Sw CY2004

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Naum21 Rk csources - Division of Water Quality
wELLCONWRALTOA(I,NDIYIDUAL) NAME (Print) ,)P
fe y
WELL CONTRACTOR COMPANY NAME
STATE WELL CONSTRUCTION PERMUTE
(tfapplicabte)
r
Graham l eij/ rv/./CYL' PHOIIEY 1122 rf 7- r1%-i"I
ASSOCIATED WO PERMIT#
((applicable)
2. WELL LOCATION: C Count S (�'A r n
Nearest /Town: i t7V
/I,Grtl rbk/ hrc/ie-A Qi?7/3
t Namc taws• Community, Subdivision. Len No- Zip Code)
(Street I/ r�� II ecity
3. OWNER. Rr CAtreA S Te (#JerT
Addrtss f ,r kor t/ bi wh
(Sot or Route No.)
Bryson C,'ry Mc
Cny er Town State Zip Code
(PR)- y47- L O/7
Atrx code- Pbnne number
4. DATE DRILLED 4-/o-0�
5. TOTAL DEPTH: S70
6. DOES WELL REPLACE EXISTING WELL? YES O NO Ei
7. STATIC WATER LEVEL Below Top of Casing: /04 FT.
(Uric "+7 ifAbow Top orOtOnz)
8. TOP OF CASING IS / FT. Above Land Surfaces
*Top easing terminated atfor below bad surface Malin a
variance In aecordmee wan ISA NCAC 3C .0111.
9. YIELD (gym). / a METHOD OF TEST o...t r
10. WATER ZONES (depth): / 'C
a�7/3
11. DISINFECTION. Type I-1 t Fe Amount !a. "2 0
12. CASING: wall Thickness
Depth Diameter or Weight/FL Materiel
From I To /[s Ft. 6,p •S)r2I PVC-
Ft.
From To FL
From To
13. GROUT: Depth Material Method
From_ -a___ To Q.0 Ft e el nien % Po mfir l y
From To Ft. rrJY
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
From
To Ft
To Ft
16 REMARKS'
292694
- Groundwater Section
CERTIFICATION a
I. WELL USE (Check Applicable Box): Residential 1 MunicipaVPublic 0 Industnal 0 Agricultural 0
Monitoring ° Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
Topographic/Lend setting
ORidge °Slope OValley OFlal
(check appmpriase box)
Latitudellongitude of welt location
I
tdcgmesrmimnahscoods)
Lalitudellongilude seurcc;ooPSDTopographic map
(checkboc)
DEPTH DRILLING LOG
From To Formation Description
(J1
LOCATLON SKETCH N
Show direction and distance in miles from Oast -z
two State Roads or County Roads. Include the road
nprmbets and conanon mad names.
, ram 4mon Nosro� iCF
Turn %P1T err! 79EGo /93%n'/fS Turn
R,• hr6T Ex,'T 74cAerokee Gv. 0.6,I'17•%s
T rn/e7'Ton Co- mperFPA"Act CO• h
Mies Tvrn le•P on N,ekory bra
%)iod�Q her, a.Snn,'/es To 4ouse cell
on fah/'.
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
/-C-01f
DATE
T-Pt°ry %/ cle
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 r...-.GW-TREV. 072001

North Carolina Department of Environment and Natural was - Division f Water Quality
WELL CONTRACTOR (INDIVIDUAL) NAME Ipd�ut) r')Ie I Nf X y 0
WELL CONTRACTOR COMPANY NAME (T r a,YIa. rr L-) ' 11 d'-r r 1l r'l'tv
STATE WELL COASfRUCf1ON PERMIT# ASSOCIATED WQ PERMIT#
Ofapplicable) (if applicable)
I. WELL USE (Check Applicable Box): Residential la Municipal/Public 0 Industnal 0 Agricultural 0
WELL CONSTRUCTION RECORD
292693
- Groundwater Section
CERTF1CATTON t 20S�O
PHONE t St
Monitoring 0 Recovery 0 Heat Pump Water Injection 13 Other 0 If Other, List Use
2. WELL LOCATION:
Nearest Town: R r P n
1,tNaNr ��Ty 297/3
r^-/N
L�mna
(Street Natttc.NumMs ay. Suhdivtdon.tar No_ Zip Cade)
0
3. OWNER' r)'Ply /U r5 Ter tdey«vmtwtwucwds) _
LstitudeJlongitudc suurcu.DOPSOTopoyraP1mepo
(check boa) civ
f)F.PTH RI LING L c0
From To Formation Descr ton o`
en 0m
0
00
Address ON e r R rii e Rd
(sweeter Ric Pb.)
PrySon G,'Ty MC 297/3
(ply or Town time Zip Code
(12*)- Lis*- o / 57
Area code- Pane number
4. DATE DRILLED /—/m3-0`f
5. TOTAL DEPTH: .530
6. UOES WELL REPLACE EXISTING WELL? YES O NO (21
7. STATIC WATER LEVEL Below Top ofCasing: Rise "*' if Above Top of Caring)
S. TOP OF CASING 1S 1 1T. Above Land Stufaoce
*Top Dreads' terminated .Uor below had surhee requires
variance In accordance with ISA NCAC 1C MIL
9. YIELD (gpm): / METHOD OF TEST Q m r
10. WATER ZONES (depth): 171 Li19
Topographic/Land setting
ORidge OSlope OValley OFIat
(rhea appropriate bat)
Latitude longitude of well location
I I. DISINFECTION. Type 147'
12. CASING:
Depth Diameter
From_j__To Ng FL_6 ShR21 PVC
From To FL
From To FL
13. GROUT: Depth Material
From_ — To 20 Ft. Gem, nY
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 FI
Amount () , S'o
Wall Thickness
or Weight/FL Material
Method
Pfliwp
Slot Size Material
in.
In.
1b REMARUS-
tag
=m
a rn
—4
0
LOCATION SKETCH
Show direction and distance in miles from at least
two Slate Roads or County Roads. Include the toad
numbers and common mad names. q T
-Prom &mond, AST ott,'Ge Tern e
-�T �n
cn G o l.m,'/PYarn rn ieG rP
79E Go a,9 m,'/eos Torn R,PA on aF
GO 3,a br)r ecs Torn /e�'To/ok tru5)7
Creek Ind, Go, o,9 rt'lr let -rut
-rut On , Yes
Deer Rr e 14, Go, 0,3 P1
Turn R'4T Go o.1 -'le %urn le i G r
o.l m,'/e To well on lot i
t 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
Te]ery lI J# l-/3-01i
SIGNATURE OF PERSON tbNSLRUCrING THE WELL DATE
Submit the original to the Division of Water Quality. Groundwater Section,1636 Moil Sentee Center- Raleigh, NC
27699-1636 Phone No. [phone]. within 30 days r=-'"4Y"[-REV, 07/2001.
t
URULi lL1P.5Tr'

WELL CONSTRUCTION RECORD
North Carolina - beP artment of Environment and Natural Rrs [aces - Divisi n of ater Quality - Groundwater Sectionr�
WELL CONTRACTOR(LYDIVIDUAL)NAME (print) t er erg/ y e CERTIFICATION ar`9D
WE.LI. CONTRACTOR COMPANY NAME Gra. a-n1 INfellA.r; lj'p9 PHONE tl(Aasiti7%fli-t
STATE WELL CONSTRUCTION PERMITF ASSOCIATED WQ PERMITS
(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 O Other O IFOther, List Use
2. WELL LOCATION:
Nearest Town: BYyso 11 Z/Ty County 5Wici yt
Dal rip 5 rot) nLira; rt PS-7/3
(Street Name. Numbers, Community Subdivision, Lot No., Zip Code)
3. OWNER: Donn./ Sn%e
Address fo ntL'S tY,ej177r../n
n (Street or Route Nu.)
r3 ry.4on Giry A/L 2 777
Cny or Town iatc hip Cot
yam, y9s o
Area code- Phone number
4. DATE DRILLED /— QJ' O 1/
5. TOTAL DEPTH: 7t)r
6. DOES WELL REPLACE EXISTING WELL' YES O NO
7. STATIC WATER LEVEL Below Top of Casing: / i— 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 15A NCAC 2C .0118.
9. YIELD (gpm): r� METHOD OF TEST G r r
10. WATER ZONES (depth): 660
1 I. DISINFECTION. Type
12. CASING:
Depth
From 0 To 3�
From To Ft.
From To Ft.
Material
Ft. Co MPnT
)"/ 777 Amount 0 •//)
Wall Thickness
Diameter or Weight/Et. Material
FL (n SQt 2I PT/C-
13. GROUT: Depth
From (> To P
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.
292691
TopographidLand setting
❑Ridge OStope OValley °Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/moods)
Latitude/longitude source:OGPSOTopographic map
(check box)
DEPTH DRILLING LOG
From To Formation DePeptitrtV
-n -v
�m
C
O
rtl
Co rn_
t Jc
Ui
as ;ice
cot
ru
co
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. D A A , f, Ur e"
-Prof"? eAdrio n g0 77-
17, bl8 so�TA c2 /,P /,-,JeS 7/irn
7 n �/e'a5TGo S• P m,les To
Method /�O o TO Sigm, 1)2
'1J` ��1"� �a d Go O-h T a n a/ar ka R
aterial
lG r� , To n a 5
Slot Size M%
m; /e TvrI it / S Turn er T
CL�{ctrt�c� G a Go I-3
o n (3a.'nes pi 177at'f Roa
�7-on -P(ICrldt sh'7°
/n; les Tara R,� �To (1
Walk Go o.! n2,%E'S Turn 1L'
Over
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
/-
DATE
�CT T ery Hyo
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. 07/20D1

WELL CONSTRUCTION RECORD 2 9 2 6 9 0
North Carolina , Department of Environment and Natural sm us - Division f Water Quality - Groundwater Section
�O ` . r cERTWICAT1ONa20ti6
WELL CONTRACTOR (INDIVIDUAL) NAME (prior)
WELL. CONTRACT OR COMPANY NAME r/.t.�li Yl'l Wld / r 'II rr/ l/ PRONE a PRSS)Y79- iiICLi
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
Of applicable) (ifapplicable)
1. WELL USE (Check Applicable Box): Residential Rif Municipal/Public 0 Industrial 0 Agricultural
CI
Monitoring 0 Recovery 0 Heat Pump Water injection 0 Other 0 If Other, List Use i
2. WELL)ACATION:
Nearest Town: 13ry(son 61'7y `CountytSlAktio
I�t'ni kd �7h;r3 nn1/4A ,`22713
(Street Name, N beta, Community, Su Lot No.. Zip Cade)
3. OWNER- chuck1vi a-ro.n`T 1
Address W"rip,m f ,pS i�nAAt
(StreVa Rowe No.)
Jar'/son CITy nic 2&7 /3
City or Town Simi Zip Coda
(kart)- 3a/-a)53
Area code- Phnne number
4. DATE DRILLED /- 3-0`1
5. TOTAL DEPTH- 1104
6. DOES WELL REPLACE EXISTING WELL? YES ° NO IN
7. STATIC WATER LEVEL Below Top of Casing: _4Q _FT.
Mew' if Above Top ofcasrng)
S. TOP OF CASING IS I FT. Above Land Surface`
*Top of min terminated Wor below had wt(ace owinAwa a
variance in accordance RIM ISA NCAC IC .010.
9. YIELD (gpm): /lt METHOD OF TEST CJ" r
10. WATER ZONES (depth): 3 q<
II. DISINFECTION. Type ri7-II
12. CASING:
Depth Diameter
From,__ To 9 7 Ft/ f
From To Ft.
FL
From To
13. GROUT: Depth Material
Frvm(_To QD Ft renietl?
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
Amotmt n. 6.2
Wall Thickness
or Weight/Ft. Materiel
spiv.) Pile
Method
Topographic/Land setting
°Ridge °Slope DValley °Flat
(check approprrue boot)
Latitude/longitude of well location
(denwealmiaweOserwda)
Latitude/longitude svurow:OOPSOTopog aphic map
(Meet bos)
DRILLING LOG
From To Formation Description°
0 n
From To Ft
16 REMARKS -
a
LOCATION $)(ETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and cornmon rood names. j� •G �-n `teJ
pesYO t h
-Prom �lman
011 `ag s 6-6/. 8n '/Cs Torn R`r�Z
/ES Turn Je F TOt
6n, vs lq Co Ali y>,r n-,�•/es �vrr7
Waha.w RoA6( 6-0 t toa G
/0PT on W,54,1n STa,'r5� 20 % c
1 M%les lef7/G-opi1 Pr 7;
'le To lie
A0a�. On
on pour
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
Jerih0r&e)A4
SIGNATURE OF PE STRUCRNG THE WELL DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center- Raleigh, NC
17699-1636 Phone No. [phone], within 30 days. GW-1 REV. 07/2001

WELL CONSTRUCTION RECORD 2926 R 9
North Carolina -.Department of Environment and Natural R:ekDivision f Water Quality - Groundwater Section
�f'`tP fly P carrencwnnnc9U,ca
WELL CONTRACTOR (IN'DiVIDUAL)NAME (PrioO r ��%g'�'N��I
WELL CO$TRRACI OR COMPANY NAME 6 ro. Yln.m to II Xr , I'.' i}[ PHONE d �'"
STATE WELL CONSTRUCTION PERMIT® ASSOCIATED WO PERMIT#
Of applicabk) (if applicable)
I. WELL USE (Check Applicable Box): Residential El Municipal/Public ❑ Industnal 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water injection 0 Other El IF Other, List Use 1
2. WELL LOCATION:
N��aarest Town: ry c c n Ci' T?(,. County S Wrti t o
-FonTa-nr. / P /F5Ta7PC as-713
(Street Name. Numbers. Community. Subdivision. tat No'. Zip Cod`)
3. OWNER: Fenn ,'s !lurk. /'son
2�7/3
Zip Code
Address niat'o. lake C SThTP5
(Street a Route No.)
Bryson C iry VC-
Ct4aTown Stitt
(Sa o- N85r- /9,Ce
Area code- Plan number
4. DATE DRILLED /- a 7 -Di/
5. TOTAL DEPTH: fi 36
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO la
7. STATIC WATER LEVEL Below Top of Casing: /Zi�T.
(Usk nw. if Abaw Top of Cuing)
8. TOP OF CASING IS / FT. Above Land Surfaces
*Top of wane terminated stfor below Ind wrist. rapines *
variance In accordance nth 13A NCAC 7C .0111.
9. YIELD (gpm): 0 6 METHOD OF TEST O-t Y
10. WATER ZONES (depth):
I. DISINFECTION. Type
12. CASING:
Depth Diameter
From_'L To 7f7 Ft. (a het
From To
From To Ft.
13. GROUT: Depth
From_ To an
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
LibG
t/ 7 // Amount a . 7'3
Wall Thickness
or Weight/FL Material
5nral pvr,
Material
Ft. Lnrnen7
Topographic/Lend setting
ORidge OSlopo DValley °Fiat
(check appropriate hex)
Lotitudeflongitude of well location
tdegrityminwriftttnndt) o
Latitude/longitude slurcu:l]GPSOi5 Topograp malo
(check boa) •)-
DEPTH DRILLING LAG 2m
From To Formation Desc IN ion 2 �
m
1 0.c
cn rn
� O
--m
—I/CI
73m
N2
0 ma"
IV
LOCATION SJ( ETCH
Show direction and distance in miles from at least
two State Roads or County Roads_ Include the road
n ers and common ro
oh
o,Pmor
H
0
-fr4
11417" or R S' 5 6-0 1 ; /es T r A
I Ton 7VE a
tie ,3 .17/, es
Rimini'' t v n /64 T (31.4 tan -are 1&Ke5 ES eA
Scot Size Material
in.
iR
From To Ft
Ta n To
o. 3.�s mjPS Yvrn 'i'� 2 mr'le
-TonTa/k V,etc) %�pA� GO • 0
%vrn /eT 6n Black-- bear Tr; I tic
o .I m,' /e t,./e/l on Rigby.,
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
i#4-Pe?/ y 1l N /-27-a9
SIGNATURE OFP PERSON NSTRUCTtNG THE WELL DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1036 Mall Service Center- Raleigh, NC
17699-1636 Phone No. [phone], within 30 days G W-1 REV. 07/2001

I 1. DISINFECTION. Type
12. CASING:
Dept S
From_ Q_ To9
From To
From_ To
13. GROUT: Depth
0 ra ao
To
Depth
From_ To FL
From To Ft.
I5. SAND/GRAVEL PACK:
Depth Size
From To Ft.
From To Ft
From
14. SCREEN:
16 REMARKS'
WELL CONSTRUCTION RECORD 292688
North Carolina -.Department of Environment and Natural woes - Division pf Water Quality - Groundwater Section
!f- y P auctriCATrnH a 20.; 0
WELL CONTRACTOR (INDIVIDUAL) LAME (prim) �/° Pry `
Graham Wejl CAin,'llii�// PHONE II S4.N79-Sr�/S'ti
W ELL CONTRACTOR COMPANY NAMEOc
STATE WELL. CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT,/
(if applicable) Of applicable)
1. WELL USE (Check Applicable Box): Residential Municipal/Public 0 Industrial ° Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other ° IFOther, List Use
2. WELL LOCATION:
Ngaj�arestTowmier- t•Sn County S kin i N
ternTAnet )atk FSTnTP 2A7/�
Motet Name. Numbers,Cnmmniry, Subdivision. to Na. Zap Cadel
3. OWNER: it/ ZyKaskI
Address-F,nTisna kW" e5T7'S
(Street or Route No.)
i3r Scn C: 7y Mr 2Ss7/3
CfY Of Town Slate Zip Code
(5(/ )- 33?- 7,Q 7
Ana code- Phone number
4. DATE DRILLED /- .2)0 - nr-1
5. TOTAL DEPTH: L1'.5.-S'
6- DOES WELL REPLACE EXISTING WELL? YES [INO
7. STATIC WATER LEVEL Below Top of Casing: Ff.
(user if Above Top of Casing)
S. TOP OF CASING 1S 1 FT. Above Land Surfaces
*Top of caging terminated ador below had wrhee roguing
martinet in accordance nth ISA !CAC IC Milt
9. YIELD (gpm): 6- METHOD OF TEST O- t r
10. WATER ZONES (depth): 370
frig Amount O. de
Wall Thickness
Diameter or Weight/FL Material
Ft. Snrat PVC -
Ft.
FL
Material
From Ft. !,PPWn7-
Ft.
Slot Size
in.
in
Dialer
in.
in.
Topographic/Land setting
°Ridge °Slope °Valley OFIat
(check appropriate box)
Latitude/longitude of well location
1
(deyeevmlaureriseconda)
Latitude/longitude source.00PSOTopographic map
(cheek box)
nFPTH DRILLING LOG
From To Formation Description
O
Ca
0
0
i
GI7i
cm
CIvC
a rn-
rno
rn
col
N -
tJl Es
r�
LOCATION LOCATION SR ETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
n tubers and nimon told na k ce "Tyr n
ram G�r)26 nay s7 g
le�ron ASSG0 /,gm;'lesTrn
Mtahad le -fry- 7yg Gd 02,3 m,/eS T-urn
Pumpine
/etTon ton%7a lo.ke 667aTes Go 3
Mntnial
Material
ri//'s Turn J?toghTon appocicCron L✓o
GG 7-orn MIT wellon
1e�T.
1 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
/-3a-ay
06 et)/ A.P
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. (9 L9) 733.3221. within 30 days. G W-t REV. 07/2001

2. WELL LOCATION:
Nearest�.-T.o,wnw: i ti County
I -"� "
(Street Name, Numbers, Community, Subdivision, Lot No., Zip(Code)
3. OWNER: /I ' p 4(V1/��sif/LC
Address OC
4� S[ree ' oute o.) 3/0€
City or Town
�'-7�,,State Zip CodeZ
Area - Phone number—0/P'll i
4. DATE DRILLED 1 — 13 Y.
5. TOTAL DEPTH: roc C
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO X.
7. STATIC WATER LEVEL Below Top of Casing
t (Use"+" if Above Top of Casing)
S. TOP OF CASING IS l fool. FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
EST
variance in accordance sv th 15. NCAC 2C .0118.
9. YIELD (gpm): 0 � METHOD 0 T
(d h) a �/ ft
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
r
(��q.� CERTIFIC�AgTION#2117 'l
WELL CONTRACTOR (tNDIVtDUAL)NAME
,r(�pr�tnt/� t1SSn-e (y�4 r"" a PHONE # gin) � ra -1 Cp
WELL CONTRACTOR COMPANY NAME i l 4 - V1 reent r�'(_`r-/,am Weil Cl ASSOCIATED WQ PERMIT#
STATE WELL CONSTRUCTION PERMIT# (if applicable)
- - (if Applicable) - � - ,�/
I. WELL USE (Check Applicable Box): Residential �(I Municipal/Public 0 Industrial ❑ Agricultural ❑r
n
jar r
29°542
WELL CONSTRUCTION RECORD
Monitoring 0 Recovery 0 Heat Pump Water jection ❑ Other 0 If Other, List Use
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
ao- Fq-
lAs —Io11
1g1-ao
SOS —�07
10. WATER ZONES ept : a l
11. DISINFECTION: Type 'r'.'�- Amount Los oC O Z Show direction and distant
12. CASING:
From 0
From
From
13. GROUT^,
From V
From
14. SCREEN:
From To
From To
15. SAND/GRAVEL PACK
Depth
Wall Thickness two State Roads or County
Depth _ Diameter or W iight/Ft.l Maaterianumbers and common road
To as Ft. .1 D I, (/- n 0 ,
To Ft.
To Ft.
Depth Material q Method
To_ _ Ft. L S2M t0 �J
To Ft. d
Depth Diameter Slot Size Material
Ft. in. in.
Ft. in. in.
Size Material
From To Ft.
From To Ft.
LOCATION SI
lles from at least
ahs Include the road
ROn r ,.r:.G, SECTION
)FR=E
o
F
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 [�
S NATURE OF SON CONS CTING THE WELL DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Ceen`tteer' RaleighREVgh, NC
27699-1636 Phone No. [phone], within 30 days.

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resourcesg-,/Division of Water Quality - Groundwater Section _ -
waL CONTRACTOR (INDIVIDUAL) NAME (print) 7�' -/c L�9g t -n, CERTIFICAATION/56 �%V
WELL CONTRACTOR COMPANY NAME %ram t 2 6- 7.//�����7'/,`C-- PHONE M ylrmJS2IP.
STATE WELL CONSTRUCTION PERMITS _,scSOCIATED WQ PERMITS
(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 L�Oyst V/C_ATI S N:
N'plyWr
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: S Chrke
Address 1$tree A n
(Street or Route No.)
AlepAl fki icy M r f /3
Citlor Town State Zip Code
CounaE}t0 _
Area coda Phone Dumber
4. DATE DRILLED J, In —O Y
5. TOTAL DEPTH: rat
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO 0
7. STATIC WATER LEVEL Below Top of Casing: / 0 b FT.
pre "+" if Above Top of Casing)
8. TOP OF CASING IS 1 FT. Above Land Surfaces
'Top of casing terminated at/or below land surface requires a
variance in accordange with ISA NCAC 2C .011&
9. YIELD (gpm): tl0--- METHOD OF TEST /}i Y
10. WATER ZONES (depth):
Topographic/Land setting
❑Ridge ❑Slope (Walley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
I.atitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From To Formation Description
b—
11. DISINFECTION: Type
12. CASING:
Dep
From <) To 0 Ft.
From To Ft.
From To Ft.
13. GROUT: Depth
From 40 To e2.3
Amount
Wall Thickness
Diameter or Weight/Ft. Material
Y
?"-
Material Method
Ft. alert LS fhurt7
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 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 WFI I 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
D
721
cD
U
0

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resourccres�- Division of Water Quality - Groundwater Section /
WELL CONTRACTOR (INDIVIDUAL) NAMES ((print) ,)�T-AM€2_ (.rime 77� CERTIFICATION #
WELL CONTRACTOR COMPANY NAME G'.9AL U" 1' uS L1G%kll%✓f`rs.'.4' 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 LOCATIQN:
Nearest Town: rystMi
1Art+
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: yRo
Address D by_ b `-o
(Street or Route No.)
Fwsi tJ&� tJ(,
Citir or Town State
CountysWi%.n)
r3Yl L3
Zip Code
Area code- Phone number
4. DATE DRILLED 3 / I d y
5. TOTAL DEPTH: .�
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO 0
7. STATIC WATER LEVEL Below Top of Casing: SC FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS 1 FT. Above Land Surfaces
'Top of wing terminated atior below laud surface requires a
variance in accordance with ISA NCAC 2C .a115.
9. YIELD (gpm): J METHOD OF TEST >41-r
10. WATER ZONES (depth):
11. DISINFECTION: Type
12. CASING:
From () To Depth.
From To
From To
13. GROUT: Depth
From0 To an
From To
Amount
Wall Thickness
Di or Weight/Ft. Material
Ft.
Ft.
Material ,
Ft. Ci...4/1.✓7
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 To Ft.
From To Ft.
Method
y a'111Vi V
Topographic/Land setting
❑Ridge 0Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degeemdminutedseconds)
Latitude/longitude sotuce:❑GPS❑Topographic map
(check box)
DEPTH DRILLING LOQ
From/( To Formation Description
iffa �f✓1%lt�i �G.
ry ,
LOCATION SKETCH -r a-1
Show direction and distance in miles front at least co
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
CONS'ftUCTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WFI i OWNER
O/11U4J -/Jr -67
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

295530
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural R sources - iv Sion of Water Quality - Groundwater Section
�,,
--i .-ri Hy A e CERTIFICATION A'� tar°
WELL CONTRACTOR (INDIVIDUAL) NAME (print) 'l r'
WELL CONTRACTOR COMPANY NAME G-ra.h r,.rw tAfN1/ areWind PHONE a fF221u y'ft,
ASSOCIATED WQ PERMIT./
(if applicable)
STATE WELL CONSTRUCTION PERMIT./
(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:
Nearest Town: rr) County 051,1/4/0..%n
86rk S aSS7/."3
(Street ame. Numbes. Community, Subdivision. Lot No.. Zip Code)
3. OWNER: Gene STi- 4%lw at
Address n1:6 Rickyf
(Street 66rr Route No.)
r Con City IV.C, 27/.3
City or Town State Zip Code
( .)- 3/-1/933
Area code- Phone number
4. DATE DRILLED S-/6-O`�
5. TOTAL DEPTH: G 6.5-
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO l�
7. STATIC WATER LEVEL Below Top of Casing: 2(10 FT.
fuse "+" if Above Top of Casing)
8. TOP OF CASING IS / FT. Above Land Surface*
'Top of casing terminated at/or below and surface requires
variance to accordance with ISA NCAC 2C .d1 W.
9. YIELD (gpm): 16 METHOD9F TEST
10. WATER ZONES (depth): 4710
1 I. DISINFECTION: Type
12. CASING:
Depth
From(_ To 35
/-WT N
Diameter
Ft. u)y
From To Ft.
From To Ft.
Amount n.7a.
Wall Thickness
or Weight/Ft. Material
fiOra.t pvc
13. GROUT: Depth Material
From fl To 2n Ft. CP'n1 onT
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:
Method
pun) riff
Slot Sim Material
in.
in.
Size Material
Topographic/Land setting,.
❑Ridge ❑Slope ❑Valley ❑FIS
(check appropriate bos)
Latitude/longitude of well locatiot1
(depeeshninutrsheconds)
Latitude/longitude source:❑GPS❑Topogra hic Tay_
(check box)
DEPTH DRILLING LOG
From To Formation Des t4t rtivn
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and commpn road names.
-romo.Jmod P To?tI'CPGo1.grn./rs
/orn /e-PTon 7yE(,-o3.7"5 Turn
/PPTan Cola SPrr'vfe RcC.Gd o.Tm,'Ies
Torn lek / on /older a/o rkc Go- O. 3
Th lam Turn R,.07hT on Soim r3av; S Rok-
Go 0.7m,'le Torn iJr on /3,,;9 RockyS
RA Go 1.0rn.'lt'S To well on R.;ghT
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED 1N ACCORDANCE WITH ISA NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
Tef>r
SIGNATURE ur PERSON CONSTRUCTING THE WELL 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

n
2JJJ...
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natura ResourceDivision of Water Quality Groundwater
ATr S cti ad .--0
on
WELL CONTRACTOR (INDIVIDUAL) NAME (print) JP P �(
%VEIL CONTRACTOR COMPANY NAME
G-rot,hafn We// rA.Y, II ✓]CI PHONE 0 f8?$ly%9— e
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: 13r y Son C • Ty County 51 i.dc.,t'n
13ochni,on a if& Q 713
(Street Name. Numbers, Community, Subdivision, Lot No.. Zip Code)
3. OWNER: /JPnn11('S t)hdTe
Address Rcc C h m Ph ck_ i/ e
(Sweet or Route No.)
Bryson Ci-y AI,C, QSr7/i
City or Town State Zip Code
(92S)- 7736.- 0 903
Area code- Phone number
4. DATE DRILLED ,t U—O tl
5. TOTAL DEPTH: /0<
6. DOES WELL REPLACE EXISTING WELL? YES Cl NO 0
7. STATIC WATER LEVEL Below Top of Casing: 2.0 FT.
(Use "t" ifAbove Top of Casing)
8. TOP OF CASING IS / FT. Above Land Surface*
*Top of cuing terminated at/or below land surface requires a
variance In accordance with ISA NCAC 2C .01IS.
9. YIELD (gpm): 7 METHOD OF TEST ( r
10. WATER ZONES (depth):
Topographic/Land setting,
ORidge ❑Slope OValley OFlat
(check appropriate box)
Latitude/longitude of well location
(degreoyrnimoa/ucotrds)
Latitude/longitude source:OGPSOTopograrL tc map
(check boa)
D P H DRILLING LOG r.
From To Formation De9Riptiog
11. DISINFECTION: Type HT Al Amount n •
12. CASING: Wall Thickness
Diameter or Weight/FL Material
Ft. 1, 17 SOral PVC
Depth
From 0 To 32
From To
From To
13. GROUT: Depth Material
From__O_-To 96 Ft. (PmpnT
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.
16. REMARKS:
Ft.
Ft.
Slot Size Material
in.
in.
t_
•
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.
-Prom o-jroond` PeSTa-FP IceG0• I•Ssrr,
Torn 16'7E7- on 71/1=6-0 �•2M-1eS
Method juke FxtT /a 7 Go To Slop s'�n Tc'r
lOvml'r /ePrGoT STop 1,&hT Turn Rt' hT
6•o /o 67-6/0 lahr Turn /e7L T 6-6 To
Po STreet 66.6.1in:le Turn
on eep Crc-%RA.6-d 0•3m:10 lr)r
on we5T-Ogepercee)K Go.1.NPi. les Tor,"
Material
/eibT on Qorl1rienAve 6"6•( miles /o --
° ':`hT•
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
Tra-NE NAP S—I/—oC4
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Maii Service Center - Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-1 REV. 07/2001

295528
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural R, sources - Division of Water Quality - Groundwater Section
�`
WELL CONTRACTOR (INDIVIDUAL) NAME (print) cJ Pt 4',A ,,t CERTIFICATION d `9aCC)
K
WELL CONTRACTOR COMPANY NAME 61rohn rti C✓P// Anil,Ina
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 ❑ Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
PHONE # erre)479-sews4
2. WELL LOCATION:
Nearest Town: Rr y.Setn (. Ty County S G✓ci.,'n
If;,eLier 1/,1PL41 ,Qg7/.'
(Street Name. Numbers, Community, Subdivision. Lot No.. Zip Code)
3. OWNER: /far/ /4.,SS
Address /(jam>/son C %Ty
(Street or Route o.)
,�rySon Ci Ty 1\/•C
City or Town State
//,'eUe,i !/,iofd
a k71.3
Zip Code
cr.2sr)-L/&1/— 3/0 %
Area code- Phone number
4. DATE DRILLED S-/4-0 tf
5. TOTAL DEPTH: ?A$
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO ta
7. STATIC WATER LEVEL Below Top of Casing: QQ d FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS / FT. Above Land Surface'
*Top of cuing terminated at/or below Ind surface requires a
variance in accordance with ISA NCAC 2C .0118.
9. YIELD (gpm): METHOD OF TEST
10. WATER ZONES (epth):
bars
Gl,t
11. DISINFECTION: Type N T N
12. CASING:
Depth
From l; To ("5-
From To
From To
13. GROUT: Depth
From__ To /S
From To
Amount A, 9/1
Wall Thickness
Diameter or Weight/FL Material
Ft. 6 y $nr&i PUG
Ft.
Ft.
Material
Ft. (amftnT
Ft.
Topographic/Land setting,
❑Ridge ❑Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(dcgreea/nrinotes/seeortds)
LatitudeFlongitude source:❑GPS❑Topographic map
(check box)
DEPTH DRILLING LUG--- _
From To Formation Descriptions
v
4-
-
LOCATION LOCATION SKETCH
Show direction and distance in miles frotn at least
two State Roads or County Roads. Include the road
-Fhers and common 0(roadnames.
om a Jmon Q l"�nOoS 4+-4- %c U 6'O
c.) m;/e on 09S41 Ti/in le7bT cn
/O mef�' /7,,A ef1 UiteLam) &O /. 3
%Ur/I 1(ighT Go. 2/
J4471r To lAJe// OYl /e# T
14. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in.
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Size Material
To Ft.
To Ft.
From
From
16. REMARKS:
m
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
a J A/
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-1 REV. 07/2001

n33 27
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and NaturaLR, sources - Division of Water Quality - Groundwater Section
(INDIVIDUAL) NAME (print) ) P k N d CERTIFICATION
PHONE # (S1t<)r/79' 1.s!1.:-
�V ELL CONTRACTOR // A
WELL CONTRACTOR COMPANY NAME (T ralietrn WN// r r II r YL A
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 LOCATIOj 1:
NearesjjTown: r)/Sdn (IT,/ County 8.Wale
/iiAkOri V,aIA/ ,2£r7/3
(Street Name. Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: /3/cG/s
Address /asrA 1/IP t✓
(Street or Route No.)
Pry Son Cl Ty MC .2k7/3
City or Town S re Zip Code
(�2x)-4Frrr q:.3c
Area code- Phone number
4. DATE DRILLED .S /7 n c/
5. TOTAL DEPTH: 3n6
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO El
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 In accordance with 15A NCAC 2C .0118.
9. YIELD (gpm): �3 0 METHOD OF TEST Ct.; Y'
10. WATER ZONES (depth): 1 LIS
11. DISINFECTION: Type HT N
12. CASING:
Depth Diameter
From 0 To 6ti Ft. 64
From To Ft.
From To Ft.
13. GROUT: Depth
From—_ Togo F.
Amount O.9 4
Wall Thickness
or Weight/Ft. ,�taterial
SnYa) PVC
Material Method
PmPsi Almp,.n3r.
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
From To Ft.
From To Ft.
16. REMARKS:
Material
('�LQ
Topographic/Land setting,.
❑Ridge 0Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(dcgreestowsoer/secmds)
Latitude/longitude source:❑GPS❑Topograkic map
(check box)
DEPTH DRILLING LOG t^.
From To Formation Description o`
c
•
r-12.;
0
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and corrlrnon r d es. t G
p� o.0
-Prom -Promct,lynora� �� I v GL°
/YI,'le on asu Tvrn /E
/71r�ai�n t/i.etri Go 1.3 r-?,•/CS Turn
R,02117- GU `oZ 1»,'/e° Torn INf T
On Or,'ve IA ov (,leiI pn 1t' T
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
T°-Pe' NyAe :5--/7-6ei
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

29) 26
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and-Naatural esourlcees -
Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) V s `rir • CERTIFICATION Manisa
/+ I PHONE N 1-.,�.1N7 c%- frN gti
WELL CONTRACTOR COMPANY NAME t 1' 1•u Yl� n't (''�e f I � r, U'`r9Gi
STATE WELL CONSTRUCTION PERMIT,/ ASSOCIATED WO PERMIT,/
(if applicable) t-
(if applicable)
I. WELL USE (Check Applicable Box): Residential tal 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: i3ry,Son C r ty County StAla.t`n
r71e. L3rnch rr#ek 2*7/,3
(Street Name. Numbers. Community, Subdivision. Lot No.. Zip Code)
3. OWNER: Ckr,rn,9 f3rOLc) efl
Address n/r Rr✓✓ A Greoek
(Street or Route No.)
13ry60n e"/Ty Af/r r)*7/3
City or Town State Zip Code
(7olo)- SSW-- / I 3 6
Area code- Phone number
4. DATE DRILLED -S 2 n - O i
5. TOTAL DEPTH: 70 S
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO El
7. STATIC WATER LEVEL Below Top of Casing: /6:16 FT.
(Use +" if Above Top of Casing)
8. TOP OF CASING IS / FT. Above Land Surface*
*Top of cuing terminated at/or below land surface requires a
variance In accordance with ISA NCAC 2C .a11S.
9. YIELD (gpm): a METHOD OF TEST r i r
10. WATER ZONES (depth):
11. DISINFECTION: Type
12. CASING:
Depth
From 0 To as -
From To
From To
13. GROUT: Depth
From_fl To n.0
Amount o, 9$?
WeR Thickness
Diameter or Weight/FL Material
Ft. /ck 5lr2) PYc
Ft.
Ft.
Material Method
Ft. (.o m e nY Pum pi'r8c
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:
Slot Size Material
in.
in.
Size Material
Topographic/Land setting,
❑Ridge ❑Slope OValley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(depeeafnnnuteslsetonds)
Latitude/longitude source:❑GPSOTopographic trap
(check box) _
DEPTH DRILLING LOG
From To Formation Dcriplf+!in
r_
-n
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
}:qumbers and r>'mcoon t» kn P sn o ice r l er 7
tort G.I
on tQ s 60 /,&r-.'les- Turn 1PhT
on 714E 6-0 9,`/in les Turn R
5 Go 3. a Wits %o r n le T
a n nlr& Brush Creek fro o.a mjeS
la (.✓eil On IQ,:ehr,
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'P it%yz.E 5-29-0y
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 e,_sources -Division of Water Quality - Groundwater Section
�^�
WELL CONTRACTOR (INDIVIDUAL) NAME ^(print) vP l Aft -A, CERTIFICATION N_L.____ 1Z
WELL CONTRACTOR COMPANY NAME 61 ryz i'trL to cAJP // rk r^ , /f/17 PHONE 0 ff,'"zlg 'S:--
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT# - r r
( if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential el 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:Bryson G' T ' County S W car f
Y(t. r r,l7.S AA
(Street Name. Numbers, Community, Subdivision, Lot No.. Zip Code)
3. OWNER: C)Wr'n parrinn
Address "The )far RA
(Street or Route No.)
/3rySvn CITY A/,G
City or Town State
aS7I3
Zip Code
(a2a)-1/&*"-6k9/
Area code- Phone number
4. DATE DRILLED .S JO - O `l
5. TOTAL DEPTH: /R'O
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO 0
7. STATIC WATER LEVEL Below Top of Casing: /'C FT.
(Use "e" if Above Top of Casing)
8. TOP OF CASING IS / FT. Above Land Surface'
*Top of casing terminated atior below land surface requires a
variance In accordance with ISA NCAC 2C .at la.
9. YIELD (gpm): /Q METHOD OF TEST (1 , r
10. WATER ZONES (depth):
295525
Topographic/Land setting
❑Ridge ❑Slope ❑Valley ❑flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑TopogiaphiC..maW
(check box)
DEPTH DRILLING LOG
From To Formation Description_
11. DISINFECTION: Type Air /-/
12. CASING:
Depth
From (`t To SC2
From To Ft.
From To Ft.
13. GROUT: Depth
From ri To QCt
Amount n . 21
Wall Thickness
Diameter or Weight/Ft Material
Ft lr�_ COr.7I 13VC
Material
Ft. CNman7-
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.
Slot Size Material
in.
in.
Material
v
G
ma -
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the mad
numbers and common road names. O JYI ./
#i'67n a)r c4 Po o -F%ce G 1,
Turn le -PT on 7qE Go S-a in17es Tr,
Method Rr�hr aT EX,T 611 Go To STO S/an
ct;cro�'S alter pass
Tura 1��r Go r h7-an /�c✓
TOS%v1 S';`in lure %�pj y
/9 Go, v,&n�,l& Trn /&) T an Tcrh`
R&, Ga . 0.3 n7,le Thrn /e'Jr T (JF ii
16. REMARKS:
1 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 NAP /1/24 c2C; oaf
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

nr
K.`7Jv 1^.
North Carolina - Department of Environment and Natr
WELL CONTRACTOR (INDIVIDUAL) NAME (print)
WELL CONSTRUCTION RECORD
esourcgs - �ivision of Water Quality - Groundwater Section
t / CERTIFICATION* !7 PHONE *
WELL CONTRACTOR COMPANY NAME
PERMIT*
ASSOCIATED WQ P��—
STATE WELL CONSTRUCTION PERMIT* if a l WQle
(if a licable {---
M
c 0 Industrial
I MWELLon t rinSE g 0 (CheckApplicable
0 1eH at Pump WaterResidential
nject on 0 othert0 If Other, List 0 e Agricultural
Topographic/Land setting
❑Ridge ❑Slope OValley OFlat
(check appropriate box)
Latitude/longitude of well location
(degrees/minute/seconds)
Latitude/longitude source:OGPSOTopographic map
(check box) im 1—
l H DRILLI G LOG p
From To
Forrnation -/escriotion
2. WELL LOCATION:
Nearest Town: r S
(Street Name. Numbers, Community, Subdivision, Lot No.. Zip Code)
3. OWNER: / L /%
Address
County cS(,✓a r 1
ute Zip Code
ity or Town
(.d'.t2)-
Area code- Phone number
4. DATE DRILLED —�
5. TOTAL DEPTH: 76S
6. DOES WELL REPLACE EXISTING WELL? YESO NO FT.
7. STATIC WATER LEVEL Below Top of Above Top of Casing)
S. TOP OF CASING IS
FT. Above Land Surface*
variance la accordance with t A NCAC 2C .0111. asing terminated ador below land surface requires a
9. YIELD (gpm): O METHOD OF TEST Q r r
10. WATER ZONES (depth):
11. DISINFECTION: Type_
12. CASING:
Depth
FromQ_ Tom
From To
From To
13. GROUT: Depth
From__ Toter —0—._
From To
14. SCREEN: Depth Diameter
From To Ft. in.
From To Fl. in.
15. SAND/GRAVEL PACK: Size
Depth
From To Ft.
From To Ft'
LJL6/! Tai
16 REMARKS
OWNER
CONSTRUCTION STANDARDS, AND `H A COPY OFHAS
il.
DATE
SIGNATURE OF PERSO CONSTRUCTING THE WELL
GWrI REV.h,NC
Submit the original to the Division of Water Quakily, Groundwater Section, 1636 Mail Service Center -Raleigh.
27699-1636 Phone No. [phone], within 30 days.
p Amount Q
Wall Thickness
Diameter or Weight/Ft Material
Ft.� or 11C
Ft.
Ft.
Material
PT --
Ft.
Slot Size Material
in.
in.
Material
._— CH `
Show direction and distance in miles from at least
State Roads or County Roads. Include the road
T, / le-kion 71/E6-O Y�
two
numbers and common road names. O� .0 Go
-rorrt clmonok PosT G �n1'
jn, t?S urn G STo�
Tke En'T (ti o.ltko,G T o
/ef Go o,crrSsauerf /9
CSC3, /,r eS �r/tlet
/etr�'nBUCkt.
19 G6, vet n7' ur�I 'o`�
% ranch fi AGp--6• 177'
aci✓�1 ff;ll.Raa
t', a scs
7r
Tin hran /77/a/
ST/7 S/fin Tarn �� ol�{ f l
lC ur
Go y�,,l('S R
1 DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTEDTHIECORD HORDANCE AS BEEN PROVIDEDITH I5A NCAC 2C, TO THE WELLLL
O o
o
-c
k__• ::

295502
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resourceso- Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) tC? ri• '( TAJ;1 eCERTIFICATION IRO2V
WELL CONTRACTOR COMPANY NAMES .i1I.�L `b .1 .JY IN/Let—
PHONE # SrJSf'V.924
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT%
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential-0 Municipal/Public ❑ Industrial 0 Agricultural 0
Monitoring 0 Recovery ❑ Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATJ,QN:
Nelazf est Town
County,�G l�s
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNE
Address
(Street or Route No.)
ati2/1n.1 SIC a28 90 1.-
City or Town State Zip Code
Area code- Phone number
4. DATE DRILLED 5—/2-
5. TOTAL DEPTH: SAS 5--
6. DOES WELL REPLACE EXISTING WELL? YES El NO 0
7. STATIC WATER LEVEL Below Top of Casing: /9U FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS / FT. Above Land Surface*
*Top of cuing terminated at/or below land surface requires a
valance In accordance with 15A NCAC 2C .0118.
9. YIELD (gpm): J—' 0 METHOD OF TEST
10. WATER ZONES (depth):
11. DISINFECTION: Type Amount
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
From d To Ft. —fr..-
From To Ft.
From To Ft.
13. GROUT: Depth Material Method
From U To c2 0 Ft. (n171./ f b1/
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:❑GPSOTopographic map
(check box)
DEPTH DRILLING LOG
From To Formation Desckiption
/2 ?- 4/5-t
LOCATION SKETCH
Show direction and distance in miles from aYieast
two State Roads or County Roads. Include etre road
numbers and common road names. •.
co a
c
c
0
0
I DO HEREBY CERTIFY THAT THIS WFi I WAS CONSTRUCTED IN ACCORDANCE Wrrf 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 Mall Service Center - Raleigh, SG
27699-1636 Phone No. [phone], within 30 days. GW-1 REV. 07/2001

WELL CONSTRUCTION RECORD
North Carolina Depagrnent of Environment and Natural Resources Division of Water Quality- Groundwater Section
A t) e1`nG'S -
WELL CONTRACTOR (r\DIVIDUAL) NAME (print) 7
�.N I�t� "� CERTIFICpA�TI�ON #�1��-�/J � � t
I)a, D PHONE # £A-5Y5-6,'-6-SS�J
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable) - - - (if applicable)
1. WELL USE (Check Applicable Box): Residential Municipal/Public 0 Industrial ❑ Agricultural ❑ ! 7,-
C Crl
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other D If Other, List Use 0
Jf
2. WELL LOCAT
Near t Town:
County S et
(Street Name, Numbers, Community, Subdi ion, Lot No. Zip Code)
3. OWNER YNAJ NYJprnAsh
Address P 0 to h-y 46 %^Q S-
(Stress inr Route No.)
liiA S(] �/
�`�ctlns�l�e
City or Town State Zip Code
Area code- Phone number
4. DATE DRILLED .3 — I -7 Q
5. TOTAL DEPTH: /p n C)
WELL CONTRACTOR COMPANY NAME
NC
296642
Topo aphic/Land setting
DRidge Slope ❑Valley ❑Flat
(check appropriate box)
a 87/ 3 Latitude/longitude of well location
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO Pkir
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):'' �: x • METHOD OF TEST 1 r
10. WATER ZONES (depth): -Er—
Ix"
U
L�
(degrees/minutes/seconds)
Latitude/longitude source:DGPSOTopogrpphic map ,'_:_ _-.- ---
(checkbox) 1 ------
DEPTH DRILLING LOG
From To Formation Description
I
'7 � -%O 6 \1A14:1-etcr
l7 -
LOCATION SKETCH
11. DISINFECTION: Type .R r 1-1- Amount . 7?, Show direction and distance in miles from at least
12. CASING: Wall Thickness • two State Roads or County Roads. Include the road
Depth Diameter
To �79 Ft. ('4 5PR-2/ or Weight/Ft. Ma.tterial numbers and common road names.
From v`1IJ) )C
From To Ft.
From To Ft.
13. GROUT: Depth Material Method
From 0 To .' Ft. l�rv�-,—� k�-cv•�-�Z
From 3 To ••-q(' Ft. \p...t.-itt**ii;i-c—r.
14. SCREEN: Depth Diameter Slot Size
From To Ft. in.
in.
From To Ft.
15. SAND/GRAVEL PACK:
Material
in.
in.
Depth Size Material
From To Ft.
From To Ft.
16. REMARKS:
c
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONFitUCTION STANDARDS, A,j•ID THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
SIGNATURE OF PERSON CONSTRUCTING THE WELL
Submit the original to the Division of Water Quality, Groundwater Section, 1636 MaiIIStiftit Center -Raleih, NC
27699-1636 Phone No. [phone], within 30 days. . 1. I G*}8REVJ07 �"

