Ja 1 CY2003

282317
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) James B. Brown CERTIFICATION: 2045
weLI.coNTancToRcoMFANV NAME Hedden Brothers Well Drilling, Inc PHONE#[phone]
STATE NV ELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT-
(if applicable) (if apolicable)
1. WELL USE (Check Applicable Box): Residential 11 Municipal/Public 0 Industrial 0 Agricultural
Nlonitoring ❑ Recovery ❑ Heat Pump \Vater Injection ❑ Other 0 IfOther, List Use
2. WELL LOCATION:
Nearest Town.CUllowhee County Jackson
Caney Fork —just past Pasafina Horse Farm
(Street N:'r e, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: Tomas N Rogers
Address PO Box 2618
(Street or Route N'o.)
Cullowhee, NC 28723
City or Town State Zip Code
62A )-293-0678
Area code Phone number
4. DATE DRILLED 6-9-03
5. TOTAL DEPTH: 150'
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO Xa
7. STATIC WATER LEVEL Below Top of Casing: 1 251 FT.
(Use "+" if Above Top of Casing)
3. TOP OF CASING IS 2 FT. Above Land Surface*
*Top of rasing terminated ae'or below land surface requires a
variance in accordance with 15A NCAC 2C .0118.
9. YIELD (gpm): 40+ METHOD OF TEST blow
10. WATER ZONES (depth): 98' & 130'
it
12
DISINFECTION: Type H T H Amount 16 oz
CASING: Wall Thickness
Depth Diameter or Weieht'Ft. Nlaterial
From 0 To 63 Ft. 6" .188 steel
From To Ft.
From To Ft.
13. GROUT: Depth Nlaterial Method
From 0 To 20 Ftta nite & =Tmt pix al
From To Ft.
14, SCREEN: Depth Diameter Slot Size. Material
From To Ft. in. in.
From To Ft. in. in.
15.SAND%GRAVEL PACK:
Depth Size Nlaterial
From To Ft.
From To Ft.
16. REMARKS:
Topographic'Landsetti
❑Ridge 0Slope ❑Valley(pat
(check appropriate box)
Latitude longitude of well to atb
(degrees minutes seconds) c
Latitudellongitude source:❑GPS❑Tcpbgraphic Inapt.:_.
(check box)
DEPTH DRILLING LOG----------
From To Formation Description
0 61' clay & sand
61' 150' anite
w
CD
CD
V-_
—D
cri
V) Sir
c-)
c�
LOCATION SKETCH W
Show direction and distance in miles from at least=
two State Roads or County Roads. Include the road's
numbers and common road names. O
icy
c_
c
I D0 HEREBY CERTIFY THAT THIS WELL \VAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCT J2t sTAN'DARDS, AND T A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
sIGN'ATURE OF PERSON CONSTRUCTING THE WELL DATE
Submit the original to the Divison of \Vater Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
27699-1636 Phone No.(919) 733-322I, within 30 days. GW-1 REV. 07f2001
bje

2. WELL LOCATION:
Nearest Town: Culowhee County Jackson
Edge Water Rd- 1/2mi up on R
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality
WELL CONTRACTOR (INDIVIDUAL) NANIE (print) James B. Brown
1\ Et.L CONTRACTOR CONIP.ANY N.ANIe Hedden Brothers Well Drilling, Inc
STATE 1VEI,L CONSTRUCTION PERMIT`, ASSOCIATED \\Q PERMIT=
(ifauplicable) (ifa l:cable)pp
282316
- Groundwater Section
CERTIFICATION: 2045
PHONE # { 828 369-9591
I. WELL USE (Check .Applicable Box): Residential d ElunicipalrPublic 0 Industrial ❑ Aga wtur Tt :
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other ❑ li Other, List Use
Topographic Land se tint j
❑Ridge ❑Slope ❑\all Flat
(check appropriate box r
e (S t Nn:ne, Numbers. Community Subdivision Lot No , Zip Code) Latitude/longitude of well bb91 on
3. OWNER: Joe Fulmer
Address PO Box 1987
(Street or Route No.)
rblllnwhpp, NC 78723
Cm or Town State
(828)- 293-9119
Area code- Phone number
4. DATE DRILLED 6-16-03
Zip Code
5. TOTAL DEPTH: 1SD
6, DOES WELL REPLACE EXISTING WELL? YES ❑ NO
7. STATIC (WATER LEVEL Below Top of Casing: 751 FT.
(Use -+" if Above Top of Casing)
8. TOP OF CASING IS 2 FT. Above Land Surface*
`Top of casing terminated at/or below land surface requires a
variance in accordance with 15A NCAC 2C .0118.
9. YIELD (gpm): So+ NIETHOD OF TEST blow
10. WATER ZONES (depth): 85' & 130'
1 I. DISINFECTION: Type H T
12. CASING:
Depth
From 0 To 51 Ft.
From 51 ' To E,51 Ft.
H Amount 16 oz
Diameter
\wall Thickness
or AA eight'Ft. Material
pvc
6" .188 steel
From To Ft.
13. GROUT: Depth Material
From 0 To 20 Ftb3rnite & curet
From To Ft.
14. SCREEN: Depth Dian;,eter
From To. Ft.
From To Ft.
15. SAND/GRAVEL PACK:
Depth
From To Ft.
Method
p.1
Slot Size Nlaterial
n. in.
in. in.
Size Material
From To Ft.
or
(degretainiraes>ro- h I
Latitud Jlongi;ud sour e:❑GPS Topouap i rrae-- _7-`,
!check bo
DEPTH DRILLING LOG----J
From To Formation Description
0 53' clay & sand
53' 150'
granite c
o
0
W
lit
mv;
LOCATION SKETCH c
Show direction and distance in mils from at least
two State Roads or County Roads. Include the road
numbers and common road names.
16. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL \VAS CONSTRUCTED IN ACCORDANCE WITH ISA NCAC 2C, \VELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE \VE/LL OWNER
29e-2,7--7 r� s/ Ems., 'DATE — G� 7
SIGNATLI E OF PERSON CONSTRUCTING THE WELL DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. OW-1 REV. 07,2001

282307 i; 7S3�X� cifh Cs �d
WELL CONSTRUCTION RECORD
North Carolina- Depaitment of Environment and^NaturalLResourrc/es-D,i�ri(sion of Water Quality - Groundwater Section
WELL CONTRACTOR(INDIVIDUAL) NAME (print) 1\'I4III t114 111Cs CERTIFICATION #(9S/ 7
in7 i PHONE # (Q�Y .J 2�P •S 50
WELL CONTRACTOR COMPANY NAh1E AAA fPC vtN�JltQS i�v(l �r(. O
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable)
(if applicable)
1. \VELL USE (Check Applicable Box): Residential,) Municipal/Public 0 Industrial 0 Agricultura
Monitoring 0 Recovery ❑ Heat Pump Water Injection ❑ Other 0 If Other, List Use
2. WELL LOCATIO t
Nearest Town: lLY1''q
>- County
E&Gffar cRd S Iyr,(UGat/7q
(Street Name, Numbers, Community, SulSdi)ision, Lot No., Zip Code)
-
3. OWNER: l cw�`
Address (+f0 Rirckwooci F1VC
(Street or Route No.) .- - -
}ckscnu(
dIc- NC 3;-42o7
pity or Town State Zip Code
(j_ t130 -- 3 55
Area code- Phone number
4. DATE DRILLED "7— w —OS
5. TOTAL DEPTH: 3 20
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO;$1
7. STATIC WATER LEVEL Below Top of Casing: ,IS FT.
(Use "+" if Above Top of Casing)
S. TOP OF CASING IS Ilk. FT. Above Land Surface*
*Top of casing terminated at or below land surface requires a
variance in accordanc$Whh 15A NCAC 2C .0I13. 9. YIELD (gpm): - (AC"/METHOD QF TEST /J
� 1 Y-
10. WATER ZONES (depth): CI ) I `f 0
oVa-
11. DISINFECTION: Type P I- Amount CJ,'I 0>
12. CASING: Wall Thickness i
Depth , Si Diameter or Weioht/Ft. Material
��{{
From C To 6 Ft. (; Yvv -50C ✓d
From _ To Ft.
From To Ft.
13. GROUT: Depth Material From
Method
From 0 Too2.0 Ft. 024-ov'-.j- --
From To Ft.
Slot Size Material
in.
in.
14. SCREEN: Depth Diameter
From To Ft. in.
From To Ft. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
16. REMARKS:
n
r
q;
Topogaphic/Land sett s-
❑Ridge XSlope ❑Valley
(check appropriate box)
Latitude/longitude of well 1
(degrees/minutes/seconds)
Latitude/longitude source:DGPS❑T
(check box)
DRIL
Format'
DEPTH
From To
— /S/C
/ 4E0 -- N 2
/ y;,( .— ac -
a9S
—,20
O
co
LOCATION SKETCH O P_.
:
Show direction and distance in miles from §ti� eas e.:
two State Roads or County Roads. Include roa3& :
number and common road names. -p' F~ 7--,
--O ri,
Lti(%'441n1/4-41--4-, rn21
fF r r z
0,-,-;.:
O
• i'y n N CD
rC Cc
t cct �CO
c:
-o
tD
0
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH I5A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE \VELL OWNER
la/nVas
SIGNA OF PERS, CONSTRUCTING THE \VELL DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mall Service Center
l REVghRaleigh,
NC
27699-1636 Phone No. [phone], within 30 days.

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural -) Resources - Division of Water Quality - Groundwater Section {3
WELL CONTRACTOR (INDIVIDUAL) NAM1�/ E (print) N / Ceti:Pry CERTIFICATION # R&
WELL CONTRACTOR COMPANY NAME rlrlK
STATE WELL CONSTRUCTION PERMIT/1
(if applicable)
40.t,.c'-( /2s 6rl i»%
ASSOCIATED NQ PERMIT#
(if applicable)
PHONE #
1. WELL USE (Check Applicable Box)' Residential l Municipal/Public ❑ Industrial O Agricultu
Monitoring ❑ Recovery 0 Heat Pump Water Injection O Other 0 If Other, List Use
•
2. WELL LOCATION' �, •j�-
Nearest Town: S;� I ✓ =I' County �+NL-ti` e >"'
7 Locust C°rea.k S((.tlIuA- toC4477
(Street Name, Numbers, Community,'Subdiiision, Lot 14., Zip Code)
3. OWNER:
Address
(Street or oute No.)
s-� , mA-I ,ws C a9R5
City or Town State / Zip Code
($h`s)- ?7'I- 3p/p6
Area code- Phone number
4. DATE DRILLED y �70'D-3
5. TOTAL DEPTH: 7 C
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO 13)
7. STATIC WATER LEVEL Below Top of Casing: 40 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS 1/2— FT. Above Land Surface*
'Top of casing terminated at/or below land surface requires a
variance In accordance with 15A NCAC 2C .0118. nn
9. YIELD (gpm): =_moMETHOD OF TEST -l-
10. WATER ZONES (depth))ID
11. DISINFECTION: Type VI 74
12. CASING:
Amount 324 D7,
Wall Thickness -
Depth� Diameter or Weight/Ft. 1<j2teria
From. C� To t9-i Ft. ()IA, SPR 2/ PO
From To Ft.
From To Ft.
13. GROUT: Depth hfateriat \ftMethod
From 7 To Ft. e947\-C-)
From To Ft.
14. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in.
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
16.REM.ARKS:
al El
Topographic/Land s Atii
❑Ridge'%lope ❑ValljIM
(check appropriate bo .
Latitude/longitude of wel .- ion
Frn
(degrees/minutes/szcorc/4
Latitude,9ongitude source:OGPSE17,c,r graphic map
Flat__,
nn
DEPTH
From To
at'--70
7P- Giza
(checkb i'j'
D ULL NG $(VG
(14 Rif cn JwS 7 h/
282305 Ps _ y651) Pr9— 4/5z`1
3-0 rr G,(,rrz _ Dr 2r -
n`l l
Form.t; n D. scrip
Tr
LOCATION SKETCH n =;
Show direction and distance in miles fro at
two State Roads or County Roads. Inc the Toad
numbers and common road names.
rn
r.
O
F
ccuvii
ege-si
O
ka % c c.2
Z
O
cis
0
-o
rm
rm
lD O
1 DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED N ACCORDANCE WITH I5A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
)l 1 CL ' L Zi�� / a- 2 F -D 3
TRUCTNG THE WELL DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center 1 - REVgh, NC
27699-1636 Phone No. [phone], within 30 days.

282300 do�� j1 01(a
Pei-- 7673- g Y-7/74
WELL CONSTRUCTION RECORD %?1,%le-c/(may itiL
North Carolina- Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print)
WELL CONTRACTOR COMPANY NAME i l re? -a? 73»&5 K.2t PHONE #
STATE WELL CONSTRUCTION PERMIT#
(if applicable)
CERTIFICATIONr�x,7?n/
ASSOCIATED WQ PERMIT:
(if applicable)
WELL USE (Check Applicable Box): Residential% Municipal/Public ❑ Industrial ❑ Agricultural 0>
Monitoring D Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use c
==c
2. WELL LOCATIO. r. ,T
Nearest Town: - (1/}� - CC u�ty_
`74,4gIG/G/e•I ' 2/9r' ✓�1 �! /tl4NC
(Street Name, Numbers, Cib Community, Sdivision, Lot NEE, Zip Cade)
3. OWNER: fre14 5.1947— Our /& e,'i C
AddresS74L —red - 1:flat re
(Street or
Ro`ut� No)
s;/e/R /v6 a8
to u tit
r1-1
Topographic/Land settirF,c
idge )ISlope ❑Valley (fig t
(check appropriate box) -
III -
77j
R
Latitude/longitude of well locaf_ipR
(degrees/minutes/seconds) .`-
Latitude/longitude source:❑GPS❑To esarhic map GTf51
(check box) m
DEPTH DRTL ING LOGJ j 1
From To Formatio
rn
,IT
0-
3 //o
//o c
,2az -_SO
0
CO
LOCATION SKETCH ea
Show direction and distance in miles fr0711lat Ilk':
two State Roads or County Roads. Inch e the1d
numbers and common road names.
n
o71a:.
rn dn:
1�1 R—Z3
C i c re �..
!i/fC!, C
ro
O
0
-r
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH I5A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNFER
1 /0
/IGNATTURE Q7PERSO`I 0 STR CTING THE WELL DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center -Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-1 REV. 07/2001
City or Town State Zip Code
(M)- /o 3 / -- /5/z
Area code- Phone number / / J `'�
4. DATE DRILLED /Q -' 10
5. TOTAL DEPTH: . 5—C,
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO
7. STATIC WATER LEVEL Below Top of Casing:_ T.
(Use "r' if Above Top of Casing)S. TOP OF CASING IS 1L FT. Above Land Surface*
*Top of casing terminated atior below land surface requires a
variance In accordance avith I5A NCAC 2C .0119. I
9. YIELD (gpm): METHOD OF TEST /r
10. WATER ZONES depth): / /U '— 5j
azo- to
it. DISINFECTION: TypeaT / f A
12. CASING: \all Thickness
Depth { Diameter orWei_ht/Ft. NI znai
From C To 4= Ft. 6-, �4 (t'4P%
From To Ft.
From To Ft.
13. GROUT: Depth Material Method
From To Ft.
From To Ft.
14. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in.
From To Ft. in. in.
15 SAND'GR AVEL PACK: - Depth Size Material
From To Ft.
From To - Ft.
Z
16. REMARKS:

Zip Code
(05- 3 G—O/41
Area code- Phone number
4. DATE DRILLED /j 0,3
5. TOTAL DEPTH: S-
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO g
7. STATIC WATER LEVEL Below Top of Casing: O FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS I VI-- FT. Above Land Surface*
•Top of casing terminated at/or below land surface requires a
variance in accordan a with 15A NCAC 2C .0118. •
9. YIELD (gpm):
10. WATER ZONES (depth):
�(7)
Topo aphic/Land setting
DRidge JSlope ❑Valley CL{as
a 2779 (check appropriate box)
F,1
Latitude/longitude of well Iocat
o=s
cn
11. DISINFECTION: Type
12. CASING:
.METHOD OF TEST f?1 r
3 a�
Amount /7r G r� Show direction and distance in miles from:tat leas
Depth
From 0 To_j_1_ Ft
From To Ft
From To Ft.
13. GROUT:_ Depth ::. Material Method
From li Too.� V Ft. —+%ra ,
From To Ft.
14. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in.
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Dap:h S.::‘:. ^gaterial
From To Ft.
From To Ft.
Wall Thickness 'two State Roads or County Roads. Inclu the rrdtU
Diameter Weight/Ft Material numbers and common road names. t— —
tame er or -
(� VV ?t L'i U cLzr �/ —o
16. REMARKS:
WELL CONSTRUCTION RECORD
282299
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR(INDIVIDUAL)NAME (print) m/kr+to /11 1��
WELL CONTRACTOR COMPANY NAME
r CERTIFICATION #. 4'59 7
Atini areenc-.-6 ros Wet,' L) f'\ PHONE H (}'at Sala za -SSA
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PEISMin
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential* Municipal/Public ❑ Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection ❑ Other ❑ If Other, List Use
2. \VELL LOCATION:
Nearest Town: 11F. County
A'PncCo -i
(StreettName, Numbers, Community, Subdivisio , Lot No. Zip Cod
3. OWNER: (la MAP+[/1r
Address a - S tAd• fine I?,e
(Street or Routd No.)
F ran,-, k I t n ;JG .-02-73I
City or Town State
(degrees/minutes/seconds) r-�^
Latitude/longitude source:❑GPS❑Topogr
(check box) 2
DEPTH DRTLLI4I L
00
U
maps
Erg)`
EcT)
From To Forma ion Description#
(1 7 f,
•z li c2Ro
ergo ea-2
as— as9-7
097-3ar
r
�� a5 s LOCATION SKETCH co
c
tTut n g2€Zt ?tom /
t
6
3•,
C L r=.
o
CO
"O mu
r
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH l5A NCAC 2C, WELL. m"
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL O ''ERA
/°/�°/
n4AZ- 7ne �.
SIGNATURE OF PER r CQ TRUCTING THE WELL DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center- Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-1 REV. 07/2001

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and NaturalT�sResources - Division of Water Quality - Groundwater Section //
\YELL CONTRACTOR (INDIVIDUAL) NAME
(print) c 17i n It115 I-)-n l iQn" «L CERTIFICATION Itof /7 `e
WELL CONTRACTOR COMPANY NAME IX.pn i' j& j1n,.Ia I1�PI I .) V'r l j, c . j - n P J PHONE # �_,5 ;2 CI-3 ;Z b Gl
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WERMIT#
(if applicable) (if applicable)
WELL USE (Check Applicable Box): ResidentialQQ---Municipal/Public ❑ Industrial 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION:
Nearest Town: -Sv /Vt h'C_ County __,
rRAny Cnt't-Lsr, , ,S-7'79 Lcf-z 4,
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3.OWNER: -- -et), (try.), /•�t'S`fQi et-
,
Address /(f •�•2 La/"e MO q r4c tw91'—
(Street or Route No.) 0 e ; Yc / �,
/94a hct. /._/. .3 3 1"/
City d/Town State Zip Code
( - 4,YG — !tt.375
Area code. Phone number ,. 3 ,
4. DATE DRILLED /-- :3 1-6 3
co
5. TOTAL DEPTH: '7/-' -1
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO
7. STATIC WATER LEVEL Below Top of Casing: Q% 0 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS / FT. Above Land Surface'
'Top of casing terminated at/or below land surface requires a
variance in accordance with I5A NCAC 2C .0118.
282297
Agricultural 0
lopographic/Land setting
tdge ❑Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:DGPSOTopographic map
(check box)
DEPTH DRILLING LOG
From To Formation Description
6 ( 3 p /cY
9 '
'
S a ,<> fr)1._
F!/- LIE' (-!'.//r'! 7 e=
c
co
V C^
/ Ca)
9. YIELD (gpm): 2 Y METHOD OF TEST /429/
10. WATER ZONES (depth): 9.; cs
II. DISINFECTION
Type f�
Amount
12. CASING: Wall Thickness
,�1 Depth Dia eter or Weight/Ft. Material
From V To //� Ft. m"` n2R,a pY4i
From To Ft.
From To Ft.
13. GROUT: Depth Material Method
From O To r"�D Ft. 6_On-4a-o CM/0
From To Ft.
14. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in.
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
LOCATION SKETCH 44 n
TA-B S Show direction and distance in miles II at least
16. REMARKS:
two State Roads or County Roads. Inclu a th&#oad
numbers and common road names.
t0
(A)
0
C)
0
t
pgni liiifv,:`
ASOL'ILLE
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH I5A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF TH S RECORD HAS BEEN PROVIDED TO THE WELL OWNER
Or SL /6 —o
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
cam=
—,
o
E SECIIUN
1..;.,AI. OFFICE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center -Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-1 REV. 07/2001

282154
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and ` tural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NA MIE (print) ,(h_Thrri CERIIFICATIION#5-?-p>.3
VS ELL CONTR:ActOR CO)IPANY NAME Cra4C t Ss Wel( V ,()r• 11 ; M) 1.4 PIIONE # f24 1"(197/,
STATE WELL CONS'IRCctION I'ERNIIT# ASSOCIATED W'Q PER.AIIT#
Of applicable) (if applicable)
I. WELL USE (Check Applicable Box): Residential-a-Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCAT N:
Nearest Town: (e I(
�M�kr ,-se
County SAC J s/NJ
(Street Name. Numbers, Connnunity, Subdivision. Lot No.. Zip Code)
3. OWNER: R•c.ytAr1 •6vOrb
Address .o 1) ZD
C�L(Street or Route No_)
4nkx to
City or Town /State Zip Code
( Area coda- Phone number
4. DATE DRILLED q-1-c3
5. TOTAL DEPTH: S
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO 0
7. STATIC WATER LEVEL Below Top of Casing: .-2t10 FT.
(Use "r" if Abo%e Top of Casing)
8. TOP OF CASING IS / FT. Above Land Surface*
*Top nt casing terminated at/or below land surface requires a
variance in accordance with I5A NCAC 2C .0118.
9. YIELD (gpm). aO METHOD OF TEST Q/ 1-
10. WATER ZONES (depth):
Topographic/Land setting
DRidge ❑Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of %veil location
(degreesau nutess/secondsl
Latitude/longitude source:❑GPS❑Topographic map
(check bps)
DEPTII DRILLING LOG
From To Formation Description
no
cy G/4y
,v BLS
MAY 1 8 2004
GROLINDINAIES SELIIUNCE
11 DISINFECTION: Type Amount
Wall Thickness
Diemen or Weight/Et. Material numbers and common road names.
12. CASING.
Depth
From 0 To 12 // Ft. y .42--
From To Ft.
From To Ft.
13. GROUT: Depth Material Method
From O To.)c` PL(lr/Mai/libel/We 2
From To Pt
14. SCREEN: Depth Diameter Slot Size Material
Prop) To Ft. in. in.
From To Ft. in. in.
15. SAND/GRAVEL I'ACK.
Depth Size Material
From To Ft.
From To Ft.
16. REV1Al2KS:
LOCA
Show direction and distance in miles from at (cast
two State Roads or County Roads. Include the reml
O p
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITII ISA NCAC 2C, WELL
CONSTRUCTION STANDARDS. AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
e -6J
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-1 REV. 07/2001

WELL CONSTRUCTION RECORD W,(/(.L. -7S- 7- aeo- -r1/45Y01'
North Carolina - Department of Environment and N tural Resources - Division of Water Quality - Groundwater Section
C ��l CERTIFICATION
WELL CONTRACTOR (INDIVIDUAL) NAME (print)//���)��.}��—//-��-��/ram—/ � �A � l
WELL CONTRACTOR COMPANY NAME 'A R eenr }ter `"J LO /'/$/5 PHONE # ov7d-f�% �,[/
STATE WELL CONSTRUCTION PERMIT. ASSOCIATED \\'Q PERMIT'.
(if applicable)
(if applicable) -
WELL USE (Check Applicable Box): Residential I�i Municipal/Public ❑ Industrial ❑ Agricultural ❑
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other 0 If Other, List Use
WELL LOCATION'
Nearest Town:
(Sr:tet N'a:ne, Nurnberi, Community, Subdivisio
3. OWNER:
Address
NCAC Ofj
9. YIELD (gom):.' � 0 METHOD OF TEST ��'j/1-
10. WATER ZONES (depth): /20
11. DISINFECTION: Tope F" I It Amount 6//7S n7
12. CASING: Wall Thickness
Depth p{� am�jyter or \CeiehLTt. Material
From ° To 3 7 Et. co / 57ne�V Po C
From To Ft.
From To Ft.
13. GROUT: Depthe1 �/t(4�3:orial /Nlethod �(
From C) To i%C G Ft. e �> 1 J2 OV1-1
Front To Ft. I)
Slot Size Material
eaNo.) I C a87ax,
it. or. sn Scat- Cote
Ares code- Phone number Fes/ - U -
4. DATE DRILLED /
5. TOTAL DEPTH: ico
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO X
7. STATIC WATER LEVEL Below Top of Casing: / 0 FT.
(Use `b' if Above Top of Casing)
S. TOP OF CASING 1S / i C FT. Above Land. Surface'
*Top of casing terminated at'ur below land surface requires a
%ariance in accordance virh 15A . A .0113.
I-l. SCREEN: Depth Diameter
From To Ft. in.
From To Ft. in.
15. S.AND:GRAVEL PACK:
Depth Size
From To Ft.
• From To Ft.
in.
in. d
Material
284240
Topographic/Land setting
❑Ridge DSlope DValley la
- (check appropriate box)
atitude/longitude of well location
(decrees. tni n::tes'secondS)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From To Formation Description
G —
/3/Z5 OZU
O
L
� Tm
o<
LOCATION SKETCH N :-----
Show direction and'distance in miles from atj st mo
two State Roads or County Roads. Include th3Coad:a,-
numbers and common road names. O ma
t-�
0
r-)
0S
f v `
C� N
L' 'J
Flo 06-tic-t`." .
16. RENT\RFS•
.
r
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH ISA NCAC 2C, WELL T=__".
CONSTRUCTION STAND.ARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER r - -
SIGNATURE OF P SCSTRGC . "G THE WELL DATE
v
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center- Raleigry,.NC !.
27699-1636 Phone No. (919) 733-323I, wGA;-1 REV.07/2001ithin 30 days. t ' i
L

g7saJAI
WELL CONSTRUCTION RECORD
76 �7-53q _-7a9�
LQepd l
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section^ 7
\YELL CONTRACTOR (INDIVIDUAL) NAME (print) —T� r, CERTIFICATION # ons7C,
lVELL CONTRACTOR COES,/���'\IPAN1' NAME 1 ^PP,n? E t 1\10-1A L/ PHONE # f T1((�2d
STATE \WELL CONSTRUCTION PERMIT' ASSOCIATED W Q PEkiN1IT
(if applicable) - (if applicable)
r
1. WELL USE (Check Applicable Box): Residential hlunicipaUPublic 0 Industrial 0 Agricultural ❑ --
Monitoring ❑ Recovery ❑ Heat Pump Water Enjection ❑ Other ❑ If Other, List Use
2. WELL LOCATION:
-• ` - :
Nea 't Town• Count �
(Street Name, ?cumber • ,ununity, Subdivision, Lot No., Zip Code)
3. OWNER: Charles
Address a$07 Pi/RACCrtaie. Cli/':
(Sreet o tr our. No.)
rnp,Con t CS, .5jao4/
�v or Town State Zip Codecity
( 7 3$ — c7g97
Area code- Phone number.
4. DATE DRILLED 0-0-03
5. TOTAL DEPTH: 11 t)
Topographic/Land setting ,
idge ❑Slope ❑\'alley ❑Flat'
� / (check appropriate box)
LL erg%/Latitude/longitude of well location
(degrees'min:res/seconds)
Latitudeilongitude source:❑GPS❑Topogra-phirmap.._ _..
(cheek box)
DEPTH
From To
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO '$i' ✓
7. STATIC WATER LEVEL Below Top of Casing: C.. FT.
(Use" it A'bo•c Top of Casing)
S. TOP OF CAS!NG IS I )/Z FT. Above Land. Surface'
crop of rasing tormin a red a['or brio)) land surface requires a
ar lance in accordance ss'th 15.-1 NCAC 2C .0113.
9. YIELD (gpm): _. METHOD OF TEST I r
O. WATER ZONES (depth): U"
11. DISINFECTION: Type H T -I-1.Amount
Wall Thickness
Depth
Diameter or Pee t. Material
4t, 'A/To i Ft. � ..saK - PO O
From To Ft.
From To FL
13. GROUT: Depth Material Method
From 0 To2 0 Ft. Lff7N�T�U
From To Ft.
IT. SCREEN: Depth Diameter Slot Size Dlfiterial
From To Ft. in. in.
From To Ft. in. in.
15. SAND GRAVEL PACK:
Depth Size Material
From 0
From
From
To Ft.
To Ft.
DRILLING LOG
Formation Dzsf"rip"tion
r, -c
u
�;Cr
��
Z cc
—0_
—
LOCATION SKETCH nG
Show direction and distance in miles from eastD o
two State Roads or County Roads. Include 8 roam
numbers and common road names. G
CA) —
CJ
Z
UL
16. REMARKS:
I DO FIEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH I5A NCAC 2C, WELL
CONSTRLCTION STANDARDS, AND THAT A COPY OF THIS RECORD AS BEEN PROVIDED TO THE \\ELL OWNER
G �i s�J 1 3 t G
SIG\ATLRE OF PERSON CON RUCTINGUHE WELL DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center-REb!gh, OOI
27699-1636 Phone No.[phone], within 30 days.

IF I33- 96 -a $7902
WELL CONSTRUCTION RECORD
284238
North Carolina - Department of Environment and
--Natural
ryResourccees. - Division of Water Quality - Groundwater Section
l [_
WELL CONTRACTOR (INDIVIDUAL) NAME .,ja{J I' `C � � CERTIFICATION: OC %A /
. (Print)—
wEL. CONTRACTOR CON' PANY NAME
STATE WELL CONSTRUCTION PERMIT: ASSOCIATED \WQ PER.\IIT%
(if applicable) (ifapplicable) .. -,,, •_.
1.
2,
PHONE # War( ,c tcs SV
WELL USE (Check Applicable Box): Residential) Nlunicipal/Public 0 Industrial ❑ Agricultural 0
Nlonitoring ❑ Recovery ❑ Heat Pump Water Injection 0 Other 0 If Other, List Use
WELL. LOCATION:
Nearest Town:
(Street Name. Numbers. Con
3. OWNER:
Address
unity, Subdivision, Lot No., Zip
(Street or Rout
r��rm
Cny or To i State
(
Area :ale- Phone nun ber - n
4. DATE DRILLED / / — 1� _ (1-
5. TOTAL DEPTH: L4
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO
7. STATIC WATER LEVEL Below Top of Casing: FT.
(Use "r' if A'boce Top of Casing)
S. TOP OF CASING IS t 5 FT. Above Land. Surface`
'Top of easing, terminated a ror below land surface requires a /
s ariance in accordance with 15A NCAC 2C .01I8. . / y^
9. YIELD (gpm): 5 METHOD OF TEST /�
I0. WATER ZONES (depth): 3 SZ)
II. DISINFECTION: Type
12. CASING:
Depth Diameter
Fro..t 0 To ill Ft. Z.Yy
From To Ft.
From To FL
13. GROLT: Depth Material ,
From 0 To 2.0 Ft. ( Oih-0->'t7-
From To Ft.
14. SCREEN: Depth Diameter Slot Size
From To Ft. in. in.
From To Ft. in.
15. SAND GRAVEL PACK
Depth
From To Ft.
From To Ft.
Amount r0z
Wall Thickness
or Wei ch:Ft.
5D21/
Nla'e;i:il numbers and common road na- es.
Gf�
&pita
Size Nlaterial
Nlethod
4
h I2l2 flat
1
Topographic/Land setting
Ridge %Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees.'minues.'seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check boc)
DRILLING LOG
Formation Description
DEPTH
From To
0—
%/Ci --3,t)
—
sr - t/s7)
c
W
O
v - c
LOCATION SKETCH Z c
2 Show direction and distance in miles from at ;test `o<
two State Roads or County Roads. Include thoad yo
✓ rn
7Lr
NZ
O PIx
c7
W S
16. RE\1ARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH LA NCAC 2C, WELL
CONSTRUCTION STANDA RDS AND T'AT A COPY OF THIS • •RDHOWNERS BEEN PROVIDED TO THE WELL OWNER
/
O
Y '
L
SIGNATURE OF PP4RS ONSTRLCTT G THE WELL DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center- Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. G\W-1 REV. 07/2001

przzo
I. WELL USE (Check Applicable Box): Residential Municipal,/Public ❑ Industrial 0 Agricultural ❑
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Othr, List Use
WELL CONSTRUCTION RECORD 5 a (A)
North Carolina - Department of Environment and Natural Resources - Division of Water Quality. - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) C�
WELL CONTRACTOR COM PANT NAME 'AM- -weewe—1gyRm
STATE WELL CONSTRUCTION PERMIT. . ASSOCIATED \t'Q PERMIT:
(ifapplicable) •
(if applicable)
CERTIFICATIONTt�J #[-�rA`
PHONE # (kP/d'!O SSS
284237
2. WELL LOCATI tlN:
Ne restt Town:
.7 VA Go erio
(Stra: Name. Numbers. Community, SubdiviIon, Lot No., Zip Code)
3. OWNER: Si \ ("�7- icka- ire'
t'O 1 J Address 0t7 i/10 f
(Stre,.: or Rout: No.)
cis111 e� s I3 P7) 7
Cry or Town Star: / Zip Code
(isL 7St - PL7 4'
Are: code- Phonc numberG
T. DATE DRILLED ! G5(�
5. TOTAL DEPTH: la - �'-0,5
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO (S.
7. STATIC WATER LEVEL Below Top oFCasine: (AO FT.
(Use "r' irAbove Top of Casing)
S. TO? OF CASING IS .5 FT. Above Land Surface-
'lop of casing terminated at.or b tusc land surface requires a
sar once in accordance ss Rh 15.-\ NCAC 2C .0113. n/�
9. YIELD (gpm):•"Tip METHOD OF TEST 1-tl r
10. WATER ZONES (depth): 3 30
I . DISINFECTION: Type I --I l+
12. CASING:
Topographic/Land setting
❑Ridge 1�Slope DValley ❑Flat
as, 74_6 (check appropriate box)
Latitude/longitude of well location
(degreei'nin•as:iecondi)
Latitudz'longitude Source:❑GPS❑Topographic map
(cheek box)
DEPTH DRILLING LOG
From To Formation Description
20
3sgo-3g.-
-3S 9Rs
O
LOCATION SKETCH a Con
Amount fie2, �S fj 2. Show direction and'distance in miles from a" ast �m
Wall Thickness
Depth Diameter opRy2jTt. Material
.n 0FroTo Ft. 4, �.j'J h'CY/
From To Ft.
From To Ft.
U. GP.OGT _ Depth Material Method
From 0--.) To R 0 Ft. CO/-N.-—Fa-(-;
From To Ft.
14 SCREEN: Depth Diameter Slot Size Materia!
From To Ft. in. in. A
From To Ft. in. in.
I5. SAND GRAVEL PACK:
Depth Size Materia!
From: To Ft.
,From To Ft.
two State Roads or Co:mty Roads. Include tjtJroac �
number and common road names. >G
a ao
-
r 0 e E
:.J
16. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL v;AS CONSTRUCTED IN ACCORDANCE WITH ISA NCAC 2C, WELL ,
CONSTRLION STANDARDS, AND THAT A COPY OF TH) REjtD HAS BEEN PROVIDED TO THE WELL OW\NER__,-____..
/2 /—�j
DATE
SIGNATUR OFW. RSON
'CTING THE WELL
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center- Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. G\ -1 REV. 07/2001

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section I
n 4 estr Vi. CERTIFICATION #
WELL CONTRACTOR (INDIVIDUAL)N.4JIE (p`ri�ntt)�` My� / �"�J 'c'�
WELL CONTRACTOR COMPANY NAME PM (j f<-Cnc... Cam' ' Ll- PHONE # )ovs
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable)
(if applicable)
WELL USE (Check Applicable Box): Residential Municipal/Public O Industrial ❑ Agricultural ❑
Monitoring ❑ Recovery ❑ Heat Pump Water Injection O Other ❑ If Other, List Use
2. WELL LOCATION:
Nearest Town: U TA- County
- (p } vrd�l f
(Street Name, Numbers, Community, Subdivision, Lot No.,
3. OWNER: 13,T • 6-f4 ens-3 r'
Address I Q 0 0 S k /1"-In { C h.(Street or Rotte No.)
HSL IN uJC a 7
2 City a Town State Zip Code
(')- 5-(0" O 3
Topographic/Land setting
A-C%4Sill" DRidge $Slope ❑Valley DF1at';
I a4. N(old'775 (check appropriate box)
ip Code) U Latitude/longitude of well location
y
Area code- Phone number
4. DATE DRILLED /I — - b3
5. TOTAL DEPTH: 4 S7)
6. DOES WELL REPLACE EXISTING WELL? YES O NO El
7. STATIC WATER LEVEL Below Top of Casing: £/c FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS ) L FT. Above Land Surface*
'Top of casing terminated at/or below land surface requires a
variance in accordance with ISA NCAC 2C .0118.
9. YIELD (gpm): 30 METHOD OF TEST f Y
10. WATER ZONES (depth): 6 Q
11. DISINFECTION: Type /4
12. CASING:
Depth Diatjeter or Weight/Ft. Material numbers and common road names. 2
From C To /05Ft. t Yj! kii_WkG( a � / Q 0
From To Ft. ;�j'C
From To Ft. V
13. GROUT: Depth Material Method
From To 2 0 Ft. (2'_a—r.a i4r,
From To Ft.
14. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in.
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
tztu. n. Its,
(degrees/minutes/seconds) -
Latitude/longitude source:DGPSOTop66raphic m
(check box) H__
DEPTH DRILLTNO LOG
From To Formation Description
/Dv --2GU
4.16.o - 26:2,-r
aL,2•r—Ott)
120-3s9LS"
LOCATION SKETCH -c
Amount -- Show direction and distance in miles fr at Igast
Nail Thickness - two State Roads or County Roads. Incli the
p C�
cry
T
72, c
-tom
mo
16. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH l5A NCAC 2C, \VELL
CONSTRUCTION STANDARDS,
AND THAT \ A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER cr.
SIGNATURE OF PERSON C STRUCTCYG THE WELL DATE
v
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Ceenter' Raleigh,
NC 1
27699-1636 Phone No. [phone], within 30 days.

2. WELL LOCATION:
Nearect,T0 V, {„ Co}tnty kl6 JC5
(Street Name, Nurnbers,rCommu4ity, Subdivision, Lot Nor, Zip Code)
3. OWNER: Lr/� /GC4h
Address 7"C / .-� 6, 4z tJ
(Street or Route No.),
%�
l_ 17,khi F'rs
y 7�- ity or Town State,( Zip Code
(6Y� )
Area code- Phone number
4. DATE DRILLED -3 - c2 -03
5. TOTAL DEPTH:/JOv
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO $
7. STATIC WATER LEVEL Below Top of Casing: ,' FT.
r (Use'+' if Above Top of Casing)
S. TOP OF CASING IS I " FT. Above Land Surface*
"Top of casing terminated aCar below land surface requires a
variance in accordance with 15A NCAC 2C .0118. /r
9. YIELD (a -pm): 27.5 'METHOD OF TEST /�
10. WATER ZONES (depth): /UO
$L0 0
11. DISINFECTION: Type fJ Tf1 Amount 5'S r7,
12. CASING: Nall Thickness
/ �" Deptthh� i/ Diameter or�Weieht/FtJ. btarerial
From—I,L T05
From To Ft.
From To Ft.
13. GROUT' Depth . Material Method
From
From
14. SCREEN: Slot Size Material
From in. in.
From To Ft. in. in.
15. SAND/GRAVEL PACK:
u:pth vita /.,,uo
To Ft.
To Ft.
STATE WELL CONSTRUCTION PERMIT#
(if applicable)
284201
WELL CONSTRUCTION RECORD
North Carolina- Department of Environment and Natural /R.eso rces - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME /(print)SJ� I r t u r/r 1 / CERTIFICATION
�fr—rC/'6"C0a
WELL CONTRACTOR CObFPANY NAME E/ IA y1 TECO C. �?0/1D0 ti./ t /7 si)ile) PHONE # . xa ohd'rr7 -\55:5 6
tY ASSOCIATED lVQ PERMIT#
(if applicable)
1. WELL USE (Check Applicable Box): Residential Municipal/Public 0 Industrial ❑ Agricultural 0
Monitoring ❑ Recovery. 0 Heat Pump Water Injection ❑ Other ❑ If Other, List Use
be 2�� en✓:I e NC ,-)y77f4,
K 7/7
4-ro J3�r Ft.
To Ft.
Depth Diameter
To Ft.
From
From
16. REMARKS:
DEPTH
From To
0 1
Jf
/DU —/0.2-
/JR
L 00-401
Lco /Ooo
Topographic/Land settino
DRidge DSlope DValley Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DRILLING LOG
Formation Description
LOCATION SKETCH o
Show direction and distance in miles frof:It lei
two State Roads or County Roads. Inclutk the
numbers and common road names.
77,
ton( `.'
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH I5A NCAC 2C, WELL '
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL O',V;CET-:'
SIGNATURE OF PERSON ONSTRUCTI THE WELL DATE �--
224
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center-Raleigh,�t4C-----'-'
27699-1636 Phone No. [phone], within 30 days. - GW-1 REV. 07/2001

284200
WELL CONSTRUCTION RECORD
North Carolina:- Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
CERTIFICATION # PHONE # ( 11/
14) � 5-SiSC�:.
WELL CONTRACTOR (INDIVIDUAL) NAME /!Ir i(pl* t� rrint) Zt D 1 V�� ( R. V` w1���(y�,
WELL CONTRACTOR COMPANY NAME Y A-e 62 z (AltaD
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ RMIT#
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential ❑ Municipal/Public ❑ Industrial 0 Agricultural ❑
Monitoring Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use
2. WELL LOCATIO a Nearest
-
Nearest Town: l2-) h1iecs County JA SJ7a
Tom,///ar„ r306 a74ac' «9/ C'-sh,eI5 WC,
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: 1 Y.( 1(I to ll\.
Address p C) 0, C LR (r1(A,�
(Street or Route No.) n i !/ 7 / 7
AM)Iev5 iv
l�
City or Tosvn State it Code
- l , - t)6
Area code- Phone number
4. DATE DRILLED 3-all-0 3
5. TOTAL DEPTH: Q 5
6. DOES WELL REPLACE EXISTING WELL? ❑ NO .M
7. STATIC WATER LEVEL Below Top of Casing: ic/A- FT.
(use "+" if Above Top of Casing)
8. TOP OF CASING IS / • FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance In accordance vjth 15A NCAC 2C .0118.
9. YIELD (gpm): ` lVllfi METHOD OF TEST
10. WATER ZONES (depth): _J-
11. DISINFECTION: Type H- 7f Amount /r 3 e
12. CASING:
YE
Wall Thickness
Depth Diameter or Weight/Ft. N'tterial
From 0 To /0 Ft. ( ./j_=L- V(a FJC.i
From To Ft.
From To Ft.
13. GROUT: Depth
From U To 3, L) Ft.
From To Ft.
Material
Method
14. SCREEN' Depth Diameter Slot Size Material
From 9S 0 To LA 5 Ft. //zz in. in.
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Size Material //r.
From To a., ' Ft.1' _.)GI a, cX'
From To Ft.
16. REMARKS:
S c'
Topographic/Lan setting ,
DRidge ❑Slope alley ❑Flat
(check appropriate box)
7/ 7 Latitude/longitude of well location
(degrees/minutes/seconds) i r --
Latitude/longitude source:❑GPS❑Topogrhphic map__
(check box) `-'-'-'-'-
DEPTH DRILLING LOG
From To Formation Description
0 — 1
L.
LOCATION SKETCH
'n
r_
1 or
CO m
Show direction and distance in miles fr rcMat lama;
two State Roads or County Roads. Incline the -go
numbers and common road names. ce? mx
O c�
N
—4
G
c9-C. (- -4- L
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH ISA NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS REC HA EEN PROVIDED TO THE WELL OWNER
SIGNATURE OF PE(cSONCNSTRUCTING TH WELL DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center -Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-1 REV. 07/2001

WELL CONSTRUCTION RECORD
North Carolina- Department of Environment and Natural Reso}-trcesl- Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) 4 _D �Cam' yi- tN tA ('']
WELL CONTRACTOR COVPPANYNAME /1- 44- Li rteet1P R-rn 5'"�"' t f Dni, PHONE Y. 151ZY -5 C)
STATE WELL CONSTRUCTION PERMIT# --
CERTIFICATION # OC/ A&.
ASSOCIATED WQ PERMIT# -----
(if applicable) (if ap
•licable)
1. WELL USE (Check Applicable Box): Residential Pr Municipal/Public 0 Industrial ❑ Agricultural 0 ::
Monitoring ❑ Recovery ❑ Heat Pump Water Injection E7 Other ❑ If Other, List Use
2. WELL LOCATION:nl9 r
Nearest Town: l e n J r � l r. County rJ /4CbZD-,
Le_uret FI-]((5 C,{ei1d.(I�IA1)L
(Street Name, Numbers, Community, Sub!ivision, Lot No., Zip Code)
3. OWNER:CiL- \ Qr -
Address ,r r^e el)
(Street or Route No.)
:J%tesboro IV (3 30 �iScfi
City or Town State Zip Code
.2g7- 5:2.3c/
(; i%21-
Area code- Phone number
4. DATE DRILLED f i — (J - U-7
5. TOTAL DEPTH: D SZ)
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO 4
7. STATIC WATER LEVEL Below Top of Casing: 55 FT.
(Use "+" if Above Top of Casing)
S. TOP OF CASING IS i IVZ FT. Above Land Surface*
'Top of casing terminated at/or below land surface requires a
variance in accordance with 15A NCAC 2C .0118. in
9. YIELD (gpm): 3 () METHOD OF TEST kJ-
10. WATER ZONES (depth): I Q O
11. DISINFECTION: Type kI Tz(-F Amount /1. 25-0 .7-
12. CASING: Wall Thickness
Depth Diame'er or\Veight/Ft. Material
From 0 To_A)_ _ Ft. 5I-7R2 / f Ft (..--
To Ft.
To Ft.
Depth , Material /' lethod
To t t) Ft. �I Z'i.X2L7 Ti•✓�
To 1
Depth Diameter Slot Size Material
in.
in.
From
From
13. GROUT:
From U
From
Ft.
14. SCREEN:
From To Ft. in.
From To Ft. in.
15. SAND/GRAVEL PACK:
Ucptit o.�.,
From To Ft.
From To Ft.
Matcri.tl
Topographic/Land setting
❑Ridge citSlope ❑Valley E)Ftat.
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds) .
Latitude/longitude source:❑GPS❑Topoq aphic matt
(check box)
DRILLINI LOG
Fo ation Description
DEPTH
From To
p — .- 7
7 -- /�2u
/A J:-5
5- /rig-1
/rY.i th?5Z)
LOCATION SKETCH
Show direction and distance in miles from at Fast
two State Roads or County Roads. Include the:load
numbers and common road names. . o
0_
c
co -c
Do
m°
73c
rnz
rn
CI
c-a
G
16. RE\LARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH I 5A NCAC 2C, WELL
CONSTRUCTION STANDARDS AND THAT A COPY OF TH REC D HAS BEEN PROVIDED TO THE WELL OWNER
SIGNATutu/. OF PFEjEON C ti'STFtU TING THE WELL DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Nlall Service Cen\tter, RaleighRE\'gh, NC
27699-1636 Phone No. [phone], within 30 days.

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality
WELL CONTRACTOR (INDIVIDUAL) NAME (print) James B. Brown
WELL CONTRACTOR COMPANY NAME Hedden Brothers Well Drilling, Inc
STATE WELL CONSTRUCTION PERMIT#
(if applicable) (if applicable)
283495
- Groundwater Section
CERTIFICATION 2045
PHONE [phone]
ASSOCIATED \VQ PERMIT:
1. WELL USE (Check Applicable Box): Residential el NlunicipatPublic ❑ Industrial ❑ Agricultural E
Nionitoring 0 Recovery ❑ Heat Pump Water Injection ❑ Other 0 I(Other, List Use
2. WELL LOCATION:
Nearest Town: Dillsboro County Jackson
just before LPatherwood RD
(Street Name. Numbers, Community, Subdisision, Lot No., Zip Code)
3. OWNER: Western Builders Inc.
Address )O Box 96
(Street or Route No.)
Sy1va, NC 28779
Cit). or To'sn State Zip Code
(828)_ 586-5094
Area code- Phone number
4. DATE DRILLED 12-9-03
5.TOTAL DEPTH: 300'
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO
7. STATIC WATER LEVEL Below Top of Casing: 150 FT.
(Use" if Above Top of Casing)
8. TOP OF CASING IS 2 FT, Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordance with 15A NCAC 2C .0118.
9. YIELD (gpm): 10 METHOD OF TEST blow
10. WATER ZONES (depth): 2451& 251
11 DISINFECTION: Type H T H Amount 16 oz
12. CASING: Wall Thickness
Depth Diameter or R'eight'Ft. Material
From 0 To 61 Ft. 6" .188 steel
From To Ft.
From To Ft.
13. GROUT: Depth Material Method
From 0 To 20 Ft. be -ante & =teat pumped
From To Ft.
14. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in.
From To Ft. in. in,
I5. SAND,'GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
Topographic/Land setting
❑Ridge ❑Slope ❑Valley ❑Flat
(check appropriate box)
Latitude 'longitude of well location
(decrees'minu:es'seconds)
Latitudc'longitude source:0GPS❑Topographic reap
(check box)
DEPTH DRILLING LOG
From To Formation Description
0 59' clay & sand
59'
300' granite
0
W
J
C>
LOCATION SKETCH t'j -
Show direction and distance in miles from at leas:-'_'
ht'o State Roads or Counts Roads. Include t road
numbers and common road names. ('
o ro
IV o
16. RENIARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 1=A NCAC 2C, WELL
CONSTRUCTION STANDA&GI, AND THAT A COPTHIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
SIGNATURE
PERSON CONSTRUCTING THE WELL DATE
Submit the original (o the Division of Water Quality, Groundwater Section, 1636 ;Mail Service Center - Raleigh, NC
GAW-1 REV07I2001
27699-1636 Phone No, [phone], within 30 days.

