Ma 2 CY2005

d.a SrA>F.a�4.,
RESIDENTIAL WELL CONSTRUCTION RECORD
. g
North Carolina Department of Environment and Natural Resources-Division of Water Quality
op
WELL CONTRACTOR CERTIFICATION If r]J�
1.WELL CONTRACTOR: /1 I. DISINFECTION:Type Amount
�1 -e Cz /�/e- g. WATER ZONES(depth):
Well Conhaclw(lndimdual)Name From To From To
L`'':1F fERQTHFRS WE I I`?II I VI: From_ To From—To—
Weil Contractor COV418'dRTANE CIRCLE Fran_ To From To
STREET ADORES SRANKLIN, NC 28734 6. CASING:
Thickness/
�Dep(h .-r, Diameter Weight Material
an Fr To FL (A 1,
SA
City or Town
F '/ Stale/ Zip Cale From To Ft. _
;1(A I-- 2 7' Y �/ L� From To_Ft.
Area code- Phone number
2.WELL INFORMATION: 7. GROUT: Depth Material Method
SITE WELL ID#(if applicable) From.___To__Ft._
STATE WELL PERMIT#(if applicable) From To Ft.
DWQ or OTHER PERMIT#(if applicable) 8. SCREEN: Depth Diameter Slot Size Material
WELL USE(Check Applicable Box): Residential Water Supply B"- From-_To_Ft.-in. _ in.
�.�- 7- �J From.—To Ft. IT, _ in.
DATE DRILLED
Ran,__To_Ft.—in. in.
TIME COMPLETED AM 0 PM-0
9. SAND GRAVEL PACK:
3.WELL LOCATION: �" yV� Iiepth Size Material
CITY: �rq/1.17( � N/ COUNTY // r�C`.:�/� FfO1n-- To Ft.
From To Ft.
Clll'I xtH From To Ft.
(Street Nam umbers,Community.Subdi.sion,Lot No.,Parcel,Zip Code)
TOPOGRAPHIC/LAND SETTING: 10.DRILLING LOG
❑Slope ❑Valley ❑Flat ❑Ridge ❑Other From To
Formation Description
(check appropriate box)
LATITUDE 3 =-,nyds
LONGITUDE
Latitude/longitude source: ❑GPS ❑Topographic map
(location of well must be shown on a USGS food,map and
attached to this form Anof using GPS)
4.WELL OWNER --/� ( r '
OWNER'S NAME �-1.tl-(le,
STREETADDRESS 4-L-,S - /li)y j_ee
�r�a A4 .n 23 y
city or Town State Ziu Code
L_)-
Area cafe- Phone number
S.WELL DETAILS: It. REt1ARKS:
)
a, TOTAL DEPTH:_
b. DOES WELL REPLACE EXISTING WELL? YES❑ NO❑
c. WATER LEVEL Below To of Casing: �V IDO HEREe,CERTIFY THAT THIS WELL WAS CONSTRUCTED N ACCORDANCE WITH
P ging) ISA NCAC]C,WELL CONSTRUCTION STANDARDS,ANDTHATACOPYOFTHIS
(Use'+-N Above Top of Casing) RECORD
/HAS BEEN PROVIDED TO THE WELL OWNER.
d. TOP p CASING IS 1 FT,Above Land S ream' ;v c 44 � � /
'Top of casing terminated aUw below land surface may require - ram:/ `-� -"'✓t-C--�
a variance in accordance with 15A NCAC 2C.01188. SIGNATURE OF CERTIFIED WELL CONTRACTOR DATE
e. YIELD(gpm):�METHOD OF TEST k i- ` &1/P r�✓.4/1 e
PRINTED NAME OF PER6QN&ONSTRUCTWG THE WELL
Submit the original to the Divisia rZG-61 'IDWithin days. Attn:
Information Mgt., --
1617 Mail Service Center—Faleigh,NC 27699-'1617 Phone No. 19)733-7015 ext 568. Form GW-ta
i Rev.7/05
FEB 01 2006 JAN 19 2006
Asheville Regional Office
Aquifer Protection

Cd��
RESIDENTIAL WELL CONS FRUCTION RECORD
Nonh Carolina Department of Environment and Natural Resources-Division of Water uali a. Quality
.. WELL CONTRACTOR CERTIFICATION 4
1.WELL C NTRACTOR: I. DISINFECTION:Type
Amount
g. WATER ZONES(depth):
W ell Contractor(Individual)Name From To
-. From To
From To From To
Well Contr C ^e _ ' 'des '�'+-�•2 From
CRANE CIRCLE -- TO From To
STREET ADDRESSFRANKLIN, NC 23734 6. CASING: Thickness/
Depth Diameter Weight Material
From U To�FL k7
City or TownState Zip Code From _To Ft. _
(!i )-�J ca[y-���� From—To—Ft.
