Tr CY2005

WELL CONSTRUCTION RECORD 01
North Carolina-Department of Environment and Natural Resources-Division of Water Quality-Groundwater Section
WELL CONTRACTOR(INDIVIDUAL)NAME (print)KENNETH MCCRARY CERTIFICATION#2008
WELL CONTRACTOR COMPANY NAME
BARKER CONSTRUCTION,INC./BARKER WELL&PUMP PHONE # [phone]
STATE WELL CONSTRUCTION PERMIT# 1871 ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
1. WELL USE(Check Applicable Box):Residential M MunicipaVPublic❑ Industrial❑ Agricultural[]
Monitoring❑ Recovery ❑ Heat Pump Water Injection❑ Other❑ If Other,List Use
2. WELL LOCATION: Topographic/Land setting
Nearest Town: BREVARD County TRANSYLVANIA E]Ridge ❑Slope ❑Valley ❑Flat
GRAY FOX SUBDIVISION (check appropriate box)
(Street Name,Numbers,Community,Subdivision,Lot No.,Zip Code) LatitudeAongitude of well location
3. OWNER: MONTY BURRELL (degrees/rnmm s/seconds)
Address 179 RICH MOUNTAIN ROAD LatitudeAongitude source:❑GPS❑Topographic map
(Street or Rome No.) (check box)
BREVARD NC 28712 DEPTH DRILLING LOG
City or Town state Zip code From To Formation Description
8( 28 )- 877-3082
Area code-Phone number
4. DATE DRILLED MAY 26,2005
5. TOTAL DEPTH: 405'
6. DOES WELL REPLACE EXISTING WELL? YES❑ NO EI c'7
7. STATIC WATER LEVEL Below Top of Casing: 50' FT.
(Use"+^if Above Top of Casing) C
8. TOP OF CASING IS 1.33 FT.Above Land Surface;
•Top of using terminated attor below land surface requires a --
variance in accordance with lSA NCAC 2C.011& -- n
9. YIELD(gpm): 1 X METHOD OF TEST TIMED t7
10.WATER ZONES(depth): LOCATION SKETCH
]I. DISINFECTION:Type BY PUMP INSTALLER Amotmt Show direction and distance in miles from at least
12. CASING: Wall Thickness two State Roads or County Roads.Include the road"
Depth Diameter or Weight/Ft. Material numbers and common road names.
From 0 To 86' Ft. 6 118 SDR21 PVC L11, tin dALt.1at,,1 ;1& 17,P
From To FL .LG
4:d O� -k�-ri/cQ���Iffu
From To FL y /
13. GROUT: Depth Material Method 1�ioQt� -10 RS/ (jGz
From 0 To 20' Ft. CONCRETE POURED �
From To Ft. � ��`�" ',//"eezd'
14. SCREEN: Depth Diameter Slot Size Material r'
From To Ft. in. _ in. •KGiK�C•�- Z�[,Jye+.w.�
From To Ft. in. in. (eG� f/YL //
15. SAND/GRAVEL PACK:
Depth Size Material vT'/
From To Ft.
From To Ft.
16. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C,WELL
CONSTRUCTION STANDARDS,AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
7
/ �-i� L �t i/k GC J� J - )� !�7
` IDS—
SIGNATURE OF PERSON CONSTRUCTING THE WELL T DATE
Submit the original to the Division of Water Quality,Groundwater Section,1636( aif�eretFe(jnt�r 7 RRleig_4,N� I '1
27699-1636 Phone Na(919)733-3221,within 30 days.
Ij JUN 27 200-5
I
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I SF-rTioN

kl IZ
WELL CONSTRUCTION RECORD _' 'l 3 0 7 9 5 3
North Carolina Department of Environment and Natural Resources-Division of Water Quality
WELL CONTRACTOR(INDIVIDUAL)NAME (print) James B.Brown CERTIFICATION#2045
WELL CONTRACTOR COMPANY NAME Hedden Brothers Well Drilling, Inc PHONE # [phone]
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable) (if applicable) _
1. WELL USE(Check Applicable Box):Residential El Municipal/Public❑ Industrial ❑ Agricultural❑
Monitoring❑ Recovery ❑ Heat Pump Water Injection❑ Other❑ If Other,List Use
2. WELL LOCATI N: Topographic/Land setting
Neare Town: r County!�1�jQ/yt IQ� ORidge ❑Slope OValley OFlat
r (check appropriatedwell) -
(Street Name,Numbers Community,Subdivision,Lot No.,Zip Code) Latitude/longitude of well location r --
3. OWNER: 4 LJI(LIL 1 `r1�S�J (degrees/minutes/seconds)
Address L RO Latitude/longitude source:OGPSOTopographicmap
(Street or Route o.) (check box) -
'rAiA A H A F-L DEPTH DRILLING LOG
City or own state Zip Code From T Formation Description
6c 26 )- �9►-a�7�a CopIYACiT 0 1 clay&sand
Area code-Phone number r granite
4. DATE DRILLED
5. TOTAL DEPTH:
6. DOES WELL REPLACE EXISTING WELL? YES
7. STATIC WATER LEVEL Below Top of Casing:
(Use"+"if Above Top of Casing)
S. TOP OF CASING IS 2 FT.Above Land Surface`
*Top of casing terminated at/or below land surface requires a
variance In accordance with 15A NCAC 2C.0115.
9. YIELD(gpm): .3 ME � SLOW
10.WATER ZONES(depth): — LOCATION SKETCH
11. DISINFECTION:Type H T H Amount 16 oz Show direction and distance in miles from at least
12. CASING: Wall Thickness two State Roads or County Roads.Include the road
Depth , Di meter or Weight/Ft. aterial numbers and common road names. o�
From 0 To Ft. �� �y G>�
From To Ft. /s„ � -rt rnm
From To Ft. n ;;o
13. GROUT: Depth Material Method _ �p
From 0 To 20 Ft. Benonite&cement pumped � �O-
�
From To Ft._
14. SCREEN: Depth Diameter Slot Size Material = ��
From To Ft. in. in. o
0
From To Ft. in. in. w =
15. SAND/GRAVEL PACK: '� rrn
Depth Size Material c7
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 STA RDS,AND THAT OPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
_.0
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
Submit the original to the Division of Water Quality,Attn:Information Management,1617 Mail Service Center-
Raleigh,NC 27699-1617, Phone No.[phone],within 30 days.
GW-1 REV.09/2004

OvOi 309974
WELL CONSTRUCTION RECORD
North Carolina-Department of Environment and Natural Resources-Division of Water Quality-Groundwater Section
WELL CONTRACTOR(INDIVIDUAL)NAME (print)KENNETH MCCRARY CERTIFICATION#2008
WELL CONTRACTOR COMPANY NAME BARKER CONSTRUCTION,INC.IBARKER WELL&PUMP PHONE # [phone]
STATE WELL CONSTRUCTION PERMIT# 1871 ASSOCIATED WQ PERM f#
(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: BREVARD County TRANSYLVANIA ®Ridge []Slope ❑Valley ❑Flat
GLADE CREEK,LOT#16 (check appropriate box)
(Street Name,Numbers,Community,Subdivision,Lot No.,Zip Code) LatitudeAongitude of well location
3. OWNER: LORENZO ROJAS (degreesiminutesiseoonds)
Address 401 CEMETERY ROAD Latitudc/longitude source:❑GPS❑Topographic map
(Street or Rome No.) (check box)
BREVARD NC 28712 DEPTH DRILLING LOG -•'{
1
City or Town State Zip Code From TO Formation Description
( 828)_ 862-8543
Area code-Phone number
4. DATE DRILLED MARCH 11,2005
5. TOTAL DEPTH: 280 T
6. DOES WELL REPLACE EXISTING WELL? YES❑ NO El a
7. STATIC WATER LEVEL Below Top of Casing: 50' FT.
(Use"+-if Above Top of Casing) ;
8. TOP OF CASING IS 1.33 FT.Above Land Surface'
•Top of casing terminated auor below land surface requires a O
variance in accordance with 15A NCAC 2C.011&
9. YIELD(gpm): 8'A METHOD OF TEST TIMED
10.WATER ZONES(depth): LOCATION SKETCH
11. DISINFECTION:Type By PuuP INSTALLER Amount Show direction and distance in miles from at least
12. CASING: Wall Thickness two State Roads or County Roads.Include the road
Depth Diameter or Weight/Ft. Material numbers and common road names. n^ , /
From 0 To 86 Ft. 6118 SDR21 PVC o:�zaw �,twa& -1aA i:C !p
From Tc Ft. ;to ,Z�Za_c&
From TO Ft. . /
13. GROUT: Depth Material Method VIZ rk( eG/.e1A-a-c-
From 0 To 20' Ft. CONCRETE POURED
From To Ft. - -
14. SCREEN: Depth Diameter Slot Size Material
From Saf a- Y�Zy
To Ft. in. in.
From To Ft. in. in.
15. SAND/GRAVEL PACK: .�.b - ./C 1/p, ., _ ti
Depth Size Material -
From To Ft. -
From TO Ft. co
16. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C,WELL -
CONSTRUCTION STANDARDS,ANNGATUREtOF�'PER�SONCiNSTR
CPY OF THS RECORD HAS BEEN PROVIDED TO THE WELL OWNER r --
l �;IGUCTING THE WELL ATE"
Submit the original to the Division of Water Quality,Groundwater Section,1636 Mail Service Center-Raleigh,NC
27699-1636 Phone No.[phone],Within 30 days. GW-I REV.0712001

00 309973
WELL CONSTRUCTION RECORD
North Carolina-Department of Environment and Natural Resources-Division of Water Quality-Groundwater Section
WELL CONTRACTOR(INDIVIDUAL)NAME (print) KENNETH MCCRARY - CERTIFICATION#2008
WELL CONTRACTOR COMPANY NAME BARKER CONSTRUCTION,INC./BARKER WELL&PUMP PHONE # [phone]
STATE WELL CONSTRUCTION PERMIT# 1871 ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
1. WELL USE(Check Applicable Box):Residential® Municipal/Public❑ Industrial❑ Agricultural❑
Monitoring❑ Recovery ❑ Heat Pump Water Injection❑ Other❑ If Other,List Use
2. WELL LOCATION: Topographic/Land setting
Nearest Town: BREVARD County TRANSYLVANIA ❑Ridge []Slope []Valley E1Flat
HIGHWAY 178 (check appropriate box)
(Street Name,Numbers,Community,Subdivision,Lot No.,Zip Code) Latitude(longitude of well location
3. OWNER DAVID&JEANIE PROSCH (degrees/minutes/seconds)
Address PO BOX 208 LatitudeAongitude source:❑GPS❑Topographic map
(Streetor Route No.) (check box) _
ROSMAN NC 28772 DEPTH DRILLING LOG - �
City or Town state Zip Code From To Formation Description C)
8( 28 )- 966-4428
Area code-Phone number —O
4. DATE DRILLED MARCH 10,2005 r7
5. TOTAL DEPTH: 180' -21
6. DOES WELL REPLACE EXISTING WELL? YES❑ NO ®
7. STATIC WATER LEVEL Below Top of Casing: 15 FT. O
(Use"+"if Above Top of Casing)
8. TOP OF CASING IS 1.33 FT.Above Land Surface'
"Top of casing terminated af/or below land surface requires a
variance in accordance with 15A NCAC 2C.011&
9. YIELD(gpm): 15 METHOD OF TEST TIMED
10.WATER ZONES(depth): LOCATION SKETCH
11. DISINFECTION:Type BY PUMP INSTALLER Amount Show direction and distance in miles from at least
12. CASING: Wall Thickness two State Roads or County Roads.Include the road
Depth Diameter or Weight/Ft. Material numbers and common road names.
From 0 To 40' Ft. 6 1/4 .185 STEEL JA")m 6 t w" � 'I
From To FL ,w� � J /W . `1
From To Ft 0
13. GROUT: Depth Material Tl
Method vny, y)t Lw Cmot
From 0 To 20' Ft. CONCRETE POURED IG� L�
14. SCREEN: Depth From TO F1Diameter Slot Size Material _.Q. u- ! _ O PMu�K-t.- ^ n G?x
From To Ft. in. in. � �LQLK-1 O� WCX.r�
From To Ft. in. in. IA ' UWWMA. d
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
16. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C,WELL
CONSTRUCTION STANDARDS,AND T A COPY OF THIS RECORD HAS BE OVIDED TO THE WELL OWNER
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE ..
Submit the original to the Division of Water Quality,Groundwater Section,1636 Mail Service Center-Raleigh,NC
27699-1636 Phone No.[phone],within 30 days. GW-1 REV.07/2001

WELL CONSTRUCTION RECORD 3 0 9 9 7 2
North Carolina-Department of Environment and Natural Resources-Division of Water Quality-Groundwater Section
WELL CONTRACTOR(INDIVIDUAL)NAME (print)KENNETH MCCRARY CERTIFICATION#2008
WELL CONTRACTOR COMPANY NAME BARKER CONSTRUCTION,INC./BARKER WELL&PUMP PRONE # [phone]
STATE WELL CONSTRUCTION PERMIT# 1871 ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
1. WELL USE(Check Applicable Box):Residential ZI Mumicipal/Public❑ Industrial❑ Agricultural❑
Monitoring❑ Recovery ❑ Heat Pump Water Injection❑ Other❑ If Other,List Use
2. WELL LOCATION: Topographic/Land setting
Nearest Town: BREVARD County TRANSYLVANIA ®Ridge ❑Slope ❑Valley ❑Flat
CHASEWOOD SUBDIVISION,LOT#27 (check appropriate box)
(Street Name,Numbers,Community,Subdivision,Lot No.,Zip Code) Latitu lMongitude of well location
3. OWNER-. FRANK DUCKWORTH (degrees/minutes/seconds)
Address 11 RONNIE DRIVE LatitudcAongitude source:❑GPS❑Topographic map
(Street or Rome No.) (check box) _
BREVARD NC 28712 DEPTH DRILLING LOG
City or Town State Zip Code From To Formation Description "s
8( 28 )- 884-5279
Area code-Phone number
4. DATE DRILLED MARCH 7,2005
5. TOTAL DEPTH: 455'
6. DOES WELL REPLACE EXISTING WELL? YES❑ NO 91
7. STATIC WATER LEVEL Below Top of Casing: 40' FT.
(Use"+^if Above Top of Casing) -ro
8. TOP OF CASING IS 1.33 FT.Above Land Surface* ti
"Top of rasing terminated atlo-below land surface requires a --
variance in accordance with 1SA NCAC 2C.0118. v
9. YIELD(gpm): TA METHOD OF TEST TIMED
10.WATER ZONES(depth): 'r'
LOCATION SKETCH
11. DISINFECTION:Type av PUMP wsTALLeR Amount Show direction and distance in miles from at least
12. CASING: Wall Thickness two State Roads or County Roads.Include the road
Depth Diameter or Weight/Ft. Material numbers and common road names.
From 0 To 82 Ft. 6 118 SDR21 PVC
From To Ft Zwr/` •T.fJ�} b' 1
From To Ft.13. GROUT: Depth Material Method • - , - CvWUY✓
From 0 To 20 Ft. CONCRETE POURED
From Ft. YfJprt / �_
14. SCREEN: Depth Diameter Slot Size Material //--_ VVo
From To Ft. in. in.
From To Ft. in. in.
15. SAND/GRAVELPACK: C` GG <LGI.fJGU.tuSIOY(.
Depth Size Material
From To FL �Q„ �f7
From To Ft. ,/'X1.6at
16. REMARKS: -
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C,WELL -
CONSTRUCTION STANDARDS,AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER F"
SIGNATURE OF PERSON CONSTRUC ING THE WI-LE ATE
Submit the original to the Division of Water Quality,Groundwater Section,1636 Mail Service Center-Raleigh,NC�
27699-1636 Phone No.[phone],within 30 days. GW-1 REV.07/2001

WELL CONSTRUCTION RECORD 308576
North Carolina-Department of Environment and Natural Resources-Division of Water Quality-Groundwater Section
WELL CONTRACTOR(INDIVIDUAL)NAME (print) KENNETH MCCRARY CERTIFICATION#2008
WELL CONTRACTOR COMPANY NAME BARKER CONSTRUCTION,INC.IBARKER WELL&PUMP PRONE # [phone]
STATE WELL CONSTRUCTION PERMIT# 1871 ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
1. WELL USE(Check Applicable Box):Residential El Municipal/Public❑ Industrial ❑ Agricultural❑
Monitoring❑ Recovery ❑ Heat Pump Water Injection❑ Other❑ If Other,List Use
2. WELL LOCATION: Topographic/Land setting
Nearest Town: BREVARD County TRANSYLVANIA ®Ridge ❑Slope []Valley OFIrd
HAMILTON ESTATES,LOT#5 (check appropriate box) -
(Street Name,Numbers,Community,Subdivision,La No.,Zip Code) LatitudcAongitude of well location
3. OWNER: SCOTTWISCHOW (degrees/minutes/seconds)
Address PO BOX 208 Latitude/longitude source:❑GPS❑Topographic map --
(Street or Rome No.) (check box)
ETOWAH NC 28729 DEPTH DRILLING LOG
City or Town State Zip Code From To Formation Description
8( 28 )_ 891-3248
Area code-Phone number
4. DATE DRILLED FEBRUARY 14,2005
5. TOTAL DEPTH: 705'
6. DOES WELL REPLACE EXISTING WELL? YES❑ NO KI
7. STATIC WATER LEVEL Below Top of Casing: 50' FT. � f
(Use"+"if Above Top of Casing)
8. TOP OF CASING IS 1.33 FT.Above Land Surface'
*Top of rasing terminated at/or below land surface requires a
variance in accordance with ISA NCAC 2C.0118. Ej1
9. YIELD(gpm): 1 METHOD OF TEST TIMED
10.WATER ZONES(depth):
LOCATION SKETCH
11. DISINFECTION:Type BY PUMP INSTALLER Amount Show direction and distance in miles from at least
12. CASING: Wall Thickness two State Roads or County Roads.Include the road
Depth Diameter or Weight/Ft. Material numbers and common road names.
From 0 To 74 Ft. 6118 SDR21 PVC
From To Ft
From To Ft. VOaQdJ ��LLO-( C f t�-C.t/G�
13. GROUT: Depth Material Method
From 0 To 20' Ft. CONCRETE POURED
From To Ft.
14. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in. (t�\� ,^t.��
From To Ft. in. in. L�✓J a A[� Ig
15. SAND/GRAVEL PACK: 44�rl vC��.¢Ql -
Depth Size Material
From To FL Q�ye/ �Qi(at4f
From-To Ft.
16. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C,WELL
CONSTRUCTION STANDARDS,AND THAT A COPY OF THIS RECORD HAS BE ROVIDED TO THE WELL OWNER
4_aiyVXz;b 1. Kn(I ')- - \
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 309052
North Carolina Department of Environment and Natural Resources-Division of Water Quality
WELL CONTRACTOR(INDIVIDUAL)NAME (print) Russell S.Taylor CERTIFICATION 0 2187
WELL CONTRACTOR COMPANY NAME Haddon Brothers Well Drilling,Inc PHONE # [phone]
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
1. WELL USE(Check Applicable Box):Residential O Municipal/Public ❑ Industrial ❑ Agricultural ❑
Monitoring❑ Recovery ❑ Heat Pump Water I,nj/e�c�'On Dr Other❑ If Other,List Use
2. WELL LOCATION { fa.,NI � Topographic/Land setting
Neare Town: Count ❑Ridge ❑Slope OValley OFlat
M70 _ (check appropriate box)
(Street ame,Nu rs,Community,Subdiv' ion,Lot No.,Zip Code) Latitude/longitude of well location
3. OWNER: (degrees/minutes/seconds)
Address JLatitude/longitude source:OGPSOTopographic map
(Stfeat or P{o.) / (check box)
�7/ �1f DEPTH DRILLING LOG
city wn to Zip Code From To , Formation Description
6( 2g )- - /O !pQ clay it sand
ne Area code-Pho numbe � / granite
4. DATE DRILLED
5. TOTAL DEPTH:
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO
7. STATIC WATER LEVEL Below Top of Casing: It() T.
(Use N+'if Above Top of Casing)
8. TOP OF CASING IS 2 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): ;4() METHOD OF ,EST BLOW
10.WATER ZONES(depth): r7� /t7
—T LOCATION SKETCH
11. DISINFECTION:Type H T H Amount 16 oz Show direction and distance in miles from at least
12. CASING: Wall Thickness two State Roads or County Roads.Include the road
Depth Di eter or We ht/Ft. M tonal numbers and common road names. - -
From 0 To�jj�Ft._ t
From To Ft.
From To Ft.
13. GROUT: Depth Material Method
From 0 To 20 Ft. Benonite&cement pumped = <
b
From To Ft.
14. SCREEN: Depth Diameter Slot Size Material N)
r>
From To Ft. in. in.
From To Ft. in. in, o
LrI
15. SAND/GRAVEL PACK:
Depth Size 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 -
CONST CTION STANDARDS,AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNED, -
3 ' 18,�m=
NATURE OF PERSON CONSTRUCTING THE WELL DATE "T 9
T Iv iJ
Submit the original to the Division of Water Quality,Attn: Information Management,1617 Mail Service Conte('T 00
Raleigh,NC 27699-1617, Phone No.[phone],within 30 days.
GW-1 RE\l..YQ/2004 g

� 11aa_ �
WELL CONSTRUCTION RECORD
North Carolina-Department of Environment and,N')� Resources-pDivvisiionn 9f Water Quality
Quality-Groundwater Sect-i�on�,
WELL CONTRACTOR(INDIVIDUAL)NAME (prier)/Y� J� C A !2<)N e ✓I[CERRTIIRC�cATIIONL#e/lf�fy i'
WELL CONTRACTOR COMPANY NAME,-eP W/O I(+c/ LOVO/l UfII I/n _PRONE # J, ? 1�LF=/1d
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ P
ifapplicable) if licable
1. WELL USE(Check Applicable Box):Residential Municipal/Public❑ Industrial❑ Agricultural❑
Monitoring❑ Recovery ❑ Heat Pump Water Injection❑ Other❑ If Other,List Use
2. WELL LOCATI N: Topo d setting
Nearest Tom} r _County//hr/tS /� ❑Ridge lope ❑Valley ❑Flat
ZIU F-><&� ISit✓v<ao d /vG z 1/a- (check appropebox)
(Sheet Name,Numbem Community,Subdividoo,la No,Zip Code) Latitudellongitude of well location
3. OWNER: e ,A4?62 e ( miautea/seeooda)
Address RE AcK 2/0 &41'rt Latitude4ongitude source:❑GPS❑Topogmphic trap
�? ¢tenetaRomeNoJ (checkbox)
DEPTH DRILLING LOG
City or Town soon tip Code From To Formation Description
Ara code Phone number
4. DATE DRILLED 3 1 Y—C',2
5. TOTAL DEPTH: 32 5' _/
6. DOES WELL REPLACE EXISTING WELL? YES NO 0 i
7. STATIC WATER LEVEL Below Top of Casing:�Ff.
(Use'+"if Above Top of Casing) ;
8. TOP OF CASING IS FT.Above Land Surface+ <
nap of casing termhated■t/or below had surface requires a
varhnce 1n accordance with ISA NCAC 2C.0118•
9. YIELD(gpm): :3 —METHOD OF TEST /
10.WATER ZONES(depth): ^
Lgt
LOCATION SKETQ1
11. DISINFECTION:Type Amount [9` Show direction and distance in miles from at leag
12. CASING: tamer Wall Thickness two State Roads or County Roads.Include the road
Depth9D Ft�� a veignyFt MUU G numbers and common road lames.
Frorgm0—To �v=/z
Frost To Ft
From To Ft c<M�
13. GROUT: Depth Material �� K a
From To ZO Ft Cfe e
From To Ft S
14. SCREEN: Depth Diameter Slot Size Material
From To Ft in. in 2
Fro To Ft in. in. Q
15. SAND/ VEL PACK
Depth Size Material _.._
From To FL
From�To Ft.
RN
16. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C,WELL'S
CONSTRU ON STANDARDS A COPY F THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
SIGNATURE OrFERSON CONSTRUCTING THE WELL DATE
J
<n
Submit the original to the Division of Water Quality,Groundwater Section,1636 Mail Service Center-Raisigh lVC
27699-1636 Phone No.[phone],within 30 days. GW-I REV.07/2001

WELL CONSTRUCTION RECORD �� 3112 0
North Carolina Department of Environment and Natural Resources-Division of Water Quality
WELL CONTRACTOR(INDIVIDUAL)NAME (print) James B. Brown CERTIFICATION N 2045
WELL CONTRACTOR COMPANY NAME Hedden Brothers Well Drilling,Inc PHONE # [phone]
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
1. WELL USE(Check Applicable Box): Residential O Municipal/Public O Industrial❑ Agricultural❑
Monitoring❑ Recovery ❑ Heat Pump Water Injection❑ Other❑ If Other,List Use
2. WELL LOCATI N: Topographic/Land setting
Ne estTown: n,, County AQ10t ORidge ❑Slope []Valley ❑Flat
f41A1 U Kw10A KdJ (check appropriate box)
(Street Name,N'' b�11bers,Community,Subdivision,Lot No.,Zip Code) Latitude/longitude of well location
3. OWNER: IAJI AM t 49C t-VAI (degrees/minutes/seconds)
Addressmica- 5 Flea MW I' - Latitude/longitude source:❑GPS❑Topographic map
(Street or Route No.) (check box)
a a A 3tbg0 DEPTH DRILLING LOG
City or 7own a' state 11 O Zip Code From 0 Formation Description
(�)-(n�- l'�7-p�$'1 Clay&Sand
Area code-Phone number ' Granite
4. DATE DRILLED 14-O�(a 'OS
5. TOTAL DEPTH: 6M'
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_ ca-1 FT.Above Land Surface*
"Top of casing terminated at/or below land surface requires a
variance in accordance wAh ISA NCAC 2C.0118.
9. YIELD(gpm): I U MET OD OF TEST BLOW
10.WATER ZONES(depth)—: 1�T a4-,9:5—
LOCATION SKETCH
11, DISINFECTION:Type H T H Amount 16oz Show direction and distance in miles from at least a
12. CASING: Wall Thickness two State Roads or County Roads.Include the road11
Depth Diameter or Wet ht/Ft. M terial numbers and common road names. 17
Ft._= ,I From 0 To�
From ft To Ft. n
From To Ft. `�
13. GROUT: Depth Material Method cJ fh
From 0 To 20 Ft.Benonite&Cement pumped
From To Ft. CA
14. SCREEN: Depth Diameter Slot Size Material ,-
From To Ft. in. in.
From To Ft. in. _ in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
16. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C,WELL
CONSTRUCTION ST ARDS,AND THAT ACOPY 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,Attn: Information Management,,:1617 Mail Service Center-
Raleigh,NC 27699-1617, Phone No.[phone],within 30 days. -" - --
GW-1 REV.09/2004

WELL CONSTRUCTION RECORD 31 ;
North Carolina-Department Of Environment and Natural Resources-Division of water Quality-Groundwater Section
WELL CONTRACTOR(INDIVIDUAL)NAME (print)RICHARD MCCRARY
CERTIFICATION#2010
WELL CONTRACTOR COMPANY NAME BARKER CONSTRUCTION,INC./BARKER WELL&PUMP PRONE # [phone]
STATE WELL CONSTRUCTION PERMIT# 1871 ASSOCIATED WQ PERMIT#
(if applicable)
(if applicable)
1. WELL USE(Check Applicable Box):Residential® Mtnlicipal/Public❑ Industrial❑ Agricultural Monitoring❑ Recovery ❑ Heat Pump Water Injection❑ Other❑ If Other,List Use ;❑
2. WELL LOCATION:
Nearest Town: BREVARD County TRANSYLVANIA Topographic/Land Setting.
LAKE TOXAWAY ESTATES,LOT#37-M glRtdge []Slope ❑Valley; ❑Flat
treet Name,Numbers,Community,Subdivision,Lot No.,Zip Code) (check appropriate box)
(S
Latitude/longitude of well location
3. OWNER- PERCON,INC.
Address 120 E.MAIN STREET,SUITE 202A (degrees/minutes/seconds)
(Street
Latitude/longitude source:❑GPS❑Topographic map
BREVARD NCC 28712 Route No.) (check box)
� -
ciI or Town Smte DEPTH DRILLING LOG
8( 2B )- 337-2810 Zip Code From TO Formation Description
Area code-Phone number
4. DATE DRILLED APRIL 5,2005
5. TOTAL DEPTH: 685 ---
6. DOES WELL REPLACE EXISTING WELL? YES❑ NO
7. STATIC WATER LEVEL Below Top of Casing: 200 FT 3—
se
if
8. TOP OF CASING IS 1.33 (tlF . Above Top oSurfa a Pd._ pit
FT.Above Land Surface*
*Top of nsiag terminated allot below land surface require a u3
variance in accordance with 15A NCAC 2C.0118.
9. YIELD(gpm): 5 METHOD OF TEST TIMED
10.WATER ZONES(depth): _
LOCATION SKETCH
11. DISINFECTION:Type BY PUMP INSTALLER Amount Show direction and distance in[[tiles from at least
12. CASING: Wall Thickness two State Roads or County Roads.Include the road
Depth Diameter or Weight/Ft. Material numbers and common road names.
From 0 To 60 FL 6118 SDR21 PVC
From To FL L,T.r!O/K AtetlQ,{� GG From To Ft. �y lCLGIZ �D
13. GROUT: Depth Material Method ��JJ
From 0 To 20' F[. CONCRETE PO
UREDn 'k" nat ��lGf.
From To Ft.
14. SCREEN: Depth Diameter Slot Size Material J
From To Ft. in. in.
From To F[. in. in. LLGCa�,<YtG'�L. oVA �L ZZ1 3/T 15. SAND/GRAVEL PACK:
Depth Size Material �•� '�
From To Ft �J C
From To Ft.
16. REMARKS: g2< M
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A CA 2C,WE
CONSTRUCTION STANDARDS,ANDT A C OF S ORD HAS BEEN PROVIDE TO L OWNER
f G
SIGNATURE PERSON CONSTRUC HE WELL DATE
Submit the original to the Division of Water Quality,Groundwater Section,1636 Mail Service Center-Raleigh,NC
27699-1636 Phone No.[phone],within 30 days.
GW-1 REV.07/2001

WELL CONSTRUCTION RECORD 3 6 - 7
North Carolina-Department of Environment and Natural Resources-Division of Water Quality-Groundwater Section
WELL CONTRACTOR UNDIVIDUAL)NAME (print)RICHARD MCCRARY CERTIFICATION 4 2010
WELL CONTRACTOR COMPANY NAME BARKER CONSTRUCTION,INC./BARKER WELL&PUMP PRONE # [phone]
STATE WELL CONSTRUCTION PERMIT# 1871 ASSOCIATED WQ PERMIT#
(if applicable) (if applicable) _ .... .
1. WELL USE(Check Applicable Box):Residential M Municipal/Public❑ Industrial❑ Agricultural❑ _
r
Monitoring❑ Recovery ❑ Heat Pump Water Injection❑ Other❑ If Other,List Use
2. WELL LOCATION: Topographic/Land setting
Nearest Town: BREVARD CountyL_NSYLVANIA lS,litidge ❑Slope ❑Valley ❑Flat.NO NAME ROAD OFF OF SILVERSTEEN ROAD (check appropriate box)
(Street Name,Numbers,Community,Subdivision,Lot No.,Zip Code) LatitudeAongitude of well location
3. OWNER TRAVIS OWEN
Address RT. 1,BOX 72 (degrcesiminutes/seconds)
LatitudcAongitude source:❑GPS❑Topographic map
(SireeNCt or Route No.) (check box) _
LAKE or Town Y NC 26p C DEPTH DRILLING -
cny or Town state zip code From To Formation Description
8( 28 )- 508-2480
Area code-Phone number
4. DATE DRB,LED APRIL 14,2005 I-1I
5. TOTAL DEPTH: 605'
6. DOES WELL REPLACE EXISTING WELL? YES❑ NO gl
7. STATIC WATER LEVEL Below Top of Casing: 200' F F.
(Use"+-if Above Top of Casing)
8. TOP OF CASING IS 1.33 FT.Above Land Surface• r
'Top of using terminated allor below land surface requires a •h.
variance in accordance with 15A NCAC 2C.011&
9. YIELD(gpm): 0 METHOD OF TEST
10.WATER ZONES(depth):
LOCATION SKETCH
11. DISINFECTION:Type Amount Show direction and distance in miles from at least
12. CASING: Wall ThiclmeO two State Roads Or County Roads.Include the road
Depth Wall
or Weight/Ft. Material numbers and common road names.
From 0 T 88' Ft. 61/8 SDR21 PVC
From To FL o.AT 1:1 ZGUCLfiIff!_IY{ (07
From De Ft. 4%u4/r7 (t�j�P�*�� /��/'',,',..�""�
13. GROUT: Depth Material Method . V!W - o K4;tUAC �L ,!L(JU.d.rrt&ee.)
From 0 To 20' Ft, CONCRETE POURED Xr
From To Ft. wL/�d./1 AY— �1,0- �1)tit tt ,�H,faL�
14. SCREEN: Depth Diameter Slot Size Material _7 -L K, O'LEv7r�-K.Cc-
From To Ft. in. in n_- _ ✓• L ^-IL7 S--"'—
From To F[. in. in. I .�/I-Y/�- lc-j-�t..x.riY`
15. SAND/GRAVEL PACK: �R�SnD� ,(.� kt41nd-
Depth Size Material ^"`�"�`�
From To Ft.
From To Ft. �� c
f wcj.enb
16. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, LL
CONSTRUCTION STANDARDS,AND THAT A CO OF THIS REC RD HAS BEEN PROVIDED TO THE LL O R
7 �Z d�-
SIUNATUYtE OF PERSON S1R WELL DATE
Submit the original to the Division of Water Quality,Groundwater Section,1636 Mail Service Center-Raleigh,NC
27699-1636 Phone No.[phone],within 30 days. GW-1 REV.07/2001

WELL CONSTRUCTION RECORD 3 1 -16 7 6
North Carolina-Department of Environment and Natural Resources-Division of Water Quality-Groundwater Section
WELL CONTRACTOR(INDMDUAL)NAME (print) KENNETH MCCRARY
CERTIFICATION#2008
WELL CONTRACTOR COMPANY NAME BARKER CONSTRUCTION,INC./BARKER WELL&PUMP PHONE # [phone]
STATE WELL CONSTRUCTION PERMIT# 1871
(if applicable) ASSOCIATED WQ PERMIT#
(if applicable)
I. WELL USE(Check Applicable Box):Residential M Municipal/Public❑ Industrial❑ Agrir
Monitoring❑ Recovery ❑ Heat Pump Water Injection❑ Outer❑ If Other,List Useculttnal❑
i
2. WELL LOCATION:
Nearest Town: BREVARD County TR ANSYLVANIA Topographic/Land Setting !
SUNRISE LANE ®Ridge ❑Slope ❑Valley []Flat
(check appropriate box)
(Street Name,Numbers,Community,Subdivision,Lot No.,Zip Code) _
Latitude/longitude of well location
3. OWNER: WALTER TAYLOR
Address 15 SUNRISE IANE (degrees/minutes/seconds)
(Street or Rome No.) Latitude/longitude souuce:❑GPS❑Topographic map_
PISGAH FOREST NC 28768 (check box)
Chy or Towm State DEPTH DRILLING LOG - - -i
684-8725 �P Code From To Formation Description
Area code-Phone number
4. DATE DRILLED APRIL 22,2005 _ -
5. TOTAL DEPTH: 255'
6. DOES WELL REPLACE EXISTING WELL? YES El NO ®
7. STATIC WATER LEVEL Below Top of Casing: 50' - -,
FT.
(Use"+"if Above Top of Casing) N r-
8. TOP OF CASING IS 1.33 FT.Above Land Surface• F" 7119
'Top of casing terminated allor below land surface requires a
varisom in accordance with 15A NCAC 2C.0118. C
9. YIELD(gpm): 50 METHOD OF TEST TIMED ---'
Ln
10.WATER ZONES(depth): 4
11. DISINFECTION:Type LOCATION SKETCH
yp BY PUMP INSTALLER Amount Show direction and distance in miles from at least
12. CASING: Wall Thickness two State Roads Or County Roads.Include the road
Depth Diameter or Weight/Ft. Material numbers and common road names.
From 0 To 160 FL 61/8 SDR21 PVC Q ^/ 1 h
From To FL-
Prom From To Ft. Jkm sC.J�..QAa.LL.0 LaL PVf' d8�.
n On
13. GROUT: Depth Mazeriaf Method JJv. Q h
From 0 To 20' Ft_ CONCRETE POURED
From Ft. d .�(�u><xx.r[,tt� �G�(/YIB
d
ry -7UU` ^ .
Dc
EE
14. SCRN: Depth Diameter Slot Size Material DL Q Oh
From To Ft. in. in a/ L''
From To Ft. in. in. Q C 011 G{J161(14 f-
15. SAND/GRAVEL PACK: t 1.
Depth Size Material kR
From To Ft
From To Ft.
16. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C,WELL
CONSTRUCTION STANDARDS,AND THAT ATHAT A C�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

