Ja 2 CY2005

WELL CONSTRUCTION RECORD
a North Carolina Department of Environment
�and
�Natural Res urces-Division of Water Quality _
WELL CONTRACTOR(INDIVIDUAL)NAME (print) �y 1 r —� CERTIFICATION#Z
WELL CONTRACTOR COMPANY NAMEAAA GREE E BROS.WELL DRLG.OF SYLV&IN PHONE # [phone]
STATE WELL CONSTRUCTION.PERMIT# ASSOCIATED WQ PERMIT#.
(if applicable) (if applicable)
1. WELL USE(Check Applicable Box):Residential❑ Mu nicipal/PublicX� Industrial❑ Agricultural❑
Monitoring❑ Recovery ❑ Heat Pump Water Injection❑ Other 0 If Other,List Use
2. WELL LOCATIO Topo raphic/Land setting
Nearest Town: C n b4 ❑Ridge JSlope ❑Valley ❑Flat
(check appropriate box)
(Street Name,N b ,Community,Subdivision,Lot o.,Zip Code) Latitude/longitude of well location
3. OWNER: (degrees/minutes/seconds)
Address. / Latitude/longitude source:❑GPS❑Topographic map
(Str eror Rou No.) ` (check box)..
1 C (71 -7 DEPTH DRILLING LOG
City or State; Zip od From /,�` Formation Descri t n
sea - ` cat t ? C'
Area code-Phone number -g
zl
4. DATE DRILLE
5. TOTAL DEPT
6. DOES WELL lP A EXISTING WELL? YES❑ NO,4
7. STATIC WATER LEVEL Below Top ofCasing: 0FT. y
f (Use"+"if Above Top of Casing) a
8. TOP OF CASING IS �� FT.Above Land Surface* -
*Top of casing terminated at/or below land surface requires a 3 O�
variance in accordance w,ith�.1.5A NCAC 2C.0118.
9.. YIELD(gpm):��METHOD OF TEST / v 4 W s .
10.WATER ZONES(depth): ?�
/ LOCATION SKETCH ?5
11. DISINFECTION:Typed Amount Show direction and distance in miles from at lest
two State Roads or County Roads.Include the�raad
12: CASING: Wall Thickness _ �' --t y
Depth Diameter or Weight/Ft. Ma nal numbers and common road names.
From p To Ft. t,�` .� G'
From To Ft. o
From To Ft. j 7
13. GROUT: Depth Material Method V
From—0 To 61,,5 Ft. 0 rvtiy,r
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. REMARK
$:
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 STRUCTING THE WELL DATE
Submit the original to the Division of Water Quality,Attni Information Management,1617 Mail Service Center-
Raleigh,NC 27699-1617, Phone No.[phone],within 30 days.
GW-I REV.09/2004
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. , AAA GREENE BROS WELL DRLG. OF SYLVA IN�.
1800 SKYLAND DRIVE
SYLVA, NC 28779
[phone]
PUMP TEST RECORD
DATE: �7z 1D 5 OUST. NAME: �6z, -A (tea r
TIME DRAWDOWN GALLON PER METER READING
FEET MINUTE
300
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274 , 2-7 S
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1 35 308 2. a
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313 ,
5�S 31s Leo
r 2 . 3/5- 23 f!
- 5 316` z3�
z: 10 31 ?` ,z3
l Z 15 319, 2 3 5
f2- : zD 32r "
z3
1 ' 30 . 3z3 � . z3o
! Z ' Y ° 32. E 23 °

DATE: 20 CUST.NAME: 4ners
TIME DRAWDOWN GALLON PER METER READING
FEET MINUTE
z 3`v 3 2.7' 230
V. -Oo 330' 230
/`v. 333` 230
"Zo 3`3-7 ` Z3 5`
1 30 `33 z3 0
' o a 310, z25
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9 Zzv
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30 39 Zos

DATE:. L�� �s OUST. NAME: C A.p�VA Nrinc rs 1
TIME DRAWDOWN GALLON PER METER READING
FEET MINUTE
�{o 3) 5. 2OS
i
'7 : 317
7. 2t� gyp` 2- O� , -
--7: 1 3 c7 f' -(OS
7v02
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417
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AAA GREENE BROS WELL DRLG. OF.SYLVA INC.
1800 SKYLAND DRIVE
SYLVA, NC 28779
[phone]
PUMP TEST RECORD
2 ` CUST._NAME: �c� �-r VA
DATE.• I •
TIME DRAW G.ALLON PER 1VE'�ER READYNG
FEET MINUTE
2 3 `t3 1 d
19D .
1 Z Lr `'3 I
, moo 3`3 � � 5
._ 9-3
s� 36
3
Z- 0 4
3 �
z : 0 3 l s
85
3 Ia
3 : Zo zr ( gs
18a
q-,6`
q . z-O ?' a
' 3d $ ' 190