Area code- Phone number
2.WELL INFORMATION: 7. GROUT: Depth Material Method
SITE WELL ID#(it applicable) From Lj To. -J Ft.C6
From _ To Ft._ /
STATE WELL PERMIT#lif applicable) From To FL
DWQ or OTHER PERMIT#(if applicable) 8. SCREEN: Depth Diameter Slot Size Material
WELL USE(Check ApplicableBox): Residential Water Supply R From To Ft.—in. _ in
DATE DRILLED)f e:);.- From' To Ft._in. _ in.
From To Ft. in. _ in.
TIME COMPLETED AM❑ PMEJ
S. SANDlGRAVEL PACK:
3.WELL LOC ION:
(Slree! � Depth . Size Material
CITY: COUNT From To Ft.From. Tc Ft.
NESf Cre, k From._ To Ft
ame,Numbers,Ccimmumly,Sabdimsion,Lot Nc.,Parcel,Zip Code)
TOPOGRAPHIC/LAND SETTING: W.DRILL ING LOG
❑Slope ClValley ❑Flat ❑Ridge ❑Other From To Formation Description
(check appropriale box) P n
LATITUDE 3 =d-iml
LONGITUDE
Latitude/longitude source: ❑GPS OTopographic map
(location of we#must be shown on a USGS fopo map and
attached to this form#not using GPS) -
4.WELL OWNER - -
OWNER'SNAME-Cho �i'1(Af'fYi.Cl/l T
_ cn
STREET ADDRESS �7
City or I Own Stale Zip Cod _
Area code- Phone number
5.WELL DETAILS: / 11. R&WARKS:
a. TOTAL DEPTH: d
b. DOES WELL REPLACE EXISTING WELL? YES❑ NO Cl
C. WATER LEVEL Below Top of Casing i FT IDO HEREBI CERTIFY THAT TR IN WELL WAS CONSTRUCTED ACCORDANCE WITH
. HA15A NCAC 2^.WELL CONSTRUCTION STANDARDS,AND THAT A COPY OF THIS
(Use-+-if Above Top of Casing) RECORD Hfs BEEN PROVIDED TO THE WELL OWNER.
d. TOP OF CASING IS FT.Above Land Surface' Y
*Top of casing terminated Wa below land surface may require
a variance in accordance With 15A NCAC 2C.0118, SIG T11ICTOF CERTIFIED WELL CONTRACTOR DATE
e. YIELD(gpm): J METHOD OF TEST i 4LNAM.E�ERS�
� -
N CONSTRUCTING THE.WELL
Submit the original to the Div is on of ater uality within 30 day ( Attn: Information �Aq[gg
1617 Mail Service Center-Ralelg ,NC 27699-1617 Phone No.(919)7 3.7015 ext 568. JH 19 2006 Porn GW-1a
FEB 07 2006 Rev,7/05
Asheville Regional Office
uifer Protection

RESIDENTIAL WELL CONSTRUCTION RECORD e ".
North Carolina Department of Environment and Natural Resources-Division of Water Qualitya
WELL CONTRACTOR CERTIFICATION#
1.WELL CONTRACTOR: I. DISINFECTION:Type Amount
ire d CyAp g. WATER ZONES(depth):
Well Contractor(Individual)Name From_ To From To
-
CRANE
CRANE ROTH RC YBFI I nRll I IN& ir4C From___To Fran To
Well Contractor ComMtjWIE CIRCLE Fran To From To
STREET ADDRESS RANKLlN, NC.Pik 4 6. CASING: Thickness/
,.t Depth D,apletpr Weight Material
U Fran- d To Ft. % r;/G
�[ City or Town State Zip Code From To Ft.
Fran To_Ft.
Area code- Phone number
2.WELL INFORMATION:
7. GROUT: Depth Material Method
Fran_ To FL .r j)/�
SITE WELL ID#(if applicable) Fran To Ft.
