Ja CY2004

11. DISINFECTION: Type }-I-
12. CASING:
7lbov_..
I ;D
�rr
WELL 'CONSTRUCTION RECORD n99,5[ ,
North Carnhna Department of Environment and Na-t^uial Resources - Division of Water Quality - Groundwater Section
\Vy'r
"ELL CO\TRACTOR RNDIVIbUAL) NAME �1'P't� � I tt ` ` tt� �i � ' CERTIFICATION q aS / 7 y
PHONE ft (8,25'5 S -0
r�
WELL CONTRACTOR COMPANY NAME t�kX��.`-zVcan f, COS )/
STATE WELL CgONSTRUCTION PERMIT:: - ASSOCIATED WQ PERMIT'
apPlicable) -- - (if applicable)
1. WELL USE (Check Applicable Box): Residential Municipal/Public ❑ Industrial ❑ Agricultural O
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other 0 If Other, List Use
2. WELL LOCATION:
Nearest Town:
County 3 4CICSOk)
I v-1-- (Q877`7
(Street Name, Numbers, Communi , Subdi ision; Lot NZ, Zip Code)
3. OWNER: aD Hal Nit FO�1G
Address ,% 4 D f 0 P n
(Street or Route No.)
�txin yo nC- a7029a
ty or Tow State Zip Code
Rs9- .S/07
Area code- Phone number _ U , llI
4. DATE DRILLED / — ) -
5. TOTAL DEPTH: 41 O
6. DOES \VELL REPLACE EXISTING \VELL? YES ❑ NO
7. STATIC WATER LEVEL Below Top of Casing: /OD FT.
1/ (Use "1" if Above Top of Casing)
S. TOP OF CASING IS I 1 FT. Above Land Surface'
'Top of casing terminated at/or below land surface requires a
variance In accordance with bA NCAC 2C .0118.
9. YIELD (gpm): METHOD OF TEST %4 / V-
10. WATER ZONES ( y4) 33 0
t-I-) 3 Gs
Amount
Wall Thickness
Depth Diameter or \Veight/Ft. Material
From_ To 9 t. � 1/y SQ.7L J.l JIX--
From To Ft.
From To Ft.
13. GROUT: Depth
From 0 To t9.0 Ft.
From To Ft.
14. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in.
From To Ft. - in. - in.
Material
UO'Y1s1+
Method
15. SAND/GRAVEL PACK:
Depth
From To Ft.
From To Ft.
16. REMARKS:
Size
Material
Topographic/Land setting
DRidge SSlope DValley ['Flat
(check appropriate box) ' Latitude/longitude of well location
- (degrees'minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
DEPTH
From To
(check box)
DRILLING LOG
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.
I r..
0
c
• ors
CD
m Cm
N >o
rn
=m
N rnz
rnz
r --1
1 �
�1.
I
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITF
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RECO' i HAS _ N PROV
15A Tr4CAC 2C, WELL
)ED TO THE VvILLDWINFR..I
SIGNATURE OF PERSON CO& STRUCTING T N FELL 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

- North Carolina • Department of Environment and Natural Resources • Division of Water Quaky • Groundwater Section 0 9 3 3 7 5
1636 Mail Service Center . Raleigh, N.C. 27699-1636-Phone [phone]
WELL CONSTRUCTION RECORD
WELL CONTRACTOR• 47r) Le (4)P I19- -P p '
WELL CONTRACTOR CERTIFICATION N: PP/6 -* .'6 Ls)luli?e
STATE WELL CONSTRUCTION PERMIT#:
1. WELL USE (CheckApplicabie easy Residentially Municipal ❑ Industrial ❑
•
Agricultural ❑ Monitoring ❑
Recovery ❑ Heat Pump Water Injection ❑ Other ❑ II Other, List Use:
2. WELL LOCATI N: SSShof sketch of the location below) jj;Ce
Nearest/To n: i / S Nlre; County fir✓
/2 _LA jtiro ,/y%.wrAi.< I S
(Road Name and Numbers. Commun y, or Subdivision and Lot No.)
3. OWNER 2711/e f-q 4 ir4/"NC
Add ie foil
9
DRILLING LOG DEPTH
From To
Address ,�1 r
,• s° el arrZioula No.) dr 63
, s elf,. Alt ( oZip ode G, 3 cos" a.v t
tyorTown le giarg."5.5*.cy/i Zip Code r'S ,JC.c • 1' " e
4. DATE DRILLED,"9'`Z-3-"o 7
5. TOTAL DEPTH 9cS
6. CUTTINGS COLLECTED YES fj NOD
7. DOES WELL REPLACE EXISTING WELL? YES Q NOd
B. STATIC WATER LEVEL Below Top of Casing: FT.
(Use': it Above Top of Casing)
9. TOP OF CASING IS `Z FT Above Land Surface'
-Top of cuing terminated Nor below land surface requires a variance In accor-
dance with 15A NCAC 2C .0118
10. YIELD (gpm)- In METHOD OF TEST !i-J
11. WATER ZONES (depth)•
F•nnation Desyriplio
•
12. CHLORINATION: Type n7, Amount
13. CASING: -
If additional space is needed use back of form
Wall Thickness LOCATION SKETCH
Depth Dia g�try or W�eg�+ UFI. serial (Show direction and distance from at least two Stale
From �'� To Cn j Ft (C77 '7 � � Roads, or other map reference points)
From To Ft ////
From — To Ft //�GLI `YY
14. GROUT:
'l Depth M ten I Methodr7
From D To �"' Ft � ° punier'
From To Fl
15. SCREEN:
Depth Diameter Slot Sizo Material
From To Ft - in in
From To Ft in in
From ____ To ___. Ft in in
16. SAND/GRAVEL PACK:
Depth Size Material
From To Ft
From To Ft.
c
rc-
.t•' o
3 0
70 cm
1 o<
N =Ern
>0
a rn = —v
m
9?rn m=
c1
m G
17. REMARKS:
i DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER.
DATE
SIGNATURE OF PE SON CONSTRUCTING THE WELL
Submit original to Division of Water Quality, Groundwater Section within 30 days GWI REV
FOR OFFICE USE ONLY
Quad No:
Sena! No.
r

2933'72
WELL CONSTRUCTION RECORD
North ('arolina - Department of Environment and N,tfrral Resources - iv ..ion or Water Quality - Groundwater Section i
A
,' _ y �f' c9
WELL comic:wit/It 1 INDI)'i DtlAl.) NADIF. Trim)) K / r/ '
tt Et.l. ton t lt.wroa COMPANY NAME ,c c—efh/.l wLb.-rP__.
CERTirICATIIIONN I CC7CfjQ
PITONS II w/"S5i✓ JT/s�l
s FATE VELL CONSTRUCTION rERMrrw ASSOCIATED WQ PERMITS
t ifapplicable) __ - (if appl icahle)
1 WE IA. USE (Check Applicable I3ot): Residw:ial fJ lvlunicipaVI'ublic ❑ Industrial ❑ Agricultural
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 II'Other, List Use
•
2. WELL LOCATION:'-/�
't(
Nearest Town: it C-k
Ubeel Name. Numhas
unnnrity. Subdivision, Lot No.. Zip Code)
3. OWNER. c /i1 -e $
Adds ess
t.' Trot ru IssI No.)
/C•
Clot/ •.I 1 OW II Slane
c,✓
8/D o1 SO
322c4
Zip Cu.h
Area c'!v Phone nnulh.
I. DATE DRILLED :� - y--,�
5. rtrrm. DIEPTH:FC'rs (_
rr. DUES WELL REPLACE EXISTING WELL? YES 0 NO I(
7. STATIC WATER LEVEL Below Top of Casing: IT.
t use "+' il' Above Top al'Casingl
S. TOP OF CASING IS � FT. Above Land Surfice•
"foil or casing Icnninuted aUor below land surface requires a
variance in accordance with 15A NCAC 3C .9118.
O. YIELD (goo): / METFIODOFTEST Air
it). \VA'I'Iil ZONES (depth):
I I. DISINFECTION: Type ,4 T/' Arne tint
12. CASING: Wall lihickness.
De oh . q' ter
From t� Tn
From
FrontI'o_—_
13. GROUT: Depth?
how 0 Ta _O
ono
I -I. NC RIiIiN: Dcplh
From...
From.._—.To
15. SAND/GRAVELPACK
Depth
From _ To 1'1.
I'tlllll 1 n 1'1.
16. ItF\IARkS:
;4
Ft.
Ft.
Waterikt,41.:t Method
Diameter Slur Sire Material
in.
�crpographic/Land setting
Ridge ❑Slope ❑Valley Gill:jt
idled appropriate hoc 1
Latitude/longitude or well location
l degrecshnimne*fsecuntist I.4 L---. ..
Latitude/longitude source:❑GPS❑Topographic rt}'gr
check loon) I_..
DEPTII . - DRILLING LOG
1'3m >To P(yn alit 1 Description
L� .3y�
..J., C) 4Nd9Y/
e
LOCATION SKETCFI
Show direction and distance in miles from at least
two State Roads or County (toads. Include the road
or / V igniEl 1. venal numbers and common road names.
°14ht4 % l -71 uue'sf
Sae Malerial
t=1
r
(V
a
0
CO
I UU I IEREl3Y CERTIFY THHATTHIS WELL WASCONSTRUCTED IN ACCORDANCE WIT(I I5r\ NCAC 2C, WELL
C'UN> f RU(:'I'ION STANDARDS. AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
_I_1, a- y-oq
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
Submit the original to the Division of Water Qur.lily, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
27699-1616 l'I • No. [phone], within 31) days. - CiW-I REV. 07/2001

WELL CONSTRUCTION RECORD
North Carolina - Department of Envirt nment and Natural Resources - Division of Water Quality - Grourdwater Section
WELL CONTRACTOR (INDIVIDUAL) NA`9E (print) OeCC:e-x CI" seta CERTIFICATION# ar:L3°
q�.�
WELL CONTRACTOR COMPANY NAME C-Ni& S-baue.C� d 5C v '
-nt3e, 9 s' PHONE # SOc q. *S-"C'Z2_
STATE WELL CONSTRUCTION PERMIT- ASSOCIATED WQ PERMIT#
(if applicable) appliiggLommon
293161
I. WELL USE (Check Applicable Bo c): Residential 0' Municipal/Public ❑ Industrial ❑ Agricul ural
Monitoring ❑ Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION:
Nearest Town: S ) J a
Sco' k
County gn_C k.5D vJ
(Street Name, Numbers, Community, Subdi ision, Lot No., Zip Code)
3. OWNER: C`. A-5 lie.R'S
Address /))tn1 (3 rt. eV-- -T+'a:\
(Street or Route No.)
S�IJ0. ?J.ct
City or Town State Zip Code
( ) eg tC it
Area code- Phone number
4. DATE DRILLED / — 0
5. -TOTAL DEPTH: 325-
6. DOES WELL REPLACE EXISTIN
7. STATIC WATER LEVEL Below 1
(Ue
8. TOP OF CASING IS /
*Top of casing terminated at/or below Jar
variance in accordance with 15A NCAC'.
9. YIELD (gpm): 5a METH(
10. WATER ZONES (depth):
epographic/Land setting
iW]R dge ❑Slop: ❑Va ley BFtat
(check appropriate t )x) I" '
Latitude/longitude of wt II location
(degrees/minutes/seer ,ds)
Latitude, longitude source:❑GPS7Top
(check lox)
DEPTH DRMLLI
From To Formation Descriptic
'-i'-/ TT 7/ ntte to
7/ 'Tb 37S-
G WELL? YES 0 NO 9--
op of Casing: I-ra FT.
"+" if Above Top of Casing)
'T. Above Land Surface*
d surface requires a
C .0118.
D OF TEST R 5
11. DISINFECTION: Type cc:\\S
12. CASING:
Depth Dianeter
From 4 / To Ti _ Ft._f��
From To Ft.
From To Ft.
13. GROUT: Depth
From t To % /
Amount ID
Wall Thickness
or Weight/Ft. Material
al
#21 T c-
M 3terial Met od
FL Ce iae Qou- From To Ft.
14. SCREEN: Depth Diame' sr Slot Size Material
From To Ft. in. in.
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Siz Material
From To Ft.
From To Ft.
G ra t e
C 1-)
r 7.3
—
TTl "m
's> 0
73.
Y _71
rn
LOCATION SKETCH x
N3 y
Show di -ection and distance in miles from at lssst
two Stat s Roads or ourty Roads Include the3oa 1
numbers and co mmo road name's.
From
��o r oK
1 rc
ts
pe:&
53
16. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTIONNANDAP» ANFATFAT A COPY OF THIS RECORD HAS BEEN I PROVIDED TO THE WELL OWNER
/.-5` oy
SIGNAT 1R
SON CONSTRUCTINGNTHE V ELL DATE
Submit the original to the Division of Hater Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-1 REV. 07/200I
Q
oco7rs
ar-
5cLot-t

293123
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL)NAME (print) c7.eDv115 CERTIFICATION #ol /74a
WELL CONTRACTOR COMPANY NAM/ 1)nIS 010 O}�nr' W e ,6 11 1td 174 P PHONE # �„yr.s a 14-3 g6 '
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED W ERMIT#
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential unicipal/Public 0 Industrial 0 Agricultural 0
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other ET If Other, List Use
WELL LOCATION:
Nearest Towln:.S / V c2i /1/C County ' (._L�CS 07V
.C)
qi 4/ 2+ ?laser. /1; 7-o p Mtn, c2 7799
(Street Name, Numbers, Community, Subdivision, Lot N6., Zip Code)
3. OWNER: 1 C �c c 0)(CA S
Address )D. L" f3rnK (r, "7
(Street or Route No.)
S
//vr--- 2,2,s779
City be Town State Zip Code
(2a t .5"n t — 37&' S
Area code- Phone number
4. DATE DRILLED / — •3 9 - D 44
5. TOTAL DEPTH: 'WY/
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO
7. STATIC WATER LEVEL Below Top of Casing: .50 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS / FT. Above Land Surface'
*Top of casing terminated at/or below land surface requires a
variance In accordance with ISA NCAC 2C .0118.e") S//
9. YIELD (gpm): 6' METHOD OFTEST _h/IJI/1i7L(/-�
10. WATER ZONES (depth): / z0' ((��
/1'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
0 /0
ca-riel"Sizryi a
gLb, e 6;k,o,viT�
DEPTH
From To
o 94711
4u' F4'
94-' y-cn'
I I. DISINFECTION: Type {ff"/f Amount ra r A- AS
12. CASING: Wall Thickness
Depth` Diameter or Weight/Ft. Matey l
From To 0 Ft. lr7" S-Z2g,21. PYC�
From To Ft.
From To Ft.
13. GROUT: Depth
From () To rZ Ft.
From To Ft.
14. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in.
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft,
16. REMARKS:
Material
0-42.rr
Method
nlA
O o
s
r'7
�z
LOCATION SKETCH W z=
Show direction and distance in miles frost lea <
two State Roads or County Roads. Include the rtiecta
numbers and common road names. _ pa
wz
C) m�
c�
J
O
z
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH ISA NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY F TH{S RECORD BEEN PROVIDED TO THE WELL 0'
fir
SIGNATURE OF PERSON CONSTRUCTING THE WELL
-�f
DATE
PR
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
r7.771
LT L
7
c�
C
Err,'

WELL CONSTRUCTION RECORD 292. fir 4
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# ASSOCIATED WQ PERMIT:
(if applicable) (if applicable)
- Groundwater Section
CERTIFICATION k 2045
PHONE [phone]
L .WELL USE (Check Applicable Box): Residential Municipal/Public 0 Industrial ❑ Agricultural 0 t
Monitoring ❑ Recovery' 0 Heat Purn? Water Injection ❑ Other 0 If Other, List Use
2. WELL LOCATION:
Nearest Town: Sylva County Jackson
•384 Billy Cove RD--EBCI well
(Street Name, Number, Community, Subdivision, Lot No„ Zip Code) -
3, OWNER:Steven Lillard
Address 384 Billy Cove RD
(Street or Route No.)
Syluas., NC 28779
City or To':+n Scare
(828 )- 586-3840
Area code- Phone number
4. DATE DRILLED 1-29-04
5. TOTAL DEPTH: 200'
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO tgc
7. STATIC WATER LEVEL Below Top of Casing.: 25 - 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): 50+ METHOD OF TEST blow
10. WATER ZONES (depth): 95' & 178'
Zip Code
I1. DISINFECTION: Type
12. CASING:
H T
H Amount 16 oz
Wall Thickness -
or Weight/Ft, Material
.188 steel
Depth Diameter
From 0 To 65 Ft. 6"
From To Ft.
From To Ft.
13. GROUT:
From 0
From
Depth Material
To 20 Ft. barrnite & c.ale
To Ft.
14. SCREEN: Depth Diameter Slot Size Material
From To Ft. - iti. in.
From - To Ft. in. in.
15.SAND/GRAVEL PACK:
Depth Size - Material
Method
pumped
From To Ft.
From To Ft.
Topographic/Land setting
❑Ridge ❑Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degreeshninutes'secords)
Latitude/longitude source:OGPS❑Topographic map
(check box)
DRILLING LOG
Formation Description
clay & sand
DEPTH
FrOom To
63'
63' 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
16. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15.A NCAC 2C, WELL
CONSTRUCTION STPc\RDS, AND THAT A COY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
F PERSON CONSTRUCTING THE WELL
/ 29-0
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
nm
ern
zm
0.�
3>m
rn
m0
rrl
cn
(n
H
0

From To
15, SAND/GRAVEL PACK:
Depth Size
From To Ft.
From To Ft.
WELL CONSTRUCTION RECORD 292615
North Carolina - Department of Environment and Natural Resources - Division of Water Quality • Groundwater Section
WELL CONTRACTOR (INDIYIDU.AL) NAME (print) Mitchell D. Cook CERTIFICATION #_ 2043
WELL CO:N'f RACTOR COMPANY NANIE ft-']--k; - s4�e11 ail- n:ft Dr PHONE [phone]
STATE WELL CONSTRUCTION PERMIT$ ASSOCIATED WQ PERNIIT (if applicable) (ifaoolicable)
WELL USE (Check Applicable Box): Residential LF Municipal/Public ❑ Industrial ❑ Agricultural ❑
Monitoring ❑ Recovery CI Heat Pump Water Injection 0 Other ❑ If Other, List Use
2. WELL LOCATION:
Nearest Town: Cashiers County Jackson
Stonefly--Well #5
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3, OWNER: Diana Nellans
Address 4384 Caryota Drive
(Street or Route No)
Boynton Beach, FL 33436
City or Town State Zip Code - - -'
(828 )- 526-1772 contact#
Area code- Phone number
4. DATE DRILLED 1-14-04
5. TOTAL DEPTH. 500'
6. DOES WELL REPLACE EXISTING WELL? YES ❑ 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 ISA NCAC 2C .0I15.
9. YIELD (gpm): 30 METHOD OF TEST blow
10. WATER ZONES (depth): 65'
1 I. DISINFECTION: Tyoe H T H Amount 16oz
12. CASING: Wall Thickness
Depth - Diameter or Weight/Ft. Material
From 0 To 51 Ft. 6" .188 steel
From To - Fe.
From To Ft.
13. GROUT: Depth Material Method
From 0 To 20 Ft lite & Wttr,L rated
From - To - Ft.
K. SCREEN: Depth Diameter Slot Size - Materiel
From To -Ft, - in. in. Ft. in. in,
Material
Topographic/Land setting
❑Ridge ❑Slope ❑Valley ❑FIat
(check appropriate box)
Latitude'loneitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:DGPS❑Topographic map
(check box)
DEPTH DRILLING. LOG
From To Formation Description
0 49' clay & s3n3
49' 500' granite
LOCATION SKETLH' �
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common road names.
P',a f t; u
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 THR WELL OWNER
c k>Zl /, A). / 41
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 RE V. 07/2001
/ la r
7004
9 SECTION
_j.._07=1=E
rn
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rnZi
c1
O

WELL CONSTRUCTION RECORD
North Cal • Dcpartment of Environment and Natural Resources - Division of Water Quality • Groundwa,, 3ec`'11b$ -,
r
WELL CONTRACTOR (INDIVIDUAL) NAME (print) Mitchell . D. Cook ' CERTIFICATION # 2043
WELL CONTRACTOR CONIPAN Y NAME FEdlfarl aptlarS Pp11 roi 1, Im PHONE /4 8281 369-9591
STATE WELL CONSTRUCTION PERMITS ASSOCIATED WQ PERMIT:
(if applicable)
(if applicable)
I, WELL USE (Check Applicable Box). Residential 6 Municipal/Public 0 Industrial ❑ Agricultural ❑
Monitoring 0 Recovery 0 Heat Pump Water injection O. Other 0 If Other, List Use
2, WELL LOC.ATION'.
Nearest Towne
Cashiers County Jackson
behind Cashiers Croncile
(Street Nam:, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: Bob Dews •
Address PO Box 188
(Sheet Or Route No.)
Cashiers, NC 287l7
City or Town State Zip Code
(828). 743-5300
Area code- Phone number
4. DATE DRILLED 1-19-04
5. TOTAL DEPTH: 300'
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO a
7, STATIC WATER LEVEL Below Top of Casing: 150 FT,
(Use "4" 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 (epm): 10 METHOD OF TEST blow
10. WATER ZONES (depth): 45' & 240'
11. DISINFECTION: Type
12. CASING:
Dep:h
From 0 To 33
H T H Amount 1 6oz
Wall Thickness
Diameter or Weight/Ft,
Ft. 6" .188
From To Ft.
From To Ft.
13. GROUT: Depth Material
From 0 To 20 Ftbarnite & cete:t
From To Ft.
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,
Material
steel
Method
turned
Slot Size Material
in.
in.
Topographic/Land setting
❑Ridge.❑Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degreahntnuteslsecondo)
Latitude/longitude source:OGPS❑Topographic mup
(cheek box)
DEPTH DRILLING LOG
From To Formation Description
0 31 &
31' 300'
granite
b c,Ui NLJANILR JECTION
LOCATION SKETCFAn.,, 'IL I F REGISNAL OFFICE
Show direction and distance in t.al-] itutn et ILaar
two State Roads or County Roads. Include the road
numbers and common road names.
a
0
16. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS AND THAT A COPY OF THIS RECORD HAS BEEN PROV-IDED TO THE WELL OWNER
.! /� : //9 /ate
SIGNATURE OF PERSON 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

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater SectionY/ _
WELL CONTRACTOR (INDIVIDUAL) NAME (print) J).en h 15. Mt Ti(L'A cle ,f CERTIFICATION # clJ7 4
WELL CONTRACTOR COMPANY NAMK ITh1 kJin• A WlieiI k1�.II' 1YL t,Mte J PHONE # 1 �2LI-'3 2-L' a
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED W ERMIT#
(if applicable)
(if applicable)
WELL USE (Check Applicable Box): Residential" unicipal/Public ❑ Industrial ❑ Agricultural ❑
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other 17 If Other, List Use
2. WELL LOCATION:
Nearest Town n I (r.'U��7�•a
a7
(Street Name, Numbers, Community, Subdivision, Lot No.iLip Code)
3. OWNER: '/a Po./C t
, T_Q-L IC
County S „
u
-
Address / 7 � mn C C�4 Ind 0-'t
(Street or Route No.)
City or Town State Zip Code
)- 7543-3t;27
Area code- Phone number
4. DATE DRILLED /— a --O
5. TOTAL DEPTH: 3So
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO ❑�
7. STATIC WATER LEVEL Below Top of Casing: 90 FT.
t723
Tj ographic/Land setting
idge ❑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
f
/3Luc GreAwl t�
DEPTH
From To
p Y7'
(Use "+".if Above Top of Casing)
8. TOP OF CASING IS / FT. Above Land Surface'
*Top or casing terminated at/or below land surface requires a
97' .350'
I i!
L9
variance In accordance with 15A NCAC 2C .0I18.
lu.wnicn ZONES (depth): 70 LOCATION
l 1. DISINFECTION: Type ff-"i Amount ra %%i S Show direction and distance in miles from at least
12. CASING: Wall Thickness two State Roads or County Roads. Include the road
Depth Diameter or Weight/Ft. MMatepal numbers and common road names.
From 0 - To 4'7 Ft. bu S� 7, YY
From To Ft.
From To Ft.
13.'. GROUT: Depth Material Method
From n To ��(7 Ft. Cagy. A t pCD
e
From To Ft.
14. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in.
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
16. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF THJS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
04- (1 DATE
SIGNATURE OF PERSON CONSTRUCTING THE WELL
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service CeentteGer1 RBVRaleigh, C
27699-1636 Phone No. [phone], within 30 days. -

292537
WELL CONSTRUCTION RECORD
North Carolina -.Department of Environment and Natural Resources -Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) James A. Brown CERTIFICATION 2045
WELL CONTRACTOR COMPANY N.AMMEHedden Brothers Well Drilling,Inc PHONE e828) 369-9591
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential !) 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: Sylva
Betty's Creek
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: Blitz Estridge
Address 405 Winnepeg Lane
(Street or Route No.)
Sylva, NC 28779
County Jackson
City or Town State Zip Code
C.J328 631-5526
Area code Phone number
4. DATE DRILLED 1-26-04
5. TOTAL DEPTH: 300'
6. DOES WELL REPLACE EXISTING WELL? YES NO ❑
7. STATIC \VATER 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 (epm): 35 METHOD OF TEST blow
10. WATER ZONES (depth): 108' & 135'
11. DISINFECTION: Type H T H
12. CASING:
Depth
From 0 To 66 Ft
From 66' To 69 Ft
From To Ft
Depth Material
To 20 Ft. Late & Gnat
Ft.
Diameter Slot Size Ntaterial
To Ft. in. in.
Ft. in. in.
13. GROUT:
From 0
From To
14. SCREEN: Depth
From
From To
Diameter
6"
6"
Amount 16 oz
Wall Thickness
or Weight/Ft. Material
pvc
.188 steel
Method
pumped
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)
DRILLING LOG
Formation Description
clay & sand
granite
DEPTH
From To
0 67'
67' 300'
LOCATION SFETCH, < r '. F
Show direction and distance iaaaifesfromiat teast --"'
two State Roads or County Roads. Include the road
numbers and common road names.
O
rnrn
F
GJ
16. REMARKS`.
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STAND.A[jD3; rfND THAT A COPY THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
SI/ 44d
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-I REV, 07/2001
/

292538
WELL CONSTRUCTION RECORD.
North Carolina - Department of Environment and Natural Resources -Division of Water. Quality
WELL CONTRACTOR(INDIVIDUAL) NAME (print) James B. Brown
\VELL CONTRACTOR COMPANY N'.AMEHamden Brothers Well Drilling, Inc
ASSOCIATED WQ PERMIT
(if applicable)
STATE WELL CONSTRUCTION PERMIT#
(if applicable)
- Groundwater Section
CERTIFICATION k 2045
PHONE#[phone]
1. WELL USE (Check Applicable Box): Residential Municipal/Public ❑ Industrial 0 Agricultural ❑ 1
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION:
Nearest Town: Whittier
Countylackson
446 East Piney Mtn Rd --DRILL DFFPER
(Street Name, Numbers, Community, Subdivision, Lot No.. Zip Code)
3. OWNER: Steve Farley
Address 446 East Piney Mtn Rd
(Street or Route No.)
Whittier, NC 28789
City or Town State Zip Code
(828)_ 586-8400 work
Area code- Phone number
4. DATE DRILLED 1-15-04
5. TOTAL DEPTH: 300ft deeper well is now 500'
6. DOES WELL REPLACE EXISTING WELL? YES 0 NOr
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.0118. blow
9. YIELD (gpm): 10 METHOD OF TEST
10. WATER ZONES (depth):
1I. DISINFECTION: Type
12. CASING:
Topographic/Land setting
❑Ridge ❑Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees'ininutesseeonds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From To Formation Description
0 clay & sand
H T H
Amount 16 oz
Wall Thickness
Depth Diameter or Weighs/Ft. Material
From 0 To Ft.
From To Ft.
From To Ft.
13. GROUT: Depth Material Method
From 0 To 20 Ft. bate & carat 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:
granite
LOCATION KETCH- ',= -_, ^'f;
Show direction and distant..• n milisTcom at least^
two State Roads or County Roads. Include the road
numbers and common road names.
I DO HEREBY CERTIFY THAT THIS \VELL \VAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C,'WELL
CONSTRUCTION STANDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE \VELL OWNER
SIGNATURE 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-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
WELL CONTRACTOR (INDIVIDUAL) NA61E (print) James B. Brown CERTIFICATION - 2045
WELL CONTRACTOR CONIPANYNAME Hedden Brothers Well Drilling, Inc PHONE tt828) 369-9591
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable) - (if applicable) -
I. WELL USE (Check Applicable Box): Residential ES Municipal,/Public ❑ Industrial ❑ Agricultural 0
Monitoring ❑ Recovery 0 Heat Pump Water Injection 0 Other ❑ If Other, List Use
292539
2. WELL LOCATION:
Nearest Town: DillsbOro County Jackson
Tunnel Mtn RD to Paddler's Trail
(Street Name, Numbers, Community, Subdivision, Lot No.. Zip Code)
3. OWNER: Bob & Joyce Lantz
Address PO Box 4221
(street or Route No.)
Cleveland, TN 37320
City or Town State Zip Code
( 423- 339-0425
Area code- Phone number
4. DATE DRILLED 1-14-04
5. TOTAL DEPTH: 400'
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO kDC
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): 266' & 365'
11 DISINFECTION, Type H T H
12. CASING:
Depth Dieter
From 0 To 50 Ft. 6
From 50' To 53 Ft. 6" 188 steel
From To Ft.
13. GROUT: Depth Material Method
From 0 To 20 Ft. tai-nite & OarsTt pumper
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.
Amount 16 Oz
Wall Thickness
or Weight/Ft. Naterial
pvc
16, REMARKS:
Topographic/Land setting
DRidge ❑Slope ❑Valley DFlat
(check appropriate box)
Latitude/longitude of well location
(degreeshninutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DRILLING LOG
Formation Description
clay & sand
DEPTH
From To
0 51'
51' 400'
granite
LOCATION Sl ETCL`H`' .
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 STAN}YtisaDS, AND THAT A COPY F THIS RECORD HAS BEEN PROVIDED To THE WELL OWNER
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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

2925,10
WELL CONSTRUCTION RECORD.
North Carolina - Department of Environment and Natural Resources -Division of Water Quality
1VELL CONTRACTOR (INDIVIDUAL) NAME (print)
James B. Brown
WELL CONTRACTOR CO1PANY NAMEHedden Brothers Well Drilling, Inc
STATE WELL CONSTRUCTION PERMIT ASSOCIATED WQ PERMIT
(if applicable) •
(if applicable)
- Groundwater Section
CERTIFICATION# 2045
PHONE [phone]
WELL USE (Check Applicable Box): Residential Municipal./Public ❑ Industrial ❑
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use
2. WELL LOCATION: y Jackson
Nearest Town: lva Count
254 Parris Branch
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: William Clay Rigdon
Address 254 Parris Branch
(Street or Route No.)
Sylva, NC 28779
City or Town State Zip Code
( 828)- 631-9062
Area codes Phone number 1-12-04
4. DATE DRILLED
5. TOTAL DEPTH: 760'
6 DOES WELL REPLACE EXISTING WELL? YES ❑ NO
7. STATIC WATER LEVEL Below Top of Casing,: 650' 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. blow
9. YIELD (gpm): 2 METHOD OF TEST
10. WATER ZONES (depth): 640'
11. DISINFECTION: Type H T H
12. CASING:
Depth
From 0 To 20 Ft.
From 20' To 23 Ft, 6
From To Ft.
13. GROUT: Depth
From 0 To 20
From To
14. SCREEN: Depth
From To Ft.
From - To Ft.
15. SAND/GRAVEL PACK
Depth
From To
From To
Diameter
6"
16. REMARKS:
Ft.
Ft.
Amount 16 oz
Wall Thickness
or WeiehdFt. Material
pvc
.188 steel
Material
Ft. mite & t.kitt1
Ft.
Diameter Slot Size Material
in. in.
in. in.
Method
pumped
Size Material
Agricultural ❑
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 ToFormation Description
0 21'
clay & sane
21' 760' granite
LOCATION SKE-T- FE
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common road names.
—n
c
IV
—O
N
43
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STRDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
-ice -0 V
SIGNATURE OF PERSON CONSTRUCTING THE WELL - DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center RREl'igh, C
27699-1636 Phone No, [phone], within 30 days. -
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'7(.0572--4340733
WELL CONSTRUCTION RECORD 2 92% 410IDE "i s
North Carellna -:.Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section 7
!'� eL( CERTIFIC5ATII�O\Birth at # Q/1)/
WELL CO\TRACIOR (INDIVIDUAL)NAM{E�(prin�tr)� �L�u-�C-r-L [ /ate � PHONE # NY01 11—'p `>> tJ
WELLCoNtrR4aoR COMPANY N AME /Ate` r eerie
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable) ': (if applicable)
1. WELL USE (Check Applicable Box): Residential (24 Municipal/Public 0 Industrial ❑ Agricultural ❑ I
Monitoring 0 Recovery 0 Heat Pump Water Injection ❑ Other ❑ If Other, List Use
2. WELL LOCATIO Topographic/Land setting
Nearest Town: 7� Coun s--)/ C-k-- Qt DRidge fAlope ❑Valley ❑Flat
/ 11 r, 1 7,n, �,` t ) U/q. (✓ (check appropriate box)
I7 t`o����„"��� c�'777Latitude/longitude of well location
(Street Name, Numbers, Community, Subdivtsio Lot No., Zode /
3. OWNER:CRn02 O b-er / & �` �en
Address C{I.0 LL) -7 1,041
2- (Street or R/ootett a g77?
City or Q9wn jfnl' Statee V f`+'. hip Code
(-W- `Thto— j,gO/
Area code- Phone number
4. DATE DRILLED I— a o —
5. TOTAL DEPTH: tea
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO a
7. STATIC WATER LEVEL Below Top of Casing: Q FT.
I (Use "T' if Above Top of Casing)
8. TOP OF CASING IS J /2-. FT. Above Land Surface'
*Top of casing terminated at/or below land surface requires a
variance in accordance with 1>A NCAC 2C .011S.
9. YIELD (gpm): • METHOD OF TEST kik'
10. WATER ZONES (depth):0
L�T['� 3 S
r YP `1 Tit DISINFECTION: Type Amount O
1 ..CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
0 To (o9 Ft._._C_L(,. 5n/ Z/ gat-
'
From
From To Ft.
irFrom To Ft.
13. GROUT: Depth Material t
'i4bm 0 To r2 0 Ft. C
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
Method
From To Ft.
From To Ft.
pp
(degrees/minutes/seconds)
Latitude/longitude source:❑GPSOTopographic map
(check box)
DRILLING LOG
Formation Description
DEPTH
From To
JI
LOCAT ON SKETCH lii
Show direction and distancaut_tnilesfrom at least
two State Roads or County Roads. Include the road
numbers and common road names.
6-23
I, ,,II 11II
e"-)641
wa-1.
16. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CON UCTION STANDARDS, AND THAT A COPY OF THIS C HAS BEEN PROVIDED TO THE WELL OWNER
ci �-
aryoV
ATURE OF PE N CONSTR TING THE WELL DATE
v
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

292479
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section �
WELL CONTRACTOR (INDIVIDUAL) NAME
(print) e. 'hen i i S fin I) O .e rU //
CERTIFICATIONS nZ/7 cP
YELL CONTRACTOR COMPANY NAMRbMflrC 010/io,td Wei I I) trt J l .), Ye P.) PHONE a4-3 26 6
STATE WELL CONSTRUCTION PERMITS ASSOCIATED WERMITS (if applicable) (if applicable)
_ ��
1. WELL USE (Check Applicable Box): Residential 'ti--- icipal/Public ❑ Industrial ❑ Agricultural ❑
Monitoring .❑ Recovery ❑ Heat Pump Water Injection ❑ Other Ef If Other, List Use
.2. WELL LOCATION:
Nearest Town: Ci-/-en ✓' I )C VC- County SAC.LSt»
(p4L Cidal r 2,ea (161-s PA to ,Q2q.23
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: / MY) 4/e IS crn_,
Address (O SG' (UCLI n u27 ivc, pry
0till uwhee A/C afr'7a 3
Cityur Town State Zip Code
7(3 - 49301-
Area code- Phone number
4. DATE DRILLED J - 0 _ o y
5. TOTAL DEPTH: sn
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO ❑�
7. STATIC WATER LEVEL Below Top of Casing: r? 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 ISA NCAC 2C .0118.
9. YIELD (gpm): .5 METHOD OF TEST hlviiU,btr.
10. WATER ZONES (depth): SO. J 3025' (�
„Topographic/Land setting
idge ❑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
l' /0.
J31 UL�G-"CANrTe-,
DEPTH
From To
o23'
)3,350
(Street or Route No.)
11. DISINFECTION: Type
12. CASING: Wall Thickness
From 0Depth Dia�eter or Wei&ht/FL Mate 1
To .,) Ft. hit $-%2 R,2 j Pr
e-
From To Ft.
From To Ft.
13. GROUT: Depth Material Method.,
From tO To Ft. eanis7, ‘3)/1-A---/
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:
C
p
C_ T�
LOCATION SKETCH = crn
-"i-/ Amount ,-2 TA-1 5 Show direction and distance in miles froma/21easgz.
two State Roads or County Roads. Include% roaltr,2
m�
�m
cn—<
e2
ti
z
numbers and common road names.
'0
W
r5'
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 H S BEEN PROVIDED TO THE WELL OWNER
2"
SIGNATURE OF PERSON CONSTRUCTING THE WELL . DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-1 REV. 07/2001

292478.
Area code- Phone number
4. DATE DRILLED / —c. 1 —64
5. TOTAL DEPTH:
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO
7. STATIC WATER LEVEL Below Top of Casing: So FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS / FT. Above Land Surface*
'Top of casing terminated actor below land surface requires a
variance In accordance with 15A NCAC 2C .OF /IO? J)
9. YIELD (gpm): /0 METHOD OF TEST h
10. WATER ZONES (depth): // 51) e16OO 17 4,i
WELL CONSTRUCTION RECORD
--
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
ry / -
WELL CONTRACTOR (INDIVIDUAL) NAME (print) e�-en M I S /-t j l tee\ d, CERTIFICAT,I,/ON # Or-/7 le
WELL CONTRACTOR COMPANY NAME hniS O p/1Q,,1� Wei Ili 1i;t<�/(j yPt( i PHONE 411D ....S ail--3 ed
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED W4'ERMITN
(if applicable) (if applicable)
)
I. WELL USE (Check Applicable Box): Residential' unicipal/Public 0 Industrial 0 Agricultural ❑
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other d" If Other, List Use
'2. WELL LOCATION:/�
Nearest Town: trie)1 V rr )12 A/L. County JA C)C S pyre
S'nb;'(C1 _P;ne •Q4 -S; N',n5.12at6 T/d.
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code) g 8 / 3 /a
3. OWNER: FR A-,11 7(r rn32fe
Address €bty- /4 a k to : cie C
(Street or Route No.)
�DuoIOSu;lie Ga• 3 v / 35
City Yr Town State Zip Code
DEPTH
(Z�- 9�7— $l3S- From
Co3`
Coy` RS`
To ographic/Land setting
U1Ritg ❑Slope ❑Valley ❑Flat
(check appropriate box) 4
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DRILLING LOG
Formation Description
Vearrtiic-r, t ; +e-
95' S475`
LOCATION SKETCH
SKETCH
l 1. DISINFECTION: Type 1) 11/ Amount •- -75g_ A S Show direction and distance in miles from 9LL,,least
12. CASING: Wall Thickness two State Roads or County Roads. Include e roams
Depth Diameter or We hUFt. Mate 1 numbers and common road names. L.,�,m
Ft. W o rn
o ern
>o
rn
-^'rn
ens
0
Ca —ems
.' o
From To
From To Ft.
13. GROUT: Depth Material Method l
From n To r Ft. ec yyt Oyi� poi(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 Material
From To Ft.
From To Ft.
16. REMARKS:
J 'tC? .!.H7 It
I•
C" OUNC•'."';ATLP SECTION
AS+'_1-'ILLE REGR NAL OFFICE
I DO.HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH I5A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT COPY F TH�CORD HIAS BEEN PROVIDED TO THE WELL OWNER
l -a 1.-OLf
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 n�Q
WELL CONTRACTOR (INDIVIDUAL) NAME�/�l �(p�ri_n�t�) ���� dr�iptY�l.ze- CERTIFICATION 3b /
WELLCONTRACCOR COMPANY NAME I3'4tt cb S. [jlCWhJJJMff. pvG. PHONE # 10.01�3aet'yz
STATE WELL CONSTRUCTION PERMIT# _sJSSOCIATED WQ PERMIT*
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring ❑ Recovery ❑ Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION:
N st Town: CA & crS County: S �lWJ
na ;Jk Cif Mir ,q try
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: ezh+traL tit/QCA,✓Sikk
Address as. t4'Y / 14'
(Street or Route No)
C44Sk.' n /IIL 217
City or Town State Zip Code
Area code- Phone number
4. DATE DRILLED a- 'fl
5. TOTAL DEPTH: /ao5
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO 0
7. STATIC WATER. LEVEL Below Top of Casing: -- FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS % FT. Above Land Surface*
*Top of wing terminated ator below land surface requires a
variance hi accordance with ISA NCAC 2C .0118.
9. YIELD (gpm): ii METHOD OF TEST 4i
10. WATER ZONES (depth):
11. DISINFECTION: Type
12. CASING:
To Ft.�!
From b
From To Ft.
From To Ft.
13. GROUT: Depth
FromQ_ To c224)
From 'To
Amount
Wall Thickness
or Weight/Ft. Material
p1)'-
Material Method
Ft�i �� Dli
Ft.
14. SCREEN: Depth Diameter Slot Size Material
From To Ftin. in.
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth
From To Ft.
From To Ft.
16. REMARKS:
Size Material
Topographic/Land setting
[Ridge 0S1ope ❑Valley ❑Flat
(check appptwriue box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From To Formation Description
Gifr
b- /205- ✓A1>.= -
1
1471
LOCATION SKETCH: `'
Show direction and distance in miles from at least;
two State Roads or County Roads. htcltid the r$1
numbers and common road names. 4 o�
m
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
JAZ,�/ Z .3-ireV
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
1
u d=
c!

cce
245711
WELL CONSTRUCTION RECORD
6-32-327J
a- 4 g 357 W
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section �/J
WELL CONTRACTOR (INDIVIDUAL) NAME (print)rv- D �t ' , Cm`k y r��-1} CERTIFICATION ## c02/O�Oc--
WELLCONTRACTORCOSIPANYNAME k*'R- UreehC 3/-tet WeG{ PHONE#1:222-✓a�"-.7-�5° '
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 0 Heat Pump Water Injection ❑ Other ❑ If Other, List Use
2. WELL LOCATI N:
earestTown: hilleti Ile County .TRGKsar--
Lu.0 01.W LEG roil `n e -,1 e n u� l?r tr\1 C a g 736
(Street Name, Numbers, Community,fSubdivision, Lot No., Zip Code)
3. OWNER:P-0Cfl 1 U SS€U.
Address QC.to VIIIern( PVt
(Street or Route No.)
Atr po •fI 33(eb lo
City or Town State Zip Code
613)- 4a�- so5a
Area code- Phone number
4. DATE DRILLED 3 5-Co
5. TOTAL DEPTH: 3 St
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO Stil
7. STATIC WATER LEVEL Below Top of Casing: I / h FT.
(Use •'+' if Above Top of Cuing)
S. TOP OF CASING IS 3 FT. Above Land Surface*
*Top of casing terminated at'or below land surface requires a
variance in accordance with ISA NCAC 2C.01 is.
9. YIELD (gpm): O METHOD OF TEST 1 r
10. WATER ZONES (depth): �a0 Cei) 3 i s- as 5J
11.
12.
DISINFECTION: Type i1-Ti—>< Amount IC/ Tr ha
CASING: Wall Thickness
Depth Diameter or Weigh 'Ft. Material
From 0 To inio Ft. (yi 5O7`L1 PVC
From
From
To_ Ft.
To Ft.
13. GROUT Depth Material
From t) To 3 Ft. Ca
From '3 To20 Ft. i .c-nrt'1Tr.ZL
14. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in.
Topographic/Land setting
DRidge ❑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
U 70 )
101 -- a2'0
aa�r
. a -31S
1S— 17
17— 3SU
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.
CD
Method S ^
From To Ft. in.
15. SAND/GRAVEL PACK:
Depth Size Material
in.
From To Ft.
From To Ft.
16. REMARKS:
Y cam'.
OTh r 0 N c'
�JLC(�2CU�r�
1 DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
rr
z,
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

WILL CONSTRUCTJONr RECORD
r7 % 3'SW
Nohh Carolina - Department of Environment and Natural Resources - Division of ‘Water Quality - Groundwater Section n
\\'ELL CO.\TRACTOR (INDIVIDUAL) NA\I/�E�(p/rr�int) �1 D Ffl t/t. /'y7..j�rn� CERTIFICATIOON�:-r�0/.�10
\\'ELL CON'TR:\CTOR CONIPAN1' NAME • Ir J4 %Qe%7? WL'vt (/Y (i< PHO\'E 1: i2 J.f L• -3sro
STATE WELL CONSTRUCTION PERMIT. ASSOCIATED \cQ PERMIT:
(ifaoolicablel (ifaoolicable)
1. \\'ELL USE (Check Applicable Box): Residential 17' ?lunicipaPPublic 0 Industrial 0 Agricultural 0
NIonitorirw. ❑ Recovery 0 Heat Pump Water Injection 0 Other 0 ICOther, List Use
I `
2. WELL LOC.ATIO
Nearest Town: ��' lV' /�e County
rc� �L e 11 P Cat./ , /1i e rr�' 73 L
(Street Na..:e. Nu n;.rs. Cortmua(cp. Subdi•:isior., Lot Na.. Zip Code)
-. OWNER: Opal £an
Address .-Pc 0 oe, iie�.
5
6
or Rout- No.)
(� /en vet/e , /1%C a y734
Cl!;. or Tour. State Zip Code
(h&s-1- 7 Y3- a Al5'c
Area :,.de- Pi -ion:: number
DATE DRILLED 3' 3 0-10 S!
TOTAL DEPTH: 360
DOES WELL REPLACE EXISTING WELL? YES 0 NO 61
7. STATIC WATER LEVEL Balox Too of Casirie: 470 FT.
(Use if Above To, or Casic__I
S. TOP OF CASING IS • / FT. Above Land Surface'
•1 op urca,im; tertianated at br beiue land surface requires a
srivtce it: aceordanee eith ISA NCAC 2C .0113.
9. YIELD (cn):'« :N:ET OD OF TEST /i^•
0 ago
From To
From To
13. GROLT:
From 0 To 3 Ft.
W. WATER :ZONES (depth): /G 4f5) (r j,
I. DISINFECTION: Type /4 Iki Amount i •5". 0
12. CASING: Wall Thickness
De ;h Dirr. •:er or V: e _h:''F L Ndr'._T
Fro::: U To U(c FL (iv I ft I%k�)�rQ-mot -`�-�z
Ft.
From 3 To .Z.D Ft.
14. SCREEN: Dept, Diameter
Fron To Ft. in.
From To Ft. in.
15. SAND GRAVEL PACK:
D:pt'n Slze
From To Ft.
From To Ft.
16. REM ARKS:
Ft
Ma:orial M'::od
Cr Pin en+ 7L0
S!o; Size :NIa.eria!
in.
Nla;erial
Topographic Land setting
❑Ridge ($Slope ❑Walley 0Flat
(check appropriate box)
Latitude'longituda of well location
(de;reesmi :x.'secords)
Lautude'longitude source:❑GPS❑Topographic map
(else:'.: box)
DEPTH DRILLING LOG
Frorn To Formation Description
J(o� -v?S/47
LOCATION SKETCH
Snow direction and'distan:e in riles from at leas'
t.vo Sian: Roads o: Coun;v Road's. Include the road
n:!:abers and core n1on road names.
I D0 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
I r..✓r
SIGNATURE OF PERSON' ONSTR UCTING THE WELL
S - 2c-of
Submit the original to the Div is ion of IA ater Quality, Groundnater Section, 1636 Nlail Semis Center- Raleigh, NC
27699-1636 Phnna No. [phone], within 30 days. G\W-I REV. 07:2001

2957-l3
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resourcesr7c- Division of Water Quality - Groundwater Section py
WELL CONTRACTOR (INDIVIDUAL) NAME�,^(p^rint/) i(LOSS e.2 I 11Cr '^ / CERTIFICATION p a 1/d !
WELL CONTRACTOR COMPANYNAME MA l' reene (�&G,5. weed (241 PHONE % (821) j flrS3 V
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQJPERMIT#
(if applicable) (if applicable)
7653 01- 78V17
Ys J/ GRW
1. WELL USE (Check Applicable Box): Residential Municipal/Public 0 Industrial 0 Agricultural ❑
Monitoring O Recovery 0 Heat Pump Water Injection 0 Other O If Other, List Use
2. WELL LOCATION: ^ ,'-'
Nearest Town: ��tt�y 11.t . County Uf-I�
Eicher l"ree� c 5 fr IUC - 7T
(Street Name, Numbers, Commuu4iryn, Sudivisionn, Lot No., Zip Code)
3. OWNER. //-4 /2 " D/italic/0'
Address 1plJ f' mo /77
(Scree( or Route No.)
�St l u a f 7v C ax9779
City er Town State Zip Code
( 2)- (QO
Area code- Phone number
4. DATE DRILLED 4-Hag —0�
5. TOTAL DEPTH: 430
6. DOES WELL REPLACE EXISTING WELL? YES 0 NOY!
7. STATIC WATER LEVEL Below Top of Casing: -Aje FT.
(Use "✓' if Above Top of Casing)
3. TOP OF CASING IS \ FT. Above Land Surface*
*Top of casing terminated atior below land surface requires a
variance in accordance with liA NCAC 2C .011S.
9. YIELD (gpm)• 30 METHOD O TEST +71 r
10.WATER ZONES (depth):WJ, ,45- (',i'%-3qS
Q) 40
11. DISINFECTION: Type i-+ I hf' Amount I /. 3$....6 2-
1 7. CASING: Wall Thickness
Depth Diameter or Weieht'FLI, bf ten I
From Ci To R Ft. (o Nit 1J (a2(11•0
From To Ft. •
From To Ft.
13. GROUT: Depth Material Method
Fromf_ To 3 Ft. }L2�'-
, V Y
From C7 To aU Ft. `,lei- n-w 2R_.
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 I(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._ .
—may
1q—��
8'! — ;sir
31S--34-1
3ci17-395"
395 - 347
�q 7 -' 0 5-
410,5---«o7
c207 - ciesir:>
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common road names.
16. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED N ACCORDANCE WITH I5A NCAC 2C, WELL
CONS UCTION STANDARDS,D>AND THAT/A COPY OF THIS RECORD HAS BEEN PROVIDED TO THEWELLOWNER
44-eE--Y O iG/� , S- 2e —0 V
SIG TUBE OF PERSON CONSTRUCTING THE WELL DATE
v
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 296007
North Carolina • Department of Environment and Natural Resources •Division of Water Quality • Groundwater Section
WELL COINTRACTOR(INDIVIDUAL)NAME (print) Mitchell Da COOk CERIFICCION4 20d]
WELL COtN'I RACTOR COMPANY NAME fffilln Ett "et �' 1' C••Ill rg, Ito PHONE a J9281 369-9091
STATE WELL CONSTRUCTION PERMIT* ASSOCIATED WQ PERMIT*
(if applicable): (sfapolicable).
WELL USE (Check Applicable Box): Residential B Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring 0 -Recovery 0 'Heat Pump Water Injector O Other 0 II' Other List Use
2. WELL LOCATION:JacksonNearest Town; Cashiers County
Memory Lane --Well #2
(Street Name, Numbers, Community, Subdivision, Lot No.. Z!p Code)
3 OWNER Terrancg Russell
Address 486 Gramercy Drive
IStre et -or Route No.)
Marietta, GA 30068
City or Town State Zip Code
(770). 294-9656
Area code• Phone number
4. DATE DRILLED 5-25-04
5. TOTAL DEPTH: 900'
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO 2G
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*
•Topof caslna terminated at/or below an surface requires a
variance In accordance with ISA NCAC 2C .0118.
9. YIELD (gpm): 0—DRY METHOD OF TEST blow
10. WATER ZONES (depth).
I . DISINFECTION:Type H T H • Amount 16oz
12. CASING Wall Thickness
Depth Diameter or Weight/Ft: Material'
From 0 To 56 Ft. 6"
From S6' To 60 Ft.— •188
From - To Ft.
13, ;GROUT Depth Material:
From— _To 20 Flkrite & curet
From To '>Fr 14 SCREEN Depth Diameter Slot Size
From To .. Ft, in. .in.
- From To Ft:__in.
15. SAND/GRAVEL PACK
Depth Size Material
From To Ft
From To Ft.
Topographic/Land setting
ORidge ❑Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(de^yre:a/mlmiles/se:ands)
• Latitud_'iongitude sour'ceOGPSOTepographic map
meek ben) _ _
DEPTH DRILLING LOG
From To Formation Description
0 58' clay & al
58' 900' granite
Method
canbea
Material
LOCATION SKETCH'
Show direction and distance in miles from at legit
two State Roads.or County Roads. Include the cd
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
— -oz./
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
Submit the original to the Division of Water Quality, Groundwater Section, 16361Mal1 Service Center •'Raleigh, NC
27699.1636 Phone No; [phone], within 30 days, GW•1 REV: 07/2001

2964 0
WELL CONSTRUCTION RECORD
North Carolina • Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (ItNDIVIDUAL)NAME (print) Mitchell D. Cook CERTIFICATION f 20d3
WELLCO,N'IRACTOR COMPANYsNAMIE Hafel alselnat Van fir PHONEk E'2'1 369-9591'-
s"FATE WELL CONSTRUCTION PERMITS ASSOC .\TED WQ PERMIT%
(Ifapolicabie) - (tra,olicabl:).
WELL USE (Check Applicable Box): Residential 25 Municipal/Public❑ Industrial D. Agricultural 0
Monitoring 0 Recovery 0 ,Hat Pump Water Injection 0 Other 0 If Other, Ltst Use
2. WELL LOCATION
Nearest Town. Cashiers County Jackson
Memory Lane --Well #1
(Street None, Numbers, Community, Subdivision, Lot No:, Do Code)
3 OWNER: Terrance Russell
Addross 486 Gramercy i Rive
(Street or Route No.) Marietta, GA 30068
(770).yor294-9656at< zip code
Aria :ode• PhoLte number
4. DATE DRILLED 5-21-04
5, TOTAL DEPTH: 1000'
6, DOES WELL REPLACE EXISTING WELL? YES 0 NO SC
7, STATIC WATER LEVEL Below Top of Casing: 800 FT.
(Use "+" if Above Top of Casint)
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 .0119,
9, YIELD (gpm): 1 METHOD OF TEST blow
10. WATER ZONES (depth): 460'
DISINFECTION: Type
CASING:
Depth
From 0
From Ft..'
From Ft.
GROUT:
From 0
From
14. SCREEN:
From To Ft. in;
From To Ft. in,
.IS.' SAND/GRAVEL PACK:
Depth
. From ' To
From To
H T H • Amount 1602`
Wall Thickness
Diameter
Ft.
6e�
To 58
To'
To
Depth ` `- Material
To 20 FtL fhite & txainaL
To Ft
Depth `.Diameter Slot Size
Ft;
Ft
or WehvFi. Material
.18g i
steel:
Method
In.
in.
Material
':Size Material •
Topographic/Land setting
❑Ridge ❑Slope :❑Valley ❑Flat
(checkiappro riate box)
Latitude/longitude of well location
(devcIva•'mtites/seconds)
Latitsidelon •itude source:DGPS❑Topographicntup_
(check bon)
DEPTH DRILLING LOG
From To Formation Description
0 ' 56' ' clai & a
; g
56' 1000ranite
' LOCATIONS KETCH'
Show dire:tion:and distance in miles format 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 I5A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
1,i�z P . 5—aI-off
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], sylthin30 days. _ GW•1: REV. 07/2001
c
0

WELL CONSTRUCTION RECORD
North Carolina • Department of Environment and Natural Resources • Division of Water Quality• Groundwater Srtion
WELL (print) Mitchell D, Cook CERTIFICAT1Oft 20d3
WELL CONTRACTOR COMPANY NAh1E B8 1 s4 sis.'—iu'ds lit PHONE [phone]
STATE WELL CONSTRUCTION PERh1170 ASSOCIATED WQ PERiMITA
(ifaoplicable) (if applicable) -
WELL USE (Check Applicable Box): Residential 2 Municipal/Public❑ Industrial 0 Agricultural 0
Monitoring ❑ -Recovery 0 Heat Pump Water Injection ❑ Other Other, Lis: Use
2, WELL LOCATION'
Nearest Town: Sylva
Cope Creek
(Street Name, Numbers, Community, Subdivision, Lot No.. Zip Code)
3 'OWNER, Travis Stuckey
Address 529 Grand Vista Dr
(Scree. or Route No.)
Sylva, NC 28779
City or Town Stote Zip Code
( 6 31-522 5
Area code. Phone number
4. DATE DRILLED 5-18-04
S. TOTAL DEPTH: 225'
6 DOES WELL RE?LACE EXISTING WELL? YES 0 NO 6c
7. STATIC WATER LEVEL Below Too of Casing: 100 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS " 2 " FT. Above Land Surface's
*Top pleasing terminated tdor below land surface requires a
variance In a ccordance with ISA NCAC 2C,01IS
9. YIELD (rpm): 4n METHOD OF TEST blow
10 WATER ZONES (depth): 135' & 210'
County Jackson
• II, DISINFECTION: Type H T H Amount •16oz
12. CASING Wall Thickness
Depth Diameter or Weight/Ft. Material
From 0 To 87'Ft: 6"
From / To 105 Ft. 1RR steel
13..GROUT: Depth Material • . Method
From _( To 20 Ft1Dthinite & cerratt nrEa3
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 ❑Flot
(check appropriate box)
Latitude/longitudo.of well location
(ey .e,'n•.i miiesRecondi):
LiPtitudoliongitude source:❑GPS❑Topographic nap
(check bon)
DEPTH DRILLING LOG
From To Formation Description
0 106' clav & ricl
106' 225' granite
Show -direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common road names.
O
A
0
0
16, REMARKS:
I DO HEREEY'CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF -HIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
7
SIGNATURE OF PERSON CONSTRUCTING THE WELL
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center • Raleigh, NC
27699.1636 Phone No. .[phone],within 30.days, GW•I REV. 07/2001
J— /t ., Oy
DATE
2.95996
nf,
nn
r-
�..,
0

295
35
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section / - WELL CONTRACTOR (INDIVIDUAL) NAME (print) c)4 fl Pl i S /�-o I I atA r CERTIFICATION ato1/7
WELL CONTRACTOR COMPANY NAMK/X,bjlfi 'A JI444r4 IBe0tfr Jf TN. a PHONE fit-1i_SQ Y-3 V. 60
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED W4rERMIT#
(if applicable) (if applicable)
WELL USE (Check Applicable Box): Residential'inunicipal/Public 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other Ef If Other, List Use
•
2. WELL LOCATION:
Nearest Town: r /('L County.� v ty
y/4/ /1/ Ye r°7J fit/ n .Cry r�o77 `7
(Street Name, Numbers,/`Community, Subdivision, Lot No., Zip Code)
3: OWNER: l`-G�-12,� v l 1 a 7 ,r1
Address #/-3kl ` I c 441 S
S�// I V o-- (Street o/r/ u(e- r 7 7
A:ity or Town State C/ Zip Code
- - - � — y--3 d .
Area code- Phone number
4. DATE DRILLED S —,-V 7_ /> CL
5. TOTAL DEPTH: r?tic/
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO
7. STATIC WATER LEVEL Below Top of Casing: /On FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS / FT. Above Land Surfaces
'Top of casing terminated ator below land surface requires •
variance In accordance with I5A NCAC 3C ,a118. /
9. YIELD(gpm). METHOD OF TEST hloj/i,
10. WATER ZONES (depth): fj'jj"
ographic/Land setting
idge ❑Slope ❑Valley 0FIat
(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
Pia
%/1„rite Sjinn 2 >
E3//H'_ (� ire27n Th-Q—
LOCATION SKETCH
I I. DISINFECTION: Type /71---/54 Amount o� T,4k 5 Show direction and distance in miles from at least
12. CASING: Wall Thickness two State Roads or County Roads, Include the road
Depth Diapeter or Weight/Ft. Matey- l numbers and common road names.
To (n'i Ft- to" S-b &a 1 P V C
To Ft
To
13.
To
To
From 0
From
From Ft.
GROUT: Depth Material Method
From n r Ft.
From 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.
(C471 � poluo
16. REMARKS:
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
sii
orao
SIGNATURE OF PERSON CONSTRUCTING THE WELL
DATE
C-:
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. 07/2001

WELL CONSTRUCTION RECORD
''1Yr.".
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section WELL CONTRACTOR (INDIVIDUAL) NAME (print) t. De, n viisjln„ fin rU S/ CERTIFICATIONeZ/74.
WELL CONTRACTOR COMPANY NAMt1 .bjjj C Ptilarri I11P( Ia-iv'i I pm, The . PHONE S Cj 2.4-3 .6 0
STATE WELL CONSTRUCTION PERMITS/ ASSOCIATED WQ\ERMITB •
(if applicable) . (if applicable) .
I. WELL USE (Check Applicable Box): Residential' unicipal/Public 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other Cr If Other, List Use
2. WELL LOCATION:
Nearest Town: ,Si/: J V at-.- County PC pn
4/ dl./ (1ti�S1-nkct— jQicto(-e
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Obde)
3: OWNER: ( t U wMY1 ha4✓1
Address `I%n. rfiX .5 /-
(Street or Route No.
i /L54tt m VC?
City or Town State Zip Code
Area code- Phone number [
4. DATE DRILLED S — 7 --G L
5. TOTAL DEPTH: 7( 5 '
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO
7. STATIC WATER LEVEL Below Top of Casing: ic O FT.
(Use "+" if Above Top of Cuing)
8. TOP OF CASING IS / FT. Above Land Surface*
*Top of casing terminated at/or below landsurface requires a
variance In accordance with 15A NCAC 2C .0118.
9. YIELD (gpm): -Pr) METHOD OF TEST .lDUii
10. WATER ZONES (depth): ---78 )
202
;77
11. DISINFECTION
12. CASING:
Depth
From V To '20
From To
From To
13. GROUT: Depth
s��
From n To r7V
ographic/Land setting
tdge ❑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
?0t
.VPP rnt-d n I +-2
C05'
f3 I v e, G r CLn, : -)-
LOCATION SKETCH
Type 1/ ti' Amount c,Z' 7 A . 5 Show direction and distance in miles from at least
Wall Thickness two State Roads or County Roads. Include the road
Diapeter Saor Weight/Ft. MMatepi numbers and common road names.
Ft. h " � r
Ft.
Ft.
Ft.
From To Ft.
14. SCREEN: Depth Diameter
From To Ft. in.
From To Ft. in.
nMaterial '
Method
Ul�-�
Slot Size Material
in.
in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
O
C
r. -
16. REMARKS:
1 DC) HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RECORD H4S BEEN PROVIDED TO THE WELL OWNER
Ora 0
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-1 REV. 07/2001

295748 c- qk i9</ki
760 /a &s 630
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources�- Division of Water Quality - Groundwater Section
(��j
WELL CONTRACTOR (INDIVIDUAL) NAME
((pprriilntY' fl5$.C///� I rlT�r�-�Irnle"
O CERTIFICATION,hN d/i7/
WELL CONTRACTOR COMPANY NAME n In (?1eenc- L7%DS wwf O.^l� vJt L SHONE N ($�tn 517o -4'Ss
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
I. WELL USE (Check Applicable Box): Residentia0S1 Municipal/Public 0 Industrial ❑ Agricultural 0
Monitoring 0 Recovery ❑ Heat Pump Water Injection 0 Other ❑ If Other, List Use
2. \VELL LOCATION: - 7r
Nearest Town: S 1 J O' County
.TFsc
crti
il Li Ref
Li At OW-T-79
(Street Name,, Numbers, Community, Subdivision Lot No., Zip ode)
3. OWNER: DP 11 Yl l 5 8/4•
Address
(Street or Route No.)
S� /CsIm-- JVC aa' 9
City or Town State Zip Code
(9U15- S$'Ip-//av
Area code- Phone number
4. DATE DRILLED ,E-R • 27-aLI
5. TOTAL DEPTH: aQ5
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO krI
7. STATIC WATER LEVEL Below Top of Casing: 83 FT.
(Use "+" if Above Top of Casing)
S. TOP OF CASING IS / FT. Above Land Surface*
'Top of casing terminated at/or below land surface requires a
variance In accordance'tth 15A NCAC 2C .0118.
9. YIELD (gpm): ` 75 METHOD OF TEST
10. WATER ZONES (depth): .' 1
11. DISINFECTION: Type
12. CASING:
From 0
From
From
13. GROUT:
From O Ft.
From '17 Ft.
Amount
Wall Thickness
Depth / Diameter or Weighu'Ft. Material
To /Y`1'Ft. 1 IA/ / SPpVC
To Ft.
To Ft.
Depth
To
To RD
Material
14. SCREEN: Depth Diameter
From To Ft. in.
From To Ft. in.
15.
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
DEPTH
From To
/ re-/7.z
/-200
Zoo - 403
203 -- o! 2,5-
LOCATION SKETCH
Show direction and distance in miles tom akfeast
two State Roads or County Roads. IncEde thY?'aad
numbers and common road names. G
%/�" Method y"' teto
Slat Size Matenal 69 (Tr,.tV E�
in. ` p�
in. p-4t) r ♦ 9`—tA..t..rr.0 Rc€
SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
k. iyrt Yet +�
16. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH l5A NCAC 2C, WELL
CONS&»4'
STA
NDARDS, STANDAR, AND TH T A COPY. OF THIS RECORDHASBEEN PROVIDED TO THE WELL O\VNER
SIG TURE 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

295506
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources DivisionDiof Water Quality - Groundwater Section �/
WELL CONTRACTOR (INDIVIDUAL) NAMEp(print) f L C, rrnc-- CERTIFICATION
t-f 4//�c/
WELL CONTRACTOR COMPANY NAME (.. AS& WeE :/i; dy�,vC- PHONE 8) ss7, i-1'/1r7.L
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMTTM
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): ResidentiaLO*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: %5h; trs
Liih, f€ cc/ GV-c_
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNE�le�-�
Address fa:0. 4JiL /f'//
(Street or Route No.)
C,t�b : ,,' An__c.,24'7/ 7
City or Town State Zip Code
Area code- Phone number
4. DATE DRILLED 3 - s- 6y
5. TOTAL DEPTH: 9 o
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO 0
7. STATIC WATER LEVEL Below Top of Casing: t.20 o FT.
(Use "+" if Above Top of Casing)
S. TOP OF CASING IS % FT. Above Land Surface'
*Top of casing terminated atlor below land surface requires a
variance hi accordane with 15A NCAC 2C .0118.
9. YIELD (gpm): rlt5 METHOD OF TEST Air
10. WATER ZONES (depth):
11. DISINFECTION: Type Amount
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
From 0 To c2 ? Ft. 4 Y40 JO L/C -
From To Ft.
From To Ft.
13. GROUT: Depth Material Method
From O To o1-A Ft. mwed drnowt
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 OValley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/r.'rnh)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
PEPTIC DRILLING LOG
From To Formation Description
FJ—cY
los-
41c
cr
LOCATION SKETCH — 2
Show direction and distance in miles frorrCat leagE
two State Roads or County Roads. Include the raid
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 RECORD HAS BEEN PROVIDED TO THE WELL OWNER
4 -2'-y
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-1 REV. 07/2001

293.101
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) Obi)/ 1 f e I,J A�'/UL CERTIFICATION AS t>2J
WELL CONTRACTOR COMPANY NAME (44 t.e I.LINAi Z&LG-.a J c. • PHONE a j/ 101S:ZYVY /
STATE WELL CONSTRUCTION PERMIT'S ASSOCIATED WQ PERMITS
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential$ Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring ❑ Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATIQ
Nearest Town: a c�a County Li L�-u). 1
��
(Street Name, Numbers, Communi/ry,,�fSubdiivision, Lot No., Zip Code)
3. OWNER .f'/nn. 4v pay F�i-/mil
Address (/ lt-C o A-nt 7,2 7a_
ituitt'(StreetorloutaG o.) ral 7 ?2
City or Town State Zip Code
( Area code- Phone number._
4. DATE DRILLED �- Y— G
5. TOTAL DEPTH: Y
6. DOES WELL REPLACE EXISTING WELL? YES NO 0
7. STATIC WATER LEVEL Below Top of Casing: FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS / FT. Above Land Surface'
'Top of casing terminated at/or below land surface requires a
variance in accordane with ISA NCAC 2C .0I18. e
9. YIELD (gpm): �� METHOD OF TEST 04.--c,
10. WATER ZONES (depth):
11. DISINFECTION: Type Amount
12. CASING: Wall Thickness
Depth Diae f or Weight/Ft. Material
From To �Y m&O / Ft. (/G
From To Ft. /
From To Ft.
13. GROUT: DepthMaterial Method
From d Too4.� e) FL �oiii'l47-n.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
From To Ft.
Size Material
From To Ft.
16. REMARKS:
Topographic/Land setting
Midge 0Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH DRILLING LOCI
From To Formation Description
l6 Lam% Attej
0
v m�
LOCATION SKETCH .r
Show direction and distance in miles from gf least]
two State Roads or County Roads. Includeclse ro(td
numbers and common road names. z
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center -Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-1 REV. 07/2001.

WELL CONSTRUCTION RECORD
295197
CERTIFICATION A 296.
\vI:I.1. ('ON" 1(A(TOI( CO?li'ANV NAME; PH&R7
STATE: \vl:l.l. ('ONST RUCTION PERMIT/
lif applicable)
IAA ,
North Carolina - Department of Environment and aIuraal Resources - Division oT Water Quality - Groundwater Section
(vKI.L CO.\'lItAC IOR (INDIVIDUAL) NAME what) Je) tt
4-4',P e
AssoCIA't'EI) WO 1'EIz'l1' it
(if applicable)
I. WELL USE (('heck Applicable 13o,\): Residential IS vlunicip: l/public ❑ Industrial ❑ Agricultural ❑
monitoring ❑ Recovery 0 IJeat Pump Water Injection ❑ Other ❑ 11'Other, List Use
2. WELL L(ICATIO
Ncares Town:
1)
(.�— „,/
L'verl Nome. Numbers. Community. Solidi%ision. Lot No.. Zip Code)
3. OWNER:
Address �F'7
CountycJ*i[jp.N
IsiIecttt)7Nu.1 3�y
L(/Jo�c2/yf%` »4 ter_ %
City or Town stake Zip ('ode
Area ado Phone number , /
4. DATE DRILLED ..S '3 —o Y
5. TOTAL DEPTH: ‘76J .
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO
7. STATIC' WATER I.IiVIiJ. Below Top ol'casing: /So PT.
ll ( Ilse "1' if Above'rtp of Casing)
8. 'f01' or CASING IS —'S FT. Above laud Surface'
•'fop of casing terminated at/or below land surrace requires a
variance in accordance with 15A NCAC 2C .0118.
9. YIELD Limink METHOD OF TEST Arr--
10. WATER ZONES (depth):
11. DISINFEC'TION: Type hint/ Amount
12. CASING: Wall Thickness •
Depth /1' 1)is}t to or jV},•'iyln/fL Iteria -
I'r(1111 'tot To (v 7 PL 4, /y /
From To 11.
Front To •_ 19.
13. ()ROUT: Depth Mat •rial,
From a To !o_PL�
From "ro Pt.
14. SCREEN: Depth I)iantcter
HMO)TO
From To 1:I. in.
15. SAND/GItAVEI.l'ACK:
Depth Site
Prom To I t,
From To
16. REMARKS:
Slot Size
in.
It.
u Topogra) c/Land setting
Midge lope ❑Valley 'plat
(check appropriate box)
1.aliludc/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
. DRILLING LOG
FArlyati(' Description
From
DItPTFI
method
Ivinicrinl
Material
LOCATION SKETCH
Show direction and dislance in miles from al least
two Slate Roads or County Roads. Include the road
numbers and common road names. ._ r--
#/70.5'
11)0 HLREI3Y CERTIFY TIIAT IS \VEI-I. WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS. AND TI IAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO TIih' WELL OWNER.
SIGNATURE OF PERSON CONSTRUCTING -DIP. WELL DATE
Submit the original lu the Division of \Voter Quality, Groundwater Section, 1636 Mail Service Center - Ralci 4h, Net
h 01,
2769'l-Ih36 Plume No. (919) 733J221, tvilhin 311 days. GW- I RBV.N)`�/201

9
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Naturalat'Resouu�rces� - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME
r (print) irlo/t1 /£ln,Me r _ CERTWICAATIIOON�My���/�7
WELL CONTRACTOR COMPANY NAMES /A14G&», �A I/.'VJY��I? _l7^ C. PHONE 11 ftYcA.7� reze
STATE WELL CONSTRUCTION PERMIT/ ASSOCIATED WQ PERMIT/
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential.' Municipal/Public ❑ Industrial 0 Agricultural 0
Monitoring ❑ Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION:
Nearest Townz..5^ /did- Countt.» 4tsd I✓
Jfl "/Ceste ita d .
(Street Name, Numbers, Community,, Subdivision, Lot No., Zip Code)
3. OWNER:Ge1 goi L✓1'(=-44S
Address ,43..pp 'v -" e, t to it's
(StreetFFm or Roe No.)
9,%/kJ/1i AkL d-C( 7 Q
City or Town State Zip Code
Arca code- Phone number
4. DATE DRILLED y-I (.- oY
5. TOTAL DEPTH: J,S'
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO 0
7. STATIC WATER LEVEL Below Top of Casing: /t>?- D FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS / Ff. 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 o METHOD OF TEST 2.44.-
10. WATER ZONES (depth):
11. DISINFECTION: Type Amount
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
From D To .1% Ft. (o '4
From To Ft.
From To Ft.
13. GROUT: Depth
From 40-. To 1:L.0
From To
14. SCREEN: Depth
From To
From To
15. SAND/GRAVEL PACK:
Depth
From To
From To
Topographic/L.and 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 inn .r,ING LOG
From To Formation Description
O- a7
2 7- .3 rs-
4,01.7
0
rn Q
w
Show direction and distance in miles from at least:
two State Roads or County Roads. Include the road
numbers and common road names.
Material Method
Ft. 0 ,71.0rd- huae.rs19$6/
Ft.
Diameter Slot Size Material
Ft. in. in.
Ft. in. in.
16. REMARKS:
Ft.
Ft.
Size Material
LOCATION SKETCij
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-1 REV. 07/2001 ,

WELL CONSTRUCTION RECORD
295290
3--4'Ga93W
North Carolina: Department of Environment and Natural Resources - Division of Water Quality- Groundwater Section
''J
%FELL CON7RACTOR(iSDIVIDUAL)NAM/E�.�(p.,rint) �..3i.D i 1Ce—(-L WC/ CERTIFICAT•ION, c{/J
YELL CON7RACrOR COMPANY NAME /INn ( rPeCfl ' t roc, , L.()-t3(Q aril PHONE # (018,5ale,- 533
STATE WELL CONSTRUCTION PERMIT: ASSOCIATED WQ PERMIT;
(if applicable)
• (ifapplicable)
1. WELL USE (Check Applicable Box): Residentialek Municipal/Public ❑ Industrial ❑ Agricultural ❑
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other 0 If Other, List Use
2. WELL LOCATIO'r'
Nearest To�cn: J Coun —1 /ICI<idyl/
T ff1 ti7h5 a— t v A-1 / a `r' 777'
(Street Name, Numbers, Camrnuity, S4divisior., Lot No., Zip Cede)
3. OWNER:
Address n 1 'SO
(3� - 79 3 — 70vr
Area code- Prance number S. DATE DRILLED 5 .c G rOtt
5. TOTAL DEPTH: a 0 O
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO Z
7. STATIC WATER LEVEL Below Top of Casing: / 0 FT.
(L's: "r' if Above lop or Casio;)
S. TOP OF CASING IS I FT Above Land Surface'
'Top oreasing terminated at'or below lend surface requires a
9. YIELD (gpm): 3 O • METHOD OF TEST i'-TI r—'
10. WATER ZONES (depth): 'tS
11. DISINFECTION: Type Ft TL 1 Amount 9 0 2.
12. CASING: Watt Thickness
Depth /D�ia�n�e:e: crV etz:�:T:. h!a:e ia'
From 0 To rQR FL y_ ,5P .zj PLC
Ft.
Ft.
11
3
(S Ire. Or ou a No.)
uyhneif I sC/3
Cry'or Town ra:c Zip Cede
variance In accordance with ISA NCAC 2C .011S.
From To
From To
13. GROUT: Depth Ma:eria!
From 0 To 3 Ft. (l ilit-e- 4
From 3 To Z O Ft. pl-...11r-C,'t
14. SCREEN: Depth Diameter Slot Size UMa:eria'
From To Ft.
From To Ft. in. in.
15. SAND:'GRAVEL PACK:
Depth Sze MateriJ
From
From
To Ft.
To Ft.
Method
Topo; aphis/Land setting
❑Ridge ❑Slope ❑Valley ,4Flat
(ch::kapp:opia:e box)
Latitude/longitude of well location
(d-..->'minuasts:conds)
Latinude,9ongitude saurce:❑GPS❑Topographic map
(:hen Coe)
DEPTH DRILLING LOG
From To Formation Description.
V —&-/
0 —L/5
C{ i-4 S r�2cprn.c%C�G
`f-g— Zoo
0 '
r
LOCATION SKETCH r-r7
Shoo: direction a::d distance in miles from at leas'=
two Stare Roads or Couar7 Roads. Include the road
numbers and common roar' r._rr.es.
v I ct CC) -ks-w. (I to -C._.
L
Chia, %uCLK M
0
16. REMARKS:
I DO HEREBY CERTIFY" THAT THIS WELL WAS CONSTRUCTED IN"A.000RDANCE WITH I5ANCAC 2C, \YEELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL O''. YER
M Cur
5(ii�ATURE OF PERSON CONSTRUCTING THE WELL
DATE
lo� 7—oV
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Censer - Raleigh, NC
27699-1636 Phane No. [phone], within 30 days. G'.V-1 REV. 07/2001
rat

295241 .
7 4y.$3-s w
WELL CONSTRUCTION RECORD ' 5�09-63g
North Carolina ;Department of Environment arid Natural Resour
c
es - Division of Water Quality- Groundwater Section (//
WELL CO\TRACTOR (INDIVIDUAL) NASIE (print) fr e ("DJ ytl^•iq CERTIFICATION k cn( a ' 3'
WELL CO.ITRACTOR COMPANYNAMIE AI C reef' e faros w lW D t"(G PHONE p
STATE WELL CONSTRUCTION PERl1,T: ASSOCIATED WQ PERMIT:
(if applicable) • (if applicable)
1. WELL USE (Check Applicable Box): ResidentialA Municipal/Public ❑ Industrial ❑ Aericu!mral ❑
Monitoring 0 Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Ocher, Lis: Use
2. WELL LOCATION: �
Nearest Town: S.4 (U County AC1C-9>
_OW,' oat ocv-L tics 7 0.4 NCax77 j
IS:roe: Name, Nembe s, Communiy, 5'_Sditiii lc, Lou i!o Zip CLCa)
3. OWNER: » Akin e 5nctk C - V
Address SI tAJ . Main
ST
o; SP,oc•-\' ) ae»5
CI:). (Tor. n S:a:: Zip Code
( )-
Area cc::. Piore r.emb1^'
4. DATE DRILLED 4- a a -04-
5. TOTAL DEPTH: 300
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO ZI
7. STATIC WATER LEVEL Belo,: Top of Casing.: (r7 (l FT.
(Use •w' if Abor: Top ofCa,ir.:)
S. TO? OF CASING IS I FT. Above Land Su:fa:e-
'Top orn;in; termini:ea a t'or belo,. land surfre requires a
vorian:z In accordance t.iuh ISA NCAC 2C .0115. 9. YIELD (¢pm): Lf • METHOD O: T E T A 1 V
10. WATER ZONES (depth): aOU C3aj
Topographic/Land se,`iting
[Ridge ❑Slope ❑Valley. Wiat
(:hcc appropria:: box)
La ti rude/org i rude of well location
(d ,::sfmi: _:_;'a_:onds)
La:in_d:,7ongir.:de source:❑GPSDTopooraphi: map
(-na; box)
DRILLING LOG
Forr,._tion. Description.
0
• DEPTH
From Tc
0- 37
37,200
,zoo - Zo9
61o. — t0O
Gto
(obi --a00
w
1,o0 C 1 ) LOCATION SKETCH
11. DISINFECTION: T5pe tel 1frt A.„our: 4(4 b 7_ 5..o d.r.ct.o.. a..d d,s.a..ce in milts from a: leas:
12. CASING:
From 0
From To
From, To
13. GROUT; Depth
From CDTo 3
From 3 To 2.0
14. SCREEN: Depth
From To
From To
15. SAND'GRAVEL PACK:
Depth
From To
From To
16. REMARKS:
1';2II ThIc Tess two, S:a:e Roads or County Roads. Include the roar
D-2: D' rV'eiz;\T. D! camber, and co -..-to-. road_ came-. Tc [ t R. tole- jZPU)RII. : ore
Ft.
F.
Il!'_serial Me:hod
FL C0-1-1-\121.4-
Dianne::: S:o:Size
-1172- 1;37-r j tV -r Lz- I
b!axn
Ft. in. in.
Ft. in.
Size b!ateria'
Ft.
Ft.
I DO HE i CERTIFY THAT THIS WELL WAS CONSTRUCTED N ACCORDANCE Y'.1TH I iA NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS E=EN PROVIDED TO THE WELL OWYE?.
J--r
SIGNATLFR2 OF PERSON' CONSTRCCTING THE WELL
6 7-°
DATE
Submit the original to the Division of Water Quality, Groundh+ater Section, 1636 Mall Sznice Censer-Fa!e!oh, NC
27699-1636 Phone No. [phone], within 30 days. G'r+-I REV. 07/2:0I

295242 _� (7 7a�.��
75 381- J9-036'6
- Division of Water Quality- Groundwater Section
r4
rrq CERTIFICATION I: ;OW,
WELL CONTRACTOR COMPANY NAMEA/arr I�p teen
(1nr l
STATE WELL CONSTRUCTIO.N PERS! IT' �/
• (ifioplicable)
,f
North Catalina Department of Environment and Natural Reelsour/c�es
\5'ELL CONTRAC70R(I\DIYIDUAL) kASIE(print) an•'%1'C C,U
• LE -ell k/Y at _ PHONE k (Mir cJ a V
ASSOCIATED WQ PERMIT.
(if applicable)
1. WELL USE (Check Applicable Box): Residential $, Municipal/Public ❑ Industrial 0 Agricultural ❑
Monitoring ❑ Recovery' 0 Heat Pump Water Injection 0 Other ❑ IFOther, Lis: Use
2. WELL LOCATION: _' /� �
Nearest To'an: �/� County ,CSt
3� W1�(�CtL ,l7-tl�� ‘...S �If 11
WELL CONSTRUCTION RECORD
Topographic/Land setting.
tE ❑Ridge ,lope ❑Valley ❑Flat
11a..1 b' 7 . 9 (check appropri_:: box) •
(o:ra:; N:m:, Numbes, Community, Suid",isica, Lot No., tip Cc'c) � Latitudeiongii' de of well location
3. OWNER: iQ4 ne. r 2 w (�cst3
Address S7 W 1'Ylaln 5i
(Sire:: or Roce Ns),
Z5Ln /II4- /PC. QS779
Gy or iro+.-a j❑:e Zip Ccd:
(Ya1%)- 5 1. — U7-Q1f
Ara cod:- Pion: cumber
4. DATE DRILLED I '62 (o
5. TOTAL DEPTH: YC.C)
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO ,
7. STATIC WATER LEVEL Below -Top of Casing.: .511 FT.
(us:..+"i(A_o Top o(Casia;)
S. TO? OF CASING IS 1 FT. Above Land Surface -
'Top o(easinq terminated ac'or below land surru:e requires
vc iance In accordance s.irh ISA NCAC 2C .0119.
9. YIELD (gpm): t/- METHOp,OF TEST A Ir
10. WATER ZONES (depth): 5 0 Li
11
12. CASING:
Depth
From O Ter S,2
From To
From To
13. GROUT: Depth
From 0 To L3
From 3 To ZJ
14. SCREEN: Depth
DISINFECTION: Type RT{-I Amount SD /)7
WTI Thickness
Diate.!e7 cr V'eizh:T hewer
Ft. Ia t/jt SW! Z-,' 1p U C.
Ft.
Ft.
Material
C9irv-F-..
b!e:hod
Ft.
Ft. bet? 1m- 1, / ette 4j
Diare:e; S!ot Size v Ma:e:A!
(des: eis. min_:te.:m-es)
Latlr_delonglmde source:❑GPSDTopographi: ma?
(:h box)
DEPTH DRILLING LOG
From To Formation Description
i'--' 17
'77—Wei
L/G O —C,/p 2
4'O;L ej'OD
From To Ft. in. in From To Ft. in. in.
15.SAND'GRAVELPACK:
Depth Size p.!ateri
From To Ft.
From To Ft.
16. REMARKS:
LOCATION SKETCH
Shoe: direction and distance in Hiles frt a: ISas:_
two 5:_e Roads or Cou-.r> Roa_s. Inch_e the gad
cumbers and common road names c''I
(it
I DO HERESY CERTIFY THAT TH(S WELL WAS CONSTRUCTED FN ACCORDANCE \1TH 15A NCAC 2C, WELL
CONSTP,UCTION STANDARDS, AND T-:AT A COPY OF THIS RECORD HAS SEEN PROVIDED TO THE WELL O';',NER
(Th r r t.
S!GNATt E OF FERSON CONSTR.UC T ING TH-E WELL
(.-. /-Cy
DATE
Submit the original to the Division of Water Qualin, Groundwater Section, 1636 Alen Service Center Raleigh, NC
27699-1636 Phone No. (919) 733-322t, within 30 da s. GV:-1 REV. 07/2:01

29543 �f : 3W
WELL CONSTRUCTION RECORD 7sa -33 -S YS'S-
North Cafolina Ji5epartinent of Environment and Natural Ressourcess(- Division of Water Quality - Groundwater Section
\YELL CO\TRACTOR(1:\DIYIDUAL)NA\I//Ey(�pa�yn� t) V. 1--J 1 r ��C�i-f�i`,n J CERTIFICATION (p
WELL CONTRACTOR COSIPANY NAME nnr reene t7vO. (-d-1-1 PHONE K _ (p .—.S35-0
STATE WELL CONSTRUCTION PERMIT.' ASSOCIATED WQ PERMIT.'
• (if applicable) — (ifapolicable)
I. WELL USE (Check Applicable Box): Residential jil Municipal/Public ❑ Industrial 0 Agricu!mral ❑
Monitoring ❑ Recovery 0 Heat Pump Water Injection 0 Other O If Other, Lis: Use
2. WELL LOCATION'
Nearest ToVn: (t 1 0 A-- County tj i csinn
I-1-(dian ' aA,I(e.C .5r ivii E Ca1775'
(S:;e:: Name, N'unbes, Conru. ,y, SubdiAsien, C/: No., Zip Cc. )
3. O\WER:J t,Ine Srn/
Address '5"7 ' Ina .Yv Et'
(auger or Rau:: No),
, I V Fr )1r C- Q g 7 79
(S�): : o` �.o 7a zip cod:
Area c d:- Pear.: cumber
if
S. DATE DRILLED 1'_/6 —Di"
5. TOTAL DEPTH: 300
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO tic
7. STATIC WATER LEVEL Belo:: Top ofCasir.o: qv FT.
(use "r' if A'ro:: Top o.rCasir_)
S. TOP OF CASING IS / FT. Abo';e Land Surface'
'Top or casing terminated at'or belonr land surL;e requires a
variance In acmr ance n ich 1iA NCAC 2C.0113. yyLLr
9. YIELD (epm):�_ METHOD OF TEST /7ir
10. WATER ZONES (depth): aao
1I. DISINFECTION:Type H if—L
12. CASING:
From 0 To .i79
From
From
Arnot::n: /'i i7
F.'tl Thickness
Dian•:e: crY:'e:;:n:T; Ma:er,'
Ft.
To Ft.
To Ft
u'tn e (
Topographic/Land setting
❑Ridge ❑Slope ❑Valley OFla:
(et.:ck appropria:: box)
Latitude/longitude of well location
Latitude,9onsir_de source:OGPSOTopographic map
(oh -ark tot)
DEPTH DRILLING LOG
From To Formation Description.
c;2QO -vaa
c�\�1, oio0
LOCATION SKETCH o
Snow direction and distance in mires fraz at le —as:
t.vo S:a:e Reads Or aunty Roads. 1:1,71,5413 t eYmad
cumbers and common road name-.
13. GROUT: Depth Ma:eria! Me:hod
From 0 To 3 Ft. ante?-,* lbra> I � '
From c To r2 7 Ft. b o v 1rti,. -/-11 w.+U p.:re--
14. SCREEN: Depth Dianne:e: S:o: Size h!ae via:
From To Ft. in. in. •
From To Ft. in. in.
15. 5AND:'GRAVEL PACK:
Dep:'n Size Materia:
Frorn To Ft.
From To Ft.
15. RE`LARKS:
1 -f-- 7 c
-Al a . —t
µc tut uaice,/ Rc{'
I DO HER; BY CERTIFY THAT THIS WELL WAS CONSTRUCTED N ACCORDANCE WITH I SA NCAC 2C, WELL
r
CONSTRUCTION STANDARDS, AND THAT A CO?Y OF THIS RECORD HAS BEEN PROVIDED TO TET WELL Oi`:?=P.
Vl �fL •rf'
SIGN.1.71.1PliDF PERSON CONSTRUCTING Ti' WELL
(i- 7-or
DATE
Submit the original to the Division of Rater Quality, Groundw-oter Section, 1636 Dlail Service Censer -Ra ergh, NC
2 7699-1636 Phone No. [phone], within 30 days. Gti '-1 REV. 07/200I

295244
(degrees/minutes/seconds)
Latitude/longitude source:OGPSOTopographic map
(check box)
DEPTH DRILLING LOG
From To Formation Description
—
/ (o
146-170
1 70 --17o-
I'72.-175s
7. STATIC WATER LEVEL Below Top of Casino: ).5— FT.
(Use "+" if Above Top of Casing)
S. TOP OF CASING IS I FT. Above Land Surface'
*Top of casing terminated at/or beta w land surface requires a
variance in accordant with 15A NCAC 2C .0118.
4- 9. YIELD (gpm): , METHOD OF TEST AI V-
10. WATER ZONES (depth): 170
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and i��jatural Resources-hDivision of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NANIyE� (print)�iL(S-Sc'. L' /771 Jot CERTIFICATION
/ CERTIFICATION ##//�
WELL CONTRACTOR COMPANY NAME /-1rr/� Qreen� Srv17 Q( We-u C�"-�srl vier PHONE #l:i���Pc� `�
ASSOCIATED WQ PERMITS
STATE WELL CONSTRUCTION PERMIT:
(if applicable) (if applicable)
I. WELL USE (Check Applicable Box): Residential ti Municipal/Public D Industrial O Agricultural ❑
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use
2. WELL LOCAT ION:k Topographic Land setting
Nearest Torn: ,� Sin Count
y
ttfee. 1 Ake_ (aft-t,22tit 7cI
1�(Ridge ❑Slope ❑Valley ❑Flat
(check appropriate box)
(Street Name, Numbers, Community, Subdivision, otNo., Zip Co e) Latimdellongitude of well location
3. OWNER: -gets A7 ,'` G(�/Ccty
Address `776 lll/7%' tihi9//7_5 f-
(Street r Route No.)
t /1 C o7Y7K3
Zip Code
City or Town State /
lC2a-
Area code- Phone number �l
4. DATE DRILLED e-oC � d— 04
5. TOTAL DEPTH: 1 73
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO 1rl
LOCATION SKETCH-
1 - ---
1. DISINFECTION: Type Y' 14 Amount l0> t Z- Show direction and distance in milesTjem at least
12. CASING: Wall Thickness two State Roads or County Roads. Iiae7ude;tht road
Depth Diameter or Weioht,Tr Material numbers and common road names. 0 57
From 0
From To
From To
13. GROUT: Depth
From 0 To 3 Ft
From a To 80
14. SCREEN: Depth
From To in.
From To in.
15. SAND'GRAVEL PACE::
Depth
From To Ft.
From To Ft.
To (S FL b 1/j el- Loc•.Yj.1 -f.p
Ft.
Ft.
A(ateriat
Ft. �r ^ -
Diameter Slot Size
Method
�y —
Material
in.
in.
Size btaterial
Ft.
Ft.
16. REb1.ARKS:
Cs) —
Ca�
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH I5A NCAC 2C, WELL
CONSRUCTION STANDARDS, AND THAT A COPY OF THTS RECORD HAS BEENPROVIDED TO THE WELL OWNER
• S NATU 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
77

