Mi CY2005

WELL CONSTRUCTION RECORD 307636
North Carolina-Department of Environment and Natural Resources-Division of Water Quality-Groundwater Section
WELL CONTRACTOR(MIMUAL)NAME
(Prrint)f EZv� \w/E 115 CERTIFICATIONp#��+ 1 3
WELL CONTRACTOR COMPANY NAME J]�]�P.IACW4& V V r ,L?1(1 i N Q PRONE # VA)� �oJ•'1
STATE WELL CONSTRUCTION PERMIT# IIIT��� w���,1.ED WQ PERMIT#
if applicable) if livable
MEMNON
1. WELL USE(Check Applicable Box):Residential Municipal/Public❑ Industrial O Agricultural❑
Monitoring❑ Recovery O Heat pump Water Injection❑ Other❑ If Other,List Use
2. WELL LOCA N T
Nearest Town: LR �A c/Land setting
�n0 �tRleS County t' Midge USlope OValley OFIat
�l U �0!5- (checkapptopriawbmt)
(Saver Name,Numbers,Community.subdivision,lot No.,tip code) Latitude/longitude of well location
3. OWNER_Tl�i lTf� l�j-D lei
(degenlmimsue/seoonds)
Address Latitudellongitude source:OGPSOTopographic map
;3 8�'p (Sucet or Room No) (check box)
' ' t��s� I� tf e gn� EP DRILLING LOG
City or Town seam zip code From To Formation Description
L--)-
Am oode•Phone m®ber
4. DATE DRILLED
5. TOTAL DEPTH: ` ' _
6. DOES WELL REPLACE EXISTING WELL? YE NO
7. STATIC WATER LEVEL Below Top of Casing: FT.
(Use.+"if Above Top of Casing) n
8. TOP OF CASING IS I FT.Above Land Surface'
_:.
'Top of casing terminated at/or below land surface requires■
variance in accordance with 15A NCAC 2C.011L
9. YIELD(gpm): 1P_METHOD OF TEST
10.WATER ZONES(depth):_LOQi
LOCATT
11. DISINFECTION:Type Ammmf Show direction and distance in miles from at toast
12. CASING: Wall Thickness two State Roads or County Roads.Include the road
Diameter or Weight/Ft Material numbers and common road names.
From _ T Ft, �w /
From_To Ft LQ
FrorrL—To._
13. GROUT: Depth Ft C l7 ll V�(E!�)
From To
From To Ft q
14. SCREEN: Depth Diameter Slot Sim Material
From To Ft in. uL
From To Ft in. in. ao
15. SAND/GRAVELPACK
Depth- Sim Material ,.UT
From To Ft.
From To Ft.
16. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C,WELL
CONSTR ION ST ,AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO TFIE WELL OWNER
SIGNATURE OF ON 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.(919)7333221,within 30 days. GW-I REV.07/2001

WELL CONSTRUCTION RECORD 3 0 9 8 2 6
North Carolina- Department of Environment and Natural Resources-Division of Water Quality-Groundwater Section
\\'ELL COV RACI'OR(INDIVIDU.AL)NAME (print) CERTIFICATION
W ELL.CON'fRAC'fOR COMPANY NAME . ?i�,� t�✓e' t t l)( t( q' f" PHONE #
STATE M ELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable) (if appl icablc)
I. WELL USE(Check Applicable Box): Residential ID Municipal/Public❑ Industrial ❑ Agricultuml ❑
Monitoring❑ Recovery ❑ Heat Pump Water Injection❑ Other❑ ICOther, List Use
2. WELL L LOCATION Topographic/Land setting
Nearest T .own: <.np"f County 'n'r ❑Ridge QSlope ❑Valley ❑Flat
't ( 12 1 . o C
(check appropnate box)
(Street Name.Numbers,Community,SubdvYn,lotNo,Zit'
Cudc) Latitude/longitude of well location
3. OWNER: ,f5c"Z�,l''U l_c � T.ti %�(, -(c-C_ (dlegreeslminuteslseconds)
Address Latitude/longitude source:❑GPS❑Topographicmap
(Street or Route No.) (check box)
DEPTH DRILLING LOG
' aryor rmen State zip coae From To Fomtation Description
Area code.Phone number
4. DATE DRILLED 3- 2 ,!
5. TOTAL DEPTH: ye.�—
6. DOES WELL REPLACE EXISTING WELL? YES❑ NO B-
7. STATIC WATER LEVEL Below Top of Casing: //C. FT.
(Use"+"if Above Top of Casing)
8. TOP OF CASING IS FT.Above Land Surface* _
`Top of casing terminated actor below land surface requires a - .!ir;
'�f ^
variance is accordance with 15A NCAC 2C.01ILL
9. YIELD(gpm): 1 METHOD OF TEST /4/ /L
10_WATER ZONES(depth):
LOCATION SKETCH
11. DISINFECTION:Type Amount ' a 2- 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 na s.
m Fro To FL
From' To ?-% Ft%t•�c/ 4C' ?
From f<.. ' To t! Ft t
13. GROUT: Depth Material Method C Iti
From To Ft. 23.
From_ To '> FLCo
14, SCREEN: Depth Dian, e r Slot Sin Material [
From To Ft. in. in.
From To Ft. in. in. (.� CD
15. SAND/GRAVEL PACK:
Depth Size Material « $sf
From L To FL . - 4.�
From To Ft. {
16. REMARKS: f
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C,WELL(-
CONSTRUCTION STANDARPj 8,.AND THAT A COPYP OF THIS RECORD HAS BEEN PROVIDED TO THE WELL QWNER
�
1l - -
�SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE -
t`'
0
Submit the original to the Division of Water Quality,Groundwater Section,1636 Mail Service Center-Raleigk NC o
27699-1636 Phone No.[phone],within 30 days. GWA REV,t07/2001

3 0
309802
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: SPRUCE PINE County MITCH Topographic/Land setting
700 ALTAPASS CH OF GOD RD. ❑Ridge ❑ Slope ❑ Valley ❑ Flat
(Street Name,Numbers,Community,Subdivision,Lot No.,Zip Code) (check appropriate box)
3. OWNER: TIM SNYDER Latitudellongitude of well location
Address 700 ALTAPASS CH OF GOD RD. _
(Street or Route No.) (degrees/minutes/seconds)
SPRUCE PINE NC 28777 Latitude/longitude source: ❑ CPS ❑Topographic trap
City or Town State Zip Code (check box)
8( 28)—765-6087 DEPTH
Area Code Phone number From To
4.DATE DRILLED 03/05/05
5.TOTAL DEPTH: 705 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 11=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): 1 METHOD OF TEST ARD number and common names
10. WATER ZONES(depth): HWY.#221 N.FROM MARION.LEFT ON HWY.
#226 TO SPRUCE PINE. RT.HALLTOWNTO SPRUCE PINE. RT.HALLTOWN RDA
11. DISINFECTION:Type CHLORYTE Amount 19.5 BURGER ICING.RT.ON ALTAPASS RD.LEFT ON
12. CASING: Wall Thickness ALTAPASS CH.OF GOD RD.GO 3/4 MILE&RT.
Depth Diameter or Weight/Ft Material ON TOP OF THE HELL RD.WHITE TOP OF THE RD.WHITE HOUSE
From 0 To 90 Ft 6-1/4" SDR21 PVC DEAD END.
From To_Ft.
From_To Ft_
13. GROUT: Depth Material Method
From 0 To 20 Ft.OUEKRETE POURED
From_To_Ft. Av
14.SCREEN: Depth Diameter Slot Size Material
From_To_Ft._ in. in. W
From_To_Ft._ in in.
15. SAND/GRAVEL PACK: Ln
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 T14AT A.COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
9SIGgATURE OF PERSON CONSTRUCT CONSTRUCTM THE WELL DATE
Submit the original to the Division of Water Quality,Groundwater Section, 1636 Mail Service Center—Raleigh,NC
27699-1636 Phone No. [phone],within 30 days. GW-1 REV.07/2001

North Carolina-Department of Environment and Natural Resources-Division of Water Quality-Groundwater Section 3090
y n 9 0 1 '7
1636 Mail Service Center- Raleigh,N.C.27699-1636-Phone[phone] c3 l7 l/
WELL CONSTRUCTION RECORD WELL CONTRACTOR: Dewey Wrightlh'ell Pump Co.. Inc.
WELL CONTRACTOR CERTIFICATION#: 2791
050066 STATE WELL CONSTRUCTION PERMIT#: Albert Slate
1. WELL USE(Check Applicable Box): Residential DY Municipal 0 Industrial 0 Agricultural 0 Monitoring 0
Recovery 0 Heat Pump Water Injection 0 Other 0 If Other,List Use:
2. WELL LOCATION:(Show sketch of the location below)
Nearest TowdT nJ: anRd A K'F�aRRC V`oII II Fr i County: .MLT( 14FI I
RGy �i oI EN Y
ammn ~F
s nantlLot o.l DRILLING LOG DEPTH
3. OWNER I ARRY S GA 1TZ From To Formation Description
Address r R n dR nI PT("RAVF,L
HAINFSW;it oute No. El '2'iAdd Aft An C-RAKIITF
ity or Town State Zip Nue ry
ran R+ rRr=vlrF
4. DATE DRILLED !^4�S f2n0F All ^a6l u-RANIIIE
5. TOTAL DEPTH 3n0 9d.ri ^dR S;g
6. CUTTINGS COLLECTED YES 0 NO EO ?dA inn 13BAts1
7. DOES WELL REPLACE EXISTING WELL? YES 0 NO 0
8. STATIC WATER LEVEL Below Top of Casing: 5 FT.
(Use',"if Above Top of Casing)
9. TOP OF CASING IS 1 FT. Above Land Surface*
'Top of casing terminated at/or below land surface requires a variance in actor- , ` -j
dance with 15A NCAC 2C.0118 -
10. YIELD (gpm): 4 METHOD OF TEST Air LA
11. WATER ZONES (depth): 1.50 oom 60-61 2.50aom 245-248
0.00 aom 0 OOaom
12. CHLORINATION: Type HTH Amount 59 If additional space is needed use back of form a
13. CASING: Wall Thickness LOCATION SKETCH
Depth Diameter or WeighUFt. Material (Show direction and distance from at least two Slate
From D To 49-Ft. 6 '/4 IRA AIV Roads,or other map reference points) �f
From To Ft. 1
From To Ft.
14. GROUT: 11,,
Depth Material Method 1l�
From 0 To 20 Ft. mf�— Gravilty Flow
From To Ft. J�taj�
15. SCREEN: Yh7,
Depth Diameter Slot Size Material (((
From To Ft. in. in. /)-
From To Ft. in. in. L1t.tL.e eye
From To Ft. in. in. eq� •
16. SAND/GRAVEL PACK:
Depth Size Material
From To Ft. ,
From To _ Ft.
17. REMARKS: �t
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C,WELL
CONSTRUCTION STANDARDS,AND THAT COPY OF THIS RECORD HAS BEEN PRPRROVIDED TO THE WELL OWNER.
FOR OFFICE USE ONLY
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
Quad No: Submit original to Division of Water Quality,Groundwater Section within 30 days
GW-1 REV. 12/99
Serial No.

o3-1�
WELL CONSTRUCTION RECORD
North Carolina- Department of Environment and Natural Res^ouuraces(- Division of Water Quality-Groundwater Section
r?
\VELL CONTRACTOR(INDIVIDUAL)NAME (print{) J 9�ggl L1 CERTIFICATION
,�-py
WELL.CONTRACTOR COMPANY NAME�)1, ��ell ye211 s1leT PHONE # I�r>F])
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 LOCATION: ographic/Land setting
I�Learcst Town: .�+-Y:E.. A-e-- County I Idge ❑Slope ❑Valley ❑Flat
"* 'x !SN2t� -Zcii t (check appropriate box)
(Street Name.Numbers,Community.
Subdivision,Lot No.,Zip Code) Latitude/longitude of well location
3. OWNER: Ss hca✓i ' (degrees/minutes/seconds)
Address __�,$" '�f Latitude/longitude source:❑GPS❑Topographic map
� i�(Street or oute No.) (check box)
1:lYMFY4tii��� tiK �475� DEPTH DRILLING LOG
City or Town State Zip Code From To Formation Description
62g-)- t"1l_„a�Cz:a,�KA n ) 5,
Area code-Phone number
4. DATE DRILLED - •�.? �'� �Z�,_ -3.� ;
5. TOTAL DEPTH:_--i�
6. DOES WELL REPLACE EXISTING WELL? YES ElNO 'fJ �r
7. STATIC WATER LEVEL Below Top of Casing: fj�L U FT.
(Use"+"if Above Top of Casing) a t"
8. TOP OF CASING IS�_FT.Above Land Surface*
`Top of casing terminated at/or below land surface requires a N
variance in accordance with 15A NCAC 2C.0118.
9. YIELD(gpm): I —METHOD OF TEST AA
10. WATER ZONES(depth): W y r1A C -
I LOCATION SKETCH
11. DISINFECTION: Type i Amount 610 - Show direction and distance in miles from at leasM
12. CASING: Wall Thickness two State Roads or County Roads. Include the road
Depth Diameter or Weight/Ft. Mate al numbers and common road names.
From 0 To2 \ Ft. 6 � 4 �iJt•SU T `s 9 ,J� �
From To Ft.
From De FL �;,k_
L` TW 1s
13. GROUT: Depth Material n Method --- _ -
From 0 Tom Ft._L �
From To FL
r
14. SCREEN: Depth Diameter Slot Size Material I) iM
From To Ft. in. in.
From To Ft. in. in.
15. SAND/GRAVEL PACK: -. =1
Depth Size Material
From To Ft.
From To Ft. �t Q
16. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C,WELL
CONSTRUCTION ST DARDS,AND ATA OPY OF THIS RECORD HAS BEEN PROVIDED TO THE WdE�LL 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 of Water Quality-Groundwater Section
\VELL CON'q RACI'OR(INDIVIDUAL)NAME (print) evi"i l � �� CERTIFICATION�. y#�1Ll
WELL CO.N'I'RAC I OR COMPANY NAME Yr s/�e ' + e- ( PHONE # )-,6 `b� H I
S"rA I E t\'ELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT
(if applicable) (if applicable)
1. WELL USE(Check Applicable Box): Residential Municipal/Public❑ Industrial ❑ Agricultural ❑
Monitoring ❑ Recovery ❑ Heat Pump Water Injection❑ Other❑ If Other,List Use
2. WELL LOCATION" Topographic/Land setting
Nearest Town: V45NA- County !rl tIle, LoR�ge ❑Slope ❑Valley ❑Flat
fp (check appropriate box)
(Street Name,Nlirribers,Community,Subdivision,Lot No.,Zip Code) Latitude/longitude of well location
3. OWNER, 54, (degrees/minutes/smonds)
Address 36 5 Latitude/longitude source:❑GPS❑Topographic map
AAA,
vv
(Street or Route No.) (check box)
AAA,N 2 S C— 7(`44D DEPTH DRILLING LOG
City or Town State Zip Code From To Formation Description
O 417)
Area code-Phone nwnber
4. DATE DRILLED 3-1'-6'' >
5. TOTAL DEPTH: , ILLCUwt
6. DOES WELL REPLACE EXIsJrING WELL? YES ❑ NO.� -
7. STATIC WATER LEVEL Below Top of Casing: 20 FT.
(Use"+"if Above Top of Casing) (
8. TOP OF CASING IS f FT.Above Land Surface*
'Top of casing terminated at/or below land surface requires a
variance in accordance with 15A NCAC 2C.0118. 3 "+
9. YIELD(gpm): _2_METHOD OF TESTA�k —
10. WATER ZONES(depth): �� '3v"ll`i Pa :a:
LOCATION SKETCH (A
It. DISINFECTION:Type Ae Amount Show direction and distance in miles frost lea
12. CASING: Wall Thickness two State Roads or County Roads.Inclu691he road
Depth` Diameter cl��eih�Ft. terial numbers and common road names. ,
From_11 To I FL �j
From To Ft.
From To Ft.
13. GROUT: Depth Material Method
From Q_To A< Ft._ �
From To Ft. V
v jgt'
14. SCREEN: Depth Diameter Slot Size Material t
From To Ft. in. in. Ok1 Knup �j
From To Ft.—in. in. A
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 15ANCAC 2C,WELL-, --)-
CONSTRUCTION STANDAR�AT Y 0 THIS RECORD HAS BEEN PROVIDED TO THE WELT OWNER N ! -
3e
SIGNATURE OF nRSON 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

311609
WELL CONSTRUCTION RECORD
North Carolina- Department of Environment and�N//�,rur`al `Resources-Division of Water Quality-Groundwater Section
WELL CONT RACIOR(INDIVIDUAL)NAME (pri{ntt)Lr_`�+V'AJ9_�d^� I� CERTIFICATION#_ 5b
WELL CONTRACTOR COMPANY NAME f•17C /tr 1I V�/�-II r�Q� � t�'1 PHONE
STATE\CELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT# -- -
(ifapplicable) (if applicable)
I. WELL USE(Check Applicable Box): Residential Municipal/Public ❑ Industrial ❑ Agricultural,Jtx:,.
Monitoring❑ Recovery ❑ Heat Pump Water Injection❑ Other❑ If Other,List Use _--
2. WELL LOCATIQIJ: I ;Popographic/Land setting,
Nearest Town: t County / P / i
Id a ❑Sloe ❑Valle ❑Flat l
�. �� (check appropriate box) 1 _
(Street Name.Numbers,Comm.nity,Subdivision,Lot No-Zip Code) Latitude/longitude of well 1'ocatton
3. OWNER: `f +'" (degrees/minutes/seconds
Address R. Y jet Latitude/longitude source:❑GPS❑ topographic map - --
(Sire t or Route Na.) (check box) — -
N(L DEPTH DRILLING LOG
City or To State Zip Code From To Formation Description
ti)- (WIG7Y� 0— 3S k
Area code-Phone number /
4. DATE DRILLED -C'S
5. TOTAL DEPTH: ✓Z lid Iff —/
6. DOES WELL REPLACE EXI TING WELL? YES ❑ NO L�l k
7. STATIC WATER LEVEL Below Top of Casing: 60 FT. D
(Use"+"if Above Top of Casing) W
8. TOP OF CASING IS_�FT. Above Land Surface*
-Top of casing terminated at/or below land surface requires a iV
variance in accordance wiitt(15A NCAC 2C.0118. 1
9. YIELD (gpm):�/ METHOD OF TEST �92 -
10. WATER ZONES(depth): C-1n, I O
LOCATION SKETCH We
11. DISINFECTION:Type 02k-le- Amount Show direction and distance in miles from at leas
12. CASING: Wall Thickness two State Roads or County Roads. Include the roa
Depth Diameter or W ight/Ft. Material numbers and common road names.
From © To 'q0 Ft.4
From To Ft.
From To Ft.
13. GROUT: Depth Material Method / 4�
From 9 To �'Ch FL L'a--r�
From To Ft. I
14. SCREEN: Depth Diameter Slot Size Material (J[
From To Ft. in. in. 1_
From To Ft. in. in. Y
15. SAND/GRAVEL PACK:
Depth Size Material �• 1 t
From To Ft. /�
From To Ft. �-\r✓
16. REMARKS:
1 DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C,WELL
CONSTRUCTION STANDAR ,AND THAT A�!'-Y�OF T IS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
6- ;?
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