STATE WELL PERMIT#(Baoplicable)__ Fran—To-_FL_ _
DWQ or OTHER PERMIT#(if applicable) 8. SCREEN: Depth Diameter Slot Size Material
WELL USE(Check ApplicableBox): Residential Water Supply p' From—To Ft.—in. _ in.
DATE DRILLED From.—To_Ft.—in. _in.
From To Ft.—in. _in.
TIME COMPLETED AM❑ PM if
9. SAN[03RAVEL PACK:
3.WELL LOCATION: Depth Size Material
CITY: .(J, y n Fran To_Ft.
COUNTY m RC tv From To
Ft.
® /rot (A.)eAVe-✓ LA04e_ From._ To_Ft.
(Street Name Numbers,Community,Subdivision,Lot No.,Parcel,Zip Codet
TOPOGRAPHIC/LAND SETTING: 10.DRILLING LOG
❑Slope ❑Valley ❑Flat ❑Ridge ❑Other From To Formation Description
(check appropriate box)
May minutes,
e in degrees, 0-
LONGITUDE
LATITUDE 3 _ May es indegrns, U
_ _ in a decimal format ,
Latitude/longitude source: ❑GPS ❑Topographic maps
(location of we#must he shown on a USGS topo map and pJ
attached to this form 1 not using GPS) cJ'1
4.WELL OWNER �/ / I �f
OWNER'S NAME kAL11 I lIle pf f� 01
STR ET ADDRESS I�� M LAJ /� -
I� fi'�nl Fl. -3 3" .Z
City or Town Stale Zip Cale
Area code- Phone number
11. RE,AARKS:
5.WELL DETAILS:
a. TOTAL DEPTH: ASS
b. DOES WELL REPLACE EXISTING WELL? YES❑ NO❑
I DO HEREB r CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH
c. WATER LEVEL Below Top of Casing:C>FT. 15A NCAC 2C,WELL CONSTRUCTION STANDARDS,AND THATACOPY OF THIS
(Use'+•if Above Top of Casing) RECORD HAS BEEN PROVIDED TO THE WELL OWNER.
d. TOP OF CASING IS FT.Above Land Surface' �� /4��� / -;7
0
6
'Top of casing terminated atior below tend surface may require SIGNATURE OF CERTIFIED ELL CONTRACTOR a variance in accordance with 15A NCAC 2C.0118. DATE
e. YIELD(gpm): METHOD OF TEST�;r_ —L_Y�'e� �i�1rl e-- _
PRINTED NAME OF PERSON CONSTRUCTINGTHE WELL
Submit the original to the Division of Wateres jerllim+IV rM S. Att Information Mgt_;
1617 Mail Service Center—Raleigh,NC 2�7699-1617 Phone No.(919)733-701 ext 568. Form GW-la
FEB 0 7 2006
JAN 19 2006 Rev.7105
Asheville Regional Office
A ufer Protection

e Nr STAT[a n
RESIDENTIAL WELL CONS TRUCTION RECORD
North Carolina Department of Environment and Natural Resources-Division of Water Quality
" WELL CONTRACTOR CERTIFICATION#
1.WELL CONTRACTOR: t. DISINFECTION:Type Amount
Limn e— g. WATER ZONES(depth):
W e Conlr�— (individual)Name Flom To From To
Fran_ To From To
Well Cort o WELL DRILLING, IrM From— To From To
248 CRANE CIRCLE
STREET ADDRESS (,WNrN^2Z7,4 6. CASIAG: Thickness/
Depth Di- a Weight Material
From To, FL�y DL�G
SCity or Town // State / Zip Code From To Ft. _
( t11. 5� --'{ r2b From__ToFt.
Area code- Phone number
7. GROUT: Depth 2.WELL INFORMATION: .d� P Material Method
From v To Ll
SITE WELL ID#(it applicable) From To_Ft.
STATE WELL PERMITtr(dapplicable) From To—Ft.
DWQ or OTHER PERMIT#(if applicable) 8. SCREEN: Depth Diameter Slot Size Material
WELL USE(Check Applicable Box): Residential Water Supply.e' From To_Ft. in. _in.
�•l From _FL—in._in. _in.
DATE DRILLED�U'�(�-U'2' To F
_ _ToFL_in. _ in.
