Ja CY2006

WELL CONSTRUCTION RECORD
33 882
North ( 'al el ina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section q
%El.(ON'i' IRA( FOR (INOIIDU AI) NAME I print) p_,0bI&Webb CERTIFICATION k Z(//0
tvtl,t.(ONTRACTORCOMIPANVNAME 62reeL_4&/D eis GVP d-/9dif _PHONE#(92 £9S75/70
siA LE WELI. CONSI'RUCIION PERMIT#_ HO_4 _ _. ASSOCIATED WO PN:RMITk
(ifapplicable) (if applicable)
1. LVlll T, IJSE (Check Applicable Box): Residential (Municipal/Public 0 Industrial ❑ Agricultural 0
Monitoring 0 Recovery ❑ fleet Pump Water Injection D other 0 If Other, List Use
2. WELL LOCATION:
Nearest Town: ijIv . --.__-county JOLI4So7'
(Street Name. Numbers, Community, Sub�ion, tot No., Zip ('ode)
3. OWNER: C.(2 (1- LeJ6e rwoc4
Address O O)( 55(o
(Street or Route No.)
IO PS ic( G ZBi q
( ity of t„wtt State zip (ode
( BZ2f 5`52-
Area 1 >VA ('hone number
4 DATE. DRILLED __/z-ZO —O 6.._
5. 10IAI., DEP1T1: /t-QS
/0: 11'1.11 1)1111 A!1. 1.vt1' 1 lnr. IA I.1 I' VP: I I n'
7. STATIC 1NIATI R LEVEL Below" op of Casing: 910
it. se if Above Top of C using)
R. TUP OF CASING 1S FT. Above Land Surface"
1'np of casing terminated at/or below land surface requires a
s ariante in accordance pith 15A NCAC 2C .0118.
1)_ MELD Igpm): .3 97 METUOD OF TEST 2_1-loUrs
10. WATER. ZONES (depth): 10005
IMF
11. DISINFECTION: Type_ /472- Amount_. _.
12. CASING: Wall Thickness
Depth Diameter or Weieht/Ft. Mat-rjal
From_ � Toq V_S Ft ( 1" �C�
From 'Jo
1-rem... _._ To Ft.
13. ( ;ROIIT Depth Material Method
From0 To � Ft. Ccin�f TQ.P_
Ernn1 To
14. SCREEN: Depth Diameter Slot Size Material
Prom To Ft. in. in.
From_..... To Ptin. in. __._ ._
15. SAND:GRAVEI. PACK:
Depth Site Material
From 10 Ft.
1-rom... 10 It..
It. REMARKS:
Topographic/Land setting
❑Ridge ❑Slope ❑Valley Oat lat
(check appropriate box)
Latitudeilongitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTII DRILLING LOG
From To Formation Description
e Z14SA
7/
LOCATION SKFTC❑
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common road names.
1 DO I IEREBY CERTIFY TIIAT TIIIS WELL WAS ('ONSI'R(JCTED IN ACCORDANCE WITII I5A N('
(1 iNSA1d(JC TION STANDARDS, AND1I IAT A COPY OF TI IIS RECORD 1IAS BEEN PROVIDED TO
Olea---(41-dam
SIONAIURF. OF PERSON C'ONS114 (JCTING El IF WELL
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service
27699-1636 Phone No. [phone], within 30 days.
RECEIVED
OF WATER DUALITY
JAN 0 8 Z007
AC 2C, WELL
'DIE WELL OWNER
"5 D 7
DATE
Center - Raleigh, NC
GW-1 REV. 07/2001
m
ro
cza
v

NONRESIDENTIAL WELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources- Division of Water Quality
WELL CONTRACTOR CERTIFICATION # 2186
1. WELL CONTRACTOR:
J.D. MCCURRY
Well Contractor (Individual) Name
AAA GREENE BROS. WELL DRLG OF SYLVA, INC.
Well Contractor Company Name
STREET ADDRESS 1800 SKYLAND DRIVE
SYLVA NC 28779
City or Town State Zip Code
( 828 )_ 586-5550
Area code- Phone number
2. WELL INFORMATION:
SITE WELL ID #(if applicable) .3 51461qiii
STATE WELL PERMIT#(if applicable) /
DWQ or OTHER PERMIT #(if applicable) '767r7- /p D %3ad
WELL USE (Check Applicable Box) Monitoring p Municipal/Public ❑
Industrial/Commercial E Agricultural p Recovery p Injection p
Irrigationp Other ❑ (list use)
DATE DRILLED 8/31/06
TIME COMPLETED 5:00
AM p PM®
3. WELL LOCATION:
CITY: SYLVA COUNTY JACKSON
BALSAM MTN. PRESERVE OFF SUGAR LOAF ROAD
(Street Name, Numbers, Community, Subdivision, Lot No., Parcel, Zip Code)
��LLTOPOGRAPHIC / LAND SETTING:
_g2Slope ❑Valley ❑Flat ❑Ridge p Other
(check appropriate box)
LATITUDE 3
LONGITUDE
May be in degrees,
minutes, seconds or
in a decimal format
Latitude/longitude source: ID GPS ❑Topographic map
(location of well must be shown on a USGS opo map and
attached to this form if not using GPS)
4. FACILITY- is the name of the business where the well is located.
FACILITY ID #(if applicable)
NAME OF FACILITY BALSAM MTN. PRESERVE
STREET ADDRESS 52 SUGAR LOAF ROAD
SYLVA NC 28779
City or Town State
CONTACT PERSON BRAD
Zip Code
MAILING ADDRESS 52 SUGAR LOAF ROAD
SYLVA NC 28779
City or Town State
( 828 )_ 631-3021
Area code - Phone number
5. WELL DETAILS:
a. TOTAL DEPTH: 800
Zip Code
b. DOES WELL REPLACE EXISTING WELL? YES p NO
c. WATER LEVEL Below Top of Casing: 100 FT.
(Use "+" if Above Top of Casing)
ti ct u. ` ( +
d. TOP OF CASING IS 2 FT. Above Land Surface'
Top of casing terminated at/or below land surface may require
a variance in accordance with 15A NCAC 2C .0118.
e. YIELD (gpm): 25 METHOD OF TEST AIR
f. DISINFECTION: Type HTH Amount 36 OUNCES
g. WATER ZONES (depth):
From 260 To 283 From 640 To 643
From To From To
From To From To
6. CASING:
D am.6 Thickness/ M �e
From 0 Depth
Ft.6 j/4"ter W,le88t STEEL
From To Ft.
From To Ft.
7. GROUT: Depth Material Method
From 0 To56 Ft. CEMENT
From To Ft.
From To Ft.
8. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in.
From To Ft. in. _ in.
From To Ft. in. in.
9. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
From To Ft.
10. DRILLING LOG
From To Formation Description
0-51 CI AY
51-280 GRANITE
280-2R3 CAVITY
283-640 GRANITE
640-643 CAVITY
643-800 GRANITE
11. REMARKS:
()h- fl !R()tlAjITY
Alit 2 no?
100 HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH
15A NCAC 2C, WELL CONSTRUCTION STANDARDS. AND THATA COPY OF THIS
RECORD HAS BEEN PROVIDED TO THE WELL OWNER.
tt C..- d--L'7
SIGN TURE OF CERTIFIED WELL 1ONTRACTOR DATE
PRINTED NAME OF PERSON CONSTRUCTING THE WELL
Submit the original to the Division of Water Quality within 30 days. Attn: Information Mgt.,
1617 Mail Service Center— Raleigh, NC 27699-1617 Phone No. [phone] ext 568.
Form GW-1 b
Rev. 7/05

NONRESIDENTIAL WELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources -Division of Water Quality
WELL CONTRACTOR CERTIFICATION # 2186
` C3J
1. WELL CONTRACTOR:
J.D. MCCURRY
Well Contractor (Individual) Name
AAA GREENE BROS. WELL DRLG OF SYLVA, INC.
Well Contractor Company Name
STREET ADDRESS 1800 SKYLAND DRIVE
SYLVA NC 28779
City or Town State Zip Code
( 828 )_ 586-5550
Area code- Phone number
2. WELL INFORMATION:
SITE WELL ID #(if applicable) J59221W
STATE WELL PERMIT#(if applicable)
DWQ or OTHER PERMIT #(if applicable) 7672-90-6310
WELL USE (Check Applicable Box) Monitoring ❑ Municipal/Public ❑
Industrial/Commercial E Agricultural ❑ Recovery ❑ Injection ❑
IrrigationE Other ❑ (list use)
DATE DRILLED 8/23/06
TIME COMPLETED 5:00 AM ❑ PM E
3. WELL LOCATION:
CITY: SYLVA COUNTY JACKSON
BALSAM MTN. PRE. OFF SUGAR LOAF ROAD
(Street Name, Numbers, Community, Subdpasion, Lot No., Parcel, Zip Code)
TOPOGRAPHIC / LAND SETTING:
❑Slope ❑Valley ®Flat ❑Ridge ❑ Other
(check appropriate box)
LATITUDE 3
LONGITUDE
May be in degrees,
minutes, seconds or
in a decimal format
Latitude/longitude source: ❑GPS ❑Topographic map
(location of well must be shown on a USGS opo map and
attached to this form if not using GPS)
4. FACILITY- is the name of the business where the well is located.
FACILITY ID #(if applicable)
NAME OF FACILITY BALSAM MTN. PRESERVE
STREET ADDRESS 52 SUGAR LOAF ROAD
SYLVA NC 28779
City or Town State
CONTACT PERSON BRAD
Zip Code
MAILING ADDRESS 52 SUGAR LOAF ROAD
SYLVA NC 28779
City or Town State Zip Code
( 828 )_ 631-3021
Area code - Phone number
5. WELL DETAILS:
a. TOTAL DEPTH: 660
b. DOES WELL REPLACE EXISTING WELL? YES ❑ NO IE
c. WATER LEVEL Below Top of Casing: 300 FT.
(Use "+" if Above Top of Casing)
d. TOP OF CASING IS 2 FT. Above Land Surface*
*Top of casing terminated at/or below land surface may require
a variance in accordance with 15A NCAC 2C .0118.
e. YIELD (gpm): 60 METHOD OF TEST AIR
f. DISINFECTION: Type NTH Amount 29.7 OUNCES
g. WATER ZONES (depth):
From 655 To 658 From To
From To From To
From To From To
6. CASING: Thickness/ ���e a�
From 0 DTot53 Ft. 6 1/4Dlsam''ter W,leiaht STEEL
From To Ft. 88
From To Ft.
7. GROUT: Depth Material Method
From 0 To 53 Ft. CEMENT PUMP
From To Ft.
From To Ft.
8. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. _ in.
From To Ft. in. in.
From Toin.--
9. SAND/GRAVEL PACK: `
Depth
From
From
To Ft.
To Ft.
Size Material
From To Ft.
10. DRILLING LOG
From To Formation Description
0-48 CI AY
48-655
655-658
658-660
11. REMARKS:
GRANITE
CAVITY
GRANITE
REGE1Wu1
ay. OF WATER QUAL1rY
FEB x 2 2U®7
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH
15A NCAC 2C, WELL CONSTRUCTION STANDARDS. AND THATA COPY OF THIS
RECORD HAS BEEN PROVIDED TO THE W LL OWNER.
xi - (1iirL_, WET
—�-67
SIG ATURE OF CERTIFIED WEµ CONTRACTOR DATE
S.t _ fn C.. � I'n
PRINTED NAME OF PERSON CONSTRUCTING THE WELL
Submit the original to the Division of Water Quality within 30 days. Attn: Information Mgt.,
1617 Mail Service Center— Raleigh, NC 27699-1617 Phone No. [phone] ext 568.
Form GW-lb
Rev. 7/05

1. WELL CONTRACTO•
.�D
_RESIDENTIAL WELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources -Division of Water Quality
WELL CONTRACTOR CERTIFICATION # a^
f. DISINFECTION: Type HTM
g. WATER ZONES (depth): .
From a soTot%
From To
From To
6. CASING: D'arr}eter
/' /
From C Depth To FLJL4
From To Ft.
Fran To Ft.
it re"'
Well Contractor (Individual) Name
AM GREENE BROS. WELL DRLG. OF SYLVA, INC.
Well Contractor Company Name
STREET ADDRESS
1800 SKYLAND DRIVE
�—
SYLVA NC
City a Tam State
82t 8 1_ 586-5550
Area code- Phone number
WELL INFORMATION:
N/
SITE WELL ID *if apolt7aae) ���G 9
STATE WELL PERMTT#(ir applicable)
DWQ a OTHER PERMIT POI applicable)
WELL USE (Check Applicable Box): Residential Water
DATE DRILLED--
TIME COMPLETED__._-- AM PM.'
3. WELL LOC 1IO
CITY:
♦ - ��'`% OUNTY
28779
Zip Code
707,3cu
2.
(Street Name, Numbers, Community,
\TOOPOGRAPHIC / LAND SETTING:
�awpe [Valley ❑Flat Ridge❑❑Other
_ (check appropriate box)
LATITUDE
LONGITUDE_
Latitude/longitude source: ❑GPS ❑Topographic map
(location of welt must be shown on a USGS topo map and
attached to this form ?not using GPS)
4. WELL OWNER
OWNER'S NAM Sa
STET AI DRESS
City `� am Stat c)
Area code- Phan number
muber
5. WELL DETAILS:
a. TOTAL DEPTH:,
b. DOES WELL REPLACE EXISTING WELL? YES ❑ NO ❑
c. WATER LEVEL Belau Top of Casing:
FT.
(Use '+"if Above Top of Casing)
d. TOP OF CASING IS FT. Above Land Surface'
'Top of casing terminated at/or below land surface may require
a variance in accordance with 15A NCAC 2C .0118.
e. YIELD (gpm): _METHOD OF TEST I
May be in degrees,
minutes, seconds or
in a decimal format
Zip Code
SS
i
7. GROUT: Depth
Fran U Ti__ Ft.,
Fran _To 7% FL,
From To Ft.,
8. SCREEN:
Fron_,
From......
From
Depth
To
To
To
9. SANDIGRAVEL PACK:
Depth
From To
Fran To
Fran To
b777
10. DRILLING LOG
From To
11. REMARKS:
From.
From,
From
Material
rn. V 4 f y'
Amount
To
To
To
Thickness/
Weight . -
Method
Diameter Slot Size Material
FL in. —. M.
FL in. in. '
Ft. in. -- in.
Ft.
Ft.
Ft.
Size Material
Formation Description
1,0
t
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH
15A NCAC 2C. WELL BEEN PROVIDED CONSTRUCTON
STANDARDS.
AND THAT A COPY OF IRIS
RECORD
AS
SIGNATURE OF CERTIFIED WEL CONTRACTOR
11ICC .k
PRINTED NAME OF PERSON CONSTRUCTING HE WELL
Submit the original to the Division of Water Quality within 30 days. Attn: Information Mgt.,
1617 Mail Service Center— Raleigh, NC 27699-1617 Phone No. [phone] ext 566.
t
4_ fa46
DATE
Form GW-1a
Rev. 7/05

RESIDENTIAL WELL CONSTRUCTION,RECORD
North Carolina Department of Environment and Natural Resources -Division of Water Quality
WELL CONTRACTOR CERTIFICATION #
1. WELL CONTRACTOR:
0 !l'1--��{yn t,t Well Contractor (Individual) Name
AAA GREENE BROS. WELL DRLG. OF SYLVA, INC.
Well Contractor Company Name
STREET ADDRESS 1800 SKYLAND DRIVE
SYLVA NC
28779
City or Tam State Zip Code
( 828 )_ 586-5550
Area code- Phone numbs
2. WELL INFORMATION: ?IC 7(.2 �-1 �J 2
SITE WELL ID it(il applicable) srj 70 `/ 3 L� l
STATE WELL PERMIT#01 applicable)
DWQ or OTHER PERMIT #(if applicable)
WELL USE (Check Applicable Box): Residential Water Supply ID'
DATE DRILLED T — / { " 0 6,
TIME COMPLETED J AM ❑
3. WELL LOCATION:
CITY: - COUNTY,
7 Mt 7
(Street NNaa{n,�e, N,uSmbers, mrypp, Subdtisior( Lot
�NJJyb[P�ar , Zip Code)
TOPOGRAPHIC/ ND G/1 / S'"kf
(/Slope °Valley 0 Flat O Ridge 0 Other
/ v (cheek appropriate box)
LATITUDE
PMM
LONGITUDE
Latitude/longitude source: ❑ GPS 0 Topographic map
(bcation of well must be shown on a USGS topo map and
attached to this form if not using GPS)
4. WELL OWNER i')
May be in degrees,
minutes, seconds or
in a decimal Tormat
City or Town
(t -5 )- �.-J .fir' % /
Area code - Phone n mbar
- 90 ' (:/�'
OWNER'S NAME 4-D‘i Sa M A114/) 1 e
STREET ADDRESS �J" 75 L( [N La- --
o n c�I cQ 7 7
State Zip Code
5. WELL DETAILS:
a. TOTAL DEPTH: 3SO
b. DOES WELL REPLACE EXISTING WELL? YES 0 NO -
c. WATER LEVEL Below Top of Casing: / C-1I
(Use'+' if Above Top of Casing) /
d. TOP OF CASING IS FT. Above Land Surface'
-Top of casing terminated at/or below land surface may require
a variance in accordance with 15A NCAC 2C .0118
e. YIELD (gpm): 1 7_. METHOD OF TEST / ( r—
6.
ri 9 .. In .11
,tIb 7 7s�
Amount I °UCES
f. DISINFECTION: Type ^' ^
g. WATFR ZONES (depth):
Froat)'i To r2 St Fran_
Fran To From_.
From To From
To
To
To
CASING: � Thickness/
Depth pipTeter W ''`ghht . Mat aI
Fran (.� To ri.-f Ft. 11�: tly�Ll.4 5 'Q/
From To Ft.
From To Ft.
7. GROUT: Depth Material
From To Ft.
From To Ft.
Fran To Ft.
Method
8. SCREEN: Depth Diameter Slot Size Material •
From To Ft. in. in.
From To Ftin. in.
From To Ft in in.
9. SAND/GRAVEL PACK:
Depth
From
To Ft.
From To Ft.
Size
Material
From To Ft.
10. DRILLING LOG
From To Formation Description
tit
T S7d
2 S U ti
-
"•2.`y — 3 C
100 HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCDRDANCE WITH
I5A NCAC 2C, WELL CONSTRUCTICN STANDARDS, AND THAT COPY OF THIS
RECORD HAS BEEN PROVIDED TO THE WELL OWNER.
P1C:,r..
SIGNATURE OF CERTIFIED WLL COf RACTOR
—� 1i �R O lON T 6t L
PRINTED NAME OF PERSON CONSTRUC NG THE WELL
Submit the original to the Division of Water Quality within 30 days. Attn: Information Mgt,
1617 Mail Service Center— Raleigh, NC 27699-1617 Phone No. [phone] ext 568.
Form GW-la
Rev. 7/05

North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
1636 Mail Service Center - Raleigh, N.C. 27699.1636-Phone [phone]
WELL CONSTRUCTION RECORD WELL CONTRACTOR. e-9-1- 41 4' ^= L
WELL CONTRACTOR CERTIFICATION #: 2 /
STATE WELL CONSTRUCTION PERMIT#:
1. WELL USE (Check Applicable Box): Residential I!._7 Municipal ❑ Industrial ❑ Agricultural ❑ Monitoring ❑
Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use:
2. WELL LOCATION: (Show sketch of the location below)
Nearest Town: & .44LW -1 County'
l-
MOuw tetilActccr Ra.
(Road Name and Numbers, Community, or Subdivision and Lot No.)
3. OWNER S. Ccfl
ItAI:Ttr
City or Town Stale
4. DATE DRILLED I / /a l a(v
5. TOTAL DEPTH / e &
6. CUTTINGS COLLECTED YES ❑ NOca,
7. DOES WELL REPLACE EXISTING WELL? YES NO0
8. STATIC WATER LEVEL Below Top of Casing: O FT.
(Use 9 Above Top of Casing)
9. TOP OF CASING IS j FT Above Land Surface*
'Top of casing terminated at/or below land surface requires a variance in accor-
dance with 1SA NCAC 2 .0118
10. YIELD (gpm)• :SO METHOD OF TEST
11. WATER ZONES (depth): Asheville Reginnal Office
Aquifer Protection
DRILLING LOG
From To
0 — 4 l
C7' /(3
DEPTH
Formation Description
dv.n aD€EA-el i.t L
t Q n i
k'D 1 211,1S
Address 'g ,:rg ep 7 a
(Street or ?vie No.)
tom'? £s76-1
Zip Code
12. CHLORINATION: Type rt Amount c '.1
13. CASING:
Wall Thickness
Depth Diameter orwe hUFt. Material
From To g ( Ft le r `{ apa C-
From To Ft
From To Ft.
14. GROUT:
Depth np� Material Method
From 0 To Ft. ``e -r a- �:, fa
From To Ft
15. SCREEN:
Depth Diameter Slot Size Material
From —To _ Ft in _ in
From _ To _ Ft _ in — in
From To Ft. In in
16. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft
If additional space is needed use back of form
LOCATION SKETCH
(Show direction and distance from at least two State
Roads, or other map reference points)
0
U1
17. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY,QF THIS RECORD E%A.S BEEN P VIDEO TO THE WELL UWNtH.
RECEIVED
FOR OFFICE USE ONLY
Quad No:
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
Submit original to Division of Water Quality, Groundwater Sectithfn 'polo
GW-1 RED. 12/99
Asheville Regional Office
Aquifer Protection
Serial No.

North Carolba a • Daparrwnr Emkatnrend Noon d Nina dam Water Oudy Groundwater - Groundwatera Section ,., ' .: e '
1939 Met Soma Canter- RSSV% N.C. 27099-1S36Phone [phone]
WELL CONSTRUCTION RECORD WELLcoNTRACTOR: 0 Lon -I v\ni k
WELL CONTRACTOR CERTIFICATION oc;
STATE WELL CONSTRUCTION PERMIT*:
1. WELL USE Mock Appkobb sew): ReMdentdQ Municipal 0 Industrial 0 Agricultural 0 Mordlorbp ❑
Recovery ❑ teat Pump Water kh)eota, ❑ Otaer p I other, List Use
2. WELL LOCH tVN• (Show sketch of 0* location Sow) , tL.cy
Nprw*Towc - y )v'C4 cowry. I k 11l
°beer
3. OWN@i (TM l r _ . l Lr
Address
Pork
DPIWNG LOG DEPTH
Ran To Faneem
City rT )ln 8�b Zip Cede
4. DATE DRILLED
5. TOTAL DEPTH 1
6. CUTT9NGS COLLECTED YES 0 NOES
7. DOES WELL REPLACE EXISTING WELL? YES 0 NOQ'
8. STATIC WATER LEVEL Show Top of Cluing: FT.
AbeU Above Tay at Coming)
9. TOP OF CASINO IS FT. Above Land Wear
•Tay a maw brabrebt arm bYw lend sten regime a vain In ogeors
dna IS 1SA HCAC 2C A112
10. YIELD (gpm): Q_ METHOD OF TEST 1 ri
11. WATER ZONES (deplhp
•
12. CHLORINATION: Type
13. CASINO:
Amount 5 _iL ,ra) specs b needed use ben of lam
Yves THmiwus LOCATION SKETCH
Dep9h� � rwoven. dnr.7on And Sarre from at lent two Ebb
t From TO F1 { 117de, or other othmap Sant points)
lS Li
Fran To FL f
From To FL Q 1`
14. GROUT:
�^^ 'fit e Q
Ms Method .J� �/J e s
From T l fl�l •
c
C-m
O
O iU
From To FL ICV -
15. SCREEN: N,f.
Depth Diameter Slot Star Materiel
From _ To _ FI _ In. _ In.
From _ To _ FL _ In. _ In.
From _ To _ FL _ In. _ In.
16. SAND/GRAVEL PACK
Depth Size Malarial
From To FL
From To FL
17. REMARKS:
01
Lt1s
r-
t DO HERESY CERTIFY THAT TWS WELL WAS CONSTRUCTED 1N ACCORDANCE WITH 15.4 NCAC 24. WELL
CONSTRUCTION STANDARDS. AND THAT A COPX OF THIS RECOR kHAS SEEN OVIDED TO THE WELL OMIIER.
FOR OFFICE USE ONLY d� 7 tC'j g— 41-4
Owed Ire
Sold Ns.
9pNATw1E OF PERSON COMST$UCtalw 11E MEM DATE
Same adjul b O6bbnetVidor t. Owadesbr Sohn whin 30 days
OWF4 REV. 127e
ai

13. CASING:
Address
reel or 0.
City orTown State 21p Code
4. DATE DRILLED
5. TOTAL DEPTH
6. CUTTINGS COLLECTED YES ❑ NO[J
7. DOES WELL REPLACE EXISTING WELL? YES ED NOC
8. STATIC WATER LEVEL Below Top of Casing: F7.
9. TOP OF CASING IS (Use w a Above Tap of Casing)
FT. Above Land Surface'
'Top of casing tarminatad at/or below lend surface requires a variance In accor-
dance with 15A NCAC 2C.a11a
10. YIELD (gpm): _ _ METHOD OFTEST cf
11. WATER ZONES (depth):
North Carolina - Department of Environment and Natural Resources • Division of Water Duality • Groundwater Section
1636 Mail Service Center - Raleigh, N.C. 27699•1638•Phone [phone]
WELL CONSTRUCTION RECORD WELL CONTRACTOR:
WELL CONTRACTOR CERTIFICATION a:
STATE WELL CONSTRUCTION PERMIT.:
fT3o
1. WELL USE (Check Applicable sox): Residential[ Municipal 0 Industrial ❑ Agricultural ❑ Monitoring ❑
Recovery ❑ Heat Pump Water Injection
❑ Other 0 If Other, list Use:
2. WELL LOCATION: (Show sketch of the location below)
Nearest Town: ' ✓ i
County:
(Road Name and Numbers, Conrnunity. or Subdivision and Lot No.)
3. OWNER DRILLING LOG DEPTH
From To Formation DescApdon
7*'
12. CHLORINATION: Type Amount
11 additional space is needed use back of form
Depth Diameter Wail Thickness
From To �J or Weight/Ft. Material
Ft. S.
From To Ft
From To Ft,
14. GROUT:
Depth Material Method
From To ' Ft. - l
From To Ft
15. SCREEN:
Depth Diameter Slot Size Matenal
From To Ft _ in. in
From To Ft. in in.
From To FL ___ In. __- in
16. SAND/GRAVEL PACK:
Depth Size Material
From To Ft
From To Ft.
17. REMARKS:
LOCATION SKETCH
(Show direction and distance from at least two State
Roads, or other map reference points)
1 DO HEREBY CERTIFY THAT 71113 WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COP x� OF THIS RECORD AS BEEN PROVIDED TO THE WELL OWNER.
FOR OFFICE USE ONLY i� —� 4 -- 4' -- 0 fr
Quad No:
NATURE OF PERSON CONSTRUCTING THE WELL DATE
Submit original to Division or Water Quality, Groundwater Section within 30 days
Sinai No.
GW-1 REV. 12,99

RESIDENTIAL WELL CONSTRUCTION RECO:2D
North Carolina Department of Environment and Natural Resources- Division of Water Quality
WELL CONTRACTOR CERTIFICATION #- OM ate
337./07
1. WELL CONTRACTOR:
+ztc:
We Contractor (Individual) Name
ct,42- 1 ' e..twiyye4-r, * SAn.
Wen Contractor Canpay Nate
STREET ADDRESS VARoZQCI
Ho-} 6Tc;r1nS1 NC
Z����pp
City or Tam stage -Zip Code
(83%)- tn(oS- aoaa.
Area code- Phone number
2 WELL INFORMATION:
SRE WELL ID S(e applicable)
STATE WELL PERbAPr(aah,I;,em_)
DWQ a OTHER PERMIT S(8 applicable)
WELL USE (Check Apitsrhma Rug: Residartial Water Supply r0'
/
DATE DRILLED /.07a:-%-c
TIME COMPLETED" 1-4.00
3. WELL LOCATION:
CfTY: .Syq o
/d ryy 9 V/
{Slane! Name. Numbers, Cranmun:y. SabdMsion, Lot No.. Parcel, Zlp Code)
TOPOGRAPHIC / LAND SETTING:
°Slope °Valley ❑Fat ❑Ridge DOBIer
(check appropriate bare)
LATTfUDE 3 _
LONGITUDE
Latitude/longitude source: D GPS °Topographic map
(location ofwe8must be sham on a VSGS tops map and
attached to Int form 'not using GPS)
_ AM ❑ PMI;j/
COUNTY
May be in degrees,
minutes, seconds or
in a decimal finlat
0. WELL OWNER
OWNER'S NAME tf evl nst &: pso n
STREET ADDRESS 5100 E14 as Lb+ I0
Acu Sbr. c;+y &3c 2.2113
Carer Torn State Zip Code
(8a2. , Wr7-9a63
Area code- Phone number
S. WELL DETAILS: �//c
a TOTAL DEPTH: �J
b. DOES WELL REPLACE EXISTING WELL? YES D
NOV
c. WATER LEVEL Below Top of Casing: y80 FT.
(Use s+"iTAbove Top of Casing)
d. TOP OF CASING is +, FT. Above Land surface*
'Top e f casing tem&r�d Won below land surface may require
a variance in e.,,,Jan.e with ISA NCAC 2C .0118.
e. YIELD (gpm): METHOD OF TEST 0,.•'E1
f. DISINFECTION: Type r 113
Amount (/ O
g. WATER ZONES (depth):
From To From To
From To Fran To
From From To
6. CASING:
From
Fran
From
Thickness/
FT D�_WeMaterialT egtt M`
To Ft.
To Ft.
It
7. GROUT:tom Depth Material
From Q To C21 FT. Cente!1t
From To FL
From To Fi.
8. SCREEN:
From
From
From
Depth
To
To
To
psi C
Diameter Slot See Material
FT. in. in.
R r+ in
PI _ vm. in.
9. SAND/GRAVEL PACK:
Depth Size Material
Fran To FL
From To Ft
From To Ft
10. DR!WNG LOG
From To
j 3?
J-2 SOS
II. REMARKS:
4Formation/D
RECEIVED
rtL\LfF 1r 14TFR DUALITY
R9407
100 HERESY CERmWY THAT THIS WELL WAS COtSTRI'Cr® N ACCORDANCE PATH
%SA r&AC 2C. WELL CONSIRLICTDN'.TP NWRDS. AhDTHATA COPY OF THIS
RECORD HAS BEEN PRW®EDTOTHI: w ELL
SIGNATURE OF CERTIFIED V'al CONTRACTOR DATE
'bete. c% IA'tc 4atZyiti 3
PRINTED NAME OF PERSON .',ONSTRUCTiNG TIDE WELL
Submit the original to the Division of Water Quality Within 30 days. Attn: information Mgt.,
1617 Mal Service Center— Raleigh, NC 27699-1617 Phone No. [phone] ext 568.
Form GW-Ia
Rev. 7)05

RESIDENTIAL WELL CONS'TRUCT$ON RECO:1D
North Carolina Department of Environment and Natural Resources- Division of Water Quality
WELL CONTRACTOR CERTIFICATION 0- 2k 3L
1. WELL CONTRACTOR: ,
one: c k NAfac-,th 'f •+.J'^iet'S
Well Contractor (Individual) Name -
Q xJ doe.. SC.twtiy'J¢--cS Son
Web ca* for Company Nadia
STREET ADDRESS VQ:sti Vt.4J'V o209
Ho-! 3Rc4?\S NC f a8"►+i3
City or Tann State . -Zip Code
(8T%)- lo(0s- acaa.-
Area code- Phone number
2. WELL INFORMATION:
SITE WELL ID Rifapprnable)
STATE WELL PERMIT3(Oappkcable)
DWG or OTHER PERMIT A(if appfinWe)
WELL USE (Check Applicable Bon): Residential Water Supplyg
DATEDRILLED
TIME COMPLETED -Re d G AM 0 PM j9-
3. WELL LOCATION: r-
CITY: SY! vet COUNTY �rc- .: �> 4-.7
d.J c c o`yy��jj /in% l�
{Slovak Marne, NuMwrs. Cam6wnny Subdivision, Lot No.. Parcel, � Code)
TO RAPHIC / LAND SETTING:
❑Valley ❑Rat i7Ridge ❑Other
(check appropriate bwc
LATITUDE 3
LONGITUDE
May be in degrees,
minutes, seconds or
in a decimal format
Latitude/longitude source: Q (WS ❑Topographic map
(bcetion of sea must be shown on a USGS tope map and
attached to this form "not using GPS)
9, Wet, OWNER
OWNER'S NAME Se£c lttktt&G oOM
STREET ADDRESS 32CA_, beer Iced brave
hlenhom urn aa9t,o
City or Town State Zip Code
(Bab } sg6-5air
Area code- Phone numbs
5. WELL DETAILS:
a TOTAL DEPTH: �©6
b. DOES WELL REPLACE EXISTING WELL? YES NOV
c. WATER LEVEL BeJSTop of Casing 36 Fr.
(Use'+' IIfAbove Top of Casing)
d. TOP OF CASING IS \ FT. Above Land Surface'
'Top of casing terminated at/or below land surface may require
a variance in a.,coma rk,e with ISA NCAC 2C A118.
e. YIELD (gpm): A) METHOD OF TEST (t•
337
t. DISINFECTION: Type4 % 1,,$
Amount /0
g. WATER ZONES (depth):
From To From To
From To Frorn To
From To From To
6- CASING: Thickness/
Depth D' W10 Material
From�_To�a- _Fl. ip'�. f%)joT(,�';-.
From To Ft.
From To Fl.
7. GROW: Depth rnMaterial
From 0 To 00 R. &FArent-.
From To R.
From To R. -
Method
r'LNF dI
a. SCREEN: Depth Dia hater Slot Size Material
From To R. in. in.
From To R_ I',In.
From To R. in. in,
9. SAND/GRAVEL PACK:
Depth Sire
From To Ft.
Material
From To FL
From To FL
10. DRrLUNG LOG
From To
6( :7crf
11. REMARKS:
Formation DFa a' n
II
up- vFit,i
nc 1h11\7FR 011/11 IT'i
JANfiy2UU/
100 HEREBY CERTIFY THAT T11S WEI L Y 'AS CONSWF.LCIED NACCORDAICE WITH
15A NCAC 2C, WELL CONSTRUCTION Ma HOARDS. AND THAT COPY OF THIS
RECORD HAS BEEN PROVIDED TO THE IA tEF.
SIGNATURE OF CERTIFIED yI CONTRACTOR DATE
'�je t e's 0- }{io. i- '�Gt
PRINTED NAME OF PERSON XONSTRUCTING THE WELL.
Submit the original to the Division of Water Quality within 30 days. Attn: Information Mgt,
1617 Maul Service Center- Raleigh, NC 27699-1617 Phone No. [phone] ext 568-
Faro GW-la
Rev. 7/05
06

RESIDENTIAL WELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources- Division of Water Quail y
WELL CONTRACTOR CERTIFICATION# o'LK3b
1. WELL CONTRACTOR:
©eo-tIn 4-, lets
W el Contractor (Individual) Name
Ci-icie Sass 2SSot\ 4a9...NA
Well Contractor Company Name
STREET ADDRESS' \R rb 4i1ri &Oct
\\O{' kDC' n Ali..
City or Tohn tart
($a9» (otos- aozz.
Area code- Phone number
2. WELL INFORMATION:
SITE WELL ID / it applicable)
a VnbtZ. •
-Zip Cade
STATE WELL PERMIT/ Vappticabte)
DWQ or OTHER PERMIT;P(if applicable)
WELL USE (Check Applicable Box): Residential Water Supply
DATE DRILLED :/.-/o?
TIME COMPLETED l,j}O AM ❑ PM
3. WELL LOCATION:
COUNTY SGCASa h
6u+\\eats't \-tee a81'79
(Street Name, Numbers. Community. Subdivision, Lot No.. Parcel. Zip Code)
TO GRAPHIC / LAND SETTING:
Btlope ❑Valley ❑Flat ❑Ridge ❑Other
(check appropriate box)
LATITUDE 3
LONGITUDE_
CITY:_____LaSyI vg.,
May be in degrees,
minute seconds or
in a decimal format
Latitude/longitude source: ❑GPS ❑Topographic map
(location of well must be shown on a USGS topo map and
attached to this form trot using GPS)
4. WELL OWNER OWNER'S NAME Lstacy 5Cott
STREET ADDRESS (DV StsRbucai Lap»
alyyIva. tatc Zip AW19
Zip Code
428 ). Stie- 951to
Area code - Phone number
5. WELL DETAILS:
a. TOTAL DEPTH:
b. DOES WELL REPLACE EXISTING WELL? YES ❑ NO
C. WATER LEVEL BtlwvTop of Casing: 3 n FT
(Use'+' if Above Top o( Casing)
d. TOP OF CASING IS ` FT. Above Land Surface'
'Top of casing terminated aVor below land surface may require
a variance in accordance with 15A NCAC 2C .0118.
e. YIELD (9pm): CRC.) METHOD OF TEST
6. CASING:
f. DISINFECTION: Type Y, \\ a Amount lK
g. WATER ZONES (depth):
Fran To From To
Fran To From To
From To From To
Thickness/
Depth Diameter Weight Material
From / To 3S Ft Lo-..A OC -\ Tor \d5i',r;
From To Ft.
From To Ft
7. GROUT: Depth Materiel Method
From 0 To PC3 FL C..?tnt#e_ Povce4
From To Ft 1
From To Ft - _.-
8. SCREEN: Depth Diameter :14 She Material
From To Ft. in. in.
From To Ft in. in.
From To Ft in. in.
9. SAND/GRAVEL PACK:
Depth Size Material
From To Ft
From To Ft.
From To Ft.
TO. DRIWNG LOG
From To
Vs
Formatic i Description
_On c- '3\Argot-}
73—jitrittlVEQrtork
0 8 200
tt
-T1
Asheville Regional Office
fifer PTOtpction
W
11. REMARKS:
O
rs
100 HEREBY CERTIFY THAT THIS WELL WAS CONSTRW;IED N ACCORDANCE WITH
ISA NCAC 2C. WELL CONSTRUCTION STANDARDS. AND MAT A COPY OF THIS
RECORD HAS BEEN PR9VIDED TO THE WELL OWNER.
/
SIGNATURE OF CERTIFI 'WEt CONTRA:TOR DATE
b¢.cc:C4L \k'eo*t SoA-1-itss
PRINTED NAME OF PERSON CONSTRUC tIIG THE WELL
Submit the original to the Division of Water Quality within 30 clays. Attn: information Mgt.,
1617 Mail Service Center— Raleigh, NC 27699-1617 Phone No. [phone] ext 568.
Form GW-1a
Rev. 7/05

RESIDENTIAL WELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources- Division of Water Quality
WELL CONTRACTOR CERTIFICATION # 213(4
f. DISINFECTION: Type O.•1\S
g. WATER ZONES (depth):
1. WELL CONTRACTOR:
%ece'eu 'Beal 4)aAayecS
Wen Contractor (Individual) Name
C\yC4e .3cli 1Qcs t soe\
Well Contractor Company NOne
STREET ADDRESS \PSI' S , -1ALZ / oQo q
-got tvc,nq PC a87 43
City or Trim t..) State -Zip Code
( 8a8,- fobs- a oa.
Area code- Phone number
2. WELL INFORMATION:
SITE WELL ID #(a applicable)
STATE WELL PERMIT#£, applicable)
DWQ or OTHER PERMIT #(if applicable)
WELL USE (Check Applicable Box): Residential Water Supply I
DATE DRILLED 3 -029-G
TIME COMPLETED 'f ; J 6 AM D PM ®/
3. WELL LOCATION:
CITY: Ui//SAr? L .. / COUNTY TGc, c6/1
/ o.tq &z C4 ril4.t4`ez
.(Street Nene. Numbers, Community. Subdidsion, Lot No.. Parcel. Zip Code)
TO GRAPHIC / LAND SETTING:
lope Ovafey ❑Flat ❑Ridge ❑Other
(check appropriate box)
LATITUDE _'
LONGITUDE
May be in degrees,
minutes, seconds or
in a decimal format
Latitude/longitude source: oGPS ❑Topographic map
(location of well must be shown on a USGS topo map and
attached to this form 7net using GPS)
4. WELL OWNER OWNER'S NAME �• �U9eh 7y/
STR PpciRESS
City a Town State
(CA)-S' -4a64'
Area code - Phone number
5. WELL DETAILS: �
a. TOTAL DEPTH:
Zip Code
b. DOES WELL REPLACE EXISTING WELL? AYES ❑ NO 83/
e. WATER LEVEL Below Top of Casing: _SD FT.
(Use'+" if Above Top of Casing)
d. TOP OF CASING IS t FT. Above Land Surface"
"Top of casing terminated aVar beiav land surface may require
a variance in accordance with 15A NCAC 2C .0118.I
e. YIELD (gpm): $ METHOD OF TEST tom
From
From
From
6. CASING:
To
To
To
Amount c 1
From To
From To
From To
Thickness/
h
Diameter Weight
From t'\ DTot Ar Ft es.V1/2 1 F7F7/aSi-,r
From To Ft.
From •To Ft.
7. GROUT: Depth ��11 Material Method
From 0 To 90 FL C e.'fnaak PoL>< M
From To Ft
From To Ft.
8. SCREEN: Depth Diameter S'X Size Material
From To Ft. in in.
From
From
To Ft.
To Ft.
m. m.
in. in.
9. SAND/GRAVEL PACK:
Depth Size Material
From To FL
From To - Ft.
From To Ft.
10. DRILLING LOG
From T6
Formation Description
cx ec 1
SY 4.2S (s'an;te
11. REMARKS:
0
1 DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED N ACCORDANCE WRH
15A NCAC 2C. WELL CONSTRUCTION STANDARDS. AND THAT A COPY OF THIS
RECORD HAS BEEN PROVIDED TO THE WELL OWNER.
3 Aj-o
SIGNATURE OF CERTIFIED WELL CONTRACTOR DATE
teccLcw- iAgat" 50.vs'I :es s
PRINTED NAME OF PERSON CONSTRUCT ING THE WELL
Submit the original to the Division of Water Quality within 30 days. Attn: Information Mgt,
1617 Mail Service Center -Raleigh, NC 27699-1617 Phone No. [phone] ext 568.
Form GW-1a
Rev. 7/05

RESIDENTIAL WELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources- Division of Water Quality
WELL CONTRACTOR CERTIFICATION # 02143(4_
1. WELL CONTRACTOR:
es c-\c tc 1-le&w ‘‘R,.3? e.c s
Well Contractor (Individual) Name -
C\ yC+Q 5a QCS * Sors
Well Contractor Company Na ne
STREET ADDRESS \AP Ps S .1- Lay Q.0 q
lion
City or T S e
( 8as, Cobs- a oa
Area code- Phone number
-Zip Code
2. WELL INFORMATION:
SITE WELL ID PHapplicable)
STATE WELL PERMIT#(Bapplicate)
DWQ or OTHER PERMIT #(if applicable)
WELL USE (Check AppUrable Box): Residential Water Supply
DATE DRILLED -- /-fie
TIME COMPLETED 7 : 0 O AM 0 PM (g-
3. WELL LOCATION::
CITY: i //ho s/`o _ COUNTYD .)c cvi o
pA+
Joel Ur4rtcii dune
.(Street Mame, Numbers. Community, Subdivision, Lot No., Parcel, Zip Code)
TO RAPHIC / LAND SETTING:
lope °Valley El Flat ❑Ridge ❑Other
(check appropriate box)
LATITUDE 3
LONGITUDE
Latitude/Iongitude source: ❑CPS ❑Topographic map
(bcation of we/ must be shown on a USGS topo map and
attached to this form I not using GPS)
4. WELL OWNER
STR ER' SHARES - l:N�+2Gh—
AQDCity or Town State Zip Code
(fW)- SU 662_0(o
May be in degrees,
minutes, seconds or
in a decimal format
Area code - Phone number
5. WELL DETAILS:
a. TOTAL DEPTH: `! "5 —/
b. DOES WELL REPLACE EXISTING WELL? YES ❑ NO Er
c. WATER LEVEL Below Top of Casing: gO FT.
(Use if Above Top of Casing)
d. TOP OF CASING IS FT. Above Land Surface
'Top of casing terminated at/or below land surface may require
a variance in accordance with 15A NCAC 2C .0118.
e. YIELD (gpm): 3 /2 METHOD OF TEST Tl
f. DISINFECTION: Type y+\11/4S Amount at2
g. WATER ZONES (depth):
From
Ram
From
6. CASING:
From -V`\
From
From
To
To
To
From
From
From
To
To
To
Thiclmessl
Depth
hJE4 Ft to Diameter Weight 08,2l
a
To Ft
7o Ft
7. GROUT: Depth Material Method
From 0 �O Ft CQ,YYl Et1i POLL
F om �1To Ft.
From To Ft
8. SCREEN: Depth Diameter S of Size Material
From To Ft in. in.
From To Ft in. in.
From To Ft. in. in.
9. SAND/GRAVEL PACK:
Depth
From To Ft.
From To - Ft.
From To Ft
10. DRILUNG LOG
From To
/oG
In(; 445
11. REMARKS:
Size Material
Formaticn Description
oyes O .ctlon
Gcac‘ ; to
tV
J
O
ni
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED N ACCORDANCE WfH
15A NCAC 2C, WELL CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS -...
RECORD HAS BEEN PROVIDED TO THE WELL OWNER.
SIGNATURE OF CER
ED W.
3 aA-C
CONTRCTOR DATE
t ecv vCK iWo»-' z-yy '4 c s
PRINTED NAME OF PERSON CONSTRUCI;NG THE WELL
Submit the original to the Division of Water Quality within 30 days. Attn: Information Mgt,
1617 Mail Service Center— Raleigh, NC 27699-1617 Phone No. [phone] ext 568.
Form GW-la
Rev. 7105

.[\ ESIDENTIA,L WELL CONSTRUCTION RECO:2D
North Carolina Department of Environment and Natural Resources- Division of Water Quality
WELL CONTRACTOR CERTIFICATION #
WELL CONTRA{+CTOR:Aec -i- . �p
Well Contractor (Individual) Name
� d ' Sc.,a ��S *San
Well Company N
STREET ADDRESS \' Z 1 .Yzt;J7 2.39
-kok Zl C:tlgs AK.- a8'l•i3
y] Crty cc Town Stale ! . -Zip Code
(8 %). to (OS- a oar . •
Area code- Phone number
2. WELL INFORMATION:
SITE WELL ID #(d apW'aable)
STATE WELL PERMITS('soori able)
DWQ or OTHER PERMIT MP appficable)SbG ass tiv
WELL USE (Check Applicable Box): Residential Water Supply V
DATE DRILLED / 2
TIME COMPLETED Vida AM O PM E
3_ WELL LOCATION:
CITY: /.5'<Utc courgTY Xr Afar-0r<
Lta It &/'Cc,- ,‘",/ Cechc 1Ttee5 l.Vf3-c
{Stet Name. Numbers. Cammuroly. Subdivision, Lot No.. Parcet. Zip Ccne)' .-
TO RAPHIC / LAND SETTING:
OYaNey ❑Flat ❑Ridge ODther
(cheek •wrus.:.tr_ bwp
LATITUDE 3
LONGITUDE
May be in degrees,
minutes, seconds of
in a decimal fames
Latitude/longitude source: 0 GPS ❑ Topographic map
(location of wed must be shown on a USGS typo map and
et6r./�.1 (odds form ifnot usig GPS)
4. W61 OWNER
OWNER'S NAME ?eccea CLarnci ttit
STREET ADDRESS ' esoit ISS
t.fin;+/-cer !Se Q876;
City or Town State Zip Cade
(PaR )• 736 - /8 I y
Area code - Phone number
6. WELL DETAILS: a. TOTAL DEPTH: t� / VS-
b. DOES WELL. REPLACE EXISTING WELL? YES ❑ NO-5/-
c- WATER LEVEL Below Tap of Casing 7 L
(Use'+' iiAbove Top of Casng)
d. TOP OF CASING IS . FT. Above Land Suridz'
'Top of casing teminated aster below land surface may require
a variance in accordance with 15A NCAC 2C .0118.
e. YIELD(gpm): G METHOD OF ICS t (COS
FT.
337504
1. DISINFECTION: Type, a1,15 Amount acR
g. WATER ZONES (depth):
From To From To
From To From To
From To From To
6. CASING: Thickness/
D Dias -liter Weight�i Material 1
From -1- 1, To / Ft. 1D T..0E-1 n Jl (,L
From
To R.
%""�t''-
From To Ft
7. GROUT: Depth ��II Material Mslo
From 0 To ao R. CPfYLet-lt (
From To F. i�
From To Ft.
8. SCREEN: Depth
From To
From To
From To
Dia neter Sbt Sae Material
FI. Ir.. in.
R. n in.
9. SAND/GRAVEL PACK:
DePth Size Mateiad
From To Ft.
Fran To Ft
From To Ft.
10. DRILLING LOG
From To _aFormation D
I1. REMARICS:
?CCEIVED
)r- ti; wATrP OUAL4
fa (fill%
I DO HEREBY CERTIFY THAT THIS WELL V 'AS CONStRLCTED N ACCORDNCE WITH
15A NCAC 2C, WELL CONSTRUCTOR was NDARDS. AND THATA COPY OF TfpS
RECORD HAS BEEN PROYDED TO THE w
SIGNATURE OF
be {-es i`k }i a42 Fir �{„;1.1tg
PRINTED NAME OF PERSON ,'.ONSTRUCTMG 111E WELL
?
FACTOR DATE
Submit the original to the Division of Water Quality within 30 days. Attn: Information Mgt.,
1617 Mall Service Center— Raleigh, NC 27699-1617 Phone No. [phone] ext 568.
Form GW-la
Rev. 7I05

RESIDENTIAL WELL CONSTRUCTION RECOItD
North Carolina Department of Environment and Natural Resources -
Division of Water Quality
WELL CONTRACTOR CERTIP ICATION NV%y
1. WELL CONTRACTOR:
1'v-e A C rA rJ C
Well Contractor (Individual) Name
Well Conlrij IAN2DIENTfPSrt$ WELL 'LaiLL6 .i.,
248 CRANE CIRCLE
STREET ADDRESS FRANKLI r‘ff' "A
City or Town
Slate
Zip Code
1. DISINFECTION: Type Amount
g. WATER ZONES (depth):
From To From To
From To From To
From To From To
6. CASING: Thickness/
y� DepthDime r Weight Material
From (i' Ta IT � Ft. (# 4' (e_
From To FL //
Area code- Phone numb
2. WELL INFORMATION:
SITE WELL ID #fir applicable)
STATE WELL PERMIT#(il applicable)
DWQ or OTHER PERMIT #(if applica, le)Asheville Regional CWigetcR
If"t Pr t ectit r Fr
RECEIVED
WELL USE (Check Applicable Box):
DATE DRILLED 3—/5- u w
TIME COMPLETED AM p PM 6—
3. WELL LOCATION:
LL
CITY: <4, heal COUNTY JAC k A)
J.i1"rr FYj C ce
(Street Name, Numbers, Community, Subdivision, Lot No., Parcel, Zip Code)
TOPOGRAPHIC / LAND SETTING:
❑Slope ❑Valley ❑Flat ❑Ridge DOther
(check appropriate box)
LATITUDE 3
LONGITUDE
Latitude/longitude source: ❑GPS oTopographic map
(location of wet/ must be shown on a USGS ropo map and
attached to (his form 1 not using GPS)
4. WELL OWNER /�` L
OWNER'S NAME ::;-t
STREET ADDRESS /
May be in degrees,
minutes, seconds or
in a decimal formal
City or Town
Stale Zip Code
Area code - Phone nurnber
5. WELL DETAILS: 7 L�
a. TOTAL DEPTH: to J
b. DOES WELL REPLACE EXISTING WELL? YES 0
NO13-
c. WATER LEVEL Below Top of Casing: /I25-.
FT.
(Use'+' if Above Top of Casing)
d. TOP OF CASING IS J FT. Above Land Surface'
'Top of casing terminated at/or below land surface may require
a variance in accordance with 15A NCAC 2C .0118.
e. YIELD Wpm). -. c+ METHOD OF TEST A r Y
7. GRO
Fr
Fra
Fro
To Ft.
Depth Material pourdMethod
e
L T0a) Ft (On/41i
EN:
To Ft.
To Ft.
Depth Diameter Slot Size
To FI. In. in.
To Ft. in. in.
Frorn To Ft. In. in.
9. SAND/GRAVEL PACK:
Depth
From To Ft.
From
From
Size
Material
Material
To Ft.
To Ft.
10. DRILLING LOG
From To
©9 I Pi
405
11. REMARKS:
Formation Description
fric
:5
r.1
J
rJ
m
MAR L 0 ZOOS
Asheville Regional Office
Aquifer Protection
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WON
ISA NCAC 2C, WELL CONSTRUCTION STANDARDS. AND THAT A COPY OF MIS
RECORD HAS BEEN PROVIDED TO THE WELL OWNER.
I6.0 L
SIGNATURE OF CERTIFIED WELL CONTRACTOR DATE
Fie() b PRINTED NAME F PEA v RS CONSTRUCTING THE WELL
Submit the original to the Division of Water Quality within 30 days. Attn: Information Mgt., f t"t @p D
Form GW-la
1617 Mail Service Center — Raleigh, NC 27699-1617 Phone No. [phone] ext 568. /Is 7/05
1tj'J
ill, geatonal Office.

RESIDENTIAL
" 4
RWELL CONSTRUCTION RECOI
North Carolina Department of Environment and Natural Resources- Division of Wat
WELL CONTRACTOR CERTIFICATION # ad
1. WELL. CONTRACTOR:
5 i j-
Well Conti actor (Individual) Name
Well Contr tign WELL aRiL!E72, EcC,.
STREET ADDRESS 248 CRANE CIRCLE
F RANKLIN, NC 2G 1a4
�.+1 City or Town Stale
x� )- �
Area cafe- Phone number
Zip Code
2. WELL INFORMATION: _
SITE WELL ID Nil applicable)
STATE WELL PERMIT#(inapplicable)
DWQ or OTHER PERMIT #(if applicable)
WELL USE (Check Applicable Box): Residential Water Supply 0
DATE DRILLED /- a 5ct) 6
TIME COMPLETED AMP PM ❑
3. WELL LOCATION: _
CITY:41/4/A COUNTK SMC.t5 C'i
Elbt CA -
(Street Name, Numbers, Community, Subdivision, Lot No., Parcel, Zip Code)
TOPOGRAPHIC / LAND SETTING:
❑Slope oValley ❑Flat ['Ridge DOther
(check appropriate box)
LATITUDE 3
LONGITUDE
Latitude/longitude source: OCPS ❑Topographic map
(location of well must be shown on a USGS lopo map and
attached to this form / not using GPS)
4. WELL OWNER
OWNER'S NAME,�i%11
STREET ADDRESS
May be in degrees,
minutes, seconds or
in a decimal formal
/X
State
Area code - Phone number
Zip Code
5. WELL DETAILS: a. TOTAL DEPTH: IPD.S_
b. DOES WELL REPLACE EXISTING WELL? YES
N9-Q—
c. WATER LEVEL Below Top of Casing: /n) FT.
(Use'+' if Above Top of Casing)
d. TOP OF CASING IS / FT. Above Land Surface'
'Top of casing terminated at/or below land surface may require
a variance in accordance with 15A NCAC 2C .0118.
e. YIELD (gpm): /j. METHOD OF TEST i'
RECEIVED
MAR 20 2006
Quality
Asheville Regional Office
f. DISINFECTION: Type mou
g. WATER ZONES (depth):
From To From
From To From
From To
6. CASING:
From
From To Ft.
From To FI.
G
To
To
From To
Thickness/
Depth Diaer Weight Material
To/c.i& nn FI /Gcj� nLf`
7. GROUT: Depth Material Method
From b To rY O FI. (&-M J akarti
From To Ft.
From To Ft.
8. SCREEN:
From
From
From
Depth
To
To
Diameter Slot Size Material
Ft. in. In.
Ft. in. in.
To Ft. in. In.
9. SAND/GRAVEL PACK:
Depth
Frorn To FI.
From To Fl.
From To Ft.
Size Material
10. DRILLING LOG
From To
D- /2G.
— &n '
Formation Description
?2
C.-L��
,—
-R-ECEIVED
J
Asheville Regional 0r Ice
AcTtthfcl f .ctociior
11. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED N ACCORDANCE WITH
ISA NCAC 2C, WELL CONSTRUCTION STANDARDS. AND THAT A COPY OF THIS
RECORD II 4BEEN PROVIDED TO THE WELL OWNER.
cto
SIGNATilItE OF CERTIFIED WELL CONTRACTOR DATE
Lk «(4 n1e=
PRINTED NAME OF PERSON CONSTRUCTING THE WELL
Submit the original to the Division of Water Quality within 30 clays. Attn: Information Mgt.,
1617 Mail Service Center— Raleigh, NC 27699-1617 Phone No. [phone] ext 568.
Form GW-la
Rev. 7/05

RESIDENTIAL WELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources- Division of Water Quality
WELL CONTRACTOR CERTIFICATION # 31:.1 /
1. WELL CONTRACTOR:
ed CrPak_
We Contractor (Individual) Name
Well Contractor G•.
STREET ADDRESS
Limy NE BROTHERS WELL DRILLING,
248 CRANE CIRCLE
FRANKLIN, NC 28734
City or Town State
Zip Code
Area code- Phone number
2. WELL INFORMATION:
SITE WELL ID #(if applicable)
STATE WELL PERMIT#(inapplicable)
DWQ or OTHER PERMIT #(if applicable)
WELL USE (Check Applicable Box): Residential Water Supply ❑
DATE DRILLED/4 -- to— 0 (v
TIME COMPLETED AMO PM ❑
3. WELL LOCATION:
CITY: �AchlYNZ COUNTY:371C SCSU
G1/4( ,tJ
(Street Name, Numbers, Community. Subdivision, Lot No., Parcel, Zip Code)
TOPOGRAPHIC / LAND SETTING:
['Slope °Valley ❑Flat ❑Ridge ❑Other
(check appropriate box)
LATITUDE
LONGITUDE
Latitude/longitude source: ❑GPS ❑Topographic map
(location of well must be shown on a USGS topo map and
attached to this form d not using GPS)
4. WELL OWNER
OWNER'S NAME \AlrllfMAE e' S -rt
STREET ADDRESS aea-D. 1 /e-(li. AI Or; 4/•4
May be in degrees,
minutes, seconds or
in a decimal format
(-VIP- 1,1 1 c,4c/1 F I 3 / 710
City or Town Stale Zip Code
Area code - Phone number
5. WELL DETAILS:
a. TOTAL DEPTH: 5
b. DOES WELL REPLACE EXISTING WELL? YES ° NO °
c. WATER LEVEL Below Top of Casing: FT.
(Use'+' it AboveTopof Casing)
d. TOP OF CASING 15 1 FT. Above Land Surface*
*Top of casing terminated at/or below land surface may require
a variance in accordance with 15A NCAC 2C .0118.
e. YIELD (gpm): / C METHOD OF TEST 4
f. DISINFECTION: Type Amount
g.. WATER ZONES (depth):
From To From To
From__ To From To
From To From To
6. CASING:` Thickness/
From A DToth-3 3 Ft.
Diia p�r Weight Material
From To Ft.
From To Ft.
7. GROLT: Depth Material �) Method
From L To..0 Fitt ni/IdA `LAW t4 Pant, Alt;
From To Ft.II I
From To Ft.
8. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in.
From _ To Ft. in. in.
From To Ft. in. in.
9. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft
Ran To Ft.
10. DRILL NG LOG
From To
5 3— 5I)5—
Formation Description
u , i R Z0O6
11. REMARKS:
Er„...:$�n•,ri11P RoAfICOPDI OoffTHCeIS
I DO HEREBY CERTIFY THAT KU,4MSCONSTR1CSttb i! ACCORDANCE WITH
15A NCAC 2C, WELL CONSTRUCTION STANDARDS, AND THT Y
RECORD HA S BEEN PROVIDED TO THE WELL OWNER. eQA
SIG NTXTURF ISF CERTIFIED WELL CONTRACTOR DATE :C
PRINTED NAME OF PERSON CONSTRUCTING THE WEttt
Submit the original to the Division of Water Quality within 30 days. Attn: Information Mgt.,
1617 Mall Service Center- Raleigh, NC 27699-1617 Phone No. [phone] ext 568.

