Cd CY2006

ECEIVED
RESIDENTIAL WELL CONSTRUCTION RECORD
Noun Larolina Dept rtment otEnvironment and Natural Resources- Division of Water Quality
eville RegWop13LQf{?RA:TOR CERTIFICATION #
as7Z
w=l I re" 1Yrotection
w fl'1o\\zs
Well Contractor (Individual) Name
Yadkin Nell Company Inc.
Well Contractor Company Name
STREET ADDRESS 1908 Hamptonville Road
Hamptonville NC 27020
City or Town State Zip Code
( 336 y 468-4440
Area code- Phone number
2. WELL INFORMATION:SITE WELL ID #(it applicable) %Y'/`F 1'- G Q /
STATE WELL PERMIT#(it applicable)
DWQ or OTHER PERMIT #(i( applicable)
WELL USE (Check Applicable Box): Residential Water Supply r
DATE DRILLED ) - p�.r'O (o
TIME COMPLETED /.'21%o AMID PMle'
3.WELL LOCATION: '• ' •
CITY: kw t 4o r COUNTY7L/'u, ♦ze
(l�t . v �a!/r Ref
(Street Name, Nu/libels.Community. Subdivision, Lot No., Parcel, Zip Code)
LTOPOGRAPHIC / LAND SETTING:
p.alope p Valley El ❑Ridge ❑Other
(� „ (check appropriate box)
LATITUDE _,,9 4 -J 9 s
LONGITUDE L >? C 4 q'
Latitude/longitude source: )VGPS ❑Topographic map
(location of web must be S1wwn on a USGS topo map and
attached to this tom l not using GPS)
4. WELL OWNER �
OWNER'S NAME /A r4,r x),e/la M."
STREET ADDRESS 137s t / 4n-I Rre
Vti•
y 1,4 e
City mown State Z' Code
May be in degrees,
minutes, seconds or
in a decimal format
f. DISINFECTION: Type HTH
g. WATERZONES(depth).
From / .✓ To /�D
Amount
J13.crts
From To
From To Fran To
Ran To Fran To
6. CASING:
Thickness/
Fan % Dept
r . FL p1m'er FLpvc,sbtMaterial
From To Ft.
From To Ft.
7. GROUT: Depth
From 0 To V Ft
From y To (47' Ft
From To Ft
Material
'iai/4
Method
8. SCREEN: Depth Diameter Slot Size Material
From To Ft In. in.
From To Ft. In In.
Fran To Ft in. in.
9. SAND/GRAVEL PACK:
Depth Size
From To Ft
From To Ft.
m
( sjt %9L(-//*7
Area c e - Phone nuer
5. WELL DETAILS: LL'' r
a. TOTAL DEPTH: - -7O a
b. DOES WELL REPLACE EXISTING WELL? YES 0 NO,
c. WATER LEVEL Below Top of Casing: «Di0 FT.
(Use '4' H Above Top of Casing)
d. TOP OF CASING IS / FT. Above Land Surface'
'Top o( casing terminated at/or belay land surface may require
a variance M accordance with 15A NCAC 2C .0118.
+/
e. YIELD (gpm): / /1- METHOD OF TEST Air • Pump
Material
Fran To Ft
10. DRILLING LOG
From To
0
LaT /.7„•
/.To'- 9o1-•
Bit serial No
11. REMARKS:
Forrplation Description
. OzOD
trial O•.ra.r ,.-
/i4ed Ski (fruunt. «cc.
Size off L.67'7
100 HEREBY CERTFY TRAITOR WELL WAS CONSIRUCIED N ACCORDANCE WRH
15A NCAC 2C, WELL CONSTRUCTOR STANDARDS, AND THATA COPY OF MS
RECORD HAS BEEN PROMDEDTOTHE WELL OWNER.
ca r' i a5-66
TU F CERTIFIED WELL CONTRACTOR DATE
J (.4.)frl(/3
PRINTED E OF PERSON CONSTRUCTING THE WELL
Submit the original to the Division of Water Quality within 30 days. Attn:Infonnation Mgt.,''
1617 Mall Service Center- Raleigh, NC 27699-1617 Phone No. [phone] ext 568.
Date site SO
/-- Z; -, , P by (fie Permit required: ,i red: Yes
eiJ O 9"/o /JV 36;An.®./
Fain GW-la
Rev. 7105

RESIDENTIAL WELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources - Division of Water Quality
WELL CONTRACTOR CERTIFICATION # 2661
1. W ELL CONTRACTOR:
STEVE PEtTY
Well Contractor (Individual Name)
DEWEY WRIGHT WELL & PUMP CO_ iP:C
Well Contractor Company Name
STREET ADDRESS P 0 PDX 3n3
200NE NC 2E507
City or Town State Zip Code
( 828 )- 2E4-2651
Area code - Phone number
2. W ELL INFORMATION:
SITE WELL ID #(n applicable)
STATE WELL PERMIT #(if applicable)
DWQ or OTHER PERMIT #(d applicable)
WELL USE (Check Applicable Box): Residential Water Supply 0
DATE DRILLED 11Qt211118
TIME. COMPLETED 111 IV) AMU PM
3. WELL LOCATION:
CITY: MORJ: NTON COUNTY _-*LDVELL
LITTLE JOHN OFF HARTLAND RD. OFF HWY 18 OF
(Street Name, Numbers, Community, Subdivision, Lot No., Parcel, Zip Code)
TOPOGRAPHIC / LAND SETTING:
9 Slope 0 Valley 0 Flat 0 Ridge 0 Other
(check appropriate box)
LATITUDE 3 35 877'36
May be in degrees,
minutes, seconds or
LONGITUDE 0g1.65173D
in a decimal format
Latitude/longitude source: ai GPS ❑ Topographic
(location of well must be shown on a USGS
attached to this form if not using GPS)
4.WELL OWNER
OWNER'S NAMEMFl INF.4 RM(Ti-I
map
topo map and
STREET ADDRES3'rf Rr K 3482 ,
! Ff,r1Pi r`h_. 'R61.15
City or Town State Zip Code
(f 8281 ) _ 323 2375
Area code - Phone number
5.WELL DETAILS:
a. TOTAL DEPTH: 4115
b. DOES WELL REPLACE EXISTING WELL? YES 0 N0,12
c. WATER LEVEL Below Top of Casing: ?0 FT.
(Use "+" if Above Top of Casing)
d. TOP OF CASING IS 1 FT. Above Land Surface*
Top of casing terminated at/or below land surface may require
a variance in accordance with 15A NCAC 2C .0118
e. YIELD (gem): 1 METHOD OF TEST v..'r
05i1710
f. DISINFECTION: Type NTH Amount 1,9
g. WATER ZONES (depth):
From r:n To :,t From To
From To From To
From - To From To
6.CASING: Thickness/
Depth Diameter Weight Material
From n To 11R Ft. F. 1'n 1v70 ''a'r.
From iT To 0 Ft
From To Ft.
7.GROUT: Depth Material Method
From t0 To Ft.Thr-,_-,rt CZr-Zr- =low.
From To Ft.
From To Ft.
8.SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in.
From To Ft. in. in.
From To Ft. in. in.
9.SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
From To Ft.
10. DRILLING LOG
From To Formation Description
0 'CO DIRT
t00 133 GRANITE
130 1_31 SHALE
131 405 ?4ANgE
IVED`.
MAR 2 7 20�6
sheville egionalOffit.e
' r Protection
11. REMARKS:
1 GFM 130 - 131 0 GFPe1 -
O.,;Pt,i -. !0 ,'PM
fl "PRA - 0 npAA -
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH
15A NCAC 2C, WELL CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS
RECORD HAS BEEN PROVIDED TO THE WELL OWNER.
J — a o—Ok
SI NATURE OF ERTIFIED W L CONTRACTOR DATE
STEVE PETTY.
PRINTED NAME OF PERSON CONSTRUCTING THE WELL
Submit the original to the Division of Water Quality within 30 days. Attn: Information Mgt.,
1617 Mail Service Center - Raleigh, NC 27699-1617 Phone No. [phone] ext 568.
Form GW-la
Rev. 7/05

RESIDENTIAL WELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources - Division of Water Quality
WELL CONTRACTOR CERTIFICATION #
1.WELL CONTRACTOR:
Well Contractor (Individual Name)
Well Contractor Company Name
STREET ADDRESS
r JO
City or Town State Zip Code
)- -,a4-^^:._1
Area code - Phonenumber
2.WELL INFORMATION:
SITE WELL ID Mir applicable)
STATE WELL PERMIT #flt applicable)
DWQ or OTHER PERMIT #(ft applicable)
WELL USE (Check Applicable Box): Residential Water Supply
DATE DRILLED 433 '
TIME COMPLETED AM ❑ PM U
3. WELL LOCATION:
CITY: I,.-..
COUNTY
(Street Name, Numbers, Community, Subdivision, Lot No., Parcel, Zip Code)
TOPOGRAPHIC / LAND SETTING:
❑ Slope O Valley .0 Flat O Ridge ❑ Other
(check appropriate box)
LATITUDE 3 pc:, r
LONGITUDE 41Y: 1 ' n lJ
Latitude/longitude source: GPS ❑ Topographic map
(location of well must be shown on a USGS topo map and
attached to this form if not using GPS)
May be in degrees,
minutes, seconds or
in a decimal format
4.WELL OWNER
OWNER'S NAMEr*A T'c',,:
STREET ADDRESS;
City or Town State Zip Code
( ( ) -
Area code - Phone number
5.WELL DETAILS:
a. TOTAL DEPTH: �;fr
b. DOES WELL REPLACE EXISTING WELL? YES ❑ NO;17
c. WATER LEVEL Below Top of Casing: m 1 FT.
(Use "+" if Above Top of Casing)
d. TOP OF CASING IS ", FT. Above Land Surface'
' Top of casing terminated at/or below land surface may require
a variance in accordance with 15A NCAC 2C .0118
e. YIELD (gpm): METHOD OF TEST
324458
f. DISINFECTION: Type :-IT) -I Amount :..
g. WATER ZONES (depth):
From = To From To
From To From To
From To From To
6.CASING: Thickness/
Depth Diameter Weight Material
From ,_ Ft. ._. 'i.fr, f:" (-
:
From r1 To ri Ft.
From To Ft.
7.GROUT: Depth Material Method
From i1 To ;_ Ft.,..:.., .....n`
From To Ft.
From To Ft.
8.SCREEN: Depth Diameter Slot Size Material
From To Ft in. in.
From To Ft. in. in.
From To Ft. in. in.
9.SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
From To Ft.
10. DRILLING LOG
From To Formation Description
ICC'
iIS
11. REMARKS:
TN
,a)
W
rn
n
rn
c
0
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WRH
15A NCAC 2C, WELL CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS
RECORD HAS BEEN PROVIDED TO THE WELL OWNER.
SIGNATURE OF CERTIFIED WELL CONTRACTOR DATE
F Frci-i.,c:
PRINTED NAME OF PERSON CONSTRUCTING THE WELL
Submit the original to the Division of Water Quality within 30 days. Attn: Information Mgt.,
1617 Mail Service Center - Raleigh, NC 27699-1617 Phone No. [phone] ext 568.
Form GW-la
Rev. 7/05

RESIDENTIAL WELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources - Division of Water Quality
WELL CONTRACTOR CERTIFICATION #
1. W ELL CONTRACTOR:
Well Contractor (Individual Name)
Well Contractor Company Name
STREET ADDRESS
2'et507
City or Town State Zip Code
( ) - ,,:;
Area code - Phone number
2. WELL INFORMATION:
SITE WELL ID #(it applicable)
STATE WELL PERMIT #(if applicable)
DWG) or OTHER PERMIT #ff applicable)
WELL USE (Check Applicable Box): Residential Water Supply
DATE DRILLED ,. • — `+ "l
TIME COMPLETED -'.. AM ❑ PM LI
3. WELL LOCATION:
CITY: LEI
COUNTY
OFF L
E f_ R OFF t :_fie r. -JET c. :_G'EEk; R
(Street Name, Numbers, Community, Subdivision, Lot No., Parcel, Zip Code)
TOPOGRAPHIC / LAND SETTING:
9, Slope U Valley ❑ Flat O Ridge 0 Other
(check appropriate box)
LATITUDE 3 ?p' c".7.,)_:2
LONGITUDE.
Latitude/longitude source: Q GPS ❑ Topographic map
(location of well must be shown on a USGS topo map and
attached to this form if not using GPS)
May be in degrees,
minutes, seconds or
in a decimal format
4.WELL OWNER
OWNER'S NAME la :10
STREET ADDRESS ncf f "a_ -+1-=@
City or Town State
(1E231 )- '.;i^'1'_:'"1
Area code - Phone number
Zip Code
5.WELL DETAILS:
a. TOTAL DEPTH: 'i"G
b. DOES WELL REPLACE EXISTING WELL? YES ❑ NO` I
c. WATER LEVEL Below Top of Casing: 'i FT.
(Use "+" if Above Top of Casing)
d. 70P OF CASING IS FT. Above Land Surface*
Top of casing terminated at/or below land surface may require
a variance in accordance with 15A NCAC 2C .0118
e. YIELD (gpm): 1 METHOD OF TEST Air
324457
t`!Eidi; _9
f. DISINFECTION: Type ,;T-- Amount ;"•)
g. WATER ZONES (depth):
From To dT*. From To
From To From To
From To From To
6.CASING: Thickness/
Depth Diameter Weight Material
From i`. To i r Ft. r: 1 ?;';f1 ..
From rl To..)_ Ft.
From To Ft.
7.GROUT: Depth Material Method
From ii To Ft.
From To Ft.
From To Ft.
B.SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in.
From To Ft in. in.
From To Ft. in. in.
9.SAND/GRAVEL PACK:
Depth Size Material
From _To Ft.
From To Ft.
From To Ft.
10. DRILLING LOG
From To
11. REMARKS:
Formation Description
m
�; (D 01
O to
6wit
rnl
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE Wmi
1 SA NCAC 2C, WELL CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS
RECORD HAS BEEN PROVIDED TO THE WELL OWNER.
SIGNATURE OF CERTIFIED WELL CONTRACTOR DATE
R-EC`-
PRINTED NAME OF PERSON CONSTRUCTING THE WELL
Submit the original to the Division of Water Quality within 30 days. Attn: Information Mgt.,
1617 Mail Service Center - Raleigh, NC 27699-1617 Phone No. [phone] ext 568.
Form GW-la
Rev. 7/05

RESIDENTIAL WELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources- Division of Water Quality
WELL CONTRACTOR CERTIFICATION # 02.251
1. WELL CONTRACTOR:
C' 1 w1 tSu_sseu
Well Cdntractor (Individual) Name
Ru.ssail Ott i Dhi i l i n3
Well Contractor Company Name n
STREET ADDRESS �Ya// rek, beH-iy l2hateh d'/
Ty/ors vi lie- Na f26$I
City or Town State Zip Cale
(gam)- �.g23logg
Area code- Phone number
2. WELL INFORMATION:
SITE WELL ID #(if applicable)
STATE WELL PERMIT#(Napplicable)
DWQ or OTHER PERMIT #(if applicable) �/
WELL USE (Check Applicable Box): Residential Water Supply Lrf
DATE DRILLED / — 0 4,
TIME COMPLETED /D :c3D AMEfi PMO
3.WELL LO
CITY:r e ilW
Jeraa i
(Street Name. Numbers, C unity. Subdivision, Lot No.. Parcel. Zip Code)
COUNTYhf16,.
TOPOGRAPHIC! LAND SETTING:
ID Slope ❑Vafey ['Fiat ❑Ridge ❑Other
(check- appropriateA,box)
LATITUDE SS7. v7 n7 4
LONGITUDE wo Y/.-2D. 5%4/
Latitude/longitude source: ttPS ❑Topographic map
(location of well must be shown on a USGS topo map and
attached to this form )not using GPS)
4. WELL OWNER
May be in degas,
minutes. seconds or
in a decimal format
OWNER'S NAME 7/a 1/1/.1 aE" 104, 4)71(t?m/h=G
STREET ADDRESS 411.t 8 'L. cd .4.i_ fi ,ch '
44.41.4 , 77C 4R60-3 9
or Town State Zip Code
(gat? )-3R/- 6700
Area code - Phone number
5. WELL DETAILS: j'
a. TOTAL DEPTH: 'Vc2S
b. DOES WELL REPLACE EXISTING WELL? YES ❑ NO ttf/
c. WATER LEVEL Below Top of Casing: S 0 FT.
(Use -+- if Above Top of Casing)
d. TOP OF CASING IS I �,� FT. Above Land Surface
*Top of casing terminated at/or below land surface may require
a variance in accordance with 15A NCAC 2C .01188.'',�,''
e. YIELD (gpm): 4 METHOD OF TEST fJr,a�i
i eV a t3
f. DISINFECTION: Type /'r rir Amount / CL[fysi
g. WATER ZONES (depth):
From it D To 402S From To
From _ To From To
From To From To
6. CASING:
Depth Diameter
From 17 To /42 0 Ft.
From To Ft.
From To Ft.
7. GROUT: Depth
From 0 To a.D Ft.
From To Ft.
From To Ft.
Material
Thickness)
Weight Material
P✓e-
Method
7 7Aod
8. SCREEN: Depth Diameter Slot Size Material
From To Ft. in.
From To Ft. in.
From To Ft. in.
9. SAND/GRAVEL PACK:
Depth
From To Ft.
From To Ft.
Size
in.
hi.
in.
Material
From To Ft.
10. DRILLING LOG
From To
D /D
RFCE
Formation Description
2d7�
s evl Re. e
qquifer Protection
i t. RE1Mjf3 r
O
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED N ACCORDANCE WRH
15A NCAC 2C. WELL CONSTRUCTION STANDARDS. AND THAT A COPY OF THIS
RECORD HAS BEEN PROVIDED TO THE WELL OWNER.
SIGNATURU/OF CERTIFIED WELL CONTRACTOR DATE
0—Ly aRu_s53iI
PRINTED NAME OF PERSON CONSTRUCTING THE WELL
Submit the original to the Division of Water Quality within 30 days. Attn: Information Mgt.,
1617 Mail Service Center —Raleigh, NC 27699-1617 Phone No. [phone] ext 568.
Form GW-1a
Rev. Troy

RESIDENTIAL WELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources - Division of Water Quality
WELL CONTRACTOR CERTIFICATION # 2878
1. W ELL CONTRACTOR:
STEVE PRICE
Well Contractor (Individual Name)
DEMtEY WRIGHT`NELL & PLUMP CO., INC.
Well Contractor Company Name
STREET ADDRESS P. O. BOX 308
BOONE NC; 28607
City or Town State Zip Code
( 828 ) - 264-2651
Area code - Phone number
2.WELL INFORMATION:
SITE WELL ID #(it applicable)
STATE WELL PERMIT Npf applicable)
DWQ or OTHER PERMIT lkifapplicable)
WELL. USE (Check Applicable Box): Residential Water Supply ID
DATE DRILLED 130t22006
TIME COMPLETED 5-00 AM ❑ PM LI
3. WELL LOCATION:
CITY: 2873 COUNTY CALDWELL
TRCT# 2 OFF GREENFIELD PL. OFF 1-1\fa Y 18 S. 0
(Street Name, Numbers, Community, Subdivision, Lot No., Parcel, Zip Code)
TOPOGRAPHIC / LAND SETTING:
L Slope 0 Valley 0 Flat 0 Ridge 0 Other
(check appropriate box)
LATITUDE 3 36.00561
May be in degrees,
minutes, seconds or
LONGITUDE 081.23058
in a decimal format
Latitude/longitude source: 3 GPS ❑ Topographic
(location of well must be shown on a USGS
attached to this form if not using GPS)
4.WELL OWNER
OWNER'S NAME DENNIS HARRIS CONSTR.
map
topo map and
STREET ADDRESS2540 BRITTANY DR. ,
L E>!OIR f.IC 28645
City or Town State Zip Code
((8281 )- 499-3684
Area code - Phone number
5.WELL DETAILS:
a. TOTAL DEPTH: 605
b. DOES WELL REPLACE EXISTING WELL? YES 0 NO)E7
c. WATER LEVEL Below Top of Casing: 40 FT.
(Use "+" if Above Top of Casing)
d. TOP OF CASING IS 1 FT. Above Land Surface*
Top of casing terminated at/or below land surface may require
a variance in accordance with 15A NCAC 2C .0118
e. YIELD (gpm): 1.5 METHOD OF TEST Air
060112
f. DISINFECTION: Type
g. WATER ZONES (depth):
From 2E0 To 281
HTH Amount 115
From 570 To571
From To From To
From To From To
6.CASING: Thickness/
Depth Diameter Weight Material
From 0 To 81 Ft. 51/8 350 PVC
From 0 To 0 Ft.
From To Ft.
7.GROUT: Depth Material Method
From 0 To 20 Ft.Celnent Gravity Flory
From To Ft.
From To Ft.
8.SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in.
From To Ft. in. in.
From To Ft in. in.
9.SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
From To Ft.
10. DRILLING LOG
From To Formation Description
076 DIRT '.
76 280 GRANITE ..-
230 281 GRANITE
281 570 GRANITE
570 571 QUARTZ
571 505 GRANITE �.{4
-,y
11. REMARKS:
1 GPM 280 - 281 0.5 GPM 570 - 571
0 GPM - 0 GPM -
0 GPM - 0 '3PM -
I DO HEREBY CERTIFY THAT
15A NCAC 2C, WELL CONSTRUCTION
RECORD HAS BEEN PROVIDED
THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH
STANDARDS, AND THAT A COPY OF THIS
TO THE WELL OWNER.
t
�, -�//� /
SIGNATURE OF CERTIFIED
STEVE PRIG
WELL CONTRACTOR DATE
—
PRINTED NAME OF P
RSON C I ST JeTITELL 1
Submit the original to the Division of Water Quality within 30 days. Attn: Inform
1617 Mail Service Center - Raleigh, NC 27699-1617 Phone No. [phone]
tion Mgt.,
xt 568.
Form GW
Rev. 7/05
la
Ashe;;ile Rerioriai Office
'i=err, `fiction

01/4
RESIDENTIAL WELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources - Division of Water Quality
WELL CONTRACTOR CERTIFICATION N 2878
1.WELL CONTRACTOR:
• STEVE PRICE
Well Contractor (Individual Name)
DEWEY WRIGHT WELL & PUMP CO., INC.
Well Contractor Company Name
STREET ADDRESS P. O. BOXa0$
BOONE NC 28607
City or Town State Zip Code
( 828 )- 284-2051
Area code - Phone number
2.WELL INFORMATION:
SITE WELL ID #(if applicable)
STATE WELL PERMIT kit applicable)
DWQ or OTHER PERMIT #(it applicable)
WELL USE (Check Applicable Box): Residential Water Supply a
DATE DRILLED 3/21/2006
TIME COMPLETED 5.00 AM ❑ PMtI
3. WELL LOCATION:
CITY: LENOIR COUNTY 'CALDWELL
BOLICK RD. OFF BLACKBERRY RD. OFF 321
(Street Name, Numbers, Community, Subdivision, Lot No., Parcel, Zip Code)
TOPOGRAPHIC / LAND SETTING:
❑ Slope W Valley D Flat ❑ Ridge ❑ Other
(check appropriate box)
LATITUDE 3 36.06641
May be in degrees,
minutes, seconds or
LONGITUDE 081.37872
in a decimal format
Latitude/longitude source: N GPS ❑ Topographic
(location of well must be shown on a USGS
attached to this form if not using GPS)
4.WELL OWNER
OWNER'S NAMEEDDIE C LEDFORD
map
topo map and
STREET ADDRESSp'O. BOX 2581,
BLOWING ROCK NC 28605
City or Town State Zip Code
((82Fs) )_ 773-0329
Area code - Phone number
5. W ELL DETAILS:
a. TOTAL DEPTH: 405
b. DOES WELL REPLACE EXISTING WELL? YES ❑ NOS]
c. WATER LEVEL Below Top of Casing: 60 FT.
(Use "+" if Above Top of Casing)
d. TOP OF CASING IS 1 FT. Above Land Surface'
* Top of casing terminated at/or below land surface may require
a variance in accordance with 15A NCAC 2C .0118
e. YIELD (gpm): a METHOD OF TEST ,"ar
Or30128
f. DISINFECTION: Type HTH Amount 70
g. WATER ZONES (depth):
From 375 To 377 From To
From To From To
From To From To
6.CASING: Thickness/
Depth Diameter Weight Material
From 0 To 100 Ft. 61t8 .350 PVC
From 0 To U Ft.
From To Ft.
7.GROUT: Depth Material Method
From 0 To 20 Ft.Cenlent Gravity Flow
From To Ft.
From To Ft.
8.SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in.
From To Ft. in in.
From To Ft. 'ki """"-"-"tn:"r.""""""-'-,--
9.SAND/GRAVEL PACK: € ""-`- C E 'I 1 p 0
Depth Size Material
From Ft.
_To ,1
From Ft. - •-- -
_To
From To Ft. i
7! ,A51' evWe ?emjnr,-,i Odfl• ^.
10. DRILLING LOG ) Ac iie- ' ;fir,;�
From To Formation Description - — " `-
0 375 GRANITE
375 377 QUARTZ
377 405 GRANITE
e.a
1
cn
11. REMARKS:
4 GPM 375 - 377 0 GPM -
0 GPM - O GPhi -
O GPM - 0 GPM -
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH
15A NCAC 2C, WELL CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS
DHAS
RECORD
SBBEEN PROVIDED TO THE WELL OWNER. L� / (/y
-�(�ciAJG/C/iA / / t J / - UQ/
SIGNATURE OF CERTIFItD WELL CONTRACTOR DATE
STEVE PRICE
PRINTED NAME OF PERSON CONSTRUCTING THE WELL
Submit the original to the Division of Water Quality within 30 days. Attn: Information Mgt.,
1617 Mail Service Center - Raleigh, NC 27699-1617 Phone No. [phone] ext 568.
Form GW-la
Rev. 7/05

RESIDENTIAL WELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources - Division of Water Quality
WELL CONTRACTOR CERTIFICATION # 2878
1.WELL CONTRACTOR:
STEVE PRICE
Well Contractor (Individual Name)
DEWEY WRIGHT WELL & PUMP CO., INC.
Well Contractor Company Name
STREET ADDRESS P O. BOX 308
BOONE NC 28607
City or Town State Zip Code
( 823 )- 284-2851
Area code - Phone number
2.WELL INFORMATION:
SITE WELL ID #(it applicable)
STATE WELL PERMIT #(if applicable)
DWQ or OTHER PERMIT #of applicable)
WELL USE (Check Applicable Box): Residential Water Supply ND
DATE DRILLED 312GG/2008
TIME COMPLETED 12:00 AM ❑ PM I
3. WELL LOCATION:
CITY: V ILRESBORO COUNTY CALDWELL
TROT# 1 OFF GREENFIELD PL. OFF HVVY 18 S. 0
(Street Name, Numbers, Community, Subdivision, Lot No., Parcel, Zip Code)
TOPOGRAPHIC / LAND SETTING:
G[Slope 0 Valley 0 Flat 0 Ridge 0 Other
(check appropriate box)
LATITUDE 3 38.005g8
May be in degrees,
minutes, seconds or
LONGITUDE 081.231260
in a decimal format
Latitude/longitude source: GPS 0 Topographic
(location of well must be shown on a USGS
attached to this form if not using GPS)
4.WELL OWNER
OWNER'S NAME DENNIS HARRIS CONSTR.
map
topo map and
STREET ADDRESS254U BRIT-fA'I' DR. ,
LENOIR NC 28645
City or Town State Zip Code
((828) )- 49Q-3684
Area code - Phone number
5.WELL DETAILS:
a. TOTAL DEPTH: 265
b. DOES WELL REPLACE EXISTING WELL? YES 0 Nat
c. WATER LEVEL Below Top of Casing: 30 FT.
(Use "+" if Above Top of Casing)
d. TOP OF CASING IS 1 FT. Above Land Surface*
• Top of casing terminated at/or below land surface may require
a variance in accordance with 15A NCAC 2C .0118
e. YIELD (gpm): 3.0 METHOD OF TEST Air
060111
f. DISINFECTION: Type NTH Amount
g. WATER ZONES (depth):
From 250 To 252 From To
From To From To
From To From To
6.CASING: Thickness/
Depth Diameter Weight Material
From 0 To 61 Ft. 8 1t8 .350 PVC
From 0 To 0 Ft.
From To Ft.
7.GROUT: Depth Material Method
From 0 To 20 Ft.CernentGravity Flow
From To Ft.
From To Ft.
8.SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in.
From To Ft. in. in.
From To Ft. ..___,- in: -__.__.._..in,.....-.._._.
9.SAND/GRAVEL PACK: r t E, tt,..
Depth Size Tv2terI�Y'
From Fi.
_To
From F. . ..-.
_To
From To
AShevij! G, c
10. DRILLING LOG ,L.,{. 1 , r 1 r
Desa1 tlom _ - --------
From To Formation
0 56 DIRT
56 250 GRANITE
250 252 QUARTZ
252 255 GrrANfrE _
b
�T
—
9
' r
i
11. REMARKS:
30 GPM 250 - 252 0 GPM -
0 GPM - 0 GPM -
O GPM - 0 GPM -
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 CERTIFIED WELL CONTRACTOR DATE
STEVE PRICE
PRINTED NAME OF PERSON CONSTRUCTING THE WELL
Submit the original to the Division of Water Quality within 30 days. Attn: Information Mgt.,
1617 Mail Service Center - Raleigh, NC 27699-1617 Phone No. [phone] ext 568.
Form GW-la
Rev. 7/05

