Well Construction Records Macon 2 CY2000

rlonh Carolina • Department of Environment, Hue Ilh, and Natural Resources
Division of Environmental Management • Groundwater Suction
P.O. Box 29535 • Raleigh, N.C. 27626.0535
Phone [phone]I
WELL CONSTRUCTION FIECORD
BILLING CONTRACTOR:
RILLER REGISTRATION NUMB
WELL LOCATION• (Show sketch of the
Nearest Town: L /_>.r.� T
OWNER
ADORES
(Street or Route No.)
210'?15
FOR d. `FltE USE ONLY''
OUAD. NO.' ri. SERIAL NO.
VL
tt Basin Codo..... :x,...-:,.... ,. ..
•I I� A I Hoador 6L::i.: +., ...r.Y `;d;: s, if..`GW{�nC�':•'4-
STATE WELL CONSTRUCTION
PERMIT NUMBER:
below)
—County: Gd>✓
DEPTH DRILLING LOG
From To Formation Description
City or Town - State �Zp Codo
DATE DRILLED - -r- USE OF WELL d
TOTAL DEPTH C S v I
CUTTINGS COLLECTED •YES ❑ NOQi �'
DOES WELL REPLACE EXISTING WELL? YES NO( , 3S° 07' F• 1 " �3e ' � Z,o STATIC WATER LEVEL Below Top of Casing:, :ZO FT,
TOP OF CASING IS (Use'+' it Above Top or Casing)
FT, Above Land Surface-
aslr•.g Terminated auor below land surface Is Illegal unlo� s a varloncu Is Issuud
accordance with 15A NCAC 2C .0116
YIELD (gpm):�_ METHOD OF TEST � )
WATER ZONES (depth) ii .�) I
CHLORINATION.: Type
CASING:
Wall Thickness
Depth, p Dia ate r or WaighvFt, Material
From V_To tr a Ft. It _�Y$fL plOC
From To Ft.
From To FL
GROUT:
Depth Material Method
From To .,2 0_Ft. 'Cemeni 0U
From To Ft.
SCREEN:
Depth Diameter Slot Size Material
From To Ft In. In.
From To Ft. In. __ In.
From To Ft. In.
SAND/GRAVEL PACK:
Depth Size
From To Ft.
From To Ft.
REMARKS:
,0i �j %I.I'1(1
If additional space is needed use back of form
LOCATION SKETCH
(Show direction and distance from at least two State
Roads, or other map tolerance points)
0
Q D
o0
cm
F rn
Yo
3 �rn
1 yPrr
o rn:z
cn
o
z
I CO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
ONSTRUCTION STANDARDS, AND, THAT A COPYP/I-
ETHIS RECORD HAS BEEN PROVIDED
/TO THE 1'/ELL OWNER.

K:onh Carolina • Department of Environment, Health, and Natural Resources 1 Q _0
Division of Environmental Management • dioundwalor Section
FOR d!`FlCE: U§E ONLY'''%�i' ?+"rr• .
P.O. Box 29535 •Raleigh, N.C. 27626.0535 QUAD. NO.'• ''':°"
• SERIAL NO. ': .;:o'_Cti;,,;
Phone [phone]' Lai•)•�" _�—
WELL CONSTRUCTION RECORD Minor Garin z••<>•'o
Darin Code
TILLING CONTRACTOR: <Il r,r, ••
'..K:•:.: . .. 1 l 11 I�� 1'. �"l Hoa�or ;, .- �,.'` .`Gl4�fl'iiLr:^ ;%:.•. ..
TILLER REGISTRATION NUMBER: y' U STATE WELL CONSTRUCTION
airs / PERMITNUMBER:
WELL LOCATIO (Show sketch of the locallpn below)
NaarestTown:, rzJ (%
— County:
(Road. Communiry, or Subdivision and Lot No.)
OVINER AF,r a, y /
ADDRESS /n/ •r)e„ rfho
(Street or Route No.)
i1•F
ATE DRILLED, -[ D USE OF WEI Code
LL LI 'V GQ r
T- �E75 `
TOTAL DEPTH
CUTTINGS COLLECTED •YES NOQ%
DOES WELL REPLACE EXISTING WELL? YES NO[ ,
STATIC WATER LEVEL Below Top of Casing: rc,) F7,
(Use 'a•itAbove Top atCasing)
TOP OF CASING IS
ALand sing Terminated auor below land surface s IllbegolU nlosaSurface,
a vorlanoIs Issuud'
accordance with ISA NCAC 2C .0118
YIELD (gpm):, /,5Z_ METHOD OF TEST
'"ATER ZONES (depth):
DEPTH DRILLING LOG
From To Formadon Description
CHLORINATION,: Type — LI I FI Amount 'rom
- —_ It additional space is needed use back of form
%.SING:
i
=
Depth / WallThkknoss p � DI otor or WuY X � t• hiarari
-rcm�_ToTFt. pw,
-rcm To Ft. _
=rom To FL
ROUT:
h Depth�7,-, Material Melhod
rom —.[_ To = 0 Ft..Ct'menj P IDU,
rcm To Ft.
:CREEN:
Depth Diameter Slot Size Material
rcm To Ft in. IIn.
rom To Ft. In. _
In.
•cm To Ft. In. � i.in,
:AND/GRAVEL PACK: D
Depth Size Material
rom To Ft.
cm To Ft. —
MARKS:
LOCATION SKETCH
(Show direction and distance from at least two Slate
Roads, or olhor map roforence points)
I
:0 HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
,NSTRUCTION STANDARDS, ANp,7HATA COPYOF
, -THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER.
" 9 -azJ

Nonh Carolina • Department of Environment, Health, and Natural Resources
Division of Environmental Management • droundwaier Section
P.O. Box 29535 • Raleigh, N.C. 27626.0535
Phone [phone]I
WELL CONSTRUCTION IjIECORD
ILLING CONTRACTOR: ,jlp�
ILLER REGISTRATION NUMBER: AQ C7
WELL LOCATION:.GShow sketch of the
Nearest Town: I �r r) ti V r.- 5
10 �1
...
NLY.,
. FOR &FILE USE OOUAO.
NO.
SERIAL NO •_�•�:_
LZL
.�;_
•+ -
ldlnor Basin
I .�, :.. d.o t•-
Basil' Code
�:.X.r �.:I�y•
11II HoadorLnu
STATE WELL CONSTRUCTION
PERMIT NUh1BER:
below)
—. County: — �7�'1 (.c.;v,e",
(Road, cor muniry, or Subdivision a Lot No.)
OWNER.._L G I DEPTH
ADDRESS Flom To
_ (Suee1 or Route No.)
IL—)
Crry or Town ` Y
State Zip Codo
T ATE DRILLED [ — _ E OF WELL
TOTAL DEPTH
UTTINGS COLLECTED -YEKS[] NOQ% _
OES WELL REPLACE EXISTING WELL? YES [] NO
STATIC WATER LEVEL Below Top of Casing: FT.
TOP OF CASING IS ! (Use'a' it Above'Top of Casing)
FT. Above Land Surface'
--ordan
;n' Terminated aVor below lend surlaco Is Illegal unlol s a vorloncu Is IsxuuJ-------- ca with 15A NCAC 2C .o116 r.
MELD (gpm): r .2. METHOD OF TEST J2 ;
A'ATER ZONES (depth):
=HLORINATION: Type
ASING:
DRILLING LOG
Formation Descripoon
It additional space is needed use back of form
Depth
p
Wall Thickness
DI
LOCATION SKETCH
rcm--�---TO
a er or WaighvFt.
FL �.�.'-_ � � �.
�'j-o°"'
Material (Show direction and distance from at leas( two State
C
rem TO
Ft
"— Roads• or other map reference points)
:°m To
Ft.
:ROUT:
Depth �7,.,
'cm —� To
LLFt.
Material
"Cement
,om To
Ft.
oul1
cf
p
o
REEN:
Depth
Diameter
Slot Size Material
Cn
cm To
Ft ..
In.In.
b
no
cm To
Ft.
In. _ In.
Vicl^
i
cm To
Ft.
In. Lin.
'1(
C
;ND/GRAVEL PACK:
cr
�a
Depth
Size
Hater
L�
:m To
Ft.
z
:m To
Ft
undwaterSection
Asheville Reoinnnl nHlrn
0 HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
INSTRUCTION STANDARDS, AND. THAT A COPY E THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER.
i
I

North Carolina • Department of Environment, Health, and Natural Rosources
Division of Environmental Management • Groundwater Section FOR &FILE USE dNL1
P.O. Box 29535 • Raleigh, N.C. 27626.0535 QUAD. No.
Phone [phone]� SERIAL N4.
L3L Ong; ;I'.
WELL CONSTRUCTION
TILLING CONTRACTOR:
TILLER REGISTRATION NUMB
WELL LOCATION: LShow sketch of the
NaarestTown:__rr"O" P i . 1
CORD lAlnor Basin
Cash' Code--...c:_.,; ,.:: • . 4 - .
U I O, l l nl � Haadar tnL ._ ;,... x .;;.'.; •; _ .:;
G� STATE ELL CONSTRUCTION
_! PERMIT NUMBER:
below)
— County: m 0 I'r„
wnenuntry, or Uubdivisiah and Lot No.)
OWNER T)DEPTH
ADDRESS /l l I I?, r /r Frmn To
(Street or Route No.) �—
City or Town—'—
DATE DRILLED 3_ Zipcodo --�_
�_— USE OF WELL r
TOTAL DEPTH �
CUTTINGS COLLECTED •YES 0 NOQ�'
COES WELL REPLACE EXISTING WELL? YES 7NO
STATIC WATER LEVEL Below Top of Casing:. _ g�, FT,
TOP OF CASING IS I (Use '+' itAbove Top of Cuing)
FT. Above Land Surface -
Terminated auor below land surface la roIllegol unto s a vorlonco Is bsuuJ
ncrdanoe with 15A N AC 2C .0118
YIELD(gpm):_METHODOFTEST
DATER ZONES (depth): �7
:HLORINATION.: Type l j AI f --
DRILLING NG LOG
Formation Description
ASING: mount _ If additional space is needed use back of form
Depth wall Thickness
-} Dia eler or Weight/FL Ltaled,l
rCn1
— —To Ft. � �_ —rI -Pye-
rem To Ft.
=:om To Ft.
ROUT:
Depth-1 ,�, Material
rem To � SLFI. C0M&r)j Method
f0 U
;cm To Ft.
:GREEN: �—
Depth Diameter Slot Size Malarial
cm To erial
cm Ft In. In.
To Ft. In. _ In.
'cm To Ft. In. In,
AND/GRAVEL PACK: __7 n
Depth Size
cm To Ft.
:m To Ft.
NARKS:
LOCATION SKETCH
(Show direction and distance from at least two State
Roads, or othor map rolorence points)
O o
4� on
irn
<`
ym
,s y o
_ Z)
CZ)
OCa
Ca_
Cn �a
o�
:O HEREBY CERTIFY THAT THIS WELL WAS C NSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
=NSTRUCTION STANDARDS, ANp•THAT A COPY THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER.
r2 - ro

rNonh Carolina - Department of Environment. Health, and Natural Rusourcus
Division of Environmental Management • Groundwalar Section
P.O. Box 29535 - Raloigh, N.C. 27626.0535
Phone [phone];
WELL CONSTRUCTION fj�ECORD
ILLING CONTRACTOR:
ILLER REGISTRATION NUMBER:
'rdELL LOCATION:
N'aarest Town:_
tnoaa• Community, or
OVINER — 4�;1
ADDRESS
ow sketch of the iota
(Svael or Route No.)
FOA a�FlCE USE ONL}
OUAO. NO. �t SERIALNO.
L]L
1Alnor Basin ��� I •.: t
tt Basin Code
..l I� A • I Header Lr1L' ` :c `_:S'..::: FI i:'.. ;X1
STATE WELL CONSTRUCTION
PERMIT NUMBER:
below)
County:�-
^r yr rown State
DATE DRILLED _ r 2ip^ • '
TOTAL DEPTH USE OF WELL
UTTINGS COLLECTED •YES O
DOES WELL REPLACE EXISTING WELL? YES NO[D!
STATIC WATER LEVEL Below Top of Casing: e) rf.
OP OF CASING IS (Use'a•ifAboveTopoCasing)
FT. Above Land Surface*
:ng Terminated avor below land aurfaco Is Illagol unto s a vorlsnce Is IssuuJ
:cordance with iSA�ff11CAC 2C .0118
'1°LO (gpmY �``' METHOD OF TEST � . )
WATERZONES (depth):_1A Q -Ve`0 IZZ2,Lo
-HLORINATION: Type
-ASING:
Depth WallThichnoss
rcm��,TO _� Ft. Dia elan or Waight/FL Material
Y GC
Qom 7o Ft. I _
`ern To Ft.
ROUT:
h Depth �T Material
To _Q_Ft. �2men� (0tu d
cm To Ft. i
BEEN:
DEPTH DRILLING LOG
Frcrn To Farmadon Description
If additional space is needed use back of form
LOCATION SKETCH
(Show direction and distance from at least two Slate
Roads, or other map roforence points)
Depth Diameter Slot Size Material
cm To Ft _ . In.
cm To In.
Ft. In. _ _ In.
cm To Ft. In. In.
,ND/GRAVEL PACK: r
Depth Size Mal n I
:m
=m To Ft. r N y Lluil LJ
'MARKS:_
0
0
Z
a
rt
3
Z
O
ut
ti
0
o C'
oT
am
y0
ao
m
cm•.
i
HEREBY CERTIFY THAT THIS WELL WAS
>NSTRUCTION STANDARDS, AND THAT A C
-I•- - -ev er ^vuVNU lNt;t WITH (SA NCAC 2C, WELL
Y THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER.

North Carolina •Department of Environment, Health, and Natural Resources
Division of Environmental Management • Groundwater Section
P.O. Box 29535 • Raleigh, N.C. 27626.0535
Phone [phone];
WELL CONSTRUCTION RECORD
TILLING CONTRACTOR:
ilLLER REGISTRATION NUMBER:
WELL LOCATION: (Sow sketch of the
Nearest Town:_ / r/t jr� L
OWNER
AODRE�
210'734
,FOR dl•`FICE USE ONLY'i';•^: `:'9+'�
QUAD. NO..
.
• SERIAL NO. •=�_.wi;
Act
r.i^-
Minor Basin
;;,'
easin Code
Hoadar LnL::•:,;. :,,�...,x..-.,... '-�G W.
STATE PELL CONSTRUCTION
PERMIT NUMBER:
below)
— County: ^
(Street or Route No.) —�—
--� c, I_ Ito
Ciry or Town State
DATE DRILLED Z Zip Code
USE OF WELL
TOTAL DEPTH .�5--==--
CUTTINGS COLLECTED •YES NO gC -
DOES WELL REPLACE EXISTING WELL? YES[] NO( STATIC WATER LEVEL Below Top of Casing: FT.
TOP OF CASING IS (Use'i•ilAbove 'Topo�ing)
FT. Above Land Surface'
.Ina Terminated aVor below land surface Is Illegal unlol s a varlonce Is Issuud'
,ccordance with 15A NCAC 2C .0118
IIELD(gpm):_6_METHODOFTEST 1nlil
::ATER ZONES (depth): -3 r
CHLORINATION: Type
;ASING:
Depth Wall rhlcknoss
P Dlae tto( or We ighVFL Material
Ft. ''I , PksC
rom To Ft. _
,om To Ft.
ROUT: i-
h Depth �7�, Material Method
rom — To sLFt. C0rn6nI
rD CL
rom To Ft.
CREEN:
Depth Diameter Slot Size Material
,cm —To
Ft In. In.
cm To Ft. In. _
in.
Om To FL ln.
AND/GRAVEL PACK:
P !I
De lh Size f rial
m To Ft.
U
cm To Ft.
MARKS:
rnAwaMr Cnrtinn
DEPTH DRILLING LOG
Frmn To Formation Description
II additional space is needed use back of form
LOCATION SKETCH
(Show direction and distance from at least two Slate
Roads, or other map rolorence points) o
G
O �
Abrrnn
—t cm
a mC2
=M
O N2
m�
CA I
o
x
0 HEREBY CERTIFY THAT THIS WELL WAS
'NSTRUCTION STANDARDS, AND. THAT A C
;TED IN ACCORDANCE WITH 15A NCAC 2C, WELL
S RECORD HAS BEEN PROVIDED TO THE WELL OWNER.
t� lQvg,-Q- C�7'V/_t`p

:onh Carolina • Department of Environment, Health, and Natural Resources
Division of Environmental Management • (3404ndwalor Suction
P.O. Box 29535 • Raleigh, N.C. 27626.0535
Phone [phone]
WELL CONSTRUCTION
'-LING CONTRACTOR: ,)lpl., ,. , . IL
_LER REGISTRATION NUMBER:
'SELL LOCATION: (Sow sketch of the
+aarest Towm_ t-� ,,, r. I— )
(Road,(
)VINER
DDRE:
9
.. , FOFi d!`FlC� USE ONLS
QUAD. NO,;._. SERIAL NO.
Let �__. (�� .: ; __:i'; • �;...
Minor Basin i.- •: : a r
Basin Codo
Header
•!��t �.• �nl^.�•... :>ti':: : _.'-UGH
STATE WELL CONSTRUCTION
PERMIT NUMBER:
below) --
-County:
DEPTH
- -- Frorn To
(Street or Route No.)
City or Town
State —� 2ip Codo DTE DRILLED-._ JTAL DEPTH USE OF WELL i rnya
�_«_
JTTINGS COLLECTED ES
— _
DES WELL REPLACE EXISTING WELL? NO YES
p of Casing; �
ATIC WATER LEVEL Below To FT.
-? OF CASING IS (Use'a•itAbove TopII Casing)
Terminated
nd S
rdance wIlh after below la ace a Illegalu nloI a (\ Orion" IS Issuud
rdanca with 15A NC Ow
2C .Oita
`D (gpm)_ METHOD OF TEST f i
;TER ZONES (depth): Lam_-T
'_ORINATION: Type ---
31NG: �AI ourt
Depth wall Thickr oss
�SL> Dia etoa orWaighvFt, 6latarial
To Ft. p laC 7. To Ft.�_. I
TO Ft.. _ __
BUT: 'T— -
h Depth Material
To =7 Q Ft Cellner)7- Method
To f ._1 f0 L6 .
Ft..
EEN:
Depth Diameter Slot Size
To Material
To Ft in, In. _
FL In. In. _
To Ft. In. 'In.
/GRAVEL PACK: =—
Depth Size
To trial
FL
To �_ Ft ,;
210736
DRILLING ,LOG
Formation Description
It additional space is needed use back of form
LOCATION SKETCH
(Show direction and distance from at least two Slate
Roads, or othor map rolorence points)
CD
CD
Mt
r
a
7C
Cn
Ch
v
6
�m
o�
om
y0
rn �
Av
yrn
n;:o
0
_REBY CERTIFY THAT THIS WELL WAS
'RUCTION STANDARDS, ANp THAT A C
- •- ••. vwnunry t WITH 15A NCAC 2C, WELL
iIS RECORD HAS BEEN PROVIDED•TO THE WELL OWNER.

North Carolina •Department of Environment, Health, and Natural Resources
Division of Environmental Managemont • Gro�ndwator Section
P.O. Box 29535 • Ralaigh, N.C. 27625•o53s
Phone [phone],
WELL CONSTRUCTION
LLING CONTRACTOR:
LLER REGISTRATION NUMB
+tLL LOCATION: (Show tch of the
'daarest Town:_r/'— 7
;Road, Community or Subdivi 'o'
DWNER 34 nandLotNo.)
F/ c
�DDRESS� � is,.
FOR C)r�FlCl=USE ONLY
QUAD. NO SERIAL NO.
- OR D nlnor aas6r : ,
' 11 aasin Cade � •„
Header lrtt: a; .. %�.f '.,:1 ,...—•,.c
STATE WELL CONSTRUCTION cw•
_ PERMIT NUMBER:
t elow)-----
-- County: —C
(Street or Roula No.)
City ar Town �j L
State Zip Codo
ATE DRILLED - L7 CTAL DEPTH USE OF WELL y
?�_
UTTINGS COLLECTED -YES NO[c��
DES WELL REPLACE EXISTING WELL? YES _�j NO
ATIC WATER LEVEL Below Top of Casing — �-�_
)P OF CASING IS (Use 'a•itAbove Top . ICasing)
Terminat id aVor below la ace s 1110901 unuFT. Above ss3ay orlancea Is Issued'
udanoa wllh 15A NCAC 2C .011e
ELD (gpm): / 5 METHOD OF TEST 2�y
ATER ZONES (depth):
iLORINATION: Type —'----
SING: Amour t -
'r
Depth wall Thick[ ass
'----- ---TO J J Dia etor of Weight/ZL Material
n Ft. . Ys7ft_ . P1yC
To Ft. I _
'' - To Ft.___ - —
DUT: I---
n Depth Material ��Melhod
.—Z To � Q_Ft. �Cemer
To Ft.-
EEN:
Depth Diameter Slot Size
' To Material
Ft In. In. _
To FL in. _
— in.
To _
Ft. In. An,
_
DIGRAVEI: PACK:
Depth Size
To Ft.
To Ft.
DEPTH DRILLDRILL-- I�OG
From To Formadon oescripuon
It additional space is need -----------
ad use back of form
LOCATION SKETCH
(Show direction and distance from al least two State
Roads, or olhor map roforence points)
O
a
-•C
1
a
o
CA
0
0
•EREBY CERTIFY THAT THIS WELL WAS CO a hewile RAvionzi4C Tice
TRUCTION STANDARDS, ANf) THATA COPY T iIS ROE AttpRD HOADANCE AS BEEN WITH 15A TO THE WELL OWNER.

':onh Carolina • gemen
Department of Environment, Health, and Natural Resources
Division of Environmental Manat • Gro�ndwalor Section
P,O. Box 29535 • Ralalgh, N.C. 27626.0535
Phone [phone]
WEL�STRUCTION F�IEC ORD
_LING CONTRACTOR: j)
.LER REGISTRATION NUMBER: l ��
'/ELL LOCATION: (Show sketch of the
taarest Town:_
;Road, Comm or Subdivi ioh and Lot No,
�r1NER �� (
DDRESS_
(Street or Route No.)
FOA d01cE USE ONLY''
QUAD. No.., SERIAL No.
minor Basin • • .: ,: r.
Basin coda --. ..
STATE ELLCONSTRUCTION
PERMITNUMBER:
below) _ -
--County:- O)� a �
terry or Town --Slate -
Code
)TALDUSE OF WEAL f zip
DEPTH
JT 1NGS COLLECTED •YES [] NOD,
)ES WELL REPLACE EXISTING WELL? YES ,� NO TIC WATER LEVEL Below Top of Casing, FT
P OF CASING IS (Use 's• II Above Top (il Casing)
TermInato
rdancs wIt 15A below Is ace I$ Illeg l uniobove nda t orlanceu•ls Isxuud
:rdance with 75A NCAC 2C .o118 f9 :LD (gpm): METHOD OF TEST
TER ZONES (depth): I�LLi,
LORINATION: Type { ---
SING: "--AI ourt_
Depth Wall)'hickr oss
n Di
T a etas orl�eiaht=t. Ltalarial
o _�, FL -�: , ,r
To Ft. -+- -Q —ToFL-- �_
-
)UT: —r --
1 Depth Material —�Method To '20 Ft. Ce�I1j _IiDOU
To
EEN: Ft.. - -
Depth Diameter Slot Siz
Ft'. Material
In. ..
To In. _
In. _
To Ft. In. I.In.
)/GRAVEL PACK:
Depth Size M
To FL
To Ft.
RKS: t
•�G ti.."
DEPTH DRILLING LOG
From To Formation Description
It additional space is needed use back of form
LOCATION SKETCH
(Show direction and distance from at least Iwo Slate
Roads, or other map rolerenca paints)
<o
CD
r
a
' O
cn
_ Q1
C
c
�z
zm
oC')
cm
o�
NCD
rm
Av
m
O
z
_REBY CERTIFY THAT THIS WELL WAS
"RUCTION STANDARDS, ANQTHATA C
VSTRl1CTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
AT 41S RECORD HAS BEEN PROVIDED TO THE WELL OWNER.

;onh Carolina • 0epartment of Environment, Health, and Natural Resources
Division of Environmental Management • Groundwater Suction
P.O. Box 29535 • Ralofgh, N.C. 27623.0535
Phone [phone];
WELL CONSTRUCTION
TILLING CONTRACTOR:
ILLER REGISTRATION NUMBER
WELL LOCATION:
Naarest Town:_
or
DVINER _
ADDRESS_
Lr<k
)w sketch of the locE
livisioh anan—�.) _
(Street or Route No.)
210"'?9
FOR d!`FICE USE
QUAD. NO.
"'•�,�' SERIAL NO. ��,__
��.. :;i': ;o:F3Q ',aP.:r•
Alnor Basin
CORD
asin Code
[�Eoader Ertt.: ;.. .;r.^`':%°:•:;:
�
STATE WELL CONSTRUCTION
1 PERMIT NUMBER:
•.: i - ;.y...
�'•`
•� G4Y'
t slow)
-- County:
_
6 � -J � City or Town State
_'ATE DRILLED 3 _� zip Code
-OTAL DEPTHUSE OF WELL {
:UTTINGS COLLECTED -YES o NOQt ,
`OES WELL REPLACE EXISTING WELL? YES NO
STATIC WATER LEVEL Below Top of Casing; C v FT.
OP OF CASING IS / (Use'✓ it Above Top, I Casing)
FT. Above Land S irface'
.-.g Terminated auor below land aurfaco Is Illegal : unto s a arlancu Is Issuud
cardsnce with 15A NCAC 2C A118
LO (gpm):-- LS METHOD OFTEST 1
."TER ZONES (depth): 4
-�LORINATION: Type
>SING:
Depth Wall Thickr ass
Om �U Da star or weighb=l. Material
Wig_
' n To Ft. _
.m To FL
,OUT:
Depth �l �, Material "m 2 To AFt. Cemn eMethod
.m To I — ��U .
Ft.
'REEN:
Depth Diameter Slot Size Material
-•m To
' Ft In. I In. _
To Ft.
,t To Ft. in. in. _ T_
'!D/GRAVEL PACK:
Depth
SIZE MatE flat
To Ft.
,1 7o FL —r--
DEPTH DRILLING
Frorn To Formation oescriplion
If additional space is needed use back of form
LOCATION SKETCH
(Show direction and dis(anco from at leas, two Slate
Roads, or olhor map reference points)
u u G 15 D
'T!7
o
ze
o
a
�m
t
ozm
�
Do
s
=
rn
Am
p
y2
rnz
a►
g
z
HEREBY CERTIFY THAT THIS WELL WAS CO IN ACCORDANCE WIAsheville Re __'Onal - TH I SA NCAC 2C, WELL
STRUCTION STANDARDS, ANq, THAT A COPY FT AIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER.

North Carolina - Department of Environment. Health, and Natural
Division of Environmental ManagemResources
ent • CGroundwalor Section
P.O. Box 29535 • Raloigh, N.C. 2762 3-0535
Phone [phone]:
WELL CONSTRUCTION
!LLING CONTRACTOR:
ILLER REGISTRATION N
WELL LOCATION: (Show sket
Naarest Town:—_fi /A,1 .,Z,�
njrlrlR
, FOR d! FlCE USE ONLY'::'^: is�C r• r .
OUAO. NO. . ,,..rc.::y ..:: •.
SERIAL NO —_
CORD
(� .. Basin code J.. _ .:: r...... v.
. v ... 1wL.Vi Jti:�'•ily..
dor
a STATE ELL CONSTRUCTION
PERMIT NUMBER:
t elow)
-- County
�. S ` wnmunl , or Subdivisioh and Lot No—-- —�'�.
O'NNER I DEPTH DRILLING LOG
DDRES/
Frorn To
c2- _ Formadon oescapu,m
G is bet or Route No.)
ury or Town Slate � — 6—
DATEDRILLEDa-44_rn,1 f 42C,do
OTAL DEPTH _ ?7�__USE OF WELL --
:UTTINGS COLLECTED -YES 0 NOD,
:DES WELL REPLACE EXISTING WELL? YES NO
;,TIC WATER LEVEL Below Top of Casing: L FT
'OP OF CASING IS (Use 4+• it Abova Top I Cuing)
-•g Terminatod auor below IS arms Above
nlosde orfaceu•
:ordanca with 15A NCAC 2C .0110 is Isauud
'ELD(gpm):_METHODOFTEST �I J
-ATER ZONES (depth):
-iLORINATION: Type
SING: AI oUr (_ — p additional space is noedod use back of form
Depth Walll T�hiic�kkrr oss LOCATION SKETCH
To Via afar or WoighL Material (Show direction and distance from at least two State
"m Ft. Roads, or o(hor map roforenca points)
:m To Ft.-- —
:OUT: o
O
Depth
��T,-, Material S �z
To sLFt. Material Method c�
:m To ID CL �... zrm
FL v
'SEEN: - t ao
Di
Depth
p Diameter Slot Size Material = ao
'm 7o Ft ... In. In. _ mz
To Ft. In. _ CA -"i
In. -
To o
Cn
Ft. In. fitR z
,DJGRAVEL PACK:
Depth 4t4al
�Size
° To1,
TO Ft.
!ARKS:
AshivilleRevionsiolfics ---------------
HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
STRUCTION STANDARDS, AND, THAT A COPYQF T �IIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER.

210'741
North Carolina • Department of Environment, Health, and Natural Rosourcos
Division of Environmental Management • droundwator Section FOR d!`FlbE U§E ONLY''<�:•^:'s'•?+'��'..
P.O. Box 29535 • Raleigh, N.C. 27626.0535 QUAD. NO,
• SERIAL NO.
Phone [phone]' Lot..;.5;'
..'. (o� .::._:.I .:Jy.
WELL CONSTRUCTION RECORD Minor Basin
..' :i:'1';
. . ...,..Iv.:..Y.,.,
Basin Code '-.. ,•:_::_: .::..�. C '':oG;,r!:: ':1w.; BILLING CONTRACTOR:Hoadar L'
• III T.' ..,'GNFfi�ril,•,=,
BILLER REGISTRATION NUMBER: r G STATE WELL CONSTRUCTION
. ) / PERMIT NUMBER:
WELL LOCATION: (Show sketch o(the Io�atl�
wn below)
NearestTown: —Gac( /yip �j�
County:,.. y)a c'�n
(Road, Comm wry, or gubdlvi on and Lot No.)
O'+VNEA e �. >a _r � DEPTH DRILLING LOG
ADDRESS / 03 =; (n From To Formation Description
taveetw'Nouta No.)
�rGtnfClyJ A,1C1 7� t/
CiryorTown 6Wto
Zip Dodo
DATE DRILLED �2'*S USE OF WELL
TOTAL DEPTH/ —
CUTTINGS COLLECTED •YES NOD�-
DOES WELL REPLACE EXISTING WELL? YES NO[
STATIC WATER LEVEL Below Top of Casing; c7.. FT,
TOP OF CASING IS j (Use •.-itAboveTop of Casing)
FT. Above Land Surface-
3slr,g Terminated aVor below land aurfam Is file gol unlal s a varlancu Is lasuud
accordance with 15A NCAC 2C .olia
YIELD (gpm): . 3 METHOD OF TEST �n i
WATER ZONES (depth): —
CHLORINATION: Type — I-1 { F) Amount 'rT, Ih
CASING: It additional space is needed use back of form
Depth WL11 Thickness
FICm--P—To / Oia slot or WaighVFL Idacerial
Ft.-, Y 7{Y PwC
From To
From To
GROUT:
Frem
n Depth Material T l� Method
--L To =-?I Q_ Ft..•C'U,
From To Ft.
SCREEN:
Depth Diameter Slot Size Material
From To Ft In. I In.
Frcm To Ft. In. In.
From To Ft. In. �..In.
SAND/GRAVEL PACK: L5
Depth
=rcm To Ft. Size I )^ I JUN 1 9 2000
=rcm To Ft.
LOCATION SKETCH
(Show direction and distance from at least two State
Roads, or other map roforence points)
p o
a �
Ao
1 Mz
C n --1
Cn o
x
CO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
:ONSTRUCTION STANDARDS, ANQ•THATA COPY
/JTHIS RECORD HAS/BEEN PROVIDED TO THE WELL OWNER.

Nonh Carolina • Depanment of Environment. Health, and Natural Resources
Division of Environmental Management • Groundwater Section
P.O. Box 29535 • Roloigh, N.C. 27626.0535
Phone [phone]
WELL CONSTRUCTION
,RILLING CONTRACTOR:
BILLER REGISTRATION NUMBER
WELL LOCH'
Nearest Town:
,Road•(
OWNER
..i Ik 1� P.
STATE WELL CONSTRUCTION
PERMIT NUMBER:
"
FOR &FILE USE ONLY'g':;���S� r'r•
QUAD. NO."
• SERIAL No.=>��•'-'+k.: r.
Lo
Minor asill
: i •'� �_^,�;7ij�:i�+'
Basin Code
t; .
sketch of the IoCatIgn below)
— County; ro C (.7 s
DEPTH DRILLING LOG
From To Formadon Description
(SVeat of Route No.)
62 >, k f ti' 1 iC ( 3 L
City or Town Stale Zip Code
DATE DRILLED _ _I,1' USE OF WELL d
TOTAL DEPTH ' ?,r `
CUTTINGS COLLECTED •YES ❑ NO[L
DOES WELL REPLACE EXISTING WELL? YES NO[D!
STATIC WATER LEVEL Below Top of Casing: ��� FT.
TOP OF CASING IS (Use's' it Above Top of Casing)
FT. Above Land Surface'
asing Terminated aVor below lend surface Is Illegol unloi s a vorloncu la 15sUUd
'. accordance with 15A NCAC 2C .0115
YIELD (gpm): L' METHOD OF TEST L/vl n a-
1':ATER ZONES (depth):
CHLORINATION: Type `(' i) Amount 04 Lh It additional space is needed use back of form
CASING:
Wall Thickness LOCATION SKETCH
Depth Dia a or or WeighvF`, 1.1a (Shaw direction and distance from' at least two State
From. To _ Ft.„ —' IyF q y� e- Roads, or other map reference points)
From To Ft. _
From To Ft,
GROUT:
Depth Material Method
From �_ To ,2 O Ft. CerneYl l I%fD U p
From —To Ft.
SCREEN:
Depth
Frcm
To
From
To
From
To _
SAND/GRAVEL
PACK:
Depth
F(cm
To —
From
To_
REMARKS:
Diameter Slot Size Material
Ft In. In,
Ft. In. __ In.
Ft. In,
Size
Ft.
Ft.
192000
0
CC o
_ n::o
a
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� av
O �+z
t�A
Jl �
o
x
I CO HEREBY CERTIFY THAT THIS WELL WAS COST � _ DANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, ANQ THAT A COPY�, THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER.
ll/ ,) .. _ '. - �C1 /)/l,- C �2 - c`-1 9—oz0

;;onh Carolina - Depanment of Environment, Health, and Natural Rosourcos
Division of Environmental Management - Groundwator Section
P.O. Box 29535 - Relotgh, N.C. 27626.0535
Phone [phone]!
WELL CONSTRUCTION
LUNG CONTRACTOR: 1 r,,
LLER REGISTRATION NUMBER:
WELL LOCATION- (Show sketch of the lea
N'aarest Town: / 12m [. /n�_
(Feed. Conmunity, or Subdivisioh and Lot No.)
D` INER _ �lI Lr., 1
4DDRESS .S3
(street or Route No.)
--rnl�lty� �. r
..
. FOR a�Flct USE dNLY''
QUAD. NO."<`$ERIAI
tau
:'.jAng ^_l:;j';..: .--�
Minor easin .
•;;;.: •'.r� ,
Basin Code
STATE WELL CONSTRUCTION
PERMIT NUN18ER:
below)
— County: _m a e.7k
DATE DRILLED U I Zzp'Codo
USE OF WELL
-OTAL DEPTH
:UTTINGS COLLECTED YES[] NOQ%
:OES WELL REPLACE EXISTING WELL? YES NO�, ;TATIC WATER LEVEL Below Top of Casing; FT.
OP OF CASING IS (Usa'a-ilAbovoTopooic`asu,g)
FT. Above Land Surface-
-
7 Terminated aVor below lend surface la Illegal unlo� a a variance Is Issued'
cordanco with 15A NCAC 2C .0113
IELD (gpm): ` METHOD OFTEST 1 )2c�
/ATER ZONES (depth): A 0'
DEPTH DRILLING LOG
From To Formation Description
HLORINATION: Type l -�r
ASING:
Amount If additional space is noedod use back of form
Depth WallThicknoss LOCATION SKETCH
p Oia etor or WeighvFL Material (Show direction and distance from at least two State
om TO Ft..`— Roads, or other map reference points)
Om To Ft.
ROUT: T—
Depth Material Method
Om To Ft. -----__.
;REEN:
Depth Diameter Slot Size Material
;m To Ft In.. I In.
:m To Ft. In. _
In.
;rn To Ft. In. I. in.
ND/GRAVEL PACK:
Depth Size Material
:m To Fl.
:m To Ft. �—
r 129
6
c
o
cz
rn
Drn
Z
am
orn
r"a
Cn
cr1
0
z
HEREBY CERTIFY THAT THIS WELL WAS
'; S TRUCTION STANDARDS, AND, THAT A C
ED IN ACCORDANCE WITH 15A NCAC 2C, WELL
RECORD HAS/BEEN PROVIDED TO THE WELL OWNER.
r'r.�n/i, \ /— //—/) O

Nonh Carolina • Department of Environment. Health. and Natural Resources
Division of Environmental Management • Groundwater Section
P.O. Box 29535 • . FOA &FIbE USE C&Ly,'
Raloigh,N.C.27626.0535 OUAO.NO.' •<•SEAIALNO.
Phone [phone]' LaL •• _—
.
WELL CONSTRUCTION RIIECORD Minor 3as6r ..
ILLING CONTRACTOR: 1 Hoadorodo ••.:z:_c .::..;.,,; _
�`•t r.. Hoador tru^:: :.r .';.5 r,_A:•i,:•'.%�Gl'!:
ILLER REGISTRATION NUMBER: �' q STATE WELL CONSTRUCTION
/ PERMIT NUMBER:
WELL LOCA
Nawast Town:
OWNER
ADDREE
1 IShow sketch of the
i
i J Ain
or Subdivisioh and Lot No.l
(SVBet or Route No.)
below)
—County;. mQCrr,.
Ciry or Town Slate
ATEDAILLED 5-00 J Zip Code
TOTAL DEPTH S USE OF WELL
:U I I INGS COLLECTED 'YES [] NO[ ,'
DOES WELL REPLACE EXISTING WELL? YES NO(D% _TATIC WATER LEVEL Below Top of Casing; FT,
"OP OF CASING IS % (Use'f• it Above Top of Casing)
FT. Above Land Surface-
--,g Terminrdancewielad al/or below land
==ordance surface Is Illegal unto)
th 15A NCAC 2C .0119 Js e verlancu Is Issuu
IELD(gpm):_--�LMETHOD OF TEST
vATER ZONES (depth): Is, U,---------------
'
=HLORINATION: Type
'SING:
DEPTH DRILLING
Frain . To Formadon Description
r
unt It additional space is needed use back of form
Depth Wall Thickness
P Diator or WeighvFt. Material
om-- - To 0 Ft. .1� o- 6 Aw(2-
om To FL
om To Ft.
ROUT:
h Depth Material
m —L- To Ft. C2rnC�r) I Method
rD cc
m To Ft. -----__•
:REEN:
Depth Diameter Slot Size Material
cm To
Ft In. I In.
om To Ft. In. _
In.
m To FL In. .in.
":D/GRAVEL PACK:
Depth Size I Material
.m To Ft.
:m To Ft. �—
'•1ARKS:
LOCATION SKETCH
(Show direction and distance from at least two Slate
Roads, or olhor map rotorenca points) O
0
a
-c
1
6''�UT
p� N 19 2WO
O
3 HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
vSTRUCTION STANDARDS, ANQTHAT A COP/Y%THIS RECORD HAS/BEEN PROVIDED TO THE WELL OWNER.

North Carolina • Depanment of Environment, Health, and Natural So source,
Division of Environmental Managemonl • Grot, ndwelor Soction
P.O. Box 29535 • Raleigh, N.C. 27626.0535
Phone [phone]
WELL CONSTRUCTION ljIECORD
_LING CONTRACTOR; J).
_LER REGISTRATION NUMBER: r1
'TELL LOCA'
laarest Town:
the
. FOR df `jj USE ONLY'
QUAD. NO.;._,; SERIAL NO.
Minor G3sin .
11 Qasin Coda.:.
. ••i I� P ' Hoador Lnt:<:., ;,.<-:x .: .:V:, .•_. '-.::c
STATE WELL CONSTRUCTION GW
PERMIT NUMBER:
I: elow)
-- County:. 4224 Cex-)
• rsry. or Subdivision and Loi Noo i—�-----
''NNER //• O�( � DEPTH
. DDRESS - Fram To
($boat or Route No.) j �—
airy or Town - - `� �TE DRILLED _
State r Z,ip,Co�d�oy:
7TAL DEPTH -1S USE OF WELL �l
JT I JUGS COLLECTED -YES No
DES WELL REPLACE EXISTING WELL? YES NO(
ATIC WATER LEVEL Below Top of Casing; n
P OF CASING IS I (Use '`*dAbove'Top,dCasing)
Terminated aUor below la aw is Above
unlanda orlanw is Issuvd'
:rdanca wllh 15A NCAC 2C .Olt 5
.LD(gpm): METHOD OF TEST.
,TER ZONES (depth): /� '
— _
_ORINATION: Type L t /
31NG: Amour r
Depth wall Thickr oss
Dia - To . Fator or Weighv't. 1.latarial
--i_To � Ft. r' C
LU_ I �1�
TO Ft.�_ —
%UT:
Depth Malarial �— Method
To _Ft. Cemr�rlj -:)(OU
TO Ft.
EN:
Depth Diameter Slot Size
Ft
To Material
To �_ !n. � in. _
Ft. In. In. _
To Ft.
/GRAVEL PACK: In,--_LIn. _
Depth Size
To FL
TO---__ Ft.
DRILLING— LOG
Formadon Description
7
------------
additional space is needed use back of form
LOCATION SKETCH
(Show direction and distance from at least two State
Roads, or olhor map roforence points)
-
Q
o
or"
c
a
Ar
_=
6
m
rn
3
Y
Male rfal
AN
:REBY CERTIFY THAT THIS WELL WAS
RUCTION STANDARDS, ANq THATA 0
i IHUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
V-T ilS RECORD HAS BEEN PROVIDED TO THE WELL OWNER.