295245 T 4463/VW
Syb'--93— 010,7
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section / Q 7
WELL CONTRACTOR (INDIVIDUAL) NAME r(�prri�i�nt)'//?CL55 ell�Q- ,Ir / CERTIFICATION Ric i /
WELL CONTRACTOR COMPANY NAME AAI "(.�teene (_1a41�)c417%"�l� PHONE p Jda4 -�d�' �SS U
STATE WELL CONSTRUCTION PER.MIT8
(if applicable)
ASSOCIATED WQ ERMIT8
(if applicable)
1. WELL USE (Check Applicable Box): Residential IX1 Municipal/Public O Industrial 0 Agricultural O
Monitoring 0 Recovery 0 Heat Pump Water Injection ❑ Other O If Other, List Use
2. WELL LOCATI?iN:
t' rest Town: County J�iUC-Scn^'
L. PreSslC.1Itr vIa.,164.,)-%-ct IfC— ak'l 3
(Street Name,
Numbers, Commutniitty, Subdivision, Lot No., Zip Code)
3. OWNER: /r IIcYIc Yt"�Ma -
Address 3 e LA )t Ic 1 t u.rrr-a a—
S(Street or Route No.)
ift.,A NC as-t1y.
R,City orl`own StateZip Code
(,(�1S)- 50i-•U9aJr
Area code- Phone number
4. DATE DRILLED Dq
5. TOTAL DEPTH: 4/ 0
6. DOES WELL REPLACE EXISTING WELL? YES ONO g
7. STATIC WATER LEVEL Below Top of Casing: 0 FT.
(Use "✓' if Above Top of Casing)
S. TOP OF CASING IS ! FT. Above Land Surface*
•Top of casing terminated at/or below land surface requires a
variance in accordance with 15A NCAC 2C .0118.
9. YIELD (epm): _ METHOD OF TEST /—t Ir
10. WATER ZONES (depth): IIlgrit /to g—
"a (7.) 5'8 3 S
DISINFECTION: Type HT Amount bZ.
CASING: Wall Thickness
D1fiameter orp\',ioht.'Ft.
Ft. (n �� �0 lEJktrn,.,
Ft.
Ft.
Material Method
Ft. Can.an _
Ft. r. c k _ __
Diameter Slot Size �/ Materialial
Ft. in. in.
Ft. in. in.
II
l2
Topographic/Land setting
DRidge ASlope ❑Valley❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitudeilongitude source:OGPSOTopographic map
(check box)
DEPTH DRILLING LOG
From To Formation Description
Icy
Depth �) i
From_ To bit
From To
From To
13. GROUT: Depth
From D To 3
From 3 To. )
14. SCREEN: Depth
From To
From To
15. SAND/GRAVEL PACK:
Depth
From To
From To
79-95.
9S— t/7
97•- /65
615-/G7
/t'o7-' 345
3 05 -307
'307-- 39/5*
-a 9r -3rt7
3q7-- 40 )
it - L✓
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
Material number and common road names.
Ft.
Ft.
Size Material
0
L
C
16. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONST• L TION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
SI
.ATURE OF PERSON CONSTRUCTING THE WELL DATE
Submit the original to the Division of Rater Quality, Groundwater Section, 1636 Mail Senice Center -Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-1 REV. 07/2001

aa,77g
ci XJ Town Sta:: Zip Code
(� 7 2-9
Area code- Phone number
4. DATE DRILLED 5 _ 3 -as/
29 V.91 '753 %-bb -TSB/6
WELL CONSTRUCTION RECORD 7$ b 3 i W
North Catolina :Department of Environment and Natufal Resources - Division of Water Quality
WELL CO'TRACTOR(INDIVIDUAL)NAME (pprint)-.1—/. rn-cilWII}}ELL CONTRACTOR COMPANYNANIE rn I/rernQ Pros
Oriel
ISTATE WELL CONSTRUCTOY PER}IT#
ASSOCIATED WQ PERMIT:
(ifapplicable)
(if applicable)
-GroundwaterSectiorynn ),n
CERTIFICATION
PHONE 0 (bad'5f' s•sz)
1. WELL USE (Check Applicable Box): Residential ti Municipal/Public ❑ Industrial ❑ Agricultural ❑
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use
2. WELL LOCATION:
Nearest Town: i t.( 19 A- County J# 44->
jim bet- /Q'n 1 1J._ C I (),a NC c 27-75
(Srrr-t Name, Numbers, 'Communi
ry,5ubudvon, Lo(No., Zip Code)
3. OWNER:
Address
(Singes erRout: j:;.
5. TOTAL DEPTH: r-Q.L)
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO
Topoo aphic/Land setting
DRidge ❑Slope ❑Valley )1-Flat
(chef< appropriate box)
Latitude/longitude of well location
(de¢re:s'ninu:es'seconds)
Latitude1ongitude saurce:OGPSOTopographic map
•
(chec( box)
DEPTH DRILLrNG LOG
From To Formation Description
p—a5
aQ.r-a D 7
r-a07 — v
0
c
LOCATION SKETCH al
Show direction and distance in miles from att.-as:
two State Roa_s or County Roads. Include the road
numbers and common road names.
pit
From 3 To .21 Ft. payt.JUh-r.t6 9 ` .,-V la . f�' .
14. SCREEN: Depth Diameter Sloe Size Ma:-nal /
From To Ft. in. in.
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Size Material
7. STATIC WATER LEVEL Below Top of Casing,: rQ 0 FT.
(Use -;" if Above Top Casing)
S. TOP OF CASING IS I FT. Above Land Surface
'Top of casing terminated a for below land surface requires a
r a riance In accordance with 15.1 NCAC 2C .0I IS. ^
9. YIELD (gpm): ) O • METHOD OF TEST hut
10. WATER ZONES (depth): ans
1 I. DISINFECTION: Type )-i-i-lei Amount l/, ay fj7
12. CASING: }1a:I Thickness �J
Depth Dia�-/.e/:e'r or ls;eizhtTt. b
From 0 To_1Q_ ,
Ft. ra�wkC'
From To FE.
From To Ft.
13. GROUT: Depth p(. hod
From U To 3 FL aeriLesi �tj��
From. To Ft.
Ci-+A.
From To Ft.
16. REMARKS:
I DO HEP�.BY 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 O\VNER
- I - 01+
S[GNA 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], }vithin 30 days. GW-1 REV. 07/2001

Zip Code
(lab- 5 stC- - aS4
Area code- Phone number
4. DATE DRILLED q - S- -O
5. TOTAL DEPTH: 752)
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO20
7. STATIC WATER LEVEL Below Top of Casing: 3Ce r FT.
l (Use'•✓' if Above Top of Casing)
S. TOP OF CASING IS I /0--- FT. Above Land Surface*
crop of casing terminated at:'or below land surface requires a
variance In accordance with 15A NCAC 2C .OI IS. •
9. YIELD (gpm): WI -HOD OF TEST 1 P-
10. WATER ZONES (depth) 4) SVS + (I J I) / "e 6-vs-
II DISINFECTION: Type
12. CASING:
WELL CONSTRUCTION RECORD
to VV
rUpa3-le9-0885
296641
North Carolina- Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
y
WELL CONTRACTOR (INDIVIDUAL) NAME (print)P(A �.-
U 10v CERTIFICATIONS C /t/9 7
PHONES ( )
WELL CONTRACTOR COMPANYNAMEM73 (7 if he r,{if• w Y
STATE WELL CONSTRUCTION PERMITS ASSOCIATED WQ PERV ITS
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential l( Municipal/Public ❑ Industrial 0 Agricultural E -
Monitoring D Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use
2. WELL LOCATION: /�
Nearest Town: Cl / 0 A- County ,T cLS'dn
P-tre-/ Mcf s�Iva-a'\IC a3'779
(Street Name, Nutters, Com�iunity, Subdivision, Lot No., Zip Code)
3. OWNER:5W4c+ I1A4.4 O`
Address r.•(r --1-}r -01 lu L`fJ et I it
(Street or Route No.)
Reif( LOPS; P1
Ciryo4 Town State
c-
Topogaphic/Land setting
❑Ridge -lit lope ❑Valley DFlat
(check appropriate box) •W
Latitude/longitude of well location
(degees.minutestseco. ds)
Latitude/longitude seurce:DGPS1Toppgraphic map
(check tbx)'
DEPTH DRILLING LOG
From To Forttbn Description
9q
99 -34
3q5-3 V
-94 e- b/ 5
5t/s--Li
`IS
- -Sy rr
s`S-70C
LOCATION SKETCH
Amount 'Zy7)Show direction and distance in miles from at (east
Wall Thickness two State Roads or County Roads. Include the road
Depth Diameter or WeiehtfFt. Ma:eriar numbers and common road names. c
From D To /6 V Ft. C SDfl; C1Pdc- O ="6
From To Ft. T / '-.-:_
From To Ft. / ., �
a
13. GROUT: Depth Material Method5 />
U
From a To '3 Ft. ()lyrn.c-r$ 3J / u G -1
From 3 To au Ft. k].Qni/v- it _ /7-to14. SCREEN: Depth Diameter Slot Size Material SR- /Cio ' N From To Ft. in. in.
From To Ft. in. in. ,yy-•.cam tit
15. SAND/GRAVEL PACK: 6� �L� co
Depth Size Material DJ"C4A_
From To Ft.
From To
16. REMARKS:
Ft.
0
1 DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH I5A NCAC 2C, WELL
CONSjBJ1CTION STANDARDS, AND THAT A COPY OF. THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
L) o-07 4 —02(o ` U %
IGNATURE 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
ti 1 f j / to 1. l/
- /3-3 1 -a��
North Carolina - Department of Environment and Natural Resources - Division of Water Quality
C
Groundwater
rwate rScti
\\ELL CO\TRATOR (INDIVIDUAL) NAME (print) CERTIFICATION-7/i7
WELL CONTRACTOR CO>I PA\NAME nPHONE (Vir ,6 - l
ASSOCIATED WQ PERMIT1(
SLATE WELL CONSTRUCTION PER>IIT" (1
(ifap licaivablbl(if aoolicable)
e) •� 0
WELL USE (Check Applicable Box): Residential ET Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection ❑ Other ❑ If Other, List Use
2. WELL LOCATION: ,� Topo,z.fM�phic!Land setting
Nearest Town: 5l. , T' County`?'-Ac,50 r \ ❑Ridge iZlope ❑Walley ❑Flat
L T (check appropriate bon)
,�:: a S-0 1` �m m✓� 'Rd 2 C, 1 if od (� ' l Latitude longitude of well location
(S;re: ?'a:ne, Numbers. Con,muni:}�, Subdiciiion, Lot Noel Zip Cole) ,, �i�
tit fee Pitt). . �tiLL<r,/fl (de_reeiMinu:_a'seconds)
3. OWNER: C aO �O I Latitude/tom/Rude source:OGPS❑Topographic map
r\d.;ra> TO c.e v X (check box)
(s"e'crjo°t`N V' JC a '/. DEPTH DRILLING LOG
- T- Not
\'
t Formation Description
� ZipCode From To
Cc. r1o�.n S:ve
( 5- Li-k-X— (. 3 cO
Arta :ode- P'eo�.e number O r `h/
4.
DATE DRILLED '4 - '
5. TOTAL DEPTH: Rs-
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NOX
7. STATIC WATER LEVEL Below Top of Casing: 5'6 FT.
) (Use'='- ifAbove Top of Casing)
S. TO? OF CASING 1S 1 1 FT. Above Land Surface-
.: i op o: casing terminated at'or bolo) land surface requires a
sarionce in accordance Is ith ISA \CAC 2C .0113. pp
9. YIELD (gpm):' 4-15—tMETHODOFTEST /T!f
ID. WATER ZONES (depth):[ cif 5' (J)9O("2)/Or
7) i7,,' LOCATION SKETCH
p !�' 0.,,Sho•w direction and'dis ante in miles from at least
I I. DISINFECTION: Type H I N- ( Amount r t\vo State Roads or Countv Roads. Include the roach
1'_. CASING: 11'r eiehLF>s p o
Diame�:r or 1\'eieh CFt. \L'r I numbers and common road names.
Win.
From CJ T c2 i Ft. J.r�A/ 1 - r i
Front To Ft. �J — 7 Ci
1
F rot:) To Ft. .,_.. .,
n — .21
-2/ — 5�r
ys -. 417
</? — qv'
90 - 9.3
9.3
ia S lust
io
13. GROUT: Tn p;
From Tooa Ft
Fror.:_ To3.0Z_ Ft._
14. SCREEN: Depth Demeter
From To Ft.
in.
Front To Ft. in.
15. SAND GRAVEL PACK:
Dept) Size
Front To Ft.
From. To Ft.
S'ot Sir
in.
in.
Nlateria.'.
\laterial
N
5
/l�o G/o 7o w o
EA; at(
ti
16. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONST C t ION CRE STANDARDS. THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL Q\\1oE R
ix/JAW/ RE -
SIGN'.; OF PERSON CONSTRUCTING THE \SELL DATE
Submit the original to the Division of Water Quality, Ground,\ater Section, 1636 Mail SPW.,CrI Et'`07?001
27699-1636 Phony No. [phone], Within 30 days. ` �_ -
u " �, AUG 3 2004
L
GRCL,;6
_J
ER SECII(liN
L L'.

q r9 Ny9S073w
WELL CONSTRUCTION R ORD 7 5 7 a —la —cf p d
North Carolina - Department of Environment andNaturalResourceess- Division of Rater Quality - Groundwater Section f�
\\ ELL CONTRACTOR(INDIVIDUAL)NANE�\ (print)(�/� .1 D. %�'\C1 (-L 1i(,t��r-JJ. --� / CERTIFICATION; C�?///° op/
\1'ELLCO..\TR::\CTORCO\IPANYNA\IEAr-V-I Oreen e' 4 1ros U3 L( j/r PHONE X (�� _5 S t!J"JSSa
STATE WELL CONSTRUCTION PER\IIT# ASSOCIATED wQ PERATII
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential Nlunicipal:'Public 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 ({eat Pump Water Injection ❑ Other ❑ If Other, List Use
2. WELL LOC.ATIQN:
Nearest Town: a, S 1 F'r S County S pc ! Sum.
,LL`r:�:,.( i4 nt�`'t,. C i, ot e ZstAlC a/777
3. OWNR:ICi,..Wl(Prc4 (Ike LLG —
Address 'Po Gay
(Stier: or Route NoZ
�l 2 7 /
own State
(22.-7713 FV-SY
Area code- Phone camber
4. D.-\TE DRILLED 3-IS- CD
5. TOTAL. DEPTH: q00
6. DOES BELL REPLACE EXISTING
From To
From To
13. GROLT: Depth
From Q To 3 Ft.
Front 3
14. SCREEN:
Zip Cod,
i
WELL? YES 0 NO
7. STATIC WATER LEVEL Below Top of Casine: /D O FT.
(Use'=" if Above Top of Casing)
S. TOP OF CASING IS I �`i FT. Above Land Surface'
•'I up of casing terminated iCor belus' land surface requires a
nrfence in accordance pith L:\ \CAC 2C .011S. n
9. YIELD (cram): ' Vt, NIETHOD OF TEST /�f7r
10. RATER ZONES (depth): '770
11. DISINFECTION: Type Ef'T I+ Amount 7`Ui 67.0Z
12. CASING: Wall Thickness
Depth Diameter or \Veight.Tt. ?4'er:.:!
Front 0 To / I U Ft. (., 1/./ jgg MN( s-feG!
Ft.
Ft
To 7 c) Ft
Depth Diameter
Fror) To Ft. in.
From To Ft. in.
1.5 SANDGRAVEL PACK;:
-Depth Size Nleterial
NIeteriel
Cu�r+w
Sot Size
in.
in.
lethed
Alateria!
From To Ft
FrontTo Ft.
16. REMARKS:
G}'l
J.
Topographic/Land setting I .
❑Ridge DSlope ❑Valley ,Flat' •
(check appropriate box)
Latitude'loneituda of well location 1 •
(degreeslninu:etRecords)
udo'longitude source:DGPSOTopourapl icm9p_
.(afire% box) ,L
DEPTH
From To
DRILLING
Formation Des:
:lion
Iay -779 6
77a - 77-3 Ca -arty
-77 3 - 9v v M-c„er-�,c7`
LOCATION SKETCH
Show- direction and'dis:ance in riles from at leas'
two State Roads or County Roads. Include the road
numbers and common road names.
/073
as 65
7 Htuate
O
c
I DO FIEF:EBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH I5A NCAC 2C, WELL
CONSTRCCTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
•
u —
.�2 c. of
SIGNATURE OE PERSON CONS Re -'STING THE WELL DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 \ Iail San ice Center- Raleigh, NC
27699-1636 Phone No. [phone], within 30 da) s. G\\-I REV. 07:2001
4a
(: 0
c)
U

ysa�
v-n a V 4 3'_ c % 2
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section 9
WELL CONTRACTOR (INDIVIDUAL) NAME (print�[�ST°�/yL CERTIFICATIONk �/a
cis tLt c 4 '» /S
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
WELL CONTRACTOR COMPANY NAME A-A/1
(if applicable)
(if applicable)
7
PHONE k (S 2S j5ZC 3&Y
WELL USE (Check Applicable Box): Residential( Municipal/Public O Industrial 0 Agriculturia2D ('-
Monitoring ❑ Recovery 0 Heat Pump Water Injection ❑ Other O If Other, List Use
2. WELL LOCATI
Nearest Town: /.l / County.
(Str
3. OWN
Address
Name, Numbers, Community, S(,bdi
ER: etna-jtet _C
/(Street or Route No.) -/
}'Yn ((Atli/TVA—a-, , qte 3a cA
City or Town State. Zip Code
Cab as s8 ?9
Area code- Phone number
4. DATE DRILLED / T3O — U
5. TOTAL DEPTH: o:Sl'
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO
7. STATIC WATER LEVEL Below Top of Casing: FT.
(use "+" if Above Top of Casing)
S. TOP OF CASING IS _ FT. Above Land Surface*
`Top of casing terminated at/or below land surface requires a -y-y��-y)
variance in accordanc,e r)'ith I5A NCAC 2C .0118. -2eA'S '
9. YIELD (gpm): _S ME HOD OF TEST
10. WATER ZONES (depth)L&.9) l 30 «j
LOCATION SKETCH 3
Ga
Topographic/Land S ttin?
❑Ridge .Slope ❑Valliy 0Flat c.
(check appropriate bo.. )
Latitude,/longitude of well location c
_(.tktatit,tde/lone
DEPTH
From To
7)- //4t
//y1-/So
(degrees/m inutes'seco
itude source:OGPS
(check b
D
Formation Description
11. DISINFECTION: Type}.
12. CASING:
Depth Diameter
From CI To 112 Ft.L /S/
From To Ft. //,
From To _ Ft. L 2 OL, /26,
/.30-- /33
Amount J/, S - Show direction and distance in miles from-kr
Wall Thickness two State Roads or County Roads. Include( the road_'
or R'eicht/Ft. Ma 'nal numbers and common road names.
L�.,P
J
13. GROUT' Depth MaterialCD
Method a
-Ldl�fi ,
From a-3 To . � Ft. (J .. _ ]n O UY� r /%
From To ZU Ft.
!d. SCREEN: Depth h Diameter Slot Size \
From To Ft. in.
From - To Ft. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
(A)) / /j? /J m
From To Ft.
16. REMARKS:
1 DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, \VELL
CONS I UCTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
ie IGNATURE 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 CO,tIRACTORIIiyDIYIDUAL)NAMIE (pant) James 5. _B_own CERTIFICATIONR2045
WELL CON'I- RACTOR COMPANY NAME Hedden Brothers- Well Drilling, Inc PHONE [phone]
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED \YQ PERMIT;
(iraoplicable) - - (if applicable).
295999
I. WELL USE (Check Applicable Box): Residential Municipal/Public 0 industrial ❑ Agricultural O
Monitoring ❑ Recovery 0 Heat Pump Water Injection 0 Other ❑ If Other, List Use
2, WELL LOCATION:
NearestTown: -Sylva
Greene's Creek
County
Jackson
(street Name, Numbers, Community, Subdi vislmt, Lot No., Zip Code)
3. OWNER: Marie Alvarez
Address 7460 SW 130th Street
(Street or Route No.)
Miami, FL 33156
City or Taw State Zip Code
(305). 594-1715
Area code• Phone nu ber
4. DATE DRILLED 5-12-04
5. TOTAL DEPTH: 420'
6. DOES WELL REPLACE EXISTING WELL? . YES 0 NO
7, STATIC WATER LEVEL Below Top of Casing: 120' FT.
(Use" r" if Above Top of Casing)
8. TOP OF CASING IS 2 FT. Above Land Surface*
'Top of casing terminated atior below Iand surface requires a
variance Inaccordance ivlth 1SA NCAC 2C ,011S.
9. YIELD (g?m): 30 METHOD OF TEST blow
10. WATER ZONES (depth): 390', 400'-, & 412'
1 I. DISINFECTION: Type H T H Amount - 16 oz
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
From 0 To 120 Ft. 6" ppvvc
From 120'-To 123 Ft. 6" -THE stee
From - To Ft.
13."GROUT: Depth Material Method
From 0 To 20 Ft. bErcnite & L teel pumped
From To Ft.
SCREEN: '. - Depth Diameter
From To Ft. in.
From To. Ft. in.
SAND/GRAVEL PACK:
Depth Size
From. To Ft
From To Ft.
16. REMARKS:
I D0 HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH ISA NCAC 2C, WELL
CONSTRUCTION STA DS, AND THAT AC Y OF THIS RECORD- HAS BEEN PROVIDED TO THE WELL OWNER
et o
EOFPERSON CONSTRUCTINCTHEWELL DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Sarvice Center • Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. . - GW-I REV. 07i2001
Topographic/Land setting
❑Ridge ❑Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location •
(degrees/minutes/seconds)
Lrctitudo/Iongitudesource:OGPSOTopographic map.
(check box)
DEPTH
Porn 1'9) '
121' 420'
DRILLING L,0G
Formation Descr otion'
clay & sand
Granite
LOCATION SKETCH
Show di re:tion and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common road names,
O
L
rr
rai
,.
0 n >
•. rl
Ca
kD G
2

293990
WELL CONSTRUCTION RECORD
North Cal olma Dopartment of Environrrent and Natural Resources • Division of \I/tater Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) Mitchell D. Cook CERTIFICATION 20d3
WELL CONTRACTOR COMPANY NAME 1---11r11 Er±harS SJ.1Cd-11—irql lit
STATE WELL CONSTRUCTION PERMIT$ ASSOCIATED WQ PERNIITO
(if apultcable) (if epolicable)
PHONE .[phone]
1. WELL USE (Check Applicable Box): Residential Municipal/Public O Industdal O Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 1f0ther, List Use
2 WEI.L LOCATION:
NearestTown. Cashiers County Jackson
Yellow Mountain
(Street Name, Numbers, Co:ntnunity, Subdivision, Lot No., Zip Co)
3. OWNER. Jessica Griffith
Addss 309 Newton Hill Rd
(5hevorRout,N0)
Pickens, SC 29671
City or Town State Zip Code
(864). 878-5247
Area code- Phone number
4, DATE DRILLED 5-12-04
5. TOTAL DEPTH: 600'
6. DOES WELL REPLACE EXISTING WELL? YES 09 iO3•M
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 or casing terminated at/or below !and surface requires a
variance In accordance with 15A NCAC 2C .0118.
9. YIELD (gpm): 2 METHOD OF TEST blow
10 WATER ZONES (depth). 100 I
1 I. DISINFECTION: Type H T H Amount 1 6oz
12. CASING. Wall Thickness
Depth Diameter or Weight/Ft. Material
From n To 20 Ft 611 pvc.
From 20' To 41 Ft 6" .188 steel
From To
13. GROUT: Depth
From 0 To 20
From To
14. SCREEN: Depth
From To
• From •To
15. SAND/GRAVEL PACK:
Depth Size Material
• From To Ft.
From To Ft.
Ft.
Material Method
Ftbertnite & avant psiral
Ft.
Diameter Slot Size Material
Ft. in in.
Ft in. in
Topographic/Land setting
°Ridge 0Slope °Valley OFIct
(check approprta:: box)
Latitude/longitude of well location
NevIls6ninWesist:one.r)
Latitudelongitude source:OGPSOTcpographic map
. • (check box)
DEPTH DRILLING LOG
From To Formation Description
0 39' rtav & 1.3
39' 600' granite
LOCATION SKETCH
Show direction and distance ir, miles from at feast
two State Roads or County Roads. Include the road
0 :=
numbers and common road names.
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
(C-46' Za
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
c_
'"—

WELL CONSTRUCTION RECORD
295991
North Carolina - Dcpartineni of Environment and Natural Resources • Division of Water Quality - Groundwater Section
WELL CONTRACI'0R(INDIVIDUAL)NAME (print) tratchell D. Cook CERTIFICATION II 20d3
WELL CONTRACTOR CO'IPANY NAME Fia±±1En &tt} s 4 l l imr. TIC PHONE it (323369-9591
STATE WELL CONSTRUCTION PERMIT)/ ASSOCIATED WQ PERLIIT$
(if anplicabie) (if applicable)
I': WELL USE (Check Applicable Box). Residential ( Municipal/Public❑ Industrial 0 Agricultural 0
Monitoring ❑ Recovery 0 Heat Pump Water Irject:on 0 Other 0 If Other, List Use
2 WELL LOCATION:
NearestTowni Cashiers County Jackson
Little Terrapin Top Rd
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3 OWNER Erin Watson
Address PO Box 913
(Street or Rote No.)
Cashiers, NC 28717
City or Town State Zip Code
(828). 743-6909
Area code• Phone number
4, DATE DRILLED 5-13-04
5, TOTAL DEPTH: 400'
6. DOES WELL REPLACE EXISTING WELL? YES 1'NjOxm
7. STATIC WATER LEVEL Below Top of Casing: 1 0 . FT,
(Use ".e" if Move 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 vetch ISA NCAC 2C.01IS,
9. YIELD (gpm): 30 METHOD OF TEST blow
10, WATER ZONES (depth): 215' & 320'
II, DISINFECTION:Type H T H
12. CASING
Depth Diameter
From 0 To 21 Ft: 6 t
Arnount 16oz
Wall Thickness •
or Weight/Ft. `Material
.188 ` steel.
From To • Ft
From ` - To Ft.
13, GROUT: Depth Material
From 0 To 20 Ft} mite & caret
From To Ft
14 SCREEN: .^ Depth Diameter.From -To• Ft in
From To Ft. in
1.5::`SAND/GRAVEL PACK:
Depth
To Ft
From
•From To Ft.
Method
C1-1F3
Slot Size : Nlateriat l'
in.
Size Material
Topographic/Land setting
❑Ridge ❑Slope ❑Valley ❑Flat
(checkappropriatebox)
Latitude/longitude of well location
Neveesiminites(se:onds).
L tituds'iongitudesource:❑GPS❑Topographicnrap
(check oast
DRILLING LOG
Formation Description
clay &sru cl •
granite
DEPTH
From To
0 19'
19' 400'
LOCATION SKETCH'
Show direction .and distance in miles from at feast
two State Roads or County Roads. Include the road
numbers and common road names.
16. REMARKS:
I DO HEREEY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH ISA NCAC iC, 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:Qunlity; Groundwater Section, 1636 Mail Service Center -Raleigh, NC
27699.1636 Phone No(919) 733.3221, within 30 days. - GW-1 RE..V. 07/7.001
a

295.993
WELL CONSTRUCTION RECORD
North Carolina • Department of Environment and Natural Resources • Division of Water Quality - Groundwater Section
14ELL CONTRAC1`OR (INDIVIDUAL). NAME (print) Mitchell D, CCpk CERTIFICATIONS 20d3
WELL CONTRACTOR COMPANY NAnME HEtfan ErcthesG traling,"
STATE WELL CONSTRUCTION PER611Tb ASSOCLATED:WQ PERiMIfTl
(if applicable) (irapolicable)
PHONE a828) 369-9591'
WELL USE (Check' Applicable Box): Residential6 Municipal/Public❑ Industrial .Agricultural
Monitoring 0 Recovery 0 ,Heat Pump Water Injection ❑ •0tner 0 If Other, List Use
2 WELL LOCATION
Nearest Town: Clallowhee County
Caney Fork to Moses Creek
(Street Name, Numbers, Community, Subivision, Lot No.. Zip Code)
3 OWNER Dick & Marcella Hotaling •
Address 1152 Moses Creek Rd
(Street or Route No.)
Cullowhee, NC 28723
Jackson
City or Town .State Zip Code
t328 ). 293-3264
Area code• Phone number
4. DATE DRILLED 5-17-04
5. TOTAL DEPTH: 175'
6, DOES WELL REPLACE EXISTING WELL? YES 0 NO .Ex
7. `.STATIC WATER LEVEL Betow Tcp of Casing: 125' - FT.
(Use "*" if Above Top of Casing)
8. TOP OF CASING IS 2 FT. Above Land Surface+'
'Top of casing terminated a1)or below and surface requires a
variance In accordance with ISA NCAC 2C.0118.
9. YIELD (gpn):. 15 METHOD OF TEST blow
10, WATER ZONES (depth): 140'
II. DISINFECTION:Type H T H Amount- 1 6oz
12. CASING Wall Thickness
Depth -.Diameter or Weight/Ft. 'Material
From 0 To 105 Ft. 61" .188 steel
From To Fc....
From • To `'Ft,
13: ;GROUT: Depth Material • Method
From_()To 20 Ftkaiil to & cere E t73rix3
From To :Ft:
14, SCREEN Depth Diameter Slot Size
.•.From To Ft in
Prom To Ft in
15.'SAND/GRAVEL PACK:
Depth :Size Material
From To Ft
• From To Ft.
Material r'
Topographic/Land setting
❑Ridge 0Slope ` ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/n•,Inutes/seconds)..
Lati;ode/longitude source:❑OPS❑Topographic map
(check box)
DEPTH DRILLING LOG " "—
From T1o03' Formation Description
0 clay & tr.1 Ll
103' 175' granite
LOCATION SKETCH •
Show-directionand distance in miles from at least two State Roads or County Roads. Include the road
numbers and common yoad naves,
0
co
16 REMARKS:
I DO HEREaY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH ISA NCAC CC, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RZCORD HAS BEEN. PROVIDED TO THE WELL OWNER
5—/7-o4-/
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.. (919) 733•32g I, within 30.days. GW• 1 REV. 07/2001
ca_

WELL CONSTRUCTION RECORD
2959813
North Carolina • Department of Environment and Natural Resources • Division of Water Quality - Groundwater Section •
WELL COtNTRACTOR(IINDIVIDUAL)NAME (print) Mitchell D, Cook CERTIFICATION, 20d3
WELL CON•IRACT0I COMPANY NAME BCCtharS CitaCatlin; Ire PHONE # P28) 3,59-9591
STATE WELL CONSTRUCTION PERMIT# ASSOC!\TED WQ PERMIT#
(ifaoplicable) - (sfapolicable).
I WELL USE (Check Applicable Box): Residential 6 Municipal/PublicIndustrial O. Agricultural 0
Monitoring 0 Recovery❑ Heat Pump Water Injection 0 -0ther ❑ If Other, List Use
> 2. WELL LOCATION
Nearest Town; Glenville County Jackson
Robinson Creek -Well #3
(Street None, Numbers, Community, Subdivision, Lot No., Zip Code)
3 owNE aim Coast Builders of S FL LLC
Addross 661 Maplewood' Drive Suite 20
: .' (Street cr Route No.)
Jupiter, FL 33458
City or Town State Zip Code '.
( 828). _ 349-3459 Are: code• Phone number -
4, DATE DRILLED - 5-10-04
5, TOTAL DEPTH: 700'
6 DOES WELL REPLACE EXISTING WELL? YES NO 0
7, STA'rIC WATER LEVEL Below Top of Casing: : 250' FT
(Use "+" if Above Top of Casing)
8. TO? OF CASING IS 2 FT. Above Lana Surface*
•Top of easing terminated atror below land surface requires a
variance In accordance with ISA NCAC 2C.0118.
9. YIELD (gpm): 20 METHOD OF TEST blow
0. WATER ZONES (depth): 285'
11, DISINFECTION. Type H T
12, :CASING -.
Depth .Dthmeter
From 0 To 66 FL 6 •
Frain •6' To 7° Ft 8•:'.' ...Steel. '.
From ` To ` ' Ft. .
- I3; GROUT: Depth.
From n To 20
14. SCREEN. -Depth
.From To'.
From To
1.5. SAND/GRAVEL PACK:
Depth
From To
. From
Material , `Method
Ftbamite & Cut rape
Diameter - Slot Size : ,Material
Ft, In In.
Ft._in. in.`
• Ft,
To' Ft.
Size
Material
Topographic/Land setting
❑Ridge ❑Slope❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degres/mimiies/seconds)
Latitude/longitude source:❑OPS❑Topographicmap
(c'eck boa)
DEPTH DRILLING LOG
From To
0 68'
68' 700'
Formation Description
clav & satrd
granite
LOCATION SKETCH
Amount 1 60Z •' Show direction and distance in miles from at least
Vann Thickness ' tWo State Roads or'Coun;y Roads. Include the road
or WeighVFt. 'Material numbers and common road names, --_
0
C
Ca
VD
I6. REMARKS:
I D0 HERESY CERTIFY THAT THIS WELL WAS CONSTRUCTED 1N ACCORDANCE WITH I5ANCAC 2C, WELL CONSTRUCTION STANDARDS, AND AAND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL 'OWNER
i
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mall Service Center -Raleigh, NC
27699.1636 Phone No,.[phone], within 30.days, - GW•1 REV. 07/2001
rri
O7

295983
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section •
WELL CONTRACTOR (INDIVIDUAL) NAME (print) Mitchell D. CC)ok CERTIFICATION s 20d3
WELL COM RACTOR COMPANY NAME He6±n Er 'IEn.S lErila-Jt Inc PHONE # S28) 369-9591
STATE. WELL CONSTRUCTION PERMITS ASSOCIATED WQ PERMITi
(if applicable)
(if applicable)
L •WELL USE (Check Appflcablo Box): Residential L Municipal/Public 0 Industrial ❑ . Agricultural 0
Monitoring, 0 Recovery 0 Heat Pump Water Injection 0 -Other 0 If Other, List Use
2, WEI,L LOCATION:
NearestTown; Whittier County Jackson
Hensley Cemetary Rd
(Street None, Number, Community, Subdivision, Lot No.. Zip Code)
3..OWNER. Gerald Hensley
Address 238 Hensley Cemetary. RD •
(Street or Route No.)
Whittier, NC ?R7R9
• City or Town State Zip Code
(a2&)• 497-9193
Area coda Phone number
4, DATE DRILLED 5-3-04
5. TOTAL DEPTH: 400'
6, DOES WELL REPLACE EXISTING WELL? YES 0 NO
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 cairn; terminated at/or below land surface requlreaa
variance In accordance with ISA NCAC 2C ,OI l8.
9. YIELD (¢pm): 4 METHOD OF TEST blow
10. WATER ZONES (depth.): 110' & 340'
II. DISINFECTION: Type H T H
12. CASING:
Depth Diameter
From_QTTo 86 Ft. 6"
From 86 To 80' Ft 611
From To Ft.
13. GROUT: Depth Material Method
From 0 To 20 Ftbarnite & °erect arced
From To Ft
14: SCREEN: Depth Diameter Slot Size Material
From To Ft. in in.
From To - Ft. in.
15.SAND/GRAVEL PACK:
Depth Size Material
Amount 160z -
Wall Thickness
or Weight/Ft. Material
pvc
1RR `ataal
From To Ft.
From To Ft.
Topographic/Land setting
❑Ridge ❑Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(de;roes/min)ies/seconds)
Latiwdelongitude source:DGPS❑Topographic rap
(check box)
DEPTH DRILLING LOG,
From To Formation Description
0 88' Clay & C 3
88' 400' granite
LOCATION SKETCH
Show direction and distance in miles from at lean
two State Roads or County Roads. Include the rcF2
numbers and common road names.
0
W
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 WILL OWNER
mL fr 42 a 5- 3-o9
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mall Service Center • Raleigh, NC
21699.1636 Phone No. [phone], within 30 days. GW-1 REV. 07/2001
0
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en,_
� z 0

WELL CONSTRUCTION RECORD
Nortn Carolina • Deportment of Environment and Natural Resources • Division of yaier Quality • Groundwater Section
WELLCOINTRACTOR(INDIVIDUAL)NAME '(prinl) Mitchell D, Cook CERTIFICATION 4 20d3
WELLCON'I RACTOR COMPANY NAME Hearn attharS Pell It Inc - PHONE k 291 369-9591
S'rATE WELL CONSTRUCTION PERh1IT0 ASSOCIATED FYQ PERiMIITX
(if aPPlicable) (if aoalicable),
295974
WELL USE (Check Applicable Box): Residential C9 Municipal/Public ° Industrial ❑ Agricultural 0
Monitoring 0 Recovery❑ Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION
Nearescrown, Glenville County Jackson
Robinson Creek --Well #1
(Sire et. None, Num'oers, Community, Subdi visi on; Lot No Zip Code)
3 CW'NER:Palm Coast Builders of S FL LLC
Addross 661 Maplewood Dr Suite 20
(Street or Route No) Jupiter, FL 33458
City c r Town State Zip Code
828 ). 349-3489 contact
Area coda Phone number -
4: DATE DRILLED 3-31-04
S. TOTAL DEPTH: 900'
6 DOES WELL REPLACE EXISTING WELL? YES 0 NO :Itx
7. STATIC WATER LEVELBelo'vTop ofCasing: - FT.
(Use "✓' if Above Top of Casing)
8. TOP OF CASING IS 2 FT. Above Land Surface"'
'Topof casing terminated at/or below land surface requires a
variance In accordance with ISA NCAC 2C 0112
9, YIELD (gpm): 0=DRY METHOD OF TEST blew
10. WATER ZONES (depth):
I DISINFECTION:Type H T H-
12. CASING,
Depth Difnteter
From 0 To 85 Ft. 6
From85' To 93 - Ft. 6"
" -From- - To `'Ft.
13. GROUT:. Depth Material
From n ,To 20 Ftbat ite & carat
From - To ` Ft:
14. SCREEN: Depth Diameter Slot Size
From To Ft in. n.
From To Ft in. in
IS SAND/GRAVEL PACK
Depth Sir.
From To Ft.
Frorn To 'Ft.
Amount 16oz
Wall Thickness
or Weight/Ft Material
188 steel
Material
Method
Material r`
Topographic/Land setting
°Ridge ❑Slope ❑Valley ❑*tat
(check appropriate box)
Latitude/longitude of well location
(degrees/nt mutes/s aond r)
Latitude/longitude source:❑GPS❑Topographic map
(check box) '
DEPTH DRILLING LOG
From Tp Formation Description- ----
0 91 clay & b:.t d
91 ' 900granite -
LOCATION SKETCH
Show -direction and distance in miles from at least
two State Roads or County Roads, Include the road
numbers and common road names. •
16, REMARKS:
DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH ISA NCAC 2C, WELL
CONSTRUCTION STAND,4RDS, AND THAT A COPY OF THIS RECORD HAS BEEN. PROVIDED TO THE WELL OWNER
frAte.-frecerLe 3- 3i-ot/
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, OW•I REV. 07/2001
rnh—
en '
ram:

295975
WELL CONSTRUCTION RECORD
North Carolina • Dbpnrtr, eat of Environment and Natural Resources • Division of Water Quality -;Groundwater Section
WELL C0 TRAC1'OR(INDIVIDUAL)NAME (print) Mitchell, De Cook CERTIFICATION 4 20d3
WELL CONTRACTOR COMPANY INAMIE HECEen actot C-ilirp,Dr PHONES?23) 369-9591
S fATE WELL CONSTRUCTION PER%ItTS - ASSOCIATEDWQ PERM ITS
' (if applicable) (ifapplicable),.
I, WELL USE (Check Applicable Box): Residential 23 Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring ❑ Recovery 0 Heat Fun Water Injection ❑ Other 0 If Other, List Use
2 WELL LOCATION:
Nearest Town: Glenville County Jackson ->
Robinson Creek -Well #2
(Street Name, Numbers, Co mnu nity, S.+bdi visi on, Lot No:. Zip Code)
3 'OWNER: Palm Coast _Builders of S FL LLC
Address 661 Maplewood Drive Suite 20
(Street or Route No.)
Jupiter, FL 33458
City or Town State Zip Code
( 828. 349-3489 contact
Area code. Phone number 4-5-04 -.
4. DATE DRILLED
5 TOTAL DEPTH: 900'
6. DOES WELL REPLACE EXISTING WELL? YES (NO ❑
7. STATIC WATER LEVEL Below Top of Casing: FT.
(Use"+" if Above Top of Casing)
8. TOP OF CASING IS 2 FT. Above Laid Surface"
'Top of tasln; terminated ot/or below land surface regalres 2
variance In accordance with ISA NCAC 2C .0118
9, YIELD (gpm):.0—DRY METHOD OF TEST blow
10. WATER ZONES (depth):
LOCATION SKETCH
I I, DISINFECTION: Type H T H Amount 160z Show direction and distance in miles tlom at least
12. CASING Wall Thickness • two State Roads or County Roads. Include the road
Depth Diameter or Weight/Ft Material numbers and common road names.
From b 'To 53 Ft, 6" pvc
From 3 To 56 Fr.�— —7IF5 'Steel
From - To. Ft.
13, GROUT: Depth Material Method
From 12 To 20 Ft) th & =Ent. curpe'
..,From To
14. SCREEN " Depth
From To
• From To
SAND/GRAVEL PACK:
Depth ,
From To
-From To
Topographic/Land setting
❑Ridge ❑Slope ❑Valley 0Flat
(check appropriate box)
Latitude/longitude of we!' location
(Uegrees(In nures/s eoonde)
Lastlleideiliongitude source :OGPSO Topographlcrttap.
(check bon)
DEPTH DRILLING LOG
Formation Description
clay &sl-----
granite
From To 0 54'
54 900'
Ft:
Diameter Slot Size Material
Ft in.
Ft. in, _ in
Size . Material
Ft
• Ft
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 \YELL OWNER
rssce'
—S; oz./'
SIGNATURE OF PERSON. CONSTRUCTING THE WELL DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1536 Mall Service Center • Raleigh, NC
27699•1636 Rhona No. .[phone], within 30 days, GW-1 REV.07/2001

295976
WELL CONSTRUCTION RECORD
North C^.tohna • Department of Environment and Natural Resources • Division of Water Quality • Groundwater Section
•
WELL CONTRACTOR (INDIVIDUAL)NAME (print) Mitchell De Cock CERTIFICATION M 20d3
WELL CONTRACTOR COMPANY NAME rE• F'W� '. L' r PHONE q 6231 369-9591
STATE WELL CONSTRUCTION PERMIT* ASSOCIATED WQ PERMITS
(ifauulicable) • (ifaboiicable)- _.
WELL USE (Check Applicable Box): Residential L Municipal/Public 0 Industrial O.
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 -.Other ❑ If Other, List Use
2. WELL LOCATION:
Nearest Town: Glenville County Jackson
Fowler Rd
(Street Na'ne, Numbers, Community, Subdivision, Lot No., Zip Code)
3, OWNER: Paul Hoffman
Address 2888 E.-Oaicland Park Blvd
{street or Route No.)
Ft. Lauderdale, FL 33306
(828).y743-5496Sate zip code
Area code• Phone number
4. DATE DRILLED 4-20-04
5. TOTAL DEPTH: 500'
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO 87c
7. STATIC WATER LEVEL Below Top of Casing. 750 FT.
(Use "*" if Above Top of Casing)
S. TO? 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 ,0i 18,
9. YIELD (gpm)' 15 METHOD OF TEST blcw
10. WATER ZONES (depth): 135' & 465'
II. DISINFECTION:Type F T H Amount 16oz
12. 'CASING: Wail Thickness
Depth Diameter or Weight/Ft Material
From 0 To 40 Ft. 6' pvc From 40' To 44 Few"_ 188 steel
From To 'Ft. 13. GROUT: Depth Material Method
From_ To 20 Ftk mite & wi naL one
From To 'Ft,
14.-SCREEN: Depth Diameter Slot Size " Material
From To Ft. in, in.
From To- Fttn. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft,
16. REMARKS:
Agricultural ❑
Topographic/Land setting
❑Ridge ❑Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minwes'secends)
Latitude/longitude source:OGPSOTopog•aphic map
(check bon)
•
DEPTH DRILLING LOG
From To Formation Description
0 42' n1 �V & a3
42' 500'
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.
I DO HERESY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
�{ 2.0 6Y
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-1 REV. 07/2001
7,7
O
—

WELL CONSTRUCTION RECORD
°9 9"7
North Carolina-- Department of Environment and Natural Resources • Division of Water Quality - Groundwater Section
WELL CONTRACTOR (IINDIVIDUAL) NANIE (print) James 'B. Broom CERTIFICATION 4 2045
\YELL COiM RACTOR COMPANY NAME Hedden Brothers Well Drilling, Inc PHONE %28') 369-9591
STATE \YELL CONSTRUCTION PERMIT% ASSOCIATED WQ PERYIIT%
(ifaonlicable) - - (ifaoplicabley.
1. WELL USE (Check Applicable Box): Residential rsi Municipal/Public ❑ Industrial ❑ Agricultural ❑
Monitoring 0 Recovery . 0 Heat Pump Water Injection 0 - Other O If Other, List Use
2, WELL LOCATION:
Nearest Town: TuCkasegee County-acks0n
Concord Lane
(Street Name, Ntunbers, Conmmni ty, Subdivision,. Lot No., Zip Code)
3. OWNER: Lynn Henderson
Address 11524 Country Oaks Drive
(Street or Route No)
Tampa, FL 33618
City or Town State Zip Code
(813). 962-1351
Area code. Phone number
4, DATE DRILLED 4-23-04
5,TOTAL DEPTH: 500'
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO
7. ST.ATICWATER LEVEL Below Top ofCasing 200 FT,
(Use "✓' if Above Top of Casing)
8. TO? OF CASING IS 2 FT. Above Land Surface*
'Top or casing terminated at/or below land surface requtrea a
variance In accordance sy(th ISA NCAC 2C.011S.
9. YIELD (gm): 1.5 METHOD OF TEST blow
10, WATER ZONES (depth): 127' & 210'
•
1 I. DISINFECTION: Type H T H Amount 16 oz
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material numbers and common road names..
From. 0 To 61 FL 6" vac
From 61'To 64 Ft,—Cr .188 steei
From To Ft.
I3. GROUT: Depth Material Method
From 0 To 20 Ft. harrnite & LtICL. pumped
From - 'To - Ft.
SCREEN: Depth. Diameter
From - To Ft. in.
From To Ft. in.
SAND/GRAVEL PACK:
Depth
From To Ft.
From To Ft.
Slot Size
in.
in
Topographic/Land setting
❑Ridge ❑Slope ❑Valley ❑flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/iongitudesource:❑GPSOTepographic map
(check box)
DEPTH DRILLING LOG
From To Formation Description
0 62' clay & sena __
62' 500' cranite
LOCATION SKETCH
Show direction and distance in miles from,, at least
two State Roads or County Roads. Include the ram
L
c
16. REMARKS .
I DO HEREBY CERTIFY THAT
CONSTRUCTION STANDA
S WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15,A NCAC 2C, WELL
D THAT A COPY OFiTHIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
Subntlt the original to the Division of Water Quality, Groundwater Section; 1636 Mail Service Center - Raleigh, NC
27699-1636 Phone No, (919) 733-327.1, within 30 days. G\V•I REV. 07/2001

295978
WELL. CONSTRUCTION RECORD
North Cnrolina • Dcpartnent of Environment and Natural Resources • Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) Mitchell D. Cook CERTIFICATION, 20d3
WELL CON1RACTORCOMPANY NAME H35531 ErCtlarSP 1 Crilli�Y7, Tit PHONE #.[phone]
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT
(ifaoolicable) (ifaoolicable)
WELL USE (Check Applicable Box): Residential 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: Cu11owhee
Caney Fork
County Jackson
(Street Name, Numbers, Community, Subdivision, Lot No.. Zip Code)
3. OWNER: Ronnie Justice
Address PO Box 2541
(Sheet or Route No.)
Cullowhee, NC 28723
City cr Town State
828) 991-15.9
Zip Code
Area toile• Phone number
4, DATE DRILLED 4-23-04
5. TOTAL DEPTH: 300'
6. DOES WELL REPLACE EXISTING WELL? YES O NON3
7, STATIC WATER LEVEL Below Top of Casing: 150 ET.
(Use ". if Above Top of Casing)
S. TO? 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): 180'
11
12
DISINFECTION: Type
CASING
Depth
From 0 To 70
From To
From To
GROUT:. Depth
From 0 To 20
From To
SCREEN: ' Depth
From To
From To
SAND/GRAVEL PACK:
Depth
From To
From To
H T W -' Amount , 16oz
WallThickness
Diameter or Weight/Ft. Material
Ft. 6" 1188 steel
Ft
Ft.
Material Method
Fate -Ignite & Cerec t t3P,
FL
Diameter Slot Size : Materiai
Ft, in, in,
Ft. in. n,
Size Material
Ft.
Ft.
Topographic/Land setting
°Ridge °Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source.OGPSOTepographic map
(check box) DEPTH DRILLING LOG '-
From T9 Formation Description
0 68 clay & ti.cl
68' 300' 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,
16. REMARKS:
I D0 HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH I6A 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 Flail Service Center • Raleigh, NC
27699-1636 Phone No. [phone], wlthtn 30.days. GW• 1 REV. 07/2001
0
en
0
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WELL CONSTRUCTION RECORD
North Carolina • Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL)NAME (print) Mitchell De Cook CERTIFICATION , 2043
WELL CON'I R•\CTOR CONIPA,NY iNALIE 1•earl aCthar'S 1'211a Tit • PHONE K 8251 369-9591
STATE WELL CONSTRUCTION PERMIITO - ASSOCIATED WQ PERMIT*
(if applicable) • (if applicable) - -
1. WELL USE (Check Applicable Box); Residential 3 Municipal/Public0 Industrial ❑ Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection ❑ Other ❑ II'Other, List Use
2. WELL LOCATION:
Nearest Town Sylva County Jackson
Ashe Settlement
(Street Name, Numbers, Community, Subdivision, Lot No.. Zip Code)
3.`OWNER Gary &Phyllis Gibson
Address 385 West Main_ Street
(Street or Route No.)
Sylva, NC 28779
City or Town State Zip Code
(828)- 586-6345
Area code. Phone number
4, DATE DRILLED 4-29-04
5, TOTAL DEPTH: 300'
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO Zc
7. STATIC WATER LEVEL Below Top of Casing: 100 FT.
(Use'' ' if Above Top or Casing)
S. TOP OF CASING IS - 2 FT. Above Land Surface"
•Tcp of casing terminated at/or below land surface requires a
variance In accordance with ISA NCAC 3C .011S.
9. YIELD (gpm)' 40 METHOD OF TEST blow
10. WATER ZONES (depth): 60' & 265'
Topographic/Land se:ting
❑Ridge ❑Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(deyrees?in nutes.'secendi)
Latitude/longitude source:EOPS❑Topographic n•.up
(check boa)
DEPTH DRILLING LOG
From To Formation Description.
0 ' 48' clay & xed
granite
48' 300'
I I. DISINFECTION. Type H T H
12. CASING,
Depth Diameter
From 0 To 46 Ft. 6"
From 46' To 5o Fr 6".
From To Ft.
13. GROUT. Depth Material Method
From._ To 20 ' Ftbancni:te & Carat arced
From To Ft.
14. SCREEN: Depth .': ' , Diameter
From To FL in.
From To -Ft. in.
15.'SAND/GRAVEL PACK:
Amount 1 6oz
Wall Thickness
or Weight/Ft. Material
PVC
1RS tel
Slot Size Material
in.
in.
Depth Size Material
From To Ft,
From To Ft.
LOCATION SKETCH •
Show direction and distance in miles from at least
two State Roads or County Roads. Include the rid
numbers and common road names.
c
C
a
0
W
va
16. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WALL
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
22699.1636 Phonc No. [phone], within 30 days. _ . . . GW-1 REV 07/2001
Er
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G

29 9go
WELL CONSTRUCTION RECORD
North Carolina; Department of Environmentand Natural Resources • Division of Water Quality • Ground'yvater Section.
\YELL CONTRACTOR (IINDIYIDUAL)NAh1E (print) James B. Brown CERTIFICATIOtN.Z0a5
WELL COiNTR,\CTORCOMPANY NAniPHedden Brothers Well Drilling, Inc PHONEa6225.) 369-9591
STATE \YELLCONSTRUCTION PERMIT? ASSOCIATED WQ PEANUT:
Inapplicable) _ - (if applicable)
L WELL USE (Check Applicable Box): Residential ES Municipal/Public 0 Industrial ❑ Agricultural 0
Monitoring ❑ Recovery 0 Heat Pump Water injection 0 Other 0 If Other, List Use
2, WELL LOCATION:
Nearest Town: Cherokee
VFW -Post 8013
County Jackson
(street Name, Numbers, Community, Subdivision, Lot No„ Zip Code)
3. OWNER: VFW Post 8013 Attn: Jack Adams
Address PO Box 216
(Street or Route No.)
Cherokee, NC 28789
Gty or Town State Zip Code
(828). 488-1738
Area code. Phone nutnber
4. DATE DRILLED DEEPER 4-29-04
5. TOTAL DEPTH: 200'
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO
7. 'STATIC WATER LEVEL Below Top of Casing: 400 FT.
(Use "4" 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 inaccordance fv;th ISA NCAC 2C .0119.
9. 'YIELD (gpm): 1 . METHOD OF TEST blow
10. WATER ZONES (depth):
11. DISINFECTION: Type H T H Amount 16
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Mate:jai
From 0 To Ft.
From To FL
From - To Ft.
13.-GROUT: . Depth Material Method
From 0 To 20 -Ft. bemite & r..attacL .. pumped
From • To FL -
14, SCREEN:' Depth - Diameter Slot Stu `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 well is now 500'.
I DO HEREBY CERTIFY T
CONSTRUCTION STA
oZ
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 LQG
From To Formation Descrt}tion
0 clay & sanaq
granite
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and cornmon road names.
Drilled from 300'
to 500'
T THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH. I5A NCAC 2C, WELL
DS, AND THAT A COP OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
ILa9-
SIGNATURE: OF PERSON CONSTRUCTING THE WELL' DATE
01
Submit the origf'al to the Division of Water Quality, Groundwater Section, 1636 Mall Service Center - Raleigh, NC
27699-1636 Phone No, (919) 733.3t21, within 30 days. G W•I REV. 07/2001

WELL CONSTRUCTION RECORD
North Carolina • Department of Environment and Natural Resources • Division of Water. Quality • Grourd.vater Section
WELLCO,YTRAC10 (INDIVIDUAL) NAME (prIn Janes B. Brown •CERTIFICATION# 2045
WELL CONTRACTOR COMPAtNYNAME Beden Brothers Well Drilling, Inc PHONE a ') 369-95°1
STATE WELL CONSTRUCTION PERMIT?
(if applicable)
29 7981
ASSOCIATED WQ PERiMIITd
(if applicable)
WELL USE (Check Applicable Box): Residential t Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring ❑ 'Recovery 0 Heat Pump Water Injection Other 0 If Other, List Use
2. WELL LOCATION:
Nearest Town: Sylva County Jackson
Savannah
(Street Na,ne, Numbers, Community, Subdi visi mt, Lot No., Zip Code)
3. OWNER:
Address
-Mark & Holly Rowan
693 Sunrise Park
(Street or Route No.)
Sylva, NC' 7R779
City or Town Store
(FOR- CR6-9997
Are., code. Phone number
4. DATE DRILLED 4-30-04
Zip Code
5. TOTAL DEPTH: 100'
6. DOES WELL REPLACE EXISTING WELL? YES 0 N0 XZ
7. STATIC WATER LEVEL Below Top of Casing: 150''FT.
(Use"*" if Above Top of Casing),
S. TO? OF CASING IS 2 FT. Above Land Surface`
of caslny terminated at/or below land surface requires a
variance In. accordance with 15A NCAC 2C.0118,
9. YIELD(ggm): -6 METHOD OF TEST blow
10, WATER ZONES (depth): 180' & 203'
1. DISINFECTION: Type H T H Amount 16 cZ
12 CASING: Wall Thickness
Depth - Di ,,7eter or Weight/Ft.. Material
From 0 To 94 Ft eb pvc
From 941 To 97 Ft.
From, To FL
13. GROUT: Depth
From 0 To 20
From ' - To
Ia. SCREEN. Depth
From - To
From To
15. SAND/GRAVEL PACK:
Depth
From To Ft.
From To Ft.
611
188 steel
Material Method
Ft. be -Emits & tntarL pumr d
Ft.
Diameter s Slot Size
Ft. - in. in.
Ft. in, in.
Topographic/Land setting .
❑Ridge OSlope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of wet; location
(degrees/minutes/seconds)
Latitude/longitudesource:❑GPS❑Topographic map
(check box) - ... _ ...
DEPTH DRILLING LOG
From To Formation DescrLohon__.-_,_
0 95' clay & sane
95' 300' granite
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the read
numbers and common road names,
16. REMARKS`.
I D0 HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STAtI DS, AND THAT A CQPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
RE OF PERSON CONSTRUCTING THE WELL
DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1536 Mail Service Center. Raleigh, NC
27699.163h Phone No. [phone], within 30 days. GW-I REV. 07/2001

WELL CONSTRUCTION RECORD i 6 S/711V
horl'n Carolina - Department of Environment and Natural Rcsoures - Lncisio, vt;\`i ai�n Leal,,} - .rro.:u.,,retzr Jccuon
WELL CONTRACTOR (INDIVIDUAL) WLJ,
NAME (print)
WELL CONTRACTOR COMPANY NAME /7A' I C sae',
STATE WELL CONSTRUCTION PER?IITP:
(if aoplicablel
)y� n
�. / I I � CERTIFICATION C K 7
PHONE # Lin Y -St V
.ASSOCIATED WQ'PER\IIT4
(ifaoolicable)
1. WELL USE (Check Applicable Box): Residential' ' Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Us:
2. WELL LOCATIQN:
N -rest Town:
(S:ru:: Name. Nusbert. Cerununity. S'a!icii:or.
3. OWNER:
Address
County
No.. Zip &ode)
pit
TopographicLand setting
�p ���///sss jd'.Ridge OSlope OValley ❑Flat
c20 777j (check appropriate box)
Latitudellongitud: of well location
W meet Rout: No.) i1G a7sga
(On- 6o3- VI/V ate Zip
Area:..:e- Phone cumber
�" tp'
T. DATE DRILLED � / r 6 SI
5. TOTAL DEPTH: jpSO
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO )if
7. STATIC WATER LEVEL Below Top ofCasin_: Lira FT.
(Use "i' if Above Top or Casis_ I
S. TOP OF CAS!NG IS I FT. Above Land Surface`
-1,q r'rising to rn,i na and a:.'vr bolo,. land surface requires u
sarvnoci.n accord:nc', pith ISA 'CAC 2C .0116. �,
9. YIELD (eoml: ' / S METHOD OF TEST
1.
10. WATER. ZONES (dcptn): ;a, 1175-
I I. DISINFECTION: Type Fil ht' S3 mount ►29.as
1_2. CASING: Wan Thickness
Depth taricer or
W eigh Ft. \a `..!t
9 Ft. S
305330
(degree;inninu:t uaocdi)
Latitude/longitude souree:OGPSOTopographic map
(ch::k box)
DRILLING LOG
ma Formation Description
DEPTH
From To
AA
From_6 ToCn
From
To Ft
From To Ft
13. GRO'_ T: Death. \!a or: '
From C_ To t. F
Frr::� Z.
To 0 Ft
14. SCREEN: Depth Di:.n:e:er So:SizeDla:trig,
From; To Fr in. in.
Frog To Ft. in. in. '
15. SANOGR.AVEL PACK:
Depth 5
Front To Ft.
-From To Ft.
16. REMARKS:
Nlaterta:
Method
LOCATION SKETCH
Show direction and'distance in miles from a: leas:
two Sate RSads or County Roads. Include thasc„
m:rb 2ri and CJn1mOn road names.
La- '
hn
-tr_ar tr
f`J
I DO HEREBY CERTIFY THAT THIS WELL \WAS''INSTRUCTED IN ACCORDANCE WITH I5A NCAC 2C. WELL
CONSTRLCTION 5 9N RDS. ND Tj A rI' Y OF THIS RECORD HAS BEEN PROVIDED TQTHE,%\ ELL OWNER
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
Submit the original to the Division of Water Quality, Ground"ater Section. 1536?lail Sanice Center -Raleigh, NC
27699-1636 Phone No. [phone], within 30 dads. G\W-1 REV. 07.2001

WELL CONSTRUCTION RECORD j c/9�ZV�/
ogs 1/477d
North Carolina - Department of Environment anu Natural esourees - Division of Si ater Quality - tai„uuu,:a t Section p/ �y'
WELL CONTRACTOR (INDIVIDUAL) NAMIJE�,(�print)/� CERTIFICATION ,`. 1' / /
WELL CONTRACTOR CO.I PAN\ NAME MA t 4 tef n-e-_ n; W e'=/Dn4 PHONE # Jg 4/-5-g O'�-S G7
STATE 1VELL CONSTRUCTION PERNIIT# ' ASSOCIATED 11'Q PER-11IT
(ifapplicable) _ (ifaaolicable)
1. WELL USE (Check Applicable Box): Residential Municipal/Public ❑ Industrial ❑ Agricultural ❑
\1on.itoring ❑ Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. \\'ELL LOCATION:
NearestTown: Si IvA-
aiJl ellFifi$1�ei
Name. Nu:nbers. CCoommuniit . Subdivision
3. OWNER:Ail /IM/lo Yl
6
s
County (pbekcG) ,
Aat.l1iek779
o: No.. Lip Code)
Address PO Aa�/
(Street or .cut: No.)
Cit.; or�Tawn
q / State Zip Code
woq `--, qo
rtrea Cad:- Phone number
DATE DRILLED 7—O fL
TOTAL DEPTH: /�7S
DOES WELL REPLACE EXISTING WELL? YES ❑ NO (�
STATIC WATER LEVEL Below Top of Casing: FT.
(Ise "�' if Ahoy:: Top of Casir.;l
TO? OF CAS!NG IS 1 FT. Above Land Surface-
-1,ep ofcasing terminated at'ur belun land surface requires
s:Hance in accordance s�i[h 15A NCAC 2C.0113. ✓
Topographic'Land setting
❑Ridge Slope ❑valley ❑Flat
(check appropriate box)
Latitude'longitudz of well location
(decree>minu:es.secords)
Latitud_'lon itude source:❑GPS❑Topographic map
(check box)
DEPTH DRILLING LOG 1
From To • Formation Description
9. YIELD Igoml: ' cif NTETHOD OF TEST Air' >SZJ ^ /SZ
ti�
10. WATER ZONES (depth): &T / /S /2c /S7i J aZ '-/'7_
OC \TI
tI. DISINFECTION: Type f/ %�j ! Y9 0% Show direction and'dis:an:ein miles from a: leas:
-1 _2. CASING: - \tali Thickness two Stato Roads or County Roads. Include the road
er V.ei;_h: Ft. \:_:axial numbers and common road names.
From ('� To_S7 Ft. 17 Y)G SD/2. -L/ PVC
�� /��� LOCATION SKETCH
_I ' - _ . Amount
From
From
Depth Diameter
To Ft.
To Ft
13. GRO'_T: Deo:h
Froth 0 To
From,3___ To 10
14. SCREEN: Depth
From To
Fror To
15. SAND•GRA\'EL PACK:
Depth
From To
From
16. REUARKS:
Material Method (/f e,.-- • ^'
Ft. 0_C--r ar,* / ' /
Ftt_y� en, �,( 1
Diameter Sc den/lead Nlo`eri" {v , 7_
Ft. in. in.
Ft. in. in.
9
Size \lateriai
Ft.
To Ft.
1 DO FHER.EBV CERTIFY T
CONSTRUCTION STA.
STRUCTED IN ACCORDANCE WITH ISA NCAC 2C, WELL
OF THIS RECORD HAS BEEN PROVIDED TO ,kN`_}>•'ELL
SIGNATURE OF PERSON CONSTRICTING THE WELL
Submit the original to the Division of \Water Quality, Ground'later Section, 1636 Mail Service Center -Raleigh, NC
27699-1636 Phone No. 1919) 733-32221. within 30 da} s. G\W-1 REV. 07:2001
12,620
DATE
746

WELL CONSTRUCTION RECORD
306447
North Carolina - Department of Environment and Neal Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print)
WELL CONTRACTOR COMPANY NAME
STATE WELL CONSTRUCTION PERMIT#
(if applicable)
eel CV VVe_
CERTIFICATION 0311N/y
L-1 Hi'i! -S. LC1i L� sIJY; ///V5,7_TA/ # �,(pC. PHONE isay vY/L
ASSOCIATED WQ PERMIT# - -
(if applicable)
1. WELL USE (Check Applicable Box): Residential.a Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring ❑ Recovery ❑ Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATII��O,N�:�
Nearest Town:866ktCtes Coun '1j✓1
I n\ KYy Sc J Jeri
(Street Nam , Numb rs, Community, Subdivision, Lot No., Zip Code)
3. OWNER: r j' J I -iv ki. f
Address yS/i (.Aid /'Psc/ ,3Y.
(Street or Route No.)
flfir.il5n,v�cl� cGt / / 3d /(01
City or Town State Zip Code
( )
Area code- Phone number 4. DATE DRILLED /.*---0 q ..3—
5. TOTAL DEPTH: /0OS
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO ❑
7. STATIC WATER LEVEL Below Top of Casing: 3 €. 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 ISA NCAC 2C .0118.
9. YIELD (gpm): .I/, METHOD OF TEST /4; [r
10. WATER ZONES (depth):
Topographic/Land setting;
❑Ridge ❑Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
car
(degrees/minutes/seconds) -- ...
Latitude/longitude source:❑GPSDTopographic map
(check box) ....._ _. _ _. _ - _.
DEPTH DRILLING LOG
From To Formation Description
to
11. DISINFECTION: Type Amount
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
From 0 To r�% Ft. 6 Yr
From To Ft.
From To Ft.
roc.
,'
-Y>-P
LOCATION SKETCH" -iitil-
Show direction and distance in mileg.&om atic04t
two State Roads or County Roads. Include the: b`dd
numbers and common road names.
W
13. GROUT: Depth Material 4 Me ho
From D To Ft. eth
From To Ft.
14. SCREEN: Depth Diameter Slot Size
From To Ft. in. in.
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Size Material
Material
From To Ft.
From To Ft.
xi1
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
J. " 411.! i y4s—
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
306446
North Carolina - Department of Environment and Natural Resourcesrc- Divisioni'of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) �!• { ,`,}/ do
-/ CERTIFICATION t3✓?�
WELL CONTRACTOR COMPANY NAMED *f7�( (jV1rS. U[L.[{ do ri /1.-N7, fjtt. PHONE #
SSS:a4f7f
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential'C 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 N:
Nearest Town: cotsWears �
-Lob y
n1 'W
(Street Narr�, Numb rs, Community, Subdivision, Lot No., Zip Code)
County.
3. OWNER: Ra ° S tehnev S
Address arClif Unn1 �fc r .f Di:
(Street or Route No.)
�1,yyr.l4 J a/67
City or Tan State Zip Code
( )-
Area code- Phone number
4. DATE DRILLED J02 / — cl
5. TOTAL DEPTH: 70 5"
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO 0
7. STATIC WATER LEVEL Below Top of Casing: FT.
/ (Use "+" if Above Top of Casing)
/
8. TOP OF CASING IS FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordance with 15A NCAC 2C .0118.
9. YIELD (gpm): D METHOD OF TEST 4'v
10. WATER ZONES (depth):
Topographic/Land setting
❑Ridge ❑Slope ❑Valley OFlat
(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
low
cry
6 - (
11. DISINFECTION: Type Amount
12. CASING:
Wall Thickness
Depth Diameter or Weight/Ft. Material
From U To (0% Ft. % Vte /1/L
From To Ft.
From To Ft.
13. GROUT: Depth Material ethod
FromOe Toocat.) Ft. Cad
From To Ft.
14. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in.
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
+r:
-
LOCATION SKETCH
Show direction and distance in miles,fr,
two State Roads or County Roads. Include the-
numbers and common road names, a7
•
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
ryas
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

306330
WELL CONSTRUCTION RECORD
Nnrth (:arolina - Department of Environment and Natural Resources - Division�jof Water Quality - Groundwater Section
CONTRACTORWNLCONTRACTOR (INDIVIDUAL) NAME (print) A.s_ Zc2LA, _
CERTIFICATION # .2414/ 8
WELL CONTRACTOR COMPANY NAME Grkeh._ 8JCOS. l,c/� // F%ry '/
r»p .7nrz PHONE # f�.� G7 � - J./ 74
SLATE WELL CONSTRUCTION PERMIT#J feast ASSOCIATED WC) PERMIT#
(if applicable)
(if applicable)
1. WELL USE (('heck Applicable Box): Residential tel Municipal/Public O Industrial O Agricultural ❑
Monitoring O Recovery O Heat Pump Water Injection O Other O If Other, List Use
2. WELL LOCATION: C
Nearest Town: 1f+) \)a- County l '1.01/4$E \
t�c.�c1p �1 tdoe
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER:_
Address C—O rnae..
(Street or Route No
•
Sa11 LtiL fnesv,IIt IaC
City or Town State Zip ('dale 1 a.8-1 $�
Area axle- Phone number
4. DATE DRILLED 11 - 1 SS -b4
5. TOTAL DEPT/I: )
6. :)�;::�, "!!'!! P!:U! n( t. !rvlc.! INi( WELL! ,' YEN t I NO 41-
7. STATIC WATER LEVEL Below Top of Casing:
/ ((;se"+" if Above Top of Casing)
8. TOP OF C'A.SING IS
FT. Above Land Surface*
`Top of casing terminated atlor below land surface requires a
variance in accordance with 15A NCAC 2C .0118.
9. YIELD (gpm): / A METHOD OF TEST
o%:irs .
0. WATER ZONES (depth): 1' /5- C.
_ e a
1 I. DISINFECTION: Type
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
From. ) To 82 Ft. 4 11 PVC.
Prom To Ft. From To Ft.
13. GROUT: Depth Material
From 0 To_D Ft. 71 Method
From �
To__ Ft.
14. Sr 'REEN: Depth Diameter Slot Size
From To Material
From To Ft. in.
15. SAND/GRAVEL. PACK: in.
Depth Size Material
From _ To Ft.
From To Ft.
16. REMARKS:
Topographic/Land setting
ORidge ❑Slope OValley setting
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:OGPSOTopographic map
(check box)
DRILLING LOC;
Formation Description
DEPTH
From To
gQ
s9I /Zsl
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.
% '—
;si;t
} A N :2 5 2035
1 IX) I ffa(EBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITI1 I5A NCAC 2C, WELL
CONSTRUCTION STAND RDS, AND TI IAT A COPY OE THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
is 8i-o4.4
SIGNATURE OE PERSON C ONSIRUCTING 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
•
*

. OCT 18,2004 16:36
Page 3
WELI,. ,;;;.f.?Npi t KI.1: tit Ft; }tE4 ,(.!KY
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Fr!fi F.C.! 111-TEN

Page 1
OCT 18,2004 16:34
WELL CONSTRUCTION RECORD
Norm caolme - Depw.trnant of Env¢mlment and Natal Pa Division of Water Quality - GramdwsLa Section
WELL CONTRACTOR UAIN> (ru9n P h a do -' Tr. CRRnsPICATIONR+7841
wcu.corn ier =COMPANYMA fF ale .,.A, Fa.l.t?�k�. .APRONti 1L 6(Wt
STATE WELL co}�Ruc7"ONPERMITe 4 aioak n" � SY/f,94 ,
(dwalfabisl (ifwdiwble)
1. WELL LOSE ((heck Applicable Eon): Residential % MnoioiPd(Pablia 0 InshSrial 11 ASSAILS D
Monitoring 0 RCWvesy 0 Hat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATI
Nearest Taws if -14 tilt
ire �_ f
(s�eN.ew.x+rnanaw,yc N0. aacoda
3.0
Adams � /.t n .�
!. ( ae Na AcG. .�! gvs
Myer Taw State 20Oak
Ares evdo-P4mcsmbxp //
4. DATE DRILLED 4< ,� �/
/b /
5. TOTAL DEPTH. D T /
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO GI
7, STATIC WATER LEVEL Below Top of Casing: FT•
Nw" r" Hart Top ofCwbal
S. TOP OF CASING IS I -'i FT. Abon and Surface
7ep d.adaa wrola.f.d Afar bar lead .a.swe .gdrn I
variant a scoudaawwilt ISANGAG tC AUK
9. Yt6LD OW): METHOD OF TEST
10. WAWA ZONES (depth).
I1. DISINFECTION: Type /r. ly Iii Amomt PA 9[_
12. CASING: Well "(Niamey
. Dimper reWatgbdFY. Material
Prom Ton_ dal 9!l r
F To Ft
broth... To Pt
_T^ 13. GRD TOPW2a ] � e.1.Y•s.yd.
From To Pt- fievs
I4. SCREEN: Depth Dint SIOt$ia Material
F Te Ft ____ is
Fro To
15. SAND/GRAVELPACK:
Daps Sae Merril
Form_ GTO
Frone / To Pt
d
Topographic/find suing
LRidge %lope Malley Mkt
(dwdraw.apdaw coal
l4ituddlmgiutde of well location
Sagreterseemateemis)
IadS dorms de saocenGPSQbpografphis map
(duck bad
DSEM DR1L 1w0 IIlQ
From To Formation Dacriptioo
16. ItEMARKS:
Slaw directim and dislame mrmles from at feast
two Sock Roads or Camay Roads. inylods the mad
umbers and caner =R toad name.
I DO HEREBY CERTFYTHATTHIS WELL W • 'UCLPD IN ACCORDANCE W1t1[lSANCAC 1C,WEL
CONSTRUCTION ST ATT/ •y. • GF1BIS RECORD HAS MEN PROVIDED TO�cTHHE/i�j`+j/wNER
SIGN • f OF STRUCTINGTHE WELL ' DA7E /
Submit the origlnalta the Dienes at water Quasi'', Groumdwarr Section, MN "bit Service Colin -Baka NC
276194616 Mows Ns. [phone], within 30 days. GW-1 REV. 07/2001

WELL CONSTRUCTION RECORD
North Carolina D rartment of Environment and Natural Resources • Division of Water Quality - GrourdwaterSection
WELL CONTRACTOR (INDIVIDUAL) NAME (print) Mitchell D. Cook
WELL COV'IRACTORC0' IPANYN461E H-1. 1 a het hell T,.� CFRE #I828) V . 2093
k1.L11I'ti, Ire PHONE # B2H) 369-9591
STATE WELL. CONSTRUCTION PERh11TX
ASSOCIATED WQ PER.NIITB
fa Ulidable) (if applicable)'
WELL USE (Check Applicable Box): Residential Z Municipal/Public Industrial
Monitoring 0 Recovery ❑ Heat Pump Water Injection ❑ Other 0 If Other, Listse_ Ayricul!ural ❑
2, WELL LOCATIC,':
Near Town: I,1,
County
(S ree( Name, Nu j ars, Community, Subdivision, Lot No. Zip Code)
3 OW'NER..�x)Tl�i�..Mn) 1111 [ )
Address
(Sareet or Route No)
(003) L/gii� a39a zip co
City orTow State Zi do
Are ode• Phone number
4 DATE DRILLED
5 TOTAL DEPTH:
6, DOES WELL REPLACE EXISTING WELL? YES 0 NO
7. STATIC WATER LEVEL Below Top ofCasing:
(Use "r" If Above Top of Casing)
8, TOP OF CASINO IS 2 FT, Above Land Surface*
•Top of casing terminated at/or below land surface requires a
variance In accordance w}th ISA NCAC 2C ,0118.
9 YIELD (gpm): _ (� METHOD OF TEST blow
10 WATER ZONES (d. tth):
1LA DISINFECTION Type H T q Amount_ 96oz
12 CASING Wall Thickness
From Depth p Diameter o We ght/Ft �Material
To�tL Ft. r
From To 39 Ft. eel t /g
From To Ft,
13: GROUT Depth Material
From O To 20 Ft -i;te & caret anted
Metnod.
From To Ft..
I4:SCREN Depth Diameter Slot Size M
aterial
From To Ft. n
1n
From To Ft in,
15:'SAND/GRAVEL PACK: in.
Depth
From _ To Ft.
^'From To Ft.
Size
Material
Topographic/Land setting
❑Ridge ❑Slope ❑Valley. ❑Flat
(check appropriate box)
Latitude/longitudeof well location
(degr ea/m'inmes/seoo0 )
Lati;uderlongitude sour _:OGPS❑top graphic map
D EP H (check box)
:DRILLING LOG
From To Formation Description
0 &
O© granite
LOCATION SKETCH
Show direction and distance inmiles 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 I5A NCAC 2C, WELL
CONSTRUCTION STANDAR , c AND THAT A COPY OF THIS RECORD HAS /lBEEN PROVIDED TO THE WELL OWNER . ./ a•os� SIGNATURE OF PERSON CONSTRUCTING THE WELL
DATE
Submit the original to the Division of Water Quality, Groundwater Section, 16361Mall Service Center • Raleigh, NC
27699-1636 Phone No [phone], within 30 days. GWI R_EV.-07/2001
305050
CJ
0
O
ITV
NO
CO
GI ;:.
cr: z
00
r:
G

STATE WELL CONSTRUCTION PERMIT;
(ifapnlicable)
SWELL CONSTRUCTION RECORD
No th Carolina 7 D' partmeut or Environment andNatural Resou -es - Division of Water Quality - G-ounc;vater Section
YYELLCO;NTRACTOR(IIYDIYIDUAL)NAME (print) James B. Brown
CERTIFICATION 2°45
ASSOCIATED \YQ PERNIITN.
(ifaPPlicable)..
I. WELL USE •(Check Applicable Box)Residential - Municipal/Public 0 - Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Rump Water Injection Other 0 UOther, List Use
2 WELL LOCATION County/
K�p4,�� j ]Ridge ❑Slope ❑Valley ❑FlatNearco TownTopographic/Land se
tting
(check appropri❑ie box).
Latitude/longitude of well location
2.
305049
\YELL CON'lflAoTo,i COMPANY NAME Redden. B.otll9rS Well Dtilling, Inc
PHONE; �:) ^O—OCpj
(Street Name, Numbers, Commu it Subdivision, Lot No., Zip Code)irs
city or TownSlate
Do cad,
.
( )-
Awn code- Phoi.e num toes
a, DATE DRILLED ; 3-0
5.TOTALDEPTH' 0'
6, DOES WELL REPLACE EXISTING WELL7. YES O NO
7. STA F(O WATER LEVEL Below Top of Casing; /Qd
FT,
r (Use '4-" if Above Top of Casing)
8. TOP 0. CASING IS 2
:'Top of casing terminated at/or below land surface
requirovLand a$uTIaLB*.
variance In accordance vith 15A NCAC 2C ,01 IS
9. `YIELD (gpm); METNODPFTEST blow ID. WATER ZONES (depth):
II. DISINFECTION: Type H T H
12 CASING
Frorn. 0 Cepth'� D a�mv�
From�e�r
Toj"— Ft._UL_
To FL
From To Ft
13 GROUT
Depth Material'
Frwn 0 To 20 t MethodFrom ;To Ft,1tE &?t . AurrcEd
14 SCREEN
From aterial
ot Decct5 Diameter Slot Size Tbl
From in. m...
To Ft__in,'
15, SAND/GRAVEL PACK: in
Depth
From To
From To
16. RENIARKS'
I DO HERESY CERTIFY TWAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE
CONSTRUCTION' STANDARDSkFPERSONOONIST
T A COPY S OVI I D NCTR
OF THIS RECORD HAS BEEN PROVIDED TOTHE WELL
-- N° \'vL10\.ER
STRUCTING THE WELL Z94 f��_,
Submit the original to the Division of Water Quality, No 919 733. 2? uahty, Groundwater Section, 1636 Mail Servli
3 1, within 30 days,
0W-1 RE V. 022001
e
(degrees/Howes/seconds)
Latitude/longitude source;OGPSOTopographic map
(check box)
DRILL O LO
Formation Descri2tion
clay & sand
DEPTH
From To
g an.1 to
LOCATION SKETCH Amount 16 02 Show direction and distance miles from at least
Wall Thickness two State Roads or County Roads, Include the road
or Weieht/Ft, Natant:! numbers and Corn, -non road names.
a iitatet

WELL CONSTRUCTION RECORD
(
305510
North Carolina - Department of Environment and IyAural Resources - Division oT Water Quality - Groundwater Section
WELL ('ON't torrOlt(INDIVIDUAL) NAME/print)`_'1T1� �h�1)1(�C�.
fl(1r CENTIFIC�AsT.,IO/N La��
w'ELLCY).NTRArroit (»IPAKVNA%IE fiat ti,el/y-Ptzttt/2 PIIONE# ON)b"t7":,..+/p
SrsrE WEI.I. CONSTRtiC IoN PERMrr# ASSOCIATED WQ PERMIT#
lila gdicablet (if applicahle)
1. WELL USE (Check Applicable Box): Residential Isi` Municipal/Publie 0 Industrial ❑ Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION
Nest Town:
3
C
unty,7
e eel N:unI:
.
. OWNC`
Address
Nuutbers. ('wmuunil Nuhdivi.i:at 1 nt No.. Zip Code)
IN 5 Prat 1-e
(Street or Route No.)
A-1T N'C o s7o7
Coy or Tin Slaw/ Zip Code
5,(sayr
Area code- Phone number
4. DATE DRILLED //2-0
5. TOTAL DEPTH: 74/S {-h -
6. DOES WELL REPLACE EXISTING WELL? YES r0 NO L9r
7.STA'I•ICWATER I.EVE.I.BelnwTop ofCasing: 3 FT.
(use "(' irAbove Top of Casing)
8. TOE' OF CASING IS c2 FT. Above Land Surface*
'Top of casing terminated at/or helms land surface requires a
variance in acrordao e with ISA NCAC ZC .011#.
9. YIELD (gym):_______ METHOD 0!: TEST AJ7
I0. WATER ZONES (depth):
I I. DISINFECTION: Type -// 72
12. CASING:
Frmnta
Depth Di ter
Toy Ft. /;1
From To Ft.
Prom -ro - Pt.
13. GROUP: Depth rial ,/�
From 0 To 02C FL yvf
From"
1'1.
14. SCREEN: Depth Diameter Slot Size Material
From To FI. in. in.
Front '1'o Ft. in. in.
15. SAND/GRAVELPACK:
Depth Size Material
From To Ft.
From To FI.
Amount
Wall Thickness
or W ltt/Ft. tcnal
Met d
I6. REMARKS:
Topographic/Land setting
Ridge ❑Slope ❑Valley ❑Plat
(check appropriate hex/
I .at itudc/longitude of well location
(degrees/nt inutes/secunds)
Latitude/longitude source:❑GPS❑Topogniphic map
telack hox)
. DRILLING LOG
From To PO rtptioryDescription
DEPTH
HP
rn
LOCATION SKETCH
• Show direction and distance in miles from animist
two State Roads or County Roads. Include th triad
numbers and common road names.
fit, (Q3 - 76/
1 DO HEREBY CERTIFY THAT nos 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
°%- ,. JI -S-OUI
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Sen•iee Center- Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-I REV. 07/2001

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) James B. Brown CERTIFICATION# 2045
WELL CONTRACTOR COMPANY NAh1EHeClden Brothers. Well Drilling, Inc PHONE # $28-) 369-9591
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable) - (if applicable)`
Q
305144
I. WELL. USE (Check Applicable Box): Residential E Municipal/Public 0 Industrial ❑ Agricultural ❑
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION:
Nearest Town: Sylva
Little Savannah
County
Jackson
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: Melinda M. Hill
Address PO Box 2123
(Street or Route. No.)
Sylva, NC 28779
City or Town State Z:p Code
(.828)- 586-5865
Area code- Phone number
4. DATE DRILLED 3-17-04
5. TOTAL DEPTH: 200'
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO
7. STATIC WATER LEVEL Below Top of Casing: 20 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): 15 METHOD OF TEST blow
10. WATER ZONES (depth): 105' & 123'
1 1. DISINFECTION: Type H T H Amount 16 oz
12. CASING: Wall Thickness
Depth Diameter
From 0 To 917.Ft.6"
From 90' To 93 Ft 1—
or Weight/Ft. Material
pvc
.188 steel
From To Ft.
13. GROUT: Depth .Material Method
From 0 To 20 Ft berrrsite & =Ent 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
Topographic/Land setting
❑Ridge OSlope DValley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source; 0GPSOTopographic map
(check box)
DEPTH
DRILLING LOG
From To Formation Descr tion
0 91' clay & sand
91' 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.
lid C- AVW 110
et?
(A
ram)
16. REMARKS:
1 DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTIO NDARDS, AND THAT OPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
f/ i7-0 <71
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
Q/ZD
305511
North Carolina - Department of Eiivironmcnt and It oral sot cos -.Division oT Water Quality - Groundwater Section
\\'ELL rt)N-I itAC"rOK (INDIVIDUAL) NAME rim) ' i,_'�,/ y�f /7 / e- CERTIFICATION Ha Y�/
R'hn.t. CONTRA(' -mu (n»H'ANT NAME /"L6f.2$.M1L' vM/ PHONE It ecrgliati 'l
Ki A I E WE(.I. ('DNS RUCTIOS PFat3111 # ASSOCIATED wQ PERMIT/
(ifa , likable)
(ifs licablc)
I. WELL USE (Check Applicable Box): Residential B' M(micipat/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"earr st Town:
Pe e
Count
AC((6o`✓
(Street Nan.. Numbers. Comma .' . Suh.hvisi.n., led No.. Zip Code)
3. OWNER:
Address
(Street or home
7e‘tVie 'V /i/i/
(Az730
Zip Code
f ) _/a. et7n5
Area code- Phone timber
47
4. DATE DRILLED jb -,.7 - 0
5. TOTAL DEIrrH:
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO
7. STATIC' WATER LEVEL Below Top ol'Casing: cR1 r.
Wee -)" if Above Top of Casing)
S. TOP OF CASING IS 02 FT. Above Land Surfaces`
'Top of casing terminated at/or below land surface requires a
variance in accordance with 15A NCAC 2C .011R
9. YIELD(gpm): 020 METHOD OF TESTA- Pi
10. WATER ZONES (depth):
11. DISINFECTION: Type/ Amount
12. CASING:
City or Town State
From
Depth � Dia 'le
To e Pt. Y`y
From To 1'1.
From To • r•1.
pographic/Land setting
Idge ❑Slope ❑Valley ❑Il:o
(check appropriate box)
Lai of well location
(ekgrues(nt inulcs/seeondsl
Latitude/longitude source:❑GPS❑Topographic map
(check hox)
DEPTH . DRILLING LOG
From - To Plnyntio Description
/4
LOCATION SKETCH o •
Show dirccllen and distance in miles from al least
Wall Thickness . two Slate Roads or County Roads. Include the road
or Weign/Ft. tN serial / f numbers and common mad names.
+/yw7q
13. GROUT: Depth, pv1aaten
From b To ()toIltiltt,r�
From To Et.
14. SCREEN: Depth Diameter Stitt Sizc Material
From--- 1'o Ft. in. ill.
From To 1'1. in. in.
15. SAND/GRAVEL I'ACK:
Depth Sizc Material
From To Ft.
From To FI.
Method
icy
np
Una/
16. REMARKS:
1 DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS. AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNEtt
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
Submit Ilse original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
27699-163n Phone No. (9i9) 733-3221. within 30 days. GW-I REV. 07/2001

. WELL CONSTRUCTION RECORD r '760- 7y_ 0WS
Tca777-
North Carolina - Department of Environment and Natural Rejources - Dictsion of Water Quality - Urounduater Section
NAME eft-JI1
\\'ELL CONTRACTOR (INDIVIDUAL) NAME (print) ) CS
�r 1/ -/ PHONE'
‘WELL CONTRACTOR CO�IP.�N1'\,a\lE�� `1I^�-/)'P F�'� �'���" o� � ^kg2� ��
STATE WELL CONSTRUCTION PERMIT% ASSOCIATED W O PERM T%
(ifapplicable) (ifaoolicable)
jar /(' ma, )j CERTIFICATION# 025'97
1. WELL USE (Check Applicable Box): Residential y Municipal/Public O industrial O Agricultural 0
Monitoring ❑ Recovery ❑- Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION: Topo_raphidLand setting
❑Rid
County' T L-Sur--_. ge Sloe [Walley Nearest Town: �1 I1�%�' pt G 777 �- F ❑Flat
5
l` a. 3 H.e I `{J ^5(, iufl- e&23 Ghee, appropriate box)
(Sage: Sa:r.a, Numbers. Comity, Subdivision, Lot NJ.. Zip Code) Latittlde/lonoitud_ of well location
3. ER-srC.r'rl. Zc7re5
Addr:ss (D X _' (Iornash vine. lzr(
(S::e::� or Roua No.)
fl+ rrnd`6h'Jr.Lrici ky 4c 3/)
Crc or Ton"! S:at: � ZipCo-:.
(_S i 0lD-1ta
Area code- Pnon: r.u:vper
1. DATE DRILLED I I —I C7 4'4
5. TOTAL DEPTH: LfS-O
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO
7. STATIC WATER LEVEL Below Top of Casing: 70 FT.
(Use "r' i[ Abo': Top or Casing)
S. TO? OF CASING IS ) FT. Above Land Surface'
'Top of eaiim; t:rnuuatcd a:.'ur belon land wine requires a r
wrion:e in ac:urdj': t, th ISA\ CAC 2C .0I1S. ®
9. YIELD (_prn):' METHOD OF TEST /1/IJ
10. WATER ZONES (depth): o D 11
11. DISINFECTION: Tvice I -I- T /4 mount ,' Q,.*4Y%J
12. CASING:
Depth
From U Tc_q_k_ Ft._17_
Front To Ft.
From To Ft
13. CiR0'.. T:
From U To -3 Ft.
\':-'1 Thick .ess
!e:r.od.
(day:e:'minutes:seconds):
Latitud:'lon_itude source:OGPSOTopograplric map
(check box)
DEPTH DRILLING LOG '
From To Formation Description
el —acw
0— ell
R2O�' -
- 2. - 3 3 s
"13X--4.1Z •
OCATION SKETCH
L Sho. - direction and'dis:ance in riles from a: lea?:
n.o S::'e Reads or County Roads. Include the road
_ens acd common. road cures.
From 3 To ZJ Ft �
t-D
I1. SCREEN: Depth D:air.e:er S:o:Sae :W" Lateria:
From To Ft. in. in.
From To Ft. in. in.
v
15. SAND 'GRAVEL PACK:
Depth Si:
Front To F.
From To Ft.
16. REMARKS:
I DO HEREBY CEP.TIFYTHAT THIS \l
CON-T...-TIO.' STA. ' D-. AN
,
L WAS CONSTRUCTED IN ACCO'-DANCE \WITH. ISA NC AC 2C. WELL
ACOPY OFTHIS RECORD HAS BEENPRO'VID_DTOTh�`•
E LLONER
15 „zoo y
J
w L /
SIGNATURE OF PERSON CONSTR':CT;NG THE \':ELL DATE
Submit the original to the Division of Water Quality, Ground•.inter Section. 1636 >lail Scrni:e Cen:er- Raleigh, NC
o G'o• 1 RE\.G'i.200;
-o JIS_6PhoneNo.(919)i_3-;L'I,uithin3pd:ns.
r
Lrir
0

WELL CONSTRUCTION RECORD
North Carolina - Depar :lout of Environment and Natural Resources Dividiun et \: atcr
WELL CONTRACTOR (INDIVIDUAL) NAME (print) 12/24C Q . S/uc@- /
\WELL CON'1'R?\CTOR COMI PANT' NA>IE44 aerie .Stes we& fa
SPATE R"ELL CONSTRUCTION PER3IIT; ASSOCIATED WQ PERN4IT4
(if applicable) .. (ifannlicable)
76S/S7 09At2
III - is rout - to
CERTIFICATION 430 i{
PHONE R r i n-�SS d
1. WELL USE (Check Applicable Box): ResidentialZ Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring ❑ Recovery ❑ Heat Pump Water Injection 0 Other 0 If Other, List Use
2. \YELL LOCATION;
Neanst Town:
g.
(S \ante. \J.- ers. Cocununh . Subdivision. Lot N
3. O\\'NER:
Addrdss
afralatt
Ctr. or Toart Slat: Zip Code
(Ds- en,- sigma!
TopographiciLand setting
❑Ridge [Mope ❑Valley ❑Flat
(check appropriate box)
Sa 77 f Latitude'Iongitud_ of well location
A::,;..:e-Praten ::bet •
DATE DRILLED al -4p-o
5. TOTAL DEPTH: 402S
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO Od
7. STATIC WATER LEVEL Below Top of Casino: 2Vo FT.
(Use if Abo.c Top of Casir.;l
S. TO? OF CASING IS / FT. Above Land Surface-
•inp ut'casing t:rasituted aCvr below hind surface requires 2
suriano: in accurdana• with 13A CAC 2C .O113.
9. YIELD (turn): ' .ZC.) METFIOn OF TEST Mir
10. WATER ZONES (depth): 14 _0
7G3 Showdi +id' i•e i^ rnif •s from at leas•\
I I. DISINFECTION: Type � ��•�' r+K
(degreesininuaise:orals)
Latitud.'iongitude source:❑GPS❑Topographic map
(:heck box)
DEPTH DRILLING LOCI \
From To Formation Description
h7—' VD
19 -S
12. CASING:
From Irit
Fro::;
Depth
H
To % Ft.
To Ft.
From To Ft
13 GROCT: Death \1::r:... x Method
Front. O To .3 Ft. 'SAS_ 1'/
• Fero;:;� To Zv Ft
IT. SCREEN: Depth Diameter Scut Size Materia.
From To Ft. in.
Frur To Ft. in.
1:. SAND GRAVEL PACK:
Death Size \L:erla:
From To Ft.
From To Ft.
LOCATION SKETCH
Amount o� direction an.. Is.an. - -.
two State Roads or County" Roads. Include the roa c\
V. a.i Thickness
or \': ei•_ : Ft. N12;c7ia numbers and common rxd r.an;cs.
s e Dec. a c
in.
n '
D 7 0
11> I ill
16. REMARKS:
I DO FiEREBV CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH I5A NCAC 2C, WELL
CONSTVQTI0N STANDARDS. AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE \\'ELL OWNER
"---....' f 2--r7-J7
SGNATURE OF PERSON CONSTRUCTING THE WELL DATE
Submit the original to the Division of \\ater Quality, Groundwater Section, 1636 Mail Sania Center • Raleigh, NC
27699-1636 Phone No. [phone], within 30 da}s. GW-1 REV. 07.'2001

Depth D r e:cr
From Q To %4).5-F'L%,��
From To Ft.
From To Ft.
13. GROLT: Dep:h. Material
From 6 To Ft. e_.e4tt - _
From 3 To 7i9 Ft. "+2C -
14. SCREENS Depth _ Diameter S!o: Size
From _ To_.— FLT_in. _;_ j� in..
From --- To,... _ Ft. in. in.
15. SAND GRAVEL PACK:
North Carolina - Department of Environment and Natun
WELL CONTRACTOR (INDIVIDUAL) NAME (print)
WELL CONTRACTOR COMPANY NAME
STATE WELL CONSTRUCTION PERMIT#
(if applicable)
WELL CONSTRUCTION RECORD C6 ca5 \S` P
esources - D 'isiun of Water Quality - Groui.dvvatcr Section
CERTIFIC�AATIIy N: 2i£r4 r�-��
PHONE E t/Iry2)a S—z n j
ASSOCIATED \\'Q PER
(if applicable)
WELL USE (Check Applicable Box): Residential% Municipal/Public ❑ Industrial 0 Agricultural ❑.
Monitoring 0 Recovery 0 Heat Pump Rater Injection 0 Other 0 If Other, List Use
WELL LOCATIO:
Nearest Town:
(Suet Name, Nu:nbt s. Caro:
Addrrss
Li r ij4,cc4( .car Noj +1 02h 7r 3
Cr.o�r} uw Sate Zip Core
( -. OS f 3 - / 1° 1G
Topographic/Land setting
❑Ridge USlope ❑\'alley ❑Flat
nC. (check appropriate box)
g z -/a33 Latitude'Iongitud_ of well location
Arco code- Phone number ��11
4. DATE DRILLED /a' -� 7-
5. TOTAL DEPTH: r-rmirir
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO
7. STATIC WATER LEVEL Below Top ofCasin_: ot7 T.
(Use `-" if Above Top of Casing)
S. TO? OF CASING IS / FT. Above Land Surface
cuiing terminated a''ur belu"" land surface requires a
variance in accordance x irh L:\ NCAC 2C .011S.
9. YIELD (gom): ' . jC7 METHOD OF TEST
10. WATER. ZONES (depth): /15z
I I. DISINFECTION: Type % Amount 7 01
12. CASING: V. N Thickness
er Weirht'Ft. Hanoi#
From
From
Depth
To
To
16. REMARKS:
S:ze
Ft.
FL
Meshed J
.�
(degreti minutei.iecordi)
Latitud_'longitude source:❑GPS❑Topographic map
(neck box)
DEPTH • DRILLING LOG
From To • Formation Description
0 --IC0
J00 -/ 0
/.p -/s.&
—t
LOCATION SKETCH -o
S4ovv direction and'dis;_n:e in Hiles from at least c
two State Roads or County Roads. Include the road a'
umbers and common road names.
\fateria.
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH ISA NCAC 2C, WELL
CONSTRLCT!ON STANDARDS. AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
7-7 L
1. _ �tLwr,,,,''3�
SIGNATURE OF PERSON GQ TRUCTING THE WELL DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Nlail Service Center- Raleigh, NC 1.
27699-1636 Phone No. [phone], within 30 days. G1C'�:I RE\'. 07i1(J01'
prg

f
STATE M. CONSTRUCTION PERMIT:/ ASSOCIATED \VQ PERMI
(if aoolicabte)
8,_
ivision of Watt -Quality - i�wdnl aih j viler 17��-
CERTIFICATION. via
PHONE k (PterStaS 2
t
(iraoplicable)
WELL USE (Check Applicable Box): Residential Munici?al'Public 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 O:her 0 1(Other, List Use
2. WELL LOCATI
Nearest Town:
(S:r:: S_,: Nxnces. Coasacaity. Subdivision, Lot N .. Zip ode)
:. OWNER:
Address vPit 2
PKY//T 1 (5:—.: R No.)
or To..,50 _ tic's
-4 Zip Co.1
4. DATE DRILLED 40 $ �� T
5. TOTAL DEPTH: 5,0
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO X
7. STATIC WATER LEVEL Below Top ofCasine: '76) FT.
tUse Abo:c Top of. Casir.l
• S. TO? OE CASING IS / FT. Above Land Surface'
'Top ur eating Cr: united en'or belon load surfer.: requires
tarim<e is acerdaxe•t:ith lit\\ CAC 2C .0113. - A •
9. YIELD(_cr..t' t!ETH'O)QFTEST
10. WATER ZONES (d_? th)• 4C.% (J
A tea :tilt- Root:: rx:b:r
\YELL CONTRACTOR (INDIVIDUAL) NAME (print)
‘YELL CONTRACTOR COMPANY NANIE
WELL CONSTRUCTION RECORD?' sicOO83VV
i:olus Carolina - Department of Environment and Natura Resources -
4(1
IL DISINFECTION: Type Ft fi
12. CASING:
Fro::: 0
Fro-:
Fr o:a
13
14. SCREEN: Dear:e:c
From - To Ft. in.
Fror: To Ft. in.
I:. SANDGRAVEL PACK:
Depih S.ze
Fror: To Ft.
From, To Ft.
Fron 0
From 3
To a
To
To
To 3
ToJ v
De:Eh
Topographic/and setting
❑Ridge ❑Slope [Walley Flat
(Jheck appropriate box)
Latitud 'longitude of well location
(de;;:ei c inu25:'(ecords)
Latitud_'longitude so: rce:❑GPS❑T,Opo_ra?hic ma?
(ataen box)"
DRILLING LOG
Formation DescrtpfNn
DEPTH
From To
r.n.tlni ^fir 1So�
V. Thickness
c• V•: ei_:-CF:. \.tale
Sv4z, PJC
Sin: Siza Materia.
in.
in. •
Ala..•._.
LOCATION SKETCH
S;noc direction ar.d'dis:ance in miles from a: leas:.:.
rso S:::e Roads cr Co•.:at;' Roa_'s. Indlude the road ' •
nE:m.be s and cor.tmon con' names.
chkuli
4
CI 4
16. REMARKS:
I DO HEREBY CERTIFY THAT THIS \':ELL WAS CONSTRUCTED IN ACCORDANCE WITH liA NCAC IC. WELL
CONSTR':CTIO':STANDARDS. AND TEAT ACOPY OFTHISP=CORD HAS SEEN PROVIDED TO THE WELL OWNER
-a81-e51
S!GNATLRE OF PERSON COST .- - ING THE WELL DATE
Submi: the original to the Division of Water Quality, Groundtt a ter Section. 1636 Man S:nice Ccn:er- Aweigh, NC
27697-: 536 Phnn< No. (719)i33-3-'-' I, \t ithin 30 du\ 5.
GV.-! REV. 07 2001
'T
rti
tzs
a_.