31165 .
WELL CONSTRUCTION RECORD
North Carolina-Department Of Environment and Natural Resources-Division of Water Quality-Groundwater Section
WELL CONTRACTOR(INDIVIDUAL)NAME (prior)RICHARD MCCRARY CERTIFICATION#2010
WELL CONTRACTOR COMPANY NAME BARKER CONSTRUCTION,INC./BARKER WELL&PUMP PRONE # [phone]
STATE WELL CONSTRUCTION PERMIT# 1871 ASSOCIATED WQ PERMIT#(111111 if applicable) (if applicable) --
1. WELL USE(Check Applicable Box):Residential Rl Municipal/Public❑ Industrial❑ Agricultural❑ '
Monitoring❑ Recovery ❑ Heat Pump Water Injection❑ Other❑ If Other,List Use - -
2. WELL LOCATION:
Nearest Town: BREVARD County, TRANSYLVANIA Topogmphic/Land setting _r NO NAME ROAD OFF OF SILVERSTEEN ROAD ®Ridge ❑Slope ❑Valley ❑plat''.' -_
(check appropriate box) --
(Street Name,Numben,Community,Subdivuion,Lot No.,Zip Code) —
Latitude/longitude of well loeatioh'
3. OWNER: TRAVIS OWEN
Address RT.1,BOX 72 (degrees/minutes/seconds)
(Street or Rome No.)
Latitude/longitude source:❑GPS❑ pograp map
-LAKE TOXAWAY NC (check box) _
28747 DEPTH DRILLING LOG
city or Town State Zip code From To 8( 28 )- 508-2480 Formation Description
Area code-phone number I
4. DATE DRILLED APRIL 19,2005 t
5. TOTAL DEPTH: 3ii ' ,rt
6. DOES WELL REPLACE EXISTING WELL? YES❑ NO R1 a
7. STATIC WATER LEVEL Below Top of Casing: 60' FT ri
(Use`+-if Above Top of Casing) L-
8. TOP OF CASING IS 1.33 FT.Above Land Surface*
s
-Top of Ming terminated aVor below land surface requlro a -
variance in accordance with 15A NCAC 2C.011&
9. YIELD(gpm): 5 METHOD OF TEST TIMED
10.WATER ZONES(depth):
11. DISINFECTION:T LOCATION SKETCH
Type BY PUMP INSTALLER Amount Show direction and distance in miles from at least
12. CASING Wall Thickness two State Roads or County Roads.Include the road
Depth Diameter or Weight/Ft. Material numbers and common road names.
From 0 To 89 Ft. 61/8 SDR21 PVC �.T�/7C. s4�/a& �_ p �1",/a'
From To Ft n•V ICJ r:L.R,2. 'TN!
From De FL n. & �)0
13. GROUT: Depth Material Method „I��f_From 0 To W Ft. CONCRETE POURED
From To Ft. Qnct
14. SCREEN: Depth Diameter Slot Size Material - /'-- '--- d�WL-IuO-�.Q•
From To Ft. in. in ��— �oad
From To Ft. in. in 15. SAND/GRAVEL PACK: � / � � �
Depth Size Material "`f`,"^"°^]'"' /1lXx/11 mad.
From To Ft
From To Ft.
16. REMARKS:
'� rlt.CCX% lv ct[cN.t/{(��-LV-•
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C,WEL CONSTRUCTION STANDARDS AND THATTTAAA COPY F ITHS RE CO BEEN PROVIDED TO THE WEL WNER
SIGNAT'CJRE OF PE CONSTRUCTING THE WELL DA
lh
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 * 3 116 TD A
North Carolina-Department of Environment and Natural Resources-Division of Water Quality-Groundwater Section
WELL CONTRACTOR(INDIVIDUAL)NAME (print) RICHARD MCCRARY CERTIFICATION#2010
WELL CONTRACTOR COMPANY NAME BARKER CONSTRUCTION,INC./BARKER WELL 8 PUMP PHONE # [phone]
STATE WELL CONSTRUCTION PERMIT# 1871 ASSOCIATED WQ PERMIT#
(if applicable) -"
- (if applicable) -.._
1. WELL USE(Check Applicable Box):Residential® Municipal/Public❑ Industrial❑ Agricultural❑ - -
Monitoring❑ Recovery ❑ Heat Pump Water Injection❑ Other❑ If Other,List Use -
2. WELL LOCATION:
Nearest Town: BREVARD County TRANSYLVANIA Topographic/Land setting.
McGUIRE CIRCLE ®Ridge []Slope ❑Valley ❑Flat
(Street Name,Numbers,Community,Subdivision,Lot No.,Zip Code) (check appropriate box)
LatitudeAongitude of well locatson � , -
3. OWNER: JACK SCROGGS
Address 107 McGUIRE CIRCLE (degrms/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(Street or Route No.) (check box) - -
PISGAH FOREST NC 28768 DEPTH DRILLING LOG
City or Town State Zip Code From To Formation Description
877-3394
Area code-Phone number
4. DATE DRILLED APRIL 27,2005
5. TOTAL DEPTH: 405'
6. DOES WELL REPLACE EXISTING WELL? YES❑ NO
7. STATIC WATER LEVEL Below Top of Casing: 50' FT,
(Use-+^if Above Top of Casing)
8. TOP OF CASING IS 1.33 FT.Above Land Surface' -
*Top of casing terminated at/or below land surface requires a 7y„
variance in accordance with 15A NCAC 2C.0118.
9. YIELD(gpm): 6 METHOD OF TEST TIMED
10.WATER ZONES(depth):
LOCATION SKETCH
l 1. DISINFE(;LION:Type BY PUMP INSTALLER Amount Show direction and distance in miles from at least
12. CASING: Wall Thiclmess two State Roads or County Roads.Include the road
Depth Diameter or Weight/Ft. Material numbers and common road names.
From 0 To 21 Ft. 61/8 SDR21 PVC � 1
From To Ft. OJif O A „ ,
13. GROUT: On
From—Depth TO Ft Material Method �"^'^/^'^'�' AD X_U_.dAh._�O -&
From 0 To 20' Ft. CONCRETE POURED • vl^ A eC. fr,C/l.
From To Ft. Y an guy.
14. SCREEN: Depth Diameter Slot Size Material (/
From To F[. in. in. �� �w/R�d/C1{'/J•
From To Ft. in. in. 0 Q �U N.l lJ / /U.'-atax-
15. SAND/GRAVEL PACK:
From Depth Sim Material _•
FL
From To Ft.
16. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CON UCTED ACCORDANCE WITH 15A NCAC 2C, LL
CONSTRUCTION STANDARDS, THAT A COP F THIS CORD HAS BEEN PROVIDED TO THE LL O
q
SIGNATURE OF PERSON C S CTRdG THE WELL DATE
Submit the original to the Division of Water Quality, roundwater Section,1636 Mail Service Center-Raleigh,NC
27699-1636 Phone No.[phone],within 30 days. GW-I REV.07/2001

308485
WELL CONSTRUCTION RECORD
North Carolina-Deparfatent of Environment and Naa�tu/ice/1oResoutces-Division
/of_W/ater Quality-Groundwater Section. p�j
WELL CONTRACTOR(INDIVIDUAL)NAME (print) !7/—/rGGI , G /1/1 /6CIe5 JR CERTIFICATIONOZ O 7
WELL CONTRACTOR COMPANY Novae yip iI Le7F�1'EC L �� 01t. ( �IAT PHONE 0 && :Qg70
STATE WELL CONSTRUCTION PERMTTi ASSOCIATED WQ PERMCfK
if applicable) (if applicable)
f. WELL USE(Check Applicable Box):Residential B MunicipaltPublic❑ Industrial❑ Agricultural❑
Monitoring❑ Recovery ❑ Heat Pump Water Injection❑ Other❑ If Other,List Use-
WE
LL LOCATION: Tbpographic/Land setting
Nearest Town: 31C C7 �unty�QAAS��UAiUi� dge []Slope [ Valley ❑Flat
€ we.k419L (check eebox)
(Strect Name,NNumbeM C«nmwity,Subdivision,Lot No,Zip Code) LatitudcAongitude of well location
3. OWNER:/Je(7 e/t/tr & dg,4IJ (degreedaunutes/seconds)
Address t/ A1d N,.Vls 129 Latitude/longitude source:❑GPS❑Topographic map
r (Street No.)
chock box)
28768 3LEJYM DRILLING LOG
dity or Town Stec tip Code From To Formation Description
Area cote-Phone amnM _
4�DATE DRILLED �__ Sit
5. TOTAL DEPTH:
6/ DOES WELL REPLACE EXISTING WELL? YES NO Wr- ro
7. STATIC WATER LEVEL Below Top of Casing: Fr.
(Use"+"if Above Top of Casing) i
8� TOP OF CASING IS l• FT. Above Land Surface•
'Tap of casing termisated adar below land surface requires■
variance in avairdauct with 1SA NCAC 2C.0118. /
9/YIELD(gpm): METHOD OF TEST �//Yt Cd
10. WATER ZONES(depW):
I OCA�jQN SKETCH
I(DISINFECTION:Type C C Amount /� D z Show direction and distance in miles from at least
12. CASING: Wall Thickness two State Roads or County Roads.Include the road
Depth ter or Weight/Ft Material numbers and common road names.
From To 20 Ft�2�eL SPA -2 R
From To Ft
From To Ft
13. GROUT:
Depth Material _ �thod
From ¢_To_Z.Ft[O�eZG U7 /
From To Ft Lt
14. SCREEN- Depth Diameter Slot Size Material y fl 1 Hill R Gt�
From To Ft. "ML in. ` 1�
From To Ft. in. in, -;E
15. SAND/GRAVEL PACK:
Depth Size Material ;e.i
From TO Ft.
From To Ft.
16. REMARKS:
3i
a
1 DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C,WELL
CONSTRUCTI STANDARDS,AND T A C Y OF THI HAS BEEN PROVIDED TO THE WELLOWAIEpt,
C -
SIGNATURE OF PERSON CONSTRUICTING THE WELL DATE = o -'
cr
Submit the original to the Division of Water Quality,Groundwater Section,1636 Mail Service Center-k4dgh,NC
27699-1636 Phone No.[phone],within 30 days. GW-1,REV.07/2001

30 & 236
WELL CONSTRUCTION RECORD
North Carolina-Department of Environment and Natural Resources-Division of Water Quality-Groundwater Section
WELL CONTRACTOR(INDIVIDUAL)NAME (print) JereQly H. Bowman CERTIFICATION#2 8 0 9
WELL CONTRACTOR COMPANY NAME n- RnurmAn WP1I nri 11 inga Tnn _ PHONE # A7A9 757-7779
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(itaPPlicable) (if applicable)
I. WELL USE(Check Applicable Box): Residential IX Munieipal/Public ❑ Industrial ❑ Agricultural❑
Monitoring❑ Recovery ❑ Heat Pump Water Injection ❑ Other❑ If Other, List Use
2. WELL LOCATION: Topographic/Land setting
Nearest Town:Picgah Fnrcet CountymransTania ❑Ridge ❑Slope ❑Valley ❑Flat
29 Pelletier T.anPa Pisgah F_ nractr?8768 (check appropriate box)
(Street Name,Numbers,Community,Subdivision,Lot No.,Zip Code) Latitude/longitude of well location
3. OWNER: Bernard Pelletier (degreu/minutu/seconds)
Address 290 Pelletier Lane Latitude/longitude source:DGPS❑Topographic map
(Street or Route No.) (check box)
Pi .ggAh. Fnrej- Wr,')8768 DEPTH
City or Town State Zip Code From To FOrmatlon.DQSCri n
Area code-Phone number -G
4. DATE DRILLED 2 /�^.4 Ea
5. TOTAL DEPTH: ;I;i) I s
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO 3
7. STATIC WATER LEVEL Below Top of Casing: 200rFT, O
(Use"+"if Above Top of Cuing)
8. TOP OF CASING IS 1 • 4 FT.Above Land Surface'
-Top of casing terminated at/or below land surface requires a -
variance In accordance with 15A NCAC 2C.01la.
9. YIELD (gpm): rg METHOD OFTEST'-rotarY aiz
10. WATER ZONES(depth): :199 ,
LOCATION SKETCH
11. DISINFECTION:Type tablet Amount 6 Show direction and distance in miles from at least
12. CASING: Well Thickness two State Roads or County Roads. Include the road
Depth Diameter or WeigiiUFt. Material 'numbers and common road names.
From 0' To 80 Ft.f;lS_ Sch 8 pyr
From To Ft.
From To Ft.
13. GROUT: Depth Material Method
From 0 To 20 Ft. concrete gravity flow
From- To Ft.
14. SCREEN: Depth Diameter Slot Size Material - ,A..• .--
From To Ft. in. in, _a
From To Ft. in. in. r ,
15. SAND/GRAVEL PACK: -
Depth Size Material - -
From To Ft,
From To Ft.
16, REMARKS!
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C;WELL
CONSTRUCTION STANDARDS,AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
NATURE 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-I REV.07/2001

WELL CONSTRUCTION RECORD 3 8 2 3 2
North Carolina-Department of Environment and Natural Resources-Division of Water Quality-Groundwater Section
WELL CONTRACTOR(INDIVIDUAL)NAME (print) Jereipy H, Bowman CERTIFICATION#2 8 0 9
WE LL CONTRACTOR COMPANY NAME I). RnwmA rl WP11 nri l l i T gf Tnc - PHONE # H7A 252-7779
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable) (if applicable) "
I. WELL USE(Check Applicable Box): Residential IX Municipal/Public O Industrial ❑ Agricultural ❑
Monitoring❑ Recovery ❑ Heat Pump Water Injection❑ Other❑ If Other,List Use
2. WELL LOCATION: Topographic/Land setting
Nearest Town:Breyard County Transylvania ❑Ridge ❑Slope ❑Valley ❑Flat
Owens .Drive Lot #35-36 Brevard 28712 (check appropriate box)
(Street Name,Numbers,Community,Subdivision,Lot No.,Zip Code) Latitude/longitude of well location
3. OWNER: ,:Laok I Ji3hlas la (dcgrecs/minuteslseconds)
Address 216 pj ;jG44 D 4ve Latitude/longitude source;❑GPS❑Topographicmap
eat orRo(Strute No.) (check box)
Breva>r,d NC 28712 DEPTH DRILLING LOG
City or Town State zip Code From To Formation Description
Area code.Phone number g
4. DATE DRILLED 1 /21 /04
5. TOTALDEPTH: 400 ' �.
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO C9
7. STATIC WATER LEVEL Below Top of Casing:-1 n n FT.
(Use"+"if Above Top of Cuing)
8. TOP OF CASING IS 1 • 4 FT.Above Land Surface* —
*Top of cuing terminated at/or below land surface requires a �
variance In accordance with 15A NCAC 2C.0118.
n
9. YIELD (gpm): 4 METHOD OF TEST'-rotary air
10. WATER ZONES(depth): inn ' a '2F0 '
LOCATION SKETCH
11. DISINFECTION:Type tablet Amount 6 Show direction and distance in miles from at least
12, CASING: Wall Thickness two State Roads or County Roads. Include the road
Depth Diameter or Weight/Ft. Material numbers and common road names.
From 0 To 48 Ft.61 /8_ Sch_8D pur
From To Ft.
From To Ft.
13. GROUT: Depth Material Method
From 0 To 20 Ft. concrete gravity flow
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.-
Fro m To Ft.
16. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH ISANCAC2C;WELL
CONSTRUCTION STANDARDS,AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
4L4a3a1 Z r u�� //as/el
SIGNotruRE 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

308231
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources-Division of Water Quality-Groundwater Section
WELL CONTRACTOR(INDIVIDUAL)NAME (prin0 J6remy H. BOW@an CERTIFICATION#2 8 0 9
WE L L CONTRACTOR COM PANY NAM 9_D_ RnmmAn WA I T)ri l l i ngy Tn r• PHONE # A2A 757-7779
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
I. WELL USE(Check Applicable Box): Residential R Municipal/Public❑ Industrial ❑ Agricultural ❑
Monitoring❑ Recovery ❑ Heat Pump Water Injection❑ Other❑ If Other, List Use
2. WELL LOCATION: Topographic/Land setting
Nearest Town: Pisgah ForestCoug(iransylvania ❑Ridge ❑Slope ❑Valley ❑Flat
524 Lookout DPive, Pisgah Forest;28768 (check appropriate box)
(Street Name,Numbers,Community,Subdivision,Lot No.,Zip Code) Latitude/longitude of well location
3. OWNER: .1offA,-j, Pnm�= (degrecalminutes/seconds)
Address 70a—Cool gut Clive Latitude/longitude source:❑GPS❑Topographic map
(Street or Route No.) (check box) 1
Pisgah ,Forest NC 28768 DEPTH
"tityor Town State Zip Code From To Formation Descr ion
Area code.Phone number
4. DATEDRILLED 1 /20/04 y
5. TOTAL DEPTH: 340 '
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO IX c s
7. STATIC WATER LEVEL Below Top of Casing: inn FT.
(Use"+"if Above Top of Cuing) Ul
8. TOP OF CASING IS •4 FT.Above Land Surfaces east
*Top of cuing terminated at/or below land surface requires a
variance In accordance with I$A NCAC 3C.0111.
9. YIELD(gpm): 17 METHOD OF TEST`..rotary air
10. WATER ZONES(depth): 22f1 ' ,, in0F Rdn '
LOCATION SKETCH
I I. DISINFECTION:Type tablet Amount 6 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 20 Ft.A13 A SCh_A PVr - —
From To Ft.
From To Ft.
13. GROUT: Depth Material Method
From 0 To 20 Ft. concrete gravity flow
From- To Ft.
14. SCREEN: Depth Diameter Slot Size Material -
From To Ft, in. in.
From To Ft._in. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
16. REMARKS!
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C,WELL
CONSTRUCTION STANDARDS, ,A/ND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
"Y 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

A Y �$ •, 1 i)
WELL CONSTRUCTION RECORD
North Carolina-Department of Environment and Natural Resources-Division of Water Quality-Groundwater Section s�
WELL CONTRACTOR(INDIVIDUAL)NAME ((print)C&,6 J) J�hfB�'[` CERTIFICATION#s+Vl l
WELL CONTRACTOR COMPANY NAME PHONE # �j�
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
ifapplicable) i€applicable)
I. WELL USE(Check Applicable Box): Residential Municipal/Public❑ Industrial ❑ Agricultural❑
Monitoring❑ Recovery ❑ Heat Pump Water Injection❑ Other❑ If Other, List Use 6, as
2. WELL LOCATION: Topographic/Land setting
Nearest Town:06zeva.ra� County '� ❑Ridge ❑Slope ❑Valley ❑F4R 7s
(check appropriate box) C3
(Street Name,Numbers,Community,Subdivision,Lot No.,Zip Code) Latitude/longitude of well locatiodJ1 .�
3. OWNER: A&I NPt (degrees/minutes/seconds) '
Address Latitude/longitude source:❑GPS❑Topographic map
(St et or R uta No.) (check box)
,6a/-- ZZ(f ,;!?9266—L DEPTH DRILLING LOG
Ci or Town State zip Code From To Formation Description
Area code-Phone number - o^�O Zr
4. DATE DRILLED /- h'Oh
5. TOTAL DEPTH: �L 70 10— 5 O ;. a //
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO
rr -
7. STATIC WATER LEVEL Below Top of Casing:AFT. -_0 5"
(Use'•+"if Above Top of Casing)
8. TOP OF CASING IS FT.Above Land Surface* �U 16o Aiani .j'
*Top of casing terminated at/or below land surface requires a Z
variance In accorda ce with 15A NCAC 2C.0118.
9. YIELD(gpm): 7® METHOD OF TEST GG//'
10.WATER ZONES(depth):_h 60 2 70 —2-'I 6 _
LOCATION KETCS H
11. DISINFECTION:Type_ Amount Show direction and distance in miles from at least
12. CASING: Wall Thickness two State Roads or County Roads.Include the road
Depth Diameter or Weight/Ft. aterial numbers and common road names.
From��ToRd Ft.�y.�� Y5. Oly�.ps
From To F[. Q/•Gjl
13. GROUT: Depth Material Method � hBw hou5 t poy
From_4 To 7 el _Ft.SO__A ,wv;F G�
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.
'l
16. REMARKS:
j fnl�Fz$YCEiF�TiFiS�fFf�rCT'FHWELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C,WELL 4 ._
I 1 C �R60TIbN S0'A1})pA@PS A THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
.,TURE OF PERSON CONSTRUCTING THE WELL DATE �7
U L I I.�. _ �-✓
Sulimit the original to the Di iision f Water Quality,Groundwater Section, 1636 Mail Service Center-Raleigh,NC C "
276§ £6T� {ronW,(9f9}Z3221, ithin 30 days. GW-I REV.07/2007I

00 l
q 9
ca .S t_
WELL CONSTRUCTION RECORD
North Carolina-Department of Environment and Natural Resources-Division of Water Quality-Groundwater Section
WELL CONTRACTOR(INDIVIDUAL)NAME (print)6 htez* IP>7 fe/le CERTIFICATION
WELL CONTRACTOR COMPANY NAME Mb rh I LL I P I' h M.t! �JLT'1 n PHONE # (VJS( I1 7''4f Y 5 b
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
1. WELL USE(Check Applicable Box): Residential a Municipal/Public❑ Industrial ❑ Agricultural❑ -{
Monitoring❑ Recovery ❑ Heat Pump Water Injection❑ Other❑ If Other,List Use
c f
2. WELL LOCATION: + Topographic/Land setting
Nearest Town: 19re" :r'A r ! Countyzta-n Q cl ❑Ridge ❑Slope Walley ❑FIaL
(check appropriate box) O -
(Street Name,Numbers,Community,Subdivision,Lot No.,Zip Code) Latitude/longitude of well location
O
W 3
3. OWNER• nZ ,/^rrs 4 (degrees/minutes/seconds)
Address l/ A''r5 Z Latitude/longitude source:❑GPS❑Topographic map J
(street or Route No.) (check box)
Lakt T t z4a'k 7y DEPTH DRILLING LOG
City or Town state Zip Code From To Formation Description
(�J ew �iyr✓re C In nh.f
Area code-Phone number
4. DATE DRILLED
5. TOTAL DEPTH: yt n S
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO V
7. STATIC WATER LEVEL Below Top of Casing: Irl _FT.
(Use"+"if Above Top of Casing) �Q• ./
8. TOP OF CASING IS 53 FT.Above Land Surfacea
`Top of casing terminated allor below land surface requires a
variance in accordance with 15A NCAC 2C.011s.
9. YIELD(gpm):�_METHOD OF TESTZVe,
10.WATER ZONES(depth): JV'76'J
LOCATION SKETCH
11. DISINFECTION:Type Amount Show direction and distance in miles from at least
12. CASING: Wall Thickness two State Roads or County Roads.Include the road
Depth Diameter or Weight/Ft. Material numbers and
-common road names.From_Toaa-Ft. L !tLj _f)'JC Fi v. 1 h �i�.,�%r7► Co`d -//'n�.
From To Ft.
From To Ft. Gai
13. GROUT: Depth Material Method U
From 0 To G _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
From To Ft.
From To Ft.
16. REMARKS:
lI DO HEREBY CERTIFY THAT:THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C,WELL
CONSTRUCTION-STAN6.ARDS,AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER !
- SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE '
rz
Submit the original to the Division of Water Quality,Groundwater Section,1636 Mail Service Center-Raleigh,NC «
27699_1636 Fhone No [phone],within 30 days. GW-I REV.&2- '

co
WELL CONSTRUCTION RECORD
North Carolina-Department of Environment and Natural Re
,spuyrces-Division of Water Quality-Groundwater Sect'iioon�.�
WELL CONTRACTOR(INDIVIDUAL)NAME (print) /r L'4/::� /U s^tf1�__�" CERTIFICATION#_) t
WELL CONTRACTOR COMPANY NAME 10f t-r-111( 1.s 4 N 4-PV r J? PHONE # IrCLb1 �S 71 'N�l SZt
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable) _ (if applicable)
1. WELL USE(Check Applicable Box): Residential hd'/Municipal/Public❑ Industrial ❑ Agricultural❑
Monitoring❑ Recovery ❑ Heat Pump Water Injection❑ Other❑ If Other,List Use
2. WELL LOCATION: Topographic/Land setting
Nearest Town:,je.'1rdSP County E — ❑Ridge ❑Slope fey ❑Flat
(check appropriate box)
(Street Name,Numbers,Community,Subdivision,Lot No.,Zip Code) Latitude/longitude of well location
3. OWNER: r<A 6-r.4— t (degrees/minutes/seconds)
Address �c �9 B.G2r?n.l- ~� Latitude/longitude source:❑GPS❑Topographicmap
(�treet or Route No.) �v. (check box)
i 5tbar. P 4 C s��+-7,1 9 DEPTH DRILLING LOG
City or Town State Zip Code From To Form4ion Description
Area code-Phone number
4. DATE DRILLED 9'0`'1 _J i
5. TOTAL DEPTH: �/ 9 ! rt� •e C
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO ❑
7. STATIC WATER LEVEL Below Top of Casing: FT.
r (Use"+"if Above Top of Casing)
8. TOP OF CASING IS�_FT.Above Land Surface* r f
-Top of casing terminated at/or below land surface requires a a
variance in accordance with 15A NCAC 2C.0118. Ln
9. YIELD(gpm): 2 0 METHOD OF TEST A t'f 'x°
10.WATER ZONES(depth):_
LOCATION SKETCH
11. DISINFECTION:Type 't' Amount Show direction and distance in miles from at least
12. CASING: Wall Thickness two State Roads or County Roads.Include the road
Depth Diameter or WeighUFt. Material numbers and common road names.
From U To i�' Ft. (P 'A S�Q Z!
From To Ft.
From To Ft.
13. GROUT: Depth Material Method
From O To 7 �� Ft._('C"" crud ?rt Xe A14: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 / Ebt r"
From To Ft. -
From To Ft.
16. REMARKS: r—
r .,
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C,WELL �" k
CONSTRUCTIO rySTAN�y$I) ,AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNE)t
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
kJ
C
Submit the original to the Division of Water Quality,Groundwater Section,1636 Mail Service Center-Raleigh,N - -
27699-1636 Phone No.[phone],within 30..days. GW-1 REV,07/2 61 ` w

WELL CONSTRUCTION RECORD
North Carolina-Department of Environment and Natural Resources-,sDiviision of Water Quality-Groundwater Section J'
WELL CONTRACTOR(INDIVIDUAL)NAME,(�((print)61e,)/� S i-nLo ll e- CERTIFICATION#�//
WELL CONTRACTOR COMPANY NAME f !e ne'l // Lid'-"/1 11-1p"Aol:42 PHONE #
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(ifapplicable) (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 N: Topographic/Land setting
Nearest Town:llw5IN611P County A'i ❑Ridge ❑Slope ❑Valley ❑Flat
(check appropriate box)
(Street Name,Numbers,Community,Subdivision,Lot No.,Zip Code) Latitude/longitude of well location
3. OWNER:6w•`A I Ih/P{' (degrees/minutes/seconds)
Address .2q of✓/e 0 i Rr. Latitude/longitude source:❑GPS❑Topographic map
(Street or Route No.) (check box)
fl��. 9 Ss742 DEPTH DRILLING LOG
city or Town State zip code From To Formation Description
Area code-Phone number —+�— �•�.
4. DATE DRILLED,2
5. TOTAL DEPTH: s//L/ice —_o— -- �tAJ•jy/
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO a
7. STATIC WATER LEVEL Below Top of Casing: FT. —
(Use"+"if Above Top of Casing)
8. TOP OF CASING IS FT.Above Land Surface*
*Top or casing terminated atlor below land surface requires a 0
variance in accordance with�15A NCAC 2C.0I18.
��
9. YIELD(gpm): --METHOD OF TESTGt
10.WATER ZONES(depth):
LOCATION SKETCH
11. DISINFECTION:Type Amount Show direction and distance in miles from at least
12. CASING: Wall Thickness two State Roads or County Roads.Include the road
Depth l�! Diameter or,�eight/Ft. teri I numbers and common road names. e /
From 0 To�Ft. �/ / /�'."
From To FL ,y
From To Ft. �d •jj �, f(�, 'j JI J�L'+�,r�
13. GROUT: Depth Material Method !'
From 2 To� Pc-Ft.^cerr.�ini A 7"`"-'-" (�L,:j ��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.
From To Ft.
16. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C,WELL ;
a e
CONSTRUCTION STANDARDS,AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
k ,
Submit the original to the Division of Water Quality,Groundwater Section,1636 Mail Service Center-Raleigh,FNC`
27699-1636 Phone No.[phone],within 30 days. GW-1 REV.07/2001
i

WELL CONSTRUCTION RECORD
North Carolina-Department of Environment and/Natural Resources-Division of Water Quality-Groundwater Section
WELL CONTRACTOR(INDIVIDUAL)NAME (print) QII&wl MP41a)-1 CERTIFICATION#�(;y)
WELL CONTRACfOR COMPANY NAME.. MjZhh-, `� ) `C-�I SI 'IM.G� PHONE # (%i21 f?77 t/Cf_C';0
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
if licable (if applicable)
1. WELL USE(Check Applicable Box): Residential Er Municipal/Public❑ Industrial ❑ Agricultural ❑
Monitoring❑ Recovery ❑ Heat Pump Water Injection ❑ Other❑ If Other,List Use
2. WELL LOCATION: Topographic/Land setting
N arestTown:2 "� Co tyym �_ ❑Ridge ❑Slope ❑Valley ❑Flat
''��—� _ (check appropriate box)
on,
(Street Name,Number Community,Subdivisi Lot o.,Zip Code) Latitude/longitude of Well location
3. OWNER: " _ 1.4(. = (degrees/minutes/seconds)
Address _4 C'R7 Latitude/longitude source:❑GPS❑Topographic map
" (Street or Roe NVC (check box)
. 1 U/�Lut / �i DEPTH DRILLING LOG
City or Town State Zip Code From To Formation Description
(—) S
Area code-Phone number sdanrc
4. DATE DRILLED 2 -T —1 -
5. TOTAL DEPTH:_AL
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO 5L
7. STATIC WATER LEVEL Below Top of Casing:—ill FT.
(Use'4"if Above Top of Casing)
8. TOP OF CASING IS I _FT.Above Land Surface*
-Top of casing terminated atlor below land surface requires a
variance in accordance with ISA NCAC 2C.0118. Ut
9. YIELD(gpm): C" ) METHOD OF TEST A-,l2 .
10.WATER ZONES(depth):_ ICZ>
LOCATION SKETCH
11. DISINFECTION:Type C.L2:/L• Amount Show direction and distance in miles from at least
12. CASING: Wall Thickness two State Roads or County Roads. Include the road
Depth Di� eter or Weight(Ft. Material numbers and common road names.
From To�Ft. L bh�! t1.G
From Tc Ft.
From To Ft.
13. GROUT: Depth Material Method
From Td�_Ft.Clni'°ST— �
From To Ft.
14. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in.
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
16. REMARKS:
Lii it
1 DO HEREBY CERTIFY THAT T 1S WELL WAS CONSTRUCTED IN ACCORDANCE-WITH 15A NCAC 2C,WELL
CONSTRUCTION NDARDS, ND THAT A COPY OF THIS RECORD HAS BEEN PROVIDEDTO THE WELL OWNER-44 j -
_ g fL
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.07/2,461 I 'fib

WELL CONSTRUCTION RECORD
North Carolina-Department of Environment and Natural Resources-Division of Water Quality-Groundwater Section�
WELL CONTRACTOR(INDIVIDUAL)NAM,.yE( (print) GbPhh S.P(j PPllf CERTIFICATION#io "`
WELL CONTRACTOR COMPANY NAME/ 7 f'I'-yll LS-tl{I-la""/J PHONE # ( )
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: Topographic/Land setting
Nearest Town: County__ ❑Ridge ❑Slope ❑Valley ❑Flat
(check appropriate box)
(Street Name,Numbers,Community,Subdivision,Lot No.,Zip Code) Latitude/longitude of well location
3. OWNER:F & (degrees/minutes/sewnds)
Address .11TSP.f Latitude/longitude source:❑GPS❑Topographic map
(Street or Route No.) (check box)
('rt7 AP'4- /F L Jk7l7-- DEPTH DRILLING LOG
City or Town State Zip Code From To Formation Description
Area code-Phone number 0— 77,9
4. DATE DRILLED- /d-Zn6
5. TOTAL DEPTH: 6dh
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO L7
7. STATIC WATER LEVEL Below Top of Casing: k/e FT.
(Use"+"if Above Top of Casing)
8. TOP OF CASING IS FT.Above Land Surface* o
*Top of casing terminated at/or below land surface requires a
variance in accord= a with 15A NCAC 2C.0118.
9. YIELD(gpm): METHOD OF TEST a4,r
10.WATER ZONES(depth):
LOCATION SKETCH
11. DISINFECTION:Type Amount Show direction and distance in miles from at least
12. CASING: Wall Thickness two State Roads or County Roads.Include the road
Depth Diameter or Weight/Ft. Material numbers and common road names.
From ToJOL—Ft,,C;�,f 'y76o,✓l�,�Tf+ To •*�'.5��e�t Cror%G. .1—
From To Ft.
From To Ft.
13. GROUT: Depth Material Method
From O To,2 -Ft. �o7di 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.
From To Ft.
16. REMARKS: - --- `---')
I DO HEREBY CERTIFY THAT THIS WELL WAS CONS ED IN ACCORDANCE WITH 15A NCAC 2C,WELL
CONSTRUCTION STANDARDS,AND THAT A COPY 0 iHIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER _"
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE G
ry
Submit the original to the Division of Water Quality,Grdandwater Section,.1636 Mail Service Center-Raleigh,N4� '
27699-1636 Phone No.[phone],within 30 days. GW-I REV.07/,2o(11 _ S

WELL CONSTRUCTION RECORD
North Carolina-Department of Environment and Natural esour s-Division of Water Quality-Groundwater Section _
WELL CONTRACTOR(INDIVIDUAL)NAMEE rint) -, r CERTIFICATION# )S 1C
WELL CONTRACTOR COMPANY NAME_ �eGt�1t' tom+.-C f 1 Q'�/L^` PBONE # (RZY)FS77�Nt/%.t
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
i Nearest Town: jdls. GrdJt County z 5✓f�• r. ❑Ridge ❑Slope ❑Valley C3f7at
(check appropriate box)
(Street Name,Numbers,Community,Subdivision,Lot No.,Zip Code) Latitude/longitude of well location
3. OWNER: +( (degrees/minutes/seconds)
Address 1
G'T3 a' �(d' o5^Ac Latitude/longitude source:❑GPS❑Topographic map
(Street or It
No.) (check box)
/t -C, DEPTH DRILLING LOG
City or Town State zip Code From To Formation Description
Area code-Phone number Z h �0 j6'lL.
4. DATE DRILLED 2 t S -6 y gyp ` Rod i
5. TOTAL DEPTH:_ 10 5—
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO Er� (.t
7. STATIC WATER LEVEL Below Top of Casing: FT. 1. dL r_ 'eI
i (Use"+"if Above Top of Casing)
8. TOP OF CASING[S FT.Above Land Surface* _
-Top of casing terminated attor below land surface requires a s
variance In accordance with 15A NCAC 2C.0118.
9. YIELD(gpm): '1 r- METHOD OF TEST %� o
10.WATER ZONES(depth):
LOCATION SKETCH
11. DISINFECTION:Type f47:11 Amount Show direction and distance in miles from at least
12. CASING: Wall Thickness two State Roads or County Roads.Include the road
Depth Diameter or Weight/Ft. Material numbers and common road names.
From D To-3-0--Ft. to V(_ SOO,Z 9 VC.
From To Ft.
From To Ft.
13. GROUT: Depth Material Method
From 0 To 20 _Ft_Ccrxa-A, _:,,x. ev r' 6J5^
From To Ft. Lrd
14. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in.
From To Ft. in. in. trt
15. SAND/GRAVEL PACK:
Depth Size Material w
From To Ft.
From To Ft.
16. REMARKS: �-
__ _ r .._._.. I
I DO HEREBY CERTIFY THAT THIS WELL WAS CO TkUCTED IN ACCORpANCE WITH I SA NCAC 2C,WELL _ -
CONSTRUCTJ07TANDARDS,AND THAT A COPY Oi'THISRECORD HAS-BEEN PROVIDED TO THE WELL 0
_yla- 1--Ts.c,
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATEi
r;ki i
Submit the original to the Division of Water Quality,Groundwater Section,1636 Mail Service Center-Raleig y11ty!
27699-1636 Phone No.[phone],within 30 days. GW-1 REV. 1 7I2HP _..Q1 ` � -�i

WELL CONSTRUCTION RECORD
North Carolina-Department of Environment and Natural Resources-Division of Water Quality-Groundwater Section
j
WELL CONTRACTOR(INDIVIDUAL)NAME /(prrii�nt) M/4d' i,,,r kef: CERTIFICATION J
WELL CONTRACTOR COMPANY NAME /� /C rf',I f/ PRONE # ISrA V*7- S/ySl
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
1. WELL USE(Check Applicable Box): Residential D�unicipal/Public❑ Industrial ❑ Agricultural❑
Monitoring❑ Recovery ❑ Heat Pump Water Injection❑ Other❑ If Other, List Use
2. WELL LOCATION: Topographic/Land setting
Nearest Town:_ Isre iEd County n-n 1✓an,lfl� —e ❑Slope ❑Valley ❑Fla[
(check appropriate box)
(Street Name,Numbers,Community,Subdivision,Lot No.,Zip Code) Latitude/longitude of well location
3. OWNER:_j 0r4f- CV�1/LS (degrees/minutes/seconds)
Address .;�7L:vr.4- /lis Latitude/longitude source:❑GPS❑Topographic map
(Street or Route No.) (check box)
rcV,'Cuvk l-LC. DEPTH DRILLING LOG
City or Town State zip Code From To 1Formation Description
I�LZSCJ- 224 GiGu U 76 /,'
Area code-Phone number _ `7 OF 0
4. DATEDRILLED 2-1(o-di frp 3d� 1)cuf fr+�C
5. TOTAL DEPTH: ?06-
6. DOES WELL REPLACE EXISTING WELL? YES❑ NO 9-""
7. STATIC WATER LEVEL Below Top of Casing: S0 FT. —
/ (Use'+"if Above Top of Casing)
8. TOP OF CASING IS FT.Above Land Surface"
-Top or casing terminated atlor below land surface requires a
variance In accordance with 15A NCAC 2C.0118. O
9. YIELD(gpm): /d METHOD OF TEST I3��
10.WATER ZONES(depth):_
LOCATION SKETCH
11. DISINFECTION:Type I fTld Amount Show direction and distance in miles from at least
12. CASING: Wall Thickness two State Roads or County Roads.Include the road
Depth Diameter or Weight/Ft. Material numbers and common road names.
From To 90 Ft. 6 ' ,�
2 I 11[
From To Ft.
From To Ft.
13. GROUT:. Depth Material Method
From Q To Z O _Ft. ✓-
Front,_To Ft. U;ell
14. SCREEN: Depth Diameter Slot Size Material 1
From To Ft. in. in.
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Size Material o
tf � J;
From To Ft.
From To Ft.
16. REMARKS: H-Y y
r
I DO HEREBY CERTIFY THAT THIS WELLL A CONS1fd2UCTED�INACCOREANCE WITH 15ANCAC 2C,WELL
CONSTRUC ION SS1 ARDS,AND THAF i ` P THiSRECORD-HAS BEEN PROVIDED TO THE WELL OWNER i
_ a /f/aca�t--- I� ,�-%4-D f j
r SIGNATU P-PERS6Y4WI STRUCTING THE WELL DATE U..
Submit the original to the Division of Water,t _a2U�fyr;GrotlRdwater Section,1�36 Mail Service Center-Raleigh iNC
27699-1636 Phone No.[phone],with(n 30 ftys.:' GW-I REV.0 /2081 f,
_;1

-
WELL CONSTRUCTION RECORD
North Carolina-Department of Environment and Natural Resources-Division of Water Quality-Groundwater Sectioon� `'
WELL CONTRACTOR(INDIVIDUAL)NAME (print)/v�B/7/! G°fifL���L' CERTIFICATION#�
WELL CONTRACTOR COMPANY NAME -f i JI J�iYP// YSi JJ PHONE # j7j
�J N/"/^
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
1. WELL USE(Check Applicable Box): Residential Er Municipal/Public❑ Industrial ❑ Agricultural❑
Monitoring❑ Recovery ❑ Heat Pump Water Injection❑ Other❑ If Other, List Use
2. WELL LOCATI N: Topographic/Land setting
Nearest Town: A m _County � ❑Ridge []Slope ❑Valley ❑Flat
(check appropriate box)
(Street Name,Numbers,Community,Subdivision,Lot No.,Zip Code) Latitude/longitude of well location
eY�e A7/3. OWNER:S Y /17 P— (degrees/minutes/seconds)
Address - y�r7 Latitude/longitude source:❑GPS❑Topographic map
_ // (Street or Route No. (check box)
r 1cli'l I— ✓� C 2224�2— DEPTH DRILLING LOG
City or Town State Zip Code From To Formation Description
Area code-Phone number
4. DATE DRILLED
5. TOTAL DEPTH:
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO Er
7. STATIC WATER LEVEL Below Top of Casing: el FT.
n (Use"+"if Above Top of Casing)
8. TOP OF CASING IS FT.Above Land Surface'
`Top of casing terminated atlor below land surface requires a
variance In accordant with 15A NCAC 2C.0118. Q-
9. YIELD(gpm): —METHOD OF TEST t7_i/°'
10.WATER ZONES(depth):_ 'JUG rl
LOCATION SKETCH
11. DISINFECTION:Type Amount Show direction and distance in miles from at least
12. CASING: Wall Thickness two State Roads or County Roads. Include the road
Depth_ Diameter or Weight/Ft. ateSial numbers and co n roa names.
From Q To-_'uc Ft. � Y
From To Ft.
From To Ft.
13. GROUT: Depth Mat efial Method
From_a TOE/// Ft.S�^�yGm� Alec Y
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.
=r,
16. REMARKS:
Y RT�FY�'�HATLL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C,WELL
{j0 AT A COPY OF THIS RECORD HAS BE N PROVIDED TO THE WELL OWNER
'URE OF PERSON CONSTRUCTING THE WELL DATE
T 0 I7
Subrititthe original to the,I?WOon o�Water Quality,Groundwater Section,1636 Mail Service Center-Raleigh;NC
2769 '-
� T 9_SI��Phdno,
— „ ijPo (91��9�$13221,Within 30 days. GW-1 REV.07/2001

WELL CONSTRUCTION RECORD
North Carolina-Department of Environment and Natural Resources-Division of Water Quality-Groundwater Section
WELL CONTRACTOR(INDIVIDUAL)NAME (print) C,lewt, ?n fP.//Q CERTIFICATION# O//
WELL CONTRACTOR COMPANY NAME�Ie/'/',J/ LLi// 7f— �es�f1 PHONE at SfY7'Yyy'p
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable) / (ifapplicable)
1. WELL USE(Check Applicable Box): Residential fT Municipal/Pubiic❑ Industrial ❑ Agricultural❑
Monitoring❑ Recovery ❑ Heat Pump Water Injection❑ Other❑ If Other,List Use
2. WELL LOCATION: Topographic/Land setting
Nearest Town: county
County ❑Ridge ❑Slope ❑Valley ❑Flat
(check appropriate box)
(Street Name,Numbers,Community,Subdivision,Lot No.,Zip Code) Latitude/longitude of well location
3. OWNER: LQ h/°d!/ (degrees/minutes/seconds)
Address Latitude/longitude source:❑GPS❑Topographic map
I `' (St ee or Route No.) (check box)
�r.SQWh I•t?hr25>� (' �CnPd DEPTH DRILLING LOG
nyoriown state Zip Code From To Formation Description
(�- a'61 -5-gam/
Area code.Phone number — </0 •r,'
4. DATE DRILLED
5. TOTAL DEPTH: /O QO yd— /0'w
6. DOES WELL REPLACE EXISTING WELL? YES 0'NO ❑
7. STATIC WATER LEVEL Below Top of Casing: 41476' FT.
(Use"+"if Above Top of Casing)
8. TOP OF CASING IS FT.Above Land Surface*
*Top of casing terminated al/or below land surface requires a
variance in accordance with 15A NCAC 2C.0118.
9. YIELD(gpm): 7^ METHOD OF TEST cw oe
10.WATER ZONES(depth):
LOCATION SKETCH
11. DISINFECTION:Type Amount Show direction and distance in miles from ackast
12. CASING: Wall Thickness two State Roads or County Roads.Include tFe road;-'
Depth Diameter or Weight/Ft. Material numbers and common road names. CD
From O To 97 Ft. C " A7 o
From To Ft, en
From To Ft.
13. GROUT: Depth Material Method .
From-0 Tom_Ft._52 .»,'A �20A..-
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.
f =
16. REMARKS: - f,
if I
I DO-HEREBY CERTIFY-THAT THIS-WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C WELL'—
CONSTSIUCTION STANDARDS,AN9 TI AT A COPY OF THIS RECORD HAS BEEN P TO THE WELL 0)l*NF,f�.
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
Submit the original to the Division of Water Quality,Groundwater Section,1636 Mail Service Center Raleigh Nf
27699-1636 Phone No.(919),733-3221,within 30 days. GW 1 RE I:(J7/2001 v-- _,.