North Carolina • Department of Environment, Health, and Natural Rosourcos
Division of Environmental Management • Groundwalor Soclion
P.O. Box 29535 • Raleigh, N.C. 27626.0535
Phone [phone]!
WELL CONSTRUCTION FIIECORD
ill -LING CONTRACTOR:
ILLER REGISTRATION NUMB
':SELL LOCATION: (Show sketch of the Iota
NaareslTown•_
of
OWNER
(Street or Route No.)
.. . FOR df`Flbt USE 6NL
QUAD. NO..
Lit_
ldlnor Basin
Basin Coda--
STATE WELL CONSTRUCTION
PERMIT NUNIBER:
below)
-- County:
'ATE DRILLED 192 4
1p �000
TOTAL DEPTH USE OF WELLgg�
CUTTINGS COLLECTED ' YES[] NO[D�'
DOES WELL REPLACE EXISTING WELL? YESED NO( STATIC WATER LEVEL Below Top of Casing: 31,, I.T.
OP OF CASING IS (use 'i it Above Top of Casing)
�..; Terminated auor below land surface s llllbagalunto ntla varlanceo Is IssuuJ
==ordence with 15A AC 2C .ol18
iELD (gpm):� METHOD OF TEST
,VATER ZONES (depth): r
=HLORINATION: Type 1- 1
Am
.dS:f�Q
DEPTH DRILLING
From To Fo(madon Description
-SING: ount It additional space is no acted use back of form
Depth Wall Thickness LOCATION SKETCH
'cm -—To �w eior or Weight/Ft. 6lateriel (Show direction and distance from at least two State
'om TO Ftp Roads, or othor map roforence points)
m To FL
:ROUT:
0
h Depth Material"-T Method C �
m—LTo--2Q Ft. C2rnGr) (DLL
cm To
-REEN:
r �<
Depth a yv P Diameter Slot Size Material
cm To rn
Ft In. ! in. _ �rn
m To Ft. In. in. �Zo
m To Ft. �
^ D/GRAVEL PACK: In. -In. Ca o
z
Depth Size Material 0 (�
'm To Ft.
:.'n To Ft. )P,I
ll
HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN "r villeweieoneco
N Ashevdie Re'Ijce
NSTRUCTION STANDARDS, ANQTHAT A COPY THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER.

Nonh Carolina • Department of Environment. Health, and Natural Resources
Division of Environmental Management
P.O. Box 29535 . 9 Groundwater SectionEl.
NRaleigh, N.C. 27626.0535 SERIALN
Phone [phone]f
WELL CONSTRUCTION RECORD ILLING CONTRACTOR:
ILLER REGISTRATION NUMBER: {'I STATE WELL CONSTRUCTION
,J � PERMIT NUMBER:
"'ELL LOCATION: Show Sketch of the Iocz
Nearest Town:.L_j'"9_
(Road, Community, or Subdivision and Lot No.
OWNER —Lt 2- Y) 0
------% S 4 G
ADDRESS Sn L_/, 0'i._ ., .
(SUeet or Route No.)
below)
—County:_ 14 R e
City or Town ✓
Slate Zip Code
DATE DRILLED USE OF WELL '
TOTAL DEPTH__
DUTTINGS COLLECTED •YES[] NO["
DOES WELL REPLACE EXISTING WELL? YES NO STATIC WATER LEVEL Below Top of Casing: Fr.
TOP OF CASING IS j (Use'.• itAbove'Top of
;,•p Terminated stror below land surfaco is 11,99 ale nlosaa varlonceo Is Issued
:cordanca wfth 15A NCAC 2C .0118
'IEID (gpm):_ METHOD OF TEST
.'ATER ZONES (depth): `f '
:HLORINATION: Type—L—_Amount
=SING:
Depth rJ Wall Thickness
0ia
rCm —TO /� / Ft• elar or Wyei��h¢VFL Material
cm To t• F_ Pw _
,om To Fl•
ROUT:
t� Depths , Materia�
To=�.s.1_Ft. C2rY &nI Method
UU,
To Ft.
GREEN:
Depth Diameter Slot Size Material
cm To
Ft In. in.
:m To Ft. In.
�m To Ft. in. In.
;ND/GRAVEL PACK: 0
Depth Size Material
:m To Ft.
=m To Ft.
DEPTH DRILLING LOG
From To Formation Oascription
It additional space is needed use back of form
LOCATION SKETCH
(Show direction and distance from at least two Slate
Roads, or other map reference points)
u u U LS R
XN 19 2000
0
D
Q
-•c
�m
�
o—
rn
ao
3
Am
0
nA
CJI
0
z
0 HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 1 SA NCAC 2C, WELL
`:STRUCTION STANDARDS, ANQ THAT A COPY THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER.

::orth Carolina • Department of Environment. Health, and Natural Resources
Division of Environmental Management • 0roundwator Suction
P.O. Box 29535 • Raleigh, N.C. 27626.0535 OUAD. NO. •FOR dt`FlCE USE
Phone [phone] V."`: S�ERIA
WELL CONSTRUCTION RECORD Minor easin
Basin Codo�
He
;ILL ING CONTRACTOR: J) Cr, 1 ��
TILLER REGISTRATION NUMBER: q STATE WELL CONSTRUCTION
JI� / PERMIT NUMBER:
vrtLL LOCATION: (Show sketch of the
Nearest Town: r
;Road, Convnuniry, or Subdivision and Lot No.)
OVINER _ 6C 2t (?/)) o i
ADDRESS—/,1V-7-q; C..,_
below) y
— County: _ l �
(Street or Route No.J
City or Town SWIe
'?ATE DRILLED Zip Codo
USE OF WELL
TOTAL DEPTH 46b---�_
:UTTINGS COLLECTED -YES NOQi %
DOES WELL REPLACE EXISTING WELL? YES NO( STATIC WATER LEVEL Below Top of Casing: FT.
TOP OF CASING IS (Use'*• it Above Top ong)
FT. Above Land Surface,
ng Terminstod avor below lend surface Is Illegal unlol a a varlancu Is Issuud
. ccordanoe with 15A NCAC 2C .0118
MELD (gpm): Z _ METHOD OF TEST �n(>> i
.,ATER ZONES (depth): 3'
=HLORINATION: Type 1,1 I
.:SING: Amount
Depth Wall Thickness
aCm To
Dia elor or WeighvFL Material
m To Ft.
'rem To FI.
=.BOUT:
Depth�7,•, Material
"cm To =�sLFt, COMer)j (DtU d
m To Ft.
DREEN:
Depth Diameter Slot Size Material
cm To Ft In. in.
:;m To Ft. In.
�m To Ft. in.
In. !.In.
;r;D/GRAVEL PACK:
Depth Size
:m To Ft.
:m 7o Ft.
DEPTH DRILL LOG
Frorn To Fcrmadon Description
If additional space is noedod use back of form
LOCATION SKETCH
(Show direction and distance from at least two State
Roads• or other map roforence points)
JUN 19 2000
0
O
ZE
a
...C>m
cC-J
�
=nt
�rn
r
rn
a
--II
_
=o
.
rrn-0
�
-
I
z
C HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
::STRUCTION STANDARDS, AND. THAT A COPY HIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER.
/ —/ % —o v

North Carolina • Department of Environment. Health, and Natural Rosourcos
Division of Environmental Management • droundwater Section
P.O. Box 29535 • Raloigh, N.C. 27626.0535
Phone [phone];
WELL CONSTRUCTION ECORD
TILLING CONTRACTOR: r1
TILLER REGISTRATION NUMBER:
WELL LOCATION: (Show sketch
Nearest Town: n1//y, ,r
- • ..�,,.,wru , or Subdivisiola and Lot
OWNER c-�rSe
ADDRESS ,1 %.S
,FOR a!`FlCE USE ONLY'
OUAp, NO. SERIAL NO.
Lot. L�.i.,:;. i•:
Minor Basin y;, ' I '•r r =
11 I Basin Code :•.. -:-: :: -
, Haador CfIL".< 4
S .'. G4V'
STATE WELL CONSTRUCTION
PERMIT NUMBER:
below) rnrn
County: .4 �L-a
(Seeel or Route No.) r
Cr�—
�.�73
ry or Town Stale
DATE DRILLED �- zip Code
USE OF WELL
--y
TOTAL DEPTH S'n n
CUTTINGS COLLECTED YES NO[g}
DOES WELL REPLACE EXISTING WELL? YES [] NO TATIC WATER LEVEL Below Top of Casing: pp PT,
TOP OF CASING I$ 1 (Use'♦'it Above Top ol Casing)
FT. Above Land Surface•
:,ng Terminated aVor below lend aurfaeo Is Illegal unloi a a variance la Issued'
accordance with i5A NCAC 2C .0118
MELD (gpm):_ 3_ METHOD OF TEST
,'ATER ZONES (depth):
_:HLORINATION.: Type ) At
DEPTH DRILLING
From To Forma don Oescripti,
-ASING: mount. % If additional space is needed use back of form
Depth Wall Thicknoss
=rom Dia/��lat or WeighVFL Matarial
rom To
-,om To Ft,
ROUT:
rom 0Depth Material
To Ft. t? ernen j Method
'om To Ft.
CREEN:
Depth Diameter Slot Size Material
rom 7o
Ft In. In.
'om
7o Ft. In, _
"cm —To. _ in.
Ft. In. ! in.
,ND/GRAVEL PACK:
Depth Size Male
m To Ft. N
:m To Ft.
?AARKS� i
LOCATION SKETCH
(Show direction and distance from at least two State
Roads, or othor map (oforence points)
0 0
Z.. c�
'e an
2rn
0
�rn
a mKD
_ �o
0 OZ
CA �rn z
-•r
! 97rt;
210r
0 HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
=NSTRUCTION STANDARDS, ANQ•THAT A Copy THIS RECOR1D HAS BEEN PROVIDED TO THE WELL OWNER.

' 1)
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Ground Water Section
1636 Mail Service Center - Raleigh, N.C. 27699-1636 - Phone [phone]
WELL CONSTRUCTION RECORD WELL CONTRACTOR: Hedden Bros. Well Drilling Inc.
WELL CONTRACTOR CERTIFICATION #: 2043
STATE WELL CONSTRUCTION PERMIT #:
1. WELL USE(Check Applicable Box): Residential 1X1 Municipal ❑ Industrial ❑ Agricultural ❑ Monitoring ❑
Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other,List Use:
2. WELL LOCATION: (Show sketch of the location below)
Nearest Town: Highlands County: Macon
1528 McCall Rd
(Road Name and Numbers, Community, or Subdivision and Lot No.) DEPTH DRILLING LOG
3. OWNER Ruth Bryson From To Formation Description
Address 1528 McCall Rd O 51 clay & sand
(Street or Route No.) 51 Inn granite
Cashiers NC 28717
City or Town State Zip Code
4. DATE DRILLED 12/08/00
5. TOTAL DEPTH 700
6. CUTTINGS COLLECTED YES ❑ NO 0 cn--
7. DOES WELL REPLACE EXISTING WELL? YES ❑ NO 0 0
8. STATIC WATER LEVEL Below Top of Casing: 0 FT. o
-- C3
(Use " + " if Above Top of Casing) n
9. TOP OF CASING IS 2 FT. Above Land Surface* My---
*Top of casingg terminated at/or below land surface requires a variance in accor-
co
dance with ISA NCAC 2C .0118
10. YIELD (gpm): 4.00 METHOD OF TEST B10W a
11. WATER ZONES (depth): 475 m
0 rp
12. CHLORINATION: Type H T H Amount If additional space is needed use back oriorm
13. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
From 0 Tom_ Ft. 6 .188 steel
From _ 5 To 53 Ft. 6 ,PVC
From To Ft.
14. GROUT:
Depth Material Method
From 0 To 20 FL Cement Poured
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 0 To Ft.
From To Ft.
17. REMARKS:
I DO HEREB T ,
CONSTRUCT
1
FOR OFFICE US$I i LS
Quad No.
Serial No.
L]
LOCATION SKETCH
(Show direction and distance from at least two State
Roads, or other map reference points)
CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
)PY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER.
StIPNATURE OF PERSON CONSTRUCTING THE WELL
Submit original to Division of Water Quality, Groundwater Section within 30 days
Date

North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Ground Water Section
1636 Mail Service Center - Raleigh, N.C. 27699-1636 - Phone [phone]
WELL CONSTRUCTION RECORD WELL CONTRACTOR: Hedden Bros. Well Drilling Inc.
WELL CONTRACTOR CERTIFICATION #: 2043
STATE WELL CONSTRUCTION PERMIT N:
1. WELL USE(Check Applicable Box): Residential 0 Municipal ❑ Industrial ❑ Agricultural ❑ Monitoring ❑
Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other,List Use:
2. WELL LOCATION: (Show sketch of the location below)
Nearest Town: Highlands County: Macon
1528 McCall Rd
(Road Name and Numbers, Community, or Subdivision and Lot No.) DEPTH DRILLING LOG
3. OWNER Ruth Bryson From To Formation Description
Address 1528 McCall Rd O 43 rlay Rr snnd
(Street or Route No.) 43 300 Ernnite
Cashiers NC 28717
City or Town State Zip Code
4. DATE DRILLED 12/11/00
5. TOTAL DEPTH 300
6. CUTTINGS COLLECTED YES ❑ NO
7. DOES WELL REPLACE EXISTING WELL? YES ❑ NO T
8. STATIC WATER LEVEL Below Top of Casing: 0 FT.
(Use "+" if Above Top of Casing)
9. TOP OF CASING IS 2 FT. Above Land Surface*
*Top of casingg terminated at/or below land surface requires a variance in accor-
dance with 15A NCAC 2C .0118
10. YIELD (gpm): 40.00 METHOD OF TEST Blow
11. WATER ZONES (depth): 152
260
12. CHLORINATION: Type H T H Amount
13. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
From _ 0 To 21 Ft. 6'_ 189 Steed
From 21 To 45 Ft. 6" DVc
From To Ft.
14. GROUT:
Depth Material Method
From 0 To 20 Ft. Cement Poured
From To Ft.
15. SCREEN
Depth Diameter Slot Size Material
From _ 0 To Ft. in. in.
From To Ft. in. in.
From To Ft. in. in.
16. SAND/GRAVEL PACK:
Depth Size Material
From 0 To Ft.
From To Ft.
If additional space is necueu use uaca m imu,
LOCATION SKETCH
(Show direction and distance from at least two State
Roads, or other map reference points)
17. REMARKS:
I DO HEREBY C Y� I NSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRI 10 JY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER.
FOR OFFICE USE
Quad No.
Serial No. - SIG TURE OF PERSON CONSTRUCTING THE WELL Date
9Uhlj7it original to Division of Water Quality, Groundwater Section within 30 days

North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Ground Water Section ti 2 $18
1636 Mail Service Center - Raleigh, N.C. 27699-1636 - Phone [phone]
WELL CONSTRUCTION RECORD WELL CONTRACTOR: Hedden Bros Well Drilling Inc.
WELL CONTRACTOR CERTIFICATION #: 2043
STATE WELL CONSTRUCTION PERMIT N:
1. WELL USE(Check Applicable Box): Residential EM Municipal ❑ Industrial ❑ Agricultural ❑ Monitoring ❑
Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other,List Use:
2. WELL LOCATION: (Show sketch of the location below)
Nearest Town: Highlands County: Macon
_Highlands 11i11s-Mirror Lk
(Road Name and Numbers, Community, or Subdivision and Lot No.) DEPTH DRILLING LOG
3. OWNER Mark Davis From To Formation Description
Address 1461 N E 56Th Court n 19 clay rG sand
(Street or Route No.) 19 300 granite
Fort Lauderdale FL 33334
City or Town State Zip Code
4. DATE DRILLED 12/18/00
5. TOTAL DEPTH 300 a
6. CUTTINGS COLLECTED YES ❑ NO F
7. DOES WELL REPLACE EXISTING WELL? YES ❑ NO M 173 o
8. STATIC WATER LEVEL Below Top of Casing: 0 FT.
(Use " + " if Above Top of Casing)
9. TOP OF CASING IS 2 FT. Above Land Surface* cu i
*Top of casingg terminated at/or below land surface requires a variance in accor- >-o
dance with 15A NCAC 2C .0I18 --y. m'
IO. YIELD (gpm): 8.00 METHOD OF TEST Blow = - AP1
11. WATER ZONES (depth): 12R N
0r�
12. CHLORINATION: Type H T H Amount If additional space is needed use back of Corm z
13. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material LOCATION SKETCH
From _0 To 21 Ft. 6" _ i RR steel (Show direction and distance from at least two State
From To Ft. Roads, or other map reference points)
From To Ft.
14. GROUT:
Depth Material Method
From 0 To 20 Ft. Cement Poured
From To Ft.
15. SCREEN:
Depth Diameter Slot Size Material
From —0 To Ft. in. in.
From To Ft. in. in.
From To Ft. in. in.
16. SAND/GRAVEL PACK:
Depth Size Material
From 0 To Ft.
From To Ft.
17. REMARKS:
I DO HEREBY,QFRTIkY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTIpN;ST,ANIiAR1alS,-ANI3I--THAT A. COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER.
FOR OFFICE U9iI, LY LY C✓ � � �� !� , ��7 _ O�
Quad No ni
Serial No. SI NATURE OF PERSON CONSTRUCTING THE WELL Date
it on i I to Division of Water Quality, Groundwater Section within 30 days

2�g6g3
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Ground Water Section
1636 Mail Service Center - Raleigh, N.C. 27699-1636 - Phone [phone]
WELL CONSTRUCTION RECORD WELL CONTRACTOR: Hedden Bros Well Drilling Inc.
WELL CONTRACTOR CERTIFICATION #: 2043
STATE WELL CONSTRUCTION PERMIT N:
Box): Residential EK Municipal 0
Industrial 0 Agricultural ❑ Monitoring ❑
1. WELL USE(Check Applicable
Recovery 0 Heat Pump Water Injection 0 Other ❑ If Other,List Use:
2. WELL LOCATION: (Show sketch of the location below)
Nearest Town: Highlands County: Macon
Rag Flat Mtn Estates
(Road Name and Numbers. Community, or Subdivision and Lot No.)
DEPTH DRILLING LOG
3. OWNER David Bock From To Formation Description
Address 915 GreVfleld Place
n 59 r k ;Ind
y ans
(Street or Route No 59
300granite.
Atlanta GA 30328 -
City or Town State Zip Code
4. DATE DRILLED 12/15/00
5. TOTAL DEPTH 300
YES [I NO 0
6. CUTTINGS COLLECTED
EJ NO 0
7. DOES WELL REPLACE EXISTING WELL? YES
8. STATIC WATER LEVEL Below Top of Casing: 0 FT.
(Use "+" if Above Top of Casing)
9. TOP OF CASING IS 2 FT. Above Land Surface*
*Top of casingg terminated at/or below land surface requires a variance in accor-
dance with 15A NCAC 2C .0118
10. YIELD (gpm): 15.00 METHOD OF TEST B10W
11. WATER ZONES (depth): 0
0
12. CHLORINATION: Type H T H Amount
If additional space is needed use back of form
13. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
LOCATION SKETCH
From To�L_ Ft. _6". 188 STCe1—
how at )east two State
dre erence
—
A ads, or other map pointsom
From 21 To6_ Ft. " Dyc
From To Ft.
G
14. GROUT:
Depth Material Method
O o
From 0 To 20 Ft. Cement Poured
r
or.
From To Ft.
S z
N o<
15.SCREEN:
Depth Diameter Slot Size Material
;:am
From 0 To Ft. in. in.
NT
tV m�
From To Ft. in. in.
F y
From To Ft. in. in.
01 o
16. SAND/GRAVEL PACK:
Depth Size Material
From 0 To Ft.
From To Ft.
17
IDO
FOR OFFICDUSE'ONLY
Quad No.
Serial No.
THIS AS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
i,.'pID A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER.
�n
^r SIGNATURE OF PERSON CONSTRUCTING THE WELL Date
Submit original to Division of Water Quality, Groundwater Section within 30 days

r..
North Carolina -Department of Environment and Natural Resources -Division of Water Quality -Ground Water Section � ;� v}
1636 Mail Service Center - Raleigh, N.C. 27699-1636 - Phone [phone]
WELL CONSTRUCTION RECORD WELL CONTRACTOR: Hedden Bros Well Drilling Inc.
WELL CONTRACTOR CERTIFICATION #: 2043
STATE WELL CONSTRUCTION PERMIT #:
I. WELL USE(Check Applicable Box): Residential EK Municipal ❑ Industrial ❑
Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other,List Use:
Agricultural ❑ Monitoring ❑
2. WELL LOCATION: (Show sketch of the location below)
Nearest Town: Highlands County: Macon
Clear Crk
(Road Name and Numbers. Community, or Subdivision and Lot No.) DEPTH DRILLING LOG
3. OWNER Sam Schmitt From To Formation Description
Address P O Box 375 0 56 r]g Rr sand
—
(Street or Route No.) 56 750 �ranitP
Highlands NC 28741
City or Town State Zip Code
4. DATE DRILLED 12/21/00
5. TOTAL DEPTH 750
6. CUTTINGS COLLECTED YES ❑ NO ❑X
7. DOES WELL REPLACE EXISTING WELL? YES ❑ NO F
S. STATIC WATER LEVEL Below Top of Casing: 0 FT.
(Use "+" if Above Top of Casing)
9. TOP OF CASING IS 2 FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a variance in accor-
dance with 157A NCAC 2C .0118
10. YIELD (gpm): 10.00 METHOD OF TEST B10W
11. WATER ZONES (depth): 0
12. CHLORINATION: Type H T H Amount If additional space is needed use back of form
13. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material LOCATION SKETCH
From — To 5g Ft. 6"nve (Show direction and distance from at least two State
Roads, or other map reference points)
From To Ft.
From To Ft.
o
14. GROUT:
Depth Material Method
From 0 To 20 Ft. Cement Poured z
From To Ft. N
N
o.
ri
15. SCREEN:
Depth Diameter Slot Size Material 3
Mo
From 0 To Ft. in. in.
From To Ft. in. in.
rn
E5
From To Ft. in. in.
z
16. SAND/GRAVEL PACK:
Depth Size Material
From 0 To Ft.
From To F[
17. REMARKS:' q
i
ER '4ERTIFY THAT THIS Ij$I WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
I DO HER,
RECORD HAS BEEN PROVIDED TO THE WELL OWNER.
CONSTRU ST{r Sy AND A COPY OF THIS
FOR OFFIC US - ,.2
Quad No. Cmundva", Section
e'i nal O"i^S—_, SIGNATURE OF PERSON CONSTRUCTING THE WELL
Date
Serial No.
Submit original to Division of Water Quality, Groundwater Section within 30 days

North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Ground Water Section r' [ f J
1636 Mail Service Center - Raleigh, N.C. 27699-1636 - Phone [phone]
WELL CONSTRUCTION RECORD WELL CONTRACTOR: Hedden Bros. Well DrilHne Inc.
WELL CONTRACTOR CERTIFICATION #: 2047
STATE WELL CONSTRUCTION PERMIT 1f:
1. WELL USE(Check Applicable Box): Residential 0 Municipal ❑ Industrial ❑ Agricultural ❑ Monitoring ❑
Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other,List Use:
2. WELL LOCATION: (Show sketch of the location below)
Nearest Town: Highlands County: Macon
Buck Crk-Big Buck Crk
(Road Name and Numbers, Community, or Subdivision and Lot No.) DEPTH DRILLING LOG
3. OWNER David Land From To Formation Description
Address 752 Dixie Ave O 1?. dad .G sand
(Street or Route No.) 42 500 , granite
MadisonQA 30650
City or Town state Zip Code
4. DATE DRILLED 12/06/00
5. TOTAL DEPTH 500
6. CUTTINGS COLLECTED YES ❑ NO ❑X
7. DOES WELL REPLACE EXISTING WELL? YES ❑ NO
8. STATIC WATER LEVEL Below Top of Casing: 0 FT.
(Use "+" if Above Top of Casing)
9. TOP OF CASING IS 2 FT. Above Land Surface*
*Top of casingg terminated at/or below land surface requires a variance in accor-
dance with ISA NCAC 2C .0118
10. YIELD (gpm): 20.00 METHOD OF TEST Blow
11. WATER ZONES (depth): 430
12. CHLORINATION: Type H T H
Amount If additional space is needed use back of form
13. CASING:
Wall Thickness
Depth Diameter
or Weight/Ft. Material LOCATION SKETCH
From To 34 Ft. "
nvc (Show direction and distance from at least two State
-0
Roads, or other map reference points)
From To Ft.
From To Ft.
o
0
14. GROUT:
C_
L
D
Depth Material
Method
T ri
From 0 To 20 Ft. Cement Poured a
�m
From To Ft.
--
co
o <
15. SCREEN:
S
70o
Depth Diameter
Slot Size Material
rnz
From 0 To Ft.
in. in.
m'O
_
cn
—�
From To Ft.
in. in.
o
From To Ft.
in. in.
z
16. SAND/GRAVEL PACK:
Depth
Size Material
From 0 To Ft.
From To Ft.
17. REMARKS:
I DO HEREBY C9R+IEr iS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
HAS BEEN PROVIDED TO THE WELL OWNER.
CONST 'UCTIQ 7 591 A�$1D �2L( qND
IHi1T A COPY OF THIS RECORD
FOR OFFICE USL111Qd - Y
Quad No.
Serial No.
i
_ '. `SIGNATURE OF PERSON CO RUCTING THE WELL
__
Date
Submit original to Division of Water Qual , Groundwater Section within 30 days

North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Ground Water Section , ) r! IN r t
1636 Mail Service Center - Raleigh, N.C. 27699-1636 - Phone [phone]
WELL CONSTRUCTION RECORD WELL CONTRACTOR: Hedden Bros Well Drilling Inc.
WELL CONTRACTOR CERTIFICATION X: 2043
STATE WELL CONSTRUCTION PERMIT N:
I. WELL USE(Check Applicable Box): Residential 0 Municipal ❑ Industrial ❑ Agricultural ❑ Monitoring ❑
Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other,List Use:
2. WELL LOCATION: (Show sketch of the location below)
Nearest Town: Franklin County: Macon
143 Pratte Br Rd
(Road Name and Numbers, Community, or Subdivision and Lot No.) DEPTH DRILLING LOG
3. OWNER Wade McCall From To Formation Description
Address 143 Potts Br Rd O 96 r1a)4 Rr sand
(Street or Route No.) 86 300 granite
Franklin NC 28734
City or Town State Zip Code
4. DATE DRILLED 12/22/00
5. TOTAL DEPTH 300
6. CUTTINGS COLLECTED YES ❑ NO 0
7. DOES WELL REPLACE EXISTING WELL? YES ❑ NO 0
8. STATIC WATER LEVEL Below Top of Casing: 0 FT.
(Use " + " if Above Top of Casing)
9. TOP OF CASING IS 2 FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a variance in accor-
dance with ISA NCAC 2C .0118
10. YIELD (gpm): 6.00 METHOD OF TEST Blow
11. WATER ZONES (depth): 85
12. CHLORINATION: Type H T H Amount If additional space is needed use back of form
13. CASING:
Wall Thickness
Depth Diameter or Weight/Ft. Material LOCATION SKETCH
From 0 To 21 Ft.
_6" __ 1.88 Steel—_ (Show direction and distance from at least two State
Roads, or other map reference points)
From 21 To 88 Ft.
6„ DVe
From To Ft.
14. GROUT:
Depth
Material Method
From 0 To 20 Ft.
Cement Poured
From To Ft.
CD
15. SCREEN:
L
c x
am
Depth Diameter
Slot Size Material Z
em
From 0 To Ft.
in. in. N
_
From To Ft.
in. in.
s>c
m�
From To Ft.
in. in.
in a
16. SAND/GRAVEL PACK:
N
ms'
Depth
Size Material
N
o
From 0 To Ft.
z
From To Ft.
"t
17. REMARKS:
I DO HEREBY T Y
WA$ CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTI DARDS, AND THAT A CyOPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER.
N
FOR OFFICE US Y
� /j� In
Quad
Serial No. i'-^
'' SIG1IATURE OF PERSON CONSTRUCTING THE WELL
Date
''^`'.
Submit original to Division of Water Quality, Groundwater Section within 30 days

❑2909
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Ground Water Section
1636 Mail Service Center - Raleigh, N.C. 27699-1636 - Phone [phone]
WELL CONSTRUCTION RECORD WELL CONTRACTOR: Hedden Bros. Well Drilling Inc.
WELL CONTRACTOR CERTIFICATION #: 2047
STATE WELL CONSTRUCTION PERMIT #:
1. WELL USE(Check Applicable Box): Residential ❑X Municipal ❑ Industrial ❑ Agricultural ❑ Monitoring ❑
Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other,List Use:
2. WELL LOCATION: (Show sketch of the location below)
Nearest Town: Frankin County: Macon
8129 Ellijay Rd
(Road Name and Numbers, Community, or Subdivision and Lot No.) DEPTH DRILLING LOG
3. OWNER Sandy Gerber From To Formation Description
Address 8129 Elliiay Rd n 103 clay & sand
(Street or Route No.) 103 350 -granite
Franklin NC 28734
City or Town State Zip Code
4. DATE DRILLED 12/08/00
5. TOTAL DEPTH 350
6. CUTTINGS COLLECTED YES ❑ NO ❑X
7. DOES WELL REPLACE EXISTING WELL? YES ❑ NO Q
8. STATIC WATER LEVEL Below Top of Casing: 0 FT.
(Use "+" if Above Top of Casing) O
9. TOP OF CASING IS 2 FT. Above Land Surface* tB oRi
*Top of casingB terminated at/or below land surface requires a variance in accor-
dance with 15A NCAC 2C .0118 N �—
10. YIELD (gpm): 20.00 METHOD OF TEST Blow CO cm
11. WATER ZONES (depth): 312 a
0
12. CHLORINATION: Type H T H Amount If additional space is needed use back ofform n'—'`
13. CASING: Wall Thickness ~
o
Depth Diameter or Weight/Ft. Material 2
LOCATION SKETCH
From 0 To 105 Ft. 6„ 198 Steel (Show direction and distance from at least two State
From To Ft. Roads, or other map reference points)
From To Ft.
14. GROUT
Depth
Material
Method
From 0 To 20
Ft.
Cement
Poured
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 0 To
Ft.
From To
Ft.
17. REMARKS:
I DO HEREBY.CERTIFI
CONSTRUCTW STr{N
FOR OFFICE U Y.
Quad No. y
Serial No. P.
WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER.
'c,--e,, —�
_4 SIGNATURE OF PERSON 5ONSTRUCTING THE WELL
lit origifial to Division of Water Quality, Groundwater Section within 30 days
Date

North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Ground Water Section
211351
1636 Mail Service Center - Raleigh, N.C. 27699-1636 - Phone [phone]
WELL CONSTRUCTION RECORD WELL CONTRACTOR: Hedden Bros. Well DrflingInc.
WELL CONTRACTOR CERTIFICATION k:
STATE WELL CONSTRUCTION PERMIT N:
1. WELL USE(Check Applicable Box): Residential © Municipal ❑ Industrial ❑ Agricultural ❑ Monitoring ❑
Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other,List Use:
2. WELL LOCATION: (Show sketch of the location below)
Nearest Town: Franklin County: Macon
dodo Rosc r k Rd
(Road Name and Numbers, Community, or Subdivision and Lot No.) DEPTH DRILLING LOG
3. OWNER Lewis Weydandt From To Formation Description
Address 4949 Rose Crk Rd 0 19 CIA37�w -and
(Street or Route No.) 19 350 granite
Franklin NC 28734
City or Town State Zip Code
4. DATE DRILLED 11/28/00
5. TOTAL DEPTH 350
6. CUTTINGS COLLECTED YES ❑ NO ❑X
7. DOES WELL REPLACE EXISTING WELL? YES ❑ NO 0
8. STATIC WATER LEVEL Below Top of Casing: 0 FT.
(Use "+" if Above Top of Casing)
9. TOP OF CASING IS 2 FT. Above Land Surface*
*Top of casingg terminated at/or below land surface requires a variance in accor-
dance with 15A NCAC 2C .0118
10. YIELD (gpm): 6.00 METHOD OF TEST Blow
11. WATER ZONES (depth): 1405
12. CHLORINATION: Type H T H
Amount
If additional space is needed use back of form
13. CASING:
Wall Thickness
Depth
Diameter
or Weight/Ft. Material
LOCATION SKETCH
From 0 To
Ft. 611
199 Steel
(Show direction and distance from at least two State
_ _2)_-
Roads, or other map reference points)
From To
Ft.
From To
Ft.
14. GROUT:
Depth
Material
Method
From 0 To 20
Ft. Cement
Poured
o
0
From To
Ft.
L
�x
15.SCREEN:
2
Depth
Diameter Slot
Size Material
_
_n
From 0 To
Ft. in.
in.
co
0
yo
From To
Ft. in.
in.
m
From To
Ft. in,
in.
lfl
NT_
16. SAND/GRAVEL PACK:
V7
y
Depth
Size
Material
4r,
o
From 0 To
Ft.
x
From To
Ft.
17. REMARKS:
I DO HEREBY CERTIFY THAT
FOR OFFICE USE
Quad No.
Serial No.
WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
==r1*GOPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER.
SIGNATURE OF PERSON
Submit priginal to Division of Water Q,
71`RUCTING THE WELL Date
Groundwater Section within 30 days

North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Ground Water Section 215
1636 Mail Service Center - Raleigh, N.C. 27699-1636 - Phone [phone]
WELL CONSTRUCTION RECORD WELL CONTRACTOR: Hedden Bros. Well Drilling Inc.
WELL CONTRACTOR CERTIFICATION #: 2047
STATE WELL CONSTRUCTION PERMIT #:
1. WELL USE(Check Applicable Box): Residential 0 Municipal ❑ Industrial ❑ Agricultural ❑ Monitoring ❑
Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other,List Use:
2. WELL LOCATION: (Show sketch of the location below)
Nearest Town: Franklin County: Macon
2352 Tellico Rd
(Road Name and Numbers, Community, or Subdivision and Lot No.) DEPTH DRILLING LOG
3. OWNER Joe Cabe From To Formation Description
Address 2352 Tellico Rd 0 82 slab & sand
(Street or Route No.) 82 400 granite
Franklin NC 28734
City or Town State Zip Code
4. DATE DRILLED 11/27/00
5. TOTAL DEPTH 400
6. CUTTINGS COLLECTED YES ❑ NO ❑X
7. DOES WELL REPLACE EXISTING WELL? YES ❑ NO 0
8. STATIC WATER LEVEL Below Top of Casing: 0 FT. A
(Use "+" if Above Top of Casing) C O
9. TOP OF CASING IS 2 FT. Above Land Surface* C ��
fr1 om
*Top of casingg terminated at/or below land surface requires a variance in accor-
dance with I A NCAC 2C .0118
10. YIELD (gpm): 40.00 METHOD OF TEST B10W _o
11. WATER ZONES (depth): 185 s z�
NN NZ
12. CHLORINATION: Type H T H Amount If additional space is needed use back of�6rm amid
13. CASING: Wall Thickness CA ~
Im O
Depth Diameter or Weight/Ft. Material LOCATION SKETCH
From 0 To 84_ Ft. 611 199 .Steel—_ (Show direction and distance from at least two State
From To Ft. Roads, or other map reference points)
From To Ft.
14, GROUT:
Depth Material Method
From 0 To 20 Ft. Cement Poured
From To Ft.
15. SCREEN:
Depth Diameter Slot Size Material
From _ 0 To Ft. in. in.
From To Ft. in. in.
From To Ft. in. in.
16. SAND/GRAVEL PACK:
Depth Size Material
From 0 To Ft.
From To Ft.
17. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER.
M
IG`.E
�1.LJ GNATURE OF PERSON CONSTRU NG THE WELL Date
original to Division of Water Quality, Groundwater Section within 30 days

i_�=1214
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Ground Water Section
1636 Mail Service Center - Raleigh, N.C. 27699-1636 - Phone [phone]
WELL CONSTRUCTION RECORD WELL CONTRACTOR: Hedden Bros Well Drilling Inc.
WELL CONTRACTOR CERTIFICATION N: 2045
STATE WELL CONSTRUCTION PERMIT a:
1. WELL USE(Check Applicable Box): Residential 0 Municipal ❑ Industrial ❑
Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other,List Use:
Agricultural ❑ Monitoring ❑
2. WELL LOCATION: (Show sketch of the location below)
Nearest Town: Franklin County: Macon
4059 41 St Ave North
(Road Name and Numbers, Community, or Subdivision and Lot No.) DEPTH DRILLING LOG
3. OWNER Paul Thompson From To Formation Description
Address 4059 31St Ave North n RR rlai R gand
(Street or Route No.) 99 250 drat !
Saint Petersburg FL 33713
City or Town State Zip Code
4. DATE DRILLED 11/16/00
5. TOTAL DEPTH 250
6. CUTTINGS COLLECTED YES ❑ NO 0
7. DOES WELL REPLACE EXISTING WELL? YES ❑ NO MI
8. STATIC WATER LEVEL Below Top of Casing: 0 FT.
(Use "+" if Above Top of Casing)
9. TOP OF CASING IS 2 FT. Above Land Surface*
*Top of casingg terminated at/or below land surface requires a variance in accor-
dance with 15A NCAC 2C .0118
10. YIELD (gpm): 20.00 METHOD OF TEST Blow
11. WATER ZONES (depth): ? 15
225
12. CHLORINATION: Type H T H Amount If additional space is n
13. CASING:
Wall Thickness
Depth
Diameter
or Weight/Ft. Material
From _0
To 90
Ft. 6"
p vc
From
To
Ft.
From
To
Ft.
14. GROUT:
Depth
Material
Method
From
0 To 20
Ft. Cement
Poured
From
To
Ft.
15. SCREEN
Depth
From —0 To Ft
From To F
From To F
16. SAND/GRAVEL PACK:
Depth
From 0 To
From To
17 REMARKS:
Diameter Slot Size Material
in. in.
t. in. in.
t. in. in.
Size Material
Ft.
Ft.
LOCATION SKETCH
(Show direction and distance from at least two State
Roads, or other map reference points)
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONST�T.T4,°TMN STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER.
141
FOR OFF EONLY
Quad No.
Serial No.
SIGNATURE OF PERSON CONSTRUCTING THE WELL Date
Submit original to Division of Water Quality, Groundwater Section within 30 days

North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Ground Water Section ti 1216
1636 Mail Service Center - Raleigh, N.C. 27699-1636 - Phone [phone]
WELL CONSTRUCTION RECORD WELL CONTRACTOR: Hedden Bros Well Drilling Inc.
WELL CONTRACTOR CERTIFICATION //: 2047
STATE WELL CONSTRUCTION PERMIT N:
WELL USE(Check Applicable Box): Residential EK Municipal ❑ Industrial ❑
Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other,List Use:
2. WELL LOCATION: (Show sketch of the location below)
Nearest Town: Franklin County: Macon
t" laiidP Ccott Rd R US 64
(Road Name and Numbers, Community, or Subdivision and Lot No.)
3. OWNER Ervin Treadway
Address 267 Brookside Dr
(Street or Route No.)
Franklin NC 28734
City or Town State Zip Code
4. DATE DRILLED 11/21/00
5. TOTAL DEPTH 700
6. CUTTINGS COLLECTED YES ❑ NO FRI
7. DOES WELL REPLACE EXISTING WELL? YES ❑ NO 0
8. STATIC WATER LEVEL Below Top of Casing: 0 FT.
(Use " + " if Above Top of Casing)
9. TOP OF CASING IS 2 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): 1.00 METHOD OF TEST Blow
11. WATER ZONES (depth): 160
12. CHLORINATION: Type H T H Amount
13. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
From 0 To 21 Ft. 6_' _ 198 steel
From 21 To 140 Ft. 6' _ DVC
From To Ft.
14. GROUT:
Depth Material Method
From 0 To 20 Ft. Cement Poured
From To Ft.
15. SCREEN:
Depth Diameter Slot Size Material
DEPTH
From To
Agricultural ❑ Monitoring ❑
DRILLING LOG
Formation Description
If additional space is needed use back t=m r
LOCATION SKETCH
(Show direction and distance from at least two State
Roads, or other map reference points)
From _ 0 To Ft. in. in.
From To Ft. in. in.
From To Ft. in. in.
16. SAND/GRAVEL PACK:
Depth Size Material
From 0 To Ft.
From To Ft.
17. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDAR,6§,AND..THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER.
- Li l�;
IN=_:::=
No, -(/�zq SIGNATURE OF PERSON CONSTRU ING THE WELL Dale
Slpbmit original to Division of Water Quality, Gr?6ndwater Section within 30 days

120726
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Ground Water Section
1636 Mail Service Center - Raleigh, N.C. 27699-1636 - Phone [phone]
WELL CONSTRUCTION RECORD WELL CONTRACTOR: Hedden Bros. Well Drilling Inc.
WELL CONTRACTOR CERTIFICATION #: 2045
STATE WELL CONSTRUCTION PERMIT #:
1. WELL USE(Check Applicable Box): Residential © Municipal ❑ Industrial ❑ Agricultural ❑ Monitoring ❑
Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other,List Use:
2. WELL LOCATION: (Show sketch of the location below)
Nearest Town: Franklin County: Macon
Nic jack Rd
(Road Name and Numbers, Community, or Subdivision and Lot No.) DEPTH DRILLING LOG
3. OWNER Wm "Sonny" Watts From To Formation Description
Address 2785 Lake Silver Rd n 90 clay Rr -and
(Street or Route No.) 90 500 granite
Crestview FL 32536
City or Town State Zip Code _
4. DATE DRILLED 11/07/00 r
5. TOTAL DEPTH 500
6. CUTTINGS COLLECTED YES ❑ NO FX
7. DOES WELL REPLACE EXISTING WELL? YES ❑ NO X❑ 3
8. STATIC WATER LEVEL Below Top of Casing: 0 FT.
(Use "+" if Above Top of Casing)
9. TOP OF CASING IS 2 FT. Above Land Surface*
*Top of casingg terminated at/or below land surface requires a variance in accor-
dance with 15A NCAC 2C .0118
10. YIELD (gpm): 6.00 METHOD OF TEST Blow -
11. WATER ZONES (depth): 365 -
450
12. CHLORINATION: Type H T H
Amount
If additional space is needed use back of form
13. CASING:
Wall Thickness
Depth
Diameter
or Weight/Ft. Material
LOCATION SKETCH
From —0— To 92
Ft. 6"
PVC
(Show direction and distance from at least two State
From To
Ft.
Roads, or other map reference points)
From To
Ft.
14. GROUT:
Depth
Material
Method
From 0 To 20
Ft. Cement
Poured
From To
Ft.
15, SCREEN:
Depth
Diameter Slot Size Material
From —0 To
Ft. in.
in.
From To
Ft. in.
in.
From To
Ft. in.
in.
16. SAND/GRAVEL PACK:
Depth
Size
Material
From 0 To
Ft.
From To
Ft.
17. REMARKS:
I DO HEREBY CERTIFY
FOR OFFICE
Quad No.
Serial No.
CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
)PY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER.
SIG ATURE OF PERSON CONSTRUCTING THE WELL Date
rigini to Division of Water Quality, Groundwater Section within 30 days

220425
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Ground Water Section
1636 Mail Service Center - Raleigh, N.C. 27699-1636 - Phone [phone]
WELL CONSTRUCTION RECORD WELL CONTRACTOR: Hedden Bros Well Drilling Inc.
WELL CONTRACTOR CERTIFICATION N: 2045
STATE WELL CONSTRUCTION PERMIT N:
Box): Residential ❑X Municipal ❑
Industrial ❑ Agricultural ❑ Monitoring ❑
1. WELL USE(Check Applicable
Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other,List Use:
2. WELL LOCATION: (Show sketch of the location below)
Nearest Town: Frankin County: Macon
Hidden Valley-u/o11 #2
(Road Name and Numbers, Community, or Subdivision and Lot No.)
DEPTH DRILLING LOG
3. OWNER Bobby Farley From
To Formation Description
Address 418 Bertt Wood Dr
0 44 day Rr sand
(Street or Route No.)
44 150 granite
Whittier NC 28789
City or Town State Zip Code
4. DATE DRILLED 11/02/00
5. TOTAL DEPTH 150
❑ NO 0
6. CUTTINGS COLLECTED YES
YES ❑ NO
7. DOES WELL REPLACE EXISTING WELL?
8. STATIC WATER LEVEL Below Top of Casing: 0 FT.
(Use " + " if Above Top of Casing)
9. TOP OF CASING IS 2 FT. Above Land Surface*
'Top of casingg terminated at/or below land surface requires a variance in accor-
dance with 15A NCAC 2C .0118
10. YIELD (gpm): 10.00 METHOD OF TEST Blow
11. WATER ZONES (depth): 90
40
12. CHLORINATION: Type H T H Amount
If additional space is needed use back of form
13. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
LOCATION SKETCH
From 0 To 46 Ft. 6 "nyc
(Show direction and distance from at least two State
Roads, or other map reference points)
From To Ft.
From To Ft.
14. GROUT:
Depth Material Method
From 0 To 20 Ft. Cement Poured
From To Ft.
� CD
15. SCREEN:
�7
Depth Diameter Slot Size Material
From 0 To Ft. in. in.From
To_ Ft. in. in.
:7� -
From To Ft. in. in.
_. '-
16. SAND/GRAVEL PACK:
-
Depth Size Material
o :J
From 0 To Ft.
From To Ft.
17. REMARKS:
IDO HEREBY
FOR OFFICE USE
Quad No.
Serial No.
S CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
A A M Y OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER.
—I'A—e
TURE OF PERSON CONSTRUCTING THE WELL Date
urinal to Division of Water Quality, Groundwater Section within 30 days