296674
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section Q _
/ J /' CERTIFICATION # r) /v /
WELL CONTRACTOR(INDIVIDUAL)NAME �(pJrint)) /(.u) ��/ �,1//Gr/
WELL CONTRACTOR COMPANY NAME 73 L9rEV/0-e r4 hr .ti7/L
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ P RMIT# Fr_c 1
(ifapplicable) — `�;
(if applicable)
1. WELL. USE (Check Applicable Box): Residential 1)4unicipal/Public 0 Industrial 0 Agricultugal Ll • v I
0 jv2;
1 r it
Topographic/Land sorting'.
❑Ridge fgSlope ❑Valle Flat r
7 Cs) t
(check appropriate box) - fit,
Latitude/longitude of well location µ I.
1
Monitoring ❑ Recovery ❑ Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATI N:
Nearest Town
(Street Name, Numbe
3. OWNER //
PHONE # (la SO t4-C3s (,)
(degrees/minutes/second )o, L-_- -
Address t,{�J VY Latitude/longitude source:❑GPS❑ opographi map
(Street or Pour No.) /, (check box
1.<t VrIn 04ii p Qk 1/3 j DEPTH DRI
ny or Tpwn Strec?0 Zip Code From To Formation Description
(���- � iQ —
Area code- Phone number
4. DATE DRILLED .3 — 7- U CZ
5. TOTAL DEPTH: / / o U
6. DOES WELL REPLACE EXISTING WELL? YE,S,C1 liO
7. STATIC WATER LEVEL Below Top of Casing: "7 Di FT.
(Use "+" if Above Top ofsing)
8. TOP OF CASING IS f — FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accord r-With 15A NCAC 2C .0118. 1�
9. YIELD (gpm): METHOD OF TEST _
10. WATER ZONES (depth):
ion, Lot No., Zip ; .de)
'C-
141
— fig
o
LOCATION SKETCH IR = c>
11. DISINFECTION: Type N j Amount 4(7r t-2,,,_ Show direction and distance in miles frgm at ig:At
12. CASING: Wall Thickness two State Roads or County Roads. hlctc& theroad
Depth J me er or Weight/Ft. Material numbers and common road names. -ti
From L% To(f Ft.�Ll ��C-- v
From To Ft. -
From To Ft. co
t z�,�d
13. GROUT: // �� Depth Material � / Method /
From_ v To .V - Ft. l �m � GL C.t: - 9 — l�.G�7 Vc
From 3 To Cl Ft.
14. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in. C?-r��-r l
From To Ft. in. in.
15. SAND/GRAVEL PACK: e
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
CON $ ?UCTION 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 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 n 2045
WELL CON'fRACTOR COMPANY NAME Hedden Brothers Well Drilling, Inc PHONE[phone]
STATE WELL CONSTRUCTION PERiMIT/I - - ASSOCIATED \YQ PERiMIT9
(ifapolicable)--: - - - - - (ifaonlicable)• .,
I. WELL USE (Check Applicable Box): Residential Municipal/Public 0 Industrial ❑ Agricultural 0
Monitoring O Recovery.0 Heat Pump Water Injection Other ❑ IFOtner, List Use
2. WELL LOCATION:
Nearest Town: ..Cherokee County Swain
Owle Branch --DRILL DEEPER --EBCI well
(street Name, Numbers, Community, Subdivision, Lot No., Zrp Code)
3 OWNER:William Smith
Address PO Box 1985
(Street or Route No.)
Cherokee, NC 28719
Cdy or Town State Zip Cede
(828)- 497-2141
Area code• Phone number
4, DATE DRILLED DEEPER 5-11-04
5, TOTAL DEPTH: 700'
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO 0
7. STATIC WATER LEVEL Below Top of Casing' FT,
(Use "A' 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 ISA NCAC 3C.0118.
9. YIELD (gpm): .5 METHOD OF TEST blow
10. WATER ZONES (depth):
DISINFECTION: Type H T H Amount - 16 Oz
12, CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
From 0• To FL
From To Ft. From • To Ft.
13.'GROUT' Depth Material Method
From 0 To 20 Ft. betlite & Ct'Isei1L pumped
From - ' Ta Ft, - 14. SCREEN: Depth Diameter Slot Size Material
From To Ft. • in. in.
From ' To Ftin. in,
15, SAND/GRAVEL PACK: -
Depth Size Material
From " To FL
From To Ft.
Topographic/Land setting
°Ridge °Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
205938
(degree rinutes/seconds)
Latitudo/longitude source:OGPSOTopoyraphlc map
(check box) ...........
• DEPTH DRILLING LOG
From • To Formation Description
0 clay & sena
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 STADS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
5ICNA UR
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
O
L
O
CO
1/40
0

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources • Division of Water Quality - Grcund,vater Section
WELL .CONTRACTOR (IINDIVIDUAL)iNANE (print) - Jemes E., Brown CERTi9ICATt0tNkZ045
WELL CON%RSCTORCOMPANY NAMEHeaae-rt Brothers Well Drilling, Inc PHONEa23`) 369-9591
STATE WELL CONSTRUCTION PERM1Td ASSOCIATED WO PERtMI1Td
(if applicable) --.
(if applicable)
293992
1. WELL USE (Check Applicable Box): Residential Municipal/Public 0 Industrial ❑ .Agricultural 0
Monitoring 0 Recovery .❑ Heat Pump Water Infection 0 'Other 0 If Other, List Use
2, WELL LOCATION:
Nearest Town. .Bryson City County Swain
White Oak Rd
(Street Name, Numbers, Community, Subdivision, Lot No„ Zip Code)
3, OWNER: Danny Shular •
Address 595 White Oak Drive
(street or Route No.)
Bryson City, NC 28713
City or Town State Zip Code
(828)- 488-7694
Area code- Phone number
4. DATE DRILLED 4-29-04
5. TOTAL DEPTH: 700'
6, DOES WELL REPLACE EXISTING WELL? YES ❑ NO {Da
7. STATIC WATER LEVEL Below Top of Casing: 500' FT.
(Use "*" if Above Top of Casing)
fie TOP OF CASING IS 2 FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordance with ISA NCAC 2C.0I18.
9. YIELD (gpm): 4 METHOD OF TEST blow
I0. WATER ZONES (depth): 503' & 643'
l 1. DISINFECTION Type H T H Amount - . 16 oz
12. CASING: Wall Thickness
'Depth Diarletet or Weight/Ft. Material
From 0 To 109 Ft 6 pvc
From 0 Tc 112 Ft 6" .188 steel
From To Ft.
13.`GROUT: Depth - Material
From 0 To 20 FL bscnite & c.et
From To -Ft.
Method
pumped
14. SCREEN: :Depth Diameter : Slot Size 1Materia!
' Frorn To Ft. in.
From To Ft. in. - in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From ` To Ft.
Topographic/Land setting
❑Ridge ❑Slope ❑Vailey ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degmeLSninu tes/seconds)
Latitude/longitude source:GGPSGTcpographice map
(check box)
DEPTH DRILLING Lc C
From . To Formation DescrLlin.n—., 0 110' clay & sena
110' 700' crranite
LOCATION SKETCH
Shove direction and distance in miles from at let
two State Roads or County Roads. Include the- ad
numbers and common road names.
C
1
0
ca
UD
16. REMARKS:
1 D0 HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION c ARDS, AND THAT A C0j• f OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
S(GNATURE OF PERSON CONSTRUCTING THE WELL DATE
Submit the original to the Division of Water Quality, Groundwnter Section; 16361Mai! Service Center • Raleigh, NC
27699 163h Phone No. [phone], within 30 days. OW-1 REV, 07/2001

WELL CONSTRUCTION RECORD
295744
North Carolina Department of Environment and
j)atural Resources - Division of Water Quality - Groundwater Sectionn/♦
�t�yy�s,,��a 1111,,�,,rn7 j CERTIFICATION* 2J7
WELL CONTRACTOR COMPANY NAME (Irtr-s S,teen2 YO5 WCLC DY'��1 PHONE * (dorp �S� SSS(J
ASSOCIATED WQ PERMIT"
(if applicable)
WELL CONTRACTOR (INDIVIDUAL) NAME (print) U sseU /Or
Saw 1n R Cr A gcr C“
(Street Name, Number, Communal, Subdislsion, Lot No.,
3. OWNER: harry' e)cirne
STATE WELL CONSTRUCTION PERMIT*
(if applicable)
1. WELL USE (Check Applicable Box): Residential Iv tunicipal/Public ❑ Industrial ❑ Agricultural 0
Monitoring ❑ Recovery 0 Heat Pump Water Injection 0 Other ❑ If Other, List Use
2. WELL LOCATION:
Nearest Town(EirtiSdm E County ti."5/0-etiv)
v (V C
ip Cade)
Address (IFj' `Su_tl; o- .6( (r , Rd.
(Stye• or Route No.)
1 \1 Cr a 7 (a
City or town State Zip Code
( j-4 PS-- 3351
Area code- Phone number
4. DATE DRILLED 3 -a 4 - 0 `L,
5. TOTAL DEPTH: .5SV
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO Ci
7. STATIC WATER LEVEL Below Top of Casing: I St ET.
(Use ••+• if Above Top of Casing)
S. TOP OF CASING IS I FT. Above Land Surface
•Top of casing terminated ut.or below land surface requires a
variance In accordance wich 1SA NCAC SC .0113.
9. YIELD (gpm). S 5-METHOD OF TEST Al r
10. WATER ZONES (depth): 30 D
3ZO
11. DISINFECTION: Type H --r / Amount /6:15Jd Z.
12. CASING:
Depth
From b To 53
From To Ft.
From To
GROUT: Depth
From 0 To 3 Ft
From '3 To O Ft.
SCREEN: Depth
From To Ft.
From To Ft.
Diameter
Ft. en tht
Ft.
Wall Thickness
or WeizhtTt.
SDK-!
Material
poc
Method
lirY�
Diameter Slot Size Material
ir,. in.
in. in.
- MateC�9rial
^ -* edb-r
`T -
SANDIGRAVEL PACK:
Depth
From To Ft.
Size Material
From To Ft.
Topographic/Land setting
❑Ridge 3QSlope DValley DFlat
(check appropriate box)
Latitude/longitude of well location
(degrees:m inutes/seconds)
Latitudelongitude source:❑GPS❑Topographic rnap
(check box)
DEPTH DRILLINGLOG"_-
From To Formation Description.. _
—4b'
4&- 300
3eo-3tZ-
302,-320
320 —3zz
3zz -3sv
Cccl
�LG��rL.c.te—
LOCATION SKETCH r ,(- -
Show direction, and distance in miles from afleasr.:_
two State Roads or County Roads. Include thlsoaj_s :.-.
numbers and conurdn road names. ' �. -_
rJ Cr
16. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH ISA NCAC 2C, WELL
CONSTy.QCTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
e 5 - D if
SIG ATURE OF PERSON CONSTRUCTING THE WELL DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center- Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-1 REV. 07/2001

16.REMARKS:
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources • Division of Water Quality
WELL CONTRACTOR (INDIVIDUAL) NAME (print) Mitchell D. Cook
WELL CONTRACTOR COMPANY NAME I*+1 Enti rrilUrf, lit
STATE WELL CONSTRUCTION PERM1Tr ASSOCIATED WQ PER:AITr/
(if applicable) - (if applicable)
293•'70
- Groundwater Section
CERTIFICATION 4 20113
PHONE u P28) 369-9591
I. WELL USE (Check Applicable Box): Residential 3 Municipal/Public ❑ Industrial 0 Agricultural 0
Monitoring 0 Recovery ❑ Heat Pump Water Injection ❑ Other 0 If Other, List Use
2. WELL LOCATION:
Nearest Town: Cherokee County Swain
Big Cove
(Street Name, Numbes, Community, Subdivision, Lot No., Zip Code)
3. OWNER: MallrY Lossia
Address 185 Wally Welch Rd
(Street or Rouse No.)
Cherokee, NC 28719
• City or Town State
(828)- 497-3577
Area code- Phone number
4. DATE DRILLED 1-8-04
5. TOTAL DEPTH: 300'
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO x'ac
7. STATIC WATER LEVEL Below Top of Casing. 150 FT.
(Use "+" if Above Top of Casing)
S. TOP OF CASING IS 2 FT. Above Land Surface*
'Top of casing terminated at/or below land surface req ulres a
variance In accordance with ISA NCAC 2C .0118.
9. YIELD (gpm): 8 METHOD OF TEST
10. WATER ZONES (depth): 95' & 170'
•
Zip Code
blow
I1. DISINFECTION: Type H T H
12. CASING:
Depth Diameter
From 0 To 66 Ft. 6"
From 66' To R7 FL 6"
From To Ft.
13. GROUT: Depth
From 0 To
From To Ft.
14. SCREEN: Depth Diameter
From To Ft. in.
From To Ft. in.
15, SAND/GRAVEL PACK:
Amount 16oz
Wall Thickness
or Weight/Ft. Material
pvc
.1 8 - stPal
Material
20 Fatenthite & cerent
Method
s rrcei
Slot Size Material
in
Topographic/Land setting
❑Ridge ❑Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds) , u.
Latitude/longitude source:OGPSOTopographic!mup
(heck boa)
DRILLING LOG ---
Formation Description
clay & 53rd
DEPTH
From To
0 85'
85' 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.
Depth Size Material -a
From To Ft. . _ —;
From To Ft. CO
W
0
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
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 (gall 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 4 2043
WELL CONTRACTOR COMPANY NAME Medal Ercthacs Veil Crillirrh TIC PHONE [phone]
STATE WELL CONSTRUCTION PERMIT$ ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
WELL USE (Check Applicable Box): Residential Z Municipal/Public ❑ Industrial 0 Agricultural 0
Monitoring ❑ Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION:
Nea;estConley'stCrk Countyier Swain
to ChestnutCoRd
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
• 3. OWNER: Richard Whitman
Address PO Box 643
(Street or Route No.)
Whittier, NC 28789
City or Town State Zip Code
(_828)- 497-3750
Area cod:- Phone number
4. DATE DRILLED 3-26-04
5. TOTAL DEPTH: 125'
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO X]
7, STATIC WATER LEVEL Below Top of Casing: 70 FT.
(Use''+^ if Above Top of Casing)
.8. TOP OF CASING IS 2 FT. Above Land Surface*
'Top of casing terminated at/or below land surface requires a
variance In accordance with 15A NCAC 2C .0118. •
9. YIELD (gpm): 20 METHOD OF TEST blow
10. WATER ZONES (depth): 95' & 110'
11: DISINFECTION: Type
12. CASING:
Depth
From (1 To 82
From To Ft.
From To Ft.
13. GROUT: DepthI�
From 0 To a O
From To
14. SCREEN: Depth
From To Ft. in.
From To - Ft. in.
15. SAND/GRAVEL PACK:
From
From
Depth Size
To Ft.
To Ft.
16. REMARKS:
H T H Amount 16oz
Wall Thickness
Diameter or Weight/Ft. Material
Ft. 6" .188 steel
Material Method
Ftberalite & cenEnt pawed
Ft.
Diameter Slot Size Material
in.
in.
Material
Topographic/Land setting
❑Ridge 0Slope OVa!ley ❑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 Description
0 80' clay & mil
80' 125' granite
LOCATION SKETCH'
Show direction ar,d distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common road names.
Z
r
.19
W
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED 1N ACCORDANCE WITH I SA NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
.10.
SIGNATURE OF PERSON CONSTRUCTING THE WELL
3—.2G—oy
DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Maii Service Center • Raleigh, NC
27699-1636 Phonc No. [phone], within 30 days. GW-I REV. 07/2001
c
rjE
n_

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 CO;N'FRACTOR COMPANY NA\IE fi &Cthas 11 E.11irnr Ire PHONE p j328) 369-9591
STATE WELL CONSTRUCTION PERMITS ASSOCIATED WQ PERMIT%----
• (if applicable) (if applicable)
293762
I. WELL USE (Check Applicable Box): Residential Z Municipal/Public 0 Industrial 0 Agricultural
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other ❑ If Other, List Use
2 WELL LOCATION:
Nearest Town: Bryson City County Swain
just past King Meat Processing -Well #1
(Street Name, Numbers, Community, Subdlvls Lon, Lot No., Zip Code)
3. OWNER: Daniel Cloer
Address 301 Fred Breedlove Rd
(Street or Route No )
Bryson City, NC 28713
• City or Town State Zip Code
( 828. 488-2533
Area cod Phone number 2-1 0-04
4. DATE DRILLED
5, TOTAL DEPTH: 750'
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO El
7. STATtC WATER LEVEL Below Top of Casing: FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS 2 FT. Above Land Surface'
*Tap of casing terminated at/or below land surface requires a
variance In accordance with ISA NCAC 2C .0118.
9. YIELD (gpm): 0 DRY METHOD OF TEST blow
10. WATER ZONES (depth):
Ir DISINFECTION: Type
12. CASING:
Depth
From 0 To 40
From 40' To Al'
From To
3. GROUT: Depth
From D To 20
From To
14. SCREEN: Depth
From To
From
Ft
Ft.
Topographic/Land setting P
❑Ridge ❑Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minrtes,'s econds)
Latitude/longitude source:OGPSOTopographio mbp-
(check box)
DEPTH DRILLING LIOG
Formation Description
From To
0 59' clay & ssrtl
59' 750' granite
H T H
Diameter
Ft. 6"
Au
Amount 16oz
Wall Thickness
or Weight/Ft. Material
pvc
18R gtppl
Material - Method
,,a
Ftba'izlite & caret Timed
Ft.
Diameter Slot Size Material
Ft. in. in.
To Ft in. in.
15. SAND/GRAVEL PACK:
Depth - Size Material
From
From
To Ft.
To Ft.
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 0
r ct -)
W
^o
xn
on-0
n
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.
.46 49. G.e,teed
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
.7-Jo-!J41

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NA\!E (print) Mitchell D. Cook CERTIFICATION 11 2043
WELL CONTRACTOR COtMPANY NAME HECEen i arS Pill. rnairlr Itt PHONE k p28) 369-9591
STATE \YELL CONSTRUCTION PERMlT0 ASSOCIATED wQ PERMIT%
(if applicable) - (if applicable) r
l
293761
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:
NearestTcwn: Bryson City County SWairi
lust past King Meat Proce s'n•— 171 #2
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: Daniel Cloer
Address 301 Fral Rrpprllnvp Feri
(sweet or Route No.)
Bryson City, NC 28713
City or Town State Zip Code
( 828- 488-2533
Area code- Phone number
4. DATE DRILLED 2-18-04
5.TOTAL DEPTH: 600'
6, DOES WELL REPLACE EXISTING WELL? YEINdi 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 accordance with ISA NCAC 2C.0118.
9. YIELD (gpm): 0 'TRY METHOD OF TEST blow •
10. WATER ZONES (depth):
11. DISINFECTION: Type H T H
12. CASING:
Depth
From 0 To 103
From 103' To
From To
13. GROUT: Depth
From 0 To 20
From To Ft.
Amount 160o
Wall Thickness
Diameter or Weight`Ft. Material
F. 6" pvc
107' Ft 6" atppl
Ft.
Material
Ftb Dhite & Caret
14. SCREEN: Depth
From To Ft.
From To Ft.
15. SAND/GRAVEL PACK.
Depth
From To Ft.
From To Ft.
16. REMARKS:
1RR
Method
Zlltld
Diameter Slot Size Material
in. • in.
in. in.
Size Material
Topographic/Land setting'
❑Ridge DSlope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/mina teslseconds)
Latitude/longitude source,❑GPS❑Topographicmup
(check box)
DEPTH DRILLING LOG
From To Formation D^ rriptinn
0 105' Clay &
105' 600' granite
LOCATION SKETCH'
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and comrnon road names.
0
sir
1
Ca
Itt
W
W
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
aza
SIGNATURE OF PERSON CONSTRUCTING THE WELL
.2-18-a9
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

23865
WELL CONSTRUCTION RECORD
North Carolina - Dcpartment of Environment and Natu I Resources Division of Water Quality - Groundwater Section
T pry
CERTIFICATION ('2r .0
PHONE
(pCr
WELL CONTRACTOR (INDIVIDUAL) NAME (print) ('E�"!,y�`'� S"!
WELL CONTRACTOR COMPANY NAME `s ct-it,m ('✓N// A 971 ll r/ _
ASSOCIATED WQ PERMIT('
(if applicable)
STATE WELL CONSTRUCTION PERMIT('
(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:
Ne rest Town:139d( County 5cicc t /1
a()fly' Tip a57/3
(Street Name. Numbers, Community, Subdivision, Lot No.. Zip Code)
3.OWNER:cling/
r� 7Nr)/ It.1/0SSohi
Address p 1 r ✓l Mtn 1' c{
(Street 6r Route No.)
r ySon C i Ty 71/6_,
thy or Town State
(777 )- $3 - o `^r 71
Area code- Phone number
4. DATE DRILLED - L-o 171
5. TOTAL DEPTH: O 6
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO
7. STATIC WATER LEVEL Below tTop off wing . FT.
Toprcaclna)
8. TOP OF CASING IS ____L____ FT. Above Land Surface'
*Top of cuing terminated atfor below land surface requires a
vadmce lo ace ordan wtth iSA NCAC 2C .0118.
9. YIELD (gpm): METHOD OF TEST G t r
10. WATER ZONES (depth):
:87/3
Zip Code
71).�
I I. DISINFECTION: Type ti 7 N
12. CASING:
Depth Diameter
From 0 To2.Z_ Ft.
From To Ft
From To Ft.
13. GROUT: Depth Material
From 0 To .`ICJ Ft. G6:77647-
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.
Amount (-)• 194
Wall Thickness
or Weight/Ft. Material
&Qr2L Pvc
Topographic/Land setting
❑Ridge ❑Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(derpeeslmetwea&ucoods)
Latitude/longitude source:❑GPS❑Topog
(check box)
Dula D I iN
From To Fortnation Description
'C
o
s
LOCATION SKETCH -1
Show direction and distance in miles from at least -
two State Roads or County Roads. Include the road
d road [tames
GCro5Q5 11W y 8 To RO urld Te )
nnMethod Ytco.cA
into iv /-3 py� 'DNS %Ur/i �r hT
(JU
do To bevum Go. 0-3 7-„,)Riphra/1 -' ori'Ve lt/ay Gd To
Slot Size Material
in.
in.
Material
umbers an eotnmoG e 6-G S Tc r %C
rran O/iW c posrcq
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
JN-P ill/ (s oy
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Ceenterl RREVgO NOOI
27699-1636 Phone No. [phone], within 30 days.

WELL CONSTRUCTION RECORD`'
North Carolina - Department of Environment and Natur II esourceSi
vision of Water Quality Groundwater
roundw ter Section
r�
CONTRACTOR (INDIVIDUAL) NAME (print) j�T N62AS�1 y7�/ t'%S '
WELL/+/_ / /�� PHONE #
WELL CONTRACTOR COMPANY NAME Grohexm LJeI/ . /t p'
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#(if applicable)
(if applicable)
1. WELL USE (Check Applicable Box): Residential 1E1 Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection ❑ Other 0 If Other, List Use
2. WELL LOCATION:
NeveljtTown: Rryson Ge Ty County 7 ✓7
1Ynbfi'•Son Gu-° Art
(Street Name. Numbers, Community, Subdivision, Lot No.. Zip Code)
3. OWNER: ,ck y /ee
R�
Address k'nb%nc.»
(Street or Route No.) �G7/�
RrY.Son 6/TyM J
uyorTown tate Zip Code
ea )- 41-97— )4.-66
Area code- Phone number
4. DATE DRILLED s/'C—O�
5. TOTAL DEPTH: 9 F'Ci
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO El
7. STATIC WATER LEVEL Below Top of Casing: $t� FT.
(Use "+" if Above Top of cecina)
8. TOP OF CASING IS / FT. Above Land Surfaces
`Top of cuing terminated atfor below land surface requires a
variance la accordance with ISA NCAC 2C .011S.
9. YIELD (gpm): C METHOD OF TEST Gi i ✓'
10. WATER ZONES (depth): Q60
1 I. DISINFECTION: Type %Y 77/
12. CASING:
Depth Diameter
From 0 To $a Ft. _—
From To Ft.
From To Ft.
13. GROUT: Depth
From_(__ To ao
Amount 0..31a
Wall Thickness
or Weight/Ft. Material
Material
Ft. Cemein
7
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.
Topographic/Land setting
❑Ridge ❑Slope ❑Valley OFlat
(check appropriate box)
Latitude/longitude of well location
(degrar/m'nuret/secaods)
Latitude longitude source:❑GPS❑Topogfaphinmap.,
(check box)
DEPT DRILLIN
From To Formation Det2fe ipti o
o
r., .;
N
0
rt
:a
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 G G
r�r 4mvn4 POST a
I e111;18S Torn /61-P 1 or 7116
Method
Pump' w CO S.), ,'les To �x T 64
Glar Go TO 5Ta/' SGgn 7vrn
/e-'T GO Td S lop S,Ggn Turn
le T Go. 0,1 m,'leo TurnpR,,hT
Slot Size Material
in.
in.
Material
On Rob;n5on G0.R RA c.o o,2 m lc
Torn 1eFlo ri Rob,'1)s6n G-G.p lane Go . CL,
11911e Ta Vi(
D✓1 jf'�"T
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED
OWNER
16. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH
I5A NCAC THE
, WELL
t-74 P y S--o
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service CGWrI REV- gh, NC
27499-1636 Phone No. [phone], within 30 days.

293663
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natu I �R`esourcees - ivision of Water Quality Groundwater
roun w tSection
WELL CONTRACTOR (INDIVIDUAL) NAME (print) eT T Hy e CERTIFICATION
//�' We/l ckr,'t("'n�
PHONE N t��.S-1��
WELL CONTRACTOR COMPANY NAME I\-f(,. �'IA 1"ii _
STATE WELL CONSTRUCTION PERMITp ASSOCIATED WQ PERMIT,/
(if applicable)
(if applicable) ;.,
I. WELL (Check USE (Ch k Applicable Box): Residential 3 MunicipaUPublic 0 Industrial 0 Agricultural q ''- .
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL. LOCATION:
Nearest Town:. r �•SO n C 1 7y County St.✓0., n
(Street �ame, Nut rs, Community, Subdivision, Lot No., Zip Code)
RA
3. OWNER: /Va.rr \/ r z r
Address X;v //157/TS
(Shoe or Route No.)
5rysnIVG' 227/3
Cite or Town State Zip Code
ta)-'f&k-
Area code- Phone number
4. DATE DRILLED 11-4,-
5. TOTAL DEPTH: N30
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO El
7. STATIC WATER LEVEL Below Top of Casing: (i- FT.
tun `+" if Above Top of Casing)
8. TOP OF CASING IS / FT. Above Land Surfaces
*Top of wing terminated at/or below land aurfatt requires a
variance In accordance with 15A NCAC 2C .0116.
9. YIELD (gpm): 3 METHOD OF TEST Q. i r
10. WATER ZONES (depth):
1 I. DISINFECTION: Type T
12. CASING:
Depth Diameter
From n To Ft. 6 e_
From To Ft.
From To Ft.
13. GROUT: Depth
From__ To a) Ft.
From To Ft
14. SCREEN: Depth
From To
From To Ft.
15. SAND/GRAVEL PACK:
Dcpth
From To Ft.
From To Ft.
Amount
Wall Thickness
or Weight/Ft. Material
-Sprat PVC
Topographic/Land setting ..
❑Ridge ❑Slope ❑Valley OFlaf.
(check appropriate box)
Latitude/longitude of well location
(rlegrealmmuteshecoods)
Latitude/longitude source:❑GPS❑Togo
(check box)
DEPTH RI
From To Formation Description
0
r, A
- u
N n' ".4.)
°CATION SKETCH —.I
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
nturnbers and common road names. , G Go / Yh
-from �j.l y)7Dn i,1 PO57 O
lorn /e Ton 7L/F G0 5,02 nh''1>u
Material Method t!� C �� 6 Gf �.Q %0 TO
remenT minis /Urn N/c2,h f a T f-A
5�n Tunn R'ahT 61/ alekvk0. R(A•
Diameter Slot Size Material _ 1 ��` T Q r Joy ��'' q�
Ft. in. in. �j,D•Fliti1 e "Turn l L O
Size Material Go 4 r t %� r /e Turn ROT '" ° To 1
0;\ h,'ll L0N/t on (ZtahT.
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
TP -P-P i-lyAP V -/ -4‘)
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Ceenter` REV go 7/2001 NC
27699-1636 Phone No. [phone], within 30 days.

293661
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
,t� CERTIFICATION N 2 O 5 j r
IYELL CONTRACTOR (INDIVIDUAL)NAME
pp(tptrint)oo ����-r�n�` �--��z �ff,, PHONENI���y�R"8y`,
WELL CONTRACTOR COMPANY NAME (j)Ana-HI tA, S-�e �l1du-LQt
ASSOCIATE}'4Q PERMITN
(if applicable)
STATE WELL CONSTRUCTION PERMITN
(if applicable)
1. WELL USE (Check Applicable Box): Residential E/ Municipal/Public 0 industrial 0 Agricultural 0
Monitoring ❑ Recovery ❑ Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATIOX CLC'.i y 5 LD tt m
Nearest Town: /ri-L rI Count
.Rio J C
(Street Name. Numbers, Community. Subdivision. Lot No.. Zip Code)
3. OWNER: d.rtnn,
Address Rc'iL'nA1 Try WA
(Street or Route No.)
u"fin tt"rtj -11.c
City Jr Town State Zip Code
(QSc)- t S7 -3374.
Area code- Phone number /
4. DATE DRILLED `i// S 20 O Y.
TOTAL DEPTH: '7 O
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO a
7. STATIC WATER LEVEL Below Top of Casing: 6 0 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS / FT. Above Land Surface`
*Top of cuing terminated atfor below land surface requires a
variance in accordance with 1S M
9. YIELD (gpm):METHOD OF TEST A :Irv�—
10. WATER ZONES (depth): 6
I47-!I Amount Ot!/G
;-V11 3
Topographic/Landsetting
❑Ridge ❑Slope ❑Valley DFlbt
(check appropriate box)
Latitude/longitude of well location.
(deg &minuteshacads)
Latitude/longitude source:❑GPS❑Topographic: map
(check box)
DEPT uRILLINGILfiN
Formation De
From To
I1. DISINFECTION: Type
12. CASING:
Depth
From © To 1/ O
From To Ft.
From To Ft.
13. GROUT: Depth Material
From_2_To .9-0 Ft. en -runt
From To
Wall Thickness
Diameter or Weight/Ft. Material
Ft. 47,4 algal 'PV'c
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.
Saw
=ice
rri
.11 ec�
itt
:ram
IV
ri
G
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common b�road names. ` (�
Fite-nn 44nnner"'l b¢�✓ �"0 ).Lc.s U
CLf.t1.0-.,a. M&o'.)?
4,B 4` Rert'74 r1 ar
ryu
rl
Methodr}Roar-\` (i_o / e3 rate, t"t-Lv°� it.. 12,tad
?Ana
" athU7' ± -act ,4 ,»1 /y- Z 2. GC
Slot Size Material 0 3 Yindc i j -kvidr,. A+ Oh t
in.
in.
Material
Toiritw< (A.•tal G.o to SrneV 04 —lua-X
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
1.D ct -t 149 d-t 9 J J 6 f.a o 1j
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service CGWrI Raeigh 2001
27699-1636 Phone No. [phone], within 30 days.
1

293657
Amount 0.39
Wall Thickness
or Weight/Ft. Material
Laical Pvc.
Topographic/Land setting
❑Ridge ❑Slope OValley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(depaslmmures/ucmds)
Latitude/longitude source:OGPSOTopographic reap
(check box)
DEPTH DRILLING LOFT
From To FormationPscripilon
7 � n
Material p Method
Gvmen7 / limp/
Ft.
14. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in.
From To Ft. in. in.
15. SAND/GRAVEL PACK: Material
Depth Size
From To Ft.
From To Ft.
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natur IR^`esources - Division of Water Quality Groundwater
roun watSection
WELL CONTRACTOR (INDIVIDUAL) NAME /(print) tlP 1l !/Iy4, p CERTIFICATIONpCRN Natr2C2/10
ObJleii (toll r�'lr: u��r�
ASSOCIATED WO PERMIT*
(if aoolicabte)
WELL CONTRACTOR COMPANY NAME
STATE WELL CONSTRUCTION PERMIT*
(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:
Nearcst Town: ry S= w C i Tr County i (.� n
19 R 7/3
(Street Ndlne, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: r, r v+ n 6- rr, i nT
Address NE,/ 19
((Sweet or Route No.)
rySnn c/ry N.c a57/3
City or Town `State Zip Code
(221k)- CAC'' —Gf^C 3
Area code- Phone number
4. DATE DRILLED 1-i-23/'-6 4
5. TOTAL DEPTH: ) S'0
6 DOES WELL REPLACE EXISTING WELL? YES O NO IS
7. STATIC WATER LEVEL Below Top of Casing: En FT.
(Use "+" if Above Top of Casing)
S. TOP OF CASING IS l FT. Above Land Surfaces
*Top of casing terminated at/or below land surface requires a
variance In accordance with ISA NCAC 2C .0118.
9. YIELD (gpm): ip METHOD OF TEST hk r r
10. WATER ZONES (depth): 2.26
11. DISINFECTION: Type H-I % H
12. CASING:
Depth Diameter
From(_ To /00 Ft. 4719
From To Ft.
From To Ft.
13. GROUT: Depth
From t7 To .`)6 Ft.
From To
U7 z r`
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.
PG GO
rorl c )mu»el Pose a
O I
Tarn R, hT-art Hwy 19 0- , 02,
T wel/ or, RIghr
F-m,7
6 m. l d
iB'
1 RDANCE WITH I5A NCAC 2C,
CONSTRUCTION STANDARDS, AND THAT A COPYOFTHIS RECORD HD IN OA BEEN PROVIDED TO THE WELLL WNER t t
1—EA-PLO ry/ -f ie /i- `�Sf—el
SIGNATURE OF PERSO CONSTRUCTING THE WELL DATE
16. REMARKS:
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Ceenterl RREVgh,0NC 1
27699-1636 Phone No. [phone], within 30 days.

WELL CONSTRUCTION RECORD 293770
North Carolina - Department of Environment and Natural Resources • Division of Water Quality • Groundwater Section
WELL CONTRACTOR (INDIVIDUAL)NAME (print) Mitchell Da Cook CERTIFICATION# 20d3
WELL CONTRACTOR COMPANY NAME Han BLtdE S S€.1 Lizllirth LY PHONE # e28) 369-9591
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable) • (ifabolicable)
1. WELL USE (Check Applicable Box): Residential 0 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: Bryson City County Swain
Neerlmore
(Streel Name, Numbers, Community, Subdivision, Los No., Zip Code)
3, OWNER: Daniel Cloer
Address 301 Fred Breedlove Rd
(Street or Route No.)
Bryson City, Nf 2R71-4
City or Town State Zip Code
(828)- 488-2533
Area code- Phone number
4. DATE DRILLED 2-18-04
5. TOTAL DEPTH: 600'
6. DOES WELL REPLACE EXISTING WELL? YES ZNNO 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 Surface*
•Top of casing terminated at/or below land surface requires a
variance In accordance with ISA NCAC 2C .0118.
9. YIELD (gpm): DRY METHOD OF TEST blow
10, WATER ZONES (depth):
Topographic/Land setting
0Ridge ❑Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location:
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographi,c naap
(cheek box) t -
DEPTH DRILLING .OG
From To Formation Description
0 105' r•1ay & sarr1
105' 600' granite
I I. DISINFECTION: Type H T H
12. CASING:
Depth Diameter
From 0 To 103 Ft. 6"
From 103' To 107 Ft. 6" .188
Amount 1 6oz
Wall Thickness
or Weight/Ft.
From To Ft.
Material
PVC
steel
13. GROUT: Depth Material Method
From__ To 20 Ftkat1ite & tbte LPrized
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
To Ft.
To Ft.
From
From
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
-o
W
w
W
16.REMARKS.
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH I5A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center -Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. OW-1 REV. 07,'2001

WELL CONSTRUCTION RECORD
29>'7n9
North Carolina - Dcpor:ment of Environment and Natural Resources Division of Water Quality • Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) Mitchell D, Cook
WELL CONTRACTOR COht PANT NAME 1. ECt)1E-`S w'11 aillirar Irc
STATE WELL CONSTRUCTION PE RhIlT4
ASSOCIATED WQ PERMIT# ------
(if applicable) (if applicable)
CERTIFICATION R 2043
PHONE a 823) 369-9591
I. WELL USE (Check Applicable Box): Residential 6 Municipal/Public ❑ Industrial ❑ Agricultural 0
Monitoring 0 Recovery 0 Heat Purnp Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION:
Nearest Town: BrYSOn City County SwMn
Needmnre --Well #1
(Scree: Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: Daniel Cloer
Address 301 Fred 13rc dine Rd
• (Street or Route No.)
Bryson City. NC 28711
City or Town State Zip Code
(828)- 488-2533
Area code Phone number
4. DATE DRILLED 2-10-04
5. TOTAL DEPTH: • 750'
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO ❑2oc
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 ator below land surface requires a
variance In accordance with ISA NCAC 2C .0118,
9. YIELD (gpm): DRY METHOD OF TEST blow
10, WATER ZONES (depth):
11. DISINFECTION: Type H T H
12. CASING:
Depth
From q To 40
From 40 To 61
From To Ft.
13. GROUT: Depth Material
From_(_ To 20 Ftbsbrnite & caret
From To Ft.
14. SCREEN: Depth Diameter
From To Ft.
From To Ft.
15, SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
Diameter
Ft. 6"
Amount 16oz
Wall Thickness
or Weight/Ft. Material
Vic
Ft. 6" 1 RR c 1-n 1
Method
t]Iii7e5
Slot Size - Material
in. ' in.
in. in.
From To Ft.
16. REMARKS:
Topographic/Land setting
❑Ridge ❑Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minces/seconds)
Latitude/longitude sourceOGPS❑Topcg
(check box)
DEPTH DRILLIN& t nn
From To Formation Description
0 59'
clay & sand
59' 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.
—o
W
CO
W
1 DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
SIGNATURE OF PERSON CONSTRUCTING THE WEELL
—/O—a9
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

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources • Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL)NAME (print) Mitchell D. 000)C
WELL CONTRACTOR COMPANY NAME j ral altherS Fes'1 iit, II'r
CERTIFICATION 2043
PHONE % 825) 369-9591
STATE WELL CONSTRUCTION PERMIT% ASSOCIATED WQ PERMIT% (if applicable) (if applicable)
I. WELL USE (Check Applicable Box): Residential CS Municipal/Public 0 Industrial ❑ Agricultural 0
Monitoring ❑ Recovery 0 Heat Pump Water Injection 0 Other ❑ If Other, List Use
2. WELL LOCATION:
Nearest Town. Cherokee County Swain
Waterfalls C7turrh RA
(Street Name, Numbers, Community, Subdivision, Lot No.. Zip Code)
3. OWNER: Richard Bradley
Address PO Box 2454
(Street or Route No.)
Cherokee, NC 28719
• City or Town State Zip Code
( 82P- 497-4116
Area code- Phone number
4. DATE DRILLED 1-6-04
5. TOTAL DEPTH: 200'
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NOXE
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*
*Tap of casing terminated at'or below land surface requires a
variance In accordance with ISA NCAC 2C .0I19.
9. YIELD (gprn): 30 METHOD OF TEST blow
10, WATER ZONES (depth): 50' , 65' , & ' 160'
1 I. DISINFECTION: Type H T H
12. CASING:
Depth
FromQ_To 41 Ft
Ft.
From To
From To
Diameter
611
Amount 1 602
Wall Thickness
or Weight/FI.
1RR
13. GROUT: Depth. Material
From 0 To 20 Ftbarnite & utiarti
From To Ft.
tel SCREEN: Depth Diameter
From To Ft. in.
From To Ft. in.
15. SAND/GRAVEL PACK:
Depth Size Material
Material
ctnnl
Method
Slot Size Material
in.
in.
From To Ft
From To Ft.
Topographic/Land setting(
❑Ridge ESlope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(der:es/minutes/seconas) _
Latitude/longitude source:0GPSGTepograp Nic map
(check box) { �e
DEPTH DRILLING LOG-----
F rom To Formation Description
0 ' 41' play & 5.a13
41' 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
CO
W
CO
16. REMARKS:
1 DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH ISA NCAC 2C, l ELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
/- %n -az/
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
r

293800
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDU.AL)NAM E (print) James B. Brown CERTIFICATION# 2045
WELL CONTRACTOR COMPANY NA,NIE Hedden Brothers Well Drilling, Inc PHONE #[phone]
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMITO
(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 0 Other 0 If Other, List Use
2. WELL LOCATION:
Nearest Town: Cherokee
Big Cove--EBCI well
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3 OWNER: Marian Crane Gloyne
Address 160 Galamore Bridge RD
(Street or Route No.)
Cherokee, NC 28719
County Swain
City or Town State Zip Code
Ga28- 497-1562
Area codes Phone number 4-16-04
4. DATE DRILLED
5,TOTAL DEPTH: 300'
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO nt
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): 30 METHOD OF TEST blow
10. WATER ZONES (depth): 170'
1l. DISINFECTION: Type H T H Amount 16 oz
2. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
From 0 To 112 Et. .188 steel
From To Ft.
From To Ft.
13. GROUT: Depth Material Method
From 0 To 20 Ft, barnite & wtesiL 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
Frcm To Ft.
From To Ft.
Topographic/Land setting
❑Ridge ❑Slope ❑Valley OFlat.
(check appropriate box)
Latitude/longitude of well location
(degrees/ninutes/seconds)
Latitude/longitude source:OGPSOTopographic map
(check box)
DEPTH DRILLING LOG_ ___.
From To Formation Description
0 110'r clay & sand
110' 300' granite
LOCATION SKETCH
Show direction and distance in miles from at I t
two State Roads or County Roads. Include thelaad
numbers and common road names.
16. REMARKS.
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STAND�9ftT)S, AND THAT A COP F THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
SIG,'ATURE 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
0
_—PEE 32,

WELL CONSTRUCTION RECORD
North Carolina -Department of Environment and Natural Resources Division of Water Quality
WELL COINTRACTOR(IiNDIVIDUAL)NAME (print) James B. Brown
WELL CONTRACTOR COMPANY NAME Hedden Brothers Well Drilling, Inc.
STATE WELL CONSTRUCTION PERMITd
(if applicable) (if applicable)
- Groundwater Section
CERTIFICATION R 2045
PHONE a e28) 369-9591
ASSOCIATED WQ PERMIT:
1. WELL USE (Check Applicable Box): Residential Municipal/Public 0 Industrial 0 Agricultural ❑
Monitoring ❑ Recovery ❑ Heat Pump Water Injection 0 Other ❑ If Other, List Use
2 WELL LOCATION:
Nearest Town: ..Bryson City
Kirkland Creek
County Swain
(Street Name, NtImbe rs, Community, Subdivision, Lot No., Zip Code)
3. OWNER: Ken Cooley
Address PO Box 2131
(Street or Route No.)
Bryson Citvy,NC 28713
City or Town State Z:p Cede
82R )- 884-0908
Area code. Phone number
4, DATE DRILLED 4-7-04
5,TOTAL DEPTH: 700'
6. DOES WELL REPLACE EXISTING WELL? - YES 0
NO
7, STATIC WATER LEVEL Below Top of Casing: 600 FT.
(Use "+" if Abov: 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 .01I8.
9, YIELD(ebm): •5 METHOD OF TEST blow
10, WATER ZONES (depth): 400'
I I. DISINFECTION: Type H T H Amount 16 oz
12. CASING: Wall Thickness
Depth Di rceter cr Weight/Ft Materiel
From 0 To 87 Ft, .188 steel
From 87' To 90 Ft. 6
From To Ft.
• 13. GROUT: Depth Material Method
From 0 To 20 F t. beralite & critt+il- paced
From - - To Ft.
14. SCREEN: Depth Diameter Slot Size Material
From To Ftin. 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:DGPSOTopographiq map
(check box)
DEPTH DRILLING LOG
For om Ti8' Fclayion & seanaotion
88' 700' granite
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and cornnon road names, •
O
1
W
-v
W
16. REMARKS
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANj>,t.9.DS, AND THAT A CO 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 Flionc No, [phone], within 30 days. GW-I REV. 02/2901

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources • Division of Water Quality - Groun4water Section
WELL CONTRACTOR (INDIVIDUAL)NAME (print) James B. Brown CERTIFICATION# 2045
WELL CONTRACTOR COMPANY NAME Hedden Brothers Well Drilling, Inc PHONE e$28 1 369-9591
STATE WELL CONSTRUCTION PERM!Tli 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 ❑ Other 0 If Other, List Use
2. WELL LOCATION:
Nearest Town: Cherokee • County Swain
Aflama (`rppk--F.P.l.T wel 1 •
(Street Nance, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: Angele M. Woodard
Address 123 .Sally Ann Drive
(street or Route No.)
Cherokee, NC 28719
City or Town State Zip Code
(8280- 497-4740
Area code- Phone number
4. DATE DRILLED 4-15-04
5. TOTAL DEPTH: 300'
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO CZ
7. STATIC WATER LEVEL Below Top of Casing: 100' FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS 2 FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance In accordance with 15A NCAC 2C .0118.
9. YIELD (epm). 40 METHOD OF TEST blow
10. WATER ZONES (depth): 225 , 2441, & 262'
I I. DISINFECTION: Type H T H Amount 16 Oz
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
From 0 To 62 Ft. 6" pvC
From 671 To RS Ft. 6" 188 steel
From To Ft.
13.'GROUT: Depth Material Method
From 0 To 20 Ft. tacttte & oriunlL 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 0Flat
(check appropriate box)
Latitude/longitude of well location
(degrees minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH
From
To
0 63`
63' 300'
DRILLING LOCi
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.
q£:C Wd c—OWh0
16. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION ST.k'CIDARDS, AND THAT r4 PY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
SIGNA
-SC=/S-o y/
URE 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 Phonc No. [phone], within 30 days. GW-I REV. 072001