0/26
WELL CONSTRUCTION RECORD 3 0 5 7 U 1
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) James 8. Brown CERTIFICATIONS 2045
WELL CONTRACTOR COMPANY NAME Hedden Brothers Well Drilling, Inc PHONE # f 828) 369-9591
STATE WELL CONSTRUCTION PERMITS ASSOCIATED WQ PERMITS
(if applicable)
(if applicable)
1. WELL USE (Check Applicable Box): Residential 10 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
Ne rest Town:
%r— /f1
reet
me
3. OWNER:
Address
ers, Community,
b
County
vision, Lot No., Zip Code)
ugh gh j- A eat or o d j
789
City or Tom tSt Zip Code
c)- 50 7973
Area code- Phone number
4. DATE DRILLED 1I'M8'cY/
5. TOTAL DEPTH: /DL)
6. DOES WELL REPLACE EXISTING WELL? YES NO ,t
7. STATIC WATER LEVEL Below Top of Casing: FT.
(Use "+" if Above Top o Casing)
8. TOP OF CASING IS 2 FT. Above Land Surface*
'Top of casing terminated at/or below land surface requires a
variance In accords with ISA NCAC aC .0118.
9. YIELD (gpm): // !ii. METHOD OF TEST BLOW
10. WATER ZONE (dept it4
11. DISINFECTION: Type H T H Amount 16oz
12. CASING:
Diameter
From To Ft.
From To Ft. /e" 1188
From To Ft.
13. GROUT: Depth
From 0 To 20
From To Ft.
14. SCREEN: Depth Diameter
From To Ft. in,
From To Ft. in.
15. SAND/GRAVEL PACK:
Depth
From To Ft,
From To Ft.
16. REMARKS:
Material
Ft, benonite & cement
Wall Thickness
or Weight/Ft.
rial
Method
pumped
Slot Size Material
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:
DEPTH (check box)
DRILLING LOG
From To _ , a Formation Description
clay & sand
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.
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STAND h t$. AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
SIGNATU
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
3057O0a " ci
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) James B. brown CERTIFICATIONS 2045
WELL CONTRACTOR COMPANY NAME Hedden Brothers Well Drilling, Inc PHONE [phone]
STATE WELL CONSTRUCTION PERMITS ASSOCIATED WQ PERMITS
(if applicable)
(if applicable)
1. WELL USE (Check Applicable Box): Residential 0 Municipal/Public ❑ Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATI'N:
Nearest Town:
(Street Na
County
Numbers, Community, Subdivision, Lot o., Zip Code)
3. OWNER: %lyt VA Q� /il/W7
Address
•
(Street orjoute No.) 00?
City or To r St a Zip Code
0125b- 746 -,i311
Area code- Phone number �(
4. DATE DRILLED /G/'/O
5. TOTAL DEPTH: ( P
6. DOES WELL REPLACE EXISTING WELL? YES ❑ O JK
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 cuing terminated at/or below land surface requires a
variance In accordance Ith ISA NCAC 2C .0118.
9. YIELD (gpm): MFrT_$OD73 TEST BLOW
w-_
10. WATER ZONES (depth): ((pp JJ 11 bf�'
11. DISINFECTION: Type H T H
12. CASING:
Depth
From rs
To
From iv ' To
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
Dipmeier
Ft. p
Ft. (o"
Ft.
Amount 16oz
Wall Thickness
or Weight/Ft
Material
Ft. benonite & cement
Ft. .
Diameter
Ft. in.
Ft. in.
Size -
Ft.
Ft.
Method
pumped
Slot Size Material
in.
in.
Material
Topographic/Land setting
❑Ridge ❑Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic titap
(check box)
DRILLING LOG
Formation Description
clay & sand
granite
DEPTH
LOCATION SKETQj;
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common road names.
0
N
0
—o
c
16. REMARKS:
1 DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STAN S, AND THAT A C PY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
SIGNATURE TO
E OF PERSON CONSTRUCTING THE WELL DATE
Submit the orig al 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
-0:1;

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) Russell S. Taylor
CERTIFICATION'S 2187
WELL CONTRACTOR COMPANY NAME Hedden Brothers Well Drilling, Inc
STATE WELL CONSTRUCTION PERMIT'S ASSOCIATED WQ PERMITS/
(if applicable)
(if applicable)
PHONE [phone]
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 LOCATIe
N ,yst Toym !
(YET LA/ O� ounty
(Street Name, Nu ben, Community, Subd ian, • No., ip Code)
3. OWNER:
Address
t@ 7706/
(7 tygr�ows - nl,Stl Zip Code
Areaa code- Phone ennumber
fJ
4. DATE DRILLED U.-eV'0y
5. TOTAL DEPTH: /)O'
6. DOES WELL REPLACE EXISTING WELL? YESNO 0
7. STATIC WATER LEVEL Below Top of Casing: FT.
8. TOP OF CASING IS 2 (Use "+" if Above Top of acing)
FT. Above Land Surface*
`Top of casing terminated atior below land surface requires a
variance In accords gje �wh ISA NCAC 1C .0118.
9. YIELD (gpm): 6J METHOD OF TEST BLOW
10. WATER ZONES (dept
(Street or Rou o.)
11. DISINFECTION: Type H T H
12. CASING:
From U Depth rj Diameter
To /ad Ft. '
From ar ' To=
From To
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.
Ft.
Amount 16oz
Wall Thickness
or Weight/Ft. ateiial
VL
Material Method
Fr, benonite & cement pumped
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
305m
aeo
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map s"
DEPTH (check box)
DRILLING LOG
From To?a Formation Description
clay & sand
granite
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,
0
0
0
—o
N
16. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH ISA NCAC
CONS U,CTI/ON� STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED) TO THE ) WELLLg WNER
" ^,'�( a / a/ /
SIG URE OF PERSON CONSTRUCTING THE WELL DA'r�
Submit the original to the Division of Water Quality, Groundwater Section, Me Mail Service Center - Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-1 REV. 07/2001

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) Russell S. Taylor
WELL CONTRACTOR COMPANY NAME Hedden Brothers Well Drilling, Inc
STATE WELL CONSTRUCTION PERMITS/
ASSOCIATED WQ PERMITN
(if applicable)
(if applicable)
305698
CERTIFICATION # 2187
PHONE # f 828) 369-9591
1. WELL USE (Check Applicable Box): Residential ® 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
1�1sl t7 }�'n•7� County.
NQnLL/l % v /V.&
(Street e, Numbers, Community, Subdivision, Lot No., Zip Code)
05"%3/
Zip Code
(t2)- 6Z9- (p(IV/
Area code- Phone number
4. DATE DRILLED // / '6(5/,
5. TOTAL DEPTH: /�JU
6. DOES WELL REPLACE EXISTING WELL? YE$ 0 NO
7. STATIC WATER LEVEL Below Top of Casing: t'
8. TOP OF CASING IS 2 (Use ' if Above Top of Casing)
FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance In accordan a with ISA NCAC 1C .0118.
9. YIELD (gpm): fp0 METH D OF TEST
10. WATER ZONES (depth): Ib (/Q'
.2�
3. OWNER: 0 0
Address � r11
A 1b ti
(eStreet or 4oute No.)
City or Town 'state
BLOW
FT.
11. DISINFECTION: Type H T H Amount 16oz
12. CASING: Wall Thickness
0
Depth D)'arr)eter or W i ht/Ft. M tetial
From To Ft. CO e /t'
From To Ft.
From To Ft.
13. GROUT: Depth/ n Material Method
From 0 To (GO Ft. benonite & 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 Material
From To Ft.
From To Ft.
Topographic/Landsetting
❑Ridge ❑Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic ma
DEPTH (check box)
DRILLING LOG
From To Formation Description
d 6,6 clay & sand p
(r C�%' i5a' 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.
16. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH ISA NCAC 2C,
CONST CTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
SIG RE OF PERSON CONSTRUCTING THE WELL / 2/D 7 D 5i
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

WELL CONTRACTOR (INDIVIDUAL) NAME (print) Russell S. Taylor
WELL CONTRACTOR COMPANY NAME Redden Brothers Well Drilling, Inc
STATE WELL CONSTRUCTION PERMIT#
if applicable)
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Wat
a12
305697
er Quality - Groundwater Section
CERTIFICATION # 2187
PHONE # f 828) 369-9591
ASSOCIATED WQ PERMITS
fa icable
1. WELL USE (Check Applicable Box): Residential El Municipal/Public O Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water In ection 0 Other 0 If Other, List Use
2. WELL LOCATIO
Nearer; Town:
(Street Name
3. OWNER:
Address
, Community, Subdivision, Lot No., Zip Code)
°era)
! �n� nit^ . 07R7K3
(Street or Route No.)
sityorrjTyJ] S ' Zip Code
Area code- Phone number
4. DATE DRILLED Iof'D�
5. TOTAL DEPTH:
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO
7. STATIC WATER LEVEL Below Top of Casing: r)
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS 2
*Top of casing terminated at/or below land surface requiresove Land urfaCe•
a
variance in accordaniteelth ISA NCAC 2C .0118.
9. YIELD (gpm):c [> J MET OD OF MST BLOW
10. WATER ZONES (depth): R'5 , ii i,
11. DISINFECTION: Type H T H
12. CASING:
O To Depth, Ft,
From
From To Ft.
From To Ft.
13. GROUT: Depth Material Method
From 0 To 20 Ft, benonite & cement dumped
From To Ft.
14. SCREEN: Depth Diameter Slot Size Material
Amount 1802
Wall Thickness
Topographic/Land setting
ORidge ❑Slope ❑Valley OF)at
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:OGPSOTopographic map"
(check box)
DRILLINGLO I
Formation Description
cla 8 sand
granite
DEPTH
From T
•
r1
LOCATION K TCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
Diameter or /Vt/Ft. M serial numbers and common road names.
From To Ft in. in.
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft
From To Ft.
16. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
SIGNA r,i RE OF PERSON CONSTRUCTING THE WELL 2 / %
DAT
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.07/200I
d
tV
Ca
r.

WELL CONSTRUCTION RECORD
305696d
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) Russell S. Taylor
CERTIFICATION a 2167
WELL CONTRACTOR COMPANY NAME Hedden Brothers Well Drilling, Inc
PHONE a f 626) 369-9591
STATE WELL CONSTRUCTION PERMIT,/ ASSOCIATED WQ PERMIT,/
(if applicable)
(if applicable)
1. WELL USE (Check Applicable Box): Residential ® Municipal/Public 0 Industrial 0 Agricultural ❑
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION_
NeargitAi&7
(Street Name, Nu en, Community, Subdivision, Lot No., Zip Code)
3. OWNER:
Address
3 unty
9 ' WO f or Route No, itic 877d
(2ZSCCity)- or2? T wn-S5/gotate Zip Code
Area code- Phone number
4. DATE DRILLED �4' & '
5. TOTAL DEPTH: 4tOr
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO 0
1
7. STATIC WATER LEVEL Below Top of Casing: ro FT.
8. TOP OF CASING IS 2 (Use "+" if Above Top of Casing)
FT. Above Land Surface*
'Top of cuing terminated actor below land surface requires •
variance In accordant with ISA NCAC 2C .0118.
9. YIELD (gpm): ) T MgOD OF TE§T BLOW
10, WATER ZONES (depth): to(( ,
11. DISINFECTION: Type H T H Amount 16oz
12. CASING: Wall Thickness
Diameter or Weight/Ft. Mial
Depth
From 0 To I Ft.
From—� To y Ft. 48 g ` xyo
From To Ft.
13. GROUT: Depth Material
From 0 To 20 Ft, benonite & cement
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:
Method
pumped
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 tn_ , Formation Description
clay 8 sand
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.
0
N
N
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH ISA NCAC 2C, WELL
CONSTRUCTIONSTANN AARDS,'AyN)D THAT A
PY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER � te2�lif lCCcr?
SIGNAJqRE 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
r

WELL CONSTRUCTION RECORD
305695 Oyez
(Street or Route No.)
own '
State
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) Russell S. Taylor CERTIFICATION k 2187
WELL CONTRACTOR COMPANY NAME Haddon Brothers Well Drilling, Inc
STATE WELL CONSTRUCTION PERMITS
(if applicable)
ASSOCIATED WQ PERMITS
(if applicable)
PHONE k [phone]
1, WELL USE (Check Applicable Box): Residential ® Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring ❑ Recovery 0 Heat Pump Water Injection ❑ Other 0 If Other, List Use
2. WELL LOCATIO
etlToyvn:
(Street Name, Numbers, Co unity, Subdivision, Lot No., Code)
3. OWNER:
Address
City
Area code- Phone number
4. DATE DRILLED i01�n • 04
5. TOTAL DEPTH: S4
6. DOES WELL REPLACE EXISTING WELL/ YES NO 0
7. STATIC WATER LEVEL Below Top of Casing: O 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): 75 MEIjppF TEST BLOW
10. WATER ZONES (depth): rf
0?8'779
Zip Code
11. DISINFECTION: Type H T H
12. CASING:
Depth Di eter
From n Lo To 77 Ft. '/
From To Ft.
From To Ft,
13. GROUT: Depth Material Method
From 0 To 20 Ft. Penonite 8 cement pumped
Amount 16oz
Wall Thickness
or Weight/Ft. i;l
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 0Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographio:rnap
(check box)
DEPTH DRILLING LOG
Fro o ,. Formation Description
day 8 sand
granite
JOCATION 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 15A NCAC 2C, WELL
CONS 1 CTION STANDARDS AND THAT). COPY OF THIS RECORD HAS BEEN PROVIDED TO T},iE WELLpWNER
SIGN RE OF PERSON CONSTRUCTING THE WELL
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-I REV. 07/2001
F_

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) c1)-e Dhi S AlIJram, t CERTIFICATION# 0117 [P
WELL CONTRACTOR COMPANY NAM 6Y.hniS 1""'ibin.ri WPOV'J IPHONE #i'lt_6a 14-3 zb 6
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED W ERMIT#
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential-1?unicipal/Public 0 Industrial 0 Agricultural 0
Monitoring ❑ Recovery 0 Heat Pump Water Injection 0 Other Ef If Other, List Use
2. WELL LOCATION:
Nearest Town: C.4von g .)t- CountyyI R-C-(CS uh-�
r/y p4L,4 SHvyes —/3 9 t Woaric My-n. 72/4: L
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code) oZ 0 7 3
3. OWNER: /74T'p}�rCi &s C att .
Address /ea /iORP_ei-t,te p12.
(Street or Route No.)
et, t� c 363}�.
City or Town State Zip Code
(9.09c as.i - ? 7.2 p
Area code- Phone number
4. DATE DRILLED /.2. —l3 -by
5. TOTAL DEPTH: 6 02S
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO
7. STATIC WATER LEVEL Below Top of Casing: 6cO FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS / FT. Above Land Surface*
*Top of casing terminated actor below land surface requires a
variance in accordance with 15A NCAC 2C .0118. /
9. YIELD (gpm): / METHOD OF TEST_ bib/ if
10. WATER ZONES (depth): �f0 (�
11. DISINFECTION: Type
12. CASING:
Depth
From 0 To 315
From To
From To
13. GROUT: Depth
From O To , 1D
From To
14. SCREEN: Depth Diameter
From To Ft. in.
From To Ft. in.
15. SAND/GRAVEL PACK:
Depth Size Material
DEPTH
From To
as' 6-Z5
j_iipographic/Land setting
eiRldge ❑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
Pi 0 rtan . fro —
LOCATION SKETCH
//-t%% Amount ,a ng- ,I3S Show direction and distance in miles from at least
Wall Thickness two State Roads or County Roads. Include the road
Diameter or Weight/Ft. Mate 1 numbers and common road names.
Ft. (c S.b g,1 j D �-
Ft.
Ft.
Material Method
Ft.0,ytyyp na)4At
Ft.
Slot Size Material
in.
in.
From To Ft.
—v
W
N
From To Ft.
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 TH S RECORD H S BEEN PROVIDED TO THE WELL OWNER
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-1 REV. 07/2001
r`:
•

WELL CONSTRUCTION RECORD
305714
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable)
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) Russell S. Taylor CERTIFICATION # 2187
WELL CONTRACTOR COMPANY NAME Heddan Brothers Well Drilling, Inc PHONE # f 828) 369-9591
(if applicable)
1. WELL USE (Check Applicable Box): Residential El Municipal/Public 0 Industrial ❑ Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATIO
Neat Tyjvn:r( C���Q% bounty
eet Name, Numben, Community, Sudivision, (Lyoottt N)o., Zip Code)
1' i la(tv)0 (1/,
Street or oute No.) a
dith
City or Town t fr Zip Code
5
Topographic/Land setting
❑Ridge 0Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPSfTopographic map
(check box)
DEPTH DRILLING LOG
From To Formation Description
Area code- Phone number 9/_
clay & sand
4. DATE DRILLED to granite
5. TOTAL DEPTH:
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO 0
7. STATIC WATER LEVEL Below Top of Casing: FT.
(Use "+" if Above Tap 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 accordancepdfh ISA NCAC 2C .0118.
9. YIELD (gpm): ,"i METUOD 9F TEST BLOW
10. WATER ZONES (depth): ` 15
3. OWNER:
Addres
LOCATION SKETCH
11. DISINFECTION: Type H T H Amount 16oz Show direction and distance in miles from at least
Wall Thickness two State Roads or County Roads. Include the road
Depth Diameter or Weight/Ft. ;eerie! numbers and common road names.
From To Ft. ,
From ' To Ft. /d° mJR8 • r - /
From To Ft.
13. GROUT: Depth Material Method
From 0 To 20 Ft. ',enema & 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 Material
From To Ft.
From To Ft.
12. CASING:
O
7
—o
O
16. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH I5A NCAC 2C, WELL
CONST UCTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
// - /6-oit
SIG TURE 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-1 REV. 07/2001
•
c -,

WELL CONSTRUCTION RECORD '
Quality North Carolina - Department of Environment and Natural Resources - Division of Water 305713
Q ty -Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) Russell S. Taylor
WELL CONTRACTOR COMPANY NAME Haddon Brothers Well Drilling, Inc CERTIFICATION ii 2187
PHONE # f 828) 369-9591
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable)
(if applicable)
1. WELL USE (Check Applicable Box): Residential ® 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
Near T
(Street ame N , bers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: /'i II, , _ %
Address 1) 6i91� j 3/1 1
et r Ro to No.
J€/P/yr�(Tn/k 1*1
(• .:i W'S " igt) Zip Code
Area code- Phone number
4. DATE DRILLED />I ' IS O
5. TOTAL DEPTH: y (7D I
6. DOES WELL REPLACE EXISTING WELL? YES O NO At
7. STATIC WATER LEVEL Below Top of Casing: , (t O 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 accord c with ISA NCAC 1C .0118.
10. WATER ZONES (depth):/3 Adi'/ Pir-
T BLOW
11. DISINFECTION: Type H T H Amount 18oz
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft.
O To Ft.
FromTo
FroFt.
From To Ft.
13. GROUT: Depth Material Method
From 0 To 20 Ft, benonite & 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 Material
From To Ft.
From To Ft.
Topographic/Land setting
❑Ridge ❑Slope [Valley OFlat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:OGPSOTopographic map
(check box)
DEPTHDRILLING LOG
F To f Formation Description
clay & sand
granite
SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common road names.
16. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONST CTIIONSTTANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
�f-
SIGN.(`I'URE 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-1 REV. 07/2001

WELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources - Division of Water Quality
WELL CONTRACTOR (INDIVIDUAL) NAME (print) A. Brune Hedden
WELL CONTRACTOR COMPANY NAME Hedden Brothers Well Drilling, Inc
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
3r�n1
0512
CERTIFICATION # 2042
PHONE # [phone]
I. WELL USE (Check Applicable Box): Residential 0 Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring ❑ Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION:
Nearest Town: Sylva County Jackson
Woodpecker Lane
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: Donald Bailey
Address 47 Woodpecker Lane
(Street or Route No.)
Sylva NC 28779
City or Town State Zip Code
( 828 )- 586-0696
Area code- Phone number
4. DATE DRILLED 9-15-04
5. TOTAL DEPTH: 150 �{
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO )4,
7. STATIC WATER LEVEL Below Top of Casing: 50 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): 15 METHOD OF TEST blow
10. WATER ZONES (depth): 85'
11. DISINFECTION: Type H T H
12. CASING:
Depth
From 0 To 25 Ft
From To Ft.
From To Ft
Amount 16oz
Wall Thickness
Diameter or Weight/Ft. Material
6" .188 steel
13. GROUT: Depth
From 0 To 20 Ft.
From To Ft.
Material
benonite & cement
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.
Method
pumped
Slot Size Material
in.
in.
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 23' clay & sand
23' 150' 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.
.e-
0
rn
0
N
0
v
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH I5A NCAC 2C, WELL
CONSTRUCTIO ANDARDS, AND AT A C PY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER WE
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
Submit the original to the Division of Water Quality, Attn: Information Management, 1617 Mall Service Center -
Raleigh, NC 27699-1617, Phone No. [phone], within 30 days.
GW-1 REV. 09/2004

WELL CONSTRUCTION RECORD
305711 Q> )
13. GROUT:
From 0
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR(INDIVIDUAL) NAME (print) James B. Brown CERTIFICATION 8 2045
WELL CONTRACTOR COMPANY NAME Hedden Brothers Well Drilling, Inc
PHONE [phone]
STATE WELL CONSTRUCTION PERMITS ASSOCIATED WQ PERMITS
(if applicable) (if applicable)
1, WELL USE (Check Applicable Box): Residential El Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection ❑ Other 0 If Other, List Use
2. WELL LOCATIO �, /
Nea s Town: h /`*i Z un . ✓� i
(Street Name, Numbers, Community, Subdivision, No., ip Code)
3. OWNER:
Ad ss
Ile"lIcy ($treyr,,`oorr Rout
/.§,(8"y'n17, 7� 7a/
Area code- 1 /h 9f/
4. DATE DRILLED
'
5. TOTAL DEPTH: a
6. DOES WELL REPLACE EXISTING WELL? YESq NO
7. STATIC WATER LEVEL Below Top of Casing: 100 F .
(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 •
variance In accordanceth ISA NCAC 2C .0118.
9. YIELD (gpm): METHOD OF TEST BLOW
10. WATER ZONES (depth): .91 // r
3.3S/45
Zip Code
11. DISINFECTION: Type H T H Amount 16oz
12. CASING:
Dept
From To I Ft
From IA I' To ' Ft.
From To Ft.
Depth
To 20
Material
Wall Thickness
or Weight/Ft. :t r'al
Method
Ft. benonite & 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
From To Ft.
From To Ft.
Size - Material
Topographic/Land setting
❑Ridge 0Slope ❑Valley OFlat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds) 41
Latitude/longitude source:❑GPS❑Topographic map.
(check box) .:
DEPTH DRILLING LOG
From - / ^ Formation Description
clay & sand
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.
16. REMARKS:
1 DO HEREBY CERTIFY T. AT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION ST S, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
frig ,
J //'-79-v7'
SIGNATURE O ERSON CONSTRUCTING THE WELL DATE
Submit the twig nal to the Division of Water Quality, Groundwater Section, 1636 Mall Service Center - Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. . OW-1 REV, 07/2001

WELL CONSTRUCTION RECORD
305710d
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) James B. Brown CERTIFICATION # 2045
WELL CONTRACTOR COMPANY NAME Hedden Brothers Well Drilling, Inc PHONE # [phone]
STATE WELL CONSTRUCTION PERMIT#
(if applicable)
ASSOCIATED WQ PERMIT#
(if applicable)
1. WELL USE (Check Applicable Box): Residential El 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
Net Town:
(Streeett(NName Nu
3. OWNER:
Address /$ �d fl 5ka %
(jk _ (nejtor Rote No,) 813
.(8Z8)sw -d'r Zip Code
Area code- Phone number /
4. DATE DRILLED // ' `J• Crt
5. TOTAL DEPTH:
6. DOES WELL REPLACE EXISTING WELL? YES J-J NO jiQ•
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 accords ce with 1SA NCAC 2C .0118.
9. YIELD (gpm): Q METHOD QF TEST BLOW
10. WATER ZONES (depth): r70 '6Y; /0 ''
Coun
ion, Lot No., Zip Code)
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 Tp Formation Description
clay & sand
nranite
1 I. DISINFECTION: Type H T H Amount 16oz
12. CASING:
Depth/ Diameter
From To Ft. (�
From To Ft.
From To Ft.
13. GROUT: Depth Material Method
From 0 To 20 Ft. benonite & 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 . Material
From To Ft.
From To Ft.
Wall Thickness
or Weight/Ft. Mgteria
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common road names.
16. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH I5A NCAC 2C, WELL
CONSTRUCTION ST • +.aARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
S NATURE OF PERSON CONSTRUCTING THE WELL DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. , . GW-1 REV. 07/2001

WELL CONSTRUCTION RECORD
305708
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) Russell S. Taylor CERTIFICATION a 2187
WELL CONTRACTOR COMPANY NAME Hedden Brothers Well Drilling, Inc PHONE # f 828) 369-9591
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential El Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATIQN:
Ne est Town:
Ong
County
(Street Name, 11 en, Community, Sub{{//qy��'vision, Lot No., Zip Code)
3. OWNER: »4 W�e
Addre9a %%%%']�
w(Street od/Route QNo.) PM L.28 / / 7
City or Town ti�tatte��V1lCZip Code
BZ i-74:i-n(02R
Area code- Phone number ,, I
4, DATE DRILLED ' I6' at-
5. TOTAL DEPTH: 0
6. DOES WELL REPLACE EXISTING WELL? YES 0 NOK.
7. STATIC WATER LEVEL Below Top of Casing: ,50 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS 2 FT. Above Land Surface'
'Top of casing terminated at/or below land surface requires a
variance in accordan a ith ISA NCAC 2C .0118.
9. YIELD (gpm): META OF TEST BLOW
10. WATER ZONES depth): nl/
Topographic/Land setting
❑Ridge ❑Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographicrriap
(check box) •
DEPTH DRILLING LOG
Fr T.
, Formation Description
• S clay & sand
Area%I, granite
LOCATION SKETCH
11. DISINFECTION: Type H T H Amount teoz Show direction and distance in miles from at least
12. CASING: Wall Thickness two State Roads or County Roads. Include the road
Depth n/� D))'argpter or We' ht/Ft. Material numbers and common road names.
From 0 To a 11 (' Ft. (0 t leg 0toi4
From To Ft.
From To Ft.
13. GROUT: Depth Material Method
From 0 To 20 pt. benonite & 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 Material
From To Ft.
From To Ft.
CD
0
N
—p
i
7.7
iV cr-cti
16. REMARKS• to
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONS ON <STANDARDS, AND THAT A C PY OF THIS RECORD HAS BEEN PROVIDED TO THE y.'ELL OWNER
TRU
// -29 og
S NAT 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-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) James 8. Brown
WELL CONTRACTOR COMPANY NAME Hedden Brothers Well Drilling, Inc
305703
CERTIFICATION # 2045
PHONE # [phone]
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
I. WELL USE (Check Applicable Box): Residential El 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.
(Street Name
3. OWNER:
Address
County
bdivision, Lot No., Zip Code)
a
�b I • // ._(Sue/ett ,RoR `eN .) 4QR78
Ai:yyo_r j���7-7#9,9t3.1J Zip Code
Area code- Phone number s1
4. DATE DRILLED // J3-0/,
5. TOTAL DEPTH: 60
6. DOES WELL REPLACE EXISTING WELL? YES % 0 (
7. STATIC WATER LEVEL Below Top of Casing: 41 I 1`T�
(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 Ith ISA NCAC 2C .0118.
9. YIELD (gpm): /. M$THOD OFTEST BLOW
TH
10. WATER ZONE $ (depth): //
11. DISINFECTION: Type H T H Amount 18oz
12. CASING: Wall Thickness
Dept Di ;Jr or Weight/Ft. Material
From To � Ft. s
From 0 To .3 Ft. O` ,ISM
From To Ft.
13. GROUT: Depth Material Method
From_a_____ To 20 Ft, benonite & 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 - 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
Fr , •f " Formation Description
clay a sand
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.
C)
o r;_
p1
0
N
o'
c
N
16. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED M ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STAND �BH3; tLND THAT A COPY THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
ntat/ es.e Pm 3 /% 020t —O/'
SIGNATURE F RSON 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-1 REV. 07/2001
c

305702
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
WELL CONTRACTOR COMPANY NAME Hedden Brothers Well Drilling, Inc
CERTIFICATION*, 2045
PHONE a [phone]
STATE WELL CONSTRUCTION PERMIT*, ASSOCIATED WQ PERMIT*,
(if applicable)
(if applicable)
1. WELL USE (Check Applicable Box): Residential EI Municipal/Public 0 industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other ❑ If Other, List Use
2. WELL LOCATI N
Near eYd Tom):
(Street
Name, Numbers, Community, Subdivision, Lot No., Zip Code)
County eLr.ft.IGt1.0'—)
3. OWNER:
Address 3/7
(
ty ort
t Ry e N rl e a87f�
Zip Code
Area code- Phone number q
4. DATE DRILLED /-D
5. TOTAL DEPTH: O
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO
7. STATIC WATER LEVEL Below Top of Casing: 460 F
(Use "+" if Above Top of Cuing)
8. TOP OF CASING IS 2 FT. Above Land Surface*
*Top of cuing terminated at/or below land surface requires a
variance in accordant th 1SA NCAC 1C .0118.
9. YIELD (gpm): I METHQI� QUEST BLOW
10. WATER ZONES (depth): J'/b 1
11. DISINFECTION: Type H T H
12. CASING:
Depth
From To /n . 1 Ft.
From To Ft.
From To Ft.
13. GROUT: Depth
From 0 To 20
Diameter
7"
Amount 16oz
Wall Thickness
or,jiUFt. Material
.219
Material Method
pt, benonite & cement pumped
From To Ft.
14. SCREEN: Depth Diameter
From To Ft. in.
From To Ft. in.
15, SAND/GRAVEL PACK:
Depth
From To
From To
Slot Size Material
_ in.
in.
Size - Material
Ft.
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
clay&sand
/0/' r 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.
16. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDgPPS, AND THAT A CQPY 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

305726
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural/ Resources - 9Division of Water Quality - Groundwater Section
WELL CONTRACFOR (INDIVIDUAL) NAME '+' (print) �DDrj�h1n 4 L n CERTIFICATION #''.//�y/8
WEl.l. CONTRACTOR COMPANY NAME &rP the_ervs , L3sJ]t •F P,tn- p$ . PRONE # (&2$ %_7_k__'_3 / 7 e
STATE WELL CONSTRUCTION PERMIT# �ry (022 ASSOCIATED WQ PERMIT#ff
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential l- Municipal/Public 0 Industrial ❑ Agricultural ❑ Monitoring ❑ Recovery 0 Heat Pump Water Injection ❑ Other 0 If Other, List Use
2. WELL LOCATION:
Nearest Town:
aQ k
(Street Name, Numbe
3. OWNER:
Address
County ct c k Qm1_
e
Confmunity, Subdivision, Lot No., Zip Ctxlc)
(Street or Route No.)
aP et, se_e et( KbCr
City or Town sate Zip ('od
( )-
Xtea aide- Phone number
4. DATE DRILLED //—//-Uy-
5.TOTAL .DEPTH: /
(' I I U.I..I I PIP! A( P I vitY Ppq U/I.11 .1 VI._l 11 p,11
7. STATIC WATER LEVEL Below Top of Casing: (oQ FT.
(Use "+" if Above Top of Casings
R. TOP OF CASING IS i 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): X METHOD OF TEST c� 11 rs
ID. WATER ZONES (depth):
Topographic/Land setting
❑Ridge ❑Slope OValley at
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:OGPSOTopographic ipap
(check box)
DEPTH DRILLING LOG'.
From To Formation Description
LOCATION SKETCH
1 I - DISINFECTION: Type )4 -T34 Amount a 5 1'1,1 f . Show direction and distance in miles from at least
12. CASING: Wall Thickness two State Roads or County Roads. Include the road
or Weight/Ft. Material numbers and common road names.
PVC
Depth Diameter
From 12 To g9 Ft. to 1 I.
From To Ft.
From _._ To Ft.
13. GROUT: Depth Material Method
From ea To ,3C Ft. �py ± -f-I.:.
Prom To Ft.
14. SCREEN: Depth Diameter Slot Size Material
FromTo Ft. in. in.
From„_ To Ft. in. in.
I5. SAND/GRAVEL PACK:
Depth Size Material
From _To Ft.
FromTo Ft.
16. REMARKS:
n
O
.c-
r'
to
1 DO HEREBY CERTIFY TIIATTIIIS WELL WAS CONSTRUCTED IN ACCORDANCE WITI1 ISA NCAC 2C, WELL
(CONSFRIICIION STAND RDS, AND THAT A COPY OF TIIIS RECORD HAS BEEN PROVIDED TO TIIE WELL OWNER
SIGNATURE OF PERSON C(
1CI IN(i TIIE 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

WELL CONSTRUCTION RECORD (\ 3 0 6 915
North Carolina - Department of Environment and Naal tee
- Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) P Crr7 L '� CERTIFICATION It
//G// PRONE # (bzb') 8J7-Ry9 7
WELL CONTRACTOR COMPANY NAME
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
t.0 ) (if applicable)
-_ \
l it byy.:..� _
1. 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 Otitcr, List Use
2. WELL LOCATION:/
Nearest Town: C h eta toe_
F,'r< fit
di,
Name umbers
Community,
(Street Subdivision, Lot No., Zip Code)
3. OWNER: a €-(54- /os tie/
Address
(Street or Route No.)
City or Town State Zip Code
Area code- Phone number
4. DATE DRILLED //- /5- D V
5. TOTAL DEPTH: /4/2
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO 12--
7. STATIC WATER LEVEL Below Top of Casing: ‘D FT.
(Use "+" if Above Top of Cuing)
8. TOP OF CASING IS / FT. Above Land Surface'
*Top of cuing terminated at/or below land surface requires a
variance 1n accordance with ISA NCAC 2C .0118.
9. YIELD (gpm): f` O METHOD OF TEST /52/
10. WATER ZONES (depth): /3l '
11. DISINFECTION: Type
12. CASING:
Depth
From O To 76'
From 7,5" To 59
/70-/t
From To
13. GROUT: Depth
From (i Topes'
Diameter
Ft.4„21
Ft C2,2r
•
Ft.
Jat
Ft. i o frt.�/
From To Ft.
14. SCREEN: Depth Diameter
From To Ft. in.
From To Ft. in.
15. SAND/GRAVEL PACK:
Depth
From To
From To
Amount te1/4
Wall Thickness
or Weight/Ft. Material
SO/lat! /PG
, / ddee /
Method
,,crra,
Topographic/Land setting
❑Ridge 0Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
/1/3,!'°,2Sa's coo fl
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From To Formation Description
Clay
7S /5/2- G/vr/rj�
Slot Size Material
in.
in.
Size Material
Ft.
Ft.
LOCATION SKETCH 0
Show direction and distance in miles Mtn mast
two State Roads or County Roads. Include road
numbers and common road names.
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 FROY!DED TO THE WELL OWNER
tete2--
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!(' 1111111 I(
306916
11'F:LL CONSTRUCTION RECORD
North Carolina - Ucpathmcnl of Environment and Nato al Resources - Division of Water Quality - Groundwater Section
WELL CAINI IIACI OR (INDIVIDUAL) NAM F.(pi Inl) etc/ jecc €- CElt 11E1CA710N 0290 S
rituriE, ll jJ2t tP7 2ffi
WELL CON MAC I OD cord ANY NAME ..P .Iger
SI Al F. ry EI. I, CONS I IOW I DIN I'F.IIAWII If
I !in ablr
ASSOCIAI EII WI) VE111\11T0
lif n • Ilicnhle)
I. \VIII I, LIS11. (Check Applicable Pox): Rcsidcnlial IiAluuicipal/Public Ii Indusltial ❑ Agricultural ❑
6loniloting LI Recovery I_I Ileac Pump \Valet Injection ❑ Other L1 If Other, List (Jse
2. \ V P1. I. I 0 l' A l 1014 :
Nc:rccl Town: G-, 6,-ohC--e- county Tac AJOK
50C &
(:b•rl Nnin•. 1!nnil' '', ( nnnmily• S d hueinn. I . 111 , i Ip ll.I )
3. 1171'I7rlt oc-(_
Arnim cc
IF.tirrl rr Ilnnlr No )
Topogrnlihic/Lnnd selling
Ulthlgc ['Slope OVallry Llhlnl
(rl,eck npp,nprinle
Latitude/longitude of well location r r
iv3s' 'Y°.2' e,ofl°/z J( /
(degreedminulexVx rnndx)
l,lilwlc'lunl;iludc sOIIICC:l_IIiRS❑ Fopoplaphic nl;I I
(check Fox)
II41_I11 DRILL114(3 LOti
(il, „I [nun Slnlr 'nil,Club- Fronr 'Iu Formation Deviiption
Arrn r.l rw,n• nrnlInn
d. I)A rI'•, llIUJ,I
5. TWA). I)1:.I1ll1'
.2ziY-.-_-_..._....
6. IFS \VFL1, RI'PI Ace ISISTINtI \VFI.I1 V11. S 1-1 DO 1-1-
7. SEA 1 IC W'Allllt 1.FVIIL llclow'fup of C'a':ingl ��_. -_PF.
(r l.e"1." If Above Inn ol('ning)
R. Tl1I' OI' ('ASII II IS - / I-f. Above I.nnd Sullac•c"
• Iry rl r..ing I,, odnnlyd I,rinn lend inn I.re ,'orb n .
v.)Inrre In error Elmore nllh I5A N('AI' IC.01 In.
Q. Yleln(gpin): % _MEIItoOOFTES T 42/%-
10. R'A fFIR ZONES (depth): ,Z11f
I1. I )ISINI F(C.II0I1:'1}pe . hetr7 Amount Ycy�
12. CASINO: Wnll lhi( kurss
I)rpth I)inmcicr of Weight/H. t'Iatcrial
I'rom_0 To/OD Ft. w s?%! �f _-
1'nm1_/00 To 42/ n 6•.ZJ, /ii' sicee/
Ilom 'fo FL
13. CRUD': Drptl) h1 lailoin),p methodFrom CI 'hi 19 FI./S /1/44 //Of-2re-
From 'lo I1.
14. SCREEN: nrpth Uimnrtcr Slol Size hlalrlinl
From To _-- Ft. in. in.
From) To FI. in. in. _--- _
15. SANIL'l1ItAVF1.1'ACK:
nrplh Sire hLdrrial
FlOhl_ _-lo____ -II.
1I0111 To Ft.
16. REMARKS:
a ` G 0
Go- zzq
LQCAIWLS±IJS l
Slow direction and distance in miles Flom nt least
Iwo Slade Roads or County Roods. Include the toad
numbers and common road names.
a
11'(l l ll,E1:11 i Cr It 1 IrY 711A1.'I I IIS WELL WAS ( 'Or IS I IU ICI ED III ACCORILANCE W I III I SA IJCAC 2C, WELL
CO1)Sl IDICI IU1J STANDARDS, AND I I IAT A CURY 01' 1111S RECORD IIAS BEEN PROVIDED 1O 111E WELL OWI )ER
SR:11A I DEE UI' PERS(t1J CONS 11tU(:I IN0lllll WELL DA'I E
Subnli( the of IgInal to the Dll;thin of \V i(rr quality, (:I onndrtnler Section, 1636 Mall Service Center- Itnlelgh, [lc
2767'! IO( t'Ir:m.r mt. (')I") 7)] 1221, n Rhin Jt) �Irrn. GW-I ItEV. 07/2(101

WELL CONSTRUCTION RECORD 306918
North Carolina - Department of Environment and Na/t/ua1
IDResources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (pint) eeeCe CERTIFICATION efint°3
WELL CONTRACTOR COMPANY NAME %1l YIr/' PHONE It fit)en'W?
STATE WELL CONSTRUCTION PERMITS! ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
1. WELL USE (Check Applicable Bus). Residential
'ent' 2 i lunicipal/Public 0 Industrial 0 Agricultural 0
.
Monitoring 0 Recovery 0 Heat Pump Water Injection ❑ Other 0 If Other, List Use
2. WELL LOCATION::
Nearest Town: O%f6/otee / County 5' cAotz
7044f04 Ai'aley /61
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
14
.
3. OWNER: .4 YJ/4ijf'�4 Soh, r
Address
(Street or Route No.)
City or Town State Zip Code
Area code- Phone number
4. DATE DRILLED //-A 5- o f
5. TOTAL DEPTH: e26 D
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO U
7. STATIC WATER LEVEL Below Top of Casing: 2' 0 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS / Z FT. Above Land Surfaces
*Top of cuing terminated at/or below land surface requires a
variance to accordance with ISA NCAC 2C .0118.
9. YIELD (gpm): !.r METHOD OF TEST #/ 'r
10. WATER ZONES (depth): 2S 0
11. DISINFECTION: Type
12. CASING:
From O
,From 97
From_
13. GROUT:
From O
From
14. SCREEN:
From
From_
15. SAND/GRAV
Depth
Diameter
To / 7 Ft. C,-/-
To /0 7 Ft. 4;,2r
To Ft.
Depth
Toil��9�
Amount (44 ,0
Wall Thickness
or Weight/Ft. Material
JRE2/ 4 c
./19 .Threrr-
Ma,teQal/
Ft. "IC/lyd
To Ft.
Depth Diameter
To Ft. in.
To Ft. in.
EL PACK:
Depth Size Material
Method
Slot Size Material
in.
in.
To Ft.
To Ft.
From
From
16. REMARKS:
Topographic/Land seiia-.g
❑Ridge ❑Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
N/31''28'{f;/"wad.?°!L a3,5
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DRILLING LOG
Formation Description
DEPTH
From To
O - /o a
/Oo -210
ClR j/
fV
CO
0
Can
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.
1 DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH I5A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COI'Y OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
/�.1�lX-- //-2f- e Y
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
27699-1636 thnne 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
CERTIFICATION # 2045
WELL CONTRACTOR (INDIVIDUAL) NAME (print) James B. Brown
WELL CONTRACTOR COMPANY NAME Hedden Brothers Well Drilling, Inc
PHONE # [phone]
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT%
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential D 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;
Nearesst,TTown:
`' tAn
(Street Name, N bers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: f '(vf.YiQ
Address 31 7�jj G]t (Cai
(Street L r(�oute No.)
!VVa877?
ZS)tyOTown Sf, 9 Zip Code
(8
9
Area code• Phone number �J
4. DATE DRILLED /v1 J&'6
5. TOTAL DEPTH: /00
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO J�S
7. STATIC WATER LEVEL Below Top of Casing: 5
(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 accordant with 1SA NCAC 2C .0118.
9. YIELD (gpm): .n0+ ME HOD OF TEST BLOW
10. WATER ZONES (depth): 80• 1 aZ,90
11. DISINFECTION: Type H T H
12. CASING:
Dept') Diameter
From 0 To a _ Ft. to
From �/�i To�0 Ft. �i ,•
From To Ft
13. GROUT: Depth
From o To 20
From To Ft. .
14. SCREEN: Depth Diameter
From To Ft. in.
From To Ft. in.
15. SAND/GRAVEL PACK:
Depth Size -
From To
From To
16. REMARKS:
Ft.
Ft.
Amount 16oz
Wall Thickness
or WeightlFt. Material
Material
Ft. benonite 8 cement
Method
pumped
Slot Size Material
in.
in.
Material
306857
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 'Co-,. ^ Formation Description
clay 8 sand
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.
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STAND AR AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
,/'
SIGNATURE OF R ON CONSTRUCTING THE WELL DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center - Ralpigh, -NC
27699-1636 Phone No. [phone], within 30 days. `, . GW-1 °REV07/2001
MAR - 8 2005

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality • Groundwater Section
CERTIFICATION # 2045
WELL CONTRACTOR (INDIVIDUAL) NAME (print) dames B. Brown
WELL CONTRACTOR COMPANY NAME Hedden Brothers Well Drilling, Inc
306859
PHONE # f 828) 369-9591
STATE WELL CONSTRUCTION PERMIT0 ASSOCIATED WQ PERMIT#
(if applicable)
(if applicable)
1. WELL USE (Check Applicable Box): Residential ® 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
t Town:
Ire
i
County
2A'F#/
(Street Name, Numbers, Community, Sub ;vision, Lot No., Zip Code)
3. OWNER.
Addre; s
err
� (Street orRoute No,79
rue ga3
Vet-
aTol ,aC State Zip Code
LI
Area 41
code- Phone number) , `• A
4. DATE DRILLED o?' /J
5. TOTAL DEPTH: BOO' M
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO J'�
7. STATIC WATER LEVEL Below Top of Casing: avo 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): LP MET sp OF TEST BLOW
10. WATER ZONES (depth): Pt.,,
11. DISINFECTION: Type H T H Amount 16oz
12. CASING: Wall Thickness
0 Depth ? D' or Wei t/Ft. M enal
From To i -, Ft. t meter/ �
From To Ft.
From To Ft.
13. GROUT: Depth Material
From 0 To 20 Ft. benonite 8 cement
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.
Method
pumped
16. REMARKS:
Topographic/Land setting
ORidge ❑Slope OValley OFlat
(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
r.P clay & sand
6, /' 3661 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.
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STAND ND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
SIGNATURE
F 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-1 REV. 07/2001

. WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Reyss��\o\urce Oiciston of Water Quakuy - Grou
Y}}LA-Al Y/'�✓l J
CERTIFICATION':0/ Sip
\TELL CO\TRACTOR (IyDI\'IDIAI)NA\IE (print) 1 ��',���
WELL COS"lF:�\CTOR CO>IPASI' NAME!"1/-1A reef, P IZ. ✓t-S LtWcil �J" 9 PHONE k
ASSOCIATED \VQ PERMIT'
STATE \�ELLCO�ScPER.\llT; (if applicable)
(if applicable)
aSlz)
7 s9-is-37L)4:
ntivcater Section
r
1. WELL USE (Check Applicable Box): Residential (?1 municipal/public 0 Industrial 0 Agricultural
Monitoring ❑ Recovery 0 • Heat Pump Water Injection 0 Other 0 It Other, List Use
WELL LOCATIO.':
Nearos' sown:
(Sacra: V :p.
3. OWNER:
Addr ss
County
c:nbcs.Ccc\:nuain. ikisior, La: Na. Zip Coda)
(S :•uu: or R
"11lTV h Z1?Coda
Cr or To.ra 5:ate
Aa:ao- 7r.or.e c ::S:r — O
4. DATE DRILLED
5. TOTAL DEPTH: /�>>
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO
7. STATIC WATER LEVEL Below Top of Casing:
(L's;'" is Abo.e Top or Caeicgl
S. TOP OF CASING IS
FT. Above Land Surface-
•1'm yr ivsiu;; rare inaud:lave belyo lead surLee requires9.
,anon:e ir. ac orda':e ss(:h IS:\ NCAC 2C .0i13.
METHOD OF TEST )
ID. WATER. ZONES
•
I I. DISINFECTION: Type H "i 1-4— Amdun` fr9+-'�-�",
21
12. CASING:1'C_✓,i Thickness
Dr:', D:-nz'.cr
Toa Ft.0 /'
From o
Fran: To Ft
Fro:a To Ft.
13. OSO:T: Deb:
Front 0 Ta—�_ Ft.
From •- To_ _A Ft.
14. SCREEN: Dc_v D
Froin To Ft. in.
Frum To Ft in.
15. SAND GRAVEL PACK:
Death Size
From To Ft.
•Fro.• To Ft.
Scot Szc v Ala:erb..
in.
in.
Ma: er:a
Topographicttand ser\ing
❑Ridge SKIJPe ❑\alley ❑Flat
(check appropriate box)
Latitude'Ionaitude of well location
(dc zreeiinin rea'seccrds) ,
Lau tud,'IJaei:ude so' re:❑GPS❑Topo_rphi: map
(c% box) .
DRILL_ I]�G L0C'
• Formation Description
307215
DEPTH
From To
LOCATD� •.
S:no.v direction aad'dis:.a:e in miles from a: leas:
S:a:e Rinds cr Co•,:n:y Roa
ds. Include the road
numb en and common road name s.
lltn•Al ro>"ic�
6414l. Gk-i
16. REMARKS:
I DO HEREBY CERTIFY THAT TF:S WELL WAS CONSTRUCTED IN ACCORDANCE WITH.WITH.!5A NCAC 2C. WELL
CONSTit'_CTION STANDARDS. AND THAT A COPY OF /THS PPCORD FAS E EN PROVIDED TO THE . EELL 0i. ER
r14
S:GN.ATCRE OF-Pi-
TINGTHE\ELL
Submit the original to the Dirision of ater QuaIi y. Ground ate: Section. 1536 Mail S.ni;e Center - Raleigh, NC
-I REV. 0i.200:
„ , v.ithin 30 da\s.
27699-1 S: d Phone No. (919) i:_-_--I
c
t0
0

WELL CONSTRUCTION RECORD
308189
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR(INDIVIDUAL)NAME (print) /'ck gait"( CERTIFICATION#-3473
WELL CONTRACTOR COMPANY NAME eni-dc Its /.e%!1 Ac71-WW We. PHONE # (Z Sc3Z5/r7L
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable) Aimmomi(if applicable)
1. WELL USE (Check Applicable Box): Residential- Municipal/Public 0 Industrial ❑ Agricultural 0
Monitoring 0 Recovery ❑ Heat Pump Water Injection ❑ Other 0 If Other, List Use
2. WELL LOCATION:
Nearest Town: 11;e S
oh/ gerAn)
(Street Na e, Nunibers, Community, Subdivision, Lot No., Zip Code)
3. OWNER:
Address
County .t/CS1
L. 5 eu«lS
VA-AJ test icr
'' 11 (Street or Route No.)
!JeW 5114 yYJO14. P-/ 3a/6S
City or Town State Zip Code
( )-
Area code- Phone number
4. DATE DRILLED ra a 3— 65.1
5. TOTAL DEPTH: / D i S
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO 0
7. STATIC WATER LEVEL Below Top of Casing: 3/1 r 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): 7 , METHOD OF TEST A.F✓
10. WATER ZONES (depth):
1 I. DISINFECTION: Type Amount
12. CASING: Wall Thickness
To
Depth eD2 rt. Diameter or WeighUFt. Materal
Inv
From 0
From To Ft.
From To Ft.
13, GROUT: Depth Matersial • Method
From 0 To r2 0 Ftb/P/UtteS }G
From _ To Ft.
14. SCREEN: Depth Diameter Slot Size Material
From 1" 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
D- a7 01/4197
7,677e5-
cop
err
;'iT
,o4
-o o
7l
fi
a �-y'
0
LOCATION SKETCH — and
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common road names.
Tr 71
yi
9'I
CO
CO
IV
ri
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
1
a?a'a--ds
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

C-s-7
WELL CONSTRUCTION RECORD
7t(.$-7rt�"�/
\on'u Carolina - Deparnnent of Environment and Natural Resources - Division of Water Qualh - liruuuu\\a r JccuOn •,/.
Fn� /yt
\CELL COSTRACTOR(INDIVIDCAL)FA>IE (print) •1-/ r l 1c-k y CERTIFICATIOS
WELL CONTRACTOR COMPANY NAME
STATE WELL CONSTRUCTION PERMIT;
(if applicable)
PHONE k (U-yv-.
ASSOCIATED WQ PE4t}IIT
(if aolicable)
I. WELL USE (Cheek Applicable Box): Residential Yd Municipal/Public 0 Industrial ❑ Agricultural ❑
Monitoring 0 Recovery 0 Heat Pump 'Water Injection 0 Ocher 0 If Other, List Use
2. WELL LOCATI.N: (�.'s(�Topographic Land setzine
1 Near•s'Tov. -- 1 N. Ee Cou1nt,. d(C1 ❑Ridge ❑Slope ❑Valley
— . ai ► ' e.E �-d0rK' (Sick capropr:ve bat)
'v Ca L [ Na. Zi C 2tL2IItl!QC%FJngitada Of well
location
(a.,.-.\_...-.\u........ Cc....nL:ir•._ ? )
3. Add: sOWNER: ? O. rze a SU
r\ddra s (� 1' j' /� {�
0j1 �..6:a-0. a & 7c
G:. r Town S:a:: :53, Zi; CcJe
Ar:a c.d:- P:.c;:e r rh:r
DATE DRILLED 7 f 5 -vV-
=. TOTAL DEPTH: 1-1-S-0
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO QC
i. STATIC \WATER LEVEL Below Top of Casino: FT.
(L'se" i[Aio.- Tc; otCasini:
S. TO? OF CASING IS ) FT.:Above Land Surface'
'Top of n,ttr: inn rod aCcr bola,, lane ru rr.:e rag acres
vrian:eir.accor:l r..0 wi':hI 13:\\C:1C :C AI IS.
9. YIELD (cpc):' 3�T METHOD OF TEST tt1 y—
(d pteiicanaccils:.ondi)
Latimd 'longitude source:❑GPS❑TGpo_raphic nap
(n.::::14 bud
DRILLING LOG '
Fotnlation Descri?:ion
DEPTH
From To
10. WATER ZONES (d:pth):
2 '
I I. D!S!NEECTION: Tvrc f'i f'
12. CASING:
e. ,,un:-caZQai5lfZr
at
Thickness
De.;=: D:_( :; cr V.ei_ht'F:. J'•ri:'
Fro::: ci Tc ka FE.warJC _47L�,G
Fro To Ft
To Ft
I'. GRO_T` Tc_:
F:on- 0 To � F:.
From 3 To—L) Ft J F
14. SCREEN:
From Tc Ft.
Fr;n: Te Ft. in.
15. SAND GRAVEL PACK:
Deo:h S:ze >L:eria'
From To Ft.
•Fror.: To Ft.
D —57
7 7027
spa
ai
LOCATION SKETCH
Show direction a:-.d' 1:v..n-re ir. rile; from a: leas:
two S:ate RL ads or Ces:. Roads. Include the road
❑t:1:=ers and common road e2-cs.
Size (9)11rt
in.
16. RE).!ARKS-
I DO FEKEEY CEP.TIFY THAT THIS WELL \VAS CONSTRUCTED IN ACCORDANCE CL ITH. ISA NC' C 2C. WELL
CONSTRICTION STANDARDS. AND THAT A CORY OF TciS F..ECORD HAS SEEN PROVIDED TO THE WELL QV. ER.
SIGNATLREOFPERS')NCON TR_CTINGTHE \':ELL D.=.TE
Submit the original to the D"i-'oa of Water Qu-lily, Ground'..:tee: S:rtioo
1536?lai(S:rti:: Cer.::r-ReIeigh,NC
27d9)-1535 Phone No. [phone]. i'•ithin 30 days. GS:-! REV. 07 20

WELL CONSTRUCTION RECORD
'7fjeir i lr;(0/
Fro::: 0
Fran: Tc
Tc
13. CiRCC. T:
Iron b T;
From 3
14. SCREEN:
From Tc
Fror: To
15. SAND GRAVEL PACK:
Dept
Frr: To
•Fror.. To •
16. RE\!ARKS:
Tore: code- Ppw:c r_::i:
4. DATE DRILLED 9 —IOC o lF
S. TOTAL DEPTH: 9-0S
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO
7. STATIC D: ATEP. LEVEL Below Top of Casino: il/O FT.
(Cs: `t" iT Abovd Top oT Casks;
S. TO? OF CASING IS 1 FT. Above Land Surface-
-Top uf t:rr.iir!J ICbr b duo land surL ce req u;res u
sariunc.- in acord:.,� ii n 1:h Ii:\ NC\C IC AI
9. YIELD (_pm):' `t3 METHOD O: EST
10. WATER ZONES Id ; ht: 3J 0 t
3 go cf d ') Lo AT10N SKETCH ..
11. DIS' FECTPJ\.: Tcuef 1-I4 ... 7_S'oc direction arSdis:aa_r in miles front a: least
12. CASING: - v.: i Titi xss r.ro S:!:e Rcads cr Co::nt Roads. Include the road
De: h Cr V. eIch:Tt. \t.••_:.; ra:::_ ers and cor.,nw road car.les.
Tc d 7 Ft. Sale 2-/
Ft
Ft
F; !i n /
Ft
4-0
i':o;th i-t;iwhoa - Department of Environment and Natural Resources�- Division of Water Quality- Groundwater Section
\1'ELLCONTRACTOR(INDIVIDCAL)NA%IE (print —WI
/�_p c24 A.a 13 BY E �� • CERTIFICATIONR O
WELL. C01"!R:-ACTOR CO;IPA\1'\A\IE {-T V-faf>—O LL1 ei1 MAI PHONE
STATE WELL CONSTRCCTI ON PERMIT ASSOCIATED R'Q PERMIT:
(ifaoolicable)
(if applicable)
I. WELL USE (Cheek Applicable Box): Res! entia! T(G MunicipaU Public ❑ Industria! 0 Agricultural 0
Dlonitorin_ 0 Recovery 0 Heat Pump Crater Injection 0 O:her 0 It Ocher,List Use
2. WELL LOCATION: Topographic/Land setiine
Ae rostTot . (I A- Cot vc�L } ❑Ridge OSIo [Walley iat
b'+ )) of f'''1i t2 4 whit le,t- fV C (zhe.ck >)Propr._:e box)
•
(5:ce:: Sa::x. N.:-ceri. Ccrnior.ic ..S divii:or., Lot Na.! Zip Code) I Latitudellonzitude of Well location
3. OWNER:
F\ddr:ii
cr T9a..a7_S5' :' . /9g Zip Cod,:( : cJ
(dtpteCrninu:es:Rcords)_
Latitudo'longitude sour;e:OGPSOTopogr_phi: nap
(c :; box
DEPTH DRILLING LOG "
From To Formation Description
rnh
Dia,::e:c- Slot Sze Afa._.,n.Qtair—Q
Ftin.
Ft. in.ia.
Ft
FI.
S:ze
1 DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN .a.[OCO?DANCE WITH NCAC 2C WELL •-
CONST TI N STANDARDS. AND)THAT A CQ"i OF THIS F=CORD FAS SEEN PROVIDED TO THE WELL OWNER•
�J'� i� Gam- glib vs
SIGNATURE OF PERSON CONSTRUCTING THE \':ELL DATE.
Submit the original to the Di'ision of Water Quality, Groundv a:er Section. 1536 ?la" S:ni:e Ccr:er-Raleigh, NC
27699-1535 Phor: No.[phone], within 30 days. Ge:-I REV. 07.200

. WELL CONSTRUCTION RECORD - i 74
North Carolina - Department of Environment andN-��at((urra�al keesou -es - Division of Water Quality - Groundwater Section e-/-
,
\WELLCON7RACTOR(INDICI D CAL) NAME (print)__} / 1 1 _e r CERTIFICATION:
�/�/ / "fi5�
WELL CONTRACTOR CO�IPAN)" NA?IE: PHONE: (gag sd(C ` Sfft
STATE WELL CONSTRCCTION PERMIT: ASSOCIATED WQ PERM
(ifapplicable) - - (ifaooticable)
I. WELL USE (Check Applicable Box): Residential") Mun ipaL Public ❑ Industrial 0 Agricultural ❑
'Monitoring 0 Recovery ❑ - Heat Pump Water Injection 0 Other 0 li Other, List Use
2. WELL LOCATIO�N:-,I"
Near:s:Town: C_ner'D � Coun('v
q pr CA--cti \ ke_r rl �i4 5 1J ((�Gr�'k `e; ti
(Situ; Nate. Nu:abes. Ccr.::nuiicy. 5a`.di:ision, Lot Na.. Zip Code)
Topographiaiand setting
❑Ridge elope ❑Valley ❑Flat
(nh.:rk appropria:: box)
Latitude/longitude orwell location
3. OWNER: ern (d:;raiaiaus's:eor.Hj
Addr:si '�ol) 1 rd.- I //� P-, La:iter'._'longitude sour:e:❑GPS❑Topo.r_?hic nap
(Siege' or P.ou:e No.) ! (c e:: box) .
VVeA3 $n-1c;rncca f L -1 34/0f' DEPTH DRILLING LOG
Cc e-Tu..n 5:.ue / Zi;Core From To Formation De.-ripti•on
cascia. q7S— &adq
A-u ai:-Punic
4. DATE DRILLED a. —v
S. TOTAL DEPTH: GicgA.,
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO Al
7. ST.ATIC WATER LEVEL Below Top ofCasin2: / 0-ZI FT.
(Cst''" if Abo'.o Top orcasing',
S. TO? OF CASING G 1 FT. Above Land Surface-
-Hy u(ea>ing t:rnL:ru::d a:.ur betun Ind su rfne requires u
>siunce in aczordr.`.: • with ISA CAC 2C .0! 13.
9. YIELD (pr..): ' (./ METHODO�F TEST A I r
I0.V.ATERZONES(d:p:h): (,QSO
�// LOCATION SKETCH •-
II. D!S!NFECTION: Ty; j+Tt4 ? -ou, elhee.i,) 7 Sn-,v direction a^.. dis:ance in riles from a: leas:
12 CASING:: VT.! Thickness t•VO State Roads or Co::a: Roads. Include the rood
corn:nor. road c_-Cs.
z �VC
De;:':
Fro: Q To a v
Fro..: To
Fro , To
13. C1F01,.T: Dc-
From p To -3 Fr
F1::: To 7 C7 Ft
13. SCREEN: D_;:;. D
Fran.To Ft.
From To Ft.
15. SAND -GRAVEL PACK: •
Daorh S:z
Froc: To F.
Fro.';. To - Ft.
D��::�r-�.jje�ep�:
FT._jm $DRZ /
Fr
Ft
16. P.E\IARKS
ir.
S:ot Size
in.
1 DO HEREBY CERTIFY THAT THIS \':ELL WAS CONSTRUCTED IN ACCORDANCE WITH I3A NCAC 2C. WELL
CONSTR_CTIONSTANDARDS. AND THAT ACOI' 'i OF THISP_COLDHAS BEEN PROVIDED TOTHE. WELL OWNER ..
•
•
-St) ("sr\ ,- C.k� -\ — 5 - vs
5:GNATLREOFPERSON' COCST?.J?TINGTHE WELL DATE
Subr.:it the oriinol to the Disision of Water Quality, Ground"ater Section. 1536 Nisi! Service Ccr..:er-Raleigh, NC '
7699-1335 Phu:.: No. [phone], ssi:bir. 30 days. G\`:-I REV. 07:209:

WELL CONSTRUCTION RECORD
number
DATE DRILLED 1o� —/0�1 —o
5. TOTAL DEPTH:
66
6. DOES WELL REPLACE EXISTING WELL? YES IONO
7. STATIC WATER LEVEL Belo,W Top of Casing: I C� L) FT.
(Use ",' if Above Top of Casing...)
S. TOP OF CASING IS I FT. Above Land. Surfa.e'
city of cvsing terminated at ur bdu.� kind surface requires a
variance in accordance� with 15.A \C.\C 2C .0113.
9. FIELD (aonl: ' oCd METHOD OF TEST ' i r
10. WATER ZONES (depth): a..4s
G:c or Town 5tat: Zip Code
( 6' 7 0 3 557
Area :odd- Phone nu:n
North Carolina - Department of Environment and [�'alurw al Resourcesr- Division of 1Fater Qualit} - uroundreater Section / (�
WELL CONTRACTOR(INDI\'IDUAL)NA>IfE /(�prii�nt)%n'�FJGU-t.C. fc•J( (,1 n,�' . CERTIFICATION i 3�vjJ� , /,
WELL CONTR:-\CTOItCO)IPANVNAMIE AAA l�Yeenr /�71�' WaLD/ �--PHONE# f(kJQO -U sCO
STATE \WELL CONSTRUCTION PERNIIT# ASSOCIATED \VQ PERM T4
(if applicable) (if applicable)
I. WELL USE (Check Applicable Box): Residential ja( Municipal/Public 0 Industrial 0 Agricultural ❑
\lonitoring 0 Recovery 0 Heat Pump Water Injection 0 Other ❑ It -Other, List Use
2. WELL LOCATION:
Ne est T wn:y
ounty
(Stca: Saute. Numbers. Ccmmunit). Subdi(isio 1, Lot No.. Zip Code)
3. OWNER:, C1111in 40E3Addr.:ss entsi q71:7a12L f�%/]
IL DISINFECTION: Type VI T k+
12. CASING:
Deptham�-:cr
FromTo_/.2 Ft. n %¢(-
Froth To Fr.
Front To Ft.
13. -GROUT: Depth Material Method
C From v To 3 Fr. `
' From 3 To GO Ft.._
Depth Diameter Slot Size
To Ft. in. in.
in. in.
Topographic.'Land setting
❑Ridge , Slope ❑\'alley ❑Flat
(check appropriate box)
Latitude'longitude of well location
3p
77
(de_rees:minutes's conds)
Latirudellongitude sour:e:❑GPS❑Topographic map
(:i:e:k box)
DRILLING LOG '
• Formation Description
DEPTH
From To
Amount Id IS.az
Wall Th ekness
or V. ei_h:Tt. c!
cOR
•
16.RE\!ARKS:
1 DO FiEREBY CERTIFY• THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE 'WITH ISA NCAC 2C, WELL
CONSTRUCTIO." T..NDARD5 ND THAT. COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
/- /a
1-t. SCREEN:
Frora
Fran: To Ft.
15 SAND GRAVEL PACE:
Depth
From To Ft.
From To Ft.
Size
Nlater:al
LOCATION SKETCH
Show direction and+dis:ance in miles from at leas:
nvo State Roads or County Roads. Include the road
numbers and common road names.
SIGNATURE OF PERSON CONSTR'LCTING THE WELL
DATE
Submit the original lathe DIN ision IS ater Quality, Groundttater Section, 1636?lail Ser\iceCenter- Raleigh, \C
27699-1636 Phone No. [phone], within 30 days. - GP. 1 REV. 07:2001
2,5-

WELL CONSTRUCTION RECORD V 0 2 6
tNorth Carolina - Department of Environment and ral Resoures - Division of Water Quality - Groundwater Sections
\CELLCONTRACTOR(IND(\'IDUAL)NAME (print) _L�c•� CERTIFICATION:
--�j/1�o`("/
WELL CONTRACTOR COMPANY NAME ' Y •nt ( Le ,�/ PHONE C refae 7 o
STATE %VELL CONSTRUCTION PERMIT; ASSOCIATED U'Q PER3IIT
(ifaoolicable)
(if aoolicabtel
1. WELL USE (Check Applicable Box): Residential* Municipal/Public 0 Industrial 0 Agricultural ❑
Monitoring 0 Recovery 0 • Heat Pump Water Injection ❑ Ocher 0 II Other, List Use
2. WELL LOCA((�\�N: �(� � D �
Narrdst Town J-&L?JL4-&t' County
l g M-Qzh /-itQ.PA
(S.{ Nn:He. Nu: -bars. CO Unity. Sibdicision, Lot No.. Zip Coda)
3. OWNER: -
Addr. s OtL /0
ll{00(5:ra:: or Roue No.) Ca8796.
rc cr TO,O 5:4!e T,�7 �Z i; Coda
(8 SOS -sad
Area C.da- P:.or:a ems::;•e: ,,//
4. DATE DRILLED I I ^ 9 ^ OY-
5. TOTAL DEPTH: Za..073
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO);
7. STATIC WATER LEVEL Below Top of Casing: Ic2 0 FT.
(Use `." i:',Vr.ove Top of Casi:.; t
S. TO? OF CASING IS ( FT. Above Land Surface
•'Tiy of rmiug t:rn. ti. r d aCur baturr Iaad Sur Lee requires 2
in at:
9. YIELD`I '-+r.) rd ':'+Lyh Is METHOD OF3TEyT At r
LiS�) L' LOCATION SKETCH
1 !. DISINFECTION: Type 1-�TH r .\.u.3 at- 113' n 2_ SriJ'd' cibection a.^.dais:an'e in miles froma: leas:
12. CASING: V:_ i Thickness
or e' h:.
Fi. U_ n;:• ..-
o:r:• ; s and coon road tames.
To� Ft- tvv.�1 '5o a2.J -OC-
.
TopographicfLand seCting
.QRidge ❑Slope ❑\'alley ❑Flat
(check appropriate box)
Latitude'lonoitud: of well location
(degreesiainu:eair-orals);
Latitude/longitude source.❑GPS❑T6pooraphic map
(chef,:box).
DRILLING LOG'
Formation Description
DEPTH
FromTo
l0. WATER ZONES (d•pth): a tit
Fro::; a
Deeth
Fran: To Ft.
FranI To Ft.
Iron13. G RO T: Dco: .A a.
Iron 3 To 20 Ft
/
14. SCREEN: Dcrth Diameter S'o: Size .A� I,:eli:: v 'T
From. To Ft. in. in.
From To Ft. in. in.
I5. SAND GRAVEL PACK:
Depth Size NIa: r!a!
Fror: To Ft.
From To Ft.
l6. REMARKS
T..o S:a:e Roads or Co::nr: Roads. Include the road
1 4 200Eii
I DO HEREBY CERTIFY THAT TFiiS WELL WAS CONSTRUCTED IN a C CO' D'.NCE WITH ISA NCAC C. WELL
.. �
CONSTR; ` ONSTAND ., 3. A HAT A COP': OF THIS RECORD FAS BEEN PROVIDED TO THE WELL OWNER
/- /D't
SIGNATURE OF PERSON CONSTR_CTING THE WELL DATE
Submit the original to the DRIi-on of N ater Quality. Ground+ - Free Section. 1536 \ItiI Scnt Cer er Raleigh, \C
27a99-153 a Pharr: No. [phone], v.irhin 30 days. G\:::I REV07.200:

WELL CONSTRUCTION RECORD el ' `_ S a O
North Carolina Department of Environment and Na Resotaces Division of Water` tt lity `.., a -
c� ; -13 . CERTTFtcwnoN# 3 D
WELL CONTRAC[ R R'tDUAL) NAME s-������d�-c-c
WELL CONTRACTOR COMPANYNAME 4 Pill- ren-e 17iirs �/a-i 1Jd f PHONE # (Sall S-
-
STATE WELL CONSTRUCTION PERhIIT# _ ASSOCIATED WQ nitwi #
(if applicable) - - - - - (if applicable)
1. WELL USE (Check Applicable Box): Residential Blr Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use - -
2. WELLLOCAT,I2� ( Topographic/Land setting
Nearest Town:
Ll(XC ��[e� �oUnty r GS1n.- DRidge ❑Slope Malley f7Flat
.t_ 1 " (check appropriate box)
'ode) Latitude/longitude of well location
3. OWNER: 'G ' )�(.('Dc
Address o t c-V / /71 )
r 7ais t�,(Sveer0yVpC 29707
City or Town State Zip Code
Area code- Phone number !.
4. DATE DRILLED I /- / - O (%
5. TOTAL DEPTH: Qr7 Q
6. DOES WELL REPLACE EXISTING WELL? YES O NO J�
7. STATIC WATER LEVEL Below Top of Casing: 4/0 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS ) - FT. Above Land Surface*
'Top of casing terminated atlor below land surface requires a
variance in accordance with ISA NCAC 2C .0118.
9. YIELD (gpm): (o 0 METHOD OF TEST A / v-
10. WATER ZONES (depth): of S (Jv LOCATION SKETCH p
11. DISINFECTION: Type t-(- T /-i Amount �/� 0 f Show direction and distance in miles frorh4leas
12. CASING: Wall Thickness / two State Roads or County Roads. Include the to
Depth Diameter or Weight/Ft. Material numbers and common road names.
To 4 Ft. (c 4/1 5A727-/ Fi/C
To Ft.
To Ft.
Depth Material
To g Ft.
To Za) Ft. p
Depth Diameter Slot Size Materi
From To Ft. in. in.
From To - Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Size Material
(degrees/minutes/seconds)
Latitude/longitude source:OGPSOTopographic trap
(check box)
DEPTH DRILLING LOGr ,
From To Formation Description
From 0
From
From
13. GROUT:
From 0
From
14. SCREEN:
From To Ft.
Method
V l
14-WellaSeeez-
Ot`r-e-j\F-kdA4
From To Ft.
16. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C,. WELL
CONSTRUCTION STAND S, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER SSIGNAONSTRUCTrNGTHE WELL DATE
Submit the original to the Division of Water Quality, Attn: Information Management, 1617 Mail Service Center`.
Raleigh, NC 27699-1617, Phone No. [phone], within 30 days.
GW-1 REV.09/2004

From
From
16. REMARKS:
WELL CONSTRUCTION RECORD ��% ' O CI (, to
F urw Larolma Department or Environment and Natural Resources - Division or W at€r Qt ail r - / 5755 7)
WELL CONTRACTOR (INDIVIDUAL) NAME (rot).
pi •^+. .tci CERTIFICATION #,,
WELL CONTRACTOR COMPANY NAME
STATE WELL CONSTRUCTION PERMTT# - ASSOCIATED WQ PERMIT#
(ifapplicable) (ifapplicable)
PHONE # Safp 'SSS�
1. WELL USE (Check Applicable Box): Residential] , Municipal/Public 0 Industrial 0 Agricultural ❑
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCAT
Nearest To
(Street Name, Numbers, Community, Subdivisib Lot No., Zip Code)
3. OWNER:
Address "l V pL
�t (� tetsos
(�or7tunte// 1 1C _02
City or To �a Zip Code
sair 3-7a0 - `cis -
Area code- Phone number
4. DATE DRILLED /O -A g - 03
5. TOTAL DEPTH: / (S%)
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO Cr
7. STATIC WATER LEVEL Below Top of Casing: ,2 WO FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS j FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance U accordance with 15A NCAC 2C .011& 9. YIELD (gpm): / 3 J,/ METHOD OF TEST A 1 r
10. WATER ZONES (depth): 1 (p S- — 1
11. DISINFECTION: T 7 3A/
YPe 4-R-T1-j- Amount (/5 p 71
12. CASING: 7
Wall Thickness
Depth Diameter or Weight/Ft. Material
From From�) To 7 A Ft. L J j Sp R 2-1p
/ / tl G
To Ft.
From To Ft
Topographic/Land setting
❑Ridge fiSlope ❑Valley OFIat
(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
1pS-T6Y
/lnr—/(oS1
/ th 8 — 735'
735-737
737—)Pat
LOCATION SKETCH
Show direction and distance in miles from atelgast
two State Roads or County Roads. Include tlfdioad
numbers and common road names.
13. GROUT: Depth Material ..jjMe thod / O 7
From O To - Ft. ' /d f ag
From 3 To Z.ti Ft. % rJaf
14. SCREEN: Depth r/� n a 1-
From P Diameter Slot Size Materi ,1-L,fe�C_ ) e%C-`c�t-
To Ft. in. in. r v
From To Ft. in. in. �,-- / 9 t %
15. SAND/GRAVEL PACK: 7 7
Depth Size Material
To Ft
To Ft.
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STAND S, AND THATA COPY OF yWS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
Submit the original to the Division of Water Quality, Attn: Information Management, 1617 Mail Service Center -
Raleigh, NC 27699-1617, Phone No. [phone], within 30 days.
, GW-1 REV. 09/2004
r3— 1 - a��.

AN ELL CONTRACTOR (INDIVIDUAL) NAME (print)
WELL CONTRACTOICCOMPANY NAME Ant
STATE WELL CONSTRUCTION PERMIT*
(if act:al.:able)
. WELL CONSTRUCTION RECORD -TS% 1,
Nortil Crirolina - Department of Environment and Natural Resources - Division of Water Qualizy - roundwater Section
-74. S (0
et F-4 In ina-Th -5-- CERTIFICATIONS' cp.- s-577
ree4egros wed 3,4 PHONE * (stIOWSWSISrd
ASSOCIATED WQ PERMIT:
(if =Sloth:el
I. WELL USE (Check Applicable Box): Resident' Municipal/Public 0 Industrial 0 Agricultural
Monitoring 0 Recovery 0- Heat Pump Water Injection 0 Other 0 It -Ocher, List Use
2. WELL LOCATION
Nearest Tow
-ir
. Numbesi. Co unicy. Ni.. Zip Code)
3. OWNER:
Addross
to cQ377q
A2151; — 5 3 Vtin
A7o.: cc.1t- Iee.oste
4. DATE DRILLED .7- et 'lb (I
5. TOTAL DEPTH: 3-.SZ
6. DOES WELL REPLACE EXISTING WELL? YEWO/VA
7. STATIC WATER LEVEL Below -Top of Casinc: FT.
test•-r- if Abo.e.i-or, of Cosir.r.
S. TO? OF CASING IS / FT. Above Land Surface'
--r.,2 of elnili tzrnitutol Lt!..tir botu, Ind sur14:e risq u1rts u
‘3sItinos ix acetsrdsnee 1% ith ISA NCAC 2C .011S. Dems
9. YIELD (corn): '9. 1.(a.. METHOD OF TEST - i ra
N.— p
Topographictand setting..
ORidate »S!ope DValley °Flat
(zhect; nropriac: box)
Latitudellongituck ofwell location
(depetitinLatilstcor.di),•
Latitudollongitude source:OGPSOTipographic map
(thck box)
DRILLING LOG "
Formation Des:rip:ion
DEPTH
Front To
-
.R30.
10. WATER ZONES (d.:pri): YLc
LOCATION SKETCH
7.50 7_.Show direction and'dis:an.re in miles from a: ICA:
I I . DIS:NFECTION: Tyrie 44 1-14
12. CASING: %Val: Thickness two S:ate Roads or Roads. Inzlude the road
-"..- corn
or WeFt. Mater:-! r,unibtri and :mon road
r.27.es.
6
Fro::: Te Ft.
Fron: To Ft
F To Ft
13. ciROI.T: 0:c: ," .... z_N!t':'::Od
Frori Li- S--
Fron; To ...I Fe, ) Y-ts-r"..
To 2..0 Ft }.. cpc,/,-12.0.14 le %riltlir- fir& ,
I4. SCREEN: Depth DinEne:;.7 S:o: .5;:t: Nta:er::.! A
F roi: To Ft. 11.in.
Frorn To F. in. in.
13. SAND -GRAVEL PACK:
Dzpen S:z2 Mreria:
' To Ft.
To - Ft.
1wic-tot,
Fror:
Fror;
(6. 16. REN!.ARKS:
--movkal, .
I DO HEREBY CERTIF‘ THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A \CAC 2C. WELL
CONSTR:CTION STANDARDS AND -HAT OP'. 0" n 'CO HAS EEEN PROVIDED TOME WELL OWNER :
S:GNATLRE OF PEI' SON CONSTR._CTING THE WELL
Submit the original to the Di‘ ision of Warr Quaiirv, Oround...ater Section. 1536 :‘1.0 Conte:. - Ra!eigh, NC
27699-1536 Phonr Na 019; 733-322 I, v.iihin 3 0 d.as. G • ! REV. 07 200,7,

WELL CONSTRUCTION RECORD
76i-6o-gYt .
\onn Carolina - Dcparnnent of Environment and Natural Resources - Division of Water- (Quality - Gtoundivzier Sec iLun
\PELLCONTRACTOR(INDIVIDUAL)NA\IE (print)Pa 6G !CMS ,D �• .t_c CERTIFICATIO\:_c/ 4
\FELL CONTRACTOR COMPANTNAME f2»4i: Pe/)-S WPa PHONE clawJfOlp'S�`�-
STATE WELL CONSTRUCTION PERMIT; ASSOCIATED \\'Q PERMIT:
(ifaop!icabte) - (ifaoolicabte)
1. WELL USE (Check Applicable Box): Residential ts1 Municipal/Public ❑ Industrial 0 Aericul[ur_I ❑
\lonit ring ❑ Recovery 0 - Heat Pump Water Injection 0 O:hsr 0 11Other, List Use.
2. \'.ELL LOCATION: np i'I
Maros: Town: LW) 1'F4-tg.-&-) County
Sate. Nra;::i. Cc-•.,u. irv. Sj5•'icisioa. Lot No.. Zi? Code)
1
3. OVNER:^reSCel.- 1171%-�-t.✓t.
Address rQSL C')iiZQ-mil 6'
Cr:: S:jt- r Zip Cede
4q7 —7aoC
A-e
4. DATE DRILLED i� a - CAL
5. TOTAL DEPTH: --3CJO
6. DOES WELL REPLACE EXISTING WELL? YES ❑/�-".I�\O
7. STATIC WATER LEVEL Below Top orCasing: r-2V FT.
(�s: i'Aio. Top oTCosinsi
S. TO? OF CASING G 1 FT. Above Land Surface'
•Tnp u.'rutiny t:r i flj u 1'ur beluv I4a1 su rL a' requ;ees
s-ri2nee in a:cn: Jin:e s.i:h tie\ \CAC 1Cmils. /�
9. YIELD (_cn;: ' C� METHOD OF TEST I'1 f Y
ID. WATER ZONES Id:p:h): )St — / Dr
.tse, —op
aOL,
Topographicr'Land setting
❑Ridge ❑Slope Malley ❑Fiat
a;pmp _••• box)
Latitude'lon2imd. of well location
(dt.gatiininu::sszeonds)
La:I:Lid:!longitude sour;e:❑GPS❑Topouraphic ma?
(:?_: box)
DEPTH DRILLING LOG ('
From To - Formation Description
—SE3
aye) ---25M
x 3 - 30--0
tV
/g LOCATION SKETCH •( p
I I. DISINFECTION: Tyee }+ Y/4 Am, Lint /cl r 3 & Z Sho.v direction a..d•dis:dnx in mile from a:r1,1s:
122. CAS!NCr: \':_: Th'ekr.ess [::o State Roads er Co::^:y: Roads. Include the road
�).>,� Di-.. e::r or 1': e:oh:Ft. \' •:cri.:! n::::�ers and coan.on road'. L2' IT S.
Fro:::Tc'i 2S Ft. 1,,X1 S-I'Pe I
Fr, n: To Ft
To Ft
13. GR01:11 Dc„ :\!. \!::',:.: /-v�
Frori U To -3 Ft. .01'e'rr..� /TLC
: To %.a) Ft ,Ltd 2St
f�� A;'' 1 f%fi//
I.. SCREEN: Dc-:;• Dian•::::. Ro:.S a mi , it, (j ..1/ o
Froc To Ft. in.
ss. /1
Fr;r: To Ft. in. i n. �7- --GG""��77
15. S.AND GRAVEL PACK:
Depth S:ze \la:cif
8
Frog: To Ft.
•Front To Ft
16. RE\!:ARKS:
1 DO FIEREE}' CERTIFY THAT TF.iS WELL WAS CONSTRUCTED IN ACCO?.DANCE WITH I A NCAC -C. WELL
CONST I.CTION.jt;ND RDS.ANgTHATACOP•i OF THIS F_CORDHAS HEN PROVIDED TOTHE WELL OWNER
,
-
S!GNATCRE OF PERSON CONSTR_CTING THE 1.ELL
-(2 D 5-
DAiE
Submit the original to the Dhision of Hater Quality, Ground,: a ter Section. 1536 ? Tail S:ni;: Cer.:er- Ra'eigh, NC.
22 %d99-1535 Finn,: No. (919) 733-3-'-'1, nithin:0 days. G1`•-I REV. 07.2001

Topoeraphic/Land setting
J. L--t.� Co tray .r -- ❑Ridge C !ope ❑Valley Erb:je
t.- y-H' . - L(i(ijZ_ (k) `, 444r /1C .),F 7� (:hack appropri_:ebux)
(S:r:::N,a:,te,N]:nbtts.Community. Subdiiision, Lo:Yo.. Zit ode) s Latitude longitude of well location $a
73
3. OWNER:\ / iY(i.) (de;:: r..inu:es cor..Cs)_ . IN.)
r / Lati tudolonuitude sour;e:❑GPa❑Topo;r p!tic map
(:: boxy 0 '
DEPTH DRILLING1_. .a
From To Formation Description
. WELL CONSTRUCTION RECORD � /c.VUS vv
tic 5-07 .39 .4--I
Norris Larolina - Department of Lncironrnent and Naturat Resources- Division of 1A roar Quist - Looundivater Sccuon
m'ELLCOSTRACTOR(INDIVIDCAL) SAME (print)al to n7P Pith CERTIFICATION? �1-Q �J
<
WELL CONTRACTOR CO3I PAN \- NAME 4 6Y I/fy-5 /yo n.e. pt tc PHONE # (ZoI r& - ..a C'p
STATE \TELL CONSTRUCTION PERMIT; ASSOCIATED \WQ PERMIT:
(ifapplicable) _ (ifapolicable)
I. WELL USE (Check Applicable Box): Residentia!bMunicipal!Public 0 industrial 0 Agricultural ❑
Monitoring ❑ Recovery ❑ - Heat Pump Water Injection 0 O:her 0 It -Ocher, List Use
2. WELL LOCATIO
ar;s, Town:
Add :ss C
0RNa.)
.4 °Ta or Rout: .. C C2Si;
:'. _
f�-
Cr Town S:.tte Zipo.!
(x,26 3 f —
Area c.do- ?nails ra:c5:- //
DATE DRILLED 7' 3 "d 4
15. GRI_T.
Fr, rl 0
5. TOTAL DEPTH: i9) v
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO
7. STATIC \t'ATER LEVEL Below Top of Casino: /at
(Lis if .Abo'.a To oPCailr.il
S. TO? OF CASING IS / FT. Above Land Surfa:e•
aviin;; tar dna:ad na'ur bclu" land surLu• reyuirri o
arian:s in ac:nrdr..:• si:h 15.\ .CAC 2C AI IS.
9. YIELD(:n,` ' td .!EJJHOD Q=TEST gilt"
10. WATER ZONES (d:p:h): L 5'at& L r
FT.
I I. D!S!NFECTION: Type /-f Amount. ifr•S ri -A
ir
12. CASING: P:_ I Thickness
De D' rne'c _.'t .. -Tt
Fro::: (0 To,; )
Econ.: To Ft
To Ft
Nic:c•r:a!
T: F' C
Fro,., 3 To xR.0
1T. SCREEN: Dc_ch
Froth To
Frar; To
1=. SAND GRAVEL PACK
a
‘Ti a-v (/�" �i y���/
Ft �: �C-). .-,a rr7�/�. u,'-!..;rJ� - Y r r• r'
Dame:er Soo; 5 „ :::".11 �i
0—/17
117..4%L
IL/6'-IY7
ez-7(0r-rya
.45-.37J
75- 377
377-v-/Q
CLt1.-.
. YI 2J
LOCATION SKETCH
Sho.v direction r.nd'disi n:e in riles from a: leas:
t.vo S:a:c Roads or Ca.:r:; Roads. In;line t^e roe C
r:....,•s end common road names.
es.
Irk
Ft. in in.
Ft. in. ir.
Da,ti S.ze Ala...,_.
From To Ft.
.Fror: To Ft.
0&tc
1E. REMARKS:
1 DC) HEREBY CERTIFY THAT THIS \\ELL WAS CONSTRUCTED IN A'_CO2.D.A.ACE WITH 15A NC AC'C. G:ELL
CONSTR_CTION STAND. ,RD-. AND THAT .A COP OF THIS P=CO3D HAS BEEN PROVIDED TO THE WELL OWNER
/ 2-7 -nos
S(GN.ATLRE OF PET:SON CONSTR'SCTING THE WELL
DATE
Submit the original to the Di'isioa of Water Quality, Ground.,arer Section. 1536 ?fail Scnice Crn;er- Aweigh, NC
227699-1636 Hun: No. [phone], v.ithin 30 da>s. Gat..-1 REV 07.200'
T.0

. WELL CONSTRUCTION RECORD
- s13o0
S s 9-07-377)
North Carolina - Department of Encironinent end Natural Resources - Uiv st/on of Warr Quality. - Glouridaater Suction
WELL CONTRACTOR(INDI%.IDCAL)NA%IE (print) a AriI/1 17apt (/]{.,T , CERTIFICATION# Qr9 7
WELL CONTRACTOR CO\i PANT' NAME R^/%"GM0-tP` L!/a!/
STATE \c ELL CONSTRUCTION PERMIT.: •ASSOCIATED WQ fER?11T=
(ifappli.aot) _ y. (ifeoolicab!e)
1. WELL USE (Check Applicable Box): Res!dentialX Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery ❑ • Hat Pump Water Injection 0 Other 0 If Ocher, List Use
2. WELL LOCATIO
Near:..Toren:
to tc..zi
Couch
�ctL_�v
Na::::.N_:.i.—s Cc --n_m ... S-._r; isdu::, Lor No
3. OWNER:]7
Addr:ss 6- 0 / 7/
iLr'; zE or Roo::
!�1
(1.-CC C (.1S7�73�
PHONE
t48688
Topoeraphic/Land setting
Ku— ['Ridge cg!ope ❑\'alley ❑Fla!
'. (fuck 2?rw;,i_::bus)
Z'pC =) La;itud_'longitudrofv:ell location
•
1!. D!S!NFECTIO\:Tv:'. ,-f iFt
12. CAS!NG:
D:_;h Dsre:a: r
�
Fro::: 0 To SY V Ft. 61 14e 5p, 2! vrt_
Fro:: To Ft
Fro::: To FI
13. GRO_.1 Lup:'. :\:..::ri:: \1..:"-
From 0 To S Ft 0 Q r.-c;4- '-/C
Fr':: 3 To 2bj2 .O Ft -.— 1 co-
14. SCREEN: Dapc% Dar:::::. 5:0t S:zc
From. To Ftin. in.
Fran: To Ftin. in.
15. SAND GRAVEL PACK::
D:s:h 5:ze Ala.-,._.
From To Ft.
•From: To . Ft.
�-r,,.- s:.ti: Zip Cc.:
rx�-63% VS/
Are: are- Peor::
4. DATE DRILLED-7-4—OSt-
5. TOTAL DEPTH: ‘,Ct)
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO 1..'?(
7. STATIC WATER LEVEL Below Top ofCasinc: /07J FT.
ifA;u-. Top oTCnsicgl
S. TO? OF CAS!NG IS / FT. Above Land Surfaoe
'.1a ,ing turn:iru;:G aGur Leo, tine mL r:rr e y:ire)a
t.•tr. ISA NCAC2C.OI13. �j
9. YIELD (_,- ): ' % \!ETHOJ OF TEST l7!{—
I0. '.YATES ZONES (d:p:h): 4y y.r'/r•) 6-%t0Amount 5
'
C`
V•tc!i Titickneess „
16. REN!ARKS:
•
(d-z:: ;iaiaures.Secor:ds); b .{
Lain:'_:'lor. eitude sour:e:DGPSOT_opogra liF ma
(obork bus)
DEPTH DRILLING LOG
From To Formation Descation
43(3 - 4-57,
,5 5a - 4- o 0
LOCATION SKETCH .:
S::otv cir:aioa an6'dis:an;e in miles fro::: a: leas'
t.00 Sate Reads Cr Ce::a : Rc Js. Inau_re the roa6
r.:.._::s a..d common r....'. r.a ies.
e
/n24,
. / c/
IDOHERESYCERTIFYTHATTP!SV:ELLWAS CONSTRUCTED INACCO D.ANCEC'.ITHI5ANCA.C22C.WELL
CONS-Fit_CTI AS cTa,N DATAC iOF TH;SF=COvHAS EE_ENPRO's'IDEDTO THE \`.ELLO','•XER
%t�y'`,'r`
S!GNATCRE OF PERSON C0NSTRCCTING THE WELL
D.1.TE _.-
Submit the original to the Dil;sion of Water Quality, Crooner. ate; Section. 1536'!all Sonic: Ccr,:e:- Role!gh,NC
27699-1536 Pilo::: No. (919) 733-32221, xithin 30 dais. GP.-! RE1'. 07.200I

WELL CONTRACTOR (IYDIVI)UM4 NAME (-runt) 1w' f fl ! 1 -) -A t Yl •t r,
WELL CONTRACTOR COMEANY NAME {}- ra -C,
STATE WELLCONSTRUCTlON PERMITS - ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
I. WELL USE (Check Applicable Box): Residentially" Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump WaterInjection 0 Other 0 If Other, List Use
WELL CONSTRUCTION RECORD 4ciY / (p c2 -a
..aS[�-'7- r?-74
ro ._ i.�Ly"i L ul o. a:u. UULDJCUL auu Natural Kesources - Ltvt�ton of W ai r Qauauly
CERTIFICATION##, j
J9`7
PHONE # (Sag Ora—�S��..
v08
2. WELL LOCAT
Ne#rest Town:
(Street Name, Numbers, Community, Subdivision, Lo
3. OWNER:
Address • 0
Pr (Snell $$4� Y1 C 4? 7'6
City or Town State Zip Code
(dab- ��'t- t)
Topographic d setting a
❑Ridge ❑Slope Valley ❑F
(check appropriate box) N
Latitude/longitude of well locatiotr—
r1 p
/ 7 Latitude/longitude source:❑GPS❑To hic m
or oute NoNo.)-
Area code- Phone number
4. DATE DRILLED // —
5. TOTAL DEPTH: 11/ (j
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO k
7. STATIC WATER LEVEL Below Top of Casing: / p FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS / FT. Above Land Surface*•Top of casing terminated at1or below land surface requires a
variance in accordance with 15A NCAC 2C .0118.
9. YIELD (gpm): ,- 0 METHOD OF TEST A
10. WATER ZONES (depth): 3 - g 0 ' S —
o., Zip Code) _ n
nc
(degrees/minutes/seconds) 01
(check box)
DEPTH DRILLING LOG"
From To Formation Description
ba—qo
1yS—/V7
V 7 —/qs-
Iqs— /9 7
a4s -a 97
44 7 —cif
LOCATION SKET
11. DISINFECTION: Type T J_/- Amount 1', 14,c D 7. Show direction and distance in mi es from at least
12. CASING: Wall Thickness two State Roads or County Roads. Include the road
Diameter or Weight/FL Material numbers and common road names.
PograP
Dep
From n To
From To
of — /o ) s a9cs'-,
7 Ft. rp I/`f Sfa
Ft.
Ft.
From To 11- /J 7
tD
Depth ja-g1€»
!
To FtTo FtDepth e�
From To Ft. in. in.
Sic
From To Ft. in. in. t� �
15. SAND/GRAVEL PACK:. ` T4tir ! O,t A
Depth Size Material
From To Ft.
From To Ft.
16. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTR CTED IN ACCORDANCE WITH ISA NCAC 2C, WELL
CONSTRUCTION STAND ND THA Y a. t>� S RECORD HAS BEEN PROVIDED TO THE WELL OWNER
bukr
3-1
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
Submit the original to the Division of Water Quality, Attn: Information Management, 1617 Mail Service Center -
Raleigh, NC 27699-1617, Phone No. [phone], within 30 days.
.,, GW-1 REV.09/2004;.