220426
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Ground Water Section
1636 Mail Service Center - Raleigh, N.C. 27699-1636 - Phone [phone]
WELL CONSTRUCTION RECORD WELL CONTRACTOR: Hedden Bros Well Drilling Inc.
WELL CONTRACTOR CERTIFICATION #: 2045
STATE WELL CONSTRUCTION PERMIT #:
1. WELL USE(Check Applicable Box): Residential ❑X Municipal ❑ Industrial ❑ Agricultural ❑ Monitoring ❑
Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other,List Use:
2. WELL LOCATION: (Show sketch of the location below)
Nearest Town: Franklin County: Macon
Hidden galley Rd
(Road Name and Numbers, Community, or Subdivision and Lot No.) DEPTH DRILLING LOG
3. OWNER Bobby Farley From To Formation Description
Address 418 Bertt Wood Dr Il fin slay & sand
(Street or Route No.) 60 250 ,granite
Whittier NC 28789
City or Town State Zip Code
4. DATE DRILLED 11/02/00
5. TOTAL DEPTH 250
6. CUTTINGS COLLECTED YES ❑ NO F
7. DOES WELL REPLACE EXISTING WELL? YES ❑ NOW
8. STATIC WATER LEVEL Below Top of Casing: 0 FT.
(Use "+" if Above Top of Casing)
9. TOP OF CASING IS 2 FT. Above Land Surface*
*Top of casingg terminated at/or below land surface requires a variance in accor-
dance with 15A NCAC 2C .0118
10. YIELD (gpm): 60.00 METHOD OF TEST B10W
11. WATER ZONES (depth): 245
0
12. CHLORINATION:
Type H T H Amount
13. CASING:
Wall Thickness
Depth
Diameter or Weight/Ft. Material
From _0 To_62
Ft. 611 _ -npvc
From To
Ft.
From To
Ft.
14. GROUT
Depth
Material
Method
From 0 To 20
Ft.
Cement
Poured
From To
Ft.
15.SCREEN:
Depth
Diameter Slot Size
Material
From 0 To
Ft.
in.
in.
From To_
Ft.
in.
in.
From To
Ft.
in.
in.
16. SAND/GRAVEL PACK:
Depth
Size
Material
From 0 To
Ft.
From To
Ft.
17. REMARKS:
I DO HEREBY CE
CONSTRUCTION
FOR OFFICE USE
Quad No.
Serial No.
If additional space is needed use back of form
LOCATION SKETCH
(Show direction and distance from at least two State
Roads, or other map reference points)
MT UIAQ NSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
T OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER.
�&
URE OF PERSON CONSTRUCTING THE WELL Date
finalt Division of Water Quality, Groundwater Section within 30 days

North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Ground Water Section /
1636 Mail Service Center - Raleigh, N.C. 27699-1636 - Phone [phone] t • " V J 4
WELL CONSTRUCTION RECORD WELL CONTRACTOR: Hedden Bros. Well Drilling Inc.
WELL CONTRACTOR CERTIFICATION #: 2045
STATE WELL CONSTRUCTION PERMIT #:
I. WELL USE(Check Applicable Box): Residential IM Municipal ❑ Industrial ❑ Agricultural ❑ Monitoring ❑
Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other,List Use:
2. WELL LOCATION: (Show sketch of the location below)
Nearest Town: Franklin County: Macon
120 Anderson Crk Rd
(Road Name and Numbers, Community, or Subdivision and Lot No.) DEPTH DRILLING LOG
3. OWNER Norman Green From To Formation Description
Address 120 Anderson Crk Rd n ?R clay & cnnd
(Street or Route No.) 28 300 granite
Franklin NC 28734
City or Town State Zip Code
4. DATE DRILLED 10/16/00
5. TOTAL DEPTH 300
6. CUTTINGS COLLECTED YES ❑ NO 0
7. DOES WELL REPLACE EXISTING WELL? YES ❑ NO
8. STATIC WATER LEVEL Below Top of Casing: 0 FT.
(Use "+" if Above Top of Casing)
9. TOP OF CASING IS 2 FT. Above Land Surface*
*Top of casingg terminated at/or below land surface requires a variance in accor-
dance with 15A NCAC 2C .0118
10. YIELD (gpm): 6.00 METHOD OF TEST B10W
11. WATER ZONES (depth): 1405
12. CHLORINATION: Type H T H Amount If additional space is needed use back of form
13. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material LOCATION SKETCH
From 0 To_.'30 Ft. 6„ nyc (Show direction and distance from at least two State
From To Ft. Roads, or other map reference points)
From To Ft.
14. GROUT:
Depth Material Method
From 0 To 20 Ft. Cement Poured
From To Ft.
15.SCREEN:
Depth
From _ 0 To
From To
From To
16. SAND/GRAVEL PACK:
Depth
From 0 To_
From To
Diameter Slot Size Material
Ft.
in.
in.
Ft.
in.
in.
Ft.
in.
in.
Ft.
Ft.
Size Material
CD
GJ
w
CD
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
Quad No.
Serial No.
I SIGNATURE OF PERSON CONSTRUCTING THE WELL Date
original to Division of Water Quality, Groundwater Section within 30 days

North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Ground Water Section - 1636 Mail Service Center - Raleigh, N.C. 27699-1636 - Phone [phone] • U04 1
WELL CONSTRUCTION RECORD WELL CONTRACTOR: Hedden Bros. Well Drilling Inc.
WELL CONTRACTOR CERTIFICATION #: 2045
STATE WELL CONSTRUCTION PERMIT #:
1. WELL USE(Check Applicable Box): Residential 0 Municipal ❑ Industrial Agricultural ❑ Monitoring El
RecoveryEl Heat Pump Water Injection 0 Other ❑ If Other, List Use:
2. WELL LOCATION: (Show sketch of the location below)
Nearest Town: Franklin County: Macon
28N Mc oy BrltigP
(Road Name and Numbers, Community, or Subdivision and Lot No.) DEPTH
3. OWNER Hoop Tebault From To
Address 170 San Marco Ave f) 52
(Street or Route No.) 57 135
Saint Augustine FL 32084
City or Town State Zip Code
4. DATE DRILLED 10/17/00
5. TOTAL DEPTH 135
6. CUTTINGS COLLECTED YES E NO
7. DOES WELL REPLACE EXISTING WELL? YES ❑ NO F
8. STATIC WATER LEVEL Below Top of Casing: 0 FT.
(Use "+" if Above Top of Casing)
9. TOP OF CASING IS 2 FT. Above Land Surface*
*Top of casingg terminated at/or below land surface requires a variance in accor-
dance with 15A NCAC 2C .0118
10. YIELD (gpm): 80.00 METHOD OF TEST Blow
11. WATER ZONES (depth): 119
135
12. CHLORINATION: Type H T H
Amount
13. CASING:
Wall Thickness
Depth Diameter
or Weight/Ft. Material
From -- To 21Ft. 6 '
188 Steel
From21 To 54 FL U'_
DVc
From To Ft.
14. GROUT:
Depth Material
Method
From 0 To 20 Ft. Cement
Poured
From To Ft.
15.SCREEN:
Depth Diameter Slot Size Material
From — 0 To Ft. _
From To Ft.
From To Ft. _
16. SAND/GRAVEL PACK:
Depth
From 0 To Ft.
From To Ft.
DRILLING LOG
Formation Description
(-,]By & -and
granite
If additional space is needed use back of form
LOCATION SKETCH
(Show direction and distance from at least two State
Roads, or other map reference points)
0
C
in. in.
in. in. ci
in. in. CD
91
Size Material
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
Quad No.
Serial No.
%SIGNATURE OF PERSON CONSTRUCTING THE WELL Date
original to Division of Water Quality, Groundwater Section within 30 days

1.
,, W
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Ground Water Section ,:
1636 Mail Service Center - Raleigh, N.C. 27699-1636 - Phone [phone]
WELL CONSTRUCTION RECORD WELL CONTRACTOR: Hedden Bros. Well Drilling Inc.
WELL CONTRACTOR CERTIFICATION #: 2043
STATE WELL CONSTRUCTION PERMIT #:
1. WELL USE(Check Applicable Box): Residential M Municipal ❑ Industrial ❑ Agricultural ❑ Monitoring ❑
Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other,List Use:
2, WELL LOCATION: (Show sketch of the location below)
Nearest Town: Franklin County: Macon
Valley View Rd --Well #2
(Road Name and Numbers, Community, or Subdivision and Lot No.) DEPTH DRILLING LOG
3. OWNER Johnny Cloer From To Formation Description
Address 165 Louisa Chapel Rd n 96 ('13)l & caDd
(Street or Route No.) 16 200 , g nite
Franklin NC 28734
City or Town State Zip Code
4. DATE DRILLED 10/23/00
5. TOTAL DEPTH 200
6. CUTTINGS COLLECTED YES ❑ NO FV
7. DOES WELL REPLACE EXISTING WELL? YES ❑ NO 0
8. STATIC WATER LEVEL Below Top of Casing: 0 FT.
(Use "+" if Above Top of Casing)
9. TOP OF CASING IS 2 FT. Above Land Surface*
*Top of casingg terminated at/or below land surface requires a variance in accor-
dance with MA NCAC 2C .0118
10. YIELD (gpm): 12.00 METHOD OF TEST Blow
11. WATER ZONES (depth): 75
145
12, CHLORINATION: Type H T H Amount If additional space is needed use back of form
13. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material LOCATION SKETCH
From 0 _ Tom$__ Ft. 6" -188 steel— (Show direction and distance from at least two State
From To Ft. Roads, or other map reference points)
From To Ft.
14. GROUT:
Depth Material Method
From 0 To 20 Ft. Cement Poured
From To Ft. CD '
15. SCREEN:
Depth Diameter Slot Size Material
,l
From _ 0 To Ft. in. in. u
From To Ft. in. in. —
From To Ft. in. in. --' �.,--
E5
16.SAND/GRAVEL PACK: �>
Depth Size Material
From _ 0 To FL
From To Ft.
17. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER.
FOR OFFICE USE ONLY
Quad No.
Serial No. SIGNATURE OF PERSON CONSTRUCTING THE WELL Date
Submit original to Division of Water Quality, Groundwater Section within 30 days

North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Ground Water Section ,
1636 Mail Service Center - Raleigh, N.C. 27699-1636 - Phone [phone] • - •� li (f 4 II
WELL CONSTRUCTION RECORD WELL CONTRACTOR: Hedden Bros. Well Dr iniz Inc.
WELL CONTRACTOR CERTIFICATION N: 2043
STATE WELL CONSTRUCTION PERMIT #:
1. WELL USE(Check Applicable Box): Residential 0 Municipal ❑ Industrial ❑ Agricultural ❑ Monitoring ❑
Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other,List Use:
2. WELL LOCATION: (Show sketch of the location below)
Nearest Town: Highlands County: Macon
Holt Rd -Tract 1
(Road Name and Numbers, Community, or Subdivision and Lot No.) DEPTH DRILLING LOG
3. OWNER David Bock From To Formation Description
Address 915 Greyfield Place 0 28 riny Rr sand
(Street or Route No.) 29 800 granite
Atlanta GA 30328
City or Town State Zip Code
4. DATE DRILLED 10/19/00
5. TOTAL DEPTH 800
6. CUTTINGS COLLECTED YES ❑ NO ❑X
7. DOES WELL REPLACE EXISTING WELL? YES ❑ NO 0
8. STATIC WATER LEVEL Below Top of Casing: 0 FT.
(Use " + " if Above Top of Casing)
9. TOP OF CASING IS 2 FT. Above Land Surface*
*Top of casingg terminated at/or below land surface requires a variance in accor-
dance with 15A NCAC 2C .0118
10. YIELD (gpm): 1.00 METHOD OF TEST Blow
11. WATER ZONES (depth): 960
0
12. CHLORINATION: Type H T H Amount If additional space is needed use back of form
13. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material LOCATION SKETCH
From �_ To '30 Ft. 6_' nvc (Show direction and distance from at least two State
From To Ft. Roads, or other map reference points)
From To' Ft.
14. GROUT
Depth Material Method
From 0 To 20 Ft. Cement Poured O
-
From To Ft.
15.SCREEN:
..
Depth Diameter Slot Size Material , I
From -- To Ft. in. in.
i
From To Ft. in. in. -'
-
From To Ft. in. in.
16, SAND/GRAVEL PACK: rT
f,
Depth Size Material
From 0 To Ft.
From To FL
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 HAS BEEN PROVIDED TO THE WELL OWNER.
nRECORD
FOR OFFICE USE ONLY �
/1[ec:., CGS hi19-
ao
/Z�c�y
Quad No.
Serial No. SIGNATURE OF PERSON CONSTRUCTING THE WELL
Date
Submit original to Division of Water Quality, Groundwater Section within 30 days

North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Ground Water Section `" " lJ U `f 6
1636 Mail Service Center - Raleigh, N.C. 27699-1636 - Phone [phone]
WELL CONSTRUCTION RECORD WELL CONTRACTOR: Hedden Bros. Well Drilling Inc.
WELL CONTRACTOR CERTIFICATION N: 2043
STATE WELL CONSTRUCTION PERMIT Y:
1. WELL USE(Check Applicable Box): Residential E Municipal ❑ Industrial ❑ Agricultural ❑ Monitoring ❑
Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other,List Use:
2. WELL LOCATION: (Show sketch of the location below)
Nearest Town: Highlands county: Macon
325 Nall Farm Rd
(Road Name and Numbers, Community, or Subdivision and Lot No.) DEPTH DRILLING LOG
3. OWNER Hugh Harper From To Formation Description
Address 325 Nall Farm Rd. O is rjny & sand
.(Street or Route No.) j $ inn granite
Highlands NC 28741
City or Town State Zip Code
4. DATE DRILLED 10/19/00
5. TOTAL DEPTH 300
6. CUTTINGS COLLECTED YES ❑ NO 0
7. DOES WELL REPLACE EXISTING WELL? YES ❑ NO
8. STATIC WATER LEVEL Below Top of Casing: 0 FT.
(Use "+" if Above Top of Casing)
9. TOP OF CASING IS 2 FT. Above Land Surface*
*Top of casingg terminated at/or below land surface requires a variance in accor-
dance with 15A NCAC 2C .0118
10. YIELD (gpm): 4.00 METHOD OF TEST Blow
11. WATER ZONES (depth): O
12. CHLORINATION: Type H T H Amount If additional space is needed use back of form
13. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material LOCATION SKETCH
From —0 To ?0 Ft. 6" nrve Show direction and distance from at least two State
From To Ft. Roads, or other map reference points)
From To Ft.
14. GROUT:
Depth Material Method
From 0 To 20 Ft. Cement Poured
From To Ft. o .-..
15. SCREEN:
Depth Diameter Slot Size Material
From 0 To Ft. in. in. I
W
From To Ft. in. in.
From To Ft. in. in.
16. SAND/GRAVEL PACK: o
Depth Size Material O `--;
From 0 To Ft.
From To Ft.
17. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER.
FOR OFFICE USE ONLY as �
Quad No.
Serial No. SIGNATURE OF PERSON CONSTRUCTING THE WELL Date
Submit original to Division of Water Quality, Groundwater Section within 30 days

",207ls
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Ground Water Section
1636 Mail Service Center - Raleigh, N.C. 27699-1636 - Phone [phone]
WELL CONSTRUCTION RECORD WELL CONTRACTOR: Hedden Bros. Well Drilling Inc.
WELL CONTRACTOR CERTIFICATION #: 2043
STATE WELL CONSTRUCTION PERMIT #:
Applicable Box): Residential 0 Municipal ❑
Industrial ❑ Agricultural ❑ Monitoring ❑
1. WELL USE(Check
Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other,List Use:
2. WELL LOCATION: (Show sketch of the location below)
Nearest Town: Highlands County: Macon
Turtle Pond Rd
(Road Name and Numbers, Community, or Subdivision and Lot No.)
DEPTH DRILLING LOG
3. OWNER Highlands Camp & Conference Center From
To Formation Description
Address P O Box 1299
0 59 rJaV Rr ,;and
(Street or Route No.) 59
500 granite
Highlands NC 28741
City or Town State Zip Code
4. DATE DRILLED 10/27/00
5. TOTAL DEPTH 500
❑ NON
6. CUTTINGS COLLECTED YES
YES ❑ NO X❑
7. DOES WELL REPLACE EXISTING WELL?
8. STATIC WATER LEVEL Below Top of Casing: 0 FT.
r�
(Use "+" if Above Top of Casing)
9. TOP OF CASING IS 2 FT. Above Land Surface*
o
*Top of casingg terminated at/or below land surface requires a variance in accor-
dance with IA NCAC 2C .0118
IO. YIELD (gpm): 30.00 METHOD OF TEST Blow
I
11. WATER ZONES (depth): 40
—0
12. CHLORINATION: Type H T H Amount
N
If additional space is needed use back ofform c,
13. CASING: Wall Thickness
— —
Depth Diameter or Weight/Ft. Material
LOCATION SKETCH
From 0 To 60_ Ft. _(' _ i vc
(Show direction and distance from at least two State
_
From To Ft.
Roads, or other map reference points)
From To Ft.
14. GROUT:
Depth Material Method
From 0 To 20 Ft. Cement Poured
From To Ft.
15.SCREEN:
Depth Diameter Slot Size Material
From —0 To Ft. in. in.
From To Ft. in. in.
From To Ft. in. in.
16. SAND/GRAVEL PACK:
Depth Size Material
From 0 To Ft.
From To Ft.
17. REMARKS:
I DO HERE I T A TSE AS CONSTRUCTED IN
ACCORDANCE WITH 15A NCAC 2C, WELL
run cTutrr lfi —Xrl 1$ ?.A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER.
FOR OFFICE
Quad No.
Serial No. IGNATURE OF PERSON CONSTRUCTING THE WELL Date
inal to Division of Water Quality, Groundwater Section within 30 days

North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Ground Water Section
1636 Mail Service Center - Raleigh, N.C. 27699-1636 - Phone [phone]
WELL CONSTRUCTION RECORD WELL CONTRACTOR: Hedden Bros. Well Drilling Inc.
WELL CONTRACTOR CERTIFICATION #: 2043
STATE WELL CONSTRUCTION PERMIT #:
1. WELL USE(Check Applicable Box): Residential IX Municipal ❑ Industrial ❑ Agricultural ❑ Monitoring ❑
Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other,List Use:
2. WELL LOCATION: (Show sketch of the location below)
Nearest Town: Highlands County: Macon
212 Rhodey Lane
(Road Name and Numbers, Community, or Subdivision and Lot No.) DEPTH DRILLING LOG
3. OWNER Margret Meeter From To Formation Description
Address 212 Rhodey Lane O 114 c2)4 Rr sand
(Street or Route No.) 114 825 granite
Highlands NC 28741
City or Town State Zip Code
4. DATE DRILLED 10/05/00
5. TOTAL DEPTH 825
6. CUTTINGS COLLECTED YES ❑ NO ❑X
7. DOES WELL REPLACE EXISTING WELL? YES ❑ NO 7
S. STATIC WATER LEVEL Below Top of Casing: 0 FT.
(Use " + " if Above Top of Casing) O --
9. TOP OF CASING IS 2 FT. Above Land Surface* c�
*Top of casingg terminated at/or below land surface requires a variance in accor-
dance with ISA NCAC 2C .0118
10. YIELD (gpm): 80.00 METHOD OF TEST Blow
11. WATER ZONES (depth): 825 = -
0
12. CHLORINATION: Type H T H Amount If dd'i I d d b k-'
13. CASING: wall Thickness
Depth Diameter or Weight/Ft. Material
From 0 To 21_ Ft. 6 188 steel
2
From 1— To 116 Ft. 6" 12VC
From To Ft.
14, GROUT:
Depth Material Method
From 0 To 20 Ft. Cement Poured
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.
a Ilona space rs nee a use ac o(drm .
LOCATION SKETCH
(Show direction and distance fr -
Roads, or other map reference
16, SAND/GRAVEL PACK:
Depth Size Material
From 0 To Ft.
From To Ft.
17. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER.
FOR OFFICE USE ONLYii� � ,.o /� _ 0$
Quad No. Ll��"
Serial No. SIGNATURE OF PERSON CONSTRUCTING THE WELL Date
Submit original to Division of Water Quality, Groundwater Section within 30 days

North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Ground Water Section ) Lj �] S
1636 Mail Service Center - Raleigh, N.C. 27699-1636 - Phone [phone]
WELL CONSTRUCTION RECORD WELL CONTRACTOR: Hedden Bros. Well Drilling Inc.
WELL CONTRACTOR CERTIFICATION k: 2043
STATE WELL CONSTRUCTION PERMIT N:
1. WELL USE(Check Applicable Box): Residential ER Municipal ❑ Industrial ❑ Agricultural ❑ Monitoring ❑
Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other,List Use:
2. WELL LOCATION: (Show sketch of the location below)
Nearest Town: Highlands County: Macon
Pine Crk-Strawberry Hill
(Road Name and Numbers, Community, or Subdivision and Lot No.)
3. OWNER Daniel & Lorri Ouinn
Address P O Box 1273
(Street or Route No.)
Highlands NC 28741
City or Town State Zip Code
4. DATE DRILLED 10/09/00
5. TOTAL DEPTH 700
6. CUTTINGS COLLECTED YES ❑ NO F
7. DOES WELL REPLACE EXISTING WELL? YES ❑ NO F
8. STATIC WATER LEVEL Below Top of Casing: 0 FT.
(Use "+" if Above Top of Casing)
9. TOP OF CASING IS 2 FT. Above Land Surface*
*Top of casingg terminated at/or below land surface requires a variance in accor-
dance with 15A NCAC 2C .0118
10. YIELD (gpm): 4.00 METHOD OF TEST Blow
11. WATER ZONES (depth): 530
12. CHLORINATION: Type H T H Amount
13. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
From 0 To 2] Ft. 6' .188 steel
From 2_ Tom Ft.6' PVC
From To Ft.
14. GROUT:
Depth Material Method
From 0 To 20 Ft. Cement Poured
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 0 To Ft.
From To Ft.
DEPTH
From To
DRILLING LOG
Formation Description
C:)
Ea
C-)
C�
N
C.J
If additional space is needed use back of form
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 OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER.
FOR OFFICE USE ONLY /�J
Quad No. � " C�J /O-U' %-OD
Serial No. SIGNATURE OF PERSON CONSTRUCTING THE WELL Date
Submit original to Division of Water Quality, Groundwater Section within 30 days

North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Ground Water Sectiod- U U 4 5
1636 Mail Service Center - Raleigh, N.C. 27699-1636 - Phone [phone]
WELL CONSTRUCTION RECORD WELL CONTRACTOR: Hedden Bros. Well Drilling Inc.
WELL CONTRACTOR CERTIFICATION k: 2043
STATE WELL CONSTRUCTION PERMIT N:
1. WELL USE(Check Applicable Box): Residential FX1 Municipal ❑ Industrial ❑ Agricultural ❑ Monitoring ❑
Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other,List Use:
2. WELL LOCATION: (Show sketch of the location below)
Nearest Town: Franklin County: Macon
3260 Ellijay Rd
(Road Name and Numbers, Community, or Subdivision and Lot No.) DEPTH DRILLING LOG
3. OWNER _Troy Rogers From To Formation Description
Address 3260 Ellijay Rd O 96 slay Rr sand
(Street or Route No.) 46 250 granite
Franklin NC 28734
City or Town State Zip Code
4. DATE DRILLED 10/23/00
5. TOTAL DEPTH 250
6. CUTTINGS COLLECTED YES ❑ No FM
7. DOES WELL REPLACE EXISTING WELL? YES ❑ NO 0
8. STATIC WATER LEVEL Below Top of Casing: 0 FT.
(Use " + " if Above Top of Casing)
9. TOP OF CASING IS 2 FT. Above Land Surface*
*Top of casingg terminated at/or below land surface requires a variance in accor-
dance with ISA NCAC 2C .0118
10. YIELD (gpm): 4.00 METHOD OF TEST Blow
11. WATER ZONES (depth): 230
0
12. CHLORINATION: Type H T H Amount If additional space is needed use back of form
13. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material LOCATION SKETCH
From 0 To IS Ft. 61, Steel (Show direction and distance from at least two State
From To Ft. Roads, or other map reference points)
From To Ft.
14. GROUT:
Depth Material Method
From 0 To 20 Ft. Cement Poured
From To Ft. C,
15.SCREEN:
Depth Diameter Slot Size Material -
From _ 0 To Ft. in. in. - -
From To Ft. in. in.
From To Ft. in. in.
16. SAND/GRAVEL PACK: p._.
Depth Size Material-
o
From 0 To Ft. 4v
From To FL
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 ,�j f. .C1LZGiso — 49 _ 2.3 - e70
Quad No.
Serial No. SIGNATURE OF PERSON CONSTRUCTING THE WELL Date
Submit original to Division of Water Quality, Groundwater Section within 30 days

01044
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Ground Water Section
1636 Mail Service Center - Raleigh, N.C. 27699-1636 - Phone [phone]
WELL CONSTRUCTION RECORD WELL CONTRACTOR: Hedden Bros. Well Drilling Inc.
WELL CONTRACTOR CERTIFICATION #: 2045
STATE WELL CONSTRUCTION PERMIT #:
1. WELL USE(Check Applicable Box): Residential 0 Municipal ❑ Industrial ❑
Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other,List Use:
Agricultural ❑ Monitoring ❑
2. WELL LOCATION: (Show sketch of the location below)
Nearest Town: Franklin County: Macon
225 Trillium Tail
(Road Name and Numbers, Community, or Subdivision and Lot No.) DEPTH DRILLING LOG
3. OWNER Wane & Ester Siebert From To Formation Description
Address 225 Trillium Tail n Rfi rizy Rr SaDd
(Street or Route No.) 86 550 granite.
Franklin NC 28734
City or Town State Zip Code
4. DATE DRILLED 10/23/00
5. TOTAL DEPTH 550
6. CUTTINGS COLLECTED YES ❑ NO N
7. DOES WELL REPLACE EXISTING WELL? YES ❑ NO 0
8. STATIC WATER LEVEL Below Top of Casing: 0 FT.
(Use "+" if Above Top of Casing)
9. TOP OF CASING IS 2 FT. Above Land Surface*
*Top of cast ngg terminated actor below land surface requires a variance in accor-
dance with 15A NCAC 2C .0118
10. YIELD (gpm): 15.00 METHOD OF TEST Blow
11. WATER ZONES (depth): 50
12. CHLORINATION: Type H T H
Amount
If additional space is needed use back of form
13. CASING:
Wall Thickness
Depth
Diameter
or Weight/Ft. Material
LOCATION SKETCH
From 0 To gR_
Ft. _6 '
pyc
(Show direction and distance from at least two State
—
Ft.
Roads, or other map reference points)
From To
From To
Ft.
14. GROUT:
Depth
Material
Method
From 0 To 20
Ft. Cement
Poured
o
From To
Ft.
—
r
15. SCREEN:=
Depth
Diameter Slot
Size Material
I _-
:_J
From n To
Ft. in.
in.
From To
Ft. in.
in.
From To
Ft. in.
in.
16. SAND/GRAVEL PACK:
co -'
Depth
Size
Material
es�
From 0 To
Ft.
From To
Ft.
17. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER.
FOR OFFICE USE ONLY l0 ,-ozj
Quad No.
Serial No. NATURE OF PERSON CONSTRUCTING THE WELL Date
Submit iginal to Division of Water Quality, Groundwater Section within 30 days

�20718
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Ground Water Section
1636 Mail Service Center - Raleigh, N.C. 27699-1636 - Phone [phone]
WELL CONSTRUCTION RECORD WELL CONTRACTOR: Hedden Bros. Well Drilling Inc.
WELL CONTRACTOR CERTIFICATION #: 2043
STATE WELL CONSTRUCTION PERMIT #:
1. WELL USE(Check Applicable Box): Residential IM Municipal ❑ Industrial ❑ Agricultural ❑ Monitoring ❑
Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other,List Use:
2. WELL LOCATION: (Show sketch of the location below)
Nearest Town: Scaly Mtn County: Macon
Highland Gan
(Road Name and Numbers, Community, or Subdivision and Lot No.) DEPTH DRILLING LOG
3. OWNER Scott Bell From To Formation Description
Address 1847 Hickory Hill Rd n 54 clay At sand
(Street or Route No.) 54 500 ,granite
Argyle TX 76226
City or Town State Zip Code
4. DATE DRILLED 10/30/00
5. TOTAL DEPTH 500 .-.
6. CUTTINGS COLLECTED YES ❑ NO 0
7. DOES WELL REPLACE EXISTING WELL? YES ❑ NO X❑ o
8. STATIC WATER LEVEL Below Top of Casing: 0 FT. 7M -
(Use "+" if Above Top of Casing) _
9. TOP OF CASING IS 2 FT. Above Land Surface*
*Top of casingg terminated at/or below land surface requires a variance in accor-
dance with 15A NCAC 2C .0118
10. YIELD (gpm): 20.00 METHOD OF TEST Blow - - - -
11. WATER ZONES (depth): 465 tv
0
12. CHLORINATION: Type H T H Amount If additional space is needed use back of form
13. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
LOCATION SKETCH
From - To 56 Ft. 6. nyc (Show direction and distance from at least two State
From To Ft. Roads, or other map reference points)
From To Ft.
14. GROUT:
Depth Material Method
From 0 To 20 Ft. cement Poured
From To Ft.
15.SCREEN:
Depth
From _ 0 To
From To
From To
16. SAND/GRAVEL PACK:
Depth
From 0 To
Diameter Slot Size Material
Ft. in.
in.
Ft. in.
in.
Ft, in.
in.
Ft.
Size Material
From To Ft.
17. REMARKS:
I DO HEREBY CE IFY T L v'rFr r WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCT T ItRES`Aj,':COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER.
FOR OFFICE U Y
Quad No. O 30 00
Serial No. WWISI NATURE OF PERSON CONSTRUCTING THE WELL Date
origi al to Division of Water Quality, Groundwater Section within 30 days

0721
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Ground Water Section
1636 Mail Service Center - Raleigh, N.C. 27699-1636 - Phone [phone]
WELL CONSTRUCTION RECORD WELL CONTRACTOR: Hedden Bros. Well Drilling Inc.
WELL CONTRACTOR CERTIFICATION #: 2043
STATE WELL CONSTRUCTION PERMIT #:
1. WELL USE(Check Applicable Box): Residential ® Municipal ❑ Industrial ❑ Agricultural ❑ Monitoring ❑
Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other,List Use:
2. WELL LOCATION: (Show sketch of the location below)
Nearest Town: Franklin County: Macon
Clyde Kincland Mtn
(Road Name and Numbers, Community, or Subdivision and Lot No.) DEPTH DRILLING LOG
3. OWNER B.A. Miller From To Formation Description
Address P O Drawer 726 () 33 rla� R canri
(Street or Route No.) i3 600ianite
Highlands IN 28741
City or Town State Zip Code
4. DATE DRILLED 10/25/00
5. TOTAL DEPTH 600
6. CUTTINGS COLLECTED YES ❑ NON
7. DOES WELL REPLACE EXISTING WELL? YES ❑ NO X❑
8. STATIC WATER LEVEL Below Top of Casing: 0 FT.
(Use "+" if Above Top of Casing)
9. TOP OF CASING IS 2 FT. Above Land Surface*
'Top of casing terminated at/or below land surface requires a variance in accor-
dance with 157A NCAC 2C .0118
10. YIELD (gpm): 20.00 METHOD OF TEST Blow
11. WATER ZONES (depth): 0
CD
-
—J
12. CHLORINATION: Type H T H Amount If additional space is needed use back of form `
13. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material LOCATION SKETCH
From —0 To 35 Ft. 6" PVC (Show direction and distance from at least two State
From To Ft. Roads, or other map reference points)
From To Ft.
14. GROUT:
Depth Material Method
From 0 To 20 Ft. Cement Poured
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 0 To Ft.
From To Ft.
17. REMARKS:
I DO HEREBY I T Tpil$y, L WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCT11 A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER.
FOR OFFICE US Y U�_ a - � /Q - �, • 00
Quad No.
Serial No. C.,.SI NATURE OF PERSON CONSTRUCTING THE WELL Date
WOW $BCfiW 1nit origi I to Division of Water Quality, Groundwater Section within 30 days

North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Ground Water Section 0
1636 Mail Service Center - Raleigh, N.C. 27699-1636 - Phone [phone] i. i7 �
WELL CONSTRUCTION RECORD WELL CONTRACTOR: Hedden Bros Well Drilling Inc.
WELL CONTRACTOR CERTIFICATION X: 2045
STATE WELL CONSTRUCTION PERMIT N:
1. WELL USE(Check Applicable Box): Residential FRI Municipal ❑ Industrial ❑ Agricultural ❑ Monitoring ❑
Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other,List Use:
2. WELL LOCATION: (Show sketch of the location below)
Nearest Town: Franklin County: Macon
2586 Ruby Mine Rd
(Road Name and Numbers, Community, or Subdivision and Lot No.) DEPTH
3. OWNER Effie McCracken From To
Address 2586 Ruby Mine Rd O 61
(Street or Route No.) 61 200
Franklin NC 28734
Ciiy or Town State Zip Code
4. DATE DRILLED 10/11/00
5. TOTAL DEPTH 200
6. CUTTINGS COLLECTED YES ❑ NO FRI
7, DOES WELL REPLACE EXISTING WELL? YES ❑ NO
8, STATIC WATER LEVEL Below Top of Casing: 0 FT.
(Use "+" if Above Top of Casing)
9. TOP OF CASING IS 2 FT. Above Land Surface*
*Top of casing gg terminated at/or below land surface requires a variance in accor-
dance with 15A NCAC 2C .0118
10. YIELD (gpm): 20.00 METHOD OF TEST Blow
11. WATER ZONES (depth): O
DRILLING LOG
Formation Description
clay R sand
granite
12. CHLORINATION: Type H T H Amount If additional space is needed use back SUPorm o
13. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
From _0 To 21 Ft. 6 ' _ 199 Steel
From 21 To_63 Ft. 6„ nvc
From To Ft.
14. GROUT
Depth
Material
Method
From 0 To 20
Ft.
Cement
Poured
From To
Ft.
15.SCREEN:
Depth
Diameter Slot Size
Material
From _ 0 To
Ft.
in.
in.
From To
Ft.
in.
in.
From To
Ft.
in.
in.
16. SAND/GRAVEL PACK:
Depth
Size
Material
From 0 To
Ft.
From To
Ft.
17. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER.
LOCATION SKETCH
(Show direction and distance from at least two State
Roads, or other map reference points)
FOR OFFICE USE ONLY
Quad No.
Serial No.
SIGNATURE OF PERSON CONSTRUCTING THE WELL Date
original to Division of Water Quality, Groundwater Section within 30 days

North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Ground Water Section
1636 Mail Service Center - Raleigh, N.C. 27699-1636 - Phone [phone]
WELL CONSTRUCTION RECORD WELL CONTRACTOR: Hedden Bros. Well Drilling Inc. v
WELL CONTRACTOR CERTIFICATION k: 2045
STATE WELL CONSTRUCTION PERMIT #:
1. WELL USE(Check Applicable Box): Residential [XI Municipal ❑ Industrial ❑
Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other,List Use:
Agricultural ❑ Monitoring ❑
2. WELL LOCATION: (Show sketch of the location below)
Nearest Town: Franklin County: Macon
2319 Rabbit Crk Rd
(Road Name and Numbers, Community, or Subdivision and Lot No.) DEPTH
3. OWNER Shirley Waldroop From To
Address 2319 Rabbit Crk Rd n 81
(Street or Route No.) R 1 250
Franklin NC 28734
City or Town State Zip Code
4. DATE: DRILLED 10/14/00
5. TOTAL DEPTH 250
6, CUTTINGS COLLECTED YES ❑ NO ❑X
7. DOES WELL REPLACE EXISTING WELL? YES ❑ NO 0
8. STATIC WATER LEVEL Below Top of Casing: 0 FT.
(Use " + " if Above Top of Casing)
9. TOP OF CASING IS 2 FT. Above Land Surface*
*Top of casingg terminated at/or below land surface requires a variance in accor-
dance with 15A NCAC 2C .0118
10. YIELD (gpm): 12.00 METHOD OF TEST Blow
11. WATER ZONES (depth): 140
0
DRILLING LOG
Formation Description
CI AY & .SAND
GRANITE.
12. CHLORINATION: Type H T H Amount If additional space is needed use back of form
13. CASLVG: Wall Thickness
Depth Diameter or Weight/Ft. Material
From 0 To 21 Ft.6" 189 STF.F.I.
From 21 To 83 Ft.6" PVC
From To Ft.
14. GROUT:
Depth Material Method
From 0 To 20 Ft. Cement Poured
From To Ft.
15. SCREEN
Depth
From 0 _ To
From To
From To
16. SAND/GRAVEL PACK:
Depth
From 0 To
From To
Diameter Slot Size Material
Ft. in. in.
Ft. in. in.
Ft. in. in.
Ft.
Ft.
Size Material
LOCATION SKETCH
(Show direction and distance from at least two State
Roads, or other map-ov„-^^^a ^^i^'s�
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
Quad No.
Serial No.
ATURE OF PERSON CONSTRUCTING THE WELL Date
to Division of Water Quality, Groundwater Section within 30 days

North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Ground Water Section
1636 Mail Service Center - Raleigh, N.C. 27699-1636 - Phone [phone]
WELL CONSTRUCTION RECORD WELL CONTRACTOR: Hedden Bros. Well Drilling Inc.
WELL CONTRACTOR CERTIFICATION #: 2043
STATE WELL CONSTRUCTION PERMIT #:
I . WELL USE(Check Applicable Box): Residential 191 Municipal ❑ Industrial ❑ Agricultural ❑ Monitoring ❑
Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other,List Use:
2. WELL LOCATION: (Show sketch of the location below)
Nearest Town: Highlands County: Macon
\x ebbiTtont-Highlands
(Road Name and Numbers, Community, or Subdivision and Lot No.) DEPTH DRILLING LOG
3, OWNER Village DeV From To Formation Description
Address PO BOX 769 0 26 Clay Rr SaDd
(Street or Route No.) 26 400 granite
Highlands NC 28141
City or Town State Zip Code
4, DATE DRILLED 09/20/00
5, TOTAL DEPTH 400
6. CUTTINGS COLLECTED YES ❑ NON
7. DOES WELL REPLACE EXISTING WELL? YES ❑ NO M
8. STATIC WATER LEVEL Below Top of Casing: 0 FT.
(Use " + " if Above Top of Casing)
9. TOP OF CASING IS 2 FT. Above Land Surface*
*Top of cast ngg terminated at/or below land surface requires a variance in accor-
dance with 15A NCAC 2C .0118
10. YIELD (gpm): 30.00 METHOD OF TEST Blow
11. WATER ZONES (depth): 0
0
CD
Ln
12. CHLORINATION: Type H T H Amount If additional space is needed use back of form _
13. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material LOCATION SKETCH
From 0 To 28 Ft. 6" .pv_c (Show direction and distance from at least two State
From To Ft. Roads, or other map reference points)
From To Ft.
14. GROUT
Depth
Material
Method
From 0 To 20
Ft.
Cement
Poured
From To
Ft.
15.SCREEN:
Depth
Diameter
Slot Size
Material
From 0 To
Ft.
in.
in.
From To
Ft.
in.
in.
From To
Ft.
in.
in.
16. SAND/GRAVEL PACK:
Depth
Size
Material
From 0 To
Ft.
From To
Ft.
17. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTR A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER.
FOR OFFIC ONLY D� �' ' -�, p -O
Quad No.
Serial No. SIGNATURE OF PERSON CONSTRUCTING THE WELL Date
ubmii orieinal to Division of Water Quality, Groundwater Section within 30 days

North Carolina - Department of Environment and Natural Resources (- Division of Water Quality - Ground Water Section 18416
1636 Mail Service Center - Raleigh, N.C. 27699-1636 - Phone [phone]
WELL CONSTRUCTION RECORD WELL CONTRACTOR: Hedden Bros. Well Drilling Inc.
WELL CONTRACTOR CERTIFICATION #: 2043
STATE WELL CONSTRUCTION PERMIT #:
1. WELL USE(Check Applicable Box): Residential 0 Municipal ❑ Industrial ❑ Agricultural ❑ Monitoring ❑
Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other,List Use:
2
3.
WELL LOCATION: (Show sketch of the location below)
Nearest Town: Highlands County: Macon
8409 Buck Crk Rd
(Road Name and Numbers, Community, or Subdivision and Lot No.) DEPTH
OWNER Rita Houston From To
Address 8409 Buck Crk Rd n I52
(Street or Route No.)
Highlands NC 28741
City or Town State Zip Code
4. DATE DRILLED 09/07/00
5. TOTAL DEPTH 650
6. CUTTINGS COLLECTED YES ❑ NO FRI
7. DOES WELL REPLACE EXISTING WELL? YES ❑ NO
8. STATIC WATER LEVEL Below Top of Casing: 0 FT.
(Use "+" if Above Top of Casing)
9. TOP OF CASING IS 2 FT. Above Land Surface*
*Top of casingg terminated at/or below land surface requires a variance in accor-
dance with 15A NCAC 2C .0118
10. YIELD (gpm): 0.50 METHOD OF TEST Blow
11. WATER ZONES (depth): 00
12. CHLORINATION: Type H T H Amount
13. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
From 0 To 20 Ft. � nvc
From To Ft.
DRILLING LOG
Formation Description
c)
co
O
O
o
-+
J
o
If additional space is needed use back of form
LOCATION SKETCH
(Show direction and distance from at least two State
Roads, or other map reference points)
From To
Ft.
14. GROUT:
Depth
Material
Method
From 0 To 20
Ft. Cement
Poured
From To
Ft.
15. SCREEN:
Depth
Diameter Slot Size Material
From 0 To
Ft. in.
in.
From To
Ft. in.
in.
From To
Ft. in.
in.
16. SAND/GRAVEL PACK:
Depth
Size
Material
From 0 To
Ft.
From To
Ft.
17. REMARKS:
I DO HEREB
MM ((��
HJI' H18 W6L
S CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCT
, AND TH
OPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER.
FOR OFFICE U LYJ
�,
Quad No.
Serial No.
y $�jp�
SI NATURE OF PERSON CONSTRUCTING THE WELL Date
al to Division of Water Quality, Groundwater Section within 30 days