311608
WELL CONSTRUCTION RECORD
North Carolina- Department of Environment and Natural Reso ivision of Water Quality-Groundwater Section
WELL CONTRACTOR(INDIVIDUAL)NAME (print) ✓ s ) CERTIFICATION
y9; 0
WELL CONTRACTOR COMPANY NAME f j PHONE # f✓7r�'6) LfW. r�7 T)
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PE IT#
(if applicable) (if applicable)
I i
I. WELL USE(Check Applicable Box): Residentiak9---�Municipal/Public❑ Industrial ❑ Agricultural ❑
Monitoring❑ Recovery ❑ Heat Pump Water Injection ❑ Other❑ If Other, List Use
j
2. WELL LOCATION: ographic/Land setting ';'
NearestTowrr County Idge ❑Slope ❑Valley ❑Flat
icx Q !:�R (check appropriate box)
(Street Name,Numbers,Community,Subdivmmn,Lot No.,Zip Code) Latitude/longitude of well location
3. OWNER: `fit' 91 R. _ (degrees/minutes/seconds) -
Address I ! Wk _ Latitude/longitude source:❑GPS❑Topographic map -
� r (Street or Route No.) ., (check box)
(^
�C�I� 4I 3o--er7 5� DEPTH DRILLING LOG
Gry or Tow'''��J11 '�
Scat zip code From To Form ion Description -
Area code-Phone number
4. DATE DRILLED 5-3-o' -
5. TOTAL DEPTH: an A- l
6. DOES WELL REPLACE EXIS ING WELL? YES Off a �
7. STATIC WATER LEVEL Below Top of Casing: FT.
(Use"+"if Above Top of Casing) N ?'
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): _ METHOD OF TEST
10. WATER ZONES (depth): - 1D
t LOCATION SKETCH
t 1. 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 y� Di or eighUFt. teri numbers and common road names.
From To Ft.
From To Ft.
From To Ft.
13. GROUT: Depth Material Method
From To_26__Ft.
From To Ft.
14. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in.
From To Ft. in. in.
15. SAND/GRAVEL PACK: �„ - �&
Depth Size Material (e-
From To Ft. 111
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 PY OF HIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
Q�
SIGNATURE OF PE 2S0 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.(9I9)733-3221,within 30 days. GW-1 REV.07/2001

WELL CONSTRUCTION RECORD 311412
North Carolina-Department of Environment and Natural Resources-Division of Water Quality-Groundwater Section
WELL CONTRACTOR(INDIVIDUAL)NAME (print) ��
' 4 h 1& y—\ CERTIFICATION# q
WELL CONTRACTOR COMPANY NAME_r� id ell 1lc,ll�na PHONE(Y�w �9= '95�1/
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
1. WELL USE(Check Applicable Box):Residential Municipal/Public ❑ Industrial ❑ Agricultural ❑
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other,List Use
2. WELL LOCATION: / // Topographic/Land setting
Nearest T'PPwn: 17 e- AC County ?C?c� ❑Ridge V ope ❑Valley ❑Flat
/'qC nk(t- � (check appropriate box)
(Street Name,Numbers,Community,Subdivisio t No.,Zip Code) Latitude/longitude of well locating
3. OWNER: �r /A Ili, < ���s (degrees/minutesiseconds)
Address Q "416of C, tc,4Sab s.-) Latitude/longitude source:2GPS❑Topographic map
(Street or Route No.) (check box)
%5 12 id' ��j'f�eJ' DEPTH DRILLING LOG
CiryorTowf State Zip Code From To Formate nDescription
.kea code-Phone number Q1 3o
5. DATE DEPTH: l b b 9'
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)
S. TOP OF CASING IS�—FT.Above Land Surface* O
*Tap of casing terminated atlor below land surface requires a
variance in accordance with ISA NCAC 2C.0118.
9. YIELD(gpm):_ 3 METHOD OF TEST_ -
10.WATER ZONES(depth):
LOCATION SKETCH - - - --
11. DISINFECTION:Type Amount / 07- 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 WeighuTt. Material numbers and common road names
From D To Ft. (n�_ SI28.al —V(l —
From To FL -
From To Ft.
13. GROUT: Depth Material Method u
Fromm To a 1) Ft. Cone ro [e Pow -
From To Ft. ra -
14. SCREEN: Depth Diameter Slot Size Material
From To FLin. in.
From To FL in. in.
15. SAND/GRAVEL PACK: - ---
Depth Sin Material
From—To—- 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 THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
a &4'4i / - /D- 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],within 30 days. GW-I REV.07/2001

311405
WELL CONSTRUCTION RECORD
North Carolina-Department of Environment and Natural Resources-Division of Water Quality-Groundwater Section
WELL CONTRACTOR(INDIVIDUAL)NAME (print) I r 141 to ✓� CERTIFICATION k 3—t&WELL CONTRACTOR COMPANY NAME Al C�trSaj 'tf/ell 1`sr i ll..j PHONE: a n 692-2YIq
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT$
(if applicable) (if applicable)
I. WELL USE(Check Applicable Box):Residential le'Municipal/Public ❑ Industrial ❑ Agricultural ❑
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other,List Use
2. WELL LOCATION: //,, Topographic/Land setting
Nearest Town: ;?.-( NI'11 County tdge ❑Slope ❑Valley ❑Flat
___ -/^�it 19n Rnr,*J. (check appropriate box)
(Street Name, umbers,Community,Subdivision,Lot No.,Zip Code) Lati e/lo igitude of well/l+ocati n /
3. OWNER: + (degmes/minutesise nds)
Address T" Y�4�r1 W- fJ7S❑Latitude/longitude source: PTopographic map
(Sire[or Route No.) (check box)
/&21JA �'L au902 DEPTH DRILLING LOG
City or Town State Zip Code From To FOt7natio Description
(mow- b69• 1,57..? 0 /4
Area code-Phone number - lR
3. DATE DRILLED
5. TOTAL DEPTH: 'A
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO 9___�
7. STATIC WATER LEVEL Below Top ofCasing: FT. a <
(Use"+"if Above Top of Casing)
8. TOP OF CASING IS FT.Above Land Surface*
"Top of easing terminated at/or below land surface requires a „A
variance in accordanc with I5A NCAC 2C.0118. l9
9. YIELD('pm).
=METHOD OF TEST_ r-n
10.WATER ZONES (depth): ya
LOCATION SKETCH
11. DISINFECTION:Type H 7 f/ AmountJ bz. 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 Weight/Ft. Material numbers and common road names.
From To' F[. b __2
From To Ft.
From To Ft. - - -
13. GROUT: Depth Material MethodQt '
-_From To_a(Z Ft. C[>nC ro Le p eA �
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/cAI'J 71 o4�.t.
16. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C,WELL
CONSTRUCTION STANDARDS,AND THAT A CCCOPPY�OF THIS
FECORD 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

nQ,Q 31A. Z C%; ,)
WELL CONSTRUCTION RECORD
North Carolina-Department of Environment and Natural Resources-Division of Water Quality-Groundwater Section
WELL CONTRACTOR(INDIVIDUAL)NAME (print) .4rtr �` /-t'��� r CERTIFICATION# -
/
WELL CONTRACTOR COMPANY NAME f_ fTSe q well Tc(Ilmc PHONEWV) 'e V.3 -,9 1/q
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
1. WELL USE(Check Applicable Box):Residential 01" Municipal/Public ❑ Industrial ❑ Agricultural ❑
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other,List Use
2. WELL LOCATION: Topographic/Land setting
Nearest Town: k,.rest Ile County ek, ❑Ridge ❑Slope Zl*dley ❑Flat
_ _ Cub Greo. k (check appropriate box)
(Street Name,Numbers Community,Subdivision,Lot No.,Zip Code) Latitude/l ngirude of well to ation
3. OWNER:.�(7(/ !—f Ol m2tJ degrees/minutes/seconds)
Address �_ _ .S Latitude/longitude source:❑GPS❑Topographic map
F (Street or Route No.) (check box)
,4 /✓C rO,�j' DEPTH DRILLING LOG
City Town stale, Zip Code From To Formation Description
L BB- G 10
:lea ode-Phone number I �� 07 3 roe rye, .,.y-
A. DATE DRILLED 7- /6 - o `� �S/
5. TOTAL DEPTH: /SS , ?
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO
7. STATIC WATER LEVEL Below Top of Casing:_15 FT. v 'r
(Use"+"if Above Top of Casing) C
8. TOP OF CASING IS FT.Above Land Surface*
W
*'fop of casing terminated at/or below land surface requires a
variance in eccorit with 15.4NCAC2C.0118. p
9. YIELD('pm): METHOD OF TEST 1L eqLn
10. WATER ZONES(depth):
LOCATION SKETCH �-
11. DISINFECTION:Type f'/ 7-f/ Amount Oz. Show direction and distance in miles from at least
12. CASING: Wall Thicla[ess two State Roads or County Roads. Include the road
Depth Dipeier or Weight/Ft. Material numbers and common road names.
From O To_22. F[. ,e SDRdI YYC
From To Ft.
From To Ft.
13. GROUT: Depth Material Method
From_. Tom' [)Ft. Conefo Le _Ptl uc' �
'� ('�',,/�
From To FL
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. - W
From To Ft.
16. REMARKS: CD
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAO 2C WELL
CONSTRUCTION STANDARDS,AND HAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL:OWNER -
���� `-- -7-/6 - oJG
SIGNATURE OF PERSON 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-1 REV.07/2001

7",i
`F North Carolina-Department of Environment and Natural Resources-Division of Water Quality-Groundwater ction V
1636 Mail Service Center-Raleigh, N.C. 27699-1636- Phone [phone]
WELL CONSTRUCTION RECORD WELL CONTRACTOR: D"swey 4 01- Y', l! p,cmp cr
WELL CONTRACTOR CERTIFICATION#:
STATE WELL CONSTRUCTION PERMIT#: -6`t ,7i _--
r
d
1. WELL USE(Check Applicable Box): Residential El Municipal 0 Industrial 0 Agricultural Mdnftor`ng -
Recovery El Heat Pump Water Injection E Other El If Other, List Use: _
ry
2. WELL LOCATION:(Show sketch of the location below)
Nearest Town: `2Ri CE PI cyR _ County: Ml'('HP:i ' - ---,
rh ct r o-� fir;•tcNnt)� r � ;;r' r.cc r,,ai : pu -
(RoadNameand umbers, ommumry,or ubtlrvisonand o[ oL N ) DRILLING LOG DEPTH
3. OWNER H1 JGHES From To Formation Description..
Address
?e n n" te No.l rn �.n -,107
-
i tteet or ou _ i
0f217'c r�f.,R .._,r.. ;, , :y-� :. n : .0(z C
City or Town State Lip Code F'7(1 F71 4iJS( C
4. DATE DRILLED :r77�7:1rr h7i fi15 ^-rnn t . -
5. TOTAL DEPTH
6. CUTTINGS COLLECTED YES ❑ NO
7. DOES WELL REPLACE EXISTING WELL? YES O NO ED to
8. STATIC WATER LEVEL Below Top of Casing: 10 FT. z=
(Use'4"if Above Top of Casing) 1`7
Ell
9. TOP OF CASING IS FT.Above Land Surface*
"Top of casing terminated at/of below land surface requires a variance in accor-
dance with 15A NCAC 2C.0118 �.
10. YIELD (gpm): ' 5 METHOD OF TEST `aif"
11. WATER ZONES (depth): " mrr 570 ''''
DO c^n, fa 00aum t
12. CHLORINATION: Type '4 H Amount -If additional space is needed use back of form,
13. CASING: Wall Thickness LOCATION SKETCH
Depth Diameter or Weight/Ft. Material (Show direction and distance from at least two State
From ^ To IT Ft. a 110 1vo Roads,or other map reference points)
From To Ft. _
From To Ft.
14. GROUT:
Depth Material Method
From To 7n Ft. ' " -'-
From To Ft.
J
Ai A
15. SCREEN: w `
Depth Diameter Slot Size Material•'—
From To Ft. in. in. V '
From To Ft. in. in.
From To Ft. in. in.
16. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
17. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCOR15XNCE WITH 15A NCAC 2C,WELL
CONSTRUCTION STANDARDS,AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER.
FOR OFFICE USE ONLY r1
SleN161JRE OF PERSON CONSTRUCTING THE WELL DATE
Quad No: Submit original to Division of Water Quality,Groundwater Section within 30 days
GW-1 REV.12/99
Serial No.

North Carolina-Department of Environment and Natural Resources-Division of Water Quality-Groundwater Section
1636 Mail Service Center-Raleigh,N.C.27699-1636-Phone[phone]
WELL CONSTRUCTION RECORD WELL CONTRACTOR: •=. wey "Vt i2ht'
WELL CONTRACTOR CERTIFICATION#: <,n; r
05'1" STATE WELL CONSTRUCTION PERMIT#: 0=rr­ ""'"on
I '
1. WELL USE(Check Applicable Box): Residential Municipal 0 Industrial 0 Agricultural❑ Mbnitpting LJ -
i
Recovery Heat Pump Water Injection 0 Other 0 If Other, List Use: I V_-
2. WELL LOCATION:(Show sketch of the location below) 2 i C=)
Nearest Town c-,i,c!RSV'LLE County. et r HE
[5
EI-T C GL"K FcL OFF C"UE c-r�n :IFF !`
(Road Name antl Numbers ommumty orsob rvisionaod Lot No) DRILLING LOG DE TH
MIKE r-)l�'ti' From To Formation —
3. OWNER - ---
Address 24237 9UCF br,EER BL4!D ^ 2P ,IFT SLJjt-_-F
5 ug4or Route o.l ,-i h.`(..F 4 ,RO i i}C.T��ti� �:.,16. •r c. _ _ Ki ;�f! i i.
amity oror Town State ip Code t�10 'at f -F
4. DATE DRILLED +' 2 �`?'ir15 161 G iiFL"ii''F '"-;i:=�,FIT j
5. TOTAL DEPTH t325 SA 341 C,R cN TE
6. CUTTINGS COLLECTED YES E] NO Y�-, 570 'RAINITE
7. DOES WELL REPLACE EXISTING WELL? YES 0 NO ED '?IT `'71
8. STATIC WATER LEVEL Below Top of Casing: 2'=L1 FT. 57' S '7Rar`II`c
(Use"t'if Above Top of Casing) C3
9. TOP OF CASING IS FT.Above Land Surface* '
'Top of casing terminated at/or below land surface requires a variance in accor-
dance with 15A NCAC 2C.0118
10. YIELD (gpm): '- -' METHOD OF TEST A _
11. WATER ZONES (depth): 1.U0 .- 'r'1SLI81 '•.f1 CG r1
4.50 RGtn 670-57 "1 00gprn
i2. CHLORINATION: Type I-r-rH Amount `B If additional space is needed use back of fo _..
13. CASING: LOCATION SKETCH
-
Wall Thickness
Depth Diameter or WeighVFt. Material ij, (Show direction and distance from at least two State
From I' To `' Ft. 6 .19 r:5?? s'"" {� ��-+` Roads,or other map reference points)
From To Ft.
From To Ft.
14. GROUT:
Depth Material Method
From 0 To 29 Ft. '21`02211 r=.^h, clbke i
From To Ft.
15. SCREEN: I
Depth Diameter Slot Size Material
From —To— Ft. in. in.
From To Ft. in. in. --" -
From To Ft. in. in.
1`
16. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To _ Ft.
17. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C,WELL
CONSTRUCTION STANDARDS,AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER. t"
FOR OFFICE USE ONLY
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
Quad No: Submit original to Division of Water Quality,Groundwater Section within 30 days
GW-1 REV.12/99
Serial No.

i
North Carolina-Department of Environment and Natural Resources-Division of Water Quality-Groundwater Section
1636 Mail Service Center-Raleigh,N.C.27699-1636-Phone[phone] 31 T" d
WELL CONSTRUCTION RECORD WELL CONTRACTOR: ^y x,„
WELL CONTRACTOR CERTIFICATION#: ',1°7
Z 1p3 STATE WELL CONSTRUCTION PERMIT#: i'`A ils -
1. WELL USE(Check Applicable Box): Residential ❑ Municipal❑ Industrial ❑ Agricultural❑ .Monitoring-❑
Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use:
2. WELL LOCATION: (Show sketch of the location below)
Nearest Town: County _ !.-
Ta an Nam lmNo ra, omm v.o u a.741n em to DRILLING LOG
3. OWNER —.'r.-.es;;�'r E_-,-,h-c'".-'.S - From To Formation Description
Address T3 c o r - -rI=w 0,2
City or To n State Zip'Code
4. DATEDRILLED 1�21�n9 -
5. TOTAL DEPTHY
6. CUTTINGS COLLECTED YES ❑ NO
7. DOES WELL REPLACE EXISTING WELL? YES ❑ NO 0
8. STATIC WATER LEVEL Below Top of Casing: +^ FT.
(Use"+"if Above Top of Casing)
9. TOP OF CASING IS FT. Above Land Surface* t=o Q4F
*Top of casing terminated at/or below land surtace requires a variance in actor-
dance with 15A NCAC 2C.0115
10. YIELD (gpm): 1" METHOD OF TEST 6_, 1
11. WATER ZONES (depth): 1 lf1 nc t't3-'"
n 00 r^
D Qttrsrm --�—
12. CHLORINATION: Type 41TM Amount 40 If additional space is needed use back of form:.
13. CASING: Wall Thickness LOCATION SKETCH
Depth Diameter or Weight/Ft. Material (Show direction and distance from at least two Site
From To " Ft. R +,•: ^�r1 ^'+;^ �_� Roads,or other map reference points)
From A To Ft �\
From To Ft.
14. GROUT:
Depth Material Method C3
From To Ft. e^•
From To Ft.
15. SCREEN: .>�*
Depth Diameter Slot Size Material ,
From To Ft. in. in. �.k,..` 'L till
From To Ft. in. in. -- -' fi
From To Ft. in. in. '
16, SAND/GRAVEL PACK: I t i J .
Depth Size Material
From To Ft.
From To Ft.
17. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C,WELL
CONSTRUCTION STANDARDS,AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER.
FOR OFFICE USE ONLY
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
Quad No: Submit original to Division of Water Quality,Groundwater Section within 30 days
GW-1 REV. 12/99
Serial No.