TIME COMPLETED qM❑ PM❑ From
9. SANDIGRAVEL PACK:
3.WELL LOCATION: Depth Size Material
CITY: G--'qnki h COUNTY &Jp(`�,I tti From To Ft.
From To Ft.
rR RSe "C- k From Tc Ft.
(Street Name,Numbers,Community,Subdi.a.... Lot No.,Parcel,Zip Code)
TOPOGRAPHIC/LAND SETTING: 10,DRILUNG LOG
❑Slope OValley ❑Flat ❑Ridge ❑Other From To
Formation Description
(check appr6priata box)
Pay he in degrees,
LATITUDE 3 utes,n tgrsorLONGITUDE decimal format .
Latitude/longitude source: ❑GPS ❑Topographic map
(location of we7 must be shown on a USGS topo map and r _
attached to this form r not using GPS) --_
4•WELL OWNER
Ln
OWNER'S NAME Ye I
STREETAgDRESS (7 G
®iVJ X" C Og'7 I. Z
City or Town Slate Zip Code Area code- Phone number
5.WELL DETAILS: 11. REMARKS:
,�
a. TOTAL DEPTH: 3bs^
b. DOES WELL REPLACE EXISTING WELL? YES❑ NO❑
C. WATER LEVEL Below Top of '�'` IDO HEREBI CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE Wrm
OP g: �J_�� FT. 15A NCAC 20,WELL CONSTRUCTION STANDARDS,ANDTHATACOPYOFTHIS
(Use'+•if Above Top of Casing) RECORyD�HA.S BEEN PROV�IIDED TO THE WELL OWNER
d. TOP OF CASING IS I FT,Above Land Surface-of
A�n / /7 ��
'Top casing terminated atfor below land surface may require SIGNATURE OF CERT IFIED CONTRACTOR DATE
W ELL
a variance in acco��rr�dance with 15A NCAC 2C.01 18.
e. YIELD(gpm): (a'fl)115-METHOD OF TEST xv _ — e[7
PRINTED,NAME OF PERSON CONSTRUCTING THE-WELL -
Submit the original to the Division of Wat r QualQ IEd���,ttn: Info ation Mgt.,
1617 Mail Service Center-Raleigh,NC 27699 1617 rp�t a o.( 19)733.7015 ext 68. Form GW-ta
Rev,7105
FEB 07 2006 JAN 19 2006
Asheville Regional Office
Ant ifar Protection

d.r SfAIEo�
RESIDENTIAL WELL CONSTRUCTION RECORD,,;
North Carolina Department of Environment and Natural Resources-Division of Water Quality
WELL CONTRACTOR CERTIFICATION# 2045
1.WELL CONTRACTOR: 1. DISINFECTION:Type H T H Amount 166Z
James B, Brown g. WAT R ZONES(depth): a
Well Contractor(Individual)Name From I Toy From To
Hedden Br h - Well Drilling, Inc. FrDm To /L` I From To
Well Contractor Company Name From To .;z /6 From To
STREETADDRESS 73 Holly Hills Vista Rd 6. CASING: Thickness/
Depth n Dia eter Welpa� ter' I
_ Frank7 inF,NG 78734 From 0 To Ft. _tititt
City or Town State Zip Code From_To Ft.
( 82ti 1- 369-9591 From To—Ft.
Area code- Phone number
2.WELL INFORMATION: 7. GROUT: Depth Material Method
SITE WELL ID#(It applicable) From
20 Ft._caTH1t & gxrdtE jU3Ld
From To Ft.
STATE WELL PERMITO(it applicable) From To Ft.
DWO or OTHER PERMIT#(a applicable) S. SCREEN: Depth Diameter Slot Size Material
WELL USE(Check Applicable Box): Residential Water Supply❑ From_To_Ft._in. _ in.
From Jo Ft.—In. _ In.
DATE DRILLEDq�7 From To—Ft_In. _ in.
Tl1f COMPLETED Ia AMi PM[] 9. SANDIGRAVEL PACK:
7,W iv,L LOC TION: Depth Size Material
From To Ft.
',;TY: COUNTY From To Ft.
-!J a From To Fl.