DATE:
�Z l /D s: CUST. NAME: rs
TIME DRAWDOWN GALLONPER - METER READING
FEET MINUTE
�`'•`f
�o :6 Iry
9 .3 05-�
/0 ! 0
a Z7 S b'O

CUST. NAME
DATE..
TIME RECOVERY TIME RECOVERY
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WELL CONSTRUCTION RECORD
North Carolina Department of Environment and N.atura esources-Division of Water Quality
WELL CONTRACTOR(L�IDIVIDUAL)NA.LNlE:(print) ((4Ci[ !cJ CERTIFICATION#
WELL CONTRACTOR COMPANY NANiE AAA GREENE BROS.WELL DRLG.OF SYLVA,INC. PHoYE # 82( 8)586-5550
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#. 1 4400
(if applicable) (if applicable)
I. WELL USE.(Check Applicable Box):Residential l� Municipal/Public❑ Industrial❑ Agricultural❑ Y
Monitoring l Recovery ❑ Heat Pump Water Injection❑ Other❑ If Other,List Use
2. WELL LOCATI Nt `
Topographic/Land setting N `�
Near t T wn: County ❑Ridge 14SIope ❑Valley . ❑Flat
'I _ (check appropriate box) ® a�
(Street Na bers,Community, ivisio Lot o., ip Code) �� ati ude/lOngitude of well location t.T1
try y1L, 31
3. OWNER. (degrees/minuics/seconds)
Address Latitude/longitude source:❑GPS❑Topographic map
' . (Street Of R ute No.) (� (check box)
c3 l.�L tx-x DEPTH DRILLING LOG
City or 1 n, acA. �:�Code From To Forrttation Description
828 _ 111111n,
Area code-Phone oum
4. DATE DRILLED - P,
5. TOTAL DEPTH: YV
l�Z. ll
6. DOES WELL REPLACE EXISTING WELL? YES 0
D Q _
7. STATIC WATER LEVEL Below Top of Casing: ( FT.
(Use'Y'if Above Top of Casing)
8. TOP OF CASING IS FT.Above Land Surface*
*Top of casing terminated a or below land surface requires a
variance in accorda/�c�e�wlth 15A NCAC 2C.0118.
9. YIELD(gpm): / V METHOD 0-TEST
10.WATER ZONES(depth): G; '
/ LOCATION SKETCH
11: DISINFECTION:Type Amount how direction and distance in miles from at least
12. CASING: Wall Thickness two State Roads or County Roads. Include the road
Depth iameter pr Weight/Ft. ,`Uaate numbers and common road names.
From To�_Ft. �Y, CIO -10
From To Ft. j. �!�
...From To Ft. �ry
13. GROUT: Depth Material
-V Method Cr ( (((JJ
From iJ To � Ft. �N From To Z��Ft. . �
14, SCREEN: Depth' Diameter Slot Size Mat al 11"1
From To Ft. in. in.
From -To Ft. in. m
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
16.:REMARKS:
1 DO HEREBY CERTIFY THAT T S WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C,WELL
CONSTRUCTION ST A A D THAT . PY O THI RD HA B PROVIDED TO THE WELL OWNER
C7
SIGNATURE F PERSON CONSTRUCTING THE ` _ DATE
Submit the original to the Division of Water Quality,Attnc Informa��o'n I�n�ig�menf, 16t7 hail Se&i G riter-
Raleigh,NC 27699-1617, Phone No.(9.19)733-7015,within 30 days. i �.i r - - -_ _.__I }�I
N Iff
G 11V.09/2004