V CC 2 Y'• �Y
WELL CONSTRUCTION RECORD
North Carolina-Department of Environment and Natural
Reso�yJ(ces-Division of Water Quality-Groundwater Section
WELL CONTRACTOR(INDIVIDUAL)NAMES ((p,,rint)lr 0 Ij0.���21— CERTIFICATION f✓���
WELL CONTRACTOR COMPANY NAME /, Ic r'r�� INC�ll M—&10e 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 LOCATI • Topographic/Lan�-setting
Nearest Town: CnroSZ County r°^5 1~41- ❑Ridge ❑Slope BValley ❑Flat
(check appropriate box)
(Street Name,Numbers,Community,Subdivision,Lot No.,Zip Cade) Latitude/longitude of well location
3. OWNER: LerC I
FP Pdr-"C 14 (degrees/minutes/seconds)
Address dT14,444Loop R Latitude/longitude source:❑GPSOTopographic map
(Street or Route No.) (check box)
�'S�tGx rorQs�' NVc .2 DEPTH DRILLING LOG
City or Town State Zip Code From To o ation Description
Area code-Phone number
4. DATE DRILLED
5. TOTAL DEPTH: 2Y i b Q(o — Rack
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO L9� All
7. STATIC WATER LEVEL Below Top of Casing: `sO FT. y2J 2 S Sze a
(Use"+"if Above Top of Casing)
8. TOP OF CASING IS r FT.Above Land Surface*
'Top of casing terminated at/or below land surface requires a f"
variance in accordance with 15A NCAC 2C.0118. LTy.
9. YIELD(gpm): 7 D METHOD OF TEST "r&s
10.WATER ZONES(depth):_ o
11. DISINFECTION:Type
LOCATION SKETCH
)ITN Amount Show direction and distance in miles from at le=
12. CASING: Wall Thickness two State Roads or County Roads.Include the road
Dept D' eter or W ''Ght/FL Material numbers and common road names.
From To Ft. m1a I
From To Ft. ('Yd
From To Ft. fC� (
13. GROUT: Depth Material Metho
ld
From To 2.0 _Ft._Cc�Cal Iola oj—r Q
From To FL i
14. SCREEN: Depth Diameter Slot Size Material '
From To Ft. in. in.
From To Ft. in. in. w,rtpSe
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
16. REMARKS: "eP°pI
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C,WELL
CONSTRUCTION STANDARDS,AND THAT A COPY bF THIS RECORD HAS BEEN RROVIDED TO THE WELL OWNER
02
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE r'_
Submit the original to the Division of Water Qua11�g,, rpiipckv ter Slectio,1f,1636 Mail Service Center Raleight-NC
27699-1636 Phone No.[phone],within 30 aay--s- ----=--- 1 GW-1 REV.07f290�1 eft
��.�� Gib

V .� n' Yi 4p
L� � fi
WELL CONSTRUCTION RECORD
North Carolina-Department of Environment and Natural Resour/C�es- `Di-vision of Water Quality-Groundwater Section
WELL CONTRACTOR(INDIVIDUAL)NAME (print) �`I'14-4- /a,C I�r CERTIFICATION#J(5(o
WELL CONTRACTOR COMPANY NAME�/1 hl if t✓o IC d— &( ..P PHONE # (8,rf)07'H15J
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
1. WELL USE(Check Applicable Box): Residential 13- Municipal/Public❑ Industrial ❑ Agricultural❑
Monitoring❑ Recovery ❑ Heat Pump Water Injection❑ Other❑ If Other,List Use
2. WELL LOCATION: �Topographic/Land setting
Nearest Town:_UrRL."A County �F_ enSr ,y gjidge ❑Slope ❑Valley ❑Flat
(check appropriate box)
(Street Name,Numbers,Community,Subdivision,Lot No.,Zip Code) Latitude/longitude of well location
3. OWNER: L� I (lit (degrees/minutes/seconds)
Address ,. 4(nS( Latitude/longitude source:❑GPS❑Topographic map
lZ(Street or Route No (check box)
NC. DEPTH DRILLING LOG
City or Town State Zip Code From To Formation Description
Area code-Phone number t c ff 1�
4. DATE DRILLED
5. TOTAL DEPTH: co"•r
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO L9�
7. STATIC WATER LEVEL Below Top of Casing: A iro FT.
! (Use"+"if Above Top of Casing) r
8. TOP OF CASING IS Z
_�_FT.Above Land Surface*
-Top of casing terminated at/or below land surface requires a
variance in accordance with 15A NCAC 2C.0118.
9. YIELD(gpm): 6—METHOD OF TEST ISI r —
10.WATER ZONES(depth):_
LOCATION SKETCH
11. DISINFECTION:Type u ni Amount Show direction and distance in miles from at least
12. CASING: Wall Thickness two State Roads or County Roads.Include the road
DepthDiameter or Weight/Ft. Material numbers and common road names.
From To 34 Ft. (s`/'q SOILi.t l/�_ Z7�
From To Ft. g AT.M tsniss
From To Ft.
13. GROUT: Depth Material M thod
From O To 3`I Ft. at �.,r - p,r�+'n T.
From To FL T a y(,�
14. SCREEN: Depth Diameter Slot Size Material �-� � m"!-f`•t'•
From To Ft. in. in.
From To Ft. in, in. 4yI" i
15. SAND/GRAVEL PACK: 1 °
FMB \
Depth Size Material
From To Ft. ��_ {.✓1
From To Ft.
__ to
16. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C,WELL
CONSTRUCTION STAN/�JD//A!RDS, HAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
�a.-- 3�!/�s
IGNATUREOFPERSONCONSTRUCTINGTHE-WELL DATE FIT
Submit the original to the Division of WaterQuality;-Groundwater Section,1636 Mail Service Center-Raleigh,]+L?
27699-1636 Phone No.[phone],within 30 days. GW-1 REV. 07JZ0(R i Cig�.
Un

{r:
WELL CONSTRUCTION RECORD
North Carolina-Department of Environment and
/j)�/Ip�rural
/ResAurces-Division of Water Quality-Groundwater Section
WELL CONTRACTOR(INDIVIDUAL)NAME/(prirint)J/ IG'.�"IV L ke!'r CERTIFICATION#3t56
WELL CONTRACTOR COMPANY NAME //lEe'ri PRONE #
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable) (ifapplicable)
1. WELL USE(Check Applicable Box): Residential IY Municipal/Public❑ Industrial ❑ Agricultural❑
Monitoring❑ Recovery ❑ Heat Pump Water Injection❑ Other❑ If Other,List Use
2. WELL LOCATIRQN: opographic/Landsetting
Nearest Town: (Jxlg &re,e County�f3+�>yi. `. idge ❑Slope ❑Valley ❑Flat
(check appropriate box)
(Street Name,Numbers,Community,Subdivision,Lot No.,Zip Code) Latitude/longitude of well location
3. OWNER: et0-- i - C (r'\
1ti1A� �F� (degrees/minutes/seconds)
Address S]53 31rCf- ;kzJwf-ea Latitude/longitude source:❑GPS❑Topographicmap
(Street or Route No.) (check box)
46 -rA-14,ka �/C_ gmq,) DEPTH DRILLING LO
ow r
G
City or T n S, Zip Code From To Formation Description
Area code.Phone number �lr
4. DATE DRILLED A-
5. TOTAL DEPTH: 1<d5-
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO P�
7. STATIC WATER LEVEL Below Top of Casing: A60 r FT. (t L `IYa flay p( y
, (Use"+^if Above Top of Casing) � �
8. TOP OF CASING IS 1 FT.Above Land Surface*
-Top of casing terminated at/or below land surface requires a = ^
variance in accordance with 15A NCAC 2C.0I18. M
9. YIELD(gpm): IVL METHOD OF TEST -
10.WATER ZONES(depth):_ O
LOCATION SKETCH m�
11. DISINFECTION:Type NTN Amount Show direction and distance in miles from at leastnA�
11 CASING: Wall Thickness two State Roads or County Roads.Include the roa$`
Depth Diameter or Weight/Ft. Material numbers and common road names.
From To LtX Ft. W14 Vk u
From To Ft.
From To Ft.
13. GROUT: Depth Material Method 1 (Sri
From_To X0 _Ft. fn;j ae-
From To FL
14. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in.
From To Ft. in. in. 40e.�e�r r
15. SAND/GRAVEL PACK:
Depth Size Material its
From To Ft.
From Tc Ft.
16. REMARKS: Nf4 t. tiAM
I DO HEREBY CE" TIFY THAT THIS WELL WAS 66NSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C,WELL
CONSTRUCTI A AND THAT A COP4'OF THIS RECORD HAS
BEEN PROVIDED TO THE WELL OWNER, ( _.t 1
LFO
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
r 1i 4 Submit the original to the Division of Water Qualify,Groundwater Section,1636 Mail Service Center-Raleigh �
� 1� V
c._
27699-1636 Phone No.[phone],within 30 days;:: � GW-1 REV.
r _

t
WELL CONSTRUCTION RECORD
North Carolina-Department of Environment and Natural Resources-Division of Water Quality-Groundwater Section
WELL CONTRACTOR(INDIVIDUAL)NAME (print)� CERTIFICATION$f lk
�Cy
WELL CONTRACTOR COMPANY NAME a)4e( ,'(( L—eif +-n'^e PHONE # f��(C"I7-(I7la
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERrMIT#
ifapplicable) (if applicable)
1. WELL USE(Check Applicable Box):Residential Er'Punicipal/Public❑ Industrial ❑ Agricultural❑
r=a
Monitoring❑ Recovery ❑ Heat Pump Water Injection❑ Other❑ If Other,List Use
2. WELL LOCATION: pographic/Land setting z
Nearest Town: County7�^sw/r.t. i�❑Slope ❑Valley ❑TV ti
(check appropriate box)
(Street Name,Numbers,Community,Subdivision,Lot No.,Zip Code) Latitude/longitude of well locatio�
3. OWNER: ilfe (degreestminutes/seconds)
Address Lk Con. r.. Latitude/longitude source:❑GPS❑Topographic map
� (Street ar Route o.) (check box)
Pr5r11f8^lor.: J1IC- 2 DEPTH DRILLING LOG
Ciryor Town State Zip Code From To Forrpation Description
Area code-Phone number 10 I i '�IEy
4. DATE DRILLED 3-1 -6 S
5. TOTAL DEPTH: 3$� / 3�-- 5r4
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO Ei } tie per
7. STATIC WATER LEVEL Below Top of Casing: G7 FT. t{1 r{(r )J Q
(Use"+"if Above Top of Casing) H.-J-
S. TOP OF CASING IS_J FT.Above Land Surface' I
-Top of casing terminated attor below land surface requires a
variance In accordance with 15A NCAC 2C.0113. ;r e,(�✓
9. YIELD(gpm): METHOD OF TES�_
10.WATER ZONES(depth):_
LOCATION SKETCH
11. DISINFECTION:Type NTH Amount Show direction and distance in miles from at least
12. CASING: Wall Thickness two State Roads or County Roads.Include the road
Depth Diameter or Weight/Ft. Material numbers and common road names.
From�To U6 FL ler�U SDQ2f ILL
From To Ft.
From To Ft.
13. GROUT: Depth Material Method
From_To Z` _Ft._ C-
From To Ft.
14. SCREEN: Depth Diameter Slot Size Material S+job' Sl,,,.h l•�t
From—To—Ft.—in. in.
From To Ft._in. in. \ 1I
15. SAND/GRAVEL PACK: ~� � jv
Depth Size Material CC`U
From To Ft.
From To Ft.
16. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL Wdi3 NSTRUCTED IN(+LCORDANQE WITH 15A NCAC 2C,WELL
CONSTRUCTI NDARDS,AND THAT Cp Y-'QF�TFIS RESORT)HA,S B):EN.,PROVIDED TO THE WELL O
SIGNATURB b
PERSON CONSTRUCTING T� WELL DATE
Submit the original to the Division of Water Qyality,Groundwater Section,1636 Mail Service Center-Raleigh NQ•
27699-1636 Phone No.[phone],within 30 dalys:- -- GW-I REV.Ohl) ''I

WELL CONSTRUCTION RECORD
North Carolina-Department of Environment and Natural Resources-Division of Water Quality-Groundwater Section
WELL CONTRACTOR(INDIVIDUAL)NAME (print)G/BW 5-&4 'oe CERTIFICATION#.7d//
WELL CONTRACTOR COMPANY NAME -'06&�b PHONE n
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
1. WELL USE(Check Applicable Box): Residential 01 M/unicipal/Public❑ Industrial❑ Agricultural❑
Monitoring❑ Recovery ❑ Heat Pump Water Injection❑ Other❑ If Other,List Use
2. WELL LOCATION: Topographic/Land setting
Nearest Town: rGvar� CountyA ❑Ridge ❑Slope ❑Valley ❑& ",
TQ It V Aw. (check appropriate box)
(Street ame,Numbers,Community,Subdivision,Lot No.,Zip Code) Latitude/longitude of well locatiofs ,
// ll�es�3. OWNER: .
(degrees/minutes/seconds) O
Address 4/0 �7"-�n Greek Latitude/longitude source:❑GPS❑TopograWic ma'M
(Street or oute No.) (check box)
��/��, $ G �j y�7� DEPTH DRILLING LOG
city or Town stare Zip Code From To Formation Description
Area code-Phone number Q,- /� �nr•r
4. DATE DRILLED 4!-/��SJ
5. TOTAL DEPTH: � �d
6. DOES WELL REPLACE EXISTING WELL? YES NO
7. STATIC WATER LEVEL Below Top of Casing: FT.
(Use"+"if Above Top of Casing) 7i
8. TOP OF CASING IS J:3 —FT.Above Land Surface*
-Top of casing terminated at/or below land surface requires a
variance in accordance with 15A NCAC 2C.0I1S.
9. YIELD(gpm):_:METHOD OF TEST ✓
10.WATER ZONES(depth): I ye- 31tJ
LOCATION SKETCH
11. DISINFECTION:Type Amount Show direction and distance in miles from at least
12. CASING: Wall Thickness two State Roads or County Roads.Include the road
Depth Diameter or Weight/Ft. Material numbers and common road names.
From­0 To55_ Ft. -r,4- •A/
From To Ft.
From To Ft.
13. GROUT: Depth Material Method /Q�/j✓ ,�'• /keu✓ ✓o'+'✓�7t
From Tom_Ft._g¢ .( ',x se
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 'M2tiirial
From To Ft.
From To Ft.
16. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CQNsTRUCTEDINACC©RDANCE WITH 15A NCAC 2C,WELL
CONSTRUCTION STANDARDS,AND THAT A COPVqE THISRECORD HAS BEEN PROVIDED TO THE WELL OWNER
iwr✓ in ! �� s I r I j
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
Submit the original to the Division of Water Quality,Groundwater Section,1636 Mail Service Center-Raleighl,b1G
27699-1636 Phone No.[phone],within 30 days. GW-I REVAUMM Q01 GUI
1f rn

WELL CONSTRUCTION RECORD
North Carolina-Department of Environment and Natural
/�Resources-Division of Water Quality-Groundwater Section
WELL CONTRACTOR(INDIVIDUAL)NAME (print)/�ry s J4-pe -IS� CERTIFICATION# 3;1 —
WELL CONTRACTOR COMPANY NAME M'ci-rt'l1 PHONE # ffli IELI -�-{e%i'G
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
I. WELL USE(Check Applicable Box): Residential O�Municipal/Public❑ Industrial ❑ Agricultural❑
Monitoring❑ Recovery ❑ Heat Pump Water Injection❑ Other❑ If Other,List Use
2. WELL LOCATION: C
Com —Ln El
Idge ❑Slope ❑Valley ❑F2SNeares[Town: N T-opographic/Land setting rl
-;
(check appropriate.box) 7(Street Name,Numbers,Community,Subdivision,Lot No.,Zip Code) Latitude/longitude of well location
3. OWNER: srn ILw.tCQc✓ d-Z (degrees/minutes/seconds)
Address Lpiay1:��V y Latitude/longitude source:❑GPS❑Topographic map
!L (Street or Route No.) (check box)
jJl p,4)A+ L ; C az DEPTH DRILLING LOG
City or Town State zip Code From To Forman Description
�Jiq
Area code-Phone number __�l _C S- rb Ic FJc
4. DATE DRILLED
5. TOTAL DEPTH: 7- i�--- `�0 — 27 oil.
�"—
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO 9--in L fl
7. STATIC WATER LEVEL Below Top of Casing:�_FT. v C t4 l p t
(Use"+"if Above Top of Casing)
8. TOP OF CASING IS FT.Above Land Surface" r
-Top of casing terminated atlor below land surface requires a
variance in accordance with I5A NCAC 2C.0118.
9. YIELD(gpm): 5�b METHOD OF TEST d ow-
10.WATER ZONES(depth):_
LOCATION SKETCH
11. DISINFECTION:Type IITN Amount Show direction and distance in miles from at least
12. CASING: Wall Thickness two State Roads or County Roads.Include t oa 1
Depth Diameter or Weight/Ft. Material numbers and common road names.4 9
C
From To Ft.L t- 'hi S IM 21 9 � y�
From To F[. — P
From To Ft.
13. GROUT: Depth Material Methpd
From (r To /_0 _Ft_Cu �rrck
From To Ft.
14. SCREEN: Depth Diameter Slot Size Material /
From To Ft. in. in.
From To Ft. in -An.
15. SAND/GRAVEL PACK: - —'_J
Depth Size Material_ ..
From To Ft. _
From To Ft.
16. REMARKS:
I DO HEREBY CESPn THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH ISA NCAC 2C,WELL
CONS C I TANDARDS,AND THAT A COPY OF THIS RECORD"HAS BEEN PROVIDED TO THE WELL OWNER C
�b
31—�'
17
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
Submit the original to the Division of Water ,Quality Groundwater Section 1636 Mail Service Center ;t��
27699-1636 Phone No.[phone],within 30 days. GW-1 REV. xlgpl cT7

WELL CONSTRUCTION RECORD
North Carolina-Department of Environment and Natural Resources-Division of Water Quality-Groundwater Section
WELL CONTRACTOR(INDIVIDUAL)NAME
w(print)� n Z'-& 5Yb7telle- CERTIFICATION#�`
WELL CONTRACTOR COMPANY NAME/ f-- ��� n22 PHONE # UE2,* 77 'Z/.�yy,�j
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
ifa licable ifa licable
1. WELL USE(Check Applicable Box): Residential Municipal/Public❑ Industrial ❑ Agricultural❑
Monitoring❑ Recovery ❑ Heat Pump Water Injection❑ Other❑ If Other,List Use
2. WELL LOCATION: Topographic/Land setting
Nearest Town: e&n yam( County_ ❑Ridge ❑Slope ❑Valley ❑Flat
(check appropriate box)
(Street Name,Numbers,Community,Subdivision,Lot No.,Zip Code) Latitude/longitude of well location
3. OWNER:_Q(rj
11t�((_ (degrees/minutes/seconds)
Address 0. Latitude/longitude source:❑GPS❑Topographic map
(Street or Route No.) (check box)
�r5tarru �"+R C7 M( Sn6 b DEPTH DRILLING LOG
City or Town State Zip Code From To Formation Description
(S12Zd_
Area code.Phone number
4. DATE DRILLED
5. TOTAL DEPTH: �Ih f— /ad- He. aannG
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO Cf
7. STATIC WATER LEVEL Below Top of Casing:AFT. yh �br��
(Use"+"if Above Top of Casing)
8. TOP OF CASING IS Above Land Surface"*Tap of casing terminated at/or below landnd s surface requires a
variance in accordaAace with 15A NCAC 2C.0118.
9. YIELD(gpm):lo" METHOD OF TEST g i
10.WATER ZONES(depth):a-AKO
LOCATION SKETCH
11. DISINFECTION:Type Amount Show direction and distance in miles from at least
12. CASING: Wall Thickness two State Roads or County Roads.Include the road
Depth Diameter or Weight/Ft. Paterial numbers and common road names.
From ® To5^Jr FL A7-3 /i.v ?'I
From To Ft.
From To Ft.
13. GROUT: Depth Material Method Z
s
From O To AU _Ft_$Aea /jr— /f Z'd— 0 =j
From To Ft. 0
14. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in. --
From To Ft. in. in.
15. SAND/GRAVEL PACK: r \
Depth Size Material -
From To Ft.
From To Ft.
16. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C,WELL
CONSTRUCTION STANDARDS,AND THAT A COPY OF THIS RECORD-IIAS'-BE££N-PROVIDED T@iHE-WELL OWNER
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
Submit the original to the Division of Water �-'
Quality,Groundwater Section,1636 Mail Service Center-Raleig
27699-1636 Phone No.[phone],within 30 days. GW-I REV.
z Guy

WELL CONSTRUCTION RECORD
North Carolina-Department of Environment and Natural Resources-Division of Water Quality-Groundwater Section�r
WELL CONTRACTOR(INDIVIDUAL)NAME (print)61"* 7 B/7�G��L CERTIFICATION#1x1_11
WELL CONTRACTOR COMPANY NAME Al Pr.-�'61`/1�f 1�s'- A.",,,t� PHONE # (_%!Ot!JC 2-4—CLL�/,.f� -
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMMIT#
ifa liable ifapplicable)
1. WELL USE(Check Applicable Box): Residential Municipal/Public❑ Industrial❑ Agricultural❑
Monitoring❑ Recovery ❑ Heat Pump Water Injection❑ Other❑ If Other,List Use
2. WELL LOCATI N: Topographic/Land setting
Nearest Town: Countyre,s k ❑Ridge ❑Slope ❑Valley ❑Flat
(check appropriate box)
(Street Name,Numbers,Community,Subdivision,Lot No.,Zip Code) Latitude/longitude of well location
3. OWNER: J�3 �P (degreestminutes/seconds)
Address I-•63 _�P Latitude/longitude source:❑GPS❑Topographic map
(Street or Route No.) (check box)
r :a2Q/2 DEPTH DRILLING LOG
City or Town State Zip Code From To Formation Description
(%)-�O y� a;0d
Area code-Phone number Q jQ
4. DATE DRILLED `A
5. TOTAL DEPTH: (a -l�U o�Y! 1aSG/
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO a' r
7. STATIC WATER LEVEL Below Top of Casing AFT. G
(Use'+"if Above Top of Casing) SIMS
8. TOP OF CASING IS FT.Above Land Surface" _
o
`Top of casing terminated at/or below land surface requires a
variance in accordance with I5A NCAC 2C.0118. O
9. YIELD(gpm): L O METHOD OF TEST 21/1 Un
10.WATER ZONES(depth): ;I-4i0
LOCATION SKETCH -
11. DISINFECTION:Type Amount Show direction and distance in miles from at least
12. CASING: Wall Thickness two State Roads or County Roads.Include.the road
Depth Diameter or Weight/Ft. Material numbers and common road names.
From d To Ft. G 9f' .��/ � 6
From To Ft. g�-
From To Ft.
13. GROUT: Depth Material Method On Fa�eg
From_L_To�_Fr_ 0 Gvrvloe-
From To Ft.
14. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in.
From To Ft. in. in. --
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
16. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE:WITH 15A NCAC2C,WELL
CONSTRUCTION STANDARDS,AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER' in
SIG ATURE OF PERSON CONSTRUCTING THE WELL DATE " 1 �
V c-
Submit the original to the Division of Water Quality,Groundwater Section,1636 Mail Service Center-Raleigi zNd
27699-1636 Phone No.[phone],within 30 days. GWA REV. 7/SDI
rn �,

1) A fiJ
WELL CONSTRUCTION RECORD
North Carolina-Department of Environment and N tural R ources-Division of Water Quality-Groundwater Section
WELL CONTRACTOR(INDIVIDUAL)NAME (print)-�CU'll1 f7:: CERTIFICATION#31s�o
WELL CONTRACTOR COMPANY NAME tT-1�� L✓fs// ( yti� PHONE #
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
1. WELL USE(Check Applicable Box): Residential er/Municipal/Public❑ Industrial ❑ Agricultural❑
Monitoring❑ Recovery ❑ Heat Pump Water Injection❑ Other❑ If Other,List Use
2. WELL LOCATION: Topogra�ic/Land setting
Nearest Town: ike you-4 County r 1. ❑Ridge QSlope ❑Valley ❑Flat
(check appropriate box)
(Street Name,Numbers,Community,Subdivision,Lot No.,Zip Code) Latitude/longitude of well location
W 3. ONER:Ufr-lN&4 ROU 1 s'A¢ (degrees/minutes/seconds)
Address &L(YIAA6x y/eA✓ >tfr'O ar(c, Latitude/longitude source:❑GPS❑Topographicmap
(Street or Route No.) (check box)
N_Pulv.d _W 9 DEPTH DRILLING LOG
,tyor Town crate Zip Code From To o on Description
D T`9 r
Area code-Phone number
4. DATE DRILLED-9--t-0 > Z �eo(L -
5. TOTAL DEPTH: 2t(0
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO 1? _iL -7 D Y c
7. STATIC WATER LEVEL Below Top of Casing: y 0 FT. :10 -11
(Use"+"if Above Top orcasing) -11 710
8. TOP OF CASING IS ( FT.Above Land Surface* 2& 221 G&_44L
-Top of casing terminated at/or below land surface requires a ( ,� r n
variance in accordance with ISA NCAC 2C.0118.
9. YIELD(gpm): (06 METHOD OF TEST Alf'st-✓
10.WATER ZONES(depth):
LOCATION SKETCH
11. DISINFECTION:Type Amount Show direction and distance in miles from at least
12. CASING: Wall Thickness two State Roads or County Roads.Include the road
Depth Dia eter or Weight/Ft. Material numbers and common road names.
From�To Ft. tz 510le tl PVL rgfsw%'s"
From To Ft. m R,� �
From To F[.
13. GROUT: Depth2� Material alethgd
From O To _Ft._ C4(�t:-t'e. 0_ /`"�^IfG*"l-R+� dl�Uq
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(`f/ ) sii ti'
From To Ft.
From To Ft.
16. REMARKS: v c
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH ISA NCAC 2C,WELL i o -
CONST U TIO TANDARDS,AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
� J
f SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
Submit the original to the Division of Water Quality,.Groundwater Section,1636 Mail Service Center-Raleigh,NC
27699-1636 Phone No.[phone],within 30 days. GW-1 REV.07/2001

WELL CONSTRUCTION RECORD
North Carolina-Department of Environment and NaturalResources-Division of Water Quality-Groundwater Section
WELL CONTRACTOR(INDIVIDUAL)NAME yy(��print)C�Zt"/7,, i Pn 1'e 11,e CERTIFICATION#
WELL CONTRACTOR COMPANY NAME L�Prj�`/� ll�F�/ �/-(1m�7 PHONE #
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMMIT#
(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 LOCATIO . Topographic/Land setting
Ne az`est Town: zo f�/ County 7ttn S ❑Ridge ❑Slope ❑Valley ❑Flat
> 1
// P A e (check appropriate box)
(Street Name,Numbers,Community,Subdivision,
�Lot
�No.,Zip Code) Latitude/longitude of well location
3. OWNER: Zq/On���x/t %/f"�/tea '+-_ (degmes/minutes/seconds)
Address , ° 3 Latitude/longitude source:❑GPS❑Topographic map
Street or Route No.) (check box)
� j prSAIC ' / DEPTH DRILLING LOG
f�
city or Town State Zip Code From To Formation Description
(rL_) ;T 3- %4
Area code-Phone number �f
4. DATE DRILLED 6-1/-d
5. TOTAL DEPTH: a`5'a
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO
7. STATIC WATER LEVEL Below Top of Casing: 6G' FT. rye _�rSp j,�
4
LALc*e,i-
(Use"+••if Above Top of Cuing) p•�—
8. TOP OF CASING IS_�FT.Above Land Surface*
*Top of casing terminated attor below land surface requires a -
variance in accordance with ISA NCAC 2C.0119.
9. YIELD(gpm): )O METHOD OF TEST a-: T =
10.WATER ZONES(depth):_ ;�-dt
LOCATION SKETCH
11. DISINFECTION:Type Amount Show direction and distance in miles from at least`
12. CASING: Wall Thickness two State Roads or County Roads.Include the road
Depth Diameter or Wei ht/Ft. Material numbers and common road names.
From-0 To +O Ft.6.11
From To Ft.
From To Ft. /'i��,�lo4t �SBcr;✓y.� LET
13. GROUT: Depth Material Method
From d ToAO FL-9,I,,eKn,'A J7e/t-T
From To Ft.
14. SCREEN: Depth Diameter Slot Size Material -
From To Ft. in. in.
i
From To Ft. in. in.
15. SAND/GRAVEL PACK: _ L ''
Depth Size Material
From To Ft.
From To Ft. i
16. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C,WELL (- _—?!
CONSTRUCTION STANDARDS,AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER --- - '!
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
Submit the original to the Division of Water Quality,Groundwater Section,1636 Mail Service Center-Raleigh,NC
27699-1636 Phone No.[phone],within 30 days. _ GW-I REV.07/2001

WELL CONSTRUCTION RECORD
North Carolina-Department of Environment and Natural Resources-Division of Water Quality-Groundwater Section
WELL CONTRACTOR(INDIVIDUAL)NAME
A'(prfnt)C9/Pjlh •1 ou r,," Pl/et- CERTIFICATION#
WELL CONTRACTOR COMPANY NAME djeyr PHONE # fQis) ` 22 -_4?y4 � !�
t
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable) ifapplicable)
1. WELL USE(Check Applicable Box): Residential Municipal/Public❑ Industrial❑ Agricultural❑
Monitoring❑ Recovery ❑ Heat Pump Water Injection❑ Other❑ If Other,List Use
2. WELL LOCATION: Topographic/Land setting
Nearest To r7l�! /PYcLi� County //fins ❑Ridge ❑Slope ❑Valley ❑Flat
— z-✓lwl 450i�l (check appropriate box)
(Street Name,Numbers,Community,Subdivision,Lot No.,Zip Code) Latitude/longitude of well location
3. OWNERJ e'i:---T- G @.cya ao.-I— (degrees/minutes/seconds)
Address 7 ?- �/ e-,py 1-1/,.97G A-- Latitude/longitude source:❑GPS❑Topographic map
(Street or Route No.) (check box)
i/7 DEPTH DRILLING LOG
City or Town State Zip Code From To Formation Description
Area code-Phone numbeL.
4. DATE DRILLED�7
5. TOTAL DEPTH: ;Z 5fO �d fQ 4zt n.
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO @' n;,
7. STATIC WATER LEVEL Below Top of Casing: !y FT. /® -/.-/a
(Use"+"if Above Top ofCasing)
S. TOP OF CASING IS FT.Above Land Surface*
`Top of casing terminated atlor below land surface requires a
variance In accords a with 15A NCAC 2C.0118.
9. YIELD(gpm): METHOD OF TESTCZZ. o ?
10.WATER ZONES(depth):_ `y'0U G
LOCATION SKETCH ut
11. DISINFECTION:Type Amount Show direction and distance in miles from at least
12. CASING: Wall Thickness two State Roads or County Roads.Include the road
Depth Diameter or WeiPh�t. Material numbers and common road names.
From Y 7 Tom Ft. ./�`✓f /- /' I-
From�T To Ft. B..1/� ,7/ /1G V tif/ /(171d$ 'e-
From To Ft. Jj �
13. GROUT: Depth Material Method // arn 1crlla y 12,-
From__Tom_Ft._�;/ 'A D�� -
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.
From To Ft. I jF
16. REMARKS: o
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C,WELL'- G7
CONSTRUCTION STANDARDS,AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL O.Ay 11
WNED
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
Submit the original to the Division of Water Quality,Grouptlryater$ectiW,1636 Mail Service Center-Raleigh,NC
27699-1636 Phone No.[phone],within 30 days. - GW-I REV.07/2001