WELL CONSTRUCTION RECORD J S/ A a 6 W
iorut C wlina - Doparunent of Environment and Natural Resour ca/,\lll`ts IOU of v: ater Quaky - uwundµYrerS ttn^� s '
\VELLCONTRACTOR(INDIVIDUAL) N,A%IE (print) I r ml e r- - CERTIFICATION'&
WELL CONTRACTOR CONIPANS'\.{\fEer � ,.-o1`Ox Lt9Q .0 rI PHONE --CR-570
STATE WELL CONSTRUCTION PER-MITIASSOCIATED WQ PERMIT.,
• (ifao0fica5lel (ifaooticable)
I. WELL USE (Check Applicable Box): Residentia!z‘ Municipal Public 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 • Heat Pump Water Injection 0 Ocher ❑ Ir, Other, List Use
Zip CoJ-
Foonc
T. DATE DRILLED /d_ I D
5. TOTAL DEPTH: 'ASV
`f
2. WELL LOCAT ON:
Nearest Town:
(S:re:: Name. Numbers. Com nc)-icy. SuidO /GL
ltJiciiii:, Lot Na., Zip Code)
3. OWNER:$U%YldvS L.,i5
L?A dr:ssCc17 Tn'e fee<r10
au:: Na.
No-,1or
ri sta
cr.. Cr To,i^ Sat:
6. DOES WELL REPLACE EXISTING WELL? YES ❑ N
7. STATIC WATER LEVEL Be!os Top of Casino: a
(L's: r" if Ahac_ Tap of Casinil
S. TO? OF CASING IS / FT. Above Land Surface'
'Top of Casio;; t:rt.inj[.d at'ur bel„o Lind surf.tto requires u
sac ian« in actordin:a ui:h 15A NCAC 2C.tlt 13.
9. YIELD (_?m):' i '!EJHODOFTEST i►ft
ID. WATER ZONES (dep:h): ,Q — I
1 I. DISINFECTION: Tvoe -/--i f Et'
12. CASING:
Fro:r, a
Fro-; To Ft.
From To Ft
13. GRO',; 1 Dcc:`_
From 0 To
From - To
IT. SCP.EEN: Depth
From To
From To
15. SAND GRAVEL PACK:
Depth 5:r
From To Ft.
From To - Ft.
Depth
c:
Topographicitand setting
❑Ridge 5!ope ❑Valley ❑Flat
cack approprizie box)
Latitudellongitude of well location
(dear:efr..iniceis cords).:
Latitude'longitude source:❑GPS❑Topographic map
(a: c:k box)?.
DRILLING LOG
Formation Description
DEPTH
From To
LOCATION SKETCH
lu
r. m. iL.t 3��otb 2 Sho.•c direction and'dis:anc0 in miles from a:
Wan Titiikneii two State Roads or Co;.:n,y Roads. Include the es,e
or \':e: i'eE,h:'.. rrc--'-' miniber s snd cor.trnor. raa'_ r.artcs. t.11
Ifri /
Diir.:e:er 510: SiZa' Maie-F'
Ft. in. in.
Ft. in. ir,.
16. RE\!ARKS
I DO HEREBY CERTIFY THAT THIS WELL \.AS CONSTRUCTED IN ACCORDANCE \VITH ISA NCAC 2C. WELL
CONSTR_CTiON STANDARDS. AND THAT A COPY OF TH S RECORD HAS BEEN PROVIDED TO THE. WELL O'.t1ER
SIGN.ATCRE OF PERSON CONST* CTING THE WELL
DATE
Subn:it the original to the Di!sion of Slater Quality, Ground"ater Section. 1536 Nlail Son!ce Ccr. er- R3!eith,-NC
27699-I636 Phnrc \0. (719) i?:-_"l.uithin 30 Rat S.
Gl`:-! REV. 07200:

WELL CONSTRUCTION RECORD
worm li
l,nrolma sicpy uncut uc Environment and Natural Resources - Division of Water quality� ,
;WELL CONTRACTOR (INDIVIDUAL)NAME (prior) CERTIFICATION#_CRi
WELL CONTRACTORCOMPANY NAME 4 4 D -{_2eff PHONE # (Z2t .r Zc
STATE WELL.CONSTRUCITON PERMIT# -
- "- (if applicable) .
1. WELL USE (Check Applicable Box): Residential 0 Municipal/Public k Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 - Other f5 If Other, List Use
2. WELL LOCATI
ar st Town:
(Street Name, Numbers, ommunity, Subdivision, Lot No., Zip Code)
3.
OWNER:
Address creli±1 TGI
IryO�SLfare ZipCode
Area code- Phone number
4. DATE DRILLED 7 - to —Q
5. TOTAL DEPTH:
6. DOES WELL REPLACE EXISTING WELL? YES 0 NOX
7. STATIC WATER LEVEL Below Top of Casing: FT.
8. TOP OF CASING IS i /� (Use "+" if Above Top of Casing)
'Top of casing terminated actor below landAbove surfce requiirres ad UIfaCCa
variance in accordance with 15A NCAC 2C.011&
9. YIELD (gpm): 75— METHOD OF TEST
10. WATER ZONES (depth): "COI1 44-aS—
(Street or Route N
743
11. DISINFECTION: Type Int r N-
12. CASING:
lit
•
From sx Depth0 To /O Ft I�talneter
From To Ft.
From - To Ft.
13. GROUT: Depth Mate ' 1
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
DEPTH
From To
LOCATION SKETCH
s {
PO
Amount 3, %S p z Show direction and distance in miles from at lent
Wall Thickness two State Roads or County Roads. Include the ft2d
or Weight/Ft Material numbers and common road names.
From_ To -CV Ft. na Method
From To Ft. p =(,
to r1�
+1-A-.r,�.t•�
of Size Materift- 7
From To Ft. in.
in.
From
To Ft - in. in,
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
14. SCREEN: Depth Diameter SI
ASSOCIATED WQ PERMIT#
(if applicable)
16. REMARKS:
152
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
S-b , TM „ C.r^y 3- a.- of
SIGNATURE OF PERSON CONST RdCTING THE WELL
DATE
Submit the original to the Division of Water Quality, Attn: Information Management, 1617 Mail Service Center -
Raleigh, NC 27699-1617, Phone No. [phone], within 30 days.
GW-1 REV. 09/2004

T
City /� S
C a878.3
° ws rad 9s Zip Code
Area co
de- Phone number
4. DATE DRILLED 7— / 5L - G V
5. TOTAL DEPTH: .5Q>
6. DOES WELL REPLACE EXISTNG WELL? YES 0 NO jE(
7. STATIC WATER LEVEL Below Top of Casing: ' O FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS ] /yam- FT. Above Land Surface*
'Top of casing terminated actor below land surface requires a
variance in accordance with ISA NCAC 2C .011&
9. YIELD (gpm): METHOD OF TEST /f/ t-'
10. WATER ZONES (depth): 3 7(O
Topographic/Land setting
❑Ridge Il Slope ❑Valley ❑Flat
SQ pn�"e_/ _' (check appropriate box)
66 Laatitude/longitudeofwelllocation
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DRILLING LOG"
Formation Description
DEPTH
From
70
7a-tea
LOCATION SKETCH
11. DISNFECTION: Type 14 -7— /--/- Amount tiff,- O Z Show direction and distance in miles from at least CASING:
From 0
Wall Thickness
Depth ` Diameter or Weight/Ft Mate 'al
To g(F Ft. (o // $$v/.Uav
From To Ft.
From - To Ft.
two State Roads or County Roads. Include the end
numbers and common road names. tl1
13. GROUT: Depth�1 Material .{ Methodth
From_ To S U Ft t _ i
From To Ft. 4n
14. SCREEN: Depth Diameter Slot Size M[ateri V '/— --
From To Ft.
WELL CONSTRUCTION RECORD 3 0 8 6 9 5
INU(Lr Larolina uL.p,tuncut or Lnvuonmeut and NaturalResources - Division of Water Quality
WELL CONTRACTOR (INDIVIDUAL) NAME (print) 0 ; C(/// —r
� -.. CERTIFICATION # O�
WELL CONTRACTORCONY MPANAME A- tea B D tDai
STATE WELLCONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable) - (if applicable)
moNE # f 2trSze
1. WELL USE (Check Applicable Box): Residential 0 Municipal/Public j�( Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other [5 If Other, List Use
2. WELL LOCATNeare.
— `o ^
(Street Name, Numbers, Community, Subdivision, Lot No., ZipCode)
3. OdWNER: ressO 7-( /
(Street or Route
NA
�. OJ
in. in.
From To Ft. - in. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From - To Ft.
16. REMARKS:
1 DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO T'HE WELL OWNER
SIGNATURE OF PERSON CONSTReCTING THE WELL DATE
Submit the original to the Division of Water Quality, Attn: Information Management, 1617 Mail Service Center -
Raleigh, NC 27699-1617, Phone No. [phone], within 30 days.
., GW-1 REV. 09/2004

WELL CONSTRUCTION RECORD 308696
North Carolina Department of Environment and NaturalResources - Division of W arer Quality
WELL CONTRACTOR (INDIVIDUAL) NAME (print):)tt C / l CERTIFICATION #,
WELL CONTRACTOR COMPANY NAME A4µ I keep! 12 PHONE k (Ye:2t ..r. C - S. S ctS, d
STATE WELL CONSTRUCTION PERMTTIt ASSOCIATED WQ PERMIT (if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential ❑ Municipat/Public l�l' Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATI
Nearest
3.
(Sweet Name, Numbers, Community, Subdivision, Lot No., Zip Code)
OWNER: jat 0
AddressI 7 q
Route N (Street or G ,2878
wPLa >i'�
City orT wo State ode
Area Phonenumbere f
4. DATEE D DRILLLL ED 7—
— O h%
5. TOTAL DEPTH:
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO)q
7. STATIC WATER LEVEL Below Top of Casing: q a7) FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS I )' - FT. Above Land Surface*
'Top of casing terminated at/or below land surface requires a
variance to accordance with ISA NCAC 2C .0118.
9. YIELD (gpm): 3r METHOD OF TEST 4)).+
10. WATER ZONES (depth):
Topographic/Land setting
ORidge ❑Slope ❑Valleylat
(check appropriate box)
Latitude/longitude of well location
(degrees/minuteslseconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DRILLING LOG"
Formation Description
DEPTH
From To
a-4-e
9F g ��7sv
.0-
1 I. DISINFECTION: Type 14 r f f
12. CASING:
Depth Diameter41.4
From IC, To £3-Ft. V /tt rSlav 4i
From To Ft.
srai
S —
IV ^J
LOCATION SKETCH , cis r=
Amount 42, `r O how direction and distance in miles from at least
Wall Thickness two State Roads or County Roads. Include the roam
or Weight/Ft. Mat dal numbers and common road names.
From - To Ft.
13. GROUT: Depth Material Method (0 7
From C To CO Ft. 'Irt rt "'
From To Ft. M" /�
14. SCREEN: Depth on
Diameter Slot Materi QL�j'��
From To Ft. in. in.
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
L4
16. REMARKS: -71-n ,en
1 DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
t> • M i'. `C..rr— 3 :,- oS
SIGNATURE OF PERSON CONSTRUCT'G THE WELL DATE
Submit the original to the Division of Water Quality, Attn: Information Management, 1617 Mail Service Center
Raleigh, NC 27699-1617, Phone No. [phone], within 30 days.
GW-1 REV.0912004

WELL CONTRAcfOR COMPANY NAME ��-Q. �/ fI e d^ p -=: { ill A PRONE k (Zfi.S-S-10 =S S t. •"Q
STATE WELLCONSTRUCTIONPERMIT6 -ASSOCIATED WQ PERMIT
(if applicable) - -
- - -' (if applicable)
1. WELL USE (Check Applicable Box): Residential 0 Municipal/Public (�' Industrial 0 Agricultural 0
Monitoring ❑ Recovery 0 Heat Pump Water Injection El- Other ❑0 If Other, List Use
WELL CONSTRUCTION RECORD
308698
ON'FRAC[
JI y uvuoutncut and Natural Resources - Division of 1Y ater Quality - �s
OR(INDIVIDUAL)NAME (peirii) �'�"j'jC N CERTIFICATION31J(%
11. DISINFECTION: Type Pit - - /-/--
12. CASING:
From G Depth Diameter
From To Ft.
From To Ft.
13. GROUT: Depth Materia
From d To 37.) Ft.
From To Ft.
2. WELL LOCAT9N:
"-arest Tpwn:
(Street Name, Numbers, Commum , Subdivision, Lot No., Zip Code)
3. OWNER:
Address 0 7
(Street or Route
kPZa ces�� e N C a8783
City or To �tate Zip Code
( sf 3gss
Area cede- Phone number ,,//
4. DATE DRILLED � — i
a -O '
5. TOTAL DEPTH: g )
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO}S2
7. STATIC WATER LEVEL Below Top of Casing: FT.
8. TOP OF CASING IS i/�� Nse"+`ifAbove Top ofCas vg;
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): G„ METHOD F TEST p / N
10. WATER ZONES (depth):
Amount 0 7
Wall Thickness
or We
UI.,.'ht/Ft ht erial
Topographic/Land setting
[Ridge Slope OValley ❑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
L
To t.j an common road names tJi
1 n Method
14. SCREEN: Depth Diameter
From To Ft. in. in.
From To Ft. in.
15. SAND/GRAVEL PACK:
Depth Size
From To Ft.
From To Ft.
16. REMARKS:
-t c
a
-v
Show direction and distance in miles from at -feast
two State Roads or County Roads. Include tt z5oad
umbers d
lu
Slot Size Materi (Nsja
in.
Material
D7
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, Attn: Information Management, 1617 Mail Service Center -
Raleigh, NC 27699-1617, Phone No. [phone], within 30 days.
GW-1 REV. 09/2004

WELL CONSTRUCTION RECORD
Norte Carolina Department of Envuoumeut//and N�amral Resources - Division of
WELL CONTRACPOR (INDIVIDUAL) NAME (prlaQ �C•[,/,r, A'javu,,' l
WELL CONTRAcfOR COMPANY NAME 4-A.- i I n-r--a (aGII e P
STATE WELLCONSTRUCITON PERMIT# ((// ASSOCIATED WQ PERMIT/
""-(if applicable) - (if applicable)
Water t4uahty,. ^ /..
CERTIFICATION/ di
HONE # pa4 Sf -S-szy-Le
1. WELL USE (Check Applicable Box): Residential Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use �vv �'n/
V
2. WELL LOCATI
Nearest Town:
(Street Name, Numbers, Community, Suddivision,
3. OWNER:
Address 1O 6\. a
(Streetor Route No.) 2p7��
�� zn (1,/ T City o�r`T — S tp Code
Area code- Phone number -
4. DATE DRILLED 0, A -0 V
5. TOTAL DEPTH: /p rTU
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO ,r)c
7. STATIC WATER LEVEL Below Top of Casing: Co 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 ISA NCAC 2C .011& Al9. YIELD (gpm): /D METHOD OF TEST Ar
10. WATER ZONES (depth): oiSD
0 S SU LOCATION SKETCH
11. DISINFECTION: Type H-174- • Amount a7 0 2 Show direction and distance in miles from at least
Wall Thickness two State Roads or County Roads. Include the road
Diameter or Weight/FL Mater,.al numbers and common road names.
Ft. (et� SO�Zt-11s�fai
Topographic/Land setting
❑Ridge [,Slope ❑Valley Mat
chakappropriatebox) N
Latitude/longitude of well Iocattet
rZ
(degrees/minutes/seconds) 0J1.
Latitude/longitude source:❑GPS❑Topographicap
(check box) (
DEPTH DRILLING LOO '
From To Formation Description
,06 —a b-v
Y24SO -a/2 -
csl8°. -3i3O
3LD —3Li
�3-0+.,3� —X
57,
7 5 v
12. CASING:
Depth
From 0 To
From To
From To
Depth
To 3
To
13. GROUT:
From r."
Ft- n�A,�,,,, �'�- vLy4 _. -
From 3 Ft_J �J t.0 ag
14. SCREEN: Depth Diameter Slot Size ate i/vpri2-- f `o --'L
From To Ft. in. in.
From To Ft. - in. in.
15. SAND/GRAVEL PACK:
Depth Size Material
Ft.
Ft.
From
From
16. REMARKS:
To Ft.
To Ft.
Material Method
i1)7
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
--21-.uS
SIGNATURE OF PERSON- :INSTRUCTING THE WELL DATE
Submit the original to the Division of Water Quality, Attn: Information Management, 1617 Mail Service Center-
Raleigh, NC 27699-1617, Phone No. [phone], within 30 days.
GW-1 REV. 09/2004

WELL CONSTRUCTION RECORD `� Q- -
North Carolina Department of Environment and Natural R urces - Division of Water. Quahly "
WELL CONTRACTOR (DVDCVIDUAL) NAME AM
sue%' :'l # 1- CERTIFICATION # �/14
WELL CONTRACTOR COMPANY NAME AH'/'r l.\FPr?4-2:-, i' lftu// PRONE # jb1a' CZ-)
STATE WELL CONSTRUCTION PERMIT# cJ ASSOCIATED WQ PER #
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential,( 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:
I9r
(Street Name, Numbers,
Community, Subdivision,�Lot o., Zip Cade)
3. OWNER: ' Z+ior
Address Q r(,L 17
C11..-Cb 71 / C as 7£io
(Street or Route No.)
ity or Town - tate Zi Code
Area code- Phone number
4. DATE DRILLED 3 — 3
5. TOTAL DEPTH: `3 Gni
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO
7. STATIC WATER LEVEL Below Top of Casing: AO FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS 1 FT. Above Land Surface'
*Top of casing terminated at/or below land surface requires a
variance In accordance with ISA NCAC 2C .01I8.
9. YIELD (gpm): 20 METHOD OF TEST 4/ j^
Topo hic/Land setting
/t ❑Ridge JHSlope ❑Valley ❑Flat
/ 6 G (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
a -a
a�=i r
1a5-/A7
/c27--.Z0T7
Zcriv -zaz,
v3— 3cry
8
10. WATER ZONES (depth): Qs-
-,
Qi LOCATION SKETCH =
11. DISINFECTION: Type { -1-74 -
12. CASING:
Depth i Diameter
From /9 To 04-Li Ft. e t.
%�
Amount r Show direction and distance in miles frordtiat leasE
Wall Thickness +'� two State Roads or County Roads. Include —The ro'
or Weight/Ft Material numbers and common road names. p
SPrz 2/ ,im r u1
From To Ft. f /{r . From Ft t le`"^'" /1r.21'u-C,
De
13. GROUT: Dep Material- i Method
From 0 To 2 Ft. ,,:t to
From 3 To9� Ft.
pi4J •
14. SCREEN: Depth Diameter Slot Size Mate�c.2n--p/pCC'
From To Ft. in. in.
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth
From To
From To
16. REMARKS:
Ft.
Ft.
Size
Material
pc- if Ns -
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
3 t� 10'1 it Cv 3 2 -OS
SIGNATURE OF PERSON CONS•TIfUCTING THE WELL DATE
Submit the original to the Division of Water Quality, Attn: Information Management, 1617 Mail Service Center-..
Raleigh, NC 27699-1617, Phone No. [phone], within 30 days.
GW-1 REV. 09/2004

WELL CONSTRUCTION RECORD 3 O y
North Carolina Department of Environment and Natural Resources - Divisiva of atc. i/ua...} /.
WELL CONTRACTOR (INDIVIDUAL) NAME (print)
WELL CONTRACTOR COMPANY NAME
STATE WELL CONSTRUCTION PERMIT/
(if applicable)
.inn it — 1
OCIATED WQ
(if applicable)
PERMIT
ASS #
PHONE # f itar fl7 ar-
1. WELL USE (Check Applicable Box): Residential 0 Municipal/Public I Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATI0j L nn__
Nearest own: ili gilt, County
Pr -Li
e
Street Name, Numbers, Community, Su 'sibdM on, Lot
3. OWNER:
Address d/l I0t d'LL / 7
a" (Street or Rou
r Oq U S'ZK
C2.�.�[1J,o.Pe e O
C)ty or Town State Zip Code
�X 9K-tro
ip Code
44044)
Area code- Phone number
4. DATE DRILLED 3 r7
5. TOTAL DEPTH: tL7
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO I i A 3 _ a s-2)
7. STATIC WATER LEVEL Below Top of Casing: tD FT.
(Use "+" if Above Top of Casing)
S. TOP OF CASING IS % fV2 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 Al /-
10. WATER ZONES depth): ) 2S 0 —
Topographic/Land setting
❑Ridge VISlope ❑Valley ❑Flat
C.76271 (check appropriate box)
Latitude/longitude of well location
(degrees/nunutes/seconds) Latitude/longitude source:❑GPS❑Topographic map
(check box).
DEPTH DRILLING LOG '
From To Formation Description
11. DISINFECTION: Type
12. CASING:
From a
From
From
13. GROUT: Depth Material
From b To
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.
Depth
To %r'J Ft.
To Ft.
To Ft.
asv —
/'f 7 /r Amount
Wall Thickness
or Weight/Ft.
J
LOCATION SKETCH
how direction and distance in miles from east fl
two State Roads or County Roads. Include.the-roa
Mat *al JJumbers and common road names.
Method
Slot Size Material
in.
in.
Material
O
cn
16. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
3.O— M t. C- r
SIGNATURE OF PERSON CONSTRUCTING THE WELL
DATE
Submit the original to the Division of Water Quality, Attn: Information Management, 1617 Mail Service Cepter -
Raleigb, NC 27699-1617, Phone No. [phone], within 30 days.
GW-1 REV. 09/2004

2. WELL LOCA a IN:
Nearest To
a
(Street Name, Numbers, Community, Subdivisi
3. OWNER:
Address
WELL CONSTRUCTION RECORD i 3-3 147
North Carolina Department of Environment and Natural Resources - Division of Water Quality -- G
WELL CONTRACTOR (INDIVIDUAL) NAME (printp ( -' G Kit" p� CERTIFICATION #�^
PHONE # (GRAY "'Sifts Z
WELL CONTRACTOR COMPANY NAME ARA- / ,('/LOPi.. � W(j� l JJ.K.
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
I. WELL USE (Check Applicable Box): Residential Municipal/Public ❑ Industrial ❑ Agricultural ❑ ej O
Monitoring 13 Recovery ❑ Heat Pump Wate Injection ❑ Other ❑ If Other, List Use 087
1©
(ita�(o sty or Town state K Zip Code
' �F —lB & ;F o
Area code- Phone number /
4. DATE DRILLED) `g a'j -LW
5. TOTAL DEPTH: e O7)
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO/C
7. STATIC WATER LEVEL Below Top of Casing: 3D FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS 1 FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance In accordance with 15A NCAC 2C .0118.
9. YIELD (gpm): METHOD OF TEST, 1 sr
10. WATER ZONE depth): j 11 L) % Q�ry
11. DISINFECTION: Type
12. CASING:
Depth
From 0 To 31 Ft. _y _l $us-'. 2-1 PVC --
From To Ft.
From To Ft.
13. GROUT: Depth )ytaterial
From To 3 Ft.
From To ?, Ft.
14. SCREEN: Depth Diameter Slot Size VMaterial
From To Ft. in.
in.
in.
From To Ft. in.
15. SAND/GRAVEL PACK:
Depth
To
To
From
From
16. REMARKS:
Ft.
Ft.
Size Material
Topographic/Land setting
dge ❑Slope ❑Valley ❑Flat
(check appropriate box)
j Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From To Formation Description
3
m
N —
LOCATION SKETCH
►`-j-77-4 Amount or-Z7 Show direction and distance in miles frotr aaleast
Wall Thickness two State Roads or County Roads. IncludeCtee ro"
iarter or Weight/FL Material numbers and common road names.
l 3 5 ._,
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 CONST
TING THE WELL DA D�
Submit the original to the Division of Water Quality, Attn: Information Management,1617 Mail Service Center -
Raleigh, NC 27699-1617, Phone No. [phone], within 30 days.
GW-1 REV. 09/2004
CO

WELL CONSTRUCTION RECORD J S / 3 4)1
North Carolina ��'� Department of Envtronme and Natural R Mies Division of Water Quality
s �_� _ ggg���ppp
WELLCO - Met
WELL CONTRACTOR CO�IYIDUAL) � JT �h CERTIFICATION #
i .ti, tint
ANY NAME
STATE WELL CONSTRUCTION PERMIT#
(ifapPlicable) V - -ASSOCIATED WQ PERMITS
(ifap licable)
1. WELL USE (Check Applicable Box): Residential Municipal/Public ❑ Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATIO
Nearest Town:
(S3jtl Name, Numbers, Community, Subdi
3. OWNER: G� rI ej
Address
Area code- Phone number
4. DATE DRILLED
5. TOTAL DEPTH:_
6. DOES WELL REPLACE EXISTING GINTS WELL? YES 0 NO
7. STATIC WATER LEVEL Below Top of Casing: FT
8. TOP CASING IS (Use "+"ifAbove Top of Casing)
`Top OF C toor FT. Above Land Surface*
variance In accordance with ISA NCAC 2C O 1E. surfaceelow land requires a
9. YIELD (gpm): _a-e METHOD OF TEST / ✓
10. WATER ZONES (depth): �Z O
11. DISINFECTION: Type j
12. CASING: Amount
• Wall Thickness
Depth Diameter or Weight/F
From_e
From To
_ o—la Ft j I 2LJ
From_____
Ft.
From To Ft.
13. GROUT: Depth
Material
From To Ft
From_ To�� Ft
neet or Route No.) it) .71...
or Tgwn State 2� Zip Code
14. SCREEN: Depth
From To Ft.
From To Ft.
15. SAND/GRAVEL, PACK:
Depth Size
From To Ft_
From To Ft.
16. REMARKS:
Topographic/Land setting
y❑Ridge lope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
Latitude/longitude source:DGPS❑Topographic map
(check box)
DRILLING LOG'
Formation Description
PHONE # ` ily ��3—�- j,
30906(
DEPTH
From To
LOCATION SKETCH
N
O
Show direction and distance from at least
two State Roads or County Roads. Include the road
Material numbers and common road names.
Method
;frrfr
eteSlot Size Materi J,/5(Z. in.
Material
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
Nfi Cy% SIGNATURE OF PERSON CONS e'4'TING THE WELL
DATE
Submit the original to the Division of Water Quality, Attn: Information Management, 1617 Mail Service Center -
Raleigh, NC 27699-I617, Phone No. [phone], within 30 days.
• GW-1 REV. 09/2004

4. DATE DRILLED /C �G -o y
5. TOTAL DEPTH: !O 510
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO
7. STATIC WATER LEVEL Below Top of Casing: /ayo 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): O METHOD OF TEST ?/.w
10. WATER ZONES (depth):
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print)0/eh", Spp %//Q
WELL CONTRACTOR COMPANY NAME/tIe//m.•' // j4. j/>„Rwanso
STATE WELL CONSTRUCTION PERMIT# c.7 7 42 7!1/ ASSOCIATED WQ PEILMIT#
(if applicable)
(if applicable)
CERTIFICATION #j d / /
PHONE # 1¢-.9 r 7 ^ 941/2
1. WELL USE (Check Applicable Box): Residential Ki Municipal/Public 0 Industrial 0 Agricultural ❑
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION:
Nearest Town: Gr,y,h,,..>__ County4a. /y,.p
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
Topographic/Land setting
❑Ridge ❑Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
3. OWNER:CrapQ,e- /real le,t r-
Address 7 tG�f (degrees/minutes/seconds)
/ 1 O•- sop•z —e. Latitude/longitude source:❑GPS❑Topographic map
/sue (Street or Route No.)/(check box)
for? L-a a 4, era/t- 3 3 30•Sr DEPTH DRILLING LOG
City or Town State Zip Code From To Formation Description
(—)-
Area code- Phone number O — /O mil% ��
trots,
cf
c_,
C
0
LOCATION SKETCH Vt f'
11. DISINFECTION: Type Amount Show direction and distance in miles from at lease
12. CASING: Wall Thickness two State Roads or County Roads. Include the roa
Depth Diameter or Weight/Ft. Material numbers and common road names.
From a To 2 / Ft. C4 , %/ tn—
From To Ft. � �9eoIX %e ee. 'Fy .
From To Ft. r
13. GROUT: Depth Material Method /o'er�9lntun !fir"p/..�
From 0 To 2 7 _ Ft. _laads. 02 tea ..-- -4 /at c-3
From To Ft.
14. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in.
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
16. REMARKS:
I DO HEREBY CER'i?FYjTFIAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STAIND,4RUS, AND
THAT A COPY OF THIS RECORD�HAS BEEN PROVIDED TO THE WELL OWNER
7 re-n% /l/ erce i
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE ; =- l
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center R feigii, NC c
27699-1636 Phone No. [phone], within 30 days. GW-1 R�Y.)`,.7/200t
re, 4.
OJ
_.F

6. DOES WELL REPLACE EXISTING WELL? YES 0 NO &Y
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) 6/en $en );p f/L
WELL CONTRACTOR COMPANY NAMF/ •y Cep/. // [/I/a /1 y., 1a/2
STATE WELL CONSTRUCTION PERMIT# / 2 2 ASSOCIATED WQ PERMIT#
(if applicable)
(if applicable)
CERTIFICATION # 2"d//
PHONE # (Srjrit 577 — 4°y4 d
1. WELL USE (Check Applicable Box): Residential E 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: tet ( County actchon,
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER.
Address P0. /3Pj /je-1
(Street or Route No.)
City or Town State Zip Code
( )-
Area code- Phone number
4. DATE DRILLED 1-1 " 2 9'-'04'
5. TOTAL DEPTH: 704 rFr- 70
Topographic/Land setting
[Midge ❑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
7. STATIC WATER LEVEL Below Top of Casing: 1 6 FT. id-- ere
(Use "h" 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): is METHOD OF TEST az--;
10. WATER ZONES (depth): 70
11. DISINFECTION: Type
12. CASING:
Depth
From_( To "/
From To
From To
13. GROUT: Depth
From 0 To 1 U Ft.
From To Ft.
14. SCREEN: Depth Diameter
From To Ft. in.
From To Ft. in.
15. SAND/GRAVEL PACK:
Depth Size Material
Ft.
Ft.
Amount
Wall Thickness
Diameter or Weight/Ft. Material
eto-7oh
9-utrvlv,L.J
Gyr�m�.v
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.
Material
nags delestel'
From To Ft.
Method
jict.v r
Slot Size Material
in.
in.
From To Ft.
16. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH I SA NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS HAS BEEN PROVIDED TO THE WELL OWNER
RECO
✓ D
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

v
111111/ II
6-I'21II II 11
w► J,L CONS rtcuertuN w cutu) 3 0 4 0 2 4
IJorIli Cal &inn- Wpm town( of❑nviunuuculand Halo 11ItcnoIuices-Divi:ionof\VaicrQuality-(houndsvnlci Section
L II' F. L CON IltACI Olt (INIII MUM.) IIIAI.) N An 1 E unlit!!/ 6r //' &Ge UFA' 11 r 1 U71 urlll 2Cgc/d�
IN AA CON I IUCI Olt COn11'AN lto1' NAME A/'- Fl1ONF. d 1 '1 cf12-17f?
51 A 1E It-FALL(I/NC 1 IIIICIION ?FAIN'!" _ ASS(ICIAIFII WI'I)FERMII0
( i1 I , Ai( nblc) ( ifnpplicnlrlr)
I. 1PI:1.1. US": (Clark ApplirnhIe Cl lulhlnrlinl I) Ap.Iiculnnnl L)
Mooilul log U Itccovciy I_l I lead Pump \Vaiet Injection U 011ie' U I(Uthcr, List Une
2. Wlil.l.1.l)FAill)IJ: /
Huai cst Town: C hen, tee— ('minty 0—CC/lid n
C4,Cree ( ,d
(Slrrel Prone, Ihnnl•rn, l'rnunnnlly, Sitdiviolon, 1 nl Nn, 7i1. Ogle)
3. UWIJl'it: Or✓el we-elLS
AdIicss _Z1y- S ii ea t y_.__LaYI. P _--Ka-----
(SIItrtol (tonic ill)
sco LLs hero _A in 39762
lily tit lo•,n Slnre 74, Puce
1 )-
Ann r,-lr. I-hwv nnmler
•1. DAI N. 1)III1.1 Pl) /v -OS"C"/
5. .1MAL.I01111.I1: 2,2?01
___.. __ _
G. Uc)IiS \VPLI. IlIU I.A(1 lI.XISMA( \VF.I.I.7 YES L'I\ NU H
7. S I ATIC VIA I I l( I.IiVEEL Ilelow'fup of ('nr.ing: _✓7 _C) _ _PT.
y (O,e "I- If Ai 'vr Imp ul l'n.innl
8. "II 11' (11' CASINO IS i 7i _ FT. Alcove I nod Sunoco•
• I rr rl ening Ire nlle.•Ird olbn below (end nn lore •.sales e
.,Winne In oars dente mile I5A NUM' le MOIL
Q. I II?I I) (ppm): _Ju _ _ h11C11I013 OF 1 li S I/9'Y
10. \VAl nil( ZUNBS ( I(plln): .365 -
IL I)1SINUIF.Cilull :'fypr_ : — Arinniul 'kfG✓P
12. CASI11t;: \Vnll1Ilicknr^.e
I)rIlll Uimucir 01 Wright/FL hinlclial
Flout O To /92 ITG.23 JLi2a1 Ali
floe, /51_,A 'fo %J fl. as Z-- •ab' Stee T
flout Tie I'I._ 1J. T UUU I: i)rplli 1Initl}• I 11011nd
Horn o TO 028 I'i 071r-'ri-eSJ✓•,e-
lion• 'Io Ft.
14. Sit, °lit I: Urplh Uin icicr Slot Sire Malclinl
From( 'Iu f1. in. --_—__ in.
lions Tu----- IT _in. in.
15. SAN1)/til(AVIi1. I'AUIi:
17rpllt Sire hlolrtinl
luau Tv p1.
Pnnn To FI.
Il. I(Iih1ARKS:
I'vpol•tnphidl and'stint;
Ultitgc 1'Slope I"IValley 1_I1Int
(rhrrk erpm•rilme lm•)
LnlitutI /Iougiloje of wclyoca,inn
NJ.{02i1-_YQ1,.-GtJ0e) !8_ 2.(F
(drgrrrdudnnlrcoinmIe)
Lnliluddlotigilude suulcc:LH;i'SI II °p!uiI1Jrbic nap
(check IeIt)
1)111L1 UltiLhllt(i.LtIli
Foul Iu fvunaliun Ucscripliuu
0- V
_/o - e r3-
frs —3,20
-O,cv
L GATIUt+_Sr i i(:il r� =cp.
Show ditcclion and distance in nlilrs Iionr n1 J^asl ror3
Iwo Stale Roads ur County Rund+. Include IIii(nd -i
umbels and common load nnuren.
I PO III;Rf IlY CHI I Il VI I IAI 1111S WELL WAS CONS IltllU flD IN ACCORDANCE WWI 15A MAC 2C, WP.I.I,
CONS! IUJUI IUN S I AIR/AIMS, ANI l I IAT A COPY UI"I IIIS RECURD 11AS BEEN PROVIDED 10 11111 WLILL UWIIER
/54.77� /D � OJ =a t/
SIGMA I ll RI! UP !TWA J 1 CONS 1IWUIINU'1IIL WLLL DM 1!
Submit the o1Iglltal to Ilte IHrl+lun of Mart Ounllly, (;ruundlruterSectlun, 16J6 Mall Service Cenlcr- Itnlrlgh, f1C
.__. _.. rint_I tiny n'1iiur11

303746
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
CERTIFICATION # 2187
WELL CONTRACTOR (INDIVIDUAL) NAME (print) Russell S. Taylor
WELL CONTRACTOR COMPANY NAME Hedden Brothers Well Drilling, Inc
PHONE # f 828) 369-9591
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential 9 Municipal/Public 0 Industrial ❑ Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATIQN:
Nearest Town:
}Rat-) nnan) later - /V
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: £A)
Address `� f (r'267.J (Min
(street or Route No.)
e,Auty 73L I7PB
(e1L)
Ci- a. Tows2'n- 4 ) to Zip Code
Area code- Phone number
4. DATE DRILLED /6
5. TOTAL DEPTH: .� O
6. DOES WELL REPLACE EXISTING WELL? YES NO 0
7. STATIC WATER LEVEL Below Top of Casing: 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
ant w h ISA NCAC 2C MIS.
9. YIELD (gpm):� METHOD OF E T BLOW
variance In accord
10. WATER ZONES (depth): a ) ) or
11. DISINFECTION: Type H T H
12. CASING:
Depth 4 Diameter
From __../ To
From )T To .La Ft
From To Ft.
13. GROUT:
From 0
From To
14. SCREEN: Depth
From To
Depth
To 20
From To
15. SAND/GRAVEL PACK:
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
Fr m Formation Description
clay & sand
granite
LOCATION SKETCH
Amount 16oz Show direction and distance in miles from at least
Wall Thickness two State Roads or County Roads. Include the road
or Weight/Ft. to al numbers and common road names.
d eQ
Material
Ft. benonite & cement
Ft.
Diameter
Ft. in.
Ft. in.
Method
pumped
Slot Size Material
in.
in.
Depth Size Material
From To Ft.
From To Ft.
16. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
/II uz , `) a1I4/ 0 -e[ / - O T
SI ATURATUR 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. GW-1 REV. 07/2001

303745
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) Russell S. Taylor CERTIFICATION # 2187
WELL CONTRACTOR COMPANY NAME Hedden Brothers Well Drilling, Inc
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
PHONE # f 828) 369-9591
1. WELL USE (Check Applicable Box): Residential ® Municipal/Public ❑ Industrial ❑ Agricultural 0
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other 0 If Other, List Use
2. WELL LOCATI
N
( treetName, Numers, Community, Subdivision, Lot No., Zip Code)
Area code- Phone number
4. DATE DRILLED
5. TOTAL DEPTH: �r
6. DOES WELL REPLACE EXISTING WELL? YES NQ
7. STATIC WATER LEVEL Below Top of Casing: .'i() 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 w[tth ISA NCAC 2C .0118.
9. YIELD (gpm): . SU MET�-I 1XOY TEST BLOW
10. WATER ZONES (depth): /y[J
11. DISINFECTION: Type H T H Amount 16oz
Wall Thickness
Dept Di eter or Weight/Ft. M»'0
From To Q .0 Ft.
From I�Ir To ill Ft. r /8gp
� r
12. CASING:
From To Ft.
13. GROUT: Depth
From 0 To 20
Material
Ft. benonite & cement
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
pumped
Slot Size Material
in.
in.
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)
DRILLING LOG
Fro T9- ,y; Formation Description
clay & sand
granite
DEPTH
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.
P
O Crrs
Ca rite
-A rT
N
cfrl
t
,5 oo
N c^zs
.1 c-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
Rhvyleil
fat.
GNATURE OF PERSON CONSTRUCTING THE WELL
10' a21-0I/-
DATE
Submit the original to the Divi ion of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-1 REV. 07/2001

303744
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) Russell S. Taylor CERTIFICATION # 2187
WELL CONTRACTOR COMPANY NAME Hedden Brothers Well Drilling, Inc
PHONE # [phone]
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential ® 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:
Ne /La3^ t & (% XAC( County
h.�z a L�
treet Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER:
Address
.4,�y --uu �(S�t,reet or R/game No.)
1474 . .(ti7
i
4. DATE DRILLED ittrr
5. TOTAL DEPTH:
6. DOES WELL REPLACE EXISTING WELL? YE§ pc Ivo A_
7. STATIC WATER LEVEL Below Top of Casing: YUG FT.
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): Melee TEST BLOW
10. WATER ZONES (depth):
9/Sis S79O
Zip Code
Topographic/Land setting
❑Ridge 0Slope ❑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
clay & sand
granite
6171.0
&ad
11. DISINFECTION: Type H T H Amount ieoz
12.
CASING:
Depth
From To
From To
From To Ft.
13. GROUT: Depth
From 0 To 20
From
Wall Thickness
Dfariyter or Weight/Ft.
/YR
Material
Ft. benonite 8 cement
To Ft.
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.
Method
pumped
Slot Size Material
in.
in.
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common road names.
16. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUC ON STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
/ 22 7 /o ff
SIGNATUR IOF PERSON CONSTRUCTING THE WELL
Submit the original to the Division of W3'ter 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 Resourc Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAM (prim) L L eN )l d c -5 �/ )". CERTIFICATION at>2 28' /
WELL CONTRACTOR COMPANY Nsitu O.PAt 117 dr .PHONE „rue.
STATE WELL CONSTRUCTION PERMIT#�ASSOCIATED WQ P Z. IS
TJ�%99/p /a)
(if applicable) (if applicable)
1 WELL USE (Check Applicable Box): Residential gl Municipal/Public ❑ Industrial ❑ Agricultural ❑
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use
2. WELL LOCATI :
Nearest Town:
277
(Street Name, Number, Comm
•
No., Tap Code)
3. OWNER
Address �srp ad
%r ( or No. 44C. a S'?13
City or Town Sure tip Code
Area coda Phone number
4. DATE DRILLED 81y2 % / D V
5. TOTAL DEPTH: yOS
6. DOES WELL REPLACE EXISTING WELL? YES O NO
7. STATIC WATER LEVEL Below Top of Casing: FT.
(Use "+" if Above Top of Cuing)
8. TOP OF CASING IS 1. FT Above Land Surface*
'Top of cuing terminated at/or below land surface regain a
variance in accordance with 1SA NCAC 2C .0118.
9. YIELD (gpm): a METHOD OF TEST
10. WATER ZONES (depth):
11. DISINFECTION: Type /r. 4/. /()
12. CASING:
From_0_To // S Ft�
From, To Ft.
From To Ft
13. GROUT: Depth ai
From O To o7D Ft.
Material
Amormt /b °Z
Wall Thickness
or Weight/Ft Material
1! ear
From To Ft.
14. SCREEN: Depth Diameter
From '^ To Ft in.
From l To Ft in.
15. SAND/GRAVEL PACK
Depth Size Material
Fromo Ft.
From To �p Ft
.. � %% 'r/ Q �Q�
16. REMARKS: //l e l ea-C-�-c.ev ►GF-GLP iCl tcrw� t. i J.1. 4'Lt)4/
Slot Size Material
in.
in.
Topographic/Land setting
❑Ridge giS1ope ❑Valley ❑Flat
(chuck appropriate box)
Latitude/longitude of well location
(degrees/mimes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From To Formation Description
CU
rc
MKfl
y G :3,
t,3 t
cCC,
LOCATION SKETCH O
Show direction and distance in miles from at least
two State Roads or County Roads. Inude the road
numbers and common road names.
I DO HEREBY CERTIFY THAT THIS WET f W
CONSTRUCTION STANDARD
SIGN
STRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
i 1 r OF THIS RECORD HAS BEEN PROVIDED TO THE
S
OF� O O STRUCTING THE WELL :1 9
yo
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-1 REV. 07/2001

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and NaturalResources - Divisio of Water
WELL CONTRACTOR (INDTYIDUAT.) NAME (print)11P/l ( gI Q Q
n CERTIFICATION tu�_y
WELL CONTRACTOR COMPANY NA VIT (i2 f]�,( ( (t p y] T. fi 54/61.0(0
STATE WELL CONSTRUCTION PERMIT* 4/74 u l" Q ' •mg PRONE k fOfdltRT7L .jf[J
ASSOCIATED WQ PERMTIa I p AJ
(if applicable) (if applicable) `-�"---"--_
I. WELL USE (Check Applicable Box): Residential LF Municipal/Public 0 Industrial CI Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other O If Other, List Use
2. WELL LOCATION
Nearest Town:, coup kc. 0p
(Street Name, Num
Subdivisioq Lot No., Zip Code)
3. OWNER: Of vz Ro nk o
Address '., Il1 oa Pf j Rt,( •
C(,t,t!�o u,S r m nr"c.) 7 7 2, 3
City or MOM State Zip Code
( )-
Arer cote- Phone
4. DATE DRILLThEtat 2 "�- 0
5. TOTAL DEPTH: go $
6. DOES WELL REPLACE EXISTING WELL? YE NO e
7. STATIC WATER. LEVEL Below Top of Casing: FT.
ft (Use "+"if Above Top of mg;
8. TOP OF CASING IS /$ FT. Above Land Surface`
'Top of casing terminated atior below land surface requires a
variance hi accardmasgswith ISA NCAC 2C SI1g.
9. YIELD (gpm): J METHOD OF TEST_/ / ft'rYff
10. WATER ZONES (depth):
I. DISINFECTION: Type C M
2. CASING:
Fran(_, To /70 Ft.
Ft oatTo Ft.
Frog To
13. GROUT,:( Depth,/
From_ K/ To 7o
From To
I . SCREEN: Depth
From To
From_ To
15. SAND/ RAVEL PACK:
Depth
From J To
From i/ To
REMARKS.
Amount /0 o t
Wall Thickness
51R ` /ac t
Ft.
Ft.CONcti C
Ft.
Diameter Slot
Ft in.
Ft.
Ft
Ft.
I DO HEREBY CERTIFY THAT THIS
CONS? 7CT1ON STAND
Size Material
in.
Material
Topo G'Land setting
❑Ridge lope DValley 0F1a:'
(check appropriate boa)
Latitude/longitude of well location
o ees/miuurtyseeoods}
Latitude/longitude soluce:OGYSOTopographrc map
(cheek boil
DEPTH DRILLING LOG
From To Formation Description
LOCATION SKETCH N
Show direction and distance in miles (tomcat leas;
two State Roads or County Roads. lncludae roams
numbers and common road names, e+?
LL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C. WELL
T A96PY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
GNATI_ OF PERSON CONSTRUCTING THE WELL
8'2t.oy"
DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service ,enter - Raleigh. Nt
27699-1636 Phoue No. [phone], within 30 days. (.oak , (, ,7,.
�1 REV. �Ut'l i.

zoz s
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section / -
WELL. CONTRACTOR (INDIVIDUAL) NAME (print) c'h-e►l t71S 17"1I(2n ti - t CEit;TIPICCA,TIIOON
WELL CONTRACTOR COMPANY NAmit.hoj )IC OtjIOytri (JJP.I1 �-1Yu1t 4.-j'-nri PHONE Y TaiSC.S2te-3 g60
STATE WELL CONSTRUCTION PERMIT,/ ASSOCIATED WIRERMITY
(if applicable) - (if applicable)
1. WELL USE (Check Applicable Box): Residential' unicipal/Public 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 17 If Other, List Use
2. WELL LOCATION:
Nearest Town: OA,%Li t/SFe. County 34C/CS°KJ
[lea mg— Bum Pert 12e, . ftij
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: Cha4110S JChi eat_
Address "PQ. r2Dx It7L rJ
)a-i hSne,net ?transit tRoutA/oG)
o�g71 /
City Or we State Zip Code.
(K2) on' S •
Area code- Phone number
4. DATE DRILLED /) -1 9-0 4
5. TOTAL DEPTH: c 26C
Topographic/Land setting
❑Ridge ❑Slope °Valley EI-Faat—
(check appropriate box)
Latitude/longitude of well location
(degrees)minutes/ssconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DRILLING LOG
Formation Description
elA.y_
L. Vc-C, eIs7-co
DEPTH
From To
0 .36'
,3F' -Ms'
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO I711�
7. STATIC WATER LEVEL Below Top of Casing: %S FT.
(Use" +" if Above Top of Cuing)
8. TOP OF CASING 1S / FT. Above Land Surface*
'Top of casing terminated at/or below landsurface requires a
variance In accordance with 15A NCAC 2C .0118.
9. YIELD(gpm): eii0 METHOD OF TEST-hfOJ//i7L¢•,
10. WATER ZONES (depth): 4'S5 t O / //ea (l
II. DISINFECTION: Type
12. CASING:
Depth
From 0 . To
From To
From TQ
13. GROUT: Depth
From n To eZ
From To
14. SCREEN: Depth
From To
From To
15. SAND/GRAVEL PACK:
Depth
From To
From To
LOCATION SKETCH
i%-i'fe Amount ea TA' 14 S Show direction and distance in miles from at least
Wall Thickness two State Roads or County Roads. Include the road
Diapeter or Weiht/Ft. MatepQI numbers and common road names.
Ft. Y(i
Ft.
Ft.
5.2R,5J' .O
/1 Meth
Ft. C,, rr d7� pen,
Ft.
Material
Diameter
Ft. in.
Ft in.
Ft
Slot Size . . Material
in.
in.
Size Material
Ft.
RECEIVED IDENR/ DWQ
AQUIFER. PROTECTION SECTION
OCT 2 6 2004
16. REMARKS:
1 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 ` 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/pResources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) (Idle
(I CERTIFICATION# 36`
/
WELL CONTRACTOR COMPANY NAME C�L_C(•..nt_ t•Prfw,LDe..1L- 4 Li'p1Jsc .PRONE # {'R %en - .317"
STATE WELL CONSTRUCTION PERMIT# I1-141i_ `2 ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
I. WELL. USE (Check Applicable Box): Residential Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water njection 0 Other 0 If Other, List Use
2. WELLL.00ATIO
Nearest Town:
bhr't%
/ \/ et County
k
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3 OWNER:
Address
City or Town tate
( )-
1-PP
Cet or Route No
uC._
Zip (ode
-SI+41,15 Job
Aiea code- Phone number
4. DATE DRILLED a - /0-03
5. TOTAL DEPTH: /OO5 r
(\/Il l' U/1.I I R1:PI A('I L VIC9 IN(: UlLI! 1 YV I I nJL' Ie
7. STATIC WATER LEVEL Below Top of Casing: 1TX :FT.
j. (Use "+" if Above Top of Casing)
R. TOPOF 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): to METHOD OF TEST a kits
10. WATER ZONES (depth): 10O 1 - La 1pm
1I. DISINFI'tTION:Type_ L-j-'T.1 Amount I23 }41k
12. CASING:'\ Wall Thickness
Depth'/ Diameter or Wcight/Ft. Material
hum 0I. To IS Ft. ip a p)<e___
From To Ft.
From To Ft.
13. GROUT: Depth Material Method
From To jb _ Ft. (tngnf ad__Lt_ {-r.>I
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:
Topo aphic/Land setting
❑Ridge `Slope OVallcy ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:0GPSOTopographic map
(check box)
DEPTH DRILLING LOG
From To Formation Description
LOCATION SKETCH
Show direction and distance in miles from at (cast
two State Roads or County Roads. Include the road
numbers and common road names.
en Fri
—1
ter?
OOP
Cr) o
r*t
1 DO HEREBY CERTIFY TIIAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITII 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND TIIAT A -OPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
a h -a A4-. c is - a / - ri
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

>VE111 CONSTRUCTJON RECORD
orth Carolina D partment of Env onment and Natural
WELL'COTRACTOR(INDI\IDL'AL)N4�IE print) /YIiY/
VELL'CONTRACTOR CO IPA
Resources - Division of Water Qua
!n %%%a9' IS
errs
.LUElf l%✓
Qi N AM E 1' l ?o si,i `/
^�- d -ASSOCIATED \t'Q PERNA'
tTEA\EL COASTRLCTIO�PERVIIT
. 4114-:s: ifapp [cable i�' �- (if apptica
blei
13. GROUT: Depth
From 0 To
From_ To .21)
I-1. SCREEN: Depth
From To
From To
15. SAND 'GRAVEL PACK:
Depth
From To
From To
16. REYIARKS:
YLL USE (Che phi?ble`Boz
hlohnonn� ❑ - Recovery Heat
2. WEI L LOCATIOi'
Neares Town:
Groundwater Seaton
CERTIFICATION %# !/
��y
PHONE % (tag„ins- .tS3--)
:-Residential
ResiRestdd nt
enhal]Yl Municipal/Public ❑ Industrial ❑ Agricultural ❑
utompVter Infection ❑ Other ❑ ICO[her, List Use
(Street Name, number . CConun t)S ary ion tot tutu Zip Code)
3. OWNER:
Addr•»
(Street or ute No)
Crts or 'n TIne. Sutr
a 810
Zip Code
Topographic/Land setting
n ❑Ridge $Slope ❑Valley DFlat
-- G, (check appropriate bo<)
_e Lahtude/lonjnude of well)ocation
-(degras mmut "s seconds)
Latitude/longitude source ❑�GPS❑Togo raphic map
,.. (check box) .. - .-
DEPTH DRILLING LOG
From ..To - Formation Description
•
Ara code- Phone number/
DATE DRILLED n(- a SO3
5. TOTAL DEPTH: -Se513
6. DOES WELL REPLACE EXISTING WELL? YES pp NO a)
7. STATIC WATER LEVEL Below Top of Casing: I4 U FT.
(Use "*` if Above Top of Casing)
S. TOP OF CASING IS I FT. Above Land Surface'
'Top of easing terminated acor below !and surface requires a
sariance in accordance pith ISA NCAC 2C .011S. nn
•
9. YIELD(gpm): • 70 METHOD OF TEST Itlr
10. WATER ZONES (depth): a %i S/ 0! 57C
I I. DISINFECTION: Type f f TH
12. CASING:
Depth Diameter
From 0 To I 4 Ft. G 1/)<
From - To Ft.
From To Ft.
Ma•-•rial MethodlaT
Ft.Y -
Ft. '/� -.444_ 42Apry
Diameter Slot Size �lateT�� �
a!
Ft. in. in.
Ft. in. in.
Amount .2_j02
Wall Thickness
r�
PWeZq
ens-.277
-277- 570
.5-/0 - S/ 3
L3 - S7D
-6-rd
Ft.
Ft.
Size
Material
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 S CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION S TAN 4 S, TH COPY OF THIS RECORD HAS BEEN PROVIDED TO HE ELL D: ST,R-.. -
t SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE "
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Censer R?1eih, NC
G\Y 1RES:i07/2001
? i699=1636 Phone No. (919) 733-322 (, Within 30 days. ..;+

303089 sisi31t7;r;
WELL CONSTRUCTION RECORD 7 c cj - 7/,.3
North Carolina Department of Environment and Natural Resourcesrcce- Division of Water Quality - Groundwater Section
ECONTRACTORDI NA )�{ T`�'(.(_:a,(��: =Ya ace.. CERTIFICATION #�6L-/ ��
a4eene 2,-as wen DPI PHONE # (ii2d).Snr'STjD
STAT ASSOCIATED WQ PERMIT#
- - (if applicable)
WELL CONTRACTOR COMPANY NAME
y x
E WELL -CONSTRUCTION PER:V IT#
•
(ifa`pplicable) ._ -_
From
From
13. GROUT: Depth
From a To 3 Ft.
From. To ao Ft.
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: W Q.% 4C r • County JA� C --
Ne-,a st(/fs rvr. a>Z779
(Street Name, Num Urea
Subtivision, Lot No., Zip Code)
3. OWNER: WIL
Address 91 D fAi ✓oC h d r) St
(Street Route No.)
Gt. C10,4,r FiA -3i1769
City or Town State Zip Code
E ge? -57
Area code- Phone number
4. DATE DRILLED S' —3—D 4
5. TOTAL DEPTH: act
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO p
7. STATIC WATER LEVEL Below Top of Casing: WO FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS j FT Above Land Surface*
'Top of casing terminated ao'or below land surface requires a
variance in accordance with ISA NCAC 2C .0I1 IS. •
9. YIELD(gpm): 4 METHOD OF TEST my
10. WATER ZONES (depth): eQ9 r
11. DISINFECTION: Type !-f j—.}i Amount /5775"e
12. CASING: - Wall Thickness
Depth Diarnetet or \\'eight'Ft. Materia!
From To Si Ft. 6'/v $OR21 ®OL
To Ft.
To Ft.
Material Method
W +1'
Slot Size Material
in.
i n.
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:
Topographic/Land setting
[Midge RSlope ❑Valley ['Flat
(check appropriate box)
Latitudefongitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From To Formation Description
a-53
S3 -29S
a9r-aqg
aqs
LOCATION SKETCH
Show direction and distance in miles from et least
two State Roads or County Roads. Include the road
numbers and common road names. p�
cm
rn
nra
m
At
230
0'
m0
rn
tP p
171
e
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH I5A NCAC 2C, WELL
CONSTRUCTION STA ARDS AND — T 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, INC
27699-1636 Phone No. [phone], within 30 days. GW-1 REV. 07/2001
r—

(\
30g8 :S'1/La1t iv
WELL CONSTRUCTION RECORD 76 in a - S'(o_,t3go
North Carolina Department of Environment and Natural Resources} - Division of Water Quality - Groundwater Section ' / r
WELL CONTRACTOR(INDIVIDUAL)NA\IE (print) thi +'mot �rULC CERTIFICAATrIIO\g-# J3o I!
WELL CONTRACTOR CO\IPA\Y NA\1E AAA Greene,'Oros (.L�cz4 1DA'i PHONE # fa 5S -S SZ
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED w'Q PERMIT#
(if applicable)_... _ (if applicable)
1. WELL USE (Check Applicable Box): Residential Municipal/Public ❑ Industrial D Agricultural ❑
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use
2. WELL LOCATION:
Nearest Town: t. / , County�l
Sk,I.a 4 47,- 5, j(th ^V aR77?.
(Street Nam , Nurr'+:. Comrmintty. Sc.-i visi n, Lot Nol Zip Code)
3. OWNER: 71)'BL.tnri a.. Pal, tr rIS
Address (o(75% .SI h ijr
(Street or R ute No.)
Sr ! P. N c s 5
City Town St to Zip Code
( ' )- (03 / — 13319
Area code- Phone number
4. DATE DRILLED .a - 0 (71
5. TOTAL DEPTH: 3o O
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO g)
7. STATIC WATER LEVEL Below Top of Casing: 3 (5 FT.
(Use "+" i f Above Top of Cuing)
S. TOP OF CASING IS I FT. Above Land Surface`
'Top of casing terminated a L'or below land surface requires a
variance in accordance wilt ISA NCAC 2C xi Is. nJ1
9. YIELD (rpm): (c& METHOD OF TEST 11-1r
ID. WATER ZONES (depth): Q 80
acis
11. DISINFECTION: Type It 17/
Amount 13'Jr era -
Wall Thickness
or WeiehLTt. Material
S21Z21 PUC
13. GROUT: Material_Method
From e Ft.
From To 0? 0 Ft. niZ',rt-±z— �fic 1.yp-P-.e
14. SCREEN: Depth Diameter Slot Size U Mate(Sal
From To tFt. in. in.
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
Topographic/Land setting
❑Ridge KSlope ❑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
O-- IR
I •-ago
aro gag-
- 0793-
sqs - 99k
aQS —36o
12. CASING:
Depth t°r-.z;:r
From c To a"I Ft. �/�
From To Ft.
From To Ft.
Depth
To
From To Ft.
LOCATION SKETCH
Show direction and distance in miles from at rest
two State Roads or County Roads. irwly:de the
numbers and common road names. -Ce =R.4
—4 -urn
( ��
CC,
O
o Co
r1:to
�f- n
O
t,(7
-'n-4atao.
16. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH I5A `CAC 2C, WELL ..
CONSTRUCTION STANDA$DS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL G'SVNER
/- a 01
144
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%-07/2001

WELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources - Division of Water Quality
I•y�
�\tLL CO\RTRACAC 70R 0\DIM IDUAL) NAME (print) fliF3'P• - L� '' n4-
TrO♦ �O110,!°. Et Berns � AveAJ
�� ELL L CO\TR4CTOR CO\IPA\Y NAME
- Groundwater Section
CERTIFICATION
�R,, pr-.r9 7
PHONE X (pd2p 7 e'S-lo
STATE HELL CON57RUCTION PERMITS - - ASSOCIATED WQ PERMIT%
'.-;(if applicable);i".�.. .-. (if applicable)
1. WELL USE (Check Applicable Box)(Reszdential�l Municipal/Public 0 Industrial ❑ Agricultural 0
Monitoring Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use
2. WELL LOCATION:
Neare t TOwn County
fl(a ag7z9
(Street Name, L(Nuumbers, Cim/uunniity bdivision, III No., Zip Code)
3. OWNER: 1 l7
Address &6 Al-n.�-e-s-trR„� •
(Street or ou a No.) A
State Code
as 7kZ w
(a& sE L — 0/ 77
Area code- Phone number
4. DATE DRILLED %-ati--©5Z
5. TOTAL DEPTH: al D
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO Al
7. STATIC WATER LEVEL Below Top of Casing LID FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS _:- / FT. Above Land Surface*
•Top or easing terminated at/or below land surface requires a
variance in accordance with 15A NCAC 2C Al IS. nn
9. YIELD (Rpm): /b07" METHOD OF TEST f't /✓
I0.WATERZONES(depth): iss
11. DISINFECTION: Type . f T Fi Amount d/; 445 o Z.
12. CASING: Wall Thickness
Depth Diameter or WVeightFt. Material
From n To39_Ft. LCYe/ a Wk
From To Ft.
From To Ft.
13. GROUT: Depth Material
From 0 To 3 Ft. tt e.Ths„,
From 7i To v? 6 Ft. ha
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.
Topoeraphic/Land setting 3 Lr 3
❑Ridge ,&lope - ❑Valley ❑Flat
(check appropriate box) -
Latitude/longitude of well location
(degrees/m inutesheconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DRILLING LOG
Formation Description
DEPTH
From To
O O—
o -c-:
n
—1
03
LOCATION SKETCH --rc
o nrn
Show direction and distance in miles frJffiat leap
two State Roads or County Roads. Inchu the rc*g'
numbers and common road names. -
•
(lac, ,.....
16. REMARKS:
1 DO HEREBY CERTIFY THAT/�HATHIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH ! 5A NCAC 2C, WELL- ` - -
CONSTRUCTION STA/ "C D T� COP THIS RECORD HAS BEEN PROVIDED TO 7ji,W 77,-, ,
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\V-I REV. 07/2001
6

5. TOTAL DEPTH: o273
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO
7. STATIC WATER LEVEL Below Top of Casing: 1 t) FT.
(Use "-" if Above Top of Casing)
S. TOP OF CASING IS 1 FT. Above Land Surface*
•Top of CA sing terminated at'ur below land surface requires a
vuriance in accordunc • with I5:\ NCAC 2C .0t IS.
9. YIELD (gpm): �. METHOD OF TEST A I Y
10. WATER ZONES (depth): I aa5 Iss—
aio
HTH
0 To 7,2, FL to
To Ft.
To Ft.
Amount p. r n 7
\Cali Thickness
Depth QiarTeter or Weigh: Ft. \laterial
SNth- _z-.'e=
13. Depth i\la:erial Method
-r �
Fror.l 3 To & 0 Ft.
To 3 F[. JG i,. / 47-72c'n-
14. SCREEN: Depth Diameter Slot Size Nlate a!
From To Ft. in.
From To Ft. in.
15. SAND GRAVEL PACK:
Depth Size Nlaterial
.,j- _b .mST ...,.T .r'.. ...
\l`ELiL;".CONSTRUCTIO\ RECORD
Nodh Carolina .D pa a lent yt Eni.uonment and Natural Reoo -ces� U]twsii unn of Wak:- Qualli
HS 5.3`�
z"`i^Yt F
W ELL:CONTRACIOR (INDIVIDUAL) NAME (((ppriri(n'l). 1• r IA.-✓ -I
�,/y�-�1 � 1,/ firer
W ELL'CONTRACTOR COSI PANT N \NIE <' een to7
51ATE WELL CONSTRUCTION PERM IT ASSOCIATED \\"Q PERMIT('
ifapp t-• ab lertraaH-sue" 4.aW (if applicable)
\ ELL USE (Check Applicable B'o`xx)aRestdenttai,� Municipal/Public 0 Industrial ❑ Agricultural ❑
_ xx' �.
Momtonnw ❑ ,'. Recovery,`O y Heat Pump .Water -Injection D Other 0 If Other, List Use
- GronatvaterSection...
CERTIFICATION I: p. is-./ 7
PHONE C
(Sire tName Numb_
mimunit} Subdirisioh,7Loi No..
3. OWNER Vhn (T -ASfl c,
Addy as a Po" 3ey.):S S-6,
_- (Street 6s Route No) ,.W 5r-
W nesvale1/U G a8766•
Cris of Town State Zip Code
Area code- Phone number
d. DATE DRILLED (a- a - 0S1
Topographic/Land setting
❑RidgeSlope 0Valley ❑Flat
;(check appropriate box)
ab 77Q Latitude/lon ttudoF eWelllocation
1l. DISINFECTION: Type
12. CASING:
From
Fror.i
From
GROUT:
From
:n;.n ae-
Latitud(dcge'sreesmmue ❑Griestst Zi'ds x
exlon nudoucPSOTopo raphtc map
(check bot) -r
DEPTH DRILLING LOG
From To Formation Description
n-4
67-/eV
Ass-
oZ/D
LOCATION SKETCH
o
Show direction anddistance in miles from acteast cY,
two State Roads or County Roads. Include R road m
numbers and common road names. --I c
on
CO
From To Ft.
From To Ft.
16. REMARKS:
in.
in.
=tD
—40
C
-o mm
cs 2
I DO HEREBY CERTIFY THAT THIS WELL W -S CONSTRUCTED IN ACCORDANCE WITH ISA NCAC 2C, WELL
CONSTRLCTIO}.SS;NDA %COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
aniie
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) 733-32_21, within 30 daps. GW-I REV., 07/2001

✓a-31P�13Y1'!'l``�'Y'RFl✓A^.S b -
�VELL COl�'STRUCTJON RECORD gaistch
tvutthCa ouna Department of -Environment and Natural esources Drusmr 2 VA`alerQ -lily round,:Gater Sec Le..
\\ELLrCO\TRACTOR(I\DRIDL AL)NAME/l:L�,�pn�nt)"-Ili sm Ih .m "? CERTIFICATIONR
. rRACTO.. CO\IPANI ...' — CI 114:(s/L�Gil�L I?A
\\ELL'CO
PHONE if (p'�tq .&IO `
STATE LLCONST RUCTION P ER\Iliq+=s-a}-a-,.>ssk *r ASSOCIATED\Q PER\IT.
ifappbcable g''":i 4iMg4.'- f -`,::4�" , (if applicable)
;:tMp
\\'ELL USE (Ghd. ,y leBox) Restdenhal NlunicipaVPublic 0 Industrial 0 Auricultural ❑
MAlton❑IRewera ci n4 Heat Pump Neater Injection 0 Other ❑ If Other, List Use
\4 EI ! LOCATI
4` R
'eacstTown:
(Sire ci.amt i�um ra Community S'ubdm5idr Lot No Zip Cod
3. 01 NER. FYIYtI Lti
Addr.as 0
(Strad or Rout ivo)
IT),J/ iyiro NCas-7ar
v or Ton ?rat:: Zip Code
( b"a0iTown437 -70 95/
Area code. Phone number
Topographic/Land setting
❑Ridge (Slope ❑)'alley ❑Flat
eck appropriate box)
Latitudee/lonaitud o well location
From To
3"3191
(d iat'mmutes.h`econds) '
tu`de/Ion rtud source ❑GPS❑Togo graphic map
(check boy)
DEPTH `DRILLING LOG
Formation Description
4 e24 als, - 300
1101 (c '- ilia I LOCATION SKETCH
11. DISINFECTION: Type j '_ Amount �3.CF1 7 Show direction andidis:an:e in miles from at leas! p
12. CASING: Wall Thickness two State Roads or County Roads. IncludeT: road `m
D�a:zr or \\ et h. Ft Material numbers and common road names. p -no
mr=
OOrn
CO Cr".
--to-
-0
mt'*e
��
blatzn..! . tit
J rni�
0
4. DATE DRILLED g tg-OV ©+pp 3 g
J O $5
5. TOTAL DEPTH: 30 Rs` - $ 7
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO '7_ / y -
7. STATIC WATER LEVEL Below Top of Casino: r%v FT. �t49— 3
(Use`T' if Above Top of Casing) /4-3 — /G/2
S. TOP OF CASING 1S 1 FT. Above Land Surface'" //D —Pth) S—
'Top uf casing terminated atfur below land surface requires a L/,�
variance in accordance with 15:\ !CAC 2C .0113. n I(p '2L5'- cgSS v,-a ijL
9. YIELD (epm): • 3 0 METHOD OF TEST (fl r .anT ST �� s4�/
10. WATER ZONES (depth): I 16- ' /:�
Depth
From h To (r 3
From To Ft.
From To Ft.
FL 1 W I'ligr.3 l
13. GROUT: Depth Material p_ Met. rod
From 0 To --a Ft m-.y�
From 3 To a.0 Ft h eR irwu�
14. SCREEN: Depth Diameter Slot Size
Frorn To Ft.
From To Ft. in.
15. SAND GRAVEL PACK:
Depth Size
From To Ft.
From To Ft.
in.
in.
Material
16. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL \)
CONSTRUCT IQN,STANDARDS.
S CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
COPY OF THIS RECORD HAS BEEN PROVIDED 2 HE LL OWNE
SIGNATURE OF PERSON CONSTRUCTING THE WELL
DATE
Submit the original to the Division of Water Quality, Groundwater Section. 1636 dlail Service Center -RaIeigh,Y\C.....
..
27699-1636 Phone No. [phone], within 30 days. GW-1 REV. 073Q01

WELL`CONSTRUCTION:RECORD 5.587o'`
W 4e Kit' s
or��th'Carolma Department o(Envlronment and h/a�tui i. .r ResourcesM- ll,�n't}s-i(on of Water Quality - (ir u ater echo�7
. ELLr TR _ �s -' v Y4 z lma_ in 10 /+`f / i1 �$ - CERTIFICATION N IX� %-
\VELLCO1TR4CTOR(INDNDL'AirLan E.(print)�!� -
r z7 -^st°+..'- in /� R/WS &<s-f PHONE k (dxb n0'S) -1 S
V�'ELL,CONTRICIORCOVIPANI NAME PA7�.
�,TIO\ PS..�x' der ,�f �Cff "- _..
STATEAVELL-CONST R LCTION.PE RVIIT : r - ASSOCIATED WQ PE RSIITII
Wap pli ab1 "' '"" :Mt- ," _ • - (if applicable)
A7unicipal/Public 0 - Industrial 0 Agricultural 0
In)echonl7 Other 0 If Other, List Use
Topographic/Land setting 303193
❑Ridge [JSlope;OYalley ❑Flat
(chid appropriateox)
r s%
Latnude/lonottude of well location '
x ussx e_
b7i -4. i^3'htE
1 ff1VELL USE'(Check Applicable ox)
a 4 wcove , .
Momtonne❑ Recovery eatPt
2. 1VE LLOCATIO
Near TowD.v
(S•re tame t.umt+er Community Sul(dhi io
i aYM1�`irrSSiLx+•i v`"�M-.7{fv^j �`X.0 :.
3. OWNER:
Address PO )
Cne or Town Star/
(a/51) e993— 3307
Area code- Phone number
4. DATE DRILLED %—/- o y
5. TOTAL DEPTH: 360
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO Ar
7. STATIC WATER LEVEL Below Top of Casing: FT.
1 (Lye "r' ifAbove Top of Casing)
S. TOP OF CASING 15 FT. Above Land Surface'
*lop of using terminated at or below land surface requires a
variance in accordance ut h 15A NCAC 2C .0119.
9. YIELD (coin): • HS-. METHOD OF TEST Jy>
10. WATER ZONES (depth): e2* 5 / / v
(Street or Route Na) y "
Zip Code
1 I. DISINFECTION:Type /1 H Amount 1�f_ • _
I2. CASING: Wall Thickness 0
Depth Diameter or Weight'Ft. Material,�aty�
From • To 6.3 Ft. ,'/f6 rlflWa4 La¢-.z.
From To Ft.
From To Ft.
13. GROUT: Depth Material Method
From b To 3 Ft. j�/r'-*� • I ne-
From 3 To 2!) Ft. :rt„-r--"}2Tti.- fery4 C-mia
14. SCREEN: Depth Diameter Slot Size VV Alatellia!
From To Ft. in. in.
From To Ft. in. in.
ir
1=. SAND GRAVEL PACK: Depth Size Material
From To
From Tc
16. REMARKS:
Ft.
Ft.
e¢Riimmul aet
Latitude/Ion nude'source - ❑GPd S❑Topotraphic map
_ • (checkbox t.-
DEPTH ./DRILLING LOG
From ' To 'Formation Description
O-6V
!/O -
ita
gig—f7
.2 X 7 — 3o7S
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
O
O
n
CO
I DO HEREBY CERTIFY THAT THIS 'ELL WAS CONSTRUCTED IN ACCORDANCE WITH ISA NCAC 2C, WELL
CONSTRi.CpON $•TANDj.F�D • ITHAT A COPY OF THIS RECORD HAS BEEN PROVIDED TOT 'E WELL °AM- ER-
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
Submit the original to the Division of 1\ater Quality, Groundwater Section, 1636 Mail Scnice Center -Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-1 RE1'.,:D7/2001

WELL CONSTRUCTION RECORD , S a Li 0-)
Bray- (>3-3SIoS)
V'o_t t i. )roil na Dcpaument of Environment and Natural Reno:rec> Division of ASa:c- Qualilp - Groundwater
\"ELL CONTRACTOR (INDIVIDLAL)\A\IE (print) V r �L4.! CERTIFIC6ATIION: Ss
WELL CONTRACTOR COMPANY \A\IE 7 to :A -- Sines LO F/Mc� PHONE " (t Sp W �.5.3)
STATE WELL CONSTRUCTION PER\IIT: - ASSOCIATED WQ PER\IITe
(i f applicable) (if aDolicablej
I. WELL USE (Check Applicable Box): Residential gc,t Alunicipa"Public 0 Industrial ❑ A_gricultura! 0
Nlonitorirw ❑ Recovery ❑' Heat Pump Water Injection 0 Other 0 If other, List Use
2. WELL LOCATION: .�L•/
Nearest Town: Lt, hl• 11 ier County .Jar t
(S:ra: \a::::. Nu,t:cis. Corr:mur.it . Subdi vieior, Lor No.. Zip Code)
3. 0 W NER.:'RA ti FPr u.s?c7v.
Address c4 3$ 0Id LLS/on 7_I
(Sir en: or Rom. Na.},
rl7hiher J1) C. 427E9
cr% er roc,:, s:lt_ Zip Co.
( )- U97-- 9.s
Are_ de- Fn.one net.
4. DATE DRILLED C%-/‘-6
S. TOTAL DEPTH: '41D
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO kV
7. STATIC WATER LEVEL Below Top of Casing: ? FT.
(Cse i.`Aio.e To; of Casing)
S. TO? OE CASING 15 / FT. Abo•:e Land Surface*
'Tip ur ce)ing r:rm:net ed ere ur b elux lend surfe:e requires
sec: -:soya in Liceded-tee nirh 155A \CAC 2C .0113.
9. YIELD(cirri): • o0 ME OD OF TEST /lir"
10. WATER ZONES (depth): a90
I I. DISINrtCT!ON: Type ff- TH Amount
12. CASING: Waa Thickness
D:azzator a:
Df?: \'::•-)' \rt..o4)
T. . Er. &-,-1-e-p_'
Fron) 3 To 20 Ft h C- to .s. t_- .je e_' rr4t o- e,
11. SCREEN: De;;,, Dian:e:r. Siu;Siza v :\I_:eri,. OCI+-PLL.
From To Ft. in. in.
From To Ft. in. in.
15. SAND GRAVEL PACK:
Depth Size Ma:trial
To Ft.
To - Ft.
Topographic/Land setting
IrRidge ❑Slope ❑\'alley ❑Flat
(check appropriate box)
Latitude/longitude of well location,
304358
(degr:es'r..iwres+iecorda)
Lati!udelongitude souce:OGPS❑Tripu_raphic map
felitok boxf
DEPTH DRILLING LOG ,
From To Formation Description
1) —not
3 e - 393
LOCATION SKETCH
Sho'.v direction and'dis:en_e in miles from a: leas:
two St.t:e Roads, or Co..m:y Roads. Include tiro: d
numlcers and cordmon read names.
Depth
. From L ' Tc eAC:1 Ft. le 1/4 r(SfrutQ' _ C e Q
Fr, r.: To Ft.
From To Ft.
I ie GROUT:
From 0
From
From
16. REMARKS:
I DO HEREBY CEf.TIFY THAT THIS WELL WAS CONSTRUCTED IN ACCOP-DANCE V.I T H ISA KCAL-. 2C. WELL
CONS-FR:CT!AND.aRDS. AND THAT A COPY 0= THIS RECORD HAS BEEN PROVIDED TO THE WELL O'aIER
- r
S!GNATLRE OF PERSON CONSTR_CTING THE WELL
/0
-2 --6
DATE
Submit the original to the Di%ision of Water Quality, Groundwater Section. 1536 )Tail S rsice Center -Raleigh, NC
27699-1536 ?Inn: No. (919) 733-32_21, trirhin :0 days. GB:-1 REV. 07:2001
rn
crti
rein
rein
jai
,cuo
Gam.
rnr
r ; r7
r:.e
5-7 R

' NN'ELI CONSTRUCTION RECORD 350i 7/it; •
' 7S73-77-5/s.ems,
North Carolina - Department of Environment and Natural Resources-(7Division of Water Quality - Uroundwater section �j�.
WELL CONTRACTOR (INDIVIDUAL) NAME \ (print) - Z. 0s !It S t.--GC-irr' f^� / CERTIFICA(TII,ONft o2/7(e'
WELL CO\rR.\CTOROO\IPAN\ NAME AAA Or eaenerds tL)at Ilr PHONE # ferry SC-- CS5r)
S FATE W ELL CONSTRCCTION PERMIT: ASSOCIATED WQ PERMIIT#
(ifapplicable) - (ifapolicablel
I. WELL USE (Check Applicable Box): Residential I. 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: TGl{ZQ Seeyee County C'K-S Fir\
CIF.: Fie �(ILueas e., �� P21d'3
(Street Name. Nukbers. Comm(c,unity, Subdivision, Lot No.,
Zip Code)
3. OWNER: , f Ot •i'LR-L FVLSL 4\L4
Address )() La1 crs/...9 Cr/0
(Sue: for Route No.)
(!L IPms41A. vpC.l»-3
_city or Town State f Zip Code
( )-a
Area code- Phone number
T. DATE DRILLED 2 --.3/ - Sc
5. TOTAL DEPTH: /-i L.1
6. DOES WELL REPLACE EXISTING WELL? YES O NO ft)
7. STATIC WATER LEVEL Below Top of Casing: ar FT.
(Use ifAboveTop or Casing)
S. TOP OF CASING IS + FT. Above Land Surface*
•Top of casino terminated aNur below land surface requires a
variance in accordance nith 15.-\ NCAC 2C .0113. 9. FIELD (gom): , rid METHOD OF TEST A )
t0. WATER ZONES (depth): is '
II. DISINFECTION: Type HT. 14
12. CASING:
Depth Diameter
From C To dS Ft. & /j
From To Ft.
From To Ft.
13. GROUT: Depth
From 0 To 3
From .3 To 20
14. SCREEN: Depth
Topographic/Land setting
DRidge ❑Slope ❑Valley INFlat
(check appropriate box)
Latitude/longitude of well location
(deerees'minutes.'seconds) -
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DRILLING LOG
Formation Description
DEPTH
From To
304357
0-20 liiucI 44r.E,
920— 70
LOCATION SKETCH O'
Amount L. % Show direction anddistance in miles from at I:
\all Thickness:
Iickne two State Roads or County Roads. Include the road
or Weigh:Ft. Nlate:i l numbers and common road names.
%Ybu'f.C/ Stu{
Material Method
Ft.
Ft. /
Diameter Slot Size Material ((Z-
From To Ft.
in. in.
Front To Ft. in. in.
15. SANDGRAVEL PACK:
Depth Size Nlaterial
From To Ft.
From To Ft.
1
La V1c.
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
SD- mr'(urr
SIGNATURE OF PERSON COYSTPFCtTING THE WELL DATE
to -a.o?-oy
Submit the original to the Division of \Vater Quality, Groundwater Section, 1636 Mail Service Center- Raleigh, NC
27699-1636 Phone No. (919) 733-32221, within 30 dal.) s. GW-I REV. 07/2001
1

WELL CONSTRUCTION RECORD 7 /S
c
North Carolina - Department of Environment and Natural Resources _Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NA\I/jE� �(p��ri,�n�t) _ /� // LPN
n
WELL CONTRACTOR CONIPAN\'NAME r-JYi/"j ree nuns (J) /alga PHONE # (�o[q .5Sys'S--s.0
STATE WELL CONSTRUCTION PERMIT ASSOCIATED \vQ PERMIT#
(if applicable) - (ifaaolicable)
CERTIFICATION 3D //
1. WELL USE (Check Applicable Box): Residential Al t 1unicipal.'Public ❑ Industrial ❑ Agricultural ❑
b!onitoring 0 Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use
Nearest Town: trzt� Counts
fli i Tfl-b-i / /)( 11r77?
r Satyr„ Nmn Com unity. Subdi ciiiol�, Lot Zip Cole)
3. OWNER: jduz.,e ,
2. WELL LOCATION'' Topographic/Land setting
\¢Ridge ❑Slope DValley ❑Flat
(check appropriate box)
I Str Latitude%longitude of well location
Address 4 (] Zu.(-CJE-CYL
(Street or Route No.)
vat^PI dim 7 c- 441E
Cr'% or To,m. Star: Zip Code
(`�) c197- I pi(o
Aced code. Phone number
4. DATE DRILLED lO "1a -OS
5. TOTAL DEPTH: (07S
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO X
7. STATIC WATER LEVEL Below Top of Casing: --24LO FT.
(se "�' i.fAbrgt ove Top of Casi
S. TO? OF CASING IS I FT. Above Land Surface-U
•Tnp of casing terminated uCur belun land surface requires a
%ariance in accordance scith lie\ NCAC 2C .0118.
9. YIELD (gpm): ' 3 U METHOD OF TEST n I r
10. WATER ZONES (depth): 14 0
(p$ LOCATION SKETCH
11. DISINFECTION: Type 1 i I-F Amount 30.3 S b7 Show direction and'dis:ante in miles from at least
12. CASING: Wall Thickness two State Roads or County Roads. Include the road
Depth Diameter or V.eig;h:.Tt. Material numbers and common road names.
To FL ()/( 3DK Zj PVCr
304356
(degrees.ininutes:secords)
La;itude'lom_itude source:❑GPS❑Topographic map
(check box)
DRILLING LOG
Formation Description
DEPTH
From To
From 0 10$
To Ft.
To • Ft
13. GROLT: Depth Material
Fro; t 0 To 3 Ft. QJ1/trD-
From 3 To Z�L
0 Ft. Q-n: nra-t
1a. SCREEN: Depth Diameter S:otSize
From To Ft. in. in.
From To Ft. in. in. '
1?. SAND GRAVEL PACK:
Depth Size
From To Ft.
,From To Ft.
Front
Front
Material
Method
16 REMARKS:
I DO HEREBY CERTIFY THAT THIS ‘WELL WAS CONSTRUCTED IN ACCORDANCE WITH ISA NCAC 2C, WELL
CON'STRCCT!0N S7 ND.ARDS, A.. THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL 01WNER
SIGNATURE OF PERSON CONSTRUCTING THE WELL
le. - oiG
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 v 5 - I- 0 f 0,f
North Carolina Department of Luvlronment and Natural Resources - Dix -Ion of Watai Quality' - e' %%
P ^ /0 "-Q Gr-_ndo etet :, ectton
%1 ELL CO\ TRACTOR (I\Dl% I DUAL) NA\IE (printj)).) 9+1 C—L-4— 1 Prig
WELL CONTRACTOR COMPANY NA11E I-y7/7 (4rP en -ran Wet/ V 4
S FATE \%ELL CO\STRLCTION PER%I Fig ASSOCIATED WQ PE R>IIT:
fifapplicable) (if applicable)
PHONE R
CERTIFICATION tr
( 2Ss 'It•-SSsa
1. WELLUSE (Check Applicable Box):Residentialpr Municipal/Public ❑ Industrial ❑ Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection ❑ Other ❑ If Other, List Use
2. WELL LOCATIIIAN: pp(, �,
Nearest Town: Cr 1 Y�hS County ./1
(Street Name. Numbers, Community, Subdivision, Lot No.. Zip Code)
3. OWNER: lirr% �Llbet/cd.--
Address :aa1-- on- i t'e LLIAlf
��IMe. Street orFi/No).M-aai
City or Town Bute Zip Code
0< )- 730 - 30s9
Area c!e- Phone number '/
4. DATE DRILLED q -w1v1 - Si
5. TOTAL DEPTH: 40 0
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO
7. STATIC WATER LEVEL Below Top of Casing: GO FT.
(Use "." if Above Top of Casing)
S. TOP OF CASING 15 1 FT. Above Land Surface'
'Top of casing terminated aNur below land surface requires a
variance in accordance with I5.\ NCAC 2C .0115.
9. YIELD (gpm): • 6 METHOD OF TEST Hie"
10. WATER ZONES (depth): cZ5,7
3/0 -I9
I I. DISINFECTION: Type ft Tl-t Amount /0 OZ
12. CASING: Wall Thickness
Depth Diameter or Weigh:Ft. Mate al
From 0 To se FL Ian/r� S0tZ! pL7C
From - To Ft.
From Ft
To
13. GROUT: Depth
From C)
From 3 To ZC)
14. SCREEN: Depth
From To Ft. in.
From To Ft. in.
15. SAND GRAVEL PACK:
Depth Size
From To Ft.
From To Ft.
\laterial Method
Ft. S DTrna-,'
Topo,pn�raphicfLand setting
7a6
❑Ridge Iope ❑Valley ❑Flat
(chec): appropriate box)
Latitude/longitude of well location
304355
(degrees.minutes'seconds)
Latitude longitude source:❑GPS❑Topographic map
(check box) •
DRILLING LOG
Formation Description
DEPTH
From To
3 iY
°MO aLa
a6R.- -?)03/n 3/d-
R12 -yc)eJ
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.
Ft.--cmtMyX,.., 41,z.-srti CO retc.r.
Diameter Slot Size V Material
'Material
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
Kt
SIGNATURE OF PERSON C-9�tSTRL'CTING THE WELL
/0 - a2T -oat
DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 NIA Service Center -Raleigh, NC
27699-1636 Phone No. (919) 733-32221, within 30 da)s. 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) Russell S. Taylor
WELL CONTRACTOR COMPANY NAME Hedden Brothers Well Drilling, Inc
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable)
(if applicable)
304488
CERTIFICATION # 2187
PRONE # f 828) 369-9591
1. WELL USE (Check Applicable Box): Residential ® Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection O Other 0 If Other, List Use
2. WELL LOCATI� (
NearesJ,To�w/n: County.
(Street Name NO
3. OWNER:
Address
mbers, Community, Subdivision, Lot No., Zip Code)
��ppCity or , a Zip Code
4Ga)-
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: . X) 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 accordyy{{ce with 15A NCAC 2C .0118.
9. YIELD (gpm): Olaf Mg;iOp OF TEST BLOW
10. WATER ZONES (depth): / i /55 11 4,"f'
11. DISINFECTION: Type H T H
12. CASING:
/� Depth
From �/ To
From /ni 'To
From
ft
FL in•, i138 otjgp
To Ft.
13. GROUT: Depth Material
From 0 To 20 Ft. benonite & cement
From To Ft.
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.
Amount 16oz
Wall Thickness
Dsa meter or Weight/Ft. Material
Method
pumped
Slot Size Material
in.
in.
Topographic/Land setting
ORidge ❑Slope OValley OFlat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:OGPSOTopographic map
(check box)
DEPTH DRILLING LOG
From To 2 I Formation Description
l-J J clay & sand
)o3' oQ50r 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.
h
16. REMARKS:
1 DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CON RUCTION STANDARDS, AND THAT COPY OF THIS RECORD HAS BEEN PROVIDED TO Tc�lE(. WE L OWNER
TE /
D
SIG TURF OF PERSON CONSTRUCTING THE WELL E
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-1 REV. 07/2001

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of' Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) James B. Brown CERTIFICATION p 2045
WELL CONTRACTOR COMPANY NAME Hedden Brothers Well Drilling, Inc
PHONES( [phone]
STATE WELL CONSTRUCTION PERMIT,/ ASSOCIATED WQ PERMITS(
(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 LOCATI
Nearest 0o
N:
County,
(Street Name, Numb
Community, Subdivision, Lot No., Zip Code)
3. OWNERI. ,2!l7
Addrftss I ER f , ,/,/ i..77Al railro
,s� (ti . sine! or Rou7Qj» /XA z�q7
IOG6 ICity
c/ T'7 3/ Js7
Area code- Phone number
4. DATE DRILLED 1Q•%
5. TOTAL DEPTH: //
6. DOES WELL REPLACE EXISTING WELL? YES 0 A<
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 ■
variance In aceorda lth ISA NCAC 2C .0118.
9. YIELD (gpm): _ MEADp 9F,TTSIT BLOW
10. WATER ZONES (depth): /
1 I. DISINFECTION: Type
12. CASING:
Depth
From t„J To 0
From To
From To
13. GROUT: Depth
From 0 To 20
Zip Coda
H T H Amount 16oz
Wall Thickness
Diameter or Weight/Ft. Material
Ft. ,r five.
Ft.
Ft.
Material
Ft. benonite & cement
From To Ft. -
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.
Method
pumped
Slot Size Material
in.
in.
Topographic/Land setting
°Ridge 0Slope °Valley OFIat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:OGPSOTopographic map
(cheek box)
DEPTH DRILLING LOG
Frim o, * Formation Description
V clay & sand
.rat(' 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.
16. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION SCAN 1RDS, AND THAT A Y OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
O/y �F�-O C% / 4r / o V.
SIGNAT RE 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

3044"
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (pint) dames 8. brown
WELL CONTRACTOR COMPANY NAME Hedden Brothers Well Drilling, Inc
CERTIFICATION # 2045
PHONE # [phone]
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
1. WELL, USE (Check Applicable Box): Residential 0 Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery ❑ Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATIO
Neare own: /. a County,
(Street Namere, Community, S b-ivision, Lot No., Zip Code)
3. OWNER:
Addres.
(Street•r'.4Ie o.)
ty, To.y_
Area code- Phone number
4. DATE DRILLED
5. TOTAL DEPTH:
6. DOES WELL REPLACE EXISTING WELL? YESfJ O,1'
7. STATIC WATER LEVEL Below Top of Casing: of 0 0 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 ■
variance In accordant wick 1SA NCAC 2C .0118.
9. YIELD (gpm): ME�}jOi� QF1T ST a OW
10. WATER ZONES (depth): ((pp�jj
Zip Code
Topographic/Land setting
ORidge ❑Slope °Valley °Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:OGPSOTopographic map
(check box)
DEPTH DRILLING LOG
Fr T f ' Formation Description
clay 8 sand
granite
LOCATION SKETCH
11. DISINFECTION: Type H T H Amount 16oz Show direction and distance in miles from at least
12. CASING: Wall Thickness two State Roads or County Roads. Include the road
De th Di eter or Weight/Ft. Material numbers and common road names, p
From O Tot. ✓f:
From To Ft
From To Ft.
13. GROUT: Depth Material
From 0 To 20 Ft, !limonite & cement
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.
Method
pumped
U1
16. REMARKS'
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED M ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STAAIaMDS, AND THAT A COPF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
DA
tars, /1/Lmr,Ac)
SIGNATURE OF PERSON CONSTRUCTING THE WELL
Submit the origittal 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
c

304485
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 it 2045
WELL CONTRACTOR COMPANY NAME Hedden Brothers Well Drilling, Inc PHONE # f 828) 389.9591
STATE WELL CONSTRUCTION PERMIT# - ASSOCIATED WQ PERMIT#
(if applicable)
(if applicable)
1. WELL USE (Check Applicable Box): Residential 0 Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection Cl Other 0 If Other, List Use
2. WELL LOCATION:
Nearg,St Town: County
(Street N Nurr�ben, Community Subdivision, Lot No., Zip Code)
3. OWNER:
Address
ig779
ity wn S Zip Code
• .ail7
Area code- Phone number ^7
4. DATE DRILLED J0. / 'O/
5. TOTAL DEPTH: /
6. DOES WELL REPLACE EXISTING WELL? YES fJ,,j 10
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 h ISA NCAC 2C .0118
9. YIELD
10. WATER(ZONES(daep� (depth).
/05'O TEST gt BLOW
/I�(SV/et NC to No.)
I I. DISINFECTION: Type H T H Amount 16oz
12. CASING: Wall Thickness
Depth 4 an meter or Weellght/Ft. Ma eri�
From d IY To (O fj
From To Ft.
From To Ft.
13. GROUT: Depth Material Method
From 0 To 20 Ft. benonile & 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 - Material
From To Ft.
From To Ft.
Topographic/Land setting
DRidge ❑Slope OValley DFlat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:DGPSDTopographic map
(check box)
pEPTH DRILLING LOG
From To , Formation Description
clay & sand
granite
LOCATION SKETtJI
Show direction and distance in miles from at (east
two State Roads or County Roads. Include the road
numbers and common road names.
401
-
c
O
16. REMARKS•
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 1SA NCAC 2C, WELL
CONSTRUCTION STTcN1)tARDS, AND THAT A CO Y OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
SIGNATU 6P PERSON CONSTRUCTING THE WELL
DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center -Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. ', . GW-1 REV. 07/2001

WELL CONSTRUCTION RECORD 3 Q 4 4 8 4
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) James B. Brown CERTIFICATION p 2045
WELL CONTRACTOR COMPANY NAME Hedden Brothers Well Drilling, Inc PHONE I 15261 369.9591
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT,/
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential El 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 e :
Nearest To
Code)
(Street Name, Numbers, Community, Subdivisionp
3. OWNER:
Address- 5Q
(Street or Rout
e NC
( Q)nyoi�_yw• J
Area code- Phone number
4. DATE DRILLED (d. 'bµ
5. TOTAL DEPTH: ,3
•
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO fit
7. STATIC WATER LEVEL Below Top of Casing: inFT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING 1S 2 FT. Above Land Surface*
*Top of easing terminated at/or below land surface requires ■
variance In actordrnet with ISA NCAC 2C .0118.
9. YIELD (gpm)' ?SO+ ME Ci&9F TEST
I0. WATER ZONES (depth):
o,)
9
pRR779
Zip Code
BLOW
11. DISINFECTION: Type H T H Amount 16oz
12. CASING: Wall Thickness
Depth
From D To
Diameter or Weight/Ft. Material
From .3'7 ' To FL &' . /88
From To Ft.
13. GROUT: Depth Material Method
From 0 To 20 Ft. benonite & 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 - Material
From To Ft.
From To Ft.
Topographic/Land setting
ORidge ❑Slope OValley OF1at
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:OGPSOTopographic map
(check box)
DEPTH DRILLING LOG
Fromm �o� t Formation Description
clay 8 sand
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.
16. REMARKS.
I DO HEREBY CERTIFY T THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION ST4 a S, AND THAT A COPY aF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
—UV
DATE
SIG ATU ' a 'ERSON CONSTRUCTING THE WELL
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
27699-1636 Phone No. [phone], within 30 days., . GW-1 REV. 07/2001