2 92191
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL)NAh1E (print)
James B. Brown CERTIFICATION k
WELL CONTRACTOR COMPANYNANIEHedden Brothers Well Drilling, Inc PHONE# E] 369-9591
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if acolicable) (if applicable)
I. WELL USE (Check Applicable Box): Residential Municipal/Public ❑ Industrial ❑ Agricultural 0
Monitoring ❑ Recovery 0 Heat Pump Water Injection 0 Other ❑ If Other, List Use
2. WELL LOCATION:
Nearest Town: Bryson City County Swain
Laver Alarka
(Street Name, Numbers, Community, Subdivision, Lot No.. Zip Code)
3. OWNER: James Carter
Address 670 Dark Branch RD
(Street or Route No )
Bryson City, NC 28713
City or Town State Zip Code
878 )- 488-2599
Area code- Phone number
4. DATE DRILLED 4F19*04
5. TOTAL DEPTH: 140'
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO fit
7. STATIC WATER LEVEL Below Top of Casing: 30 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS 2 FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance In accordance with ISA NCAC 2C .0118.
9. YIELD (gpm): 25 METHOD OF TEST blow
10. WATER ZONES (depth): 80', 105, & 123'
11. DISINFECTION: Type H T H Amount 16 cZ
12. CASING: Wall Thickness
Depth Diameter or Weicht'Ft. Material
From 0 To 70 Ft. 6n .188 steel
From To Ft
From To Ft.
13. GROUT: Depth Material Method
From 0 To 20 Ft. b nzr to & orni taL -pumped
From To Ft. -
14. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in.
From To Ft. in. in.
15, SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
16. REMARKS:
Topographic/Land setting •
❑Ridge ❑Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/mi nut es/seconds)
Latitude/longitude source',❑GPS❑Topographic map
—
(cheek box)
.__.
DEPTH DRILLING LOG
From To Formation DeserLotion
0 68' clay & sand
68' 140' granite
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the®ad
numbers and common road names. :i
W
—o
•
W
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STA. RDS, AND THAT A COF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
di-e)9-0 5�
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
r
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center -Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-1 REV. 07/2001
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) James B. Brown CERTIFICATION % 2045
WELL CONTRACTORCOMIPANY NAme Hedden Brothers Well Drilling, Inc PHONE%$28I) 369-9591
STATE WELL CONSTRUCTION PERtMIT% ASSOCIATED WQ PERMIT/4
(ifaonlicable) - (ifapplicable)•
293794
I. WELL USE (Check Applicable Box): Residential el Municipal/Public ❑ Industrial 0 Agricultural ❑
Monitoring ❑ Recovery 0 Heat Pump Water Injection 0 Other ❑ If Other, List Use
2. WELL LOCATION:
Nearest Town: Bryson City
Marr Creek Rd
County Swain
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: Paula & Kelvin Roberts
Address 1751 Winchester Rd
(Street or Route No.)
St. Petersburg, FL 33710
City or Town State Zip Code
(727)- 345-5752
Area code- Phone number
4, DATE DRILLED 3-24-04
5, TOTAL DEPTH: 180'
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO»
7. STATIC WATER LEVEL Below Top of Casing: 80 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 15A NCAC 2C .0118.
9. YIELD (gpm): 6 METHOD OF TEST blow
ID. WATER ZONES (depth): 80' & 110'
1 I. DISINFECTION: Type H T H Amount 16 oz
12. CASING:
Wall Thickness
Depth Diameter or Weight/Ft. Material
From 0 To 38 Ft. (-" pvc
From 38' To 41 Ft. 6' .188 steel
From
13. GROUT:
From 0
To
Depth
To 20
Ft.
Material
Ft. barnite & tx+i
From To Ft.
14. SCREEN: Depth Diameter
From To Ft. in.
From To Ft. in. W
15. SAND/GRAVEL PACK: ca
Depth Size Material r
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 STA ' DS, AiTHAT A Y OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
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 To Formation Description
0 39' clay & sand
39' 180' 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.
Slot Size Material
in.
n,
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
O
r
W
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
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294936
WELL CONSTRUCTION RECORD
North Carolina - Dcpartment of Environment and Natural esourceS -,Division of Water Quality - Groundwater Section
c—�
--{{- !/T/ CERTIFICATION 0.2L."L=
WELL CONTRACTOR (INDIVIDUAL) NAME (print) /c/� r PHONE S t,'2 t>l A/19 �15�
WELL CONTRACTOR COMPANY NAME GT'eA rn tJ,°// rnr,/li ✓�
STATE WELL CONSTRUCTION PERMITS
SSOCIATED WQ PERMITS
(if applicable)
(if applicable)
1. WELL USE (Check Applicable Box): Residential S 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: RrySen CiTyCounty tSkin. An
IA/FSCPr C,rpro k RA 7/,�
(Street Name. Numbers, Community, Subdivision, Lot No.. Zip Code)
3. OWNER: //nrctC,- h VrrlQn
Address iA/Acs&r l;r,opk
(Street or Route Na)
Rryson Zi Mtn 'QC-7/3
City or Town S to Zip Code
(11S)- '/? • 9,c<�
Area code- Phone number .�/3G/C�
4. DATE DRILLED_
5. TOTAL DEPTH: 7/) 5
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO Cad
7. STATIC WATER LEVEL Below Top of Casing: '5' 3 FT.
(Use "s" if Above Top of Casing)
8. TOP OF CASING IS / FT. Above Land Surfaces
flop of casing terminated .Nor below land surface requires a
variance to accordsace with 15A NCAC 2C .0118.
9. YIELD(gpm): r METHOD OF TEST a f"
10. WATER ZONES ('epth): 691
11. DISINFECTION: Type 11 i li
12- CASING:
Depth Diameter
From_._ To 33 Ft. /Ct
From To Ft.
From To Ft.
13. GROUT: Depth Material
From__To `1n Ft. (/ /7lPt17
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.
Amount 6 ///
Wall Thickness
or Weight/Ft. Material
SDr st/ P vC,
Topographic/Land setting
❑Ridge ❑Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degreWminutestseeoods) hic ttia
Latitude/longitude source:❑GPS❑Topograp P - _—
-
(check box)
DEPTH DRILLING LOG-------
FromTo Formation Description
c
c
tt J
LOCATION SKETCH —0 :
Show direction and distance in miles from at lest n?
two State Roads or County Roads. Include the i33d c
numbers and common ro
ad names. 'o
�ror� olmo tick P sr o-�1,ce urn
/e b r o17 in Go // a irides Torn
Method I� ,,0 %On b'tu y /7 6r-O 3, & yv,, 6 s
Tarn /c° r cn %-Jesse/ cre&r(
Go. o.ypi,/e "urn /Njr on
Go-s.UJCt ROAC\ G'o. 0,9 m%les" Go
le 6-4CJ7t Road Wo//on je-fr
Slot Size Material
in.
in.
Material
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
J eltP _fi�Ati ,i� ',3o/ay
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Ceenter' RREVgh, NC
27699-1636 Phone No. [phone], within 30 days.

North Carolina - Department of Environment and Natural
WELL CONTRACTOR (INDIVIDUAL) NAME (print) /I TP
rrz n rt.)YI
WELL CONTRACTOR COMPANY NAME
STATE WELL CONSTRUCTION PERMIT*
(if applicable)
1. WELL USE (Check Applicable Box): Residential ilK1 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 RrvSnn Gi'Ty CountyScan n
(Street Name. Numbers, Community,, Subdivision, lot No.. Zip Code)
3. OWNER: C`ell rl r.S /Y6'r`/r
Address ra, n,n 5 inno nTan
(Sueet or Route No.)
Rr son cr'Ty )V,c caS-7/.3
City or Town State Zip Code
(17., C)- 4'8"sf — W.5O
Area code- Phone number
4. DATE DRILLED 3i Q v/o y
5. TOTAL DEPTH: 7,5K
6. DOES WELL REPLACE EXISTING WELL? YES O NO 131
7. STATIC WATER LEVEL Below Top of Casing: O FT.
(Use "+" if Above Top of Cuing)
8. TOP OF CASING IS / FT. Above Land Surfaces
*Top of cuing terminated at/or below land surface requires a
variance In accordance with IS METHOD CAC 2C 01 TEST a I"9. YIELD (gpm): ()
10. WATER ZONES (depth): 0
ncaltip 5 nic0.47'.in F7/3
11. DISINFECTION: Type N7 // Amount 0
12. CASING: Wall Tbiclmess
Depth Diameter or Weight/Ft. Material
From__ To 57 Ft. (o if Ant ' i Put
From To Ft.
From To Ft.
13. GROUT: Depth Material
From 0 To 20 Ft. CPrnen %
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
From To Ft.
Topographic/Land settitjg
°Ridge ❑Slope ❑Valley OFlat
(check appropriate box)
Latitude/longitude of well location
(degrees/mmutemecoods)
Latitude/longitude source:OGPS❑Topogiaphic map
(check box)
DEPTH neu I ilti0 �.OG
From To Forrnatior Description
Cd
a— G�
o
cJt %'—
.rL c^
rn -.
LOCATION SKETCH tv rr
Show direction and distance2m�clofrom
de at
road
two State Roads or County
numbers and common road names. t r ,C F o
-tram 04r'lonc. Pos r °
/-FS �,,'les Tvin IefTon lye G-6
Method t YI T O n get/% 6„PV r+-i p v�q 5 9- pir'/es Toro f
294935
WELL CONSTRUCTION RECORD
esqurces - Division of Water Quality - Groundwater Section
ye
CERTIFICATION
PHONE * E"1a ss t—'r'y
ASSOCIATED WQ PERMIT*
(if applicable)
Material
Material
Go To sTP i'srti /orn R iohT 0(fi
0-IcArkcL Rok ,6-v/.3f7,/N5 Torn
fe-P ro n CctsT °dark GU 1, a Pi /7 's
/Ur/7 ILA?-( o/) Betimes mean o.:0 RG
/ Co /.3 m,'/es Turn •P6"7-on rren� sh.
16. REMARKS: /Iyd r/i �flar ri/ °clef
1 DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH I5 NCAC THE ,WELL
From To Ft.
We//
7a hio
OWNER
CONSTRUCTION STANDARDS, AND THAT A COPY OF�THIS RECORD HAS BEEN 3/7y/O
—re di -Pt
e
SIGNATURE OF PERS N CONSTRUCTING THE WELL DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Ceenterl RREV eigh, NC 1
27699-1636 Phone No. [phone], within 30 days.

294934
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural sources - Divison of Water Quality Groundwater
Aer ScioN n
�, T >IVm.N
WELL CONTRACTOR COMP (INDIVIDUAL) NAME (plat) r PHONE 0 raja --if
1
ll//TT�, i90�
\VELLCONTRACTORCOMPANYNAME a
SSOCIATED WQ PERMITN if applicable
STATE WELL CONSTRUCTION PERMIT#
(if applicable)
I. WELL USE (Check Applicable Box): Residential la MunicipaUPublic 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
TopographiC/Land setting
❑Ridge ❑Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
2. WELL LOCATION:
Nearest Town: /3r y SO4 C i 7y County 5 Lh . n
(i r7Pr CrPr'/k Rd a27/ 3
(Street Name. Numbers, Community, Subdivision. Lot No.. Zip Code)
( �n"m'°esheeonds) , -
3. OWNER: chuck- &r rnr- T Latitude/longitude sottrce:❑GPS❑Topoglaphid-map
Address l)7TFNr �'rrtF/r RrA (check box)
(Streeter Route No.) Q c-713 DEPTH DR►LLINt LOG
OT
Brjyn r, T)a w'C' From To Formation Description
City or Town State Zip Code
(fla)- Sal- 305-3
Area code- Phone number
4. DATE DRILLED J y/!/c9 lig
5. TOTAL DEPTH: 66.5
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO El
7. STATIC WATER LEVEL Below Top of Casing: 0 FT.
(unsay" if Above Top of Casing)
8. TOP OF CASING IS / FT. Above Land i r.c-
Surface*
*Top of cuing terminated at/or below land surface requires a r„,
vadaete In accordance with ISA NCAC 2C .011a. ..0 ��
9. YIELD (gpm): 0 METHOD OF TEST 0..., r
!0. WATER ZONES (depth): (1 LOCATION SKETCH r
Amount Show direction and distance in miles
from at least the road f"3 S
12. DISINFECTION: ON: Type f iTi� two State Roads or County Roads. 12. CASING: Wall tas
Depth Diameter or Weight/Ft. Material numbersrand common mantes' ���G F 6-0From 0 To 7D Ft. 647 Snr V PVC '} ro Gl,non POs r O
From To Ft. / %✓1,'/PS nip,j�cyhion usi?
From To Ft.
13. GROUT: Depth Material �J Method Gv //, u m /NS Turn /P r U /l
From 6 To Qe Ft. er p m n r l" VrnethAn<77
From To Ft. a lt.%.hao\ j�var�. Go, y,7 '!`°S TU7�
14. SCREEN: Depth Diameter Slot Size Material
From To Ftin. in /6frf r O h O 7T it creek RA -
From To Ft in.in.
15. SAND/GRAVEL PACK: Go , Y %n,?NS %rn /e t Tan Depth Size Material
From To Ft. 0e)weese Pa n • GO. 6,q milts
From To Ft.. (j 7-aril /e! � GU /, 3 m'le %D L✓e//-
16. REMARKS: Lk' // / O hP t1/Arcr'frkt 7 l rF
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
Ye 1/ //ydl e 3 /�c 4'
SIGNATURE OF PERSON CONSTRUCTING THE WELL �TE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Ceenter` RREV eigh, C01
27699-1636 Phone No. [phone], within 30 days.

WELL CONSTRUCTION RECORD
urea/Division of Water Quality - Groundwater Section
CERTIFICATION
pt oC°
North Carolina - Department of Environment and Natural
j.
ar
WELL CONTRACTOR (I$OIYIDUAL) NAME (prlan�i'
WELL CONTRACTOR CUMPANY NAME GYC.hO m Weil ay t /I1 l,9 PRONE M �'Y1�Y79-CrKSQ
STATE WELL CONSTRUCTION PERMIT/ ASSOCIATED WQ PERMIT/
idapplicable) (if applicable)
294933
/Ato
I. WELL USE (Check Applicable Box): Residential f8 Municipal/Public 0 Industrial 0 Agricultural ❑
Monitoring 0 Recovery 0 Heat Pump Water Injection ❑ Other D If Other, List Use
2. WELL LOCATION:
Nearest Town: Jsr •56n /.i17 County 5LJ0.it n
7�,5/)/ Km 4 / Sr7 /,"3
(Street Nude. Numbers. Community. Subdivision, tut No.. Zip Code)
3. OWNER: tAA
Address f r /y
(Siren or Route No.)
j3ryson C/77 Net7i3
ensre✓✓or Town Suhp Cede
($211)- '7r b' s- - ?O 9/
Area code- Prone number
4. DATE DRILLED 1/43//57017.
5. TOTAL DEPTH: /.5-5-
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO l
7. STATIC WATER LEVEL Below Top of Casing: 5 < FT.
(Use "r if Above Top °MCasutg)
S. TOP OF CASING IS / FT. Above Land Surface`
'Top of casing terminated Wm below land surface regains t
variance in accordance wits ISA NCAC 2C .011S.
9. YIELD (gm): Q METHOD OF TEST o-,'r
10. WATER ZONES (depth): /DO
11. DISINFECTION. Type If T
12. CASING:
Depth Diameter
From_ To'/7 FL6Y
From To Ft.
From To FL
11. GROUT: Depth
From 0 To 20
Ft.
From To Ft.
14. SCREEN: Depth
From To Ft. in. in
To Ft. in. _ in.
From
15. SAND/GRAVEL PACK:
Depth Size
From To Ft
From To Ft.
Material
Amount n.i4
Wall Th ckncss
or weight/FL Material
sera) Pvc
Topographic/Land setting c-
❑Ridge ❑Slope OValley OFIat
(cheek appropriate bait) '
Latitude/longitude of well location
(degrees/mummy/seconds)
Latitude/longitude aource:❑OPS❑Topographie map
(check box)
'DEPTH pRIL1 1NG Loa '.
From To Formation Dcscriptipi
G
-70
•
CP _
N^�
LOCATION SKETCH N �r
Show direction and distance in miles from at least
two State Roads or County Roads. Include the mad
numbers and cormmonlIroad names. tF�
rthn4nA PasTot�,Ce C-6 /
L/ E. Go 5,M'"/es
"Turn 1N�T on 7y-/�
Material Method _4hi �T /�h'I�T tp -r Go To s%aP
(on1PNT PL'rn ,h /vrn Ri7t /�
� Grn /f rYoto OUer cvec. ass
S,n!
Diameter SId Site Material s n Torn R 161hTon /T U'�y /R
GO r�oM •%STurn/e Tern/3uckner
/3rAnch Go l,am,lesTorn leJT on
c n51y Rooud1/4 , oST'l�s Torn Rr�(%yr
wet/ on SitghT
16 REMARKS -
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
SIGNA URE OF PERSON CONSTRUCTING THE WELL Es4�
Submit the original to the Division of Water Quality, Groundwater Section, t636 Moil Service Center- Raleigh, NC
27699-1636 Thom No. [phone], within 30 days. OW-1 REV. 07/2001

10. WATER ZONES (depth):
294932
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Wawa lRpsotimes - Division of Water Quality - Groundwater r Section
�j•
WELL CONTRACTOR (LNDIYIDUAL) NAa1E (print) t7rv' /7(A CERTIFICATION a_u saCQ.
rRaNE a fc,a H71 H6
-4�{
WELL CONTRACTOR COMPANY NAME Gnc ha. ro L✓P/` e)ri7/r17
STATE WELL CONSTRUCTION PERMITS ASSOCIATED WQ PERMfra
lif applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential 1il MunitipaVPublic 0 Industrial I Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other IFOther, List Usc
2. WELL LOCATI N:
Nearest Town: I r y.So: YI Gr 7y County S ✓ ict n
Spin a P;'/,o a-ccp RA `o25r7/3
(Street Name. 61uumbers. Commodity.
Subdirisiat. lot No. Zip Code)
3. OWNER: �R-rO•b Il I(c^td</r
Address SjOil0 P,'/F (-ry? P4
(Street or Route Nu.)
13ry sen (,/Ty
my
or Town State Zip Code
(y)- lag- 9'0. ? 9
Ares ride- Pion number r,)
4. DATE DRILLED 3//�i/Di/
5. TOTAL DEPTH' 1/6/ rt
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO SI 4
7. STATIC WATER LEVEL Below Top of Casing: /%S F. O
(Osc"s' if Above Top of Casing) CI jG
8. TOP OF CASING IS rr. Above Land Surfooei 't
*Top of casing ter.alnzted .Uor below land suttee requires a S r'
variance In Mordants With ISA NCAC 1C .0i16. Us `'
9. YIELD (gpm):O METHOD OF TEST air
t�? CD,-
LOCATION SKETCH NJ
11. DISINFECTION. Type /T fre Amount 0 ,37 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. terial numbers and common read names. (G CO/ GmrL(�$
From__ To 6Co Ft.44 SDr21 ,romPllnci7 A 6 ! o
From To Ft. rUYn lNron 7y�Go./o.3 m'/PS Tvrn
From__ To FL 13. GROUT: Depth Material • t_/,T 7 G-O To STOP e5MateriallaT �x� T
From n To �a FL fa>nanr P(J
Method I )��rnp, Torn >ePT Go over pass 1'urnler7-
From To Ft.
I4. SCREEN: Depth Diameter Slot Size Material on Wo✓rt'r t</deAy 6-b HZ Imilts' Torn
From To Ft in. in. Rt/7T on Co ver/'ldr :,-51c na IRacad Go
From To Ft. in. �_ in. i Cr NNk
15. SAND/GRAVEL PACK: 016 m,'/e �p(rr �PTon G,0J.bnr t%7
Depth Size Material flak^ Go l.9 /n,'/es TL-: <a fli llTol�,
From To Ft. From To Ft. n
S/Ge Pile) �c,.P lleac4 Ga. 0.3 Plies Tlir'i
16. REMARKS'. - Rtyl1T ()--0 /
C�o-f �o�
wed //
100 HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL I
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER on 1 e
t � oN\ >c% 3//9/69
S IGNATURE OF PERSON NSfRUCTtNO THE WELL DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Moil Service Center - Rakigh, NC
27699-1636 Pban No. [phone], within 30 days. GW-I REV. 07f2001
Topographic/Land setting
ORidge OSlopc OValley OFlat
(check appropriate box)
Latitude/longitude of well locatton
(drycesrmrnuteatseconds)
Latitude/longitude source:OGPSOTopographie map.
(check box) -
DEPTH DRILLING LOG
From To Formation Descripii n_, ____
1

WELL CONSTRUCTION RECORD 2 9 4 9 31
North Carolina - Department of Environment and Nature ources - Division of Water Quality - Groundwater Section
WELL CO VTRACfOR (INDIVIDUAL) IMAM (print) ./P /
Cre1.L7am Well clrIL(.'ngli PRONE YhaGN -Sr Kt{
ASSOCIATED WQ PERMITI
(if applicable)
W ELT. CONTRACTOR COMPANY NAME
STATE WELL Col\SIRUCTtON PERMITS
(ifapplicable)
I. WELL USE (Check Applicable Box): Residential C's! Municipal(Public 0 Industnat 0 Agricultural 0
Monitoring 0 Recovery0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION:
Nearest Town: 13 r yS/'n City County SWet.r'vt
Lvr/ Qc s..a7h 7/1
( treet.l.Eae. Numbers, Community, Subdivision. Lot No-. Zip Code)
3. OWNER:.R,r•ky 1'r ici C
Address Al y si rh
(Sireei or Route No.)
B rCity��/ Teel Tmm iry
=S am N' Zip Code
(ka8)-Wfl—
2Q7/3
Area code- Phone number
4. DATE DRILLED , 3 //2/O4i
5. TOTAL DEPTH: ,..170S
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO 141
7. STATIC WATER LEVEL Below Top of Casing: St, FT.
(Usc'v' if Above Top of Casfa&)
8. TOP OF CASING 1S / FT. Above Land Surface*
*Top of using terminated auor blow had surface relight •
variance in accordance with ISA NCAC IC.0111.
9. YIELD(gpm): / METHOD QFTEST CL,'r
10. WATER ZONES (depth): L/ o1J
11. DISINFECTION. Type L71 r%7i
12. CASING:
Depth Diameter
From 0 To & S- Ft. 6 -19
From To Ft.
From To Ft.
11. GROUT: Depth Material
From_ To 10 Ft. C.°ni, ni
From To Ft.
14. SCREEN: Depth Diameter Slol 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 6.76
Wall Thicknas
or Weight/FL tenal
Or `QJ
Medved
it
Topographic/Land setting I
°Ridge °Slope °Valley OF)iaf_.
(thee& vvptopriate her)
Latitude/longitude of welt location
(degius mimaerhescada)
Latitudefongitude source.cGPSOTopographie map
(check boa) -
DFMH DRILLING LOG,
From To Formation Description
G
1ry
I °
,
v
eF
LOCATLON SKETCH
1 <
Show direction and distance in miles from at least 'T.2
�--
mod;
rn ;i-
ntro State Roads or County Roads. Include the mad' N r-
m
cm
numbers and common road names. N r r
-From ahno n A Po 5 r o t roe
Z
jniles /Urn jN T an Tyr
Go. P-9 ))/ ,'leas 72,,n fi, hTon
d.lm;/e ?lent /64T
lro. 0.yyY,,i, % & //on J�tT
16 REMARK°
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
/ 3 lr�/c11
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Moil Service Center- Raleigh, NC
27699-1636 Phone No. [phone]. within 30 da3•x.

294960
TYZ-S1.Q..
ith021
4.0,c2
(Ves-
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From To Ft.
16. P.E.\LARKS:
S [ t��e t Topographic/Land setting
County . Ridge DSlope ❑Valley DFlat
(Street Name, Numbers, Community, Subs sision, L No., Zip Coda
3. OWNER: EcLt P� � I 0 .SJCL
Address -VC) 0 a.31
(Street r Rout: No ) ‘
�N't'(a UT..0 1{-1, r1G r.X 7i3
-y C(�n%',:lty T4»-n Sra:e I Zip Code
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i b - S r2Z 3
Area code- Phone number
4. DATE DRILLED R - .20 -O _ _
5. TOTAL DEPTH: /IOC — 1�e(CCeY�'Deeptle.
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO
7. STATIC SVATER LEVEL Below Top of Casing: FT.
(Vse-+" if Above Top o(Casine)
S. TOP OF CASING IS I • — FT. Above Land Surface'
•Top of casing terminated a Cor beta w land surface requires a
variance In accordant •ith 15A NCAC 2C .0119.
9. YIELD(gpm): 14 . MET�HODOFTEST /1-t r
10. WATER ZONES (;pth): q'$b
11. DISINFECTION: Type il-1 (-I Amount D
12. CASING: Wall Thickness
Depth Diameter or Wei?h:Tc. hLreri_I
From To Ft.
From To Ft.
From To Ft.
13. GROUT: Depth Material Method
From To Ft.
From To Ft. s
14. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in.
From To Ft. in. in.
li. S.ANDIGRAVEL PACK:
Depth Size Material
To Ft.
WELL CONSTRUCTION RECORD 294463
North Catolina :Department of Environment and Natural Resources -
WELL CONTRACTOR (INDIVIDUAL) NAME(print)
%YELL CONTRACTORA COMPANY NAME A-14-14
h'i
5 SQ./( /
reene "3
Division of Water Quality- Groundwater Sectioncic
g
Or CERTIFICATION 0 2 1a 7
YO' Gt1�/✓� PHONE a: ad: Shia �SSU
STATE WELL CONSTRUCTION PERMIT. ASSOCIATED WQ PERMIT:
(if applicable)
(if applicable)
1. WELL USE (Check Applicable Box): Residential Er-Municipal/Public ❑ Industrial ❑ Agricultural ❑
Monitoring ❑ Recovery 0 Heat Pump Water Injection ❑ Other ❑ If Other, List Use
2. WELL LOCATION: /L
Nearest Town:re rr(S-6%�
�JI-q-S-nZ vC ei cY 7f� (cheek appropriate
'r Ot ) Latttudz/longitudzof���elllocation
(des:e:imin ut:s'seconds)
Latitudeiongitude source:❑GPS❑Topographic map
(check box)
DRILLING LOG
Formation Description
DEPTH
From To
6,sa — qb'D
p P
en
LOCATIONLOCATION SKETCH
Show direction and distance in miles from-etIeaS
two State Roads or County Roads. Include`{.`(: roatce
numbers and common road r.arnes. -o r"
m
cn7-•
cn
G
Gv 7 u /�,Q4 ZoY
1'9
S
(n
fin R97m2--c
rC1'
Ca�Lt� z?o
Uc
[ DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSSRUCTION STANDARDS, AN THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OR\TP.
GNATURE OF PERSON CONSTRUCTING THE WELL DATE
tr
Submit the original to the Division of Rater Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-1 REV. 07/2001

WELL CONSTRUCTION RECORD
297302
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 Haiial littt s WTI Drillil'1g Tm
CERTIFICATION # 2045
PHONE # LR2R) 169-9597
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential ®C 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: Cherokee County Swain
Wolfetown
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: Elaine Younce
Address PO Box 2353
(Street or Route No
Cherokee, NC 28719
City or Town State
(E28)- 497-5181
Area code- Phone number
4. DATE DRILLED 6-8-04
5. TOTAL DEPTH: 400'
Zip Code
6. DOES WELL REPLACE EXISTING WELL? YES ❑ N0 4
7. STATIC WATER LEVEL Below Top of Casing: 150 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS 2 FT. Above Land Surface*
'Top of casing terminated at/or below land surface requires a
variance In accordance with 15A NCAC 2C .0119.
9. YIELD (gpm): 20 METHOD OF TEST blow
10. WATER ZONES (depth): 95', 120', & 307'
11. DISINFECTION: Type H T H Amount 16 nz
12. CASING: Wall Thickness
Depth Diameter or �' i ht/Ft. Material
From 0 To 84 Ft. 6" tSS steel
From To Ft.
From To Ft.
13. GROUT: Depth Method
From 0 To 20 wrced
From
Material
Ft.barnita & oaaent
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:❑GPS0Topographic map
(check box)
DEPTH DRILLING LOG
From To Formation Description
0 82' clay & sand
82' 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
16. REMARKS:
1 DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THATT 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
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 NAYIE ii33331.PireelltrrSFk+11 rxillirtg, Trr PHONE # fR2R) VD-9591
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
9
`I0
1. WELL USE (Check Applicable Box): Residential 63c 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: Cherokee County Swain
Jerome Bradley Rd
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
Topographic/Land setting
DRidge ❑Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
3. OWNER: Debbie West --Qualla Housing Authority (degrees/minutes/seconds)
Address PO Box 547
(Street or Route No.)
Cherokee, NC 28719
City or Town State
(828 )- 497-1835
Area code- Phone number
4. DATE DRILLED 6-16-04
Zip Code
5. TOTAL DEPTH: 700'
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO %a
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 at/or below land surface requires a
variance In accordance with 15A NCAC 2C .0118.
9. YIELD (gpm): 3 METHOD OF TEST blow
10. WATER ZONES (depth): 571' & 607'
11. DISINFECTION: Type H T H Amount 16 n7
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
From 0 To 169 pt. 6" pvC
From 169To 190 Ft. 6" 188 steel
From To Ft.
13. GROUT: Depth Material Method
From 0 To 20 Ft.b3rnite & cement pulped
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.
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From To Formation Description
0 188' clay & sand
188' 700' 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
L
c
IV
0
CI)
0
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
• SIGNATURE F RSON 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) 733-322I, within 30 days. GW-I REV, 07/200C

297298
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 HST BrdiE 142,11 Drill irg, Try`
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
CERTIFICATION # 2045
PHONE # (R75) TIS-SC91
I. WELL USE (Check Applicable Box): Residential 5dc 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: Bryson City County Swain
Conley's Creek --FBCI well
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: Kristie Green
Address 223 Parkview Acres
(Street or Route No.)
Bryson City, NC 28713
City or Town State Zip Code
( 828)- 488-2607
Area code- Phone number
4. DATE DRILLED 6-17-04
5. TOTAL DEPTH: 400'
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO Ia
7. STATIC WATER LEVEL Below Top of Casing250 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): 176' & 230'
11. DISINFECTION: Type H T H
12. CASING:
Depth Diameter
From 0 To 37 Ft. 6"
From To Ft.
From To Ft.
13. GROUT: Depth
From 0 To 20
From To
14. SCREEN: Depth
From To
From To
15. SAND/GRAVEL PACK:
Depth
From To
From To
Amount 16 o7
Wall Thickness
or Weight/Ft. Material
.188 steel
Material Method
Ft.tenztite & raTent prrpri
Ft.
Diameter Slot Size Material
Ft. in. in.
Ft. in. in.
Ft.
Ft.
Size Material
Topographic/Land setting
❑Ridge DSlope ❑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 T , Formation Description
0 35 clay & sand
35' 400' granit.e
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include thedsad c-
numbers and common road names.
c—
•
0
CO
16. REMARKS:
1 DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STAN RDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
SIGNATURE OF PERSON CONSTRUCTING THE WELL
G, / 7—Y) V
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 Natura Resources- Division of Water Quality - Groundwater Section
Nam.=
WELL CONTRACTOR (INDIVIDUAL) NAME (print) ) -IRe1 i")/l PHONE N fili"..22
WELL CONTRACTOR COMPANY NAME -
STATE WELL CONSTRUCTION PERMIT#
(if applicable)
I. WELL USE (Check Applicable Box): Residential ® Municipal/Public 0 industrial 0 Agricultural
Monitoring 0 Recovery 0 Heat Pump Water Injection ❑ Other 0 If Other, List Use
ASSOCIATED WQ PERMITN
(if applicable)
2. WELL LOCATION:
Nearest Town: RrySnn 17y County S r'✓I
DPtip C rePk Rr) Q 7/3
(Street N me. Numbers, Community, Subdivision, Lot No.. Zip Code)
3. OWNER: R.'// /-ovslty
Address %)FFf1 C-rePI'r R,rA
(Street or Route Na)
�ryion C.'Ty I\R.- elf-7/3
Ci y or Town State Zip Code
(77n )- S/(e- 7k.39
Area code- Phone number
4. DATE DRILLED (n-/(o'ON
5. TOTAL DEPTH: 20 C
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO IS
7. STATIC WATER LEVEL Below Top of Casing: /n0 FT.
(use "s^ 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 (g accordance /t with i5 METHOD OF TEST O- r r
CAC 2C .01111.
9. YIELD :�L)�
10. WATER ZONES (depth):
?96946
TopographicrLand setting
❑Ridge ❑Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(dcgreoslminutesheemtds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH
From To Fortnatiorl Description
11. DISINFECTION: Type #7 ry Amount b •.'3 4
12. CASING: Wall Thiclatess
Depth Diameter or Weight/Ft. Material
From ( To 76 Ft. C y $nr4-1 P VC -
From To Ft.
From To Ft.
13. GROUT: Depth Material {� Method
From 6 To rr)-O Ft. (e nitn7 AUMphici
From To FL KK
14. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in.
From -. To Ft. in. in.
15. SAND/GRAVEL PACK: Material
Depth Size
From To Ft.
From To Ft.
16.
REMARKS:
LOCATION SKETCH
Show direction and distance in miles frorR.t Ieait
two State Roads or County Roads. Include -the road
¶umbers and common road names, r» , %e S
Torn.cJ (kb) Pas? c-�r'o e G°
he4Ton 7ye 6-to �m,7dS Tke
k-.T (P76-07-6 srap S:sett Turnle
Go 7o sTop ) t' hYTuraz l e I 6-6 To
(16'0- ST» 1.411T %urn Jelei 6-o To
Dein ,STreeT Go.b,l>ti,le Trn
Rtlahron !Jeep Creek 610 IN r ;/e
Turn I e JT c —P01 k S T n N
/d r a v) Bac. k ivio,ii a u
G6 , 6.6 yn,le Tclnn /e4TonhSTtP lton ie-P-
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
DATE
—re -4 /)> p
SIGNATURE OF PERSON CONSTRUCTING THE WELL
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Ceenter' Raleigh,
EV g0 N 001
27699-1636 Phone No. [phone], within 30 days.

296945
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural iR-esources - Divt ion of Water Quality - Groundwater Section
c��
1P Ny �J CERTIFICATION 88LLtt`—�
WELL CONTRACTOR (INDIVIDUAL) NAME (print) mo% JJJ r t ��'��/UUU O / PHONE N eill'1 µ
WELL CONTRACTOR COMPANY NAME
STATE WELL CONSTRUCTION PERMITS
(if applicable)
1. WELL USE (Check Applicable Box): Residential ES Municipal/Public ❑ Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection ❑ Other 0 If Other, List Use
2. WELL LOCATION:
!rest Town' V n r' ."Tt County $ 1 ✓� . n
`riS r , r•
77-3
b
(Street Name. Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: £c rrc nifLkL✓rt11
Address i'rvs;Cier 1 r
(Street or Route No.)
Brsicnn c;T n/.<. a7/3
C' v or Town Site Zip Code
(112-)- 7'/t ' I as
Area code- Phone number/
4. DATE DRILLED !n-/7—/) L/
5. TOTAL DEPTH: 3
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO EI
7. STATIC WATER LEVEL Below Top of Casing: `nib FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS 1 FT. Above Land Surface'
*Top of casing terminated atier below Iand surface requires a
variance In accordance ,with 1SA NCAC 2C .0118.
9. YIELD (gpm): 4 METHOD OF TEST G r
10. WATER ZONES (depth): 35-0
11. DISINFECTION: Type Kr /i Amount O. (ram
12. CASING: Wall Thickness
or Weight/Ft. infat Pvc
From To Ft..
From To Ft.
13. GROUT: Depth Material
From 0 To ab Ft. ea erne ni
From To Ft.
14. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in.
From To Ft. in. in.
15. SAND/GRAVEL PACK: Material
Depth Size
From To Ft.
From To Ft.
ASSOCIATED WQ PERMIT('
(if applicable)
Dcpth Diameter
From h To-aa.__, Ft. t 4
Topographic/Land setting
❑Ridge ❑Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds) �
Latitude/longitude source:❑GPS❑Topog Vrrtap .-
(check box) -.
DEPTH DRILLING LOG
From To Formation Description
r-i
c
LOCATION SKETCH —
Show direction and distance in miles front -al least;
two State Roads or County Roads. Includee road
umbers and commoqq road names. G A Ci U �'
ro1� cchnono� Posi a-F
Er
M//i65/%�urn ietr°n 71f Aso(Y.
Method Urn rlihra,rF`�%TA/ Gr17oSTopS'
P"n'/i
p'no, 77urn 4,9hT on market Rd, 6-0 3'am'
Trn R, h r0 tn Deep
Turn Ri hTon ullis Go. pq ',/es
04. m lea To%ayse we11 car N?c T,
Turn .R t h l vh retVe R h
16. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH I5A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Ceenter, Raleigh,
EV g0, N OOl
27699-1636 Phone No. [phone], within 30 days.

n9
r,9
944
North Carolina - Department of Environment and N�atur l Resources
WELL CONTRACTOR (INDIVIDUAL) NAME (print S1t-
WELL CONSTRUCTION RECORD
vision of Water Quality - Groundwater Section
CERTIFICATION
PHONE S 6Yatrj1l k91sy
WELL CONTRACTOR COMPANY NAME
STATE WELL CONSTRUCTION PERMITS
(if applicable)
1. WELL USE (Check Applicable Box): Residential IS Municipal/Public ❑ Industrial 0 Agricultural 0.' .-
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use____
ASSOCIATED WQ PERMITS
if applicably
2. WELL LOCATION:
Nearest Town: Bry&' l C/ Ty County S
Can For pp fg7�.3
(Street Name. Numbers, Community, Subdivision, Lot No.. Zip Code)
3. OWNER: R/!,t mienrcX
Address C-PnTQ r Q r
(Street or Route No.)
Rry.cln r;JTy WC,
nv or Town
St
ate, ,
>-Le -ov6
Area code- Phone number
4. DATE DRILLED /r-jg-09
5. TOTAL DEPTH: DO 5-
El
6. DOES WELL REPLACE EXISTING WELL? YES O NO
7. STATIC WATER LEVEL Below Top of Casing: 70 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS / FT. Above Land Surfaces
*Top of casing terminated at/or below land surface requires a
variance le accordance with 15A NCAC 2C .0118.
9. YIELD (gpm): (5- METHOD OF TEST (i- % f
10. WATER ZONES (depth): / 3_S
Zi Code
Topographic/Land setting
❑Ridge OSlope ❑Valley ©Flat
(check appropriate box)
Latitude/longitude of well location'
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Togo pbic-map--._-_-
(check box)
ntxn 1 1N)G LOG
DEPTH--�-r�-...-----
From To Formation Description
p
I I. DISINFECTION: Type // T !-F
12. CASING:
Depth Diameter
Fromm To 7 7 Ft. 6
Ai
From To Ft.
From To Ft.
13. GROUT: Dept
From aTo
Amount 0.4.4
Wall llamas
or Weight/Ft. Material
SnrAi Pvc
Material
Ft. CFmPn-T
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
Pfi rl/ r'n�
Slot Size Material
in.
in.
Material
c
LOCATION SKETCH -
Show direction and distance in miles from at least =-=
two State Roads or County Roads. ►ncludeate road
nrbers and common road names. G r) /
rom cx/mcfl P05 7 0c
011ieS Turn lei r on 7Lf Go,
�. miles Take 't' l 6ct ciorIC.4
GO T STo/° :61 Turn 1ePT Gd
TrOn Ilk);
To STo�D 5,8n Turn '
l� C.O 09 17'J IC'S /c,rn i Ton
,
Aucknerr flrthnc1160, 0,(o1nr1PS 7 rl
R ItahTC-41 70 IA)
an lt-T
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
Ten-4 l-1 ate 6-/s-aq
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Ceenterl RREVgh, NC
27699-1636 Phone No. [phone], within 30 days.