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality
WELL CONTRACTOR (INDIV'IDUAL) NAME (print) James B. Brown
\HELL CONTRACTOR COM PANY NAME Hedden Brothers Well Drilling, Inc
283494
- Groundwater Section
CERTIFICATION a 2045
PHONE = 828) 369-9591
STATE WELL CONSTRUCTION PERMIT.' ASSOCIATED \VQ PERM1Td
(if applicable) (ifapplicable)
I. WELL USE (Check Applicable Box): Residential ES NlunicipaFPublic E Industrial ❑ Agricultural 0
NIonitorine ❑ Recovery 0 Heat Pump \Vater Injection ❑ Other ❑ IF Other, List Use
2. WELL LOCATION:
Nearest Town: Sylva
County ,Tar lcgon
Grashopper Hi11 to ragl e Rt=ne'ir hm n L
(Street Name, Nwnbcrs, Community, Subdivision, Lot No., Zip Code)
3. O\VNER: Michael Melton
Address 528 Cagle Branch Rd
(street or Route No.)
Sylva, NC 2R779
CITS or Town State Zip Code
(828)_ 586-6647
Area code- Phone number
4. DATE DRILLED 11-04-03
5. TOTAL DEPTH: 600'
6. DOES WELL REPLACE EXISTING WELL? YES ❑ N'Ox6rbc
7. STATIC WATER LEVEL Below Top of Casino,: 500 ET.
(Use'=" if Above Top of Casing)
8. TOP OF CASING IS 2 FT. Above Land Surface*
"Top of casing terminated at'or below land surface requires a
variance in accordance with 15A NCAC 2C .011S. •
9. YIELD (gpm): 1 METHOD OF TEST blow
10. WATER ZONES (depth): 140'
11
12
13
14
15
DISINFECTION: Type H T H Amount 16 oz
CASING: - Wall Thickness
Depth Diameter or Weight Ft. Nlaterial
From 0 To 11 Ft. 6" pvr-
From 11 ' To 137 Ft. 6" 188 RI -Pei
From To Ft.
GROUT: Depth Material Method
From 0 To 20 Ft. hanute & anent pumped
From To Ft.
SCREEN: Depth Diameter
From To Ft. in.
From To Ft. in.
SAND/GRAVEL PACK:
Depth Size Nlaterial
Slot Size Nlaterial
in.
in.
From To
From To
16. REi\IARKS:
Ft.
Ft.
Topographic'Land setting
❑Ride ❑Slope ❑valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(deyreeslnioures seconds)
Latitude/longitude source:❑GPS❑Topooraphic map
(check box)
DRILLING LOG
Formation Descri tion
clay & sand
DEPTH
From To 0
135'
135' 600'
granite
r
n
r-1
LOCATION SKETCH 0
Show direction and distance in miles from af3 as: `.1
two State Roads or County Roads. Include the road_;37
numbers and common road names.
O
f
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH I SA NCAC 2C, WELL
CONSTRUCTION STANr . I Si AND THAT A •PV OF THIS RECORD HAS BEEN PROVIDED TO THE WELL O\\ NER'- —
//—
SIGN -' IF PERSON CONSTRUCTING THE WELL DATE
Submit the original to the Division of Water Quality, Groundwater Section; 1636 Mail Service Center- Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. OW -I REV. 07/2001

283493
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INNAME (print) James A. BrownCERTIFICATION6 2045
\CELL CONTRACTOR COMPA\Y NAME Hedden Brothers Well Drilling, Inc PHONE : [phone]
STATE \1 ELL CONSTRUCTION PER.\IITd ASSOCIATED WQ PERMED;
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential Dlunicipal:Public ❑ Industrial 0 Agricultural ❑
Monitoring ❑ Recovery ❑ Heat Pump Water Injection 0 Other ❑ If Other, List Use
2. WELL LOCATION:
Nearest Town: Cullowhee County Jackson
Indian Mound Rd-5th hm on L
(Street Name, Number, Community, 5ubdi rislon, Lot So., Zip Code)
Topographic/Land setting
❑Ridge ❑Slope ❑Valley ❑Flat
(check appropriate box)
Latitude longitude of well location
3. OWNER: Bob Gregg
(decrees minutes 'seconds)
Address 217 Maple Hill Drve Latit Ida lonzitude source:EGPS❑Topographic map
(street or Route No.) (check box)
Cullowhee, NC 28723 DEPTH DRILLING LOG
City or Town State Zip Code From To Formation Deseri tion
(828 )- 293-3977 0 70' clay & sand
.Area code- Phone number 70' 600' granite
4. DATE DRILLED 12-2-03
5. TOTAL DEPTH: 600'
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO fit
7. STATIC WATER LEVEL Below Top of Casing: 450 FT.
(Use "t" if Above Top of Casing)
8. TOP OF CASING IS 2 FT, Above Land Surface*
*Top of casing terminated atior below land surface requires a
variance in accordance with ISA NCAC 2C .0118.
9. YIELD (gpm): 3 NIETHOD OF TEST blow
10. WATER ZONES (depth): 345'
1 I, DISINFECTION: Type H T H Amount 16 oz
12. CASING: Wall Thickness
Depth Diameter or AWeieht'Ft. Material
From 0 To 69 Ft. 6" pVC
Froth 69' To 72' Ft. 6" 188 steel
From To Ft,
13. GROUT: Depth Material Nlethod
From 0 To 20 Ft. ten ite & Mart pumped
From To Ft.
14. SCREEN: Depth Diameter Slot Size tNlaterial
From To Ft. in. in.
From To Ft, in. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
16. REMARKS:
O
'1
s r=
Show direction and distance in miles from atN IeasC�r2
two State Roads or County Roads. Include ti road^
numbers and common road names.
LOCATION SKETCH
O
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH ISA NCAC _C, WELL
CONSTRUCTION ST.'i.RDS, AND THAT A C51[jY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
J
/02-0.2-03
S NATUE F PERSON CONSTRUCTING THE WELL DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center -Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-I REV. 07:2001
r

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAN1E (print) James B. Brown CERTIFICATION0 2045
WELL CONTRACTOR COMPANY NAME Hedden Brothers Well Drilling, Inc PHONE e$28) 369-9591
STATE WELL CONSTRUCTION PER,\I1T# ASSOCIATED \WQ PERMIT
(if applicable) (if aplicable)
283492
I. WELL USE (Check Applicable Box): Residential Nlunicipal.Public ❑ Industrial ❑ Agricultural ❑
Nlonitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other 0 If Other, List Use
2, WELL LOCATION:
Nearest Town: Sylva Count\ Jackson
Savannah-Cab(zi Rd-4th drive on R
(Street Name, Numbers, Community, Subdivision, Lot No.. Zip Code)
3 O\\'NER: Wm Joseph Ccone
Address PO Box 2078
(S:reat or Route No.)
Sylva, NC 28779
Cit cr Towr. State Zip Cod;
(828)- 586-4279
Area code- Phone number
4. DATE DRILLED 11-21-03
5.TOTAL DEPTH:
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO
7. STATIC WATER LEVEL Below Top of Casing: 300 FT.
(Use "A" if Above Top of Casing)
S. TOP OF CASING IS 2 FT. Above Land Surface*
"Top of casing terminated at/or below land surface requires a
variance in accordance with 15A NCAC 2C .0118.
9. YIELD (gpm): 8 :METHOD OF TEST blow
ID. WATER ZONES (depth): 135' & 570'
I L DISINFECTION: Type H T H Amount 1 6 oz
12. CASING: Wail Thickness
Depth Diameter or Weieht'Ft. Material
From 0 To 50 Ft, 6" pvc
From 50To 53 Ft. 6" .188 steel
From To Ft.
13, GROUT: Depth Material ;Method
From 0 To 20 Ft.bErrnute & osrelt pumped
From To Ft,
14. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in.
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Size Materiel
From To Ft.
From To Ft.
16. REMARKS:
Topographicitand setting
❑Ridge ❑Slope ❑Valley ❑Flat
(check appropriate box)
Latitude'longitude of well location
(decrees minutes seconds)
Latitude.' longitude source:OGPS❑Topographic map
(check
ebox)
DEPTH DRILLING LOG
From To Formation Description
0 51' clay & sandy
51' 600'
(granite
r
co
r�
rig
LOCATION SKETCH ni
Show direction and distance in miles from at least'
two State Roads or Count' Roads. Include t road
numbers and common road names. o
fV
I DO HERESY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH ISA NCAC 2C, \\'ELL
CONSTRUCTIONS, DARDS, AND THE-TjA COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNERL-
//-02 /- D,_3'
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
Submit the original to the Division of \1 ater Quality, Groundwater Section, 1636 Dlaii Service Center -Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GVs'-I REV. O'::001

WELL CONTRACTOR COMPANY NAMICLC',hniQ (sk`'n414 !1)mI•f1,fril . -y(e J PHONE q _Say-3 b- 60
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED W ERMIT#
(if applicable)
283294
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) she nYI15 M-O /IQ,A rtl CERTIFICATION# of/7 `e
r (if applicable)
1. WELL USE (Check Applicable Box): Residential lXuni Mcipal/Public ❑ Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
�
2. WELL LOCATION:
e
Nearest Town: .524 VOA- •V C, County. ) 4 CI( S (�)c)
CI- C(I AI �- i -t' ii Li 0 re ale . ,� y 1'7 `j
(Street Name, Numbers, CommuniW,, Subdivision, Lot No.. Zip Code)
3. OWNER: (11 • ki' l (./4/ r7 i i9 g )jt1irr�
di I I S {Mi(Street or N) E ��
Address ka�.()) /Sz7X S/ (V
or Route o.
City or Town State Zip Code
Cnin- r5 6'7 - 7/0
Area code- Phone number
4. DATE DRILLED 1 .Q „fib R
5. TOTAL DEPTH: 4'OS"
�opographic/Land setting
edge ❑Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DRILLING LOG
Formation Description
C / (k,k
(Z.n '*vt e -,
ILL(CC:-J? 4N1Tt
DEPTH
From To
n 7.1'
7U' )2A.
i.;)3' Yh.S•
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO
7. STATIC WATER LEVEL Below Top of Casing: /.C` FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS / FT. Above Land Surface*
`Top of casing terminated at/or below land surface requires a
variance in accordance with I5A NCAC 2C .0118.
9. YIELD (gpm): 30 METHOD OF TEST b/OPier c
10. WATER ZONES (depth): .' RS 0 2
LOCATION SKETCH
o n
I I. DISINFECTION: Type Hi', f Amount TJ4. S Show direction and distance in miles fro '4t le slc
12. CASING: Wall Thickness two State Roads or County Roads. Include —the rg§d-'-'
From 0
From
From
13. GROUT:
Material
From /) earn, Jo -.From
14. SCREEN: Slot Size Material
in. in.
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth
From To Ft.
From To Ft.
epth Diapp��eter or Weight/Ft. Materipal numbers and common road names. c.rt
To I;L Ft. (c" $j0R�/' QY�
To Ft.
To Ft.
Depth
To e*:0 Ft.
To Ft.
Depth Diameter
From To Ft.
16. REMARKS:
Size Material
Method
LU)
0
0
I
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WEII,c::.
CONSTRUCTION STANDARDS, AND TVHHAA,T^A COPY�YOF TH�SS RECORD H(\A�/S BEEN PROVIDED TO THE WELL OSIER
OratX�t�fL✓ / Tlvt.G c(/!h(J`-' I ,i- - •5 -'�{,' �i
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE 1T
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center -Raleigh, NC
27699-1636 Phone No. (919) 733-322I, within 30 days. GW-1 REV. 07/2001
J
�f,
JJ

TI's97w
29254315-7s-93-siec
WELL CONSTRUCTION RECORD C_&04 , brIcamAir
North Carolina - Department of Environment and N((a�tturyalyR�esour es - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAM/�E� �(prinnt)/,{{' L / , 1 C Lty(f� �- 1 �t (J�,,,/,�y CERTIFICATION
r-# 1
WELL CONTRACTOR COMPANY NAME M' - "I reen-c_ •'eras "----4. Ai `'✓` �7 PHONE # (f�y S 6 la'-J-S.S-U
STATE WELL CONSTRUCTION PERMIT#
(if applicable) (if applicable)
ASSOCIATED WQ PERMIT#
•
1. WELL USE (Check Applicable Box): Residential Municipal/Public 0 Industrial ❑ Agricultural ❑/
Monitoring 0 Recovery ❑ Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION: Topographic Land setting
NearestTown:7s 6 � ❑Ridge ❑Slope (Walleygt
lat
a ) e flC Yj ��� (check appropriate box)
tubers, Commu{iity Subdivision, Lot No., ZijCode)
(Street Name,
3. OWNER:
Address
3A
ty ((Streator Route No.) 1 t^ a& f
UL GYGG��Sje
IZf`.City or Town SZip Cade
c1i5- aP 3—
Area code- Phone number
4. DATE DRILLED -a•l -03
5. TOTAL DEPTH: (QS-0
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO ❑
7. STATIC WATER LEVEL Below Top of Casing: ¥D FT.
Jv (Use "+" if Above Top of Casing)
. S. TOP OF CASING IS I P., FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance In accordance with ISA NCAC 2C .0118.
9. YIELD (gpm): • METHOD OF TEST /Y
10. WATER ZONES depth): c2.d- r
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From To Formation Description
gs,r�aS
as 7
aa7-aSa
LOCATIO
11. DISINFECTION: Type N I W Amount ' I i AS- 67/Show direction and distahce in iles oms1.1east.- i,i
12. CASING: Wall Thickness two State Roads or Coun{f,', Roads: Inblude tha Ebad c,,
Depth _ Diameter or Weight/Ft. M tena numbers and common rogd,Dat:08_ - -- --- —
sf
From (.) To cgS Ft. (o "1fxWgv1t
From To Ft. r (�¢�¢� c
From To Ft.�,..y - 0 p
13. GROUT: Dept Material Method od ¢t p2 1 L -Tt yam
:From 0 To a O FL (I D �{~-r_9ap� m
W cm
From To FL Y /Yr✓' �'1' 1 an
14. SCREEN: Depth Diameter Slot Size Material . 9. /I N nm�
From To Ft. in. in. Fzl`�ln'^i�.�A/__ --1....,From To Ft. in. in. an°
15.SAND/GRAVEL PACK: tV Trl 7;
cn
Depth Size Material ,' y
From To Ft. a -
From To Ft. z
16. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH ISA NCAC 2C, WELL
CONS-F6UCTION STANDARDS, AND THAT A COPY OF THIS CORD HAS BEEN PROVIDED TO THE WELL OWNER
1n.c.1 e,-QC'-
SIGNATURE PERS ONSTRUCTIN THE WELL DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mali Service Center - Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. _ GW-1 REV. 07/2001

eu3 Q ,
29-2544
North Carolina -Department of Environment and Natural $sources - Division of Water Q(uality- Groundwater SectionWELL CONTRACTOR (INDIVIDUAL) NANIE (print) 7 ,
'. - �.%✓I �� /Y\l .,i�uS1 Y� V CERTIFICATIIOON# r9S 9 / .
WELL CONTRACTOR COMPANY NAME ft irrt '/nZ�f1 "r / PHONE # 9 517 .dS..S 6
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable) t
1. WELL USE (Check Applicable Box): Residential Municipal/Public ❑ Industrial 0 Agricultural D(
Monitoring ❑ Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATIO,
Nearest Town: '
1 VP --
r�, Topographic/Land setting
County ZFi-efegg-- ❑Ridge ❑Slope DValley DFlat
(check appropriate box)
Latitude/longitude of Well location
(Street Name, Numbers, Community, Subdivisi , Lot No., Zip Code)
3. O\VNER:7K1I�t�-
Address QO%L- 5V100t1f
�-s \.(J(9[me�t or Route No.)v
r C_
ty orto own State 1v Zip Code
5
(degrees/minutes/seconds)
Latitude/longitude source:DGPSOTopographic map
. (check box)
DEPTH DRILLING LOG
From - To • ° Formation Description
Area code- Phone number fie C
4 DATE DRILLED to— LP'o3 i
5. TOTAL DEPTH: 5 els - (1)r'tied dew- /as CJry 6 34
6. DOES WELL REPLACE EXISTING WELL? YES D NO ,
7. STATIC WATER LEVEL Below Top of Casing: ..SSi) FT.
/ (Use "+" if Above Top of Casing)
S. TOP OF CASING IS / 7z- FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordance with I5A NCAC 2C .0118.
9. YIELD (gpm): T • METHOD OF TEST ✓
10. WATER ZONES (depth): — t.
LOCATIO SKETOH".I
11. DISINFECTION: Type tt % f %- Amount a 51, ( l Show direction and distance In miles from at least
12. CASING: Wall Thickness J two State Roads or County Roads. Include the road
Depth Diameter or Weight/Ft. Material numbers and common road names.
WELL CONSTRUCTION RECORD
(if applicable)
-11
13. GROUT:
'From Ft.
From Ft. p
14. SCREEN: Diameter Slot Size Material
From Ft. in. in.
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft. 2f j p
From // To ,, ,1 Ft. ,�,,((�� _ f� (� a 1 /
16. REMARKSa 'On (A�t-d— U( I\-1- / rut - r 3 �/ 7�� `5(1'S �0 -6- 63
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF THI RECORD HAS BEEN PROVIDED TO THE WELL OWNER
From To Ft.
From To Ft.
From To Ft.
Depth
To
m To
Depth
To
%/0
03
SIGNATURE OF F4tSON COQ:STRUCTING THE WELL
DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-1 REV. 07/2001
1

292545
North Carolina Department of Environment and Natural Resources - Division of Water Quality Groundwater Section .
WELL CONTRACTOR (INDIVIDUAL) NAME (print) O M� �`/ �a,vlettq-�1� �,pp CERTIFIC�ATII/ON/p�i7'�
WELL CONTRACTOR COMPANYNAISIE Pdaa Pee !" -P Psi) CS Vera/ PHONE n ()`P$).4 d7,
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED LVQ PERMIT#
(if applicable) - - - (if applicable)
1. WELL USE (Check Applicable Box): Residential' Municipal/Public 0 Industrial ❑ Agricultural f�
Monitoring ❑ Recovery 0 Heat Pump Water Injection 0 Other ❑ If Other, List Use
QoPt, 75-44-2sr �
Co Pa. Lt7S70W
WELL CONSTRUCTION RECORD
2. WELL LOCATIO Nearest Town: ' Pn f Q F County
4 �eQ-4e
(Street Name, Nur?ibers, Community, Subdaision, Lot No., Zip Code)
3. OWNER: CZ I rS n cx r'
Address r(S Gvu r (o s n-}' � I'
(Street or Route )
C�l,lowb.en_ 1�C a87a,R.
City or Town State Zip Code
( %)).tj 3- 3a(/G
Area code- Phone number
4. DATE DRILLED is-alc- 03
5. TOTAL DEPTH: 70/)
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO ❑
7. STATIC WATER LEVEL Below Top of Casing: /00 FT.
t (Use"+" if Above Top of Casing)
S. TOP OF CASING IS I'2- FT. Above Land Surface'
*Top of casing terminated actor below land surface requires a
variance In accordance with 15A NCAC 2C .01 IS.
9. YIELD (gpm): • METHOD OF TEST fin -
10. WATER ZONES (depth): LEE
11. DISINFECTION: Type hi Amount II P 7_
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. ,lvrial
From N To 59 Ft. (e t/,C s n 2 Z( (,/�
From To Ft.
From To Ft.
13. GROUT: Depth Material
-From 0 To ao Ft. (_any-a,.�
From To Ft.
14. SCREEN: Depth Diameter
From • To Ft. in.
From - To Ft. in.
15. SAND/GRAVEL PACK:
Depth Size Material
Method
Slot Size Material
in.
in.
From To Ft.
From To Ft.
16. REMARKS:
Topographic/Land setting
y'^y�l`-❑Ridge $lope ❑Valley ❑Flat
s"v (check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From To Formation Description
�— &z/o
4L/2
rov
IL
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common road names
O
-n
rn
W
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED
CONSTRUCTION STANDARDS, f}h'DTHAT A COPY OF THIS
7n C
F 'z
z
IN ACCORDANCE WITH 15A NCAC 2C, WELL
OR!7 AS BEEN PROVIDED TO THE WELL OWNER Si
j
SIGNATURE OF'ERSOIG CONSTRUC
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Sersice Center -Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-1 REV. 07/2001
G THE WELL DATE
•

2 9 2
WELL CONSTRUCTION RECORD
North Carolina - D partment of Environment and Natural Resources - Division of Water Quality Groundwater Section •
WELL CONTRACTOR (INDIY'IDUAL) NAME (print) PLtchell D, COO;K CERTIFICATION# 2043
WELL CONTRACTOR COMPANY NAME i . 1 'ES ;fell )�>11L'Y1, Ire PHONE R fs28) 369-9591
S'rATE WELL CONSTRUCTION PERMIT; ASSOCIATED WQ PERMITAI
(if applicable) - - (if applicable)
1. WELL USE (Check Applicable Box); Residential 6 Municipal/Public ❑ Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection ❑ Other 0 If Other, List Use
2. WELL LOCATION';
Nearest Town. Balsam County Jackson
Balsam, Willets, Ochre Hill Fire Dept
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: Balsam, Willets, Ochre Hill Fire
Address PO Box 291
- (Svee: or Roue No.)
Balsam, NC 28707
City or Town State
( 828 586-9331
Zip Code
Topographic/Land setting
❑Ridge 0Slope ❑Valley ❑Flat
. (cheek appropriate box)
Latitude/longitude of well location
Dept
Latitude/long
Area code- Phone number
4, DATE DRILLED 10-28-03 -
5. TOTAL DEPTH: 300'
6. DOES WELL REPLACE EXISTING WELL? YES:0c NO 0
7. STATIC WATER LEVEL Below Top of Casing: 5 FT.
(Use "+'- if Above Top. of Casing)
8. TOP OF CASING IS 2 FT, Above Land Surfaces'
'Top of casing terminated at'or below land surface requires a
variance In accordance with 15A NCAC 2C ,0118.
9. YIELD (gprn): . 100+ METHOD OF TEST blow
10. WATER ZONES (depth): 225' & 245'
11. DISINFECTION: Tvpe H T H
12. CASING:
Depth
From• 0 To 84 Ft.
From To FI.
From To Ft.
13. GROUT: Depth
Fram 0 To 20 •
From To
14. SCREEN: Depth
From To
15
From To
SANDIGRAVEL PACK
Depth Size Material
From To Ft.
From To Ft.
Diameter
6"
- Amount 160z •
Wail Thickness
or Weight/FL Material
188 steel
Material Method
Ftt iritite & prce3
Ft.
Diameter Slot Size Material
Ft. in. in.
Ft. • in. in.
DEPTH
From
0
- 82'
To
82'
300'
(degrees/minutes/seconds)
itude source:DGPS❑Topographic map
(cheek box)
DRILLING LOG
Formation Description
clay & se 3
granite
LOCATION SKETCH
Show direction and distance in miles from at least
t'vo State Roads or County Roads. Include the road
numbers and common road names. •
16. REMARKS: ----
I DO HEREBY CERTIFY THAT THIS WELL.WAS CONSTRUCTED IN ACCORDANCE WITH ISA NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
SIGNATURE OF PERSON CONSTRUCTING THE WELL - DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center -Raleigh, NC
27699-1636 Phone No, [phone], within 30 days. - GW-I REV.07/2001

SWELL CONSTRUCTION RECORD
7rf7'2
North Carolina - Department of Environment and Natural Resources - Division of Water Quality • Groundwater Section
• WELL CONTRACTOR (INDIVIDUAL) NAME (print) Mitchell-D. CookCERTIFICATIOtN k 2043
WELL CONTRACTOR COiMPANYtNANIE HeCEIFI1 - rS 1»11 rj -liana lit PHONE # ea) 369-9591
S'LATE•WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT
(ifaoolicable) (ifanolicable)
1. WELL USE. (Check Applicable Box): Residential 25 Municipal/Public ❑ Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection C. Other ❑ If Other, List Use
.2. WELL LOCATION:.
Nearest Town: Sylva County Jackson -
Parris Br -cross 2nd vrk=1st new dr on-R
(Street Name, Number, Community, Subdivision, Lot No., Zip Code)
3, OWNER: Jarnes &trton
Address 1221 Ric Way Lai
(Street or Route No.)
Iawerenceville, GA 30044
City or Town State Zip Code
[phone]
Area code- Phone number
4, DATE DRILLED 12-03-03
5.- TOTAL DEPTH: 900'
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO) .
7, STATIC WATER LEVEL Below Top of Casing: FT.
(Use "+" if Above Top of Casing) '
8. TOP OF CASING IS 2 FT. Above Land Surface*
'Top of casing terminated at'or below land surface requires a
variance In accordance with ISA NCAC 2C AI I8.
9, YIELD (epm): 0--DRY METHOD OF TEST blow
10. WATER ZONES (depth):
11. DISINFECTION: Type H T H Amount 16oz
12. CASING: Wail Thickness
Depth - - Diameter or Weight/Et. Material
From 0 To 53 Ft, ' 6" pvc
From 53' To 60 Ft. 611 .188 steel
From To Ft.
13. GROUT: Depth Material - Method
From 0 To 20 Ftbanii:te & cellar ruzoad
From To ' Ft.
14. SCREEN: Depth Diameter Slot Size Material
From ' To ' Ft. ' in. - ' in.
From To Ft. in. in,
15, SAND/GR-AVEL PACK:
Depth Size Material
From To Ft.
From To Ft,
Topographic/Land setting
❑Ridge ❑Slope ❑Valley ❑Flat
. (check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
ud /longitude source:QGPS❑Tepo_graphlc map
(check box)
DEPTH DRILLING LOG
From To Formation Description
O 58' f lay & s
58' 900' granite
L.
LOCATION SKETCFI--
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common road names.
60:IIWd 1-833h0
16. REMARKS:
I DO HERESY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH ISA NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
^
/ SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
Submit the original to the Division of Water Quality, Groundwater Section 1636 Mail Service Center -Raleigh, NC
27699-I636 Phonc No. [phone], within 30 days, GW•I REV. 07/2001
0
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13. GROUT:
From 0
WELL CONSTRUCTION RECORD
North Carolina - Department of Emiironment and Natural Resources - Division of Water Quality - Groundwater Section
CERTIFICATION # 2043
WELL CONTRACTORCOMPAN''Y NAME E'rt 's ?P11 aintT-i, 71"L' PHONE # [phone]
WELL CONTRACTOR (INDIVIDUAL) NAME (print) Mitchell D, Cook
STATE WELL CONSTRUCTION PERMIT#
(if applicable)
ASSOCIATED WQ PEANUT#
(if applicable)
1, WELL USE (Check Applicable Box): Residential ® Municipal/Public ❑ Industrial 0 Agricultural ❑
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use
.2. WELL LOCATION:
Nearest Town: Whittier County Jackson
Widerness Campground -prop @Trash bin
(Street Nome, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: Robert P. Hyatt
Address PO Box 233
(Street or Route No.)
•
CAstalie, NC 27816
• City cr Town Sate Zip Code
(828)- 586-0294 contact
Area code- Phone number
4. DATE DRILLED 12'>O5-03
5. TOTAL DEPTH: 400'-
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO XS
7. STATIC WATER LEVEL Below Top of Casing: - 300 FT.
(Use "+" If Above Top of Casing)
8..TOP OF CASING IS 2 FT. Above Land Surface*
`Top of casing terminated atior below land surface requires a
variance In accordance with 15A NCAC 2C .0118,
9. YIELD (gpm)• 10 METHOD OF TEST blow
10, WATER ZONES (depth): 140' & 350'
11. DISINFECTION: Tyoe H T H
12. CASING:
Depth • Diameter
From 0 To 102'Ft. 6"
From 1 02' To 110 Ft. 6"
From To Ft.
Depth Material
To 20 Ft}rnite & =sit
Amount 16oz
Wall Thickness
or Weight/Ft. Material
pvc
1RR ctee1
From To Ft.
14. SCREEN` Depth Diameter
From To `'Ft. in.
From To Ft.' in.
15, SAND/GRAVEL PACK:
Depth Size
From To Ft. From To Ft.
Method
Tarred
Slot Size Material
in,
in.
Material
Topographic/Land setting
❑Ridge ❑Slope ❑Valley ❑Flat
. . (che:k appropriate box)
Latitude/longitude of well location
(degrets(m nu!esrseconds)
Latitude/longitude source:DGPSDTopographic mup
(check box)
DEPTH DRILLING LOG
From To Formation Description
0 108' &
108400' granite
LOCATION SKETCH'
Show direction end distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common road names.
3C
O
16. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL'WAS CONSTRUCTED IN ACCORDANCE WITH I5A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Nlail Service Center -Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-1 REV. 07/2001
0
0
0
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0
2

WELL CONSTRUCTION RECORD
29a0c0
North Carolina • Department of Environment and Natural Resources - Division of Water Quality - 0roundWate r.Section
WELL CONTRACTOR (INDIVIDUAL) NANIE (print) 6LtCne11. D. Cook CERTIFICATION , 2043
WELL CON"' RACTOR CON PANY NAME 1 &attars 1,1=11 L.ZL' im, Dr - PHONE M 8251 369-9591
STATE WELL CONSTRUCTION PERM1TM ASSOCIATED WQ PERMIT::
(if applicable) - (if applicable)
1. WELL USE (Check Applicable Box): Residential 3 Municipal/Public ❑ Industrial 0 Agricultural 0
Monitoring ❑ Recovery 0 Heat Pump Water Injection ❑ Other ❑ If Other, List Use
(352). 795-3243
Area code- Phone number
4. DATE DRILLED ' 12-8-03
5. TOTAL DEPTH: 250'
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO Ex
7, STATIC WATER LEVEL Below Top of Casing: 95 FT,
(Use "*" if Above Top of Casing)
8. TOP OF CASING IS 2 FT. Above Land Surface"
`Top of casing terminated at/or below Iand surface requires a
variance In accordance with 15A NCAC 2C .0118.
9. YIELD (pm): 20 METHOD OF TEST blow
10. WATER ZONES (depth): 130' & 210'
2. WELL LOCATION:
Nearest Town Sylva County Jackson
Blanton Br. to Chestnut Ridge
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: John Crider
Address PO Box 2410
• (Street or Route No.)
Crystal River, FL 34423
City or Town State Zip Code
11. DISINFECTION: Type H T H - Amount 1 602
12. CASING: Wall Thickness
Depth Diameter or WeighVFt, Material
From 0 To 57 Ft. 6't pvc
From 57' To ' 61 ' Ft. 611 1 RR steel
From To Ft.
13. GROUT: Depth Material Method
From 0 To 20 ' FtbanIite & rent gnu
From - To FI.
14. SCREEN: Depth ' Diameter Slot Size Material
From To Ft. in. in.
From To ' Ft. in, in.
15, SAND/GRAVEL PACK:
Depth Size Material
From To
From To
16. REMARKS:
Ft.
Ft,
Topographic/Land setting
DRidge :Slope ❑Valley ❑Flat
(check appropriate box)
Latitude,/longitude of well location
(degrees/minutes/seconds)
Latitud_/longitude source:DGPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From To Formation Description
0 59' rly & Bni
59250' granite
LOCATION SKE—CH , "`
Show direction and distance in imtrM-frmirzrhzs)---
twa State Roads or County Roads. Include the road
nurnbers and common road names.
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH I5A NCAC 2C, WELL
-CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
Submit the original to the Division of Water Quality, Groundwnter Section, 1636 Mail Service Center -Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. - _ GW-1 REV. 07/2001
E

292619
WELL CONSTRUCTION RECORD
North Carolina • D ; artment of Environment and Natural. Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) Mitchell. De Cook- CERTIFICATION A 2043
WELL CONTRACTOR CO.NPANY NAME 1 ErtharS Well jell rtl lit PHONE [phone]
STATE WELL CONSTRUCTION PERMIT; ASSOCIATED WQ PERMIT;
(if applicable) (if applicable)
WELL USE (Check Applicable Box): Residential BS Municipal/Public ❑ Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Fump Water Injection 0 Other 0 Ietther, List Use
.2. WELL LOCATION: -
Nearest Town: Sylva County Jackson
Little Savannah 1-o Rnsroe Lauds Pd •
(street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: Kimberly Shea Lewis
Address 395 Shea]ea Lane
(Sireat or Route No.)
Sylva, NC 28779
City or Town State
( 82- 586-3413
Area code Phone number
4. DATE DRILLED 11-26-03
5. TOTAL DEPTH: 200'
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO f
7. STATIC WATER LEVEL Below Top of Casing: 100 ` FT.
(Use "*" if Above Top of Casing) '
8. TOP OF CASING IS 2 FT. Above Lard Surface'*
*Top of casing terminated actor below land surface requlres a
variance In accordance with 15A NCAC 2C .MIS. •
9. YIELD (gpm): 12 METHOD OF TEST blow
10. WATER ZONES -(depth): 1 70'
•
11. DISINFECTION: Type H T H Amount 16oz •
12. CASING: Wall Thickness •
Depth • Diameter or Weight/Ft. Material
From 0 To 85 Ft. 6" pyr
From 85' To 89' Ft. 6" 1AR stecil_
From To Ft.
13. GROUT: Dep:h Material Method
From, 0 To 20 - Ftbe ni:te & taste 3
From To ' Ft.
14. SCREEN: Dep!h Diameter Slot Size Material
From To •- Ft. in. in.
From To Ft. - in. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To
From To
16. REMARKS: 11
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH I5A NCAC 24, 54-ELL.
STANDARDS,
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED 70 THE WEtt—OWNER
`
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
Ft.
Ft,
Zip Code
• Topographic/Land setting
❑Ridge ❑Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(decrees/minutes/seconds)
Latitude/longitude source:DGPSGTopographic map
(check box)
DEPTH DRILLING LOG
From To Formation Description
0 87' cIRV & sa.*ri
87' 200' granite
LOCATION SKETCH
Show direction and distance in miles Dom at least
two State Roads or County Roads. Include the read
numbers and common road names.
tl
tee
,4.- ED
rn 0cp m al
CO Cm
CD
Cam
Do
0
bra
rnz
mpu
Submit the original to the Division of Water Qualiy, Groundwater Section, 1636 Mail Service Center -Raleigh, NC
27699-1636 Phone No, [phone], within 30 days.
GW-1 REV. 07/2001
N
FH: F

WELL CONSTRUCTION RECORD
292618
North Carolina • Department of Environment and Natural Resources - Division of Water Quality -Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) Mitchell De Cook
WELL CONTRACTOR COMPANY NANIE F135531 FdLt1- s ppl1 atilirtr,
CERTIFICATION 4 2043
PHONE k 8231 369-9591
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT:
(ifaoolicable) (ifaoplicable)
1. WELL USE.(Check Applicable Box): Residential 6 Municipal/Public ❑ Industrial ❑ Agricultural ❑
Monitoring 0 Recovery 0 Heat Pump Water Injection ❑ Other ❑ If Other, List Use
2. WELL LOCATION:
Nearest Town: Cullowhee
TaPorte Acres Lot #26'
County
Jackson
(Street Name, Numbers, Community, •subdivision, Lot No., Zip Code)
•
3, OWNER: Connie Hanna
Address 15 Crows Rest
(Stre:t or Route No)
Cullowhee, NC 28723
City or Town State Zip Code
(828). 293-9250
Area code Phone number •
4. DATE DRILLED 12-11-03
5, TOTAL DEPTH: 450'
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO
7. STATIC WATER LEVEL Below Top of Casing: 350' FT.
(Use "+ if Above Top oCasing)
8. TOP OF CASINO IS 2 FT. Above Land Surface'
•Top of casing terminated at/or below land surface requires a
variance In accordance with ISA NCAC 2C Alit IS.
9. YIELD (gpm): 7 METHOD OF TEST blow
10. WATER ZONES (depth): 410'
11, DISINFECTION:Tvoe H T H Amount 16oz
12. CASING: Wall Thickness
Depth Diameter or Weight'Fl, Material
From 0 ' To 80 Ft. 611 pvc
From 80' To - 84 Ft, 6 .188 steel
From To Ft.
13, GROUT: Depth Material Method
From 0 To 20 Rbernite & catii _prized
From - To Ft.
14,SCREEN: Depth Diameter Slot Size Material
From ' To Ft. in. - - ' in.
'From To Ft in. in.
15. S.AND'GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
16. REMARKS:
Topographic/Land setting
❑Ridge ❑Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degreesitnimnes/seconds)
Latitude/longitude source,❑GPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From To Formation Description
0 82' clay & srd
82' 450' granite
f Y.
LOCATION SKETCH
Show direction and distance in miles from at least o
two State Roads or County Roads. Include theSad p
numbers and common road names.
co En
1 oc
0
AEn
rn
crn��o
n
[A Z
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0
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I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH ISA NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
72/cX' �, //d3
SIGNATURE OF PERSON CONSTRUCTING THE WELL - DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mai! Service Center -Raleigh, NC
27699.1636 Phone No. [phone], within 30 days. , ' GW-1 REV. 07/2001

29"r1
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality— Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) Nlitcnell D. Cock ' CERTIFICATION >< 2043
\YELL COY!RACTOR COMPANY N.AAIE E3T eS ?bp- Ek1_1hrrl, ' PHONE [phone]
STATE WELL CONSTRUCTION PERMITP ASSOCIATED WQ PERMIT.'
(if applicable) - (if applicable)
1. WELL USE(Check Applicable Box): Residential CZ Municipal/Public ❑ Industrial 0 Agricultural 0
Monitoring ❑ Recovery 0 Heat Pump Water Injection 0 Other ❑ If Other, List Use
2, WELL LOCATION:
Nearest Town: Sylvia County Jackson
761 Cagle Branch RD
(Street Nome, Numbers, Community, Subdivision, Lot No., Zip Code)
3.OWNER: Monty & Becky Kirkpatrick
Address 761 Cagle Branch RD
' (Sheet or Route Nc )
Sylva, NC 28779
City or Town State • Zip Code•
[phone]
Area code- Phone number
4. DATE DRILLED 1 2-18'403
5.TOTAL DEPTH: 200'
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO I
7. STATIC WATER LEVEL Below Top of Casing: 1 0 FT.
(Use"+" if Above Top of Casing)
8. TOP OF CASING IS 2 FT. Above Land Surface"
*Top of casing terminated at'or below !and surface requires a
variance In accordance with ISA NCAC 2C -OI18.
9. YIELD (gpm): 40 METHOD OF TEST blow
10. WATER ZONES (depth): 80' , 1 35' i 180'
II. DISINFECTION: Type H T H Amount 16oz
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. - Material
From 0 To 126't. 611 .188 steel
From To Ft.
From To Ft. -
13. GROUT: Depth Material Method
From 0 To 20 Ftherrni±e & Ixatr=d_ mimed
From To Ft.
14. SCREEN: Depth Diameter Slot Size t`laterial
From To - Ft in. in, From To Ft. in. ir..
15, SAND/GRAVEL PACK:
Depth Size Material
From To
From To
Ft.
Ft.
• Topographic/Land setting
❑Ridge ❑Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source,❑GPSDTopagraphic map
(check box)
DEPTH DRILLING LOG
From To
0 124'
124' 200'
Formati oar Desc ription
i & szi
granite
I i •
.23124
i "'t F_ UF_ICE
LOCATION SKETC1r?'
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common road names,
0
16. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH I5A NCAC 2C, WELL
CONSTRUCTION STAANDARRDSANND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER ,A
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center -Raleigh, NC
27699.1636 Phone No. [phone], within 30 days. GW-1 REV. -0 7/2001
0
x

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality • Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) Mitchell D, CookCERTIFICATION R 2043
WELL CONTRACTOR COMPANYtNAMIE 5�' l leer PHONE [phone]
STATE WELL CONSTRUCTION PERMIT#
(iiaoplicable)
29wi)lt)
ASSOCIATED WQ PERMIT#
(if applicable)
1, WELL USE (Check Applicable Box):Residential Lx Municipal/Public ❑ Industrial ❑ Agricultural ❑
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
WELLLOCATION:
Nearest Town: Cherokee County Sarkgnn
Soco Rd to Wright Is ('reek-EBCI well
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code) •
3. OWNER. Lilliemay Tucker
Address 252 Freeman Branch Rd
t Stree; or Rout: No.)
Marietta, SC 29661
City or Town Sate Zip Code
(864)=836-2118
Arca code. Phone number
4, DATE DRILLED 1 2-1 8-03
5: TOTAL DEPTH: 600'
6. DOES WELL REPLACE EXISTING WELL? YES 0 NOS
7. STATIC WATER LEVEL Below Top of Casing: 400 FT.
(Use "+" if Above Top ofCasing)
8. TOP OF CASING IS • 2 FT. Above Land Surface*
'Top of casing terminated at/or below land surface requires a
variance In accordance with 15A NCAC 2C All IL
9. YIELD (gpm): 12 METHOD OF TEST blow
10. WATER ZONES (depth): 555
II. DISINFECTION: Type H T H - Amount 16oz
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
From 0 To 126E't. 6" .188 steel
From To Ft.
From To Ft.
13, GROUT: Depth Material Method
From 0 To 20 Ftira kite & caret_ UI
From To Ft,
14. SCREEN: Depth Diameter Slot Size Material
From To Ft in. in. From To Ft. in. in.
15, SAND/GRAVEL PACK:
Depth Material
To
Topographic/Land setting
❑Ridge ❑Slope ❑Valley ❑Flat
(cheek appropriate box)
Latitude/longitude of well location
( degreesMslnu!es/seconds)
Latituderlongitude source:0GPS0 T opographic map
(check bo.rt)
DEPTH DRILLING LOG
From To Formation Description
0 124' Clay & brar3
124' 600' granite
I.=ti
L'7
LOCATION SKETCC
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common road names.
a
Size
From Ft. ••
From To Ft.
16.REMARKS: Eastern Band of the Cherokee Indi ans well
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE. WITH I5.A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS SEEN PROVIDED 70 THE W, ELL OWNER
%%i e.. GE, i2 /iy/n3
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
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. GW-I REV. 07/2001
0
O
n,D cCD
0m
rn
—"
y0
m�
(7/
rn
cn
mX)
c4
0

WELL CONSTRUCTION RECORD
711ZO 14 4307
North Carolina Department of Environment and Natural Resources - Division of Water Quality- Groundwater Section
%YELL CONTRACTOR.(I\DIVIDUAL) NAS1E (print))tip
/ CERTIFICATION k, e7
WELL CONTRACTOR COMPANY NAME /4'7-t":"4 aric_eh P. kms/A(u,L1 /(P HONE II n'
STATE WELL CONSTRUCTION PERSIIT:
•(if applicable) ASSOCIATED WQ PER. IIT:
Street Nane, Numbers, Communiy, .Subdi isic „ Lot 'c. Zip Cede)
3. OWNER:
(if applicable)
I. WELL USE (Check Applicable Box): Residential 13 Municipal/Public ❑ Industrial 0 Agricultural ❑
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other 0 If Other, Lis: Use
2. WELL LOCATIQN:
Nearest Town:13atsy7,. County Cc
D 1� L_ tYad t)
St?ar✓c S /:,rz nr/,24779
C--t P a
Address %t �StI1pro4-1 P.Cielt
( :reet or Roue N>.)
-Fksrse s hoe Id ( a Si
Cry or Toga S:a:e s Zip Code
(sue)- "fs6- /093
Area code- Phone number
4. DATE DRILLED AP— / — O�
— Air
Topog a hic/Land setting
DRidge :Clops ❑Valley ❑Flat
(chef< appropriate box)
Latitude/longitude oflocation
•
(degr:es'minutessecondi)
Latitudelongin:de source:❑GPS❑Topographic map
• (che k box)
D=PTH DRILLING LOG
From To Formation Description
S. TOTAL DEPTH: ?2C
14S'— 4/5
O--2y
7. STATIC WATER LEVEL Below Top of Casing: 416 FT. p
(Use "�' if Mot: Top of Casing) / r-97
S. TO? OF CASING IS / ,, FT. Above Land Surface R 7 --130
'Top or eosin; terminated at'or belon Lind surrs:e requires a / 30 —/3 ?
+ariance In accordance+.ith Ii.A NCAC 2C.0I15. n- . /33- /Os-
9. YIELD (gpm): ,42METHOD OF TEST /L-, /(pj - 7
10. WATER ZONES (depth): fe 9 S %3 0 / /6 v- /0 7 - 3 z r
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO l� _ 9 r
II. DiS[N-FECTION: Type /-f'T%-f- Amount /ef 7Z)7
12. CASING: ,•
el Thickness
O Depth Dia.te:er or V�eigh:f:. b(a:e:i2
From To,-,2 Ft. to '/. $ Z?J P U C-
From To Ft.
From To R.
13. GROUT: Dep:ho Ma:eria!
From 0 To - Ft. e. Pilr7.-„
From 3 To JG FL betnr a-sc , w IV)
14. SCREEN: Dep:h Diame:er Sic: Size ha:eria' Pt/1-i2—
Rom To R. in. in
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From, To Ft.
From To Ft.
16. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN A.000RDANCE WITH IiA NOAC 2C, WELL
CON-�F?UCTION STANDARDS, AND THAT A. COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
Submit the original to the Division of Water Quality, Ground++a ter Section, 1636 Mail Service Center- Raleigh, NC
27699-1636 Phone No. [phone], within 30 days.
Gl';-1 REV. 07/2001
LOCATION SKETCH
Show direction and distance in miles from, pat least::t ;o Sate Roads or County Roads. Include, e ro`3
LUmberS and CJ^^:OT. road names.
—1 roc -
cumbers
c
4-23
o-'
3 also->,, M-hv Re&V ;
End
Ul

1Q
07
(Street or Rou:eNo.)
rLi
Ciro, d•T +-. 5::• Zip Cadc
((23v.- 5'7—(049J
A'U :ode. Pho'e:dlnber II
u. DATE DRILLED I/ 1(7't73
5 TOTAL DEPTH: I
6 DOES WELL REPLACE EXISTING WELL? YES ❑ NO ❑
7, STATIC WATER LEVEL Below TcpofCasing: FT.
(Use "-"ifAdoveTad c:Cas'.ng1
E. TOP OF CASING IS 2 FT. Above Land Surface'
'Top of :ashy; term;nated at:or below land surface requires a
variance In accordance I5A NCAC .01 I8.
9 YIELD (_pm): _ METHOD GE TEST
10 WATER ZONES (de
S..4vson, Lo No, Z7p Code`
«'ELL CONSTRUCTION RECORD 2 93860
Nor*, Ca: olio: -Do a., ,en Er,:ircnment and Natural R.sv,.:v._ • Di visicn cfWaterQ_ali. C,,un. _ ., Section
WELL COA TRACTOR (lND14IDUAL)NAME (prorot) Mitchell D. Cook CERTIFICATIOrA 20(13
W ELL COvrR.YCTORCOMP.A:VY NAME ri-eriars &iners Wed airitrz, =-t P;COVE: E2'S1 369-959
s'rATE ',YELL C0" STRL'CTIOV PERMIT; ASSOCIATED AYQ PER.IiTc,
(ii aooli:able) (i(z:cilcable)
I. WELL USE (Check Applicable Box): Residential Z V.S Ipal;r .lid ❑ Ind I,.ria: ❑ c_It ❑
Monitoring ❑ Re:overy ❑ Heat Pump Waver liieodon 0 Other ❑ if 0:her, List Use
2 WEI L LOCATIQN
NearTovrn:-
(Sree Y e, Nam':
3. OWNER:
Addvos
l 1. DISINFECTION: Ty; e H T H ' Amount — 1 Ecz
12. CASINO: Wall Thickness
['depth Diameter or W e. n ': L Material
From 0 To Ft. ia' I
Front R &n r To_Q °t.
From To Ft.
13, GROUT: Depth Nla'erial Method
From O To 20 Ft Lk its & L .c:L ❑1;h
From To F.
I;. SCREEN: Deprr, Dias.-.-. Slot Size Matra
From To F. in. ' in.
From To - F. in. in,
15. SAND/GRAVEL PACK:
Deo h Size tiateria:
Fro,,, To Ft.
From To Ft.
Topographic/Land se..
r'�;iic_ ❑Si: Vile ❑; Ic
• (check ads•:p ::: bcY!
L_! tude , d' we11 r atidn
r.a_
DE?T,. ,`.0 LOG
T �� F,.,L,, i_r De p:icn
From C:..W & �'S3
3531 )5Q0' arm ite
LOCATIONSKETCH-
Show dir^tion and dis:ance in r..iies i:s:n _' least
two State Reads or Cer.nty Roads. lnaude t;:e road
numbers and co-. ,cr. road names.
16. RE:MARKS:
I D0 HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH I6 A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED 70 THE WELL C'0`'NER
-Gy' 4dp //, -?D •
SIGNATURE. OF PERSON CONSTRUCTING THE WELL DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mil Service Center • Raleigh, NC
27699.1036 Phone No, [phone], vvithlri 30 days. GV; -: REV, CT:..,
0
0

WELL CONSTRUCTION RECORD
North Carolina - Department at -Environment n:1 Natural F. scum s DiVsbn o` Water Q.1 II Gro.:nd,vateraectioa
»ELL CONTRACTOR (I)DIYiDU aL1 SAVE (p ell James B' nra4n C_ST:. ICATION 2045
'Et.Lawl rtncTonco:titPAnYNA 1EKada' Brothers Well Drilling, Inc Po,YE = 2a1 369-9591
293857
STATE WELL CONSTRUCTION PERMIT - ASSOCIATED WQ FERMITd
(ifaorlicable) - (if aonli: ble)-
1, WELL USE (Che c e P.pp:iezble Sox): Res1den 1al i unicipa Public•❑ Indus:dal ❑ A.tricul.tr1 ❑
Monitoring' ❑ Recovery .0 Heat Pe,mp Wa:er Injection EL 0;her 0 If ot'c , Lis). Use
2. WELL LOCATipN
Neil:v: Town: U; A,U.� a Coi:❑
(SireM1 s<, N`n crap Cn'n luni�%IF�_;i,!oe. Lai N:., Z'p Cede)
3. OWNER:
nda:SS
; ct , sc a9,9�8
Are, code Pure mrrbe-
DATE DRILLED a -I �d3
TOTAL DEPTH: r200
6, DOES WELL REPLACE EXISTING WELL? YES 0 NO G
STXflC WATER LEVEL Below Top c:'Casir.2 0 FT.
c.i5: = if At : Top e. . '..-yl
S, TOP OF CASING IS 2 FT. Adc;e Land Surfa:e*
'Top of casing :criminate: actor below land rurace req:ires a
variance In accords' e th ISA NCAC 2C .011S.
9. YIELD (gpm): METHOD Q TEST blow10,WATERZONES (depth). 1 15 ¥' I70 '
1 L-DISINFECTION• Type
12, CASINO:
Depth
Fron 0, To
Frc'n_ To
Fran To
13. GROUT: Depth Ma:trial
• ,,,,, 0 To 20 F:, LCuute & tom L
From • To Ft.
Id, SCREEN: Dep:'n DIa,r.e:ee Slot Size Nlater!a:
Frorn ' - To - Ft. - in.
From To in. t'..
15, SAN'DLORAVEL PACK:
Depth Siz Material
From To Ft,
An,,oun: 16 oz
Wail Thickness
.., or ` e:g' :'F:. 3.4---eria
From To Ft.
T. pozraphicia::d se:r ,
DRidge ❑Slone Walley OFiat
(evi<a,pro a e bee:
Lutilude long ode of we:: location
Ide,.-.ml,.ln ites' . • -
L tItudel :it Ide sour:e.CGPS 1 , _rani map
DEPTH DRILLING LOG
..
To For—:' ^ ..ctlx�
cr ay & Des.san
cranite
LOCATION SKETCH
Snow direction and distance in rn;:es from a: leas:
r,vo State Roads or Ccunty Roadslrci..ide toe road
numbers and common road names
—o
3
(W
W
iD
16, REMARKS
I. DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WiTH 15A NCAC 2C, WPLL
CONSTRUCTION STANDARDS, y-` THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE';V!L: OTTNER
NATURE OF PERSON CONSTRUCTING' THE WELL DATE
Submit the original to the Division of Water Quality, Groundwater Section, 16361N1a:I Service Center • Raiei;'a, NC
27699-1636 P'nnnc Ao [phone], Within 30 days: - G11'-! REV .';"I_ _

293848
WELL CONSTRUCTION RECORD
NOrIII Ca H one • Dcpa: „.ent c°Er ; (comment and Natu a'. R:s3d:ce, • Division of Water Quality Groundwater Se_tion
1,1 LLCO,rTRACT'OR(I)DIVIDUAL)NAN1E (print) Janes E' Ero'rm CERTIFICATIONr2045
WELL CON'f RACTOR COMPANY iNA'1E Median Brothers Well Drilling, Inc PHONE = f2.81 369-9591
SPATE WELL CONSTRUCTION PERMMIfl ASSOCIATED WQ PERMIT:. C
(if aonlicabiel
aorlicab:e)•.
I. WELL USE (Check A?pliable Box) Residential ei Mdnicipa!, Pun: : C Industrial 0 A.grdttll:drat C
Monitoring ❑ Recovery 0 Heat Pump Water Imectien 0 Other C I(Ot:ner, List Us:
2 WELL LOCATI
Nf.rest Tcwn
3 OV/NE
Addrdss
Arn ., t 'l/7 63
4 DATE DRILLED
5. TOTAL DEPTH: BOO
6. DOES WELL REPLACE EXISTING WELL? YES% NO
7. STATIC WATER LEVEL Ee1c h' To: of Casina'. FT.
8. TO? OF CASING IS 2 FT. Above Lan= Surf_
'Top orrsinz torminate: ac'or below land surface rucuires a
vurlance In accordance h ISA NC.AC 2C A115,
9, YIELD (2om): _ METHOD OF TEST bLOW
10.WATER ZONES (
11. DISINFECTION: Type H T H Amount • 10
I?. CASING.
Depth
From 0 To
From= To
From To
13. GROUT: Depth.
Fro:-, 0 Tc 20 Ft. s_Ld.te & cx,
Waft Thickness
or Weight/Ft. Masr
0z
From To
14 SCREEN: De,±
From To
.From, To
Matena
pumar-
F!.'
Diameter Slot Size
Ft. in. in.
Ft. In. In.
15, SAND/GRAVEL PACK:
Depth
From To Ft.
Size ,blatenal
From To F:.
T000sraphic/Land sr:ine;
❑Ridge CS1ooe GVal ley ❑Flat
(check ac arcpria:e bc.)
Latltude'longHdc cf we',i location
La tud 'r ;I „_e sou.._:0GPSa:az . n-ap 't
DFJLLIN'G LOG
Fr..
T T- For Des: 'coon
0 clay & san
9 00' cra to
DErT�;
LOCATION SKETCH
Show direction and distance in Riles from, a'. least
two S!ate Roads c:Counr., Roads. Include the road
numbers and cornn,on roar: names,
0
w
'a
s
(.J
CO
CO
16. REMARKS'
I DO HEREBY CERTIFY Tr'ATTHIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH. ISA NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A 0^PY' OF THIS RECORD HAS SEEN PROVIDED TO THE WELL OWNER
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 3.Ia:1 Service Center - Raleigh, NC
27699.1636 Prune No, (919) -133.3221, within 30 days, GW•I F.EV. C7t2001