WELL CONSTRUCTION RECORD
North Carolina- Department of Environment and Na rat Resource ivtelsiio,,n,of Water Quality-Groundwater Sectiioon�/;
W'ELLCON'TRACfOR(INDIVIDUAL)NAMEE(prin_t) �Z, yl L—)��L,qc. �� CERTIFICATION i Z5010
WELL.CON1RACTOlt COMPANY NAME 1 r=� ) J7Ci II11'�'tQ PHONE #
STA'I E w'ELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
I. WELL USE(Check Applicable Box): ResidentialB-Municipal/Public ❑ Industrial ❑ Agricultural 113"
Monitoring❑ Recovery ❑ Heat Pump Water Injection❑ Other❑ If Other,List Use
2. WELL LOCATION: M , Topographic/Land setting
Nearest Town:`?1PxjlP2�,� County M! ❑Ridge ❑Slope IRValley ❑Flat
1 t`7 7_1 1±1�2( l-4, =Z?& (check appropriate box)
(Street Name.Numbers,Community,Subdivision,Lot No.,Zip Code) Latitude/longitude of well location
a
3. OWNER "xe-vw (degrees/minutes/seconds)
Address I I q:i --ICv Latitude/longitude source:❑GPS❑Topographic map
e f (Streeter Route o.) (check box)
I�FIQP [ �IQ NC 25'70< DEPTH DRILLING LOG
City or Town State Zip Code From To Formation Description
(�)-h t l 8 U'-4 lcf -
Area code-Phone number — '7 4s`
4. DATE DRILLED Cn`1 — 7 T
5. TOTAL DEPTH: CE �. 1 �
6. DOES WELL REPLA EXIS ING WELL? YES ❑ NO 6�
7. STATIC WATER LEVEL Below Top of Casing: ;A� FT.
(Use"+"if Above Top of Casing)
8. TOP OF CASING IS FT.Above Land Surface'
'Tap of casing terminated at/or below land surface requires a �r
variance in accordance with ISA NCAC 2C.0118. (.
9. YIELD(gpm): N' METHOD OF TEST_,h,- L
10. WATER ZONES(depth):
LOCATION SKETCH
11. DISINFECTION: Type 4 lolinc Amount c,, d Show direction and distance in miles from a&st
12. CASING: Wall Thickness two State Roads or County Roads. Include the road
Depth Diameter or we
M�at�enypI numbers and common road names.
From b To 30 Ft �l /
From To Ft.
From To Ft.
13. GROUT: Depth Material Method /
From 0 To_��Ft. Ge ✓ `
From To Ft. ��. .
14. SCREEN: Depth Diameter Slot Size Material X� 0
From To Ft. in. in.
From To Ft. in. in.
15, SAND/GRAVEL PACK:
Depth Size Material nih
From To Ft.—
From—To Ft.
16. REMARKS:
J C —51
CC
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C,WE --z I—
CONSTRUCTION STA ARDS,AND T A C Y OF THIS RECORD HAS BEEN PROVIDED TO THE WELL R
-i
O c_
SIGNAT RE OF PERSON WINS I RUCTING THE WELL DATE ? :�{ o G
cn
Submit the original to the Division of Water Quality,Groundwater Section, 1636 Mail Service Center-Rai, G'7
27699-1636 Phone No.[phone],within 30 days. GW-1 RE F07/

WELL CONSTRUCTION RECORD
North Carolina- Department of Environment and jj))Natural Resourcest- Division of Water Quality-Groundwater Section
WELL CONTRAC1 OR(INDIVIDUAL)NAME (print)ii/` 7c A-> (i D��c��Z CERTIFICATION
ya�.-�yo
WELL COM RACfOR COMPANY NAME Y't F1 GI �'X x ) 1` PHONE ItfVS) Ira�^�'r 17I
STA'I E\YELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(ifapplicable) (ifapplicable)
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:!�@�tj I' County Elkidge ❑Slope ❑Valley ❑Flat
V/^ U FO& (check appropriate box)
(Street Name,Numbers,Community,Subdivision,Lot No.,Zip Code) Latitude/longitude of well location
3. OWNER:;Z" fh4t 1JE)J (degrees/minutes/seconds)
Address /B I-) mjjt Latitude/longitude source:❑GPS❑Topographic map
({tree[or Route No.) / (check box)
It'2 �� a � 3 DEPTHDRILLING LOG
Gry o To Town rate Zip Code From To Fo a ion Description
(�)- -,Zt
Area code-Phone number
4. DATE DRILLED 7 l—Q� _ '
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 A FT. Above Land Surface*
*Top of casing terminated aVor below land surface requires a
variance in accordance with ISA NCAC 2C.0118.
9. YIELD(gpm):.0 METHOD OF TEST 44t?�
10. WATER ZONES(depth): 6DyJ:Z0 , tl9v­c> .�
LOCATION SKETCH
11. DISINFECTION: Type Amount Show direction and distance in miles from at I6
12. CASING: Wall Thickness two State Roads or County Roads.Include the road
Depth Diameter or W i�hr1Ft. Material numbers and common road names.
From To 3� FL d" Wl 7okJ.�f,
From To Ft. `
From To Ft.
13. GROUT: Depth Material Method
From To Al FL
From To Ft.
14. SCREEN: Depth Diameter Slot Size Material
From To Ft, in. in.
From To Ft. in. in. O
15. SAND/GRAVEL PACK: �
Depth Size Material
From To Ft.
From To Ft.
16. REMARKS: r �
c- - �c-
I DO HEREBY CERTIFY THAT IS WELL WAS CONSTRUCT IN ACCORDANCE WITH 15A NCAC 2C,W rL_ r
CONSTRUCTION STANDA ,AND THAT HI ECORD HAS BEEN PROVIDED TO THE WELL (PW3�ER
CD
SIGNATURE OF PERSON CO TRUCTING THE WELL DATE
is vi
Submit the original to the Division of Water Quality,Groundwater Section, 1636 Mail Service Center Ra7�d(teio NC �
27699-1636 Phone No.[phone],within 30 days. GW I REV 07/2001 --_---

WELL CONSTRUCTION RECORD
North Carolina- Department of Environment N' and�Natural Resources- Division of Water Quality-Groundwater Section �}
WELL COTRACIOR(INDIVIDUAL)NAME '1/1 �o ?Rse?y CERTIFICATION A;? 5. N(%4
W 'f WELL CON RAC COMPANY NAME /
� I t• e1I Loe I' -5bR 1 � PHONE #
STATE q'ELL 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 LOCAT ON,,:11-- (y�x` topographic/Land setting
Nearest Town:�A1eEQ`vU 1� Ile Cot(my� Topographic/Land
❑Slope []Valley ❑Flat
�& V4L)� ;katp ( i�V ,rr�p a•, (check appropriate box)
(Street Nanre,Nm ers,Community.Subddivision,Lot No.,Zip Code) Latitude/longitude of well location
3. OWNER: !° /'ry IG I��.C't CDR (degrees/minutes/seconds)
Address &9 ��fl Latitudedongitude source:❑GPS❑Topographic map
( r et or Route No.) (check box)
CrR�J), I�e �Cv �q Gif�>, DEPTH DRILLING LOG
City or Town state Zip Code From To Formation Description
Area code-Phone number
4. DATE DRILLED I-O
5. TOTAL DEPTH:
6. DOES WELL REPLACE EXI ING WELL? YES ❑ NO GY
7. STATIC WATER LEVEL Below Top of Casing: tyn 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
f.
variance in accordance with ISA NCAC 2C.0118. �
9. YIELD (gpm): �50—METHOD OF TEST �l✓ , 57
t 0. WATER ZONES(depth):
��a�
LOCATION SKETCH
11. DISINFECTION: Type Amount Show direction and distance in miles from at9st ..A
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._�� _,�kI "NIL
From To Ft.
From To Ft. �iL
13. GROUT: Depth Material Method -'�
From To Ft._C-Ps--< <2 - .
From To Ft. IF
c
14. SCREEN: Depth Diameter Slot Size Material r
From To Ft. in. in. ` 7I
From To Ft. in. in. -= p
15. SAND/GRAVEL PACK:
Depth Size Material
v
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 STANDA SAND THAT A C9T_y OF THI 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,INC
27699-1636 Phone No.[phone],within 30 days. GW-1 REV.07/2001

a
C#
WELL CONSTRUCTION RECORD
North Carolina- Department of Environment and Natural Resources-Division of Water Quality-Groundwater Section
WELL CONTRACTOR(INDIVIDUAL)NAME (print) It A,�,.. OFXI�SL� CERTIFICATION
yk/r��rC,I
WELL CON IRACTOR COMPANY NAME /' It e I I l A d/�i PHONE #
STATE O'ELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
E/
1. WELL USE (Check Applicable Box): Residential Municipal/Public ❑ Industrial ❑ Agricultural ❑
Monitoring ❑ Recovery ❑ Heat Pump Water Injection❑ Other❑ If Other, List Use
2. WELLLOCATIOV: Topogra m/Land setting
Nearest Town: �Jtx'.. '..f'C County 1 "� ❑Ridge .�e ❑Valley ❑Flat
KoZ6 1�L 1�c «2;tCp (check appropriate box)
(Street Name.Numbers,Community,Subdivision,Lot No.,Zip
Zip—Code) Latitude/longitude of well location
3. OWNER .A
X l'o . UI.'W (degrees/minutes/seconds)
Address �O t , 1 6 i Latitude/longitude source:❑GPSOTopographic map
(Strecc oror Route No.) (check box)
tl +c-C �'- - a8'777 DEPTH DRILLING LOG
City or Town State Zip Code From To Formation Description
( A)- 6`3' LL
Area code-Phone number � v } ---Z V ,
4. DATE DRILLED 'Z� 5 '��' S
5. TOTAL DEPTH:
6. DOES WELL REPLACE EXIS ING WELL) YES ❑ NO-Y
7. STATIC WATER LEVEL Below Top of Casing: 20 FT.
(Use"+"if Above Top of Casing)
8. TOP OF CASING IS I FT. Above Land Surface• 6
'Top of casing terminated at/or below land surface requires a t - =
variance in accordance with 15A NCAC 2C.0118. �{
9. YIELD(gpm): a� METHOD OF TEST
10, WATER ZONES(depth): 6e SCf7 )Ar> -�
—� ' LOCATION SKETCH
11. DISINFECTION: Type Amount Oe:, Show direction and distance in miles from at least
12. CASING: Wall Thickness two State Roads or County Roads. Include the road
Depth( Diamet r or Wgight/Ft. eriaal numbers and common road names.
From © To Ft. Ci flPy
From To Ft.
From To Ft.
13. GROUT: Depth Material �f� Method
From To Ft. GY.--Q
From To Ft. V
14. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in. t;W �
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Size Material '
From To Ft.—
From—To—Ft.
v — -
16. REMARKS:
_ - c C�)
' r—
I DO HEREBY CERTIFY PAT
THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH ISA NCAC 2C,WEL " N
CONSTRUCTION STA ARDS,AND T Y F THIS RECORD HAS BEEN PROVIDED TO THE WELL
CD
SIGNATURE 0 PERSON CONSTRUCTING THE WELL DATE , '� o
Submit the original to the Division of Water Quality,Groundwater Section, 1636 Mail Service Center-Ralei ;,
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
WELLe 0�61ELL COS"TRAC T OR(INDIVIDUAL)NAME,�r(print) '� CERTIFICATION#aC,77
\YELL CO.N'IRAC'I'Oil COMPANY NAME /✓�t 1i 4c iI 1 77a?+ /I PHONE # fief/
STATE\\'ELI,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 LOCATION: 1�) iTopographic/Land setting
Nearest Town: A-�tP1t5 County Ridge ❑Slope ❑Valley ❑Flat
"/ (check appropriate box)
(Street Name,( �^//CNuurnbers,,Corinna Loot No.,Zip Code) Latitude/longitude of well location
ff 3. OWNER: V � _S (degreeshninutes/seconds)
Address ILatitude/longitude source:❑GPS❑Topographic map
(Street or Route No.) (check box)
DEPTH DRILLING LOG
City or Town state Zip Code From To Form tion Description
Area code-Phone number
4. DATE DRILLED
5. TOTAL DEPTH: t
6. DOES WELL REPLACE EXIS ING WELL? YES ❑ NO Pf
za
7. STATIC WATER LEVEL Below Top of Casing: C'Q FT. .eT
(Use"+"if Above Top of Casing)
8. TOP OF CASING IS FT. Above Land Surface*
`Top of casing terminated at/or below land surface requires a
variance in accordance with ISA NCAC 2C.0118.
9. YIELD(gpm): �. METHOD OF TEST A;Ct
10. WATER ZONES (depth): ;,290 -56irli
` LOCATION SKETCH
c11
11. DISINFECTION: Type _ w4P-- Amoom, Show direction and distance in miles from at least 12. CASING: Wall Thickness two State Roads or County Roads. Include the road a
Depth Diameter or Weight/Ft. Material numbers and common road names.
From To '�_)Cli Ft.— F JeL .3�t. ±�_ -17P
From To FL
From To FL
13. GROUT: Depth Material t Method
From To ;W Ft. C:r
From To Ft. �
14. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in. _ --- __- -
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Size Material �-
From To Ft. �444Z
From To Ft.
16. REMARKS:
1 DO HEREBY CERTIFY TH THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C,WELL
CONSTRUCTION STAND DS,AND THAT Y THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
/6.. 0�-_
SIGNATURE!O ER 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

314824
t 4
WELL CONSTRUCTION RECORD
North Carolina- Department of Environment and Nat yral Resources- Division of Water Quality-Groundwater Section L�/�
WELL CON'TRACIOR(INDIVIDUAL)NAME
E((printt)� AXA Ai i � CERTIFICAA.TIIION.9 -25'�/" `
R'ELL CONTRACTOR COMPANY NAME I/ 1 4cle-1I ram'e I I TRI Y PHONE # 0.5`T�T'� r
S'rA I E WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
1. WELL USE(Check Applicable Box): Residential-E Municipal/Public ❑ Industrial ❑ Agricultural ❑
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other❑ If Other, List Use
2. WELL LOCATION: ArwH/f Topogra Ic/Land setting
Nearest Town .-^ >. I1�. Count /�1 ❑Ridge lope ❑Valley ❑Flat
/y P� /' \C Cd'���j/ f (check appropriate box)
(Street Name,Numbers,Community,Subdivisio ,Lot No.,Zip Code) Latitude/longitude of well location
3. OWNER r _ J10 I&Ii f-� (degrees/minutes/seconds)
Address /b!5! % tL-L&A 7R6 Latitude/longitude source:❑GPS❑Topographic map
i (StreetorRputcl o. (check box)
T*W 50, � +uC �g�p�j DEPTH DRILLING LOG
ity or sown state zip code From To Formation Description
Area code-Phone number
4. DATE DRILLED 'ro'- Sze �©
5. TOTAL DEPTH: a• 0
6. DOES WELL REPLACE EXI ING WELL? YES ❑ NO E +
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*
t�
"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 +�'�� '� "A
10. WATER ZONES(depth): M t4b `
LOCATION SKETCH w3
11. DISINFECTION: Type D l-'e—Amount DC Show direction and distance in miles from at least
12. CASING: Wall Thickness two State Roads or County Roads. Include the road
Depth p� Diameter or Wei*hdFt. Material numbers and common road names.
From ® To �O Ft. ��'p'-_•'Jt+�-'.-
From To Ft.
From To Ft.
13. GROUT: Depth Material li
Method COX
.,a/L'�~ q
From To Ft. L u' "�,, K
From To FL U
14. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in.
From To Ft, in. in.
15. SAND/GRAVEL PACK: ^7_
j
Depth Size Material
From To Ft.
From To Ft.
16. REMARKS:
1 DO HEREBY CERTIFY THAT THIS W LL WAS CONSTRUCTED IN ACCORDANCE WITH ISA {CAC Z'£rIWELL
CONSTRUCTION STANDARDS,AN HAT A C HI CORD HAS BEEN PROVIDED Ty0.T-HEW£LL OSUN6R - ---
r
41 -CJ3
SIGNATURE OF PERSON COTijSTRUCTING 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

