCCRARY CERTIFICATION#2010
WELL CONTRACTOR COMPANY NAME BARKER CONSTRUCTION,INC./BARKER WELL&PUMP PRONE # [phone]
STATE WELL CONSTRUCTION PERMIT# 1871 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 .s
2. WELL LOCATION: Topographic/Land setting - l
Nearest Town: HENDERSONVILLE Cowty HENDERSON ®Ridge ❑Slope [ Valley ❑Flat
OLD DISTILLERY ESTATES,LOTS 2&3 (check appropriate box) - --
(Street Name,Numbers,Community,Subdivision,Lot No.,Zip Code) LatitudeAongitude of well location
3. OWNER GARY AND MARY BURRELL (degrws/minutes/seconds) -
Address 1522 GREENVILLE HIGHWAY Latitude/longitude source:❑GPS❑Topographic map
(Street or Route No.) (check box)
HENDERSONVILLE NC 28739 DEPTH DRILLING LOG --
City or Town State zip Code From To Formation Description
( 828)- 692-0819
Area code-Phone number
4. DATE DRILLED FEBRUARY 2,2005 „
5. TOTAL DEPTH: 905
G'!
6. DOES WELL REPLACE EXISTING WELL? YES❑ NO KI
7. STATIC WATER LEVEL Below Top of Casing: UNKNOWN FT, _ 1
(Use"+^if Above Top of Casing)
8. TOP OF CASING IS 1.33 FT.Above Land Surface"
-Top or casing terminated at/or below land surface require;a N
variance in accordeacc with 15A NCAC 2C.0118.
9. YIELD(gpm): 2% METHOD OF TEST TIMED O
10.WATER ZONES(depth):
LOCATION SKETCH
It. DISINFECTION:Type nv PUMP INSTALLER Amount Show direction and distance in miles from at least
12. CASING: Wall Thickness two State Roads or County Roads.Include the road
From 0 � t Ft. Diameter or WReiight/Ft. Material numbers and common road names.
�J
From To Ft n/ as�e� e1LGw L—�
From To Ft. YV
13. GROUT: Depth Material Method "� A�J�� pp � ��"" ��
From 0 To 20 Ft. CONCRETE POURED �p OlOac[-L �,1L� - k,&-
From To FL ,,,,llll�.... L �OQ.d. �'/.(,Lt/YL L ) 0 k v
14. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in. � � ieccGi�JyC-I!r
From To Ft. in. in. / /InG6%` U •Za �n v
15. SAND/GRAVEL PACK: �Y
Depth Size Material
Front—To Ft.
From To Ft.
16. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NC 2C, L
CONSTRUCTION STANDARDS,AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO HE LLO1(2JER
I6NATURE OF PERSON CONS CTING THE WELL ATE
Submit the original to the Division of Water Quality,Groundwater Section,1636 Mail Service Center-Raleigh,NC
27699-1636 Phone No.[phone],within 30 days. GW-I REV.07/200 t

308580
WELL CONSTRUCTION RECORD
North Carolina-Department of Environment and Natural Resources-Division of Water Quality-Groundwater Section
WELL CONTRACTOR(INDIVIDUAL)NAME (print)KENNETH MCCRARY CERTIFICATION#2008
WELL CONTRACTOR COMPANY NAME BARKER CONSTRUCTION,INC./BARKER WELL&PUMP ptIONE # [phone]
STATE WELL CONSTRUCTION PERMIT# 1871 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: Topoglaphic(Land setting -- `
Nearest Town:HENDERSONVILLE County HENDERSON ❑Ridge ❑Slope ❑Valley HlFkat -
RONALD LIVELY ROAD (check appropriate box) -
(Street Name,Numbers,Community,Subdivision,Lot No.,Zip Code) LatitudeAongitude of well location. .-
3. OWNER: BARBARA MEDFORD (degrees/minums/secoads)
Address PO BOX 568 Latitude/longitude source:❑GPS❑Topographic map
(Street or Rome No.) (check box)
HENDERSONVILLE NC 28793 DEPTH DRILLING LOG -
City or Tow❑ slate Zip Code From To Formation Description
( !28)- 692-7299
Area code-Phone number
4. DATE DRILLED FEBRUARY 4,2005
5. TOTAL DEPTH: 455
6. DOES WELL REPLACE EXISTING WELL? YES❑ NO
7. STATIC WATER LEVEL Below Top of Casing: 10 FT.
(Use"+"if Above Top of Casing)
8. TOP OF CASING IS 1.33 FF.Above Land Surface*
`Top of rasing terminated at/or below land surface requires a O �"
variance in accordance with 15A NCAC 2C.0118.
9. YIELD(gpm): 205' METHOD OF TEST TIMED
10.WATER ZONES(depth):
LOCATION SKETCH
11. DISINFECTION:Type_WY PUMP INSTALLER Amount Show direction and distance in miles from at least
12. CASING: Wall Thickness two State Roads or County Roads.Include the road
Depth Diameter or Weight/Ft. Material numbers and common road names.
From 0 To 74 Ft. 611/. .185 STEEL Jx6
From TO Ft �O��GaG,C2✓69Z_ ��-� QZ`'
From To Ft.
13. GROUT: Depth Material Method �L(.[t•L-r- /c[L7 iCLC, kCJ-D �
From 0 To 20 Ft. CONCRETE POURED
From To Ft. �/ n
14. SCREEN: Depth Diameter Slot Size Material �CQ�G( �i.rU r1,rt, /!0a�: .
From To Ft. in. ink- I/dlll,,,at
�n�
From To Ft. in. in LQLCa,/C/Z/,15. SAND/GRAVEL PACK: yt0
Depth Size Material
From To Ft.
From To Ft.
16. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH I SA NCAC 2C,WELL
CONSTRUCTION STANDARDS,AND THAT A COPY OF THIS RECORD BEEN PROVIDED TO THE WELL OWNER �v
L6-41nn. IMG� "L- / / - o
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
Submit the original to the Division of Water Quality,Groundwater Section,1636 Mail Service Center-Raleigh,NC
27699-1636 Phone No.[phone],within 30 days. GW-1 REV.072001

WELL CONSTRUCTION RECORD 3 0 S 5 7 9
North Carolina-Department of Environment and Natural Resources-Division of Water Quality-Groundwater Section
WELL CONTRACTOR(INDIVIDUAL)NAME (print)RICHARD MCCRARY CERTIFICATION#2010
WELL CONTRACTOR COMPANY NAME BARKER CONSTRUCTION,INC./BARKER WELL&PUMP PHONE # [phone]
STATE WELL CONSTRUCTION PERMIT# 1871 ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
I. WELL USE(Check Applicable Box):Residential ID Municipal/Public❑ Industrial❑ Agricultural❑ _
Monitoring❑ Recovery ❑ Heat Pump Water hijection❑ Other❑ If Other,List Use - -
2. WELL LOCATION: Topographic/Land setting _Nearest Town: HENDERSONVILLE County HENDERSON ❑Ridge ®Slope ❑Valley ❑Flat.,
SKY LAKE DRIVE (check appropriate box)
(Street Name,Numbers,Community,Subdivision,Lot No.,Zip Code) I-atitude/iongitude of well location
3. OWNER SWANSON CHILDRESS (degrees/minutes/sewnds)
Address 224 SKY LAKE DRIVE Latitudellongitude source:❑GPS❑Topographic map
(Street or Route No.) (check box)
HENDERSONVILLE NC 28791 DEPTH DRILLING LOG -
City m Town State Zip Code From To Formation Description
8( 28 )- 891-5839
Area code-Phone number
4. DATE DRILLED FEBRUARY 10,2005
5. TOTAL DEPTH: Ddled an additional 380' a
6. DOES WELL REPLACE EXISTING WELL? YES❑ NO IDr
7. STATIC WATER LEVEL Below Top of Casing: 50' FT. tV
(Use-+-if Above Top of Casing)
8. TOP OF CASING IS 1.33 FT.Above Land Surface* °
'Top of casing terminated at/or below land surface requires aLn ...yy
variance in accordance with 15A NCAC 2C.0118. !:3
9. YIELD(gpm): 3% METHOD OF TEST TIMED
10.WATER ZONES(depth):
LOCATION SKETCH
11. DISINFECTION:Type BY PUMP INSTALLER 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 Wet t/Ft. Material �numbers and common road names.
From To Ft. ,
From To Ft�i74;%J`
From To Ft.
13. GROUT: Depth Material Method J
From 0 To 20' Ft. CONCRETE POURED LAW— 2kQ Gr---
/74-r—
From TO Ft.
14. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in. 'ems' ��4
m
Fro To F[. in. in. ��
15. SAND/GRAVEL PACK:
Depth Size Material K�ttiLL
From To Ft.—
From—To Ft.
16, REMARKS: We went back in and drilled deeper(additional 380')making the well 505'total depth.
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2 WELL
CONSTRUCTION STANDARDS,AND THAT A COPY OF THIS RECOW HAS BEEN PROVIDED TO WELL�bWNER
L I S
SIGNATURE OFTFRSON CONSTRUCTWELL j 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

W
WELL CONSTRUCTION RECORD 3 09 5 5 9
North Carolina-Department of Environment and Natural Resources-Division of Water Quality-Groundwater Sections
WELL CONTRACTOR(INDIVIDUAL)NAME (print) -Efs trtlt11'r�-``� �ptT\ /s CERTIFICATION 042+ .1�
WELL CONTRACTOR COMPANY NAME`art ) ri - Wo-\` 4 {—L MA`� PHONE p (GY/s1� LoO3-1 a�
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
I. WELL USE(Check Applicable Box): Residential 21/Municipal/Public❑ Industrial ❑ Agriculhual❑
Monitoring❑ Recovery ❑ Heat Pump Water Injection❑ Other❑ If Other, List Use
2. WELL LOCATION: Topographic/Land setting
Nearest Town M i IzluP Cotmt S6� ❑Ridge ❑Slope ❑Valley B15llat
(7 (VtCDoluei fi�d en ,�1 atc �a y (check appropriate hot)
(Socc(Namc,Numbers,Community,Jubdivision,Lot No.,Zip Code) Latitudellongitude of well location
II,,,, ,(, 35°a5' oµnl 3S' I5W
3. OWNER:�aks ",��f7.l,yJ 50-Y) (dcgr=s/mmuk%/scwnds)
Address Latitude/longitude source:❑GPS❑Topographic map
f/� � ($ecclorRoumNo.1 (check box)
odl�n�1.X. �`6 1O4 DEPTH DRILLING LOG
city or iown $lam Zip Code From To Formation Description
Tsai l
Area code-Phone numb-
4. DATE DRILLED 'tlglt7�
5. TOTAL DEPTH: ya - —
6. DOES WELL REPLACE EXISTING WELL? YES ELNO Ot
7. STATIC WATER LEVEL Below Top of Casing: J FT.
(Usc"+^if Above Top of Casing)
8. TOP OF CASING IS I FT.Above Land Suface- n
'Top of casing terminated•llor below land surface requires a
variance in accordance with 15A NCAC 2C.011&
9. YIELD(gpm): 2,0 METHOD OF TEST Ac1f i
)0. WATER ZONES (depth): 00
LOCATION SKETCH O
11, DISINFECTION: Type 1-V' H Amount Show direction and distance in miles from Weasi -4 -
12. CASING: Wall Thickness two State Roads or County Roads. Include the road
Depth Di miter or Weight/Ft. MM l"atI a[ numbers and common road names.
From To�Ft. 4 276 pc
From 7y0 To 100 Ft. Z 7 i L 9 4-G
From t70 To 119 L Ft % -"-�( lid
13, GROUT: Depth Material Method
From D To :Z D Ft. Siirk2jolg M,'y 9`l'oe k C
From To Ft. E
14. SCREEN: Depth Diameter Slot Size Material iu
From To N.M. in.
From To Ft. in. in.
15, SAND/GRAVEL PACK:
Depth Sim Material
From To Ft—
From—To— Ft. 191
16. REMARKS: - —
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTR CTED IN ACCORDANCE WITH 15A NCAC 2C, WELL -
CONSTRUCTION STANDARD"D THAT A COPY OF S RECORD BEEN PROVIDED
77 bTO THE WELL OWNER
—____._ -/O�1_
SIGNAT OF PERSON CONSTRUCTING THE WELL DATE -
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center-Raleigh,-NC
27699-16.36 Phone No.[phone],within 30 days. GW-I REV.0712001

309 � 5 �
WELL CONSTRUCTION RECORD
North Carolina-Department of Environment and Natural Resources-Division of Water Quality-Groundwater Section
WELL CONTRACTOR(INDIVIDUAL)NAME (print) Brl t rl f11 l �" Y "-Th CO, Cel2TlFlcanoN x�t)
WELL CONTRACTOR COMPANY NAME Gc-f'n is-"LY WI� P��C PHONE x ($�')00-1 a9D
STATE WELL CONSTRUCTION PERMITx ASSOCIATED WQ PERMPPx ,-05-11961 n 1 L g
(if applicable) (if applicable)
1. WELL USE(Check Applicable Box): Residential 13'�Municipal/Public❑ Industrial❑ Agricultural❑
Monitoring❑ Recovery ❑ Heat Pump Water Injection❑ Other❑ If Other,List Use
2. WELL LOCATION: Topographic/Land setting
Nearest Town: '0-�1.- County C�-l'4Sdn ❑Ridge fs75(ope ❑Valley ❑Flat
('i �q h K C.L.` (check appropriate boot)
(Street Name,Nu ,Community,Subdivision,tot No.,Zip Code) La[itlldeQongi[_uds of wel�locat on
3; oyz ac 1rw
3. OWNER: IkU t '' 'Jw IbtL_l(J (dcgms/minutes/secoads)
Address ?c�1C $41 Latitudetlongitude source:M(5f SOTopographic map
(Sheet or Route Na.) (check box)
�[�( h ) C 5 N 5 DEPTH DRILLING LOG
city state Zip Code From To Forman D seription
Area cod.-Phone,nuunbe _ 70 5
t 4. DATE DRILLED '-f`7- OS --
5. TOTAL DEPTH: 'f j
6. DOES WELL REPLACE EXISTING WELL? YES O NO
7. STATIC WATER LEVEL Below Top of Casing:_(,OFT. R
(Use"+"if Above Top of Casing)
8. TOP OF CASING IS FT.Above Land Surface'
sTop of easing terminated at/or below land surface requires a
variance in aco rdan.with 15A NCAC 2C.0118.
9. YIELD(gpm): METHOD OF TEST A'fZ
10.WATER ZONES(depth): Z 1
LOCATION SKETCH
I L DISINFECTION: Type H r - Amount Show direction and distance in miles from least i
12. CASING: Wall Thickness two State Roads or Cotmty Roads. Include e road
Depth D't�eter or WeighNFt. to tat numbers and common road names.
From ToL.0-Ft. 7 G v G
From /00 Ft. ------
From To Ft.
13, GROUT: Depth Material Method
From O To Ft. .5.iAli=zY"
From To Ft.
14. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in. --�-"-` �7
151✓/=w �r1 .
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Sim Material �� •yl-�
From To Ft.
From To Ft.
16. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUF.TED IN ACCORDANCE WITH 15A NCAC 2C,WELL .Y.a
CONSTRUCTION STANDARDS D THAT A COPY OFT S RECO HAS BEEN PROVIDED TO THE WELL OWNER 77,
SIGNAlifJRF PERSON CONSTRUCTING THE WELL DATE a„
Submit the original to the Division of Water Quality,Groundwater Section,1636 Mail Service Center-Ralelgh,NC
27699-1636 Phone No.[phone],within 30 days. GW-I REV.07/2001,