_Swain.
WELL CONSTRUCTION RECORD 297142
North Cafdlina:Department of Environment and Natural Resources - Division of Water Quality- Groundwater Section
CERTIFICATION; Agin
PHONE II disaS J Slp^ $ c - )
\YELL CONTRACTOR (INDIYID UAL) NAM�E,((,p�lrii`nt.).//���' LL35- 10✓ f
WELL CONTRACTOR CO.'IPANYNAME I'iM -4 lttenc.�'Yts bight I�Y`l3
STATE WELL CONSTRUCTION PERMIT:
ASSOCIATED wQ PERMIT'
(if applicable)- (if applicable)
1. WELL USE (Check Applicable Box): Residential a Municipal,/Public ❑ Industrial O Agricultural ❑
Monitoring 0 Recovery ❑ Heat Pump Water Injection ❑ Ocher O If Other, List Use
2. WELL LOCATION:
Nearest Toil:
11. DISINFECTION: Type
12. CASING:
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO tv
7. STATIC WATER LEVEL Below Top of Casing,: IS FT.
(Use "r' if Aboa Top of Casir.sl
S. TOP OF CASING IS t FT. Above Land Surface'
•Top or casing terminated at'or below land surface requires a
variance In accordance s•Ith I5A NCAC 2C .01I5.
9. YIELD (gpm): L f METHOD OF TEST AMR
10. WATER ZONES (depth): I._dS l-12o' /-y/,S'
/4.t' 9
/IT
Depth Dia-e:er
From 0 To 603 Ft. Co 17y
From To Ft.
From To Ft.
13. GROUT: Depth
From 0 To 3
From 3 To .2D
14. SCREEN: Depth
From To
From To
15. SAND/GRAVEL PACK:
Ct County 5
eel Na e1c A t x t Wt. �p
(Beret Na .e, Ki.mbe , Community, Subdivision, Lot
No., Zi Code)
3. OWNER: {gaits Co L brea- l -
Address PO l e 10,3i1
r� (S:net or Rou:e N.)
:;odTo r) n 541 ( NI...Zip Ccgfi7/3
cde
(R21)- 48" 399.z
Area cove- Pbooe number
4. DATE DRILLED-S—IS-0'L
5. TOTAL DEPTFI: as7t
Si7/3
Topographic/Land setting
❑Ridge p(Slope ❑Valley OFlat
(:ht:k appropriate box)
Latitude/longitude of well location
(dts::ei minu:es'sc:onds)
Latitude,9on�itude source:DGPSDTopographic map
(:h _ lox)
DRILLING LOG
Formation Description.
DEPTH
From To
5-97
97— 1nO
120-lam,
iaa -JAr
7
!ID 7- MS'
IQS-- f 7 CCu/
!Q7-a5-0
LOCATION SKETCH
/% 7 Amount /tali- 09 Shay: direction and distance in miles fror7 at lea>-C
V.a'I Thickness two State Roads or County Roads. Iadud'euhe r5ai :
numbers and common road .tames.
51Na 2/
PVC
Material Me:hod
Ft. Qo.4n.a- a
Ft. bg ri m 0pleat) ty --kLt-rr- -i2----'
Diame:et 5:ot Size is!a:enal.
Ft. in. in.
Ft. in. in.
Depth Size Material
To
From Ft.
r-34.4r,
From To Ft.
16. REMARKS:
I DO HEP-EEY CERTIFY THAT THIS WELL WAS CONSTRUCTED TN ACCORDANCE WITH 15ANCAC 2C, WELL
CONST UCTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS EEEN PROVIDED TO THE WELL OWNER
GNATURE OF PERSON CONSTRUCTING THE WELL DATE
Submit the original to the Division of Water Quality, Ground's ater Section, 1636 Mail Seri:e Center - Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-1 REV. 07/2001
J,

298494
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL)tNAME (print) James B. Brown CERTIFICATION: 2045
WELL CONTRACTOR COMPANY NA31EHedden Brothers Well Drilling, Inc PHONE a823) 369-9591
STATE TELL CONSTRUCTION PER.\IIT= - ASSOCIATED WQ PERMIITOI
(ifaoplicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential Municipal Public ❑ Industrial ❑ Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other ❑ If Other, List Use
2. WELL LOCATION:
Nearest Town: Cherokee County Swain
Big Cove to Charles Johnson Rd--EBCI well
(street Name. Numbers, Community, Subdivision, Lot No., Zip Code)
3. O\\'NER: Zhana Michelle Wolfe
Address PO Box 464
(Street or Route No )
Cherokee, NC 28719
City cr Town State
(828)- 497-5325
Area code- Phone number
4. DATE DRILLED 3-8-04
Zip Code
5. TOTAL DEPTH: 300'
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO XS
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 15. NCAC 2C .0118.
9. YIELD (gpm): 6 METHOD OF TEST blow
10. WATER ZONES (depth): 115' & 227'
11. DISINFECTION: Type H T H Amount 16 Oz
12. CASING: \Wall Thickness
Depth Diameter or Weight/Ft. Nlaterial
From 0 To 70 Ft. 6" .188 steel
From _ To Ft.
From To Ft.
13. GROUT: Depth Nlaterial Method
From 0 To 20 Ft. tsrntte & 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 OSlope ❑Valley ❑Flat
(cheek appropriate box)
Latitude:longilude of well location
(degrees'mi nutes'seconds)
Latitude/longitude source:OGPS❑Topographic map
(check bon)
DEPTH DRILLING LOG
From To Formation Decor otion
0 68' clay & sand
68' 300' granite
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include tloadr.E
numbers and common road names.
b
0
O
16. REMARKS:
1 DO HEREBY CERT
CONSTRUCTIO,
THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH I5A NCAC 2C, WELL
ARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
SIGNA
-«J
URE OF PERSON CONSTRUCTING THE WELL DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-1 REV. 07/2001

298183
WELL CONSTRUCTION RECORD
North Catalina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater /� Section erg
CONTRACTOR (INDIVIDUAL) NAME (printUSS-P.lt / Llf 10✓ CERTIFICATION p
WELL CONTRACTOR COMPANY NAME) (;iQei1 C /-K/i! < LaJ'c',C/ I tit• PHONE # t7CZACs r -5SS' 0
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PER IIT#
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential$ Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery ❑ Heat Pump Water Injection ❑ Other 0 If Other, List Use
2. WELL LOCA N:
Nearest TOVM: brp] San County
(Street Name, Numbers, Community, Subdivision, Lot No.,
( itUcc/it
Zip Code)
3. OWNER: A'Ut 11) i--f e1 izlzezL
Address 0 i-3 5y i 51, c-
( trot or Route N
(�I,1SOn Ct ,,lI C. a 7/ 3
'Pit or Town tale / Zip Code
(gab)- 48. o7/0
Area code- Phone number
4. DATE DRILLED 1 — I -0 clj
5. TOTAL DEPTH: 1 7
6. DOES WELL REPLACE EXISTING WELL? YES ❑ �N1O,g
7. STATIC WATER LEVEL Below Top of Casing: c�v FT.
/ Oise"+" if Above Top of Casing)
S. TOP OF CASING IS I /a-- FT. Above Land Surface*
•Top of casing terminated atlor below land surface requires a
variance In accordance with ISA NCAC 2C .0118. nn
9. YIELD (epm): 6 METHOD.OF TEST f-f'/ C.
10. WATER ZONES (depth): 5 (4S .5 l.Zaf t)
11. DISINFECTION: Type (-f- 7--1-1 mount 4/ rF! —
12. CASING: Wall Thickness
_ Depth - or Weight/Ft. Material
From Pi To a' " / s t/e ck
From To
From To
13. GROUT: Depth
From C) To i-)0
Diameter
Ft. (/
Ft.
Ft.
Material
Ft. (v O
Method
From To Ft. r
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 DFlat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DRTLL!NG LOG
Formation Description
DEPTH
From To
ys
95-•- 97
cj 7 -
/2G - / 43
!3S
/3ps� —/.0
/3d /7c
LOCATION SKETCH
Show direction and distance in miles frac�rt at least
two State Roads or County Roads. thole the -TV
numbers and common road names. 23 ;m
-- m
Y-o
"O m�
C C
� id iK m
to ki-LA-LE.`
(9Qcil i
<� //,, ��
co G
T DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE 1VITH 16A NCAC 2C, WELL c9
CONSTRUCTION STANDARDS, AND THAT A COPY OF TH S,RECORD HAS BEEN PROVIDED TO THE WELL OWNER
Caz /1, -get /5
SIGORE OF PE CONS CTING THE WELL DATE
5 Lit
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 RED`. 67/2001

WELL CONSTRUCTION RECORD
North Carolina _ Department of Environment and
Natural Resources -^Division of Water Quality - Groundwater Section m Jr
WELL CONTRACTOR (INDIVIDUAL) NAME (print) i 5S�! 4 TA-(1/0 7 - CERTIFICATION II 2/0 7
WELL CONTRACTOR COMPANY NAM{-f7-L47 Eege/I G k� hrZ I A1C�.L9 PHONE #
STATE WELL CONSTRUCTION PERMIT#
(if applicable)
ASSOCIATED WQ PERMIT#
(if applicable)
298182
yin (S357a 555U
1. WELL USE (Check Applicable Box): Residential Municipal/Public 0 Industrial 0 Agricultural ❑
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other 0 If Other, List Use
2. WELL LOCATION
Nearestr7gwn: (.L=r L4A County
(Street Nome, NOttbers, Community, Subdivision, Lot No., Zip Code
3. OWNER: 1 fiJLc=`(, {� .b�
Address 3 (J1V)'1e
5 l R C1i e_
IC (Screet(pr Routci ^�vo,); , O 7 O 3
Ciry or Town State Zip Code
( )- C O,4) 3'37 3f1oS�
Area code- Phone number
4. DATE DRILLED j I a -
5. TOTAL DEPTH: 300
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO g
7. STATIC WATER LEVEL Below Top of Casing: 1 t_o FT.
/) (Use "+" if Above Top of Casing)
S. TOP OF CASING IS I 2— FT. Above Land Surface`
'Top of casing terminated atior below land surface requires a
variance 1n accordance with 15A NCAC 2C .0118.
9. YIELD (epm): I METHOD OF TEST
10. WATER ZONES (depth): a 0
11. DISINFECTION: Type 14 J I-1 ✓ Amount
12. CASING: Wall Thickness
Depth Diameter or WeightFt. Ma:erial
From 0 To_/__ Ft. (t/'/ 5 De 2 i POL
From To Ft.
From To Ft.
13. GROUT: Depth
From 0 To Q C.) Ft.
From To Ft.
Material Method
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 lope DValley ❑Flat
check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DRILLING LOG
Formation Description
DEPTH
From To
p-!p2
Lora a -RR
c
_ LOCATION SKETCH
- Show direction and distance in miles fr614at'Fps
two State Roads or County Roads. Incltg the
rn
numbers and common road names.
-o
rn
cn z
m�
CO
H
O
z
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
ris -e,/ SIG/Dr'HI/
OFIE S C THE WELL DATE
Lt
Submit
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

298118
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 1-61a-1 BL'othecs W'11 [�illitty, lit PHONE [phone]
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
WELL USE (Check Applicable Box): Residential 2 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: Bryson City County Swain
520 Fast Alarka Rd
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: Heath & Rebecca Woodard
Address 520 East Alarka RD
(Street or Route No.)
Bryson City, Tv 28713
City or Town State Zip Code
(828- 488-2096
Area cod:- Phone number
4. DATE DRILLED 2-20-04
5. TOTAL DEPTH: 400'
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NOS
i. STATIC WATER LEVEL Below Top of Casing: 200 FT.
(Use "+" if Above Top of Casing)
S. TOP OF CASING IS 2 FT. Above Land Surface'
'Top of casing terminated at'or below land surface requires a
variance In accordance with I5A NCAC 2C .0118.
9. YIELD (gpm): 20 METHOD OF TEST blow
WATER ZONES (depth): 370'
DISINFECTION: Type H T H Amount 1 6oz
CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
From 0 To 111 Ft. 6" pvc
From 111 ' To 115 Ft. 6" .188 steel.
From To Ft.
13. GROUT: Depth Material Method
From 0 To 20 Ftkarn to & Caret armed
From To Ft.
14. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. - in.
From To Ft. in. in.
I5. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft,
16. REMARKS.
Topographic/Land setting
❑Ridge ❑Slope ❑Valley OFIat
(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 Description
0 113' c1av & sand
113' 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.
0
er
0
3 nA
cm
�n
-rT
co o
Drn
ao
m
teat
ni
n
c
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RECO HAS BEEN PROVIDED TO THE WELL OWNER
2 —.20-04'
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. (9I9) 733-322I, within 30 days. GW-1 REV. 07/2001

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) James B. Brown CERTIFICATION a 2045
88 ELL CONTRACTOR COMPANY N,AN1E Hedden Brothers Well Drilling, Inc PHONE #[phone]
STATE WELL CONSTRUCTION PERMIT* ASSOCIATED WQ PERMIT#
(if aorlicable) (ifaoo!icable)
I. WELL USE (Check Applicable Box): Residential Ntunicipah?ublic 0 Industrial ❑ Agricultural 0
Nlonitering 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION:
Nearest Tc'.vn: Cherokee County Swain
1660 Towstring Rd --EBCI well
(Street Name, Number, Community, Subdivision, Lot No., Zip Code)
3. OWNER: Daniel Lambert
Address 1660 Towstring Rd
(Street or Route No.)
Cherokee, NC 28719
City or Town State Zip Code
(828)_ 497-7382
Area cede• Phcae number
4. DATE DRILLED 1-30-04
5. TOTAL DEPTH: 300'
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO ES
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 attor below land surface requires a
variance In accordance with 15A NCAC 2C .0118.
9. YIELD (gom): 20 METHOD OF TEST blow
10. WATER ZONES (depth):• 135', 165', & 170'
DISINFECTION: Tvpe
12. CASING:
H T H
Depth Diameter
From 0 To 96 Ft. 6"
From To Ft.
From To Ft.
13. GROUT: Depth Material Nlethod
From 0 To 20 Ft. Mite & wi iL Pumped
From - To Ft.
14. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in.
From To Ft. in. in.
I5. SAND/GRAVEL PACK:
• Depth Size Material
t
Amount 16 oz
Wall Thickness
or 1/21'eight/Ft. Material
.188 steel
From To Ft.
From To Ft.
16. REMARKS:
Topographic/Land setting''
❑Ridge !]Slope ❑Valley ❑Fla:
(check appropriate box)
Latitude/longitude of well location
(degrees',r.lno testsecor,ds)
Latitudo/longitude source:❑GPS❑Tcpographic map
(cheek box)
DEPTH DRILLING LOG
From To Formation Desorption
0 94'clay & sand
94' 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 CERTIF
CONSTRUCTION
AT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH I5A NCAC 2C, \VELL
RDS, AND THA COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
_ "per �
SIGN.
ARE OF PERSON CONSTRUCTING THE WELL DATE
Submit the ori, nal 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
a
Ozs
2981tl
0
0
10
0
01
-rat
tin
2-0
O
am
cn
r x,
0
ti
0
2

298110
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality
WELL CONTRACTOR (INDIVIDUAL)NAME (print) James B. Brown
WELL CONTRACTOR COMPANY NAME Hedden Brothers Well Drilling, Inc
- Groundwater Section
CERTIFICATION 0 2045
PHONE [phone]
STATE WELL CONSTRUCTION PERSITT: ASSOCIATED WQ PERMIT
(ifacniicable) (if applicable)
1
WELL USE (Check Applicable Box): Residential Eli Municipal/Public 0 Industrial 0 .Agricultural ❑
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 IfOther, List Use
2. WELL LOCATION:
Nearest Town: Cherokee County Swain
Big Cove-Sherril Cove Rd--EBCI well
(Street Name, N.nn'bcrs, Community, Subdivision, Lot No.. Zip Code)
3. OWNER: Henrietta Armachair
Address PO Box 1191
(Street or Route Nc )
Cherokee, NC 28719
City or Ton State Zip Code
p28 )- 497-2154
Area code- Phone number
4. DATE DRILLED 2-3-04
5. TOTAL DEPTH: 200'
6, DOES WELL REPLACE EXISTING WELL? YES ❑ NO {c c
7. STATIC WATER LEVEL Below Top of Casino, SD FT.
(Use "+" if Above Top of Casing)
S. TOP OF CASING IS 2 FT. Above Land Surface'
'Top of casing terminated at'or below land surface requires a
variance In accordance with 15A NCAC 2C .0118.
9. YIELD (gpm): 30 METHOD OF TEST blow
10. WATER ZONES (depth): 120' . 148' . & 164'
11. DISINFECTION: Type H T H Amount 16 oz
12. CASING: Wall Thickness
Depth
From 0 To 61 Ft
From, To Ft
From To Ft
13, GROUT: Depth Material Method
From 0 To 20 Ft. bernite & CanEnt purnped
From To Ft.
14. SCREEN: Depth Diameter Sic): Size Mater.al
From To Ft. in. in.
From To Ft, in. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
Dhmeter or WeightFt. Material
6f' .188 steel
Topographi✓Lar.d setting
❑Ridge ❑Slope ❑Valley ❑Flat
(check appropriate box)
Latitude'longitude of well location.
(de;rees.m.i.Hu:es seconds)
Latitudorlongitude source:❑GPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From To Formation Description
0 59' clay & sand
59' 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.
c
O 0
r 0
Xs.
CO
a
O ma
rV r'
'c- c
16.REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION ST ARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED 70 THE WELL OWNER
gFG NATURE OF PERSON
c�
SIGNATURE Pc'RSON CONSTRUCTING THE WELL DATE
Submit the ode al 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

29,8V1
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality
WELL CONTRACTOR (INDIVIDUAL) NAME (print) James B. Brown
WELL CONTRACTOR COMPANY NAME Hedden Brothers Well Drilling, Inc
- Groundwater Section
CERTIFICATION € 2045
PHONE a 828) 369-9591
STATE WELL CONSTRUCTION PERMIT* ASSOCIATED W'Q PERMIT=
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential ES Municipal/Public 0 industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 Il""Other, List Use
2. WELL LOCATION:
Nearest Town: Cherokee County Swain
Hyatt Creek --EBCI well
(Street Name. Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: Christopher Hyatt
Address 69 Dugan Rd
(Sttce: or Route No.)
Cherokee, NC 28719
City or Town State
(828)- 497-1502
Arta code- Phone number
4. DATE DRILLED 2-4-04
5. TOTAL DEPTH: 600'
6. DOES WELL REPLACE EXISTING WELL? YES 0 NOC
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 ISA NCAC 2C .0118.
9. YIELD (gpm): 7 METHOD OF TEST blow
10. WATER ZONES (depth): 120', 237', & 340'
Zip Code
11. DISINFECTION: Type H T H
12. CASING:
Depth
From 0 To 97
From 97' To 100'
From To
13. GROUT: Depth
From 0 To 20
Diameter
Ft. 6"
Ft. 6"
Ft.
From To
14. SCREEN: Depth
From To
From To
15. SAND.GRAVEL PACK
Depth Size
From To Ft.
From To Ft.
Amount 16 oz
Wall l Thickness
or Weight:Ft. Nlaterial
pvc
.188 steel
Nlaterial Method
Ft.ban-Lite & osre t pumped
Ft.
Diameter Sot Size Dlzterial
Ft. in. in.
Ft. in. in.
Material
Topographic/Land setting-
❑Ridge 0Slope ❑Valley ❑Flat
(cheek appropriate box)
Latitud.'Ion_itude of well location
(degrees hn'awtes'seconds)
Latitude/long i tide source:❑GPSDDTopographic map
(check box)
DEPTH DRILLING LOG
From 98' clay & Description
and tion
98' 600' granite
LOCATION SKETCH
Show direction and distance in miles from at (east
two State Roads or County Roads. Include the road
numbers and corrunon road names.
1V
f.11
16. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION ST. '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 NIail Service Center -Raleigh. NC
27699-1636 Phone No, (919) 733-3i21, \+ithin 30 days. GW-I REV. 07 2001
0

298108
North
WELL
WELL
_STATE WELL CONSTRUCTION PERMIT*
(if aoplicable)
WELL USE (Cheek Applicable Box)' Residential El Municipal/Public 0 Industrial 0 Agricultural 0
WELL CONSTRUCTION RECORD
Carolina - Department ef Environment and Natural Resources -Division of Water Quality
James B. Brown
CONTRACTOR (INDIVIDUAL)NAME (print)
CONTRACTOR COLT P.ANY NAME Redden Brothers Well Drilling, Inc
ASSOCIATED WQ PERMIT=
(if applicable)
- Groundwater Section
CERTIFICATION le 2045
PHONE [phone]
Monitoring 0
Recovery 0 Heat Purnp Water Injection ❑ Other 0 if Other, List Use
2, WELL LOCATION.
NearestTown: Bryson City County Swain
Franklin Grove Church RD --EBCI well
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Cede.)
3.-OWNER: Judy BoH. B5evins
Address
(Street er Route No.)
Cherokee, NC 28719
c:rycr Town Sae Zip Code
(828)- 488-7856
Area code- Phone number 2-5-04
4. DATE DRILLED
5. TOTAL DEPTH: 600'
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO 3:g
7. STATIC WATER LEVEL Below Top of Casing: 400 FT.
(Use "r' if Above Top of Casing)
S. TOP OF CASING IS 2 FT. Above Land Surface'
*Top of casing terminated at'or below land surface requires a
variance In accordance with 15A NCAC 2C .0118. blow9. YIELD (goo): 2 METHOD OF TEST
l0. WATER ZONES (depth): 235'
II. DISINFECTION: Type H T H Amount 16 Oz
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
From 0 To 79 Ft. 6" .188 steel
From 79' To 82 Ft. 6"
From To Ft.
13. GROUT: Depth Material Method
From 0 To 20 Ft. La-2Sute & C rot 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
To
To
From
From
Ft.
Ft.
Topographic/Land setting'
❑Ridge ❑Slope ❑Valley ❑Fla:
(check appropriate box)
Latitudz'lon_itude of well location
(desmi nutes's roads)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From, To Formationat& D stir Lion
0 80'
80' 600' granite
LOCATION SKETCH
Show direction and distance in miles from at ieast
two State Roads or County Roads. Include the road
numbers and common road names.
0
CO
a
x0
cn
16. REMARKS`.
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTIONsNDARDS, AND THAN COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
SIGN
JRE OF PERSON CONSTRUCTING THE WELL
DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Centert; RREaleigh_'CO1
27699-1636 Phonc No. [phone], within 30 da's.
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298107
\YELL CONSTRUCTION RECORD
North Carolina • Department or Environment and Natural Resources - Division of Water Quality
WELL CONTRACTOR (INDIVIDUAL) NAME (print) James B. Brown
WELL CONTRACTOR COMMP.ANYNANIEHedden Brothers Well Drilling, Inc
- Groundwater Section
CERTIFICATION # 2045
PHONE # [phone]
STATE WELL CONSTRUCTION PERNIiTk ASSOCIATED WQ PERMIT:
(if apclicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential Municipal/Public 0 Industrial ❑ Agricultural ❑
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other 0 IFOther, List Use
2. WELL LOCATION:
Nearest Town: Cherokee County Swain
Wrights Creek -Dobson RD --PBCI well
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: Aaron "Cherise" Husky
.Addrss PO box 19
(Scree: cr Route No,)
Cherokee, NC 28719
City cr To'wr. Stab Zip Code
( 828- 497-4317
Area code- Phone number
4. DATE DRILLED 2-11-04
5. TOTAL DEPTH: 840'
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO2
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"
*Tap of casing terminated atlor below land surface requires a
variance in accordance with 15A NCAC 2C .0115.
9. YIELD (gpm): 15 METHOD OF TEST blow
10. WATER ZONES (depth): 782'
11. DISINFECTION: Type H T H
12. CASING:
Depth Diameter
From 0 To 62 Ft. 6"
From To Ft.
From To Ft
13. GROUT: Depth Material Method
From 0 To 20 Ft.lantite & Cetera Pumped
From . To Ft.
14. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in.
From To Ft. in. in.
15. SAND/GRAVELPACK:
Depth Size Material
From To Ft.
From To Ft.
Amount 16 oz
Walt Thickness
or V,'eicht Ft.
.188
Topographic/Land settin;
DRidge ❑Slope ❑Valley ❑Flat
(cheek appropriate box)
Latitude/longitude of well location
(de ) lninute;,Sezends1
Latitude/longitude souse:DDGPS❑Tepographic map
(check box)
DRILLING LOG
Fclayi & sanDesction
DEPTH
From To
60'
60' 840'
granite
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County' Roads. Include the road
Material numbers and common road names.
steel
0
F
a
c
16. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION SDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
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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], aaithin 30 days. GW-I REV. 07/200:

299237
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) L: Bruce Morgan CERTIFICATION # 2047
WELL CONTRACTOR COMPANY NAME F'51 Etchers bell llnllirm. Inc PHONE # f828) 169-9S91
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
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: Bryson City County Swain
East Deep Creek
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER:Dinanath "Curtiss" Maharaj
Address 90 Poverty Hi 11
(Street or Route No.)
Whittier, NC 28789
City or Town State Zip Code
p28 )- 497-5631
Area code- Phone number
4. DATE DRILLED 6-15-04
5. TOTAL DEPTH: 550'
6. DOES WELL REPLACE EXISTING WELL? YES D NO
7. STATIC WATER LEVEL Below Top of Casing: 300 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING 1S 2 FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordance with ISA NCAC 2C .0118.
9. YIELD (gpm): 1 5 METHOD OF TEST hl oar
10. WATER ZONES (depth): 190& 340'
11 DISINFECTION: Type H T H
12. CASING:
Depth
From 0 To 92
From 92' To 95' Ft. 6"
From To
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.
Diameter
Ft. 6"
Amount 16 oz
Wall Thickness
or Weight/Ft. Material
pvc
.188 steel
Ft.
Material
Ft.h3rnite & rat
Ft.
Method
PTrird
Slot Size Material
in.
in.
Material
Topographic/Land setting.
DRidge ❑Slope DValley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:OGPSOToiaographic map'.
(check box) r
DEPTH DRILL(WG LOO--
From To Formation Description
0 93' clay & sand
93' 550' 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
c_
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
SIGNATUIkE,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-1 REV. 07/2001
0

WELL CONSTRUCTION RECORD
299332
North Carolina - Dopartment orEn'ironment and Natural Resources - Division of Water Quality - Groundwater Section
ELLCOVTRACI'OR(! DIYIDUAL)N.A?IE (print)
James B. Brown CERTIFICATION# 2045
WELL CONTRACTOR CC/WANT NA.IEHedden Brothers Well Drilling, Inc PHONE a e28 1 369-9591
STATE WELL CONSTRUCTION PERJIIT= ASSOCIATED WQ PER.IITc
(it -applicable) (if applicable') -
I. WELL USE (Check Applicable Box): Residential Municipal 0 Industrial ❑ ?.pricul:ural ❑
Monitoring 0 Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use
2. WELL LOCATION:
Nearest Town: Whittier
Hyatt Creek --FBI well
County Swai n
(Scree: Name, N:unber, Community, Subdi vis, on, Lot No., Zip Code)
3. OWNER: Travis Smith
Address C/O FWI-Tribal Construction
10 Bo (_54Fr Route No.)
Cherokee, NC 28719
Cltr or Town Sam Zip Code
(828r- 497-1825
Area code- Phone number
4. DATE DRILLED 7-6-04
5. TOTAL DEPTH: 600'
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO g
7. STATIC WATER LEVEL Below Top of Casing.: 400 FT.
(Use' =" if Above Top of Casing'
S. TOP OF CASING IS 2 FT. Above Lard Surface'
'Top of casing terminated aCer below land surface requires a
sariance In accordance with 15. ;NCAC 2C .0118.
9. YIELD (gore): 2.5 METHOD OF TEST blow
10, WATER ZONES (depth): 253' & 512'
I I. DISINFECTION: Type H T H Amount 1 6 oz
I2. CASING: Wall Thickness
Depth Diameter or Weighs'Ft. Material
From 0 To 44 Ft. 6" pvc
From 44' To 47 Ft. 6" 188 steel
From To Ft.
13. GROUT: Depth Material Method
From 0 To 20 Ft. b3Dtite & u itao, pumped
From
To Ft.
14. SCREEN: Depth Diameter Slot Size Materiel
From To Ft. in. in.
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
TopograohiciLand setting
❑Ridge ESlope ❑Valley ❑Flat
(c:lteek oppr'pr:a e bps)
Latitude.'lonaitude of wel'. location
Latiturfeliong:CJc.
DEPTH
From
0
To
45'
r. I maes'seconds)
rune:0GPS❑TopoLraphp (c ma
(clm;k buc) _ .
DRILLING LOG
Formation Description
clay & sand
45' 600'
granite
LOCATION SKETCH
Shout' direction and distance in miles froir, at least
two State Roads or County Roads. Include the road
numbers and common road names.
W
0
t7)
16. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDAFgDS, AND THAT A COSOF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
- C? V
SIGNATURE OF PERSON CONSTRUCTING THE WELL DAT
Submit the ori;inal 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
299331
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 COMPANYNAME Waal WC:MIsGh11 Tlrillirv, Tm PHONE # (A2fi) -i(Z9`9S91
STATE WELL CONSTRUCTION PERb1IT#
(if applicable)
ASSOCIATED WQ PERMIT#
(if applicable)
1. WELL USE (Check Applicable Box): Residential 63c 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: BrYson City County Swain
Hyatt Creek --FBCl/QHA well
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: James McMillan
Address 414 McMi11an Rd
(Street or Route No.)
Bryson City, NC 2871.3
City or Town State Zip Code
(828)- 497-1835 contact
Area code- Phone number
4. DATE DRILLED 7-1-04
5. TOTAL DEPTH: 300'
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO 13
7. STATIC WATER LEVEL Below Top of Casing: 100 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS 2 FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordance with 15A NCAC 2C .0118.
9. YIELD (gpm): 20 METHOD OF TEST blow
10. WATER ZONES (depth): 107' & 115'
11. DISINFECTION: Type H T H Amount 16 07
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
From 0 To 23 Ft. 6" pvc
From 23' To 26 Ft. 6" .188 steel
To Ft.
13
14
15
From
GROUT: Depth
From 0 To 20
From
SCREEN:
From
From
To
Depth
To
To
SAND/GRAVEL PACK
Depth
From To
From To
Material Method
Ft.leu2ite & catett priced
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:❑GPS❑Topographic map
(check box)
DEPTH DRILLING LOG"
From To Formation Description
0 24' clay & sand
24' 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. CD
c
_j
0
rn
16. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPYO5. THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
23gave3/ yJL4-rcntJ '7—(—U 1
SIGNATURE OF P SON 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) James B. Brown CERTIFICATION # 2045
WELL CONTRACTOR COMPANY NAME FIa %T RtrthF S Nh11 Ilillitrf Trr PHONE # IFOR) 1 fl_9rjW1_.
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
2993 0
1. WELL USE (Check Applicable Box): Residential Ric Municipal/Public 0 Industrial 0 Agricultural ❑
Monitoring ❑ Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION:
Nearest Town: Bryson City County Swain
Hyatt Creek --IDCI well
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: Mary McMillan
Address PO Box 182
(Street or Route No.)
Bryson City, NC 28713
City or Town State Zip Code
(82$)- 488-3270
Area code- Phone number
4. DATE DRILLED 7-8-04
5. TOTAL DEPTH: 300'
6. DOES WELL REPLACE EXISTING WELL? YES 0 NOT]
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): 15 METHOD OF TEST blow
10. WATER ZONES (depth): 65' . 193' . & 246'
11. DISINFECTION: Type H T H Amount 16 07
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
From 0 To 42 Ft, 6" .188 steel
From To Ft.
From To Ft.
13. GROUT: Depth Material Method
From 0 To 20 Ft.barnite & cement pulp el
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 ❑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 40' clay & sand
40' 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.
r7)
CD
rn
16. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH I5A NCAC 2C, WELL
CONSTRUCTION STANDARD AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TKO THE WELL OWNER
-;�Z1-:/ c('ct,ti&) ' -sz ' C `%
i SIGNATURE FPER ON 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 299323
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 FI-7}iEr1 Brothers w41 IYIllirn, Trr
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
PHONE # (RiR) i ..g591
I. WELL USE (Check Applicable Box): Residential blk Municipal/Public ❑ Industrial ❑ Agricultural ❑
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other ❑ I(Other, List Use
2. WELL LOCATION:
Nearest Town: Cherokee
Big.Witch--EBCI well
County Swain
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: Jean Nichole Dozier
Address 2060 Big Witch Rd
(Street or Route No.)
Cherokee, NC 28719
City or Town State
( 828. 479-6338
Area code- Phone number
4. DATE DRILLED 7-7-04
5.TOTAL DEPTH: 300'
Zip Code
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO a
7. STATIC WATER LEVEL Below Top of Casing: 150 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): 15 METHOD OF TEST blow
10. WATER ZONES (depth): 105' & 232'
l I. DISINFECTION: Type H T H
12. CASING:
Depth Diameter
From 0 To 85 Ft. 5"
From To Ft.
From To Ft.
13. GROUT: Depth Material Method
From 0 To 20 Ft.barnite & mtatt p,E
Amount 16 07
Wall Thickness
or W'eight/Ft. Material
steel
From To
14. SCREEN: Depth
From To
From To
15. SAND/GRAVEL PACK:
Depth
From To Ft.
From To Ft.
Ft.
Diameter Slot Size Material
Ft. in. in.
Ft. in. in.
Size Material
Topographic/Land setting
❑Ridge ❑Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic-map -
(check box)
DEPTH DRILLING LOG
From To Formation Description
0 83' clay & sand
83' 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:
1 DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH ISA NCAC 2C, WELL
CONSTRUCTION STAN,ARDS, AND THAT AA�COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
e SIGNATURE f7F PERSON C CTING THE WELL DA7EJ�
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center -Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-1 REV. 07/2001
0

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quaiit;
YVELLCO:NTRACTOR(INDIAIDUAL)NAi11E (print) James A. Brown
WELL CONTRACTOR COIPANI' N'A;MEHedden Brothers Well Drilling, Inc
299228
Groundwater Section
CERTIFICATION @2045
PHONE e F28) 369-9591
STATE WELL CONSTRUCTION PER.\1IT'- ASSOCIATED WQ PERMIT
(if zcrlicablel (if applicable)
WELL USE (Check Applicable Box): Residential Municipal'Public 0 Industrial 0 Aericul:ural ❑
Monitoring ❑ Recovery 0 Heat Pump Water Injection ❑ Other 0 If Other, List Use
2. WELL LOCATION: Swain
Nearest Town. Whittier Swain
Conley's Creek
(Street Nano, Numbers, Community, S.Sdirislon, Lot No., Zip Code)
3 OWNER. Chester Steckel
Address 5065 Conley e Creek ku
(Sree: cr Root; NoA
Whittier, NC 28789
City or To'.cn Stale Zip Code
( 82$ 497-7101
Area code- Phm-.e number
4. DATE DRILLED 7-14-04
TOTAL DEPTH: 400'
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO
7. STATIC WATER LEVEL Below Top of Casing.: 200 FT.
(Use if Abo: Top eSCasing)
S, TOP OF CASING IS 2 FT. Above Land Surface'
*Top of casing terminated zCor below and surface requires a
variance In accordance with 15.4 NCAC 2C .0115,
9, YIELD (gpm): 15 METHOD OF TEST blow
10. WATER ZONES (depth): 365'
I I. DISINFECTION: Type H T H Amount 16 co
12. CASING:
Wall Thickness
Depth DiPtteter or \Ve r$Ft NtsEeel
From 0 To 80 Ft. 6
From To Ft.
From To Ft.
13. GROUT: Depth
From 0 To 20
From To
14. SCREEN: Depth
From To
From To
iNlaterial Method
Ft. teYrlite_ & orent pumped
Ft.
Diameter Slot Size Dlaserial
Ft. in. in.
Ft.
15.SAND/GRAVEL PACK:
Depth
Frcm To
From To
Ft.
Ft.
Size Material
Topographic'Land setting.''
0Ridge ❑Slope ❑Valley ❑Flat
(check appropriate box)
Latitude'iongitudo of well location
(deziees ,rdn'.des'i---.ndi)
Latiuda'loncitu;.e sou e:r•GPSI0Topo rchjc map--
(Meek fox)
DEPTH DRILLING LOCr---.....
From To Formation Description
0 78' clay & sand
78' 400' granite
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and cor^,:nen road names.
16. RENIARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH I5ANCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OTHIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
iK—e
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
•
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh,.NC
27699-1636 Phone No. [phone], within 30 days. GV.-I REV. 07,2001

DISINFECTION: Type H T H Amount 16 07
CASING: Wall Thickness
Diareter or Weight/Ft.
Ft. 6
From
From
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) James B. Brnwn CERTIFICATION # 2045
WELL CONTRACTOR COMPANY NANIE HEC121211 Bcpthers W I1 I-!1) irrjr Trr PHONE # (FOR) 2 9—g591
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
299?27
I. WELL USE (Check Applicable Box): Residential Oc Municipal/Public ❑ Industrial ❑ Agricultural ❑
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use
2. WELL LOCATION:
Nearest Town: Whittier County
Hyatt Creek --KPCI well
Swain
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: Zbsha McMillan
Address PO Box 1391
(Street or Route No.)
Whittier, NC 28789
City or Town State
?28 )- 488-3846
Zip Code
Area code- Phone number
4. DATE DRILLED 7-9-04
5. TOTAL DEPTH: 240'
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO 12IX
7. STATIC WATER LEVEL Below Top of Casing: 40 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): 20 METHOD OF' EST blow
10. WATER ZONES (depth): 35 r 175 r & 210
11
12
Depth
From 0 To 19
From 19' To 2 Ft. 6"
From To
13. GROUT: Depth
From 0 To 20
From To
14. SCREEN: Depth
Material
pvc
.188 steel
Ft.
Material
Ft.lsiiite & cater t
Ft.
Diameter
From To Ft. in.
From To Ft. in.
15. SAND/GRAVEL PACK:
Depth Size
To Ft.
To Ft.
Method
PITed
Slot Size
in.
in.
Material
Material
Topographic/Land setting
❑Ridge ❑Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds) ....
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From To Formation Description
0 20 clay & sand
20240' granite
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include th road
numbers and common road names. -'
W
O
C)
16. REMARKS:
1 DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH ISA NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT ,C9J'Y OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
tip" SIGNATURE OFO�,CONSTRUCTING THE WELL DATE C)
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center -Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-1 REV. 07/2001
0

WELL CONTRACTOR (INDIVIDUAL) NA)IE (prints
WELL CON'IR:\CTOR COMPANY NAME Hedden Brothers Well Drilling, Inc
STATE WELL CONSTRLCTIO:N PERMIT
(ifaoolicable) (ifaoolicable)
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quali
B. Brown
James
299325
ty - Groundwater Section
CERTIFICATION 2045
PHONE 0 V.281 ..369-9-591
ASSOCIATED WQ PERi\ItT:
1. WELL USE (Check Applicable Box): Residential NfunicipatPublio 0 Industrial 0 Agricultural ❑
Monitoring 0 Recovery ❑ Heat Pump Water injection 0 Other ❑ IF Other, List Use
2. WELL LOCATION:
Nearest Town: Cherokee Coun;., Swain
137 Dugan RD--FBI well
(Street Name, N");nbers, Community, Subdi,,is: on, Lot No., Zip Code)
3. 0\1'NER: Kimberly Fischer
Address 139 Dugan Rd
IS ,ree: cr Ream No.)
Cherokee, NC 28719
City or Tosr. State
(828)_ 497-6684
Area code- Piton: number
4. DATE DRILLED 7-13-04
Zip Code
5.TOTAL DEPTH: 800'
6, DOES WELL REPLACE EXISTING WELL? YES 0 NO C
i. STATIC WATER LEVEL Below Top of Casing: 700 FT.
(Use "r" if Above Top of Casing.)
3. TOP OF CASING IS 2 FT. Above Land Surface
'Top ol'casing terminated at/or below land surface requires a
variance in accordance with ISA NSC.AC 2C .0I18.
9. YIELD (gpm): .5 NIETHOD OF TEST blow
10. WATER ZONES (depth): 430'
II. DISINFECTION: Type H T H Amount 1 6 oz
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
From 0 To 17 Ft, 6" Iwo
From 17' To 20 Ft. 6" .188 steel
From To Ft.
13. GROUT: Depth Material Method
From 0 To 20 Ft, beniite & Critrt pumnPd
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 ❑Slone ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(de_rees:'m inures/seconds)
delon, itude. source,OGPS❑Toco-_rephicman _
DEPTH
From To
0 18'
18' 800'
(:'auk box)
DRILLING LOG
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.
e)
0
rn
16. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STAN''DA .DS, 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 Alait Service Center - Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. Gel -I REV. 07:2001
r;
0

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources�- Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) ogee/ /yI � - CERTIFICATION
$1.3D/J7�
WELL CONTRACTOR COMPANY NAME (ppm & s— N'L/I DY/,,Z✓G. PHONE # yKOV�J���
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT.
(if applicable) (if applicable)
I. WELL USE (Check Applicable Box): Residential a Municipal/Public ❑ Industrial 0 Agricultural 0
Monitoring ❑ Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCAT N:
Neatest�Town:, yy,bN �;+. CountyslL✓1}.'A)
W!i/A/k taVe
(Street Name, Numbers, Community', Subdivision. Lot No., Zip Code)
3. OWNER: r' OA/A/el the+
Address-31°14/ f-i r Awry *c.
(Streett or
tp pute No.)
11/ ff
VC,/L
CityorTown State Zip Code
Area code- Phone number
4. DATE DRILLED �"Q_L--O7
5. TOTAL DEPTH: %3 0
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO 0
7. STATIC WATER LEVEL Below Top of Casing: /9d 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): .3 METHOD OF TEST 09,r1'
10. WATER ZONES (depth):
11. DISINFECTION: Type
12. CASING:
Dep Diameter
From D To V Ft. G /Y
From To Ft.
From To Ft.
13. GROUT: Depth
From k To am 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
Material
L6a-u -
Amount
Wall Thickness
or Weight/Ft. Material
1 te
Method
From To Ft.
From To Ft.
Topographic/Land setting
❑Ridge ❑Slope Malley ❑Flat
(check appropriate box)
Latitude/longitude of well location
299501
(degrees/minuteaheconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH DRILLING I:OQ
From To Formation Description
t 7- 73° fS471-r .
LOCATION SKETCH
Show direction and distance in miles from at fast
two State Roads or County Roads. Include theiad
numbers and common road names.
4
Ft
v
16. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED rN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
£44wc — 7'7P—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

North Carolina - Department of Environment and Naturl rsoUrces -
WELL CONTRACTOR (INDIVIDUAL) NAME (print)
' .r�
WELL CONTRACTOR COMPANY NAME
STATE WELL CONSTRUCTION PERMIT#
(if a licable)
299904
WELL CONSTRUCTION RECORD
ivision of Water Quality - Groundwater Section
CERTIFICATION d
PHONE d
ASSOCIATED WQPERMIT/
(if a icable
I.
d i al 63 MunicipaUPublic D Industrial D Agricultural D
WELL USE (Check Applicable Sox): Rest en t
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other D If Other, List Use
2. WELL LOCATION:
Nelaarest Town:
(Street Name. Numbers. C
,.sly or Town
State Zip Code
Area code- Phone number n
4. DATE DRILLED
5. TOTAL DEPTH: 7l t — YES p NO
6. DOES WELL REPLACE EXISTING WELL -
El
7. STATIC WATER LEVEL Below Top of Casing • —FT
(use'v^ if Above Top of Casing)
8. TOP OF CASING IS
FT. Above Land Surfaces
of
*Top of casing terminated aver below bed surface requires
variance In accordancewithISA NCAC 2C .011S.
9. YIELD (gpm): METHOD OF TEST
10
WATER ZONES (de th):
Topographic/Land setting
DRidge DSlope OVA ❑Flat
(check appropriate
)
Latitude/longitude of well location
() hie map
Latitudenongilude source: PSOTopogmP
_on t ING�OG
Fomtation <Description
WILL
From To
I nCATION SKETCH
_ Show direction and d m mtles from al least
11. DISINFECTION: Type Wr n -rhicimrss (n two State Roads or County Roads. Include the road
and lemon road names.
Diameter or Weight/FL V� elm co
12. CASING:
Depth Ft. ( SAr rurvt eA_ipione Pe /vrn 1
To
To F(
From
From �� T
From Material Method C•rc) 5 , 1p_ m /es- T rM R �
13. GROUT: Tnopt _ Ft . o i�t1 f / I,Ur n
From_52--- t y G �W' No, (r0 7-3 sT 'S , n
14.
(ro l,sr miles%vrn /e4T on 74/E
To
FL T ay'.
From To Ft. �Jc 5S "Id
SCREEN: Depth
j 7hT G a.crocc over
From_To
From To
15. SAND/GRAVE L PACK
From.
From
Diameter
Ft. in.
in.
Ft
Slot Size
in.
in.
Material
S 72/0 5,�� Turn /P,h roe A'y
r
6-6 o ,(J. /r/, /es Tsui /e;� r o/7 010117
Deem /9 Ce To �� s T kit Tarn let T o n
To Ft.
To FL — ----- jjcecknear , jretincA &_) Pie leS T vh
pYEY
Size
Material
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
T/rr - DATE_--..
SIGNATURE OF PE SON CONSTRUCTING THE WELL— — —
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Cornet Ctt14N' - Raleigh,,NC
NC
27699-1636 Phone No. [phone], within 30 days. GW_) REV. h

WELL CONSTRUCTION RECORD Groundwater Section
North Carolina - Department of Environment and NaturalResources j 01 ision of Water Quality Groundw ter a�Q
7- f/ rv�s�y�9-rCO
WELL CONTRACTOR (INDIVIDUAL) NAME (print) l iP /I p ,^ PHONE II ��
lial
r rii t[ �l
WELL CONTRACTOR COMPANY NAMES-- ASSOCIATED WQ PERMtTM
STATE WELL CONSTRUCTION PERMiT% if a licable
(ifa licable)
1. WELL USE (Check Applicable Box): Residential IS Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection ❑ Other 0 If Other, List Use
Topographic/Land setting
°Ridge °Slope °Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
3. OWNER: Latitude/longitude sourcef �ToPogr°Phic map
tchasAddress D P H DRIL'NGLOG
From To
Formation Description
2. WELL LOCATION:
Nearest Town: a " County S i
(Street me. Numbers. Community. Subdivision, tot No.. Zip Code)
Cit, or Town
(7.f 7)-.
Area code- Phone number
4. DATE DRILLED _
5. TOTAL DEPTH: 3 ` — 6. DOES WELL REPLACE EXISTING WELL? NO
Casing: _S YES p 0 NO
7. STATIC WATER LEVEL Below(Use p Wo 'if��goporCasing)
8. TOP OF CASING IS
FT. Above Land Surface
'Top of casing terminated arar below load surface requires a
vadaace la accordance with ISA NCAC 2C .BiIS. r
9. YIELD (gpm): METHOD
10. WATER ZONES (depth):
11. DISINFECTION: Type
12. CASING:
Depth
From Q To Z_ FL
From To Ft..
From To Ft.
13. GROUT: Depth
From_ Tom . Ft.
From To Ft.
14. SCREEN: Depth Diameter
From To Ft. in.
From To Ft. in.
15. SAND/GRAVEL PACK: Size
Depth
From To Ft.
From To Ft.
gmowt n 'i!
Wall Thickness
Diatrreter orWeight/Ft. Material
Chr1J
Material
Slot Size
in.
in.
Material
LSn Method
Lrl2pua
Material
29919
�....r,nnt cKFTCH
State and distance in miles from at least
w
two
two direction Roads or County Roads. Include the mad
n bers and common road names. / , /PS
numbers
CtijMona Po �r0
Turn on lye G_ED s.`,Z %Y),1c
Turn R,'ah T cx F4 ' T 6 Q CJ c.r
C-o To 5Thf Van 7-&r/7 RloghT
on 0,163-Kr& Rod, Go Lb codes
Turn /eh- onea,les gOOST G
0.7 /ot,'le Turn. Ri$hT on m'Ck'' 1c
Go. o.lm!e T Well on Ri'sah i
16. REMARKS:L
1 DO HEREBY CERTIFY ,HAT WAS A COPYONOF THIS RESTRUCTEECORD HIN AAS BEEN PROVIDED TO THE WELLRDANCE WITH I5A NCAC 2C, LOWNER
CONSTRUCTION STANDARDS, AND T
• -PP 1 - _ 0
• �
SIGNATURE OF PER ON CONSTRUCTING THE WELL DATE
NC
Submit the original to the Division of Water Quality, l GW-I REV. h Groundwater Section, 1636 Marl Service Center -Raleigh,, NC
27699-1636 Phone No. [phone], within 30 days.

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - ivision of Water Quality - Groundwater CERTIF CATION Section
PHONE
WELL CONTRACTOR (INDIVIDUAL) NAME (print)
Cr
WELL CONTRACTOR COMPANY NAME
STATE WELL CONSTRUCTION PERMITS'
(ifs licable)
1. WELL USE (Check Applicable Box): Residential IN MunicipallPublic 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
Topographic/Land setting
❑Ridge ()Slope °Valley °Flat
(check appropriate box)
Latitude/longitude of well location
Latitude/longitude sotuce:OGPS❑Topographic map
(cberlrboz)
DEPTH DRILLING LOG
Formation Description
299902
v_+ y Jq-1NS9
2. WELL LOCATION:
Nearest Town:
(Street Name. Numbers, Community, Subdivision, Lot No.. Zip Code)
County S w0., 0
Ci y or Town S to Zip Code
Area code- Phone number Q n -
4. DATE DRILLED
5. TOTAL DEPTH: &tO YES p NO
6. DOES WELL REPLACE EXISTING WELL? y1 FT.
IS
7. STATIC WATER LEVEL Below o�C� Casing: of Casing)
S. TOP OF CASING 1S FT. Above Land Surfaces
*Top of casing terminated aler below land surface requires a
valiance In accordance with ISA NCAC 2C .0115.
9. YIELD (gpm): 12 METHOD OFTEST G•,r
a`3
10. WATER ZONES (depth): -C
ASSOCIATED WQ PERMIT'S
if applicable)
11. DISINFECTION: Type f T e Amount 0. `/a
12. CASING: WaR Thickness
Depth Diameter or Weight/Ft Material
From n Tom Ft ID r ll PVC
From To Ft.
From To Ft.
13. GROUT: Depth Material
From__ Tom— Ft• l h rvI N n T
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
Pvrhlv;nlr
Slot Size Material
_ in.
in.
Material
From
To
-„
0
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
J
n bers and common road names.
1-rem, l3ry5on c/ry Go, o,3h1lt c
Turn on 6'aS T tDNNp Creek Cc
J„2 t)n,'I,s Turn N,r. hT on ,
-6_11„/ Jek 'r TuT (ro
Tajo o N h /11 Ta (4/cell
16. REMARKS:
1 DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED 1N ACCORDANCE WITH I5A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
Tice J-J�,e,to 7-go-n4l
SIGNATURE OF PERSON ONSTRUCTING THE WELL
DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Ceenter' R le gh Z001
h, NC
27699-1636 Phone No. [phone], within 30 days.
ip

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division Quality Groun water SectM io^ ^ `�
n
COMP
WELL CONTRACTOR (INDIVIDUAL) NAME (pint) \,C lT`YI-` /am _PHONE a _10-21:fdli y
CERTI
WELL CONTRACTOR COMPANY NAME GY 1�0 Or
ASSOCIATED WQ PERMIT*/
STATE WELL CONSTRUCTION PERMIT# if a licable
(ifa Iicable)
I. WELL USE (Check Applicable Box): Residential ® MunicipaUPublic ❑ Industrial ❑ Agricultural 0
Monitoring ❑ Recovery 0 Heat Pump Water Injection 0 Other ❑ If Other, List Use
Topographic/Land setting
❑Ridge ❑Slope ❑Valley DFlat
(check appropriate box)
Latitude/longitude of well location
otegreerirrunotesiseeonde,
Latitude longitude source:❑GPSlTopographic map
(rbcdtbox)
DEFT nRll i ING t QG
From To Formation Description
2. WELL LOCATION:
Nearest Town: _ C.X t S —`-- County / 7 n
�
(Street Name. Numbers. CommnllitY, Subdivision, I.at No.. Zip Code)
3. OWNER:
Address
Ci y or Town tate Zip Code
Area code- Phone number
4. DATE DRILLED — / S n q
5. TOTAL DEPTH:
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO
la
7. STATIC WATER LEVEL Below ou�� opofC+s in FT.
S. TOP OF CASING IS _L_- FT. Above Land Surface'
*Top of toing Iolalet land
regains a
variance accordance Dated NCAC
•
9. YIELD (gpm):
METHOD OF TEST A r
Q
10. WATER ZONES (depth):
11. DISINFECTION: Type_.____ Amok
12. CASING: Wall Thickness
Dept, Diameter or Weight/FL MatPVC
From U To3 k Ft. -
From To Ft.
From To Ft.
13. GROUT: Depth Material Method
�
From 0 To r 0 Ft._n'" �t'npvmP'ti.9
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
To
From
From
16. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND A` A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
SIGNATURE OF PER ON CONSTRUCTING THE WELL
Ft.
To Ft.
Size
Material
299901
0
I OCATI� ONy SKETCH Show direction direction and die in miles froelat least
two State Roads or County Roads. tncludothe toad
ny�om al berT and corllmonrnondl rqad Pnames.oG� / g i%i vas
fr
%vrn /e T on 7yE Go e,a/vi,tles
t rn R thT cA7 k T 6,4/ Ga To ST,
Stan %urn AlOhT Go 11,6 tni'le5 7-‘
R. hTon T,'r71,en Ec5TaTes Go.
0,6 /n,.ie Turn 144on Or; ve t.(!a
Go 5Tra4bT T Ale .
DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Ceenterl REV. NC
27699-1636 Phone No. [phone], within 30 days.