North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Ground Water Section �- .l 8 4 15
1636 Mail Service Center - Raleigh, N.C. 27699-1636 - Phone [phone]
WELL CONSTRUCTION RECORD WELL CONTRACTOR: Hedden Bros Well Drilline Inc.
WELL CONTRACTOR CERTIFICATION #: 2045
STATE WELL CONSTRUCTION PERMIT #:
WELL USE(Check Applicable Box): Residential [M Municipal ❑
Industrial ❑ Agricultural ❑ Monitoring ❑
1.
Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other,List Use:
2. WELL LOCATION: (Show sketch of the location below)
Nearest Town: Franklin County: Macon
538 Popular Cove
(Road Name and Numbers, Community, or Subdivision and Lot No.)
DEPTH DRILLING LOG
3. OWNER Grady Jones From
To Formation Description
Address 538 Popular Cove
0 71 clay Rr sand
(Street or Route No.) 71
150 granite
Franklin NC 28734
City or Town State Zip Code
4. DATE DRILLED 09/07/00
5. TOTAL DEPTH 150
❑ NO ❑X
-�
6. CUTTINGS COLLECTED YES
YES ❑ NO X❑
_
7. DOES WELL REPLACE EXISTING WELL?
"
8. STATIC WATER LEVEL Below Top of Casing: 0 FT.
-
(Use " + " if Above Top of Casing)
^y -
9. TOP OF CASING IS 2 FT. Above Land Surface*
*Top of casingg terminated at/or below land surface requires a variance in actor-
dance with 15A NCAC 2C .0118
10. YIELD (gpm): 30.00 METHOD OF TEST BIOW
E5
11. WATER ZONES (depth): 90
0 -'-
140
--1
12. CHLORINATION: Type H T H Amount
If additional space is needed use back of form
13. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
LOCATION SKETCH
From 0 To ?I Ft. 611 IRS steel
iShow direction and distance from at least two State
From 21 Tom Ft. " PVC
goads, or other map reference points)
From To Ft.
14. GROUT:
Depth Material Method
From 0 To 20 Ft. Cement Poured
From To Ft.
15. SCREEN:
Depth Diameter Slot Size Material
From _0 To Ft. in. in.
From To Ft. in. in.
From To Ft. in. in.
16, SAND/GRAVEL PACK:
Depth Size Material
From 0 To Ft.
From To Ft.
17. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRU I R I R I A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER.
FOR OFFIC ONLY
Quad No.
Serial No. IGNATURE OF PERSON CONSTRUCTING THE WELL Date
S 11 . riginal to Division of Water Quality, Groundwater Section within 30 days

North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Ground Water Section [., 184 14
1636 Mail Service Center - Raleigh, N.C. 27699-1636 - Phone [phone]
WELL CONSTRUCTION RECORD WELL CONTRACTOR: Hedden Bros. Well Drilling Inc.
WELL CONTRACTOR CERTIFICATION #: 2045
STATE WELL CONSTRUCTION PERMIT #:
1. WELL USE(Check Applicable Box): Residential ❑X Municipal ❑ Industrial ❑ Agricultural ❑ Monitoring ❑
Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other,List Use:
2. WELL LOCATION: (Show sketch of the location below)
Nearest Town: Otto County: Macon
2695 Cow tta Church Rd
(Road Name and Numbers. Community, or Subdivision and Lot No.) DEPTH
3. OWNER - Margaret Davis-EZZard From To
Address 2695 Cowetta Church Rd 0 19
(Street or Route No.) Is 500
Otto NC 28763
City or Town State Zip Code
4. DATE DRILLED 09/13/00
5. TOTAL DEPTH 500
6. CUTTINGS COLLECTED YES ❑ NO 0
7. DOES WELL REPLACE EXISTING WELL? YES ❑ NO
8. STATIC WATER LEVEL Below Top of Casing: 0 FT.
(Use " + " if Above Top of Casing)
9. TOP OF CASING IS 2 FT. Above Land Surface*
*Top of cast ngg terminated at/or below land surface requires a variance in accor-
dance with 15A NCAC 2C .0118
10. YIELD (gpm): 2.00 METHOD OF TEST Blow
11. WATER ZONES (depth): 0
DRILLING LOG
Formation Description
clay k sand
granite
� L>
12. CHLORINATION: Type H T H
Amount
If additional space is needed use back of form
13. CASING:
Wall Thickness
Depth
Diameter
or Weight/Ft. Material
LOCATION SKETCH
From �_ To 20
Ft. 6'
nve
((Show direction and distance from at least two State
From To
Ft.
Roads, or other map reference points)
From To
Ft.
14. GROUT:
Depth
Material
Method
From 0 To 20
Ft. Cement
Poured
From To
Ft.
15, SCREEN:
Depth
Diameter Slot
Size Material
From 0 To
Ft. in.
in.
From To
Ft. in.
in.
From To
Ft. in.
in.
16. SAND/GRAVEL PACK:
Depth
Size
Material
From 0 To
Ft.
From To
Ft.
17. REMARKS:
I DO HER EI'IY
"�AA''1�IS�JE�
AS CONSTRUCTED
IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRU
AR COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER.
FOR OFI
Quad No.
Serial No.
ATURE OF PERSON CONSTRUCTING THE WELL Date
to Division of Water Quality, Groundwater Section within 30 days

North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Ground Water Section {-, 18412
1636 Mail Service Center - Raleigh, N.C. 27699-1636 - Phone [phone]
WELL CONSTRUCTION RECORD WELL CONTRACTOR: Hedden Bros. Well Drilling Inc.
WELL CONTRACTOR CERTIFICATION k: 2043
STATE WELL CONSTRUCTION PERMIT M:
1. WELL USE(Check Applicable Box): Residential 0 Municipal ❑ Industrial ❑ Agricultural ❑ Monitoring ❑
Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other,List Use:
2. WELL LOCATION: (Show sketch of the location below)
Nearest Town: Franklin County: Macon
165 Long Rd
(Road Name and Numbers, Community, or Subdivision and Lot No.) DEPTH DRILLING LOG
3. OWNER Brandon & Chris Flrestlne From To Formation Description
Address 165 Long Rd 0 64 clay Rr sand
(Street or Route No.) 64 250 granite
Franklin NC 28734
City or Town State Zip Code
4. DATE DRILLED 09/20/00
5. TOTAL DEPTH 250
6. CUTTINGS COLLECTED YES ❑ NO FRI
7. DOES WELL REPLACE EXISTING WELL? YES ❑ NO
8. STATIC WATER LEVEL Below Top of Casing: 0 FT.
(Use " + " if Above Top of Casing)
9. TOP OF CASING IS 2 FT. Above Land Surface*
*Top of cast terminated at/or below land surface requires a variance in accor-
dance with 15A NCAC 2C .0118
10. YIELD (gpm): 10.00 METHOD OF TEST Blow
11. WATER ZONES (depth): 20
0
cn
=o
N
12. CHLORINATION: Type H T H Amount —
If additional space is needed use back of form
13. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
LOCATION SKETCH
From 0 Tom_ Ft. 611 189 Steel (Show direction and distance from at least two State
From 8 To 66 Ft. �' pVe Roads, or other map reference points)
From To Ft.
14. GROUT:
Depth
Material Method
From 0 To 20
Ft.
Cement POUIed
From To
Ft.
15. SCREEN:
Depth
Diameter Slot Size Material
From-0 To
Ft.
in. in.
From To
Ft,
in. in.
From To
Ft.
in. in.
16. SAND/GRAVEL PACK:
Depth
Size Material
From 0 To
Ft.
From To
Ft.
17. REMARKS:
I DO HEREBY 1'I
> CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTI
iD
N T T PY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER.
FOR OFFICE US i Y
U-CJo
Quad No.
Serial No.
SI NATURE OF PERSON CONSTRUCTING THE WELL Date
bmundwater
$eCtl mtt origi al to Division of Water Quality, Groundwater Section within 30 days

North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Ground Water Section
1636 Mail Service Center - Raleigh, N.C. 27699-1636 - Phone [phone] L .18409
WELL CONSTRUCTION RECORD WELL CONTRACTOR: Hedden Bros. Well Drilling Inc.
WELL CONTRACTOR CERTIFICATION #: 2045
STATE WELL CONSTRUCTION PERMIT #:
1. WELL USE(Check Applicable Box): Residential 0 Municipal ❑ Industrial ❑ Agricultural ❑ Monitoring ❑
Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other,List Use:
2. WELL LOCATION: (Show sketch of the location below)
Nearest Town: Franklin County: Macon
Shope Rd
(Road Name and Numbers, Community, or Subdivision and Lot No.) DEPTH DRILLING LOG
3. OWNER Millie & Colnel Holden From To Formation Description
Address P O BOX 767 0 29 clay Rr sand
(Street or Route No.) 29 250 granite
Franklin NC 28734
City or Town State Zip Code -
4. DATE DRILLED 09/14/00 CD
r-.
5. TOTAL DEPTH 250 cn - -
6. CUTTINGS COLLECTED YES ❑ NO FRI
7. DOES WELL REPLACE EXISTING WELL? YES ❑ NO FX-1 v
8. STATIC WATER LEVEL Below Top of Casing: 0 FT.
(Use " + " if Above Top of Casing) -
9. TOP OF CASING IS 2 FT. Above Land Surface* — _
*Top of cast ngg terminated at/or below land surface requires a variance in actor- n
dance with 15A NCAC 2C .0118 .. r-
10. YIELD (gpm): 20.00 METHOD OF TEST BIOW ^ ��
11. WATER ZONES (depth): 0 r
0
12. CHLORINATION: Type H T H Amount If additional space is needed use back of form
13. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material LOCATION SKETCH
From 0_ To1O_ Ft. fi„ .12YC__ (Show direction and distance from at least two State
From To Ft. Roads, or other map reference points)
From To Ft.
14. GROUT:
Depth Material Method
From 0 To 20 Ft. Cement Poured
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 0 To Ft.
From To Ft.
17. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTIO A11PAQD52AgDTHyr PY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER.
7SerialNo.
CE USE l5 ll7 IS Il U LS / ✓O�
�I11`O
ATURE OF PERSON CONSTRUCTING THE WELL Dace
_ __ ieina to Division of Water Quality, Groundwater Section within 30 days

North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Ground Water Section L 18 9 9 U
1636 Mail Service Center - Raleigh, N.C. 27699-1636 - Phone [phone]
WELL CONSTRUCTION RECORD WELL CONTRACTOR: Hedden Bros. Well Drilling Inc.
WELL CONTRACTOR CERTIFICATION #: 2043
STATE WELL CONSTRUCTION PERMIT t/:
1. WELL USE(Check Applicable sox): Residential M Municipal ❑ Industrial ❑ Agricultural ❑ Monitoring ❑
Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other,List Use:
2. WELL LOCATION: (Show sketch of the location below)
Nearest Town: Franklin County: Macon
1000 Wayah Rd
(Road Name and Numbers, Community, or Subdivision and Lot No.)
3. OWNER Carmen Jessup
Address 1000 Wayah Rd
(Street or Route No.)
Franklin NC 28734
Co or Town State Zip Code
4. DATE DRILLED 09/25/00
5. TOTAL DEPTH 200
6. CUTTINGS COLLECTED YES ❑ NO 0
7. DOES WELL REPLACE EXISTING WELL? YES ❑ NO X❑
8. STATIC WATER LEVEL Below Top of Casing: 0 FT.
(Use " + " if Above Top of Casing)
9. TOP OF CASING IS 2 FT. Above Land Surface*
-Top of cast terminated at/or below land surface requires a variance in accor-
dance with 15A NCAC 2C .0118
10. YIELD (gpm): 12.00 METHOD OF TEST BIOW
11. WATER ZONES (depth): 95
0
12. CHLORINATION: Type H T H Amount
13. CASING: wall Thickness
Depth Diameter or Weight/Ft. Material
From 0 To_$_ Ft. 6_ 188 steel
From 8 To 0 Ft. 6„ PVC
From To Ft.
14. GROUT
Depth Material Method
From 0 To 20 Ft. Cement Poured
From To Ft.
15. SCREEN:
Depth Diameter Slot Size Material
From 0 To Ft.
From To Ft. _
From To Ft. _
16. SAND/GRAVEL PACK:
Depth
From 0 To Ft.
From To Ft.
17. REMARKS:
001[903=
in. in.
in. in.
in. in.
Size Material
DEPTH DRILLING LOG
From To Formation Description
0 18 rlaV Rr sand
38 200 granite
o -
r
—1
iJ
m
ry
to
U
If additional space is needed use back of form -
LOCATION SKETCH
(Show direction and distance from at least two State
Roads, or other map reference points)
- WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
T A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER.
FOR OF SEpNLl, r,; _ _ QA g
Quad No.
Serial No. SIGNATURE OF PERSON CONSTRUCTING THE WELL Date
11pt Sub it original to Division of Water Quality, Groundwater Section within 30 days

From
To
Ft.
From
To
Ft.
17. REMARKS:
r
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Ground Water Section r.; 1 8 9 9 7
1636 Mail Service Center - Raleigh, N.C. 27699-1636 - Phone [phone]
WELL CONSTRUCTION RECORD WELL CONTRACTOR: Hedden Bros. Well Drilling Inc.
WELL CONTRACTOR CERTIFICATION X: 2043
STATE WELL CONSTRUCTION PERMIT ✓{:
1. WELL USE(Check Applicable Box): Residential 0 Municipal ❑ Industrial ❑ Agricultural ❑ Monitoring ❑
Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other,List Use:
2. WELL LOCATION: (Show sketch of the location below)
Nearest Town: Franklin County: Macon
1309 Louisa Chapel Rd
(Road Name and Numbers, Community, or Subdivision and Lot No.) DEPTH DRILLING LOG
3. OWNER Christy McConnell From To Formation Description
Address 1309 Louisa Chapel Rd Cl 33 clog & Rand
(Street or Route No.) 33 200 granite
Franklin NC 28734
City or Town State Zip Code
4. DATE DRILLED 09/25/00
5. TOTAL DEPTH 200
6. CUTTINGS COLLECTED YES ❑ NO FRI
7. DOES WELL REPLACE EXISTING WELL? YES ❑ NO
8. STATIC WATER LEVEL Below Top of Casing: 0 FT. u _
(Use " + " if Above Top of Casing) r� _
9. TOP OF CASING IS 2 FT. Above Land Surface* c (_
' Top of cast ngg terminated at/or below land surface requires a variance in accor-
dance with l5A NCAC 2C .0118
10. YIELD (gpm): 80.00 METHOD OF TEST Blow w
t I. WATER ZONES (depth): 960
0 `
12. CHLORINATION: Type H T H Amount
If additional space is needed use back o�rm c
13. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material LOCATION SKETCH
From �_ Tom_ Ft. 6 .188 steej ((Show direction and distance from at least two State
From 10 To 35 Ft. 6„ PVC Roads, or other map reference points)
From To Ft.
14. GROUT:
Depth Material Method
From 0 To 20 Ft. Cement Poured
From To Ft.
15.SCREEN:
Depth Diameter Slot Size Material
From �_ To Ft. in. in.
n. in.
in. in.
Ft.
Ft.
Size Material
WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER.
SIGNATURE OF PERSON CONSTRUCTING THE WELL Date
original to Division of Water Quality, Groundwater Section within 30 days

North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Ground Water Section
1636 Mail Service Center - Raleigh, N.C. 27699-1636 - Phone [phone]
WELL CONSTRUCTION RECORD WELL CONTRACTOR: Hedden Bros. Well Drilling Inc.
WELL CONTRACTOR CERTIFICATION N: 20043
STATE WELL CONSTRUCTION PERMIT a:
I. WELL USE(Check Applicable sox): Residential 0 Municipal ❑ Industrial ❑ Agricultural ❑ Monitoring ❑
Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other,List Use:
2. WELL LOCATION: (Show sketch of the location below)
Nearest Town: Otto County: Macon
1470 Sam Corn Rd.
(Road Name and Numbers, Community, or Subdivision and Lot No.) DEPTH DRILLING LOG
3. OWNER .Jerry Quick From To Formation Description
Address P O BOX 119 (1 55 clay & -,.and
(Street or Route No.) 55 600 granite
Otto NC 28763
City or Town State Zip Code
4. DATE DRILLED 09/21/00
5. TOTAL DEPTH 600
6. CUTTINGS COLLECTED YES ❑ NO EXI
7. DOES WELL REPLACE EXISTING WELL? YES ❑ NO X❑
8. STATIC WATER LEVEL Below Top of Casing: 0 FT.
(Use "+" if Above Top of Casing)
9. TOP OF CASING IS 2 FT. Above Land Surface*
"Top of casingg terminated at/or below land surface requires a variance in accor-
dance with 15A NCAC 2C .0118
10. YIELD (gpm): 4.00 METHOD OF TEST Blow
11. WATER ZONES (depth): 615
0
0
a
--t
r�
12. CHLORINATION: Type H T H Amount
If additional space is needed use back of form
13, CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
LOCATION SKETCH
From —0— To 57 Ft. 6 PVC (Show direction and distance from at least two State
From To Ft. Roads, or other map reference points)
From To Ft.
14, GROUT:
Depth Material Method
From 0 To 20 Ft. Cement Poured
From To Ft.
15. SCREEN
Depth
From 0 To
From To
From To
16, SAND/GRAVEL PACK:
Depth
From 0 To
From To
17. REMARK
I DO HER
CONSTRU
FOR OFFIC O]
Quad No.
Serial No. _
Diameter Slot Size Material
Ft. in. in.
Ft. in. in.
Ft. in. in.
Size Material
Ft.
Ft.
tS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER.
:LJ U
.Z /EGG
i0CU011 OF PERSON CONSTRUCTING THE WELL Date
� SubmiIr"GNATUR'
iginal to Division of Water Quality, Groundwater Section within 30 days

North Carolina- Department of Environment and Natural Resources - Division of Water Quality - Ground Water Section r.. 1. U 9 9:7
1636 Mail Service Center - Raleigh, N.C. 27699-1636 - Phone [phone]
WELL CONSTRUCTION RECORD WELL CONTRACTOR: Hedden Bros. Well Drilling Inc.
WELL CONTRACTOR CERTIFICATION N: 2043
STATE WELL CONSTRUCTION PERMIT N:
1. WELL USE(Check Applicable Box): Residential IN Municipal ❑ Industrial ❑ Agricultural ❑ Monitoring ❑
Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other,List Use:
2. WELL LOCATION: (Show sketch of the location below)
Nearest Town: Franklin County: Macon
205 Fouts Lane
(Road Name and Numbers, Community, or Subdivision and Lot No.) DEPTH DRILLING LOG
3. OWNER Thomas Ray Welch From To Formation Description
Address 205 Fouts Lane 0 84 rlayk Band
(Street or Route No.) 84 175 �granite
Franklin NC 28734
City or Town State Zip Code
4. DATE DRILLED 09/26/00
5. TOTAL DEPTH-
6. CUTTINGS COLLECTED YES ❑ NO FRI
7. DOES WELL REPLACE EXISTING WELL? YES ❑ NO FX r�
8. STATIC WATER LEVEL Below Top of Casing: 0 FT. _
(Use "+" if Above Top of Casing)
9. TOP OF CASING IS 2 FT. Above Land Surface*
*Top of casingg terminated at/or below land surface requires a variance in actor-
dance with MA NCAC2C .0118
10. YIELD (gpm): 30.00 METHOD OF TEST Blow rJ
11. WATER ZONES (depth): 140 r n
0
12. CHLORINATION: Type H T H Amount If additional space is needed use back of form
13. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material LOCATION SKETCH
From 0 To 71 Ft. 6_ 188 steel ((Show direction and distance from at least two State
From 21 To 86 Ft. 6„ PVC Roads, or other map reference points)
From To Ft.
14. GROUT
Depth Material Method
From 0 To 20 Ft. Cement Poured
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 0 _ To Ft.
From To Ft.
17. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONST h"r^ADi1Q ° T A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER.
FOR OF
Quad No.
Serial No. 11, / SIGNATURE OF PERSON CONSTRUCTING THE WELL Date
Sub nit original to Division of Water Quality, Groundwater Section within 30 days

North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Ground Water Section 1. [ ;) l l tj 1-
1636 Mail Service Center - Raleigh, N.C. 27699-1636 - Phone [phone]
WELL CONSTRUCTION RECORD WELL CONTRACTOR: Hedden Bros. Well Drilling Inc.
WELL CONTRACTOR CERTIFICATION H: 2043
STATE WELL CONSTRUCTION PERMIT k:
1. WELL USE(Check Applicable Box): Residential ❑X Municipal ❑ Industrial ❑ Agricultural ❑ Monitoring ❑
Recovery 0 Heat Pump Water Injection 0 Other ❑ If Other,List Use:
2. WELL LOCATION: (Show sketch of the location below)
Nearest Town: Franklin County: Macon
4675 Clarks Chapel Rd
(Road Name and Numbers, Community, or Subdivision and Lot No.) DEPTH DRILLING LOG
3. OWNER Jim Ledford From To Formation Description
Address 4675 Clarks Chapel Rd f) 75 clay Rr sand
(Street or Route No.) 75 500 granite
Franklin NC 28734
City or Town State Zip Code
4. DATE DRILLED 09/22/00
5. TOTAL DEPTH 500
6. CUTTINGS COLLECTED YES 0 NO
7. DOES WELL REPLACE EXISTING WELL? YES 0 NO X❑
8. STATIC WATER LEVEL Below Top of Casing: 0 FT.
(Use "+" if Above Top of Casing)
9. TOP OF CASING IS 2 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): 1.00 METHOD OF TEST Blow
11. WATER ZONES (depth): 130
0
C7
0
0
12. CHLORINATION: Type H
T H Amount If additional space is needed use back of form
13. CASING:
Wall Thickness
Depth
Diameter
or Weight/Ft. Material
LOCATION SKETCH
From 0
To 77
Ft.
6' IRS steel (Show direction and distance from at least two State
From
To
Ft.
Roads, or other map reference points)
From
To
Ft.
14. GROUT:
Depth
Material Method
From 0
To 20
Ft.
Cement Poured
From
To
Ft.
15. SCREEN:
Depth
Diameter Slot Size Material
From 0
To
Ft.
in. in.
From
To
Ft.
in. in.
From
To
Ft.
in. in.
16. SAND/GRAVEL PACK:
Depth
Size Material
From 0
To
Ft.
From
To
Ft.
17. REMARKS:
LL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
HAT ACOOPY OF THIS RRECORD HAS BEEN PROVIDED TO THE WELL OWNER.
MYbmit
SIGNATURE OF PERSON CONSTRUCTING THE WELL Date
original to Division of Water Quality, Groundwater Section within 30 days

North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Ground Water Section-. i. O 9 9 4
1636 Mail Service Center - Raleigh, N.C. 27699-1636 - Phone [phone]
WELL CONSTRUCTION RECORD WELL CONTRACTOR: Hedden Bros. Well Drilling Inc.
WELL CONTRACTOR CERTIFICATION N: 2045
STATE WELL CONSTRUCTION PERMIT #:
1. WELL USE(Check Applicable Box): Residential 0 Municipal ❑ Industrial ❑ Agricultural ❑ Monitoring ❑
Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other,List Use:
2. WELL LOCATION: (Show sketch of the location below)
Nearest Town: Franklin County: Macon
Off Wide Horizon Drive
(Road Name and Numbers. Community, or Subdivision and Lot No.) DEPTH DRILLING LOG
3. OWNER Harrell Wood From To Formation Description
Address 289 Silver Spruce Lane 0 RR clay & sand
(Street or Route No.) 88 firm granite
Franklin NC 28734
City or Town State Zip Code
4. DATE DRILLED 09/29/00
5. TOTAL DEPTH 600
6. CUTTINGS COLLECTED YES ❑ NO FRI
7. DOES WELL REPLACE EXISTING WELL? YES ❑ NO 0 0 "
8. STATIC WATER LEVEL Below Top of Casing: 0 FT.
(Use " + " if Above Top of Casing)
9. TOP OF CASING IS 2 FT. Above Land Surface* —
*Top of casingg terminated at/or below land surface requires a variance in actor- r'
dance with IA NCAC 2C .0118
10. YIELD (gpm): 8.50 METHOD OF TEST Blow _ - r '
11. WATER ZONES (depth): 540 v __
0 rn
12. CHLORINATION: Type H T H Amount If additional space is needed use back of form "•
13. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
LOCATION SKETCH
From _ 0 Tog_ Ft. 6" nvc (Show direction and distance from at least two State
From To Ft. Roads, or other map reference points)
From To Ft.
14. GROUT:
Depth Material Method
From 0 To 20 Ft. Cement Poured
From To Ft.
15. SCREEN:
Depth Diameter Slot Size Material
From 0 To Ft. in. in.
From To Ft. in. in.
From To Ft. in. in.
16. SAND/GRAVEL PACK:
Depth Size Material
From 0 To Ft.
From To Ft.
17. REMARKS:
I DO HEREBY CERT r�iiLL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CON ptS'IjQNIbASttA 19 hIHAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER.
FOR O USE ONLY Psu
uq —��
Quad No. ( Serial NoNATURE OF PERSON CONSTRUCTING THE WELL Dale
it rigind to Division of Water Quality, Groundwater Section within 30 days

North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Ground Water Section i- 184 Or)
1636 Mail Service Center - Raleigh, N.C. 27699-1636 - Phone [phone]
WELL CONSTRUCTION RECORD WELL CONTRACTOR: Hedden Bros. Well Drilling Inc.
WELL CONTRACTOR CERTIFICATION Y: 2045
STATE WELL CONSTRUCTION PERMIT k:
1. WELL USE(Check Applicable sox): Residential 0 Municipal ❑ Industrial ❑ Agricultural ❑ Monitoring ❑
Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other,List Use:
2. WELL LOCATION: (Show sketch of the location below)
Nearest Town: Franklin County: Macon
Jim Deal Rd Off Floyd Shu
(Road Name and Numbers. Community, or Subdivision and Lot No.) DEPTH DRILLING LOG
3. OWNER Clifford Hinson From To Formation Description
Address P O Box 3021 0 58 day Rr sand
(Street or Route No.) 59 400 granite.
Crystal River FL 34423 4
City or Town State Zip Code
4. DATE DRILLED 09/15/00
5. TOTAL DEPTH 400 C0
6. CUTTINGS COLLECTED YES ❑ NO ❑X
7. DOES WELL REPLACE EXISTING WELL? YES ❑ NO 0
8. STATIC WATER LEVEL Below Top of Casing: 0 FT. —� -
(Use " + " if Above Top of Casing) -= N r%-
9. TOP OF CASING IS 2 FT. Above Land Surface*
*Top of cast ngg terminated at/or below land surface requires a variance in actor- _
dance with 15A NCAC 2C .0118 -
10. YIELD (gpm): 6.00 METHOD OF TEST Blow
11. WATER ZONES (depth): 110
0
12. CHLORINATION: Type H T H Amount
If additional space is needed use back of form
13. CASING:
wall Thickness
Depth
Diameter
or Weight/Ft. Material
From To 60
Ft. 6
nvc
From To
Ft.
From To
Ft.
14. GROUT:
Depth
Material
Method
From 0 To 20
Ft. cernent
Poured
From To
Ft.
15. SCREEN:
Depth
Diameter Slot Size Material
From 0 To
Ft. in.
in.
From To
Ft. in.
in.
From To
Ft. in,
in.
16. SAND/GRAVEL PACK:
Depth
Size
Material
From 0 To
Ft.
From To
Ft.
17. REMARKS:
I DO HEREBY
FOR OFFICE
Quad No.
Serial No.
LOCATION SKETCH
(Show direction and distance from at least two State
Roads, or other map reference points)
-2LL$iCONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
TMDPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER.
ATURE OF PERSON CONSTRUCTING THE WELL Date
to Division of Water Quality, Groundwater Section within 30 days

North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Ground Water Section pp
1636 Mail Service Center - Raleigh, N.C. 27699-1636 - Phone [phone] -� O
WELL CONSTRUCTION RECORD WELL CONTRACTOR: Hedden Bros. Well Drilling Inc.
WELL CONTRACTOR CERTIFICATION #: 2045
STATE WELL CONSTRUCTION PERMIT N:
1. WELL USE(Check Applicable Box): Residential � Municipal ❑ Industrial ❑ Agricultural ❑ Monitoring ❑
Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other,List Use:
2. WELL LOCATION: (Show sketch of the location below)
Nearest Town: Franklin County: Macon
1547 Rabbit Creek Rd
(Road Name and Numbers, Community, or Subdivision and Lot No.)
3. OWNER Brian StameY
Address 1547 Rabbit Creek Rd
(Street or Route No.)
Franklin NC 28734
City or Town State Zip Code
4. DATE DRILLED 09/14/00
5. TOTAL DEPTH 125
6. CUTTINGS COLLECTED YES ❑ NO ❑X
7. DOES WELL REPLACE EXISTING WELL? YES ❑ NO
8. STATIC WATER LEVEL Below Top of Casing: 0 FT.
(Use " + " if Above Top of Casing)
9. TOP OF CASING IS 2 FT. Above Land Surface*
"Top of cast ngg terminated at/or below land surface requires a variance in accor-
dance with ISA NCAC 2C .0118
10. YIELD (gpm): 40.00 METHOD OF TEST Blow
11. WATER ZONES (depth): 95
105
12. CHLORINATION: Type H T H Amount
13. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
From 0 To 3? Ft. 611 p vc
From To Ft.
From To Ft.
14. GROUT:
Depth Material Method
From 0 To 20 Ft. cement Poured
From To Ft.
15. SCREEN:
Depth Diameter Slot Size Material
From 0 To Ft.
From To Ft.
From To Ft. _
16. SAND/GRAVEL PACK:
Depth
From 0 To Ft.
From To Ft.
17. REMARKS:
I DO HEREBY
FOR OFFICE USE
Quad No.
Serial No.
in. in.
in. in.
in. in.
Size Material
DEPTH
From To
DRILLING LOG
Formation Description
CD
If additional space is needed use back of form
LOCATION SKETCH
(Show direction and distance from at least two State
Roads, or other map reference points)
4STRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER.
'URE OF PERSON CONSTRUCTING THE WELL Date
Division of Water Quality, Groundwater Section within 30 days

North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Ground Water Section p p
1636 Mail Service Center - Raleigh, N.C. 27699-1636 - Phone [phone] L.
.� J 4 O O
WELL CONSTRUCTION RECORD WELL CONTRACTOR: Hedden Bros. Well Drilling Inc.
WELL CONTRACTOR CERTIFICATION k: 2045
STATE WELL CONSTRUCTION PERMIT N:
Applicable sox): Residential FX1 Municipal 0
Industrial D Agricultural ❑ Monitoring El
I. WELL USE(Check
Recovery El Heat Pump Water Injection D Other 0 If Other,List Use:
2. WELL LOCATION: (Show sketch of the location below)
Nearest Town: Franklin County: Macon
1 akey Creek
(Road Name and Numbers, Community. or Subdivision and Lot No.)
DEPTH DRILLING LOG
3. OWNER Harriet Ri. Mike Holloway From
To Formation Description
Address 8159 Molina St
0 91 clay & sand
(Street or Route No.) 91
300granite
Navarre FL 32566
City or Town State Zip Code
4. DATE DRILLED 09/14/00
5. TOTAL DEPTH 300
0 NO FRI
6. CUTTINGS COLLECTED YES
YES ❑ NO 0
^
7. DOES WELL REPLACE EXISTING WELL?
8. STATIC WATER LEVEL Below Top of Casing: 0 FT.
(Use " + " if Above Top of Casing)
r"1
9. TOP OF CASING IS 2 FT. Above Land Surface*
*Top of casingg terminated at/or below land surface requires a variance in actor-
dance 15A NCAC 2C
-
with .0118
10. YIELD (gpm): 15.00 METHOD OF TEST Blow
11. WATER ZONES (depth): 179
240
0
12. CHLORINATION: Type H T H Amount
If additional space is needed use back Zorn -�
13. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
LOCATION SKETCH
From _Q_ To 93_ Ft. 611 nvc
(Show direction and distance from at least two State
From To Ft.
Roads, or other map reference points)
From To Ft.
14. GROUT:
Depth Material Method
From 0 To 20 Ft. Cement Poured
From To Ft.
15. SCREEN
Depth Diameter Slot Size Material
From - 0 To Ft. in. in.
From To Ft. in. in.
From To Ft. in. in.
16. SAND/GRAVEL PACK:
Depth Size Material
From 0 To Ft.
From To Ft.
17. REMARKS:
I DO HEREBY
FOR OFFICE U Y
Quad No.
Serial No.
CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
)PY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER.
ATURE OF PERSON CONSTRUCTING THE WELL Date
to Division of Water Quality, Groundwater Section within 30 days

North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Ground Water Section J``�� .�
2 1636 Mail Service Center - Raleigh, N.C. 27699-1636 - Phone [phone] :_ -)_ V „ 9
WELL CONSTRUCTION RECORD WELL CONTRACTOR: Hedden Bros. Well Drilling Inc.
WELL CONTRACTOR CERTIFICATION N: 2045
STATE WELL CONSTRUCTION PERMIT M:
I . WELL USE(Check Applicable Box): Residential EK Municipal ❑
Industrial ❑ Agricultural ❑ Monitoring ❑
Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other,List Use:
2. WELL LOCATION: (Show sketch of the location below)
Nearest Town: Otto County: Macon
197 Ruth Wells Rd
(Road Name and Numbers, Community, or Subdivision and Lot No.)
DEPTH DRILLING LOG
3. OWNER Eloise Ho-pely From
To Formation Description
Address 197 Ruth Wells Rd
n 39 rlay k Sand
(Street or Route No.) 39
1 150 granite
Otto NC 28763
City or Town State Zip Code
4. DATE DRILLED 09/12/00
—
5. TOTAL DEPTH 1150
❑ D
6. CUTTINGS COLLECTED YES NO
YES ❑ NO M
7. DOES WELL REPLACE EXISTING WELL?
8. STATIC WATER LEVEL Below Top of Casing: 0 FT.
-
(Use "+" if Above Top of Casing)
=
9. TOP OF CASING IS 2 FT. Above Land Surface*
_
*Tap of cast ngg terminated at/or below land surface requires a variance in actor-
dance with 15A NCAC 2C .0118
10. YIELD (gpm): 0.50 METHOD OF TEST BIOW
o —
11. WATER ZONES (depth): 0
c'
12. CHLORINATION: Type H T H Amount
If additional space is needed use back of form
13. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
LOCATION SKETCH
From 0 To 40 Ft. 6' nvr_
(Show direction and distance from at least two State
From To Ft.
Roads, or other map reference points)
From To Ft.
14. GROUT:
Depth Material Method
From 0 To 20 Ft. Cement Poured
From To Ft.
15, SCREEN:
Depth Diameter Slot Size Material
From 0 To Ft. in. in.
From To Ft. in. in.
From To Ft. in. in.
16. SAND/GRAVEL PACK:
Depth Size Material
From 0 To Ft.
From To Ft.
REMARKS:
17.
I DO HEREBY r EDTMV T-AT Tutc WL I. WAS CONSTRUCTED IN
ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRIAMN BrARD&S, WS11111rIMM COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
FOR OFFIC ONLY
Quad No. IJ 1 &.4. -
Serial No. GNATURE OF PERSON CONSTRUCTING THE WELL Date
bmi riginal to Division of Water Quality, Groundwater Section within 30 days

North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Ground Water Section �` 1 8 3 93
1636 Mail Service Center - Raleigh, N.C. 27699-1636 - Phone [phone]
WELL CONSTRUCTION RECORD WELL CONTRACTOR: Hedden Bros Well Drilling Inc.
WELL CONTRACTOR CERTIFICATION N: 2045
STATE WELL CONSTRUCTION PERMIT k:
1. WELL USE(Check Applicable Box): Residential 0 Municipal ❑ Industrial ❑ Agricultural ❑ Monitoring ❑
Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other,List Use:
2. WELL LOCATION: (Show sketch of the location below)
Nearest Town: Franklin County: Macon
152 Rlnccnm Towm Dr
(Road Name and Numbers, Community, or Subdivision and Lot No.) DEPTH DRILLING LOG
3. OWNER Porter & Louise Thomas From To Formation Description
Address 152 Blossom Towm Dr 0 93 clad, k canri
(Street or Route No.) 93 275 granite,
Franklin NC 28734
City or Town State Zip Code c
4. DATE DRILLED 09/01/00 c. - -
5. TOTAL DEPTH 275
6. CUTTINGS COLLECTED YES ❑ NO F
7. DOES WELL REPLACE EXISTING WELL? YES ❑ NO
8. STATIC WATER LEVEL Below Top of Casing: 0 FT.
(Use " + " if Above Top of Casing)
9. TOP OF CASING IS 2 FT. Above Land Surface*
*Top of casingg terminated at/or below land surface requires a variance in accor-
dance with 15A NCAC 2C .0118 '.�
10. YIELD (gpm): 60.00 METHOD OF TEST Blow ra
11. WATER ZONES (depth): 50
0 `
12. CHLORINATION: Type H T H Amount If additional space is needed use back of form
13. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material LOCATION SKETCH
From _0 To 15 Ft. 6_ 188 Steel_— Show direction and distance from at least two State
From 15 To 95 Ft. 6„ nye Oads, or other map reference points)
From To Ft.
14. GROUT:
Depth Material Method
From 0 To 20 Ft. Cement Poured
From To Ft.
15. SCREEN:
Depth Diameter Slot Size Material
From -0 To Ft. in. in.
From To Ft. in. in.
From To Ft. in. in.
16. SAND/GRAVEL PACK:
Depth Size Material
From 0 To Ft.
From To Ft.
17. REMARKS:
I DO HERE WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
rnra(ZTUlt M .�'AM)ADA. MDRHIMI COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER.
FOR OFFICE NLY _
Quad No. "
Serial No. GNATURE OF PERSON CONSTRUCTING THE WELL Date
L1mi iginal to Division of Water Quality, Groundwater Section within 30 days
wRe Section 1

North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Ground Water Section -� rJ 3 9 4
1636 Mail Service Center - Raleigh, N.C. 27699-1636 - Phone [phone]
WELL CONSTRUCTION RECORD WELL CONTRACTOR: Hedden Bros. Well Drilling Inc.
WELL CONTRACTOR CERTIFICATION /t: 2045
STATE WELL CONSTRUCTION PERMIT N:
I. WELL USE(Check Applicable Box): Residential FX1 Municipal ❑ Industrial ❑ Agricultural ❑ Monitoring ❑
Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other,List Use:
2. WELL LOCATION: (Show sketch of the location below)
Nearest Town: Franklin County: Macon
7074 Bryson City Rd
(Road Name and Numbers, Community, or Subdivision and Lot No.)
3. OWNER Robert Morgan
Address 7074 Bryson City Rd
(Street or Route No.)
Franklin NC 28734
City or Town State Zip Code
4. DATE DRILLED 08/29/00
5. TOTAL DEPTH 295
6. CUTTINGS COLLECTED YES ❑ NO FRI
7. DOES WELL REPLACE EXISTING WELL? YES ❑ NO 0
8. STATIC WATER LEVEL Below Top of Casing: 0 FT.
(Use "+" if Above Top of Casing)
9. TOP OF CASING IS 2 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): 100.00 METHOD OF TEST Blow
11. WATER ZONES (depth): 295
0
12. CHLORINATION: Type H T H Amount
13. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
From _ 0 To_g$_ FL 6" PVC
From To Ft.
From To Ft.
14. GROUT:
Depth Material Method
From 0 To 20 Ft. cement Poured
From To Ft.
15. SCREEN:
Depth Diameter Slot Size Material
From _0_ To Ft. in. in.
From To Ft. in. in.
From To Ft. in. in.
16. SAND/GRAVEL PACK:
Depth Size Material
From 0 To Ft.
From To Ft.
17. REMARKS:
I DO HEREI
FOR OFFICE
Quad No.
Serial No.
DEPTH DRILLING LOG
From To Formation Description
H 56 riny Rr sand
56 295 granite
e 'r—
If additional space is needed use back of fo m
LOCATION SKETCH
(Show direction and distance from at least two State
Roads, or other map reference points)
tS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER.
ATURE OF PERSON CONSTRUCTING THE WELL Date
to Division of Water Quality, Groundwater Section within 30 days

North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Ground Water Section pp (� [[��
1636 Mail Service Center - Raleigh, N.C. 27699-1636 - Phone [phone] r_ 1 O 3 9 U
WELL CONSTRUCTION RECORD WELL CONTRACTOR: Hedden Bros. Well Drilling? Inc.
WELL CONTRACTOR CERTIFICATION #: 2045
STATE WELL CONSTRUCTION PERMIT #:
1. WELL USE(Check Applicable Box): Residential IX Municipal ❑ Industrial ❑ Agricultural ❑ Monitoring ❑
Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other,List Use:
2. WELL LOCATION: (Show sketch of the location below)
Nearest Town: Aquone County: Macon
Nantahala-OSpri g
(Road Name and Numbers, Community, or Subdivision and Lot No.) DEPTH DRILLING LOG
3. OWNER Steve Mason From To Formation Description
Address 110 N Parson n 11D clav Rr sand
(Street or Route No.)
Brandon FL 33510
City or Town State Zip Code
4. DATE DRILLED 08/24/00
5. TOTAL DEPTH 425
6. CUTTINGS COLLECTED YES ❑ NO 0
7. DOES WELL REPLACE EXISTING WELL? YES ❑ NO
S. STATIC WATER LEVEL Below Top of Casing: 0 FT.
(Use "+" if Above Top of Casing)
9. TOP OF CASING IS 2 FT. Above Land Surface*
*Top of casingg terminated at/or below land surface requires a variance in accor-
dance with 15A NCAC 2C .0118
10. YIELD (gpm): 15.00 METHOD OF TEST BIOW
11. WATER ZONES (depth): 406
12, CHLORINATION: Type H T H Amount
13. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
From —0 To 112 Ft. 6" nvc
From To Ft.
From To Ft.
14. GROUT:
Depth Material Method
From 0 To 20 Ft. cement Poured
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 0 To Ft.
From To Ft.
17. REMARKS:
IDO HEREBY
FOR OFFICE USE
Quad No.
Serial No.
r: r
CD
-i
c
If additional space is needed use back of form
LOCATION SKETCH
(Show direction and distance from at least two State
Roads, or other map reference points)
dSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER.
'URE OF PERSON CONSTRUCTING THE WELL Date
Division of Water Quality, Groundwater Section within 30 days

293979
WELL CONSTRUCTION RECORD
Norch Carolina - Dcpinmenl of Environment and Natural Resources -Div is ion of Water Quality • Groundwater Section
- WELL COINTR.4CTOR(INDIYIDUAL)NAME (print) MitChelI D. Cook - CERTIFICAT10}N� 204_3
WELL CON'I'R\CTOR COMPANY NAME Er&-}kz-s tv�--n �='Tier ' PHO:YE # E28) 309-9591
STATE WELL CONSTRUCTION PERMITM ASSOCIATED-WQ PERNIITd
(if aoolicable) (if abolicable)
1. WELL USE (Check Appllcab_le Box): Residential 6 Municipal/Public ❑ Industrial ❑ Agricultural ❑
Monitorin,• ❑ Recovery ❑ Heat Puno Water Injection ❑ Other ❑ If Other, List Use
2, WELLLOCATIO,iJ:
Topographic/Land setting
Nearos' own. County
_ ❑Ridge ❑Slope ❑Valley ❑Flat
(che:k appropriate bCx)
(Street 4 ne, Nua'oers, Comm Ity, Subdiviswnn,� Lot Nc , Zip Code)
Latitude/lonaitudaDf well location
}, OWNER:,�„(,.f' [;G�LC�C.F.
(d<Sr-es/udmaes/s<co nds) _ '.
Ad,dl% 5 j� o�d
Latiwd_'lcnaltude source:❑GPS❑Topographic map
(AS.t,e,e.o,r R , to No) -
(check ban)
DEPTH DRILLING LOG
nyorTo n t"• Zp ccde
From To Formation Description
— 0 clav & Seri
Area code. Flote number M
7T
a5� crra llte
4, DATE DRILLED
5, TOTAL DEPTH:
6, DOES WELL REPLACE EXISTING WELL? YES ❑ NO
i. STATIC WATER LEVEL Below Toc of Casing: . 0 FT.
-
(Use "+" if A'oove Top of Casing)
8, TOP OF CASING IS - "[ FT. Above Land Surface`
*Top or casing terminued arvor below land surface requires a
variance In accordance InISA NCAC 3C .0113
9. YIELD (gpm): METHOD O blow
psT
10, WATER ZONES (dccth): era aZJ
_
LOCATION SKETCH
11. DISINFECTION: Type N T H Amount -1 Eoz
Show direction. and distance in miles from at least
' 12, CASING: Wall Thickness
two State Roads or County Roads, include the road
Depth _ Diameter or WeighbFl Maerial
numbers and common road names.
From,_ To Ft. PVC
c
From To Ft.
CD
U
From To Ft.
13. GROUT: Depth Material Method
From n To--20L Ft�itee & CetB:t tzi oed
_ ••<
c';;
r
From To Ft.
14, SCREEN: Depth Diameter Slot Size Material.-
T �%
From —To —Ft. —in. in
- From - To Ft,in. in
^,
15 SAND//RAVEL PACK:
M�
Depth Size Nlateria;
W
:..:From To - Ft.
- —
—
From - To Ft.
16. REMARKS;
i�.
I DO HERESY CERT IFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH I5A NCAC 2C, W<LL I".
CONSTRUCT (ON STANDARDS, AND THATCOPY OF(THIS Ri—ECORD HAS
BEEN PROVIDED TO THE WELL OWNER
/A -( / I
SIGNATURE OF PERSON CONSTRUCTING
THE WELL DATE —'
Submit the onginnl to the Division of Water Quality, Groundwater Section,
1636 Mall Service Censer • Raltigh,NC,
27699.1636 Pllonc No, (919 733.3221, within 3 days.
) Q
G1V-I REV 07/240