RESIDENTIAL WELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources - Division of Water Quality
WELL CONTRACTOR CERTIFICATION # 2872
1. W ELL CONTRACTOR:
STEVE PRICE
Well Contractor (Individual Name)
DEVVE v WRIGHT WELL B. PUMP CO.. INC
Well Contractor Company Name
STREET ADDRESS P. 0. BOX 308
R!'?± it1F NC 78807
City or Town State Zip Code
( 828 )- 284-2851
Area code - Phone number
2.WELL INFORMATION:
SITE WELL ID #(d applicable)
STATE WELL PERMIT #(d applicable)
DWG or OTHER PERMIT #(if applicable}
WELL USE (Check Applicable Box): Residential Water Supply 6
DATE DRILLED 3l31.12008
TIME COMPLETED 2:: UC AM ❑ PM CI
3. WELL LOCATION:
CITY: LENOIR COUNTY �_...4LDWELL
Cl iNE PL OFF 90 WEST OFF NORTH MAIN OFF 32
(Street Name, Numbers, Community, Subdivision, Lot No., Parcel, Zip Code)
TOPOGRAPHIC / LAND SETTING:
❑ Slope Gil Valley 0 Flat 0 Ridge 0 Other
(check appropriate box)
LATITUDE 3 36.56055
May be in degrees,
minutes, seconds or
LONGITUDE 081.32846
in a decimal format
Latitude/longitude source: 21 GPS 0 Topographic
(location of well must be shown on a USGS
attached to this form if not using GPS)
4.WELL OWNER
OWNER'S NAMEDAVI D S EHLERS
map
topo map and
STREET ADDRESS) 829 CUNE PL. ,
LENOIR NC 28845
City or Town State Zip Code
((826) )- 754-2894
Area code - Phone number
5.WELL DETAILS:
a. TOTAL DEPTH: 205
b. DOES WELL REPLACE EXISTING WELL? YES 0 NOO
c. WATER LEVEL Below Top of Casing: 40 FT.
(Use "+" if Above Top of Casing)
d. TOP OF CASING IS 1 FT. Above Land Surface*
`Top of casing terminated aVor below land surface may require
a variance in accordance with 15A NCAC 2C .0118
e. YIELD (gpm): d METHOD OF TEST Air
060149
f. DISINFECTION: Type HTH Amount 3c`
g. WATER ZONES (depth):
From 1 70 To 171 From To
From To From To
From To From To
6.CASING: Thickness/
Depth Diameter Weight Material
From t7 To .116 Ft. 6 1 /8 350 PVC
From 0 To 0 Ft.
From To Ft.
7.GROUT. Depth Material Method
From 0 To 20 Ft. Cement Gravity F'ciim
From To Ft.
From To Ft.
8.SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in.
From To Ft. in in.
__- . -- .
From To Ft. in.io"-------_ _
9.SAND/GRAVEL PACK: T r ' -.
Depth Size Material
From Ft. ? ,
_To
From To Ft. I
From To Ft. ,
.f-;:-F n r:?‘, 7F, f iT
' ` S
10. DRILLING LOG
From To Formation Description '
0 109 DIRT
109 170 GRANITE
170 171 QUARTZ
171 205 GRANITE
=D
0
al
11. REMARKS:
4 GPM 170 - 171 0 GPM -
0 GPM - 0 GPM -
O GPM - 0 GPM -
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH
15A NCAC 2C, WELL CONSTRUCTION STANDARDS. AND THAT A COPY OF THIS
RECORDHHHAASSBBEEN
�PROVIDED TO THE WELL OWNER. ) th
SIGNATURE OF CERTIFIED WELL CONTRACTOR DATE
STEVE PRICE
PRINTED NAME OF PERSON CONSTRUCTING THE WELL
Submit the original to the Division of Water Quality within 30 days. Attn: Information Mgt.,
1617 Mail Service Center - Raleigh, NC 27699-1617 Phone No. [phone] ext 568.
Form GW-la
Rev. 7/05

NON RESIDENTIAL WELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources- Division of Water Quality
WELL CONTRACTOR CERTIFICATION # 2- 440
1. WELL CONTRACTOR:
EDWARD (Al. "1-A41-c'4•. TrL
Well Contractor (Individual) Name
GEM FT/cs C002reog/tre4
Well Contractor Company Name
STREET ADDRESS 13S bni. Co fret QCs
BeoiJc tJG 2.P1.01
City or Town State
(82f )- 2GS- 1577
Zip Code
Area code- Phone number
2. WELL INFORMATION: t�T
SITE WELL ID Cif applicable) fI tA(- I&
STATE WELL PERMIT/SW applicable) NA'
DWQ or OTHER PERMIT #(if applicable) PIA
WELL USE (Check Applicable Box) Monitoring $ Municipal/Public ❑
Industrial/Commercial 0 Agricultural ❑ Recovery 0 Injection ❑
Irrigation° Other ❑ (list use)
DATE DRILLED U I I I I 0 G
TIME COMPLETED 3.3 • AM ❑ PM LR'
3. WELL LOCATION:
CITY: Lill•14
COUNTY CALOtILLL-
1J0t k',4CA10 Sr gilt
(Street Name, Numbers, Community, Subdivision, Lot No., Parcel, Zip Code)
TOPOGRAPHIC / LAND SETTING:
❑Slope ❑Valley ❑Flat M'Ridge ❑ Other
(check appropriate box)
LATITUDE 3_5 , 5Z , 05 rs
LONGITUDE 0 L 30' S4"
May be in degrees,
minutes, seconds or
in a decimal format
Latitude/longitude source: &GPS ❑Topographic map -
(location of well must be shown on a USGS opo map and
attached to this form it not using GPS)
4. FACILITY- is the name or the business where the well is located.
FACILITY ID #(if applicable) rJC 0 00D1 CAC. 213
NAME OF FACILITYL fa O IL �.R4•R. Co.
STREET ADDRESS li 01 K1p4GA16 Sit
LFIJo1R Nc. 280Q6"
City or Town State Zip Code
CONTACT PERSON ,,TACK D E B We
MAILING ADDRESS 4 01 /lgaC4I0 S7
EWolrl- ski zBGNC
City or Town State Zip Code
( 8.14 )- -7z8- 39.1I
Area code - Phone number
5. WELL DETAILS:
a. TOTAL DEPTH:
30
b. DOES WELL REPLACE EXISTING WELL? YES ❑ NO pr
c. WATER LEVEL Below Top of Casing: 2 q FT.
(Use'+- if Above Top of Casing)
d. TOP OF CASING IS 2.. FT. Above Land Surface'
'Top of casing terminated at/or below land surface may require
a variance in accordance with 15A NCAC 2C .0118.
e. YIELD (gpm): WA METHOD OF TEST
f. DISINFECTION: Type NA1Amount
g. WATER ZONES (depth):
From 2,,t To %9 From To
From To From To
From To From
To
6. CASING:
Depth
From a A LS To 20 Ft.
From To Ft.
From To Ft.
7. GROUT: Depth
From 0 To 13 FL
From (3 To IC Ft.
From To Ft.
Thickness/
Diameter Weight Material
2.' scg 40 PVC*
Material
(srlatl
f Sit
$ nit PaiTC
Method
GO - ,ID,
h
8. SCREEN: Depth Diameter Slot Size Material
From 20 To30 FL 1 in..910 in. PVC.
Fran To Ft. in. in.
From To
9. SAND/GRAVEL PACK:
Depth .. .. -
From IS To 30
From To
From To
10. DRILLING LOG
From To
0 t-S'
'- I1.6'
II,s'- 0'
- 30'
30'- 3c
11. REMARKS:
Ft. in. in.
Size Matadal
Ft. a2. (.•l)
Ft.
Ft.
Formation Description
O PP./ flew!, F. (Ad.'t fII
$ grab 1, f. SAFI Dy SILT
LT. •RtWa1 , r. snarl SIL? ?
6,L?4 6441
-Tend S 11.YM 6A a"b
-.7
0
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH
ISA NCACELL CONSTTrr{{UC r=y STANDARD MD THAT A COPY OF THIS
RECORp'H/ATtBEEN EROYIOJ:D ,•are WELL • NER.
SIG
llhyifrA
ATURE OF CERTIFIED EL rJ • TRACTOR DATE
PRINTED N!}ME OF PERSON CONSTRUCTING THE WELL
Submit the original to the Division of Water Quality within 30 days. Attn: Information Mgt.,
1617 Mail Service Center- Raleigh, NC 27699-1617 Phone No. [phone] ext 568.
Form GW-lb
Rev. 7/05
T
•

RESIDENTIAL WELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources - Division of Water Quality
WELL CONTRACTOR CERTIFICATION # 2687
1. WELL CONTRACTOR:
STEVE REECE
Well Contractor (Individual Name)
DEWEY WRIGHT WELL & PUMP CO„ INC.
Well Contractor Company Name
STREET ADDRESS P. ll. BOX 309
BOONE NC 23607
City or Town State Zip Code
( 828 )- 284-2851
Area code - Phone number
2.WELL INFORMATION:
SITE WELL ID #(it applicable)
STATE WELL PERMIT #(it applicable)
DWQ or OTHER PERMIT #(It applicable)
WELL USE (Check Applicable Box): Residential Water Supply El
DATE DRILLED 4/27120066
TIME COMPLETED 3-_OD AM ❑ PM E7
3. WELL LOCATION:
cITY: LENOIR COUNTY CALDWELL
HUSE,AND CREEK RDI#1317 OFF ROCKY RD OFF
(Street Name, Numbers, Community, Subdivision, Lot No., Parcel, Zip Code)
TOPOGRAPHIC / LAND SETTING:
❑ Slope 0 Valley W Flat 0 Ridge O Other
(check appropriate box)
LATITUDE 3 36.53705
May be in degrees,
minutes, seconds or
LONGITUDE 081.37848
in a decimal farmat
Latitude/longitude source: 3 GPS 0 Topographic
(location of well must be shown on a USGS
attached to this form if not using GPS)
4. WELL OWNER
OWNER'S NAMEDOUGLAS A PRITCHARD
map
topo map and
STREET ADORESSI e99 HUSBAND CREEK ROAD ,
LENOIR NC 28645
City or Town State Zip Code
((828) )- 759-1353
Area code - Phone number
5.WELL DETAILS:
a. TOTAL DEPTH: 365
b. DOES WELL REPLACE EXISTING WELL? YES 0 NOKI
c. WATER LEVEL Below Top of Casing: 40 FT.
(Use "+" if Above Top of Casing)
d. TOP OF CASING IS 1 FT. Above Land Surface*
`Top of casing terminated at/or below land surface may require
a variance in accordance with 15A NCAC 2C .0118
e. YIELD (gpm): 20 METHOD OF TEST Air
(1611208
f. DISINFECTION: Type HTH Amount 67
g. WATER ZONES (depth):
From 320 To a,ts From To
From To From To
From To From To
6.CASING: Thickness/
Depth Diameter Weight Material
From 0 To 62 Ft. 61/8 .350 PVC
From 0 To 0 Ft.
From To Ft.
7.GROUT. Depth Material Method
From 0 To 2n Ft.U?ment 5raaity Flow
,
From To Ft.
From To Ft.
8.SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in.
From To Ft. in. in.
From To Ft. in. in.
9.SAND/GRAVEL PACK: Depth Size Material
From To Ft.
From To Ft.
From To Ft.
10. DRILLING LOG
From To Formation Description
0 55 DIRT SAND .21-IALE
55 320 GRANITE
320 324 QUARTZ
324 365 GRANITE _. 1...
tr.! . _..
—:....z
Coc•
ai,V V 0 LIi�J .. CP • t
CT
11. REMARKS:
20 GPM 320 - 324 0 _5PM -
0 GPM - 0 GPM -
0 GPM - 0 GPM -
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 PROVIDED9TO THE WELL OWNER.
ld s-- ngige _- ,F / _ p(a
SIG ATU E OF CERT WELL CONTRACTOR AT
STEVE REECE
PRINTED NAME OF PERSON CONSTRUCTING THE WELL
Submit the original to the Division of Water Quality within 34 days. Attn: Information Mgt.,
1617 Mail Service Center - Raleigh, NC 27699-1617 Phone No. [phone] ext 568.
Form GW-la
Rev. 7/05

RESIDENTIAL WELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources - Division of Water Quality
WELL CONTRACTOR CERTIFICATION # 2878
1. WELL CONTRACTOR:
STEVE PRICE
Well Contractor (Individual Name)
DEWEY WRIGHT WELL & PUMP CO
Well Contractor Company Name
STREET ADDRESS P O. BOX 308
BOONE NC 28607
City or Town State Zip Code
( 828 ) - 264-2651
Area code - Phone number
2. WELL INFORMATION:
SITE WELL ID #pt applicable)
STATE WELL PERMIT II
(if applicable)
DWO or OTHER PERMIT #(if applicable)
WELL USE (Check Applicable Box): Residential Water Supply
DATE DRILLED 4/12/2006
TIME COMPLETED 6.00
3. WELL LOCATION:
CITY: LENOIR
AM PM II
COUNTY `OALDW'ELL
NOTT1NGHA.M WAY OFF HEADWATERS RD. OFF 8
(Street Name, Numbers, Community, Subdivision, Lot No., Parcel, Zip Code)
TOPOGRAPHIC / LAND SETTING:
C Slope 0 Valley 0 Flat 0 Ridge 0 Other
(check appropriate box)
LATITUDE 3 36.06495
LONGITUDE 081.37368
Latitude/longitude source: CH GPS 0 Topographic map
(location of well must be shown on a USGS topo map and
attached to this form If not using GPS)
May be in degrees,
minutes, seconds or
in a decimal format
4.WELL OWNER
OWNER'S NAMERICHARD D BERRY, JR.
STREET ADDRESS5665 GRACE CHAPEL RD.
HICKORY Nr 286101
City or Town State Zip Code
((828))- 328-6548
Area code - Phone number
5.WELL DETAILS:
a. TOTAL DEPTH: 405
b. DOES WELL REPLACE EXISTING WELL? YES 0 NOO
c. WATER LEVEL Below Top of Casing: 60 FT.
(Use "+" if Above Top of Casing)
d. TOP OF CASING IS 1 FT. Above Land Surface'
Top of casing terminated at/or below land surface may require
a variance in accordance with 15A NCAC 2C .0118
e. YIELD (gpm): 12 METHOD OF TEST Air
0601 EU
f. DISINFECTION: Type HTH Amount 70
g. WATER ZONES (depth):
From 370 To 372 From To
From To From To
From To From To
6.CASING:
Depth Diameter
From 0 To 71 Ft. 61/8
From 0 To 0 Ft
From To Ft.
7.GROUT: Depth Material
From 0 To 20 Ft.Cernent
From To Ft.
Thickness/
Weight Material
350 PVC
Method
Granty Finn
From To Ft.
8.SCREEN: Depth Diameter
From To Ft. in.
From To Ft. in.
From To Ft. in.
9.SAND/GRAVEL PACK:
Depth
From To Ft.
From _To Ft.
From _To Ft.
10. DRILLING LOG
From To
0 65
Slot Size Material
in.
in.
in.
Size Material
Formation Description
DIRT
6-5 370 GRANITE
370 372 CREVICE
372 405 GRP,NRIE
11. REMARKS:
12 GPM 370 - 372 0 GPM -
OGPM - OGPM -
0 GPM - 0 GPM -
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 CERTIFIED WELL CONTRACTOR DATE
STEVE PRICE ._
PRINTED NAME OF PERSON CONSTRUCTING THE WELL
Submit the original to the Division of Water Quality within 30 days. Attn: Information Mgt.,
1617 Mail Service Center - Raleigh, NC 27699-1617 Phone No. [phone] ext 568.
Form GW-la
0 6 20v. 7/05
�ir � r

RESIDENTIAL WELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources - Division of Water Quality
WELL CONTRACTOR CERTIFICATION # 27C1.7
1.WELL CONTRACTOR:
}FRRY WI LSON
Well Contractor (Individual Name)
DEVVE (M/RI :BHT WELL 8: PUMP CO I f-t e
Well Contractor Company Name
STREET ADDRESS P 0. AnK 309
PO,, NE No 2F607
City or Town State Zip Code
( 92c )- 254-2851
Area code - Phone number
2.WELL INFORMATION:
SITE WELL ID #(if applicable)
STATE WELL PERMIT *tot applicable)
DWQ or OTHER PERMIT #(n applicable)
WELL USE (Check Applicable Box): Residential Water Supply 07
DATE DRILLED s `/2rK
TIME COMPLETED 1 `-n AM ❑ PIA0
3.WELL LOCATION:
CITY: Bi OW1 --N'G ROCK COUNTY CALDWELL
WHITE ROCK RD OFF SAMPSON RD. OFF AHO R
(Street Name, Numbers, Community, Subdivision, Lot No., Parcel, Zip Code)
TOPOGRAPHIC / LAND SETTING:
Q Slope ❑ Valley ❑ Flat 0 Ridge 0 Other
(check appropriate box)
LATITUDE 3
May be in degrees,
minutes, seconds or
LONGITUDE
in a decimal format
Latitude/longitude source: W GPS ❑ Topographic
(location of well must be shown on a USGS
attached to this form if not using GPS)
4.WELL OWNER
OWNER'S NAMEfl-40 {4R f) ("AMPP I 1
map
topo map and
STREET ADDRESi5U CAMP RCT4RY PD.
r'A5-17nn1 Nr' -Rnc,^
City or Town State Zip Lode
(r 7n41 ) - Rnii7-flpfld
Area code - Phone number
5.WELL DETAILS:
a. TOTAL DEPTH: C RF
b. DOES WELL REPLACE EXISTING WELL? YES 0 NOS]
c. WATER LEVEL Below Top of Casing: ": nn FT.
(Use "+" if Above Top of Casing).
d. TOP OF CASING IS 1 FT. Above Land Surface"
' Top of casing terminated at/or below land surface may require
a variance in accordance with 15A NCAC 2C .0118
e. YIELD (gpm): 10 METHOD OF TEST Air
0550ff7Ci
f. DISINFECTION: Type H � kH Amount 'h
g. WATER ZONES (depth):
From C^ To CH From To
From To From To
From To From To
6.CASING: Thickness/
Depth Diameter Weight Material
From 0 To 1Ffl Ft. R 11P ;?,r1 cVC'
From To Ft.
From To Ft.
7.GROUT: Depth Material Method
From 1 To 11 Ft.+'arnnnl t=rgr;h. Plnw
From To Ft.
From To Ft.
8.SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in.
From To Ft. in. in.
From To Ft. in. in.
9.SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
From To Ft.
10. DRILLING LOG
From To Formation Description
0 140 DIRT SAND SHALE
140 470 GRANITE QUARTZ
470 4.%. GRANITE
11. REMARKS:
19'P1vi-i7n-471 aGPt...i -
it I,Pt.;1 - C ,P'M -
n GPAA ri ern A. _
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 CERTIFIED WELL CONTRACTOR DATE
IFRRY',Al1f 2N.....
PRINTED NAME OF PT3ISON CONSTRUCTING THE WELL
Submit the original to the Division of Water Quality within 30 days. Attn: Information Mgt., JUN 06 air, Form GW-1 a
1617 Mail Service Center - Raleigh, NC 27699-1617 Phone No. [phone] ext 568. Rev. 7/05

RESIDENTIAL WELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources- Division of Water Quality
WELL CONTRACTOR CERTIFICATION # 5 7)._
329519
1. WELL CONTRACTOR:
Soto W nit SA ktr
Well Contr for (Individual) Name
Yadkin Well Company Inc,
Well Contractor Company Name
STREET ADDRESS 1908 Hamptonville Road
Hamptonville NC
City or Town State
( 336 - 468-4440
Area code- Phone number
2. WELL INFORMATION:
SITE WELL ID *Cif applicable) 44 L -- ?33
STATE WELL PERMIT#(it applicable)
27020
Zip Code
'DWQ or OTHER PERMIT #(if applicable)
WELL USE (Check Applicable Box): Residential Water Supply"
DATE DRILLED /o en-v6
TIME COMPLETED 3700 AM PM
3. WELL LOCATION:
CITY: %. p h/'O Y COUNTY :a/A, e.f4
SS m.L
(Str&et Name. Numbers,- munity, Subdnts , Lot No.. Parcel, Zip Code)
TOPOGRAPHIC / LAND SETTING:
}ffalope oValley ❑Flat DRidge OOther
(check appropriate box)
LATITUDE 3 6),_ p44, 3!'9
LONGITUDE ,'f ! 3 Q, l( e
Latitude/longitude source: Mt3PS ❑Topographic map
(location of well must be shown on a USGS topo map and
attached to this form if not using GPS)
4. WELL OWNER OWNER'S NAME LLB y4 / ',061
STREET ADDRESS *v3Q /rrs- oa4 . r Lt.rtzeo.
J
ekrar C.
City or Town state Zip Code
( fsz7)_ f',� _ 26 C 3 f 4.1-.16 63
Area code - Phone number
yes 852-lO6S
May be in degrees,
minutes, seconds or
in a decimal format
5. WELL DETAILS:
a. TOTAL DEPTH:
4 O6
b. DOES WELL REPLACE EXISTING WELL? YES 0 NO,r
c. WATER LEVEL Below Top of Casing: 70'
(Use "+' if Above Top of Casing)
d. TOP OF CASING 1S 4 FT. Above Land Surface'
'Top of casing terminated at/or below land surface may require
a variance in accordance with 15A NCAC 2C .0118.
e. YIELD (gpm): (i7 METHOD OF TEST Air pump
FT.
f. DISINFECTION: Type HTH
Amount l
g. WATER ZQNES (depth): i 'e-
From SOS To ( 40" From
To
From J'DO To SO> -r"'
To
From To From To
6. CASING: Thickness/
Depth 'Diameter Weight aterial
From 7L � To JO4 Ft. be r son
rVC
From To FL'
From To Ft.
7. GROUT: Depth ,,.� MM/aterial Method
FromTo I - FL�V� noba.
From S To. FL Q� p ed
From To Ft. f
8. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in.
From To Ftin. in.
From To FL in. in.
9. SAND/GRAVEL PACK:
Depth Size Material •
From To
Ft.
From To FL
From To Ft.
10. DRILLING LOG
From To
0 - /OS "
/03' o17C
ate'
ltd•_ Co00
Bit Serial No
11. REMARKS:
Fo ation Description
Size off S.99S
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED N ACCORDANCE WM4
15A NCAC 2C, WELL CONSTRUCTOR STANDARDS, AND THAT A COPY OF THIS
RECORD HAS BEEN PROVIDED TO THE WELL OWNER.
���4sE
SI RE O ERTIFIED ELL CONTRACTOR DATE
7.‘ Pritt Mull?
PRINTED NAME OF PERSON CONSTRUCTING THE WELL
Tti
f"'"
r
Submit the original to the Division of Water Quality within 30 days. Attn: Information Mgt.,
1617 Mail Service Center- Raleigh, NC 27699-1617 Phone No. [phone] ext 568.
Date site visited c /9-06 by permit required: equired: Yes No
Form GW-la
Rev. 7/05

RESIDENTIAL WELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources - Division of Water Quality
WELL CONTRACTOR CERTIFICATION #
1. WELL CONTRACTOR:
STEVE PRICE
Well Contractor (Individual Name),
DEVVEY VdR(GHT WELL & PUMP CO., INC.
Well Contractor Company Name
STREET ADDRESS P 0 BOX 308
BOONE NC 28807
City or Town State Zip Code
( 828- 284-2851
Area code - Phone number
2.WELL INFORMATION:
SITE WELL ID #(d applicable)
STATE WELL PERMITS/cif applicable)
DWO or OTHER PERMIT #(1applicable)
WELL USE (Check Applicable Box): Residential Water Supply 0 j(
DATE DRILLED fu8120n8
TIME COMPLETED 8m AM 0 PM OX
3. WELL LOCATION:
CITY: LENOIR COUNTY CALDVVELL
PRIVATE DR. OFF UPTON PL. OFF JOHNS RIVER
(Street Name, Numbers, Community, Subdivision, Lot No., Parcel, Zip Code)
TOPOGRAPHIC / LAND SETTING:
0 Slope 0 Valley 0 Flat 0 Ridge 0 Other
(check appropriate box)
LATITUDE 3 36 04012
May be in degrees,
minutes, seconds or
LONGITUDE OR1 one
in a decimal format
Latitude/longitude source: 0 %PS 0 Topographic map
(location of well must be shown on a USGS topo map and
attached to this form if not using GPS)
4.WELL OWNER
OWNER'S NAME i OHISF CARIISO
STREET ADDRESS % SAM CARUSO . 6104 31 STREET EAST
RRADFNTON F( '34203
City or Town State Zip Code
( (941,- 758-3626
Area' code - Phone number
5.WELL DETAILS:
a. TOTAL DEPTH: 805
b. DOES WELL REPLACE EXISTING WELL? YES 0 NO Ox
c. WATER LEVEL Below Top of Casing: 80 FT.
(Use "+" if Above Top of Casing)
d. TOP OF CASING IS 1 FT. Above Land Surface'
Top of casing terminated at/or below land surface may require
a variance in accordance with 15A NCAC 2C .0118
e. YIELD (gpm): 2 METHOD OF TEST Alf
2878
329410
080287
f. DISINFECTION: Type Hi7( Amount 109
g. WATER ZONES (depth):
From 57(fo 571 From ', p 541
From To From To
From To From To
6.CASING: Thickness/
Depth Diameter Weight Material
From OTo eft 61/8 iSO PVC
From OpofFt.
From To Ft.
7.GROUT: Depth Material Method
From (to 70Ft. Cptm.tll Gravity Ft•a
From To Ft.
From To Ft.
8.SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in
From To Ft. in. in.
From To Ft. in. in.
9.SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
From To Ft.
10. DRILLING LOG
From To Formation Description
n 57 DIRT T-7
57 5771 Pc? ANITF
5'0 511 QIIAPT7 - 'I,)
L
571 50 GPANITF -
can cal Cu IAATT
Sq4 1415 GP ANITF l7 r-'i i
1-0rm -.�
co
r-
11. REMARKS:
05GPF.A_570_1371 1 iRPM 5Q2-544
O GPM - O GPM -
0 GPM - O GPM -
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.
1eAt‘/ :/- ,--:C Q / 19 -G) �.
SIGNATURE OF CERTIFIED WELL CONTRACTOR DATE
STEVF PRICE
PRINTED NAME OF PERSON CONSTRUCTING THE WELL
Submit the original to the Division of Water Quality within 30 days. Attn: Information Mgt,
1617 Mail Service Center - Raleigh, NC 27699-1617 Phone No. [phone] ext 568.
Form GW-la
Rev. 7/05

RESIDENTIAL WELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources - Division of Water Quality
WELL CONTRACTOR CERTIFICATION # 2878
1. WELL CONTRACTOR:
STEVE PRICE
Well Contractor (Individual Name)
DEWEY WRIGHT WELL & PUMP CO., INC.
Well Contractor Company Name
STREET ADDRESS P 0 BOX 308
BOONE NC 28607
City or Town State Zip Code
( 828- 264-2851
Area code - Phone number
2.WELL INFORMATION:
SITE WELL ID #(it applicable)
STATE WELL PERMIT #(d applicable)
DWQ or OTHER PERMIT #(d applicable)
WELL USE (Check Applicable Box): Residential Water Supply 0 X
DATE DRILLED 8'13/2n08
TIME COMPLETED 3.00 AM O PM OX
3. WELL LOCATION:
CITY: LENOIR COUNTY CAL.DWELL
ADAKO RD. OFF HWY 90 OFF SETZER CREEK 0
(Street Name, Numbers, Community, Subdivision, Lot No., Parcel, Zip Code)
TOPOGRAPHIC / LAND SETTING:
❑ Slope 0 Valley 0 Flat 0 Ridge 0 Other
(check appropriate box)
LATITUDE 3 38 64R77
May be in degrees,
minutes, seconds or
LONGITUDE Gm Ali 16
in a decimal -format
Latitude/longitude source: O QQS O Topographic
(location of well must be shown on a USGS
attached to this form if not using GPS)
4.WELL OWNER
OWNER'S NAME THE BLUFFS OF WILSON
map
topo map and
CRFFK
STREET ADDRESS % CHAD GRAGG 4441 COLLETTSVILLE
,
COLLETTSV1LLE NC
_28611
City or Town State Zip Code
( (828i1- 754-8100
Area code - Phone number
5.WELL DETAILS:
a. TOTAL DEPTH: 405
b. DOES WELL REPLACE EXISTING WELL? YES ❑ NO OX
c. WATER LEVEL Below Top of Casing: 20 FT.
(Use "+" if Above Top of Casing)
d. TOP OF CASING IS 1 FT. Above Land Surface*
Top of casing terminated at/or below land surface may require
a variance in accordance with 15A NCAC 2C .0118
e. YIELD (gpm): 30 METHOD OF TEST At
329407
060319
f. DISINFECTION: Type NTH Amount 76
g. WATER ZONES (depth):
From 11Yo 117 From 730 731
From 37t-o =79 From To
From To From To
6.CASING: Thickness/
Depth Diameter Weight Material
From Cjro RTt. 61/8 Vie PVC
From Oro ¢t.
From To Ft.
7.GROUT: Depth Material Method
From_Clo 20Ft. Cement C.ravDyFlow
From To Ft.
From To Ft.
6.SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in
From To Ft. in. in.
From To Ft. in. in.
9.SAND/GRAVEL PACK:
Depth Size Material
FrOm To Ft
From To Ft.
f:..
From To Ft.
10. DRILLING LOG
From To Formation Description
0 78 DIRT MI ID
t�
78 116 r;RANITF
r.
ire 117 RHAIF
117 " R G11AP41TF G —.y`*T
'flh 711 4I:Af2T7 t-
711 370 GRANITE �- 71
370 37'2 OU4RT7 —;
37? MP SPANITF o
O --
11. REMARKS:
3GPM 115-Ill BGPM 230-231
21 GPM 370 - 372 O GPM - -
O GPM - O GPM -
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/T/HE WELL OWNER.
—: �—. �V ./ '/* J'
SIGNATURE OF CERTIFIED WELL CONTRACTOR DATE✓
STEVE PR ICE
PRINTED NAME OF PERSON CONSTRUCTING THE WELL
Submit the original to the Division of Water Quality within 30 days. Attn: Information Mgt.,
1617 Mail Service Center - Raleigh, NC 27699-1617 Phone No. [phone] ext 568.
Form GW-la
Rev. 7/05