293847
WELL CONSTRUCTION RECORD
North C I llla • Department &Environment and Na e :DW'C?4)!.�OiW'e Qua' Gro,..nd,vatep s--:OfI
YrELLCOYTRAC10,R(IN DIYIDUAL)NAME (print; Tames B. Erotin CERTIFICATION = 2045
EILCON* iRACTORCO:NIPAINYNAnIEHeiden Brothers Well Drilling, Inc P".OINE S[.d) 369-9591
STATE WELL CONSTRUCTION PERM1T9
(ifzonncable)
AcSOCIATED WQ PERYIIT r c"
11
• (ifaooiicable)-.
I. WELL USE (Check Applicable Box) Residential MurdcipallPublic 0 Industr a'. ❑ :A.gricul:'i :al 0
Moni;orin,gg 0 'Recovery O Heat Pump A';a:e:Injecticn. ❑ Other ❑ IFO:her, List Use
WELL LOCATIQN
Near S Tpwn:
3. OWNER:
Addrr3trs
pU%i^ ''orIV
LLUI County
1�2 Pee i ltiw 4t1
rs, Comun:pity, Salod iv6lon, Loy o, Z p. Ccde)
C,r, cr"--y Slate
(-fiTi0-31/5
Are, c de. ohcee numbr
C DATE DRILLED I I- leg' -63
5. TOTAL DEFTH, 1pnC)
6. DOES WELL REPLACE EXISTING WELL YES O NO
7. STA:FIC WATER LEVEL Belo 'h Tep cfCasir.r FT.
(Us: "-" it Abav: Top of Caslrb..
8. TO? OF CASINO IS 2 FT. Above Land Surface'
*Ton ot casing terminate: atror below land surface requires a
variance in accordar with ISA NCAC 2C MIS.
9. YIELD (yam) _;METHOD OF TEST blow
I0, WATER ZONES
018-7S9
Zip Cod:
II DISINFECTION. Tvice H T H Amount 1 c cz
12. CASINO: WaL T'nickness
De:,- - Dar,eler or We c-,t'Ft, Ma'e-aC
From 0 To .t ,011C
From-r.TcF,
Frcci To Ft,
13. GROUT:. Depth Mat:riai tMe::roc.
From 0 Tc 20 Ft. Smite & .z_
From - To Ft.
Id SCREEN: Depth • Dian:e:er Slot Size 111r:erial
From • To • rot.. in, in
From To Ft. in.
15, SAND/GRAVEL PACK:
Dep:h Sze Material
FromTo Ft
From To Ft.
Tucozraphic'Land setting.
❑Ridge EsSioee ❑Vaitey ❑Fla,
(c.he::k anropric!e box)
Latitude/lonei'.ade cf we'I lccaaor
ELL t
Latlr idc'longl:t de--•_.-e:00PS='Tcpc;radhrc map p, I
(cork 53s) • L _- _.__-
�__
DE D;lu_:\e L0 .
F:D171 '-n I Formation Gscrj:1ion
0 33 Cl aa' & sa_nra
33' (&COO' cram t=
LOCATION SKETCH
Shc-n direction and d:staro.re ir. mires fro:-. a: least
two State Reads or Ccun:y Roads. lnc:::_e the road
n u ,oers a con -um,. road name's.
0 c
16. REIL{A.RKS(
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH I5A. NCAC 2C, WELL
CONSTRUCTION'. STAND .- S, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TC THE WELL
4/1-12-0 TUX
SIGNATURE OF PERSON CONSTRUCTING THE WELL -
DATE
Submit the original to th'Division of Water Quality, Groundwater Seztion; 1636 Mail Service Center • Raleigh, NC
27699-1636 Porn: No. [phone], within 30 days. 0W-1 REV. 072001

WELL CONSTRUCTION RECORD
r710312 � 3,�46s9g/
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section'?
WELL CONTRACTOR (INDIVIDUAL) NAME ((prin9 4.1 ' I ` C eht fYfiJ CERTIFICATION # OC /cp
WELL CONTRACTOR COMPANY NAME MA Lyttt.-f revyr3 Wet,' V-4 ciScloctPHONE 551. -SSsv
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable)
(if applicable)
I. WELL USE (Check Applicable Box): Residential jB' Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use •
2. WELL LOCATION:
N'�,a`rest Town: 5 Li Li Pr County11� AZ/Spry
"'piths �eleN-)<.. Szi 1 ouC as7-7
(Street Name,'Numbers, Commu ty, Sub vision, Lotivo., Zip Code)
3. OWNER: DO in (IncztL
Address 10 lio5C Loc cQ. 17r
1k �)
(Sc get or Route No.)C R5heL r;2 io I
City or Town State Zip Code
(U2)- G 3) — i 3 73
Area code- Phone number
4. DATE DRILLED I 'v2 e/— 03
5. TOTAL DEPTH: •30 0
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO tif
7. STATIC WATER LEVEL Below Top of Casing 40 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS I FT. Above Land Surface*
*Top of casing terminated ab'or below land surface requires a
variance In accordance with I5:\ NCAC 2C .01 IS. ,
9. YIELD (gpm): 3 D METHOD OF TEST frf
Al
10. WATER ZONES (depth): j c/o o'
Topogaphic/Land setting
ORidge j:{I'Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From To Formation Description
0---/Oo
/OU—/Stp
/ y�
rid - r;350
a.5I 0
I1. DISINFECTION: Type i—} 1 1-4
12. CASING:
From
From
Depth • Diameter
Amount 13. S
Wall Thickness
or NA/eight/Ft. Material
O To )05 Ft. iga104.t-LP _eQ
To Ft.
From To Ft.
13. GROUT: Depth Material
From_(? To 3 Ft.
From a To , 1 iJ Ft. is Crn v (to,
14. SCREEN: Depth Diameter Slot Size
From To Ft. in.
From To Ft. in.
15. SAND/GRAVEL PACK:
Depth Size Material
To Ft.
To Ft.
From
From
Method
LOCATION SKETCH
Oa Show direction and distance in miles from at IeaSt
two State Roads or County Roads. Inclurt he r6sd
numbers and common road names. -
/Dr r
itJ U' 1
Material�
in.
in.
t — _
16. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS,
AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
SIGNATURE OF PERSOIJCEOTRUCTING THE WELL DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center -Raleigh, NC._.... _.
27699-1636 Phone No. [phone], within 30 days. GW-1 REV. 07/2001

„Sy73�.(21- J =_•
North Carolina - Dcpa.Lmen1 of Luvironment and Natural Kesourz Ul or o- \\�1:, llu::i,:� - (Jrun Seci(eu St02?
\YELL CONTRACTOR (INDI\IDUAL)NANIE r C u-r:` CERTIFICATIONa
WELL CONTRACT ORCO\I PANI'NA\IE rrn 'L�1TPene nil? PHONE #-C-42P^S3r0
STATE \WELL CONSTRUCTION PERNIIT: ASSOCIATED \VQ PER. IIT=
... _T:. (ifa plicxbiz) ti L - fir aolicab e)
1. WELL USE (Check Applicable Box): Residential% MunicipaL'Public 0 Industrial 0 A__ricultural 0
Nlonitorine ❑ Recovery 0 • Heat Pump Water Injection 0 Other 0 If Ocher, List Use
2. WELL LOCATION:
Nearest Town: s ountv
Nai::e- Nar-.,uers, Ccr. unity. Subucitar.. Lo'
3. OWNER:
Addr:ss
WELL CONSTRUCTION RECORD
e eanlsgek‘
�G�
1R L CCt
ode)
m (5.:.•u;l nrR�u::Nu) Ni a81Y 1
U Zip Code
(V81- 9a�— 790o
Cm 5at:
Area :.: t- Phonc
-I. DATE DRILLED 1/' 5-0-3
S. TOTAL DEPTH: 7
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO
7. STATIC WATER LEVEL Below Top ofCasitt : 2c 0 FT
ifmuce To; orCaringl
S. TOP OF CASING IS I ig- FT. Above Land Surface'
'Top of ce.iug t;rr.:inuttd u''ur helon land sur(ce requires u
wrnnc in ac;urdr„n i:h ISA NC:\C 2C .01 IS. ___.
9. YIELD (_gym): ' `7METHOD OE
10. WATER ZONES ld:ph):
Yee
Topographic/Land setting
❑Ridge 0Slope ❑\'alley eeFlat
•
(check appropriate box)
Latitude'loneituda awe!! location
303090
(deccei rn inu:eis:cor.ds) ;.
Latitude/longitude source:❑GPS❑Topographic map
(this; box? .
DRILLING LOG
Formation Description
DEPTH
From To
LOCATION SKETCH t
ISM , H77-1 Amount 3J3,lTh a S::o..c direction and'dis:an;e in miles from a:SS:
1 I. DISINFECTION: Tv; e
12. CASING: V:all7ir..kcess C.cO S:.l:c Roads or Cc'.a C: Roads. Include theliad
De -,'' // Di_-.a::r or V: e: h:T: \:_:}}'.:.' numbers and cornmon rand names. co
Fro::: 0 To '7`i� It eo vy as -swear t�j-A}him, izes
Fro:-.: To Ft.
Frain To Ft
13. GROAT: D_,:>. Nla:eria:
Fro-: 0 To VC) It CQM7.es.X
From To Ft
11. SCREEN: Deprh Diar..e:er So:Size :\ la:ri:.:
From To Ft. in. in.
From To Ft. in. in.
15. SAND GRAVEL PACK:
D:c:^ S:ze Nlarer!J
Fror.:
Fran:
16. RE\!ARKS:
To F.
To Ft.
I DO HEREBY CERTIFY THAT THIS WELL V: AS CONSTRUCTED IN ACCORDANCE WITH I SA NCAC 2C, WELL r _ _.
CONSTR':C T 10N' STANDARDS. AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL Od-NER_.
C1„Cv 9 -.23
S!CNATLRE OF PERSO..-TR'_CTING THE V: ELL DAT:.
Submit the original to the Division of 1\ater Qualitc, Ground.... a ter Section. 1636 MailS:niceCenter-Raregh,NC
27699-1636 Finn: No.1719) 733-322I, within 30 dacs. G;:-I RE, 1"".07.2001
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WELL CONSTRUCTION RECORD
280128
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) / -/.r %G'cc CERTIFICATION # 2 7°3
WELL CONTRACTOR COMPANY NAME 727/ l/er hjej 1 Dr6 11 (19 PHONE 8 (Z2) S7.3? ''- 9?
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential Er-Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION:
Nearest Town: Ciie,0hee County Te,cdsort
So( o 07ov 411Vn 2t.
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: 43 e 7/7,'/4
Address e6n Tt; c./ Cca> 1".
(Street or Route No.)
Pr RPX 54 7
CMAUL b r '2B7101
City or Town State Zip Code
Ares code- Phone number
4. DATE DRILLED 9 - 26 ' 3
5. TOTAL DEPTH: 36 s
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO El'
7. STATIC WATER LEVEL Below -i op of Casing: Y O ET.
L (Use "+" if Above Top of Casing)
8. TOP OF CASING IS / a FT. Above Land Surface'
*Top of wing terminated at/or below land surface requires a
variance In accordance with 15A NCAC 2C .0118.
9. YIELD (gpm): (t METHOD OF TEST l it
10. WATER ZONES (depth): ? iS
11. DISINFECTION: Type
12. CASING:
Depth
From 0 To 6 G
H t//
Diameter
Ft. L-15
From To Ft.
From To Ft.
13. GROUT: Depth Material
From 0 To 2-0 Ft. 70rOuni
Amount it-'iz
Wall Thickness
or Weight/Ft. Material
5,04z) Qd&
From To Ft.
14. SCREEN: Depth Diameter
From To Ft. in.
From To Ft. in.
15. SAND/GRAVEL PACK:
Depth
From To Ft.
Method
�r51�-t
Slot Size Material
in.
in.
Size Material
From To Ft.
16. REMARKS:
Topographic/Land setting
❑Ridge ❑Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
.'1135°. 9''fa.o"Wo83°//' oo-1 "
(degrees/minutes/seconds)
Latitude/longitude source:OGPSOTopographic map
(check box)
DEPTHDRILLING LOG
From To Formation Description
O ` 2 5 ck
75-- 76S' (1Fan, Ve
LOCATION SKETCH J
Show direction and distance in mile's from }t least
two State Roads or County Rook Include *mid r
numbers and common road names.
0
w
O
0
rn
-o
w
N
CO
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUC1 ED IN ACCORDANCE WITH I5A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY
OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
r- a 7- D 3
SIGNATURE ❑/PERSON CONSTRUCTING THE WELL DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Maii Service Center -Raleigh, NC
27509-1636 Phone No. [phone], within 30 days. GW-1 REV. 07/2001

2'75S 3-3,7?-?// 7
279530 7cS4,�`3�3� W�
WELL CONSTRUCTION RECORD n1c "" 7
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
�(,^t
I\ fh� 1 +. II ;;�� // CERTIFICATION f! add
WELL CONTRACTOR COMPANY NAME y"xty - tQC'fx 2 3r0 • IrVQYt Drl PHONE R frtocpl551j—, Sry
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERNIITh
(if applicable)
WELL CONTRACTOR (INDIVIDUAL) NAME (print) I `1C
(if applicable)
1. WELL USE (Check Applicable Box): Residential 5't Municipal/Public ❑ Industrial ❑ Agricultural 0
Monitoring 0 Recovery ❑ Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATI N:
Nearest Town: a Q 1 /e County
as
(Street Name, Nu .,ers, Community, Subdivision,jivof No., Zip Code)
3. OWNER:Dr• . LDL Lunt �J an es
Address :W 31 l.) w ew D r—
(Street or R ut No.)
J�h s loom„
30a3(�
O )ity oSoit.);46
Area code- Phone number
4. DATE DRILLED f/9— 03
5. TOTAL DEPTH: Ip a r
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO1
7. STATIC WATER LEVEL Below Top of Casing: (d 0 FT.
(Use "+" if Above Top of Casing)
1
S. TOP OF CASING IS 1 2-- FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordance with 15A NCAC 2C .0118.
9. YIELD (gpm): / METHOD OF TEST / r
10. WATER ZONES (depth): „5-6-0
Topographic/Land setting
❑Ridge Alope ❑Valley ❑Flat
(check appropriate box)
9 '73 f, Latitude/longitude of well location
11. DISINFECTION: Type
12. CASING:
Zip Code
(degrees/minutes/seconds)
Latitude/longitude source:❑GPSOTopographic map
(check box)
DEPTH DRILLING LOG
From To Formation Description
Tx-_`4C
'SRO — 3-8r
(V
to
two State Roads or County Roads. Inclurdd?the rtsaZ
Depth Dian ter or Weight/Ft. M serial numbers and common road names. N
From D To 3 Ft. t, > 50/4 21 UG
From To Ft.
From To Ft.
13. GROUT: Depth Material lethod
LOCATION SKETCH 3 mo
Amount ,Zlifra.Show direction and distance in miles from at let
Wall Thickness
From 0 To (20 Ft. «&g t
From To Ft.
14. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in.
From To
15. SAND/GRAVEL PACK
Depth
From To
From To
16. REMARKS:
Ft. in. in.
Size Material
Ft.
Ft.
&.}2ctc-7
,-,,t *1 I
IT) -71) t,
,/ /712iI'
t
4
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH I5A NCAC 2C, WELL
CONSTRUCTION STAN C. J RDS, AND THAT A CO OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
-as- 6
SI'AT
CONSTRUCTING THE WELL DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center -Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-1 REV. 07/2001

vrei
630-a-8-79.0
279529 n rnkTl4 —ash
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (p'riint)) MA r-I ( A) rAlit l S / CERTIFICATION-r#N(25.97
c2 9 7
WELL CONTRACTOR COMPANY NAME AAA (l eOn e_ (3.^O . kir./I 1)r/ Cj PHONE # (rg giro-55 0
STATE WELL CONSTRUCTION PERMIT# �..J ASSOCIATED WQ PIERMIT#
(if applicable) (if applicable)
1 WELL USE (Check Applicable Box): Residential Municipal/Public ❑ Industrial 0 Agricultural 0 f 3 1—
Monitoring 0 Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use
2. WELL LOCATION: jr�
Nearest Town:' i 1 I S-U 0 I County ;, 1IAx.SOKI
rcI .1)I,. 5y f l' A /\S C 9-775
(Street Name, umbers, Cohm unity, iubdivisidn, Lot No., Zip Code)
`
3. OWNER: \20k_ Qfr
Address r--&..R/ I cl9 )
fleet or Route No.)
8lI
r-I 0
City or Town State ) Zip Code
(&)- 0 v
Area code- Phone number
4. DATE DRILLED S') ti — V3
5. TOTAL DEPTH: Li 7f-
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO [l
7. STATIC WATER LEVEL Below Top of Casing: 2,0 0 FT.
(Use "+" if Above Top of Casing)
S. TOP OF CASING IS _) '/Z FT. Above Land Surface*
"Top of casing terminated at/or below land surface requires a
variance in accordantce, with ISA NCAC 2C .0118. //��
9. YIELD (gpm): L S METHOD OJES1 PLI t-
10. WATER ZONES (depth): 3`L
fD S
Topographic/Land setting
❑Ridge $(Slope ❑Valley DENt'
(check appropriate box)
Latitude/longitude of well locatiop
(degrees/minutes/seconds) ..
Latitude/longitude source:DGPSDTopographicmap
(check box) `--
DEPTH DRILLING 0b j
From To Formation D scription !
O- #i
1/ — 390
39 ^� _
2.141,
-- 4t7s
11. DISINFECTION: Typ e�� aAmount
R OZ
12. CASING: Wall Thickness
Diameter or Weiehi/Ft. Materi 1 numbers and common road names. `
r*i
Depth
From To 7S Ft.
From To Ft
From To Ft
13. GROUT: Depth
From To v2O Ft
From To Ft.
14. SCREEN: Depth B
From To Ft.
c
O
LOCATION SKETCH rnV c
-c
py Show direction and distance in miles fro i t leaxl^_.2
Material Method
From To Ft.
Si-e rate_ l
ar:eter Sist .,ii. :�...,...'a.
in. in.
in. in.
15. SAND/GRAVEL PACK:
Depth Size y Material
From To Ft.
From To Ft.
two State Roads or County Roads. Includnthe t ;
77' / eAA9-te2
'
16. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
7SIGNATUT 1 E ON C��NST UCTING THE WELL D E
/a
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-1 REV. 07/2001

• • IS
279528 .,..
WELL CONSTRUCTION RECORD
'7 ai9 as -4t 35
-='`177Isto
&tD rncC
North Carolina - Department of Environment and
`Natural
� Resources - Division of Water Quality - Groundwater Section �{
WELL CONTRACTOR (INDIVIDUAL) NAME (print) JM I r sC e.LL4A_ .M CERTIFICATION #.21 V 40
\VELLCONTRACTOR COMPANYNAME r PHONE C 7 /�j
STATE WELL CONSTRUCTION PEPo\IIT# ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
# J�Y�rp Sr�SSJ
1. WELL USE (Check Applicable Box): Residential $ Municipal/Public ❑ Industrial ❑ Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATIO
Nearest Town:
(Street Name, Ndlnber
3. OWNER:
Address
Cs
s cc-/l I 1 C' (-2 87I 7
Community, Sub vision, LotNo., Zip Code) Latitude/longitude of well location
7r,�1't ee
�Topographic/Land setting
County C1Th t-efea )— DRidge ❑Slope ❑Valley Flat
(check appropriate box)
Street orR t .) e C/73
City oaan� (P Zip Code
Area code- Phone numbe
4. DATE DRILLED al -a 8 ' 0 3
5. TOTAL DEPTH: ¥3
6. DOES WELL REPLACE EXISTING \VELI,? YES ❑ NO ,l
7. STATIC WATER LEVEL Below Top of Casing: / 0 FT.
(Use' +" if Above Top of Casing)
8. TOP OF CASING IS I /2- FT. Above Land Surface*
•Top of casing terminated at/or below land surface requires a^
VV
variance in accordance with ISA NCAC 2C .0118. rl 9. YIELD (gpm): (n METHOD OF TEST
10. WATER ZONES (depth): 1‘,..?
4L 0
11 DISINFECTION: Type_ Amount (1,5"
12. CASING: Wall Thickness p�
Depth _ Diameter or Weigh t. Material
From 0 To 35 Ft. 6, 1/t GooL
From To Ft.
From To Ft.
13. GROUT: Depth Material
From U To aU Ft. r..a. 7La
From To Ft.
14. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in.
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
Iethod
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From To Formation Description
o-- 311
- 3�
�S— 280
.21/Cy
I -3
a fo 53 c
•3)C/.S— 4/3o
n
W u
rn o�
^l c^'
LOCATION SKETCH -13 cm
Show direction and distance in miles frogt Ie3�3<
two State Roads or County Roads. Include the r d�
numbers and common road names. 3 z o
tnz
.vy ry rnz
/ ✓1 ice'
(<JS
16. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, \VELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
#Thr\ uhJW 0 OJ4Lt S - a5-o:3
SIGNkTU F PERSON NSTRUCTING THE WELL DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center -Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-I REV. 07/2001

WELL CONSTRUCTION RECORD
279617
North Carolina - Department of Environment and Natural Resourcesrc- Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NANIE
(p�/�J(print) (?t%1 ' / CERTIFICATION it.- 67f/
WELL CONTRACTOR COMPANY NAMEtelk PHONE #((Y[) ,�y7>��j
STATE WELL CONSTRUCTION PER\IIT# ASSOCIATED WQ PERMITS/
(if applicable)
(if applicable)
I. WELL USE (Check Applicable Box): Residential Municipal/Public ❑ Industrial ❑ Agricultural ❑
Monitoring ❑ Recovery ❑ Heat Pump Water injection ❑ Other ❑ If Other, List Use
2. WELL LOCATION:
Nearest Town: S/41,K1
fie-/Iy s e gee ,c
(Street Name. Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: ;,bey.*
Address (c-3) /*WQ._
/(l� / (Street or Route No.) ,t.1{�/yeio. . 331/7
;le
City or Toms State Zip Code
)-
Area code- Phone number
4. DATE DRILLED 7 2/- 0 3
5. TOTAL DEPTH: //CS
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO ❑
7. STATIC WATER LEVEL Below Top of Casing: a O FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS / FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordance with ISA NCAC 2C .0118.
9. YIELD (gpm): / u METHOD OF TEST
10. WATER ZONES (depth):
County ' \4Ckit rJ
Topographic/Land setting
❑Ridge ❑Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees'minutes/seconds)
Latitude/longitude sourer❑GPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From To Formation Description
ed4
t5`_- //DS Gy/ C-e
1 I. DISINFECTION: Type Amount
12. CASING:
Wall Thickness
Depth Diameter or Weight/Ft. Material
From L7 To O 5—Ft. 6 Yv
From To Ft.
From To Ft.
7
13. GROUT: Depth Material Method
From Q To Ftfr 6l t
From To Ft.
14. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in.
From To Ft. in. in.
15. SAND/GRAVEL PACK: Depth Size y Material
From To Ft.
From To Ft.
16. REMARKS:
LOCATION SKETCH
Show direction and distance in miles from at (east
two State Roads or County Roads. Include the rya 1
numbers and common road names. O o
0
nT
rn c
r=
N oc
-4o
rt
rnz
rn�
c a
G
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH I5A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
C11
a
O
03
SIGNATURE OF PERS
Submit the original to the Division of Water Qualify,nctnr le,tio2B36 Nl .!
27699-1636 Phone No. [phone], within 30 days.
DATE
vice Center - Raleigh, NC
GW-1 REV. 07/2001-
GROUNDWATER SECTION
ASHEVILLE REGIONAL OFFICE

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Na
WELL CONTRACTOR (INDIVIDUAL) NAME (print)
WELL CONTRACTOR COMPANY NAME
STATE WELL CONSTRUCTION PERMIT#
(if applicable)
279511
Resources - Division of Water Quality - Groundwater Section CERTIFICATION d P77
PHONE #
�nLg2�8a
ASSOCIATED WQ PS • •rsycJ ,-_.. .._—..
(if applicable)
1. WELL USE (Check Applicable Box): Residential g Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATIO ..
NeaJ,estTown: , -� - - Countyatt .e
(Street Name, Numbers,
3. OWNER:
amity, Subdivision, Lot No., Zip Code)
II le
Address /7' 3 ln-S 777 afist- qi
P (StreetorRpNo.) �
d Cityasru��JJF/ Zip Code
6,30- s n- 3 Sr) t
Area code- Phone number
4. DATE DRILLED to / n 3
5. TOTAL DEPTH: >t S
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO gr
7. STATIC WATER LEVEL Below Top of Casing: J/13
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS .S FT. Above Land Surface*
'Top of casing terminated at/or below land surface requires a
variance in accordance with 15A NCAC 2C .0118.
9. YIELD (gpm): S METHOD OF TEST T�Gn tfi
10. WATER ZONES (depth): ..23®'
11. DISINFECTION: Type
12. CASING:
DepthDJ
From .0To S O Ft L.-
From To Ft.
From
13. GROUT:
From 0
From
14. SCREEN:
Fro
From
15. SAND GRAVEL PACK:
th
To Ft.
Amount /s nz
Wall Thickness
or Weight/Ft. terial
fr.21 d e
Depth„ Material
To 2 n Ft. flslri2. et
To Ft.
Depth Diameter Slot Size Material
o Ft. in. in.
To Ft. in. in.
Topographic/Land setting
❑Ridge {$Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/mixtures/seconds)
Latitude/longitude source:❑GPS❑Topogra hic map t, (_ ,
(check box) ,v_ _
DEPTH DRILLING LOG
From To Formation Description
O
LOCATION SKETCH
Show direction and distance in miles fro
two State Roads or County Roads. In
numbers and common road n
* 629 0
msteliziy
From
Fro
16. REMARKS:
Size Material
To Ft.
To Ft.
-o
s
scorAtegy
No WOOS c
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.
oa
SIGNATURE OF PERSON CONSTRUCTING THE WELL
DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-1 REV. 07/2001

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section �7
WELL CONTRACTOR (INDIVIDUAL) NAME (prin�t)� �a.J/ e CERTIFICATION #4�7(
WELL CONTRACTOR COMPANY NAME ....a iiAAt1 /cw t4),//n lfit y HONE # J ES G i�9 O y'fa
STATE WELL CONSTRUCTION PERMIT./ ASSOCIATED WQ PERMIT# ry.. :q CA) .
(if applicable) (if applicable)
279510
I. WELL USE (Check Applicable Box): Residential 6if Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection ❑ Other ❑ If Other, List Use
2. WELL LOCATIO
Nearest own: �r-� G
T Asia- A/
•2 t 779
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER:U -A- ✓ G
Address'ale j t9Lit t/it/ C,
Strect or Rome No.)
1f�iu /'.
Js979
City or Town State Zip Code
( Area code- Phone number//
4. DATE DRILLED OD/ D 3
5. TOTAL DEPTH.
6. DOES WELL REPLACE EXISTING WELL? YE❑ NO i
7. STATIC WATER LEVEL Below Top of Casing: y/) FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS / 3 FT. Above Land Surface*
'Top of casing terminated aVor below land surface requires ■
variance In accordance with 15A NCAC 2C .0118.
9. YIELD (gpm): _ p METHOD OF TEST ...e.e r.
10. WATER ZONES (depth): ,2 8.S f
11. DISINFECTION: Type �r/
12. CASING: Vv
Depth
Front_ To 7D Ft
From To Ft.
From To Ft.
Amount JO* °Z
Wall Thickness
or Weight/Ft. Material
04../ fdC
13. GROUT: Depth Material M od .
From_b_To.2D Ft �a.rta.w7i
From To Ft.
14. SCREEN: Depth Diameter Slot Size Material
From -To Ft. in.
From
15. S
To Ft. in.
GRAVEL PACK:
Size
From To Ft.
From To Ft.
16. REMARKS:
in.
in.
Material
Topographic/Land setting
❑Ridge XSlope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map'y=
(check box)
PRILLING4.QC -.
Formation Description
DEPTH
From To
rrcl
LOCATION SKETCH
Show direction and distance in miles front least,
two State Roads or County Roads. Include$ie reed
numbers and common road
t�
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, ANJ])THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
C9'% ee
az„ /ens
SIGNATURE OF PERSON CONSTRUCTING THE WELL DA
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-1 REV. 07/2001

279509
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and I9asural Resources - Division of Water Quality - Groundwater Section /� n
��Qp //%� �% /7 CERTIFICATION #1! / /
WELL CONTRACTOR COMPANY NAME(rtACt't2 e4 1J.L!/A ,0127 z2.e YHONE a
4a
STATE WELL CONSTRUCTION PERMIPERMIT,'/1///5t _ASSOCIATED WQ PERMIT,' TW L. 7 /aI
(if applicable) (if applicable)
WELL CONTRACTOR (INDIVIDUAL) NAME (print)
11. DISINFECTION: Type
12. CASING:
Depth
From To Y
From To
From To
13. GROUT:
From 0
From
e Amount .aljr Show direr
Wall Thickness
ameter or Weig;UFt.-pte)ia1 numbers
D FL y #.2/ /J'!/G
Ft.
Ft.
Depth ,^f Materia M od r
To P) Ft. ! la Ji
To Ft.
14. SCREEN: Depth Diameter Slot Size Material
From�To Ft in. in.
From / To Ft, in. in.
15. SAND/GRAVEL PACK:
th Size Material
From To Ft.
Fro To Ft.
16. REMARKS:
rrj c^
LOCATION SKETCH o L`-'
Lion and distance in miles frog y least_- �,
two State Roads or County Roads. Include the rofd-.
d common road names. nt rn
tV m
tit
1. WELL USE (Check Applicable Box): Residential $ Municipal/Public ❑ Industrial Cl Agricultural Q,
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use
2. WELL LOCATION:
Near? Town:
C�a-n
(Street Name, Numbers, C�nmunity, Subdivision, Lot No., Zip Code)
3. OWNER:1- ) .9 add
Address s(o ^l : ivlt�0 /�
(s r-`_ ,4-/Vbo Coden Zip
Ama code- Phone number
4. DATE DRILLED �v/ y/ n 3
5. TOTAL DEPTH: 8o T'
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO i�
7. STATIC WATER LEVEL Below Top of Casing: .05 'FT.
— (Use "+" if Above Top of Casing)
8. TOP OF CASING IS J. .) FT. Above Land Surfaces
'Top of casing terminated atlor below land surface requires a
variance in accordance with 1SA NCAC 2C .0118. •
9. YIELD (gpm): _..,— METHOD OF TEST - rem-,
10. WATER ZONES (depth): y5 i 5 UP2 S '
oz,
Topographic/I-and setting !
t ridge ❑Slope ❑Valley OFlat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS0Top$tapc map
(check tax) �.: - -.
DEPTH DRILLI"
From To Formation Description
S'-T
tom
I DO HEREBY CERTIFY THAT THIS WFI I WAS CONSTRUCTED IN ACCORDANCE WITH 1SA NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WET 1 OWNER
&'L#-C; 4,5a49 �.3
SIGNATURE OF PERSON CONSTRUCTING THE WFI L DA
G
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-1 REV. 07/2001

2. WELL LOCATION:/ / !`Seh
Nearest Town: C` E/c(LeZ County Tr~C
• rc
(Street Name,umbe, Community, Subdivisinu, Lot No., Zip Code)
3. OWNER:
AddresC-PUOs
City or Town State
Arcs code- Phone number
4 DATE DRILLED
WELL REPLACE EXISTING WELL? YES ❑ NO lY
5. TOTAL DEPTH:
an
6. DOES
7. STATIC WATER LEVEL Below tTop of
se "+" if Above gTop of Casing)
8. TOP OF CASING IS / FT. Above Land Surfaces
*Top of cuing terminated aUor below land surface requires a
variance to accordance with ISA NCAC 2C .0118. n
9. YIELD (gpm): METHOD OF TEST /7/_ _--
10. WATER ZONES (depth):
11. DISINFECTION: Type
12. CASING:
Depth
Front t5 TOE F
From To
From To F
13. GROUT: Depth F
Frorn (/ To From To F
14. SCREEN: Depth
From To
From To
15. SAND/GRAVEL PACK:
Depth
From To
From To
r e_5
(Street or Route No.)
,6d' (01,f ta_ Lc 1 �)
Zip Code
Ft
Ft
Ft.
Ft.
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Nat ral Resources - Division of Water Quality - Groundwater Section
�fo3
`,ei a AC o e°
WELL CONTRACTOR COMPANY
NAL) ME
(print) i��il Drl`1irQ PIIONE N I Zb1 _. y%
!mil/
WELL CONTRACTOR COM1IPANY NAME ASSOCIATED WQ PF,ItM1tITB
STATE WELL CONSTRUCTION PERMITS/ if a lWQ P
if licable
bl Box): Residential Er-Municipal/Public 0 Industrial 0 Agricultural 0
1.
WELL USE (Check Apphca e ox
Monitoring ❑ Recovery 0 Heat Pump Water Injection ❑ Other 0 if Other, List Use
Topographic/Land setting
❑Ridge ❑Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
/t/35° 5 "H3.o Taco&,`/u 'oG•9
(degrees/minuteslseconds)
Latitudc/longitude source:❑GPS❑Topographic map
(cbeck box)
• r rni C% L.S2Li
r
Formaiaa ^ration
From To "'
27 4
br -v tL
O
___ Amount 29242 — Shotwo S aes f
te Roads or County Roads. direction and distance in l Inch
Wall Thickness
Diameter or Weight/Ft. Material numbers and common road names.
(. Li- sailz l d�
E.
Material ethod
t.2
t._
Diameter Slot Size Material
in. in.
in. in.
Size Material
16. REMARKS:
I DO IIEREBY CERTIFY THAT THIS WELL WAS
ST
CONSTRUCTION STANDARDS, AND THAT A CO a OF
SIGNATURE OF PERSON CONSTRUCTING THE WELL
,NC
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mall Service Center - Raleigh,
7/2001
27609-i63N
6 chi= ^- (9191733-3221, within 30 days. GW-1 REV. 0
-o
w
fV
Oa
at least
croad
0
c
vo
0
0
RUCrED IN ACCORDANCE WITT( 15A NCAC 2C, WELL
THIS RECORD HAS BEEN PROVIDED TO TIIE WELL OWNER
y-2 -dJ
DATE

WELL CONSTRUCTION RECORD 278994
North Carolina - Department of Environment and atural Resources - Division of Water Quality - Groundwater SectionwELr�
VYELL cosERACTOR CONTRACTOR (INDIVIDU' NAME NAME ((pp jinntt)) /244P (2llt-�l CERTIFICATIONTth, �i 2/ /
Cf �`//'/-Vit- • PHONE # 1'Nr!/1'zYY'Y/�,G1
STATE VA'ELt, CONSTRUCTION PERJIIT# ASSOCIATED AVQ PERMIT#
(if applicable) (if applicable)
I. WELL:USE (Check Applicable Box): Residentiala Municipal/Public ❑ Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection ❑ Other 0 IFOther, List Use
2. WELL LOCAT IN. (�
Nearest Town: t//r�,_ , County(?22(4rt4Tn ,
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER:',) A )
7/ Z/ ///9A10i CCv/c
Street or Route No.)
C orn State 2 Cade
Address
rea code- Phone number
4. DATE DRILLED .6.--‘22-03
5. TOTAL DEPTH: 76
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO 0
7. STATIC WATER LEVEL Below Top of Casing: 't/o FT.
(Use "+" ifAbove Top of Casing)
8. TOP OF CASING IS / FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordance with ISA NCAC 2C .0118.
9. YIELD (gpm): 3 METHOD OF TEST
10. WATER ZONES (depth):
azb
11. DISINFECTION: Type Amount
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
From 0 To JILL Ft. & Y G1t__
From To Ft. �`�
From To Ft,
13. GROUT: Depth Material / Method
From D To a DFt. C.4yltw� p�
From To Ft.
14. SCREEN: Depth Diameter Slot Size Material
From To Et. in. in.
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Size , Material
From To Ft.
From To Ft.
16. REMARKS:
Topographic/Land setting
❑Ridge ❑Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degreesan notes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From To Formation Description
LOCATION SKETCH C
N m:a
Show direction and distance in miles from ajJ ast 2
two State Roads or County Roads. Include tkt7toa(E
numbers and common road names. E-
c.
CO
O
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH ISA NCAC 2C, WELL
CONSTRhICTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
29--
SIGNATURE OF PERSON CONSTRUCTING THE WELL
DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-1 REV. 07/2001 L \`
m
Cn',

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and N ral Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME rint) % / C/ �G CERTIFICATION t✓
347-3
\VEI.L CON"IRACIOR COMPANY NAME PHONE # WsifIr-QVX-- -•76
STATE VWELL CONSTRUCTION PERMIT# ASSOCIATED AVQ PERMIT!!
(if applicable) (if applicable)
2
WELL USE (Check Applicable Box): Residential4Er Municipal/Public 0 Industrial ❑ Agricultural 0
Monitoring ❑ Recovery 0 Heat Pump Water Injection ❑ Other 0 If Other, List Use
WELL. LOCATION
3. OWNER
Address
t (Street or Ro No/t
Tc �-7 77
ity Or Town i/ A S" / Zip Code
Area code- Phone num er
4. DATE DRILLED % -7- 0 3
5. TOTAL DEPTH:
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO 0
7. STATIC WATER LEVEL Below Top of Casing: /Z o FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS / FT. Above Land Surface*
°Top of casing terminated at/or below land surface requires a
variance in accordance with 15A NCAC 2C .01IS.
9. YIELD (gpm): / (i METHOD OF TEST w'u
10. WATER ZONES (depth):
Topographic/Land setting
DRidge DSlope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degreesrmi nu es/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From To Formation Description
Z r^
•
aC
rn
UI a
II. DISINFECTION: Type Amount
12. CAS WG: Wall Thickness
Depth Dian'ieyr or Wei ght/Ft. Material
From b To_ Ft. p- PUL
From To Ft.
From To Ft.
13. GROUT: Depth Material Method
C
From 0 To a 0 Ft. ,m� �
From To Ft.
14. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in.
From To Pt. in. in.
15. SAND/GRAVEL. PACK:
Depth Size r Material
From To Ft.
From To Ft.
16. REMARKS:
LOCATION SKETCH
Show direction and distance in miles from at (east
two State Roads or County Roads. Include the road
numbers and common road names.
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED 1N ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER;
SIGNATURE OF PERSON CONSTRUCTING THE WELL
DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Nlail Service Center -Raleigh, N
27699-1636 Phone No. [phone], within 30 days. GW-I REV. 07/2 01
L_

WELL CONSTRUCTION RECORD 278987
SFA'FE WELL CONSTRUCTION 1'ER\IIT#
(if applicable)
North Carolina - Department of Environment and N ral yR�esoouurrces - Division of Water Quality - Groundwater Section �J
WELL CONTRACTOR (INDIVIDUAL) NAME rint) t°�.40,' C_�iMei CERTIFICATIONS#J62Y
WELL CONTRACTOR CO,AIPAN1' NAME (/Z�ir� `LO `1, PHONE # J`'�i��e
ASSOCIATED WQ PERMIT#
(if applicable)
2.
WELL USE (Check Applicable Box): Residential -Er Municipal/Public 0 Industrial ❑ Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection ❑ Other 0 If Other, List Use
or o'n S o[me _ Zip Code
Area code-)' one inwfiberY
4. DATE DRILLED J -.0:? 0-* 63
5. TOTAL DEPTH: li'S
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO ❑
7. STATIC WATER LEVEL Below Top ofCasing_4J-4 -s) FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS ,/ FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordance with 15A NCAC 2C .0118.
9. YIELD (pm): 3 0 METHOD OF TEST LZ[fc�
10. WATER ZONES (depth):
WELL LOCATI? _
Nearest Town:-i.e2+uo2ij •
County��s•C��ifl2+ o
ill/Li rvOca,
(Street N. ne, Numbers, Community,
—S,ubdivisi en, Lot No., Zip Code)
3. OWNER: R /GIGO
Address-R."---9
(Street or Pcqutde No. /,//
f/c,
11. DISINFECTION: Type Amount
12. CASING: Wall Thickness
Depth Dianeier or Wciuht/Ft.
From 0 To 3 (a FL
From To Ft.
To Ft.
Material
aanS,
From
13. GROUT: Depth
Front (CD To w Ft.
From To Ft.
14. SCREEN: Depth
From To Ft.
From To Ft.
15. SAND/GRAVEL PACK:
Material
Pu(-)
Diameter Slot Size Material
in. in.
in. in.
Depth Size r Material
From 'fo Ft.
From To Ft.
16. REMARKS:
Topographic/Land setting
DRidge DSlope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degreesaninutesCseconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From To Formation Description
�- 3/,
34,- 1'7r
O
W
0
0,
ai
o cc)
or
ni
LOCATION SKETCH ;rim
Show direction and distance in miles from pMcasrn
two State Roads or County Roads. Include the roe
numbers and common road names. Cl1
ca
C)
1
-o
Cs)
sr-
cn
0
1 DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH ISA NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER.
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE .,,
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center- Raleigly NC
27699-16361'hone No. [phone], within 30 days. GW-I REV. 07/2001

279089
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section WELL CONTRACTOR (INDIVIDUAL)NAME
�,,(print) c7)-e nY1151 II II an di• CERTIFICATION # le
WELL CONTRACTOR COMPANY NAMIi/X,()niS 1�OIoMa WI
I.lt(r 1i-34 I
}�nPl PHONE# [phone]
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED W ERMIT#
(if applicable) (if applicable)
I. WELL USE (Check Applicable Box): Residential Pi"-Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery ❑ Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION:
Nearest Town: Svlva Ate— County �a-C(C5 ��---
L/9 / 47 e5TR ✓Q h»,i X-) (elm n7I t , /=rtpJL ,mo d
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code) c2 8 7 7 f
Topographic/Land setting
['Ridge ❑Slope ❑Valley QFhal—
(check appropriate box)
Latitude/longitude of well location
3. OWNER: a ( it lU P.M (degrees/minutes/seconds)
Address /t f /CO/ /c* P c_4 Latitude/longitude source:❑GPS❑Topographic map
(Street or Route No.)
S�, (check box)
j1 �r �g72 J DEPTH DRILLING LOG
Ci y or Town State zip Code From To , Formation Description
(���) Sa m— 9 7i n 0 2 / 0 / 4.
Area code- Phone numbers C g /' .--2r C / / f P . l"- t n' m t l Q�
4. DATE DRILLED J / — D y
5. TOTAL DEPTH: --VAS'
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO m--"'"---
7. STATIC WATER LEVEL Below Top of Casing: .fn FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS / FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance In accordance with 15A NCAC 2C .0118.
9. YIELD (gpm): 30 METHOD OF TEST lO7Ut7LC_f
10. WATER ZONES (depth): / 4 6 -
(�
LOCATION SKETCH
11. DISINFECTION: Type {J"-/"» Amount 4 TA- A S Show direction and distance in miles from at least
12. CASING: Wall Thickness two State Roads or County Roads. Include the road
Depth i.Diameter or Weight/Ft. Mate al numbers and common road names.
0
From To tn.,-/ FL In SZ2 R . ! p rQ--•
From To Ft.
From To Ft.
13. GROUT: Depth Material Method ,
From n To , )Z) Ft. CP44t 4 pom/v
From To Ft.
14. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in.
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Size Nterial
From To Ft.
From To Ft.
16. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH I5A NCAC 2C, WELL Ir
CONSTRUCTION STANDARDS, AND THAT A COPY OF TH S RECORD H S BEEN PROVIDED TO THE WELL OWNER i
O'184- .0- ee . 9 3
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center- Raleigh, NC -:;
27699-1636 Phone No. [phone], within 30 days. GW-I REV. 07/200r, j
' L___
L h :0I WV S I d3S CO
r-.