l.� 34g555
WELL CONSTRUCTION RECORD
North Carolina-Department of Environment and Natural Resources-Division of Water Quality -Groundwater Section
WELL CONTRACTOR(INDMDUAL)NAME (prior) hrl I ti, 'F7 "ii\ CERTIFICATION NJtI
WELL CONTRACTOR COMPANY NAME GCeLn f�,t Lpr y� k '�? r MA PHONE R BeM I&3-121
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT# �Z#OhrIDO�020&
(if applimble)NINE
(if applicable)
1. WELL USE(Check Applicable Box):Residential C3'Municipal/Public❑ Industrial❑ Agricultural❑
Monitoring❑ Recovery ❑ Heat Pump Water Injection❑ Other❑ If Other,List Use
2. WELL LOCATION:
p Topographic/Land setting
Nearest'^�T„ow�n: V .1c C1V County 1.CUvson DRidge ❑Slope F3'Qalley ❑Flat
'0 Z Yet A ry tc i Z V I C �.. al lJ o�K'��n (check appropriate box) .
(Street Name,Numbers,Cummuniry,Subdivision,lot No.,Zip Code) alitude/lon [ude of well location
S tip 3IV O�Z ag1 430
3. OWNER: r DVI/i 45 P�S"I I�VNR.K'�( (degrees/m;nmes/seconds)
Address JUJ. 'v -LeL25 LatitudeAongitude source:9GPSOTopographic map
(Street or Route No.) (check box)
�C C I k ) r 6 C�?) DEPTH DRILLING LOG
(�Cary oy Tp�L Slot Zip Code From To Fymtifm Description
=(d-i (SRfi u)'ti•'.
Area code-Phone number _
4. DATE DRILLED ,2
5. TOTAL DEPTH: 'Y y
6. DOES WELL REPLACE EXISTING WELL? YES❑ NO ❑
7. STATIC WATER LEVEL Below Top of Casing: /7 r FT.
(Use"*"if Above Top of Casing)
8. TOP OF CASING IS / FT.Above Land Surface'
`Top of casing terminated allor below land surface requires a -
variance in accordance with 15A NCAC 2C.0110.
9. YIELD(gpm): J- METtIOD/� OF TEST Z�,iZ p
10.WATER ZONES(depth):
LOCATION SKETCH un
11. DISINFECTION:Type Amount Show direction and distance in miles from at I!!gst r
12. CASING: Wall Thickness two State Roads or County Roads.Include th wd
,/
Depth Diameter or Weight/Ft. Material numbers and common road names.
From 46! fo
From Ft. '
To Ft.
m _
Fro To Ft. 7i 5
13. GROUT: Depth Material Method
From_ To 7 e( Ft. 'Izki? fr Qom?
From To Ft.
14. SCREEN: Depth Diameter Slot Size Material
From To Ft. in, in, g,
From To Ft m. in.
15. SAND/GRAVEL PACK:
Depth Size Material
3l
From To Ft. RO.GS l..lZElckRd
From To Ft. x' •
x
16. REMARKS: 1AJ :ir
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C,WELL
CONSTRUCTION STANDARDS,AND THAT AOPY. OF JTHIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
/ �1Z!4 I� / 2 -A z -OS-
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],wjtbin 30 days. GW-I REV.07/2001

309554
WELL CONSTRUCTION RECORD
North Carolina -Department of Environment and Natural Resartccees_-Division of Water Quality-Groundwater Section
�7--t
WELL CONTRACTOR(INDIVIDUAL)NAME (print),�rt�nn11���",,���" Tt ' CERTIFICATION pgL
WELL CONTRACTOR COMPANY NAME x..A(•yT��s\Jef- tlly.,\` �—�'!�t�."--PHONE R fSe1411�3-I atSr
STATE WELL CONSTRUCTION PERM1Tp ASSOCIATED WQ PERMITk
(if appl'cable) (if applicable)
1. WELL USE(Check Applicable Box):Residential Cr�Mu r&ipal/Public O Industrial❑ Agricultural❑
Monitoring❑ Recovery ❑ Heat Pump Water Injection❑ Other O If Other,List Use —
2. WELL LOCATION: Topographic/Land stating
Nearest T�ow^n:- 2' a CountyCU SUYI Cadge ❑Slope OValley ❑Flat
)�1 ai' (l,(L. 1 (check appropriate box)
(Street Name,Numbers-Community,Subdivision,Lot No.,Zip Code) La[ityde/longitude of well loe�tion
r .3>`z' o 31 A) o9 ' 371
. 3. OWNER: PC'_ X ra eiJ Sk"on Lam (degxs/mirmtes/seconds)
Address O a oX 2�6 Latitude/longitude source:RePSOTopographic map
(Street or Route o. (check box)
G / O DEPTH DRILLING LOG
City or Town State Zip Code From To Fo tion Description
(�- �94 `fyg0 U — Sr0
Ate.code-Phone numba y — e+ 3 _ w r
4. DATE DRILLED
5. TOTAL DEPTH:
6. DOES WELL REPLACE EXISTING WELL? YES❑ NO 13'
7. STATIC WATER LEVEL Below Top of Casing: C O' FT. 0
(Use"+^if Above Top of Casing) '
8. TOP OF CASING IS FT.Above Land Surface" -p
'Top of easing terminated at/or below land surface requires a
varlanee in accordance with 15A NCAC 2C.0119. .I
9. YIELD(gpm):_� METHO_D OF TEST Ili R �--
10.WATER ZONES(depth): A 41 2 �1 ," �
5-- /corn LOCATION SKETCH t,j1
11. DISINFECTION:Type /-f T/'f 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. a anal numbers and common road names.
From To -- FL L _ t�������'�G
From_,f To_�_.Ft. 21 L [--sL
From To Ft.
13. GROUT: Depth Material u/ Method,
From d To� 7 Ft. 5 .z !s'li Z
From To Ft.
14. SCREEN: Depth Diameter Slat Size Material
From To Ft. in. in `C
From To Ft. in. in. .®
15. SAND/GRAVEL PACK: �`*VM ({Ul/
Depth Size Material
From_To—Ft.
From To Ft.
16. REMARKS:
[ DO HEREBY CERTIFY THAT THIS WELL WAS CON RUCTED IN ACCORDANCE WITH 15A NCAC 2C,WELL _
CONSTRUCTION STANDARIA AND THAT A COPY 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 _

ou 309552
WELL CONSTRUCTION RECORD
North Carolina-Department of Environment and Natural Resources-Divisioy of Water Quality-Groundwater Section
WELL CONTRACTOR(INDIVIDUAL)NAME (print) t2 vfJ-W t sm fh CERTIFIC�¢ATION/N���
WELL CONTRACTOR COMPANY NAME G+ C C`V1 K (I("La �)21 � '0A(ti PHONE # 6� 1O 5 /�'200
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PEANUT#(Jr a r"aal oa.7D
(if applicable) (if applicable) SON
1. WELL USE(Check Applicable Box):Residential Municipal/Public❑ Industrial❑ Agricultural❑
Monitoring❑ Recovery ❑ Heat Pump Water Injection❑ Other❑ If Other,List Use
2. WELL LOCATI9N Topographic/Land setting
Nearest TownI:^N UCOCIO County (Af' Sdri []Ridge lope Malley ❑Flat
LO f 121 I-�.0 I f kl rb TuE.,�dn (check appropriate box)
(Street Name,Numbers,Community,Subdivision,Lot No.,tip Code) La,ude/lotlgltpae of well location
3. OWNER:C aka S( 5-t t (w..�dse (degrees/rates�Fctrnds)
Address h I Y, [;— Vo Latitudellongitude source:BGPSOTopographic map
(Street or RouteNo.) (check box)
S-L))o U DEPTH DRILLING LOG
rry or Toev state tip Code Fort To Formation Description
Area code-Phone number
4. DATE DRILLED
5. TOTAL DEPTH:
6. DOES WELL REPLACE EXISTING WELL? YES O !N-O III
7. STATIC WATER LEVEL Below Top of Casing: / G S- FT.
(Use"+"if Above Top of Casing)
8. TOP OF CASING IS FT.Above Land Surface*
'Top of"sing terminated atlor below land surface requires a
variance in accordance with 15A NCAC 2C.0115.
9. YIELD(gpm):aD METHOD OF TEST
10.WATER ZONES(depth):
LOCATION SKETCH t
11. DISINFECTION:Type Gr7r T/1i Amount Show direction and distance in miles from ki..
12. CASING: Wall Thickness two State Roads or County Roads.Include bDmadr-
Depth !!�� Dia�eter or Weight/Ft. Material numbers and common road names.
From To Ft.er 7 L ✓G `*
From­'� �To 10V Ft. Lz 1. L
From To Ft.
13. GROUT: Depth Material Method
From--V To ;J 0 Ft. Slfll17
From To Ft.
14. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in.
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.—
From—To—Ft.
HG)y A
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 RECOJP HAS BEEN PROVIDED TO THE WELL OWNER
8zz t
SIGNATURE OF PEFKON CONSTRUCTING THE WELL DATE
Submit the original to the Division of Water Quality,Groundwater Section,1636 Mail Service Center-Raleigh,-INC ---
27699-1636 Phone No.[phone],within 30 days. GW-I REV.01/2001

WELL CONS'I'RIICTION RECORD_ `
J
Water tT+>liry
North Carolin ro an
a • De aranc nt of Envirurlmt d f ROfO et�� /t�lr • OrAv t e OeOd�"WLLL CONTRACTOR fiwMD U AL)NAML (prl.0 \AI II P4 (t'1O Ct1 —PNONL.a _ �p• �'
WELL CONTRACTOR COMPANY NAMLY ASSOCIATLD WQ PERMITS ) ' r �.
it-
STATZ WELL CONSTRl1 Cr10N PERM1Ta (j(eppllubl e) L µme'
4
1. WELL USE(Check Applicable Box): Residential Cd�Must eipal/Pyblie ❑ Industrial O� Agricultural p �t
Heat Pump Water Injection❑�lher O l(Other, List Use.
Monito ng ❑ Recovery ❑ "
Too hse/I.Aod setting..
2. WELL LOCATION P !'>�P
Neare t Town: `r v t i-e County ",S nt- ORidge n OVa11ey ❑Flat
q 5 �QX A 1 S e S Ail r vSvn U U ie f��a is�TL (eb«k Appropriate cox)
Uti dcAongitutl�oW le, tbon W7 `
(Sereel Neme.Numben.Cemm n
un,ry,Subd, not.Lot Ne.DZrp Cede) PTO � y i
�I Ir 3. OWNER:SDr I 'n�r.i/4li2tAaQ �.-, w �-/d- (depeed/mYieute�lueond). i.e
Addess LatitvddlongiNdecown:p(pSOTo o P t1n
P, ;•
k box)
(s:r ,o'Ro .No.) (ch«
x m DRiLLfNG LOG '- -'
^•1( lam F DEPTH
L 3d 5 70
Chy Taw+ Sul. Zip Code Froln _ ToFo nDesm
e
Area eodo-Pbont number
N 4. DATE DRILLED � '�) ��5 — lIf
5. TOTAL DEPT1j:--2_2 J
6. DOES WELL REPLACE EXISTING WELL? YES O NO 13' 1.35— 22
7. STATIC WATER LEVEL Below Top ofCasing: . LO, FT. `-•+ :-
(Us."-"if About Top of CuIns)
C1 .,e cam:
8. TOP OF CASING IS FT.Above Land Surfaces 9 _
'Top ortulna ltrmineted Wor below laod tarfate requires a '0
rartanteln utord,nee with ISA NCAC 1C.0I18. - !
9. YIELD(gpm):_40_METHOD OF TEST /li/7 t!1
10. WATER ZONES (depth):
P t.OGATION SKETCi� t
I t. DISINFECTION: Type li 7711 Amount Show direction and distance in miles from mist .. 1
r 12. CASING: Will Thickness State Roads or Cowry Roads.Inilitda ad. '� ,
Depth Di at or Weight/Ft, a nil numbers and common road names. §ti
• From / To Ft.
From Ltl To Ft. C (✓ �,-
From To Ft. I "
13. GROUT:: DepLh • • MM t Metho �rt'
F.ronL_,Q_Tom Ft. .
From To FI.
14. SCREEN: Depth Diameter Slot Size Materiel V
From_ To Ft. in. _ in. a
From To Ft. in. _ in. f n''
15. SAND/GRAVEL PACK: nR r5�
Depth Size MIUriil „?s
From � To Ft.
.From To Ft. 'c
' K fr.
16. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTS ACCOILDANCE WITH ISA NCAC 2Ce 1ttEIL
CONSiRUCFION STANDARDS. THAT ACOPYOFTHIS OPM B EN PROVIDED TO THE WELL OWNER
•_ If — C75
SIGNA OF PERSON,CONSTRUCITNOTHE WECL DAM -.
StbissIt the original to the Division of Water Quallilty.Croeindwater Section,16361"10 Ser-vice cenfet-RatelItIlls NC'
v 5769¢16s6?hone No.[phone],within 30 days. OW'i Rom'07l2�1
,. kii I 1 ) w Fe
a.
t .