North Carolina - Department of Environment and Natur at Resource
WELL CONTRACTOR (INDIVIDUAL) NAME (print)
WELL CONTRACTOR COMPANY NAME
STATE WELL CONSTRUCTION PERMIT'S 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
WELL CONSTRUCTION RECORD
29g000
ivision of Water Quality - Groundwater Section'' c��'
CERTIFICATION Mir
PHONE 0 tfN slang=S '-tY
2. WELL LOCATION: ���
Nearest Town: _ County .
(Street Name. Numbers, Community,+Subdivision, Lot No.. Zip Code)
3. OWNER: net i r . O Xn 2✓e//
Address 7=morr fSTq?/S
ff11 (Street or Route No.)
ryson el. Ty A/.e. ,2»7/3
City or Town State Zip Code
( )-Sot 99/3
Area code- Phone number
4. DATE DRILLED 7-9-6f{
5. TOTAL DEPTH: 7,675-
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO
7. STATIC WATER LEVEL Below of Casing:
�1 Ff.
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 .0110.
9. YIELD (gpm): METHOD OF TEST air10. WATER ZONES(depth): IC
11. DISINFECTION: Type 4/7-1%
12. CASING:
Depth Diameter
From_ To ' ' 7 FL (rk
From To Ft.
From To Ft.
Amount Q //n
Wall Th)clatess
or Weight/FL Material
Snrll P✓G
13. GROUT: Depth Material
From_ To . G FL CPIrte/T
From To Ft.
Diameter Slot Size Material
Ft. in. in.
Ft. in. in.
Topographic/Land setting
❑Ridge ❑Slope ❑Valley ❑Fiat
(check appropriate box)
Latitude/longitude of well location
(demeetknrnures/seeorrds)
Latitude/longitude source:i GPPS❑Topographic map
DEPTH DRtLLING LOG
From To Formation Description
Method
Pump;no
14. SCREEN: Depth
From To
From To
15. SAND/GRAVEL PACK:
Depth Size
From To Ft.
From To Ft.
Material
.77
cn
LOCATION SKETCH tit
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common road names• k n: C e �i /, sl /yt . �P S
-P-rerr) oimarcX Pe5T (3+4 ones %Urn 1eTon 7q&G-0a_ .amIes,
Turn r',ghT a7 Ek%T 4 y a le r1 'k 6'° 70
STef s,,;n 7urn roghT&o y,6mNeS
%urn r,021R on T,'nrbere67 Tes lobo-5
M,'IE Turn rl'OTon m,'Anti,)Tlaner
Go . o„se rn:les -urn R �T weN"I lehr
16. REMARKS:
1 D0 HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS CORD HAS BEEN PROVIDED TO THE WELL OWNER
lriirt /�'f/ 7-9-Qy
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Ceenter' R ie gh, NC 1
27699-1636 Phone No. [phone], within 30 days.

299899
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and NaturaLRpsources,- 'visi n, of Water Quality Groundwater
runwtrSecion
WELL CONTRACTOR (INDIVIDUAL) NAME (print)f L=CERTIFICATION
7L PHONE � ! r
G1c. v l to// rtH 11r'n
WELL CONTRACTOR COMPANY NAME ASSOCIATED WQ PERMIT«
if applicable)
STATE WELL CONSTRUCTION PERMIT,/
(if applicable)
I. WELL USE (Check Applicable Box): Residential Gj Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Uses
Topographic/Land setting
❑Ridge ❑Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
2. WELL LOCATION:
'
NgarestTown: RJr /5on /,Tr, County. tJn. n
IC,rKlend,s r.rAek D743
(Street Name. Numbers, Community, Subdivision. lot No.. Zip Code)
n (degre�mro°oes(seconds)
3. OWNER: Rn�,-O/Pn OP t-e. /C Latitude/longitude
6sou�rce:❑GPS❑Topographictnap
Address Ktr/f%A.n�t Cretan" (checkbox)
(Sven' or Route No.) DEPTH DRILLING LOG
Br CyorT w Cv Zy N-Cr Zip From To Formation Description
C y or Town a Zip Code r-,
(sf )- tie 7�8�
Area code- Phone number _Cl' _n Y - -
4. DATE DRILLED
5. TOTAL DEPTH: Srn
6. DOES WELL REPLACE EXISTING WELL? YESng: y s O FT.
7. STATIC WATER LEVEL Below ortAbovee Top of Casing)
8. TOP OF CASING IS / FT. Above Land Surface' J
*Top of casing termloatcd odor below land stwrace requires a Ut
variance In accordance with ISA NCAC 2C .011.0.
9. YIELD (gpm): / 2 METHOD OF TEST C>`ir G
10. WATER ZONES (depth): 3`1- ) °CATION SKETCH
Show direction and distance in miles from at least
11. DISINFECTION: Type /'f` % Al Amount n . 'R' Roads. Include the road
wen.lLidme,s two State Roads a County 12. CASING: umbers and co road names.
Depth Diameter ornrai /EY. erial -F, Ge Go % t m Ne S. -ref r
From�To 7,� FL �nl� sf1/"a) I/G �fOYn G,�j»OI'r O+
From To Ft. ! 7-0 /) 79 EGQ 3 %IlS Teske LE- ,
From To Ft.
13. GROUT: Depth
Material Method 7 Bryson /Ty GOT STO/0 6•1yh %Urn
From n To 26 Ft. GPhPPt1T P"r"Pi‘71$ LoPTGo To STio /, hT Tvrn Rr�hTa
From To Ft. O %,
14. SCREEN: Depth Diameter Slot Size Material STO� 1, h 7' Gl/T 1 /� O S' 71.0.t�h T' (T
From To Ft. iin. in.M •l Turn %Djr hurT(oTn 5AFperk"Cneek
From To Ft, in. in. r PS
15. SAND/GRAVEL PACK: �e Tvyr g,h7 an ktrklwxl`
Depth Size Material Go • C,6 7 2,
From To Ft. Creek- o 1,9p),'47,5 Turn 11t hT Go, o.i
From To FL m;le 7-i'rn RrihT Well on Izv1T.
16. REMARKS:
1 DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED )N ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
‘ � NAP 76—c1
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Ceenter' R le gh, NC
27699-1636 Phone No. [phone], within 30 days.

299898
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
-� • F �A. CERTIFICATION aC[sS4
WELL CONTRACTOR (INDIVIDUAL) NAME (pry) [/ PHONE a t`'1P1Hy
WELL CONTRACTOR COMPANY NAME ASSOCIATED WQ PERMITN
if applicable)
STATE WELL CONSTRUCTION PERMIT,/.
(if applicable)
I. WELL USE (Check Applicable Sox): Residential ® MunicipaUPublic 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: County <SGJoL % n
%‘mborf,S
(Street Name, Numbers, Community, Subdivision, Lot No.. Zip Code)
Topographic/Land setting
❑Ridge ❑Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
( /mmuaysecondc)
3. OWNER: Chi C e Latitude/longitude solute:❑GPS❑Topographic map
Address ` %'fr/ S Pr EST %PS (check box)
t� (5"ar°rRwreN°-) ak7/3 DEPTH DRILLINGLOG
Br iv or
w Citytk From To Formation Description
C ty ar Town Sw Zip Code
Area code- Phone number
4. DATE DRILLED
5. TOTAL DEPTH: r O<c-
6. DOES WELL REPLACE EXISTING WELL? YES O NO
HI
7. STATIC WATER LEVEL Below Top of Casing: FT.
(the "+" if Above Tap of Casing)
8. TOP OF CASING IS __L_____ FT. Above Land Surface*
*Top of catalog terminated actor below land surfs t tega6es a
variance la accordance with ISA NCAC 2C .0118.
9. YIELD (gpm): 6 METHOD OF TEST air
10. WATER ZONES (depth): -S 7.5-
11. DISINFECTION: Type h / N
12. CASING:
Depth Diameter
From h To�_ Ft. 64
From To Ft.
From To Ft.
13. GROUT: Depth Material
From 0 To a.0 Ft. (70 MPni
Amount 0,/n3
WallThickness
or Weight/FL Material
S.nral Pvc
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.
0
JOCATION SKETCH
Show direction and distance in miles frorn)t Ie�Ist
two State Roads or County Roads• tncIug)the road
nehers and common road names. 1� . c - it 0
irern cc) man f� Pa5To
melts en ,2''S -Turn /N>"7-on 79
�^ rn1 h r CtT t ; T-
Method GO � , d /"/'t � �/CS Tarr, R�
Pvmp,', y (9 adkrkc&. /20 To snip s,',2n Turn
Material R,'ghT GO y,V pi,veS %Urr)
Gn T inAer ES Ales r
° ° well p on
/JT %altC l:r6T %Z �
Rt41)T.
Slot Size
in.
in.
Material
16. REMARKS:
1 DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED 1N 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 Ceenterl R le gb, NC I
27699-1636 Phone No. [phone], within 30 days.
1,Tr

North Carolina - Deportment of Environment and Natural Resourc
\\ELL CON IR:\C'I OR (6DI\'IDtiALI NAME (prin�t�)j LetrYAy
LII
\VEI.l. (.ON'fR %CI OR COMPANY NAME bJ�A�I• {OIL
S I;\'I'E WELL CONSL KLc rION PERMIT'
lii applicable)
WELL CONSTRUCTION RECORD
- Division of Water Quality - Groundwater Section
CERTIFICATION 4 LVb.`5
r T ��3
PHONE r! �fSl�y
ASSOCIATED \\Q PERMITS —_ ---- Of applicable)
I. WELL LSE (Check Applicable Box)' Residential Cd Municipal/Public 0 Industrial 0 Agricultural 0
\lon::oring 0 Recovery 0 Heat Pump Water Injection 0 Olhcr 0 If Other, List Use
Topographic Land setting
❑Ridge (lope []Valley ❑Flat
(checl oppropriate box'
Latitude/longitude of \\ell location
2. WEI.LLOCATION:
Nearest Tow ate,,,"��.,-_��
3 rue, Nun. rs. Con rnurity. Subdivision, La No_ Zip Code;
3. O\VNER:
tl:, orlu'n
t
Arc.: m:de none nun•.her
4. DATE DRILLED jq-
5. TOTAL DEPTH: (97...S
6. DOES WELL. REPLACE EXISTING WELL? YES Q NO E
7. STATIC WATER LEVEL Below Top of Casing: ZU FT.
(Use " if Above Top of Casmgl
8 TOP OF CASING IS L-._ FT. Above Land Surface'
`fop of casing terminated atior below kind surface requires a
variance in accordance with 15A NCAC 2C .pt la.
9. YIELD (pm): I METHOD OF TEST I• 1bJ -&%----
0. WATER ZONES (depth): $ 51 SLQ.O
u:e Nu.)
Stale
County {l•l _
Zip Code
299924
(degreedml l.'u:es/seconds I
Latitude/longitude sourcc:OGPSOTopoaraphic map
tcheLK hiYI
DEPTFI DRILLING LOG
From To Formation Description
11. DISINFECTION: Type 18-6.IC3Amount 2...
12_ CASING. Wall Thickness
0 _ To Depth it(
` or Weight/FL Material
From Ft Oi.71 /\
From To Et.‘ ---
Front To Et.
13. GROUT: Depth //''�Material .�/�," Method
Front_ To._ Ft ld &.C.i'4`�4 �Lf—
Flom To Ft --
14 SCREEN. Depth D:mncler Slot Size Malsia1
From fo—_—. Ft. in. ir,.
From To _ Ft. in. in.
15. SAND'GR:AVEL PACK:
Depth Size Material
Flort _To - Ft.From To -_ FL— -- - ----
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
C ONSTItI LbIO, , TAN ARDS. AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL
OWNE
O
IGNATURE OF PERSON CONSTRUCTING THE WELL "1--DATE
Submit the 1 rP2inal to the Division of Water Quality., Groundwater Section, 1636 Mali Set -Nice -Center • Raleigh, NC
27699-I636 Phone No. lylY) 733-3221, Within 30 dRcs.
(iW-I REV. 0712001

WELL CONSTRUCTION RECORD
30193'3
North Carolina - Department of Environment and Natural Resourcess-y�- Division of Water Quality - Groundwater Section
\%'ELL CONFR4CTOR (INDIVIDUAL) NAME (print) \` )9 ' ' 1R I VI IS CERTIFICATION # a 5-5-'_7
•
WELL CONTRACTOR CO\IPANYNA\I£ r 1r1H lT reenc bras , Watt V4f PHONE k ( )
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED w'Q PERMIT:
(if applicable) _ (if applicable)
1. WELL USE (Check Applicable Box): Residential INI Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use
2. WELL LOCATION:
Neatest Torn:
(Street Name, Num&rs, Cornmuni4,
Subdivis
County o5WCain
,n C. L-S17 /3
n, Lot No., Zip e)
3. OWNER: Cen Z1 a la Liss Mirth.
Address SSE Rain e rs t
(5u:et or Route No.)
Fra"icI&irj NC a8-3V
ow or Town State Zip Code
Area code- Phone number
4. DATE DRILLED .. - 7-1 -Uy
5. TOTAL DEPTH: a57-)
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO I
7. STATIC WATER LEVEL Below Top of Casing: )5 FT.
(Use "r' if Above Top of Casing)
S. TOP OF CASING IS 1 FT. Above Land Surface"
'Top of casing terminated atior below land surface requires a
variance In accordance with IiA NCAC 2C.0I IS. �y
9. YIELD (gpm): - 1 S • METHOD OF TEST w
10. WATER ZONES (depth): a. 00') ID tc23.01)
11. DISINFECTION: Type
12. CASING:
Topographic/Lend setting
❑Ridge I'Slope ❑Valley DFlat
(check appropriate box) '
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/lonaitude source:❑GPS❑Topographic map
(check box)
DEPTH DRILLING -LOG
From To Formation Description
-s�
Sq- /00
/00-102-
/Da-170
170 —/ 72—
/ 1.2 --A2 3v
3Q -a33
a33—a5D
3 1700 LOCATION SKETCH
}t) r i4 Amount g a7S 04 Show direction and distance in miles from at leas:
Depth Dia,;.:�7:er
From 0 To 1061 Ft. %%
From To Ft.
From To Ft.
13. GROUT: Depth
From 0 To 3 Ft.
From 3 To 20 Ft.
14. SCREEN: Depth Diameter
From To • -Ft. in.
From To Ft. in.
15. S.AND'GRAVEL PACK:
From
From
Material
Depth Size
To Ft.
To Ft.
16. REMARKS:
Wall Thickness two State Roads or County Roads. Include the road
or Weighf'Ft. Material numbers and common road names.
•
19Yul S tP
Slot Size
in.
in.
-oralMethod 70'
ea? eit-)Farei
Material — A �
J �rn
tri-a
Cc)
Z.-
�ptn
Material
-v
W
t
c
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH l5A NCAC 2C, WELL
CONSTRUCTION//ANDARD AND TH A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL CAVNEK
SIGNATURE OF PERSON CONSTRUCTfNG 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

301930
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section 7
WELL CONTRACTOR (INDIVIDUAL) NAME (print) /1 U r 1-�n - � I /"� r�s p/ CERTIFICATION R�
WELL CONTRACTOR COMPANY NAME /4211/F C7Yeen'— IEYY, t"ett »r j11 PHONE # pus)
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PER_MIT:
(if applicable) (if applicable)
1. \VELL USE (Check Applicable Box): Residential It Municipal/Public ❑ Industrial ❑ Agricultural ❑
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use
2. \VELL LOCATION:
Npgrest Tor :4
County
(Street Name, Numbers, CCoommunity, Subdi+hsion, Lot No., p Code)
3. OWNER:
Address
en ($rreer or Route No.)
YILLX�/t-9"I-j�CR_ -i r7 G- 02R 71,
City or Town State Zip Code
(fa )- clg7-a )act
Area code- Phone number
4. DATE DRILLED 7 - a a - ov
5. TOTAL DEPTH: 70 D
6. DOES \VELL REPLACE EXISTING \VELL? YES ❑ NOR]
7. STATIC WATER LEVEL Below Top of Casing: o2o0 FT.
(Use 't if Above Top ofcasing)
S. TOP OF CASING IS I FT. Above Land Surface*
•Top of casing terminated atior below land surface requires a
variance in accordance with ISA NCAC 2C .0119.
9. YIELD (Epm): '1 METHOD OF TEST A, r
10. WATER ZONES (depth): 85
11. DISINFECTION: Type 14 T H Amount
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
Ram 0 To y✓D Ft. 4 141 SDoe7J JUG
From To Ft.
13. GROUT:
From 0
From 3
14. SCREEN: Depth Diameter
From , _To Ft. in.
From To= Ft. in.
15. SAND/GRAVEL PACK:
Depth Size
From To Ft.
From To Ft.
From To Ft.
Depth Material Method
To 3 FL ./ �s e-
To 2 D Ft. �+A,Q
Slot Size Material (d
in.
in.
Topographic/Land setting
❑Ridge pISlope ❑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
Craic
✓ ter"
-
N1
r0
LOCATION SKETCH �- a
n
.3/ C o 7 Show direction and distance in miles from east
two State Roads or County Roads. Include e road p0
numbers and common road names. ' d
tJ n
16. REMARKS:
2 ` e-a—
Material
Rao
a_
SIGNATURE OF [PERSON CONSTRUCTING THE \VELL DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Alail Service Center- Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-1 REV. 07/2001
1 DO HEREBY CERTIFY THAT THIS \VELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDSI A. .'D THAT ASOPY OF 7IIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
y— �G/-12cv

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural
Resources - Division f Water Quality - Groundwater Sections
WELL CONTRACTOR (INDIVIDUAL) NA\IE (print) /��,I Ia4 t'n '�• a 4 1� n ,r CERTIFICATION k�
1
\\ELL CONTRACTOR COMPANY NAME Ann- (C-r�ee rt r"e"n witi 'l-L 2 PHONE if fsga_ S -S t)
STATE WELL CONSTRUCTION PERMIT: - - ASSOCIATED WvQ PERMIT.
(if applicable)
(if applicable)
1. WELL USE (Check Applicable Box): Residential Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery ❑ Heat Pump Water Injection 0 Other ❑ If Other, List Use
2. \VELL LOCATIOO 11
Nearest Town: Senn !Ida County )
(Street Name, Numbers. Community, Subdivision, Lot No., Zip Code)
3. OWNER -
Address
17z1
(Street or Route No.)
e nC ag7I3
city or TState - Zip Code
/ppi99Si). /WAR tSw-n to 2,-
Area code. Phone number
4. DATE DRILLED 7 - 20-44
5. TOTAL DEPTH: 73-0
6. DOES \VELL REPLACE EXISTING \VELL? YES ❑ NO
7. STATIC WATER LEVEL Below Top of Casino: 35D FT.
(Use "T' if Above Top orcasing)
S. 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 .0119.
9. YIELD (gpm): ) .with
• METHOD/CO TEST_
10. WATER ZONES (depth): 110 /Xe' 3G0
Topographic/Land setting
DRidge %slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From To Formation Description
v--44s
-//a
I/o � //ca.
1/A -3&'O
360 --3(03
3b3-5/0
C/O -s)Ats
s-D - 75
,v-ej LOCATION SKETCH
11DISINFECTION: 53,7 aa- Show direction and distance in miles from at least
. cat
12. CASING: \: Type r tit P.mod Wail Thickness two State Roans or County Roads. Include the road
Depth Diameter or\Veigh:Tt. Material numbers and cornmon road names.
•
b To SO FL (al// 5D271 pVC,
From
From
To Ft.
From To Ft.
13. GROUT: Depth
From 0 To 3
From 3 To 20
14. SCREEN: Depth
From To
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth .Size Material
From To Ft.
From To Ft.
Material Method
Method
Ft.
Ft. ipi -t7,fit. 4,4 s.� eA W "i(,t-y' ---; �_,
Diameter Slot StzeV Malerial 1—t
Ft. in. in.
16. REMARKS:
1 DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, D TH. TT A C OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER .
G ����. \V /y—do°y
DATE
SIGNATURE OF PERSON CONSTRUCTING THE WELL
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 CONSTRUC'110iN RECORD 0'J 4.
North Carolina - Department of Environment and Natural Resource- Division of Water Quality - Groundwater Section
!, �,1 CERTIFICATION:
WELL CONTRACTOR(INDIVIDUAL) NAME (print)�inrh0-4-�-e /�,y [-�
WELL COSTR:-\CTOR CO>IPA]1' NAME -! 7✓Z:!z'M F es' �a�, PHONE • f: �NS-5-'rr)
5'f ASSOCIATED \\'Q PERMIT ATE \\ELL CONSTRUCTION PERaIIT; (if aoolicable)
(ifaoPlitabfe) _. .....a
1
2. WELL LOCAT iN.
� wya.r- ---r--
Nearest Town: ` _�4r _a Count\`INN' 67 L—
(S:rce:Nane. Nanber;. Coon:nu�_ni ;.nnabdicisi n, Lot Na. ip Code)
3. OWNER: Ltzi02/ 1
AdS.ss C'I (Q'J
S' •e: or Route No.)
�it� �eler n r a x-71
Cc: or l °An S:at: Zip Cod_
( )-
A-m.,2e- ru::'c cr
T. DATE DRILLED g-I1 ..psi
d.TOTAL DEPTH: AOO
6- DOES WELL REPLACE EXISTING WELL? YES ❑ NO
7. STATIC WATER LEVEL Below Top of Casing: —
Ilse "r' if Abo': Top or Casing)
S. TO? OF CASING 15 FT. Above Land Surfa:e
•Tap ut using terminurrd at ur brio% land surldre requires u
sari nCC in accordance sj irh 13.\ NCAC 2C .0113.
/
METHOD OF TEST L C vv
10. WATER ZONES Idcpt'h). 736
1I. DIS!N-ECTION:Type NTH Amount 3k OZ,
12 CASING: \':a'i Thickness
Dc_;h D:amotc- cr\\ei_hCF:. \!z:a:.'.l
Fro:;., To Ft.
Frog; To Ft
From To Ft
From To Et.
Frog) To Ft
14 SCREEN: Depth Dlvicexr SIo: Siz_ Nlareria'.
From To Ft. in. in.
Fran: To Ft. in. in.
15 SANDGRA\'ELPACK':
Depth Size Material
Front To F;.
•Fror.: To Ft.
16. REV ARKS
.
W
WELL USE (Check Applicable Box): Residential 0 Municipal/Public 0 Industrial ❑ Agricultural ❑
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 5 )(Other, List Use ' P LO-N
Topo_raphic/Land setting
❑Ridge ❑Slope ❑\'alley ❑Flat
(check appropriate box)
Latitude'longitudo of well location
(degrees minu:es:seconds)
Latitudo.om_itude sourer❑GPS❑Topographic nap
(check bog)
DRILLING LOG
Formation Description
DEPTH
From To
LOCATION SKETCH
Show direction and'dis:ante in nil_> from a: leas:
two S'.i:. Roads or Cot:my Roads. In'3fip, b_ rood
numbers and common road names. Z4``,p``c; jG
O
��a�oOOF2�i
O
.9 G- /y
�GOQ FCTP
4-
Ate, 6A-e-y-A < W s io Von
I DO HEREBY CERTIFY THAT THIS WELL WAS CONST UCTED IN CCO S BEEN WITH
A TO THE 20, WELT 'ER
CONSTR_CTION ST?.NDAR THAT CO" ,2?< v
jlli,\ATGRE OF PERSON CONSTP.�CTING THE WELL
DATE
Submit the original to the Division of Water Quality, Groundwater Section. 1636 Nlait-S rkiae Center- RE\ gh, �0!),I
2769'9-1636 Phone No. [phone], rsithin 30 days. ""... - i 0

WELL CONSTRUCTION RECORD
North Caroline • Department of Environment Natural Resoulces • DIYI8icri of Water Quali
ELLCONTRACT0R11NDIYIDUAL)NAntE (print) James E. Eraan
WELL: CONTRACTOR COMPANY NAMEF'ec0en Brothers Well Dril-Lng, Inc
STATE wELLCONSTRUCTION PERMIT/ ASSOCIATED WQ PERMIT/4
'fir applicable) (ifaooliczble)
ty - Groundwater Section t✓
CERTIFICATION 2045
PHONE k 291 269-9591
WELL USE (Check Applicable Box) Residential " Municipal/Public 0 —Industrial 0 Agricultural 0
Monitonrg O Recovery 0 Heat Pump".Water ln)ection 0 Other 0 If Other, List Use
2 WELL LOCATIO
Neare Town
(atreet.Name, Nutters
3 OWNER. I[L
County
ommunity, S diviilcn, Lot No., Zip Code)
(71 45reeicrRoue_tJ 46719.:
Gly fm zip Code
(B5)-?8G�%'
A rea code. Phone number ,,rr
4 DATE DRILLED'lit "err
5 TOTAL DEPTH: 00 I
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO
7. 'STATIC WATER LEVEL Below Top of Casing: 7&O FT
(Use'r' if Above Tcp a( Cesing)
8 TOP OF CASINO IS 2 FT Above Land Surface*
•Top of casing terminated at/or below land surface requires a
variance In accordance with 1'.4: NCAC 2C.0118.
9 YIELD (gpm) / MET, iOD OFTEST blow
10 WATER ZONES (depth):. y Q
Topographic/Land setting
ORidge OSlope :❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Lati'ucc/'Longitude source;OGPSOTopographic map
(chock box)
DEPTH PRILLING LOG_
From To Formation Description
0 /nq clay & sand
Granite
e
1! DISINFECTION: Type H T H Amount 16 oz
12 CASING: Wall Thickness
Depth Di meter or WeiSht/Ft. M terial
From 0 To 'i' Ft t i 11 11/36 10
From ' To Ft:-
13 GROUT. ' Depth Material Method
From 0 Tc 20 Ft: berrn.ite & tit pumpel
14 SCREEN Depth _ Diameter Slot Size Material
From'. To — Ft. in. in.,.i
IS SAND/GRAVEL'PACK
Depth Size Material
From To Ft
From' To. Ft
LOCATION SKETCH
Show direction and distance in miles fiom 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 STAN \RDS, AND THAT A C Y OF THIS RECORD. HAS BEEN PROVIDED TO THE WELL OWNER
SIGNATURE OF PERSON CONSTRIJCT!NO THE WELL DATE
Submlt the original to the Division of Water Quality, Groundwater Section, 1636 31a11 Service Center • Raleigh, NC
.'. 27699.1636. Phone No,:[phone], within 30 days. CW-I_REY. 07/2001

WELL CONSTRUCTION RECORD
North Can:lino •Department of Environment and NaturalResoulces • DivIsior of Water Quality • Groundwater Section d
WELL. CONTRACTOR (INDIVIDUAL) (print) James A. Brown . CERTIFICATIONa 20 5
WELL CON'I RACIOR COiMIPANY NAME Hedden Brothers We11 Drilling, Inc PhONE 0 $281 369-9591
STATE WELL CONSTRUCTION PERMITS ASSOCIATED WQ PERMITS
(if applicable) _. -(if applicable):
I WELL USE (Check Applicable Box) Residential El Municipal/Public 0 -.Industrial ❑ Agricultural ❑.
Monitoring ❑ Recovery..0 -. Heat Pump Water injection 0 Other 0 If Other, List Use
2 WELL LOCATI
Nearest wn`
(Street Name, Nu'inbe s, Connunity, Sub
3. OWNER.
Addross
slon Lot No., Zip Code)-.'
City or town Site Zip Code
Area code. Phone number
4 DATE DRILLED 7•/ "OY'
5. TOTAL DEPTH.
6 DOES. WELL REPLACE EXISTING WELL? YES G 0 ;ItZ'7STATIC WATER LEVEL' Below Top of Casing: FT.
(Use "4,':if Above Top of Casing) •
8 TOP OF CASING Is 2 FT Above Land Surface"
'Top. el'cesiny terminated at/or belowland surface requires a
• variance In. accordance with IS.4 NCAC 2C ,0118:
9 YIELD (gpm) ,50 MET 013 OF TEST blow
10 WATER ZONES (depth): Y-0
11 DISINFECTION: Type H T H Amcunt 1 6 OZ
12. CASING• WallThickness
Depth y e Dt meter or Weight/Ft, riotprom `' 0 To / FL
tee
From f'eTcaD Ft • tin.,
From From To Ft
13 GROUT: '., Depth Material • ..Method
From 0 To 20 Ft bernite &'OBSett pump
• 14 SCREEN Depth Diameter Slot Size Material
15 SAND/GRAVEL PACK
.Depth Size Material..
From To Ft::
'Ft.' -..
16 :REMARKS° -•'<
Topographic/Land setting'
ORidge :Slope :OValley OFlat
(check appropriate box)
Latitude/longitude of well location
301
:.(Cegre eshni mutes/seconds)
Latitude/longitude source, OGPSOTopographic map
(check box).
DEPTH •
DRILLING LOG
Qom �rJ a F1clay!& Sean! icon _.
Fr
18s
granite
LOCATION SKETCkj
Show direction and distance in miles From at least
two State Roads or County Roads. Include the road
numbers and common read names:
I DO HEREBY CERTIFY THAT THIS WELL WAS CON'STRU'CTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION ST RDS, AND THAT A CC$ Y OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER -. .
DATE
SIGNATLfRE OF PERSON CONSTRUCTING THE WELL
Submlt the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center • Raleigh, NC
27699-1636'Phone No..[phone], within 30 days. CW-1 REV 07/2001
89

WELL CONSTRUCTION RECORD
North Carolina - Dcpdrtrpent cf Environment and Natural Resources • Division of Water Quality • Groundwater Section
James B. Brown CERTIFICATION~ 20a5
WELL CO,YTRACI'ORfl DIYIDU,AL)NAME (print) 9'O1
WELL CONTRACTOR COMIPANYNAME Redden Brothers Well Drilling, Inc PHONE a AT1
ASSOCIATED WQ PERMITn
S'rA7E WELLCONSTRUCTiON FER;VI1Ti7 - (ifaprlicable)
(if applicable)
1. WELL USE (Check Applicable Box): Residential N Municipal/Public ❑ industrial ❑ Agricultural O
Monitoring 0 Recovery 0 - Heat Pump Water Injection 0 Other ❑ IC Other, List Use
2 WELL LOCAT 0
Ne: cstTo
s ti '
Je
(Street N
, 14. SCREEN ' Depth
From- To Ft. in
From To Ft. in
15, SAND/GRAVEL PACK:
Depth - Size
From To Ft.
From To Ft.
Countv
660
16. REMARKS.
s' f Derre
Nw*bns, Community, Subdivision, Lot No., Zip Code)
OWNER /AI E '
Address '• ' 1CfeY
(peat or Route Na.)
W Ogg19
pp ••��ppCity or Town E1jta Zip Code (,
(C]E5. )• /l/4e aei
Area code. Phone number p
4 DATE DRILLED 0.23'�7
5 TOTAL DEPTH: thee'
6. DOES WELL REPLACE EXISTING WELL? YES No0 CI
'l, 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 atior below land surface requires a
variance In accordan�c�e�/r"�lthIS.A NCAC 2C.0118. b1CW
9 YIELD (gpm): 74" MET i 40F TEST
10. WATER ZONES (depth): . `JJ
I l DISINFECTION: Type H T H Arnount 16 oz
12 CASING. Wall Thickness
Depth D yeter or et htlFt. MMaeertal
From 0 To 10i Ft. a ��f
From To Ft,
From To Ft.
13 GROUT: . Depth - Material Method
From 0 To 20 Ft. teicaite & tatn1L pumped
From To Ft.
Diameter Slot Size ` Material
in.
in.
Material
301794
Topographic/Land setting
ORidge 0Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degreesiminulesgeconds)
Lattudc/longitude source; OGPSOTopegraphic map
(check box)
DEPTH DRILLING LOG
From T f 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,
I. DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 1S.A NCAC 2C, WELL
CONSTRUCTION STAND B.4S, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED 70 THE WELL OWNER
i.,,J3-n
SIGNATURE. OF PERSON CONSTRUCTING THE WELL DATE
1
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

3: OWre's
Adadss - 1 I
0{�
2. WELL'LOCATI
Ne ^s4
WELL USE (Check Applicable Box)Residential $ -Municipal/Public CD Industrial O Agricultural 0
Monitoring egovery
CCAM tv✓J(,4J/
Fgpl w
l Jee<< Yew
,IStreet.Name, Numbers; Community, Subdivis oh, Lot No Zip Code)
cries
267i9
City or Town State Zip Coco
(8a81• 736- IRAS
Area code- Phone number A �[
4. DATE DRILLED` Tot / •ur
5 TOTAL DEPTH:- 3t0a
6 DOES WELL REPLACE EXISTING WELL? YES 0 NO
WELL CONSTRUCTION RECORD
North Carolina • Department of Environment. andaturai
mNatural Resources •,Divsion of Water Quai ty • Groundwater Section
WELL CONTRACTOR (INDIVIDUAL)NAME (print)
JaTes fi. Ergm CERTIFICATION# 2045
WELL CONTRACTOR coMPANY NAntz Heddien brothers Well Drilling, Inc PHONE #.FLU} —a�
STATE WELL CONSTRUCTION PERMIT/4 - ASSOCIATED WQ PERMIT#
(if aoplicable) -
301793
0 R 0 Heal Pump Water Injection 0 Other 0 If Other, List Use
Topographic/Land setting
❑Ridge 'OSlope ❑Valley CFlat
(check appropnote box)
Latitude/longitude of well location
(degce eslr i nut es/seccnds)
Latitude/longitude source,OGPSOTopographic nap
(check box).
DEPTH DRILLING LOG
From Tor. Formation DescrLotion.
0 54J• clay & san
334' 3001 crru,ite
7 STATIC WATER LEVEL Below Top of Casing: ado FT
(I./setup" if Above Top of Casing) - -
8 TOP OF CASING IS 2 FT Above Land Surface'
'Toq of c asing terminated odor belowlandsatiate requires 9
variance inaccordanc with 1S.ANCAC 1C A118; blow9. YIELD (gpm) iD METHOD OF TEST
10 WATER ZONES (depth): Igor 4203a
LOCATION SKETCH
1I ,DISINFECTION::Type H T H Amount 16 oz - Show direction and distance in miles Son; at least
12. CASING: ' Wall Thckness two State Roads or County Roads. Include the road
Depth Di meter or WeighiFt , Material m
numbers and cornon roar, names,
From ' 0 To Ft nD
From $3r..ToFt ou .�� �-
13 GROUT' Depth Material Method
From 0 To 20 Ft:Pumped`
rwm-
14'' SCREEN Depth Diameter Slot Size ' Material
15 SAND/GRAVEL PACK:
Depth
From To Ft.
_In in
Size Material
16. REMARKS.
1 DO HEREEYCERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15ANCAC 2C, WELL
CONSTRUCTION S NDARDS, AND THAT A: COPY. OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER '.
7-19—o.
SIGNATURE. OF PERSON CONSTRUCTING THE WELL DATE
Submit the original to the Division of WaterQuality, Groundwater Section, 1636 Mail Service Center • Raleigh, NC
27699-.1636 Phone No. [phone], within 30 days _ GW-1 REV 07/2001
.:i

Monitoring ❑ Recovery O Neat Pump Water Injection O Other 0 if Other, List Llse
2 WELL`LOCATI
Nears T wn:
County
(SueeiName, Numbers, Community, SubdivTron, Lot No.. Zip Code)..
WELL CONSTRUCTION RECORD
IN orti1 Carolina • Dcparlment of Environment and Natural Resources • :Division of Water Quality • Groundwater Section.
WELL CONTRACTOR(INDIVIDUAL)NAME (print) J ?1es A. Eraan CERTIFICATION'# 2045
WELL CONTRACTOR COiMPANYNAME Redden Brothers Well Drilling, Inc PHONE k 6291 6g_9591
S'r ATE WELL CONSTRUCTION PERMIT ASSOCIATED WQ PERMIT:
(if applicable) • - `(ifapnlicable)
I WELL USE (Check Applicable Box) Residential '. Municipal/Public O. Industrial 0 - Agricultural 0
e ..
3 OWNER:
Address.
(ctrot Route d1
(�/J//4 1 7 �3
City Town St Zip Code
$Z4)•��" /$70•
- granite
Area code. Phone number ryry A -Ur
4 DATE DRILLED O' 6T
5 TOTAL DEPTH
6 DOES WELL REPLACE EXISTING WELL? YES C]ONO�
7. STATIC WATER LEVEL Below Top of Casing: fj
301792
Topographic/Land setting
ORidge ❑Slope ❑Valley ❑Flat
(check appropriate box). •
Latitude/longitude of well location
(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 18.A: NCAC ZC .0118.
9 YIELD (gpm): AC {MET Q TIyST blow
10. WATER ZONES (depth) (o
1 I DISINFECTION: Type H T H Amount 16 oz
12. CASING: Wall Thickness
De th Diameter or Weiichht/Ft , Material
From ' 0 To 7 7 Ft. CO 11 .1 8
From ' To - Ft.
From To Ft.
13 GROUT . Depth Material Method
Frorn 0 To 20 Ft.l:Ernits &cerint pumped
14. SCREEN ,' Depth D'lanuter :'Slot Size : Material
15 SAND/GRAVEL PACK:
Depth Size
From To Ft.
From To Ft.
16 REMARKS: •
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC2C, WELL
CONSTRUCTION 'DARDS AND THAT A COP OF THIS RECORD HAS SEEN PROVIDED TO THE WELL OWNER
SIONATURE OF PERSON CONSTRUCTING THE WELL DATE
Submit the original to the Division of Water Quality, Groundwnter Section, 1636 Mail ServiceCenter• Raleigh, NC
27699.1636 Phone No. 733-3221, within 30 days. GW.t.REV, 07/2001
Material'..,;..
( degre eshnmutei/seconds) -
Lau^uec/longit de -source OGPSOTopagraphic'map
(check box)
DEPTH DRILLING LOG
From Tpa Formation Descr tion
clay &sand..
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,

WELL CONSTRUCTION RECORD 3 0 0 7 4 4
Nord•, Carolina - Department of Environment and Natural Resources • Division of Water Quaky - Groundwater Section
WELL CONTRACTOR (INDIIIDL.AL)NAME (prints James B. Brown CERTIFICATION# 2045
WELL CON'IR:\CTOR COMPANY NAME Hedden Brothers Well Drilling, Inc
STATE WELL CONSTRUCTION PERMIT* ASSOCIATED WQ PERMIT#
(if applicable)
(ifaoofcable)
I. WELL USE (Check Applicable Box): Residential Municipal/Public 0 Industrial 0 Agricultural C
Monitoring ❑ Recovery 0 Heat Pump Water Injection ❑ Other 0 If Other, List Usc
2. WELL LOCATI
Near T.wn,
(Street
3. OWNER,
Address
e M:.n ben. Community, $ubdi
County
Lot No., Zi ode)
veep <r R�' A��
eiie : � con/9
r -^ Zip Coce
Area code• a lumber ,/
4. DATE DRILLED `-p%i'O7I
5, TOTAL DEPTH: �� e L
6. DOES WELL REPLACE EXISTING WELL? YES C NO Zl
7. STATIC WATER LEVEL Below Top of Casing: 160 FT.
;Use "t" if Above Top of Casing)
£. TO? OF CASING IS 2 FT. Above Land Surface'
•Top of casing terminated at/or below land surface requires a
variance In accordance s Ith 15A NCAC 2C.011S,
9. YIELD (gpm). METX0D ,F TEST blow
10 WATER ZONES (depth): L5&
11. DISINFECTION Type
12. CASING: Dryepth /
From 0 To /
From. T^
From To
13 GROUT: Depth
From 0 Tc 20
From To
14. SCREEN: Depth Diameter
From To Ft. in.
From To Ft. in.
15, SAND.GR.AVEL PACK:
H T H Amount 16 oz
Wali Thickness
ateriol
Ft. D;}n er old/O�JFt VE/tie
Ft.
Ft
Material ;Method
Ft. hernite & ciatert pumped
Ft
Slot Size Material
in.
in.
Sze Material
From Ft.
From o Ft.
Depth
To
T
PHONE k 251 369-9591
Topographic/Land settine
CRidge :Slope CValley :Fiat
(check appropriate box)
Latitude/longitude of well location
(deg Tees/minu:es'seconds)
Latitude/longitude source.CGPSCTopographic map
(cheek box)
DEPTH FormationDDRILLING LOG
O m sea�dsnI.cn
clay
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.
—D
Cei
16. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15ANCAC 2C, WELL
CONSTRUCTION STA3i^?ARDS, AND THAT A CA COPY OF
THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
SIGNATURE OF PERSON CO RUCTING 7HE WELL DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
•
27699-1636 Phone No. (9I9) 733-3221, within 30 days. .iW.I REV:_0' :001
c
CD
0
DD
rrt
ora
OG
*Pi
t7
tunz
1710
c4
--s
O

WELL CONSTRUCTION RECORD
North, Carolina - Dcpartrnent of Environment and Natural Resources - Division of Water Qua
WELL CONTRACTOR (DDI;'IDUAL) tiA)1E (print) James B. Brown
\NEL.L CONTRACTOR COMPANY NANIEHedden Brothers Well Drilling, Inc
30074 '24 '2Groundwater Sec
tion
CERTIFICATION ;2045
PHONE F;`29) 369-1
STATE WELL CONSTRUCTION PERMITS ASSOCIATED WQ PERMITS
(If acrfcable) (ifaoniicable)
!. WELL USE (Check Applicable Box): Residential Municipal/Public C Industrial C Agricultural ❑
Monitoring 0 Recovers C Heat Pump Water Injection ❑ Other ❑ If Other, List Use
2 WELL LOCATION:
Nea cs. Town: 8 60iN1 'IN County Smut)
QLA41.A KP
Topographic/Land sett
❑Ridge ❑Slope ❑\'alley
(check appropriate box)
CFia.
,_see: No.,, e,' .,-.bars Cm» nr_r.hy, Eabd;' s on, Lot No., Zip Code) Latitude/Iongi ude of we,l location
3 OWNER.X.ASE/TH - &(3te5
Add'css l089/ 4ul ta QO
--Br.tso�E' anyNe2a87i3
Zip Coca
Pa -`�$$- 1570
Are.;.,,ce. RI. °.,whet
4. DATE DRILLED 8-2-04
5. TOTAL DEPTH: 180'
7.
6. DOES WELL REPLACE EXISTING WELL? YES NO
STATIC WATER LEVEL Below Top of Casing: n T.
(Use ' if Above Top of Casing)
Fc TOP OF CASING IS 2 FT. Above Lard Surface
'Top or casing :arm:nated al or below land surface requires a
variance in accordance with 1SA NCAC 2C .0IIS.
5. YIELDrgcrnl. a0 METH.ODOFTEST blow
;YATES' ZONES (depth.): 65 . 85 . 05 '
11 DISINFECTION: Type E. T H
12 CASING: �(!�
From 0 T J at
For.. To Ft
From To
.3. GROUT: Dept:.
From. 0 To 20
From To
14 SCREE,\.
=tom To
Froc. To Ft.
:5 SAND GRAVEL PACK:
Dept:-.
° rcrr To Ft.
From To Ft.
D-meter
Amount 16 oz
Wall Thickness
4ateria
Ft. I mite & Letts
Ft
Size
Method
pumped
Slot Size Ala:eric!
in.
in.
Material
(de;reesimi nutessecc ads)
Latituddlongi t:de sourue.:GPSCTopographic map
(weck box)
DEPTH DRILLING LOG
From " Formation Descr^ticn
0 p� ' clay & sand
LIA' ii0' granite
LOCATION SKETCH
Show direction and distance in m°;es F.O.V. at ieast
two State Roads or Cr:nty Roads. Induce the road
numbers and common road names.
W
W
16. REMARKS:
I DO HEREBY CERT:FY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION ST.AN,DS, 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 W ater Quality, Groundwater Section. 1636 Mail Service Center- Raleigh, NC
2"699-1636 Pnonc No. (919) '33-3221, within 30 days.REV

301381
WELL CONSTRUCTION RECORD
Division of Water Quality - Groundwater Section
North Carolina - Department of Environment and Natural Resources - CERTIFICATION Skikird
PHONE M m"a `/
WELL CONTRACTOR (INDIVIDUAL) NAME (print)
£LL CONTRACTOR COMPANY NAME
(ifa
f a Ipplicaca ble) CONSTRUCTION (if apPl_icable)
1. WELL USE (Check ApplicableDos)PumpWaterl Injection
lPublic Other ❑❑If Industrial
List O e Agricultural 0
Monitoring ❑ Recovery 0
Heat
Topographic/Land setting
❑Ridge 0Slope ❑Valley ❑Fiat
(check appropriate box)
Latitude/longitude of well location
( i
Latitudeliongit de :OGPSOTopographc map
(cheek bac) -- --
w
STATE WELLN PERMITS ASSOCIATED WO PERMITS
2. WELL LOCATION:
Nearest Town:
(Street Name. Numbers, Community. Subdivision. lot No.. Zip Code)
3. OWNER: )o.cC trrcc.ic_
Address ,S`n L)rn,'// r'.rgek
(Steer or RS NO.) DEPTH
Jar yorTo Ciwn 57y� • i� 3 From To
City or Tr,
Area Coder - Phone number
4. DATE DRILLED ,
5. TOTAL DEPTH: WELL? YES ❑ NO
6. DOES WELL REPLACE EXISTING WEl
7. STATIC WATER LEVEL selow Top &Casing
(Use" " HA6weTap of Casing)
8. TOP OF CASING IS Ft Above Land Surface.
*Top of mac terminated ■tlr belay Ind earame requires a
variance In aecordance with ISA NCAC 2C METHOD IOTEST O-i 4'
9. YIELD (gpm):
10. WATER ZONES (depth):
County 3 IA-)O. , rt
11. DISINFECTION: Type
12. CASING: DiameterDepth
From_o TD ,S 7 FL
From To Ft.
Amount
Wall Thies
or Weight/FL Material
5Ar2) AVc
From To Ft.
13. GROUT: Depth Material
From_n_ TO_2L— Ft. (ern I n T
From To Ft.
14. SCREEN: Depth Diameter Slot Size
From To Ft. in. in.
From To Ft. in. in.
15. SAND/GRAVEL PACK: Depth SiMaterial
Size
From _ To Ft.
From To Ft. i /
16. REMARKS:
1.1 el/ 12)b f' / t j ,c)ir 6 rr C Th in e
THIS WELL WAS CONSTRUCTED 1N ACCORDANCE WITH 15A NCAC 2C, WELL
Formation Description
Cr,
LOCATION SKETCH
Show direction and dime in tanks from at least
two State Roads or County Roads. Include die road
nc� and common road names.
Tram cat- %✓andt //"" 06.0
o / Fatm , l es Turn
lePT on 71/E �o �,Glyv,'les.
A Method jvrrl R,obT an a�' S Go . 6,9 mile
_-
turn IP�T on ,Sawrn,'/I Grec�lT R'
Go /.(oprl;le5 'Turn R,gh`ron
G/c4/nciT Cove Go oil mr'l,9 -Urn
R,i9hTGo, o,1rl•'le 71-rn let% Gc)
-7-07-6o-' h,'71 well on /e T
Material
I DO HEREBY CERTIFY THAT
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
e R > oil
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Ceater' R le g0 NC l
27699-1636 Phone No. [phone], within 30 days.