27908E
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural%�Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME}E� _(print)CI Ie�17 n15I I'}D LI an r< • CERTIFICATION# �/740
WELL CONTRACTOR COMPANY NAM IC))9,()nt� 'RDIIa4nri (Deli4)lei Jilt PLCJ PHONE #�aY-3 r-66
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED W4'ERMIT#
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential YVMunicipal/Public ❑ Industrial ❑ Agricultural ❑
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use
2. WELL LOCATION:
Nearest Town: yy/YL4 ,ste_ County ift-LJC'5LJu)
4''/ /l�- 5bihke Q se Lot
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code) aleT7 Cy
3. OWNER: 77377 Li.. , ap -e e/I Q .
Address /VE-3 f /VO✓-C," 5hee' / P
(Street or Route No.) C
weir,,Lgfi� ri. 3 /
City or Tobin State Zip Code
(s6/)- 7q-5-- can,2
Area code- Phone number
4. DATE DRILLED 67--05 - D 3
5. TOTAL DEPTH: 4zes- •
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO ❑y
7. STATIC WATER LEVEL Below Top of Casing: /IJG FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS / FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance In accordance with ISA NCAC 2C .0l I8.
9. YIELD (gpm): S METHOD OF TEST IOIUi74
10. WATER ZONES (depth): /.SL' 3i 70 (1
11. DISINFECTION: Type %i'-'P Amount
12. CASING: Wall Thickness
Depth Diajneter or Weight/Ft. Mate al
From 0 To 102 Ft. b 5.- R. ;! pYQ.—'
From To Ft.
From To Ft.
13. GROUT: Depth Material Method
From n To rif7 Ft. ep07' Ll'h pcMx_)
From To Ft.
14. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in.
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Size Material
To Ft.
To Ft.
From
From
T_opographic/Land setting
age ❑Slope [Walley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From To Formation Description
4
p 7/9 /af,)
zi C" /7.,2 ' S"Cl ,n eft Ot e
'7, ' 4'C5-' R/& t, l ✓h-4n%V -e
LOCATION SKETCH
rQ 7"A- S Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common road names.
16. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH ISA NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF TH S RECORD HAS BEEN PROVIDED TO THE WELL OWNER
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636Mail Service Center - Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-1 REV. 07/2011n
O
W
to
-D
UT
a
O
J

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
\\ELL CONTRACTOR (INDIVIDUAL) NAME (print) Mitchell D. Cook CERTIFICATION; 2043
R ELL CONTRACTOR CO.YI PANY N%NIE Fk313=11 ErtS PF»11 £ 1]acr, TIC PHONE e23) 369-9591
STATE WELL CONSTRUCTION PER,NIIT=
(if applicable)
ASSOCIATED 1PQ PERMIT=
(if applicable)
i. WELL USE (Check Applicable Box): Residential Municipal/Public ❑ Industrial ❑ A_criculturai 0
tNloni:oring 0 Recovery 0 Heat Pump Water lnjecdon ❑ Other ❑ II Other, List Use
2, WELL LOCATION:
Nearest Town Cashiers County Jackson
64W to Hv4arth Lane
(Scree: Name, Numbers, Community, Subd poison, Lot No., Zip Code)
3. OWNER. Bernard & Kathleen Lanigan
Address 314 Gordan Ave
(Street or Route No.)
Thomasville, GA 31792
City or Town State Zip Code
(224)- 226-6RR7
6
i
Area code- Phone number
DATE DRILLED 10-6-03
TOTAL DEPTH: 375'
DOES WELL REPLACE EXISTING WELL?. YES 0 NO x
STATIC WATER LEVEL Below Top of Casing: 200' FT.
(Use "+" if Above Top of Casing)
S. TOP OF CASING IS 2 FT. Above Land Surface'
'Top of casing terminated at'or below land surface requires a
variance In accordance with 1SA NCAC 2C .0I18.
9. YIELD (gpm): 10 METHOD OF TEST blow
10. WATER ZONES (depth). 290'
11. DISINFECTION: Type H T H Amount 1 607
12. CASING Wall Thickness
Depth Diameter o: Wei ht Ft. Nk»rial
From 0 To 31 Ft. 6" pvc
From 31 ' To RS Ft. 6" 1 RR at e1
13.
From
GROUT:
From 0
To
Depth
To 20
From To
14. SCREEN: Depth
From To
From To
15. SAND:GR.AVEL PACK
Depth
From To
From To
16. RENIARKS:
Ft.
Material Nlethod
Ftk2ft:rite & pant aimed
Ft.
Diameter Slot Size Material
Ft. in. in.
Ft. in. in.
Ft.
Ft.
Size Nlateria:
280701
Topoaraphic(Land setting
❑Ridge 0Slope GValley EFlat
(check appropria:e box)
Latitude'Icngi:uda of well location
(Sod._>.'mirdies seconds)
Latitude'lon,:itude souree:03PS❑Topognphdc Tamp
e:x ox)
DEPTH DRILLING LOG
From To Formation Description
33'
0 clay & srri
33' 375' granite
LOCATION SKETCH
Show direction and distance in miles fro)., at least
two State Roads or County Roads. Include the road
numbers and common road names. a
W
ro
-4 :Ern
� mo
1
coo dr.
m73
c-a
C11 --t
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH I SA NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
Submit the original to the Division of \V ater Quality, Groundwater Section, 1636 Mail Service Center -Raleigh. NC
27699-1636 Phone No, [phone], within 30 days. GW-1 REV. 07;2001

WELL CONSTRUCTION RECORD
North Carolina - Dapartment of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) Mitchell D. Cook CERTIFICATION; 2043
1\ELL CONTRACTOR COM PAM'. AME Ha-1 11 EWehelt Veil DtZLl3tYrr ITC PHONE = 623) 369-9591
STATE WELL CONSTRUCTION PERMITS ASSOCIATED WQ PERMIT;
(if applicable) (if atoneable)
WELL USE (Check Applicable Box): Residential 25 Municipal/Public. ❑ Industrial ❑ .Auricuitural ❑
Nlonitoring 0 Recovery 0 Heat Pump Water Injection ❑ Other 0 I Other, List Use
2. WELL LOCATION:
Nearest Town: Sylva County Jackson
Dark Ridge RD
(Street Name, Numbers, Community, Su5dlvis on, Lot No. Zip Code)
3. OWNER: Richard V Gandy
Address 1943 Tawis RD
(Street or Route No-)
Leesburg, FL 34748
City cr Town State Zip Code
(352- 787-5454
Area code- Phone number
4, DATE DRILLED 1 0-10-03
5. TOTAL DEPTH: 300'
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO DOC.
7. STATIC WATER LEVEL Below Top of Casino,: 200 FT.
(L'se "+" if Above Top of Casing)
8. TOP OF CASING IS 2 FT. Above Land Surface'
'Top of casing terminated at/or below land surface requires a
variance In accordance with 15A NCAC 2C .0115.
9. YIELD (gpm): 12 NIETHOD OF TEST blow
10. WATER ZONES (depth): 235'
II
12
DISINFECTION: Type H T
CASING:
Depth Diameter
From 0 To 39 Ft. 6"
From 39To 50 Ft. 6"
From To Ft.
13. GROUT: Depth
From 0 To 20
From To
14. SCREEN: Depth
From To
From To
I5.SAND'GRAVELPACK
:
Depth Size
From To Ft.
To
Amount 16oz
Wall Thickness
or A\eight:Ft. Material
pvc
steel
_186,
Material
Ftbhrnite & =art
Ft.
Diameter
Ft. in.
Ft. in.
Method
Slot Size materiel
in.
in.
Na'er.c,
From Ft.
2S070 :2
Topographic'Land setting
❑Ridge❑Slope ❑Valley ❑Flat
(cheek a,pprorriate box)
Latitudelongitude of well location
de: _s:utn..:e _econd-.
Latitude'loneituthe soure:EGPS❑Tcprc_rnphic tier;
(aiieu t box)
DEPTH DRILLING IfOG
From To Formation Description
0 48' clay & sard
48' 300' granite
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Inc;ude the road
;7-7--
numbers and common road names. W c
CD n_
n _
N o
Yr
n
0
C.J1
16. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 1 SA NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE \\ LL OWNER
--t S eagda -20 CSC /O/CJ /n 3
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 ,Mail Service Center -Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-I REV. 07,200:

2$O 'Y0..
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Qualitc - Groundnca er Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) Mitchell D. Cook CERTIFICATION'- 2043
W ELL CONTRACTOR C081PA,1Y NAME liEddEn;$ S Well aillitz?, LID PHONE _ (251 369-9591
STATE Na ELL CONSTRUCTION PER?11T8 ASSOCIATED wQ PERMIT,
(if acolicable) (if aooiicabie)
I. WELL USE (Check Applicable. Box): Residential L N1unioipal. Public ❑ Industrial 0 A_r culmrai 0
Monitoring ❑ Recovery 0 Heat Pump Water Injection ❑ Other ❑ If Other, List Use
2.
WELL LOCATION:
Nearest Town: Cashiers County Jackson
Tower Rd Well #1
(Scree: Name, Numbers, Communlie, Subdivision, Lot No., Zn Code)
3. OWNER: John Ezell
Address 14417 Pattyharg nr
(Strew or Rock No.)
Ft. Myers , FL 33919
City or Town State Zip Coda
(239). 482-0557
Area code- Phone number
4. DATE DRILLED 10-02-03
5, TOTAL DEPTH: 1200'
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO
7. STATIC \\'ATER LEVEL Below Top of Casino: FT.
(Use "-" if Above Top of Casing)
S. TOP OF CASING IS 2 FT. Above Land Surface'
•Top of casing terminated atter below land surface requires a
variance In accordance with 15A N'CAC 2C .0118.
9. YIELD (gpm): 0 DRY NIETHOD OF TEST blow
10. WATER ZONES (depth):
Topographic'Land setting
❑Ridge ❑Slope ❑Valley ❑Flat
(check appropmce boo)
Latitude'Ionsitude of well location
(de -.^es - r,:r"_se: nd .
Latitude/longitude source' �.GPSCT cpo_ra'phia n
:'cos)
DEPTH DRILLI:G1Lt .....
From To Formation Description
0 24' clay & sad
74' 1700' granite
11. DISINFECTION: Type H T H Amount 16oz
12. CASING: Wall Thickness
or Weight 'Ft. Material
pvc
1 RR ctRPl
Depth
From 0 To 22
From 22
From
13. GROUT:
From 0
To 2 6 '
To
Depth
To 20
From To
14. SCREEN: Dep:h
From To Ft.
From To Ft.
15. SAND/GRAVEL PACK:
Depth Size , Material,
From To Ft.
From To Ft.
16. REMARKS:
Ft.
Ft.
Ft.
Material
Fetarnits & ce e t
Ft.
Diameter
Diameter
6't
H„
Method
lasted
ed
Slot Size cMatedal
in. n.
in. n.
LOCATION SKETCH
Shoe' direction and distance in Miles front at least
two State Roads or County Roads. Include the
numbers and common road names.
O
W
O
S
ND
U1
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mall Service Center - Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-I REV. 07:200:

WELL CONSTRUCTION RECORD
North Carolina • Department of Environment and Natural Resources - Division of Water Quality • Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) Kitchell D. Cook
13, ELL CONTRACTORCOMPANY NAME 1' elerT actinsI" 1a7.1LllY7r Lc PHONES 8281 369-9591
STATE WELL CONSTRUCTION PERMIT= ASSOCIATED 11'Q PERMIT
(if applicable) (ifaoolicabie)
280704
CERTIFICATION? 2013
L WELL USE (Check Applicable Box): Residential N1unicipaLFubllc ❑ Industrial ❑ Agricultural ❑
Monitoring ❑ Recovery 0 Heat Pump Water Injection 0 Other ❑ If Other, List Use
2, WELL LOCATION:
Nearest Town: CU11owhee County
Caney Fork Rd to Peach Tree Rd
(Scree: Name. Numbers, Community, Subdivision, Lot No., Zip Code)
3. OAv'NER:Jack Stiwinter
Address 302 Peacl Tree Pt)
(Street or Route No.)
Cullowhee, NC 28723
City or Tows State
(828). 293-3074
Area code- Phone number
4. DATE DRILLED 9-25-03
5. TOTAL DEPTH: 175'
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO (3
7. STATIC WATER LEVEL Below Top of Casing: 25 FT,
(Use "r" it Above Top of Casing)
8. TOP OF CASING IS 2 FT. Above Land Surface'
'Top of casing terminated at'or below land surface requires a
variance in accordance with ISA NCAC 2C .0I18.
9. YIELD (gpm): 60 METHOD OF TEST blow
10. WATER ZONES (depth): 135' & 170'
Zic Ccde
Jackson
11 DISINFECTION: Tvoe H T H
12. CASING:
Depth
From 0 To 72 Ft.
From To Ft.
From To Ft.
13. GROUT: Depth
From: 0 To 20
From To
14. SCREEN: Depth
From To
From To
.15. SAND/GRAVEL PACK:
Depth
From To Ft.
From To Ft.
Amount 16oz
Wall Thickness
Diameter or P:eicht Ft. Material
6" .188 steel
Nlaterial Method
Ftlen ite & cerart nnce3
Ft.
Diameter Slot Size NIa:erial
Ft. in. in.
Ft. in.
Size Material
Topographic land setting
❑Ridge ^_Slope ❑Valley EFlat
(check approone:e box)
Latitude longitude of well Iocat1oa
Latitude lonoi
DEPTH
From To
0 70'
70' 175'
eesin'.ccerse
ource-DGPSOTopo_raphic'rnoo
DRILLING LOG ._------ _._
Formation Description.
clay & ssrrl
granite
LOCATION SKETCH
Show direction and distance in miles tiront a: least
two State Roads or County Roads. Include the road
numbers and common road names.
W
O
N
� m
ui
16. REMARKS:
1 DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH ISSA NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
11 _.4 4Y .d7 G' 7/� SA ?
SIGNATURE OF PERSON CONSTRUCTING THE WELLDATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center -Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GR'-I REV, 07;2001

280705
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
VS ELL CONTRACTOR (INDIVIDUAL) NAME (print) Mitchell D. Cook CERTIFICATION: 2043
\SELL CONTRACTOR COMPANY NANTE Haim ic1�"S Fell crilli't, TIC PHONE e28,) 369-9591
STATE \SELL CONSTRUCTION PERMIT ASSOCIATED \SQ PER?SIT=
(if aro:icable) (if applicable)
1. WELL LSE (Check Applicable Box): Residential L Municipal/Public ❑ Industrial ❑ Agricultural 0
Monitoring 0 Recovery ❑ Heat Pump Water Infection 0 Other ❑ If Other, List Use
2. WELL LOCATION:
Nearest Town: Cashiers County Jackson
High' Hemlock Section 2 Tnt 178
(Sr.teeName. Numbers, Community, S u'bd'rvi S on, Lot No., Zip Code)
3. OWNER: Kenn Terry
.Address PC) Box 41R7
(Street or Roue No.)
Vero Beach, ET, 37964
City, or Tsar, Sate Zip Code
[phone]
Area codes Phone number
4. DATE DRILLED 9-29-03
5, TOTAL DEPTH: 300'
6, DOES WELL REPLACE EXISTING WELL? YES ❑ NO GS
7. STATIC WATER LEVEL Below Top of Casing: 95' FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS 2 FT. Above Land Surface'
'Top of casing terminated atter below land surface requires a
variance In accordance with 15A NCAC 2C.0118.
9. YIELD (gpm): 30 METHOD OF TEST blow
10. WATER ZONES (depth): 1 60' & 7 5' (—
LOCATION SKETCH p a
Show direction end distance in mites from at 1.41, ;o—
Ile DISINFECTION: Type 14 T FT Amount 16oZ :cc-:,
12. CASING: Wail Thickness two State Roads or County Roads. Include the Sd o.
„ Veig F t numbers and common. road names. --i i=rc
Depth Diameter o:1 Weight'Ft. MaterialN cl,
From 0 To 38 Ft. 6" pyc r :;c
From 18' To_tjy.__ Ft. 6" 188 stool m
From To Ft. 3 -2'r_
13. GROUT: Depth Material Method m'7,-
From 0 To 20 Fcbsennite & c.st .. arced
From To Ft. .. z
14. SCREEN: Depth Diameter S:ot Size Material
From To Ft. in. in.
From To Ft. in. in.
15.SAND'GRAVELPACK
:
Depth Size Material
TopographucLand setting
❑Ridge 0Slope ^Valley ❑Flat
(cheek appr]p:'. a:e boit)
Latitude longitude of well location
(!e¢reestmi,..._.seconds)
Latltudelon_itude source: OPSETeporap his , -.
,_.:eok box)
DEPTH DRILLING LTG.._.....
From To Formation Description
0 40' Hay & sir]
40' 300'r granite
From To Ft.
From To Ft.
16. REMARKS:
1 DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH I5A NCAC 2C, AA ELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE \`. ALL OWNER
,7e..e-,,dC A9, Pc 9, 947 4
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center -Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. OW -I REV. 07'2001

YELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Rater Quail;p
WELL CONTRACTOR (INDIVIDUAL) NAME (print) hhtche11 D. Cook
WELL CONTRACTOR CCOIPA.N1' iNANIE FeafiEn Brothers Cl-all III
STATE \\ ELL CONSTRUCTION PER,\IIT4 ASSOCIATED \PQ PERMIT
(if aso;icable) (if applicable)
1.
2
280701.3
Groundwater Section
CERTIFICATION = 2043
PHONE a 828) 369-9591
WELL USE (Check Applicable Box): Residential 3 Municipal.Publlc ❑ Industrial ❑ Ae:icuitural ❑
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use
WELL LOCATION: Jackson
Nearest Town: Highlands County
US 64 1st R past Highlands Cove Entrance
(Street Name. Numbers, Community, S obdivision, Lot No., Zip Code)
3. OWNER: Rick Hodges
Address 1317 Cullasaja
(Stye:: or Roo:: No.)
Highlands, NC 28741
City or Town State Zip Cole
(828 )- 421-4300 cell
Arra code- Phone number
4. DATE DRILLED 9-23-04
5. TOTAL DEPTH: 300'
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO t9
7. STATIC WATER LEVEL Below Top of Casing: 85 FT.
(Use "+" if Above Top o` Casir, )
8. TOP OF CASING IS 2 FT. Above Land Surface"
'Top of casing terminated atlor below land surface requires a
variance In accordance with I5A NCAC 2C .0118.
9, YIELD (gpm): 30 NIETHOD OF TEST blow
10. WATER ZONES (depth): 95 & 180'
I1. DISINFECTION: Tvoe H T H
12. CASING:
Depth
From 0 To 11
From 11 ' To 32
From To
13. GROUT: Depth
From 0 To 20
From To
14. SCREEN: Depth
From To
From To
15. SAND/GRAVEL PACK:
Depth
From To
From To
Diameter
Ft. 6"
Ft. 6"
Ft.
Amount 16oz
Well Thickness
or R'ei_ht"Ft.Material
pvc
188 steel
Material btetho.".
Edda -date & erelt. Tanned
Ft.
Diameter Slot Size t`(aterial
Ft. in. in.
Ft. in. in.
Fr
Ft.
Size Materla:
Drive L_
Topographic Land setting
❑Ridge ❑Slope ❑Valley ❑FL
(.-.neck 3]pbCl0 2 box)
Latitude"longitude of well locatior,
DEPTH
From To
0 30'
301 300' granite
(tegrees 5:.,..: __
tidelongitude source•'DGPSOTopo_-aah'i: mr.
-ea<box)
DRILLING Leif,----..
Formation Description
Hay &
{
LOCATION SKETCH
Show direction and distance in miles from
two State Roads or County Roads. Include
numbers and common road names.
_t le_
the roai
O c
W c F
se: re
O
— I tee n
N o
i
✓ o
3 am
a m"
-- a
c�
U1
z
16. REMARKS:
1 D0 HEREBY CERTIFY THAT, THIS WELL \VAS CONSTRUCTED IN ACCORDANCE WITH 1SA NCAC 2C, \\ELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO TEE WELL OWNER
'19. 40 A), y/ 3/0_3
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
27699-1635 Phone No. [phone], within 30 days. GAA'-I REV. 0 %200'.

280707
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Rater Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL)NAME (print) Mitchell D. Cook CERTIFICATION; 20413
WELL CON" IR,\CTOR COMPANY NAME Han atharS S 11 [Alin, PHONE ; e28) 369-9591
STATE WELL CONSTRUCTION PERMIT; ASSOCIATED \vQ PERMIT;
(ifaoulicable) (if aoelicable)
1. WELL USE (Check Applicable Box): Residential Municipal/Public ❑ Incustria: 0 Agricultural 0
Monitoring ❑ Recovery 0 Heat Pump Water Injection ❑ Other ❑ If Other, List Use
2. WELL LOCATION:
Nearest Town Tuckasegee County Jackson
Cedar Creek Farms past Shook Cemetary
(Scree! Name. Numbers, 0om mU r.ity, 5u div slor., Lot No., Zip Code)
3. OWNER: Phillip & Sandy Smith
Address 8700 West Ave.
(Street or Route No.)
Dien, NY 14057
City or Town Slate Zip Code
(716 )- 992-4755
Area :ode- Phone number
4. DATE DRILLED 9-18-03
5. TOTAL DEPTH: 300'
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO EX
7. STATIC WATER LEVEL Below Top of Casing: 1501 FT.
(Use =" if Above Top of Casing)
S. TOP OF CASING IS 2 FT. Above Land Surface
'Top of casing terminated at/or below land surface requires a
variance In accordance with I5A NCAC 2C .0118.
9. YIELD (pm): 5 NIETHOD OF TEST blow
10. WATER ZONES (depth): 95'
11. DISINFECTION: Type H T H
12. CASING:
Depth Diameter
From 0 To 22 Ft. 6"
From To Ft.
From To Ft,
13. GROUT: Depth Nlatenat Method
From 0 To 20 Ft1tite & wtraiL Rttc's.1
From To Ft.
14. SCREEN: Depth Diameter Slot Size NL=xrjol
From To Ft. in. • in.
From To Ft. in. in.
15.SAND .'GRAVEL RACK:
Depth Size Nlateriai
From To Ft.
Amount 1 6oz
Wall Thickness
or Weich.t'Ft. Material
.188 steel
From To Ft.
Topographic'Land setting
ORichze ESlope ❑Valley .—Flat
c
cheo:k a7pmariate bar)
Latitudelongitude of well location
(Ce_xes nr,n:tes.sececds)
Latitudz'ion_itude source. DGPS❑Tepog;aphis mt-
todec<bor)
DEPTH DRILLING L10 ._
From To Formation, Description
0 20' Hay & S ll
22' 300' granite
LOCATION SKETCH c
Shore direction and distance in miles frc.n at ':st
two State Roads or County Roads. Include thoad cn
numbers and cornmon road names. r;
N c
=ice
Nr
n
rn
D r,
01
0
16. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH I5A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE \\ELL OWNER
yfj„ gyp �, , ter/ 9/A7 /aa
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
Submit the original to the Division of Rater Quality, Groundwater Section, 1636 Mail Service Center -Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. OW -I REV. 07.2001

WELL CONSTRUCTION RECORD 260708
North Carolina - Department of Environment and Natural Resources - Division of Rater Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL)iNAME (print) Mitchell D. COok CERTIFICATION: 2043
N ELL CONTRACTOR COWANt'NAME u-z--1 at-5 VCellf)111E t Itt PRONE e 628) 369-9591
STATE WELL CONSTRUCTION PERMIT; ASSOCIATED WQ PERMIT
(if aooiicable) (if aoolicable)
. WELL USE (Check Applicable Box): Residential Lx Municipal'Pub!ic ❑ Industrial 0 A2ricu'.turai 0
Monitoring 0 Recovery ❑ Heat Pump Water Insection 0 Other 0 If Other, List Use
2. WELL LOCATION:
Nearest Town: Cullowhee County Jackson
Moses Creek
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3 OWNER, Alvin Hodges
4
5.TOTAL DEPTH: 100'
6, DOES WELL REPLACE EXISTING WELL? YES 0 NO
7. STATIC WATER LEVEL Below Top of Casing.: 30 FT.
(Use "+•• if Above Top of Casing)
8. TOP OF CASING IS 2 FT. Above Land Surface'
'Top of casing terminated at/or below land surface requires a
variance in accordance with ISA NCAC 2C .0118.
9. YIELD (gpm): 30 METHOD OF TEST blow
10. WATER ZONES (depth): 35', 65', 80'
.Addrrss PO Box 2222
(Street or Route No.)
Sylva, NC 28779
City or Town State Zip Code
828)586-0334
Area code- Phone mu:nher
DATE DRILLED 9-17-03
11. DISINFECTION: Type H T H
12. CASING:
Depth Diarrse!e
From 0 To 30 Ft. 611
From To Ft
From To Ft.
13. GROUT: Depth
From 0 To 20
From To
14. SCREEN: Depth
From To
From To
15. SAND.'GRAVEL PACK:
Depth Size
From To Ft.
From To Ft.
Amount 16oz
Wall Thickness
or P:eioht'Ft. 'Material
.188 steel
Material
Fthernlite & Lettrit
Ft.
Diameter Slot Size 'Ma;eriol
Ft. in. • in.
Ft in. in.
Method
Rlrced
16. RENIARKS:
Nlateria:
Topographic. -Land setting.
❑Ridge ❑Slope :Valley ❑Fla:
(Sneak cope vie:,. `or':,
Latitudeloneitude of well location,
Jeareos :;ir::os.se:o:CY)
Latitude'lon_itude soure.OGPSOTopo rap
,:;: ce cos)
DEPTH DRILLING LOG
From in Formation Description
rl & setrd
28' TOO' granite
0 281
LOCATION SKETCH
Show direction and distance in miles from at leas
two State Roads or County Roads, Include�e rear
numbers and conur:on road names. CO r,
v m,-
rr
cnar-
tD rr"
0
Ul
.— o
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH ISA NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY GE THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
SIGNATURE OF PERSON CONSTRUCTING THE WELL
DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center -Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-1 REV. 07:2001

280709
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) Mitchell D. Cook CERTIFICATION r• 2043
WELL CONTRACTOR COMPANY NAME lialt111CithEICS ainincT, Inc PHONE 0 e28) 3669-9591
STATE WELL CONSTRUCTION PERMIT: ASSOCIATED WQ PERMIT#
(ifapplicable) (it -applicable)
1. WELL USE (Check Applicable Box): Residential M Nlunicipal.Public 0 Industrial 0 Aericultura! ❑
Monitoring ❑ Recovery 0 Heat Pump Water Injection ❑ Other 0 If Other, List Use
2. WELL LOCATION:
Nearest Town: Cashiers County Jackson
Cashiers to Whiteside Cove RD
(Street Name. Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: Jack Morse Well $1
Address 2820 Normandy Drive
(Street or Route No.)
Atlanta, GA 30305
City or Town State
(404 )- 290-0144
Zip Code
.Area code- Phone number
4. DATE DRILLED 9-1 0-03
5. TOTAL DEPTH: 1100'
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO :El
7. STATIC WATER LEVEL Below Top of Casino: FT.
(Use "t" if Abair:: Top of Casing)
8. TOP OF CASING IS 2 FT. Above Land Surface*
'Top of casing terminated atior below land surface requires a
variance In accordance with 15A NCAC 2C .0118. blow
9. YIELD (gpm): 0—DRY METHOD OF TEST
10. WATER ZONES (depth):
Topographic/Land setting.
❑Ridge DSlope ❑\'alley ❑Flat
(check appropriate box)
Latitude longitude of well location:
(degrees niau:es. seconds)
Latitude:Iongituce source:❑GPS❑Topogralihiemwr—
(cl:ec:k box)
DEPTH DRILLING LOG
From To Formation Description
0 30' clay & :and
30' 1100' 4ranite
1l. DISINFECTION: Type H T H
12. CASING:
Depth Diameter
From 0 To 28 Ft, 6"
From 28'To 32 Ft. 6" 18R atral
From To Ft.
13. GROUT: Depth Material Method
From 0 To 20 Ftbafilte & carat pint d
From To Ft,
14. SCREEN: Depth Diameter Slot Size Nlateria:
From To Ft. in. in.
From To Ft, in. in.
15.SAND/GRAVEL PACK
:
Depth Size Material
From To Ft.
From To Ft.
Amount 16oz
Wall Thickness
orAWeight:Ft. Material
pyc
I6. REMARKS:
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common road names.
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH I5A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
JD. r /n 9
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
27699-1636 Phone No, [phone], within 30 days. G\W-1 REV. 07'2001

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality
),YELL CONTRACTOR (INDIVIDUAL) NAME (print) Mitchell D. Cook
WELL CONTRACTOR CONIPAM NAME Fis2den Bmthers 4 1 rril irrr, ITC
STATE WELL CONSTRUCTION PER>IIT: ASSOCIATED WQ PERMIT:
(if applicable) (if applicable)
280710
- Ground'a'ater Section
CERTIFICATION 2043
PHONE = [phone]
L WELL USE (Check Applicable Box): Residential LR :Muniaipal'Publie ❑ Industrial 0 Agricultural ❑
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other ❑ If Other, List Use
2. WELL LOCATION:
Nearest Town: Cashiers County Jackson
107S. to Whiteside Cove Rd
(Street Nane, Nu;nbers, Camin un i tc, Subd!sis'or, Lot No.. Zr, Code)
3. OWNER. Jack Morse Well #2
Addross 2820 Normandy Dr
(Street or Route No )
Atlanta, GA 30305
City or Town State Zip Code
(404)- 290-0144
Area code- Phone numher
4. DATE DRILLED 9-15-03
i.TOTAL DEPTH: 800'
6. DOES WELL REPLACE EXISTING WELL? YES E9 NO 0
7. STATIC WATER LEVEL Below Top of Casing: 700 FT.
(Use "+" if Above Top of Castag
S. TOP OF CASING IS 2 FT. Above Land Surface'
'Top of easing terminated atior below land surface requires a
variance in accordance with 15A NCAC 2C .011B. blow9, YIELD (gpm): 3 METHOD OF TEST
10, WATER ZONES (depth): 295'
11. DISINFECTION: Tvoe
12. CASING:
Depth
From 0 To 66
From 66' To 70
From To
13. GROUT: Depth
From 0 To 20
From To
14. SCREEN: Depth
From To
From To
H T H Amount 16oz
Wall Thickness
e
Diameter or lei_^"Ft.
FL 6"
pvc
Ft. 6" -1BR steel
Ft.
Material
Ft}.7aflute & caret,
Ft.
Diameter .Slot Size Niater:z:
Ft. in.
Ft. in. n.
Method
lc reed
15.SAND/GRAVEL PACK
:
Depth. Size
From To Ft.
From To Ft.
16. REMARKS:
Material
Topographic 'Land setting
❑Ridge ❑Slope ❑A'a!Iey ❑Flat
(cheek appropriate box)
Latitude'longitude of well location,
Latitude'lonuitude soure:OGPS❑Topc_rat hie map
bOy)
DEPTH DRILLING LOG
From To Formation Description
0 68' Hay &
68' 800' granite
LOCATION SKETCH
Show direction and distance in miles From at least
two State Roads or County Roads. Include the road
numbers and comrn..on road names.
o
c> _
ars
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH I5A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
LP. ��o# 7�iSA3
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center -Raleigh. NC
27699-1636 Phone No. [phone], within 30 days. GW-1 REV. 07/2001
;n
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2S0711
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) Mitchell D. Cook CERTIFICATION = 2043
WELL CONTRACTOR CO.\IPA(51' NAME }teem arthaz Val Drilling, Ire
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED \\'Q PERMITS
(if applicable) (if applicable)
PHONE e23)
L WELL USE (Check Applicable Box): Residential Lx !Municipal Public ❑ Industrial ❑ Agricultural ❑
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use
2. WELL LOCATION:
Nearest Town: Tackasegee County
Shook Cove to Locket Lane
(Street Name, Numbers, Community. Subdivision, Lot No., Zip Code)
3. OWNER: Dorothy Long
Address 1888 Downing Street
(Street or Route No.)
Memphis, TN 38117
cin or To„n State
(82a- 226-8415
Area code- Phone number
4. DATE DRILLED 9-16-03
5. TOTAL DEPTH: 200'
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO Ca}
7. STATIC WATER LEVEL Below Top of Casino: 1 30 FT.
(Use "+" if Above Top of Casing)
S. TOP OF CASING IS 2 FT. Above Land Surface"
'Top of casing terminated at/or below land surface requires a
variance in accordance with ISA NCAC 2C .0118.
9. YIELD (gpm): 20 METHOD OF TEST blow
10. WATER ZONES (depth): 11 5' , 1 35' , & 160'
Jackson
Zip Code
11, DISINFECTION: Type H T H
12. CASING:
Depth
From 0 To 71
From 71' To 92'
From To
13. GROUT: Depth
From 0 To 20
From To
14. SCREEN: Depth
From To
From To
15. SAND/GRAVEL PACK:
Dept):
From To
From To
16. REMARKS:
Ft.
Ft.
Ft.
Diameter
6"
6"
Amount 16oz
Wall Thickness
or R'eicht'Ft. Material
pvc
188 steel
Nlaterial
Ftk:e zhite & o ra t
Ft.
Diameter Slot Size Nlater'.a:
Ft. in. in.
Ft. in. in.
Method.
piTed
Size
Ft.
Ft.
Nlaterial
Topographic Land setting
❑Ridge ❑Slope ❑\'alley ❑Fla
(check approorime bon)
Latitude'longimde of well location
(decrees ntin:::es'seconds)
Latitude)lonuitude source:EGPS❑TopooraphLC man
box)
DEPTH DRILLING LOG
From To Formation Description
0 90' clay & sand
90' 200' granite
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common road names.
O
CJ
I DO HEREBY CERTIFY THAT THIS WELL. WAS CONSTRUCTED IN ACCORDANCE WITH I5A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
h,. /moo . — ?/CAT 3
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
Submit the original to the Division of Water Quality', Groundwater Section, 1636 Mail Service Center - Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-1 RE\', 07,2_001

WELL CONSTRUCTION RECORD
North Caroline. - Department of Environment and Natural Resources - Division of Water Quail
WELL CONTRACTOR (INDIVIDUAL) NAME (print) Janes B Brown
\\EL1. CONTRACTOR COMPANY iN'.491E Redden Brothers Well Drilling, Inc
STATE WELL CONSTRUCTION PERMIT; ASSOCIATED \VQ PERMIT=
(if applicable) (ifacelicable)
2807:3C
tv - Groundwater Section
CERTIFICATION ei 2045
PHONE 1 ( 828 369-9591
I. WELL USE (Check Applicable Box): Residential O Municipal/Public ❑ lnd.>..ia! 0 Agricultural ❑
tbton'nor'mg ❑ Recovery 0 Heat Pump Water Injection 0 Other 0 Ir, Other, List Use
2. WELL LOCATION:
Nearest Town.Cullowhee
Pressley Creek RD
County Jackson
(Street N:nne, N.unbers, Community, Sub,PHision, Lot No., Zip Cede)
3 ONWNER:John & Janice Cox
Address 674 Pressley Creek RD
(Street or Rcute No.)
Cullowhee, NC 28723
C,a: orTovsr, State
t828 ).'293-9088
Area code, Phalle number
4. DATE DRILLED
5.TOTAL DEPTH: 200'
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO
7, STATIC WATER LEVEL Below Top of Casing: 125' FT.
(Use "r' if Above Top of Casing)
S TOP OF CASING IS 2 FT. Above Land Surface
*Top of casing terminated a'or below land surface require a
variance In accordance with ISA NCAC 2C .0113.
9. YIELD (gpm). 15 METHOD OF TEST blow
10. WATER ZONES (depth): 50' & 175'
9-3-03
Zip Code
11. DISINFECTION: Type H T H Amourt 16 Oz
12. CASING: Wall Th:ckr.ess
Depth Diameter or A'rei_ t'Ft. Ntater,a'.
From 0 To 27 Ft. 6" pvc
From 27' To 31 Ft. 6" 188 Steel
From To Ft.
13. GROUT: Depth Material Method.
From 0 To 20 Frbemite & ceTrTt paired
From To Ft.
14. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in.
From To Ft. in. in,
15, SAND%GRAVEL PACK:
• Depth. Size Material
From To Ft
From To Ft.
I6. REMARKS.
Topographic'Land setting,
❑Ridee ❑Slope ❑Valle} GFlat
(check appropriate box)
Latitudeiloneilude of well location
Latitudc.)ong
DEPTH
From To
0 29'
29' 31'
raXtgrees -re scurae'� EGPSOTcpo amhic mac
(ececk toe)
DRILLING 'CffO""`-"
Formation Descriotion
clay & sand
granite
LOCATION SKETCH
Show direction and distance in miles from at (east
two State Roads or Count: Roads. Include the road
numbers and common road names.
O
O
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH I:A NCAC 2C, WELL
CONSTRUCTION STANDARDS, 3?46)THAT A COPY OF TF RECORD HAS BEEN PROVIDED TO THE WELL OWNER
494.2 jo,3 93
ATURE OF PERSON CONSTRUCTING THE WELL DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center -Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-I REV. 0- 2001
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280737
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
W ELL CONTRACTOR(INDIVIDUAL) NAME (print) James B. BrOWF1 CERTIFICATION 204
\\ ELI. CONTRACTOR CO NIPANY'NAME Redden Brothers Well Drilling, Inc PHONE = ( 828 369-9a9.1
STATE. w'EI.L CONSTRUCTION PERMIT; ASSOCIATED WQ PERM1T
re
(if applicable) (if acoliaable)
I. WELL USE (Check Applicable Box): Residentiainc MlunicipaVPubiic ❑ Industrial ❑ A ricultural ❑
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other ❑ IrOther, List Use
2 WELL LOCATION:
Nearest Town: Sylva
County Jackson
Laurel Branch RD
(S:r ! None, N.imbers, Community, Subdi•n islsn, Lot N'o., Zip Code)
3. OWNER: Rhonda Stephens
Address 132 Laurel Branch RD
(S trstc or Rcu le No.)
Sylva, NC 28779
City or Tony. S®te
(828)- 586-3673
Area code- Pbone number
DATE DRILLED 9-4-03
Zip Code
5. TOTAL DEPTH: 300'
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO 7c
7, STATIC WATER LEVEL Below Top of Casing: 200' FT.
(Use "=' if Above Top of Casing)
5. TOP OF CASING IS 2 FT. Above Land Surface"
`Top of rasing terminated acor below land surface requires a
variance in accordance wkb ISA NCAC 2C .0118.
9. YIELD (epm): 10 METHOD OF TEST blow
10. WATER ZONES (depth): 250'
11 DISINFECTION: Type H T H Amount 16 oz
12. CASING: Wall Thickness
Depth Diameter or Weic`t1Ft. Nla'er.a:
From 0 To 146' Ft. 6" .188 steel
From To Ft.
From To Ft.
13 GROUT: Depth Ntateria! Method.
From 0 To 20 Ft1arnite & ogrent osmerl
From, To Ft.
14. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in.
From To Et. in. in.
15. SAND/GRAVELPACK:
Depth Size Material
From To Et.
From To Ft.
T000graphioland setting
❑Ridge ❑Slope ❑Valley °Flat'.
(cheek appropriate box)
La:itude'Iongltude of well location
Latitude long
DEPTH
From To
0 144'
144' 300'
de source^❑GPS❑Tc_ = aptr::cmap_
:seek box)
DRILLING LOG
For„aticn Descr ion
clay & sang
granite
LOCATION SKETCH
Show direction and distance in miles from at leas:
two State Roads or County Roads. Include the read
numbers and common road names.
]s
b
O
CO
15. RENIARKS:
I DO HEREBY CERTIFY THAT THIS WELL \VAS CONSTRUCTED IN ACCORDANCE WITH I SA NCAC 2C, WELL
CONSTRUCTION STANDARD.51 AND THAT A COPYOF THIS RECO.RD HAS BEEN PROVIDED TO THE WELL OWNER
S-4510517"----) Q—O.(1
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center -Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. OW -I REV. 0712001
c
nes
0

290 738
WELL CONSTRUCTION RECORD
North Caroline - Department of Environment and Natural Resources - Division of Water Qual!ty
WELL CONTRACTOR (INDIVIDUAL) NAME (print) James B. Brown
WWELt. CONTRACTOR COMPANY NAME #ieddel Brothers Well Drilling, Inc
ASSOCIATED MQ PERMIT
STATE \'EI.L CONSTRUCTION PERMIT+
(ifaoolicab,e) (if acni cable)
Groundwater Section
CERTIFICATION = 2045
PHONE a ( 828 369-9591
I. WELL USE (Cheek Applicable Box): Residential ❑ Nlueicipal:Publie 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery ❑ Heat Pump Water Injection 0 Other ❑ II -Other, List Use
WELL LOCATION: NearestTown Whittier Jackson
County
3575 Conley's Creek Rd
(street Name, M1lurbers, Cominunity, Subdi•.isim, Lot No., Zip Code)
OWNER: Richard Whitman
Addrces PO Box 643
(Sre( or Route No.)
Whittier, NC 28789
City or Town State Zip Cod:
(828). 497-3750
Area code- Phone number
DATE DRILLED 10-01-03
5. TOTAL DEPTH: 320'
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO
7. STATIC WATER' LEVEL Below Top of Casins: 200 ET.
(terse "" it Above Top of Casing.)
5, TOP OF CASING IS 2 FT. Above Land Surface`
*Top of casing terminated at'or below land surface requires a
variance In accordance e'Ith I5A NCAC 2C.0118. blow
9. YIELD (gpm): 2 NMET O OF TEST
10 WATER ZONES (depth): 65
I I, DISINFECTION: Tvpe H T H
12 CASING: Wall Thickness
Depth Diameter or P'ei_:-,t'Ft. Mlaterm
From 0 To 61 Ft. 6" .188 steel
From To FL
From To Ft.
13. GROUT: Depth Nlateria! Nlethod
From 0 To 20 _ Ft arnite & ustaoL pitted
From To Ft.
14. SCREEN: Depth Diameter Slot Size Material
From To Ft. in, in.
From To Ft. in. in.
15. SAND%GRAVEL PACK:
Dect'n Size Material
From To Ft.
From To Ft.
16. REMARKS:
Amount 16 oz
Topographic Land setting
❑Ridge ❑Slope ❑A -alley ❑Flat
(c'oe-ck appca rote bon)
Latitude longitude of vve11 location
I,. -'... 4 sconest
Lztitt,de loncLudesource i:GF'SOTopigins .__.
creeL bat;
DEPTH DRILLING LOG
From To Formation Descrption
0 59' clay & sane
59' 320' Granite
LOCATION SKETCH
Show direction and distance in miles from at leas:
t'vo State Roads or Count- Roads. Include the d
V
numbers and common road names.
0
rr
`cam
n�
CA
so:n
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE vk'ITH 15A NCAC 2C, WELL
CONSTRUCTION STAND RDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
14-0/-03
SIGNATUR— OF PERSON CONSTRUCTING THE WELL DATE
v
Submit the original to the Division of \Valor Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, N'C
27699-1636 Phone No. (919)733.3J21, within 30 days. GW-1 REV. 07' OOi
0

280'739
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Rater Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) Janes B Brown CERTIFICATION = 2045
\\ELL CONTRACTOR COMPANY iNANIE Redden Brothers Well Drilling, Inc PHONE ( 828 369-9591
STATE \\'ELL CONSTRUCTION PERMIT: ASSOCIATED WQ PERMIT=
(if applicable) (if applicable)
7
WELL USE (Check Applicable Box), Residential ❑ Nlunicipa.Pubiio ❑ Industrial 0 Agricu',tura''. ❑
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other ❑ 1F0ther, Lis: Use
WELL LOCATION:
Nearest Towr• Sylva
429 Stony Brook RD
Count' Jackson
(S:rea: Name, N,nnhers, Corn.nunity, SebdAlsLoa No., Zip Code)
OWNER: Andy Mallin
Addrass 429 Stony Brook Rd
(Streit t or Route No.)
Sylva, NC 28779
Cry et Town State Zip Core
( 828. 631-3249
Area cede• Phone number
DATE DRILLED 10-7-03
5.TOTAL DEPTH: 500'
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO Plix
7, STATIC WATER LEVEL Below Top of Canna: 200 FT.
(Use''—'' if Ahove Top of Casing)
TO? OF CASING IS 2 FT. Above Land Surface
*Top of rasing terminated at.'or below land surface requires a
variance in accordance with ISA .\CAC 2C .0118.
9. YIELD (epm): 1 METHOD OF TEST blow
10. WATER ZONES (depth): 70'
1 i, DISINFECTION: Type H T H Amour.: 16 oz
12. CASING:
Depth D!ameior
From 0 To 38 Ft. 6"
From 38' To 42' Ft. 6"
Frorn To Ft.
13. GROUT: Depth Material
From 0 To 20 _ Fbirlalite & rarts:L
Wall Thickness
or \': ei_bt'Ft. Nta:er,a
pvc
.188 steel
From To
14. SCREEN: Depth
From To
From, To
Methoc
T-Utreci
Ft.
Di ametzr Slot Size Material
Ft.
Ft. in, in.
15.SAND:GRAVEL PACK:
Depth Sir Ntateri al
From To
From To Ft.
15. RENIARKS:
Topographic'Eand setting
❑Ridee ESlope ❑Y'alle\ ❑'Flat'.
(cheek appropriate Sue.)
L atitude.'longitude of well location
Latituda'; ongit',:Se source. OGPSOTcpc,maphic maZ
,ecsbox)
L
DEPTH DRILL I N7C0L
From To Formation Desan^_tion
0 40' clay & sena
40' 500'
granite
LOCATION SKETCH
Show direction and distance in miies from at Ss' `-'
two State Roads or Count Roads. L.ciude thic)
numbers and common road names cc
fV
N r2r
io
O
CO
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, {ND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
-yw
SIGNATURE OF PERSON CONaTRUCTIN'G THE WELL DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
27699-1636 Phony No. [phone], within 30 days. GW-1 REV. 07. 200:

2. OWNER
Aie2From To Formation Description
ADDRESS " D7 / 77 / /I /J n 6)6 t
fff 6,,6' /6,CI La,rCfi
County:
Depth U DRILLING LOG
NORTH CAROLINA DEPARTMENT OF NATURAL RESOURCES AND COMMUNITY DEVELOPMENT
DIVISION OF ENVIRONMENTAL MANAGEMENT - GROUNDWATER SECTION
P.O. BOX 27687 - RALEIGH.N.C. 27611, PHONE [phone]
2&OS
WELL CONSTRUCTION RECORD
DRILLING CONTRACTOR �kD h) ✓l l.� L
DRILLER REGISTRATION NUMBER . / S
FOR OFFICE USE ONLY
Quad. No. Serial No.
Lat. Long Pc
Minor Basin
Basin Code
Header Ent. GW-1 Ent
STATE WELL CONSTRUCTION , /L/
PERMIT NUMBER: / 'f-
1. WELL LOCATION: (Show etch of the location below)
F Ite
Nearest To n
(Road, Com ty,t.r Subdivisionp Lot No.) l 1
,f' (2_ Gkeld r� l L
�/ (St eet op Route No. n yg7�J
[.L. C[�/� C S v l l/ �' C c175,
S Cl�
Ciit/ty or Town State I Zip Code
3. DATE DRILLED '�/ /--Zg U3 USE OF WELL hPail»10 X 1�'-1
4. TOTAL DEPTH ) G) -J ' CUTTINGS COLLECTED ❑ Yes xi No
5. DOES WELL REPLACE EXISTING/o�WELL? El Yes t No
U 6. STATIC WATER LEVEL: G FT ❑ above TOP OF CASING,
ED below
TOP OF CASING IS / FT ABOVE LAND SURFACE.
7. YIELD (gpm): 3 CC METHOD OF TEST .d h /-S
8. WATER ZONES (depth).
9. CHLORINATION: Type 1-4T1-1 Amount / g -i\ 177c,
10. CASING:
Wall Thickness
Depth Diameter or Weight/Ft. Material W /�_� / LOCATION SKETCH O
From t = To 4l.) Ft & I I P I/ (' (Show direction and distance from at least t r� StSff3oads,
From To Ft or other map reference points) N c�
CDFrom To Ft.
"O nc
11. GROUT: -. ^'r:
Depth Material Method V'=`-
From l2 To �M1: Ft. `._i .1 -Ili AL- !L`� N
QT f
From To Ft.
12. SCREEN:
Depth Diameter Slot Size Material
From To Ft. in. in.
From To Ft. in. in.
From To Ft in in.
13. GRAVEL PACK:
Depth Size Material
To Ft.
To Ft.
From
From
14. REMARKS:
If additional space is needed use backeof fofm.
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15 NCAC 2C, WELL CONSTRUCTION
STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVD TO THE WELL OWNER.
`Zli e-3D_C3
GW-1 Revised 6/88
SIGNATURE OF CONTRACTOR OR AGENT DATE
Submit original to Division of Environmental Management and copy to well owner.

WELL CONSTRUCTION RECORD
North Caroline. - Department of Environment and Natural Resources - Division of ?Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) N AMIE (print) James B. BrOWEI CERTIFICATION; 2045
\v ELL CONTRACTOR COMPANY iNA`IE Hedden Brothers Well Drilling, Inc PHONE a 1828 369-9591
STATE. W ELL CONSTRUCTION PERMIT s ASSOCIATED WQ PERMIT
(if applicable) (if applicable)
280'768
WELL USE (Check Applicable Box)' Residential J Municipa!:Public 0 Industrial 0 A_ricultura'i. ❑
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other ❑ I [-Other, List Use
2- WELL LOCATION: Nearest TownaJackson
�T� Count
Forest Hills Lot #11
N.nnbers, Community, Suir isision, Lot No., Zip Code)
3 OwNER:Allen & Kolleen Begley
Address 873 Cave Springs RD
(Street or Route No.)
t 111owhee N . 28723
or Town State Zip Code
(727). 542-3808
Area :ode• Phone number
4. DATE DRILLED 9-01-03
5. TOTAL DEPTH: 1000'
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO IN
7. STATIC WATER LEVEL Below Top of Casing: 995' FT.
(Useif Above Top o: Casing)
5. TOP OF CASING IS 2 FT. Above Land Surface -
"Top of casing terminated at'or below land surface requires a
variance In accordance with ISA NCAC 2C .0118.
9. YIELD (gpm): .5 METHOD OF TEST blow
10. WATER ZONES (depth): 700'
1 i, DISINFECTION: Type H T H .Amount 16 oz
12. CASING: Wall Thickness
Depth Diaeter or V-eient'Ft. Material
From 0 To 88 Ft. 6"pvc
From 88' To 92' Ft. 6" .188 steel
Frorn To Ft.
13. GROUT: Depth Material Method
From 0 To 20 Ft.tefl ite & (parent P.t1
From To Ft.
14, SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in.
From To Ft. in. in.
15. SAND%GRAVEL PACK:
Depth Size NLterial
From To Ft.
From To Ft,
16.REMARKS:
T000graphic'Land setting
❑Ridge :Slope ❑Valley ❑Flat
(check appropriate box)
Latitude longitude of well location
Lati:ude'loneibude seurce:DGPSDTcp.ecraphic map
c, reck box)
DEPTH DRILLING LOG
From �Tpt Formation Desorption
0 U clay & sane
90' 1000' granite
0
LOCATION SKETCH .
Show direction and distance in miles (rem at least
two State Roads or County Rods. 1 .c,mle the rea::
numbers and common road names.
O
CO
O
0
IV
fV
Ts*
O
o
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARD.'D THAT A COPY 0= TB'S RECORD HAS BEEN PROVIDED TO TEE WELL OWNER
semisco_n_..)
SIGNATURE OF PERSON CONSTRUCTING THE WELL
DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
27699-1636 Pltonc No. [phone], within 30 dacs. GVA'-I RED'. 072001
J

WELL CONSTRUCTION RECORD 2 817 3 3
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) Mitchell D. Cook CERTIFICATION o 2043
\\ ELL CONTRACTOR CONIPANY NANIE Fihi 1 i"PSS UPI( ct^illim, TIC PHONE: e281 369-9591
STATE WELL CONSTRUCTION PERMIT; ASSOCIATED WQ PER.IIT=
(if aco icabie) (if apolicable)
1. WELL USE (Check Applicable Box): Residential 6 Municipal/Public ❑ Industrial ❑ A ricultura! ❑
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 IfOther, List Use
2. AVELL LOCATION,
Nearest Town Cullowhee County Jackson
107 to Moody Bridge to Wike Cemetary
(Street Name, Numbers, Communite, Subd i,'uion, Lot No., Zip Code)
3. OWNER: Doug L. Shaw
Address 431 Jupiter Lakes Blve. 2132A
(scree: Cr Rout: No.)
Jupiter, FL 33458
City or Town Sale Zip Code
(828). 586-0294 contact#
Area code• Phone number
4. DATE DRILLED 11-3-03
5. TOTAL DEPTH: 200'
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO Ec
7. STATIC WATER LEVEL Below Top of Casing: 150 FT.
(Use •'-" it Above Top of Casing)
S. TOP OF CASING IS 2 FT. Above Land Surface*
•Top of casing terminated at/or below land surface requires a
variance In accordance with 15A ,NCAC 2C .0118.
9. YIELD (gprn),• 20 METHOD OF TEST blow
10. WATER ZONES (depth): 160'
11. DISINFECTION: Tvoe H T H Amount 16oz
12. CASING: Wall Thickness
Depth Diameter Cr Weight/Ft. Material
From 0 To 56'Ft. 6" .188 steel
From To Ft.
From To Ft.
13. GROUT: Depth Material Method.
From 0 To 20 Ftba h1te & carat p.f'
From To Ft.
14. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. ir,.
From To Et. in. in.
15. SAND 'GRAVEL PACK: •0r
Depth Size Material - -07
From To Ft. LO
TopographicLand setting
❑Rids ❑Slope ❑Valley ❑Fla:
�. (chrs appropriate box)
Latitude'Iongitude. of well locator,
(degrees e:_
Lati;,udL z'loneitude souroe.G.,
PS'❑?cp chic map
.:de;.< box)
DEPTH DRILLING LOG
From To Formation Description
0 54' (-lay & sad
54' 200' granite
LOCATION SKETCH •
Show direction and dis:ance in miles From at least
nee State Roads or County Roads. Include the road
numbers and common road names,
From To Ft.
!6. RE,MMARKS:Set 5" packer--steel-84' to the top —grouted
I DO HEREBY CERTIFY THAT THIS WELL \VAS CONSTRUCTED IN ACCORDANCE WITH ISA NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
�D. l /,1/4 /c)?
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center -Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-1 REV. 07200:
n

WELL CONSTRUCTION RECORD
North Carolina - Dcpartment of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) Mitchell D. Cook
WELL CONTRACTOR COMPANY NAME Haien REtt-harS pa11 mill isni TIC PHONE % 828) 369-9591
STATE WELL CONSTRUCTION PERMIT% ASSOCIATED WQ PERMIT
(if applicable) (if applicable)
281732
CERTIFICATION. 20a3
1. WELL USE (Check Applicable Box): Residential ® Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring ❑ Recovery ❑ Heat Pump Water Injection 0 Other ❑ If Other, Lis; Use
2. WELL LOCATION:
Nearest Town Cashiers County Jackson
Hoo}pr Mtn
(Stree: Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: Hannah Kunz
Address 30 4bxawav Lane #1912
(Sties): or Rouse No.)
Sapphire, NC 28774
City or Town Sale
[phone]
Zip Code
Area code- Phone number
4. DATE DRILLED 10-14-03
S. TOTAL DEPTH: 300'
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO P3
7. STATIC WATER LEVEL Below Top of Casing: 100 FT.
(Use "a" if Above Top of Casing)
5, TOP OF CASING IS 2 FT. Above Land Surface*
•Top of casing terminated at'or below land surface requires a
variance in accordance with 15A NCAC 2C .0118.
9. YIELD (gpm): 30 METHOD OF TEST blow
10 WATER ZONES (depth): 195' & 265'
11. DISINFECTION: Tvoe H T H
12. CASING:
Depth Diameter
From 0 To 48 Ft. 6"
From 48 To 51 Fr. 6"
From To Ft.
13. GROUT: Depth
From 0 To 20
From
14. SCREEN:
From
From,
15. SAN'D'GRAVEL PACK:
Depth
From To Ft.
From To Ft.
To
Depth
To
To
Amount 16oz
Wall Thickness
or Weight'Ft.
.188
Material
Ftbiattrate & =at
Ft.
Material
pvc
steel
Method
gulped
Diameter Slot Size Material
Ft. in. ic.
Ft. in. n.
16. REMARKS:
Size Material
Topographic Land setting
❑Ridge ❑Slope ❑Valle}' ❑Fla;
(cheek appropriate 'box)
Latitudelongituds of well location
Latit d_.'lonait' e sourCC:0GPSJTepogap'nic map
(Ckeck Lox)
DEPTH DRILLING LOG
From Tc Formation Description
0 49' clay & 5arrl
49' 300' yianite
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common road names.
I DO HEREBY CERTIFY THAT THIS WELL \VAS CONSTRUCTED IN ACCORDANCE WITH ISA NCAC 2C, WELL
CONSTRUCTION STANDARDS,
AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
AN
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 blail Service Center -Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. OW -I REV. 07)2001
CCP
G

281731
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) Mitchell D.r�Cook
„ CERTIFICATION i= 2043
N ELL CON'TRACTORCOM PAN N'ASIE l B therS VL.l..cuwy, L-c PHONE # e28) 359-9591
STATE \y ELL CONSTRUCTION PERMIT# ASSOCIATED \VQ PERMIT:
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential 25 Nlunicipal.'Public ❑ Industrial ❑ Agricultural 0
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use
2. WELL LOCATION:
Nearest TownCashiers Countdackson
Yellow Mtn to Braham Lane PBCI well
(Street Name, Nunbers, Community, Subdivision, Lot No-, Zip Code)
3. OWNER: Jimmie Rogers
Address PO Rnx 776
(Street or Route No
Cashiers, NC 28717
City or Town State Zip Code
(828)- 743-1744
Area code. Phone number
4. DATE DRILLED 9-24-03
5. TOTAL DEPTH: 600'
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO
7. STATIC WATER LEVEL Below Top of Casing: 450 FT.
(Use "+" if Above Top &Casing)
S. TOP OF CASING 1S 2 FT. Above Land Surface`
"Top of casing terminated at/or beta e' Ian d surface requires a
variance in accordance with 15A NCAC 2C .0t 18.
9. YIELD (gpm): •5 METHOD OF TEST blow
10. WATER ZONES (depth):
11. DISINFECTION: Type H T H
12. CASING:
Depth Diameter
From 0 To 50 Ft, 6"
From 50' To 71 Ft. 6"
From To Ft.
13. GROUT: Depth
From 0 To 20
From To
14. SCREEN: Depth
From To
From To
15
Amount 1 6oz
Wall Thickness
or Weight/Ft. Material
pvc
1RR steel
Material
FtbEnalite & tenant
Ft.
Diameter
Ft. in.
Ft. in.
SAND/GRAVEL PACK:
Depth Size
From To Ft.
From To Ft.
16. REMARKS:
Topographic Land setting
DRidge ❑Slope ❑\'alley ❑Flat
(check appropriate box)
Latitude'longitude of well location
(degrees '.m. r. es seconds)
Latitude/ longitude source:OGPSOTopographic rnup
._beck box)
DEPTH DRILLING LOG
From To Formation Description
0 69' clay & srrl
69' 600' granite
Method
_P-Ered
Slot Size Material
in.
in.
Material
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the ittyd
numbers and common road names. CO
t=1
m
n
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE \\ELL OWNER
°Z. � _r sz 3
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
Submit the original to the Division of \\'ater Quality', Groundwater Section, 1636 Mail Service Center - Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. G\V-1 RE\'. 072001
aid
tee es
a rib