(Sheet Name,I ma rsT ommun ty,SUbdlyfillon.Lot No.,rArcel,Zip Code)
TOPOGRAPHIC/LAND SETTING: 10.DRILLING LOG
❑Slope ❑Valley ❑Flat ❑ll OOther From To Formation Description
(check opprdprlale box) 'May e in Clay & sand
lLATITUDETUDE ,� _ minutes,secondscoeds or r Gran i-a
L(3-iTUDE in a decimal fomut
La-udellongitude source: ❑GPS OTopographic map
(location of well must be shown on a USGS topo map and
attached to this Iorm ff not using GPS)
4.WELL OWNER - r
OWNER'S NAME -
STR-ET ADDR S ry
W
4y r Town
77 � - q e Zip Code eTr -
Area code- Phone number
11. REMARKS:
S.WELL DETAILS: ,
a. • CITAL DEPTH:
Id. t.9E3 WELL REPLACE EXISTING WELL? YES O NO 0
ADO 100 HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH
o. WATER LEVEL Below Top of Caaing:, FT. ISANc 2C,WELL CONSTRUCTION STANDARDS.AND THAT A COPY OF THIS
(Use'+'9 Above Top of Casing) jZATURE
AS BEEN PROVIDED TO THE WELL OWNER.
d. TOP OF CASING IS 2 FT.Above Land Surface'
'Top of casino terminated atfor below land Surface may require da
OF CERTIFIED WELL CONTRACTOR DATE a variance in accordance With 15A NCAC 2C.0118.
e. YIELD(gpm):—ZaL METHOD OF TEST B1Cfw James B. Brown
PRINTED NAME OF PERSON CONSTRUCTING THE WELL
Sul r 11 the original to the Division of Water Quality within 30 days. Attn: Inform tlon Mgt. Gw
161' all Service Center-Raleigh,NC 27699.1617 Phone No.[phone] ext 668 n E C E 1 V E bm.7/05•m
FEB 0 7 2006
Asheville Regional Office
Ag2jer Protection

01� <, ?, 1437
WELL CONSTRUCTION RECORD
North Carolina-Department of Environment and Natural Resources- IDS Division Water Quality-Groundwater Section
�
WELL CONTRACTOR(INDIVIDUAL)NAME'�(print I s lI 4'V yyl. �L,�Ij,.I�� CERTHrICATIONO—
WELL CONTRACTOR COMPANY NAME�1d)1 F F' 1 F2r-A iz')1('./) I T-3�1� PHONE # �
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
1. WELL USE(Check Applicable Box):Residential Municipal/Public❑ Industrial❑ Agricultural❑
Monitoring❑ Recovery ❑ Heat Pump Water Injection❑ Other❑ If Other,List Use
2. WELL LOCATION• Topo hic/Land setting
Nearest Town: 1 Courly ❑Ridge lope ❑Valley ❑Flat
10 <a iM( A 13.\k O C, 101
1 � (cheek appropriate box)
(Street Name,Numbers,Community,SubdivisiM Lot No.,Zip Code) Llt itudelloII etude 0 we l at
((�� j/� H Dt�J �'
3. OWNER: f"Ca.t,�,1 }�. , 0 C (degtees/miwres/seeonds)
Address 1l ' p(' i a T, C Latitudellongitude sourcep6PS13Topographic map
(Street or Rome No.) (cheek box)
L �� �� DEPTH DRILLING LOG
�)- 5 74 -`\64 Zip�e ?m /1 5 Fo'5 lion escriptioII
Area code•Phone number 1 - aoi hi
4. DATE DRILLED - -U
5. TOTAL DEPTH:
6. DOES WELL REPLACE EXISTING WELL? YES❑ NO)�
7. STATIC WATER LEVEL Below Top of Casing: FT.
(Use"+"ifAbove Top of Casing)
8. TOP OF CASING IS FT.Above Land Surface*
'Top of casing terminated at/or below land surface requires a
varia see is accordance with 15A NCAC 2C.0119.
9. YIELD(gpm): METHOD OF TEST
10.WATER ZONES(depth):
LOCATION SKETCH
11. DISINFECTION:Type 61 Amount JtLp Show direction and distance in miles from at least
12. CASING: Wall Thickness two State Roads or County Roads.Include the road
Depth Diameter Toy�m t Material numbers and common road names.