RESIDENTIAL WELL CONSTRUCTION RECORD -
North Carolina Department of Environment and Natural Resources - Division of Wafer Quality
WELL CONTRACTOR CERTIFICATION #
1. W ELL CONTRACTOR:
STEVE PRICE
Well Contractor (Individual Name)
DEWEY WRIGHT WELL & PUMP CO., INC.
Well Contractor Company Name
STREET ADDRESS P A RCA MR
BOONE NC 28607
City or Town State Zip Code
( 27a- 264-2R51
Area code - Phone number
2.WELL INFORMATION:
SITE WELL ID #(if applicable)
STATE WELL PERMIT #fd applicable)
DWQ or OTHER PERMIT #(iapplicable)
WELL USE (Check Applicable Box): Residential Water Supply CI X
DATE DRILLED 6/i2120f18
TIME COMPLETED 5 f11j AM ❑ PMDX
3. WELL LOCATION:
CITY: LENOIR COUNTY CM DWELL
RACKETT CREEK RD. OFF ANTHONY CREEK OF
(Street Name, Numbers, Community, Subdivision, Lot No., Parcel, Zip Code)
TOPOGRAPHIC / LAND SETTING:
❑ Slope 0 Valley 0 Flat 0 Ridge 0 Other
(check appropriate box)
LATITUDE 3 16113Bp8
LONGITUDE QR1e3214
May be in degrees,
minutes, seconds or
in a decimal format
Latitude/longitude source: 0 'S 0 Topographic
(location of well must be shown on a USGS
attached to this form if not using GPS)
4.WELL OWNER
OWNER'S NAME Rio-IMO L CRUMP
map
topo map and
STREET ADDRESS 6460 RACK^Tr CREEK Pi
col FI'TS1VIt I F NC 2RR11
City or own State Zip Code
( (828)- 758-2275
Area code - Phone number
5.WELL DETAILS:
a. TOTAL DEPTH: 10g
b. DOES WELL REPLACE EXISTING WELL? YES 0 NO Qx
c. WATER LEVEL Below Top of Casing: 20 FT.
(Use "+" if Above Top of Casing)
d. TOP OF CASING IS 1 FT. Above Land Surface*
Top of casing terminated aVor below land surface may require
a variance in accordance with 15A NCAC 2C .0118
e. YIELD (gpm): 15 METHOD OF TEST Ayr
2878
329404
060320
f. DISINFECTION: Type NTH Amount 57
g. WATER ZONES (depth):
From "Alb 271 From 379 71C
From To From To
From To From To
6.CASING: Thickness/
Depth Diameter Weight Material
From 6 )/8 PVC
_pio___Oft. .350
From bfo qt.
From To Ft.
7.GROUT: Depth Material Method
From_oo 26Ft. t__ Graudy Flow
From To Ft.
From To Ft
8.SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in.
From To Ft. in. in.
From To Ft. in. in.
9.SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
From To Ft.
10. DRILLING LOG
From To Formation Description
0 Sr/ DIP ULID
5P 2'0 GpAMITE r-
270 271 .:PAHITE , J
71 'x10 f PANITE '
_
3X1 71.1487
-
No
305GRAP''TE CO
0 )
C.
11. REMARKS:
2GPLv1 270-271 13GPM 2R0-222 co -
N.,-_
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH
15A NCAC 2C, WELL CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS L
RECORDHASBEEN PROVIDED TO THHEE WELL OWNER.
c se"w �/ j7 --7 772 `2 6.2,
SIGNATURE OF CERTIFIED WELL CONTRACTOR DATE
STEVE PRICE
PRINTED NAME OF PERSON CONSTRUCTING THE WELL
Submit the original to the Division of Water Quality within 30 days. Attn: Information Mgt.,
1617 Mail Service Center - Raleigh, NC 27699-1617 Phone No. [phone] ext 568.
Form GW-la
Rev. 7/05

RESIDENTIAL WELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources - Division of Water Quality
WELL CONTRACTOR CERTIFICATION # 2878
1. W ELL CONTRACTOR:
STEVE PRICE
Well Contractor (Individual Name) •
DEWEY WRIGHT WELL & PUMP CO., INC.
Well Contractor Company Name
STREET ADDRESS P O. BOK 308
BOONE NC 28607
City or Town State Zip Code
( R7a- 2(44-2651
Area code - Phone number
2.WELL INFORMATION:
SITE WELL ID #(d applicable)
STATE WELL PERMIT #(4 applicable)
DWO or OTHER PERMIT #(n applicable)
WELL USE (Check Applicable Box): Residential Water Supply D x
DATE DRILLED 8/12/2008
TIME COMPLETED 12.00 AM ❑ PM ❑K
3. WELL LOCATION:
CITY: LENOIR COUNTY CALDWELL
RACKETY CREEK RD. OFF ANTHONY CREEK RE
(Street Name, Numbers, Community, Subdivision, Lot No., Parcel, Zip Code)
TOPOGRAPHIC / LAND SETTING:
❑ Slope O Valley 0 Flat 0 Ridge 0 Other
(check appropriate box)
LATITUDE 3 ske 0363G
May be in degrees.
minutes, seconds or
LONGITUDE Q81 41372
in a decimal format
Latitude/longitude source: 0 gS 0 Topographic map
(location of well must be shown on a USGS topo map and
attached to this form if not using GPS)
4.WELL OWNER
OWNER'S NAME F.IC`%APE, $14AAIF GRAGG
STREET ADDRESS 8449 RA CKGTT CPFfK PL
COE l 'MVP t P NC 78811
City or Town State Zip Code
( (82E6- 759-0525
Area code - Phone number
5.WELL DETAILS:
a. TOTAL DEPTH: 305
b. DOES WELL REPLACE EXISTING WELL? YES 0 NO Ox
c. WATER LEVEL Below Top of Casing: 10 FT.
(Use "+" if Above Top of Casing)
d. TOP OF CASING IS 1 FT. Above Land Surface*
`Top of casing terminated•at/or below land surface may require
a variance in accordance with 15A NCAC 2C .0118
e. YIELD (gpm): 20 METHOD OF TEST Air
329403
060321
f. DISINFECTION: Type 1 iTH Amount 54
g. WATER ZONES (depth):
From halo :WI From To
From To From To
From To From To
6.CASING: Thickness/
Depth Diameter Weight Material
From (to 1Q4t. R 1;8 3'Q PVC
From Oro frt.
From To Ft.
7.GROUT: Depth Material Method
From 0b 2OFt. Cwmptnt GravWyFEmu
From To Ft.
From To' Ft.
8.SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in.
From To Ft. in. in.
From To Ft. in. in.
9.SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
From Ft
_To
10. DRILLING LOG
From To Formation Description
99 7R8 GPANEtTE
ME1 '5.0 QUAPT'
irxi 3 rPANrTE
r-r
r
�_::
�:T!
O C-`!
11. REMARKS:
20 GPM 78R - 790 O GPM - =1
O GPM -. 0 GPM -
O GPM - OGPM -
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH
15A NCAC 2C, WELL CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS
REECOORRD HAS BEEN PROVIDEDROTO THE WELL OWNER.
/
SIGNATURE OF CERTIFIED WELL CONTRACTOR DATE
PRINTEDhIAOFFPPEI9SbN CONSTRUCTING THE WELL
Submit the original to the Division of Water Quality within 30 days. Attn: Information Mgt.,
1617 Mail Service Center - Raleigh, NC 27699-1617 Phone No. [phone] ext 568.
Form GW-la
Rev. 7/05

RESIDENTIAL WELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources - Division of Water Quality
WELL CONTRACTOR CERTIFICATION # 2878
1. WELL CONTRACTOR:
$TJEVE PRICE
Well Contractor (Individual Name)
DEWEY WRIGHT WELL & PUMP CO., INC.
Well Contractor Company Name
STREET ADDRESS P 0 BOX 308
BOONE NC 28607
City or Town State Zip Code
( 8717 - 2644651
Area code - Phone number
2. WELL INFORMATION:
SITE WELL ID #lit applicable)
STATE WELL PERMIT *Cr( applicable)
DWQ or OTHER PERMIT #(rt applicable)
WELL USE (Check Applicable Box): Residential Water Supply O X
DATE DRILLED 511512006
TIME COMPLETED 2A0 AM ❑ PM ❑X
3. WELL LOCATION:
CITY: BLOWING ROCK COUNTY CALDWELL
BOLICK RD. OFF BLACKBERRY RD. OFF 321
(Street Name, Numbers, Community, Subdivision, Lot No., Parcel, Zip Code)
TOPOGRAPHIC / LAND SETTING:
D Slope D Valley 0 Flat 0 Ridge 0 Other
(check appropriate box)
LATITUDE 3 se mini
LONGITUDE 081 17715
May be in degrees,
minutes, seconds or
m a decimal forrnat
Latitude/longitude source: 0 IXPS 0 Topographic
(location of well must be shown on a USGS
attached to this form if not using GPS)
4.WELL OWNER
OWNER'S NAME FI'IDIF f] I FRFfRf
map
topo map and
STREET ADDRESS P 0 BOX 1581
RI QVVINf; ROCK NC. 98865
City or Town State Zip Code -
(82&)- 773-0399
Area code - Phone number
5.WELL DETAILS:
a. TOTAL DEPTH: 205
b. DOES WELL REPLACE EXISTING WELL? YES 0 NO DX
c. WATER LEVEL Below Top of Casing: 80 FT.
(Use "+" if Above Top of Casing)
d. TOP OF CASING IS 1 FT. Above Land Surface*
Top of casing terminated at/or below land surface may require
a variance in accordance with 15A NCAC 2C .0118
e. YIELD (gpm): 4 METHOD OF TEST Ajr
329402
0603.30
f. DISINFECTION: Type HTH Amount 28
g. WATER ZONES (depth):
From FOTo R7 From 1efs 4
From To From To
From To From To
6.CASING: Thickness/
Depth Diameter Weight Material
From OTo gt. 6 118 V 0 PVC
From gTo('Qt.
From To Ft.
7.GROUT: Depth Material Method
From fo 2`0Ft. Csr170rt rra„Ityr Ftgt',
From To Ft.
From To Ft.
8.SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in.
From To Ft. in. in.
From To Ft. in. in.
9.SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
From To Ft.
10. DRILLING LOG
From To Formation Description
0 43 DIPT
42 Ee CID. !:TE
B2 67 SHALE
8' t67 G-PAN/TE
9R7 913 OU4PT7
1f4 'fIX. riDANlTF
r
.. C tutiv r�
N�
11. REMARKS:
1 GPM 86 - 87 3 GPM 167 - 1A8
OGPM - OGPM -
O GPM - O GPM -
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH
15A NCAC 2C, WELL CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS
RECORD HAS BEEN PROVIDED TO THE WELL OWNER.
t
ecfred4../J3G/E�y %/cr
SIGNATURE OF CERTIFIED WELL CONTRACTOR - DATE
R'TEI/E PRICE
PRINTED NAME OF PERSON CONSTRUCTING THE WELL
Submit the original to the Division of Water Quality within 30 days. Attn: Information Mgt.,
1617 Mail Service Center - Raleigh, NC 27699-1617 Phone No. [phone] ext 568.
Form GW-la
Rev. 7/05

RESIDENTIAL WELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources - Division of Water Quality
WELL CONTRACTOR CERTIFICATION # 2878
1. WELL CONTRACTOR:
STEVE PRICE
Well Contractor (Individual Name)
DEINEY WRIGHT WELL & PUMP CO., INC.
Well Contractor Company Name
STREET ADDRESS P O AOX 10R
BOONE NC 28607
City or Town State Zip Code
( 876 - 264-2651
Area code - Phone number
2.WELL INFORMATION:
SITE WELL ID #(n applicable)
STATE WELL PERMIT #(i applicable)
DWQ or OTHER PERMIT #(n applicable)
WELL USE (Check Applicable Box): Residential Water Supply O X
DATE DRILLED 5422J2'006
TIME COMPLETED 5:00 AM ❑ PM OX
3.WELL LOCATION:
CITY: LENOIR COUNTY CAI DLVELI
GLOBE RD. OFF JOHN RIVER RD. OFF BUSINES
(Street Name, Numbers, Community, Subdivision, Lot No., Parcel, Zip Code)
TOPOGRAPHIC / LAND SETTING:
O Slope O Valley O Flat O Ridge O Other
(check appropriate box)
LATITUDE 3 321 Q67Lj
May be in degrees,
minutes, seconds or
LONGITUDE ORI i11®77
in a decimal format
Latitude/longitude source: ❑ (X4S 0 Topographic map
(location of well must be shown on a USGS topo map and
attached to this form if not using GPS)
4.WELL OWNER
OWNER'S NAME AAMFS N ICI4OI SON
STREET ADDRESS %TIM INMAN PC) BOX 592
NG ROCK NG 28604
City own State Zip Code
( (826)- 2051333
Area code - Phone number
5.WELL DETAILS:
a. TOTAL DEPTH: 2d0
b. DOES WELL REPLACE EXISTING WELL? YES ❑ NO OX
c. WATER LEVEL Below Top of Casing: SO FT.
(Use "+" if Above Top of Casing)
d. TOP OF CASING 1S 1 FT. Above Land Surface`
' Top of casing terminated at/or below land surface may require
a variance in accordance With 15A NCAC 2C .0118
e. YIELD (gpm): 6 METHOD OF TEST Air
329399
060264
f. DISINFECTION: Type HTH Amount 40
g. WATER ZONES (depth):
From 219-0 2 g From 25y 9,-.)5
From To From To
From To From To
6.CASING: Thickness/
Depth Diameter Weight Material
From gro__g(Ft. 6118 350 PVC
From tyro Ift.
From To Ft.
7.GROUT: Depth Material Method
From db 20Ft. cement Gravity now
From To Ft
From To Ft.
8.SCREEN: Depth Diameter Slot Size Material
From To Ft. in in.
From To Ft. in. in.
From To Ft. in. in.
9.SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
Froth To Ft.
From To Ft.
10. DRILLING LOG
From To Formation Description
0 74 DIG'
7 9 215 GPAp'TE
n15 115 Oi IART7
115 735 /WAN17F
215 TAR fit IAPT' ct
'19R 2,10 f OANITF
b:, rr--'i`'I
C
'r_ -Y
r,
. 11. REMARKS:
1 GPM 215 - 210 5 f;PM 2'95 - 21:6 . ..
O GPM - 0 GPM -
OGPM - OGPM -
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.
.C3-✓: Af/ ✓:F%.-ram 7 -ice'- 26
SIGNATURE OF CERTIFIED WELL CONTRACTOR DATE
STEW PRIOR
PRINTED NAME OF PERSON CONSTRUCTING THE WELL
Submit the original to the Division of Water Quality within 30 days. Attn: Information Mgt.,
1617 Mail Service Center - Raleigh, NC 27699-1617 Phone No. [phone] ext 568.
Form G W-1 a
Rev. 7/05

RESIDENTIAL WELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources - Division of Water Quality
WELL CONTRACTOR CERTIFICATION # 2878
1.WELL CONTRACTOR:
STEVE PRICE
Well Contractor (Individual Name)
DEWEY WRIGHT WELL & PUMP CO., INC.
Well Contractor Company Name
STREET ADDRESS P A BOX 10R
BOONE NC 28607
City or Town State Zip Code
( 870 - 964-2651
Area code - Phone number
2. WELL INFORMATION:
SITE WELL ID ti(itappiicable)
STATE WELL PERMIT kit applicable)
DWQ or OTHER PERMIT B(n applicable)
WELL USE (Check Applicable Box): Residential Water Supply D x
DATE DRILLED 5/lO>20116
TIME COMPLETED 4;(10 AM ❑ PM GX
3. WELL LOCATION:
CITY: LENOIR
COUNTY CALDWELL
MOBILE HOME OFF ANTHONY CREEK RD. OFF
(Street Name, Numbers, Community, Subdivision, Lot No., Parcel, Zip Code)
TOPOGRAPHIC / LAND SETTING:
❑ Slope D Valley U Flat D Ridge 0 Other
(check appropriate box)
LATITUDE 3 36 03123
LONGITUDE 0R1 42R10
Latitude/longitude source: 0 grrS D Topographic map
(location of well must be shown on a USGS topo map and
attached to this form if not using GPS)
4.WELL OWNER
OWNER'S NAME Lap RY W GRAB.:
STREET ADDRESS R29C C"1 ngF Rfl
May be in degrees,
minutes, seconds or
in a decimal format
ckyEN961R
State Nr Zip Coae8"5
754-5913
Area code - Phone number
5.WELL DETAILS:
a. TOTAL DEPTH: 205
b. DOES WELL REPLACE EXISTING WELL? YES ❑ NO DX
c. WATER LEVEL Below Top of Casing: 10 FT
(Use "+" if Above Top of Casing)
d. TOP OF CASING IS 1 FT. Above Land Surface`
Top of casing terminated at/or below land surface may require
a variance in accordance with 15A NCAC 2C .011 B
e. YIELD (gem): 40 METHOD OF TEST Air
060236
f. DISINFECTION: Type
g. WATER ZONES (depth):
From 131To 111 From 1713o 171
From 117To_ 102 From To
From To From To
6.CASING: Thickness/
Diameter Weight Material
6 14—.188.- GAI V
NTH Amount t0
Depth
From__07o__5p.
From__ OTo__(Ft,
From To Ft.
7.GROUT: Depth
From_O-o___2QFt.
From To Ft.
Material
Cement
Method
Gravity Flaw
From To Ft.
8.SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in.
From To Ft. in. in.
From To Ft. in. in.
9.SAND/GRAVEL PACK
Depth
From _To
From To
From To
10. DRILLING LOG
From To
Ft.
Ft.
Ft.
Size Material
Formation Description
0 51 13011L0E0S6PAvFLc
51 130 GRANITE
CPANITF
GP AN IT=
OUAPT7
GRANITE
QUARTZ
GR?AI rTF
Q
•
<�.-. Fps)
",
11. REMARKS:
2 GPM 130-131 2GP1v1 170-171
36GPM 190-192 OGPM -
O GPM - O GPM -
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.
Set& Si/u Crz
SIGNATURE OF CERTIFIED WELL CONTRACTOR DATE
STEVE PRICE
PRINTED NAME OF PERSON CONSTRUCTING THE WELL
Submit the original to the Division of Water Quality within 30 days. Attn: Information Mgt.,
1617 Mail Service Center - Raleigh, NC 27699-1617 Phone No. [phone] ext 568.
Form GW-la
Rev. 7/05

03233
RESIDENTIAL WELL CONSTRUCTION RECORD
North Carolina Deparbnent of Environment and Natural Resources - Division of Water Quality
WELL CONTRACTOR CERTIFICATION # 2878
1. WELL CONTRACTOR:
STEVE PRICE
Well Contractor (Individual Name)
DEWEY WRIGHT WELL & PUMP CO., INC.
Well Contractor Company Name
STREET ADDRESS P 0 ROX 30R
BOONE
City or Town
( R2 - 28A-2A81
Area code - Phone number
NC
State
2.WELL INFORMATION:
SITE WELL ID #(d applicable)
STATE WELL PERMIT #(d applicable)
DWO or OTHER PERMIT #(d applicable)
28607
Zip Code
WELL USE (Check Applicable Box): Residential Water Supply ❑ x
DATE DRILLED 55/11/2008
TIME COMPLETED 5:00 AM ❑ PM ❑X
3. WELL LOCATION:
CITY: BOONF COUNTY CALDVuFI L
METAL BLDG OFF ANTHONY CREEK RD. OFF JO
(Street Name, Numbers, Community, Subdivision, Lot No., Parcel, Zip Code)
TOPOGRAPHIC / LAND SETTING:
❑ Slope ❑ Valley ❑ Flat ❑ Ridge ❑ Other
(check appropriate box)
LATITUDE 3 _ 3L034't8
LONGITUDE
Latitude/longitude source: ❑ Ws ❑ Topographic map
(location of well must be shown on a USGS topo map and
attached to this form if not using GPS)
4.WELL OWNER
OWNER'S NAME L R�r ( CRAI=G
STREET ADDRESS R7AS GI ORF RD
May be in degrees,
minutes. seconds or
in a decimal format
C Flot:7owwn State
Area ccoode - Pho e5n Abe 3
5.WELL DETAILS:
a. TOTAL DEPTH: 't(O
Nr
Zip Cod
b. DOES WELL REPLACE EXISTING WELL? YES ❑ NO Dx
c. WATER LEVEL Below Top of Casing: AO FT.
(Use "+" if Above Top of Casing)
d. TOP OF CASING IS 1 FT. Above Land Surface'
• Top of casing terminated at/or below land surface may require
a variance in accordance with 15A NCAC 2C .0118
e. YIELD (gpm): 15 METHOD OF TEST Arc
f. DISINFECTION: Type HT}1 Amount 80
g. WATER ZONES (depth):
From 123b 171 From 77® 271
From 1.10b 111 From To
From To From To
6.CASING: Thickness/
Depth Diameter Weight Material
From_IIfo_—ggtj—.tra 350 PVC
From__,_Oro_ fft.
From To Ft.
7.GROUT: Depth Material Method
From__.4o__20Ft. Cement — GFioy_
From To Ft.
From To Ft.
8.SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in.
From To Ft. in. in.
From To Ft. in. in.
9.SAND/GRAVEL PACK:
Depth Size
From To Ft.
• From To Ft.
From _To Ft.
Material
10. DRILLING LOG
From To
0 EC
IC 120
120, 121
121 270
270 2Zt
271 230
330 331
331 3'0
Formation Description
DIRT
CRNAITE
'_HALE
GDAdITE
Of I ePTZ
CRANITE
DI IfRTZ
GoANITE
I?t�
11. REMARKS:
2 RPM 190 - 121 10 GPM 970 - 971
3GPM 330-331 OGPM -
OGPM - OGPM -
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.
2k0eAd tr.s ji G c�
SIGNATURE OF CERTIFIED WELL CONTRACTOR DATE
PRINTED' N CONSTRUCTING THE WELL
Submit the original to the Division of Water Quality within 30 days. Attn: Information Mgt,
1617 Mail Service Center - Raleigh, NC 27699-1617 Phone No: [phone] ext 568.
Form GW-la
Rev. 7/05

n s�
e) ti \, s
RESIDENTIAL WELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources- Division of Water Quality
WELL CONTRACTOR CERTIFICATION #
1. WELL CONTRACTOR:
C_Iwk. Ru.5self
Well Cothractor (Individual) Name
Ku..sse_ tl (,Jell pr; II /Ns I.wc.
Web Contractor Company Name
STREET ADDRESS .44 `T L l b e r ty CA go(
!0i5Vi Ilc /N . &&b
City or Town State Zip Code
(g1.5} 1,3 —3(o �38
Area code Phone number
2. WELL INFORMATION:
SITE WELL ID #fdapplicable)
STATE WELL PERMIT#fdappkeable)
DWQ or OTHER PERMIT #(d ahb)
WELL USE (Check Appficabie Bac): Residential Water Supply Er'
DATE DRILLED 7- / 7 - 0 b
TIME COMPLETED / I D AM re PM ❑
3. WELL LOCATION: /� /]
CITY: fQ,i L-G'L COUNTY .414
"Jrl k2
(Street Name, Numbers, COMM Subdmaim, Lot No., Parcel, Zip Code)
TOPOGRAPHIC / LAND SETTING:
LK ❑Valey ❑Flat ❑Ridge ❑Oter
(check appropriate box)
LATITUDE �v!C .) 7 . n(glp
LONGITUDE J,(1 )(,fl O.-74, .37q
Latitude/longitude source: EiPS oTopographic map
(location of we/ must be shown on a USGS logo map and
attached to this farm /not using GPS)
4. WELL OWNER
OWNER'S NAME / �f/LL^L // + I t7')Rs:
STREET ADDRESS 7424t ' 1 iyyi Ltd
i71�1/L' CI— .ggt s—
City or Town Stale Zip Code
Area code - Phan number
May be in degrees.
minutes, seconds or
in a decimal fort
5. WELL DETAILS: y
a. TOTAL DEPTH: az QS
b. DOES WELL REPLACE EXISTING WELL? YES ❑ NO e
c. WATER LEVEL Below Top of Casing: tip 0 FT.
(Use •+• 8 Above Top d Casing)
d. TOP OF CASING IS / '/2 FT. Above Land Surface -
*Top d casing terminated attar belay land surface may require
a variance n aocadalcewith 15A NCAC 2C .0118.
e. YIELD (gpm): 3D METHOD OF TEST
f. DISINFECTION: Type /-{ T(4 Amount (.
g. WATER ZONES (depth):
From in To /�J.S From To
From To From To
From To From To
6. CASING: Thickness/
Depth Diameter Weight Metere/
From 0 To SS Ft i/ V
Fran To Ft.
From To Ft
7. GROUT: Depth Material
1 Method
From p To �D Ft �✓)<yl,(
From To Ft _ _
From To FL
8. SCREEN: Depth Diameter Slot Sae Material
From To FL in. is
Fran To FL in. it.
From To FL in. irL
9. SAND/GRAVEL PACK:
Depth Sae Material
From To FL
From ' To Ft.
From To FL
10. DRIWNG LOG
From To y Formation Desaiption
11. REMARKS:
0
Q
n
c-1
1 D01EREBy ten ref THAT THIS WHL WAS CONSTRUCTED N ACCO DAdsE Wrtft' v
15A CAC 2C. WEIL CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS
RECORD HAS BEEN PROJIDEDTO THE WELL OWNER --
((����••te,, 17-as-6k
SIGNAL C ED WELL CONTRACTOR DATE
Ae tu-s5.ell
P NAME OF ERSON CONSTRUCTING THE WELL
Submit the original to the Division of Water Quality within 30 days. Attn: Information Mgt.,
1617 Mail Service Center— Raleigh, NC 27699-1617 Phone No. [phone] ext 568.
Form GW-la
Rev. 7/05

RESIDENTIAL WELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources - Division of Water Quality
WELL CONTRACTOR CERTIFICATION # 2878
1.WELL CONTRACTOR:
STEW PRICE
Well Contractor (Individual Name)
" DEVVEY VVRIGHT WELL & PUMP CO., INC.
Well Contractor Company Name
STREET ADDRESS
BOONE
City or Town
( R9$) - 26L-2R51
Area code - Phone number
P 0 ROX 328
NC
State
2.WELL INFORMATION:
SITE WELL ID #fd applicable)
STATE WELL PERMIT #fd applicable)
DWQ or OTHER PERMIT BIN applicable)
28807
Zip Code
WELL USE (Check Applicable Box): Residential Water Supply 0 X
DATE DRILLED 7/3/2008
TIME COMPLETED
1:00
AM ❑ PM DX
3.WELL LOCATION:
CITY: f)FFP GAP COUNTY CAI flIWI L
DARBY RD. OFF ELK CREEK RD. OFF OLD 421 0
(Street Name, Numbers, Community, Subdivision, Lot No., Patel, Zip Code)
TOPOGRAPHIC / LAND SETTING:
❑ Slope 0 Valley 0 Flat O Ridge 0 Other
(check appropriate box)
LATITUDE 3 _
LONGITUDE _ _ 081 30801
latitude/longitude source: 0 9,PS 0 Topographic map
(location of well must be shown on a USGS topo map and
attached to this form if not using GPS)
4.WELL OWNER
OWNER'S NAME DARimmENONITE CHURCH
STREET ADDRESS JaT74 PI K CREEK PM DARBY an
City 6r mown � � State Zip Co e
rea co A - Phonne n3umber
5.WELL DETAILS:
a. TOTAL DEPTH: 120
b. DOES WELL REPLACE EXISTING WELL? YES ❑ NO OA
May be in degrees,
minutes, seconds or
in a decimal format
c. WATER LEVEL Below Top of Casing: 20 FT
(Use "+" if Above Top of Casing)
d. TOP OF CASING IS 1 FT. Above Land Surface*
• Top of casing terminated at/or below land surface may require
a variance in accordance with 15A NCAC 2C .0118
e. YIELD (gpm): 15 METHOD OF TEST Air
R
r 3 . �i
'v
080385
f. DISINFECTION: Type NTH Amount 21
g. WATER ZONES (depth):
From 710To 112 From To
From To From To
From To From To
6.CASING:
Depth Diameter
From_-__ 01b__sirt._ R4JR
From___cTo_OFt.
From To Ft.
7.GROUT: Depth
From______ p___.20Ft.
From To Ft.
From To Ft.
8.SCREEN: Depth Diameter j Slot Size Material
Thickness/
Weight Material
.350 PVC
Material
Cement
Method
Gravity Flow
From To Ft.
From To Ft.
From To Ft.
9.SAND/GRAVEL PACK:
Depth
From To Ft.
in.
in.
in.
in.
in.
irk
Size GTy4ateriat
• From To Ft.
From To Ft.
10. DRILLING LOG
From To
0 83
83 110
110 112
112 120
r
Forination.Description _
DIRT
GRANITE
nUARTZ
GRANITE r
'1)73
.ram CisCOW Cr-i
Arr
11. REMARKS:
15 GPM 110-112 OOPM
OGPM - .0GPM -
OGPM - OGPM -
I DO HEREBY CERfFV THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WfmH
15A NCAC 2C, WEU. CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS
RECORD HAS BEEN PROVIDED TO THE WELL OWNER.
E Or OF E IED WELL CONTRACTOR
PRIMED Nd'fv1�aT=) MbN CONSTRUCTING THE WELL
Submit the original to the Division of Water Quality within 30 days. Attn: information Mgt.,
1617 Mail Service Center - Raleigh, NC 27699-1617 Phone No. [phone] ext 568.
Fort GW-la
Rev. 7/05