WELL CONSTRUCTION RECORD
North Carolina-Department of Environment and Natural Resources-Division of Water Quality-Groundwater Section
WELL CONTRACTOR(INDIVIDUAL)NAME (print) � IPi9/9 �Y[Z le Ile— CERTIFICATION# �l
(r
WELL CONTRACTOR COMPANY NAME.,' !</' too'Il)`-&ZL4IJ PHONE # kf1-i) 5j7j'
I
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
ifa licable (if IN
licable)
1. WELL USE(Check Applicable Box): Residential Municipal/Public❑ Industrial ❑ Agricultural ❑
Monitoring❑ Recovery ❑ Heat Pump Water Injection❑ Other❑ If Other,List Use
2. WELL LOCATION: Topographic/Land setting
Nearest Town:&_&,eirW County ❑Ridge ❑Slope ❑Valley ❑Flat
(check appropriate box)
(Street Name,Numbers,Community,Subdivision,Lot No.,Zip Code) Latitude/longitude of well location
3. OWNER: /� /./ry�/'/[a (degrees/minutes/seconds)
Address /.�/t/ "rLLQi1?l4a Latitude/longitude source:❑GPS❑Topographic map
(Street or Route No.) (check box)
e It NC J 9-fe6- DEPTH DRILLING LOG
City or Town state Zip Code From To Formation Description
(5ZZ- -270/- /5-71-
Area code-Phone number
4. DATE DRILLED !/n
5. TOTAL DEPTH: a- -
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO H — Cvt -
7. STATIC WATER LEVEL Below Top of Casing: �PFT. .f(J .- 1
(Use"+•'if Above Top of Casing) r^a°
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. O
9. YIELD(gpm): CIO METHOD OF TESTS// r
10.WATER ZONES(depth):J'!Gam' �!/<i' c.rl
LOCATION SKETCH
11. DISINFECTION:Type Amount Show direction and distance in miles from at least-�
12. CASING: Wall Thickness two State Roads or County Roads. Include the road
Depth Diameter or Weight/Ft. Njaterial numbers and common road names.
From cp To ffe Ft. er,'g-
From To Ft. _/ �-`'""� '
From To Ft.
13. GROUT: Depth Material Method
From d Tom FL_ sm;'� Di s�
From To Ft .Is�sf�ify�rg,(� -'rt- �'� r-
14. SCREEN: Depth Diameter Slot Size Material . r,_
>From To Ft. ,in. in. rru�
From To Ft. in. in. L
15. SAND/GRAVEL PACK: C= C>;
Depth Size Material
From To Ft.
From To Ft.
16. REMARKS: _ C>
C.
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH I SA NCAC 2C,WELL
CONSTRUCTION STANDARDS,AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO-THE WELL ON WER _.?;�
SIGNATURE 6F PERSON CONSTR CTING THE WELL DATE
Submit the original to the Division of Water Quality,Groundwater Seetioly 163WN[hil Service Center-Raleigh,NC
27699-1636 Phone No.[phone],within 30 days. GW-1 REV.07/2001

IV\ :� 1
WELL CONSTRUCTION RECORD
North Carolina-Department of Environment and Natural Resources-Division of Water Quality-Groundwater Section
WELL CONTRACTOR(INDIVIDUAL)NAME (print)0eil,7 c5P le-112 CERTIFICATION# 2F47
WELL CONTRACTOR COMPANY NAME/! PI'/w J/f�'YP.// -y�r»y n PHONE # 9151 �i 77'1/rjy D
i
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
ifa licable (if applicable)
1. WELL USE(Check Applicable Box): Residential EK Municipal/Public❑ Industrial❑ Agricultural❑
Monitoring❑ Recovery ❑ Heat Pump Water Injection❑ Other❑ If Other,List Use
2. WELL LOCATION: �y Topographic/Land setting
Nearest Town• LY County- ❑Ridge ❑Slope OValley ❑Flat
/'z➢ SOn / (check appropriate box)
(Street 1.1 Nam;,,L Numbers,Community,Subdivision,Lot No.,Zip Code) Latitude/longitude of well location
3. OWNER:1 /'nPSt" �a ,Wa ,i (degrees/minutes/seconds)
Address ��t5LY1 • Latitude/longitude source:❑GPS❑Topographic map
et'or Route No.) (check box)
►QAlO I �L -21? 1 DEPTH DRILLING LOG
Cityor7own State Zip Code From To Formation Description
(5)- r 3-�/�"3
Area code-Phone number_
4. DATE DRILLED
5. TOTAL DEPTH: Her h�
6. DOES WELL REPLACE EXISTING WELL? YE 0-NO IT
7. STATIC WATER LEVEL Below Top of Casing:_4 FT. r
� (Use"V'if Above Top of Casing) C�
8. TOP OF CASING IS l, h FT.Above Land Surface*
-Top of casing terminated at/or below land surface requires a S _
variance In accordaac with I5A NCAC 2C.0118.
9. YIELD(gpm): _METHOD 9F TESTL1.i j'
10.WATER ZONES(depth): Al 1h o
LOCATION SKETCH
11. DISINFECTION:Type Amount Show direction and distance in miles from at least"
12. CASING: Wall Thickness two State Roads or County Roads.Include the road
DeptIL Djameter or Weight/Ft. Material numbers and common road names.
From /
To FLU `�f l'� �1t%1c^t'Sy %C/ �/"�S!!7 A�
From To Ft.
From To Ft.
13. GROUT: Depth Material Method f_ L
From_!' To � c% _Ft._ .' ,14 � �^ C----t--�
From To Ft.
n iPi
14. SCREEN: Depth Diameter Slot Size Material
�= L
From To F[. in. in.
From To Ft. in. in. Z
15. SAND/GRAVEL PACK: ?; I:
T
Depth Size MaterialT'
From To Ft. •n to
From To Ft.
16. REMARKS:
__.
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC --- -
CONSTRUCTION STANDARDS,AND THAT A C PY OF THIS UCORD HAS PEEN PROVIDED TO THE
/WELL
r OWNER
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
`Sd}bmit&j ilt'riginal to the Division of Water Quality,Groundwater Section,1636 Mail Service Center-Raleigh,NC
27699-1636 Phone No.[phone],within 30 days. GW-1 REV.07/2001

WELL CONSTRUCTION RECORD V_
North Carolina-Department of Environment and Natural Resources-Division of Water Quality-Groundwater Section
WELL CONTRACTOR(INDIVIDUAL)NAME (print) KENNETH MCCRARV CERTIFICATION#2008
WELL CONTRACTOR COMPANY NAME BARKER CONSTRUCTION,INC./BARKER WELL&PUMP PRONE # [phone]
STATE WELL CONSTRUCTION PERMITN 1871 ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
1. WELL USE(Check Applicable Box):Residential M Municipal/Public❑ Industrial❑ Agricultural❑
Monitoring❑ Recovery ❑ Heat Pump Water Injection❑ Other❑ If Other,List Use
2. WELL LOCATION: Topographic/Land setting
Nearest Town: BREVARD County TRANSYLVANIA ❑Ridge ®Slope ❑Valley ❑Flat
SHERWOOD RIDGE (check appropriate box)
(Street Name,Numbers,Community,Subdivision,Lot No.,Zip Code) LatitudeAongitude of well location
3. OWNER: EARL OWEN (degrees/minutes/seconds)
Address PO BOX 2333 Latitude/longitude source:❑GPS❑Topographic map
(Street or Route No.) (check box)
BREVARD NC 28712 DEPTH DRILLING LOG
City or Town State Zip Code From To Formation Description
8( 28 )- 884-9807
Area code-Phone number 'b
4. DATE DRILLED MAY 10,2005
5. TOTAL DEPTI-L• 430'
6. DOES WELL REPLACE EXISTING WELL? YES❑ NO 91 -.
7. STATIC WATER LEVEL Below Top of Casing. 10' FT.
(Use"+'if Above Top of Casing) LrI -
8. TOP OF CASING IS 1.39 FT.Above Land Surface' `'
•Top of casing terminated War below land surface requires a t9
variance in accordance with 15A NCAC 2C.0118. Ul
9. YIELD(gpm): 20 METHOD OF TEST TIMED
IO.WATERZONES(dep[h):
LOCATION SKETCH
11. DISINFECTION:Type av PUMP INSTALLER Amount Show direction and distance in miles from at least
12. CASING: Wall Thickness two State Roads or County Roads.Include the road
Depth Diameter or Weight/Ft. Material numbers and common road names.
From 0 To 27 Ft, 6 1/8 SDR21 PVC &Xwa -Z L�� �7/-
From To F[. G t�
From De Ft. C•Z �,®f � � "�w,,,�,�
13. GROUT: Depth Material Method
From 0 To 20' Ft. CONCRETE POURED �� � �d Aj L� o(J
From TO FL �/ g� �`"
14. SCREEN: Depth Diameter Slot Size Material o.-e.r c 2,�r7-r�o'w��,y'/'/7d -cf- tl�•� t
From TO Ft. in. in. L. CFL�^57 !/ U�From TO Ft. in. in. '`-"
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
16. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C,WELL
CONSTRUCTION STANDARDS,AND THAT THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
SIGNATURE OF PERSON CONSTRUCTING T LL nATE
Submit the original to the Division of Water Quality,Groundwater Sections I636 Mail-Service Center-Raleigh,NC
27699-7636 Phone No.[phone],within 30 days. r .1 'ij_ �� lliW REV.07/2001

WELL CONSTRUCTION RECORD 312
North Carolina-Department of Environment and Natural Resources-Division of Water Quality-Groundwater Section
WELL CONTRACTOR(INDIVIDUAL)NAME (print) KENNETH MCCRARY CERTIFICATION#2008
WELL CONTRACTOR COMPANY NAME BARKER CONSTRUCTION,INC./BARKER WELL&PUMP PHONE # [phone]
STATE WELL CONSTRUCTION PERMIT# 1871 ASSOCIATED WQ PERMIT#
111111 (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: BREVARD County TRANSYLVANIA Topographic/Land setting
HANNAH FORD ROAD ❑Ridge ❑Slope ❑Valley 87FIat
(Street Name,Numbers,Community,Subdivision,Lot No.,Zip Code) (check appropriate box)
Latitude/longitude ofwell location
3. OWNER: DAVID BASS
Address 19 DOUBLE RIDGE ROAD (degrees/minutes/seconds)
(Street or Route No.)
Latitude/longitude source:❑GPS❑Topographic map
)
ox
PISGAH FOREST NC 28768 DEPTH (check bDox LOG City or To" State Zip Code From To
( 828 )- 884-9356 Formation Description
Area code-Phone number
4. DATE DRILLED MAY 24,2005 s
5. TOTAL DEPTH: 280'
6. DOES WELL REPLACE EXISTING WELL? YES❑ NO 91 L `
7. STATIC WATER LEVEL Below Top of Casing: 10 IN'
8. TOP OF CASING IS 1.33 (Use`+"if Above Top ofCasing) — $
*Top of"sing terrain .Above Land Surface'
ated at/or FT below land surface requires a 0 js
variance in accordance with ISA NCAC 2C.0118.
9. YIELD(gpm): 30 METHOD OF TEST TIMED
10.WATER ZONES(depth)- °•T
1 I. DISINFECTION:Type LOCATION SKETCH
yp BY PUMP INSTALLER Amount Show direction and distance in miles from at least
12. CASING: Wall Thickness two State Roads or County Roads.Include the road
Depth Diameter or Weight/Ft. Material numbers and common road names.
From 0 To 55' Ft. 61/8 SDR21 PVC
From To-Ft. FrovnTrevnrd to.Ke. flwy. (o4 West
From To-De F[. 90 OpprOX1rKQ..t-lY 4 miff-S.
13. GROUT: To 29 Material Method TLtn-L lent on Green KlVer-kd.
From 0 Ft. CONCRETE POURED /n�
From To Ft. go 0f1PrOX1Y y I VlufeS lZS S}vp
14. SCREEN: Depth Diameter Slot Size Material �'q .1�
From To Ft. in in. S1 JK . ��rn Ie }- on
From To Ft. in. in, For& VJ • �tLCL ,Marne, VrL left,
15. SAND/GRAVEL PACK: 11"-
Depth Size Material
From To Ft.
From To Ft.
16. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C,WELL
CONSTRUCTION STANDARDS,AND THAT A COPY OF TMS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
SIGNATURE OF PERSON UUNSIXUCWM THE WELL DATE
Submit the original to the Division of Water Quality,Groundwater S 1¢36 Mail 3e"e Ceaiterr'27699-1636 Phone No.[phone],within 30[lays. - 11 � �b NC
— L$ µ i r/2001
i i" J U N 2 7 2005 1 i {,

WELL CONSTRUCTION RECORD 00
North Carolina-Department of Environment and Natural Resources-Division of Water Quality-Groundwater Section
WELL CONTRACTOR(INDIVIDUAL)NAME (print)RUSSeII S.TaylOr CERTIFICATION#2187
WELL CONTRACTOR COMPANY NAME Hedden Brothers Well Drilling,Inc PHONE # [phone]
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable) (ifapplicable) _
M1 ?I
1. WELL USE(Check Applicable Box):Residential® Municipal/Public❑ Industrial❑ Agricultural ❑
Monitoring❑ Recovery ❑ Heat Pump Water Injection❑ Other❑ If Other,List Use _
2. WELL LOCATbNi ^ Q Topographic/Land setting
� !
Neste own• Coungr��E� U a+ ❑Ridge ❑Slope ❑Valley ❑Flat
� I (check a
(Street Name,Numbers,Community,Subdivision,Lot No.,Zip Code of
Pere box)
JJ ), • Latitude/longitude of well location',
3. OWNER:Address �►/1y7—�� (degrces/minutes/secands)
1O�{l/ �/LT !D/fdY) Latitude/longitude source:❑GPS❑Topographic map
ft(11rRo to o.) (check box)3 DEPTH DRILLING 1.0( o Zip Code Fr T ' Formation Description
clay 8 sand
Area code-Phone number ' _
4. DATE DRILLED .05 granite
5. TOTAL DEPTH:
6. DOES WELL REPLACE EXISTING WELL? YES NO
7. STATIC WATER LEVEL Below Top of Casing: D FT.
(Use"+"if Above Top of Casing)
8. TOP OF CASING IS 2 FT.Above Land Surface•
•Top of casing terminated at/or below land surface requires a
variance in accordan with ISA NCAC 2C.0118.
9. YIELD(gpm): _ ODOES( BLOW
10.WATER ZONES(depth):
LOCATION SKETCH
11. DISINFECTION:Type H T H Amount 16oz Show direction and distance in miles from at least
12. CASING: Wall Thickness two State Roads Or County Roads.Include the road
Depth / Di eter or Wei ht/Ft. Material numbers and common road names.
From o_To Ft.
From' To Ft. /
From To Ft.
13. GROUT: Depth Material Method y ^
From 0 To 20 Ft. benonite 8 cement pumped W "
From Tc Ft. c7 f
14. SCREEN: Depth Diameter Slot Size Material p :'
From To Ft. in. in. Ln
From To Ft. in. in. `
15, SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
16. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C,WELL
CONSTRUCTION STANDARDS,AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
ZIG�3
NATURE 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

1 ' i
.+ t ,
WELL CONSTRUCTION RECORD
North Carolina-Department of Environment and Natural Resources-Di'7ion of Water Quality-Groundwater Section'p
WELL CONTRACTOR(INDIVIDUAL)NAME (priK G l CI 2- CERTIFICATION O�J
wELL CONTRACTOR COMPANY NAME)W P p 7 tA)A fl' PRONE a&Zb 6�2_0 y8d
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT# ...- I - ..
(if applicable) (if applicable)
i
I. WELL USE(Check Applicable Box):Residential B"MunicipaUPublic❑ Industrial❑ Agricultural❑
Monitoring❑ Recovery ❑ Heat Pump Water hyection❑ Other❑ If Other,List Use - -
I
2. WELL LOCATI N: Topog9phiefl nd setting
Nearest Town: M A) County, ❑Ridge OSrlope ❑Valley ❑Flat
Z31; A7f;% 61,A 114 777_ (cheek appropriate boar)
(Strew Name,Num ro bers,Cam 'ty,Subdivision,LotNo,Zip code) Latitudellongitude of well location
3. OWNER:5
u e/jjosy W#9/SNe"eJ (aegreeym;mmay,rmaa,)
Address235-NA a., iI /4 Latitude/longitude source:❑GPS❑Topographicmap
(Street aRowe . (dmk box) -
��AS ka o--) W e 2 F7 DEPTH DRILLING LOG
City or Town Stan tip Code From To Formation Description
Ara code Phone comber _
4. DATE DRILLED
5. TOTAL DEPTH: S' —J
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO er m
7. STATIC WATER LEVEL Below Top of Casing:
(Use'+'ifAbove Top of Casing)
8. TOP OF CASING IS 1. FT.Above Land Surface-
'Top of castes termlaated at/or below land surtm requw a
varlaace to accordance with 1SA NCAC 2C.0118. /
9. YIELD(gpm):'_METHOD OF TEST 1."stir fif
10.WATER ZONES(depth):
LOCATION SKETCH
11. DISINFECTION:Type Amount_ /0 o Show direction and distance in miles from at least
12. CASING: Wall Thickness two State Roads or County Roads.Include the road
��yy(( Depth or Weight/Ft Material numbers and common road names.
Fron( 1�To�Ft $OKZ/ PUC,_
From To FL
From Tc Ft co
13. GROUT: Depth Material Mqthod
From_To Z�FtC* Cllele WerHsix
From To Ft
14. SCREEN: Depth Diameter Slot Sim Material ({,
From — To Ft in. in. Tin
From To Ft in. in.
15. SAND/GRAVEL PACK:
Depth Sim Material i
From Tc Ft.
From To Ft.
16. REMARKS:
i��
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED ACCORDANCE WITH 15A NCAC 2C,WELL
CONSTRUCTION STAND AND THAT A COP F S RD HAS B PROVIDED TO THE WELL OWNER
SIGNATURE OF PERSON CONSTRU G 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 dayL GW-I REV.07/2001

a114
WELL CONSTRUCTION RECORD 2
North Carolina Department of Environment and Natural Resources-Division of Water Quality
WELL CONTRACTOR(INDIVIDUAL)NAME (print) AM11oruY Bryant Smith CERTIFICATION N 2571
WELL CONTRACTOR COMPANY NAME Green River Wal S Pump Company PHONE # 6?41 693.1200
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if a icable (if applicable)
I. WELL USE(Check Applicable Box):Residential Mu nicipaLPublic O Industrial O Agriculnral❑
Monitoring❑ Recovery ❑ Heat Pump Water Injection O Other O If Other,List Use
2. WELL To�wnTTf aka Topographic/Land setting
Nearest
Coumry l ro r75 l�Uan l Y @fudge OSlope Malley 0F1at
30M6nWerl 94 (n Ld Oy trier. A)C_ (Chock appropriate boa)
(Street Namq Numbers,Community,Subdivision,Lot No.,Zip Code) Latitude/I !Ride of Well location
3. OWNER:J 0e_ /yl 3 Sc0 0971 CA/ 09`2 0 location,
tc�
(degrece/mmut«heeoadr)
Address 5 LatitudeAongitude source:PePSOTopographic map
(Street or Route No.) (chock box)
La �.4 ,Jam ate.t I C ZS 7µ� DEPTH DRILLING LOU
Coy«Town SWd Zip Code From--�� //�(T��o Formation Description
Am code•Phone number
4. DATE DRILLED toIUIoS Ail/-Rnnk
_
5. TOTAL DEPTH: _=I
6. DOES WELL REPLACE EXISTING WELL? YES❑ NO CtY y
7. STATIC WATER LEVEL Below Top of Casing: f1 Fr.
. ,
Noe"r"if Above Top of Cuing) G
8. TOP OF CASING IS�_FT.Above Lard Surface* —„
'Top of euiag twmioatsd at/or Wow iand surface requires a t -
variance is accordance with lSA NCAC 2C.0118.
9. YIELD(Spin): _METHOD OF TEST A t r
10. WATER ZONES(depth):
LOCATION SKETCH
11. DISINFECTION:Type Amount Show direction and distance in miles from at least
12. CASING: Wall Thickness two State Roads or County Roads.Include the road
Depth aa Di *ter or W 'ghtlFt. Material numbers and common road names.
Flom To Ft G7
From Tc Ft.
From— 7/.
From To Ft
13. GROUT: Depth Material Method _
From_Q Tom Ft. M ,)y 4r�
From To Ft
14. SCREEN: Depth Diemetcr Slot Sim Materiel From To Ft. in. in.
From—TO—Ft—in. in.
15. SAND/GRAVEL PACK: Q
Depth Size Material
From To Ft.
From To Ft.
16. REMARKS:
1 DO HEREBY CERTIFY THAT THIS WELL WAS NSTRUCTED IN ACCORDANCE WITH I SA#CAC 2C,WELL
CONSTRUCTION STANDARDS,AND THAT A�ECORD HAS BEEN PROVIDED TO THE WELL OWNER
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
Submit the original to the Division of Water Quality,Attn: Informptio6 Management 1617 MaS Setwlef Center-
Raleigh,NC 27699-1617, Phone No.[phone],within 30 days
... -- REV.09/2004
� l I' ` Ire fl,1z I

V C'
WELL CONSTRUCTION RECORD
North Carolina-Department of Environment and Natural Resources-Division of Water Quality-Groundwater Section
WELL CONTRACTOR(INDIVIDUAL)NAME (print)KENNETH MCCRARY CERTIFICATION#2008
WELL CONTRACTOR COMPANY NAME BARKER CONSTRUCTION,INC.BARKER WELL 8 PUMP PHONE # [phone]
STATE WELL CONSTRUCTION PERMIT# 1871 ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
1. WELL USE(Check Applicable Box):Residential M Municipal/Public❑ Industrial❑ Agricultural❑
Monitoring❑ Recovery ❑ Heat Pump Water Injection❑ Other❑ If Other,List Use
2. WELL LOCATION: Topographic/Land setting
Nearest Town-. BREVARD County TRANSYLVANIA ®Ridge []Slope ❑Valley ❑Flat
PAUL MCCOY DRIVE (check appropriate box)
(Street Name,Numbers,Community,Subdivision,Lot No.,Zip Code) LatitudcAongitude of well location
3. OWNER STEVE CRABTREE (degrecs/mmutes/seconds)
Address 78 TRINITY LANE Latitude/longitude source:❑GPS❑Topographic map
(Street or Rome No.) (check box)
LAKE TOXAWAY NC 28747 DEPTH DRILLING LOG
City or Towa State zip Code From To Formation Description
( 828)- 553-1419
Area code-Phone number
4. DATE DRILLED JUNE 7,2005 _
5. TOTAL DEPTH: 630 Y3
6. DOES WELL REPLACE EXISTING WELL? YES❑ NO ® 7
7. STATIC WATER LEVEL Below Top of Casing: 200' FT. L
(Use`+-if Above Top of Casing) r r~
8. TOP OF CASING IS 1.33 FT.Above Land Surface*
'Top of casing terminated at/or below land surface requires a
variance in accordance with 15A NCAC 2C.0115.
9. YIELD(gpm): 4 METHOD OF TEST TIMED L
10.WATER ZONES de
LOCATION SKETCH
IL DISINFECTION:Type BY PUMP INSTALLER Amount Show direction and distance in miles from at least
12. CASING: Wall Thickness two State Roads or County Roads.Include the road
Depth Diameter or Weight/Ft. Material numbers and common road names.
From 0 To 80 Ft. 6 118 SDR21 PVC ID
OffA
From To FL
From To Ft. Q
13. GROUT: Depth Material Method 6^� J n 0_ II
From 0 To 20' Ft. CONCRETE POURED U���lllkLLLN�^+�Lu
From To Ft. 1LCIL r<
14. SCREEN: Depth Diameter Slot Size Material y%NCAC
Q
From To Ft. in. in. �a -� l a
From To Ft. in. in.
15. SAND/GRAVEL PACK: \P
Depth Size Material r L
From To Ft.
From To Ft.
16. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15AWELL
CONSTRUCTION STANDARDS,AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
f 11 C.C12zs./(^j/ i.0 -- I
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
ei
Submit the original to the Division of Water Quality,Gran r n,MM Mali Scry`rce'� t-Raleigh,NC
27699-1636 Phone No.[phone],within 30 days. ��11 �J �5 V L I 1 REV.07/2001
I
AUG 9 200'

WELL CONSTRUCTION RECORD
North Carolina-Department of Environment and Natural Resources-Division of Water Quality-Groundwater Section
WELL CONTRACTOR(INDIVIDUAL)NAME (print)KENNETH MCCRARY CERTIFICATION#2008
WELL CONTRACTOR COMPANY NAME BARKER CONSTRUCTION,INC./BARKER WELL&PUMP PHONE # [phone]
STATE WELL CONSTRUCTION PERMIT# 1871 ASSOCIATED WO PERMIT#
(if applicable) (if applicable)
1. WELL USE(Check Applicable Box):Residential Rl Municipal/Public❑ Industrial❑ Agricultural❑
Monitoring❑ Recovery ❑ Heat Pump Water Injection❑ Other❑ If Other,List Use
2. WELL LOCATION: Topographic/Land setting
Nearest Town: BREVARD County TRANSYLVANIA ®Ridge ❑Slope ❑Valley ❑Flat
WOODWIND WEST,LOT#12 (check appropriate box)
(Street Name,Numbers,Community,Subdivision,Lot No.,Zip Code) Latitudellongitude of well location
3. OWNER: RICHARD JARLOWE (degrees/minutes/sewnds)
Address PO BOX 763 Latitude/longitude source:❑GPS❑Topographic map
(Street or Rome No.) (check box)
HIGHLANDS NC 28741 DEPTH DRILLING LOG
City or Town State Zip Code From To Formation Description
(_—)
Area code-Phone number
4. DATE DRILLED JUNE 9,2005
5. TOTAL DEPTH: 63o' _
6. DOES WELL REPLACE EXISTING WELL? YES❑ NO Rl C1
7. STATIC WATER LEVEL Below Top of Casing: 140 FT.
(Use"+-if Above Top of Casing) .�
8. TOP OF CASING IS 1.33 FT.Above Land Surface* f�
*Top of casing terminated War below land surface requires a
variance in accordance with 15A NCAC 2C.0118.
9. YIELD(gpm): 3 METHOD OF TEST TIMED
10.WATER ZONES(depth): 0
LOCATION SKETCH f�a
11. DISINFECTION:Type_WY PUMP INSTALLER Amount Show direction and distance in miles from at least 1S
12. CASING: Wall Thickness two State Roads or County Roads.Include the road
Depth Diameter or Weight/Ft. Material numbers and cons ron road names.
From 0 To 41 Ft. 61/8 SDR21 PVC
From To F "/x
L .CJ ,^,LL "�Gt.CC GLCl4:f-L
From To Ft. C1� ,tD )�/ZdGC) OGtGI. ► v" a
T:13. GROU Depth Material Method l.-
From 0 To 20' Ft. CONCRETE POURED
From To Ft. A00
14. SCREEN: Depth Diameter Slot Size Material -A64 � LEI/�
From To Ft. in. in
From To Ft. in. in. ✓Ux `�J y
15. SAND/GRAVEL PACK: 1,Z _J .`gC0.� j / I U
Depth Size Material !�L[-u,W'cLC.(
From To Ft. � �o� SO-
From To Ft.
16. REMARKS: ti.
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
V—A- � '�� C�� 4 — ! y — U S
SIGNATURE OF PERSON CONSTRUCTING THE WELL ' DATE
Submit the original to the Division of Water Quah Gro drvater,Seetioe;1636maifScivice Center-Raleigh,NC
27699-1636 Phone No.[phone],within 30 days `J �L GW-1 REV.07/2001
AUG 9 2005 I
r,�ounln' F

WELL CONSTRUCTION RECORD
North Carolina-Department of Environment and Natural Resources-Division of Water Quality-Groundwater Section
WELL CONTRACTOR(INDIVIDUAL)NAME (print)KENNETH MCCRARY CERTIFICATION#2008
WELL CONTRACTOR COMPANY NAME BARKER CONSTRUCTION,INC.1BARKER WELL&PUMP PRONE # [phone]
STATE WELL CONSTRUCTION PERMIT# 1871 ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
1. WELL USE(Check Applicable Box):Residential M Municipal/Public❑ Industrial❑ Agricultural❑
Monitoring❑ Recovery ❑ Heat Pump Water Injection❑ Other❑ If Other,List Use
2. WELL LOCATION: Topographic/Land setting
Nearest Town: BREVARD County TRANSYLVANIA ❑Ridge ❑Slope ❑Valley E]Flat
OSCAR CHAPPELL ROAD (check appropriate box)
(Street Name,Numbers,Commonly,Subdivision,Lot No.,Zip Code) LatitudeAongitude of well location
3. OWNER PETER&HELEN HOYT (degrees/minutes/seconds)
Address PO SO 958 Latitade/longitude source:❑GPS❑Topographic map
(Street or Rome No.) (check box)
ROSMAN NC 28772 DEPTH DRILLING LOG'-' �
City or Town State Zip Code From TO Formation DescriptioiP
8( 28 )- 883-2255d
Area code-Phone number t+
4. DATE DRILLED JUNE 21,2005 r n
5. TOTAL DEPTH: 1230'
6. DOES WELL REPLACE EXISTING WELL? YES❑ NO 91 -$
7. STATIC WATER LEVEL Below Top of Casing: 50' FT. p Y
(Use"+-if Above Top of Casing)
8. TOP OF CASING IS 1.33 FT.Above Land Surface*
-Top of casing terminated attor below land surface requires a
variance in accordance with 15A NCAC 2C.0118.
9. YIELD(gpm): 3 METHOD OF TEST TIMED
10.WATER ZONES(depth):
LOCATION SKETCH
11. DISINFECTION:Type BY PUMP INSTALLER Amount Show direction and distance in miles from at least
12. CASING: Wall Thickness two State Roads or County Roads.include the road
Depth Diameter or Weight/Ft. Material numbers and common road names.
From 0 To 83 Ft. 6118 SDR21 PVC 1l'emSreva.rcf+LAke Awy. 178 -to
From To Ft. �
From To Ft. Dld�7L , `4JcLy oad. I-�• - � LLIeff
13. GROUT-Depth Material Method
From 0 To 20' Ft. CONCRETE POURED ml2 Oscar &a ppeL( �,Oa&It•t
De From Ft. 'e r��{I't� Y
14. SCREEN: Depth Diameter Slot Size Material LWer park. on thee I � 1 �
From To Ft. in, in. �I
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Size Material
Front-To Ft.
From To Ft.
16. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C,WELL
CONSTRUCTION STANDARDS,AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
< '4t VI/i --Cn JkY � - "; l - 40 Sr
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
r \_
Submit the original to the Division of Water Quality,ICTI'dlindwaPM'Section,1636 Mail�erviip'p Center-Raleigh,NC
GW
27699-1636 Phone No.[phone],within 30 clays. -1 REV.07/2001I
AUG 9 2005
GRIYIN�4"'"TF� Sf.GTI']N
ASHEb'i1� L NFIiIJ;:,r t1`tIC

WELL CONSTRUCTION RECORD
North Carolina-Department of Environment and Natural Resources-Division of Water Quality-Groundwater Section
WELL CONTRACTOR(INDIVIDUAL)NAME (print)RICHARD MCCRARY CERTIFICATION#2010
WELL CONTRACTOR COMPANY NAME BARKER CONSTRUCTION,INC./BARKER WELL&PUMP PHONE # [phone]
STATE WELL CONSTRUCTION PERMIT# 1871 ASSOCIATED WQ PERMIT#
(ifapplicable) (if applicable) NINE
1. WELL USE(Check Applicable Box):Residential® MunicipaVloublic❑ Industrial❑ Agricultural❑
Monitoring❑ Recovery ❑ Heat Pump Water Injection❑ Other❑ If Other,List Use
2. WELL LOCATION: Topographic/Land setting
Nearest Town: BREVARD County ❑Ridge ❑Slope ®Valley ❑Flat
LYDAY LOOP ROAD (check appropriate box)
(Street Name,Numbers,Community,Subdivision,Lot No.,Zip Code) LatitudeAongitude of well location
3. OWNER CLIFFORD SWANN
(degrees/minutes/seconds)
Address 17 LYDAV LOOP ROAD LatitudeAongitude source:❑GPS❑Topographic map
(Street or Rome No.) (check box)
PISGAH FOREST NC 28768 DEPTH DRILLING LOG
City or Town State Zip Code From To Formation Description
( 828)- 877-3261
Area code-Phone number :^)
4. DATE DRILLED JUNE 14,2005
5. TOTAL DEPTH. 225 _
6. DOES WELL REPLACE EXISTING WELL? YES❑ NO 91 C =F
7. STATIC WATER LEVEL Below Top of Casing: 20' FC.
(Use-+^if Above Top of Casing) L)
8. TOP OF CASING IS 1.33 FT.Above Land Surface"
'Top of using terminated aVor below la surface requires a
variance in accordance with 15A NCAC 2C.0118.
9. YIELD(gpm): 20 METHOD OF TEST TIMED crl
10.WATER ZONES(depth):
LOCATION SKETCH
11. DISINFECTION:Type BY PUMP INSTALLER Amount Show direction and distance in miles from at least
12. CASING: Wall Thickness two State Roads or County Roads.Include the road
Depth Diameter or Weight/Ft. Material numbers and common road names.
From 0 To 53 Ft. 6 1I8 SDR21 PVC A ,.�J t,I�e ✓ 4- p ,/ ���
From To FL 6.� lDicxc-cc[Gt�_ //..CZ((YLaa//J
From To Ft. �/ir�f pM�nia� Q
13. GROUT: Depth -MaterCONCRETE
al Method - !-�(/yJ//,"._ �,,,,, ,,/4�7
From 0 To 20' Ft, CONCRETE POURED u/t- j rlll cs'/t-r.�
4
From To FL
14. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in.
From To Ft. in. in. �
15. SAND/GRAVEL PACK: UV7
Depth Sin Material
From TO FL
From To Ft. ��j
16. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAVD
CONSTRUCTION STANDARDS,AND THAT A COPY OF RECO HAS BEEN PROVIDED TO T
!lam- �� 6S�
SIGNATURE OF PERSON CONSTRUC THE WELL
Submit the original to the Division of Water Quality,Groundwater Section,1636 Mail Service Center-Raleigh,NC
27699-1636 Phone No.[phone],within 30 days. -- --- GW-1 REV.07/2001
AUG 9 2005 Y
rrinurdn,,° ^TF�' s�r,IioN
ASHEViI I t H'rtilJ�B.i t�`rIC

WELL CONSTRUCTION RECORD
North Carolina-DepaAment of Environment and Natural Resources- vision of Water Quality-Groundwater Section
WELL CONTRACTOR(INDIVIDUAL)Nurse Cmten��/FG� C lI,G,,n t 5 /i' CERTMCATXON12 7
ZY
WELL CONTRACTOR cowmy NAm5wPf L-a eZ well % l-yet,,� rHONEt (&A&/9
-O L/OO
STATE WELL CONSTRUCTION PERMrr# ,leenr•reT6D WQ PZRMff#
(if applicable) (if awlieable)
I. WELL USE(Cbeck Applicable Box):Residential G Municipal/Public 0 Industrial❑ Agricultural❑
Monitoring O Recovery ❑ Heat Pmnp Water Injection 0 Other 0 If Other,List Use
2. WELL LOCAT ON• TopoBmphiclAnd setting
1�esyrest Tow 1: � : ,9 Coanry t / MWv E3Slope Malley
(SbeaNamq Numbw3,Cammm(g.,Subdtvuvau,Iallo„Tip Code) Letitudell itudeP� )
o»gittide of well location'
3. OWNER� �/J{7 C/tJ /1 S ( .e000dc)
Address ' - ' y i IablUdellongitude source.MPSOTopographic map
(Snst or Roma Na.) (ebmk boa)
2 1A %yMcu 4 78 7 8 z pEM DRILLING nr
City ar Town Su Zip C de From To Formation Description
L—)-
Area coda Pho e number
4. DATE DRR.LED y'q -O S�
5. TOTAL DEPTH: 12 5
6. DOES WELL REPLACE EXISTING WELL? YES❑ NO Er�
7. STATIC WATER LEVEL Below Top of Casing 6 FT,
�. (Uu'4`if Above Top of Como
8, TOP OF CASING IS _FT.Above Land Surface*
'Top of cWag terminated Wer bete land nrface require,■
vmf=w in aemrdaaes udlh 15A NCAC 2C.a11a.
9. YIELD(gpm): TO METHOD OF TEST i 1
10.WATER ZONES(depth):
LOCATION SKETCH
11. DISINFECTION:Type CC& Amount ,(D a z Show demon and distance in miles from at Last
12. CASING: Wall Tbidmess two State Roads or County Roads.Include the road
From—T�/o0 Ft /c y Diameter a w? 22 Pc)C numbers and on road
Fromm To Ft —�y�—
From_To Ft.
13. GROUT: Depth
From Tom_Ft� cu t e 1��G X � ca
From To Ft
14, SCREEN: Depth Diameter Skit Size Material "A
Frame] r To Ft in. in.
From To Ft in in,
15. SAND/GRAVELFACK
Depth Sian Material Cn
From,—g_To Ft._ ��L C
From To Ft "
16. REMARKS:
I DO HEREBY CERTIFY THAT THIS WAS NSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C,WELL
CONSMU STANDARDS, TA 07kECORDHASBEENPROVIDEDTOTHEWELLOWNER
SIGNATURE OF PERr CONSTRUCTING THE WELL DATE