((Street /tte No filly
City or ywAC/lJA/ " 60477 Zip Code
Area code- Phone number
4. DATE DRILLED /O' O7
5. TOTAL DEPTH: az
6. DOES WELL REPLACE EXISTING WELL? YES D O J'�C
7. STATIC WATER LEVEL Below Top of Casing: aUJ FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS 2 FT. Above Land Surface*
*Top of cuing terminated attor below land surface requires a
variance In accordan with 1SA NCAC 2C .0118.
9. YIELD (gpm): IS MET �Q D OFT T BLOW
10. WATER ZONES (depth): aYA . * 6
J.00ATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common road names.
Numbers, community, Subdivision,
OWNER: J v "
A re;s /.StS,3 QL/ ZJI72
U� r f7
WELL CONSTRUCTION RECORD
304483
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) James B. Brown CERTIFICATION # 2045
WELL CONTRACTOR COMPANY NAME Hedden Brothers Well Drilling, Inc PHONE # J 828) 369-9591
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential 0 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:
Ne rest Town:
3.
(Street Nam
ty
No., Zip Code)
Topographic/Land setting
°Ridge ❑Slope Malley °Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:DGPS°Topographic map
(check box)
DEPTH DRILLING LOG
Frl Tp„ r ' Formation Description
clay 8 sand
nranite
11. DISINFECTION: Type H T H Amount 16oz
12. CASING:
Depth
From To
Fro To
From To Ft.
13. GROUT: Depth
From 0 To 20
Wall Thickness
Di mettr or Weight/Ft. trial
Ft.
Ft.
Material Method
Ft. benonite & 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 - Material
From To Ft.
From To Ft.
O
r
0
to
-o
0
et%
16. REMARKS'
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH ISA NCAC 2C, WELL
CONSTRUCTION ST¢NPARDS, AND THAT A CQPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
5� St
SIGNAT OF PERSON CONSTRUCTING THE WELL �a DATE
D
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail ServieeCenter -Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. . GW-1 REV. 07/2001

WELL CONSTRUCTION RECORD
304482
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (pint) James B. Brown
WELL CONTRACTOR COMPANY NAME Hedden Brothers Well Drilling, Inc
CERTIFICATION 2045
PHONE [phone]
STATE WELL CONSTRUCTION PERMITS/ ASSOCIATED WQ PERMIT,/
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential 9 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
Near T'wn: L/s !' County
(Street Name, ' m.. n, ommunity, Subdivision, Lot No., Zi. Code)
3. OWNER:
Address '• ie �i'
treet or to No.)
c.8 i
n3
y o ��160 gga Ste Zip Code
Area code- Phone number
4. DATE DRILLED I I '
5. TOTAL DEPTH: / 0�/
�
6. DOES WELL REPLACE EXISTING WELL? YES Q JQO
7. STATIC WATER LEVEL Below Top of Casing. n((/ 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 accords with 1SA NCAC 2C .0118.
9. YIELD (gpm): METHOD OF TEST BLOW
10. WATER ZONES (depth): 15' g5; /oa
11. DISINFECTION: Type H T H Amount 16oz
Wall Thickness
or Weight/Ft. at rial
12. CASING:
Depth Diameter
From To Ft Direct
Fro ttt To Ft. /e„JAIL
From To Ft.
13. GROUT: Depth Material Method
From 0 To 20 Ft. benonite 8 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 - Material
From To Ft.
From To Ft.
Topographic/Land setting
Midge ❑Slope Malley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From Tp r r Formation Description
clay .5 sand
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.
0
(Jl
16. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION ST S, AND THAT A CQP,Y OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
SIGNATURE
1s co //m? —U V
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-1 REV. 07/2001

-) 304481
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) Jamas B. Brown
CERTIFICATION 2045
WELL CONTRACTOR COMPANY NAME Hedden Brothers Well Drilling, Inc PHONE s 1828) 369.9591
STATE WELL CONSTRUCTION PERMITS ASSOCIATED WQ PERMITS
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential 9 Municipal/Public 0 Industrial O Agricultural 0
Monitoring O Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATI
Neares
tY
(Street Name, Numbers mmunity, Subdivision, Lot No., Zip Code)
3. OWNER:
Address
�1 `r�rnp Royte i%(
(-
rty r °"age to / Zip Code
Area code- Phone number �r //
4. DATE DRILLED /1'nf '6
5. TOTAL DEPTH: 0
6. DOES WELL REPLACE EXISTING WELL? YES NO
7. STATIC WATER LEVEL Below Top of Casing: FT
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS 2 FT. Above Land Surface*
*Top of cuing terminated at/or below land surface requires a
variance In accord, Oh 15A NCAC 1C .011S.
9. YIELD (gpm): METHOD nF TEST BLOW
10. WATER ZONE (dep
11. DISINFECTION: Type H T H Amount 16oz
12. CASING:
Depth Diameter or Weight/Ft.
From To Ft.
From , a I To Ft.
From To Ft.
13. GROUT: Depth Material
From.2._ To 20 Ft. benonite & cement
Wall Thickness
,jag
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 Fly . ' Formation Description
clay 8 sand
granite
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
erial numbers and common road names.
Method
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:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDi 19S, AND THAT A COPY Of THIS RECORD HAS BEEN PROVIDED TOT THE WELL OWNER
tOny t > /% �2-0{
SIGN 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
c0

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) Russell S. Taylor
WELL CONTRACTOR COMPANY NAME Haddon Brothers Well Drilling, Inc CERTIFICATION,/ 2187
STATE WELL CONSTRUCTION PERMIT,*PHONE p f 828) 369-9591
if applicable)
ASSOCIATED WQ PERMIT,/
if applicable)
1. WELL USE (Check Applicable Box): Residential 0 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:
Ne:.,t Town: r 4 i County,
(Street Name, Numb
3. OWNER:
Addres
Area code- Phone number
4. DATE DRILLED
5. TOTAL DEPTH:
Zip Code
6. DOES WELL REPLACE EXISTING WELL? YES gi yp. K.
7. STATIC WATER LEVEL Below Top of Casing: FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS 2
Above Land 'Top of casing terminated at/or below land surfacereq roSurface*
variance In accordance w th ISA NCAC 1C .0118.
9. YIELD (gym): ' MET Q QF TEST BLOW
10. WATER ZONES (depth): U . /o,3 1
11. DISINFECTION: Type H T H 7 Amount 16oz
12. CASING: Wall Thickness
Depth Fro To Ft, Di ete
Fro To r or Weight/Ft. M
SL n' f
c LFt.=
From To Ft.
13. GROUT: Depth Material
From 0 To 20 Ft benomte & cement
From To Ft.
14. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. _ in
From To Ftin. in.
15. SAND/GRAVEL PACK:
Depth Size Material
0
To
T
From Ft.
From Ft.
16. REMARKS:
Method
umped
304676
Topographic/Land setting
❑Ridge OSlope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
DE?TH (check box)
DRILLING LOG
From Tn Formation Description
clay 8 sand
ranite
LOCATION KET H
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common road names.
1 DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH I5A NCAC 2C, WELL
CONSpyCTION STAp7DDARDS, AND THAT,COPY OF THIS RECORD HAS BEEN PROVIDED TOTHEWE%L OWNER
cIR 1,i`_iG3r
SIGNN RE OF.RSON CONSTRUCTING THE WELL /�/ CAD/
ATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
27699-1636 Phone No. [phone], within 30 days.
GW-I REV. 07/2001

WELL CONSTRUCTION RECORD 3 0 4 6 7 5
North Carolina - Department of Environment and Natural Resources • Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) Russell S. Taylor
WELL CONTRACTOR COMPANY NAME Hedden Brothers Well Drilling, Inc CERTIFICATION tt 2187
STATE WELL CONSTRUCTION PERMITN PHONE p 028) 369-9591
if applicable)
ASSOCIATED WQ PERMITe
if applicable)
1. WELL USE (Check Applicable Box): Residential ID Municipal/Public ❑Industrial0
Agricultural 0
Monitoring 0 Recovery CI Pump Water Injection 0 Other❑ If Other, List Use
2. WELL LOCATIO
Near
(Street Name, Numb
3. OWNER:
Addrtss
Community, Subdivi ton, Lotion, Lot No., Zip Code)
(Street or Route No.)
�-yyf Ally or Town Zipp Code
Ste
r+'---bf�-L�a�/��
Area code- Phone number
4. DATE DRILLED
5. TOTAL DEPTH:
6. DOES WELL REPLACE EXISTING WELL? YES
7. STATIC WATER LEVEL Below Top of Casing: _
(Use "+" if Above Top of Cuing)
8, TOP OF CASING IS 2
*Top of casing terminated at/or below land surface rLand requires ove Surface*
variance in accordanc!ith ISA NCAC 2C .0118.
9. YIELD (gpm): METO 9F TEST BLOW
10. WATER ZONES (depth): .�..404
11. DISINFECTION: Type
12. CASING:
Depth
Fro To
From ' To
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
16. REMARKS:
H T H Amount 180z
Ft.
Wall Thickness
or Weight/Ft. M
Material
Ft. benonite & cement
Ft.
Diameter Slot Size Material
Ft. in. in.
Ft. in. in.
Size Material
Ft.
Ft.
Method
yumped
Topographic/Land setting
Midge ❑Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DRILLING LOQ
Frem 1 n Formation Description
clay 8 sand
granite
EPTH
LOCATION KET H
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 15A NCAC 2C, WELL
CON UCTION STANDARDS, AND T. T A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WE L OWNER
/
SI ATURE OF PERSON CONSTRUCTING THE WELL x ATE
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-1 REV. 07/2001
(2/C.err

WELL CONSTRUCTION RECORD
?:o t - Depe?;,.::nt of En: ironrnent cod iiatura! 1os.o urces - L.LvislD:: of <tzr Quality
WELL CONTRACTOR (INDIVIDUAL) NAME (prjnt)
tVELL CONTRACTOR COMPANY NAMEI\J FtQT�
STATE NVELL CONSTRUCTION PERNIIT0 ASSOCIATED P'Q PERM(
(if aoolicable)
if aoplicablel
teen C-i
gas
1
WELL USE (Check Applicable Box): Residential Y Municipal/Public 0 Industrial ❑ Agricultural ❑
Monitoring ❑ Recovery 0 - Heat Pump Water Injection ❑ Other 0 If Other, List Use
WELL LOCATIO:
Nearest To1vn:
County Tria:4 Y'v1—
3. OWNER
Address
Communit . Subdivision, Lot No.. Zip Code)
(5::...: or R.ut-No.)^ V Otd !/ /
To,.c S:att 1 f 1 Zip Colt
to3i -- s97
Topographic/Land setting
❑Ridge ($.Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/'longitude of well location
G;c_nd,cater Section
CERTIFICATIONt: 4-S
ON ' /
u�l P ,vim PHONE p �'�.51
•
3048o4
(degreest inu:ts'stcor. )
Latitud-_'Ion_itude source:❑GPS0Tdpographic nap
(cnak box)
DEPTH DRILLING LOG ,
From To Formation Description
As: :. dt- P:.oru n_ abet
;. DATE DRILLED 'el — 0Y- as- aw
>. TOTAL DEPTH: /� Q-^
6. DOES WELL REPLACE EXISTING \WELL. SES 0 NO ❑
7. STATIC WATER LEVEL Below Top of Casing: FT.
(Cie",-" if Above Top orCasiayl
S. TOP OF CASING 15 FT. Above Land Surface'
'To; ti(casing taaunared uc'or b clot, lead surface req uirti
va:Lana• in accorded'¢„ irh ISA \CAC IC.0l IS. /-�
9. YIELD (c?n):' 4 METHOD OF TEST `//P 1/1`-•
10. WATER ZONES (depth): as
II. DISINFECTION: Type Ft .7-14
12. CASING:
De Diane.:,•
From To Ft.
From To Ft.
Fro;'. To Ft
13. GRO'..T: D- „-.. N!e:.
From To Ft
FromTo Ft.
14. SCREEN: Decth Diir.e:er Slot Size NIa:eria:
Eton. Tc Ft. in. in.
From To Ft. in. in. .
1=. SAND GRAVEL PACK:
Dt,!h - S;ze Material
From To Ft.
From; To - FL
LOCATION SKETCH
Amount Show' direction and'di: an:e in miles from a: leas.
-�V two State Roads or CountyRoads. Include the road
cr.Web_h:'Ft. Hater::.! numbers and common road names.
r
16. RE)!ARKS.•
czcil
I DO HEREBY CFD\TI'S THAT THIS WETAS CON,STRL'CTED IN ACCORDANCE WITH 15A NCAC 2C, WELLCONSTit C tIO\ S.TPDAR°\DrT-r:�COP OF -THIS RECORD F:.4S BEEN Pr20VID7DjOTHy\%CL�NEE2Li
/
S GN.4TLRE OF PERSON CONSTP.':C T LNG THE \'•ELL DATE
Submit the original to the Division of Water Quality, Ground" ater Section. 1636 Sor i;e Center - Ra:eigh, NC
27699-16i6 Phnr.a No. 1919, 733-32I 1. ithin 30 dais. GP•-1 REV. 07:2001

WrELL CONSTRUCTION RECORD
- C. eitAti
,-,
North Carolina - Department of Environment and Na cal Resourc - Di ..lion of Water Quality - Groundwater Secuon CERTIFICATION Is / '(
a�/j6jn�
\1'ELLCONTRACTOR (INDI\'IDCAL)NAME (print) CERT
PHONE d ST-SELLS-v-�—S� S
WELL CONTRACTOR CO31PA]\ NAME
STATE \\ELL CONSTRUCTION PERMIT:
(if applicable)
1. WELL USE (Check Applicable Box): Residential ix Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 IFOther, List Use
Topographiciand setting
I Ridge ❑Slope ❑Valley ❑Flat
24'775 (check appcopnatebon)
Latitude!longintde of well location
(th: tent nioutes'secerds)
Latitude/longitude soure:❑GPS❑Topo_raphic map
(check boll
DEPTH DRILLS LOT`
Formation Description
2. WELL LOCATION
Nearost Tow ci: . 4
(S:re_: Saar+ tit
3. OWNER:
Address
County
or.::nu.:ity. Subd1 ij101:, Lot No
(Sr or Route
Co
State Zip Cade
Ar:a:ol:- Pcone n'r,e:r .! » ;'
4. DATE DRILLEDI
5. TOTAL DEPTH: S22---
6. DOES WELL REPLACE EXISTING )WELL? YES
7. STATIC WATER LEVEL Below
.`LTop of Casin"7op o!Ca,ic t
S. TO? OF CASING IS
FT. Above Land Surface'
•'1 iy uf easing tuarnatd u': ur bolo+• land surLce rry uin•s u
Sarlance in aac,rdar:. 91:h ISA N CAC SC .011S.
•
9. YIELD ( prn): ' j N'•ETHOD OF TEST�IL
10. WATER ZONES (depth): 7-
11. DISINFECTION: Type
12. CASING:
13.
14
15
Fro:r,
Fry::
From
It 4
D
To FL
Tc Ft,
To Ft
Fro-tQ_To Ft
11(
ASSOCIATED WQ PERMIT:
(it -applicable)
From To
ATInN SKETCH
S:ho..' direction a-d'di>:^ae in mile, from a: leas:
Amount c - A ! or „d;. Include the road
Ids': R�
two State Roads Ce::n,
\':_ i Thickness oers and common r:a'_ ramcs.
304803
rant S'.ot Siz: v :\Ia rt
SCREEN: Dcth Diarxs
Ft. in. in.
Frog. To
Fro,', To
Ft.__in. ir..
SAND GRAVEL PACK: S:z2
Dca:
Fror. To Ft.__
Fror.. To Ft._
.later'._.
ovr—
16. REMARKS: \'.EL
c
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH ISA NC�C'C' _
// — Li Z \`,
CONST;li?':CTI N STANDARDS. AND 7�T A COPY OF TTHISR=..03J F:AS BEEN PROVIDED ID THE ELL 0`..1❑
DATES:GNAThRE OF PERSON CONSTRUCTING THE WELL
Submit the itonin original totheD33-3221 of Nester Qu
ality, Ground .:ater Section. 1636 y f ail S rti eCenter - Raleigh, eigo N �')';
?%6°'J-15idPimn<No.(9(9)i33-?"'-1.\`ithirt30day s. ___

CONSTRUC AT ND.ARDS.P
2. WELL LOCATIO:
Nearest Town:
(Sere: Name. Numbers. Co
3. OWNER:
Addrrss
t$;;e:: or Roue N
North Carolina - Deparunent of Environment an
UELL CONTRALTOS(INDIYIDCAL) NAME (print)
CQ\YELL CONTRACTOR COMPANY NAME AAA
STATE \� ELL CONSTRCCTION PERMIT CJ
(ifaopticablel
WELL CONSTRUCTION RECORD
d Na ral Res iurce$ - Division of Water Quality - Groundwater Section (I/i, PHONE R Leat5t53111.t
ASSOCIATED WQ PERMIT:
(if aoolicable)
1f,53-oS-si4n,
J5/817W -
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 Uses--
Topographic%Land setting
❑Ridge elope ❑Valley ❑Flat
(check appropriate box)
Latitude%Iongitude of well location
Citlinty
vis:Sn• Loti
✓)C arnes
. Zip Code)
(de_:ees nimcei: ia<ordi).
Latitld_'longitude source:❑GPS❑Topographic map
(check box) .
DEPTH DRILLING LOG
Formation Description
CI q
Cx0 J --
City or Tow], jejl7 Zip Co.a
7aw
Area cone- Pion nu::;a:: /U •�(]
-,. DATE DRILLED_ -,=�i
5. TOTAL DEPTH:._9TU
6. DOES WELL REPLACE EXISTING \YELL? YES � O
itt
7. STATIC WATER LEVEL Below Top of a n`Tap or Basin l
(lase -r' f.
- S. TO? OF CASING IS _____— FT. Above Land Surface'
•Tip ur Pain terminated a:.ur belts. land surface requires a r
,ariane.• in accordance with 15A NCAC'-C .0113.
9. YIELD Capri): Lia__-- METHOD OF TEST
10. WATER ZONES (depth):
•
11. DISINFECTION: Type hF T -- Amount
12. CASING:
1'. Thickness
De=;i, Dia.rc;er or \': ti_.'.:'Ft.
From D To Ft.� SDr2Ll _PLC)
Front To Ft.
From To Ft Nle;- .'.
13. CP0 T` D \!
_�— Ft 1 ,-,
From De +-
IJ. SCREEN: Depth Dan;e:er S.u; Size :\facer':
Frorn To Ft. in.
From To - Ft. in. in.
15. SANDGRAVEL PACK:
Depth
From To
. •Front To
"
.?
16. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH ISA NCAC'_C. WELL c
' THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OV.'NER
SIGNATURE OF PERSON CONSTRCCTING THE WELL DATE
Submit the original to the Division of Water Quality, Ground„ater Section. 1636 Mail Service CG t?r` Raleigh, C
27699-1636 Phone No. [phone], nithin 30 days.
_ Ft.
Ft.
Size Marcia!
From
To
LOCATION
Show- direction and'dis:an:c in miles from at leas;
two State Roads or County Roads. include the road
numbers and common rood names.
1/42

WELL CONSTRUCTION RECORD
North Carolina - Ueparunent of Environment and Natural Kesou1ce
WELL CONTRACTOR (INDIVIDUAL)NA)IE (print)
U'ELL CON'1'R'ACFOIi COMPANY NAME idFi4 gn
STATE WELL CONSTRUCTION PER)IIT:
(if applicable)
1. WELL USE (Check Applicable Box): Residential I2I Nlunicipal.'Public 0 Industrial ❑ Agricultural ❑
C50 7ia h/
753y-09-O'3f7,,
s - Division of 1A ater Quality - Gtb.:adwatei SLCLon
CERTIFICATION
PHONE R (OW7� 5c�o-S-S a
Monitoring 0 Recovery 0 Heat Pump Water Injection 0
2. WELL LOC.ATIO ':
Nearest Town: County
9d C tea • i) C2..a577y
7
ASSOCIATED \VQ PER)IITtt
(ifaoolicabte) _
�.
(Street Name. Numbers. Community. ubdivisi Lot No.. Zip Co&e
)
/�� {j� ���n(�y,�,y, �L r
3. O\WNER: UIQ.Cr� c4+-�J`'0-d-IA-e !.
Addy;;; 7~ ///11111�����' VVVVV
(Sr:c; or Ro
or�NNo.
rieei 9+ i,i, Q S/ 7
Cry n 'State Zip Code
R1n O%
Arta “tie- Prone rumba
4. DATE DRILLED /& — £ _pCai
5. TOTAL DEPTH: / 9 C-
6. DOES WELL REPLACE EXISTING )WELL? YES 0 NO
cit
7. STATIC WATER LEVEL Below Top of Cushy:: 220 FT.
( Use "T..if Above Top ofCasin_ )
S. TOP OF CASING IS I FT. Above Land Surface'
•T op of casing terminated aCur beton !and surface requires a
variance in accordance n rh 15A NCAC 2C .01 IS.
9. YIELD (gpm): ' /00 /- METHOD OF TEST /r
ID. WATER ZONES (depth): (05. / 70
11. DISINFECTION: Type /-I T H Amount 5? ,. a-.
12. CASING: Wall Thickness
Depth Diameter or Weigh:Ft. Nh:e:i t
From 0 Tc (v �L Ft. a 79 , J%'2/0r.UU >ti;�Q.d .
13
14
15
From To Ft.
From To Ft
od+.
FronGROUT: Tonth Material . -nJ N_) 1-.c J
From 3 To 2 0 Ft. t1itn & 'J h.-n- t
SCREEN: Depth Diameter S:o: Size V Nla:eri
Fror.1, To Ft. in. is
From To Ft. in. in.
SAND Gt-\VEL PACE;:
Depth Size NL^feria:
Other ❑ If Other, List Use
Topographic/Land setting
❑Ridge ❑Slope ❑Valley jFlat
(check appropriate box)
Latitude'longituda of well location
(degreeiininutei3.conds)
Latitud:longitude source:❑GPS❑Topographic map
(eit� k box)
DEPTH DRILLING OG':
From To Formation Description
b-6-7
(07-I'70
/70 --/7�
17.3- /90
LOCATION H
Show direction and'distance in miles from at least
tsvo State Roads or County Roads. Include the road
numbers and common road names.
From To Ft._
•Front To Ft._
16. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH IiA NCAC 2C, WELL
CONSTR!_CTEON ST. . RDS. AND THAT A COPY OF T "- RECORD HAS BEEN PROVIDED TO THE WELL OWNER
0,4
er SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
Submit the original to the Division of \\afar Quality, Groundwater Section, 1636 Mail S.nice Cent rl RaWigh, �OI)I
NC
27699-1636 Phone No.1919) 733-3221, within 30 days.

Fro;:, To
From To Ft U_ mod
13. GRO'.:T: Depth Nlaier:..l / Opp*
`� S
From 0 To _3 Ft. W
From : De 7 (� Ft.--� � i.3 I
I1. SCREEN: Depth Diameter Sot Size 0 "Mad: rig! pp nkaJ 1
in. I.
From To Ft. in.
From. To ft. in. in. 1 \
I5. SAND GR4\ EL PACE;:' a' pj
Dtptit Size NI_tria: er't-T"�.
From To Ft. t 1 c
WELL CONSTRUCTION RECORD
North Ca Olin:.. - D: ;aruneut of cove.. n:...:st , Id N_.u:U Resources i-ir. ision of Water Qu; 1
C.
WELL CONTRACTOR (INDIVIDUAL) NAME (print)
J, O50
)- iromr,: =Sec.:^r1
CERTIFICATION %
WELL CON'rRACFORCOMPANl' NAME PrAA csreelQ.a rb Wee-1^
.ASSOCIATED\VQ PERMIT%
(if applicable)
STATE WELL CONSTRUCTION PERMIT%
(if applicable)
I. WELL USE (Check Applicable Box): Residential &I Municipal/Public 0 industrial ❑ Agricultural ❑
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 IrOther, List Use
2. WELL LOC.ATN:
p.loLntY(str:o.umbers. Community Sub..icision, L No.. Zip Coda)
3. OWNER:
Addr;ss
(Sr:or I�j tt
aeepso
City orTo•.s:.ue
(tot g4 y - sore
Zip Code
A-aa :;we- Prone r.u:nber
4. DATE DRILLED g —/8 -- (1-
5. TOTAL DEPTH: r9, ry
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO (1,
7. STATIC \\*ATER LEVEL Below Top orCasing: % o b FT.
(Use ">" it'Aboce Top o`Casic_1
S. TO? OF CASING IS / FT. Above Land Surface"
•'I up u.r casing terminateds''u r below land surface requires a
s rianca in accordance s, ith I$;\ NCAC 2C LOCATIONw
LOCATISKETCH
Topographic'Land setting
J 4(, 6.41 -' ORidce }ISlope ❑\'alley ❑Flat
r.
a1 ] 71, (check appropriate box)
Latitudeilongitud: of well location
(de_reesininutes+seconds)
Latitud_'lon__itude source:DGPSDTopographic map
(check box)
MUST •
• Formation Description
DEPTH
From To
d 49
S Y- VI?
y0o -2oL
10. WATER ZONES (d;pth): <' 0U
I1. DISINFECTION: Type 04 T )
12. CASING:
D:p;n II���� Dieu
From. 0 To
Ft.
Amount
Wall Thickness
or \Weigh:It.
, wall S O 9
Show direction and'dis:an:e in miles from at leas:
two State Roads or County Roads. include the road
numbers and common road names.
•Fron To Ft.
16. REMARKS:
1 DO HEREBY CERTIFYTHAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE \VITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS. AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
• a'7- "t
DATE
SIGNATURE OF PERSON CO. STRUCTING THE WELL
Submit the original to the Division or Water Quality, Ground„Ater Section. 1636 MalI Service Ceen„rl RE\igh, C
27699-1636 Phone No. [phone], within 30 d:r. s.
PHONE % (AIR S-S-S'Sd
J'
O

WELL CONSTRUCTION RECORD
Nort'n Carolina - Department or Environment and�I!a_turat CULL-
- uuity'�is,ou of�‘_rarer Quah
WELLCONTRACTOR(INDIVIDUAL)NA>IE (print) 11 CUL_t %�2 �' . —e n
WELL CONTRACTOR COMPANY NAME ( '.I//OtL+� I- -a a214-1 FVn lad
STATE WELL CONSTRUCTION PERMIT: a ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
r i93,g'/wv
-7534 -O 1-63
ty - Gwm,,,a at., Section
CERTIFICATION. 30(11
PHONE a Wef JeererZS-5-d
I. WELL USE (Check Applicable Box): Residential g Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection ❑ Other ❑ If Other, List Use
2. WELL LOCATIO
Nearest Town: _ County
53 U7,.Ple
(S:ree: Name. Numbers. Cenununity. Subdivisio cc No., Z
3. O\VNER: Wltc
Address`'(
(Street or Rooua-Stu,
or State
(- _ orcio
Arc_ code. Phone member
4. DATE DRILLED )O —'/
3. TOTAL DEPTH: 3(20
AC. 7q
cae)
Topographic/Land setting
❑Ridge titSlope ❑\'alley ❑Flat
(cheek appropriate box)
Latitud'Iongitud: of well location
kf„ /7, (degreeiininu:es.secor.ds)
Latitude/longitude source:❑GPS❑Topographic map
(check box) •
7s7 79 DEPTH DRILLING LOG
Zip Code From To Formation Description
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO kg
7. STATIC WATER LEVEL BelowTop orCasimz: 5D FT.
it' Aboec Top of Casing)
S. TO? OF CASING IS I FT. Above Land Surfa:e'
clop of caring t:rminared +Cur below land surface requires a
arlame in accordance ss ith ISA NCAC 2C .011S.
9. YIELD (goml:' 30 METHOD OF TEST �lr
10. WATER ZONES (depth):
I L DISINFECTION: Type j-f 'j'"- }-I
Amount (3,5— f)Z
12. CASING: Wall Thickness
Depth Diameter or V.eigh:Tr. Ma:e ia1
From C' To 72 Ft. 4 V/ sot ZI comes
From To Ft.
From To Ft.
13. GROUT: Depth Material
From C To 3 Ft. g12/-Nre.4'—
From 3 To ZO Ft. 1. 'D tig--
1a. SCREEN: Depth Diameter Slot -Size
From To Ft. in. in.
From: To Ft. in. ir,.
15. SAND GRAVEL PACK:
Depth Size 3.12rerial
From To Ft.
-Frond, To Ft.
Method
uM
16.REMARKS:
LOCATION SKETCH
Shore direction and'distan:e in miles from at least
two State Roads or County Roads. Include the road
numbers and common road names.
Qrr�t-
1/413
O :
I DO HEREBY CERTIF.). THAT THIS WELL WAS CONSTRUCTED IN ACCOP.DANCE WITH I5A NCAC 2C, WELL
CONSTRLCT(ON TANDARDS, AND THAT OPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
SIGNATURE OF PERSON CONSTRUCTING THE \\ELL
DATE
Submit the original to the Division of Water Quality, Groundwnter Section, 1636 Mail Service Center -Raleigh, NC
27699-1636 Phone No. (919) 733-322 I, within 30 days. GW-I REV. 07:2001
Cr

33
WELL CONSTRUCTION RECORD Cam' 3646
North Carolina Department of Environment and Natural Resources - Division of Water Quality
WELL CONTRACTOR (INDIVIDUAL) NAME (print) Clayton Bigham CERTIFICATION # 2320
WELL CONTRACTOR COMPANY NAME Lee 8 Sims Drilling Services, Inc. PHONE # f 864) 243-2682
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential ® Municipal/Public ❑ Industrial ❑ Agricultural ❑
Monitoring 0 Recovery 0 Heat Pump Water Injection ❑ Other ❑ If Other, List Use
2. WELL LOCATION:
Nearest Town: Mountain Rest County Jackson
2215 Bullpen Road
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: Mark Vissage
Address 871 Stakey Mountain Road
(Street or Route No.)
Mountain Rest SC 29664
City or Town State Zip Code
( 864 } 638-8435
Area code -Phone number
4. DATE DRILLED 09/13/2004
5. TOTAL DEPTH: 765
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO 3
7. STATIC WATER LEVEL Below Top of Casing: 200 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS 1.5 FT. Above Land Surface*
•Top orcasing terminated at/or below land surface requires a
variance in accordance with 15A NCAC 2C .0118.
9. YIELD (gpm): <1 METHOD OF TEST Air Purge
10. WATER ZONES (depth): None
11. DISINFECTION: Type Ca Hypochlorite
12. CASING:
Depth Diameter
From 0 To 20 Ft. 6.25
From To Ft.
From To Ft.
Amount 8 oz.
Wall Thickness
or Weight/Ft. Material
.25" PVC
13. GROUT: Depth Material Method
From 0 To 20 Ft. Neat Cement Tremie
From To Ft.
14. SCREEN: Depth Diameter Slot Size Material
From N/A To Ft. in. in.
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From N/A 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 5 PWR
5 765 Bedrock
t7 G
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.
• TO ck51M r
,rye gvt-w f�9 o ,fJ qmi
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
I
TI'
[GNATURE OF PERS CONSTRUCTING THE WELL DATE
Submit the original to the Division of Water Quality, Attn: Information Management, 1617 Mail Service Center -
Raleigh, NC 27699-1617, Phone No. [phone], within 30 days. -
OW-1 REV. 09/2004
DLC14

North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
1636 Mail Service Center - Raleigh, N.C. 27699-1636-Phone [phone]
WELL CONSTRUCTION RECORD WELL CONTRACTOR- / Z c ar44.€
WELL CONTRACTOR CERTIFICATION #: 3 D* r
CRANE �(r1Tul�(rs WELL DRIWNG, INC STATE WELL CONSTRUCTION PERMIT#:
-,ass r akir Crpct E
fRANf(L,N, NC 2o134
1. WELL USE (Check Applicable sox): Residential Municipal ❑ Industrial ❑ Agricultural ❑ Monitoring 0
Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use:
2. WELL LOCATION: (Show sketch of the location below) Nearest Town. `ry% ✓» County: CA A •y
S 6�
l,�,ckT )2r_.l
(Road Name and Numbers, Co oily, or Subdivision and Lot No.) DRILLING LOG DEPTH
3. OWNER y r 4'AI / V 1�1i' &(4Y From To Formation Description
'� p rih-L.
Address p,
1 �.Y for to
lam/ t� C • of S.?
City or Town n ' ,� State Zip Code
4. DATE DRILLED
5. TOTAL DEPTH S
6. CUTTINGS COLLECTED YES ❑ NOQ
7. DOES WELL REPLACE EXISTING WELL? YES f—I NO0
8. STATIC WATER LEVEL Below Top of Casing: /V FT.
/ (Use '+' 8 Above Top o1 Casing)
/
9. TOP OF CASING IS FT. Above Land Surface'
-Top of casing terminated at/or below land surface requires a variance In accor-
dance with 15A NCAC 2C .0118
10. YIELD (gpm): a METHOD OF TEST /li r
11. WATER ZONES (depth)*
—
3s- SSr
12. CHLORINATION: Type
13. CASING:
ceoit
frfrikrt-
Amount If additional space is needed use back of form
Wall Thickness LOCATION SKETCH
Depth �' Diame� r or Weight/Ft. Material (Show direction and distance from at least two State
From b To • �`' Ft. 111 ---p_tti..- Roads, or other map reference points)
From To Ft.
From To Ft
14. GROUT:
Depth Mast Method _ 1
From b �- To 6 Ft e0-q'I"7�u�Mr•-(
From To Ft
15. SCREEN:
Depth Diameter Slot Size Material
From To _ Ft _ in _ in
From To — Ft — in in
From To _ Ft.— in _ in
16. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft
17. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER.
/62-0' t— //,fe
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
Submit original to Division of Water Quality, Groundwater Section within 30 days
GW1 REV. 12/99
FOR OFFICE USE ONLY
Quad No:
Serial No.

North Carolina - Department of Environment and Natural Resources - Division of Water (Duality - Groundwater Section
1636 Mal Service Center - Raleigh, N.C. 27699-1636-Phone [phone]
WELL CONSTRUCTION RECORD WELL CONTRACTOR (Ciet—/41-/VC
CRANE BROTHERS WELL DRILUNG, INC.
240 CRANE C.Ryt,[
rt1ANiUJN, NC 28/34
WELL CONTRACTOR CERtIFICATION #: 36
STATE WELL CONSTRUCTION PERMIT#:
304339
1. WELL USE (Check Applicable Box): Resident)al,E1 Municipal ❑ Industrial ❑ Agricultural ❑ Monitoring ❑
Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use:
2. WELL LOCATI7p�N_: (S ow sketch of the location below)
Nearest Town: 1-7t'J 'WS County l
M.enA--0# y LA -AIL
(Road Name and Nambers, Community. or Subdivision and Lot No.) DRILLING LOG DEPTH
3. OWNERS /(tJ4 j _�(1 /-e /, From To Formation Description
Address 3 3v t�r �,yyyO�
ekrYli (be or Rou)¢N�j 'a 71 !7 Ds � %/ f
City or Town State ZipCode 'f .Lt�
4. DATE DRILLED''' -if.) ✓
5. TOTAL DEPTH
6. CUTTINGS COLLECTED YES Q NOO
7. DOES WELL REPLACE EXISTING WELL? YES Q NOE
8. STATIC WATER LEVEL Below Top of Casing: /TKO FT.
(Use •+' if Above Top of Casing)
9. TOP OF CASING IS I FT. Above Land Surface'
'Top of easing terminated at/or below land surface requires a variance In accor-
dance with 15A NCAC 2C .0118
10. YIELD (gpm): 10ls METHOD OF TESTA Y.
11. WATER ZONES (depth)•
•
12. CHLORINATION: Type
13. CASING:
From 1)
From To Ft
From To Ft
14. GROUT:
Amount If additional space is needed use back of form
Wall Thickness LOCATION SKETCH
Depth Diameter or Weight/Ft. Material (Show direction and distance from at least two State
To Ft l0 �/y o-• Roads, or other map reference points)
Depth Material(
From D To Ft athibir
From To Ft
15. SCREEN:
9Mujethod
Depth Diameter Slot Size Material
From To _ Ft _ in _ in
From To _ Ft._ in _ in
From To Ft _ in _ in
16. SAND/GRAVEL PACK:
Depth Size Material
From To Ft
From To Ft.
17. REMARKS:
71
Lr
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A C Y OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER.
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
Submit original to Division of Water Quality, Groundwater Section within 30 days
FOR OFFICE USE ONLY
Quad No:
Serial No
GW-1 REV. 12/99

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources,- Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAM/E�. (print) D h l y) 'ttLL/Lb b CERTIFICATION #44/j_8
wl;l,l.CONTRA('TOR COMPANY NAME I_Caty)G Ti1-nG, )a .1h - W Tn�, PHA
ONE # fp�$ In¥g" 3. 70
STATE WELL CONSTRUCTION PERMIT# / 1/40.2 ASSOCIATED WQ PERMIT#
(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 0 Other 0 If Other, List Use
2. WELL LLOCATION; /
!' v Ohl_L—L
sole um
Nearest Town: / UCc County
(Street N
hers, Community, SUM Vision, Lot No., hip Code)
tt )
3. OWNERtLG.e_ A wo%.(s 0-3c (sort, ertt
Address go ! .ryZ�.tyyr Z
Street or Route Na)
?gin/ F(41r✓rL tee/ S7-a-. / 70
City or Town to Zip Code
n,.1e4/e NC .2S'i2G
Area creie- Phone number
4. DATE DRILLED 9 -a '/ -U
5. TOTAL DEPTH: gLS''
!),.)Es, U1,11 REPLAY!: LYIC!!kf ',(1.11 , VL:SLe! NO 4,
7. STATIC WATER LEVEL Below Top of Casing: 40 FT.
(Else "+" if Above Top of Casing)
H. TOP OF CASING IS FT. Above Land Surface*
*'lop of casing terminated at/or below land surface requires a
variance in accordance w'th ISA NCAC 2C .0118.
9. YIELD (gpm): � METIHOD OF TEST & Ars ,
10. WATER ZONES (depth): 2Q5- /Si pm
1 1 _ DISINFECTION: Type /-/ "T
12. CASING:
Depth
Eroin i To cgD
From To
From,. To
13. GROUT: Depth Material
Amount 41-1L.M
Wall Thickness
Diameter or Weight/Ft. Material
Ft. Lo )1
Ft.
Ft.
From_ _ To .?O Ft. ,.
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.
P itc,
Method
Slot Size Material
in.
in.
Material
16.REMARKS:
Topographic/Land setting
❑Ridge OSlope ['Valley *at
(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 a 1 p
av' .45-'
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.
1 DO HEREBY CERTIFY TIIAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH I5A NCAC 2C, WELL
( ONSFRUC"IION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED'fO T11E WELL OWNER
SIGNATURE OF PERSON CONSTRUCTING THE WELL
/D - 3/-0�
DA"fE
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
3017.83
12. CASING:
"Del
From 0 To
From-5e3'To
From _._ To Ft.
13. GROUT: . Depth.
From 0 To 20
From , To
14 SCREEN Depth
From ` To
From To
SAND/GRAVEL PACK:
Depth - Size
From To Ft.
From ` To Ft.
" 15.
North Carolina • Department of Environment and Natural Resources • Division of Water Quality
}YELL CONTRACTOR (INDIVIDUAL) NAME (print)
James B. Brown
WELLcON'IRACTORCOMPANY NAMIEHedden Brothers Well Drilling, Inc
STATE WELL CONSTRUCTION PERMITO
`, (ifapplicable),
- Groundwater Section
CERTIFICATION 112045
PHONE r e28) 369-9591
ASSOCIATED WQ PERMIT%
- - - (if appliceble)". - - -
I WELL USE (Check Applicable Box): Residential 6 Municipal/Public C - Industrial 0 Agricultural C
Monitoring C Recovery 0 Heat Pump Water Injection ❑ Other ❑ If Other, List Use
WELL LOCATIG M�e�2� Topographic/Land setting
NearerJ.,Tpwn. County / ❑Ridge CSlope CValley CFlat
li/A f _l (check appropriate box)
Fly Latitude/longitude of well location
(Street Name, Numbers, Conununity, Subdivision,, Lot Nc., Zrp Code)
4
3. OWNER:
Address
(Street or Route No.)'_
e (o31n-19a'tlfe Zlp Code
Area code Phone number
4, DATE DRILLED 8' 5O' 4
5 TOTAL DEPTH: V001
6 DOES WELL REPLACE EXISTING WELL?, YES 0 NO
7. STATIC WATER LEVEL Below Top of Casing: aSO F .
(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 IS.A NCAC 2C.0118.
9 YIELD (gpm) ME H D OF TESL' blow
10 WATER ZONES (depth): 70 Pf c'��B
'DISINFECTION: Type i T H< Amount: 16 oz
Wall Thickness
Diameter - or Weight/Ft. N aterial
Ft ln , stop
Material Method
Ft. bertnite & uznet ptrntei
Ft.
Diameter Slot Size ` Material
Ft. _in in
Ft. in. in.
Material
(degrees/minutes/seconds).
Latitude/longitude source.OGPSCTopoeraphic map
(check box)
DRILLING LOCI
Formation Descr, ^lion
clay & sand
granite
LOCATION SKETCP
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 CERTfFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH ISA NCAC 2C, WELL
CONSTRUCTION STANDDS, AND THAT A COPY of THIS RECORD HAS SEEN PROVIDED TO THE WELL OWNER
! p-ciD-o
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
Submit the original to the Division of Water Quality, Groundwater Section, 16361,elaii Service Center- Raleigh, NC
27699.1638 Phone No, [phone], within 30 days, G W-I REV'. 07i2001

WELL CONSTRUCTIONr RECORD 301782
North Carolina • Dcoartment of Environment and Natural Resources • `Jivis,or of Water Quality'- Groundwater Section
t'ELL CONTRACTOR (INDIYIDUAL)NAME (print) James B. Erown CERTIFICATION #2045
XYE LI. CON'I RACT'OR COMPANY. NAME Redden Brothers Well ; Drilling, Inc PHONE kl7 ) 369-9591
s rATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable) (if acrlicable).. '
WELL USE (Check Applicable Box): Residential Ei Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring 0- Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2 WELL LOCATIC
Nrr stTown: C unty ..:
(Street Name, Nuinbars, Community Subdivuion, Lot Na Zip Code)
OWNER. }'�Qnit�(_/is7/11baCe�(
Addressjertmal.AStre
e, or Na, �f1707'
.� _City
ol/ 373,e 2.,c Code
tan-
Area code• Phone number jai
DATE DRILLED t
TOTAL DEPTH: SOO
DOES WELL REPLACE EXISTING WELL? YES O NO
STATIC WATER LEVEL Below Top of Casing: OROC FT.
(Use "+" if Above Top of Casing)
TOP OF CASINO 1S 2 FT. Above Land Surface"
'Topof casing terminated at/or below land surface requires 2
varlanceIn accordance with. ISA NCAC 2C.0118.
9 YIELD (gpm): /Q METHOD OF TEST blow
10, WATER ZONES (depth): t CA I
11.-DISINFECTION`Type H T H
12 CASING Wall Thickness
Depth e D meter or Weight/Ft.. P1 t�� l
ee
From 0 To rt.
From. 90 e Tc Ft, (i " /Jet
From To FL
13 GROUTDepth Material
From 0 To ' 20 Ft. berrdte & cer t
From Tc Ft.
14. SCREEN. Depth Diameter Slot Size Material
From To Ft, in m
From, To Ft. in in.
IS SAND/GRAVEL PACK:
Amount 16 oz
From
From
Size
To . Ft.
To Ft..
Topographic/Land setting
❑Ridge OSlope 0Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(deg reeslini nutem4econd)
L t rude/(ongitiide scurce.OGPSCTopographic map
(check box)
DEPTH DRILLING LOG
Gem 9,( F1clayiognDeas�crirlion
sd
Uranite
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common road names,
16. REMARKS
I DO HERESY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STADS, AND THAT A COPY OF. THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
-49
SIGNATUR
F PERSON CONSTRUCTING THE WELL
Submit the original to the Division of Water Quality, Groundwnter.Section, 1636 NI
27699.1636 Phone No.[phone], within 30 days.
7 n2-4 -o
DATE
IS rvl ce Center - Raleigh, NC
GW-I REV. 07/2001

WELL CONSTRUCTION RECORD 301781
North Carolina • Department of Environment and Natural Resources - Division of Water Quality • Groundwater Section wELLCONTRACTOR (INDIYIDUAL) NAME (prints James A. Brown CERTIFICATION # 2045
WEtLcoiv'rR,\C1OR conipA.Nv NAME Fleaden Brothers Well Drilling, Inc PHONE 8$25) 369-9591
STATE WELL CONSTRUCTION PERMIT, ASSOCIATED WC? FERNIITk
(ifacpticable) (ifaprlicable) •- -
WELL USE (Check Applicable Box): Residential Municipal/Public O industrial O Agricultural ❑
Monitoring 0 Recovery 0 Heat Pump Water lnjection ❑ Other O IC Other, List Usc
2, WELL LQCAT
Neat Town:
County 4
(Street Name, Numbers, community, Subdivision, Lot Nc., Zip Code)
n
OWNER:,.
Address
.et or Rout�NaJ n8129
City or aState Zip Code.
Area code, Phone number ,,}/
4 DATEDRILLED 8' C/'�
5 TOTAL DEPTH: If
• 6, DOES WELL REPLACE EXISTING WELL? , YES ONO X
7, STATIC WATER LEVEL Below Top of Casing: aO FT.
•. (Use"+" if Above Top of Casing),
8. TOP OF CASING 1S 2 FT. Above Land Surface*
'Top of casing terminated atier below land surface requires a
variance In accordance w t ISA NCAC 1C .0118,
9 YIELD (Pm)"METH D OF TEST blow
10 WATER ZONES (depth): it &
Topographic/Land setting
❑Ridge DSlope OValley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:DOPSOTopographtc map
(check box) __
DEPTH DRILLING LOG
From T r Formation Descr odor.
0 clay &sand
aranite
II. : DISINFECTION: Type H T H Amount . 16 cz
l2. CASING Wall Thickness
Depth y Diameter�/�or Weight/Ft,. M_z�erial
From 0 To E0 / Ft. (�N r/ea 4)
From •.- To Ft
From .., To. Ft,
13.°GROUT:, Depth Material Method
From 0 To 20 Ft. bet its pupped
From To Ft.
14. SCREEN Depth. Diameter Slot Size `Material
From To FL m In
From To Ft. in in.
15. SAND/GRAVEL PACK:
Depth Size Material-
From To FL
From ' To Ft.
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Reads. Include the road
numbers and common road names,
CP s o
0�y
se
16: REMARKS.
I. DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15.A NCAC 2C, WELL
CONSTRUCTIONA, RDS, AND THAT A OPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
® —.e
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE:
Submit the original to the Division of VV_ater Quality, Groundwater Section, 1636 Mail Service Center- Raleigh, NC
27699.163.6 Phone No..[phone], within 30 days. - GLV•I.REV. 07/2001

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources • Division of Water Quailty• Groundwater Section 301
ELL CONTRACTOR IIiNDIYIDLaL)'NAME (print) JalneS E. Ercwn CERTIFICATION eZQa5
WELL COM RAC1OR COMPANY NAn1E?edaen BrothersWell Drilling, Inc PHONE#�28) 369-9991
STATE WELL CONSTRUCTION FERMTT# - ASSOCIATED WQ PERMIT#
. Cif applicable) - (ifaoolicable)• ' _._.
1. WELL USE (Check Applicable Box): Residential Municipal/Public ❑ Industrial ❑ Agricultural O
Monitoring 0 Recovery - HeatPumpWaterInjection -❑ Other 0 If0ther,List Use
2, WELL LOCATI
NeCU
War
(Street Name, Numb re, Community, $u di
County
pion, Lot No,, Zip Code)
3. OWNER'
Address
(e reet of Rut )
Eha, ,, w& 0181I1
City T •
l _ry• 7 //O ee/ sip code
O- (17
Area code• Phone number �/
4, DATE DRILLED' 8' •c
5 TOTAL DEPTH:' a O
6. DOES WELL REPLACE EXISTING WELL? YES O NOX
7. STATIC WATER LEVEL Below Top of Casing: /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 tend surface requires a
variance In accordance with. le.A NCAC 2C .0118.
9 YIELD (gm) ,�i�. MET , D 0 TEST. blow
10 WATER ZONES (depth): /95 e (a218
IC- DISINFECTION: Type H T H Amount . 16 cz
12.CASING: Wall Thickness
O DepthFt
m Di-rr;ter cr Weight/Ft.. n1a riat
From
FroTc 4J Ft, e186
From To Ft.
GROUT: Depth Material
From 0 Tc ' 20 Fite -mite & ccirsil pump
From To Ft,
SCREEN: Depth Diameter
From To - Ft. in.
From To - Ft. in.
SAND/GRAVEL PACK:
Depth - Size
From To Ft
From To Ft.
Topographic/Land setting
ORidge OSlope ❑Valley ❑flat
(check appropriate box)
Latitude/longitude of well location
(degreeshninntes/seconds)
Latitude/longitude source.OGPSOTopographic map
(check box)
DEPTH DRILLING LOG j
From To/ Formation Descr otion
0 (� clay & sand
et ` dA0 ` granite
LOCATION SKETCH
Show direction and distance ir. miles from at least
two State Roads or County Roads. include the road
numbers and common road names: •
16 REMARKS
I. DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION ST ARDS, AND THAT A OPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
L} Jc /9_0Se
.
SIGNATURE OF PERSON CONSTRUCTING THE WELL-l. DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636b1ail Service Center- Raleigh, NC
27699.1636 Plume No:,(9l9) 733.3221, Within 30 days. GW1 REV. 07/2001
80

WELL CONSTRUCTION RECORD
301
79
From To Ft
From743E To Ft
From ` To Ft
13 GROUT: ' , Depth Material Method
From 0 To ' 20 Ft. hefllite & =sit I purnoxi
North Carolina -Department of£r,vironmentand Natural Resources •Division of Water, Quality • Groundwater Section
WELL CONTRACTOR (INDIVIDU,AL)NA11E (print) James A. Brown CERTIFICATION ';<_2045
WELL CON'IRACTORCOMPANY NAME Hedden Brothers Well Drilling, IncPHONE pE281359-9591
STATE WELL CONSTRUCTION PERMIT/0ASSOCI I7 ED WQ PEBMiT# (if applicable) - (ifaohlicable)
WELL USE (Check Applicable Box) Residential 6 Municipal/Public 0 Industrial 0 AE;iculturzl ❑,.
Monitoring 0 Recovery 0 :Heal Pump' Water Injection 0 Other 0 If Other, List Use
2 WELL LOCATI
Near Town• -' 6... County_
StreetName, Number, Community, Subdivision, Lot nNo, Zip Code)
Nisit
3. OWNER. inNet," Addl.-3 j _evi
G•
p- L(Street or Route No.) �7
b4
.Ciity o Tow StateZip Code •3&e. Gal
Area code, Phone number
4 DATE DRILLED
%'o�ip'O�
5. TOTAL DEPTH: e
6 DOES WELL REPLACE EXISTING WELL? YES
7. .STATIC WATER LEVEL Below Top of Casing n FT •
- - (Use '+'.if Above Top of Casing) 8. TOP OF CASING IS 2 FT. Above Land Surface*
'Top ol•casIng terminated at/orbelow. land surface requires a
variance -ln.a acordon with ISA NCAC 2C 011S "
9, YIELD (gpmj M HOD OF TESTblow
10 WATER ZONES (depth): iC • /6 I 130
Il DISINFECTION: Type H T H Amount 16 oz
Wall Thickness
Di;meter crweightFt Material
_ee
14 SCREEN " 'Depth Diameter Slot Size Material
IS. SAND/GRAVEL PACK:
Depth Size Material.:.
From To Ft.
From To Ft.
- -Topographic/Land setting
ORidge ❑Slope .OValley ❑Flat
(check appropriate box)
Latitude/longitude ofwell location
`<. (degrees/minutes/seconds)
Lat rude/lone tueesource DGPSOTcpopraphic map
(check box)
DEPTH
From
DRILLING LOG
Formation Description
clay &_anc
crrani to
LOCATION SKETCH
;Show direction and distance in miles from at least
two State Roads or County Roads, Inchide the road
numbers and common road names,
16. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS. CONSTRUCTED IN ACCORDANCE WITH 15.A NCAC 2C, WELL
CONSTRUCTION STA S, AND. THAT A COPY OF THIS RECORD HAS SEEN PROVIDEDTO THE WELL OWNER
02Ue
SIGNATURE OF eRSON CONSTRUCTING THE WELL DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service.Center • Raleigh, NC
27699.1636Phone No [phone], within 30 days CW•I.REV. 07/2001

WELL CONSTRUCTION RECORD
3 0.1'77 8
North Carolina - Department of Environment and Natural Resources • I) yLcicr.of Water.. Quality - Groundwater Section
li ELL COE TRAC10R (INDIYIDUAL) NAME (print) Jarnes B.. Erown CERTIFICATION 2045
WELL CONTRACTORcortPAwvN NAME Brothers Well Dri11#.ng, Inc; PHONE a $ ) 169-9591
STATE WELL CONSTRUCTION PERMITS ASSOCIATED WQ PERMITS
Of applicable) i (If aoolicable)_.
WELL USE (Check Applicable Box) Residential 8 Municipal/Public 0 industrial ❑ Agricultural 0
Monitoring 0 Recovery_0 :1-:eat Pump Water lnjection 0 Other 0 if Other, List Use
2 WELL'LOCATI N
Neares town
(Street Name, N
3. OWNER:
Addross
^^�,�
W County
nbers, Communit ,5ub 'vision, Lot .No,Zip •Code)
_.-
le - ,beet or Ute NO,)
efe
CityorTown State Zip Code-
(B2)•7A(p-f0140
Area code. Phone number p ,/
4 DATE DRILLED O11' Oat
5 TOTAL DEPTH: 50
6 DOES WELL REPLACE EXISTING WELL? YES 0 NO K
7 'STATIC WATER LEVEL Below Top of Casing: %L* FT
(use '+'if Above Top of Casing)
8 TOP OF CASING IS 2 • FT. Abcve Land Surface*
'Top of casing terminated at/or below land surface requires a
variance In aceordanpy tyy,((rh ISA.NCAC 2C ,0118.`
9 YIELD (cm): '7U MET 0 qF 7 S blow
10 WATER ZONES (depth), /3b r ICP rit
I1 : DISINFECTION. Type H T H Amount . 16 oz,
12 CASING. „ Wall Thickness
Depth, D meter or Weicht/Ft NIterm!
From 0 To hi Ft. �t as r itS 6
5
From To -Ft:
13 GROUT' ' Depth Material 'Method
From `' 0 To 20 Ft: herrnite & trtes,L " ,. pumped
From Tc Ft
14 SCREEN Depth Diameter Slot Size Material
From r To Ft in
15 SAND/GRAVEL PACK'
Depth Size
From To. Ft.
Frcm To Ft.
Material
Topographic/Land setting
DRioge OSI.ope OValley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds) .
Let tude/long tt desource OGPSDTopographic map
(check box).
DEPTH DRILLING LOG
From To a Fo mation Description
0 8 clay &'sand
$le i Z r granite
LOCATION SKETCH
Show direction and distance in miles km at least
two State Roads or County Roads. Include the road
numbers and common road names,
16 REMARKS
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION .DARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
tom/ A
SIGNATURE,OFPERSON "CONSTRUCTING THE WELL ' DATE
Submit the original to the Division of Water Quality, Groundwnter Section, 1636 Mad Service Center • Raleigh, NC '.
27699. 1636 Phone No [phone],.within 30 days, OW I_ REV.-07/2001

WELL CONSTRUCTION RECORD v�
North Carolina - Department ofEnvlronc ent and Natural r.esouces Dlvlslon of Water Quality • Ground,vater c eticii
WELL CONTRACTOR (IIND(YIDUAL)KANE (print) James A. Frown CERTIFICATION „_2045
Hedaen Brothers Well Dri_lin
VVELLEOt\'I R,\CTORCOMPANY dAME � • 1 g, Inc PHONE k e2aj 369-9591
STATE -WELL CONSTRUCTION PERM1Tk ASSOCIATEDWQ PERMITS;
(if applicable) • (ifaoplicable)'.
I WELL USE (Check Applicable Box) Residential Is5 Municipal/Public 0 Industrial 0 Agricultural G
Monitoring 0 Recovery.O Heat Pump Water Injection O .'`Other 0 II Other, List Use
•
2 WELL LOCATI.• r
Neare t7cwn: . f ' 4, aOLS• County
tom/' i ra740/8
(Street Nanie, inbers Community, Subdivision, Lot No., Zip Code)
3: OWNER:
Address i '0 Roic 80
aaStreet eYRolle Na.)
TEdVIVAZI Air
j. orl0o3 ►- 4 (0ay,
(tizt1 Zip Code
Area code• Phone number
4 DATE DRILLED a Iai011
5 TOTAL DEPTH:(OtDO a 6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO Of
7. :STATIC WATER LEVEL Below Top of Casing: 3C0 FT.
` (Use '4' f Above Top of Casing)
8 TOP OF CASING 1S 2 FT. Above Land Surface"
•Top of casing terminated at/or belowland surface requires a
variance In accordance lwwth ISA NCAC 2C .0118.
9 YIELD (gpm): /.0 METiOD OF TEST blow
10. WATER ZONES (depth): 1!`ta
0746
11. DISINFECTION: Type H T H Amount 16 oz
12. CASING. Wall Thickness
•
Depth p Diameter ".or Weight/Ft.- Material
From ' 0 To ` /U Ft PYQ
From le' To Z/ Ft, —:75131— Site,
From '—To Ft.
13 GROUT ' Depth Material Method
From ` 0 To 20 Ft: be -mite'& Lt 1L' ,'pumped
From To Ft
14: SCREEN Depth _ Diameter iSlotSiee Material
15 SAND/GRAVEL PACK'
Depth
From '< To Ft.
Fram To Ft.
Size Material_
Topographic/Land setting
❑Ridge OSlope OValley OFlat
(check appropriate box)
Latitude/longitude of well location
_.(degrees/minutesiseccnds)
Latitude/longitude-source:OGPSOTopcuraphic map
(check box)
DEPTH DRILLING LOG
From To Formation Descr lion
0 %/9 clay & san
if` [,OO' crranite
LOCATION SKETCH Show direction and distance in miles fiom at least
two State Roads or Cotir.ty Roads. include theroad
numbers and common road names.
16 REMARKS:
1 D0 HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A: NCAC 2C, WELL
CONSTRUCTIONN-SARDS, AND THAT A C Y OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
7-1a_o
SIGtNATURE-OFPERSON 'CONSTRUCTING THE WELL DATE
Submit the original to the Division of Water Quality, Groundwnter:Section, 1636 Nlatl Service Center • Raleigh, NC
27699.1636. Plume No, ;[phone], within 30 days G W• 1 REV. 07/2001

WELL CONSTRUCTION RECORD
301774
North Carolina - )epannen tit -Environment and N...raesp`wee� - tvision oT Water Quality -
WELL CONIIt %CIOR (INDIVIDUAL) NAME (prim) / 44.0
WELL coNtRA(-run COMPANY NAMELite t,1�1LCY-./vmf
Assoaxreo WQ PERMITR
Groundwater Section l
CERTIFICATION,/
'HONE it —fggl
STATE WELL CONSTRUCTION 1•E IIMFT#
lifapplieablel (if;pilicl -ahlc)
I. WELL USE (Check ApplicableBox): Residential )Municipal/Public ❑ Industrial 0 Agricultural 0
Monitoring 0 Recovery ❑ Heat Pump Water Injection 0 Other 0 IIOther, List Use
2. WELL LOCATION•
Nearest Tow 9, ✓�
At -
!Sure! N:ane. Emirs. Cot))) uutiay. Subdivision, Lot No.. Zip Code)
3, OWNER:
Address
r
a
(Street or It. to No.)
County- 1s4�
d-k779
(n)r
g J.c V. Zip Code
Area code- mmc number //
4. DATE DRILLED 1�.t
5. TOTAL DEPTH: / -S
6. DOES WELL REPLACE EXISTING WELL? YES O NO 63
7. STATIC WATER LEVEL 13clow Top or Casing: / 3 FT.
ttJsn "t" if Above Ton or Casing)
8. TOT' OF CASING IS FT. Above Land Surface`
.Top of casing terminated al/or helots- land surface requires a
variance in ecrordance with 15A NCAC 2C MOIL
9. YIELD (gpm): /0 METHOD OF TEST fit
10. WATER ZONES (depth):
So iv
I I. DISINFECTION: Type
12. CASING:
-✓ I
From To 1'1.
From To Ft.
From To - H.
13. c RouT• Dept 'Oil �cthod
i limp
From Tt 17 1't.
From To Ft.
14. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in.
From To Ft. in. in.
15. SAND/GRAVEL 1'ACK:
Depth Sizc Material
From To 11.
Topographic/Land setting
❑Ridge ❑Slope ❑Valley ❑PIN
(check appropriate box )
I .al ituttc/longil tide of well location
(degrces/minules/secondsl
Latitude/longitude source:❑GPS❑Topographic map
Iclxeck box)
DEPTH . DRILLING LOG
From To Fr raft Description
fi
LOCATION SKETCH
Amount Show direction and distance in miles from al least
Wall Thickness IwO State Roads or County Roads. Include the road
numbers and common road names.
IN W a • WK.
k(�aterta
r
Frmn To Ft.
16. REMARKS:
I7or
I DO HEREBY CERTIFY TIIAT This WELL WAS CONSTRUCTED IN ACCORDANCE WITH I5A NCAC 2C, WELL
CONSTRUCTION STANDARDS. AND THAT A COI'Y OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
% ' e-18-cq
SIGNATUR I' OF PERSON CONSTRUCTING THE WELL DATE
Submit the original to the Division or Water Quality, Groundwater Section, 1636 Mail Service Center- Raleigh, NC
27699-1636 rhonc No. [phone]. within 30 days. GW-I REV. 07/2001

WELL CONSTRUCTION RECORD 301'7'71
d • mr Section
North Carolm:l - I eparlmcnt or Environment an
d tpitural !Resources -
;ion 61 Water Quality - Groun water /
CERTIFICATION N
WEi.l.n)YIIt.\t'T(/R (lNnl\'ll)t:Al.)NAME riu') �-�I 1p GG- �y
%�/ PllpNlr N �/'_O� /J
c e _ 1�1�( ^� .
"Tilt ('l1N'I R \(-1'11H tint I':\N\' NAME _ _
s r A rt; \\ El.1. ('ONSFRCCIION
t if, ,heablel _.: ....
I. Vs I 1 1 USE (Cheek Applicable Box): Residential li Mnnieipal/Public 0 Induslrml 0 Agricultural 0
Monitoring D Recovey 0 Heat Pump Water Injection ❑ Other 0 I Other, List Use
Topogra tic/Land setting
❑Ridge lope DVallcy OFlat
(check appropriate hoer)
I.at itudc/longitude or well location
L.al it u(L:/longitudc source:OGPSOT opographic map
(check box)
Dlil'TH . D121LL INC LOG
F
2. WELL LOCATION
N5arest Town:
-tz
(Street Nam
3. OWNER•
Address
Wi
ti
Numbers. l'onunun}I y. Subdivision. l a,l No.. Zip Code)
Coy or Town
If!)-�
.Area ode- Phone nun, _ G
A. DATE DRILLED ._
5. TOTAL DEPTH:2_ ��-1-4
6. DOES WELL REPLACE EXISTING WELL? YE$_ ❑ NO LV
7. STATIC WATER LEVEL Below T.
ITop of Ab ing: ve Top of Casing)
S. TOI' 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 .(II18.
9. YIELD (gpm): __C---- METHOD OF TEST /Zi_----
10. WATER ZONES (depth):
I1. DISINFECTION: Type
12. CASING:
Dcplh7 / /
From To /P J
From To
From To. -- IFt.--- MIhud
Deal) Material vi
From G' "fo_25- Pt. e
From To ht.
Diameter Slof Size Material
Id. SCRI'.I:N: Depth Diameter
To Ft._ _ in.
Prom--iu.
From
To Ft in.
15. SAND/GRAVEL I'ACK: Sire Material
Depth
From To Ft.
From To Et.
Zip Code
ASSOCIATED \\'Q I'ERAl I'I#
(ifa„Iicable)
LOCATION TCI-I
Amount Show direction and distance in miles
Wall Thickness two Slate Roads or County Roads. Include the road
; m Dieter or Vs/: 1/1:1. erial numbers and common road names.
FLALZY—
Ft
From
To
�s
pp 11ity, Description
%Q
rrom al least
Sep ecIN/Dino
1 v' e° Fcl1pN
oif
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 TFIIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
3p
I(iNAIUI(E OF PERSON CONSTRUCTING 111E WELL DATE
Submit the original to the Division of Water Quality,, Ground wuter Section, 1636 Mail Service Center - Raleighgh,,NC
27699-1636 Phone No. [phone], within 30 days. GWrI REV.01

WELL CONSTRUCTION RECORD
301770
North Carolina - Department of Environment and J/`Nur'ital/Resqurces - Division oT Water Quality - Groundwater Section' .
(/�( e CERTIFICATION k c2
w'II.l.LO.N'' WWI Olt 11ND1\IDIIAI.) NA\II. nnl)/"reft 4
{/� y,,Y /
"tit.l. ('ON"I RAC TIIR (T)?IIA \' N.U11 Jeri? _iW/=�-. �VAi;/JN ---------- p.m,: SJ,l '
ASSOc1AT ED tvQ PEItMII'I'q
(if table)
S'ractt: vi:i.l. CONSTRt:CTION I EItNIera
l if II i tlicahlcl
1. WELL USE (Check Applicable 13ox ): Residential EY Municipal/Public ❑ Industrial ❑ Agricultural 0
Monitoring 0 Recovery ❑ Heat Pump Water Injection ❑ Other 0 If Other, List Use
2. WELL LOCATION:
Nearest "11own:i1/r -
1-75 "—Fr %'.�reK
1 Slrc.q Name, Nno,hcrs, lonununily. Suhdry i eii n. Lot No.. Zip Cute)
3. OWNER:n ' h CA.y
Address .V
A r e.„v. c2
(Si reel or Rome No.)
CocntycT_/&.4)
2g7U
ez8C)ny ur'rurru laic Lip Codc
.Area node- Phone number
4. DATE DRILLED 7-30—o/
5. TOTAL DEPTH: 3Cs -i
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO L9r
7. STATIC WATIiR LEVEL I3clow Top of Casing: °a EF.
1 Use'•a•' if Above Top of Casing)
8. '1.0P OF CASING IS PT. Above Land Surf:tee•
'Top or ruing terminated at/or below land rn duce requires a
variance in accordance with 15A NCAC 2C .nilg. 7
9. YIELD (rpm): METHOD OFTEST li+'r-
10. WATER ZONES (depth):
11. DISINFECTION: Type
12. CASING:
Depth Dcr
Pn� Ton�o �� la
From To _ Ft.
From _ To • Pl.
13. CiROU'I: DepthrN7,v Fri" h'Iclhotl
From V To C—�'`70 I. r0:--r r' -1,7
From "ru Et.
14. SCREEN: Depth Diameter Slol Size Material
From To Ft in. in.
Prom To hI. in. in.
15. SAND/GRAVELI'ACK:
Depth Size Material
From To Ft.
From To Ft.
Topogr�gphiclLand setting
❑Ridge 2Slopc ❑Valley ❑Plat
(check appropriate hox)
I.a l itudenongiludc of well location
(degrees/minutes/seenndsl
L:uinule,longil ode source:❑GPS❑Topograph is map
(cheek hox)
DEPTH . DRILLING LOG
From . To Fo rgitio Description
LOCATION SKETCH
Amount Show direction and distance in miles from at least
Wall Thickness • two State Roads or County Roads. Include the road
to Wcia:ht/Fl. y\A(tlI) numbers and common road names.
16. REMARKS:
I DO HEREBY CERTIFY TFLAT'f-US \YELL. WAS CONSTRUCTED IN ACCORDANCE WITH I5A NCAC 2C, WELL
CONSTRUCTION STANDARDS. AND "II1AT A COPY OF THIS RECORD IIAS BEEN PROVIDED TO THE WELL OWNER
U deir -1 3O Q I
SIGNATURE OF PERSON CONSTRUCTING TIE WELL DATE
Submit the original to the Division of Water Quality, Groundwater Section, 163E Mail Service Center- Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-I REV. 07/2001

3. OWNER:Y
301814
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section�i1
WELL CONTRACTOR (INDIVIDUAL) NAM (printt))aClii5/G Be L i n CERTIFICATION Of 77
WELL CONTRACTOR COMPANY NAMF t e y )t, �J� � 7�'✓ PHONE # cathef -#9td --
STATE WELL CONSTRUCTION PERMIT# A /y ASSOCIATED D WQ PERMIT# T.S/fSG1 L1J
(if applicable) (if applicable) - -
1. 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 - —1
(Street Name, Numbers, Commnj yoity, Subdivision, Lot No., Tsp Code)
Address Ate /L 'Pin //)$s'7C0%/^b!y/"L/-1-- /Pt I
leat(Strew or kemw No.)
�.r. a42779
City or Tharp State Zip Code
aG7)- •Ceh -flat?
Area code- Phone numbsy
4. DATE DRILLED /// 9/0 9
5. TOTAL DEPTH: S f> S
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO S.
7. STATIC WATER LEVEL Below Top of Casing: +3 no FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS �,S FT. Above Land Surface*
'Top of casing terminated at/or below Iaad surface requires a
varhnte In accordance with ISA NCAC 2C.ar18.•
9. YIELD (gpm): • y METHOD OF TEST? nt,
10. WATER ZONES (depth): .2 yb
Topographic/Land setting
❑Ridge "Slope ❑Valley gnat
(check appropriate box) -,
Latitude/longitude of well location
c_
CD
41.
(degrta/minunsesxonds)
Latitude/longitude source:❑GPS❑Tr graphictnap
(chuck box)
PRILLING LOG
Formation Description
DEPTH
From To
LOCATION SKETCH
11. DISINFECTION: Type f . t N. Amount 9 In" Show direction and distance in miles from at least
12. CASING: Wall Thickness two State Roads or County Roads. Include the road
Depth Lira or Weight/Ft. Iv�ateci? yLnb rs and common road names.
From O To 1S 0 Ft.4 #�/ _ c ' J }.
From_ ,? �y1�l/1 To Ft . eV a
From To Ft.
13. GROUT: Material
From 0 To 02el Ft. Cases a.�
From To Ft.
14. SCREEN: Depth Diameter Slot Size Material
Fro To Ft. in. in.
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From o Ft.
From To Ft.
16. REMARKS: L(J,rAA
/vat yB Pni
0
I DO HEREBY CERTIFY THAT THIS WFI 1 WAS CONSTRUC IEO IN ACCORDANCE WITH 15A NCAC 2C, WFi l
CONSTRUCTION STANDARDSTHAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
SIGNATURE F PERSON CONSTRUCTING THE WELL
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-1 REV. 07/2001

WELL CONSTRUCTION RECORD
WELL CONTRACTOR (INDIVIDLAL)NAME (print)
WELL CONTRACTOR COMIPA YNAMEHedden Brothers Well Drilling, Inc PHONE Is fx, 51 369-95°1
STATE WELL CONSTRUCTION PERM1TP ASSOCIATED WQ PEANUT.
(if ar:oh:abie) (if aco!Icable)
North Carolina - Department of Envircnnmen: and Natural Resources - Division of Water Q.c , - Grocndxva:er Secho
James B. Brown CERTIFICATION e 2055
WELL USE (Check Applicable Box). Residential Municipal/Public 0 Industrial ❑ Age` ricultura1 C
Monitoring 0 Recovery 0 Heat Pump Water Injection ❑ Other ❑ If Other, List Use
2. WELL LOCATI
N ncs: T wn:�
($tree: Name, ,, .NJTbo: e, CAimmu
3. OWNER.
.Address ' •S &S. P451
;$wee crAc eNe)
a. l�i��/p � Nc Ai19
(&t 7iih ' �8/fijt Zlp Cece
Amacode• PPhc.e n.cber
». DATE DRILLED /a lip,/
��j� r
IV, SJba
Coll^ty
-.'..� Lot No., Zip Code)
5. TOTAL DEPTH:
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO
7. STATIC WATER LEVEL Below Top of Casing: MO T.
(Use " if Above of Carr;" if Top of
S. TO? OF CASING IS 2 FT. Above Land Surface
'Top of casing terminated at'or below land surface requires a
variance in accordance vtth 15A NCAC 2C .0115.
9. YIELD (gem): _ MET OD 0 T--ST blow
O. WATER ZONES (depth): /Q' �nQ.3
I I. DISINFECTION: Type
12. CASING:
Dent:-
From 0 To
From, s3 To
Frcn- To
13. GROUT:
From 0
From To
SCREEN Dep:h
From To
From To
15. S.AND:GRAVEL PACK:
Depth.
From To
From To
H T H
Dept.'
To 20
16. REMARKS:
Size
Ft.
Ft.
Arunt 16 oz
Wa;i Thickness
Ft o
D'meter or Wei;i:VFt.
ar � f
Ft. .IM
Ft.
Mattria; tMeth•oct
F. te:rnite & csrrrrt pumped
Ft
Diaz;e:e; Slot Size p!a:e:ia!
in.
Ft_ ;n. in.
Material
Topographic/Land setting
DRidge ❑Slope ❑Valley DFlat
(check appropriate box)
Latitudellongitude of well Iccatior
(ceg:ees. lnln,aes'seconds)
Latitude/longitude sc GPST c, ph c map
c..eok box)
DR. 'NC LOG
Formation D .,r'^Uon
clay & sand- _
granite
FO tr To
LOCATION SKETCH
Show direction and distar,e in .n,.es„c
^ m e _. at leas;
t o State Roads or Coney Roads. lno!uce tee road
numbers and cortm •• ra d „ates,
0
0
V7ON
Cd
w
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRLCT!ON STAND0ADS, AND THAT A COPY 0 HIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
DATE
•
SIGNATURE OF PERSON CONSTRUCTING THE WELL
Submit the original to the Division of IAater Quality, Groundwater Section, 1636 Mail Service Center Raleig t,NC
27699-] 636 Phone No, [phone], within 30 days.
GR-! R -Vh-07:9Ct

WELL CONSTRUCTION RECORD
Nor.'. CacolL:a • Dc,-_r r ent of Environment and Natural Resources - Division of Water Q':a
WELL CONTRACTOR(iNDIIIDL'AL)NAME (print) James A. Erown
WELL coy; RACToRcam PANYNA;MEHedden Brothers Well Drilling, Inc
300729
y - Groundwater Sec.:ion
CERTIFICATION 2045
PHONE e $281 369 2Z91
STATE WELL CONSTRUCTION PERMIT0 ASSOCIATED \vQ PEANUIT;.
(ifaoolicabe) (ifaoplicable)
WELL USE (Check Applicable Box): Residential Municipal/Public 0 Industrial ❑ Agricultural 0
Monitoring ❑ Recovery 0 Heat Pump Water Injection 0 Other G If Other, List Use
2 `HELLwATIO.y Tot A
At
12i-' 5.6ajre
Are; once- P`c-.e nelnte.
DATE DRILLED % at0071
5.TOTAL DEPTH:
/�
Connt.
(Scree: N3me, Nu::. 75.. Cmnmurl tv, Scbci vis. on, Lol No., Zip Code)
_. OWNER..
Addras
/II . i;Since:aRsu:eNoagzo
rt.
Z:
6. DOES WELL REPLACE EXISTING WELL? YES 9 NO
7. STATIC \V.ATER LEVEL Below. Top of Casing: 10T
(Use `." if Above Top of Casing
TO? OF CASING IS 2 FT. Above Land Surface
'Top of casing terminated aror below land surface requires a
variance in a ccorda wish I5A NCAC 2C .0118.
9. YIELD (gam) b:°'HOD OF TEST blow
10. WATER ZONES (depth): YO' /03' 46 e
1 I. DISINFECTION: Tvpe
12. CASING
Dept:. D:arne;er
FroTo 15
FromTo
From To
H T
._. GROUT: Depth
From 0 To 20
From To
14 SCREEN Depth
Prom To
From To
i5.SAND :GRAVEL PACK
:
Depth.
From To
From To
16. RE\'ARKS'
S; ateria
Amount 16 oz
WaIi r. knees
or \ie:_h:.F:. Mated,.
Ft. !rite & Laic L purrna
Ft
D:ame:er Sot Size Materia!
Ft. in.
Ft._tn. in.
Size Material
Ft.
Ft.
Topographic/Land setting
❑Ridge ❑Slope ❑Valley :Eat
(check appropriate box)
Latitude/longitude o^ well location
(ee;rees'm:rraLeslseccods)
Lail[ d,'iongi0.:de source.❑GPS0Topc_raphh.c map
(Sleek box)
DEp' -t DRILLING LOG
om " , Fo.rnatlen Derr' -lion
�,aa
923' 1+i0 ' granite
clay & saah
LOCATION SKETCH
Show. direction and dIstancei , mi les flom. al leas
two State Roads or Co - Roads. IncLce the road
numbers and conumen road names,
I DO HEREBY CERT:FY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15,A NCAC 22C, WELL
CONSTRL'CT:ON ST-i.Y+3a\RCS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
E IIF PERSON CONSTRUCTING THE WELL
2—aG--oc7
DATE
Submit the original to the Division of \Vater Quality', Groundwater Section, 163E Mail Service Center, • Raleigh, NC
2-699.1636 Phone No. [phone], within 30 days. -
0
0
cn�
am
o<
10
nc
—+0
mo
enZ
rra
6
Z

WELL CONSTRUCTION RECORD
North Ca:'c,ina - Department of Environment and Natural Resources - Division of. \Vater Qua:
WELL CONTRACTOR(IiNDIVIDUAL):NA:1E (print) James B. Brown
WELL CO.NTRACTOR COMPANY NAMMEHedden Brothers Well Drilling, Inc
STATE WELL CONSTRUCTION PERMITa ASSOCIATED WQ PERM i in
(ifaoollcabk)
(if at7iicaNe)
30r"''-'8
• Ground.vater Section
CERTIFICATION e 2045
PHONE e 251 369-9591
I. WELL USE (Check Aop:icable Box). Residential Municipal/Public ° Industrial C Agricultural C
Monitoring C Recovery ° Heat Pump Water Injection ❑ Other IfOther, List Use
2. WELL LOCATi N':
et Town: Di
&boan \___
County
(Scree: N3:ne, Numbers, Community: 5„bdividion. of No.. Zip Code)
n
3. OWNER:
Address
er Re'ae N' 0
CAW ni?)J ia�
TAr��cJ� �
966- 7474 Zip Coat
ArrTE DRILLED
cdmbe'`-e ......yyyyyy005/
=. DATE DRILLED 7���/J�\
5. TOTAL DE?TH:
lest :t
6. DOES WELL REPLACE EXISTING WELL? YES rr^ NO
7. STATIC WATER LEVEL Below Top of Casing: &Of FT.
S. TO? OF CASING IS 2 (Use "*" ifAbcve Top of Casing,
FT. Above Land Surface'
'Top of casing terminated ator below land surface requires a
9. YIELD (gpm)
variance In accardanc rlth 15A NCAC 2C .011S.
ME OD nir TEST blow
IO WATER ZONES (depth): )7
11. DISINFECTION: Tvpe H T H
12. CASING:
De,oth
From 0 To
From 7' To 3(j e Ft.
From To
:. GROUT:
Fr. 0
From
14. SCREEN.
From
From
15 SAND/GRAVEL PACK:
Depth
From To Ft.
From To Ft.
Ft
Depth Materia: Method
To 20 Ft. becite & cs air ptirnnxi
To Ft.
Depth D.amexr Slot Size Material
To Ft. in. in.
To Ft. in, in.
mete,
Amount 16 oz
Wald Thickness
or WeichuF:. NK
J8d
Size Material
16. REMARKS:
Topographic/Land setting
°Ridge ❑Slope DVaI1ev CFia:
(cheek opproa riate bon)
Latitude/longitude of well location
(degree /n n,nes/seconds)
La:!tudc!ion_ih,tde source:CGPSCTopo_raoh!e map
(cke.k box)
_ DRILLING LOG
clay & sandoft:
..n
DEPTH
?corn
0
granite
LOCATION SKETCH
Show direction and distance in miles from at least
to State Roads or County Roads. Include the road
numbers and common road names. a
0
:= `n
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STA�Ji RDS, AND THAT OPY OF THIS RECORD? HAS BEEN PROVIDED TO THE WELL OWNER
SIGNATURE OF PERSON CONSTRUCTING THE WELL
DATE
Submit the original to the Di>ision of Water Quality, Groundwater Section, 1636:NIail Service Center- Raleigh, NC
2-699.1636 Phone No. [phone], within 30 days. -
G:J REV 07/20C1
'1

WELL CONSTRUCTION RECORD
North Carolina - Department ofrural R { e f1 (' •�
spa men: and Na ;sources • Division o Water QuaiRy - Groundwater S � dr!
WELLCO;NTR.ACTOR(I�DIYIDLALO'AD1E (print) James A. Brown CERTIFICATION 2045
WELL CONTRACTOR COIIPANY NAME Hedden Brothers Well Drilling, Inc PHONE ;fah 369-9591
STATE WELL CONSTRUCTION PERMIT* ASSOCIATED WQ PERMIT*
(if a:nlable) (if aonlicablel
I. WELL USE (Check Applicable Box): Residential Municipal/Public ❑ Industrial ❑
Monitoring ❑ Recovery ❑ Heat Pump Water Injection 0 Other ❑ Ir, Other, List Usc
2 WELL LOCATION`
Nearest Town: Sylva County Jackson
Thorn Ridge Development -Lot #10
(Scree: Name, Numbers. Community, S..Mivis.on. Loc No., Zip Code)
3. OWNER: Joseph Michael Dries
Address 9 Dries Drive
Old Fort,(sNC `r 5$7g2'
:.or T ohr. S•_:e Zlp Code
(828 269- 2014
Area rice- FJc'e ncnber
4. DATE DRILLED 7-19-04
5.TOTAL DEPTH: 200'
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO)
7. STATIC WATER LEVEL Below To; of Casing: 50 FT.
(Use "r" if Above Top of Casi^g'
E. TO? OF CASING IS 2 FT. Above Land Surface'
•Top of casing terminated ae'or below land surface requires a
variance in accordance wlth 15.4 NCAC 2C .0118.
9. YIELD (gpm): 60+ METHOD OF TEST blow
10, WATER ZONES (depth): 87' • 106' , & 185'
II. DISINFECTION` Tvoe H T H Amount 16 oz
12. CASING: Wail Thickness
Depth Diaeier or W'ech•!F.. Ma:erio:
From 0 To64 Ft. pvc
From 64' To 67 Ft.---6 e- .188 steel
From To Ft.
3 GROUT: Depth.
blz'sria; tie:;^n,",
From 0 To 20 Ft. bs iite & Cetcad punioed
From To ❑t
14. SCREEN: Dept. D.ame:e Slot Size Material
From To F:
in.
From To Ft in in.
15. SAN'D•GRAVEL PACK:
Depth Size Nlaterial
From To Ft.
From To Ft.
16. REMARKS:
DEPTH
From To
65' 200'
Agricultural ❑
Topographic/Land setting
❑Ridge DSlope ❑Valley ❑Fla:
(Check appropriate box)
Latitudellongitude of well location
(de;;eeshnin:,tesis econds)
:udo/;ongitude sour:e:DOPS❑Toxgraphic neap
(c eck box)
DRILLING LOG
Formation Descr tton
clay & sand
Granite
LOCATIONSKETCH
Show direction and distance in miles frcr. at least
two State Roads or County Roads. Include the road
numbers and common road names.
O
c
aT
-12
w
ca
I Do HEREBY CERTIFY .AT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION ST ,. D RDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
ten -4-no
S:GNATLR„ PERSON CONSTRUCTING THE WELL
- J
CATE
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.
GAS-1 REV. 07/2001

WELL CONSTRUCTION RE( ORI
300"'81
' n i _ ' . Ircpa.» tie nt.: f Environment and,' tura-Resources• D;rlslor of Nater Ouaio: - rrz »ndw-ucr Sea'nc.
C.'V` ikAc;op Ih I,tY1Li:AL)NASt lyric! 5'
- � 's--, 9LLjoct
._ (..'La. hi ll- +I ION I .2_07
t t_E,1 s NA. "I OP COMY4b'1 1AML p
-
of ar,-, n:ai:ie, 'N{-wSSt CIA!En WQ PExHllr 7y7�yy
(ifapplicah:t •-
4ppEicablc B:ixj. Residential IR Municipal/Public CJ InciustriaJ AL: icultvr i
L. ke r . ❑ Beal pump Water Injection 0 Other 0 If Other Lis, List
/etre -
loo�no,,t s,..
-aTj'st _Z..49 7.57
SutXjnnauc jot Nc Zg ! nC
,,rCa,
Topog.ant`l Lard setil
❑7Udge giti!apn Dv alit
rG` i apv flat-
...atitu eio n urle of w i 7 .4.,.
.' rah.
Latitude. !ur:'icudc source L.itii ot_ra:,t3;. nua;
nc tr
f)i i`Ii�
O _ `:tines direistmr.an;i dis . t� e
tw-t, Swt:
uu:aL: ar!i '/ ,tw±.;;- roau
t/L
_. iranaal_ ..:,..
Sid: S¢< bfaarm:'
f'L, FHA! A COPY Or Thf
8- -
,tti.. Jt PLb.Jt)?- f' G TrEi
C,C)AN(.r Wi ,- - - _.
• of %ftacer 0u ht. +>:9tiad eater Sec non 16;e '', kil
with;° ib nx'>
„ `F
I
EP 1 <;i'

l s L,LL LV1\311\U \. A ♦v...•yt,V1NU
WELL CONTRACTOR (INDIVIDUAL) NAME (print)
.//�]] J-D rimscs4
\\ ELL CONTRACTOR CO. IPAN'Y NAME H M-.,.� ase-s /- )4C./
STATE \CELL CONSTRCCTION PERMIT; ASSOCIATED \cQ PER?
(if aoolicabl&
(irapolicablel
CERTIFICATION:
PHONE 0024 .K70—Ss5t
1. WELL USE (Check Applicable Box): Residential 0 DlunicipalPublic f Industrial ❑ Aericulturaf O
Monitoring 0 Recovery 0 Heat Pump Water Injection ❑ Other;k \(Other, List Us: im2-4-c-_ -e
2. WELL LOCATIQN
Maros: Town:
3. OWNER:
Adc::ss
1
V
County
Nutb:s. Co^:muni:. Sabdi visioc, Lac No.. Zip Ccdo)
/ Yot)
(Stec^cr Rau:: \a.)„ 970 -ISoU
Cr:. 071.;R S:ne ' zip Cele
( 1 h /A p
DATE NDRILLED 6 -76 - 69 fa -j.zt
5. TOTAL DEPTH: 5'OO /i).S - I,?.7 �t��!I�I
6 DOES WELL REPLACE EXISTING WELL? YES 0 NO A _) .7 AjC - %�
7. STATIC WATER LEVEL Belo.: To? orCasine: /00 FT. ii• U J� r .�:�
/ (Cse'r'if Abo-.:• Tap oTCair.y 103-'$70 iC_L_- -��
S. TO? OE CAS'NG IS i'.2- FT. Above Land S;:r::e- 5'70 673 C..ezal`vfe-5
Topographictand seine
❑Ridge OSlope O\'alley [crlot
:ppropriam box)
La:itnd 'longitude of \cell location
300898
'1 iy
,l u. t1)in;; r:r-.r•.i::d T'vr bebn, Lind serL regal re. v
s:- r_.Nal:irJ,n:.,,I:` 1;.\NCAC2C.0113. 5J f 3 O 0� fiJ
9. YIELD (,o- ,: ' / 8 METHOD OE TEST v
IC. \.-ATER. ZONES (d:?:F..). / aY lia O
57 7 c3 ♦ LOCATION SKETCH
11. D:S:\FECTION. Tv:-.;: �'/ .r (-/ A- 'RC 0.7 SS,., di:aaior. _n.'do._n:c in riks fro.-.1 le:
C,. t S',:_ Roais cr Cc.. . Road.. In:::de, ra.W
./D::::-. D- :r c. Ve: -.:T.. N._:a'. r .. c' s ar.'. co-'- r r+::a p �m
0 T, S% F: 1KYlu�{I— ccli cm
Fr:-.: To F: o.;
F::r_ To Ft , 5.;o
F:07: 0 T: F: eZ kt1/4cnr-
-
Fr; T; Ft L 7\-, (9
14 SCREEN: D.^:F. D.nr.:a: 5:; 5:z. \ra:eri'' r --4
G
(d:pb:siminusi'3eeoedy) ;
La:itud::'lon,_itude sot:r;e:OGPSOpographic rap
(ohczk bo<
DEPTH DRILLING LOG
From To Formation Description
Tc Ft.
Ii. SAND GRAVEL PACE;:
Sze
F;on. To Ft.
Fsc:• To n,�Ft. /: ^' //'
I E REV ARKS
I DO HE-:°_Y CEr.T:FY THAT TH:5 WELL c:AS CONSTRCCTED IN ACCORDASCE \`: ITr: IiA NCAC 2C, c:F !
CONSTi'._CTION STANDARDS. AND THAT A COPY OF THIS F °CORD HAS EEEN FRO 'v IDECD TO TEE WELL O '.NER
J-� Mt„-.L,„o (46-°f
v 5:6\ATLRE OF PERSON CO .':CTINO THE P.-ELL DATE
S.br.a the crigi❑ul t) the DIN ision or \\ titer Quality, Grcund.. titer Section.. 1536 \Ia". 5:r o? Center. Ra'eigh, NC
'_ c9''•:6 5 PI:...: N;. 1Y:9; 733-3221, \.ithin 30 da\ s. G\' i RE \ C.? 20L:,

11 t.LL L kJ IN J I I%V\. 1 lll1\ 11.1:a Vitt/
.......-r-..,..-n. U
•}�/'�1�4�_�r- �C`�i(�
.w
WELL CONTRACTOR(INDIVIDUAL) NANIE(priin)YitA/t4'
WELL CONTRA C-FOR CO%IPANI' NAME AAA erre-eetC,V✓BS ..�
�� Pr-1 i
STATE WELL CONSTRUCTION PERMIT: ASSOCIATED WQ PERMIT:
(if aoolicable)
(if applicable)
CERTIFICATION : are? 7
PHONE K (S2t .s 2f' -.tS c
I. \\'ELL USE (Check Applicable Box): Residential?. Municipal/Public a( Industria! ❑ Auricultural D 3 0 0 ^ ,7
Moni!oria� D Recovery 0 Heat Pump \Vater Injection 0 Ocher 0 If Other, List Use .j
2. \\'ELL LOCATION:
Nea:estTo,Wn: d County
� 9v�2,
Name
3. OWNER:
Adi Rss
Nu. -'reps. Con nu ;in, Sebdisisior, Lot No.. Zip Code)
Zip Cod.
_2) - 5 goo
.•, Lo Pram ru.cSer ,
4. DATE DRILLED y- 03
5. TOTAL DEPTH: 5-h'(]
6. DOES \:ELL REPLACE EXISTING WELL? YES ❑,fire/NO '
7. STATIC WATER LEVEL Bolo.,. Top o°Casii,_. /TO FT.
Qae •._.. i.' A'bo;: Top of Cash:_ f
r�
S TO? 0= C:\S!NG IS / �1 FT. Above Land Surface'
•l p v'.min;; Kra,luated acbr be:a$, land surfa.a require u
sa-ian:. i a.<ordan _. s,ith 15.\ NCAC 2C.011s. /�
9. Y{E_D(e„):' 3S NIETHOD OF TEST AA—)
I6. WATER ZONES (d_p:b,. 9s, o/ 7,, 5 as-
!. D:SINFECTION. T,�e >-1 1'1-I
L'. CAS;SG:
D:;;i-. Di_.-c:c..
Fr`... 0 T; 5.R Ft. /0 Vy
Fran: To Ft
Tc Ft
From Q Tc 5'0 Ft. Lg-rne>-t- V--e3-AL-•
To Ft
IJ. SC:SEEN: D,::`, D.r_•.-.a:er Slot S,z: DL:eri:.'
Fps-. Tc Ftic. in.
Fr..-'. T: Fc. in. in.
Topoeraphic/Land setting
❑Ridge slope ❑\'alley check appropriate box)
Latitude'longitude o,r\Well location
(dearee;'e.ir:es.'secor.ds)
Latltud_'longitude source:❑GPS❑Tdpographic nap
DEPTH DRILLING LOG
From To Formation Description
-97
7--24 o
arya-a7.3-
c2 77- 6-as
•5c7 -5-x7
sal- as--ro��a �Q
LOCATION SKETCH
Anti it .r /97 S�hou dmootior a-.: os:7'._e IL raloi Frci i a: lea::
�_,
71r:kc:<, r.;o S: �:: Roads Cr Count,. Roads. Include tie ra.
c(./\•,. e ..•- ,Fe c:: n.::-.x:; azd COE:c.an Ion rannos. 0 n�
a co
Al
Gn
z t«r
"o �O
`^ z
1' -
5 S `,\D GRAVEL PACK
Dcc:h S:ze Nl=:era::
Fcc 7o FL
F:..: To Ft.
l6 REv!AR:a. .,c-- - --tzro(�- Jae '7-3/-03
I DO HEF.EB':
CONST';
ERT:FY THAT THIS P.
AS CONSTRUCTED IN ACO7.D.ANCE\\ITHI5ANCP.C2C.VELL
T A COP'i OF TH;S RECORD FAS BEEN PROVIDED TO-
S:c>-.-::RE OF PERSON coxsTR
CTNG THE WELL
Submi: the oriinal to the Ditision o. \\ ater Qa !i:'. Ground„ater SeoCon. 1536 \Iv! Szr
2'69?-1535 Phom: \9. (9; 9) 733-::21,''!thin 30
DATE
Center - Ra'eigh, NC
G\'.-I REV. GT:oo:

WELL CONSTRUCTION RECORD
Fortn L.arahna - Department of Environment and
WELL CONTRACTOR (INDIVIDUAL) NA)IE (print)t
\WELL CONTRACTOR CO%IPANY NAME hitIt
STATE \1 ELL CONSTRUCTION PERMIT;
(if aoplicable)
Natural Resources - Li' si9��, of. Water Quality - urouna wa ter Section
1) 1I Q/L L' -. I')'i ��-•y'� CERTIFICATION
# 597
6r'eene ''5LOCI1 LrL. PHONE K(s.21J"S6Z[j
ASSOCIATED WQ PER\IIT:
(if aoolicable)
300896.
NIonnonng ❑ Recover): ❑ Heat Pump Water Injection ❑ Other ❑ lFOther, List Use
WELL USE (Check Applicable Box): Residential C ?1unicipal:'Public Of Industrial ❑ Agricultural 0
2. WELL LOCATIO
N- .- gTown: ( County
3. OWNER:
rs. Ce.^...n unit;. SabJi\ision, Lot No.. Zip Code)
orC
1
o- l'e.m 5:.de Zip Code
4.
DATE DRILLED 474 71.5—" 03
5. TOTAL DEPTH: tee
6. DJES WELL REPLACE EXISTING WELL? YES 0 NO XI
7. STATIC WATER LEVEL Belo.- Top of Casirc: /S FT
1'-se "=' n'.4So.e Top of Casin_ 1
8 TO?OF CASINO IS I�Z FT. ASo‘e Land Surface
o` sa dog ter-,hut:d or or brlvo Lod surO;c require, a
1. nirh I5\\G\C2C.O!15.
9. YIELD ( - 17S .`-!ETHOD OF TEST �v
IC \,-.', T ZONES (de :�-:). 90 Rix • atc�
D:S ECT10N•Type 7-774.
Fr: 0 Tc ... SZ Fi. & T/q
i?. G:.-, l D-_:'
U T, 3.71-) F:
Topoeraphic%Land setting
❑Ridge 14Slope [Walley ❑Fla:
(check appropriate box)
Latitude'longitude of well location
(de a: a'innin.res. Records)
Latltud:'longitude socr;e:❑GPS❑copo_raphic map
boc) .
DEPTH DRILLING LOG
From To Formation Description
417
4 7— 90
)jr-it jsj
/17—RY0
0290 —:a9a-
9'2— her
LOCATION SKETCH
O o
1 I' Izk-es• r S F- C7 Co:Roo Include ude Grc: �
c. \. e : Ft. \! ...bCone,.,.". .... r__..,. 0 arm
/��LUrifP � t o
' C� y �}c N A
L r^
14 SCREEN• Dr; D:r.rt _. Si.): Size N!a: r
Frc:c To Fi. ic- ir..
Frr. To Ftir.. in. '
15. S. ND GRAVEL PACK
Der:
Fran: To � F.
Fr- Tc Ft
.6 F.EV„?KS
P/-3
/TS G
I DO kE i B''' CEP.TiFF THAT TH:5 WELL \`:A
CONS CTiDNSTAND A/)S.
1
SIC
STP L CTED IN ACCORDANCE WITH I5A NCAC '_C, WELL
OF THIS RECORD F.?S BEEN PROVIDED TO TEE WELL
RE 0? PERSON CON'STRi CTI\G THE P• ELL
DATE
Scbn:!: tf.- on :nal to the Di\ision of Water Qua!it\, Groundwater Section. 1636 )lail Sen e Center-Rolei_h; NC
2969)-1:36 Pio,r: A.) (' 9, 733-3'.1, within 30 day s. - I REV. 07.20O:

N
CONST?iryjiDN S A
Ali fr
\VLLL C:U Nj1 KVt.1 JUIN KLIJUKV
Nuein Carolina - Department of Environment and Natural Resources - Division of v. ater Quality-- Liroundsetcr Section
\\ELL CONTRACTOR (INDIVIDUAL) NAME (print)
\ELL CON'rR::\CTOR COSI PAM' NAME
STATE \\ELL CONSTRUCTION PERNIIT:
(if applicable)
//,,,� 1' CERTIFICATION: O)5 7
c Cates /aTIPHONE p 4.351 -a te ••-r 0
ASSOCIATED \\Ql PERMIT
(ifaaolicable)
1. WELL USE (Check Applicable Box): Residential :. MunicipaUpttblic 011 Industrial 0 Agricultural ❑
\loniloring 0 Recovery 0 Heat Pump Water Injection 0 0:her ❑ It -Other, List Use
2. WELL LOCATIO
Nea:cst To\c
(S
-. OWNER:
ACCr., s
County
ifs r�.P-II--4_
err. Cor..munity. Sab.isifion, Lot No. Zip Code)
G:• or l'a,ur 5:3:: Zip Code
O
4. DATE DRILLED y - -. �t-25--63
5. TOTAL DEPTH: 4bS
6. DOES \YELL REPLACE EXISTING WELL? \'ES 0 NO 121
7. STATIC WATER LEVEL Beio.: Top efCasi:g: 13J FT.
(Lit .o.b.s.c. Top of Casing
S TO? OF CAS!NG IS I /Z FT. Abo':e Lana Surface'
•i„�: u.' c,,ul t rciiu Yed ut'ur be a‘‘ isnd surf4ce require. u
u':n:a ir. x:ardn:; nirh li:\ \C.\C 2C.OIIS.
9 YIELD (tnc):' ?IETHODOFTEST EA-)
10. WATER ZONES (death\: rr2io
11. D:S ECTN. Ty; N . IC) T 14 a. v. c: apt) Z
12. CAS.\C. \.7.: T:!akeess
D'rh D._.—::r c ' V.'e Ich.: F; Mesh::
,: IC 1r Ft 0% f &.ort r .,,, Q
Fran To Ft
Iron'. To Ft
Der:` /}N�'t:-:c:.: . N!:.h:ct
To 56 pi; --)
Te Ft
1- SCF.EEN Dcgrei D:r.a:er SIot S,ze Nilt: H
i 3.
F: U
Fra r.
FraT.. Tc
Fr-r. T:
I5. 5 \\C GRAVEL PACK
Deg:a
Fr.c. To
F,r To
6 RE11-\RKS.
Ftin
Ft.
5.z- Nla:eria:
Ft
Ft.
300895
TopoeraphicLand setting
❑Ridge "(Slope ❑\'alley ❑Fla:
(check appropriate box)
Latitudelongiutde of well location
(d ,ees ininu:erdsecor.dsi. .
Ladaid:'longitude socre:❑GPS❑Topographic nap
(:h. box)
DEPTH DRILLING LOG
From To Formation Description
c
LOCATION SKETCH CO o
Sho'., di. d: in miles from ea•7C1A
7 m
Rt_Sa c Cc: Roadsoa'. I u_'e ter.,. . _n�
r'. n:bees and cor..e.ar. r_..: ra-,es. N ?-,,
ar
" r0 rrZ
r
.D z
iercires
sLoK
I DO F:_P.EEY CEP.T!FY TnAT THIS
SICNATURE OF PE f S.ON CONSTRCCTI\G THE \\ ELL
Sub the original to the Division of \\ ater Quality, Groundwater Sectior.. 163o ?lail $eni
2'699-N36 Pi,n.: Na. [phone], \'ithin 30 des\s.
LL v':AS CONSTRUCTED IN ACCO?DANCE WITH I5A NCAC 2C, WELL
HAT A COP' OF THIS RECOFD F.A.S. BEEN PROVIDED THi le LL 1=R
DATE
Center - Raleigh, NC
GC. -1 REV. C'7 200:

WELL CONS 1 KUU 1 JU:\ xLLUxll
(.orui Carolina - ueparunent of Environment and Natural Resources - Division of water Quauy - Groundwatc.
/�� wad CERTIFICATION. cQS 9 7
WELL CONTRACTOR (INDI\'IDCAL)NA?l NAME (print) ///1 ���7 L/I< �+%'•/ 9�! �(�- �.y
\\ELL CONTRACTOR CON] PANT" NAME 'A -AA- gn,4v4a v (%%'fir ^"^�-y PHONE z J(fc2r
STATE W ELL CONSTRUCTION PERMIT, a' ASSOCIATED % Q PER?IIT: /
(i f aaol icabk) (i f aoolicable)
( WELL USE (Check Applicable Box): Residential D Municipal/Public 16 industrial ❑ Agricultural 0 30 0 8 9 4.
Monitoring ❑ Recovery ❑ Heat Pump Water Injection 0 O:her ❑ it -Other, List Use
2. WELL LOCATI
Kea:ost T2\�
tic
County.�
Ssa::. So:-:e:;. Cor.ununiy, Sjb ' ;io;, Lot Na.. Zip Code)
3. OWNER:
Address
-2-/(o/j
C:. or T.),S:.ir Zip co.:,
(30,-2g / —9V00
-t. DATE DRILLED 4-aa-03
5. TOTAL DEPTH: 730
6 DOES WELL REPLACE EXISTING WELL? YES ❑ NO kj
7. STATIC WATER LEVEL Belo..Top ofCasir:e: 30 FT.
(IUS:"='i .Abo; To; oTCasin,l
S TOP OE CASING 15 I to FT. Abo\e Lane Surface
-t u.'.u,i:, t<rrdnutad a:'ur belu„ Iaod surface requ:res
a-ince ir. a.:ord,nc<„ i:h 15.\ ,‘CAC 2c .o:IS. ^ ,
S. YIELD y:,.^.1: ' RC) METHOD OF TEST U...A .--+ --0
l'i? WATERZONES (depth \ SS /O5
Topo¢raphic'Land setting
❑Ridge Xlope ❑\'alley ❑Flat
(check appropriate box)
Lati:ud_'longitud_ or well location
(degreesiniau:es'secords)",
Latituda'longitude source:❑GPS❑ Topographic map
(:i:: boc)
DRILLING LOG
Formation Description
DEPTH
From To
COMET _ II-)VST:\'
SS-87
8z—i0S
lvs —iv'7
147-/90
—JQO"-/yz
/y - 7qo
o
/ q0 LOCATION SKETCH . C 073
S: o'S sh " d n i riles f ' 1 at. st pm
I! D:�� �cn_�N:Ty:e i-�7-/.-1 A ,.�., 3a.YS�7�_ -.�,:
12.. C AS•NG: \.'_li TPJckr.ess r.'o S' Ru__s cr Col. Roods. L ude th .i�.`r `.5 corn
cc
D: D.- a: \'. :F; �! r.r-_-,a acd eor., r. rs... r_-,es. F y�
-I -- re2 73 r
Nz
A /,/ '
ref; 7'
O Tc S 7 Ft. LG (/.� I Algfra-i441
Fr:r: To R
Fr. Tc Ft
F:u: : 0 To � Ft.
Frac'. Tc Ft
1; SCREEN. Dcp:E.
FY: c. To Ft.
To Ft.
15. SAND GRAVEL PACK'
Deo'h S:za
FEW-, To Ft.
Ere Tc Ft
IE RE?I\RrS.
in
IG.
S'A: S:ze NIate
Materia:
4
1/40 o
l
pi-7
I DO HEP.EBY CERTIFY THAT THi v."LL WAS CONSTRLCTED IN.A CO.'.D.A\"CE WITH ISA NCAC '_C.\`•ELL
yh ATACOPY OE THIS RECORD HAS BEENPROVIDED T- THE.
StC A,T LRE OF PERSON CONSTRLCTI\G THE WELL
DATE
Subn:i: tl:e originil to the Dk ision of \\ a ter Quality • Ground"nter Section. 1636 Maa Sr'cice Center - Ra!eigh, NC
2-c°':-L Pi.in: No (1,9)733-3221.\,ithin 30 d:ns. Cy. .-I-REV 07 200 I

J `tS'744 W
County yf dn-1
2'69)-153o Pl:.c: N3. 019) 733-.' I, 1rithin 30 d:ls.
ELL CONTRACTOR(INDI\-IDL-AL)NAME (print) IYl Qn7r-+`- Yn4!"
\CELL CONTRACTOR CO%IPANY NAME
STATE \\ELL CONSTRUCTION PERMIT;
(it -applicable)
the LvCa.
CERTIFICATION k# 5- 7
PHONE k (pz0 sSte
ASSOCIATED \vQ PERMIT:
(if aoolicabte)
1. WELL USE (Check Applicable Box): ResidentialkJ Tlunicip:t Public ❑ Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other ❑ IFOther, List Use
?. WELL LOCATE
Nearest Town:
V 44-.
(5.-- \a-,::e. i\v:r`:rs Ccrt nun :. S,:.'.i:ii:o::, Lot Na.. Zip Cod:)
3. OWNER:
Addr:ss
(S:r:: or a:: No )
o : or I own S:.s r ' Z, cod.
fgl— 9cioo
:.::• Fco.:: ro.::Ser
4. DATE DRILLED go
6. 5. TOTAL DEPTH: a Ra
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO
7. STATIC WATER LEVEL B:;o: Top cfCasir,c: FT.
('_se 'i.`A..o':-: To; of Casing`
S. TO? OF CAS!NG IS I FT. Abo•e Lan.'. Surra:a'
• arcnin.g t hlu•, i :, 1 s'--race r:Gctrn
S. YIELDs ('; .-; M_TF:'OD 0.TEST
IC. F..ATER ZONES Idr,:=.1. (83 4.255
1330
300893
Topographictand setline
❑Ridge Zlope ❑\'alley ❑Flat
(check appropriate box)
Latitude'longimd: of well location
(d?reciltino:ei ia:or.d4.
Latitud.'longitude soure:❑GPS❑Tipographic nap
(:)::d box)
DEPTH DRILLING LOG
From To Formation Description
! I. D:S:\FELT;ON.. Tyra T ("'f-.n.,:c: I 7r3.3"n
. c-L e:.. :T: �.., -.'
F:-1ro:-. n Tc la-5- Ft /y. ) Y et"( ,yt z t
F ron..:
To F:
Tc Ft
F:. 0 T: 3
3 To Zvi
14 SCF.=EN.
Tc
Fr r. To
5. SA\D GRAVEL PACK
Ft ae-r-Nent
Ft don.L 7n ZZt-- d..•rt zt.7, 4 %
Ft.
Ft
S.z: Uz:eria'.
Frcc To Ft
Fr.7 Tc Ft.
16 REA: -ARKS:
d — tab
u-IxS
jliS-I X7
r- r
ass -a.> 7
as-7- 330
t 32. - 32 Gu��
1'3Z390
0
-f
0 0
LOCATI)\ SKETCH -..7.0m
orection an5'd!.._r.e h miks
t.wo F.c: sc 7 Cc...nti.
m
0
m�
Az
\D
A.J' frt.
I DO H=FEB'' CERTIFY THAT TF:!E \'..
CONS'? - tION_TAND.
LWAS CONSTP.JCTED NA7C0?-DANCE WITH ISANCAC2C,WELL
AT A C0.' f OF THIS R.ECORD HAS BEEN PFF.O'VIDED T / C1\
9
SIGN.ATL-PE OF FERSJN CONST R' CTi\G TEE P. ELL
DATE
�..b.... t!rz original to the D:'ision or V. a:er Quality, Gro::nd,•ater Se;r:or. 1536 \IJ!! S; : Ccr,tar - RYeigh, NC
G I REV. CT 200

.. .J ..•..
eat ute
I". \'.'ATER
ZONES ld:? that
WELL CONTRACT OF(INDIVIDUAL)N.AME ((pprint)1 /1/7/ 1 inn ThA
\\'ELL COSTA::CrOR >I COPANY NAME A4A I //ppT/Qeh. e C3.45 w ece Dr Ai
STATE \\ELL CONSTRUCTION PERMIT; ASSOCIATED \\'Q PERMIT;
(if aoolicablc)
(if applicable)
• J 0 / J JoC7tor -
11.5- 9 V / In/
CERTIFICATION gas 5
17
PHONE # .770_
1. WELL USE (Check Applicable Box): Residential Municipal/Public 0 Industrial ❑ Agricultural 0
300892.
Nlanitorini.❑ Recovery ❑ Heat Pump Water Injection ❑ Omar 0 If Other, List Use
2. WELL LOCATIQI\
Maros: To .c
•
County. j4.a-�-1.-/
(5:;;Loc N)_ Zip Cote)
3. OWNER:
Address
.2-(1 G /
'n
G:. o-T»•5:nt. t Zip Co.!Codc
( ai gr-
I - ou
Topo2raphio'Land setting
, ❑Rid_: Slope ❑Palley ❑Flat
(check appropriate box)
Latitude'longitnde of well location
(d:g:ee;'cinu:e;iecordi}
Latitud:'longitudesocre:❑GPSO po raphicma?
(ci:: box
DEPTH DRILLING LOG
From Te Formation Description
(__.
P.:o,:::- �! f�— Hag
DATE DRILLED `-ta - 7— 0 13a— - 490
5. TOTAL DEPTH: (-iss R90 _ 92
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO.S 7i%Z �
7. ST.ATIC\�.ATERLEVEL B:Io.=Top orCasin::: O FT.'i (! '•" i' .5O. Top c.rCcsin_
S TO? OF CASING IS FT. Abo.e Land Surfa;e•
•l ,Sid cn,du:.d a:. ur b r:v,, Lind sue L:, rcGcro
'J':a' ir. a::,v.0 n:•h I5\NCAC2C.0; IS. y�
9 Y'I_LD :1 METHOD OF TEST r7" I r
U
1 : D:S!N _CTI.)N: T 7C f"t' T 1-4
12 CAS:NC.
O4XG�\ _ Thick
D:;,`. D.'-_. :-. c- \`...i ;•.:.F;. N',:o-:..'
Fr::: b T: I Ft. LPVy..J�'Sc3&d 3 r-c2
Fa..1 T; F:
Fr r: Tc Ft
Ctr.7tL7 0.-:` NI : V_:ac
F::ri 0 T: Et 2 jl _
Fro::: a.- T:2-� Ft � 43
1= SCREEN' Do_'r. D.'::e.e- So: S:zc ?!a:=:a..
Fr;:-. To Fr H. in.
Frs. T: Ft.
15. SAND GRAVEL PACK
Depth
NI_:::ii
Frc': To Ft.
Fr. Te Ft
16 REV.\RKS
r:::-:: ors ar' Cer:.-.0r.
c
f
LOCATI9N'ktTCFi /0 o
Shox sir:: a^ a. c it r. f .;: eostC'„
Reo as c Cc .. FO2 2. I. ,:_': tgro: Sr"
-ea
m
-o z%
,o
� •rE1( r c+`�
nor
I DO HE=.E3': CFr T:FY TinAT THIS \:E L .AS CONSTP.::CTED IN?.CCO7_D.=.NCE 1':ITr' I:A NCAC 2C. \VEELL
CONSTIi \'lA DT.. ACOTr'O: THIS R=.ORD F.AS BEEN PROVIDED TO TF-VELr ':NEP..
11
S:GNAT ARE OF PERSON CONSTRCCTING THE WELL
Submit the cri4;in it to the Division of \\ a:er Quality, Grotirtdvater Seot;or.. 1636 > loi! So.,.
Fn,n:Na.H'1,9) 733_3221, vithi^. 3D darts.
DATE
GVl', PEA C7'200-

,._. C I)_. .I:`.Ci o, h.ri. o: ,,J kanac. Rc>o.' •)i: i:io r, c
\1ELL CO.NTR.ACTOR(INDl1'IDUAL)N,AsIE (print) Al Artn% (Y n1-h T1
\1£LL CONTRACTOR CO>IPANY NAME •Apt
v v 0 r
CERTIFICATION: vt-) 7
PHONE x J5'gsn -Ss'r 0
STATE V. ELL CONSTRUCTION PERMIT, ASSOCIATED %1Q PERMIT
(if applicable)
(irapplicable)
r2Pal 0rrz . (.flee( J7/4(?
1. WELL USE (Check Applicable Box): Residential Oiti Municipal/Public 0 Industrial 0 Agricultural ❑
Dlonitoring0 Recovery 0 Heat Pump Water fnj:tion❑ Other If Other, List Use
2. WELL LOCATIO.
Nearest Town:
County.
Lcc No.. Zip Cod:)
. OWNER L
Add::is
cr
Y coirRC2°L
1 r. Zip CeJ-
(qt) 3 3 R- o U- o
Area Z.::- P:.o::e rot`.her
DATE DRILLED (71— 30' 04/
5. TOTAL DEPTH: cl0 O
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO )0
7. ST?.TF. WATER LEVEL b'd .- Top of Casin : RO FT.
S TO? OF CAS!NG IS I FT. AS"".: Lrd S trrn:e-
•l r:r....ru:., ar:u- b.;.,,, 4',d V surf : r:{clrc, J }. I5.\\cAC 2C.on S.
9. YIELD (N:ETHOJ OF TEST
\'.-,:.TERZONES (d:;::,). fire)
A
I:. D:SNFECTION.Typc N %'TF . 3,._' pZ
F r_c O Tc /OG Ft
Ffl7.1T: R
Te
F 0 T. 3 F, ic11\ 7.
Fr. 1
3 Tc.� Q Ft br i'r" tQ
I-. SCREEN: D::: Dame::7. S.a; 5z:
Frx To F:
Fr;r. To Ft. ir. in '
15. SAND G._a\-EL PACK:
Fr:r: To Ft
To Fr.
I.6 F.E\! ARKS
300891
Topographictand setting
❑Ridge pSlope ❑Valley ❑Fla'
(check appropriate boa)
La;itude'4aneitudr of well location
Latitudc'longitude sxre:0GPSDypagraphic nap
(a : box
DEPTH QRILLING LOG
From To Formation Description
/ao-/a-7-
/a2—/tor
/(OS — /e,
/L7— dc)
6(0
O o
T c;�
ED ATI>N SKETCH
�ir.� c•.c.'ar a-' c - 'e it e n
Roaa: 07 Roads
r.::::hers ar' C :..—,... ran,es -O Am^
Np
LiL.0
I D0 HES.E.31 CERTIFS THATTH!SY.:ELL v:.5
CONSTIL_CThON
N'STRL'CTED IN TCO?DANCE V.ITT. ISA YCAC 2C. WELL
t' OF T:::S F°.O:J F..aS SEEN PROVIDED T= THE
ATL'RE OF PERSON CO':STF,LC T ING THE e. ELL
Sabo,.: t':e eri�inu! to the Di' ision cr \\ a,•er Quality, Ground
2-69)-!5=' Pilo:::: M. (')19) is _-5-'-'!. ''.Ithin: 0 dui s.
DATE
ter S:,tion. 1536 Mail S:ni.: Center-Ra'elgh, NC
G'.-! REV. C'72ODi

WELL CONTRA -TOR (INDIVIDUAL) NANIE (print)/IIMA'r-.- t (S CERTIFICATION: sk-)
WELL CONTRACTOR CO.IPANI• NAME MR:1 �} Ji.41 �wQ d ha... y, PHONE C (P,�-5'�'�,
STATE WELL CONSTRUCTION PER>IITt a - ASSOCG\TED R'Q PER?l[T
(i(aoolicabte)
(i(a t'cable)
WELL USE (Check Appticabk Box): Residential 0 A luni:ipaVPublic 0 Industrial 0 Agricultural D
Monitoring 0 Recovery 0 Heat Pump Water Injection ❑ Other 0 I(Other, List Use
WELL LOCATIO.
Nearest Town:
Count' JC(I Ply ",
(S:r::: U:r:. \_:-yeas. Ccrimunit . Subdivisluf.. Lo; No.. Zip Cod:)
3. OWNER: � Oiled �
Adds o Mani 41 73
or Rout: No )
Cry rl'u•vn :.xit: Z'p Co.!:
(22=2- Ir31 'as
A•:
4. DATE DRILLED i.'/7-04
5. TOTAL DEPTH: ' OO
6 DOES WELL REPLACE EXISTING WELL? YES 0 NO Oir
7. STATIC \VATER LEVEL Reio:. Top orCasin_: a SD FT.
(ls: i5A':,5.-1 757 of Casin_1
S TO? OE C?S!NG IS ) FT. Abc.e Land Sur.`i_e
•I„ .ink tzr:t h:1%d u)curb :.1 1::•,d rirt.i rcqu;re,
s:-i-4- c is ucc,rd:e:c v i:h 15 \ N CAC _SC .0113.
S YIELD(:- / 'M:ETH000FTEST
11. \ .'ATES ZONES l-'':pr.r .3-2S
1!. D.51\rtcTloN:T,: ff Tll
12 C=S:NG:
D_-c:e:
Fro:- 0 To ‘90 Ft C.47y-
Ft
0 T. 3
Fr:r 3 T: 2 0
I_. SCREEN: Doc::-. DIE.
Fra:, Tc Ft
Fc.0 To
I:. SAND GRAVEL PACE;:
S.ze
Fra .1 To F
F;. Tc Ft
IE. EE\'.ARKS:
Ft
Ft
Topozraphic/Land setting
❑Ridge AjIope ❑Falk)' ❑Flat
(check :pprapriate box)
La:itud 'lonsitud: or well location
Latitude:longitude soarce:OGPSDTipographic nap
•(: : boxy
DEPTH DRILLING LOG
From To Formation Description.
n— 1/5-
/ I s-3t5'
gas -327
.3..2 - Xvd
4
f a�
LOCATION SSETCH
dL OZ Sow dir,.l�on,.r.d'dis._c_e i:. nil:s (r:;ib: lea..
V. i' Tic... r,es t:'.0 5::.: F.C2'_s Cr Co:'.n:. F�„->. Ir.: R.- : tn_ ro .
� L.
e::..._::s :cam co.:'.. -,Lint Tara c::,es O P
/tSW4it S Q� G
tV
f
I DO HEPEE CERTIFY THAT THIS \': EL
CONSTR-;CTION STA.'4i DS. .. DTI
AS '." RL'CTEDINACCORDANCEWITH I5ANCAC'_C,WELL
r THIS RECORD HAS BEEN PROVIDED TOTF VWELL Q• ONES
SIGN -.T.RE 0
EL SON CONSTR':CTINS THE WELL
DATE
Sub.^.,.: t::e cri;inil to the Di. is!on of \Vat:r Quality. Ground,'. Litter 5e'crbor..:636 3Ia!! S^u:e Center -Raleigh, NC
2769').�1c.6 Pion: No. (919) 733-322t, x.ichin 30 da\s. CV: -I REV. 07 2,12,
OJ0

7sv 711th/
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CO\TR.A&IOR(INDIVI DUAL)NA\IE (print) /.T ji �i1 �td YY'V �(} CERTIFICATION: C/:6
\WELLCO\TR:\CTORCO\IPA\v NAME %t tjV!-N .L )tf-I ketfi) PHONE # (12Tr'3C6.6S3[D
STATE WELL CONSTRCCTION PERMIT, (� ASSOCIATED u Q PERMM
(If aopticable) (if aool icable)
I. WELL USE (Check Applicable Box): Residential tt b(unicipa'Public ❑ Industrial 0 Agricultural 0
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ O:her ❑ It -Other, List Use
2. \\'ELL LOCATION:
Nearest Town:
V
Jere: N
County.
r1( £A77
�meSri. CO :nunir(-uhdieisi�: Lot No.. Zip Code)
3. OWNER: /Th4$%7n_
Add::ss Q4 (i LC) Ai—egt AO4.
i (Sir::: or Rout: No.)
lc� �7C &/779
Crpi6r To•)r. S:.rt: Zip Cade
()- Sb?v - (VE 71
Are_
4. DATE DRILLED 5-a7s2 —0 `i
5. TOTAL DEPTH 41.30
6 DOES WELL REPLACE EXISTING WELL? YES ❑ NO ix-
7. STATIC WATER LEVEL Belo. Top of Casing: 8'O FT.
(-
R. -..
-' II A'o J'•': TCp OrI_ailny`I
S TO? OF CASING IS ) FT. Abo%e Land Surface'
'lop of ca,L r:r-:;ru;ed aver land surL;e require)
)a: ionic ir, c uri.i ,c/oi:h 15.\\CAC2C.0113.
9. YIELD (_rn;: ' 'Y' METHOD OF TEST
IC. A'. ATtR ZONES (A: p., 11_ 4L'ad
D:S:N: rCTION: Tvnc l-{ % hi ?.-roam )9, /3 L7Z
i'_. CASING: \'._.I Thickness
De:;:-. D,a¢c::r cr \Vel -,CR. Ua:r..:!
From 0 To Ile Ft.
From To Ft
Fro::: Tc Ft
13_ CRT)._ i
Fra:,, [l To 3 Ft
To 2O Ft
14 SCREEN: Dcc:F. Dlai.:e:er S:ot S:zd
Frc:r. Tc Ft. in. i::
From Tc Ft. in.
L. SAND GRAVEL PACK:
Size N1_:eria'
Frc.r. To F:.
From Tc Ft.
Fro,.. 3
' Jam"'
4
30088s
Topographic'Land setting.
❑Ridge ❑Slope ❑\'alley {!("Flat
(check appropriate box)
Latitude tlongitud_ of well location
(deg:;ei.'minu:es`scor.ds)
Latitude/longitude source:❑GPS❑Topographic map
(ci:eck box)" _
DEPTH DRILLING LOG
From To Formation Description
D - 7i
7r — Cu.)
9os'-ycz
<1d.2-`13o
G">
c
LOCATION SKETCH
Shoo. direction and'dis:an:e is cil_s from a: leas: re
t-Ae S'.t:e Roads or Co.:n:: Roads. Inclu'e the roe d`D
c::...bers and corn rc n roe.= names.
Cpc
0
I6. REMARKS:
I DO HEREBY CERT;FF THAT THIS WELL WAS CONSTRJCTED IN?.CCOPDANCE WITH I5A NCAC 2C. WELL
CONSTR CTION STANDARDS. AND THAT .A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OvNER
, p..1 C <6` i5J`4S.h
SICNATLRE OF PERSON THE WELL DATE
Submit the original to the Di' ision of N ater Ground»ater Section, 1636 ylail S.n
2769)-153) Phone No. [phone]. s'ithin 30 day s.
Center - Ra!eigh, NC
G\'.--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/E(print) T(�iCI.L7t Ve 'hIs CERTIFICATION # 315it
WELL CONTRACTOR COMPANY NAME Are $.10 . CC! f _WW1 �F LLat ».e PHONE # (g t e{ Q - 3) 70
STATE WELL CONSTRUCTION PERMIT# 1 4 D.R ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
300517
1 WET I TiSF (Check Applicable Box). ResidentialYi MunicipalfPublic ❑ industrial ❑ Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection ❑ Other 0 If Other, List Use
2. WELL LOCATION:
Nearest Town: IS Lpro CountycTn c tstrYI
C-rrr n vssi C' v- tk 'QA *
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER:
Address
4
(Street or Route No.)
•ZILI Iva nlC
City or Town ' State
,ree k 1Pyb .
Zip Code
( )-
Area code- Phone number
4. DATE DRILLED '1- 21 - O4-
5. TOTAL DEPTH: .QO S I
6. DOES WELL REPLACE EXISTING WELL? YES [' NO 15t
7. STATIC WATER LEVEL Below Top of Casing: 4-0 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS / FT. Above Land Surface`
*Top of casing terminated actor below land surface requires a
variance in accordance with 15A NCAC 2C .0118.
9. YIELD (gpm): SD METHOD OF TEST of Arc
10. WATER ZONES (depth): l3 S' —
11. DISINFECTION: Type
12. CASING:
Depth
From % To 50
From To
From To
13. GROUT: Depth
From_ To ,i t
From To
14. SCREEN: Depth
From To
From To
15. SAND/GRAVEL PACK:
Depth
From To
From To
/-/ 77-1 Amount
Wall Thickness
Diameter or Weight/Ft. Material
Ft. to 'I PVC,.
Ft.
Ft.
Material Method
Ft. P¢th✓I�t
Ft.
Diameter Slot Size Material
Ft. in. in.
Ft. in. in.
Size Material
Ft.
Ft.
Topographic/Land setting
['Ridge ❑Slope ['Valley $Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:IJGPS['Topographic map
(check box)
DEPTH DRILLING LOG
From To Fo t n Description
L> St' • f
sue' aas' Asc.•LI
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the roe
numbers and common road names.
16. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH ISA NCAC 2C, WELL
CONSTRUCTION STAND DS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER -.
7-31-611
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

300516
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section WELL CONTRACTOR (INDIVIDUAL) NAME (print) CERTIFICATION#.,I.3JS `t n _
WELL CONTRACTOR COMPANY NAME
STATE WELL CONSTRUCTION PERMIT# / 9 .Z ASSOCIATED WQ PERMIT#
(if applicable)
(if applicable)
.PHONE # (gulg(n Vt-3/9b
1. WELL USE (Check Applicable Box): Residential(' Municipal/Public O Industrial O Agricultural O
Monitoring O Recovery O Heat Pump Water Injection ❑ Other O If Other, List Use
2. WELL LOCATION'
Nearest Town:
..1.J
CountyUn r Gc
(Street Name. Numbcks, Community. Subdivision. Lot No., Zip Code)
3. OWNER:
Address
(Street or Route Nd.1
at -Lana KC- . 1'/ O
City or Town State Zip Code
( )-
Area code- Phone number
4. DATE DRILLED '7 - $ - Q 4-
5. TOTAL DEPTH: S '
6. DOES WELL REPLACE EXISTING WELL? YES O NO 71
7. STATIC WATER LEVEL Below Top of Casing: V b FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS j 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): 313 METHOD OF TEST c jn rS
10.WATER ZONES (depth): 2ij5I - ZLE'
11. DISINFECTION: Type 1-4T N Amount 41 4614
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
From [; To 7'7 Ft. L0 1' PVL
From To Ft.
From To Ft.
13. GROUT: Depth Material Method
From L) To QCN Ft_C_.nn__ -},�
From To Ft. _ i
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 IXSlope OValley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:OGPSOTopographic map
(check box)
DEPTH DRILLING LOG
From To FormaCon Description
JO q r1 1 sAi
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the roy-d
numbers and common road names.CD o
C
N
O
a
1 DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDS, AND THAT A COPY OF THIS RECO�p 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 3 0 0 1 3 8
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (prin0 Mitchell D. Cook
WELL CONTRACTOR COMPANY NAME Fhd331 artirns W1.1 Drilling, l itnr Inc
CERTIFICATION # 2043
PHONE # (S28) 169-9591
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential Municipal/Public ❑ Industrial ❑ Agricultural ❑
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use
2. WELL LOCATI
Ne est Town: County40420)
�/L In.iJtiA Rrir ivN _
(Street Name, Numbers, Community,ubdivision, Lot No.. Zip Code)
3. OWNER:
Addre
(Stre or lCou`gNo.) wee
City or Ty n State Zip Code
(eat' 62 —94"
Area code- Phone number
4. DATE DRILLED '�� 1f
5. TOTAL DEPTH:
6. DOES WELL REPLACE EXISTING WELL? YES NO
7. STATIC WATER LEVEL Below Top of Casing: FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS 2 FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance In accordant with I5A NCAC 2C .0118.
9. YIELD (gpm): COO MET.i2D 0)j TEST hl cnr
10. WATER ZONES (depth): ,� 03
11. DISINFECTION: Type H T H
12. CASING:
Dept Di�rnger
From To Ft.
From O' To Ft.
From To Ft.
13. GROUT: Depth Material
From_ To 20 Ft.hs>inite &tilt
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.
Amount 16 07
Wall Thickness
or Weight/Ft.
Method
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 a clay & sand
t203f 7 bf granite
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the roams
numbers and common road names. C p
a m
Cn
r='
p
3 me
N mp
• n
sD 2
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
d� Cud 7- -off
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
300137
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) Mitchell D. Cook CERTIFICATION # 2Q43
WELL CONTRACTOR COMPANY NAME }kiln lrOJllas I+k@U Drillir)q, Trip PHONE # JA2R1 1A9-9591
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential$ Municipal/Public ❑ industrial ❑ Agricultural ❑
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use
2. WELL LOCATION:
Nearest Town: Count
(Street mne, NumberssCommuni , Subdivision, Lot No., .p Code)
3. OWNER
Addr• s • •" Alit.
• (Sir t or
RRR
(am- ty or Tow 5 hip Code
ay�•5a�`�r
No.)
CQ%71
Area code- Phone number h
4. DATE DRILLED % �J '0T
5. TOTAL DEPTH: 450
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO X
7. STATIC WATER LEVEL Below Top of Casing: 00 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 h I5A NCAC 2C .0118.
9. YIELD (gpm): / MEJ Qi9 OF TEST hl rx r
10. WATER ZONES (depth): / �JQ
t 1. DISINFECTION: Type H T H Amount 16 nz
12. CASING:
From ToQ Ft
From a To ••[[ff Ft.sat_
From To Ft.
13. GROUT: Depth Material
From_ To 20 Ft Entriitr & r tt
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.
Wall Thickness
or Weight/Ft.
Method
Fa 9-P i
16. REMARKS:
Topographic/Land setting
Midge ❑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 �i clay & sand
as r 2 r gran to
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
Ai.,.7./S.Po 20. 2 — 02, 3
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-1 REV 07/2?0I

WELL CONSTRUCTION RECORD 3 0 013 6
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 H3:3T $LtherS ?.l IIt^t11i 9r Tr C PHONE # J828) ' i9-9S91
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable)
(if applicable)
1. WELL USE (Check Applicable Box): Residential$ Municipal/Public ❑ Industrial ❑ Agricultural 0
Monitoring 0 Recovery ❑ Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATIQN•Pion.)
Nea est Tow • County
( tree[ me, Nu}pbar Community, Subdivision, Lot No., Zip Code)
3. OWNER:
Address
• Street or Route No.)
AC
(City
j3=S56e
Area code- Phone number ' /
4. DATE DRILLED %a? of
5. TOTAL DEPTH: CO t
11. DISINFECTION: Type
12. CASING:
Depth
From__Q_ To
From= To Ft. ate
From To
13. GROUT: Depth Material
From_ To 20 Ft.),artinito & rmra
From To Ft.
•
J8rst
Zip Code
Topographic/Land setting
❑Ridge OSlope ❑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 Ty . Formation Description
0 clay & sand
79
r / granite
6. DOES WELL REPLACE EXISTING WELL? YESX 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 accordanc with 15A NCAC 2C .0118.
9. YIELD (gpm): METHOD OF TEST h1 nw
10. WATER ZONES ( epth):
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.
H T H Amount 16 oz
Wall Thickness
Diameter or Weight/Ft. Material
Ft.
Method
pTrtna
14. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in.
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth
From To
From To
Ft.
Ft.
Size Material
16. REMARKS:
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
///.L i de 20- , '# 7 - Q 02: ,,d Li
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center Raleigh, N
27699-1636 Phone No. [phone], within 30 days. GW.I REV '07/ 001 3

WELL CONSTRUCTION RECORD ' W (JT aro-13y
North Carolina - Department of Environment and Natural / Resources - Division of Water Quality - Groundwater Section
\CELL CONTRACTOR (INDIVIDUAL) NANIE (print) . Kv/ rl aJii/-f / CERTIFICATION* Pi-97
WELL CONTRACTOR COIPANV NAME PHONE # (Ian&--Sf)
STATE \CELL CONSTRUCTION PERMIT* ASSOCIATED \VQ PERNIIT
(ifapplicable) (if aoolicable)
WELL USE (Check Applicable Box): Residential ti, Dtunicipal'Public ❑ Industrial ❑ Agricultural ❑
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use
2. WELL LOCATION:
Nearest Town: fr I u A- Counts T s0+--
�nl�t'r 'co .Sr ( Pei // NC as-71
(S:re:: Nax:e. NutrSers. Corr:munI:. Subbicislon•1.ot No.. Zip Code)
3. 4e17477-
Addr s:Larry
3�(iti
or Roue No.)
S it/ N c a 779
Cc. -1-� ^ 'Seam ZipCode
(7a8) gq9-Og90
4 D.-ATE DRILLED 7-a9 -O(1
5. TOTAL DEPTH: 300
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO yr
7. STATIC WATER LEVEL Bela:: Top o`Casing. FT.
(Cs•..r.. i.`?.'to.e Top or Caiinp
S. TO? OE CASING IS ( FT. Above Land Surface'
'1 ui .'twin;; I;rnt ,j cd a:'ur b u.. lend serL:e requ:rr, u
‘-` ^:r inac:ordja:e ni:h I$\NC.\C 2C.01 IS.
9. YIELD !pm): ' 3tj METHOD OF TEST Alt-
! 0. WATER ZONES
LOCATION S:<ETCti
S;.o.w d::e:tion a:d'dis:-: :e in nil_, fro:-1 a: Ica z
cwo S:a:e Roa's or Co::n>• Reads. Include ro,:i2
c,.... ea and corner. r:' caaes.
Topographic/Land setting
%Ridge ❑Slope ❑Valley ❑Flat
(:heck appropriate box)
Latitudc'Iongitude of well location
Latitud:'lon_itude source:❑GPS❑TopoUraphic nap
(:I:_ box)
DRILLING LOG
Formation Des:ription
DEPTH
From To
!!. D:S!!<FECTION.T•vne T►-( Amouri /3..< 02
12 CASP' C: V _'I TO::;kaess
Do.* D: .e:er c- V.-els1T:. N la•'-'''
Fro:, D To 77 F:. 6V9 .5prz24 Peter
From To Ft — a--
S
From: To Ft CA 7,:c
I3. G^.7_T. D_;:h N::::cr:i MerIo.d. 9 Vic:
Fro:7 O To 3 Ft CPJ3-7144f' = UY
Fro:. 1. 3 To ZO Ft hD.,.tDhui-c.,
14. SCF.EEN: Dr;:`• D::::,_.e- S'!o:Slzr (p
Frog. To Ft. in. in. GO i
0 6 7 n
From. To Ft.
1 . SAND GRAVEL PACK:
D;r.:b. Size
From T' Ft.
Fror: To Ft.
16. R.EN!ARKS'
I DO HERESY C
CONSTii _ STAND DS
TFY THAT THIS V.ELL WAS C
RU:CTED IN ACCORDANCE WITH I SA NCAC 7C, WELL
T A w' OF THS RECORD FAS BEEN PROVIDED TO
SIGNATCRE OF PERSON CONSTRUCTING THE V. ELL
Submit the original to the Division of )\ ate!. Quality, Groundoater Section. 1536 Mart S.roi
2769)-1636 Phone No. [phone]. ithin 30 da} s.
E WELL 0'.VNEP
Center- Raleigh, NC
GV.1REV. G.' 2.0,fri,,
/ ih ':

\YELL CONSTRUCTION RECORD . µg 33/ W
North Carolina - Department of Environment and Natural -Resources -,/Division of Water Quality - Groundwater Section
\\ELLCONTRACTOR(I.NDIVIDUAL)NA)IE,r\(.p,rintt))� Matt l_9.i tt CERTIFICATION II Q
WELL CONTRACTOR CO\1PA\\' NAME ?AA 1TI'P�„ C 131^B'� W ea PHONE k ��ID -'^"-
STATE \\ELL CONSTRUCTION PER>IIT% ASSOCIATED WO PERVIT*
(ifaoolicable) (ifaoolicable)
1. WELL USE (Check Applicable Box): Residential MunicipaPPublic 0 Industrial ❑ Agricultural ❑
Monitoring 0 Recovery ❑ Heat Pump Water Injection 0 Other ❑ 1(Other, List Use
2. WELL LOG.ATION:
N:a:;s_ To‘\n: �(
IJ�G+Zr//�..,,
County
`.2S7�y
(S:r:: Name. Nunnberi. Corununit:.kubd isf7l:, Lot No.. Zip Code)
3, OWNER:
Address
::ec: or Roure No.)
Coo or Torn S.at:
L )- aai- 6,90O
A'e� Pconc n:nae:
DATE DRILLED 7-IS-01�
S. TOTAL DEPTH: ..00
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO 1$
7. STATIC WATER. LEVEL Belo,: Top of Casino: 30 FT
(Cs: `T" if A3o'c Top or Casir._1
S. TO? OF CASING IS 1 FT.-Aboxe Land Sur face-
•l .caking ter tinered :o'er beta., land sur(aze require. a
ei.-. ae;urJJ^:e nirh 15 \ \CAC 2C .0119. nn
9. YIELD (.-c::I: a METHOD OF TEST (}Ir
i
IC- WATER ZONES (dcp'''): ��) - l� Pep
k7C a8 7as
Zip Coo
Il `O
I1. D:SIN. LCTIO\: Tyne 1--HTAmu 9 0 2
1' CAS:NG: WaIl Thickness
Ma
54 Out
Fro.., (°)
Fr
13 ORD.T
Fro,.. 3
D,ar,.e:er
To tic F;. io I/y
To Ft
Te Ft
To
To
14. SCP.EE\:
Fran. To Ft.
FrorA To Ft.
15. SAND GRAVEL PACK:
D:r:h S:ze
From To Ft.
MeOndd
Ft
Ft,Izlryr
D.:, .T_Nto r.z 4724-r,
in in.
in. in.
Fro-'. To Ft.
16 RE\' ARKS.
I DO Fi :._B}.
CO\STI :C%i
) l arena.
300671
Topographic/Land setting
❑Ridge ( SIope ❑Valley ❑Fla:
check appropriate box)
Latitude'longitude of well location
(dcoreeiininu:ea.'iecocds)
Latitud_'longitude source:❑GPS❑TOpographic map
(ohc;k box)
DEPTH DRILLING LOG
From To Formation Description
D-go
(oS-(o7
6,---`/r
TS -In
rj7-0.5-
//S- // 7
//7—ZOO
LOCATION SKETCH
Show direction ond'd;s:once irk miles from a: lead
i.,o S:::e Roads 0: Co.:ntc Ro s. Include• roa2
mnr-,be:s and con.mor. rose names. 9 yr.
CO yG
1-nm
N7.‘
=S THAT THIS
DS.A
.AS CON jCTED IN ACCORDANCE WITH IRA NCAC-C, RELL -.--G/
-Tr..5RC0�HAS BEEN PD'IDEDTrTFE WELL\'�1R / =
r9
SIGNATURE OF PERSON CONSTR':CTING THE WELL
Submi: the original to the Division of \Cater Quality, Ground., ate; Section, 1636 Mall Scr is
27699.1636 Phnr.: No. [phone], within 30 days.
Center - Raleigh, NC
Gvy•I REV. 07'001

WELL CONSTRUCTION RECORD 7/ V/-%-73-0Z
North Carolina - Department of Environment and Natural Resources - Division of Water Quali
WELL CONTRACTOR (INDIVIDUAL) NAME ((print)
WELL CONTR\CtOR .SI COPANV NAME AAA %'L.t t ett DILy
STATE \\ ELL CONSTRUCTION PERMIT; ASSOCIATE \VQ PERMIT:
(if applicable) - (ifapplicaable)
I. WELL USE (Check Applicable Box): Residential % Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery ❑ Heat Pump Water Injection 0 Other 0 If Other, List Use
ty - Groundwater Section�p/
CERTIFICATION# (.7 /!(b
PHONE # (( jaid-2SS0
0,:. or Turn Start
(VS 368
A'e Paaee:timber
DATE DRILLED Oi'9 -DV
TOTAL DEPTH: 00
6 DOES WELL REPLACE EXISTING WELL? YES 0 NO,
7. STATIC WATER LEVEL Belo.: Top of Casino: (200 FT.
(L'seif Abo.c Top orCasio_)
8 TO' OE CASING G 1 FT. Above Land Sur.`ace
-1 • , or. -fling t<rr..:nutcd surfic requires a
w -isr:e i- ueord:nce,'i:h 15 \ :‘CAC 2C.0113. A
9. `.MELD (pr.;: ' ) METHOD OF TEST F'Y)4r
lln. V.'.'.TER ZONES (dap!-:) 26,0
2 WELL LOCATION: _
Maros: Town: S' jV R County _SS (1ri
AtiPt pr s(j,) 4 Are aS779
is— •• Name. Nu.nbers. Centmunt. StibdFisL, Lot No.. Zip Code)
OWNER: Graf Wh(i%-
A drJss [(plc PrtIAS ¶)r
or Rout: No.
1.0 R N C aggy
Z'p Co..
I:. D:S!NFECTION:Tyne H-174 Anlaani 3(2) DZ
I'-. CA5:NCe \'.'a': Th`ckness
Fr::.-. 0 To 53 Ft. L'At Jrpc24 60W,
Fro:.. To
Rer To
I C•:: _ _ 1
0 T: 7741 F;
Fic‘ttt a To a 0 F:
I,. SC.EEN Deeth D:z :e:rr SR): y:z:
Fra:r. Tc Ft in
Front To Ft. in. in.
1 . SAND GRAVEL PACK.
D:pth S.z- Mater,a'
Ft
Ft
Fro:: To Ft.
Fro-: To Ft.
l6 RE\t \P.bS
Topographic/Land setting
❑Ridge aSlope ❑Walley ❑Flat
(check appmpriete box)
Latitude'longitude of well location
1
(degrees'rninuteCsecor.ds):
Latitude/longitude source:❑GPS❑T,,opo$raphic map
(:heck box)
DEPTH DRILLING LOG
From To 'Formation Description
LOCATION SKETCH
SHo _nd'db._..ee ni;_s fr.:.,
Roads Or COun Roads. Include
and common roar'. na-zs.
06"'0
_: le._t
the road
0
t
V' 'Lit'
CO
ro
-
Z c_gym
)
O o
W
I DO HEF:EEY CEP.TiFF THAT TH'S WELL WAS CONSTRUCTED IN ACCO'.DANCE \WITH. I5A NCAC 2C, WELL
CONSTA_CTiON STANDARDS. AND THAT A COPY OF THIS RECORD HAS SEEN PROVIDED TO THE WELL O's.NER
In C
S1C\A.TLRE OF PESSON COt<STR'�CTINC THE WELL
ep' \� 0 �{
DATE
SuSn:i: t':e original to the Di' ision ater Quality, Ground.rarer Section. 153631J:IScniceCenter -Raleigh,.NC
27699-1c36 Ptmne No. (919) 733-3'21. v.ithin 30 s. G\ -I REV. 07 200:..
•

WELL CONSTit VC 1 JU.\ RECORD
7 5 72-Y3-5 V7
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - //
\YELL CONTRACTOR(INDI\IDUAL)NAN(print) 7D m— EC' CERTIFICATION It {o
n'y ^
\\ELL CON'rR'\CTOR CO\IPA\Y' �'ANIE VcA� reevi e Bro - Wcei DYI(PHO\E k (eVa
STATE 1\ELL CONSTRUCTION PER>IIT4 ASSOCIATED \\'Q PERMIT
(ifaoplicable) »- M (ifaoolicable)
I. WELL USE (Check Applicable Box): Residential pitMunicipal:'Public ❑ Industrial 0 Aericultural ❑
Monitoring. 0 Recovery 0 Heat Pump Water Injection 0 Other 0 It -Other, List Use
2. WELL LOCATI N: Topoeraphic/Land setting
Nearest Toyyn: La an le h S
Coun:v 3
Lanc4 le t4 fA--Lt WrS 1UC 2Q7/7
❑Ridge LITSlope ❑\'alley ❑Flat
(check appropriz; box)
lyie Latiiude'longitud:ofwell location
U:•ro:: Sme. \m^.be; s. Cccraun¢. S�bd'. u:on, Lor NS., 2p Ca®-)
3. O\\NER IIS Se \/nx Jiro (LinLewooQ LV-R'(G/`/hS0t3 (de eiir.inu:es:s:cords)'
Address Q 6 1j61. Ig a- Latitude longitude source:❑GPS❑Topogra?hic map
(S::ec: or Route No.) (:P:e:k box)
#s1(1 e s pJ C a27( 7 DEPTH DRILLING LOG
From To Formation Description
3006C3
y,7u(G3iris, zip Code
T. DATE DRILLED (e —Z/
5. TOTAL DEPTH: 7570
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO yp
7. STATIC WATER LEVEL Beloo. Top ofCasir_: iCIO FT.
t.se -n" is A:oc Top o`Casic_1
S TO? OF CASING IS I FT. Above Land Surface*
•7 •
'..wa ing tm:n.tr:d u, r ba:uo Lind surrace rcyuirn u
a::urd,nunitht+.\.C:\C.C.OIt3. �}lr
9. YIELD 1_?—:): f METHOD OF TEST
10. \:.',TER ZONES (depth):
11. DiSINEECTION: Type 1- A:-to.r..t = r701, cl7
12 C.ASING: 1: a.. Ti:ickress
p. \..e: ...F. r,.....
Frcc 0 Tc a7 Ft. (c, /8
Fro:r: To Ft
To Ft
13. CR:)_T`
F: 2r, Q To Ft
Fror; '3 TooQU Ft
I,. SCREEN: Dep:h
Fn. To
Frr: To Ft.
15. SAND GRAVEL PACK:
Dep
Frcn To Ft
-Fro,:'. To Ft.
Et
S:ze
�4�nll�l -
LOCATION SKETCH
Sho,y dcec:ior, ar.d'dls:ance ir. miles from a: leas:
cxo S: :e Roads or Coun:•: Reads. Include the road
or.
_„„GU
So; S:ze \ lateti.:
in.
In
16 RE\!-\F.KS.
I DO FEREEY CERTIFY THAT THIS WELL w.AS CONSTRUCTED IN ACCORDANCE WITH ISA CAC 2C, WELL
CO\-T?. CTIO\ STANDARDS. AND TEAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL O\'.-NER._,_� ..
4
':NATURE OF PERSON CO\STRT4TI\G THE WELL DATE
Submit the original to the Di+ision of ater Quality, Ground++et
27699.1536 Piro•❑_ Na. (919) 7: 3-_ 221. 1+ ithin 30 days.
Section, 1536?fall Sor.i:e Censer- Reteigh,_X"
CA:-1 REV EL 2001

NVLLL CO\STRUCI7U\ RECORD
North Carolina - Department of Environment and Natural Resources/c�- Division of Water Quality - Groundwater Section
��/
\\ ELL CONTRACTOR (INDIVIDUAL) NAME (print) /a/�D rn41--4 eri CERTIFICATION.______ �5��
\\ELL COVER:\ CT 12 CO31 PANV NAME FM -A frreehr 'eV- (lie II DP1 PHONE % —6i6-
STATE \\ELL CONSTRUCTION PERMIT# ASSOCIATED \cQ PER?IfT
(ifaoplicablel (ifaaolicab!e)
3006CE
I. WELL USE (Check Applicable Box): Residential Nlunicipa!:'Public 0 Industrial ❑ Agricultural 0
Monitoring ❑ Recovery 0 Heat Pump Water Injection 0 Other ❑ 11Other, List Use
2. WELL LOCATION: ,
Nearest Town: PJNf7Ul /(G County
CA l(owhee nifty fZa a/enva! el 1 &C- P8734,
LS::ee: Na:.eNumbers. Corepnu:,ir:. Subdifision, Lot No., Zip Code)
3. OWNER: U TU QQ 1&L Sq
Address 00(0 /3/Prr o. •-
(Sase: or Route No.)
emtog RI 33 4vro
C r.. or l oon Sate Zip Code
2/3)- ,Z59— a ra
A -es ode Hoot::, reoi;e,- ' /
T. D:\TEDRILLED 3-a -o`%'
5. TOTAL DEPTH: SD
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO
7. STATIC' WATER LEVEL Below Top ofCasine: II
(L1:..r.. is Abo.c Top orCasi-. ,
S. TO? OF CASING IS I FT. Abo\e Land Surfa:e`
•-1.y o: Lasing to rzuuatad aUvr belun Lind surface requires a
”runs: ir, ac:ordan: with 15.\ NCAC 2C .011S. 9. YIELD (pm): I 30 . !ETH9D OF TEST 4: r
IC. W: ATER ZONES (depth): <2070 - c5'3
313-
fr
FT.
11. D:S!N: tCTION: Typo H 7-N `lAmount /675 /'
12. C:\S;\G:
Dena
Fro::, 0 To: /0G- Ft.
From To Ft.
Fran, To Ft
IP. GP.O'_l. Dcp:-.
From v Ta 3 Ft.
20 Ft
14 SCREEN. Drip;:-,
Frar.. Tc
From To
SAND GRAVEL PACK:
Depth
From To Ft.
Fran:. To Ft.
1ko:1 Thickness
Darer r, \`:ei_h8Ftt_ NL'a
Topographic/Land setting
❑Ridge ❑Slope ❑\'alley Flat
(check appropriate box)
Latitude Longitude ofwell location
(degreesmina: s:seconds)
Latitud_'loneitude sour-e:❑GPS❑Topo_raphic map
(chtick box)
DEPTH DRILLING LOG
From To Formation Description
D /D!
/O/-..2ao
r7.w - 222.
an-3IS
3!S' .L/ 7
3/7- BSG
0
LOCATION SKETCH O
Z S:ho.\ direction rind_'dis:ance in miles from a:cas' '. ..
t.,o State Roads or County Road. Include thg.td
0 pG
n:Lmhers and coimmon road nammes.
(0Yy SPR ZI 490G cs a
En C
3 pt
a Ml
S
� O C
DL.meier Sot Sze " NIa:err:a'l
Ft. in in.
Ft. in. ir,. •
16 RE>! ARKS.
Size Nlateria:
nFx i2s
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH ISA NCAC 2C, WELL
CONSTR-CTION STANDARDS. AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
i Cv r
SICNATLRE OE PERSON CONSTR' ZING THE WELL DATE
Submit the original to the Di‘ Bien of \\ ater Quality, Ground\inter Section, 1636 >lail Scnice Center -
Raleigh,: C'.
2769)-I63o Phone No. (919) 73i-3221, nithin 30 day s. GV.-I REV. 07:200!
7- l y- 04

RTLT. CON'STRT?CTTON RPCORT)
North Carolina - Department of Environment. and Nat(urralrResourc ss• . Division of Water Quali
MILL CONTRACTOR (INDIVIDUAL) NAME (print) T1 /' 1 C
Y
WELL CONTRACTOR CONI PANT' NAME din rLP �.• BYOS.
SATE \\ELL CONSTRUCTION PERMIT: ASSOCIATED \\'Q PERM'
(if applicable) •. (ifaaolicable)
300665
ty - Groundwater Section
CERTIFICATION # �v2/��
PHONE K /tr -655a
WELL USE (Check Applicable Box): Residential (Yr Municipal:'Pu:blic ❑ Indust:la! ❑ Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection ❑ Other 0 If Other, Lis: Use
WELL LOCAT N:
Nee a;T. %T
(S:rc: Sn:r.: Nu:,.5_ . Con::aunin.5'
3. OWNER:
of No.. Zip Code)
Ad -drays c� ,2 c,C 3 7 /
or Roue
Nac ar7% 7
�j.� o:; or To,,:. s c. Zip CoJ©
(21X)- 7a1,3—(06,79
DATE DRILLED 5- -0�%
5. TOTAL DEPTH: 4/0
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO RC
7. STATIC HATER LE\'EL Belo.: Top c`Casiau: 41-0 FT.
(Lse-_.. if ASo, Top of Casin>i
S TO? OF CASING IS / FT. Above Land Ser.ra_e
-10
,, lilt; t:r •Ha;d a:ur bclo,� Zane. surf:. rcGuire3 a
��. a::onLn:c ni:h I5:\ \ CAC :C Al l3.
9. YIELDf_?m) ' 3 METHOD OF TEST Fib"
I. WATER ZONES Id: -:'a). ? 20
Topographic/Land setting
❑Ridge ❑Slope ❑Valley glrlat
as 'Sr✓ (check appropriate box)
Latitude'longitudz of well location
II. DISIN-ECTIDN,Tvoc 14T1-�
1-. C A"
r. 0 Tc Ft. U fir
From To Ft
Fr_r.•. To F:
13
Frr0 T. 3 Ft
Fr.:r.. ToeW R
i:. SC:.EEN: Dcc:h D.a.
Fr..i To Ft
Fran. To Ft.
15 SAND GRAVEL PACK:
Dr'',, S.ze
From. To Ft.
From Tc Ft.
RE\:\RKS.
(degree>i-.lmrs.'secocds)
Latitud,'longitude source:❑GPS❑Topographic map
box)
DEPTH DRILLING LOG
Front To Formation Description
0- 19
19 -,2ao
,moo aaa-
t
O
GC O %,
LOCATION SKETCH G tcr:Is
d: 0 ~
A,. ,c-.: IS, (iS �L S:�.o.` ar.c d n d in nil:, from a: leas: I p
Thickness t. o S: R- 's or Cc . _ Fcads. Inalu_aa the real: cp 'aip
mc.bars anal. common ra:.a rates.
1 (,fkli r
o
2
T\1,•.:, W TomWrr"aJt-
)fAA111-taLl_Pla, get
"..__ (
I DO F.EF-E•: CEPTH'!
IEl THAT V.ELL V. AS CONSTRUCTED IN ?.CCOFDA\CE\''.ITH I>A\Ca.C'_C WELL .
CONST;:_CTioN STA\DARDS. AND T'r..AT A COP'i OF TH15 RECORD HAS BEEN PROVIDED TO THE WELL O \HER
O frt II Lv, 7— 11-(- c4
c!iLA.ATI:RE OF FEI SOA CONS-T-r N IAG THE A':ELL DATE
S bmi: the on r..al to the Dis ision of \\ ater Quality, Groundwater Section, 1536 Nla!I Sa'\i • Center Ra!eig`u;SC E
o r, t Gb.-1 RPT G`:"@(5:i
p,, oPi:onc So. I`)19i 73}.-„I, oithin 30 d.r. s.

3. OWNER: /7 I berr-
Address cQDO j'FOLLc/ LAVE
1 (Street or Route No:)
P0.l 0.rk a. r_ f 3.2 / 7
City or Town State Zip Code
(2i24)- g(P S' j r7o 6
Area code- Phone number
4. DATE DRILLED c / -4 7'
5. TOTAL DEPTH: '7. 3
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - DivisionofWater Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (Out) c��n l71 S f I1 CERTIFICATION 8 o1/7 `e
WELL CONTRACTOR COMPANY NAMI ErgnTC OjIn,4d Wet 11) frrj lilt Tnt PHONES . Sa4-3 ab
STATE WELL CONSTRUCTION PERMIT,/. ASSOCIATED WORERMITS
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential' unicipal/Public ❑ Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other C1 If Other, List Use
2. WELL LOCATION: //�l
Nearest Town: 5y 1 V k County eer/'t C IC S 0r—)
44IN L3RRPs Ctl?. I+tC-ItTop Ditn La
300693
Topograph d setting
❑Ridge ope ❑Valley ❑Flat
(check appropriate box)
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code) #' 4 S' Latitude/longitude of well location
(degrees&minutesheconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DRILLING LOG
Formation Description
o/a✓J
8,-Ut /e_anu f-2.
DEPTH
From To
i 5L
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO 123-
7. STATIC WATER LEVEL Below Top of Casing: /C 0 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS / FT. Above Land Surface*
*Top of casing terminated actor below land surface requires a
variance In accordance with ISA NCAC 2C .0118. /
9. YIELD (gpm): . T METHOD OF TEST_,/ 102int�/�-�
10. WATER ZONES (depth): `f 7S' (/
11. DISINFECTION: Type
12. CASING:
�t Depths
From V To
From To
From To
13, GROUT: Depth
From n _ To r"D
From To
14. SCREEN: Depth
From To
From To
15. SAND/GRAVEL PACK:
Depth
From To
From To
16. REMARKS:
LOCATION SKETCH
}{-f"F Amount ea %1), at; 5 Show direction and distance in miles from at least
Wall Thickness two State Roads or County Roads. Include the road
Dia ter or Weight/ft. Mate ' 1 numbers and common road names.
Ft.s�R,Bq Pre —
Ft.
Ft.
Material
C.P'Yr
Ft.
Diameter Slot Size Material
Ft. in in.
Ft. in. in.
Ft.
Method,
Size Material
Ft.
Ft.
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 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-1 REV. 07/2001: -.
Q

304279
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print)(p'..rt. A/AP11 CERTIFICATION #.`9/r�0
WELL CONTRACTOR COMPANY NAME 6- NAhdn1 L✓e// e4 r7 %l, rYlC/ PHONE # - 1y77-5.44-gy
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
I. WELL USE (Check Applicable Box): Residential ® 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:
Nest Town: County e k.n n
4. t r Wei.) h/ Rem
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: %/IYI �� rT
Address 4,.'.ryV,'ew
(Street or Route No.)
.Sy/vaA p/,c.
City or Town State Zip Code
(a-QS')- Soh -- )76 a
Area code- Phone number
4. DATE DRILLED /0 -//-dW
5. TOTAL DEPTH: 6/1_<
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO 13!
7. STATIC WATER LEVEL Below Top of Casing: 42 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): / METHOD OF TEST tfLit r
10. WATER ZONES (depth): 5/3
11. DISINFECTION: Type NTH
12. CASING:
Depth Diameter
From._ To /08 Ft. Y
From To Ft.
From To Ft.
13. GROUT: Depth
From 0 To ao
Amount AID
Wall Thickness
or Weight/Ft. Material
.oral PVC
Material
Ft. Cemen-j
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
Method
Pump/ne
From To Ft.
14. SCREEN: Depth Diameter Slot Size
From To Ft. in. in.
From To Ft. in. in.
Material
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
16. REMARKS:
T'
,7
LOCATION SKETCH
Show direction and distance in miles from at lea -
two State Roads or County Roads. Include the road.
nfmbers and common repad names.
rem almond Po Go l ,ss m,'/ts 7 rn
IPPT on 7/yE Go a2Sm1'l"s To
gS-E Sy/V&L Ga To STmp sin Turn R4rb
Go 1,3 r7 //es % S7ap �/, hT T/rn le#7
Go 1,pines T sro%
do lbe rV,/eto Roca Go, 0,6rvl%le
7rn lePi 6=o T �.O 04 ha/ Oen
6►'1>d
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPYt/OF THIS RECORD HAS BEEN PROVIDED TO THE WELLOWNER-;
SIGNATURE OF PERSbNCONSTRUCTING THE WELL (o `DATE 7 Cr)
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, Ne
27699-1636 Phone No. [phone], within 30 days. GW-1 REV. 07/2001

2
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - DivisionofWater Quality - Groundwater Section /-
WELL CONTRACTOR (INDIVIDUAL) NAME (print) c?)Itn h I S I'1 t II an. rb • • ••- CEItTIPICAT,ION # or-J7'f'
\YELL CONTRACTOR COMPANY NAME: 4n1 S (0"OjJ04n.4 Wei I Z) 6 11744 .JT4 (a J PHONE # l(1YJre'2 y-3 Z24 0
STATE WELL CONSTRUCTION PERMIT# ASSOCIATEDERMIT#
{if applicable)
(if applicable)
1. WELL USE (Check Applicable Box): Residential' unicipal/Public 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other GI If Other, List Use
2. WELL LOCATION: Topographic/Land setting
Nearest Town: lAJ 41: 1- i f p . County 3 4 Ll� S cm.- Topographic/Land
❑Slope ❑Valley f17F{gt�
Berl 14 R.tta a. Cl:wa mn .'t V: era R a tit, (check appropriate box)
(Street Name, Numbers, Commnity, S division, Lot No., Zip Code) Latitude/longitude of well location
3. OWNER: B. 11 `.1 (raise (degre&minutes/seconds)
Address ji 00 / /CI AT $h DAL 5 R d • Latitude/longitude source:❑GPS❑Topographic map
(Street or Route No.) (check box)
COIItgL �ARIe 3 M. 3 03 4 �I DEPTH DRILLING LOG
City'olTown State Zip Code Frrop
m T�o Formation Description
! y G-2- v g i2
[YYI • ea..' I r e
ga' 3So' Lite G IQ-AN1re.
(110)- 494_ 3o
Area code- Phone number
4. DATE DRILLED I1- —U et
5. TOTAL DEPTH: . SD '
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO 17Y--
7. STATIC WATER LEVEL Below Top of Casing: -2 S' FT.
(Use " t" if Above Top of Casing)
8. TOP OF CASING IS / FT. Above Land Surface*
'Top of casing terminated at/or below landsurface requires a
variance In accordance with ISA NCAC 2C ,0118.
9. YIELD (gprn): / 0 METHOD OF TEST hf070i72-(f•-4
10. WATER ZONES (depth): .O Z4S (�
J,QCATION SKETCH <<,,
11. DISINFECTION:,Type /'i'a'P Amount .279-1i S Show direction and distance in miles front -least =n
ell
12. CASING: Wall Thickness two State Roads or County Roads, Include Q road ,r
Depth Diameter or WeIghUFt. Matepgl numbers and common road names. .e, �•
From 0 To Ft. /n $ j3,21, 0 Y C�i t '6-'
From To Ft. a `D rJ*'
From To Ft.
'
13. GROUT: Depth Material Method C?;,
From n To�� Ft. CQ C i3
From To FL -- ';�.
14. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in.
From To Ft in. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
16. REMARKS:
1 DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF TH S RECORD H S BEEN PROVIDED TO THE WELL OWNER
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE - ...,
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center Raleigh, NC
27699-1636 Phone No. [phone], within 30 days, GW-1 REV. 07/2001

53
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Divisionfof Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) tD-Pn v) I SI / '! la -A ri . CERTIFICATION # 1I7/Y
WELL CONTRACTOR COMPANY NAMIC 19, 1 C irk lite pnri i)JP,I L j 11.4-1(41, T•yy e i PHONE MiSci_3a. 4-3 . A a
STATE WELL CONSTRUCTION PERMITS ASSOCIATED WiRERMITa
(if applicable)
(if applicable)
I. WELL USE (Check Applicable Box): Residential 'cd-' tviunicipal/Public 0 Industrial 0 Agricultural ❑
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION:
Nearest Town: S /va.. CountyJ,4C/CSL7t1 Topograpllle✓Landsetting
y / N U � a _ . Lo7- d3 a sem ❑Ridge OSlope ❑Valley DINE
% (check appropriate box)
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code) Latitude/longitude of well location
Fa
3. OWNER: -,met L n,d 's%• CO -
AddressY'D.fOx 9�
(Street or Route No.)
Cft IlOuJhee. AlC.
agl23
City'or Town State Zip Code
( as- Sob -e3792..
Area code- Phone number
4. DATE DRILLED //—.9
5. TOTAL DEPTH: 9 SS'
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH
From To
6 3s•
3 5' S'ss
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO mJ�
7. STATIC WATER LEVEL Below Top of Casing: /0 0 FT.
(Use " t" 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 /!1"
10. WATER ZONES (depth): 93.S' (�
11. DISINFECTION: Type
12. CASING:
From 0
From
From
13. GROUT:
From n To (91)
Depth Diam�neeter or Weight/Ft. Matt I 'numbers and common road names.
Toys Ft. /,` s2zR,T1 pr
To Ft.
To Ft.
Depth
1/-41-{ Amount a7"/}S5
Wall Thickness
Material Method
Ft. C0m�r pcmuC.)
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.
DRILLING LOG
Formation Description
fi/
t16 t es- fieten r• 7C.
LOCATION SKETCH
Qrn
Show direction and distance in miles fromcoleasl srA
two State Roads or County Roads. Include roads
-Ca
▪ p
• cn.,-
From To Ft.
16. REMARKS:
1 DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF TH S RECORD H S BEEN PROVIDED TO THE WELL. OWNER
Or eel- ii�.D-o51
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-1 REV. 07/2001

304196
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section,/ WELL CONTRACTOR (INDIVIDUAL) NAM - (print) i f It W-0—. , jr,)� CERTIFICATION# -a Y / g
WELL CONTRACTOR COMPANY NAME "e-(>-ram__ y$ _ -4.)_' j'jL vt, ...ist,_ PHONE # (g' n 4_%? -3/ 7 6
STATE WELL CONSTRUCTION PERMIT#
f VC 2 ASSOCIATED WQ PF,RMIT#
(if applicable)
I . WEI.I. USE (Check Applicable Box): Residential*. Municipal/Public ❑ Industrial ❑ Agricultural ❑
Monitoring ❑ Recovery ❑ Beat Pump Water Injection ❑ Other 0 If Other, List Use
2. WELL LOCATION:
Nearest Town: Topographic/Land setting
w C'ounry cS ❑Ridge ,Slope OValley OFlat
' (check appropriate box)
Latitude/longitude of well location
(if applicable)
r.
I Street Name, Nunihers, Community. Subdivision, tax No., Zip Code)
3. OWNER: t I (y e
Address 5 D931 � �h ,rt
(Street or Route No.) tt
City hr Town r Slate Zip Code
( )-
Area case- Phone number
4. DATE DRILLED 9-.27-D'ti
5. TOTAL DEPTH: 1 $
nnrc yn;:':I trl:p( nC t: �. vic-i Inu; �q;l!I ' YLS Li Nil% t�
7. STATIC WATER LEVEL Below Top of Casing: of e) FT.
(Use "4" if Above Top of Casing)
R. TOP OF CASING IS / FT. Above Land Surface*
*lop of casing terminated at/or below land surface requires a
variance in accordance with 15A NCAC 2C .0118.
9. YIELD (gpm): J'—. 5 METHOD OF TEST cQ b rS
•
ID. WATER ZONES (depth): / 85 ' — 5 5 Prn
LOCATION SKETCH
(degrees/minutes/seconds)
Latitude/longitude source:OGPSOTopographic map
(check box)
DEPTH DRILLING LOG
From To Formation Description
D .7 2
aa' /$5 .ti t.
11. DISINFEC'TION: Type I—f Y/- Amount 33 4-bl h
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
From_b To a Ft. 41t Pt/C,
From To Ft.
From . To Ft.
13. GROUT: Depth Material Method
Prorn_Q To a 6 Ft, ito I^, e
l rom To Ft.
14. SCREEN: Depth Diameter Slot Size Material
From To Ft. in, in.
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Sive Material
From-- To Ft.
From_ To Ft.
16. REMARKS:
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common road names.
Q
0 -earl
P3
S' in"
Ln
I DO IIEREBY CERTIFY THAT TIIIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH I5A NCAC 2C, WELL
('ONSfRIJCIION STANDARDS, AND TIIAT A COPY TIIIS RECORD HAS BEEN PROVIDED TO TIIE WELL OWNER
it- al—oi7
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
'7(16--Jx— ?&q/
295745
North Carolina - Department of Environment and Natural Resources—^ - Division of Water Quality - Groundwater Section
M1 WELL CONTRACTOR (INDIVIDUAL) NAM
E (print) PRO $see lrCERTIFICATION # .2197
t WELL CONTRACTOR COMPANY NAMIEAAA are enD /Vs /,/rW'01/ Di PHONE #JC1za1 St--S-C-SU
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential Municipal/Public ❑ Industrial 0 Agricultural 0
Monitoring 0 Recovery O Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION:
Nearest Town: 57 ,,t l on. County aCL'SCl--
`4ACtit-k.Cv- tstjiiA NC oZg'777
(Street Name, Numbers, Cr,ommunity, Subdivision, Lot No., Zip Code)
3. OWNER: gab etrir -
Address 90/ me Leo4 Dt-
(Street or Route No.
Tnnl A hMsee ( 3c:(303
City or Town State ( Zip Code
(- Gl3l - 3a�1
Area code- Phone number
4. DATE DRILLED 4-0-4 -0
5. TOTAL DEPTH: G, 50
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NOyr
7. STATIC WATER LEVEL Below Top of Casing: 1.5 0 FT.
(Use' 4" if Above Top of Casing)
S. TOP OF CASING IS 1 FT. Above Land Surface*
*Top of cuing terminated at'or below land surface requires a
variance In accordance with ISA NCAC 2C .0I19.
9. YIELD (gpm): S METHOD F TEST • IV
10. WATER ZONES (depth): C/-�, /D/2) 30 0 3 (.1 4.0
�l)10OS
I1. DISINFECTION: Type 1+T R Amount 49.0157)z
12. CASING: Wall Thickness
Depth Diateter or WeightFt. M terial
From n To /31 Ft. (o 'Al i�!r
From To Ft.
From To Ft.
13. GROUT: Depth
From 0 To 3
From 3 To 20
14. SCREEN: Depth
From To
From To
15. SAND/GRAVEL PACK:
Depth Size btateria!
From To Ft.
From To Ft.
Ft.
Ft Diameter
Ft. in.
Ft. in.
Material \/F2
t. . nei 9 yIS y—/
_/
Topographic/Land setting
❑Ridge fifJSlope ❑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
a— lain
/'10 - /4.2-
3O0 3d2
30 2 --c6t0
1fyi'1 So2-s
OJGs—GOS
Las—&O7
60 7- °.sv
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.
Slot Size Materia
in.
in.
16. REMARKS:
gaizA4_
T L cry, rarck. eta.
I DO HEREBY CERTIFY.THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH I5A NCAC 2C, WELL
CONST ION STAND S, AND THAT &COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
ey
Zv — 0 V
SIGNAT{)RE 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
W
N

WELL CONSTRUCTION RECORD
29'792
North Carolina - Department of Environment and Natural Resources • Division of Water Quality - Groundwater Section, •
WELL CONTRACTOR (I.NDIVIDUAL)NAME (print) Mitchell De Cook • CERTIFICATION # 2043
WELL CONTRACTOR COMPANY NA F leer1 arthe15 Kell E iU.±rgr PHONE # [phone]
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if acolicable) (if abolicable)
1. WELL USE (Check Applicable Box): Residential 0 Municipal/Public 0 Industrial ❑ Agricultural 0
Monitoring ❑ Recovery 0 Heat Pump Water Injection ❑ Other ❑ If Other, List Use
WELL LOCATION:
Nearest Tewn, Whittier
Claude Brooks RD
County Jackson
(Stree: Name, Nwn'bers, Community, Subdivision, Lot No., Zip Code)
3. OWNER. Robert B. Catt, Jr.
Address 280 Claude Brooks Rd
(Street or Route No.)
Whittier, NC 28789
City or Town State Zip Code
(828). 497-28789
Area code- Phone number
4, DATE DRILLED 1-12-04
5, TOTAL DEPTH: 300'
6. DOES WELL R.PLACE EXISTING WELL? YES ❑ N0
7. STATIC WATER LEVEL Below Top of Casing: 100 FT.
(Use "+" if Above Top of Castng)
8. TOP OF CASING IS 2 FT. Above Land Surface*
'Top of casing terminated at/or below land s u dace requires a
variance In accordance with 15A NCAC 2C .01I5.
9. YIELD (gpm)' 12 METHOD OF TEST blow
10. WATER ZONES (depth): 190'
t I. DISINFECTION: Type H T H Amount 1 6oz
12. CASING:
Depth
From _ , To 21 Ft. 6 '
From 21 To 24
From To
13, GROUT: Depth.
From 0 To 20
From To
14. SCREEN: Depth
From To
From To
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
Wall Thickness
Diameter or WeighUFt. Material
pvc
Ft 6" 188 steel
Material
Ftbaari:te & Li:m=1 L
Ft.
Diameter Slot Size Material
Ftin. in,
FL in. is
Method
rutted
Topographic/Land setting
❑Ridge ❑Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude.rlongitude source:OGPSOTopographic map
(check box)
DEPTH DRILLING'LUU
From To Formation Description
0 22' r•1ay & 53rd
22' 300' granite
LOCATION SKETCH •
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and cornmon road names.
0
a
CO
—D
ca
CJ
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 WELL OWNER
2d.W.a.e t 49. GrZc.4 > - / i - o 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. (9l9) 733.3221, within 30 days.OW-1 REV, D7/2001

WELL CONSTRUCTION RECORD 293781
North Carolina • Department of Environment and Natural Resources • Division of Water Quality • Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAMIE (print) Mitchell D. Cook - CERTIFICATION # 2043
WELL CONTRACTOR COMPANY NAME 1-611"1 End ftL, ?ea 1f7.1]_wq, Irt PHONE % e) 369-9591
STATE WELL CONSTRUCTION PERMIT% ASSOCIATED WQ PERMIT%
(if applicable) - (ifabolicable)
WELL USE (Check Applicable Box): Residential 3 Municipal/Public 0 Industrial ❑ Agricultural 0
Monitoring 0 Recovery ❑ Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION:
Nearest Town: cashiers County Jackson
Laurel Knob --Well #1
(Street Name, Numbers, Community, Subdivision, Lot No.. Zip Code)
3. OWNER: Cal Owen
Address 384 Kettle Creek RD
(Street or Route No.)
Cashiers, NC 28717
City or Town State
( 828)• 743-3421
Zip Code
Area code Phone number
4. DATE DRILLED 4-15-04
5. TOTAL DEPTH: 750'
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO EX
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 15A NCAC 2C ,01I3.
9. YIELD (gpm)• 0 METHOD OF TEST blow
10, WATER ZONES (depth):
1 I. DISINFECTION: Type H T H Amount 1 6oz
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
From 0 To 87 Ft. 6" PVC
From 87f0 91Ft. 611 _188 steal
From To Ft.
13.GROUT: Depth Material .. Method
From 0 To 20 Ftksmite & trait tapped
From To Ft.
14. SCREEN: Depth Diameter Slot Size Material
From To • Ft. in. in.
From To Ft. in. in.
15, SAND/C'PAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
Topographic/Land setting ,
❑Ridge ❑Slope ❑Valley ❑Flat
(check appropriate cox)
Latitude/longitude of well location
(degrees/mtmnes;s econds)
Latitude/longitude source:DGPS❑Topographic map
(check bats)
DEPTH DR(LLING'Lf36'--
From To Formation Description
0 89' clay & and
89' 750' granite
LOCATION SKETCH •
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road c
numbers and common road names. o 0
3 c _
7-7
-c 'T
W
W
W
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 RECORD HAS BEEN PROVIDED TO THE WELL OWNER
SIGNATURE OF PERSON CONSTRUCTING THE WELL
Lit -15-o4/
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. OW -I REV. 07/2001

WELL CONSTRUCTION RECORD 293780
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,NI PAN Y tNA,titE Haini li= Inc PHONE# e28) 369-9591
•
STATE WELL CONSTRUCTION PERMITO ASSOCIATED WQ PERMIT4
(if aoolicable) (if applicable)
I. WELL USE (Check Applicable Box): Residential ® Municipal/Public 0 Industrial ❑ Agricultural 0
Monitoring 0 Recovery ❑ Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION:
Nearest Town: Cu]lowhee County Jackson
Fast La Porte
(Street Naine, Numbers, Community, Subdivision, Lot No,. Zip Code)
3, OWNER'JameS & Wanda Herren
Address 897 'Britt RA
(Suet or Route No.)
Cullowhee, NC 28723
City or Town State Zip Code
(-$29- 293-5131
Area code• Phone number
4. DATE DRILLED 4-21-04
5. TOTAL DEPTH: 350'
6. DOES WELL REPLACE EXISTING WELL? YES 0 NOc
'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 atlor below land surface requires a
variance In accordance with ISA NCAC 2C .0118.
9. YIELD (gpm): 60 METHOD OF TEST blow
10, WATER ZONES (depth): 330'
II. DISINFECTION: Type
12. CASING:
Depth
From 0 To 65
From 65 To 86
From To
13. GROUT: Depth.
From 0 To 20
From To
14. SCREEN: Depth
From To
From To
15. SAND/GRAVEL PACK
H T H Amount 16oz
Wall Thickness •
Diameter or Weight/Ft. Material
Ft. 6" PVC
Ft. 6'r- .188 steel
Ft.
Material Method
Ftbarni.te & cerutt tarred
Ft.
Diameter Slot Size Material
Ft. in, ' in.
Ft. in. in.
Depth Size Material
From To Ft.
From To Ft.
Topographic/Land setting
El Ridge ❑Slope ❑Valley 0Flat
(check appropriate box)
Latitude/longitude of well location
(des^r-es/minutes/secor.ds)
Latitude/longitude source'❑OPSOTopographic map
(check box)
DEPTH DRILLING LOG
From To Forraatior, Description
0 84' clay & seer]
R4' 350' 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.
0
CO
W
CO
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
Gee
SIGNATURE OF PERSON CONSTRUCTING THE WELL
4L-Z/-Cgr
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. 07/2001

2937'79
WELL CONSTRUCTION RECORD
North Carolina • Department of Environment and Natural Resources • Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL)NA,ME (printl Mitchell De Cook CERTIFlCAT101Vk 2043
WELL CONTRACTOR COMPANY NAME lis-- 13rot1SS N�e11 g711am, hC PHONE k 825) 369-9591 •
STATE WELL CONSTRUCTION PERM1Tk ASSOCIATED WQ PERMIT#
(if anolicable) (if anaiicable)
WELL USE (Check Applicable Box): Residential 6 Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring ❑ Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION:
Nearest Town: Cashiers
Laurel Knob --Well 112
(Street Name, Num'oers, Community, Subdivision, Lot No.. Zip Code)
County ,Tackcnn
3. OWNER: Cal, XIWen
Address 384 KM -tics Freak RD
(Street or Route No.)
Cashiers, NC 28717
City or Towrt State
(828)- 743-3421
Area code- Phone number
4. DATE DRILLED 4-16-04
5, TOTAL DEPTH: 400'
6. DOES WELL REPLACE EXISTING WELL? YES aNO ❑
7. STATIC WATER LEVEL Below Top of Casing: 200 FT.
(Use "*" if Above Top of Casing)
S. TOP OF CASING 1S 2 FT, Above Land Surface*
'Top of casing terminated actor 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): 130' & 265'
Zip Code
1 I. DISINFECTION: Type H T H
12. CASING:
Depth
From 0 To 20
From 20' To 24
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
Ft._6"—
Ft.
Amount 16oz
Wall Thickness
Diameter or Weight/Ft. Material
Ft. 6" Dvr
1AR ctaal
Material Method
Ftlxr iite & tareTt usrcal
Ft.
Diameter Slot Size Material
Ft. in. in.
Ft. in. in,
Size Material
Ft.
Ft.
Topographic/Land setting i'
:Ridge ❑Slope ❑Valley ❑Flat
(check appropriate box)
Latitude,/lonei rude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑ T opcgraphic mup-
(check box)
DEPTH DRILLING LOT -------
From To Formation Description
0 22' r'1 ay & sand
22' 400' 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
D
cad
.-.D
3
C)
Cad
16. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH ISA NCAC 2C, WELL
CONSTRUCTION STANDARDS,,S,Q.J. AND THAT/�A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
—4- e^ •V Z
SIGNATURE OF PERSON CONSTRUCTING THE WELL
--05,
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

WELL CONSTRUCTION RECORD 293778
North Carolina - Department of Environment and Natural Resources • Division of Water Quality • Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) Mitchell De COOk CERTIFICATION # 2043
SPELL CONTRACTOR COMPA;NYtNAPIE 1 1 $t)- -11 �1111't�'Sr Ire PHONE p e ) 369-9591
STATE WELL CONSTRUCTION PERMITh ASSOCIATED WQ PERMITo
(ifaoplicable) (if malleable)
WELL USE (Check Applicable Box): Residential 2 Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 IC Other, List Use
2, WELL LOCATION:
Nearest Town: Sylva County :Jackson
Blanton Br to Chestnut Ridge
(Street Name, Numbers, Community, Subdivision, Lot No.. Zip Code)
3, OWNER: Joy LeGrone
Address 513 Vera Cruz Drive
(Street or Route No,)
Destin, FL 32541
- City or Town State
($50)- 837-3362
Area code- Phone nwnber
4. DATE DRILLED 4-7-04
5. TOTAL DEPTH: 950'
Zip Code
6, DOES WELL REPLACE EXISTING WELL? YES 0 NO TX
7. STATIC WATER LEVEL Below Top of Casing: 25 FT.
(Use "-" if Above Top of Casing)
8. TOP OF CASING IS 2 FT. Above Land Surface"
•Top of casing terminated aVor below land surface requires a
varlance In accordance with ISA NCAC 2C .0118.
9. YIELD (gpm): 40 METHOD OF TEST blow
10, WATER ZONES (depth): 225'
11. DISINFECTION: Type
12. CASING:
Depth
From 0 To 57
From 57' To 60
From To
13, GROUT: Depth
From 0 To 20
From To
14. SCREEN: Depth
From To
From To
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
H T H Amount 16oz
Wall Thickness
Diameter or Weight/Ft. Material
pvc
Ft. 6" 1R8 steel
Ft.
Material Method
Ftbaalite & vw esiL g11
Ft.
Diameter Slot Size Material
Ft. in. - - • in.
Ft. - in. in.
Topographic/Land setting
❑Ridge ❑Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:OGPSOTcpcgraph c map
(check box)
DEPTH DRILLING L G
From To Formation Desch tion__
0 58' clay & sand
58' 250' 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.
W
w
0
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
� — 7 — 09/
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 293777
North Carolina • Department of Environment and Natural Resources • Division cf Water Quality • Groundwater Sectior,
WELL CONTRACTOR (INDIVIDUAL) NAME (print) Mitchell D. Cook CERTIFICATION 4 2043
WELL CONTRACTOR COMPANY NAME He 1'1E.5 Well Eri—lartts TIC PHONE p P25) 369-9591
STATE WELL CONSTRUCTION PERMITS ASSOCIATED WQ PERMITS
(ifaculicable) (if applicable)
WELL USE (Check Applicable Box): Residential L Municipal/Public ❑ Industrial ❑ Agricultural 0
Monitoring ❑ Recovery 0 Heat Pump Water Injection 0 Other ❑ If Other, List Use
2. WELL LOCATION:
Nearest Town: Sylva County Jacked:In
Fairview
(Street Name, Numbers, Community, Subdivis'wn, Lot No., Zip Code)
3, OWNER:Doris Higdon
Address 120 Hwy 107
(Street or Route No,)
Sylva, NC 28779
City or Town State Zip Code
020 )-269-0991
Area code- Phone number
4. DATE DRILLED 4-9-04
5. TOTAL DEPTH: 450'
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO flc
7. STATIC WATER LEVEL Below Top of Casing: 200 ET.
(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 ISA NCAC 2C .01IS.
9. YIELD (gpm): 2 METHOD OF TEST blow
10, WATER ZONES (depth): 235'
11. DISINFECTION: Type H T H Amount 16oz
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
From 0 • To 124 Ft. 6"
From 124To 177 Ft. 6"
From To Ft.
p'rc
188 steal
13. GROUT: Depth Material
From_ To 20 FtbaD ite & =ant
From To Ft.
Method
harps l
14. SCREEN: Depth Diameter Slot Size Material
From To FL in. in.
From To Ft. in. in,
15. SAND/GRAVEL PACK:
Depth Size Material
From
From
To Ft.
To Ft.
Topographic/Land setting
❑Ridge ❑Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longituda of well location
(des., s/minutes/seconds)
Latitude/longitude source:OGPSOTopographic map
(check box) •_—_...
DEPTH DRILLING LOG
From To Formation Description
0 125' clan & srd
125' 450' 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.
0
DC
—D
0
CO
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
y7v so .c.,e_yA
SIGNATURE OF PERSON CONSTRUCTING THE WELL
�- y`U4'
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. 07/2001

From 9A,' To i 1 7
From To
13. GROUT: Depth.
FroTo 20
From To
14. SCREEN: Depth
From To
From To
WELL CONSTRUCTION RECORD 293776
North Carolina • Department of Environment and Natural Resources - Division of Water Quality • Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) Mitchell D, Cook
Halm Brothers Well trilling, Irr
WELL CONTRACTOR COMPANY NAME
CERTIFICATI0IN p 2043
PHONE [phone]
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if aculicabie) (if aoolicable)
1. WELL USE (Check.Applicablc Box): Residential Z Municipal/Public ❑ Industrial 0 .Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 IIIOther, List Use
2 WELL LOCATION:
Nearest Town: Whittier County .Tarksnn •
Wilmont to Cheek's Circle RD
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER. Luther & Carol Gore
Address 825 Cheek Circle RD
(Street cr Route No.)
Whittier, NC 9R7R4
City cr Town State Zip Code
828 )-497-4152
Area code- Phone number
4. DATE DRILLED 4-8-04
5. TOTAL DEPTH: 250'
6, DOES WELL REPLACE EXISTING WELL? YES ❑ NO %c
7. STATIC WATER LEVEL Below Top of Casing: 25 FT.
(Use "+'' if Above Top of Casing)
8. TOP OF CASING IS 2 FT. Above Land Surface*
•Top or casln: terminated at'or below land surface requ l Fes a
variance In accordance with ISA NCAC 2C .0118.
9. YIELD (gpm): 30 METHOD OF TEST blow
10. WATER ZONES (depth): 155& 91 5'
11 r DISINFECTION: Type F T H
12. CASING:
Depth Diameter
From_ — To 96 Ft. 6"
Ft. bee
Ft.
Amount 16oz
Wall Thickness
or Weight/Ft. Material
pvc
.188 . stool
Material Method
Fti2dalitte & CTt6It tuip d
Ft.
Diameter Slot Size Material
Ft. in. ' in.
Ftin. 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,
(degreeshni notes;seconds)
Latitude/longitude source:❑GPSOTopographic !tap
(check box) c--
DEPTH DRILLING LOG
From To Formation Description
0 115' clay & sari
115' 2S0' granite
LOCATION SKETCH
Show direction and distance in miles fl'om at least
two State Roads or County Roads. Include the road
numbers and common road names. p
✓
w
- o
CJ
W
(x7
16. REMARKS:
I DO HEREBY CERTIFY. THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH ISA NCAC 20, 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-I REV. 07/2001

WELL CONSTRUCTION RECORD 2 9 2. 7 75
North Carolina - Department of Environment and Natural Resources - Division of Water Quality • Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) Mitchell De Cook
WELL CONTRACTORCOYI PAN YNAME Henn ) ,2s Well Dri li a-11 PHONE 8 t523) 369-9591
STATE WELL CONSTRUCTION PERMITa ASSOCIATED WQ PERMIT#
(ifaoolicabie) (if applicable)
CERTIFICATION 4 2043
1. WELL USE (Check Applicable Box): Residential L3 Municipal/Public ❑ Industrial ❑ Agricultural ❑
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use
2. WELL LOCATION:
Nearest Town: SYlva
Greens Creek
Countv Jarkson
(Street Name, Numbers, Community, SubCi vision, Lot No., Zip Code)
3. OWNER: Kenneth -.Hnnp
Address 189 ,Tones rreek
(Street or Route No.)
Sylva, NC 28779
City or Town State Zip Code
(828). 631-3837
Area code- Phone number
4. DATE DRILLED 3-23-04
5,TOTAL DEPTH: 150'
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO 40
7. STATIC WATER LEVEL Below Top of Casing: 20 FT.
(Use "+" if Above Top orCasing)
8, TOP OF CASING IS 2 FT. Above Land Surface*
•Top or casing terminated aror 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): 120'
II. DISINFECTION: Tvce F T
12. CASING:
Depth
From_ To 97 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.
H Amount 160z
Wall Thickness
Diameter orWeightFt. Material
6" .188 steel
Material
Ftbfv:te & 7t
Ft. •
Diameter
Ft. in.
Ft. in.
Method
g
Slot Size Material
in.
in,
Size Material
Topographic/Land setting r
❑Ridge ❑Slope ❑Valley ❑Flat
. (check appropriate box)
Latitude/longitude of well location
(de;reel/minutes/seconds)
Latitude/longitude source:GGPSOTopographic nup-
(check box)
DEPTH DRILLING LDG
From To Formation Description
0 95' r13y & sari
95' 150' 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.
0
w
3
w
w
w
16. REMARKS: - -
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center -Raleigh, NC
27699.1636 Phone No. [phone], within 30 days. GW-I REV. 07/2001

WELL CONSTRUCTION RECORD
North Carolina • Department of Environment and Natural Resources - Division of Water Quality • Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) Mitchell D. Cook CERTIFICATION # 20d3
WELL CONTRACTOR COMPANY NAME HECEen alat 5? l EYz]].3rq, Irt PHONE k /325) 369-9591
STATE WELL CONSTRUCTION PERNIIT0 ASSOCIATED WQ PERMITo
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential 6 Municipal/Public ❑ Industrial 0 Agricultural ❑
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2, WELL LOCATION:
Nearest Town: Cashiers County Jackson
282 Chimney Pond Rd
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: Thomas Sawyer
.Address "87 ('himney pond RC7
(Street or Route No.)
Glenville, NC 28736
City or Town State Zip Code
(828 743-9941
Area code• Phone number
4. DATE DRILLED 3-29-04
5.TOTAL DEPTH: 300'
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO Jac
7. STA'TIC WATER LEVEL Below Top of Casing: SO FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS 2 FT. Above Land Surface*
•Top of casing terminated at/or ',flow 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' 120' , & 2,45,
1 I. DISINFECTION: Type H T H
12. CASING:
Depth
From 0 To 63
From To
From To
13. GROUT: Depth
From 0 To 20
From
14. SCREEN:
From
To
Depth
To
From To
Amount 160z
Wall Thickness
Diameter or Weight/Ft. Material
Ft. 6" .188 steel
Ft
Ft.
Material Method
Ftbentnite & osrett turned
Ft.
Diameter Slot Size Material
Ft. in. - in.
Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
Topographic/Land setting
❑Ridge 0Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degreesimi m:tes'seconds)
Latitude/longitude source:❑GPS❑Topographic Map
(check box) i
DEPTH DRILLING -LOG ----
From To Formation Description
0 61' clay & s i
granite
61' qQ0'
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.
0
ca
-0
W
(q
16. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH ISA NCAC 2C, WELL
CONSTRUCTIONSTANNDARRDDSS, AND �THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
3- .-2.9-CS'
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. 01/2001