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) Mitchell D. Cook CERTIFICATION 2043
\\ ELL CONTRACTORCOII PAN N'A,\IE =1 at)"PrS Scel1 tfli11Tit, Ire PHONE: [phone]
STATE WELL CONSTRUCTION PERbIIT6 ASSOCIATED \\ Q PER>IITn.
(ifaculicable) (if apolicabie)
281730
WELL USE (Check Applicable Box): Residential E Municipal/Public 0 Industrial 0 A;r:cuiture: 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other ❑ If Other, List Use
2. WELL LOCATION:
Nearest Town: Cashiers Count, Jackson
Stonefly Lot #1 Well #4 on Streamside Dr
(Street Nano, Number, Communit'. Subdl:ir.on, Lot No.. Zip Code)
3. OWNER: Diana Nellans
Address 4384 Caryota Drive
(Street or Route No.)
Boynton Beach, FL 33436
Sate Citycr Townip Code
(828y 526-1772 Ron Waller contact
Area cods- Phone number
4. DATE DRILLED 11-18-03
5. TOTAL DEPTH: 1000'
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO
7. STATIC WATER LEVEL Below Top of Casing: 900 FT.
(Use "-" if Above Top of Casing)
8. TOP OF CASING IS 2 FT, Above Land Surface`
'Top of casing terminated at/or below land surface requires a
variance In accordance with 15.1 NCAC 2C .01IS.
9. YIELD (gpm): 3 METHOD OF TEST blow
10. WATER ZONES (depth): 65' & 85'
11. DISINFECTION: Type H T H Amount 1 6oz
12, CASING:
Depth Diameter
From 0 To 36 Ft 6"
From To Ft.
From To
13. GROUT: Depth ,xiateriai Method
From 0 To 20 FtL-anZite & oanazt rvrozd
From To Ft.
14. SCREEN: Depth Diameter Slot Size Nlatertz:
From To Ft. in. in,
From Tc Ft. in. in.
15. SAND.'GRAVEL PACK:
Depth Size Nlaterial
Wall Thickness
o: v:eiehtFL Material
.188 steel
From
From
I6. REMARKS:
To Ft.
To Ft.
T opo_raphic:Land setting
❑Ridge ❑Slope ❑Valley ❑Flat
(cheek o,- -:ia:e box)
Latitude'longituds of well location
Latitude 1on_itude sours e::1GPS❑ T epogr--p'hic map
DEPTH
From Tc
0 34'
34' 1000'
DRILLING LOG
Fermation Description
r19y & s on3
granite
LOCATION SKETCH
Sho'.v direction and distance in miles Ron: at least
two State Roads or County Roads. Include thoad `
numbers and common road names. e..a
0
m
1 DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, War —
CONSTRUCTION ,.
CONSTRUCTION STANDARDS, AND THAT A COPY 0? THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
///.� P/o-?
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center -Raleigh, NC
27699-1636 Phone No, [phone], within 30 days. OW -I REV. 07 200
UJ
0

WELL CONSTRUCTION RECORD 2 817 2 9
North Carolina - 0cpartment of Environment and Natural Resources - Division of Rater Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) Mitchell D. Cook CERTIFICATION; 2043
WELL CONTRACTOR C0l1PANY,NA,WIE FiediEn thEL` S Well aillinCri lit PHONE # [phone]
STATE WELL CONSTRUCTION PERMIT; ASSOCIATED WQ PERMIT
(ifaaplicable) (if applicable)
WELL USE (Check Applicable Box): Residential ❑ Dlunicipal/Pubiic ❑ Industriai ❑ Agricultural ❑
Monitoring ❑ Recovery ❑ Heat Fump Rarer Injection ❑ Other ❑ If Other, Lis: Use
2. WELL. LOCATION:
Nearest Town: Cashiers Count. Jackson
Stonefly Lot #3 Well #3 on Troutrreek Trail
(Street Name, Numbers, Co:n:na n ity. 5 ubdi v'nlon, Lot No., Zip Code)
3. OWNER: Diana Nellans
Address 4384 Caryota Drive
(Super cr Route No.)
Boynton Beach; FL 33436
City cr Town State Zip Cad:
S28)-526-1772 Ron Waller contact
Area code, Phone number
4. DATE DRILLED 11-13-03
5. TOTAL DEPTH: 1000'
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO
7, STATIC WATER LEVEL Below Top of Casing: 775' FT.
(Use''-" if Above Top ofCasin3)
8. TOP OF CASING IS 2 FT. Above Land Surface*
'Top of casing terminated ator betaw land surface requires a
variance In accordance with IAA NCAC 2C .0118.
9. YIELD (gpm): 12 METHOD OF TEST blow
10. WATER ZONES (depth): 125'
II DISINFECTION: Tvoe H T H Amount 1 6oz
12, CASING: Wall Thickness
Depth Diameter or Weight:Ft. Material
From 0 To 102 Ft. 6" .188 steel
From To Fr.
From To Ft.
13. GROUT: Depth Material Method
From 0 To 20 FtbEnmite & u iasL pj[r_el
From To Ft.
14_ SCREEN: Depth Diar,eter Slot Size Material
From To Ft. in. in.
From To Ft. in. in.
15. SAND.'GRAA'EL PACK:
Depth. Size Material
From To Ft.
From To Ft.
16. REiLIARKS:
Topographic/Land setting
❑Ridge ❑Slope ❑Valley ❑Flat
(cheek ap„rarr:ate box)
Lar.tude'longude of Well location
(detiees bn..tes: =.wonds)
Latitudalon_itude source.OGPS❑Tepo_raphic map
su;CC, box)
DEPTH DRILLING LOG
From To Formation Description
0 100'
clay &srrl
100' 1000' granite
LOCATION SKETCH'
Show direction and distance in miles from at least
two State Roads or County Roads. Include theoad
W
numbers and coMMOr. road names.
rn
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH I fA NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
tP
r
xD
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center -Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GVV-1 REV. 07/2001
en
0

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of 'Water Quality
WELT,CONTRACTOR (INDIVIDUAL) NAME (print) DFD t ,1._./1 e ID
(� , \\ /a �"�
WELL CONTRACTOR COMPANY NAME.reLYIC FJ r(J.S. LtJ211 4 PLt mP,
STATE WE.I.1. CONSTRUCTION PERMIT# _ L 7 -2_ A _ _..__.-\SSO('IAIED WQ PERMIT# _.
(if applicable) (if applicable)
281686
- Groundwater Section
('ER 1'IFIC:\(ION# ea 41/
�/ ff . 3 /
PHONE # r
1_ WELL USE, (Check Applicable 13ox): Residential Municipal Public 0 Industrial ❑ Agricultural ❑
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 It Uther, List (isc
2. WELL LOCATION'
Near - loam 0)11Stir,ro county z kSO/1
P IC C 0 re_e k-
(Strca Name, Numbers. ('omutuality. Subdn 'sum. Lot No_ tip yodel
3. OWNER:11Glra 1.
Address
13e,1sam tad
•
(Stree) or R)n to Na_I
tinesV)P1 NC g
n ( n State Lip Coda
('u}
A ire. code -Phone number
4. DATE DRILLED // `a`) 1 - 8
5. ToTAL DEPTH: shy'
6. DOES WELL REPLACE EXISTING WELL' YES 0 NO
7. STATIC WATER LEVEL Below Top ofCasing: s F"I
(Use` it Alms e Top of Casing)
8. TOP OF CASING IS l PT. Above (.and Surfucc*
*Top of casing terminated at/or below land surface requires a
variance in accordance with ISA NCA(' 2(' MI IN. 1 - -
9. YIELD (gpin): % METHOD OF TEST irS .
IU. WATER ZONES (depth): �� ' - 1 Gp»I -- -- -- — P t'--
� 7 u� I (K':AT ION SKETCH
II
I I. DISINFECTION: Type_}-} Y:Amount (7/_ } ) /5_- lhoii direction and distance in miles from at least
12_ CASING: v all Thickness tiio State Roads or County Roads. Include the road
Depth Ditnneter or Weight Pt. Valero( numbers and common road names.
Topographic/Land setting
❑Ridge %Slope ❑Valley ❑Plat
ich:ck appropriate bes)
Latitudelongitude ofirell location
Idcsrc, Canutex N¢ond,l
',atit(Idelongitude source:❑(iPS❑Topographic map
(check box)
UI.I'll I DRILLG DRILLING LO
From To Formation Description
10a
__40 3 -'--_SIBS
�c-
i
From I/) To 42 Et /o '(
From l o Pt.
From 'lo Ft.
13. GROUT: 1)cpth n Material Method
From 0 To A n Pt. ?LG.-ii_T
From To Pt.
Pve_
14 S(.RFLN: Depth Diameter Slot Siic Material
From To Ft_ in. in.
From To Ft. in. in_
15. SAND GRAVEL- PACK:
Depth Size \latcrial
From _ To Ft.
From To Pt_ - —_
16. REMARKS:
0
r,r
=
rJ
0
1 DO I1E12E131" CERTIFY lIlAT TIIIS WELL l.L \VAS CONS I RUCTED IN AC UORU ANC). A I iI1 15.A NC AC 22C, W1.l.
('ONST RIi(TION STAND DIIy1)S, AND THAT A CUP( or Tins RFC012D II:\S 13F_f:N PROVIDED 11) THE VAE1.1. OWNER
// 3r v 3
Y
SIGNATURE 011'I[RSON CONS I12) f I Mt
IIIF VA1111. D,V11.
Submit the original to the Division of Water Quality, Groundwater Section, 163o ,Mail Set-) ire Center - Raleigh. NC
27699-1636 Phone No. [phone], within 31) days. (iW-1 REV. 07 2001

281954
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
\YELL CONTRACTOR (INDIVIDUAL) NAME (print) James B. Brown CERTIFICATIONS 2045
WELL CONTRACTOR CONIPA:NYNAMEHedden Brothers Well Drilling, Inc PHONE :[phone]
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMLTd
(if applicable) (if applicable)
WELL USE (Check Applicable Box): Residential Nlunicipal'Public ❑ Industrial ❑ Aericuitural ❑
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use
2. WELL LOCATION:
Nearest Town: SYlva County Jackson
Cope Crk Rd to Toy Cove Lot #9
(Street Name. Number, Community, Subdivision, Lot No., Zip Code)
3 OWNER: James A Keener
Address PO Box 543
(Street or Route No.)
Dillsboro, NC 28725
City or Town State
(828 )- 586-6635
Zip Code
Area code- Pl:one number
4, DATE DRILLED 11-06-03
5. TOTAL DEPTH: 500'
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO XC
7. STATIC WATER LEVEL Below Top of Casing: 300 FT.
(Use "+" if Above Top of Casing)
S. TOP OF CASING IS 2 FT. Above Land Surface*
'Topcasing terminated at'or below land surface requires a
variance in accordance ts'ith 15A NCAC 2C .0118.
9. YIELD (gpm): 10 METHOD OF TEST blow
10, WATER ZONES (depth): 455'
I I. DISINFECTION: Tvpe H T H
I2. CASING:
Depth Diameter
From 0 To 67 Ft. 6"
From 67' To 70Ft. 6"
From To Ft.
13. GROUT: Depth Naterial
From 0 To 20 FL barnite & cement
From To Ft,
14. SCREEN: Depth Diameter
From To Ft. in.
From To Ft. in.
15. SAND/GRAVEL PACK:
Depth
From To Ft.
Amount 16 oz
Nail Thickness
or Weight'Ft. Material
pvc
1RR steel
From To Ft.
Method
pumped
Slot Size Material
in.
in.
Size Material
Topographic. Land setting
DRidge ❑Slope ❑\'alley EFlat
(check appr:elate box)
Latitude'longitude of well location
(degrees :nin•.nes'seconds)
Latitude'Iongitude sourue.❑GPS❑Topoer
:beck box) ! 1
DRILLING LOG t``
DEPTH
From To
0 68'
ft
Formation Description
clay & sand
68' 500' granite
LOCATION SKETCH
Shove' direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common road names.
cJ
0
VD
-o
16. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH ISA NCAC 2C, WELL
CONSTRUCTION ST.41B1\RDS, AND THAT A COP ' OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
v
Submit the original to the Division of ater Quality, Groundwater Section, 1636 Mail Service Center -Raleigh, NC
27699-1636 Phnnc No. [phone], within 30 days. GW-1 REV. 07/2001

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality
WELL CONTRACTOR (INDIVIDUAL) NAME (print) James B. Brown
)1ELL CONTRACTOR COMPANYNAMEHedden Brothers Well Drilling, Inc
281953
- Groundwater Section
CERTIFICATION r 2045
PHONE ;$28) 369-9591
STATE \NELL CONSTRUCTION PERMIT- ASSOCIATED WQ PERMIT#
(ifannlicable) - (if applicable)
WELL USE (Check Applicable Box): Residential Nlunicipal'Public ❑ Industrial 0 Agricultural 0
Monitoring ❑ Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
WELL LOCATION:
Nearest Town: Whittier County Jackson
Casey Mtn
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: Jimmy C. Wheatley
Address 755 Lakewood ('1 rrl p
(Street or Route No.)
Merritt Island, FL 32952
City or Town State Zip Code
821 )-454-4205
Arco code- Phone number
4. DATE DRILLED 10-15-03
5. TOTAL DEPTH: 240'
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO L�4
7, STATIC WATER LEVEL Below Top of Casing: 150 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS 2 FT. Above Land Surface'
"Top of casing terminated atror below land surface requires a
variance in accordance with 15A NCAC 2C .0118.
9. YIELD (gpm)'. 10 METHOD OF TEST blow
10. WATER ZONES (depth): 95' & 270'
11. DISINFECTION: Type H T H Amount 16 oz
12. CASING: Wall Thickness
Depth
From 0 To 68
From cF' To 77'
From To
13. GROUT'. Depth
From 0 To 20
or Weight Ft. Material
Ft. pvc
Ft.
Ft.
Diameter
6"
6"
,1-R8 ctccl
Nlaterial Ntethod
Ft. henmite & mere t pumped
From To Ft.
14, SCREEN: Depth Diameter Slot Size Nlaterial
From To Ft. in. in.
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
16. RENIARKS:
Topographic/Land setting
❑Ridge ❑Slope DValley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees ini n.ttes.'secor.ds)
Latitude'iongitude source:0GPS0Tepographic ap
(check box)
DEPTH DRILLING _OG I� _
From To Formation Desr nlinr
0
70' clay & sand1
70' 240' granite
LOCATION SKETCH
Show direction and distance in miles (rein at least
two State Roads or County Roads. Include the road e
numbers and common road names. o
CO
o
—o
(..)
N
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH ISA NCAC 2C, WELL
CONSTRUCTION NDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. G\W-I REV. 07/2001
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WELL CONSTRUCTION RECORD
281952
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (IN'DIVIDUAL)N'AAIE (print) James B. Brown CERTIFICATION; 2045
\\ELL CON'TRACTORCONIPANY NAFME Hedden Brothers Well Drilling, Inc PHONEa829E) 369-9591
STATE WELL CONSTRUCTION PERMIT'.
(if applicable)
ASSOCIATED \\'Q PERMIT=
(if applicable)
I. WELL USE (Check Applicable Box): Residential NlunicipalPublic ❑ Industrial ❑ Agricultural ❑
Monitoring 0 Recovery ❑ Heat Pump Water Injection ❑ Other 0 If Other, List Use
2. WELL LOCATION:
Nearest Town: SylVa
3.
County Jackson
Ashe Settlement
(Street Name. Numbers, Community, Subdivision, Lot No., Zip Code)
OWNER: Fredrick Rosenkampff
Address 300 Francyne Court
(Street or Rome No.)
Atlanta, GA 30328
City' or Tory'.^ State Zip Code
(82a- 421-7947
Area code- Phene number �,�- 0-03
4. DATE DRILLED
5. TOTAL DEPTH: 420'
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO EX
7, STATIC WATER LEVEL Below Top of Casing: 300' FT.
(Use "+" if Above Top of Casing)
S. TOP OF CASING IS 2 FT. Above Land Surface*
'Top of casing terminated at/or below land surface requires a
variance in accordance with 15A NCAC 2C .0118.
9. YIELD (gpm): 30 METHOD OF TEST blow
10. \VATER ZONES (depth): 137' & 385'
11. DISINFECTION: Type H T H Amount 16 oz
2. CASING: Amount
Thickness
Depth Diameter or Weight/Ft. Nlaterial
From 0 To 99 Ft. 6"pvc
From 999 To 102' FL 6" .188 steel
From To Ft.
13. GROUT: Depth Nlaterial Method
From 0 To 20 Ft. baznite & LatkiL pumped
From To Ft.
14. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in.
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
16. REMARKS:
Topographic/Land setting
DRidge ❑Slope ❑\'alley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(dearees'inino tes(seconds)
Latitude/longitude source.❑GPS❑Topographic map
(check box)
DEPTH DRILLING LOG
To Formation Derr nlion
clay & sand(
From
0
1009
100'
420'
anite r
LOCATION SKETCH
Show direction and distance in miles frets
two State Roads or County Roads. Include`
numbers and common road names.
0
CO
0
tO
W
N
N
1 DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE \VITH ISA NCAC 2C, WELL
CONSTRUCTION ST j.RDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
63
—i
co
G
SIGN'ATUItdfl"f'ERSON CONSTRUCTING THE \YELL DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-1 REV. 07/2001
Lrt .

WELL CONSTRUCTION RECORD 281951
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) James B. Brown CERTIFICATION k 2045
WELL CONTRACTOR COMPANY NANIEHedden Brothers Well Drilling, Inc PHONE # [phone]
STATE WELL CONSTRUCTION PER.\IIT# ASSOCIATED \.Q PERMIT#
(if applicable) (if applicable)
1.
2,
WELL USE (Check Applicable Box): Residential I Municipal/Public ❑ Industrial 0 Agricultural ❑
Monitoring ❑ Recovery 0 Heat Pump Water Injection ❑ Other ❑ IFOther, List Use
WELL LOCATION:
Nearest Town: Whittier
Shoal Creek Rd-1mi up
County Jackson
(Street Name, Number, Community, Subdivision, Lot No., Zip Code)
3. OWNER: Jonathan M. Brown
Address 280 Bar Cove
(Street or Route No.)
Bryson -City, NC 28713
City. or Town State Zip Codc
(828)- 488-1064
Area code- Phone number
4. DATE DRILLED 10-28-03
5. TOTAL DEPTH: 280'
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO fl
7. STATIC WATER LEVEL Below Top of Casing: 200 FT.
(Use' if Above Top of Casing)
8. TOP OF CASING IS 2 FT. Above Land Surface'
*Top of casing terminated at/or below land surface requires a
variance in accordance with 15A NCAC 2C .0I lS.
9. YIELD (gpm): 6 METHOD OF TEST blow
10. WATER ZONES (depth): 160'
11. DISINFECTION: Type H T H Amount 16 oz
12. CASING: Wall Thickness
Depth Diameter or Weicht'Ft. Naterial
From 0 To 145'Ft. 6" .188 steel
From To Ft.
From To Ft.
13. GROUT: Depth Material Nlethod
From 0 To 20 Ft. bsrnite&tralath pumped
From To Ft.
14. SCREEN: Depth Diameter Slot Size Nlaterial
From To Ft. in. in.
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To - Ft.
16.REMARKS:
Topographic: Land setting
❑Ridge ❑Slope ❑Valley DFlat
(check appropriate box)
Latitude/longitude of well location
(degrees minutes. seconds)
Latitudalloneitude source:❑GPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From To Formation Description ---i
0 143 c
clay & sand ___',—._, 1
143' 280' •ranit . r.-
Gin]
LOCATION SKETCH
Show direction and distance in miles fron
two State Roads or County Roads. Includ
numbers and common road names.
O
w
O
tD
W
N
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH I5A NCAC 2C, WELL
CONSTRUCTIONN'DARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
SIGNATRE OF PERSON CONSTRUCTING THE WELL DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Dlail Service Center -Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-1 REV. 07/2001
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WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
��n��`��/
\SELL CONTRACTOR (INDIVIDUAL) NAME (print). �AMEi E2°")� CERTIFICATION?-20ZJ
\\ ELL CONTRACTOR COMPANY NAME u-77 IEICOtharS 1)p11 Dij.1LIY', L'r PHONE ti 828) 369-9591
STATE WELL CONSTRUCTION PER,\IIT# ASSOCIATED \VQ PERMIT=
(ii aco icable) (if applicable)
281950
1 WELL USE (Check Applicable Box): Residential E MunicipalPublic ❑ Industrial ❑ Agricultural ❑
Monitoring 0 Recovery 0 Heat Purnp Water Injection 0 Other 0 If Other, List Use
2. \VEI-L LOCATION:
Nearest Town: Sylva Count: Jackson
Green's Creek to Sugar Fork to Grand Vista
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: Lloyd & Betty Screven
Address 909 Grand Vista Drive
(Street or Route No.)
Sylva, nC 28779
( 828): 5M.
Area code- Phone number
4. DATE DRILLED
5. TOTAL DEPTH:
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO
7. STATIC WATER LEVEL Below Top of Casing: 400 FT.
(Use "r' if Above Top of Casing)
S. TOP OF CASING IS 2 FT. Above Land Surface'
"Top of casing terminated actor below land surface requires a
variance In accordance with ISA NCAC 2C .01 IS.
9. YIELD (gpm): 5 NIETHOD OF TEST blow
10. WATER ZONES (depth): 130'
10-27-03
Zip Code
500'
11 DISINFECTION: Type F T H
12. CASING:
Dept
h
From 0 To 80 Ft.
From 80To 83 Ft,
From To Ft.
Amount 16oz
)Wall Thickness
Diameter or Weight'Ft. Material
6" pvc
6" 188 steel
13, GROUT: Depth Material
From 0 To 20 Ftkarnite & carat
From To Ft.
14. SCREEN: Depth Diameter
From To Ft. in.
From To Ft. in.
15. SAND/GRAVEL PACK:
Dep:h Size
From To Ft.
From To Ft.
16. REMARKS:
Method
Slot Size Ma:erir,
in.
m,.
Material
TopographicLand setting
❑Ridge ❑Slope ❑Vaiiey EFlat
(cineek 2 ppropn a:= box)
Latitudelongiude of well location
(9eerees :.,inn its sea —must
ol Latitudon_itude source:0GPS❑Tcpo_re.phic ma
p ec<'box)
DRILLING LOG
Formation Description
DEPTH
From To
0
8l
50U
clay &
granit
LOCATION SKETCH
Show direction and distance in miles L".
two State Roads or County Roads. Inc;ud
numbers and common road names.
—o
Pi)
rV
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH I5A NCAC 2C, ),),ELL
CONSTRUCTIQ?C-S1}YNDARDS, AND THAT A CAPS OF THIS RECORD HAS BEEN PROVIDED TO TEE WELL OWNER
SIGNATURE OF PERSON CONSTRUCTING THE WELL
Submit the riginnl to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center -Raleigh, NC
27699-1636 Phone No. (919) 733-3J21, within 30 days. GR'-I RF-V. 07:200t
DATE

WELL CONSTRUCTION RECORD 281949
North Cnrohnn - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) arrasB. 2TC'N^.1 CERTIFICATION e 2045
-5
VEL.I. CONTRACTOR CO:IPANY,NAOIE Redden Brothers Well Drillina, Inc PHONE # ( 828 369-9591
STATE. WELL CONSTRUCTION PERMITS ASSOCIATED WQ PERMIT:
(if auelicable) (if aonlicable)
I. WELL USE (Check Applicable Box): Residential 07 MuaicipaliFc'clic ❑ lndustria: ❑ A riouiturai 0
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other 0 1rOl'her, List Use
2. WELL LOCATION:
Nearest Town Sy1Va County ,Tarkcnn
Piney Mtn to Whispering Pine Dr
Na.ne, Numbers, Community, Sdrd'.vision. Lot No Zip Ccde)
3. O'WNER: Daniel Smith
Add: ss 35 Whispering Pine Dr
(Skeet or Rome No.)
Sylva, NC 28779
Gry cr To' r, State Zip Code
(828)- 586-1434
Area cud:- Pnoce mum'cer
u. DATE DRILLED 10-16-03
5.TOTALDEPTH: 140'
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NOX3
7, STATIC WATER LEVEL Below Top of Casing: 100 FT.
(Use "+"'irAbove Tcr ofCasin3)
S. TOP OF CASINO IS 2 FT. Above Land Surface
'Top of casln; terminated a;,'or below land surface requires a
variance In accordance with ISA NCAC ?C .011S.
9. YIELD (gprn): 40 METHOD OF TEST blow
10. WATER ZONES (depth,): 112' & 135'
11. DISINFECTION: Type H T H Amount 16 oz
12. CASING: ka.0 Thia':-ess
Depth Diame;e. or Y'eig:.IFt. Ma'eral
From 0 To 34 Ft. 6" pvr
From 34' To 38 Ft, 6" 188 Steal
From To Ft.
13. GROUT: Depth Material Method
From 0 To 20 Ftl=uite & carat' arced
From To Ft.
14. SCREEN: Depth Diameter S'mtSize Harem:
From To Ft. in, in.
From To Ft. in. in.
15. SAND'GRAVEL PACK:
De"", Size Materi_,
From.
From
To
To Ft.
Topographic/Landse:ting
❑Ridge 031ope ❑Valley CFI_t
tc'oesk appropriate �o )
_atinde'londit:de of well location
L„ir.uc_ ion H>.i DGP ❑To. ot graphic noo
(d,ec's bcl)
DEPTi-i DRILLING LOG
From 70 Forma;' Des_r:o:i_n
0 36' clay & sand
36' 180' cr?nite
LOCATION SKETCH —�
Show d,rection and disiande in miles from
ta,oState Roads or County Roads ,Include ru?, _ I )�
numbers and common road names.
0
W
0
0
C
w
D
IV
+V
16, REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15.A NCAC 2C, WELL
CONSTRUCTION ST NDARDS, AND THAT A COP OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
J r N CONSTRUCTING �a -/G o3
SiGNATL:s. PERSON'CONSTRUCTiNGTHE WELL DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center • Raleigh, NC
27699-1636 Phone Nu. [phone], within 30 days. GVA'-1 REV. 0i/2001

WELL CONSTRUCTION RECORD
Werth Cnro!inn - Deportment of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR {I:NDIVIDUAL)NAME (print) James B. 2row".? CERTIFICATION = 2045
\\ELL CONTRACTOR CONIPA:NY NAME Hedden Brothers Well Drilling, Inc PHONE _ (828 369-9591
SLATE \\EI.L CONSC RUCTION PERJ1ITk
(if acnli:able)
281948
ASSOCIATED WQ PERMIT=
(if aoolicable)
1
WELL USE (Check Applicable Box): Residential Er' N1unicipa1/Publlo ❑ Industrial ❑ Aid r—al 0
Monitoring ❑ Recovery ❑ Heat Purnp Water Injection 0 Other 0 1«Other, List Use
2. WELL LOCATION:
Nearest Town Sylva County Jackson
Bradley Branch last hm on state maint. rd
(Sate Name, Nu,nbers, Comrr_nln, Sobdlvis:on, Lc' No.. Zip Co)de
OWNER Frank Colbert
Address 4950 26th Ave North
(S:ree: or Roue No.)
St Petersburg, FL 33710
Cyr. or Town Sst_ Zip Code
(727). 321-4997
Area code. Phone narncer
Al DATE DRILLED 10-20-03
5. TOTAL DEPTH: 120'
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO SX
7, STATIC WATER LEVEL Below Top of Casing: 75' FT.
(Use eise if A'eove Top orCasin;)
S. TOP OF CASING IS 2 FT. Above Land Surface'
'Top of casing terminated at:or below land surface requires a
variance In accordance with I5A NCAC 2C .0119.
9. YIELD (;pm): 25 METHOD OF TEST b1d
10. WATER ZONES (depth): 80', 105', & 110'
LOCATION SKETCH r---
leas
Showdirection and al ,c r ,:: s fro a
two. State Reads or County Roads Ine1ude the read
numbers and corm :on react names. _
DEPTH
From To
0 40'
40' 120'
T coo-, 'Land settira
❑Ridge ::=Slone GVaaey GFiar.
(check a- r -.. -JC'
ari.l,
Latitudetiongitude of well Io.oat'Ar.
.:a_9on'o'itude source E!CPS.7.2Tcprur
.tsitne tut)
DRILLING LOG
nap
clay & san9
granite
r
DISINFECTION, Type H T H Amount 16 oz
12, CASING: Rail Thickness
Depth Diameter or We: cht'Ft. Material
From 0 To 39 Ft. 66 pvc
From 39' To 42 Ft. 6" 188 steel
From To Ft.
L, GROUT: Depth Material Method
From 0 To 20 Ft,Ltrudte & carat ar a3
From To Ft.
Imo. SCREEN: Depth Diameter SIG: Size Ma:erla,
From To Ptin. in.
Frog To Ft. in. in.
15. SAND'GRAVEL FACK:
Depth Size Material
From. To Ft.
From To Ft.
0
ca
0
0
uD
16. REMARKS:
1 DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH I5A NC.AC 2C, WELL
CONSTRUCTION STARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
SIGNATURE OF PERSON CONSTRUCTING THE WELL
DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. OW -I REV. 07'2-001
ft 3j
5?�

281947
WELL CONSTRUCTION RECORD
Nand; Caroline - Dec_.:mem of Environment and Natural Resources - Division of 1','a:er Quality - GrounchAater Section
WELL CONTRACTOR(NDIVIDLAL) NAME (print) .32.MES B. Pro4,T1 CERTIFICATION 4204S
yELL CONTRACTORCOOIPANYIVA.SIEEedden Brothers Well Drilling, Inc PHONE .s(828 369-9591
STATE. WELL CONSTRUCTION PERMITS ASSOCIATED WQ PERMITS
(if aunlicable) (iffacplica'cle)
WELL USE (Check Applicable Box): Residential' Municical/Public ❑ Indus:real 0 Auriculturai ❑
Monitorin_ ❑ Recovery 0 Heat Pump Water Injection ❑ Other ❑ [Other, Lis: Use
2. WELL LOCATION:
Nearest Town. Sylva County Jackson
264 Tanglewood Drive
(Sae. N,une, N.urSers. Conmuniry, Subc'ir'isi or, Los No., Zip Cede)
OWNER. LLoyd Hoyle Jr.
Ads PO RC% 526 '-
(Street or Rouse No.)
Webster, NC 28788
C,tc or Town Sate
828 t-586-9201
Zip Coe
Are: cal P',:rne n'amher
4. DATE DRILLED 10-02-03
5. TOTAL DEPTH: 380'
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO
7, STATIC WATER LEVEL Below Top ofCasino:
100 FT.
(Use "-,' d Aboaa Tc: of Casing)
S. TO? OF CASING IS 2 FT. Above Land Surface`
'Top of wising terminated aVor below land surface requires a
aarionce in accordance+vlth ISA NCAC:C .0113.
9. YIELD (;pm): 30 METHOD OF TEST blow
10. WATER ZONES (depth): 365'
11, DISINFECTION: Tvae H T H Amount 16 oz
12 CASING: Wall Thickness
Depth D' -eier or Wei;^.t.'F.. Nlaiebal
From 0 To 56 Ft. 6 pvc
From 56' To 71 Ft. 6" .188 steel
From To Ft.
I3. GROUT: Depth Material tNlerho6
From 0 To 20-Ftl-nite&orrt Rrc"
Fror.-, To Ft.
14. SCREEN: Depth Diameter Slot Size Nlaienal
From To Ft. in. in,
From. To Ft. in. in.
,_. SAND'GRAVEL PACK:
Depth Size Nlater;al
From To Ft.
From To Ft.
i6. REMARKS:
Topoeranhic'_and setting
:Ridge :Slope ❑Valley ❑Flat
rcheo);a,propri ate 'rox)
_.l...ue?io'.?Cude of well location
DEFT.
Fro:^, To
0 69'
69' 380'
ce.G'-GPS❑Topa_ra_'hic mac
DRILLING LOG
Fo ._, on Des iocion
clay &
ctanitel
LOCATION SKETCH
Shot. direction and distance in miles fro;
two S:a:e Roads er County Reads Inciud
num'cers and c rrro on road names.
0
N
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH ISA NCAC 2C, WELL
CONSTRUCTION S T AN RDS, AND THAT A COPY OF THIS RECORD HAS EEEEN PROVIDED TO THE WELL OWNER
SIGNATURE OF PERSON CONSTRUCTING THE AYELL DATE
Submit the orig Ito the Division of Water Quality, Groundwater Section, 1636 Mail Service Center -Raleigh, NC
27699-1636 Phone No, [phone], within 30 days. GA1'-I REV. 07/2001
c

281809
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (pent)_�(/�Q1j./,p�/ ' �l'�nz L- CERTIFICATION 77
WELL CONTRACTOR COMPANY NAME)CLOLI.Lxcc.M. .mot /L2C44 ♦LPt1 4i�.p PHONE # (Xvie)I- to f%9 618-, )
STATE WELL CONSTRUCTTON PERMIT# /U/n ASSOCIATED WQ PFRMTT#
(if applicable)
(if applicable)
I. WELL USE (Check Applicable Box): Residential al Municipal/Public ❑ Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection ❑ Other 0 If Other, List Use
2 WELL LOCATION:
Nearest Town:untyr
eiSe/2 876
Subdivision, Lot No., Zip Code)
(Street Name, Num
3. OWNE
Address
( trees Route No.)
m�a� Town o� N.c'.
�(d
Zip Code
Area code- Phone number
4. DATE DRILLED 9/ g D 3
5. TOTAL DEPTH: e..70_ 7�
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO pi
7. STATIC WATER LEVEL Below Top of Casing: v 2 87. FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS / S FT Above Land Surface*
'Top of casing terminated at/or below land surface requires
variance in accordance with ISA NCAC 2C.011&
9. YIELD (gpm): /D METHOD OF TEST"T.C#n -
10. WATER ZONES (depth): // e
11. DISINFECTION: Type Amount
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft
From() To 3 .2- Ft. 6 ,
From, To Ft i
From To Ft.
13. GROUT: Depth Materriali
From 0 To a b Ft. ��.ry�.,e pr
From To Ft.
14. SCREEN: Depth Diameter
From o Ft. in.
From / To Ft. in.
15. SAND/GRAVEL PACK:
th Size Material
From,
From
16. REMARKS:
To Ft.
To Ft.
Topographic/Land setting
❑Ridge %Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minor's/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH, DRILLING LOG
From To Formation Description -
LOCATION SKETCH
Show direction and distance in miles
two State Roads or County Roads. I
Material numbers and ommon road nam
Slot Size Material
in.
in.
5
a r_
e the road
0
C. )
0
N
Ut
0
1 DO HEREBY CERTIFY THAT THIS WF.I r WAS CONSTRUCTED IN ACCORDANCE WITH I5A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
� .,, CZE, 9//e/o 3
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mali Service Center - Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-1 REV. 07/2001

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR(INDIWIDAAL)NAME (print) Mitchell D. Cook CERTIFICATION 2043
PHONE : KS) 369-9591
\\ELL CONTRACTOR COMPANY NA,\IE Iii Brothars kc
STATE WELL CONSTRUCTION PERMIITz
281737
ASSOCIATED WQ PERMIT=
(if applicable) (if apnlicable)
1. WELL USE (Check Applicable Box): Residential 13 Municipal/Public ❑ Industrial ❑ Agricultural ❑
:Monitoring ❑ Recovery ❑ Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION:
Nearest Town: Cashiers County Jackson
N. Norton to Strawberry Hill to Belli fate
(Street Name. Numbers, Community, 5ubd ivisi en, Lot No.. Zip Code)
3, O\VNER: Brian McSweeney
Address 1620 Main Street Suite 12
(Street or Route No.)
Sarasota, FL 34236
Gtv or Town State Zip Code
(941 )- 320-2295 cell
Area code- Phone number
4. DATE DRILLED 10-20-03
5. TOTAL DEPTH: 1700'
6, DOES WELL REPLACE EXISTING WELL? YES 0 NO ARK
7. STATIC WATER LEVEL Below Top of Casino: 900 FT.
(Use "-" if Above Top of Casing)
8, TOP OF CASING IS 2 FT. Above Land Surface*
'Top of casing terminated at/or below land surface requires a
variance in accordance with 1:A NCAC 2C .0118.
9. YIELD (gpm): 6 METHOD OF TEST blow
10. WATER ZONES (depth): 665' & 915'
11. DISINFECTION: Type H T H Amount 16oz
12. CASING: Wail Thickness
Depth Diameter or Weight Ft. Material
From 0 To 19 Ft. 6" pvc
From 19' To 25' Ft. 6" .188 steel
From To Ft.
13. GROUT: Depth Material Method
From 0 To 20 Ftblte & tenant limed
From To Ft.
14. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in.
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth
From To Ft.
From To Ft.
Size Material
16. REMARKS:
Topographic Land setting
❑Ridge ❑Slope DValley ❑Flat
(check appropriate box)
Latitude'lon itude of well location
:0
Er)c
(decrees eoe..,:es seconds) rr,
Latitude'lonaitude source:❑GPS❑Topograph l: map
.;:nch tox)
DEPTH DRILLING LOG
t r
0
Inc
From To Formation Description
0 23' rlay & sr]
23' 1200' granite
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common roai names.
1 DO HEREBY CERTIFY THAT THIS WELL \VAS CONSTRUCTED IN ACCORDANCE WITH ISA NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
3' �X1 20, 7,,, Ia/.2.-©/o3
SIGNATURE OF PERSON CONSTRUCTING THE WELL 6BATE
Submit the original to the Division of Water Quality. Groundwater Section. 1636 A1ail Service Center -Raleigh, NC
27699-1636 Phone No. [phone], within 30 days, GW-1 REV. 07'2001

WELL CONSTRUCTION RECORD 281736
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
CERTIFICATION = 2043
PHONE (t 828) 369-9591
WELL CONTRACTOR (INDIVIDUAL) NAME (print) Mitchell D. Cook
N ELL CON TRACTOR CONIPA,NY N A}1E Han litheS Well Drilling TIL"
STATE WELL CONSTRUCTION PERMITS ASSOCIATED WQ PERMIT=
(if applicable) (if applicable)
WELL USE (Check Applicable Box): Residential L Municipal/Public ❑ Industrial 0 A_ricultura1 ❑
Nionitering 0 Recovery ❑ Heat Pump Water Injection 0 Omer 0 I'3Other, List Use
2. WELL LOCATION:
Nearest Town. Sylva County Jackson
FLRrk Ridge Rd EBCI well
(Street Nm;re. Numbers, Community, Subdivision, Lot No.. Zic Code)
3. OWNER:BettY Luker
Address 41 Wicker RD
(Street or Route Ne.)
Sylva, NC 28779
City or Town State Zip Code
B28) 456-6827
Area cede- Phone number _
4. DATE DRILLED 10-9-03
5. TOTAL DEPTH: 200'
6, DOES WELL REPLACE EXISTING WELL?. YES ❑ NO
7. STATIC WATER LEVEL Below Top of Casing. 45' FT.
(Use "-" if Above Top of Casing)
8. TOP OF CASING IS 2 FT. Above Land Surface
'Top of casing terminated at'or below land surface requires a
variance in accordance with ISA NCAC 2C .0118.
9. FIELD (gpm): 10 NIETHOD OF TEST blew
10. WATER ZONES (depth): 45' & 165'
11 DISINFECTION. Tvoe H T H
12. CASING:
Depth Diameter
From 0 To 31 ' Ft. 6"
From To Ft.
From To Ft.
13. GROUT: Depth
From 0 To 20
From To
14. SCREEN: Depth
From To
From To
15.SAND%GRAVEL PACK:
Depth
From - To
From To
16. REMARKS:
Amount 16oz
Wall Thickness
or Weight'Ft. Ntateria,
.188 steel
Material Method
Ft}xi'rnite & wte1L psmed
Ft.
Diameter Slot Size Alateria'.
Ft. in.
Ft. in. in.
Size Material
Ft.
Ft.
Topographic Land setting
❑Ridge ❑Slcoe ❑Valley 0Flat
(chee:: oror:nate box) '-rrl
Laitude 'longitude of well Ioc_t'c n c) i
(de —
La::tudc'ion_imde source .-GPSE T opo mph,,, ..
:ner: beet
DEPTH DRILLC'n I CC;
0
From To Formation Description
0 29' r-lay & �t11
29' 200' granite
LOCATION SKETCH
Show direction and distance in mile_ from at least
two State Roads or County Roads. Include the road
numbers anal common toad names.
0
w
0
m
0
m
0
VD
l DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH I SA NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE \\ ELL C\NER
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. G\A'-1 REV'. 07.2001

WELL CONSTRUCTION RECORD
281735
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CO\TRACTOR (INDIVIDUAL) NAME (print) Mitchell D. COOk CERTIFICATION# 2043
NY ELL CONTRACTOR COM1PANY NAME H233En aCtillerS l'P11 137.11ir71, Irn PHONE : [phone]
STATE WELL CONSTRUCTION PER.IIT# ASSOCIATED \VQ PERMIT#
(if applicable) (if applicable)
1.
2.
WELL USE (Check Applicable Box): Residential Municipal//Public E industrial ❑ Agricultural ❑
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use
WELL LOCATION:
Nearest Town: Cullowhee
Caney Fork to Brasstown
County Jackson
(Street Name. Number, Community, Subdivision, Lot No.. Zip Code)
3. OWNER Michael & Crystal Johnson
Address 1982 Brasstown Rd
(Street or Route No.)
Cullowhee, NC 28723
City or Tovr. State Zip Code
( 828- 293-5160
Area code- Phone number
4. DATE DRILLED 10-29-03
5, TOTAL DEPTH: 300
6, DOES WELL REPLACE EXISTING WELL? YES 0 NO i§c
7. STATIC WATER LEVEL Below Top of Casing: 200 ET,
(Use "—" if Above Top of Casicg)
8. TOP OF CASING IS 2 FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordance with I5A NCAC 2C .0118.
9. YIELD (gpm): 8 METHOD OF TEST blow
10. WATER ZONES (depth): 1 32' , 21 5' , & 220'
11, DISINFECTION: Type H T H Amount 1 60z
12. CASING: Wall Thickness
Depth Diameter or Weiaht'Ft. Material
From 0 To 126 Ft. 6n -188 steel
From To Ft.
From To Ft.
13. GROUT: Depth Material Nlethod
From 0 To 20 Ftbarnite & ce att carped
From To Ft.
14. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in.
From To Ft. in. in.
15. SAND'GRAVEL PACK:
Depth
To
From
From
Ft.
To Ft.
Size Material
16. REMARKS:
Topographic/Land setting
❑Ridge ❑Slope ❑Valley ❑Flat
(check appropriate box)
Latitude'longitude of well location
(degrees.'rnin'utes: seconds)
Latitudo'longitude source:OGPS❑Topoeraphic map
(check box)
DEPTH DRILLING LOG
From To Formation Description
0 124' day &sard
124' 300' granite
LOCATION SKETCH
Show direction and distance in miles From
two State Roads or County Roads. Include
numbers and common road names.
0
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH liA NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
� r 2/
9,/0-?
SIGNATURE OF PERSON CONSTRUCTING THE WELL D. TE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center -Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-1 REV. 07/2001
o .-
r- ose
—- Jr-TT
cn .0
r 5.
G

281734
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) Mitchell D. COok CERTIFICATION '4 2043
\\ELL CONTRACTOR COMPANY NAME ikl}s1 Bothers If\e-1l rah Ine PHONE e28) 369-9591
5'rATE WELL CONSTRUCTION PERMIT: ASSOCIATED \VQ PERMITa
(if applicable) (if applicable)
I. WELL USE (Check Applicable Box): Residential 29 Municipal/Public ❑ industrial ❑ Agricultural ❑
Monitoring 0 Recovery 0 Heat Pump Water Injection ❑ Other ❑ IC0ther, List Use
2. WELL LOCATION:
Nearest Town: Sylva CountyJackson
Balsam, Willets, Ochre Hill Fire Dept
(Street Name. Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNERpalsam, Willets, Ochre Hill FD
.Address PO Box 291
(Street or Route No
Balsam,NC 28707
Cit.) or Loss State Zip Code
(828)- 586-9331
Area code- Phone number
4, DATE DRILLED 10-28-03
5, TOTAL DEPTH: 200'
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO IN
7. STATIC WATER LEVEL Below Top of Casing: 75 FT.
(Use "-'' if Above Top of Casing)
8. TOP OF CASING IS 2 FT. Above Land Surface*
*Top of easing terminated at/or below land surface requires a
variance in accordance with 15A NCAC 2C .0118.
9. YIELD (epm): 100+ METHOD OF TEST blow
10. ACATER ZONES (depth): 225' & 245'
11. DISINFECTION: Type H T H Amount 16oz
12. CASING: Wall Thickness
Depth Diameter or R'eight.'Ft. Material
From 0 To 84 Ft. 6" .188 steel
From To Ft.
From To Ft.
13. GROUT: Depth Material tNlethod
From 0 To 20 Ftb lhite & Tared
From To Ft,
14. SCREEN: Depth Diameter Slot Size Naterial
From To Ft. in. in.
From To Ft. in. in,
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
Topographic/Land setting
❑Ridge DSlope DValley ❑Flat
(check appropriate box)
Latitude longitude of well location
1deere slalcords)
Latitude longitude sourze:fGPSOTopographiu map
(_'neck box)
DEPTH DRILLING
From To Formation Desc
0 82' . & and
82' 300'
LOCATION SKETCH
Show direction and distance in miles from at ea
two State Roads or County Roads. Include t e road
numbers and common road names.
0
c.a
0
rn
a
0
Nn
16, REMARKS.
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH I SA NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS 1 ECORD HAS BEEN PROVIDED TO THE WELL OWNER
/O czP/D
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Alail Service Center - Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GAV-I REV. 07.-2001
0

283069
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au.%ilt1r. ION (IN UIYtUCwr
y' ry' LOOM__ zu.
Ni LL e
-� —
lappalii
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�4 Yt k w kl t. C'.1♦51 RI C 1'IU? fk:Nrll'i�
• :: a ,eucan
Heat Pump Walei lnjcaion ❑ Other Cl II' Other, List Cse__—
,ua.-: �,. 'j= t(yktk Applicable t3ox r R �ei'icN"!
WELL CONSTRUCTION RECORD �trnum
mankaricostitt COOK5101500:1511. Ai
1nNitt41
. .. � I.) ;�ncltiWfal 0
-yp �Ni nxipultubltc 0 Indust
Topographic Land setting
01.
_ \\ III 1 LUC
� 1 It uauti ot,
Nc
Slope OV a ley
❑RtdEc ❑ 4
ich A anprun.�.+!
-1-�t---'.-�'��� 73 Latitude/longitude Ji'ast
nnm�,:ny. SuFdrvC!nn l ! No Lr� C!tikl
9,(4<.*
.�((f� (C 1' � ie,:!'•r %"�%r ! Z4 ' 1 Zip Coat
Itionta itw11J3•(0,illry++t.'
j ova
NmM1NSf 1
�n--�•Y twi . lOg. 7ht 1011`lp l'
Lutitud_ longitude souGe: '• t
i�S:. - p�'n374I IL1U(j
;. .)4T E. DIM LEU-_V �--
5. TO1.\L DEPTH'__-- - __-
W
N
h DOES WELL. REPLACE EXISTING ELL' YES OO FT
t. LEVEL BCIoW Top g• -- _- _.
�. �I>TiCH',1T:k-: iralw,cTnpnfCm:ng,
` El. Above Land Surface'_ -
__—_-
'reptit eio raturd...cc wart/orb<C CIlea.Grt1L rpNkrf i y -- _ .-
vItILD ioaccordf�ra•wnt'Uwn H2<'OETESTV e _--____ ___
h1F"fZ
v. YIELD tgpml _�Q--. I p gT10� 54: ETC t
UEPf
From To
-
tt;. WATER ZONES (depth):.---1.--
timount
?I UIS1NlE(TIi1N Te'pe µ.all'hickness
!?. CASING DiameterDepth or Wc•.ghtI .
1 ��
hlaleri !
�1Kpt;'i UcP•1i .Q_'�' �..i___
Method
How rFrt it oc`. _.__.-.-
I.; tit.: K! Fh
15 :SANI1 OKAVEL PACK S;x p1aterial
d distano: in milts from at Taal
Maley al number s and common mad names
z3- 4- �.
ICI
Show c,r vtion an
two Styr, Roads or Coun,. RoaaS. Incn:d: the road
0
w
O
i Fri-
O c'
RDS ND THAT A COPS' OF THIS RECORD HAc BE.E\ PRO \'DED 10 7 4E WELL OWNER
ID(�Eik:RLl;, Chin li:,DHAT1HHIS WELL WASCO'�STRUC1ED IN ACC`)PDAN'CE WI1H I.` A Nt �t'3eQ .__
DATE'
f
51(., 171:RE OF PERSON C:UNST{t L(:71 h.i 7H1. \tEL .
thDouoWaehruundw titer Sutton. InJb Mud Stoke Cc�mcr Ralr!gh. NC-
Submit the lioniu :tl ( 191 33 3223. w thin 3 Q
ualitv,(� GA'-1 RL:ei h7._Ct01
:-n4'J•II,tA 1'hnnc Nu. 14141 '!l'�2-'1. within JO does

WELL CONSTRUCTION RECORD 282714
North Carolina - Department of Environment and Natural Resources - Division of Water Oualit> - Groundwater Section
w'ELI. CONTRACTOR (INDIVIDUAL) NAME (print) 1.-1o�� I Y\. _. _I,, ) ). yU D= C FRTIFI(.ATIU,N # I
Q.
WELL CONTRACTOR COMPANY NAME. Gr.e_± N,p_. B1�5.. LQ.1 .).- 4- 1 L....0.0 PIIONI: # Lett eg - 3 1 '1
�t
SPA"lE wilt" CONS RUCTION PERMIT# cX 0 _ — ASSO(tATED WQ PERMrf#
01 applicable) 1 if applicable)
I. WELL USE (Check Applicable Box): Residential calunicipal Public 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection ❑ Other 0 IllOther, List Ose _
3. WELL LOCATION:
Near•st Town:
Strcu Nuntr. Kumhers. Community, Subdn islou, Lon No.. Zip'inlet
3. OWNER:
Address
CI D
r.aAl et C
rein or Route No.) �« t J c , .7`617 �--1 [
Gilt or itt't i State' hip ( ode
I )-
Area code- Phone number
4. DATE DRILLED /L) — /5" -D 3
5. "TOTAL DEPTH: /5/S '
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO
7. STATIC WATER LEVEL Below Top of Casing: ,.. PT.
(Use^t it Abote Top of Lasing)
8. TOP OF CASING IS / ET. Above Land Surface*
*top or casing terminated at/or below land surface requires a
variance in accordancewith 15A NCAC 2C.0118.
9. YIELD (gpm): het) METHOD OF TEST a A rS
•
10. WATER ZONES (depth): ) — gi_CAp_i_"YA
Topographie/Land setting
❑Ridge ❑Slope ❑Valley tat
I check appropriate box}
Latitude longitude of well location
(degrees nunute. Sxond_s)
1- latitude. lon_iulde source:❑OPS❑Topographic map
(check boa
UI-.I'Ill DRILLING LOG
I'tom l t _0_ 3Sd Form, ti n Description
t�
LOC; ATION SKETCH
I I. DISINFECTION: Type _141r9 Amount a_{-1,1_1,_Show ,lireetion and distance in miles frill
12. CASING: Wall Thickness ttto State Roads or County Roads. Induct
Depth Diameter or Weittht Et. Alatent Pundit/is nntl conllnoll road names.
Pronl._�.L__•To 3 Ft.L i t
From "lb Ft.
From lb Pt.
13. GROUT Depth Materiel AIethod
From To .� 6FL CO n-vt, 41
From To Et.
14. SCREEN: Depth Diameter Slot Site
From To Ft. in. in.
From 'Co Pt. in. in.
15. SAND'GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
Material
16. REMARKS:
e
alto'
I S I
oId
1 1)0 HEREBY. ('P.RTIFY ll1ATTIIIS WEl.l. AVAS CONSIRUCII[D IN AC'CURD:ANC'Il WITII 15.A NCAC 2C, AA ELI.
CONSTRUC) ON S'TANDA I)AND TIIAT A COPY OF TIIIS RECORD IL-AS IN PR.OVIDFI) -CO THE \\ EI.I. OWNER
SIGNATURE OF PERSON ('DNSI ItUCfINCi III 1111. D:ATI.
Submit the original to the Division of Water Quality., Groundwater Section, 163n Mail Seri ice ('enter- Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. CiW-1 REV. 07 2001