WELL CONSTRUCTION RECORD 01 31 OIL 44
North Carolina Department of Environment and Natural Resources-Division of Water Quality
WELL CONTRACTOR(INDIVIDUAL)NAME (print) BryanlSmith CERTIFICATION#2571
WELL CONTRACTOR COMPANY NAME Gram River Well 6 Pump Company PHONE # [phone]
STATE WELL CONSTRUCTION PERMrr# ASSOCIATED WQ PERMIT#
(ifapplicable) -/ (if applicable)
1111
I. WELL USE(Check Applicable Box):Residential GR Mtmicipal/Public❑ Industrial ❑ Agricultural❑
Monitoring❑ Recovery ❑ Heat Pump Water Injection❑ Other❑ If Other,List Use
2. WELL LOCATION: opographic/Land setting
Nearest T�owt_n:_� 0-t Coumrylr�(0.. dge ❑Slope ❑Valley ❑Flat
W X)l V1IIl l I E5 th.+e S (check appropriate box)
(Street Name,Nmnben,Community,Subdivision,Lot No.,Zip Code) Latitude/IOngitude of well location
3. OWNER: u(SQIk Qo(20nslin 3S°i343�D81`a6'm?4/
(degree✓minuld/acconde)
Address p Latitudellongitude source:WPS❑Topographic map
( or Route No.) (check box)
4(54aL1 ktStr IJGa ��('g DEPTH DRILLING LOG
Ci r Town State Zip Code From To Fo ation D rip[ion
e( } $ZS 3 L(o?n !J — /3
Arcs c � -1
Aoda Phone numbm _
4. DATE DRILLED S_O
5, TOTAL DEPTH:
6, DOES WELL REPLACE EXISTING WELL? YES❑ NO Urd rn W
7. STATIC WATER LEVEL Below Top of Casing: 3 d0 FT. 7T��
(Use"+"if Above Top of Casing) -�'-
8. TOP OF CASING IS�_FT.Above Land Surface• `''
•Top of cuing terminated at/or below land surface requires a
variance in accordance with 15A NCAC 2C.0118. O >j
9. YIELD(gpm):�_METHOD 0F_TEST­Ak Ln �a
10. WATER ZONES(depth):
LOCATION SKETCH z
IL 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 Di myter or Weight(Ft. Material numbers and common road names.
From 1 To�Ft�, .2/.L pile—
From To Ft. b L'et 8 k Kd
From To Ft C R A
13. GROUT: Depth Mat rial Method
From—a—To-2AV �i Ft. RAP&-
From To Ft -�- -----� D
14, SCREEN. Depth Diameter Slot Sim Material LC
From To Ft in. in. 6
From To Ft in. d
15. SAND/GRAVEL PACK: 1Y /[
Depth Size Material n�m/ d't1/
From To Ft.
From To Ft.
16. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONST CTED IN ACCORDANCE WI"TH 15A NCAC 2C,WELL
CONSTRUCTION STANDARDS,,,AANDD THAT ACOPY OF IS��RE�C�OJR/DD HAS BEEN PROVIDED TOO THE WELL
,OWNER
_.... (�j.. 6.f —
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
Submit the original to the Division of Water Quality,Attn:Information Management,_1617 Mail Service Canter-
Raleigh,NC 27699-1617, Phone No.[phone],within 30 days.
GW-1 REV 09/2004

t�
WELL CONSTRUCTION RECORD
North Carolina-Department of Environment and Natural Resources-Division of Water Quality-Groundwater Section
WELL CONTRACTOR(INDIVIDUAL)NAME (print)RICHARD MCCRARY CERTIFICATION#2010
WELL CONTRACTOR COMPANY NAME BARKER CONSTRUCTION,INC./BARKER WELL&PUMP PHONE # [phone]
STATE WELL CONSTRUCTION PERMIT# 1871 ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
1. WELL USE(Check Applicable Box):Residential M Municipamblic❑ Industrial❑ Agricultural❑
Monitoring❑ Recovery ❑ Heat Pump Water Injection❑ Other❑ If Other,List Use
2. WELL LOCATION: Topographic/Land setting
Nearest Town: BREVARD County TRANSYLVANIA ❑Ridge ®Slope ❑Valley ❑Flat
ROCKY MOUNTAIN ACRES,LOT#12 (check appropriate box)
(Shut Name,Northam,Community,Subdivision,Lot No.,Zip Code) Latitude/longitude of well location
3. OWNER: MONTYBURRELL
(degrees/minutea/axonds)
Address 179 RICH MOUNTAIN ROAD
Latitude/longitude source:❑GPS❑Topographic map
(Strad or Route No.) (check box)
BREVARD NC 28712 DEPTH DRILLING LOG
City or Town State Zip Code From To Formation Description
C28)- 877-3082
Area code-Phone number
4. DATE DRILLED SEPTEMBER 28,2005 _
5. TOTAL DEPTH: 726
6. DOES WELL REPLACE EXISTING WELL? YES❑ NO 13 -
7. STATIC WATER LEVEL Below Top of Casing: 0 FT. a'
(Use'•+^if Above Top of Casing) CD
ry
8. TOP OF CASING IS 1.33 FT.Above Land Surface'
-Top of casing terminated actor below land surface requires■
variance in accordsoce with 15A NCAC 2C.0118.
9. YIELD(gpm): o METHOD OF TEST
10.WATER ZONES(depth):
LOCATION SKETCH
11. DISINFECTION:Type Amount Show direction and distance in miles from at least
12. CASING: Wall Thickness two State Roads or County Roads.Include the road
Depth Diameter or Weight/Ft. Material numbers and common road names.
From 0 To 21 Ft. 61/8 SDR21 PVC 11 . //.� � �
From To Ft. Gfi iL.U7C .G(�I��WQGL �"_
From To Ft. ��//a�K4.� +LL'
13. GROUT: Depth Material Method fp �zQ�•(jDG!'!CGIq) (�GGLQd
From 0 To 20 Ft. CONCRETE POURED if _ , ofi7 d /LCG�cC
From To Ft. C.O�I o /
14. SCREEN: Depth Diameter Slot Size Material ;6D
From To Ft. in. _ in. je( (/ _ CP !/0;� r
From To Ft. irL in.
15. SAND/GRAVEL Depth :
Depth Size Material
From-To-Ft.-
From-To-Ft.- �- /L
16. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C,WEL
CONSTRUCTION STANDARDS,AND THAT A COPY F THIS RC RD HAS BEEN PROVIDED TO THE WEL WNE
GNATURE OF PERSON CONSTR WELL DATE
Submit the original to the Division of Water Quality,Groundwater Section,1636 Mad Service Center-Raleigh,NC
27699-1636 Phone No.(919)7333221,within 30 days. GW-1 REV.07/2001

�rf<ts uaSo zz9Z--
2�s-
WELL CONSTRUCTION RECORD
North Carolina-Department of Environment and Natural Resources-Division of Water Quality-Groundwater Section
WELL CONTRACTOR(INDIVIDUAL)NAME� (print) i ll U CERTIFICATION N[32`M
WELL CONTRACTOR COMPANY NAME I�„AYi{Tf jL 1 III B 11')C PHONE
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT# _—
(if applicable) (if applicable)
1. WELL USE(Check Applicable Box):Residential Municipal/Public❑ Industrial❑ Agricultural❑ n
Monitoring❑ Recovery ❑ Heat Pump Water Injection❑ Other❑ If Other,List Use m
I
2. WELL LOCA ON: Topogra dsetting l I
Nearest Town: C Midge idge ope ❑Valley dF1at,, to i
l ;
ll]Jd" l � ( box)
(Street Name,Numbers,Community,Subdivision,Lot No.,Zip Code) LatitudeAmigitude of well location o
3. OWNER: (1- V`iYl (degrcea/minutes/aeconds)
Address LatitudeAongitude source:❑GPS❑Topo phtc map: - --
(Street or Route No.) (check box)
�reuCYCA AK an� D P I� L
city or �5�a Zip Code FromTo Formati n Description
(� ZF42
Area code,Phone number �z /rS
4. DATE DRILLED D'
5. TOTAL DEPTH:
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO Ir'
7. STATIC WATER LEVEL Below Top of Casing:AFT.
(Use"+"if Above Top of Casing)
8. TOP OF CASING IS�_FT.Above Land Surface•
-Top of cuing terminated at/or below land surface requires■
varisoce in accordance with 1SA NCAC 2C.0119.
9. YIELD(gpm):1_METHOD OF TEST B LO u.J
10.WATER ZONES(depth):
LOCATION SKETCH
11. DISINFECTION:Type Amount Show direction and distance in miles from at least
12. CASING: Wall Thickness o State Roads or County Roads.Include the road
Depth Diameter or Weight/Ft. Material n hers and common road names. /
From�To. 7,2 FL�_ .S at
From To FL
From To Ft.
13. GROUT: Depth Material Method
From t_To 20 Ft. .!�arksrely ^uy- h
From To Ft. ✓
14. SCREEN: Depth Diameter Slot Size Material , i o -7
From To Ft. in. (�
From To Ft. in. in. l�
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
16. REMARKS:
1 DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C,WELL
CONSTRUCTION STANDARDS,AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
A" &Q /0,5--
SIGNATPIE OF PERSON CONSTRUCTING THE WELL bATE
Submit the original to the Division of Water Quality,Groundwater Section,1636 Mail Service Center-Raleigh,NC
27699-1636 Phone No.[phone],within 30 days. GW-1 REV.07/2001

WELL CONSTRUCTION RECORD
North Carolina-Department of Environment and Natural Resources-Division of Water Quality-Groundwater Section
WELL CONTRACTOR(INDIVIDUAL)NAME (print)KENNETH MCCRARY CERTIFICATION#2008
WELL CONTRACTOR COMPANY NAME BARKER CONSTRUCTION,INC./BARKER WELL&PUMP PHONE # [phone]
STATE WELL CONSTRUCTION PERMIT# 1871 ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
I. WELL USE(Check Applicable Box):Residential M MunicipaUPublic❑ Industrial ❑ Agricultural❑
Monitoring❑ Recovery ❑ Heat Pump Water Injection❑ Other❑ If Other,List Use
2. WELL LOCATION: Topographic/Land setting
Nearest Town: BREVARD County TRANSYLVANIA ❑Ridge ❑Slope ❑Valley glFlat
OFF OF HIGHWAY 64 EAST (check appropriate box)
(Street Name,Numbers,Community,Subdivision,Lot No.,Zip Code) LatitudeAongitude of well location
3. OWNER: JERRY PEARSON (degrees/minutes/sewnds)
Address PO BOX 1455 Latitude/longitude source:❑GPS❑Topographic map
(Street or Rome No) (check box)
BREVARD NC 28712 DEPTH DRILLING LOG
Coy or Town State( 928)- 883-2351 Zip Code From To Formation Description
Area code-Phone number
4. DATE DRILLED JULY 6,2005
5. TOTAL DEPTH: 455'
6. DOES WELL REPLACE EXISTING WELL? YES❑ NO ID
7. STATIC WATER LEVEL Below Top of Casing: 20' FT.
(Use"+"if Above Top of Casing)
8. TOP OF CASING IS 1.33 FT.Above Land Surface* v
*Top of casing terminated at(or below land surface requires a L7
variance in accordance with 15A NCAC 2C.0118, p,)
9. YIELD(gpm): 2 METHOD OF TEST TIMED
10.WATER ZONES(depth): 0
LOCATION SKETCH "-
11. DISINFECTION:Type By Punta INSTALLER Amotmt Show direction and distance in miles from at least �-
12. CASING: Wall Thickness two State Roads or County Roads.Include the road "
Depth Diameter or Weight/Ft. Material numbers and common road names.
From 0 To 116 Ft, 6 1/8 SDR21 PVC 1�rn r2 k-W�� /���
From To Ft. �7 !1 zGl-RR Y-Y
From To Ft. 64 eQ�d� &Wa zd �n,,,, �
13. GROUT: Depth Material Method t."A/Y? U kt 6l fllE/"L!J �t=Gi tCJl
From 0 To 20' Ft. CONCRETE POURED
From Ft. }n ( d �j ,�j)-)d
De llJ
14. SCREEN: Depth Diameter Slot Size Material (�^ , o -
From To Ft. in. in. Ac(,LCL d l&u ..
From To Ft. in. in. ./p�
15. SAND/GRAVEL PACK: (�L l�0.C,�.
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 STANDARD , THAT A C PY OF THIS RE CO HAS BEEN PROVIDED TO THE WELL OWNER
!M C- /�f . 2 (P
SI 7 GNATURE OF PERSON CONSTRUCTING THE L DATE
Submit the original to the Division of Water Quality,Groundwater Section,1636 Mail Service Center-Raleigh,NC
27699-1636 Phone No.[phone],within 30 days. GW-1 REV.07/2001

3 -*
WELL CONSTRUCTION RECORD 00
North Carolina-Department of Environment and Natural Resources-Division of Water Quality-Groundwater Section
WELL CONTRACTOR(INDIVIDUAL)NAME (print)KENNETH MCCRARY CERTIFICATION 0 2008
WELL CONTRACTOR COMPANY NAME BARKER CONSTRUCTION,INC.IBARKER WELL&PUMP PHONE # [phone]
STATE WELL CONSTRUCTION PERMIT# 1871 ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
I. WELL USE(Check Applicable Box):Residential® Municipal/Public❑ Industrial❑ Agricultural❑
Monitoring❑ Recovery ❑ Heat Plnnp Water Injection❑ Other❑ If Other,List Use
2. WELL LOCATION: Topographic/Lazed setting
Nearest Town: BREVARD Comdy, TRANSYLVANIA Midge ❑Slope ❑Valley ❑Flat
WHITEWATER CHURCH ROAD (check appropriate box)
(Street Name,Numbers,Conuaunity,Subdivision,Lot No.,Zip Code) Latitude/longitude of well location
3. OWNER: TONYA POLJATTA (degrecenunutas/soccads)
Address 400 CASH ROAD Latitude/longitude source:❑GPS❑Topographic map
(Street or Route No.) (check box)
SAPPHIRE NC 28774 DEPTH DRILLING LOG
City or Town State Zip Code From To Formation Description
8( 28 )_ 508-6235
Area code-Phone amber < j
4. DATE DRILLED DULY 27,2005
5. TOTAL DEPTH: 406
6. DOES WELL REPLACE EXISTING WELL? YES❑ NO M C '1
7. STATIC WATER LEVEL Below Top of Casing: 240 FT.
(Use"+„if Above Top of Casing) _
S. TOP OF CASING IS 1.33 FT.Above Land Surfaces
'Top arming terminated at/or below land surface requires a r Ir
variance in accordance with 15A NCAC 2C.0115
9. YIELD(gpm): 7'h METHOD OF TEST TIMED
10.WATER ZONES(depth):
LOCATION SKETCH
11. DISINFECTION:Type aY PUMP INSTALLER Amount Show direction and distance in miles from at least
12. CASING: Wall Thickness two State Roads or County Roads.Include the road
Depth Diameter or Weight/Ft. Material numbers and common road names.
From 0 To 31 Ft. 61/8 SDR21 PVC
From To Ft. ALUJL� /
From To Ft.
13. GROUT: Depth Material Method Oto/
From 0 To 20 Ft. CONCRETE POURED � ( ��� n %"� gp
From To Ft. L.JLf ejL K.00• t>�fJt-tl.r-- Gl ju. 07
14. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. is
From To FL in. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft. ''��//
From To Ft. �-Lke_ -
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
��c vac --I- a9 - ® !`
SIGNATURE OF PERSON CONSTRUCTING THE WE 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

ag
v j rL ,',
WELL CONSTRUCTION RECORD
North Carolina-Department of Environment and Natural Resources-Division of Water Quality-Groundwater Section
WELL CONTRACTOR(INDIVIDUAL)NAME (print)KENNETH MCCRARY CERTIFICATION#2WS
WELL CONTRACTOR COMPANY NAME BARKER CONSTRUCTION,INCJBARKER WELL&PUMP pHON, # [phone]
STATE WELL CONSTRUCTION PERMIT# 1871 ASSOCIATED WQ PERMIT#
if applicable) (if applicable)
1. WELL USE(Check Applicable Box):Residential 10 Municipal/Public❑ Industrial❑ Agricultural❑
Monitoring❑ Recovery ❑ Heat Pump Water Injection❑ Other❑ If Other,List Use
2. WELL LOCATION: Topographic/Land setting
Nearest Town: BREVARD (,`pit). TRANSYLVANIA KRidge []Slope ❑Valley OFlat
OFF OF HWY.281 PASS SUCK FISHER ROAD (checkappmpriatebox)
(Street Name,Numbers,Cmunuoity,Subdivision,Lot No.,Zip Code) Latitudenongitude of well location
3. OWNER: RONALD PENLAND(HUBERT ARRINGTON) (degreee/miautes/seocnds)
Address PO BOX 1465 LatitudcAongitude some:DGPSOTopographic map
(Sheet m Routc No.) (chock box)
BREVARD NC 28712 DEPTH DRILLING LOG
City or Town state Zip Code From To Formation Description
883-2351
Ares coda Phone nambor
4. DATE DRILLED JULY 29,zoos
5. TOTAL DEPTH: 180
6. DOES WELL REPLACE EXISTING WELL? YES❑ NO M c
7. STATIC WATER LEVEL Below Top of Casing: 15 FT.
(Use" "if Above Top of Casing)
8. TOP OF CASING IS 1.33 FT.Above Land Surface'
-Top of casing terminated st/or below land surface requires a
variance in accerdance with 15A NCAC 2C.0118.
9. YIELD(gpm): 30 METHOD OF TEST TIMED
10.WATER ZONES(depth):
LOCATION SKETCH
11. DISINFECTION:Type av PuuP wsTULER Amount Show direction and distance in miles from at least
12. CASING: Wall Thickness two State Roads or County Roads.Include the road
Depth Diameter or Weight/Ft. Material numbers and common road names.
From 0 To 78 Ft. 61/8 SDR21 PVC �� /h' J Z�
From To Ft GLLLc
Fromaacy-
To F[. / Q //_ �/,
13. GROUT: Depth Material Method (O .Y(/�.0 S�FGLGL�
From 0 To 20 Ft. CONCRETE POURED !
From To Ft.
14. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in.
From To Ftin. in. -
15. SAND/GRAVEL PACK:
Depth Size Material .
From To FL
From To Ft.
16. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C,WELL
CONSTRUCTION STANDARDS,AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
I '?.
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

CONSTRUCTION RECORD .
WELL CO
North Carolina-Department of Environment and Natural Resources-Division of Water Quality-Groundwater Section
WELL CONTRACTOR(INDIVIDUAL)NAME (print)KENNETH MCCRARY CERTIFICATION#2008
WELL CONTRACTOR COMPANY NAME BARKER CONSTRUCTION,INC.IBARKER WELL&PUMP pHONE # [phone]
STATE WELL CONSTRUCTION PERMIT# 1871 ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
1. WELL USE(Check Applicable Box):Residential M Municipal/Public❑ Industrial❑ Agricultural❑
Monitoring❑ Recovery ❑ Heat Pump Water Injection❑ Other❑ If Other,List Use
2. WELL LOCATION: Topographic/Land setting
Nearest Town: BREVARD CotrnTy TRANSYL4ANIA ❑Ridge ❑Slope ❑Valley 91Flat
HART ROAD (check appropriate box)
(Street Name,Nomben,Community,Subdivision,Lot No.,Zip Code) Latitudefiongitude of well location
3. OWNER: JOHN HUGGINS (degees/minutea/semnds)
Address 192 HART ROAD Latitude/longitude source:❑GPS❑Topographic map
(Sheet or Route No.) (checkbox)
PISGAH FOREST NC 28768 DEPTH DRILLING LOG
City or Town State Zip Code From To Formation Description
Area code-Phone munber
4. DATE DRILLED DULY 25,2005
5. TOTAL DEPTH: 255' rTt
6. DOES WELL REPLACE EXISTING WELL? YES❑ NO 91
7. STATIC WATER LEVEL Below Top of Casing: 10 FT.. _t _-
(Use`4"if Above Top of Casing)
8. TOP OF CASING IS 1.33 FT.Above Land Surface* =
-Top of casing terminated at/or below land surface requires a r n
variance in accordance with 15A NCAC 2C.Oil&
9. YIELD(gpm):. 4 METHOD OF TEST TIMED
10.WATER ZONES(depth):
LOCATION SKETCH
11. DISINFECTION:Type BY PUMP INSTALLER Amount Show direction and distance in miles from at least
12. CASING: Wall Thickness two State Roads or County Roads.Include the road
Depth Diameter or Weight/Ft. Material numbers and common road names.
From 0 To 32 Ft. 6 114 .189 STEEL �7,COOK &Wa,[d Zak
From To Ft u /J A. 0. Q
From To Ft. T' o®JGf�� 1 -,�-n
13. GROUT: Depth Material Method L4AA4-_ett 41. z0
From 0 To 20 Ft. CONCRETE POURED �� ) d�a
From To Ft. /�n^� ��//�� oL ��.��(.00Ch��rf���-
14. SCREEN: Depth Diameter Slot Size Material �d a L- 1a _ � dAVAX^�
From To Ft. in. in � adtAud-
From To Ft. in. in. � n
15. SAND/GRAVEL PACK:
Depth Size Material `# /O.
From To Ft.-
From—To—Ft.
16. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH I SA NCAC 2C,WELL
CONSTRUCTION STANDARDS AND THAT A COP OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
McoA� 1 — tg -US
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 Na(919)733 3221,within 30 days. GW-1 REV.07/2001

WELL CONSTRUCTION RECORD yr
North Carolina-Department of Environment and Natural Resources-Division of Water Quality-Groundwater Section
WELL CONTRACTOR(INDIVIDUAL)NAME (print)KENNETH MCCRARY CERTIFICATION#2008
WELL CONTRACTOR COMPANY NAME BARKER CONSTRUCTION,INC.BARKER WELL 8 PUMP PHONE # [phone]
STATE WELL CONSTRUCTION PERMIT# 1871 ASSOCIATED WQPERMIT#
(if applicable) (if applicable)
1. WELL USE(Check Applicable Box):Residential M Municipal/Public Cl Industrial❑ Agricultural❑
Monitoring❑ Recovery ❑ Heat Pump Water Injection❑ Other❑ If Other,List Use
2. WELL LOCATION: Topographic/Land setting
Nearest Town: BREVARD CommV TRANSYLVANIA ®Ridge ❑Slope Malley ❑Flat
SEVEN SPRINGS ROAD (check appropriate box)
(Street Name,Numbers,Community,Subdivision,Lot No.,Zip Code) Latitude/longitude of well location
3. OWNER: BRUCE KRZYZANOSKI (degrees/miwtes/seconds)
Address PO BOX 22 Latitude/longitude source:❑GPS❑Topographic map
(Sneer or Route No.) (chcckbm)
PISGAH FOREST NC 28768 DEPTH DRILLING LOG
City or Town state zip Code From To Formation Description
( 828)_ 8834205
Area code-Phone number
4. DATE DRILLED AUGUST 10,2005
5. TOTAL DEPTH: 405' _
6. DOES WELL REPLACE EXISTING WELL? YES❑ NO 91
7. STATIC WATER LEVEL Below Top of Casing: 200 FT. -,
m
(Use"+^if Above Top of Casing)
8. TOP OF CASING IS 1.33 FT.Above Land Surface'
-Top of cuing terminated at/or below land surface requires a J _
variance in accrdanor with 15A NCAC 2C.0118.
9. YIELD(gpm): 25 METHOD OF TEST TIMED C5
10.WATER ZONES(depth):
LOCATION SKETCH ,':_
11. DISINFECTION:Type aY PUMP INSTALLER Amount Show direction and distance in miles from at least
12. CASING: Wall Thickness two State Roads or County Roads.Include the road
Depth Diameter or Weight/Ft. Material numbers and common road names.
From 0 To 44 Ft. 6118 SDR21 PVC J� /J
From To Ft. 1J ff
From To Ft. Jatlx lea'.
13. GROUT: Depth Material Method A Q
From 0 To 20 p3, CONCRETE POURED h%
From To Ft.
m -! K �/f
14. SCREEN: Depth Diam
eter Slot Size Material 4 !/ QG�_ . �/�
From To Ft. in. is v�
From To Ft. in. is
15- SAND/GRAVEL PACK:
Depth Size Material
From To Ft.—
From—To—Ft.
16. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C,WELL
CONSTRUCTION STANDARDS,AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
2
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 REC,,(ORD'
North C�afolina-Department of Environment and Natural Resources-Division of0as QuaEty-Groundwater Section
� //•�7 WELL CONTRACTOR(DIDLV•ID``U�AL)NA SE WICAri
CI�2ONa�!/r
weLL CONTRACTOR coldrAMY NAM .. .. PHON4 i t'J V_Sa 4-3 g 4,
STATE WELL CoNSritUCTrom PERMiTa. �ffiOCGriSD W 9Raa11'S .
(ifappl'resbla) •(ifrtppllatble)
I. WELL USE(Check Applicable-Boxy RaWa4(Ia10 un)cipd Public 0 IndushrW 0 Agricultural Q
Monitoring 0 Recovery 0` Hut Pump Water Nect)on❑ Other C( IfOtbar,List Use
2.-WELL LOCATION: 1 Toap trJLsnd setfin
N `To%" e 14 aunt)'./&dld y.&4y �4 g®Rtcge []Slope Malley .031at
.t?7 tE I (em*apprapriato 4o) a
(surrr Name,Numbers,coanauni uldirgiou,l.a No»zip Cods) - L`atitwe/longitudo of well location
3. OWNER ()Q LNR., 112 .
(dage�miauta/seaends) .
Address D 6 Lat(tude/longittide soorce:00PSOTopographic map
•(Street a R w 1. -(*beck box) .
d 4 k IQ.A.�s 7C>' ar7��� I DEPTH DRILLING LOG
a Taw sous Ilp Cde From TO ' Formation Description
s'a.b- 573.9
AM Cade•P630e aumbsr .. .:. .i .. , r - �%-�a•ter, .
4. DATE DRILLED j b
5. TOTAL DEPTH: E 06' + *-e -
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO:_
7. STATIC WATER LEVEL Below Top of Casing:
Naa 4^if Abox Top oreadojii
8. TOP OF CASINO IS�_FT.Above Land Surface*
-Top of easing termtaated x9or bOg q 1ptaarfass rpalros a
varlues is seeordw witls'15"CAC 2C.e11L
9. YIELD(gpm): '.'r _METHOD OF TEST
10.WATER ZONES(depdt):
LOCATION SKETCH
it. DISINFECTION:.Type Amount -Show direction and.diaunca in mhos from at least
12. CASING: Wall Thies two State Roads or County Roads.Include the road
_�Toepth�� DI" a wetjht/Ft numbers&W-common road names.
From FL h"
From To FL
From_ Tp Ft, �
13. OROl1T_ Depth Material Method
Fron)_b__To_g�2D_Ft.. y`4—
From.To FL
.4. SCREEN: Depth Diameter . Slot Sim Material
From To Ft�in. in. _
From To Ft`__jn, in o
5. SAND/GRAVELPACK: cn
Depth Sim material -From To F4
From To FL 1
6. REMARKS:
DO HEREBY CERTIFY THAT INS WELL WAS CONSTRUCTED IN ACCORDANCE WTM SA ONSTR(1CTION STANDARDS,AND THAT A COPY OF S RECORD BEEN P40VIDIED TO THE WELLOWNER P l
SIGNATURE OF PERSON CONSTRUMNO THE WELL
. - .
Submit the original to the Division of Water Quallty,Groundwater Section,1636 MatI Service Center-Raleigh,NC
.1-7699-1636 Phone No.[phone],within 30 days.
OW-1 REV.M2001

WELL CONSTRUCTION RECORD
North Carolina-Department of Environment and Natural Resources-Division of Water Quality-Groundwater Section
WELL CONTRACTOR(INDIVIDUAL)NAME (print) i�°'/:-�- .-.fi'/ice- CERTIFICATION#,��
WELL CONTRACTOR COMPANY NAME/✓/iJC/f-// LI��/ Y—�G1.�1i yJ PHONE # r,;2IJ
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable) ifa licable)
1. WELL USE(Check Applicable Box): Residential Municipal/Public ❑ Industrial ❑ Agricultural ❑
Monitoring❑ Recovery ❑ Heat Pump Water Injection❑ Other❑ If Other,List Use
2. WELL LOCATION: � Topographic/Land setting
Nearest Town: /Pdt�y� x� s County ❑Ridge ❑Slope ❑Valley ❑Flat
(check appropriate box)
(Street Name,Numbers,Community,Subdivision,Lot No.,Zip Code) Latitude/longitude of well location
3. OWNER: .e (degrees/minutes/seconds)
Address t D`aQ I T ' Latitude/longitude source:❑GPS❑Topographic map
(street or Route No.) (check box)
City
o or�t wnc3 1 DEPTH DRILLING LOG
r sown State Zip Code From To Formation Description
4& 94"1
Area code-Phone number
4. DATE DRILLED ' :Z Z -C,7yi
5. TOTAL DEPTH: /i
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO
7. STATIC WATER LEVEL Below Top of Casing: I Zl FT.
(Use"+"if Above Top of Casing)
8. TOP OF CASING IS FT.Above Land Surface*
'Top orcasing terminated at/or below land surface requires a
variance In accordagcee wlth 15A NCAC 2C.0118.
9. YIELD(gpm): �L METHOD OF TESTA-//
10.WATER ZONES(depth):__ y
LOCATION SKETCH
11. DISINFECTION:Type Amount Show direction and distance in miles from at least
12. CASING: Wall Thickness two State Roads or County Roads.Include the road
FromDepth Diameter or Weight/Ft. Material numbers and common road names.
_To 1Id Ft.
From To Ft.
From To Ft. .}
13. GROUT: Depth Material Method n 5 .j/ /'� Tv crf .4, /
From d To2-�_Ft.5,v / J7„+u.i
Front_To Ft.
14. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in. o
n
From To Ft. in. in.
15. SAND/GRAVEL PACK: ry -
r
Depth Size Material
From To FL o -
From To F[.
crI
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-1 REV.07/2001

WELL CONSTRUCTION RECORD
North Carolina-Department of Environment and Natural Resources-Division of Water Quality-Groundwater Section
WELL CONTRACTOR(INDIVIDUAL)NAME (print)h/ -1 I'/�fc�(/�. CERTIFICATION M�1/
WELL CONTRACTOR COMPANY NAMF/`ne/r/'/ I� �N P�� t �tGn�•7 PHONE 0 fyxy-57/
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
ifa licable (if applicable)
I. WELL USE(Check Applicable Box): Residential MunicipaVPublic❑ Industrial❑ Agricultural❑
Monitoring❑ Recovery ❑ Heat Pump Water Injection❑ Other❑ If Other,List Use
2. WELL LOCATI N: / Topographic/Land setting
Nearest Town" F 0- _County re n 5 _ ❑Ridge ❑Slope ❑Valley ❑Flat
(check appropriate box)
(Street Name,Numbers,Community,Subdivision,Lot No.,Zip Code) Latitude/longitude of well location
3. OWNER: lGt"�f �//9✓r"l s'�n (degrees/minutes/seconds)
Address g .fr�i ✓n /'// L ��� Latitude/longitude source:❑GPS❑Topographic map
($tree[or Dote No.) (check box)
f 71 2—. DEPTH DRILLING LOG
City or sown _ state zip Code From To Formation Description
(Sr1�ir3A " Z Y�7
Area code-Phone number
4. DATE DRILLED I - I
5. TOTAL DEPTH: 110
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO
7. STATIC WATER LEVEL Below Top of Casing:l99 FT.
(Use"+"if Above Top of Casing)
8. TOP OF CASING IS h 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): I O MET
FJ�D OF TEST �rr�
10.WATER ZONES(depth):_�h
LOCATION SKETCH
11. DISINFECTION:Type Amount Show direction and distance in miles from at least
12. CASING: Wall Thickness two State Roads or County Roads.Include the road
Depth Diameter or Weight/Ft. Material numbers and common road names.
From 61 To-24' Ft.G�.�/= 007 , r
From To FL 2 76'
From F[.De
13. GROUT: Depth Material Method f�
From To'2-�-Ft.Sn- r Hyet ,G- F e
From To Ft.
Glil��Oq /2T�
14. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in.
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Size Material 0
r�
From To Ft. --I From—To Ft. rb
16. REMARKS: o
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C,WELL
CONSTRUCTION STANDARDS,AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
Submit the original to the Division of Water Quality,Groundwater Section,1636 Mail Service Center-Raleigh,NC
27699-1636 Phone No.[phone],within 30 days. GW-I REV. 07/2001

WELL CONSTRUCTION RECORD
North Carolina-Department of Environment and Natural Resources-Division of Water Quality-Groundwater Section
WELL CONTRACTOR(INDIVIDUAL)NAME (print)G/e/9gr 9 ✓en ,O�✓s"e
,fi!r v CERTIFICATION#
WELL CONTRACTOR COMPANY NAME./ Frv.^,ff/ l.�/j/j y� _. f
STATE WELL CONSTRUCTION PERMITq ASSOCIATED WQ PERMIT#
ifa licable ifa licable)
1. WELL USE(Check Applicable Box): Residential W Municipal/Public❑ Industrial O Agricultural ❑
Monitoring❑ Recovery ❑ Heat Pump Water Injection❑ Other❑ If Other, List Use
2. WELL LOCATION: /
NearestTown:�fedr.-,0' County sj Topographic/Landsetting
ORidge ❑Slope ❑Valley ❑Flat
(Street Name,Numbers,3. OWNER:.,LLCommunity,Subdivision,Lot No.,Zip C (check appropriate box)
ode)
Latitude/longitude of well location
/
Address _ Pr s (degrees/minutes/seconds)
�+' Latitude/longitude source:OGPSOTopographic map
AV
( et or Route No.
7 DEPTH (check box)
City or Town State ip Code From To DRILLING LOG
�t )-T7 j Formation Description
Area code-Phone number
4. DATE DRILLED 1- / :i '—
5. TOTALDEPTH: �'3d {YN//
6. DOES WELL REPLACE EXISTING WELL? YES O ❑
7. STATIC WATER LEVEL Below Top of Casing:_ FT.
(Use"+"if Above Top of Casing) '� /Y //
8. TOP OF CASING IS �• FT.Above Land Surface'
-Top of casing terminated at/orbelow land surface requires a 1 Iy� g 612;2, Yi
variance in accordance with 15A NCAC 2C.0118. ✓
9. YIELD(gpm):4/f7 METHOD OF TESTA/i^
10.WATER ZONES(depth):-Z �i
LOCATION SKETCH
1 I. DISINFECTION:Type Amount Show direction and distance in miles from at least
12. CASING: Wall Thickness two State Roads or County Roads. Include the road
Depth Diameter m Weight/Ft. M5crial numbers and common road names.
From_C To FL yr--
From To Ft. ���Ct e Gi sd j/Od A�
From To Ft. /
13. GROUT: Depth Mat nal Method rim/� yyle
From �/ To` _Ft.;in ,I- 17;rGy„
From To Ft. '
14. SCREEN: Depth Diameter Slot Size Material co
From To n
Ft. in. in. --t -
From To Ft. in. in. ry
15. SAND/GRAVEL PACK:
Depth Size Material O
From To Ft. c.rt
From To Ft.
16. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C,WELL
CONSTRUCTION STANDARDS,AND THAT A COPY OF THIS RECORD HAS PROVIDED TO THE WELL OWNER
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
Submit the original to the Division of Water Quality,Groundwater Section,1636 Mail Service Center-Raleigh,NC
27699-1636 Phone No.[phone],within 30 days. GW-1 REV. 07/2001

WELL CONSTRUCTION RECORD
North Carolina-Department of Environment and Natural Resources-Division of Water Quality-Groundwater Section
WELL CONTRACTOR(INDIVIDUAL)NAME t r(print) /fnii •7�>an �p//� CERTIFICATION#i 'IZ1
WELL CONTRACTOR COMPANY NAME! ar4.-// --y„ .,
,/ PHONE ly'el o e v
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable)
� (if applicable)
1. WELL USE(Check Applicable Box): Residential Dl Municipal/Public❑ Industrial ❑ Agricultural❑
Monitoring❑ Recovery ❑ Heat Pump Water Injection❑ Other❑ If Other, List Use
2. WELL LOCATION:
Nearest Town:,8j-rii<;...rzd County ' Topographic/Land setting
y ++��s ty ❑Ridge ❑Slope ❑Valley ❑Flat
L-t Name,
Numbers,ell v (check appropriate box)
(Street Name,Numbers,Community,Subdivision,Lot No.,Zip Code)
Latitude/longitude of well location
3. OWNER: �Pi e i4-r — ,-/,
Address �l (degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
`J (Street or Rot No.) (check box)
/V C a�7� DEPTH DRILLING LOG
u ity or l'(Iwn, State ZipCode From Formation Description
( fi 1) -/ 7 I To P .
Area code-Phone number
4. DATE DRILLED
5. TOTAL DEPTH: 7
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO R
7. STATIC WATER LEVEL Below Top of Casing: JG' FT. lr;
(Use"+"if Above Top of Casing)
8. TOP OF CASING IS. �L —FT.Above Land Surface*
'Top of casing terminated at/or below land surface requires a
variance In accordance with ISA NCAC 2C.0I18.
9. YIELD(gpm): Z//1 METH % /OD OF TESTt
10.WATER ZONES(depth):_ 7'ffl
LOCATION SKETCH
11. DISINFECTION:Type Amount Show direction and distance in miles from at least
12. CASING: Wall Thickness two State Roads or County Roads. Include the road
Depth Diameter or Weight/Ft. aterial numbers and common road names.
Fromm To , Ft.
From To Ft. �1712
From To Ft.
13. GROUT: Depth Material
From_i��To;Z c/ -Ft.
From To Ft. T_ r
14. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in.
From To Ft. in. in.
15. SAND/GRAVEL PACK: o
Depth Size Material - 1
From To Ft. PQ
From To Ft.
C:)
16. REMARKS: Ui
1 DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C,WELL
CONSTRUCTION STANDARDS,AND THAT AJ�CO,PY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
Submit the original to the Division of Water Quality,Groundwater Section,1636 Mail Service Center-Raleigh,NC
27699-1636 Phone No.[phone],within 30 days. GW-1 REV.07/2001

WELL CONSTRUCTION RECORD
North Carolina-Department of Environment and Natural Resources-Division of Water Quality-Groundwater Section
WELL CONTRACTOR(INDIVIDUAL)NAME (prin CERTIFICATION#7!7//
WELL CONTRACTOR COMPANY NAME/-f f!Z'. PHONE # f77-j'
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMMIT#
(if applicable) (if applicable)
1. WELL USE(Check Applicable Box): Residential Municipal/Public O Industrial ❑ Agricultural❑
Monitoring❑ Recovery ❑ Heat Pump Water Injection❑ Other❑ If Other,List Use
2. WELL LOCATION:
Topographic/Land setting
Nearest Town:_ i P %%—Yc County ❑Ridge ❑Slope ❑Valley ❑Flat
(check appropriate box)
(Street Name,Numbers,Community,Subdivision,Lot No.,Zip Code) Latitude/longitude of well location
3. OWNER:Address (degrees/minutes/seconds)
ri�tr $/z"fy Fs n n � T� //r A"'L-atitude/longitude source:OGPSOTopographic map
(Sweet or Route No.)
�r (check box)
7-"-;Pyq DEPTH DRILLING LOG
Cityor Town State Zip Code From To Formation Description
( 77 t Z I&
Area code-Phone number
4. DATE DRILLED—!f h O
5. TOTAL DEPTH: f :2 ,6 _ y/
6. DOES WELL REPLACE EXISTING WELL? YES O NO �` n
7. STATIC WATER LEVEL Below Top of Casing: �Z e:;1 FT.
8. TOP OF CASING IS ( : (Use"+"if Above Top of Casing)
FT.Above Land Surface*
-Top of casing terminated attor below land surface requires a
variance in accordance with ISA NCAC 2C.0118.
9. YIELD(gpm): /1l✓ METHOD OF TEST It c r
10.WATER ZONES(depth):_/ /U
LOCATION SKETCH
11. DISINFECTION:Type Amount Show direction and distance in miles from at least
12. CASING: Wall Thickness two State Roads or County Roads.Include the road
Depth Diameter or Wei ht/Ft. Material numbers and common road names,
From1LTo //7 Ft. .46�7 �
From To Ft. 6 ed� lz"YJ/c9,'� r� ee7X,
From To Ft.
13. GROUT: Depth Material Method
From r7 To .2[. _FL_ - �YYi�r�^ t' l �.�, '�J
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 C:)
From To Ft.
From n3 To Ft.
16. REMARKS: CD
CA
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C,WELL
CONSTRUCTION STANDARDS,AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
SIGNATURE OF PERSON CONSTRUCTING THE WELL i DATE
Submit the original to the Division of Water Quality,Groundwater Section,1636 Mail Service Center-Raleigh,NC
27699-1636 Phone No.[phone],within 30 days. GW-1 REV.07/2001