V h C, s. 2.
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Reso - ivislon of Water Quality-Groundwater Section
WELL COV'IRAC'1'OR(INDIVIDUAL)NAME�nt) � � PHONE #CERTIFIC�� .(00\Y ELL CONrl1RACPOR COMPANY NAME
STA"f F,M ELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERM T#
(if applicable) (if applicable)
1. WELL USE(Check Applicable Box): Residential Municipal/Public ❑ Industrial ❑ Agricultural❑
Monitoring ❑ Recovery ❑ Heat Pump Water Injection❑ Other ❑ If Other, List Use
2. WELL LOCATI 1 topographic/Land setting
Nea, "Town: iPr County edge ❑Slope Malley ❑Flat
A— Pn br�h-S r (check appropriate box)
(Street Nerve,Numbers,Community,S
ubdiv
isi
o
n,
LLot No.,Zip Code) Latitude/longitude of well location
3. OWNER: `��—ilL (degrees/minutes/seconds)
Address t- �.hA1+ 7 Latitude/longitude source:❑GPS❑Topographic map
(Sir� )te—teNo.)/�J � (check box)
eF�,}"L9-/til_ DEPTH DRILLING LOG
Cu
y o own state zip code From To F rmaf n escription
- � K - 1727 c�- / Py6o
Area code-Phone nwnber
4. DATE DRILLED
5. TOTAL DEPTH: ! -
J
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO TJ '�-
7. STATIC WATER LEVEL Below Top of Casing: ,TO FT. -
(Use"+"if Above Top of Casing) C
8. TOP OF CASING IS FT.Above Land Surface* l
'Top creasing terminated at/or below land surface requires a
variance in accordance with 15A NCAC 2C.0118. F
9. YIELD(gpm): 13-- METHOD OF TEST
10. WATER ZONES(depth): ARID ,!b �t5iil� un -
LOCATIONSKETCH
11. DISINFECTION: Type OR 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 Diame er or Wei!y�ht/Ft. Materialnumbers and common road names.
From To—A, U ��
From To Ft. k
From To Ft.
13. GROUT: Depth Material - (� Method '
From To_ aS Ft. I'l
From To Ft.
14. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in. )�,,,.,
From To Ft. in. in. +"P"�+'� I� ,.-_ ^. ? a�
15, SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
16. REMARKS:
I DO HEREBY CERTIFY THAT TH=WELLASUCTED IN ACCORD NCE WITH ISA NCAC 2C,WEELCONSTRUCTION STANDARDS,AH HA EEN 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

3148 21
WELL CONSTRUCTION RECORD
North Carolina- Department of Environment and Natural Resources- Division of Water Quality-Groundwater Section
WELL CON I'RACIOR(IN'DIV[DUAL)NAME (print) "� �� ` 0 b /� CERTIFICATIONN## 2_
WELL COSI'RAC-I OR COMPANY NAME f r h�� `�_LL-5e[1_ z� PHONE # 11) L�i�'ol�yl
STATE\\'ELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential [tom Municipal/Public❑ Industrial ❑ Agricultural ff-�
Monitoring ❑ Recovery ❑ Heat Pump Water Injection❑ Other❑ If Other, List Use
2. WELL LOCAT N: topographic/Land setting
Nearc/$tt Toww � C,1�,.�o1untym� idge ❑Slope ❑Valley ❑Flat
l::y^IIO� HZ V 7` (check appropriate box)
(Street Name,Numbers,Community,S�ion,Lot No.,Zip Code) Latitude/longitude of well location
3. OWNER: �c,6,f�-A k
(degrees/minutes/seconds)
Address 01- tLatitude/longitude source:❑GPS❑Topographic map
_ L (Sneer or out No.) �� (check box)
DEPTH DRILLING LOG
city Town s are Zip Code From To ForTnatiqn Description
Area code-Phone number
4. DATE DRILLED -Pq-©
5. TOTAL DEPTH: -
6. DOES WELL REPLACE EX STING WELL? YES ❑ NO �
7. STATIC WATER LEVEL Below Top of Casing: &-) FT.
(Use-+"if Above Top of Casing) C
8. TOP OF CASING IS FT.Above Land Surface*
`Top of casing terminated attor below land surface requires a 1 `gib
variance in accordance w'th 15A NCAC 2C.0118.
9. YIELD (gpm): I METHOD OF TEST 0
10. WATER ZONES(depth): �, � -�
LOCATION SKETCH .i4,
11. DISINFECTION:Type Amount a' Show direction and distance in miles from at least 'l
12. CASING: Wall Thickness two State Roads or County Roads. Include the road
Depth Diameter or Weight/Ft. aater numbers and common road names.
From :> To_t-FL &
From To Ft.
From To Ft.
13. GROUT: ,c� Depth Material Method
From_c To_,;k-6' FL C
From Ft.De
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
From To Ft.
From To Ft.
16. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL AS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C,WELL
CONSTRUCTION STANDARDS,AND T A COPY R ORD HAS BEEN PROVIDED TO THE WELL OWNER
71,
/
GNATURE OF PERSOK CONSTR 1
i
Submit the original to the Division of Water Quality,Groundwat S lon,`r(II Mpil,,Semvrr cenit leigh,NC
27699-1636 Phone No.[phone],within 30 days. 4'1 '�"" GW-i' V.07/2001

4
WELL CONSTRUCTION RECORD a 3- : 19
North Carolina- Department of Environment and N tural Reso rces- Division of Water Quality-Groundwater Section
WELL CO.\TRACTOR(INDIVIUUAL)NAM Ey(Vp�rint1)_ ftlo�� 1 '4Jll CERTIFICATIONq�jt,�L'
WELL CO.N'I RAC I Oil COMPANY NAME�1i�C CyN�' Dq1 r�—PHONE # �i 7G5--
.�
Sl',YfE\\'ELL 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. WE[_L LOCATION: Topogr and setting
Nearwesst Town: " (. f� Countyp ❑Ridge Slope ❑Valley ❑Flat
check appropriate box)
(Street Name,Numbers,Community,Subdivision,Lot No_Zip Code) Latitude/longitude of well location
3. OWNER: `&A.— 17KM )� (degreeshninutes/seconds)
Address s'�. (�.v Latitude/longitude source:❑GPS❑Topographic map
� (Sweet orRpme No.)� q�� r-y check box
l .(Z�)Pl� � � I�S� DEPTH ( DRILLING LOG
Gry n To tale Zip Code From To r ton Description
4S (�9 5 Cg - F�.rn�
Area code-Phone number
4. DATE DRILLED
5. TOTAL DEPTH:
6. DOES WELL REPLACE EXIS ING WELL? YES ❑ NO E5' 7
7. STATIC WATER LEVEL Below Top of Casing: /CG FT.
(Use"+"if Above Top of Casing)
8. TOP OF CASING IS_�FT. Above Land Surface* C 11
-
*Top creasing terminated at/or below land surface requires a
variance in accordance with 15A NCAC 2C.0118. r
9. YIELD(gpm): tjO METHOD OF TEST AU� _-
10. WATER ZONES(depth): G,5 1 ZOO) 170 cn
t LOCATION SKETCH _
It. DISINFECTION: Type mount O't Show direction and distance in miles from at leash
12. CASING: Wall Thickness two State Roads or County Roads. Include the road
Depth Diameter or Weight/Ft. rial numbers and common road names.
From---CL To '96 Ft. C`4`4 � g� I
From 1�_Tom Ft �T /v�
1 f —
From To FL
13. GROUT: Depth Material Method
From To �Ft. e
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: ram%
P �Yle
De th Size Material - e
r.
From To FL -
From To Ft. L_____—_._
16. REMARKS: .-- -.
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C,WELL
CONSTRUCTION STANDARDS,AND TXT A COP THIS ECORD HAS BEEN PROVIDED TO THE WELL OWNER
%-a 1•-CIS'
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
Submit the original to the Division of Water Quality,Groundwater Section, 1636 Mail Service Center-Raleigh,NC
27699-1636 Phone No.[phone],within 30 days. GW-1 REV. 07/2001

North Carolina-Department of Environment and Natural Resources-Division of Water Quality-Groundwater Section — r3 1 4 663
1636 Mail Service Center-Raleigh, N.C.27699-1636-Phone[phone] cD
WELL CONSTRUCTION RECORD WELL CONTRACTOR: r'F"^ „'rtgFt`;V-0 =j r " 3
WELL CONTRACTOR CERTIFICATION#: 2637
FMOt301 STATE WELL CONSTRUCTION PERMIT#: -teve gFare
t - Cry
1. WELL USE(Check Applicable Box): Residential ❑ Municipal ❑ Industrial ❑ Agricultural❑ M_omt;4rrng
Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use:
2. WELL LOCATION:(Show sketch of the location below)
Nearest Town: ROAN 604 - County: f liT_-HP I i
-215 J ` ,
(Road Name and Nu hers, ommun ty,or ubdi Iona dLo[No DRILLING LOG DEPTH )
3. OWNER ELNOV I I JISEY From To Formation Description
Address 142PI BRYANT n 1 T
rNAFLCI} petar_'LteNo.l n1[ '32C13 37 5D GRGnj1TE
City or Town stare zip code r1l 53 �;HAi F
4. DATE DRILLED 5?2tR'2n5 r14 ?el ^AG1 t'T;:
5. TOTAL DEPTH '^� 7t, 73 HAI F: a
6. CUTTINGS COLLECTED YES ❑ NO ❑
7. DOES WELL REPLACE EXISTING WELL? YES ❑ NO
8. STATIC WATER LEVEL Below Top of Casing: 6^'T FT.
(Use'+"if Above Top of Casing) r
9. TOP OF CASING IS 1 FT. Above Land Surface* - -
•Top of casing terminated at/or below land surface requires a variance in actor-
dance with 15A NCAC 2C.0118 1t.
10. YIELD(gpm): n METHOD OF TEST Air op
11. WATER ZONES (depth):145 DO Onni 7-50 R 0"litnrn 70-7= -f----
0,'7n Conn n.nocom - T
12, CHLORINATION: Type 'tea Amount 24 If additional space is needed use back of form
-
13. CASING: Wall Thickness LOCATION SKETCH
Depth Diameter or WeighUFt. Material 1,tll, t�4Show direction and distance from at lea6t t $tate
f! ^ I?$ 'i i P ter, P V r Ci j ft p p l+(-•
From To Qa Ft. �— Roads,or other ma reference
From To Ft.
From To Ft.
14. GROUT: }
Depth Material Method J/ 7
From O To ;'D—Ft. a�•�pnt 'rat.->y Flow
From To Ft. — ., �< �\ i V-•
lub \k f{ vi
15. SCREEN:
f._
Depth Diameter Slot Size Material s— —� 1�, / /•�
From To Ft. in. in.
From To Ft. in. in.
From To_ Ft. in. in.
16. SAND/GRAVEL PACK:
Depth Size Material �..
From To _ Ft.
From To Ft. 1
17. REMARKS:
1 DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C,WELL
CONSTRUCTION STANDARDS,AND THAT ACOFTH RDHAS EN PROVIDED TO THE WELL OWNER.
FOR OFFICE USE ONLY p� `
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
Quad No: Submit original to Division of Water Quality,Groundwater Section within 30 days
GW-1 REV. 12/99
Serial No.

AD
North Carolina-Department of Environment and Natural Resources-Division of Water Quality-Groundwater Section
1636 Mail Service Center-Raleigh, N.C.27699-1636-Phone[phone]
WELL CONSTRUCTION RECORD WELL CONTRACTOR: czvreV:vriora`}'uEli Pimp C3_ Inc
WELL CONTRACTOR CERTIFICATION#: 2587
0502CA STATE WELL CONSTRUCTION PERMIT#: Steve Reece
1. WELL USE(Check Applicable Box): Residential [2 Municipal E] Industrial El Agricultural E] Monitoring ❑
Recovery Heat Pump Water Injection 0 Other E] If Other, List Use:
2. WELL LOCATION:(Show sketch of the location below)
Nearest Town: R,3KFR41/Il 1 I= County: hAlT-HPI i
ARI1!4TF F1A r4FC FCSAK h/ITN( R[Z rtFF !-i�V,/ 7R1 ("tFF H
( oadNamean um ers, ommum[y,orsu tlrvsionan on DRILLING LOG RED PTH
3. OWNER SHERRY S HDII MAN From To Formation Description
Address 171A F('SRK Mr'1l1NiTAIN Af i In F;i; 17!RT
1 tre Route No.l
Fn inn GRANITE
or Town State ip 6o0e 'Inn 1n SHA.I F
4. DATE DRILLED 6116;217106 103 41710 ;RAAOTE
5. TOTAL DEPTH 40f1
6. CUTTINGS COLLECTED YES NO F f
7. DOES WELL REPLACE EXISTING WELL? YES EJ NO 0 -'
8. STATIC WATER LEVEL Below Top of Casing: 217 FT.
(Use'+'if Above Top of Casing)
9. TOP OF CASING IS 1 FT.Above Land Surface* `?
Top casing terminated at/or below land suFT.e requires a variance in actor- 1s
dance with 15A NCAC 2C.0118 it
10. YIELD(gpm): ! METHOD OF TEST .Air
11. WATER ZONES (depth): 1.00 aCrr.1LT0-103 0.00nrm '*W'
0 00 yorn 0 OOoom
12. CHLORINATION: Type HTH Amount 75 If additional space is needed use back of form
13. CASING: LOCATION SKETCH r� .
Wall Thickness
Depth Diameter or Weight/Ft. Material (Show direction and distance from at least two State
From 0 To rR Ft. a 1iR ?a0 purr Roads, r othCr reference points)
From To Ft. LLCC��
From To Ft. a
14. GROUT: II''
Depth Material Method
From Q To 20 Ft. Cement Gravih Flow
From To Ft.
15. SCREEN: �a
L
Depth Diameter Slot Size Material `
,
From To Ft. in. in. a. �_
From To Ft. in. in.
From To Ft. in. in.
C"
16. SAND/GRAVEL PACK:
Depth Size Material
i
From To Ft.
From To Ft.
17. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C,WELL
CONSTRUCTION STANDARDS,AND THAT COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER. t��r
i w
FOR OFFICE USE ONLY
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
Quad No: Submit original to Division of Water Quality,Groundwater Section within 30 days
GW-1 REV. 12/99
Serial No.

DO
North Carolina -Department of Environment and Natural Resources-Division of Water Quality-Groundwater Section y- �)
1636 Mail Service Center- Raleigh,N.C.27699-1636-Phone[phone]
WELL CONSTRUCTION RECORD WELL CONTRACTOR: ^v0'v+e'rV iio itVVyji Pun—to ;, .-
WELL CONTRACTOR CERTIFICATION#: 2687
G502401 STATE WELL CONSTRUCTION PERMIT#: `*eVe Reece
1. WELL USE(Check Applicable Box): Residential ❑ Municipal ❑ Industrial ❑ Agricultural❑ Monitoring ❑
Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use: 'd
2. WELL LOCATION: (Show sketch of the location below) c
Nearest Town: RAKPR7VILLE County: MIFPCHELL
N
FCiP P+iTJ R6 6FF .,R1 I;�F 228 co(Road Nameand Numbers, ommumty,or Sub rvision and Lot No.) DRILLING LOG DEPT "
3. OWNER CHRISTOPHER_ C HOBSON From To Forma Do ription
Address 1800 PUGHFS GA 0 p.5 r: T
1 pe�r Route o.l `
�>aKERStILPt' F`7 2D�1 55 70 CRApliTE'
6lty or Town State ➢per
-71; 74 EHikl_F
4. DATE DRILLED 5130,'2nn5 74 iFn GRANITP
5. TOTAL DEPTH Im 14M 153 `DI IART7
6. CUTTINGS COLLECTED YES ❑ NO ❑ 15:3 27A GRANJTTr
7. DOES WELL REPLACE EXISTING WELL? YES ❑ NO El 27R 2B1 CatIART7 ERC1t,VNSHA1 F
8. STATIC WATER LEVEL Below Top of Casing: ?..rl FT. :'P1 W'Irl RaNIIE r
(Use"+"if Above Top of Casing)
9. TOP OF CASING IS FT.Above Land Surface*
*Top of casing terminated at/or below land surface requires a variance in actor- ''<«,,
dance with 15A NCAC 2C.0118
=:7
10. YIELD (gpm): 5 METHOD OF TEST Par `
50 7 0
11. WATER ZONES (depth): 0- 41Gm D'7'-i qpm 150'153
3.50 ppm 278-281 C.DOaom
12. CHLORINATION: Type HTH Amount 56 If additional space is needed use back of form>
13. CASING: Wall Thickness LOCATION SKETCH
'tJ
Depth Diameter or Weight/Ft. Material (Show direction and distance front at least two State
From i? To 62 Ft. 8 'IM 1RR yai. '-..+ Roads,or other map(\\ e points)
From To Ft.
From To Ft.
14. GROUT: t Ut k-
Depth Material Method I }
From 0 To 2f)—Ft. '-ement Gravif+,, Floeu / 1) `1
From To Ft.
15. SCREEN:
Depth Diameter Slot Size Material
From To Ft. in. in.
From To Ft. in. in.
From To Ft. in. in. - - ----- �9
16. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft. IV
17. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C,WELL
CONSTRUCTION STANDARDS,AND THAT COPY OF THIS RECORD PS BEEN PROVIDED TO THE WELL OWNER.
FOR OFFICE USE ONLY
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
Quad No: Submit original to Division of Water Quality,Groundwater Section within 30 days
GW-1 REV.12/99
Serial No.

me
North Carolina-Department of Environment and Natural Resources-Division of Water Quality-Groundwater Section 31 e4 3 4
1636 Mail Service Center-Raleigh,N.C.27699-1636-Phone[phone]
WELL CONSTRUCTION RECORD WELL CONTRACTOR: Deeoey'A.right yrto
WELL CONTRACTOR CERTIFICATION#: 256
05035I-It STATE WELL CONSTRUCTION PERMIT#: s Pee Reere _ -_-
1. WELL USE(Check Applicable Box): Residential ❑ Municipal ❑ Industrial ❑ Agricultural❑ Monitoring ❑
Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other,List Use:
2. WELL LOCATION:(Show sketch of the location below)
Nearest Town: SAKERSVILLE County: EAITCL?ELL.
.tDs-N SPARKS RD. OFFMj,' 226 OFF H'.'dY 1'2F
(Road Name and Numbers, ommuniry,or ubdrvision an Lot No.
DRILLING LOG DEPTH
3. OWNER CHRIS K SPARKS From To Formation Description
Address 24 JOHN :SPARKS RD 0 55 L,IRT ,1
1 Wr Route NO.l •
BAe�ERS I��c NCI / 705 55 105 iaRAhliTF
City or Town State tp Code 7
n5
4. DATE DRILLED 7`21/2005 G
5. TOTAL DEPTH 705
.z
6. CUTTINGS COLLECTED YES ❑ NO ❑ _N
7. DOES WELL REPLACE EXISTING WELL? YES ❑ NO 0 r
8. STATIC WATER LEVEL Below Top of Casing: 100 FT. r
(Use"+"if Above Top of Casing) ��
9. TOP OF CASING IS M FT. Above Land Surface* ">
*Top of casing terminated at/or below land surface requires a variance in actor.
dance with 15A NCAC 2C.0118
10. YIELD (gpm): 0 METHOD OF TEST Air r
11. WATER ZONES (depth): 0.00 €IpmDRV HOLE 0.00gp1n
0,00 qpm :0.00oprrl
12. CHLORINATION: Type HTH Amount If additional space is needed use back ofform
13. CASING: Wall Thickness LOCATION SKETCH
Depth Diameter or WeighUFt. Material (Show direction and distance from at leas[two State
From 0 To 80 Ft. 03 'V8 350 F'7C Roads,or other map reference points)
From To Ft
From To Ft. -� �`�"—'—"—"T� � T
i
14. GROUT:
Depth Material Method k h�
From 0 To 20 Ft. Cetne!`A Gravity Flow •;y
From To Ft.
15. SCREEN: -
Depth Diameter Slot Size Material {
From To Ft. in. in.
From To Ft. in. in. `
From To Ft. in. in. t`
16. SAND/GRAVEL PACK:
v
Depth Size Material
From To Ft. y
From To Ft.
17. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C,WELL
CONSTRUCTION STANDARDS,AND THAT A COP OF THIS RECORD IJA�BEEN PROVIDED TO THEW,ELL OWNER.
FOR OFFICE USE ONLY '1� I( -Z6�L - � t ,
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
Quad No: Submit original to Division of Water Quality,Groundwater Section within 30 days
GW-1 REV.12/99
Serial No.