282694
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Na Iral Resources - Division 11 Water Quality - Groundwater Section
CERTIFICATION # 3 V [� /
WELL (ONFRAClOR (INDIVIDUAL) NAME (print) �� - 3 ?G
WELL CONTRACTOR COMPANY NAME IG r. �� '— //w>`.�-Ul/J I'IIONE # ��
/4/v.2
SPATE WELL CONSTRUCTION PERMIT# _
2
Of applicable)
\SSOCI:\TED \\ Q PERMIT#
t if applicable)
WELL USE (Check Applicable Box): Residential II/Municipal Public 0 Industrial ❑ Agricultural 0
Monitoring ❑ Recovery 0 Heat Pump Water Injection 0 Other 0 IfOther. List Use
WELL LOCAIIO
Nearest Town:_
7 CJ
(Street tame. NuQmhe
Countty
Ca,.vv. pi--e �P�M
Suhd,ision. Lot No.. lip Todd
3- OWNER:.-4 �:��—
Lu kj
Address KL r.�'V{;
YYYhhh oytrc,vo.5-3 `Q
c us or -,tern
l )-
Area code- Phone munher
4. DATE DRILLED - `I -0 3
5. TOTAL DEPTH: / RS'
6. DOES WELL. REPLACE EXISTING WELL? YES ❑ NO Er-
7 STATIC WATER LEVEL Below lop of Casing: Si) PT.
((Ise"1 ` i(Ahorc Top of Casing,
8. TOP OF CASING IS
IO. \V Al 112 LON 1.8 (depth):
FT. Above Land Surface'
"Top of casing terminated at/or below land surface requires a
variance in accordance with I5A NCAC 2C' .11118.
9. YIEI.D (gpm): Lop METHOD OF TEST YS
- 3 qj n-
�,-)O 1 .- 5/ ci LOcA! R)N sKErcit
1 I. DISINPECIION: Tvpe 4 amount 9 f S }I, . Shots direction and distance in miles from at least
12. CASING:
Topogl phic/Land settinc
❑Kidge dope ❑Valley fI0
cticcL uppropri:u hnnl .�
L:uitudelongitude of well loci. nob-.
itieto cgs nunutseconds; q
L:allude. lom_inrle source:❑(iPS❑ Top lrtt tp
(cheek host
I)R[1 I NG l OG
DI P111
From To
-ak
a
Format. )it Description
Wall Thickness INN Slate Roads or County Roads. Include the road
Depth Diameter or Weight In. Material nt nt crO and commas road males.
front 0 To a Ft. to '' --- P v C
From 'To Ft.
From To Ft.
13. GROUT: Depth Material
From n ._ l u cl�i Ft.
From _ To Ft.
14. SCREEN: Depth Diameter Slot Si'c
From To Ft. in.
From to Ft. in. in.
15. SAND/GRAVEL PACK.
Depth Size
From _ To Ft.
From io Ft.
Nlahod
wlatcrial
N latcrtal
16. RENIARRS:
0
W
O
C
0
se
se
CD
(J1
I DU HEREBY (ER FHA' liIAT TIIIS WELL \VAS CONSTRUCT I iD IN ACCORDANCE AA I III IS:A NCAC 2C, WELL
CONSTRUCTION STANDA{2I) ANDIItA'1 A COPY OF THIS RECORD I1-ASI3IFN PROVIDED TO IIIP. WELL OWN lilt
YT% L i 3LLL k f /L - 3/_ O 3
SIGNATURE OF PERSON C ONS ITLGC FIN(.(.TI II-. WAIT L [MIT
Submit the original to the Division of Water Quality, Groundwater Section, 1630 Mail Sen ice ('enter - Raleigh, \C
27699-1636 Phone No. [phone], within 30 days. (iW-I REV. 07. 200I
Lrd

282385
\VELL CONSTRUCTION RECORI)
North C:u'oluld - I)CI) 11Mient Or t-it‘ ironment and' - tural R •. ources - Divisi n el Water Quality - Groundwater Section
V I..II.(-U]lm.A('I OIt(INDIAID( \I,1N:AAll. print) VP////T QA .4j)/1,e(2ER fIf ICAlION :76/
\\I:I I('( ON I I:\(' 101'.(O\II'\\\ iUII( rLCc.hied 7--/ v.,-1 P. _-_. _._----rIIO E a (5.246R. -..5-7.9-
I .\l I.1 \\ 1..1.1. ('OS.S Ili.(: I ION I'1'.12\II'rk
ASSOCIATED AA 0 I'EI(\ii r#
ilal,plic:lhle) (il :pH leahle)
I AVII.I_ LSL': (Check Applicable 13ox): Residcn.lul LK I-ltinlcipalll'ublic ❑ Industrial 0 Auricullulal 0
VIonilnriilg ❑ Iecovcry 0 ilea( I'nnp CV:',er Injection ❑ Other ❑ If Uthcr, I.ist Use
VA Id.1.. I.00 V I ION: • 11: S.
FLOH
.�
1' �o erc_e-��
Vi ai N.iwr. N ut ua. Cuiriniunity, Subdl✓_ in. IAlt No /_ip Cole)
t 11ANIR: C'
\vIdles. ��r /Ce ',c/
779
-I.
7
'I.
u
('ll\ ur l,unl }Aq ic� Lip ('a,ic
�
( )- '�`S(c- augh
Al...! credo I'hvi. uiiinh,r IL\ [I! URII.LED1Q - a29
- `o3
rOIAl. Dl:I'II /5/' f.f
DULS VVEL1- RLI'LACE EXISTING WELL! YI S -❑�1 NO
S EATIC AVA TER LEVEL Below Top oiCasin_: U9J fT.
(Ise 'it Ab„)L lop ol(asinpl
1 ()1' VI: CASING IS R F'f. Above Lund Surface"*
'top urc:rsiu„ lerniinatetl :tt/ur L, li,n I.uul surfue rc:;::ices a
variance iu acci,rd:uac midi I5.k NC:\C 2C.0118.
VHELD tepinl: h iNIL!TI IUD OF TEST /gir- l
VV,ATI!R ZONES (depth): -
Topt)al )IIic1L)nd setting
❑Ridge Sit 1 e ❑Valle\ �l I n;
I dieck applopipaw ln,a
Luliludc'Ioniiludc lic Weil hoc ua ';
11 Srecshulml wundsl ":I
[al H.H.11/42/1Lunlitint, source:❑GI S❑Topoorollie map
l k bosh
DEPTH DRILI-14 F; LOG
[ J
1.1o1I1 TO nI atiun )escripliot `-
I/,i Y
6 Ll 86
s /9s
Co
W
itC
I I_ DISINFECTION - Type Ann".uu
i_. CASING: A'all hiekocss
Depth I,)ianxlcr or V. uiuhi I-t_ ALterial
I1nni /IR, To Sj I.t.& fir/5 /7D lee /
1 it,nl la I'1.
i i ([ ( IU r. Uclnit Matcrtal Method
Pnm1 C-_.-IO-‘C) Et.ZAr .v7/- /./_m '_—.
I mu it II
I -I. S(RI.IthI I)eptl, Di:tweIet Slot Mato eil
I t„nt To I'I.
I lnai ro I I.
15 S:ANU(iRACF1, PACK:
Depth Site :Material
I loin lb lal.
I tont ro R.
III I: 1'. AI:AI<hs
n
LOCATION SKETCH I I 3 _ -
Shoo direction and distance in miles Irani al IeasT'li,:
two Slate Roads or County Roads. InclLid i • nmdcI-
nul➢beiS and common road names. ter•,
W V,;_
Na
o
1 I.n) 1 ILRI:IR( CERTIFY "Il I:\ I TI IIS WELL \VAS Ct.-NSRtJCLED IN .ACCORDANCE Will 115r\ NCAC 2C, WELL
CONS I<YCTION STANDARDS. AND TIIAT A COPY OE THIS RECORD HAS BEEN PROVIDED TO 111H WELL OWNER
t • _d_
SIGNATURE OF I'EKSON CONSTRUCTING ll-IE WELL
DATE
Suhmil the original to the Division of Water Qu:lity, Groundwater Section, Io36 Mail Service Center- Raleigh, NC
2709-I636 Plume No.1919) 733-3221. within 31) (lays. GW-I REV. 07/2001
LLt

282380
Groundwater Section
` CCERTIFICATIONk
\\.l NIlt C .\((' 'POIUAII'.\N\ NAME( / c1 /g / t'?c PHONE 4 6t33)'\'/7 "7
na-uti`/g
SI.CIT: \\ 111.1. CONS I RI'(''I ION 11.101114 ASSOCIATED \\'Q PERMED/
if applicuhlc) (ir applicablc)
I. AV'NLI. USIL (('heck Applicable Box I: Residemiul 12<MunicipaLl'ublic ❑ h)duslrial 0 Agricultural 0
Vlocilining ❑ Rcrovcry 0 I Ira Pump AValet' Injection ❑ Other 0 If Other, List Use
2. WELL I L LOCATION:
N%�o Cm est town. 4 / e',5if' oIIvJMdea
/
11 ikiLVNf /Yin
ISI«:1 Nwnc. Nwuhcr.. ('on nnunily. Subdnision, Lal No.. Zip Cudcl
3. OWNER. vs- c`[ot/4�
ye
ISIical i.al
�Pr�t��/ �19 3 i/6i5
Cnc or t LOOI Aldle
8 )- 5/54 — (9175-
Arca c,nl. Phone number.
4. DAII! 1R11.1.1!D�('-'_ 62,}
5. TOTAL DEI'TI I: •-2
Zip code
6. DONS VA'NL.I. RNI'LAC'L EXISTING WELL? V'ES ❑
.21opoglaph is/Land setting
Gr12idge ❑Slope DValley 011
(check appn pniil box)
Lalitudc'lorWIEltic of well location
(U.:grecs odnoic'boamdsl
Laliludcilongilude source:❑GPS❑Togo I I
/check bo.x)
DEPTH DRILLING
From To P/
ara Viol
( Jv /
_42
3 /
NO EPIC r<)6S
7. STATIC AV 1TI[It LEVEL Below Top of C'asioe: %O I -'I .
(Ltic_4-d.Alaw iOp nr Caano
S. IITP )f ' \SING IS _ _ _ I f. �Abocc Land Sulfuce*
ou or caning Ice miu:oed at/or Rehm land surface requires a
adance in accordance „ill 15,\ NC.\C 2C .1111N.
9. YII:LD(gpml: .5 VMNIIIODOI'TISSI ,C)•f"
10_ WATER ZONES (depth):
r _7
�/O :G7_y N� jTvNe
Ic� ifA N f 1
Le
c
z
z
C. -
I I_ DISINPIiCIION. Tvpc N T11 Amount
12. CASING: Wall Thickness
Depth Diatihner or AA'ciehYPt. NI: F erial
From i) To (! / II 4 7// tic< .)---ve / .3 " ��/
From 10 I I. ,�
lti
from To Il.
13. GROUT: Dcplh :ALdlenal Method
From C _
front IA, 1•1.
11. SCREEN: [N: Depth Diwmnci Slot sihr M;Ilenal
Prom To PL___... in. _.._._ _.. in.
Prom Ib PI. in. in.
15. SAND GI(:AA L I PACK:
Depth Site Ntaleriul
Prom To 1.1. Z c—'
from To 1:1. C cif
I o.-
=r
'D ��
3 rnrr)
I DO I II:REI3V' CERTIFY lI I:AITI IIS WEI.1 \VAS CONSTRUCTED IN ACCORDANCE WIII I 1.5A NCAC 2C. WELL
�.ti
UII CONS IRCON STANDARDS. AND l I IA I A COPY Of THIS R[C012D I-IAS BLLN PROVIDED TO TI IE WELL OWNL9 rmz
",;2: -0
16. R[NIARKS:
WELL CONSTRUCTION RECORD
North C .00lina - Department of I. uv inuunwnt and Natural Resources Division of Water Quality
VAEI.I(OVIII.A("I OR (INDIAI111A1) N AIDprint) ci1_'-( 6 Gtor.K6/NI
LOCATION SK E:LCI I CL
Show direction and distance in miles lroIii least
two State Roads or County Roads. Includete roams
numbers and common rood names. CDj c
S �I('N;AII11:[ 0f I'I`RSON' CONS IItUC`IING'1I Ili \\'ELI. DATE
Submit h • original to the Division of \\';der Quality, Groundwater Section, 1636 plait Service Center- Raleigh, NC
27699-I61( Phone No. [phone], within 30 days. GAV-I REV. 07/2001

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) James B. Brown CERTIFICATION 2045
\VELL CONTRACTOR COMPANY NAME FIden Brothers Well Drilling, Inc PHONE #f 828 369-9591
282320
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED \WQ PERMIT#
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential Municipal/Public 0 Industrial 0 Agricultural ❑
NIonitoring 0 Recovery 0 Heat Pump Water injection 0 Other ❑ If Other, List Use
2. WELL LOCATION:
Nearest Town: Sy1Va County Jackson
Green's Creek —Ivy Ridge Phase 1 Lot #2
(Street Name, Numbers, Community, Subdisision, Lot No.. Zip Code)
3. OWNER: Dean & Sandra Hedges
Address 6633 Jog Palm Drive
(Street or Route No.)
Boynton Beach, FL 33437
City or Town State Zip Code
( 561)- 386-7672
Area code- Phone number
4. DATE DRILLED 5-1 3-02
5. TOTAL DEPTH: 200'
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO DK
7. STATIC WATER LEVEL Below Top of Casing: 100 FT.
(Use "—" if Above Top of Casing)
8. TOP OF CASING IS 2 FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordance with 15A NCAC 2C .0118.
9. YIELD (pm): 80+ METHOD OF TEST blow
10. WATER ZONES (depth): 70' & 190'
11 DISINFECTION: Type
12. CASING:
From
From
H T H
Depth Diameter
0 To 48' Ft. 6"
48' To 52' Ft. 6"
From To
13. GROUT: Depth
From 0 To 20
From To
Depth
To
To
14. SCREEN:
From
From
15. SAND/GRAVEL PACK
Depth
From To
From To
16. REMARKS:
Ft.
Amount 16 oz
Wall Thickness
or WeighCR. Material
pvc
188 steel
Material Method
Ft tanlite & cerent prrre i
Ft.
Diameter Slot Size Material
Ft. in. in.
Ft. in. in.
Ft.
Ft.
Size Material
TopographicrLand setting
❑Ridge ❑Slope ❑\'alley IFlat;
(check appropriate box)
Latitude/ longitude of well loca/->
T' c
Latitude%longitude source:❑GPS❑Topogr3�hi� ma�
(degrees minutes secondst
DEPTH
From To
0 50'
50' 200'
(check box)
DRILLING L G
Formation 0DeLifi1
clay & s W ()
granite nO
0
O
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common road names.
O
w
0
CO
W
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION ST.Aj ARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
,yam teSZCZ-7, .' ^i 3 —0 '
SIGN'A URE OF PERSON CONSTRUCTING THE WELL DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center -Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-I REV. 07/2001

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NANIE (print) James B. Brown CERTIFICATION c 2045
\ELL CONTRACTOR CO>1PANYNAME Redden Brothers Well Drilling, Inc PHONE ( 828 '169-9591
SLATE. WELL CONSTRUCTION PERMIT? ASSOCIATED \VQ PERMIT:
(if applicable) (if applicable)
282319
1. WELL USE (Check Applicable Box): Residential I" Municipal:Public 0 Industrial ❑ Agricultural 0
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other 0 If Other, List Use
2. WELL LOCATION:
Nearest Town: Dillsboro
493 Cowee Tunnel Rd
(S:r<ti Name, Numbers. Community, Subdiyisloa. Lot No., Zip Code)
3. OWNER: Sam Hearnsberger
Address 18650 Hiway 55
(Street or Route No.)
Silverhill, AL 36576
City or Town State Zip Code
(251 )- 989-2873
Area code- Phone number
4. DATE DRILLED 6-5-03
5, TOTAL DEPTH: 200'
6, DOES WELL REPLACE EXISTING WELL? YES ❑ NO ›
7. STATIC WATER LEVEL Below Top of Casing: 75' FT.
(Use "-r' if Above Top of Casing)
3. TOP OF CASING IS 2 FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordance with 15A NCAC 2C .0118.
9. YIELD (gpm): 50 METHOD OF TEST blow
10- WATER ZONES (depth): 139' , 165, & 195'
County Jackson
11. DISINFECTION`. Type H T H Amount 1 6 oz
12. CASING: Wall Thickness
Depth Diameter or Weight'Ft. Nlaterial
From 0 To 22 Ft. 6" pvc
From To Ft
From To Ft.
I . GROUT: Depth Material Nlethod
From 0 To 20 Ft ntte & °mart }ur1116:1
Ft.
From To
14. SCREEN: Depth Diameter Sot Size Material
From To Ft. in. in.
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From
From
16.REMARKS:
To Ft.
To Ft.
coupling at the bottom
<<D
r
rn rl
mn
Topographic/Land setting cog;
❑Ridge ❑Slope ❑Valley Cif,
(check appropriate box) ca
o_t
Latitude/longitude of well local cpo
(degrees.'minutes. seconds)
Latitude longitude source:❑GPS❑Togo; raphic ma
(:heck box)
DEPTH DRILLING LOG
From To Formation Description
0 20' clay & sand
20' 200' granite
0
O c3
(1 2 ---
CJ
CO
LOCATION SKETCH
Show direction and distance in miles from®IeasH
two State Roads or County Roads. InciudeWe ro2
numbers and common road names.
F 1-4'
0
W
L
c-)
0
—o
1
CJ.)
CO
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION SURDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-1 REV. 07t2001

282318
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
CERTIFICATION et 2045
828 369-9591
WELL CONTRACTOR (INDIVIDUAL) NAME (print) James B. Brown
w ELL CONTRACTOR CONI PAN stNAME Hedden Brothers Well Drilling, Inc PHONE p
STATE \WELL CONSTRUCTION PERAIIT4 ASSOCIATED VVQ PERMIT:
(if applicable) (if applicable)
WELL USE (Check Applicable Box): Residential 1 Municipal Public ❑ Industrial 0 Agricuitura
Monitoring ❑ Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION:
Nearest Town: Cullowhee
#6 Stone Haven Drive
(Steel N' ame, Numbers. Community, Subdivision, Lot No., Zip Code)
3. 0\WNER: Anthony & Wendy Wilkinson
Address 2440 Caney Fork Rd
(Street or Route No.)
Cullowhee, NC 28723
City or To.m State
(828)- 293-7191
Area code- Phone number
4. DATE DRILLED 6-6-03
5. TOTAL DEPTH: 400'
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO
7. STATIC WATER LEVEL Below Top of Casing: 300 FT.
(Cse' if Above Top of Casing)
8. TOP OF CASING IS 2 FT. Above Land Surface*
`Top of casing terminated at,'or below land surface requires a
variance in accordance with l5A NCAC 2C .0118.
9. YIELD (gpm): 10 [METHOD OF TEST blow
10. WATER ZONES (depth): 170' & 305'
County Jackson
Zip Code
I I. DISINFECTION: Type H T H
12, CASING:
Depth Diameter
From 0 To 90...Ft, 6"
From To Ft.
From To Ft.
13. GROUT: Depth
From 0 To
From To
14. SCREEN: Depth
From To
From To
15. SAND)GRAVEL PACK:
Depth Size
From To Ft.
From To Ft.
Amount 16 oz
Wall Thickness
or AVeioht.'Ft. Material
.188 steal
Nlaterial
20 Fite -mite & carat
Ft.
Diameter Slot Size
Ft. in. in.
Ft. in. in.
16.REMARKS:
Method
pxrced
Material
Nlaterial
H
Topographic'Land set In>1
❑Ridge ❑Slope ❑N'alley't4 lat
(check appropriate box) �
Latitude'longitude of well n
c"
C
(degrees minutes seconds)
Latitude 'longitude source:OGPSO t opographi t
(check box)
DEPTH DRILLING LOG
From To Formation Description
0 88' clay & sandy
88' 400! granite
c
O
0
CD
O
0
csa
1
W =,
LOCATION SKETCH O
Show direction and distance in miles Bong? Ieasp
two State Roads or County Roads. Include the road
numbers and cor rnon road names.
1 DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION NDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
1GN
E OF PERSON CONSTRUCTING THE WELL
DATE
c>
Submit the original to the Division of Water Quality, Groundwater Section. 1636 Mail Service Center - Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-I REV. 07/2001

276581
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Ntiatural Resources Dive.
iv Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) r
0
Y/L/!CERTIFICATION M aZ ci 3
NAME (print) Ell
PHONE q �Zfl� �s_—'Z S5
WELL CONTRACTOR COMPANY NAME rn//el h1� l I tit 1 I 1 (\rj
STATE WELL CONSTRUCTION PERMIT"ASSOCIATED WQ PERMIT#(if applicable)
(if applicable)
1. WELL USE (Check Applicable Box): Residential �Municipal/Pubhc ❑ Industrial ❑ Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION:/ //
Nearest Town: CL,erv)(Lee.
l5 40,k fa
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: --)0`u2dariL Tv,,(/!
Address CIthf( f f' PI) W4 YL1�
(Street or Route No.) 1,1n1 ^
ono ovs
City or Town State Zip Code
Ares code- Phone number
4. DATE DRILLED 7,7o - ° I
5 TOTAL DEPTH: /G 0
County -Mc ks0h
30 — /Go
6 DOES WELL REPLACE EXISTING WELL? YES ❑ NO 0-
7. STATIC WATER LEVEL Below Top of Casing: 3 O FT.
, (Use "+" if Above Top of Casing)
8. TOP OF CASING IS z- FT. Above Land Surface'
*Top of casing terminated at/or below land surface requires •
variance In accordance with ISA NCAC 2C .0118.
9. YIELD (gpm): 30 METHOD OF TEST /T '-
10. WATER ZONES (depth): /So
11. DISINFECTION: Type //TH
12. CASING:
Depth
From 0 To yl
From To
From To
13. GROUT: Depth
From 0 To
From_ To 20
14. SCREEN: Depth
From To Ft. in.
From To Ft. ....
IS. SAND/GRAVEL PACK:
Depth
From To.
From To
Ft.
Ft.
Diameter
Ft. G-2.r
Ft.
Ft.
Ft. Aaten¢¢1
i71Svid
Ft. derfcd,rt
Diameter Slot Size Material
in.
in.
Amount 'l1 cc/
Wall Thickness
or Weight/Ft. Material
OR.21 Qoc-
Method
Leif e
e
Size Material
Topographic/Land setting
❑Ridge ❑Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
v35''19 Ob.S' wave j.%o"
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From To Formation Description
(7 — cl '%
3o
(jtaq, /
LOCATION SKETCH
Show direction and distance in miles from east':
two State Roads or County Roads. Include Ca road;
numbers and common road names.jt
Ir•1'
O
03 c:
16. REMARKS:
r! I
1 .1 DO HEREBY CgRfij*Y THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
I L' f — CONSTRUCTION ST DARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
2-A0-63
DATE
SIGNATURE OF PERSON CONSTRUCTING THE WELL
Submit the 'briglnal t the Division of Water Quality, Groundwater Section, 1636 Mall Service Ceenller' RREVgh, C01
t __Z.yyt.h36-ghene No: 19)733-3221, within 30 days.

276580
11'ELL CONSTRUCTION);
Lam"=
on
;Audi' Cmuliva - Ucpal farad of liuvlwuutctl mid tda,/�llcsutlet9, Ivlslun of 1Vnlct OaalilY "CIEnIrIrIG-11uN �Iwn
e10 J ��GGDD .Li s -•Zft1
ac FAA, CON IIUC'I UR UNun•IuuAl.)NAnIc ✓lr,/%�)�—��'— �\ NOME II ly 18"
w' CLI, CON IIIACI Olt COMPANY NAME— —1 WllJ St` _
ASSUCIAI PII WO PP.ItP11Ilr
SI A I F. t+f 1.L CONS 11t1IC111IN 1'F.IUI11 __--- if n r rlicnblc
it n iliatblcI. \\'I I,L UST (Check Applicable
i 1011itd Ler/t.luuiclpal/I'ulrlic U IutlttsItial 1J Aglicullulal U
it
I 11 ): Iles'
Mouilolltg U Rrcnvely LI heat I'uuq' \Vnlcl Injection LI tither U If Other, Us( WC
'fupnlnnpllir/Lnnd ertling
2. S Ultidgc IJSIopc UVnlIry UI'Inl
(511,41t nitiopikir
LnIlluddlungllude of well location ,
/3.? wOfl C'es: c•
Idrptrrdndnntrdt--�nd•1
Lnlilud:!I^npihldo Siutce _RII S'J l npoglapllic ur•It
L)I111.LIIIU 1,1H7
Yolrttalio❑ Ucscliptiuu
Sri
/47`
Lt)h-
Ncnrecl'Iowii:_CE/& e County Ora
---
J� "-- C< Lr'.
n.a S II dtvkIon, 1. I li , 71p Cwlr)
ISlrt<l flame. Ilundm , �.' .
I)1.
vaPll[RJea/1/1`e- ±ru//skc
—
Addlc99 _ l2_721—
IStrrt of Route Ion.)
City Im•n Slnle
tor, cr-tr. Muffle mnnbei �.v)
.1. IJAl1 Nltll1I°1)_� b
5. :WEAL. I)IEEN'l ll:_rt0-kr
6. IAIIiS vvi[I.1, RPI'I,ACR. I.XISIIIJO AVE1.1;1 YES© NU Fr
1. SfAlll;AA'AI-EII LEVEL IIcIoo(lige"rlotr II Nwae -Inp DI Cnilop)
R. .1(111 UPCAIS
..fAbove hind Sul Ece•
• ir r.dntbtulln.p,1 .11rr Imd ',flint rtrpJtn
r Wontr In er<m Jd¢r nllh ISA NCAC ]C.nrllt.
20 NMI11U1)0I'1PS3/'
` Ti __
Mr Code
III\VA I eft 7,UI11:S (depth): _ 025-r— -- — —
,I,) r� — Amuoul�_1-_
II. UISINfI!CfIUN:1)pc�---\Vnll"Ildcknca
IZ CASINO: Diameter orWeight/It Nlnitrini
Irr pllt Ge2S ,/ff gee/
D lo�ZC 1.1._, - -
Ilom
10--_ 1•1- ---_
fnnn—
now_ _"I)o- tt.ln�lc) inl Melbcnl
11, 0101U1 ltcpth nt /pSfuiL
2 n 7- at—
IlOM_ IIl _il_
linntrlcl Slut Sirn Mnlctini
Id. SCPI:pt1 Itcpllo Ito
___in.
Tv__._ II.__ill.
h0nt_-_ -- --
15. SAN U)U R.AVI'1• PACK: Sire Mnlrllnl
Depth
Hon_ Ion__ I'I __ ------
__
1.1
Rout lo______ __ — --
plum to
p - L0
60 ." 72,60
Show direction nntl r!inlnuce itt toile, Bout nl len-1
Iwo Stale Itondl or Coutly Itondl. Include IhC1 road
lt0ilbcts nod collllnn❑ loud tatic9. Or""-'
O
Cr)
16- Il1 N1ARKS-------
i Th. 1 1 Utlall IUIIS CEP, 0111;.1111A1 I IIIS WI'I 1, WAS CONS I1I11CI1!U 111 ACCORDANCE AVIM ISA IICAC ZC V/I'LI.
C0!T5TR111:1lows 1A1 191(ORUS, A 40-1IIAt ACOPY UP'I111S RECUIIU 11AS BEEN I'lIUV1UEU'1 1217 E!LLU ---
�µ _e�c z-- -------- unl R
SIUNALURE UI' I'ERSUll CUIJS11lUCII1JU 111E WELL
Peddle', NC
1
Subnotl Iltr tirlglnnl Io II a IIhIJon of \I'nlrr 1lunlllp, Clnmldrvnlcr Section, 1616 Mill Service Center - Peddle',NC
_1II19,IU36y ucir,�pl�)1JJ-J))1, wllllhr ]II tiny]. UVJrI REV.
w

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
CERTIFICATION # 2045
MELT CONTRACTOR COMPANY NAMEHedden Brothers Well Drilling, Inc PHONE rJ828 369-9591
STATE WELL CONSTRUCTION PERMIT'- ASSOCIATED \VQ PERMIT=
(if applicable) (if applicable)
WELL CONTRACTOR (INDIVIDUAL) NAME (print) James B. Brown
276473
I. WELL USE (Check Applicable Box): Residential g Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring ❑ Recovery 0 Heat Pump Water Injection 0 Other ❑ If Other, List Use
2. WELL LOCATION:
Nearest Town: Cashiers County Jackson
Laurel Knob-Terrabrook Project Well #3
(Street Name, Numbers, Community, Subdisisi on. Lot No.. Zip Code)
3 OWNER: Terrabrook
Address 3505 Frontage RD Suite 145
(Street or Route No.)
Tampa, FL 33607
City or Ton r, State Zip Code
028 )-697-7334
Area code- Phone number
4, DATE DRILLED 5-28-03
5. TOTAL DEPTH: 1000'
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO
7. STATIC WATER LEVEL Below Top of Casing: 500' FT.
(Use "+" If Above Top of Casing)
S. TOP OF CASING IS 2 FT. Above Land Surface'
•Top of vas ing terminated a t;or below land surface requires a
variance in accordance with 15A NCAC 2C .0119.
9. YIELD (gpm): 25 NIETHOD OF TEST blow
10. WATER ZONES (depth): 245' & 545'
11 DISINFECTION: Tvpe H T H Amount 16 oz
12. CASING: Wall Thickness
Depth Diameter or Weidht'Ft. Nlaterial
From 0 To 23 Ft. 6" PVC
From To Ft.
From To Ft.
13. GROUT: Depth Material Method
From 0 To 20 Ft La ite & cerent Tut»\
From To Ft.
14 SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in.
From To Ft. in. in.
15.SAND'GRAVELPACK
:
Depth
To Ft.
To Ft.
From
From
Size :Material
Topographic,'Land setting
❑Ridge ❑Slope ❑Valley ❑Flat
(check appropriate box)
Latitude'longitude of well location
(degrees l inutes. seconds)
Latitude'longitude source:❑GPS❑Topographic map
(:hecc box)
DEPTH DRILLING LOG
From To Formation Description
0 21' clay & sand
21' 1000' unite
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common road names.
c,)
r_
saw
0
16. REMARKS: This well is to be abandoned ASAP
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH I5A NCAC 2C, WELL
CONSTRUCTION STANj1ARDS. AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
h
� NATTL'RE OF PERSON CONSTRUCTING THE WELL D.ATE`:1
Submit the original to the Division of 11'ater Quality, Groundwater Section, 1636 Mail Service Centerh Raleigh, NC
27699-1636 Phone No, [phone], within 30 days. GW-1 IEV. 07r2001
0 :o
0

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Rater Quality - Groundwater Section
CERTIFICATION % 2045
PHONE 7 j 828 369-9591
WELL CONTRACTOR (INDIVIDUAL) NAME (print) James B. Brown
\\ELL COYIRACTORCOMPANYNAMEHedden Brothers Well Drilling, Inc
2764'72
SLATE \VEI.L CONSTRUCTION PERMITa ASSOCIATED wQ PERMIT=
(if applicable) (if applicable)
I. WELL USE (Check Applicable Box): Residential Municipal Public ❑ Industrial ❑ .Aoricultural 0
Monitoring 0 Recovery ❑ Heat Pump Water Injection ❑ Other ❑ IC Other, List Use
2. WELL LOCATION:
Nearest Town: Glenville County Jackson
Cullowhee Forest Lot 7 & 8
to;ree: Name. Numbers, Community. 5ubdis i sion, Lot No., Zip Cod:)
3. OWNER: Tim Stone
Address 15868 Silverado Court SW
(Street or Route No_)
Ft. Myers, FL 32908
City or Town State
(239)_ 476-8822
Area code- Phone number
4. DATE DRILLED 6-24-03
S. TOTAL DEPTH: 570'
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO
7. STATIC WATER LEVEL Below Top of Casing.: 175' FT.
(L'se "s ' if Above Top of Casino)
8. TOP OF CASING IS 2 FT. Above Land Surface"
"Top of rasing terminated at/or below land surface requires a
ariance in accordance with 15A NCAC 2C .0118.
9. YIELD (gpm): 1,5 METHOD OF TEST blow
10. WATER ZONES (depth): 200'
Zip Code
II, DISINFECTION: Type H T H
12. CASING:
Depth Diameter
From 0 To 65' Ft. 6"
From To Ft.
From To Ft.
13. GROUT: Depth Material Method
From 0 To 20 Ft ite & cerent RrF-al
From To Ft.
14. SCREEN: Depth Diameter Slot Size Naterial
From To Ft. in. in.
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Size Material
Amount 16 oz
Wall Thickness
or Weight'Ft. Material
pvc
From To Ft.
From To Ft.
16. REMARKS.
Topographic Land setting
❑Ridge ❑Slope ❑\'alley ❑Flat
(check appropriate boa)
Latitudelon_itude of well location
(decrees :::Irm tes'seconds)
Latitudciloneitude source.❑GPS❑Topographic map
-.s box)
DEPTH DRILLING LOG
From To Formation Description
0 63' clay & sandy
63' 570'
granite
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common road names.
7-7
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH ISA NCAC 2C, WELL
CONSTRUCTION STANJ3.jRDS. AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
/17112-c0-"/
SIGNATURE OF PERSON CONSTRUCTING THE WELL DAME''
Submit the original to the Division of \Pater Quality, Groundwater Section, 1636 Mail Senlce!C2n't§r-Raleigh, NC
27699-1636 Phone No. [phone], within 30 days.
r%s . Y1l
I G'-1 REV. 07.'2001
�;I

276471
«'ELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
VA ELL CONTRACTOR (INDIVIDUAL) NA,AIE (print) James B. Brown
\ELL CONTRACTOR COMPANY NAME Hedden Brothers Well Drilling. Inc PHONE k J 828 369-9591
STATE \\ ELL CONSTRUCTION PERMIT; ASSOCIATED \\Q PERMIT
(if applicable)
(if applicable)
CERTIFICATION = 2045
I. WELL USE (Check Applicable Box): Residential.. Nlunicipal:Public ❑ Industrial ❑ Agricultural ❑
Nlonitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other ❑ II -Other, List Use
2. WELL LOCATION.
Nearest Town: Sylva
#205 Shealea Lane
ts:reer Name, M.unbers, Community, S. u'bdi vi si ou. Lot No., Zip Code'
3. OWNER:
Address
County Jackson
Paul & RRrbara Lewis
395 Shealea Lane
(Street or Route No.)
Sylva, NC 28779
C it;: or Tom m State
(828)- 586-3413
Area code- Phone number
4, DATE DRILLED 7-8-03
TOTAL DEPTH: 600'
DOES WELL REPLACE EXISTING WELL? YES ❑ NO Er
i
6.
i. STATIC WATER LEVEL Below Top of Casing: 500' FT.
(Use •"sr" if Abo:'e Top pi -Casing)
3. TOP OF CASING IS 2 FT. Above Land Surface*
'Top of casing terminated at/or below land surface requires a
variance in accordance with ISA NCAC 2C.011S.
9. YIELD (gprn): 3 METHOD OF TEST blow
10 WATER ZONES (depth): 145'
Zip Code
11- DISINFECTION: Type H T H
12. CASING:
Depth Diameter
From 0 To 43 Ft. 6"
From 43' To 64' Ft. 6"
From To Ft.
13. GROUT: Depth Material
From 0 To 20Ftlarnits & wtsr
From To Ft.
14- SCREEN: Depth Diameter
From To Ft. in.
From To Ft. in.
15. SAND -GRAVEL PACK:
Depth
From To Ft.
Amount 16 oz
Wall Thickness
or Weicht Ft. Material
pVC
1RR c*pel
Method
17-ticed
SlotSize Material
in.
in,
Size Material
Topographic.'Land setting
❑Ridge ❑Slope ❑Valley ❑Flat
(check appropriate box)
Latitude'longitude of well location
(degrees 'minutes seconds'
Latitude'loneitude source:❑GPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From To Formation Description
0 62' clay & sand
62' 600' granite
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common road names.
From To Ft,
16. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH ISA NCAC 2C, WELL
CONSTRUCTION ':.NDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
SIGNA
LIRE OF PERSON CONSTRCCTING THE WELL DA
0
c.a
C.—
cn
,r
0
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Cente RAleigh, NC
27699-1636 Phone No. [phone], within 30 days. GAVfLR;=.A. 07.2001
c•

er
276470
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Rater Quality - Groundwater Section
\\ ELL CONTRACTOR (INDIVIDUAL) NAME (print) James B. Brown CERTIFICATION''- 2045
w ELL CONTRACTOR COMPANY NAME $edden Brothers Well Drilling, Inc PHONE = f 828 369-9591
SLATE \\ELL CONSTRUCTION PERMIT? ASSOCIATED \PQ PERMIT
(if ap',>licnble) (if applicable)
1- WELL USE (Check Applicable Box): Residential XI Municipal:Public 0 Industrial ❑ Agricultural ❑
Monitoring 0 Recovery 0 Heat Pump Water Injection ❑ Other ❑ If Other, List Use
2 WELL LOCATION:
Nearest Town: Sy1Va Count. Jackson
Brooks Branch to Laterns' Wick Tract #9
(Street Name, Num.bc:s, Community, Subdivision, Lot No, Zip Code)
3. OWNER: Ted Kilpatrick
Address 8238 Hollyhill RD
(Street or Route No.)
Pensacola, FL 32526
City or Town State Zip Code
(850)- 941-8681
Area rode- Phone number
DATE DRILLED 7-10-03
4.
5. TOTAL DEPTH: 450'
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO IOC
7.
STATIC WATER LEVEL Below Top of Casino: 400' FT.
(Use -4" if Above Top of Casing)
3. TOP OF CASING IS 2 FT. Above Land Surface'`
*Top of casing terminated attar below land surface requires a
variance in accordance with ISA NCAC 2C .0118.
9. YIELD (gpm): 4 METHOD OF TEST blow
10 WATER ZONES (depth): 245'
II. DISINFECTION: Type H T H Amount 16 02
Wall Thickness
13. CASING:
Depth Diameter or Weight Ft
From 0 To 111 Ft, 6
From 111 ' To 115 Ft. 6" -188
Material
pvc
G PPS
From To Ft.
13. GROUT: Depth tNLteria! Method
From 0 To 20 Ftb dte & mot. >zntfl
From To Ft.
14. SCREEN: Depth Diameter Slot Size Nlater.u'.
From To Ft. in. in.
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
16. REMARKS'.
Topoeraphic'Land setting.
❑Ridge ❑Slope ❑Valley ❑Flat
(check appropriate box)
Latitude.lon_itude of well location
(degrees',aia'uces seconds)
Latitude:longitude source:❑GPS❑Topographic map
(meek box)
DRILLING LOG
Formation Description
clay & sand
DEPTH
From To
0 113'
113' 450'
granite
LOCATION SKETCH
Show direction and distance in miles from at leag-
two State Roads or County Roads. IncludJe rcat
numbers and common road names. U .,
0
I DO HEREBY CERTIFY THAT THIS WELL \VAS CONSTRUCTED IN ACCORDANCE \VITH 15A NCAC 2C, WELL
CONSTRUCTION BARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE \: ELL OWNER.
SIGNATURE OF PERSON CONSTRUCTING THE WELL D'AT.,
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Cerytjj-Ebleigh, NC
27699-1636 Phone No, [phone], within 30 days. GV 1 REV. 07.2001
GRi
ASHEr t

276469
WELL CONSTRUCTION RECORD
'L fr, Li�•17 :'r Qa1:7;,.c. .
u I CVI76:1 C-vB 11"; Y, t A::I'rAS' GN.r Mitchel' D. Ccok c "A"'!0N . 2
?ti !: amdEen O••'-arc 7:-' 1 Cr,'' 1-.7e p::C'7 i 'pY.` in�d_.
'r. ..L COhTP?.CTCR.C 0. ?.'r A.`H���
Al! T C!AT' ". 14' Q ?::iv,:T?
(if aocl!eab!tl
:UTi w:LLCC�iTao,:e tiP:R�tITi (if a:;l::a:,:1
WELL USE (Chea A o: -ox) Res ce aht':.I,a 'Tear,_ C r.y ._.! C
N:orLc, ns ❑ • R.;c.e , ❑ Egat ; WattC , , ,. , C,h... , 'CAI:, Lis: Lae
.,r
2, WELL LOCATION'', Tc : : .. a c' ..Wg
Nerest?eo.T,' Glenville Cc'u. ,Tacksnn 7.Rid3s CS!o C', C.:ILI'
Sheperd's Dr -cross bridge 1st rd on R I:ar'<:r'=p^a
,. ertrs, Ctstrss.rtri,$ fral,',I:r, L:: N':,, Zr Cc4C • _.`_a 1^nfi;Cd.: c, 1::aLo„
CFTcF.Jack & Bev Henry c+e:.ar Ad . ess PO Box 541 _ahr:de r.;:n-de so- -.. .;s ro_a: I: -
Glenville. NC 28736 '_
us,Z0 , 22' ca. &
:4e 743-6928 •
22' 450' =--_.
A� :�:, t::re r,c.-:<r •
4, DAT; DR!'-' :D 7-2-03
3, TOTAL DEPTH: - 450'•
eI DOES WELL RSFLACE EXlSTNO WELL? YS:'_ NO Ye(
7. STP.T(CWATERLEYE_StI xTcpofCa!ias:
(Vli" " I'A`•cv, Top c fCu::jr •
S.'T0? OF CASINO IS 2 7, Above Land S:rfce a'
'Top a!et m.'net:: IVOt edcW ler„ :uh,, r,;vlrue
v:d1:n::l;,e:::r2:n::Y'1:1 ; 34 NCAC: C 4:13. ,
YtE D (y, —i): • 2 NMSTH:OD OF TEST
I0, WATER ZONES (eepin): 310'
D' _ :,-,dc,
I SiN'F=OTiOh': Ty;e F� A'^::r, 1_
12. CASiN'C': - Wail T}::'.cneu
Dr„ G,L.T. �e: Cr R'c-r..! i:, N.x::ei
-r,r; 3 Ti C7 pvC
0 -,
pr 3' T c 24 , 6" .188 steel
I3. OROT...7, Drr_5 Matadi b!eL4cd
. ,. a Tc 7h_r—sit &. ccnw'.'; ' r11 F—
Fcor Tc I Ft.
14, SCFEEN: Dep'W D t..-,::er S!ct S!a: ti.s nt:
... Tr. 17t__in• .
E - F!0.,Tc 'L__in_ In
16. SAN'D/OFAYEL PACK'
To '
From is • Ft,
',OCA.TION SKETC'-
::
.,. .:1!cn a„d d!ss;u in c�,,a z ,.;s',
S.osisc: F,C2f.3
r: _ ,._-....
16. REMARKS)
i : C HE7,=9Y CERT?Y ThAT TX:3 4.3' .. WAS CcNST P.,:CTt N AC e . ANCE ?- :?, NCAC ti-
CC�'S"RCCTION'S'Ah7�' S A.'`.:.ir 4' ACCFYOF -'.i /C; Ft. -.,k$3 N?3C :_:TOT -,.`c'^'`,_.
. `Zat' >/ /o -1)
s:CNAT7-74.2 ? 7E .S0ni CONS-74. 27NGTF; _ DA
•
•j P,'
•Sub ' the or'q!nal to•the Dlvts!o: of Watt; Q all y,Grouecwa:toSt;tit: 1323 Mol!Zenists Ce:; Ra a:g' NC( it
2763„323PhcntNo, (313)112.'121,within 30da;t, ,• CH•..
L
A7. _,✓!Lc .L.
0
co

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NA\IE (print) Mitchell D. Cook CERTIFICATION k 2043
\\ELL CONTRACTOR CO\11'ANY NA\IE Hedden Brothers Well Drilling, Inc PHONE 4 182q 369-9591
STATE WELL CON S'f RC CTION PERMIT# ASSOCIATED WQ PERMIT.(if applicable)
(if applicable)
WELL USE (Check Applicable Box): Residential 0 Municipal/Public INX Industrial 0 Agricultural ❑
2. WELL LOCATION: Jackson
Nearest Town. Cashiers Count
Laurel Knob—Terrabrook—Well #2
(Street Na:ne. Numbers. Community, Subdivision, Lot No., Zip Code)
3. OWNER: Terrabrook
Address 3505 Frontage Rd Suite 145
(Street or Route No.)
Tampa, FL 33607
City or Town State Zip Code
( 828- 697-7334
Area code- Phone number
4. DATE DRILLED 6-25-03
5. TOTAL DEPTH: 725'
6. DOES WELL REPLACE EXISTING WELL? YES 0 NOS
7. STATIC WATER LEVEL Below Top of Casing: 150' FT.
(Use"+" if Above Top of Casing)
S- TOP OF CASING IS 2 FT. Above Land Surface'
*Top of casing terminated at/or below land surface requires a
variance in accordance with 15A NCAC 2C .0118.
9. YIELD (apm): 1 50+ METHOD OF TEST
Monitoring 0 Recovery 0 Heat Pump Water Injection ❑ Other 0 If Other, List Use
Topographic/Land setting
❑Ridge DSlope ❑Valley 0Flat
(check appropriate box)
Latitude/longitude of vicell location
(degrees minutes seconds)
Latitude longitude source:❑GPS❑Topotraphie map
(cheek box)
DEPTH DRILLING LOG
From To Formation Description
0 54' clay & sand
54' 725' granite
10. WATER ZONES (depth): 720' & 725'
blow
I . DISINFECTION: Type HTH Amount 16oz
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
From 0 To 56 Ft. 8" .188 steel
From To Ft.
From To Ft.
13. GROUT: Depth Nlaterial Nlethod
From 0 To 56 Ft. cement pumped
From To Ft.
14. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in.
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Size Nlaterial
From To Ft.
From To Ft.
16. REMARKS:
276468
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common road names.
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH I5A WELL:—
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO TNA VA ELL OAVNER
SIGNATURE OF PERSON CONSTRUCTING THE WELL (I ti •
ATE
tJ L.
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail ServHe Center - Raleigh NC
27699-1636 Phone No. [phone], within 30 days.
CorA

276467
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
\\ELI. COST RACTOR (INDIVIDUAL) NAME (print) Mitchell D. Cook CERTIFICATION # 2043
%NELLcoNR.ACroRCOMPAN\'NAME Hedden Brothers Well Drilling, Inc PHONE k(82$ 369-9591
STATE VA'ELL CONSTRUCTION PERMIT# ASSOCIATED \\Q PERMITS(if applicable)
(if applicable')
I. WELL USE (Check Applicable Box): Residential 0 Municipal IN Industrial 0 Agricultural 0
Monitoring ❑ Recovery 0 Heat Pump Water Injection ❑ Other ❑ If Other, List Use
2
WELL LOCATION:
Nearest Town: Cashi era County Jackson
Laurel Knob-Terrabrook-Well# 1
(Street Name, Number, Community, Subdivision, Lot No.. Zip Code)
;. OAVNER:Terrabrook
Addross 3505 Frontage Rd Suite 145
(Street or Route No.)
Tampa, FL 33607
City or Town State Zip Code
(828)- 697-7334
Area code- Phone number
4. DATE DRILLED 6-1 9-03
5. TOTAL DEPTH: 917'
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO fl
7. STATIC \VATER LEVEL Below Top of Casino: 500' FT.
(Use "-" if Above Top of Casing)
3. TOP OF CASING IS 2 FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordance with 15A NCAC 2C.0118. blow
9. YIELD (gpm): 60 METHOD OF TEST
10. WATER ZONES (depth): 95' & 885'
Topographic/Land setting
DRidge ❑Slope ❑Valley ❑Flat
(check appropriate box)
Latitude'longitude of well location
(degrees minutes. seconds)
Latitude'longitude source:❑GPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From To Formation Description
0 76' clay & sand
76' 917' granite
1 1. DISINFECTION: Type HTH Amount 160Z
12. CASING:
Depth
From 0 To 78
From To
From To
13. GROUT: Depth
From 0 To 78
From To
14. SCREEN: Depth
From To
From To
15. SAND/GRAVEL PACK.
Depth Size
From To Ft.
From To Ft.
Wall Thickness
Diameter or AWeiebt:Ft. Nlaterial
Ft. 8" .188 steel
Ft.
Ft.
Material
Ftcement
Ft
Diameter Slot Size Nlaterial
Ft. in. in.
Ft. in. in.
Nlethod
pumped
Nlaterial
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common road names.
16. RENIARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH ISA NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
D
SIGNATURE OF PERSON CONSTRUCTING THE WELL ' ,p,ATF
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Nlail Senv cleiCWer - Raleigh, NC
27699-I636 Phone No. [phone], within 30 days,
i) L4W-I REV. 07/2001
GROUN'DVIATEF. SECTION
ASHE\'ILL E RE; I; i.UAL OH)ril

276465
WELL CO\STRUCTIO' RECORD
��. NLtchell D. Cxk c F ,.A7: 2:43
r�LLcciTrUC"O>ps71�;^�A:.�'rAS`• �'
)%,ELL CONTRACTOR CC'M7,{.4Y,1I?"E H°=ttlen ErOthc.-F 4:a11 r1.-il14rr- T
STATE YrELL CCS7RL'C7'0,) 7ERf't'Te ..
ilrac.t<aa.
WELL USE (C1 e:'k A• r -^X): Resldedl(a; 7.7.6 M^-1^I Ic1a2rtai ❑ Ar..:. _ .
Mcr,tt:rtnq ❑ R: - ❑ Fiat , R'ater fr,122,t;:r,❑ ,.•r a t 0th :,'_ir, US:
2, WELL LOCA t Oti'r Jackson
Nea'e3•'i0�, Cashiers CO_:`
Laurel Knob-Terrabrook Project -Well #3A
(3 rti; Via. e,4':�:�n, C:.-„', '•IC,S:�:I �:I:r N:., Z.p Cam':;.
;, OWTsR Terrabrook
Ad"ess 3505 Frontage RD Suite 145
Tampa,• FL • 33607
C: r, T,w S Lu Z:2 C>c:
(RJR;. Aq6=7314
. A'a cx'e. ?::ne
4, DATE DRILLED 5-28-03
TOTAL DEEM:: '1000'
6: DOES WELL REFLACE EXISTING WELL? YE: ❑ NO "Qc
7, STAT.0WATER LEVEL ..e!c'wTc2 Cutng 900' r,,
(Un"."'!A.av: Ts; c!C&
S.`TOF OF CASINO IS 2 `,Aicve Land S:^ace'
'-c, :rcL:!22 wnInant t:'er tdos+l:e'. rVC+ar ngclrn a
rarrd:n: NCAC'CA119, • r
e ".t
„ YIELD (ipm)' 8 • MET:.OD OF TEST
IC WATER ZONES(da?Ih): 85'
1 I, DIS;.N'FECTION: T;;e I-ECF.
12. CAS:NO.
0 Zi7- 46 D''tifiei.
Flo- s� ^•,
Etc:- T:
Tc r.
13 GROUT': JrC, Mate„a:
Ft r,_Q—Tc 7 F'},�rr"- _P cam=
FSCr. Tc F
14, SCREEN: Dr,-. Dii:, _ Sio{S!c. ?!a_...
Fro- To 1-.
Fr:rr. Tc °l1- t-
15 SAND/GRAVEL PACK!
DrC; Slu . Mxtert2:
To Tt
Fr Tc F'
Mr.:71i
pc
N k-
;
CRd ❑c ,-
3'
cf
{:17.1:17is �-r.'_,
.s.!Hn'. r.;Clde
n'C
:a z:es
C 44'
44' 1000'
16 ;k2.2m,2.3xs This well is to be abandoned ASAP
L0CAT10N 5K=TC'
,1a3
Sae .Rcyjs. c: C. . >,
c,.C- r.1r,._..
S;G,ArjR.E CF PERSON CONsT'C-N= = WILL
Submit the bri¢nal to tha Jl\nsic: at Watt:. Q:a:Ity, Grc'.edwa'er St:t.::, 163$ M t5eM2e Ce:'e na e!y'1. C
27429.1626 p-eNs. (S19)733.3121,withinSOU:Ls 0W: VA7._;OL
%aHERE3YCERII?Y ^:&T h3 h3_L WAS CCNSTAL`! ",A..:.:AT A NACC `^
COhSP..L� SON STAN7A-7-05, A.4 7=47 A COPY OF 7:=15 32BN ti ;0 L Q.4?
5 /2 '/0i, -I
DATE �,....