RESIDENTIAL WELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources - Division of Water Quality
WELL CONTRACTOR CERTIFICATION /1 2878
1. WELL CONTRACTOR:
STEVE PRICE
Well Contractor (Individual Name)
DEWEY WRIGHT WELL & PUMP CO., INC.
Well Contractor Company Name
STREET ADDRESS P. O. BOX 308
BOONE NC 28807
City or Town State Zip Code
( 828) - 284-2051
Area code - Phone number
2.WELL INFORMATION:
SITE WELL ID #(if applicable)
STATE WELL PERMIT #(if applicable)
DWQ or OTHER PERMIT #(it applicable)
WELL USE (Check Applicable Box): Residential Water Supply O X
DATE DRILLED file A/7018
TIME COMPLETED 510 AM ❑ PM OX
3. WELL LOCATION:
CITY: LENOIR COUNTY CALDWELL
WHITE ROCK RD. OFF SAMPSON RD. OFF AHO
(Street Name, Numbers, Community, Subdivision, Lot No., Parcel Zip Code)
TOPOGRAPHIC / LAND SETTING:
❑ Slope ❑ Valley O Flat 0 Ridge O Other
(check appropriate box)
LATITUDE 3
May be in degrees,
minutes, seconds or
LONGITUDE
ina decimal format
Latitude/longitude source: ❑ GIPS O Topographic
(location of well must be shown on a USGS
attached to this form if not using GPS)
4.WELL OWNER
OWNER'S NAME TMQMAS r) '.;AMPFIiei
map
topo map and
I
STREET ADDRESS 356 CAMP RC""Ay RD
ras RN aIC 2R0!2
City or Town State Zip Code
( )-
Area code - Phone number
5.WELL DETAILS:
a. TOTAL DEPTH: d05
b. DOES WELL REPLACE EXISTING WELL? YES 0 NO <
c. WATER LEVEL Below Top of Casing: RD FT.
(Use "+" if Above Top of Casing)
d. TOP OF CASING IS 1 FT. Above Land Surface*
Top of casing terminated at/or below land surface may require
a variance in accordant& with 15A NCAC 2C .0118
e. YIELD (gpm): 8 METHOD OF TEST Air
33 519
050670-2
f. DISINFECTION: Type 1'1TH Amount 87
g. WATER ZONES (depth):
From 370fo 371 From To
From To From To
From To From To
6.CASING: _ Thickness/
Depth - Diameter Weight Material
From OTo 170=t._$J[8 350 PVC
From_01-o
__0Ft.
From To Ft.
7.GROUT: Depth Material Method
From_.lo 911Ft. Cement Gravity Flow
From To Ft.
From To Ft _...........-
8.SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in.
From To Ft. in. in.
From To Ft. in. in. r
9.SAND/GRAVEL PACK: `„.'
Depth Size Material``
CI
From To Ft.
FIbm To Ft. <.
From To Ft. °-''
10. DRILLING LOG
From To Formation Description
0 184 niRT
184 37(1 (CRANITF
37d 371 011ART7
371 CS (:RANITF
11. REMARKS:
8 GPM 370 - 371 O GPM -
0 GPM - 0 GPM -
OGPM - OGPM -
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. /
—it f (a
S NATURE OF CERTIFIED WELL CONTRACTOR DATE
RTEUF PRICE
PRINTED NAME OF PERSON CONSTRUCTING THE WELL
Submit the original to the Division of Water Quality within 30 days. Attn: Information Mgt.,
1617 Mail Service Center - Raleigh, NC 27699-1617 Phone No. [phone] ext 568.
Form GW-la
Rev. 7/05

RESIDENTIAL WELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources- Division of Water Quality
WELL CONTRACTOR CERTIFICATION #
1. WELL CONTRACTOR:
ELtodaRs e ( `
Well (Individual)
Name
lKu.sse.l( We.t( Dr: Ili/Ns IIN1
Well Contractor Company Name
STREET ADDRESS od''/'7 LI e r ly Ch 11d
l agici-s✓i Ile k/C 384281
City or Town State Zip Code
(g3Sy 623;2-3/0'2
Area code- Phone number
2. WELL INFORMATION:
SITE WELL ID Wit applicabie)
STATE WELL PERMITWB applicable)
DWG) or OTHER PERMIT #(if applicable)
WELL USE (Check Applicable Box): Residential Water Supply
DATE DRILLED
TIME COMPLETED /r3D AM I] PMjQ-
3. WELL LOCATION:
CITY:-yrq.ai. COUNTY
Subdivision, Lot No., Parcel, Zip Code)
TT�OPOGRAPHIC / LAND SETTING:
e7Slape °Valley ❑Flat [Midge ❑Other
(check appropriate box)
LATITUDE _3 /Sips cet '/7/
LONGITUDE/Alai 12°Z3, 461
Latitude/longitude source: otPS ❑Topographic map
(location of well must be shown on a USGS topo map and
attached to this form ifnot using GPS)
4. WELL OWNER Y�� On
OWNER'S NAME \J/Lp7ytQ� RILL,
STREET ADDRESS 44).3 41 iez
l ar Town State Zip Code
( )- `7'Lp 3
May be in degrees.
minutes, seconds or
in a decimal font
Area code - Phone number
5. WELL DETAILS: r
a. TOTAL DEPTH: / 9j
b. DOES WELL REPLACE EXISTING WELL?YES CINO E '
c. WATER LEVEL Below Top of Casing: cg i FT.
(Use -+• if Above Top of Casing)
d. TOP OF CASING 15 / //2 FT. Above Land Surface'
-Top of casing terminated at/or below land surface rnay require
a variance in accordance with 15A NCAC 2C .0118.
•
e. YIELD (gpm): /Jr METHOD OF TEST &A./
f. DISINFECTION: Type /4TN Amwmt 4/. ea.rr?
g. WATER ZONES (depth): /
From cif) To / g
From To
Fran To From To
From - To From To
6. CASING:
Thiclmess/
a.,Depth % Diameter Weight Material
From / Ft 0 ToP I/ (I
From To Ft.
From To FL
7. GROUT: Depth
MaterialMethod
From 0 To �0 Ft. 54 y,4_1- papAgi
From To Ft.
From To Ft.
8. SCREEN: Depth Diameter Slot Size Material
Fran To Ft. in. in.
From To FL in. in.
From To Ft. in. in.
9. SAND/GRAVEL PACK:
Depth
From To FL
From To FL
From To Ft.
10. DRILLING LOG
From To
0 r//
/YS'
11. REMARKS:
Size Material
Cation Description
I00 HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED N AC
ISA NCAC 2C, WELL CONSTRUCTION STANDARDS AND THAT A COPY
RECORD HAS SEEN PROVIDED TO THE WELL OWNER ..
( _ C
E el E g�'
SIGNATU E OF CERTIFIED WELL CONTRACTOR DA -
C yd e Ross e. (( LT)
PRINTE NAME O ERSON CONSTRUCTING THE WELL, �
.
Submit the original to the Division of Water Quality within 30 days. Attn: Information Mgt,
1617 Mail Service Center- Raleigh, NC 27699-1617 Phone No. [phone] ext 568.
a

RESIDENTIAL WELL CONSTRUCTION RECORD
North Carolina Depanment of Environment and Natural Resources- Division of Water Quality
WELL CONTRACTOR CERTIFICATION #
�. WELL CONTRACTOR:
1-4 tva
Well Contractor (Individual) Name
Yadkin Well Company Inc.
ArO tvn
Well Contractor Company Name
STREET ADDRESS 1908 Hamptonville Road
Hamptonville NC 27020
City or Town - State Zip Code
( 336 ). 468-4440
Area code- Phone number
2. WELL INFORMATION: A
SITE WELL ID #(if applicable) N—/Q 1— 6 9 S
STATE WELL PERMIT#(ir applicable)
DWQ or OTHER PERMIT #(if applicable)
WELL USE (Check Applicable Box): Residential Water Supply
DATE DRILLED T - 21/-- 06
TIME COMPLETED t, 30 AM❑ PMX
3. WELL LOCATION:
CITY: Lr(4i e r
LE Db r Pt.., M // ... PL
(Street Name. Numbers, Community, Subdivision, Lot No., Parcel, Zip Code)
TOPOGRAPHIC I LAND SETTING:
Slope °Valley ❑Flat 0 Ridge ❑Other
(check appropriate box)
LATITUDE 3 S9.yry
LONGITUDE I L Z3 • / `6
Latitude longitude source: treIGPS °Topographic map
(location of tWel must be shown on a USGS topo map and
attached to this form not using GPS)
4. WELL OWNER OWNER'S NAME ;-/IG. de P7 Fae�r�
STREET ADDRESS 400S ,bta., ., Ato htst sa Pt
City or Town State Zip Code
(ray - T/€a 121-7141-it fie(
Area code - Phone number
COUNTY&.i9s ilF
May be in degrees,
minutes, seconds or
in a decimal format
%ka, 52P-3W — 760 2_
5. WELL DETAILS: / a. TOTAL DEPTH: " / 2 2
b. DOES WELL REPLACE EXISTING WELL? YES ° NO
c. WATER LEVEL Below Top of Casing: - J FT.
(Use "+" if Above Top of Casing)
d. TOP OF CASING IS 1 FT. Above Land Surface
'Top of casing terminated atior below land surface may require
a variance in accordance with 15A NCAC 2C .0118.
e. YIELD (gpm)' 3 0 METHOD OF TEST Air pump
I. DISINFECTION: Type HTH Amount t1/3 CUPS
g. WATER ZONES (depth): 2.ffdnn
From 7r` To 7$ ' From To
From //il '- To 1/ 4 ' .Fprrom To
From To 'r,Fta�n To
6. CASING: Thickness/
Depth Diameter Wei ht Material
From To bit
% FL I,12f" J1 L/ PVC,
From To Ft.
From To Ft.
7. GROUT: Depth i Material
From t) To 6 Ft/vos+
From 6 'To Z2 FL /4.../ani'A_
From To Ft.
8. SCREEN: Depth
From To
From To
From To
Method
Diameter Slot Size Material
Ft. in. in.
Ft. in. in.
Ft. in. in.
9. SAND/GRAVEL PACK:
Depth
From To Ft.
From To Ft.
From ' To FL
Size Material
10. DRILLING LOG
From To
. tr
— '- /002
k2'— /22'
Rit Serial No
11. REMARKS:
Formation Description
SO,'1
/I'lA 1;-An/r -
Mn.( Ca a„ /)-t.
0
r--
LT r-i
0
Size off
188
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED N ACCORDANCE WITH
ISA NCAC 2C, WELL CONSTRUCT/ON STANDARDS, MD THAT A COPY OF THIS
RECORD HAS BEEN PROVIDED`TTOOOTHjE WELLU.O�W'N�EER. �',,`''
SIt;IMATURC�yE OF / CERTIFIED WELL CONTRACTOR - DATE
11A'% D. . O/D!✓h -
PRINTED NAME OF PERSON CONSTRUCTING THE WELL
"it--214-0C
Submit the original to the Division of Water Quality within 30 days. Attn: information Mgt.,
1617 Mali Service Center- Raleigh, NC 27699-1617 Phone No. [phone] ext 568.
Date site visited 14 - (—o G by kg Permit required: Yes N
FormGW-la
Rev. 7/05
3
p2
p

1.WELL CONTRACTOR:
RESIDENTIAL WELL coNSTRucrlom RECORD
North Carolina Department of Environment and Nat
ural Resources -Division of Water Quality
WELL CONTRACTOR CERTIFICATION # 2701
well Contractor (Individual Name)
Well
Contra oWRIGHTpay1e WELL & PUMP CO- INC.
—26L number
Area co a umbe
-Phone n� �--'-�
2. WELL INFORMATION:
SITE WELL ID #ptapplicable/ _
STATE WELL PERMIT #(it appiicabie
DWQ or OTHER PERMIT #tit appiicabie)
WELL USE (Check Applicable Box): Residential Water Supply 0 X
DATE DRILLED
TIME COMPLETED )�
AM ❑ PM OX
3.WELL LOCATION:
CITY: NOIo
COUNTY .AI r„
NIGHTINGALE LANE OFF ROCKY KNOB RD. 0
(Street Name, Numbers, Community, Subdivision, Lot No., Parcel, Zip Code)
TOPOGRAPHIC / LAND SETTING:
❑ Slope 0 Valley 0 Flat 0 Ridge 0 Other
(check appropriate box)
LATITUDE 3
LONGITUDE
STREET ADDRESS �� A pAX 9AR
8OONE NC
City or Town State 2867
Zip Code
May be in degrees,
minutes, seconds or
in a decimal format
Latitude/longitude source: ❑ xPS ❑ Ton
hic map
(location of well must be shown onU GS t po map and
attached to this form if not using GPS)
NELL OWNER
JWNER'S NAME
iTREET ADDRESS 1FgpRnr,._
Ci or own EhIACEANAy_—
M 5_
State Zip Co e
r -—._&8i$ger
rea code -Phone numbed
/ELL DETAILS:
TOTAL DEPTH:
DOES WELL REPLACE EXISTING WELL? YES 0 NO
lax
WATER LEVEL Below Top of Casing:
(Use "+" if Above Top of Casing)
TOP OF CASING IS
bove Land Surfaces
' Top of casing terminated at/or elow land surface may require
a variance in accordance with 15A NCAC 2C .0118
YIELD (gpm):
--AL_ METHOD OF TEST e;.
332466
f. DISINFECTION: Type is
g. WATER ZONES (depth): ��—amount oe
From 6_-- 9-
o_ —
FromFrom To
TO
Depth Diameter Weight
From —a g MaMaterialFrc"To
t.s
From�-—
To Ft.
7. GROUT: Depth
Material Method
From__$o__ 0Ft. _ ""
v�aV1--
From To Ft.. .'^7r
From To
9.SAND/GRAVEL PACK:
Depth
From To_
From To
From
Formation Description
I DO HEREBY CERnpy THAT THIS
15A NCAC 2C, WELL CONSTRUCTIOWN S1ANDACRDS, AND CTHAT INTED COPY 0o THIS W�
RECORD HAS BEEN PROVIDED TO THE WELL OWNER.
SIGNATURE OF CERTIFIED WELL CONTRACTOR 7 %DATE
DATE
PR ..-EU N Sb'LATC
wnsrRUCTING
submit the original to the Division o1 Water Quality within 30 days. THETHE 617 Mail Service Center - Raleigh, NC 27699-1617 Phone No. (919) 733-701ext 568
Form GW-la
Rev. 7/05

RESIDENTIAL WELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources - Division of Water Quality
WELL CONTRACTOR CERTIFICATION# 2791
1. WELL CONTRACTOR:
Al RFRT SLATF
Well Contractor (Individual Narne)
DEWEY WRIGHT WELL & PUMP CO.. INC.
Well Contractor Company Name
STREET ADDRESS P 0 BOX 308
BOONE
City or Town
( R98) - 9114,-2851
Area code - Phone number
2. WELL INFORMATION:
SITE WELL ID #(if applicable)
STATE WELL PERMIT #(if applicable)
DWQ or OTHER PERMIT #Of applicable)
NC
State
28807
Zip Code
WELL. USE (Check Applicable Box): Residential Water Supply 0)(
DATE DRILLED 8/22/2008
TIME COMPLETED 41,;00 AM ❑ PM OX
3.WELL LOCATION:
CITY: BLOWING ROCK cowry CALDWELL
ROCKY HIGHWAY OFF ROCKY KNOB RD. OFF
(Street Name, Numbers, Community, Subdivision, Lot No., Parcel, Zip Code)
TOPOGRAPHIC / LAND SETTING:
❑ Slope 0 Valley 0 Flat 0 Ridge 0 Other
(check appropriate box)
LATITUDE 3 38 OF6O7
LONGITUDE D81,34848
Latitudeflongitude source: Cl XPS ❑ Topographic map
(location of well must be shown on a USGS topo map and
attached to this form if not using GPS)
.WELL OWNER
OWNER'S NAME DOROTHY FRIE
STREET ADDRESS 1906 WESTERN TRAIL
May be in degrees,
minutes, seconds or
in a decimal format
City or own State Zip Co
( (919)- 583-1154
Area code - Phone number
.WELL DETAILS:
a. TOTAL DEPTH: 300
b. DOES WELL REPLACE EXISTING WELL? YES 0 NO 4(
c. WATER LEVEL Below Top of Casing: RO FT.
(Use "+" if Above Top of Casing)
d. TOP OF CASING IS 1 FT. Above Land Surface'
* Top of casing terminated at/or below land surface may require
a variance in accordance with 15A NCAC 2C .0118
e. YIELD (gpm): 8 METHOD OF TEST Air
0 O O
000435
65
f. DISINFECTION: Type Hi1'I • Amount
g. WATER ZONES (depth):
From 12yTo_ _ From To
From To From To
From To From To
Ii. CASING: Thickness/
Depth Diameter Weight Material
From_ OTo_ _ j t._-8118 —.35O PVC
From__OTo__OFt,
From To Ft.
7.GROUT: Depth Material Method
From__ofio___20Ft. __ _Gi_
From To Ft.
From To Ft.
47
8.SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in.
From To Ft. in. in.
From To Ft. in. in.
9.SAND/GRAVEL PACK:
Depth Size Material
From _To Ft.
From _To Ft.
From To Ft.
10. DRILLING LOG
From To
0 62
Formation Description
DIRT SAND
' 132— t25 GRANITE QUARTZ
125 123 CREVICE
1213 703
11. REMARKS:
GRANITE QUARTZ f1
OGPM - OGPM -
O GPM - O GPM -
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 CERTIFIED WELL CONTRACTOR DATE
ALBFRT SLATE
PRINTED NAME OF PERSON CONSTRUCTING THE WELL
Submit the original to the Division of Water Quality within 30 days. Attn: Information Mgt,
1617 Mail Service Center - Raleigh, NC 27699-1617 Phone No. [phone] ext 568.
Form GW-1a
Rev. 7/05

RESIDENTIAL WELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources - Division of Water Quality
WELL CONTRACTOR CERTIFICATION # 2791
1. WELL CONTRACTOR:
ALBERT SLATE
Well Contractor (Individual Name)
BOONE
City or Town
i }�
Area ccode - Phone lumber
DEV%EY WRIGHT WELL & PUMP CO., INC.
Well Contractor Company Name
STREET ADDRESS P 0 BOX 108
NC
State
28807
Zip Code
2.WELL INFORMATION:
SITE WELL ID #(if applicable)
STATE WELL PERMIT #(if applicable)
DWQ or OTHER PERMIT #(if applicable)
WELL. USE (Check Applicable Box): Residential Water Supply O j(
DATE DRILLED 8Q3/20116
TIME COMPLETED 4:30 AM O PM Ox
3. WELL LOCATION:
CITY: LENOIR
COUNTY CALDWELL
LOTS 57 THE BLUFFS AT WILSON CREEK OFF
(Street Name, Numbers, Community, Subdivision, Lot No., Parcel, Zip Code)
TOPOGRAPHIC / LAND SETTING:
❑ Slope O Valley O Flat O Ridge 0 Other
(check appropriate box)
LATITUDE 3 _ 3R,5R243
LONGITUDE
Latitude/longitude source: ❑ %PS ❑Topographic map
(location of well must be shown on a USGS topo map and
attached to this form if not using GPS)
.WELL OWNER
OWNER'S NAME _ MIKE rAJDESKJ
STREET ADDRESS % H&C; CANCTR _ 9RRL IACI PI ACC
CI y or own State
( 1898)- 499-3825
Area code - Phone number
WELL DETAILS:
a. TOTAL DEPTH: 400
b. DOES WELL REPLACE EXISTING WELL? YES O NO Lk
c. WATER LEVEL Below Top of Casing: 75
(Use "+" if Above Top of Casing)
d. TO• P OF CASING IS 1 FT. Above Land Surface'
Top of casing terminated at/or below land surface may require
a variance in accordance with 15A NCAC 2C .0118
e. YIELD (gpm): 20 METHOD OF TEST Air
May be in degrees,
minutes, seconds or
in a decimal format
Zip Co?
FT.
f. DISINFECTION: Type
g. WATER ZONES (depth):
HTH
3 f} ci 4 Q ii
Amount
67
From____3150_ _ From To
From To From To
From To From To
6.CASING: Thickness/
Depth Diameter Weight Material
From_ OTo_40ft _6418 350 - Pyt
From-_—OTo__Cft.
From To Ft.
7.GROUT: Depth Material
From___jfo _,20Ft.
From To Ft.
From To Ft.
8.SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in.
From To Ft. in. in.
From To Ft. in. in.
9.SAND/GRAVEL PACK:
Depth Size Material
From _To Ft.
From To Ft.
Method
From _To Ft.
Cement
10. DRILLING LOG
From To Formation Description
0 102 DIRT SAND GRA' EL
1% 315 GP&NITE OUAPTZ
335 340 GRANITE QUAPTZ
GRANITE QUAPT7
11. REMARKS:
0 GPM _ 0 GPM
OGPM - OGPM -
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.
Sired OF R1Ea CONTRACTOR / /D T °
PRINTED NAAl ME OF PERSON CONSTRUCTING THE WELL
Submit the original to the Division of Water Quality within 30 days. Attn: Information Mgt,
1617 Mail Service Center - Raleigh, NC 27699-1617 Phone No. [phone] ext 568.
Form GW-la
Rev. 7/05
1

ns__ 1tRSg�
titudelongitude source: ❑ XP$ 0 Too
raphic map
(location of well must be shown ona USGS t po map and
attached to this form if not using GPS)
ELL OWNER
/NER'S NAME 1]Alu f IR tit
BEET ADDRESS IN V Rr11Fw
City or Town SI^
State Zip Co
13
)- 7 -9932
a code - Phone number
LL DETAILS:
:TOTAL DEPTH: _a__
5
)OES WELL REPLACE EXISTING WELL? YES 0 NO Ck
VATER LEVEL Below Top of Casing: (Use "+" if Above Top of Casing)
OP OF CASING IS 1 FT. Above Land Surface'
' Top of casing terminated at/or below land surface may require
a variance in accordance with 15A NCAC 2C .0118
IELD (gprn): J_ METHOD OF TEST
1. WELL CONTRACTOR:
Well Ka=fTH PRF NEI L
Contractor (Individual Name)
DEUYEY WRIGHT WELL & PUMP CO., INC.
Well Contractor Company Name
STREET ADDRESS P. O BOX 08
BOONE NC 28607
City or Town State
Zip Code
RESIDENTIAL WELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources - Division of Water Quality
WELL CONTRACTOR CERTIFICATION # _ 2780
Areaccoode-Phon bee WELL INFORMATION:
SITE WELL ID #(if applicable)
STATE WELL PERMIT #fd applicable)
O WQ or OTHER PERMIT #(If applicable)
NELL USE (Check Applicable Box): Residential Water Supply 0X
/ATE DRILLED
"IME COMPLETED AM 0 PM OX
YELL LOCATION:
:ITV LENOIR
COUNTY C„ALD ELL
PRIVATE DR. OFF CRAIG CRK RD.OFF BRN
treet Name, Numbers, Community, Subdivision, Lot No., Parcel, Zip Code)
JPOGRAPHIC / LAND SETTING:
I Slope 0 Valley 0 Flat 0 Ridge 0 Other
(check appropriate box)
\TITUDE 3 _
NGITUDE
May be in degrees.
minutes, seconds or
in a decimal format
332501
f. DISINFECTION: Type_t Amount
g. WATER ZONES (depth): 58
From 15Oo _-155_ From
From To
To From
From_
6.CASING:
To
Depth
From__ OTo_2(F
From_�To__0F
From To
7. GROUT Depth
From__ j�o__�Ft
From To Ft.
From To
8.SCREEN: Depth
From To
From To
From To
9.SAND/GRAVEL PACK:
Depth
From _To
From _To
From _To
10. DRILLING LOG
From To
Q._ M
1c0 15
11. REMARKS:
C
—�� - 0 GPb• ;�
To
From To
Thickness/
Diameter Weight Material
t._Rt/R 3cn
Ft. _
Material Method
—.tamed__ Braid/y.8
Ft.
Diameter Slot Size
Ft. in in
Ft. in in
Ft. in. _ in.
Ft.
Ft.,
Ft.
Material
Size Material
Formation Description
n IDT
fAl IOT7
M IA__,DT,7rr.OAMITF
1.
SIGNATURE • CERTIFIED WELL CONTRACTOR 9_1'
DATE
PRINTED NAME OF PERSON ONSTRUCTING THE WELL
bmit the original to the Division of Water Quality within 30 days. Attn: Information Mgt.,
17 Mail Service Center - Raleigh, NC 27699-1617 Phone No. [phone] ext 568.
I DO HERESY CERnFY 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/ V?
Form GW-la
Rev. 7/05
-53

1.WELL CONTRACTOR:
KEITH PRESNELL
Well Contractor (Individual Name) -
DEWEY MIGHT WELL &"PUMP CO-, INC.
Well Contractor Company Name
STREET ADDRESS P. O. BOX 308
BOONE NC 28807
City or Town State
( 828) - 28e
4- Zip Code
Areacode - Phone number
?.WELL INFORMATION:
SITE WELL ID #pr applicable)
STATE WELL PERMIT #Of applicable)
D WQ or OTHER PERMIT to applicable)
WELL USE (Check Applicable Box): Residential Water Supply ❑ X
DATE DRILLED a
TIME COMPLETED _in__ AM 0 PM DX
WELL LOCATION:
Dry: BLOWING ROCK COUNTY
CALDWELL
PRIVATE RD. OFF GLOBE RD. OFF HWY 321
Street Name, Numbers, Community, Subdivision, Lot No., Parcel, Zip Code)
TOPOGRAPHIC / LAND SETTING:
Slope ❑ Valley 0 Flat 0 Ridge 0 Other
(check appropriate box)
ATITUDE 3
ONGITUDE
atitude/longitude source: 0 Xp
s 0 Topographic map
(location of well must be shown on a USGS topo map and
attached to this form if not using GPS)
/ELL OWNER
WNER'S NAME DAVID G KLINE
MEET ADDRESS 307 FAIRWAY DR. .
NEW ORLEANS
City or Town State
'828 - 295-0808
3a code - Phone Phone number
ELL DETAILS:
TOTAL DEPTH: 425
May be in degrees,
minutes, seconds or
in a decimal format
LA 70124
Zip Code
DOES WELL REPLACE EXISTING WELL? YES 0 NO CX
WATER LEVEL Below Top of Casing: 20
(Use "+" if Above Top of Casing) FT.
TOP OF CASING IS
Above Land
Top of casing terminated at/or below land surface may require
a variance in accordance with 15A NCAC 2C .0118
/IELD
(gpm): —� METHOD OF TEST Alf
the original to the Division
mMal Service Center - Raleigh, NC 27699-1617 WPhone Noe (919) 733' 7015 ext 568.E
317ys.
To
To
Thickness/
Weight Material
.350 PVC
RESIDENTIAL WELL CONSTRUCTION RECORD
North Carolina Department of Environment and N atural Resources -Division of Water Quality
WELL CONTRACTOR CERTIFICATION # 2780
f. DISINFECTION: Type
g. WATER ZONES (depth):
From Ma 305
Depth Diameter
OTo 7t. 81/8
_OFt.
To Ft.
Depth
To
To
9.SAND/GRAVEL PACK:
Depth
From To_
From To_
From r
I DO HERESY CERnFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH
15A NCAC 2C. WELL CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS
8E0 RD HAS EEN PROVIDED TO THE WELL OWNER,
0,1
SIGNATURE 0 CERTIFIED WELL CONTRACTOR DATE
KEITH PRESNELL
PRINTED NAME OF PERSON CONSTRUCTING THE WELL
Form GW_1a
Rev. 7/05

I. WELL CONTRACTOR:
RESIDENTIAL WELL coNsnwenoN RECORD
North Carolina Department of Environment and Natural Resources -Division of Water Quality
WELL CONTRACTOR CERTIFICATION# 2780
'.Nell Contractor (Individual Name)
DEWEY WRIGHT WELL & PUMP CO. INC.
Well Contractor Company Name
STREET ADDRESS
BOONE NC 28807
City or Town State
( Zip Code
4rea co e - Ph—t umber
NELL INFORMATION:
$ITE WELL ID #(it applicable)
STATE WELL PERMIT #(ff applicable)
)WQ or OTHER PERMIT tit applicable)
WELL USE (Check Applicable Box): Residential Water Supply ❑ x
)ATE DRILLED
IME COMPLETED AM ❑ PM ❑X
/ELL LOCATION:
TY: _1ENOIR __ COUNTY CAt ems, r
ROBY MARTIN RD.
:reef Name, Numbers, Community, Subdivision, Lot No., Parcel, Zip Code)
)POGRAPHIC / LAND SETTING:
Slope ❑ Valley ❑ Flat U Ridge ❑ Other
(check appropriate box)
TITUDE 3
NGITUDE
Itude/longitude source: U
U Topographic map
(location of well must be shown on a USGS topo map and
attached to this form if not using GPS)
LL OWNER
NER'S NAME T!.A rt Cull
EET ADDRESS G Pf Roy gs
City or own State
Zip Co e
ell: 7R1 11LRR
code -Phone number
.L DETAILS:
OTAL DEPTH: __mat_
,OES WELL REPLACE EXISTING WELL? YES ❑ NO
May be in degrees,
minutes, seconds or
in a decimal format
'ATER LEVEL Below Top of Casing:
(Use "+" if Above Top of Casing)—�'
DP OF CASING IS FT. Above Land Suace*
Top of casing terminated at/or below land surface may require
a variance in accordance with 15A NCAC 2C .0118
ELD (gpm): 10 METHOD OF TEST _Air
)mit the original to the Division of Water Quality within 30 days. Attn: Information Mgt.,
7 Mail Service Center - Raleigh, NC 27699-1617 Phone No. [phone] ext 568.
339503
080429
f. DISINFECTION: Type_ u _ Amount
g. WATER ZONES (depth):
From
From To From
To From
From To From
6.CASING:
To
To
To
Thickness/
Depth Diameter Weight Material
From_0T --a- t. — 8 Il8 — —RVG—
From_oTo t.
From To Ft.
7.GROUP. Depth Material
From_ 01 Method
0_._-10Ft._ n.
From Ft.
From To_
&SCREEN: Depth
From To
From To
FromTo_
9.SAND/GRAVEL PACK:
Depth
From To_
From _To
From _To
10. DRILLING LOG
From To
Ft.
Diameter Slot Size Material
Ft. in. _ in.
Ft in in.
Ft. in. _ in.
Size
Ft._
Ft._
Ft.
0
Material f )
Formation Description
11. REMARKS: .'.
10 RIM ;
970 ➢7� R Qol,�
—oG� 0 tiP11I
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.
9 ✓ice
�11-
SIGNATURE OF CERTIFIED WELL CONT CTOR DATE
PRINTED NAME MAI CONSTRUCTING THE WELL
Forth GW-la
Rev. 7/05