293978
WELL CONSTRUCTION RECORD
North Carolina • D-pnrtnent of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL)NAME (print) Mitchell De 000}C CERTIFICATI01N� 3
E L L CO.N•rRACTOR COMP.ANY,NAME FiE� P:Ct�_ PFrt T7ill;rn, JrC PHo.NE, 628) 369-9591
S'r ATE WELL CONSTRUCTION PERNIM ASSOCIATED WQ PERMITO
(if aoolicable) - Vapolicable)
L WELL USE (Check Applicable Box): Residential Municipal/Public ❑. Industrial ❑ Agricultural ❑ -
Monitcrin., Cl Recovery Cl Heat Pump Water Injection ❑ Other ❑ froth, List Use
2. WELL LCCATI h Topographic/Landsett,ng '
Nea�,c�stIT,own: or•nty ❑Ridge []Slope ❑Valley []Flat
\ Y�Ly+.. (che:4approPriSte bex)
(Street Na NJm'oefs, Community, Subdivision, Lot No., Zlp Code) Latitude/lon_Itud! of well locat;on
3. OWNER'. (c'egre:a/minutes!seccnds)
Address Latitude/longitude source,❑GPSuTopagrnphic mua
(St i or Lit tt No (check bps)
Q/OQ/114 .3D)-37 DEPTH DRILLING LOG
ysky�^ bn55y 2ircode Fro
m To r _ Formation Description
O
—L7 al C13V & �Il
Area ;ad-. Flone nurber ,,,, -granite
4, DATE DR1: LED /a - I.5 -OO
5. TOTAL DEPTH:
6, DOES WELL REPLACE EXISTING WELL? YES q NO ❑
i. STATIC WATER LEVEL Below Top o°Casir,g: FT.
(Use ii Above Top ofCasing)
8, TOP OF CASING IS 2 FT, Above Land Surface'
'Top of casin; terminated at/or below land surface requires a
variance In accordance h ISA NCAC 2C.0I I8•
9. YIELD (gpm): q METHOD OF TEST blow _
10 WATER ZONES (d pth):
LOCATION SKETCH
11, DISINFECTION: Type H T H - Amount l 6o2 Show direction and distance in mites from a' least
12 CASING: Wall Thickness two State Roads or County Roads. Include the road
Depth Diameter or Weight/FiMaterial numbers and common road names.
From_ To Ft.
From - To Fr. c
From To Ft. c.�.
13, GROUT: Depth Material Method
From O To 20 Ftk�nrni.te & cF�EBt, Mr, > d < ='
From To - Ft.
14. SCREEN: Dea,h Diameter Slot Size Material C4 -
From To Ft.in. in.
- From - To - Ft._in. - in.
15.'SAND/GRAVEL PACK: c t <n -
Depth Size Material �-
From To Ft. w o
From To Ft. `
16. REMARKS F
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH I5A NCAC 2C, R'ELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WILL OWNER
LAAE,, - n
SICNATURE OF ERSON CONSTRUCTING THE WELL DATE
j
Submit the original to the Division of Water Quality, Groundwater Section, 1636 tNlail Service Center -Raleigh, NC '•�
27699.1636 Plwnc No. [phone], within 30 days. GW-1 REV, 0i/2J01 -
I

293977
`FELL CONSTRUCTION RECORD
Nort'r, Carolina - D part,ment of Environment and Natural Resources - Division of Water Quality . G;oundwater Section -
WELL COiNTRrCTOR(INDIVIDUAL)NAb1E (print) M=tChelI D. CCCk CERTIFICATIONS2043
WE L L CONTRA CTO R CONIPANY tN A N I E 1.8-g31 - �I' -LII?, IrC PHONE ;e28) 36D.-9591
STATE WELL Ca\STRUCTIOiN PERMiTg ASSOCIATED WQ PERMITd
(ifacplicable) (ifaooliceble)
_1, WELL USE (CheckAcplicable Box): Residential L3 Municipal/Public ❑. Industria! ❑ Agricultural ❑
Monitoriq, ❑ Recovery ❑ Heat Pump Water Injection ❑ Other ❑ if Other, List Use
2, WELL LOCATinx° y Topographic/Landsetting t
N'epAcs,tTjow � f LL) Cour
.9 ❑
ZIA/e' Rldg ❑Slop ❑Vall y 0-Flat
:a " � ;,C{ � (cn- P ap-ropnv. cox)
(Street N.r , Nwnbers, Ccmmunity, Subdivision, Lot No„ Zip Ccdt) Latitude/lon,ibdde of Well loca:ion
3, OWN'ER: (de irteV'r i hates/seconds)
Addres5 - LaUtuderl ngitude source.❑0PS❑Tepegrnphic map
I� (check tat)
DEPTH DRILLING LOG
y or rv, , vStIt Zip Code From T r t Formation Description
Area c-d:.. P`ooeeSn[u(iinnb:r / e Q r Qianite
4. DATE DRILLED
5. TOTAL DEPTH. :2(')0
6 DOES WELL REPLACE EXISTING WELL? YES ❑ NO
7. STATIC WATER LEVEL Below Top of Casing: FT. —
(Use '," ifAcov: Top ofCasln7)
8. TOP OF CASING IS 2 FT, Above Land Su; face'
'Top orcasln2 terminated at/or below land surface requires a
Yarlance In accord�ance�( h ISA NCAC 2C.0113.
9. YIELD (gpc,): V_ METHOD OF TEST blow
10, WATER ZONES (d p1h),
LOCATION SKETCH
11. DISINFECTION: Type H T H Amount 16cz Show direction and distance in miles f;om at least -
2. CASING: Will Thlcic•ess two State Roads or County Roads. Include the road
Depth Dl .^:.tar or Wei ht/F, Material numbers and common road names.
From_0 ToS Ft „ S DyJ—` From To - Ft. —'f`�— C.
From To Ft. o: c
13. QR0UT: Depth Maerial Method ? Coo ,
From 0 To 20 Ftke Ite & Cast z7 cFii } �m
From To Ft. -
14 SCREEN: Depth Diameter Slot Size Mateial �+ sm
c
From To Ft. —in. in. r,�
From To Ft. in. irt.
' --
15. SAND/GELAVEL PACK W �z`
Depth Size Material - r
From To - Ft.
From To Ft.
I6 REMARKS, 1--j
r'
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH I6A NCr•C 2C, WcLL ' _' +? "rJ)
CONSTRUCTION STANDARDS AND T A COPY OF THIS RECORD HAS BEEN PROVIDED 70 i 1E WELL OWNER
l �
SIGNATURc 0i Pe SON CO STRUCTIN•G THE WELL DATE
�1
Submit the original to the Division of Water Qunlity, Groundwater Section, 1636 Mail Service Center-Raleigh,NC
27699.1636 Phone No. [phone], within 30 days. G4V-I f2E V. 0i/2001

WELL CONSTRUCTION RECORD 293961
North Carolina • Dcpartment of Environment and Natural Resources • Division of Water Quality - Groundwater Section
WELL CoIvTRaC1'OR IIN�IVID'JAL) NAhIE (pro Mitchell D, Cook CERTIFICAVOIY A2Od3
1YELL CON'fRr\CTOR COiSIPAN,Y NANIE 1'q:bm 5 %Li. Ci7..tit1' r ITn PHONE M 629) ?A`J-559�
s"rATE WELL-CONSTRUCTIO�Y PERMIT# ASSOCIATED-WQ PERMIT#
I. WELL USE (Checit Applicable Box): Residential 0 Municipal/Public ❑ Industrial ❑ Agricultural
Monitoring ❑ Adcovery ❑ Heat Pump Water injection M. -Other, ❑ If Other, Lis, Use
2 WELL LOCAiI0
� Topographic/Land sating '
Neares'Town. County�� _r_0 ) ❑Ridge ❑Slope .❑Valley -❑flat
(chebkappropriate box).
(S(ree: Nnme,Numbers,Lmnmuniry, Subdivision, Lot Nc., Zip Code) -. Latitude/longi!udo of well location
J OWNEF (de yr<: it .miiteshe<onda)
- Addivss -4M JU14AP Latitude/longitude souc: ❑OPS❑Topographic map
(check box)
35469- DEPTH DRILLING LOG
Ci.y or Town me Zip Code From T I Formation Description
clay & sar3
Area c<de-Phone number c r'TL•6I11te
4 DATE DRILLED
6. 'TOTAL DEPTH:
6 DOES WELL REPLACE EXISTING WELL? YE ❑ NO
7 STATIC WATER LEVEL BolowTcp of Casing: FT. --
- -
(Use '-" If Abcve Top. of Cahn.;)
8, TOP OF CASING IS 2 FT. Above Land Surface"
-Top of easlna terminated atlor below land surface requlref a _
variance In accordance th ISA NCAC 2C ,01Is, -
9. YIELD (gpm): _ ) METE ? OF TpT blow
10. WATER ZONES (depth): 'f ��
LOCATION SKETCH
11, DISINFECTION: Type F T H Amount 16cz Show direction and distance in miles from at least
12:' CASING Wall Thickness two Stag Roads or County Roads, Include the road
Depth Diam�pr or Weaht/Ft. Material numbers and commcnroad names,
From 0 ToLZQQFt.
o
n kr" o
D
From To _. Ft.
.. '....From.., To .: Ft.
I3 GROUT: Depth'; Material Method
From n To 20 Ftia3mLte & Cast MrcEds
o
.
Fromw
. To...Ft.
t4. SCREEN: Depth Diameter Slot Size : Nlatrtal
From. To Ft. —in. in.
From To Ft. in, in, �?
IS SAND/GRAVEL PACK r
Depth Size Materia! w
z
From _. To - Ft. —
From To` Ft. - - - -
16 REMARKS f--
1
—
r
J DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE.WITH ISA NCAC 2C, WELL
CONSTRUCTIONSTANDAROS AND THATACOPY OFTHIS`c ORRD` HAS BEEN PROVIDED TO THE WELLOWNER
/D 7�Q Qa
I�LC c`t3rrc
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
Submit the original to the Division of tiVaterQunlity, Groundwater Section, 1636 Mall Service Center -Raleigh, INC
27699.1636 Phone No,.(9.19)-733-3221, within 3Q days. - QW1 REV. 07/200:
o --
:
u> ti jJ[

WELL CONSTRUCTION RECORD '293959
North Carolina • Department of Environment and Natural Resources - Division of Water Quality • Crouiidwater Section
WELL COINTRA701I!NDIVIDUAL)NA.ME (print) "Mitchell D. Cook CERTIFICATIONd—IL3
WELL.CQNTF,ACTOR COMPANY NAhIE $'� ailliI'tfr"I= -. PHO,YS.b 625) 369-959)
STATE WELL CONSTRUCTION PERMITN - - �—ASSOCIATED WQ PER,, I[T`#
" (ifaoolicable) "(ifabolibsble)"
' It WELL USE (Check Applicable Box): Residential 0 Municipal/Public ❑ Industrial ❑ . Agricultural ❑
Monitoring ❑ Recovery ❑ "Heat Pump Water Injection ❑ -Other ❑ If Other, List Use
2 WELL LOCATIOhI _
/ Topographic/Landsetting
Nearest I wn; G�ounty ❑Ridge ❑Slope ❑Valley ❑Flat
� (check -appropriate box)
(Street Name,: Numbers, Community, Subdivision, Lot No., Zip Code) 'Latitude/longitude of well locatiod..
3 OWNER (Jegreei/minntes.0 rands)
Address . Lautude/Ion,itude sourc :❑GPS❑Topograchic map
Street Ro teN ) (check bcn)
DEPTH DRILLING LOG
�� aCC�ty ar, n :1p Code - From o Formation Description
(
& 5�3
-a co
Are code. Phone number a _. crra7l.ite
4 DATE DRILLED
TOTAL DEPTH: s
6 DOES WELL REPLACE EXISTING WELL? YES ❑ NO 0
7, STATIC WATER LEVEL Below Top of Casing 00 FT. --
(Use"-" Ir Above Top. or Casing) _
8. TOP OF CASING IS 2 FT. Above Land Surface'
-Top of casing terminated at/or below land surface requires a
varlance In eccorda with ISA NCAC 2C.0I l8,-
9. YIELD (3pm): _ METHO TEST blow
�OF
10, WATER ZONES (depth): �
LOCATION SKETCH
I I DISINFECTION: Type H T H Amount 1 6oz Show direction and distance jr, miles from at least
,-
12 CASING Wall Thickness two State Roads or Ccunty Roads. Include the road
Depth Diam.efer or Weighi/Ft "Material mmoers and common road names.
From A ee
_0_To Ft ✓'
From To -' Ft.
-...
... .Fronr To " Ft. F
13 GROUT. Depth Material Method
�
From. To 20 Ftb�aLi,te & cmjIg t s c
From" _ To ; �..Fr
14. SCREEN. Depth Diameter Slot SizeNfIteriol
From To Ft. in in..
From To Ft. in, in
15 SAND/GRAVEL PACK: w
mN
Death Size Material
-�-+
From - To Ft. N
c
...'From To' Ft:
z
16 RENIARKS
=-
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE. WIT H 16A.N'CAC 2C,:WELL I?
CONSTRUCTION STANDARDS AND THAT A COPY OF THIS RECORD HAS BEEP PROVIDED
)r
TO THE WELL OWYER.
SIGNATURE OF PER50N CONSTRUCTING THE WELL DATi
Submit the original to the Divislon of WaterQunlity, Groundwater Section, 1636 Mall Sorvlce Center. Raleigh, INC I
21699.1636
POo to No. [phone], Wthln 30.days, GW•1 REV: 07/2001
I11 I

WELL CONSTRUCTION RECORD 29395$
North Carolma - Dcpartmenl orEnvironmml and Natural Resources - Division or Water Quality - Groundwater Section -
tiVELLCONTRACI'OR(lIvDIYIpuAL)NANIE (prink hUtchell D. Cook CERTIFICAMN4 2043
WELL CONTRACTOR COMPANY NAM E FZb&Ji-:.S F�U 131.L '-P 73-C PHONE# P28) 36}-979) -
- STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERN1174
f aoplibable) Nraoolioable)
' I WELL USE (Check Applicable Box): Residential 6 MunicipaUlaublic ❑.. Industrial ❑ . Agricultural O
Ij
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑
Other IrOther, List Use
2 1VE(.L LOCATI �n�
Topographic/Land setting
,�-�
Neares Town; County) L1AdO�J
❑Ridge ❑Slope []Valley 0-lat
'
(S Mree Nine Nmniaers, Communlly, Subdi^vision, Lot No., Zip Code)
t\14
.. (check appropriate box)
Latitude/longitude of Well location
3 OWNER 44A:aL4 L�1 11 (1 `Q %
Jeareei/iniriueih a;onE.)
Address nK _ I I e
-
LadtudeAongitude source: OGPSOTopographic mzp
.' (Sweet or Route No)
(check ban)
1( c2 %�
DEPTHDRILLING LOG
(O�QhySfTp ,_ ate ZaCode
From T / Formation Description
- Area code Phoue nwnbe•
clay &
1 r
)S �P l7b crranite
4 DATE DRILLED
6 TOTAL DEPTH:
6, DOES WELL REPLACE EXISTING WELL? YES Y ❑
7, STATIC W'ATERLEVEL Below Top ofCasing FT:
--
. (We "✓' if Above Top cf Casiq)
_
S. TOP OF CASING IS 2 FT Above Land Surface'
- •TOP. Or Ming t erminated at/or below land surface rqulrtf a.:
-
varlanct In accordavi with ISA NCAC 2C,0118,
-
9. YIELD (gpm): METHOD OF TEST blow
10.WATER ZONES (depth):_ Jr /5
—
LOCATIONSKET H
11 DISINFECTION: Type H T H Amount 1607
Show direction and distance in miles from a: least
12 CASING:Wall Thickness
two State Roads or Co'vi ty Roads. include tee
Dt meter or We. ht/Ft. Material
n _ g
From T e Ft.
road
numbers and commo, road names.-
"
From To Ft. .... ....
..
-..From.To Ft..
13 'GROUT Depth Malarial Methce.
From_#_ To 20 Fthatni;te & c8;stt a2 te3
-From _ To Ft.
- -
-
. 14:SCREEN' Depth. Diameter Slot Size-Materia'�
q
FTo —'Ft. _. m '
CMrom
From To Ft. in. in.
" -
IS. SAND/GRAVEL PACK
a
Depth Size Materfal
( __
From —To— Ft.
w =
From To Fr
3 rig.;
16 REMARKS
W - --
y DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH I3A NCAC
o
CONSTRUCTION STAND.4RD5 AND THAT A OP,Y OF THIS RECORD HAS
2C, WELL
BEEN PROVIDED TO THE
WELL
SIGNATURE OF P 11SON CONSTRUCTING THE WELL DATE
j
Su b It h
m t e original to the Division of Water Qunitty, Groundwater Section, 1636 Mall Service Center - Ralelgh, NC
27699.1636 Pho lc No, [phone], within 3Q days,t
GW-1 REVr07/2001

WELL CONSTRUCTION RECORD 293957
North Carolina - Dopartment of Environment and Natural Resources • Division of Water Quality - Groundwaler Section
wEL�coivTa�e�oa(avDlvlDu�L)N�mIE iprhtj Mitchell D, Cook CERTIFICA7101va2043
WELL C0,47RACTOR COMPANY NAME fffMEM&J S ii L PHon # 628) 369--955j
STATE WELLMO STRUCTIOiN PERMIT# ASSOCIATEDWQ PERMIT#
(ifaoulibabla)- (ifapplicabie) -
' L WELL USE (Check Applicable Box): Residential6 MuniclpaVPublic ❑: .Industrial ❑ . Agricultural ❑
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use
2 YVELLLOCATIO Topographic/Landsening
Neares'T wn: County���-1' ❑Ridge ❑Slope ❑Valley ❑Flat
.. (check appropriate bea) - - -
' (Strefi Nnina,. moors, Cmninunity S division, LwNo., Zip Code) -Latitude/Iengitude of well location .
3 .OWNER: _ (c'eareei/t,L-uteihe:onds)
Address Latitude/longitude source:❑GPS❑Topcgraphic map
/► Sue et or Route�hf) (clock ban)
DDT DRILLING LOG:
uy or To n a Zip Code From r T'o , Formation Description
Area cod nu Phone mbe /�� n ' crrcanite
4. DATE DRILLED 9-�n� -on
5, TOTAL'DEPTH:b r
6, DOES WELL REPLACE EXISTING WELL? YES P NO :Z
7. STATIC WATER LEVEL Below Top ofCasm3' FL --
- (Use"+' Ir AbaYe Top. o!Casiq)
8 TOP OF CASING IS 2 FT. Above Land Surfaee"
'Top of <asln8 terminated atlor below land sumacs requires a _
Yarlance In accordance Ith ISA NCAC SC ,0118.
9. YIELD (gpm): METHOD OF TEST blow
_10. WATER ZONES (depth): AqO
LOCATION SKETCH
11. DISINFECTION: Type H T H Amount 16oz Show direction and distance in miles Ivom at least -
12. CASING:Wall Thickness two State Roads or Co.mty Roadsinclude the
road
Depth Dt MCC, or Wes ht/Ft. • Material --. numbers and common road names.
From n _ To Ft. -n o _ )
C
-�L
-From To.. Ft. .. ;,
p
L-•
.
-r:�
.',
-From.... . To FC..-
13. GROUT Depth. Material Method
From 0 1 To 20 Ftk�' to & cast Mzrpe3
'From - To ' ;Ft.. _
W
-3 nY
14 SCREEN. Depth Diameter Slot Size : Material
From To —'Ft, —in.
From To Ft,_in, in.
j
�s
IS SANDLORAVEL PACK
Depth Siz: Mate, [at �
r
rV
From To' Ft,—
From— To Ft.
16 REMARKS
HIS ELL IN ACCOS
CONHEREBYTCONSTRUCTION
_
STIFY ANDARDS, AND
S, THAT A C COPY OF THIS ME SSEN .WITH ISA NCAC 2C, WELL
CONSTRVCTION STAh D.ARDS AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE W'cLL OWNER
:r
-1,41-
06
SI NATURE OF PERSONCONSTRUCTING THE WELL DATE
�
Submit the original to the Division of Water Qunllfv, Oroundwiter Section, 1636 Mall Service Center -
RENC 1
37699J 6J6 Phone No. .(Y 19) 733-3221, within 30 days. - - GWt REV. 07/3001

WELL CONSTRUCTION'RECORD 293956
North'Catcima • Dcpar:rrent of Environment and Natural Resources - Division of Water Quality.. Groundwater Section
-
WELL CONTRACTOR (NDIVIDUAL)NA14IE (print) MitChiell D. Cook CERTIFICATIOlYd 2043
WELL CONTRACTOR COMPANY NAME f8±'k1. Pi".� �k'1 D3i.Ll.ira, I= PHONE. M 82S 36S-959�
STATE WELL COiNSTRUC7101V PERMIT# �ASSOCI ATED WQ PER,MITd
_
- (ifac licabie) '(ifapolicable)�
I WELL USE (Check Applicable Box) Residential 6 Municipal/Public ❑ Industrial ❑ Agricultural ❑
Monitoring ❑ Recovery ❑ ' Heat Pump Water Injection ❑ Other ❑ IrOtner, List Use
2 WELL LOCATI N Topogrzphic/Land set;mg
Nearest\Tewn Cotnty ��U� ❑Ridge ❑Slope .❑Valley ❑Flat
1AAS1 y1 (check appropriate box)
(Street Na:ne,:Nui berg, Community, subdlvlsm LoINa.. Zip Code) Latitude/longitude of well location
3 OWNER ( earCCl�IIllnllk!/!<CpOdf)
Add ess . Latitude/lonyltu a sourceZOPS❑Topographic mup
_
: (Street a: Route N (check boa)
DEPTH DRILLING LOG
p� City or Town suite zip Cade From Formation Descriplion
38"70
(lnQ _0 clay & Q3
Area code- Phone number crrarl.lte?
4 DATE DRILLED
5 TOTAL DEFTH:
6 DOES WELL REPLACE EXISTING WELL? YES N
7, STATIC WATER LEVEL Below Top o°Casing: FT:-- -
., (Use'." If A'ocve Top of Casing) -
8. TOP OF CASING IS 2 FT. Above Land Surface*
-Top of easing terminated at/or belowland surface requires a
variance fn a<cordanc to iSA NCAC 7C A.la. - -
-
9. YIELD (uCpm): 5 METE(OD 9F TEST blew
10, WATER ZONES (depth):
LOCATION SKETCH
11, DISINFECTION: Type H T H Amount 16oz' Shcw direction and distance in miles Ivonrat least
12 CASING Wall Thickness two State Roads or County Roads, Include the road
c
Depth DlynetIt or Welghl/Fi. M tenzf numbers and common road names o
Frain To Ft.1p_
o
From
From.... To Ft.
13 ;GROUT. Depth Material Method
From n To 20 Ft k ifte & Leath nr rrxi W
rr�
From'- To `- Fi;..
>o
14 SCREENDepth Diameter Slot Si" : Nlateri4l
From To 'Ft. —in, in. (.9
From To- Ft._in. in.
.15. SAND/GRAVEL PACK ry
c
Depth - -Size `- Material -
z
From To LFt.-
From-To- - - Ft:
16 REMARKS. j
r-
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED Wt ACCORDANCE WITH t
15A NCAC 2C WELL
CONSTRUC71ON STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
7.�/fi/. %�f "AnL' /b 7k cro
5 GNATURE OF PERSON CONSTRUCTING THE WELL DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636uMall Sorvice Center - Ralelgh, NC
'
27699.1636 Phonc No..[phone], srithln 30 days. OW-1 REV. 07/200I

WELL CONSTRUCTION RECORD 293955 '
Nor(h CuoIIno • Dcpnrment of Environment and Natural Resources -Division of Water Quality -Grow ndwa ter Section
WELL CONTRACTOR (INDIVIDUAL) NAME (prinq MitChell D. Cook CERTIFICATION i 3
vYELL CON'f RACTORCOtYIPANYNA.NIE "'S P,�11. 13-+11 =, j '. PHONE N m) 9-9791
-
STATE WELL CONSTRUCTION PERMIT# - ASSOCIATED vYQ PERMIT# -
(ifacUlicable) - `(ifapolicable)
L WELL USE (Check Applicable Box): Residential 0 MunlcipaVFublic ❑ <Gdus;rial ❑ Agricultural ❑
-
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ . -Other ❑ IrOther, List Use
2 WEOCATIO ! II (/jny�y�.� Topographic/Land setting
Near s Town: (/IIA o ny—v
'
❑Ridge ❑Slope ❑Valley ❑Flat
(checkappropriatebox)
(Sager Name, Numbers,Lammunity, Subdivision, Lai No., Zip Code) Latitude/longitude of Well location. -
3 OWNER•
C
- (degrees/.t :gates/se:onds)
Addrass
s
Latinid _/longitude source:❑ 0 PS❑Topographic map
JMAALJ73DEPTH,
'tSlree i.or Route No) (cht:kbox)
DRILLING LOG
na ni Iyor �IXwn �So Zip Code - FromT J Formation Description
&
clay sar,3
Area codePhone ber 9 33' ��v 'granite
4. DATE DRILLED-T=
d. TOTAL DEPTH:_Ado
6. DOES WELL REPLACE EXISTING WELL? YES
7 STATIC WATER LEVEL Below Top of Casing FT: --
.. (Use"=' Ir Above Top. o(Casing)
8. TOP OF CASINO IS 2 FT. Above Land Surface' -
'Top creasing terminated atlor below land surraco requires a
varlance In accordance with ISA NCAC 2C 0118,
9, YIELD (gpm): __ ME�TH�OD OF TE•S blow
10 WATER ZONES (depth): 1120 /y(j! —
"0 ATION SKETCH
:I. DISINFECTION: Type H T H Amount 16o7 Shaw direction and distance in miles I)om at least
12 CASING Wall Tmcxriess two State Roads or County Roads, Include the road
Depth Di , o� We.ght/F;, M serial numbers and common road names.
From TOFt. _
From rTo" Ft. �e„_: _%I�s�T
-- From— To Ft..,. - :.. 4;_
13 GROUT Depth Malcrial Method b
�'
From n To 20 Ft4nm to & C31, &_ n <
From 70 ` FL p
14. SCREEN: Depth Diameter Slot Size Material
°[J
From To 'Ft_in. ir,.''
From To FL—iit,
an
in.
15 SAND/GRAVEL PACK w
Depth Size Ma'eial
From - ToFt. ru
From To Ft.
_
16 REMARKS
t `
1 DO HEREBY CERTIFY THATTHIS WELL WAS CONSTRUCTED IN ACtORDANCE.WITH I5A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF TH(
jj
4EC0 HAS BcEN PROVIDED TO TH-- WELL OWNER
SIC ATURE OF PERSON CONSTRUCTING THE 54ELL DATE
Submlt the original to the Division of WaterQunlety, Groundwater Section, 1636 Mall Sarvlce Center - Ralelgh, INC
27699.1636 Piano No. [phone],
wlthln 30.days. G ti4•I RE.V. 07/:001

WELL CONSTRUCTION RECORD 2 ,1954
North Catolma - Deportment of Environment and Natural Resources • Division of Water Qua Iity - Groundwati rSection
1YELLCONTRX&OR(INDIVIDUAL)NAME 1prini) �Litchell D. Cook CERTMCATIOIN2043
wELL CONTRACTOR COMPANY NAME Febm$'C:'72.'S G(E1. a-illirrr, pHON&A 8.) 369-959�
S'rATE WELL CONSTRUCTION PERNUTat ASSOCIATED WQ PERh117N
(ifaoulicable)— - '(ifacolicabie)
1 WELL USE .(Check Applicabie Box): Residential 6 Municipal/?ublic ❑ ..lndusvial ❑ Agricultural ❑
Monitoring. ❑ Recovery ❑ Heat Pump Water Injection ❑ -Other ❑ frOther, List Use
2 tiY aATIC) Topographic/Land setting
Nedrcses, ' 0 own; County ❑Ridge ❑Slope ❑Valley ❑Flat
(check -appropriate box) _
(Street Nnn,e,.Numbcrs,Can . unity, Subdiviaiun, Lot No, Zip Code) Latitude/longitude of well location. -
3 OWNER {CegreeiAnlaiiteihecondU
Address Latitud:/long tude source:❑0PS❑Tepcgraphic muc
AC'IS Sect r Rou;e No ^ (check boa)
D ^PTH DRILLING LCG
ChyOFT w�Zip Code From 7 Formation Description
Area code Phone number��ssnn r
4. DATE DRILLED--��� ��)[ granite
5, TOTAL DEPTH: r
6, DOES WELL REPLACE EXISTING WELL? YES ❑ N0 K
7, STATIC WATER LEVEL Below Top of Casing.. inn FT.
(Use,•," it Above Tapor
8. TOP OF CASING IS 2 FT. Above Land Surface,
•Top. orearina terminated atlor below land surface reautrera
. variance In accordance with 16A NCAC IC,01 18,
!VD 9F TEST blow
9, YIELD (gpm): y` Q_ ME j�'
10. WATER ZONES (depth) �i
LOCATION SKETCH
IL DISINFECTION: Type N T Fr Amount 16oz "
Show direction and distance in miles from at least -
12 CASING Wall Thickness
two State Roads or County Roads. Include the road
Depth Di Teti- or Weibhr/Fl ' Material
From To Ft. 4
From To r
numbers and co ,,:non road names
o
Fr.�(¢�
-Jar—
.From - To Ft.
13.:GROUT. Depth Material Method
From n To 20 FJ:1 a tE & ce s t
t.
From To < Ft.
w
f4 SCREEN' Depth': Diameter Slot Size Nlarena'
- -�
From To Ft._in. in.
From To Ft —in, in.
Cl)
.15..SAND/GRAVEL PACK:
Depth Size - Maria;
From To Ft.
rV
From _. To- Ft:
e7o
z
16 RE NI ARKS I
r- I
LDO HEREBY CERTIFY THATTNIS WELL WAS CONSTRUCTED INACCORDANCE.WITH 13A NCAC 2C, WELL _
CONSTRUCTION STANDARDS AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
SIGNATURE OF PERSON CONSTRUCTING THE WELL o�
ATE
r t
Submit the orilinnl to the Division of Water Qunlity, Groundwater Section, 1636 Mall Sorvlce Center-AaIe.IQh, NC
27699.1636 Phone No [phone], within 30.dayL
0W•I REV.07/2001

WELL CONSTRUCTION RECORD
293952
North CaTolma • Department of Environment and Natural Resources • Division of Water Quality • Groundwater Se.tion
WELL COIVTRa,�C9'0R0NDIVIDUAL)NANlF (prinl) MitChell Q, Cxk CERTIFICATl01Vtr20d3
1YELL{ON'I'RACTOR COiIIPANY NAiYIE H333 1 Fz&�5 Nam. D LLlingZrz " PHon k 829 3p9-5j9�
STATE WELL CONSTRUCTION PERMIT# - ASSOCIATED WQ PERMIT# -
- (ifauulicable)- -' (if abolicable)-
Ir WELL USE (Check Applicable Box): Residential 3 Municipal/Fublic ❑ Industrial ❑ Agricultural ❑ .
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ -Other IrOther, List Use -
WELL LOCATIO Topographic/Landsetting
6M.LCO
Nea-es;
w Alw k ty.614,M111 ❑Ridge ❑Slope ❑Vall.y ❑Fiat
(check opproprmte box)
(Street None Numbers Come oily, Subdivision, Lot No, Zip Cole) Latitude/longitude of well location
..
3 OWNER
(ce7r«s/n muteahe:ond.)
- -
Address fS)
Latuude/longitudesourc ❑GPS❑Topographicmuo
Jp/A�pQ (Sit 'Route No) (check b:a)
3��aa�
'� T DEPTH DRILLING LOG:
a:yo•Tw S t Zip 0 Fla&on�Descriptior.
Area code Phone number 'g2'd71.1 t.E
4 DATE DRILLED
- TOTAL DEPTH:
6 DOES WELL REPLACE EXISTING WELL? YES ❑ NO I�
7. STATIC WATER LEVEL Below Top ofCasing--
-(Use "+" it Above Top. art Cas ra)
8 TOP OF CASING IS 2 FT. Above Land Surface"
'Tap ofca lnp terminated at/or below land surface requires a -
-
varlance In accordant with ISA NCAC SC,Gll3, -
9. YIELD (gpm): _ METE flD F TEST blow
10. WATER ZONES (depth): L�[ ��e
LOCATION SKETCH
11. DISINFECTION: Type H T H Amount 16oz Show direction and distance in miles from a; least
12 CASING Wall Thickness two State Roads or County Roads. Include the road
Depth„ , Dia e r or We.ghl/Ft. MPtec numbers and comnon read fames
From n To C/O
Ft:_� y
From To Ft. -
From To Ft.
O
13.-GROUT: - ,Depth .. Material Method '
fir_
'From n To 20 lctk to & tes? _ txl �
n
_
From To '.; .:Ft,.'
`
14, SCREEN: Depth Diameter Slot Sae
From To Ft._m. n.
From -To Ft, in. in Y
IS. SAND/GRAVEL PACK
n�
Depth Size Material
-
From - To Ft. r
From - To Ft. N
o
-
16 REMARKS
I
1 DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH, I iA NCAC 2C, W—ELL
CONSTRUCI"ION STANDARDS AN`D�TYnAT A COPY OF
THIS/P-ECOOR�D BEEN PROVIDED TO THE WELL OWNER
�HAS
In od
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
Submit the origlnnl to the Divlslon of WaterQunlity, Groundwnter Section, 16361Mail Service Center •RaleighNC 2i699•t636 Phono No..[phone],
,
within 30.days G'N•I REV. 07/200!
-
I I

NVELL CONSTRUCTION RECORD 293949
North Carolina - Dopartment of Environment and Natural Resources - Division of Water Quality - Groundwater Section
4VELLCOiVTRACTOR(IIVDIVIDUAL)NA,ti!E (prfn!} Mitchell D. Cook CERTIFICATION# 2043
WELL CONTRACTOR COMPANYNAME_ `S V,E.L�. f]-11L=' T1-L' PHONE ,°. 62 ) 3649591
s'rATE WELL CONSTRUCTION PERMITr - ASSOCIATED NYQ PERMIT#
(ifaoplicable) - '(ifapolicable)-
I WELL USE (Check Applicable Box): Resid-intial 6 Municipal/Public ❑ Industrial ❑ Agricultural ❑
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ other ❑ If Other, List Use
2. WELL tOCATIO YontYNea'cs�' Topographic/Land s. tting�cwrr-LJ�U ❑Ridge ❑Slone Valley
❑Plot
,.(check opprapricte box)
(Si«et Natie, Numbers, Co:runur iry, Subdivision, Lot No., Zip Code) Latitude/long,lude of Well location
3. OWNER:
(deq::>/u'ninesheconds)
ma
Address Latitude/lon"i uae source.❑OPS❑Topographic p
o'cct or Ro to of (clack bat)
DEP T H DRILLING LOG
JA
CitYcf w'n t e Zip Code From o Formation Description
(read) &
Area coda Phone man^ter g2,anite
4. DATE DRILLED
S,TOTALDEPTH: �
6. DOES WELL REPLACE EXISTING WELL? YES ❑ N0
7, STATIC WATER LEVEL Below Top of Casing'. F
(Use "=' it A'ocve Top or Casird)
S, TOP OF CASING IS 2 FT. A'ocve Land SuFCace'
-Top of casin; term,nated at/or below land surface requires a
variance In accordance th ISA NCAC 2C.0113. - -
9. YIELD (gpm): � METHOD OF TEST blow
10 WATER ZONES ( .nth) —
LOCATION SKETCH
I I. DISINFECTION: Type zr T H Amount 16o7. Show direction and distance in miles fiom a: least
12.CASING: Wall Thickness two State Roads or Cot:nty Roads. Include the road
Depth Dor Weight/FI. M ter'al numbers and common road names.
From To Ft.
ee ��'/'
Frcm�ToFt.ell
.From - To - Ft,
13. GROUT: Depth Material Method - �-
From n To 20 Ftke-mite & C�tg;t n�3 - 47 CD
From To -Ft.
14, SCREEN: Depth Diameter Slot Sizc NlatrinI
.:Prom To FL —in. in. '^^
From To Ft in in.
W Gn
15,'SAND/GRAVELPACK:
is
Depth Size Size Material
-From To _ FL
From To Pt. M
� o C
16 ct
REMARKS:
I DO. HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED INACCORDANCE WITH ISA NCAC 2C, WELL
CONSTRUCTION STANDARDS AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE @l al.L OWNER I
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE I
Submit the original to the Division of Water Quality, Groundwater Section, 1636 tNlml Service Center - Raleigh, NC 27699.1636 Phone No. [phone], within 30 days. OW-1 RE.V. 07/2G01 : -

WELL CONSTRUCTION RECORD 2938.45
North Carolina -Department of Environment and Natural Resources • Division of Water Quality- Groundwater Section
VELLCOTRACTOR(IIYDIYIDUAL)INAME (prini) Tares B. .Prow CER7I9117ATIVI_2045
WELL CCiN'r R,v CTOR COiMPAiVY NAM11dN�dEn BrO lE''r5-We11 :Dr111inQ,;. inc PRoNz A8 1 3fi9 y591
- STATE WELL CONSTRUCTION PERMITp ASSOCIATED WQ PERv11Td
1. WELL USE (Check Applicable Box): Residential IMunicipal/Public 0 Industrial ❑ Agricultural ❑
1 '
NicrikQeing 0 'Recovery ❑ Y.eat Pump Water injection ❑ Oilier ❑ 110ther, List Use
2 WELL LOCATIO �� Topog.appic/Land setting
Near tTown: _County —Iy ❑Ridge 11Slope ❑Valley ❑Flat
i0 VPA II A/yte (check avpropriate bcx).
(Strain Na 'Numbcn, Coimnwdty, subdivivon, Lot No, Zip Code) Latitude/longitdde cf well location
3 OWNER r"Idae Gegre ea,, In ,tmheca da;
Adatnds - �ni - Lahttida/longitudesoi c.:C7GPSOTapograohw maP
(s11rer
or Roue No. '. (check bcx)
��- 52 73� DEPTH, MLL(NG LOC3'
'— i r
Iry o'r Ta.vn- St t Zip Ccde FromJ Formation Deser anon
S
,To�} clay & Sand
ciiLDi ,5i�—Sy.
Area code Pho"o 750 crranite _
4. DATE DRILLED
5, TOTAL DEPTH. O r
—
6 DOES WELL REPLACE EXISTING WELL? YES ❑ NO (
_
7.. STATIC WATER LEVEL Below Top of Casing: ).'50 FT. —
(Use •'t" if Above Top of Caeina).
S. TOP OF CASING IS 2 FT, Above Land Surface" —
-Top. of casing tarminated at/or below land rarface requlru a —
varNnce In: accordance with ISA NCAC IC.0118.
9. YIELD (grim): 4Q_ METblow _-
rFTEST
10• WATER ZONES (depth):LOCATION
SKETCH
11. DISINFECTION Type H T H Amount. ; 16 cz Show direction and distance in miles froin at least
12, CASING: Wall Thickness twoStatc Roads or County Roads, Include the road
Depth DI meter or WeighVFl Material numbers and common road names. '
From 0 ToFt u
o
From To - Ft.
From To Ft.-
13.'GROUT: Depth Material Method
—
From 0 To 20 Ft. ba'u& O e t . 'pumped t
c
T.
From ' To Ft.
-
14,- SCREEN:. , Depth Diamet:r :. Slot Size . Material 3
From To '.Ft.in in. -
w
cn •�
From To Ft. in. in. -
r"^'
15. SAND/GRAVEL PACK:` F
Depth Size Size Material
From -' To Ft.
From ` To _ Ft.
16. REMARKS.:.
i.DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE %VITH I5A NCAC 2C, WELL
CONSTR UCTION STANDARDS; AnTHAT
.A COPY OF HIS OR:D HAS S EEN PROV ID E D TO THE WS LL ONk1=R
V
ATURE OF -PER ONCONSTRUCTING7HEWELL. DATE
Submit the orlyinal to the Division of Water Quality, Groundvynter Section,1636 Mall Servlca Center- RaleiZh, NC
�,27699.1636 Phonc No, [phone], within 30 days, - OW•I.REV. .07/2001

WELL CONSTRUCTION RECORD P.
North Careiina • Department of Enro ironment and Natural Resources • Division o. Wale Quality - Grour.d,vate; Section
YELLCO;NiRAC1'OR(IINDIYIDUAL)NA�1E (pnnp James B. Brown CRTIFICATIOtNR 2045
WEI, IL CON1 R,\CTOR CONIPAlvY nAMEHedderl Brothers Well : Drilling, ric PHONE k �') �g1
s'rATE WELL CONSTRUCTION PER'.MITp ASSOCIATED WQ PERNIfTk
(if ace l icable) - (i f aor. l!cable) : .------ --_.
I, .WELL USE (Check Applicable Box)', Residential 21 Municipal/Public ❑ Industrial ❑ Agricultural ❑
Monitoring ❑ Recovery Cl Heat Pump Waterinjection ❑ Oilier ❑ If Other, List Use —
2, WELL LOCATIn.� /�/'^/nA ,I�, � Topographic/Land setting
Near �tTo��n:' g 1 County--L�l-kgleno ❑Ridge ❑Slope Oval' y ❑Flat
lox�• - - (che k app ovratt box)
(Street Nrin: Numbcrs,Comn"n , Subdivision, Lot No- ZipCode) Laitude/lonvitudC ofwel: location
3. OWNER. (dtgr:a9r'n, .es'a:ernds;
Address Latltudc,l ncltudesot �e,❑GPSr'Topovraphw map
(Siren r ult, a.) (clteck bea) i - --.
DRILLING LOG '
City or To.,n tam Z',;Code From T , Formation U1e�cc�taea =_--- -
(_) —` Clay & S'�hCl
Area
' Aa code Ph,,.�e uumhe1rT5 64raIlitE _
4. DATE DRILLED
I: —
5. TOTAL DE?Tf:':
6. DOES WELL REPLACE EXISTING WELL? YES ❑ _NO ❑
7. STATIC WATER LEVEL BelowTop of Casing, r� `D FT. _
(Ls.- "r" if Above To? o,` Casing).
S. TOP OF CASING IS 2 FT, Alcove Land Surface'
"Tap or casing terminated at/or below land surface requires a —
Variance In accorden�e frith ISA NCAC 2C.0118 —
9 `YIELMETHOD OF TEST blow _-
10. WATER ZONES (depth) /Mi LOCATION SKETCH
I I. DISINFECTION: Type H T H Amount 16 OZ Show direction and d'sr nce in miles froin at (east
12. CASING'. Wall Thickness two Statz Roads or County Road;. Include the road e=
De^tnDI m_ter or Weight/Ft,, i tonal n3mbea anal common road names. O� o
From To
. From To ((nn// Ft
From- To Ft.
13.'GROUT: Depth Material. Method i
W —r,
From 0 To 20 Ft. mite &S Pur xsl
From To Ft. A
14 SCREEN: Depih Diameter Slot Size Material r-n'
. From To Ft._im _ in. W
From To - Ft. itt _ in. rn
15. SAND/GRAVEL PACK
Depth Size Material -
From To Ft. - -
From Tc Ft. -
16. REMARKS`.
1 DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A AC 2C, WVELL
CONSTRUCTION STANDARDS, A' THAT A COPY OF THIS CORD. HAS BEEN PROVIDEDTOT HE WELL OWNER
SIG A7URE OF PERSON CONSTRUCTING THE WELL DATE
Submit the original to the Division of Water Quality; Groundwater Section, 1636 Nla" Service Center - Raleigh, NC
27699.1636 Phone No. [phone], within 30 days, - GW•1 REV. 07/2001