From_ �Q Ft 1,�1",2� f
From Tc FL_ �-
From To Ft
13. GROUT: Depth Material, Method
From_Top .Ft
FmmQ_To c
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:
I DO HEREBY CER THA S WELL WAS NSTRUCTED iN ACCORDANCE WITH 15A NCAC 2C,WELL
CONSTRU ON S AND THATA PY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
I ATURE OF PERSON CONSTI fffftwn DATE
Submit the original to the Division of Water Quality, roundwater Section,1636 Mail Se a Center-Raleigh,NC
27699-1636 Phone No.[phone],within 30 days. JAN 30 2006 GW-1 REV. 07/2001
Asheville Regional Office
Aquifer Protection

WELL CONSTRUCTION RECORD
North Carolina-Department of Environment and MNatural Resources-pDivision of Water Quality-Groundwater Section
WELL CONTRACTOR(INDIVIDUAL)NAME
E((prinq/'J idyikl I f t�i11-_1 k�e, CERTIFICA�TI(1ON�#_ _''jq
WELL CONTRACTOR COMPANY NAME /C.(P�12 P—A III CAe \f PM�'Va'�lT . YXL PHONE # LASLL0/110
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
1. WELL USE(Check Applicable Box):Residentia Municipal/Public❑ Industrial❑ Agriculnual❑
Monitoring❑ Recovery ❑ Heat Pump Water Tn lion❑ Other❑ If Other,List Use
s„2.111
2. WELL LOCATIO T: Topo phic/L and setting
Nearest Town: LA ll r County ❑Ridge A31ope ❑Valley ❑Flat
i n)t i I L Lci Li C tC k lL.n (check appmpriate box)
(Street Name,Numbers,Community,Subdivision,Lot No.,Tip Code) LatitudeAon 'lode of Il location
� N35a laS�oa2.H "k,0 0 5 3`'D 3'
3. OWNER: Ic as rL'A -'s ac_S (degreeam;mnesisecouds) '
Address `A Cf`0.:� .t Latitude/longitude sou rce:03PS❑Topographic map
(Suect or Rouen No.) r (eheckbox)
\ C DEPTH DRILLING LOG
City m Town sate Zip Code From To Formation Description
tom- 7k Lmt
Am coda Phone tnmtber Vi l r
4. DATE DRILLED �— l
5. TOTAL DEPTH: 5�=2
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO
7. STATIC WATER LEVEL Below Top of Casing: FT. 66,01
(Use"+"if Above Top of Casing)
8. TOP OF CASING IS FT.Above Land Surface•
'Top of casing terminated attar below land surface requires a
variance in accordance with 15A NCAC 2C.0118.
9. YIELD(gpm): �2 METHOD OF TEST 'f s2o ter
10.WATER ZONES(depth): L14ja
LOCATION SKETCH
11. DISINFECTION:Type Lt 1 I C ,r1 E, Amount I l Show direction and distance in miles from at least
12. CASING: Wall Thickness two State Roads or County Roads.Include the road
1 Depth Di or Weight/Ft. Material numbers and common road names.
From�_To]R� Ft el 1 0 aJQ;tl
From To Ft
From To Ft
13. GROUT: Depth Material Method
From To�Ft n ,
From��Tom_Ft n t
7
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 W CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C,WELL
CONSTRU N ST �, COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
S
SIGN OF PERSO ON ATE
RECEIVED
Submit the original to the Division of Water Quality,Gro dwater action,1636 Mail Service Cc iter-Raleigh,NC
27699-1636 Phone No.[phone],within 30 days. JAN 3 0 2006 -1 REV.07/2001
Asheville Regional Office

WELL CONSTRUCTION RECORD
North Carolina Department of Environment
andipattaaal Resources-Division of Water Quality
WELL CONTRACTORONDIVIDUAL)NAME
�(priui)11/LI-clyw+ J` --` •tL,-+r� CERTIFICATION#��-/
WELL CONTRACTOR COMPANY NAME I57 Yt�P.I t.��C CPC TdP[ Pl�� �.NC- PHONE#J .3Lq DI�-/U
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMTT#
(if applicable) (if applicable)
1. WELL USE(Check Applicable Box):Residential MunicipaYPublic❑ Industrial❑ Agricultural❑
Monitoring❑ Recovery ❑ Heat Pump Water Injection❑ Other❑ If Other,List Use
2. WELL LOCATION: q,, Topographic/Land settin
Nearest Town: Ic 1� Couny I✓i( CO-f _ ❑Ridge E3SIope ❑Valley t
5 M (,f1(Y-\ I (check appropriate box)
(Street Name.Numbers,Camrminity.Subdivision,Lot No..Zip Cade) Latitude(longitude of well location )I
3. OWNER:e-aQvc f Qtzi �o A!35 degre e9.3'' oads) ,3 �� 3S. i
Address4545 owtl\ Latitude/longitude sourcekY,y�G�rPS❑Topographic map
(Street or Route No.) (cheek box)