RESIDENTIAL WELL coNSI UCTIorr RECORD
North Carolina Department of Environment and Na
tural Resources - Division of Water Quality
WELL CONTRACTOR CERTIFICATION # 2780
1. WELL CONTRACTOR:
Area cod _ Phone number
r —_
2.WELL INFORMATION:
SITE WELL ID #(if applicable)
STATE WELL PERMIT #(if applicable)
DWG) or OTHER PERMIT Or applicable)
WELL USE (Check Applicable Box): Residential Water Supply ❑ X
DATE DRILLED _ oJt MMe
TIME COMPLETED 3-00 AM ❑ PM ❑x
.WELL LOCATION:
CITY: I ENOI COUNTY .A1 I I
LINDSEY LANE OFF PLAYMORE BEACH RD. OF
(Street Name, Numbers, Community, Subdivision, Lot No., Parcel, Zip Code)
TOPOGRAPHIC / LAND SETTING:
Slope ❑ Valley ❑ Flat ❑ Ridge ❑ Other
(check appropriate box)
LATITUDE 3 _
_ONGITUDE _
_atitude/longitude source: ❑ XPS ❑ Topographic 0
graphic map
(location of well must be shown on a USGS topo map and
attached to this form if not using GPS)
YELL OWNER
)WNER'S NAME WIi I L j WMI AE
ITREET ADDRESS 2800 YNO8ET Bare
City or Town State
Zip Coe _
- 754-0g7R
rea code - Phone number
/ELL DETAILS:
TOTAL DEPTH: 185
DOES WELL REPLACE EXISTING WELL? YES ❑ NO Ck
WATER LEVEL Below Top of Casing:
(Use "+" if Above Top of Casing)
TO• P OF CASING IS - J_ FT Above Land Surface`
Top of casing terminated aVor below land surface may require
a variance in accordance with 15A NCAC 2C .0118
YIELD (gpm): 1? METHOD OF TEST
Well Contractor (Indio IdualeN
DEWEY WRIGHT WELL & PUMP CO. INC.
Well Contractor Company Name
STREET ADDRESS•
-_ D A'PDX08
BOONENC 28007
City or Town State
Zip Code
May be in degrees,
minutes, seconds or
in a decimal format
iubmit the original to the Division of Water Quality within 30 days. Attn: Information Mgt.,
1617 Mail Service Center - Raleigh, NC 27699-1617 Phone No. [phone] ext 568.
32505
f. DISINFECTION: Type_ mi_ Amount 1n
g. WATER ZONES (depth):
From__ g0 i1Q From To
From To From
To
From To From
6. CASING: To
Thickness/
Depth Diameter Weight Material
From_ QTO_ t.__ 8 --.350—
From_-0To_t.
From To Ft.
7. GROUT: Depth Material
From_.$o_20Ft --- Method
CQrglAi-- �: it FI
FromTo Ft. "rr-w+�_
From To Ft.
8.SCREEN: Depth Diameter
Slot Size Material
From To Ft. in
in
From To Ft.in.
in
From To Ft in. in.
9.SAND/GRAVEL PACK:
Depth Size Material
From _To_ Ft.
From To Ft.
From__To Ft.
10. DRILLING LOG
From To
— 0
—85_
100
Formation Description
n aT
_Gram
c
GRANITt
11. REMARKS: -r
19GPM 1/c 11R D ''�°
_ a
OQPM OOPM
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 SEEN PROVIDED TO THE WELL OWNER.
SIGNATURE OF CERTIFIED WELL CONTRACTOR DATE
PRINTS p pERSONCONST
IRUCTINGTHE WELL
Form GW-la
Rev. 7/05

RESIDENTIAL WELL CONSTRUCTION RECORD
North Cambia Department of ErWvuomaa and Natural Resources- Daisiaa of Water Quality ,
WELL CONTRACTOR Cut tIr1CATION # a3/
1. WELL CONTRALTO&
C 1 rile- RL 3sett
Ei Rome
W (tdruiti,l
«LLs s e- i Weal D r : /isms -I- iv c
We1 Cat Company Name
STREET ADDRESS 0:/ L- i' b e rty Ch Rd
-ray l0rsv;'lte k/cT .-gt#51
City or Tom Stale Zip Code
(EE3S) (23d-340f33
Area code_ Phone mamba
2 WELL DFORMATIOIt
SITE WELL ID Hfdamicable)
STATE WELL PER)AT#faapptioate)
DWG or OTHER PERMITSR applicable)
WELL USE (Check Applicable Bad: Rtsderdial Water Supply
DATE DRILLED 7 — A5 G
Tom coetPLErED 0 0 AND PMg-
3. WELL LOCATION
CITY- i1t .rei COUNTY a.)..
Numbers,
Cam,�J
(Smc tame. reaabers• Community. Smut Lot No_ Pfl Zip Code)
TOPOGRAPNOC l LAND SETTNG:
e Maley ❑Flat [Wedge ❑other
(road appaproro bon
LATTIIA)E - {� ° Se • / 1 7
LONGrruoE Je)0 g(° 35: 0 ( 8
Laitudelangitticle source: Er'cPS OTopogra(itic atop
(beaHo, of sea must be slam an a USGS bpo map mad
attached 'OHM lam snot [sang GPS)
4. WELL OWNER /n�� _ (,
OWP S NAME ✓ tc, LLia
STREET ADDRESS c"ge 029 .. 1 /L
City or Tam State Zip Cale
( 8a81_ 7S7-,30_s0
Area code - Phone number
May &o
roimm,soccads
ca deSnl format
5. WELL DETAIS:
a. TOTAL DO'T)t
b. DOES WB_L REPLACE BUSING / WELL?, YES ❑ NO l
Beim: c. WATER LEVEL Tcp of Casing / D Fr.
(Use -+- HAbove Top el Casity)
d_ TOP OF CASNG S / 1/Z FT. Above Lard Steam"
'Tap of cooing leminaled athr tebe land surface mayRa[uire
a valance in a¢adaceugh 15A►CAC 2C .OIT&
e. YIELD ((purr 3 MEMO OF TEST °°Nt/
333562
L DISI FECllolt Type Mt TN Anoeot / %; arm
g WATER ZONES (depth):
Front l70 To 4a5 From To
From To Fran To
Fan To Fton To
5. CASING:
Tilt:tr ss/
Faun Two /,3� FtD W
eiglit Material
Fan To R
Foe To R
7_ GROUT: Depth
Material Mailed
Fran 0 To v20 R C✓)flr��7,a,a yes()
Fero To Ftd __
Flora To R
L SCREE& Depth Diameter Slot Size Mafaial
Fran To R a a
Frain To R a M.
Fran To R it i1
9. SAND/GRAVEL PACK
Depth
From To R
Frain ' To Ft
Fran To R
Size italerial
10. DRRLNG LOG
Rom To
n /34
134' 4.2s'
11- REMARKS:
Formation
Description
did
/LCrzr�
�N. of
00 16 2DOf)
MOD Hater, @ffFY1H00116 WELL WAS CONSIRUCIED aACCORDNICE WnN
1SA ICAC 2V. WELL CONSTNCTON SIANDARON NOWT CCPr OF 1HIS
CORD HAS let FROWNED TOTE WELL OMER_
9-013-G4'
SCAT Oe MfH.L CONTRACTOR DATE
Ct3 a.s'st(I
PRIDED e_
OF PERSON CONSTRUCTING THE WELL
Submit the original to time Division of Water Quality within 30 days. Aar In an.ato. Mgt,
1617 Mai Sedvice Center— Raleigh, NC 27699-1617 Phone Mo. [phone] eat Slit
F®GW-1a
Rat 7105

NONRESIDENTIAL WELL CONSTRUCTION RECORD
North Carolina Depanmem of Environment and Natural Resources- Division of Water Quality
WELL CONTRACTOR CERTIFICATION N 3162
ex .v J
1. WELL CONTRACTOR:
Walter Davis
Well Contractor (Individual) Name
Subsurface Enviro. Investigations
Well Contractor Company Name
STREET ADDRESS 2155 Mocksvil le Hwy
Statesville, NC 28625
City or Town State Zip Code
( 704)-876-0010
Area code- Phone number
2. WELL INFORMATION:
SITE W ELL ID #(if applicable;
STATE WELL PERMIT#(it applicable]
DWQ or OTHER PERMIT #(if applicable)
WELL USE (Check Applicable Box) Monitoring W Municipal/Public 0
Industrial/Commercial 0 Agricultural 0 Recovery 0 Injection ❑
Irrigation0 Other 0 (list use)us
DATE DRILLED p/�e2.Q4
TIME COMPLETED AM 0 PM 0
3. WELL LOCATION: /'
CITY J TIC/ t couNTYr.,IC/d we/f
S®Z WilkesAge° Aiv55
(Street Name. Numbers, Community, Subdivision, bet No., Parcel. Zip Code)
TOPOGRAPHIC / LAND SETTING:
0 Slope ❑Valley ❑ Flat ❑ Ridge 0 Other
(check appropriate box)
LATITUDE 3
LONGITUDE
May be in degrees.
minuet. seconds or
in a decimal formai
Latitude/longitude source. ❑GPS ❑Topographic map
(location of well must be shown on a USGS opo map and
attached to this form if not using GPS)
4. FACILITY• is The name of the business where tne welt is located
FACILITY ID #(i( applicable)
NAME OF FACILITY
/r p /7PJf
STREET ADDRESS C z /a,/,kesL+
3f
o feyfr
City or Town T State
CONTACT PERSON Trey GA RESS /f
/Q/, /c
City a T n State
MAILI
7/9 )-.2S'o— 99rf
Area code - Phone number
5. WELL DETAILS:
a. TOTAL DEPTH:
Zip Code
then/
y View, cf,
, Code
b. DOES WELL REPLACE EXISTING WELL? YES 0 NO 7
c WATER LEVEL Below Top of Casing. FT
(Use'+- if Above Top of Casing)
d. TOP OF CASING IS N 0 FT. Above Land Surface'
-Top of casing terminated at/or below land surface may requite
a variance in accordance with 15A NCAC 2C 0118
e. YIELD(gpm) n/a
f. DISINFECTION: Type
g. WATER ZONES (depth/
From n/a To
From To
From To
6. CASING:
Depth
From To
From To
From To
METHOD OF TEST n/a
n/a
From
From
From
Amount
To
To
To
Thickness(
Ft Diameter Weiphl Mar erla'
SAND Dy C—
FI.
Ft
7. GROUT' Depth
From 9 To 2, FI
From_ To FI
From To FI
Material
Memo;
8. SCREEN: Depth Diameter Slot Size Material
Frcosj.2 ToS Ft. 7 in. a in.
From To Ft.
From To Ft. in in
9. SAND/GRAVEL PACK:
Depth
From Zo To
From To
From To
10. DRILLING LOG
From To
I
Size M 1./
� Fly
FI.
Ft
Formation Description
so%7
11.REMARKS
Div. OF Wqi PALITY
OCT 0,1 (gag
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED A ACCORDANCE A
ISA NCA AC. E)r CONs COON$1},NDARDS. AND THAT A COP OF 'HP
R OR HAS:�iY VHOVI pTOT
ELL OWNER
ate_
f� J v se
SIGNATU•E OF CERTIFIED WELL CONTRACTOR DATE
Walter Davis
PRINTED NAME OF fl7:ia1
Submit the original to the Division of Water Quality within 30 days. Attn: Info
1617 Mail Service Center- Raleigh, NC 27699-1617 Phone No. [phone] ext
ation Mgt.,
. OCT 17 2006
Form GW t.
Rev 7'05
Asheville Regional Office
A f lifer Drntectlnn

North Carolina Department of Environment and Natural
WELL CONTRACTOR CERTIFICATION #
1. WELL CONTRACTOR:
snA
<) i in irei/9e 1 IiwJ ryr,n.1/
LONGITUDE
Latitude/longitude source: te.GPS OTopographic map
(location of we0 must be shown on a USGS topo map and
attached to this form not using GPS)
4. WELL OWNER�,
OWNER'S;NgME '�LFG(/Ard 1/4.3t}2gf(
STRREETADDRRSS 37 LDrNOUg 4/- C(Jnf.
City or Town ) State Zip Code
(g 79/-8�77-
Well Contractor (Individual) Name
/lleu)4114-t/ b"VYZeMS Nc-
Well Contractor Company Name E '
STREET ADDRESS /67t,.? 7/Ci, / /he)ci ..2 4,-0,f
City or Town State Zip Code
(336)-235-Vr//5%
Area code- Phone number
2. WELL INFORMATION:
SITE WELL ID 4(N applicable)
STATE WELL PERMIT#(dappricable)
DWQ or OTHER PERMIT #(if applicable)
WELL USE (Check Applicable Box): Residential Water Supplyi
DATE DRILLED / / — �tL — D (2
TIME COMPLETED L.S, 7%/15 AM ❑ PM
3. WELL LOCATION:
CITY: (3 IA07e r COUNTY C..f+' IAj L'(/
�Drgnp M a 4es i40 # / SsV
(Street Name, Numbers, Community. Subdivision, Lot No., Parcel, Zip Code)
TOPOGRAPHIC / LAND SETTING:
alargliValley ❑Flat ORidge ❑Other -
(check appropriate box)
LATITUDE Cr , 0!7 76 eft
1) 21- 3-7 61,V &
May be in degrees,
minutes, seconds or
in a decimal format
Area code- Phone number
5. WELL DETAILS: -
a. TOTAL DEPTH:
b. DOES WELL. REPLACE EXISTING WELL? //YES O NOt
c. WATER LEVEL Below Top of Casing: !ri 6 - FT
(Use 'I"' if Above Top of Casing)
d. TOP OF CASING IS 1 FT. Above Land Surface'
'Top of casing terminated at/or below land surface may require
a variance in accordance/with 15A NCAC 2C .0118. r
e. YIELD Wpm):/ METHOD OF TEST /%
RESIDENTIAL WELL CONel'RuL ift/N REC.ORI
duality
i rces®D ist 01 Pater
#2445
334394
f. DISINFECTION: Type //%/` # atirAmount ...6 oc -
g. WATER ZONES (depth):
From , 3XZt To «00 - Rom To
Fran To From To
From To From To
6. CASING: Thickness/
Depth rrtr, - Diameter Weight MaJ�edralW
Rom f/ To rQCO FL7e4r=b SOZf.-1,G Pi/F1
Rom To FL
From To Ft.
7. GROUT: Depth Material n Method
From 0 To J-0 Ft. It)('N 7 _e 4�.�e
From To Ft. � 1..,d
From To FL
8. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. n.
From To Ft. in. n.
From To Ft. in. n.
9. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
From To Ft.
10. DRILLING LOG
From To
—i
Formation Description
dirt . SA.cd
1,16,6 Qta.u,'IeC
11. REMARKS:
RECENED
DIV. OF WATcp n�,IALITy
Nn1/ r r 2006
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED N ACCORDANCE WITH
15A NCAC 2C. WELL CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS q
RECORD BE [ D TO W WNER
421-0M100 / D 6
SIGN URE OFF/ CERTIFIED WELL CONTRACTOR DATE -
Li
PRINTED NAME OF PERSON CONSTRUCTING THE WELL
Submit the original to the Division of Water Quality within 30 days. Attn: Information Mgt.,
1617 Mail Service Center— Raleigh, NC 27699-1617 Phone No. [phone] ext 568.
Form GW-la
Rev. 7/05

WELL CONSTRUCTION RECORD
North Carolina - Department of Environs ent and N / - Division of Water Quality - Groundwater Sectio3lt
WELL CONTRACTOR (INDIVIDUAL) NAME (print / rid n CERTIFICATIONp�a.�6/0
WELL CONTRACTOR COMPANY NAME �7C1L0rt Gi/Eb 1 l/Jiff j a PHONE car (�01329a'S.S
STATE WELL CONSTRUCTION PERMIT' QQ _ASSOCIATED WQ PERMTTS
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Reaidentialfii_ Municipal/Public ❑ Industrial ❑ Agricultural 0
Monitoring ❑ Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATI N: Nearest Town: Di r County PideaP8
442 0Q /;#ke //Ilan P'/ 2/1
(Street Manic, NumbatCan nvnity, Subdivision, Lot No., Zip Code)
3. OWNER 0 fiSP t DM
Address 8 /(' anee/ enn,r%
(Street a RAte No.)
Ale
leao
City orTown State
(ge )- 952- i0//
Area code. Phone numbs
4. DATE DRILLED DOG -07-0ea
5. TOTAL DEPTH: efr_r
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO EL
7. STATIC WATER LEVEL Below Top of Casing: -b?J FT.
(Use''+" if Above Top of Cuing)
8. TOP OF CASING IS at FT. Above Land Surface*
*Top of casing terminated atla below bad surface requires a
variance In accordance with 1SA NCAC 2C .0118.
9. YIELD (gpm)• /0 METHOD OF TESTA, Ai- Tc1
10. WATER ZONES (depth).
LA,loilh—
Topographic/Land setting
❑Ridge ❑Slope ❑Valley ❑Flat
(the& appropriate box)
Latitude/longitude of well location
()
Latitude/longitude source:❑GPS❑Topographic map
(c box)
DEM DRILLING LOG
From To Formation Description
Tip Code
LOCATION SKETCIL
!�T A��( � Show direction and distance in miles
Wall Th(dmcas two State Roads or County Roads. In
/WWI
or��t lystenglc�� numbers
and common road net ines.
11. DISINFECTION: Type ! from at least
12. CASING:Include the road
Depth RECEIVED
From_ To /9/ Ft
From To Ft
From To Ft
13. GROUT: Depth
From_Q_ To ,a,
From To
14. SCREEN: Depth
From To
Material
Ft. 677rvd--
Ft.
Diameter Slot Size
Ft in. in.
From To Ft._in. in.
15. SAND/GRAVEL PACK
Depth Size Material
From To Ft.
area'
From To Ft.
Lti
aft'
S
QUALITY
1N(rOr�V 1 4 2006
MAY, /8 '--)Z4Voit-
16. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH I5A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
SIGNATURE OF PERSQhTC() _ CTING THE WELL DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-1 REV. 07/2001

WELL CONSTRUCTION RECORD 3 3 4 61
North Carolina - Department of Environment and �Natural l Re/s,,ources - Division of Water
WELL CONTRACTOR ) (print) e ha itarf)(esS Quality - Groundwater Section9�n,
(INDIVIDUAL) NAM�EJ ,, /, ""� CERTIFICATION N.17cm
WELL CONTRACTOR COMPANY NAME l7/µiOrt /A/e// Zail. t ,. PHONE # (12d),3254'gjf
STATE WELL CONSTRUCTION PERMIT/
(if applicable) ASSOCIATED kable) IT#
(if applicable)
1. WELL USE (Check Applicable Box): Residential ° Municipal/Public ° Industrial 0 Agricultural 0
Monitoring ° Recovery ° Beat Pump Water Injection ❑ Other ° If Other, List Use
2. WELL LOCATI • N:
Nearestp . ' s,r County ea(6( ,J/
tYPrSide .-r:
(Sheet Name,Numbers, Community, Subdivision, Lot No, Zip Code)
3. OWNER -Lick
icrk /L4C,Ey/✓ee41
Address 5S>ib Mtbbin greet kez.
lads -
(Street «ggftallo) or(s4(5
City or Town State Zip Code
(828 )- VS8. 95692
Area code- Phone mow
4. DATE DRILLED OV-OS -(26
5. TOTAL DEPTH: 70.5-
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO E;
7. STATIC WAttit LEVEL Below Top of Casing: SO FT.
8. TOP OF CASING [S 2 (tlae „+ if AboeTop of acmes)
Surface*FT. Above Land
`Top of easing terminated atior blow land surface require a
variance in accordance with ISA NCAC 2C Aiit
9. YIELD (gpm): /. S METHOD OF TESt/9p 4r %f
10. WATER ZONES (depth):
11. DISINFECTION: Type /7 5
12. CASING:
th
From 0 TDr
Do%8(p Ft (cy Se
From To Ft__
From To Ft
13. GROUT:
terial
From 1) To 2t7 Ft Ghro
From To
14. SCREEN: Depth Diameter
From To Ft in.
From To Ft in.
15. SAND/GRAVEL PACK:
Depth Size
From To Ft.
Front To Ft.
16. REMARKS:
Amount /$R
Wall Thic*ness
Ft.
rAwwmoo
t tred
Topographic/Land setting
°Ridge °Slope °Valley °Flat
(check appropriate box)
Latitude/longitude of well location
(dewe Wmimuealseeonda)
Latitude/longitude source:°GPS°Topographic map
(`beck box)
MEM From To GRILLING LOG
Formation Description
Z.00ATION SKETCH
Show direction and distance in miles from at least
two State Roads or County RoadEtticiuqge road
numbers and common 1,0 4 VER OUALiTY
Slot Size Material t,(/
in.
in.
Material
iffwfr
1 4 2006
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
Clad c ati)� /) 47-6s cep
SIGNATURE OF PERSON tSTTkUC 1NG THE WELL
DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Seat Center - Raleigh, NC
27699-1636 Phone Na [phone], within 30 days.
GW-1 REV. 07/2001

North Carolina -Department of Environment and
WELL CONTRACTOR (UVDIVIDUAL) NAME
WELL CONTRACTOR COMPANY NAME
STATE WELL CONSTRUCTION PERMITS v if licable OCIATED WQ P) T*
If 'cede I. WELL USE (Check Applicable Boa): Residential
61 Agricultural ❑
WELL CON TRUCTION RECORD
actual
a3 eJ / Q7 I FE
- Division of Water Quality - Groundwater Section
CERTIFICATION M_
Monitoring 0 Recovery 0 Heat Injection
Public 0 Industrial t 0
Pump Water J 4cctjon 0 Other O If Other, Lint Use
2. WELL LOCATION:
Nearest Town:
2
county
(Street Name, Numbs% Comansaity. Subdivisito, Lot No, Tip code)
3. OWNER:
Address
Ct � City
orT Stwe 2St ZPcede
Ma code -Pion manta
4. DATE DRHZED222-a
5. TOTAL DEPTH
6. DOES WELL REPLACE
7. STATIC WATER LEVEL Below�op of CYES asing
NO 0
8. TOP OF CASING IS (Use 'cr1fAberm Top of f
�
FT. Above Land S
*Top of easingmre
mar below lead surface reface
variancevarianceto accordance with ISA NCAC 2CMIR9.
gake.
10. YIE D S` --_ METHOD OF TEST T
(depth):
11. DISINFECTION: Type
12. CASING: Aoj—�_
Depth Wall Thickness
To-s 2_ Ft or
� F
To t
FroT
13. GROUT: O
FrFom__ To 20
To
14. SCREEN: Depth
Fromm_ To
Flom To
15. SAND/GRAVEL PACK
From Depth
To_
From To
16. REMARKS:
FiMatetial
t_
Ft
Diameter
Ft in.
Slot Size
in.
Material
PRONE s
, ta7.5I./ as-
Topographic/Land setting
['Ridge OSlope OValley OF1at
Lati( aW�P�ate boa)
dde/longinide of well location
Latitude/longitude oPo&aphic map
(check boa)
From To
Formation Description
I. ATION RrrTrcr
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common road names.
RECEIVED
5bIV Or WATER QUA! ITY
NOV 1 4 2006
It10HEREBY
I DO RUC170NTHAT THIS WELL WAS CONSTRUCTEDTHIS
IN ACCORDANCE WITH 1SA NCAC 2C, WELL
STANDARDS, AND THAT COPY OF
/RD HAS BEEN PROVIDED TO THE WELL OWNER
Size Material
Ft
SIGNATURE OF PERSON CTRQG THE WELL
D7-
Submit the original to the Division Water DATE
27699-1636those No. (919) 733-322 of Quality, Groundwater Section, mg Mao service center -Raleigh, NC
4 thin 30 days.of
GW-1 REV. 07/2001

RESIDENTIAL WELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources - Division of Water Quality
WELL CONTRACTOR CERTIFICATION # 2686
1. WELL CONTRACTOR:
LESLIE REECE
Well Contractor (Individual Name)
DEWEY WRIGHT WELL & PUMP CO., INC.
Well Contractor Company Name
STREET ADDRESS P. 0. BOX 308
BOONE NC 28607
City or Town State Zip Code
( 828) - 264-2651
Area code - Phone number
2.WELL INFORMATION:
SITE WELL ID #(n applicable)
STATE WELL PERMIT #(,F applicable)
DWO or OTHER PERMIT #(A applicable)
WELL USE (Check Applicable Box): Residential Water Supply ❑ X
DATE DRILLED 9/12/2006
TIME COMPLETED 4:00 AM ❑ PM ❑X
3. WELL LOCATION:
CITY: LENOIR COUNTY CALDWELL
OFF GREENFIELD PLACE OFF HWY 18 OFF 321
(Street Name, Numbers, Community, Subdivision, Lot No., Parcel, Zip Code)
TOPOGRAPHIC / LAND SETTING:
❑ Slope 0 Valley ❑ Flat 0 Ridge 0 Other
(check appropriate box)
LATITUDE 3 38,00612
May be in degrees,
minutes, seconds or
LONGITUDE 081.23068
in a decimalformat
Latitude/longitude source: 0 MPS 0 Topographic
(location of well must be shown on a USGS
attached to this form if not using GPS)
4.WELL OWNER
OWNER'S NAME DENNIS HARRIS CONSTR.
map
topo map and
STREET ADDRESS 2540 BRITTANY DR. ,
LENOIR NC 28645
City or Town State Zip Code
( (828)_ 4993684
Area code - Phone number
5.WELL DETAILS:
a. TOTAL DEPTH: 340
b. DOES WELL REPLACE EXISTING WELL? YES 0 NO 0(
c. WATER LEVEL Below Top of Casing: 20 FT.
(Use "+" if Above Top of Casing)
d. TOP OF CASING IS 1 FT. Above Land Surface'
Top of casing terminated at/or below land surface may require
a variance in accordance with 15A NCAC 2C .0118
e. YIELD (gpm): t2 METHOD OF TEST Air
3 60V..
060516
f. DISINFECTION: Type HTH Amount 68
g. WATER ZONES (depth):
From 299ro 2B From To
From To From To
From To From To
6.CASING: Thickness/
Depth Diameter Weight Material
From OTo 45Ft. 61/8 .350 PVC
From Oro OFt.
From To Ft.
7.GROUT: Depth Material Method
From Oro 2OFt. Cement GravitvFlow
From To Ft
From To Ft.
8.SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in.
From To Ft. in. in.
From To Ft in. in.
9.SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
From To Ft.
10. DRILLING LOG
From To Formation Description
0 40 DIRT
40 298 GRANITE
298 299 SHALE
299 340 GRANITE
OF ,,y,,TC
DN.
2po6
WV 16
11. REMARKS:
12GPM 298-299 OGPM -
O GPM - 0 GPM, -
O GPM - 0 GPM -
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH
15A NCAC 2C, WELL CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS
RECORD HAS BEEN PROVIDED TO THE WELL OWNER.
a &I % 3 "� PO -0 b
SIGN LF CE D WELL CONTRACTOR DATE
LESLIE RR CCE
PRINTED NAME OF PERSON CONSTRUCTING THE WELL
Submit the original to the Division of Water Quality within 30 days. Attn: Information Mgt.,
1617 Mail Service Center - Raleigh, NC 27699-1617 Phone No. [phone] ext 568.
Form GW-la
Rev. 7/05

RESIDENTIAL WELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources - Division of Water Quality
WELL CONTRACTOR CERTIFICATION # 2686
1.WELL CONTRACTOR:
LESLIE REECE
Well Contractor (Individual Name)
DEWEY WRIGHT WELL & PUMP CO., INC.
Well Contractor Company Name
STREET ADDRESS P 0 BOX 308
BOONE NC 28607
City or Town State Zip Code
( 828)- 264-2851
Area code - Phone number
2.WELL INFORMATION:
SITE WELL ID #(if applicable)
STATE WELL PERMIT #(it applicable)
DWQ or OTHER PERMIT #(d applicable)
WELL USE (Check Applicable Box): Residential Water Supply 0 X
DATE DRILLED 9/11/2006
TIME COMPLETED 4:00 AM 0 PM ❑X
3.WELL LOCATION:
CITY: LENOIR COUNTY CALDWELL
OFF GREENFIELD PLACE OFF HWY 18 OFF 321
(Street Name, Numbers, Community, Subdivision, Lot No., Parcel, Zip Code)
TOPOGRAPHIC / LAND SETTING:
❑ Slope 0 Valley 0 Flat 0 Ridge 0 Other
(check appropriate box)
LATITUDE 3 36 00424
May be in degrees,
minutes, seconds or
LONGITUDE 081.22810
in a decimal format
Latitude/longitude source: 0 XPS 0 Topographic
(location of well must be shown on a USGS
attached to this form if not using GPS)
4.WELL OWNER
OWNER'S NAME DENNIS HARRIS CONSTR.
map
topo map and
STREET ADDRESS 2540 BRITTANY DR.,
I FNOIR NC 28645
City or Town State Zip Code
( (828)- 4993084
Area code - Phone number
5.WELL DETAILS:
a. TOTAL DEPTH: 300
b. DOES WELL REPLACE EXISTING WELL? YES 0 NO 3(
e. WATER LEVEL Below Top of Casing: 20 FT.
(Use "+" if Above Top of Casing)
d. TOP OF CASING IS 1 FT. Above Land Surface*
Top of casing terminated at/or below land surface may require
a variance in accordance with 15A NCAC 2C .0118
e. YIELD (gpm):. 8 METHOD OF TEST Air
3
060515
f. DISINFECTION: Type HTH Amount 58
g. WATER ZONES (depth):
From-26Ro 262 From To
From To From To
From To From To
6.CASING: Thickness/
Depth Diameter Weight Material
From 0To 1O0Ft. a t/8 350 PVC
From OTo_OFt.
From To Ft.
7.GROUT Depth Material Method
From Oro i0Ft. Cement GravityFlow
From To Ft.
From To Ft
8.SCREEN: Depth Diameter Slot Size Material
From To Ft in. in.
From To Ft. in. in.
From To Ft. in. in.
9.SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
From To Ft.
10. DRILLING LOG
From To Formation Description
9 50 DIRT
50 95 SAND
96 261 GRANITE
781 787 SHAI F
262 300 GRANITE
RECCE ECL W
OF j)A
to
NfV1"`"
11. REMARKS:
8 GPM 261 - 262 O GPM -
O GPM - O GPM -
OGPM - OGPM -
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.
gait; 'Ake /N—l0 �b 6
SIGNATURE OF CE IED WELL CONTRACTOR DATE
LESLIF RFFCF
PRINTED NAME OF PERSON CONSTRUCTING THE WELL
Submit the original to the Division of Water Quality within 30 days. Attn: Information Mgt.,
1617 Mail Service Center - Raleigh, NC 27699-1617 Phone No. [phone] ext 568.
Form GW-la
Rev. 7/05
Y