WELL CONSTRUCTION RECORD 293835
North Carolina • Department o, cnvironment and Natural Resources - Division of Water Quality • Grourcwater Section.
YELLCOIYTRAC1'OR(IiVD1VlDUAL)lYA 1E (print) Janes B. Brown :_ CERTIFICATIOtV 2045
WELL CONTRACTOR COMPANY NANIEHedCIen Brothers well Drilling, inc PHONE d G�31-sp-�91
- s'rATE WELL CONSTRECTION PERMITA 4SSOCIATED WQ PERMIT"
- (if applicable) ,_ (if applicable)
t
I. WELL USE (Check Applicabla Bo,e). Resicer ial o MunicipaVPublic ❑ Industrial ❑ Agricultural ❑
- Monitoring C Recovery.0 Heat Pump Water Injection❑ Other ❑ if Other, Lis! Use
2, WELL LOCATIQ : {�/�p,,�,, � Topog;apnic/Land setting ;.
NearestTown. County_LlJ%1d,� - ❑Ridge ❑Slope. ❑Vall y CFlat .
N&AA 0 VA# Lk, � - (checR approp'ate box)
_I
(StrewNm. IN en,Community, S bdMvon, Loa Na., Zip Code) - Latitude/longil'ude ofwelt location
_ 3.-0WNER, -(Legroom ninwm/aeands)
_._._
- Address _Latitude/longitude source ,OGPSETopogreohicma,
'—
(51 ees or to No.) - - (u.eck box)
�lI/Llt/%1�wnJ 1UC ��73L/ DEPTH DRILLING
- n,rCt otTcwnr� 5.; �J ZlpCode from T FornulonDescription
JdV 0 / coiay & sdIla
(X/h� a7
Aron toot. Pwnenumber ar?S1ite _
4, DATE E DRILLED 10.19-11
5. TOTAL DEPTH:QA S s —_
6, DOES WELL REPLACE EXISTING WELL? YES ❑ NO
i. STATIC WATER LEVEL Below Top of Casing: MID FT. -- —
. (Use •',' If Ata'/e Top cf Casln;)
S. TOP OF CASING IS 2 FT. .Above Land Surface' —
'Top of casing terminated at/or belo+v land surface requires a —
varianceInaccordance vlsh I5A ;NCACZC.0113. —
9. YIELD (pm) a METHOD OF TEST blow
'
to, WATER ZONES (depth): UO
LOCATION SKETCH,
11. DISINFECTION: Type H T H Amount 16 02 Shoo direction and distance in miles fi'oin at least
12, CASING: W4 Thickness I hvo State Roads or County Roads. Include the road
Depth D:amete; p• WeighL'Ft.. Material numbers and common road names.
From 0 To.-.Oq& Ft._o „ �lj[G— o
o`
From To - Ft
From - To Ft.
13, GROUT: . Depth. iMaterial 1Nlethod
From 0 To 20 Ft, bai=te & citim pumped t
v-
From To Ft. _
y
14, SCREEN: Depth Diameter Slot Size tNlaterial 73
r^
z
' From -"To Ft —in in.
�
From To Ftin.in W
na
15, SAND/GRAVEL PACK' m
o
Depth Size Ma!erlaF _
z
From _ To Ft.
From To Ft.
16. REMARKS
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
COt 1STRUCTION STANDARDS, AN THAT A COPY OOF THIS °COR-D HAS BEEN PROVIDED TO THE WELL OWINER
IGt' TURE OF PERSON CONSTRUCTING THE WELL DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center • Raleigh, .NC
27699-1635 Phunc No. [phone], within 30 days, - - - G\vI.REV. 07/2901
t

29*78" -
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Wate, Quality - Ground'vater Section
wELLCOIVTRAC1'OR(INDIYIDL�L)NA}IE (print) James H. Hrv4,n . . CERTIFICAT10,, 20�5
wELLCOiv'IRnC'ORCoI,NIPANYNAhIEHedd?n brothers Well Drilling, Inc PHoNE a828) 63 9-9591
STATE WELL CONSTRUCTION PERMIT9 ASSOCIATED F'Q PERMIT,
(if aonlicable). _. _ (ifapnlicable)
- I. WELL USE (Check Applicable Bo,x)'. Residential l!1 Municipal/Public ❑ Industrial ❑ Agricultural ❑
-
-- Monitoring ❑- Recovery ❑ Heat rump Wate, Injection Cl Other ❑ bother, List Use _
2, WELL LOCATION: M�,�,�-y , Topographic/Land setting
NearestT wn I Countvll- Q—fx—) ❑Ridge ❑Slope: ❑Valley. ❑Flat
(chaRappropriate boz)
tStrcC aine,Ntijnburit, Ca tnuoily, uhdiYiflOn, Lot Na., Zip {ode) Latiwd-/Iongltude or well location
3. OWNER'. (dege sminwes/sacanas) l
'-
�t- -
Address JAAAD Lail(ode/loruitudesotca❑GPSLT000ur4ohlcmar
- (�(rntt.ar Route nN y) (cl�.eck tipsI
—
Q�rJI /11a-s�-1j-C�-(/lf� j NL 7 �,/ DEPTH DRILLING LOG
11v or To, n Sate Zip Code +- From To Formation Descr Lotion
OW). '5;94 - 35 A 0 I clay & sans
Area code Plwne num'aer e Qranite
_
4. DATE DRILLED 1O
P
5 TOTAL DEPTH:
6 DOES WELL REPLACE EXISTING WELL? YES ❑ NO ❑
7. STATIC WATER LEVEL Below Top of Cash,,,: a00 FT.
(Use "✓° if Above Tap of Casing)
S. TOP OF CASING IS 2 FT. Above Land Surface' —
'Top of casing larminated at/or below land avrrace requires a —
variance In accordance with ISA NCAC 2C.0118. —
9. YIELD(gpm) eQ METHO OF TEST blow _—
10. WATER ZONES (depth): ) C)
LOCATION SKETCH,
11. DISINFECTION: Type H T H -Amount - 16 02 Show direction and distance in miles from at least
12. CASING: Wail Thickness twoStatc Roads or County Roads. Include the road
- Depth �.�,� DI :.r cr Weigh�JFt.. %1 tzrtnt numbers and common road names.
..From To w� Ft ys rrc:
r_
_ O
From To /I�LHH Ft Zee
From To - Ft.
13, GROUT: Depth (Material : ivichcd
c�
From - 0 To 20 Ft.t�rnite & csTErt P=Ped
Front ' To Ft,-
7,F m
14, SCREEN.. -Depth: Diameter Slot Size tblatertal -v
From -- To - Ft —in, in.
From To - Ft _in. in.
�•—
15. SAND/GRAVEL PACK: w
<=
Depth Sae Vote nal - a7
From To ct
z
Frcm To - Ft
16. R^IVIARKS:-,.
I.DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, ANDD A COPY OF THIS R�_^ORD HAS SEEN PROVIDED TO THE W cLL OWNER
SIGNj.UREOFPERSON CONSTRICTING THE WELL - DATE
Submit the orl,inal to the Division of Water Quality; Groundwater Section, 1636 Mail Service Center- Raleigh, NC
27699-1636 Pitunc No. [phone], within 30 days. OW-1 RSV. 07/2,001

293830
NVELL CO','NSTRUCTION RECORD
Ncrth carcliiiia D-partmeit of Environment and Natural Resources . Division of%'/aterQuality - Groundwater Section
. James B..Bzown 2045
(print) CIRT
ing , Inc ,
WELL CC NTRACTOR COMP AIN Y NAME Heiden Brothers weil.Dnilli PHONE
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED 'IVQ PERMIT.
I WELL USE (Check Residential N Municipal/Public 0 Industrial 0 AgriculturalC3
Applicable Box)�
Monitorin6Cl Recovery 0 Heat Pump Water Injection C Other 0 IfOther, List Use
2. WELL LOCATI 1 Topographic/Land setting
Neare yTfo"wn. ?.� County ila —SI cpe CValley OFlat
(check appropriate box)
(Street Name Nwr'-Qrs Comiimnity ubdivisiou,. Lot Na., Zip Code) Latitude/longitudc of well location
3. OWNER:
Addl'uss source:CGPSC]Tcpogra.phic map
a(r4el of out Na (check box)
u;-Iu X, lur AL41 DEP I H DRILLING LOG
City dr o.�n at 2:' Code From Tn Format'on D I U.
on
clay & sa�"
Area code. Plicoo nwr'car
.)141 tP GILD I crr&n2.te
4. DATE DRILLED _�V'�'13-60
5 TOTAL 0--'PTF:, DOO'
6i DOES WELL'UPLACE EXISTING WELL? YES ID NO
—
7.,STATIC WATER LEVEL Below Top of Casing,
(Use"+"irAbove Top of Casing).
—
S. TOP OF CASING IS — 2 FT. Above Land Surface*
-Top at casing terminated at/or below Tand surface requires a
varlAnce
9. YIELD (ypm) (,0 METHOD OFTEST b1CW
10. WATER ZONES (ftpth): —7
LOCATION SKETCH
11, DISINFECTION: Type 1i T H Amount— 16 Oz Show direction and distance in miles from at least
11 CASING:.' Wall Thickness Iwo State RcIads or County Roads. Include the
road
Dept-th 'ool/ Da t or Wei
W i I VFt. materialmaterialnumbers and common road names.
Frorri Tct__%� Ft._=.nVc
From To Ft
From To Ft.—
CD
4�
13, GROUT: Depth mawia! Method
:M
Firm 0 To ' 20 Ft. agns­± ptImbed
FromTo Ft.
14, SCREEN: Depth Dialnetep Slot Size Nlate;ial
From— To— Ft. in in.
From To Ft. —in. In
15. SAND/GRAVEL PACK,
Depth Size Material
From To Ft. —
From To Ft,
M REIVIAW;
100 HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH I SA NCAC 2c, WELL
CONSTRUCTION STANDARDS,O THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
IN CONSTRUCTING THE WELL T DATE
Submit the. original to the Division of Water Qu'alit.y, Grouldwtiter S",tiori, 1636�Nlafl Stry1ce Center - Raleigh, INC
27699-1636 Phnnc No. [phone], withlin 30 dais. GW-I.R_=V. 07/2001

293831
WELL CONSTRUCTION RECORD
North Carolina- Department orcnvirenment and Natural Resources - Divtsior,'of Water Quality- Ground,vater Section
WELL CONTRACTOR (IiNDIYIHAL)INAME (prinl) James A. .Frown CERTIFICAT10tyR 2045
WE LL COiV'ILRA CTO R CO hI P A NY. N AM E Hedden Brothers PtE?11;Dr1111ng,-. Inc — PHONE k L i_3_E _Qj91
"- STATE WELL CONSTRUCTION PERMITS ' ASSOCIATED WQ PER,YI IT.
"`-(ifxoplicable). ": .. ..(ifaohLcable)
I WELL USE (Check Applicable Box): Residential J� Municipal/Public C7 Industrial ❑ Agricultural O -
-
Mcnitoring ❑'Recovery ❑ Heal Pump WaterinjectionIJ Other ❑ If Other, Lis! Use _
2 WELL LO.CAT1 Tupcgraphic/Land setting
Nearest s Wn: Cou ri 1 /G{�Cd ❑Ridge ❑Slope. ❑Valley, ❑Flat
V tie (check appropriate bon) -
(street Name,Nui crs, Cmmisunity, Subdivision, Lot No., Zip -C de) Latitude/longitude of Well location
. 3. OWNER: - (de greeshnlndres/seconds)
-Address.I source:OGPSGTepograph,ie map-
-
SireitM ear eteek box
��^ -73� IDEPTF DRI LL NG OG
G s, Zip Co,.From T Formation Descrlohon
Q Yt SdI4
—/
Area code• Pneiw umosr 3 granite
4.DATE DRILLED
5. TOTAL DEPTH:
6. DOES WELL REPLACE EXISTING WELL? YES NO j
7. STATIC WATER LEVEL Below Top of Casing' FT.
" (Use"f" if Above Top of Casino) .
S. TOP OF CASING 1S " 2 FT, Above Land Surface* —
-•Toli. cl'culng larminated at/or below land surface requires a . .
varIAn ce In accordance srtth 1S.A. NCAC IC.0118
_.
9.'"YIELD (gpm): ME]4Lj]6F TEST —blow
10, WATER ZONES (depth): _
LOCATION SKETCH
I I iDISINFECTION: Type' F: T H Amount 16 02 Show direction and distance in miles froin at least
12. CASING: Wall Thicknesiltwo State Roads or County Roads. Inckide the road
"
Depth Di mete; or Weight/FI � Cenal numbers and common road names
From—�0 Ti; Ft —7�' C
F to
From To Ft. "
o .
. 13.'GrROUT: - - . Depth . Material Method
From 0 To 20 Ft, br3rnite & C8 St puml ed
From ., To Ft. .. t.
14, SCREEN. Depth Diameter Slot Sae Material -
;
.. ..:
'From -'To Ft, _ill. in.
From To Ft._in.'
15. SAND/GRAVEL PACK: w
`.Depth SIZe .Material W
From "- `.To Ft. rn
o
From ` To Fl. _
z
I REMARKS. "
I.DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH ISA NCAC 2C, WELL
CONSTRUCTION STANDARDS, AN AT A COPY OF THIS RE ORD HAS SEEN PROVIDED TO THE W ILL OWNER
6v
i URE O- PERSON CONSTRUCTING THE WELL -. DATE
Submit the orl;inal to the Divlsla, oLWater Quality, Groundwater Section; 1636 Mall Service Center- Raleigh, NC
27699.1636 Phhno No. [phone], within 30 days: '_., - G W:I.REV. 07/2001

WELL CONSTRUCTION RECORD 2 � v
(forth Caroluia-Department of Environmentand Natural Resources • Dlvtsiinof Water Quality • Groundwater Section.
1YELEC0ITRAC1'OR(hYDIVIDUaL)yA61E (prin!) James A..PrDwn CERTIFICATION 22045
wE1L' CON' IMACTORC0N1PAiN.YNAME Hedden Brothers We11;Drilling; Inc ?Hon a M 369369 95 1
STATE WELL CONSTRUCTION PERMITO. ASSOCIATED, IYQ PERM17"
WELL USE (Check Applicable 3o,e): Residential el' MlmicipaI/Public ❑ Industrial ❑ Agricultural ❑
Monitoring C Recovery ❑ Heat rump Water injection ❑ Other ❑ IFOther, List Use
2. WELL LOCATI yy��,,��� Topographic/Land setting
Neares own: CountyJ�K2 ❑Ridge ❑Slope. ❑Valley. ❑Flat
1 /VU ta%r OA - (check appropriate box)
(Streel Name, Nwnbera, Community, Subdivision, Lot Nc., Zip Code) Latitude/longitude of well location
3, OWNER. LegreeaAdmnta se<onda)
� 'Address. P4 JJ AjaAi, Latilurr!c/longitudescurce:CGPS❑Topographic map
($geee or ow NcJ (chrk box) -
G�i DRILL(NG LOG
ery orT vn Zip Code From To Formation Description
Qgrj\( 77`f y clay sand
Area coda Phc iie number CfraIlltE
, 2ano
-lo-=
4. DATE DRILLED - II' —
6 TOTAL DEPTH: (y f)0 r
6 DOES WELL UPLACE EXISTING WELL? YES ❑ 0 —
7. 'STA'r IC WATER LEVEL Below Top of Casing:—
(�h:"+"if ASave Top c.`Catin�r. -
S. TOP OF CASING 15 2 FT, Above Land Sur face' —
'Tap al cailng terminated at/or below land surface requfrer a —
variance In accordance vlrh tSA ,NCAC 2C.0118.
9.'YfELD (gpmj e9tO ME�� TEST blow _—
10. WATER ZONES (depth): Qj _
LOCATION SKETCH
I I DISINFECTION Type' H T H Amount 16 oZ Show direction and distance in miles from at least
12. CASING: Wall Thickness two State Roads or County Roads. Include the road
.
Depth Dlzp eiTr or Weigh'lFt N',aterial numbers and common road names.
From 0 ToPt
From - To - F;.
o
From - To - Ft. -p
o
11 GROUT: Depth Material Method s
Ffbm 1-0 To 20 Ft. h3rnite & CEtn� : .pumped
From ... To Ft. <
72
14,- SCREEN -' -Depth Diameter Slot Size Material C4
' From To '.Ft _in.
From To Ft._in,' zz
r
IS SAND/GRAVEL PACK;
to;
.Depth- SIZa - Materiah
From :To FL - w
7)
From ` To Ft. -
G
Z
16, REMARK$ .;.
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC ZC, WELL
CONSTRUCTION STANDARDS; AN AT A COPY OF TH:S Rs ORD. HAS BEEN PROVIDED TO THE WELL OWNER
G�
- - JRE OFPERSONCONSTRUCTING THEL WELL ` DATE
- Submit tile ori2lnat to the DIVIsIO. of Water Quality, Groundwnter Section, 1636 Mall Service Center • Ralelgh, NO
37699.1636Phonc No. [phone]-, within 30 days, GWI.REV. 07/2001

WELL CONSTRUCTION RECORD _ 29?8^(;
North Carclind • Depa moot of Envirdnment and Natural Resources • Drvtslon cc Water Quality- Ground water Section.
VELLCOVTRACTO,R(LY MDUAL)IMIME (prfo0 JBmes A..Br�wn , , CERTIFICATIOtV_Z045
WELLCONTRACTOR CoiviPANYNAMEFedden Brothers well Drilling, InC - PHONE o L2L a-2 91
- STATE WELL CONSTRUCTION PERMIT® :ASSOCIATED WQ PERM17d -
-
. .. .' (iraottlicable) - .: (ifacolicable)..
r ,
1. WELL USE. (Check Applicable Box): Residential i Municipa;/?ubltc Industrial ❑" Agricultural ❑
lonitorinri ❑ Recovory ❑ Past Pump}Va;:rin ec;io .O Other ❑ 1f 0iher, List Use
2 WELL LOCAT19 �A`� Tupographic/Land sailing
Near To County L16.d2� CRidge CSlope ❑Valley.❑Flat
_
- (check appropriate bon)
- (Stroll Name iunbum Cannitunity, Subdivirlou, Lot No., ZIp.Code) _ Latitude/longitude orwell location
... �3, OWNER. '(deg;eesAninntea/seconds)..
-Adaress Latiiude/longitude source:CGPSCTopographic map
-
(5 renter Route e.) (check box)
- DEL_jPTH DRILLING LOG;
Cnv or Tmvn ' to Zip Code From To Formation DISC Don
— -- — _-- -'
( tri�'{4•'ca'JI�' I clay & sand
- Are,, cote. Phcne number ' granite
4. DATE DRILLED 4" I -_
5 TOTAL DEPTH 3—
6: DOES WELL'REPLACE EXISTING WELL? YES NO —
7.,STA'rICWATER LEVEL Below Top of Casing: FT. -- —
(Ua- "t" fAbove Top a!Casing. —
S. TOP OF CASING IS 2 FT. Above Land Surface* —
-'Top ol'casing tunninateC at/Dr b-slow land surrace requfres a —
.
varlance In accordincnv!th ISA NCAC 2C.Ot IS.
9. YIELD (gpm) Q_ MET :OD OF TEST blow _
10. WATER ZONES (depth), 47�() _
LOCATION SKETCH
11. DISINFECTION Type H T H Amount 16 02 Show direction and distance in miles from at least
12, CASING WaILThickness two State Roads or County Roads, Include the road
- Dept �, Da V. crr eigl1VF! IIIerial numbers and common road names'.
From 0 To ni % Ft. l88
,..From To _ F:-
From To - Ft.
(3:°GROUT: Depth. M,ateria! Method
c
__
O
Frbm 0 To ' 20 Ft. ixrrnite & afet Pumped r
n`
From - To Ft.
14, SCREEN. Depth Diameter Slot Size - Material �o
`From 'ToFt. in. in.
-
From To Ft. in, in c 3
15. SAND/GRAVEL PACK
„ Depth Size Malaria(
. From - To. Ft.
m�
From ` To Ft. w.
rn
—
16. REMARKS.
z
l DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH I5A NCAC ZC, WELL -
-
CONSTRUCTION STANDARDS, ANC
? A COPY OF THIS RECO HAS BEEN PROVIDED TO THE WELL OWCIER
_ - SI -\ < T RE OF PERSON CONSTRUCTING THE WELL DATE
Submit the 0H21naI to the Divlslon of Water Quality; Groundwater Section,1636 i`Aail SerYlce Center - Raleigh, NC
27699•1636 Phhnc No. [phone], vvithln 30 days'. GWI.REV. 07/2001 -.
r

2938,7
WELL CONSTRUCTION RECORD
North Carolina - Department of ❑nvirerme'nt and Natural Resource3 • Divislpn of Water Quality • Groundwater Section
tiYELL.CO,ITRACI'OR(IINDIVID'J�LI�A tE (prlol) James A.:.Brown CERTIFICr1TIONV 22045
WELL' CONTRACTOR COiMPA,N Y N A nle Kedden brothers We11:Drilling,. Inc PHONE q BZ91.. 3E9 =9391
� vATE WELL CONSTRUCTION PER,v11Tp -ASSOCIATED 1YQ Pf RNIITe
(ifacolieable) (if aoblicable)
I. WELL USE (Check Applicable Box): Residential !J Municipal/Public ❑ Industrial ❑ Agricultu;al ❑
Monitorink 0 Recovery.[ Heat Pump Water Injection Olhv ❑ if 0ther, List Usc
2, WELL LOCATION T opog.aphic/Land setting
Ne rCi,Q1 t wn: ❑Ridge ❑Slope. OValley OFlar
(check appropriate boa)
(Street Nauce,-Nuirbcrs, Community, Subdivis'on Lot No., Zip Code) La!I!ud a/i0ngitOde Of Well location '..
3. OWNER o�/ti j% - (de;tees/minutm/wants)
'Ado .lMs M,L[ La!nude/longitude source:OGPSOTopagraphlc map
` - - (S`rYetof Route Nor)_ (check boa) _ _._. _.
14 I�iC—s DEPTH DRILLfNG LOff
p, I CIya.v a: Zip Code'. From , Formation Description
(�) .�• % —0 clay sand
www Aren code- nrb4r er � � C_aill t to _
4. DATE DRILLED 9-5—on
5, TOTAL DEPTH:.7 5 —
6: DOES WELL REPLACE EXISTING WELL? YES P,,NO ❑ _ —
7. STATIC WATER LEVEL Below Top of Casing FT.
(Use "✓'if Above Top ar Carron) . S. TOP OF CASING IS 2 FT. Above Land Surface` -
-Top of caslnq terminated at/or blow land surfact. requfres a —
varl nce In accordant{ s Ith 15.4, NCAC 2C.0118.
9. YIELD (gp n) ?St METHOD OF TEST bLO�
10. WATER ZONES (depth): ) 7(7 r _
LOCATION SKETCH
11, DISINFECTION: Type : H T H Amount 16 oz Show direction and distance in miles from at least
1
2. CASING WallThickhess two 5tatc Roads or County Roads. Include fne road .
Depth a..
Dtam, er or We,ghVFt Material: numbers; bers and common road names: '
From 0 ToFt. /_
From _ To Ft. o
' From To Ft. -� o
13.'GROUT: :. Depth Material Method 3 c—'—
From 0 To L 20 ' Ft. be dte A Lad !at Pumped �"
From ' ' ToFt. s
14� SCREEN..-Depthr Diamet:rSlotSae:�`.11aeerial
'"From iTo Ft —ill. -_ in.
From To Ft. —in. ' _'in.
15, SAND/GRAVEL PACK: �?
Depth Slz: M,a:eriaF — r�
From To - sot,
From To Ft. - z
16. REMARKS;. .. .
I.DO HEREBY CERTIFY THAT T WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15.A NCAC 2C, WELL
CONSTRUCTION STANDARDS A`! TtjAT A COPY OF TiilS Vf ORD HAS 5e?N PROVIDED TO THE \/\s LL wk P,
SI ATUREOFPERSONCONSTRUCTING THEWELL: DATE
Submit the 0 r I
Inal to the Dlvis on of Water Quality, Groundwnter Secticn, 1636 Mail Service Center- Raleigh, NO
21699.1635 Phone No. [phone], within 30 days, : OW-I.REV. 07/2001
t

WELL CONSTRUCTION RECORD 2 g 3$ r2l
North Carolina - Oocartment of Environment and Natural Resources - Division of Water, Quality- Groundwater Section:
VELLCONTRACTOR (IlNDMDUAL)NAME (prfnO Janes A. Brown CERTIFICATION 1_2045
-ivELL CON'f RACTOR COMPANY NAME Redden Brothers -Well:Drilling,-.Inc PHONE d fi2"A.') 3o9_U.91
- . STATE WELL CONSTRUCTION PERMITA '' ASSOCIATED 1YQ PERMIT. -
'-(iLzcnlldable)-:
I, WELL USE (Check Applicable Box): Residential 29 Municipal/Fub:o ❑ Industrial 0 Agricultural
Monitoring ❑ Recovery Cl Heat Pump Watt, Inicction 0 Oilier ❑ If Other, List Use
2, WELL LOCATION Topographic/Land setting
Near= -own: CountyLl�?�'= ❑Ridge ❑Slope []Valley ❑Flat
(check appropriate bex)
(Street Na re, -NO, b Conniwnity(jubdivision, Lot No., Zip Code) - Latitude,/lOngltudo of well location
3. OWNER J - ydeg;:eshninutes/seeands)
-
Address - Ladiudo/Icngitude source',CIGPSOTcpcgraphic,ma?
(SI eel or Paw .) (check box) -
P_!� DRILLING LOG
try or Town tat Zip Cade- - From 1 Fo mation Deser otion
clay &sand
Area <ode•Phule nnnberyranite
'�,--,
_
4. DATE URILLBD--
5 TOTAL DEPTH: —
6; DOES WELLREPLACE EXISTING WELL?: YES ❑ NO —
7. STATIC WATER LEVEL Below Top of Casing: /Q T
- (Use "r" if Above Top or Cas:np)
S. TOP OF CASING IS 2 FT. Above Land Surface
-Top at casing tarminated at/or betow land surface requlres a
variance In accordance with 15.4 NCAC 2C MIS. -
9. YIELD (gpm)Jnh ME2QOD TEST blow
10. WATER ZONES (depth); __
_
LOCATION SKETCH
I l-'DISINFECTION: Type H T H Ampunt. 16 02 Showdirection and distance in miles from at least
12. CASING:, Wall Thickness two State Roads or County Roads. Include the road
.
Depth DI m.ter or Wei hVft b1ateHal numbers and convnon road names.
�qg } s
c
From.0— TLLZ Ft. ' o
-
c
From To Ft.
From- To FL - .
n
13;°GROUT: . Depth Material Method a
<
ern
From 0 To 20 Ft, bsasite 8 ciirs+t . purnbed s
o
From To Ft.
14, SCREEN:' .—Depth Diameter Slotsize'.;� Material
m
From ToI Ft- ,
From To . Ft. -in.' _-in.
15, SAND/GRAVEL PACK: w
. -:Depth - Size .Materia, — - — u>
o
From To - Ft. —
—To—
From Ft. I_
16. REMARKS: ,.
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, YVELL -
-
CONSTRUCTION STANDARDS, A HATA COPY OF THI RD.HAS SEEN PROVIDED TO THE WELL OWNER
SPERSON
UREOFCON TRUCTINOTHE -WELL DATE
I 70r
Submit the original to the Div151oWater Quzllty; OroundwnterSection, 1636 Mall Service Center • Raleigh, NC
27699.1636 Phnnc No, [phone], withln 30 days, GW•1.REV. 07/2001

WELL CONSTRUCTION RECORD _29384 n
North Carolina - Dcpartmen: of Environment and Natural Resources • Division of Water Quality- Groundwver Sectior.
1YELLCO,YTRAC1'Oft(IIYDIY(DVAL)1A9fE (prlat) James Ae Brown : CERTI9ICATIOt`II_2045
}YELL CO,rrRACTCRCOiwPANYnA,titi Hedden Brothers Well Drilling, Inc PHo,vE q 8t�31 369 �j91
`STATE W€LL CONSTRUCTION PERMITtl ASSOCIATED 1YQ PERV117:
' (ifabnlicable) -- (ifaonli<able)-:.
1. WELL USE (Check Applicable Box)! Residential i� Municipal/Public ❑ (ndustrial 0" Agricultural ❑
Monitoring 0 Recovery O Heat Pump Water Injection 0 Othitr Cl If 0ther, List Usc
2 WELL LOCATI N Topographic/Land setting''
N:are'`own: County MA'ete —)
❑Ridge CSlope. OValley,.OFlat
�.ffi4 n. (check epproprla:e boa)
(street name, umbers Community, subdivision, Lot No, Zip{cde) Latituce,/longitude of well location
3. OWNER:
fit AQO
.(de,reeshninai ItI/seconds)
'Addlcss
Latitude/longitude source:OGPSOTopograpf•w reap
($ eet or Rd It No.) (check box)
DEPTH DRILLING LOG
Zip Code FOrom r F Derr onor,
ry o � § &o5-7
( / layton
A-c�p, O{ C1a &sand
s _
Area code. Plsc,sc Aum'ee�rG granite
4,' DATE DRILLED_Q �— —
5• TOTAL DEPTH: A Q0 —
DOES WELL REPLACE EXISTING WELL? YESy�No —
i. STATIC WATER LEVEL Below To of Casing T—. -- —
(Use '*" rAbove Top c!Cas:n2)
S. TOP OF CASING 1S 2 FT. Above Land Surface' —
--Top or casing tarminated at/or below land surface requires a - —
varianceInsccordance)�vlJt�IlA NCAC 2C.0I18.
9. YIELD (pm): /e(1 METH QZ Of BEST blew —
10. WATER ZONES.(depth):--
- -- - LOCATIONSKETCH
11. DISINFECTION Type H T H Amount , 16 oz Show direction and distance in miles from at least
12 CASING Wall Thickness two State Roads or Co.mtyRoads.lnNude the rend
Deptn Dame— cr W t let ^NI !erial numbers and common road names. ' o�
From 0. To� Ft
o
l __[L_" . 6� (! ZM
c
From To Ft, >,-
c^i
From To Ft.
I3,` GROUT: Depth Material Method
CD—
From 0 To ' 20 ' Ft, b=-dte & ai.-ert pumped ca
From '`' - To -.Ft.
mG
14, SCREEN Depin D,a,nete, Slot Size Material r
"'
.;
"From 'To Ft.`_in. in. W
(n F"
From To Ft. in. _'in w
15, SAND/GRAVEL PACK: rn
E
` Depth Size _ Material
From To Ft.
From To Ft.
16. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH ISA NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND T A COPY OF THIS OP:D HE WELL OWNBR
AS BEEN PROVIDED TO T,.��'
.
SIGL11H Or PERSON CONSTRUCTINOTHE WELL DATE
Submit file orl;inal to the DIYlalon of Water Quality; Groundrvnter Section, 1636 Mall Service Center • Raleigh, NC
27699.1636 Phitno No, (919) 733•3221, vvlthln 30 days. _ GWI. REV. 07/2001

WELL CONSTRUCTION RECORD 2 �?
North Carol tia - Department of Environment and Natural Resources • Division of Plate• Quality • Groundwater Section
tiYELL CONTRACTORiDDIYIDUAL)INAIY(E (prinl) James B..Brown:. CaRTIFICATI0INI_Z0a0
' 1Yi CON'I' RA CTO R COMPANY NA,nIEFedden Br0`�12rs-Gie11 ,Drill ing,�. Inc PHOINE
STATE WELL CONSTRUCTION PERMITY ASSOCIATED 1YQ PBRbi1T.:
! (ifabolicable) — iifaon;icable)':
I WELL USE (Check Applicable Box): Resiaantial i' Municipal/Public 0 Industrial q Agricultural ❑
Monitoring C. Recovery.0 - Heat Pump Water Ir;cction-0 Other ❑ IFOther, List Use
2, WELL LOCATI m Topographic/Land setting
Neares� t wn: County ❑Ridge CSlope. GValley, ❑Fix
"JZ7'ff�jilv) Ed (check appropriate ben)
(Street Na,;:e;:Nuin' va. CC�oI inun ityy,, SS bdivision Lot Na., Zip Code) Latitude/longitude of Well location
3 OWNER-f� 4a4r LI (Legr.eshninitx s/aeconds).
Add uss ! /O 0A(1G"L uEc/longlhtca source, COPS MTopovra'h to nap
( nee: or Rou: ) (check bdx)
DEPT H DRILL(NG LOCI
City �To'. ',sO �y2 Zip Code'. From /To i FC1a}yl& 6dllCycpon
Arm ce
5de. Phmw nu Hoer Rr nite
.` DATE DRILLED- —
, TOTAL DEPTH: ' —
6 DOES WE! L REPLACE EXISTING WELL? YES ❑ NO� —
7. ,STATIC WATER LEVEL Below Top of Casing: —
(Use "*"if Above Top of Caiiny) . S. TOP OF CASING IS 2 FT. Above Land Surface" —
-Top of aaainy :arminate5 at/or below land Surface requires a —
varlance In accordance with IS.A NCAAC ZC.0118 —
9. YIELD (gpm): _(fj— METHOD OF TEST blow _—
10. WATER ZONES (depth): ' LOCATION SKETCH
11. DISINFECTION: Type' . H T H Amount 16 oZ Sho:v direction and distance in muss from at least
12. CASING: WaILThickness two Stale Roads or County Roads. Include the road .
Depth Dla f or WeighVrt Material n mce;s and con non road names: "
From 0 To O
From To - Ft. V
From To - Ft. ..=,�.
13 'GROUT , Depth. MaterialMethod
From 0 To 20 Ft. mite 8 Caret pumped s =-
From To Ft
14 SCREEN.'. Depth Diameter Slot Size Material
}rum To Ft._in. in. y —7
From To Ft. —in, ' _tin.
15. SAND/GRAVEL PACK: w
`.Depth Sae .Material — rn c
From `To oI
From ` To Ft.
16. REMARKS:
-I. DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15�A NCAC 2C, WELL -
CONSTRUCTION STA`JDARDS t DTHATACOPY OF THIS RECORD. HAS BEEN PROVIDED TO THE WELL OWNER
NATURE OF PERSON CONSTRUCTING THE WEI L DATE
Submit the orl;irial to the DI rislon of Water Quality, Groundwnter Stellar, 1636 Mail Service Center • Raleigh, NC
27699.1636 Pititnc No. [phone], wlthln 30 days:' _ - GW'•I.P_.V• 07/3001
.s

293807
WELL CONSTRUCTION RECORD
North Caroline - Department of Environment and Natural Resources - Division of Wate, Quality - Ground.vater Section
YELL CO)TRACTOR (ODMDUaL) NAME (prinq Jemes B e -Brown CERTIFICATION, 22045
SYELLCON'IRACI'ORCOiYIPANYNANIEHedden Brothers Well Drilling, inc. PHONE s LDS ) 309-0,591
STATE 1YELL-CONSTRUCTION PER;MITp ASSOCIATED 1YQ PERMIT:
--
:-(ifzdnlicable) (ifaoniicabfe).
- I. WELL USE (Check Applicable Box): Residential E� Municioal/Public ❑ - 1nd,lst'iai ❑ Agricultural ❑
Monitoring ❑ -Recovery ❑ - Hea! Pump Water Injection ❑ Other ❑ If Other, Lis; Use
2, WELL LOCATION: Topogra-phic/Lands n;
NearestTo nk, County❑Ridge ❑S ce ❑Valleyi❑F'
FJvieaatLia
- Papprai ime box)
Fs -vet Na,ne Nu .p rs, Community, Subd!viiloo, Lot Ne., Zip Code) L titude1on;itude of well location
' 3, OWNER: - (Le;:e esh^I nu tea/uconds)
- Address La ltudc/longitude soLree ❑GFS❑ l o ogralhlc map
-
Route�'�°�, (o he:k box)
�y
/ r�—l� y DEPTH DRILLINGrTC
(CiN or Town e - Zip Code From Formation Descrotion
'3609 -(iX 0 ' clay & sand
Are, coda Pho oe nu-oe: 6 50Crra:ate
_
4,' DATE DRILLED —zo
5 TOTAL DEPTH; —
6 DOES WELL REPLACE EXISTING WELL? YES ❑ NO
7. STATIC WATER LEVEL Below Too ofCasing: -300 FT. -- —
(Jae "*" if Above Too cf Casi.ng)
S. TOP OF CASING 1S 2 FT. Above Land Surface' —
'Top ofcosine terminated at/Dr below land surface requires a -
- Yarlanee In accordane w!tb ISA NCAC 2C,0115. _
9. YIELD (gpm): _ 10 METHOD OF TEST blow
10, WATER ZONES (deoth): y —_
LOCATION SKETCH
11, DISINFECTION: Type H T H Amount.. }E OZ Show direction and distance in miles from a' least
12, CASING Wall Thickness _ two Slate Roads or County Roads. Include In- road
De^th Da ela or We,g'-VFt� Material members and co .-ton road names.
From 0 To� Ft"�
c
_ From - To - Ft. ai
o-
From Z7 To Ft- - -
�^
13, GROUT Depth M.a:eria! M.!hod �
c
From 0 To 20 Ft be=ite & CcrE-t pumbed
Front 'To _Ftt
`?
14.SCREEN. Depth Diameter Slot Size ;Plateria!
' From To Ft. in. in
From To - Ft.—in.in,
15. SAND/GRAVEL PACK:
Depth Size Material
From To
-.
From To Ft. -
16, REMARKS
100 HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 16A NCAC 2C, WELL
CONSTR(JCTIONSTANDAPI)S,ANDTHATACOPYOFTHISR/EZ ORD�HAS BEEN PROVIDEDTOTHE/V,`ELLOV/NE?.
Sic-1 RE OF PERS�UCTING THE WELL DATE
- Submit the orl,inal to the Division of Water Quality, Groundwater Section, 1636 beail Service Center • Raleigh, NC
27699-1636 Phnnc No, [phone], within 30 days, - GW''-I REV. 07/2001

WELL CONSTRUCTION RECORD
� North Carolina - Dcpartment oPEnvironmertand Natural Res owces - DivisionofWater Quality' • Groundwater Section
YYELL COiNTRACI'0R(01)(YIDUAL)NAM E (print) James B. Erann CERTIFICATIOiNR 2045
wELCCCnrRAC70RCOroiPANVNAM�H-'dd�1 Brothers Well.Drilling, Inc PHONE, Qu) -2a,91
S'rATE WELL CONSTRUCTION PERMIT* ASSOCIATED WQ PERMIT,.
- -
' - - flf apnieable)- (If aDflllCable)' -
1. WELL USE (Check App,icable Box)! Residential � Municipal/Public ❑ Industrial ❑ Agricultural ❑
- - Monitoring ❑- Recovery ❑ Heat Pump Water Injection ❑ Other ❑ I70!lner, List Use _
2, WELL LOCAT( N.- Topographic/Land setting
Nearesryown% ounly�
1 ❑Ridge Elope OValley OFlat
l
OIj �(4_
(check appro,r:a!e box)
- (Stha Nnine, Num bu n, Cainmuni!Y, S�ubd�ivi�ilon�, Lot Na„ Zip Code) Latitude/longitude of well location
3 OWNER' ii i L/ii
U(Y!(!7� �d1 �/ CeSro shnina!es/rcanCe)
- Ad uss ( n - Latitude/Iongiw6c sot %e:OGPS"Tcpographtb map
(S ree, or Rock Na.) / - (cheek ;ox) ......__
_ _.
_j(L�pllC_
rR1�`f DEPTH DRILLING LOG
From To FormationrLonon
lcly&
sand
n
A«n code Phc:enanoa ofraAi to
4. DATE DRILLED-
5. TOTAL DEPT'r. '1 ZX7 t ���,,,///
6. DOES WELL REPLACE EXISTING "'ELL? YES O NO �
i. STATIC WATER LEVEL Be,ow To of CasinA.,: ESL ,. -
- (Use '," if Abow- Top of Casing).
S. TOP OF CASING IS 2 FT. Above Land Surface* -
-Top. ol'casln, tcrTirtzled at/or tcelow land surface requires a -
- variance In accordance 15A NC.AC 2C.0115. -
iv
9, YIELD ""', 1 ME2�O r TEST blow —
10. WATER ZONES (depth):
LOCATION SKETCH
- It. DISINFECTION: Type H T H Amount - 16 oz Show direction and distance in miles fiom, at least
12, CASING: Wall Thickness two State Roads or County Roads. Include t'ne road
DeDth Diameter or Weight/Ft. numbers and common road names.
-Material
r—�—To—
' Fromm Ft.
C:o
13."GROUT: . Depth Material - Method _ -
o
From 0 To 20 Ft. bsudlte d ct ptunoed
_a
From To Ft. -t
c
. 14, SCREEN:Depth Diameter Slo!Siza > Nlatzrial
' From 'To - c't.in. in. - w
=r,
From - To FIin, in,
15, SAND/GRAVEL PACK' 3
De,,!h Size Material
From To Ft. t)
From Tc Ft. -
o
16. REN!ARKS
-- I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONS7R UCTI ON STANDARDS, AND THAT A COPY OF '.1S RECORD HAS BEEN PROVIDED TO THE WELL OWNER
_ekrn t-2 _e zi
IGN,A7URE OF PERSON CONSTRUCTING THE WELL DATE
Submlt the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center -Raleigh, N'C
27699.1636-Phone No, [phone], within 30 days. - G1L'•I REV. 07i2001