k 5S l mfnee [L 3`A I Lkta DEPTH DRILLING LOG
City3 orTowa State Zip Code From To FormationDescsipti
S _
o C 5ayk n- /,�L-7
Area code-Phone number
4. DATE DRILLED 5
S. TOTAL DEPTH: 1'
6. DOES WELL REPLACE MUSTANG WELL? YES❑ NO�
7. STATIC WATER LEVEL Below Top of Casing:_�[j�FT.
(Use"+"if Above Top of Casing)
K TOP OF CASING IS_�FT.Above Land Surface•
•Top ofcarbtg remYated Wow below Imd surface requires a
variance in seewdaacewhh 15A NCAC 2C.011&
9. YIELD(gpm): 1/,2 METHOD OF TEST ,f ?�
10.WATER ZONES(depth): 5y0
LOCATION SKETCH.
IL DISINFECTION:Type Ch ( i ;6f Amount C Li.0 Show director[and distance in miles from at least
t2. CASING: Wall Tbic)m�e —T two State Roads or County Roads.Include the road
Depth Diameter er Weight/Ft. Materiel numbers and common road names.
From tL_To-4�Ft. (r.l, 5J)S/_ v�
From To Ft.
From To Ft.
13. GROUT: Depth Material Method p
From o To_3 _Ft._(lfta4
From_To,g(o Ft. Gen)nii1e o
14. SCREEN: Depth Diameter Slot Size Ma Frl
From To Ft. in. in.
From—
From To Ft. in. in. cn ;n
15. SAND/GRAVEL PACK
Depth Sim Material o
Cn
From To Ft.—
Front—To—Ft.
16. REMARKS:
I DO HEREBY CERTIFY
°THAT SS WELL WAAS S PLUG ROE IN ORD ACCORDANCE
BEEN WITH 1 D TO THE WELL
CONS OWNER
ell
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
<a-
Submit the original to the Division of Water Quality,Attn:Information Management,1617 Mail Service Center-
Raleigh,NC 27699-1617, Phone Nw(919)733-7015,within 30 days
GW-I REV.09/2004

WELL CONSTRUCTION RECORD gt�
North Carolina-Department of Environment and Natural esou es-Division of Water Quali Groundwater Section, /
WELL CONTRACTOR(INDIVIDUAL)NAME (prim1) ' C' t'1 � C CERTIFICATION# G—Jq'R,/�
WELL CONTRACTOR COMPANY NAME 1CLJ UweA it mSeir.�ff-chneri �S- PRONE # nl'G7-(C)
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMM
1111111101 (if applicable) (if applicable)
1. WELL USE(Check Applicable Box):Residential Municipal/Public❑ Industrial❑ Agricultural❑
Monitoring❑ Recovery ❑ Heat Pump Water Injection❑ Other❑ If Other,List Use
2. WELL LOCATI L(� ` Topographic/Land settin
Nearest Town.- II t1 County ❑Ridge ❑Slope []Valley at
(checlswropdamboa)
(Street Nsme,Nombem,Community,Subdivision,Lot No,Zip code) Latitudellongit}ide of well location
���c c111 1 /-\LuO.0 ^J35(d �1 L�a,h�t la)yB, "o2�{1
3. OWNER: (aegteesmimocsiaemnds)
Address Sch;s�,L \&. LatitudellongitudesourceNGPS❑Topographicmap
_ (Strat or Rome No.) � - (amckboz)
E S� �y DEPT� tJL ���� DRILLING LOG
city or Town Sisk Zip Code Fr To Formation Description
Atea code-Phone member
4. DATE DRILLED I
5. TOTAL DEPTH:
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NOJAC
7. STATIC WATER LEVEL Below Top of Casing: '3D—FT.
(Use-+-if Above Top of Casing)
8. TOP OF CASING IS�—FT.Above Land Surface•
'Top of wing terminated atfor below land surface requires a
variance in accordance with ISA NCAC 2C.0118.