WELL CONSTRUCTION RECORD
North Carolina -Department of Environment and Natural Resources - Division of Water Quality CERTIFater ICATION ATION Mtio Q
WELL CONTRACTOR (INDIVIDUAL) NAME (print) , PHONE F1CAT1)y7�gN`'��
ems---T-
301380
WELL CONTRACTOR COMPANY NAME ASSOCIATED WQ PERMITS.�---
STATE WELL CONSTRUCTION PERMIT% (if anolicable)
(if aPPlicable)
I. WELL USE (Check Applicable Box): Residential 0 Municipal/Public 0 Industrial 0 Abmcultural ❑
Monitoring 0 Recovery 0 Heat Pump Water Injection Cl Other 0 If Other, List Use
s--
2. WELL LOCATION:
Topographic/Land setting
N rest Town:_ar.i,G�r County SWa%rr ❑Ridge (thick appropriate
❑F►at
nnTN !rn KP
F STn S .jr7 /.1 Latitude/longitude(kappro of a box)ell cation
(Street Name. Numbers, Community, subdivision. lot No.. Zip Code)
{{{D�� �- EPS t`G..S tom)
3. OWNER: K1 /& RW ESTaTe S Lautuderlongitude source:0OPSOTopograptoc map
Address nv) T (Sim (dtedc box)
(5aeetw RomeI'C, ) DEPTH QRt1IlNG LOG
,�YySa n n:�`Ty aleG `�87l3 From To Formation Description
tity or Town stale � COS
(911/4)- 1-g16
Area code- Phone number
4. DATE DRILLED
5. TOTAL DEPTH: (nn.< WELL? YES 0 NO
6. DOES WELL REPLACE EXISTING/�/.� FT.
lia
7. STATIC WATER LEVEL Below Top ofCasing
(the "t' if Above Tap of Casing)
8. TOP OF CASING IS / FT. Move Land Surface*
*Top of caring terminated attar blew load sorbet requires a
variance 1. am): a with 1S MNETHOD OF TEST Q. i r
9. YIELD (gpm):
10.WATER ZONES (depth): L KiO
11. DISINFECTION: Type N�—
12. CASING:
Depth
From_ To /d FL
From To Ft..
From To Ft.
13. GROUT: Depth
From_!L_ To at; Ft.
From To
14. SCREEN: Depth
From To
From To
15. SAND/GRAVEL PACK:
Depth
From To
From To
Amount tl.P']
wan Tb)cltness
Diameter or Weight/FL Material
Stith PVC
Material
CPrne nT
Ft.
Diameter
in.
in.
Ft..
Ft.
Ft.
Ft.
Slot Size
_ in.
in.
Method
Pu m p,'rw
Size Material
��C�I�I'.
LOCATION SKETCH
Show direction
danddistancea®lesframatleast mad
State Roads or County Road:- Include the
-Fumbers and common roadrenames.
rom almond Pc Go l ir" m s les
Turn /e 7- on 71-/E .3 iv)-'le,s
Turn 1r?7 on itaaranet lake 6SThTCS
S
CO 91nt'1PS Turn R hT' n runTan0.
Material
loop Net-7-4 0.2 That turn RiyhT
o n 734 jra;1 G0 0.1 m To Gvc11
o 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
Cl2%
DATE
sf P-�-P h p./
SIGNATURE OF PER ON CONSTRUCTING THE WELL
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center
1 REV !Weigh,
NC
hon
27699-1636 Pe No. [phone], within 30 days.

WELL CONSTRUCTION RECORD
1st GrovadWpta+Sation
North Carolina - Department of Environment and Natural Resources - Division of Water Qua • y - Qrcun CERTIFICATION M `wig
J ..
WELL CONTRACTOR (INDIYiDDALI NAME ion � PRUNE rc:+cam -8�54S�i
WELL CO,\TRACTOR COMPANY NAMEr r• • ' -
ASSOCIATED WQ PERMIT!
it applimbic
STATE WELL CONSTRUCTION PERINITa
(ifapplieable)
licable Box): Residential Sl MunicipalPublic ° Industrial CIAg ieutturat 0
Monnititoring 0 Recovvery Hat Pump ) ° 1. M USE (Cheek ep Water Injection 0 Other If Other, List Use
�
Topographic/Land sorting
F�t
°Ridge °Slope Malley
(ehak apptapdmrbox
1.anluddlongilude of well) iocatitm
Nurntreuswasseeenta
LantudellOenil4de eourceriGPSOTopographic map _.
trhed bon
From To Formation Description
301379
2. WELL LOCATION: County S!✓a,'vr
N4arest Town ' _ J4i7/.2
(Esti Tame. Numbers. Cmnmmdty. Subdlvblw4 leiNo.. tip Cad•)
3. OWNER:
Address (Sinner Relate
Aryson ld'Ti Mc. 97 3
City srTown state Zip
Arta cods- Phone aumbr+
4. DATE DRILLED�(_fx= 4/
5. TOTAL DEPTIL 7, VS WELL? YES CI NO
6. DOES WELL REPLACE EXIS INO
7. STATIC WATER LEVEL Below Top &Casing / °S FT.
Sher sTapurcmua
E. TOP OF CASING IS _L____ PT- Above Load Solace
'Top .f coda rermiattea age Wm and ante flies •
vnh.w l..c rra..a ant tSA NCAC 2C MIR
9. YIELD Wm): 3 METHOD OF TEST ex. i r
ID. WATER TONES (depth): 6
11. D1SlNFECRON: Type /7✓ T N Ann* 6. //3
12. CASING: W.IIThiclorras
Depth it or Weight/Ft. PMaterial
VC
To____
Fro
m
From To Ft.
cnrii
From To FL
13. GROUT: Depth Material Pumpth
From_ Tom Ft./tine+, T
From To FL
14. SCREEN: Depth Diameter
From To FL in.
From_ To Ft in.
15. SAND/GRAVEL PACK:
Depth Size
From To Ft.
From To Ft.
Slot Size Material
_ in.
in.
Material
o-,
micaggingagil
Show direcdon andtune is niilcs from at last
too Stain Roads mr Camay Roads. include the mad
numbers said Ozininten road names.
tram, p0 G0 beiniYes 7 rn /e T
can 794GO 02,3In//rs Turn/Phr
[)/ niana AR&tSTTrsGinL39Thh/ts
Tarn /e? T on 4ofl7 Lnet /sap Savih
CO, 0,3 p,/% Turn RighT 6 kid/
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
je-.P z.e 8-�-r,v
SIGNATURE OF P N CONSTRUCTING THE WELL DATE
Submit the original to the Division of Water Quality, Groundwater Section,1636 Mai Service Caner
Gls I REV. Raleigh, NC
01
;37636 Phone No. [phone], within 30 days.

WELL CONTR.ACTOR(INDIVIDUAL) NAME (print)
I I CERTIFICATION: �/d-S- /
WELL CONTRACFORCO�IPANvNANIE• (J�2P�-C- / We& d2cCx PHONE N ((l2i�,V -Ssso
STATE WELL CONSTRUCTION PER.IIT; ASSOCIATED WQ R?IIT;
(if applicable)
(if aoolicablel •
c- R
I. WELL USE (Check Applicable Box): Resdentia!'i blunicipa" Public 0 Industrial ❑ Agricultural 0
Monitoring ❑ Recovery 0 Heat Pump Water Injection ❑ O:her ❑ 1f Other, List Ur
2. \VELL LOCAT10j:
Kea 'ss: To�w�n:_
(Srr::: N_:::e. No:roes. Car.:mur.
3. O\CNER:
Addr;ss 314,0
(S:• -•: or Rout: t o.)
3 A/.Qk , n*CL
Zip Cc:
(4/I)- X LFc1 - ioq
R
r\-:: Frone ra::cer
DATE DRILLED L' -D`'(
5. TOTAL DEPTH: `DC)
6 DOES WELL REPLACE EXISTING WELL? YES 0 NO IX
7. STATIC WATER. LEVEL Belo:: Top o,rCar:rr. /b0 FT.
(Ls..._.. if .4boa Top or C_
S TO? OF CAS!NG IS 1 Casing..
FT. Abo:e Lan.': Surface'
•l o . ci.!n; Lr.,..i.�..G et'ur b: v.i IJ:ld ter -Li reyuire3l
Ic c.ia: Ii.\ NCAC1CJ0113.
9. YIELD OF TEST
IE WATEP.ZONES(d::±\.Ls
300883.
Topographic/Lend setting
County
67571C-on, 3.
Lo0 No. Zip Code) LaiiilldelOpititud.: of well location
❑Ridgelope ❑Valley ❑Flat
(check approcra:e box)
(d:}re:: iseconds:ti
onds:
LatItud:'Iom_itude source:❑GPS❑Tppo_ raphi: mop
(:ice.: box .
DEPTH DRILLING LOG
From To Formation Description.
civ7C (
I . D:s NEECTI3N. T}c; H I R-
D:,r
c T. b'3
To
... CSC./
T . 3
Ft::7; 3 Tc �U
1= SCREEN:
fro- Tc
Fr.r: Tc
I5. SAND GRAVEL PACK
Fr..,, To Ft.
•51077 Ft
Fro:-.
F:
r. )._:.-0?:1?,.5 hi
F: /0w seal PL•IC•
Ft
Ft
F:
F,.eort—
D.z. r.et- Su: 5z.
RE\! \"KS -
Ft
in.
S:ze NI-:er:a
e
i
LOCATION' S'(ETCH
chc: c a c riles r;a"f" '`
'A
c.:....... _r' co,-.r.,.r.
0`
r Yo
-o r^o
NZ
I DO HE iEE. V cEr.T!FF THAT TEIS WELL WAS CON-
CONST'..CTION STAN. DS. ;ND Tj',f.YCO,
e CTED IN ACCO?.D.=.NCE WITH. I5A NCAC 2C, WELL
ra_ F_CO3D F:AE EEE\ PROVIDED TO :E C'.ELLOa•'N`S
iia&iy
S:GNATLREOFPERSON CONSTR:.:CTING TEE\`• E!
S"br..: the crigina! to the Di'.ision cf \\ _:er Quat: t\, Grattnd+•.zter .5ezt o', 1516
2'69)-!$35 Prn.-.:\,.(9:9i73-___'I,vi;hin 3i) d.t5.
DATE

WELL CONSTRUCTION RECORD
North Carolina • Department of Environment and Natural Resources •Division of Water Quality - Groundwater Section
WELL CO�NTR,1CtOR_iliND!VIDUAL) NAME (print) Mitchell D. Cook CERTIFICATION 2043
WELL CONTRACTOR COMPANY NAME HEC5E1 $CtibErS F'�.1 Trilling, Irc PHONE k)928) 369-9591
STATE W ELL CONSTRUCTION PERMITk ASSOCIATED WQ PERiAII7®
(if applicable) (if apolicable)
300142
L WELL USE (Check Applicable Box): Residemial 6 Municipal(Public❑ Industrial ❑' Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 'Other 0 If Other, List Use
2. WELL LOCATION
NearestTownlar'YSOri City County Swain
5030 Watai RD
(Street Name, Numbers, Community,Subdivision, Lot No,, Zip Code)
3 OWNER Daavid Noletti
Address 1 West Pack Square -Suite 305
LS trees or Rouie No )
Asheville, NC 28801
• City or Town Stab Zip Code
( 82e)• 210-8127
Area code• Phone number
DATE DRILLED 7-12-04
TOTAL DEPTH: 300'
DOES WELL REPLACE EXISTING WELL? YES ❑ NO -0
STATIC WATER LEVEL Below Top of Casing: - 1(10 FT
(Use '•*' if Above Top. of/Casing)
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.0118,
9, YIELD (gpm): 40 METHOD OF TEST blow
10, WATER ZONES (depth): 80' . 11.5', & 215'
I L DISINFECTION: Type H T H Amount 16oz
12 CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material.
From 0 To 49 Ft:_
From 441 To Sir Ft 6 .188 Steel
From To -Fi,
13, GROUT: Depth Material Method
From (1 To 20 Ftkauite & winaL osrb&
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/n•.mtites/seconds)
Latititdoriongitude. source:❑GPSOTcpograp'hic map
(check box)
DEPTH DRILLING LOG
Formation Description
ciao & rd
From 51 ,
51' 300' granite
LOCATION SKETCH'
Show direction: and distance in miles (loin at least
two State Roads or County Roads. Include the road
numbers and corra-non road names.
16, REMARKS:
DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH SA NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF. THIS RECORD HAS BEEN. PROVIDED TO THE WELL OWNER
SIGNATURE .OFPERSON .CONSTRUCTING THE .WELL DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mali Service Center •'Raleigh, NC
7699.1636 Phone No„(919),733.3221, within 30.days. GW-I REV, 07/2001

300132
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality
WELL CONTRACTOR (INDIVIDUAL) NAME (print) TARRY F. JONES
WELL CONTRACTOR COMPANY NAME CHEROKEE WELL DRILLING AND PUMP COMPANY, INC.
STATE WELL CONSTRUCTION PERMIT/1 ASSOCIATED WO PERMITN
Of applicable) (if applicable)
- Groundwater Section
CERTIFICATION N 3295
PHONE N [phone]
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 LOCATION:
Nearest Town: TOPTON County SWAIN
GREGORY HILLS RD
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: JASON POE - SOUTHERN VENTURES, INC.
Address P.O. BOX 450
(Sheet or Route No.)
THONOTOSASSA, FL 33592
City or Town State Zip Code
( 813 )_ 767-8557
Area code- Phone number
4. DATE DRILLED 07-20-2004
5. TOTAL DEPTH: 385'
6. DOES WELL REPLACE EXISTING WELL? YES90 NO El
7. STATIC WATER LEVEL Below Top of Casing: 90
(Use "+" ifAbove Top of Casing)
8. TOP OF CASING IS 1 FT. Above Land Surface*
"Pop of easing terminated alor below land surface requires a
variance in accordance with 15A NCAC 2C.0119.
9. YIELD (gpm): 25 METHOD OF TEST AIR
10. WATER ZONES (depth): 365'
11. DISINFECTION: Type CHLORINE
12. CASING:
Amount 100 PPM
Wall Thickness
Depth Diameter or Weight/Ft. Material
From 0 To 61 Ft. 51/4" .188 STEEL
From To Ft.
From To Ft.
13. GROUT:
From 0
Depth Material Method
To 20 Ft. CEMENT GRAVITY
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
3515.799N/8341.112W
(degrees/minutes/seconds)
Latitudc/longitude source:RIGPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From To Formation Description
0' TO 20' BLACK DIRT
20' TO 60' BLACK DIRT/BOULDERS
60' TO 81' GRANITE
81' TO 385' GRANITE
GRANITE
O_
LOCATION SKETCH CI
Show direction and distance in miles from at lead;
two State Roads or County Roads. Include the road vtC'
numbers and common road names. Sr=,1
Ck
V
16. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WWI I5A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RECO HAS BEEN PROVIDED TO TIIE WELL OWNER
IE
N CW TING TILE WELL DATE
SIGNATURE OF PE
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-I REV. 07/2001

\1LLLCO.N JRUC: 1luNRECORD 300666
North Carolina - Department of Environment and Natural Resources • Division of Rater Quality - Groundwater Section
'ta7.
%%ELL CONTRACTOR (INDIVIDUAL) NA%IpE �((pp,r�iin(t)�� CERTIFICATION
-:-�oyf�,. //
\WELL CONTRACTOR COat PAN\" NAME 'AAA /lP �' —PHONE F JCyfq. d G'`Scro
STATE \%ELL CONSTRUCTION PERMIT; ASSOCIATED %tQ PERMIT.:
(if applicable)
(if applicable)
1. WELL USE (Check Applicable Box)'. Residential y� MunicipaYPublicii Industrial ❑ g i- ply} tural
Monitoringi'1•/L
❑ Recovery 0 Heat Pump Water Injection ❑ Other 0 If Other, List Use 4
0
2. V.•ELL LOCATI N
Nearest Town: County
L., ..WcirNC X1. l4V i3- '
(5:ree: Sn:::. Nu:nbri. Con I:tunitj. Sjhdisis:ort, L t Na, Zip
OWNER: (,
Address
Topographic/Land setting
%Ridge ❑Slope ❑Valley ❑Flat
(check appropriate box)
Coke)) Latitudelongitudeofwell location
-,1C'.08?l3
vp,� ,!
(10 c'4't 77.
Zip Code
.be: n 1e- Pnone eve:S::
An DATE DRILLED is IIu�
:. TOTAL DEPTH: 10CI
6 DOES WELL REPLACE EXISTING WELL? YES ❑ NO g
7. STATIC WATER LEVEL Rebut To o.fCasiir IfCO FT.
(use if Abo.: To; of Casey',
S TO? OF CASING IS FT. Above Land Surface-
•1 uy ur.v)in; tIrv:iiu t.d a'br belu.i land surfeee reQu.re)
ucardm:e ui:h I .\ NCAC IC .011S.
9. YIELD Lip METHOD OF TEST 1Y
1C.WATER ZONES Ic pih) 7�
11. D:SI'<-ECTION. Tvpc I-) I H
12. CASING:
Fro::. C Te �Oa
F o7: To
From To
I 3 CiP.Cl_ :
Err.', C To 3
Fro::; 3 Te Zc
14 SCREEN. Dc.i-,
Fr.):r. To
Froni To
15. SAND GRAVEL PACE::
Deplh
Friir1 To
Frcr. To
16. RE\!.\RKS:
Ft. !c'/%
Ft
FI
(dear •s'iniru'es. seconds)
Lot tud_'lon;itude so irce:❑GPS❑Topogra?hip map
(ni:c, box)
DRILLING LOG
Formation Description
DEPTH
From To
T
LOCATION SKETCH
t 3/.0 OZ. Show direction nd'dis:__ae in miles from a: leas
1`.�a.: 7;:,
: Th zkeess r.co S:d e Roads or Co.:r . Road:. ro0.5t0
Cr V.eieh:F:. "p:i-1 niiiiYaiers and coeemon road names.
SDR-21 CC
H. (1 e/I .,.
FI
D,a:::ete- Sio: S:z_
Ft
Ft
Sze.
F;
Ft
GI rrc.
Lei-t `a+p
'/q,7'1,v lb `J- --
C z--a ff —
DO HERESY CEPTIF
CONSTRICTION
TEAT TH S'. ELLWASCON
DAP
. AND I7?YTI>3" 0'
S'CN.ATLREOFPE2EONCONSTRCCTINGTHE \ELL
Submit Cre original to the Division of Water Quality, Ground.•.uter Section. 1536 ?latl San
27699-16.6 Phon: No.19191733_3221, ithin 30 s.
R:: CTED IN ACCORDANCE WITH I5A NCAC 2C. \'.TLL
THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
V—C/%=_
DATE
Cee:ar • Fa!eiF/h�';
G\ -1 REVlyJ12OC:

3029'71
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural It
WELL CONTRACTOR (INDIVIDUAL) NAME (print) :Tea
WELL CONTRACTOR COMPANY NAME //2
STATE WELL CONSTRUCTION PERMIT#
(if applicable)
esources - Division of Water Quality - Groundwater Section
I9'Yd CERTIFICATION # a0•Sr7
i^a.Y
W" / 1 )0.m
Ap ; / /s PHONE # (Ir371)y79- 5'YS
( / rLfrpf0 Tu
ASSOCIATED vVQ PERMIT#
(if applicable)
I. WELL USE (Check Applicable Box): Residential ti4Municipal/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: Bit son /.' zy County S L✓fn i'Y!
/ands cPPph `s7/3
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: Per Do,r1 nog
Address /n--a4 creek
(Street or Route No.)
Br,Seln c:7-�, lt/c a S-7/3
City or Town tare Zip Code
(ti9)- Lin —ySSt7
Area code- Phone number
4. DATE DRILLED 9-/3-- 0 q
5. TOTAL DEPTH: 70
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO DC
7. STATIC WATER LEVEL Below Top of Casing: $ / FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING 1S / FT. Above Land Surface*
*Top of casing terminated ator below land surface requires a
variance in accordance with ISA NCAC 2C .0118.
9. YIELD (gpm): / METHOD OF TEST a i r
10. WATER ZONES (depth): (a D.4
11. DISINFECTION: Type // rid
12. CASING:
Depth Diameter
From_Q_ To 7 7 Ft. 64
From To Ft.
From To Ft.
13. GROUT: Depth
From_ To a U
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.
Amount 0, 112
Wall Thickness
or Weight/Ft. Material
<nr11 pvc
Material
FL C ernerT
16. REMARKS:
Ft.
Slot Size
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
.7
Q G
c -n
�j 13L
co
' o
LOCATION SKETCH r"
a
Show direction and distance in miles from at led
two State Roads or County Roads. Include the road
n tubers and common repad names.
-Fror''l al ynand, Po Go /. tms'/es Trn
/e?ron 79(&of ay ,'/fSTurn
Method Rr41h l a/ Pot 6,7 ,Qrysort c-Ty
Pinn G-o 7-o sTopS.8n Trnkonon ✓err/.
i3lt/✓6-6 To siopIiihTTurn/QisihT
6-0 T next lraghTTurnJelT 6 To
tonTo-noL R. Go 2,3 mr'les ton)
RIo,br on loon,js creek R16-o ),s
Mlles Turn RtNWr 0sneNi'ne O-o
Material
Material
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
t�/ I P 9- /s-o 9
SIGNATURE OF PERSON' CONSTRUCTING THE WELL DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-1 REV. 07/200I
t'IAR7l-

302970
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
Ter': ,�
WELL CONTRACTOR (INDIVIDUAL) NAME (print) t/ra-r� /-r"i �/ CERTIFICATION # 20ro
WELL CONTRACTOR COMPANY NAME Cr .ham Well (krill iv PHONE #grfii tar
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential 2 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: Rry Son C t ty County StJa . n
Set bl m//l ereick 2S-7/3
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: .Trlhn Eller
Address SAtw m;ll creek
(Street or Route No.)
Qr-t.ion G/T' NJ G d,Fs713
y or Town State Zip Code
(8.2t)- Uk8- (n9 aI
Area code- Phone number
4. DATE DRILLED 9-/3-n t-1
5. TOTAL DEPTH: `ai?0
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO 1531
7. STATIC WATER LEVEL Below Top of Casing: go FT.
(Use "+" if Above Top ojfeasing)
8. TOP OF CASING 1S 1 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): (4' METHOD OF TEST O.i�r
10. WATER ZONES (depth): 100
11. DISINFECTION: Type %1 T /i Amount Q. 34
12. CASING: - Wall Thickness
Depth Diameter or Weight/Ft. Material
From__ To /00 Ft. 614 5ora.1 PVG
From To
Ft.
From To Ft.
13. GROUT: Depth Material
From h To `..0 FL C,P MO/it
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
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
O Gs'\
€" rin
-o
nt t3°
o O0
r*t
n
horn Dimond po 6-0 1. e rn les Turn
/e Ton 754E Go as miles.
PQrnp/re ifern R'ghT on &9' Go. o 9 i»,'les
From To Ft.
From To Ft.
16. REMARKS:
_ mrTt
a
LOCATION SKETCH nc -473
cp
Show direction and distance in miles from atVst
two State Roads or County Roads. Include theroad mQ
numbers and common road names.
Tvrn le -PT on So-tam/II Creek Go
1,6 rn 'IP$ Turn R,:ghron WcJ,nuT
cove Go, ol rn,'/e Tvnn 1 T G'o
'"I'rle Turn letT on pave way
Wen on letf%
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
Te44 N Ae 9-/3-oti
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

302969
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
CERTIFICATION,, aos0
WELL CONTRACTOR (INDIVIDUAL) NAME (print) x/ N'"1 /T y�
WELL CONTRACTOR COMPANY NAME Cr I^ 1141'19 WP/1 e rt11 r mei
STATE WELL CONSTRUCTION PERMIT/4 ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential fraMunicipal/Public-❑ Industrial ❑ Agricultural.O-.__ ---
Monitoring 0 Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use
PHONE # 479—$H10I
2. WELL LOCATION:
Nearest Town: i3ryS0 n C i 7y County S Lr.IA. i n
Sn 1. a rn l II r. v oe K acne
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: NaTB an:nke
Address Sa u ?pa/ 1 rrtek
(Street
or Route No.)
Qy i sonor cr r1 ale V,C, Zi 713
Cde
cry-in7-q�a
Area code- Phone number
4. DATE DRILLED 9- /fl-o Li
5. TOTAL DEPTH: ab S
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO
7. STATIC WATER LEVEL Below Top of Casing: 40 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING 1S 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): 3o METHOD OF TEST Q i r
10. WATER ZONES (depth): / ys'
1 I. DISINFECTION: Type NT IV Amount A 24
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
Fromf_To SC Ft. 6If Cnr2t PVG
From To Ft.
From To Ft.
13. GROUT: Depth Material
From_ Tom Ft. Cement
From To Ft.
14. SCREEN: Depth Diameter
From To Ft. in.
From To Ft. in.
15. SAND/GRAVEL PACK:
Depth Size Material
Slot Size
in.
in.
From To Ft.
From To Ft.
Topographic/Land setting
❑Ridge ❑Slope ❑Valley ;CFIat
(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 Cr'
rA
LOCATION SKETCH rTI
a cc--,--.
Showdirection and distance in miles from ar%ast j
03
two State Roads or County Roads. Include thEDoad ?9
numberst�and common road names N N3
"f rO M a.,
.font Po . Go 1 of r11?)s
%vrn 1d Ton lye Go riles
Method t h'f- on as-3 Go • o.9 �vl t l CS
PvTa Turn R �
Turn le4T on So.Wr1'i1 creek.
Material hT an
Go L(oyiJnTvrnR.,g
Weinor cove Go , or i rN%1e Turn
1e+T Go - o.1 m,'le TUYn RIighT-
GO TO /op o4 °rive tn/eil on Rt• ha
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.
Mt-2-REV. 07/2001

WELL CONSTRUCTION RECORD
(' Department f Environment and Natural Resources -Division of Water Quality - Groundwater Section
)
North Carolina
- epartmen o r , j/et e q,,,�
WELL CONTRACTOR (IND1YIDDAL)NAME (print) \/
T f.J CERTIFICATION M er(x-s0
WELL CONTRACTOR COMPANY NAME
( rO.1wali f✓411 r./PHONE #eat7n6Cii
STATE WELL CONSTRUCTION PERMITfI
ASSOCIATED WQ PERMIT#
(if applicable)
(if applicable)
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
2. WELL LOCATION:
Nearest Town: �fl'r� cso C i Ty CountyeS L✓O-.'n
Fair a et NA AA 07/3
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: Be T v 0rreiecrle`
Address F&s it; r o Ai
(Street or Route No.)
Br.Ce n C,'ry Ale. 2f7/3
City or Town State Zip Code
(q )- aqs-- //are
Area code- Phone number
4. DATEDRILLED 9 /O-oy
5. TOTAL DEPTH: cure
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO V
7. STATIC WATER LEVEL Below Top of Casing: 3 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): L% METHOD OF TEST Q / r
10. WATER ZONES (depth): ALIS
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
11. DISINFECTION: Type HT fl Amount 0.44
12. CASING: Wall Thickness
or Weight/Ft. Material
Depth Diameter
From 0 To SS Ft. 614
From To Ft.
From To Ft.
13. GROUT: Depth
From_ To AD
sorJi) PVC.
7-urn les-PT on 71f6Go 6.2r►1•les
/orn RragkT• on tA.tT (04 cA.larket
Material Rd . Go To 5Tolo 5.8n Turn Rtgh t
on q)arka Re? Go 1r4'n-i,leS.
TTrn le -PT On ta5 T c�,lo,rK . (rO
to hides 7iirn le#T oh Dr;tie
L)&y We!] on 1e47.
Material
Ft. Gement
a
c CC;
O pvin
r_
nt "Ori
t 0
cp o n
n
Method
Ptvtp;n8
From To Ft.
14. SCREEN: Depth Diameter Slot Size
From To Ft. in. in.
From To Ft. in. in.
15. SAND/GRAVEL PACK:
From
From
Depth
To
To
Ft.
Ft.
Size Material
LOCATION SKETCH y
Show direction and distance in miles from of -last o
two State Roads or County Roads. include thVoad yam.
n mbers and common road names. N
trap
from oimono( Po. Ga F,$ :lets
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
/O—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-1 REV. 07/2001

302968
2. WELL LOCATION:
Nen1e�arestTown: /3ry.Sdn City County SLio i rl
Tdn7ara hike f'5-rates asr71-?
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: 1,.SC.*ro 3e1/
Address +nt,TanA la k p FS /a /t0S
(Street or Route No.)
�ryson cr'Ty MC, as-7I3
City or Town State Zip Code
(xy7)- 7 aa—
Area code- Phone number
4. DATE DRILLED 9— 9— Off
5. TOTAL DEPTH: 7O.i
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO RI
7. STATIC WATER LEVEL Below Top of Casing: /t0 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING 1S / FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordance with ISA NCAC SC .0118.
9. YIELD (gpm): aA' METHOD OF TEST a- t r
10. WATER ZONES (d pth): s
II. DISINFECTION: Type f / T
12. CASING:
Depth Diameter
From_CS__3 _To /3Ft. 6.4-
From To Ft.
From To Ft.
13. GROUT: Depth
From_ To rn1C) 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.
Amount O , c/2l
Wall Thickness
or Weight/Ft. Material
viral PVC
Material Method
rot-Nnf Pvmph!q
16. REMARKS:
Slot Size Material
in.
in.
Material
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
ad.SU
WELL CONTRACTOR (INDIVIDUAL) NAME (print)P T+ i/yeAe CERTIFICATION at
PHONE */ fP9>r) t/7%'sg1-dt
WELL CONTRACTOR COMPANY NAME
WQ PERMIT*/
STATE WELL CONSTRUCTION PERMIT*/ ASSOCIATED(if applicable)
(if applicable)
1. WELL USE (Check Applicable Box): Residential Municipal/Public 0 Industrial ❑ Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
Topographic/Land setting
❑Ridge ❑Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From To Formation Description
CD C-2
Tri
air LOCATION SKETCH m
a
Show direction and distance in miles from atjoast a
two State Roads or County Roads. Include the�pad c Q
n mbers and common road ames. �-'
cn y
_prom c.lnicn Po Ga 7 S'rr les
Tarn %eiT on 7yE 6-0 a?,3
in alE'S Turn Ie4T an 4onTdna
IaKe E6%Tes Go l-I ,6 n- ;les
%vrn lt' I on-un7anu c.'rcle
6-o , o, 2 n-, t'les Turn 164 T on
E! Ks L✓«Tch Go . o. i h-+,'IF's
To Well on T,
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 /71/Ae 9-9-ay
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
Sulptit the original to the givision of Water Quality, Groundwater Section, 1636 Mail Service Center ' RiaVgh, C
27699-1636 Phone No. [phone], within 30 days.

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources` - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) cie%Re/ / yc{e CERTIFICATION11206-2,
WELL CONTRACTOR COMPANY NAME GreA i aai Weil Ars )i:kw
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WO PERMIT#
(if applicable) (if applicable)
PHONE # (p y74-g4 nt
1. 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:
N arestTown: Or, ysan Ci'Ty County r5(.✓�n.,n
jonTana laRP £STare5 ag7/3
(Street Name. Numbers, Community, Subdivision, Lot No.. Zip Code)
3. OWNER: 0eA GU! /Lbeau
Address lonTan4 /n ICA FSTATfS
(Street or Route No.)
Pryson C,'Ty /ibC, 2S'7/3
City or Town State Zip Code
(776)- `//U - d / S3
Area code- Phone number
4. DATE DRILLED 9- a - 0
5. TOTAL DEPTH: 37 .5-
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO W
7. STATIC WATER LEVEL Below Top of Casing: cO 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): / 3_ METHOD OF TEST a; r
10. WATER ZONES (depth): h1 rots
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
11. DISINFECTION: Type NT /-/
12. CASING:
Depth Diameter
From 0 To 99 Ft. 419
From To Ft.
From To Ft.
13. GROUT: Depth Material
From 0 To aO Ft. (_PrvlanT
From To Ft.
14. SCREEN: Depth Diameter
From To Ft. in.
Amount Q .74,
Wall Thickness
or Weight/Ft. Material
sore Pvc
From To Ft. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
Method
Purnp,Y,i1
Slot Size Material
in.
in.
071
o cri
-Tin
c 73
-4 -or"
1 �O
da
rn
a -73
at tyst o 0
than ad a -c
nt7
/ 8'rn;/es
t9
LOCATION SKETCH
Show direction and distance in miles from
two State Roads or County Roads. Include
n mbers and common road names.
From ct.lmuncl Po Go
lurk /6,Pr an 7yE 6o a,3
lvi,'les %vrn /447-an Pon7a.nu
/&Ke Es TAM 5. Go ' ,( rides
Turn R, h7on Rocket' DJv'
v, 4 m,Ye Turn /eh -
on chock% Wafer Gc✓e R(%, Go
oil rn/ /e %, Well on R@hr,
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
`cy",.)f 9—a—a�
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center-Rahaigh,INC
27699-1636 Phone No. [phone], within 30 days. GW-I REYb /2001

Z029"
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
'�--�
CONTRACTOR (INDIVIDUAL) NAME (print) fJ r T /Ck e CERTIFICATION #2
WELL ,s,,�.`
f T%' /i,.YYI W %i Ar'/'%Ii ngi PHONE It (�c.y� l/ 79- S'�/,Cii
WELL CONTRACTOR COMPANY NAME Cr' v
STATE WELL. CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#(if applicable)
(if applicable)
1. WELL USE (Check Applicable Box): Residential la Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION:
N crest Town.� San C, 7" County t.Ja County ,..+ r1
FinnTanA, ha c# fS"Si PS
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: . -It ket B P."7 ; i0.
Address -to,7'7&na %Q ka ESTa % PS
(Street or Route No.)
Bryson r,'try Mc, 2Fr7/3
Crly or Town State Zip Code
(22O- a79- 0162f
Area code- Phone number
4. DATE DRILLED 9- J-o 4
5. TOTAL DEPTH: 36Z3
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO 6d
7. STATIC WATER LEVEL Below Top of Casing: .5-0 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): /0 METHOD OF TEST G. i r
10. WATER ZONES (depth): 30C
11. DISINFECTION: Type
12. CASING:
Depth Diameter
From_ To Jlo Ft. (p
From To Ft.
From To Ft.
13. GROUT; Depth
From o To ra,0 Ft. cerriOf7T
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.
16. REMARKS:
Amount o
Wall Thickness
or Weight/Ft. Material
<nral PVC-
berg
Material
Method
amp, 0
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)
DEPTH DRILLING LOG
From To Formation Description
r— rt ,
r�
0
..� n •—
Q O
LOCATION SKETCH N o
Show direction and distance in miles from at least n
two State Roads or County Roads. Include the road
n mbers and common road names.
rom calrncnA Po. C-o /,&m,')ts
:g
%urn /eJT on 7e/e Go a,a
r
m; les /��,-n on 0177Anot lace
E5Tares Gp .5-,(-1,111;16,5 Thrn
RioghT on 4'onTa.nett Loofo hor7Tj
bra o,3 m,'le Turn) R,othT a/)
co woeririty l",'v2e R,4e Go, O, I
[h" IrS jefrn le4T on To Drtxve Wc1
C'--o To e)-'J• L&fell can R/ghT,
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH I5A NCAC 2C, L LL
OWNE
R
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO
p-F-F ilyeAe ;•` 9-/-69
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

3029"
2. WELL LOCATION:
Nearest Town: I31..iSon r%77 County 5' 1.4 /cx:'n
/OmAS Crept! ag7/
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: Pe Tie Da j-'lrna
Address /And Greek
(Street or Route No.)
J3nSon ciT�, we at7/3
C itY 5
or Town tate Zip Code
(mac)- NS'S — 96-2 7
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and N tur l es urces -,,Di vision of Water Quality - Groundwater Section
eite CERTIFICATION # a�,OS�
WELL CONTRACTOR (INDIVIDUAL) NAME (print) a Xpp
WELL CONTRACTOR COMPANY NAME 62 re.h cam L✓, / / �1L le at. _r1 4
PHONE # 617.79" Ssit
##' 9,
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT
(if applicable)
(if applicable)
1. WELL USE (Check Applicable Box): Residential g Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
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
Area code- Phone number
4. DATE DRILLED 9 —/S- a l
5. TOTAL DEPTH: 7o S
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO W)
7. STATIC WATER LEVEL Below Top of Casing: $ / FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING 1S / 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 A i r
10. WATER ZONES (depth): 621.1
11. DISINFECTION: Type fi r» Amount 0.111
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
From_aL—To 77 FL 64 4t.' PVC -
From To Ft.
From To Ft.
13. GROUT: Depth
From O To a O
Material
FL C Ea nenT
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:
G
rn
-o a
9
3
LOCATION SKETCH Err a�
i
Show direction and distance in miles from at le
two State Roads or County Roads. Include the road
n tubers and common wad names.
-From alpiend Po Go t4'n s'les Then
/eJ(ttron 7y6&o 0,a m;/es Tvrn
Method 0RrG1L Pot /) a! r'T 67 Bryson e,7y
(-vm/)', o Goro s7 f S.o9f Turn ie4Ton Vern.,
i3/vv6-o m 5Topl iihTTonn R►91T
&o T Oex" 1, he Turn l e T Co To
-Porlro-nek Rd, Go 2,3 In,'les Turn
R1.,9,1fir on /0.41creek Rh(,-o %,5
Pi %les Turn Ro(hT on Snell ilne 6 o
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH I5A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
SIGNATURE OF PERSON' CONSTRUCTING THE WELL DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
GW-1 REV.07/2001
27699-1636 Phone No. [phone], within 30 days.

3029"70
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural - Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) Te >% CERTIFICATION ft ROO
WELL CONTRACTOR COMPANY NAME Gr z ha m L./ell rlll )YlA PHONE o f 7e1-SYSH
STATE WELL CONSTRUCTION PERMITS/ ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
I. 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 LOCATION:
Nearest Town: Rry to n C / Ty County StJa . n
SeW»n»I creek a97/3
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: -0.24-tn Eller
Address Se,w rn;lI Greek
(Street or Route No.)
liy Son Cr r/ N• L o`�,Ss7
City or Town State Zip Code
(82I)- URS-- �9 al
Area code- Phone number
4. DATE DRILLED 9—/3-0
5. TOTAL DEPTH: ea Yr0
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO
7. STATIC WATER LEVEL Below Top of Casing: go FT.
(Use "+" if Above Top ofCasing)
8. TOP OF CASING IS I 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): q METHOD OF TEST &.'r
10. WATER ZONES (depth): Z00
11. DISINFECTION: Type $ 7 N Amount A. 36
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
From_ -To /00 Ft. 6.4 Stlra.l net
From To Ft.
From To Ft.
13. GROUT: Depth
From o To a 0
From To Ft.
14. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in.
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Size Material
Method
m
Material
Ft. term n'T
From To Ft.
From To Ft.
16. REMARKS:
Topographic/Land setting
DRidge ❑Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From To Formation Description
O c^
• "es,"
• rev
• vaG
-o
CO
• 0'
Min
3 Tr
LOCATION SKETCH
no
Show direction and distance in miles from at Vst
two State Roads or County Roads. Include thq.cpad 1c
numbers and common road names. C �'
from o-Imonat PO Go l.9- m; les. Turn
/e7�T on 79E Go as m; /eS.
Turn RIghT on fd9s Go. 0,9 m,'leS
Turn le- T on So.wm,'N Greek Go
/,6 fln /Ps trn Ig4hron WeJtrluT
cove Go, o,l m:le Turin le)T G'O
0,i ni,l$ Turn 1e-J'7 on Dave way
Well on /e_it T.
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
llye e 9-/3-04
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-1 REV. 07/2001

302969
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section �i,
p
WELL CONTRACTOR (INDIVIDUAL) NAME (print) �N7^fr I`rP) Y� CERTIFICATION # Z0ur0
WELL CONTRACTOR COMPANY NAME Grahrlm Weil rit,rtllrYl C/ PHONE kV 74'$42%
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT('
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential 14 Municipal/Public ❑ Industrial ❑ Agricultural ❑
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use
2. WELL LOCATION:
Nearest Town: R ry sa n C ; 7y County S 1..10. i n
Seiwrit:l) rytoe, K ac713
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: NaTe 13n;nke
Address Saw nut)) rrPtoi(
(Street
or Route No.) t�
3 n cr r$ta NFL, ZD5d7)3
City o�
Area code- Phone number
4. DATE DRILLED q- /3-0 q
5. TOTAL DEPTH: ae s
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO El
7. STATIC WATER LEVEL Below Top of Casing: 60 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS l FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordance with ISA NCAC 2C .0118.
9. YIELD (gpm): 3o METHOD OF TEST C.: r
10. WATER ZONES (depth): l y�
1 I. DISINFECTION: Type li i li
12. CASING:
Depth Diameter
From_._ To .SS Ft. 6 if
From To Ft.
From To Ft.
13. GROUT: Depth
From 6 To A.40
From To
14. SCREEN: Depth
From To Ft. in.
From To Ft. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
Amount t .2(/
Wall Thickness
or Weight/Ft. Material
Cnr21 PAL
Material Method
FL ce mewl" PU}rrp:40
Ft. O
Diameter 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
CD Grn
-r\rn
n
b0
s p`
fA --40
LOCATION SKETCH rnol
so no -
Show direction and distance in miles from ad6ast --A
two State Roads or County Roads. Include tli oad L0
numbers and common road names. �itv , it o
-Prom oirnond PO.6o liOANrI.
Turn /e) T o n vie Go a s &Ines
Turn Ri811T on a.F- Go, o.9 j-n,'lrs
Turn 16Ton Said n%Il Gree lc,
Go 1,6 w)t'les Trn R:tghtan
I,✓A.1nur cove Go . o, t pi%le Turn
let T Go . o.1 m'1e Turn R1 hT
GO To Tof 07 Orive Welt on R1
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
9-/3-ay
Alynt
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-1 REV. 07/2001

2. WELL LOCATION:
Nearest Town: 13�r� (sop C e 5i CountyeS Wa4 n
En„ac r a etNA AA ,95 7 /3
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: prof 0rTnepri
Address gAT'C��a-Pko „A
(Street or Route No.)
BrVA/70 Cry 11/e, 2Y-7/3
City or Town State Zip Code
(q_2x)- aqk- /I3G.
Area code- Phone number
4. DATE DRILLED 9- /a -a y
5. TOTAL DEPTH:aEr0
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO X
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resrourcesj-fry�iviston of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) c% T /sync e/ CERTIFICATION # .3�O
WELL CONTRACTOR COMPANY NAME (Trroy M OP 11 4 r4!is"Ni3 PHONE # F'Sh49' PM"
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable)
(if applicable)
1. WELL USE (Check Applicable Box): Residential IN Municipal/Public ❑ Industrial 0 Agricultural 0
Monitoring 0 Recovery D Heat Pump Water Injection 0 Other 0 If Other, List Use
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
7. STATIC WATER LEVEL Below Top of Casing: 3'S FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS / FT. Above Land Surface'
*Top of casing terminated ator below land surface requires a
variance in accordance with ISA NCAC 2C .0118.
9. YIELD (gpm): a METHOD OF TEST a t r
10. WATER ZONES (depth): :iris
11. DISINFECTION: Type
12. CASING:
HTH
Depth/ Diameter
O
From 0 To � Ft. 6.14
From To Ft.
From To Ft.
13. GROUT: Depth
From n To OD
Amount O . M 4
Wall Thickness
or Weight/Ft. Material
sar i PVC.
MaterialFt. GPmPH%
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
Pumcfnq
Slot Size
in.
in.
O c r'
.c_ _viC3
O f„n
n ;.0r
-4-oo
1 %U
tp oo
LOCATION SKETCH v
Show direction and distance in miles from af�east o
two State Roads or County Roads. Include tI oad 3.
n tubers and common road names. Nfr
from o.)mend Po. GO Fri n/c
%urn /c4T on 7gEG0 6,ahi.')es
%ern RtghT• an ek,tr (oit a.larkq
Material RA • 6-o To STOP 5,an Turn Ri 'h T
On c lavka, RJ,. Go 1,ii-w,'l es.
Trn le -PT on ta5 T a.Io-rKa. 6-0
I'( hides Torn le T ort Drive
Material
t`'&y toe 11 on le -PT.
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
TiQ rt /'f yGle
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mali Service Center -Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-I REV. 07/2001

302968
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural R'sources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print)(p�ITpt /Vyl�11 e CERTIFICATION #& CO
WELL CONTRACTOR COMPANY NAME Gratiha l'r/ Wen elk airily PHONE (99£B477/— C4
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WO PERMIT#
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential 6a Municipal/Public ❑ Industrial ❑ Agricultural ❑
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use
2. WELL LOCATION:
Nnkearest Town: /3ry Sort G'Ty County S WO. i'n
T61-L7opo. Lake FS a-Tekc
. (Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: Son-i Jae
Address-tntiresnA. /ake
(Street or Route No.)
Rrysan ciTy Mc, air7/.3
City or Town State
(5147)- 7aa- S,So &
Area code- Phone number
4. DATE DRILLED p- 9- o `I
5. TOTAL DEPTH: 70.5
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO 51
7. STATIC WATER LEVEL Below Top of Casing: /St'O FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS / FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordance with ISA NCAC 1C .0118.
9. YIELD (gpm): %' METHOD OF TEST f A t r
10. WATER ZONES ( epth): 6 `a.S
FSTaTes
Zip Code
11. DISINFECTION: Type /1 Y N Amount O . c/N
12. CASING: - Wall Thickness
Depth Diameter or Weight/Ft. Material
From 4 To 133 Ft. S4ral pVC
From To Ft.
From To Ft.
13. GROUT: Depth Material Method
From O To ao Ft. (prnrnT Pvmpr'ny
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.
16. REMARKS:
Size
Material
Topographic/Land setting
❑Ridge ❑Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From To Formation Description
LOCATION SKETCH
0 Gin
...C.;,m
s `1
1 O
a �o
rrti l
Show direction and distance in miles from atJsest
two State Roads or County Roads. Include thatad c o
-Ftubers and common road 'tames.
rom cd monc f PO Go S- rs ,/
Tvrn 1e4'T on lye G-o 9.,3
Yht'les Torn 1e4'T on 4onTana
lake ESTa es Go l-1 ,ni ; les
Turn le?Ton4-on%anct Cttrc/e
LS9 , o,2 mt'les Turn 114'T oA
E./Ks 1,✓aTch Go. 0.1 Y'-1,7&s
To Well can 1F T,
I DO HERE)3Y 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
SIGNATUREZr
PEN CONSTRUCTING THE WELL T e
Sua(nit the original to the Qiv)eion of Water Quality, Groundwater Section, 1636 Mail Service Cenler-ijalpigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-1 REV. 07/2001