WELL CONSTRUCTION RECORD 2931309
North Carolina :- Dcoartment of Envirornent and Natural Resources - Division of Water Quality • Groundwater Section
1YELLCO,VTRACTOR IINDIVIDUAL)NA61E rinC JamesB. Broom, a 2045
( (V � CERTIFICATIONS—_
WELL CONTR,ICTOR COMPANY NAMENedden Brothers Well Drilling, inc eHonea 29'1 1
STATE WELLCONSTRUCTIONPERMIT! ASSOCIATED WQ PERMIT,
-(ifzbpllcable)'
-.- (ifaonlicable)
I, WELL USE (Ch.ck Applicable Bo.e): R s d ntial Municipal/Public ❑ Industrial ❑ Agricultural D
- . Monitoring ❑ 'Recovery.[I Heat Pump Water Injection C3 Other ❑ IFOI•ner, List Us-
2, WELL LOCATION:
Topographic/Land setting
_ -Near Town' County
! ❑Ridge ❑Slope. ❑Valley,❑Flat
(check app-opr c!e ben)
(Stra<t Nome, Num ban, Community, Subdivision, Lot Na., Zip Code) Latitude/longitude of well l0catiOn
J. OWNER,-
'Address (deg: •es/irlmates4 e:onda)
-
.
Latitude/longitude source:CIGPSOT000erapl` c map
- (Surat or Route No.) ' ` - (check boy '-
I&Akj�4
- ---
1 / �c2273 DEPTH DRILLING LOG
ACity o. Town State z p Code - From To Formation De;criotion
id) .ay �-�
CLZY & S��Cl
Area unon r cZ'd111
A. DATE DRILLRILL �'ED S' 0 to_
5,TOTAL DEPTH:
6 DOES WELL REPLACE EXISTING WELL? YES ❑ NO d� —
7, STATIC WATER LEVEL Below Too of Casing: T, -- —
(Use "I' If Above Top ai Casing)
S. TOP OF CASING 1S 2 FT, Above Land Surface
-'Top ol'<as:n; torrrInVed at/or below land surface requires a
_
varian It In accord anc vlth 15A NCAC 2C.0118.
9. YIELD (gom) METHOD OF TEST blow —
10, WATER ZONES ( eoth): --
LOCATION SKETCH
11. DISINFECTION: Type H T H Amount 16 Oz Show direction and distance in miles from at ;east
12 CASING: Wall 7vckhe3s t,vo State Roads or County Roads Include the road
Depth Dlarne!e'r or Weight/Ft Material numbers and conmon road names,
From 0 To—,5,�?— Ft L „
. From To fie
0
s
CD
,. From To - Ft. _t-
o
13.'GROUT: _ Depth Material Method �
r'--
` From 0 To 20 Ft. ternI to & css En . - PUInPEd
c^-.
From To Ft.—
. 14. SCREEN: Depth. Diameter SrotS N( z: - aterial - W
From To Ft._in in. p
oo
From To Ft.. in. in.c
15. SAND/GRAVEL PACK: ca
..
Depth Size Material LJ
Mm
From To - Ft. - -- --_j
c
From To Ft..
16, REiNIARK8
I DO HEREBY CERTIFY THAT THIS WELL WAS CON5TRUCTED IN ACCORDANCE WITH
15A NCAC 2C, WELLCONSTRUCTION STANDARDS, AND T T A COPY OF THIS RZCORD HAS BEEN PROVIDED TO THEW
ELL OWNER
�a �,7 --/o
SIGNA EOFPERSO CONSTRUCTING THEWELL DATE
Submit the Ori;inal to the Division of 1Yater Quality,. Groundwater Section; 16361Mall Service Center • Raleigh, NC
27699.1636 Phonc No. [phone],
within 30 days.
- - - CYV•I REV. 07i20:1

WELL CONSTRUCTION RECORD
North Carolina - Dapartment of Environment and Natural Resources - Division of Water Quality • Groundwater Section
WELLCO,NTRACTOR(I:NDIVIDUaL)NANE (print) James B. Brown czruICdTiON� 2045
WELL Cov9RACTOR COMPANY NAMEHedderl Brothers Well Drilling, Inc PHONE q 828') 369-95 1
STATE WELL CONSTRUCTION PERMIT' ASSOCIATED WQ PERiMIT#
'(ifabplicable) - - (ifaonlicable) —
I, WELL USE (Check Appllcable Box): Res d_n!ial 2 Municipal/Public ❑ Industrial ❑ Agricultural ❑
Monitoring ❑ Recovery ❑ Heal Pump Water Injection.❑ Oilier ❑ IFOtner, List Use
2.. N cs LOCATION: Topographic/Land setting'
cs:Town: County�,� ❑Ridge ❑Slope ❑VaPey ❑Fla!
Q/1t. A (che:k appropriate box)
(Street Name, Numbers, tmunny, Subdivis'mu, Lot No.. Zip Cede) Latitude/longitude of well location
OWNER: C /
(degr-esnr'milw/secandi) .
Add.cssA4—) Latinidc/lcngihidesource'❑GPS❑Topographic neap
Sire,: or Roule No. (check boz)
13 DEPTH DRILLING LOG
CGo or Town State Zip Cod<. From T Formation Desc-otion
�L19 aD`�� O ' clay & s� ,O}
Aran cafe.Phmw number QTalllte
a D.AIEDRILLED JI-Z]-00(00' —
5. TOTAL DEPTH: :200 t - —
6 DOES WELL REPLACE EXISTING WELL? Y2A:❑ NO —
7. STI IC WATER LEVEL Below Top of Casing: FT, —
(US: "F' it Above Too of Casing) , S. TOP OF CASING 1S 2 FT. Above Land Surface"
-'Top at'casln; tarmin ate? actor below land surface requires a - _
varlan ce In accordance wlrh 15A NCAC2C.0118.
9. YIELD (gpm) 5 y T ,QD OF TEST blow
10. WATER ZONES (depth): ' --
LOCATION SKETCH
1 L. D(SINPECTION: Type H T H Amount 16 Oz Snow direction and distance in miles fro[-, at least
12 CASING Wall Thickness two State Roads or County Roads, Include the road
De th Diameter or WeighVFt Material numbers and corr=on road names..
From 0 To Ft w eL �7/t
From To FL
From - To Ft. - O
13, GROUT. Depth Material Method
From 0 To 20 Ft. Ysrnite & car]2t P=Ced
Front -To ct �
14. SCREEN: Depth' Diameter Slot Siz. Nlaterial 1
W
From TO —Ft— -in. in,
From To - Ft —in. in.
3
I5, SAND/GRAVEL PACK'
Depth - Siu Material - Cl)
From —To— - Ft. - - _ w
Frcm ` Tc Ft.
16. REMARKS
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND SA
T A COPY OF THIS 'CORD HAS SEEN! PROVIDED TO THE V, ELL N'c OYP.
OFPERS.ONCONSTRUCTINGT4cWELL DATE
Submit the orl;inal to the Division of Water Quality; Groundwnter Section, 16361MaN Service Center- Raleigh, NC
27699.1636 Phone No. [phone], within 30 d
- ays. 01V•1 REV. 07/3G01 -
s
c
0

WELL CONSTRUCTION RECORD
North Carolina,- Department of Environment and Natural Resources • Division of Water Quality - Grozo.3-SIT! IT!
VELLCO,NTRACTOR(INDIYIDU�IL)INAME (print) James fi._Brown CBRTI5ICATIOtNY_2045
\YELL CONTRACTOR COMPANY N'AMEHedden Brothers Well Drilling,. Ir1CPHONE q8��3. 1`309 �•�91
STATE WELL. CONSTRUCTION PER;N ITp ASSOCIATED tYQ PERN1179
I WELL USE (Check Applicable Box): Residential i!$ Municipal/Public ❑ Industrial ❑ Agricultumf 0
Monitoring ❑ 'Recovery ❑ Feat Nimp}Water Injection ❑ Other ❑ If Other, List Usc _
LOCATIO Topographic/Land setting
2,. WZA1
at own: Co,mty �l� ❑Ridge ❑Slope ❑Valley ❑Flaf
• (c'neck appropriate bon) - -
atrcet Nan:e, No vi, Community, Lot No., Zip Code) Latitude/IOngitudlt of we!! location
.. 3. OWNERuAYTI
rSubdivisicr•,.
1 (degre<s/ininnush«onLoJ
Address. / (} Y»t .Pi Latitude./longitude source:❑GPS❑Topouraphic map
A (5unet or Route No.) - (check box)
Nati/zh/lY a � C. Co LOC
4_9 DEPTH, DRILLING
Ciiv ar TawnT Spa;e Zip Code From + Forma:ion Deaeription
clay & sand
Area cedes Phci•.e numby� ard.^.ite
Q
_
4, DATE DRILLED 7
5, TOTAL DEPTH: O'
6: DOES WELL REF LACE EXISTING WELL? Y'cS �] NOk]
7. STAiICWATERLEVELBelowTopofCasing: �`�L FT. --
(Use "*" if Above Top or Casing).
S. TO? OF CASING IS 2 FT. Above Land Su: face"
--Topof casing torminated it/or belo,v land surface requires a -
variance In accord +nc vlth 13A NCAC 2C.01 M _
9. YIELD (gpm) / META' D OF TEST blow
10, WATER ZONES (depth):
LOCATION SKETCH
I L=DISINFECTION TypeH T H Amount . 16 Oz Show direction and distance in miles fioin at least
12, CASING: Wall Thickness two Slat- Roads or Ccurtty Roads. include tn.- road
De to Dta er or Wei h)Ft MatvW numbers and common road name's.
g
0
.
From To Ft
From To Ft
-
' From To - Ft.
13, G,ROUT:... . Depth - Material Depth Method a
Frbm 0 ' To 20 ' Ft. kSt111.tE 8 ta'r3tb . "Pumped
^^
' - From �� 'To t. ,F- -
:4. SCREEN Depth Diann«= Slot Size Material
From To Ft._in. in:
m^
From To Ft. in. in.
15. SAND/GRAVEL PACK W
rN
Depth Size Material - - C,•�
From .. :To Ft. -
From —To— Ft.
16. REbIARKS: -
'I.DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH ISA NCAC 2C, WE__
CONSTRUCTIONSTANDARDS, AN HAT A COPY OF THIS RF. OR'D.HASI-BEEEN PROVIDED TO THE WELL OWNER
i' TURE OF PERSON CONSTRUCTING THE WELL. -' . DATE
Submit the orl;iriat to the Divlslon of Water Quality, Groundwnter Section 1676 Mail Servlce Center- Raleigh, NC
27699.1636 Phunc No, [phone], wlthln 30 days..' GW'•I.Rr. V. 07/2:01 -

WELL CONSTRUCTION RECORD
Nortil Caro na • DcpartmeIt of ..nvlronment and Natural Resources • Division of Water. Qua!ity - Groundwater Section
IYELL,CO;NTRACI'OR(IINDIVIDUr�hlhYA11E (prlN)- Janes B..-Brown CERTIFICATIOtN# 2045
WELL CON'.rR,,CT'ORCO;vIPANY.NAbli Fadden Brothers well Drilling,: Inc PHONE
STATE; WELL CONSTRUCTION PERMI70 ASSOCIATED.IYQ PERMIT: -
-
-
1. WELL USE (Check Applicable Box): Residenda( i 3 Municipal/Public 0 Industrial CI Agricultural ❑
Monitoring 0 Recovery 0 Heat Pump Water Injection M Other ❑ If Other, Lis! Use _
2.. WELL LOCATIO /�� _ - Topographic/Land setting
NearcztTown. County ❑Ridge ❑Slope. GValley, ❑Flat
_
X C4UP (c:neck appropriate bon)
(Sleet Name, Nainburs, Comiitanily, 9ubdiviejnl�oa,, Lot No , Zip Code) - Latitude/l,,niitude of well location
3. OWNER. ,/./L'Y7 9CKG4,// '(dega<s,'ininmah:aondeJ
Addre'7 Lahtudc/longitude. source:�GPS!]Topographlc map
.
/ $pee ar Rowe No (check boa)
n�{
�� ' r-92 DEPTH DRILLING L--OG
_
City or To.vn Star Zip Code -. From o , Formation Des —Lotion
(_) clay 3 sand
Area<ode. Phone nw,o:r , Crra2lite
4. TOTE llDEPTH
—
6, TOTAL DEPTH. ' -
6: DOES WELL REPLACE EXISTING WELL?- YES ❑ NO ❑
i. STATIC WATER LEVEL Below Top of Casing: �_FT.
_
(Use"•" it Above Top a!Casiny)..
S. TOP OF CASING IS 2 FT. Above Land Surface'
--Tap. of casing rarminated at/or below land surface requires a
vvlanu In acrordan5a vhtISO. NCAC 2C.0118,
9 YIELD (gpm): 4y METYOD OF TEST 51cw
10 WATER ZONES (depth): 110, _
LOCATION SKETCH
11.. DISINFECTION: Type H T H - Amount 16 OZ Show direction and distance in miles froin atleast
12 CASING. Wall Thickness two State Roads or County Roads. I nclude the road
Depth.qh� Diameter it. Materia4 numbers and com;,on road names:
Ft.
From 0 Tom Ft.
From To —,Ft. - - -
c
From To 'Ft. O
o
13:°G�ROUT:. , Depth NlmerW Method
From 0 To 20 Ft.Mite & Arent pumped
;
From - To Ft <
cT
14, SCREEN '. Depth Diameter Slot Sae > tiMaterial t
�-
prat='
- From To Ft —in. in, _ -
From - To _ Ft —in.
IS SAND/GRAVEL PACK
Depth Size _ Material
"- From To. FL
From To Ft - 's
z
16. REMARKS.: .> -
I.DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 11A NCAC 2C, WELL
THc
CONSTRUCTION STANDARDS, AND HAT ACOPY Or'1S ORD.HAS-D TO ID SEEN PROVETHE WELL OWNER
.._.,.
•."
URo- N TRUCTING7H'�ELLTPERSOOSE
Submit the original to the Division of Water Quallty; Groundwater Section, 1636 Mail Service Center- Ralergh, NC
27699.1636 Phonc No, [phone], within 30 days'. OW-1 REV. 07/2C01

292?
tiVELL CONSTRUCTION RECORD
Forth Carolina • Depart, ent of Environment and Natural Resources •
Ulvsion of Water Quality - Groundwater Sectior!
tiYELLCOIVTRACTOR(li)DiYIDUAL)i)AdiE.(prinl) James A. Era n .. CERTI°ICATI01Yrt_2045
Wrt,LCON' fRACTORCOMPA,vYNAMsKedden Brothers We11:Drilling,
Inc - P onE s E�"'�. 1 ja--2 91
-- STATE WELL CONSTRUCTION PERMITI ASSOCIATED
5yQ PCRh117o - _-
' �'-(ifabnlioable)-
(ifaonlicable)-. -
--:_
I. WELL USE (Check Applicable Box): Residential 8MunicipaVPubl!c 0 Industrial 0 Agriculturaf 0
Nlonitor'1 ❑ Recovery ❑ Heat Ptimp Wateinjectwn D Otte.
❑ irCther; List Use _
2 WELL LOCATI
Topog;aph(c/Land setting
•'
Nearestown: —T/CountyJ..l-16NS�5J�.
❑Ridge OSlooe. []Valley ❑Flat
111-41 1 10 -
(Enc.'s appropriate box)
(Street Nalne, NumbC.o,nmunity, Subdivgloo,. Lot No., Zip Cote)
La:Ituce/longitude of Weil location
3. OWN°R• f�ers- zs,,,-1t7
- (de3ee<shnin<,tesls eeonds)
'Add,css I'17 M-L(A� 11 ) LA
Latlwdc/longuudescurce:OGPSOTopographic map
(Street or Route N•pI y, ..
A-70
(check box)
cD_P7F. DRULLiNG LQG
9 C ly �7s Zip Cade
(r). �i�a•7 x
Iron; Formation Descrpkon
5clay sand
ae<a <c'e Pnehe nainber
� granite
e _
4. DATE DRILLED
S.TOTAL DEPTH.
6. DOES WELL'REFLACE EXISTING WELL?, YES O NO /t
7. STATIC WATERLEVEL BalowTopofCasing! 1/OOFT.
_
- (Use" *' if Above Top of Casing) .
S. TOP OF CASING IS 2 FT, Above Land Surface'
:-Top of cosiny terminated at/or blow land surface requires a
variAnce In as aordanct wl h IBA NCAC 1C.0118
9. YIELD (gpn): 6 M.E71�C,n F TEST blow
10. WATER ZONES
—
.(depth):
LOCATION SKETCH
11.: DISINFECTION: Type' H T H Amount 16 oZ
Show direction and distance in miles froin at least
12. CASING: Wall Thickness
two State Roads or County Roads. Include the road
.
Depth Diapnter or Weight/Ft Material
numbers and common road names:
Fro n 0 To Ft. pVc
From To - Ft.
- FromTo Ft
From 0 To 20 'FL kmite & �i8t . ptmoed
c
From To Ft.
a
—c
cT
14, SCREEN:''.' Dt Diameter Slot Sae '. Material
From T,o Ft._in. in.
C 3
sn
»v
From To Ft._in.'
15. SAND/GRAVEL PACK:
ZZ
Depth Size Malerigl.
rrn*
From To Ft.
:From ` To Ft.
v
o
16: RENIARKS,
I.DO MERSEY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE
WITH 15A NCAC 2C, WELL
CONSTRUCTIONS STANDARDS; AND THAT A COPY OF THIS °CORD HAS
BEEN PROVIDED TO THE WELL OWNER
D -7 60
- - . TURE OF PERSON CONSTRUCTING I HE WELL; DATE
Submit the original to the Divlslon ol'Water Quality; Groundwnter Seetion,l636
Mail Servlce Center- Rale[gh, NO
27699.1635 Phone No. [phone], within 30 dais, ' ...
- GW•1 REV. 07/2001

14,
WELL CONSTRUCTION RECORD938
North Carolina - Department of Environment and Natural Resources • Division of Walker Quality • Groundwater Section,
IYELi CQ�'TRAC1'OR(IYDIVIDUAL)I`IA�IE (prinl) James'A..1?rown .. CERTIFICATIOP 2045
WELL CCN'I R;\CT'OR COMPANY N AMEFedden Broers Well,Drilling,. Inc -PHONE a �>; 8 369-,95
STATE WELL CONSTRUCTION PERMITO - '' ASSOCIATED, IYQ Pf RbliTk - -—
(ifzonlicable) - iifaoohcable)
-
I, WELL USE (Check Applicable Box): Residential el Municipal/Public ❑ industrial O Agricultural 0
Monitoring 0 Recovery.❑ Heat Pump WaterInjection ❑ Other ❑ if Other, List Use —
2 WELL LOCATION,7opogranhlc/Land setting
NearestT n, County --fj�- ❑Ridge OSlop.. []Valley CIFli
(check oopropric a box)
(Svect Name; N' cero, Coniownity, Sub?ivisicn, Lot No. Zip Code) Latitude/longitude of Well location
.. �3. OWNER::. - (degreeshn inu tea/s econda)
Address Lat w fc/longitude nwe:DGPSDTopour3P�i c map
Ire I or au s No.)I / - (clmck box) i
.... - —
-A.3`i,
\ �/a. //ILA , A (- '17DEPTH DRILLING LOGY
Ci ty dr To,v Sate Zi, Coco From T y Form lion Descr otion
(i 344 - 3 7O0 0 �: ( clay & sand
Area code. —
Pho,,c ru,roer Crane _
4: DATE DRI----
TOTAL DEPTH: 1 e —
6; DOES WELL REPLACE EXISTING WELL?. YES NO �t —
7. STA'r(CWATER LEVELBelow Top ofCasing: 'FT. -- —
(USe * it Above Top of Casing) -
S. TOP OF CASING 1S 2 FT. Above Land Surface'
--Top of basing to rr Inated at/or beiew land mrface requires a —
variance In accordan tvf(h ISA NCAC 2C,0118. -
9.'YfELD (gpm) [� METF.OD O 7iisT blow
10, WATER ZONES.(depth): � _
LOCATION SCETCH
1 I: DISINFECTION: TypeH T H Amount 16 oz Shoyv direction and distance in miles rtoi-, at least
12 CASING: Wall Thickness hvo Slate Roads or County Roads. Include the road
Depth D/tzTp or Weight/Fi Mnate/riat numbers and common road names.
From 0 To Ft. CO'T _r✓i,
-
From To�Ft.
o
- From - To - Ft. - -
IJ.`GR,OUT: ,Depth Material Method _
co
Frbm 0 To 20 ' Ft. L�allte &ate : . Pt i;n <
c�
From .. - ,To "Ft.
_
: 14, SCREEN . Depth Diameter S'ut Size > :. Malarial ems,
a:c
From To Ft. in in. v
m�
From To Ft: —in.' zc
-ern
_"in.
15, SAND/GRAVEL PACK: 4?
m`
- - - Depth Size Material :
From .To .' Ft. �! ..c
From To Ft..
I6: RENIARKS:
I DO HEREBY C"c RTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH -1'A NCAC ZC, WELL
CONSTRUCTION'S STANDARDS, AND AT A COPY OF THIS RFC RD HAS BEEN PROVIDED TO THE WELL OWNIER
SIGs A URH.OF PERS N CON TRUCTINC THE WELL DATE
Submit the orlginal to the Division of Water Quality, Groundwater Section, 1636 Mall Service Center • Raleigh, INC
27699.1636 Phone No. [phone], within 30 days GW'•I.RE V. 07/3.:I

2 15
WELL CONSTRUCTION RECORD
North Carolina • Department of Environment and Natural Resources • Division of Water Qua.lty'- Groundwater Section
1YELLCO,YTRACTOR(11YDIYIDUAL) NAM E (prIN) James A. Bra» ), CERT(FICITIOIV„_20a5
WELLCon�i'RACTORComaAnYNAMEFedden Brothers 47e11:Drilling, Inc PH0NEaEc�31 309 9�91
- STATE wELL CONSTRUCTION PERMITtl :ASSOCIATED. WQ PERMITS-
.
I WELL USE (Check Applicable Box): Residential li� Municipal/Publio O Industrial O Agricultural' 0
Monuorinj ❑ Rizovery 0 Heat Pump Water lnjection O Oilier ❑ If Other, List Use _
2. WELL LOCATIO I: Topographic/Land setting
Nearest"ow
:
County rn ,6 ' []Ridge❑Slope ❑Valley..OFlat
- (check appropriate boa) -
(Screet Name,Nuinhcn, Co munity, Subdivision, Lot No., Zip. Code) Latitude,/longitude of well location
3, OWNER'-(degeeeahnin!teshecondi)..
Add css - La!intde/Icr.gitudesottrce.OGPSOTopograp'nicimap
Srcre; or Roue No.) (check boa)
/14�n
PY/iriJ, iVL DEPTH DRILUNGLOG
City or To.v ae Zip Code rr^m T Formation Oescrotion
�.b
A 3 r clay & sa,
Area code Phcne number C{rd711t2
4. DATE DRILLED 7T
5 TOTAL DEPTH:.I50
6; DOES WELL REPLACE EXISTING WELL? YES ❑ NOk1 —
7. STATIC WATER LEVEL Below Top of Casing, Aa_FT. -- -
- (Use"+"if Above To, aC asln2). -
S. TOP OF CASING IS 2 FT. Above Land Surface' -
-Top of basing tsrminated at/or blow land rartace requires a —
.. variance In: accord. aRc%qtvlrr�.h' ISANCACIC.0115.
9. YIELD (gpm) _10 (L ME j F TEST blow _—
� D
10 WATER ZONES.(depth): _
- - LOCATION SKETCH, -
.
1!. DISINFECTION Type F: T H Amount 16 oz Show direction and distance in miles from at least
12 CASING:. WaILThickness ttivo State Roads or County Rods Include the road
Depth Diameter or Wa;ghVBt Material numbers and common road names
From-�Z�--r To
From�tt To Ft�_
From To Ft. C:)
ZE
13:"GROUT Depth Ma,eria! Method 3
'
e
From 0 To 20 'Ft. @gM to & c a± . pumoed a
_S-i
FromTOFt.
14 SCREEN '. Depth Diameter SIo:Size Material e D
KD.
From To Ft —in. in:
�\
From To Ft. In. in
15. SAND/GRAVEL PACK!n_
(a
Depth Stz: Material
na
From To FL
v
From To Ft.
o
z
16. REMARKS:. S
100 HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH I5�A NCAC 2C, WELL
CONSTRUCTIONSTANDARDS,AN THATAC0, OF HISRECORDHAS BEEN PROVIDED TO THE WcLLOWNER
d -6a
- ATUREOFPERSONCONSTRUCTING THE WELL DATE
Submit the orlginal to the Division of Water Quality, Groundwater Sectlon 1636 tN1311 Service Center - Raleigh, NC
27699.1636 Phisnc No, [phone], wlthlri 30 days. GWI.REV. 07/2001
.

tVELL CONSTRUCTION RECORD 29 3 816
North CaroIina-'Department of Environment and Natural Resources • Division of Wa!e. Quality• Groundwater Sectiort
WELL.CO,NTRACTOR(IIYDIYIDUAL) IINAME (prlol) JamesR.Frown CERTIFICATIOiVR_2Q45
- WELL COiN9'RACTORCOtMPANYNAhaEHedden Brothers Well Drillingr:: lnC - PHONE # [phone]_Q,�91
- '- STATE w E L L CON ST R U CT IO N P E RM ITS' :ASSOCIATED SYQ PERMITS'
"--- --
-
I. WELL USE (Check Applicable Box): Residential 25 Municipal/Public ❑ Industrial ❑" Agricultural G
Monitoring G Recovery.❑ Heat Pump Water lnjection G Oil)--. ❑ If.Other, List Use
2 WELL LQCATIO aphtc/Land setting F
dge
��/�p�t,y� �
N:ar�r,{(tewMpnL, County--I-�`-' ❑Ridge GSlop,. ❑VaIl:y ❑Flat
M
(c'ne.k aiPrrpricte bcs)
(Street Name, NwnScrs, Ccmmui ity, Subdivision, Lot No., Zip Code) Latitude/longitude of well location
k-
3. OWNER:� - (d eg« e sAr, inu It s/s ea a ads)..
-Addicss ( - .Lautudc/lcngitudcsou,ce:GGPSGTopographicmap
-
( trees or Rey le(cha<k box)
)NI)
� DEPTH DRILL(NG LCifi
-- =
City a T Sate Zip Code From Formation Descrption
�-
0 clay & sand
Aran code Phew number a Crral;ite
Ob ly
4. BATE DRILLED
5. TCTAL DEPTH: O
6; DOES WELL REPLACE EXISTING WELL? YES NO ;11C'
7. STATIC WATER LEVEL Below Top of Casing FT. --
- (List"✓if Above Top or Casinj).
S. TOP OF CASING IS 2 FT. Above Land Surface' —
:-Top of caslnq tormlaated at/or blow land surface requires a
variance In Accordance M2 IS.A NC.AC 2C.01 Ia.
U blow
9. YIELD (gp n): r J` METHOD QQFtTEST
10. WATER ZONES,(depth):a �O _
LOCATIONSK?TCF,
11, DISINFECTION: Type' H T H Amount- 16 oz Shona direction and distance in miles f o n at least
12, CASING Wall Thickness ? two Stoic Roads or County Roads. Include the road
.
Depth r D metes or Weight/FI Material numbers and common road naves:
From 0 To � Ft. CCaa �7 c�
.: CD
From - To - FL
From To Ft.
13: GROUT:. , Depth Material Method <
`
c
From 0 To 30 Ft. YsrsZite 8 o3-e-± Pum6ed
From ' To Ft, ca
ter.
14, SCREEN. Depth Diameter Slot Size` Nlaterial
m^
From To FL_in. in. _ a
From To Ft. in.
15. SAND/GRAVEL PACK: w
•.
:Depth - ;Size .Material - s
From To Ft.
`z
From ` To Ft.
16. REMARKS.
I.DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15-A NCAC 2C, WELL
CONST RUCTION STANDARD A; 0)THAT ACOP Y "TH RECORD HAS SEEN P.ROVIDEDTOTHE wELLOWNER
NATURE OF PERSON CONSTRUCTINGTHE WILL - DA,E
Sulomit the original to the Islon of Water Qualit•Y, Groundwater Section, 1636 tNlail SerYlee Conic. Raleigh, NC
27699.1636 Phonc No. (919) 733J221, within 30 days: '_, GW'•l.REV. 07/2001

293817
WELL CONSTRUCTION RECORD
(forth Carolina - Department of Environment and Natural Resoul'ces • DMsiorncf Water Quality • Ground.Yater Section.
tiYZLLCO, TRACTOR(IIVDIYID'JaLly��tE (prlol) James fi, .Prows: CiBTI61CATI0tVR_Z�as
\YEL,L CON'I RACTOR COivIPANY NA,YtEKedden Brothers P7ei1 ,Drilling,: Inc PHONE M Q23 )�369__2ii1
- 5'rATE \YELLCONSTRUCTION PERMITS ASSOCIATED, IYQ PERM17.
'(ifappli<able) _ _ (ifaonh<able)
I. WELL USE (Check Applicable Box): Residential 21 Municipal/Public 0 Industrial C3 Agricultural C
Monitoring O Recovery C Heat Pump Waterinjection.11 Oitier ❑ If 0ther, List Use
2, WELL LOCATION: Topographic/Land setting
Neares'`own: County_[(f _�/ ❑Ridge ❑Slope OValey ❑Flat
(c'neck approyiu: taco)
-
(Strw Name, Nuinben, Convnunity, Subdivi>.loiy Lot No.. Zip Code) Latitude/longitude of well location
.��.
_-
... 3. OWNER:.. TN'Lld/1
- '(degre<ahnlnut<ehecohdr)
Address - 1 .J -v, i!N source:C lOPSOTopographi€ map
)
Sv:a or Reuie No.) / - (check box)----
'
�An IVC �d 7�7 EQ f� DRILLING LOG
Gtycr Taw.v ate Zip Code. From f Formation DescrLctior
M(5 ui 3 4 7 9. 0 � clay & sans
Area < de.Pna:ct num� p75T granite
4. DATE DRILLEDber ! �� "0� —
5 TOTAL DEPTH: `:!:)`15/ —
6 DOES WELL REPLACE EXISTING WELL? YES 0� 0
i.STA'IICWATER LEVEL Below Topo"Casing: F —
(List"✓'if Above Top o` asin2)..
S. TOP OF CASING IS 2 FT. Above Land Surface' -
-'Tap.of dulny Icrminated at/or blow land surface requires a -
- varlance In accordant wlthlSANCAC 2C.0118.
9. YIE' D (gpm) (go M TYQDO F TEST blow _-
10. WATER ZONES (depth): �!, -
- LOCATION SKETCH
It. DISINFECTION: Type H T H Amount 16 oz Show direction and distance in miles fmin at least
12, CASING: Wall Thlckness two State Roads or County Roads..6nckide the road
Depth Dla eter or WeighVFt h13te;ial numbers and common road nz nes.
From—o0 Cr To Pt �9 VC
From_ov To Ft /�,•.. �[�
c-
..
-From To 'Ft. - I
o
IJ °GROUT: Depth Material - Method
From 0 To 20 Ft. tsrnite & rsices Pumped
= '
from To Ft
^'
14 SCREEN:'. Depth Diameter Slot Site t\laterial LJ
-7: n
'- From ' To Ft. _in. in. - -`
From To Ft. —in. _'in. av
�F
16 SAND/GRAVELPACK:
V==
`Depth - Sc. Material -
n�.
From _ To Ft. v
E
From ` To Ft.
16. REMARKS. .
.I SA NCAC 2C, WELL
I DO F?ERESY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH
CONSTRUC71ONSTANIC,
ND THAT A C Y 0" HIS RECORD HAS BEEN PROVIDED TOT =
JWELL,O\hi'=R
IGNATURE Or PERSON CONSTRUCTING TI-IS WEL! DA
Submlt the orlginaI to the ivislon of Water Quality; Groundwnter Section; 1636 Mail Service -Center • Rale(Ii NC27699.1636
Phonc Na. [phone], rvlthln 30 days. - GW-I.R2V• 07/2001

WELL CONSTRUCTION
RECORD
North Carolina - Department of Environment and Natural Resources - Ulvfsion of IVattt Qua!Ity - Groundwater Section.
NLLCONTRACTOROINDIVIDUAL)iINAME (prinl) Janes F.-Brown CER7IFICATIOtNa_2045
WELL CONTRACTOR coivi FANV NAatEHedden Brothers well :Drilling, Inc PeoNEaBcB) 3c99.5,01
STATE WELL CONSTRUCTION PER',MIT# ASSOCIATED WQ PERh11744.
_
(ifzpplicable)- : {if aoplicable)::
-
I .WELL USE (CheckApplicableBo,e):Residential 1!3 Municipal/Public ❑ Industrial 0, Agricultural ❑
_
Mcniloriny C3 Recovery 0 Heat Punp Water Injection ❑ Other ❑ If Other, List Use —
2 WELL LOCATIO �/�,���Topographic/Land setting
N req;Townl
County Feu Midge CSlope. ❑Va!1ey OFlat
IItA
- '- (check appropriate bon)
(6cr #Name, Nuiin'bera,Community, Subolvisior. Lot No., Zip Code) Latitude/longitude of wall location
3 OWNER: Y^�
) (de3;eea/imnutu/aenndaJ
Addl.s P DP 3,61:� 1 Lahnldc/to ,gihtde sotrce,GGPSC7TepolII map
tNet or to No.) (check box)
L
DEPTH DRILLING LOG
(City orT.vn S to Zip Cade. From Tn Formation Descf C110n
'C 5 0 clay & sanc`f
_
Area< de P o,cviwnber �`T v ores—Zlte
4. DATE FILLED
5,TOTAL DEFTH. q,061-
6 DOES WELL REPLACE EXISTING WELL?: YESP N0 ❑ —
7. STATIC WATER LEVEL Below Top of Casing FT. —� —
(Use "."if Above Top of Caain2) —
8. TOP OF CASING IS 2 FT. Above Land Surface'
- --Top of caaing Nrrrinatd at/en below land rurfaee regcfru a _
variance In itecordancl with ISA NCAC 2C.0118.
9, Y1ELD (gpm) o METYOD OFTEST blow
10 WATER ZONES (depth): ID'
_
LOCATION SKETCH,
! 1. DISINFECTION Type' . H T H Amount . 16 02 Show direction and distance in miles (cin at least
I2, CASING: Wall Thickness twe Stote Roads or County Roads. Include t'ne road
De Ill DI me ^r or Weigh n aerial numbers and cannon road names.
From 0 ToFt,= s V
c
From To' Ft. O
o'
From To - Ft. -
i3."GROUT: . Depth Material Method
From 0 To 20 Ft.tsnZite & Msit oumoed
v
. From To— - Ft. {
-¢
14, SCREEN: '. Depth D�amecer � Siot$ize A'lateial
'- From - •'To :."Ft, in. in.
m
i
From To —Ft. —.in,' _'in ca
N
ma
15. SAND/GRAVEL PACK:
M
' `.Depth Siz. :.Material w
—'
From To Ft. J
o
From - To Ft.
16. REMARKS.
I.DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH I5.A NCAC 2C, WELL
CONSTRUCTIONSTANDARDS, AND T TA COPY OF THI R.ECOP HAS BEEN PROVIDED TO THE WcLLOWNER
SIGN or PERSON CONSTRUCTING 7H-WELL . DATE
Subnit,tile original to the Division of Water Quality, G. oundwnter Section, 1636 Mail Service Center- Raleigh, NC
27699.1636 Pitnnc,vo. [phone], WIthln 30 days,' GW'•I P,BV. 07/2C01

North Carolina - Department of Environment and Natural Razourcan - Divlsion of Water Quality - Groundwater Sociion 234 4 9
1636 Mail Sowlco Center -Raleigh, N.C. 27699-1636-Phono [phone] 12
WELL CONSTRUCTION RECORD WELL CONTRACTOR: Th S S � � `A C11 �C
WELL CONTRACTOR CERTIFICATION It:
STATE WELL CONSTRUCTION PERMITII:
1. WELL USE (chock Applicable Box): Residential Municipal ❑ Industrial ❑
Recovery ❑ Heat Pump Water Injection Other It Other, Llst Use:
2. WELL LOCATION
sketch of the location below) (�
Noarost Town: O=, 1\0Ayl r r _ County:
Agricultural ❑ Monitoring ❑
(Road Name any Numbors. Col rnunay, at Rg`�bdivislon and Lol l4u.) DRILLING LOG DEPTH
KPLY-WIIrk
3.
OWNER , F1111 `�( '� ''4' (/1 IL'4'� Flom To Formation Doxrlpilun
Address C
r t l.Ill pC
City Tuvrn Slate CJ 7 L�l
4.
Coda
Zip Coda
DATEDRILLED (IIr—�I�
S.
TOTAL DEPTH =n'-`
C.
7.
CUTTINGS COLLECTED YES [2� NOD
DOES WELL REPLACE EXISTING WELL? YEG
G.
STATIC WATER LL=VEL Below Top of Casing:_ FT.
(Uso'f' ll Abovo Top of Gazing)
O
0.
TOP OF CASING IS_�_ FT. Above Land SuHa co'
C
o
'Top
or caabrg larn9nalud aVor belovr land surfaco requires a vnrlanco In accvr- --
dance
10.
with 15A NCAC 2C .0110 �'v�" l _
YIELD (gpm): .,lL METHOD OF TES _
r
p'
��
oM
11.
_ _
WATER ZONES (dopth):
117:
l� -II .�'rCD
12.
CHLORINATION: Type a Amount �s l 15 I: additional space 15 necdc.: use back of (orm
m�
13.
CASING: ----------- —=--gym
LOCATION '1KETCH
Wall Thichncs;
tiN
Depth Bipolar Or Wei{7tivi 1. d toilet (Show direction and distance Ir. O;n at least two SlateLl
LOB L (
.C�
•rill Roads, or other map refers,.co points)
Front, To — LD1 Ft.
Z
From; To 1:1.
From To-- Ft.
14. GROUT:
Dopl�hh `l Matollal Method
From Tb G 0 FL.
From To Ft.
15. SCREEN:
Depth Diameter
From —To _ Ft In.
From To Ft. In.
From To Ft. In.
1G. SAND/GRAVELPACK:
Depth Sizo
From To Ft.
From To Ft.
17. REMARKS:
Slot Sizo Mialorial
In.
In. In.
Dla:orial
`JCxY1C� 5 -�D�� it Qd
To)-),� Qj
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITI I iSA NCAC 2t), Y/ELL
CONSTRUCTION STANDARDS, AND THAT A COf;Y OF THIS RECORD HAS BEEN PROVIDED TO TI1E'NELL C
FOR OFFICE USE ONLY
Quad No-
Serial No.
Submit original to Division ci
' � L
IlfSFRUCTING TI1E W _ .
Gmundv.ater Scclion Within "I
DATC
GY1.1 REV. 12P77
1335)

11051
North Carcli. iivi
s - Department of Environment and Natural Resourcea - Dsion of Water Quality- Groundwater Section J
1636 Mail Service Center - Raleigh, N.C. 27699-1636-Phono [phone]
WELL CONSTRUCTION RECORD WELL CONTRACTOR: I � �� NC In r
WELL CONTRACTOR CERTIFICATION P: A /',f-/ _
STATE WELL CONSTRUCTION PERMITh:
1. WELL USE (Check Applicable Box): ResidenliaYL_] Munlcipal ❑ Industrial ❑
Reco.ory ❑ Hoof Pump Water In;cclion ❑ Other ❑ If Other, Usl Use:
Agricultural ❑ Moni!Crng ❑
2. WELL '_OCATION{y-' /1Show sketc.h/ of the location below) .
Nearest Tovm: /_ T%r A/ � r'N CCU, y: MCX, C U N/ _
?u Pr bclyd M rvJ 0F4� 14u_,g a
(Road Nano antl umbc Con•.,-un//i!y'. or Sobd:vision nd Lc
3. OWNE? �/1 lam( n u- -
Addres /.QG IQ rl a At RnA r'
Cip or To.vn State Zip Codc
4. DATE DRILLED aani,5 Cl .2wc
S. TOTAL DEPTH :2,©6
G. CUTTJi:GS COLLECTED YES© NO❑
7. DOES ::ELL REPLACE EXISTING VIELL? YES NOQ,
B. STATIC WATER LEVEL Bclmv Top of Casing: FT.
(Use -.' If Abo•:e Top of Cvioq)
9. TOP O CASING IS FT. Above Land Surface -
'Top of east: 3 tcroilnated a'Jer below land surface roquires a varlanco In aeeor.
dance vdlh 15:. I ICAC 2C .0118
10. YIELD (gpnl), LP_. METHOD OF TEST _ A I
11. WAT E' 7.Of,ES (deplh): �2 qOr •� - d'O l
DRILLING LOG DEPTH
Fan To Fcnra;lon Ocscripl:cn 1
0 — a.� C /CL
b -c-
-
o
J
O
C7
c
O
m�
-- --`--rrr=
12. CHLOF.INATION. Type �"1.--l..r,ct,'r.l "�Uf�L� Uneeded use
13. CASING:
\Yee i''Jb.r.css
Depth DL-ytor c;�y,,r
From -C> To Ft. -L—(`' --.
From— To Fl. ------ —
Fror1 _ To— FI.
14. GROU:':
Depth F.la to as Molhod
From' To Ft.
From --To FL _-
15. SCREEN:
15
Depth Diameter Slot Slzo M.alorial
Frorn --- To FI in. In.
From __ To Ft. 1:1. In. —_
From To __ FL In. In.
SAND,'_,RAVEL PACK:
Depth Size Material
From To Ft. —
Fporn To Ft.
17. REMARKS
LOCATION:,KEI ;H
(Showdirer;:c;, c .d dicta. -:Cc bops\ n; Icast two Slate
Roads, or c!.`.zr map re!C: c'.C.. pcirda)
Fra/-;H fA)
R UC,r brnrcl RC)
AL, 1) Rj
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCEWITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO T HE \YELL OWNER.
FOR OFFICE USE ONLY -' „ �O '-` C> C'Qe1 (�! �) C OS �o�,- � V, I C " )
Ouad No: SIG4iAWRE CF PERSON CONSTRUCTING T HE WELL DATE
Submllor ra , to DJdslon or Wa er Oua,:y, Groundna.er See.:en 'v:i'^h 30 days
Senal No. G'.v-I Rr V. 12l59
ip
vcjD1r5)LC

North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
5 3 1.
1636 Mail Service Center - Raleigh, N.C. 27699-1636-Phone [phone]
WELL
r T I
CONSTRUCTION RECORD WELL CONTRACTOR: RU.<SS P 'A t 1 04 10,f-
_
WELL CONTRACTOR CERTIFICATION k: �. 1
STATE WELL CONSTRUCTION PERMIT#:
1.
WELL USE (chock Applicable Box): Residenli,114 Municipal ❑
Industrial ❑ Agricultural ❑ Monitoring ❑
Recovery ❑ Heat Pump Water Injection ❑ Other ❑
If Other, List Use:
2.
WELL LOCATION (Show Sketch of the location below) -
0�IO�N,( �
: 4—
Nearest Towrr—'�-, Vt.V s� County (
LA
QQ2!
4A
(Road N a lid Numhnrs, Commu.�nity, or S and Lot No.)
DRILLING LOG DEPTH
3.
�trims^ion
OWNER �g��l
From To Formation Description
Address
It -,;i
City or Tavm - Stale Zlp Code
4.
DATE DRILLED��--OG
5.
TOTAL DEPTH
G.
CUTTINGS COLLECTED YES [ NOE]
7.
DOES WELL REPLACE EXISTING WELL? YES ❑ NOJ�J
6.
STATIC WATER LEVEL Below Top of Casing: FT.
9.
(Use '.-il Above Topol rmgJ
TOP OF CASING ISFT. Above Land Surface'
u
y;l
'Top of easing terminated ab'or below land surface requires a variance In actor-
dance
10.
with 16A NDAD 2C .0116
YIELD (gpm):_ METHOD OF TEST
11.
WATER ZONES (depth): �'CAT� G0C�
-
12.
CHLORINATION: Type ivy- Amount_
I: additional space Is needed use back of form �p Gn
m u
13.
CASING:
Cil ti
Waa Tnkamss
LOCATION SKETCH W
Dep h Diameter orWeight/Ft.c�M�a...,l_�eda�l
(Show direction end distance from at least two Stale
From C? ToFt. �� �
#
Roads, or other map reference points)
From To Fl.
From To Fl.
14.
GROUT:
Depth Malorlal Mothod
f�
+e.r 1l,,
From To--:;�C_Z FL 02=nL iA­
From To Ft.
15.
SCREEN:
Depth Diameter Slot Size_ Material
From To Ft in. In.
From To FL In. In.
From To Ft. In. In.
15. SAND/GRAVEL PACK:
Depth Size Material
From To __ FI.
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'AA COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER.
FOR OFFICE USE ONLY a �JhL� �'�%�Qy �k\ d J GV o S���Ii�
Quad No SIGNATURE OF PERSON CONSTRUCTING THE WELL —I DAT
Submit original to Division of Waver Quality, Groundwater Section Within 30 days
Serial No. GW-I REV. 12199