1. WELL CONTRACTOR:
eftl
onb actor (Individual) Name
Well Contractor Company Name
CRANE 3ROTt4ERR WELL DRILLING, INC.
STREET ADDRESS
FRANKLIN, NC 28734
City or Town State
Area code- Phone number
2. WELL INFORMATION:
SITE WELL ID Cif applicable)
STATE WELL PERMIT1/01 applicable)
DWQ or OTHER PERMIT #(if applicable)
WELL USE (Check Applicable Box): Residential Water Supply ja] -
DATEDRILLED _y�� G� --
TIME COMPLETED__
3. WELL LOCATION:
CITY: rAtcy,+ €r5
Zip Code
5�1143Subdivision,Subdivision,v '
beet Name. Numbers, Community, Subdivision, Lot No.. P el, Zip Code)
AMD PM
COUNTY
TOPOGRAPHIC 1 LAND SETTING:
❑Slope D Valley ❑Flat 0 Ridge ❑Other
(check appicprlate box)
LATITUDE 3 _
LONGITUDE__ -_
May be in degrees,
minuses, seconds or
in a decimal formal
Latitude/longitude source: ❑GPS ❑Topographic map
(bcalion of well must be shown on a USGS lopo map and
attached to this form A not using GPS)
4. WELL OWNER —T
OWNER'S NAME)mJ1/Ace-
STREET ADDRESS 5 "+1 %a-v-5 ,4 /
P7. )[ f l
City or Town Slate lip Cade
Orn/t1Ac1 & Q'
( )-
Area code - Phone number
5. WELL DETAILS: II
a. TOTAL DEPTH: l0 oS
b. DOES WELL REPLACE EXISTING WELL? YES ❑ NO-0
c. WATER LEVEL Below Top of Casing: % 0 FT.
(Use'+' it Above Top of Casing)
d. TOP OF CASING IS / FT. Above Land Surface'
'Top of casing terminated abet below land surface may require
a variance In accordance with 15A NCAC 2C .0118.
e. YIELD (gpm): 3'o METHOD OF TEST _Pr,
RESIDENTIAL WELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources- Division of Water Quality
WELL CONTRACTOR CERTIFICATION ri i.O2Y
I. DISINFECTION: Type Amount
g. WATER ZONES (depth):
From To
From To
From
To From To
From To From
6. CASING: Diameter
��,� Depth
From,_L�_To y7 FI. 149
' From To Ft.
From To FI.
7. GROUT: Depth
From To3L Ft.
From To Ft.
From To FI.
To
P6Q
Thickness/
Weigh) Material
Material
Method
i
8. SCREEN: Depth Diameter Slot Size Material
in.
From To FI. in.
From_ To Ft. in. —._ in.
From To Ft. In. in.
9. SAND/GRAVEL PACK:
Depth
From To
From To
From To
Size
Ft.
Ft.
Ft.
Material
10. DRILLING LOG
From To Formation Description
11. REMARKS:
O
ixtv'_ Ae
,r_+cfi1ki RepiOfa1 Office
At:Niiter Protection
a
WAS
TED TN
RDANCE
IIDO HEREY SA NCAC 2C. WELLFY THAT 114IS WECONS UCTION STANDARDS. AND THAT A COPY OF THIS W�
RECORD HAS BEEN PROVIDED TO THE WELL OWNER.
SIGNATURE OF CERTIFIED WELL CONTRACTOR DATE
A e_—
PRINTED NAME OF PERSON CONSTRUCTING THE WELL
Submit the original to the Division of Water Quality within 30 days. Attn: Information Mgjt,�N 6 2006
1617 Mail Service Center— Raleigh, NC 27699-1617 Phone No. [phone] ext 568.
Form GW-la
Rev. 7/05

RESIDENTIAL WELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources- Division of Water Quality
WELL CONTRACTOR CERTIFICATION N 2/
1. WELL CONTRACTOR:
Jr Cry
Well Contractor (Individual) Name
Well t&Ail{EI$RA7r{*Sn'yltitaL DP,ILLI a, ;Sr.
248 CRANE CfRCLE
STREET ADD I"! Iql --c
City or Town Stale
(f9%;L
Area code- Phone number
Zip Code
2. WELL INFORMATION:
SITE WELL ID #(it applicable)
STATE WELL PERMIT#(it applicable)
DWQ or OTHER PERMIT #(if applicable)
WELL USE (Check Applicable Box): Residential Water Supply [
DATE DRILLED
TIME COMPLETED AM ❑ PM ❑
3. WELL LOCATION: _ -I,
CITY: fr(QiIJ4 COUNTYJrCb 8
nyr J2
(Street Name umbers, Community, Subdivision, Lot No.. Parcel. Zip Code)
TOPOGRAPHIC / LAND SETTING:
DSlope [Valley ❑Flat ❑Ridge ❑Other
(check appropriate box)
LATITUDE 3
LONGITUDE
May be in degrees,
minutes, seconds or
in a decimal format
Latitude/longitude source: ❑GPS ❑Topographic map
(location of well must be shown on a USGS topo map and
attached to This form not using GPS)
4. WELL OWNER
OWNER'S NAME All11 ltay_ f- �^" /'
STREET ADDRESS (o t/'j{rky}ry-/IS 41,05
l✓H- Ak- .2ry
Ci or Town Slate Zip Code
Area code - Phone number
5. WELL DETAILS:
a. TOTAL DEPTH: S"OS
b. DOES WELL REPLACE EXISTING WELL? YES
0 NO a
c. WATER LEVEL Below Top of Casing: /�j FT.
(Use -+- if Above Top of Casing)
d. TOP OF CASING IS / FT. Above Land Surface'
'Top of casing terminated al/or below land surface may require
a variance in accordarthe with 15A NCAC 2C .0118.
e. YIELD (gpm): 7 METHOD OF TESTA'/
329823
1. DISINFECTION: Type Amount
g. WATER ZONES (depth):
From To From To
From To From To
From To From To
6. CASING: Thickness/
From d Depth
�y Ft D e�r Weight 4,7 DVMaterial
G
From To FL
From To Ft.
7. GROUT: Depth "� Ma�t//eriallB Method
From 6To aV rtet'1 i,4 . I(.L{'t/jJN ( n
From To Ft.
From To Ft.
B. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in.
From To Ft. in. in.
From To Ft. in. in.
9. SAND/GRAVEL PACK:
Depth Size Material
Frcm To Ft.
From To Ft.
Frcm To Ft.
10. DRILLING LOG
From To Formation Descript'Lon_
11. REMARKS:
rri
JUL U LUDO
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.
L.6L (j>lx., ?—nrtL
SI ATURE OF CERTIFIED WELL CONTRACTOR DATE
nit
PRINTED NAME OF PERSON CONSTRUCTING THE WELL
Submit the original to the Division of Water Quality within 30 days. Attn: Information Mgt.,
1617 Mall Service Center— Raleigh, NC 27699-1617 - Phone No. [phone] ext 568.
Form GW-la
Rev. 7/05

RESIDENTIAL WELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources- Division of Water Quality
WELL CONTRACTOR CERTIFICATION H 36 2/
1. WELL CONTRACTOR:
D4 nfe_ Cr( g-nic
Well Contractor (Individual) Name
Well conhBAAtito0ROTHE YIELL DRILLI .2,
STREET ADDREss 248 CRANE CIRCLE
F{iANKLI`v, NC 2C734
City or Town Slate
Zip Code
Lam)-�aV-V99c.
Area code- Phone number
2. WELL INFORMATION:
SITE WELL ID #(if applicable)
STATE WELL PERMIT#(if applicable)
DWQ or OTHER PERMIT #(if applicable)
WELL USE (CheckApplicableBox): Residential Water Supply 0
DATE DRILLED JtI S—O b
TIME COMPLETED AMID PMD
3. WELL LOCATION: --��
CITY: Et/ I V Ps- COUNT$3t .k mod$
S Greek
(Street Na , Numbers, Community. Subdivision, Lot No., Parcel, to Code)
TOPOGRAPHIC / LAND SETTING:
[Slope [Valley ❑Flat ['Ridge DOther
(check appropriate box)
LATITUDE 3
LONGITUDE
May be in degrees,
minutes, seconds or
in a decimal format
Latitude/longitude source: DO'S (DTopographic map
(location of well must be shown on a USGS fopo map and
attached to this form A not using GPS)
4. WELL OWNER A.,,
OWNER'S NAME r hY j1r`^r i-_ 1)(J ti JAI-tea-�
STREET ADDRESS i 4l Jat' / ' G, a-
kb'4/ A 6— •114111
City or Town State Zip Code
( )-
Area code - Phone number
5. WELL DETAILS: a. TOTAL DEPTH: LO—A✓
b. DOES WELL REPLACE EXISTING WELL? YES 0
Nft0
c. WATER LEVEL Below Top of Casing: b FT.
(Use'+' if Above Top of Casing)
d. TOP OF CASING IS / FT. Above Land Surface'
'Top of casing terminated at/or below land surface may require
a variance in accordande with 15A NCAC 2C .0118.
e. YIELD (gpm): 3 O METHOD OF TEST, r
/. DISINFECTION: Type Amount
g. WATER ZONES (depth):
From To From To
From To From To
From To From To
6. CASING: Thickness/
Depth r� D)i)arr er Weight Material
From 0 To %/ Ft. La PuC.
From To Ft.
From To FI.
7. GROUT: Depth Material �� Method
Frcin 0 TO 3c Flf//�� efteAj-4 44/
Frctn To FI.
Nun To Ft.
8. SCREEN: Depth Diameter Slot Size Material
Frcm To Ft. in. in.
Frcin To Ftin. in.
Frnn To Ft. in. in.
9. SAND/GRAVEL PACK:
Depth Size Material
Frcm To Ft.
From To Ft.
From To Ft.
10. DRILLING LOG
From To
-
11. REMARKS:
Formation Description
0
r.r
fr7
ry
JUL 29 2005
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED N ACCORDANCE WITH
ISA NCAC 2C, WELL CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS
RECORD HAS BEEN PROVIDED TO THE WELL OWNER.
SIGMA I URE OF CERTIFIED WELL CONTRACTOR DATE
ibvuiic COM(
PRINTED NAME OF PERSON CONSTRUCTING THE WELL
Submit the original to the Division of Water Quality within 30 days. Attn: Information Mgt.,
1617 Mail Service Center— Raleigh, NC 27699-1617 Phone No. [phone] ext 568.
Form GW-la
Rev; 7/05

RESIDENTIAL WELL CONST RUCTION RECORD
North Carolina Department of Environment and Natural Resources- Division of Water Quality
WELL CONTRACTOR CERTIFICATION # 3U / I
1. WELL CONTRACTOR:
A-rJc
Well Contractor (Individual) Name
Well GRAtIgcSItailaiiaaigl. DRILLii'a,
248 CRANE CIRCLE
STREET ADDRFsANKI IN NC 2.3734
City or Town State
(Zar)_ CiZ -C/ 91(o
Zip Code
Area code- Phone number
2. WELL INFORMATION:
SITE WELL ID #(if applicable) - -
STATE WELL PERMIT#(if applicable)
DWQ or OTHER PERMIT #(If applicable)
WELL USE (Check Applicable Box): Residential Water Supply
DATE DRILLED ICY-3 CI -CI L
TIME COMPLETED AMO PM El
3. WELL LOCATION: LL
CITY: �Lt I.0 14 COUNTY?VP eJC &
C—Ilrr». .yit C.ctk
(Street aN meR . Nu irDers. Community, Subdivision, Lot No., Parcel, Zip Code)
TOPOGRAPHIC / LAND SETTING:
❑Slope °Valley ❑Flat ❑Ridge El Other
(check appropriate box)
LATITUDE 3
LONGITUDE
Latitude/longitude source: In GPS ❑Topographic map
(location of well must be shown on a USGS topo map and
attached to this form Prot using GPS)
4. WELL OWNER �� ,Q
OWNER'S NAME V 7f.�L U to re-,5
May be in degrees,
minutes, seconds or
in a decimal formai
STREET ADDRESS
�ckic Se -fee nJ C j2-7g3
City or Town State Zip Code
Area cafe - Phone number
5. WELL DETAILS: O�
a. TOTAL DEPTH:
b. DOES WELL REPLACE EXISTING WELL? YES CI NO ❑
c. WATER LEVEL Below Top of Casing: /3 V FT.
(Use'+' 8 Above Top of Casing)
d. TOP OF CASING IS J FT. Above Land Surface'
-Top of casing terminated at/or below land surface may require
a variance in accordance with 15A NCAC 2C .0118.
e. YIELD (gpm): 3 METHOD OF TEST 4i Y
334472
t. DISINFECTION: Type Amount
g. WATER ZONES (depth):
From To From To
From To From To
From To From To
6. CASING: Thickness/
Dint Weight
Depth
From To 73 Ft
From To Ft.
From To Ft.
Material
7. GROUT: Depth Material Method
From a Torn-0 Ft. f)f-/
From_,_To FL .UryWk.
From To Ft.
8. SCREE'I: Depth Diameter Slot Size Material
From To Ft. in. in.
From To Ft. in. in.
From To FI. in. in.
9. SAND/GRAVEL PACK:
Depth
From
To Ft.
From To Ft.
Size
Material
From To Ft.
10. DRILLING LOG
From To Formation Description
11. REMARKS:
F
ED
DIV OF tAA/A EQUALITY
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED N ACCORDANCE Wm,
ISA NCAC 2C. WELL CONSTRUCTION STANDARDS. AND THAT A COPY OF THIS
RECORD HAS BEEN PROVIDED TO THE WELL OWNER.
SI N URE OF CERTIFIED WELL CONTRACTOR DATE
sbonnbc Acnc
PRINTED NAME OF PERSON CONSTRUCTING THE WELL
Submit the original to the Division of Water Quality within 30 days. Attn: Information Mgl.QV O 6 oQ6 Fo m Gw-1a
1617 Mail Service Center - Raleigh, NC 27699-1617 Phone No. [phone] ext 568. Rev. 7/05.

RESIDENTIAL WELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources- Division of Water Quality
WELL CONTRACTOR CERTIFICATION # 3t, 79'
1. WELL CONTRACTOR:
Frtd &Atilt -
Well Contractor (Individual) Name
Well Contractor C CIRCLE
FRANKLIN, I\IC 23; S4
STREET ADDRESS
City or Town State
FE AFC aV 4/926
Zip Code
Area code- Phone number
2. WELL INFORMATION:
SITE WELL ID Cif applicable) .
STATE WELL PERMIT#(If applicable)
DWQ or OTHER PERMIT #(if applicable)
WELL USE (Check Applicable Box): Residential Water Supply$
DATE DRILLED /O- f ► - 0 to.
TIME COMPLETED AM El PM
3. WELL LOCATION:
CITY: CANISLi+wrS
COUNTY 3-14f 4b.t"D
LbW 1114-.
(Street Na Numbers, Community, Subdivision, Lot No., Parcel, Zip Code)
TOPOGRAPHIC I LAND SETTING:
❑Slope ❑Valley ❑Flat ❑Ridge ❑Other
(check appropriate box)
LATITUDE 3
LONGITUDE
Latitude/longitude source: ❑GPS ❑Topographic map
(location of well must be shown on a USGS topo map and
attached to this form A not using GPS)
4. WELL OWNER r /���
OWNER'S NAME LPN 1 Anvviari s
STREET ADDRESS G 9.49Ase71s-S f �
asil34/
City or Town State Zip Code
Area code - Phone number
May be in degrees,
minutes, seconds or
in a decimal format
5. WELL DETAILS:
a. TOTAL DEPTH:
5b5
b. DOES WELL REPLACE EXISTING WELL? YES ❑ NO ❑
c. WATER LEVEL Below Top of Casing: Vtl FT.
(Use "+" 8 Above Top of Casing)
d. TOP OF CASING IS / FT. Above Land Surface*
'Top of casing terminated aVor below land surface may require
a variance in accordance with 15A NCAC 2C .0118.
e. YIELD (gpm): / S METHOD OF TEST as-4d
334470
f. DISINFECTION: Type Amount
g. WATER ZONES (depth):
From To From To
From To From To
From To From To
6. CASING:
Depth
From o To Sr Ft
From To Ft.
From To Ft.
Thickness/
Diia etek Weight
Material
7�G
7. GROUT: Depth Material Method
"
From 4 To a-d FVeafj k4 t
From_ _To Ft.
From To Ft.
8.-SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in.
From To Ft. in. in.
From To Ft. in. in.
9. SAND/GRAVEL PACK:
D :pth
Ran
Size
To Ft.
Rom To Ft.
From To Ft.
10. DRILLING LOG
From To
6 — 27
3 f—
11. REMARKS:
Material
Formation Description
RECE
DIV. Or- WtdATr
twu-.p g._2006
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRICTED N ACCORDANCE WITH
15A NCAC 2C, WELL CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS
RECORD HAS BEEN PROVIDED TO THE WELL OWNER.
4% E" "•v G! —�O b
SIGNATUP. OF C RTIFIED WELL CONTRACTOR DATE
•&'teal ft it
PRINTED NAME OF PERSON CONSTRUCTING THE WELL
Submit the original to the Division of Water Quality within 30 days. Attn: Information Mgt., NOV Q 6 2GIS GW-la
Rev. 7/05
1617 Mail Service Center— Raleigh, NC 27699-1617 Phone No. [phone] ext 568. '.

RESIDENTIAL WELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources- Division of Water Quality
WELL CONTRACTOR CERTIFICATION ti 20,7*v
f. DISINFECTION: Type
g. WATER ZONES (depth):
From To
1. WELL CONTRACTOR:
Well Contractor (Individual) Name
Well ccasME CM13114E11141WELL DRILLit:G,
STREET ADDRE448 CRANE CIRCLE
ANKLIN, NC 237s4
City or Town State
( )Sas' Vntss
Zip Code
Area code- Phone number
2. WELL INFORMATION:
SITE WELL ID #(if applicable)
STATE WELL PERMIT#(a applicable)
DWQ or OTHER PERMIT #(if applicable)
WELL USE (Check Applicable Box): Residential Water Supply ❑
DATE DRILLED /I — i0' 6 (P
TIME COMPLETED AM O PM ❑
3. WELL LOCATION: /-
CITY: Sri)A- COUNTY, Taisiv
tne—A
(Street Name, Numbers, Community, Subdivision, Lot No., Parcel, Zip Code)
TOPOGRAPHIC / LAND SETTING:
❑Slope ❑Valley ❑Flat ❑Ridge ❑Other
(check appropriate box)
LATITUDE 3
LONGITUDE
Latitude/longitude source: ❑GPS ❑Topographic map
(location of well must be shown on a USGS topo map and
attached to this form # not using GPS)
4. WELL OWNER fr-��(�^ //I
OWNER'S NAME o/41c64 tT"I]fIO-
STREET ADD ESS 0 x—�
IAkbS a
May be in degrees,
minutes, seconds or
in a decimal format
City or Town State Zip Code
Area code - Phone number
5. WELL DETAILS:
a. TOTAL DEPTH:
b. DOES WELL REPLACE EXISTING WELL? YES ❑ NO ❑
c. WATER LEVEL Below Top of Casing: FT.
(Use'+' if Above Top of Casing)
d. TOP OF CASING IS / FT. Above Land Surface'
'Top of casing terminated at/or below land surface may require
a variance in accordance with 15A NCAC 2C .0118.
e. YIELD (gpm): J METHOD OF TEST
From
From To From
From To From
Amount
To
To
To
6. CASING: Thickness/
'1 Depth Diane} Weight Material
From_() To/Are (n� ,AlvG
From —__To Ft.
From To Ft.
7. GROUT: Depth
Material Method
From To...2-6 Ft.fr �-
From_ To Ft.
From To Ft.
8. SCREEN:
From
From
Depth Diameter Slot Size Material
To Ft. in. in.
To Ft. in. in.
From To Ft. in. in.
9. SANDIGRAVEL PACK:
Depth
From To
From_ To
From_ To
10. DRILLING LOG
From To
11. REMARKS:
Ft.
Ft.
Ft.
Size
Material
Formation Description
Ceqy
DEC 14 200
A<snevilie Regional
rn'nr.r,
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE Wm1
15A NCAC 2C, WELL CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS
RECORD AS BEEN PROVIDED TO THE WELL OWNER.
SIG ATURE
702/oz-6G
CERTIFIED WELL CONTRACTOR DATE
PRI
ED NAME OF PERSON CONSTRUCTING THE WELL
Submit the original to the Division of Water Quality within 30 days. Attn: Information Mgt.,
1617 Mail Service Center— Raleigh, NC 27699-1617 Phone No. [phone] ext 568.
Form GW-la
Rev. 7/05

WELL CONSTRUCTION RECORD
Nonh Cefolina - Department of Envhonmattt end Natural Resources.- Division f WLator Quafty'- Groundwater. Section
wELL CONTRACTOR (WDIVIDUALrfint (prfap ;hen
ten P11 S /�n l i /Ln r±. CK1 7PICATION i74
WELL CONTRACTOR COMPANY NAMc•I �•
.M SS 111 bort 111E1 Iilv'e jl;aeTice ,'Pttoets•
( t524-3 Ali
••
STATE WELL CONSTRUCTION PERMIT/ ASSOCG7•LD w rimers '
(if applicable) . •fftapplitable) '
•
I. WELL USE (Check Applicabla Box): Reside tial unicipalPublic 0 Industrial 0 Agricultural I J
Monitoring 0 Rccovcty 0` Heat Pump Water Injection 0 Other C7 If Other, List Use
2. WELL LOCATION:.
Nearest Town_: Ste. / vQ. Cotter,/ AC lrs 6
()4
11/Floc/C10.Rel •cxF77e,
(Street Name, Numbers, ca(uaanar, Subdivisioe, Lath., Zip Code)
3. OWNER
•
T bidnetind setting ZffiMage OSlope Malloy .OFlat
(clack wpmpelata boa)
f L titude/bagitude of well location
n i e p.r ad_ 4 s ''l I L' 7` 7/Q!' t? , (depeahnioutaboeonm)
Address ,3, A Psi_ L ' L 3i 6/) Latitude/ongtudesource:OOPSOTopographic map
r%DEPTH ' DRILLING LOG
(Sacs a(.RoweIfo.
nl
FPa1nii,
Area coda. Phone aumba
4. DATE DRILLED / — 3 —() Or
5. TOTAL DEPTH: SIDS'
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO cW-
7. STATIC WATER LEVEL Below Top ofCasing: :r0 FC:
(Uaa "in if Above Top orGuag)
R. TOP OF CASING IS / FT. Above Land Surface'
"Top of eWag terminated at/or below isadaerfaea makes a
vantage is sesordaaa wttb'ISAl7CLC 3C MIS. •
-
9. YIELD (gprp): .J 0 METHOD OF TEST�OIU/M .
10. WATER ZONES (depth).
• (check boa)
VIP code From To,
el •'7
r
Formation Descnpnon
Seac'fin�J
eierr/i
B LI) P_ ram-•t-0-
JOCATION SKETCH
11. DISINFECTION: Type fji- Amount .-3 TA-.4 5 Show direction and distance In miles from at least
12. CASING: Wall Thickness two State Roads or County Roads.' Include the road
Depth Diaptda or Weight/ft. t. Matp numbers and common road names.
From 0 . To /0/ e` S-b.:Jul Ure :•
From To FL '
From Tp FL
13. GROUT: Depth MateriM Method. -
From -To as Ft. CQ.Yjtal� pOVA.)
From To FL
.4. SCREEN: Depth Diameter . Slot Sire - • Material
From To FL in. in.
From To Ft. —ill. in.
5. SAND/GRAVEL PACK:
Depth Size Material
From To Ft
From To Ft.
4
0'
L
IV
O
6. REMARKS:
p
DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 1 SA NCAC 2C, WELL •
ONSTRUCTION STANDMDS. AND THAT A COPY OF TiqSRECORD BEEN PI(OVIDEDTOTHE.WSLLOWNER
SIGNATURE OF PERSON CONST'RUCTIt r� v E DA
submit the original to the Division of Water Quality, Groundwater Section,1636 Mall Service Cente-Raleigh, NC
n699-1636 Phone No. [phone], within 30 days. FEB 0 i 2006 OW 1 REV. 07/2001
Asheville Regional Office
Aaulfer Protection

• WELL CONSTRUCTION RECORD' : %
h,
North Carolina - DeparUnent of Environment and Natural Resources.- Diriaion of ater Quality- Oro»adwakr Section
WELL CONTRACTOR (WDIX/DUAL)ttAME,� �(pMI) c�ri Ptt S J4 j idea .rt....;-r .`- • gammAnoei of/7 to
WELL CONTRACTOR COMPANY NAMI[y'/X.Mn S Pe illwi (i)1 I3ifi In, Ir.-rice J 1 Piripi aaide-32- 4-3 3•b 0
STATE WELL CONSTRUCTION PERMIT{ /1ssO_CfATED WQpFRMITI ' -
(irappliabk) . illat4'lieable) • .
i. WELL USE (Check Applicable Boor -Residential lrMudcipaiPublic ❑ Itdushial CI Agricultural
0 Recovery ❑• Heat Philp Water Injection 0 Other CI If Other, List Use • - •
.
"2. -WELL LOCATION:. t ogripblnd setting •
/. Nearest Town: OR 5 tvt P P,S - Coenty CIC S the ,,CITHddge 0S160e Malley . OFlat
f( • Al ra±ox , /, n I )-n t 0 c- Lorh- r 5 (chuck appaprha box) . •'
(Sued Na Numbers, Cam nakySal l a, t h„ Vp Cme) ; g' / 7 L iit04 Aoagitnde Of w II location
3. OWNER Pobe 1-1-1-1-(t,S) e Ic'f'I 1412_ , ( )
Address (e-05 s P-1 L: 1 ASS (z • Latituddlongittide souce:00PSOTopographic map
nn (Siraa eeteitmn) oakum)
u qr`u 4 ta; Go- = 3 O or b 9 D 'TH " - QRTLLING LOG
Chlyar Tows Stan •""ttp Cods From.To' .Formation Description
C./2/4- Vet? -I{kk40 . _$S' / c,
4. DATE DRILLED t -/ & -- it-) %' . >'1 5 2 ' ` . ran' R i I f _ L, 2 4- A i t Q_ .
5. TOTAL DEPTH: . ? 00 ' '-,
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO_ -M-
7. STATIC WATER LEVEL Below Top ofCasing: 5C) FT_; (..,-
(Mania if Above Top of Carlos)
8. TOP OF CASING IS / FT. Above Land Surface*
ro
'rep of easing taratwted at/oe tutu leataarfaa requires a - - cn
variance aeees,Lnee wmt[SA1ft.AC 3C MILj
ut
9. YIELD (gm):/ 5 M$I'HOD OFTEST_./T/OIDj,t -, o
10. WATER ZONES (depth): `L 5 I}/ 5In J .m,_,s,a' Q `f'
LOCATION SKETCH
I I. DISINFECTION.Type filh4: Amount -.2174 4 5 Show direction and distance in miles from at least
12. CASING: Wallmtns two State Roads or County Roads. include the road
• Depth Dom} or Wad numbers and•cou n on road names.
From— Q . To S 3 Pt h , S.bs:Sj _ •
From To FL .
From Ty Ft._T---._
13. GROUT: Depth Mataila Medtod - -
Frem_[i.To (ate,a Ft, f)Oy i.)
From To -Pk -
.4. SCREEN: Depth Diameter . Slot Size : = Material .
From To Ft,_•_in. in.
Front. To FL in. in RECEIVED
5. SAND/GRAVEL PACK _
From DepthTo SirsSae Material FEB 0 7 2006
From To FL -
6. REMARKS:
Asheville Regional Office
Aquifer Protection
DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH ISANCAC 2C, WELL •
ONSTRUCflON STANDARDS, AND ThAT A COPY OFONSTRUCTION STANDAEDS, AND THAT A COPY OF1144SRECORD BEEN PROVIDED TOTHE.WELLOWNER
I ems. = /-)6 -0 '
SIGNATURE-0 PERSON CONSTRUCTING THE WELL • DATE
submit the original to the Division of Water Quality, Groundwater Section, 1636 Mali Service Center -Raleigh, NC
,T7699-1636 Phone No. [phone], Within 30 days. _ GW-I REV. 07/2001

• .WELL• CONSTRUCTION RECORD'
--,(. . .
North Carotin - Department of Emimmnent and Natural Resources - Division of Water Quality' -groin dwater Section
WELL CONTRACTOR (INDIVIDUAL)
WELL CONTRACTOR COMPANY _ nn
STATE WELL CONSTRUCTION PERMIT!_ ASSOCtATgD W4nMITI
(ifappficabk) --(ifapplicable) • .
R(pria0c Tin /,roiTartA, is • '` CLIkTIP[�CATet/ON a ofr!te .
:rttorli S2Y-3 ab O
•
1. WELL USE (Check Applcabk-Box):-Reaideatial&4i icipaVPubiic 0 , Industrial 0 Agdcultunl Q
Monitoring 0 Recovery 0- Heat Pump Wolin -Injection 0 Other C1 If Oilier, List Use
2.-WELL LOCATION:
caveat Town Coup C
. RisTbl a. DP4 attic.
(Street Name. Numbers. Community, Subdivision, Lot No- Zip Code)
3. OWNER kb/2. C 4- ✓n n S - /Y1 C 0 r•
Address . °I D/ R3 R) 3 n s 4-e
R I Y�
(StremsrkamsNo) d- ten 9
S,Iva. At.C•
ry Tore state ' - Zip Code
Bel- (Dal+ bb3te -
Area code- Phme amber
4. DATE DRILLED / - 1 j
5. TOTAL DEPTH: a 5 ' . -
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO Pk --re
7. STATIC WATER LEVEL Below Top ofCasing . Cr - FP:
parr if Above Top of CauaD
S. TOP OF CASING IS / Ff. Above Land Surface'*
?ap of mtag terminated attar balm! load.aar4a requires a .: -
atrium is aeeordues with ISATfCLC SC ARIA.
9. YIELD (gpm): f? METHOD OF TEST tr%DI/Jr' 4-
10. WATER ZONES (depth): q c-. J r d r20 ' (/
LOCATION SKETCH
11. DISINFECTION: Type 1f-f-/{, Amount cr.7 TR-S 5 Show direction and distance in miles from at least
12. CASING: Wall Thickness Iwo State Roads or County Roads. Include the road
Depth Diapiaa or Weight?t. numbers and common road names..
From_0 . To Ft " 5.i2R.t)•lrt -
Front To Ft. -
From_ Tp Ft
13. GROUT: Depth - Matenat M—e-th'od . .
From_ Toe Ft eQA nil F'OWO .
From To Ft.
4. SCREEN: Depth Diameter . Slot Sisa : = Material
From To Ft._(n. is
From To Ft._in. in. •
Typo d setting -
U‘f Midge opts OValley uflat
$r7'l9 (Meekappiepias box) . a
Littituddlongitude of w.cU location -
, (dagosalmiaurod oohs)
Latituddlongitiide source:0OPSOTopographic map
• - (ebodc boa)
DaPThi . DRILLING LOG
From To - Fommtion Description
in it a P i ,14./
5- SAND/GRAVELPACK:
Depth
From To Ft
From To Ft
6. REMARKS:
Size
Material
c_
n)
(n
0
m
RECEIVED
FEB 0 7 2006
I —Asheville -Regional Office
DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE Wf h$ ISANCACZ, coma. • _Aquifer Protection
ONSTRUCTION STANDARDS, AND THAT A COPY OFTIii3 RECORD H S BEEN P$OVIDED TOTHE .WILL OWNER
SIGNATURE -OF PERSON CONSTRUCTING THE WELL , - DATE
as I
submit the original to the Division of Water Quality, Groundwater Section, 1636 Mall Service Center - Raleigh, NC
j7699-1636 Phone No. (919) 733-322i, within 30 days. - GW-i REV. 07/2001

WELL CONSTRUCTION RECORD: : `. 3 2 2 r; f; 1
Nonh Carolina - Department of Enviroamdnt and Natural Resources - Division ofWater Quality- Groundwater Section
wELLCONTRACrOR(WDnwDUAL) E (prisf c riPiis I�A1in.A At .• ~_ CL�IWtcATsON. ilt
WELLCOMfRACFORCOMPANYNAMr1�IµIr.S eJllj�e l IIMI1�1y.11;u nt_,'eaotvst .3Dy-3 a 0
STATE wets, CONSTRUCTIOPt PUPATE- ASSoctATED w sitar/-. ,
(ifappleable) . - (Irapplible) - .
1. WELL USE (Check Applicable -Box): Residentialt-ea icipauPublic l7 Industrial O Agricultural-O
Monitoring D Recovery D' Heat Pump Water Injection ❑ Other Cf IFDiet, List Use _ -
2...WELL LOCATION: . �•
Nearest Town: !lJ CP�s7e • County�J A C IC S c+>v
()3 nod 1',c4 e. LoritL-- 07278-V
(Street Name, Number; tamaby, SabdM$ea. Lot Ho, Tap Cade)
3. OWNER: Se . /Yl , I I2tZ -
Address t R 91 Get. Qa •
(SueeterletseNo.)
r/2A-AAe L; A/ AA C• S73 IA
Owls Town State - - Tlp Code
(5 ) 34,,-a-Sc7cc -.
Ares Lade- Phone member
4. DATE DRILLED / - S - o 6
5. TOTAL DEPTH-
grapbieiLtind setting -
dge DSlopc Malley OFlat
(cheek appendagebox) . 4
Latitude/longitude of Well location
, Womees m eulalaeoww)
Latitude/lonettde source:DGPSDTopographic map
• (ebesebos) METH DRILLING - DRILLING LOG
From To ' Formation Description
TJ -(n5' - Cr'/.4 •
.5" • ,Ph' hn`.a,
�..'7' C?d • aLUt CIaAa)7�
6. DOES WELL REPLACE EXISTING WELL? YES CI ND_
7. STATIC WATER. l LEVEL Below Top ofC Cubit; .SD Ff.
(User if Above Top or Casing)
8. TOP OF CASINO IS __ FT. Above Land Surfaces
step of cuing tnrnlaMed she WW1 leataurfeee raper&
9. YIELD (gprp): 02 0 METHOD OFTESTI JD2Of7f..
variaen. N enerdaaa witA ISAT(CAC 2C .9111I.
10. WATER ZONES (depth): 1/SJ / T5J be-'
•
LOCATION SKETCH
11. DISINFECTION.Type Amount .3 T14-4 $ Show direcdon and distance in miles from at least
12. CASING: Wan Thiclup n two State Roads ar County Roads. Include the road
Depth or Weigwpt numbers and -common road names.
From i3 . To . 7 F saR:S•% •
From To
From Tp
13. GROUT Depth Mate)al
From_ Toe D Ft. e047, 427
From To Ft.
4. SCREEN: Depth plunder Slot Size • Material
From To Ft.__jn. in
From To FL is in.
5. SAND/GRAVEL PACK: _ Depth Size Size Material
From To Ft -
From To FL
n Mathod�
RECEIVED
MAR 0 8 2005 ,
Asheville Regional Office
Aquifer Protection.
6. REMARKS:
DO HEREBY CERTIFY THAT THIS WELL, WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 20, WILL
'INSTRUCTION STANDARDS, AND THAT A COPY OF RECORD HAS DREN PROVIDED TOM—MN/ELL OWNER
SIGNATURE -OF PERSON commCT=NOtill WELL . • DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mall Service Center -Raleigh, -NC
17699-1636 Phone No. [phone], within 30 days. - OW-1 REV. 07R001
-r)
ll
c3
0
en

• . WELL CONSTRUCTION RECORD
North Ca(otina - Deparnaent of Environment aerrd Natural Resources - Division f W Quality'- Groundwater Section
� �1yy
WELL CONTRACTOR UNDIVIDUAI4 t fpri;(1 riV. flVI!$ fin iInM d, •• 'd-. C1TPeAutiiti le
wet.LcorrnucroaCOMPANY NAMrE'tlrc lie 1kiwi f)tP.IIIyii vt T7 a�'Puo\NstCSa4-3na
STATE WELL CONSTRUCTION PERMIT•/ AaSOCI* rED Ena/l1't :.
(if applicable)••-OfappRoable) ' .
1. WELL USE (Check Applicable Box):-Revidential7Y MunkipaVPublk 0 Industrial 1] Agricultural
Monitoring 0 Recovery D • Heat Pump Watts Injection ❑ Other CI If Oilier, List Use -
Z -WELL LOCATION —(
'Nearest Town: S yes V /i- CountyC/r's fNC)
S o rim') . (2, 2z - ea•R'7q r -
(Suca Na Mambas. Cow, Subdivision, lot No -Zip Code)
•
3. OWNER: ECOUrrL 20 Co -tit, CO '
Address ? n o X f , Y,
otro«a< C F 70- 3
Gty or Town State • ' Cods
(.2% 79 Soto— 3TipFrom
Arcs cede- Kane number
4. DATE DRILLED - d i0
5. TOTAL DEPTH. ('SO
_
T bic/tand setting -
dge OSlope Malley OFIat
(sheds appropriate bw) -.
Cathode/longitude of well location
•
, (dnpedmi nneshooadr)
Latlt(enongitude source:DGPSOTopogtaphic map
• (cheek boa) -
DEPTH ' DRILLING LOG
To ' Formation Description
a7
a Cc So' .Formation
'CAA 1/ it-er
6. DOES WELL REPLACE EXISTING WELL? YES D NO. _ VI ' -
7. STATIC WATER LEVEL Below Top ofCaling:Sf FT;
(User ifMbove Top ofMaitg)
8. TOP OF CASING IS / FT. Above Land Surfaces
•fop of easing tnluatod at(ar blow landaarfoee rp o n
vartuns L aeeordana withISATfCLC 2C A11a,
9. YIELD (gpm): Co 0 METHOD OF TEST 6�DI/1771�Q .
10. WATER ZONES (depth): 6, 3,5" (/ -
•
LOCATION SKETCH
11. DISINFECTION: Type fFf/4- Amount .0.Th-I3 5 Show direction end distance Its mile from et last
12. CASING: Wall 'Mohne a two State Roads to County Roads. Include the road
Depth.... or WelgbuvL numbers and common road names.
From._ 0 . T0_LL Pit $bR:2 � . -
From To FL
Front Tp Ft.
13. GROUT: Depth Malerfd Method
From - FL CQ',ne ' L7
From To FL f
4. SCREEN: Depth Diameter . Slot Size • Material
From To FLin in.
From To
5. SAND/GRAVEL PACK:
Depth Size
From To Ft.
From To Ft.
Material -
RECEIVED
MAR 0$'2006
Asheville Regional Office
Aquifer Protection
6. REMARKS:
DO HEREBY CERTIFY THAT THIS WELL. WAS CONSTRUCTED IN ACCORDANCE WWI ISA NCAC 2C, WELL •
ONSTRLICTION STANDARDS, AND THAT A COPY OF T ECORRn H S BEEN PROVIDED TO THE WELL OWNER
I `90 -o(p
-
SIGNATURE-OP PERSON courntUCT1NO THE WELL . - DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mall Service Center -Raleigh, NC
27699-1636 Phone No. [phone], within 30 days OW-1 REV. 07/2001
rn
rn
•

• WELL CONSTRUCTION RECORD
,(,.
North Department
Cafolina- Deparent ofEnvlrouResourcest and Natural Resources - Division of WaterQuality�-Groundwa. . ter Section
was. coran.croR grion ituAL)TtAMg (Talao ;he II n t 5 /4 in. rt.' • , • r car CATIOr(/ ell. 4p -
MiiS 1 i Ora !IN • T a,t,,tS
WELL CONTRACTOR COMPANY NAMIC' � (i1?JI —u t4"t ��Paota / 2.4-3 A6 O
STATE WELL CONSTRUCTION PZI1MtTI - assocwain watihriaari .
(if applicable) (ifapplicable) • .
1. WELL USE (Check Applicable liox):-ReddemtialZYMwticipM/Pubiic 0 Industrial O Agriwlt ralU
Monitoring O Recovery Cl'Heat Pump Water Injection ❑ Other a 1f other, List Use •
. -
2 "WELLLOCATIQ$: �.
Nearest Town: (rA Q 0-3 " County-) A-G /L
H tt' (0 Li
(street Nimbus. Caomaehy, Subirielem LeiN., Tap D)
3. OWNER ;(0111-.
Address r. t 7 )C .9 / r r`
(StreeteiRmaeNt) - -
C)4sI Q s _n2G &7) 7
esn orToown State - ' Zip Cede
(FOR)- 14' 3 - t 3 3 .
Area code- Pbooe amber 3 �G o
4. DATE DRILLED
5. TOTAL DEPTH : N/! S'
5 TopoglapbiPneand
°Ridge OSlope MalloyL1
(Mack worts '
app
Cathode/longitude ofWell location -
n• S �. v Cis
, (desreealmiaumNwbnda)
Latittde/longittide aource:OGPSOTopographic map
Ohms hog
DRILLING LOG
Forttmtion Description
12LJ .
Ll1
From To
a/'
-- 4 / ' 'fir si
6. DOES WELL REPLACE EXISTING WELL? YES ONO _liY`
7. STATIC WATER LEVEL Below Top of Casing:. L. FT:
(Uart" if Abram Top oWadaa)
8. TOP OF CASING 1S �— FT. Above Land Surface*
'Top of easing terminated atter Mlaw leadaartaa requires a
variants to accordant RIO ISAHCLC 2C.0113.
9. YIELD (gpm): / a- METHOD OFTESTJY/DI//pt4. ,
10. WATER ZONES (depth): 9.5 ' u
11. DISINFECTION: Type
12. CASING:
De
pth
coot
From To
From______ To
13. GROUT: Depth
From_Q_ To
From To
4. SCREEN: Depth
From To
From T
5. SAND/GRAVEL PACK
Depth
From To
From T
• - J.00ATION SKETCH
Amount .3 T/�•B 5 Show direction and distance in miles from at least
Wall Thickness two State Roads a County Roads. Include the road
tf pa %W k r a; .' -.numbers and common road tames.
Ft �_ in: ?'fee%:
Ft
FLU_
Ft
F
o
Diameter . Slot Six : Material
in.
Six
FL
in.
Material
o FL
RECEt 'EO
Asheville Regions Office
6. REMARKS Amite. Protection
DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC2C, WEIL .
ONSTRUCf1ON STANDARDS, AND THAT ACOPY OF S RECORD BEEN PROVIDED TO THS-WELL OWNER
SIGNAThRE0! !0N CONSTRUCTING THE WELL - DATE -•
submit the original to the Division of Water Quality, Groundwater Section,1636 Mall Service Center -Raleigh, NC
.17699-1636 Phone No. [phone], within 30 days. - GW-) REV. 072o01
r3
0

• WELL CONSTRUCTION RECORD : 3 2 6 0 5 5
�.:
•,- - = • -
North Ca{oiiaa - Department of BtWitosmrdt and Nadal Resources - Division of Quality-Groundwater-(i�odudwaief Section
wvn. coumcron (Ummnewuat 6 rieWM ;hell r l S 1Iltn A . • r ativrc ltloN e -
nu. corctawcroncoaarnivtuatent.lq):c fin I!Uri 111PNIlAy%ai;u t � if tame" a-4-3 Ab 0 .
-
STATE WELL CONSTRUCI1ON nuthliTe AssoUWTu) Wj]7atiwrri —
&appl(ceble) - . •-or applicable) • .
1. WELL USE ((heck ApPBcablts lioar-Re idaUiali Muuctpaurubiic 0 - Industrial 0 Agricultural-?
- ' Monitoring 0 Recovery 0- Heat Pump Water Injection 0 Other Cf IfOdia, List Use -
-2. `WELL LOCATIO r j i - birJLttnd Setting -
Nearest Town: &if t !i V. 1 /2� CotmtS /q S 11 + 'dge [)Sieber Malley . ()Fiat
pilot /Y1 n . kart* 2 0r 873 (o ( p- -
tsumNama. Numbers. Coounyun�hr.Subdwbioo,I.eiN ..rpCoe) ... L'edihtl&Iongidldoofwglllocation
3.OWNER 1 /C1A a,-�CLi1IN4.LCC• , ()
Address /t2 V T. s ,�L VA bSA DP • Ladtudefongittide sourccoOPSOTopographic map
VN-L.K S ow a girt• A du_ $/. .3.2.2- 6DRILLING LOG
_ Color r - Zip F To Panned eacription
Asa tale- Moog .amber G Y-t __( ,rj • /A01 A—,
4. DATE DRILLED .S f"Jv V - th •0 ' i An 5 r *'t--
5. TOTAL DEPTH' /c?-A S ' - - -
6. DOES WELL REPLACE EXISTING WELL? YES 0 NU::Qr -
7. STATIC WATER LEVEL Below Top of Casing: '% On FT.
(W o 9^ if Mena Ter ottesiog)
8. TOP OF CASING IS _/ Fr. Above Land Surface'
'Top ofawing terminated odor Watt gedaartneenotate • - .
nrtaaer la aeeordaa rrn475ATIGCC 2C MIL j�
9. YIELD (gin): _ram METHOD DETEST Q%11lDpf-.
S 1O. WATER ZONES (depth): /51 ' (/
- IACA'rION SKETCH
11. DISINFECTION: Typo 1-1111: Amount ...i.TJM i Show direction and distance in miles from at least
12. CASING: - Wall Thebes! two State Roads or Coimty Roads.lncludc tho road
Depth _Dt•a�er or Wei%gbt!Pt. Met•1 'mambas andtommon road names.
Frotq�:Tolle Ff`(fj'` S.aR-st. a:
From To Ft,_ - .72
T
bll
From Tp Ft
13. GROUT_ Depth Material- Meshed
From_�_To_ Pt.eQd,La,t PC»0
From To FL
.4. SCREEN: Depth Diameter . Slot Size . • Material
From To FL__in, ie.
From To Ft. ID. in -
S.. SAND/GRAVEL PACK: _
Depth sirs Material
From To FL_
From To Ft`___
6. REMARKS: - -
DO HERESY CERTIFY THAT THIS WELL WAS ODNSf&UCfW) IN ACCORDANCE( Willi ISANCAG2C, WEIL
-ONSTRUCIIONSTANDARDS, AND THH}ATAACOPY ,OF RECORD f-CORDASBEENPROVIDEDTOTHB.WELLOWNER
j/ .t
SIGNMIJRE-OF PERSON CONSI'RUCFINO THE WELL - - DATE
submit the original to the Division of Water Quality, Groundwater Section, 1636 Mall Service Center -Raleigh. NC
,17699-1636 Phone No. [phone], within 30 days. . - GW-1 REV. 07/2001

. . • , .
WELL CONSTRUCTION RECORD'
.-. ,(y s
North Carolina - Department Of Environment and Natural Resources - Division of Water Quality-- Qroimdwater Section
WELL coNrRACTOR (NotV•InUAL)'N,�p}aR� �(Rug coal Pit S MO I i/).,A ,4,•`' - •- CrtgmrcATION date
watt -CONTRACTOR COMPANY NAMEC4)%iir.c Pt II/1,1 UM IINtfal su m-ttS "Puomt ia"�i�ay-3 ab 0
STATE WELL CONSTRUCTION PERMPTI ABBOckATSD YRMrTO . '
Cif applicable) • -(if applicable)
•
I. WELL USE (Check Applicable Box):-Residential7YMwicipal/Public ❑ Industrial 0 Agricultural Q
• Monitoring O Recovery ❑- heat Pump Water injection 0 Other ti If other, List Use '
2. "W WELL LOCATit,
n: �..1 Nearest Tow'CM ✓�'I4, ' County S
L. .o.J•
pIAY'M+&I. tot &let .Qifrf%I/R
(Sweet Naas. Number. Community, SubdMdon, Lot No, Zip Cam)
3. OWNER: B; D R et
s P412t714n 5 LLr:
Address /4e87S LU lY1riS,4 pit
(StremorAonsxoa -
SAeltS/en;rim tack-, pt. 3aa� a
Gry brTown Sum '� ZOCode
kab- k
Ass code-. Pbsm number
4. DATE DRILLED 5 / --0.(a
5. TOTAL DEPTH' /d00 •'•
TopogrspbirlLand setting
4.42116:1ge OSlope OValley Opal
(dedcappropdste . a
tistitugellongitude eve location
•
326657
, (deg,eeilmimnahecoads)
Latitudellongittidc sourcc:0OPSOTopogtaphic map
• (csdc ban)
DffiFi DRILLING LOG
From To ' F i tier( Description
0 ZS• 4
5•' (.3•
co 3• / Doe e �C L-uQ- :.,v.t-e•
6. DOES WELL REPLACES EXISTING WELL? YES 0 =m•��
7. STATIC WATER LEVEL Below Top of Casing .S6D FT.
(Usa`NifAbom Top denim)
8. TOP OF CASING IS / FT. Above Land Surfaces
'Top et castes tarminalad woe beam tpd.amrfip requires s
variance to occordampo4itb"1SAT CAC 2C.0113.
9. YIELD (gpm): r METHOD OF TEST_/)
I O. WATER ZONES (depth): (! to (1
11. DISINFECTION: Type
12. CASING:
Depth
From fl.To6 el
From To
From Ty
13. GROUT: Depth
From__ ToAD FL cant
From To FL
-4. SCREEN: Depdh Diameter
From To FL ip-
From To Furs
5. SAND/GRAVEL PACK:
Depth Size
From To Ft.
SUM(LOCATION S(
N-/-/f" Amount o2 TA S Show direction and.diatance hi miles from at least
Wall Thielmas two State Roads or County Roads. Include the road
Ft
h
Dia�ua s•Iartg Wei ter. numbers and common road names.
Ft.
FL—�
From To Ft
•
phlothey)Lid
Slot Size - = Material
in.
in.
Material
J
6. REMARKS: "
DO HEREBY CERTIFY THAT THIS WBLL WAS CONSTRUCTED IN ACCORDANCE Wtfl-1ISANCAC2C, WELL •
ONSTRUCTION STANDARDS, AND THAT A.COPY OFTT}I�((S RE�C�ORD HAS BEEN PRGVIDEOTOTHE-WELL OWNER
�a r- z 0 6
SIGNATURE -OP PERSON CONSTRUCTING THE WELL DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mall Service Center -Raleigh, NC
.27699-1636 Pboae No. [phone], within 30 days. . OW-1 REY. 07/2601

• . WELL CONSTRUCTION RECORD "
North Carolina - DeparDpent of Envimraneht and Natural io ,( lr - Resources.- - Divfaton of Water Quality. Oroiudwat� section
•
WELL CONTMC!'OR(WDIY,tnUAL)NAaj1B� (pAoQ c�)f flpli s /4t iia, - CL�77FtCATI/a(a (. _
WELL CONTRACTOR COMPANY NAhlitrcIthr q Pa Inert I IlP.I I IN ye; .I j g n'c � t!Rora a
STATE WELL. CONSTRUCTION PERMITS L`�-*�- `�e'i t./--q �b
(ifapplieable) - ASBOCGTED Wtble) Min .
•
<ifapplicable) •
•
L WELL USE (n....4 w...tt..u_ n__). .l
l
_
,,,,
Agnculhnal 0
.
w
yays uuuc u
U
Monitoring O Recovery CI' Heat Pump Water Injection 0 Other Cr If OIndustrialIndustrialtlier, List Use
-2. -WELL LOCATION:
*Neippst Town:
0 OCAL • :T, dd
(Street Name, Numbers.
3. OWNER:
County,
. Saba *. • Let No. rei Cade)
.ffl&eav4 nNew
4_ DATE DRILLED -, as -64
5. TOTAL DEPTH: %OS -,
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO in- ea-
7. STATIC WATER LEVEL Below Top of Casing: /.f0 _ I•T:
8. TOP OFCASING IS / (user itabove Top or ssisa)
trip Musing terminated *der
ade a Above Land surface
an to accordant LSAACAC2C MIL fib. a
mitten .
9. YIELD (gm): _ �_ METHOD OF TEST 6%DUI,�f .
I D. WATER ZONES (depth): 3 75 r (/
11. DISINFECTION: Type fFfff. Amount .l— O N SKE3z
12.1CASING c a ma 9 Show ditectioa ard.distantx Ia allies from at leasi
Wall Thickness two State Roads or County Roads. Include the mad
Front_DToc Depth
F( Disputer S oc� Wa'� tatitejill _.'numbers and common road names.
From To a ..�.1
From Tp R.
13. GROUT.: Depth Material. Method
Frora _Q_ To Ft,�l D.v„ apt" !_p��
From To I
.4. SCREEN: Depth Diameter . Slot Size : • Material
From To FL_ -_ice in.
From To FL_in, in. •
5. SAND/GRAVEL PACKDepth
_
From Size Material
Ft.
From To Ft.
6. REMARKS:
AdCu dress p
e. b i a_ t! 0217
7 O O
• a )- 'Cgs .. cos° •From
Arncode- Phone number '_ -` S{"e
T B*pbieffeind setting
43R�idge °Slops UVauey . °Flat
(°
Littitudenotigitu weillocation
•
, (degnettmimtalsamoda)
Latltude/longittide saoucce:00PSCITopographic map
(atxictaav)
DEPTH' OK!LLINO LOG
Formation Description
L/ Cieaa;*e
326248
m
DO HEREBY CERTIFY THATTHIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH ONSTRUCT1ON STANDARDS, AND THAT A COPY OF/� RECORD BBE N PIRO DVI tEDTOTHPICACB WELL OWNER
SIGNATURE-UFPERSON CONSTRUCANGmaWELL. DATE
Submit the original to the Division of Water Quality, Groundwater Section,1636 Mall Service Center -Raleigh, NC
J7699-I 636 Phone No. (919) 7333221, within 30 days. OW-1 RSV 07/200I
CO
O
m