bow 309550
WELL CONSTRUCTION RECORD
North Carolina-Department of Environment and Natural Resources- Division of Water Quality -Groundwater Section
WELL CONTRACTOR(INDIVIDUAL)NAME (print) 'Erl icink,- c]M�sr� ///sst CERTIFICATION#c0j
G i �
WELL CONTRACTOR COMPANY NAME Ctfr� %UCf' WQ_\, `(PLlrn$k C,0 PHONE M Bs7Y11�3-IaCO
STATE WELL CONSTRUCTION PERMITN ASSOCIATED WQ PERNITTk C 5 Ir1 N 0V65O
(ifapplicable) / (ifapplicable)
I. WELL USE(Check Applicable Box): Residential 9 Mtaticipal/Public❑ Industrial❑ Agricultural❑
Monitoring❑ Recovery ❑ Heat Pump Water Injection❑ Other❑ If Other, List Use
2. WELL LOCATION: ` _ Topographic/Land setting
�Nearest Town:�t V1 t1�421 County �=6l ❑Ridge O31ope ❑Valley ❑Flat
(check ePPropri to box)
(Soeei Name.Numboss,Comrnuniry,gubiivision,Lot No-Zip Codc) Latitude/longitude of well location
!, 03_;` ar' �514 DSz° =�Ct rick;
(J 3. OWNER: U R ,,It JX0,2ITf", j (degrees/minutes/seconds)
Address i 4`6 h O'tevYa i f• LatitudeAongitude source:POPS❑Topographic map
(Soeet or Route No.) (check box)
5 t4 tit) e 1 ; C �K l.� DEPTH DRILLING LOG
city car Town stem Zip Code From To Fo tiara cMption
6 J`t4 - ? n3� p - /D IM l�F
Area code-Phone number _ 16 ;
4_ DATE DRILLED 9 `40S
5. TOTAL DEPTH: 144 j'
6. DOES WELL REPLACE EXISTING WELL? YES❑ NO B-- [7Rar{
7. STATIC WATER LEVEL Below Top of Casing: 3 D , FT.
(Use"+"if Above Top or Casing)
8. TOP OF CASING IS l FT. Above Land Surface-
'Top of casing terminated at/or below Land surfs"require,a
variance in accordance with 15A NCAC 2C.0118.
9. YIELD(gpm): _6 METHOD OF TEST
10, WATER ZONES(depth):
LOCATION SKETCH Uf
11, DISINFECTION: Type Amount Show direction and distance in miles from at lea�
12, CASING: Wall Thickness two State Roads or County Roads. Include the"I
Depth Dia eter or Weight/Ft. Material numbers and common road names.
From To_!,
Ft. G 37/ PYC.
From-3-0—To J 0 Ft. L ,pyL
From To FL_ — �. ft r R J,
13. GROUT: Depth Material Method J
From_ Tom Ft. Sffki?,;J& QOj?
From To Ft.
14. SCREEN: Depth Diameter Slot Size Material a
From To FL in. in. 1
From To Ft in. in.
15. SAND/GRAVEL PACK: 9
Depth Size Material �'
From To Ft.-
From—To—Ft. /
�I
16. REMARKS: �(
1 DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS,AND THAT�A�C�OPY OF THIS CORD HAS BEEN PROVIDED TO THE WELL OWNER
SIGNATU F PERSON CONSTRUCTING THE WELL DATE
Submit the original to the Division of Water Quality,Groundwater Section,1636 Mail Service Center-Raleigh,:NC '•'-
27699-1636 Phone No.[phone],wjthin 30 days. GW-1 REV.:07/2001 -_
- c7

P4 309549
WELL CONSTRUCTION RECORD
North Carolina -Department of Environment and Natural Resources-Division of Water Quality-Groundwater Section
WELL CONTRACTOR(INDWIDUAL)NAME (print)�t�rMo pi 1p�-l�t_]fYts i-T\ CERTIFICATION apt t I
WELL CONTRACTOR COMPANY NAME GCtfrl f��tlXf' W¢..1� rA PHONE N ($ I/^t013'I am
STATE WELL CONSTRUCTION PERMITa ASSOCIATED WQ PERMITM DO
_ (ifapplicablc) (ifapplicable)
L WELL USE(Check Applicable Box): Residential 0/Mmilcipal/Public❑ Industrial ❑ Agricultural❑
Monitoring❑ Recovery ❑ Heat Pump Water Injection❑ Other❑ If Other,List Use
2, WELL LOCATION: Topographic/L�andd etting
Nearest Town:t. '` 1 Count1y �v5dr) _ ❑Ridge ❑Slope L�'Valley ❑Flat
�'6 `( (�(A V i \ _ �t��I� f (check appropriate box)
(Street Name,No,mbcrs,Community.Subdivision, (No..Zip Code) Lat tude/longltud0 f well locations
3- OWNER: s� (:WAijlftkKv LLB 3r��"' :,t3' hP onds) /9 38w
r�, l� (dcgas/minuies/seconds)
Address es ()_(_jPQ' :Or. LatitudcAongitude source:1!1 PS❑Topographic map
(Strcct or Routs No.) y (check box)
o. �4 ( ..{"n \t \ DEPTH DRILLING LOG
City or Town Slats Zip Code FrorJl To Formatipn ,e caption
izd ` vt
Area code-Phone numbs —D_ .[7't�-- rt
4. DATE DRILLED/8 -O S" q0 GQ
5. TOTAL DEPTH: 3 5 r
ej
6. DOES WELL REPLACE EXISTING WELL? YES❑ NO R� L
7. STATIC WATER LEVEL Below Top of Casing:J-0 FT. �
(Use"+"if Above Top of Casing)
8. TOP OF CASING IS_�_FT.Above Land Surface' .
'Top of easing terminated at/or below land surfs"requires a — -^>—
"osancein aecord ea with ISA NCAC 2C.011& ^' a
9. YIELD(gpm): MEYiO OF TEST.\c r rr
10. WATER ZONES (depth):
LOCATION SKETCH
1 I. DISINFECTION: Type Amount Show direction and distance in miles from at le
12. CASING: Wall Thickness two State Roads or County Roads.Include the r
Depth Di eter or Weight/Ft. n aleal numbers and common road names.
From To�Ft.D _. ✓G
To f{ry
From -0— Ft. 2/, L /wL From To Ft.
13. GROUT: Depth Material Method
From__,L To .2,0 Ft. 5Q/S/?0r.E
From To Ft.
14. SCREEN: Depth Diameter Slot Size Material �
From To FLin. in. 3
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft. a
L1
16. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C,WELL
CONSTRUCTION STANDARDS,AND THAT A COP OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER 1—
GNATUR IN E OF PERSON CONSTRUCTG 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],wjthin 30 days. GW-I REV:-07/200V
C
E'.

v_ 309548
WELL CONSTRUCTION RECORD
North Carolina-Department of Environment and Natural Resources-Division of Water Quality -Groundwater Section
WELL CONTRACTOR(INDMDUAL)NAME (prim) 'A-h CERTIFICATION pMM I
(1 Tl r �'1� \`
WELL CONTRACTOR COMPANY NAME`�C �n r��t Yr" y�U-� 1 uMe Cn PHONE p (%FYI l&3'IaOD
i MI
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERT# (.iJ = 7�J95_
(if applicable) (if applicable) 0�0
I. WELL USE(Check Applicable Box): Residential2r Municipal/Public ❑ Industrial ❑ Agricultural❑
Monitoring❑ Recovery ❑ Heat Pump Water Injection❑ Other❑ If Other,List Use
2. WELL LOCATION: Topographic/Land setting
Nearest Town At d_"SfJy'lU)lI,- Coun[ 1"`_`n
❑Ridge 0-51ope ❑Valley ❑Flat
O�-f:- SMCV U 's (check appropriate box)
(Sleet Name.Numbers,Community,Subdivision,Lot No.,Zip Code) Latitudellongitude of well location
^^ 83 lf' SIN C 8z� 33'
T
3. OWNER: Or'i-) C LN i Y1Tr (degees/minutes/seconds)
-� Address • Latitude/longitude source:C36PSOTopographic map
(Socct or outs,No.) (check box)
�...,i (� 4�t�vl-� LI�'er 'a�S�I3s DEPTH DRILLING LOG
city or Town slam Zip code From To Formation scription
xzs)_ dsx — 1 co r3 — /o Rod IIAV
Arcs,cads,-Phone number /0 _ C o
4. DATE DRILLED �1 �-'3 D -05 Cr0 - /00
` wF
5. TOTAL DEPTH: 4 s I /cc, ._ //0 /
6. DOES WELL REPLACE EXISTING WELL? YES O,.NP �
7. STATIC WATER LEVEL Below Top of Casing:�Fr.
r
(Use"."if Above rap of Casing)
8. TOP OF CASING IS I FT. Above Land Surface-
'Top of raring terminated it/or below land surfs"requires a •-- —
variance in acrnrdanrx with ISA NCAC 2C.011& I
9. YIELD(gpm): 'i' MET�IQD9F Ty�ST / r
10. WATER ZONES (depth): ! 5 L .?7
Y 00 LOCATION SKETCH
] I. DISINFECTION:Type H I-mount Show direction and distance in miles from at least
12. CASING: Wall Thickness two State Roads or County Roads. Include the road
Depth D rt�eter or Wei ht/FL tdial numbej
n road ames.
From 40 Tom Ft.V � P4,r-
From�T,_L! 0 " :2/TL UL (y,
From To Ft.
13. GROUT: Depth Ma cnaI MethodV
From To�c7 Ft. S yy . U
From To Ft.
14. SCREEN: Depth Diameter Slot Size Material ✓ OJ r
From To FL in. in. 4From To FLin. in.
15, SAND/GRAVEL PACK:
Depth Sir Material
From / To / 35 Ft. 21" / [��' c✓tY/l�A k, j�
From To Ft. gA���A y� �(j
16. REMARKS: f /`(►•
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTR TED IN ACCORDANCE WITH 15A NCAC 2C,WELL
CONSTRUCTION STANDARDS,AND THAT A COPY OF S RE RD HAS BEEN PROVIDED TO THE WELL OWNER
31 __--
SIGNA RE OF PERSON CONSTRUCTING THE WELL DATE
Submi[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.07/2061'C7} -
_
r_.
-i-

3114 � 2
WELL CONSTRUCTION RECORD
North Carolina-Department of Environment and N / Resources_�vigion of�Water Quality-Groundwater Section
WELL CONTRACTOR(INDIVIDUAL)NAME (print / �L/dI�J L� 6-Qey'o. 11he CERTMCATION
WELL CONTRACTOR COMPANY NAME _LkL fo'�UJ ,'/ Ia1 N�� I7/^s�/�/ /p�PHONE # �-C230'
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
if licable ifapplicable)
1. WELL USE(Check Applicable Box):Residential Municipal Tublic❑ Industrial❑ Agricultural❑
Monitoring❑ Recovery ❑ Heat Pump Water Injection❑ Other❑ If Other,List Use
2. WELL LOCA / /
4� County P/)4 v/ itJ Top° c/Land setting
N, Town: n r/ / ❑Ridge lope ❑Valley ❑Flat
�� (,)eeert 55 n e yJ (check appropriate box)
(Suva Name.Number,Community,subdiAsi m,Lot No,Zip code) LatitudeAmigitude of well location
3. OWNER: wl r / ton / i^a (depRalmiuutalseconds)
Address fl r' loo,9 LatitudcAongitude source:❑GPS❑Topogtaphic map
/ (Sweet or No.) (ehwkbox)
CJ�d P/50N UlP /U� 7 L DEPTH DRILLING LOG
City or Town snag zip Code From TO Formation Description
U-
Area code Phone numbe _ -
4. DATE DRILLED — "C)S
5. TOTAL DEPTH: .
6. DOES WELL REPLACE EXISTING WELL? YES❑�JO � t
7. STATIC WATER LEVEL Below Top of Casing: Z FT.
(Uu"r"if Above Top of Casing)
8. TOP OF CASING IS . S FT.Above Land Surface" _
'Top of castes terminated Wor below land surface require■
variance in aveardance with 1SA NCAC 2C.8118. .�->� /
9. YIELD(gpm):��METHOD OF TEST z/i�?-e / �
10.WATER ZONES(depth): _ sI
~_ LOCATION SKETCH 21
11. DISINFECTION:Type ' Amount� Show direction and distance in miles from at least
12. CAS MU: Vval( Iludi fm 'two Sate Roads or County Roads.Include the road
M. I D! see or Iveir' :Tt. -W ieria) uwr4eirs and common road names. '
Fro n_.. Tt _FL_
�p.. /` $ -U C�
from To FL
From Ft
13. ,zROISF Depth M38 d
ItrrO .._JT . C? Fti�t1&C �_ 4? id(:; i 011 Gv
14. SCREED(: Depth Diameter Siot Sim �h9seezial� �
From To Ft in. in. 2
Fro To Ft in. in.
15. SAND RAVEL PACK: a cl r�fiC
Fr-
1 ry ti.`ftrkY C E it"Tr x 31A?TI tS'�dl.?.,WA.5 CoNTST)21JC.M. 3 ih ACCORDANCE WrfH 15A NCAC 2C WE�S T'i
:�. V KIN tIr,ly"`ARDS AND THA A MP' V G_ F Tel"R.' /.tlkD HAS BEEN PROVIDED TO THE WELLyp�VtRI�R
's WELL
is =retmdwatrr Section,1636 Mail Service Center-Ral;-gh,NC
GW-1 REV,-07P2001

t
u 1
O� `�aye yNor�
V Q`�is,0
�e5o VlC, cV\l
4 �a� p,55°GNSaQQ aJs�as\�Se a5e\\,��Q(\a` ,
%o`er\
3� aVe c�0 0p0 oP op v c�\ maP
e c��w ayy ae°t aP��c
Res�Ne a e'`s'�eci ` yam nLl.� \,L`t °eJ�Q�O' \��,5 nP�o/o
'n
oi _
F�¢1
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pAf� .t�v¢ sJbyn co
� ) �
\S n top, C04�
TO at: atess �, s�:��9 is6\ • /P,P\O�,ce °aa�
s
oy°\� aGe �aa` ut'a oa4
.d°`��L' oa R\G ai'aS / c °�C
Owner �,,G ta' a°jO \S� •(oQ .SP �e(' .`ee° „ yte °aas mo°
Mailing Ad l r���v4PN Q1 PJE\ 9e\oNN��C' llnTYjY svoOS9 co
Lot Size a Opp �1�\\ �v0 owwt�S�
11 , Pin # S Qp�'C\C�l+ �G\J°d•J OQ V Nb
b S•(P CPS �ms e�
Well I.will b 'OR O�o•�� 'a-\\v �\,�' `Na`v�,
6 rC°Q°,,%0 m�. SOO, ctVtO °
IV ��e ID
Oirectfons/to Prof \gt�F�c o°p`b
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sr�r��wy o�c:ratS
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\�be
[3y�7 ti�b`fl

