Additional Well Surveys

RESIDENTIAL WATER -SUPPLY WELL SURVEY: PROPOSED SNOW CAMP MINE
Owner Information:
Braxton Carol S
PO Box 596, 8825 Snow Camp Rd
Snow Camp, NC 27349
Parcel Site Address:
8825 Snow Camp Rd
Parcel ID:
102671
Old Tax ID:
8-25-2a
MAP ID #:
83
Please answer the following questions and provide the requested information for the property listed above.
Do you have a residential water -supply well, active or inactive, on your property? If yes, please indicate so
below, complete the table below for each well, and return this form. If you do not have any water -supply
well(s) on your property, please indicate so below and return this form.
Yes No
For each well (the table below will accommodate two wells), please complete the following information. This
information was provided by the drilling company when the well was installed, and it should be printed on a
thin metal plate that is attached to the top of the well. If you have no information, please indicate so here
and return this form. /.
No Information Available
Well Number:
1
Well Number:
2
Circle the use of the well:
Drinking Water
Circle the use of the well:
Drinking Water
Irrigation
Irrigation
Total Depth of Well (in
Total Depth of Well (in
feet below land surface):
feet below land surface):
Casing Depth (in feet
Casing Depth (in feet
below land surface):
below land surface):
Static Water Level (in feet
Static Water Level (in feet
below top of casing):
below top of casing):
Well Yield (in gallons per
Well Yield (in gallons per
minute):
minute):
Pump Type/Depth
Pump Type/Depth
(submersible, jet, etc):
(submersible, jet, etc):
Date Drilled:
Date Drilled:
Driller Name/Company:
Driller Name/Company:
Please return this page to GMA using the enclosed stamped, self-addressed envelope by February 17, 2020.
Thank you again for your assistance.

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RESIDENTIAL WATER -SUPPLY WELL SURVEY: PROPOSED SNOW CAMP MINE V(,L"
Owner Information:
Ratcliffe Heather
1722 Quackenbush Rd
Snow Camp, NC 27349
Parcel Site Address:
1755 Quackenbush Rd
Parcel ID:
102772
Old Tax ID:
8-25-93
MAP ID #:
35
Please answer the following questions and provide the requested information for the property listed above.
Do you have a residential water -supply well, active or inactive, on your property? If yes, please indicate so
below, complete the table below for each well, and return this form. If you do not have any water -supply
well(s o ,your property, please indicate so below and return this form.
Yes No
For each well (the table below will accommodate two wells), please complete the following information. This
information was provided by the drilling company when the well was installed, and it should be printed on a
thin metal plate that is attached to the top of the well. If you have no information, please indicate so here
and return this form.
No Information Available
Well Number:
Well Number:
Circle the use of the well:
Drinking Water
Circle the use of the well:
Drinking Water
Irrigation
Irrigation
Total Depth of Well (in
i
Total Depth of Well (in
.�
feet below land surface):
I�
feet below land surface):
Casing Depth (in feet
�'
Casing Depth (in feet
--
below land surface):
below land surface):
Static Water Level (in feet
Static Water Level (in feet
below top of casing):
below top of casing):
Well Yield (in gallons per
Well Yield (in gallons per
�� C1QtM
minute):
minute):
Pump Type/Depth
ey
Pump Type/Depth
(submersible, jet, etc):
(submersible, jet, etc):
Date Drilled:
Date Drilled:
Driller Name/Company:
Mrw-s
Driller Name/Company:
S�nn4j
Please return this page to GMA using the enclosed stamped, self-addressed envelope by February 17, 2020.
Thank you again for your assistance.

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