Depth
From. I . To a3
From To
From ,To
13. GROUT_ Depth
From n To .- D
From To
.4- SCREEN: Depth
From To
From To
5. SAND/GRAVEL PACK
Depth
From To
From To
6. REMARKS:
• WELL CONSTRUCTION RECORD -
Nonh Ca?olina - Department of Envlroomeot and Natural Resources.- Division of. , Quality-- Oroimdwater Section
WELL CONTRACTOR(MDI1(WUAL)NAM6 (Pw9 c fl Pit S %tibia,. r(,. - • - t CIAq, CAteUOtl>! ��te -
WELLCONTRAC[ORCOMPANY NAat <!•.�„ .n. J 'ruoNRa/IYI,_.SIY--3 ab 0
STATE WELL CONSTRUCTIONPamartro - AaSOCG�Te9 ,I g gTy
(ifappliable) i(fariplicable) •
I. WELL USE (Citeclt Applicable Box): -Residential it MtwicipellPablic o Industrial D Agricultural 0
Monitoring 0 Recovery O' Heat Pump Water Injection O Other [ If Oilier, List Use
2. "WELL LOCATI /,�
'Nearest Town: CPI ✓ r //e. - County t--/T� C-IC 5 !/A.:
Ored0.A.i a.113
(sued Name. Nantbaa, Comma* Sabdir(doa, La No., VW Ccde)
3. OWNER: re/eh/II-he ' C 7p C_.
Address /2 .3 &ee1tee 2a
p, et o� g? 3 io �ltnvl /lam
&aZ-7
Gryer 13 era 3SSata-o 39 �- - Tg.Code
--. .
Area nada. Phone number "1.
4. DATE DRILLED •- 9 •A Co
5. TOTAL DEPTH: Sob' -
-opoBep so
t6l idge i7Slope OKLandaik)!y , QFkt
(elwotc apptaprlasbuz -
L'e6tuchllongitude of wcil kedon
326
47
, (depsaimauwd ewatI l
Ladtuddlongihide somce:OOPSOTopographic map
. (chart emu)
ThHila - • DRILLING LOG
From To Foronadon Description
• M a3 CI -Ay -
--a3r 43603 j3L!/LG-RAv27 ,
6. DOES WELL REPLACE EXISTING WELL? YES O N0
7. STATIC WATER LEVEL Below Top ofCaaing:. 1 _ •;
/ (Ws't ifAbove Top ofC tg)
!
8. TOP OF CASINO IS PT. A ovcLand Snracer
-Tap ofwing unstated atlor ttelovi ImuLaartme regains■ , - .
variance in amerdaaeewkY15ATIC&Clc Alfa. )) - ..
9. YIELD (gm): _,� METHOD OF TEST ti%Dilp 0
10. WATER ZONES (depth): 3S5 SD -, 90 '
11. DISINFECTION:.Type #111LOCA710N SKETCH
- Amount aTN-At Show direction and distance in miks from at least
12. CASING: - Wall Thickness two State Roads or County Roads. Include the road
or Weighbyt. Ma ': numbers andcommonroad names.
Ft
Diameter - Slot Size : • Material
Ft_�in hi.
Ft_jn in.
Size Material
FL
JUN 06 21)U3 •
DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTRD IN ACCORDANCE V/I H ISA NCAC 2C, WELL -
ONSTRUCTIONSTANDARDS, AND THAT ACOPY OFT RECpRDf SBEM PP,OYIDEDTOTHBWELLOWNER
SIGMATUREOJ�FPERSON CONSTUCTINO THE WELL - - DATE
Submit the original to the Division of Water Quality, Groundwater Section,1636 Mall Service Center -Raleigh, -NC
,17699-1636 Phone No. [phone], within 30 days. . - OW -I REV. 07/2001
Co
CO
Cr,

- WELL CONSTRUCTION RECORD '
.,,(t1 6 -
North Catolina - Department of Envimmneiant and Natural Resources - Division of Water Quality"- Qroimdwater Section
WELL CONTRACTOR (INDIV•SDUAL)TtAMY(mia04)en91iS /in.10;r;d,.°• .,,._ - `. cz tCATToh...l 4'
WELLCONTRACTOR COMPANYNAMKb'pill c PttI bort 11/0.1I1)r.i 1 TR.. Tice �J PttoNris.sa4-'3 Ab 0
STATE WELL CONSTRUCTION mutativeASSOcf_AT® WQYRRMIT!
(irappliceble) ' -(if applicable) • .
1. WELL USE (Check ApplicabW Box):-Residential7Y witude paYPublic ❑ Industrial CI Agriculturala
' Monitoring 0 Recovery ❑' Heat Pump Water Injection 0 Other CI If Oilier, List Use •
2.-WELL LOCATION:
Newest TownP BSTQ t Countysuc hen 00P a f
(sour Name. Numbds, Canoeing, Subdkaim, tot Ho.. rip Code)
3. OWNER: 4Lcomb e /71c
Address •0•Bax4-D -
U.) t sS T2ror�e 1 tglie
el1_r 5- 6 - gab b xaaaae
Ares cods- Phone mamba
4. DATE DRILLED • '-•J S' -
5. TOTAL DEPTH: .jf).5 ' " •
TopD• d setting -
°Ridge �� alley . Fiat
(cbedc approptier boa) _
LittitmW471tetude of well location
(duet IOC:
nwder)
Latitude/longitude somco:OOPSETTopographic map
• ' (Meet boa)
DEPTH ' ',KILLING LOG
Fro To ' Formation Description
Ef 0' I L. (4
4b• .Sag ' Ld e '6:,e ,v; te.,
6. DOES WELL REPLACE EXISTING WELL? YES O NO VY/'
7. STATIC WATER LEVEL Below Top ofCawtg: h FT.
(Use"' itAbore Top ofanba&
8. TOP OF CASING IS / FT. Above Land Surface*
-rap of cuing terminated atterneinlead adns requires a .
variant, amera whit ISAJICACSC.Oua.
9. YIELD (gpm): �r-D OD OF TEST
vartl
10. WATER ZONES (depth): 7(DS 4
• LOCATION SKETCH
11. DIS(NFECTION:_Type i f«- Amowd .3TA- A5 Show direction outdistance in miles from at least
12. CASING: Wall Tbidoresa two State Roads or County Roads.. Include the road
Depth D;,p�ter or w.ey r/Pt nimbcra and -common road names.
From 0 . To ILO Fr`l�- 5ZzR:.$
From To FG •
From Tp FL
13. GROUT: Depth Malaga Method
From fl To as pt_aents pall-4 )
From To B.
4. SCREEN: Depth Diameter " SlotSize = • Material
From To FLia, in.
From To FL in. ti4
5_ SAND/GRAVEL PACK:
Depth Size Material
From To_ FL
From To Ft
6. REMARKS:
DO HEREBY CERTIFY THATTHIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC2C, WELL •
ONSTRUCTION STANDARDS, AND THAT A COPY OF S RECORD I S BEEN PROVIDED TO THE.WELL OwNER
ihicts
SIGNATUREOF PERSON CONSTRUCTING THE WELL " DATE
submit the original to the Division of Water Quality, Groundwater Section,1636 Mall Serviee Center -RaleIgh, NC
.27699-1636 Phone No. [phone], within 30 days. , GW-I RBV. 07/2001

•. WELL CONSTRUCTION RECORD "
•
. at •.. �$(,(��`: wator Section North Cafo►ina - Deparhaent of Enviroann nt and Natural Resources - • Diivision of Watw Quality'- Oroimti "
WELL CONTRACTOR (WDIV,WUAL)E (prt.Q dill! PALS .p/12nd.:• csf�rlP1C*TlON a_ate
WELLCONTRACTOR COMPANY NAM Ajj)r.0 fit IInW UM IA1 11-Tara(( T-wt •r1101,1 4"�k%5a Y-3
STATE WELL CONSTRUCTION PEWrtrd ASSOCfATED WQ4ERM1nI -
(Yappliable) / (itspplicabto) •
1. WELL USE (Check Applicable Box):-ResidaUialflunicipalPublic 0 , Industrial 0 Aviculturist O Aviculturist
Monitoring 0 Recovery 0 Hest Pump Water Injection 0 Other CJ if Other, List Coo' 7 -
.2.WELL LOCATION: - f
Town: (W 8.8S%a - c«mty ul.�
(Street Name. Nuummhaa, Cmumuaity, Sabdivisiaa. LotHenZip Code)
3. OWNER: Q.. caw..b-c- %C -/1 e
Address •C • OX SED -
CuE1.3,5 -2"`tit allrr
Arn mde- Pboae number t'
4. DATE DRILLED 4S`-a D —0 Co
5. TOTAL DEPTH: Q j•
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO_ :
7. STATIC WATER LEVEL Below Top of Casting /DO FT:
wareSabonTopofCedes)
8. TOP OF CASING IS _/ FT. Above Land Solace'
Kap of cadet termloamd attar bdtt( ipadaa is regains a
varltanla aeaordaaeead* lSANCAC 2C A11R _
9. YIELD (gprn): OD OF TEST
10. WATER ZONES (depth): z, J 9. fa
•
., •
1I. DISINFECTION:.Type fl-flf: Amount ..� %E1-13
12. CASING: - WallThidmem
Depth 10 Diaprser or Welphtt q. Mac 1
From fl . To TX Ft, �k4yy" Argiio
From Tdt FL
From Tp FL_�
13. GROUT: ff�� Depth Mataiil Medved
From_�� To r4'7i ' ,' pa od
From To FL
4. SCREEN: Depth Diameter , SlotSize- Harslet
From To FL_ in. in.
Frorn- To
5. SAND/GRAVEL PACK _
Depth Size Material
From To Ft.
From To FL
6. REMARKS:
•
Tppograpbj•
�
pRidgeLI331opa allay OFiat
&beckapptoptiatebox) . a
L"etitodefloiigitodaofwall location
, (desnahnim teshowods)
Latituddlongitdde sotrce:DOPSOTopographic map
Mach 1030
DEPTH • DRILLING LOG
From To " Formation Description
j,OCATION ETCH
5 Sbow direction and.diaWuaSKETCH
miles from at least
two State. Roads or County Roads. Include the road
'-numbers and common road names.
•
c
DO HEREBY CERTIFY THATTHIS WELL WAS CONSTRUCTED 1N ACCORDANCE yam ISp NCAC.2C, WELL "
ONSTRUCTION STANDARDS, AND THAT A COPY OF TM RECORD H6S BEEN PROVIDED TO THEN/ELL OWNER
401 /-ao -oG
SIGNATUREOFPERSON CONSTRUCTINOTHBWELL . DATE -
•
,Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mall Service Center - Raleigh, NC
.27699-1636 Phone No. [phone], within 30 days. . OW -I REV. 07/2001

. • . WELL CONSTRUCTION RECORD'
/4
NorihCaoGm-DepattmadofEavimen and Mini ealEmmen-1ES=ofWaiorQuai(Y-Oro dwa Section
(pM;9a47.11vir S T,},oIla. d, :` irrislutacriart
TAILS at! -3 a-b 0
WELL CONTRACTOR (WDnXpDUAW
WELL CONrRACTORCOMPANY rrAaaw-, r4)nTS arorae...d ..ru.t.�:�r
STATE WELLCONSTRUCRON PERaat'ra AiOCATED
(*applaab's) lifset table) -
1. WELL USE (Check Apphabli Eo4-RpideiSt( pal/Pu1 b
Monitoring O Rewrap, O Heat Pang Watt Injection ❑
.2 -WELL LOCATION:
euv N1Town: C-I end i)-G. - Cam CS
lot tY9rtl• aif'73(O
(Street None, Nanbaa, Doestaneity, Sabbnidt4 Lot Ha. tip Code)
3_ OWNER: R%a .c Pan.171446 LLC
Address / 4' 7 s_ V pc u cot se.. 02. -
(sawiorscot -- -
.T/)-(.Ksp•ujibe- tS A4C/• .322s0
GtyurTawu Mae rep T.p Cade
sl
f a- soG-/92k•
Area code- Moneaamber
4. DATE DRILLED I / t —o_ - ' -
5. TOTAL DEPTH.-
7So'
Ec C _ Industrial CIAgdcaltmal Q
Other EIIfO ,IistUse
•
3opograptiC/Land setting -
L-Btfidge OSlope [Walley . [Flat
(dtadrapyspdatebox) -
Catiludefloagituda five 11 location
Ldhuddlwtgittide sourecOOESOTopographic map
DRILLING LOG
From To - OttnationDescription
_-5/ , '7 Mr ,glut /,-lRin/ ;- -C_
6. DOES WELL REPLACE EXISTING WELL? YES C NQitale
7. STATIC WATER. LEVEL Below Top of Casing pia 5 FT.
(IWmin it'AhereTop of Cabe
R. TOP OF CASING IS _/ FT. Above Land Surface`
•Tep ofclogtatdaandanarWow pd Scc..*.a
whale 4 aeeerdaesemt75AliCxt2CLUL . j
9.-nab (gp*_[�MZWODOFTEST fj1DI/%t7IQ-,
10. WATER ZONES (depth):(Pp02!7 ' _ (1
11. DISTNFECTION,Type H#li- Amami ..2TA-S5
12. CASING: - - Wall Thickness
From fl .Two -S� Ft m kSh
ilits In.
From To Ft
FromTp FL -
13. GROUT:
ToFt_ d-
From A TINDI )
From To R.
.4. SCREEN: Depth Diameter , scot Size - = Msaaial
From To Et. in, in.
From To Ft —in. in. -
5_ SAND/GRAVEL PACK:
Depth Size Material From To FL
From To Ft.
LOCATION SKETCH
Show (Erection an&distance in miles Rom at least
two Sato Roads or County Roads. Include the road
-numbers and -on road names.
6. REMARKS: - - -
DO HEREBY C RTIFYTHATTHIS WELL WAS ODNSTRUCIED IN ACCORDANCE WWI 154NCAD2C. WE L •
ONSTRIK•FIONSTANDARDS, AND THAT ACOPY OFRBWRD HAS EEW4PlOVIDEDTOTHEWELLOWNER
- SIGNAT RE•UFPERSOHCOi�Si1Ueruini WEU. DATE -
submit the original to the Division of Water Quality, Groundwater Section, I636 Mali Service Center -Raleigh; NC
.27699-1636 Phone No. [phone], within 30 days. - GW-I REY. 07W2001

WELL• CONSTRUCTI
North Cafol'ma-Depaclmpd O
of Envkonw&t and Natural Resources
VKLL CONTRACTOR U NDIXIDUAW'NAJfS•
N RECORD "..
•
• <fa
Err. Slli',usasi.��� t1r1�r+• CL�7'IYtCA'C10Ni 0/r7
r •
�l _saw -a ab o
JEu.coNrRAcroDcowpArrcetwyr,r raow4s
STATE WELL COnmucrtoij PRRidfra Asso(YAT®W n]tw -'-T
airapplicable)- - -(If Wplleable) • . . .
1. WELL USE (Check Applicable 13oxk-R sidential�M=kiwi/Publ c ❑ Industrial 0 Agricultural.°
Monitoring 0 Recovery a • Heat Pump Water Injection ❑ Other CJ If Oder, List Use •
_ Topogriptic/Lmtd setting -
Midge OSlope OValley ..
(chest appropriate boa) .
L'etiturkAongituda of moll location
,(
Latitude/longitdde sourestiOOPSOTopographic map
' Ida* hag
' r�,p'fl3 - DRILLING LOG
. From To - Formation Description
-- Ra' 9A-D' if:/4-1).-t _sinf tft.--,
2_ "YELL LOCATION
-Nearest T,Rwn C h'
U-Yeetts t2;eek- • 8'7 7 9
(streetName Numbers. Cmve&y, Subdiri4an.l a th.. Zip Code)
3.OWNER: SD; I►;(J,„ to-een,
tStmTo Itatil9
5 /va- ;vr✓ .V-8/79
Address . n. sox
CZatowa State . l�rip
(.1/2)-.s R /o — 9/5 Code
Area ecde- Thane amber
TE DRILLED %/ 7-0. (,
5. TOTAL DEPTH:_/ 4-'ID ' '
6. DOES WELL REPLACE EXISTING WELL? YES O NQ-.�r"
7. STATIC WATER LEVEL Below Top ofCaaing —0— FT.
(We'r if Above Top or Cain)
R. TOP OF CASING IS ___� __ PT. AboveLand Surfaces
'Tap el mane tumlaatad at/or betas; lsod.aeian ngatres a
mien hi aecwdaaas 'althlUNCAC 2C .a11E.
9. YIELD (gpmk /OD f- METHOD OF TEST biullir 4•-,
10. WATER ZONES (depthk / ef0 ' (/ - LOCATION SKETCH
11. DISINFECTION: Type /t-%i4. Amount 4T1)43 $ Show direction anddistance in miles from at least
12. CASING: - Wau Thickness two State Roads or County Roads. Include the road
DepthWeight/ft.
or �°� numbers and -common road names. CI
From 0
. To 35 FL k�" S��i-$- K`.`"' c
From To_ Ft r
From Tp FL
13. GROUT.: Depth Material Method l.
r•; n -
'"
From_ To aFt. oo„m.i - pc34) r" `
0
From To Ft` _
c. __
.4. SCREEN: Depth Diameter . Slot Size - ' Material —
From To FL in. M.
From To FL —in. in
5_ SAND/GRAVELPACK:
Depth Size Material
From To Ft
From To Ft -
., •l
329579
-DtvisionofW"atcrQuality.-Qraundwator Seca on
•
•
6. REMARKS:
DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15ANCAC2C. WIii3. -
UNSTRUC170N STANDARDS, AND THAT AA COPY OF TT RECORD HAS BEEN PROVIDED TO THB WELL OWNER
SIGNATUREOFPERSON CONSTRUCTING TUB WEU. . • DATE -
,submit the original to the Division of Water Quality, Groundwater Section, 1636 Mall Service Center -Ralelgh,-NC
n699-1636 ?bone Na [phone], within 30 days. . OW -I REV. 072001

• WELL CONSTRUCTION RE
Nosh edolioa - Depattmatt of Envhoameot and Natural Reso+Ruas- Division %
WCII. CONfRAC1OR(n'mt1(WnAW .tjn•S
CrOR COMPANY
32 878
CORD'
r Water Quality - Groundmter section
jsJeJlAn l 1!)ell�)I;u "Try e ,Puoiu(eig� ,4.t�=--3 3.6 0
Watt
WELL CONTRA . d(
STATE: WELL CONSTRUC 1O(/PfIMt'ra AasocWn D WQ4
(1fnPBabla) •(ffappllablei •
1. WELL USE (Check Applicable'Box):-Re5WeatialiYM utpal/PublIc CI Industrial 0 Agricultural 0
Monitoring ° Rtxovmy 0'' Ueat Pump Warm Igjoction ° Other CJ If Other, List Use
Z. WELL LOCATI N: .
"Nearest Town: 1/ 5 bill°
L/N-rz 5 A-v»ufA-r� •a1 �lr>t
(Suer Name, Numbme.Caam'wky, Sebdiraao, Lot No, Zip Cade)
3. OWNER:/9, IC t',..Cle.nn.TK-0F
Address �i -O. I$ o r Sr ((11
tst to Ranwifo
Ji: 1/ s hnr-n ' Af c.
Size Trp Cute
Color To
97/0 .
Area code- tome comber n / S% +D %
4. DATE DRILLED
5. TOTAL DEPTH: • 3 Q5 "
6. DOES WELL REPLACE EXISTING WELL? YES ° NQ_ - 1 J—
7. STATIC WATER LEVEL Below Top of Cellar '% 0 Fr:
(weir 1f Above Top of atlas)
8. TOP OF CASING IS FT. Above Land Surfaces
step or rating termle+tad attar ben Ipdaufeu req.IS a .:
rartan Is eeesrdaep vidt• ANCIC 2C SM. j`_ -
9. YIELD (8pta): _ METHOD OF TEST b i02./h Lg-.
10. WATER ZONES (depth): / 8.5,
Topograph' d setting -
ORidge ope Malley . °Flat
0:heet epproinheebax)
Letitoddlotigitude of well location
(aes.eimtevted eoom0
Latituddlongitlide sourcaDGPSDTopographic reap
• (ebedcbmt)
,•D{ DRILLING LOG
From To ' Formation Description
- LOCATION SKETCH
Show direction and. distance in miles from at least _
11. CIS CASING:
ION :Type /f f ff: Amomd en TN two State Roads or County Roads. Include the road
12. CASING WaETbitW9t
(rrh �� . or Wei,B n. nu mbera and -common road names.
From�To 8 � rz �_ Safct:.� Q y , :
From To FL
From Tp Ft _
13. GROUT: Depth Material Method
From__a__To AO Ft. CPyr plTM it)
From To FL
4. SCREEN: Depth Diameter . Slot Siu - • Material
From To Ft.__in. in.
From To Ftia to
5- SAND/GRAVELPACK:
Depth Size Material
From To Ft.
From To FL
6. REMARKS:
C
DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WIT)I ISANCAC2C, WEIL •
ONSTRUCrION STANDARDS, ANDTHAT A COPY OF TIR,ItECORD HAS BEEN PROVIDED) TOTHWWBLL OWNER
SIGNATURE -OF PERSON CONSTRUCTING THE WELL . • DATE -•
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mall Service Center -Raleigh, NC
n699-1636 ?bone No. [phone], within 30 days. . GW-1 REV. 072001

10. WATER ZONES (depth): 07 (- D
11. DISINFECfION.Typc JFt/-1 Amomd aTJM
12. CASING: - WalTtdcimm. Depth
From 0 . To (n % Ft i� Sltfc K'
13. GROUT: Depth
From Tm_ Ft
From_ To FL
�a Ft � C,la^2
Method .,
From To Ft
.4. SCREEN: Depth Diameter . Slot Size - • Material
From To Et. in. in.
From To �a in.
5- SAND/GRAVEL PACK: F[
Depth Sire Material
From To Ft
From To Ft
,.. r. “. v L' i t
• WELL• CONSTRUCTION RECORD'
ai : ofEnrkonmentandNaturalResowtn-D'tviionofWiterQuality'-Q+o®dwatorSection
Nosh Caiol'uu - Dryatlmatt . . - . .. � 7 1y /
e.aa..-. ctrICATlotia =`e .
wrli.cotrrRwcroR (a'mMmtJ-NAMa psua —r-
WELL CONTRACTOR COMPANY r60N>F9t S�1''�'-3 Lb Q
STATE WELL CONBTRUCrtOi PZRMI7'a AffiOCIAT®W rat '' ..
Cfappliable) •(If!ppllable) . .
1. WELL USE (Check ApF6cabkBox): Residential micipaVPnbiic ❑ IndusRIal 0 Agriwltu al Q
Monitoring 0 Recovery 0' Heat PurimWater injection 0 Other C1 if Other, List Use•
2. WELLLOCATIQp:.
Nearest Town: (_ U l I 0 t1)h i Courtin.) 4.t I L S tM"
8r1.3
-Cl.elt- ZAtkar
(Sava lame, Numbest, Coma�ny, Lath, Tip Code)
3. OWNER:JO/ S h kt# UJ h i y) 2 fta t
Address 314 let Hati--GN, �✓J
eu (In rr,y,,t•e :itiC) g3-
GtyorToun ` 2i➢Codc.
rgst6 a��- Ira i
amaxle.Pt.=aumker3 ! 3
4. DATE DRILLED JS/
- T d sus
UiRidgo l6STope galley . °Flat
Latimdellotigi(ude Of well location
(aesteahntouteaheomda)
Latitude longitdde so urce:OOPSOTopograpluc mug
pRiLLING LOG
From To - Formation Description
5. TOTAL DEFTIL_
6. DOES WELL REPLACE EXISTING WELL? YES IJ NO ct —
7. STATIC WATER LEVEL Below Top of Caii m 4 0 FT:
(User if Mow Top of Cube
8. TOP OF CASING 1S _ FT. Above Land Surface*
'rep of cuing tgmlaatad allot hair leatarfas raqulS a
.artaas la saordaas.uYtsA7ictc 3C o118.
9. YIELD (gym): .� _ METHOD OF TEST 1 /Ogipt.
(! LOCATION SKETCH
5 Show direction anddisWux In miles from at last
two State Rods or County Roads. include the road
numbers and -common road names.
• e tv i-p 42—
2.
no
6. REMARKS:
DO HEREBY CERTIFYTHATTHIS WELL WAS CONSTRUCTED IN ACCORDANCE Wf1•H ISANCAC2C, WELL
CONSTRUCTIONSTANDARDS, AND THAT ACOPY OF'TT RE�CCORD BEEN PROVIDED TO
�1
SIGNATURE•OFPEASONCONSLRUCI'INOTHE WELL . • DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mall Service Center -Ralelgh,'NC
n699-1636 Phone Na. [phone], within 30 days. . GW-1 REV. 072001
0

• WELL CONSTRUCTION RECfIRD
Hor111 toms- Department of Emehomat tt and Natural Resources.- Division of Watts Quality-- Grwindwafer Section
%WEL ; cow anon ormixtotutm bolo v n n t 5 - . fiI�T•lYtcATtoN a .a l 4' -
WELL corrrawcroRCOMPANY vAAtsa4thT tin o.l It)PII 1;,�• 1,39 s
srA a WELL CONstrfoti aucflRMtra Assocwrii wt�ro roars - '• •
ff ,bk) - {ifappitable) • .
1. WELL USE (C71eck Appftable Box):-ResideatialtMimicipal/Public ❑ Industrial 0 Agriculttaal Q
Monitoring 0 Recovery 0' Heat Pump Water Injection O Other 0 If Oilier, List Use
7- "WELL LOCATION: 1
Nearest To,w.(n.
(styNam
1 Ne CCore y,
_ThpogrtpbtrlLimd setting
ronnty SAX lc s - •age oslopa 0ualley . OF1at
a173r (duck aPPaW4kbox)
Subdivision, tattle. rap code) Latitutkllongltuds of vet notation
•
3. OWNER B: q. Q I vt S L C
Address /SkIcTS"U or. D2 e . Latitodellmgihide somee:OGPSOTopographic map(dam
(Streeteisauexo.) • -- (a,aa:bea)
�4-((cc-lb.-44k 4., - j h 3o2;,S C) '12 __ - DRILLING LOG
GtybrTwa State rap es . ,. From To ' Formation Description
Sob - /Y D k D fob' PI44
4. DATE DRILLED 7— Ce- _6Y ' — -rr
5. TOTAL DEL'TI _p/)S'
6. DOES WELL REPLACE EXISTING WELL? YES EI NO. -NI
7. STATIC WATER LEVEL Below Top of Cuing: "4(-) T.
(Dare if Above Top of Cain)L TOP OF CASING IS _— FT. Above Land Surface`
.7ep of eats{ unabated atter belt! IULaarfaee midst a .:
C
C
.rELD(gpw) a..e/3- wMETHODOFTEST A%IU��Q
s. YlEi.l) (gp�r.
10. WATER ZONES (depthx %S' y c2 %-5 • - LOCATION SKETCH
11. DISINFECTION .Type !i-111- Amount ... TA 635 Show direction and. distance in miles from at least
12. CASING: Wall Thickness • two State Roads or County Roads. Include the road
o Depth or Wei-ghtRR. -numbersand-common road names.
From fl.-Te G - saR: -
From To Ft - -
From Tq Ft. _
13. GROUT: Depth Material Method
Frorl_a_ To a17 p
From To Tt
.4. SCREEN: Depth Diameter . Slot Size : ° Material
From To Ft —ill. in.
From To Ft,____in. in.
5. SAND/GRAVEL PACK
Depth Size
From To Ft -
From To Ft.
Ana Phone mwber
6. REMARKS:
td1SU Tdli)1 S) AU Wir
DO HEREBY CERTIFY THATTHIS WELL VMS CONSTRUCTED 1N ACCORDANCE WITH sm. NCAC2C, WELL
oNSTRUCTIONSTANDARDS, AND THAT ACOPY OFT�ORD RECORD. HAS BEEN PROVIDED TO THE .WEILOWNER
SIGNATURE -OF PERSON WNSTRUCEINOTHE WELL • DATE -
.submit the original to the Division of Water Quality, Groundwater Section, 1636 Mall Service Center -Raletgh,-NC
_'7699-1636 ?hone No. [phone], within 30 days. . GW-1 REV. 07/2001

t, 7
WELL CONSTRUCTION RECORD'
North Carolina- Department of Enyironnieht water. Secs'
WELL CONrnACrmn tirmrVIDUAW # ..t .t_
WELL CONTRACTOR COM►ANY
STATE WELL CONaTRLCTIO(f P1ral
monarraarabw�l-�a,.�,�.,.,..�....1-.. ilo►lin4
(p,;;��1u n" s F e&A'.': accI!►c"
BONS s
Assoaterno �4m*nlY
Erweliable) •(R1pplleable)
•
1. WELL USE (Chet* Appliesbl Boxy ResideatialtMtiem�UbUC ❑ Industrial 0 Agricultural
Monitoring O Recovery a Heat Pump Water Injection O Other f7 If Other, List Use
"WELL
Nearest Town: C. - n ✓, /l2, - 0.7�T/3'G le s tau
L LOCATION:
13 g nrei ea a- 73 t'O
(Sued Nt me, Nd(oberr. C r Sttbd'mdoo„ lot Ho. Zip Cade)
3. OWNER T ? �� .. �• -1 %.5
Address 36 f y R; & IZ; et;ALd
(Stnetpraeetattod
Olen✓;ge- NC agg3b
°tr.&Ton Stec .t" Zip Code
Arc redo Moss Number /
4. DATE DRILLED - ab '0 L
5 TOTAL DEPTH;�2 ()$ ' .
- TopogfapbiclLimd setting "
/�BR(dgc OSlope Malley CIfilat
theta apprapciatoboc) -
L'adtot�dloogitude of well location
tde_ow/miworYwamds)
Latituddlongittide sourcGOOPSUfopographic map
• D (check DRILLING LOG
From To " Formation Description
�`//"
(065' LveJ6.- t -
6. DOES WELL REPLAN EXISTING WELL? YES CI
7. STATIC WATER LEVEL Below Top of Casing: �Q11 k"f•
(User It Above Top oWUb&)
S. TOP OF CASING IS Fr. Above Land Swfacc*
'Tap of man unabated oder banhadaurdu require o
noun V anerdeaes
" D OF I O. WATER ZONES (depth) "� O j Sin .
erab'LSATICAC 3C.uua.
9. YIELD (Spat). n M13f10 JDWPtf
' LOCATION SKETGF(
t 1. DISINFECTION .Type Ifni Amount -i %A• A $ Show direction and distance is miles from at least
12. CASING: Wall Thiclmeu two State Roads or County Roads. Include the road
A. DePth � ����� awe numbers and common road namca.
From Lt. . Too - PL1Z_stig. 12a `^' "
From To Ft
Frog^ TO FL
I3. GROUT:. Depth Material' .,
From_a_To Ft. (�dn� pom .
From To FL
.4. SCREEN: Depth Diameter Slot Size : , Material
From To Ft._ia in.
From To Ft,_ia in.
5- SAND/GRAVELPACK
Depth Size
From To Ft -
From To FL
6. REMARKS:
DO HEREBY CERTIFY THAT THIS WW. WAS CONSTRUCTED IN ACCORDANCE ROTH ISA NCAG 2C, WELL •
"(INSTRUCTION STANDARDS, AND THAT A COPY OFF RECORD H&S BEEN PROVIDE[) TO THE WELL OWNER
SIGNATURE -OF PERSON CONSTRUCTING THEWELL " DATE -
•Submit the original io the Division of Water Quality, Groundwater Section, 1636 Mall Service Center- RREYglz. NC I
.27699-1636 Phone No. (919) 7333121, within 30 days.
t�T14d 'IYHJ tE:i) AU Q3ti14

••
. WELL CONSTRUCTION RF.0 tD'
Nord% eats - Department of EnvimNatResourcesnmaut and blatant Resources - Division of afar Quality-- Groundwater Section
mat. CONTRACTOR (NDnlCIDUAta it (prtat)S flln t S /Jtb j l?In% Ai - = ' =.I CL ctSPICATWN'oi% l e -
wma.CONTRACCOWCOMPANY `moans;emu_, 4-2 Li-3 Ab 0
STAT¢ WELL. cOmer:ru TION PZRMITa - As$oCfxTtm
(if applicable)
• girap$Rable) • .
I. WELL USE (Check ApplicableBox):-ResidentialiYMenkipal/Publc 0 , Industrial 13 Agricultnel Q
Monitoring O Recovery O' Hat Pun p Waits Injection O Other CJ If Other, List Use
-2. WELL LOCATIO - jte/Land setting -
Nearest Town: �t� 11 ✓'. )1 - County s 1 A}- Uc . tnJ idge OSIo" • OP/al Oblat
C1/4- S e 41hs _ ar_0.P d c) v (14,Dit. 6736, stappap! box) - ''
(Suva Name. Numbeta.Cemmmigr,subMvidaa.tat Nalap Code) L'atitMdlongitldaofvet location
3.0WN - ft. -I-kie- -
Address / Y `?_3 Se e. 7= e -e e - 2ca . Latitude/Iongitdde sottecOOPSOTopogtaphic map
Cien d i l ! G h' 3 ro ) (eltreaD LLING LOG
From To - Fj nnation Description
Area cafe. Phone strobes '/ , - 3 -coz -t �,, , i. S - t4 L t '�� (- 2441 r I ±LQ-
4. DATE DRILLED
5. TOTAL DEPTH; ?e. 5''
6. DOES WELL REPLACE EXISTING WELL? PESO NU. 3--"r
7. STATIC WATER LEVEL Below Top ofC ubtg: , -- S _ -Pt
(Us'H' if AboveTop dCadold
8. TOP OF CASING IS ___/__ FT. Above Land Surface*
'Top ofesslag teradaated atlr t�4uaaarfathMafhn a - •
variant
varn to aaordaaa �wkYtSA 2C Alta.
9. YIELD(gpm} .._5 METHOD OF TEST tiDIUpe��.
10. WATER ZONES (depth): ( h' (/ -
- - LOCATION SKETCH
11. DISINFECTION:Type 1,4'AE- Amomd ,.2.T41-.4 5 Show direction and distance bt mites from at least
12. CASING: - - Wall ThIdwaa two State Roads or County Roads.'Include the road
Dept Diepeta or Weight/ft. Mtitt'umbers and -common road names.
From_�To V3 ` S. * aY.,NP.: - -
c^`My-wren Stabs a Zip Cede
(g ijI_ 7`7c3— 35`39
From To Ft -
From Tp FL
13. GROUT_ Depth Ma*crfat. Netted
From A To ' - - FL CQy71y*'� ppyt c)
From To 7t.
.4. SCREEN: Depth Diameter - Slot Size : Material
From To Ft_in in.
From To Ft,__in. in. '
S. SAND/GRAVEL PACK
Depth Sire Material
From To Ft,
From To FT
6. REMARKS:
DO HEREBY CERTIFY THAT THIS WEU. WAS COMMIX/BD IN ACCORDANCE' VIM ISjINCAC.2C. WELL -
ONSTRUCTIONSTANDARDS, AND THHyATTAACOPY OF RECORD BEEN PROVIDED TOTHB-WIH.LOWN
ER
'')/! �t -3-60
SIGNATURE -OF PERSONCONSfRUCTINGTIMWELL. - - DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mali Service Center - Raleigh, NC
17699-I636 Phone No. (919) 733J221, within 30 days. . OW -I REV. 07/2001
r;7
CD

From To Ft
Front- Tp Ft
13. GROUT_ Depth Mataid. Method
From�TO—a. Ft eao7, a, r pew c) .
From To Ft
.4. SCREEN: Depth Diameter . Slot Size : Material •
From_ To Ft_ is in.
From To Ft• —in. in # ).
5. SAND/GRAVEL PACK: -
Depth Size Material
From To Ft
From To
6. REMARKS:
•
DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WTTIM 15A NCAC2C, WELL -
GNSTRUCTION STANDARDS. AND THAT ACOPY OF SRECORD BERNPROVIDEDTOTHE-WELL OWNER
Gtyi,rTona Sues r Ea Cale
(itdSc. d-9'l - o3a9 .
Mn coda- Mae ember -
4. DATE DRILLED 7 — 7 --O b
5. TOTAL DEPTH LSO'
6. DOES WELL REPLACE Kamm WELL? YES D NU;li7✓�
7. STATIC WATER LEVEL Below Top of Cosby e2*0D FT
M a rKAboveTopdrSona)
8. TOP OF CASINO I3 __ FT. Above Land Surface*
wrap or canna terminated *tier Wale (pd rkeerequiresn ...-
Tartan la aaefeees wni73A'NCAV2C MIL
9. YIELD (gpm): _Y 2. METHOD OF TEST POW"
O pcir—.
10. WATER ZONES (depth) Lib?Q -
• LOCATION mica
1 I. D!S(NFECTION:.Typo A4-/f- Amount c2 5 Show direction end.distence ip miles from at least
12. CASING: - Wdl1L ekness two Stabs Roads or County Roads. Include the road
'members and-twnunwl road names.
Frain. _O.Te th q `i Ft.: 5:2a�:�
SIGNATURE -OF PERSON CONSTRUCTING THE WELL - DATE -
Submit the original to the Division of Water Quality, Groundwater Section,1636 Mali Service Center -Raleigh, -NC
,J,7699-1636 Phone No. [phone], within 30 days. . GW-1 REV. 07/2001
- WELL CONSTRUCTION RECORD' `? .
North Ca#olina - Department of Rnvlmumant and Wettest Resources - DivWon of Water Qua(itr Orotmdwatct Section
wen. CONTRACTOt(UWtlsistt?,y s(p1;)c nVIIS AOfil aA : `�.I '" Rrty:9ona etn* .
WELL coNTwteroscomma ,wtnrt 'Jgjt.. fkfla_r'l (tMari■-NTu4YW#,senora silt SG.4-3 2-6d
STATE WPSR WELL CONSTRUCTION pitr7 - - ASSOCIATIIIw s%Mn ' -`- -•
(if applicable) • , {if ,plkable) • .
1. WELL USE (Check AppUtsbtte Bo4-Renide tialndoipaIIPublic 0 Industrial a Agriwitaral-Q
- r Monitoring O Recovery IT Heat Pump Water Injection ❑ Other aIf other, List Use . - -
-2. -WELL LOCATION -
NearestTown; 3 1-4 li - County:TA CIC5tn--) -
t3RAOLP/ BR A. r R_a...a'v , tto ESt. aY 79
(Sued Noma Nimbus, . ttobdOgion, Lot No., Zip Cads)
3. OWNER:iniChE.a1 CQ U•i riL
Address 1296 S to I e7 ?-h s r,
_ Topogrinic/Lind setting -
ORidge CISlope °Valley . °Flat
(that ienetehm) .
Latitude/longitude of well location
(degressiodouteehecond4
Latitude/laugittide sourec DOPSOTopographic map
in i a m'. pa 3 3 / B 43 Orin DRILLING LOG
F� (.
To• Formation Description
--lot.• 47• .SA.iDsta,V-e..
9 7 ' &!Se• FLU RAev:7e-.
N
0

. .
• .WELL• CONSTRUCTION RECORD' - :
North &otina - Department of a:whonmait and Natural Resources.- Division f W Quality'- Groundwater Section •
wEt.L CONTRACTOR (INDO touAt,)TtA►(6 (pi .° c7il.►i n I S AO/ lo.r. d.'• ` 2.1 `` CE,17tcATtott s 2/7 4
wet .cONThAaoRCOMPANYNAMrrt.pilac POI Inert UMlil‘YJI- u -j"%cJ!uoios Slat .5 a4-E ab O
STATE WELL CONSTRUCTION PERMt77 - Anson/'t'in wQOpeih r ' - '
(ifapptiable) •(Want/cable) • .
I. WELL USE (Check Applicable Box):-Residapia1TYMtmicipal/Public 0 Industrial a Agricultural 0
• ° Monitoring O Recovery 0' • Heat Pump Water lnjcction 0 Other 0 If Other, Liat Use
-2. WELL LOCATION: .{ T sg�ic/Ltind setting .
Nearest Town. lr/ t N J A P 1 Qouaty U �_( 3p�: ' , OSlope OKaUcy . t7Flat
1� �L N rr p aQ � •01'R3gyp i� `" (�odcappropfaaat�
(Street come. Number. CanmwJq, subdiridoe, tot Net Zip Cade) Latitude/longitude of well location
3. OWNER:, �/4 R2� ///Yf d �. 1 a , (d.nmiminme+haaoade)
Address 4 d PD A_ ! ib a BL.L6 .47-e Latitudelongitude aourccOOPSOTopographic map
EhPOf-/i F/ N- 3392 . >n' (an box)
DRILLING LOG
City -or Townd 2
3 - atygQb' , Tap From 6 e Format( Deacri ion
// l-",--
Ara cock- Pboae rumba � � -, ` _ _ s e 7 N
4. DATE DRILLED -S `- d a WAS'
5. TOTAL DEPTH fpA1S I - •- ' 1
6. DOES WELL REPLACE EXISTING WELL? YES 0 No-cW —
7. STATIC WATER LEVEL Below Top of Casing JS FT:
(User if Above Top of Wog)
2. TOP OF CASINO 1S / FT. Above Land Surface*
-Tep of earlag terrelaated atlw below Ipdaatea ngobb a
wham to whb'1SATICLC2C MIS.
9. YIELD (gpm): I jCL METHOD OF TEST iiggi <.,
W. WATER ZONES (depth): fib ' (/
•
LOCATION SKETCH
11. DISINFECTION: Typo WW1- AnamU ,•2 TAASS Showdirection end.diu4nca In miles from at least
12. CASING: - Wall Thlcknew two State. Roads or County Roads. Include the road
Depth D' or Weightup* numbers and-cornmon road names.
From___12. To, t a Sat$, _ -
From To Ft. - •
From Tp P1. -
13. GROUT: Depth Matadi! Method -
From_A To eP D Ft yjrip - : po c)
From To FL
.4. SCREEN: Depth Diameter • Slot Size : • Material
From To FL —In. in.
From To Ft_in• in. i
5_ SAND/GRAVEL PACK -
Depth Size Material -
From To R
From To Ft
6_ REMARKS: -
DO HEREBY CERTIFY THAT THIS WELL WA$ CONSTRUCTED IN ACCORDANCE WRT( ISANCAC 2C, WEIL •
ONSTRUCTIONSTANDARDS, AND THAT ACOPY OF S RECORD HAS BEEN PROVIDED TO THEWBLLOWNER
a - 4 5--
SIGNATURE-OF PERSON CONSTRUCTING THE WELL , • DATE -
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Map Service Center-Ralelgh,-NC
1'f699-I636 Phone No. [phone], within 30 days. . GW-i REV. 07/2001

• WELL CONSTRUCTION RECORD' : ' ,
North Caio)ina - Department of Envhonmmt and Natural Resources.- Df'bw:rbti_ of Wakr Quality*.. Choaudwates Section �
WELL CONTRACTon pros IIIDUAitwaseL fl c 11 n 1 S 41h-,` AA - • t ri2'IFICATION�"sla/t •
WELI.coNTRAcroaCOMPANY ruarr i� c ldniIn 1 Ili�tillySIi ,. �'..e 'axon�a i( .Sat/-3 a6 O
STATE WELL CONSTRUCrtOH nSt7e.
AaOCNTED
Fit applicable) 4ifapplieable) ' -
I. WELL USE (Check Applicable Bca):Itesidardiallfli icipalPublic O .lndutRial Q I1gdcultuaL•
Monitoring ❑ Rccovay aHet Pump Water Injection O Other f7 IfOdier, List Use -
2. WELL LOCATION: .
Nearest Town: S y/ Ai - County)
y 4 1 T. / PI 1 e•e/c. fir
(Suva Na. Numbers, CaeaelIy 1at So. TN Cads)
3. oWNER: !' VYI t' p f 4' s 1Li V>7 l A c�� .
Address 3 3.5 N P L L b n y
(Sbuta�Ronclio.) II
FA AMU iJ 1J �. c, 173
°c r ,
G" J�9 -0� a.. rip Cava
Am code- Phone aaabar _� & C �F
4. DATE DRILLED
5-
6.
7-
a.
Topogtap setting -
/rLIL S 41.° °Ridge UBStope ()Valley Ohlat
1'
TOTAL DEPTH. 3<Sn • •
DOES WELL REPLACE EXISTING WELL? YES O NO.:
STATIC WATER. LEVEL Below Top of Casing: In 0 FT: .
(user if Above Top of said
TOP OP CASINO IS / FT. Above Land Surma`
-Top of easing traWW atter Way ipdmrfsanaWi ■ .:
.arWala .rortaaeewMYiSA1ICAC IC .eta
9. YIELD (wink_ S METHOD OFTEST t JUI//pt.
�S
Phutapptaphlsito4
Lititu4c o rgitedc of wall location
324619
(� , -
LatitudeAagidide smntacUOPSOTopogaphic map
DIM - DRILLING LOG
From To Formation Description
10. WATER ZONES (depth): / �s J
11. DISINFECTION: Type
12. CASING: ��, �_°
From 1L_Y—
From To Ft
From_ Tp a.
13. GROUT_ Depth Matarwt
From ToeFt___ j
From To Tt.
.4. SCREEN: Depth Diameter .
From To
From To Ft is
5. SAND/GRAVEL PACK
Depth Size
From To Ft.
From_ To Ft
S to AtR—'
Iins 1ge1" v/e.iem,cpt •+z
�j ir-- =SG__ " P L.U G RAN i 't t.
laCtingtiaCai
Amount aTI B S Show direction and distance M miles from at least
%II Thickness two State Roads orCounty Reeds. Include the road
"-numbers and common mad mums.
or Weildf,t.
pit(
r
Slot Six = Materiel
in.
_ in.
Material
6. REMARKS:
DO HEREBY CERTIFY THATTHIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH IMNCAC2C. WELL -
ONSTRUCTION STANDARDS AND THAT A COPY OF RECORD BEEN PP,OVIDBD TOTHE WELL OWNER
244. .... 3-02 is
SIGNATURE -OF PERSON CONSIRUCTNGTHB WELL . • DATE
submit the original to the Division of Water Quality, Groundwater Section, 1636 Mall Service Center -Raleigh, -NC
J7699-1636 Phone No. [phone], within 30 days. - GW-1 REV. 07/2001

ed .. `.
NorthC olua-DepartmentofEnvkoomotandNaturalRasm en- Division ofWaterQuality--_OroimdwatorSection
ww. conrRAcroR wlDmDa uAton nts an* tiV•ti n15 /Pa iidM A.,-- - CltrICATIONI2n4
wEtL CONTRACTOR COMPANY
STATE WELL CONSTRUCTION PSRM1t'M - _ a0caTn
Of applicable) •(ifappliable) • -
- . WELL CONSTRUCTION RECORD" :
:ruor! 42-11< -.Sat-/-3 Ab 0
•
I. WELL USE (Meek ApplitabWBox):-ResideaGai'1M cipal/Publc D Industrial 0 Agri-cultura4Q
Monitoring O Recovery 0- Heat Pnrnp Watts Injection ❑ Other CIif &liar, List Use
2. WELL LOCATIO, N:
Nearest Town: (,- )'t VI V , I Le- ' county —TA t K S eve-
in-,deitenn ma_ SuNb:rd873Q
(Street Name. Number.. Cammooky. Sobdiriwaa, la Ho, Tip Cade)
3. OWNER: SteYC •Y PRT 2-Oil h Seta
Address / DI(f- PSrhle5' tekQ.
tatreet.o(RameNa) --
S'tm;h4,IC C l• 53 77 4P
allot Town SWe ." � Zip Code -
(1/21- s9b- T4'a7 -
Almt code- Phone number
4. DRILLED Co — 3 O —0 CO
5. TOTAL DEPTH: d OS'
6. DOES WELL REPLACE EXISTING WELL? YES O NO_
7. STATIC WATERVEL LEBelow Top of Casing: IS' FT:
9. YIELD (Split): METHOD OFTT Swept
10. WATER ZONES (depth): f lJ j % i' J o •
11. DISINFECTION: Type /f-rP: Amount .. rfh-SS 5
12. CASING: WallT6ielmess
(Use rItMon Top ofCasan)
8. TOP OF CASING IS / FT. Above Land Stuface'
•Tep or offing teminpd atlor belgv Iendsarraa mare a
enlace In accordance wl&1SATICAC 2C MIL
Depth or Wdjht/FL
From_& To
From To Ft.
From Tp FL
13. GROW'_ Depth Matei Method,-
From_� T0S Ft 8247. APIPf134
From To Ft
.4. SCREEN: Depth Diameter . Slot Sim : , Malarial
From To Ft _in. in.
From" To FL . ju in.
5. SAND/GRAVEL PACK -
Depth size Material
From To Et
From To Ft.
Topogtspp et,Sltmd -
°Ridge OSI alley Mat
Wader:-:,
Lacbua) a
gtit ti$c ofwell location -
LatigndMoug1tdda graphic map
. From To
3r0 • s•
ems ' .04C'
DRILLING LOG
Ftiim$ion Description
i-A S Aar c hRJ
G- aa;---e_
. LOCATION SKETCH
Show director anddistance in miles from at least
two State Roads or County Roads. Include the road
"numbers and -common road names.
cz
c
t—
t
rn
N
0
rn
6. REMARKS: -
DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 1SANCAC 2C, WEIL •
ONSIRUCTION STANDARDS, AND THAT ACOPY OF TM RECORD BE N PROVIDEDOWNER
14=-3b_OEv.
SIGNATUREOFPERSON causnwcrimotte WELL . - DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mall Service Center -Raletgh,-NC
.17699-1636 ?hone No. [phone], within 30 days. - ow-i REV. 07/2001
u it
c1-;

Latitud&Icngitude scauccOOPSOTopographic map
• - (dweitha)
rISZIEL- DRILLING LOG
To ' Fo,�Iattat Description
Area code. Phone awake n _ v n ~ - �0 4'
1La
- • WELL CONSTRUCTION RECORD • •
- . v.._ :. ....G. • i - . - .
NalhCaioline- Departing* ofEavirand fstaalResauoas-DivWionof Quality... Gittiadwiter Section
WILL cow lACTORtnexXwo tlaWi. �ss f A;hetinIS /Jniln«.a;;" " csr0frcna'o!N■ a17le
WELL, CONTRACTOR C urAI(Y tuaar'r-ram` C 1�n11A -.� 1!)ell�r.)I-,�. 'T'.se , euora�st - y-'3 24 a
STATE WELL CONSTRUCTION MOT/ .. ASSOCIATE.; _ - -� .
Pil
Ofapplieabta) •-fdappliable) ' .
1. WELL USE (M edt ApSUeeble Box}.-Reddenttala Mumctpal/PubUC 0 Industrial CIAgriaUaal Q
Monitoring O Recovery aHeat Pomp Wei Injection CIOther Cl IfOtlier, PAUse " •
2. -WELL LOCATION: T grapkialLtmd soiling •
Nearest Town; CYI f vl i , i it - Couoty�J .4 C Ic S rn.� " pSbpo bv.Iky DFlat
C,4ts btO. SL &D. L.o-ti: s' a87i7 (thick.,,. JJamx) .
(wen Na Pm ar cwb. S*iehhe. LANs. arm) Liataldloigituda of Well location •
3. OWN FR ?hi', PeAtli w_t -
Addres lay- n ter CA' na.
(aaMaiRemstie.) - _ "
Ti}-La-astr a • ter. 3 a-3/ 8.
OW"ar e.m Sine ..�� Zip Code . - From
sr s ,- 384 - ' 6
5. TOTAL DEPTH fern - ' •
6. DOES WELL REPLACE EXISTING WELL? YES CJ
7. STATIC WATER LEVEL BelowTop of Cuing ad:FT.
(User itAbove Top of Wm) S. TOP OF CASING IS / FT. Above Land Surfaces
-rep dada' SSaated idler hpef IWteertme r.q lr ss
wince a mend.aswith ISA/ CACSCAtli
9. YIELD(gpm):_La._METHOD OFTEST 6%DNJp4-.
10. WATER ZONES (depth):/7S , et O S • Q
(M'
LOCATION SKJTCfj
t 1. DISINFECTION.Type be-i%i: Amount ..2T11-R 5 now direction and.distaneo In Sias from at least
12. CASING: - Well Thickness two State Roads or County Roads: Include the road
Depth DLL or Wells/It.-numbers and` road names.
From i� • S.<�JQ',$j
From_TR Ft _
From
13. GROUT: Depth Mattvnl...�!
From To . Ft. Can, a77
From To FL
.4. SCREEN: Depth 11amfer . Slot Sig : Material
From To FL.. ---in.
From To Ft. in.
5. SAND/GRAVEL PACK:
Depth Size Mataial
From To Ft,
From To FL
6. REMARKS:
DO HEREBY CERTIFY THATTHIS WELL WAS CONSTRUCTED Of ACCORDANCE WITH I5ANCAC2C. WELL •
ONSTRUCf1ONSTANDARDS, AND THAT ACOPY OF TI, RECORD BHENPROVIDEDTOTHE.WELLOWNER
SIGNATURE -OF PERSON cotantucnNo "Ha WELL . DATE -
•
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mall Service Center -Raldgh, NC
,n699-1636 Plume No. [phone], within 30 days. GW-I REV. 07(2001
7

• .WELL CONSTRUCTION RE -CORD "
•
North Carolina - Department of Envirmun int and Natural Resat ces - Division f Water . Quality-- Qrotindwatmr Section
WELL CONTRACTOR(INDW1DUAL) a (pint) cefiPI S /44JM 4 ri, csrtrmcnttor s l74o
•
WELL CONTRACTOR COMPANY {�e 1�A..,I 1i}biI h..c,i,. r senora sit( .524-3 air d
STATE WELL CONSTRUCTION Pandits
(ifapplicable) ASSOCUTae w ) • .
1. WELL USE (C eclt Applicable Box): Residentia(rr— MtaltcipaUPubllc ❑ Indusgial 0 Agricultural 0
•
Monitoring O Recovery ❑ Heat pump Watts Injection ❑ Other CJ If other, List Use'
•
2. WELL LOCATION:
• Nearest Town: 6.Jen V,//e County �ili C KS to . ' T Il�pbic/t and setting .
p/ Loi- Am,. L,at d* J7 a 873 (o �.I�ftldge (OSbpe DMa Valley ❑Fiat
(Street Name, Numbers, Community, Subdivisio4l a No.. rip Code) L'atitugeAoagitude awe! location
3. OWNER: B; C R. d ,n_ PR•Rthtin 4 LC , (dsznSmimtwamands)
Address Pi 80 S P N. U M aS4. .7 Q .. Latitudenon tlide source:❑GPS❑To
(Socerailoae Nea pographic map
Jr¢Lltser..y:.neeta , Cl, •3& igb eebeeama)
atya St DES? DRILLING LOG
M. 566 • / (la tip Code
- From 1' F Ilea Description
Ph
Area code- an manner (o i>•
4. DATE DRILLED 'ir ..aZ ` .. Q 6
5. TOTAL DEPTH• / Ddd • f6A '
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO•m./'�
7. STATIC WATER LEVEL Below Top ofCasing: 'i 5/) Ft•;
S. TOP OF CASING IS � bAbove aSurface
FT. Above
Les ad Surface*
'Top Mewlna terminated MUa• bar lkad.serfiee requires a
variance hi mar with "isaT9 C3C A1I11. .
9. YIELD (gm):METHOD OF TEST ./DID
10. WATER ZONES ( th): 9.2.5 •
I I. DISINFECTION: Type
12. CASING:
From Va. Do % .TOG
From To
From T9
I3. GROUT: Depth
From n To v4 D
From To
4_ SCREEN: Depth
From To
From To
5. SAND/GRAVEL PACK:
Depth
From To
From To
6. REMARK$:
•
Ltd•
�Odn'
LOCATION SKETCH
i>�d ff Amount ..,2 T#4 5 Show direction and. distance In miles from at leas)
cumbers
Walt Thiohten two State Roads or County Roads. Include the road
a WeiighUFL
Drs " SbR:,.t'
Ft _
FL
Materiel Mew -
(oar 47# FOWL-)
Diameter . Slot size • Material
in.
Ft_ia in.
Size Material -
FL
Ft
and -common road names.
JUN 0 6 2006
DO HEREBY CERTIFY THATTHIS WELL WAS CONSTRUCTED IN ACCORDANCE
SBEBNPI{OVIDEbTTOMB WELL 'ONSTRUCTIONSTANDARDS, AND THAT ACOPY OF RECORD yarn5 WLO
THfS NROWNER
-a6 —o b
Oria
SIGNATURE•OFPERSON CONSTRUCTING THE WELL . • DATE
Submit the original ito the Division of Water Quality, Groundwater Section,1636 Malt Service Center -Raleigh, -NC
17699-1636 Phone No. [phone], within 30 days.
OW -I REV. 072001
326244
CA
0
cr'

, . 1
. WELL• CONSTRIICTION RECORD"
No;" NoI'in-Departme!otBarkvfWSaodNdwai Resources.-ffrvbioa� Qua>&9=
WELL CONTRACTOR �� 1� ,� ..� 4p,w,cii!_tln.S J.L114;. A,`' ` . - ac nsorla an4
wEu. ooNTZACTOR COMPANY
STATE vans corarrRUCtto slab IIV.
(itarslia4ta) .
334396
4-3Al. 0
*Web)
l_ WELL USE (Cheek bMHmtk-Rasd lilt Mr lwPabllen ,I attial0 A_ griw[dRal-4
- ` Monitoring El Recovery 0- HatPpo4Water Wean 0 Other UOdim,List Use •
••, -
2 WELL LOCATION:"
Nearest To1vrc Coat9t4noOSbtpa Malloy .OP�at
T" // L rs 1 (dud apPoth debad -
tsu�.NmK as .a ea+ier..tottt0,219 add i; aotvtatttoan= -
3. O
Adder ,BOO NW cortpeeaxed/t!v
!Roca- - a . FIN ` 3 3- '3 1 • •
Bay "fie - ? '7
-e°`
•
Aene.ds Pha.saom6et
d. DATE DRILLED /b — 3 D -i Co
5. TOTAL DEPTH: 705 ''•
6. DOES WELL REPLACE EXISTING WELL? US a
t
LZC -
Sir Le6� _ sourecIXIPSEMpographic m"P
ernient
DRILLING LOG
Flom To - Fton
QQ 3 R' Y,
AW` `'loss •
7. STATIC WATER LEVEL Below TopotCamy 0t1 FT:
ltreirMenTop dc
8. TOP OF CASING IS ` FT. Above Su +
flopMae! te adededaCbrbet gapish,*m.k+a - -
ndr.ata.nwdeeawkeild WCAC3CS11t .
9. Ton (gp __METHOD Qfl r /Dy1,7it
10.WATER ZONES (depth): 755 (o.W' - - - -
I I. DISINFECTION:Typ& 1 tf.1: Amount .2TA173! Show (Breeden and.db hmeninmiles fom at least
12. CASING: - Wattide oaea - two State Roads orCotmty Ro d s.Include die mad
- Depth ` � aura Ms •--numbers and en toad names.
From L- -TQ 1S 1 /$r _Stee-L _
Fcom__T0 Ft - - -
Fmin-
13. GROUT Depth Materiii. MethodFrom—a— ' ptJ - .
From__To 7•t• - - - -
_4. SCREEN: Depth Diameter- Slot She = = M.twlat - - - RECEIVED
From To Ft in ut DR' OF tNA?ER QUALITY
FromTo FL in. in
5_ SAND/GRAVEL PACK
Depth Sae Material
From To Ft.
From To Ft
6_ REMARKS:
DOHEREBY(ERTWYTHAT?HISWELL WAS CO ST&UCIBDWACCORDANEWITHisitweA4'2c.WBIL-
'DESTRUCTION STANDA4tDS,ANDTHATACOPY OF itip _RECORD HAS MUM aOVIDEOIOTHBW&LOWNER
'0'YIP4&- iMabt•osiMos-- . /6 ; 3a Ca
SKBIATHRBEFPERSON (=MAMMOTHSVIE1d: - DATE -
submit the original to the DIvLslon of Water Quality, Groundwater Section,1636 Mail Service Center-Reletgh,-NC
7699-1636 Phone No. [phone], within 30 days - GW-I REV. 07/2001
NOV' © 6 Z006