RESIDENTIAL. WELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources - Division of Water Quality
WELL CONTRACTOR CERTIFICATION # 2686
1.WELL CONTRACTOR:
LESLIE REECE
Well Contractor (Individual Name)
DEWEY WRIGHT WELL & PUMP CO., INC.
Well Contractor Company Name
STREET ADDRESS P. O. BOX 308
BOONE NC 28607
City or Town State Zip Code
( 828)- 264-2651
Area code - Phone number
2.WELL INFORMATION:
SITE WELL ID #(f applicable)
STATE WELL PERMIT #(if applicable)
DWO or OTHER PERMIT #(f applicable)
WELL USE (Check Applicable Box): Residential Water Supply DX
DATE DRILLED 10/18/2006
TIME COMPLETED 3.00 AM ❑ PM DX
3. WELL LOCATION:
CITY: COUNTY CALDWELL
LITTLE ROCK CANYON RD. OFF WHITE ROCK R
(Street Name, Numbers, Community, Subdivision, Lot No., Parcel, Zip Code)
TOPOGRAPHIC / LAND SETTING:
❑ Slope D Valley 0 Flat 0 Ridge D Other
(check appropriate box)
LATITUDE 3 36 06832
May be in degrees,
minutes, seconds or
LONGITUDE 081.33146
in a decimal format
Latitude/longitude source: 0 XPS 0 Topographic
(location of well must be shown on a USGS
attached to this form if not using GPS)
4.WELL OWNER
OWNER'S NAME OLIVER C ROGERS
map
topo map and
STREET ADDRESS P.O. BOX 1289 ,
JACKSONVILLE NC 28541
City or Town State Zip Code
( (910)- 938-1636
Area code - Phone number
5.WELL DETAILS:
a. TOTAL DEPTH: 500
b. DOES WELL REPLACE EXISTING WELL? YES 0 NO q(
c. WATER LEVEL Below Top of Casing: 80 FT.
(Use "+" if Above Top of Casing)
d. TOP OF CASING IS 1 FT. Above Land Surface'
' Top of casing terminated aVor below land surface may require
a variance in accordance with 15A NCAC 2C .0118
e. YIELD (gpm): 0.5 METHOD OF TEST Air
060554
f. DISINFECTION: Type NTH Amount 87
g. WATER ZONES (depth):
From 250ro 261 From To
From To From To
From To From To
6.CASING: Thickness/
Depth Diameter Weight Material
From Oro 60=t. 61/8 .350 PVC
From 0To OFt.
From To Ft
7.GROUT: Depth Material Method
From_01-o 20Ft. Cement Gravity Flow
From To Ft
From To Ft.
8.SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in.
From To Ft. in. in.
From To Ft. in. in.
9.SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
From To Ft.
10. DRILLING LOG
From To Formation Description
0 55 DIRT
58 260 GRANITE
260 261 SHALE
781 500 GRANITE
RECEf QED UTY
cF DNA+ .. • p
ON.
WV 1 S COOL
11. REMARKS:
0.50PM 200-261 0GPM -
OGPM - OGPM -
0 GPM - O GPM -
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 BEENPROVIDED TO THE gWELL,L�OWNER. (]
J' /'DAT 6
SI'i'?WAt OF f701 r WA--UgbNTRACTOR
LESLIE EECE
PRINTED NAME OF PERSON CONSTRUCTING THE WELL
Submit the original to the Division of Water Quality within 30 days. Attn: Information Mgt.,
1617 Mail Service Center - Raleigh, NC 27699-1617 Phone No. [phone] ext 568.
Form GW-la
Rev. 7/05

RESIDENTIAL WELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources - Division of Water Quality
WELL CONTRACTOR CERTIFICATION # 2686
1.WELL CONTRACTOR:
LESLIE REECE
Well Contractor (Individual Name)
DEWEYWRIGHT %NELL &PUMP CO., INC.
Well Contractor Company Name
STREET ADDRESS P. O. BOX 308
BOONE NC 28607
City or Town State Zip Code
( 828) - 264-2651
Area code - Phone number
2.WELL INFORMATION:
SITE WELL ID #(n applicable)
STATE WELL PERMIT #(if applicable)
DWQ or OTHER PERMIT #Qf applicable)
WELL USE (Check Applicable Box): Residential Water Supply DX
DATE DRILLED 9/4/2006
TIME COMPLETED 5-00 AM ❑ PM DX
3. W ELL LOCATION:
CITY: LENOIR COUNTY CALDWELL
HWY90OFF HWY18
(Street Name, Numbers, Community, Subdivision, Lot No., Parcel, Zip Code)
TOPOGRAPHIC / LAND SETTING:
❑ Slope 0 Valley 0 Flat 0 Ridge 0 Other
(check appropriate box)
LATITUDE 3
May be in degrees,
minutes, seconds or
LONGITUDE
in a decimal format
Latitude/longitude source: 0 N'S 0 Topographic
(location of well must be shown on a USGS
attached to this form if not using GPS)
4.WELL OWNER
OWNER'S NAME BRUSHY MTN PROP,LLC/ROBERT
map
topo map and
PE
STREET ADDRESS 8602 SOUNDVIEW CT. ,
EMERALD ISLE NC 28594
City or Town State Zip Code
( (252)). 659-2534
Area code - Phone number
5.WELL DETAILS:
a. TOTAL DEPTH: 500
b. DOES WELL REPLACE EXISTING WELL? YES 0 NO L (
c. WATER LEVEL Below Top of Casing: 100 FT.
(Use "+" if Above Top of Casing)
d. TOP OF CASING IS 1 FT. Above Land Surface'
' Top of casing terminated at/or below land surface may require
a variance in accordance with 15A NCAC 2C .0118
e. YIELD Wpm): 3 METHOD OF TEST Air
t tJ
060496
:10
f. DISINFECTION: Type HTH Amount 84
g. WATER ZONES (depth):
From 303To 304 From To
From To From To
From To From To
6.CASING: Thickness/
Depth Diameter Weight Material
From 0To 100=t. 61/8 -350 PVC
From 0To Ort.
From To Ft.
7.GROUT: Depth Material Method
From flo 90Ft. Cement Gravity Flow
From To Ft.
From To Ft.
8.SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in.
From To Ft. in. in
From To Ft. in. in.
9.SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
From To Ft.
10. DRILLING LOG
From To Formation Description
0 g5 DIRT
05 303 GRANITE
303 304 OUARTZ
304 500 GRANITE
CEPal—
H T`
DIV. of
200R
NOV 1 C
11. REMARKS:
3GPM 303-304 0GPM -
0 GPM - O GPM -
0 GPM - 0 GPM -
I D0 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 x
Ip,fh. Waina /aye-Pu 1/-10 -v6
SIGNATURE OF CE9 IED WELL CONTRACTOR DATE
LESLIE REECE
PRINTED NAME OF PERSON CONSTRUCTING THE WELL
Submit the original to the Division of Water Quality within 30 days. Attn: Information Mgt.,
1617 Mail Service Center - Raleigh, NC 27699-1617 Phone No. [phone] ext 568.
Form GW-la
Rev. 7/05

RESIDENTIAL WELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources - Division of Water Quality
WELL CONTRACTOR CERTIFICATION #
1. WELL CONTRACTOR:
LESLIE REECE
Well Contractor (Individual Name)
DEWEY WRIGHT WELL & PUMP CO., INC.
Well Contractor Company Name
STREET ADDRESS P. 0 BOX 308
BOONE NC 28607
City or Town State
( 828)- 284-2851
Zip Code
Area code - Phone number
2.WELL INFORMATION:
SITE WELL ID #(if applicable)
STATE WELL PERMIT #(if applicable)
DWQ or OTHER PERMIT #(n applicable)
WELL USE (Check Applicable Box): Residential
Water Supply 0 X
❑ PM OX
CALDWELL
DATE DRILLED 9/8/2006
TIME COMPLETED 2-00 AM
3.WELL LOCATION:
CITY: LENOIR COUNTY
MAPLE GROVE CHURCH RD. OFF 90 WEST OFF
(Street Name, Numbers, Community, Subdivision, Lot No.,
TOPOGRAPHIC / LAND SETTING:
0 Slope 0 Valley 0 Flat 0 Ridge 0 Other
Parcel, Zip Code)
(check appropriate box)
LATITUDE 3
May be in degrees,
minutes, seconds or
in a decimal format
LONGITUDE
Latitude/longitude source: ❑ WS ❑ Topographic
(location of well must be shown on a USGS
attached to this form if not using GPS)
4.WELL OWNER
OWNER'S NAME RICHARD LAWRENCE
map
topo map and
STREET ADDRESS % SHIRLEY HERRICK . 1212 SOUTH DAYT
BEACH FL 32136
City or Town State Zip
( (386)_ 439-1902
Code
YES 0 NO CX
FT.
Area code - Phone number
5.WELL DETAILS:
a. TOTAL DEPTH. 300
b. DOES WELL REPLACE EXISTING WELL?
e. WATER LEVEL Below Top of Casing: 20
(Use "+" if Above Top of Casing)
d. TOP OF CASING IS 1 FT. Above
Land Surface'
surface may require
2C .0118
TEST Air
Top of casing terminated at/or below land
a variance in accordance with 15A NCAC
e. YIELD (gpm): 1.5 METHOD OF
2688
7
060370
f. DISINFECTION: Type jITH Amount 5R
rTD
g. WATER ZONES (depth):
From 74To 75 From To
From To From To
From To From To
6.CASING: Thickness/
Depth Diameter Weight Material
From 0To ?fit. ft 1/R 350 PVC
From OTo______CFt.
From To Ft.
7.GROUT: Depth Material Method
From Oro ?OFt Cement Gravity Flow
From To Ft.
From To Ft.
B.SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in.
From To Ft. in. in.
From To Ft. in. in
9.SAND/GRAVEL PACK:
Depth Size Material
From _To Ft.
From To Ft.
From To Ft.
10. DRILLING LOG
From To Formation Description
n 17 nun Mt ID
nun
17 74 GRANITE
74 75 4H Al c
75 a[YI GP ANITF
Submit the original to the Division of Water Quality within 30 days. Attn: Information Mgt.,
1617 Mail Service Center - Raleigh, NC 27699-1617 Phone No. [phone] ext 568.
Form GW-la
Rev. 7/05

RESIDENTIAL WELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources - Division of Water Quality
WELL CONTRACTOR CERTIFICATION # 2686
1.WELL CONTRACTOR:
LESLIE REECE
Well Contractor (Individual Name)
DEWEY WRIGHT WELL & PUMP CO., INC.
Well Contractor Company Name
STREET ADDRESS P. O. BOX 308
BOONE NC 28807
City or Town State Zip Code
( 828) - 264-2651
Area code - Phone number
2.WELL INFORMATION:
SITE WELL ID #(it applicable)
STATE WELL PERMIT #(it applicable)
DWQ or OTHER PERMIT #(if applicable)
WELL USE (Check Applicable Box): Residential Water Supply O X
DATE DRILLED 11/20/2006
TIME COMPLETED 3:00 AM ❑ PM OX
3. WELL LOCATION:
CITY: LENOIR COUNTY CALDWELL
MULBERRY RD. OFF KIRBY MTN. RD. OFF 321
(Street Name, Numbers, Community, Subdivision, Lot No., Parcel, Zip Code)
TOPOGRAPHIC / LAND SETTING:
0 Slope 0 Valley 0 Flat 0 Ridge 0 Other
(check appropriate box)
LATITUDE 3 '16n2015
May be in degrees,
minutes, seconds or
LONGITUDE n81 into
in a decimal format
Latitude/longitude source: 0 6cpS 0 Topographic
(location of well must be shown on a USGS
attached to this form if not using GPS)
4.WELL OWNER
OWNER'S NAME F Ef M STEN
map
topo map and
,JEIMF-S
STREET ADDRESS 3992 MULBFP.RY RD
Cityor own State Zip Co e
( (828)- 758-9868
Area code - Phone number
5.WELL DETAILS:
a. TOTAL DEPTH: 280
b. DOES WELL REPLACE EXISTING WELL? YES 0 NO O,{
c. WATER LEVEL Below Top of Casing: 90 FT.
(Use "+" if Above Top of Casing)
d. TOP OF CASING IS 1 FT. Above Land Surface`
* Top of casing terminated at/or below land surface may require
a variance in accordance with 15A NCAC 2C .0118
e. YIELD (gpm): 10 METHOD OF TEST Air
060657
m
f. DISINFECTION: Type 14TH Amount 3$ CO
g. WATER ZONES (depth): CA
From 16gro 1E8 From To LCD
From To From To C``J
From To From To Ce3
6.CASING: Thickness/
Depth Diameter Weight Material
From QTo 17t. R 1/8 456 PVC
From QTo Qrt.
From To Ft.
7.GROUT: Depth Material Method
Fromo 20Ft. Cement Gratify Flow
From To Ft.
From To Ft.
8.SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in.
From To Ft. in. in.
From To Ft. in. in.
9.SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
From To Ft.
10. DRILLING LOG
From To Formation Description
9 127 DIPT
i 'X1 16E GRA}nTF
IRA 1Fa3 QUART?
iRR "n'i'1 rpAA'ITF
Ng) IN
s.,In
w���1A70
11. REMARKS:
10 GPM 164 - 168 O GPM -
OGPM - OGPtv1 -
0 GPM - O GPM -
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.
144 fir it e/� 0 a -7.0a
SIGNATURE OF J RTIFIED WELL CONTRACTOR DATE
I FSI IF RFFCF
PRINTED NAME OF PERSON CONSTRUCTING THE WELL
Submit the original to the Division of Water Quality within 30 days. Attn: Information Mgt.,
1617 Mail Service Center - Raleigh, NC 27699-1617 Phone No. [phone] ext 568.
'Form GW-1a
kev. 7/05

RESIDENTIAL WELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources - Division of Water Quality
WELL CONTRACTOR CERTIFICATION # 2888
1. W ELL CONTRACTOR:
LESLIE REECE
Well Contractor (Individual Name)
DEWEY WRIGHT WELL & PUMP CO., INC.
Well Contractor Company Name
STREET ADDRESS P. 0. BOX 308
BOONE NC 28607
City or Town State Zip Code
( 828) - 204-2851
Area code - Phone number
2.WELL INFORMATION:
SITE WELL ID #(it applicable)
STATE WELL PERMIT #(11 applicable)
DWQ or OTHER PERMIT #(t applicable)
WELL USE (Check Applicable Box): Residential Water Supply 0 X
DATE DRILLED 10/31/2008
TIME COMPLETED 1 A0 AM 0 PM OX
3. WELL LOCATION:
CITY: BLOWING ROCK COUNTY CALDWELL
COY MILLER RD. OFF WARRIOR RD. OFF 321
(Street Name, Numbers, Community, Subdivision, Lot No., Parcel, Zip Code)
TOPOGRAPHIC / LAND SETTING:
0 Slope 0 Valley 0 Flat 0 Ridge 0 Other
(check appropriate box)
LATITUDE 3 38 58908
May be in degrees,
minutes, seconds or
LONGITUDE 081.34082
in a decimal format
u
Latitude/longitude source: 0 X'S 0 Topographic
(location of well must be shown on a USGS
attached to this form if not using GPS)
4.WELL OWNER
OWNER'S NAME WILLIAM M HOLSCLAW
map
topo map and
STREET ADDRESS 3302 COY MILLER RD. ,
LENOIR NC 28845
City or Town State Zip Code
( (828)_ 758-5843
Area code - Phone number
5.WELL DETAILS:
a. TOTAL DEPTH: 500
b. DOES WELL REPLACE EXISTING WELL? YES 0 NO U(
c. WATER LEVEL Below Top of Casing: FT.
(Use "+" if Above Top of Casing)
d. TOP OF CASING IS 1 FT Above Land Surface*
`Top of casing terminated at/or below land surface may require
a variance in accordance with 15A NCAC 2C .0118
e. YIELD (gpm): 0 METHOD OF TEST Air
080625-1 its
w
f. DISINFECTION: Type HTH Amount CM
g. WATER ZONES (depth): ritZ
From DRYro HOLE From To VO
From To From To VIZ
From To From To
6.CASING: Thickness/
Depth Diameter Weight Material
From Oro 120=t. 61/8 .350 PVC
From Oro Ot.
From To Ft.
7.GROUT: Depth Material Method
From Ylo 20Ft. Cement Gravity Flow
From To Ft.
From To Ft.
8.SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in.
From To Ft. in. in.
From To Ft. in. in.
9.SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
From To Ft.
10. DRILLING LOG
From To Formation Description
0 115 DIRT
115 500 GRANITE
REPIERQ NU
O\ • t*
OEC14
11. REMARKS:
OGPM DRY -HOLE OGPM -
O GPM - O GPM -
O GPM - O GPM -
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH
15A NCAC 2C, WELL CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS
RECORDCOpHASBEENPROVIDED TO THE WELLELOWNER. /
�i °.�] { ;)/(/ }7 t / -40.2/ I - 7 -O6
SIGNATUREtOF CER,TI ED WELL CO<SR7ACTOR DATE
LESLIE RE CE
PRINTED NAME OF PERSON CONSTRUCTING THE WELL
Submit the original to the Division of Water Quality within 30 days. Attn: Information Mgt.,
1617 Mail Service Center - Raleigh, NC 27699-1617 Phone No. [phone] ext 568.
Form GW-la
Rev. 7/05

RESIDENTIAL WELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources - Division of Water Quality
WELL CONTRACTOR CERTIFICATION # 2886
1. WELL CONTRACTOR:
LESLIE REECE
Well Contractor (Individual Name)
DEWEY WRIGHT WELL & PUMP CO., INC.
Well Contractor Company Name
STREET ADDRESS P. O. Box 308
B00NE NC 28607
City or Town State Zip Code
( 828)- 284-2851
Area code - Phone number
2.WELL INFORMATION:
SITE WELL ID #(if applicable)
STATE WELL PERMIT #(if applicable)
DWO or OTHER PERMIT #(if applicable)
WELL USE (Check Applicable Box): Residential Water Supply O X
DATE DRILLED 10/31/2006
TIME COMPLETED 3-00 AM ❑ PM OX
3. WELL LOCATION:
CITY: LENOIR COUNTY CALDWELL
COY MILLER RD. OFF WARRIOR RD. OFF 321
(Street Name, Numbers, Community, Subdivision, Lot No., Parcel, Zip Code)
TOPOGRAPHIC / LAND SETTING:
O Slope 0 Valley O Flat 0 Ridge 0 Other
(check appropriate box)
LATITUDE 3 36.58908
May be in degrees,
minutes, seconds or
LONGITUDE 081.34082
in a decimal format
Latitude/longitude source: 0 ORS 0 Topographic
(location of well must be shown on a USGS
attached to this form if not using GPS)
4.WELL OWNER
OWNER'S NAME WILLIA1v1 M. HOLSCLAW
map
topo map and
STREET ADDRESS 3302 COY MILLER RO. ,
LENOIR NC 28845
City or Town State Zip Code
( (828)_ 493-0517
Area code - Phone number
5.WELL DETAILS:
a. TOTAL DEPTH: 400
b. DOES WELL REPLACE EXISTING WELL? YES 0 NO U(
c. WATER LEVEL Below Top of Casing: 80 FT.
(Use "+" if Above Top of Casing)
d. TOP OF CASING IS 1 FT. Above Land Surface*
Top of casing terminated at/or below land surface may require
a variance in accordance with 15A NCAC 2C .0118
e. YIELD (gpm): 0.75 METHOD OF TEST Alf
25-2
f. DISINFECTION: Type HTH Amount 89 CL2
g. WATER ZONES (depth): Ca
From 34ko 350 From To LCD
From To From To VIZ
Cs,
From To From To
6.CASING: Thickness/
Depth Diameter Weight Material
From Oro 113=t. 81/8 .350 PVC
From Oro 0=t.
From To Ft.
7.GROUT: Depth Material Method
From0o 20Ft. Cement Gravity Flow
From To Ft.
From To Ft.
8.SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in.
From To Ft. in. in.
From To Ft. in. in.
9.SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
From Ft.
_To
10. DRILLING LOG
From To Formation Description
0 110 DIRT
110 349 GRANITE
349 350 QUARTZ
350 400 GRANITE
REGECRQUO"
of ��
ON.
1OOfi
11. REMARKS:
0.75GPIA 349-350 OGPM -
O GPM - O GPM -
0 GPM - 0 GPM -
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.
ALIA, ra,cyrt� eu l2 -7 -0 &
SIGNATURE OF QE TIFIED WELL CONTRACTOR DATE
LESLIE REECE
PRINTED NAME OF PERSON CONSTRUCTING THE WELL
Submit the original to the Division of Water Quality within 30 days. Attn: Information Mgt., '
1617 Mail Service Center - Raleigh, NC 27699-1617 Phone No. [phone] ext 568.
Form GW-la
Rev. 7/05

RESIDENTIAL WELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources - Division of Water Quality
WELL CONTRACTOR CERTIFICATION # 2686
1. W ELL CONTRACTOR:
LESLIE REECE
Well Contractor (Individual Name)
DEV EY WRIGHT WELL & PUMP CO, INC.
Well Contractor Company Name
STREET ADDRESS P. 0. BOX 308
BOONE NC 28807
City or Town State Zip Code
( 828) - 264-2651
Area code - Phone number
2.WELL INFORMATION:
SITE WELL ID #(it applicable)
STATE WELL PERMIT #(if applicable)
DWG or OTHER PERMIT #(if applicable)
WELL USE (Check Applicable Box): Residential Water Supply O X
DATE DRILLED 10/28/2008
TIME COMPLETED 10:00 AM O XPM ❑
3. WELL LOCATION:
CITY: LENOIR COUNTY CALDWELL
HWY 90 OFF SETZERS CREEK OFF WARRIOR R
(Street Name, Numbers, Community, Subdivision, Lot No., Parcel, Zip Code)
TOPOGRAPHIC / LAND SETTING:
❑ Slope 0 Valley 0 Flat 0 Ridge 0 Other
(check appropriate box)
LATITUDE 3 36.57895
May be in degrees,
minutes, seconds or
LONGITUDE 081.40570
in a decimal format
Latitude/longitude source: ❑ %'S 0 Topographic
(location of well must be shown on a USGS
attached to this form if not using GPS)
4.WELL OWNER
OWNER'S NAME J SON T V!NFS
map
topo map and
STREET ADDRESS % FLOYD R. VINES , 5215 HWY 90
COLLFTTSVILLE NC 28811
City or Town State Zip Code
( (828)_ 754-8586
Area code - Phone number
5.WELL DETAILS:
a. TOTAL DEPTH: 300
b. DOES WELL REPLACE EXISTING WELL? YES 0 NO OK
c. WATER LEVEL Below Top of Casing: 80 FT.
(Use "+" if Above Top of Casing)
d. TOP OF CASING IS 1 FT. Above Land Surface`
' Top of casing terminated at/or below land surface may require
a variance in accordance with 15A NCAC 2C .0118
e. YIELD (gpm): 7 METHOD OF TEST Air
060621 rl
f. DISINFECTION: Type HTH Amount 45
en
g. WATER ZONES (depth): CeD
From 260b 281 From To
From To From To
From To From To
6.CASING: Thickness/
Depth Diameter Weight Material
From OrollEt. 6 1/8 .350 PVC
From Oro 0=t.
From To Ft.
7.GROUT: Depth Material Method
From_So_iOFt. Cement Gravity Ficw
From To Ft.
From To Ft.
8.SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in.
From To Ft. in. in.
From To Ft. in. in.
9.SAND/GRAVEL PACK:
Depth Size Material
From Ft.
_To
From To Ft.
From To Ft.
10. DRILLING LOG
From To Formation Description
0 155 DIRT
15,5 260 GRANITE
260 X1 QUARTZ
291 300 GRANITE
�1 NATERED Ala'
)mot
i3ECS4ZN06
11. REMARKS:
7 GPM 260 - 261 0 GPM -
O GPM - O GPM -
OGPM - OGPM -
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.
t % pp �1
SIGNATURE' FIE WEldiONTRACTOR , DAT2' 0
F
t.ESLI REECE
PRINTED NAME OF PERSON CONSTRUCTING THE WELL
Submit the original to the Division of Water Quality within 30 days. Attn: Information Mgt.,.-
1617 Mail Service Center - Raleigh, NC 27699-1617 Phone No. [phone] ext 568.
.. i Form GW-la
Rev. 7/05

RESIDENTIAL WELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources- Division of Water Quality
WELL CONTRACTOR CERTIFICATION # ca aZ 3I
1. WELL CONTRACTOR:
Well Contractor Company Name
STREET ADDRESS 0l 417 L. t b e i- ty ell Rd
i y l o i-s v i l l c lJ C_ a- g“ I
City or Town State Zip Code
(3 8>_ 623-3(088
Area code- Phone number
2. WELL INFORMATION:
SITE WELL ID #(H applicable)
C1vd✓Ru-sset?
Well C actor (Individual) Name
Busse[[ [Jell Drl lirn�Wc
STATE WELL PERMIT#(if applicable)
DWQ or OTHER PERMIT #(if applicable)
WELL USE (Check Applicable Box): Residential Water Supply Er'
DATE DRILLED // — )3-06,
TIME COMPLETED 171 1 G7 D AM ❑ PM)y
3. WELL LOCATION: gg JJ ,��J
CITY: COUNTY (Q,ay., u'z(�
•
(Street Name, N re Community. Subdivision, Lot No., Parcel, Zip Code)
TOPOGRAPHIC / LAND SETTING:
g lope ['Valley ❑Flat ❑Ridge ❑Other
(check appropriate box)
LATITUDE _ /iko @Oh6ui7
LONGITUDEJIL +I D/ 3L/. T 69
Latitude/longitude source: its ❑Topographic map
(location of we/ must be shown on a USGS topo map and
attached to this form I not using GPS)
4. WELL OWNER
OWNER'S NAME r`k e�lp
STREET SS lc -RR �.7�xw- `JirrAcvi
May be in degrees,
minutes, seconds or
in a decimal format
ity or Town State Zip C,Coddee s
( R702 ). 4.53— ( is
Area code - Phone number
5. WELL DETAILS: p" /
a. TOTAL DEPTH: ry Z.s
b. DOES WELL REPLACE EXISTING WELL? YES 0 NO I -
c. WATER LEVEL Below Top of Casing: , C' FT.
(Use'«- if Above Top of Casing)
d. TOP OF CASING 1S i /6y FT. Above Land Surface
'Top of casing terminated ator below land surface may require
a variance in accordance/�with 15A NCAC 2C .0118.
e. YIELD (gpm): METHOD OF TEST 712;3.i
' IidE
PRINTED NAME OF
f. DISINFECTION: Type 1.-1 rt-i Amount
g. WATER ZONES (depth):
From AD To 6 ;,25-7 From To
From To From To
From To From To
6. CASING: Thickness/
Depth Diameter Weight
From O To -53 Ft.
From To Ft
From To Ft
aterial
V Or
7. GROUT: Depth Material Method
From () To ,QL) Ft /1.0*.nt fpr u tcet
From To Ft d
From To Ft
8. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in.
From To Ft. in. in.
From To FL in. in.
9. SAND/GRAVEL PACK:
Depth Size
From To Ft.
From To Ft
From To Ft.
10. DRIWNG LOG
From To
i
Material
Formation Description
O .14
' /n5 r jZ17-7-1C
REMARKS:
RECFIVED
C)11/, OF WQUALI I Y
DEC lATER 8 200E
I DO HEREBY CERTIFY 1HAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH
1SA NCAC 2C. WELL CONSTRUCTION STANDARDS, AND THAT COPY OF THIS
RECORD HAS BEEN PROVIDED TO THE WELL OWNER.
I1-.36-O¢
SIGNA TtJ, E OF CERTIFIED WELL CONTRACTOR DATE
Liss (2I
_RSON CONSTRUCTING THE WELL
Submit the original to the Division of Water Quality within 30 days. Attn: Information Mgt.,
1617 Mail Service Center- Raleigh, NC 27699-1617 Phone No. [phone] ext 568.
Form GW-la
Rev. 7/05
ets
co
GYD