02n4
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources�- Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) red% / ALAI' CERTIFICATIONS/20S,
WELL CONTRACTOR COMPANY NAME 6 rCa hn..m I.JN ./ I rlrr I1 t,L79 PHONE # na 4#741—$4/cy
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
I. WELL USE (Check Applicable Box): Residential ® Municipal/Public ❑ Industrial ❑ Agricultural 0
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use
2. WELL LOCATION:
N arestTown: IQT SUn CiTy County e54✓rti.rn
- orlrana lake £STares a97/3
(Street Name. Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: ;red, Gu,/(7eaU
Address .l*onTanq In ire FSTea TIS
(Street or Route No.)
/3rySaft Ci'Ty /VIC. £if7/3
City or Town State Zip Code
(77a)- 9/0— a1S3
Area code- Phone number
4. DATE DRILLED 9-2-04-1
5. TOTAL DEPTH: Sn C
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO
7. STATIC WATER LEVEL Below Top of Casing: Go 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): JD_ METHOD OF TEST a , r
10. WATER ZONES (depth): L/ 2s
11. DISINFECTION: Type HT tl Amount
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
From 0 To 99 Ft. (o J9 $or u PUG
From To Ft.
From To Ft.
13. GROUT: Depth Material
From 0 To 2U Ft. GE'WIPp7
From To Ft.
a•�G
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
v
o CM
CD fi--
730.4 O01
t 00
CD �o
crt
LOCATION SKETCH - nib
Show direction and distance in miles front at tg S1 `3
two State Roads or County Roads. Include the toad a'
numbers and common road names. r,0
4co
roro ct.l m.Jr
orcl Po -0 /, ii ThY/es
7'rn /pfr a n 79 E 9-O a, 3
Method
PUwtp,ne ln,'les Turn le7er en 4'onTank
/oJQ E5TATeS. Go Lf% /fl '/CS
'rn /, h1 on Rock9y (3J{v71'P
Ra. 62'o . v,G m,Ye Tfirn 11/en-
an c/ePr'WaTtorCo✓e Ra.•�o
oil nr,Ye 7? well on R41177.
14. SCREEN: Depth Diameter Slot Size
From To Ft. in. in.
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
Material
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
1Jil 9-g- a N
SIGNATURE OF PER yON 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
R/esources- Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) � P$ if/de CERTIFICATION # 2oS )
WELL CONTRACTOR COMPANY NAME f TFaAo.,M Wet! cknrI/119 PHONE #(P Sin -
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 ❑ Heat Pump Water Injection 0 Other ❑ If Other, List Use
2. WELL LOCATION:
N crest Town: San Cr County S L✓0. t'n
-rnnTa.no, lo. FSra s 25.71,3
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: `Turn I3 E7 //a
Address ��n•Tana la kg c STare 5
(Street or Route No.)
J3 ryso n c»ry N, c, 2cc713
(220-- 379- O1&(
Area code- Phone number
4. DATE DRILLED 9-i—o
5. TOTAL DEPTH: 3SS
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO Od
7. STATIC WATER LEVEL Below Top of Casing: 5-0 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 .0118.
9. YIELD (gpm): /0 METHOD OF TEST CA i r
10. WATER ZONES (depth): 30C
z 2l3
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
C y or Town State Zip Code
11. DISINFECTION: Type %I 7 N Amount O. SY
12. CASING:
Depth
From_ To %4, Ft.
From To Ft.
From To Ft.
13. GROUT: Depth Material
From n To go Ft. GPMen7
Diameter
6'f1
Wall Thickness
or Weight/Ft. Material
Snr21 Pvc-
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.
16. REMARKS:
73L
T
F T
,- cp
LOCATION SKETCH N �p
Show direction and distance in miles from at least cl
two State Roads or County Roads. Include the road -
npYmbers and common road names.
Prom calm{�
onc PO. Go 1,gm,'les
%urn le-1'T on 7yc Go a.3
mill es jurn on tonTgnet 1o.Ke
E5TATes Gp 6,9,13i;les Turn
Slot Size Material p
in. R,c,qhT on 4'onTam Ioo10 nor?-4
in. Q
uI's/Oeriney Pine R;A, Go , I
Theirs 72-rn 1404'Ton7a Airt've, r,
Gd To enck • Well c)n R1�ghT 1
Method
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
ilyeA
SIGNATURE PERSON CONSTRUCTING THE WELL DATE / - /-C y
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

cq
3042175
North Carolina - Department of Environment and Natural e
WELL CONTRACTOR (INDIVIDUAL) NAME (print)
WELL CONTRACTOR COMPANY NAME ! a IRCIJIn /✓I
STATE WELL CONSTRUCTION PERMIT#
(if applicable)
1. WELL USE (Check Applicable Box): Residential IN Municipal/Public ❑ Industrial ❑ Agricultural ❑
WELL CONSTRUCTION RECORD
e ources - D� on of Water Quality - Groundwater Section
�—,,
/A7/ CERTIFICATION #V
! Pi'/Ir PHONE #
ea rl2 74 S�Fsti
ASSOCIATED WQ PERMIT#
(if applicable)
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use
2. WELL LOCATION:
Nearest Town:Rry.<nn Ge'Ty
PIOPT Ta1,or
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: j'Y)n rk Regi\-nir
Address /nar2'r Tati�r'
(Street or Route No.)
rJ ;Ty MC, 2,Cr7>3
t�rC City
oTown rState Zip Code
ity or
(foa)- .5.34 s: ` 0 3
County 8' We t ri
Area code- Phone number
4. DATE DRILLED /h —/—!1 N
5. TOTAL DEPTH: SCS
6. DOES WELL REPLACE EXISTING WELL? YES NO
7. STATIC WATER LEVEL Below Top of Casing: iFf0 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): 1 METHOD OF TEST c C
10. WATER ZONES (depth): -3 7<
11. DISINFECTION: Type /d T N
12. CASING:
Depth Diameter
From 0 To 9Q Ft. 6,16
From To Ft.
From To Ft.
13. GROUT: Depth Material
From (3 To 20 Ft. r,mPnT
From To Ft.
14. SCREEN: Depth Diameter
From To Ft. in.
From To Ft. in.
15. SAND/GRAVEL PACK:
Depth Size Material
Topographic/Land setting
DRidge ❑Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds) '1'
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From To Formation Description - -
Amount O.G7
Wall Thickness
or Weight/Ft. Material
:Or2L Pvc
rR
:0 a�co
.'�
0n
LO rnL'=
(Y
LOCATION SKETCH
Show direction and distance in miles from at leas
two State Roads or County Roads. Include the road
numbers and common road names.
roNl Gt%/nonet 100. Go l,S l't'/es
%vrn R, h r 0 n U5 /9 Go //-'-/
Method r )
Pvn-11vr'4 %rl /rs %vrn /C'] T on C Jc tat,.
Slot Size Material
in.
in.
From To Ft.
From To Ft.
Roaa< Gr-0 S,& ii.'ler fern /cr':kJ
On Mount' %atber Go, /,/7it7e
/0 &hi l I on /e T,
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
c-7" -P hiyAB /-44/
SIGNATURE OF PERSQN 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
/(p�rint) tJPTY- y P CERTIFICATION if 0-Q<o
WELL CONTRACTOR COMPANY NAME (rc hlI.N) Well art Il, )'( PHONE # Si
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential Igl 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: flr .nnn C etTy County Sidra i I I
ZnhnSDIr LSrr.nch Q27l
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: ajjal.17
Address hnSnn brnrr
(Street or Route No.)
Rryson r'cry A/C.
Coy or Town State
om- e—/ei/2
Area code- Phone number
4. DATE DRILLED /o-e'ny
5. TOTAL DEPTH: 3n_<
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO W
7. STATIC WATER LEVEL Below Top of Casing: aCJO 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): j1 METHOD OF TEST Gu r
10. WATER ZONES (depth):
,2Ff7I —i
Zip Code
304276
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
11. DISINFECTION: Type %7I Tire Amount R .I$
12. CASING: - Wall Thickness
Depth Diameter or Weight/Ft. Material
From 6 To'9/ Ft.64 snrai PVC
From To Ft.
From To Ft.
13. GROUT: Depth Material Method
From b To 2. Ft. CPtrINnj ripify
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:
t%e�
LOCATION SKETCH t
Show direction and distance in miles from at leant'
two State Roads or County Roads. Include the road
n tubers and common road names.
*rori'► aline n61 Po 61a !srvYes %Urn
/e Ton 79E6.o /o,-3 »-,des,
.hrn R;c9hT %T o? j/yaT% Creeok
Go To STop SIC9h nirn lk-ti
hide Turn /dr-on L✓ailkvr wvcoke
6-o i, r., 2-y !PS Torn Rissihro n G--0 VeP•hi
Ssro:nJ Roe- , (0 , 0,3 by. it's Tvrvl
le -PT on Uatinson bro.nch Go, o.9114,1/es
6Ur
o c'
1 DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND --Sec TH�tATrA COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
+ I 0 /t* -61/
SIGNATURE OF PERSON CONSTRUCTTNGTHW 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
NOV 2 9 2004
:.7
r.
c'�

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and
WELL CONTRACTOR (INDIVIDUAL) NAME (print)
Grail
WELL CONTRACTOR COMPANY NAME
STATE WELL CONSTRUCTION PERMIT#
(if applicable)
1. WELL USE (Check Applicable Box): Residential ? Municipal/Public 0 Industrial 0 Agricultural ❑;
304277
Natural Resources�%- ivision of Water Quality - Groundwater Section
rT,c � ?y7 CERTIFICATION # 11S-0
4,. WI well C1V at) on., PHONE # f1/4$)t(79•WS'(
ASSOCIATED WQ PERMIT#
(if applicable)
Monitoring 0 Recovery 0 Heat Pump Water Injection ❑ Other 0 if Other, List Use
2. WELL LOCATION:
Nearest Town: /3ry.caln G: T�/ County S'L✓o-i"n
,Te-ksn n /, nee, / 2*7/3
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: Ro.Ymo;Jt Or ha.r
Address trio ck.san Jine
(Street or Route No.)
/3rySon Cri`S
y NC. ,fi7/3
City or Town State Zip Code
(2.Zss)-q s--3.27/
Area code- Phone number
4. DATE DRILLED /6-7-e'l
5. TOTAL DEPTH: /A .0
6. DOES WELL REPLACE EXISTING WELD YES 0 NO IR
7. STATIC WATER LEVEL Below Top of Casing: 446 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): j 0 METHOD OF TEST O r
10. WATER ZONES (depth):
11. DISINFECTION: Type
12. CASING:
Depth
From Q To to l
From To Ft.
From To Ft.
13. GROUT: Depth
From /5 To ad
,v Amount tl.//
Wall Thickness
Diameter or Weight/Ft. Material
Ft. (, y coral Pte.
Material
Ft. Cpmpn7-
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:
Topographic/Land setting.
❑Ridge 0Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
[v
t_o
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic-map-.`
(check box)
DEPTH DRILLING LOG --
From To Formation Description
J
G_
ro
LOCATION SKETCH s" c' '
Show direction and distance in miles from at least'
two State Roads or County Roads. Include the road
tethers and common road names.
- ran CAA Vrlo)1 a Pa 6-0 l S ni rihos Terri
/gr on 79E6-6 S,o2 Yrl,'les io
Method GJeir k0, -(."7 TOY Go % Slap S g n
Pumichv
-7-urn l0.Pi Ea across over Pc&ss
Slot Size Material
in.
in.
Size Material
%o STap S c 9 n %urn Rr i7T on N&iy
/7 GO l,9 Miles 7-Len !e r GO
oil yr2;1a Turn JetT G-o Ta A'rS
Drive on lePT 7o LJeII,
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
y�,(^y, O -7-0 tf
SIGNATURE OF PERS 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

304278
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resource Division of Water Quality - Groundwater
Section
!ft/y P
WELL CONTRACTOR (INDIVIDUAL) NAME (print) LT t /f t�l , PHONE # (P.?514'79/yy��i
WELL CONTRACTOR COMPANY NAME tT rrLkts. WI (JF'�I fir:it/no
ASSOCIATED WQ PERMIT#
STATE WELL CONSTRUCTION PERMIT# (if applicable)
(if applicable)
1. WELL USE (Check Applicable Box): Residential W 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:nr)/Snn Ccry County StJQ1n
/vl:Ara/ sprintp Q.r7/3
(Street Name, Numbers, CMT6munity, Subdivision, Lot No., Zip Code)
3. OWNER: :1itti n Qowmos
Address
(Street or Route .) �iY%
t7 S,sn r;'iv Mr•
n or Town mte Zip Code
(g29)-r7*f-• -c! %'H
Area code- Phone number
4. DATE DRILLED /0-7'—O 4
5. TOTAL DEPTH: : *0
6. DOES WELL REPLACE EXISTING WELL7 YES ❑ NO I$
7. STATIC WATER LEVEL Below Top of Casing: 7 S FT.
(use "+" if Above Top of Casing)
8. TOP OF CASING IS / FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordance with IS NCAC 2C .0118.
D OF TEST a.; f
9. YIELD (gpm):
10. WATER ZONES (epth): Pf {
11. DISINFECTION: Type # 7-if
12. CASING:
Depth
From V To 512
From To
From To
13. GROUT: Depth
From O To a.0
From To
14. SCREEN: Depth
From To
From To
15. SAND/GRAVEL PACK:
Depth
To
To
From Ft.
From 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
TP A /4)/Si H /0-7 -0 y
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Ceenterl REVgR.h, NC
27699-1636 Phone No. [phone], within 30 days.
Diameter
Ft.h
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
Amount 0, 34
Wall Thickness
or Weight/Ft. Material
$nrnll Pvc
Material Method
Ft. (eynPn? Pump,'f 6.,s'»1?to -%r/rn /e4T on hieder �kv
Ft. lc°�Ton !'nrYlY`F1
Diameter Slot Size Material ire ,l ` It/e,s .T��pn
Ft. in. in. "7
Ft. in. in. Sprt'it9 '0 /tl miles [urn jP T on
greasy bro.nch 6-di a,l r%/P To tJe/l
enleT
tCa
w
r.71
-- ;:c
s C„....,
rr,.
.r,. C'.:j
cn;.5
tP c'
Size Material
LOCATION SKETCH
Show direction and distance in miles from at (east
two State Roads or County Roads. Include the road
n kmbers and common road names.
-From 0,114041 Pc Go l-g'm' d es /urn
/e r On 7/915 Carp 3.7 in,jes Torn
%t°tT or eolok SPP noY Rt1Cro
0
CO
0

304203
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resourcess-- Division of
Water Quality - Groundwater Section
WELL ('ON7RACTOR (INDIVIDUAL) P
NAM/+E (print) � r• (+t• `1 /f t st n t 1 1I CERTIFICATION # 33 41
WEI.L('ONTRA('TOR COMPANY NAME(;rrr nr. lrf:�4���:... 4`u rip ,'&M-t" - PRONE # (2'RJpy 8_-317b
STATE WELL CONSTRUCTION PERMIT# i -b S
(if applicable)
ASSOCIATED WC) PERMIT#
(if applicable)
1. WELL USE (Check Applicable 13ox): Residential tit. Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Fleat Pump Water Injection 0 Other 0 If Other, List Use
2_ WELL. LOCATION: (` 4
w
Ntjirr;titt Town: e) t so-vv CI �+.t County as
Fla bn.
11DU ll1'II —Rd
Name, Numbers, C'omrn u n ity, Subdivision, Lot No., hp Code)
:, OWNER: I Ins r,il �F Tess.. L3rl'c'k4
Address Q—t7est
(� ( Street r Route No.)
to sr -TT (� NI C a 8 7 1 3
City or own Stale hp Code
( )-
Aura rode, Phone number
4. DATE DRILLED 10--J -b
5. TOTAL DEPTH: 4/ OS'
I )Oti U;I.I 1 RI:OI ACE I: YIV I !NC AAII_l, 17 VNO
7. STATIC WATER LEVEL Below Top of Casing: I D FT.
I use "+" if Above Top of Casing)
8. 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): (I) Q METHOD OFTEy c% hr5
10. WATER ZONES (depth): (ASr - I/a 9prr-1
8S - I gprrm
II. DISINFECTION: Type -HTH Amouhe q 4 4-61#.
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
From To 3b Et. / PVC'
From To Ft.
From To Ft,
13. GROUT: Depth Material Method
From b To .2O Ft. 1 tris
From To Ft.
14. SCREEN: Depth Diameter Slot Size Material
From To Ft, in. in.
From To Ft. in, in.
I . SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Et.
16. REMARKS:
Topographic/Land setting
❑Ridge Slope ❑Valley ❑Flat
(cheek appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DRILLING LOG
To Formation Description
. n -
DEPTH
From
0 3D'
ybf'
3bI
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.
© CC?
L
-T ri—
0
..v.„0ti
1 DO I IEREBY CERTIFY TIIAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND TIIAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
Led d
SIGNATURE OF PERSON CONSTRUCTING THE WELL
/0 - 3/ -6 V
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

9354s
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Loral Resources - Divisionief Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (ptiatl jagn#e 9Alf CERTIFICATION 0 -Li 77
WELL CONTRACTOR COMPANY NAME$ta,C WR rr 11J'el/ 4 par?jnc PHONE # 64 hQ '-oy80
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box)• Residential VMunicipal/Public 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WFT I LOCATI N: f
Nearest Town: d 10 C 1 County N
NairI3 r�Af14 ti $1;
(Street Name,
LNumbers, Commtmity, Subdiwioo, Lot No., Zqi Code)
3. OWNER: it Ar&M get ion
Address / y o D tepfecez rote k id
13e./son eIH NC 25713
Ctr or Town S 21p Code
Topo c/Land setting
°Ridge lope °Valley °Flat
(cloak epprwtiate box)
Latitude/longitude of well location
(degreedm'mutm/aemods)
Latitude/longitude source:OGPS°Topographic map
(check box)
DRILLING LOG
Formation Description
DEPTH
From To
Area code- Phone number �I.�
4. DATE DRILLED dJ' 23 - O
5. TOTAL DEPTH: / W $/
6. DOES WELL REPLACE EXISTING WELL? YEW", NO Eff
7. STATIC WATER LEVEL Below Top of Casing: FT.
(Usc '4" if Above Top of Casing)
8. TOP OF CASING IS / . LJ Fr. Above Land Surface'
'Top of casing terminated at/er below land surface requires a
vartaace In accordance with ISA NCAC 2C .0I18. —,
9. YIELD (gpm): 30 METHOD OF TEST timed
10. WATER ZONES (depth): fi 0
11. DISINFECTION: Type C..f/. /)<.
12. CASING:
Amount /0 02
Wall Thickness
nt � Depth DiluterDiluters Weight/Ft ' Material
Fro 5� Ft, le, a zug—" put
From_____ To Ft.
From To Ft.
13. GROUT: Depth Material
From Q To Z0 Ft COno/e/Y wP. /Il/5l
From To Ft.
14. SCREEN: Depth Diameter
Fro To Ft. in.
Fro To Ft. in
15. SAND/G VEL PACK
Depth
/ To Ft.
(/ To Ft.
From
From
16. REMARKS:
Slot Size Material
in.
in.
Size Material
LOCATION SKETCH
Show direction and distance in miles from at 1
two State Roads or County Include the
numbers and common road i •. s.
lab
3 _
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A N - WELL
CONS TIjSJ TION STANDD�A�RDDS,
L�AND THAT ty�OPY of T#IIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
%� �' "/ 2 SIGNATURE OF PERSON CONSTRUCTING THE WELL
wAl ket
9y
DATE
r
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-1 REV. 07/2001

o s 4
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
CERTIFICATION # 2045
WELL CONTRACTOR (INDIVIDUAL) NAME (prtot) James B. Brown
WELL CONTRACTOR COMPANY NAME Haddon Brothers Well Drilling, Inc
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
PHONE # [phone]
1. WELL USE (Check Applicable Box): Residential El Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring ❑ Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
(
cet Name,
3. OWNER:
Address
Co
my
ty, Subdivision, Lot No., Zip Code)
31 ion kcrxl_£ We
„ /Street �)rRoute CdWf/9
(ZL2 it ycga7\ 3d! 7
Area code- Phone number
4. DATE DRILLED
5. TOTAL DEPTH: yy
6. DOES WELL REPLACE XISTING WELL? YES 0 NO lam
7. STATIC WATER LEVEL Below Top of Casing: 560 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 sccordangAwith 15A NCAC 2C .0118.
9. YIELD (gpm): r! MjT1jQD QFIESTBLOW
10. WATER ZONES (depth): // _ :
Zip Coda
11. DISINFECTION: Type H T H
12. CASING:
Dept Di ever
FromTo Ft.
Fro To Ft._40.,
From To Ft
13. GROUT: Depth
From D To 20 Ft.
From To Ft.
14. SCREEN: Depth Diameter
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 0Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:[GPS°Topographic map
(check box)
DEPTH DRILLING LOG
From i + ' Formation Description
clay & sand
granite
LOCATION SKETCH
Amount 1802 Show direction and distance in miles from at least
Wall Thickness two State Roads or County Roads. Include the road
or Weight/Ft. atenal numbers and common road names.
. 1as r a><p
YC
Material Method
benonite & cement pumped
Slot Size Material
16. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION ST¢NIDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
/or-/2 -o V
SIGN KT(TRE 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

O
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 Hedden Brothers Well Drilling, Inc PRONE # 1828) 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 LOCATION:a,
Neares Town: if )ifigt`e
?IOANS QD
County a ei..1rr/(1)
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: r"1' QjJd1'
Address •Tif 7own
o�Jwits
it or xoutCjoJ "587,,9
Zip Code
ity or q e
cl�'-y
Area code- Phone number
4. DATE DRILLED
5. TOTAL DEPTH:
6. DOES WELL REPLACE E ISTING WELL? YES OpaNO L�
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 accordance th 15A NCAC 2C .0118.
9. YIELD (gpm): METHOD;O1T0 BLOW10. WATER ZONES (depth): n jar
11. DISINFECTION: Type H T H
12. CASING:
Depth/ el
From D To LP Ft.
Amount 16oz
Wall Thickness
Dite»r or Weight/Ft. rial
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.
Topographic/Land setting
ORidge 0Slope OValley OFIat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:OGPSOTopographic map
(check box)
DEPTH DRILLING LOG
From 'Eo 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:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDAIgD$, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
/0 —75-—O 5(
SIGNATURE lldF 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"6O
A

303680
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) -an s B. Brown CERTIFICATION # 2045
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 ® 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
Nearest own:
County .._
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER:
Addre
Street a Rou;
City Town/737
Area code- Phone number
4. DATE DRILLED IA VP Lai
5. TOTAL DEPTH: 500
6. DOES WELL REPLACE EXISTING WELL? YES fNO 4
7. STATIC WATER LEVEL Below Top of Casing: /U
(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 accordant h I5A NCAC 2C .0118.
9. YIELD (gpm): TROD RRFry TyE,ST BLOB_
10. WATER ZONES (depth): (p $ r NW"� fTt
d8773
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)
DRILLING LOG
FrgZrt �o t Formation Description
clay & sand
granite
DEPTH
11. DISINFECTION: Type H T H
12. CASING:
Depth() DliaTeter
From (J To d3 Ft. CP
From To Ft.
From To Ft.
Amount 16oz
Wall Thickness
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
o; eetgt/Ft. Materiaa numbers and common road names.
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.
Method
pumped
Slot Size Material
in.
in
16. REMARKS:
I DO HEREBY CERTIF --HAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION ARDS, AND THAT 9,COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
/O -(1-o °L
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. \VELL LOCATIO
Nearest Town:
(Street Name, Nu
3. OWNER:
Address
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources -/Division of Water Quality
WELL CONTRACTOR (INDIVIDUAL) NAME (print) `
�jras li�
ASSOCIAT ED VVQ PERMIT _
(if applicable)
STATE WELL CONSTRUCTION PERMIT#
(if applicable)
WELL USE (Check Applicable Box): Residential Municipal'Public ❑ Industrial ❑ Agricultural ❑ 9 0 9 4 3 8
- Groundwater Section �>
CERTIFICATION: �id
PHONE R (SS5-0
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use
Topographic/Land sating
❑Ridge DSlope ❑\'alley plat
Community, Subdisisiut
(Seca: or Rou No.)
r\ l2
Coy otfTown State
( 1- (7S$ -2L5
Area COda- Phone number D. /
T. DATE DRILLED ? "i` a
5. TOTAL DEPTH: 52 O
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO X.
7. STATIC WATER LEVEL Below Top of Casing:
SD FT.
(Use "-" i' Aboce Top of Casing)
S. TOP OF CASING IS I FT. Above Land Surface'
*Top or casing terminated ut'ur belo„ land surface requires u
trance in accordanc Rh is.A NCAC 2C .011S. /� '
9. YIELD(gpen): METHOD OFTEST`?
c610. \\' JER ZONES (depth): 3t 2 St 0
��/ r{ 7S
o� I. DI�;�\FECTION: Type I' '! "/'f Amount eld,Co Z.
51¢ _ C' Wall I Thickness
.
=v. r7.. Depth Di_:nexr or Wz_❑:.'Ft. \;ax:i ::
To. _ FL& 5D/?Z/ PVC
Count%
eta (check appropriate box)
Latitude/longitude of well location
us La
'a Fro
occ Fror.l To Ft.
wa' Frokr To Ft
>smO
4a. GP.E : Depth
`,-: Fro,ra 0 To 3 Ft.
==a Fran? To 2- U Et.
I-1. SCREEN: Depth Diameter
From To Ft. in.
From To Ft. in.
15. SAND GRAVEL PACK:
Depth
Size
From: To Ft.
•From.-, To Ft.
Zip Cod::
t
Method
• FA" —be
Sao; size DI_, t... , /,J
in.
(degrees minuteiisecoeds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From To Formation Description
D -53
VO
a /o— ,?S«
o94'2- 4/7/-
4175- 4/7.S
y75_ sz,o
LOCATION SKETCH
Show direction and'dis:ance in mils from at leas:
two State Roads or County Roads. Include the road
numbers and common road names.
NIateria:
16. REM ARKS:
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 SHE WELL`O OWNER
SIGNATURE OF PERSON CONS CTI\G THE WELL DATE
Submit the original to the Division of \\ater Quality, Grounds titer Section, 163o Mail Senice Center RE t © , �I
2 699-163o Phone No. (919) 733-3'21, within 30 days. 0—

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
CERTIFICATION
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 ® Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
zovol
2. WELL LOCAT
Neares Town:
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code
3. OWNER:
Address / ""^ '
1/d/1 Street orRou jNo.) jei wq
• • zi Code/
cg�4749T inI83k Cs of
Areacode- Phone number ^ n i
4. 7 DATE DRILLED fl /�,/+fyj��
5. TOTAL DEPTH:
6. DOES WELL REPLACE EXISTING WELL? YES NO A
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 accordan tth ISA NCAC 2C .0118.
9. YIELD (gpm): METHOD OF TEST BLOW
10. WATER ZONES depth):
Topographic/Land setting
❑Ridge DSlope OValley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:OGPSDTopographic map
(check box)
DEPTH DRILLING LOG
From 7'A s Formation Description
clay 8 sand
granite
11. DISINFECTION: Type H T H
12. CASING:
Depth Diameter
From Q To cif / Ft. G
From To Ft.
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 Size
From To Ft.
From To Ft.
Amount t6oz
Wall Thickness
or Weiht/Ft. M terial
PA%
Material
Ft. benonite & cement
Method
pumped
Slot Size Material
in.
in.
Material
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the 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 STTI ARDS, AND THATOPY 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.h/REN. 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. Brawn CERTIFICATION # 2045
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 0 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
Nearest Town:
County 1AaCI[,,su
3. OWNER:
Addres
(Str�t Name, Numbers, Community, Subdivision, Lot No., Zip Code)
ellAheri
(Ste or Route No.)
h,/S llllll- .Ale e7ey.�3
Zip Code
City r Town ta!
(�)- R37. 7sz
Areacode-
IL number 9 0
4 DATE DRILLED
5. TOTAL DEPTH:
6. DOES WELL REPLACE EXISTING WELL? YES NO
7. STATIC WATER LEVEL Below Top of Casing: E.-4 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS 2 FT. Above Land Surface"
'Top of casing terminated atior below land surface requires a
variance in accords with ISA NCAC 2C .0118.
9. YIELD (gpm): METHOD�OF TEST LOW
10. WATER ZONES (depth): A. /
11. DISINFECTION: Type H T H Amount 16oz
Wall Thickness
Depth Di meter or Weight/Ft. Material
pp�
From /�i To _ Ft. — 5t0ed)
12. CASING:
From CS S To
From To Ft.
13. GROUT: Depth Material Method
From 0 To 20
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.
Ft. benonite 8 cement pumped
From To Ft.
Topographic/Land setting
❑Ridge 0Slope OValley OFlat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:OGPSOTopographic map
(check box)
DEPTH DRILLING LOG
From Formation Description
t
a � w clay 8 sand
si K• a 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 THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL "'--"
CONSTRUCTION STAND AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELLOWNER
RSON CONSTRUCTING THE WELL DATE
'4m0d
SIGNATURE OF
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

10. WATER ZONES
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 Hedden Brothers Well Drilling, 1 Inc PRONE * 828) 369-9591
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT*
(if applicable)
(if applicable)
302n
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:•
Nearest : i /It Co
3C) Cb4.60 (Vain mto r
(Street Name, Numlers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: 11
Address n X
C'. 1
Street or Route No.)
ty
018119
City or To 5/ Zip Code
1�- K8s-• 89,17.
Area code- Phone numbera.
4. DATE DRILLED /b '' •O
hil
5. TOTAL DEPTH: LO '
6. DOES WELL REPLACE EXISTING WELL? YES NO 0
7. STATIC WATER LEVEL Below Top of Casing: FT.
(Usc "+" if Above Top o using)
8. TOP OF CASING IS 2 FT. Above Land Surfaces
*Top of casing terminated aHor below land surface requires a
variance In accordant th ISA NCAC 2C .0118.
9. YIELD (gpm): METHOD OF TEST BLOW
pth):
Q
(
11. DISINFECTION: Type H T H
12. CASING:
Depth Diameter
From To Ft. "
From r To Ft. (i
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 Size
From To Ft.
From To Ft.
16. REMARKS:
Amount 16oz
Wall Thickness
or Weight/Ft. MAterial
Material
Ft. benonhe & cement
Method
pumped
Slot Size Material
in.
in.
Material
DEPTH
Topographic/Land setting
DRidge ❑Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DRILLING LOG
From J,o„ r 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 D0 HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDS, AND THAT A COPY
�OF�THIS RECORD�HAS BEEN PROVIDED TO THE WELL OWNER---
—"ea/ i 9/ 1`-firltr— /0 ——r%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. b7/2001

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 Drillinth Br
others roers , Inc PHONE # [phone]
WELL CONTRACTOR COMPANY NAME 9 f
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:tt4(Seth) erry
5ANOtAt) to
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: feil PM+� '
Address '1 SANotn QO
County SwAlJ
tiDT1 StrpetTNNR) N- 2 S
City or c Og�oSltea Ivy Zip Code
(.8zb- yAI' yrt
Area code- Phone number /' Ai)
4. DATE DRILLED fib' Teti
5. TOTAL DEPTH: /aI O#
6. DOES WELL REPLACE EXISTING WELL? YES g NO ❑
7. STATIC WATER LEVEL Below Top of Casing: _st0—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 1C .0118. BLOW
9. YIELD (gpm): 30 METHOD OF TEST
10. WATER ZONES (depth): 53'. 80, 10.2e
11. DISINFECTION: Type H T H Amount 16oz
12. CASING: Wall Thickness
Depth ,1 Diameter or Weight/Ft. aterial
From 0 To 7 Jr Ft. p_., t/d D
From To Ft. co
From_ To Ft.
13. GROUT: Depth Materiel 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 ❑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„ 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.
16. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH I5A NCAC 2C, WELL _
CONSTRUCTION STAN a -a'. a S, AND TH i COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
SIGNAT RE OF PERSON CONSTRUCTING THE WELL DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Ceenter' Raleigh,
NC
27699-1636 Phone No. [phone], within 30 days.GW

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources -
WELL CONTRACTOR (INDIVIDUAL) NAME (print) James B. Brown
WELL CONTRACTOR COMPANY NAME Hedden Brothers Well Drilling, Inc
STATE WELL CONSTRUCTION PERMITS, ASSOCIATED WQ PERMIT#
(if applicable)
Division of Water Quality - Groundwater Section
CERTIFICATION 6 2045
PHONE # [phone]
(if applicable)
303202
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 •N:
earest To
3. OWNER:
Addres
County
No., Zip Code)
it 55"
or Route,G a8 �/9
CC, or wn89tiG , $ , N
aaZip Code
(-y
Area code- Phone number Q�
4. DATE DRILLED ( ' - 0
5. TOTAL DEPTH:
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO X
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 15A NCAC 2C .0118. BLOW
9. YIELD (gpm): METHOD OF TEST
10. WATER ZONES (epth):
Topographic/Land setting
❑Ridge ❑Slope OValley OFlat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:OGPSOTopographic map
(check box)
DEPTH DRILLING LOG
o_ Formation Description
clay & sand
granite
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 toad
Depth D'ia^meter or Weight/Ft.Material numbers and common road names.
Rom To Ft. CV .
From To Ft._le__ 06
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
To
To
12. CASING:
s
From Ft.
From Ft.
16. REMARKS:
t)
0
1 DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STP1ThRDS, AND THATA COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
30 —o Cie
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
cnn
;" pi
r++�
QUO
eel 00
r--
C7
s!
rn

WELL CONSTRUCTION RECORD
303201
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) James B. Brown CERTIFICATION g 2045
WELL CON"IRACTOR 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 0 Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection D Other 0 If Other, List Use
2. WELL LOCATION:
Nearest Town:
pd (Street Name, Nbers, Community, Subdivision, Lot No., Zip Code)
3. OWNE (� vJ r%•
Address t7�/ 7
Street or RowNo.)
am
reerl
(BzBi- ?7 92,c4st%
Area code- hone number
4. DATE DRILLED
5. TOTAL DEPTH:
6.DOESWELLREPLACEEXISTINGWELL? YES0 O,J�
7. STATIC WATER LEVEL Below Top of Casing: or
(Use "4-" 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 accords a with ISA NCAC 2C .0118. BLOW
9. YIELD (gpm): — h'IET T ST
10. WATER ZONES (depth):
County%/J/ I �-
0280
Zip Code
11. DISINFECTION: Type H T H Amount 16oz
12. CASING: Wall Thickness
Depth /J �j DI)n)fter or Whei�ht/Ft..�M3tterial
From To Y / Ft. 0 ,J/� �2i From To Ft.
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.
16. REMARKS:
Topographic/Land setting
DRidge ❑Slope °Valley °Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:°GPS°Topographic map
(check box)
DEPTH DRILLING LOG
Fr. . r 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.
o
Jr'- _;:it:
o rrtr
�
C
om
zrd
cJt 4o
j-rtr-rt.
"-o n--
nr --1
C.3 0o
o U%0
F r*r
n
1 DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL "--
CONSTRUCTION STAS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
7- 0
SIGNATU
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

variance In accordance
9. YIELD (gpm):
10. WATER ZONES
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
ASSOCIATED WO PERMIT#
STATE WELL CONSTRUCTION PERMIT#
(if applicable)
(if applicable)
303200
PHONE # f 528) 369-9591
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 LOCATIC)I�T; /;
Ipearest Towp li(/�((/ Lf L
n0)10
Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3.OWNER:CJ'I�+�terc�"^� 1
Address
Countyjd k 2La)
ditt Roate No,_ a8 7/9
City or Town iSla4 Zip Code
Area code- Phone number
4. DATE DRILLED
5. TOTAL DEPTH:
6. DOES WELL REPLACE EXISTING WELL? YES KNO ❑
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
Ith 15A NCAC 2C .0118.
METHOD OF TEST
epth):
BLOW
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 'Cp„ r Formation Description
clay & sand
granite
11. DISINFECTION: Type H T H
12. CASING:
Depth , + Diameter
From o To 4' Ft. /O"
From To Ft.
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:
Amount 16oz
Wall Thickness
orfsbht/Ft. Material
Material
Ft. benonite & cement
Method
pumped
Slot Size Material
in.
in.
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.
00
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STA ' S, AND THAT A C PY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
lSIGNATURE 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
303199
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
2045
WELL CONTRACTOR (INDIVIDUAL) NAME (print) James B. Brown CERTIFICATION a
WELL CONTRACTOR COMPANY NAME Hedden Brothers Well Drilling' Inc PHONE a [phone]
ASSOCIATED WQ PERMITS
(if applicable)
STATE WELL CONSTRUCTION PERMITS
(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
Near To °u e()L
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER:
Ad ess
e (Street or ute No.)
_fazile
r
City q
(rrVs )
Area code- Phone number
4. DATE DRILLED
5. TOTAL DEPTH: i /0
6. DOES WELL REPLACE EXISTING WELL? YESXNO 0
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 land surface requires a
variance in accordance with 15A NCAC 2C .0118. BLOW
a
9. YIELD (gpm): 8C) METHO�P9F T ST
10. WATER ZONES (depth): 'YO 1-. 15
,A7i9
11. DISINFECTION: Type
12. CASING:
De thr-g4 D' meter
From D To / 7 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.
Zip Code
Topographic/Land setting
❑Ridge ❑Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
Latitude/long
DEPTH
Fro
(degrees/minutes/seconds)
tude source:❑GPS❑Topographic map
(check box)
DRILLING LOG
Formation Description
day & sand
granite
LOCATION SKETCH
Amount l60z Show direction and distance in miles from at least
Wall Thickness two State Roads or County Roads. Include the road }-
orr/Vhl�Qht/Ft. M aterial numbers and common road names. O c�
r
�— p ri1 -
▪ b rn
C11 O t7
mril
M,
s c2.47
72
W yo_
O MU
• n
16. REMARKS:
HTH
1 DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION ST ARDS, AND THAT A C�PY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
14.
DATE
i
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-1 REV. 07/2001

WELL CONSTRUCTION RECORD
f E ronment and Natural Resources - Division of Water Quality - Groundwater Section
North Carolina - Department o nviCERTIFICATION p 2045
WELL CONTRACTOR (INDIVIDUAL) NAME (print) dames B. Brown
WELL CONTRACTOR COMPANY NAME Hedden Brothers Well Drilling, Inc
STATE WELL CONSTRUCTION PERMITS
(if applicable)
1. USE (Ch k A plicable Box): Residential 1 Municipal/Public 0 Industrial 0 Agricultural 0
PERMIT(ASSOCIATED WQPERMIT(
applicable)
PHONE *I(828) 369-9591
2. WELL LOCATIO
WELL ec p
Monitoring 0 Recovery 0 Heat Pump Water injection 0 Other 0 If Other, List Use
n
Topographic/Land setting
❑Ridge ❑Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
N rest Toz
County
-Ge30 wg nn
(Street umbers, Community, Subdivision, No.,=Zip Code)'^^eiC
3. OWNER: t i
~S� fib .a K/dJ
Address 4 / 11J�A
(Sneer or Route No.)
aokoe, Ai
A,
City or T Zip Code
Area code- Phone number
4. DATE DRILLED
5. TOTAL DEPTH: -
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 Surface'
*Top of casing terminated at/or below land surface requires a
variance to accordance with 15A NCAC 2C .0118. BLOW
9. YIELD (gpm): CD MEpg9 ,f1 t
10. WATER ZONES (depth): jj(�JJ ¢ 11&ST
e
11. DISINFECTION: Type H T H
12. CASING:
Depth Diameter
From 3 To (D.) Ft. (0��
From To Ft.
From To Ft.
13. GROUT: Depth
From 0 To 20
From To
14. SCREEN: Depth
From To
From
Ft.
To Ft.
Amount 16oz
Wall Thickness
or Weighterial
8P3 o&
303198
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From Tq „ l Formation Description
clay 8. sand
granite
Material Method
Ft. benonite & cement pumped
Ft.
Diameter Slot Size Material
in. in.
in. in.
15. SAND/GRAVEL PACK:
Depth
From To Ft.
From To Ft.
Size Material
16. REMARKS:
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common road names.
I DO HEREBY CERTIF
CONSTRUCTION
THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL _. - -- "
)ARDS, AND THA COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
&—LP to
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
v
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Ceenter' REV &h,7NC
27699-1636 Phone No. [phone], within 30 days.