. • , .
•
•�L' CONatSrl 1 Irt0(l ,fI1
WELTRUCTIONDRE--
. lf-ru'•w Q�ty. .
Sa t.
NoshCsiotua-Deprle!tEYOnteadilivalsleea'
'k TIOI/
ale
bdataaKanS 211n
weu CONTnwcrot(usmtvruuAW- TtO t,,/ Lnt-1..3 7-b
vvELL COrm.ACTORcataract' SCATS WELLcON! tiatoN !limits {AfT,ro w
I. WELL USE (Cheek AppBeeb Bx- l IpallPublie 0
Monitoring O Recovery 0" Heat Pomp Wattsbljectioa ❑ Other 17 If
Z'WELL LOCATION:. l L C u✓�%
Nearest Town: Ce.I_ Couah --
eta." Aottb140 g¢?3 rp
tweet Name, Mambos. Coammmity, Sabttvwo4LONG.,* Cade)
120 5-t
3. OWN �95
•Lo. /ier— Q; V
allot Tan Slag VP Code
Ann code- Plum man �-� ..
4. DATE DRILLED r-. S 5 �
5. TOTAL Dciaal.
6. DOES WELL REPLACE manna WELL? YES 0 NO:-3f '
7. STATIC WATER LEVEL Below Top of Clain' "• .
(Ua'r itAbove Top of Wag)
S. TOP OF CASING IS _. �_ PT. Above Land Surfaces
easing umiea a 42
nuke ■
Ionians In a,prdaeevNs15&2C
9. YIELD (gpm): METHOD OF TEST , '1
10. WATER ZONES (depth): .5
t 1. DISINFECTION: Type Amount-
v
Address
12. CASING: • War ekn07i
Depth Ft�_.�i=_ • or WeighdFt .
From To Ft —
From TO Ft.
13. GROUT- Depth � Mc,
od
From._O—To _F
From To 7R..._
.4. SCREEN: owls O(erneter . Slot Sae : = Material
•
To PL__in. is
Fro'^To-
From Ft�ln• in.5. SAND/GRAVEL PACK: See Material
Depth
From To Ft
From To Ft.
From fl • Tq,_1,S_ as Vint
. ipSLand setting -
P1dR-dge OSlope ['Halley .ORlzIt
I;atitodeAoagitudrOrwell location -
topographic map
I etituddimrBitpde • Moot ma)
r1Rtt7CI LO�r
From To ' Ft do LDescription
.#
htdtoorlat O pgrioolbual
Other, — : -
MeltapproprWe
1 r•a•TICN SKS
Show direction outdistance is milts from at least
two State Roads or County Roads. Include the road
numbers and common road names.
6. REMARKS:
DO HEREBY CERTIFY THATTHIS WEIL WAS CONSTRUCTED IN ACCORDANCE WITH 15ANCA.C2C, WELL
•
TOTI1B.VfELLOWNER
�DNS77tUCfiONSTANDAI;t).4,AND THATACOPY OF �SR1K701tD ' BEEN P$OVIDffi/ 5 'Q
• DATE
SIQ4ATURE-UPPERSON CONS7'RUCfIN(iTHE WELL -
submit the original to the Division of Water Quality, Groundwater Section, 1636Mall Service Center
i RREYgh;NC
„1699-1636 Phone No. [phone], within 30 days.
ryrl
-o
IV •
0
0 =
171'
t e -

WELL CONSTRUCTION RECGRD" : 3 2
North Ca olina- Department of Eurhlmmant and Natural Resources- Divbion of Wake Quality-- Groundwater Section
wELLCONTRscroat Omrt'IDIIAW (FLQ Vb_ fi Pl15 JJai n c% - r CLiwRtcATi01t& of/7l
wELLcoNTRACrORCOMPANY N.Aur' .1c i��fln• (tpil �fc�l st '�'�tie �'rtloiRs ad-3 gb
STATE WELL CONSTRUCTION nERIttits ASSOCYATIm I Mrn
(if spoilable)
-ET applicable) - .
1. WELL USE (check Applicable -Bo* Reridentuln VPubrtc ❑ - Industrial 0 Agrioultutai
Monitoring 0 Rome!), 0" Heat Pimp Water Injection ❑ Other t7 If other, List Use
z AVELL LOCATIOR:
"Nearest Town: lr-I Cn✓.Camty ‘TX4C/LSA.>
pi Lb 1 ,Mk''t _&23te-
ams Name, Nambea, tkm®ity, Sabariooa Lot No, Tap Cede)
3. OWNER: got g PLar d/�f}ptit .N-S Cr ,
Address /9Lf5U 9 L /A b c_ f) a • LatitudellmtgiGide aoma:OGPSOTopogtaphic map
tstteetsr`Aarett 3 - (cbedtbez)
J DRILLING LOG
From To " Ft nnation Description
n (AS '
gsapbidiand setting •
dgc OSlope Macy °Mat
(ohedtsppsptttebax)
Letitatdiaigitude aye location
J4 ./et ✓.jr,v Fi k I 3,2
Gtyittowayttb� � tip Cade
4" DATE DRILLED .J -,2_4 - big
--JaC' //4.'
•
5. TOTAL DEPTH 3h 5 - • , / t LiSi S '
6. DOES WELL REPLACE EXISTING WELL? YES O NO.:W-r-
7. STATIC WATER. LEVEL Below Top oiCasing 1 0 PT:
(User ifAbort Top of Cann)
8. TOP OF CASING IS / FT. Above Land Sodacee
-Top leasing taWOWd actor bei m Isadsabeamats a . :
.atlases In sessdaaes rf YisANCAC 2C MIL9. YIELD(gpm):_�_METHOD OFTEST/%Dvl/lid{-.
10.WATER ZONES (dep&): .J to' Q .
LOCATION SKETCH
11. DISINFECTION: Type %t-fl/- Amotmt ..a TARS Show
12. CASING: Wall Thickness two Stabs Roads or Cony Roads. Include the road
Depth Diameter or Waahtlpt. Moist --numbers antcoramonroad names.
From . . To__ _ R.__
From 0 To // St FL . ifl- steel -
From Tp R. '
13. GROUT_ Depth ,,stafal Method - - C
From n TorD n Cri7u, PC)410 - - N
From To it =:
c=.
4. SCREEN: Depth D " Slot Size : • Material - or.
From To Ft. in. is
From- To Ft,,_in. in -
S" SAND/GRAVEL PACK: -
Depth Size Material
From To Ft.
From To FL
6. REMARKS: - -
•
DO HEREBY CERTIFY THATTHIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH ISA Now 2C, WELL -
ONSTRUCTIONSTANDARD$, AND THAT ACOPY OF RECORD BEEN PROVIDED TOTHE.WELLOWNER
/ / I !/41-%•14ti s off% — 0
SIGNATURE -OF PERSON OONSIRUCUNG THE WEIL DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mall Serrtee Ceuta -Raleigh, -NC
fl699-I636 Phone No. (919) 7333221, within 30 days. - GW-I REV. 07/2001

WELL CONTRACTOR COMPANY -
STATE WELL CONSTRUCTION math" . - A Tw
(itapplicabla) ` -•
{Uappliable) - - . .
1. WELL USE (Cheek Appl(eabk'Box):-Reside trat'�M ww I1Public a , Indices! 0 Agricltural
covO
Monitoring O Reery O- Heat Pomp Water Injection ❑ Other II If Otiier, List Use -
• • . r-
- • WELL CONSTRUCTION RECORD
- :il5.- - -= - •
North Giant -Department orEnvbamteat and Natal Resources - Division_ of W. abprwlit
Qatar- Shoo 'a
WE :CO/MEAD-OR(Omti(IWAW7tA! M1ao cal ilR i S ��,o llaA d, - • r. CPc7 tCAT10/1i e� T -
-T✓r11rt ;�Kt 'rawaicJ t( -5"D.4-3 a.b a
Z "WELL LOCATIQN:
Neatcsl j'own: ('f}S%►;• is - County IC S
R17Rd- 0727/7
(Svra ttamq Numbers. Comatooky, Sub/nista, Ludic, rrp Cade)
3. OWNER: i C L,g- j.0 se La tt4
Address f13 tid 2I /`y /do Pe. 1) Q. Ai.
Allis' TA- ./7,63 .4 't. 4 & :
Calor Ton State .a" 7 Code
(Yoe)- Fla- 4o4' -_
Arm code- Phone amber9—/
4. DATE DRILLED t�
ORidge OSIope OValcy
(anatepptesdawbtx)
Lirt�j*Awjtude of wcll location
TtlpogapiddLtmd setting
Plibr—
, (tiepleahoiraSkstoods)
LatitudeAmtgitdde>amccfGPSOTopographic map
• "rem* box) -
DE >TiF , " DRILLING LOG
From To _Formation Description
-- 3 cL' .3as• Z. u'tJC24V#1,; t
5. TOTAL DEFIII:_30S•
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO _QI/*"
7. STATIC WATER LEVEL Below Top of Owing jT.
( tare ifAboreTop d
8. TOP OF CASING IS / FT. Above Land Suttee'
*Tap .1 ado' mra oald agar bean bod tvhq egafrn a -
MUMS 4aeeaNaaeearLb'1SA1ICJLCZeal& j
9. YIELD (gpa!)
a): �Q_ METHOD OFTES-L,1D1/b
10. WATERZONES(depth) 02.30 ' (1
;rink -now SKETCH
11. DISINFECTION: Type I1-1-9- Amount r2 MS $ Show dinette anddinuc4 bi miles from at (east
12. CASING: - - Wall Thiebress two State Roads or County Roads:Include the road
Depth � Diameteror Weitll'L »timbers and tx�on road names
From, 0 . To .3 PL�Z_Sb Q "Er.e .
From To Ft
From Tp FL
13. GROUT. Depth " Metgia Method
From_- t_To _FL 89yxavt FkljtA.,
From To Tst�
.4. SCREEN: Depth Diameter - Slot Sirs - Material
From To Ft_in in.
From To Ft _ n. in -
5. SAND/GRAVELPACK -
Depth Size Material
From To Ft
From To FL
6. REMARKS.:
DO HEREBY CERTIFY THATTHIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 1S .NCAC2Q, WELL -
ONSTRUCRONSTANDARDS, ANDTHATACOPY OFT? R1...D HAS BEEN PROVIDED TOTAE-WEILOWNER
SIGNATURE -OF PERSON cons-memoTMEV/EU; " - DATE
.submit the original to the Division of Water Quality, Groundwater Section, Mail Service Center -Raleigh NC
,'7699-1636 Phone No. [phone], within 30 days. - - GW-1 REV. 07/2001
4
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;,
. WELL• CONSTRUCTION REC�IW
North Caiohna- Deportment of Envhouotalt atdNaheal Resources - Dirialon of Wetw Quality-Groundvratar Section
WELL CONTRACTOR (INDMEDUALYPUJEZ (FI.o at. IiPIJS AI110 nci.-`• `. cc(7IFrCATION s tilt° -
WELL CONTRACTOR COMPANY
STATE WELL CONSTRDCTIt%(PERadr/ - ARBOCG(Ttm WQPnnatTT/
Cf(sporeable) - j'd'applicable) • -
1. WELL USE (am Appliablp Bois-Residadie1 wenwipd/Public 0 _ Industrial 0 Agricultural{7
Monitoring O Recovery ❑- Hat Plump Water injection 0 Other Cl If tither, List Use •
2. "WELL LOCATION: _
Nearest Town: G l en V t 'I I e County,1"- A CIC S to
D.Ln7- 177j7/t 173/o •
(Sues Name, Maim Comosoky,seb6ridm.Lallo-Z.Cade)
3.OWNER.& /L: e -19/14vttits LL-G
Address /Ci-Ug PI-nrinc Dle•.
i- (saee��r RreseN . •
. t4u4cnr'n-i ti'lt.it• p 3 a a .5i7
Gor--aTo.a Stag rot Code
012Eh Sn6-/9afr -. •
Arca code- Phone somber
4- DATE DRILLED .3 - .26 - C f.
5. TOTAL DEPTH: /6 So '
6. DOES WELL REPLACE EXISTING WELL? YES ONO 51I---`-
7. STATIC WATER LEVEL Below Top ofanner S r) Ft
(Un'r Nathan Top of 6aim)
R. TOP OF CASING IS. / FT. Above Land Surface
'Top ofcadsg tereehmated attrbelpw Ipdwrfesrowdies a
- verbal* laaastdaaawhb7SANCAC2C Mai /
9. YIELD (gpfp): .9 METHOD OF TEST Akio/
10. WATER ZONES (depth) . 5 one ' (�
6tiimd selling i1 0S -
� OSiope OS(ailcy gslal
(duet sveres sle boot) %
Catitadcllongitudc of well location
R c:
•
, (denverhaiwkeiw000as)
Latituddiongittide sonce:OGPSOTopographic trap
DEPTH ' _ DRILLING LOG
From To - Formation Description
Cf. L:
_-diu• /t$o -L.0 ex/.-.2A/V i7'C-,
LOCATION SKETCH
11. DISINFECfION.Type Ri''/•#: Amount ..2 TAP, 5 Sbow direction and distance; in miles from at least o
12. CASING: Wan "n idose's two State Roads or Comity Roads." Include the road {
o
Depth or WeeohVPt numbers and -common road MEM
Fro_OL To 4LV akt 1 _ -ri
From To EL - - t
From Tp F1.__ c, rri - -
I3. GROUT: Depth /tmMateri I Method . - N
From_ To LJ
FL 'a1• p(sp� . - - - r..=;.
From To IZ I —
.4. SCREEN: Depth Diameter . Slot Sirs - , Matetiai -1 t
From To FLin. in.
From To FL in. in.
5_ SAND/GRAVELPACi:
Depth Size Material - -
Ram To Ft. From To Ft
6. REMARKS:
DO HEREBY CERTIFY THATTHIS WELL WAS CONSTRTICLED IN ACCORDANCE Wffim NCAC 2C, WELL -
ONSTRUCI7ON STANDARDS, AND THAT A COPY
OF TM RECORD HAS BEEN PROVIDED TO THE WELL OWNER
SIGNATURE -OF PERSON CONSTRUCTING THE WELL DATE
submit the original to the Division of Water Quality, Groundwater Section, 1636 Mall Service Center - Raleigh, NC
.27699-1636 ?bone No. (919) 7333221, within 30 days. - GW-I REV. 07/2001

e.
. - • .WELL CONSTRUCTION RECORD " : ? .1 u 5 1
NorthC olin-DominietdofFmhomnaotmda6onalRaourees-Ixvhloaof Qualit•y-- won
WELLCOrnnutva
tprigS .na. ��lle mod.-�- � � ci;iimG`
WELL. CONTRACTOR COMPANY "rams s 2Y_-3 ate
stern nu. Asap {u )
I_ WELL USE (Check AppbSbk Box)-R fir ddtm lrPtblic CI O Ag Industrial riadtwalP
Monitoring CI Recovery a Neat Pu Water Weller CIOther Ci !FOtliar, List Use -
. WELL LOCATIOtk
Nearest Tows Sy I ✓a - CatmttJ (ld s !Ma
0/1-NE Carex. Loy-tb 37
(Street Name, tt—a�ml'.Comeoais,Sabariaa4Lottie.ZrCade)
3_ OWNER- \T•e R R 1. u / IC -
Address D' l3 o X rig'i-
(saI4aeuometi1/2)
FT Latic erd.w : JC/: 333j
Carurlaaa - Stoic .�� ' Zip Code
pegtiptliClifind setting -
d� DSlope Malley . t7Fkt
eta i•vi_tidsla a)
Leamddloogiada omit !wagon
Latitude/longidide sourca:0PS0l apographis map
ern - DRILLING LOG
(95v.). (oos- &'7V& _ -• _,. From To.•g Description
Ara tolePhases/abet - i� %c,-• � ,$' flat fur-.
4. DATE DRILLED "�$'p ('� .1ea5' lops- /IL(re- t-2-4.4"1 t•t--
5. TOTAL DErnt & n S• ,
6. DOES WELL REPLACE EXISTING WELLY YES O NO .QV'`
7. STATIC WATER LEVEL Below Top ofclaw jiiikr.
(Ua't 1fAhorTopal
S. TOP OF CASING IS _/ FT. Above Land Surface'
stop orasks traaabdaWrhelp( ltattanbcsmaim a
nearalaaeasedaaandeflS&1ICACJCa11t
IT�/%pGQ
0. WATRZONES (depth):
• LOCATION SKETCH
t i. DISINFECTION:.Type Air* Amend .371)-A 5 Show direelicn and &Wool iu miles ham at Least
12. CASING: - Wefl'13ickness two State Roads or County Roads. Include the toad
Depth DDrry� or We'titlPt -numbers and -common road tames.
From-O_To /00 1t kr"° $. : -
Froot,_To Ft. -
Fronk_Te Ft` .
13. GROUT: Dept Motet . Method -
FromTo Ft. (3o yj peDt�
a1—
FroTo FI. - - ces
_4. SCREEN: Depth Diameter . SiotSit : : Material C;';_,� .� rn 4
Frnm To Ft M. ice. _ t
From____ To_ Ft`ia in. - - Q'
5_ SAND/GRAVEL PACK:
Depthe Material -
From To Ft
From To FL
CI •
Q►
6_ REMARKS:
DO HEREBY CwrflHATTHISWEILWASOCZSTRUC1W)RIAOCORDANCBWIT IISj1NCAQ2C,WSW-
'ONSTRUCTIONSTANDARDS! AND -THAT ACOPY OF RECORD BBBNPROVlDEDTOTHEW&LOWNER
- SEMATUREOFFERSONCO S7RUCIBloliEWauu. . DATE -
submit the original to the Division of Water Quality, Groundwater Section,1636 Mail Service Center -Ralet is NC
.27699-1636 Phone No. (919) 7333224 within 30 days. _ GW-1 REV. 072001

• • • 1.
• WELL CONSTRUCTION RECORD'
NonhCatolina-DepfartmentofEnrhoonbntandNaturalResources-Iiv(aiaaof Or Quality-'Otvoadw terSectionn 1
wui COICIRACTOR (INDEODUAL) tpr�4�Vj� ff PI S Id» f JMn rl/ •-• , ' `�,_ CRIVEFICA1Wii i 4e •
WELLCONnACrOR COMPANY NAanP' , j.Q It���ae l �Itall 1f.J�;u �t(�•_�rn , arsons s $‹, 53Y-3 1b 0
snit WELL CONSTRUCTION nst S .. A86OCIATSD N'Q►LRMrl7 - `:?
fir applicable) --frfappUable) ' •
1. WELL USE (Check Appleable-Box) -Resident el7Yle1lauicipal/Publc ❑ Industrial CIAgril eotura •
-O
Monitoring ❑ Recovery ❑' Heat Pump Water -Injection ❑ Other U If Other, List Use -
Z "WELL LOCATjQ g ilActksnd setting
Nearest Town:. `/L v - Coan1}S it ITSav��laRidge ❑Slope Malley ❑Flat
(sued Name, Nombem Caaamordy, Let No. EP ) • L'atituddlongiude of well location
4-41 5. ( ivA 2 tza. .2 2 171 (ema:ap
3 as36I(iIAds 4kC S.4-LS•
unferTemt Sian _ 7V Cade
Pais- SItto- .39.3
area ow. Phonemmiber/ f_o _
4- DATE DRIIIPO (o
5. TOTAL DEPTH: •4''3B
6- DOES WELL REPLACE EXISTING WELL? YES ❑ Nl21.---"`
(6epe dminatalame ds)
Laliudellongitdde sow-cenGPSfl opographic map
• - (cbceicbm) -
vDt - DRILLING LOG
. From To - F i : tion Description
N•�
L-U t
7. STATIC WATER LEVEL Below Top of Caring: /66• FT:
peer if Above Top ofCesia) _
8. TOP OF CASING IS FT. Above Land Surface'
'rep Measles wadaatad attar balm hatwrfa remain a
vnteaa In amerdaaa b'ISAT(CAC EC AIL
9. YIELD (gpw1): `f OD OFTBSf�1D//)pfrQ .
10. WATER ZONES (depth):(/
11. DISINFECTION. Type lint fE- Amount c.2.TA- R5
12. CASING: - Wall Thickness
Depth Diapsr
or We%8WPt. Ma I
From 0 .to S1 3 Sea fct-st Pia -
From
To FL______:.
From Ty FL
13. GROUT: Depth Matafd Method
From_�To as FL CQ.y .4,t - FOY- -2
From To FL
4. SCREEN: Depth Diameter - Slot Size : = Materiel
From To Ft,_ja in.
From To Fr_in. in
5- SAND/GRAVEL PACK
Depth Size Material
From To Ft
From To FL
•? s . ; -t -e--
LOCATION SKETCH
Show duecton anddistance in miles from at least
two Slats Roads or County Roads. Include the mad
-numbers andcommonroad names.
RIECE V.::..,.:
AUG25/u
� sf ieVille
iiec.
Amite-
6- REMARKS:
DO HEREBY CERTIFY THATTHIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH ISA NCAC2C, WELL -
oNSTRUCf1ONSTANDARDS, AND THAT ACOPY OF RECORD HAS BEEN PROVIDED TOTHEWELLOWNER
SIGNATUREOFPERSON CONSTRUCTING THE wail; - . DATE
Submit the original Co the Division of Water Quality, Groundwater Section,1636 Mall Service Center - Raleigh; NC
;1699-1636 Phone Ne. (9r9) 7333221, within 30 days. - . GW-I REV. 072001
0

•
,
• WELL CONSTRUCTION RECORD'
Nano CaIollm - Department of Enviro mttmt and Natural Resources - Divbion of Quality - Gtamdwater Section
war. COtRfRAC1OR (R'mmKmDUAWT(AMI
E (pd.Q cflu S 1115 l/LA rii.-, CII4Tt?ICATIOt1�af%4
WELL coKrRACCORCOMPANY
SPATE WELL CONBTRUCRON PERMh1
!- WELL USE (Check AppleabldHoa):-ReddentnlnunicipaYPublic ID Industrial D Agricultural IJ
• Monitoring O Recovery O' Heat Pump Water Injection ❑ Other tl If Other, List Use •
2. WELL LOCHT� itQ: kJ l Siar- - - Topogtapbic/Lend scttin�g� u
'Nearest Town: F� - Canty J AC-t $ 0—'Mudge Ugh* 'Nancy /,tner
41- �f/— SA-4/.-.✓�l/A- t!)-mm'�(lAr tera:•Paroprbte�
(Somalian; Numbers. Gerry,sabardoe,ta$o,Z cane) •- - L`atitodc/ongtude ofa&l location
•
3.OWNER.. -
Address • D . �Sr .. - . -1... _ . _ . _ . _ •
L at tuddlongitdde soma:DGPSOTopographic map
ROSCH )
lueBSta'"•(StrealoiiJ t 0i7T
CaybrTaam State �` 21p Code.
DEna DRILLING LOG
From To _ _ Formation Description
Ara code. Moue ' _
4. DATE DRLLL.ED (o - o9 — 0 Ice• - - 90 '
5. TOTAL DEPTH .f EIS • •
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO -Ill` - -
7. STATIC WATER LEVEL Below Top of Caviog: 'S`O FT':
_� (Ua''f if Above Top denim)
PT. Above Land Surface* 'Top ofadagwai ss&ithr beetgd.vtaha ngdeb a .: - -
variants Is ammdaaesa461SANICAC2C aria.
9. YIELD (gpm): f . - METHOD DETEST lj%DIUizI -.
10. WATER ZONES (depth) /a2 b i sY0 ' (l
LOCATION SK�TCF(
11. DISINFECTION.Type Mill: Amount oiTA-ii 5 Show dircedat and.distancc In codas from at least
12. CASINO: - Wall Thicknesstwo State Roads or Canty Roads. Include the road
Depth Diameter . or Weight/pt. Mir -'• _"-numbaa and -common mon road names.
Fron_ :To_ _ Ft.__ _ _
From To Ft._ - -
From D T9 97) Ft. 4" .11 r 5tre/
13. GROUT_ Depth . Material. Method .l
From A To FL eQar � pews/ f C Ell
From To }L �+ BB
-4. SCREEN: Depth Diameter . S1ot Size : , Mataid•
From To FL in. in. ` r
From To Ft�Dn in• -�� Z J 1�"
5_ SAND/GRAVELPACK: Size
- A evii.9 0e(y ,,Dep,
From To Ft
From To FL
S. TOP OF CASING IS
2 U L2
6. REMARKS:
rz,
DO HEREBY CERTIFY THATTHIS WELL WAS CONSIRUCTFD IN ACCORDANCE WTTH ISA NCAC2C, WEIL -
ONSfRUCf10NSTANDARDS,AND `[fRHOORDHAS BBRl7PIIOYIDEDTOTHBWHLLOWNtr1t
/�' 'n•
6 -o Co •
SIGNATURE -OS PERSON COASIRUCIINGMEWELL _ - DATE -
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mali Service Center -Raleigh, NC
27699-1636 Phone Net [phone], within 30 days. . GW-1 REV. 07/2001
l�C4.L
1�' ,JAtA)D jffd.Y
2OS01..de a-RApr i f -Q-
0

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WELL• CONSTRUCTION REC6RD"
Norde Giolina-DepwtwadofEnvkont®tandNaturalResources-DivWonofWi Qualty-Gtoordwate<Section
�
wen. corrwACron proxvWW UArutats ed07llFh rl-PIIS AO = - h. C6�RYICATIONaB (.^ •
WELL CO rraAeroRoorrArwlIpa,r ,Mlti I���Qh l IliPll y%4$ i t11 we ' taota s ra, 524-3 3 b 0
STATE WELL OON/STRLCnortTanta ASSOC:CATS
(ifsppltubla) . - idapplisable) " .
•
1. WELL USE (Chat AppIk bk Box):-Re$idatisl1YA4ai eEPublie 13 industrial O Agricultu&E)
co Monitoring O Revery a Heat P nip Watts Injection ❑ Other D If other, List Use - . .
2. DWELL LOCAT30N:
aRD Csi 1114 r H. R.s-, .7E7a5
and Nam, i Cmmo'�7,SsLdrima.Let Ho..LpCode)
•NearrstTownQ : its boro Coumtr kck 5
Front_ To FL
6. REMARKS:
g[ap�ldisnd setting -
tiSt OSlope OKafcy Ogle
(dwelt appapiitae boot)
Litilode/longitude o(vRll location
•
3. OWNER: SZn vQai`)ri0A'R5 j • — , tom)
Address O D X .C*5 Latitude/longitude soutee:DOP3OTopographic map
9 ".%' a j 1
N h i
•
(St eetartme sMk) -
AILS b6ro AlC' <2174.5
ClorTown Sate " TyCcde
cflt- fi-aQ-7b
Ara code Mow number
4- DATE DRILLEDa -b /n
5- TOTAL DEPTH: nDf) rr •
6. DOES WELL REPLACE EXISTING WELL+ YES D NO_:57
7. STATIC WATER LEVEL Below Top ofCasing: 2D ET:
(User if Above Top o(Cuing)
8. TOP OF CASING IS / FT. Above Land Surface*
-Top Dreads' terminated Woe blow leadsrrfntngtlree a
nrtaaa V aaardaKa wwUATlCACSC .Slat /
9. YIELD (gpm): oAke/
METHOD OF IL/j714-,
10. WATER. ZONES (depth): /alb' (l
Nock box)
`'DIDEM DRILLING LOG
From T - _Formation Description
604F' YN� !+'t 'n i•
4 4 ' .5.0S,
LOCATION SKETCH
11. DISINFECTION:Type }ft.4- Amotmt a M-A 5 Show (voodoo anddistance in miles from at last
12. CASING - Wag Midas; two State Roads or County Roads. Include the road
Dri Dt • 4_•
ofwe iigbtlPt numbers and' on wad tame.
From 0 . To/ Ft h 5b j�I.,$: -
From To FL
Front T9 FL - -
13. GROUT: Depth
From_ Tca poiMen
From To Ft.
4. SCREEN: Depth Diameter . Slot Sir = = Material
From To Ft_�a in.
Front To FL In. in.
5. SAND/GRAVEL PACK
.AUG 2
Depth Size Material r AShovi l,t) F7
From To Ft At, '',> t-,:,
DO HEREBY CERTIFY THAT THIS WEIL WAS CONSTRUCTED IN ACCORDANCE WanTt iStsNCAC2C, WELL •
ONSTRUCf1ONSTANDA$DS,ANDTHAT ACOPYOFT RBCCRDH BBENPROVIDEDTOTEE-WELL OWNER
6_gpyo
SIGNATURE -Of PERSON CONSTRUCTING THEWELL - DATE
Submit the original to the Division of Water Quality, Groundwater Section,1636 Mall Service Center -Ra1d;h,'NC
.'21699-1636 Phone No. [phone], within 30 days - OW-1 REV. 072001
G
W
0
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. . 3 2 8 3 P,
. - . : WM. CONSTRUCTION RRCORD" -
• , ...„
.- - - •
Nora: &Mina - Departma, of linviroonnid =distend ResouroM- Di;leidi . ‘ Quality-7 CiMimdwa-bsr Section -
was ".. cormtecrou mairetinuto tee;.“,beilvt i s Allinalsi. curie -man IF-M-111 •
'irtfk 40C,41,L---3 2- b 0
WELL cortnatcroa coware . ,
srxrt wax ciworntucnow vastritrs_... ASBOCNCIDwdbaiint :1.:
Of IIPPbable) - • - - firliPPEcable) - -
. .. • -
1. WELL USE (Check APPrIall*Rua-ResuktilailrCsmtpal/PuThile a Industrial 0 4icubstalti
- " Monitoring 0 Recovers 1:1- fleet Pomp Wane- lojeclioa 13 Odits Ei If other, thrt use . , - .
•
-2. -wEii. LoSmott .
*_ la' ieag. - - - .114e/d1,..kgd.eeMalslaely t
Nearest Town5/14 - cocaintLICjSCS; . gM"-
nk4
t
B4ReEgi !leek•en...mb..
ametNemNmd0aNs•SOde1‘01ilOfVel10Cito3. OWNER: 7 e A h I . C -ea., rna 5 . . • • . - .
, otinahscheciss)
3-1115
Address -ea 4.54 .Ti m &it e Rs st. . uditugenongise sotuccDOPSCITopographie map
PristaiRaws119 - - - ' - • . (thociaxa)
Sy IVO--- - Att. pl ? 1 1 7 - ;ran - -_ DEliajliglia-
In Gfitta- ALM/ .Fatjoinion Description
-
•
Geier Tan Stoic ..el rip Code - From To -
meg code- Phone arta , ...L t_ -i
4. DATE DRILLED to - 25 - 0 4' . . 1-12-
5. TOTAL DEPTH: 1 -ZS' - -,
6. DOES WELL REPLACE masToto WELL? YES 0 NO-i/21--
7. STATIC WATER LEVEL Bebw Top of Clang 4'6 n Ft
(UnifAboveropeltembi)
8. TOP OF CASING IS FT. Above Limd Surface*
sei.
*Tap orndfl welsabe attar beipileadartece mall • , :
misses le aseerdeserwidilaNCAC2C.91111. . f, ) - -
9. yap op* / Q 7- METHOD OP T1351 JO / fi)fitt.
10. WATER ZONES (depth): -5-...7h -
• . - a ' . SI a
i I_ DISINFECTiON:lNype if -rib Amount al. T/4-R. 5 Shaw aracrlall Ind -distance hi yaks from at least :c
12. CAS . Wall Thickness . two State Roads or County Roads; Include the --1-177
frorn_t El.rerh9 7 Ftet, Ht. altlifl- hirt."-numbess and-counnott toad names.
FroTo Ft.—_ o
rornrn. —
= <
___ Ty Ft-i—r---- r, c -.I - _
13. GROUT: Depth . Matacal. . c=
crt,
From_h_ Toa - - f)as.A2) I -
RECEIVED , =,
•-‹
Frain to Tt„_._
.4. SCREEN: Depth Dbmeter . Slot Size - -- Matmial
From__ ToFL in. la,
From__ To Pt, in. In. -
5_ SAND/GRAVEL PACK: - AUG 2 3 -20s
Depth size Material
From To Ft.
-Asheville Re.giond Office
FL____
From _To
Aquifrr Protection
6. REMARKS:
DO HEREBY CERTIFY THEBES WELL WAS COMM/CM INACCORDAN� Willi ispiraa2c, WELL •
ONSTRUCTION STANDARDS, ANDTHAT A COPY OF TAB RECORD HAS BEM PROVIDEDTOTEB:WELL OWNER
Pi& 141144449-4.
SIGNATUREOPPERSON CONSTRUCDN071111 WSW . • DATE -
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mall Service Center -Italeigh,-NC
,n699-I636 Phone No. (9E9)733-3221, withht 30 days • . REV. 0712001

;Pr
; WELL CONSTRUCTION RECORD" - .
-
Nmtit. liiva-D aad-� Resaaces-Division aw-squility-7thutindypter
Sectioncinamiscialc
nu.cowmesnxroompi stir 10,1;n ;7�ttfvltS 411202.41. .41. _�
WELL corancroaSaimaYF*3 C� "'-�c imnl�:stiz:_11 t1��1;1;3te �'.ir .'y= v 3 a-b O
snot weacotantuanott amino
I. WELL USE (Check ApivabkBa*RaidenJt7drNtmuapawPublIcC Odin;
Algtiwltawl-O
• - Monttoring0 Recovaq 0- NalPP" Wi sallicclia0 OHtera IfOdia.LidUat
- .
I. -YELL LOCATION: - � .r - - T Iall.�d sang -
NatcatTovra S yy/ V.4' Camty /� C/! S Qn� MidgeMalloy .13plat
f' r 511 a} &u. to 41719 tehodmopeeides aeo - ' .
oa Isom NemotoDeammu& a+'/�aIatRoapadd . Li�laale 6ada� 11[ocatton
3- OWNER; Sg'iviz - /Tbop •w
Address 3-a. - At /G/d•1 A-.eif Po , n 4. e - d. • La itlid_ aouri DOPSCTopttgmpbic map
(J ell4 u; if A 'C ,. Q 7 B T - << DRILLING LOG
ch7err saw f' ' ZIMS. From To - PccaffitiaDaaiption
620- .S • 9170 -:- . r • • , ..Fin - tote ' 9 L f L/
4. DATE DRILLED .4-4 -O Co ' - x - e n • / jrS L... U 6 %0- 2 e A i `e-"
5- TOTAL D • c' '
6. DOES WELL REPLACE EXISTING WI$L7 TES D NtY_
7. STATIC WATER LEVEL Below Top of adn' m TO FT:
/ (UairRtawani ydCaaea)
IL OF CASING IS at/ PT. Above landSv `
envormlgtaSfl ed be4tbSauSasmei,a ..:
•mlaesta.om.ineswiYtsnllie2CM • . /'%D�/! -
9. VIELD(gpR*-/_METHODOFTEST_A /�G +
10. WATER ZONES (depmk /.fs'✓ e2 4S ' N -
•
LOCA'TION SKETCH
11. DISINFECTION:yypt WW1- Amount carl1-E Show direction autdiat esinWit! from atleast
12. CASING: - - WallTitiILI.. - two State Roads or County Raads Includetieroad
fl• . TDepth
h DIPS FL hat ' `- or Weliddlit. MAIM I ,5 - :lumbers and'comma road names.
From
From To Ft -
Fron Ty Ft • ,^ - -
13. GROU'C lhyth tom- Method'\V�� @l\
Wind. -
From —a-. �i To —..Ft. %ynhD p�� . - SkS (,�t1.
Fro.., TeL.._a it' �.N�'(�
.4. SCREEN: Depth Dioomter . $lotF :: = Material - \ti llllk;
Ram To FL in. in. r r 1 a
From To Ft-_jo. in. ' ) ''
5_ SAND/GRAVELPACK: •
Depth Size Material -
From To Ft. -
From To Ft. - -.
6. REMARKS:
DO HEREBY OIRTIPTTRATIMS WEIL WAS CONSTRUCTED INAOCORDANCII WITH ISAICACYC. Ski. •
ONSTRUCIIONSTANDARDS. AND THAT ACOPY OPT_RECORD BS@_ !PIROYIDEDTOTHEWELLOWIER
PERSON CONStRUCTINGIDDRMU; . DALE -
Submit the original io the Division of Water Quality, Groundwater Section, 1636 Mali Service Center •Ralelgh, NC -
,27699-1636none No.(9i9)733-m1,within 30days. . - GW-I REV. mow
r

• • .
• • WELL• CONSTRUCTION RECORD' ,:
Noah Caiolina-DepattnuatofEnvkoiim idmdNatmalResances-Dir6lonofW ee -y
weu,corrraAcroe Q�ty"CholindvratorSedi�onT�
tomnpouMa bStsl4 tlei1s /4njlor:.t.'= `'-t '-' ati;roCAUON. 4
wata oortraacroaCuPa u4r .I eC" fltj43wl tititi �1�JtaC.�tt ytt-s ,'rgoivj�sf_ 4i�_ d4-3 ab D
STATE tYRt.I.ODNd7'RrfLTr01'f metro Asso_cran n wJ 1Y - . ='•�' " -• '
fdappnine) . - •
y •Orre1.) • . -
1. WELL USE (Check ASPiieabWBBaa):-Residentnlar M' aVPoblic CI _Industrial 0 Agricoltmal D
' Monitoring 0 Rem" O-- Heat Pump Water irfeetion 0 other a IfOder, List Use - . .
Z -WELL LOCATION:. txihng
•
.Neaseat Tower D: Il s bo ra - Count : " - ' ask*. pulley DBlat
11"4lI ttMa.v- 1M— aS•7. 4?L� di't_S -tjantahee ; ,—'ntb9
Meet Mem t aeldw, as ,Lana.,rapCede) iadtmk/longiutdet t I1locedon
•
3. OWNER:_i. k-e..
l:�nv
Address 'i-.Q+ IdDx Stye
a
(Saezei, Ro tltaJ te: It5lwr12- �v//�,.77{{"" g7as-
cwbrTeaa t' ' Elmode
8(n. So'% 47s0-
area wee. Phone mac
4. DATE DRILLED (1—Sr-6 �o
5. TOTAL DEPTH- nr) •
•
(Cupeerladatersismeass)
LatitudeilongiuidesomccOOPSOTopographic map
.rJ - . t DRILLING LOG
From To ' FtinnationDescription
.
(pr• tL�na' :fL-ytCk.4in'rt. .
6. DOES WELL REPLACE MISTING WBIL7 YES O
7. STATIC WATER LEVEL Below Top of Outlier / 2 <FT:
(User Mahon Top ettimies)
S. TOP OF CASING IS / FT. Above bed Smacea
wrap ofeWugte attar Wm Madaafiwnea4isa ,
whims LaawreasewplSA 2CAUt . - .
9. YIELD (gprp):--_L METHOD OFTESS/Miist4_. -
10. WATER ZONES (depth):7 3o ' (/
•
- 11. DISINFECTION.Typc /irk Ate I.f1t'A"PION3K@TCFI
t 2. CASING: _ 3TN-8 � Show diraedwt a�aiamaca la miles from at least
Wall Thickness two State Roads or County Roads.'Include the road
> � � or Wei hu.pt, nmabersaid-common mad names.
From From fl To To Depth,
___
From Te F4�_
13. GROUP, Method
From A To .�
Fran__ p�t'J
.4. SCREEN: Depth Diameter . Slot Sim - = Material
From To PL in; in.
From To PC in. in.
5_ SAND/GRAVEL PACK: _ -
Depth Size Material -_
From To Ft`_ _
From To FC__
6. REMARKS:
•
DO HEREBY CERTIFYBarniaS WEu. WA$ CONSIRucreD IN ACCORDANCE wms 13ANCACW. Rig[., .
ONSTRUCIIONSTANDARDS, ANDTHATACOPY OF RECORD BEBNTII
PROVIDED TO 461,
fia.,s. /
r
- SERIATIM -OF t UCTING TUE WEIL DA:� _
Submit the original to the Division of Water Quality, Groundwater Section, I636 Mall Service Center. Raleigh, NC
17699-1636 Phone No. [phone], witbin 30 day;
_ OW-1 RHV.072001

-it
.17649-t636 Paine No. p19j 7333221, within 30 days
r>onhada�-D ____ oc>nrhao .oataaBern
wuntowntecroR ._2.. itllm.S
ware
itteA
srsrevevbrAailt7 cws
Iffasobei k) - .
• ..
-_-
-
- - .WELLCONSTRUCTION BECORW _:
331164
- Cane
:.c idol (l 31 gb
vslia
I. WELL USE Owe eifficaikeGediFtrobitolflifablic0 Indastdd 0 Agttoulhn W
• Ikea* 0 Reooraq O'Ban PPMIVOtleit solionU Oar a Netter,umuse ` = •
rWELLLOCA _ _ iaftand iog-
trisaq, _prat
Neae T r % ' ' ilomlp GSur�y i- (dadteppepidetarP
•
tmmtrmecte�rra c- - - - •+,aane.atraed� - CtiSoddlmigiiroda fv1Sl6 dton
1 OWNER•„�� G Q (n rr_ (r- I tv
Address / cr ies.03 R ".
entaseso
CityitTan _PM .4er Wide
/�
4. DATMBtusD / 1/ ' � -1) 6, •
s TOTAL DEPTH 3 Op
6. DOES WELL REPLACE nifllW wili.LY 'TESpNOa21-e--
1 STATIC WATERLt3YRLBdowTopottesing r n 6 gr_- -
IRe ritAboallor ,
S.TOP OFCASIWGIS / PT.A6ovetLaadSeete.' - -.
-repo[edrse sibandaeGbeierkai+ +Aekir...-
'Widen bnairainiillikigniCAtat
t Y16Lb(a* /.2 _T MUST Dneat
10 WATER.ZONES(depOrx a &s-'
II. D1SINFBC7iLDkerse EF#.4 knead ..277)4; Shordeeo andantinos *sift tome least
12. CASING: - WitUddsteea - IwoState t s or Courtly ItondsaucInda the toad
MP*arW4WPL i o0m6enand- toad names.
Flom 6 - To /QP PI QF:- - -
Fmm___To R -
•
From
11 GROUT' Death ltier'rt. - taw -
Ltosp p01brA_, -
tenteediatentesendado
mP
DRILLING LOG
�I�ota
= _ 5 A A s.0 Sit n
-IR Lis P.. .rr 22r,
To;
4 SCR Tominuneter _ statare - _ i � GP Rpup�
From To Ft in. m. • = : o\� F `
5_ SAND/GRAVEL PACK:°$�0
Depth
ale Material
Rom
Fro�To ft - -
6 REMARKS
no muliir%.TilawrniAlt7BB WELL WNICONSERUCTED niACCORD1ua8Wnlf ISAiCAC WALL -
tNSIRUCTWNSTANDARDS, ANDTH1lTACOPY;; El'R7OD : , HEEMPFAVIDED7UTlI-IPffiLOWISR
/6--. S-off
RtP1ATEntio inns rtinaIRtentipT EWEIL DATE
Slitmit the origioai to the Division of Water Quality, Groundwater Seetioy, I636111a0 Service Center -Ratefgb, NC
GW-I RSV 07/2001

111"1.1.1111aft"1.1•1111S
_r
I_ WELL USE (Me App -Box)_g llPa6DC[i JudusIda113 Monitoring o' Pimp o Other aWO�iarpLiIIUse •
t�
-WELLtOal•
Tows• 'i Coual �f}L�k��,�- �t�dsdimS•
`F}U 12eL out: /12 .O1faIlaY : OF7et
Ismea►LnrCN t�y°�G1�18�doamohair ode - Liti- - - -gitods Swam
• laiwwlpekw)
3.0 i_••II i 6-J01
-WELL CONSTRUCTION Itt
Mog6(ufoSm-Departure of mdri d saGitiml‘tercHm
sysr cotrralatuaanre co�iviena�rts oZ/7!P
WE1.6ameralc7oaao i .test fkih -J Ltf,II._.•.__ ._ ._( _
ab
ASSOCATRII StATtWELLaoaspa.._-i, l+js •
•fJriPp .ble) •
3-j 58 -
Ada t rush LI�•
, /
Ggarrose taw a$D7P'
*
(8a0- At -/_e-/S` • :?�-:--
IR.cab. Me rather
4_ DATE DRILLED ! A— i -- y (o
S_ TOTAL
•
• Ltilito.deflong, opopapIde snap
:wr . - DRXWNG LOG
ant To -
rchp,
6_ DOES WELL REPLACE EXISTINOIVELO 0 --
7_ STATIC WATEIMIVIO.BalowTop
Warrrw
B. TOP OFCASING 1S % Jr.AboveLand
rap etesdagtraa4aai lea
9 YIELD (gpq);----�IMMOOF
10. WATER ZONES (dopthk
L.Desoripdon
'I"-R ;-
11. DISWFECTI01 AatotmtItgraQiien
Show anew* audditmwo in 12. CASING: - Wal7 - two State dmikebaud*at leastroad
Fmm Q -� RO°����s.'�bided�otoad
otWer rumba' roadaaatea.
Front Tq_ __ -g� -
l3.OROUC , Mai& --
Frmq�Tp�_ efe�hod
A. SCREEN: om"'--�R_"�-----
ash
From. o. IHahtial
From is
5_ SAND/GRAVI7�PACK�-• ° is __ _
FrontDepth Mae
F
To pt__
From •1"tL-----per---._
6_ REMARKS:
material
fl MATIIRS 1fl WA$ WACcoRDy g ISAIICAC�,WELL•
A�THAT COPIf W .: �'! D ' f : BTOT1ltt waLLOWNER
lb—l.3—O(d shratutaabnyasatcousneumotenvetz, DATE
Sabath the original to the Division of Water Quality, Groundwater Section, I636 Mall 3erake Canter -Raleigl NC
„+.7699-1636 Phone No. (919) 933-n21D Within 30 daps,
GW I Mc 07/2001
REG0 Q;,P4\i_
\NP•

- f • WELL CONSTRUCTION RFC8RD
Nanhta lion-DepaMteptofflaamaeattad•W �f�[4-Wwmiggie SIdb1� tr 0
watsCONTxnCrott �flt5 �ltnad.- 11 _ 1Y/� -
wew.coNrewcroacarm ur •ram Yi R3-aii--3 34 0
sten Daoeartntcemttrmr(ni `
I. WELL USE (Check ApiNes*Box>Reakk rrM Upu�eC3 .radmhuo Agri ob at
f MO1"0d8ZO Rom"O•Ike bar Wier We anE Other 0.Milker, LisUm ` •
•-
7_ 'WELL LOCA.TWA
Towns (, l e n ✓ N ht- - county
d�; rti t' .arc -+re - 5 Ali- R Doc a k'73
tsampt>-Ca.r..lpt � .t t*a.Bro -
3 OJi 1/
Address
53
S. TOTAL DEPTH: .S 00' - a
it-Sh, e rc` • r°8 -
ciwatrao -.- Saar =alpcase
(FM uo-
Area lb®e.rrar
4. DATEflDILIHD /b-4/ -01,
6. DOES WEILREPLACE EXISTING Watt YES OI JI}/'
7. STATIC WATER LEVEL gttow fC(g -S o )f:
8. TOPOFCASINGIS % mann mmur mots
PT.AboreLan &dwelt*Top dank* rennbathe bispartratisaremdrara
9 YIELD (gpq� (0' ETHpc,nat
10. WATERZONES(depdrk / THSI`J/1�--isiper
( twit iaod .
Calitudalaigimds awn Emerson
aagh_da map
D L LNG LOG
To ' .FdtamSonDeaaiptimt
ALL , l:.P ; t-e..
•
II. DISINFECTION: Typa /f-f1 Amount 4T/J-R5 Show threctionwt wceinmawsRomatMasi
12. CASING: - Wa176 ryes - - two 8tabsRoadsa Canty Rumb:Iaciudethe toad
FmF 0 . Txo�r�a+ orWei�TW<R _'numbmatmd'oommontoad names.
Froiq__Tp
Front___—Tct__R f"�"° sc- .
_4. SCREEN: Depth D - Sias :. Mataml
FtmtL__ To. _ _ 9a. in.
From To Ft.
5. SAND/GRAVELPACK: m
From DepthTpFt Sue M
From To Fri__
6. REMARKS
RE - RE%pet nt
DNW
. OF A
OCT ;i i 200E
DO HEREIWCEISFYINATIRIEWELWASCOWIE/CIROM
ONSiRUCTIONSTANDARDS. ANDTEATAC`OP,YOF $EODEp 'ro�at.OWNS
. /6 -A; -o L"
= SI(0iAtuRE-OPIaR30NCatartucentarint- • DATE -
ahmit the orient to the Division of Water Quality, Groundwater Seedont I636Ma0 Service Center -Ratdpb; NC
;7699--2636 Phone Na (9t9j 733.3131, within 30 days
• - GW-i REY.07/2001
7

_WELL CONSTRUCTION RECf RD' • . - -- - . - 3 3 5 5 8 3
DGi61on
N�(ytoSoa-D�6udofllnritoomebtt6td _
tteirS = 6'
dgater Seaton
nub �°N` .. =: . _ �'>�y-3 ab 0
wtn tcaaessac7 onmosa►�mrrm r sui-Pr flafh, ► W&Eb1�ja T.se • 'mom ;s
sr. rewau.a xorreticsWwtldttf_ _ - 6aaodglm
c app_adda - - •(i<6gppltabla) •
I- WEILUSE Cana cso 8 &a .tea 4100819110
Mtmitotmg0 Rccowy a- Rat PpmpWaw*lion a Other II Ifother, Lit"'
-L-van WCATIQlt_ - - - T idimt8>I B
cm,* t.-t en v; Ile, - - voomy /SLOGS dI.J' �opa pK.Qay _Ore
i�ILDwhse-- rY-)4-n. 4e934; t
csuc.tNa i�leR .»Rfmik.Sr� - - _ _OriginIomfian
3.OWN - mae2i.c2` 4►
Add , -3 St Al Ps- L oIMP
Wmter-Rarrtt9 - _
f f /1/1 A-! AL ` a 8? 3 DRILLING LOG
(g211- Cj t1-Y_ 2 " Ss "MSc p 3-To - FaamSonDaxrlprlm
�3c33 ?n e1
NAems. phaoitilt x ,'4 T _ p ' = SO' L VC C QA.t/% f -P—
S 4_ DATE DRILLED / t • - a- . ;; '
S TOTALDEPTH lsn - -' -
6. DOES WEU.REPLACE ID6STEWWELLY TES 11f_Y0-
7. STATIC WATERLEVELHdowTopofl.LSD Fr:
PT. AboscLaadSmSoe'
sra8sai _ • ..
adi'tiA7WJlC7C q7L
l Shear Cabaret* SOSO .
9.
10. W
ATERTOWN (depan vamp
th):
crimes
S. TOE OF CASING IS
nap hi amereaes sawSta�N'N
Tab (1Ttl�iL+ . .
II. DlSINFECITON Typc link Amount ..3Th41 ' Show tlireelion muldblunes iodlaSend ltxst
12. CASING - WeB - - too Slate Road; aCandy Rads. , -tv. the toad
neptb «We gee.-numb=andtomniontad
From O _ ToS PI, sz -
From_ To R -
Fmin Tp Ft.__
l3 GRAtIC Depth ILiJ 1- Matlnd-
From_STe Pt. �Q ?' pewit"
Fmnt___T4—E _ -
A. SCREEN: Depth Ithunaer_ Sleighs - Material
Front To Ft,_in tt4
From To FtL_yt m
5. SAND/GRAVELPA(XC:
Depth Size Wait)
Ram To FL -
From To_ Ft
6. REMARKS - -
DO muiiircistiwYTEVETTIES MEL WASCONSTRUCTED INACCORDAWSWITS MICA=W&L-
ONS7RUCrIONSTANDARDS, ANDTNATACOPY OF RECORD HBRNP$OVWBDIOTHB-WBLLOWNER
#44- f.Qissr�' J i— l�fp- O Co
SNrNATURBOFP SONCCWS7RUCINITEBWPId. _ - DATE -
Submit the original to the Divides of Water Quality, Groundwater Section. 1636 Ned Service Center -Ratelgb; NC
.27699-1636 flume No. [phone], within 30 days. _ - OW-1 REV. 07t200I
iND
0
r

.WELL CONSTRUCTION REbEFRD - .: •. 3 N 6 b 14
li f1W Quality-7 Section
Nosh Cai oliea-Department of ERYbomficut end Natural Resources Divitdon o ..
WELLCONTRAC[DR(urowom t,L; . o oi1^•ri 1i5 QMct;: - t CATIOr111-otn`C -
WELL CONrRACrORCOMPANY NM s't�w"• lliss1": Il -11 t._1 .,,'�"nP ,'raoii a _. 22 -'3 a6 D
STATE WELL OONSTRUCttON units M11100tATIM
(if applicable) / - iit pplicablo) • -
I. WELL USE (Check APpfCable Box):-Rdidert(iatfl minicip5UPoblie 0 Industrial 0 Agricultural
- - Monitoring O Recovery O- Heat Pump Waler Injection O Other El If Colitis, List Use
2. -WELL LOCATION: -
Nearest Town: LLT2E3S7EIL
Cy.
TopogrinNo/Lend setting -
tk ORfdge 0Slope malty
OFlat
SAYa/VN.41E Comte, • 42A'1P (cheek opptopideboa) - '
(sum Nome, NWS W%CoawA, Sab6tiao.. Lartno.. Tap Cde) • L`athude/Iongitude of w ll location
3. OWNERss at-) rh ✓/c.7 in Pr1y s LG ( )
Address ��I'l. It� i x S4ex5' G LatitudeAongididesoniccfoPSOTopographicmap
c7). iiSharri
CrlsTon Snta - Tap Coder
5'.7l—.75a7D
Arta (Yd� Mom somber
4. DATE DRILLED la — 6 - 0 CO
5. TOTAL DEPTH:_24525'
(Mock box)
DEPTH ' DRILLTNG LOG
Erom To - Ftinm6ou Description
cci�e,•
_��, qSo' ;fay t -'. tar e
6. DOES WELL REPLACE B7QSTING WELL? YES 0
7. STATIC WATER. IFVELBelow Top ofCastor SO FT.
(User itAbon Tap orcomg)
/
8. TOP OF CASING IS FT. Above Land Surface*
'Tap ofadag trmlvand atlorbeim hard.amtaearp.IS a : - - 3variant la meentasee wIttilSATICAC IC AM
. YIELD YIELD (wn0 1Y._W6 M HP OF TEST jeke t/+
10. WATER ZONES (deplb) '
LOCATION SKETCH
11. DISINFECTION .Type H--111- Atmwd ...2 MS SI Show direction and-dna= in mil= from at least
12. CASING: - - Wall Madmen two State Roads or County Rods.Include the road
,-- Depth to or WeighdPt. mambas and -common road names.
From_ To ei FL hat n area-. •
From To Ft
From To Ft.
13. GROAT_ Depth - Material Method -
prom_a_ To AD FL__Celr, dpt JOC,llr t�
From To FL
.4. SCREEN: Depth Diameter . Slot Size : , Material
From To PL`_ia in.
From To Ft_ja in. -
5. SAND/GRAVEL PACK
Depth Size Material
From To Ft -
R Asheville Rey ions) Citi „
AQJlter P otFPrtion
6. REMARKS:
DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED Bt ACCORDANCE WUH ISANCAC 2C. WELL •
ONSTRUCTION STANDARD; AND THAT ACOPY OFTHIS RFmRD�BEBN PROVIDBDTOTHE-WBI L OWNER
From To
RECEIVED
AUG 25 206b
c_
era
0
SIGNATURE -OR PERSON CONSTRUCTING THE WEU. - - DATE
Submit the original to the Division of Water Quality, Groundwater Settion,1636 Mall Service Center-Raleigh,'NC
.27699-1636 Phone No. [phone], within 30 days. , GW-1 REV. 072001