311062
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources- Division of Water Quality-Groundwater Section
WELL CONTRACTOR(INDIVIDUAL)NAME (print) CERTIFICATION 0,05'
�
WELL CONTRACTOR COMPANY NAME`((11 tern 1XI.s41 t1/�"C( {—lr MOra�1�—_PHONE # (S(2YI�t
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT# C J 5 I b 0 1 U 3 S 03
(ifapplicable) (ifapplicable)
I WELL USE (Check Applicable Box): Residential r/MunicipalTublic❑ Industrial ❑ Agricultural ❑
Monitoring❑ Recovery ❑ Heat Pump Water Injection ❑ Other❑ If Other,List Use
2. WELL LOCATI N: Topographic/Land setting
Nearest Town: _I County JJ '',, �9 IRZ-dge ❑Slope ❑Valley ❑Flat
19 5 /i�u�Tvvu;sGT��� P—� " Y U11(2 (check appropriate box)
(Sweet N e,Numbers,Community,Su�on,Lot 140..Zip Code) IUCa81742
P, 3L5at irt'u d�eA'fo'n gLtu dA,of d lBl Izxa aµ0d
'
3 OWNER: P; __ °° N-w
to �6 ck b n C-y4 V tC/ (1 P (dcgees)minuies/seeonds)
Address Po f>nttl-7n1,, 1 LatitudcAongitudesource:9CTS❑Topographicmap
(Sweet or Route No.) (check box)
mdAL: t n H t,-P s Alf" aF.r1G3 DEPTH DRILLING LOG
citym Town Sim Zip Code From To Formation Description
( (m4kJ _'745 5 D — i-t c
Arze code-Phone number rr ly Q :— 2 S 70LtL-
4. DATE DRILLED 4!14)05 �5Y
5. TOTAL DEPTH: $OS' L
6. DOES WELL REPLACE EXISTING WELL? YES❑ NO O- t Qp y" _ r
7. STATIC WATER LEVEL Below Top of Casing:_J�0 FT. C3
(Use"t"if Above Tap of Casing)
8, TOP OF CASING IS FT.Above Land Surface*
'Top of casing terminated atior below land surface requires a
variance in aesnrdance with 15A NCAC 2C.0118.
9. YIELD(gpm): -� MET HOD OF TEST t i-
yl�
10. WATER ZONES (depth): /L r r /mo
LOCATION SKETCE e F- _
1 I. DISINFECTION: Type u 1 4 Amount Show direction and distance in miles fro least"
12. CASING: Wall Thickness two State Roads or County Roads.i Ynclude road
Depth Diiamycr or WeighVFt. plrial numbers and common road names:
From H_To S_ Ft.
From To IT Ft. L 21.L
From To Ft.
13. GROUT: Depth Material Method �T
From To ), f) Ft. 519l4Zkfz limT
From To Ft.
-_i
14. SCREEN: Depth Diameter Slot Size Material
From To Ft._in. in.
From To Ft. m. _ in. -
15. SAND/GRAVEL PACK: R�
Depth Size Material � +,k,�ls G,rD T
From To Ft. rn� rrI G
From To Ft.
w
16. REMARKS: --
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE W 1'I H 15A NCAC 2C,WELL 7U
CONSTRUCTION STANDA S,AND THAT COPY THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER a-
'SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
Subunit 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

3114 � 1
WELL CONSTRUCTION RECORD
North Carolina -Department of Environment and Natural Resources-Division of Water Quality -Groundwater Section
WELL CONTRACTOR(INDIVIDUAL)NAME (print) Min I R co,
�` a_lrY� -1rh CERTIFICATION M)�u
WELL CONTRACTOR COMPANY NAMEGarn-kcL 41J9._`1 �l ryip C�—PH�O[NE 'Mt($�Q)pL BOD
STATE WELL CONSTRUCTION PERMIT* ASSOCIATED WQ PERMIT* U I O a r
(if applicable) (if applicably
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 LOCATI N: Topographic/Land setting
Nearest Town: L'ecMUtttiecounty •.CLE1StYt ❑Ridge Bblope ❑Valley ❑Flat
�' —�: '2"2�L'L' (check appropriate box)
(Street Name,Numbers,Communiry,Subdivision,Lot No.,Zip Code) LattW�e/19ng1[u C OFwt}(IOCaJ.iOn
35 (9 /3rt�081 3 OWNER: 23S94J
S . es - `'�i�brKs= c
Address7kL' S rQQ (C((i nr'Y (degces/minu¢s/sewnds)
130 $; c=vefl LatitudcAongitude source:BGPS❑Topographic map
(Soeet or Route No.) CC-Aq3/ (chock box)
DEPTH DRILLING 1
City or Town Su¢ Tip Codc From number
T� Formatio s riprion
�
Area code-Phone numbs
4. DATE DRILLED
5. TOTAL DEPTH:
6. DOES WELL REPLACE EXISTING WELL? YES❑ NO
T STATIC WATER LEVEL Below Top of Casing: S D FT.
(Use"+"if Above Top of Casing) a
8. TOP OF CASING IS_ I FT.Above Land Surface' t
'Top of casing terminated at/or below land surface requires a
variaoce in Accordance with ISA NCAC 2C AII& LJ
FO
9. YIELD(gpm):C METHOD OF-TEST 1.•IZ I+
10. WATER ZONES (depth): rn C
LOCATION SKETC
I I- DISINFECTION: Type Amount Show direction and distance in miles;
s from at
412, CASING: Wall Thickness two State Roads or County Roads.Include the road
Depth D!)ar2Ftcr or WcigWET, a�lg9rsal numbers and common road names.
From j To Ft. (/G
From To Ft �({r1r/
From ToFt. 1 / $f
13. GROUT: Depth Material Method
et hod
From_42 To10 Ft. ,S(Y kR.tGhr 'Z
From To Ft.
ei
1,f SCREEN: Depth Diarneter Slot Size Material Q
From To Ft. in. in. �C
From To Ft. in. in. .�
15. SAND/GRAVEL PACK: Cn
Depth Size Material
From To Ft.-
From—To— Ft.
�"j04lhroh ' t'}�
16. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CON RUCTED IN ACCORDANCE WITH 15A NCAC 2C,WELL
CONSTRUCTION STANDARDS,AND THAT A COPY THIS RF,E RD HAS BEEN PROVIDED TO THE.WELL OWNER l -
SI NATURE OF PERSON CONSTRUCTING THE WEL L DATE
CJ r
Submit the original to the Division of Water Quality,Groundwater Section, 1636 Mail Service Center-Raleigh,NC
27699-1636 Pbone No.[phone],within 30 days. GW-I REV.0j?j001 e-n

311Q � 0
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources- Division of Water Quality -Groundwater Section
WELL CONTRACTOR(INDMDUAL)NAME (print) $fl t[lflk ��fl-t t iT\ CERTIFICATION Mpt�t�
WELL CONTRACTOR COMPANY NAME GCttr,T s"\Xl' WQ-„ ll MA C/1 'P/HONE s (Ye�Y��I//l
STATE WELL CONSTRUCTION PERMIT, ASSOCIATED WQ PERMIT,Q"� 1 7`f '76`
(if applicable) (if applicable)
I. WELL USE(Check Applicable Box): Residential a Mlmicipal/Public ❑ Industrial ❑ Agricultural ❑
Monitoring❑ Recovery ❑ Heat Pump Water Injection❑ Other❑ If Other, List Use -
2. WELL LOCATION: Topogm hic/land setting
Nearest Town:_Hikt fw-cr Cclufnty 41 ❑Ridge lope ❑Valley ❑Flat
0 F-E �Q-fAG+- OA i I ��CLi 'f �YJ)iF g (check appropriate box)
(Street Name,Numbers,Commwity,Subdivision,A No.,Zip Code) Latitude/lopgitu a of well location
3. OWNER: fla�a ��.A.f�m0.c-I..LT 35 �2a �Yd/6S2`933'i7k.1
( egecs/minums/sccands)
Address ART Lm p✓t nq Troll I Latnude/longitude source:PIPSOTopographic map
1 (Sneer or Routs No.) (check box)
S.2 DEPTH DRILLING LOG
Clry or Town su tip Code From To Fo Iation Sscription
3Ss 4 number
u
Area cads-Phone numbs r1G
4. DATE DRILLED
5. TOTAL DEPTH:
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO - I fx�
7. STATIC WATER LEVEL Below Top of Casing: 31ZFT, 0
(Usc"+"if Above Top of Casing) v
g. TOP OF CASING IS FT.Above Land Surface-
'Top of using terminated allor below land surface requires a a' r
variance in accordance with 15A NCAC 2C.0118. 2�
9. YIELD ZOO S METHOD OF TEST AP,
ZON t 10. WATER ES (depth): /G 5�
LOCATION SKETCH
I t. DISINFECTION: Type Amount Show direction and distance in miles from at 1
12. CASING: Wall Thickness two State Roads or County Roads. Include thud
Depth D a ter or Weight/Ft. Material numbers and common road names.
From To z 'l,Ft. C ✓C-
From_To Ft. la
From To Ft. 2 `rj
13. GROUT: Depth Material Method V) �
From To Ft. ~ j
QO
14, SCREEN: Depth Diarueur Slot Size Material
From To Ft._in, in. f�
From To Ft. in. in.
15, SAND/GRAVEL PACK: V`
Depth Size Material
From To Ft.-
From-To-Ft. y
16. REMARKS:
I,t
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C,WELL_
CONSTRUCTION STANDARDS,AND THAT A CO OF THIS CORD IiAS BEEN PROVIDED TO THE WELLt9WNER I "-
t
SI ATURE OF PERSON CONSTRUCTING THE WELL DATE i
I r
Submit the original to the Division of Water Quality,Groundwater Section, 1636 Mail Service Center Ri Igo,NC _
27699-1636 Phone No.[phone],wjthin 30 days. GW-I REVi:47/2041,�
c�
' i;

311059
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources- Division of Water Quality-Groundwaur Section
WELL CONTRACTOR(INDIVIDUAL)NAME (print) rr� r�fYx�t tpf\ CERTIFICATION Mp��
WELL CONTRACTOR COMPANY NAMEGote k"tri- �lWO\ 41 unnpc 1 PHONE M ($m(rpa''I/a(�)
STATE WELL CONSTRUCTION PERMITM ASSOCIATED WQ PERMITM 61�51 U W 0 &Z.�-f
(if applicable) (if applicable)
I. WELL USE(Check Applicable Box): Residential 2� Municipal/Public❑ Industrial ❑ Agricultural❑
Monitoring❑ Recovery ❑ Heat Pump Water Injection❑ Other❑ If Other,List Use -
2. WELL LOCATION:
Topographic/Land setting
Nearest Town: Fl-e Co ty (tci,tlw n Rfgage ❑Slope ❑Valley ❑Flat
to-f-j4 f3loorkttrgLati-w71-a l L+Ivllle Nc- (checkappmpriaebox)
(Street Name,Numbers,Community,Suhdivision,Int No.,Zip Cods) Latitude/longitude of well IOCeIIO)7
351 z?'y7Al 0,41 .4�37uJ
3. OWNER:- V0 C.L- .kA L'P (dcgn=shuinutzs/scconds)
Address Ida 1 ,- poll rjL gd 536Sfz)nt1) 70( Latitude/longitude source:&CPS❑Topographic map
^,\ (Sweet or Route No I r (check box)
DEPTH DRILLING LOG
City or Town State zip Code From To Formation Description
�- &9& - 91'+5 0 - 5- r
An;a code-Phone numbs
4. DATE DRILLED 4 'S _�- c7
5. TOTAL DEPTH:_ S 2l9_ -55- - 1 "- —
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO Q
7. STATIC WATER LEVEL Below Top of Casing: /L U FT, 3 t 11
(Use"+"if Above Top of Casing)
8. TOP OF CASING IS_�FT.Above Land Surface' _
'-fop of casing terminated attor below land surface require,a
varlaoce in accordance with 15A NCAC 2C.0118.
9. YIELD(gpm):_j METHOD OF TEST
10. WATER ZONES(depth): S �3� ^
LOCATION SKETCH 4-g
1 L DISINFECTION:Type /> 04 Amount Show direction and distance in miles from at lei
12. CASING: Wall Thickness two State Roads or County Roads.Include the road
Depth D) eter or Wc. I/Ft. Material numbers and common road names.
From j To Ft. < z7. c Ar/G
From_Q_To FL 1. C l�✓L Q
From To Ft.
13. GROUT: Depth Material Method From C7 To :2` 0 Ft. 5,4AR9l 7[�
From To Ft.
14. SCREEN: Depth Diameter Slot Size Material -
From To Ft._in. in. j
From To Ft. in. in. �_ L
15. SAND/GRAVEL PACK: F
Depth Size Material i
From To Ft.
From To Ft.
16. REMARKS: �.-_--
I DO HEREBY CERTIFY THAT THIS WELL WAS CON SfRUCTED IN ACCORDANCE WITH 15A NCAC 2C,WELL
CONSTRUCTION STANDARDD THAT A COPY iF THIS RE ORD HAS BEEN PROVIDED TOO THE WELL OWNER —
SIGN TURF OF PERSON CONSTRUCTING THE WELL DATE
Submit the original to the Division of Water Quality,Groundwater Section, 1636 Mail Service Center-Ralelgh,NC
27699-1636 Phone No.[phone],wjthin 30 days. GW-I REV. 07/2001

V 0 O11053
WELL CONSTRUCTION RECORD
North Carolina-Department of Environment and Natural Resources- Division of W aicr Quality -Groundwater Section
WELL CONTRACTOR(INDIVIDUAL)NAME (print) ho i n n-- Sur' A'1 CERTIFICATION Nam,
WELL CONTRACTOR COMPANY NAME�( n�t Yr- W \k n. r PHONE k (gj�5nLM-I aoD
STATE WELL CONSTRUCTION PERMITN ASSOCIATED WQ PERMIT# O`'f 1 a O 1 7 C� I '79
(if applicable) (if applicable)
1. WELL USE(Check Applicable Box): Residential tir MtmicipaUPublic ❑ Industrial ❑ Agricultural❑
Monitoring❑ Recovery ❑ Heat Pump Water Injection ❑ Other❑ If Other, List Use
\ 2. WELL LOCATION: "I opographic/Land setting
Nearest Town: 1F'vx r
--- lL`,'c,00_I1 1 - County !1 l Ff GKidge ❑Slope Malley ❑Flat5 `IDiL4 rIrh � C.A79Z Ichttkappropris m box)
(Street Name,Numbers,Conununny,Subdivision,Lot No.,Zip Code) Lalttu Icingitude of wel�ocation
3. owrrER:_ c�r .. Dvcli=zt-E- 3> l=/'� � oS-x A3'4,&,
(degree s/minu ms/secoods)
Address Inn 5hou;J f)hC ht` �t-u.i Latitude/longitude source:BGPS❑Topographic map
(Street or opm No.) 0.1,box)
j cl� rec y ll�e PJ ��nqZ DEPTH DRILLING 1-06
City or Town Stem Zip Code From To Formation Description
(`6LK)- 1n45 - `6 cj7 � - A )
Area code-Phone numbs
4. DATE DRILLED " -2 J,' -CI!5 2 C P7
5. TOTAL DEPTH:
6. DOES WELL REPLACE EXISTING WELL? YESC] NO PJ' - --_— —_
7. STATIC WATER LEVEL Below Top of Casing: 9 FT. -- {�J
r
(Use" if Above Top of Casing)
8. TOP OF CASING IS / PT. Above Land Surface* -- -- —3a--==—
`Top analog lerminand at/orbelow land surface requires a
variance in accordance with 15A NCAC 2C.0118.
9. YIELD(gpm): Q METHOD OF TEST
10. WATER ZONES(depth):
o
LOCATION SKETC— H --
11. DISINFECTION: Type i-f TH Amount Show direction and distance in miles from at le
12, CASING: Wall Thickness two State Roads or County Roads.Include the r
J Depth Diayter or Weight/Ft. Material numbers and common road names.
From To_�Ft P✓L
From_To--3-A—Ft. 2 / L ✓L
From To Ft. -
13. GROUT: Depth Material Method \J -
From U To � y Ft. 5Ah -t-- �(' $F , 0
From To Ft. -
14. SCREEN: Depth Diameter Slot Size Material rgCr
From To Ft. in, in, -
From To Ft. in. in.
15. SAND/GRAVEL PACK: _
Depth Size Material
From To FL .l ---_ _...-"._�__-_____�
From To Ft.
16. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITIt 15A NCAC 2C,WELL
CONSTRUCTION STAND RDS,AND THAT A - PY OF T�}�%S RECORD HAS BEEN PROVIDED TO THE WELL OWNER
Al i-c-r✓/ �f -Zz -o 5
G
IGNATURE OF PERSON CONSTRUCTIN THE WELL � DATE
Submit the original to the Division of Water Quality,Groundwater Section, 1636 Mail Service Center-Raleigh, NC
2 7 6 99-163 6 Phone No.[phone],within 30 days. GW-I REV. 07/2001