WELL CONSTRUCTION RECORD
North Carolina -Department of Environment and /Natural
WELL CONTRACTOR (INDIVIDUAL) NAM (^^prLint--) !_
WELL CONTRACTOR COMPANY NAME [i CN) r
- Division of Water Quality - Groundwater Section
h eS.S CERTIFICATI�ON2s� ICl F
i /li r1Cy f r). PHONE p 62g)S5tGY3 7
est
STATE WELL CONSTRUCTION PERMITS A OC1A WQ PERMIT/
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential$ Municipal/Public 0 Industrial 0 Agricultural E
Monitoring 0 Recovery 0 Heat Pump Water injection 0 Other O If Other, List Use
2. WELL LOCATIO �
Nearest Towns 'i r' County/Xi/U'rr/P//
3 3. 4/ e/ham. '.rt/e Jed
(Street Name, Number, Communky7Subthva Lot No, Op Cock)
3. OWNER i ( (Wit // `
Address -tiW ,Norms ri%'y Ec/
(Street orRpmeNo.)
City orTown Stan VC .4.Zip Code
(egg} VS2-T5,20
Area rode- Phone number
4. DATE DRILLED I/ /tf-e ,
5. TOTAL DEPTH- 5 Q 7
6. DOES WELL REPLACE EXISTING WELL? YES NO O
7. STATIC WATER LEVEL Below Top of Casing:
(Use "4"'if Above Top of Casing)
8. TOP OF CASING IS % FT. Above Land Surface*
,fop of easing terminated aNa below and mine require, a
variance la accordance wide ISA NCAC 2C .0115.
9. YIELD (gpm): � METHOD OF TESTF, y 4 r /e& /-
10. WATER ZONES (depth):
11. DISINFECTION: Type d 7&nc Amount 9 7
12. CASING: Wall
Thickness
From 0 Tom (' R.( A/ei =
From To Ft
From To Ft
13. GROUT:
r, Material
From 0 To Ft anal- --..14wsile7-11
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 FL
From To FL
Topographic/Land setting
ORidge OSlope OValley Mkt
(deck appropriate box)
Latitude/longitude of well location
(desteedmimovheoaedt)
Latitude/longitude source.OGPSOTopographic map
(check box)
DEEM DRILLING LOG
From To Formation Description
RCCEIVCD
OI .
JAN 0 5 L00
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common road names.
16. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARD; AND THAT A COPY OF THIS RD HAS BEEN PROVIDED TO THE WELL OWNER
l/ic li 7 ) CI
SIGNATURE OF PERSON e a , TRU G THE WELL DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mall Service Center - Raleigh, NC
27699-1636 Phone No. (919) 7333221, within 30 days. GW-1 REV. 07/2001
CJ°J
Cne
r.t
c

RESIDENTIAL WELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources- Division of Water Quality
WELL CONTRACTOR CERTIFICATION # a 3/
1. WELL C1ONTRACTOR.
CLtdtor R u-s s e 1 I
Well
(Individual) Name
Ku-Sse.tt Lk) e-tl
Well Contractor Company Name
STREET ADDRESS 4:247
%ity/oisvi i e.
City or Town State
( �S} 623a - 36 F R
Area code- Phone number
2. WELL INFORMATION:
SITE WELL ID #(a applicable)
Ll'bei-fyCh Rc(
NC a-86 81
Zip Code
STATE WELL PERMIT#(if applicable)
DWQ or OTHER PERMIT #(if applicable)
WELL USE (Check Applicable Box): Residential Water Supply LDY
DATE DRILLED - w? -/,oQQ - ,e)
TIME COMPLETED 4:OG- AM CI PMp�
3. WELL LOCATION:
* 4nect,G,
(Street Name, Numbers. Community, Subdivision. Lot No., Parcel, Zip Code)
TOPOGRAPHIC / LAND SETTING:
IBilope °Valley ❑Flat ❑Ridge 0 Other
(check appropriate box)
LATITUDE .V3.5 -,
LONGITuDE Qg/ d .25: c g
Latitude longitude source: eoPS ❑Topographic map
(location of we® must be shown on a USGS topo map and
attached to this form d not ushg GPS)
4. WELL OWNER
OWNER'S NAME
STREET ADDRESL
171
Hy or Town State
(RO-9) 11 3- 758(
Area code - Phone number
5. WELL DETAILS:
a. TOTAL DEPTH: .2?ps
b. DOES WELL REPLACE EXISTING WELL? YES ❑ NO
c. WATER LEVEL Below Top of Casing: <20 FT_
(Use "+• if Above Top of Casing)
d. TOP OF CASING IS / /6Z FT. Above Land Surface
'Top of casing terminated at/or below land surface may require
a variance in accordance with 15A NCAC 2C .0118.
e. YIELD (gpm): ,(j METHOD OF TEST
COUNTY toe/LLUAP.Qt
May be in degrees,
minutes, seconds or
in a decimal format
O �C (4.S
Zip Code
336 0
t. DISINFECTION: Type /4 T14
Amount / V&t en Pa
g. WATER ZONES (depth): r
From 30 To -3g.� From To
From To From To
Ran To From To
6. CASING: Thickness/
Weight f,terial
Depth Diameter
From 1) To SS FL
From To Ft.
From To Ft.
7. GROUT: Depth
Material Method
From 0 To AO Ft �jt74.49�`''4- �'wu.4L
From To Ft ✓
p
From To Ft.
8. SCREEN: Depth
From To
From To
From To
Diameter Slot Size Material
Ft. in. in.
Ft. in. in.
Ft in. in.
9. SAND/GRAVEL PACK:
Depth
From To Ft
From To Ft.
From To Ft.
10. DRIWNG LOG
From To /
1i
�-s' 39±'
I. REMARKS:
Size Material
Formation Description
u
TtE.(.l_t Y 64
DIV. OF WATER QUALITY
JAN 1 6 zuu7
100 HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED N ACCORDANCE WITH
1SA NCAC 2C, WELL CONSTRUCTOR STANDARDS, AND THATA COPY OF THIS
RECORD HAS BEEN PROVIDED TO THE WELL OWNER
SIGNATURE OF CERT IED WELL CONTRACTOR /- DATE
e 9Russe. it
PRINTED&&JAE OF PERSON CONSTRUCTING THE WELL
Submit the original to the Division of Water Quality within 30 days. Attn: Information Mgt.,
1617 Mail Service Center— Raleigh, NC 27699-1617 Phone No. [phone] ext 568.
Form GW-la
Rev. 7/05

RESIDENTIAL WELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources - Division of Water Quality
WELL CONTRACTOR CERTIFICATION # 2680
1.WELL CONTRACTOR:
LESLIE REECE
Well Contractor (Individual Name)
DEWEY WRIGHT WELL & PUMP CO., INC,
Well Contractor Company Name
STREET ADDRESS P. O. BOX 308
BOONE NC 28607
City or Town State
( 828)- 264-2651
Zip Code
Area code - Phone number
2. WELL INFORMATION:
SITE WELL ID #(if applicable)
STATE WELL PERMIT #(if applicable)
DWG or OTHER PERMIT #(it applicable)
WELL USE (Check Applicable Box): Residential
DATE DRILLED 12/28/2006
Water Supply 0>1
❑ PM 0X
CALDWELL
TIME COMPLETED 2.00 AM
3. WELL LOCATION:
CITY: LENOIR COUNTY
PRIVATE DR. OFF CEDAR VALLEY CHURCH RD.
(Street Name, Numbers, Community, Subdivision, Lot No.,
Parcel, Zip Code)
TOPOGRAPHIC / LAND SETTING:
❑ Slope 0 Valley 0 Flat 0 Ridge 0 Other
(check appropriate box)
LATITUDE 3 1R GUAR
May be in degrees,
minutes, seconds or
in a decimal format
LONGITUDE 081 758611
Latitude/longitude source: ❑ XPS ❑ Topographic
(location of well must be shown on a USGS
attached to this form if not using GPS)
4.WELL OWNER
OWNER'S NAME GARY D PENNINGTON
map
topo map and
STREET ADDRESS 1371 CEDAR VALLEY CH RD. .
I ENOSR NC 28645
City or Town State Zip
( (828)- 758-1136
Code
YES ❑ NO Lk
FT
Area code - Phone number
5. W ELL DETAILS:
a. TOTAL DEPTH: 280
b. DOES WELL REPLACE EXISTING WELL?
c. WATER LEVEL Below Top of Casing: 150
(Use "+" if Above Top of Casing)
d. TOP OF CASING IS 1 FT. Above
Land Surface*
surface may require
2C .0118
TEST Air
' Top of casing terminated at/or below land
a variance in accordance with 15A NCAC
e. YIELD (gpm): 8 METHOD OF
1656
f. DISINFECTION: Type HTH Amount 73
g. WATER ZONES (depth):
From ?iffo 731 From To
From To From To
From To From To
6.CASING: Thickness/
Depth Diameter Weight Material
From OTo 61 t. 61/8 350 PVC
From OTo OFt.
From To Ft.
7.GROUT: Depth Material Method
From Oro 20Ft. Cement Gravi'yFiftyv
From To Ft.
From To Ft.
8.SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in.
From To Ft. in. in.
From To Ft. in. in
9.SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
From To Ft.
10. DRILLING LOG
From To Formation Description-" `--'
0 SRi I)IP1
SR nit( rIPANITF
711 711 CHAI F
^1f 7P11 ,PANITF
DIV, OF WATER QUALITY
JAN 2 I ZOU7
1. REMARKS:
8 GPM 230 - 231 0 GPM -
0 GPM - O GPM -
O GPM - O GPM -
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH
15A NCAC 2C, WELL CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS
RECORD HAS BEEN PROVIDED TO THE WELL OWNER.
.�.t ,1..; kly , fired -a -0 7
SIGNATURE OF CER7 IED WELL CONTRACTOR DATE
1 FSI IF RFFCF
PRINTED NAME OF PERSON CONSTRUCTING THE WELL
Submit the original to the Division of Water Quality within 30 days. Attn: Information Mgt.,
1617 Mail Service Center - Raleigh, NC 27699-1617 Phone No. [phone] ext 568.
Form GW-la
Rev. 7/05

r D n O
rssi 2'3
RESIDENTIAL WELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources- Division of Water Quality
WELL CONTRACTOR CERTIFICATION # t a 3/
1. WELL COONTRACTOR:
Cavartor e. sse Name` t
Well
Wpp (Individual)
I�U..SS2(( LJe.tlj7t- tltns.! vc.
Well Contractor Company Name
STREET ADDRESS a147 L- i b e r tDy C��h Rd
t1 yiors ; /t-e Il/C .%J/ogt
City or Tom State Zip Code
(S') (o32 3tcfl
Area code- Phone number
2. WELL INFORMATION:
SITE WELL ID Air appfrcade)
STATE WELL PERMR?fe appicable)
DWQ or OTHER PERMIT #(if appicn*b)
WELL USE (Check Applicable Bar): Residential Water Supply [ice
DATE DRILLED / —U'-D
TIME COMPLETED // ;. -3 0
3. WELL LOCATION:
CITY:
fl P
AM IY PM ❑
COUNTY dr-�i.- befit
(SbeNName. Numbers. Communty, Subdivision. Int No.• Parcel Zu Code)
TOPOGRAPHIC / LAND SETTING:
PI/Slope OValey ❑Flat ❑Ridge ❑Other
(check appropriate box)
LATITUDE �'3' °57•;.19
tin
LONGITUDE2i! /O sI• LI%a.
Latitude/longitude source: p'FPS ()Topographic map
(locator of wel must be shown on a USGS topo nap and
attached to this tam 1 not using GPS)
4. WELL OWNER y� J�
OWNERS NAME 922d
'STREET ADDRESS oW;&L Lis( 721de,&
a
raya Tam Stye r4 Cade
May to in degrees,
minutes, sods a
in a decimal format
(W25 > 75'- $3 67
Area code- Phone numbs
5. WELL DETAILS: Oa /
a. TOTAL DEPTH: c3 J
b. DOES WELL REPLACE EXISTING WELL? YES ❑ NO Fe.
c. WATER LEVEL Below Top cf Casing: / Q Q FT.
(Use -.0 if Above Top of Casing)
d. TOP OF CASING IS Ph-, FE Above Land Surface*
'Top el casig terminated at/or below land surface may rye
a variance it acmrdance with 15A NCAC 2C .0118.
•
e. YIELD (gpm): (es METHOD OF TEST LULL
T. DISINFECTION: Type /1 7-74 Amount it 1113 apes/
g. WATER ZONES (depth):
12 o
From /0To .3 JS From To
Fran To From To
From To From To
6. CASING:
Depth ,
From O / FL Diameter
From To Ft.
Fran To Ft
7. GROUT: Depth
Fran () To 014
From To
Fran To
Ft
Ft
FL
Material
Thickness;
Weight fpt erial
Method
p RUM �1 .
8. SCREEN: Depth Diameter Slot Size Material
Fran To Ft in.
From To FL in_ it.
From To Ft. in. in.
9. SAND/GRAVEL PACK:
Depth
From To
From To
Fran To
10. DRILLING LOG
From To
_
`4.
11. REMARKS:
FL
Ft.
FL
Size Material
Formation Description
3a
0
I DO HEREBY R.tt r ET THAT THIS WELL WAS C01SIALCim M ACCORDANCE WITH
1SA NCAC 2C. WELL CONSTRUCTOR STAIIDARDS. AND THAT A COPY OF THIS
RECORD HAS BEEN PROVIDED TO THE WELL OWNER.
SIGMA
FIED WELL CONTRACTOR DATE
t t/dt Rwssei1
PRINTED
OF PERSON CONSTRUCTING THE WELL
•1
Submit the original to the Division of Water Quality within 30 days. Attn: htonnation Mgt.,
1617 Mail Service Center — Raleigh, NC 27699-1617 Phone No. [phone] ext 568.
Form GW-la
Rev. 7I05

RESIDENTIAL WELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources - Division of Water Quality
WELL CONTRACTOR CERTIFICATION # 2878
1. WELL CONTRACTOR:
STFVE PRICF
Well Contractor (Individual Name)
DEWEY WRIGHT WELL & PUMP CO., INC.
Well Contractor Company Name
STREET ADDRESS P 0 ROX 308
BOONE NC 28807
City or Town State Zip Code
( R28) - 284-2851
Area code - Phone number
2.WELL INFORMATION:
SITE WELL ID #(If applicable)
STATE WELL PERMIT *Alf applicable)
DWQ or OTHER PERMIT #rd applicable)
WELL USE (Check Applicable Box): Residential Water Supply O x
DATE DRILLED 6/14/2018
TIME COMPLETED e-o0 AM ❑ PM Ox
3. WELL LOCATION:
CITY: LENOIR COUNTY CALDWELL
CAVIAR FARM OFF IND►AN GRAVE RD. OFF HW
(Street Name, Numbers, Community, Subdivision, Lot No., Parcel, Zip Code)
TOPOGRAPHIC / LAND SETTING:
❑ Slope 0 Valley 0 Flat 0 Ridge 0 Other
(check appropriate box)
LATITUDE 3 16 0A224
May be in degrees.
minutes, seconds or
LONGITUDE 081,12A$1
in a decimal format
Latitude/longitude source: ❑ 1x'S 0 Topographic map
(location of well must be shown on a USGS topo map and
attached to this form if not using GPS)
4.WELL OWNER
OWNER'S NAME W1 LLAM WHITE, .Rl
STREET ADDRESS 1815 HWY 268
LENOIR NC 28445
City or Town State Zip Code
( (8284- 320-1404
Area code - Phone number
5.WELL DETAILS:
a. TOTAL DEPTH: 605
b. DOES WELL REPLACE EXISTING WELL? YES ❑ NO Off(
e. WATER LEVEL Below Top of Casing: 10 FT.
(Use "+" if Above Top of Casing)
d. TOP OF CASING IS 1 FT. Above Land Surface'
Top of casing terminated, at/or below land surface may require
a variance in accordance with 15A NCAC 2C .0118
e. YIELD (gpm): 15 METHOD OF TEST Air
329401
f. DISINFECTION: Type HTH Amount 119
g. WATER ZONES (depth):
From_ larv% 101 From dy 227---
From 370o 371 From « A 1
From To From To
6.CASING: Thickness/
Depth Diameter Weight Material
From___OTo- 7Wt. & 118 350 PVC
From OTo 6Ft.
From To Ft.
7.GROUT: Depth Material Method
From Oro 90Ft. cetm qt crnity Flow
From To Ft.
From To Ft.
8.SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in.
From To Ft. in. in.
From To Ft. in. in.
9.SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
Frdm To Ft.
From To Ft. .,
10. DRILLING LOG
From To Formation Description
0 73 D!PT
—
73 1r101 GRANITc
ire 101 fzp irrE r-
1Q1 '>76 MCP AkITG --
22iS 7. B'J1G GRAtJITE
_r,
-27 27e rvvttfHTE C ••..,
370 371 n'taaT7 --. -7
371 AJAR tOANITP ...0 r• i
ARA .4A'1 GRANITE . ,, -
dtY1 F F GRAN ITC.:.---
ti
11. REMARKS:
7 GPM 100 - 101 2 GPM 226 - 227
4 GPM 370 - 371 7 GPM 488 - 4Q0
OGPM - OGPM -
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE W RH
15A NCAC 2C, WELL CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS
RECORD �H�jASyBEEN PROVIDED TO THE WELL OWNER.
r.
-,ca.- ' I/ j� 7 /) ./rl,
SIGNATURE OF CERTIFIED WELL CONTRACTOR DATE
$TEVE PRICE
PRINTED NAME OF PERSON CONSTRUCTING THE WELL
Submit the original to the Division of Water Quality within 30 days. Attn: Information Mgt.,
1617 Mail Service Center - Raleigh, NC 27699-1617 Phone No. [phone] ext 568.
Form GW-la
Rev. 7/05

RESIDENTIAL WELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources - Division of Water Quality
WELL CONTRACTOR CERTIFICATION # `" "
1. W ELL CONTRACTOR:
STEVE PRICE
Well Contractor (Individual Name)
C'E`. E FiC,H >.:L.L 8: PULIF CC I`'-i'v
Well Contractor Company Name
STREET ADDRESS r. tJ. `�� 302
BCONE i4 2630"
City or Town State Zip Code
( 3128 ) - 264-24`.r"-
Area code - Phone number
2.WELL INFORMATION:
SITE WELL ID #(d applicable)
STATE WELL PERMIT #(d applicable)
DWG or OTHER PERMIT #(it applicable)
WELL USE (Check Applicable Box): Residential Water Supply LEI
DATE DRILLED ' I"`L,5
TIME COMPLETED AM 0 PM l
3. W ELL LOCATION:
CITY: LE'C-'IrS COUNTY •.•i Li`.''=_L
i E114i'4 .U?E. RE 1rF i ." t 68 .)c i.r`1('Nl F4
(Street Name, Numbers, Community, Subdivision, Lot No., Parcel, Zip Code)
TOPOGRAPHIC / LAND SETTING:
0 Slope 0 Valley 0 Flat 0 Ridge 0 Other
(check appropriate box)
LATITUDE 3
May be in degrees,
minutes, seconds or
LONGITUDE
in a decimal format
Latitude/longitude source: 0 GPS 0 Topographic
(location of well must be shown on a USGS
attached to this form if not using GPS)
4.WELL OWNER
OWNER'S NAME''`-L''"sa 1-1`E: -.,
map
topo map and
STREET ADDRESSd' -' " r
L ENOI R 4'6615
City or Town State Zip Code
(• 2S1 )_ j-415t7
Area code - Phone number
5.WELL DETAILS:
a. TOTAL DEPTH: 725
b. DOES WELL REPLACE EXISTING WELL? YES 0 NO"O
c. WATER LEVEL Below Top of Casing: (- FT.
(Use "+" if Above Top of Casing)
d. TOP OF CASING IS 1 FT. Above Land Surface*
" Top of casing terminated at/or below land surface may require
a variance in accordance with 15A NCAC 2C .0118
e. YIELD (gpm): ?.`' METHOD OF TEST "
0
f. DISINFECTION: Type HT 1 Amount
g. WATER ZONES (depth):
From 2^=2 ' 43 To From <� I-::S11 To
From E-40-E42 To From 560-F-f,1 To
From To From To
6.CASING: Thickness/
Depth Diameter Weight Material
From J To 83 Ft. ti 1/1 188 GALV
From 0 To 25 Ft. E 1 8 350 'true
From To Ft
7. GROUT. Depth Material Method
From 3 To 213 FL'- meat .ir E"v Pio,:-r
From To Ft.
From To R.l'er+ent
8.SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in.
From To Ft. in. in.
__ �
From To Ft. in; in.
9.SAND/GRAVEL PACK: _ CE y rgr'q�
Depth Size 1 Material
From To Ft.
From To Ft. �--
From To Ft.
z o
i 9ef?i0p -1 0
10. DRILLING LOG _ %1 t ,r rte ; .Z7
From To Formation Description -'
0 102 DIRT
102 242 GGuNIT5
242 243 QUARTZ
243 2&O 6f? NITE
29U :31 uuJARTZ :z -
29 40 :eRAh)FTE ".
540 42 }JPiiTZ '=
542 560 ,=FtnrrE `3
To
560 a .1 ^TZ Il4 4t
-
y .vA
11. REMARKS:
2 GPM 242-243- d ,I 290-291-
6 Grmi 54nF". :::t-it,,{ 63•31 6, -
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 PROVIDEDTO THE WELL OWNER.
.ENDTOPRROOVIDED
SIGNATURE OF CERTIFIED WELL CONTRACTOR DATE
tTr_VE PRICE
PRINTED NAME OF PERSON CONSTRUCTING THE WELL
Submit the original to the Division of Water Quality within 30 days. Attn: Information Mgt.,
1617 Mail Service Center - Raleigh, NC 27699-1617 Phone No. [phone] ext 568.
Form GW-la
Rev. 7/05
!ice

RESIDENTIAL WELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources - Division of Water Quality
WELL CONTRACTOR CERTIFICATION # 856
1.WELL CONTRACTOR:
!FEU E REECE
Well Contractor (Individual Name)
DE VEY W'RIGHT WELL &r PUMP CO., INC
Well Contractor Company Name
F.
STREET ADDRESS O. BOX33;
BOONE NC 29607
City or Town State Zip Code
( 828 )_ 254-2551
Area code - Phone number
2.WELL INFORMATION:
SITE WELL ID #fitapplicable)
STATE WELL PERMIT #('d applicable)
DWO or OTHER PERMIT #(it applicable)
WELL USE (Check Applicable Box); Residential Water Supply 6
DATE DRILLED
12 '200o
TIME COMPLETED - "I AM ❑ PM
3. WELL LOCATION:
CITY:
LE`rIR
COUNTY - Lni'AJELL
ND(AN GRAVE RD. CtFF 26B OFF YADKIN RIVER R
(Street Name, Numbers, Community, Subdivision, Lot No., Parcel, Zip Code)
TOPOGRAPHIC / LAND SETTING:
Cf Slope 0 Valley 0 Flat 0 Ridge 0 Other
(check appropriate box)
LATITUDE 3
LONGITUDE
Latitude/longitude source: 0 GPS 0 Topographic map
(location of well must be shown on a USGS topo map and
attached to this form if not using GPS)
May he in degrees,
minutes, seconds or
in a decimal format
4.WELL OWNER
OWNER'S NAME IOSEPH'3 GONSMAN
STREET ADDRESSI `II I'c ` I AK L HUk'Uri Ku.
LENQIR ',hC :E S
City or Town State
(Ks) j 751-2252
Area code - Phone number
Zip Code
5. W ELL DETAILS:
a. TOTAL DEPTH: "U
b. DOES WELL REPLACE EXISTING WELL? YES ❑ NOt
c. WATER LEVEL Below Top of Casing: In FT.
(Use "+" if Above Top of Casing)
d. TOP OF CASING IS 1 FT. Above Land Surface'
' Top of casing terminated at/or below land surface may require
a variance in accordance with 15A NCAC 2C .0118
e. YIELD (gpm): '" METHOD OF TEST
n9
0150462
f. DISINFECTION: Type HTH Amount
g. WATER ZONES (depth):
From 183 To i34 - From To
From To From To
From To From To
6.CASING: Thickness/
Depth Diameter Weight Material
From fl To 55 Ft. b 13'5 -050 PVC
From To Ft.
From To Ft.
7.GROUT: Depth Material Method
From 0 To 213 Ft.
Gr3v.ty' Pon
From
From To Ft.
From To Ft'-.'rrleH. Vr_.it f-toit
8.SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in.
From To Ft. in. in
From To Ft. in. in.
9.SAND/GRAVEL PACK:
Depth Size Material
From _To Ft.
From To Ft.
From To Ft.
10. DRILLING LOG
From To
0 81
di 133
Formation Description
DIRT
GRANITE
16 184 SHALE
154 220 GRI,nJITE
11. REMARKS:
4 GP(3.4 153 - 184
0 GPM -
0GF±M - 0iiPh:1 -
I D0 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 CERTIFIED WELL CONTRACTOR DATE
LESLIE REECE
PRINTED NAME OF PERS
ON CONSTRUCTING THE WELL
RECEIVED
Submit the original to the Division of Water Quality within 30 days. Attn: Informatior Mgt., Form GW-1a
1617 Mail Service Center - Raleigh, NC 27699-1617 Phone No. [phone] ext 568.
FEB 13 20fty 7/05
Asheville Regional Office
Antiifar Pretnetion

RESIDENTIAL WELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources - Division of Water Quality
2878
WELL CONTRACTOR CERTIFICATION #
1.WELL CONTRACTOR:
STEVE PRICE
Well Contractor (Individual Name)
DEWY WRIGHT 'WELL 6, PUMP CO., INC.
Well Contractor Company Name
STREET ADDRESS P. O. BOX 308
BOONE NC 28607
City or Town State Zip Code
( KS)_ 264-2051
Area code - Phone number
2.WELL INFORMATION:
SITE WELL ID #(4applicable)
STATE WELL PERMIT #(If applicable)
DWG or OTHER PERMIT #(f applicable)
WELL USE (Check Applicable Box): Residential Water Supply 6
DATE DRILLED 11/3/2005
TIME COMPLETED AM ❑ PM t:I
3.WELL LOCATION:
CITY: LENOIR COUNTY CALDWELL
INDIAN GROVE RD. OFF HWY 268 OFF Y.ADKIN RI
(Street Name, Numbers, Community, Subdivision, Lot No., Parcel, Zip Code)
TOPOGRAPHIC / LAND SETTING:
❑ Slope ❑ Valley 0 Flat 0 Ridge 0 Other
(check appropriate box)
LATITUDE 3
May be in degrees,
minutes, seconds or
LONGITUDE
in a decimal format
Latitude/longitude source: 0 GPS 0 Topographic
(location of well must be shown on a USGS
attached to this form if not using GPS)
4.WELL OWNER
OWNER'S NAME/in-LIAM WHITE, JR
map
topo map and
STREET ADDRESS 1815 HWY 268 ,
LENOIR NC 28645
City or Town State Zip Code
I(828)) 766-4416
Area code - Phone number
5.WELL DETAILS:
a. TOTAL DEPTH: 725
b. DOES WELL REPLACE EXISTING WELL? YES 0 NOJ
c. WATER LEVEL Below Top of Casing: 10 F E
(Use "+" if Above Top of Casing)
d. TOP OF CASING IS 1 FT. Above Land Surface'
' Top of casing terminated at/or below land surface may require
a variance in accordance with 15A NCAC 2C .0118
e. YIELD (gamy 20 METHOD OF TEST u"I
n fj
f. DISINFECTION: Type NTH Amount 134
g. WATER ZONES (depth):
Fron?42-243 To Fronle0-291 To
Front`140-542 To From660-661 To
From To From To
6.CASING: Thickness/
Depth Diameter Weight Material
From 0 To 63 Ft. 61/4 .188 'aALV
From 0 To 20 Ft. 6 1/8 .350 PVC
From To Ft.
7. GROUT: Depth Material Method
From 0 To 20 Ft. Cement Gravity Flow
From To Ft.
From To Ft. t'ement=i1-avity Fiuvt
8.SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in.
From To Ft. in in.
From To Ft. in. in.
9. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
From To Ft.
10. DRILLING LOG
From To Formation Description
0 102 DIRT
102 242 GRANITE
242 243 QUARTZ
243 290 GRANITE "
290 291 QUARTZ
291 540 GRANITE
540 542 QUARTZ
542 550 GRANITE •
Eno 661 QUARTZ I,"
561 725 GRANITE
o+�
1 LRflIA 14'1-243 - 4 GPM 200-261 -
6 GPM 540-542 - 3 GPM 600-8b1 -
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.
./ .. .,17%' TH'-1C7 /, / G/ . ClY
SIGNATURE OF CERTIFIED WELL CONTRACTOR DATE
S I EVE PRICE
PRINTED NAME OF PERSON CONSTRUCTING THE WELL
Submit the original to the Division of Water Quality within 30 days. Attn: Information Mgt.,
1617 Mail Service Center - Raleigh, NC 27699-1617 Phone No. [phone] ext 568.
Form GW-1a
Rev. 7/05