33i;
;..
• WELL CONSTRUCTION RECORD"
North Carlina - Department.or Envkomuwt and Natural Resources-- Division oon of Qwfltr tiroimdwater Section .
WELL corm AcroRtnmlltuuAL) (ptkq cb-el'i In J,IDjIn t AL s. ( TIR[CATtON(S 4-
WELL CONTRACTOR COMPANY tu�tUd-hl q _PolllMJI_ t l\liw.4 Tice J. **toriks a, .Say-3 t6 0
STATE WELL CONSTRUCTION SWAN AssocwT®w&ziscri :- s
rdapplcble) // '(•JWPiI ) • .
1. WELL USE (Check AppBmble Box):-ResidatidtYAiamiapaUPublic ❑ • industrial CIAgriwltaral Q
Monitoring CI Ramp! O" Hat Pump Water Injection ❑ Other CI If Oilier, Liu Use - - -
35
2. "WELL LOCATION: .
Ne (Tome lAi2i3Sf
UeatLboin
(street Nome. Number. Camavailr, S.b#rmm,
3.OWN N•• / A-1 CoMl3L.
Address '• O• e L5 4.0 -
ss N - g7$
GlybrTam .-' -viscose
ode -
( - 5�6- o95 0 -
Countyci4 QCslxci
F7f'�
LAN*. Sp at)
MSC Neill
Atca eodd Pbose nbc
4_ DATEDRILLED ?-
5. TOTAL DEPTH: 3 OS ' - •
6. DOES WELL REPLACE EXISTING WELL? YES O NO Qlr
7. STATIC WATER LEVEL Below Top ofCaeinW 6 D T.
(Wee r MahanToop of Casino)
8. TOP OF CASING 1S /FT. Above Land Surface'
'Top of=lagremYWdanarb. hadsorfaa mails a
?arises to swordswkb75ANCAC2C ADS.J
9. YIELD (glut* `f. 0 METHOD OF TBSTl)JD10Thf4-,
10. WATER ZONES (depth) a /0 '
11. DISINFECTION: Type Amotmt ,a TAApi 5
12. CASING: - - Wail Thickness
DeNh _ D�raw o WdgimlPi.
From 0 .
From To Ft
Front Tp
13. GROUT_ Depth � "N�atan�t� Method -
From ATo azi Ft pa i ap pcjjtA-)
From To Ft
.4. SCREEN: Depth Diameter Slot Smc - = Material
From To FL_in. in.
From To Ft,_jn.
5_ SAND/GRAVEL PACK
Depth Size
From To Ft
From To Ft
6. REMARK&
- TOPliSriPL1ic/Laid�.�'�ng -
DRidge OSlope 6A[alley .Olilat
(d etapprpSWebox) . -
C titorjdlongitede pfvedl location
(cloonwholoutahwoods)LatiNdellongihide soucc 0OPSOTopographic map
• (cbxthaa)
,1?M - DRILLING LOG
From To " Formation Description
0 -R6' -CI g y.
(e 5 S 9 v+1 Afi x�
Sa ' 3 PS . a Lau G (',--R,ea t-E---
LOCATION SKETCH
Show direction anddislanan in miles from at last
two State Roads or County RoadL Include the road
-numbers and common road names.
DO HEREBY CERTIFY THATTHIS WEIL WAS CONSTRUCTED IN ACCORDANCE WITH ISANCAC2C, WELL •
"ONSTRUCiION STANDARDS, AND MAT A COPY OF RECORD 0H(A► BEEP( PROVIDED TO THE -WELL OWNER
r I l i a�>c� 2-S —o try
SIGNATURE -OF PERSON CONSTRUC1INOmaWELL - • DATE -
Submit the original to the Division of Water Quality, Groundwater Section,1636 Mall Semite Cutter -ReIelgh,•NC
:7699-1636 Phone No. [phone], within 30 days. GW-1 REV. 072001
r r
r

• WELL CONSTRUCTION RECORD;
_ •
(}ramdwR. Section .
North Caatulina- Depatmoent of EevironmeM and Naomi Rnomcas - Di�iaion of Wder Quality. .... on
;hen ►i �.i1u _S . Cp4•rww'CAT10Na
t tr„- corrtnwcroR (tPmnpotlArJ (PetaO J�* •r Ego4 .t y_. -3 a. b 0
WELL COt1TRACTORCOMPANY - = _ .
_ T®w wan
SrwTE Iir� leelicahle) PifatE7'a ` {if appllwble) ' - .
•
I. WELL USE (Check Boxy..RaidentieltY lupaUPublie ❑ Industrial 0 Agdceltwal 0
Monitoring O Recovery 0' • Heat Pump Water Injection 0 Other 0 If Other, List Use .
- Tppograp'04.imd setting -
ORidge opt Malley . OFIat
Edna aperopristebox) - at 4 .
Laiituddlongitude of well location
1 WELL LOCHT(ON:.
'Nearest Towit: `U: 11 5 bor O - County J 1l' L it S dry
(3 on.,-c /) Peel— • ., 7.5
Mite lame, Ninp.ben, Cooennimiq', Sobdirisp4Lot No. MP Cam)
3- OWNER:_ Jo S k o in-Q YJ.• .0 wevesthataseasheeema Address to Q tF T U / ; C,-.VN C 7--• •S (L2 Ladtuddlongitdde sourcC0GPPS oPographie map
Moto RomaNuJ
rT 41(i'e t_s r.= / . 33 q, 9'
GtyirTon State /" Trp Code
aaj).i-33—aa6.9
Area code- Phone samba o
4 DATE DRILLED 0 -- 9 �p b
_ DRITrnt0tOG
-
Proxu To - Fo , don Description
0 a3.
.23 ' (0/)5'
5. TOTAL DEPTH:_{D OS ' '
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO -0--------
7. STATIC WATER LEVEL Below Top of Coley ,ono FT:
(Us/AN', ifMaas Top orb
8- TOP OF CASINO IS __ PT. Above Land Seam*
-r doming tarmtnated atlor Wax badman requires a
autism la� srardaaa vRh iSA11CACSC Alit
L-d
/1-Qnr
j
YIELD (SP * METHOD OP TEST Qthey
10. WATER ZONES (depth) 5 3s • SKET --'--
LOCATION SKETQH
INFECT„� TN n c Show direction awl distinct In miles from at least
m O� DT DD� orweig6irpr.
Froo 01-3 F ��szz_p:.P
From` To Ft
From Tp Ft.._.,„__
13. GROUT: Depth _Materiii;_er. Method .
From,__ To FL fold
From ToFt--
.4. SCREEN: Depth Diameter . Slot Size : • Material
From To Ft. --in. in.
From To Ft._._io. in.
5_ SAND/GRAVEL PACK - _
Depth Size Material
From To Ft.
From To Ft.
6. REMARKS:
1 l . C S CASING:
ION :Type f Armtmt•Include the road
12. CAS1NCr WaElldclowv two State and -common
or on road
Rands.
-�numhersand'conmaoaroadnames.
0
C
DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH ISl1MAC 2C, WELL
•
oNSTRUCIION STANDARDS, me THAT A COPY OF TT RECORD HAS BEEN PROVIDED TO THE.WELL OWNER
SIGNATURB-UF PERSON CONSTRUCTING THE WEIL - DATE
Submit the original to the Division of Water Quality, Groundwater Seetion,1636 Mall Service Center` RREVgh NC
.27699-1636 Phone Na. (919) 7333221, within 30 days.

ry nWJ9
Joi
• WELL CONSTRUCTION RECORD'
Caftan
of VJder Quality-- Croimdwator Section
NoshCafolim-Dr�adofFavironmeidandNaturalResout�-Drviaton .. ., c�rmGTfoNi��
wart. cosi-macron (rsntODUAW (P�9c flrl t5 311' _ - 4-3
WELL cONTmNcro=coMPANY II).11l��tl '•. _rot .'rsoxr��itil:
AsaodATW-
s'rwTti: WELL. mad rg7tAl1'f'a__� applicable) •
(ttappliabta) - •
1. WELL USE (Check ApplicablWBox):.ResidmGai'urueij l/Public ❑ Industrial 0 Agricultural[
Monitoring O Recovery O' . Heat Pimp Water Injection ❑ Other 0 If tidier, List Use
2.IVELL LOCATION:. ^, gripie/Lt nd setting -
Narest Town: 6-1-e in J I I t✓ - county —I A V S Uri) "dgo 0Slope 'Macy . OFIat
Stone Point- r- 5/R»w l3Litttr tj:11 ,,913(r (badrap,rtPIWe box)
tttoet NICK Numbest, Community,Ste„ Lot Ma. Dp Cods) • j4tui flongitudeofwell location
3- OWNER:. E A A/ ll y.. R v CO t--; - , (desneshoisotheca )ue map
Address () . t3 O K ? 1 S' . Latitoddlongitlide aonrceAGPSmopograp
(�etyiRmcfo.) - (dwdcbmc)
07 g 7a 3 nRtt.T LNG LOG
C Ot frTo a Stein - 74Codc From To. - , Forma6ofDeactiption
( 7tt3- g6ei i - - a-� C I
Area cod. Pains ■amber . -- 2 • ‘10 5 '
4. DATE DRILLED r - P -- .
5. TOTAL DEPTH; 5 `
•
6. DOES WELL REPLACE EXISTINo WELL? YES El NO_ cQII-e
7. STATIC WATER LEVEL Below Top of Casing: /O b FT.
(Wee if Above Top of Casing) -
8. TOP OF CASINO IS _._�— FT. Above Land Surface'
'Top of ruing tsnelatted atior Inky t W amtacs requ S amimes la '_METHODOFTESTI/02/h
9. YIELD (gpmr 3-- (v!
10. WATER. ZONES (depth) 3 3s- '
LOCATION SKETCH
11. DISINFECTION ,Type Ammmt ... TA- R 5 Show direction and distance In miles from at (east
Wall Thickness two State Roads or County Rands• Include the road
12. CASING• : Mitaiiii number and -common road names.
From fl:De*orwei�htrPL . Tc a a e-Ziiti:8
From To Ft
From Tp FL _ Materiel
13. GROUT: Depth - -
. 1.4atmrel. Method
From_& -To rr' Ft. eQ471M'< f2oyfo
From To B. c
.4. SCREEN: Depth Diaraeter . slot size - • Malarial c.-:
From To Ft. ---in. in. c:,
From To Ft�a in. t 12 :) tr_..,
5. SAND/ORAVELPACK
Depth Size
From To Ft
From To Ft
6. REMARKS:
DO HEREBY CERTIFYTHATTHIS WELL WAS CONSTRUCTED IN ACCORDANCE WIM ISANCAC2C. WELL •
ONSLRUCRONSTANDARDS, AND THAT ACOPY OFTW�RECORD HAS BEEN PROVIDEOTOTHE:WELLOWNER
SIGNATURE -OF PERSON CONSTRUCTINOTHE WELL .
Submit the original in the Division of Water Quality, Groundwater Section, 1636 Mall Service Center -Raleigh, -NC
n699-1636 Phone No. (919) 7333721, within 30 days. - GW-1 REY. 07/2001
ado

n
9
- WELL CONSTRUCTION R ea-RD v ; J i
Norafotina-DepttmadofEnrkomaeidandNaturalResourc Resources isionofWider Quality--OrobndwatcrSection
wry EraintACCOR Gras p ur) naT (p ;be vi i s no i l if;e. 3- - :t, csaTTFICATtOr(ijaf 4o .
WELL CONTRACTOR COMPANY (tAniR c jao1�.7 -.d �I)2al�i*ml, � Tnt �"tttot;10-11i�I1-3 a-e a
STATE WELL CONSTRUCTION PRndn ASnocfstn)
(11sw1iable) . •fmf ) . -
1. WELL USE ((beck Appliabifsox): ResidaUid l/PubliC ❑ Industrial CI Agricultutala
Ram"- - Monitoring Ram"aHat Pump Water Injection ElOther CI If &tier, List Use
N Tows:A - enemy -i¢ L C 5 ifs-� ORidTgtelpoOgtStllpos thing [Vint'
iatM
l. 6zf3 A 11 (Q�- ,- 7)'9
(dmd*WpropLaebox)
(Sava Name, Nma,m.Cmm ay, taNov VIP Cade) LetitadeIlotigittrdeafoul! location
3. OWNa Po 12tei--
Address cf a (0 1•I •. a dor.V !2 d.
syy/vas (ste _02-279e
Gryiermaa Stoat �." - rip Code
&asp- 56'4. aS-45 •
Arear>o -Pbaoe nmbar
4. DATE DRILLED et- �/ ' v-5
5. TOTAL DEPTH:_/ 7-5- ' •
-
6. DOES WELL REPLACE EXISTING. WELL? YES ❑ NO:_ i-
7. STATIC WATER LEVEL Below Top ofCaiing: b O FT:
(W e'4^ if Above Top amen*
S. TOP OF CASING IS. / FF. Above Land Smfice'
Tap efeulag torahmd 'der Min [pd.aScs marts o . .
masa la aseardaaee sYYISA 3C MIS.
Z -WELL LOCATION:
Dc�h trWa»IIF.
From i� . T0_ S.oN_$h.
From To Ft
Front_—Tp Ft -
13_ GROUT: Depth Material Method
From__a_. To_a pays ti
From To Ft, f
4. SCREEN: Depth Diameter - Slot Size Material
From To Ft, in. in.
From To FL in.
5_ SAND/GRAVELPACK:
Depth Size Material
From To FL
From To Ft
ice)
Latift ie/I ngittidc mateed3OPS0Topograpbtc map
• (check box)
e DRILLING LOG
From o - _Formation Description
? 2-' 1 7S' �G li a.22n;-f c
79CAC
9. YIELD (spot):__METHOD OFTEST lDIUfltQ-•,
10. WATER. ZONES (depth) /bo ' Q - - - LOCATION SKETCH
11. DISINFECTION.Type ff-f-H Amount .i. MS 5 Show direction outdistance ki miles from at least
12. CASING: Wall Thidenea two State Roads or County Rods. Include the road
--numbers and -common road tunes.
6_ REMARKS:
DO HEREBY CERTIFY THATTHIS WELL WAS CONSTRUCTED 1N ACCORDANCE WLTR 15MNCAC2C, WELL •
ONSTRUCfIONSTANDARDS, ANDTHATACOPY OF TM RECORD HAS BEEN PROVIDED TOTHE:WE(LOWNER
SIGNATURE -OF PERSON CONSTRUCTING THE WELL _ • DATE - -
submit the original to the Division of Water Quality, Groundwater Section,1636 Mall Service Centex. -Raldgh. NC
fl699-I636 Phone No. [phone], within 30 days. . GW-1 REV. 07/2001

-
- • :WELL CONSTRUCTION 1&,C I D - 2
NocBtCorogns-Dope: ofEnviup t� -
wena�nx♦c »eS ,, - /h, _ • it Q S- d�wierSae4on
spat Le ott
mitom crasm itre muntaarrissaiss-
��� ••
aaaer�•�
1. WELL USE (Cbedt/pmtic
. monitoring 0 Raoonrya Hem PpmreAtta n OglerQW0641*Goo
•NearattT ot5 / LI Ty� ` _ : T1,lpogriptik d j golfing-
/7- c.�7 9. Wong .aitlat
annoetenekra Om)
Latitatorloada &wall toeauon •
Ladtpdefionsk• -sontetcOOPSOToPogroPmn msP
er •DRILLING LOG
:Fan To ' .FtiretionDeaedptttm
n.i
rmaia2-6
tam
tot
4- DATE DRII LLD v Co
S. TOTAL DE7jH• ' - '—
6. DOES WELL REPLACE IDCISTRIOWEILITE3p ma:
7. STATIC WAITER LEVEL EebwTopof ,s'D W
ercedno
g. TOP OFCASINO ISn.MSt�
Walline FT A6ovsLmm
9 YIELD anal_ SIBMOD OP
It WATER ZONES (IRS
ctyurTaaa- Stets ' ryt7ode
Sfl-9u _
Ana mP600eueeet - -:•.z r
•
Q
11. DLSIIJFECTIODjIdICAnasignia
11. DISING lblebotss Show dhe eoaW.dis6m;s8imemRomatleex
• Depth
taoSpbRoatirot potpryRude6wroad
From 0-. TTo_ o`er nuabasandeommonroadnames.
FFm__ T �_
v--
•
I3_ QROUt D
Fmm�T4-C _p ' 14 2
_4. SCREEPP. Tit,- - - �_ -Par 0�--
al
From Depth - slot Sirs
From q oow-' tea• i4
I SAND/GRAVEL PACK: "'M in
From � roe Matelel
From To
6_ REMARKS.
DO HERatiCEIGIMNATTEM WELL WAS_COtagRUClED "ONSTR
ucnav ANDAR S• , COPYOF RECORD apt PROMOTE; THEW= OWNER
yn _ -6G
•
T�90id _ • DATE -
Submit the original to toe Division o/ Water Quality,•
-i7699-1636 Phone No.(PI9) 733.3221, With@ 30 day; Groundwater Section, I636tYIall Service tkptstI !WV.p NC
. G1V I REV.07/2001

RESIDENTIAL WELL CONSTRUCTION RECORD
1),S1,0 322
North Carolina Department of Environment and Natural Resoulcr - Division of Water Quality
WELL CONTRACTOR CERTIFICATION # ((S,� )
1. WELL CONTRACTOR: 11
c f %ie
W/et�Cateactor (Moidud) Planetry-Yac3../i(ten 1.1.4'// (r,v hg
Wel Cattalo/ gummy
Name /
STREET ADDRESS i tl 7 /i��P e T cJn RA
Rfi b') ern vet," /vim 025-77/
City or Tam Stara Zip Cale
( ate )- ply ?Licit/
Area code- Phone number
2. WELL WORMATIOtt
SITE WELL ID Ofd applicable)
STATE WELL PERMfTItite apaooe)
DWQ or OTHER PERMIT #(if apt:table)
WELL USE (Check AppioableBain Reside dfel Wale Supply�
DATEDRILLED ^/.,7"!)(j
TIME COMPLETED //.' 4 AM ❑ PMf�
3. WELL LOCATIOtt L
CITY: 5)//L�r� COUNTY ark.5b
A'Az% nn-» Tine's �5177q
(Street NnMea. Conmaasy'Sdamision,Lana. Parcet.$ Code}
TOPOGRAPHIC I LAND SETTING:
13Slope OVatey °Rat ®Ridge Daher
(diea appropriate OmQ
LATITUDE 3�`r St3 3Ca
LONGf WE it of. /%Q I Sr i?"
Latitude longitude source: ❑OPS °Topographic map
(location of we/ mat be shown an a USES topo map and
aibdmd to Ws farm Ind taig GPS)
4. WELL OWNER
OWNER'S NAME RvSSei/ C.hew"Ie
sTREETADDRESS A%neo mm:n "Viaye'
Sy Mk )VG ,;Q77?
May or Town State 2p Cole
Phone lumber y�
May be in degas,
misaq moods a
in a decimal tamer
HL WELL DETAILS:
a. TOTAL DEPTH ( aft
b. DOES WELL REPLACE EXISTING WELL?YES CI NO III
c. WATER LEVEL Below Top d Caskm /q� O FT.
(Use '+' if Above Top d Casing)
d. TOP OF CASING I l . FT. Abaco Laid Sedate'
?op d casing 6.m .sad al(a bdom land surface may remire
a variance in accordance math 15A NCAC 2C .0110.
e. YIELD (gpm): 1 METHOD OF TEST a., r
L DISIFECTIOrt Type %{%/7 Amount 9.1 n 2
g. WATER ZOIES (depth):
Rom n To /2ff) Fran To
Fran To From To
Fran To From To
6. CASING:
c� Thickness/
w Fran C7 To i 3 Ft
Fran To Ft
From To Ft
7. GROAT: Depth Material r� Method
Fran 0 To kJ Ft CPrne?l77- POsap rin
From To Ft tX
Fran To FL
0. SCREW Depth Diameter Slot Size Material
Fran To FL in. in.
Ran To FL it _ in.
From To FL iI. in.
9. SAND/GRAVEL. PACK:
Depth Size Material
From To Ft.
Fran To Ft.
Fran To R
10. DRIUJNG LOG
Ram To Fomma6on Description
IVCD
MAR 08 24116
Asheville Hegional Office
Aquifor Protection
11. REMARKS:
100CPEBY CER iS IM6MelWASCm6AMICl®mcwvf r Valli
15a WPCS. WELLCOM WI1Ofl WETS WIER. may COPTOF 7aa
RabaD HAS wen PROVD®7O pig WELL OVmER
l l Ylfv
CONTRACTOR DATE
PRINTED NAME OF PERSON CONSTRUCTING THE WELL
SIGNATURE
L(
OF WELL
Submit the original to the Division of Water Quality within 30 days. Attn: Infommatlon Mgt.,
1617 Mail Service Center— Raleigh, NC 27699-1617 Phone No. [phone] ext 568.
Form GW-la
Rev. 7105
98

RESIDENTIAL WELL coNsrRucnoN RECORD
North Carolina Department of Environment and Natural Resources- Division of Water Quality
WELL CONTRACTOR CERTIFICATION # gel 5;9
1. WELL CONTRACTOR:
:07E 7b 4 P
Well Contractor (Ind • Name
�rr.Lk)ram &JAW r.1/1,'nor
Well Contactor Company Name 1
STREET ADDRESS .6 3 C /A P TeW n Re-)
lea&rnsv,%/e7 nr[
City or Taws State
1/2179- y- s
Area code- Phone number
2. WELL INFORMATION:
ar77/
Zip Code
SITE WELL ID #(if appfpebte)
STATE WELL PERM TSOV appioble)
DWQ or OTHER PERMIT Sid appicade)
WELL USE (Check Applicable Box): Residential Water Supply
DATEDRILLED 6'.,L-Q(o
TIME COMPLETED (n . 3O AM❑ PM®
3. WELL LOCATION:
CITY: y vlrl
COUNTY T. disci n
h P;Y(S GTP
rime et*
(Street !tree. CornanariY-Sk&drmaic.r. a Parkzl. zp.ceaeT
TOPOGRAPHIC / LAND SETTING:
El Slope ®Valey ❑Flat ❑Ridge ❑Other
(creek appropriate herd
LATITUDE 1d J r3 LI /„
LONGITUDE .3 /7' ft. a "
Latitude/longitude source: MGPS cTopographic map
pocaban el welt must be shown on a USGS tope map and
attached to mis Imp End mite GPS)
4. WELL OWNER
OWNER'S NAME COS n l
May be in degrees.
minutes, seconds O
in a decimal foram
STREET ADDRESS Cr A P r1S
S�f vlrt N.(
City w Town State
c'. $ - S6 9D
Area code - Phone number
/lo /
Cr,'sk
Z,Cde
& WELL DETAILS:
a. TOTAL DEPTH: n ()5
b. DOES WELL REPLACE EXISTING WELL? YES ❑ NO
c. WATER LEVEL Below Top d Casing: 96 Fr.
(Use 8 Above Top d Casing)
d. TOP OF CASING IS / FT. Above Lad Surface'
'Top d casing laminated at/or belay land surface may require
a variance in acmdance wAh 15A NCAC 2C .0118.
e. YIELD Wpm): / METHOD OF TEST r7._i r
At,
f. DISINFECTION: Type 117/7/ Amount 7. ET z.
g. WATER ZONES (depth):
Fran Nn To'Q.y
From
Fran To From
Fran To From
6. CASING:
Depth Diameter
Franf_ To /2.0 FLf4
From To Ft.
Fran To FL
To
To
To
Thic1Oess/
Weight Material
its- 57e4
7. GROUT: Depth Material
Fran 0 To no FL rim mPnr
From To Ft.
From To FL
Method
Purn11
8. SCREEN: Depth Diameter Slat Size Material
From To Ft. in. _ in.
From To Ft in. M.
From To FL in. in.
9. SAND/GRAVEL PACK:
Depth Size
From To FL
From To Ft
Fran To Ft
Material
10. DRILLING LOG
From To Formation Description
11. REMARKS:
r
0
71
r"v
LUJU
I 001431ERT CERTFYTHAT T6 WELL WAS CONSTRUCi;D N ACCORDANCE WIN
ISA NCAC 2C. WELL CONSTRUCTOR STANDARDS, AIDTRAT A COPY OF T16
RECORD ItAS BEEN PROVDED TOM* WELL OWNER
J o Alyde 4-2-0/r
SIGNATURE OF CERTIFIED WELL CONTRACTOR DATE
.0-74Pe
PRINTED NAME SON CONSTRUCTING THE WELL
Submit the original to the Division of Water Quality within 30 days. Attn: Information Mgt.,
1617 Mail Service Center — Raleigh, NC 27699-1617 Phone No. [phone] ext 568.
Form GW-1a
Rev. 7/05

RESIDENTIAL WELL CONSTRUCTION RECORD
North Carolina Department of Envionment and Natural Resources- Division of Water Quality
WELL CONTRACCE TOR RTIFICAI7ON 8 aO Sd
1. WELL CONTRACTOR:
Wd Contractor (navemaft Name
urinckbent 1n tidy/ Ar.Ill,`y�
Web Contractor CmpanyNa e ``
STREET ADDRESS to c3A% 14',..i cd ? i n R4
IC b , i g v///e /Itt .2. j7 /
(Slyer a n Slab T.p
(gQTh- 979 - Er WSW
Area coda- Phan number
2. WELL INFORMATION
SITE WELL D 9paka)
STATE WW.PEfM ITSyggfaahbl
DWQ a OTHER PERMIT frif ,ppicahb)
wla.t.USE (Cheek AppiAM161eBora ResidentialResidentialIq Weer S4
DATE DR0.LED /�-p(u
t�e(
TIME COMPLETED 7 i 3a AMp PUM
9. WE11LOCATION
Crtr. (.✓y),'r err Comm etch -Son
(Street Name. iiip
�Pawt�ZIP tode)
TOPOGRAPHIC I LAND SETTING:
COMB OWiey ORM ERidge 0O6eer
(check apprepide bag
LATITUDE j_ ° aU t.7. `j I'
t T 2_ sue! 12/ 7. S„
Iatitudc4ongit de some: SOPS °Topographic map
potation of era swot ee sham on a USGS typo nary and
a@ethed b 1* fast Ind fllg GPS)
4. WELLOWNER
OWNERS NAMEV, STnITZ-]uS
STREET ADDRESS am I ey 13ran C ,
Ed itte
Citya Taws Stele rm Code
(k2s )- SOS' -9698'
Area code- Phone number
Nay be is dams.
dodm aeoodser
tea aeeioa tams
6. wa1. DETAILS:
a. TOTAL. DEFT1t .Sc S�
b. DOES WEU. REPLACE SORTING WELL? YES ❑ NO p
a WATER LEVEL Reba Top Staring IFit') FT.
(Use 't'YAbove Tap of Casing) d. TOP OF CASING I /_ FT. Above Lad Sulam*
Tap d casing famiafed elver below lad surface may require
avalance 6 accordance WM 15A !CAC 2C .0116.
e. TURD Wan 6' METHOD °FIRST 0. )'r
3]5,101
t, DISaFECTIon; Type NTH Amount /9. oz
9• WATER ZONES (deal*
From 51%a To ecag- Fran To
From To From To
Fran To From To
6. CASING:
Depth
Fmmta_ TO fn St
Fiore To
Frain To
7. GROUT: Depth
Fran O To AD
Finn To
Flan To
Thiftmessf
Diameter Weight kabala
Ft�.4.__ tors. Pvc
Ft
Ft
Material Method
Ft Cashier/7" _pumping
Ft
Ft
S. SCREEN Depth Diameter Slot Sim Mrs'
sl
From To Ft in. it
Fssm To Ft in. _ in.
Fenn To Ft Si. in.
9. SAMKNRAwiPACK:
Depth Size Material
From To Ft
From To R
Fnn To FL
ip-
10. DRWFNG LAG
Flom To
11. REMARKS:
Formation Description
oc
I OOtB1E$Y CI WY THAT1lee MIL WAS Ca6Taer ED elACCaW UWRN
ISA NeA62C.WELL CQOnRUC Oa 6TNOARDS. AIDTWTACOPY OFTM
RECORD HAS BENPRWOII TOTE WELL OWNER.
SIGNATURE OF CEWELL wCONTRACTOR l/ _ DATE 6
*Tek-ycie
PRINTED NAME OF PERSON CONSTRUCTING THE WELL
Submit the original to the Division of Water Quality within 30 days. Attn: (nfonnatlon Mgt.,
1617 Mail Service Center -Raleigh, NC 27699-1617 Phone No. [phone] ext 668.
Form GW-la
Rev.7A5

RESIDENTIAL WELL CONSTRUCTION RECORD
North Carolina DepuOacn of Environment and Natural Resources- Division of Water Quality
WELL CONTRACTOR CERTIFICATION # a OsO
1. WELL CONTRACTOR:
r* 4i AP
Well nb � caaclm Naie
lrn part Gs JP .r: rgy
Wei Contractor Company Nape STREET ADDRESS 634 }/yAe TO ton Ili
rCaAHtt►1.tv/I//P /✓cL 2-77/
City or Tarn Slurs rip Cab
( Sri- Li 79— 2g5'l
Area coda- Plane number
2. WELL RFORMATIOTt
SITE WELL ID*Of sa rabid
STATE WELL PFRIARegtaser sbb)
DWQ or OTHER PERMR i(i applicable)
WELL USE (Check Applicable Bat¢ Residential Wafer Supplye
DATE DMLLE D %/Se)6
THE COMPLETE I..30 AMO PMMI
3. WELL LOCATW It
CITY: (aJi'lan77"aPr couwry Z1.e rsein
Thread/eery are, nch 7 gct
(Street Peme. Iar-No. NEW. DP Code -
TOPOGRAPHIC / IAND SETTING:
OSfope DVSs, and ARldge OOSer
(chock blew Pesbas
LATITUDE a. ace' ag '01/.11/"
LONGmmEj s.°
Tat tdcJlongit>de source: BOPS °Topographic map
*cafes ddaestbe shown at a USGS kaa map and
aided b his bat Inot using (; PS7
4. wssOWNER II
OWNERS NAME 0a.LIr4ml STO/77- LS
STRUT ADDRESS .3revi/ey °ranch
t441/1777tir /VG
OW a Town SUM Zp Code
(9c2 h .5-65?--969�
Area code - Phone number
May be io degrees.
yaks sweat at
le a (WNW bag
5. WELL DETAILS: !�,,,�
a TOTAL°EMIR aC�
b. DOES WELL REPLACE EXISTING WELL? YES O NO
c. WATER LEVEE. BSowTap of Catnip 'IV FT.
(Use + I Above Tap d Casing)
d. TOP OF CASING IS / . FT. Above Land Surface*
Top d wing Nninfad allar bete lad surface MEW regale
a weariesin amoadanceat 15ANCAC2C .0116.
e. YIELD Wpm): /D METHOD OF TEST CL.i
335402
f. DISIN ECTIOtt Type %/T? Amount 6 ..67
g. WATER ZONES (deem):
Fran Sti To aid S From To
Fran To From To
Fran To Fran To
6. CASING:
Thidaess/
�-6 To p n. o/ia�'eeerr Welnc
Material
Fran To Ft
From To Ft
7. GROUT: Depth btalsial Method
Fran6To Ah Ft. CPf71#n"
Fran To Ft.
Fran To Ft
S. SCREEEItt Depth Diameter got Size Material
Ran To Ft In. in.
ROM To Ft in. _ K
Fran To Ft In in.
_amikke
9. SAMYGRAVEL PACK
Dept Size Material
Fran To FL
Rom To Ft.
Fran To Ft.
i
10. DEALING LOG
From To Formation Description
11. REMARKS:
l
rWHEREBY CERTIMNMTMIS WELWAS ODralwrtmNAGWon aaNan
150k NCPC2C. wa1CON5IIW1 ]N SWOARDS. AND TINTACOPY CFDOS
RECORD HAS BEEN PROVIDED 1O1NE WELL Owia
�HYdeSi
SIGNATURE OF cei7aw WELL CONTRACTOR- DATE p
red i
PRINTED NAME OF CONSTRUCTING THE wai.
Submit the original to the Division of Water Quality within 30 days. Aim: hfonna0on Mgt.,
1617 Mail Service Center — Raleigh, NC 27699.1617 Phone No. [phone] oxt 568.
Farm GW-la
Rev. vas

RESIDENTIAL WELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources- Division of Water QualityWELL CONTRACTOR CERTIFICATION # r,(rcQ „Co
1. WELL CONTRACTOR: te
W/ell�C� tract (In ividual)}� me
CT l-ojn a n Wpil etir,'1lw�n
Well Contract Company Name
STREET ADDRESS 63 v fix A to 7 a./n Rj
Rabb ns vw'//a /i/c 2k77/
City or Twin State _ Zip Cale
($ at)- L/79-g-4<c
Area code- Phone number
2. WELL INFORMATION:
SITE WELL ID Aft applicable)
STATE WELL PERMIT#(t applicable)
DWQ or OTHER PERMIT *cif applicable)
WELL USE (Check Applicable Box): //Residential Water Supply IV
DATE DRILLED 6-
'.2 Ce'
TIME COMPLETED Y. 30 AM ❑ PM Ei3
3. WELL LOCATION: L
CITY: W })/ Tic rTer COUNTY c loon
a 2rt,
( fNSeae.Numbers. Cammariy.Subdivairn.NParcel. Z3
TOPOGRAPHIC LAND SETTING:
0Slope OValey $Flat ❑Ridge ❑Other
(check appropriate bad
/
LATITUDE 3 Li°
LONGITUDE 7 3±1 /7 ,. /7, L/ rt
Latitude/longitude source: prGPS DTopographic map
(location of wet must be shown on a USGS tope map and
attached to this form Inot usig GPS)
4. WELL OWNER
OWNERS NAME (iarn'n ammo ns
May be m degrees,
minutes, seconds or
in a decimal format
STREET ADDRESS /Zir/h Lin 6 .r ✓A'
W h1'rrrr < 2$789
City a o n
State Lp Code
(gfl L/R*-g'l `/t
Area code - Phone number
5. WELL DETAILS: a TOTAL DEPTH: A6 /
b. DOES WELL REPLACE EXISTING WELL? YES 0 NC) (d
c. WATER LEVEL Bebe Top of Casing (.5-4 FT.
(Use's' 6 Above Top of Casing)
d. TOP OF CASING IS / FT. Above Lad Surface-
. 'Top cf casig terminated War below lard surface may require
a variance n accordance with 1SA NCAC 2C .0118.
e. YIELD (gpm): / S METHOD OF TEST G i r
327556
f. DISINFECTION: Type / %/-7 Amount 9 of
g. WATER ZONES (depth):
From Lis To o2 CAC From To
From To Rom To
From To Rom To
6. CASING: Thidaress/
Depth Diameter Weight Material
Fran c\ To 6Q Ft. (p., 407.7 .zm_/
From To Ft.
Fran To FL
7. GROUT: Depth Material
From () To r OL FL reMei1T
From To FL
From To Ft.
8. SCREEN: Depth
From To
From To
From To
Diameter Slot Size
��77 McOad
t'(J
Material
Ft m. in.
FL in.
Ft in.
9. SANDIGRAVEL PACK:
Depth Size Material
Fran To FL
From To Ft.
Fran To FL
xx-
10. DRILLING LOG
From To Formation Description
11. REMARICS:
r
n
rn
CO rTl_
► ^I-1
0
I DO HEREBY CERIFYTHAT THS WELL WAS CONSIRUCim N ACCORDANCE Wrlll
1SA nCAC 2C. WELL CONSTRIILTON STANDARDS. AND THAT A COPY OF Tay
RECORD HAS BEEN PRODDED TO THE WELL OWNER
SIGNATURE OFEFCTI IED�WELL CONTRACTOR S_ DATE-64
JP 1M J41.9J9
PRINTED NAME OF PERSON CONSTRUCTING THE WELL
Submit the original to the Division of Water Quality within 30 days. Attn: Information Mgt.,
1617 Mail Service Center - Raleigh, NC 27699-1617 Phone No. [phone] end 568.
Fenn GW-la
Rev. 7105

RESIDENTIAL WELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources- Division of Water Quality
WELL CONTRACTOR CERTIFICATION # (-2,050
1. WELL CONTRACTOR:
Je-rt 4
Well Contractor (Individual) Name
�Trr>Lr') (.%/l r-Ar,�/l/`ng
Well Contractor Company Name
STREET ADDRESS (#3I-1 ifyjtd /Ol.an Rrj
Rabb; nsveY/e etc `n.. 77/
City or Town State Zip Code
(Sr2�Sr) '-/79- 5?HS2i
Area code- Phone number
2. WELL INFORMATION:
SITE WELL ID SO(apgkabk)
STATE WELL PERMITO(a appiode)
DWG or OTHER PERMIT tIgf appfieabie)
WELL USE (Check Applicable Box: Residential Water Supply ig
DATE DRILLED 7-l0.-6S
TIME COMPLETED / i 3r) n o PM®
3. WELL LOCATION:
CITY: y / tires COUNTY Jnc)GSaf
S u 7Ton brancln 779
(Street Name,Nmnbera, CanmWy-Sbdasim. tcPNa, 2*Code)-
TOPOGRAPHIC / LAND SETTING:
p Slope °Veiny ❑FWat aRidge CI Other
(check appropriate boo
LATITUDE .. uc .ie 1 SO.3"
LONGITUDEt.Y4 /Ie t.b.7"
May be in degrees,
minutes, seconds or
in a decimal format
Latitude/longitude solace: MGPS °Topographic map
(location of wel must be shownone USGS topo map and
attached to this brm Inot using GPS)
4. WELL OWNER (�
OWNER'S NAME Pot t/I SAutcr%trv✓L
STREET ADDRESS S ulThri hp,
Sy) vo, p(r. a -77q
ay or Tam State Zip Code
(376)- 909.3o419
Area code - Phone number
5. WELL DETAILS:
a. TOTAL DEPTH: (0.3 0
b. DOES WELL REPLACE EXISTING WELL? YES 0 NO )a
c. WATER LEVEL Blow Top of Casing: &CO FT.
(Use+' if Above Tap d Casing)
d. TOP OF CASING IS / FT. Abate Lad Surface'
-Tap d wsig to rated ally below fad surface may rezone
a variance in accordance with 15A NCAC 2C .0118.
e. YIELD (gpm): 9 METHOD OF TEST CA.; r
? r A fa V -
t.0v
f. DISINFECTION: Type N 7-1/ Amount
g. WATER ZONES (depth):
From 2rta To ad From To
Frain To From To
From To From To
6. CASING:
Thickness/
Depth Dianeter Weigh erial
Fran_a_ToSC Ft. 4. CARS)
Fran To Ft
From To FL
7. GROUT: Depth Material
Fran r) To 2c Ftf es/49717"
Fran To Ft
Fran To Ft
Method
R
& SCREEN: Depth Diameter Slot Size. ,..
From To Ft in in.
Fran To Ft. in. it.
From To Ft in. in.
9. SANDIGRAVEL PACK:
Depth Size Materiel
From To Ft.
Fran. To FL
Fran To Ft
r-4
10. DRILLING LOG
From To Formation Description
11. REMARKS:
t
U
I DO HEREBY CERTIFY THAT MIS WEU. WAS CONSIRUCIED N ACCORDANCE WITH
15A NCAC 2C, WELL CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS
RECORD WAS BEEN PROVIDED TD THE WELL OWNER
73-61-4 SIGNATURE OF CERTI WELL CONTRACTOR DATE
PRIN1tD NAME OF PERSON CONSTRUCTING THE WELL
Submit the original to the Division of Water Quality within 30 days. Attn: Information Mgt,
1617 Mall Service Center — Raleigh, NC 27699-1617 Phone No. [phone] ext 568.
Form GW-la
Rev. 7/05

RESIDENTIAL WELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources- Division of Water Quality
WELL CONTRACTOR CERTIFICATION # _ 906O
1. WELL CONTRACTOR:
f) P
Well Contractor (Ind' Nane
�r t ark We// G)r:/l,'n,"
WeY Contractor Company Narnee , /
STREET ADDRESS .O 3 7 /TrjioiE TGIn ioi
Rnhb;ns vi'//i A/c 01Fr77/
City or Taws State Zip Code
192 )• 4179- 57- 4115-5/
Area code- Phone number
2. WELL INFORMATIODt
SITE WELL ID O(d applicable)
STATE WELL PERMIT/(dappicable)
DWQ or OTHER PERMIT S(d applicable)
WELL USE (Check Applicable Box): Residential Water Supply Q
DATE DRILLED 7 - jo - 6 6
TIME COMPLETED Q; 66 AM PMZ
3. WELL LOCATION:
CI�1': Sy vet COUNTY :fe.kvHn
(Street Nama!b1 Cears.VCaamaan$K-Sabtiveiaq LatNo.. Par�.7Zip 0040-
TOPOGRAPHIC / LAND SETTING:
❑Slope OValy DFlat MRidge ❑Other
(check appropriate baud
LATffUDE La d /9167 9'•,
LONGITUDE _a 3d Ali /S.S"
Latitude/longitude source: M GPS °Topographic map
(location of eel must be shown on a USGS Mpo map and
attached to this loom AT not rsig GPS)
4. WELL OWNER
OWNER'S NAME R}..// f Poi rkha r
W
STREET ADDRESS 7'/!'L)/ CeI Vie
SY /vc. tic 79
city or Town State Dp Cede
(9C4 7/6-Se) 2
May be in degas,
aim Seams or
isa drama) (mat
Area code - Phone number
5. WELL DETAILS: [[��
a TOTAL DEPTH: of c-c)
b. DOES WELL REPLACE EXISTING WELL? YES ❑ NO IN
c. WATER LEVEL Below Top d Casing: b 0 FT.
(Use'+• if Above Top d Cog)
d. TOP OF CASING IS / FT. Abase Land Surfaces
Top ct casing laminated aHor below tad surface may relive
a variance in accordance W0h 15A NCAC 2C .0118.
e. YIELD Wpm). q METHOD OF TEST a
466
f.
9•
DISINFECTION: Type //r/ Amount /n, aL
WATER ZONES (depth):
From i A To .4310 From To
From To From To
Fran To From To
6. CASING: Thickness/
Depth Diameter Weight Material
From (1 To ? Ft .r sorai PVC
From To Ft
From To Ft
7. GROUT: Depth Material Method
From 5 To 2/1 FL CCrnen" P/IM(DH12
Fran To Ft. b(-
From To Ft
8. SCREEN: Depth Diameter Slot Sae Material
Fran To Ft in. in.
From To Ft is _ in.
From To FL it in.
9. SAPID/GRAVEL PACK:
Depth Sae Material
From To Ft
From To Ft
From To Ft
10. DRILLING LOG
From To Formation Description
11. REMARKS:
CC
u
r DO HEREBY CERTIFY THAT'S/IS WELL WAS CONSTRUCTED N ACCORDANCE WITH
15A NCAC 2C. WELL CONSTRICTION STANDARDS. AND THAT A COPY OF THIS
RECORD HAS BEEN PROVIDED TO THE WELL OWNER
SIGNATURE OF utRTIFlm WELL CONTRACTOR 7 /DATE
yde
PRINTED NAME OF PERSON CONSTRUCTING THE WELL
Submit the original to the Division of Water Quality within 30 days. Attn: Information Mgt.,
1617 Mail Service Center- Raleigh, NC 27699-1617 Phone No. [phone] ext 568.
Form GW-la
Rev. 7/05

CC NON RESIDENTIAL WELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources. Division of Water Quality
WELL CONTRACTOR CERTIFICATION # 2187
1. WELL CONTRACTOR:
Russell S. Taylor
Well Contractor (Individual) Name
Uedden Brothers'Well Drilling, Inc.
Well Contractor Company Name
STREET ADDRESS 73 Holly Hills Vista RD
Franklin Nr 28714
City or To'm State Zlp Code
( 828 )- 369-9591
Area code- Phone number
2. WELL INFORMATION:
•i E W ELL ID 0(II epplieable)
',TE WELL PERMIT#(N applicable)
OWQ or OTHER PERMIT #(if applicable)
WELL USE (Check Applicable Box) Monitoring 0 Municipal/Public
Industrial/Commerclal ( Agricultural 0 Recovery 0 Injection 0
Irrigation❑ Other ( (list
use)
047E DRILLED 10 • ( u•0 /Y-+
TIME COMPLETED - 3 I. AM ❑ P
1. WELL LO T ON:
0 } 3
(S raat Name, Numbers, Community. SubdMslon, Lot
TOPOGRAPHIC / LAND SETTING:
(Sops (Valley ❑Fie( (Ridge 0 Other
(check appropriate box)
L'.TITUDE
LONGITUDE
Perch, Zip ooa)
May be in degrees,
minutes, seconds or
in a decimal forma
Latitude/longitude source: ❑GPS (Topographic map
(location of well must be shown on a USGS opo map and
attached to this form Nnor using GPS)
4. ?AGILITY Is the Berm of the Wetness whin the well Is owed.
FACILITY ID er(1f applicable)
NAME OF FACILITY
STREET ADDRESS
City or Town ln State_ Zip Code
CONTACT PERSON i X D_
MNLING ADDRES
GAO s I - /U 3705
City or Town State Zip Code
( %l ')-723-5447
.Area coda - Phone number
,YELL DETAILS: ^�
e, TOTAL DEPTH: L000I
b. DOES WELL REPLACE EXISTING WELL? YETIS 0 NO
e, WATER LEVEL Below Top of Casing: 15V FT.
(Use+' If Above Top of Casing)
d. TOP OF CASING IS 2 FT. Above Land Surface'
'Top of casing terminated at/or below land surface may require
a variance In accord(aynce with 15A NCAC 2C .0118.
a"
e. YIELD (ppm): METHOD OF TEST Blow.
1. DISINFECTION: Type li T H Amount 1 60Z
g. WATER ZON&S (depth): r
From I' To 1OthS From To
From ao To c CY7 r From To
From To From To
6. CASING: Thickness/
Depth `/ Diynq�er Weipl�t Ma�eria�l
From ) To ST Ft. l G , 10'1� �S1p-JI
From To Ft.
From To Ft, _
7. GROUT: Depth Material yn� M//;:dI ('
From l / To 54 Ft.�
From To Ft.
From To Ft.
6, SCREEN: Depth Diameter Slat Size Material
From To Ft. in. In.
From To Ft. In. In.
From To Ft. In. In,
9. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
From To Ft.
10. DRILLING LOG
From To
Icw
Formation Description
0
n
Co.- •
N isst
r
11. REMARKa. S: -UAL. 412 e wi p
-gym ph it'A b
I D0 HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH
ISA NCAC 2C, WELL CONSTRUCTION STANDARDS, MD NATA COPY OF THIS
REC94WyAS SEEN PPROVIDED THE WELL 0 ER. e e
S
SIGNATOFIE OF CERTIFIED W A CONT- - TOR 1 r/ATE
Russell S. ylor
PRINTED NAME OF PERSON CONSTRUCTING THE WELL
Submit the original to the Division of Water Quality within 30 days. Attn: Information Mgt.,
1617 Mall Service Canter- Raleigh, NC 27699.1617 Phone No. [phone] ext 558.
Form GW-lb
Rev, 7/05

NO/ Y RESIDENTIAL WELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources. Division of Water Quality
WELL CONTRACTOR CERTIFICATION # 2187
1. WELL CONTRACTOR:
Russell S. Taylor
Well Contractor (Individual) Name
geiden Bret; hers' Well Drilling, Inc
Well ContractorGompany Name
STREET ADDRESS 73 Holly Hills Vista RD
Franklin Nr 28734
City or Town State Zip Code
( 828 )• 369-9591
Area code- Phone number
2. WELL INFORMATION:
SITE WELL ID Mil eppileabte)
STATE WELL PERMITM(II applicable)
UWQ or OTHER PERMIT M(if applicable)
WELL USE (Check Applicable Box) Monitoring 0 Munlclpal/Public yr
Industrial/Commercial O Agricultural 0 Recovery ° Injection 0
Irrigation❑ Other ° (Ibt use)
DATE DRILLED 4 '(Ji t75.0
"IME COMPLETED Jag 1P 5 AMPM fp/
LOCATI
CI
4'
! treat Name, Numbers, Community, Subdivision, Lot No. Parcel, Zip Code)
TOPOGRAPHIC/LAND SETTING:. ��
CISlope °Valley OFMNI ❑Ridge CI Other p
(check appropriate box)
LATITUDE 4 a
LONGITUDE ta, .0(
May be In degrees,
minutes, seconds or
in a decimal forma
Latitude/longitude source: 04PS °Topographic map
(location of wel must be shown on a USGS topo map and
attached to this form anot using GP$)
4., ACILITY-le the name el line armness where Na welt Is located.
1;;ILITY ID M(11 apple b)
LAME OF FACILITY pi id- ; Adync, Ca,
STRigT ADDRESS
� fl"
City or Town State ' Zip Code
CONTACT PERSON
MAILING ADDRESS
City or Towri State Zip Code
Area code • Phone number
5. WELL DETAILS: �n(� /
a. TOTAL DEPTH; UUU
b. DOES WELL REPLACE EXISTING WELL?VEES NO 0
H
c. WATER LEVEL Below Top of Casing: / (N FT.
(Use'+' It Above Top of Casing)
Submit the original to the Division of Water Quality
1E17 Mall Service Center -Raleigh, NC 27699.1617 Pho
d. TOP OF CASING IS 2 FT, Above Land Surface'
'Top of casing terminated at/or below land surface may require
a variance In accordance with 15A NCAC 2C .0115.
e. YIELD (pm): i., . ,METHOD OF TEST Bloc.
1. DISINFECTION. Type H T H Amount 1 6oz
g. WATER ZONES (depth):
From (j'To 345 From ioyo To :%/ r
From No5•To 1401I From/et/9'To /0415r1
From ycA3;To LAS' From To
6. CASING: Thickness/
Depth Dlameter Wag 1 M eri
From L1 '' To ,34\ Ft. /Q " Jt
From To Ft.
From__ To Ft.
7. GROUT: Depth Material Method
From 0 To_A�FI
From To Ft
From To Ft.
e. SCREEN: Depth
Diameter Slot Size Material
From To Ft. In. _ In.
From To Ft. In. _ in.
From To Ft. In. _ In.
9. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
From To Ft.
10.. DRILLING LOG
From Zo
n '
50 197D 9
11. REMARKS:
Formation escriptio
I D0 HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE W mi
ISA NCAC 2C, WELL CONSTRUCTOR STANDARDS, AND THAT A COPY OF THIS
RECO HAS BEEN PROVID3TO THE WE OWNER.
�1p
SIGNATURE OF CERTIFIED tf/ELL CONTRACTOR f DATE
Russell Se Taylor
PRINTED NAME OF PERSON CONSTRUCTING THE WELL
s No. (wEc I IMO
MR 27 2006
A4hevllle Regional Office
If r Protection
Form GW-lb
Rev. 7/05

;: NON RESIDENTIAL WELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources• Division of Water Quality
WELL CONTRACTOR CERTIFICATION N 2187
1. WELL CONTRACTOR:
Russell S. Taylor
Well Contractor (Individual) Name
$edden Brothers Well Drilling, Inc.
Wed Contractor Company Name
STREET ADDRESS 73 Holly Hills Vista RD
FYankllrt, wr 28734
City or Town Stale Zip Code
( 828 )• 369-9591
Area code• Phone number
2. WELL INFORMATION:
SITE W ELL ID M(If applicable
STATE WELL PERMITM(If applicable)
DWC or OTHER PERMIT M(If applicable)
WELL USE (Check Applicable Box) Monitoring ❑ Municipal/Public Q/
Industrial/Commercial❑ Agricultursl O RecoveryO Injection 0
Other(list us
DATE DRILLED
DATE DRILLEDD OCP
"ME COMPLETED AM p PM
S..SVEU LOVIATdON: �(
,CITY:
'COUNTY
r]iL�
(strut Nema, umbers. Co munity. Subdivision, Lot No., Parcel, Zip Coda)
TOPOGRAPHIC I LAND SETTING:
❑Slope OValley ❑Flat 0Ridpe O Other
(cheek appropriate box)
LATITUDE _3_
LONGITUDE
May be In degrees,
minutes, seconds or
in a decimal forma
?.ztitude/longitude source: OGPS ❑Topographic map
(location of well must be shown on a USGS fopo map end
attached to this form M not using GPS)
4. FACILITY -I. al. name of the business whets the well Is lossbd.
P AGILITY ID e(IC applicab )
NAME OF FACILITY , /
STRCfAqDRESS 3P3e7'Y
ity orTCode
CONTACT
PERSON
MAILING ADDRESS
't 9 or � r(3 g y Zip Code
:Area Bode • Phone number 9
5. WELL DETAILS: a. TOTAL DEPTH: HV f /� /
b. DOES WELL REPLACE EXISTING WELL? VES D NOk
c. WATER LEVEL Below Top of Casing: 91 /1/(l FT.
(Use 'elf Above Top of Casing)
d. TOP OF CASING IS 2 FT. Above Land Surface'
'Top of casing terminated at/or below land swine may require
a variance In accordance with 15A NCAC 2C .0118.
e. YIELD (gpm): I5 . METHOD OF TEST Blow.
1. DISINFECTION: Type H T-B-- Amount 1602
g. WATER ZONES (depth):
From 374To 377 From To
From 64337 to 535r From To
From (p3('rTo 1i3g' From To
6. CASINO: Thickness/
/� Depth Diameter WOQ2pt ensii,
From (/ To iGJ Ft. /0�r /Xt (
From To Ft. _
From To Ft.
1. GROUT: Depth
Depth Material Method
From 0 To 85 Ft.
From To Ft.
From To Ft.
8. SCREEN: Depth Diameter Slot Size
From To Ft. In. _ In.
From To Ft. In, _ In.
FromTo Ft. In. _ In.
9. SAND/GRAVEL PACK:
Depth
From To Ft.
From To Ft,
From To Ft.
10.. DRILLING LOG
From
jairke
11. REMARKS:
Yell/1J .�
Size
Material
Material
Per nation escrIption
or
CO
ktheauad
i
100 HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH
ISA NCAC 2C, WELL CONSTRUCTION STANDARDS, AND THAT A COPY OP THIS .
REC HAS HEN IDES TO THE WE OWNER.
SIGNATURE OF CERTIFIED ELL CONTRACTOR
Russell S. Taylor
PRINTED NAME OF PERSON CONSTRUCTING THE WELL
Submit the original to the Division of Water Quality within 30 da
161 T Mall Service Center —Raleigh, NC 27699.1617 Phone No. (19) 733. 0 e S
�IVED
MAR 27 2006
Form GW-lb
Rev. 7)05
Asheville Regional Office
An, ['far Prntpr:tinn

12. CASING:
Depth A Diameter or Weight/Ft. Material numbers and common road names.
From "l'9- To 7� Ft.
From To Ft.
From To Ft.
13. GROUT: Dept Material �/ ,., Meth
From To Frct neeCt . nC4.
From
14, SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in.
From 'fo FL in. in.
15. SAND/GRAVEL PACK:
Depth
From To Ft.
From To Ft.
To Ft.
Size Material
TIN .96 U05
326780
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural(��Resourc s - Division of Water Quality - Groundwater Section
\YELL CONTRACTOR (INDIVIDUAL) NAME (print)' Vet(
/ CERTIFICATIONd �r�#p U�
WELL CONTRACTOR COMPANY NAME '��i (�I‘l.f c 1 j�N ��/ et( ix; t1 PHONE # (p/tq cog ,5-9 aapa,
Sl'A't'E WELL CONSTRUCTION PERMIT# T ASSOCIATED WQ PERMIT#
t ifa ilicable) - (if ap)licable)
WELL USE (Check Applicable Box): Residential U/ MunicipaliPublie 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery ❑ Heat Pump Water Injection 0 Other 0 if Other, List Use
WELL LOCAT`IO'N:
Nearest Town: Yg � yµ ' Rai County tr```
(Street Name, Numbers. Community, Subdivision, Lot No.. Zip Code)
3. OWNER:
Address 4
0
. 6c et or Route No.)
AgAw WV�� f( 3230$
City or Town Slate
Zip Code
Area code- Phone number
4. DATE DRILLED
5. TOTAL DEPTH: ' T
6. DOES WELL RE LAC EXISTING WELL? YES ❑CVO
7. STATIC WATER LEVEL Below Top of Casing: FT.
/ (Use "+" if Above Top of Casing)
S. TOP OF CASING IS / FT. Above Land Surface*
'Top of casing terminated at/or below land surface requires a
variance in accorda e h 15A NCAC 2C .0118. �7
9. YIELD (gpm): METH OF ES ii . _____ .i5
10. WATER ZONES (depth): I� (NCO
Topogra is/Land setting
DRidge lope ❑Valley DFlat
(check appropriate box)
Latitudi/lonoitudeofwglllocation •
1 35 02' G UK:0.231
(degrees/minutes/seconds (0 pc. boa.
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH
From To
DRILLING LOG
Formation Description
Q / LOCATION SKETCH
I I . DISINFECTION: Type L,61Q.'f- Amount A.. Show direction and distance in miles from at least
Wall Thickness two State Roads or County Roads. Include the road
N
0
0
v+
0
0
Ylw
Din
l
r-
16. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRJJCTION STANDA)DS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
3
SIGNATURE OF PERSON CONSTRUCTING THE WELL rATE
6 p
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

SLATE WELL CONSTRUCTION PERMIT#
(ifal. licable) (if applicable)
3264.9.6
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and )Natural) Resource�/$ - /Diivision of Water Quality - Groundwater Section/
WELL CONTRACTOR (INDIVIDUAL) NAM (print) /�,%'(K 1 di CERTIFICATION#/CW 63
WELL CONTRACTOR COMPANY N.AMEAA AgeN I U✓�%/ l)Pi Uiv,, PHONE # MILi-3'92a3
(666, ASSOCIATED WQ PERMIT#
1. WELL USE (Check Applicable Box): Residential leKunicipaliPtiblic ❑ Industrial ❑ Agricultural ❑
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use
2. WELL LOCAT N: Topograp eiLand setting
Nearest Town: Wq yga“51i6k CountvP /`i' ❑Ridge ope ❑Valley ❑Flat
(check appropriate box)
(Street Name, Numbers, Community, Subdivision,, /LootrN,o`.,ZZip Code) ).,p tttQn ,u ee o4Vell 1QCEttipp
3. OWNER: 4M n')fu. Ott. Oc fA"1 (degrrees/minutteess/•seeconds)) Y
Address t50A- ��� Latitude/longitude source:❑GPS❑Topographic map
(Street or Rout Mai (check box)
yneS 4iLc He, a `cv•cP DEPTH DRILLING LOG
City or Town State Zip Code From To Formation Description
)-
Area code- Phone number ;Chia
4. DATE DRILLED 2
5. TOTAL DEPTH.:..."O S/
6. DOES WELL REPLACE EXISTING WELL? YE; LI 0 CY
7. STATIC WATER LEVEL Below Top of Casing: Lis 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 accordalgs with 15A NCAC 2C.0118. //77�/ ��A� y ppp
9. YIELD (gpm): METH tOF TESTV77 W! n{QIl
10. WATER ZONES (depth): //
�_ QQ LOCATION SKETCH
11 DISINFECTION: Type &C31 Q-+ Amount �� Show direction and distance in miles from at least
12. CASING: Wall Thickness two State Roads or County Roads. Include the road
Depth 22% Diameter or Weight/Ft. Material numbers and common road names.
From To /Ute Ft.
From To Ft.
From To Ft.
13. GROUT: Dept MateSJrJ��1�/�, h cth
From C ToFt.CbL�tw 1 =
From Ta Ft. - _. , - -C
14. SCREEN: Depth Diameter Slot Size Material
J
From To Ft. in. in.
From '1-o Ft. in. in. Cr •
C71
15. SAND/GRAVEL PACK:
Depth Size Material
From To FI.
From To Ft.
JUN 0„ .,,.....
16. REMARKS:
1 DO HEREBY CERTIFY TH T THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONS VCTION STA; DAR S, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL 0 NER
SIGNATURE OF PERSON CONSTRUCTING THE WELL IRATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mali Service Center- Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-1 REV. 07/2001