«'ELL CONSTRUCTION RECORD
� ,y xI ..,i:.2
Mitchel
l D C'�,ik
G„LL Cvi,1
AAC'v� (I,�C ,u' A..)'+A.Y' G ; v � 1R71
{. wi' r rc.-c G_11. nri 1',in'• 9=
W?LL CC,ITFA CTOR ^. C?t FA,4Y ;4'A.v 0871 H_O
STATI GTLL CCtifnUCT:Crl TEn.`f; '
5.5 a:.
(if ac:ll:abiel
...7Se:
c R. AT:34 x 2043
WELL, USE (C'o:X A r <z i 7 :X) :>,ce, a' 7IX ;, ra I :: 'C-
�c. t_rirtit 0 Cfed: Fr,F WWWate i, '"' C O o :,2, ituse
2, AYcLLLOCATION,
N:dres:Ts e;Casheirs Ccu.y Jackson
North Norton •
r;—ry+.'y'. •, N:.a:a.�Gr,„rtrtr:-5 212 .^:;
0`1_R' Darlene Grant
A_`1i3 2784 NE 24th Street
(Strr e, F::u N )
Lighthouse Point, FL 33064
-• *over Z.; C>'e
(9547). 941-9997 •
L, DATE DRILLED 7-9-03
TOTAL DE?Tii: 150'
5: DOES WELL 17(5?2.ACi EXISTING WfLL7 YES C NO
5TA71C AT EF LEYE..3e!o'r 7c? of Cz,tns' 100'
• (Lhar;ctCu'a;i
S. bcva Land Sc^ace'
TOF OF CASING U 2 t, A
'2:: :! eu:nf lir _Ini;t: icor.elow lee: r.daca ?Igclru
ve�ac:e la a::: r'_ar:ewill IIA NCAC:C. ll3 •.
YIELD(ir„i- 20 \IET7.-inD0 'r;sT
IC. WATER ZONES (c:pl'n); 115'
i
1 t D'S-N.. CTn^N; Tv .: E.7-i A 1
12. CASr1.12, 1..9:Tr:cc:u
56 DIL ye; or�i'C.�t.., 1? rCC
< 6 .
56' To 60 188 stool
From Ts
:3 OROUT :e7Lk.
Ft, Material A5e,4c'
n. T c 71 F;•r�+i -e R ca-s r rC""
Fron To Ft,
14 SCREENS Drpth. :•'1. e'd:
.r:rr Tc Ft__!1
Frr To
15, SA.0 tORAYEL PACK:
F:cm it
From Tc Ft.
S!u
S:c; i't-t a1
in.
Ma;eriai
i::Y.:S,; sic.: L'
tax tcr:
=re.
58' 150' '==
TCATIONSK=TC='
Sk_ 575:: ' sr..1 dis'2c._ „ M.11i -_T—. It Edit
: S'.�.nr._s cr Cc_ :Scads.
name 9.
IE. iv1.A..'XS:
CH?Z3BY09RT,?YT-ATm:3 RfLL WAS CCI'57?.CCZJIN'CACtC �'-_L•_
A'r:+TakT A COPY OF 7:i:S ILECCF2::A53::Th "�=�iCTr
�i9� � cQ12 7/947
s.:NATJAEOF?E2SONCON S 7 'N_-==rsL. DATE
Svbnit. the cr glnal to the Dl411a: of Water Qcality, Ciro]:d'walerSectl9:, 1535 bfa:i 5enl:e Owe: • lelyi,
21599.1535? on,tNo.(919)1334221,within30days, - G'»'•i iv.C•
276463
iATER SECTION
_i_E FEGi0N'J,L OFFIOE

276207
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and N tural^R,esourrc^ess Division of Water Quality - Groundwater Section
/y��j
WELL CONTRACTOR (INDIVIDUAL) NAME (priiInnt/t) .ne (h,/,M1,/( O r/ CERTIFICATION # rsll�,f7.0/�
WELL CONTRACTOR COMPANY NAME 2((JrICer Well and Pf/ PHONE # J 6Q7-/z(J
STATE WELL CONSTRUCTION PERMIT# 'd 7 I ASSOCIATED WQ PERMIT#
(if applicable) • (if applicable)
1. WELL USE (Check Applicable Box): Residential IEK Municipal/Public ❑ Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection ❑ Other 0 If Other, List Use
2. WELL LOCATION:
Nearest Town:
—raYli1 essee
(Street Name, Numbers, Com
3. OWNER:
Address
(Street or Route No.)
ri edrxonf L3&
Countyjlso0
unity, Subdivision, Lot No., Zip Code)
(ffhIity Town State
)- Town State S287
criO3
Zip Code
Area code- Phone number
4. DATE DRILLED �-0-3
* 5. TOTAL DEPTH: S
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO V
7. STATIC WATER LEVEL Below Top of Casine: a20 FT.
(Use "r' if Above Top of Casing)
S. TOP OF CASING IS • 33- FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordance with I5:\ NCAC 1C .0118.
9. YIELD (gpm): t METHOD OF TEST) t
10. WATER ZONES (depth):
Topogra /Land setting
❑Ridge lope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/loneitude source:❑GPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From To Formation Description
O
W
Zy pu.rsp (RStai co LOCATION SKETCH = en:
11. DISINFECTION: Type Amount Show direction and distance in miles fronnij least-; --
12. CASING: Wall Thickness two State Roads or County Roads. Includdcttte rpad
Depth Disa re
or Weight/Et. Material numbers and common road names.
From 0 To 4 7 FL (o SD ail Pt1 C'> Prot511 va -E n ve_ 72, nn e•�s ee.
From To Ft. ��ry/
From To FL G-00 d., GO +2 O1 F
13. GROUT: Depth �t Material,,n Method cam(/yu.a,ln'Th_ p CO -ill From 0 To 20 FL Ci le',d t YQUYI2G� n (Gr�L�+•' W t
From To Ft. rx nu �2S on yyle- r_I9
14. SCREEN: Depth Diameter Slot Size Material �,( .(r-y OCA l�J
From To Ft. in. in. die e- fS " ���
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From
From
16. REMARKS:
To Ft.
To Ft.
L_
�•1) I DO HEREBY CERTI
--•',,( LON IRtfLTlOr4SiPt
11I4T THIS WELL WAS CONSTRUCTED IN ACCORDANCE \VITH I5A NCAC 2C, WELL
S, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL 01VNER
SIGNATURE OF PERSON CONSTRUCTING THE \•ELL
13-0-
DATE
--SUtl?,Rllt (he urigila,io the Division of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
276194636 Phone-No:'(919) h33-3221, within 30 days. GW-1 REV. 07/2001

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) Kenneth.McCrary CERTIFICATION # 2008
276205
WELL CONTRACTOR COMPANY NAME Barker Construction, Inc./Barker Well and Pump PHONE # [phone]
STATE WELL CONSTRUCTION PERMIT# 1871 ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential Ea Municipal/Public ❑ Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION:
Nearest Town: Sylva County Jackson
Canada Road - Hess Phillips Road - Lot #10
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: CANANG LLC
Address PO Box 7
(Street or Route No.)
Dana NC 28724
City or Town State Zip Code
( 828 )_ 293-5828
Area code- Phone number
4. DATE DRILLED 06-18-03
5. TOTAL DEPTH: 280'
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO El
7. STATIC WATER LEVEL Below Top of Casing: 60 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS 1.33 FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordance with 15A NCAC 2C .0I18.
9. YIELD (gpm): 12 METHOD OF TEST Timed
10. WATER ZONES (depth):
11. DISINFECTION: Type By pump installer Amount
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
From 0 To 62 Ft. 6 1/8 SDR21 PVC (Iitt) ,kjQ�..iiLo ka Ls, 1O
From To FI. / _ a 0�
From ToFL Ld�R.QQ.Q.C�.t2 ke
13. GROUT: Depth Material Method pyy,LtA.6j - may/ gi l L / � � )'
From 0 To 20 Ft. Concrete Poured JAIL a. bp a. �(�QC//:pO,e6
From To Ft. o,�JGn�ur-c. / �'-"--�"
14. SCREEN: Depth Diameter Slot Size Material Ye-L� • +fit/ Ap
From To Ft. in. in. �t.�. / q//t.tA.(.2c[J oS A`/O
From To Ft. in. in.
15.
Topographic/Land setting
®Ridge ❑Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:OGPSOTopographic map
(check box)
DEPTH DRILLING LOG
From To Formation Description
SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
LOCATION SKETCH -' r"
Show direction and distance in miles from afql�east t
two State Roads or County Roads. Include (e roa(1;
numbers and common road names. a-
16.REMARKS:
l .T' DO HEREBY CpR l)1`Y fNrt-THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
t dNSTRUCTION STANDARI?$, OD THAT A COPY OF THIS RECORD HAS B EN PROVIDED TO THE WELL OWNER
I
i II�rov .. lM o' C. 3
I ! 84NATURE OF PERSON CONSTRU ING THE WELL DATE
I
Submit the original to the Divisi n of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
2769Sf636Tttimet(tr,-(9i-9) 4133-32?1, within 30 days. GW-1 REV. 07/2001

11. DISINFECTION: Type
12. CASING:
Depta
From To 90
279346
WELL CONSTRUCTION RECORD
�rtae of Environment and N Resources - Division of Water Quality - Groundwater Section
North Carolina - Dep
n �/
WELL. >at UAL) NAM (print) .fi NAI%C -'%n AL ,-LQ/f CERTIFICATION #r.r 7` y
-LL COt f"IUCT t ANY NAME� �ditbr tad, y.,Zl GLOM PHONE # { K /� Sf�J' ®�!1 D
STATE WELL CONSTRUCTION PERMIT#ASSOCIATED WQ PE MIT# itTI > D 17 tJ
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential Qit Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATI
Nearest Town:/ Gfe f f/.C. Countyl
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3.
OWNER:Mieffar—ss)
%'Gr .c .ei
Address C a& ed
or Route No.)
l�J.,:genet rag
n9
City or Town State Zip Code
( Area code- Phone number
4. DATE DRILLED SY/2 / D 3
5. TOTAL DEPTH: ,2DS
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO ,@[1
7. STATIC WATER LEVEL Below Top of Casing: /O FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS JS FT. Above Land Surfaces
`Top of wing terminated atlor below land surface requires a
variance in accordanceg with 1SA NCAC 2C .0118. •
9. YIELD (gpm): /n% METHOD OF TE
10. WATER. ZONES (depth): ///D
railer Amount
Wall Thiclmess
'meter or Weight/Ft. Material
Ft #.2/ (vdC.
0L.
Topographic/Land setting
❑Ridge ❑Slope (Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DRILLING LOG
Formation Description
From To Ft.
From To Ft.
13. GROUT: Depth�t ]`{ater'al Method ,
From 0To cC 0 Ft. 1.Ee-ryretJ( t A. +f
From To Ft.
14. SCREEN: Depth Diameter Slot Size Material
From o Ft. in. in.
Fro To Ft. in. in.
15. S /GRAVEL PACK:
th Size Material
From o Ft.
T
From To Ft.
16. REMARKS:
DEPTH
From To
nr ac
LOCATION SKETCH Na rN, w
Show direction and distance in miles ffongS leagi
two State Roads or County Roads. IncludC*ie rt)$d
numbers and common road names.
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 1 5A NCAC 2C, WFT T
CONSTRUCTION STANDARDS, AND THAT A OPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
FGli
SIGNA OF PERSON CONSTRUCTING THE WELL DATE
c//3//7-S
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center -Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-1 REV. 07/2001

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section _
E-/ 9
WELL CONTRACTOR (INDIVIDUAL) NAME(print)[hi n n i SlI /4 II fln\ rli CERTIFICATION # ail /e'
WELL CONTRACTOR COMPANY NAM.11nt i'ttA It, tA'V' fdei I.Th s )1:lilt_ l-n e PHONE # 11/..—.5 2Y-3;6
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WoPetnmIT#
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential Id�Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION:
Nearest Town: 'y 1 V Q_ WO Count
Ekw-y'S Ck.:1Stalt
�-�Pm)oel It i
(Street Mime. Numbersnity, Subdivision, Lot No., Zip
3. OWNER: Le1 ioX
Address r 0OL/�-12 111 C i2 i ( Route No.)GI fruit
CityorTown Zip Code
(TV»-5.D.37.2_.
Area code- Phone numbe
4. DATE DRILLED 55
5. TOTAL DEPTH: -'S�e%'
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO 17JJ�
Typographic/Land setting
Y� �i G,�S1JX_ dge ❑Slope DValley ❑Flat
LS to fa 14 (check appropriate box)
Code) 07 77el Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From To Formation Description
F) '
7. STATIC WATER LEVEL Below Top of Casing: 3'E5 n FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS / FT. Above Land Surface'
*Top of cuing terminated at/or below land surface requires a
variance In accordance with I5A NCAC 2C .0118.
9. YIELD (gpm): 42, METHOD OF TEST Akil1, r7,(/
10. WATER ZONES (depth): 4 Jn' (�
278006
53/s' /.1llcc_- &-iTh,7#-e._
11. DISINFECTION: Type H #P
12. CASING:
Depth
From 6 To �7 , Ft.
From To Ft.
From To Ft.
13. GROUT: Depth
From n To rV Ft.
LOCATION SKETCH
Amount ,-� TA -AS Show direction and distance in miles from at least
Wall Thickness
Diajneter or Weight/Ft.
s22R,�j
Material
I(9an-13r
From To Ft.
14. SCREEN: Depth Diameter
From To Ft. in.
From To Ft. in.
15. SAND/GRAVEL PACK:
Depth Size
From To Ft.
From To Ft.
two State Roads or County Roads. Include the mad
Material numbers and common road names.
Method
(o,4,v
0
ram)
c
Slot Size Material
in. :n
in. xx
Material 0
16. REMARKS:
N
1 DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF TH S RECORD BEEN PROVIDED TO THE WELL OWN
071(X (h— 01 e0�f —/ 3
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center- Raleigh,$C.
27699-1636 Phone No. [phone], within 30 days. GW-I REV. 01/200
r5 -
LnTli
,J

r
NORTH CAROLINA DEPARTMENT OF NATURAL RESOURCES AND COMMUNITY DEVELOPMENT
DIVISION OF ENVIRONMENTAL MANAGEMENT - GROUNDWATER SECTION
P.O. BOX 27887 - RALEIGH,N.C. 27811, PHONE [phone]
WELL CONSTRUCTION RECORD
DRILLING CONTRACTOR /SO L) n LEJ& 4 A
DRILLER REGISTRATION NUMBER c 4i / '
FOR OFFICE USE ONLY
Quad. No. Serial No
Lat. Long. Pc
Minor Basin
Basin Code
Header Ent GW-1 Ent
STATE WELL CONSTRUCTION ,//
PERMIT NUMBER: /itiU 2
1. WELL LOCATION: (Show etch of the location below)
Nearest Tow
ft.M� Cr Le
(Road, Community, or Subdivision and o No.)
2. OWNER 0()t,, LA-)
�/) ` c
ADDRESS .•
7'U Street o/FH,odte No.) 4./` 0 n /
LAA.z r1t_ x( L�
City or Town State Zip Code
3. DATE DRILLED T - a 2 'V._ USE OF WELL fe51cQe.,,41L
1'�'
4. TOTAL DEPTH �'2 5 CUTTINGS COLLECTED5El--1
Yes �yvo
5. DOES WELL REPLACE EXISTING WELL? ❑ Yes f�l-.No
6. STATIC WATER LEVEL: 4o6 FT 4 above TOP OF CASING.
below
TOP OF CASINGIS 1 FT ABOVE LAND SURFACE.-
7. YIELD (gpm): l METHOD OF TEST « 11 n
'
8. WATER ZONES (depth): 7
/2 5 r - 1/4- of p r'-n
a, d� r _ //L "rC3 p rr,
r-F 1
9. CHLORINATION: Type T-r�I Amount I - 1p i } 5
10. CASING:
County.
Depth
DRILLING LOG
T From To Formation Description
Wall Thickness
f7'�� lA Depth ` Diameter or Weight/Ft. Materials
From V To 6 Ft LP 1t P v 4
From To Ft
From To Ft
11. GROUT:
GW-1 Revised 6/88
n Co
/pt• ' G 15
(JP
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 IC-
W o
From V ToO Ft. C�'-l�Vv-i'-,4L yo
A�ril
From To Ft. _ =r�.l
N2
12. SCREEN: Cn n
rV o
z
n=
rn 0n
- cm
Depth Material Method o�
Depth Diameter Slot Size Material
From To Ft. in. in.
From To Ft. in. in.
From To Ft in in.
13. GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
14. REMARKS.
CROUNf,', 'FR SECTION
A -Pd:L. FC )RJ* UHKE
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15 NCAC 2C, WELL CONSTRUCTION
STANDARDS, AND THAT A COPY OF THIS RECORDS HAS BEEN PPJRQQVIDED TO THE WELL OWNE
SIGNATURE OF CONTRACTOR OR AGENT DATE
Submit original to Division of Environmental Management and copy to well owner.
-3/-63

WELL CONSTRUCTION RECORD
North Ce:oi na - Department of Environment and Natural Resources - Division of Rater Quality. - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) N ANE (print) James B. Brown CERTIFICATION''-2045
1c ELL CONTRACTOR COMPANY NAME Hedden Brothers Well Drilling, Inc PHONE = f 828 369-9591
STATE A' ELL CONSTRUCTION PERMIT ASSOCIATED WQ PERMIT;
(if aoollcablel (if acnlicable)
at
4.70i 3 1
I. WELL USE (Check Applicable Box): Residential Municipal -Public ❑ Industrial 0 A_ricuit:ral 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other ❑ IrOther, List Use
2 WELL LOCATION:
Nearest Town Sylva County Jackson
178 Pyramid Place
jjree: A;.:ne, Ne,r5ers, Con'.ineniro. Sub.i':('aion, Lot No., Zip Coce1
3 OwNER. Edward C. Zimmer
Addr.>s 178 Pyramid Place
(Street or Route M1a)
Sylva, NC 28779
Cit.; or Town State Z,p Code
f828i- 586-1767
Arta :ado- Phone number
DATE DRILLED 8-28-03
5, TOTAL DEPTH: 380'
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO
7. STATIC WATER LEVEL Below Top of Casing,: 300 ET.
(Use if Above Top of Casing)
S. TO? OF CASING IS 2 FT. Above Land Surface'
•Top of casing terminated atror below land surface requires a
variance in accordance with I5A NCAC 2C .0118,
9. YIELD (gpm): 10 METHOD OF TEST blow
10 WATER ZONES (depth): 160' & 354'
I I. DISINFECTION: Tvoe H T H Amount 16 02
12, CASING: Wall Thickness
Depth Diameter or Wei_ht'Et. Material
From 0 To 68 Ft. 6" pvC
From 68' To 72 Ft. 6" .188 steel
From To Et.
13. GROUT: Depth Material Method.
From 0 To 20 Ft.lotencrlite & u=tite1- pre: 3
From To Ft.
14. SCREEN: Depth Diameter Slot Size Nlaterlal
From To Ft. in. in.
Fro,^. To Ft. in. in.
15. SAND'GR.AVEL PACK:
Depth Size Material
Frorn To Ft.
From To Ft.
16. REMARKS:
Topographic.' Land setting.
❑Ridute ❑Sloes ❑�'aaey ❑Flat
(check apprc^!a:, box::
Latitudelomzifude of well Ioca_ticn
Latrt'.?_'Ionzin.tde source:❑GPS❑Tcpos.c rap
axbou)
DEPTH DRILLING LOG
From To For -ration Description
0 70' clay & sane
70' 380' oyanite
0
CI
73
—� co orn
I 0<
yo
-.0-1MO
.....
— 7% rn
ca COx
LOCATION SKETCH c,
Show direction and distance in miles from at lea; o
VA o State Roads or Count': Roads. Include the road z
numbers and common road names.
w
N
1 DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH I5A NCAC 2C, \VELL
CONSTRLCT10NNDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE' WELL O'W`'NER
—
SICNAT R OF PERSON CONSTRUCTING THE WELL DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center -Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-I REV. 07.20G:

278536
WELL CONSTRUCTION RECORD
North Carolina. - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
W ELL CONTRACTOR (INDIVIDUAL) NAME (print) James B. BroWT1 CERTIFICATION 2045
\VEL. I. CONTRACTOR COMPANY NAME Hedden Brothers Well Drilling, Inc PHONE # [phone]
SLATE. \ELL CONSTRUCTION PERMIT; ASSOCIATED WQ PERMIT?
(if applicable) (if applicable)
I,
2
WELL USE (Check Applicable Box): Residential i Municipal: Pu'olie ❑ Industrial ❑ .Agricultural 0
Monitoring. ❑ Recovery 0 Heat Pump Water Injection 0 Other 0 IfOther, List Use
WELL LOCATION:
Nearest Town. Cherokee
Indian Hills Lot #12
(Street Na:ne. Nurr.bers, Community. Subdi :isloe. Lot No., Zip Code
3. OWNER: Candler Cooper
Address PO Box 523
(S:reet or Rote No.)
Cherokee, NC 28719
Cary or To.:n State
(M8)- 497-2381
.Area code- Phone number
4. DATE DRILLED 8-11-03
5.TOTAL DEPTH: 500'
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO GEE
County Jackson
Zip Code
7. STATIC WATER LEVEL Below Top of Casing.: 400 FT.
(Use if Above Top of Casing)
8. TOP OF CASING IS 2 FT. Above Land Surface*
'Top of casing terminated atror below land surface requires a
variance in accordance with 15A NCAC 2C .0118.
9. YIELD (gpm): 3 METHOD OF TEST blow
10. WATER ZONES (depth): 223' & 480'
I I. DISINFECTION: Type H T H
12. CASING:
Dep:h Diameter
From 0 To 70 Ft. 6"
From 70' To74 Ft. 6" 188 steel
Amount 16 oz
Wan Thickness
or WeiohtFt. Material
pvc
From To Ft.
13. GROUT: Depth Nlaterial
From 0 To 20 _ Ft ute & oaTertt
From To Ft.
14. SCREEN: Depth Diameter Slot Size Nlateral
From To Ft. in. in.
From To Ft. in. in.
15. SAND:GRAVEL PACK:
Depth Slze Nta:uial
From To Ft.
From Tc Ft.
16. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRICTION STAND ARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
Nlethod
FUTPed
TopographidLand setting.
❑Ridge 0Slope ❑Valley ❑Flat
!check appropri a:e box)
Latitude longitude of well location
ldegrees mirage( seconds}
-
Latitude longitude source: ❑GPS ❑Topographic map
heck box)
DEPTH DRILLING LOG
From To Formation
Description
&
0 72' clay sand
72' 500' granite
0
O 0
N
rn
—D
m
om
m 1m
0
LOCATION SKETCH —o mo
Show direction and distance in miles from.. leastta=
rvo State Roads or County Roads. lnciudet4 ro �E
numbers and cords -non road names. CAI 2
=f- t
J Li '
SIGNATLRE iF PERSON CONSTRICTING THE WELL DATE
Submit the original to the Dieison of Water Quality, Groundnater Section, 1636 Mail Service Center - Raleigh, NC
27699-1636 Phone No. [phone], within 30 days.
GW'-I REW.0?2001

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
BELL CONTRACTOR (INDIVIDUAL) NA>IE (print) James B. Brown CERTIFICATION is; 2045
WELL. co NTRACTOR COAIPANY NAME Hedden Brothers Well Drilling, Inc PHONE ; ( 828 369-9591
SLATE w ELL CONSTRUCTION PER?IITo ASSOCIATED 1VQ PERNMITy
(if acolicable) (if applicable)
1
2. WELL LOCATION:
Nearest ToAvn. Whittier County Jackson
74W just past Fldprs Rttperet-ta
(Street Naina. Numbers, Community. Subdi. ision. Lot No., Zip Code)
3. OWNER. Donald Kinsland
Addr.:ss 1950 US 441 North
(S:reet or Route No.)
Whittier, NC 28789
City or To'.cn State Zip Code
(828)_ 497/4624
Area code- Phone number
4. DATE DRILLED 8-7-03
5. TOTAL DEPTH: now is 400'
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO
7. STATIC WATER LEVEL Below Top of Casing.: FT.
(Use' if Aboce Top of Casing)
5. TOP OF CASING IS 2 FT. Above Land Surface*
*Top of casing terminated at'or below land surface requires a
variance in accordance e'ith ISA NCAC 2C .0118.
9. YIELD (gpm): 8 METHOD OF TEST hlnw
0. WATER ZONES (depth): 288'
11. DISINFECTION: Type H T H
12. CASING.
Depth
Fron150 To 300 Ft.
From To Ft.
From To Ft.
13. GROUT: Depth
From 0 To
From To Ft
Diameter
5"
Amount 16 oz
Wall Thickness
or Weight. Ft. Material
•188 st-pel
Naterial
20 Ft 1e-rnite & 0:1tt3i
Method
Paired
14. SCREEN: Depth Diameter Slot Size
From To Ft. in. in.
From To Ft. in. in.
15.SANDGRAVELPACK
:
Depth Size Material
From To Ft.
From To Ft.
Material
278535
WELL USE (Check Applicable Box)' Residential ❑ Nlunicipa1/Publlc ❑ Industrial 0 Agricultural 0
Ntonitor'ing 0 Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List LseDrill Deeper
5" well
Topographic: Land sett ng
❑Ridge ❑Slone DValley ❑Flat
(check appropriate box)
Latitude'longitudc of well location
(degrees a.inutes. seconds)
Latitude longitude source:❑GPS❑Topographic map
Pack box)
DEPTH DRILLING LOG
From To Formation Description
0 clay & sand
unite
0
O
U
U5
0
oA
fri
rn
Zm
0<
yrrl
0
NO
LOCATION SKETCH c?
Show direction and distance in miles from atcfpast 2
two State Roads or County Roads. Include th€oadz
numbers and common road names.
16. REMARKS: Drilled deeper from 150' to 300' & installprl S" stppl liner
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH ISA NCAC 2C, WELL
CONSTRUCTION ST_ DARDS, AND THAT OPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
'r1'
iCN'A L' <E OF PERSON CONSTRUCTING THE WELL DATE
Submit the or ginal to the Diris`on of Water Quality, Groundwater Section, 1636 Mail Service Center • Raleigh, \C
27699-1636 Phone No. [phone]. within 30 days. G11'-I REV. 07 2001

273534
2. WELL LOCATION:
Nearest Town. Sylve County Jackson
Barker's Creek —Holly Cove RA
(Street Name, Nuinbers. Cootmoo ity. Subdivision, Lot No.. Zip Code)
3. OWNER: Michael Keith Powell
Addr.:ss PC) Box 3757
(Street or Route No.)
Cullnwhee Nr 78723
Cityor To n� State Zip Code
(828 I- 793-1 ORS
Area code- Phone number
4. DATE DRILLED 8-4-03
5, TOTAL DEPTH: 350'
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO 1:7c
7. STATIC WATER LEVEL Below. Top of Casino.: 200' FT.
(Use" if Above Top of Casing)
S. TOP OF CASING IS 2 FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordance with 15A NCAC :C .0115. blow
9. YIELD (gpm)- 15 NIETHOD OF TEST
10. WATER ZONES (depth): 182' & 330'
11. DISINFECTION: Type H T H Amount 16 oz
12, CASING: Wall Thickness
Depth Diameter or WeigEt Ft. Material
From 0 To 53 Ft. 6" pvr
From 53' To 57 Ft. 6" 1148 steel
From To Ft.
13. GROUT: Depth Material Method
From 0 To 20 Ft ute & wtcirt lanfed
From To Ft.
14. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in.
From To Ft. in. in.
15. SAND GRAVEL PACK.
:
Depth Size Material
From To
From To
Ft
Ft.
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality
WELL CONTRACTOR (INDIVIDUAL) NAME (print) James B. Brown
\ EL1. CONTRACTOR CO\1PANY N4\IE Hedden Brothers Well Drilling Inc
STATE \\Et.L CO.NSTRLCTION PERMIT; ASSOCIATED \\Q PER}f1Ta
(ifaupicable) - (ifapnlicable)
- Groundwater Section
CERTIFICATION d 2045
PHONE af628 369-9591
1. WELL USE (Check Applicable Box): Residential 0 Municipal Pu'blio 0 Industrial 0 Agrioulturai 0
Vlonitor'mg 0 Recovery 0 Heat Pump Water Injection ❑ Other 0 ICOther, List Use
Topographic. Land setting
❑Ridge ❑Slope ❑Vallel. GFlat
(check appropriate box)
Latitude'lon_itude of well location
(degrees minutes seconds)
Latitude longitude source:GGPSGTopoeraphic map
3i1ea's box)
DRILLING LOG
Formation Description
clay & san
DEPTH
From To
0 55'
55' 350'
rranite
O
O
N Trn
m a�
1 0<
O m
Cl
0
W m�
LOCATION SKETCH ca --4
Show direction and distance in miles from mast 0
two State Roads or County Roads. Include the road
numbers and common road names.
16, RENIARKS,
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION SARDS, AND THAT PY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
— a3
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
27699-I636 Phone No. (919) 733-322I, within 30 days.
GW-1 RENI.072001

From To Ft.,
15. SA.NDCRAYEL PACK:
Drth
Front To Ft.
' 78 28
«ILL CONSTRUCTION RECORD
Ncr:n Cai:lir.i - &;zrtrent o`En'yifor-tent and Na u.':; ?.:s ,uaas • Dr. ,s r. Cr Wa,:r rg
wattCONTRACTOR UNDIti1DUAJ)NAME ((ri tchell D. Cook
WELL CONTRACTOR COMPANY NAME Hedden Broth.ers Gi=11 t)ri11 nyr Trr ?Hop., (A7C*1Cna_CCC1
STATE V,. ELL CCN57RtiCT:ON'PLRS:ITs ASSOCIATED WQ? R.'r Ta
(if anl(cablel (if aoo!icable)
c 7 R--::ATlo,v e 2043
L WELL USE (Check Applicable Box): Residential hb icipa:%ub!i c 0,Industr21 C Ag•:c_I Monitoring C Recovery 0 Heat Pam; Water Injection ❑ 0t'her C 1f0tbr, Lis: Vs:
2, WELL LOCATION;
NearestTownGlenville County Jackson
111312 Lakeside Circle Drive
(Sr..l Ne, Cr)
3. OW'OR Brightman (Buddy) Skinner, JR
Address 1309 Florida Avenue North
(Stir or Rene Nc.)
Tampa ,FL 33602
c:n; or Tcws Sure ZIp Cady
(_8 • 743-5345
Arta cx'c, Peon. nu.:.ber
4, DATE DRILLED 7-10-03
5, TOTAL DEPTH: 600'
6, DOES WELL REPLACE EXISTIN'O WELL? YES C NO XX
7, STATIC WATER LEYEL Be!ow Tc; cf Cuing 550 rr
(L'se twm I( Abcve Top cr Cut:2;
S. ICE OF CASINO IS 2 FT, Above Land Sar ace•
'Tcpo(mingtrm(nated sa'or l tic* l snd eurrace regcIrua
vsrta nee In s::rdancs wL'h ISA N CAC:C .0II3,
5. YIELD (gtr ); 5 METHOD OF TEST hug,'
10. WATER ZONES (depth); 415' & 555'
Ii, DISrN'FECTION: Tyre MTH
12. CASrNG: �}
Frog 0 , 23 it b�':,a!er,
Fro m=To 27Ft, 6'r—
A.:.41 Ecz
Y'cl Tniectess
cr Wei 3L!Rt. Macpe^'cal
v
.188 steel
From To F
13. GROUT: Dept Material Me" c'_
From 0 To 2"1 Ft. h?rniro & r=t t prrci
From To Ft.
14, SCREEN': Pcptb Diameter Slot Size M*_ca!
Frorr To et,_in. • In,
ir
Size
. N:alr.;ai
From To F',
TcpegrapniciitaC. serang
❑Ridge CSlooe ❑Va! CFlat
(:: r.!<a 1opriia_'•••
cf S'-e 'i_:d'A.,
(:e�:;irdcuus's :ca�7
LatitcCe ,_ng:^ade so_a rO?s_- ca,a: r.
(c;,r'c tot;
D;v- ry ''NG LOG
Fncnt To Itant Descr
C 25' c:e. &
25' 600' =trite
;0CA.TION 5KETC'=
S; „ irect!en and d:s'.r :e in mites `cT, at Ins;
rac State RoanCcr,_s o, :.r Reeds. lit,_.: Cie read
,.,r,.bers and co,^con road
16, RE`MSARXS:
I DO Y.T_RBBY CSATi?Y T.kT TXIS RZLL WAS CONS: RIiCJ tv' ACCOP.ICANC'c !v,1 1 SA NCAC
CONSP.LcTIGS STANDAr S, Alr7 T^.A7 A CORY OF i•::;!5 R CC:ti HAS 3EE N'?RC'v'IDED T'OT F:'w'ELL C
5:C','ATtraiCFPERSONCON'STRUCTiN'C7-2WELL DATE
SubcJt the Original to the Division of Water Quality, Groundwater Section, 16?6 Mali 5en'.;o Ce_!ar • Ra:eir, NC
27655•1636 Phone No. [phone], within 30 days, G'ri'•1 REV, 07i2 01
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7c
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.7r.
ma
0
L11-
C '1

WELL CONSTRUCTION RECORD
N rl.n.Ct.:0:1n2 • Dep1r77,erito'Ens, ,eitsna;1 ..':IR:3.',:::I P' isC a'W'e:Qua!t-f G
WILL CONTRACTOR (IND1h 1DUAL,NA.xs (;rnt) Mitchell D. Cock c_sc ::A•.ost 2043
WELL CONTRACTOR COMPANY N A..MZ Hedden Brothers W&11 p.-illinyr. Tmr• nuC,yE rF. r'sc,4ecc1
STATE 1iELL ccNsmUCTICN?ER?:IT! AS:OCiATED WQ PERNIT+
(if ab;llcable (if ax!icaele)
1, WELL USE (Cheek AppH:able Bcx): Res!der:ial Mi4.11e1paL7 !i: ❑ Ind sti?,' 0 A3.-;' ft. z! ❑
Menl,cring C Re:cvery ❑ Heat Punp Water Injectio., G Other C 1i OtEer, List Use
2. WELL LOCATION,;
Nearest Town; Glenvile Ccun;y Jackson
Sheperds erive
(S-aitNoT:,N:.00rm, Ca ... •-.-'y, ' row, LTztN:, 2,pCdc
3. 0WN3R: Janet Kunde
Add.•ee3 300 Shepherd Drive
($t, ? or Roue Na)
Glenville, NC 28736
Ci / cr Town Satz
82§. 743-1810
.v .:• ..Acoda ?e:ee av`.er
4 DATE DRILLED 7-8-03
S. TOTAL DEPTH: 450'
6; DOES WELL REPLACE EXISTING WELL? YES a NO
7. STATIC WATER LEVEL Below Top cf Casing• 400 FT
(uwe ," I(.A tvi Tee et CuaE;
E. •TO? OF,CASJNG 1S 2 FT, Above Land Su^ace'
• 'Top of will tu-lnotti it'or 6 dow Isnd sar'rer rslvlret s
vsrisnct 1p s:ecrdan:1 with UA h'CAC 2C •0!13,
9, YIELD (ppn)i 4 METHOD OF TEST }W
I0! WATER ZONES (depth): 185'
11, DrSrN.?ECTION:Ty;e HA-1
12, CASINO:
Drt` F*T,e"
-� 0 "e 14 Ft
Frcon14' To, 1 'Ft._(y'_,_
fro n - ?0
13, GROUT: Dept Ma:etiai
From_a_ To 20 it • Tiro &
Fron To Ft
14, SCREEN•: Dept Dia.-no:e:
From ,To _i�.
From Tc Ft
15. SAND/GRAVEL PACK:
Dept: Size
FroTc
From Tc Ft,
A ^i' 16:
Wall T:ic. 'cess
or Wc''• t t, MaterialSvc
1RR steel
Method
c :L prri
Stet Site l+:a'1a!
• I•
. Male,; a:
To;cr D u:.ewd settizg
:Ridge 0Slope CFIat
(:ark e,77:p:;t.
.....•.:da,cnpi^.deefYe•:1c aLcr
(::•took taz;
;;;Tv DRILLING LOrr
To at!c. Des:retort rot, On, 33 nvv&�
33450'+ite
;.00ATt0NSKETCH
SItow direction and dis' .:e to „ilea from at !loos:
rwc State Roads or Ccu-.ty Roads, Include the road
e:smbers and co-eno.e, to rants,
16, REMARKS:
1 Do HEREBY CER T I?Y i =AT XIS ti'r?LL WAS CONSTAL,CrED TN ACCOR.DAN'C3 `h'. );A NCAC :C, `%r:L:.
CO:rSMVCTIOAStA:WA-WS,ANDa_4,ACO?YOFIHISRECCR1;AS3EEN;?RCYiDECTOTP W='LC"NEP,
s:CN,A7DREOFPEts0NCONS�DOTING T h:IL „A„
SubcJtthe orig!nal to eh* DRHsiat of Water Qcal ey, Groucdwater Seetlon, 153$ i1a11 5eniee Cc:ter • Ra;e1r, NC •
27699.163d?hone No. [phone],within30daya, - C'W•1R_'-V•C7/2201
0
CO
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273 526
WELLCONSTRUCTION RECORD
Non;CL:olre-Dagar,rrer,(otErtriroaTt:nland Na^.ccIR:nu:;a•Dirlfon:( a:erC7.cr.:,aar9eela
w2LL ccA'TRACioR (INDIY77uAL) NA.NS prir.j Mitchell D. Cook CSRT,?tcATIoN 2043
WELL CONTRACTOR COM?A.NN NAY= H�.'den Brothe'-s wAl 1 D•-i 11 4 ra, Tnr,
STATE V,ELL CONSTRUCTION ?ERNIIT* ASSOCIATED WQ ?ERM17a
(if aooileable) (ir a:olicab!t)
?::ONE (82c1'),6q-c• a,
I WELL USE (Check Applicable Box); Residential M'_.nic!pat7 afo C. Industla1 C ❑
Mcr tcr'i; 0 Recove,y 0 Heat PJ.m; Water Injectice 0 Other ❑ IfOther, List Vs:
2, WELL LOCATION;
Nearest Town' Tuckasegee Cca^,ry .Tacksnn
Cedar Creek Farms Lot # H-1 •
-
(sr it Ns.r , N.;m:cra, Ca ,rr.L ir•, S r:arid l:q i s Nc„ Zlp Cc4C
3, 0wN Calvin & Rosanne Walker
Address 1164 Jaguar Circle
($t',t C,ar:uh':,)
Gulf •Breeze, FL 32561
Ch Of Town Stau Z2
(52�• 586-0294
.A. --a tc e P. nariber
'4 DATE DRILLED 7-16-03
S. TOTAL DEPTH: 300'
6; DOES WELL REPLACE EXISTING WELL? YES C' NO
7, STATIC WATER LEVEL Below Top cfCasing 250 FT
(Ur:"•" 1!A'yr Top crCuLr )
8.'TO? OF CASING IS 2 FT, Above Land Surface•
• 'Top at evina Ier .mated u'or 61Aw land rudaee relvlru
va'aaee Ir, a:wrdare wlih 13A NCAC SC,0119,
9, YIELD (gpm)! 10 M°TI:OD Tr:ST h a
10. WATER ZONES (depth); 95' & 240'
Tcrcg-a; ic/La d set^.Dg
0Rld3e ❑Slope 0Val!:y :Fiat
Lttic.Jae. tonic 1.cie c( Icca:!..,
La:1rJde. c;lrsd: so•u :. 0C'?S=Tcpera:h!: c_.
ecs)
D:?T • DP.'s-LrNG LOG
^•
To Formation
Deae G::{Jr
0'78' caav &
78' 300'
;OCATION SKsTC-;
11, DISINFECTION: Type HLsi An cunt 15¢ S'now direction and disc ,:e in -'!es `- at leas;
h'a! i5,ickleu rwc State Roa^s o1 Roads..nolcde the road
80 DtAter or W4a?t �tL rur-bens a.td cont-nor. road names.
=t
:2, CASING:
Dr rn
Fro^ 0 To
From To F'
Fnrn Tc F'
13, GROUT: Depth Mat,r'a; • McLt,c_
Frori 0... To 21 Ft.bscatteent pt-j-e?
From To Ft,
14. SCLEEN; D:,t6 D'a.'eter Slc: Sizz Maier al
From, To Ft,_in In
From Tc Fti^
15. SA.ND/C•RAVEL PACK:
t
Frc To Ft.
From, Tc Ft.
Size .Male y
16. REMARKS:
1 DC HEREBY C?RTI?Y T-LAT MIS W!LL WAS CONSTRLCicD N ACCC LANCE •h1 1:A NCAC ZC, WEL:
CONSTRUCTION STAN'DA_Y.DS, A.''W 'C.-:A T A CO?Y OF r ri15 RECC RD HAS BEEN PROVIDED TO Tin 9,Atti R :.L O-
�1�� 1D - a 7//6, 7)
Si:NArJREOFPERSON CON! lUCrrNGTrawz_L DATE
Submit the original todh. Division of Water Quality, Groundwater Section, 1436 Ms!l5.Mce Center • Raitir^ NC
276;5•1636 Phone No, [phone], within 30 days, GW•1 F=V. 0':2001
tie :C Wd 8- d3S CO
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13. GROUT:
Frrim 0
From To
14. SCREEN: Depth
From To
From To
15. SAND/GRAVEL PACK:
Depth Size
From To Ft.
From To Ft.
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) Mitchell D. Cook
WELL Co.NTRAcroR COMPANY NAME F it &cttCrs WI l l i m, jam`
CERTIFICATION # 2043
PHONE # [phone]
STATE WELL CONSTRUCTION PERNIIT# ASSOCIATED WQ PERNIIT#
(if applicable)
(if applicable)
2
WELL USE (Check Applicable Box): Residential IN Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring ❑ Recovery ❑ Heal Pump Water Injection 0 Other ❑ If Other, List Use
WELL LOCATION:
Nearest Town: Sylva County Jackson
Blanton Branch -Cane Creek Ridge
(Street Name. Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: Larry & Jolene Watford
Address POBox 1108
(Street or Route No.)
Holly Hill, SC 29059
City or Town State Zip Code
(803)- 496-9351
Area code- Phone number
4. DATE DRILLED July 24, 2003
5. TOTAL DEPTH: 300'
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO
7. STATIC WATER LEVEL Below Top of Casing: 200 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS 2 FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordance with I5A NCAC 2C .0118.
9. YIELD (gpm): 20 METHOD OF TEST blow
10. WATER ZONES (depth): 70', 95', & 270'
1 I. DISINFECTION: Type H T H Amount 16oz
12. CASING: Wall Thickness
Depth •Diameter or Weight/Ft. Material
From 0 To 43 Ft. 6" pvc
From 43' To 47 Ft. 6" _ 1 RR_ ctpel
From To Ft.
Depth Material Method
To 20 Ftber ite & wit carpal
Ft.
Diameter Slot Size Material
Ft. in. in.
Ft. in. in.
Material
Topographic/Land setting
❑Ridge ❑Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/ni notes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From To Formation Description
0 45' ' clay & sand
45' 300' granite
LOCATION SKETCH
Show direction and distance in miles from @fleas ,'.�
two State Roads or County Roads. Include& roa
numbers and common road names. F o
W
rri
r*7
-12
CO
.o
3
16. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
SIGNATURE OF PERSON CONSTRUCTING THE WELL
22. V /0,.s%
DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center- Raleigh, NC
27699-1636 Phone No. (919) 733-322I, within 30 days. GW-1 REV. 07/2001

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) Mitchell D. Ccok CERTIFICATION 2043
\\ ELL CONTRACTOR COMPANY NAME LS -ll-1 F dfiarS Will Irc
278524
PHONE it H28) 369-9591
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT-0
(if applicable) (if applicable)
WELL USE (Check Applicable Box): Residential ® Municipal./Public ❑ Industrial 0 Agricultural ❑
Nlonitoring ❑ Recovery 0 Heat Pump Water Injection ❑ Other 0 If Other, List Use
2. AVEI-L LOCATION:
Nearest Town: sylva
1110 Ben ('nok Rr1
County Jackson
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: Dennis Beck
Address 1110 Ben Cook Rd
(Street or Route No.)
Sylva, NC 28779
City or Town State Zip Code
(828)_ 586-2506
Area code- Phone number
4. DATE DRILLED July 17, 2003
5. TOTAL DEPTH: 350'
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO PPC
7. STATIC WATER LEVEL Below Top of Casing: 250' FT.
(Use "+' if Above Top of Casing)
8. TOP OF CASING IS 2 FT. Above Land Surface*
`Top of casing terminated at/or below land surface requires a
variance in accordance with 15A NCAC 2C .0118.
9. YIELD (gpm): 8 METHOD OF TEST blow
10. WATER ZONES (depth): 135' & 310'
1 I. DISINFECTION: Type H T H
12. CASING:
Depth
From 0 To 104Ft.
From 104' To 108t'
From To Ft.
Diameter
6"
6"
13. GROUT:
From 0
From To Ft.
Amount 16oz
Wall Thickness
or Weight/Ft. Material
pvc
188 steel
Depth Material Method
To 20 Ftba'mTite & careTt lanced
14. SCREEN: Depth Diameter Slot Size Nlaterial
From To Ft. in. in.
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
16. REMARKS:
Topographic/Land setting
DRidge ❑Slope DValley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees"in i nu tesseconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From To Formation Description
0 106' clay & sand
106' 350' granite
w O
LOCATION SKETCH —D i�
Show direction and distance in miles from a t east o <
two State Roads or County Roads. Include tte roacgo
numbers and common road names. 1r7),0
pap;
cc,z
ms
CO -1
o
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH I SA NCAC 2C, WELL �
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNS _._
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
Submit the original to the Division of Rater Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-1 REV. 07/2001
L--lf yI�I
r<

278523
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) Mitchell D. Cook
Flinn $cth¢s tz‘11 Er-i 11 irp,
WELL CONTRACTOR COMPANY NAME
CERTIFICATION # 2043
PHONE ) 369-9591
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential 3, Nlunicipal/Public 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery ❑ Heat Pump Water Injection 0 Other ❑ IFOther, List Use
2. WELL LOCATION:
Nearest Town:CullOwhee
County
Jackson
corner of Caney Fork & Hwy 107
(Street Name, Number, Community. Subdivision, Lot No., Zip Code)
3. OWNER:Barnes Masonry, Tnc
Address 4262 Skyland Drive
(Sueet or Route No.)
Sylva, PC' 28779
City or Town State Zip Code
828 )- 586-0503
Area code- Phone number
4. DATE DRILLED 7-30-03
5. TOTAL DEPTH: 225'
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO C
7. STATIC WATER LEVEL Below Top of Casing: 75 FT.
(Use .," if Above Top of Casing)
8. TOP OF CASING IS 2 FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordance with I5A NCAC 2C .0118.
9. YIELD (gpm): 100+ METHOD OF TEST blow
10. WATER ZONES (depth): 55' , 180' , & 210'
11. DISINFECTION: Type H T H Amount 16oz
12CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
From 0 To 45 Ft. 6" 1811 steel
From To Ft.
From To Ft.
13. GROUT: Depth Material Method
From 0 To 20 Ftbarnite & gent. )urged
From To Ft.
14. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in.
Ft. in. in.
From To
15,SAND/GRAVEL PACK
Depth Size Material
From To Ft.
From To Ft.
16.REMARKS:
Topographic/Land setting
DRidge ❑Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees(in i nutes'seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From To Formation Description
0 43' clay & sand
43' 225' granite
LOCATION SKETCH
Show direction and distance in miles from
two State Roads or County Roads. Include
numbers and common road names.
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH I5A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OW ER
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
Cn `.a
rig C_`n
aithastc_
Tyri
roatt3-tr.
rn
"ID
mo
3 ar,
ca
w
r
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-1 REV. 07/2001

hWR. nn
WELL CONSTRUCTION RECORD` �" ``
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR(INDIVIDUAL) NAME (print) Mitchell D. Cook CERTIFICATION # 2043
WELL CONTRACTOR COMPANY NAME Hall i terS W-112-nirr4, LL PHONE #P28) 369-9591
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
1
WELL USE (Check Applicable Box): Residential 2S Municipal/Public 0 Industrial ❑ Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION:
Nearest Town: Sylva County Jackson
Monteith Branch
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: Johnny Maney
Address PO Box 2146
(Street or Route No.)
Sylva, NC 28779
City or Town State Zip Code
(828)- 586-2541
Area code- Phone number
4. DATE DRILLED 7-31-03
5.TOTAL DEPTH: 500'
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NC/Kr]
7. STATIC WATER LEVEL Below Top of Casing: 400FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS 2 FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordance with I5A NCAC 2C .0118.
9. YIELD (gpm): 10 METHOD OF TEST blow
10. WATER ZONES (depth): 300'
11. DISINFECTION: Type H T H
12. CASING:
From 0
From 51
From
GROUT:
From 0
From
SCREEN:
From
Depth
To 51
To 52
To
Depth
To 20
To
Depth .
To
From To
SAND/GRAVEL PACK
Amount 1 6oz
Wall Thickness
Diameter or Weight/Ft. Material
Ft. 6" pvr
Ft. 6" 188 steel
Ft.
Material Method
Ftten ite & oan t Finial
Ft.
Diameter Slot Size Material
Ft. in. in.
Ft. in. in.
Depth Size Material
From To Ft.
From To Ft.
16. REMARKS:
Topographic/Land setting
DRidge DSlope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees'm inuiesrseconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From To Formation Description
0 50' clay & sand
50' 500' granite
c
rrl
0
o�
o�
numbers and common road names. I o�
CO -ern
-D-io
rn`
�o
ni
rn0
LOCATION SKETCH 0
Show direction and distance in miles from at It
two State Roads or County Roads. Include thef ad
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 0\\ NER
7.. ,)Ov 7/3i/c e
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center- Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-1 REV. 07/2001

2'75)21
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) Mitchell D. Cook CERTIFICATION�p# 2043
Halal Brothers kill Erillirn, Itt PHONE # p) 369-9591
WELL CONTRACTOR COMPANY NAME
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED \\'Q PERMIT#
(if applicable) (if applicable)
I. WELL USE (Check Applicable Box): Residential Municipal/Public ❑ Industrial 0 Agricultural ❑
Monitoring 0 Recovery 0 Heat Pump Water Injection ❑ Other ❑ If Other, List Use
2. WELL LOCATION:
Nearest Town: Cashiers County Jackson
Wolf Knob'Rd-Hawks Crest Lot #2
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: Douglas &'I Pamela Smith
Address 390 Milford Point Rd
(Street or Route No.)
Merritt Island, FL 32952
City or Town State Zip Code
(321)- 459-2620
Area code- Phone number
4. DATE DRILLED 8-4-03
5. TOTAL DEPTH: 400'
6. DOES WELL REPLACE EXISTING WELL? YES 0 N0xIN
7. STATIC WATER LEVEL Below Top of Casing: 300 FT.
(Use -r" if Above Top of Casing)
8. TOP OF CASING IS 2 FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordance with 15A NCAC 2C .0118.
9. YIELD (gpm): 19 METHOD OF TEST blow
10. WATER ZONES (depth): 95' & 365'
11 DISINFECTION: Type H T H
12. CASING:
Depth Diameter
From 0 To 76 Ft. 6"
From 76' To 80 Ft. 6" .188 steel
From To Ft.
13. GROUT: Depth Material Method
From 0 To 20 Ftbarnite & carat pirre3
From To Ft.
14. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in.
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Size Material
Amount 160z
Wall Thickness
or Weight/Ft. Material
pvc
From To Ft.
From To Ft.
16. RENIARKS:
Topographic/Land setting
❑Ridge ❑Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees in inures/seconds)
Latitude/longitude source:OGPSOTopographic map
(check box)
DEPTH DRILLING LOG
From To Formation Description
0 78' clay & sand
78' 400' granite
-c
LOCATION SKETCH
W
cn �a
rnr
Cr
I o.c
co m
Show direction and distance in miles from at least ➢o
two State Roads or County Roads. Include t roarg-;
numbers and common road names. cnz
t!? m
w
m
Ca)
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH I5A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
l 20 7;•r— /`!4 /n2
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center -Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GVV-1 REV. 07/2001

WELL CONSTRUCTION RECORD
I) rI . Y1
fi,ri
t),_
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) Mitchell D. Cook
WELL CON'IRACTOR COMPANY NAME Hall &tilers Roll aailuy, lit
CERTIFICATION # 2043
PHONE # [phone]
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
WELL USE (Check Applicable Box): Residential 3 Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection ❑ Other 0 If Other, List Use
WELL LOCATION:
Nearest Town: SylVa County Jackson
Fisher rreek-1 7 miles on T.
(Street Name. Numbers, Community, Subdivision, Lot No.. Zip Code)
3. OWNER: Edward Far1 Greer
Address 1857 Fisher Creek Rd
(Street or Route No.)
Svlva, NC 28779
City or Town State Zip Code
L828- 586-5096
Area code- Phone number
4. DATE DRILLED 7-29-03
5.TOTAL DEPTH: 500'
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO42F
7. STATIC WATER LEVEL Below Top of Casing: 300' FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS 2 FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordance with 15A NCAC 2C .0118.
9. YIELD (gpm): 20 METHOD OF TEST blow
10. WATER ZONES (depth): 140' , 310, & 475'
11 DISINFECTION: Type H T H Amount 1 6oz
12. CASING: Wall Thickness
Depth Diameter or Weight/D. Material
From 0 To 101 Ft. 6" .188 steel
From To Ft.
From To Ft.
13. GROUT: Depth Material Method
From 0 To 20 Fttarnite & cEmnt. purred
From To Ft.
14. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in.
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
16. RENIARKS:
Topographic/Land setting
❑Ridge ❑Slope ❑Valley 0Flat
(check appropriate box)
Latitude/longitude of well location
(degreesm inutes.Seconds)
Latitude/longitude source:OGPSOTopographic map
(check box)
DEPTH DRILLING LOG
From To Formation Description
0 99' clay & sand
99' 500' granite
r^
O
w
Cn m
cm
LOCATION SKETCH CO orn
Show direction and distance in miles from at leastilF,
-10
two State Roads or County Roads. Include S roao
numbers and common road names
CA)
W
cnz
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH I5A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
>/� 9
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-1 REV. 07/2001
0.