North Carolina-Department of Environment and Natural Resources-Division of Water Quality-Groundwater Section 3 J_ 5 3 4 7
1636 Mail Service Center-Raleigh, N.C.27699-1636-Phone[phone]
WELL CONSTRUCTION RECORD WELL CONTRACTOR: Dev Y wricht ivyo Ftar:,p Cc . Inc.
WELL CONTRACTOR CERTIFICATION#: 4C'87
cel
0503?1 STATE WELL CONSTRUCTION PERMIT#: Stare F:eC-'
1. WELL USE(Check Applicable Box): Residential 0 Municipal❑ Industrial ❑ Agricultural❑ Monitoring ❑
Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other,List Use:
2. WELL LOCATION: (Show sketch of the location below)
Nearest Town: ROAN N M! County: WITC-HE i
N I^HFG CLP RL7 nFF "Cl�`l� r�RF F'r,' "!FF 1u'i C2E,_ gE
iRoad Name an umbers, ommumty,or ubdrvisionan Lot No.l DRILLING LOG DEPTH
3. OWNER HAn EN1G ISH _ From To Formation Description
Address 3009 H' °GHES GAo RD 0 X.5 DIRT
RAK=P=,(;"VT rRouteNo.l tot 55 -
5705 t90_ GRAN(T F
City orTown State ZipCotle 90 94 OIJGRT
4. DATE DRILLED ?.t.1t0J5 R5 cr,.AnI1E ' ---1�—
5. TOTAL DEPTH 185
6. CUTTINGS COLLECTED YES ❑ NO
7. DOES WELL REPLACE EXISTING WELL? YES ❑ NO ❑ '__'
8. STATIC WATER LEVEL Below Top of Casing: 0 FT. -n+
(Use"+"if Above Top of Casing) '°
9. TOP OF CASING IS 1 FT. Above Land Surface*
'Top of casing terminated ai below land surface requires a variance in actor- .;=y
dance with 15A NCAC 2C.0118 E*
10. YIELD (gpm): 7 METHOD OF TEST Aar
11. WATER ZONES (depth): 7.00 Qpr0,Gt1'Q4 C 00gnon
0.00 porn 0 0000m
12. CHLORINATION: Type HTF' Amount 39 If additional space is needed use back of,form
13. CASING: Wall Thickness LOCATION SKETCH
Depth Diameter or WeighUFt. Material (Show direction and distance from at least two State
From 0 To 3O Ft. t 1+'A 060 PP +.rr Roads,or other map reference points) C�Ik ax u
From To Ft. � D HIr
From To Ft. t
14. GROUT:
Depth Material Method
From 0 To 4�- Ft. r-:z;nant Gicvf*v Flo'w>
From To Ft. t�aC Ys
15. SCREEN: '\
Depth Diameter Slot Size Material ,y
From To Ft. in. _ in.
From To Ft. in. in.
From To Ft. in. in.
16. SAND/GRAVEL PACK:
Depth Size Material ,�3-
From To Ft. \r
From To Ft. Y-
17. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCOR NCE WITH 15A NCAC 2C,WELL
CONSTRUCTION STANDARDS,AND THAT A COPY OF THIS REC RD HAS BEEN PROVIDED TO THE WELL OWNER.
FOR OFFICE USE ONLY ���
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
Quad No: Submit original to Division of Water Quality,Groundwater Section within 30 days
GW-i REV.12/99
Serial No.

North Carolina-Department of Environment and Natural Resources-Division of Water Quality-Groundwater Section 'I Tl eCI' Cb l3
1636 Mail Service Center- Raleigh, N.C. 27699-1636-Phone[phone]
WELL CONSTRUCTION RECORD WELL CONTRACTOR: C°``'"e "'c"^VV2;; PumYpCo' l
WELL CONTRACTOR CERTIFICATION#: ` `!
"5U' g STATE WELL CONSTRUCTION PERMIT#: Steve Reece
1. WELL USE(Check Applicable Box): Residential 0 Municipal D Industrial El Agricultural E] Monitoring ❑
Recovery 0 Heat Pump Water Injection D Other E:1 If Other, List Use:
2. WELL LOCATION: (Show sketch of the location below)
Nearest Town: EURNc_VILLE County: MITCHFLL
f:,UJLR Th1^1 TOP CR. OFF i-ikfv'it3URti F;E1 OFF BEAR CF?
(Road Name and Numbers,Community,or ubdivision and Lot o.)
DRILLING LOG DEPTH
3. OWNER JOE HOBSON From To Formation Description
Address 5SO HGERS: "N RC. 0 55 Q!IRT
SAKFF,SJ,tLT ar Route Nei.) f,,C ;i5 73 e3R)kN!TE j?�v!✓FTf l IC
City or Town State Zip Code M
4. DATE DRILLED " 'Ei2005 ion 185 QUARTZ
TZ
5. TOTAL DEPTH 2255 1?5 225 ,T+f'rfiJvl'.'c
6. CUTTINGS COLLECTED YES 0 NO r -
7. DOES WELL REPLACE EXISTING WELL? YES 0 NO F
8. STATIC WATER LEVEL Below Top of Casing: in FT.
(Use"+"if Above Top of Casing)
9. TOP OF CASING IS 1 FT. Above Land Surface*
'Top of casing terminated at/or below land surface requires a variance in actor- z.
dance with 15A NCAC 2C.Q118
10. YIELD (gpm): LU METHOD OF TEST Alf
11. WATER ZONES (depth)`(=-CL1 porn 180-145 L.L10ppm
i).UL nom 0.00ppm - '...
12. CHLORINATION: Type HIH Amount -5 If additional space is needed use back dfiorm
13. CASING: `P LOCATION SKETCH
Wall Thickness 11
Depth Diameter or Weight/Ft
Material r ',($how direction and distance from at least two State
From D To "14 Ft. "i 1/8 350 PVC 1' Roads, or other map reference points)
From To FL
From To Ft. '
14. GROUT:
Depth Material Method - --
From O To 2'7 Ft. Cement 'r3v tJ Flo.re
From To Ft.
15. SCREEN:
Depth Diameter Slot Size Material
From To Ft. in. in.
From To Ft. in. in.
From To Ft. in. in.
16. SAND/GRAVEL PACK:
I
Depth Size Material
From To Ft. @(
From To Ft.
I
17. REMARKS: �LttYca
1 DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, ELL (J
CONSTRUCTION STANDARDS,AND THAT A COPY OF THIS RECORBIHAS BEEN PROVIDED TO THE WELL OWNER.
FOR OFFICE USE ONLY
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
Quad No: Submit original to Division of Water Quality,Groundwater Section within 30 days
GW-1 REV.12/99
Serial No.

D'"
North Carolina-Department of Environment and Natural Resources-Division of Water Quality-Groundwater Section f)1636 Mail Service Center-Raleigh,N.C. 27699-1636-Phone [phone] 0 16 2 C 0
WELL CONSTRUCTION RECORD WELL CONTRACTOR: Geerey
WELL CONTRACTOR CERTIFICATION#: `gS1
0s0t60 STATE WELL CONSTRUCTION PERMITM Sfeye E'etty
1. WELL USE(Check Applicable Box): Residential Municipal El Industrial 0 Agricultural 0 Monitoring
Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use: -
2. WELL LOCATION: (Show sketch of the location below) r,,
Nearest Town: SPRUCE PINE County: FAITCHELL t
MC(``iNNEY MINE RD.
(Road Name and Numbers,Community,or Subdivision and Lot No.l p
DRILLING LOG DEPTH o
3. OWNER E'ERND GNEISS From To Formation,Description - -
Address 517 RO NDTEu2EE DP. 0 15 C3iRT
e�Jui
LONGS puts Not 2Z226 15 80 GRANITE �
City or Town state Zip Code 20 E12 SHALE
4. DATE DRILLED 32 140 GRANITE
5. TOTAL DEPTH 405 140 143 ql-iALE QUARTZ
6. CUTTINGS COLLECTED YES NO 143 180 GRANITE
7. DOES WELL REPLACE EXISTING WELL? YES D NO E] A,,50 182 SHALE
8. STATIC WATER LEVEL Below Top of Casing: 80 FT. 15.2 3661 GRANITE
(Use"+"if Above Top of Casing) See 3$E SHALE ,
9. TOP OF CASING IS 1 FT.Above Land Surface* 339 4015 GR,AS�iTE Tr
'Top of casing terminated at/or below land surface requires a variance in actor- :.
dance with 15A NCAC 2C.0118 1
10. YIELD(gpm): I METHOD OF TEST 'fir
11. WATER ZONES (depth): 1.00 ppm90-G2 O.o5-p rn
0.00 nom OAOgpm --,rn
12. CHLORINATION: Type HTH Amount B7 If additional space is needed use backooff form'r
un
13. CASING: LOCATION SKETCH
Wall Thickness a
Depth Diameter or Weight/Ft. Material (Show direction and distance from at least two Stdte
From 0 To 21 Ft. B 1/t3 . .50 R`/C ' --Riaa•-ds.,or o k map reference points)
From To Ft
�_.� n.t,tir. ,�•,
From To Ft.
14. GROUT:
Depth Material Method
From 0 To 20 Ft, Ca_meflt Gratiih,` Flow
From To Ft. Y ,�
15. SCREEN:
Depth Diameter Slot Size Material
From To Ft. in. in.
From To Ft. in. in.
From To Ft. in. in.
16. SAND/GRAVEL PACK:
Depth Size Material - „J
' U
From To Ft.
From To Ft. +�
Y
17. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDA E WITH 15A NCAC 2C,WELL
CONSTRUCTION STANDARDS,AND THAT COPY OF THIS RECORD
HAS BEEN PROVIDED TO THE WELL OWNER.
- �
FOR OFFICE USE ONLY
et
SIGNATURE OF PERSO ONSTRUCTING THE WELL DATE
Quad No: Submit original to Division of Water Quality,Groundwater Section within 30 days
GW-1 REV.12/99
Serial No.

WELL CONSTRUCTION RECORD
North Carolina-Department of Environment and Natural Resources-Division of Water Quality-Groundwater Section
tv'ELLCO.NTRACTORfINDIVIOUAL)NAME (print) .Td5`i'iceC.1CC.t.Df'rtLcNG CERTIFICAT(ONp !jll - r�
tt'ELLCO\7'RACI'ORCOatPANYYAME O:Atz S Ir--PHONE # I
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if apnlieablc) (if applicable)
I. WELL USE(Check Applicable Box):Residential 63'Nfunicipal/Public❑ Industrial ❑ Agricultural❑
Monitoring❑ Recovery ❑ Heat Pump Water Injection❑ Other❑ If Other,List Use
2. WELL LOCATIO Topographic/Land setting
Nearest Town: `' f County I�?9�^� CJ/ ❑Ridge C3STope ❑Valley ❑Flat
A';Z aR 'TAY`F m�t, (theca appropriaw box)
(Street Name,Numbcm,Community,Subdivision,Lot No..Zip Code) Latitudellongitude of well location
3. OWNER: 6f ti - Se—o—�— (desreWminutWsecotats)
Address oTs /'et f Latitude/longitude source:❑GPS❑Topographic map
/J_ ` `&& (StrcctotijP No.) � ' (check box)
[S(2�'ifpUL(.[./ C �Q'��j DEPTH DRILLING LOG
c
(.)-ity or Tow ute zip Coat From To Formation Description
_ Ca�B-, pvv
Area code-Phone number +S E �! / FL
4. DATEDRILLED Z—/�/-oS—
5. TOTAL DEPTH: '2 X,S— /o /ton
6. DOES WELL REPLACE EXISTING WELL? YES❑ NO M1
7. STATIC WATER LEVEL Below Top of Casing:�f _FT. 10 , ..cog— -7.
(Use"+"if Above Top of Casing)
S. TOP OF CASING IS FT.Above Land Surface*
*Tap of toshg terminated attar below had serAee require,a
variance in accordance with I5A NCAC 2C.611& eGy.,eft t
9. YIELD(gpm): 6- METHOD OF TEST elEt r7—
10. WATER ZONES(depth): (� "Q Q
LOCATION SKETCH L
11. DISINFECTION:Type tf4W,AK Amount XQ 2 Show direction and distance in miles from at least v ty
12. CASING: Wall Thickness two State Roads or County Roads. Include the road ' nK
Deprh Din er or WdgltVPt. Material tmm)oers and common road names.
From To ©1 Ft.461a
JO YVVj
From lal To /Z! FL — (7 L
From ,z/ To /iU Ft. /b$ ��LrA!
13. GROUT: Depth Material Method F
From To Ft.
From m To�s7 Ft.� C1 p p o
14. SCREEN: Depth Diartreter Slot Size Material n ��
Y �
From To Ft. in. in. — _
From To Ft, in. in. co
15. SAND/GRAVEL PACK: �� CD
Depth Sin Material � uT _
From To Ft.
From To Ft.
16. REMARKS:_ �a(o
1 DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C,WELL
CONSTRUCTION STANDARDS,AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER'
SIGRATPE OF PERSON CONSTRUCTING THE WELL DATE
Submit the original to the Division of Water Quality,Groundwater Section,1636 Mail Senice Center-Raleigh,NC
27699-1636 Phonc No.(919)733 l??1,within 30 days. G W-I REV.07/2001

WELL CONSTRUCTION RECORD '
f 6
North Carolina-Department of Environment and Natural Resources-Division of Water Quality-Groundwater Section
TELL CONTRACTOR(INDIVIDUAL)NAME (prfat) Cn,,4 ZA4 Tii C i t Lc CERTIFICATION YU)S�
tt'ELI.CONTRACTOR COMPANY NAME. . tC:d PHONE i(c ) 72ji-
STATE WELL COMSTRL'CrION PERMITS ccOC(ATxo wQ PERafrr#
(ifa livable) (ifapplicable)
I. WELL USE(Check Applicable Box):Residential Municipal/Public❑ Industrial❑ Agricultural❑
Monitoring❑ Recovery ❑ Heat Puma/Water Injection❑ Other❑ If Other,List Use
2. WELL LOCA
Nearest '09: / Topogtaphic/Laand&aet'ng
CGS 1F: _ efdltr(1. County ❑Ridge ❑Slope alley ❑Flat
G F �&AA/�4 Q'G
(chackappropiimebon
(Shcti4 Nmno.Numbers,tommunity.Subdivision,tot No„Zip Cale) Latitude/longitude of well location
3. OWNER gn6l £ T/j_w� t,Cf',C)� .4A./ fdageeslmaaua/seromis)
Address 400 449 doc -j Latitudellongitudesource:❑GPS17Topographicnap
(Street a Robe No,) (chuck box)
�^ CGIyorToan StateS DEPTH DRILLING LOO
Zip Cade From To Formation Description
Area code-Phone number
4. DATE DRILLED /U R--O
5. TOTAL DEPTH: Ids I� 7047 _
6. DOES WELL REPLACE EXISTING WELL? YES❑ NO ❑�
7. STATIC WATER LEVEL Below Top of Casing: Zd FT
(the-+�if Abow Top of Cuing)
S. TOP OF CASING IS FT.Above Land Surface*
-Top of earitra unabated aver kehw bad avtate n%alru a
varbate)a atawNaom with ISA NCAC 2C.01I&
9. YIELD(Wm): YZ,METHOD OF TEST Al/n
10.WATER ZONES(depth): Y?C,&,, , 7dn'
LOCATION SKETCH
11. DISINFECTION:Type CO � e Amount O1 Show direction artd dislanre in miles from at least
12. CASING: Wall Thickness two State Roads or County Roads.Include the road
Depth Diamacr or Wd9hM. Matettal numbers and cormmon road moves.
From To FL
From To Ft. CD
:-3
Frort�,C,�To�O Ft. to!rg �� y r --,
13. GROUT: Depth —Material Method
From Tc FL a co
From N_To1n FL_� / wG6i�—Q � a Ln
14. SCREEN: Ln
h Diane a—�—
DeM Slot Sia M erml
From To FL in. in. � 26
From To Ft. in. in. �
15. SAND/GRAVEL PACK:
Depth size Material
From To Ft.
Prom To Ft.
16. REMARKS:
1 DO HEREBY CERTIFY THA 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'
IGN TURF qF PERSON CONSTRUCTING THE WELL DATE
Submit the original to the Dialsion of Water Quality,Groundwater Section,1636 Mail Service Center-Raleigh,NC
27699-1636 Phone Na.[phone],within 30 days. GWA REV.07/2001