' ? CcPARiN�
i:i•JT Qr E,'NYIRONME .HEALTH.&NIAT
OIV!Si0N'0_c VP0N.V..;: i � U'�'"L RCSOURCES
p.l F.l,,�tiAGEMcN'
GROUNDWATER SECTION
-ECOg3
i TEST P.O.EOX 27687-RALEIGH.N.C.27611
A' (919)733- 221
r'e5t C~ted by: t*22i�
e11 crjction Pernit. �Io.
!. WELL LO ,k•TLOP�: onst
t'iezr `-
Court-
ip
icae
Cc - `y'
Cr CuL,.d — �uacra,
LiSior and �ot Po.
N�9e1 FIJ. _ --�_► Lc ►Y1 � I �r c )
vv 4e -4
USE 0 kELL:
t—
Fu bli tidezres:i
aGIrLL � ) irriPg
Pa tf'
Casing Dja:pete, o
or,
s)rg tyP
y;P,lIiti� Ctr. ( ?
,_ % �F;-� ae4 {'ia$'C3i1n•" CI!•i�+
_mot. 1 L �� 5�r,g rs ti! �� .
gp''�' CC7fiC CaJ C ?�. c:Sp�o 1an� yi�r,rC
pJ`IPIPiG PATER ,5-1— e�';/t-t
- aft.er__t `F hours ai /~�
'•^itr L E V iE:`LCE
r� e -
..
cFwCl ty_ 300
Tirtz t Depth _
"-3 ter , ptre
r Fu
--�_ i eve1 t _
Rate Pz,rars �---�
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WELL CONSTR
North Carolina De a . UCTION RECORD
WELL CONTRA P ►ument of Environment and Natural Resources-Division r
CTOR(INDIVIDUAL)NAME (print) - of Water Quality
WELL CONTRgCTOR COMPANY N
STATE WELL CONS ` E AAA GREENE BROS, 11 t
TRUCTION PE�HIT# WELL DRLG.OF SYLVA,INC. CERTIFICATION#a�� 9
if a licable) PHONE # [phone]
. ASSOCIATED WQ PERMIT#
1.; WELL USX(Check Applicable
(if a licable)
Monitorin Box):Residential❑
gRecovery ❑ Heat N: Pump Municipal/Public 0
Water Injec tion❑. Industrial❑ Agricultural❑
mum
2. WELL LOCAT Other p. If Other List Use
i� Nearest ,Town: � r
1 L ` Coun
(Street Name,Numbers, op°graphic/Land Settin
Community,Subdivision, ' ge OSIoPe Malley Flat
`Lot No.,Zip Code) Rid (check appropriate
3 OWNER' `�' Latitude/longitudebox)
Addressofwelllocation
( treet or Route No.) (degrees/rtunutes/seconds)
City or 1 t a $ Latitude/longitude source:OGPSpTOPographic ma
Stvte -7 P
828 _ a 7 Zip Code ��--- DEPTH (check box)
Area code-Phone number s i From To DRILLING LOG
4• DATE DRILLED Formation Description
5, TOTAL DEPTH: I , — � D��
6..DOES WELL REPL�gC'EXISTING
7. STATIC WATER LE ELL? YES O NO a
VEL Below Top of Casing. 0
8•_TOP OF CASING IS (Use.•+•if Above Top o f� FT.
*Top orcastn to FT•Above
variance in accordance ed at/or
below land surface Land$urfaCe* :.
9• YIELD `' NCAC 2C.0 lgCe requires a Nyy
(gPtn)_,� ! METHOD OF TEST
,.�.10.WATER ZONES }�
mil: DISINFECTION:Type _
12. CASING: Amount LOCATIONS
r Show direction and.distancem le from at Depth Wall Thickness in
From [� Diameter or Wet ht/Ft. two State Roads or Coun least,
From To Ft. g Material numbers and co h'Roads..Include the road
From — Ft sf= Z f �y� moron road names.
13. GROUT;• -De th Ft•
From Top Material
From To---Ft. Method
14. SCREEN: Ft:
From Depth 1
Diameter
From . TO Ft. �'in. t Size M�n'a .
15. SAND/G To----Ft. in. _� LZ
RAVEL PACK: in. a �—
DepthFro
In �-
FromTo Ft.: S _Me Material (/
16. REMARKS:
I DO HEREB Y CERTIFY THAT THIS
CONSTRUCTION STANDARDS A WELL WAS CONS y
' TH q O TRUCTED IN ACCORDANCE
I RECORD WITH ISAN CAC 2C;WELL.
RD HAS BEEN� PROVIDED TO L.
THE WELL LL OWNER
OF PERSON CONSTRUCTING THEWELL:
Submit the original to the Di '
Raleigh,NC.27699- vision of Water Quali DATE
1617, Phone No.[phone] ty'Attn:Informahoa.]ySa
within 30 days.' J .4 �abeknt(>61�b M51$Lr�c #G rater_
1tlEV.09/20
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