13
14
15
WELL CONSTRUCTION RECORD
278519
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) Mitchell D. Cook
\\ ELL CONTRACTOR COMPANY NAME Hail Enters Will Wiling, Dr
CERTIFICATION # 2043
PHONE # [phone]
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
2
WELL USE (Check Applicable Box): Residential ® Municipal/Public ❑ Industrial 0 Agricultural 0
Monitoring 0 Recovery ❑ Heat Pump Water Injection ❑ Other 0 If Other, List Use
WELL, LOCATION:
Nearest Town: Whittier County Jackson
22 Apple Blossom Lane
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: Charles & Susan Bogart
Address 22 Appie Blossom Lane
(Street or Route No.)
Whittier, NC 28789
City or Town State
(828)- 586-0085
Zip Code
Area code- Phone nuinber
4. DATE DRILLED 8-6-03
5. TOTAL DEPTH: 350'
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO KIK
7. STATIC WATER LEVEL Below Top of Casing: 300 FT.
(Use "✓' if Above Top of Casing)
8. TOP OF CASING IS 2 FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordance with ISA NCAC 2C .0118.
9. YIELD (gpm): 6 METHOD OF TEST blow
10. WATER ZONES (depth): 215' & 308'
11 DISINFECTION: Type H T H Amount 16oz
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
From 0 To 58 Ft. 6" .188 steel
From To Ft.
From To Ft.
GROUT: Depth Nlaterial Method
From 0 To 20 Ftbarnite & carntt ptirpxii
From To Ft.
SCREEN: Depth Diameter Slot Size Material
From To
From To
SAND/GRAVEL PACK
Depth
From To
From To Ft.
16. RENIARKS:
Ft. in. in.
Ft. in. in.
Size Material
Ft.
Topographic/Land setting
❑Ridge ❑Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees 'm inutes'seconds)
Latitude/longitude source:❑GPS❑Topoeraphic map
(check box)
DEPTH DRILLING LOG
From To Formation Description
0 56' clay & sand
56' 350' granite
O D
CO o
LOCATION SKETCH
Cn 3n"
rn on"
Show direction and distance in miles from 3iCeast c
two State Roads or County Roads. Include ate roaaCO 7C
numbers and common road names. >0
-4
-m
nt
mJ
I 7 3
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL II
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWtt—
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
27699-1636 Phone No. (919) 733-3J21, within 30 days. GW-1 REV. 07/2001

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) Mitchell D. Cook
WELL CONTRACTOR COMPANY NAME F±SI $Otha'S 11 brie Ire
273518
CERTIFICATION # 2043
PHONE # S28) 369-9591
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMITS(
(if applicable)
(if applicable)
WELL USE (Check Applicable Box): Residential 3 Nlunicipal/Public ❑ Industrial 0 Agricultural 0
Nlonitoring 0 Recovery 0 Heat Pump Water Injection 0 Other ❑ If Other, List Use
WELL LOCATION:
Nearest Town: Tuckasegee County Jackson
401 Grassy Creek RD
(Street Name, Numbers, Community, Subdivision, Lot No.. Zip Code)
3. OWNER: Ronnie Creasman
Address 401 Grassy Creek Rd
(Street or Route No.)
Tuckasegee, NC 28783
City or Town State
( 828- 293-0171
Area code- Phone nwnber
4. DATE DRILLED 8-1-03
Zip Code
5.TOTAL DEPTH: 200'
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO EPC
7. STATIC WATER LEVEL Below Top of Casing: 100 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING 1S 2 FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordance with ISA NCAC 2C .0118.
9. YIELD (gpm): 10 METHOD OF TEST blow
10. WATER ZONES (depth): 100' & 180'
11. DISINFECTION: Type H T H Amount 16oz
12. CASING: Wall Thickness
Depth Diameter or WeightrFt. Material
From 0 To 36 Ft. 6" pm -
From 36'To 57 Ft. 611 1RR steel
From To Ft.
13. GROUT: Depth Material Method
From 0 To 20 Fttasnzite & oanEnt PWSI
From To Ft.
14. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in.
From To Ft. in. in.
15
SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
16. REMARKS:
Topographic/Land setting
❑Ridge ❑Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees minutes: seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From To Formation Description
0 55' clay R sand
55' 200' granite
Oen
en
w
m
LOCATION SKETCH v m
i .
Show direction and distance in miles from aettast rn
two State Roads or County Roads. Include th roar
numbers and common road names. 3 wo
W
W
DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH I SA NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
CAT
H
0
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-I REV. 07/2001

WELL CONSTRUCTION RECORD 278517
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) Mitchell D. Cook CERTIFICATION # 2043
w ELL CONTRACTOR COMPANY NAIVE F$z±XZI atthes V,�71. DLlllarYl, Inc PHONE # [phone]
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential Municipal/Public 0 Industrial ❑ Agricultural 0
Monitoring 0 Recovery ❑ Heat Pump Water Injection 0 Other ❑ If Other, List Use
2,
WELL LOCATION:
Nearest Town: Glenville County Jackson
107 to Pine Creek to Southridge
(Street Name. Numbers, Community, Subdivision, Lot No.. Zip Code)
3. OWNER:Vincent T. Zarzaca
Address 1600 US 64 W 190
(Street or Route No.)
Sapphire, NC 28774
City or Town State Zip Code
(828 )- 884-8410
Area code- Phone number
4. DATE DRILLED 8-11--03
5. TOTAL DEPTH. 1470'
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO $X
7. STATIC WATER LEVEL Below Top of Casing: 1000 FT.
(Use ` r" it -Above Top of Casing)
S. TOP OF CASING IS 2 FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordance with 15 A NCAC 2C .0118.
9. YIELD (gpm): 10 METHOD OF TEST blow
10. WATER ZONES (depth): 1380'
I I. DISINFECTION: Type H T H Amount 1 6oz
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
From 0 To 28 Ft. 8" .188 steel
From To Ft.
From To Ft.
13. GROUT: Depth Material Method
From 0 To 20 Ftbaznite & Yt RarPed
From To
Ft.
14. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in.
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
Topographic/Land setting
❑Ridge ❑Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees'minutes'seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From To Formation Description
0 26' clay & Rana
26' 1420' _____granite
r
CO
Grn
ctn
LOCATION SKETCH Ao
Show direction and distance in miles from gOeasE^-p
two State Roads or County Roads. Include 1 roasI,z
numbersand common road names. G.) ma
W o
z
J
GRouN k-r:
o ur. L. L REA:,
16. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH I5A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center- Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-1 REV. 07/2001
I f, iu
tn^F

278516
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) Mitchell D. Cook
WELL CONTRACTOR COMPANY NAME F�31�S1 Pa tlms [xp11 1�n 11 ir�T, Inc
CERTIFICATION # 2043
PHONE # ��) 369-9591
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
2
WELL USE (Check Applicable Box): Residential ® municipal/Public 0 Industrial ❑ Agricultural ❑
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use
WELL LOCATION:
Nearest Town: Cashiers County Jackson
Breedlove RD-Glen Ridge Lot 1-A
(Street Name. Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: Bruce Dickey
Address 131 Swiss Lane
(Street or Route No.)
Cashiers, NC 28717
City or Town State Zip Code
(828)- 399-0363
Area code- Phone number
4. DATE DRILLED 8-13-03
5. TOTAL DEPTH: 250'
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO Ec
7. STATIC WATER LEVEL Below Top of Casing: 150 FT.
(Use "+" if Above Top of Casing)
3. TOP OF CASING IS 2 FT. Above Land Surface*
'Top of casing terminated at/or below land surface requires a
variance in accordance with 15A NCAC 2C .0118.
9. YIELD (gpm): 30 METHOD OF TEST blow
10. WATER ZONES (depth): 60' & 205'
11. DISINFECTION: Type H T H
12. CASING:
Depth Diameter
From 0 To 25 Ft. 6"
From 25' To 29 Ft. 6"
From To
13. GROUT: Depth
From 0 To 20
From To
14. SCREEN: Depth
From To Ft.
From To Ft.
15. SAND/GR.AVEL PACK:
Depth
From To Ft.
From To Ft.
Amount 160z
Wall Thickness
or Weight/Ft.
.188
Material
pvc
steel
Ft.
Material Nlethod
Fttarilite & oeTrnt plrf sl
Ft.
Diameter Slot Size Material
in. in.
in. in.
Size Material
Topographic/Land setting
❑Ridge ❑Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees' minutes'seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From To Formation Description
0 27' clay & sand
27' 250' _granite
LJ
8
W Q
rn 33
ca t
c,°,r
LOCATION SKETCH pip o.c
Show direction and distance in miles from at least *fail
two State Roads or County Roads. Include roacl---
as
numbers and common road names. fin
Cifz
rta
c-,
--t
0
W
w
W
IL
L--
{. it ' 't\t,f
ASV t GL I,
16. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
.G/9 cP // Q
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center- Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-1 REV. 07/2001

WELL CONSTRUCTION RECORD
STATE WELL CONSTRUCTION PERMIT#
(if applicable)
278653
North Carolina - Department of Environment and Naturaf`tR sources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) 7o. -Kris r� <.'e CERTIFICATION #'zGS0
WELL CONTRACTOR COMPANY NAME G r,L.1Ks Yn P wII Myra.'
11, no, PHONE # (tz44 '1 79 - Tr3I soy
ASSOCIATED WQ PERMIT#
(if applicable)
I. WELL USE (Check Applicable Box): Residential la Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION:
Nearest Town: t1i County aoek se yl
Pra bI Capper I .2tnq
(Street Name, Numbbeefss, Community, Subdivision, Lot No., Zip Code)
3. OWNER: , W,
Address &u) Cenger A•
(Street or ' oute No.)
PA; rtihn Me 2�799
Zip Code
(VV2t)- 269- in, 9
City or Town State
Arca code- Phone number
4. DATE DRILLED S( 2' 0 3
5. TOTAL DEPTH: yb,
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO $
7. STATIC WATER LEVEL Below Top of Casing: 470 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS / FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance In accordance with ISA NCAC 2C .0118.
9. YIELD (gpm): D. METHOD OF TEST a' r
10. WATER ZONES (depth): 3 L/cT
11. DISINFECTION: Type %}T /21 Amount 0. L 2.
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
From A To MO FL 6.y Sara) PVC
From To Ft.
From To Ft.
13. GROUT: Depth Material
From (1 To 2.6 Ft. CPMeYl7
From To Ft.
14. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in. creek go O.6 miles Turis.R, 1 ol7
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
Topographic/Land setting
❑Ridge ❑Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From To Formation Description
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common road names.
4royn alrlo», posT 6P-lx,ce t0
/.8m;les Torn )e-i zits
n
vrnp,'n}6 IAr9 ri;Its TzX& e ago
ogo
6.6 Vni'lEs Tvrn q + al
PavI cooper Rd go 0• o ; torn
R,4hi gem ',r67DrireOPte T
90 re TopoP hall welr'or>z/cIt
16. REMARKS:
1 DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH I5A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
e
SIGNATURE PERtON CONSTRUCTING THE WELL
Submit the original to the Division of Water Quality, Grou
27699-1636 Phone No. [phone], within 30 days.
rliec An,',_ 3 alifSeixic
8-22-03
DATE
r - Raleigh, NC
-I REV. 07/2001
GROUNDWATER SECTION
..nl in,.i I L Qrr InN31 npRCr

WELL CONSTRUCTION RECORD
C-e)
n•r 8
• 7 7s 9 / C
sLr4t 51 / 1/
x
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section /
CERTIFICATION OH�Sir
WELL CONTRACTOR (INDIVIDUAL) NAME (print),t_f D 5 3 �--q C
WELL CONTRACTOR COMPANY NAME A-{'-1-t�tcezpI� Lt1 ,}r.. ONE # ( U - .(),5 (J
ASSOCIATED WQ PERMIT#
STATE WELL CONSTRUCTION PERMIT#
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential Municipal/Public ❑ Industrial CI Agricultural ❑
Monitoring ID Recovery ❑ Heat Pump Water n)ection ❑ Other ❑ If Other, List Use
2. WELL LOCATIO
Nearest Town:_
(Street Na
3. OWNER
Address Plfl7' J70
County
�L{
ommunity, Subdivision, Lot No.,
(Street or Route No.)
•n State ' Zip Code
Area code- Phone number ( a ?
4. DATE DRILLED / J
5. TOTAL DEPTH: /ate
6. DOES WELL REPLACE EXISTING WELL? YES ❑ 0
7. STATIC WATER LEVEL Below Top of Casing: /j FT.
(Use "✓' if Above Top of Casing)
S. TOP OF CASING IS /i FT. Above Land Surface*
'Top of casing terminated at/or below land surface requires a
variance in accordance with 15.''" NCAC 2C 0118
9. YIELD (gpm):
10. WATER ZONES
Topographic/Land setting
/❑Ridge Slope ❑Valley ❑Flat
d' Jto
3 (check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From Tn Formation Description
5- 6 - /45-
v23a - A --
,a32 -a 67)
L7o-67
METHOD OF TEST 10 73 - -9yn- -
depth):(/,
r/
I I. DISINFECTION: Type �
12. CASING:
From n
From
From
13. GROUT:
From 0
From To
14. SCREEN: Depth
From To
From To
15. SAND/GRAVEL PACK:
Size
Depth
Ft.
To Ft.
To Ft.
Depth Material
To a O Ft. Cc9--nt
Ft.
Diameter Slot Size
Ft. in.
Ft. in.
Amount
7 70 -t l r f '--
,bow direction anraFistatrtee in mils om at t :Y'K•
Wall Thickness t ` / two State Roads or County Roads. Include the road
Diamejer or Weight/Ft, _Material numbers and common road names.
b y � / f/f
From
From
Depth
To
To
16. REMARKS:
Ft.
Ft.
Method,
btateriai
/07 lu
t ffr /2-4
-0 cm
Pc Jji 2 per. etc-r —
in.-rrCJ6 m�
7
i _ N�
rn�
Material C
Q� G
z
1 DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH I SA NCAC 2C, WELL
CONS(''^TION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
V47 04.
� TUREPERSON ORt7CT[\� TfIE W'E� LL£ DATE
/
( SIGNATURE
Submit the original to the Division of Water Quality, Groundwater fiction
27699-1636 Phone No. [phone], within 30 days.

11. DISINFECTION: Type
12. CASING: Wall Thickness
3. OWNER:
Address
WELL CONSTRUCTION RECORD
/loY7-`/2_-/a-2(
3- 46a3GGv
278754
North Carolina - Department of Environment and Natural�tResources
r-"��/D/ivision of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAJIE((pprint) til Phe /j'1///�r`'W 'L �,/ (� // CERTIFICATION Y. �!_ 97
WELL CONTRACTOR COMPANY NAME �(/-{Jt-i(,%s een c_. B O e bi y PHONE JOefSe 'IJX�r7 ,5 c.)
STATE WELL CONSTRUCTION PERMIT# J/
(if applicable)
ASSOCIATED WQ PERMIT,'
(if applicable)
1. WELL USE (Check Applicable Box): Residential Municipal Public 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water njection 0 Other ❑ If Other, List Use
2. WELL LOCATIO
Nearest Town:
County
(Street Name, Numbers, e.mmmulA
nity,,Su:disisio Lot No., Z Code)
1mu
012) ° 9 i
lam;eiret or Ro ;\lo.)c,.. O'
Vtry or Town'/ State Zip Code
( ) A
Area code- Phone n tuber
4. DATE DRILLED 8 - S — 0-3
5. TOTAL DEPTH: L / n
6. DOES WELL REPLACE EXISTING WELL? YES CI O •-i
7. STATIC WATER LEVEL Below Top of Casing: J FT.
(Use' =" if Above Top or Casing)
S. TOP OF CASING IS 11/?.- FT. Above Land Surface*
'Top of casing terminated at/or below land surface requires a
variance in accordaneith 15A NCAC 2C .0118.
9. YIELD (gpm): / • METHOD OF TEST
10. WATER ZONES (dept
Topoe phic/Land setting
DRidge f lope ❑Valley ❑Flat
(check appropriate box)
Latitude/loneimde of well location
(degrees/minutes/seconds)
Latitude/longitude source:OGPSOTopographic map
(check box)
DRILLING LOG
Fo 'on Description
DEPTH
From To
p
O17/
y' 6 /
4— rQG �
rafn — a� 3
c & — a.7D
g-70 — a174y
a7Y_ 3a
—y
3Ira- " gb
3 itD LOCATION SKETCH j • Oezifir)
Ca two State Roads or County Roads. Include the road
Depth f . 11 Diameter or Neioht'F[. Mate I numbers and common road names.
f� �14) Ft. L- �� , »S��' � t
r Z Amount how direction and distance inmiles- at lzast
in) Cruz'
From
From To Ft.
From To Ft.
13. GROUT: 0 Depth /`, Maer-T �1 ethod
From To �V Ft.�'r`e+"'-f From To Ft.
14 SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in.
From To Ft. in. in.
15.SAND/GRAVEL PACK:
Depth Size t`ta!at i:P,
From To Ft.
From To Ft.
16. REMARKS:
atatL
Zdt Pi
Ott)
ihrty;_c at -IC
n
GO
Z
1 DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH I5A NCAC 2C, WELL
CONSTRUCTION STANDARDS AND THAT A COPY O THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
.27 v_
Submit the original to the Division of Water Quality, Groundwat
27699-1636 Phone No. [phone], Within 30 days.
b 242-42- g
SIGNATURE ERSON NSTRUC' '— "F- %Y('ELL iiiti a `;ij PA
f= Lf II, r ' L-'
on, 1636 Mail Service Center,- Rja eigh, NC
GANtIti_OE�N.07/2001
4

2'7• 61 ' ,S�luu 74 w
667�u- co�3Y7�
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section Q-7
CERTIFICATION # / /
WELL CONTRACTOR (INDIVIDUAL) NAME (print)/1'It,K'T�t1 /N I rfI'T (t6
WELL CONTRACTOR COMPANY NAME 9" K-7—zr_e ttJc
AIN
PHONE # (� c; s S C)
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential Municipal/Public ❑ Industrial 0 Agricultural ❑
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other 0 If Other, List Use
2. WELL LOCATI N: Topographic/Land setting
>leirest Town. ��L ,,'C7ounty' ❑Ridge�Slope [Walley ❑Flat
1LQ�t ,(u� j-7J)J-t,GClt r{ ��i.-- (check appropriate box)
(Street Name,
�Numbers, Comlmunity, Subdivision, Lot No�., Zip Code) j') c )_'S? _ice tttude/longitude of well location
3.OWNER I\(Jer 1I Y'ell A/ l/
1
11. DISINFECTION: Type-/l//t Amount
12. CASING: Wall Thickness
Depth ! Diamet r or Weight/Ft. Literjal
From 0 To .2/ Ft._�,4 5�,2 Z/ VG/C--
From To Ft.
From To Ft.
13. GROUT: Depth ""1� Material 1 �Method
From v To cL`
Ft.+Y- ! 4 C
From To Ft. //
14. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in.
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
City or Town State_ Zip Code
Area code- Phone number -�
4. DATE DRILLED — 2 % G 3
5. TOTAI, DEPTH: +q(
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO ,K
7. STATIC WATER LEVEL Below Top of Casing: 9 S FT.
(Use "+" i f Above Top of Casing)
S. TOP OF CASING IS i /2— FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordance with 15A NCAC 2C .0118. /'�,
9. YIELD (gpm): Y METHODelf ST C Jt/c-
0. WATER ZONES (depth): .��5 ��1�
16. REMARKS:
(degrees/minutes/seconds)
Address 5-no w m o,,L.-f-C+—�'a.IP - %C'�J Latitude/longitude source:❑GPS❑Topographic map
(Street o Route No.) (check box)
1C Yvt-1.4I ro ) _ °Z Jl% f DEPTH DRILLING LOG
From To Formation Description
/crz)
/O7) - 5-y;-
'jc%) -Z,CRJ
r/SZ
0
Co
CO �T
111 o
LOCATION SKETCH -1
1 oc
Show direction and distance in miles froprat least^;
two State Roads or County Roads. Include the fkat .at
numbers and common road names. a�
O mz,
0
CO -"t
C% 0
LiaLd
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH I5A NCAC 2C, WELL
CONSTRUCTION /l Gti- STANDARDS,
Tt., A COPY OFRD BEEN PROVIDED TO THE/gELL OWNER
SIGNATURE OFfrit
RSON CON
Submit the original to the Division of Water Quality, Ground
27699-1636 Phone No. [phone], within 30 days.
THvikL
ection, 1636 Mail Service Cen
GRCUNPWATEP SECTION
nourvo L 1-[1.1F. F1FFICF
- Raleigh, NC
REV. 07/2001

d-o
278760 3 tvu96 vv
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section (}
WELL CONTRACTOR (INDIVIDUAL) NAME
t,(,p�riinntt) / ✓ v.,/l n' / l/l', 5 CERTIFICATIONy# (45 7 7
\YELL CONTRACTOR COMPANYNAME Alin•UI`t?—ne- .//OS U)n-( PHONE # fjay nri`CS,S )
STATE WELL CONSTRUCTION PERMIT#
(if applicable) (if applicable)
ASSOCIATED WQ PERMIT#
1. WELL USE (Check Applicable Box): Residential Municipal/Public 0 Industrial O Agricultural 0
Monitoring ❑ Recovery 0 Heat Pump Water Injection 0 Other ❑ If Other, List Use
2. WELL LOCATIO
Ne. est Town:
(Street Name, Nu
3. OWNER
Addres 57-Y /
County
rs, Community Subdivision, Lot No
(Street or Route No.) 2'o `/y
or Town State ] Zip Code Y'
(
Area code- Phone number
4. DATE DRILLED S U
5. TOTAL DEPTH: 57)
6. DOES WELL REPLACE EXISTING WELL? YES 0 NOM
7. STATIC WATER LEVEL Below Top of Casing: /60 • 'FT
1 (Use "+" if Above Top of Casing)
8. TOP OF CASING IS / �2—) FT. Above Land Surface*
'Top of casing terminated at/or below land surface requires a
variance in accord.^ce with �15A NCAC 2C .0118.
9. YIELD (gpm): METHOD OF TEST
10. WATER ZONES (depth): .5 75 v
59_) LOCATION SKETCH p, �T
11. DISINFECTION: Type -�_ Amount _'?Li (� �= Show direction and distance in miles fr6� at lec%11:
12. CASING: Wall Thickness % two State Roads or County Roads. Inclt1t the
Depth, Diameter or Wei ht/Ft. Mat nal numbers and common road names. 1 cn / g
From 0To 7 Ft. ��! .5 OJC 7/ a,
From To Ft. MC rm
From To Ft. GO cil ma
13. GROUT: Depth Material t Method W
From To �U Ft. cr.Z
From To Ft.
14. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in. ,/ ei 7
From To Ft. in. in. "^
15. SAND/GRAVEL PACK:
Depth Size • Material
ode) 7
Topographic/Land setting
DRidge )Slope ❑Valley DFIat q
�4�Lc ) l (»J check appropriate box)
Lattiituu T/ongitude of well location
e.�) (degrees/minutes/seconds)
Latitude/longitude source: DGPSOTopographic map
(check box)
DRILLING LOG
DEPTH
From To
Formation Description
From To Ft.
From To Ft.
16. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
/
SIGNATURE OF PERS n C WI7CTEG'�H'11"'�` I n ` DATE
Submit the original to the Division of Water Quali
27699-1636 Phone No. [phone], within 30 days.
undwater Section, 1636 S
vice Center - Raleigh, NC
GW-1 REV. 07/2001
GROUPPIVATER SECTION p

278759 54629/S-0
76V3 l4o 3/ 9
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and NaturaleResources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print)�'wf1tu/ ! t t C i�.f�✓Z.�+} CERTIFICATION # IX g,Qj
WELL CONTRACTOR COMPANY NAMEA77 ( ree4 C&TvS6i
STATE WELL CONSTRUCTION PERMIT#
(if applicable)
PHONE # a.0 5S50
ASSOCIATED WPERMIT#
(if applicable)
1. WELL USE (Check Applicable Box): Residential Municipal/Public 0 Industrial ❑ Agricultural 0
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use
2. WELL LOCATIO
Nearest Town: i -' County
(Street Name, Numbers, Community, Subdivision, Lot No
3. OWNER:
Address
(&2t o
Area code- Phone number
4. DATE DRILLED
5. TOTAL DEPTH:
6. DOES WELL REPLACE EXISTING WELL? YES 0 NOX
7. STATIC WATER LEVEL Below Top of Casing: _l r2 FT.
Use "+" if Above Top of Casing)
8. TOP OF CASING IS y/7r (FT. Above Land Surface*
*Top of casing terminated atfor below land surface requires a _
variance in accordance with 15A NCAC 2C .0118. //W7) r�ity
9. YIELD (gpm): /,f�1 METHOD OF TEST
10. WATER ZONES (depth): 3/71 y
o.) ,'r�
�i C� rail 77,
State /ZipCode
�� Topographic/Land setting
y'1%❑Ridge DSlope ❑Valleylat
/ L (01,3977 (check appropriate box)
L titude/longitude of well location
11. DISINFECTION: Type f Amount
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. ten
From 0 To Fthilly_ r`�!_
From To Ft.
From To Ft.
13. GROUT: Depth Material Method
From 0 To �-6 FL t�rl��liu7-� .�/I-� J
From To Ft.
14. SCREEN: Depth Diameter Siot Size Material
From To _ Ft. in. in.
From To Ft. in. in.
15.SAND/GRAVEL PACK:
Depth Size Material
To Ft.
To Ft.
From
From
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DRILLING LOG
Formation Description
DEPTH
From To
W o
LOCATION SKETCH rn c�:�
Show direction and distance in miles frortft lea
two State Roads or County Roads. Includb the triala
numbers and common road names.fri
_.
m
N
m�
17
O
O
3 /F✓t
/fit
16. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH I5A NCAC 2C, WELL
CONSTRU1�TION STAN RDS, AND T ATperC�P F THIS RECORD HAS BEEN PROVIDED TO
THE WELLOWNER
rf� b/��tin1 V�1 Ill 6`2
>-o3
(
SIG
ATUREY PIPET SON CO
aC
Submit the original to the Division of W
Quality, Gro
27699-1636 Phone No. [phone], within 30 days.
�INeiiT a I I�d
dCJ ter Motion)I 1436 Mall Sen
II`
DATE
nter - Raleigh, NC
GW-1 REV. 07/2001
GROUNDWATER SECTION
ASHEVILLE REGIONAL OFFICE

278758
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAh1E/� -((}�p,�j}riinjt) �� /)1 ` .i p�u CERTIFICATION #
WELL CONTRACTOR COMPANY NAME air
STATE WELL CONSTRUCTION PERMIT#
(if applicable) (if applicable)
( 1i7✓Q. Y1../C5 (C) wPHONE # -5 ti-GSS
1. WELL USE (Check Applicable Box): Residential Municipal/Public ❑ Industrial ❑ Agricultural ❑
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use
2. WELL LOCATION:
Nearest Town:.
(Street Name,
3. OWNER
Address
)ec(Scree r Route No.)caa_ j .3,Th do
City or Town State Zip Code
Vi )-,2 v2 — 7700
ho e number
4. DATE DRILLED `� 3 Q3
5. TOTAL DEPTH:']
6. DOES WELL REPLACE EXISTING WELL? YES ❑////NOS-•
7. STATIC WATER LEVEL Below Top of Casing: 7`Z) FT.
/ (Use "+" if Above Top of Casing)
8. TOP OF CASING IS / 72 -, FT. Above Land Surface*
*fop of casing terminated at/or below land surface requires a
variance in accordance with 15A NCAC 2C .0118.
9. YIELD (gpm): C-) ET OD _OF TEST
10. WATER ZONES (depth): toe, V7%
J ar
11. DISINFECTION: Type %7il- Amount
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft Materi
From To 5 / Fla
From To Ft.
From To Ft.
13. GROUT: Depth Material
From Q To o.24 Ft. (°‘i --,, �-7`
From To Ft.
14. SCREEN: Depth Diameter
From To Ft. in
From To Ft. in
County
mbers, Community, Subdivision, Lot
ASSOCIATED WQ PERMIT
tJ
J
ere_,
J Ys-y vv W
Topographic/Land setting
DRidge ,'4Slope DValley DFlat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:DGPS❑Topographic map
(check box)
DRILLING LOG
Formation Description
DEPTH
From To
sD,e z� &ac,
Area code-P
Method
Slot Size Material
in.
in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
16. REMARKS:
S �Ln
-.2cJZ' — Zo#y
- 3a.f
36,o - 3 4,
a Se —
LOCATION SKETCH
Show direction and distance in miles from at least
wo State Roads or County Roads. Include the road
numbers and common road names.
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RECOIjH-TJ-IAS BEEN PROVIDED TO THE WELL OWN R
. 0 l `4
✓ SIGNATURE OF PE ON CONS
Submit the original to the Division of Water Quality, Groundwater Section, 16361v
27699-1636 Phone No. [phone], within 30 days.
sAt
ice Center - Raleigh, NC
OW-1r REV. 07/2001
L /
rROUNDWiATER SECTION_

278'757 -Rn 75-d-,?3 3/y
v s i,v
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Naturalf�/R{esourcc s - Division of Water Quality - Groundwater Section C��
WELL CONTRACTOR (INDIVIDUAL) NAME (print)M��l D / Il C-1���� �1./[/�� %{ /_ CERTIFICATION #�7 dc'
WELL CONTRACTOR COMPANY NAME , /i ig roen e or t.0 Id Co( U I'`LJ PHONE # Q.'A JO U— .J.S0
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#/
(if applicable)
(if applicable)
1. WELL USE (Check Applicable Box): Residential Municipal/Public ❑ Industrial 0 Agricultural ❑
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATIOk: % �(-p-c'-1'e_ CIL S
Nearest Town:_ , CountyLJ
A
(Street Name, Numbers, Community, Subdivision, LotNo., Zip Code)
3. OWNER:
Address
(Street lioute No. )� Y� .s ,
(- c fJ
Cityor n St [ Z Code
(J-)-- Z °!'/40 / j 3(e0- b-s73- 6 //✓--
Area code- Phone number
4. DATE DRILLED ,/(?
5. TOTAL DEPTH:
6.
7. STATIC WATER LEVEL Below Top of Casing: 6,0 FT.
p (Use "+" if Above Top of Casing)
S. TOP OF CASING IS _ / /2i FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordance with 15A NCAC 2C .0118.
9. YIELD (gpm): 67I) METH OF TEST —6_,
10. WATER ZONES (depth):(%
DOES WELL REPLACE EXISTING WELL? YES O NO j'
11. DISINFECTION: Type_/714___ Amount
12. CASING: Wall Thickness
Depth Diameter or Wet ht/Ft. Miter 1
From___ To .17/ Ft. (p'cc IGUCdIt_ s--c�C
From To Ft.
From To Ft.
13. GROUT: Depth \\ Material Method
From 0 To .2V Ft. ea-ma,-.7% 7�e y-2/
From To Ft.
14. SCREEN: Depth Diameter Slot Size Material.
From To Ft. in. in.
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Topographic/Land setting
ORidge)Slope DValley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:OGPSOTopographic map
(check box)
DRILLING LOG
Fomlation Description
DEPTH
From To
o- 764
/6,6 —/7/
/ 7/ — 02S-0
& K g, 2)
Size Material
From Ft.
From Ft.
16. REMARKS:
Depth
To
To
O
-O
t
LOCATION SKETCH C Er'
Show direction and distance in miles fronts9S lea -
two State Roads or County Roads. IncludeRce rrCoFir
numbers and common road names. —Calqn_ T Z.g
„Lisp_
JTh
f
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDA' 1S, AND THAT A COPY OF T. S RE SRD HAS BEEN PROVIDED TO THE WELL OWNER
v? 7
SIGNA RE •' PERSON CSNSTR J TING THE WELL DAT
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-1 REV. 07/2001

279S21
'YELL CONS'1'1tUC'1'1(1N ILlikiliW
North Caroline - Devi tumid of Environment mid Nau Resources - Division of Water Quality around ',valet -rtivl
•
WELL CON TRACI OIL (INDIVIDUAL) (P / it i e. CERllF1CA"LIONa{os
wELL CUNItACI OR CUDTANY NAME
//et Wei l Of lj iln TOONE 0 (159) • - _--_,____ASSOCIA ASSOCIATED WO PERM(' I
S FA LE WELL liceblC110N fE1U111� i! o14icablc
iff a r 4icalc
ILI
Other U If Oilier, List Usc
I. WELL USE (Check Applicable Ilos): Itcs}dcnliot W Municip1Vl'ublic U Indushinl U Agricultural
Motrilming U Recovery U Neat Pump Wein Injection Ll U
I "fopoglnldlidl.olld selling
1-14C Z en UKidge ['Slope UVnceil UI'Inl
2. WELL LOCATION: 4!, County
Iowa' --- }check npiunvtIale hr•)
hod} o/; A t5j i�6. ---- Latilude/lougilurlc of well location
Cale N35`31 "/4._2_'" (.a.•ai11 `13 "2C_y
/I / ,r/ _gree Jndnu `)
/11 C.4 e do//� ie er 1'f rhlC RP`p
). OWNER: `` Lntttudeliongilutle source:UGPSUTopog • I
TnL< Cin%f• � � (checkbox)
AJdlcssQ@LLING LOG
(Stied m Route No.l n �L
''root 'fo fonnnlion Ucsuipliun
j—T--- —
2-
(Sliver Nettie. Nnmbrin. Ca: '..... Ity, Sub4rvlslun, Lol No., 7,Ip )
b Qe _ _
eThi oc.
smle vp Code
City or 1o011
(" )
Arta code- Phone mmnber `D ;
4. DATIi DRILLED --•i �f ,
5. -I0TAL 17E1'llL•___________ tcY
(,. DUES WELL REPLACE EXISTINO WELL/ YES U NO
7. STN1 IC WATER LEVEL Below Te opb
f Casielnrgn c.,ins) I -I
R. 7 Iv OF CASINO IS _/ �—
rt. Above I.naul Sul Iike'
•-I p rl t•rl•a lennhdra •Ilrr Felon bad rnrl•ce implies • ✓
r eil•nce In accordante rcllh I5A NCAC 1C .01111.
Q. YIELD (pion): d -- p11iTUOD OF TEST ,4'
Ill. \VATEIt ZONES (depth):
II.. UISINlClION:IyIc Amount
L. l
\Noll "I hickncse
12. CASINO Depth Diameter or Weight/It. Mnlctinl
Tv_ `: ItC..2f .file.A___, Iron I'I.
Porn To_--
from_ to II. cUlod
Depth t0 nl(
13. ORODI P /, fLlj Ufe
_ 1'o It. 4!
1 relll t! � _
Io——it_ _—---- tvtnloinl
flout_ __ Dimneicr Slot Sire
14. 5;.1t1- ia.:
Depth }n.
[tom 1 — I! in.
It ih in.
front Ta---
15. SAND/GRAVEL PACK: Mntednl
Urplh Size
From To 11. ---__
Treln
To It.
O — t%
to
t/1 _I x
V(Q'(IQIJ SKEJ_G1l 1 0<�t
Show direction and distance in miles Rom nt leases`
Iwo Stale Itonds or Courtly Ronda. Include rod o
nuulllcis nod conurmn rood uanres. 0 r�
n
tJ1 =
CO z
16. REMARKS: WELL
I DU IIERERY CEltl IEY MAT 71115 WELL WAS CONS I RUC' LD IN ACCORDANCE WI11I I5A NCAC 2C,
CONS ItUCI ION STANDARDS, AND'fIIAT A C01'Y OF 1111S RECORD IIAS DEED PROVIDED101 IE WELL OWNER
SIG AlUIll1.Or PERSON CON571tUCIINO711E WELL
, NC
Submit the nrlglnnl to the Uh'Iflan of Wider ()wilily, CromldwnleF Section, 1636 Mall Service Coderr REV.01 - IInIeIghRh
11644-1616 thane No. [phone], itIthln 311 tlnys. OW
_

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality Groundwater Section /
WELL CONTRACTOR (INDIVIDUAL) NAME (print) then V)151 MY)IIare% rL CERTIFICATI/ON# te r>Z%�
xt ELL CONTRACTOR COMPANY NAMSIX.nnii fjJn.J Wei 1l)ver, it:lf��j( ).PIPS PHONE -.Ca 14-3;240
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
278830
I. WELL USE (Check Applicable Box): Residential ld---Municipal/Public 0 Industrial 0 Agricultural ❑
Monitoring ❑ Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION: � Topographic/Land setting
Nearest Town: _ lV /1 4-/L County �JLtC c/STC'Y'.� DRitrge ❑Slope ❑Valley ❑Flat
-S(/if0 J YI a- i CC. A') /) Ler1412 rj Pc� F ilr ){ L J i ria (check appropriate box)
(Street Name. Numbers, Community, Subdivision, Lot No.,ZIP Code) 0.2 Et? ..) Cry Latitude/longitude of well location
3. OWNER: D h e r r /, L- if 4 h; *led l ain L. (degrees/minutes/seconds)
Address 41t) 14a4/ MAI(44-12a (� ,Latitude/longitude source:❑GPS❑Topographicmap
(Street oroRoute No.) G (check box)
5;9 /Vh.- /C- C 77 y DEPTH DRILLING LOG
City orTown State zip Code From To Formation Description
(X�r')- ` ; - '7-> '7 .5712` (71el<
Area code- Phone numberr� , 41/, ' f"/ r L) /7 t.(. y fj1>“
4. DATE DRILLED e'r-4F-03 ,S'/r 71.95` 1/it (-ran;t'L
5. TOTAL DEPTH: 7CS'
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO O-
7. STATIC WATER LEVEL Below Top of Casing: &CIO FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS / FT. Above Land Surface*
`Top of casing terminated at/or below land surface requires a
variance in accordance with ISA NCAC 2C .0118. -
9. YIELD (gpm): /_5 METHOD OF TEST /07/i177-4-
10. WATER ZONES (depth): & n 1 i/
1 1. DISINFECTION: Type HIP
12. CASING:
13
14
15
LOCATION SKETCH o
Amount ,� T.,4 %4 S Show direction and distance in miles from at- st
Wall Thickness two State Roads or County Roads. Include thtf..abad ng..r
Depth n Diam�eter or Weight/Ft. Material numbers and common road names. Crn/2 c.-t
From 0 To FI Ft. bit sZ2Rr71 Pt-0__m
From To Ft. I S E
N -cr,
From To Ft. ya
GROUT: Depth Material _/ Method A` o
�(,,�/ S zm
From n To r"-f7 Ft. ep m9, % pa/AA- vsz
tm
crl co
to 3
2
From To Ft.
SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in.
From To Ft. in. in.
SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
16. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF TH S RECORD HAS BEEN PROVIDED TO THE WELL OWNER
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center -Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-1 REV. 07/2001

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality Groundwater Section
fry t(.e LLB CERTIFICATION$••
WELL COMIItACTOR(INDIVIDUAL)NAME (print) Jam-
WELL CONTRACTOR COMPANY NAME 7/i'/fet wet PHONE #
ASSOCIATED WQ PERMIT#
if applicable)
STATE WELL CONSTRUCTION PERMIT#
if applicable)
1. WELL USE (Check Applicable Box): Residential 12"---Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
Topographic/Land setting
[Ridge ❑Slope [Valley ❑Flat
(check appropriate box)
i Atitudellongitude cf well location
/U33''.C.r541. (wo85`i?'of:2"
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
DEPTH,(check box)
noH1.1NG L OG
From To Formation Description
2. WEL 1 LOCATION:
Nearest Town: t e'vz'
ff°`t
C�.e- e- County
//te C`''lt',n t2L -rye/7 ea,lE
(Street Nathe, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: .5°ny4 %il5A-46 ,2
Address °ie i 6"./ 4,st. Qo ee FJ11
(Street or Route No.)
0
City or Town State
Area code- Phone number DS
4. DATE DRILLED b''(,
5. TOTAL DEPTH: )'/° '
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO 0
7. STATIC WATER LEVEL Below Top of Casing: 6 FT.
i
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS FT. Above Land Surface
flop of casing terminated at/or below land surface requires a
variance In accordance with ISA NCAC 2C .0118.
9. YIELD (gpm): METHOD OF TEST
10. WATER ZONES (depth): .1-2
Zip Code
11. DISINFECTION: Type F!T/f
12. CASING: Depth Diameter
From To Ft. k4�
To 6b Ft. L-LS
From
From To Ft.
13. GROUT: Depth
From O To ?
From�I To ` e)
14. SCREEN: Depth
From To
From_ To
15. SAND/GRAVEL PACK:
Depth Size
From To Ft._
From To Ft.
Amount '<' coo
Wall Thickness
or Weight/Ft. Material
54),(21 tv
/5'fr' it4 z i
Material Method
Ft.
7resl�'t
%ii�an
Ft. Siyt/0.4-ft 4e'ssv-t
Diameter Slot Size Material
Ft. in. in.
Ft. in. in.
16. REMARKS:
Material
- °
2p_ tO
eU 7YO
278829
I QQATION S EK TCH -9 zr"
Show direction and distance in miles frg0 at Cul
two State Roads or County Roads. Inc1u4 theYnal
numbers and common road names. = N Z
rn
en
Cr?
CA
tea
I ON HEREBY CERTIFY THAT THIS
AND THAT A COPY OF THISL WAS CONSTRUL tED IN ACCORDANCE WITH I5A NCAC 2C, WELL
RECORD HASEEN PROVIDED TO THE WELL OWNER
CONSTRUCTION STANDARDS. 7"/�i-f`i_U_Z
J, cr a _
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
GW-! REV. 07i2001
27699-1636 Phone No. [phone], within 30 days.

\YELL CONS'1'KUC'1'10N ILEL RI:
r
Not th Car olina - Department of Environment and rintu' eD
al ReiouI e Division
D—r %Valet Quality -
CEondwater� Suction
2�
P
is ELL CON IItAC10I7 (INDIvIl1UAL) NAAIE lrrinp /—Y-- f CEP P, or 1At I t
13.2
writ, CUNIIIA CIOn COPIf ANY NAME
ASSUCIATP.0 ri'11 fP.RPlII li
(il Pv rticablc)
St Air a ILL PUNS I Itli t1UN fElUllir __.__-----
if a r dicublc
I. WELL USE (Check Applicable Ilya): Itesidculial IaMuntcipal/\'oldie U Industrial CI Agricultural U
%enilollug U Recovery U Ilc it Pinup Wntct injection U Other U 1f Other, List Use
'Iopogrnphic/I.nml selling
Ultidge USlope llVnllcy UI'Int
(check npptr.,nlele hn )
Latitude/longitude of well location s„
Nis`20 22.2' w0B3`Z_. f_
ideerteddnulee/s. nndi
Lntitud;'!^1leiludc soulcc: J {check
l'S IT^poglal'hic nr'p
�E' 11 UR1LL]flO LQt1
14om To formation Vest iplion
4 I
Pan-tc
t" Z
2. WELL LOCAIION: County
Nearest .lowIl Lra4e_�'.
— \ IFdividon, t of No., Zip Code)
'Suet! Nome, Nnnshu,, Ce•-^""
3. oWril:lt: Spar n vte�
Add ICSs(Slitl nr ItouteIln.)
Cily or loon SW!
Nu cuJc rl.,.ne number
d. DATE 0RILLEt) g -22- 03
5" 10 FAL DIET' I I1:.2.Q_-------- r t, L
6. 7UI1S WELL REPLACE pxISIMMMO WELL/ AYES L(NO L
1. srnT1C WnrElt LEVEL Udo1`ITc.p ^IfA ove „_o_Cm,h,g)
r
te el
•
P"r. Mimic Loud Sul lace'
A. TOE CASINO IS _�— •
-
p <•dnq In ndndvd .lint lido,/ Inul ins bee twit.,
,nlmce In .rrrtdrhte nllh 15A NCAC IC .aI IP.
O. YIELD (pony _l1l— N1E11100 OI' 1ESI 1
—
-- .
I
ill. WA I ER ZONES (depth): / L7 Amount
II. UISINfEC�rION: T}'pc__Y %- �--\Noll "Ihickncae
I2. CASINO: Depth I.)imnclar or Weight/El. Mnlclinl
iJG
noll�-o�.ZL _ I`I.. _ 50Kd
Site, i
fmnl_ 1n II. _ Method
Depth Material l
13. OROUf f p teL __
Et ou1 D To�� fl. c� ai
fr^nr____ 1j1_.—I'1__ -_ ___ ' Mnlcrinl
r,vEI Diameter Slot Site 14. 5:...caJ. Depth hr. in.
-k.. _ PI .—
hom= flour__—. To rt. in. in.
15. SANIJIGtAV FL PACK: Size Mnlcdnl
from
DeDepthIo Et
front To It
Zip Code
20y
0
m
1-9CAII.IU11 SY_._EJ-G71 o
Show Illrecllorl alld distance 111 Tittles Emirr111 len0'c
two Stale (toads or County Roads. IncludPAie rtprJ
>a
uurnbcrs and common rand uanus. Z >0
Cr
ma
n
01
W Z
16. REMARKS:
I DO IIlllEUY CERTIFY I IINT'11115 WELL WAS CUNSI RUC( ED IN ACCORDANCE With I5A IICAC 2C, WELL
CONSTRUCT ION S INWARDS, AND I11AT A COI'Y OF MIS RECORD IIAS DEED PROVIDED � THE WELL 0i,
51 ' IAlUltl! UI' PERSON CONSIIIUCIIN0'111E WELL DAIS
Ralei
Sulnnll the el Iklhlnl to Ilse !)Eldon of Willer Qunllly, Croundtrnler Section, 16J6 Ndl Service CU;VrI IlLVgh, NC 1
116ao-1636 \'hone No. (919)133-3111011111l 1 31) dn} �.

WELL CONSTRUCTION RECORD
No21Ca:o1r2 •✓<, rte to(En,i:ora :n;zr,d�'a�i.'t F:aVX:os•Di isi:na!1� erQea';rf C ..:i :.. 5t:;.n
wtLLCONTRACTOR(INDII1D"u)NAY G^^"nt Mitchell D. Cook CRTr!CATION'Y 2043
WELL CONTRACTOR CO,M?A,NY;N A.1'lz H Ci8r1 BDOthorS Wo11 Dri 114rgr Tr.- 0•:04': s IFNl:er:3-C::1
STATE 14ELL CCNST RCCION PS.7:41 ! AScOCIATED WQ PERN:T•
(ifacolleablel (:(a:Plicaae)
2'7'7'77 7
1, WELL USE (Che;k Appl!cable':cx): Reside„fiat M'��lcipa'.:7c ❑ Inch al 0 A .—t;', L.:nal
Mcnitt r'n; 0-Recove,y 0 Heat Pat; Waw Injection 0 Other 0 If Other, List Use
2, WELL LOCATION:
Nearest Town: Tuckasegee cc,i-r, Jackson
Beside Thoipe Power Plant
(d-;+ir•'LTiN'-ban,...nr,. 5.`.dl¢,ilc, t$o,Z:PCdc;
3, 0y,TER' John Stronski
Adcess PO Box 690081
(S:-r! sr Ro'.ts No.)
Orlando,•FL 32869
C,y erTow- Stot4 ZlpCz'e
( 407,345-9041
Ana ca'e, P'r,e nior.ber
4, DATE DRILLED - 7-15-03
5. TOTAL DEPTH: -6751
6: DOES WELL REPLACE EXISTING WELL? `.''?S 0 NO Utc
7, STATIC WATER LEVEL Below Top ctCatin3: 600 FT
Nu I(A-ova To; crCuth;) •
S.`TO? OF CASING IS 2 r s, Above Land Se^acee
• 'Top of ese!na ur,9thetS a:or aalow lone ruracc a
var',anoe la aerordan:t with ESANCAC 2C ,41:3,
9, YIELD (g';^,)'- 40 METHOD 0? TEST hLc
10, EATER ZONES (depth): 660'
1l, DJSrN'ccCTifN'Tv2e
12, CA5fNC 0 Pr': L:120
Fror. 20rio 24
FZH A.mrd:,t 1 ECz
W'a Tnicxness
D' fete•. cr Wei?h;T!, h`+'•:y,
te, vcvc
Ft. 6" .188 steel
From To F
13, GROUT: Dept Mattnal
Fro,^ 0. ^c 20 Ft,}�n,;re.g +a,r
From To Ft
14, SCREEN: Dept Diameter Sic: Size Maeca;
F^^r, Tc rtIn, __ 1n.
From Tc ce _i^ _ In
I6. SAND(ORAYEL FACK:
pep. Size . Ma:eda:
From To Ft
From Tc F',
TcpOrsphiciLatri set".:&
CR:dpe °Skye C'r'alle; :Flat
1.4L.Jde ,One":.de Iccat,ort
(Scri n.r.!c.'a t'c e cc J
�S Tcp
tap
tcas
DccT` DTP'' L J'C LC'
F:c7,
122, Fcrotaticr. D:SO- 0..
0 z &
22 675c3^_te
LOCATION SKcTC'r'
Sh :.' d:r e::ion.. and dis.a.:e in, miles Z:7, _t least
rwt Stale Roads ciCo.ar,O4 Roads. Inatic_e _,. ,r_d
ers and r,."Nrr. , _ad Carr..,
16, REMARXS: Obpy of Jackson Co. variance enclosed
I tC H! ,.ESY CER r c°Y T?-:AT r,fls W.ILL WAS CONSTRLC.7 N ACCCA_NC=' 1 1:A NCAC 2C, `;,(E:.L
CONSTRUCTION STA.'r'DARZSiAND THAT ACOPY 0?Th5A2C0:v' HAS 3.32NPROVIDED ',0T-::WELL
O'wtiE?,
14 . ' •
S IC:NATURE OF PERSON CON$ • CTINCTF�weLL
7 - /S o ?
DATZ
Submitthe or g!nal to.the Divisloa of Water Quality, Orouedwater Section, 1405 Mal! Str4 , Center • Rale!a`" NC
7699.163S Phdne No. [phone], wlth!n 30 days. •C'n''I REV O'i2'.0l

'/ ' M1