WELL CONSTRUCTION RECORD
North Carolina-Department of Environment and Na/�711 1 Resources-Division of water Quality-Groundwater Section
WELL CONTRACTOR(INDIVIDUAL)NAME (print) r4lai i ��Q s�. 1 Cc= CERTIFICATION#2I S b
WELL CON I"RACfOR COMPANY NAME SU,$ 1 c l t)E-LL h r i LLB PHONE # .) 72!� -�g-j o
STATE WELL CONSTRUCTION PERMIT# •ttOCIATED wQ PERMIT#
(if applicable) fifapplicable)
1. WELL USE(Check Applicable Box):Residential m-`M unicipal/Public❑ Industrial ❑ Agricultural❑
Monitoring❑ Recovery ❑ Heat Pump Water injection❑ Other❑ If Other,List Use
2. WELL LOCA: N: ( Topographic/Land setting
Nearest Town: f P �C L County Midge re ❑SIo
�4! Ste; e ( VPcI ix u) OFlat
' L' (check oppprimc Ea<r
(Street Name,NuaMxs,Commatg.S- 'vision.Lot Nq-Zip Cock) Latitude/longitude of well location
3. OWNER: �1P tmtes/arratsk)
Address _ rR 1 S 4 2ei W La titudc1longituile source:❑GPS 3Topographic map
1 (rat or Roue 1�o.I (c6xk bu)
� C' DEPTH DRILLING LOG
Goy w Tow cute zip Code From To Formation Description
(ft)-_6 S�- ZV6P
Arch code-Phnoe number �---
4. DATE DRILLEDI -2 3- O
5. TOTAL DEPTH, /i o S- ZA Sn - rt
6. DOES WELL REPLACE EXISTING WELL? YES❑ NO Er
7. STATIC WATER LEVEL Below Top ofCasin g_Jf _FT.
(Use"+"if Above Top ofCuio&)
8. TOP OF CASING IS�_FT.Above Land Surface*
•Tap of cute&tere,tatd War belww bad swim regains a
vu(atne Is arewdace with 1SA NCAC 2C.9115. S 5- 7,7, V
9. YIELD(Spirt): Y _METHOD OF TEST /4/.2
10. WATER ZONES(depth)-
r�
LOCATION SKETCH
11. DISINFECTION:Type /d//U'L Amount 1 Fa 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 (w WdgLVPt. Material numbers and common road ramp.
From TO FL
From To=FL
Fro TO—Z-4_FL 42 W !
13. GROUT: Depth Material Method n
From To Ft.
From M To7`_Ft.� uea.
14. SCREEN: Depth Di SlotSiae Material
From To FL in. in. co =.
Front.__To Ft. in. in. S L 2( z
15. SAND/GRAVEL PACK: u( itt
Depth size Material
From To FL
FTom TO FL
16. RE.4IARKS:
1 DO HEREBY CERTIFY TH T THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH I SA NCAC 2C,WELL
CONSTRUCTION STAND S,A AT A COP OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER'
GNA EOFPERSONCONSTRUCTINGTHEWELL.. DATE
Submit the original to the D'n$ion of Water Quality,Groundwater See.don,'t636_Mail Service Center-Raleigh,NC
27699-1636 Phone No.(919)733,3221,within 30 days. G WA REV.07/2001

WELL CONSTRUCTION RECORD 5 K
North Carolina-Department or Environment and Natural Resources- Division of Water Quality-Groundwater Section
WELLCONTRACTOR(INDIVIDUAL)NAME (print) / CERT)F1CA-TptONd'
tt'ELL CONT'R-tCl'OR COMPANY NAME T, 1)S (E tA✓P V2 PHONE
STATE WELL CONSTRUCTION PERMITa SSOCIAtED WQ PERMITa
Van (ifapplicable) (ifapplicable)
L WELL USE(Check Applicable Box):Residential 0 MunicipaltPublic❑ Industrial ❑ Agricultural❑
Monitoring❑ Recovery ❑ Heat Pump Water Injection❑ Other❑ If Other,List Use -
2. WELL LOCATI
Nearest Town: �„1-,,.-a County-Aezg t �' T e GSlpple/Land setting
(e 4 r � 0e ❑Ridge check pp ❑Vbox) ❑Flat
(checkitudc f boil
(9ruut Nam..Numbers,Commuahy,Subdivision,Lot No.,Zip Code) Lalitude/longitude of well location
3. OWNER: ""61�lL (degre�s/mirmhs/secomis)
Address Latitude/longitude sourcc:❑GPS❑Topographicmap
15trM ar Rque No.) //r` (chuck box)
�tf'u DEPTH DRILLING LOG
Coy or Town Sate Zip Corfu From To Formation Description
Area code-Phone number pet}
a. DATE DRILLED 7- Z . Z'15—
5. TOTAL DEPTH: .3115
6. DOES WELL REPLACE EXISTING WELL? YES❑ NO pi' .25L �� `
7. STATIC WATER LEVEL Below Top of Casings 3 0 _Fr,
(Use"+^if Abow Top of Casing) C�
8. TOP OF CASING IS _FT.Above Land Surface'
•Top of easing terminated attar helew land surfauu requires a
varlanee in acmrdaa with 15A NCAC 2C.011& 00 `4
9. YIELD(gpm):�_METHOD OF TEST to
10. WATER ZONES(depth):�r ,a,, !2 ? CS Ln
LOCATION SKET H
t 1. DISINFECTION:Type Amount L Show direction and distance in miles from at fast
12. CASING: Wall Thickness two State Roads or County Roads,Include the road
h Diameter rn W elgbtlft M nal numbers and common road tames.
From 6 To��Ft. 6,! v >°
From�_To 3-D Ft. &Yq
From To Ft.
13. GROUT: Depth Material Method
From To Ft.
From N: o To Ft.14. SCREEN: Depth Diameer Slot Size Mat al / R
From To Ft. in. in.
From To Ft. in. in. __"•y`-✓C" '4f-
15. SAND/GRAVEL PACK:
Depth Sim Material
From_ To Ft.
Frinn To Ft. y��
16. REMARKS: ,�t /l.d
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED 1N ACCORDANCE W1TR'IS/CNCAC 2C,WELL
CONSTRUCTION STAND RD ,AND THAT-A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER"
-SIG ATU OF PERSON CONSTRUCTING THE WELL DATE
Submit the original 10 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
\%ELL COST-RACTOR(INDIVI➢UAL)NAME (Print) /
CERTIFICATION M (S�
)zELt.COSTRaCfOR COAiPANY NAME r
1 Y - - PHONE S j,4z IL'.
5'fn'1'E WELL CONSTRUCTION PERhtITO ASSOCIATED WQ PER.NIITB
applicable) / (if applicable)
I. WELL USE(Check Applicable Box): Residential B Municipal/Public ❑ Industrial ❑ Agricultural ❑
Monitoring❑ Recovery ❑ Heat Pump Water Injection❑ Other❑ lfOther, List Use
2. WELL LOCATION:
Nearest own: '= Pr' '(LLc? County Grp Topographic/Land setting
94ge ❑Slope ❑Valley ❑Flat
(Street Name.Numhers.Community,Subdivision,Lot No.,Zip Code) (check appropriate boll
—{� Latitude/longitude of well location
3. OWNER: C1r P. J
Address 1,(� (�•r-,v (degreestminutes/secands).)St ee Latitude/longitude source:❑GPS❑Topoeraphic map
ft or Roots No.) (check box)
Coy or Town Statec� C'I DEPTH DRILLING LOG
Zip Code
From To Formation Description
Area code-Phone number.
4. DATE DRILLED (- - 13 ' ct�'5. TOTAL DEPTH: .yaf'
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO Lr -
7. STATIC WATER LEVEL Below Top of Casing: r_ - FT,
(Use'•+••if Above Top of Casing)
3. TOP OF CASING IS FT.Above Land Surface*
`Top of casiae terminated atlor below land surface requires a r?
variance iu acrnrdaace with 15A NCAC 2C.01 IS.
9. YIELD(gpm): Jo METHOD OF TEST 1
co
10- WATER ZONES(depth):_��r�r „ (k; 4 `/{
LOCATION SKETCH cn
11. DISINFECTION.-Type C4 4 4¢I Amount S [' i Show direction and distance in miles from at least L
12, CASING: Wall Thickness two State Roads or County Roads.Include the rotad ijr�
Depth Doungtcr or WeighUFL Material numbers and common road names. 4X
From C To ) Jr Ft.--L& _ G '
From38' To�Ft. G Y-4 1 }' C1 1V /
From To Ft.
13, GROUT: Depth Material Method
From U
From To—Ft. �—14. SCREEN: Depth Diameter Slot Size Material - Z"/7
Q'
From To-_ Ft. in. in. i
From To Ft. in. in.
15. SAND/GRAVEL-PACK: A' 3
P fit
Depth Size Material
From
To Ft. ¢ f� ref
From To Ft. , t
16, REMARKS:
1 DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH ISA NCAC 2C.WELL
CONSTRUCTION STAN D/S,eAND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
1 r ��1✓1 U
_ if
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
Submit the original to the Division of Water Quality,Groundivater Section, t636 Mail Service,Center-Raleigh,NC
27699-1636 Phone No.[phone],within 30 days. •
_. GW-I REV.070-001

WELL CONSTRUCTION RECORD
North Carolina-Department of Environment and Natural Resources-Division of Water Quality-Groundwater Section
WELL CONTRACTOR(INDIVIDUAL)NAME (prlot)TCtA,a� ^tilt C¢ CERTIFICATION# 7/5
tt'ELL CONTRACTOR COMPANY NAME PHONEY ( )y..1 y-ysyg
STATE:WELL CONSTRUCTION PERMITS ASSOCIATED WQ PERMIT#
fifamlicable) (if applicable)I. WELL USE(Check Applicable Box):Residential❑ Municipal/Public 0 Industrial 0 Agricultural 5 /
Monitoring❑ Recovery 0 Heat Pump Water Injection❑ Other❑ If Other,List Use
2. WELL LOCATT: qq /�
Nearest Town: .j9r cam. P&IX Countyxl;�.oX ❑Ridge OSlope �alleytnOFlat
(cheek appropriate boxl
(Suttiv Nmtte.Numbers,Commulnity,SuIbdivisi LLot No.,Zip Code) Latitudellongitude of well location
3. OWNER: t L [�,C4, nItA.Qy�ti. (dcgrees/minutes/seetwtk)
Address 4Y ci i K Latitude/longitude source:OGPSOTopographic map
Istreet M R to No.)
(cloth box)
DEPTH DRILLING LOG
CnY or Toa� State C
Zip Coat From To Fomiation Description
($2)_ 21p�-y 2 3V
Area rode-Phone number -�-� -
4. DATE DRILLED 7�1
5. TOTAL DEPTH: 125
6. DOES WELL REPLACE EXISTING WELL? YES,0, NO
7. STATIC WATER LEVEL Below Top of Casing: 2OFT,
(Use'+"if Above Top of Casing)
S. TOP OF CASING IS ' FT-Above land Surface* -4
•Tap%(casing terataored at/or below land sarince squires
varlance is accordance with ISA NCAC 2C.011& `-
9. YIELD(gpm): 5 METHOD OFT i o
10. WATER ZONES(depth): 3 S q�p/vl � y r ST N n!
LOCATION SKETCH
11. DISINFECTION:Type Y�Si Amount 02- Show direction and distance in miles from at lean
12. CASING: Wall Thickness two State Roads or County Roads.Include the road
Depth
FL Diameter or WeighVPt. Material numbers and corms road mesr 6 LRI,,�f Lt;LCA From n r Vv fJ
From—To=FL* �
From_l-To4�_Ft.
13. GROUT: Depth Material Method
From To Ft.
From_D To —FL m
14. SCREEN: th �Dep Diam er Slot S Slim Ma I •
From To Ft. in. in.
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Sim Material
From To FL YU f
From To FL
16. REMARKS:
1 DO HEREBY CERTIFY THAT THIS ELL WAS CONSTRICTED 1N ACCORDANCE WITH 15A NCAC 2C,WELL
CONSTRUCTION STANDARDS, THAT A COPY'
OPY 0 TH RECO PROVIDED TO THE WELL OWNER
— GN O ERS RUCTING THE WELL DATE
Submit the original to the Division of Water uality, undwater Section, 1636 Mail Service Cen ter-Raleigh,NC
27699-106 Phunc Nit(919)733-3221,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(INDIVIDUAL)NAME (print) fro � S. ,41 Ci CERTIFICATION#Z-is-'
W E'LI.CONTRACTOR COMPANY NAME Ji s- PHONE f t&-2j 7Z4-etLf
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED\ Q 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 LOCATION:
Topographic/Land setting
Nearest Town: S�)PCJt �a 4 t County g e-& ❑Ridge ❑Slope PraIley EaNal
tz-1 (check appropriate Mx) C .,
(SIml Name.Numbers,Community,Subdivision,Lot No.,ZIP Code) Latitude/longitude of well local--4
tan
3. OWNER: e'. Ai O
(degreWnut mics/aecondt)
Address 51 O
IS Latitude/longitude soacc:❑Gck box) _"hic trap
o
SIStrect ar Roae No.) (deck box)
ZP,,`7 DEPTH DRILLING LOG
City or Tool store Zip Code From To Formation Description
&�L)-'f r�— 4"? 3y
Arcs code-Phone number -
4. DATE DRILLED
S. TOTAL DEPTH: -4 <' U
6. DOES WELL REPLACE EXISTING WELL? YES❑ NO M,"
7. STATIC WATER LEVEL Below Top of Casing: %6!J FT. SAiy t
IUW-1+ if Above Top of Cuing)
S. TOP OF CASING IS _FT.Above Land Surface'
'Top of easiaa teradaated aver below lead sarfate reauinx a
variance is■mrdanee with ISA NCAC IC.6118.
9. YIELD(gpm):__METHOD OF TEST S to
10. WATER ZONES(depth): I? - yp
'at p lv� LOCATION SKETCH
11. DISINFECTION:TypeClORfnsu Amount 0 0 Z, Show direction and distance in miles from at least
12. CASING: Wall Thickness two State Roads or County Roads.Include the road
DepthDismetcr or Welgialft. Material numbers and common road cremes.
From_To -5-a FL--k Vm go PU e
Fran To Ft. 7,1 -224
From _so To ,21 _Ft. 42� _ — G
13. GROUT: Depth Material Method '
From To FL ll'�rrrjoaaj From I) To 2 Z Ft.�_
14. SCREEN: Depth d'Dep Diameter Slot size Material �(`�' Po[A M/rR`d"v
From To Ft. in. in. V � �
From Ft. in. in.
15. SAND/GRAVELEL PACK:
Depth Sim Material
From_ To Ft.
From To Ft.
16. REMARKS: r'
1 DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH I SA NCAC 2C,WELL
CONSTRUCTION STAND RDS,AND THAT A C PY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER'
GN RE OF PERSON CONSTRUCTtNGrHE WELL - - DATE
Submit the original to the Division of Water Quality,Groundwater Section,1636 Mail Service Center-Raleigh,NC
27699-106 Phone No.[phone],within 30 days. G W-1 REV.07/2001

WELL CONSTRUCTION RECORD a `�
North Carolina- Department of Environment and Natural Resources-Division of Water Quality-Groundwater Section
W ELL CONTR:ICTOR(INDIVIDUAL)NAME (print) i_ �.�y\tf C-/..j/L�. ,y�_ CERTIFICATION#yl./ /''
XN'ELI.CON'IRaC'I'012 COMPANY'NAME ( tN i,�+Q� (
l PHONE
STATE IN ELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(ifa licable) (ifa licable)
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:
Nearest Town: 1 Kr rtit I i r TOpDBrWhic/Land setting
c
County 1t`Ic It LC . ❑Ridge Wlope ON/alley ❑Flat
re-, 1' ` C• -c ( 1 (check appmpriate box)
(Street Name,Numbers,Community,Subdivision,Lot No.,Zip Code)
Latitude,'longitude of well location
3. OWNER:-�.ki�,�i2,.: •f�e t ,1 E�-�Ye�I
Address 1 ' 1 (
(degrees/mmutes(seconds)
r h
r
'----ter Latitude/longitude source:❑GPS❑Topocraphic map
1
1 trees Roure NoJ (check box)
owf---� � " s c DEPTH DRILLING LOG
G y or Town State Zi Codc Formation Description
(��_ 7 .�1_ rL. p From To p
Area code-Phone number f
4. DATE DRILLED t - t�' r:-•j
5. TOTAL DEPTH t, C,Y rr (1 .t tt <• E l�
6. DOES WELL REPLACE EXISTING WELL? YES❑ NO Uw� ^
7. STATIC WATER LEVEL Below Top of Casing: _ C. Fr. �'� 7�'( ' ��fa-r--�✓�2, —
(Use"+"if Above Top of Casing)
8. TOP OF CASING IS ( FT.Above Land Surface"
*Top of casing terminated attar below land surface requires a
variance in accordance with ISA NCAC 2C A118.
YIELD(gpm): to 2. METHOD OF TESTS /7:• /
"f! 10- WATER ZONES(depth): ,;,
I LOCATION SKETCH
IL DISINFECTION:Type_:'— f ,h1 c Amount V 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 Ft.
From C' To Ft. — (!
From-1.�To .i'3 Ft. _
13. GROUT: Depth Material Method JWITIIJ�CAC"21(�
From To Ft.-
From
_6�To_21, Ft. t': - 1'rot t.
14. SCREEN: Depth Diameter Slot Size MaterialFromTo Ft. in. in.From To Ft. in. in.
I5. SAND/GRAVEL PACK:
Depth Size Material
FromTo Ft.FromTo Ft.16. REMARKS:1 DO HEREBY'CERTIFY THAT 7HI5 WELL WAS CONSTRUCTED IN ACCOR ,WELL�z�� � 4
CONSTRUCTION STANDARDS .4ND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
/
IGNAT me l._ .. ,,SON
�'�•'�•N:�c vrrcnnvry t_.vrvJIRUGI"ING 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. G W-1 REV. 07/2001