North Carolina - Department of Environment and Natural Resources - Division of Water Duality - Groundwater Section
1636 Mail Service Center - Raleigh, N.C. 27699-1636-Phone [phone]
WELL CONSTRUCTION RECORD WELL CONTRACTOR: D_
WELL CONTRACTOR CERTIFICATION #:
STATE WELL CONSTRUCTION PERMIT#
(} 1. ) 995
MGCU�Q�
21 8i
,.
1. WELL USE (Check Applicable Box): Resldentlel E,..,/Municipal ❑ Industrial ❑ Agricultural ❑
Monitoring ❑
Recovery ❑ Heat Pump Water Injection ❑ Other ❑ It Other, List Use:
2. WELL LOCATION: (Show sketch of the location below)
H inkox is
Nearest Town: _County:
Cw o
(Road Namey�/a�n(tl� 1�,1�u�m,�h,a�r``s, Co munity, or S bdI Ision and Lot No. I DRILLING LOG DEPTH
9i.u�JfT �OAdl
3. OWNER � r� 1411C� �q. From To Formatlon
Description
Address -P.C) �8ox ac�a
eo or ou o 0
as-)Ii x-56I,ke.
City or Town r^� Stale Zip Code -Q — 154 sO
n CL
4. DATE DRILLED d—�L%'Ob
_
5. TOTAL DEPTH •. L
6. CUTTINGS COLLECTED YES CK NO[:]
7. DOES WELL REPLACE EXISTING WELL? YES NOd 5(Q -' 2*00
o
❑
8. STATIC WATER LEVEL Below Top of Casing: _(Z FT.
`✓'� S,'-?
(Use'+' It Above Top of Casing)-'
9. TOP OF CASING IS FT. Above Land Surface'
'Top of casing terminated aVor below land surface requires a variance In actor.
dance with 15A NCAC 29, fi118
10. YIELD (gpm): .'+I:) METHOD OF TEST
11. WATER ZONES (depth):?'
_
N o
12. CHLORINATION: Type VITN Amount It additional space Is needed use back
of form
13. CASING
Depth��,., Diameter
FromTo Ft. �0'/Ll—
From To Ft.
From To-- Ft.
14. GROUT:
Dopt
From To DIU Ft.
From —To Ft.
15. SCREEN:
Wall Thlcknoss LOCATION SKETCH
er eighVPL SMated�T�I (Show direction and distance from at least two State
-4Q ok- Roads, or other map reference points)
Malfirlal Method
9-h*-a � C-rL{-
Depth Diameter
From To Ft In.
From To Ft. In.
From To Ft. In.
16. SAND/GRAVEL PACK:
Depth Size
From To Ft.
From To Ft.
17. REMARKS:
Slot Size
In.
In.
In.
�\ Vwn&a ,
UP,
Material -
Material
amLl-C-s
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS AND THAT A COPY OF THIS ECORD HAS BEEN PROVIDEDD /T/p��T,,H�E WELL OWNER.
FOR OFFICE USE ONLY �h 0aIAc� LY!' 3-
Quad No: ,r SIGNATU O PERSON CONSTRUCTING THE WELL DATE
---..--�I', -Submit original to Division of Water Quality, Groundwater Section withln 30 days
Serial No. { "'. GW-1 REV. 1W9
Alf"' .: I
-va
n4a

North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
1636 Nail Sorvice Center - Raleigh, N.C. 27699.1636-Phono [phone]
WELL CONSTRUCTION RECORD WELL CONTRACTOR: IlusscLL _rA-4LOa"
WELL CONTRACTOR CERTIFICATION F: 2-
STATE WELL CONSTRUCTION PERMITN:
1, WELL USE (Check Applicable Box): Res;denli*l Municipal ❑ Industrial ❑ Agricultural ❑ Moni:oring ❑
Recovery ❑ Heat Pump Water Injection ❑ Olhcr ❑ 1( Other, Llsl Use:
2. V/ELL LOCATION: (Show skelch of the location be!ew)
Nearest Town: ffly-LAN J9 Coun:7: /AACON
NtNOl.O ''zo
(Road Name and Numbers, Commur, ty, or Subdwision �d Lot `:o.) DRILLING LOG_ DEPTH
3. OAINER RiglulN0t> ZE/�IT`f N2tU% -% {1lX.rN TAC{},JT?.T 'fo Formation Descriplion
a�y i (AV
Address QO. 1.l.�- 2Cc'i � C1—
(SIoe or Thou Iio.) f)
SAND(=R�J(UL- (rAl
Ciy or Tc.vn Slate Zip Coco
4. DATEDRILLED �'�"� ��� )O
5. TOTAL DEPTH
G. CUTTINGS COLLECTED YES `� NOD —
7. DOES WELL REPLACE EXISTING WELL? YES ❑ H0,
8. STATIC WATER LEVEL Below Top of Casing: y6 FT.
(Use',' it Abo,e Tep of Cnsm,)
9. TOP OF CASING IS I FT. Above Land Surlacc'
-Top of eaaln0 terminated aJor below land surface requires a variance In accorr
dance vath 15A NCAC 2C.0110 -- --
10. YIELD (gpm): CIO METHOD Or' TEST _
11. WATER ZONES (dapih): t0 (J,AL:5 3`0 F7 SO
r�+•N ITS
12. CHLORINATION: Type ti Amount _ "�'S . c�:t:oral space is -.ceded use bzci 0: lo;r.��-
13. CASING: --- --- — ------
4l3p 1lkkncss
Depth
Dia: ncicyr cc Ylci;'�STt. :'a:edai
FrornC-)—To
G5
Ft.
Q �Y. Pvc
From
To---
FI.
Fr,nn
To--
Ft.
1A. GROUT:
Depth
Lia!er!ol b:ethed
From O
To"_gCI_FL
From _
To
Ft.
_
15. SCREEN:
16
17
Depth
Dimnetor
Froln
To
Ft in.
From
To
Ft. In.
From
To
Fl. In.
SAND/GRAVEL
PACK:
Depth
Size
From
To
Ft.
From
To
Ft.
REMARKS:
Slot Size Matnlial
in.
In.
in.
Material
LOC ATON SKEIC:H
(Shove direcCon and di; a o from .at Icast Y.va State
Pc;ds, or etlher map ralerencepoints)
&4
,�9
�rp1G L.acF
Ccu zSc
ARN�i-D
Eu-
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE 'NITFI 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PRO\9DED TO THE WELL O IINER.
FOY R OFFICE USE ONL
N�� Q(Q-QY)Q -PTce� ��,V-u c\D� S jIu(3'. IZ�COJ
Ound No:
Serial No.
SIGt1ATUPs OF FERSON CONSTRUCTING Tfl'c 0_1_1_ DATE
Submit on;ir.al to Divlslon of l'falor Quality, Groun,I,ater Section V;ilhin 30 days
GVJ1 REV. 12157
I

North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
1636 Mail Service Center - Raleigh, N.C. 27699-1636-Phono [phone] ? 15 ?(
WELL CONSTRUCTION RECORD WELL CONTRACTOR: L56EL— 7AYLLUL
WELL CONTRACTOR CERTIFICATION N: 218"}
STATE WELL CONSTRUCTION PERMFN,:
1. WELL USE (Check Applicable ooz): Residentia'A
p
Municipal ❑
Industrial ❑
A, icullural ❑ Monitoring ❑
Recovery ❑ Heat Pump Water Injection ❑
Other ❑
If Other, List Use:
2. WELL LOCATION: (Show sketch of the location bolo':+)
Nearest Town: k,cr)Pt.A/uD
Coun;�:
MQL�`rl
Ae.ricl-D Pj.
(Road game and Numbers. Com r.urdly, or Subdlvis'ion a:,d Lot tJo.)
DRILLING LOG_
DEPTH
3. OWNER NI trt-Mk"i -Ua1.r Ty —Itte a c,
14V A _t Q'17"
From To
Formation Deseriat:o,
Address P.V. W 2 q
0 - $�(
ri
Sr� (SueoTor ttou:o Io 7
YTNCil�2-5V iICE �yQ
3i �'�Z
rily or Tervn State -
Z' Code
� v� �
_. _ (rQ,j ,,z
—
e. DATE DRILLED CO--
5. TOTAL DEPTH
G. CUTTINGS COLLECTED YES [� NO❑ _
7. DOES WELL REPLACE EXISTING WELL? YES [❑ N0,
8. STATIC WATER LEVEL Below Top of Casing: 4,)
lure'.' if Above Top of Caring)
9. TOP OF CASING IS I FT. Above Land Sufface'
v
'Top of casing Iermina;ed nVor below land surtazo ra quires a variance In accor-
dance with 15A NCAC 2C.011e _ _CID
10. YIELD (gpm): —_ tr1ETFIOD OF TEST
11. WATER ZONES (depth): ZSC> FT EJ
u 1, CD P
12. CHLORINATION: T)'pe_ H,V D Amount-�—It or:alzp3ce is odrd use br?ciol;o.,
13. C.AS!rdG: - --
'�: ra 7lnc:nc;; LOCI TION SKIT CH
Depth Diome:er cc V.,V-' a:'th�,// L:a:edst (Sher dirccl:cn and d:aacco Gem of least 1.vo State
From �— To _�_ Ft. Cie �� YYL _ , c s, or o;hcr map f Drente point;)
From-- To---- Fl.
From To _. Ft. In
I
1 GROUI — ,.�
Dopu, t.la:oaal F.'elhod
Front Tot:7QC_) Ft. _0_-__SN1S;T1
Front __ To __Ft. _
15. SCREEN:
Depth Diamelor
Front _ To Ft in.
From ro Ft. In.
From To _ Ft. In.
16. SAND/GRAVEL PACT;:
Depth Size
From To Ft.
From To Ft.
17. REMARKS:
Slot Size Mietial
in.
Material
QQ c
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WI T H 15A NCAC 2C. ,VELL
CONSTRUCTION STANDARDS. AND THAT A COPY OF THIS RECORD HAS BEEN PROVIOEO TOTHE;'TELL OWNER.
�T
FFD�ROFFICE USE ONLY fE-�•,�\ �FliCl-T2�OU StONATURE OF PERSON CONSTRUCTING THc �SLL PATE
Submit oriclnal to GMr Ion of \Valor Ouallty. Ground:,ator Seton ithin 30 days
GYJ.I REV. 12+59

North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section 22,1128
1636 Mail Service Center - Raleigh, N.C. 27699-1636-Phone [phone]
WELL CONSTRUCTION RECORD WELL CONTRACTOR: _ C61Qr2o�ee 6Je
WELL CONTRACTOR CERTIFICATION A: d Fi
STATE WELL CONSTRUCTION PERMIT#:
1. WELL USE (Check Applicable Box): Residential [H Municipal ❑ Industrial ❑ Agricultural ❑ Monitoring ❑
Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use:
2. WELL LOCATION: (Show sketch of the location below)
Nearest Town',_d/d-JTi1-l-fMLli County: M4 COnI
( 11IM-mr AD '
(Road Name and Numbers', Community, or Subdivision and Lot No.) !� DRILLING LOG DEPTH
3. 501y
l )C S CD'N 1 RW C-10 From To Formation Description
, p _ oX Nq Lr) 7 0 <- 7 H 5 -.
12io ouerT��lq $ p or Town State Zip Code
4. DATE DRILLED / l' / b !9 v
5. TOTAL DEPTH (,, `4 ) '
6. CUTTINGS COLLECTED YES NO[3'
7. DOES WELL REPLACE EXISTING WELL? YES E] NOE3- o A
S. STATIC WATER LEVEL Below Top of Casing: FT.
po a
(Use'+' N Above Too{II Casing) C-;i, c
9. TOP OF CASING IS / FT. Above Land Surface' o�
*Top of easing terminated eVor below land surface requires a variance In OCCef•
dance with 1SA NCAC 2C 311e �o
10. YIELD (gpm): L METHOD OF TEST
11. WATER ZONES (depth): 0-
a cy c�rz~
12. CHLORINATION: Type - Amount 2 0 VL Y- It additional space is needed use back ti �lorm z
13. CASING:
Wall Thickness LOCATION SKETCH
Depth Diameter or WolghVFt. M ferial (Show direction and distance from at least two Slate
From To �� Ft. aiLl_7) " `- Roads, or other map reference points)
From To Ft.
From To Ft.
14. GROUT:
Depth wlatedal Method
From To ) FI.n s
From 7-O To .S y Ft.
15. SCREEN:
Depth Diameter Slot Size Material
From _ To _ FI _ 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 HERE yCERTIFyyI AT THIS -WELL WAS CONSTRUCTED IN ACCORDANCE WITH 1SA NCAC 2C, WELL
CONSTRU ION fAhiAgALAID THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER.
FOR OFFICE TIE ONLY
Qur�
Mad No: NATUR F P SON CONSTRUCTING THE WELL DATE
Su I oat nafb.DlvlN n d aler Quality, Groundwater Section within 30 days
Serial No. ), -..... ..."-foll OW-1 REV. t2l99
er
kheviifa Fe+=ional

North Carolina - Department of Environment and Natural Resources - Division of Water Ouality - Groundwater Section `l f
1636 Mail Service Center • Raleigh, N.C. 27699.1636-Phone [phone] %� 1
WELL CONSTRUCTION RECORD WELLCONTRACTOR: \ -he�y-� mil)
WELL CONTRACTOR CERTIPICATION N: (1 S5
STATE WELL CONSTRUCTION PERMITM:
1. WELL USE (Check Applicable Boa): Resident al LvJ Municipal ❑ Industrial ❑ Agricultural ❑ Monitoring ❑
Recovery ❑ Heat Pump Water In)ection [3 Other O If Other, List Use:
2. WELL LOCATION: (St
Nearest Town: —L/i_
(Road Name and Numbers.
3. OWNER , >11�
Address I rr';
J
sketch of the location below)
N'�-S —Courtly:_ 1221TCD(y
or su�bdivfsion and Lot No.) DRILLING LOG
From T
? I r-
filAF) 0a0
o. �87FS I �6 J o7
i ..y or 1 own State ZIP Code
4. DATE DRILLED 3- eo
5. TOTALDEPTH
6. CUTTINGS COLLECTED YES NO[]-
7. DOES WELL REPLACE EXISTING WELL? YES Q NOD
B. STATIC WATER LEVEL Below Top of Casing: a S FT. -
(Use'+' It Above Top of Casing)
9. TOP OF CASING IS FT. Above Land Surface -
'Top of cuing terminated stfor below land surface requires a variance In accor-
dance with 16A NCAC 2C.0118
10. YIELD (gpm): /O METHOD OF TEST / 01
11. WATER ZONES (depth): _1 o
12 CHLORI F/J
DEPTH
FormationFoution Description
'5
('r
NATION. Type / /✓ Amount /A( If additional space Is needed use back of IGmt C'
13. CASING: r —r
z
From
From
Depths p
To
To
Ft.
Fl.
Wan Thickness
Of n' r or WelghVFt. M fedal
_ _6LI6 21 Y�C-.
LOCATION SKETCH
(Show direction and distance from at least two State
Roads, or other map reference points)
From
To
Ft.
14. GROUT:
Fromy
Depth
To I C
Ft.
Material Method
From
To
Fl.
—..
15. SCREEN
Depth
Diameter
From
—To _
Ft — in.
From
_ To _
Ft. _ In.
From
—To _
Ft. _ In.
16. SAND/GRAVEL
PACK:
Depth
Size
From
To
FL
From
To
Ft.
17. REMARKS
Slot Size Material
_ In.
In.
In.
Material
I DO HEREBY CERTIFY 1j%LUUS.WE TRUCTED IN ACCORDANCE WITH ISA NCAC 2C, WELL
CONSTRUCTION S$rTAI 06 %9. gDaH 0 F THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER.
FOR OFFICE USE SS IU�J ^` A Oo
Ousd No: �. - TURE OF PE ONSTRUCTINO THE WELL DATE
`' 4 Serial No. SubrTit odgl to vision of Water Quality, Groundwater Section within 30 days
GW-) REV. I V"
�gdw�[ftlbi a
� bwitle Rtlmtlnal to

North Carolina - Department of Environment and Natural Resources -Division of Water Quality -Groundwater Section
i9493
1636 Mail Service Center - Raleigh, N.C. 27699-1636-Phone [phone]
WELL CONSTRUCTION RECORD WELL CONTRACTOR: �!t 2c•/L�t �LiL�) �aJLA5
WELL CONTRACTOR CERTIFICATION N: 7 5- G ^—
STATE WELL CONSTRUCTION PERMITM:
1. WELL USE (Check Applicable Box): ResidentialG Municipal ❑ Industrial ❑
Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use:
Agricultural ❑ Monitoring ❑
2. WELL LOCATION: (Show sketch or the location below)
Nearest Town:_ 4-JblQe—IJ5 County: /A14C-017
it,J•)TAHAL->'4
(Road Name and Numbers. Communily, or Subdivlsion and Lot No.) DRILLING LOG DEPTH
3. OWNER I ty� 2 E'a :v From To Formation Description
Address �—� rjr �� ".t,Nl.:i J�
_ tolree or OU 5 NO. _ )
City or Town State Zip Code
4. DATE DRILLED /ti /L' Cc
5. TOTAL DEPTH
6. CUTTINGS COLLECTED YES D NOD
7. DOES WELL REPLACE EXISTING WELL? YES Q NOD -
6. STATIC WATER LEVEL Below Top of Casing: /S FT. o (Use'.* 11 Above Top of Cealnp) O _
9. TOP OF CASING IS FT. Above Land Surface'
.I
-Top of cuing terminated Wor below land surface requires • variance In eccor- N
dance with 15A NCAC 2C p11e
10. YIELD (gpm): rF METHOD OF TEST
11. WATER ZONES (depth): •) 2. - 1 / •' -a
12. CHLORINATION: Type
Amount
13. CASING:
I-
Depth
Diameter
Wall Thickness
or Wel hVFI. M tedal
'1
From
To `
Ft..JI —
/_ ` I.�,.,
From
To
Ft.
From
To
Ft.
14. GROUT
Deplh
From I, To ��
From To
15. SCREEN:
Material Method
Ff.
Ft.
Depth
Diameter
From _
To
Ff In.
From —To
Ft._ In.
From —To
—Ft._
In.
16. SAND/GRAVEL PACK:
Depth
Size
From
To
Ft.
From
To
Ft.
17. REMARKS:
Slot Size Material
In.
In.
In.
Material
If additional apace Is needed use back of 1@1p
r>
LOCATION SKETCH
(Show direction and distance from at least two State
Roads, or other map reference points) - � „/(Z r
0
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
Quad No:
Serial No
SIGNATURE OF PE6SON CONSTRUCTING THE WELL
Submit original to Division or Water Quality. Groundwater Section within 30 days
DATE
GW-I REV. IM9
ti
0

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 WELLCONTRACTOR: �QQD�e���I�l1a�I
WELL CONTRACTOR CERTIFICATION 0: 2 SG J
STATE WELL CONSTRUCTION PERMITN:
1. WELL USE (Check Applicable Boa)! Residentlal Municipal ❑ Industrial ❑ Agricultural ❑ Monitoring ❑
Recovery ❑ Heal Pump Water In)ection ❑ Other If Other, List Use:
2. WELL LOCATION: (Show sketch of the location below) nn ry�^I
Nearest Town: kcysSo 0) C,IT✓ County:—/'/C�
Sl Lv a.vI l o E
(Road Name and rN�umbers, Community, or Subdivision and Lot No.) DRILLING LOG DEPTH
3. OWNER /'!Y%QI�-.I /i AIll!Cli C- "— From To Fonnallon Description
Address S �� T:. Iq✓e-
�vee or ou a o. _
r�o< u24 � 70�f
Cdy or Town W slale Zip Code
4, DATE DRILLED 2 JU
5. TOTAL DEPTH t o
6. CUTTINGS COLLECTED YES NOQ-
7. DOES WELL REPLACE EXISTING WELL? YES NOEn"
8. STATIC WATER LEVEL Below Top of Casing:_ FT. o
(Use': If Above lop of Casing) r.
9. TOP OF CASING IS�_ FT. Above Land Surface-
(n
'Top of cuing terminated atlor below land surface requires a variance In seeor--
dancewithiSANCAC4 its c'} ;�-
10. YIELD (gpm): METHOD OF TEST
11. WATER ZONES(d pth):1'�
12. CHLORINATION: Type Amount D G%7 11 additional space Is needed use back of lq" i
13. CASING:
Well Thickness LOCATION SKETCH
From Depth`-i r Ft Dla(T or W` a e�'� MBlariat (Show direction and distance from at least Mro State
✓ �' Roads, or other map reference points)
From To Ft.
From To Ft.
14. GROUT:
U Depth Material Method
From To r1-(y Ft.
From 2z—�— To 2-2 r 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 --- -
FOR OFFICE USE ONLYy"
Quad No:
Sedal No.
Subrnll original to
)NSTRUCTING THE WELL
Groundwater Section within 30 days
GW-1 REV. IV99

North Carolina - Deparlment of Environment and Natural Resources - Division of Water Duality - Groundwater Section .l % 0 O 4
1636 Mail Service Center - Raleigh, N.C. 27699-1636-Phone [phone]
WELL CONSTRUCTION RECORD WELLCONTRACTOR: _LAeAD%ee 061I 1>adtwq
WELL CONTRACTOR CERTIFICATION N: S
STATE WELL CONSTRUCTION PERMITIt:
1. WELL USE (Check Applicable Box): Residential E Municipal ❑ industrial ❑ Agricultural ❑ Monitoring ❑
Recovery ❑ Heat Pump Water Injection ❑ Other II Other, List Use:
2. WELL LOCATION: (Show s k/etch of the location below) p , /
Nearest Town: ��7V County: �4/�-C"10
LUN! ��MCH dd'
(Road Name end Numbers, Community, or Subdivision and Lof No.) DRILLING LOG DEPTH
3. OWNER 77111 '1�"0/) � )In�G�l-�Q From To Formation Description
Address �iv 1 s-yMO�-T �Q p 0 /O_?
ree� oueFO. 1 �03 Coo-)�—
Cily or Town (-State Zip Code
a. DATE DRILLED 2 2y-00
5. TOTAL DEPTH So V2
6. CUTTINGS COLLECTED YESQ NOD-
7. DOES WELL REPLACE EXISTING WELL? YES NO[a
8. STATIC WATER LEVEL Below Top of Casing: ? .-j-FT.
(Use'+' It Above Top of Casing)
9. TOP OF CASING IS � FT. Above Land Surface'
-Top of cuing terminated at/or below land surface requires a variance In accor-
dance with 15A NCAC 2C .0118 /
10. YIELD U
(gpm): _� METHOD OF TEST
11. WATER ZONES (depth): L/,p i
12. CHLORINATION: Type Amount C' ,.5 If additional apace Is needed use back of form
13. CASING:
Well Thickness
Depth,., ��1 b ter �r elghVFt. Material /
From �To
1 Ft. (— r .. V
From To Ft.
From To Ft.
14. GROUT:
Depth Material Method
From ��L_ Tor 2 Ft.
From % D To /D � Ft.
15. SCREEN:
Depth Diameter Slot Size Material
From _ To FI 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:
0
--
69
rn
--
r
CJ7
Fi
LOCATION SKETCH
(Show direction and distance from at least two State
Roads, or other map reference points)
100 HEREBY CERTIFY THAT Tj,, WE L WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, ANq%I** � WPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER.
✓ 0
FOR OFFICE USE ONLY Jr m �O new 21� D
Ouad No: I IVIF SIGNATURE OF PE CONSTRUCTING THE WELL DATE
SuMnll original to Division of Water Ousllty, Groundwater Section within 30 days
Sedal No. OW-1 REV. 12/99

'?2791
North Carolina - Department of Environment and Natural Resources • Division of Water Ouality • Groundwater Section
1636 Mail Service Center - Raleigh, N.C. 27699-1636-Phone [phone] � \� a.L \D P—t L-L
WELL CONSTRUCTION RECORD WELLCONTRACTOR: 5
WELL CONTRACTOR CERTIFICATION ff: 3
STATE WELL CONSTRUCTION PERMITO:
1. WELL USE (check Applicable Box): Residential Ell, Municipal ❑ Industrial ❑ Agricultural ❑ Monitoring ❑
Recovery ❑ Heat Pump Water Injection ❑ Other If Other, List Use:
2. WELL LOCATIO (� how k Ich of the location below)
Nearest Town: County:.Yi-P 1M,�
(Road Name no bars, o unity, or Subdivis d Lot No.) DRILLING LOG DEPTH
3. OWNER
From Ssr Fo .anon Descripl on
Address <�\ 6
ree o e o 1`=;?;71 �5
rtyor Town State DO Code
4. DATE DRILLED at5
5. TOTAL DEPTH
O x
6. CUTTINGS COLLECTED YESQ NOEa__� O o
7. DOES WELL REPLACE EXISTING WELL? YES (—I NOd o
B. STATIC WATER LEVEL Below Top of Casing: Fr,
(Use'.' II Above Top of Cuing) N o M
9. TOP OF CASING IS FT. Above Land Surface
'Top of casing terminated atlor below land surface requires a variance In secor•
dance with 15A NCAC 2C . 18 m
10. YIELD (gpm): M METHOD OF TEST �. 2
11. WATER ZONES (depth): \Q O --
12. CHLORINATION: Type Amounl If additional space is needed use back of form
13. CASING:
Wall Thickness LOCATION SKETCH
Depth Q r)IaRgttr Swai t� AAetedp� (Show direction and distance from at least two State
From .�.L� To — Ft. (�',,// -V V Roads, or other map reference points)
From To Ft.
From To Ft.
14. GROUT:
Depth Ma al Method
From _�_ To _(S� Ft.
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 HERE BY.:CERT)FVT' WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION 5( N&FjbS,IyNJT T AC.OPY�OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER.
FOR OFFIC ONLY p r
160
Ouad No: r i=�� p '-' ' SIGNATURE &4iERs6N CONSTRUCTING THE WELL DATE
Su rut to Division or Water Duality, Groundwater Section within 30 days Serial No. OWI REV. 17199

F 22792
North Carolina - Department of Environment and Natural Resources - Division of Water Duality - Groundwater Section
1636 Mail Service Center - Raleigh, N.C. 27699.1636-Phone [phone]
*wYe�s.r\u_E w EtL.. ')�Q ((.. L I SIG, _
WELL CONSTRUCTION RECORD WELL CONTRACTOR: --W A=L IROA�V �cY
WELL CONTRACTOR CERTIFICATION N: 3
STATE WELL CONSTRUCTION PERMITp:
1. WELL USE (check Applicable Boa): Residential EI Municipal ❑ Industrial ❑ Agricultural ❑ Monitoring ❑
Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use:
2. WELL LOCATION: ( ow s e h of the location below) ^^
Nearest Town:
t& i k SV (o acounty: \
Inn kti Ik -n
I. I— e a "moers. omn o iry, or Subdivfsidn and Lot No.) DRILLING LOG
3. OWNER
From To
reSS � tut
ee or ou s n D r I
a Town t Stab Zlo Cad.
4. DA7tJDRILLEO L)U
5. TOTAL DEPTH
6. CUTTINGS COLLECTED YESD NOCa-
7. DOES WELL REPLACE EXISTING WELL? YES (—j NOd
8. STATIC WATER LEVEL Below Top of Casing: -p FT,
(Use'.• If Above Top of Casing)
9. TOP OF CASING IS
�_ FT. Above Land Surface'
'TOP of cuing terminated actor below land surface requires a variance In near.
dance with 15A NCAC 2C . 18
10. YIELD (gpm): METHOD OF TEST ta-�
11. WATER ZONES (depth):
12. CHLORINATION: Type Amount
13. CASING:
DEPTH
Fo ation Description
If additional space is needed use back of form
Wall Thickness -LOCATION SKETCH
Depth I ter r Wei hVF1. 1 cat (Show direction and distance from at leas! two Stets
From To � Ft. 2 VC, Roads, or other map reference points)
From To Ft.
From To Ft.
14. GROUT:
Depthn�l M el'iel Method
From t% To Ft. _
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 I -CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTI t� T D 0 A PPOF THIS,RECORO HAS BEEN PROVIDED TO THE WELL OWNER.
FOR OFFICE NLI� �' I7 ` DD
Ouad No: r LPG — S e IONATUR F PERSON CONSTRUCTING THE WELL OAT
SubrNt)o�g to DMslon of Water Duality, Groundwater Section within 30 days
Serlsl. No. - _ 0W.1 REV. 121"

North Carolina - Deparfmenl of Environment and Natural Resources • Division of Water Quality • Groundvvaler Section 236174
1636 Mail Service Center • Raleigh, N.C. 27699-1636-Phone [phone] D f ��L
WELL CONSTRUCTION RECORD WELL CONTRACTOR: 2J9ill" W b
WELL CONTRACTOR CERTIFICATION N: � IM!2
STATE WELL CONSTRUCTION PERIAITN:
WELL USE (chock Applicable Box): ResidenI1al9 Munlclpae ❑ Industrial ❑
Recovery ❑ Heat Pump Water Injection ❑ Other n 11 Other, List Use:
Agricultural ❑ Moniloring ❑
2. WELL LOCATION: (Show sketch of the location below)
Nearest Town: /T�%�PZWJ county: 4L Oil
X 1141,e Gilme r, -- DEPTH
(Road Name and llrers, Communl% or Subdivision and Lal No.) DRILLING LOG
3. OWNER ��e/"n �%�„ from To Fomvxn Des:l+pdo-
Address �r
ueel or Mount o.
—�
fL
City or To" Slate Zip Code
4. DATE DRILLED �—
5. TOTAL DEPTH Z116
6. CUTTINGS COLLECTED YFS Q NO[3-
7. DOES WELL REPLACE EXISTING WELL? YES Q NOQ-
8. STATIC WATER LEVEL Below Top of Casing: S' O FT.
(We'i N Above Top of Casing)
9. TOP OF CASING IS FT. Above Land Surface'
-Top of caslnp terminated eVor below land surface tequires a variance In accor-
dance with 15A NCAC 2C.0118��
10. YIELD (gpm): _,eLS:�_ METH �OD OF,TEST
11. WATER ZONES (depth): 3y 4
12. CHLORINATION: Type ITT Amounl
13. CASING:
Wall Thickness
Depth Diameter or Welphl/Ft. Material
From —To /,2� FLU /
From To Ff.
From To Ff.
14. GROUT:
Depth atedal M hod
From G To �—Ff. , 411VG
From To Fl.
15. SCREEN:
Depth Diameter Slot Size Material
From To Ff In. — In.
From —To —Ft. In. —In.
From —TO —FI.— In. — In.
16. SAND/GRAVEL PACK:
Depth Size Material
From To F)•
From To FI.
17. REMARKS:
It additional sFace is needed Ls^ back of lc r
LOCATION SKETCH
(Show direction and distance hcurt b IeW teo `'ale
Roads, or other r<a relererv_ points.`
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH NSA 01CAC 7C. r//ELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF RECORD BEEN PROVIDED 70 THE VfE=l a1�EF.
FOR OFFICE USE ONLY `(n m'E
Quad No: ' :�. I (; 1��1 SION URE of PERSON coNsimn-11110 Trt vwELL
Sub I original to Division of Water oualliy. omvndwalsr Seccn within `) COYS Ee•1 Fig V. L`71
--- -
sedaf No.
situ n16+* br�

­rl
1636rMa I Service Center - Ralei rh. N.C. 27699-1636-Phone 919 733- f
9 ( ) 3221 f.. J. 4 4 �. V
WELL CONSTRUCTION RECORD WELL CONTRACTOR: fl 1• IIP C `, )n_Il clC,l l; 11
WELL CONTRACTOR CERTIFICATION H:
STATE WELL CONSTRUCTION PERMIT#:
1. WELL USE (Check Applicable Box): Residential U�­Municipal ❑ Industrial ❑ Agricultural Monitoring ❑
Recovery ❑ Heat Pump Water Injection ❑ OtherEj H Other, List Use:
2. WELL LOCATI,lp�N: (7ghow sketch of the location below) {y�yy^1
Nearest Town: ry✓ir l•rf'-(tis County:
L��n�
1J :•CT K?hnQ4;
(Road Name and Numbefs. Community, or Subdivision and Lot No.) DRILLING LOG DEPTH
3. OWNER 05 CG V' /VI LLar Le✓- From To Fomax Des:ripti •-
Address 0 - / S
(Street or Route o. //,S -
City or Town slate Zip Coda
4. DATE DRILLED - .00
5. TOTAL DEPTH `KS
6. CUTTINGS COLLECTED YES Q NOEZ]�-
7. DOES WELL REPLACE EXISTING WELL? YES/ _Q,A/ N0�
8. STATIC WATER LEVEL Below Top of Casing: Ff.
(Use'i if Above Top of Casing)
9. TOP OF CASING ISFT. Above Land Surface'
'Top of casing terminated at/or below land surface requires a variance In accor-
dance with 15A NCAC 2C.011ea—
10. YIELD (gpm): 160 METHOD OF TEST /Ai/
11. WATER ZONES (depth):
12, CHLORINATION: Type Ah Amount 41 it additional s;.ace is needed tse back cf fc m
13. CASING:
Wall Thickness LOCATIONSKETCH
Depth Diameter or Weight/Ft. Material (Show direction and d"Sance fr„m a; leas:'mo Slate
FromTO r C Ft.K 1 0 ..M / k)� Roads, or oL'rrr�q relere: cs poins'
From To Ft.
From To Ft.
14. GROUT:
Depth Mat vial Method
From _P) To -2h r Ft.
From To Ft.
15. SCREEN:
Depth
Diameter
From
To
Ft In.
From
To _
Ft. in.
From
To _
Ft. _ In.
16. SAND/GRAVEL PACK:
Depth
Size
From
To
Ft.
From
To
Ft.
17. REMARKS:
Slot Size Material
In.
In.
In.
Material
0
CD
L
c
t—
v
rs
a
0
O
rV
1 DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A MCAC t:,'/lELL
CONSTRUCTION STANDARDS, AND THAT PY OF THIS RECORD HAS BEEN PRONGED -10 THE Wa-L Otk'rEP.
FOR OFFICE USE ONLY
Quad No: (a R Sir
OF PERSON CONSTRUOCTING IaZ wSLL Or'E
lUJ L5 (erOrvlslon of Water Oualily, Grwnd• ler Seen, within vi fiys
Serial No.
Ce.l /.'ev. 1`91

North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section ; : j 0 c (�
1636 Mail Service Center - Raleigh, N.C. 27699-1636-Phone [phone] (.:, 1) 11 2
WELL CONSTRUCTION RECORD WELL CONTRACTOR: le"Ikmy 1A it
WELL CONTRACTOR CERTIFICATION #:a%��
STATE WELL CONSTRUCTION PERMIT#:
WELL USE (check Applicable Box): Residential® Municipal ❑ Industrial ❑ Agricultural ❑ Monitoring ❑
Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use:
2. WELL LOCATIOy: (Show skptC of the location below)
Nearest Town: tip= �>a
(Road Name Numbers, Cy{mmuntry, or Su you and I.ol No.)A' n� DRILLING LOG DEPTH
3. OWNER _ l.Ni( ��/i/ i From To FomuGon Description
Address
4. DATE DRILLED `Y .
S. TOTAL DEPTH
6. CUTTINGS COLLECTED YES ❑ NO21
7. DOES WELL REPLACE EXISTING WELL? YES NO®
S. STATIC WATER LEVEL Below Top of Casing: 11,_ FT.
(Use's' It Above Top of Casing)
9. TOP OF CASING ISFT. Above Land Surface'
'Top of easing terminated ar/or below land surface requires a variance In accor.
dance with 15A NCAC 2C .0110
10. YIELD (gpm): L- METHOD OF TEST �:�
11. WATER ZONES (depth):—y0 AID'
12. CHLORINATION: Type Tit/? Amount z
13. CASING:
Well Thickness
Depth Diameter or weights. Material
From 0 To Ft.
From To Ft.
From To Ft.
14. GROUT:
Depth Material M
� , From � To Ft. �-r-�+�r-��
From To Ft.
16. SCREEN:
Depth Diameter Slot Size Material
From To —y Ft —/ in. In.
From To _L Ft. In. In.
From To - f/— FL _/ in. In.
16. SAND GRAVEL PACK:
Depth Size Material
From To FL
From To —
To— Ft.
17. REMARKS:
LOCATION SKETCH
(Show direction and distance from at least two State
Roads, or other map reference points)
i DO HERE �'�a.-. T� YwFr WAS CONSTRUCTED IN ACCORDANCE WITH 1SA NCAC 2C, WELL
CONSTRU #A0A Alp TjlJA PY OF IN4AWORD H6S-VEA PiJWDED TO THE WELL OWNER
FOR OFFIC ONLY i /
Chad No: - _ _ _ &GNATURE OF PERSON CONSTRUCTING THE WELL DATE
Su , to Division of water Quarry. Gnoundrrelar S Kdon within 30 days
Serial No.
GW1 REV. 17099

Norlb Cmolb+a t[7l1e.pnlln+aul of El+vlrpr+r,lrlrli. Ilaolih, m+rl Nnlur of finwurcan (pry G((ICE U.^•E OI11 'I
Division of nvl'onn+pnlnl lvinnngn,no nl • Olollnttwnlet SnCllo,l ol1AU. NO. SEt11AL ilp, ____
P.O. Box 29595 . Rnloigh, N.r. M20 0535 -- fir)
19 191739-3221 1 at. __- Long
Mint Illocda -__- Q
WELL COLISTIiUCTiON LIECORU Uao6+Code
DRILLING CONTMACTO11: %j ���� I leader pill. GV1 f Fol.
STATE WELL CONSTRUCTION
URILLEn REGISIRATION NUMUEn: �yl _ PE11MIT NUMREn: _
1. WELL LOCH) IO�qN: (Show sketch of the locallon below)
/9yew� count % eicell
Nearest 7owm /�1 _Y�
------- UEp II I UPILLII iG LOG_
Innad. Conn+q,nilyL, or SomM,lon and Lol No-) -
2. OWNER- �4(71 W"''if —_ hom In (mmaenn Un :olpam+
ADDRESS - - -- --- -- ---
ISuenl or
CIIY or lam++ Slain Ip Call"
3. ulmr Dnll-LED USE or Wrl_L
A. 101ALDEp111—LZG ___
5. CurnrlF;SCOLLr_Ctr.:D YEs[] NoL-E"
B. DOES WELL nErLACE Exist ING WrLL7 YES
7. S rA1IC WAtEn LEVEL Uelow Top of Casing:.2, _ rT.
(Une'r' II Ahnvo -top of Casing)
s, top Or CASING IS �_ rr. Above Land Sutiace'
+ Caping Terrnlnnled nllor below Im+d su,Iace Is Illegal unless a varlanca Is Issued
In acc o,dpnce wllll ISA NCAC 2C .0110
9. YIELD(gpin):_ 12 ME11100or- t F S r "ggl
IU. WATER ZONES (depth): b !%
11. c[ILOnINA1ION
12. CASING:
Ih
1 Ype /�NnOUnt II addillonal space Is neednd usa back nl Inrn, — -
Depth Dian+eler
Rom < To f-� rl./ lf-
rl0ill 5 02 10-�-�-
rtomI"t.---
Gnoul
r-loin C
r-tanl
Id. SCREEN:
LOGA-1 ION SKE I CI I
Will 1lnrGuu.^s
or welglivrl. molelial (Show dilvellon and dislanc9 born at least I -no Slate
SOP'21 &6 noads, or olher map relelence enrols)
,/6'b' dIe�l
Dept at Ilal M� Ihod
10 ,2G' rI. i'cr��r� — 7eff"'f-
t0 rt.
Depth
rtonl Io -
riot,l to .
riom to .
15.S �lL =.
m
Diameter Slot Slze
--
Malellal
lot.
Ilt.
In.
Matel lal
0
c.1
C—
c
r
N
c:vvo�.p•�.y. --� ppfFFIC
1 tEl1hV°LtEtt`CIR TYIA r_LL WAS CONS NIUCM) IN ACCORDANCr WI111 ISA NCAC 2C, WELL
cONSTnUC I ION 9 TANUMOS, ANO 11IAT A COpY Or I1119 RECOgU IIAS BEEN pnOVIDEU 10 111E WELL OWI t[rl.

North Carolina - Department of Environment and Natural Resources - Division of Water Duality - Groundwater Section-• 1 :J Sl Q -`
1636 Mail Service Center - Raleigh, N.C. 27699.1636•Phone [phone]
WELL CONSTRUCTION RECORD WELL CONTRACTOR: I,i y , � • u d'(�-'�'v ---
WELL CONTRACTOR CERTIFICATION #:
STATE WELL CONSTRUCTION PERMIT#:
1. WELL USE (Check Applicable sox): Residential Z Municipal ❑ Industrial ❑ Agricultural ❑ Monitoring ❑
Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use:
2. WELL LOCATIO: (Show s 1 pf the location below)
N94res. Jown: —�} l _ , � County:
(Road Ndne and Nymbe ty, Su an t No DRILLING Q D DRILLING LOG DEPTH
3. OWNER �%%/.N�lzrl _ �L-!) .7 �ear�.Y.L _ �! From To Formation Description
wry or r own sum up waa
4. DATE DRILLED
S. TOTAL DEPTH
6. CUTTINGS COLLECTED YES ❑ NO®
7. DOES WELL REPLACE EXISTING WELL? YES Q NOLO
8. STATIC WATER LEVEL Below Top of Casing: Fr.
_�---- (Lisa '+' 0 Above Top of Casing)
9. TOP OF CASING IS / Z- FT. Above Land Surface -
'Top of casing terminated War below land surface requires a variance In accor-
dance with 1SA NCAC 2C .0,,118
10. YIELD (gpm): 18^
- METHOD OF TEST LEA
11. WATER ZONES (depth): 102'r
12. CHLORINATION: Type r#% _Amount— l--
13. CASING:
Wail Thickness
Depth r or WeiyhuR. Ma(erial
From —To -J1 6 Ft. _ea % d'Ll n
From To Ft.
From To Ft.
14. GROUT:
Depth �l Material Method
From _� To 12 F/1t. J. 1� WAYE1,�L
From To Ft.
15. SCREEN:
Depth Diameter Slot Size Material
From To /Ft _ in. t
From To _ Ft. �in. in.
From To /_ Ft. in. in.
IS. SAND/GRAVEL PACK:
Depth Size Material
From To t.
From To Ft. '17/ 17
17. REMARKS: G
se
FOR OFFICI ffaONLY
Ouad No: II'' -
Sedal No.
If additional space is needed use
LOCATION SKETCH
(Show direction and distance from at least two State
Roads, or other map reference points)
IUCTED IN ACCORDANCE WITH
THIS RECORD HASMEJ4 PROW
SIGNATURE OF PERSON CONSTRUCTING THE 1
at to Division of Water Duality, Groundwater Section
a W.
4RK
NCAC 2C, WELL
TO TH ELL OWNER.
V DATE
within 30 days
GW-1 REV. 121"