WELL CONSTRUCTION RECORD
North Carolina-Department of Environment and Natural Resources-Division of Water Quality-Groundwater Section
WELL CONTRACTOR(INDIVIDUAL)NAME (print)//
WELL CONTRACTOR COMPANY NAME CERTIFICATION# -'Xe '
STATE WELL CONSTRUCTION PERMITq PHONE # �
(if applicable) ASSOCIATED WQ PERMIT#
(if applicable)
1. WELL USE(Check Applicable Box):Residential 0- Municipal/Public❑ Industrial ❑ Agricultural❑
Monitoring❑ Recovery ❑ Heat Pump Water Injection❑ Other❑ If Other,List Use
2. WELL LOCATION: /
Nearest Town: I /PlI i r I County I �' Topographic/Land setting
/ ,'Tt > e q, L P� �r�a ❑Ridge ❑Slope ❑Valley ❑Flat
(Street Name,Numbers,Community,Subdivision,Lot No.,Zip Cade) (check appropriate box)
Latitude/longitude of well location
3. OWNER:�az r- �Cc ns S
Address 6 6 /-rt �l / •t 5 / (degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(Stye t or Route No.)
I�YP6-t%s-J' �/� ) e.] zl (check box)
City or Town State DEPTH DRILLING LOG
Zip code From
17 '=s` `> TD Formation Description
Area code-Phone number
4. DATE DRILLED !j�— mil' -,
5. TOTAL DEPTH: 7d%7
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO y �' ZZ
7. STATIC WATER LEVEL Below Top of Casing: M,0�91FT.
(Use'•+••if Above Top of Casing)
8. TOP OF CASING IS FT.Above Land Surface* /
`Top creasing terminated at/or below land surface requires a
variance in accordance with 15A NCAC 2C.01IS.
9. YIELD(gpm): --� _METHOD OF TEST �-
10.WATER ZONES(depth):_d'l/y �--
11. DISINFECTION:Type LOCATI_ ON SKETCH
YP Amount Show direction and distance in miles from at least
12. CASING: Wall Thickness two State Roads or County Roads.Include the road
Depth Diameter or Weight/Ft. Material numbers an common road names.
From To Ft. /,, 7� , J
From 7 Ft. n JLl� �/ �, ef/
Fro
To Ft. Z 2 l
13. GROUT: Depth Material Method
From
From YJ To ,'a _Ft.� �
ti
To Ft.
14. SCREEN: Depth From To Ft.Diameter Slot Size Material
in in
From To Ft. in. in. CD
15. SAND/GRAVEL PACK: c7
Size Depth 3
From P Material
To Ft.
From To Ft. O
Ui
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 AS BEEN PROVIDED TO THE WELL OWNER
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
Submit the original to the Division of Water Quality,Groundwater Section,1636 Mail Service.Center-Raleigh,NC
27699-1636 Phone No.[phone],within 30 days.
GW-1 REV.07/2001

WELL CONSTRUCTION RECORD
North Carolina-Department of Environment and Natural Resour -Division of Water Quality-Groundwater Section _
WELL CONTRACTOR(INDIVIDUAL)NAME (print) //�n �.`�- u'�Lls"" /
7-- r j�f�'� CERTIFICATION#_`? GS"
WELL CONTRACTOR COMPANY NAME_ /fir` rt�A/ ( ..-���/� (yiy PHONE #
fr>
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED Q PERMIT#
(if applicable)
- if applicable)
1. WELL USE(Check Applicable Box): Residential E l Municipal/Public❑ Industrial❑ Agricultural❑
Monitoring❑ Recovery ❑ Heat Pump Water Injection ❑ Other❑ If Other, List Use
2. WELL LOCATION:
Nearest Town: ^neatf4-w/f County 7 r ,, opographic/Land setting
17 Idge ❑Slope ❑Valley ❑Flat
4El'i< /�'1! (check appropriate box)
(Street Name,Numbers,Community,Subdivision,Lot No.,Zip Code)
Latitude/longitude of well location
3. OWNER: d/ S5t1` j./rA
Address L (degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(Street or Route No.) (check box)
w�!(l f c Mil l
DEPTH DRILLING LOG
C.� cC,llyorTo _/Suite Zip Code From TO
(yo- <�. \f l:R(r Foration Description
Area code-Phone numbe -L�'Vrm
4. DATE DRILLED FI---�—
5. TOTAL DEPTH: td�i r
6. DOES WELL REPLACE EXISTING WELL? YES❑ NO 9,
7. STATIC WATER LEVEL Below Top of Casing: -)'` FT.
(Use"+"if Above Top of Casing)
8. TOP OF CASING IS�_FT.Above Land Surface*
`Top of casing terminated at/or below land surface requires a
variance In accordance with 15A NCAC 2C.0118. 77 ,
9. YIELD(gpm): Q METHOD OF TEST Yti' '1 d ✓
10. WATER ZONES(depth):
LOCATION SKETCH o
11. DISINFECTION:Type / ;-)
YP / __ Amount Show direction and distance in miles from-ht least
12. CASING: Wall Thickness two State Roads or County Roads.Inclucralhe road
Depth Diameter or Weight/Ft. Material numbers and common road names.
From '%i To--�4 Ft. (r 11.1 SI) !. Z - �'y p
From To Ft.� -
From To Ft.
13. GROUT: Depth Material M`ethod
From C To 'Z C _Ft i.�,.-.E., ...-,njj a,:fit tv :, ,a/ *•„�.�� F
From To Ft
14. SCREEN: Depth Diameter Slot Size Material ,\1-E't;1N°
From To Ft. in. in.
From To Ft. in. in.
15. SAND/GRAVEL PACK: ot(?c'1 ���_��
Depth Size Material1�'' • '—�
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 S A ND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
IF SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
Submit the original to the Division of Water Quality,Groundwater Section, 1636 Mail Service Center-Raleigh,NC
27699-1636 Phone No.[phone],within 30 days. - GW-1 REV.07/2001

WELL CONSTRUCTION RECORD
North Carolina-Department of Environment and Natural Resources-Division of Water Quality-Groundwater Section
WELL CONTRACTOR(INDIVIDUAL)NAME (pr(n[) u' �(�>+flc.— CERTIFICATION#aIJ 6
WELL CONTRACTOR COMPANY NAMEAICvf rfl( t>- �%{ p�q. 7l? PHONE # ( IJ 77"y 7J
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable)
(iCapplicabie)
I. WELL USE(Check Applicable Box): Residential [19-5funicipal/Public❑ Industrial❑ Agricultural❑
Monitoring❑ Recovery ❑ Heat Pump Water Injection❑ Other D If Other,List Use
2. WELL LOCATION: �9
Nearest Town:11/th 2 k, County ({Ff� S'on Topographic/Land setting
(y ks�ll�a t ❑Ridge &Stoge ❑Valley DFlat
�n '1 (check appropriate box)
(Street Name,Nii umbers,Community,Subdivision,Lot No.,Zip Code) Latitude/longitude of well location
3. OWNER:C. D1 (degrees/minutes/seconds)
Address _ Jr) (�n('c-�6 ,Q Latitude/longitude source:GGPSGTopographic map
�( tree, Route No.)
Ai rif2se � 29-? (check box)
DEPTH DRILLING LOG
7 'ry or T;w ' sac J zip code From To Fo[{�,7�at It Description
Area code-Phone number
�, �= '-t
4. DATE DRILLED_ 4"7 -0l Y� J tq
5. TOTAL DEPTH: ZY. _
6. DOES WELL REPLACE EXISTING WELL? YES D NO 7 3 5 ka
L�
7. STATIC WATER LEVEL Below Top of Casing: FT.
(Use"+'•if Above Top of Casing) t�
8. TOP OF CASING IS--FT.Above Land Surface*
"Top of casing terminated attor below land surface requires a _ _-
variance in accordance with 15A NCAC 2C.011S.
9. YIELD(gpm): i/ METHOD OF TEST t, -%- �
10.WATER ZONES(depth):_
cil
LOCATION SKETCH
11. DISINFECTION:Type Amount Show direction and distance in miles from at least
12. CASING: Wall Thickness two State Roads or County Roads.Include the road
Depth Diameter or Weight/Ft. Material numbers and common road names.
From 0 To `J�Ft. (�a4 S 22 UC-
From To Ft.
From To Ft.
13. GROUT: Depth Material Method Y�
From 0 To-L�--Ft.5o, Aela W�.- t.--
From To Ft.
14. SCREEN' Depth Diameter Slot Size Material --t-� �_t_
From To Ft. in. in, Its r,�Y,_
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 IS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C,WELL
CONSTRUCTION ST ND NO THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
Submit the original to the Division of Water Quality,Groundwater Section,1636 Mail Service Center-Raleigh,NC
27699-1636 Phone No.[phone],within 30 days. GW-1 REV.07/2001

WELL CONSTRUCTION RECORD
North Carolina-Department of Environment and Natural Resources-Division of Water Quality-Groundwater Section
WELL CONTRACTOR(INDIVIDUAL)NAME (print)GZr_ ry7
�r,,, CERTIFICATION#�
WELL CONTRACTOR COMPANY NAME/ �rrr,' �� /A/�/� �p_
PHONE # flOt Ems,'4",*---0
STATE WELL CONSTRUCTION PERMIT#
(if applicable) ASSOCIATED WQ PERh1IT#
/ (ifapplicable)
1. WELL USE(Check Applicable Box): Residential Q- Municipal/Public❑ Industrial❑ Agricultural❑
Monitoring❑ Recovery ❑ Heat Pump Water Injection❑ Other❑ If Other, List Use
2. WELL LOCATI/O2N:
Nearest Town: C _lam Topographic/Land setting
o��
-L"z— ❑Ridge ❑Slope ❑Valley ❑Flat
(Street Name,Numbers,Community,Subdivision,Lot No.,Zip Code) (check appropriate box)
Latitude/longitude of well location
3. OWNER:
Address y �� (degrees/minutes/seconds)
(Street or Route
Latitude/longitude source:❑GPS❑Topographic map
No.)
/I
/191 N.lfs LC Of? DEPTH z4 (check box)
Ctry or Town State ` DRILLING LOG
Zip Code From To Formation Description
Area code-Phone number --�_
4. DATEDRILLED g-->7-de— e
5. TOTAL DEPTH:_�1 ----- ---
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO ( �"'I Z e-
7. STATIC WATER LEVEL Below Top of Casing: rO _FT.
(Use"+"if Above Top of Casing)
8. TOP OF CASING IS 2_FT.Above Land Surface•
"Top of casing terminated atlor below land surface requires a
variance in accordance with 15A NCAC 2C.0118.
9. YIELD(gpm):1—METHOD OF TEST_gnL
10. WATER ZONES(depth):19 O 19O
1 I. DISINFECTION:T e LOCATION SKETCH
YP Amount Show direction and distance in miles from at least
12. CASING: Wall Thickness two State Roads or County Roads.Include the road
Depth Diameter or Weight/Ft. Material numbers and common road names.
From 4 To-7J _Ft.�,4 From To Ft.
From To Ft. ,•CO"' S�yZ�, '
13. GROUT: Depth Material dyho-Niethod
Qc d r-i -Lr�GL
From_To�_Ft._�p
From To FL rf✓-- 7L
14. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in. _
From To Ft. in. in. C-D
15. SAND/GRAVEL PACK:
Depth Size
Material (V
From To Ft. r
From To Ft, o
cJl
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-1 REV.07/2001

WELL CONSTRUCTION RECORD
North Carolina-Department of Environment and Natural
Resources-.[Division of Water Quality-Groundwater Section
WELL CONTRACTOR(INDIVIDUAL)NAME ((print)(;//-//L/''/ � AFi/f'/�/Jr' CERTIFICATION
WELL CONTRACTOR COMPANY NAME f r(3/r/',��( y�'Y %� /G(r�Ih7 PHONE pf(yy}
STATE WELL CONSTRUCTION PERMITq ASSOCIATED WQ PERMIT#
ifa licable ifa licable
1. WELL USE(Check Applicable Box): Residential Municipal/Public❑ Industrial❑ Agricultural❑
Monitoring❑ Recovery ❑ Heat Pump Water Injection❑ Other❑ If Other,List Use r-l"- i 17,-iZ4.9•L
2. WELL LOCATI N: Topographic/Land setting
Nearest Town: —CountyZ/211'5 ❑Ridge ❑Slope ❑Valley ❑Flat
(check appropriate box)
(Street Name,Numbers,Community,Subdivision,Lot No.,Zip Code) Latitude/longitude of well location
3. OWNER: e , G /, (degrees/minutes/seconds)
Address #,J (',/f - - 5n v�� Latitude/longitude source:❑GPS❑Topographic map
(Street or Route No.) (check box)
�5 �,� � DEPTH DRILLING LOG
aty or Town State Zip Code From To Formation Description
Area code.Phone number .r
4. DATE DRILLED 7-A 7 -ol j �
5. TOTAL DEPTH: 1 7
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO
7. STATIC WATER LEVEL Below Top of Casing: !2' FT. 9
, (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 accordan a with 15A NCAC 2C.0118.
9. YIELD(gpm): METHOD OF TEST u i /^ r-
10.WATER ZONES(depth):_1 dU
LOCATION SKETCH -a-
ll.
DISINFECTION:Type Amount Show direction and distance in miles fr9s at least
12. CASING: Wall Thickness two State Roads or County Roads.Inclftde the road
Depth Diameter or Weight/Ft. Waterial numbers and common road names. `
From U To-4L41--Ft. v.1 h ,7 / (' /
From To Ft. /"7 y
From To Ft. /✓/6-,1h 13. GROUT: Depth Material Method
From_To,'�_Ft._
From To Ft. 6 471Wr,11 e
14. SCREEN: Depth Diameter Slot Size Material / s
From To Ft. in. in.From To Ft. in. in.
15. SAND/GRAVEL PACK: JJ
Depth Size Material
From To Ft.
From To Ft.
16. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C,WELL
CONSTRUCTION STANDARDS,AND THAT A COPY OF THIS RE OORRD`DHH, S 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. I `% .--- GW-1 REV.07/2001

WELL CONSTRUCTION RECORD F
North Carolina-Department of Environment and Natural Resources-Division of Water Quality-Groundwater Section
WELL CONTRACTOR(INDIVIDUAL)NAME (p,W)C24(ea j S o yam/.
�iI J �,/y CERTIFICATION
WELL CONTRACTOR COMPANY NAME
L_�wry,• l/ _
�t PHONE N
STATE WELL CONSTRUCTION PERMIT# L�
(ifapplicable) ASSOCIATED WQ PERINIIT#
(if applicable)
1. WELL USE(Check Applicable Box): Residential❑ Municipal/Public❑ Industrial ❑ Agricultural❑
Monitoring❑ Recovery ❑ Heat Pump Water Injection❑ Other O If Other,List Use
2. WELL LOCATION:
Nearest Town:$ZO*14-it�d _County 9 Topographic/Land setting
�Y' — ❑Ridge ❑Slope ❑Valley ❑Flat
(Street Name,Numbers,Community,Subdivision,Lot No.,Zip Code) (check appropriate box)
Latitude/longitude of well location
3. OWNER:,,'l t� I u ��Q dI
Address (a=,f© G � y (degrees/minutes/seconds)
Street or oute N .) • V Latitude/longitude source:❑GPS❑Topographic map
Cry r Town State �i r ��� DEPTH (checkDRILLING
Lip Code From To
(—)- Formation Description
Area code-Phone number
4. DATE DRILLED _ 7%_p z
5. TOTAL DEPTH:_�r�cJ�J —/
6. DOES WELL REPLACE EXISTING WELL?i YES ❑ NO Er 3
7. STATIC WATER LEVEL Below Top of Casing: FT �— 4 ell
8. TOP OF CASING IS _Use . if Above Top Surface
*Top of casing terminated atlor below landsurface V equte;Surface*
variance In accord cc with 15A NCAC 2C.0118.
9. YIELD(gpm): METHOD OF T,✓Yi i
10.WATER ZONES(depth):_�S{b
11. DISINFECTION:Type direction
ETCH,
12. CASING: r
Amount Show diion and distance in miles from at least
Wall Thickness two State Roads or County.Roads.Include the road
Depth Diameter or Weight/Ft. atenal numbers and common road names.
From To�_FL� ,Z/ �
From To Ft.
From Ft.
13. GROUT: De Depth Materi�al �0 WP/
Fromf,2—Tp Method Pefv00�
Ft
From Toj2eZ -111�, � rg
. .art. rL
de f't IO
14. SCREEN: Depth Diameter .+
From Slot Size _ Material
To Ft. in. in.
From To Ft. in. -
15. SAND/GRAVEL-PACK. n.
Depth Size Material
From . '
From To Ft.*
t y
N
16. REMARKS:
O
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C,WELL
CONSTRUCTION STANDARDS,AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER`
SIGNATURE OF PER nN r y
ONSTRUCTING 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

e :
WELL CONSTRUCTION RECORD
North Carolina-Department of Environment and Natural Resources-Division of Water Quality-Groundwater Section
WELL CONTRACTOR(INDIVIDUAL)NAME (print)[-fP.� <�
"X/Y CERTIFICATION#�nw
WELL CONTRACTOR COMPANY NAME Pi-r i• �p/ o t
PHONE a 52f 6 y
STATE WELL CONSTRUCTION PERMIT#ifalicable ASSOCIATED WQ PERMIT#
(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:/_/c yti.yam_Coven _ Topographic/Land setting
❑Ridge ❑Slope Malley ❑Flat
(Street Name,Numbers,Community,Subdivision,Lot No.,Zip Code) (check appropriate box)
Latitude/longitude of well location
3. OWNER:141j. 4e
%.4m ". t (degrees/minutes/seconds)
Address fj?„ZO reef ort ;ro.)-r..� Latitude/longitude source:❑GPS❑Topographic map
�_•(Street or Route No.)
PJ�— �� � f (check box)
r DEPTH DRILLING LOG
City o�Town State Zip Code From TO
( - Formation Description
Area code.Phone number
4. DATE DRILLED 7";7g_O r_ 0 zc'
5. TOTAL DEPTH:_ -6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO CY/
—rz/
7. STATIC WATER LEVEL Below Top of Casing:�/ FT,
(Use"+"if Above Top of Cuing)
8. TOP OF CASING IS_�FT,Above Land Surface" --- —
`Top of casing terminated attor below land surface requires a Pi/c-:r
variance In accordance with 15A NCAC 2C.0118. r'
9. YIELD(gpm): :�Z- -METHOD OF TEST C.c i Y .
10.WATER ZONES(depth):_L&IZI
11. DISINFECTION: T e LOCATION SKETCH
3P 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 We' ht/Ft. ter I numbers and common road names.
From G7 To '/U Ft. Z L J / � /7
From To Ft.
From To Ft.
13. GROUT: Depth Material JMethod �! j, r , e
From O To�_Ft._E�,.n
� ilm :� 1) ��'t`Y Jrist�PY L//'/ P
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. 'mot
r\.t
From To Ft. -c-
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 REg0RD HAS BEEN PROVIDED TO THE WELL OWNER
SIGNATURE OF PERSON CONSTRUCTING THE WELL 7 DATE P7�-
Submit the original to the Division of Water Quality,Groundwater Section,1636 Mail Service Center-Raleigh,NC
27699-1636 Phone No.[phone],within 30 days.
GW-1 REV.07/2001

WELL CONSTRUCTION RECORD
North Carolina-Department of Environment and Natural Re/nurces-Division of Water Quality-Groundwater Section _
WELL CONTRACTOR(INDIVIDUAL)NAME (print) I�A_N CERTIFICATION# (o WELL CONTRACTOR COMPANY NAME_OMQrf-il� te-,r// Gnje PHONE #
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
I. WELL USE(Check Applicable Box): Residential 0'ivlanicipal/Public❑ Industrial❑ Agricultural❑
Monitoring❑ Recovery ❑ Heat Pump Water Injection❑ Other❑ If Other,List Use
2. WELL LOCAT N: Topograp and setting
Neares Town: nr+a-1 Coun(YAL-' uaw'�_
C CIT ❑Ridge 29ope ❑Valley ❑Flat
(check appropriate box)
(Street Name,Numbers,
Community,Subdivision,Lot No.,Zip Code) Latitude/longitude of well location
3. OWNER: //,r✓/Q/ (degrees/minutes/seconds)
Address 0 OaK t{T'r Latitude/longitude source:❑GPS❑Topographic map
/� (Street or Route No.) (check box)
Frrctr, .h/.c • DEPTH DRILLING LOG
City or sown rate Zip Code From To Fo9ptatign Description
(FefU- �3 D G r —,
Area code-Phone numher -
4. DATE DRILLED 7- Z7-"f' lT" to
5. TOTAL DEPTH: FYr
6. DOES WELL REPLACE EXISTING WELL YES ❑ NO mi— ti
7. STATIC WATER LEVEL Below Top of Casing: FT.
(Use"+"if Above Top of Casing)
8. TOP OF CASING IS FT.Above Land Surface*
'Top of casing terminated attor below land surface requires a
variance In accordance with 15A NCAC 2C.0118.
9. YIELD(gpm): 2.d METHOD OF TEST
10.WATER ZONES(depth):_
LOCATION SKETCH
11. DISINFECTION:Type l{Tfi/ Amount Show direction and distance in miles from at least
12. CASING: Wall Thickness two State Roads or County Roads.Include the road
Depth Diameter or Weight/Ft. klaterial numbers and common road names. A
From-0 To 2'V Ft. & f -U vlfG
From To Ft.
From To FL 14'
13. GROUT: Depth Material Method�� {From 0 To 1A Ft._ *Il 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 MaterialFromTo Ft. 0 3
FromTo Ft.16. REMARKS: �
u7
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C,WELL
CONST UCTION S NDARDS,AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OW
IF SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
Submit the original to the Division of Water Quality,Groundwater Section,1636 Mail Service Center-Raleigh,NC
27699-1636 Phone No.[phone],within 30 days. GW-1 REV.07/2001

WELL CONSTRUCTION RECORD
North Carolina-Department of Environment and Natural Resources-Division of Water Quality-Groundwater Section
WELL CONTRACTOR(INDIVIDUAL)NAME
E( !w Z
(print) E1_e1,* :/e-z, Pile CERTIFICATION#z!-//
WELL CONTRACTOR COMPANY NAME! r,-", ,� -{1 f /-K,W PHONE # LY21 IT7%
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable) ifa licable)
1. WELL USE(Check Applicable Box): Residential Municipal/Public❑ Industrial❑ Agricultural❑
Monitoring❑ Recovery ❑ Heat Pump Water Injection❑ Other❑ If Other,List Use
2. WELL LOCATION: �la Topographic/Land setting
Nearest Town: feYl-r-pl.� County S ❑Ridge ❑Slope ❑Valley ❑Flat
Z�".7, "' / , (check appropriate box)
(Street Name,Numbers,Community,Subdivision,Lot No.,Zip Cade) Latitude/longitude of well location
3. OWNER:W;,* e /3�F�L s�j[3!y (degrees/minutes/seconds)
Address J,,,�a,;z lfe yea/ Latitude/longitude source:❑GPS❑Topographic map
,t I �n(Street or Route No.) t (check box)
DEPTH DRILLING LOG
City or Town State Zip Code From To Formation Description
Area code-Phone number
4. DATE DRILLED h
5. TOTAL DEPTH:_ 4f0
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO Er 1e2L_ 7�
7. STATIC WATER LEVEL Below Top of Casing: V FT.
(Use'+"if Above Top of Casing)
8. TOP OF CASING IS FT.Above Land Surface•
J
-Top of casing terminated at/or below land surface requires a
variance In accordance with ISA NCAC 2C.0115.
9. YIELD(gpm):'_METHOD OF TESTGL%/'
10.WATER ZONES(depth):_ ;2�40
LOCATION SKETCH
11. DISINFECTION:Type Amount Show direction and distance in[Hiles 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 C7 Toyer FL
From To Ft. J d ✓ V�J"f p rJ
From To Ft. 0C f j-
13. GROUT: Depth Material Method [
From_To_/,:5�' -Ft._ iJy
From To Ft.
14. SCREEN: Depth Diameter Slot Size Material ern f.y q
From To Ft. in. in. ✓� /7PNi h4�-i
From To Ft. in. in. � ,t- p
15. SAND/GRAVEL PACK: 7-l' h /
Depth Size Material --t
From To Ft. ti
From To Ft.
O
16. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C,WELL
CONSTRUCTION STANDARDS,AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
Submit the original to the Division of Water Quality,Groundwater Section,1636 Mail Service Center-Raleigh,NC
27699-1636 Phone No.[phone],within 30 days. GW-1 REV.07/2001

WELL CONSTRUCTION RECORD
North Carolina-Department of Environment and Natural Resources-Division of Water Quality-Groundwater Section
2
WELL CONTRACTOR(INDIVIDUAL)NAME (print) �T C9�P/!//;7 �/j�e � CERTIFICATION#I�l G4
WELLCONTRACTORCOMPANYNAME/ Ie"/'// WeL/, tGtlo& PRONE # (!8 '3f1 —!!4� d
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: / 2 Topographic/Land setting
Nearest Townt:1 /-eti11 County_&?- n 5 ❑Ridge ❑Slope ❑Valley ❑Flat
l � r�i f �d y5 (check appropriate box)
(Street Name,Numbers,Community,Subdivision,Lot No.,Zip Code) Latitude/longitude of well location
3. OWNER: V i.- 4 h O/l�S (degrees/minutes/seconds)
Address g90G�.rr 2na Latitude/longitude source:❑GPS❑Topographicmap
( (St get or t oute No.) (check box)
�c r�4'el 3 0 D ,13 DEPTH DRILLING LOG
City or Town State Zip Code From To Formation Description
(jtnL)- ;d/I - 7y7 ey
Area code-Phone number _ /2 O
4. DATE DRILLED
5. TOTAL DEPTH:_2 5Tb �I�rtiii y
6. DOES WELL REPLACE EXISTING WELL? YES NO
7. STATIC WATER LEVEL Below Top of Casing:, O FT.
(Use'+"if Above Top of Casing)
8. TOP OF CASING IS �/ FT.Above Land Surface*
`Top of casing terminated at/or below land surface requires a
variance in accordance with I5A NCAC 2C.01 18.
9. YIELD(gpm): 5 METHOD OF TEST�G!/
10.WATER ZONES(depth):
LOCATION SKETCH
11. DISINFECTION:Type Amount Show direction and distance in miles from at least
12. CASING: Wall Thickness two State Roads or County Roads.Include the road
Depth Diameter or Weight/Ft. Material numbers and common road names
From To 0'L/ Ft. 6?� ram/ /9/ �_ �� t-o� -
From To Ft.
From To Ft.
13. GROUT: Depth Material Method /✓ l /�
From
From To Ft.
14. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in.
From To Ft. in. in.
15. SAND/GRAVEL PACK: p
Depth Size Material n
y
From To Ft. ry
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 THAT
A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
Submit the original to the Division of Water Quality,Groundwater Section,1636 Mail Service Center-Raleigh,NC
27699-1636 Phone No.[phone],within 30 days. - GW-I REV. 07/2001

WELL CONSTRUCTION RECORD
North Carolina-Department of Environment and Natural Resources-Division of Water Quality-Groundwater Section
WELL CONTRACTOR(INDIVIDUAL)NAME (print)G/Puri rs fi'et/7 71P/lP
WELL CONTRACTOR COMPANY NAMELfJ ifeL-, CERTIFICATIONq
STATE WELL CONSTRUCTION PERMIT# PHONE p
(if applicable) ASSOCIATED WQ PER6IITk 3�i
(ifapplicabi 1
l WELL USE(Check Applicable Box): Residential&Municipal/Public❑ Industrial ❑ Agricultural ❑
Monitoring❑ Recovery Cl Heat Pump Water Injection❑ Other❑ If Other, List Use
2. WELL LOCATI N:
Nearest Town: c County�� 's _ Topographic/Land setting
O /p ORidge OSlope ❑Valley OFlat
(Street Name,Numbers,Community,Su division �— (check appropriate box)
//,Lot No.,Zip Code) Latitude/longitude of well location
3. OWNER:-4. l �7•�q
Address (degrees/minutes/seconds)
(Street or Route No.) Latitude/longitude source:OGPSOTopographic map
�rw (check box)
Ciry or Town State A DEPTH DRILLING LOG
Zip Code From To
y- `/ 6. 7- Formation Description
Area code-Phone number
4. DATE DRILLED_c"- Z!�X D' S/_p ;j,T
5. TOTAL DEPTH:_ 1`cr
6. DOES WELL REPLACE EXISTING WELL? YES O NO
7. STATIC WATER LEVEL Below Top of Casing:AFT.
8. TOP OF CASING IS (Use"+"if Above Top of Casing)
FT.Above Land Surface"
-Top of casing terminated attor below land surface requires a
variance in accordance with 15A NCAC 2C.0118. ---
9. YIELD(gpm): I el METHOD OF TESTt2/'r
10. WATER ZONES(depth):.
-- --
7
11. DISINFECTION:T LOCATI_ O SKETCH
Type Amount Show direction and distance in miles from at least
12. CASING: Wall Thickness two State Roads or County Roads. Include the road
7Depth Diameter or Weight/Ft. terial numbers and common road names.
From,_Toed " Ft4,14_ ,�/ M _
From To Ft. ;7- I/7 . 4� 4
5l/.yr
From To Ft. �7
13. GROUT: Depth Depth Material
From G� Tod O Method
Ft:�ir�s_ m �v
From To Ft. 7 -
14. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in.
From To Ft. in. -
15. SAND/GRAVEL PACK: — in. O
Depth c"3
To FL
From—To_
Size fv Material \34
From To Ft. �-
0
16. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C,WELL
CONSTRUCTION STANDARDS,AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
SIGNATURE OF PERSON CONSTRUCTING 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.07/200]

WELL CONSTRUCTION RECORD W
North Carolina-Department of Environment and Natural Resources-Division of Water Quality-Groundwater Section
WELL CONTRACTOR(INDIVIDUAL)NAME (print)jr/ i S Pcy & CERTIFICATION
1'i # 6r!
WELL CONTRACTOR COMPANY NAME Lyi`:`%/ 1/l/.>%/ / (,
.{� PHONE #
P F tl> stL—�y ctjf Cf
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ ERh1IT#
(if a licable (if applicable)
1. WELL USE(Check Applicable Box): Residential Municipal/Public❑ Industrial❑ Agricultural❑
Monitoring❑ Recovery ❑ Heat Pump Water Injection❑ Other❑ If Other,List Use
2. WELL LOCATION: e
Nearest Town:rt,+•-mac j�7 County �, Topographic/Land setting
1"!qrya h ,��,4 } r ❑Ridge ❑Slope ❑Valley ❑Flat
��— r'c (check appropriate box)
(Street N me,Numbers,Community,Subdivision,Lot No.,Zip Code) Latitude/longitude of well location
3. OWNE
Address �i(_7 (degrees/minutes/seconds)
T7 Ji1 (f r Latitude/longitude source:❑GPS❑Topographic map
(Street or Route No.)
l �c`��✓�trrlr �� 2 `��� DEPTH (check box)
City or Town State Zip Code DRILLING LOG
, _ y e . —p From To Formation Description
Area code-Phone number
4. DATE DRILLED-9-;Z
5. TOTAL DEPTH: / �n
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO GY dr_ fZ
7. STATIC WATER LEVEL Below Top of Casing:�_FT.
(Use"+"if Above Top of Casing) +
8. TOP OF CASING IS�_FT.Above Land Surface'
`Top of casing terminated at/or below land surface requires a
variance in accordance with 15A NCAC 2C.011S.
9. YIELD(gpm): !A METHOD OF TEST_0
10.WATER ZONES(depth):_ jCJ j O
LOCATION SKETCH
11. DISINFECTION:Type Amount Show direction and distance in miles from at least
12. CASING: Wall Thickness two State Roads or County Roads.Include the road
Depth Diameter or Weight/Ft. Niaterial numbers and common road names.
From�_Tofy;1— FL(, .1'� _ . 7-1
From To Ft. //`✓' e �+'�/ l'f+'Y� /p
From To Ft.
13. GROUT: Depth Material Method P"-A->9rg /e�l lfi j
From d To-1-a _
From To Ft.
14. SCREEN: Depth
p Diameter Slot Size Material - -
From To Fr—in. in.
From To Ft.—in. in.
15. SAND/GRAVEL PACK: o
Depth Size Material t7
From To Ft. '-A
From To FL
16. REMARKS: C:)
cn
1 DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH I5A NCAC 2C,WELL
CONSTRUCTION STANDARDS,AND THAT A COPY OF THIS REC AS 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

ou
WELL CONSTRUCTION RECORD
North Carolina-Department of Environment and NaturaIl Resources-Division of Water Quality-Groundwater Section /WELL CONTRACTOR(INDIVIDUAL)NAME (print) d'--"" '
-'�—fl(4e/r— CERTIFICATION# 3 (/4e'
WELL CONTRACTOR COMPANY NAME (✓7Q�r I lI f^-'F-/r J' t"t'^`n PHONE It (�t�)e77 7III 6
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- I Topographic/Land setting
Nearest Town: gefl / �DCrSy- County fr^1-0 ✓ce,rati Eqidge ❑Slope ❑Valley ❑Flat
Holly Aorcgt- (check appropriate box)
(Street Name,Numbers,Community,Subdivision,Lot No.,Zip Code) Latitude/longitude of well location
3. OWNER: (`-, ,-q I'(fI (degrees/minutes/seconds)
Address YJ Latitude/longitude source:❑GPS❑Topographic map
(Street or Route No.)
(check box)
aqLA-t 1er 5 fU C- ,'k'?L� DEPTH DRILLING LOG
�(�City or Town state Zip Code From To F trnation Description
(—)- 2 c (cc/C
Area code-Phone number ? Z(? 7(t"
4. DATE DRILLED -I��11`ao -c at 41
5. TOTAL DEPTH: "76 3" —/
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO M
7. STATIC WATER LEVEL Below Top of Casing: FT.
I (Use"+"if Above Top of Casing)
8. TOP OF CASING IS _ / _FT.Above Land Surface*
-Top of casing terminated at/or below land surface requires a
variance in accordance with 15A NCAC 2C.0I18.
9. YIELD(gpm): ® METHOD OF TEST r
10.WATER ZONES(depth):
11. DISINFECTION:Type
LOCATION SKETCH
NTH Amount Show direction and distance in miles from at least
12. CASING: Wall Thickness two State Roads or County Roads.Include the road
Dept{ Diameter or Weight/Ft. yaterial numbers and common road names.
From To C Ft. ullq /,e
From To Ft.
From To Ft.
13. GROUT: Depth Material Method
From C Tola Ft._C6^cr<>
m
Fro To Ft. -
N
14. SCREEN: Depth Diameter Slot Size Material �
From To Ft. in. in.
From To Ft. in, in. '(�/ 2°Lc.t3
15. SAND/GRAVEL PACK:
Depth Size Material I _
From To F[.
From To Ft.
16. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C,WELL
CONSTRUCTION ST ND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
ll
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
Submit the original to the Division of Water Quality,Groundwater Section,1636 Mail Service Center-Raleigh,NC
27699-1636 Phone No.[phone],within 30 days. GW-1 REV.07/2001

WELL CONSTRUCTION RECORD
North Carolina-Department of Environment and
/Natural Resources-Division of Water Quality-Groundwater Section
WELL CONTRACTOR(INDIVIDUAL)NAME (print)/ jA.•I-:[:: �.A:J/te r- CERTIFICATION WELL CONTRACTOR COMPANY NAME.Mj2ff-fII l P / r/-' PV,s� PHONEq yTX'7'y-
STATE WELL CONSTRUCTION PERMITq ASSOCIATED WQ PERMIT#
(if applicable) (ifapplicable)
1. WELL USE(Check Applicable Box): Residential LkMunicipal/Public❑ Industrial ❑ Agricultural❑
Monitoring❑ Recovery ❑ Heat Pump Water Injection❑ Other❑ If Other, List Use
2. WELL LOCATION:
Nearest Town: C Coun t y ��Topographic/Land setting
ty t(Y LYfRidge ❑Slope ❑Valley []Flat
(check appropriate box)
(Street Name,Numbers,Community,Subdivision,Lot No.,Zip Code) Latitude/longitude of well location
3. OWNER:-�tE`✓'j���l)+ (degrees/minutes/seconds)
Address Latitude/longitude source:❑GPS❑Topographic map
(Street or Route No.) ���� (check box)
If. DEPTH DRILLING LOG
City or Town State Zip Code From To Formation Description
Area code-Phone number
4. DATE DRILLED -2 a-,f
5. TOTAL DEPTH:_ J/ 5 f4 4k) y
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO Q yl gfin `
7. STATIC WATER LEVEL Below Top of Casing: FT. 07
(Use"+"if Above Top of Casing)
8. TOP OF CASING IS L_FT.Above Land Surface*
-Top of casing terminated attor below land surface requires a
variance in accordap cc with 15A NCAC 2C.0118.
9. YIELD(gpm): V f METHOD OF TEST 17.• /y
10.WATER ZONES(depth):_
LOCATION SKETCH
11. DISINFECTION:Type Amount Show direction and distance in miles from at least
12. CASING: Wall Thickness two State Roads or County Roads.Include the road
Depth Diameter or Weight/Ft. Material numbers and common road names.
From C To L q Ft. (,f� S0 2f2 E
From To FL
From To FL tfq
13. GROUT: Depth Material Method
From b To 10 _Ft_Core-et..
From To Ft.
14. SCREEN: Depth Diameter Slot Size Material W��cJ—
From To Ft. in. in.
i�
From To Ft. in. in. -
15. SAND/GRAVEL PACK:
Depth Size Material t\\_�_
From To Ft. L.r" �From To Ft. N
�)¢ r
st1 7b..3
16. REMARKS:
u1
I DO HEREBY CERTIFY THAT THIS W LL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C,WELL
CONSTRUCTION STANDARD THAT A COP OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
�6JA
S GNATURE OF PERSON CONSTRUCTING THE WELL DATE
Submit the original to the Division of Water Quality,Groundwater Section,1636 Mail Service Center-Raleigh,NC
27699-1636 Phone No.[phone],within 30 days. GW-1 REV.07/2001