WELL CONSTRUCTION RECORD
North Carolina- Department of Environment and Natural Resources-Division of Water Quality-Groundwater Section
\\'ELL CONTRACTOR(INDIVIDUAL)NAME (print)_Og�!-7 Y r S'f/Cy
CERTIFICATION#2/S__Z`
XN ELL.CON T RAC'fOR COM PANT NAME SU�Q'1�.�1Nf^� L r�/ r!;ivn
PHONE Y (e4'r JZy-G
$'i',\'1'C WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(ifap�licable) /�, (if applicable)
1. WELL USE(Check Applicable Box): Residential&Y Municipal/Public Cl Industrial ❑ Agricultural ❑
1MOnitoring❑ Recovery ❑ Heat Pump Water Injection❑ Olher O If Oder,List Use
2, W ELL LOCATIO
Nearest Town: l ) 'G_County t i(; ile � _/Topographic/Land setting
d Idge OSlope ❑Valley ❑Flat
�r y.Subd"s (check appmpriatc box)
IStrcet Name,N��u/��jmbcrs,Cmnmunny,$ubdivi;Tun,Lot No.,Zip Code) Latitudeilongitude of well location
3. OWNER: e'- C' ( 4 eltsR'
Address 35' tdcgrecs/minuus/seconcLt)
Latitude/longitude sourcc:OGPSOTopographic map
I Street or Route No.) / (check box)
DEPTH DRILLING LOG
ay or Town tare Zip Code From TO
7 Fom)ation Description
Area code-Phone number
4. DATE DRILLED W 9t/OT__$
5. TOTAL DEPTH: lrrL.)
6. DOES WELL REPLACE EXISTING WELL? YES❑ NO WY
7. STATIC WATER LEVEL Below Top ofCasing: Cc ' F-f.
(Use'W'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 r--s
variance in accordance with ISA NCAC ZC Al 18. --I
9. YIELD(gpm): 3 METHOD OF TESTA 1
10. WATER ZONES(depth): f N k - m
LOCATION SKETCH
t I. DISINFECTION:Type_a4� r� Amount £ t' 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 eo w9 qad names.
From To FL
From To c: _Ft.� _ ��` �1.0
m
From ,42 To � Ft. - _ ;; ZLA
13. GROUT: Depth Material Method
From To Ft. •.Ali,Fro m m
_To Ft. Z/ey7 Cf'
14. SCREEN: Depth From To Ft.Diamcl r Slot Size Material
in, in. u /
From To Ft, in. in.
15. SAND/GRAVEL PACK:
Depth Size Material !�r
From To FL - A
From To FL
16. REMARKS:
1 DO HEREBY RTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C.WELL CONSTRUCT '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

J. 4 6 4s ,w o%d
WELL CONSTRUCTION RECORD
North Carolina- Department of Environment and Natural Resources- Division of Water Quality-Groundwater Section
WELL CONTRACTOR(INDIVIDUAL)NAME (print) C /4124 - lus TI C! CERTIFICATION#!/�
WELL CONTRACTOR COMPANY NAME .T�US.II r_°,E ��L(, Y C-CtI�7v PHONE # Aa 7L_/_Z/,VS
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
1. WELL USE(Check Applicable Box): Residential tN Municipal/Public❑ Industrial ❑ Agricultural ❑
Monitoring❑ Recovery ❑ Heat Pump Water Injection❑ Other❑ If Other,List Use -
2. WELL LOCATION: Y_(.LLltvo o a hic/Land setting o
Nearest Town: . g✓4* t'p/e Count 4eel P P
tdge ❑Slope ❑Valley ❑1Ta _
- A IC'` o0 iLle F idii',"r (check appropriate box)
(Street Name,Numbers,Community,Subdivision,Lot No.,Zip Code) Latitude/longitude Of Well lOCat10®7 sg
3. OWNER: J .C_ �J (P& (degrees/minutes/seconds) '^
Address p0 LIT
GQX 6 A Latitude/longitude source:❑GPS❑Topographic map
I (Street or Route No.) (check box)
�1 1 i,,1 IVY � 7� DEPTH DRILLING LOG
City or Town State Zip Code From To Formation Description
(6M )-M-3y l
Area code-Phone numb ram�„„ Q G oS E /eee lL.
4. DATE DRILLEDA 6p- (p- O�j
5. TOTAL DEPTH: ,M1 _$
6. DOES WELL REPLACE EXISTING WELL? Y zkz NO
7. STATIC WATER LEVEL Below Top of Casing: 4 FT. / (S UC S'
(Use"+"if Above Top of Cuing)
8. TOP OF CASING IS FT.Above Land Surface" U�P �u�
*Top of casing terminated at/or below land surface requires a
variance in accordance with 15A NCAC 2C.0115.
9. YIELD(gpm): 2—�—METHOD OF TEST
10. WATER ZONES(depth): Q! elr- Froe
LOCATION SKETCH
It. DISINFECTION:TypeC110Af C Amount D 2. Show direction and distance in miles from at least
12. CASING: Wall Thickness two State Roads or County Road Include the r ad
Depth Diameter or Weight/Ft. Material numbers and common road name1e"l`
From To Ft.
From To FLlu fo- v� 1
From dt) To_cA3 Ft. _ /80
13. GROUT: Depth Material Method Q
From To FL
From C5 To 2-5 Ft. P.e l MO
14. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in.
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Size Material A
From To Ft. G
From To Ft.
16. REMARKS:
1 DO HEREBY CERTIFY THAT YIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C,WELL
CONSTRUCTION STANDAR S A./N��D��THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
wW
SIGNKTUP 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. 07l2001

WELL CONSTRUCTION RECORD It w
North Carolina-Department of Environment and Natural Resources- Division of Water Quality-Groundwater Section
WELLCONTRACPOR(I.NDIVIDUAL)NAME (print)
CERTIFICATION#
WELL CON7RACI'OR COMPANY NAME_ SU,�Y(•� l io/j {�
-AL—J�t__PHONE # . ?,`iP Y fB
S'fA'I'E WELL CONSTRUCTION PERMIT#
61"applicable) SSOCIATED WQ PERMIT#
(if applicable)
I. WELL USE(Check Applicable Box): Residential D/Municipal/Public❑ Industrial ❑ Agricultural❑
Monitoring❑ Recovery ❑ Heat Pump Water Injection❑ Other❑ If Other,List Use
2. WELL LOCATIQN: �' ,
Nwresi Town: �. 1�;,�—'� Coumy 2t-,car TopoBrapMc/Land setting
lflfJ (�[e u� � ❑Ridge pSlope Malley ❑Flat
ISlntir Nana,Numbcn,Community,Su�bdi�a,Zip Code) (chuk appropriate box)
pp, LatitudeJlongitude of well location
3. OWNER: �tJ�i� (� �!P
Address j t/Z Z�j L�/Kr .(� , ,,j �I,F (tkgrecsttamumsmands)
5 - Strett or_Rowe No.) Latitude/longitude source:OGP$❑Topographic map
��/ 0?�% (check box)
s� Zip Codc DEPTH DRILLING LOG
City or Town Sate
I")- S2 N_ p y S 7 p From To Fomiation Description
Area code-PMate number--
d. DATE DRILLED_Z 2"/fi 3 —
5. TOTAL DEPTH: y e,5-
6. DOES WELL REPLACE EXISTING WELL? YES❑ NO ❑ — —
7. STATIC WATER LEVEL Below To ofCasin : 0 ye y— `0----- ri
P g �_FT.
3. TOP OF CASING IS i (Use"� itAbove Top of Casing) --
FT.Above Land Surface* r =r
'Top of egtaa termlaated ntlor below land%Wfut rrquires a —t
rarianu is aeenrd�nlb with ISA NCAC 2C.011& --
9. YIELD(gpm): /2 METHOD OF TEST/
10. WATER ZONES(depth): �Z
0
11. DISINFECTION:Type�LUtiU c�, �,�,.� LOCATION �-
12. CASING: Amount _ Show direction and distance in miles from at least
Wall Thickness two State Roads or
Doh Diameter or WeighUp, Material numbers and common roadRnun=..Include the road
From J To_442 FL (r Y Y
From Too Ft.
From Method
TO
�_Ft. Litt Q L111�
From T /�(•(�sG ii
13. GROUT: Depth Material r C
Ft.T_ rNt�
From i', TO 2-3 �,,
14. SCREEN: 75
From Depth Diameter Slot Size Material /Z�
Tir Ft. in.
From in. \ `
To Ft. in. in. I
15. SAND/GRAVEL PACK: /
_ Depth
From Size Material
From To FL �-
16. REMARKS:
1 DO HEREBY RTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC?
CONSTRU STANDA A ND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER'
'
1GNA1 URE OF PERSON CONSTRUCTING THE WELL
DATE
Submit the original to the Division of Water Quality,Groundwater SectioD,1636 Mail Service Oeater-Raleigh,NC
27699-1636 Phone No.(919)733-332 1,Within 30 days.
-GIN-1 REV.07/2001
i

North Carolina- Department of Environment and Natural Resources-Division of Water Quality-Groundwater Section ( ' `'➢
l/ V3 J
1636 Mail Service Center-Raleigh, N.C. 27699-1636-Phone [phone]
WELL CONSTRUCTION RECORD WELL CONTRACTOR: Oeeroev \'.'titx"Tt'ryF{) Purnp co ;,,c
WELL CONTRACTOR CERTIFICATION#: a2f 87
')50152-i STATE WELL CONSTRUCTION PERMIT#: Stew Reece
1. WELL USE (Check Applicable Box): Residential 0 Municipal 0 Industrial 0 Agricultural❑ Monitoring ❑
Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use: -
2. WELL LOCATION: (Show sketch of the location below)
Nearest Town: gpt2L%F P1 NIP County: Ldl Tf'*;Jl=; l
Ino��l amer�an I um'�ber�s,�omlm�Ey,or?;u5tl�n ado'[ ol�l �I�
DRILLING LOG DEPTH
3. OWNER From To Formation Description
Address 5:17 r=OL �(�F�k�E 6� 1 v PT
1 tree or ou[e o.l
City or ToirvS " ' State "' ip ode
4. DATE DRILLED
5. TOTAL DEPTH ROO _
6. CUTTINGS COLLECTED YES 0 NO E�
7. DOES WELL REPLACE EXISTING WELL? YES 0 NO 0
8. STATIC WATER LEVEL Below Top of Casing: FT. co
(Use"+"if Above Top of Casing)
9. TOP OF CASING IS 1 FT. Above Land Surface* c�it
*Top of casing terminated at/or below land surface requires a variance in accor-
dance with 15A NCAC 2C.0118
10. YIELD (gpm): ft METHOD OF TEST ?ir
11. WATER ZONES (depth): '1 IN' lylnrn EnRY E F 0 t1n aern
0 f1n aprr' .1 Cirlgnm
12. CHLORINATION: Type ;47'14 Amount If additional space is needed use back of form
13. CASING: Wall Thickness LOCATION SKETCH
Depth Diameter or Weight/Ft. Material (Show direction and distance from at least two State
From O To D Ft.—k_ y9 Q 2 ^ Rpads,or other map reference points) ft
From To Ft. LEI, t' .,(_r,F_. ,
From To Ft.
14. GROUT: 1 q
Depth Material Method
From r. To -;g Ft. r-_ =rd' _ _ :,I�
From To Ft.
15. SCREEN: 1/14 N i
Depth Diameter Slot Size Material
From To Ft. in. in. � ,.,
From To Ft. in. in.
From To Ft. in. in. .y
16. SAND/GRAVEL PACK:
Depth Size Material
From To Ft. -)r1pc, - --
From To Ft.
u
17. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C,WELL
CONSTRUCTION STANDARDS,AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER.
FOR OFFICE USE ONLY ~" "' �� 110 " aol
7
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
Quad No: Submit original to Division of Water Quality,Groundwater Section within 30 days
GW-1 REV.12/99
Serial No.

North Carolina- Department of Environment and Natural Resources-Division of Water Quality-Groundwater Section
1636 Mail Service Center-Raleigh, N.C.27699-1636-Phone[phone]
WELL CONSTRUCTION RECORD WELL CONTRACTOR: 4e.1fe, ua ,r7nt, ' PQrn. C, Erc
WELL CONTRACTOR CERTIFICATION#: 20,97
4i',SZG? STATE WELL CONSTRUCTION PERMIT#: "'EVE Ree,_s!
1. WELL USE (Check Applicable Box): Residential 0 Municipal 0 Industrial 0 - Agricultural❑ Monitoring 0
Recovery 0 Heat Pump Water Injection 0 Other Q If Other, List Use:
2. WELL LOCATION: (Show sketch of the location below)
Nearest Town: SR ICE PIN
EIR:oatitl DNa me[a1n d 3NFumFc nit)L,'r F County: h4T ^-.EDU
E=1 CoL 41 S
ionantlR KN:ySSb(v LoN Jb R om .
'`rkr"Ar1411'; '' - DRILLING LOG DEPTH
3. OWNER 7F From To Formation Description
Addresses 3 .� 226
_I r rRouteNo.l tl R CdF"T
��F I lr- ice° r 2�„_ _ zfi r r t?r�4rd� 'City or Town fate Zip Code -
4. DATE DRILLED if1!•+7rhr+DF
5?}
5. TOTAL DEPTH ?d..5 62 er Asyt`F
6. CUTTINGS COLLECTED YES D NO E �00 r�l ICN,7
7. DOES WELL REPLACE EXISTING WELL? YES 0 NO 0 %na 'dF GFz,M-E -
8. STATIC WATER LEVEL Below Top of Casing: df1 FT.
(Use"+"if Above Top of Casing) -
9. TOP OF CASING IS 1 FT.Above Land Surface* -
Top of casing terminated avor below land surface requires a variance in accor-
dance with 15A NCAC 2C.0118 -
10. YIELD (gpm): U.5 METHOD OF TEST 6J- -
11. WATER ZONES (depth): 0.25 gpm4B-50 0 25pom E0C�604
0.00 ppin D DDppm
12. CHLORINATION: Type HT Amount isEf If additional space is needed use back of form
13. CASING: Wall Thickness £.�, LOCATION SKETCH
Depth Diameter or Weight/Ft. Material I" (Show direction and distance from at least two State Cori
From i1 To :a,Ft. 6 1fe '..xi!1 FlAiC `s
Roads,or other map reference points) ,�,.}+�, ;,,• t��"
From To Ft.
From To Ft.
14. GROUT:
Depth Material Method
From To '/0 Ft. � p'lo,„
From To Ft. .,
15, SCREEN:
1
Depth Diameter Slot Size Material
From To .Ft. — in. in.
From To Ft. _ in. in. !
From To Ft. _ in. in.
16. SAND/GRAVEL PACK:
p
De th Size Material `
From To Ft. /_`;v
From To Ft.
17. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C,WELL
CONSTRUCTION STANDARDS,AND THAT A COPY OF THIS RECORD HAS EEN PROVIDED TO THE WELL OWNER.
FOR OFFICE USE ONLY
Quad No: SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
Submit original to Division of Water Quality,Groundwater Section within 30 days —
GW-i REV. 12/99 -
Serial No. -..

S RESIDENTIAL WELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources-Division of Water Quality
@« �' WELL CONTRACTOR CERTIFICATION# 2687 G60548
1.WELL CONTRACTOR:STEVE REECE I. DISINFECTION:Type HTH Amount e1
Well Contractor(Individual Name) g• WATER ZONES(depth):
DEWEY WRI GHT WELL &PUMP CO., INC. From 80-� To From To
From To From To
ct Well Contraor Company Name From To From To
STREET ADDRESS F. O. BOX 30"c 6.CASING: Thickness/
SO-ONE NC 2$607 0 Depth 5 @ metef eight PMaterial
From To Ft.
VC
City or Town State Zip Code From To Ft.
( 848 )_ 264 c6$1 From To Ft.
Area code-Phone number
7.GROUT. Depth Material Method
2.WELL INFORMATION: From 0 To 2O Ft.Cement Gravity Flow
SITE WELL ID#[If applicable) From—To Ft.
STATE WELL PERMIT#(if applicable) From To Ft.t'ement 'GrFa ty ovv
DWQ or OTHER PERMIT#hf applicable) B.SCREEN: Depth Diameter Slot Size Material
WELL USE(Check Applica�QBo ): Residential Water Supply From To Ft.—In. in.
DATE DRILLED 99 y1��05 FromTo Ft.—In. in.
TIME COMPLETED AM❑ PM 6 From To Ft, in. _in.
3.WELL LOCATION:
9.SAND/GRAVEL PACK:
CITY: SPRUCE FINE COUNTY MITCHELL Depth Size Material
From _To Ft.
OLD 19 E OFF KWY 19E OFF 226 From _To Ft.
(Street Name,Numbers,Community,Subdivision,Lot No.,Parcel,Zip Code) From o Ft.
-
T
TOPOGRAPHIC/LAND SETTING: 10.DRILLING LOG
❑Slope O Valley O Flat 0 Ridge ❑Other From To Formation Description
(check appropriate box) 0 so DIRT
May be in degrees,
LATITUDE 3 minutes,seconds or
LONGITUDE in a decimal format
- S
Latitude/longitude source: La CPS ❑Topographic map
IONt
(location of well must be shown on a USGS topo map and ik
NITE
attached to this form if not using GPS) - 110 505
4.WELL OWNER
OWNER'S NAMEWILLIAM E GOFF v^-
STREET ADDRESS `54
t' RL) ICJ
SPRUCE PI
Clty or Town State Zip Code
i8( 28) )_ 785-5516
Area code-Phone number
SWELL DETAILS: 505 11�RElyIARlf.�:84 - 0 GPM -
a. TOTAL DEPTH: CaPM tll>-
b. DOES WELL REPLACE EXISTING WELL? YES❑ NOb
c. WATER LEVEL Below Top of Casing: 80 FT I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH
(Use"+"if Above Top of Casing) 15A NCAC 2C,WELL CONSTRUCTION STANDARDS,AND THAT A COPY OF THIS
RE90RD HAS BEEN PROVIDED THEWELLOWNER.
d. TOP OF CASING IS 1 FT Above Land Surface` �-�—�— G�
'Top of casing terminated at/or below land surface may require
a variance in accordance with 15A NCAC 2C.0118 SIGNATURE OF CERTIFIED WELL CONTRACTOR DATE
e. YIELD(gpm): 1 METHOD OF TEST Air STEVE REECE
PRINTED NAME OF PERSON CONSTRUCTING THE WELL
Submit the original to the Division of Water Quality within 30 days.Attn:Information Mgt., Form GW-ta
1617 Mail Service Center-Raleigh,NC 27699-1617 Phone No. [phone] ext 568. Rev.7/05