I * 314696
WELL CONSTRUCTION RECORD
North Carolina-Depmk oent of Environment and Natural Resources-Di/vision of Water Quality-Groundwater Section
WELL CONTRA=R(IND1MUAL)NAME (prtat ( I CLRTInCATION M6-3WD 6
WELL CONTRACTOR COMPANY NAME i // 1 PHONE i (921683129W
STATE WELL CONS[RUCIION PERMITN ASSMATED WQ
(ifapplicable) if
I. WELL USE(Check Applicable Box):Residential M®icipallPablic O Industrial❑ Agricultural1
Momwrmg[3 Recovery O Heat Pump Water Lrjectim 13 Other O If Other,List Use
2 WELL N: Ui1` { � Tsettin
g
O i 17Valhy 17F7at
M
(� b=)
(Stmet Nam%NmbeM Caknowhy.Sabd VWM Lot No.Zap Cade) Latittddlongihide of Well location
3. OwNE flRO� C (dam)
Address ��[mY1e p Lauto&4ongiwde sourcer10PSETopographic map
-ilk zzx r I lE, �l C. �.3 1 p� ( DRII LING LOG
City or Tma stmee zip(:tern From To Forraticn Description
Am cods Phone amnbe r
4. DATE DRII.LED ,(6,;5- y
5. TOTAL DEPTH: /
6. DOES WELL REPLACE EXISTING WELL? YES O O 0'
7. STATIC WATER LEVEL Below Top of Casing: kT.
(Use-+-ifAbm Top ofCa W
S. TOP OF CASING IS FT.Above Land Surfice•
`Top of Meng a rmhuded atlor belaw land amine regotres a
variance to aecorifam with HANCAC 2C A11L /t / /�� ' `/� �
9. YIELD(gpm):: METFIOD OF TEST AI S is• l Ot�1 f�JCY
10.WATER ZONES(depth): 260
LOCATION SXETCFI
11. DISINFECTION:Type / Amomt Show direction and distance in miles from at leas(
12. CASING: Wan Thirlmeas two State Roads or County Roads.Include the mad
Depth Diameter err WgOAWL Material numbers and common road names.
From '8- To2gCo Ft
ronL _To Ft
From To Ft
13. GROUT: Depth From To (K'.�.Mecesy /TE�
From To Ft
14. SCREEN: Depth Diameter Slat Size Material
From To Ft---bL in.
Fmm__To Ft_jn. in.
15. SAND(GRAVELBACK:
Depth Sine Material
From To Ft
From To Ft
16. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSIRUCIED IN ACCORDANCE WITH 15ANCAC 2C,WELL
CO CTION ST ARDS.AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE OWNFR
k�--
C SIGNATURE OF PERSON ONNSTRUCfING THE WELL D (J
Submit the original to the Division of Water Quality,Groundwater Section,1636 Man Service Center-RHdgh,NC
27699-1636 Phone No.[phone],within 30 days. GW-1 REV.07nMI

� 1069 �
WELL CONSTRUCTION RECORD
North Carolina-Deparmxnt of Enviromnem and atural Resomc C of Water Quality-Groundwater Se�1"n�^ Z
WEtd.COMMACIOPLONDIVIDUAL)NAME ft �1 , l�. CERTUrrGTION Ot Wl
WELL CONTRACTOR COMPANY NAME R' R 114r 1`� PROM, s j 5Z,3
STATE WELL CONSTRUCIION PERNM ASSOCIATED WQ
ofapplicable) if lc
1. WELL USE(Check Applicable Box):Residential Municipal/Public 0 Industrial❑ Agricultural 0
Monitoring❑ Recovery ❑ Heat Pinup Water Injection 0 Other 0 If Other,List Use
2. WELL LOCH O h1vL�d sag
a
�-1J�r V.
CoolrP
{4e1�De( ril oslopc valley 13Flat
Mo CP l I a 00 _ (cbwkm1 I l box)
(steedNamr,Nmnbem,Commemay,Se*&"Sae,LetNa,ZkoCMe)�I(� �' LatitodeAttagitude ofwell location
: E r 1E
3. OWNER &ZC4?6u+eC�S1tt\1QI rck, ( )
Address 9.0 • ;L so
Latitmleflougidrde somx:OGPSOTopog%phic map
-uN WT" DEPTH ( DRILLWGLOG.
City or Tewa sine Tip Code From To Formation Iksctip'
Amer coda Pbaoe aeaob �
4. DATE DRILLED logs -o
5. TOTAL DEPTH- / '9
6. DOES WELL REPLACE EXISTING WELL? Y�0 NO 9— p�
7. STATIC WATER LEVEL,Below Top of Casing:�Ff.
(UM-+-rfAbove Top ofCssmM C.A
8. TOP OF CASING IS FT.Above Land Surface•
'Top of cadog terms odic'-'- cud prim mitshm a
Miuea In UmnlanclMn 15ANCAC 2C Alta. /'+CLI 9. YIELD(Spin): LO METHOD,.ES1l 4
10.WATERZONES(depth): r
LOCATION SKETCH
11. DISINFECTION:Type Amount Show direction and distance in miles from at least
12. CASING: wall Thickness two State Roads or County Roads.Include the road
Depth Diameter orWaghUPt Mareaal numbers and common road natuaL
From` 00 To�� Ft. -Eck
From To Ft
From_To FC It GC
13. GROUT: Depth Mra,b�eti�al ,(� bia6od C C_-J
From To Ft�_yl e..1 V1C. 1 oV.Y
From To Ft
14. SCREEN: Depth Diameter Slot Size Material
From To Ft---- in
From To Ft.—in. in.
'-
15. SAND/GRAVELPACK -_
Depth Size Material
From To Ft
From To Ft
16. REMARKS: ------ .�
I DO HEREBY CERTIFY T THIS WELL WAS CONSIRUCfID IN ACCORDANCE WITH ISA NCAC 2C,WELL
CoN UCTION Sf�THATA COPY OF THIS RECORD HAS BEEN PROVIDED TO OWNER
I-
SIGNATURE OF PERSON CONSTRUCTING THE WELL DA
Submit the original to the Division of Water Quality,Groundwater Section,1636 Mail Service Center-Ra cigh,NC
276W1636 Phone No.(91g)733-3221,within 30 days. GW-1 REV.07/2001

WELL CONSTRUCTION RECORD w 310699
North Carolina-Department of Environment and Nahaal Itmourc -Division of Water Quality-Groundwater Section
WELL CONTRACI'OR(IMMADUAL) ^ 04r2 �11�I�_ 1 Clarr1FICATION
WBLLCONTRACTOR COMPANYNAME T1 1 ?,t Ilt PHONE a ��0
STATE WELL CONSTRUCTION PER UM ASSOCIATED WQ
d liceble (ifapplicable)
1. WELL USE(Check Applicable Boa):Residential MunicipaUPubnc❑ Industrial O Agricultural O
Monitoring❑ Recovery 0 Heat Pump Water Injection I7 Other O If Other,List Use
2. WELL crest AT N�� y ��(�� T
Nearest Town QRidge .]Verney pFlat
(Ool�+el►.G :2R-t.�2 (Cbwkbm)
(SteeGNanm Number.C=o w4.svbdirien ,la'io Mp Code) Laculaanongimae ofwen location
3. OWNER OW- • worit y ( )
Address 150 IVK-Ma
5-ftS.
Flo C_ Lai ituciellongipde stmrow0GPSOTopographic map
DEPTH ( DRILLING LOG
City wrower sure zip Code From TO FormaOen Description
�)7
Arta code-Pboaemmb �
4. DATE DRILLED 3�
5. TOTAL D n
6. DOES WELL REPLACE EXISTING WELL? YES 17 NO
7. STATIC WATER LEVEL,Below Top of Casing gqq .
L
(Uec-+-ifAbweropofcaeie� ,y
8. TOP OF CASING IS_ FT.Above Land Surface'
'TOP of cuing termLaEed Afer below land avraue re9sh ■ C!i 4
varluainfemrdam ISANCAC2C.a11a.
9. YIELD(gpm):�METHOD OF TEsI�c.e 1)
10.WATER ZONES ):
LOCATION SKETCH e
11. DISINFECTION:Type Amount Show direction and distance in miles from at least
12. CASING: Wall Thicimess two State Roads or County Roads.Inchrde the road
Depth Diameter or Weigher t. Material members and common mad names.
Fran--Z�To—,?a Ft• L�a4 d., m4-fl
FronL._To FFtt
13. GROUT: m C'on 'e4t, dO�L��Th(se✓From To
From jJv 4�r�,. Q
_.
14. SCREEN: Depth Diameer Slot Size Material yy��,�,,,�J II ^^
From To Ft_m. in. /r"W /.!'i(J✓CL
From To Ft m. to,
/i t_ 1A .
15. SAND/GRAVELPACK f "1T J••r �%LY�l1l_ 1.../V �
Depth Size Material
Front--To—Ft
From To R.
16. REMARKS:
I DO HEREBY CERTIFY THA THIS WELL WAS CONSTRUCTED IN ACCORDANCE W)TH ISA NCAC 2C,WELL
CON UCTION ST AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
SIGNATUREOFPERSONCONSTRUCfING THE WELL ATE
submit th rigiaal to the Division of Water Quality,Groundwater Section,1636 Mail Service Center-Raidgk NC
27699-1636 Phone No.[phone],within 30 days. GW-1 REV.072001

TO 310700
WELL CONSTRUCTION RECORD
North Carolina-Department of Bnvuourneut andNatmal Division of Water Quality-Groundwater
WELL.CONTRACTOR(INDIVIDIIAL)NAM (pAet I tseTTFICAT1onlod
WELL CONTRACTOR COMPANY NAME 1 MN I i�lII1IPRONE f ta1�
v
STATE WELL CONSTRUCTION PERM1T9 ASSOCIATED WQ PERMIT$
d licable (ifapplicable)
1. WELL USE(Check Applicable Boa):Residential Municipal/Public 0 Ind i*W 0 Agricultural 0
Monitoring 0 Recovery 0 Heat P®p Water Injection 0 Other 0 NOther,List Use
2. WELL LOCA�1 T luc/Land stXhng
-fir �+�Se cf1��f�SSjs offer
(su<at Namk Nambem Comm ndly.SAdiiviam.Eat No,Zip Cone) Latib"ongidide of wen location
3. OWNER �O `CLC�Q�S (dog
I)
Address Co�{ g\�me CW o ! Latituddtongitude source:13MOTopogcaphic map
I kn,opDEPTH ( DRIIZINGLOG
(-�CkrerTooe Stab 2$Co& Front To Formation Description
Area cede•Phcoe amber
4. DATE DRILLED 0�1
5. TOTAL DEPTH
6. DOES WELL REPLACE EXISTING WELL? YES O NO
7. STATIC WATER LEVEL Below Top of Casing I Oo FT.
(tJW t"ifAbow TopofCuhW
8. TOP OF CASING IS FT.Above Land Surface'
'Top of caYne twulb"d atler below IaN»arh..r q Am a
vaiftom In accordancfTM 15ANCAC 2C A11a. /
9. YIELD(gpm):: METHOD
10.WATER ZONES(depth): 1 (a O I F /
LOCATION SKETCH
11. DISINFECTION:Type Amount Show direction and distance in miles from at least
12. CASING: Wall Thickness two State Roads or Comity Roads.Include the road
DqA Diameter or WeigltUFt. Material numbers and common road names.
From To�Ft- 4bo6rD
From To Ft
From To Ft.
13. GROUT: Depth �; �� (V,�T, 0
14. SroCREEN.nL Depth Diameter Slot Size Material JKvL� l-ati , �
From_To FtJa h
From To Ft_in. in. Co
15. SANDIGRAVELPACK:
Depth Sim Material
From To Ft
From To Ft
16. REMARKS:
IDO HEREBY CERTIFyTHAT 1 WASCONSTRUCTIDINACCORDANCEWI1H15ANGC2r v,1ELL
CONSTRy ION STANDARDS, THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO "_ WELLPWNER
SIGMATURE OF PERSON CONSTRUCDNG THE WELL DATE
Submit the original to the Division of Water Quality,Groundwater Seetion,1636 Man Service Canter-Raleigh,NC
27699-1636 Phone No.(9t9)733-3221,within 30 days. GW-1 REV.07=1