293173
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 It 2043
WELL CONTRACTOR COM PAN NAME HEtiferli har5 Well Ekt11 flZ ITS PHONE = 623) 369-9591
STATE WELL CONSTRUCTION PERMITN ASSOCIATED WQ PERMITM -
- (if applicable) - (if applicable)
1. WELL USE (Check Applicable Box); Residential Lag Municipal/Public 0 industrial 0 Agricultural 0
0 Heat Pump Water Injection 0 Other 0 If Other, List Use
Topographic/Land setting
❑Ridge ❑Slope El Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
Monitoring Recovery
2. WELL LOCATION:
Nearest Town: Sylva
Savannah to Fox Trace
County ,Tarkcdn
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Cede)
3. OWNER: Eddie & Linda Cody
Address 1090 Lands rre e Rd
(Street or Route NO
Bryson City, NC' 78711
City or Town State Zip Code
($2$)- 4RA-1563
Area code- Phone number
4. DATE DRILLED 3-22-04
5. TOTAL DEPTH: 200'
6, DOES WELL REPLACE EXISTING WELL? YES ❑ NO £c
7. STATIC WATER LEVEL Below Top of Casing: 1S 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): Ff1 METHOD OF TEST blow
10. WATER ZONES (depth): 85& 175'
11. DISINFECTION: Type H T H
12. CASING:
Depth Diameter
From 0 To 61 Ft. " _
From 61 ' To 65 Ft. 6"
From To Ft.
13. GROUT: Depth Material
From 0 To 20 Fti_YSZSIite & cereit
From To Ft.
14. SCREEN: Depth Diameter
From To Ft. in.
From To Ft. in,
Amount 16oz
Wall Thickness
or Weight/Ft. Material
pvr
-1.88-- cteol
Method
=Ted
Slot Size Material
in,
in,
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
(degrees/minutes/seconds)
Latitude/longitude source',❑GPS ❑Topographic map -
(check box)
DEPTH DRILLING
From To Formation Description
0 Ai' clay & ssrd
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
w
C.)
r,.)
16. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH ISA NCAC 2C, WELL
CONSTRUCTION
STANDARDS,
AND THATA COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
20
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

293772
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
CERTIFICATION 0 2043
WELL CONTRACTOR COMPANY NAIVE 1-13:3281. BLd7EZS 1 . Ti J.J..l Tlr PHONE p 028) 369-9591
WELL CONTRACTOR (INDIVIDUAL) NAME (print) Mitchell D. Cook
STATE WELL CONSTRUCTION PERMITP ASSOCIATED WQ PERMIT4
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential 13 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, Glenville
Norton-Upsey Daisy Lane
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3, OWNER: Curtis & Linda Koon
Jackson
Address PO Box 196
(Street or Route No.)
Mayo, FL 32066
County
• City or Town State Zip Code
(386+ 294-1736
Area code- Phone number
4. DATE DRILLED 3-4-04
5. TOTAL DEPTH: 500'
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO Ex
7. STATIC WATER LEVEL Below Too of Casing: 250 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS 2 FT. Above Land Surface"
*Top of easing terminated actor below land surface requires a
variance In accordance w!th 15A NCAC 2C .0118,
9. YIELD (gpm): 15 METHOD OF TEST blow
10. WATER ZONES (depth): 35' & 445'
' l L DISINFECTION: Type H T
12. CASING:
Depth
From 0 To 21
From 21' To 25
From To
13. GROUT: Depth
From 0 To 20
Ft.
Ft.
Ft.
Material
FtbEit rite &
Diameter
6"
6rr
From To Ft.
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.
Amount 1 6oz
Wall Thickness
or Weight/Ft. Material
pvc
-188 steel
Method
!mired
Slot Size Material
• in.
in.
Topographic/Land setting
❑Ridge ❑Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/mi n,;tes,4 econds)
Latitude/longitude source:❑GPSi7Topographic map
(check box) _..
DEPTH DRILLING !JOG
From To Formation Desc�i}�.ti•r.
0 23' clay &
23' 500' 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
3
w
'D
w
w
CO
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
3-4/--04'
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

293771
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
WELL CONTRACTOR CONIPANY (NAME Rafael BrOttl'1P1S 4�.11 aillinit TIC PHONE x e ) ASSOCIATED WQ PERMIT# 369-9591-
STATE WELL CONSTRUCTION PERh11Tt1(if applicable)
(if applicable)
WELL. USE (Check Applicable Box): Residential ® Municipal/Public ❑ industrial 0 Agricultural 0
Monitoring ❑ Recovery 0 Heat Pump Water injection 0 Other 0 If Other, List Use
2. WELL LOCATION:
Nearest Town: Ciallowhee County Jackson
La Porte Acres
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: William J Bailes
Address PO Box 1073
(Street or Route No.)
Camden, Sr 29020
- City or Town State Zip Code
( 864-429-7943
Area code- Phone number
4. DATE DRILLED 3-19-04
5. TOTAL DEPTH: 350'
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO
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 ISA NCAC 2C .0118. blow
9. YIELD (gpm): 20 METHOD OF TEST
10. WATER ZONES (depth): 210'
11. DISINFECTION: Type H T H Amount 16oz
12. CASING: Wall Thickness
Depth Diameter or Weight'Ft. Material
From 0 To 81 Ft. 6" 1 RA Stppl
From To Ft
From To Ft.
13. GROUT: Depth Material Method
From 0 To 20 Ftl2emite & cerEnt =mei
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)
Latitudarlongitude source:❑GPS❑Topographic map
(check box) ""—
DEPTH DRILLING LOG
From To Formation Description
0 79' clan & sand
79' 350' 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.
££ :£ Wd £- AVW h0
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
1Q, Goflx 3+ IQ-C�f
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-1 REV. 07/2001

WELL CONSTRUCTION RECORD
293792
North Carolina • Department or Environment and Natural Resources Division of Water Quality- Groundwater Section
W1' ELL CONTRACTOR (INDIVIDU,AL)NAME (print) James B. Brown CERTIFICATION 2045
WELL COiNTRACTOR COMPANY NAME Redden Brothers Well Drilling, Inc- PHONE 0 P3) 369-9591
STATE WELL CONSTRUCTION PERMIT$ ASSOCIATED WQ PERMITO (if applicable) (ifapplicable)..
I. WELL USE (Check Applicable Box): Residential 81 Municipal/Public ❑ Industrial O Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection O Other 0 If Other, List Use
2. WELL LOCATION:
Nearest Town: TUCICaSegee County Jackson
lake View Rd
(Street Name, Numbers. Community, Subdivision, Lot No., Zip Code)
3.OWNER: Tan Lamb
Address PO Box 325
(street or Route No.)
Wrens, GA 30833
City or Town State Zip Code
(20.6)- 947-6905
Area code. Phone number
4, DATE DRILLED 4-21-04
5. TOTAL DEPTH: 600'
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO )
7. STATIC WATER LEVEL Below Top of Casing: 400 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): 6 METHOD OF TEST blow
10, WATER ZONES (depth): 245' & 342'
I L DISINFECTION: Type H T H Amount 16 oz
12. CASING: Wall Thickness
Depth Diameter or Weight: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. 1an'1ite & txitesiL pumped
From To Ft.
14. SCREEN: Depth Diameter Slot Size Material
From To FL in. in,
Ft. in.' in.
From To
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
Topographic/Land setting I.
❑Ridge ❑Slope ❑Valley ❑Flat
(cheek appropriate box)
Latitude/longitude of well location
( degreeshninutes/seoonds)
Latitude/longitude source:OGPSOT000graphic map
(check box)
DEPTH DRILLING LOG— - .--
From To Formation Descr otion
0 51' clay & sand
51' 600' granite
LOCATION SKETCH
Show direction and distance in miles from, at least
two State Roads or County Roads. Include the end
numbers and common road names.
16 REMARKS:
I D0 HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STAND; DS, AND THAT A CO Y OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
pL e
SIONATURE OF PERSON CONSTRUCTING THE WELL'DATE
Submit tite 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 293791
North Cal olina • Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL COI)TRACTOR(IINDIVIDUAL)NAME (print) James A..Erown CERTIFICATION #2045
wELLCOiNTRACTORCONIPANYNAMEHedden Brothers Well Drilling, Inc PHONE 0$28) 369_9191
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED 1YQ PERYIIT.
(ifaoolicable) - (ifaoalicable).
WELL USE (Check Applicable Box): Residential 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: Dillsboro County Jackson
Jarrett Hills
(Scree: Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: Natalie D. Adams
Address 67 Farmstead Rd
(Street or Route No.)
Sylva, NC 28779
City or Town State
)- NONE
Area code. Phone number
4, DATE DRILLED 4-8-04
5. TOTAL DEPTH: 500'
6. DOES WELL REPLACE EXISTING WELL? YES O NO
7. STA:PIC WATER LEVEL Below Top of Casing: 300' FT.
(Use "+' if Above Top of Casing)
8. TO? 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): 10 METHOD OF TEST blow
10. WATER ZONES (depth): 362' & 425'
Zip Cede
11. DISINFECTION: Type H T H Amount 16 oz
12. CASING: Wall Thickness
Depth Diameter or Weigh/Ft. Material
From 0 To 89 Ft. 6" pvc
From 89' To 92 Ft. 6" - .188 steel
From To Ft,
13. GROUT: Depth Material Method
• From -0 To 20 Ft. )atnite & carat 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.
• Topographic/Land setting
❑Ridge 0Slope OValley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(derreeshninuresls:conds)
Latitude/longitude source,OGPSOTopographic map
(check box)
DEPTH DRILLING LOG_
From To Formation Descr otion
0 90' clay & sands
90' 500' granite
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
number and common road names, •
0
w
16. REMARKS',
I. DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH I5A NCAC 2C, WELL
CONSTRUCTION STAND DS, AND THAT ACQgY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
• -d9 del.
RE OF PERSON CONSTRUCTINGTHE 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
293790
North Caroiina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) James B. _Erown CERTIFICATION #2045
WELL CONTRACTOR COMPANY NAME }leaden Brothers Well Drilling, Inc PHONE k �f2'3 1 369-9591
STATE WELLCONSTRUCTIONPERMIT# ASSOCIATED WQ PERMIIT:
(if applicable)
(if aoplicable)'.
WELL USE (Check Applicable Box): Residential Municipal/Public 0 Industrial 0 A.gricultural ❑
Monitoring ❑ Recovery 0 Heat Pump Water Injection 0 Other ❑ If Other, List Use
2, WELL LOCATION:
NearestTown: Cu11oWhee County Jackson
South Wayehutta
(Street Name, Numbers, Comuwnity, Subdtvisii ou, Lot Nc., Zip Code)
3. OWNER:{Olin Fazzini
Address 114 Reedy Creek Drive
(Street or Rcuhe N'c.)
Frostproof, FL 33843
Citf or Town State Zip Code
(863). 635-9135
Arta coda Phwm nude er.
4.' DATE DRILLED 4-26-04
5.TOTAL DEPTH: 160'
6. DOES WELLRIPLACE EXISTING WELL? YES 0 NO /X
7. STATIC WATER LEVEL Below Top of Casing : 25 FT.
(use "+" if Ahove Tcp of Casing)
8. TO? OF CASING 1S 2 FT. Above Land Surface*
'Top or casing torminate: actor below land surface reauirer a
variance in accc rdan ce with ISA NCAC 2C .0118.
9. YIELD (gpm): 60 METHOD OF TEST blow
10. WATER ZONES (depth): 90' & 132'
I I, DISINFECTION: Type H T H Amount 16 oz
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft Material
From 0 - To 20 Ft. 6" pvc
From 20rTo 23 Fi 6" • .188 steel
From To Ft.
13. GROUT: Depth Material Method
From 0 To 20 Ft. smite & txtp±L Ptun»ed
From To Ft.
14, SCREEN:'' Depth Slot Size Material
From To - in,
From To in.
15, SAND/GRAVEL PACK.
Depth
To
To F.
Diameter
F. in.
Ft. in.
Size Material
From Ft.
From
Topographic/Land setting
❑Ridge ❑Slope ❑Valley ❑Flat
(chef: apprepda!e box)
Latitude/loneitude of well location
(degrees/minutes/se:ends)
Latitude/longitude source:DGPS❑ T 000urap tic map
(check box)
DEPTH DRILLING LOG
From To Formation Description
0 21' clay & sang
21' 160' 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.
16. REMARKS
1 D0 HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH ISA NCAC 2C, WELL
CONSTRUCTION S'-5 a-,. RDS, AND THAT A COPY 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 ?hone No. [phone], within 30 days. - GW•I REV. 07i2501

CONSTRUCTION SykC5}1
293789
WELL CONSTRUCTION RECORD
North Carolina • Deparh'nent o(Environment and NatLit Resvu1Ce6 Division of Water Qllati . (Tr0utd,41tr Stoti,en
?all CONTRACTOR (INDIVIDUAL) NAME (print) JBIneS B. Brown CERTIIICA�TIOY# 209E
WELL CON'TRACros CCMPAN: NAvt: Redden Brothers Well Drillinc, Inc. PEONS it ps, 369-9591
STATE WELL CONSTRUCTION PERMITS ASSOCIATED WC) PERMIT/
(if acolicable) (if aoolicable)
L WELL USE (Check Applicable Box): Residential C3 MunicipaVPublic 0 IndusSial C Agriculrunl ❑
Monitoring ❑ Recovery 0 Heat Pump Water Injection 0 Other O If Other, List Us:
2. WELL. LOCATION:
Nearest Town. Sylva . County Jackson
Big Laurel Acres—Sec2 Lot #6--FRCT well
• (Srnt h1-e, Nt:mben, Cea,r,:ar.:A Suhdi Ai or, Lot No,, Zip Code)
3. OWNER. •
Address __-
(steet or Rouu No,)
Cullowhee Tyr 2R721
City cep To,m Sou Zip Code
(.am)• 497-6849
A'ea code• Pe.ene aunber
. 4, DATE DRILLED 4-14-04
5. TOTAL DEPTH: 6nn'
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO3d8
7, STATIC WATER LEVEL Below Tcp of Casing: 209 FT.
(Vs' "t" If Above To of CuLei) •
8,• TOP OF CASINO IS 2 FT Above Land Surfaces
*Top or Guinn ler:zineted IVor below land rr'aee rrettlret a
•
twi nel In a:cerdanes with 16A NCAC 1C ,0113, .
9, YIELD (gpm)I 20 METHOD OF TEST liacw
10. WATER ZONES (depth): 145' R 560'
11, DISINFECTION: Type EN
12, CASING:
Dit;th Dhiiteter
From 0 To 59 Ft.•�•_
Frca S ''To42_'_Ft_c _ _444..
From ' To Ft
13. GROUT: Depth Material
From 0 . To 20 Ft,1xs"udte & cst
F•em To I.
14, SCREEN: Depth Diac,iter
From, .To Ft. _It
From To Ft in.
15. SAND/GRAVEL PACK:
Depth Size
Frorn_ILTo Ft.
From To Ft.
Amount 1Ecz
Wal! TT^Jek•,ess
or Weilbtflt.. Mateiai
£vr
stool
Method
taarEs
Siet Size Material
M•ateial
T opeg:aphlc(Laad setting
❑Ridge OSlope ❑Valley ❑Flat
(cbrk apropr:au box)
L.atit derlor,gi de cf well location
(Ger.ses'rteuuoheeen'.a)
Latirudetiongitude source:CGPSOTopographie r4p
(once bcx)
DEP T W . DRILLING LCQ
0 80e Formation
x.LI ;;icn
60' 600' granite
LOCATION SKETCW
Show direction and dists,ce in miles from at leas:
two State Roads or County Roads. Include the road o
numbers and common road names. �—
—o
16, REMARKS:
I DO HEREBY CERTIFY TIAT .THIS WILL WAS CONSTRUCTED N ACCORDANCE W1 T ri ISA NCAC 2C, WELL
RDS,AND TLATA YOFTHIS RECORJr :LASBEEN PROVIDED TOT'r LLOW`ER
51GNA1i1RE OF PERSON CONSTRUCTINGT:+=WELL DATE
Submit the or ginal to the Division of Water Quality, Groundwater Section, 1636 MSJI5 nice Center • Raleigh, NC
37699.1636 Phone No. (919)133J131, within 30 days, • OW-1 LEY, 07/200i
Cr?
W
CAS

CONSTRUCTION ST
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division. of Water Quality - Groundwater Section
WELL CONTRACTOR (IiNDIVIDUAL)NAb1E (print) James B. Brown CERTIFICATIONS 2045
WELL CONTRACTOR COMPANY NAME Hedden Brothers Well Drilling, Inc PHONE 0D281 369-9591
STATE WELL CONSTRUCTION PERM1T4 ASSOCIATED WQ PERMITS
(if applicable) (if applicable)
293788
1. WELL USE (Check Applicable Box): Residential Municipal/Public ❑ Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other ❑ If Other, List Use
2. WELL LOCATION:
Nearest Town: Dillsboro
Bradley Branch Rd
County Jackson
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: Bobby Hendrix
Address 1663 Nesmith -Proctor RD
- (Street or Rwne No.)
Nevils, GA 31321
City or Town State
(91 7 )- A39-3540
Area code. Phone number
4. DATE DRILLED 3-1-04
5. TOTAL DEPTH: A00'
6. DOES WELL REPLACE EXISTING WELL? YES 0 NOxrCx
7. STATIC WATER LEVEL Below Top of Casing: 600 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): 1 METHOD OF TEST blow
10. WATER ZONES (depth): 290' & 710'
II. DISINFECTION: Type
12. CASING:
Depth
From 0 To 58
From 5RTo f,1
From To
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.
Zip Code
H T H Amount 16 cz
Wall Thickness
Diameter or Weight/Ft. Material
Ft. 6" pvc
Ft. A," 1 AR cfpal
Ft.
Material - Method
Ft. barnite & carat pumper
Ft.
Diameter Slot Size Material.
Ft. in. in.
Ft. in. in.
Material
Topographic/Land setting i'
❑Ridge OSlope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH DRILLING LOG-- . --
0From 59' clays & sand cripLion
59' 800' aranite
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the roi1d
numbers and common road names.
CO
—D
W
W
ca
16. REMARKS`.
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
RDS, AND THAT 6..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
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WELL CONSTRUCTION RECORD 293183
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (IINDIVIDUAL)NAME (print) James B. Brown CERTIFICATION # 2045
WELL CONTRACTOR COMPA.NYNA;NMEHeddel Brothers Well Drilling, Inc PHONE k$28) 369-9591
STATE WELL CONSTRUCTION PER,N1IT4 ASSOCIATED WQ PERMIT.
(if applicable)
(if applicable)
1. WELL USE (Check Applicable Box): Residential Municipal/Public 0 Industrial ❑ Agricultural 0
Monitoring 0 Recovery 0 Heat PumpWater Injection 0 Other 0 if Other, List Use
2. WELL LOCATION:
Nearest Town: Cullowhee County Jackson
Pressley Crk to Cabin Ridge
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: Mark Dickerman
Address 5636 NW 49th Place
(Street or Route No,)
Ocala, FL 34482
City or Town State Zip Code
(352f- 629-2067
Area cede- Phone number
4. DATE DRILLED 3-23-04
5. TOTAL DEPTH: 460'
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO [3
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 .01I8.
9. YIELD (eon): 8 METHOD OF TEST blow
10. WATER ZONES (depth): 209' & 440'
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 L Jf}
Formation Description
clay & sand
DEPTH
Dom 44'
44' 460'
granite
LOCATION SKETCH
11.. DISINFECTION: Type H T H Amount 16 oz Show direction and distance in miles from at least
12. CASING: Wall Thickness two State Roads or County Roads. Include the road
Depth Diameter or Weight/Ft. Material ' numbers and common road names.
From 0 To 43 Ft. 6n c
From 43' To 46 Ft. 6" .188 steer
From To Ft.
13. GROUT: Depth Material Method
From 0 To 20 Ft. be -mite & Uri ICoL 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.
W
w
W
16. REMARKS.
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH I5A NCAC 2C, WELL
CONSTRUCTION STAND ND THAT A COPY 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

CONSTRUCTIO
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL)NAME (print) James A. Brown CERTIFICATION 2045
WELL CONTRACTOR COMPANY NAME Hedden Brothers Well Drilling, Inc PHONE 0 e28) 369-9591-
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERiL1IT#
(ifapplicable) - (if applicable)
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 LOCATION:
Nearest Town: Sylva County Jackson
Little Savannah
(Street Name, Numbers. Community, Subdivision, Lot No., Zip Code)
3. OWNER: Melinda M. Hill
Address PO Box 2123
(Street or Route No.)
Sylva, NC 28779
City or Town State Zip Code
(.B28)• 586-5865
Area cede- Phone number
4. DATE DRILLED 3-17-04
5. TOTAL DEPTH: 200'
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO XX
7. STATIC WATER LEVEL Below Top of Casing: 20 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.A NCAC 2C .0118.
9. YIELD (gpm): 15 METHOD OF TEST blow
10. WATER ZONES (depth): 105' & 123'
II. DISINFECTION: Type H T H Amount 16 oz
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
From. 0 To 90Ft. 6et pvc
From 90' To 93' Ft. 6" •188. steel
From To Ft.
13. GROUT: Depth Material Method
From 0 To 20 Ft: }arnite & Caret pumped
From To Ft.
14. SCREEN: Depth
From To
Diameter Slot Size Material
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 0Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degreeshri nut es/seconds)
Latitude/longitude source:❑GPS❑Topogrph-ie-rcaep------
(check box)
DEPTH DRILLING LOG
From
91' Formation
lay & sanrdotion
Y d
91' 200granite
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.
0
3
W
W
W
16. REMARKS.
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
ty8'IT�NDARDS, AND THAT OPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
v ."/7-0V
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 293
86
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (I:NDIVIDUAL)NAME (print) James B.
WELL CONTRACTOR COMPANY NAME Hedden Brothers Well Drilling, Inc PHONEa$28) 369-9591
STATE WELL CONSTRUCTION PERMIT4 ASSOCIATED WQ PERMIT";
(if aoplicable) (if applicable) -
CERTIFICATION a 2045
WELL USE (Check Applicable Box): Residential el Municipal/Public ❑ Industrial 0 Agricultural ❑
Monitoring ❑ Recovery 0 Heat Pump Water Injection ❑ Other 0 If Other, List Use
2. WELL LOCATION:
Nearest Town: Sylva County Jackson.
Old Settlement Rd to Shealea Lane
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: Joe & Sandy Miller
Address 275 Match Point
(Street or Route No.)
Sylva, NC 28779
City or Town State Zip Code
(828). 586-6462
Area code- Phone number
4. DATE DRILLED 3-17-04
5.TOTAL DEPTH: 840'
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO7E$
7. STA'rIC WATER LEVEL Below Top of Casing: 700 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): .5 METHOD OF TEST blow
10, WATER ZONES (depth): 237' & 693'
11. DISINFECTION: Type H T H Amount 16 oz
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
From 0 To 87 Ft. 6" pvc
From 87 To 90 Ft, 6.188 steel
From To Ft.
13.'GROUT: Depth Material Method
From 0 To 20 Ft. b Lite & unreal. pumped
From
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
Formation Description
clay & sand
From
88'
To
88'
840'
granite
LOCATION SKETCH
Show direction and distance in miles from at lent
two State Roads or County Roads. Include thernad o
numbers and common road names. 3
cc,
1 0^
W
-o
To Ft. W
14. SCREEN: Depth Diameter Slot Size Material W
From To Ft. in. in. 03
From To Ft. in. in.
15. SAND/GRAVEL PACK: -
Depth Size Material
From To Ft.
From To Ft.
16. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION ST- BARDS, AND THAJ-A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
Jr/.
SIG RE OF PERSON CONSTRUCTING. THE WELL DATE
Submit the o iginal 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 • Dcpartment of Environment and Natural Resources - Division of Water Quality • Groundwater Section
,WELL CONTRACTOR (LNDIYIDUAL)NAME (print) Mitchell D. COOK CERTIFICATION k 3
WELL CONTRACTOR COMPANY NAME }Ellen 's F.PI.l ailari, Tic PHONE i 8281 369-9591_
STATE WELL CONSTRUCTION PERMITh ASSOCIATED WQ PERMIT#
(if aoolicable) (if abolicable)
293785
1, WELL USE (Check Applicable Box): Residential 6 Municipal/Pu'ofc 0 Industrial 0 Agricultural 0
Monitoring ❑ Recovery ❑ Heat Pump Water Injection 0 Other ❑ If Other, List Use
2. WELL LOCATION:
Nearest Town: Tuckasegee
Charlie's Creek
County Jackson
(Street Name, Numbers, Community, 5ubdi visi on, Lot No., Zip Code)
3, OWNER: David Gates
Address PO Box 1934
(Street cr Route No.)
Cullowhee, NC 28723
City or Town State Zip Cod:
( 828. 586-3891
Area code Phone number
4. DATE DRILLED 4-28-04
5. TOTAL DEPTH: 600'
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO 12x
7. STA'TIC WATER LEVEL Below Top of Casing: 300 FT.
(Use "t" if Above Top cf Casing)
8. TOP OF CASING IS 2 FT, Above Land Surface'
'Top of casing terminated ator below land surface requires a
variance In accordance with 15A NCAC 2C .0118.
9. YIELD (gpm): 6 METHOD OF TEST blow
10, WATER ZONES (depth): 325'
I I. DISINFECTION: Type H T H Amount 16oz
12. CASING:
Depth Dieter
From 0 r To 119 Ft. 6"am
From 119 To 123 Ft. 6
From To Ft.
13. GROUT: Depth Material
From 0 To 20 Ftbatri.te &
From To
14, SCREEN: Depth
From To
From To
15. SAND/GRAVEL PACK:
Wall Thickness
or Weight/Ft.
Material
pvc
188 steel
Method
armed
Ft.
Diameter Slot Size Material
Ft, in. in.
Ftin. in.
Depth Size Material
From To Ft,
From To Ft.
Topographic/Land setting i'
❑Ridge ❑Slope ❑Valley ❑Flat
(cheek eppropriale box)
Latitude/longitude of well location
(de-rxes/m'inutes/seconds)
Latitude/longitude source:OGPSDTopographic map
(check box) .. ___..__.._
DEPTH DRILLING LOG
From To Formation Description
0 121relay &
121' 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. o� CD
—c
w
w
W
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
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

2 437S4
12. CASING:
Depth
From 0 To 121 Ft.
From 121 'To 125 Ft.
From To Ft.
13. GROUT: Depth
Fro To 20
From To
14. SCREEN: Depth
From To
From To
15. SAND/GRAVEL PACK:
Depth
From To Ft.
From To Ft.
WELL CONSTRUCTION RECORD .
North Carolina - Department of Environment and Natural Resources r Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) Mitchell D. Cock CERTIFICATION; 2043
WELL CONTRACTOR COMPANY NANIE HerBa1 Er±t1�*s Wall Tr I PHONE k 828) 369-9591
STATE WELL CONSTRUCTION PERMIITp ASSOCIATED WQ PERMIT# (if applicable) - - (if applicable)
1. WELL USE (Check Applicable Box): Residential 6 Municipal/Public 0 lndustriah❑ Agricultural 0
Monitoring ❑ Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WEl-L LOCATION:
Nearest Town: Cullowhee County Jackson
Caney Fork Rd
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: Kent Titcomb
Address 400 Nut Tree Drive
(Street or Route No.)
Deland, FL 32724
• City or Town State Zip Code
86 )- 804-2066
Area code- Phone number
4. DATE DRILLED 4-27-04
5. TOTAL DEPTH: 700'
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO et
7. STATIC WATER LEVEL Below Top of Casing: 400' FT.
(Use "✓' if Above Top of Casing)
8. TO? 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): 635'
I . DISINFECTION: Type P T H • Amount 16oz
Wall Thickness
or Weight/Ft, Material
pvc
Diameter
6"
Htt
1 RR ai-r-.1
Material
Ftbainite & Leman
Ft.
Diameter
Ft. in.
Ft. in.
Method
ta_m:e l
Slot Size Material
in.
in,
Size Material
Topographic/Land setting r -
❑Ridge ❑Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/loneitude of well location
(degrees/minutes/secocdi)
Latitude/longitude source:OGPSOT000graphic map •
(check tax)
DEPTH DRILLING LOLL _
From To Formation Description
0 123' clay & sad
123' 700' granite
LOCATION SKETCH '
Show direction and distance in miles from at least
two State Roads or County Roads. Include theTad o
numbers and common road names.
1
C9
W
w
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
„do • -
1-71 — ..2 7 —QY
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. 072001

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
293783
CERTIFICATION # 2043
WELL CONTRACTOR COM PAN YNAME }k et E$'Ceat?kl Era112Yj, Ti'}~ PHOiN_k 8231 369-9591
STATE WELL CONSTRUCTION PERMITO ASSOCIATED WQ PERMIT#
(if applicable) (if aoolicable) ------ —
I. WELL USE (Check Applicable Box): Residential 0 Municipal/Public ❑ Industrial ❑ Agricultural 0
Monitoring ❑ Recovery ❑ Heat Pump Water injection ❑ Other ❑ If Other, List Use
2. WELL LOCATION:
Nearest Town: Sapphire
281 South --Well #2
County Jackson
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: Dorothy Sweari nger
Address 100 Hemlock Lane
(Street or Route No.)
Sapphire Nr 78774
City cr Town Stare Zip Code
( 828- 883-5575
Area code- Phone number
4. DATE DRILLED '2-3-04
5. TOTAL DEPTH: 100'
6. DOES WELL REPLACE EXISTING WELL? YESXS NO 1 2c
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 Surface*
•Top of casing terminated at/or below land surface requires a
variance In accordance with 15A NCAC 2C ,0118.
9. YIELD (gprn): 30 METHOD OF TEST blow
10, WATER ZONES (depth): 851
I I. DISINFECTION: Type H T H
12. CASING: •
Depth Diameter
From 0 To 30 Ft. 6"
From 30' To 34 Ft. 6"
From To Ft.
13. GROUT: Depth
From 0 To 20
From To
Topographic/Lane setting,...
❑Ridge ❑Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source.OGPS❑Topographic map
(Check box)
DEPTH DRILLING LOG
From To Formation Desctipifon -, -
0 32' clay & srrl
32' 100' granite
LOCATION SKETCH
Amount 1 6oz • Show direction and distance in miles from at least
Wall Thickness two State Roads or County Roads. Include the road c
or Weight/Ft. Material numbers and common road names, o o
Fvr 3 n,
1 RR ci- i �.
Material Method
Ftbetnite & txtra-tt tamoe3
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.
Ce
W
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
27699-1636 Phone No, [phone], within 30 days. - GW-I REV. 07/2001

29466$
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section ' 1
/
WELL CONTRACTOR (INDIVIDUAL) NA?Orion�(J Y �L(j�p1 flr(�(ire ). ..- _ CERTIFI('.UIOON#,3/&b"L-
WELL CONTRACTOR COMPANY NAME csOrionrCI`r h,( �a�° D 4 '( Pets.[) (-Le- .('(TONE N (8n to 31 r]D
STATE. WEI.I. CONSTRUCTION PF.R>IIT# I LI D a :\SSOCI:\TED WO Pt:1011T#
(if applicable) (if applicable)
I. W EI.L IJSE (Check Applicable Box): Residential V. Municipal Public 0 Industrial 0 Agricultural ❑
Monitoring ❑ Recovery ❑ lleat Pump Water Injection ❑ Other ❑ 1 f(dtcr. List Use
2. WEI.I. LOCATION:
Nearest Town: ne_ra 1<e f. County a(JCS yl
Y `1 TS
t5trect Nane. t nbers. Community. Suhdi VI.)um. Tot No.. Zip C tdet
3. OWNER.: AA. CO J/ C •J
Address
Street or Roulc No.
C its or limn State -,
Area vote- Phone number
4. DATE DRILLED 3 - I - v14-
/P
NC I rout To
O Lb/
a87S /-__/t/ ?! 5
5. TOTAL DEPTH: a IDS I
6. DOES WELL. REPLACE EXISTING WELL? YES 0 NO 51.
7. STATIC WATER LEVEL Below Top of Casing: gC) FT.
(Use "I" (f Ahmc Top oFCusing)
S. TOP OE CASING IS 1 FT. Above Land Surface*
*Top or casing terminated at/or below land surface requires a
variance in accordance with 1SA NCAC 2(' .0118.
YIELD (spin): QO METHOD OF TITS T a h
9.
10. WATER ZONES (depth): D e+�eYti—_
i151.-- - -
J LOGV I ICN SKETC'I I o
11. DISINFECTION: Type I--} Y 1-1 Amount 33 -}-i-, I}5 Show direction and distance in miles bond leie
12. CASING: vNall Thickness t\vu State Roads or County Roads. IncludAte rtgoll�
=m
Depth Diameter or Weight Pt_ Material numbers and common road names. r m
From f� To I l It. to tt P�(. '� z
Front To Ft. N Rio
From To Ft. 47)
l3. (iROU1. Depth Notarial Methodfin ci
..-0
0
_.___._ _ _ cn
From To � D Et. C-f .�-t,- �o r ri cl_ -V
Prom To Ft. al �'
14. SCREEN: Depth Diameter Slot Size Material i"- CO L
From lb Ft. in. in.
From To Ft. in. in.
15. SAND GRAVEL PACK:
Depth Size Material
TopographicLand setting
❑Ridge ❑Slope ❑Valley ❑Ulat L�
(check appropriate boss �' r etAt Re' I I
Latitude longitude of well location
Idear:o minutes seconds)
LatitutlL lon!itude source:❑GPS❑Topographic neap
(cheek boll
DTPTII DRILLING LOG
Formation Description
Front To It.
Prom To Ft.
16. REMARKS:
I DO I IEREBY CERTIFY THAT THIS WEI.I. WAS CONSTRUCTED IN ACCORDANCE VATII 115.A MAC 2C. WELL
CONSTRUCTION STANDA DS ANT)' IL T A COPY OE IIIIS RECORD ILAS III, EN PROVIDED I0 TIIE WELL OWNER
>2✓,�tw— ,74(,) 3-3I �.
SIGNATURE OF PARSON CONS TRl F Illvv l t 1. DATE
Submit the original to the Division of Water ()unlit', Groundwater Section, 163n .Vail Nen ice Center - Raleigh, i('
27699-1636 Phone No. [phone], within 30 days. OW-1 RPV. (17 20111

2. WELL LOCATION:
Nearest Town: (I et7 u, J1.0 1/( County JA-L k 5 p1C)
C c,3 Crc.:.-1eS f -r C•cdcc 2 is rep'? Cti-IPr, v-e• p P�
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Cclde) q /73
3. OWNER: J .eCLLo.; C�nC• O i�
Address 1:).j;'rq% d .JG"i} /-kv 2a- Ai
L) ' (Street or Route No.)
(3-6 )- % %l - l Si /r
Depth
From 0 To / Ft.
From To Ft.
From To Ft.
13. GROUT: Depth
From () To r
From To
14. SCREEN: Depth
From To
From To
15. SAND/GRAVEL PACK:
Depth
From To Ft.
From To Ft.
Area code- Phone number
4. DATE DRILLED 3 —) t —[
5. TOTAL DEPTH: (r.C.S''
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO J�
7. STATIC WATER LEVEL Below Top of Casing: /Ca^ FT.
(Use "+" if Above Top of Cuing)
8. TOP OF CASING 1S / FT. Above Land Surface'
'Top or casing terminated at/or below land surface require a
variance In accordance with ISA NCAC 2C .a118. /
9. YIELD (gpm): / 0 METHOD OF TEST /k W/tit
10. WATER ZONES (depth): Si,S"'
STATE WELL CONSTRUCTION PERMIT/ ASSOCIATED W(+ERMITN
(if applicable)
(if applicable)
294903
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resourcesl- Division of Water Quality - Oroundwater Section
WELL CONTRACTOR(INDIYIDUAL) NAME �(print):he nV)1 SI I'l'OIJ/frn r% CERTIFICATION N of/Ile
WELL CONTRACTOR COMPANY NAMEf fl1C hkiia„1A I))PI I Y' jlfl((Tn& PHONE Nil7U�Sa L/-3
WELL USE (Check Applicable Box): Residentiafid�Mun cipal/Public 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 if Other, List Use
e3.3 %ny DEPTH
C y or Town State Zip Code From To
C /"
SS'
bpographic/Land setting
idge ❑Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
pRILLING LOG
Formation Description
1i(nr
iCeJC r2nl'te-
i
O. U
9 r
-13 Gam.
r:DF.
Ut 9c
LOCATION SKETCH -o 1;'
I I. DISINFECTION: Type J F'/-/ Amount of TA 5 Show direction and distance in miles from at kits( r7
12. CASING: Wall Thickness two State Roads or County Roads. Include [herded Ce
Diameter or Weight/Ft. Mateppl numbers and common road names. 755
eM P
Material
Ft. ear), ark
Ft.
Diameter
Ft. in.
Ft. in.
16. REMARKS:
Method
Slot Size Material
in.
in.
Size Material
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 H S BEEN PROVIDED TO THE WELL OWNER
0 �a PP- _3 — C — r
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. OW -I REV. 07/2001

291462
7- enLicalthil
4
5,
6.
7.
County aN{lC3DY‘
1 , p e)
3. OIINER: keSi(CVl. /7/ »Zo
Address 35�,3 J3L(4F' PIIPliPE.IUNINF'i FP/
+' al (Street or Rout: No.)
V rl� a 1 3_59 (-1
CIy or Town Ser: Zip Cade
� )- . < 7,3- 773G
Area code- Phone number
DATE DRILLED /-3D-6c/
TOTAL DEPTH: 700
S.
13. GROUT:
From U
From 3
14. SCREEN: Depth
From To
in. in.
From To Ft. in in.
15. SAND/GRAVEL PACK:
Depth Size
From To Ft.
From To Ft.
8 to. GLJ 4 4
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
-
• WELL CONSTRUCTION RECORD 7 3`45-- 7/-7247
North Catalina =Department of Environment and Natural Resources - Division of Water Quality- Groundwater Section
WELL CONTR&CTOR (INDIVIDUAL) NAME (print) �'1 me � CERTIFICATIIO
WELLJ.
ELL CONTRACTOR COMPANY N.4JIE //�N k �j/ .0.0/4-( rreeAe' Odra el-f h(7 PHONE # (SWI ,SCOt-5t.r STATE WELL CONSTRUCTION PERT MId
•
(if applicable) ASSOCIATED � NIT
(if applicable)
lee))
1. WELL USE (Check Applicable Box): Residential
•'onitoring [ Recovery ❑ Heat Pump Water Injection ❑ Other 0 If Other, List Use
2. WELL LOCATION:
Nearest Tossn i Yl p e Y •
Mona ks-ch Qe htcr. f'\C
(Street Warne, Numbers, Comrnuni;� uSdi,ision, Lot No. i Code)
Topographic/Land setting
[Ridge ❑Slope ❑Valley '2:51at
(check appropriate. box)
Latin:de/longitude of well location
(dee:e:s'rninutes.'seconds)
Latitude/longitude source:[GPS[Topographic map
• (check box)
DEPTH DRILLING LOG
From To Formation Description
^
DOES WELL REPLACE EXISTING WELL? YES ID/ms NO n---_40 7of Casing: (e'- 7�U
STATIC WATER LEVEL Below Top
P D _FT.
TOP OFC.gSINGiS L(Ls e T irAbov:TopofCasin;)
FT. Above Land Surface
Top of casing terminated a Cur below land surface requires a
variance In accordance with I5A NCAC 2C .0I19.
9. YIELD (gpm): y5-- • METHOD OF TEST
10. WATER ZONES (depth): 4,4,
11. DISINFECTION': Type 1-1TJ� Amount 4..5; (S7
12. CASING: Wall Thickness
• Depth D eter or Welcht'Ft. bfa:e,ii
'
From 0 To 2 Ft. 4.0 SD
From To Ft.
From To Ft.
Depth Material
To 2- Ft. e-P�n`a...�—
To 20 Ft. laid ll Ct- --
Diameter Slot Size
Ft.
Material
Municipal/Public ❑ Industrial 0 Agricultural [
G
O CIC
na
LOCATION SKETCH
Show direction and distance in miles from Vi.east ^^•
two State Roads or County Roads. Include Inc roao
ms+-.
rs numbeand common. road names.
16. REMARKS:
CONSTRUCTIONST STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL O\ XEP,
' f?Fi ( rr 3 aS ot/
SIGNATURE OFN 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. WELL LOCATIO-N1:
v.
Nearest Town: (Wl //
(S:re: Nome, Numbers, Communiy, Sub. -fix -ion., to: A' . Zip Ce2e)
ei4
3. Address f a �Q%/
eJ
Address (J e?�
Ci:; or Town S:a:: Zip Ccd:
(gb02 r — 9r1911
Arta coal:- Phone number
4. DATE DRILLED c2 `4:251-0 (�
5. TOTAL DEPTH: 4 7 a
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO PC
7. STATIC WATER LEVEL Below Top of Casing.: I D FT.
.. (Usa"r' if Above Top of Cash;)
S. TOP OF CASING IS _ FT Above Lard Su,rface-
'Tap of casing terminated at'or below land surface requires a
s a riance In accordance sc irh ISA NCAC 2C .0113.
9. YIELD (epm): r . • METHOD OF TEST
10. WATER ZONES (depth): / i— V. S-
E
3 3/C "`
11. DISINFECTION: T LOCATION SKETCH �o c"
y-pe % F T1-E-- Amour: , 7 7 Q7 Showdirection and distance in mailes from eastz'
12. CASING: R a:I Thickness D o Sm;e Rood or County Roods. Inc _
WELL CONSTRUCTION RECORD
Nortn Carolina D partment ofEnvtronment and Natural Resources - Division of Water Quality- Groundwater Section
WILL CONTRACTOR (INDIVIDUAL)NAM/E��L(�print
;) /+ /�yy//&es-
%ELL CONTRACTOR CO\IPANYH'A\(E /I/t7 rrenp' j //dew
STATE WELL CONSTRUCTION PER\IIT.
(if applicable)
ASSOCIATED WQ PERMIT;
(if applicable)
y9a673rfv`
294461
CERTIFICATION tan
7
PHONE k
r:
1. WELL USE (Check Applicable Box): Residential If. . Municipal/Public 0 Industrial 0 Agriculniral4p
Monitoring 0 Recovery 0 Heat Pump Water Injection ❑ Other ❑ If Omer, List Use r
T6
County C/CSvi-j Top aphic/Land se,�itj¢-
q� ❑�}R dge slope ❑Valley 'OFht
/VC.2 Z/ (:heck approp•ia:o bu.c)'
Latimdeiongitude of well location ''
G 'I
(deg-: s.minutes'scooc6)
La;itude,9oncir_dessurce:❑GPS❑Topo>-aphicmap )[ti"•:
DEPTH DRILLI-CLOG
From To Formation D ;aiptior.
0— .3r
C • 7S
7S--7r
-78— 3/r
17 —37e)
From 0
From To FL
From
c
O
Dep Dia-" - r - - ..tea ,. ty o u lace tom' roa
r\feizh: r. ?- a.eria. numbers and common rood names.
To y6 Ft. 4 SQ L/ PLJ C. -o
3 fir.
vl{ /
To FL
13. GROUT: D-p' :A'w 6 l Yn o Znell --
(a:eria, eM a
Ft. �
From O To \-o`'
Crny„�-
From 3 FL Te '` '^Y9'�-
i1¢XAyta�; :
14. SCREEN: Depth Diame r S1o: Size Material `st
Di. ern. t•
From To Ft. in. - _.
in.
From To Ft. in.
15. S.AND'GRAVEL PACK: in.
Depth Size Male:ia:
From To Ft.
From. To Ft.
16. REMARKS:
T3 TjlornAa U&1tc 7 �Q
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONST UCTIO\ STANDARDS, ANDTHAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OV.NER. A if
SI NATURE OF PERSON CONSTRUCTING THE WELL
3-29-0V
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.
G4;-1 REV. 07/2001

STATE WELL CONSTRUCTION PERVIITA'
ASSOCIATED WQ PERMIT.;
5 97q3
474
WELL CONSTRUCTION RECORD ��7� (�j� l�po(�
North Ca?olina - p 2 V 4 4 U J •
rD artment of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTO
R (INDIVIDUAL) NAME (print)CRO_LS'P� 7' Qlv
WELL CONTRACTOR COMPANY NAME
CERTIFICATIpY p8�
PRONE k 0_Elat
• (ifapplicable) •• _.
/ (if applicable)
1. WELL USE (Check Applicable Box): Residential a I‘funicipal/Public ❑ Industrial ❑ ASriculrural ❑
Monitoring O Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATIeN.
Nearest Town: �// �� l)t/ County Topographic/Land set3ing
at-❑ r 7/ Ridge lope []Valley ❑Elat
(Suet Name, Numbers, Community, Subdi•.isicr,, Lot 7�o.. Zip Code) 'v` 01016 (` Latitude lor a2;rop.ia:_ box)
ngitude of well location
3. OWNER: , e---c risk et--
Address 0 i?) C R3 7 �—
(S1:ee-: or Rau::: N>)
Cull rn-uh e e.
n) L a 87.2 3
Cry or Town $gate Zip Code
( $ 631- 6330
Area code- Phone number
4. DATE DRILLED oa - (/— Q Li
5. TOTAL DEPTH: /%j--'
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO -
7. STATIC WATER LEVEL Below Top ofCasing: / FT.
S. TOP OF CASING IS I (LUse''ss" it Above Top of Cagrog)
FT. Above Land Surface
'Top of casing terminated at'or below land surface requires a
rat iance In a ;cordance srirh ISA NCAC 2C.011S.
9. YIELD (gpm): S 0 • METHOD OF TEST
10. WATER ZONES (depth): 15 S
From. To Ft.
From To Ft.
13. GROUT: Depth Material Method
From °`'
From 3 To 2O Ft. ibt{-�ni,tA.': r~, � '-7- v ,�j
14. SCREEN: Depth Diameter Stot Size Material 'Y'f`'e' 1 Y�
From To Fr in.
in.
From To Ft. in.
15. SAND•GRAVEL PACK: In
Depth Size Material
From To Ft.
From To Ft.
(degrt mir.u:ei's:cords)
Latitude:9ongirde souresOGPSOTopographic map
(check box)
DEPTH DRILLING LOG
From To Formation Description
L
0 C3
y rm
LOCATION SKETCH s:_
C. DISINFECTION Type y r/--/ Amount D Show direction and distance in miles from aL.Pas: `c-
12. CASING:
V, aIt Thickness two State Roz_'s or County''`-
D.r.th Dar. -.. ,ter r Roads. Include r..�ryad mom;
From To er1,,- eizh:'Fr. Ma:e:if r.umbers and cora-mo-.. road games. "r`.c.
/a
l
06-4
u1
16. REMARKS:
I D0 HEREBY CERTIFY THAT THIS WELL %VAS CONSTRUCTED IN ACCORDANCE WITH I iA NCAC 2C, WELL
CONS UCTISTANDARDS,
AND�THAT A COPS' OF THIS RECORD HAS BEEN PROVIDED TO THE WELL O',t1T_R
aelp
y
3 29 —DY -
SICff,'ATURE OF PERSON CONSTRUCTING THE WELL
DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center -Raleigh, NC
27699-1635 Phone No. [phone], )within 30 days.
GF.-1 REV. 07/200i
Ji

297365
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Altura' Resouijces - Db ision of Water Quality - Groundwater Station p
WELL CONTRACTOR (INDIVIDUAL) NAME (print) (ipp(\ r1h St HtDCERTIFICATION a332O
WELL CONTRACTOR COMPANY NAME (l1 ) - PHONE # (Qt) tfarCA9
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential 0 Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring V.-Recovery 0 Heat Pump Water Injection ❑ Other 0 If Other, List Use
2. WELL LOCATION:
Nearest Town: syI ✓ County S LK SpfN
1-1-C9 W6o4pr
(Street Name, Numbers, Community, Subdiwioot, Lot No., Zip Code)
3. OWNER: 3 \45/S.SC L07'A
Address tact t wi� r 2c t
syl(Street or Route No.) N1C. a8-119
C or Town Stale Code
Zip (tZg)- sirs—Q' 11
Area code- Phone number
4. DATE DRILLED ID/,nO 1 N
5. TOTAL DEPTH: Ia
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO 111—
7. STATIC WATER LEVEL Below Top of Casing: to FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS FT. Above Land Surface*
`lop of wing terminated at/or below land surface requires a
variance In accordance with ISA NCAC 2C .01111.
9. YIELD (gpm): METHOD OF TEST
10. WATER ZONES (depth): — l a'
11. DISINFECTION: Type
12. CASING:
mDepth Diamoer
To oZ Ft._.11_
Fro
Topographic/Land setting
❑Ridge ❑Slope Walley ❑Flat
(check appropriate box)
Latitude/longitude of well location t t
7,s al' o.)a"t.)743'1a' ac is LJ
(degtem/maut s/secoads)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DRILLING LOG
Foripation escri tam; IDS
r b
DEPTH
From To
to is
T e.
3
11 iktfirs
SAk--
LOCATION SKETCH N
Amount Show direction and distance in miles from at legit
c.Wall Thickness two State Roads or County Roads. Include the ro; ,
or el t/FL vial numbers and common road names. `r
CSV
From To Ft.
Front To Ft.
13. GROUT: Depth Material'1 Method
From 0 Te 1 Ft.'Y 1' fit) r
From To Ft.
14. SCREEN: Depth Diameter Slot Side (Material
FCOmt_a_To 1)Ft n`- in ODIDin. 1"V(
From. To FL in.
Fro
From To 11 Ft.
16. REMARKS: I�IIW - I
15. SAND/GRAVEL PACIC:
Depth
m ) To 12 Ft.
in.
It`Mra,terial
S.1'ct; `mow
THIS WELL
AND TttTA COPY OF THIS RECORD HAS BEEN PROVIDED TO THE jNE1 I OWNER._ ..
we 5
1 ,
fAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
ATURE OF PERSON CONSTRUCTING THE WELL
In/al 0 Lj
DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-1 REV. 07/2001

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section /-
WELL CONTRACTOR (INDIVIDUAL) NAME (print) c2.nVtls fin IIOn%et - .t CERTIFI�C',A„T�I/ON# �eZ/7 eta
WELL CONTRACTOR COMPANY NAMQ)1XpnrC AO!!Owl IWJelI\\Y' lI, 17'nP., PHONE #�a<tll—s�a4-32-e,o
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED W&ERMIT#
(if applicable) (if applicable) .
297081
1. WELL USE (Check Applicable Box): Residentiali icipal/Public 0 Industrial 0 Agricultural ❑
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other cf If Other, List Use
2. WELL LOCATIN:
Nearest Town: ^—w^ 0 b'r / l -2 County rJ Li (-{CS Lix-,
3s7S'h-w hntiAs fi 07k'r7,�1^
(Street Name, Ne�u
hers, Community, Subdivision, Lot No., Zip Code)
3.OWNER: cI)el)S IJIect_u_
Address SST Sher /) o �J s i )
(Street or AoutE Na )
1'nun,IIE it/C
City or Towstate
(Sec✓)- 75i.3— .52.5')
Area code- Phone number
4. DATE DRILLED ?—/ --01-71
5. TOTAL DEPTH: 3 QS'
6, DOES WELL REPLACE EXISTING WELL? YES 0 NO 1-
7. STATIC WATER LEVEL Below Top of Casing: g7) FT.
(Use "+" if Above Top of Cuing)
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): /0 METHOD OF �TEST J,JO?Ut
IO.WATERZONES(depth): 7/0) /�'L), 9r/ U
Zip Code
11. DISINFECTION: Type Jt-/"f-/ Amount 4 7-A- S
12. CASING: WallThicltness
Depth Dia eter or We-t�ghiFt. Matep' I
From 0To___,_ Ft.��` S.bR,ij t7Y �
To Ft. •
From
From
To Ft.
13. GROUT: Depth Material`� Method 11
From () To r9f7 Ft. Cans pa1Ail/
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 Id� ❑Valley QFlat
(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
QQ 3 7'' P l r?r-
.3 X' y0' Z17vhi ('f, I )Y--�--
9G' sins - tit L•e- ray, ; t e�
LOCATION SKETCH r—
Show direction and distance in miles from at (east .1
two State Roads or County Roads. Include the roar
numbers and common road names.
0
16. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF TH S RECORD S BEEN PROVIDED TO THE WELL OWNER
SIGNATURE OF PERSON CONSTRUCTING THE WELL
DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mall Service Center- Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-1 REV. 07/2001
n

From
13. GROUT: Depth Material
From 0 To 20 Ft.ljnit-p R rwn-,t
From To Ft.
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.
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 Ptcthars Ti 1 t 7,,,,.
IXnlli';/ Ire PHONE # ($?Fj) '16¢9591
STATE WELL CONSTRUCTION PERMIT/4 ASSOCIATED WQ PERMIT#
(if applicable)
(if applicable)
I. WELL USE (Check Applicable Box): Residential$ Municipal/Public ❑ Industrial ❑ Agricultural ❑ Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use
2. WELL LOCATION:
Nearest Town: Dillsboro County Jackson
Monteith Cove --Well #2
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER:Tifftothy & Emily gla (A2n.wTo2
Address PO Box 698
(Street or Route No.)
Sylva, NC 28779
City or Town State
586-6994
Area code- Phone number
4. DATE DRILLED 6-10-04
Zip Code
5. TOTAL DEPTH: 700'
6. DOES WELL REPLACE EXISTING WELL? YES EKNO ❑
7. STATIC WATER LEVEL Below Top of Casing: 500 FT.
8. TOP OF CASING IS 2 (Use "4" if Above Top of Casing)
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 hl nw
10. WATER ZONES (depth): 170' & 410'
I I. DISINFECTION: Type H T H Amount 16 nz
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
From 0 To 67 Ft. 6" .188 steel
From To Ft.
To Ft.
16. REMARKS:
Method
irri
Slot Size Material
in.
in,
g97093
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 T6o Formation Description
0 5' clay & sand
65' 700' granite
r
LOCATION SKETCH
Show direction and distance in miles from at least ;-
two State Roads or County Roads. Include —Re 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- --
47,
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
zr tF7a 7714/
297145
DepartmentNorth Carolina - _Environment Natural Resources Division ,.nWater Quality - Groundwater Section
CERTIFICATION�'## 02127
PHONE # (+0'/Ny.�'n rO 'Can
)
asscei 774-4 /0r)
(print)
A�/}�re�lea!%7
WELL CONTRACTOR (INDIVIDUAL) NAME
WELL CONTRACTOR COMPANY NAME
ASSOCIATED WQ PERM
(if applicable)
T#
1. WELL USE (Check Applicable Box): Residential Municipal/Public 0 Industrial ❑ Agricultural ❑
Monitoring ❑ Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use - ---- -
2. WELL LOCATION
NearestTolvr• Co ty JekSvitJ
Lk,lltb( � %1C c�5'7$)
(Street Name, Numbers, Co
fmm
unity, Subdivision, Lot No., Zfp Code)
3. OWNER: e /vo Jen
Address 1'1l� t'=ores-i-- Run l2d
(Street or RoutiO0L Q.EN,
City orState
-ag —
Zip Code
Area code- Phone number
4. DATE DRILLED 5-13-0
5. TOTAL DEPTH: 3G0
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO �Q
7. STATIC WATER LEVEL Below Top of Casing: ) 0 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS I FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance In accordance svitb ISA NCAC 2C .0I I3.
9. YIELD (gpm): 4 METHOD OF TEST A1 r
ID. WATER ZONES (depth): f 1 )
Topographic/Land setting
❑Ridge 0Slope A1Valley ❑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
q- i5v
lS-2— 300
do
302. -3 fo 0
.30 U p% I/y �/1 LOCATION SKETCH
11. DISINFECTION: Type I fi-rk Amotht 140r 20 r17 Show direction and distance in miles frail at IeaSf
12. CASING: Thickness
Wall Th'tk two State Roads or County Roads. Incluee the road
From 0
From
From
13. GROUT:
From O To 3
From To 2.(7
14. SCREEN: Depth
From To
From To
15. SAND/GRAVEL PACK
Depth
From To
Depth
To
To
To
Depth
Ft.
Ft. in.
Diameter
Ft. /y!
Ft.
Ft.
or Weight Ft. M feria numbers and common road names. - • .-
gICC94Li •ibpa -0
v
Material Method
Ft. 0 0
FOOD-,..'(-vstalf
Diameter Slot Size A.far_rial
in. in.
in.
Ft
From To Ft
16. REMARKS:
Size Material
of
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH I5A NCAC 2C, WELL
CONSTRILCTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER at
SIGNATU OF PERSON CONSTRUCTING THE WELL DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center
1 REVgh,0NC
27699-1636 Phone No. [phone], within 30 days.

2971 43
WELL CONSTRUCTION RECORD 5 G a 57fr/
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
4 %
WELL CONTRACTOR (INDIVIDUAL) NAME (prtnt)_14aJ C..LL j �pf�.'{ I O ✓� CERTIFICATION p'C�C-
1
WELL CONTRACTOR COMPANY NAME / - /'f !Zf"P�rie Q.�I PHONE #
STATE \YELL CONSTRUCTION PERMIT: ASSOCIATED \VQ PERMITS
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential' Municipal/Public ❑ Industrial ❑ Agricultural O
Monitoring 0 Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use
2. WELL LOCATIO;j
Neargst Town:
0.�
Topographic/Land setting
❑Ridge Slope ❑Valley ❑Flat
Ca.Q7�i
(check appropriate box)
• - V.. l
(Street Nome, Numbue, Commur.iry, SJoCivisiona-ot No., Zip Code) Latitude/longitude of well location
County
A
3. O\WNER&-4n' 0_4_62, t E-1J
Address CV C- el rnl- 15 31
(S:reet or Rouse No );
City or Town Stare Zip Cod:
(c k3- 73 - QSSS
Ara codes Phone number
4. DATE DRILLED S - a 7 -O 4
S. TOTAL DEPTH: .5 -D
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO l$j
7. STATIC WATER LEVEL Below Top of Casing: SO FT.
(Use "r' if Above Top of Casing)
S. TOP OF CASING IS I FT. Above Land Surface.
'Top of using terminated a Cur betaw land surface requires a
variance in accordance with 1;,\ NCAC 2C .0115.
9. YIELD (pm): 3 METHOD OF TEST ) Y
10. WATER ZONES (depth): 2 — /
11. DISINFECTION: Type l-j TN A coo n
12. CASING: Wan Thickness
Depth -eter cr(� 7\-W��eiehtTL. btar--via'
From To /..5 . Ft. ��Y/ j L1' / 4k.z-d
From To Ft.
From To Ft.
13. GROUT: Depth blal`Q -r�
From_0 To 3 Ft. t
From .3 To R.0 Ft. 40--r.,- •
14. SCREEN: Depth Diameter Slot Size
From To
From To
1i.SAND'GRAVELPACK
:
Depth
From To Ft.
(degrees/rhir.o:es:seconds)
Latitudelloneitude source:OGPSOTopographic r,.ap
(check box)
DEPTH DRILLING LOG '
From To Formation Description- --.
LOCATION SKETCH 271
Show direction and distance in miles ffm aLl as:
two State Roads or County Roads. IncMde Woad
ri_rr.0e6 and Nn'.fr:Jn CJ1,4 Cam.'>.
CO
J
Method
Cr 42c,-2r-lira--C )
Material
Ft. in. ir,.
Ft. in. in.
S: e Material
From To Ft.
16. REMARKS:
1 DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE \SI T H I SA NCAC 2C, WELL
CONS TION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL O'', ER
.42-en a , C2 7- 6 <J
SIGN. RE 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

297141
'`15‘ 9- 3)-d Y7
WELL CONSTRUCTION RECORD Z- so 9 17 VV
North Carolina - Department of Environment and Natural Resourc - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME ��(print)
WELL CONTRACTOR COMPANYNAMIE A/'E�"a"
t' m�((r CERTIFICATION#e2 d� l
j reen-2- ✓`fJs eti PHONE # fR24Sf -o% St
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable)
(if applicable)
1. \VELL USE (Check Applicable Box): Residential PIS Municipal/Public 0 Industrial 0 Agricultural ❑
Monitoring ❑ Recovery O Heat Pump Water Injection 0 Other ❑ If Other, List Use
2. WELL LOCATION: ( �y �- Topographic/Land setting
N^`n`estTown:�a�YIISCE'/ee County Y1� kC c -.. ❑Ridge ❑Slope ❑Valley ,$Flat
l 'a mon � ^FZI JT& e _t yra� 72
(check appropriate box
(Street Name, Nmb.rs, Communist, Subdivision, Lot No., Zip ode) / Latitude/longitude of well location
3. OWNER: fIV)n U-1e-CJt '�, rr
Address Nv-% Rre'en (L-- IC1L
(Street or R. ure No.)
't,{Vi0/4-- 1\3 a8779
C)- ity aorITcowng3- S StateVo9 Zip Code
(
Area code- Phone number
DATE DRILLED (p— 1— 0 4
4
5. TOTAL DEPTH: t
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO X
7. STATIC WATER LEVEL Below Top of Casing: Lf o FT.
1 (Use "Y' if Above Top of Casing)
S. TOP OF CASING IS FT. Above Land Surface*
•Top of easing terminated aror below land surface requires a
variance in accordance svidi ISA NCAC 2C .011 S. 9. YIELD (gpm): METHOD OF TEST 44-
10. WATER ZONE depth): i a0 F?
LOCATION SKETCH
(degrees/minutes/seconds)
Latitude/longitude source:OGPSOTopogtaphic map
(check box)
DEPTH DRILLING LOG
From To Formation Description
D--63
✓a3—/20 ,(c•
/2. D - /z z Cez.ulxiii;
/ZZ -/-CD C `
1I. DISINFECTION: Type rt Tft Amount 4=, YS 02- Show direction and distance in miles f at gas:
12. CASING: Vial Thickness two State Roads or County Roads. Include the=road
Depth Diameter orWeigh:'Ft. Matt lat numbers and common road names.
•
From 0 To (r^.l Ft. ( V4 Mists( ,
From To_ Ft. j(TA
From To Ft. 221 rTh-, L
13. GROUT: Depth Material Method
From To Ft. I.
From 3 To 20 Ft. � 7�'1 (-aGit. &cr-Q •
14. SCREEN: Depth Diameter Slot Size Motel -ill u xi 7}v'
From To Ft. in. in. I n
Ft. in. in. - �r �I -
From To
15. SAND/GRAVEL PACK:
Depth Size
From To Ft.
From To Ft.
16. REMARKS:
Material
1 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
_-073—oaf
SIGNATURE OF PERSON ONSTRUCTING THE WELL DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh; NC - 27699-1636 Phone No. [phone], within 30 days. GW-1 REV. 07/2001

WELL CONSTRUCTION RECORD
•
7�S v-7. /W
7 y'-y6-7/q
297140
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR ONDR1DUAL)N.4SI/E (print)��0 (r tC(i(.( ri n /
WELL CONTRACTOR COMPANY NAME AAA
- Rime's ���'p�it<U✓`L�/
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT„/
(if applicable)
(if applicable)
CERTIFICATION # �-c�/� 4O
PHONE # fai JaV -f3sn
I. WELL USE (Check Applicable Box): Residential% Municipal/Public ❑ Industrial ❑ Agricultural ❑
Monitoring 0 Recovery ❑ Heat Pump Water Injection ❑ Other 0 If Other, List Use
2. WELL LOCATIOaN
Near t Tol�n:_County
(Street Name, 'umbers, Community,Subdivisan, Lot No.,
3. OWNER: S�'�`}e (`/j`y
Address r' 626 (fit,%? p C.t
(Sweet or Route No.)
SL2C 82g 77R
O `City Town I Scat Zip Code
O�x 2
( - �� 7 /
Area code- Phone number
4. DATE DRILLED �., -:QR -o 5`
5. TOTAL DEPTH: 413J
6. DOES WELL REPLACE EXISTING WELL? YES ❑��/-N�O at
7. STATIC WATER LEVEL Below Top of Casing: 6" FT.
(Use "�' irAbove Top of Casing)
S. TOP OF CAS[NG IS ' FT. Above Land Surface*
*Top of casing terminated an'or below land surface requires a
variance in accordance with NSA NCAC 2C .0118.
9. YIELD (epm): METHOD OF TEST
10. WATER ZONES (epth): �Q
11. DISINFECTION: Type / T Amountii isO'7
Wall Thickness
12. CASING:
C' 21'7'71
der
Depth Diameter oy\3ly2t. Material
From To 7& Ft._(n gi �'llfl 1 f
From To Ft.
From To Ft.
13. GROUT: Depth
From 0 To Ft.
From To QD Ft.
14. SCREEN: Depth Diameter
From To Ft. in.
From To Ft. in.
15. SAND/GRAVEL PACK:
Depth Size blaterial
From To Ft.
From To Ft.
Topographic/Land setting
❑Ridge ❑Slope ❑Valley Flat
(check appropriate box)
ip Code) Latitude/longitude of well location
(de zreesin i n utesheconds)
Latitude longitude source:❑GPS❑Topographic map
.. (check box)
DRILLING LOG
Formation Description
DEPTH
From To
c-5
LOCATION SKETCH I
Show direction and distance in miles Fam of least
two State Roads or County Roads. Include tneroad
number and common road names. h!,
f% r'
C e
a�L J
J
;c,
Method Ce<v
,lr.,7 pf.
Slot Size OrliftateriaY
in.
in.
16. REMARKS:
1 DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE \\1TH 15A NCAC 2C, \VELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
— m �Cvrr L—a3- oz-!
SIGNATURE OF PERSON CONSTRUC ING 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

297311
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 IS 2045
WELL CONTRACTOR COMPANY NAME FIEClia6 Bittle slg W]1 DI'-illl Trr
nJ, PHONE # 0R78) 169-Q591
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable)
(if applicable)
I. WELL USE (Check Applicable Box): Residential ik)( Municipal/Public ❑ Industrial ❑ Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION:
Nearest Town: Cherokee County Jackson
Sunnyview Drive
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: Joyce Cooper
Address PO Box 1254
(Street or Route No.)
Cherokee, NC 28719
City or Town State Zip Code
(828)- 497-5249
Area code- Phone number
4. DATE DRILLED 6-1-04
5. TOTAL DEPTH: 300'
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO 1x
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 .01I8.
9. YIELD (gpm): 8 METHOD OF TEST blow
ID. WATER ZONES (depth): 235' & 250'
11. DISINFECTION: Type H T H
12. CASING:
Depth Diameter
From 0 To 58 Ft. 6"
From SR' To 61 Ft. 6"
From To Ft.
13. GROUT: Depth Material Method
From 0 To 20 FLtiite & ant Plh
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:
Amount 16 c-)7
Wall Thickness
or Weight/Ft. Material
pvc
188 steel
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
clay & sand
granite
DEPTH
From Tp
0 59
59' 300'
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. _
CD
L7
r) —
p
0)
I D0 HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION S)DARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
5/
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. 07/200I

297310
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
WELL CONTRACTOR COMPANY NAME fiEtiBiTililefq Gp11 Drillinj, Try., PHONE # MR) T-9-9591
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable)
(if applicable)
I. WELL USE (Check Applicable Box): Residential Or Municipal/Public ❑ Industrial ❑ Agricultural ❑
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use
2. WELL LOCATION:
Nearest Town: sylva County Jackson
East Fork to West Fork--EBCI well
(Street Natne, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: Shelly Deitz
Address PO Box 121
(Street or Route No.)
Sylva, NC 28779
City or Town State Zip Code
(828)- 507-7193
Area code- Phone number
4. DATE DRILLED 6-7-04
5. TOTAL DEPTH: 160'
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO klc
7. STATIC WATER LEVEL Below Top of Casing: 15 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): 80+ METHOD OF TEST blow
10. WATER ZONES (depth): 115& 157'
11. DISINFECTION: Type H T H
12. CASING:
Depth Diameter
From 0 To 61 Ft. 6"
From 61' To 64 Ft. 6" .188
From To Ft.
13. GROUT: Depth Material Method
From 0 To 20 Ft.bar rite & cHrslt Pnpai
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.
Amount 16 nz
Wall Thickness
or Weight/Ft. Material
pvc
steel
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)
DRILLING LOG
Formation Description
clay & sand
granite
DEPTH
From To
0 62!
62' 160'
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.
0
r
r
tV
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH ISA NCAC 2C, WELL
CONSTRUCTION ST DARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
�zz_iz (__, � � - / ash
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
c

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Sego. 1
WELL CONTRACTOR (INDIVIDUAL) NAME (print) James B. Brown CERTIFICATION# 2045
WELL CONTRACTOR COSIPANY NAME HEC1131 Bratfisrs W 11 Drilling, Trr
PHONE # (808) IF9-9S91
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable)
(if applicable)
WELL USE (Check Applicable Box): Residential a Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring O Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION:
Nearest Town: Sylva County Jackson
Union Hills Rd to Troy Martin Rd--E7CI well
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: Freeman Owle
Address PO BOX 855
(Street or Route No.)
Cherokee, NC 28719
City or Town State Zip Code
(828)- 497-5317
Area code- Phone number
4. DATE DRILLED 6-14-04
5. TOTAL DEPTH: 800'
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO Eix
7. STATIC WATER LEVEL Below Top of Casing: 700 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): .5 METHOD OF TEST blow
10. WATER ZONES (depth): 240'
1 I. DISINFECTION: Type H T H
12. CASING:
Depth
From 0 To 62 Ft.
From 62' To 65' Ft.
From To Ft.
13. GROUT: Depth
From 0 To 20
From To Ft.
14. SCREEN: Depth
Amount 16 nz
Wall Thickness
Diameter or Weight/Ft.
6"
From To Ft. in.
From To Ft. in.
15. SAND/GRAVEL PACK:
Depth Size
From To
From To
6ts
16. REMARKS:
Ft.
Ft.
Material
188
FL Win/cent
Material
pvc
steel
Method
PIS
Diameter Slot Size Material
in.
in.
Material
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
0 63' clay & sand
63 800 grani to
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 15A NCAC 2C, WELL
CONSTRUCTION STANgARDS, AND THAT A C PY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
(7-24_,flz 3-,"a e..�-1—. 6 /y -6 V.
SIGNAT 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, 07/2001
r
c0

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) Mitchell D. Cock CERTIFICATION k 2043
WELL CONTRACTOR COMPANY NAME fklin aCtherS l f�—tllit't?, PHONE [phone]
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential d 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: Cullowhee County Jackson
5 twin Fiddlers Tone
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: Leonard Dills/Ruth Thompson
Address 5 'Bain Fidclers Zane
(Street or Route No.)
Cullowhee, NC 28723
• City or Town State Zip Code
( 828- 293-9884
Area code- Phone number
4. DATE DRILLED 2-6-04
5. TOTAL DEPTH: 250'
6. DOES WELL REPLACE EXISTING WELL? YES C `10 ❑
7. STATIC WATER LEVEL Below Top of Casing: 100 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): 6 NIETHOD OF TEST blow
10. WATER ZONES (depth): 50' & 175'
L DISINFECTION: Type H
12. CASING:
Depth
From 0 To 21
Front To
From To
Depth
To 20
To
Depth
Ft.
Ft.
Ft.
T H Amount 1 6oz
Wall Thickness
Diameter or Weight/Ft. Material
6" 188 steel
13. GROUT: Material
From 0 Flbart ite & anent
From Ft.
14. SCREEN: Diameter
From To Ft, in.
From To Ft. in.
15. SAND/GRAVEL PACK:
From
From
Depth Size
To
Ft.
To Ft.
Method
to r1
Slot Size Material
in.
in.
Material
298122
Topographic/Land setting'
❑Ridge ❑Slope 0Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check bo.x)
DEPTH DRILLING LOG
From To Formation Description
0 19' clay & sand
19' 250' 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.
16. REMARKS:
I D0 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
17' .22 .2 - 6- D+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. GW-I REV. 07/2001

From
14. SCREEN:
From
From
15
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 CONI PAN YINALIE }t BLotherS F±11 r 17t PHONE # s28) 369-9591
STATE WELL CONSTRUCTION PERNIIT# ASSOCIATED WQ PERMIT
(ifapolicable) (if applicable)
298121
CERTIFICATION # 2043
WELL USE (Check Applicable Box): Residential Municipal/Public 0 industrial 0 Agricultural 0
Monitoring ❑ Recovery ❑ Heat Pump Water Injection 0 Other ❑ If Other, List Use
2. WELL LOCATION:
Nearest Town:Glenville
Cloud Walk
County Jackson
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: Dick & Sherry Howard
Address Rural Rt 2 Box 404 B
(Stites or Route No.)
Lake Toxaway, NC 28747
City or Town State Zip Code
( 828)- 877-6162
Area code- Phone number
4. DATE DRILLED 2-5-04
5. TOTAL DEPTH: 750'
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO ;ak
7. STATIC WATER LEVEL Below Top of Casing: 500 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS 2 FT. Above Land Surface'
'Top of casing terminated actor below land surface requires a
variance In accordance with I5A NCAC 2C .0118.
9. YIELD (gpm): 4 METHOD OF TEST blow
10. WATER ZONES (depth): 275' & 600'
11. DISINFECTION: Type
12. CASING:
H T H Amount 16oz
Depth
From 0 To 56 Ft.
From 561 To 60 Ft.
From To Ft.
13. GROUT: Depth
From 0 To 20
To
Depth
To
To
Diameter
6"
6"
Wall Thickness
or Weight/Ft. Material
pvc
.188 steel
Material
Ft mite & cement
Et.
Diameter
Ft. in.
Ft. in.
SAND/GRAVEL PACK:
Depth Size
From To Ft.
From To Ft.
Method
Ftaroa3
Slot Size Material
in.
in.
Material
Topographic/Land setting'
❑Ridge 0Slope 0Valley ❑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'
0 58' Clay & s rd
58' 750' 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.
h Z :6 WV 8— elVW 10
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
127` r_0 4 2- 5- _
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-I REV. 07/2001

WELL CONSTRUCTION RECORD
298497
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
\\ ELL CONTRACTOR (INDIVIDUAL) NAME (print) James B. Brown CERTIFICATION 2045
\ ELL CONTRACTOR COMP.ANVNAME Hedden Brothers Well Drilling, Inc PHONE a828) 369-9591
STATE WELL CONSTRUCTION PERMIT= ASSOCIATED WQ PERMIT=
(if applicable) (if applicable)
I. WELL USE (Check Applicable Box): Residential NlunicipaLPublic 0 Industrial ❑ Agricultural 0
Nlonitoring ❑ Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION:
Nearest Town: Whittier County Jackson
Thomas Valley RD to: Btmlgarner Cemetery Rd
(Street Name, Numbers, Community, Subdii, islon, Lot No., Zip Code)
3. OWNER: Robert Hoke
(degrees 'minutes 'second )
Address p0 box 1841 Lab tudclongitudesource:❑GPSOTopographicmap
(Sires: or Route No.) (-Meek box)
Bryson City, NC 28713 DEPTH DRILLING LOG
City or Town sate Zip Code From To Formation Description
(828 )- 488-4982 0 110' clay & sand
Area code- Phone number
Topographic/Land setting''
DRidge ❑Slope DValley ❑Flat
(check appropriate box)
Latitude/longitude of well location
4. DATE DRILLED 3-9-04
5. TOTAL DEPTH: 400'
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO N
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 .0I18.
9. YIELD (gpm): 2 METHOD OF TEST blow
10. WATER ZONES (depth): 120'
l 1. DISINFECTION: Type H T H
12. CASING:
Depth Diameter
From 0 To 109 Ft. 6"
From 109' To 112 Ft. 6"
From To Ft.
Amount 16 oz
Wail Thickness
or WeightFt. Material
pvc
188 steel
13. GROUT: Depth Material ,Method
From 0 To 20 Ft. batlite & wlritL 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.
110' 400'
granite
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include ti:broadg
numbers and common road names. .r 0
IJD
Tars
0
0
16. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, \VELL
CONSTRUCTION',S=ANDARDS, AND THAT WY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
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-I REV. 07 2001

WELL CONSTRUCTION RECORD
299496
North Carolina - Department of Environment and Natural Resources - Division of Water Quality. - Groundwater Section
HELL CONTRACTOR (INDIVIDUAL) NAME (print) James B. Brown CERTIFICATION: 2045
WELL CONTRACTOR COMPANY NASIEHedden Brothers Well Drilling, Inc PHONE F $28) 369-9591
STATE \FELL CONSTRUCTION PERMIT:: ASSOCIATED R'Q PERMIT#
(if applicable) (if applicable)
I. WELL USE (Check Applicable Box): Residential El NlunicipallPublic ❑ Industrial ❑ Agricultural ❑
Monitoring 0 Recovery 0 Heat Pump Water Injection ❑ Other 0 If Other, List U'se
WELL LOCATION:
Nearest Town: Sylva County Jackson
Old Settlement Rd -just past New Hope Church
(Street Name. N;unbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: Cwter Woods
Address 108 Mint Rd
(Sore:: or Route No.)
Sylva, NC 28779
Cry cr Tow n State Zip Code
(82S- 586-5357
Area code- Phone number
4. DATE DRILLED 3-10-04
5. TOTAL DEPTH: 300'
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO C
7. STATIC WATER LEVEL Below Top of Casino: 100 FT.
(Use' " if Abase 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 svith 15A NCAC 2C .0118.
9. YIELD (gpm): 20 METHOD OF TEST blow
I0. WATER ZONES (depth): 125' & 290'
11. DISINFECTION: Type H T H
12. CASING:
Amount 16 oz
Wail Thickness
or Weight Ft, :Material
.188 steel
13. GROUT: Material
From 0 Ft. barnite & OaraTt
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
Depth Diameter
From 0 To 119'Ft. 6"
From To Ft.
From To Ft.
Depth
To 20
From To Ft.
From To Ft.
16. REMARKS:
Method
pumped
Topographic'Land setting
❑Ridge ❑Slope ❑Valley ❑Flat
(check appropriate box)
Latitude.'longitude of well location
(degrees m inutesseaonds)
Latitudc'ongitude source:❑GPS❑Topographic map
b,,x;
DEPTH DRILLING LOG
Formation Description
clay & sand
117' 300' granite
From To
0 117'
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 15A NCAC 2C, WELL
CONSTRUCTION ST..,et+]E RDS, AND THAT A COP F THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
—/O �U /
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

298123
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 C0M PAN NAME HralFri art7erS Id.- t llprr?r Irt PHONE #S28) 369-9591
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT*
(if applicable) (if applicable)
CERTIFICATION # 2043
1. WELL USE (Check Applicable Box): Residential 6 Municipal/Public ❑ industrial ❑ Agricultural ❑
Nlonitoring ❑ Recovery ❑ Heat Pump Water injection ❑ Other ❑ If Other, List Use
2. WELL LOCATION:
Nearest Town: Sylva County Jackson
Piney Mtn-Varnadore Sub Div -Lot #7
(Street Name, Number, Community, Subdivis(on, Lot No.. Zip Code)
3. OWNER: John & Phyllis Thompson
Address 2025 Sylvester Rd # GG2
(Street or Route No.)
Lakeland, FL 33803
- City or Town State Zip Code
(_828- 413-0144
Area code( Phone number
4. DATE DRILLED 2-23-04
5. TOTAL DEPTH: 400'
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NOxffc
7. 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 belot. Ian d surface requires a
variance In accordance with 15A NCAC 2C .0118.
9. YIELD (gpm): 6 METHOD OF TEST blow
10. WATER ZONES (depth): 11
11. DISINFECTION: Tvpe H T H Amount 16oz
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
From 0 To 100 Et, 6" pvc
From 100' To 104 Ft. 6'r— .188 steel
From To Ft.
13. GROUT: Depth Material Method
From 0 To 20 Ftte rni.te & uaia1 Fairm-e3
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 Nlaterial
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
0 102' day & sand
102' 400' 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.
LO
IV
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
-23-a9
DATE
Subunit 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
0
Ern
ern
-era
A0
rn o
n�
0
z

WELL CONTRACTOR CO\IPANYNA\IE
PHONE
STATE WELL CONSTRUCTION PERMIT:
ASSOCIATED
(if applicable) -- WQ PERMIT:
(if applicable)
1. WELL USE (Check Applicable Box): Residential Municipal/Public O Industrial ❑ Agricultural O
Monitoring ❑ Recovery O Heat Pump Water Injection ❑ Other O If Other, List Use_
2. WELL LOCATI,N: •
Nearest Town - ', V :/
Jic I i
(Street Name, Numbes, Com
E
3. 01VNER: /&1-54
Coyygryty
(2— P/IUi C,.N
runkyl Sgbdisision, Ldt No., Zip Code) 0 /
YT3 (.e.,
uf— Irl
Address PO /-Stry ) fp j
0- I er? th( / ct or Route No.)
Ciry or Town Seam r
7,4•s _ 7 V/ g Zip Code
Area code- Phone number
4. DATE DRILLED I — r. Y —Q LP
5. TOTAL DEPTH: ZSTj
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO I
7. STATIC WATER LEVEL Below Top of Casing: / S— FT.
S. TOP OF CASING IS / t L (Ds:. t.bAbove TopnSurface"
a1
( laFnd
s Arace r Land Surra:z'
'Tap of casing terminate) attar below land surface requires a
variance In accordance s. iq J5.S NCAC 2C .0113.
9. YIELD (gpm): 5 • METHOD OF TEST
10. WATER ZONES (depth): 9 U
R 071
I I. DISINFECTION: Type 11 7-1-1 Amount ,&1.27
12. CASING.
From 0Depth Diarr ter
To /) Lj Ft.
From To Ft.
From To Ft.
13. GROUT: Depth Material
From 0 To .�G Ft. ( E/ A-j
From To Ft. Qt.
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.
5'9 4146kt7
WELL CONSTRUCTION RECORD 75-444 = 4, 7- 3 3 3
298185
North Carolina Department of Environment and Natural Reso rces - Division of Water Quality- Groundwater Section
\YELL CONTRACTOR (INDIVIDUAL) NAME ��ss C(}JI"
) (Print (r's l.(il.. i'��
CER7IFICATIONAe�-� r'r
Cat
Topoo aphic/Land setting
DRidge Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degre:iminu:esise:onds)
Latitudeiongimde scurce:OGPSOTopographic map
•
(cheek box)
DEPTH DRILLING LOG
From To Formatio Description
- S'.�S7 �i,r1 c
--r V
2_
:2 (It7 — 3L'L'
�� — r3c)
3e —3y
? Ti 5
LOCATION SKETCH
-ai �� Show direction and distance in miles frorleast
Wall Thickness two State Roads or County Roads. Includdx e royd
crR,��r&zht-Ft. Nra:eri ' number and common road names. '
NIe:hod
/0 7 S
TR
i `l IZ< <17 -c i'1
IV
CO
c- m
c<
m
rn
rn- �
cn
rn=
m�
co
i
16. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE \VITH I5A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL O .NER
3— 6i c;�
SIGNATURE OF?EONSTRUCT(NG THE WELL DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Senice Center- Raleigh, NC
27699-1636 Phone No. [phone], within 30 days.
GW-1 REV. 07/2001

- .u.rrrli
WELL CONSTRUCTION RECORD
North Carolina :Department of Environment and Natural Resources - Division of Water Quality- Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NANIE (print 1 n 7
_ j,.� `� �- l h>�• CERTIFICATIONg l r� / ,4
WELL CONTRACTOR COJIPANY NANI LL
r etn�r0L �� PHONE K
STATE WELL CONSTRUCTIO\'PERMIT. 1 '�_S�S'`)
(ifapplicable) - ASSOCIATED WQ PE Emit:
(if aoolicable)
I. WELL USE (Check Applicable Box): Residential Municipal/Public ❑ Industrial 0 Agricultural ❑
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other D If Other, List Use
2. WELL LOCAT ON: •
y�
Nearest Tov.n: i1 Z County cal /-)�L (Street Name, Numbers, Communry, Subdi 'sion, Lo +
3. OWNER:
Address
L.5
(S:rect or Rout: No.) �—
DorC SC. %?YJ
Miy gr,Tarn 5 L Zip Code
Area cunt:- Phone numberI /
4. DATE DRILLED � ' :� 6v
5. TOTAL DEPTFI: 7UCJ
6. DOES WELL REPLACE EXISTING WELL? 'YES 0 NO '13:1
7. STATIC WATER LEVEL Below Top ofCasinn:
Fr.
S. TOP OF CASING IS 1 (�F . � Iboveveanp Surface
'Top of casing terminated a t,'orb�r land surfaceAbreq irsd a Surface"
variance in accordance with 15A NCAC 2C .0113.
9. YIELD (epm): / METHOD OF TEST
10. WATER ZONES (depth):
1
11. DISINFECTION: Type H / if —Arno
12. CASING:
• Wall Thickness
Depth, Diameter cr eigh:Tt Ms/'e i,
From
From --To /i3—Ft. e Sot:-' oj*..
To Ft T
Topographic/Land setting
DRidge .Slope ❑Valley DFlat
?-t7 7y (check appropria:: box) '
Latitude/longitude of well location
(deprees'minuterrsecords)
Latitude,9ongi[ude source:DGPSOTopographic map
(check box)
DEPTH DRILLING LOG
From To Formation Description
Js-o — , 3 0
--31—
AC/o .3
`%U(J
From To Ft.—
GROUT:
13. Depth Material
From__ L To 7� i F[. Ct LiJ a /7nr
From To Ft.
14. SCREEN: Depth Diameter Slot Size Material
From To Ft. in.
in From
To Ft. in. in.
45. S.AND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
16. REMARKS:
-z`'tr-
Cez_-e.,
LOCATIONSKETCH
Show direction and distance in miles from..ivlea&
two State Roads or County Roads. Include ro
numbers and common road names. c-o
rn
rn
> on
rn
m
2 Yr
I DO HEREBY CERTIFY' THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH l5A NCAC 2C, YSFLL
CONSTR TION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OY.1TR
5 GNAT OF PERSON CONSTRL'CTNG THE WELL
76SS" -410- V.44
298184
DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mill Service Center - Raleigh, NC
27699-1636 Phone No. [phone], within 30 days.
GW-I REV. 07/2001
r

12. CASING:
Depth / Diameter
From 0 To Ft. %n Y$/
From To Ft.
From To Ft.
13. GROUT: Depth Material Iethod
From 0 To Vol, Ft. CQ-y-r_a,i /—
Ram To Ft.
Q 7631- U - v998
a48y0)918181
WELL CONSTRUCTION RECORD
North Catalina - Department of Environment and
WELL CONTRACTOR (INDIVIDUAL) NAME (print
WELL CONTRACTOR COMPANY NAME
STATE WELL CONSTRUCTION PERMIT#
(if applicable)
Resources ivision of Water Quality - Groundwater Section
CERTIFICATION #
Lam+ ✓ W `c-X-C PHONE # £ o C.(J
ASSOCIATED WQ PERMIT#
(if applicable)
1. WELL USE (Check Applicable Box): Residential Municipal/Public ❑ Industrial ❑ Agricultural ❑
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use
2. WELL LOCAflQN.
Nearest Town
(Street Name, Numbers, Community, Subdivi on, Lot No., Zip Code)
3. OWNER: j3LwiUCCL
. OWNER:dzi
(Sweet er Route Noc.) _ arias -
Town Vtate�
Zip Code
Area code- Phone number
4. DATE DRILLED II- `7 - Z� Y
5. TOTAL DEPTH: 'C 0
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO
P
7. STATIC WATER LEVEL Below To of Casing: FT.
++ I/ (Use "+" if Above Top o Casing)
S. TOP OF CASING IS l at FT. Above Land Surface`
*Top or casing term noted at/or below land surface requires a
variance In accarda'jce nwith l5A NCAC 2C .0118.
9. YIELD (gpm): J- METHQD OF TEST 14 ) r
10. WATER ZONES (depth): '� d
I I. DISINFECTION: Type i fYH Amount es 0 7
Wall Thickness
or Weight/Ft. Ma erial
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
- ray0
eRVO
a&a- t3(57)
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.
1
Slot Size Material
in.
in.
0
LOCATION SKETCH o 0
Show direction and distance in miles fromat liter;
two State Roads or County Roads. IncltA the Sid
numbers and common road names. — _ _
rn
CO
,..,
04‘dji:Lni;
-o =c
COM
fn
l /11141,67- Jab
7A_
16. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL \VAS CONSTRUCTED IN ACCORDANCE WITH ISA NCAC 2C, WELL
CONSTRUCTIONSTA �'DARDS, AND THA A COPY OF RECORD�BEEN PROVIDED TO WELLOWNER
( Mg'
IG u `/
t
SIGNATURE OF PERSONc,/
,.DNS TIKG THE FELL AT
((4;ro water
Section, the original to the Division of Water Quality, 1636 Mail Service Center - Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-I REV. 07/2001

c
WELL CONSTRUCTION RECORD 298180
WELL CONTRACTOR COMPANY NAME fJw/d-(J— jentaO _C 1)ee,�
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED—WQ PERMIT#
• (if applicable) (if applicable)
NorthCafolina Department of EnvironmentandN�jUrallResources-DivisionofWaterQuality-GroundwaterSection p�
WELL CONTRACTOR (INDIVIDUAL) NAME (print) /L(,ffs�CA J ULL-p /jg�, CERTIFICATION # fd •
% r ' to-SSsc
PHONE #
1. WELL USE (Check Applicable Box): Residential Municipal/Public ❑ Industrial ❑ Agricultural ❑
Monitoring 0 Recovery 0 Heat Pump Water Injection ❑ Other ❑ If Other, List Use
2. WELL LOCATIO?
Nearest Town:
(Street 'ame., umbers,. �ommunity, Subdivision
3. OWNER- U�
• Addres �.� 6"e"
���,VVrr''(Street or n�o-t-O
e tp'o.)�_/iy�,
5n,v>/s�t J i `7 code
(
Zip Code)
Area code- Phone number
4. DATE DRILLED / — o`2oZ ' Oy
5. TOTAL DEPTH: 357)
6. DOES WELL REPLACE EXISTING WELL? YES _NOW
7. STATIC WATER LEVEL Below Top of Casing: J FT.
(Use •-r' 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 accordance with ISA NCAC 2C .01 IS.
9. YIELD (epm): Jc'Z• METHOD OF TEST
10. WATER ZONES (depth):
g-CZ (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
315- -31 `j
3/7- 337)
c
0 o
I� LOCATION SKETCH E m
11. DISINFECTION: Type 14 _/ - Amount , how direction and distance in miles fm`� at lase
12. CASING: Wail Thickness two State Roads or County Roads. Incheele th sgad
From
Depth or R'ei ht/Ft. Ma:e•ial numbers and common road n es. — = m
To r�/.Ft. /34/ »d1.1 ll g zG c
From To Ft.
From To Fr.
13. GROUTr' \ DepthMaterial b ethod
C/ ToVD Ft tit_40,721
From To
14. SCREEN: Depth
From To
From To
15. SAND/GRAVEL PACK:
Depth
From To
From To
From
Topographic/Land setting
❑Ridge Slope DValley ❑Flat
El
Ft.
Diameter Slot Size Material
Ft. in. in.
Ft. in. in.
Size Material
Ft.
Ft.
16. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH ISA NCAC 2C, WELL
CONSTRUCTION STANDARDS AND THAT COPY OF THIS RECO$Id HA&BEEN PROVIDED TO THE WELL OWNER
SIGNA URE OF PERSON C STRUCTIN,f%THE WELL
ATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-1 REV. 07/2001

298115
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 02043
WELL CONTRACTOR COMPANY NAME Redden Brothers Well Drilling. Tyr PHONE a f828 369-9591
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT,/
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): ResidentiaPl3 Municipal/Public 0 industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other ❑ If Other, List Use
2. WELL LOCATION:
Nearest Town: Glenville County Jackson
107 toward Cashiers #3677--variance well
(Sceet Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: Sue Campbell
Address 4800 SW 82nd Street
(Street or Route No.)
Miami. FL 33143
City or Town State Zip Code
(304. 661-4072
Area code- Phone number
4. DATE DRILLED 1-30-04
5. TOTAL DEPTH: ROO'
6. DOES WELL REPLACE EXISTING WELL? YES)I3 NO 0
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 cuing terminated at/or below land surface requires a
variance In accordance with 1SA NCAC 2C .0118.
9. YIELD (gpm): 10 METHOD OF TEST blow
10, WATER ZONES (depth): 45& 85'
11. DISINFECTION: Type
12. CASING:
Depth
Front_ To
From To Ft.
From— To Ft.
13. GROUT: Depth
From 0 To
From To
H T H Amount 1 F,nr
Wall Thickness
Diameter orWeightFt. Material
42 Ft tV' �188 steel
Material
42 Ft. cement
Ft.
Method
poured
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• copies of variances included
Topographic/Land setting
❑Ridge ❑Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degsees/ninutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From To Formation Description
0 39' clay & sand
39' 300' 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.
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED TN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO Tl-M WELL OWNER
Sl�v .4, / c,f
SIGNATURE OF PERSON CONSTRUCTING THE WELL
9- 5'0-05L
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-1 REV. 07/2001
0
r
S
co

WELL CONSTRUCTION RECORD
29811.'
• North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAHE (print) James B. Brown CERTIFICATION k 2045
WELL CONTRACTOR COMPANY NAME Redden Brothers Well Drilling, Inc PHONE 0$281 369-9591
STATE WELL CONSTRUCTION PERMIT, ASSOCIATED WQ PERMIT:
(ifaoolicable) (if applicable)
WELL USE (Check Applicable Box): Residential Municipal/Public 0 Industrial ❑ .Agricultural ❑
Monitoring 0 Recw,ery 0 Heat Pump Water Injection ❑ Other 0 If Oder, List Use
2. WELL LOCATION:
Nearest Town: Sylva County Jackson
Lot #1 Grandview Estates
(Street Nate, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: Rose Jurgonski & Joseph Alderman
Address 2914 Joyce Drive
(Scree: or Roue No.)
Tallahassee, FL 32303
City cr Towr, State Z.p Code
(850 )- 562-1060
Area code- Phone number
4. DATE DRILLED 2-12-04
5. TOTAL DEPTH: 500'
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO Ig<
7, STATIC WATER LEVEL Below Top of Casino: 200 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): 6 METHOD OF TEST blow
10. WATER ZONES (depth): 130' & 240'
Topographic'Land setting'
❑Ridge ❑Slope ❑Valley ❑Flat
(check appropriate box)
Latitude'longitude or well location
(degrees•nl nutesaeeonds)
Latitude/longitude source:❑GPS ❑Tcpographic map
(ciieck box)
DEPTH DRILLING LOG
From To Formation Description
0 75' clay & sand
75' 500' granite
LOCATION SKETCH
11, DISINFECTION: Type H T H Amount 16 oz Show direction and distance in miles from at least
12. CASING: Waal Thickness two State Roads or County Roads. Include the road
Depth Diameter or W&ehLFt. Nlaterial number and common road names.
From 0 To 74 Ft.6 pvc_
From 74' To 77 Ft. C," .188 steel
From To Ft.
13. GROUT: Depth Material Method
From 0 To 20 Ft. Ida -mite & t,al L pumped O
From - To Ft.
14. SCREEN: Depth Diameter Slot Size Material 3
70
From To Ft. 01. in. I
From To Ft. in. in. - Co
—
15. SAND GRAVEL PACK:
Depth
From To Ft.
From To Ft.
Sze Material
a
to
i'
16. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH I5A NCAC 2C, WELL
CONSTRUCTION DARDS, 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
2,7699-1636 Phone No. [phone], within 30 days. GW-I REV. 07/2001