9. YIELD(gpm):;—METHOD OF TE I J
10.WATER ZONES(depth): .:�70
� � LOCATION SKETCH
IN 11. DISFECTION:Type _� "d Amount e u P Show direction and distance in miles from at least
12. CASING: Wall Thickness two State Roads or County Roads.Include the road
To = or�m, ly{atetial numbers and common road names.
tF Ft Jt,"
From To Ft
From To Ft.
13. GROUT: Depth Method
Fromm To Ft. �' o
14. SCREEN: Depth Diameter Slot Size 'al ;
From To Ft in. in. Ln
From To Ft in. in. p
15. SAND/GRAVEL PACK: Ln
Depth Size Material -
From To Ft.
From To FL
16. REMARKS:
I DO HEREBY CERTIFY THAT SWELL WAS CO UCTED IN ACCORDANCE WITH 15A NCAC 2C,WELL
CONSTRUCTION /CO F THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
L _ 5
SI ATURE OF PERSON C STRUCTING THE WELL DATE
Submit the original to the Division of Water Quality,Groundwater Section,1636 Mail Service Center-Raleigh,NC
27699-1636 Phone No.[phone],within 30 days. GW-1 REV.07/2001

W 312, 1 .13h
WELL CONSTRUCTION RECORD
North Carolina-Department of Environment and Natural Resources
-Division of Water Quality-Groundwater Sectio_on`/)� �
WELL CONTRACTOR ONDWWUAL)NAME (priar) Aqq (.�1 C&A 14�G l_.1lh.�Fi CERTIFIC�7A*T�RION# /24
WELL CONTRACTOR COMPANY NAME 1&V 1ACCt LC�1C l ffn-6t'4 S1 C PHONE #A.- ELII-e Plo
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable) if applicable)
1. WELL USE(Check Applicable Box):ResidentialA Municipal/Public❑ Industrial❑ Agricultural❑
Monitoring❑ Recovery ❑ Heat Pump Water Injection❑ Other❑ If Other,List Use
2. WELL LOCATIO Topographic/Land setting
Nearest Town: Y County Ridge ❑Slope ❑Valley []Flat
Fox 1k c1. yij-d> _ / � (check wmwnote,box)
(Street Name,Num miry,Subdivision.Lot No.,tip code) Latitude/longitude of well location /
j IDS 0�l'S�l o" W1/) 3V 23i:57< zy
3. OWNER: IJCI�(f lIP Lii1Aed0i'Yl i (�esred�sxoads)
Address `i Q x 9�C, / X 7 t oC2p Cse Latimde/longimde souro GPS❑Topographic map
(S Route No DEPT1. ( DRILLING LOG
city or Town State Zip Code From To Formatio Description
( } ,,7A-4to'I'l n — zC ` U
Area code-Phone number �7t^-• h`� 1I l'1Cx( ' I g'fkn.,
4. DATE DRILLED �2C"
5. TOTAL DEPTH: S ;3 cY
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO
7. STATIC WATER LEVEL Below Top of Casing: .
(Use'+"if Above Top of Casing)
8. TOP OF CASING IS FT.Above Land Surface•
`Top of casing termfoated st/or below land surface requires■
variance in aceordan with 15A NCAC 2C.0119.
9. YIELD(gpm): METHOD OF TEST
10.WATER ZONES(depth):- (oS
LOCATION SKETCH
11. DISINFECTION:Type("R n -j n P, Amount Show direction and distance in miles from at least
12. CASING: Wall Thickness F two State Roads or County Roads.Include the road
DepthQQ�� or Weight/Ft. Material numbers and common road[tames.
From To�Qy�Ft iE t � ll1(1�
From To FL
From To Ft. _-
13. GROUT: Depth A7Method
From_,i', _To `ZO Ft. C' I � 2f1ti �
From_�� To_Z _Ft�- ('E'r7�eo .
14. SCREEN: Depth Ihameter Slot Slu Matenal
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 THA THIS WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C,WELL
CONSTRUCTION ST S, A CO Y F THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
SIGNATURE OF PERSON C STR DATE
RECEI /
Submit the original to the Division of Water Quality,Gr undwater Section,l Service enter-Raleigh,NC
27699-1636 Phone No.[phone],within 30 days. JA N 3 O ;00
66 GW-1 REV.07/2001
Asheville Regional Office
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