WELL CONSTRUCTION RECORD
North Carolina—Department of Environment And Natural Resources—Division of Water Quality—Groundwater Section
WELL CONTRACTOR(INDIVIDUAL)NAME(print) NEIL CRAFT CERTIFICATION# 3114
WELL CONTRACTOR COMPANY NAME PITTMAN WELL BORING,LLC PHONE# [phone]
STATE WELL CONSTRUCTION PERMIT#_ ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
1. WELL USE(Check Applicable Box): Residential ® Municipal/Public ❑ Industrial ❑ Agricultural ❑
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other,List Use
2. WELL LOCATION:
Nearest Town:BATCAVE County HEND Topographic/Land setting
REEDY RIDGE P.D. ❑Ridge ❑ Slope ❑valley ❑Flat
(Street Name,Numbers,Community,Subdivision,Lot No.,Zip Code) (check appropriate box)
3. OWNER: GARY COPE Latitude/longitude of well location
Address REEDY RIDGE RD.
(Street or Route No.) (degrees/minutes/seconds)
BATCAVE NC 28710 LatitudMongitude source: ❑ GPS ❑Topographic map
City or Town State Zip Code (check box)
2�9 —6534787 DEPTH
Area Code Phone number From TO
4. DATE DRILLED 04/20/05
5.TOTAL DEPTH: 305 DRILLING LOG
6.DOES WELL REPLACE EXISTING WELL? YES❑ NO® From To
7. STATIC WATER LEVEL Below Top of Casing: 80 FT.
(Use"+"if Above'fop of Casing)
8.TOP OF CASING IS 1-1/2 FT. Above Land Surface' LOCATION SKETCH
'Top of casing terminated at/or below land surface requires a Show direction and distance in miles from at least
variance in accordance with 15A NCAC 2C.0118. Two State Roads or County Roads. Include the road
9.YIELD (gpm): 6 METHOD OF TEST ARD number and common names
10. WATER ZONES(depth): FROM RUTH.GO UP 64/74 TO BATCAVE.LEFT
ON HWY.#64.GO 1-1/10 MILE.RIGHT ON REEDY
11.DISINFECTION:Type CHLORYTE Amount 7.5 RIDGE RD.
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
From 0 To 95 Ft.6-1/4" SDR21 PVC
From_To_Ft.
From To_Ft._ r�
13. GROUT: Depth Material Method
From 0 To 20 Ft.OUHMETE POURED 3v �
From To Ft. —c
14.SCREEN: Depth Diameter Slot Size Material
From_To_Ft._ in. in. a
From_To_Ft._ in. in. Ln
+�
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft._
From To Ft.
16.REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C,WELL
CONSTRUCTION STANDARDS,AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
TC- 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

3 119 87
WELL CONSTRUCTION RECORD
North Carolina-Department of Environment and yNatural Resources-Division of Water Quality-Groundwater Section
WELL CONTRACTOR(INDIVIDUAL)NAME (print) .�2/'rtGk #," SCCLoyet^S CERTIFICATION# 47
WELL CONTRACTOR COMPANY NAME dZ SC,wei S -Ir Son I 1 L -L --Jt )PHONE * f5L.3N /:
E
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ P� RMIT#�
(if applicable) - - (ifapplicable)
I. WELL USE(Check Applicable Box): Residential Municipal/Public❑ Industrial ❑ Agricultural ❑
Monitoring❑ Recovery ❑ Heat Pump Water Injection❑ Other❑ If Other,List Use
2. WELL LOCATIOqN: II II Topogr hic/Land setting
Neu---- -own: jtit tt^4D Wes' `l.2 County twSOh ❑Ridge lope ❑Valley ❑Flat
N C.F itG?h �04[j (check appropriate box)
(Street Name,Numbers,Community,Subdivision,Lot No.,Zip Code) Latitude/longitude of well location
3. OWNER: Kav;yi (degrees/minutes/seco ids)
Address agcao A 2w.r„eKtaiee Latitude/]ongitude source:❑GPS❑Topographic map
(Street or Route No.) (check box)
� lOve' Ft at, c DEPTH DRILLING LOG
City or Town State Zip Code From To Formation Description
(r 3 >- seib S%, -. I 1l3 fSf)e r' r.n�Pn -Area code-Phone number
4. DATEDRILLED
5. TOTAL DEPTH:
6. DOES WELL REP A E EXISTING WELL? YES ❑ NO
7. STATIC WATER LEVEL Below Top of Casing: /o o FT.
(Use"+"if Above Top of Cuing) -3
8. TOP OF CASING IS FT.Above Land Surface* Pi
z
*Top or casing terminated at/or below land surface requires a Q,
variance in accordance with 15A NCAC 2C.0115. p a a9. YIELD(gpm): l METHOD OF TEST R tom_ �
10.WATER ZONES(depth):
LOCATION SKETCH ZA -
11. DISINFECTION:Type D i 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 Wei ht/Ft. Materials numbers and common road names.
From}� o .3 Ft. �-
From To FL K
From To Ft. — f�wy /9 1 Urt
13. GROUT: Depth Material II Method f
Fromm To�Ft. (.e ir,Z nT P OLv`e
From To Ft.
14. SCREEN: Depth Diameter Slot Size Material p�nnfy/✓aa�. Rd.
From To Ft. in. in.
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Size Material ,(1J
From To Ft.
From To Ft. µ�
16. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C,WELL
CONSTRUCTION STANDAR S,AND THAT COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER -
3-3ev,
SIGNATURE OF P SON CONSTRUCTING THE WELL DATE
Submit the original to the Division of Water Quality,Groundwater Section,1636 Mail Service Center-Raleigh;NC c
27699-1636 Phone No.[phone],within 30 days. GW-I REV:-03/2001 --
f
i I

• rN 308483
WELL CONSTRUCTION RECORD
North Carolina-Department of Environment and NN1a Resources-Divisio of Water Quality-Groundwater Section
y�
WELL CONTRACTOR(INDIYIDUALI NAME (print) /� rg r. �Z/ 5. 3� CEICTIFICATION#-Z/ U Y
WELL CONTRACTOR COMPANY NAM�y-��tTy��}T'E(` t�d( 1J(t:j �t/)��PHONE #
STATE WELL CONSTRUCTION PERMTr# ASSOCIATED WQ PERMFr#
(if applicable) (if applicable)
I. WELL USE(Check Applicable Box):Residential® /Municipal/Public❑ Industrial❑ Agricultural❑
Monitoring❑ Recovery 13 Heat Pump Water Injection O Other❑ If Other,List Use
2. WELL LOCATION- 6pographie/Land setting
Nearest Town: RA)eV01 e- County P lrzl_OC_✓ fudge OSlope Malley OFlat
1' Z & aers r est U Z8 7-l (eh-kaq w tom)
(Sneer Name.Number,Commwity,Subdivision,Lot No,zip Cone) Latitudellongitude of well location
3. OWNER: e#Y kh,�nd <ttge m na«aa1
Address Ar SG 114 _ Latitudellongitude source:OGPS❑Topographic trap
(saeaorRom No.) (chackbox)
/f// 7_;?Z�q DEYMD�tLLING LOG
city or Town Stet zip Code From TO Formation Descripti
Area code-Phase member _
4. DATE DRILLED
5. TOTAL DEPTH: 7- — >
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO W' ;
7. STATIC WATER LEVEL Below Top of Casing:—Y.E----FT.
(Use"+"if Above Top of Casing)
8. TOP OF CASING IS L_FT.Above Land Surface•
`Top of casing termiasted at/or below had surface requires a
varisace in accordance with 15A NCAC 2C.0118.
9. YIELD(gpm):�_METHOD OF TEST I i mew
10.WATER ZONES(depth):
LOCATION SKETCH
11. DISINFECTION:Type C Amount le O 2 Show direction and distance in miles from at least
12. CASING: Wall Thickness two State Roads or County Roads.Include the road
Depth Dh or t numb rs and co on road nanus.
Fro To 5 t`� FtAyU L
From To Ft ?�
From To Ft t
GRO�
Depth
13• Frorq l Mybd
To ZD Ft CPE�L t"
From To Ft ts= lJ �
14. SCREEN: Depth Diameter Slot Size Material h ►4
ic>�.�Ft iIt, in.
in.
L.P.PACK. Q
Depth Size Material t
From�To Ft. SIy�CCp
From To Ft rov
16. REMARKS:
1 DO HEREBY ERTIFY THAT THIS WEWAS NSTRUCrEDJNACCORDANCE WITH 15A NCAC 2C,WELL
CONSTRIZ N STANDARDS, 7 A C Y OF THIS CORD HAS BEEN PROVIDED TO THE WELL OWNER;_' IV
C,
SIGNATURE OF PERSO CONSTRUCTING THE WELL DATE -- E--
Submit the original to the Division of Water Quality,Groundwater Section,1636 Mall Service Center-Raleigh,N -'
27699-1636 Phone No.[phone],within 30 days. GW-1 REV.07/20b1 - -

30848E
WELL CONSTRUCTION RECORD
North Carolina-Department of Environment and,Neattp;al Resources-Division of Water Quality-Groundwater Section �/
WELL CONTRACTOR(INDIVIDUAL)NAME (prior) A Hein GYt C k OCI1`,s CER=cATIoN##�p,�.
WELL CONTRACTOR COMPANY NA]N&Ss CLTLSIF!✓-VC r eAl ON 1 ling PHONE # fflAkW9,'ONFO
STATE WELL CONSTRUCTION PERMM ASSOCIATED WQ PERMTfY.
(if applicable) / (if applicable) _
1. WELL USE(Check Applicable Box):Residential ff Municipal/Public❑ Industrial[3 Agricultural❑
Monitoring O Recovery O Heat Putt Water Injection 0 Other❑ If Other,List Use
2. WELL LOCATION: opogtzphivl and Seating
Neaten Town- egille county 10Ms ID [midge Mope []Valley DFlat
2 rAesV-tj(kt w gd 227q T (Chook"P uprim box)
(Strcet Nam4 Numbers,Community,Subdivision,Lot No,Mp Code) Latitude/longnude of well location
3. OWNER:. / n r—ON— ( miovueslsecoods)
Address / NµT t� LatitudeJlongitude soueca[]GPS[JTopographic snap
/ (S RouteNo.) (drockbox)
/y(A0�/Sn n u iN/ A/C, 2—x '7%2 DEPTH DULLING LOG
City or Town sore zip Code From To Formation Description
Aura coda-Phone number s..
4. DATE DRILLED,
DEPTH: _.
5. TOTAL /
6. DOES WELL REPLACE EXISTING WELL? YES❑ NO fd'
7. STATIC WATER LEVEL Below Top of Casing:
_ZL _FI.
(Use"+"if Above Top of Casing)
8. TOP OF CASING 1S /• FT.Above Land Surface•
`Top of casing terminated Wor below land sortare requires a
variance In acaordmce with ISA NCAC 2C.011a. z La
9. YIELD(gpm):S METHOD OF TEST //Il2Yt(
10. WATER ZONES(depth): LOCATION SKETCH
11. DISIIdFECTiON:Type C Amount &02 Show direction and distance in miles from at least
12. CASING: Wall Thickness two State Roads or County Roads.Include the road
Toth or Wei tlFt al numbers d common road names.
From, To�y Ft_= 5DR2/ U G
From To Ft v
From To Ft
13. GROUT:,,( Depth Material M thod
From v To 2� Ft O C/tC C
From / To Ft rb
14. SCREEN: Depth Diameter Slot Size Material '-
From To Ft in. in.
From To Ft in. in.
15. SAND/GRAVEL PACK: G
Depth size Material
From TO Ft.
From 777����To Ft
16. REMARKS:
1 DO HEREBY CERTIFY THAT THIS WELL WAS CONSTR IN ACCORDANCE WITH 15A NCAC 2C,WELL
CONSTRUCTION/nvST ARDS,AnND THAT CO Y OF S RECORD HAS BEEN PROVIDED TO TH/�E W,rE/�L(�L OWN�FjR
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE _. c
Submit the original to the Division of Water Quality,Groundwater Section,1636 Mail Service Center-RaleiIVC
27699-1636 Phone No.[phone],within 30 days. GW-I REVAW2001 7n

WELL CONSTRUCTION RECORD
North Carolina-Department of Environment and Natural Resources-Division of Water Quality-Groundwater Section
WELL CONTRACTOR(INDIVIDUAL)NAME
E(M(print)Cle,%,Al rah/P//� CERTIFICATION N�//
WELL CONTRACTOR COM PANY NAMEL /'///y,/ell;- /r,jJ PHONE•A (ItAf'V-7j^'L/'Nj!�
STATE WELL CONSTRUCTION PERMITB ASSOCIATED WQ PEILYIITB _a7 17 6�6
ifa licable (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: 2
Nearest Town: // /t // Topographic/Land setting
c� �P�cxPryaH.v '� County --4--& PP3rr
r/eA G '��3 U,.nd �� ❑Ridge ❑Slope ❑Valley ❑Flat
,;tlf77ti (check appropriate box) O I—
-
(Street Name,Numbers,Community,Subdivision,Lot No.,Zip Code) Latitude/longitude of well locatiop
�7
3. OWNER:!/o60Z /�ji f/i i�5 (degrV Slminutes/seconds)
Address 'v tk A Lqu Latitude/longitude source:❑GPS❑Topographic map
(Street or Route No.)
(check box)
�G- DEPTH DRILLING LOG
+r..��v,City or Town state Zip Code From To Formation Description
ozz- 6-,TA--
Area code-Phone number ��r
4. DATE DRILLED %t'7 —dg r/ t
5. TOTAL DEPTH: ;7'%d
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO fd� fin`
7. STATIC WATER LEVEL Below Top of Casing: L71P FT.
(Use'•+•'if Above Top of Casing)
8. TOP OF CASING IS I FT.Above Land Surface"
-Top of casing terminated atlor below land surface requires a e7— 'X�f�
variance In accordance with ISA NCAC 2C.0118.
9. YIELD(gpm): Oa0 METHOD OF TEST A-//
10.WATER ZONES(depth):�' �d
LOCATION SKETCH
11. DISINFECTION:Type Amount Show direction and distance in miles from at least
12. CASING: Wall Thickness two State Roads or County Roads. Include the road
Depth _ Diameter or Wei ht/Ft. Material numbers and common road names.
From d To�Ft. 6.h' 1 !/li
From To Ft. '��D�y' /Qec
From To Ft. -cyP-,.yc,�i,� �— c
13. GROUT: Depth Material Method //"cv`
/
From ® To�_Ft:$.��c
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. - r__._._._.
From To FL
l
_ F I EiOHERESYtERTtPY-THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH ISA NCAC 2C WELL-- �-
CONSTRUCTION STANDA"S,AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE i
i
Submit the original to the Divfision of Water Quality,Groundwater Section,1636 Mail Service Center Raleigh,NC I
1-7699-1636 Phone No.(9I9)733 3221,within 30 days. GW 1 REVb 07/2001 - J�

WELL CONSTRUCTION RECORD
North Carolina-Department of Environment and Natural `Re'so�urcJC� Division of Water Quality-Groundwater Section
WELL CONTRACTOR(INDIVIDUAL)NAME ( rI t) `t^/' i /�1P1� CERTIFICATION#
WELL CONTRACTOR COMPANY NAME e I I i�� (O eP 9"-t0t // PrH'ONE # pJgfj_fvt`7-yr/SO
STATE WELL CONSTRUCTIONPERMIT# ASSOCIATED WQ PERAIIT#
(if applicable) (if applicable)
R
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: /r opographic/Land setting
Nearest Town:A&J&z-'F— County D;ll ®'Ridge ❑Slope ❑Valley ❑Flat
(check appropriate box)
(Street Name,Numbers,Community,Subdivision,Lot No.,Zip Code) Latitude/longitude of well location
3. OWNER: rn �ihl kP4 (degrees/minutes/seconds)
Address y -]�T>er 1a..f_ Latitude/longitude source:❑GPS❑Topographic map
(Sheet or Route No.) Q�/ (check box)
A��rrr /VC. z�� ( DEPTH DRILLING LOG
City oSvw1n ���9y Zip Code From To Formation Description
(�Y)- 7 G dot k
Area code-Phone number '
4. DATE DRILLED l"0 s-05, (
5. TOTAL DEPTH: 9� 4a'
- r_ a
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO lY
7. STATIC WATER LEVEL Below Top of Casing: FT. :r(
a (Use"+"if Above Top of Casing) :J
8. TOP OF CASING IS I FT.Above Land Surface*
'Top of casing terminated atlor below land surface requires a 0 '
varlance in accordance with I5A NCAC 2C.0118. —`71
9. YIELD(gpm): - METHOD OF TEST ,-r �0 1
10.WATER ZONES(depth): 49
LOCATION SKETCH
11. DISINFECTION:Type Amount Show direction and distance in miles from at least
12. CASING: Wall Thickness two State Roads or County Roads.Include the road
Depth Diameter or Weight/Ft. Material numbers and common road names.
From O TO ii re Ft. Usr SU2 rVC
From To FL
From To Ft.
13. GROUT: Depth Material �M�etthood A QL< ( 1
From O To 'Z.6 FL_ MCA r ik A /(/�"L 1A A'c
From To Ft.
14. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in. N'y
From To Ftin. in. e'o
15. SAND/GRAVEL PACK:
Depth Size Material NN,II
From To Ft.
From To Ft. PVIJ5 ---
16. REMARKS: _
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C,WELL = i _
CONSTRUCTION STANDA ,S�AND/�HAT A COPY OF THIS RECORD HAS.BPEN PROVIDED TO THE WELL OWNER.-
1-6t
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{. r;

3 1 9, '. " 3
WELL CONSTRUCTION RECORD
North Carolina-Department of Environment and N tu/rIal/I Res,QVt�'ces-Division of Water Quality-Groundwater Section
WELL CONTRACTOR(INDIVIDUAL)NAME (print) .titY' I0.I'CJ 1� CERTIFICATION# 3
lOp�
�f
WELL CONTRACTOR COMPANY NAME �E'.+"Y ( i.r%ell 3- A- ttie PHONE # IY2��C'i 1•l{r•�SG'
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT# 0i4166(!'4 i 36 <�
(if applicable) (ifapplicable)
L
I. WELL USE(Check Applicable Box): Residential 9K�Municipal/Public❑ Industrial❑ Agricultural❑ ^_?
Monitoring❑ Recovery ❑ Heat Pump Water Injection❑ Other❑ If Other,List Use
2. WELL LOCATIff {
Nearest Town: i-fa�cW 1 County tf5l%� TT� ographic/Land setting
(nRidge ❑Slope ❑Valley ❑Flat
Flfa t� / =_i7 (check appropriate box)
(Street Name,Numbers,Community,Subdivision,Lot No.,Zip Code) Latitude/longitude of well location
3. OWNER: Mfnk &omit f (degrees/minutes/seconds)
Address /1tif PWr e4- con&e ti.� Latitude/longitude source:❑GPS❑Topographicmap ,
1-� l (Street or Route No.) (check box)
}Erb tr$en� It /NC. DEPTH DRILLING LOG
City or Town State Zip Code From To Formation Description
(�)- 99 1-3a4I` u (10 Q v4-
Area code-Phone number ,�, �O S S%U-
4. DATE DRILLED i—lo-t ,�
tu-
5. TOTAL DEPTH: : —
6. DOES WELL REPLA E EXISTING WELL? YES El 1�0 Er 0 3' S
7. STATIC WATER LEVEL Below Top of Casing: � FT. l m (1 of
, Y (Use"+"if Above Top of Casing) /)- �-Z,�- 5
8. TOP OF CASING IS— FT.Above Land Surface" T �
"Top of casing terminated at/or below land surface requires a
variance In accordance with 15A NCAC 2C.0I18.
9. YIELD(gpm): 30 METHOD OF TEST r`r
10. WATER ZONES(depth):
LOCATION SKETCH
11. DISINFECTION:Type �t"({ Amount Show direction and distance in miles from at least
12. CASING: Wall Thickness two State Roads or County Roads.Include the road
Depth Diameter or Weight/Ft. Material numbers and common road names.
From l) To.LL_Ft. !,f�_ SUR ZIl f C-
From To Ft.
From To Ft.
13. GROUT: Depth Material Method
From 0 To 20 _Ft. Cr,,Cnt(,r
From To Ft.
14. SCREEN: Depth Diameter Slot Size Material I
From To Ft. in. in. \� i
From To Ft. in. in. ,
u
R
15. SAND/GRAVEL PACK:
Depth Size Material d>'
From To Ft.
From To Ft. u
C
16. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONS' ED LN ACCORDANCEi WITfi'ISA NCAC 2C,WELL I
CONSTRUCTION STAN ARDS,AND THAT A COPY OF �'SXO1tD Y1AS'BEEN PRCI 'iDED TO THE WELL OWNER '-
SI NATURE OF PERS(12�J CgNSTROCTING TH$'�ELL I DATE
Submit the original to the Division of Water Quality,Groundwater Section,1636 Mail Service Center-Raleigh;NC
27699-1636 Phone No.[phone],within 30 days. - GW-1 REV.07/2003 i

WELL CONSTRUCTION RECORD
North Carolina-Department of Environment and /Naattural1R,esourrccees-Division of Water Quality-Groundwater Section
WELL CONTRACTOR(INDIVIDUAL)NAME (print) I 1 1Cfi-`ice 2x A-,« CERTIFICATION#�[��`L /1
WELL CONTRACTOR COMPANY NAME_�fT't I 1 LJP,I L .f-- ODU a PHONE # (J2&!F I`1 ' 4 7�v
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(ifapplicable) (ifapplicable)
1. WELL USE(Check Applicable Box): Residential "unicipal7Public❑ Industrial ❑ Agricultural❑
Monitoring❑ Recovery ❑ Heat Pump Water Injection❑ Other❑ If Other,List Use �—
Z
I
2. WELL LOCATIO // Topogra�Ic/Land setting O `'�
Nearest Town: t fct. 4k County c'f'sLlffSd!t ❑Ridge L9Slope ❑Valley ❑Flat f-;
(check appropriate box) :3 ;CA �
(Street Name,Numbers,Community,Subdivision,Lot No.,Zip Code) Latitude/longitude of well location
n -
3. OWNER: �✓� GSM '7. 7-I, o f\ (degrees/minutes/seconds) 1
Address2(;�T:,I -- Cr Latitude/longitude source:❑GPS❑Topographic map
(Street r Route No.) (check box)
IIrS' . 'KT DEPTH DRILLING LOG
City gCToown _ slate zip Code From To F rmation Description
(tea i lK `Ls G 1
Area code-Phone number
4. DATE DRILLED 1—
5. TOTAL DEPTH: (�05t `
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO GJ/Z g7
7. STATIC WATER LEVEL Below Top of Casing: FT. V u0
r (Use"+"if Above Top or Casing)
8. TOP OF CASING IS FT.Above Land Surface•
`Top of casing terminated atlor below land surface requires a
variance in accordance with ISA NCAC 2C.0118.
9. YIELD(gpm):A METHOD OF TEST r(3(a✓
10.WATER ZONES(depth):_
LOCATION SKETCH
11. DISINFECTION:Type + Amount Show direction and distance in miles from at least
12. CASING: Wall Thickness two State Roads or County Roads.Include the road
Depth Diameter or Weight/F[. Material numbers and common road names.
From- To 3 ' Ft. (, SK'2-k f yG 0d���
From To Ft.
From To Ft.
13. GROUT: Depth Material Methodt�'y.
From C To 20 _Ft._frnc�c4 (y)„/���•.T- \i
From To Ft. 7
14. SCREEN: Depth Diameter Slot Size Material J
From To Ft. in. in.
From To Ft. in. in. L
15. SAND/GRAVEL PACK:
Depth Size MaterialFrommTo Ft. tE
Fro To Ft.
r_ I
16. REMARKS:
I
1 DO HEREBY CERTIFY THAT THIS WELL WAS to T7tLhtED IN ACCORDANIC,E WITH ISA NCAC 2C,WELL
CONSTRUCTION S RDS,AND THAT A OF THIS RECORD PROVIDED TO THE WELL OWFPK-
L! JUN 27
I .
i� SIGNATURE OF PERSON CONSTRUCTINUTHE WELL DATE
Submit the original to the Division of Water Quuljty,troundwatet$CV*n',1636 Mail Service Center-Raleigh,NC '
27699-1636 Phone No.[phone],within 30__- "sF=� t __ GW-1 REV. 0772001

WELL CONSTRUCTION RECORD
North Carolina-Department of Environment and Natural Resources-Division of Water Quality-Groundwater Section
WELL CONTRACTOR(INDIVIDUAL)NAME io(print) �4->t- Wor�ePr CERTIFICATION# `I'Y�`
WELL CONTRACTOR COMPANY NAME_Merr-M G' D
ll c /,-10J PHONE # fr!_14) Y77-4yf-p
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQPERMIT# 0SI001100011
(if applicable) (ifappiicable)
1. WELL USE(Check Applicable Box): Residential R6 Municipal/Public❑ Industrial ❑ Agricultural❑
Monitoring❑ Recovery ❑ Heat Pump Water Injection❑ Other❑ If Other,List Use
2. WELL LOCATION: Topographic/Land setting
Nearest Town: Dkn County-14endemm ❑Ridge ❑Slope ❑Valley
3) Fro4c 14 i 1( RDd (check appropriate box)
(Street Name,Numbers,Community,Subdivision,Lot No.,Zip Code) Latitude/longitude of well location
3. OWNER:_ Donw.t f (Ve C 6.' 4 (degrees/minuws/seconds)
Address 133 E—ic 1141 Rol Latitude/longitude source:❑GPS❑Topographic map
(Street or Route No.) (check box)
��PN�<Kan�ill n/C. �k 9 DEPTH DRILLING LOG
y,�City or Town , I lScaatt Zip Code From To Formal*on Description
( 2 )- 61), �l a J-� L r�,s't _
Area code-Phone number
4. DATE DRILLED a-V lly y 5­
5. TOTAL DEPTH:
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO 2 r
7. STATIC WATER LEVEL Below Top of Casing: FT.
t (Use"+"if Above Top of Casing) :-.�
8. TOP OF CASING IS�_FT.Above Land Surface*
r, >
`Top of casing terminated aUor below land surface requires a �
variance In accordance with 15A NCAC 2C.01la. ff -"i
9. YIELD(gpm): I METHOD OF TEST r50ew F
10.WATER ZONES(depth):_
LOCATION SKETCH
11. DISINFECTION:Type (-(Y(f Amount Show direction and distance in miles from at least
12. CASING: Wall Thickness two State Roads or County Roads. Include the road
Depth Diameter or Weight/Ft. Material numbers and common road names.
From 0 To /Z 4 Ft. LI4 Art 5,.
From To Ft.
From To Ft.
13. GROUT: Depth Material Method ,Al
From 0 To ZO _Ft._ "e.e•r-/e
From To Ft.
14. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in.
From To Ft. in. in.
15. SAND/GRAVEL PACK: Fa--C N.,JI
Depth Size Material /20
From To Ft.-
From-To-Ft.
16. REMARKS: U,
" 1
I DO HEREBY CERTIFY THAT THIS WELL WAS CON NCAC 2C WELL i
CONSTRUCTION STANDARDS,AND THAT A COPY O JP I CORD TAS-LI E P I TO THE WELL OWNER t� ,
orS'
SIGNATURE OF PERS CONST T �' -- i
�`� i , RUB,. �THF.�t�j!);LL I I t I DATE �_
i
Submit the original to the Division of Water Qualitt ,Groundwater Section,1636 Mail Service Center Raleigh,; 1 r }
27699-1636 Phone No.[phone],within 30 days. `` - - ,J GW I REV 6VT 1 ��

WELL CONSTRUCTION RECORD R`
North Carolina-Department of Environment and Natural Reso/i1[)ces-Division of Water Quality-Groundwater Section _
WELL CONTRACTOR(INDIVIDUAL)NAME (print) h[/(1:� (�CAcpr— CERTIFICATION# 31`�
WELL CONTRACTOR COMPANY NAME 14 f e m,II W/ I/ bliPvn PHONE # f`raY) s'7�_y YJ'-6
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT# n51 vfJl CU b)�,�
(if applicable) (ifapplicable)
1. WELL USE(Check Applicable Box):Residential 3 Municipal/Public❑ Industrial❑ Agricultural❑
Monitoring❑ Recovery ❑ Heat Pump Water Injection❑ Other❑ If Other,List Use
2. WELL LOCATI i Topogr 1c/Land setting
Nearest Town: County jti<�/t '` 0"� ❑Rid e g C�Slope ❑Valley ❑Flat
(check appropriate box)
(Street Name,Numbers,Community,Subdivision,Iqr No.,Zip Code) Latitude/longitude of well location
3. OWNER: LQ rf. "t,lt II iGv^'cS (degrees/minutes/seconds)
Address f 7�M`r,_(,G,;f e -tee Latitude/longitude source:❑GPS❑Topographic map
�C '/Cl (Street oN�to No.) ; (check box)
i Yt DEPTH DRILLING LOG
City or To��,nn _ State Zip Code From To ommation Description
Area code-Phone number
4. DATEDRILLED /-24,-05-
5. TOTAL DEPTH: 2oS
b
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO 8'
7. STATIC WATER LEVEL Below Top of Casing: 7-o' FT. c
f (Use•'+•'if Above Top of Casing)
S. TOP OF CASING IS FT.Above Land Surface*
-Top of casing terminated at/or below land surface requires a _-
variance in accordance with 15A NCAC 2C.0118. /� _
9. YIELD(gpm): 10 METHOD OF TEST A' fir✓ ut
10.WATER ZONES(depth):_
LOCATION SKETCH
11. DISINFECTION:Type L4rY Amount Show direction and distance in miles from at least
12. CASING: Wall Thickness two State Roads or County Roads.Include the road
Depth Diameter or Weight/Ft. Material numbers and common road names.
From 0 To 7 Ft. & 50Ft 2t VG
From To Ft.
From To Ft. \
13. GROUT: Depth Material Metho S
From 0 To ZO _Ft. Cc,c,,4- /l1,elei LA
From To Ft. Lu'
x
14. SCREEN:. Depth Diameter Slot Size Material '
From To Ft. in. in. -J
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft. k r—==
From To Ft. o
J
t7 �a1R
16. REMARKS:
1 DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED-IN ACCORDANCE WITH 15A NCAC 2C,WELL
CONSTRUCTION STANDARDS,AND H A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL 0 "
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE _-
Submit the original to the Division of Water Quality,Groundwater Section,1636 Mail Service Center-Raleii(
27699-1636 Phone No.(919 733-3221,within 30 days. - 7/20 ? !i
) Y GW-1 REV.07/2001