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and ^Naatural Resources - L i ision of Water Quality
\1"ELL CONTRACTOR (INDIVIDUAL)NAMI�E].((,pp�ri��nt) /(9, A-1—f1A r�,,,,t(�� 'q 15
w"ELL CONTRACTOR CONIPANV NAME Ak-A (- reeve. rI.c r03 L')w.Gl.
STATE WELL CONSTRUCTION PERMIIT4 ASSOCIATED wQ PERMIT
(if aoolicable)
(if applicable)
- Groundwater Section
�
CERTIFICATION: 01-59'7
PHONE R (dX0 5—S2
I. WELL USE (Check Applicable Box): Residential A blunicipalrPublic ❑ Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other ❑ If Other, List Use
2. WELL LOCATION: ,J
Nearest Town: 'rtj,S in „gip
County' 6SICt1Ca'/�.
(Scree: Same. Nma3es. Cojrn:nunit . Subdivision. Lot No.. Zip Code)
OWNE ONER:1 P(1 'e �'radne es
Address 33 41/) 7 F I r�k a X', n nAi Dp-
(S::ee:or .c2
C u sf(.� FI 736
cit. or To,..„ / Snot Zip Cod_
(-- qSR -D.
Area cvde• Pcone number I�-�J"
4. DATE DRILLED
5. TOTAL DEPTH: 10
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO, Ai
7. STATIC WATER LEVEL Belo.. Top of Casino,: '10 FT.
(Use --" if A'bo.e Top of Casing)
S. TO? OF CASING IS ( FT. Above Land Surface
-Top or casing; mraiina;ed a'br bcluss land surface requires u
s,risnae in uccordmcc virh ISA NCAC 2C.0I IS. yy��
9. YIELD (_pn): ' � METHOD OF TEST Hire
ID. WATER ZONES (depth):
Topographic/Land setting
❑Ridge Ars lope [Walley ❑Flat
(check appropriate box)
Latimde'lonoitud: dwell location
Latitud_'lone
DEPTH
From To
0-9b
9� - /AD
1a0 -!at
o`Z x7i --33
1 1. DISINFECTION: Type /-t
12. CASING:
From C
h' Amount e't y-
Tc /0/ Ft. CY✓
From To Ft
From To Ft
I 3. CiROL_T:
From a To 3 Ft -
From a To a t Ft
14. SCREEN: Dope, Diameter
From To Ft. in.
From To Ft- in.
15. SAND GRAVEL PACK:
Deprb Size
From To Ft
Froc.', To Ft.
16. REMARKS:
\Vali Thickness
or v: ei 2h:-R.
5 Poz :j PzOC,
30319?
(degree;.'aninutei'seeords),
tide soure:❑GPS❑Ttpo_raphic map
(check box)'
DRILLING LOG
Formation Description
4i
S //i'a -� R
. a- a—nL D
LOCATION SKETCH
Sho.v direction and'dis:an e in miles from at leas:
two State Roads or Count. Roads. Include the road
numbers and common road names.
0
C5
0
CD
rip,-- 9 L33 V SO; Size - Ma:er C':
-
in.
in
\later:"•
—o
J
I DO HEREBY CEP.TIFV THAT THIS V:ELL WAS CONSTRUCTED IN ACCORDANCE WITH IiA NCAC 2C, WELL
CONSTRIXTIONS7 NDARQiil T,Jc.T A COPY OF THIS RECORD HAS BEEN PROVIDE D TShTHE ': LL OV.NER
SIGNATURE OF PERSON CONSTR'I_CTINGTHE \':ELL DATE
Submit the oriiinal to the Division of Water Quality, Groundwater Section. 1636 Nlail Smice Center-RHexf,b,INC
et'
'7599-1636 Phnno No. ('719) 733 _n'-'1, within G-I R&'i•Z200: 30 dins. ,.
0

o WELL- RECORD -...-4,-,...-•
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
u' / f
\\ELL CONTRACTOR (I\DI\.IDUAL) NAME (pprint)/^1� TUC- %{�� CERTIFICATION # Y/
\\'ELL CONTRACTOR CO\I PA\\' NA\IE Mil (7ree/9Ce 'r=A a) CI{ EJr g? PHONE #irA r�� S Z%
ASSOCIATED w'Q PERMIT#
SrATE \\ELLCO\SPERMIT# • (if applicable)
- (if appliccab ablee)l '- -
2. WELL LOCATION:
1. WELL USE (Check Applicable Box): Residential (a+ Municipal/Public ❑ Industrial ❑ Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 IfOther, List Use 3 0 4 3 6 0
Topographic/Land setting
❑Ridge QfSlope ❑Valley ['Flat
(check appropriate box)
Latitude/longitude of well location
Near-st To\yn:
Count Snt�+-0
Pn etn C a87/3
(StreetName. Noun ers.Con(munity, Su- division, Lot No. Zip Code)
3. OWNER:.F-rETt Shia r
Address 4LSr NPnth-, t6les rigid.
r (Street or Route No.) /
C F2 tor s iron Fl. 33'Nd
City or Town State / Zip Code
Area code- Phone number
4. DATE DRILLED gin C71:
5. TOTAL DEPTH: / 75-
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO Rgi
7. STATIC WATER LEVEL Below Top of Casing.: 30 FT.
(Use "-e' if Above Top of Casing)
S. TOP OF CASING IS I FT. Above Land Surface*
•Tip of casing terminated at'ur below land surface requires a
variance in accordance with 15A NCAC 2C .0113. (\ r Y
9. YIELD (epm): i0 METHOD OF TEST A j
10. WATER ZONES (depth): 70', % go/ ILO
t
l 1. DISINFECTION: Type /4 T H Amount � dz
12. CASING: Wall Thickness
Depth, or WeighCFt. Material
<J
From b ToFt.�r�_ La ant-Q.
From -
From
13. GROUT:
From 0
From 3 To 7L) Ft.
Diameter Slot Size v NIate}sat
From To Ft. in. in.
From To Ft. in. in.
15. SAND 'GRAVEL PACK:
Depth Size \laterial
From To Ft.
Material
To Ft.
To Ft.
Depth
To 3 Ft.
14. SCREEN: Depth
From To Ft.
Method
(degrees:minutes/seconds)
Latitude/longitude source:OGPSOTopographic map
(check box)
DRILLING LOG t
Formation Description
DEPTH
From To
/
`-`_/ - 70
7e - 70/—
7a—IVO
pia —/SS3
__ 6 d --/40-
_-
LOCATION SKETCH
Show direction anddistance 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 ISA NCAC 2C, WELL
CONSTRUCTION TAND�.. a_ RDS, A `D TH. OPY OF THIS RECORD HAS BEEN PROVIDED TO �L OWNER
/ DATE
SIGNATURE OF PERSON CONSTRUCTING THE WELL
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center-1 - REVg,NC
07/2001
27699-1636 Phone No. (919) 733-312I, within 30 days.

cfNV ...w
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources--yDivision
eofJWater Quality - Groundwater Section , / /
WELL CONTRACTOR (INDIVIDUAL) NAME (print)(piti6at&t A.;]� �"�y_`�/—�%��,y�/ CERTIFICA�TII(ON,## 3�0<1 T
WELL CONTRACTOR CONM PAN'NAME AM G APe t. gen /LLk p r/ PHONE # (det0 SSC'� 1.'
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED %VQ PERMIT#
(if applicable) _ (if applicable)
1. WELL USE (Check Applicable Box): Residential Municipal!Public 0 Industrial 0 Agricultural ❑
Monitoring 0 Recovery ❑ Heat Pump Water Injection 0 Other 0 If Other, List Use
2,
9.
10. WATER ZONES (depth): Le U 4 Sg
%OG' t ..as''� /� LOCATION SKETCH
11. DISINFECTION: Type I+ 7- 1-1- Am int Ur 7.5— O" ZShow direction and,distance in miles from at least
12. CASING: Nall Thickness two State Roads or County Roads. Include the road
Depth Diameter or Weight: Ft. `�Nlaat-erianlll numbers and cornrnon road names.
From 0 To 32 Ft. (a /� , I &B u! , jf d
From - To Ft. Azar el etc"-
From To Ft. .
13. GROUT: Depth Material Method
From 0 To�_ Ft. O [T. o /at'l—r `6�/ cry-'%`��i
From 3 To % O Ft. M�n.%'1/ - i.45 V / -' £.1 Lipa,...e. 1,
14. SCREEN: Depth Diameter Slot Size v Mater`ia! —"Lie.
_ '
From To Ft. in. in. ✓G . i £/%r�-t� Cr)-1.©
WELL LOCATI
Nearest Town: Count 0.-
I3oD 5h ,2-n-cLs0k e
(Street Name, Numbers, Cohununity, Subdivision, Lot No., Zip Code �1 V
3. OWNER: -r-1 LAIC JvO
Address a /At. AIX
(Street Qr Route No.)
f
1 y1�
CZipCAt 713
cuy own State
(
Area code- Phone number
T. DATE DRILLED �"c 9 —051
5. TOTAL DEPTH: I5-0
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO 25
7. STATIC WATER LEVEL Below Top of Casing: oZ& FT.
(Use "r' if Above Top of Casing)
S. TOP OF CASING IS FT. Above Land Surface*
*Top of rasing terminated at/or below land surface requires a
variance in accordance with 15A NCAC 2C .011S. YIELD (gpm): 30 METHOD OF TEST P/'
Topographic/Land setting
❑Ridge Pope ❑Valley DFlat
(check appropriate box)
Y3 Latitude/longitude of well location
304fl9
(degrees'minutes/seconds)
Latitude/lonizitude source:❑GPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From To Formation Description
C-3.3
33 -„ lid
-�L7��
IUD -JOa -
�19arS- /sO
1
Lp�,rlc-teat
�c 'z"
From To Ft. in. in. :
15. SANDGRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
16. RE>IARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH ISA NCAC 2C, WELL
CONSTRLC"�t N STANDARDS, THAT A C Y OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
DATE
SIGNATURE OF PERSON CONSTRUCTING THE WELL
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
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 # [phone]
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 ❑ Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATIO :
Nertest TLown: /: County
ege-/GfJ
t Name, Numbers, Community, Sgbdivision, Lot No., Zip Code)
3. OWNER:
Address
J(D9 U
emewitz RRlieNo) cum(- City oyTf�y �te, Zip Code
Area code- Phone number ���JJJ �[
4. DATE DRILLED /5 /J OT
5. TOTAL DEPTH: Qo
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO A.,
7. STATIC WATER LEVEL Below Top of Casing: git) FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS 2 FT. Above Land Surface*
*Top of using terminated at/or below land surface requires a
variance in accordantjjh ISA NCAC SC .0118.
9. YIELD
(gpm):
WATERONES (depth): METHOD//gLOW tit
11. DISINFECTION: Type H T H
12. CASING:
Depth Diameter
From V To Ft. IA N
From To Ft.
From To Ft.
13. GROUT: Depth
From 0 To 20
From To
14. SCREEN: Depth
From To
From To
15. SAND/GRAVEL PACK:
Depth
From To
From To
Amount 16oz
Wall Thickness
or Weight/Ft. Material
Material Method
Ft. benonite 8 cement pumped
Ft. .
Diameter Slot Size Material
Ft. in. in.
Ft. - in. in.
Ft.
Ft.
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
Fr
1311SL_ w Formation Description
yy 8 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
16. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH ISA NCAC 2C, WELL
CONSTRUCTION STANS, AND THAT A 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 Sectlon,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 8. Brown CERTIFICATION # 2045
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 ® Municipal/Public Cl Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATIO
Nearest Town:
(Street Name, Numbers," Community,
3. OWNER:
Address
City
Area code- Phone number
4. DATE DRILLED
5. TOTAL DEPTH:
C aunty
ubdivisio� Noip Code)
at„QVA
or Route Ner' 4 713
L
7owr�`- S e Zip Code
6. DOES WELL REPLACE EXISTING WELL? YES 0 C) O j)�.
7. STATIC WATER LEVEL Below Top of Casing: MC) 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 ■
variance In accordance w h ISA NCAC 2C .0118.
9. YIELD (gpm): Aft ) MET}/ 9F TEST BLOW
I0. WATER ZONES (depth): /
Q
11. DISINFECTION: Type H T H Amount 16oz
12. CASING:
Wall Thickness
Depth D}'amyter or Weight/Ft. Merial
From To Ft.
From_'(9
To Ft. /j is //8PI
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.
Method
pumped
A-b
304410
Topographic/Land setting
Midge ❑Slope OValley OFIat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source: OGPSOTopographic map
(check box)
DEPTH DRILLING LOG
Fr8n To t ' Formation Description
,36 clay & sand
lfo' 3f2:0' 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.
_t
16. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION DARDS, AND THAT COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. \ . OW-1 REV. 07/2001

\\'ELL CONTRACTOR (I\DI\_IDUAL) NAME (print) r A lli/J— CERTIFICATION
WELL -CONSTRUCTION RECORD 31-�,,
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
((prrrt(y `�
WELL CONTRACTOR CO>IPA\\'NA\IE / tfar7 Prire�-9>'C��'S. 1-ea 1 /"//
.3 PHONE # t1S Z'� ^
ASSOCIATED w'Q PERMIT#
STATE WELL CONSTRUCTION PERMIT. ' (if applicable)
... (if applicable) .
I. WELL USE (Check Applicable Box):. Residential,j l Municipal!Public 0 Industrial 0 Agricultural ❑
Monitoring 0 Recovery 0 Heat Pump Water Injection ❑ Other ❑ If Other, List Use
2. WELL LOCATI tN:
Nearest T pan:
DSJ74U/s
(Street Name, Numbers, Community, 6.ubdi
3. OWNER: ,T4-r-i 1al7zere—
Address 6&O3 /i[h-ed -c %3
(St em r Rouie No.)_ 's a
Cu or Town SLe ode
Area code- Phone number
d. DATE DRILLED c—/b-DV
5. TOTAL DEPTH: jr IS
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO A
7
of No., Zip Code)
STATIC WATER LEVEL Below Top of Casing.: iiC> FT.
(We"," if Above Top of Casing)
S. TOP OF CASING IS I FT. Above Land Surface'
'Top of casing terminated ator below land surface requires a
variance in accordancen'ith ISA NCAC 2C .0113.
9. YIELD (gpm):. METHOD OF TEST iti I r
10. WATER ZONES (depth): %0' 4.1
get
I1. DISINFECTION: Type �-}'�f-f' C/Amount a�O &i
12. CASING: Wall Thickness
Depth 9i;)meter or Wei•zht'Ft. MateriPVC,
From 0 To V Ft._lk.' — PVC,
From To Ft.
From To Ft.
13. GROUT: Depth ' Material
From To Ft. =-�
From .' � To r�O Ft. -P..''
14. SCREEN: Depth Diameter Slot Size
From To
Ft. in. in.
From To Ft. in. in.
15. SAND 'GRAVEL PACK:
Depth Size Material
Topoaraphic/Land setting
❑Ridge ,Slope DValley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees. minums'seconds)
Latitude/longitude source:❑GPSOTopographic map
(check box)
DEPTH DRILLING LOG
From To Formation Description
0 1iS
S— 70
7o -7,2_
won - D%
416 - S"U7i)
LOCATION SKETCH
Show direction and�distance in miles from at let
two State Roads or County Roads. Include the
numbers and common road names.
Method
ice-7 1-
From To Ft.
From To Ft.
16. RE\!ARKS:
Q�
61Lut
r
Mate�'ial - , riA/1,.---
I DO HEREBY CERTIFY THAT THIS WELL WAS
CONSTRi:CTIONSTAN ST;�
.ONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
PY OF THIS RECORD HAS BEEN PROVIDED TO HE WELL OWNER
S GNATURE OF PERSON CONSTRUCTING THE WELL
DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center ! REVghh, NOI
27699-1636 Phone No. [phone], within 30 days.

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural �Kesourcea - Divrter QuaiIty
\\'ELL CONTRACTOR (INDIVIDUAL) NAME (print) // /ancs. /�1/ J
WELL CONTR:-\CTOR COM PAST' NAME J444 arena ets.tesilat
STATE \, ELL CONSTRUCTION PERMIT: ASSOCIATED\VQ PERMIT.
(ifaoolicab!e) _ �_a (if aaol able)
V.a44.
- li 'Jahn to xurcn
CERTIFICATION: C2 7(�V��7)
PHONE # J2130 S"
1. WELL USE (Check Applicable Box): Residential MunicipaUPublic 0 Industrial 0 Agricultural ❑
\!onitorine ❑ Recovery ❑ Heat Pump Water Injection 0 Other 0 If Other, List Use
Z. WELL LOCATI N.
Kean' T \vn: Count' S 'N1
(i:r:_: Name. Nu:ibis. Coruitunin. Sub - ision, Lot No.. Zi Coda)
3. OWNER: ispaild.LOU
Addr/:ssss� iota-6
Saaar
CM or Toren State Zip Code
(_fi 'Pi G79/
Aree coda- Pitons number ,
4. DATE DRILLED //'� . -OS
5. TOTAL DEPTH: aSo
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO 91C
7. STATIC WATER LEVEL Below Top ofCasin_: 11-0 FT.
(Use "+" if Above To; orCasin n
S. TOP OF CASING IS / FT. Above Land Surface'
city or eaiiug termini led actor below land surface requires a
so Dance in accordance a it?)15A \CAC 2C .0119.
9. YIELD (Tom): ' c2O METHOD OF TEST I"—
10. WATER ZONES (depth): IIO
i
I1. DISINFECTION: Type N-TN-/Amount //ap7
12. CASING: Wan Tii ckness
Depth Dame :r I r \
From 0 Tn� Ft. �n-�—Ste& SAW"
From To Ft.
Fro::t To Ft
13. GROLT: D_o:(: erd
Material`I \leetod
Fron_0_ Toga_ F I. 7
From 3 To Z.t7 Ft. tpleiaapt Co
14. SCREEN: Depth Diameter S!o:Size MateriaI
From, To FL in. in.
From To Ft. in. in.
TopographiciLand setting
❑Ridge XSIope ❑\'alley ❑Flat
(check appropriate box)
Latitudeflongitude of well location
(degrees:minutes:seconds)
Latitude'longitude source:❑GPS❑Topoeraphic map
telleck box)
DEPTH - DRILLING LOG \
From To Formation Description
15. SAND GRAVEL PACK:
Depth SiMateria:
From To Ft.
From To
16 REN!ARKS:
I DO HEREBY
CONSTR•
Ft.
LOCATION SKETCH
Show direction and'distance in miles from a: leas: 77
two State Roads or County Roads. Include the road '0 c
numbers and common wad names.
--n
a 3<1
\ 04
0,
..-,--
9* j751
SIG. ATCRE OF PERSON CONSTRUCTING THE WELL
Submit the original to the Division of Water Quality, Ground'sater Section, 1636 >tail Service Center-Ra!eigh, NC
27699-I bib Phone No. (919) 733-37' I, within 30 days. G\V•! REV. 07.'2001.
': AS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
A COPY OF THIS RECORD HAS BEEN PROVIDED T/ HE WELL OWNER
DATE

WELL CONSTRUCTION RECORD
305228
North Carolina - Department of Environment and Na ura Resour -i - Ui isio:t of Water Quality - urounu.vatci Szctim ��
C . [O,.{(yy��,,..,,,, q I,, � Ale
CERTIFICATIION:
rent: r* 3 A.w/ LLa.�L PHONE A fog 5-n, "%S1SZ
ASSOCIATED%VQ PE .IIT"
(if aoolicable)
VELL CONTRACTOR (INDIVIDUAL) NAME (print)
WELL CONTRACTOR COMPANY NAME
STATE WELL CONSTRUCTION PERMIT',
(ifavoticable)
I. WELL USE (Check Applicable Box): Residential( Municipal'Public 0 Industrial 0 Agricultural ❑
Monitoring ❑ Recovery 0 Heat Pump Water Injection ❑ Other 0 ICOther, List Use
2. WELL LOCATI
Nea;cstTown: u
•
•
County CCrzLG—.✓
IS:cue: Sa::,e. Nu:^bers. Cenmunit . Sabdivision, Lo: No.. Zip Code)
3. OWNER
Address
0 8Re>5w,1—)
(S::ee: or Rout: No.)
*Cr:'. orlour Sil.a. Zip Code
Ara e...12- Pnci.c numb::
4. DATE DRILLED 113 - 5- 0SI
S. TOTAL DEPTH: - SZ
6. DOES WELL REPLACE EXISTING )WELL? YES NO
M
7. STATIC WATER LEVEL Below Top of Casing: T.
(Use ".' if .Abocc Top or Cash gl
S. TOP OF CASING IS 1 FT. Above Land Surface
'7 tq: ur caning terminated ut.'ur belu". hind surface requires u
sari:nce in aea.rdance n WI 13A NCAC 2C .0113.
9. YIELD (eon):'Lao N!E HOD OF TEST Ali-'
W. WATER ZONES (depth): 'I5 r2/6
1I. DISINFECTION: Type /t H
12. CASING:
0To _ Ft. `% SD2 Ll r JC. `�''
From i Its'i1
Fro;:. To Ft. 1 �,/ `^
From To Ft ' 4 Tn ,.r
n :tla:eria Method C"a T'
I3. GRm._T: Dens. ? � �7 - -r
From i n To .. Ft. C� _ (:�--�`.L�G« - o,"
L -,
From V,-�- c's
11. SCREEN: Depth Divne:er S.o: Size AI
From To Ft. in. in. /� sL ��>>
From: To Ft. in. in. -
TopographiciLand setting
❑Ridge Slope ON/alley ❑Flat
(hack appropriate box)
Latitud 'Iongitud: of well location
(degreeiiranuteCseconds)
Latitud 'Iongitude sour e:❑GPS❑Topographic map
(elicck box) •
DRILLING LOG \
Formation Description
From
DEPTH
To
LOCATION SKETCH
Amount �_ Show direction and'dis:ance in riles from a: leas:
Wall Titickmess
two State Roads or County Roads. Include the road
iamemr et Weigh:Tr. Ntr.erial numbers and common road names.
Depth
15. SAND GRAVEL PACK:
Depth Size :Materia:
To Ft.
To Ft.
From
-From
c
7jo r
16 REN!ARKS:
I DO HEREBY CEP.TIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH I5A NCAC 2C. \\ELL
CO\STRCCTfON ST. DS. A\'D THA �COP1_OF�fF RECORD HAS PROVIDED TO THE WELL OWNER
�C DATE
SIGN. TIRE OF PERSON CON iiEF:ELL
Submit the original to the Division of Water Quality, Groundwater Section, 1536 Mail Scyice Center I - RE1igh, COI
a_7699-1636 Phone No. [phone]. Within 30 days.

WELL CONSTRUCTION RECORD 305227
13. GROUT:
From
11. DISINFECT(
12. CASING:
orth Carolina - Department 01 Environnlenr and i
WELL CONTRACTOR (INDIVIDUAL) NAME (print)
WELL CONTRACTORCO>IPANV NAME jtAA �ZQ.Q'nX wulr
STATE WELL CONSTRUCTION PERMIT,
(if aooticable)
ual R_eso icea Division of i'.ater Qua!i:j - Groww t r Saciron u/�
CERTIFICATCERTIFICATIONS:�
30 4i
PHONE II (V 5&& —cSS-6
ASSOCIATED WWQ PERMIT,/
(if aoolicab!e)
•
1. WELL USE (Check Applicable Box): Residential g Municipal/Public ❑ Industrial ❑ Agricultural ❑
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use
2. WELL LOCATION:
Near'• Town: County. .o.—)
(S:re:: Name. Nu:dserY. Ceeu? In :. out/ gion, Lot No.. Zip Cote)
3. O\CNER:
Addr;s;
gn
�C�:' o Tof S:ace )
(ot2 1$ 'Ssr & 7.1
Arta ode- Pconc r.u:::b::
T. DATE DRILLED 1/- 0 / D
5. TOTAL DEPTH: 'vVt3
6. DOES V:ELL REPLACE EXISTING (CELL? YES I NO la
7. STATIC WATER LEVEL Below Top ofCasin_: 90D FT.
(Use "T' it .Abo'c Top of Casi n_I
S. TO? OF CASING IS / FT. Above Land Surra:et
o up of caiing terminated u''ur belu%: land surface requires a
♦.r!ana• in accordni pith ls.\NCAC 2C .0t IS. •
9. YIELD (epm): ' 36 M!E;/HOD OF TEST (2.L
ID. WATER ZONES(d:p'.
in): Yr2Jr I'2y
951 JRCj
ON: Type j-} 1 !-l' Aniount
W':= 1 Thickness
Diane:er or WeichtT;.
ip Code
Topoaraphic/Land setting.
❑Ridge Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(de ;eesininueise:or.de)
66Latitud 'longitude source:❑GPS❑Topographic map
(ace;: box)
DEPTH DRILLING LOG W
From To - Formation Description
Z
Depth
From 0 To Ft.
From To Ft.
From To Ft
Dept.
To 3
From To V
14. SCREEN': Depth
Fror, To
From To
15.SAND GRAVEL PACK:
Depth,
Fran To
-Frog; To
r4, 'WP z/ eve,
.D _ 7
l !? 7 fi
d F
S J
LOCATION SKETCH
Show direction and'distan:e in miles from at levy
two State Roads or County Roads. Include the rgs
numbers and common roe' names. C�'a
:M aterizI :Meta ed
Ft.S
Ft. Diameter
ffl) pt f '� T %4r^ri ' �. na
Diameter Sloe Size AI_. -eta. �({,eZW"
Ft. in.
Ft in.
16 REV ARKS.
in-
in.
Size Nla.erL.
Ft.
Ft.
o�A
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 16A NCAC 2C, WELL
CONSTRCCTIO. • . ARDS. AND THAT A C PY OF T 1S ORD HAS BEEN PROVIDED TO THE WELL OWNER
/I-/4,-0Cf
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
Submit the original to the Division of IA ater Quality. Ground"%ater Section. 1636?tail Service Center- Raleigh, NC
27699-1636 Phone No. (9191 733-3221. \Within 30 da's. GW-I REV. 07.7001
-o

WELL CONSTRUCTION RECORD
Frain J
I.. SCREEN: Depth DP.neetc
From To Ft in.
Fran: To Ft. in.
15. SAND GRAVEL PACK:
Depth
Size AL:eria'
mti: C....LUir,.. - ii r .. i_... ui and( -at
\%ELL CONTRACTOR (INDIVIDUAL) NAME (print)
n A. _ wn_ _ rJx�,m/ll.2L!/SUL14, _PHONE a
WELL CONTRACTOR COMPANY NAME�TlJ J
STATE AV'ELL CONSTRUCTION PERMIT*
(if aaolicabte)
1. WELL USE (Check Applicable Box): Residential yr blunicipaCPL:blic 0 Industrial 0 Agricultural ❑
Monitoring ❑. Recovery ❑ Heat Pump Water Injection 0 Other 0 l(Ocher, List Us:
2. WELL LOCATIt _ Neo^'St Town: ,tl�q� County
Name. \u:r.ir. t. Ccm. F:nit.). Sr. .-,:or., Lot Na.. Zip Code)
3. OWNER:
Addrass
gig
(p.2 or lo,3 q.05 3 & Zip Code
Arn\'.fie Pro::cc sb::
DATE DRILLED it — 3 - dCC
5. TOTAL DEPTH: 6Vt)
6. DOES \`:ELL REPLACE EXISTING WELL? YES ONO 2.
7. STATIC WATER LEVEL Belo.: Top of Casin_: bid FT.
(use "�' if A'bow To; of Casings
S. TO? OF CASING 15 / FT. Above Land Surface'
•l:q: urc,,Trt t:raunr.0 u::ur bctu" Land surtj requires a
sariun:e i. accordant: pith IS:\ \CAC 2C .011S.
9. YIELD (_pnl:'MO *' METHOD OF TEST .L."lJ
IC. WATER ZONES (depth): :316 '- %0
5� o - qo t
I1. DISINFECTION: Type j-h 1 !-j Amount(
ASSOCIATED WQ PERMIT:
(if aaolicable)
12. CASING:
Depth Diarre:er
Fro:n 0 To '7{ t
3 Ft. '7✓r3iz2i f'✓t
Fro::: To Fc.
Fro;n To Ft
fit...,, Method
Frr. t Z% To Depth. . Ft. eLn-L't�1-r �/, . �..GJ ./_1�l'J%^V (�
To L-.l% F. fZPn.�f'Ytc�t� 7
S:o;Size :\I_.en. iyA----tt^ /
CERTIFICATION: .mod 51/
TopographiC'Land setting
❑Ridge *Slope ❑\'alley ❑Flat
(,h.;,.rrrtpriaze box)
La:itud 'I?ngitud_ of well location
(de_:::;5nia4:esie:ocei)
/ogLatitud 'longitude sour:e:❑GPS❑Topographic nap
(:t::; box)
DRILLING LOG S
Formation Desoription
DEPTH
From To
\'•: a:i Thickness
or \': h:Ft. �L
From To Ft.
From Tc Ft.
LOCATIONH
Show direction and'dis:_flee in mile; from at leas:
two SLttt Roads or County Roads. Include tag road
numbers and common road names.
16 RE\!ARKS:
I DO NCE WITH
A NCAC 2C. WELL
CONSTF. TILE(1.GNDAw5Ts'N0TH:ATACOPYOFTHWELL WAS iSP_ECORDHED IN ASBEENPROMEOTOTHE_\ELLO\ OWNER
coN$r._GTIo.fri
SIGNATURE OF PERSONCOWSTRYCTi<GTHE WELL
Submit the original to the Di\ision of Water Quality", Groundwater Section. 1536 Mail S.niee Center ` RRaleigh,, COI
27699-1536 Phone No. (919) i33-3"_l. \sithin 30 dais.
DATE

1l. DISINFECTION: Type
12. CASING:
From 0
From
From
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural JZesources - Di%t.ion of Water Qua
WELL CONTRACTOR (INDIVIDUAL) NAME (print)
/ '
WELL CONTRACTOR CO>I PAN. NAME
STATE WELL CONSTRUCTION PERMIT• ASSOCIATED \VQ PER?II
(ifapplicable) (if aoolicable)
-..._r r
Oat
05224
y - Gcuand:rater Seciioii
CERTIFICAtION ..7.477
PHONE # (Si 5SlJ
4
WELL USE (Check Applicable Box): Residential Municipal/Public ❑ Industrial ❑ Agricultural El
0 Recovery ❑ Heat Pump Waterinjection 0 Other 0 lfOther, List Use
2. WELL LOC.AT Ni -
Nearei Town n Cgunty
y�, ice
:-miunitj. Subdivision. Lot (a.. Zi cde)
Calwaa
Nuinbers. C
3. OWNER: 17cu -
Addr:ss 40 It1gY w(>.ai'z.rtn6/tilt
nn __' (S:cee: or Rout: No.)
Alec\()), N c. �139 RV-51
Cr or To.cc ]Sian:
Zip Code
( - &CS(-9T 4ty
r\rea :. de-Phor, ra:::h:r
4. DATE DRILLED S -AO 'd
5. TOTAL DEPTH: 1.00
6. DOES WELL REPLACE EXISTING WELL? YES Fl NO C}(
7. STATIC WATER LEVEL Below Top orCasinc: c /-..)DFT.
(Use "-' if Aio.e Top of Casing)
8. TO? OF CASING IS ) FT. Above Land Surfa:e"
-it ur<vi ri carmine rod u''ur bolun land surface requires a
wrtacce it aceurb:li a ith 1:A NCAC 2C .0113.
9. YIELD (gpnl: ' //J. METHOD OF TEST ,47,'
ID. WATER ZONES (d:pth): 4.10
Su
/-i- Amain'- 0
Wall Thickness
Depth Diar.e:er or V.eigh_iEr. )j?:ar,.::
To 9c Ft. /n Vy Sbiz .,
To Ft.
To Ft
TopographidLand setting
❑Ridge $t51ope ❑\'alley ❑Flat
(check appropriate box)
Latitude'longitud_ of well location
(degreeabninu:es.ieeor.ds)
Latitud_'longitude source:❑GPS❑Topographic map
(check box) '
DRILLING LOG s
Formation Description
DEPTH
From To
0-77
2J0 —o/a—
al.a — x �z-
LOCATION SKETCH
frt
how direction and'dis:_n:e is miles from a: )earl
two State Roads or County Roads. Include the roil
numbers and common road ❑anies.
From 0 To 3 Ft. CX�✓ -.7 la."-Z'9�
Fro;.i — To v3O Ft bo-,iv+uit>
14. SCREEN: Depth Dane:er Sot size
From To Ft. in. in.
Fran: To Ft. in. in.
15. SAND GSAVELPACK:
Depth
From To Ft.
•Frog: To Ft.
16. RE\!:\RKS.
Size \ta.eria.
611/nA i 770,224---
r 47,2
a^ e 4-7 0
1 DO HEREBY CERTIFY THAT T :IS WELL WAS CONSTRTR
CONSTi?CCTtONSTA�7AND :AT �!���//`
TED IN ACCORDANCE WITH I5A NCAC 2C. WELL
-.RECORD HAS BEEN PROVIDED TO T.F \\ELt,�\t; TR
S.GNATLRE OF PERSON CONSTRICTING THE WELL ° DATE
Submit the original to the Division of \\ater Quality, Groundwater Section. 1536?)ail Send:a Cen:ar-Raleigh, NC
27699-1636 Phone No.(919) 733-32221. \Within 30 days. GWI REV. 07.:200I
73
;v
8®
2
O rj

WELL CONSTRUCT ION RECORD �� 306431
North Carolina - Department of Environment and NaturalResources
C.
Resources - Division of Water Quality - Groundwater Section
JRWELL CONTRACTOR (INDIVIDUAL) NAME (print) '�Fl -14,1er CERTIFICATION #3677'
WELL CONTRACTOR COMPANY NAME t 4i}!l t 6)y-JS, LA-l/ /'ivy •7'WC- PHONE # Plegic,i47776
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residentialonunicipal/Public ❑ Industrial ❑ Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCH N '1
Neares,t, Town: y) (ij7 CountySLAV/A
Rkes (AncGi
(Street Name, Numbers, Community. Subdivision, Lot No., Zip Code)
3. OWNE
Address J0O d\ry(Sit sede_NOYtt
(Street or Route No.)
C14-wmi-ey U7 3 39 by
City or Town State Zip Code
( )-
Area code- Phone number
4. DATE DRILLED /0 73-05/
5. TOTAL DEPTH: 7 Or
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO 0
7. STATIC WATER LEVEL Below Top of Casing: oleo 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): / e METHOD OF TESTQi Y
10. WATER ZONES (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.
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
o- 9a
9 —DOS'
11. DISINFECTION: Type Amount
12. CASING: Wall Thickness
Depth Diarrieter or Weight/Ft. Material
__ From 0 To92 Ft. / /JVc
From To Ft. 1
From To Ft.
13. GROUT: Depth Material i Method
From 0 To ta_b Ft. eDvL`pni oUV:07
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 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-1 REV.07/2001
!Fri I

305524
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural pet/r
s�ource1�
s- Di issiion of Water Quality - Groundwater Section_ r
WELL CONTRACTOR (INDIVIDUAL) NAME (print) . )di 7L ya CERTIFICATION # 2CNG
WELL CONTRACTOR COMPANY NAME G r�ha psl tfrt (�,1/ :11/noqPHONE # rant
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 ❑ If Other, List Use
2. WELL LOCATION:
Nearest Town: silt/son Ci'Ty County cS La/rv;Kt
-77;n6'rt57a-res Afr7/'3
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: Vnhn 7&nS%PP"'
Address 7%'m(>Nr ES Tetnids
(Street or Route No.)
Bryson r try NC 94713
City or Town S to Zip Code
Area code- Phone number
4. DATE DRILLED // 31 --o'i
5. TOTAL DEPTH: `J'O.0
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO 181
7. STATIC WATER LEVEL Below Top of Casing: 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): 6 METHOD OF TEST a-. r
10. WATER ZONES (depth): G
I I. DISINFECTION: Type ri
12. CASING:
Depth Diameter
From_ To 9;? Ft.
From To Ft.
From To Ft.
Amount a
Wall Thickness
or Weight/Ft. Material
C'✓1r2i PUC
13. GROUT: Depth Material
From Q To ao Ft. 60In Jerr
From To Ft.
14. SCREEN: Depth Diameter
From To Ft. in.
From To Ft. in.
15. SAND/GRAVEL PACK:
Depth
To
From
From
16. REMARKS:
Size
Ft.
To Ft.
1Je/l r be
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)
DEPTH DRILLING LOG
From To Formation Description
i
two State Roads or County Roads. Include the road
n tubers and common road n es.
1rom cAl monl PD Go /S ni/'/e
LOCATION SKETCH
Show direction and distance in miles from at least
Method /0,4 /C tfr on 79sEc CTd S%n/r/c
Avmp; w T rn R }-Q Ili T --1(15-- (p y cdorkok.
Go To S7 J S&h Trn/Q,t4 1,
&c 9/4 m,'/es i'rH R))a TCn
Timber S575.7es )Ut Gd /,7
/ y�ro Mile-5 r t✓N//an Rt�AAT•
-PrickTore
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
YeP¢& g 1/-3a-ay
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center -Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-1 REV. 07/2001
0
n-t
0
cc

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural sourcc/es - ivision of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) ;Jet/Iy4 e CERTIFICATION #205-0
(S WELL CONTRACTOR COMPANY NAME i•.31CL-01 /Je%/ aY. c at.tNj PHONE # (83.2.f%) .»s' q
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
305520
1. WELL USE (Check Applicable Box): Residential Q 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: 3r./San CI i County eSL✓ctr'n
l�r/gt•T ' //C.h Rua `iF7t'3
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: T fin Os L✓4A.1!
Address Iirar7 tin Rj
(Street or Route No.)
Br yso et Ct''7/>, At
City or Town State Zip Code
(t)-a3Q/- 933 S
a8 7/3
Area code- Phone number
4. DATE DRILLED 1/ R o 1/
5. TOTAL DEPTH: 6 iQ
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO 0,
7. STATIC WATER LEVEL Below Top of Casing: 0 `1O 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): 3 METHOD OF TEST G i r
10. WATER ZONES (depth): ..'1S?)
11. DISINFECTION: Type 1jf717/ Amount O. 6_3
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
From 0 To 7Q Ft.6n ki Snr21 Pvc
From To Ft.
From To Ft.
13. GROUT: Depth Material
From (ii To c2O Ft. (ni b n7
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
Pvn2pi./48
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
3
O -011
fnt
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
umbers and commonroad names.
4ran-la.lnronPo OW 14ni,'/CDs
RI1hT an us19 Ga /l, ywit`/es
%vrn /eJ on Wcthaw Rde6 66
Miles %urn hatra W•'ntt'noq STa.;
RA. GO o8in"1e %rnRiotlire n
Brt'a 7eLdr RA Go /m.'/e Torn
/101 fro (Lyn -Hiles To oie l l a n
Rl�h Te
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 n
-1,14 e
SIGNATURE OF PER ON CONSTRUCTING THE WELL
DATE
O
Iv
CO
ry
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
Tu r n

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and NaatuIrsourcQs1Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) Jr'
WELL CONTRACTOR COMPANY NAME G rekint rn Li en 11d V it PHONE #
t2l0
305597
'� CERTIFICATION # O.CO
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
I. WELL USE (Check Applicable Box): Residential 6d 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: n unty S Wet n
ei a7/3
Bnc)rN
(Street Na Numbers, Communnits/Subdivision, Lot No., Zip Code)
3. OWNER: eb uric 6ra.ri7
Address ✓3rinil h?vmilky Roo -A
t7 (Street or Route No.4
13ryson rrjy !t/C. at-7/3
City or Town State Zip Code
1 ;3 i
Area code- Phone number
4. DATE DRILLED /7- Sf -6 4
5. TOTAL DEPTH: Qc1 C
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO Did
7. STATIC WATER LEVEL Below Top of Casing: 66 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): Ali METHOD OF TEST 0- I r
10. WATER ZONES (depth):
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) 0
DEPTH DRILLINgLOG s-)
From To Formation DesttriptiotUD
n
—,
J
11. DISINFECTION: Type
12. CASING:
Depth Diameter
From_,_ To 731 Ft.
From To Ft.
From To Ft.
13. GROUT: Depth Material
From 0 To C).0 Ft.JNrnpwT
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
Amount
Wall Thickness
or Weight/Ft. Material
Cnr11 PVC
c
0
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.
- re GilmnontX Po O-O /,?Th/lee
T r n R i 6) i on "II 6-1
Method Tv rn lei / o n Wedia-t,-J RA
Irv,"panar
Go zl"3 m"'les %urn /e 7E / Or! (Narlk
sru'rS Ri GU 0/.2.
nh,"t° Tufnh
lt'Ir on GGrop brekncil RA 6L0
Turn Ie'b on 13o9a
inerwae y ROM , Oil 114 le Turn R i:ghT
Material
From To Ft.
From To Ft.
16. REMARKS: &0•acimales T t.cleiI en le l+
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
T� // .ie
SIGNATURE OF PERSON CONSTRUCTING THE WELL
/I-9-oti
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
O
m
Co
V

G
305145
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources Division of Water Quality • Groundwater Section
1' ELL CONTRACTOR (INDIVIDUAL) NAME (print) James A. Brown _ CERTIFICATIOtN q 2045
WELL CONTRACTOR COiMIPAiNY NAME Hedden Brothers Well Drilling, Inc PHONE k f28) 369-9991
STATE WELLCONSTRUCTIONPERMITH ASSOCIATED WQ PERiMIT#
(if applicable) - . (If applicable)
I. WELL USE (Check Applicable Box); Residential 8 Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery_0 Heat Pump Water Injection ❑ Other ❑IfOther, List Use
2. WELL LOCATION:
Nearest Town: BYysOn City
Kirkland Creek
County swain
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3 OWNER: Ken Cooley
Address PO Box 2131
(Street or Route No.)
Bryson Cityy,NC 28713
City or Town State Zip Code
621)- 884-0908
Area code. Phone number
4. DATE DRILLED 4-7-04
5. TOTAL DEPTH: ' 700'
6, DOES WELL REPLACE EXISTING WELL?, YES 0 NOX
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 wlrh 15A NCAC 2C,0118. 9. YIELD (gprn): ; .5 METHOD OF TEST blow
10. WATER ZONES (depth): 400'
1 L. DISINFECTION: Type H T H
12. CASING: Wall Thickness
'Depth Dii2iveter or Weight/Ft. Material
From 0 To 87" Ft. b pvc
From 87' To 90 Ft. 6T ..188 steel
From To - Ft.
GROUT: -. Depth - Material Method
From 0 To ' 20 Ft, berm to & area-±.. pumped
From . - To - Ft,
SCREEN: Depth Diameter , Slot Size Material
From To FL in. in.
From To Ft. in. in.
SAND/GRAVEL PACK:
Depth Size Material
From To - Ft.
From To Ft.
Amount 16 oz
Topographic/Land setting
❑Ridge ❑Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source;OGPSOTopoeraphic map
(check box)
DEPTH DRILLING LOG
F0rom Td8t
clay & sand Formation Description
88' ` 700' 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:
-v
0
16. REMARKS
1 D0 HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANp1DS, AND 'THAT A CO 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
0
0
rri
ri 0
o
rn a Fri
0

WELL CONSTRUCTION RECORD
306159
North Carolina - Department of Environment and NaturalResources- Division of Water Quality - Groundwater Section
R WELL CONTACTOR (INDIVIDUAL) NAME (print) 3e-�?" !`�yot.A CERTIFICATION #a.05-27
WELL CONTRACTOR COMPANY NAME Grain 6.yn We /l (k P, 11 ,r41�} PHONE # s-,7814179 - S'(
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 ❑ Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION:
Nfarest Town:
County.S/JG_, e4
n%aLrIcl ,c) / as 7/3
(Street Name, Numbers, mmunity, Subdivision, Lot No., Zip Code)
3. OWNER:J[LVI nnk1
Address t nnTa»,k t .o
f2 (Street or RoulCNo.)
23ry5aa f1F5 i'JG
ny or Town State
(4Q/1)- 73q. -7/22_
Area code- Phone number
4. DATE DRILLED I .-/(o
.2-7/3
Zip Code
5. TOTAL DEPTH: /nf7S
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO RI
7. STATIC WATER LEVEL Below Top of Casing: n 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 ('tar
10. WATER ZONES (depth): 0
11. DISINFECTION: Type //TN
12. CASING:
Depth Diameter
From6 To JAL/ FL 6 4
From To Ft.
Amount el
Wall Thickness
or Weight/Ft. Material
,3nrD.1 PVC
From To Ft.
13. GROUT: Depth Material
From !) To .a0 Ft..fP ,1e fl %
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
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
"T1
m
Crn
,cc7
u
-K7
LOCATION SKETC1,0
H(
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
timbers
c1 coemmn rPOd nam66s.
&11 tves _urn
rn /eh
an 74/06-0 5,ain;kg %vrn RiRhTaT 61,1
Method ‘i-rE exlo,rkei (,-o ? S73310 54,7 %orn %FPT
AzinD,,�no Go o.CroSs over /oc ss Turn Rt,bh To ii licc )
C>
From
From
' To Ft.
To Ft.
16. REMARKS: WAN TO
�9 Go,c2,6 rn,Yes Turn /ePTon of Hwy
/9Go C,I Th,"/es Torn /e"TOn 8vckneli
Uro%ricj) G-O 2,9 int"les lvn5 ,fl to •
/c /rl branch 6-6 males Tomn /ePT
On Pen -Tama. R-Je Gv, 0,a m,le Tarn
I� TGo, 0,3r7;le %v;-n Rehr m Ye
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
--Ni-•oN
/a->6-49
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
bo 44,-€)-frA-,tr-77,`e
Quer

WELL CONSTRUCTION RECORD" 3 0 6 914
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (prrinntt))� / 4.,-,7 t ee- a CERTIFICATION a 2 $6 3
71/
WELL CONTRACTOR COMPANY NAME err PHONE K lea) g -an2
STATE WELL CONSTRUCTION PERMITS _ ASSOCIATED WQ PERMITS
(if applicable) (if applicable)
1. WELL USE (Cheek Applicable Box): Residential CYMunicipal/Public 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery G Ilcat Pump Water Injection 0 Other LI If Other, List Use
2. WELL LOCATION:/
Nearest Town: rIo—rite e
Ca. ILO /5ter "44,
County -1"ca n
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: 2%ry £r/'ny e r'
Address % Tr •a) Co4ft•
(Street or Route No.)
City or Town State Zip Code
Area code- Phone number - D
4. DATE DRILLED /RI O
5. TOTAL DEPTH: /G R '
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO 9--
7. STATIC WATER LEVEL Below Top of Casing: ¥ U FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS / FT. Above Land Surface'
*Top of easing terminated atior below land surface requires ■
variance 1n accordance with ISA NCAC 2C .0118.
9. YIELD (gpm): /2— METHOD OF TEST /52 r
10. WATER. ZONES (depth): /5/0
11. DISINFECTION: Type
12. CASING:
Depth
From O To re)From, 70 To /6W
From To
13. GROUT: Depth
From,_.0.___ To egO
From To
14. SCREEN: Depth
From To
From To
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
/7°T/t
Diameter
Ft. G�
Ft. G.
Ft.
Amount /V c,.Q
Wall Thickness
or Weight/Ft. Material
l ri itL'c
/9r?
Material
FL /'o/74/
Ft.
Diameter
Ft. in.
Ft. in.
S1` ee
ethod
r efivrL
Slot Size Material
in.
in.
Front To Ft.
Topographic/Land r.etting
[Midge ❑Slope ❑Vaiky (Flat
(check appropriate box)
Latitude/longitude of well location
,vgr .29'VS./"''0f3'/7'Y/.z''
(degren/minutestmeends)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
PEPTU DRILLING LOG
From To Formation Description
o—Vs-
-l6 2-
a
n
IN)
4
LOCATION SKETCH at
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 STANDARDS, AND D THAT A C(M'Y_ OP IRIS 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
,D

WELL CONTRACTOR (INDIVIDUAL) NAME
ET ��((ppTrri�iTnt);�-,r n
WELL CONTRACTORCOM PANT NAME ARA I—YPC'n IA. x.0
STATE U'E LI CONSTRUCTION PERMIT;
(if applicable)
. WELL CONSTRUCTION RECORD LLLt L� r
North Carolina - Department of Environment and Natural aesources - Uiviision of \Yater Quality. - Ground eater Section
1 I CCI 4 47 CERTIFICATION # c2.
l� R
PHONE : A —sr V
ASSOCIATED P'Q PER?IlT#
(if applicable)
-
1. WELL USE (Check Applicable Box): Residential,, Municipal/Public ❑ Industria! 0 Aericulntral ❑
Monitoring ❑ Recovery ❑ • Heat Pump Water Injection ❑ Ocher 0 If Other, List Use
2. WELL LOC.ATIOi
Nearest Town:
County, . i
(Scree; :Nome. Nu:nb:r. . Community. Subdivison, Lot No.. Zip Code)
3. OWNER:
Address t-�-
I—ViAtc.ory
lu.
frtirlir);10,4 reel
i or Route No.)
ci p Co::
;2 ()- cog D' — f� g q Z
.Treycode-Pnore r. u:::cer
J. DATE DRILLED )9 - 27- C
5. TOTAL DEPTH: J QS"
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NOS
7. STATIC WATER LEVEL Below Top of Casing: 2 FT.
(Ise •'-" if Abo.e To; o r Casir._ i
S. TO? OF CAS!NG IS 1 FT. Above Land Surfa:e-
•T0p u!(vsin' s;rnu na tcd u:.ur beluw lead surtiic,i requires a
eu:Inn• in aceordea:e m,i:h 15,A NCAC 2C .0119.
9. YIELD ' 3C) METHOD OFTEST Ir)
10. WATER ZONES (d:pth): lib
11. DISINFECTION: Type (--(- CH'
12. CASING:
From
From
From
13. GRO'_ T:
From G
From o
Depth
To a 7 Ft.
To Ft
To Ft
To
14. SCREEN: Depth
From To
Frog To
15. SAND 'GRAVEL PACK
:
Depth
Front To
'From
16. REV!:ARKS:
O,,:r
141
Amount 1-,in;/17
V."-:I Thickness
or V.ei_ :Ft. Motor:./
sotz4 fvC—
Topographic/land setting
❑Ridge ❑Slope. ❑Valley )flat
(check appropriate box)
Latitude ongitudz of well location
(de;:ee>'cinu:e .'records).
Latitude longitude soure:❑GPS❑Topo_raphic map
(check box)
DEPTH DRILLING LOG
From To Formation Description
�7 rsZ
?`7'
//n
1/i--
TO
N
LOCATION SKETCH
Snow. direction and'dis:an:e i,: miles fronaeast
two State Roads or Co::ntc Roads. Include the roc
nambers and common road names.
Ft. aQ.inutt ' Nri%1P) _
Fr is meter +- c' vr*fu- t 4' .
Diameter S;o; Size Dtaxrh,
Ftin. in.
Ftin. in.
Size O.Izte ,_.
Ft.
To Ft.
I DO HEREBY CERTIFY THAT THIS WELL \VAS CONSTRUCTED IN ACCORDANCE WITH I5.A NCAC 2C, WELL
CONSTRICTION STANDARDS. AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
SIGNATLRE OF PERSON NSTRCCTING THE WELL DATE
Submit the original to the Division of Water Quality, Ground' ater Section. 1536 3 loll Sorsi:e Center -Raleigh, NC
27699-1536 Phnn: No. (919) 733-32! 1, a ithin 30 days. GV. -! REV: 07.2001

/v V
WELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources -
WELL CONTRACTOR (LNDIVTDUAL)NAME (print)
WELL CONTRACTOR COMPANY NAME AAA GREENE BROS. WELL DRLG.OF SYLVA, INC.
STATE WELL CONSTRUCTION PERMIT#
(if applicable)
ASSOCIATED WQ PERMIT#
(if applicable)
ivision of Water Quality
CERTIFICATION # Z S 9
PHONE # [phone]
1. WELL USE (Check Applicable Box): Residential' i Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection ❑ Other 0 If Other, List Use
2. WELL LOCA N• i
Nearest Town: �j M) t-
-#-/ �-I Li" 1
(Street Name, umbers( o unty, Subdivision, o4Zip Code)
3. OWNER: /T t-"t,a. t
Address Lilt P 3 /7-1,45-y „ 3 (/
(Street or Route o.)
County ��i [ t lw-c , ❑Ridge,qSlope OValle Topographic/Land setting
fL.ccY. - /�G (check appro riate box)
City or town State ��.,� Zip Code
( 828 )- c -- y / 76
Area code- Phone number
4. DATE DRILLED 1 - / [ -. 01/47
5. TOTAL DEPTH: -S D
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO RI
7. STATIC WATER LEVEL Below Top of Casing: / 3t) 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): C j METHOD 0 TEST
10. WATER ZONES (depth): CPS- )
11. DISINFECTION: Type
12. CASING:
Depth r
From C.)Y�' To / ,3 Ft.
From To Ft.
From To - Ft.
13. GROUT::�??' Depth
From [J To j , Ft.
From 3 To 72, C)
14. SCREEN: Depth
From To
From To
l5. SAND/GRAVEL PACK:
Depth
From To Ft.
From To Ft.
Amount
Wall Thickness
Diameter or Weight/Ft. Mate_ri l
50R7./
Material
Ft._�
Diameter
Ft. in.
Ft. in.
16. REMARKS:
Size
Slot Size
in.
in.
Material
Method
P
7f3Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:OGPSOTopographic map
(check box)
DEPTH DRILLING LOG'
From To Formation Description
30906
O--/.j/
l �l - 3OC
7r's -3'j
-r
LOCATION SKE H
Show direction and distance in miles from at least
o State Roads or County Roads. Include the road
numbers and common road names.
tc7 i2z
IV
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH ISA NCAC 2C WELL
CONSTRUCTION ST NDARDS, AND T� T A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
y//f/�`jC7,/.i,/SSIIGNATURE OF PERSON CONSTRUCTING THE WELL 3— a I -0-0
Qj
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.
DATE i-
-U
)
GW-1 REV.09/200`4n