WELL CONSTRUCTION RECORD
North Carolina-Department of Environment and Natural Resources-Division of Water Quality-Groundwater Section/�y
n
WELL CONTRACTOR(INDIVIDUAL)NAME (print) ��./ �'� CERTIFICATION q?_ J
WELL CONTRACTOR COMPANY NAME Gft/ / PHONE # fdtk) �tFYJU
STATE WELL CONSTRUCTION PERMITq ASSOCIATED WQ PERMIT#
if applicable) (if aoolicable)
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 N: Topographic/Land setting
Nearest Town: Mr�Sc County < ( �� ❑Ridge ❑Slope ❑Valley IMF at
(check appropriate box)
(Street Name,Numbers,Community,Subdivision,Lot No.,Zip Code) Latitude/longitude of well location
3. OWNER: `00" pa (degreesiminutes/seconds)
Address Ufilp lkmo. Latitude/longitude source:❑GPS❑Topographic map
�CSA.fs.i (Street or Route No.) (check box)
/`�r_ �R'�Wl DEPTH DRILLING LOG
city Town Ste Zip Code From To F ❑nation Description
�- �<<<�- y S� n 2d dl-r-
Area code-Phone number
4. DATE DRILLED
5. TOTAL DEPTH: 2Y5' G �c1 Lgv
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO � y t.c
7. STATIC WATER LEVEL Below Top of Casing: 20 r i. 57-
i, (Use"+"if Abovc Top of Casing)
S. TOP OF CASING IS FT.Above Land Surface*
-Top of casing terminated atlor below land surface requires a
variance In accordance rXUh 15A NCAC 2C.0118.
9. YIELD(gpm): 0 METHOD OF TEST t"A
10.WATER ZONES(depth):_
LOCATION SKETCH
11. DISINFECTION:Type i/ Amount Show direction and distance in miles from at least
12. CASING: Wall Thickness two State Roads or County Roads.Include the road
Depth �pmeter or Weight/Ft. Material numbers and common roaq names.
From,.Q_To SZ FL* IY 5o 7 1 rl c_
From To Ft.
From To Ft.
13. GROUT: Depth Material Method
From-6 To U -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:
✓7
Depth Size Material /
From To Ft. f _
From To Ft. I(
16. REMARKS:
1 DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED M ACCORDANCE WITH 15A NCAC 2C,WELL
CONSTRUCT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
T AND THAT—� 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

oiu)
WELL CONSTRUCTION RECORD s
North Carolina-Department of Environment and Natural Resources-Division of Water Quality-Groundwater Section
WELL CONTRACTOR(INDIVIDUAL)NAMES (print)CSLG tP.02 �,C//i J' y CERTIFICATION#2—e&
WELL CONTRACTOR COMPANY NAME/—! �/J/' f1� �.1� � � PJ PHONE # (4JW S7
v
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PEILYIIT#
(if applicable) (if applicable)
1. WELL USE(Check Applicable Box): Residential MunicipaYPublic❑ Industrial ❑ Agricultural❑
Monitoring❑ Recovery ❑ Heat Pump Water Injection❑ Other❑ If Other,List Use
2. WELL LOCATION: / �r�ryyS Topographic/Land setting
Nearest Town/,7PB r6i County Midge ❑Slope ❑Valley ❑Flat
r P l C f e.-A (check appropriate box)
(Street Name,Numbers,Community,Subdivision,Lot No.,Zip Code) Latitude/longitude of well location
3. OWNER: Ni-G _ fe/ �n�Oh (degrees/minutes/seconds)
Address a�;/_ Latitude/longitude source:❑GPS❑Topographic map
�y/(1S(tr,eet or Route o.) (check box)
Ct /IP' / 7AI /u � /� DEPTH DRILLING LOG
city or sown state Zip Code From To Formation Description
Area code-Phone number O`-T_ z `,
4. DATE DRILLED
5. TOTAL DEPTH:
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO or
7. STATIC WATER LEVEL Below Top of Casing:lh 6 _FT. t»p_
n (Use"+"if Above Top of Casing)
8. TOP OF CASING IS / FT.Above Land Surface* �/3t yh h ter,
-Top of casing terminated at/or below land surface requires a
variance in accordance with 15A NCAC 2C.0118.
9. YIELD(gpm): t S/ METHOD OF TESTS/
10.WATER ZONES(depth): J/
LOCATION SKETCH
11. DISINFECTION:Type Amount Show direction and distance in miles from at least
12. CASING: Wall Thickness two State Roads or County Roads.Include the road
Depth � `Diameter or Weight/Ft. Material numbers and common road names.
`7 From O To- I Ft.".,1�From Tc Ft. C, p�L
From To Ft. P!f / / /
13. GROUT: Depth Material Method
From O To `j0 _Ft._Stw.,w�ii�s�'Y os�s. ✓
From To Ft.
14. SCREEN: Depth Diameter Slot Size Material CJ
From To Ft. in. in. n
'—i
From To Ft. in. in. fV
15. SAND/GRAVEL PACK: r
Depth Size Material :Z.
From To Ft. --
From To Ft.
16. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C,WELL
CONSTRUCTION STANDARDS,AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
Submit the original to the Division of Water Quality,Groundwater Section,1636 Mail Service Center-Raleigh,NC
27699-1636 Phone No.[phone],within 30 days. GW-1 REV.07/2001

WELL CONSTRUCTION RECORD
North Carolina-Department of Environment and Natural Resources-Division of Water Quality-Groundwater Section
WELL CONTRACTOR(INDIVIDUAL)NAME (print) 6 Z/0/74 51°9 !-P e-
CERTIFICATION#;2 /
WELL CONTRACTOR COMPANY NAME .7
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if a licable
(if applicable)
1. WELL USE(Check Applicable Box): Residential Municipal/Public❑ Industrial ❑ Agricultural ❑
Monitoring❑ Recovery ❑ Heat Pump Water Injection❑ Other❑ If Other,List Use
2. WELL LOCATION:
Nearest Town:Rririmsr o County �11 1
5 Topographic/LandOV setting
'Midge ❑Slope ❑Valley ❑Flat
(Street Name,Numbers,Community,Subdivision,l.ot No.,Zip Code) (check appropriate box)
Latitude/longitude of well location
3. OWNER: Ott- (Zr00( a
Address ; (degrees/minutes/seconds)
(Street or Route No.)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH DRILLING LOG
6City or Town gtstc Zip Code From TO
1V SU -'1 1 tit Formation Description
Area code-Phone number
4. DATE DRILLED '(/lS r r/
5. TOTAL DEPTH: S 4Tf/ /
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO B G
7. STATIC WATER LEVEL Below Top of Casing: lC 4 FT.
(Use"+"if Above Top of Casing)
8. TOP OF CASING IS — FT.Above Land Surface"
*Top of casing terminated atlor below land surface requires a
variance in accordance with 15A NCAC 2C.0118.
9. YIELD(gpm): I METHOD OF TEST CZ1�
10.WATER ZONES(depth):
11. DISINFECTION:Type LOCATION SKETCH
YP Amount Show direction and distance in miles from at least
12. CASING: Wall Thickness two State Roads or County Roads.Include the road
Depth Diameter or Weight/Ft. 119terial numbers and common road names.
From O To f'l' Ft 1.�7 1,�-l
From To Ft.
From To Ft. '�}J / /13. GROUT: Depth Material Method z r` "1`1'3/1 J"l�' /)/.-.•3 f3" 47,
From -"' To Ze,' _ -Ft. i.ten./si. j),r -
r f>
From To Ft.
14. SCREEN: Depth Diameter Slot Size Material rJ
From To Ft. in. in. n
From To Ft. in. in. ry
15. SAND/GRAVEL PACK: s
Depth Size Material
From To Ft 0
From To FL
16. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C,WELL
CONSTRUCTION STANDARDS,AND THAT A COPY OF THIS FF�/�.r0/1,R-r�D�HAS BEEN PROVIDED TO THE WELL OWNER
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
7 E 417
Submit the original to the Division of Water Quality,Groundwater Section,1636 Mail Service Center-Raleigh,NC
27699-1636 Phone No.[phone],within 30 days.
GW-1 REV. 07/2001

WELL CONSTRUCTION RECORD
North Carolina-Department of Environment and Natural Resources-Division of Water Quality-Groundwater Section
WELL CONTRACTOR(INDIVIDUAL)NAME (print) u 1 P 7
y� CERTIFICATION q !J JI
WELL CONTRACTOR COMPANY NAME_/ R-, PHONE
STATE WELL CONSTRUCTION PERMIT#
if avolicablel SSOCIATED WQ PERMIT#
ifs licable)
1. WELL USE(Check Applicable Box): Residential Mimicipal/Public❑ Industrial ❑ Agricultural❑
Monitoring O Recovery ❑ Heat Pump Water Injection❑ Other O If Other, List Use
2. WELL LOCATION:
Nearest Town: t7 s&? County_Jr�'y Topographic/Land setting
ft---•n &IAl /YW Ridge ❑Slope OValley ❑Flat
(Street Name,Numbers,Community,Subdivision,Lot No.,Zip Code) (check appropriate box)
Latitude/longitude of well location
3. OWNER: E � �e
Address Q 2�2S" (degrees/minutes/seconds)
Latitude/longitude source:OGPSOTopographic map
(Street or R ute No.)
(check box)
City or Town 7 Sate DEPTH DRILLING LOG
Zip Code From To
I! Formation Description
Area code-Phone number ---�_
4. DATE DRILLED '7— /—]�
5. TOTAL DEPTH: 4,9
6. DOES WELL REPLACE EXISTING WELL? YES O NO
agCc11,--1 v
7. STATIC WATER LEVEL Below Top of Casing: t&e FT.
8. TOP OF CASING IS (Use"+"if Above Top of Casing)
-L 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):_e METHODfJF TES
T�r
10.WATER ZONES(depth):_r7 "'I 5
11. DISINFECTION:Type LOCATION SKETCH
YP 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 orb/ghVFt. aterial numbers and common road names.
(1 From To jh F[. m
From To Ft. i� �y'� �v /
From To Ft. ✓ / / .�i��
13. GROUT:- Depth Material Method
From Z�
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 C:3
From To Ft. r'7
From 1
To Ft. tV
r
16. REMARKS: C)
fi
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C,WELL
CONSTRUCTION STANDARDS,AND THAT A COPY OF THIS RECORD HAS B P VIDED 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

oy-k)
WELL CONSTRUCTION RECORD
North Carolina-Department of Environment and Natural esooyJ�ces-Division of Water Quality-Groundwater Section
WELL CONTRACTOR(INDIVIDUAL)NAME (print) ///.v�1�' !�
P CERTIFICATION#
WELL CONTRACTOR COMPANY NAME �N9rr'f(t t /l� �—// >✓�
PHONE # ylb�ffr]7"'�1yj�r
STATE WELL CONSTRUCTION PERMIT#(if applicable) ASSOCIATED WQ PERMIT#
� (ifa licable
1. WELL USE(Check Applicable Box): Residential B- Municipal/Public❑ Industrial ❑ Agricultural ❑
Monitoring❑ Recovery ❑ Heat Pump Water Injection❑ Other❑ If Other,List Use
2. WELL LOCATI N: i
Nearest Town-pcdwrd County�/n n PDgraphic/Land setting
uh � r �ayA/nitySubdivisi idgeo ❑Slope ❑Valley ❑Flat
(Street Name,Numbers,Commu , on Lot No.,Zip Code) (check appropriate box)
/ , Latitude/longitude of well location
3. OWNER: /
Address ��� � � (degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(Street or Route No.) (check box)
DEPTH
City or T wn late DRILLING LOG
� Zip Code From To o It Description
Area code-Phone number
4. DATEDRILLED
5. TOTAL DEPTH: 4k
6. DOES WELL REPLACE EXISTING WELL? YES❑ NO
7. STATIC WATER LEVEL Below To of Casing: C o 1
P 8 �_FT. j0 �
(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
variance f,accordance with 15A NCAC 2C.0118.
9. YIELD(gpm):__ t -METHOD OF TEST it 6a
10.WATER ZONES(depth):_
11. DISINFECTION:Type. LOCATION SKETCH
yp AFT/! Amount Show direction and distance in miles from at least
12. CASING: Wall Thickness two State Roads or County Roads.Include the road
From _To Depth Diameter or Weight/Ft. Material numbers and common road names. „
Ft. 5(X 0a'I4/ �{PI
From To Ft. Q
From To 'Ft.
13. GROUT: Depth Material Method
Fromm Too_Ft._Cot I d'✓r r s✓ •` ��
From To Ft. ryt•'j/ /,14. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in. q�
From To Ft. in. in �w 6 41utTf
15. SAND/GRAVEL PACK: 2� �C
Depth Size Material
From To FL /'�^�,- _L.-- `O
From To Ft.
16. REMARKS: -
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C,WELL
CONSTRUCTION AND T�COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
SIGNATURE OF PERSON CONSTRUCTING THE WELL
DATE
Submit the original to the Division of Water Quality,Groundwater Section,1636 Mail Service Center-Raleigh,NC
27699-1636 Phone No.[phone],within 30 days.
GW-1 REV.07/2001

WELL CONSTRUCTION RECORD
North Carolina-Department of Environment and Natural Resources-Division of Water Quality-Groundwater Section
WELL CONTRACTOR(INDIVIDUAL)NAME�(print)C /"/i[� T—C�//>/ CERTIFICATION a6lC 1
WELL CONTRACTOR COMPANY NAME//"7 f/',- % �� L'!�r'�� J'- h 3 PHONE N "F zS 77'
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
ifa licable (if applicable)
1. WELL USE(Check Applicable Box):Residential Municipal/Public❑ Industrial ❑ Agricultural❑
Monitoring❑ Recovery ❑ Heat Pump Water Injection❑ Other❑ If Other,List Use
2. WELL LOCATION: ( Topographic/Land setting
Nearest Town: &eil¢'s j1,- County_ f,�'"e17 S ❑Ridge ❑Slope ❑Valley ❑Flat
(check appropriate box)
(Street Name,Numbers,Community,Subdivision,Lot No.,Zip Code) Latitude/longitude of well location
3. OWNER: a.. fi:1 (degrees/minutes/seconds)
Address aol- 47CAiOLAW Latitude/longitude source:❑GPS❑Topographic map
/� J�Street or Route No.) (check box)
9 J e C to a e a,Ru DEPTH DRILLING LOG
City or Town Slate Zip Code From To Formation Description
Area code-Phone number C1 fC7 �r
4. DATE DRILLED Sr-/.7
5. TOTAL DEPTH: -2 1�e Cl /
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO Q
7. STATIC WATER LEVEL Below Top of Casing: /C7 FT.
(Use
'+"if Above Top of Casing)
8. TOP OF CASING IS y 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 a
10.WATER ZONES(depth): /,1!-'
LOCATION SKETCH
11. DISINFECTION:Type Amount Show direction and distance in miles from at least
12. CASING: Wall Thickness two State Roads or County Roads. Include the road
Depth Diameter or Weight/Ft. Material numbers and common road names.
From To hj g Ft.C %-9y-
From To Ft.
From To Ft.
13. GROUT: Depth Material Method )VelI
From Ca To _Ft.f2 r&T �L i
From To Ft.
14. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in. o
From To Ft. in. in. C-)
-s
15. SAND/GRAVEL PACK: v
Depth Size Material X7,
From To Ft. p
From To Ft. LA
16. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C,WELL
CONSTRUCTION STANDARDS,AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
Submit the original to the Division of Water Quality,Groundwater Section,1636 Mail Service Center-Raleigh,NC
27699-1636 Phone No.[phone],within 30 days. GW-1 REV.07/2001

WELL CONSTRUCTION RECORD
North Carolina-Department of Environment and Natural Resources.,{
-Division of Water Quality-Groundwater Section
���
WELL CONTRACTOR(INDIVIDUAL)NAME (print) 6Je4L& gea; elle CERTIFICATION#-.2
/WELL CONTRACTOR COMPANY NAMEAe" 11 1114 Z/ &A;S T7 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: Topographic/Land setting
Nearest Town:/14GveerI/ County rmnrS ❑Ridge ❑Slope ❑Valley ❑Flat
(check appropriate box)
(Street Name,Numbers,Community,Subdivision,Lot No.,Zip Code) Latitude/longitude of well location
3. OWNER:&r C, r d (degrees/minutes/seconds)
Address dY %L/ 3 Latitude/longitude source:❑GPS❑Topographic map
(Street or Route No.) (check box)
QM, i9nc i?/u1- DEPTH DRILLING LOG
City or Town State Zip Code From To Formation Description
Area code-Phone number
4. DATE DRILLED<�^ l 7Oh
5. TOTAL DEPTH: ;A 4-y ��d_ 7 O
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO 21
7. STATIC WATER LEVEL Below Top of Casing, FT.
(Use'+"if Above Top of Casing)
8. TOP OF CASING IS FT.Above Land Surface*
'Top of casing terminated at/or below land surface requires a
variance in accordant with 15A NCAC 2C.0I18.
9. YIELD(gpm):T METHOD OF TEST (r-
10.WATER ZONES(depth): ?11�5�
LOCATION SKETCH
11. DISINFECTION:Type Amount Show direction and distance in miles from at least
12. CASING: Wall Thickness two State Roads or County Roads.Include the road
Depth Diameter or Weight/Ft. atertat numbers and common road names.
From_iTort�Ft.f,%b — s;/ !�� 6 L/ qa �q5 L . _/ _} Zd✓� /�_
From To Ft. �T
From To Ft.
13. GROUT: Depth Material Method
Fromm To 1-d _FI_,AJ0hIE-
From To Ft.So.or� 'A r�
14. SCREEN: Depth Diameter Slot Size Material --1
:v
From To Ft. in. in. w
From To Ft. in. in. o
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
16. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 1 SA NCAC 2C,WELL
CONSTRUCTION STANDARDS,AND THAT A COPY OF TTHHIS REC OVIDED TO THE WELL OWNER
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
Submit the original to the Division of Water Quality,Groundwater Section,1636 Mail Service Center-Raleigh,NC
27699-1636 Phone No.[phone],within 30 days. GW-1 REV.07/2001

WELL CONSTRUCTION RECORD
North Carolina-Department of Environment and�Natcoral Resources-Division of Water Quality-Groundwater Section
WELL CONTRACTOR(INDIVIDUAL)NAME (print) r�i f�/7h rc 7 Ph rely CERTIFICATION# �{/
WELL CONTRACTOR COMPANY NAME 2 / I� f`/ 1 PHONE # jy1• `S7/
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable)
� (if applicable)
1. WELL USE(Check Applicable Box): Residential GY Municipal/Public❑ Industrial ❑ Agricultural ❑
Monitoring❑ Recovery ❑ Heat Pump Water Injection❑ Other❑ If Other,List Use
2. WELL LOCATION:
Nearest Town: n s:mr �0 County </ Topographic/Land setting
❑Ridge ❑Slope ❑Valley ❑Flat
(Street Name,Numbers,Community,Subdivision,Lot No.,Zip Code) (check appropriate box)
Latitude/longitude of well location
3. OWNER: j�4oc 5s l , AAr—
Address &X I/o S irlJ Z—/t (degrees/minutes/seconds)
Latitude/longitude source:OGPS❑Topographic map
(Street or Route No.) (check box)
Gc4i/'.e 2�i7/ Y DEPTH
Ciry or Town State Zip Code From To DRILLING LOG
(S1$)- 7 ql-O l .3 — Formation Description
Area code-Phone number
4. DATE DRILLED 7
5. TOTAL DEPTH:
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO t� I 0'3 Zf 2i
7. STATIC WATER LEVEL Below Top of Casing: 4y '6 FT.
(Use"+"if Above Top of Casing)
8. TOP OF CASING IS 127— FT.Above Land Surface*
-Top orcasing terminated aVor below land surface requires a
variance In accordance with 15A NCAC 2C.0118.
9. YIELD(gpm): '?-J- METHOD OF TEST Q , 'Y
10.WATER ZONES(depth):
LOCATION SKETCH
11. DISINFECTION:Type Amount Show direction and distance in miles from at least
12. CASING: Wall Thickness two State Roads or County Roads.Include the road
Depth Diameter or Weight/Ft. lAaterial numbers and common road names. '{y
From �/' To�L FL I'�G ,. /
From To Ft.
From To Ft.
13. GROUT: Depth Material Method / / � ��'�'"`fr/-'
From G To-70 _Ft.5,1.
From To Ft.14. SCREEN: Depth Diameter Slot Size Material C-f9 U!"o dj
From To Ft. in. in.
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Size Material n0
From To Ft. .�
From To Ft. ti
16. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C,WELL
CONSTRUCTION STANDARDS,AND THAT A COPY OFF THIS REC RD HAS BEEN PROVIDED TO THE WELL OWNER
—
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
Submit the original to the Division of Water Quality,Groundwater Section,1636 Mail Service Center-Raleigh,NC
27699-1636 Phone No.[phone],within 30 days. GW-1 REV. 07/2001

WELL CONSTRUCTION RECORD
North Carolina-Department of Environment and Natural Resources-Division of Water Quality-Groundwater Section
WELL CONTRACTOR(INDIVIDUAL)NAM,EE (print) ( SPh/ O CERTIFICATION#
WELL CONTRACTOR COMPANY NAME/ /P/'r/-�I{z�`/ t- '04 aw PHONE
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
ifa licable ifapplicable)
1. WELL USE(Check Applicable Box): Residential Municipal/Public❑ Industrial❑ Agricultural❑
Monitoring❑ Recovery ❑ Heat Pump Water Injection❑ Other❑ If Other,List Use
2. WELL LOCATION:
Nearest Town ff Topographic/Landsetting
County
❑Ridge ❑Slope ❑Valley ❑Flat
(Street Name,Numbers,Community,Subdivision, (check appropriate box)
Lau.. Lot No.,Zip Code) titde/longitude of well location
3. OWNER:, ;0,e A �r #O (degrees/minutes/seconds)
Address X!J /�.oA�' ,�,e Latitude/longitude source:❑GPSOTopographic map
(Street or Route No.) (check box)
� � C pZ�1L�P DEPTH DRILLING LOG
ty or Town State Zip Code From To Formation Description
Area code-Phone number w _�---
4. DATE DRILLED70
5. TOTAL DEPTH:6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO e
7. STATIC WATER LEVEL Below Top of Casing: !'OFT_
(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 4 0
variance in accordance with 15A NCAC 2C.0118.
9. YIELD(gpm): �— METHOD OF TESTS/ f-
10.WATER ZONES(depth):_ 1�0 �' �/6 l
LOCATION SKETCH
11. DISINFECTION:Type Amount Show direction and distance in miles from at least
12. CASING: Wall Thickness two State Roads or County Roads.Include the road
Depth Diameter or WeighVFt. temal numbers and common road names.
Fromf—To�Ft. Jr ..21
From To Ft.
From To Ft.
13. GROUT: Depth Mater' I Method
From—,a_To `j0 -Ft. �r,e t
From To Ft.
14. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in. -
From To Ft. in. in. '_A
15. SAND/GRAVEL PACK: O
Depth Size Material n
�t
From To Ft. N
From To Ft. -
O
16. REMARKS: 0
1 DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C,WELL
CONSTRUCTION STANDARDS,AND THAT AAC�COPPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
Submit the original to the Division of Water Quality,Groundwater Section,1636 Mail Service Center-Raleigh,NC
27699-1636 Phone No.[phone],within 30 days. GW-1 REV.07/2001

WELL CONSTRUCTION RECORD
North Carolina-Department of Environment and Natural Resources-Division of Water Quality-Groundwater Section
WELL CONTRACTOR(INDIVIDUAL)NAME (print) 10°,70 Surf ft011"
CERTIFICATION#:LA%J
WELL CONTRACTOR COMPANY NAME �PI/ •'// ,/, Nyh
�� Pxoxe #fig}
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMMIT#
(if a licable (if applicable)
1. WELL USE(Check Applicable Box): Residential Municipal/Public❑ Industrial❑ Agricultural❑
Monitoring❑ Recovery ❑ Heat Pump Water Injection❑ Other❑ If Other,List Use
2. WELL LOCATION:
Nearest Town:.&5acs/7 County &Id7 Topographic/Land/Land letting
� ( ❑Ridge []Slope ❑Valley ❑Flat
_ U
(Street Name,Numbers,Community,Subdivision,Lot No.,Zip Code) (check appropriate box)
Latitude/longitude of well location
3. OWNER: ffir
Address !) Jr�/+l! (degmes/minutes/seconds)
--7�•
(St Latitude/longitude source:❑GPS❑Topographic map
reet or Rout(e'No.j I (check box)
11 F Cary DEPTH or Town state Zip Code From To DRILLING LOG
Formation Description
Area code-Phone number
4. DATE DRILLED 7-
5. TOTAL DEPTH: LT—& /
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO 2"l
7. STATIC WATER LEVEL Below Top of Casing: td FT.
(Use"+"if Above TopofCasing)
8. TOP OF CASING IS�_FT.Above Land Surface•
`Top of casing terminated at/orbelow land surface requires a
variance In accordance with 15A NCAC 2C.0I18.
9. YIELD(gpm): 7d METHOD OF TESTel
10.WATER ZONES(depth):_l j0 — /%5 V
LOCATION SKETCH
11. DISINFECTION:Type Amount Show direction and distance in miles from at least
12. CASING: Wall Thickness two State Roads or County Roads.Include the road
Depth Diameter or Weight/Ft. Material numbers and common road names.
From © To eI'/ Ft. �
From To Ft.
From To Ft.
13. GROUT: Depth Mateial l �t A,-/ b �+�
° L
7 !
From O To�t7 Ft._`3an. i»/,L Method /
From Tc Ft. T---
14. SCREEN: Depth Diameter Slot Size Material n0 '
From To Ft. in. in.
Front— ti
To Ft. in. in. _ N
15. SAND/GRAVEL PACK: r
Depth Size Material O
From To Ft. V7
From To Ft.
16. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C,WELL
CONSTRUCTION STANDARDS,AND THAT A COPY OFTHIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
e �
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
Submit the original to the Division of Water Quality,Groundwater Section,1636 Mail Service Center-Raleigh,NC
27699-1636 Phone No.[phone],within 30 days.
GW-1 REV. 07/2001

�a^`STaRob� V
r 3 4
RESIDENTIAL WELL CONSTRUCTION RECORD J
North Carolina Department of Environment and Natural Resources.Di%ision of Water Quality
WELL CONTRACTOR CERTIFICATION # `r
1.WELL CONTRACTOR: I. DISINFECTION:Type f �I 'I D` Amount T Z
g. WATER ZONES(depth`)
pW Well Contractor(Individual)Name L� From 1 7 Y' To 1-I J From To
1 ..,�C.YJ CALD(,,.;e i_L f,'�lt�l �� IBC' From_1g5 To �� From To
Well Contractor Company Name T— From To From To
STREET ADDRESS 1 CAS T(�Q '\W`` 6. CASING: Thickness/
p r [ Dept Diann ter Weigh�7( a1Pri�
From To��1J Flat ' S It VV
City a Town State Zip Code From To Ft.
13( 3>,( )- qy4 " From To FL
Area code- Phone number
2.WELL INFORMATION: 7. GROUT: Depth Material n Method
SITE WELL ID#(il applicable) From.To 3-Z FL Ck,rnLN")Frcm To Ft.
STATE WELL PERMIT#pf applicable) From To Ft.
DWQ or OTHER PERMIT#(if applicable) B. SCREEN: Depth Diameter Slot Size Material
WELL USE(Check Applicable Box). Residential Water Supply From To Ft.—in. _ in.
From To FL—in. —in.
DATE DRILLED ta' - D J From To FL—in. _ in.
TIME COMPLETED 1 AM❑ PM9
9. SAND/GRAVEL PACK:
3.WELL LOCATION/: _ , Depth Size Material
CITY: 'fi�� `+ f�+0-D COUNTYI"+�'S �`I},A�I A From To_Ft.
�c REST �A Lr From ToFt.
rJ RN `I C From To Ft.
(Street Name,Numbers,Community,Subdivision,Lot No.,Parcel,Zip To—de)
TOPOGRAPHIC if LArjtD SETTING: 10.DRILLING LOG
❑Slope ❑Valley Flat ❑Ridge ❑Other From / To
rm F ation Description(check appropriate box) 4 .-, ) (� 0t tP�.�.Ei,;
May be in degrees,
LATITUDE 3 minutes,seconds or floc ♦ �-1 (ea Ctl�rN t-T,
LONGITUDE in a decimal formal 1"t�'�� t�s' C �LC. - c�.
Latitude/longitude source: ❑GPS ❑Topographic map t4 r._ e( 1v/ t _, � S L
(location of we0 must be shown on a USGS topo map and ,[t b i ._ ` O.A tJ tT G
attached to this form If not Using GPS)
4.WELL OWNER()
OWNER'S NAME 1\y (t
STt EETADDRESS �3_Yj C,2.Ipt-7d L�cr- D \RAIL _
1Ve
City
c? or Town State Zip Code
number
Gl
Area code- Phone number
11. REMARKS:
5.WELL DETAILS:
a. TOTAL DEPTH: /
It. DOES WELL REPLACE EXISTING WELL?/^YES❑ NO'p
c. WATER LEVEL Belo T of Casin V� I DOHEREBY CERTIFY THATTHISWELLWAS CONSTRUCTED MACCORDANCE WRH
$ FT. 15A NCAC 2C.WELL CONSTRUCTIDN STANDARDS.AND THAT A COPY OF THIS
(Use'*'H Above Top of Casing) RECORD HAS BEEN PROVIDED TO THE WELL OWNER
d. TOP OF CASING IS FT.Above Land Surface' �`` CC �LieQ 1-q 1. Oa
'Top of casing terminated at/or bNov land surface may require SIGNATURE OF CERTIFIED WELL CONT CTOR DATE
a variance in accordance with 15A NCAC 2C.0116. ^ C�1
e. YIELD(gpm): l C METHOD OF TEST FIG " I 1)1
PRINTED NA F NSTRUCTING THE WELL
Submit the original to the Division of Water Quality within days. Attn: Information Mgt.,
1617 Mail Service Center-Raleigh,NC 27699-1617 Phone No. 919)733.701$ x �g Form GW-1a
d1 A 1V Z006 Rev.7105
Asheville Regional Office
Aquifer Protection

WELL CONSTRUCTION RECORD
North Carolina-Department of Environment and Natural Resources-Division of Water Quality-Groundwater Section Q���/�WELLCONI[LkCTOR(INDIVIDUAL)NAM!FF�..(print) [ I CERTIFICATLOt N�AN/"�i/'pV/
WELL CONTIIACrOR COMPANY NAh[EL LLgU tQA/1 b h-1 4ekj 3 LL PHONE j�t a 6,9 9q%
STATE WELL CONSTRUCTION PERMITq ASSOCIATED WQ PERMITp
(if applicable)
(if applicable)
1. WELL USE(Check:Applicable Box):Residential 9�Municipal/Public ❑ Industrial ❑ Agricultural ❑
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other,List Use
2. WELLLOwn: 7- Topographic/Landsettin
Nzarzs[Totm: vy County✓ Z1Jr,%a C ❑Ride @Sloe ❑Valle ❑Flat✓s< 4L ex /l./ g p y
(check appropriate box)
(Sueet Name,Numbers,Community,Subdivision,Lot No.,Zip Code) Latimde/longltude of well location
3. OWNER: 4JOUS.11M
I (degrees/minu[esiseconds)
Address l (f / Latitude/longitude source:0- PS❑Topographic map
' I (Stttet ar one No.)
N M19 ( DEPTH (check DRI
DRILLING LOG
Cty or own Zip Code From To Formation Description
ca) 6i 7- ���3 075-11 P
.Area code-phone number
4. DATE DRILLED 3-A,Or" -e
9 zy �c
5. TOTAL DEPTH: 21/r
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO
7. STATIC WATER LEVEL Below Top of Casing: Cc' FT.
(Use"+"if Above Top of Casing)
S. TOP OF CASING IS L_FT.Above Land Surface"'
Top ofeasing terminated atlor below land surface requires a
variance in accordance with ISA NCAC 3C.0118.
9. YIELD(,,pm): 7 METHOD OF TESTjg
10. WATER ZONES(dep[h): 7?' , Z201 J
LOCATION SKETCH
i/-c Amountl� 1cSr Show direction and distance in miles from at least
IL DISINFECTION:Type-C12. CASING: Will Thickness two State Roads or County Roads.Include the road
Depth Diameter or Weighr/Ft. Material numbers and common road names.
From To 9-5 Fr. �.G)�t'L1 ✓'�C
From To Fr
From To F[. C'(abCre. ,
13. GROUT: Depth Material Method
From�To , FL /rC E E '�ilLn,'„1a - r�arc ( I ,
From To F[. 17-1
14. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in.
From
To F[. in. in.
15. SAND/GRAVEL PACK: O .
Depth CA
P Size Material
From To - Ft.
From To Ft,
16, REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH ISA NCAC 2C,WELL
CONSTRUCTION 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 9ettion,,-lb36',)Vtai['Serptga'Center-Raleigh,NC
27699-1636 Phone No.[phone],within 30 days. - GW-1 REV.07/2001

RESIDENTIAL WELL CONSTRUCTION RECORD 4,
ry y
- North Carolina Department of Environment and Natural Resources-Division of Water Quality '�,�^' f A t
WELL CONTRACTOR CERTIFICATION A 2045
1.WELL CONTRACTOR: f, DISINFECTION:Type H T H Amount 166Z
James B. Bruwri g• WATER ZONES(depth):
Well Contractor(Individual)Name Proo, �To /67_ From--To
,I'iddan Rrnthars Well DrillircT, Inc. From To From To
Well Ccnlraclor Company Name From-_ To From To
STREET ADDRESS 73 Holly Hills Vista Rd S. CASING Thickness/
///��� Depth 2 Diameter Weight Material
ankl i n F Alf' 98714 From To 5✓ FL /n „ -
City llft Slate Zip Code From �Tontg Ft.=,• /,(T
1 828 )- 369-9591 From To_Ft.
Area code- Phone number
7. GROUT: Depth Material Method
2.WELL INFORMATION: JI -� FromQ_To 20 Ft. CEiHIt &hffr 1i _JRX]:E
SITE WELL ID#(If applicable) �hJ From To Ft.
STATE WELL PERMIT#(II applicable) From__To Ft.
DWQ or OTHER PERMIT#(If applicable) 8. SCREEN: Depth Diameter Slot Size Material
_/ From_To_Ft.—in. _ in.
WELL USE(Check plieable Box: Residential Water Supply'pd From_To Ft.—In. _ In.
DATE DRILLED J From—To Ft.—In, — In.
TIME COMPLETED AM V PM❑ g, SANDIGRAVEL PACK:
].WELL LOC TION: Depth Size Material
From To_Ft.
CITY: COUNT From To_Ft.
n/&4fi Alip From To Ft.
(Street Name,Numbers,community,Subdivslon,Lot No.,Parcel,Zip Coos)
TOPOGRAPHIC I LAND SETTING: 10.DRILLING LOG
❑Slope OVallay ❑flat ❑Rldge ❑other FrommTTo Formation Description
(check apprdprlate box) -- Clay & SaI1CI
May be In deyea, r s (rani to
LATITUDE �� �,.�� minutes,seconds or
LONGITUDE _f0� in a decimal termer
Latitude/longitude source: OOPS ❑Topographic map
(location or welf must be shown on a USGS tope,map and
attached to this form Mnof using GPS)
4,WELL OWNER
OWNER'S NAME
ST E ADDRESS
M
City or Town State Zip Code
($1e � (nR'3
Area code- Phone number
11. REMARKS:
1
5.WELL DETAILS; /_ f z,?
a. TOTAL DEPTH:
a
b. DOES WELL REPLACE EXISTING WELL? YES❑ NOA 0
100 HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE Wmf ..
c. WATER LEVEL Below Top of Casing', FT, 76A NC C,WELL CONSTRUCTION STANDARDS,AND THAT A COPY OF THIS
(Use d+'d Above Top of Casing) RE D AS BEEN PROVID 70 THE W ELL OWNER.
d. TOP OF CASINO IS 2 FT.Above Land Surface'
'Top of casing terminated atlor below land surface may require GNATURE OF C RTIFIED WELL CONTRACTOR DATE
a variance in accordance With i5A NCAC 2C,0118.
e. YIELD(gpm): METHOD OF TEST B1C7W James HER. CON BPOWr
PRINTED NAME OF STRUCTING THE WELL
Submit the original to the Division of Water Quality within 30 days. Attn:Information Mgt., Form GW-1a
116117 Mall Service Center-Raleigh,NC 27699.1617 Phone No.[phone] ext 568. Rev.7105