WELL CONSTRUCTION RECORD
North Carolina-Department of Environment and Natural Resou es//-Division of Water Quality-Groundwater Section
WELL CONTRACTOR(INDIVIDUAL)NAME (print) w,1y n' r'Isi~— CERTIFICttA+�TION# � to
WELL CONTRACTOR COMPANY NAME 6�� PHONE #
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PEILMIT#
(if applicable) (if applicable)
I. WELL USE(Check Applicable Box): Residential L]-�unicipal/Public❑ Industrial ❑ Agricultural❑
Monitoring❑ Recovery ❑ Heat Pump Water Injection❑ Other❑ If Other, List Use
2. WELL LOCATION: County r.r A Topographic/Land setting
Nearest Town:_ klch[/trCar� '��0^,+((.
❑Ridge ❑Slope ❑Valley 1111`tat'
(check appropriate box)
(Street Name,Numbers,Community,Subdivision,Lot No.,Zip Code) Latitude/longitude of well location
3. OWNER:�q,-bbQ c,/JeS (degrees/minutes/smonds) -
Address p[). Pisx_a,(i(tr(Y¢ Latitude/longitude source:❑GPS❑Topographic map
C tea,5 treat or Route No.) (check box)
7F' DEPTH DRILLING LOG
City or Town ` State Zip Code From To Form tion Description
Area code-Phone number �
4. DATE DRILLED
5. TOTAL DEPTH:_ UZ
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO 2'
7. STATIC WATER LEVEL Below Top of Casing: FT.
(Use"+"if Above Top of Casing)
8. TOP OF CASING IS r FT.Above Land Surface*
*Top of casing terminated at/or below land surface requires a r rs
variance in accordance with 15A NCAC 2C.0118.
9. YIELD(gpm): ')aMETHOD OF TEST •�P�r _ !
10. WATER ZONES(depth):
LOCATION SKETCH
11. DISINFECTION:Type /��/f 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. k4atcrial numbers and common road names.
From To Ft. tst/y Soe 21 ;(A/C
From To Ft.
From To Ft.
13. GROUT: Depth Material M— ethgd�
From f3 To 2 0 _Ft._(e��c ram!-•. /yy� /( t/
From To Ft.
14. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in.
From To Ft. in. in. Aa�«
15. SAND/GRAVEL PACK: YA1 P^=E
Depth Size Material o��R
From To Ft.
From To Ft.
16. REMARKS: t -
I DO HEREBY CERTIFY THAT THIS WELL WASEONSTRUCTEDIN—AQCOR4ANCE WITH ISA NCAC 2C WELL r'• i �1`,
CONSTRUCTION STr�I�YID THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNED C-
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE ., I G`
Submit the original to the Division of Water Quality;Groundwater Section,1636 Mail Service Center Raletki44_NO
27699-1636 Phone No.[phone],within 30 days.--- .... _. GW 1 REV 107/2001

WELL CONSTRUCTION RECORD
North Carolina-Department of Environment and Natural Resources-Division of Water Quality-Groundwater Section
WELL CONTRACTOR(INDIVIDUAL)NAME
rI(print)6"o— P"' CERTIFICATION#3i 5�
WELL CONTRACTOR COMPANY NAME I'/e—ill a rl( y-A, ') PHONE # fi 2971 S'77-41VY::
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
1. WELL USE(Check Applicable Box): Residential EK—Municipal/Public❑ Industrial ❑ Agricultural❑
Monitoring❑ Recovery ❑ Heat Pump Water Injection❑ Other❑ If Other, List Use
2. WELL LOCATION: ,Topographic/Land setting
Neare Town 46r1 hx: CountyLJR idge ❑Slope ❑Valley ❑Fla[
�- (2L✓ (check appropriate box)
(Street me,Nu/mbers,Community,Subdivision,Lot No.,Zip Code) Latitude/longitude of well location
n
3. OWNER: Aux ee"ba (degrees/minutes/seconds)
Address 135' wgiiok Ri( Latitude/longitude source:❑GPS❑Topographic map
(Street or Route No.) (check box)
.7h - DEPTH DRILLING LOG
From City or Town State Zip Code m To Formation Description
2� )- g y-To,-q-- & ("o ,,
Area code-Phone number _c' (;0 Sufi- j�, ✓/
4. DATE DRILLED
—3=
5. TOTAL DEPTH: 3di
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO ��>n 2 5/ e L
7. STATIC WATER LEVEL Below Top of Casing: FT.
Zri 32i IJ.wl Q..�F_
(Use"+"if Above Top of Casing) �
8. TOP OF CASING IS ] FT.Above Land Surface' _
-Top of casing terminated at/or below land surface requires a -
variance in accordance with 15A NCAC 2C.0118. A
9. YIELD(gpm): 0 METHOD OF TEST (r '. o
10.WATER ZONES(depth):_
LOCATION SKETCH
11. DISINFECTION:Type HT-H 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 b To III Ft. (ot�_ SNLlf VLFrom To Ft.
From To Ft. 5
13. GROUT: Depth Material Method
From 0 To to Ft.Cv1"1-4a hLLe-rd
From To Ft.
14. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in. `'ff
From To Ft. in. in.
15. SAND/GRAVEL PACK: �a r
Depth Size Material
From To Ft.
From To Ft.
lCe
16. REMARKS: {
I DO HEREBY CERTIF /1 HIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C,WELL Imo"
CO—NrI,([/C I ,, /RDS HAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNEg i �-•
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
Submit the original to the Division of Water Quality,Groundwater Section,1636 Mail Service Center-Raleigh,
27699-1636 Phone No.[phone],within 30 days. GW-I REV.07/40�1 i e�3i
z L Gib i

V
ti
WELL CONSTRUCTION RECORD
North Carolina-Department of Environment and Natural ReApurcce-"s-Division of Water Quality-Groundwater Section
WELL CONTRACTOR(INDIVIDUAL)NAME
/(print)410— 4- VUOAI�G-1 CERTIFICATION# 3 s T(—
WELL CONTRACTOR COMPANY NAME 1 r 12(Ct�� w�l� 1'Pe'^`!� PHONE #
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
I. 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: tI Tographic/Land setting
Nearest Town: derv{er3ar �>IE. County#&+ 1erjcr�
N�,f Idge ❑Slope ❑Valley ❑Flat
.f...esl°� �'O�w (check appropriate box)
(Street Name,Numbcn,Community,Subdivision,Lot No.,Zip Code) Latitude/longitude of well location p
3. OWNER: �JUC Pf10ar{e (degrees/minutes/seconds)
Address G 3�— -L$`7(i Nrr" 1t Latitude/longitude source:❑GPS❑Topographic map
(Street or Route No.) (check box)
I�c'serknr zc DEPTH DRILLING LOG
City or Town State Zip Code From To Formation Descri tion
�)--�`tEp 3r--! D W n•,F P
Area code-Phone numb
LPG
4. DATE DRILLED 'zl-°r 067
O'
5. TOTAL DEPTH: 363
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO in 10 7 �E
7. STATIC WATER LEVEL Below Top of Casing: Cz* FT. 2'f 5':.�- ((�.,.� E .
(Use"+"if Above Top of Casing)
8. TOP OF CASING IS Z FT.Above Land Surface* C�
'Top of casing terminated et/or below land surface requires e
2
variance In accordance,with 15A NCAC 2C.0118. 8 -`
9. YIELD(gpm): METHOD OF TEST A.,all
10.WATER ZONES(depth):_ C:) €-
LOCATION SKETCH :111
11. DISINFECTION:Type t'Irµ Amount Show direction and distance in miles from at least
12. CASING: Wall Thickness two State Roads or County Roads.Include the road
Depth 13'a(neter or Weight/Ft. Material numbers and common road names.
From To`I r Ft.
From To Ft.
From To Ft. Z
13. GROUT: Depth Material Method
From C To LO Ft. �nnG�ck, frr1�R"+.✓-- •�y
From To Ft. � �.
14. SCREEN: Depth Diameter Slot Size Material �rcNO g)c�
From To Ft. in. in. FYPf
From To Ft. in. in. _
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft. }✓�
From To Ft.
16. REMARKS:
I DO HEREBY CERTIFY T T THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C I LL'
CONSTRU ON A S,AND THAT A'COPY OF THIS RECORD HAS BEEN PROVIDED TO THE •L6 R"- _
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
o C:Q
Submit the original to the Division of Water Quality,Groundwater Section,1636 Mail Service Center-1,�,1' h,NC°''� E
27699-1636 Phone No.[phone],withiYr30-dayr---- =- =----` GW-1 07/200, G'�)
r �� K

WELL CONSTRUCTION RECORD
North Carolina-Department of Environment and am al R��e$$//QQurces-Division of Water Quality-Groundwater Section
WELL CONTRACTOR(INDIVIDUAL)NAME (print / CERTIFICATION#31D
WELL CONTRACTOR COMPANYNAMEMecn II Wed yL­ Pkje PHONE # ($28S1 7-44VE_c�
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
1. WELL USE(Check Applicable Box): Residential 16 Municipal/Public❑ Industrial ❑ Agricultural❑
Monitoring❑ Recovery ❑ Heat Pump Water Injection❑ Other❑ If Other,List Use
2. WELL LOCATION: Topographic/Land setting
Nearest Town: NC^4rSortdd(� County erwerSa�. ❑Ridge lope ❑Valley ❑Flat
111 v k6inCrae/( (check appropriate box)
(Street Name,Numbers,Community,Subdivision,Lot No.,Zip Code) Latitude/longitude of well location
3. OWNER: F-01, AT grr
`I f(degrees/minutestseconds)
Address /b `7 Ot Cr"(e Latitude/longitude source:❑GPS❑Topographic map
'I ' (Street or Route No.) (check box)
tftw 47w)yQ Alt, DEPTH DRILLING LOG
(4110 City or Town state Zip Code From To Formation Description
Area code-Phone number 1r(_
4. DATE DRILLED 3-21 fzs foctr-
5. TOTAL DEPTH: AZr ll,� /PU Srrf p( v t L-
6. DOES WELL REPLACE EXISTING WELL? YES_❑ NO.E�liO LLj Re<(L Z
_1
7. STATIC WATER LEVEL Below Top of Casing: • FT.
(Use'Y'if Above Top of Casing) .t
8. TOP OF CASING IS FT.Above Land Surface* o
'Top of casing terminated at/or below land surface requires a
variance In accordance with 15A NCAC 2C.011d. 't3
9. YIELD(gpm): Za METHOD OF TEST tl �4
10.WATER ZONES(depth):
LOCATION SKETCH
11. DISINFECTION:Type (.{T Amount Show direction and distance in miles from at least
12. CASING: Wall Thickness two State Roads or County Roads. Include the road
Depth Diameter or Weight/Ft. Material numbers and common road names.
From D To ss FL G I�_ SQK Lt Poe-
From—To Ft.
From To F[. I
13. GROUT: Depth Material ethyd
From O To Lo Ft._Co^e QhI
From To Ft.
14. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in.
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft. vr,*4.
From To Ft.
16. REMARKS:
1 DO HEREBY CERTIFY THAT THIS WEEL, ,kS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C,WELL
CONS RUZ STANDARDS,AND THAT k1 COPY OF THIS RECORD$AS BEEN PROVIDED TO THE WELL OVAIER
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE --=i 3
= i trt
Submit the original to the Division of Wata['Quality,Groundwater Section,1636 Mail Service Center-Raleig ;
Gib
( ) y GW-1 REV. ittO01
27699-1636 Phone No. 919 733-3221,Wi[f1iH��a s.-

WELL CONSTRUCTION RECORD
North Carolina-Department of Environment and Natural Resources-Division of Water Quality-Groundwater Section
y y"
WELL CONTRACTOR(INDIVIDUAL)NAME (print) C/1eo t? ��'//�G/��- CERTIFICATIONa�i
WELL CONTRACTOR COMPANY NAME/ relse_/ / 1�t�Az PHONE k C79 '�7Y�'Y�//� ' �
I
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
ifa licable (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
Neatest Town:hohe,1EZ Ser/l Ji;-��e County ❑Ridge ❑Slope ❑Valley ❑Flat
-Ioz? ,/,2 ? '� ,ST b�.//T/�. •a1L (check appropriate box)
(Street Name,Numbers,Community,Subdivision,Lot No.,Zip Code) Latitude/longitude of well location
3. OWNER: F/ S cYrn "-7W (degrees/minutes/seconds)
Address il3 ,VX 7_,f 5' - Latitude/longitude source:❑GPS❑Topographic map
(StrSe�t or Route No., -3 (check box)
1-1/," � afl //e04P DEPTH DRILLING LOG
City or Town State Zip Code From To Formation Description
Pew)- 66'� -6-4//l
Area code-Phone number_ _ �) •".rfi a ,.�
4. DATEDRILLED 5
5. TOTALDEPTH: 2=T-2
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO �� L
7. STATIC WATER LEVEL Below Top of Casing: FT. c)p •- Q�(i
(Use"+"if Above Top of Casing)
8. TOP OF CASING IS FT.Above Land Surface* _?
*Top of casing terminated attor below land surface requires a
variance in accordancgwith 15A NCAC 2C.011 a. C:)
9. YIELD(gpm): MET OD OF TEST4/ /`
10.WATER ZONES(depth):
LOCATION SKETCH
11. DISINFECTION:Type Amount Show direction and distance in miles from at least
12. CASING: Wall Thickness two State Roads or County Roads.Include the road
Depth ' Diameter or Weight/Ft. aterial numbers and common road names.
From 0 To Ft. 24
From To Ft. crFe' '4
From To Ft.
C7 r j�� L477 d�
13. GROUT: Depth Matf , I Method I
From_Toj Z e_Ft.,-srr/�tf ;"X �,J1
From To Ft.
14. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in. -
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
G
16. REMARKS: — -7
1 DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15ANCAC 2C,WELL
CONSTRUCTION STANDARDS,AND THAT A COPY OFF THIS RECORD H S BEEN PROVIDED TO THE WELL OWNER
��
17
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
Submit the original to the Division of Water Quality,Groundwater Section,1636 Mail Service Center-Raleigh,NC
27699-1636 Phone No.[phone],within 30 days. OW-1 REV.07/2001