(.Y ( �'
WELL CONSTRUCTION RECORD
North Carolina-Department of Environment and Natural Resources-Division of water Quality-Groundwater Section
tt'ELL CONTRACTOR(INDIVIDUAL)NAME (print) Ar IZl � CERTIFICttA�rr,,T�ION#
WELL CONTRACI'OR COMPANY NAME 'vS•Fi CF t_w e CL OJ IC.L..AI: PHONEY JGY ) �•'/'!%�Y�
STATE WELL CONSTRUCTION PERM ITa ASSOCIATED WQ PERMITS
_(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: � � �// Topo�graWLand setting
Nearest Town: 1.3 1.2 Swi�"Zc%N 'ounty,4 '� ❑Ridge Mlope ❑Valley ❑Flat
e_P ho�tt- d— !�c �( (check appropriate box)
(Street Name.Numbers,Community.Subdivision,Lot No..Zip Code) Latitudellongitude of well location
3. OWNER: Q'Yil 7"L% K l(t5 a.>'au (degreeymimncsfseconds)
Address . O ({y�7C S ;' ip o Latiluddlongitude source:❑GPS❑Topographic map
tStrtxi or R e No.) g (check box)
)ndhe.sw F� jAY�_ �ey, DEPTH DRILLING LOG
(M City or Town Sum Zip code From To Formation Description
?lo5'-24/16,
Area code•Phone number
4. DATE DRILLED /©•/7-r35
5. TOTAL DEPTH: 405
6. DOES WELL REPLACE EXISTING WELL? YES❑ NO G!/
7. STATIC WATER LEVEL Below Top of Casing: 6_0 _FT.
(Use"+"if Above Top of Cuing) e
3. TOP OF CASING IS FT.Above Land Surface' ,.
•Top orearing tetvtlaated atlor below land aerlace reautres a
vartance in accordaW with ISA NCAC 2C.0110. r.,3
9. YIELD(gpm): /_METHOD OF TEST !�[�
10. WATER ZONES(depth): ueia jjg
LOCATION SKETCH -
11. DISINFECTION:TypeClOn fJe- Amount JLY CSy 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 WeightTI. Material I ombors and common road rta
From To FL lq e,L>
From To Ft. �/T Z2�'uf SLot'�
From To Ft. L� R
13. GROUT: De Material Method
From To Ft. {
From�_ToFL �yl
14. SCREEN: Depth Diameter Slot Sim M rial p ��
From To Ft. in. in. 0 VC
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Sim 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 STANDA D ,AND THAT OPY OF IS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
SIGNA RE 'PERSON CONSTRUCTING THE WELL DATE
Submit the original to the Division of Water Quality,Groundwater Section,1636 Mail Senice Center-Raleigh,NC
27699-1636 Phone No.[phone],within 30 days. GW-1 REV.07/2001

E'
WELL CONSTRUCTION RECORD
North Carolina-Department of Environment and Natural Resources-Division of Water Quality-Groundwater Section
WELL CONTRACTOR(INDIVIDUAL)NAME (print) - CERTIFICATION#21'50
WELL CONTRACTOR COMPANY NAME `PHONE # IRI`j�y-��i l
STATE WELL CONSTRUCTION PERMIT# ASSOCIA WO PERMIT#
(if applicable) (if applicable)
1. WELL USE(Check Applicable Box): Residential❑ Municipal/Public)Q Industrial ❑ Agricultural❑
Monitoring❑ Recovery ❑ Heat Pump Water injection❑ Other❑ If Other,List Use
2. WELL LOCATION: ` Topo luctImil setting
Nearest Town. l-.�CPr�, �e County .rl ❑Ridge E3SIope ❑Valley ❑Flat
1A w.J , aZ Cn K\ FSG-� PL2.ii , 11J C (check appropriate box)
(SUeet Name,NumberA Comm'imunitty,Subdivision,Lot No.,tip Code) ` Latitudetlongitude of well location
3. OWNER: Z'nik.l,; tY.�I .-,n�l ,�r Y1 (degtees(minuteslseconds)
AddressC r�'�kpn ^,\k'A n t\ l41�l LI ` i1 10 ,Latitudellongitude source:❑GPS❑Topographic map
---� (Street or Rome No.) (check box)
P rt,\C DEPTH DRILLING LOG
Cityor Town State Zip Code From To Formation Description
Imo). (o�ty
Area coda Phone number
4. DATE DRILLED_
5. TOTAL DEPTH:
6. DOES WELL REPLACE EXISTING WELL? YES Q NO
7. STATIC WATER LEVEL Below Top of Casing
Nso"+^if Above Top of Casing) C�
8. TOP OF CASING IS , FT.Above Land Surface• —
'Top of casing terminated aUor below laad smr6ce requires a i
variance in accordance with 15A NCAC 2C.0118. -
9. YIELD(gpm): IL LC*
METHOD OF TEST_
10.WATER ZONES th): CD
LOCATION SKETCH EP
11. DISINFECTION:Type�p�k., Amount _ Show direction and distance in miles from at teas[
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
From—Q_To /Z n Ft.ja::� 476
� Tt
Fromm To 1 Z Z- Ft. f., PC) aA
13. GROUT: Depth 'Material
eh1
From O To�Q_Ft. c,.1 M{ r4.� �� 7
From To F[.
14. SCREEN: Depth Diameter Slot Size Material 1
From To FL in. in. o
From To Ft in. in.
15. SAND/GRAVEL PACK: n L.
Depth Size Material
S �
From To Ft. Iy//11
1./Q
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 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/R�e�sources-Division orwater Quality-Groundwater Section
�
W �
ELL CO�TRACfOR(1\DIVIDUAL)NAME (print) 9Z4 Q Tusk CERTIFICATION#.�//
%%*EL'-CONTRACTOR COMPANY NAME NTjJ ke jc A)& l��_PHONE #cif
STATE WELL CONSTRUCTION PERMIT# ROCIATED WQ PERMrrs
(if applicable) (irapplicable)
I. WELL USE(Check Applicable Box):Residential©�­MunicipaUPublic❑ Industrial ❑ Agricultural❑
Monitoring❑ Recovery ❑ Heat Pump Water injection❑ Other O IrOther,List Use
2. WELL LOCAT10
Nearest Town: ���f Topo Idl.and setting
'County-e p)�ge pe OVallcy OFlat
1 (� (Check appnpuiate but
(Siren Name.Numbcrs.Community.Subdivision,tot No-Zip Code) Lalitudc%ngitudc of well location
3. OWNER: .r1 /©?/ 46yi w,p� i, 6zd (depxtlmim�ms/acawlsl
Address PO AO �-7" Latitude/longitude source:OGPSOTopographie map
k)Oion/1�r' al ) (/ a Irarxtboat
t sued DEPTH LOG
S��P/u Su
( fit) Z ?Or ztpcaae From To Formation Description
Am code.Ptane number
4. DATE DRILLED
5. TOTAL DEPTH:
G#d` 6. DOES WELL REPL A E EXISTING WELL? YES O NO W ?�yr
7. STATIC WATER LEVEL Below Top of Casing:_ya__FT, -
�\�nN� (the-4�irAbow Top ofCacing)
r 3. TOP OF CASING 1S _FT.Above Land Surface;
'Tap at—tax tenth t"t attar be4w hod surface icea'nn a
Varhace in accerdance with 1SA NOW 2C At IL
9. YIELD(gpm): /,Q METHOD OF TEST_/ rL
10. WATER ZONES(depth): le) p di G� ?l Q
"�r LOCATION SKETCH
11. DISINFECTION:Typc-11 .00i„(/Q Amount � /12 Show direction and distance in miles from at least
12. CASING: Wall Thickness two State Roads or County Roads.Include the road
DepthD)ametm or WLi*WPt. Material tntrrtbets and common road names.
From To FL _
From--C_To�Ft.�
From To—(a
"?
13. GROUT: Depth Material Method �/
From To Ft. 22k
From 0CREEN: Tom_Ft.
14. SCREEN: '�—'"—
Depth Diante'ter Slot Sim leria) /
From To Ft in. in, ��
Fro __
rRTo Ft. in. in. /,
15. SAND/GRAVEL-PACK:
Depth Size Material --
From. To Ft. b
From To Ft /'
16. REMARKS: LI
I DO HEREBY CERTIFY T?AT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH ISA NCAC 2tw WELL
CONSTRUCTIONST A DS,ANDTH TACO OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER'
4
SIGN RE OF PERSON CONSTRUCTING THE WELL - DATE - -
Submit the original to the Division or Water Quality,Groundwater SeetioR,1636 Mail Service Center-Raleigh,NC
27699-!636 Phnne Na.(919)733,'iL 1,within 30 days. G W-1 REV.07/2001
v .
r7

WELL CONSTRUCTION RECORD
North Carolina- Department of Environment and Natural Resources-Division Of Water Quality-Groundwater Section
))'ELL CO-N7R,tCTOR(INDIVIDUAL)NAME (print)_ /3�+/ J J C�
--�-- S` CERTIFICATION S_�
WELL.CO.XT'RACrOR COMPANY NAME- jj,,SFieti PHONE R f`&J_ 7,y—y�r�X
STATE WELL CO STRI;CTION PERMITS
(ifa licable) ASSOCIATED WQ PERMIT*
hfao licablc)
I. WELL USE(Check Applicable Box):Residential 4/Municipal/Public❑ Industrial ❑ Agricultural❑
Monitoring❑ Recovery O Heat Pump Water Injection❑ Other❑ If Other,List Use
2. WELL LOCATION-
Nearest Town: %t+ ,,;..�c o County ,2,EJ /Topographic/Land setting
127 L _ Ridge Mope ❑Valley OFlat
(SUVtiCt Namc Number,Commune ,Subdivi ' (check".appropriate boat
y srogt.otNq,ZpCale) Latitudellongitudeofwelllocation
3- OWNER: 1 A-V
Address �% ,J fl Jl Ai G r tdcgrees/mimrt�sisecoottcJ
Latitude/longitude sOUrce:0GPS0Topogmphic map
1S<<-Y4tin4 1'L l�c ),) e .2 2 705— (check trial
Cnyat Town State Zap Code From DEPTH DRILLING LOG
(r.i)-�,�- IU S?Gt TO Formation Description
..%=code-Phwrc number --�_
4. DATE DRILLEDJ4-Zo- EIS
5- TOTAL DEPTH, 40c; l
6. DOES WELL REPLACE EXISTING WELL? YES Q NO Q �-
7. STATIC WATER LEVEL Below Top ofChsing�}-f L
S. TOP OF CASING is (Use`er if Abaft Top of Casing)
2 FT.Above Land Surface*
'Top of cuing tenotanted u1w below land surfs a requires a
variance in accordance with ISA NCAC 2C-Ol I&
9. YIELD(gpm):-1 a _METHOD OF TEST
10. WATER ZONES(depth): i
u�
N SKETC14
11. DISINFECTION: YPe
T /� LOCATIO-iJ 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 Wdghl/FL Material numbers and Lvrmnon road names,
From To Ft
From O To�
From �a To�_Ft,
13. GROAT: Depth Material Method _
From To FL
From O De Zo F(- {r op/ U
14, SCREEN: fi — n�i r` Maienal
� Dia ter Slot Sir
From To ft.
Fro in- in.
m To FL in- in. ✓ ti�a /j1� c_
15. SANDJGRAVELPACK: v�
yy yr<
Depth size Material From To Ft. ti�n
-
From To Ft.
A,C
16. REMARKS: Z Ce
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A AC 2C,WELL
CONSTRUCTION ANDARDS,ANDTHATACOPYOFTHISRECORDHASBEENPROVIDED THE WELL OWNER
JiD
LA IV
SIG ATURE OF PERSON CONS CSC E ,•'F(� DATE
Submit the original to the Division of Water Quality,Groundwater Sect-io!, I6T67lait Seni Center-Raleigh,NC
27699-1636 Phone No.[phone],)within 30 days-
MAR 08 2006 GW-1 REV.07n001
Asheville Regional Office
Aquifer Protection

9
WELL CONSTRUCTION RECORD NO
North Carolina-Department of Environment and N turat Resources-Division of Water Quality-Groundwater Section
\\'ELLCO]TR,\CTOR(L\DIVIDUAL)NAhrE (prise) Lx [. . r^'
CERTIFICATfINz tZjJ`�
Ns'ELI.COSTR\CfOR COMPAN\'NAME
W PHONE M ;W1n4$`I/_ 8
(ifanplicacabl
STATE WELL CONSTRUCTION
e) ON PERMITS aSSOC1ATED WQ PERMITd
(ifapplicablc)
I. WELL USE(Check Applicable Box):Residential"Unicipal/Public❑ Industrial❑ Agricultural❑
Monitoring❑ Recovery O Heat Pump Water Injection❑ Other O IfOther,List Use
2. W EI_L LOCATION:
Nearest Town:\ Topogl
C 3Phic/Land setting
re County / ORidge lope OValley plat
IStr�v Nano-Numbers.Community,Subdivisim- Lol No„Zip Cade) (check appropriate bozit -
/ Latitudeilongitude of well local'"
3. OWNER:. e,11Pir �L)��
Address �, _ r.r� - - _ (�eestminunutmon k)
Latitudc/longitude source:OGPSOTopogra�hic map
(Street or Route No.) u
fj (check box)I��'f7// DEPTH DRILLING LOG
fimyo Toxm Store Zip Code
From To Formation Description
AL code-Phone number � _
4. DATEDRILLED /2-26-vim j S4-
5. TOTAL DEPTH: �D6-
6. DOES WELL REPLACE EXISTING WELL? YES Q NO M-1 a:i�
7. STATIC WATER LEVEL Below Top ofCasing:—!K42 _Ff,
(Use`+-if Above Top of Casing)
8. TOP OF CASING IS�_FT.Above Land Surface*
*Top Ofcasiae terad ated atfor below land surface requires a
variance is accordance m with ISA NCAC ZC-61 it
9. YIELD(gpm): t G METHOD OF TEST 19/2
10. WATER ZONES(depth): 4 411 4
Sop'
LOCATION$t\_SKETCH11. DISINFECTION-.Type Artiount O Show direction and distance in miles from at le t
12. CASING: Wail Thiclu two State Roads or County Roads.Include the ad
Depth Diamctcr or Weitfln/ L Material numbers and common road names,
From
From To FL
�_TD�Ft /I �G� U��
From_7L_To­f.1:_Ft. G
13. GROUT: Depth Material Method G -
- From To FL
From_Togo Ft. °yi2
14. SCREEN: Depth Diameter Stot Sim Material
From To Ft. in. in.
From To FL in- in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft. /•(LG,
From To Ft. •��J�,�
16. REMARKS: "f
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C WELL
CONSTRUCTION STAND DS,.AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
S19N&7UREOFPERSONCONSTRUCTING�THE WELL DATE
Submit the origin)to the Division of Water Quality; rountFlli(f 16SftAfo1` P636 Mail Sen c Center-Raleigh,NC
27699-1636 Phone No.[phone],within 30 days GW-I REV.07/2001
MAR 08 2006
pch�villee7lonal Ofrl^e

l!
WELL CONSTRUCTION RECORD ) t J
North Carolina- Department of Environment and Natural Resources-Division of Water Quality-Groundwater Section
w ELL CONTRACYOR(INDIVIDUAL)NA51E (print) k aii�`/f �� ?L')fICl- ,dI r�,Y CERTIFICATION#Z [�w'E LL COY'IRACfOR COMPANY NAME l "�'TI ( U��LI f i ��� l�C PHONE # ( ) 72-Y- '/.�yy
STATE\YELL CONSTRUCTION PERMIT# ASSOC1.47En WQ PERStIT#
(if applicable) — (if applicable)
I. WELL USE(Check Applicable Box): Residential M /Municipal/Public❑ Industrial ❑ Agricultural ❑
Monitoring❑ Recovery ❑ Heat Pump Water injection❑ Other❑ If Other,List Use
2. WELL LOCATION: '//' /� ,/���Q� Topographic/Land setting
Nearest Town: ({ 11 L;, t,t< - 1 f County ❑Ridge Q51ope ❑Valley ❑Flat
, RR Ti�t a-�—/o,v tft,ve g,�za i®Q �t/e ,Byes (check appropriate box)
I Street Name,Nullifiers,Community,Suhdnision.Lot No.,Zip Code) Latitude/longitude of well location
3. OWNER: 4Q C4)'rt�-P (degreeslminuteslse<onds)
Address —190%r'r W1770W A Q rjW et re/G Latitude/longitude source:❑GPS❑Topographic map
(StreM or Route No.) (check box)
r a �A $OOZZ DEPTH DRILLING LOG
City or Toon State Zip Code From To Formation Description
( -)-_ fc7S-4Z(- 58oY
Area code-Phone number �� 7,5--
4. DATE DRILLED IZ-ZZ-o5
5. TOTAL DEPTH: 315' 7S- Z n 5,dw
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO 2
T STATIC WATER LEVEL Below Top of Casing: roc FT.
(Use"+'ifAbiwe Top of Casing) T •�
S. TOP OF CASING IS FT.Above Land Surface*
'Top of casing terminated ntlar below Land surface requires a
variance in accordance with 15A NCAC 2C.01IS.
9. YIELD(gpm):I—METHOD OF TEST ArR
10. WATER ZONES(depth): (7V 306'
LOCATION SKETCH
IL DISINFECTION:Type IfLdiy;Ne Amount S OZ. Show dir ction and distance in miles from at least
12. CASING: Wall Thickness two Slat Roads or County Roads. Include the road
Depth Diameter or Weight/Ft. Material number and common road names.
From To Ft.
From O Tom Ft. ro Poe
From Z'Q To ?o Ft.
13. GROUT: Depth Material Method
From To Ft.
From0 To 25- Ft. sOC/ �/L74� D kod
14. SCREEN: Depth Diameter Slot Size Material
From To Ft, in. in. �oi2lc01 a 414W-C,
Front—To Ft. in. in.
15. SAND/GRAVEL PACK: 0
Depth Size Material
From To Ft.
From To Ft. �r
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,we-a eaR.d- & SzfFLe l5!C•e coil Nat ekel,OZC �I ZC Zq(3 t
SIGNATURE OF PERSON CONSTRU6TIAG pZ:W li Q n TE
Submit the original to the Division of Water Quality,Groundwater'SkMd^ef��`'149Pnice Cen er-Raleigh,NC
27699-1636 Phone No.[phone],within 30 days. G -1 REV.07/2001
MAR 0 8 2006
Asheville Regional Office
Aquifer Protection