326495
11. DISINFECTION: Type 346LC_
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and /Natturaral Resource
WELL CONTRACTOR (INDIVIDUAL) NAME (print) �/e��TF�.te(t//,n
WELL CONTRACTOR COMPANY NAME AppRlh Vhi
STATE WELL CONSTRUCTION PER!! IT#
(if applicable)
Division of Water Quality - Groundwater Section
s„J CERTIFIC�A�T%ION #A.
DP! tinjQ PHONE # QKO) 0;3 •
ASSOCIATED WQ PERMIT#
(if applimbic)
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
WELL LOitVMCV.//G
Nearest Towtwri JW l
Countrls�
(Street Name, Numbers, Community, Subdivision, Lot No.. Zip Code)
3. OWNER:
t� M�
Il 2!
Address
C60456 NI tre or Ril tte No) .2965 /
City or Town State Zip Code
( )-
Area code- Phone number
4. DATE DRILLED
5. TOTAL DEPTH:
6. DOES WELL REPLACE EXISTING WELL? YES JJ NO
7. STATIC WATER LEVEL Below Top of Casing: / FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS 7 FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accords e w•' SA NCAC 2C .0118. � �+�, efes,L�,
9. YIELD (gpm): _ MET TES
'It306�zt��K
10. WATER ZONES (depth): 3F D
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.
06
Lat
Topogra IciLand setting
❑Ridge lope ❑Valley ❑Flat
(check appropriate box)
Latitude/Ion tudr� o_f well location
r( j .W3 C.3113'Co•;2-f
(degrees/minutes/seconds) EIE V. 37(1(
ude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From To Formation Description
Amount
12. CASING: Wall Thickness
Depth ,c/ Diameter or Weight/Ft. Material
From To /00 Ft.
From To Ft.
From To Ft.
13. GROUT Depth T/ Materi Meth
From j To i,r Ft. t L7A
From To Ft.
14. SCREEN: Depth Diameter Slot Size Material
From To Ft. In. in.
Flom 'fo Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ftt! t• i r
From To Ft.
J
w
Ow
01•
16. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 1SA NCAC 2C, WELL
CONSSTJ2UCTION STAN fARDS, 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

326503
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
CERTIFICATION a
„z14&3-9M3
WELL CONTRACTOR (INDIVIDU.AL) NANyr- ((p�riint)),,—/
WELL CON'rit Acl'Olt COMPANY N'.AME//7xL('rj/R`�1�.tf l0
STATE WELL CONSTRUCTION PERMIT/A
(ifa 7Iicable)
/
PHONE
ASSOCIATED WO PERMITS
(if a. • I icable)
I. WELL USE (Check Applicable Box): Residential Municipal/Public 0 Industrial ❑ Agricultural ❑
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCAT
Nearest Town: DM County .j_MrLi
Sag E Ei(A • RP+
(Street Name. Numbers, Community, Subdivision, Lot No.. Zip Code)
3. OWNER:dfet'ce
'a(F
Address /SSA AIt(� y CE7}M DTI
eiXe
M fWCIMtreet ar ur �/) l C-
/TM1A �L7 ,T Zip Code
City or Town State
( )-
TopoQr is/Land setting
DRidge Slope 0Valley ❑Flat
(check appropriate hox)
Latitud'ee lon itu icrve IJ I atyyt2 f q� f
•(degrees/minutes/seco(ndss) &C e CF
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From To Formation Description
Area code- Phone numb \r7 aiIQ6(p
�
4. DATE DRILLED
5. TOTAL DEPTH:t2 /
6. DOES WELL REPLACE EXISTING WELL? YES❑ NO
7. STATIC WATER LEVEL Below Top of Casing: 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 accu d "th I -A NCAC 2C.0118.
9
r ag �rt o
10. WATER ZONES (depth):
II. DISINFECTION: Type
12. CASING:
YIELD (gpm): MAW. u-/I`+ tt r �Q'S
METHOD OF TES
/00, No 200
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common road names.
Dept
From To Ft.
From To Ft.
From To Ft.
13. GROUT: Depth /J� a er'cies. ut!d
From Tom" � F[.(
From To Ft.
14. SCREEN: Depth Diameter
From To H. in.
From 'lo Ft. in.
15. SAND/GRAVEL PACK:
Depth
From To Ft.
From To Ft.
Amount p"r�
Wall Thickness
Diameter or Weight/Ft. Material
Slot Size Material
in.
in.
Size Material
I!i"1 \/r r
ll
1
1
16. REMARKS:
1 DO HEREBY CERTIFY TH. T THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUfTION STANDARJ6S. AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWN
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

WELL CONSTRUCTION RECORD
n n
3
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) DaO b 5
P ELL CO]l RACroli CODu'ANY SAME Ri PARC.%iAA1
SLt'rE WELL CONSTRUCTION PERMIT)",ASSOCIATED WQ PERMITS'
(tt aopl;cable) (tfaophcable)
atfo tJ
CERTIFICATION #3stA i
1 Dill n PHONE x (ta8)1,231 3
i. WELL USE (Check Applicable Box): Residential d 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: BR t.Q:ch
�a c3Flaf "PEE —
County SdcASSt3 t
(Street Name. Numbers. Community. Subdivision. Lot No.. Zip Code)
3. OWNER: ej N.c Q 5j
Address 'P0 t'.)' 53 4-
6L/ 'Y fSueci or R�c No.)
(e7 N
Coy or Town Stale Zip Code
Topogr hie/Land setting
❑Ridge Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude o well location
N35-0/16:514 14 83'/5.33 S 4 p
(degreeslminutes)seconds) E IEY. VP ro
Latitude/toneitude source:❑GPSDToporaphic map
(check box)
DEPTH DRILLING LOG
From To Formation Description,
( )-
T
Area code- Phone number JJJ1
. DATE DRILLED Diap �O
TOTAL DEPTH: o7 Jam'
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO
7. STATIC WATER LEVEL Below Top of Casing: IOU FT.
(Use "." if Above Top of Casing)
8. TOP OF CASING IS / FT. Above Land Surface'
*Top of casing terminated actor below land surface requires a
variance in accordance with ISA NCAC 2C .0118.
9. YIELD (epm): 3D METHOD OF TESTC
10. WATER ZONES (depth): 0210
I L DISINFECTION: TvpeT3t3Q+ Amount a2
12. CASING: WalLThickness
Depth Diameter or WeiehliFt. Material
From". To Cog Ft.
From To Ft.
From To Ft.
13. GROUT: Depth r /,,Mate ' 1 /�� Method
Frorne To I FtCOrcCe L--L-I.;;;,-S
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
Front To Ft.
From 7o 1- t.
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Incltbde thEroad
numbers and common road names. e _ -
c�
I •
—
J
r-
C� r'—
m
16. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH ISA NCAC 2C. WELL
CONSTjt1,CTION STANDARDS. AND 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 Mail Service Center- Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-1 REV. 07/2001

WELL CONSTRUCTION RECORD
to r t)-.
001>c:
North Carolina - Depanment of Environment and Natural Resourcesout- Division of Water Quality - Groundwater Section
\VELL CONTRACTOR (INDIVIDUAL) NAME (print) tt�aviD..r Jr ��
43413A1r) We() SJ�i )\i.1�
WELL CONTRACTOR COMPANY NAME
CERTIFICATION #39 I
PHONE # a pig)(083" 9aa
STA 1'E WELL CONSTRUCTION PERMIT# ASSOCIATED VQ PERMIT#
(if applicable) (if applicable)
I. \VELL USE (Check Applicable Box): Residential 6d" Municipal/Public ❑ Industrial ❑ Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. \VELL LOCATIO Topogr a/Land Setting
c�iN ❑Ridge it Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
N35' a3•oIa yfp8-- .*.. 3-%
Nearest Town: 'yne.`uViIlC County0-
1 - (js415... e( cank, Cot it tcc
(Street Name. Numbers. Community, Subdivision, Lot No.. Zip Code)
C3. OWNER:CA C% i4' CCESPO 1 .VUD ThN' (degrees/minutes/seconds)EIEY. 3 %3
Address PO 130\L 9 3 if Latitude lonL_itude source:LJGPSLJTopographic map
(5trse or oule No.) k 449 (check box)
,�..r IjG u� U DEPTH DRILLING LOG
1iryorTown Slate Zip Code From To Formation Description
)-
.Area code- Phone number
4. DATE DRILLEDS/R4c,
5. TOTAL DEPTH: r
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO Q---
7. STATIC WATER LEVEL Below Top of Casing: !S0 FT. •
(Use "r' if Above Top of Casing)
8. TOP OF CASING IS � FT. Above Land Surface*
*Top of easing terminated atior below land surface requires a
variance in accordant 'ith 15A NCAC 2C .0118.
9. YIELD(gpm): METHOD OFTEST @1at.contf)cl
10. WATER ZONES (depth): .9.egO
11. DISINFECTION: Type 1361Ce
12. CASING:
Amount ,.
Wall Thickness
Depth Diameter or Weight/Ft. Material
prom I-o LPri Ft.
13. Wn' Material Method
Ft. p ,I 1
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.
From -I o Ft.
From To Ft.
GROUT: Depth
From _:r To 20
LOCATION SKETCH
Show direction and distance in miles from at leastt1
two State Roads or County Roads. Include the road;
numbers and common road names. r-:-
c7
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
coo,_ 6 O cp
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE'
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center- Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-I REV. 07/2001

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resourcesso�tt�� -/ Division,�of Water Quality - Groundwater Sectionor
w ELL CON"' R,ACI OR (INDIVIDUAL) NAME (print) Duo; D IJC MC.i�1, CERTIFICATION ,t3) 21
PHONE ; (83VA3.5a193
w Et.L CONI RACrOR COMPANY NAME /4r fHMAckhi N.—WC I l;Ng
Sl ATE WELL CONSTRUCTION PERNIET0 ASSOCIATED WQ PERMIT#
lit anphcable) > (itapiiicable)
" 1 n -
ci 0 15 et d-
. \\'ELL [SE (Check .Applicable Box): Residential Municipal/Public 0 Industrial ❑ .Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List lisc
2. WELL LOCKET pN�:
}'earest Town: ' lug
(bF (lam 7.3L47vv\
CountyZ 1 6b—
(Street Name_ Numbers. Community. Subdivision, Lot No.. Zip Code)
3. OWNER: Feb Address W JC zI3(.0 X
(Street or Route 315Ca r
City or Town Stare Zip Code
)-
Area code- Phone nombea-
4. DATE DRILLED 0�tJ-'�OgP
Topogra Ieland setting
❑Ridge lope ❑Valley ❑Flat
(check appropriate box)
Latit"dry. la of
K35 U
(degrees/minutes/seconds)
Latitude longitude source:❑GPS❑Topographic map
I cneck box)
DEPTH DRILLING LOG
From To Formation Description
FT
6. DOES
5. TOTAL DEPTH:
7.
WELL REPLACE EXISTING WELL? YE 0 NO iX
STATIC WATER of �ZiIJ
S C Casing:s •
(Use "+" if Above Top of Casing)
S. TOP OF CASING 1S 1 FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordan vith ISA NCAC 2C .0I18.
9. YIELD (gpm): n METHOD OF TESIG7R( QQMU1E6(-ALQJ)
10. WATER ZONES (depth): s eft
11. DISINFECTION: Tvpe JRISiCt Amount 02
12. CASING: WaliThickncss
Depth., `� Diameter or Wei_htiFt Material
From fl To iD D Ft.
From To Ft.
From To Fr
13. GROUT: Depth/ Material r _ ?G t d
From— To 7 Ft.�iLic-
From To FL
14. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in.
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
LOCATION SKETCH
Show direction and distance in miles from at feast
two State goads .ar.Caun4S ads. Include thezoad
numbers and common road names.
c
c).
t
1
O f
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. GVv'-1 REV. 07/2001

*2
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources Division1_of Water Quality - Groundwater Section
r1
WELL CONTRACTOR (INDIVIDUAL) NAME (print) tD5Ul 1::)54t b *614 CERTIFICATION'&OTd 1
\\'ELL CON"f R.\CTOR COMPANY NAME R(�f�P1ActltRt•1 yV Q,�I -�1\�\�� PHONE # ($2S)&23.7na
SLATE \\'ELL CONSTRUCTION PERMIT# 1 ASSOCIATED WQ PERMIT#
(if applicable) (ifapplicable)
33t.,35?
1. WELL USE (Check Applicable Box): Residential hd' Municipal'Public 0 Industrial ❑ Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection ❑ Other 0 If Other, List Use
2.
WELL LOCATION:
Nearest Town:`e/eh na.ST.% I IAA
County.CJdt SON
(Street Name. Numbers. Community. Subdivision, Lot No.. Zip Code)
3. OWNER: tlr-n Lt 33't
Address 16,340 U.a.rViAU dLC Kd
(Street or Route No.)
R I- ,a�, GI/t . 3o 9-O
rtr or Town State Zip Code
Topogic/Land setting
DRidge 2Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
N35%0'o5 Wg3I
(degrees/minutes/seconds)C Iev 31 n)
Latitude/longitude source: LJG PSLITopographic map
(check box)
DEPTH DRILLING LOG
From To Formation Description
( )-
Area code- Phone number r
4. DATE DRILLED 31 �t-O
5. TOTAL DEPTH:t��jjj LPL I
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO F3'
7. STATIC WATER LEVEL Below Top ofCasing:If) ( FT. '
(Use "T' if Above Top of Casing)
8. TOP OF CASING IS i FT. Above Land Surface*
`Top of casing terminated at/or below land surface requires a
variance in accordance with 15A NCAC 2C .0118.
9. YIELD (gpm): rat. " METHOD OF TESIGA ( CA/Tid fna 5
10. WATER ZONES (depth): goo'
11. DISINFECTION: Type I V f3(d*5
12. CASING:
Depth d Diameter
From —6-- Lo 9 O Ft.
From 1 o Ft.
From 10 Ft.
13. GROUT: Depth Material Method''
From Too7D FtO-OnegeiCi C.t^�L
From To Ft.
14. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in.
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Stze Material
Amount -2
Wall Thickness
or WeighUFt. Material
From To Ft.
From To Ft.
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common road names.
)
N
C�
16. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH ISA NCAC 2C, WELL
COi9SIRUCTION STANDARDS. AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
69
SIGNATURE OF PERSON CONSTRUCTING THE WELL DA E'
—i
Submit the origin -al to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center- Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-1 REV. 07/2001

SKATE WELL CONSTRUCTION PERAIITF
i t applicable)
n. )
L t%1 fi 40
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural ResourcesRs- Division of Water Quality - Groundwater Section�yq
lt' ELL CO:NT RAC Olt (INDIVIDUAL) NAME (print) LA?Ky ti/eafi' /\' CERTIFICATION =/}f 03
It EI.L ToN'FRACFOR COMPANY N AME flPPRw�I„�A, (�{/Qf/ LKl in PHONE k (rpa868.s- 223
ASSOCIATED QPER\1ITi
ptapjlicable) ..
I. WELL USE (Check Applicable Box): Residential [.'l Municipal/Public 0 Industrial ❑ .Agricultural ❑
Monitorine 0 Recovery 0 Heat Pump Water Injection 0 Other ❑ if Other, List Use
2. WELL LOCATION: ^�
Nearest Town. Q Countyy "`i' ti
(Sirs ci Norm.. Numbers Community. Subdivision, Lot No.. Zip Code)
0WNERWArlba1t* G/Mw 'r 241(
Address t54-1\An,, &SF
(Street or kouteC No.)
L�l.t.�.&bal ag?a �.
Cily or Town State Zip Code
Area rude- Phone number 11
4. DATE DRILLED W ! S/OG
5. TOTAL DEPTH: 51
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO ly
7. STATIC WATER LEVEL Below Top of Casing: IOC FT.
(Use"+' if Above Top of Casing)
S. TOP OF CASING IS % FT. Above Land Surface"
Topog lc/Land setting
❑Ridge Slope :Walley DFlat
(check appropriate box)
Latibudee//lon itude of well location
R,3n 4I CP 6J683' ra . t3!'
(degrees(minutesiseconds)
EIcv: 32 35 r
Latitude/longitude source:❑GPS❑Topographic map
(Cheek box)
DEPTH DRILLING LOG
From To Formation Description
*Top of casing terminated at/or below land surface requires a
variance in accordan a with I5A NC.AC 2C .0118.
F. YIELD(gpm): y5 METHOD OF TESTca(.that3AV-fey
10. WATER ZONES (depth): /20 r3( S
r
11. DISINFECTION: Type la (SW- Amount o2
12_. CASING: Wall Thickness
Depty... Diameter or Weight/FL Material
From To / T FL
From To Ft.
From To Ft.
13. GROUT: Dept _) /' MaterialriMe rid
From To oCi / Ft. i,ec 3tc
From To FL
14. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in.
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Size Material
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.
C1)
rrt
,
CIl
0
Crt
16. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C WELL
CONSTRUCTION ST NDA 3S. AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO TH WEL OWNER
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

North Carolina Department of Environment and Natu
WELL CONTRACTOR (LYDIVIDUAL) NAME (print)
WELL CO:\TR�CfOR COMPANY NAME AAA GREEWE BROS. WELL DRLG.OF SYLVIC. PHONE # f828)$8-5550
STATE WELL CONSTRUCTION PER IT# ASSOCIATED WQ PERyfITN
(if applicable)
(if applicable)
1. WELL USE (Check Applicable Box): Residential MunicipaVPublic 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Ocher 0 If Other, List Use I C 4 9 8 3
2. WFI r LOCATION-
•
Near-, ost'n: L7� CountY dgeTopographic/LandPSloe°Va slettine
'v/1{ ❑_Ridgelope ❑Valley Flat
J r'�• COI - 'E L_ _ (check appropriate box)
(Sett[ Name. Numbersunity, Subdivision, Lot No.. Zip Cote) Latitudell d f II I
3. O56'NER:k �. ra-O—YN 5J Y'-z-
Address :QC (,' ) - -/ J`�D �ct�tit7i=
i (Scree or Route No.)
/ d'7 y
.6, y
Cir+ or Town State ( ) Zip Code /
(828 )- ;23 0 50 C-
4. DATE DRILLED •
y 1 %C2C 'CJa( /
5. TOTAL DEPTH: rQd>iJ
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO XI
7. STATIC WATER LEVEL Below Top of Casing: • I CD FT.
Area code- Phone number
From O 6' `J3
From To
From To
13. GROUT: Depth
From jj To ',
From .3 To 7 c'
14. SCREEN: Depth
From To Ft.
From To Ft.
15. SAND/GRAVEL PACK:
Depth
From To Ft.
From To Ft.
16. REMARKS:
Ft.
Fr.
Ft.
WELL CONSTRUCTION CORD `` '> S 73 /S q.)
7 3 /
ral Resources -Division of Water Quality t ;. 2‘./7
—�Q 40 t vi C C-Gc7 CERTIFICATION. 2 / 3
(Use: "-r" if Above Top of Casing)
8. TOP OF CASING IS FT. Above Land Surface*
'Top creasing terminated ae'or below land surface requires a
variance in accordance pith ISA NCAC 2C .011S.
9. YIELD (Rpm): rI METHOD OF TEST A / r--
I0. v ATLF ZONES (dcp;lh): (.,CJ C' ,
I I. DISINFECTION: Type �+ J Amount
12. CASING: t Wall Thickness
Depth Diameter or Weighat. at� numbers and common road names.
• /t 4 S P Q L 01) c—
ongttu eo welocation
(degrecs/minures/scconds)
Latitude/loneitude source:❑GPS❑Topographic map
(check box) .
DEPTH DRILLING LOG
From ' To Formation Description
A
!) --- 5 L) "o
) G' r '''I-; -- T�
T,Bv ';G'i C'F xUi
(,-, C 3 - 7CJ
LOCATION SKETCH
Show direction and distance in miles from at (east
two State Roads or County Roads. Include the road
Material Method
Ft. C.P-1-a,--e-, C—l'--
FL t-v
Diameter Slot Size I - Material 1-
in. in.
in. in.
Size Material
-� C.1
�� 1
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 1SA NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
.9 - YTj j Cyr 3- J 4 o
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
Submit the original to the Division of Water Quality, Attn: Information Management, 1617 Mail Senice Center.
Raleigh, NC 27699-1617, Phone No. [phone], within 30 days.
RECEIVED
Gw-I REV.o9rz0o;
Asheville Regional Office
Aq!lifer Protection

1
rra-
LeCONSTRUCTION
CORD':
13. GROUT:
From -0
From 3
14. -SCREEN:
Noah Carolina Department of Envuo ent and Na ral Resources Division of Water Qualifty J tS 7
a:WELL CONTRACrOR(LYDIVIDUAL)N.131E (print) -" t ( _ CERTIFICATION.. f
4'WELL COCSTItACiOR CON1PA.\Y NAISIE— GR�ENE BROS "WELLDRLG OF SYLVA, INC PHOtYENf8Z8)59tr5a50r
-. STATE WELL'CONSTRUCTIONPER�[ITX t" ASSOCIATEDWQ eiR.�IITN
-:: zn X�+*- i-,'(ifapplieable)t5t1 . -‘,, - - t (if applicable)'i . ,.
I.�WELL USE (Check Applicable Boz) Resident al MunicipaVPublic 0 Industrial 0 Agricultural 0
Monuorin`j 0 $Recovery 0 Heat Pump Water Injection 0 -??.:Other 0 ,If Other, List Use
2. WELL LOCATI
Tearesf T•an•
uhty
Street Name Nuinbers'Conununity:S
. OWNE
( ea or Route o)`t:
ion, Lot No=Zrp ode);
1"ff 4
o .,f I
City or Town -Sere Zip Cade
8(�- - 32. q :tog
Area code- Phone number ,,
4. DATE DRILLED 02 D6' 97-
5. TOTAL DEPTH: sc._ ,39 fJ '3 Z
6. DOES WELL REPLACE EXISTING WELL? YES D NO q9
-ta L FfJ V
7. STATIC WATER LEVEL Below Top of Casing: ( (5 FT.
(Usa ifAbove-Top or ruing)
8. TOP OF CAS ENG iS 1 FT. Above Land Surface'
•Top of casing, terminated at/or below land surface requires a
variance in accordance with 15.4 NCAC 2C .0118.
9. YIELD (¢pm): METHOD OF TEST fT I /'-f
10. WATER ZONES (depth): 3q 0
LOCATION SKETCH
1 I. DISINFECTION: Type _/-J (i Amount 33 7 Show direction and distance in miles from at least
12. CASING: - Wall Th .kness '`�o State Roads or County Roads Include the road
Depth Diameettter or Weight/ht. b tep3numbers anti common ro names. �n
p To f�r� FLU'-L'F iSO�Z( (/" V �R.—dX-!/�.
To'o phic/Land setting
tdge. lope_,,OValley OFlat
.check appropriate box) c.-.
ahtGd o,[tu'� ofjellIdeatiori
23
>: . degreesfrtuaut_eii/seeonds) '
atitud i1nrib nide sours:OGPSOTopoo aphicmap
���DRILLPIG LOG
Formation Descnptton
k _ '0 k-b ) t.,�
DEPTH
rom . ..
.1:11rt
From
From To Ft. From To Ft.
Depth :-Material tethod
To 3 Ft.Df"1'_Q �'
To W Ft. ��jyy ^ �' ° W
Depth - Diameter Slot Size Material t-04 Xy.,-
From To - Ft. in.:
15. SAND/GRAVEL PACK:
Depth " Size
From To
From To -: 'Ft
16. REMARKS:
1 DO HEREBY CERTIFY THAT Tilt
CONSTRUCTION STANI5
r�
tn.
btaterial
4
U
LL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL "
AT A CittI1Sr:R.ECOrynit 13EENPROVIDEDTOTHE7LLOWNE177
R}Y '-•r9
A-ft!. C 'f.i:0 iG'-S Lfi.
Submit the original to the Division of Water Quality,'Attn:
Raleigh, NC 27699-1617, Phone NO. [phone], »ithtn 30 d
n ormahon Ianaaemepf, 17 Mail Se nice Center +'
Ys. RECEI `c -
CP' 1 REY n7 °00!.
Asheville cti)fai Office
Aquifer tarolcet Ort

WELL CONSTRUCTION'RECORD IT 3 j Y. fit%
er _5" /6 - fig/
North Carolina Department of Environment and NaturalResources -Division of Water QualityY
WELL CONTRACTOR (CIDIVW UAL) NAME (print) ((C77 /t Al. C (-.(.(�(,�r , CERTIFICATION # 2/ 3 4„,.
WELL CONTRACTOR COMPANY NAME AAA GREEWE BROS. WELL DRLG.OF SYLVA INC. PHONE # [phone]
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable)
(if applicable)
1. WELL USE (Check Applicable Box): Residential MunicipaVPublic 0 Industrial 0 Agriculrural 0
Monitoring 0 Recovery 0 Heat Pump Water njection 0 Other 0 If Other, List Use
2. WELL LOCATIO�N,{./'
Nearesiso«n. ,2 L '-e'�ru- 14 County
(Sncet Name. Numbers. CoiCouunity, Subdivision. Lot No., Zip Code)
3. OWNER:frb c
(Street or Route No.)
<iQ .1(; )1 C. .26' // 'f
City or Town 1vSmte Zip Cade
(828 )- 3 J — :2)50 C- .
Area code- Phone number
4. DATE DRILLED y / CI Jet - a.'- 2--
5. TOTAL DEPTH: St' C
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO Xi
7. STATIC WATER LEVEL Below Top of Casing.: ./ 07.) FT.
(Use "+" if Above Top o f Casing)
8. TOP OF CASING IS 1 FT. Above Land Surface'
'Top of easing terminated a'or below land surface requires 3
variance in accordant ith ISA NCAC 2C.0118.'
9. YIELD (epm): 'METHOD OF TEST A i
l0. 1VATER ZONES (depth): /
r
Fr. 't 5P£QL 1)-I.�C
From To Ft.
From _ .To Ft
13. GROUT:
From (}
From ,
14. SCREEN:
From To Ft. in.
From To Ft. in.
324282
Topographic/Land setting '
❑Ridge ❑Slope ❑Valley ,Flat
,` _ (check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitudeflongirude source:❑GPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From To Formation Description
51 fUt
( dL c
to 5 - ,S
!) — 5—/'
,e
Cary <<--J'L.i
.4.2r
LOCATION SKETCH
11. DISINFECTION: Type i-l- 774-- Amount ;� 76Show direction and distance in miles from at least
12. CASING: Wall Thickness 4 tw'o State Roads or County Roads. Include the road
Depth _ iam�ter or WdR. 'eigh.Materii numbers and common road names.
From () To' 5 (- )
15. SAND/GRAVEL PACK:
Depth
From To
From To
16. REMARKS:
Ft.
Ft.
Depth Marerial
To 3 Ft. CV-��..<n
To 7 c- Fr L1z,\ ft;-1,; '
Depth Diameter Slot Size
in.
in.
Method
C—, Z- .
k. .2Lr7i- 7 FCC
"Material
Size Material
I D0 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
J9 f;Cwr 3-iD- o&
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
Submit the original to the Division of Water Quali , n: n ormaati 'klppaSeptent, 161
Raleigh, NC 27699-1617, Phone No. [phone], with n 30 d ors✓ V C LJ
Asheville Regional Office
Aquifer Protection
Mail Service Center -
GW-I REV. 09/2004

`i ELL CONSTRUCTION RECORD
North Carolina Department ofEnviro Ent and Na ralResources - Division ofWater Quaairy Y% •
, CERTIFICATION (P� t)
STATE WELL COYSTRL'CTION PERMIT% - 1 (if a-licable) ' "
. WELL USE (Check Applicable Box) Residential &, MunicipaVPublic 0 - Industrial 0 Agricultural 0
Injection 0 Other 0 If Other List Use
WELL CONTRACTOR (LYDryIDLAL) NA -MI " . - .. 828 586-5550 �-
WELLCONTRACCORCOMPA-rY NAME GREENE EROS WELL ORLG.OF SYLVA. INC 'PHUYE M f )
ASSOCIATED WO PERMITS
,(Streethali Numbers Cottunumry Subd,
3. OWNER.:.
ss
-,( etc or Route o.)
CiTown Sate Zip Code
.828)-a)
Area code- Phone cumber
4. DATE DRILLED o2 rf
5. TOTAL DEPTH:
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO FS
7. STATIC W'ATERLEVEL Below T.
(Top offCAboeTopof acing)
8. TOP OF CASING IS 1 FT. Above Land Surface`
*Top or easing terminated actor below land surface requires a
variance in accordance with 15A NCAC 2C .0118. 9. YIELD (gpm): _2 METHOD OF TEST 1
10. WATER ZONES (depth):
11. DISINFECTION: Type
-12. ': ^.SING:.
Depth Dia
From, /2_To_ibiL' Ft.4
From To Ft'_
From To Pt
13. GROUT:
Material tethod
FromQTo 3- Ft
_To ITO `f—[-'y�
From_ Te�_ Ft.
14. SCREEN: Depth Diameter Slot Size
in Material--f��9'
From - To Ft. in. From
To Ft. in, in.
15. SAND/GRAVEL PACK:
MonitoringO'Recovery 0 Heat WaterPump3
- r - Topog aphic/Land setting
/ /� ❑Rid elope OValley ❑Flat
NzarestT un. %�tatat unty �1 _.. -� ' (check appropriate box)
atitudelong rude of well location --,!
(degrees/minuresheeonds) hie ma
Latitude/longitude source:OGPSOTopograp, p
>. (•heck box) ,
DEPTH .
From ', 'To Formation Descrip roa`
f2n
LOCATION N SKETCH
Show direction and distance in miles from at least
Wail Th;ckness Amount 14„o State Roads or County Roads. Include the road
e'er: o�r^weight/Ft., "joc, n3„txu and i.ornmon roIfraL.. :o.•
From
From To 'FL
16. REMARKS:
I DO HEREBY CERTIFY THAT THI
CONSTRUCTION STAND:
YELL WAS CONSTRUCTED IY ACCORDANCE WITH 1SA NCAC 2C, WELL
T AT A C y HI5 RECORL iAS BEEN PROVIDED TO THE WELL OWN
Submit the original to the Division of Wrier Quality, Attn: Information Management, 1617 Mail Senice Center -
Raleigh, NC 27699-1617, Phone No; [phone], within 30 days. t GW-1 REV. 09.'2004

WELL^CONSTRUCTION RECORD , ,
North Carolina Department of Envuo eat and Natural Res ces of Water Quality
�"�V ` 111 /1 CERTIFICATION N C
WELL ID
CONTRACTOR (LVDIVUAL)NAStE (print) r 828 58fi-5550
CONTRAC OR COat?.LNY tiASME AAA GREENE BROS. WELL DRLGOF SYWA. INC PHONE
""'� yO C// - ASSOCIATED WQ PER-�OTN :' _ J r:
STATE WELL CONSERUCTIOY PERSIITN ` (if applicable) - ' -'
�s��`"'�tfapphcable) - --- '' .... .. . �"
3
WELL USE (Check Applicable Box) Residential Municipal/Public 0 Industrial 0 Agricultural 0 3 ?a C t
- Monitoring ❑,'Recovery ❑ Heat Pump Water Tnjection ❑ '. Other ❑ If Other, List Use
2 WELL LOCAT
Meares Town: Topographic/Land setting
ia��
Coun f �� ❑Rdgepe ❑Valley . ❑Flat
Iiasrtarf/ • check approprute box)
atttude/160ttude of well location
(5. thame NumbersComm
r. n A
3 OWNER-
Address'
erect or Route
Lot No., Zip
53 Vc
Area code- Phone number - G
4. DATE DRILLED ''I &7 — 0
5. TOTAL DEPTH: ICE
6. DOES WELL REPLACE EXISTING WELL? . YES 1-Q-TI 2,�'+0
7. STATIC WATER LEVEL Below Top of Casing: ! a1 FT.
-.. ruse "t if Above Top of a mg)
8. TOP OF CASING IS / FT. Above Land Surface'
'Tap of casing terminated at/or below land surface requires a
vaeianee In accordance with ISA NCAC 2C .0118.
9. YIELD (¢pm): METHOD OF TEST I {J
10. WATER ZONES (depth): 1 3 r7
DISINFECTION: Type ! j j-f Amount - ,. 7 �.}s Show direction and distancemiles from at least
rAcING:•el Th;ckness - ,t--hut State Roads or County Roads. Include the road
(Ditam ter .: orb Vei at. numbers ac u cunvnton road na::us.
From O'
From
From
GROUT:
From
From S
14. SCREEN:
Matedfethod
n�•
Depth Diameter Slot - Slot Size _ Material �:l t9-
From . _. To Ft. in.
From To Ftin. in.
O. SAND/GRAVEL PACK:
Depth Size Material 0...
-From To • Ft. - Cr
From To Ft.
(degred/mtnureshcconds) "� '"_
Latttude/[ongintde source❑GPSOTopographic mad
DEPTH DRILLING LOG
From To Formation Descnptton
LOCATION SKETCH
16. REMARKS: tt _.
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH I5A NCAC 2C, WELL
CONSTRUCTIOS�'ANDARDS, AN A COPY OF THIS RECORD HAS BEEN PROVIDED TO THEL
�
OrJ'cr'SUr; CONS R liCt INC THE WELL
LAlL
'Submit the original to the Division of Witter Quality, Attu: Information Management, 1617 Mail Senice Center -
Raleigh, NC 27699-1617, Phone No. [phone], within 30 days. t GR'-I REV. 09/2004

wrth Carolina Department of Envuo cnt and Natt ourc Division of Water Quality ,
.R WELL C0.`(7RACf0R a(LNDIVIDCAL)(YANff (pant)- a.ewaae aa.n aau�v ss a
-:z, �kYLLC0 qrp. CTORte0IPA.\YhA.HE AS GREENE BROS. % LDRLG.OF SYLVA, MC : PHOttf J828) 586-5ac0`
STATE WELL CO\STRUCfIO.N PERMIT-
•.-✓r 5`(ifapplicable) =- -
>:--
•
t WELL USE (Check Applicable Box) Residential J- Municipal/Public 0 Industnal 0 Agnculcuial 0 •
hfomtoring 0 Recovery ❑, Heat Ptimp Waterinje'ction 0 `.Other 0 If Other, List List
•
2.:WELL LOCATE
Nearest Town:
City or Town` - State .2ip Code
(828)-' a.l V -.-
Area code- Pboec number
4. DATE DRILLED � g --Q
5. TOTAL DEPTH: )
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO 1
7. STATIC WATER LEVEL Below Top of Casing: FT.
(Use`* itAbove Top o Casing)
8. TOP OF CASING IS / • FT. Above Land Surface
ASSOCIATEDWQ PERS•OTr - •—_ _ . _..
OFaptilieable) .- .. _
*Top eosin terminated a Nor blow land surface requires a
variance in accordant wij� ISA NCAC 2C .01 IS.
9. YIELD (gpm): 5CJv METHOD�QF TEST
10. WATER ZONES (depth): /9 )
cJ
Topographic/Land senrne
❑Ridge $lope _❑Valley ❑Flat
(check apptopnatc box)
location
16211("F s/nunutdscconds) -•
Latitude/longtmde source:OGPS❑Topographic ma
;(chrk box);.,:
DEPTH DRILLING LOG
From To Formation Descnphon
33 2411
11 DISINFECTION: Type 774 Amount Show direction and distance in miles from at least
I'_ Ct SfNG: - v"-1.1 -chick .en - 4 o State Roads or County Roadsinclude the road Diameter -
and iom,—,io:� toad names.
LOCATION SKETCH
.Y.•� tl
waa . o1 Weight/Ft. nt - a Wnr
a
From 0 To S0 Ft. (o� 512tu -PVc_
From To FL From To Ft. .
13. GROUT: Depth - —Material Iethod -
From"(, To 3 Ft. ( �
From To W Ft. L' pv�, K C te...n - ,) W 7'L�I .,.
14.-SCREEN: Depth -Diameter --Slot Size Material .._a a ft_
From To Ft.. - in. in.
From To Ft. in. in.. 15. SAND/GRAVEL PACK:
Depth
From - To • . -Ft:
From - To - 'Ft.
16. REMARKS:
1 DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH ISA NCAC 2C WELL L'.
CONSTRUCTION STANDARDS, AND THAT COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
V to G ui /
Sto.c: it.;; V. 1 _.. r1 L .\S I r: U 1\Ci 1 L
Submit the original to the Division of Water Quality, Attn: Information Management, 1617 Mail Senice Center - �>'
Raleigh, NC 27699-1617, -Phone No: [phone], within 30 days.
GW-1 REV.09/20004

WELL -CONSTRUCTION RECORD
North Carolina Depart—ient of Envuonrnent and Natural Res es -Division of Water Quality
WELLcoNti3 tC10R(LYDIVIDL'Al.)NA:SE(pita ` CERTIfICATIOK
-'ELL CONTRACTOR COMPANY NAME MA GREE BROS. WELL DRLG.OF SYLVA, I C. PHONE [phone]'
Wt -
STATE WELL CONSTRUCTION PEZ}IITa - `ASSOCIATED WQ PERtil1T%
:' (if aooticablc) _ - - . _ (if applicable)
( WELL USE (Check Applicable Box) Residential Z MunicipaVPubltc ❑ Industrial 0 -Agricultural O 3 32.1
Monitoring 0 -Recovery ❑ Heat Pump Water Injection 0 Other O If Ocher, List Use
2 WELL LOCATIO ! : _ TopographidLand setting
Near: Toun��4y,4 ounty f �i ❑Ridge °Dglopz". ❑Valley . DFIat
(cEeck appropnatebox)
(S-cet 'ire Nunbcn;_Cammuni - ubdt i 1 —:o C c) 't Latitirdellongitude of Well location
3. OWNER:
Addre
:(Scoot or Rou
iv or 1.wn Stott
/ I �
( 528 )- -
A:to codc. PSorc number L.,
4. DATE DRILLED / to
5. TOTAL DEPTH: 2, to C
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO _ .3i/ c7
7. STATIC WATER LEVEL Below Top of Casing: FT. RHO _ 3 f
(Us<`*""ifAbovcTopo Casmg) _
8. TOP OF CASING IS I ., FT. Above Land Surface* r;443 :3{- )
•Top or essine term1n2ted at'or below land surtoce requires a
variance in accorda�nc,Se with 15A NCAC 2C .0118.
9. YIELD (epm): '7`6 METHOD OF TEST it 1 r'
to. WATER ZONES (depth):. o?oZ.G l • 3 iC
/ LOCATION SKETCH
F ( ti !
11. DISINTECTION: Type ' Amount to Show direction and distance in miles from at least
- l 2 r'gcr��. W-!! Th.icke ;s �2,)-6 o State Roads or County Roads. include the road
Depth , Diameter Of Weight/FL Materiag:' ilt:mbers attci r.:_otarnort road names. . .
From Q To 6O7 Ft. (c t/y,. e6P2 Zi - -42V r
Zip C e
g71
From To Ft.
From To Ft.
':(degreeshttiautcs/seeonds)
Latitude/longitide source;OGPSOTopographic;ma
:(check box)
DEPTH DRILLING LOG
From --:To -. Formation Description•
13. GROUT: Depth - - .-Manorial - Iethod - ..
From 0 To 3 Ft.
From p1 ,tTo W Ft. tc. ja.tr r,r- G /.v 7"1!1-';—'
14 SCREEN: Depth -Diameter - Slot Size _Material - :.
From • To Ft. in. in.
From To Ft. in. in.
15. SAND/GR.AVEL PACK:
Depth Size
.From ;: To Ft.
From To "Ft.
16. REMARKS
1 DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
- I"'1 U q" a 5 o t`
Submit the original to the Division of Witter Quality, Attn: Information Management, 1617 Mail Senice Center -
P.aleigh, NC 27699-16I7,-Phone No: [phone], within 30 days.
GW-1 REV.09.'2004

3 rCi,' Or Town Lute Zip Code From -To F anation Descri nor.
4 DATE DRILLED - 0 — 0 Co
5. TOTAL DEPTH- ,,e5-7) . -
6 DOES WELL REPLACE EXISTING WELL9 YES 0 NO WV
7 STATIC WATER LEVEL Below Top of Casing.: cZO FT
, Ws< "4-- if Above -Top o Casing)
8 TOP OF CAS NG IS / FT. Above Land Surface*
•Top or clam: terminated atIor below land 'tither requires 3
9. YIELD (gpm): MET OD QIEST A
0 WATER ZONES (depth):
•
I I. DISINFECTION: Type
12 T ASNC.
Depth
From 0 To 7
From To
From To
. • .:-
{...,11",ssf-ELL-CONSTRUCTION RECORD
.., North CarolinaDepaltm tent of Enirir rtinerit and Natural Resourccs -Divisit:i of Water Quality
7.-ffi..-_,:-.45_1-z..,,, 7.?.r.wit..L cOrTtACTOR (DMIYMOAL) NANCE (print) .- -": . :•-• - - --telVit r. ...- 7 --.:.-y.-.zoCERTIFICATION I
- ..,-.,,,,,i- a- ce..t...,- rr..1,-"-• .-... - -... - . . , . . tp.):‘,..E.K4-5/E AAA GREE BROS. SNELL GRLG.OF A. INC.r...=.1,410Ni15828)5!6:5.55.°......
.
z-117.,--1,-Y-tirsr-4,-•'%.-..-.------ -,....,....- _. . ._ -... - .. - . t... .. ;
•
...-----s•---'-±cte'r- - - — oNsTiucrios piR3m-4 -- - . - • - - - - - ,.. . . , : ...; , ..e„.!, -. -,t':,-'-...._ : ,--_--; .:; ----V4-4:1.3.7:1.774 (if ippliCible) ••*"'"-C”,-;441'-1,--7. - • ' - ' . , .....
: I- (if iihilicable) -Y '.,...-r-- :. . - • . : - .--. • _
A
• - -. - '••; f-' ' ''' 1.':WELL USE (Check Applicable Box): Residential , MunicipaVPublic 0 .. Industrial p :- Agnc.11Furt o i 2 g .
. .
,--PuitiP:Water Injection 0 . Other 0 If Other, List Use . - ' • .
. ".- ' .. :-: . - • . t. _•":,: ..c.:-;:-_,-:..1.;..„-irli';;;-:r-,j,,;,,,,:,lf,;,;.:.,:.:::;,,:-.7.:,..!:;...!‘..,..•4;t:.:T,.}2.- :;..,..i.,...,-..„:„ .-.-. lc.: :: ._---, ,,-'...:...,:-. 7. -: :' j,-,- f:...1.; . '.. _,
2. --WELL LOcA_IIS.. : . ...,,.....:,,_‘[.....,,.-,c).. ..., :..- ., 2: ..-: - .?..y. ,.-..- .i0p0araphiciLand settmg • . t , -.• . -„ : . _ -
---- °Ridge I cpelilope lOyalley .7.-„OFIat , : : . • -
1..• Ln a .4 .f. I 1
thia.-e Numbers Comniunity,Subdion, Lot No., ZipC24o)',..],: % -....:;.-7:f9:;-,..-j:yri_aqtyow ionsituotpir1 .ocp.tiont7
, . _.. .. . .. n.: . . .. . . .. . _
Address 13 "7, rEV42)(14' ...et"( --6 --)...---<:... -‘: : - --. -:?,-Latitddeflongitiide source:ocpspx500pliAF59
nrv.k i
.3. OWNER:-.-:6112-:::' -• &la :'''tth',4:1-iit'-t- -7 :-. • .s..:. ':: :-- ' :::-•.: .:.(ClereeilirliDUCCSISCC°n6),
. „
0 LOG
variance in accordance with 15A NCAC 2C .0118.
LOCATION SKETCH
•
14 774 Amount c:::, 7 , Show direction and distance in miles from at least
v5,1 -i-hk.kr„, 3,),-Kvo State Roads or County Roads. Include the road : -
Napa; tor or Woight(lt. l',,laicria?:, I. ualb.213 anti C.21/inien I Ur::: ;tames
Ft. bzfr3Z , / ecitraiderri . -
Ft
Ft
13. GROUT: Depth
From 0 To 3
Froma_ To ZD
14. SCREEN: Depth
- Material lethod
. _
Fr. 143
Diameter Slot Size Material 03..—ef...9-J
.
,...12.7--r1/4_ex1/4..
From To Ft. in. .
15. SAND/GRAVEL PACK:
To Ft.
. - . •
I DO HEREBY CERTIFYTHAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH I5A NCAC 2C, WELL
CONSTRUCTION STANECARDS, AND THAT A COPY OF THIS RECOROBAS BEEN PROVIDED TO THE WELL . .. •. . ,
•
. 0 .
01\ t_ ,t I r
m e_.
Submit the original to the Division of Wititer Quality, Attn: Information Management, 1617 Mail Service Center -
Raleigh, CIC 276991617, Phone No. [phone], Iiithin 30 days.
; GW- I REV 09'2004

WELL CONSTRUCTION RECORD 75 n
5ZS' asp
isorth Caroima - Department of Environment and 1eural Resourcesf ti/'i� ion of Water Quali - Ground are; Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print)
WELL CONTRACTOR?I CO PANV NA?IE_'A
STATE WELL CONSTRUCTION PERMIT: ASSOCIATED \VQ PER3IIT#
(if aoolicable)
CERTIFICATION ncQrjenci
PHONE # (Wlc e b— `' 5O
(if aaplicable)
I. WELL USE (Check Applicable Box): Residential MunicipaPPublic ❑ Industrial 0 Agricultural ❑
Monitoring 0 Recovery ❑ Heat Pump Prater Injection 0 Other 0 If Other, List Use
WELL LOCATION
OlCadKea:ast T n: Coto
(Scree: Sa:::e Numbv.s. Ceeununin. Su0.!icii:ot:. Lot No.. Zip Cod
3. OWNER:
Addr;sss(� /f n ' r-�
.111.QfZ�, ..�C-CoGF'jv-c\alb 2-1 iO 1.J
(1°i ' e'°-0(v5_--a41� co._
de. Pcu:r.-_:i::r .
4. DATE DRILLED J�JI2-..O m"
5. TOTAL DEPTH: i C&•
6. DOES \':ELL REPLACE EXISTING WELL? YES ❑ NO:4;17
7. STATIC WATER LEVEL Below Top ofCasinc: r0 FT.
(Lit` " i:"Al..evc Top or Casi:.p
8. TO? OF CAS!NG 1S I( FT. Above Land Surface-
-T.y u:
sr..ana:.G Y_'ur beta, land s_::a:t r:gcires a
saran::: in nrcordun a ssi:h 15:\ NCAC 2C .01 IS.
9. YIELD (pr..): ' r METHOD OF EST
10. WATER ZONES (d:pth).
3
IL- - DiS:NF ECTION: Tv['e FT TH
12. CASING:
From 0
Econ.. 1/45
I 3. GP.CYS:
From 0
14. SCREEN:
Tc 4 1 Ft. (/J .71,
To Fr.
Tc Ft
To a Ft k1�Lrr
To Ft
Dc_k Dita:c: S:o: Sizc
Topoara hic/Land setting
❑Ridge ope ❑Valley ❑Flat
rr� appropriate box)
atitude:lot(gitud: of well location
(deaeeitinus'se_ordi) t
La;itud:'lon_situde sour:e:DGPS❑TSpo_raphic map
(chck butt.
DRILLING LOG
Formation Description
DEPTH
From To
LOCATION SKETCH
Amount . 3 7y6> S:ho.v direction anz'dis:an:e i:: mixes from a: leas:
For.. To Ft. in.
From To FI.
15. SAND -GRAVEL PACK:
Depth Size Niz:e ,-.
Te Ft.
To Ft.
P: a5 Tif.ckr.ess
two S,:.e Roads or Cot::v Roads. Include the road
o; v: e - �' r.: -.--rs adr:: co -.or. road ra-.es.
L'u'Ft. . n
ont
. •Froi
n0
FJ
N j
rn
A.
16. RE\!:\RKS:
I DO HEKESI CERTIFY THAT THIS WELL WAS CONSTRUCTED INACCOaDANCEWITH I5ANC.C2C.RT_LL
CONST!CXTION ST.ANDARDS. AND THAT A COPY 0?' THSRECORD HAS BEEN PROVIDED TOTHE WELL OWNER
S:GNA.TLRRE QF rsSDC CD.NSTRLCTING THE WELL DATE
Submit the original to the Division of Water Quality. Gr undorater Section. 1536?lailSanice Center - Ro!eigh, NC
27699-1636 Phone No. (919) 733-32221. ❑ithin 30 da\s. GW-I REV. 07.2001
3

WELL CONSTRUCTION RECORD • 'T Skfl7z4J
IO. \..\TER ZONES (d:p.n).
55 D
II.-DiSINFECTION:Tv�e H- TH Amount 3 6�
12. CASING: \': ThicknessDep
Tc_ a o: \t: a/ ����,
Fro::. T% T:� Ft SDI.-�2J-'Y�-'L"
North Caroima - Department of Environment ands'
WELL CONTRACTOR (INDIVIDUAL) NAME (print)
\ELL CONTRACTOR Co?I PANT" NAME _
STATE WELL CONSTRUCTION PERM ITS (% :
(if applicable)
of Water Qualm' Grou:towa:er Section -%
CERTIFICATION .�f�yI grJYjC
PHONE % (Z .� o dam. v95C
ASSOCIATED %VQ PERMIT"
(iraoolicable)
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 I FOther, List Use
?: WELL LOCATION:
Nearest Town:
IS:re N nn5;rs. Cr"
3. Olt: NPR:
Acdr:ss
i
( er P ut: No.) .a b l�
(Y; - 5r) - tfD—zco._
Topographic: Land setting
DRidge Jra8!ope ❑Valley ❑Fla' '
y T ( &XZZ' (check opprapri_t: box)
Latitud 'lon_gitud_ofwelllocation
apt, (d:are.>r..iausiecors)(
Lamy longitude source:❑GPS❑Topographic map
(.!: box)
DEPTH - DRILLING LOG
A-- - e. Pions e_aie,,//
4. DATE DRILLED Y'— &u 't)
kt
5. TOTAL DEPTH: �L
6. DOES \\'ELL REPLACE EXISTING WELL? YES ❑ N
7. STATIC WATER LEVEL Below Top ofCasiau: 1L� FT.
• (US: if Above Top of Casing•;
S. TO? OF CASING IS / FT. Above Land Surface'
-Tnt u.r caiin� cr nitta:cd vtbr b,ju„ Ij::d sertaa• reycirei
wrian.c in accord -in i:h I5A N.C-IC aC .011S.
9. YIELD (•apm):' '7` ?.!`.ETHO OFSEST !/v
r c CJ
LOCATION SKETCH
Show direction and'dis:an:e in miles from a: leas:
two S:::e Roads or Cou n:v Read_. Include the road
numbers and cur.;^on road names.
ri
From To • Formation Description
14.
From. To Ft. in.
From. To Ft.
15. SAND GRAVEL PACK:
DepthSze
Fran. To Ft.
. -From. To F.
From: To Ft.
To Ft.
GR ' T: Depth - ?Lxr:a:
From 0 To e , a Ft. _=4f-1
('ran: 3 To �c7 Ft.k ,CJL
SCREEN: Dec:` Dian:e:er So: Size A!'fari_:
in.
16. REMARKS:
in.
I DO HE"r.E.El CERTIFY THAT THIS WELL WAS CONSTRUCTED IN A=CORDANCE WITH 15A NCA C 2C, WELL
CONSTI CTION STANDARDS. AND THAT A COPY OF THG RECORD HAS BEEN PROVIDED TO THE WELL OWNER
S!GNA T I RE OF PERSO. CONSTRUCTING THE WELL DATE
• v frt ekNrc
Submit the original to the Division of Water Qu:Sli;;trounds%ater Section. 1636 31ai1 S:n1:e Center - Raleigh, NC
27699-1636 non: No. [phone], within 30 du? s. G\t: -1 REV. 07:2001
.'. `l

ELLCONSTRUCTION RECORD
a v
North Carolina Department of Environment and Natural Res urces ,Division of Wat t Quality
YTRACTOR (LYDIYIDVAL)IYA.\ff (pttat) �.-'' ��� � ���(�f//� CERTIFICATIOY Y__Eu- �.
{
;,'+WELL Cq _ _
'aw a----. COCTfRAC - COJIPA.\Y hA}tE AAA 'GHEE BROS. VlELL DRLG OF SriVA. IN - PHOhE N {828) 586-Sa50 ':`
.STATE WELL CONSTRUCTION PER\IIT9r. '- -' ASSOCIATED WQ PEA\WFS
;....:6 - :> ifi olicable) - c.:..: 1 (tfa olicable)
t WELL USE (Check ApplicableBox) Residenna ., Municipal/Public 0 - Industrial 0 .1 Agricultural 0
: Monitoring ❑ Recovery ❑,HeatPumpWaterInjection❑ S.Other 0 If Other, List Use
2 WFIL-LOCATIO
Nears, Tot
(Soto Name Numbers •Communtry. Subdivision, Lotho Ztp Code
3. OWNER
Address "/
(Sete
tQ 114
City or Town Scare
( 828 )- 5-0 —
A: ea code- Phone aumbcry
4. - DATE DRILLED_ ' ao
5. TOTAL DEPTH: _
6. DOES WELL RE CE EXISTINTG WELL? YES 0 NO s
7. STATIC WATER LEVEL Below Top of Casing: FT.
(Use -r if Mon Top creasing)
8. TOP OF CASING 15 / AbFT. Above Land Surface'
'Top of casing terminated odor below land surface requires a
variance in accordance sr' 15A NCAC2C.0118.
9. YIELD (epm): /5 METHOD OF TEST I r'
10. WATER BONES (depth):
a5(, J )
LOCATION SKETCH
I I. DISINFECTION: Type {{- j H Amount , 5 e-,7' Show direction and distance in miles from at least
12 C &S?NG: - u'?!: Th ckn's )--6.vo State Roads or County Roads. Include the road
Depth - Diameter or Weight/Ft.. Matcriaf - i.._mbcr and con�n:o:: road catacs. .
2J4LD7
• Topooraphic/Land setting
Ridge : lope" ❑Valley': 0F1at
check appiopnate box)
arimde/long rude of well location_
"(degrees/minutes/seconds) '
Latitude/longirude source:OGPS❑TpPooraphlcma
DRILLf G LOG
Formation Description
From To r Ft.
From To Ft.
From
13. GRO
From
From 3 T F
14. SCREEN:
From
From
15. SAND/GRAVEL PACK:
To Ft.
From
:16. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED EN ACCORDANCE WITH I5A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDEDTO THE WELL OW —NEB. =._
C G\Ali (•. Fc: CELL
Depth _ blit-rial tethod
To 3 Ft.
o t. 0W7
-Depth - Diameter Slot Size . Material
To Ft. in. - in.
Material ='
Submit the original to the Division of Witter Quality, Attu: Information Management, 1611 Mail Senice Center -
Raleigh, NC 27699-1617,- Phone No. [phone], within 3D days.
GW-I REV.0912004

1''.-11:4:LtL:T7a61;eCi-
•KopIica.lal,Resi:natt:r&ni MunicipaVP11 blin 0 - Induinial 0 -1Agrkulturn a to) 1 8 6
-..mohitorini 0 ,:-Recovery 0-Heat yr e'ction 0 . Other 0 If Other, List Use • IA
2. :-NWeELLar tLTOaCvrilsilif , r: -•,- ,..; .-_,„:?-:i:::eft ,dolunrtyl.: • . : :.-.- - - .• k.,;,.:0'...n.dT01.0.
OgraSIPolPiecaYtand Valley -,,lait
- 4:7 7cr "
(scrod Nann ti . ornmunity.updivisioi, Lei ti.,.., c ipc ) ::. :, • -,,-,)c--y.- itau-Tell ngityde of_v/e111ocalion -.1L-;,:...:
. ji
. ,
alfrt‘S" • . (dernsiminutesIscoonds)
•
3. OWNER: •
• '-'
Addr fdij • source;OGPSOToPOg,raphin Map TOp„;---,47::...
, •
•
City or Town Sur A.Zip Cot
( 828 )- -29 3 97
0 -/
Ana code- Phone number
4. DATE DRILLED to. —04
5. TOTAL DEPTH:
6. DOES WELL REPLACE EXISTING WELL? YES 1:1 NO 5K
7. STATIC Ve ATER LEVEL Below Top of Casing: FT.
, Meat -if AboveTop ofcasing)
8. TOP OF CASING IS / FT. Above Land Surface*
*Top eosin: terminated actor below land surface require a
variance in accordance with.15A NCAC 2C .0118.
10. WATER ZONES (depth): /
LOCATION SKETCH •
in
from at least
DEPTH --)-1,-.--DRILLING LOG
rom To - Formation Descmption
•
• 2-o
9. YIELD (epm): p METHOI/CIE-TEST I rl
miles
Amount / (
. .
I 1. DISINFECTION: Type. ' j-1- i 1-1 - Show direction and distance m es
. .
12. CASING: . 1.1:a1! Tliick .css MA State Roads or County Roads. include the road
- Depth Diameter . or Weigh . t/Ft. Mate afY numbers and common road nan1na-
. From 0 To .03,2—Et. ..52,azi .. C
From To Ft. .
--L. -
II- 17S-
177 a50
• From To Ft.
13. GROUT: Depth Ntaterial tethod
4-1 rom From :.S To W FL ___OsstiO 1.4-1
14. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in.
From -To Ft in in.
15. SAND/GRAVEL PACK:
Material -
From To -Ft.
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
.. CONSTRUCTION STANT/ARDS, AND THAT A COPY OF THIS RECORDHAS BEEN PROVIDED TO THE WELL OWN a. r,
. , .
. . _ .
S IGNA1 LIKEOF FP1O: COS! PG-1.1N3 ti 7 V !
I ,
Submit the original to the Division of Wpier Quality, Attu: Information Management, 1617 Mail Service Center -
Raleigh, NC 27699-1617, Phone No.[phone], within 30 days.
GW-1 REV 09'2002