RESIDENTIAL WELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources - Division of Water Quality
WELL CONTRACTOR CERTIFICATION # 2878
1.WELL CONTRACTOR:
STEVE PRICE
Well Contractor (Individual Name)
DEWEY WRIGHT WELL & PUMP CO., INC.
Well Contractor Company Name
STREET ADDRESS P. O. BOX 308
BOONE NC 28607
City or Town State Zip Code
( 828 ) - 264-2851
Area code - Phone number
2.WELL INFORMATION:
SITE WELL ID #01 applicable)
STATE WELL PERMIT #(ff applicable)
DWO or OTHER PERMIT #(if applicable)
WELL USE (Check Applicable Box): Residential Water Supply 6
DATE DRILLED 11r8'2005
yy,,
TIME COMPLETED AM ❑ PM'L'I
3. WELL LOCATION:
CITY: LENOIR COUNTY CALDWELL
INDIAN GROVE RD. OFF f-NVY 268 OFF YPDKIN RI
(Street Name, Numbers, Community, Subdivision, Lot No., Parcel, Zip Code)
TOPOGRAPHIC / LAND SETTING:
❑ Slope 0 Valley 0 Flat 0 Ridge 0 Other
(check appropriate box)
LATITUDE 3
May be in degrees,
minutes, seconds or
LONGITUDE
in a decimal format
Latitude/longitude source: 0 GPS 0 Topographic
(location of well must be shown on a USGS
attached to this form if not using GPS)
4.WELL OWNER
OWNER'S NAMEV''I LLIAM WHITE, JR
map
topo map and
STREET ADDRESS 1815 HWY 268 ,
LENOIR NC 28645
City or Town State Zip Code
( (828) ) 758-4456
Area code - Phone number
5.WELL DETAILS:
745
a. TOTAL DEPTH:
��
b. DOES WELL REPLACE EXISTING WELL? YES 0 NO'rb
20
c. WATER LEVEL Below Top of Casing: FT.
(Use "+" if Above Top of Casing)
d. TOP OF CASING IS 1 FT. Above Land Surface`
Top of casing terminated at/or below land surface may require
a variance in accordance with 15A NCAC 2C .0118
e. YIELD (gpm): 5 METHOD OF TEST Air
;:2097
050586
f. DISINFECTION: Type HTH Amount 139
g. WATER ZONES (depth):
Frort342-343 To Frorrfi60-461 To
Fron730-731 To From To
From To From To
6.CASING: Thickness/
Depth Diameter Weight Material
From 0 To 89 Ft 61/4 .188 GALV
From To Ft.
From To Ft
7.GROUT: Depth Material Method
From 0 To 20 Ft.Cement Gravity Flow
From To Ft.
From To Ft. Cement Gravity Flow
8.SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in.
From To Ft. in. in.
From To Ft. in. in
9.SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From Ft.
_To
From To Ft.
10. DRILLING LOG
From To Formation Description
0 8,3 DIRT SAND MUD
83 342 SOFT GRANITE
342 343 QUARTZ
343 460 SOFT GRANITE
450 461 QUARTZ
461 730 SOFT GRANITE
730 731 QUARTZ
731 745 SOFT GRANITE
r1 �;
0'
111t�R1ib-343 - 1 GPM 480-451 -
3 F'Atl I3U-131 - U UF'M -
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� �BEE—N�PROVIDED TO THE WELL OWNER.
ze
SIGNATURE OF CERTIFIED WELL CONTRACTOR DATE
STEVE PRICE
PRINTED NAME OF PERSON CONSTRUCTING THE WELL
Submit the original to the Division of Water Quality within 30 days. Attn: Information Mgt.,
1617 Mail Service Center - Raleigh, NC 27699-1617 Phone No. [phone] ext 568.
Fonn G W-1 a
Rev. 7/05

CS3
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
1636 Mail Service Center - Raleigh, N.C. 27699-1636 - Phone [phone]
310849
WELL CONSTRUCTION RECORD
WELL CONTRACTOR. Dewey Wright Well Pump Co
WELL CONTRACTOR CERTIFICATION #: 2681
050118 STATE WELL CONSTRUCTION PERMIT#: Steve Petty
Ine.
WELL USE (Check Applicable Box): Residential I XI Municipal Industrial ❑
Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use.
Agricultural ❑ I1Vi& itoring_n
2. WELL LOCATION: (Show sketch of the location below)
Nearest Town: I PNflR County: CAI n4VFl L
oa Tame n3Fumbers, omP munity,,oFSu33v on a�ndd�Lot 13
3. OWNER I ANF T HAMRV
Address P 0 BOX 450
PATTER±a or Route Nn.I
City or Town State
NC 28861
4. DATE DRILLED 4/7/2005
5. TOTAL DEPTH 705
6. CUTTINGS COLLECTED YES ❑ NO 0
7. DOES WELL REPLACE EXISTING WELL? YES I I NO
8. STATIC WATER LEVEL Below Top of Casing: 60 FT
(Use "+" if Above Top of Casing)
9. TOP OF CASING IS 1 FT Above Land Surface*
'Top of casing terminated at/or below land surface requires a variance in accor-
dance with 15A NCAC 2C.0118
10. YIELD (gpm): 0.5 METHOD OF TEST Ar
11. WATER ZONES (depth) 0.50 ppm80-81 0.00gpm
0.00 gpm O.000pm
Zip Code
12. CHLORINATION: Type HTH Amount 127
13. CASING:
From
From
From
Depth
0 To
To
To
14. GROUT:
50 Ft
Ft
Ft
Diameter
6 1/8
Wall Thickness
or Weight/Ft. Material
350 PVC
Depth Material Method
From 0 To 20 Ft Cement Gravity Flow
From To Ft
15. SCREEN:
From
From
From
Depth
To
To
To
Diameter Slot Size Material
Ft in in
Ft in in
Ft in in
16. SAND/GRAVEL PACK:
Depth Size Material
From To Ft Wilkes
From To Ft
DRILLING LOG
From To
0 45
Im,
IltGPTH
Formati •, iJescription
DIRT I
45 80 GRANITE
80 81 SHA! E
81 705
GRANITE QUARTZ
O
If additional space is needed use back of forms
LOCATION SKETCH
(Show direction and distance from at least two State
Roads, or other map reference points)
17. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY QF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER.
5f—/_o�"
FOR OFFICE USE ONLY
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
Submit original to Division of Water Quality, Groundwater Section within 30 days
GW-1 REV. 12/99
Quad No:
Serial No.

North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
1636 Mail Service Center - Raleigh, N.C. 27699-1636 - Phone [phone]
WELL CONSTRUCTION RECORD WELL CONTRACTOR:
350175
Dewey: nerrlgf t \t" Eii Pi
314639
WELL CONTRACTOR CERTIFICATION #:
STATE WELL CONSTRUCTION PERMIT#:
401!
..Jerry, v iNon
1. WELL USE (Check Applicable Box): Residential ❑ Municipal ❑ Industrial ❑
Recovery Heat Pump Water Injection ❑ Other If Other, List Use-
2. WELL LOCATION: (Show sketch of the location below)
Nearest Town: 1 FNO?R County
"JURRtN f'RK Rr1 r3FF RI'Jr--Pco Pr? OFP I-r:':;-+ 288 C'F
(Road Name and Numbers, Community, or Subdivision and Lot No.)
3. OWNER '1V;.a f AC..= R HP TON
Address 55 30 .AVE PM/
ltreet or Route No.)
City or Town 7 State
N ^Rfit?1
Zip Code
4. DATE DRILLED .,/3/2005
5. TOTAL DEPTH 2n5
6. CUTTINGS COLLECTED YES ❑ NO H
7. DOES WELL REPLACE EXISTING WELL? YES ❑ NO El
8. STATIC WATER LEVEL Below Top of Casing: 10 FT
(Use "+" if Above Top of Casing)
9. TOP OF CASING IS 1 FT Above Land Surface*
'Top at casing terminated at/or below land surface requires a variance in accor-
dance with 15A NCAC 2C.011B
10. YIELD (gpm): 20 METHOD OF TEST Airr+ rti1
11. WATER ZONES (depth): 3 CO Clc.,. 75-78 2.00Apr-, . 1.
15.00 3prr1 170-1 7 1 0,00npm
12. CHLORINATION: Type HTH Amount 40
13. CASING:
Depth Diameter
From n To 10 Ft ft 41°
From To Ft.
From To Ft
Wall Thickness
or Weight/Ft. Material
'50
14. GROUT:
Depth Material
From 0 To 20 Ft tCement
From To Ft
Method
Gravity Flow
Agricultural ❑
Monitoring 'PT
DRILLING LOG
From
r)
rr`,
DEPTH
To Formation Description- —
15 C,RT 4"HAiF GRAN:7C"--.—__
r=,RANIT'E (-NA)
76 '•'r^, nRANGE qH,t,
75 1 r=RRPiiTE J11ART7
115 I1? flRottnE gHAI c
170 GRA1,111-7- QUART7
70 71 G,R,ANTr:
N
If additional space is needetjseibk of form
LOCATION SKETCH `ml
(Show direction and distance from at least two State
Roads, or other map reference points)
..--s"
15. SCREEN: ` s, -1,----
Depth Diameter Slot Size Material' .v1\'t'
From To Ft in in f
From To Ft in in
From To Ft in in
16. SAND/GRAVEL PACK:
Depth
From To
From To
Size
Material
l \\
17. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NC1gG2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TOI,HE WELL OWNER.
Ft
Ft
FOR OFFICE USE ONLY
Quad No:
Serial No.
SIGWATURE OF PERSON CONSTRUCTING THE WELL DATE
Submit original to Division of Water Quality, Groundwater Section within 30 days
GW-1 REV. 12/99

North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
1636 Mail Service Center - Raleigh, N.C. 27699-1636 - Phone [phone]
inc.,
WELL CONSTRUCTION RECORD WELL CONTRACTOR De'wey'vevngti 'v'veii Pump Co.21387
040538 WELL CONTRACTOR CERTIFICATION #-
6112.0
304713
STATE WELL CONSTRUCTION PERMIT# et
1. WELL USE (Check Applicable Box): Residential 7 Municipal I I Industrial 0
Recovery
Agricultural El Monitoring 0
Heat Pump Water Injection F 1 Other 0 If Other, List Use: -
2. WELL LOCATION: (Shgyy.sketch of the location below)
Nearest py❑ ttyy CALDWELL
U ULALN.UFbSIbLLIOWN HU.OFPItVUI'ANGRAVE
(Road Name and Numbers, Community, or Subdivision and Lot No.)
3. OWNER DWAYNE WRIGHT
Address % PRLEN KANAGY , 2545 ZACKS FARM RD.
LtNUIR (Street or Route No.) N(. 2884A
DRILLING LOG DEPTH
Frorn T80 DIRT Formation Description
0tfU 81 t,RANIIt
City or Town State
4. DATE DRILLED 1911/2004
5. TOTAL DEPTH 500
6. CUTTINGS COLLECTED YES 0 NO �1�II
7. DOES WELL REPLACE EXISTING WELL? YESWNO L
8. STATIC WATER LEVEL Below Top of Casing: taslut FT
(Use "i" if Above Top of Casing)
Zip Code
R
9. TOP OF CASING IS 1 FT Above Land Surface*
*Top of casing terminated at/or below land surface requires a variance in accor-
dance with 15A NCAC 1.0118 N1 SL{ FEg Air
10. YIELD (gpm)' 4EOOOD 81T83T
11. WATER ZONES (depth)
U.UU Apm U.UUgpm
12. CHLORINATION: Type HIH Amount tl!
81 83 SHALL
d3 5UU caHAN(It
13. CASING:
`rom 0 DepthTo 68 Ft DiO 1�G
From To Ft
From To Ft
14. GROUT:
U.UU gpm
If additional space is needed use back of form
Wall Thickness
orilkght/Ft. ly]atelyal t
66UU FY'VVCC..,
Depth Material Mgthho_d
From To 20 Ft Cement GravityFlow
From To Ft
15. SCREEN:
LOCATION SKETCH
(Show direction and distance from at least two State
Roads, or other maNeefirence points)
Depth Diameter Slot Size Material 141
4I _ r,a�
From To Ft in in
From To Ft in in �— •61 --
From To Ft in in l _ ='ii
%
16. SAND/GRAVEL PACK: bn. -k �-
1n 2
Depth Size Material k.,
From To Ft < •8
From To Ft
17. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COP OF THIS,ISRECORD HA EpENN PROVIDED TO THE WELL OWNER.
/
FOR OFFICE USE ONLY /""� /`'`'Q�' / 7 - D I
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
Submit original to Division of Water Quality, Groundwater Section within 30 days
GW-1 REV. 12/99
Quad No.
Serial No.

North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
1636 Mail Service Center - Raleigh, N.C. 27699-1636 - Phone [phone]
302185
WELL CONSTRUCTION RECORD
WELL CONTRACTOR. Dewey Wright Well Pump Co., Inc.
WELL CONTRACTOR CERTIFICATION #• 2878
040440 STATE WELL CONSTRUCTION PERMIT#: Steve Price
WELL USE (Check Applicable Box): Residential
Recovery ❑ Heat Pump Water Injection
x
Municipal ❑ Industrial ❑ Agricultural ❑ Monitoring ❑
❑ Other ❑ If Other, List Use.
2. WELL LOCATION: (Show sketch of the location below)
Nearest Town: LENIOR County. CAI DWFI 1
YADKIN OVERLOOK/YADKIN VIFW DR PFF HWY 968 O
(Road Name and Numbers, Community, or Subdivision and Lot o.)
3. OWNER MICHELLE A MABE
Address 1250 NC HWY ?68
I ENOIR Street or Route No NC 2864E
City or Town State Zip Cade
4. DATE DRILLED 8/24/2004 •
5. TOTAL DEPTH 205
6. CUTTINGS COLLECTED YES ❑ NO Lid
7. DOES WELL REPLACE EXISTING WELL? YES ❑ NO L2SJ
8. STATIC WATER LEVEL Below Top of Casing: 40 FT
(Use'." if Above Top of Casing)
9. TOP OF CASING IS 1 FT Above Land Surface*
'Top of casing terminated at/or below land surface requires a variance in accor-
dance with 15A NCAC 2C.0118
10. YIELD (gpm): 4 METHOD OF TEST fur
11. WATER ZONES (depth): 0.50 gpm 125-126 0.50opm 148-149
3.00 opm 178-179 0.00gpm
DRILLING LOG
From To
0 Rd
Rd
175
176
148
149
178
179
DEPTH
Formation Description
DIRT
179 GRANITE
126 GRANITF
1411 GRANITE
149 QUARTZ
178 GRANITE
179 QUARTZ
205 GRANITE
12. CHLORINATION: Type HTH Amount 35
13. CASING:
Wall Thickness
Depth Diameter or Weight/Ft. Material
r-rom 0 To 90 Ft 8 1/8 350 PVC
From To Ft
From To Ft
14. GROUT:
Depth Material Method
From 0 To 20 Ft Cement Gravity Flow
From To Ft
15. SCREEN:
Depth Diameter Slot Size Material
From To Ft in in
From To Ft in in
From To Ft in in
16. SAND/GRAVEL PACK:
Depth Size Material
From To Ft
From To Ft
v Gt^
s. ^
cp tn--
F
6
O 1 fa
-n
If additional space is needed use back- form
f,
fn13
9 �
LOCATION SKETCH
(Show direction and distance from at least t�tttp State
Roads, or other map reference pointst r R
Lb4
17. REMARKS.
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER.
FOR OFFICE USE ONLY
.r4Q7///Temv .1.0.- 9- /6 -O
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
Submit original to Division of Water Quality, Groundwater Section within 30 days
GW-1 REV. 12/99
Quad No:
Serial No.

North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
1636 Mail Service Center - Raleigh, N.C. 27699-1636 - Phone [phone]
302178
WELL CONSTRUCTION RECORD WELL CONTRACTOR- Dewey Wright Well Pump Co., Inc.
WELL CONTRACTOR CERTIFICATION #- 2878
040357-2 STATE WELL CONSTRUCTION PERMIT#- Steve Price
1. WELL USE (Check Applicable Box): Residential El Municipal 0 Industrial 0 Agricultural 0 Monitoring
Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use.
2. WELL LOCATION: (Show sketch of the location below)
Nearest Town: LENOIR County CALDWELL
2ND DR. PAST RIVER RIDGE DR. OFF I -WY 288 OFF YA
(Road Name and Numbers, Community, or Subdivision and Lot No.(
DRILLING LOG DEPTH
3. OWNER ERIC A. HELTON From To Formation Description
Address 3222 HELTON ST. , 0 A17 DIRT
LENOIR (Street or Route No.) NC 28645 117 390 GRANITE
City or Town State Zip Code 390 391 GRANITE
4. DATE DRILLED 7/31/2004 391 750 GRANITE
5. TOTAL DEPTH 805 750 751 GRANITE
6. CUTTINGS COLLECTED YES 0 NO ® 751 785 GRANITE
7. DOES WELL REPLACE EXISTING WELL? YES fl NO 0 785 805 GRANITE
8. STATIC WATER LEVEL Below Top of Casing: 80 FT
(Use "+" if Above Top of Casing)
9. TOP OF CASING IS 1 FT Above Land Surface*
*Top of casing terminated at/or below land surface requires a variance in accor-
dance with 15A NCAC 2g.0118
10. YIELD (gpm): METHOD OF TEST fir
11. WATER ZONES (depth) 0.25 ppm390-391 0.25aPm 750-751
0.00 qpm 0.00ppm
12. CHLORINATION: Type HTH Amount 139
13. CASING:
Wall Thickness
Depth Diameter or Weight/Ft. Material
From 0 To 124 Ft 8 1/8 .350 PVC
From To Ft
From To Ft
14. GROUT:
Depth Material Method
From 0 To 20 Ft Cement Gravity Flow
From To Ft
15. SCREEN:
Depth Diameter Slot Size Material
From To Ft in in
From To Ft in in
From To Ft in in
16. SAND/GRAVEL PACK:
Depth Size Material
From To Ft
From To Ft
O Ct
t
r[Z .0L
-tt -c1 Q
N :
If additional space is needed use back t�Fform
LOCATION SKETCH t Zg
(Show direction and distance from at least twi3 State
t'
Roads, or other map reference points) %
r8
17. REMARKS.
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A CAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED • THE WELL OWNER.
'ladle -In pi ✓ef
FOR OFFICE USE ONLY
Quad No:
SIGNATURE OF PERSON CONSTRUCTING THE WELL
Submit original to Division of Water Quality, Groundwater Section within 30 days
DCi
DATE
GW-1 REV. 12/99
If
Serial No.

10. YIELD Igpm1• 60 3215g 1-JLE U.UUppm
11. WATER ZONES (depth):
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
1636 Mail Service Center - Raleigh, N.C. 27699-1636 - Phone [phone]
WELL CONSTRUCTION RECORD
302179
WELL CONTRACTOR: Dewey Wright Well Pump Co.. Inc.
WELL CONTRACTOR CERTIFICATION f1• 2878
040357-1 STATE WELL CONSTRUCTION PERMITS• Steve Price
WELL USE (Check Applicable Box): Residential X Municipal In Industrial ❑ Agricultural ❑ Monitoring ❑
Recovery ❑ Heat Pump Water Injection
❑ Other ❑ If Other, List Use:
2. WELL LOCATION: (Show sketch of the location below)
Nearest Town: LENOIR County: CALDWELL
HVVY 268 OFF YADKIN RIVER RD. OFF HWY 268
(Road Name and Numbers, Community, or Subdivision and Lot No.)
3. OWNER ERICA HELTON
Address 3222 HELTON STREET ,
LENOI R (Street or Route No.( NC 28645
DRILLING LOG DEPTH
From To Formation Description
0 118 DIRT
118 605 GRANITE
City or Town State
Zip Code
4. DATE DRILLED 7/26/2004
5. TOTAL DEPTH 605
6. CUTTINGS COLLECTED YES El NO LS]
7. DOES WELL REPLACE EXISTING WELL? YES ❑ NO
8. STATIC WATER LEVEL Below Top of Casing: 80 FT
(Use "+' if Above Top of Casing)
9. TOP OF CASING IS 1 FT Above Land Surface*
'Top of casing terminated at/or below land surface requires a variance in accor-
dance with 15A NCAC 2 40118
Air
x
U.OU ppm 0.00ppm
12. CHLORINATION: Type HIH Amount
If additional space is needed use back of %co
t
13. CASING: Wall Thickness LOCATION SKETCH
Depth Diameter or Weight/Ft. Material (Show direction and distance from at least two State
From u To 124 Ft 6 1/8 .350 PVC Roads, or other map reference points)
From To Ft
From To Ft
14. GROUT:
Depth Material Method
From 0 To 20 Ft Cement Gravity Flow
From To Ft
15. SCREEN:
Depth Diameter Slot Size Material
From To Ft in in
From To Ft in in
From To Ft in in
16. SAND/GRAVEL PACK:
Depth Size Material
From To Ft
From To Ft
17. REMARKS'
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A CAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER.
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SIGNATURE OF PERSON CONSTRUCTING THE WELL
Submit original to Division of Water Quality, Groundwater Section within 30 days
GW-1 REV. 12/99
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FOR OFFICE USE ONLY
Quad No:
9 -/6-0 9
DATE

29g089
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
1636 Mail Service Center - Raleigh, N.C. 27699-1636 - Phone [phone]
WELL CONSTRUCTION RECORD WELL CONTRACTOR- Dewey Wright Well Pump Co., Inc.
WELL CONTRACTOR CERTIFICATION #: 2887
040020 STATE WELL CONSTRUCTION PERMIT#- Steve Reece
1. WELL USE (Check Applicable Box): Residential n Municipal 0 Industrial 0 Agricultural 0 Monitoring 0
Recovery I I Heat Pump Water Injection I I Other 0 If Other, List Use.
2. WELL LOCATION: (Show sketch of the location below)
Nearest Town: LENOIR County CALDWELL
CALDWELL LINE RD OFF SAMPSON RD OFF PARKWAY
(Road Name and Numbers,Community, or Subdivision and Lot No.) DRILLING LOG -ii DEPTH
3. OWNER SCOTT T WATSON From To Formation Description
Address 7899 OLD SAMPSON RD.. 0 80 DIRT SHALE
(StreetorRouteNo.)
LENOIR NC 28645 80 180 GRANITE
City or Town State Zip Code
4. DATE DRILLED 2/3/2004 183 300 GRANITE
5. TOTAL DEPTH 500 300 303 QUARTZ
6. CUTTINGS COLLECTED YES ❑ NO 0
7. DOES WELL REPLACE EXISTING WELL? YES 0 NO 171 430 434 QUARTZ o
8. STATIC WATER LEVEL Below Top of Casing: 0 FT 434 500 GRANITE s-
(Use '+' if Above Top of Casing)
9. TOP OF CASING IS 1 FT Above Land Surface*
'Top of casing terminated at/or below land surface requires a variance in accor-
dance with 15A NCAC 2 .0118
10. YIELD (gpm): METHOD OF TEST Air
11. WATER ZONES (depth): 1.00 ppm 180-183 0.50ppm 183-300
4.50 ppm 303-430 0.00ppm
12. CHLORINATION: Type HTH Amount 105 If additional space is needed use bcc of Grit
180 183 QUARTZ
303 430 GRANITE
13. CASING
Wall Thickness
Depth Diameter or Weight/Ft. Material
From 0 To 8e Ft, 6 1/4 .188 GALV
cror To Ft
From To Ft
14. GROUT:
Depth Material Method
From 0 To 20 Ft Cement Gravity Flow
From To Ft
15. SCREEN
Depth Diameter Slot Size Material
From To Ft in in
From To Ft in in
From To Ft in in
16. SAND/GRAVEL PACK:
Depth Size Material
From To Ft
From To Ft
17. REMARKS.
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RECORD BEEN PROVIDED TO THE WELL OWNER.
LOCATION SKETCH
(Show direction and distance from at least two State
Roads, or other map reference points)
�7 cm
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2
FOR OFFICE USE ONLY
Quad No:
Serial No.
SIGNATURE OF PERSON CONSTRUCTING THE WELL BATE
Submit original to Division of Water Quality, Groundwater Section within 30 days
GW-1 REV. 12/99

NORTH CAROLINA DEPARTMENT OF' ENVIRONMENT & NATURAL RESOURCES
DIVISION OF' WATER QUALITY - GROUNDWATER SECTION
APPLICATION FOR PERMIT TO CONSTRUCT A MONITORING WELL SYSTEM
Date:
(Please Type or Print Clearly)
County
In accordance with the provisions of Article 7, Chapter 87, General Statutes of North Carolina and regulations pursuant
thereto, application is hereby made for a permit to construct monitoring wells.
1. Name of Applicant: (Telephone
Applicant's Mailing Address.
2. Name of Property Owner (if different from Well Owner):
Owner's Mailing Address:
3. Contact Person: (Telephone:
4. Location of Property
5. Reason for Monitoring Well(s):
(ex: nondischarge permit requirements, suspected contamination, environmental assessment, etc.)
6. Type of facility or site for which the monitoring well(s) is needed:
(ex: nondischarge facility, waste disposal site, landfill, underground storage tank, etc.)
7. Type of contamination being monitored (if applicable):
(ex: nutrients, organics, heavy metals, etc.)
8. Are any existing recovery wells associated with the monitoring well(s)? If yes, how many?
Recovery Well Construction Permit No.
9. Distance to a known waste or pollution source. feet
10. Are any water supply wells located less than 500 feet from the proposed monitoring wells?
If yes, give distance: feet
11. Well Contractor:
12. Well Contractor Certification #:
13. Well Contractor's Address:
PROPOSED MONITORING WELL CONSTRUCTION INFORMATION
1. Total Number of Wells to be constructed: • (A) Number to be completed in bedrock?
(B) Number to be completed in unconsolidated material?
2. Estimated depth of well(s): feet
3. Gravel or sand pack interval (if appropriate)
From feet To feet
4. Type of casing used:
(ex: PVC, stainless steel, galvanized steel, etc.)
5. Diameter of casing:
GW-22M (REV 3/2000)
inches
(Cnntinued nn Reversal
FOR OFFICE USE ONLY
— PERMITTED ACTIVITY
U S T LEAK DETECTION
- GROUNDWATER QUALITY STANDARDS
VIOLATIONS SUSPECTED FROM UNPERMITTED
ACTIVITIES
NOTICE OF NON-COMPLIANCE AT
UNPERMITTED FACILITIES
PERMIT NO. ISSUED 19
INCIDENT #

6. Thickness of casing inches
7. How will the well(s) be secured?
8. Estimated beginning construction date
9. Estimated completion date.
ADDITIONAL INFORMATION
1. ATTACH A SITE MAP SHOWING THE LOCATIONS OF THE FOLLOWING:
1 - PROPOSED MONITORING WELL(S)
2 - ALL EXISTING MONITORING AND RECOVERY WELLS OR TEST BORINGS WITH THE PROPERTY
BOUNDARY
3 - ALL WATER SUPPLY WELLS WITHIN 500 FEET OF THE WASTE SOURCES
4 - AT LEAST TWO REFERENCE POINTS (NUMBERED ROADS, INTERSECTIONS, STREAMS, ETC.)
2. PROVIDE A WELL CONSTRUCTION DIAGRAM OF EACH WELL SHOWING DIAMETER, ESTIMATED DEPTH, SCREEN
INTERVALS, SAND/GRAVEL PACKS, TYPE OF CASING MATERIAL, CASING WALL THICKNESS, WELL HEAD
COMPLETION DETAILS, ETC.)
The Applicant hereby agrees the proposed well(s) will be constructed in accordance with
approved specifications and conditions of the Well Construction Permit as regulated under the Well
Construction Standards (Title 15A North Carolina Administrative Code, Subchapter 2C) and accepts
full responsibility for compliance with these rules.
Signature of Applicant or Agent
Title (if applicable)
If the property is owned by someone other than the applicant, the property owner hereby
consents to allow the applicant to construct monitoring wells as outlined in this application and that
it shall be the responsibility of the applicant to ensure that these monitoring wells conform to the Well
Construction Standards (Title 15A North Carolina Administrative Code, Subchapter 2C).
Signature of Property Owner (if different from applicant)

NONRESIDENTIAL WELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources- Division of Water Quality
WELL CONTRACTOR CERTIFICATION #
1. WELL CONTRACTOR:
Well Contractor (Individual) Name
Well Contractor Company Name
STREET ADDRESS
City or Town State Zip Code
( )-
Area code- Phone number
2. WELL INFORMATION:
SITE WELL ID #(if applicable)
WELL CONSTRUCTION PERMIT#(B applicable)
OTHER ASSOCIATED PERMIT #(if applicable)
3. WELL USE (Check Applicable Box) Monitoring❑ Municipal/Public°
Industrial/Commercial❑ Agricultural]] Recovery0 Injection°
Irrigation Other° (list use)
DATE DRILLED
TIME COMPLETED AMO PMD
4. WELL LOCATION:
CITY:
COUNTY
(Street Name, Numbers. Community, Subdivision, Lot No., Parcel, Zip Code)
TOPOGRAPHIC / LAND SETTING:
0 Slope 0 Valley 0 Flat 0 Ridge 0 Other
(check appropriate box)
LATITUDE
LONGITUDE
Latitude/longitude source: 0 GPS 0 Topographic map
(location of well must be shown on a USGS topo map and
attached to this form if not using GPS)
May be in degrees,
minutes, seconds or
in a decimal format
5. FACILITY. is the name or the business where the well is located.
FACILITY ID #(if applicable)
NAME OF FACILITY
STREET ADDRESS
City or Town State Zip Code
CONTACT PERSON
MAILING ADDRESS
City or Town State Zip Code
( )-
Area code - Phone number
6. WELL DETAILS:
a. TOTAL DEPTH:
b. DOES WELL REPLACE EXISTING WELL? YES° NO0
c. WATER LEVEL Below Top of Casing: FT.
(Use "+' if Above Top of Casing)
d. TOP OF CASING IS FT. Above Land Surface'
*Top of casing terminated at/or below land surface may require
a variance in accordance with 15A NCAC 2C .0118.
e. YIELD (gpm): METHOD OF TEST
f. DISINFECTION: Type Amount
WATER ZONES (depth):
From To From To
From To From To
From To From To
7. CASING: Thickness/
Diameter Weight Material
9•
From
From
From
Depth
To
To
To
8. GROUT: Depth
From To
From To
From To
Ft.
Ft.
Ft.
Material
Ft.
Ft.
Ft.
Method
9. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in.
From To Ftin. in.
From To Ft. in. in.
10. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
From To Ft.
11.DRILLING LOG
From To Formation Description
12. REMARKS:
I00 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 CERTIFIED WELL CONTRACTOR
DATE
PRINTED NAME OF PERSON CONSTRUCTING THE WELL
Submit the original to the Division of Water Quality within 30 days. Attn: Information Mgt.,
1617 Mail Service Center — Raleigh, NC 27699.1617 Phone No. [phone] ext 568.
Form GW-lb
Rev. 3/07