• A
WELL CONSTRUCTION RECORD
North Carolina- Department of Environment ands rah Resources-Divisi of Water Quality-Groundwater Section �� ('�
"'ELL CONTRACTOR(INDMDUAL)NAME (print) CERTIFICATION#Q�Q
WELL CONTRACTOR COMPANY NANIEawd. PHONE A.U.459-
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable) (ifa plicable)
1. WELL USE(Check Applicable Box):Residential Municipal/Public ❑ Industrial ❑ Agricultural ❑
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other,List Use -
2. WELL LOCATIO
Topogr c/Land setting
Nearest Town: A ACounty IU4/5. ❑Ridge Sl ❑Valley ❑Flat
(check appropriate box)
(Street Nome,NcNumbers,,Comnunityy,'Subdivision,Lot No.,Zip Code) L titude/longimde of well locati n
3. OWNER: y(rJ I�OL )C' t (�1� I(S �n �
b (degrees/minut •sEconds)
Address "i_ C.V I I 'P �}t..._, Latitude/longitude source: GPS❑Topographic map
(Scree[or Route No.) (check box)
f,CLSrSBlitti V r\r s9 291 DEPTH DRILLING LOG
City or Town Slate Zip Code From To Formation Description
(r_)- 88 G_
Area code-Phone number ! —F C7 SE(tI(J�S XeJu�p
4. TOTEDRH,L_F: 7�i�AS (us
5. TOTAL DEPTH: A _
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO 400
7. STATIC WATER LEVEL Below Top of Casing: M FT.
(Use"+"if Above Top of Casing)
S. TOP OF CASING IS_ _FT.Above Land Surface"
-Top of casing terminated atlor below land surface requires a
variance in accordance with UA NCAC .
9. YIELD(,,pm): 0 _Iv1ETHOD OF OF TEST�y '
10.WATER ZONES(depth):
LOCATION SKETCH
11. DISINFECTION:Typ /kt) Z Amount� Show direction and distance in miles from at least
t2. CASING: Wall Thickness two State Roads or County Roads.Include the road
Depth mmeter or' '/WeighdFt. Material numbers and common road names.
From.- To (OS Ft..� '/aliR/''7-(KS
- From To Fr. I., 7 I
Front To Ft. cl'gLCre-e-k
13. GROUT: Depth Man Method
From,Q �jZ
_ToFt. 2id4 LYE, r'e� 1�
From To Ft.
14. SCREEN: Depth Diameter Slot Size Material
From
To Ft. in. in. �7
From To Ft. in. iu. -
15. SAND/GRAVEL PACK: t
Depth Size Material cn
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 47 HAS EN PROVIDED TO THE WELL OWNER
SIGNKFUM7`PE MN CO� CTMG THE WELL
Submit the original to the Division of Water Quality,Groundwater
Section, 1636 Ml it 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 QQ
WELL CONTRACTOR(INDIVIDUAL)NAME ((print)_ CERTIFICATION#�jda1
WELL CONTRACTOR COMPANY NAME delyii iA,p j („�,G PHONE
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable) (ifa licable)
1. WELL USE(Check Applicable Box):Residential Municipal/Public ❑ Industrial ❑ Agricultural ❑ -
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other,List Use
2. WELL LOCATIQN:'-t✓e�d Topogrra hic/Land setting
Ne/a�rtest T/Qwn/:•�" _County 7;: sc e.,.•� pRidge L751ope ❑Valley ❑Flat
'Y '� / (check appropriate box)
(Street Name,Numbers,Community,Subdivision,Lot No.,Zip Code) Latitude/longitude 9f well location
3. OWNER r(/ +ou/GtCa�lf/au Ciivr /V3f°deg �n bOn'J7 bT/!�a
(degrees/minutes/seconds)
Address _A�U;�l a t. Latitude/longitude itude source:
t g' C�PS❑Topographic map
(Sttee[or Route No.) (check box)
264•e✓SairJ /c. /1�C DEPTH DRILLING LOG
City or Town State Zip Code From To Fo ation Description
(Qy)- fi B 7�Qg-3 o- �i
Area code-Phone number
5. TOTAL DEPTH: ULO / 4 ✓ "Y f/ (o
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO 3
7. STATIC WATER LEVEL Below Top of Casing:�60 FT.
(Use"+"if Above Top of Casing)
S. TOP OF CASING IS_�FT.Above Land Surface*
•Top of casing terminated at/or below land surface requires a
variance in accordance with ISA NCAC 2C.0118.
9. YIELD(gpm): 49n- METHOD OF TEST
10.WATER ZONES(depth): /0j 'MI
LOCATION SKETCH
11. DISINFECTION:Type Amount 2/ Show direction and distance in miles from at least
12. CASING: Wall Thickness two State Roads or County Roads.Include the road
p Depth Diameter or Weight/Ft. Material numbers and common road names.
From U To ,YO Ft. 4� /CJ J/Be'L/ vL
From To Ft. y full/ �.
From To Ft. ���e><� �-/
13. GROUT: Depth Material Method ( 1 t (L
From,_(-To;Q Ft. /f E E (L/(/'GL cY
From To Ft.
14. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in.
From—To—Ft.—in. in.
15. SAND/GRAVEL PACK: - n
1
Depth Size Material
From—To—- Ft. -
From To Ft._ o
cst
16. REMARKS:
1 DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH ISA NCAC 2C,WELL - - - -
CON�T yCTION ST NDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
SIGNATURE OF PERSON CONSTRUCTING THE WELL _ _ DATE C—
Z
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. N
G
rta -

WELL CONSTRUCTION RECORD
North Carolina-Department of Environment and ral Resources-Div is of Water Quality-Groundwater Section
WELL CONTRACTOR(INDIVIDUAL)NAME (print) CERTIFICATION#Q�
WELL CONTRACTOR COMPANY NAME (,fSON II PHONEA.12;1SQ'Sr'{gr/
L-
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
1. WELL USE(Check Applicable Box):Residential IZ Municipal/Public ❑ Industrial ❑ Agricultural ❑ -
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other,List Use
2. WELL LOCATION: TopograykiiVLand setting
Nearest Town: e- County I ra _ ❑Ridge IZSlope ❑Valley ❑Flat
- 1'.1 t)SIX (check appropriate box)
(Street Name,Numbers,Community,Subdivision,Lot No.,Zip Code) Latitude longitude o well location
eJ Sic, y)�� 6 , 3�y.
3. OWNER: ,/ fi.7�irAr C� Cq-3 (degreesmatumes/s;conds)
Address �f}S{trV/ G c— Latitude/longitude source:f; PS❑Topographic trap
1 (Street or Route No.) (check box)
Glttltf CV.VV,�/e, A C ,2 J?79 / DEPTH DRILLINGLOG
City or Town Suite Zip Code From To Formation Description
&$)- (,e 8'7- a?&3 () , ss
Area code-Phone number $$ 70 i d.✓¢
a, LIpTE DP.ILLED 4-11A St.— 7�
5. TOTAL DEPTH: ! :CO.� / 70 7 ' 7 S
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO CT
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*
*Top ofcasing terminated at/or below land surface requires a
variance in accordancewith 15A NCAC 2C.0118. ,
9. YIELD(gpm):W METHOD OF TEST - '
10.WATER ZONES(depth):
LOCATION SKETCH
11. DISINFECTION:Type CA/ r e Amount e 2 Show direction and distance in miles from at least
12. CASING: Wall Thickness two State Roads or County Roads.Include the road
Depth Diameter or Weight/Ft. Material numbers and common road names.
From_�_To_.5_Ft. L15 }&/u' A /
- From To Ft. b' �, 0%a)5' .
Front To Ft. Ne Q a� a
13. GROUT: Depth Material Method 0
C
From_ To�Q Ft.0p/v-,Q�4R
From To Ft. IT'
14. SCREEN: Depth Diameter Slot Size Material p
From To Ft. in. in.
From To—Ft.—in. in. n
15, SAND/GRAVEL PACK:
Depth Size Material CJl ,
From To Ft. 0
From To Ft. cn "t
16. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C,WELL
CONSTRUCTION STANDARDS,AND THAT A COPY OFT AS BEEN PROVIDED TO THE WELL OWNER
4za
Sl RE 0 ERS -CONSTRU_CTING THE WELL TE -
Submit the original to the Division of Water Quality,Groundwater Section, 4636 Mail Service Center-Raleigh,NC
A�
27699-1636 Phone No.[phone],within 30 days. - " ' GW-1 REV.074�nZ 20

WELL CONSTRUCTION RECORD
North Carolina-Department of Environment and Natural Resources-Division of Water Quality-Groundwater Section
WELL CONTRACTOR(INDIVIDUAL)NAME(�,(�print) ` CERTIFICATION#9 tr
�
WELL CONTRACTOR COMPANY NAME / -[Cf`! ki Ilt-Pz'l P PHONE # (il t7?—(`r a
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(ifapplicable) (if applicable)
1. WELL USE(Check Applicable Box): Residential t!/Municipal/Public❑ Industrial ❑ Agricultural❑
Monitoring❑ Recovery ❑ Heat Pump Water Injection❑ Other❑ If Other,List Use
2. WELL LOCAT N: ,XOpographic/Land setting
+
Nearest Town: CC✓O.rt(.. County 7 Tc+/�St aN,t (
dge ❑Slope ❑Valley ❑Flat
F-Clb/6 Lae
(check appropriate box)
(Street?fame,Numbers,Community,Subdivision,Lot No.,Zip Code) Latitude/longitude of well location
3. OWNER: rPEp`y_ f'd ixPtiI
(degrees/minutes/seconds)
Address I->`( Rh .... PpCe 19 f- Latitude/longitude source:❑GPS❑Topographicmap
C f (I (Streett�r Rnote No.) (check box)
µdi f ql 1�1 32 OrG DEPTH DRILLING LOG
Ciry di Town state zip Code Frogo m To Formation Description
(�tlY)- go ti 7ogr o P. c � plvf
Area code-Phonene number (
If 11r
4. DATE DRILLED G 2 t -43 i r`a`ir
5. TOTAL DEPTH:7 �(�2—�S fa c�
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO Ed'
7. STATIC WATER LEVEL Below Top of Casing: CLO FT.
r (Use"+"if Above Top of Casing)
8. TOP OF CASING IS t FT.Above Land Surface*
-Top of casing terminated attar below land surface requires a
variance In accordance with I5A NCAC 2C.0118.
9. YIELD(gpm): I —METHOD OF TEST l^
10.WATER ZONES(depth):_
LOCATION SKETCH
Show direction and distance in miles from a[least
11. DISINFECTION:Type_ifT-14 Amount
12. CASING: Wall Thickness two State Roads or County Roads.Include the road
Depth Diameter or Weight/Ft. Material numbers and common road names.
From-0 TOE Ft. &l Y Q l i rUG -
From To Ft.
From To Ft.
13. GROUT: Depth Material Metho O
n
From 6 To 26 _Ft_ Q%e/e
From To Ft. ` .c-
14. SCREEN: Depth Diameter Slot Size Material Egq(tL')" 4Zdt9 J2it
O
From To Ft. in. in.
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Size Material n Bch1�
From To Ft. P` 1, 1
From To Ft.
16. REMARKS:
®2Cetx-�
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C,WELL
CONSTRUCTION STANDA S THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
�V_-- fp-2t�5,
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

WELL CONSTRUCTION RECORD
North Carolina- Department of Environment and Natural Resources-Division of Water Quality-Groundwater Section
WELL CONTRACTOR(INDIVIDUAL)NAM, (print) t QQ
WELL CONTRACTOR COMPANY NAME E CERTIFICATION 05M
r Q!✓� L.L.C. PHONE I�NV�O"O T/ctZ STATE WELL CONSTRUCTION PERMIT#
(ifaplicable) ASSOCIATED WQ PERMIT#
- (ifa plicable)
1. WELL USE(Check Applicable Box):Residential Ea .Municipal/Public ❑ Industrial ❑ Agricultural ❑
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other,List Use
2. WELL LOCATION:
Neare [Town: ,At!/e,1 County '2a, iv . Topograp�hic/Land setting
Ae Z/-p ❑Ridge FS°lope ❑Valley ❑Flat
(Street Nam ,Numbers,Cnnm unift (check appropriate box)
y,Subdivision,Lot No.,Zip Code) Latitude/longi ude of well location
3. OWNER: C A13,�°/d; /rlcl�t./Vnei 549 </r4tr-/
Address _ XQ/0 e/v u.% / (degrees/minutes econde)
(Street or Route NO.) y Latitude/longitude source: ZOnTopographic slap
S6,,v '/L (check box)
Cuy or Town grate! 5�-- DEPTH DRILLING LOG
Zip Code From
/0 7- y�{r/� om Tn Formation Description
Area code-Phone nuntbe 0 — 2d -
+. DATEDRiLLED :74)-- 7- 54<-/
5. TOTAL DEPTH: S-Of'-' /
6. DOES WELL REPLACE EXISTING WELL^ YES ❑ NO a
7. STATIC WATER LEVEL Below Top of Casing: 1,19 FT.
(Use`+-if Above Top of Casing)
S. TOP OF CASING IS
--. FT.Above Land Surface` ----.
r. `Top ofcash"terminated atlor below land surface requires a
variance in accordance with 15A NCAC 2C.01 Is.
9. YIELD(,pm): e METHOD OF TEST
10.WATER ZONES (depth): ,J.?b '/?Z'/
I . DISINFECTION:2. CASING T e rin LOCATION SKETCH
YP Amount ZG f Show direction and distance it,miles from at least
Wall Thickness two State Roads or County Roads. Include the road
Depth Diameter or WeighUFL Material numbers and common road names.
From- (,z To 25' Ft. .&�-
From To FL
From To FL 06
13. GROUT: Depth Material W From-
To Method
Ft. b//C,2E E �Ws.2-
From To Ft.
14. SCREEN: Depth Diameter Slot Size Material to
From To
FL_in. in. 1
From To Ft._in.
15. SAND/GRAVEL PACK: in.
Depth 0
To
From p F Size Material V1
-
From To FL -.
16. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C,WELL
CONSTRUCTION STANDARDS,AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
SIGNATURE OF PERSON CONSTRUCTING THE WELL -. ._-
DATE
Submit the original to the Division of Water Quality,Groundwater Section, 1636 Mail Service Cetuer-Raleigh,NC
27699-1636 Phone No.[phone], within 30 days.
GW-1 REV.07/200]

". .._
WELL CONSTRUCTION RECORD
North Carolina- Department of Environment and Natural Resources-Division of Water Quality-Groundwater Section'�
WELL CONTRACTOR(INDIVIDUAL)NAM (print) 3 CERTIFICATIONib76
WELL CONTILACTOR COMPANY NANIEL I hJtTll 1ZW /np ' LLG PHONE
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(i f appl icable) (if applicable)
1. WELL USE(Check Applicable Box):Residential ❑ Municipal/Public ❑ Industrial ❑ Agricultural ❑
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other,List Use
2. WELL LOCATIO},j�: Topographic/Land setting
Ne/aI�est Town: CYt v«o/ County '7.sIY`< ❑Ridge E3Siope ❑Valley ❑Flat
l li� C� (check appropriate box)
(direct Name,INumbers,Conuounity,Subdivision,Lot No.,Zip Cade) eLatitude/longitude of well location
3. OWNL-R: dw,� /•.3f° /S: Us�S'`.✓�rzd�Y,
r$ r ' (degrees/minutes/seconds)
Address O( � H.°u. 1 r y Latitude/longitude source:�S❑Topographic map
(Suer or Rowe No.) (check box)
N U t Cl C arz� I DEPTH DRILLING LOG
&N��
City or Town ' I State Zip Code From To Formation Description
—)- �n g7—�f I !I" [// ��r
Area code-Plmne number S// - y6 ii /J
4. DATE DRILLED �J�- � Ds— y6_ %61"
5. TOTAL DEPTH- 7C/
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO 0"
7. STATIC WATER LEVEL Below Top of Casing:AFT.
(Use"+"if Above"fop of Casing)
S. TOP OF CASING IS, FT.Above Land Surface*
`Tap ofeas'ing terminated at/or below land surface requires a
variance in accordance with 15A NCAC 2C.0118.
9. YIELD(gpm): JO METHOD OF TEST OBI W Ng�g
10.WATER ZONES (depth):
LOCATION SKETCH.
It. DISINFECTION:Type C/i:;r+t Amount < s Show direction and distance in miles from at least
12. CASING Wall Thickness two State Roads or County Roads. Include the road
Depth Diameter or Weight/Ft. Material numbers and common road names.
From D To </G FL l./ ,� Ss'x f�✓G
From To Ft. /l
From To Ft. r�h
13. GROUT: Depth Material Method
From__0 To�Q_Ft.eplyaEte i�rv.n.'wq
From To Ft. 7` —T
14. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in. rJ
From t
To Ft._in. m. L�
15. SAND/GRAVEL PACK: _
Depth Size Material
From To - FL
From To Ft.
16. REMARKS: '-
[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�9 /J• ��f�-ate-- /d SIGNATURE OF PERSON CONSTRUCTING THE WELL -- DATE
Submit the original to the Division of Water Quality,Groundwater Section, 1636 Mad Service Center-Raleigh,NC
27699-1636 Phone No.[phone], within 30 days. - GW-I REV.07/2001

WELL CONSTRUCTION RECORD
North Carolina-Department of Environment and Natural Resources-Division of Water Quality-Groundwater Section��JJ
WELL CONTRACTOR(INDIVIDUAL)NAM (print) r / CERTIFICATION na1�
WELL CONTRACTOR COMPANY NAME/ L RA SON A /JP�� awl j 1-1—C PHONE¢(2&j257 6_
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
1. WELL USE(Check Applicable Box):Residential G' Municipal/Public ❑ Industrial ❑ Agricultural ❑
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other,List Use
2. WELL LOCATIQN: Topographic/Land setting
Neares/[/Town: err„/ County,//rt/✓e,ir ❑Ridge 09lope ❑Valley ❑Flat
(check appropriate box)
(Street Name,Numbers,Community,Subdivision,Lot No.,Zip Code) Latitude,1ongilude of well location
3. OWNER: ,I','i°/d%c/PC
(degrees/minutes/seconds)
Address U / - -� cue..f Latitude/longitude source:OGPS❑Topographic map
(Sneer or Route No.) (check box)
efl/1(iv�r$/2N �P yC o1$7 / DEPTH DRILLING LOG
city orTown Srate Zip Code From To Formation Description
(Pi)-- 4 7- 44-/7 / O - G, ,O/
Area code-Phone number
4. DATE DRILLED J '26'01'
5. TOTAL DEPTH: Z y!-
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO ff�
7. STATIC WATER LEVEL Below Top of Casing: b 0 FT.
(Use"+"if Above Top of Casing)
8. TOP OF CASING IS�_FT.Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordance with 15.4.NCAC 2C.0118.
9. YIELD(gpm):f_METHOD OF TEST�g
10.WATER ZONES(depth): 1?0' J
LOCATION SKETCH
11. DISINFECTION:Type C' �%.+r. Amount /D Al e 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 7/ Ft. L./2.r S1-Yp2/ /c
From To Ft. - ��
From To FL
13. GROUT: Depth Material Method
From_(-To ,2D FL /YG E e �- �J"�1/r>/}/� A✓C -
From To Ft. 'a
14. SCREEN: Depth Diameter Slot Size Material �.
From To Ft. in. in. =.
t l
From To Ft.—in- in. n _
15. SAND/GRAVEL PACK: t
j
Depth Size Material t-n -•
From To - Ft. p
From To Ft.
16. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C,WELL
CONSTRUCTION STANDARDS,AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
Submit the original to the Division of Water Quality,Groundwater Section,: I436,Mai;Service Center-Raleigh,NC
27699-1636 Phone No.[phone],within 30 days. -` — GW-1 REV.07/2001
i
2 9

WELL CONSTRUCTION RECO7
North Carolina Department of Environment and Natural Resources-Division of Water Quality U �^
WELL CONTRACTOR(LNDIVIDUAL)NAME (print) - Vc O Y A C�'LC�/24./1 CERTIFICATTONM
WELL CONITLACTOR COMPANY NA6IE AAA GREE BROS.WELL DRLG.OF SYLVA,IN . pHONE k [phone] —
STATE WELL CONSTRUCTION PERNHTX ASSOCIATED WQ PER.NfIT#
(if applicable) _ (if applicable)
1. WELL USE(Check Applicable Box):ResidentiaX Municipal/Public❑ Industrial❑ Agricultural ❑
Monitoring❑ Recovery ❑ Heat Pump Water Injection❑ Other O If Other,List Use
2. WELL LOCATI — Topographic/Land Setting
Nearest Town: L7..0 Count 1,4'st-Tt-gidge lope ❑Valley ❑Flat
heck appropriate box)
(Street Farle,Numbers,Community,Subdios,on,Lot No.,-Lip Code) Latitude/longitude of well location
3. OWNER: t
1 / (dzgrees/minutes/secands)
Address �a,,cc---- ,6,r D_—� Latitude/longitude source:OGPSEITopographic map
Street or Rout No.) (check box)
�� DEPTH DRILLING LOG'
Ci Town Smte From To Formation Description
.Area code-Phone number
4. DATE DRILLED �� J
5. TOTAL DEPTH:
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO e D
7. STATIC WATER LEVEL Below Top of Casing: /0--Z)FT.
(Use"*"if Above Top of Casing)
8. TOP OF CASING IS FT.Above Land Surface.
-Top orcasing terminated at/or below land surface requires a
variance in accordan with 15A NCAC 2C.0118.
9. )'1ELD(gpm): METHOD OF TEST 41 )-
10.WATER ZONE (depth):
LOCATION SKETCH
11. DISINFECTION:Tyne Amount G Show'direction and distance m miles from at least
12.. CASING: Wan Thickness two State Roads or County Roads. Include the road
�Depttk _ iat�t�er �o��t. b terial numbers and common road names.
From To Ft. W«.
From To Ft M
From To Ft.
13. GROUT: Depth ki!g
[ethod c_ t?
From ToFromTo Ft. t14. SCREEN: Depth Size aterial a
From To Ft. in. in. O
From To Ft in. in. - - Lrl ... -
15. SAND/GRAVE LTA CK:
Depth Size Material =.
From To Ft. -
From To Ft.
16. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED N ACCORDANCE WITH 15A-NCAC 2C,WELL
CONSTRUCTION STANDARDS,AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
Cyr L - 0S
SIGNATURE OF PERSON CON RUCTNG THE WELL DATE
Submit the orisinal to the Division or Water Quality,Attn: Information Management, 1617 Mail Service Center-
Raleigh,NC 27699-1617, Phone No.[phone],Within 30 days.
�V.09;2004
f
AUG 2 3 2005 ii l
_ I
i
- --

WELL CONSTRUCTION RECORD ok
North Carolina-Department of Environment and Natural Resources-Division of Water Quality-Groundwater Section
WELL CONTRACTOR(INDIVIDUAL)NAME (print)RICHARD MCCRARY CERTIFICATION#2010
WELL CONTRACTOR COMPANY NAME BARKER CONSTRUCTION, INC.BARKER WELL&PUMP PHONE # [phone]
STATE WELL CONSTRUCTION PERMIT# 1871 ASSOCIATED WQ PERMIT#
(if applicable) (ifapplicable) _
1. WELL USE(Check Applicable Box):Residential® Municipal/Publlc❑ Industrial❑ Agricultural❑
Monitoring❑ Recovery ❑ Heat Pump Water Injection❑ Other❑ If Other,List Use
2. WELL LOCATION: Topographic/Land setting
Nearest Town: BREVARD County TRANSYLVANIA ❑Ridge ❑Slope ❑Valley ®Flat
LAURA BROOKE LANE (check appropriate box)
(Street Name,Numbers,CommonAy,Subdivision,Lot No.,Zip Code) Latitude/longitude of well location
3. OWNER: PAUL LAJEUNESSE (degrees/minutes/aeconds)
Address 3201WIDMANDRIVE Latitude/longitude source:❑GPS❑Topographicmap
(Street or Roots No.) (check box)
SUMTER Sc 29150 DEPTH DRILLING LOG
City or Town State tip Code From To Formation Description
( 803)- 494-2474
Area code-Phone number -
4. DATE DRILLED OCTOBER 4,2005
5. TOTAL DEPTH: 545 0
6. DOES WELL REPLACE EXISTING WELL? YES❑ NO 91 `-
7. STATIC WATER LEVEL Below Top of Casing: 44 FT.
(Use"+"if Above Top of Casing)
S. TOP OF CASING IS 1.33 FT.Above Land Surface• -
n
'Top of casing terminated aUor blow land surfare requires a
variance in accordance with 15A NCAC 2C.0118.
9. YIELD(gpm): 10 METHOD OF TEST TIMED
10.WATER ZONES(depth):
LOCATION SKETCH
11. DISINFECTION:Type aY PUMP INSTPLLER Amount Show direction and distance in miles from at least
12. CASING: Wall Thickness two State Roads or County Roads.Include the road
Depth Diameter or Weight/Ft. Material numbers and common road names.
From � �� '/ ,/�p"
From 0 To 52 Ft. 61/8 SDR21 PVC J,r(,(k7Lpjt.Q(lQ.([(p9j,ErlpL;f6cp((2P�C,eI(dd1LQ1jt(Jl?
From To Ft. Q�q�y,-{'�]WAJ/ aih. bip aii-i'1�oui"l') v
From To Ft. Q.i`L0� /Q.{�.4._ CLI.(JLC'1E On
13. GROUT: Depth Material Method `p_ � � ^ V�� ""''
From 0 To 20 FL CONCRETE POURED �LCGCLkt2 �j �p ((�J-n txx fb1b10�
From To Ft. �, d � 7 �p
14. SCREEN: Depth Dimaeter Slot Size Material
�'�""��, tvco J�
From To Ft. in in. LrQGLQX.,a-cu.a�u,F
From To Ft. in. in
15. SAND/GRAVEL PACK:
Depth Size Material /(,tp,�rtlt�.�u.-•
From—To—Ft.-
From—Tom—Ft.
16. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15ANCAC 2C,WE
CONSTRUCTION STAND S AND AATACO Y OF THIS RECORD HAS BEEN PRO E D TO THE WE O
S[ NATURE OF PERSON CONSTRUC�RM THE WELL DATE
Submit the original to the Division of Water Quality,Groundwater Section,1636 Mail Service Center-Raleigh,NC
27699-1636 Phone Na(919)7333221,within 30 days. GW-I REV.07/2001

o//Ck ��
�1TLL CONSTRUCTION CORD
North Carolina Departrnentp of Environment and Natural Resources-Division of Water Quality 3 � 4 2 8 V
WELL COWRACTOR(L-fDIVIDUAL)NA.ME (prioQ � '� y�G l,v.�r f., CERTIFICATION#"—d :)..
WELL CONTRACTOR COMPANY NAME AAA GREENE BROS.WELL DRLG.OF SYLVA,INC. PHONEM [phone] '
STATE WELL CONSTRUCTION PERMIT% ASSOCIATED W'Q PERMITN
(if applicable) (if applicable)
1. WELL USE(Check Applicable Box):Residential ❑ MunicipaVPublic❑ Industrial❑ Agriculrural ❑
hfonitoring❑ Recovery ❑ Heat Punp Water Injection❑ Other❑ If Other,List Use
2. WELL LOCATI \ Topographic/Land setting
\zarestTown: v Con - q.
' - .cfIISlope (7Vallzy ❑Flat
Lt G l (check appropriate box)
(Sent Name.Numbers.CornInuniri,Subdivisi n,Lot No. ode) Latitude/longirude•f well location
1 3. ONNE R: i a -t v-, lh'LV L (degrces/miouteslsccands)
Address ! U J '714 l U 6 Latitude/loneirude source:OGPSI]Topographic map
' (Swett or Ro [r aJ (check box)_ ,.
�(A!Lw, -, / � 3 Z DEPTH DRILLING LOG
—Fity or Town State zip Code From To Formation Description
828)-
Area code.Phone number ' 2l
4. DATE DRILLED— J ���
5. TOTAL DEPTH:
6. DOES WELL REPL CE EXISTING WELL? /Y"ES O IjO
W
7. STATIC WATER LEVEL Below Top of Casing: �> U T.
(Use'-+-if Abovc Top of Casing)
8. TOP OF CASING IS FT.Above Land Surface'
-Top urnsine terminated atlor below land surface requires a
rarianceinaccordanc ithliANCAC2C.0118.' A _
9. YIELD(epm): J METHOD OF TEST I
10. WATFP.70NES(depth):---- Icv
LOCATION SKETCH
SKETCH
11. DISINFECTION:Type Amount 2U.• Show direction and distance in miles from at least
12. CASING: Wall Thickness two StJte Roads or County Roads. Include the road
Depth D'amet r or Weight,Tt. Iatenal numbers and common road names.
From To' -2- _Ft. I I u 7s-17121 1 �
From__To Fr. j
From - To FLU:•� -
13. GROUT: Depth Material Method
From y To_.3_Ft.
From Tom Ft. h..^� -+r,,� 7�-G; `✓
14. SCREEN. Depth Diameter Slot Size h�— LG/a yi/7J(-
From To Ft., in. in. �• V✓
From To Ft. in. . in.
15. SAND/GRAVEL PACE:
Depth Size Material
From To Ft.
From To Ft.
16. REMARKS:
I DO HEREBY CERTIFY THAT T I WELL V69S CONSTRUCTED IN ACCORDANCE WITH ISA NCAC 2C,WELL
COWSIONS NDA MPY OF THIS RECORD HAS BEEN PROVIDED TO THF WELL 9WNER
Uo
SIGNATURE OF PERSON CONSTRUCTING THE"'ELL DATE
Submit the original to the Division or Water Quality,Attn: Information Management, 1617 Mail Service Center-
Raleigh,NC 27699-1617, Phone No.[phone],within 30 days.
GW-I REV.09,2004
RECEIVED
Asheville Regional Office
Aquifer Protection

WELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources-Division of Water Quality
WELL CONTRACTOR tVMrVIDUAL)N.4�IE
CERTIFICATIONN
;.WELL CONTRACTOR COMPANY NAME
+' .�>_� PHONE !
STATE WELLCONSTRUCTION PER�IITR 0 ,
(if applicable),.- - ASSOCIATED WQ PERMIT#
(if applicable)
1. WELL USE(Check Applicable Box):Residential'k Municipal/Public❑ Industrial❑ Agricultural❑
Monitoring❑ Recovery ❑ Heat Pump Water jection❑ 9ther IfiIf Other,List Use
2. WELLTLCI �:
estL owOC
n: , t ., R�if l v E
�0 C ty 7 / Midge O Topographic/Land
allettmg e
(Street Name,Numbers,Community,Su via n, o� Zip Cade) ya�777 (check appropriate box) lat
�taZ Latitude/longitude of well location
3. OWNER: /
Address v '�.p�,V _(degrea�minuresheconds)
/ (Street or RoutyJ�o.) _Latitude/longitude source:❑GPS❑Topographic map
DEPTH (check box)
Gty or Town Sratc Zip Code DRILLING TAG t ..
�} From To Formation Description
Area code-Phooe aunber - '
4. DATE DRILLED -7 _off_
5. TOTAL DEPTH: Sg'� (o ^
6. DOES WELL REPLACE EXISTING WELL? YES❑ NO Id\ /
7. STATIC WATER LEVEL Below Top of Casing: Scr2) FT 3
(Use"+^if Above lop of casing) ------
8. TOP OF CASING IS i FT.Above Land Surface•
`Top of casing terminated atlor below land surface requires a
variance in accordan�ce�with 1SA NCAC 2C.011a.
9. YIELD(gpm):. ltZ , METHOD OF TEST
10.WATER ZONES(depth): ( ( b
11. DISINFECTION:Type / F LOCATION SKETCH
YP Amount Show direction and distance in miles from at least
12. CASING: Wall Thickness two State Roads or County Roads. Include the road
Depth Diameter or Weight/FL M crial numbers and common road names.
From t) To zL Ft. r �$�triel
From To Ft
From To Ft.
]3. GROUT: Depth Material Method
From___(_To
From To=FL FL�--
14. SCREEN: Depth .. Diameter Slot Size Mate al
From To Ft. in.
From To in.
15. SAND/GRAVEL PACK: Ft in in. 7
Depth - Size N
Material �1
From To FL
From To Ft.
cn -
16. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C,WELL -
CONSTRUCTION STANDARDS,AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
- - SIGNATURE OF PERSON COirS UCTING THE WELL ---
DATE
Submit the original to the Division of Water Quality,Attn:Inf0rmgtinn AI&M me —
Raleigh,NC 27699-1617, Phone No.[phone],within 30 days. RECEIVED
y G� sT6��lyYJG
e Center-
R E C E I G Li -1 RFV.09/2004
Asheville Regional o

WELL CONSTRUCTION RECORD
North Carolina-Department of Environment and Natural Resources-Division of Water Quality-Groundwater Section
ry
WELL CONTRACTOR(INDIVIDUAL)NAM,E (print)C>/B hn + tte e—e CERTIFICATION#��
WELL CONTRACTOR COMPANY NAME/4
r.rB/,- LWaI/ /l/&M/7 PHONE #
J
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERRIIT#
(if applicable) (if applicable)
I. WELL USE(Check Applicable Box):Residential Municipal/Public❑ Industrial❑ Agricultural❑
Monitoring❑ Recovery ❑ Heat Pump Water Injection❑ Other❑ If Other,List Use
2. WELL LOCATI N: TopograpJuc/Land setting
Nearest Town:9^0 f CountyTDt-n's ❑Ridge OSIope ❑Valley ❑Flat
C-E DA 4i y21Tt--1 (check appropriate box)
(Street Name,Numbers,Community,Subdivision,I.ot No..Zip Code) Latitude/longitude of well location
3. OWNER:tK- r />" D (degrees/minutes/seconds)
Address ?- � l �2c`i 0-0C - I J Latitudetlongitude source:❑GPS❑ map
ap
(Sued ar Route No.) (check box)
a'lla nt Gr 14�//h� DEPTH DRILLING LOG
city or Tovm ware Zip Code From To Formation Description
( fiG4--ay6r
Ara code-Phone amber
4. DATE DRILLED tC- 4f-U�
5. TOTAL DEPTH:!d ig-
6. DOES WELL REPLACE EXISTING WELL? YES❑ NO
7. STATIC WATER LEVEL Below Top of Casing:ts'4 FT.
(Use"+"if Above Top of Casing)
8. TOP OF CASING IS FT.Above Land Surface*
-Top of cuing terminated allor below land surface requires a
variance In accordance with ISA NCAC 2C.01IS.
9. YIELD(gpm): 2-;k= METHOD OF TESTGL/T
10.WATER ZONES(depth): CA4
LOCATION SKETCH
11. DISINFECTION:Type Amount Show direction and distance in miles from at least
12. CASING: Wall Thickness two State Roads or County Roasts.Include the road
Depth Diameter or Weight(Ft. Material numbers and common road names.
Fromm To m Ft.Gjh_ AQ- CO v I
- -
From To Ft. _ 11�
From To Ft. - ,
13. GROUT: Depth Material Method m
From ,-O Toyd Fty�iono�ib;le sw�rv/
1, , 1
From. To Ft. r-
14. SCREEN: Depth Diameter Slot Sin Material T-'J
L&
From To Ft. in. in. 1 _
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Size Material
FronL To Ft.
rt
From To Ft.
16. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH ISA NCAC 2C,WELL
CONSTRUCTION STANDARDS,AND THAT A COPY OF THIS RECHAS BEEN PROVIDED TO THE WELL OWNER
/, nDt�trs,-
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

�OF M A TFRO Michael F.Easley,Governor
\Q G William G.Ross Jr.,Secretary
f7 r North Carolina Department of Environment and Natural Resources
Alan W.Klimek,P.E.Director
O C
Division of Water Quality
AQUIFER PROTECTION SECTION
June 7, 2005
Mr. Allen Merrill WCC#2004 =-! c
Merrill Well &Pump,Inc.
Route 1,Box 105 _
Penrose, North Carolina 28766
RE: Variance Request to Rule 15A NCAC Mf G
2C. 0107(a)(2)(N)—Well Location
Nichols Property, Cedar Mtn. _-
Transylvania County,North Carolina
Dear Mr. Merrill:
On June 7,2005,the Asheville Regional Office received your request for a variance to Rule 15A NCAC
2C. 0107(a)(2)(N). This Rule requires a 50 ft- separation distance between a well and a surface water body,
such as a pond or a lake. This variance is for the construction of a water supply well on property owned by
William Nichols, off of US 276,in Transylvania County,North Carolina.
In your request you indicate that the only suitable location for the well is 29 feet from the pond. Based
upon the information you have submitted to this office, a variance to the above-cited Rule is granted. This
variance will be effective for a period of six (6)months beginning from the date of issuance. Since the well will
not meet regulatory requirements, the following minimum additional construction requirements will be
necessary to mitigate any potential problems that could affect public health and/or the well's effective
operation:
1. The casing shall be GALVANIZED and shall extend to the following depths:
a) if bedrock depth is<50 feet,the greater of 15 feet into bedrock or 40 feet below land surface;
b) if bedrock depth is 50-100 feet, 10 feet into bedrock;
c) if bedrock depth is>100 feet, 5 feet into bedrock.
2. The entire depth of the casing shall be grouted. A drill bit that is at least 1/3 greater than the
outside diameter of the easing shall be used to drill the cased portion of the well. The grout shall
be installed using the pressure method. The installation of grout using a tremmie pipe is
acceptable if the annular space to be grouted is free of obstructions.
3. The well shall be located in the area identified on the map included with the variance request.
N}o0�0 tCam¢'na
,Nllll[Jr!p
North Carolina Division of Water Quality-Asheville Regional Office 2090 U.S.Highway 70 Swannanoa,N.C. 28778 Phone[phone]
FAX [phone]
Customer Service "77-623-674a
Internet: h2o.enr.state.nc.us
An Equal OppaWnilylABYmaWe Action Empbyer-50%Regded/lG 6 POSWO(altmaf Paper

Mr: Allen Merrill
June 7, 2005
Page 2
4. The well driller shall be certified by the North Carolina Well Contractor Certification
Commission as required by General Statutes 87-98.4, Title 15A NCAC 27. 0101 and .0110.
5. Notification shall be given to H.E.Minnick or Landon Davidson at the letterhead address or by
phone at(828)296-4500, at least 24 hours prior to the start of well construction.
6. Notification shall also be given upon completion of the well.
It is my finding that the factors specified above are sufficient to satisfy the conditions of approval of a
variance as defined in 15A NCAC 2C.0118. A copy of this variance should be attached to the required Well
Construction Record(GW-1)that is submitted to the Department.
The granting of this variance is for the location of the well only and in no way relieves the owner or
agent from other requirements of the North Carolina Well Construction Standards, or any applicable law,rule,
or regulation that may be regulated by other agencies. If you are dissatisfied with this decision,you may
commence a contested case by filing a petition under G.S. 150-23 within sixty(60)days after receipt of the
decision.
If you have any questions regarding this variance,please contact H.E. Minnick or Landon Davidson at
the listed telephone number.
Sincerely,
G. Landon Davidson,L.G.
Aquifer Protection Section Regional Supervisor
Asheville Regional Office
cc: Mr. William Nichols
Environmental Health,Transylvania County Health Department
ARO/file

Date Oj
Mr. G. Landon Davidson,L.G.
NCDENR-DWQ-APS Section
2090 US Highway 70
Swannanoa,North Carolina 28778
Subject: Request For a Variance
Dear Mr. Davidson:
I would like to request a variance to the NC Well Construction Standard that
requires a well to be so Fear t"- do i R A-0 . Because of the
SMktc brr stO67 # C CWW vt s prc-T�f� ,the well will be Z9
A;ri Aram IIQ- '--- __ I-have included a -
sketch of the property with the location of thef�rc iz.v�
and the proposed well site.
If you have any questions,please call me at 7
Ally- Y77-3ZOS
Sincerely,
Owner's name and mailing address: fl
-2. -)3 i)cacN
C - 104
Driller's name, WCC#and address: , Ljc4j jrz) Q A 3d 30 S
��/Fit rn�RR.11 1 X /cam I76Nf r $Z kl.0 z-97&C-
(Sketch,incI street name or DOT#) Qmkw.� County::rj4qW S
1 I➢soli AP lwcw SCR
�1k9
C400R- H.-A/
(MUST BE SUBMITTED BY A CERTIFIED DRILLERI