--ALL-CONSTRUCTION RECORD
North Carolina De artment of Envtr eat and Natural Resour es Division of Water Quality .
LL COYfRACTOR(LYDIVIDLAL)NA>O (print) 3 '� .f LiVri �t --.:-;.CERTIFICATION
\V-ELL CO:(rRACTOR CONPeCNYN.(3IE AAA GREEMIE BROS. WELL ORLG.OF SYLVA. INC. o # s828i 586.5550
STATE WELL COYSTRIICTIOY PERVtITz � --' - " - ASSOCIATED WQ PERMITS - 7-
apolicable) ..>.: _ ..7•,,:.. -. r. :: '.c 1(if eoplieabk)
1 WELL USE (Check Applicable Box) Residential e Munletpal/R:blic 0 Industna1 ❑ 'Agricultural 0 1 .j y
Monitoring ❑'Recovery0 Heat Pump Water Injection 0 .Other 0 If Other, List bse •7 J I f�
2 WELL LOCATI
N-ar est Tow
unity„Suhe i
3. OWNER
Address a� o pc+P�7".:1
(Sete. orrRoututetp�No.)
City egTown Sste r / Zip Code
- (628 )- .003j O,— 3i O C,n
A:ea code -Phone number, /� _ fj.-.'12,
4. DATE DRILLED �(/ �/� y j 55, 47 - 5 2v .
5. TOTAL DEPTH: / D 2 p 19 3
6. DOES WELL REPLACE EXISTING WELL?YE ❑ NO
7. STATIC WATER LEVEL Below Top of Casing: On FT- d3—
(Use`* if AboveTopofCasing)
8. TOP OF CASING IS / ' FT. Above Land Surface'
•Top of casin: terminated at'or below lend surface requires a
variance in accordance with ISA NCAC 2C .0118. n
9. YIELD (cm). / METHOD OF TEST /T 1 1- •
10. WATER ZONES (d• th): t L 7 -O'
i LOCATION SKETCH
1 I. DISINFECTION: Type H. — 1 Amount ,y/� Show direction and distance in miles from at least
12 C!.S1G: v•-i; Th:ckr-: ' .-6vo State Roads or County Roads. include the road
Depth Diameter or weight/FL MateriaVV- Lumuers and _ow;J�;o: to :: metes.
From To�-?j,_Ft. tC V SPQ- Z/ fig C
From To Ft. From To Ft.
13. GROUT: Depth Mit.rial tt2
hod
From To .3 Ft. -g rn�p�a- I
From 70 20 Ft. hDA W ,.
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.
ToddSraphic/Land setting
dge .Olope (tValley i:;. ❑Flat
'(cbeckippiapriate box) _.
de/longitude of well location
(degre&at nuteslseeonds) -.
gitude source: 0GPS❑Topographtc Ina,
(.hrk
DRILLING LOG
FM—Mailon Description
16. REWLARKS:
n
c1 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
Sa s4114. CC - —
Submit the original to the Division of Witter Quality, Attn: Information Management, 1617 Mail Service Center -
Raleigh, NC 27699-) 617, Phone No. [phone], within 30 days.
GR'-I REV. 0912004

zi.:WE.1.4.1.501TRA-C:DE/R (LND BX.I;) Nei_Mi (print)
rgee „et. (if applicable)
*Th.eit-riffr .1-Zik.STATEI8p-1-C2`, "
WELL C6NSTRUCtION RECORD
7 N-cat cfEncffi t and Natural 0i-th Carolina Departm IN
GAL N=anda.NithILL 0/2LG.O'FSy±V, INC
'zCSFStt
3. OWNER:'
. . (der:es/m.1-u
Address .,';'‘LitinfddlonaitUde sOurce:DGPS0ToPographtc
(Set- 1RoFte
;:rt:DRILLING LO.G.
Cie/ or yen State ' Tt :To z Fonpanort Descnpttonr,.
Ana code- PS= Ca.liter
tO
4. DATE DRILLED
• 5. TOTAL DEPTH: 0
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO t5k „17
7. STATIC WATER LEVEL Below Top of Casine: 7 0 FT. S-7) --
(use"?' Abov: Top o Casing)
8. TOP OF CASING IS / FT. Above Land Surface' ‘9-9-3 — 5.0
fl
OR COtPtes'Ysi,clq. d.v.1/4A„
By!
1.:-.WELL US. (Chee.15 Appiteable Box). Rest enna i‘ffuntcapa bite 0 -7. Indust-tal Agnculcur
..:32'18 7 2:
Monitothii El ',ReeoVery.; Heat Pumpyriter InjeCtion Other 0 If Other, List Us: •
2 -WELL LOCATIGE, ;),..ezecs.„_..,Topoc. p _ .
Nearest TCPATI: '"g CCounty Ridge :.05160e °Valley Flat
t box
" d location
o I —
•Top °rosin termins red atior below land surface requires a
variance in atcordalie with ISA. NCAC 2C .0118.
9. YIELD (gpm): .....) 0 METHOD OF TEST P
10. WATER ZONES (depth): 02_ 01,-
LOCATION SKETCH
11. DISINFECTION: Type ' 47-ti Amount 43. S _ Show direction and distance in miles from at least
:12 rASTNCt: ‘,....„11 Thickn:„ f1A-Kvo State Roads or County Roads. Include the road
Diameter or weight/a Moto jaw% III.1.21013 and C.9:11.110:t 1021 naines
Depth •
From a To a 5—Ft. c '4 5D 2_2( if C- - . • .. '-- :
•
•
From Ft.
From To Ft.
13 GROUT: Depth Ma:trial fethod
To 3 Ft
From .:g To i Ft ,
14. SCREEN: Depth Diameter Slot Size Material
From
From To Ft. m. in. ' • '
•
From To 'Ft.
16. REMARKS : '
C1T .t11
.
• •••:.-T. I DO HEREBY CERTLFYTF1AT THIS WELL WAS CONSTRUCTED IN ACCORPANCEWITH 15A t-ICAC 2C WELL ..
CONSTRUCTION STAND.ARDS, AND THAT A COPYOFTHIS RecpiRRHAEEEEN.Pitoy/DEDTO THE: WELL OWNER
3b it\ _
_
ELL
Submit the original to the Dilision of Wner Quality,Attot Informatioo Management, 1617
Rakich, NC 276991/617, Phone No. [phone], within 30 days.
G REV. 09.'2002
MaitSenice Center -

WELL CONSTRUCTION RECORD t.
Korth Carolina Department ofEnvirorune andNaturrjallReso ces Division of Water Quality
�J
.>WELit .PDPIT ACTOR mirgYIDUAL)tA}� (Pdat) 1"� C- -. _.CATI?erlf -.
y��iLL CdYiEtACiOR COtNPA.IYhA-s[E AAA GR— NE BROS WEfibRLG.OF SYLVA INC pgOt�Es1 '(828) 586-SoSp
TATE WELL CQNSTRUCTION PER%tIT9 : ASSOCIATED WQ PER�UTY
.,.kr.-.r(ifapplicable)'+ ,. -'-(if applicable)'"
1. L WELUSE (Check Applicable Box) Residents . . MuntcipabPublic 0 Industnal ❑ Agricultural 0 `- .
Monitoriris 0 Recovery ❑ ?Heat Punp Water Injection ❑ Other 0 If Other, List Use •
2 WELL. LOCATI To Vern hie/Land setts o
~ � " 3 " � " 1R dg z ❑S ope'_❑Va1Iey Flai
'(<hcek appropriat box)
Lat'tilde/longitude of well location
ti
:(S¢cetN
Community Subdimion, Lotti.o.; Ztp Cgie)
3 OWNER: O � (- - - (degr s/runuteslseconds)
Address - Latitudellonottude source ❑GPS❑Topographic ma
(S¢ctt or Routc ha.)= , (hcck box)
G ' 7� EPTH OG DRILLING L
City or Town . -+ Smte Zip Code =From -To Formation Des option
Area code- Phone number
4. DATE DRILLED e— -'�
5. TOTAL DEPTH: ( S
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO S
7. STATIC WATER LEVEL Below Top of Casing: e�i� FT.
(Use `P if AboveTop of Casing)
8. TOP OF CASING IS / FT. Above Land Surface'
'Top eosin: terminated atfor below land surface requires a
variance in accord rice with 1SA NCAC 2C .0118.
9. YIELD (epm): METHOD TEST I I--,
10. RATER BONES ( -pth): LOCATION SKETCH
11. DISINFECTION: Type : 1 Yf Amount 07 Show direction and distance in miles from at lea
- 12 SiN we!:v: T kr _,s al�/,�vo State Roads or County Roads. include the r
49,
Depth J /(/ Diane}er or Weight Ft. Ma nal iumbcrs ane yoi toad r.a .c .
From 0 To Ito Ft. �O %t% sp 2 Z1 02 V 6 tT1 d
—0 p
tl. p.
From To Ft.
From To Ft.
13. GROUT: Depth —Material tethod
From .d To 3 Ft. W _ / O�
From Q De Ft.— meter Y t�� C.
14. SCREEN: Depth Diameter Slot Size Material .O1-C. `
From - To - Ft. - in. in. - -
From To Ft. in. - in.
15. SAND/GRAVEL PACK:
Material
'. From - To - Ft:
From - To - 'Ft.
:16. REMARKS:
--1 DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH ISA NCAC 2C WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
r`1 its�^1 d! 01,P
Submit the original to the Division of W ter Quality, Attu: Information Management, 1617 Mail Service Center -
Raleigh, NC 27699-1617,-Phone No: [phone], within 30 days.
GW-1 REV. 0912004

r
r lit psi 4 :7 I }. -eYY
WELL CO\STRUcz-Iot` RECORD
Korth Carolina Dcpartmttalt
cat of Et vro lntne diva r-Division l Reso ' nsion of Water-
: \ £LL :atiiiALTOR(LYDlYIDUAL)N.l\� (print .CEAT[FICATIO\NCy( r'y
t 1\'ELLCONTRACTOR Cq%fPA,\Y NA.�[E GRC lE BROS. WELL CPLG.OF SYLVA INC. : _ FRON-g'p'"(828 j 53
.' STATE WECL cO`STRL'CTIONPER.MiTtl ASSOCIATED WQ PER1QT2
451=tifapplicable)
1 WELL USE (Chet k Applicable Box) Residentialr MuntcipaVPublte ❑ Industrial ❑ Asncultural 0 ;
hfonttoring ❑ Recovery ❑ Heat Pump Water Injection 0 aLpillet ❑ If Other, Ltst List
2.=WELL LOCATh-,'
Nea st Touir
0
City or wn Sate
Area code- ?bone number -
4.-DATE DRILLED % 3 —©'tio
5. TOTAL DEPTH: 7 C/
6. DOES WELL REPLACE EXISTING WELL? YES ❑ 0
7. STATIC WATER LEVEL Below Top of Casing: FT.
- (Use "+" if Above Top creasing)
8. TOP OF CASING IS / FT. Above Land Surface*
'Top of easio; terminated a t'or below land surface requires a
I ariance in accordanis wjlls 15.4 NCAC 2C.0I l8.
9. YIELD (rpm): ' S METHO QE EST A I r✓ •
10. WATER ZONES (depth): _3_5Th
LOCATION SKETCH
I I. DISINFECTION: Type kJ- l Yf Amount I„,. r Show direction and distance in miles from at least
12. CA;_kr.
SING: 11c s r9)--Kvo State Roads or County: Roads. include the road
Depth ' D`ammetcr . 0 14"ef right/FI. Al criaY' :eaio::r and .on;rio:1 roar; rar,:cS.
From 0 To 9:2) Ft. (0From To Ft. From To Ft.
13. GROUT:
To Depth3 Ft. tvbrrial
From ' Method
atitiiddiongitiidr�F well l ocaiion
(degre s/minuus/scconds)
tlt Laude/Ion;iiudesource:DGPS❑Topographic ma
box) -
DEPTH - _ DRILLING LOG
From .: -To Fortion Des ripiion
From Q To W Ft. pr 7 t.J
14. SCREEN: Depth Diameter Slot Size Material rt¢
From To Ft.. in. in. _1
15. SAND/GRAVEL PACK:
From To - Ft: From To -Ft. •
16. REMARKS:
in in.
. Material
s
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC2C WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEENPROVIDED TO THE WELL OWNER
ssl I' 1\o Et L
Submit the original to the Division of Water Quality, Attn: Information Management, 1617 Mail Senice Center -
Raleigh, NC 27699-1617, Phone No. [phone], within 30 days.
GR`-1 REV.09:2004

77 WELL CONSTRUCTION RECORD
North Carolina Department of Envir000Dxnent andf�(latural Res(/ourc -D vision of Water Quality S
a WELLCONTR\CCORm%DIvmuALNAME (prior)�I `�d�:yt(ay+� J*r cc - CERTIFICATION_ '3k_,
c - _. rE11 .::
WELL cc rRAaoR CObIPA.\Y N•AME GREENS BROS. WELL RLG.OF SYLVA, INC PHONE l f 828) 586-Sa50
STATE W_ ELL CO\STRUCT OY PER\RTX ASSOCIATED WQ PER�IIT$
-.;;_=(if applicable) ;,.. - %"(if applicable) . ..,
1 WELL USE (Check Applicable Box) Residential bfunicipaVPublic 0 dndustnal 0 Agricultural
. Monitoring 0 ;Recovery 0 Heat;Pump Water njection 0 Ocher D If Other, List Use
2. WELL LOCAT ]:'
Nearest To-ri��' ounty
(Secet Name Numbers, Community. Subdivr)on Lot NoYtpCode)
3. OWNER:
Address
r(Sccet or Rout No.)
323;
wv rr�— /
City or Town Sete 1 Zip Code
(828}•
A: ca code- Phone number/
4. DATE DRILLED (),--/3 d _ Q r
5. TOTAL DEPTH: c
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO
7. STATIC WATER LEVEL Below Top of Casing: 7pO
(Use "*"ifAboveTopo acing)
8. TOP OF CASING IS / FT. Above Land Surface'
'Top or c,sin; terminated at'o r below land surface requires a
variance in accordance with ISA NCAC 2C .0118.
9. YIELD (epm): (51 METHOD OF TEST 11J
10. WATER ZONES (depth): a 0 5
FT.
Topographic/Land setting
°Ridge Slope- °Valley :: DFlat
(check appropriate box)
Latitude/longitude of well location :
'(degecs/minur Ilse-Fads),';--
>Lantudeflongitudecource;OGPSDTopocrraphic ma,
(cheek box) =
DEPTH ` DRILLING LOG''.:
From To• Formation Description•
LOCATION SKETCH
11. DISINFECTION: Type /'f 'Fri Amount /, pl } Show direction and distance in miles from at 1
- 12 yam,.,,.: . t,.,!! Th;rkr- s CIAwvo State Roads or County Roads. Tncic the %d
TYI
Depth Diameter - or Weig)iUFL b iaN' Lumbers and ViroliOn road itatiled. -y To a7 Ft. 40 i// 5.9_,,e,Z1 -elk
To Ft. -
To Ft.
Depth - Material lethod
To 3 Ft. Orr.2..L-
To Z� .0 Ft. v n'L8-v.rA L-A �{]��_,,,�,�,D W4,
Depth Diameter - Slot Size Material t Gl 01-,
From 0
From
From
13. GROUT:
From .d
From
14. SCREEN:
From To -Ft. in. in.
From To Ft. in. - in.
15. SAND/GRAVEL PACK:
Depth - Size
From To FL - -
From To "Ft.
Material
,
16. REMLARI:S: 0
iI
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH ISA NCAC 2C, WELL
CONSTRUCTIORDS, DJHAT A COPY OF HIS RECORD HAS BEEN PROVIDED TO THE WELL OW NER
Submit the original to the Division of Wpter Quality, Attn: Information Management, 1617 Mali Service Center - ter"
Raleigh, NC 27699-1617, Phone No. [phone], within 30 days. GW-1 REV.09;2004

.. 3;.Yr.#o (ifapplicable) *:
WELL USE (Check Applicable Box) Residential
Monitotirig ❑ Recovery ❑ Heit Pump War
2. VE11,10CA.TeON:
Ne rrFit To vtt
(street Name, Numbm Community Subdivision, Lotho 2
3. OWNER Address
cy vac
(Sceetor Route h'o
City Town Sate bp Code
sze)-a O 1 3 p
Area code- Phone rumberC..
4. - DATE DRILLED J
5. TOTAL DEPTH:
6. DOES WELL REP ACE EXISTING WELL? YES ❑ NO ISK
7. STATIC WATER LEVEL Below Top of Casing: FT.
-.(Use`s 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
I ariance in accordance with I5A NCAC 2C.0118.
9. YIELD (gpm): MET OD OF TEST 1 s�
10. WATER ZONES (depth): - 1 .9
5t LOCATION SKETCH
11. DISINFECTION: Type 141 Amount Show direction and distance in miles from at (east,
2 ,.F SNG: t„,,: Th ckr _ss �r '1)4 vo State Roads or County Roadsinclude the roz
Depth, - - ,D,a peter o�\Veight/R b er)aF� numbers znd rtilC, on rvap-rmn7tes
_ - From t7 To74
From To
=`YELL CONSTRUCTION RECORD t
North Carolina Detparniient of Envirotunent d Natural Resour -Division of Water Qualityco
WELLCO hitkeTOR TiDIVmOAL)NAStE (print) ' CERTIFICA•
TIOYM
LDRLGOSYLVA PHOh_E i826)5865050
yaLCORiR\CTOR CO�PAM -
TTATE WELL CONSCRUciIiNPERNiR#"- ASSOCIATED WQ PERKED/ -
...-.:'"(if applicable) :' - -- .
MunicipaVPublid 0 Industrial 0 Agricultural 0
Injection 0 Other 0 If Other, List Use
TopograpludLand setting
❑Ridge;Wive -_(]Valley ❑Flat
(ebeck appropriate box)
f{L#hnide/longitude of well location
, nunutes/seconds) -
atitude/longttude source.❑GPS❑Topographic ma
I:DEPTH DRILLING LOci:
rom ::-To - Format on Description
Q:-
•
Ft
From To Ft.
13. GROUT: Depth . Material (ethod
From "0 To 3 Ft. JI - l
From To FL W r "� '
14. -SCREEN: Depth - Diameter Slot Size .Material:
From To Ft in. in.
From To Ft. in. . in.
15. SAND/GRAVEL PACK:
- Depth '. :- SizeMaterial
From To `Ft.
rn
14- sec
:16. REMARKS:
p
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED Iv ACCORDANCE _wan I5A NCAC 2C WELL
CONSTRUCTIONj-CAtIT)ARDS, AND FT ACOP THIS RECORD HAS BEEN PROVIDED TO THE WELL'O WNE
SGa,tU�tEjP "...,;ii<L it ls, 1,cLC
Submit the original to thbDl -ision of Water Quality, Attu: Information Management, 1617 Mail Service Center -
Raleigh, NC 27699-1617, Phone No: [phone], within 30-days. - -
GW-1 REV.09.'2004

WELL -CONSTRUCTION RECORD a 76J E.
North Carolina Department of Eavirocinent anndd N
atural eseurces Division of Water Quality ''
(41
WELL CONIRACTORR'WIVTDLAL) NAMIE (print) g201 1. - -t:ms CERTIFICATION$
WELLCONTRACTOR COMPANYNA.CIE AAA GHEE BROS. WELL DRLG.OF SYLV4J4C 'PHONE / (828 ) 586-5550
STATE WELL CONSTRUCT_ ION PER1IIT7 i ` ' ✓ ASSOCIATED WQ PERMIT$
'`>(ifzpplicable)" - - - - - (if applicable) r ..._. .
I WELL USE (Check Applicable Box): Residential 0 Municipal/Public 0 Industrial 0 Ag
. Monitoring 0 Recovery 0 Heat Pump Water Injection 0 _Other If Other, List Use
2. WE,LL LOCATIO
Nearest✓TDown: J/y
(Sacet Name, Numbers.
3. OWNER:
Address
Cir. or
(82Q )-
A:aeode- Phone minter !, / /
4.-DATE DRILLED �4/O -L
5. TOTAL DEPTH: 3
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO IX
7. STATIC WATER LEVEL Below Top of Casing: FT.
(Use "+' if Above Top of Casing)
8. TOP OF CASING IS / FT. Above Land Surface'
- County
ommuniry. Subd vision, Lot No., Zip Code
wn Sere Zip Code
'Top of casing terminated at/or below land surface require a
v
aria nce in accordance with 15A NCAC 22C .0118.
9. YIELD (gpm): METH
O2TEST 1 {�
10. WATER ZONES (depth): LH
11. DISINFECTION: Type
Depth
From To c5 Z Ft.
From To Ft.
To Ft.
From
iN Amount % i 7 2cl
l\•," Th.:kn ss
la ter or WeightFE. Materi
lnL kill
13. GROUT: Depth - . Material - Icthod
From- "D To 3 Ft.
� From To VP Ft. .t-Q� L'> . -
14. SCREEN: Depth Diameter Slot Size Material �..—(.�9—a
From To Ft. in. in.
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Size .- Material -
From - To -Ft.'
From To -Ft.
ultural 0
Topographic/Land settine
DRidge ❑Slope -:`OValley'FIatEE
(check ppri proate box) ff — t-
LaiitudeAongaitude of well location
--` (degreestmiautes/seeonds) . `l
Latitude/longitude source:OGPSOTopographlc ma;
:..DEPTH ;�. _ - DRILLING LO01-:
From -._To Formation Description
• D 47
/f-7-
/fin ^/t-/7
3- C
LOCATION SKETCH
Show direction and distance in miles from at least
--6co State Roads or County Roads. Include the road
nu�41bersand common road ❑arnc5.
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'i'
S ,\AI 07 r .SuN U.`-tiiPLIC f.N3 ,-n t.
Submit the original to the Division of Water Quality, Attn: Information Management, 16(7 Mail Senice Center -
Raleigh, NC 27699-1617, Phone No: [phone], P,ithin 30 days.
: GW-1 REV. 09,2004

WELL CONSTRUCTION RECORD • '1 S 7 g/ a/
"w o CERTIFICATION
I�— J" 1
WELL CONTRACTOR CO>1PANSNA?IE / t'4 �L�O V" PHONE it (ate J o &5O
STATE \\'ELL CONSTRUCTION PER\IIT: ASSOCIATED UVQ PERMIT:
(it -applicable)
kortn Carolina - Ueoaruneat of Environment and Natural Resources - Uicision of 1`. ater Quality - GrounawaAtQ iSif
WELL CONTRACTOR (INDIVIDUAL) NAME (print) I3
(if applicable)
1. WELL USE (Check Applicable Box): Residential h_ NIunicipaL'P« olio ❑ Industrial ❑ Agricultural ❑
tNIonitoring ❑ Recovery 0 Heat Pump Water Injection 0 Other ❑ If Other, List Use
3. OWNER:
AddresS
2. WELL LOCATION:
�Nearest Town: (,�-.{- _V �y"County
.Ti'{
t 5:re: Na:ne. Nu: 5:ri. Coa:mu .in. Subd:';isiot:, Lot No../Zip CodQ) ,I
( mil i,
7
1
(5:se:err
ct:, o- T,n 5:ate Ztp Co..
( )-
e- Pr. n_:;bc:
4. DATE DRILLED 1 - ( 7- 0
TopographicTLand setting c ^ r r
idee ❑Slope ❑\'alley ❑Flat b `' 1
(check appropnat: box)
La iitude'longitud_ of well location
(dot ..-: ninu:eiseconds),F
Latitudo lom_itude source:❑GPS❑ kopographic map
(ckrcc Dos)
DEPTH DRILLING LOG
From To Formation Description
0 443
jn2 - /o3
p—i — / an
LOCATION SKETCH
11. D:S:\FECTION: Type H- TH Amount 5 may_ S:=.o.c direction and'ci;:anc: in. miles from a: least
12. C.AS;NG: Wall Thickness U two S:. t R^='_s or Co::nx Roads. Include the road
Do /�/ EL:r/ C•7 Wei,n6Ft. Ntaterith ru:..-erg and common roci ra-.es.
From To Ft USQa -
From To
Fr._... D Ta / F;.atZ W " V
Fr; e. To 2�
Ft
14. SCREEN: Dcp:6 Dia....,r Slot 5iz: J._xr, a.
Fare. To Ft i in.
Fr.:nt T; Ft in
5. TOTAL DEPTH: 2-01.)
6. DOES \VELL REPLACE EXISTING WELL? YES 0 NO41'
7. STATIC WATER LEVEL Brio Top of Casino-: ci-05-1) FT.
(Ls: if Ahoy,' Top ofCasin t
S. TOP OF CASING IN ET. Above Land Surface -
or c..iu;p t rniinu;cd at ur b. iu., 12nd sur(.ce requirci
. erbncc in accordin:: yith 15.\ NCAC 2C .0115.
9. `,MELDIacn).' )`%/� METHOD OF TEST CoA-1
I0. 1';ATER ZONES ldcp''nA: /2731
15. SAND GRAVEL. PACK:
De:.;. 5:ze Ma:eria:
F:cr. To Ft.
Front Te Ft.
16. RE>!,\°KS
I DO HESE3Y CERTIFY THAT TiniS v: ELL \c?S CONSTRIXTED IN A.TCOR DANCE WITH I5A NCAC. 2C, V.-ELL
CONST \,_1- T MON S T ;X�i\ a. AN r?i:.'..4. P?V OF T:-iiS ° . ':AS BEEN PROVIDED TUT THE \'CELL O\VNER
5� ( COL
L.G\.=.T'i RE OF PERSON CONSTRUCTING THE \;ELL DATE
Submit ti:e original to the Division of Water Quality, Groundnater Section. 1636 )fail Soryice Censer -Raleigh, NC
27699-1636 Pimna No. (919) 733-322I. i:hin 30 days. GW-I REV. 07:2001

YELLCONSTRUCTION RECORD`
North Carolina Department of Environment and Natural Resources Division of Water Quality `
CERTInCATii a'jO'
WELLCONTRACTOR(LYDfVIDCAL)NA?tE (prlo[)�'�K!-t'�
Y� ? vv 828 586-5050
AAA .A INC.HU�E - I ±
„\I'ECL CONTRACCOR C06lPA-\Y hA3IE GREENE BROS.WELL ORLGOF SYLV
ASSOCIATEDW - -
:STATE WELL COYSTRLCTIOY PER�ITrX Q
applicable) - "
1 WELL USE (Check Applicable Box) Residential. MunicipaVPublic 0 Industrial 0 Agricultural 0
Monitoring ❑'Recovery 0 _ Heat Pump Water Injection ❑ - Other ❑ If Other, List Use
•
2 WELLCOCATha Toponraphic/Landsettifie
Nearest Too
,Numbe
City or
(828 )- i
Area code- Phone nurnber 7
/ _
4. DATE DRILLED a/O _
5. TOTAL DEPTH: f ocro _
6. DOES WELL REPLACE EXISTNG WELL? YES 0 NO _
7. STATIC WATER LEVEL Below Top of Casing: T.
--(Usc"+" ifAbovcTop ofCaV ring)
8. TOP OF CASING IS I FT. Above Land Surface* �� -
Top of casing terminated actor below land surface requires a
variance in accordow with ISA NCAC 2C .01 I8.
9. YIELD (gpm): 0 METHOD OF TEST 1 r'
10. WATER ZONES (depth): rl% 3 7 D
-77S gL/O f�
1 I. DISINFECTION: Type {-{ "Fri Amount
i7 C.SfYC: - wan,m tr-:
From D
From
From
13. GROUT:
From -0
Depth
To 7 L
To
To
Depth
To 3
To 20
❑Ridge .dope- ❑Valley , LIFlat
'(cbeek appiopnatc box)
atitudeAongitude ofwell location
(degrees/minutes/seconds)
Latitudeflongttude source:❑GPS❑Topographic ma
DEPTH DRILLING LOG ;
From To _" Formattign Descnption
2'/
3 7A - 3 7 "
LOCATION SKETCH
Show direction and distance in miles from at least --
��--(wo State Roads or County Roads. include the road
Diamf/etzr . or Weight/Ft. numbers and common road tni .cs.
d"
14.-SCREEN: Depth Diameter Slot Size - Material -. ..__GL(��-•
From To -Ft. in. in.
From To Ftin.. in. 15. SAND(GRAVEL PACK. -
Depth From To Ft: -
From To Ft. - - - _s,
IL$JZW LDI CERTIFY a •"
CONSTRUCTION STAND COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL 0
C
pp "?
11
CONSTRUCTEDACCORDANCE' ....'., vier 2f wFC!-. or,nes
O•
Submit the original to !he Division of Wpter Quality, Attu: Information Management,1617 Mail Senice Center
Raleigh, NC 27699-1617, Phone No: [phone], within 30 days. - ; GW_1 REV. 09.'200-
It

WELL CONSTRUCTION RECORD COS/ 7 - -5- i
North Carolina Department ofEnvwonmfntan/ddNNaturalResources Division ofWater uality i
WELL CONTRACTOR (DMIVIDUAL) NAME (print) lQ�d {' / e U CERTIFICATION%1
WELL CONTRACTOR COMPANY NAME AAA GRE NE BROS. WELL DRLG.OF SYLVA, I C. PHONE % [phone]
STATE WELL CONSTRUCTION PERSIIT% - ASSOCIATED WQ PER 1T% - -
(if applicable) - -
(if applicable)
1. WELL USE (Check Applicable Box): ResidentialW MunicipaVPublic 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Wateflnjection 0 Other 0 If Other, List Use
2. WELL LOCATI
!��,}
yNea�rest TTov.
'-` (Sa et Name,Numbc
Topographic/Land setting
❑Ridge lope ❑Valley ❑Flat
-v.+K _ check appropriate box)
.,/0 p ode) - - Latitude/lonzitudeofwell location
��II��j
3. OWNER: 1/ y G WW ' Q(degrees/minutes/seconds)
Address ) j 5 - 4...L..2-C-0 t e-g.-- __•Latitude/longitude source:OGPSOTopographic map..
(cheek box) -
_ DEPTH DRILLING LOG .
t - Se g � 7p Code . From To
28 J- /
Area code- Phone number D /_
4. DATE DRILLED I - / CO
5. TOTAL DEPTH: _
6. DOES WELL REPL -E E ISTNG WELL? YES ID 0
7. STATIC WATER LEVEL Below Top of Casing: l` O 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 accordan with ISA NCAC 2C .0118.
9. YIELD (gpm): ` L� METHOD OF TEST 1 ti •
10. WATER ZONES (depth): tan) LOCATION SKETCH
Show direction and distance in miles from at least
11. DISINFECTION: Type {i- 1 H Amount <')�he.o State Roads or County Roads. include the road
-12. CASINO: Wail Thicknesss
Depth Diameter or Weight/FL bf�a/teria
19 number and common road names.
From () To_ Ft.40 tx./.-P -2 J Ci• L"O
From To Ft.
From To Ft.
13. GROUT: Depth Material lethod
From 0 To 3 Ft. ,(� "��
From To RO Ft. �tL-w•- O W� '
R. SCREEN: Depth Diameter Slot Size Material VJs _I."J
From . To Ft. in. in.
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Size Material -
- From To Ft. - -
From To Ft.
3 3 i S
Formation Description
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
IT-V C". C. r S 5 0 4
SiGNAT(IRE 0.F PERSON CC.NS1ROOPTING THE WELL _ DATE
Submit the original to the Division of Water Quality, Attn: Information Management, 1617 h1ai1 Senice Center -
Raleigh, NC 27699-1617, Phone No. [phone], within 30 days.
7
C
GW-1 REV.09.2004

iFr
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y:::, 2::•"..';‘,.T :
ai(ifigiicabe) l,c.",yc..:!_(i(aTplcible)
rt..,..t[rivirlt.:6SE (Check- App1ieibleBefiyResideritial
rty:1-:';'--r-Ilec...-:.- .7::::';"-rr;:<i....:::::::-F-.). ''': . ' . 1 0 : ke ulmial 0 ' . .t-'. "x , v•.•cj.:-
., IsfunicipaVPublic 0 -,. Industria :: nc
Monitoring 0 ;:accewery:D :D;Heat Pump Water Injection 0;', OtherO2fpth sr, LI!tUse
2.CVELI;L6CAll jil:.1.,1":: in ' . ,.....c. .. j-- :::::d:ii%,n--.5:5-TopOgraiillic/Land setung •-c...„:.-",••,,;.:.:.
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ropdattbox
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. alC.: :;:r1. (45!1IPPIll Cation ...- - ..... . .
• • -• • OWNEII.:€„; - .
• Address eK
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ot PrC°4S).-- •
derce moo : '
i
Ichrk box)
.,:_fi,!;:.:,Latitu-denduirudeiouicencpso. p a
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..57.1DEPTH I.OG
onnation
, .
,. •
k..ea cod:- Necee tember
14.0/ 4. DATE DRILLED
5. TOTAL DEPTH: JP-5-D
- 6. DOES WELL REPLACE EXISTING WEIL? YES NO
7. STATIC WATER LEVEL Below.Top of Casine: -51 FT.
, (thest- if Above -Top °Wising)
8. 70? OF CASNG IS FT. Above Land Surface'
'Top of cask: terminated at'or below land surface requires 2
latiinceia I:cc:dm:cc • h 15A NC/1/4C 2C .0111.
9. YIELD (gpm): lefETHOD OF TEST I
• 10. WATER ZONF,S ( epth): 95
• :F — Deirri .16-r
/0-0- _,114-4-:1frit-1-,
LOCATION SKETCH
I I. Dlo1Nr ECTION: Type ' 14 I H Amount 45 Show direction and distance in miles from at least - '- „,.
_ _ ._ _ wall -2.;ckress fl Stat.- Roads or County Roads include the road - -
d -
-17 re cry"
Depth 19tarpcter or Weight'Ft. - hilotegp, numbers at.0 common road names.
From 0 To 23 Ft (0 44 EP-a-7 I (nt.— _
To Ft
From
From To F.
From 0 To 3 Ft
To W Ft
Depth - Nlaterial tethod
13. GROUT:
14 SCREEN: Depth Diameter Slot Size MatetiaI a% s ^ 0---,
---..n — . .. ,...
.
From To
. ,
15. S.AND/GRAVEL PACK:
•
7.From To •"Ft.
r 22:
.1 DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANLCARDS, AND THAT A COPY OF THIS kEcoir.bHAt BEEN PROVIDED TO THE WELL OWNER:;" C'7"st
- - - csItkei.
Sf0;<A1 ti.n,1 OF PERSON CO. S1 RUCTING ; HE 1:‘
Submit the original to the Division of Witter Quality, Attn: Information Management, 1617 Mail Sen-ice Center -
. ,.‘ Raleigh NC 27699-1617, Phone No. [phone], within
Gw.i REV. 0912004

TELL CONSTRUCTION RECORD
North Carolina DePirtMent Of EnVixOnMent Nayja1 Resources - sion of Water Quality? F..
WELL CONTRACTOR (EYDIVIDUAL) NAME (print) - '!" • - -fSERTIFICATION
3,11.::.c.tiNTR-:•1/4OfORSOMPAS"ikiA.,IE AAA GREENE BROS. WELL .OF SYLV (828 ) 586-55k
'-t----trrn't-:?..Yi.:Er-ificvc.)-ii:gtitr6ifolzi-ii‘Etii0; •••1-Th
- '
• .1 DO HEREBY CERT1FY:THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC -f
•-• ape, ma e . -
1V7ELIAISEleteiscItiCiiPlialb1;1394Residentie9b , /vIunicipal/Public 0 Induitrial 0..Agricultural 0 "
hfonitorixii 0 •?Recovery0:-;Fcat Pnihji Wat r Injection 0 Other D If Other, List Inc
ilOCAT _ To bo hiC/Lerid jetting
ope OValley 5,-0 Flat ;
'County
. . • . •
NSIOZLOCWSIP
Lot p.,
3. OWNTR:
Address /-*
-tt;t47-:c
ei27t
Ciry or Town Smc Zip Code • '
( 628 )- ' 5"--(5) 6 -- Lart, 7
4. DATE DRILLED 5-r2 06 •
/Near st T z
; A E(dd:rFFl&t
source
bescriPaoh.nl,
From : •
c(cheCkb° ' No LOG:
5. TOTAL DEPTH: -2 St) / 0 /N-2-
6. DOES WELL REPLACE EXISTNG WELL? YES 0 SO
7. STATIC WATER LEVEL Below Top of Casine: Lie FT.
, (use ••••• if Above Top o r Casing)
8. TOP OF CASING IS 1 FT. Above Land Surface*
*Top eosin: terminated atior below land surface requires a
NCAC 2C .0118. 159. YIELD (epm): 7 yz_ METHOD OF TEST A I —'1
nriance in accordance with .4
• 10. WATER ZONES (depth): /6- 0 3 I 0, 3 / )--
-
.11. DISINFECTION: Type ' kt t H Amount is—, 7r /.9 Show direction and distance in miles from at least --
LOCATION SKETCH
/
12 'AS !NG: v'..1, -FH.-i„.,..-.“ )'61,-0 Skate Roads or County Roads. include the road
Depth , n DiaTeter or Weight/a mau.riagi.- Lumb.;ts anti cs-...to:Itoa.:: naincs.
Tojai _ Ft.dp4 SpiLK2/ _plc -
To
From ()
From
From To Ft
13 GROUT: Depth Material
1A-) From 0 To 3 Ft. . ...ii- rethod
rn -c arnit,
From :.". To W Ft 4:1-can-v1) 4-1-1.--;—' . —a
14. SCREEN: Depth tharneter Slot Size Material •M__{..n...9-1
"-' • .
From To Ft in. in
From To Ft in in.
15. SANDIGRAVEL PACK.
To • :Ft.
•
CONSTRUCTION STANISARDS, HAT A COP OF THIS RECORD HAS BEEN PROVIDEDIt THE WELL OWNER - -
sIGNATLF,cE (yr }-Lt-J.ur-, riLICl/NO E:E V, ELL - i L
•
Submit the original to tile Division of Wpter Quality, Attn: Information Management, 1617 Mail Senice Center -
Raleigh, NC 27699-1617, Phone No. [phone], within 30 days.
GW-1 REV. 09.1200-1
• - -

02/16/2007 03:31 8285861899
GREENEBROS WNC TOILE PAGE 01
N : Lantow id
RESIDENTIAL WELL CONSTRUCTION RECOR4
North Carolina Department of Environment and NaturalResources-Division of Water Quality
WELL CONTRACTOR CERTIFICAT ON # 3041
1. WELL CONTRACTOR:
PAUL BRYANT BRUCE
Won Contractor (Individual) Name
AAA GREENE BROS. WELL ORLG. OF SYLVA, INC
Well CalueOtor Company Name
STREET ADDRESS 1800 SKYLAND DRIVE
SYLVA NC 28779
City or Town Slats Zip Code
(828 y 588-5550
Area code- Phone number
2. WELL INFORMATION: —7'/�
SITE WELL ID pinappncaae) J 5 q� L 3
STATE WELL PERMITe(If applicable)
DWQ or OTHER PERMIT e(11 applicable) 7584- 0ZJ41:r
WELL USE (Check Applicable Box): ReaidenUel Water Supply
DATE DRILLED 10/12/06
TIME COMPLETED 5:00 AM 0 PM El
3. WELL LOCATION:
CRY: TUCKASEEGEE
COUNTY JACKSON
SHOOK COVE TO MAJESTIC VIEW ROAD
(Street Nome, Numbers, Community, SubdMalon, Lot No, Panel, ZIP Coal)
TOPOGRAPHIC / LAND SETTING:
Slope OValley Oriel CI Ridge ❑Otter
(eheak appropriate ba4
LATITUDE 3
LONGITUDE
LatitudWlongitude source: pGPS ❑Topographic map
(location of web must be shown on a USGS repo map and
attached to this form Inot uskig GPS)
4. WELL OWNER
OWNERS NAME SHERRA CARMERUCI
May be in degrees,
minute, seconds or
in a decjTaI foetal
STREET ADDRESS 1345TH AVENUE SUITE 102
INDIALANTIC, FL 32903
City or Town State
( 321 )- 4483737
Area Code • Phone number
Zip Cods
5. WELL DETAILS:
a TOTAL DEPTH: 800
b. DOES WELL REPLACE EXISTING WELL? YES 0 NO E
a WATER LEVEL Below Top of Casing: 40 FT.
(Use '+• ifAbove Top of Casing)
d. TOP OF CASING IS 1 FT, Above Land Surface'
'Top of cawing terminated atlr below land surface may require
a variance In accordance elm 15A NCAC ZC .0115.
e. YIELD (gpm): 1.75 METHOD OF TEST AIR
f. DISINFECTION: Type NTH Amount 27 OUNCES
g. WATER ZONES (depth):
From 200 To 203 From 490 To 493
Fron_ To Front_ To
Fran_ To From To
8. CASING: The -knee/
er W4� n Depth
1'4 gittt
From 0 OD' To tS' FL 68 Ii
FriirnT To Ft
FromTo FL
7. GROUT: Depth Material Metrcd
From 0 ToI0J F!. del LL nl �AT.t?
Fr9m To Ft.
TO Ft
Frail
8. SCREEN: Depth Diameter Slot Size
Fran____ To FL_In. In.
From ToFt In In.
From To Ft. In. h-
9. SAPID/GRAVEL PACK:
Depth
From To
Fran
FI
To Ft.
From To Ft.
10. DRILLING LOG
Froth To Formation Description
0-95' 8' CLAY
Malarial
Size Materiel
95' 6"-200 GRANITE
200-203 CAVITY
203-480 GRANITE
490-493 CAVITY
GRANITE
493-500
11. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS Ca STRJCTED IN ACCORDANCE N1re
I5A WAG A 20, SEEN PRbn E0DTDWELL ORSniE ANDARDS, ND 'HATA COPY OF TIS
rieWELL OvvN.
/S : Ii A
SIG�PW\TURE OF CERTIFIED WELL C Fit' ACTOR DATE
PRINTED NAME OF P
?' JL
ON CONSTRUCTING THE WELL •
Submit the original to the Division of Water Quality within 30 days, Attn: InformatIon Mgt,
161T Mail Service Center - Raleigh, NC 27899-1617 Phone No. (919) T33.7015 ext 668. FEB 1 6 20K 7
5
•e

RESIDENTIAL WELL CONSTRUCTION RECUR.
North Carolina Department of Environment and Natural Resources -(Division of Watt
WELL CONTRACTOR CERTIFICATION # 'Q `
1. WELL CCT r5, ant-.1
/&uc
Well Contractor (Individual)
AAA GREENE BROS. WELL DRLG. OF SYLVA, INC.
Well Contractor Company Name
STREET ADDRESS 1800 SKYLAND DRIVE
SYLVA NC 28779
City or Town State Zip Code
( 828 )- 586-5550
Area code- Phone number 2. WELL INFORMATION: 9 - _ Ira-)
. '
SITE WELL ID tip' applicable)�-y6� (Cr 1-7 c2
STATE WELL PERMIT#(il applicable)
DWQ or OTHER PERMIT #(if applicable)
WELL USE (Check Applicable Box): Residential Water Supply
DATE DRILLED / - 06
TIME COMPLETED AM O PMik
3. WELL L M n
CITY' . ' c
COUNTY
(Street Name, Numbers, Cor�n`yrvly, Subdivisionjot No., Parcel, 1p Code)
OGRAPHIC / LAND SETTING:
lope ❑Vafey ❑Flat ❑Ridge ❑Other
(check appropriate boa)
LATITUDE _
LONGITUDE
Latitude longitude source: ❑GPS ❑Topographic map
(location of well must be shown on a USGS topo map and
attached to thistorm ¥not using GPS)
4. WELL OWNER
OWNER'S NAME
f. DISINFECTION: Type HTH
g. WATER//'ZONES (d th):
Fran t3 3- To Fra
From To Fran_ From To From To
6. CASING: • Thickness/
Depth D' rn er Weight Material
From t% To 3 . J .SIW,e 21 j7/
From To Ft.
From To Ft.
7. GROUT: Depth
Material
Fran () To Ft&4tkr,r2 rq
Fran --t To Ftbc_-..'ivwL-
From To FL
pre
8. SCREEN: Depth Diameter Slot Size Material .
Fran To Ft. In. In.
From To Ft. in. - ht.
From To Ft. in. in.
9. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
r,CRA'4� From To Ft.
From,To Ft.
May be in degrees,
minutes, seconds or
in a decimal format
STREET
City or T
Area
DDRESS
State C "Zip Code /
'/sa' —/os2'
e • Phone number
5. WELL DETAILS: 44
a. TOTAL DEPTH: / 5 'V
b. DOES WELL REPLACELEXISTING WELL? YES O NOOC1
c. WATER LEVEL Below Top of Casing: 'SO FT. __
(Use •*- if Above Top of Casing)
d. TOP OF CASING IS / FT. Above Land Surface'
Tcp of casing terminated atkr below land surface may require
a variance in accordance with 15A NCAC 2C .0118.�,
e. YIELD (gpm): T:Jl
METHOD OF TEST
♦—J
10. DRILLING LOG
From To
11. REMARKS:
Formation Description
G-3
r-.
rtt
r-�
10O HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED PI ACCORDANCE WITH
ISA NCAC 2C, WELL CONSTRUCTION STANDARDS. AND THAT A COPY OF THIS
REf.Orrp HAS BEEN PRQJIDED TO THE WELL OWNER.
-A UI'
SIGNATURE OF CERTIFIED WELL CONTRACTOR DATE
a t1
JACI
PRINTED NAME OF PERSON CONSTRUCTINGTHE WELL
Submit the original to the Division of Water Quality within 30 days. Attn: Information Mgt,
1617 Mail Service Center— Raleigh, NC 27699-1617 Phone No. [phone] ext 568.
Fonn GW-1a
Rev. 7/05
OCT 13 2006

RESIDENTIAL WELL CONSTRUCTION RECORD
North CarolinaDepartment of Enviromnent and Natural Resources -Division of Water Quality
WELL CONTRACTOR CERTIFICATION #
1. WELL CONTRACTOR: a
D ��1- (' it fl
Well Contractor (Individual) Name
AAA GREENE BROS. WELL DRLG. OF SYLVA, INC.
Well Contractor Company Name
STREET ADDRESS 1800 SKYIAND DRIVE
SYLVA NC 28779
City or Town State Zip Code
82( 8 )_ 586-5550
Area code- Phone number 2. WELL INFORMATION: ,7 L ' - Z - /,� 7�
J _/ (� �,i.
SITE WELL ID #(if applicable) 'a1 5 ( V- 9Q L11
STATE WELL PERMIT#(if applicabe)
DWQ Or OTHER PERMIT #(if applicable)
WELL USE (Check Applicable Box): Residential Water Supply
DATE DRILLED 3- ` 0 -6 XX
TIME COMPLETED r AMp PMys,
3. WELL LOCATION: -
CITY: IV COUNT}YtY��/
��cL.Cr 1E-St'[.—
Y: I L' ' (U \
(Street Name, Numbers. Community, Suou+on, Lot No., Parcel, ZZp Cade)
TOPOGRAPHIC / LAND SETTING: 11
*lope OValley ❑Flat ❑Ridge CI Other
�(check appropriate box)
LATITUDE
LONGITUDE
Latitude/longitude source: oGPS ❑Topographic map
(Iocatfon of well must be shown on a USGS topo map and
attached to this form not using GPS) ` )
R
WELL
!. OWNER S NEAME •`-- / C
May be in degrees,
minutes, seconds or
in a decimal format
STQIF,ETA DRESS/
'1 fl
¢Town r� State
City
Area code - Phone number
5. WELL DETAILS:
a. TOTAL DEPTH: L!
b. DOES WELL REPLACE EXISTING WELL? YES IDNO y
e. WATER LEVEL Below Top of Casing: O r-'• FT.
�
(Use'+' if Above Top of Casing)
d. TOP OF CASING IS
A SO
7
L.
Zip Code
FT. Above Land Surface'
'Top of casing terminated ator below land surface may require
a variance in accordance with 15A NCAC 2C .01 8.
e. YIELD (gpm): 4 � METHOD OF TEST ) r
f. DISINFECTION: Type HTH
g. WATER ZONES (depth):
From ;.2 2 U To
To From
To Fran.
From
From
3 9
,
Amount/1' �
To
To
To
6. CASING: Thickness/
.Depth _ Diameter Weight Material _-}J�
Fran LI To 7 Ft. (-/` =1:= Z1 i;4.
Fran To Ft,
From To Ft
7. GROUT: Depth Material Method
From To Ft.
From To Ft.
Fran To Ft.
Diameter Slot Size Material' ,
Ft. in. _ in.
Ft. in. __ in.
Ft. in. _ in.
8. SCREEN: Depth
From To
From To
From To
9. SAND/GRAVEL PACK:
Depth
From
To
From To
From To
10. DRILLING LOG
From To
70
In--- .0 i0
NO 3.7
11. REMARKS:
Size Material
Ft.
Ft.
Ft.
Formation Description
S,te� a..7r
`r Lit e
rta
tw
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WFTH
15A NCAC 2C, WELL CONSTRUCTION STANDARDS. AND THAT A COPY OF THIS
RECORD HAS BEEN PROVIDED TO THE WELL OWNER.
SIGNATURE OF CERTIFIE ELL CONTRACTOR DATE
p IAA ec.t,TV' v79
PRINTED NAME OF PERSON CONSTRUdTING THE WELL
Submit the original to the Division of Water Quality within 30 days. Attn: Information Mgt,
1617 Mail Service Center— Raleigh, NC 27699-1617 Phone No. [phone] ext 568.
Form GW-la
Rev. 7/05

RESIDENTIAL WELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources- Divisioa of Water Quality
WELL CONTRACTOR CERTIFICATION #
1. WELL CONTRACTOR: v
1i Y\` LtAit,C1
Well Contractor (Individual) Name
AAA GREENE BROS. WELL DRLG. OF SYLVA, INC.
Well Contractor Company Name
STREET ADDRESS 1800 SKYLAND DRIVE
SYLVA
NC 28779
City or Town State
( 828 )- 586-5550
Area code- Phone number
2. WELL INFORMATION:
Zip Code
SITE WELL ID #(if applcable) Li .1 `7 4' 0 / V Vr
STATE WELL PERMIT#(it applicable)
DWQ or OTHER PERMIT #(if applicable)
WELL USE (Check Applicable Box): Residential Water Supply 0
DATE DRILLED (Q.'2" 1
TIME COMPLETED c:R--/ ' L 6-- AM 0 PMX
3. WELL LOCATION: _ I'
CI : 'uc G4SPer ic couNTY u�G1 ( SOOY
t° (Ca r �� R,E", Pd.
(Street Name, Numbers, Communit , Subdivision, Lot No.. Parcel, Zip Code)
TOPOGRAPHIC / LAND SETTING:
❑Slope ❑Valley tatla[ ❑Ridge ❑Other
(check appropriate box)
LATITUDE
LONGITUDE
Latitude/longitude source: ❑GPS ❑Topographic map
(bcatbn of well must be shown on a USGS topo map and
attached to this form i1 not using GPS)
4. WELL OWNER 0 T
OWNER'S NAME 1 Il) l S 1 ra G'
STREET ADDRESS 3(i ,2 keecul(rig--
c.If_SC )m JI II.,C. 1= I 3 .2 i /
City or Town State Zip Code
(904)- 474-'CJGLf
May be in degrees,
minutes, seconds or
in a decimal format
Area code- Phone number
5. WELL DETAILS: Q
a. TOTAL DEPTH: '
b. DOES WELL REPLACE EXISTING WELL? YES ❑ NO C§
c, WATER LEVEL Below Top of Casing: I S FT.
(Use -+- if Above Top of Casing)
d. TOP OF CASING IS 1 FT. Above Land Surface'
'Top of casing terminated atlor blow land surface may require
a variance in accprdance with 15A NCAC 2C .0118n ,
e. YIELD (gpm).
METHOD OF TEST '✓i
f. DISINFECTION: Type FT"
g. WATER ZONES (depth):
FromaTo,1Y Z-
From To
Fran
To
6. CASING:
Depth c
From (7 ' To 1 FL,
From To Ft.
From To Ft.
7. GROUT: Depth
From To Ft.
From To Ft.
From To Ft.
Material
Amount 13 &' CES
From To
From To
From To
. Thickness/
ameter Weighty Material
8. SCREEN: Depth
From To FL in. in.
From To Ft. in.
From To Ft. In.
9, SAND/GRAVEL PACK:
Depth
From To Ft.
From To Ft.
Method
Diameter Slot Size . Material
in:
in.
Size Material
From To FL
10. DRILLING LOG
From To
(� --
5-Z —d?Y"•
<150 / 2--
Sc-7r2
11. REMARKS:
Formation Description
C-L
s
,N
J
30 .
a+•
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH
15A NCAC 2C. WELL CONSTRUCTICN STANDARDS. AND THAT A COPY OF THIS
RECORD HAS BEEN PRWIOED TO THE WELL OWNER.
G
�. Mel(-�-y
SIGNATURE OF CERTIFI WEtCCONTRACTOR DATE
PRINTED NAME OF PERSON CONSTFIUCTING THE WELL
Submit the original to the Division of Water Quality within 30 days. Attn: Information Mgt,
1617 Mail Service Center— Raleigh, NC 27699-1617 Phone No. [phone] ext 568.
Form GW-la
Rev. 7/05