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) Mitchell D. Cook CERTIFICATION # 2041
WELL CONTRACTOR COMPANY NAME Haiti 11 Ccillii# Trr PHONE # (82R) 169_g591
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable)
(if applicable)
299236
1. WELL USE (Check Applicable Box): Residential$ 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: Sylva County Jackson
Savannah Community
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: Dillard Phillips
Address 463 Hall Town Rd
(Street or Route No.)
Sylva, NC 28779
City or Town State
(828)- 631-9884
Area code- Phone number
4. DATE DRILLED 7-8-04
Zip Code
5. TOTAL DEPTH: 225'
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO X
7. STATIC WATER LEVEL Below Top of Casing: 15 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): 30 METHOD OF TEST hl nur
10. WATER ZONES (depth): 205'
11. DISINFECTION: Type H T H
12. CASING:
Depth
From 0 To 24 Ft.
From To Ft.
From To Ft.
13. GROUT: Depth
From 0 To 20
From To
14. SCREEN: Depth
From To
From To
Amount 16 oz
Wall Thickness
D6ifimeter o.Wl eight/Ft. Material
258 Steel
15. SAND/GRAVEL PACK:
Depth
From To
From To
Material
Ftrvrrnit-p & mn-.1L
Ft.
Diameter
Ft. in.
Ft. in.
Ft.
Ft.
Method
P TIP=ri
Slot Size Material
in.
in.
Size Material
Topographic/Land setting
❑Ridge ❑Slope 0Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From T2ot Formation Description
2
0 clay & sand
Hite
22' 225'
n
LOCATION SKETCH r—
Show direction and distance in miles from at-}gast
two State Roads or County Roads. Include the road
numbers and common road names.
CO
1s.)
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
1A 2 /icarA
SIGNATURE OF PERSON CONSTRUCTING THE WELL
;—R—e
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
299235
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
W ELL CONTRACTOR (INDIVIDUAL) NAME (print) Mitchell D. Cook
CERTIFICATION # 2043
WELL CONTRACTOR COMPANY NAME Haltl Ettthers {1$11 Drilling, Tar PHONE # (82ffi 169-95:4
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable)
(if applicable)
I. WELL USE (Check Applicable Box): Residential$ 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: Sylva County Jackson
Betty's Creek
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: Melvin F. Sears
Address 422 Cross Creek Circle
(Street
Sylva, NC2879 Route No.)
City or Town State
(828)- 631-4764
Area code- Phone number
4. DATE DRILLED 6-30-04
Zip Code
5. TOTAL DEPTH: 200'
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO MX
7. STATIC WATER LEVEL Below Top of Casing: 50 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): 20 METHOD OF TEST 111 ow
10. WATER ZONES (depth): 155'
11. DISINFECTION: Type H T H Amount 16 oz
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
From 0 To 73 Ft. 6" pvc
From 73' To 77 Ft. 6" .188 steel
From To Ft.
13. GROUT: Depth Material Method
From 0 To 20 Ft. aznitp & cnmalt pnpra
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 ToFormation Description
0 75'
clay & sand
—grsanite
75' 200'
n
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include tl[eoad
numbers and common road names.
N
N.)
16. REMARKS:
1 DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
117j P -AD COVA - 3o - a1-1
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. GW-I REV. 07/2001

WELL CONSTRUCTION RECORD 299234
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 Ha}isi PEWEES V U Drill irk Trr
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable)
(if applicable)
CERTIFICATION # 2043
PHONE # 0328) if 9-9591
I. WELL USE (Check Applicable Box): Residential X Municipal/Public ❑ Industrial ❑ Agricultural ❑
Monitoring ❑ Recovery ❑ Heat Pump Water Injection 0 Other ❑ If Other, List Use
2. WELL LOCATION:
Nearest Town: Sylvia
Savannah Colflmunity
County Jackson
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: Carroll Morgan
Address 379 Hall Town Rd
Sylvan NC (s28779 Route No.)
City or Town State Zip Code
(828)- 586-2946
Area code- Phone number
4. DATE DRILLED 7-8-04
5. TOTAL DEPTH: 200'
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NOa2
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 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 bl ow
10. WATER ZONES (depth): 40', 70', & 190'
11. DISINFECTION: Type H T H Amount 1 6 07
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
From 0 To 2 Ft. 6" pVC
From 2' To 33 Ft. 6" .188 steel
From To Ft.
13. GROUT: Depth Material Method
From 0 To 20 Ft.hrnita & is nit pnp 7
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:OGPSOTopographic map
(check box)
DEPTH DRILLING LOG
From To Formation Description
0 31' clay & sand
31' 200' granite
LOCATION SKETCH -;
Show direction and distance in miles from aTTeast r' ;.
13
two State Roads or County Roads. Include tha roams
numbers and common road names. IN)
............
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
2;7,,. 060 ilk 7- P' ^ 0 9
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-I REV. 07/2001

6. DOES WELL REPLACE EXISTING WELL? YES ENO
7. STATIC WATER LEVEL Below Top of Casing: 50 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): 50 METHOD OF TEST blow
10, WATER ZONES (depth): 95' & 198'
LOCATION SKETCH
I 1 DISINFECTION: Type H T H Amount 16 oz Show direction and distance in miles from at least
12 CASING Wall Thickness two State Roads or County Roads. Include the road
Depth Diameter or Weinht/Ft Material numbers and common road names.
To 33 Ft. 6' T88 .steel.
To Ft,
To Ft.
Depth Material
To 20 Ft. termite &
To Ft
Depth Diameter
To
t. in
From To Ft. in.
15. SAND/GRAVEL PACK:
Depth
From
from'
To Ft.
To Ft.
Size
Area code. Phone number
WELL CONSTRUCTION RECORD
299328
North Carolina - Department of Environment and Natural Resources • Division of Water Quality • Groundwater Section
WELL CONTRACTOR (ILLDIVIDU,AL)NAME (print) James B. Brown CERTIFICATION „2045
WEL,i-coN' RkCTORCOMPANY NAME Hedden Brothers Well Drilling, Inc PHONE x $28') 369_9_591
STATE WELL CONSTRUCTION PERMIT*/ ASSOCIATED W(2 PERMIT/1
(irapplicable) (if applicable)
I: WELL USE (Check Applicable Box): Residential 2 Municipal/Public❑ Industrial ❑ Agricultural 0
Monitoring ❑ Recovery CI Heat Pump Water injection 0 Other ❑..IFOther, List Use
2, WELL LOCATION:
Nearest Town: Cherokee
Union Hill
County Jackson
(Sere . Name, Numbers, Community Subdivision, Lot No., Zip Code)
3. OWNER: Ralph Henry
Address PO Box 522
(Sleet or Route No.)
Cherokee, NC 28719
City or Town State
(8..2$)- 497-9708
Zip Code
4. DATE DRILLED 6-29-04
5, TOTAL DEPTH: 200'
Topographic/Land setting
❑Ridge ❑Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source,OGPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From To Formation Desor' Lion
31'clay & sand ___.._ .
0
31' 200' crranite
From 0
From
From
13. GROUT:
From 0
From
Method
trail, pumped
'F
14. SCREEN Slot Size Material
From - in.:
in.
Material
16.REMARKS
I. DO HERESY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY QF THIS RECORD HAS SEEN PROVIDED TO THEE WELL OWNER 7
SIGNATURE OF ERSON CONSTRUCTING THE WELL DATE
Submit the orig.nal to the Ditsion of Water Quality, Groundwater Section, 1636 plait Service Center- Raleigh, NC.
27699.1636 Phone No. [phone], within 30 days, GW-1 REV. 07/2001

WELL CONSTRUCTION RECORD
299324
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) James B. Brown
WELL CONTRACTOR COMPANY NAME H3BalFi #17-s Wh11 Dr"i 11 in-j, Trr
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable)
(if applicable)
CERTIFICATION # 2045
PHONE # OUR) 169-95591
1. WELL USE (Check Applicable Box): Residential E3c Municipal/Public O Industrial O Agricultural O
Monitoring O Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use
2. WELL LOCATION:
Nearest Town: Whittier County Jackson
Olivet Church Rd to Indian Hills RD
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: David Brooks
Address 203 Beech Tree Rd
(Street or Route No.)
Whittier, NC 28789
City or Town State Zip Code
(828)- 631-3411
Area code- Phone number
4. DATE DRILLED 6-23-04
5. TOTAL DEPTH: 200'
6. DOES WELL REPLACE EXISTING WELL? YES O NO PSK
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 15A NCAC 2C .0118.
9. YIELD (gpm): 15 METHOD OF TEST blow
10. WATER ZONES (depth): 125 , 135 , & 160'
11. DISINFECTION: Type H T H
12. CASING:
Depth
From 0 To 67
From 67' To 70
From To
13. GROUT: Depth
From 0 To 20
From To
14. SCREEN: Depth
From To
From To
15. SAND/GRAVEL PACK
Diameter
Ft.
"
Ft. 66"
Ft.
Amount 16 oz
Wall Thickness
or Weight/Ft. Material
pvc
.188_ steel
Material Method
FLbarnite & Malt l
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
❑Ridge ❑Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds) '_ -
Latitude/longitude source:OGPSOTopographic map
(check box)
DRILLING LOG
Formation Description
clay & sand
granite
DEPTH
From To
0 68'
68' 200'
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. n
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH I5A NCAC 2C, WELL
CONSTRUCTION STANDgq/,RDS, AND THAT A C PY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center -Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-1 REV. 07/2001

WELL CONSTRUCTION RECORD
9o
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater ectton `� r'" i3
WELL CONTRACTOR (INDIVIDUAL) NAME (print) James B. Brown CERTIFICATION# 2045
WELL CONTRACTOR COMPANY NAME ]13:1 srl BPOKOvrs W?1] Drilling Try PHONE # 'FOR) 7,69_9591
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
WELL USE (Check Applicable Box): Residential 63c Municipal/Public ❑ Industrial ❑
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2 WELL LOCATION:
Nearest Town: Sy1va County Jackson
Cane Creek Ridge -Lot #26
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: Patricia Vance
Address 16540 SW 276th Street
(Street or Route No.)
Homestead, FL 33031
City or Town Stare Zip Code
(305)_ 247-4301
Area code- Phone number
4. DATE DRILLED 6-22-04
5. TOTAL DEPTH: 400'
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO)C
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): 8 METHOD OF TEST blow
10. WATER ZONES (depth): 192'
11. DISINFECTION: Type H T H
12. CASING:
Depth Diameter
From 0 To 33 Ft. 6"
From 33 To 36 Ft. 6" .188
From To Ft.
13. GROUT: Depth Material
From 0 To 20 Ft.baw.te & cstmt
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.
Amount 16 07
Wall Thickness
or Weight/Ft. Material
pvc
steel
16. REMARKS:
Size Material
Method
Wiped
Agricultural 0
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 34 To Formation Description
0 clay & sand
34' 400' 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,
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C WELL
CONSTRUCTION STANDARDS, AND THAT A CORY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
SIGNATUP,E' 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-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) James B. Brown
CERTIFICATION # 2045
WELL CONTRACTOR COMPANY NAME H2dial BrOthet:G Fh11 Il-i11i Trip rrJ, PHONE # lROR7 Ire-4597
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable) """--"-
(if applicable)
2992"
I. WELL USE (Check Applicable Box): Residential Ric Municipal/Public ❑ Industrial ❑ Agricultural ❑
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use
2. WELL LOCATION:
Nearest Town: Whittier County Jackson
Shoal Creek--PPrI well
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: Coss Hicks
Address PO Box 44
(Street or Route No.)
Cherokee, NC 28719
City or Town State Zip Code
(828)_ 497-7619
Area code. Phone number
4. DATE DRILLED 6-25-04
5. TOTAL DEPTH: 300'
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NOXN
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 .0118.
9. YIELD (gpm): 15 METHOD OF TEST blow
10. WATER ZONES (depth): 189& 290'
11. DISINFECTION: Type H T H
12. CASING:
Depth Diameter
From 0 To 73 Ft. 6"
From 73' To 76 Ft. 6"
From To Ft.
13. GROUT: Depth Material
From 0 To 20 Ft.bsrnits & cement
From To Ft.
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.
Amount 16 07
Wall Thickness
or Weight/Ft. Material
.188 steer
16. REMARKS:
Method
RnPed
Slot Size Material
in.
in.
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
074' 300''clay & sand
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.
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTIONSTANDARDS, AND THAACOPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
/ SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-1 REV. 07/2001

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) James B. Brown
CERTIFICATION # 2045
WELL CONTRACTOR COMPANY NAME H331211 Broltprs W311 j�•-i 111TiJ, TTY,
PHONE # If37R) 769-9591
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable)
(if applicable)
299 20
WELL USE (Check Applicable Box): Residential lR3c Municipal/Public ❑ Industrial ❑ Agricultural ❑
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use
2. WELL LOCATION:
Nearest Town: Whittier
Jess Nations RD
County Jackson
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: Charles Bradley
Address PO Box553
(Street or Route No )
Cherokee, NC 28719
City or Town State
( 828)- 488-8943
Area code- Phone number
4. DATE DRILLED 6-30-04
Zip Code
5. TOTAL DEPTH: 700'
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NOX2
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 easing terminated at/or below land surface requires a
variance in accordance with 15A NCAC 2C .0118.
9. YIELD (gpm): 0—DRY METHOD OF TEST blow
10. WATER ZONES (depth):
11. DISINFECTION: Type
12. CASING:
H T H
Depth
From 0 To 32 Ft.
From 32' To 35 Ft.
From To Ft.
13. GROUT: Depth
From 0 To 20
From To
14. SCREEN: Depth Diameter
From To Ft. in,
From To Ft. in.
15. SAND/GRAVEL PACK:
Depth Size
From To Ft.
From To Ft.
16. REMARKS:
Diameter
6"
6'. .188
Amount 16 07
Wall Thickness
or Weight/Ft.
Material
pvc
steel
Material Method
FLWLitE & cstEnt pulped
Ft.
Slot Size Material
in.
in.
Material
Topographic/Land setting
❑Ridge ❑Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees,9ninutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DRILLING LOG
Formation Description
33' clay & sand
granite
DEPTH
From
0
To
33'
700'
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.
1 DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT
A+` COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
6 -j6 -.-o V
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

299
93
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
�4 tv./1421/e
CERTIPICATTION&3)2V
L.t).OJi. J/ll. Y^'"r PHONE *
_ASSOCIATED WQ PERMIT*
WELL CONTRACTOR (INDIVIDUAL) NAME (print)
WELL CONTRACTOR COMPANY NAME (-rimk_
STATE WELL CONSTRUCTION PERMIT*
(if applicable)
(if applicable)
1. WELL USE (Check Applicable Box): ResidentialEY Municipal/Public ❑ Industrial ❑ Agricultural ❑
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use
2. WELL LOCATION: L
N st Town:. t/ ✓� Coj1°ry 14t r J cd
(Street Name, Number, Comm(nity, Subdivision, Lot No., Zip Code)
3. OWNER: OOM E_ C fs#y -t
Address aytJT
(Street or Route No.)
Uiarlf-S P-"/ . 33 g.. 1
City or Town State Zip Code
Area code- Phone number �[
4. DATE DRILLED /o— 7— U 9
5. TOTAL DEPTH: 'i-DO
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO ❑
7. STATIC WATER LEVEL Below Top of Casing: /60 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 hi accordance with ISA NCAC 2C .0118.
9. YIELD (gpm): Lc METHOD OF TEST 47 ✓
10. WATER ZONES (depth):
11. DISINFECTION: Type Amount
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
From_ n To . C/ Et._ "VG.
From To Ft
From To Ft.
13. GROUT: Depth MeMethod
� From 0 To Ft._+• a }�,'it. — 1�Lamfre .l
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
0-1
(�9
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box) _,
DEPTR DRILLING LOG
From To Fotmation Description
Q,
. -/- Ca)b
16. REMARKS:
0
LOCATION SKETCH( �)
Show direction and distance in miles from,abteast `
two State Roads or County Roads. Include tl)re road
numbers and common road names.
Ni
Gt
t 'l o r_
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
%o(O -6�
SIGNATURE OF PERSON CONSTRUCTING THE WFI T 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
299885
North Carolina - Department of Environment and N lur/al esoY%rccs - Division oT Water Quality - Groundwater Section q
wid.t.COY' RACTUR(INDIVIDUAL)NA\IE rriat)e)/ hA-,11//,/C CERTIFICAT'IONq CiV/
\vf:i.t.rum IHACIORco.\O'ANANAME T ,Ce L.?/ PC,-, PHONE a (54%ce) 6277- i"
STATE \\'EI.L ('OSS'i RI C TION 1'ER\IIl'k ASSOCIATED WYQ PERMITS
I if a ppl icablel (if applicable)
I. WELL USE (('heck Applicable Box): Residential !7--0unicipal/Public 0 Industrial 0 Agricultural ❑
Nloniloring 0 Recovery ❑ I leaf Pump Water Injection ❑ Other 0 If Other, List Use
2. WELL LOCATION: %
un
Ncar'si'Fown: ✓// Gil Cot
Cjd(1LIATe -
(Sired Name. Numbers. Camm11mily. SuPdreision Inl No.. Zip Cartel
3. OWN Id2•
Address -.,'o
I Soea or Rolle No.)
4'.C.
C'ay or Town Slate
Dcpll, Dia ncicr
From t? ToIQ *" Ft. 67 s
From To FI.
fromTo • Fl.
13. GROUT: Depth N1: cria McthaJ
N .V p
From 0 Tor>, Ft.ce /✓niet
From To
14. SCRIiIiN: Depth Diameter Slot Size Material
tram To FI. in. in.
From To hI. in. in.
15. SAND/GRAVEI. PACK:
Depth Size Maleri; l
From To Ft.
Prom To Pt.
IJ779
(gX )- 9-3 3
O.��i Zip (wile•
Area Halo Phone nmnbtr
4. DATE DRILLED /-r�-3"-01"
5. TOTAL DEPTH: /�s`-�>L
6. DOES WELT. REPLACE' EXISTING WELL? YES ❑ NO M
7. STATIC' \k'ATlil( I.EVEI. Below Top ol•('asiug: �() FT.
(the ' 4" i f Ahuwe Top oT Casing)
8. TOP Of CASING IS FT. Above Land Surface*
-Top of rasing terminated at/ur below land surface requires a
variance in accordance with ISA NCAC 2C .1)I18. 9. YIELD (pm): 3o METFIODOFTEST /9,1-
10. WATER ZONES (depth):
topographic/Land setting
Ridge ❑Slope ❑Valley ❑Flat
(check appropriate box)
I al itudc/longilocle of well location
(dcgrecs/minute./secondsl
L,mimde/langilude source:❑GPS❑Topographic map
(check box
DEPTH . DRILLING LOG
Flom • To F• t atit t Description
v
4 ✓/
NQ
e
LOCATION SKETCI I
II. DISINFEC'TION:'fype 1%%/ Annlunl Show direction and distance in miles fronriTPIcasf'-'
12. CASING: Wall 'Thickness two Stale Roads or County Roads. Includilic road-7
or Mr/Ft. 1 trial numbers and common road names.
)
16. I(ENIARKS:
�w aD 7
I UO HEREI31' CERTIFY TI IAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL -
CONSTRUCIION STANDARDS. AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
_t.e>t<;Z-
SIGNATTTUI(li OF PERSON CONSTRUCTING -HIE 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 31) (lays. GW-1 REV. 07/2001

WEI4L CONSTRUCTION RECORD 299884
North Carolina - I )eparunent of Environment and Natt ul. Rc •ourccs - Division oT Water Quality - Groundwater Section
r
%El.l. ('U,\'I RAC" UI( (INDIVIDUAL/NAME (Print) e
n
WEI.L('ONIR.1("1'OI((O?NAME
D'ANV NA/CC_�.tiei/� { `A Y PIN I IOE N 6051a627- p
s'rATi: \vi:l.l. ('ONS'I-RI:("IION rr:R]IITR
I il a s 1Iicahlc)
34_n ) d4 if
AssocievrED WQ I'F:HM IT#
(il'a dicahle)
CERTIFICATION p 46/
I. \\'IiLI. USE (('heck Applicable Box): Residential C7 Nlunicipal/Public ❑ Industrial ❑ Agricultural ❑
Nlouiloring ❑ Recovery ❑ Heat Pun1p Water Injection ❑ Other ❑ 11'Other, List Use
2. WELL LOCATIO
Nearest 'lowjs:
4r\/ 9,0 9
(So-eci Name. Numbers. Community. Subdivision. Lot No.. Zip ('ode)
3. OWNE.R:/
Address L77R 4.4qW:,72-7�
ISo'ecl or Route No.) C2 '
City or 'I ow 51 lc Zip Ctalc
(QC.)- ag6 — CS7°.
Area code- Phone numb •r
4. DATE DRILLED i /T—U
5, TOTAL DEPTH: 15/5/5' /
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO Id
7. STATIC WATER I.EVEJ. Below Top ofC'asing: 30 FT.
(Use "I" if Above Top of Casing)
8. Top OF CASING IS FT. Above Land Surf;tcc
*Top of casing terminated at/or below land surface requires a
variance in aceordauc • will' 15.'. NCAC 2C .I)11N.
9. YIELI) (gpm ): t METHOD OF icir
10. WATER ZONES (depth):
II. DISINFECTION: Type )7''7$ Amount
12. CASING: Wall 'thickness •
DeplhGc� I ia17lcicr or cjgly/Pt.
Penn � To 6 J FL
Front To 1'I.
From _ "hi • _ R.
13. GROUP: Depth e MMal
From To r,�0 •'i't .
Fro
From To Ft.
14. SCREEN: Depth Diameter Slnl Size Material
From To li. in. in.
From To Ft. in. in.
15. SAND/GRAVEL. PACK:
Depth Size Nlaleriol
ee County JA CJ i✓
Topographic/Land setting
Ridge ❑Slope ❑Valley ❑FIai
(check appropriate box)
I.alilude/Iongilude of well location
(degrees/minwes/seconds)
Latitu(Ic/longitude source:❑GPS❑Topographic map
(check box)
DIiI'TII . DRILLING LOG
- To F• I ati, Description
("10 if 7
11011
LOCATION SKETCI I
Show direction and distance in miles from itileasC-
two State Roads or County Roads. Includei road
numbers a11d common road names. 1 --,
kite 2gl
From To Pt.
From To FI.
16. REMARKS:
11)0 HEREBY CERTIFY TI IAT THIS \VETT WAS CONSTRUCTED IN ACCORDANCE WITH I5A NCAC 2C, WELL
CONSTRUCTION STANDARDS. AND 1'I IAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
S ;NATURE. OF PERSON CONSTRUCTING 111E WELL DATE
0
Submit the original to the Division of Water Qualify, Groundwater Section, 1636 Mail Service Center- Raleigh, NC
27699-1636I'hune No. [phone], within 30 days. GW-I REV. 07/2001

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural ResourcesI- Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) cb-en VI 5 /)-A I i(1rA rL CERTIFICATION # oin
WELL CONTRACTOR COMPANY NAME J-X',h)jt S (ciof ifiv r1 Wei 11)16 J I T c 1. 74 t'✓ PHONE Hier is a 4-3 g6
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WERMIT#
(if applicable)
(if applicable)
I. WELL USE (Check Applicable Box): Residentialti—" tunicipal/Public 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other CI If Other, List Use
2. WELL LOCATIO :
Nearest Town: i,oy) �, /) P County cf4C(CS
�a k-e tr; egyrate <ot # i (Street Name,, �Numbers, Community, Subdivision, Lot No., Zip Code)
3.OWNER:fl-lP&f Sono kr h {n. l�IlF2S
Address Q O. jipx .-337
(Street or Route No.)
aIen;/le A/C-, 873 /P
City Or Town State Zip Code
(jab- '7YY.S-- (o a
Area code Phone number
4. DATE DRILLED 7—, 3-0
5. TOTAL DEPTH: St) S'
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO
7. STATIC WATER LEVEL Below Top of Casing: .Sa'r 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 1SA NCAC 2C .0118.
9. YIELD (gpm): / METHOD OF TEST hit»!), (�..-,
10. WATER ZONES (depth): 27) (j
299897
opographic/Land setting
rdge ❑Slope OValley QFIat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DRILLING LOG
Formation Description
DEPTH
From To
0 6, '
n)s-
t3 U G-,PEA/ r 7 e
LOCATION SKETCH
I I . DISINFECTION: Type Jt-t l/ Amount a T)g-g 5 Show direction and distance in miles from at least
12. CASING: Wall Thickness two State Roads or County Roads. Include the road
Depth /t,,.i_ Diameter S or Weight/Ft. Mate/ I numbers and common road names.
To--tFt. z2 R e j Pr
To Ft.
To Ft.
From 0
From
From
13. GROUT: Depth
From O To r Ft.
From To Ft.
14. SCREEN: Depth Diameter
From To Ft. in.
From To Ft. in.
15. SAND/GRAVEL PACK:
Depth Size Material
Material
n Method
i
Slot Size Material
in.
in.
From To Ft.
From To Ft.
16. REMARKS:
c
0
101
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 H S BEEN PROVIDED TO THE WELL OWNER
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mall Service Center -Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-I REV. 07/2001
C

WELL CONSTRUCTION RECORD
•
North Carolina - Department of Environment and Natural Resources - DivisionofWater Quality - Groundwater Section
WELL CONTRACTOR(INDIVIDUAL) NAME (print) c7)-en%IS � nJlnM n� CERTIFICATIONS or-n/74'
WELL CONTRACTOR COMPANY NAMth�4f I S tkjk ,A Wel I Y4 JJ;u e_ PHONE B . Set 4 —3 0'7. 6
STATE WELL CONSTRUCTION PERMIT', ASSOCIATED W ERMITS•
(if applicable) (if applicable)
I. WELL USE (Check Applicable Box): Residential' unici•
pal/Public 0 industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other li If Other, List Use
2. WELL LOCATI N!•
Nest Town: rl P 11 V ,/2 �it.l)e" County�J �-LI� S (J7L
/AyLOe21— -f�, h P C'� �L F 3 �o
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
299896
graphic/Land setting
dge ❑Slope ❑Valley ['Flat
(check appropriate box)
Latitude/longitude of well location
3. OWNER: Pi) Q Y1 tl P 1 cV-2- ci 0.-0-4,k_ , , (degrees/minutes/seconds)
Address -EEO• 0 f) X I..5 e Latitude/longitude source:❑GPS❑Topographic map
(Street or Route No.) (check box)
14 I C.44 L /- LDS /�/C %L/ j DEPTH DRILLING LOG
City or own State Zip Code From To Formation Description
(La- h'3&-a - rS""t-9)Y 0 /
Area code- Phone number
4. DATE DRILLED / — 6 — 0 (� / l� 5-Y
5. TOTAL DEPTH: c 9OSt
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO 0-
7. STATIC WATER LEVEL Below Top of Casing: c (I 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 'SA NCAC 2C .0118. /
9. YIELD (gpm): c% METHOD OF TEST /!D)/%n (}�
10. WATER ZONES (depth): c) 70' Q
LOCATION SKETCH
11. DISINFECTION: Type H-t» Amount c,./. Th-/3 5 Show direction and distance in miles from at least
12. CASING: Wall Thickness two State Roads or County Roads. Include the road
Depth/�� Diameter or Weight/Ft. Matey' I 'numbers and common road names.
From 0
To %/ Ft. /nat SZRay' Or
From To Ft.
From To Ft.
13. GROUT: Depth Material______., Method'll
From () To 1.-"D Ft. Ceti-n o- pcn -O . 1
From To Ft.
14. SCREEN: Depth Diameter Slot Size , Material
From To Ft. in. in.
0
From To Ft. in. in.
15. SAND/GRAVEL PACK: ut
Depth Size Material
From To Ft
From To Ft.
16. REMARKS:
1 DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY F THd RECORD Hr�S BEEN PROVIDED T�T � WELLOWNER
SIGNATURES OF PERSONn/CONSTRUCCTIIcN,(GILT•HE 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. 07/2001

Topographic.Laud setting
Gktdge [y51oi'e OValley ❑Fiat
tstlecI appmpnrt burl
Latitude'longti ud, of well Iu.anon
.-- jleareas iron
1 atia.!.l.� ion;uudc scurce•OO PSOT optiei api.i: map
)r Pali
From To
DRILLI\G Formation Des: r:puon
9. VI'tLD1_Dm)' __It.•C___ME OD OF7EST'&It1j11\ 11 i..--_...-
1!! 't1 ATER ZONES Ideptill _.. 1 01 Z ZO _ _ __--..._._.____.._.-_-
16
—i ��—� --- LO(A I I::)\ )! hJC'H
' I. I)ISI \IECTIO\'. Type l CIC3 _ Amount __Z... _. Shutt di''ali.,n ane distan_ • in mile% :ion at Teas!
12 ('ASING. µ al Thlckr:ss t%v Sane Roads or Co•anty Roads. Include P . road
Dtpra _ Diameter or µ'ciEhI- et. \ta:iva: numbers and common road names.
I nsm. C To it Ft.
WELL CONSTRUCTION RECORD 299923
',;rol;na - Department of tiniromnent and Natural Resuurc • Jivlsion of Water Quality - Groundwater Section
Lt�YYr__}t CEMT!FIC.ATION t_ 6_
NF,I,[. <'l l\IR\('l ORll\UTA iDI: ALI NAME (➢rindI_ —i
11 l.1 I l'O\ IRA( I OR CO\IPA\\ \.AMMF �t't
SI :It w1l 1. tll.S-IR((' nos. FtgMtTn�____--__.__.r
If appl:c.dil.1
'.\ E.:.L L\'.)C:he k Applicable Bin). Residential C"J :\luni.Ipe1Pu71!; 0 Industrial 0 A_ricul:ural 0
`.lonlo( n[. 0 Rccovcry ❑ Hal Pump Water Iola:mon 0 O. her O li other, List Use._ _ .-.---
�S.Jp,S,659.0.5
ASSOC (Al LI) NQ ►tRNITM
(,t upi'I:(-able)
7 \\iJJ.. LOCN1 /ya 1,
Nearvs: Tnu n. LlUV .__. CounI 4 M1-
_ u-L'_Y ok-Ste, z%i
1 i•.:rr, "t::me, Nmnbcr.. C'nnwmniq Subdivision. Lot No . Z'p Code.
.1 ,; Rnu' Z19 z-
t r'I.r:n a:a+: I'm('oIt
V. :code Pi..m:nun:hc• )r
4 I)1"E DRILLED 7-J 3-DT
TOT AL DEPTH. 2
(-,. POE\ µELL REPLACE EXISTING WEL.L.' YES ❑ NO
7 ST \ 1 IC W \ TER LEVEL Hclow Top or Casing. lZO __)-T.
!lie •" ifAscAt lop of Camnb,
t< I C)P OF CASING IS --_.� FT. Above Land Surfaae•
'lop u' cacint terminated 'Woe below land surface requtres a
sarlencr in at toraanae with I. A NC A .
Idiom T., Ft.--- _. __.__ /), ` . 1 01
hl in --- To .---- Ft - - __
I ( R C��� rDi
FT
IIL T D Jth .\irl lal \ICI oI.
Ft
1i \(R -, ti.__ Jy,u D;,.Inctu Slol SI, 141t4va. t `^
gLUCaYe64 1`( cP
i11 _.... _.._ tn. __... 1
1'-s19_ lC._.._ fI In ill __..._.----- G.)�
To
n) To
I S SAND CiRi\'•-El... PACK.
oeplb Size \Lieu.
F Mill _ To Ft
.
ror:i --- _
Ir, l<t.\I:\RICS.. - .
I L)0 :IO(;Ci\ C'1. itTIFY ii•ATII;IS µ ELL .\,ASCO\ill(LC 1ED I\ AC 7:ORD.\NC'E WITH IAA NC AI' 2C, WELL
nt:Srltt < Tu7\ "' \ AND THAT A (OM' OF THIS at( ORL) IiAS BI bN FROFIDED 10 I HE µ A
El.!. CA
r
SICUNAfl':lit OF PERSON I:O\SfRI_t it'.ti I N V. Ls. Ft-L OAre
Submit the urilginal to the Di' talon of Water Quality. Gr(lundti Alai Section Thin\till -J n, CaW!RFY:tr.' I101 SSrt IA'v 'ea t l;- 'Ralci gh, \(.
'
:-nvatnsl; Ph:Inc vn. 19lvi 111-'221, wirllin 30 dry S. `1 1
,..- ...-

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Na 1 Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME
QQ (print) .L.a / L- CERTIFICATION ti %
WELL CONTRACTOR COMPANY NAME .(N.fI oO tie Lc' .f/ /4 ). A t f..t4. i0 ACNIONE #8r2.A L/ 4 $a
STATE WELL CONSTRUCTIONPERMIT/ / � ASSOCIATED WQ FEERMIT# T igR •.2l t.Ai
(if applicable) (if applicable) -- -
1
WELL USE (Check Applicable Box): Residential $. 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 n
N st T �Ou�l�LLd` County , ,
000 a I'
(Stree ame, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER:
Address /77 ei%r rcid cift
(Street or Route No.)
ity or Town State Zip Code
(— )- Area code- Phone number
4. DATE DRILLED .S/c2 D /lO 9
5. TOTAL DEPTH: .2 D 'S'
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO (SI
7. STATIC WATER LEVEL Below Top of Casing: /9 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 •
variance in accordance with 15A NCAC 2C .0118.
9. YIELD (gpm): 3 D ME OD OF TEST? n1 p
10. WATER ZONES (depth): VD i �t O'
/ fS'
11. DISINFECTION: Type C. N 1 /. Amount $ t OL
12. CASING: Wall Thickness
iarneter
From 0 To rho
From To
From To
or Weight/FL
#.2/ ttafial
/C-
13. GROFrom f Depth
e,�/ /.Material a
From !/ Too(Q FL t��.f'K.GW
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_GTo Ft.
From !/ To Ft.
16. REMARKS(
C)
Topographic/Land setting
°Ridge °Slope °Valley 1Flat
(check appropriate box)
Latitude/longitude of well location
—1
I, 7,
4
(degreea/minutes/scconds)
Latitude/longitude source:DGPSOTopographic map ..
(check box)
DEPTH DRILLING LOG
From To Formation Description
LOCATION SKETC1-
Show direction and distance in miles fro,g.3%� at liZiat
two State Roads or County Roads. IncltW the read
numbers and common road names. C
1T
C.J
O
CO
0-4
„in
o'
21.10
>rt
t-4
o
rnz
mP:3
ti
O
z
1 DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH ISA NCAC 2C, WELL
CONSTRUCTION STANDARDS, ANjYF3IAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
e11'W4 Sae. s410/109
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

\1'LLL CONS1KUL,uv;1 nr.t.ustcu
nr.a- 1)..p. ri f irm lyi �,ci❑ ,1;e:r irC 1:�.,(5�. rC A _„fl
\1"ELLCONTRACTOR(INDIVIDUAL) NAME (print)) tr lmrlrir( Atli hLSD
WELL CONTRACTOR CO\IPANV NAME (ap'A-Greene 13ioS l-e)e-GU Dr1,
STATE WELL CONSTRUCTION PERMIT:. ASSOCIATED WO PERMIT;
(if appticable) (if applicable)
7Col Y�/6� 13'7✓�
tdinn
CERTIFICATIONX 0?-27 7
PHONE k ( ISS-'eP'L --rgro
1. WELL USE (Check Applicable Box): Residential g Municipal:Public ❑ Industrial 0 Acricultural ❑
Dlonitoring 0 Recovery ❑ Heat Pump Water Injection 0 Other 0 I Other, List Use
2. WELL LOCAT
Kear:st Town: Counts
(S:re:: N'o:::e. \a:a:es. Contmu :ic:. Subdivision:. Lor Na,. Zip Code)
3. OWNER: t c44ro71T-
Addr:ss gjo/in/J0%
)
teG.v✓v "" 7 / ( OC
27,15
{c�;ry orlb,.c S: Zip CoJe
(I`0 1- �i5&.—'3 Y
Area:,.a Pbor: am::bc
4. D:\TE D3lLLED 7-15-0
S. TOTAL DEPTH: 175-
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO
7. STATIC WATER LEVEL Below Top orCasin_: FT.
(1'se ".. if A:o:.: Top oTCa;ivl
S. TO? OF CASING IS I FT. Above Land Sura_e
u!cesin;; trra,ivat.d at'ur b 1us Frio surL:a require, a
hire:t:r in x:nrJia:e uirh 15.\ NCAC IC.0113.
9. YIELD (_n ' -7 METHOD OF TEST
W. WATER ZONES (depth`: g S / 1AO/ f (/
1 . D:S'\FECTIO.N:Ty 1 Amour:
12. CAS:NC: 1''..2. Thick.ess
Cr
From
From
I6. REMARKS:
From. To Ft.
From To Ft-
15. SAND GRAVEL PACK:
Dc , S.ze
To Ft.
To FI
Dtcth Fr:-:0 Tc (v 4 Ft. /.e . :. I LUecCL p" LT q / N
From To Ft. T
Fnr. To Ft "G',
Fro - ) 0 T; Ft. Lp -->.T '�7J P '—L- 'L6:h�J
From 3 To w Ft ��ti �w "n f°'f.k_" 1
�i 'ir
14. SCREEN: Dc_r. Din.cter Siot Sze (/ DI_•r.;a ���j
e9�O sFc�O
0Q 4
Topographic/land setting
❑Ridge OSlope ❑Valley Fla:
(check appropriate box)
La;itud 'Ioneitude of well location
La:itud.o'loneitude sourz:OGPS❑Topa raphic nap
box)°.
DEPTH DRILLING LOG
From To Formation Description
LOCATION SKETCH
301565.
7,G 2— s:'o'.c direction. _nd'dis:an:c is rill from a: leas:
Roads cr Co::n . Ron_s. I1cic'e f,: roc:.
r::clxrd ar' co:: r c' . r,c.:1 rr-:es.
1:1.
la
I DO HE 1EBV CEP.T!FY THAT THIS WELL WAS CONSTRUCTED IN A'_CO?.DANCE WITH H LiA NCAC 2C. WELL
CONSTP...CTIONSTA(Da.R S. AND .A.TA OF THiSRECORD HAS EEENFRO\IDEDTOTH:EP:ELLO'WNER
f,t/1�4( l -`-e .. ? — O (7`
S:GNATL RE OF PERSON CONSTR_CTINS THE WELL DATE
S.hm1t the ori.ginal to the Di'ision of \\ titer Quedict. Ground,' a'er Set:or.. 1636 )IaUS:r',i;: Cen::r-Aweigh, NC
2769)-1535 Poor: No. (919) 733-312 , v: ichin
C
Ol):
G;:..1 R—v':67 2

WELL CONSTRUCTION RECORD 3 0 1 6 O J
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 Ft3C$31 PrOt712T5 Nell f1r-t11irq ire PHONE # (828) VQ-9591
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable)
(if applicable)
I. WELL USE (Check Applicable Box): Residential Municipal/Public ❑ industrial ❑ Agricultural ❑
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use
2. WELL LOCATIO
Nearest Town:
h 0
(Street Name, N
3. OWNER:
Address
if
City.tt Town State Zip Code
( ) a is s.�Oa
(Street r oute 7o.)
` N
Area code- Phone number
4. DATE DRILLED / -30- Cy
5. TOTAL DEPTH: % 150,
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO
7. STATIC WATER LEVEL Below Top of Casing:
(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 accordanceJth ISA NCAC 2C .0118.
9. YIELD (gpm): w METHOD OF TEST hi nw
10. WATER ZONES (ddpth):
T.
11. DISINFECTION. Type H T H
12. CASING:
Depth s Diameter
From_t._
To 5ahFe ' _
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 Material
Amount 16 n7
Wall Thickness
or Wgght/Ft. Material
.a56
Material
Ft.tatnitn & runs It
Ft.
Diameter Slot Size Material
Ft. in. in.
Ft. in. in.
Method
P'Ria3
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
cl-y & sand
,501a - ) I. O' 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.
sSe° 9o7co� 7o
%
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
yjJe ,e• 7 - 30 -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-1 REV. 07/2001
I / -

WELL CONSTRUCTION RECORD
301604
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) Mitchell D. Ocek CERTIFICATION # 2043
PHONE # JAN) lEQ-9591
WELL CONTRACTOR COMPANY NAME FECthrl arldesS WaU Editing' _Tr
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential$ Municipal/Public ❑ Industrial ❑
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use
2. WELL LOCATIO
Nearest Town:
0,4
County
/ ISi nt/ 44.4
. •i 4 o
.41
ityp% ApAe._. .
li 4..'
(Street Name, Nm
3. OWNER:
Address
City o
tote) -
ers,
ninun
ry
APIMINT I
4
1
State
0
•
Zip Code
Area code- Phone number
4. DATE DRILLED s l,ol•o
5. TOTAL DEPTH: 6
'/ . ,a'A1
1#' /' 0.2a
No., Zip Code)
6. DOES WELL REPLACE EXISTING WELL? YES&NO ❑
7. STATIC WATER LEVEL Below Top of Casing: FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING 1S 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):0 11 METHOD OF TEST hl rxa
10. WATER ZONES (dep ):
11. DISINFECTION: Type
12. CASING:
Depth
From_ To ��
From To
From To
13. GROUT: Depth
From__ To 20
From To
14. SCREEN: Depth
From To
From To
15. SAND/GRAVEL PACK:
Depth
From To Ft.
From To Ft.
Agricultural ❑
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 T Formation Description
0 clay &sand
granite
H T H
Diameter
Ft. 8"
Ft.
Ft
Amount 1 6 oz
Wall Thickness
or Weight/Ft. Mptetib
Material
Ft]gynita & rvmr!lt
Ft.
Diameter
Ft. in.
Ft in.
I6.REMARKS:
Size
Method
P'R'R
Slot Size
in.
in.
Material
Material
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.
4tt14i
"0 rtitit,
eoof
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH l5A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
cam' .� /_024 7-1.2-0if
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
Y'
Subdivisio

WELL CONSTRUCTION RECORD
301603
North Carolina - Department of Environment and Natural Resources • Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) Mitchell D. Ccok CERTIFICATION# 2041
WELL CONTRACTOR COMPANY NAME Mtn PatharS Nt1.1 �tllimr TIl's PHONE # fR2R)-1FiQ-9591
STATE WELL CONSTRUCTION PERMIT#
ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential Municipal/Public Industrial ❑ Agricultural ❑
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other o If Other, List Use
2. WELL LOCATI
Ne es tTown: County
(Street Name, Numbers, Co, muniry, Subdivision, `t No., Zip Code)
3, OWNER:
Addre s
/�e
City, `own t-ate Zip Code
Area code- Phone number ^^ _' /
4. DATE DRILLED B'pt �(y CJ7'
5. TOTAL DEPTH: /1Vdt
6. DOES WELL REPLACE EXISTING WELL? YES NO ❑
7. STATIC WATER LEVEL Below Top of Casing: / 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 accordaryce with ISA NCAC 2C .0118.
9. YIELD (gpm): hi MET OD OF TEST h1 Or"+
10. WATER ZONES (depth): 3't'
11. DISINFECTION: Type
12. CASING:
Depth4
From 0 To �J
From To
From To
13. GROUT: Depth
From_ 0 To 20
From To
14. SCREEN: Depth
From To Ft.
From To Ft.
15. SAND/GRAVEL PACK:
Depth
From To Ft.
From To Ft.
16. REMARKS:
H T H Amount 16 07
Wall Thickness
D0y'ii�meter or Wei ht/Ft. Material
Ft. Q' .e45o 6teil
Ft.
Ft.
Material
FibmoniteiLaamrt
Ft.
Diameter Slot Size Material
in. in.
in. in.
Method
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 f Formation Description
0 .1a2 clay & sand
52' //00' 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.
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
_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

WELL CONSTRUCTION RECORD
301602
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) Mitchell D. COo)C CERTIFICATION # 2043
WELL CONTRACTOR COMPANY NAME HECtiEn Brothers ;cell LL11IiIYir Tir PHONE # JR2S) -ifi9-9541
STATE WELL CONSTRUCTION PERMIT#
ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential$ Municipal/Public ❑ Industrial 0 Agricultural 0
Monitoring ❑ Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCAT
Nearest Town
(Street Nam
County
division, Lot No., Zip Code)
3. OWNER: (aj/I/f,GLO C s(/f//i-LOJJ.CNLCi
Address
.(St eat or RQIIIe NoC.)
iv
0?87se
City or Town StairZip Code
4. DATE DRILLED ,r4)49'011
5. TOTAL DEPTH: /MO
6. DOES WELL REPLACE EXISTING WELL? YES NO 0
7. STATIC WATER LEVEL Below Top of Casing: FT.
(Use "+" if Above Top £Casing)
8. TOP OF CASING IS 2 FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accords with ISA NCAC SC .0118.
9. YIELD (gpm): METHOD OF TEST h1 ow
10. WATER ZONES (depth
Area code- Phone number
l 1. DISINFECTION: Type H T H
12. CASING:
Depth ameter
From To A' Di
Ft. l0
From To J' Ft. io tt
From To Ft.
13. GROUT: Depth Material
From 0 To 20 Ft.hee niter & n:mpri1
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.
Amount 1 6 nz
Wall Thickness
or Weight/Ft. Material
,18e)
Method
P n['3
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 e Formation Description
0 33 clay & sand
3 S' /60a] 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.
16. REMARKS:
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
%17.., Z ScoA R'-7_o4'
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

3. OWNER:
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 FY7a1 acthars.1 1ki111rch Trr PHONE # JRil) 369-9591
JU1UV1
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
I. WELL USE (Check Applicable Box): Residentiallg Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery ❑ Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELLLOCATIO/� �) /�_ ,--_ ,
Ne3rgst Town 11lQbl! County t�(J
���� h -
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
Address (S60_
Q(Street oAr Lute No.)
City or Town i Stat Zip Code
(td.11)- (024 - a 78&
Area code- Phone number
4. DATE DRILLED_ 8-5-oH
5. TOTAL DEPTH: JC t
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO X
7. STATIC WATER LEVEL Below Top of Casing: .O 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): 0 METHOD OF TEST 1
10. WATER ZONES (depth): 135 t .as -8�rt
36
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 T e Formation Description
0 0� clay & sand
granite
11. DISINFECTION: Type H T H
12. CASING:
Depth Di
From To /q Ft.�
From To e2 Ft.J
From To Ft.
13. GROUT: Depth
Fromm To 20
From To
14. SCREEN: Depth
From To
From To
15. SAND/GRAVEL PACK,
Depth Size
From To Ft,
From To Ft.
meter
u
Amount 16 07.
Wall Thickness
or Weight/Ft. Myterial
188 Mal
Material
Ft hat & c>srrnF
Ft.
Diameter Slot Size Material
Ft. in. in.
Ft. in in.
Method
Ft' -81
Material
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.
I6.REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUC ttD IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
%�.. e,39 _A9
SIGNATURE OF PERSON CONSTRUCTING THE WELL
S-o4%
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-1 REV. 07/2001

WELL CONSTRUCTION RECORD
301600
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 }J1 $chars M11j7YJ. IYY` PHONE # (R23) l69-9591
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential$ Municipal/Public ❑ Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATI
Nearest Town
(Street Name, Num.ers
3. OWNER:
Address
County 4021
munity, bdivision, Lot No., Zip Code)
A(^egt or Route ftJCNo.) 078717
City or Town gtate Zip Code
(Roe -7q — &B15
Area code- Phone numberh apy(
4. DATE DRILLED 6 /y'VT
5. TOTAL DEPTH: DO I �{
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO fE'
7. STATIC WATER LEVEL Below Top of Casing: 110 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 accorda ce with ISA NCAC 2C .0118.
9. YIELD (gpm): �� MM.TH QDD OF EST hl rxu
10. WATER ZONES (depth): .60
11. DISINFECTION: Type H T H Amount 16 nz
12. CASING: Wall Thickness
Depthrt Dlpme
ToR� Ft.( 4188ter or Weight/Ft. Material
From
From Q To Of O Ft. ((�O
S
From To Ft.
13. GROUT: Depth Material Method
From 0 To 20 Ftbr+rnitn & txarwit Fltrca
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 Q' clay & sand
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.
16. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH l5A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
J,:/4%9 / , eea4 Q-.2Li-05i
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-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 CERTIFICATION # 2043
WELL CONTRACTOR COMPANY NAME 11 Ett±DETS !Atli tr 1i1 nr The
STATE WELL CONSTRUCTION PERMIT#
ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
PHONE # f8281 1hq-9591
1. WELL USE (Check Applicable Box): Residential$ Municipal/Public ❑ Industrial ❑ Agricultural 0
Monitoring ❑ Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATIO /
Neatest Town:_. i{id County �P_ )
(Street NamhNumbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER:
Address
(Street oq e No.)
a67'79
Qp��ppCir Ton' 4 7 Zip Code
((Jfeid' a�/r/4- 6 �ji+
Area code- Phone number p '
4. DATE DRILLED T J / OT/
5. TOTAL DEPTH. �i Do
I
6, DOES WELL REPLACE EXISTING WELL? YES 0 NO
7. STATIC WATER LEVEL Below Top of Casing: SO 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 accorda with 15A NCAC 2C .0118.
9. YIELD (gpm): n METH D 2F T T hl nw
10. WATER ZONES (depth): &lo ' Y w•O
1 I. DISINFECTION: Type H T H
12. CASING:
Depth �/ Diameter
From Q To 1 / Ft. el
From .5 7 s To / FL
From To Ft.
Depth Material
To 20 Ft.ha1nita & (atnL
From To Ft.
14, SCREEN: Depth Diameter
Amount 16 nz
Wall Thickness
or Weight/Ft. atenal
let?Q
13. GROUT:
From 0
From To
From To
15. SAND/GRAVEL PACK:
Ft. in,
Ft. in.
Method
PrTal
Slot Size Material
in.
in.
JVIJOJ
Topographic/Land setting
❑Ridge 0Slope ❑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 a Formation Description
0 clay & sand
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.
Depth Size Material
From To Ft.
From To Ft.
16. REMARKS:
1 DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
tie Zota '7- 9-a'1
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-1 REV..07/2001

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - DivisionofWater Quality - Groundwater Sectionn
WELL CONTRACTOR (INDIVIDUAL) NAME (print) c�i n V1 i S /4-n') rid - CERTIFICATION d c1 /7 l
WELL CONTRACTOR COMPANY NAME; jynj i $AiJo. IW el 11)Yi 1 I :-tt d_7711. e J PHONE M ..Sac L/-3 6
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED W ERMITB•
(if applicable) . (if applicable)
1. WELL USE (Check Applicable Box): Residential' unicipaI/Public 0 Industrial 0 Agricultural 0
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other 17 If Other, List Use
2. WELL LOCATION:
Nearest Town: C-hen✓.IIt CountyJ4-LICSlrv'—
I b'1 S To 1; Inf. Cvc•ek- L a- �IrPtVr)t e
(Street Name. Numbers, Community, Subdivision, Lot No., Zip Code) a g 73 t.
3. OWNER: C IrV\1-0-w.•area r1..
4
5
6
7
Address LP- D- B D X (v r6 S
Royce. (Street or Route No.) c� 1,
r 1oy$C Sho-e ,%uC. p'%Ta-
City or Town State Zip Code
£z- (oQa -bl3
Area code- Phone number L�
DATE DRILLED P b
TOTAL DEPTH: .Q S'
DOES WELL REPLACE EXISTING WELL? YES 0 NO W—
STATIC WATER LEVEL Below Top of Casing: -rO FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS / FT. Above Land Surface*
*Top of cuing terminated at/or below Iaad. surface requires a
variance In accordance wIth ISA NCAC IC .0118.
9. YIELD (gpm): J METHOD OF TEST A 1Ife .
10. WATER ZONES (depth): in 2' !SD' (l
LOCATION SKETCH
11. DISINFECTION: Type kill Amount ri.TA-6I < Show direction and distance in miles from at least
12. CASING: Wall Thickness two State Roads or County Roads. Include the road
Depth Dia ter or Weiiht/Ft. Mate l numbers- and common road names
From 0To Si Ft. S.a R e n P IP
From To Ft.
From To Ft.
13. GROUT: Depth Material Method ,
From () To tap Ft. CQ421 tty,7 pClityLi
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
301574
T ographic/Land setting
edge ❑Slope ❑Valley OFIat
(check appropriate box)
Latitude/longitude of well location
• (degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DRILLING LOG
Formation Description
DEPTH
From To
0 SP }p
-ct' SBS' tSLUI a-lets-e_,
From To Ft.
From To Ft.
16. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
ae
CONSTRUCTION STANDARDS, AND THAT A COPY OF THJS RECORD 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
or

3019,32
S y s6/ w
WELL CONSTRUCTION RECORD .-7 s- 8 cJ_ / 2- in
6.7a
North Carolina - Department of Environment and Natural -N((ayttu�ral Resources - Division of Water Quality - Groundwater Section pY//)
WELL CONTRACTOR (INDIVIDUAL) NA\IEE�(print)t)T.U. �C 3US 1 CERTIFICApT�I�ON# . 1U
WELL CONTRACTOR COMPANY NAME AAA Green e 1>res l2,5 mill PHONE # (yytSafi? -5-557
STATE WELL CONSTRUCTIONPERMIT ASSOCIATED W Q PERV IT#
(ifapOlicable) (if applicable)
1. \VELL USE (Check Applicable Box): Residential t$ Municipal/Public ❑ Industrial ❑ Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other ❑ If Other, List Use
2. \VELL LOCATIQ N: L1
Near stTown: 9-1enullic County J'i-c_k_SdrJ
•rueA- {{. �►ccA&73f
(Street Name, Numbers, Community, Sadly -iron, Lot No., Zip Code)
TopographidLand setting
DRidge 'Slope ['Valley ❑Flat
(check appropriate box) .
Latitude/longitude of well location
3. OWNER: ){a -I iC. € I y (degrees/minutes/seconds)
Address P a 66-v 036 Latitude/longitude source:❑GPS❑Topographic map
(5...... or Route No.) (check box)
Ttkcje aseQxry fi &' a $ 7S3 DEPTH DRILLING LOG
Ciry or Town State Zip Code From To Formation Description
(124- Sat/ -/5/9
Area code- Phone number
4. DATE DRILLED 5-/I-041
5. TOTAL DEPTH: oZ 0 0
6. DOES WELL REPLACE EXISTING \VELL? YES ❑ NO (c(
7. STATIC WATER LEVEL Below Top of Casing: 1$ FT.
(Use "T' if Above Top of Casing)
S. TOP OF CASING IS j FT. Above Land Surfaces
• •Top of casing terminated at'or below land surface r eq u ires a 073
variance In accordance with 15A NCAC 2C .0118. /� G/� — ^a
.5"P
9.YIELD (epm): � METHOD OF TEST /r r �nr.,..%
10. WATER ZONES (depth): /aO 01 •sL
LOCATION SKETCH '9 �fl
11. DISINFECTION: Type f+T H Amount 7 d 2. Show direction and distance in miles frorrtleast O'a
12. CASING: Wall Thickness two State Roads or County Roads. Include the road ret
Depth Diameter or R eigcommonEt. Ntateria! numbers and commonroad names. • �+73
From 0 To SG FL (, dig 5 PIK 21 PVC_6/1 �1 S Is
0
From To Ft. �r O
trt
From To Ft. /."JLQ� ca
13. GROUT: Depth Material Method
From 0 To -3 Ft. C Slac- . f' / ,
From 3 To 'ZO Ft.-rctun'v-t� pm�.o,.l w {'4%n-) , ^ V yam,o
14. SCREEN: Depth Diameter Slot Size Material (f"1-1—" !) co_42
From To Ft. in. in. Or
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Size Material
—
as-- Jae
lac -/a3
/aR-aelo
From To Ft.
From To Ft.
a
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 CONSTRUE-T-PNG THE WELL DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mali Senice Center - Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-1 REV. 07/2001

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) /��l Y 1' I e LUJ r r9 CERTIFICATION taiga
3 revile.3YPa 1)0-at Doll
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PER IIT#
(if applicable) (if applicable)
WELL CONTRACTOR COMPANY NAME
301931.
54X3s0
75-7&--/0-S'1a'I
PHONE # f52A.5 fl-'-5-s3—c?
1. WELL USE (Check Applicable Box): Residential ($ Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring ❑ Recovery ❑ Heat Pump Water Injection 0 Other ❑ If Other, List Use
2. WELL LOCATI
Nezcest Town: Qrl
Countyvn
a91& Pa
a wnec.�ie�. 173�
)
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Cdde)
3. OWNER: 6&iL uw'
Address Pc 60-14. a3'
ems t (Sweet or Route No.)
�•1'CC.JC.
I
City or Town State Zip Code
- S1S10—g7t1z-
7�G .2-151.65
Area code- Phone number
4. DATE DRILLED S 2 -o4-
5. TOTAL DEPTH: (BUD
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO I'
7. STATIC WATER LEVEL Below Top of Casing: IS FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS ) FT. Above Land Surface*
•Top of casing terminated atfor below land surface requires a
variance in accordance with 15A NCAC 2C .0118. �I
9. YIELD (gpm): a METHOD OF TEST 47?'
10. WATER ZONES (depth): 1? L.0
11. DISINFECTION: Type H T H
12. CASING:
Depth
From 0 To %Ur
From To
From To
13. GROUT: Depth
From_O To Ft
From 3 To Zvi Ft
14. SCREEN: Depth
From To Ft
From To Ft.
15. SAND/GRAVEL PACK:
Depth
From To
From To
Ft.
Amount aroT
Wall Thickness
Diameter or R'eicht Ft. Material
lo'�y spR.if Puc
Ft.
Ft.
Topographic/Land setting
❑Ridge DSlope ❑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
DEPTH
From To
rm
n
Tv
'a �ot
J ad
Show direction and distance in miles from at least rn;
two State Roads or County Roads. Include tc*9road w"•
numbers and common road names. •Zp
0
Material �,7.�,.^ M--etthhodd-p�
Di meter SlotSize t Material
in. in.
in. in.
Size Material
Ft.
Ft.
LOCATION SKETCH
t�
c
16. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
SCE•
SIGNATURE OF PERSON CONST{F2CTING THE WELL
�l- I4-0`i
DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center -Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-1 REV. 07/2001
•

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources
- Division of Water Quality
Y 7 WELL CONTRACTOR (INDIVIDUAL) NAME (print) arl);) rc//9 7/7/ u
rC ene. 1.3.z'r Lo ZLj (�.,15
STATE WELL CONSTRUCTION PERMIT. ASSOCIATED WQ PERMIT.
(ifapplicable) (if applicable)
WELL CONTRACTOR COMPANY NAME
301929
Js- agc>1rc�
7(oa3-33-ase (
- Groundwater Section
CERTIFICATION* 171 9 /
PHONE # fgag S`Xb'-L-s3 C.)
1. WELL USE (Check Applicable Box): Residential 5g Municipal/Public ❑ Industrial ❑ Agricultural ❑
Monitoring 0 Recovery 0 Heat Pump Water Injection ❑ Other ❑ If Other, List Use
2. WELL LOCATI/ptr-
Nearest Towmi �LJetdkee County ja-CkJf->J
Fuel/ CAero/&.t /(IC•', a811q
(Street Name, NumNeers, Communittyy, Subdivision, Lot No., Zip Code)
3. OWNER:ROYLCidt
Address /1 , 7 O SW
(Street or Ro'e 'o.
W ebS
'Jt- f )r.
o,33S97
City or Town State Zip Code
(Wa' ,q3-7 q69
Area code- Phone number
4. DATE DRILLED 8- a 3- D 54
5. TOTAL DEPTH: -2Qr
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO'W
7. STATIC WATER LEVEL Below Top of Casing:'/ 6 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 IiA NCAC 2C .0119.
9. YIELD (¢pm): LA METHOD OF TEST At•'
10. WATER ZONES (depth): MS -
II. DISINFECTION: Type hJ T H-
12. CASING:
Depth Diameter
From /O To L FL (e tVi
From To Ft.
From To Ft.
13. GROUT:
From 0
From 3
14. SCREEN:
From
From
Depth Material
To 3 Ft.
To 20 Ft.
Depth Diameter Slot Size Ma,enal
To Ft. in. in.
To Ft. in. in.
Amount JUt/q et Z
Wall Thickness
or WeightTt. Material
5/JaRJ1 Pac,
Topographic/Land setting
❑Ridge RSlope DValley ❑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 - 6 3
to3 -/a-
/a,c -/a7,5
/a s da.s-
_otn
0
LOCATION SKETCH —1�m
Show direction and distance in miles from- least c�
two State Roads or County Roads. Include -tree. road oQ
numbers and common road names. • t.- ��
N n
Cell I1 Method
"''h�y„' `�
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
16. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS ,g.NP THAT A ?Y OF j yhIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
4
/yam0?odc
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Senice Center - Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-1 REV. 07/2001

30192S.
a 470 7V 711/
WELL CONSTRUCTION RECORD -7(, / / _ 8a _ 3,5,42_,
North Carolina - Department of Environment and NaturalatResources
�-/�Divissiioo of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (,priinnt) /7 li-r+//ICJ// /fit//4.i ?1 CERTIFICATION # Qs97
V,ELL CONTRACTOR COMPANY NAME Thtzr"CY/P-P/2 e 73.ros 4./e-LF Dn PHONE # gap SlZ-�. r0
STATE WELL CONSTRUCTION PER\IIT# ASSOCIATED WQ PER\IIT#
(if applicable) - - (if applicable)
1. WELL USE (Check Applicable Box): Residential Municipal/Public ❑ Industrial ❑ Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water n)ection ❑ Other 0 If Other, List Use
2. WELL LOCATION:
Nearest Town:
1-trt - 1244-t
County_�A�hSEr
MC;%00
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
re-4&J�-c Sc -
�3
12. CASING:
Depth
From a To Ft. i0 'I 1$f lalctoadpxa�a-Q.
From To Ft.
3. OWNER:
Address 0`�1083
f5 bor-oet or Route�C•) 7a,S"
rnagvr)• °TLP -$t�tza Zip Code
Area code- Phone number
4. DATE DRILLED 2 - 20 -0 t/
5. TOTAL DEPTH: a 7a`
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO Cav
7. STATIC WATER LEVEL Below Top of Casing: 1 a 0 FT.
(Use "r' if Above Top of Casing)
8. TOP OF CASING IS I FT. Above Land Surface*
•Top of casing terminated a tior below land surface requires a
variance in accordance svitii IiA NCAC 2C .0I IS. l
9. YIELD (gpm): eZO • METHOD OF TEST /7I Y
10. WATER ZONES (depth): 5
11. DISINFECTION: Type L4- r It Amount P.351C
Wall Thickness
Dia,eter or Weighr.'Ft. Material
From To Ft.
13. GROUT:
Topographic/Land setting
❑Ride (lope ❑Valley DFlat
.. (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
9-3
0-9.3
�� � - 21
'75
aa�- a•�s
Ox
s�
�n
Aa
-a -01;
LOCATION SKETCH �D
Show direction and distance in miles from aT13 ast mt�TV
two State Roads or County Roads. Include (t koad 20
3
numbers and common road names. • Op
W Zg
�- Fozlt:o ZaAAvreo
rN*Q
Fe
From rl To 3 Ft. 0.2rn-
From -3 To A Ft At,itirt,rni_ t'Qto-kra- ' _ n r)
14. SCREEN.
From
Depth Material Method
Depth Diameter Slot Size Material
To Ft. ir. in.
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Size Material
Depth
From To
From To
Ft.
Ft.
)m
16. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED TN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, A}D THAT A PY OF,rTj7i!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

301927
3y25loaDO
7la3/- So-Iyos
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Q Section
WELL CONTRACTOR (INDIVIDUAL) NAS1��E ��(pLLr,ii�nt)JlM art t nn JJ'14 of 1 r CERTIFICATION k / 7
AAA
- - �lC/iC jBrvs OW 017 PHONE # ( 75$10 '3 o
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PER\IIT#
WELL CONTRACTOR CO V PANY NAME
(if applicable)
a
WELL CONSTRUCTION RECORD
(if applicable)
1. WELL USE (Check Applicable Box): Residential/itMunicipal/Public ❑ Industrial ❑ Agricultural ❑
Monitoring 0 Recovery 0 Heat Pump Water Injection ❑ Other ❑ If Other, List Use
2. \VELL LOCATIO
Nearest Town:
?TIC -an
(Street Name, Numbers,
3. OWNER:
Address ' O 63( 3 L (o
Street or Route No.)
.tea-19-L6-' i '7'1 C a R Iar
City or Town State Zip Code
(qc j)- .S-Tao- S53-0
County
ommunity, Subdivision, Lot No., Zip Code)
n< atlas
Area code- Phone number
4. DATE DRILLED -it -oil
5. TOTAL DEPTH: 4SD
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO II
7. STATIC WATER LEVEL Below Top of Casing: 1 SU FT.
(Use "T' if Above Tcp of Casing)
S. TOP OF CASING IS FT Above Land Surface*
•Top of casing terminated at/or below land surface requires a
variance In accordance with 15A NCAC 2C .011S. n 9. YIELD (epm): 3 o METHOD 0„.t. TEST /f I r
10. WATER ZONES (depth): / 70
aesas
11. DISINFECTION: Type 1-f rkr Amount r�O..4rC2Z
12. CASING: - Wall Thickness
Diameter or Weiaht.Tt. Material
/yi 3Die P 00.
Depth
From 0 To 7Co Ft.
From To Ft.
From To Ft.
Topographic/Land setting
[Midge SidSlope 0Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(dearees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DRILLING LOG
Formation Description
DEPTH
From To
Jar -.3a7
iq7-370
37a-373
373-Ys
co rn
• niryl
tr• i
rn
-o Q
LOCATION SKETCH j pp
Show direction and distance in miles from at least r^;
two State Roads or County Roads. Include toad n+p
numbers and cornrnon road names. • , • cafl
rcl
13. GROUT: Depth Material Method
From 0 To 2 Ft. 67..-Yr..o—r.+,2
From 3 To 2-v iY Ft. t_ `i p11n1
14. SCREEN: Depth Diameter Slot Size Maternal Tr
From To Ft. in. in.
From To Ft. - in. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
LLB tz190
16. REMARKS:
1 DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT P, COP THIS RECORD HAS BEEN PROVIDED TO THE WE L OWNER
/� - aON
ON CONSTRUCTrNG THE WELL
DATE
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

WELL CONSTRUCTION RECORD %7S `37 jo(
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - GroundsSSz t(o'j6 Q VV
CERTIFICATION: 111/0 e0
WELL CONTRACTOR CO>IPANY NAME
'A IA PI-PP/Fe
e
STATE\WELL CONSTRUCTION PERMIT# �Gi
(ifa ilkable)
\WELL CONTRACTOR(INDIVIDL'AL)NASIE (print)_, f 1, `C <-(•l-E•
at Mt
ASSOCIATED \WQ PERMIT
(if aaolicable)
PHONE #
1. WELL USE (Check Applicable Box): Residential I Municipal/Public 0 Industrial 0 Agricultural ❑
iiIonitoring 0 Recovery. 0 -Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATI N:
Nearest Town: County
(S:rce: Name. N; b::>'. Community. Subdi -isior., Lot No]Zip Code)
3. OWNER:
Address I -IO J rai44—e— .
(- rotor Rout: Na)
City or Town Ss: Zip Code
(1101 g77_97at
Arta c.i:- Fhone umber
4. DATE DRILLED g -OV
=. TOTAL DEPTH: tar
6. DOES \VELL REPLACE EXISTING WELL? YES 0 NO Ur
7. STATIC WATER LEVEL Below Top of Casing: / 0 FT.
if Ab,r. To; of Casing)
S. TO? OF CASING IS / FT. Above Land Surface'
ev>im; terminated u:.'ur befun Land surfe;e requires a
saran:c in ucca rdamr• s. ith 15A NCAC 2C .0119.
9. YIELD (g=n): ' 30 METHOD OF TEST
10. \Y.-1TER ZONES (depth): ) 00
1 1. DISINFECTION: Type 1-t Yt Amount . do 5 07
12. CASING: \'.211 Thickness
Depth Di:m.-. c- pe e,.-''F; :.i .,
Fro::: 0 To
To
To
Detrth
Ta
FrFrom3 To? 014. SCREEN: Depth
From To
Fron: To
15. SAND GRAVEL PACK:
Depth
From To
•Fror.: To•
? rOS
F; rv.�yiyscv4S, 5:6-e1L a
Fro-. Ft.
Fro::: Ft /
13. From'_ t: \::i:r N!er ad r) —3 e,�,,,../ /C , J tutu.
` Ft.1C1 Yam--,�-- - W. aDiameter S'ut Sir :\Iti:r
Topo_raphicrLand setting
❑Ridge ❑Slope ❑\'alley got lat
(check appropriate box)
Latitud 'loneitudeofwelllocation
301925
(degreea'.imre>'secoads)
Latimdo longitude sour:::❑GPS❑Topographic reap
(check boa)
DEPTH DRILLING LOG
From To Formation Description
a �=
/CO
/oo -102
/0.Z -as
Ft. in. in.
Ft. in. in.
S:ze Nlz:eria.
Ft.
Ft.
OG
o oa
- �0
LOCATION SKETCH nZ
Show' direction and'di;:un:e in miles froth a: leas: % �03
......---
cc;
two S:a:c Roads or Co::n:c Roads. Inzlude the ro-d ta y�
nun; ers and cor::mon r.a_' namesi tP m0
r-3 0
16 REN!:\RKS:
I DO HEFIEBY CERTIFY THAT THIS WELL VAS CONSTRUCTED IN ACCORDANCE WITH I?A NCAC 2C. WELL
CONSTRUCTION STANDARDS. AND THAT .A COPY OF TF:I5 RECORD HAS BEEN PROVIDED TO THE WELL OWNER
i
SIGNATURE OF PERSON CONS%f._CTING THE WELL
C1-
DATE
Submit the original to the Division of Water Quality, Ground,.ater Section. 153c \Iil Ser iee Center - Raleigh, NC
27699-1636 Phone No. (919) 733-32221, n ithin 30 das. G'C..-1 REV. 07:2001

WELL CONSTRUCTION RECORD CrS/ ,g3 w
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
\TELL CONTRACTOR (INDIVIDUAL) NAME (print)
'AAA
CERTIFICATION#.. L.P-(7
1t'ELL CONTRACTOR CONI PANY NAM E T7/424 djrern-P 2ss-�CetM I( lae
PHONE # .SO(f) sJv C
STATE %ELL CONSTRICTION PERMITS ASSOCIATED \\'Q PERNIYT
(i f applicable)
(ifaaolicable)
2. WELL LOCATIO.'. . Topographic/Land setting
'
N. cst Town: /4�� �^ "' founts 2Q1e9y�+-7 ❑Ridge ❑Slope ❑\'alley kkat
?-�(".�J(r � J n ,/'2 8 7/7 (check appropriate boa)
I Siete: Name. Nu:n; S . CCC::nu it . Subdivisfoi Lot No.. Zip Code/ Latitude'longitude of well location
1. WELL USE (Check Applicable Box): Residential$ blunicipaL'Public ❑ Industrial ❑ Agricultural ❑
blonitorin2 ❑ Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use
30I9^r
3. OWNER: !Q]
Address /b- 3
no a er Rou'e lar: n 3 7/ 7
i.c or Town
T•Cn-C•/S/_ r� Zip Code
(ay)- in- 3179
A-e c.de- Plane combo:
4. DATE DRILLED
5. TOTAL DEPTH: SU(J
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO pi
7. STATIC WATER LEVEL Below Top ofCasin< /UD FT.
(L'se'=" if Above Top of Casino)
S. TO? OE CASING IS 1 FT. Above Land Surface-
-Top of mine r:r-iinoted a:.'ur tabu Iv.id surf] c requires a
wriameir: ueo rd.ence it i:h 15,\ NCAC 1C .01 IS. • 9. YIELD (_Dn):— p�-"y�-- > !ETHOD OF TEST 1)24—,
10. W.'.\TER ZONES (d!pt`): 62
I1. DIS!NFECTION: Type jf 4.-}
122. CASING:
An,tint c (e OZ
\'•.-.I Thickness
From 0pegC:1 e.c crV.eiuh:Pt. �:o:n'L!
To 37 Ft'ii; ' SD//Li piC: o
From To Ft G
Fra;:i To Ft L`-�� N n�
Fro-. U To _7i Ft..-P��� ( %r L
Froni 3 To,..)_ Ft lye -retie- a.."' n"
14. SCREEN': Depth D:ar,:e:er S:ot S:ze r \Ia:er,^.1 From. To Ft. in.
From To Ft. in.
1=. SAND GRAVEL PACK:
D<a,h Sze
From To R
-Frog: Tc - Ft.
(de_:eesAninu:ei iecords).6
La:itudc'lon_itude source:❑GPS❑Topographic map
(check box)
DRILLING LOCI
Formation Description
DEPTH
From To
- ea.
.3?- -.RXO
c eta - xnv
in.
in. •
Nlareria'.
16. REMARKS:
CD cm
Cr)• Ill .91 <
LOCATION SKETCH -O -om
Show di.eodor...nd'distanoe in miles from. at lea 00
two State Roads Cr CC.:n': Roads. Include the rS#d �r0,.a
nett:'::ers and common road names. 'U n2
c4 a.
I DO HEREBY CEP.T(FY THAT THS WELL WAS CONSTRUCTED IN ACCORDANCE WITH I5A NCAC 2C, WELL
CONSTiCCTION STANDARDS. AND THAT A COPY OF THIS RECORD HAS SEEN PROVIDED TO THE WELL OWNER
Jam, I'' aC rr
SIGN.ATLRE OF PERSON C0STR:CTING THE WELL
DATE
Submit the original to the Di',ision of WaterQuality. Ground"•ater Section. 1636?tail S:ni:e Center- Raleigh, NC
27699-1636 Phone No. [phone]. aithir. 30 days. G\':-I REV. 07.2001

. 1YP;LL CUi\J A tt U i- IA WI 1
WILL CONTRACTOR COMPANY NAME,
STATE ‘I CONSTRUCTION PERMIT:
(if applicable)
7S64
o;ti, L -uiiru - D-parttacnt u L i:unm n eaa h;:;uaai RCSGw _ > :c i;!e.. of \': ater Quality. - Li: c x to '0b /��y /.
\YELL CONTRACTOR (INDIVIDUAL) NAME (print) 1�! �--�:.- r' CERTIFICATION. rR/O(%e,
.{-GpQ' !ic._'5r U» -Dr CPHONE : O
, �. ----Ili°r'�t�t--IATED \)"Q PER(.(I(1T
(if applicable)
WELL USE (Check Applicable Box): Residential IX- MunicipaUPublic 0 Industrial O Agricultural ❑
Monitoring ❑ Recovery ❑ Heat Pump Water Injection 0 Other 0 IF Other, List Use
2. \\'ELL LOCATION: �, Q,�
NearestTown:T�,(!Kaa.SC�eryt County `,t..��r/<'cr-t'7"
Nu:nbe:s. Com:nueity. Subdivision. Lot No.. Zip Code)
o •cn S_t:: / Zip Cc.ef
Are_ PS.oce � /
4. DATE DRILLED S —) CD— d
5. TOTAL DEPTH: 390
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO
7. STATIC WATER LE\'EL Below Top c(Casir,c. FT.
(use 'iF Abo':c lap o,rCuc>s
8. TO? OF CASING IS 1 FT. Above Land Sur(a_e-
•Tn'i of n>iu;; r:rrnin3 and ardor lends•] rine red etra>
vsrivn:eie. e.enrJnr'•vv i:h 1i:\ NCAC 2C .0113.
9. YIELD (antra): ' / METHOD OF TEST
10. EATER ZONES (d:p: h): ;3 t4 0
• 3 4, 0
1 DISINFECTION: Tv6e is I /4
12. CASING:
Fro::: 0
From
Fr r.
13. GF,J':T.
From 0
Fro,., 3
14. SCREEN:
Fro
Front Ft.
15. SAND GRAVEL PACK:
De2th Size
Front To Ft.
:Even: To F1.
I6. RE\!c\PKS:
Amount % %.S�• !1'Z
Walt Thickness
Deoth
T08 cLFt. (014
Tc Ft
To Ft
Dsath
T; _3 Et
To Z-O Ft
Depth Div,:e:e: Slot Size
Tc Ft. in.
in. in.
Ib'xal-14{ dii 2
Topographic/Land setting
❑RidecfSlope ❑\'alley [Mat
(check appropriate box)
Latitudelloneitud: of well location
301 505
(d:zr;eiminu: s.fror.dt)
Latitude longitude soure:DGPSOTopographic nap
(check bo}
DRILLING LOG
To Formation Description
From
LOCATION SKETCH F�P1��/O
Silo.): d o ±c in miles °o,m2:le3'< e.tk 9
pc . S:. F. ? c. Co - Roari. 1 1ude the road 0a,,��/4,
,..' con.:nen r.,'_ r_nies t9 '_ 'Z• P*"
t et
de7
k/C 1J ./-_1 tyr hJ
Evv
I DO HERE E':" CERTIFY THAT THiS WELL WAS CONSTRUCTED IN ACCORDANCE WITH I?A NCAC 2C. WELL
CONSTRUCTION STANDARDS. AND THAT A COPY OF THIS RECORD HAS SEEN PROVIDED TO THE WELL 0A'NER
o
S:GNATCRE 0:? PERSON COS-STt=ISTi\O. THE WELL
DATE
Submit th.e original to the Dkision of Water Quality, Grour,d,tater Sector. 1036 \1] S: Ce er R e , NC
2_-69:-1535Pima: No. (919;73t3221,sithin30days. - I' I,) C�#" I,REV:Gi_200;

. 111iLL L.V:\J 11�vv�..
.T `p / rn -i d` a 37 t
north C o.iw - D Patintent c f r iroi.::,_nt anu hMattur� (Rcsu...... L../-i.,:.:n. o. 11 ate. �. y _ L' .a,wzw C,��
2
r
\WELL CONTRACTOR (INDIVIDUAL) NAME
,��\(ppr�rintt))J I taA t _.'+ ""-r y.i Q,�� CERTIFICATION # /
WELL CO.NTRACTORCOM?ANY NAMEM\A lr,te.e-r-A. tQ24 LQ-1S+/C7 C_ PHONE # (& /1 J f - sz � 0
STATE\W ELL CONSTRUCTION PERMIT; . ASSOCIATED %VQ PERMIT=
(ifaoolicable)
(if applicable)
I. WELL USE (Check Applicable Box): Residential, Municipal/Public 0 Industrial ❑ Agricultural ❑
Nlonitorinw ❑ Recovery 0 Haat Pump Water Injection 0 Other 0 1 Other, List Use
301509
2, WELL LOCATION: �
Nearest To\v _ A. Cca-a-,.
c4J C.. ( iJountW' �; ir ). -b nci
(S:r-' \a--' . Nu-',,`- s. Coocununit . 5vh'i'ision, Lot N.D. Zip Cods)
3. OvCNER: l .T h/'i/�L-o04, #. ,
AdT
dress /L—A .5s ti4 P
• (S:ru_: or Rouse No.)
1-4.11 71 C. a a7Y4s
Cr!. or Tu,x:: u!t Zip Co..!e
(TA)- 511P'- 33
DATE DRILLED -" 0CI
5. TOTAL DEPTH: (p 7S
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO �(
i. STATIC WATER LEVEL Bald.. Top ofCasinia: FT.
IL'se" 15Asa Top orCasio_l
TO? OE CASINO IS FT. Abet.: Land Surface-
-I iip cu)ing t:rr.:iruud u''ur btivu ❑::d surf4 requires
sur:..tn:e is accurduace wi:h 15.\ NCAC 2C .0113.
9. YIELD (_cm): ' 114,1• METHOD OF TEST /�-
I0. WATER ZONES (depth).
I1. DISINFECTION: Tvx
12. CASING:
De
From0 To CIS Ft.
Front To Ft.
Frain To Ft
13 . G RO': T` De'. :
From
To.
'pi Ft.
From, 3 To_2.Cj Ft
Topographic/Land sewing
DRidge Glope ❑\'alley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(du;,eiininu:Ci.'secords) .
La;itudo longitude source:OGPSOTdposraphic map
(click boxf
DRILLING LOG
Formation Description
DEPTH
From To
0--1fo
n1202: 2
ZPD— 62-
9 - 2 - 7,S
LOCATION' SKETCH
I-t ) 1-1- Amount 34\3 Y Q' 2 Show direction and'dis:anze ir. milts from a: leas:.
\•.:?I Thickness two S:... Roods erCe::n : Roads include the road
\r.-c-:.: r:un._:a and cor:mor. road came �C
cr\':e,h:h�
50rczj Pvc leo ea
90i<O4,
Q
cob .115
sit 4,
LODiameter
C/r7
14. SCREEN: Dc_t„ Dace:r S'o; Size
From To Ftin. in.
From To Ft. in. ir,.
IL. SAND GRAVEL PACK:
Depth Size Alareria'
From To
Fro:. Tc
16. REVI:ARKS:
Ft.
Ft.
Method
/Z`}2
1 DO HEREBY CERT,FY THAT THIS WELL v:AS CO
CONSTi:_C T ON TAND..2DS. i\ jeA C
RGCTED IN ACCOR DASCE WITH I5A NCAC 2C, WELL
OF TH:iS P.ECORD HAS BEEN PROVIDED TO T& 'JELL r9'\\'NER
i
SIGNATLRE OF PERSON CONSTRCCTINC THE WELL
Suomi; the original to the Di\ision of Water Quality, Ground\\ ate:- Section
27699-1636 Phone No. (919) 733-322 1, v, ithin 30 daA s.
DATE
1636 Mail Service Center- Ra1eigh, NC
GL I R
_AI. 07. 200:
, r I
SEP 1 7 2004

i, tl Cairo ino - )c nnctm'rrl o` 1[n:l', inn: r erid r•Hir uai RCS0a cc Divis?i
WELL CONTRACTOR(I.NDIVIDLAL) NAME E% (print) 4-r 1 gj-'iI IS
M WELL CONTR:ACTORCOMPANI'NAE/'I
(AA .,reeve "Bros IA)at
STATE %YELL CONSTRUCTION PERMIT: ASSOCIATED 4Q PERMIT:
(ifapplicable) (ifaoolicable)
TT a
c, 7/eb Y �5t/
- CERTIFICATION:-(Qt? 7
PHONE C / Y �4�-Ssi 0
1. WELL USE (Check Applicable Box): Residential ❑ Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery ❑ Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION: a
Nearest Town: IDPbs+..� cr County /"lC-—S"h
N'a:ae, \v:rbt:. Ccr::aurity. Sabdivislort, Lot No.. Zip Code)
3. O\VNER:.PYmP4a (Iop r
Addr:ss c?r3 5` / Igoe seer 2ci
(S::::: or Pour: No.)
-Sc� I e � N C a.9 7�
Cc o.'- gate Zip Cod:
(R4.4)- SSb- 5796
A-aa:.d:- ?nor:: r.:::b:r , /
T. DATE DRILLED 1-30 -6
5. TOTAL DEPTH: q 75"
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO
7. STATIC WATER LEVEL Below Top c,rCasiva: 40
(Lir,- if Aio:: Top or Casir;l
8. TO? OF CASING IS 1 FT. Above Land Surface'
Top or casing trrndrie tad o_br bHus. Fend surface requires u
1,U :2^.:e in ororderee ni:h ISA "CAC 2C .C113. A
9. YIELD (_7m):' 3 '-!ETHODOFTEST /4I Y
ID. \`..ATER ZONES (dapthk a i i)
II. Dr.SI\'FECTION: Typo 14 1-1-1 Am.30:1:.2 139as_
i 2. CAS NG: Y'..a'i Tir:ckr.ess
Fro : 0 Tor Lc Ft. (0''A/:r I is ee 5..�u_..P
From To Ft
Front To Ft
13. GROG: D.,-;' M �):e:),dd
Fron Q T. FL�?_ 6Y%1J
Fr.•r�, a- To oZf� Ft 2. fJ-tinv f>Paa'
14.. SCREEN: De;;,• D:ai:,e:e: scot sr- Ma:er....:
Fro-. To Ftin. in.
Fr,:nt To Ft. in. in.
15. SAND GRAVEL PACK:
D4pCn Size Ma:erai
Frog To Ft.
•Fro.:.. To Ft.
16. REM ARKS:
ETT..
r.:..._-rs and C0rtr Cr. road r.on:s.
Fuv.
TopoLgraphictand setting
❑Ridge fASlope ❑\'alley ❑Fla!
(check appropriate box)
Latitude/longitude of well location
301508
(desr:n mi,:u:ei'secords)
Latitud:'longitude soure:OGPSr0Tepa_raphic map
(check box)
DEPTH - DRILLING LOG
From To Formation Description
0-4g
5'8 calor)
.R(00 tab 3
i2
1A
Poai
fr
LOCATION SKETCH IP �.cf'0
S:ho..v dix.�, _nd'dis._nce ir. riles from 4.)43: FAO
r.vo S:J:_ Roads cc Cccat: Roods. Include t'nOkla_ /p4-
11,Lc—Y1— z�
�j� /1I/2ut of
I DO HEREBY CEP. JI FY TH s CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 22C.\'+TELL
CO^'i OF THIS P=CORD HAS BEEN FRO':'IDED TO THE `''.ELL OWNER
SIGNATURE OF PERSON CO.ASTR;.CTINC THE WELL
DATE
Submi• ti:e original to the Di'ision of %\ater Qualit', Ground•,n:er 5ecrban. 1535 )IairScni:e Cen:er-Raleigh. NC
G\t--I RE -A-. 07. 200:..
2T697-I536 Phone No. (919) 733-322 t, n ithin 30 dai s.

..,orti C :�,;n:•, D , rtn--.arrt r , ICJ: ' .tt N:�' ffi.) T �',: isio n o" .::er (.2..:
\TELL CONTRACTOR (INDIVIDUAL) NAME (print) c� l� 1I1 %-( 1:4.4"l— f�
\YELL CONTRACTOR COSIPANV NAME AAA /.-e-tAn e &zs OC7e2% Dr
STATE WELL CONSTRUCTION PERMIT: V - ASSOCIATED \VQ PERM
(if applicable) (if applicable)
CERTIFICATION �
7N:-C-J�C�/�v
PHONE # ((➢rdo — 5 <7ID �G
WELL USE (Check Applicable Box): Residential Municipal/Public ❑ Industrial 0 Agricultural ❑
Monitoring ❑ Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATI=\
Nearest Town
(S:r::: Name, Nt tb :s. Ccc,.
4 r L
mk>. Subdi4isior:, Lo( a.. Zip Code)
3. OWNER: D, IYI %a, �zP II�u
- I-47
r, ::.: c is \0off t 61 2 7s7?
o.n
Address
Cie: or l 5'u / Zip Code
Axe xde- Prot:: rtatilt.er
4. DATE DRILLED Y— /c, —
5. TOTAL DEPTH: 457)
6. DOES V:ELL REPLACE EXISTING WELL? YES ❑ NO 0
Topographici'L.and setting
r, ❑Ridge Ar Slope ❑Palley ❑Flat
c 72��ii (check appropriate box)
JLatitude'longitude of well location
30150.7
(dxr:eiminu:e tsecor&) <
Latitude/longitude soure:0GPSDTopo_ra?hid ma?
(cheek box '
DEPTH DRILLING LOG
From To Formation Description
— 38C � cnvx
3S'5-33'7 C-6-y 4,
7. STATIC WATER LEVEL Below To? or Casing: /00 FT.
(Use "=' i.'Aio:: Tcp o.FCasing)
S. TO? OF CASING 15 / FT. Above Land Surface-
-to 'n.iu;; termiva:cd ubr land sdrtce requires a
%nure in uc:o rJn ce n i:h Is:\ "CAC 2C .o t i S.
9. YIELD (_'m): 3 METHOD :NTH' S OF TEST
10. WATER ZONES (depth):
11. DISINFECTION: Type /' % ti ?.natal Qi
12. CASING: V._:1 Tirar:eii
D: ;:-. D::-.cter o-:C:e:gR. NSL2:,:ri!
Fro::, 0 To / £'3" FL 6,%/ 5P/z 7,/ PVC-
From. To Ft.
FIX71 To Ft
From 0 Tel__3,_ Ft. R.Emrt' n*
From, 'B To 700 Ft bSnci_b -
1,. SCREEN: Depth, Diante:or SIo:Sze " :\latarl
Fro,-. Tc Fti❑. i::.
Fro; To Ftir,. in. .
15 SAND GP AVEL PACK:
Depth 5
Frog:. To
To •
Fro,:.
Ft
F.
LOCATION SKETCH
So'.‘.. direction _nd'di>._noe in miles from a: leas:
t)vo S:.c; Roads cc Cci:.n:v Roads. Include Elea road
...bees and common nod_ names
16 REMARK - /f[ / .Q.: d4-001-zr /A O� /t/�2/ O 7 —07"
I DO HEF'.EB V CEP.T!FY THAT THIS WELL \VAS C NSTP..L'CTED IN 21.CC07-D?.\CE \'VI E H I iA NC.=.0 2C, \S'Er L
CO\STi:'_CTIO\ STANDARDS. AND T H.AT A COPY OF THIS RECORD FAS BEEN PROVIDED TO THE WELL OvSER
SIC\ATCRE OF PERSON CO\5F?'{ \C THE WELL
Submit the original to the Division of Water Quality. Ground•:.^,ter Section. 1536 ).lil Scr.
27699-1536 Phone No. (919) i_3-_ 221, vr!thin. 30 days.
7l - 0 4
D.'.TE
Center- Raleigh, NC
GP. -I REV. 0 2OH)
12 I
SLP 1 7 r.OUV•

\Yt1LL cuiNis1tcU'11UI\ r\L.t-.tit( r'` n�
i c: Eh C�alina- Lpaw:lent ci 11 tiron:a-� u:;
\1ELLCONTRACT'OR(I\DICIDLAL)NANII EE, print) � ^�
WELL CO.\TRACTORCOMPAN NAME /i r/T l !//
STATE IVELL CONSTRUCTION PER>IIT:
(if applicable)
-
NatL a l F zsuuiy-e L) v lion of \4ater Q I
�, rncPALrr
�teenP rr5 nr./
CERTIFICATION% die
PHONE # (a ?S3 ' S3 sD
ASSOCIATED \�Q FERMI
(ifaoolicablej
1. R'ELL USE (Check Applicable Box): Resid'ential;j Municipal/Public ❑ Industrial 0 Aericultural ❑
Alonitoring 0 Recovery ❑ - Heat Pump Water Injection ❑ O:her 0 If Ocher, List Use
2. V'ELL LOCATLN:•
`vc (-ninLe taa:&--a-T.._/fl
7.25Nearest Town: County
Nu:ab:rs. Cor::nu.:it_. S'ubdivisEon, Lot No.. Zip Cede)
3. OWNER: P
Address L(&+a.,d .2-D !o
(Src:: or Rdu:: No.)
�ttn �.— 33 —76
Cnc ur To“c 51:: ( Zip Cote
(QIal- 16/— Sn7a-
Are/ c:u- /
1. DATE DRILLED (O!'c2II- 0Li ,
5. TOTAL DEPTH: 7/O
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO a
7. STATIC WATER LEVEL Belo',: Top of Casin_: (0u FT.
Rs: Air.: To; o.rCasic_l
/ S. TO? OF CASING IS FT Above Land Surfa;e-
-Ti, cubing urz hi mired it'or btu" I�ad S9rLca reNcires a
V. c is arcu rdin:cvkh I:,v \CAC 2C .0113.
9. YIELD (._, I): ' 7j METHOD OF TEST 4-1r
10. WATER ZONES (depth). 2470
A:10;17.t , ii_ Li z.
12. CASING: �''.:� Thickntis
Tc• cy
Fro-; To Ft.
Front Tc FE
13 . G F.•J _ T: Dc,:F..
From 0 T: .3
Front .3 To Z.
1-1 SCREEN: D._:F, Dtax:c'
11. DISINFECTION: Type ft % /�-
Fro::', b
Frm- To
Fro,.. To
15. SAND GRAVEL PACK:
DeptF.
Fro.., Tc Ft.
•Fro). To . Ft.
F1 yM'-,y-r`—
Ft Ote.--i b tA—
Dian:::c S'o: Size
F. in.
16. REM AP -KS
.
S;z: Ala:eria!
Topographiciand setting
❑Ridge ,'Slope ❑Valley ❑Flat
(check appropriate box)
Latitude'longitude of well location
(Lit-prtfrain•tees: secordt)Y
Latitud-_'Ion_situde sour::❑GPS❑Topo_ra?hic nap
(ci: _kbut)
DEPTH - DRILLING LOG
From To Formation Description
0 -- 6'a2.
SR —3-g0
390 -- i2-
311 —11/0
QK-CF
c sAo*e,
LOCATION SKETCH
U�FyP
dc.;:io,a. and'd;::_ �:e is r..ile> fro;;, a: ems: Oycp
E::o S:ax Roads cr Ca.:n:: Roads. tcaud_ the K9.4 0 J'F�a�O
n:niaca and coc:'non road r.anies. CQ
mAu;, -Iv>7,
I DO HEREBY CEP.TIFY THAT TEI5 WELL V: A5 CONSTRCCTED IN ACCORDANCE WITH I iA NCAC 2C, \'•.ILL
CONSTR:'_CTION STA\RkRDS. AND THAT A COPY OF THIS FECOJ FAS BEEN PROVIDED TO THE WELL O's.1'ER
ftC,v 6 -31—o4
SICN.A T CRE OF PERSON CC ST�1NG THE WELL DATE
Submit the original to the Division of Water Quuiity, Groundssa:e,- Section. 1636?la?l Scr,
27699-1636 Phone O. [phone], Nsith in 30 dals.
Cen:er - Re!ei•gh, NC
Gv:-1 REV. 07.2001
SEP 1 7

WELL CONSTRUCTION RECORD
301784
North Carolina - Department of ;am/worm-lent and Natural Resources CERTIFICATION ZOaS
James F.. Erown
11ELLCOtvTRACTOR(I��NDIVIDUAL)'NAp1E (Prinq 9 PHONE # 28'1 —9591
wE1.L Corr R;\cTo11 COMPANY NAme Header. Brothers. Weil Drilling, Inc
STATE WELL CONSTRl1CTlON PERMIT# ASSOCIATED WQ PERhitT#
•
".. (if applicable) <
(if applicable) •.
1. WELL USE (Check Applicable Box). Residential Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water injection 0 Other 0 IC Other, List Use —
WELL LOCATION:
Ne^ estTown:•• County
< }L
¢1II VifVv
(Street Name, Numcrs, Comm,unn'iony, $ rv❑ Lot No .dip Code)
OWNER:
Address {'0BOY— 0g46
(5 trees. orJCReu le No.)
(�?��'w t r.
(SitJrB
City or Town et Z.p Code
i b�JS
Area number op,
3f ON
DATE DRILLED
TOTAL DEPTH; Nth) 15 01
DOES WELL REPLACE EXISTING WELL? YES /❑s NO
14.
STATIC WATER LEVEL Below Top of Casing: e?t0 FT.
(Use +" if Above Top of Casing)
TOP OF CASING IS 2 FT, Above Land Surface'
'Top . of casing lerm!nated allor below land surface requires a
var!an ceIn accordance qwith 15A NCAC 2C .0118. blow
9 YIELD (gpm): 10 METHOD OF TEST
10. WATER ZONES (depth): 8
0M4C rA.).
a8188
DISINFECTION: Type H T H'
CASING:
Depth
From 0 To Ft
From Tc Ft
From To Ft, _
13 GROUT. Depth - Material
From 0 To 20 Ft, ieniiite & lxuucs6. pu'np�
From To Ft.
14 SCREEN Depth. Dtaoreter
From To Ft, m
From To Ft. in,
15. SAND/GRAVEL PACK:
Depth Size
From To. Ft.
From ToFt.
16. REMARKS
1 DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORD4NCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STAN ARDS, AND THAT A OPY OF THIS RECORD. HAS SEEN PROVIDED TO THE WELL OWNER441-1
SIGNATUREOFPERSON CCNSTRUCTINGTHE 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
Amount 16 oz
Wall Thickness
or Weight/Ft. Material
Slot Size Material
in
in.
Topographic/Land setting
❑Ridge OSlope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds).
Let!tudc/longitude source. OGPSOTopographic map
(check box)
DEPTH DRILLING LOG
From To Fe/motion Description
0 clay & sand
Granite
LOCATIONSKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common road names.