RESIDENTIAL WELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources -Division of Water Quality
WELL CONTRACTOR CERTIFICATION #
f. DISINFECTION: Type HTH
1. WELL CONTRACTOR:
W e8 tractor. (Individual) Name
AAA GREENE BROS. WELL DRLG. OF SYLVA, INC.
Well Contractor Company Name
STREET ADDRESS 1800 SKYLAND DRIVE
- c 5 -7
SYLVA
City or Tam State
g2f 8 1- 586-5550
Area code- Phone number
2. WELL INFORMATION'
NC 28779
Zip Code
SITE WELL ID #(i/ applicable)
�V SSa.23w
STATE WELL PERMIT#(ir applicable)
DWQ or OTHER PERMIT #(if applicable)
WELL USE (Check Applicable Box): Residential Water Supply 0
DATE DRILLED — I - c' C.
TIME COMPLETED �O AM PM
3. WELL LOCATION: ��T
CITY: l� \ a r I e COUNTY i-A-
I, e* I ? Tt7 r L) at) d (� h e?
(Street Name, Numbers, Community, Sub6rsion, LI No., P 7dp �qd
TOPOGRAPHIC / LAND SETTING:Ilat(S(�
tope °Valley °Flat 12 Ridge ['Other
(cheek appropriate box)
LATITUDE
LONGITUDE
Latitude/longitude source: OOPS ❑Topographic map
(location of well must be shown on a USGS topo map and
attached to this form X not using GPS)
4, WELL OWNER 6
STREET ADDRESS o�-S I L �t Ver 13ePrj J/
C 4 4er-rl.+�- G1 - 31 U 2 t{
May be in degrees,
minutes, seconds or
in a decimal format
OWNER'S NAME t I ( LA v
City a Town'/ & C State _ e 7 Zip Code
( 7o(e)- T �
Area code - Phone number
6. WELL DETAILS: ff�
a. TOTAL DEPTH: ��JJ
b. DOES WELL REPLACE EXISTING WELL? YES ❑ NO
e. WATER LEVEL Below Top of Casing:
(Use'+' if Above Top of Casing)
d. TOP OF CASING 15 / FT. Above Land Surface
'Top al casing terminated at/or below land surface may require
a variance in accordance with 15A NCAC 2C .0118.
e. YIELD (gpm): a. METHOD OF TEST � / r
FT.
6. CASING:
tl r9 h1131
g. WATER ZONES (depth):
Fron1.JfI __To I r(2--- From To_
From ./ C l) To �.'3 From To
FromTo From To
Thickness/
7. GROUT: Depth Material Method
From_a_TO Ft.
Fram r. To � Ft. rI[ is
From To Ft.
8. SCREEN: Depth Diameter Slot Size Material
•
From To Ft. In. in.
From To Ft.__in. __ in.
From__
To Ft. In. __ in.
9. SAND/GRAVEL PACK: Size Material
Depth
From To Ft.
From To Ft.
From To Ft.
10. DRILLING LOG
From To Formation Description
11. REMARICS:
1 CO HEREBY CERTIFYTNAT THIS WELL WAS CaJSTRUCTED IN ACCCNDANCE WDH
15A NCAC
BEEN
LN PROVIDED
clTHE ANDARS. OWNER.D THAT A COPY OF THIS
RECORD
SIGI9ATURE OF C RTIFIED WELL CONTRACT,"
PRINTED NAME OF PERSON`ONSTRUCTING'1<IQE I�JELL
G. M/a,+n r��tiitS Tr
Submit the original to the Division of Water Quality within 30 days. Attn: Information Mgt, Form GW-la
1617 Mall Service Center— Raleigh, NC 27699-1617 Phone No. [phone] ext 568. Rev. 7/05
r

kt
RESIDENTIAL WELL CONSTRUCTION RECORD
North CarofmaDepartment of Environment and Natural Resources -Division of Water Quality
r
WELL CONTRACTOR CERTIFICATION # 30 (.
1. WELL CONTRACTOR:
Well Contractor (Individual) N
AAA GREENE BROS. WELL DRLG. OF SYLVA, INC.
Well Contractor Company Name
STREET ADDRESS '1800 SKYLAND DRIVE
SYLVA
NC 28779
City or Town State Zip Code
( 828 )_ 586-5550
Area code- Phone number �}- -p /�� oG
2. WELL INFORMATION:�3(ytttch-v' et 3 S 7 ao&)
SITE WELL ID #(02411lYeeade) /. S a 6 9 9 97,9 2-
STATE WELL PERMIT#(k apprirade)
DW Q or OTHER PERMIT #(if applicable)
WELL USE (Check ApplicablepLBox): Residential Water Supply 0
7
DATE DRILLED —/0 U S�
TIME COMPLETED 11 — / D — O"
3. WELL LOCATION:
CITY:
( )�� ree1 NajNumbemmCommunity,
TOPOGRAPHIC / LAND SETTING:
Slope DValley ❑Flat ❑Ridge CI Other
/�' (check appropriate box)
LATITUDE
LONGITUDE
Latitude/longitude source: ❑GPS Topographic map
(location of well must be shown on a USGS topo map and
attached to this form if not using GPS)
4. WELL OWNER
SA ' / j�/g CC --
STREET OWNER'S NAME t + m r /t—/L—M�1_�tL / ,7
STREET ADDRESS 70 % CZ) 37 7 PEA Lew vim,
sf11 v r a ry c aP 777
City or Town State Zip Code
AM PM
COUNTY
No., Parcel, Zip Code)
May be in degrees,
minutes, seconds or
in a decimal format
Area code - Phone number
5. WELL DETAILS:
a. TOTAL DEPTH:
c2v _
)
b. DOES WELL REPLACE EXISTING WELL? YES ❑
c. WATER LEVEL Below Top of Casing: ad Fr.
(Use'+' if Above Top of Casing)
d. TOP OF CASING 15 / FT. Above Land Surface'
-Top of casing terminated at/or below land surface may require
a variance in accccord with 15A NCAC 2C .0118.
e. YIELD (gpm): / ETHOD OF TEST ,7 l r
From
6. CASING:
3?
f. DISINFECTION: Type HIH
g. WATE/yG- ���ONES (depth
From On To CS-'
From To
To
Amount / OU
N
CE
From To
From To
From To
Thickness/
Depth rnr la ter Wei hl ' ]I
From (% To PC �FL SD Z( V
Frcm To Ft.
From To Ft.
7. GROUT: Depth Material 1 Method
From D To 3 Ft.
From To FL,
Fran To Ft.
8. SCREEN: Depth Diameter Slot Size Material
Fran To FL in in.
From To FL in in.
From To FL in. in.
9. SAND/GRAVEL PACK:
Depth
From To Ft.
Frain To Ft.
Size Material
From To Ft.
10. DRILLING LOG
From To
n-zA—
.SS"
- s7 ,D
11. REMARKS:
Formation Description
rA
Q
c,
1 DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED at ACCORDANCE WRH
15A NCAC 2C. WELL CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS
RECORD HAS BEEN PRONDEO TO THE WELL OWNER.
SIGNATURE O'F CERTIFIED WELL CONTRACTOR DATE
Pa -f la Rtuc_e_
PRINTED NAME OF PERSON CONSTRUCTING THE WELL
Submit the original to the Division of Water Quality within 30 days. Attn: Information Mgt,
1617 Mail Service Center- Raleigh, NC 27699-1617 Phone No. [phone] ext 568.
Form GW-la
Rev. 7/05

RESIDENTIAL WELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources -Division of Water Quality
WELL CONTRACTOR CERTIFICATION 11
Well Con for (Individual) Name /
AAA GREENE BROS. WELL DRLG. OF SYLVA, INC.
Web Contractor Company Name
STREET ADDRESS 1800 SKYLAND DRIVE
City orTown scare —•----
B2f 8 1- 586-5550
Area code- Phone number �r / `
2. WELL INFORMATION: C5' 5 t 8 9 tL T 62.1
v ,
SITE WELL ID #(W ep / e)
1 f/., r 1 f D
STATE WELL PERMIT#(if apeacade) -
DWQ or OTHER PERMIT #(if applicable)
WELL USE (Check Applicable Box): Residential Water Supply
DATE DRILLED___
TIME COMPLETED— AM ❑ PM)S
(Street Name, Numbers{Gom�umry, a��p��••^.
TOPOGRAPHIC / LAND SETTING:
°Slope ❑Valley ❑Flat ❑Ridge O Other.
(check appropriate box)
LATITUDE _ --
LONGITUDE_ _
Latitude/longitude source: ❑GPS °Topographic map
(location of well must be shown on a USGS topo map and
attached to Mis lo ff not using GPS)
4. WELL OWNER
OWNER'S NAME Q Vtt
ST TADDRESS /OV 5
IUG� see��t' tilCdh7
City or Town _ State Zip Code
Area code - Phone number
5. WELL DETAILS:
a. TOTAL DEPTH:,
b. DOES WELL REPLACE EXISTING WELL? YES
c. WATER LEVEL Below Top M Casing:
(Use -+' S Above. Top of Casing)
d. TOP OF CASING IS — FT. Above Land Surface
-Top of casing terminated aver below land surface may require
a variance inar/�ordante with 15A NCAC 2C .0118. y/��
e. YIELD (gpm): 1 METHOD OF TEST /`-t
May be in degrees,
minutes, seconds or
in a decimal format
f. DISINFECTION: Type HTH
g. WATER ZONES (depth):
From22 /D94�To •�D� rom
From�To —j
From To Fran
es'
,.n ?4
a ei.�v
I DO HEREBY CERTIFY THAT THIS WELL WAS ISA NCAC 2C. WELL CONSTRUCIION STANDARDS. AND THAT A COPYOWITH
OF THIS
RECORf,HAS BEEN PROd�7E&5O THE WELpgWNER n '
Submit the original to the Division of Water Quality within 30 days: Attn: Information Mgt,
1617 Mail Service Center— Raleigh, NC 27699-1617 Phone No. [phone] eat 568.
Form GW-1a
Rev. 7/05

1. WELL CO . RACT
R:
•
North Carolina Department of Environment and Natural Resources -Di 'on of Water Quality 3 on 2, 't/
RESIDENTIAL WELL cONSTRvcT[oN RECORD
WELL CONTRACTOR CERTIFICATION #
Well Con (Individual) Name
AAA GREENE BROS. WELL DRLG. OF SYLVA, INC.
Weil Contractor Company Name
1800 SKYLAND DRIVE
STREET ADDRESS
SYLVA
City or State
gyt 8 1- 586-5550
Area code- Phone number
2. WELL INFORMATION:
SITE WELL ID #(x applicable)
STATE WELL PERMIT/Rif applicable)
DWQ orOTHER PERMIT *(if applicable)_..--
WELL USE (Check Applicable Box): Residential Water Supply 0
DATE DRILLED
TIME COMPLETED___ AM 0 PM
3. WELL LO r ION:
CITY:
NC
28779
Zip Code
``/ (� ✓� 1 /i 1 )q
(Street Name, Number , Community, Subdiusion, Lot �ee)
TOPOGRAPHIC / LAND SETTING:
❑Slope OyalleY Alat DRidge ❑Other
(check appropriate box)
LATITUDE — —
LONGITUDE
Latitude/longitude source: ❑GPS ❑Topographic map
(location of wel must be shown on a USGS topo map and
attached to this form Bnot using GPS)
4. WELL OWNER
OWNER'SFNAME
4Rr .Q ADDRESS
City cr Tam State Zip Code
nab)_ (3 co )(0 �7
Area code - Phone number
5. WELL DETAILS:
a. TOTAL DEPTH: L
/0
b. DOES WELL REPLACE EXISTING WELL? YES 0 N
c. WATER LEVEL Belau Top of Casing: FT.
(Use'+' if Above Tap of Casing)
d. TOP OF CASING IS FT. Above Land Surface
'fop of casing terminated afar below land surface may require
a variance in accordance with 15A NCAC 2C .01
e. YIELD (gpm): / ox-- METHOD OF TEST
May be in degrees,
minutes, seconds or
in a decimal format
4
ca
1. DISINFECTIO Type HTH
g. WATER ZONES (depth):
Fran To
From*-2i9 (7 To
From To
6. CASING:
Rom
From
Fran
Depth
To
To
To_
Ft.,
Ft.
Ft.
Amount
Fran To
From To
From To
Thickness/
Diameter Weight Material
Material r Method
_
7. GROUT: Depth ,, .�—e`--
From To Ftf _
From 3 To� FL
From To Ft,
B. SCREEN: Depth
From To
From To
From To
Diameter Slot Size Material
Ft. in. __ In.
FL in. in.
Ft. In. __ in.
9. SAND/GRAVEL PACK: Size Material
Depth
From To Ft.
From To FL
From To Ft.
0. DRILLING LOG
From To
11. REMARKS:
Formation Description
CP)
_U
IN)
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WT11
15A NCAC DC. WELL CONSTRUCTICN STANDARDS, AND THAT A COPY OF T VS
RECORD HAS BEEN PROv1DED TO THE WELL OWNER.
SIGNATURE OF CERTIFIEDC LrOMRACTOR DATE
PRINTED NAME OF PERSON CON
Submit the original to the Division of Water Quality within 30 days. Attn: Information Mgt.,
1617 Mail Service Center- Raleigh, NC 27699-1617 Phone No. [phone] ext 568.
HE WELL
Fonn GW-1a
Rev. 7/05

RESIDENTIAL WELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources
Diivviisiioon of Water Quality
WELL CONTRACTOR CERTIFICATION
f. DISINFECTION: Type HTH
g, WATE ZONES (d th
FromTo
Well C(Individual) Narne
AAA GREENE BROS. WELL DRLG. OF SYLVA, INC.
Well Contractor Company Name
STREET ADDRESS 1800 SKYLAND DRIVE
NC 28719
SYLVA Zip Code
City or Town State
Area50
Phone num
2, WELL INFORMATION. \
SITE WELL ID PO appGrablef'
STATE WELL PERMIT#(if applicable)
DWQ or OTHER PERMIT #(if applicable)�
WELL USE (CheCI( Applicable Bo� gsidential Water Supply"(
DATE DRILLED / I�(p
TIME COMPLETED AM PM1
U
(Street Name, Numbers, Community, Subth4&Cn, Lot No.. Parch, Zlp Code
TOPOGRAPHIC 1 LAND SETTING:
OValley ❑Flat ['Ridge ❑ Other (check appropriate box)
LATITUDE
May be in degrees,
minutes, seconds or
in a decimal format
LONGITUDE_
Latitudeflongitude source: OOPS ❑Topographic map
(location of wen must be shown on a USGS topo map and
attached to this form I not using GPS)
4. WELL OWNER IA )d ]A'11-Qd"-m1 t
OWNER'S NAME ( f
STREET ADDRESS J
aZip Code
Area code- Phone number
5, WELLDETAILS:
a. TOTAL
DEPTH:
b. DOES WELL REPLACE EXISTING WELL? YES 0
c, WATER LEVEL Below Top of Casing:
(Use 'e if Above Top of Casing)
d. TOP OF CASING IS FT. Above Land Surface'
slop of casing terrain ed at/cr belay land surface may require
a variance in a ante with 15A NCAC 2C .011
e. YIELD (gpm): METHOD OF TEST
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH
ISA NCAC
WELL BEEN PROVIDED 2C.CTO SN STANDARDS.
AND
THAT A COPY OF THIS
RECORD
DATE
SIGNATURE WELL t'ITRA,�: rF'
OF PERSON CONSTRUCTIDIGT WELL
OF
PRINT
1617Submit Mail the
ge Center— Ralvision of Water eigh, NC 2 699-1617 Quality within
(9 9) 733-7015 e0 days. Attn: nxt 566lion Mgt,
Foml GW-1a
Rev. 7105

1. WELL CONTRACTOR.
Well Contracts (Individual) Name
AAA GREENE BROS. WELL DRLG. OF YLVA. INC.
Well Contractor Company Name
STREET ADDRESS 1800 SKYLAND DRIVE
SYLVA NC
City a Tam State
82( 8 )- 586-5550
Area code- Phone n17 u ber 75 5"2. WELL INFORMATION:
/)f
SITE WELL ID #(if applicable)
STATE WELL PERMITggr applicable)
DWQ or OTHER PERMIT #(if applicable)
WELL USE (Check Applicable Box): /Residential Water Supply ❑
DATE DRILLED -T
TIME COMPLETED 6S— AM ❑
3. WELL LOCATION: CITY: 5 Kit
�-W� COUN
(Street : me, Numbers,
C
community, Subdiw. on, Parcel. Zip Code)
• POGRAPHIC 1 LAND SETTING:
��.lope OValley OFlat O Ridge ❑Other �—
(check appropriate box)
LATITUDE
LONGITUDE__
Latitude/longitude source: OOPS ❑Topographic map
(bcatbn of well must be shown on a USGS topo map and
attached to this form ifnot using GPS
4. WELL OWNER
OWNERS NAME
STRUT ADDRESS
r ity or Town State
2- aq3- 3/%57
Area code - Phone number
28779
Zip Code
3 st ' Z,
��J`Z�v
PM
May be in degrees,
minutes, seconds or
in a decimal Comet
Zip Code
5. WELL DETAILS:
a. TOTAL DEPTH:
b. DOES WELL REPLACE EXISTING WELL? YES NO 0
c. WATER LEVEL Below Top of Casing: FT•
(Use'+- if Above1Top of Casing)
d. TOP OF CASING IS FT. Above Land Surface
Top of casing terminated at/or blow land surface may require
a variance In accordance vrith 15A NCAC 2C .0118.
e. YIELD (gpm): METHOD OF TEST Ai
RESIDENTIAL WELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources -Division of Water Quality
WELL CONTRACTOR CERTIFICATION #
f. DISINFECTION: Type MTh
g. WATER ZONES (depth):�
From a/ 0 To!��L From
a. ID To a Yrn
Fran -
From To From-
6. CASING: Dial4et
Depth , /
Fromy Tojra.. Ft.
From To Ft.__t
From To Ft.�_
7. GROUT:
Fran
Fran,
Frcm
Depth
To
B. SCREEN: Depth
From To
FromTo
Fran To
9. SAND/GRAVEL PACK:
Depth
From To
From To
net To___
10. DRILLING LOG
From To
a i 3 — 7c
11. REMARKS:
Material
Ft
Fi r5 ,
e l r}
Amount
To,
To,
To
Thiclmessl
Weight M,'�
Diameter Slot Size
Ft._ —In. —,_, In.
Ft.in. __ in.
Ft. In. _ In.
Size Material
Ft.
Ft.
Ft.
ethod
Material
Formation Description
CO Tit
47)
100 HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED 91 ACCORDANCE WrTH
t5A NCAC 20 WELL CONSTRUCTION STANDARDS. AND THAT A COPY CF THIS
RECORD HAS BEEN PROVIDED TO THE WELL OWNER.
(n1 C4YM
SIGNATURE OF CERTIFIED WF JOh�
PRINTED NAME aF PERSON CONSTRUCT
Submit the original to the Division of Water Quality within 30 days. Attn: Information Mgt,
1617 Mail Service Center— Raleigh, NC 27699-1617 Phone No. (91S) 733-7015 ext 568.
RACTOR DATE
G THE WELL
Form GW-la
Rev. 7/05

I.
RESIDENTIAL WELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources -Division of Water Quality
WELL CONTRACTOR CERTIFICATION #
1. DISINFECTION: Type— Amount
g. WATER ZONES (deprth�): To
Fromn_-To `°l.7 ii From
To From To
From To
From To From
Thickness/
6. CASING: �, �J D Weigh/
From 0 .D os-t--FL '_Pa
Fran To Ft.
Fran To Ft.
7. GROUT: Depth
Material Method
Fram1� To 5 Ft.
Frcn __To FL
From To FL
8. SCREEN: Depth Diameter Slot Size Material
From To FL In. in.
From
To Ft.in. _ in.
From To Ft In. in.
9. SAND/GRAVEL PACK: Size Material
Depth
From To Ft.
From To Ft. �—
From To Ft.
WeA Contractor (Individual) Name
AM GREENE BROS. WELL DRLG. OF SYLV INC.
Wen Contractor Company Name
STREET ADDRESS 1800 SKYLAND DRIVE
SYLVA NC 28779
City or Town State Zip Code
Aracode- Phone number
1 5q qq
2. WELL INFORMATION: �iN P/c( � 1G � � y[� `� —
SITE WELL ID #(B appficade)
STATE WELL PERMIT#(X applicable)
DWQ or OTHER PERMIT #(if applicable)
WELL USE (Check Applicable Box): Residential Water Supply El
DATE DRILLED ITV
�— AM 0 PM%
TIME COMPLETED
3. WELL LOCATION:
COUNTY
CITY:
(Street Name, Numbers, Community, SWANS on, Lot No., Parcel, Zip Code)
TOPOGRAPHIC / LAND SETTING:
°Slope °Valley ❑Ridge ❑Other
(check ropdate box)
LATITUDE —
LONGITUDE_
Latitude/longitude source: OOPS °Topographic map
(location of well must be shown on a USGS topo map and
attached to this form ynot using GPS)
4. WELL OWNER
OWNER'S NAME
ST18EFT ADDRESS
City or Town
Area tcode- Phone nufnber
5. WELL DETAILS:
a. TOTAL DEPTH:
b. DOES WELL REPLACE EXISTING WELL? YES ° NO )
c. WATER LEVEL Below Top of Casing:
30 FT.
(Use se if Above Top of Casing)
d. TOP OF CASING IS 1 FT. Above Land Surface
'Top of casing terminated at/or below land surface may require
a variance in accordance with 15A NCAC 2C .0118.
e. YIELD (gpm): 3 Ll METHOD OF TEST
May be in degrees,
minutes, seconds or
in a decimal format
Zip Cade
Q6
10. DRILLING LOG
From To
11. REMARKS:
G47
0 )
MINCES
4_ 4
Formation Description
U
tV
Ge
I DO HEREBY CERTIFY THAT THIS WELL WAS CCNSTRUCTED M ACCORDANCE WITH
15A NCAC 2C. WEU_ CONSI ED TS D ION STANDARDS.
WELL AND THAT A COPY OF THIS
RECORD HAS BEEN
ER.
SIGNATURE OF CERTIFIED WELL CON RACTOR DATE
�1 L r I" -
PRINTED NAME OF PERSON CONSTRUCTING THE A LL
116 Submit Mail thoriginal to e
Center- Raleigh, NC 2 699 1 17 e Division of Water Quality within eNo. 9 9) 733-7 5 enxt 568ation Mgt,
Form GW-1a
Rev. 7/05

RESIDENYTAL WELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources -Division of Water Quality
WELL CONTRACTOR CERTIFICATION #
1. WELL CONTRACTOR:
.� D p1 —'L cc r' r~ r J
Well Contractor (Individual) Name
AAA GREENE BROS. WELL DRLG. OF SYLVA, INC.
Well Contractor Company Name
STREET ADDRESS 1800 SKYLAND DRIVE
SYLVA NC
City or Town
( 828 )_ 586-5550
Area code- Phone number ' / y
2. WELL INFORMATION: G'n y& -5� - L) / v im
5b
SITE WELL ID Nil applapplicable)c i '7 9(.a4'✓
STATE WELL PERMIT#(B applicable)
DWQ or OTHER PERMIT #(if applicable) ✓
C1
WELL USE (Check ^Applicable Box): Residential Water Supply)
DATE DRILLED L I ` 0
TIME COMPLETED AM ID PM V
28779
3. WELL LOCATION:
CITY
State
1C 1 chitin I74?-1
Zip Code
COUNTY ti L. J(. )J
(Stre'et Name, Numbers, Community, Subdivision, Lot No., Parcel, Zip Code)
TOPOGRAPHIC / LAND SETTING:
❑Slope OValley `ram.' lat ❑Ridge ❑Other
(check aApropdate box)
LATITUDE
LONGITUDE
Latitude/longitude source: ❑GPS ❑Topographic map
(location of well must be shown on a USGS topo map and
attached to this form ifnot using GPS)
May be in degrees,
minutes, seconds or
in a decimal format
4. WELL OWNER
I
OWNER'S NAME OIl ttj('-t L'1
STREET ADDRESS 0 p) c7.
I�,115130t C x-7a
City a Town Stag Zip Code
Area code- Phone number
5. WELL DETAILS:
a. TOTAL DEPTH: 7 El U \ "�
b. DOES WELL REPLACE EXISTING WELL? YES CINOT(}'
c. WATER LEVEL Below Top of Casing: -) FT.✓V�
(Use -+' if Above Top of Casing)
d. TOP OF CASING IS / FT. Above Land Surface'
'Top of casing terminated atior below land surface may require
a variance in acoorian a with 15A NCAC 2C .0118.
7
S METHOD OF TEST
e. YIELD (gpm):
2_/ rZ -,
f. DISINFECTION: Type HT}i Amount
g. WATER ZONES (depth):
7V FramTo 179-2 From To.
From To From To
From To From To
w
6. CASING: Thickness/ .
Depth eri is Di er Weight -
From 0 - To r Ft. G7 5(9/mc-21
From To Ft.
From To Ft.
7. GROUT: Depth
From To Ft.
Fran To Ft.
From To Ft.
8. SCREEN: Depth Diameter Slot Size
From To Ft in. in.
From To Ft. in. _ in.
Fran To Ft. In. _ in.
Material
9. SAND/GRAVEL PACK:
Depth Size
From To Ft.
From To Ft.
From To Ft.
Material
Method
Material
•
10. DRILLING LOG
From To Formation Description
U — 44
L �,1 ��,,S���... /VA L. i
r 7 � .7-1147) J t 4,4
11. REMARKS:
.•
1
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH
ISA NCAC
2C. WELL TOSTANDARDS. AND E WELL OWNER. THAT A COPY OF THIS
RECORDHAS BEEN PROVIDED
I3e tG
SIGNATURE OF CERTIFIED ELL CIt7TRACTOR DATE
\ Del — WV"- �W TI
PRINTED NAME OF PERSON CONSTRUCjING THE WELL
Submit the original to the Division of Water 1617 Mail Service Center- Quality
Raleigh, NC 2 699.16117 Phone hNo. 9 9) 733-7015 ext 68.Uon Mgt.,
Faro GW-la
Rev. 7/05

RESIDENTIAL WELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural ces-Division of Water Qu ty
WELL CONTRACTOR CERTIFICATION #
1. WELL CONTRACTOR:
w�
Well Contractor (In ividual) Name
AAA GREENE BROS. WELL DRLG. OF SYLVA, INC.
LLC-
Well Contractor Company Name
STREET ADDRESS 1800 SKYLAND DRIVE
SYLVA
NC 28779
City or Tam State
( 828 )_ 586-5550
Area code- Phone number
2. WELL INFORMATION:
Zip Code
SITE WELL ID Ike applicable) 1 SZ C - S C - 05o t
STATE WELL PERMIT#(i/applicable)
DWQ or OTHER PERMIT W(it applicable)
WELL USE (Check Applicable Box): Residential Water Supply ❑
DATE DRILLED / -IY" C C� i
TIME COMPLETEDC:c AM EtPM UI"'
3. WELL LO ATION: _l v
t.
CITY:
!r LL C. I) i Y r' 5 (COUNTY
I /'
N4r t'L^l 4-5/ _ /n0� ti-j"
(Street Name,hirmbers, Communit/Subdusion, Lot No., Parcel, Zp Code)
TOPOGRAPHIC / LAND SETTING:
Ape oValey ❑Flat ❑Ridge ❑Other
(check appropriate box)
LATITUDE
LONGITUDE
May be in degrees,
minutes, seconds or
in a decimal format
Latitude/longitude source: ❑ GPS ❑ Topographic map
(bcatbn of well must be shown on a USGS topo map and
attached to this form if not using GPS)
4. WELL OWNER �� I
OWNER'S NAME Li.S Sc'.L t 11ef'jCLV'
STREET ADDRESS PG) i'Z(-T�L / ClC S
(/ yR�1l C— ;2 7/ 7
,5 e
City or Town State Zip Code
(R 3k')- i, _ ��; (V
Area code - Phone number
5. WELL DETAILS:
a. TOTAL DEPTH:
Zva
b. DOES WELL REPLACE EXISTING WELL?YES ❑ 180
c. WATER LEVEL Below Top of Casing: 2 U FT.
(Use -+- 6 Above Top of Casing)
d. TOP OF CASING 1S / FT. Above Land Surface*
Top of casing terminated at/or below land surface may require
a variance in accordance with 15A NCAC 2C .0118.
e. YIELD (gpm): I 0 METHOD OF TEST A I r^
ri f I
f. DISINFECTION: � Amount ount / O1"Ca
g. WATER ZONES (depth):/
5
From so` To kFrom To
From '7' To 1' ,/ Fran To
From 7%(/LITo /fit? From To
6. CASING: Thickness/
Depth ID-iamLeter Weight Material L/
Fran 0 To 'Q _ FL u' /)/ A K. 0 )/ l? (' J ?Li
Frorn To Ft.
From To Ft.
7. GROUT: Depth Material
From To FL
Fran To FL
From To FL
Method
8. SCREEN: Depth Diameter Slot Size Material 1
From To FL in. in.
From To FL in. in.
Fran To FL in. in.
9. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To FL
Frpm To Ft.
10. DRILLING LOG
From To Formation Description
0 • - /S _
,r7 S.
S S -
- r
j)--7,Y
'78 - / CZ)
e - /c-
11. REMARKS:
I DO HEREBY CERTIFY TNAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WMTH
ISA NCAC 2C. WELL CONSTRUCTION STANDARDS. AND THAT A COPY OF THIS
RE BEEN PROVIDED TO THE WELL OWNER ( I
Cl/_ACI
SIGNATURE OFCERT! ED WELL CONT OR DA E
Ci-1 r (3)'Ut •C
PRINTED NAME OF PERSON CONSTRUCTING THE WELL
Submit the original to the Division of Water Quality within 30 days. Attn: Information Mgt.,
1617 Mail Service Center— Raleigh, NC 27699-1617 Phone No. [phone] ext 566. - - 5
Form GW-la
Rev. 7/05

Y
RESIDENTTAL WELL CONSTRUCTION RECORD
North Carolina Deparliuent of Environment and Natural Resources -Division of Water Quality
WELL CONTRACTOR CERTIFICATION # 2/ g 6
0
'- 3
1. WELL CONTRACTOR:
T ) M CaurhN
Well Contractor (IndrvWuaQ Name
AAA GREENE BROS. WELL DRLG. OF SYLVA, INC.
Well Contractor Company Name
STREET ADDRESS 1800 SKYLAND DRIVE
SYLVA
NC 28779
City or Tarn State Zip Code
( 828 )_ 586-5550
Area code- Phone number i ()o1�^ •. / 7 GROUT: Depth
2. WELL INFORMATION:.. 4— .jf CS I$ n O Sp 6O P"(/ F rom 6 To FL
From_a_To 0 FL�L7 a rc.. _
f. DISINFECTION: Type
Amount awlsg. WATER ZONES (depth):
FramS3 To s7.3 From To
From To From To
From To From To
6. CASING:. Thickness/
Depth lapp�r�tter Weight eri I
Fran 0 To 3 Z FL % / S..D C 2./IPV I
From To FL
From To FL
SITE WELL ID #(if applicable) 7 m tY Y f 3 7G 3
STATE WELL PERMITS/9f applicable)
DIN or OTHER PERMIT 0(if applicable)
WELL USE (Check Applicable
Box): Residential Water Supply ID
DATE DRILLED - {} °/ Y
TIME COMPLETED S -/ W -- DCAM 0 PM217
3. WELL LOCATIOop�i \_\ ' /' `
CITY: COUNTY L.la-de---5 7--I
c64-i e al 1 c11 it.t- l_Seeyet'
(Street Name, Numbers, Community, Sggbdidsion, Lot No., Parcel, Zip Code j) C
From To
Material
Ft.
S. 'SCREEN : Depth Diameter Slot Size
Fran To Ft. in. in.
From To FL in. in.
From To Ft. in. in.
9.
TOPOGRAPHIC / LAND SETTING:
Llope °Valley °Flat ❑Ridge ❑Other
7�=� (check appropriate box)
LATITUDE
LONGITUDE
Latitude/longitude source: 0 GPS 0 Topographic map
(location of well must be shown on a USGS topo map and
attached to this form if not using GPS)
Maybe in degrees,
minutes, seconds or
in a decimal format
4. WELL OWNER ' ^
OWNER'S NAME �/1
STREET ADDRESS e'D
1-(99
90
City or Twirl. State Zip Code
(72K )- 6 - -
Area code - Phone number
5. WELL DETAILS {�!
a. TOTAL DEPTH: �66)
b. DOES WELL REPLACE EXISTING WELL? YES 0 NO LY /
c. WATER LEVEL Belau Top of Casing: (c) FT.
(Use'+• if Above Top of Casing)
d. TOP OF CASING IS / FT. Above Land Surface'
-Top of casing terminated aVor below land surface may require
a variance in accordance with 15A NCAC 2C .0118..r7�
e. YIELD (gpm): - METHOD OF TEST //7/ d`
Material
SAND/GRAVEL PACK:
Depth Sae Material
From To Ft.
From To Ft.
From To Ft.
10. DRILLING LOG
From To Formation Description
Pl — e2 %
27 — 'T70
S7o - 5173
11. REMARKS:
-O
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.
Jam- M i 5-ob
SIGNATURE OF CERTIFIED WELL CA NTRACTOR DATE
D h' vCIL.i°f^-
PRINTED NAME OF PERSON CONSTTHE WELL
Submllt the original to the Division of Water Quality within 30 days. Attn: Information Mgt,
1617 Mail Service Center- Raleigh, NC 27699-1617 Phone No. [phone] ext 568.
Form GW-la
Rev. 7/05
L""P03

RESIDENTIAL WELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources -Division of Water Quality
WELL CONTRACTOR CERTIFICATION # cRl /np
1. WELL CONTRACTOR:
D 1\
Well Cmbactor (Individual) Name
AAA GREENE BROS. WELL DRLG. OF SYLVA, INC.
Wen Contractor Company Name
STREET ADDRESS 1800 SKYLAND DRIVE
SYLVA
NC 28779
City or Tam State Zip Code
( 828 )- 586-5550
Area code- Phone number (/ J
2. WELL INFORMATION: - /5-()� / 1G / tc ?
SITE WELL ID#(dappficatie) f -� tL/%—/X vz )
STATE WELL PERMIT#(U applicable)
DWQ or OTHER PERMIT #(If applicable)
WELL USE (Check
Applicable Box): Residential Water Supply ❑
DATE DRILLED `-('' T� II-s - 0 /sue
TIME COMPLETED - 5 - d b AM ❑ PM,)
3. WELL LO
CITY:
6�ee (Name, N ninunty, Sugthis
TOPOGRAPHIC/LAD SETTING:
❑Slope ❑Valey ❑Ridge ❑Other
((check a upriMe bat)
TIO
LATITUDE
LONGITUDE
Latitude/longitude source: ❑GPS ❑Topographic map
(locahbn of wel must be shown on a USGS topo map and
attached to this form if not usTing GPS)
4. WELL OWNER /ln rve�-escsiit/
OWNER'S NAME '/ I(/LQ. � �J
STREET D S.3 1-f ((,"AyQ7,T f f--a O
City or Town State Zip Code
Ise 5wo 4"&/7
Area code - Phone number
COUNTY
Jr� tiRIYG(.�
La No., Parcel, ar
May be in degrees,
minutes, seconds or
in a decimal format
5. WELL DETAILS: /��
a. TOTAL DEPTH:
b. DOES WELL REPLACE EXISTING WELL? YES 0 NO5k
c. WATER LEVEL Below Top of Casing: _62 D FT.
(Use'+' if Above Top of Casing)
d. TOP OF CASING IS / FT. Above Land Surface
?op of casing terminated at/or below land surface may require
a variance in accordance with 15A NCAC 2C .0118.
e. YIELD (gpm): METHOD OF TEST ` 1p( (�
c84
f. DISINFECTION: Type ^' ^
g. WATER ZONES (depth):
From To jlA b\
From To
From To
6. CASING:
Depth --11 Material
From (} To 1o(/ Ft. Per,
Amount
Fran To
From To
From To
Thickness/
Diame er Weight
5nr U
From To Ft. /
From To Ft.
7. GROUT: Depth Material /, Method
From Q To 3 Ft. C/�ti__
From_ ->) To � Ft. 1� e G
L,) (
From To
8. SCREEN:
From
Ft.
Depth Diameter Slot Size 'Nlatenal
To Ft. in. in.
From To FL in. in.
From To Ft. in. in.
9. SAND/GRAVEL PACK:
Depth Sae Material
From To FL
From To Ft.
Flom To Ft.
10. DRILLING LOG
From To
11. REMARKS:
Formation Description
.X-
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WRH
15A NCAC 2C. WELL CONSTRUCTION STANDARDS. AND THAT A COPY OF THIS
RECORD NAS BEEN PROVIDED TO THE WELL OWNER
SIGNATURE OF CERTIFIE L CONTRACTOR DATE
- }Y1 C(O11 knr
PRINTED NAME OF PERSON CONSTRUCTING THE
Submit the original to the Division of Water Quality within 30 days. Attn: Information Mgt,
1617 Mail Service Center— Raleigh, NC 27699-1617 Phone No. [phone] ext 568.
Form GW-la
Rev. 7/05

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources(- Division of Watej Q
WELL ('ON'1'RAC'fOR(INDIVIUUAL) NAME: (prin�t),o._..(J tread
' -Pa
WELL CONTRACTOR COMPANY NAME.. 61 een,t- [fros_ 'WMP I. _Ann
STATE WELL CONSTRUCTION PERMIT# /7 Q Z ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
329866
uality ,tlojr/oundtyater Section /
_ERR ICATIUS#.30215155
PRONE #Q(23) 6q8-3/70
I. WELL USE (Cheek Applicable Box): Residential Municipal/Public ❑ Industrial 0 Agricultural ❑
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 [f Other, List Usc
2. WELL LOCATION' ``
DN
Nearest "foam:.--Sy1-II✓a- County d ..
3.
( Street Name, Numbers.. Community. Subdivision, Ica No., Zip Code)
OWNER:
. a. Bdyc 6S6
e- keakkenz,vociet.
Route I Snc •t or Na)
'w pA CU? N C_ vs7'B
City or Town State Zip ('ode
azd31_ , (/St o
.Area code- Phone number
4. DATE DRILLED 6 42
5. TOTAT. DEPTH: 5h3-
Do!' S 'Ut.1 I IJt.nl A('I. EY:1S1INI_\A-1.11Vl.t 11 N.'. IIr
7. STATIC WATER LEVEL Below Top of Casing: £ P FT.
(Use "+" if Above Top of Ca ing)
S. TOP OF CASING IS ' FT. Above Land Surface*
"'fop of casing terminated at/or below land surface requires a
variance in accorda a with I5A NCAC 2C .0118.
9. YIELD (gpm): METHOD OF TEST Z /f e Jt-
10. WATER ZONES (depth): 'i65
11 DISINFECTION: Type f-ftif Amount
12. CASING: Wall Thickness
or Weieht/Ft. Material
pv�
Depth Dianyctcr
From Q To�ig Ft. (0
From To Ft.
From To Ft.
13. (GROUT: Depth Material Method
From 0 To Ft. Lem ea- rop
From To Ft.
14. SCREEN : Depth Diameter Slot Sizc Material
From To Ft. in. in.
From To Ft. in. in.
15. SAND/GRAVEL. PA('K:
Depth Sizc Material
From To Ft.
Ft.
From To
16. REMARKS:
Topographic/Land setting
❑Ridge ❑Slope ❑Valley RKTat
(check appropriate box)
Latitude/longitude of well location
1 dcgrceslm inuteslseconds)
Latitude/longitude source:❑GPS❑Topographic map
. (cheek box)
DEPTI' nowt T TNr. I OCi
From
E is Pee e?EC vvei(F lti �p ion
251- • 61 pv1e ,a Clyde
_
u l� is n . r 1 7 Rd
-77o3
ywcool CI>.
LOCATION SKETCH
Show direction and distance in miles from at (cast
two State Roads or County Roads. Include the raid
numbers and common road names.
L
r—
fV
CS1
rsa
I DO I IEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH ISA NCAC 2C, WELL
CONSTRUCT y SR' STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
SIGNA FURE OF PERSON CONSTRUCTING TILE 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 NaturalurResourcesRer- Division of Water Quality - Groundwater Section
Q
WELL CONTRACTOR (INDIVIDUAL) NAME (priinntt))�..__ 6QG(RQ�///(''L,I ^6`/_/ CERTIFICATION #ypvz
WELL CONTRACTOR COMPANY' NAME 6reen� 8roS Imo % M PIIONE # 6y(3_ :30C.)
SKATE W'F.LL CONSTRUCTION PERMIT# _L70_2— _ _ _ ASSOCIATED WQ PERMIT/4
(if applicable) (if applicable)
cy.
I. WELL USE (Check Applicable Box): Residential Municipal/Public ❑ Industrial 0 Agricultural 0
Monitoring ❑ Recovery ❑ Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION:
Nearest Town:_ J%L ._- County Ja,(L(O/C-
(Street Name, Numbers. ('ommunity_ Subdivision. lot No., Zip Codc)
3. OWNER
� ' I� JrJf�s
Address I v g B)C. 49 A
(Street or Rome No
tat. ,in Nc_ ZS7°7
City or Town State Zip (otte
('Zf- (152- 2128
Area code- Phone number
4. DATE DRILLED %- LS-o
5. TOTAL DEPTH: / 05
ss:(:(( ) v(.c
7. STATICWATER LEVEL Below Top of Casing: 5 D FT.
(Lee "it- if Above lop of Casing)
S. TOP OF CASING IS FT. Above Land Surface*
'Top of casing terminated at/or below land surface requires a
variance in accordance with IS.A NCAC 2C .0118.
9. YIELD (gpm): ZC METHOD QF TEST 2/fw,Pi
10. WATER ZONES (depth):
Topographic/Land setting
❑Ridge ❑Slope ❑Valley [3'F'lat
(check appropriate box)
Latitude/longitude of well location
(degrees; minutes/seconds)
Latitude/longitude source:DGPS❑Topographic map
(check box)
DRILLING LOG
Formation Description
DEPTH
From To
D' 5b'
57' - p2.51
11. DISINFECTION: Type
12. CASING:
166
if7H Amount
Wall Thickness
Depth Diameter or Weight/Ft. h teriF1
From To (o FL bttC-
From To Ft.
From To Ft.
13. GROUT Depth Material i Method
From D To Z b Ft. tt Top
From To Ft.
14. SCREEN: Depth Diameter Slot Sips Material
From _ To Ft. in. in.
Flom To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Size Material
Dram To Ft.
From To Ft.
16. REMARKS:
LOCATION SKETCH
Show direction and distance in miles from at (east
two State Roads or County Roads. Include the road
numbers and common road names.
C
CI)
v
0
1 DO IIEREBY CERTIFY THAT TlIIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONS". CTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
g /-o
SIGNATURE OF PERSON CONSTRUCTING TILE 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

OWNER
RESIDENTIAL 1VELL CONS'IRUC'1'ION RECORD 3 w 6 d 1 I wO
North Carolina Department of Environment and Natural Resources- Division of Water Quality
TVELL CONTRACTOR CERTIFICATION N . �} 0 3
1. WELL CONTRACTOR:
'err ,.eece_
Individual Na
Well Conti (Individual) me
MILLER WELL DRILLING, INC.
Well Contraclor Company Name
STREET ADDRESSP•0. BOX 567
HAYESVILLE, N.C. 28904
City or Town Slate Zip Code
( 828 } 837-2997
Area code- Phone number
2. WELL INFORMATION:
SITE WELL ID Cif applicable)
STATE WELL PERMITapI applicable)
DM Q or OTHER PERMIT N(il applicable)
WELL USE (Check Applicable Box): Residential Water Supply W
DATE DRILLED y-20 'DC
TIME COMPLETED 3. 00 AM D PM lg---
3. WELL LOCATION:
CITY: ,Sy/l/G-
Crar(c,If
COUNTY J0-c/130I1
(Sheet Name. Numbers. Community, Subdivision. Lot No., Parcel, hip Code)
TOPOGRAPHIC I LAND SETTING:
BSbpe °Valley °Flat ❑RkJge ❑Other
(check appropriate boa)
LATITUDE yT re ,S : 6-?
LONGITUDE 9 3° 691
Latitude/longitude source: gPR'S UTopographic map
(kncnlbn or we, most be shown on n USGS repo nap and
attached 10 Ibis fomn !not uskig GPS)
4. WELL OWNER I / ,,��/
OWNER'S NAME 8ue-4 �i-C•ye. 4-eietrt ei LLC
STREET ADDRESSl0 en fl LPu)'S
)90'6oi Stale I)2- )v lle A1i Zip
Olt
City a
Area coda • Phone number
May Ire in degrees.
minutes. seconds or
In a decimal formal
5. WELL DETAILS:
a. TOTAL DEPTH: 3412
b. DOES WELL REPLACE EXISTING WELL? YES D NOET--
c. WATER LEVEL Below Top of Casing: free) FT.
(Use '+' N Above Top al Casing)
d. TOP OF CASING IS / FT. Above Land Surface'
'Top d casing Terminated al/or below land stir lace may require
a valance In accordance with I5A NCAC 2C .0118.
e. YIELD Wpm): METHOD OF TEST /! i r
NC ✓
1. DISINFECTION: Type ((rig
g. WATER ZONES (depth):
From 200 To 301 From To
From To From To
From To From To
Amount /r`1C,-/e7
6. CASING: Thickness/
Depth_ Diameter Wei Id
From 0 To 7/ Ft 0-2- Sag
From 2 / To 83— F1. 6.15 • in
From To Ft.
7. GROUT: Depth aterial
From 0 To 3 FL at ?Vivid
From 1 To .20 FI.&n/on-'f�
From To Ft.
Material
At
stet,
Method
iftfi-�
6. SCREEN: Depth Diameter Slot Size Material
From To FI. In, In.
From To FI. In. In.
Fran To FL In. In.
9. SANDIGRAVEL PACK:
Depth
From To Vt.
Size Material
From To FI.
From To Ft.
10. DRILLING LOG
From To
v-70
Formation Description
76 -- 3y2 ot4e, aG-e-
n
I I. REMARKS:
100 HEREBY CE.RIFY 711AI DM WELL WAS COtlS?RUCIED at ACCORDANCE WNW
15A NCAC 7C. WELL CONSifUCIEN SIANDAROS, AND OAT ACOPY OF INS
RECORD HAS BEEN PRcNDED 10 THE W ELL OW NER.
SIGNATUf1E OF CERTIFIED WELL CONTRACTOR DATE
/ //2/ Ace -
PRINTED NAME OF PERSON CONSTRUCTING THE WELL
Submit the original to the Division of Water Quality within 30 days. Attn: Information Mgt.,
1R17 Mell Cervlen renter - Rnlnlnh_ NC 27G99-1617 Phone No. (9151733-7015 ex1568.
Form OW -II
Nev 7MS

WELL CONSTRUCTION RECORD
North Carolina --Department of Environment and Natpra Resources - Divis on of Water Quali
�f" r /
WELL CONTRACTOR (INDIVIDUAL)NAME..{print).a„/f�r� bly..; e7��/t��
\YELL CONTRACTOR COMPANY NAME frIce L71�//�` / v.'7A'
336676
ty - Groundwater Section
CERTIFICATION ft NY!
�j
PHONE # 6. ) K''17--tq y/07
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
I . WELL USE (Check Applicable Box): ResidentialMunicipal/Public 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
3. OWNER:/ B4Aj
2. WELL LOCATIOVi
Nearest Town: s43 / CountCj"
/ arAW %t, ees t44 rter
(Street Name, Numhers, Community, Subdivision, Lot No., Zip Code)
t
Address /370 rMOL�N1iC,U'•
(Street or Route No.)
Y il/ C `3R77�
11. DISINFECTION: Type
12. CASING:
City or Town St to. Zip Code
)- 5%SOZ -//
Area code- Phone number
4. DATE DRILLED/ eR/-off
Topographic/Land setting
Sedge ❑Slope ,❑Valley DElat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From F. ratior Description
J
(i}-O 70
5. TOTAL DEPTH: o�5 ��/o26
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO
7. STATIC WATER LEVEL Below Top of Casing:...' FT.
2 (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 accordanc5e with ISA NCAC 2C .0118.
9. YIELD (gpm): /5— METHOD OF TEST f /
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.
FrommDepth ,%t peter
Toy Ft& -1S/
From To Ft.
From To Ft.
13. GROUT: 0G'� Depth < M04 �/ ethod
From (l To 6�?O F . ZL
From To Ft.
14. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in.
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth
From To Ft.
From To Ft.
Amount
Wall Thickness
or Weieht/Ft. Ma iai -
NA, _
Size Material
RECEIVED
DIV. OF WATER QUALITY
JAN 0 8 Z007
16. REMARKS:
1 DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
Cfpi.1STRUCT a `.TANDARDS, AN A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
,iC;/ 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-I REV. 07/2001

WELL CONSTRUCTION RECORD
North Carols - Department of Environment and Natural Retowces--yDiivision of Water Quality - Groimdwoter Section
WELL. CONTRACTOR (IDIVTVA )NAME 11� /I.
//en c Hodes T/e CIRTBIr.TION s27 Er
nu. coratsCTOt COMPANY NANLC("toL° /.t)P9i e/ l: i e// 4 PL(aN non s girl 6 Y9-O'Ob
STATE WELL CONSTRUCTION PERMITS OC ATLD WQ 1
Off) Ofrlicable)
333521
1. WELL USE (Check Applicable Box): Residential t7 11IMmicipaYPublic ❑ Industrial 0 Agricultural 0
Mattering ❑ Recovery 0 Heat Pump Water Injection 0 Other C If Other, List Use
2. WELL LOCATION;
Nearest Town: 1 N /I / i t f r County 3/ ,Sa/v
(Sever Nma. Numbs. Casualty. SSW* Lot No., Zip Code)
3. OWNER ke(/in J /4fileSoni
Address 7100 nett,' frihe /A 2n7?%
// .� (9uect rRom Ne.l
Cut) i`//iter lvG Z.Fr7Fg
City or Ts Ss My Cella
(_}
Assdspho szsber
4. DATE DRILLED g /0 —D
S. TOTAL DEPTH- "2-0 5--
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO o
7. STATIC WATER LEVEL Below Top of°wing;
n t Is Y' tfAbove Top MOSS
-
8. TOP OF CASING IS /0 FT. Above Land Surfaces
Tap death baaataaeW Sr bdew IS arts spire ■
.arlaas to asardas wain ISA NCAC 2C MIL /
9. YIELD (gpm): / S METHOD OF TEST /
10. WATER ZONES (dep h):
11. DISINFECTION: Type (7chf Amount /ri a r
12. CASING: Wag TLidmess
Depth Diaper or Weight/Ft Metwiel
From V To 60 Ft. (o tg SO,e -7/ PO
Fran_ To Ft.
From_ To Ft
13. GROUT: n, Depth /' Material
To .2 Ft. Lin c/efx`
From To Ft
14. SCREEN: Depth DIMS Slet Size Material
From 9' To Ft,_ia in.
From To Ftin in.
15. SAND/GRAVEL PAOC:
Depth Size Mamie'
Frmt_f_To Ft
From__To Ft
Topoe� cJLa V setting
MidgeOValley goat
(chat appraprise box)
Latitude/longitude of well location
(dgaemulasoade)
Latitude/longitude wince:00PSOTopograpbic map
Sock ban)
DEEM DRILLING LOG
From To Formation Description
e711,1:17, X
16. REMARIGS-
ldranaLSIn
Show direction and distance in files from at lent
two State Roads ce County Roads. Include the mad
numbers and common road mmea.
C/il'1/"
red
creek
I DO HEREBY crtnFY THAT THIS WELL WAS CO:
C NSTRUCriON STAND*D3. AND THAT A
SI(BNATURE OF PERSON
ACCORDANCE WITH ISANCAC 2C, WELL
PROVIDED TO THE WELL OWNER
VEC
R QUALM
2006
Sabath the origlaal to the Midst of Water Quality, Groundwater Section, NM Man Service Center -RaWgh, NC
27e9-16 4 Mae NA (915) T333221, within 30 days. GW-1 REV. 072001

WELL CONSTRUCTION RECORD 3 3 3 5 2 2
Nods Crofts - Doprtstast ofBarken sM end boaat- Division of Water Quality - Gmaodwatar Section
visa cor'laActta(I NIvmvAr,)MOM . 4/ 'A/ C �1 pi o 44 5 1
NUi ooursACme COMPANY Nua - t ee W 4 it LLJ F // 7 . n/7 ► o a a ("A% d, 9'9-6- i2c .
CmtnricATMII. 2 7 h `1
ELM WILL at]N/'S.UCTION MINIM At#OCIA11iP WQ town
Ofasollo bls) ifft elkebiaf
I. WALL USE ([beef& Ap; -'- r Bob RaddrMial E Nuabipavpaltic O "breistrial [] Aerkultund O
Ma_Modoe 0 Recovery CI Hest Amp Wear Bestial 0 Odor CI If Other, LMMM (be
2. WELL LOCATION -
Nesters T / (teeny S/ sett'
DR
IYre'e'tter�s NuaYq,Cal% SeilifiikaLatea.Zip Cads)
3.OWNffiefr&S j* Zf4 G /wirtlwrdre'sear)
Address /IM II��G�3l[f Wile /cug,,J !)(r
K I ad-4. B de eaarc.:CKWI Topogepi is map
(a wtelasnNy Lyra)
/ter' /VG '7�7n% DBE vI- itilrr
au Tan erne' 21♦ Cris Frost To Potation Description
C_)'
4. DATE DRILLED 8 q`OG
3. TOTAL
6. DOB.4 WE L REPLACE E)OSffii0 WELL? YES 0 NO er—
7. STATIC WATER LEVEL Below Top *Mott SIT.
„ sure irMw. Tee altade )
a TOP OP CASINO 1S .. PT. Above Lad Sieber'
'ryed itsrr letWorDias bed aim rapine' s
men rs dsment15A/CAC3Cdtli
9- YIELD ( t r MIME) oFTBST /imei
10. WATER ZONES (depth):
I1. DISINFECTION: Type % CAC Amend /c' 0-
12. CASINO: Wall Thickets �r�1
Promt To $C Ft r 5Og e/ rt'L
Front_ To
Pta�_To IM.
13. GROUT: se Dip&
Ptme_t_To ZC Pt c'rcrefr
Frmn_To Pt.
14. SCREEN: Dept Dar I1fat She Metri!
Profi
m " To Ft _ie. bt
Proee__To PLja. in.
1S. SANDORAVBLPACK:
Depth She Ud[MeW
Prom 7 To, _ Pt,__
Pram__To Ft
16. R8h1AR1ES•
I Do HERESY 012121111YTTRAT1Im WILL WAS
ODNSIIWCTION STANDA*S. ANDTHAT A
4
MEONA7DRR • PERSON
w fape Malley
(t& .. tYhtea)
Letierde&kIFsitOde of wall location
OGOCIUKREZ
Show dbaetloe adLitem at least
two Serie Roods or County Roads. Mode the road
rembers end amm road senses.
C/N"_
ACCORDANCE WITH ISA !CAC 2C. wti.
HAS BEEN PROVED TO THE WELL OWNfl
TIW WELL DATE
Subs* tie Witt le the MSS OWN* Quay, Gr.ndw.rr Suede%1436Man Series Cast -_stir tic
21100406 PineNa.AD)733,1nt..MU.31 Soy& OW-1 REV. 07/2001

32150y
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment andNaturalRes urcee,ts�+1- Division,tjof Water Quality - Groundwater Section 1 )�
WELL CONTRACTOR (INDIVIDUAL) NAME (print) All )f:Veke
`-f-�,, 1'v ll ILL(€- CERTIFICATION#3id2 /
WELL CONTRACTOR COMPANY NAME la .J keel IAA:�.CC-( \(CCk T C, PHONE # j78?6?-074O
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 Ie on 0 Other 0 If Other, List Use
2. WELL LOCATION:
Nearest Toqwn: County
21hut /Y" . .
(Street Name, Numbers, Community, Subdivision, Int No., Tip Code)
3. OWNER: i f['rot_ home c
Address '1\ SCOftk (V \. Pot.
(Street or Route No.) 3
Cc -MO(, 1,._)aa7a
City or Town State tip Code
('1&*)- act? t(10
Area code- Phone number
4. DATE DRILLED . 7 "7 / C 1,--)
5. TOTAL DEPTH. god,
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO
7. STATIC WATER LEVEL Below Top of Casing:
(Use''"" ifAbove Top of Casing)
8. TOP OF CASING IS ' FT. Above Land Surface*
'Top of easing terminated atla below land surface requires a
variance in accord et ISA NCAC 2C A118.
9. YIELD (gpm): F O D1 '? TEST
)' ( Qo ten
10. WATER ZONES (depth):
LOCATIONSKECCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common road names.
T hic/Land setting
❑Ridge ' lope ❑Valley ❑Flat
( mproP box)
latitude/longitude of well location t i I
i,,( 3S 09 e yb-O/'Pilo 8H° i i 71-,
(d�eek )
Latitude/longitude source: GPS❑Topographic map
()
DRILLING LOG
Formation rescription
Snt
DEPTH
EPTH
,
iheetiw,r hovel ( �e
11. DISINFECTION: Type h Inc :'rt a Amount
12. CASING: Wall Thickness
'J Depth or Weight/Ft Material
From77 To &2T Ft& /Y �3'11Q0I 00C.
From_ To Ft.
From To Ft
13. GROUT: Depth
From B3 To0 Ft..
From 0 To .3 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:
Asheville Regional Office
Act }es PPirotecticn
0
I DO HEREBY CERTIFY THAT
CONSTRUCTIO
S WE1 S 1WAS CONSTRUIN ACCORDANCE WITH 15A NCAC 2C, WELL
C9PY OF sTfRS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
SIGNA
d
F PERSON CONSTRUCTING THE WELL DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-1 REV. 07/2001

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and l
Natural onurces - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (pried? lc 1la-e 'I �'`a Cl wfe CERTIFICATION) I�ft o2,
WELL CONTRACTOR COMPANY NAMETI life IA ) -1P0.tYhc/1 1WC� - PHONE iftZ2A. *2,9- 07 0
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable)
(if applicable)
r/ev€ 3LiS
I. WELL USE (Check Applicable Box): Resider . Mtn icipal/Public 0 Industrial 0 Agricultural ❑
Monitoring 0 Recovery 0 Heat Pump Wa Inj 'on 0 Other 0 If Other, List Use
2. WELL LOCATI : I t ,
Nearest Town:
c.
(Street Name, NJujmb s,,1Com'm�u1nity, Subdivirioo, Lot No., Zip Code)
3. OWNER �' �(kitl) � 1N1 t f)
Address LA C ['KS qn rca*k"\ )j 31134
County
ad:, J — Aer \ Code
Men code- Phone number/-_ 7 - o Co
4. DATE DRILLED (�
5. TOTAL DEPTH. 746)
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 Surfaces
`Top of easing terminated at/or below land surface requires a
variance In amp a with ISANCAC 2C.011S. /�� /��
9. YIELD (gpm): /'h MEXIIOD OF TEST/Ji ( w
10. WATER ZONE th): i 4U
T... ,.hic/Land setting
❑Ridge t 1 Slope Malley ❑Flat
(-. appropriate box)
Latitude/longitude of well location,
(dgg�Latitude/longitude seeandsPS❑T)opographic map
(chat box)
DEPTH DRILLING LOG
From To Formatiop Description
tP� 4l 113 t-L'
1 LOCATION SKETCH
11. DISINFECTION: Typist/lint 1 n P . Amotm 6� C u �$ Show direction and distance in miles from at least
12. CASING: Wall Thickness two State Roads or County Roads. Include the road
-d1 De$, Diametq can
i t /I numbers and common road names.
From To Ft . /d5
From To Ft.
From To Ft
13. GROUT: Depth Depth Y
From To `S Ft.
From 3 To.Q/C 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.
r_
r
0
0
a
16. REMARKS:
I DO HEREBY CERTIFY THtkT THIS WELL WAS CON
CONSTRUCfIO�hla// /
CIED IN ACCORDANCE WITH 15A NCAC 2C, WELL
r.
COPi i'THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
SIGNATURE OF PERSON CONSTRUCTING THE WELL
DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mall Service Center - Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-1 REV. 07/2001

Dw
E 3597
North Carolina
WELL CONSTRUCTION RECORD
- Department of Environment and N
WELL CONTRACTOR (INDIVIDUAL) NAM._,EimUt
WELL CONTRACTOR COMPANY NAME lazii '1 T✓� e✓
STATE WELL CONSTRUCTION PERM#
(if applicable)
7763
vision of Water Quality - Groundwater Sections
CERTIFICATION # ,32 21
T.�c— PHONE #fZ 36?-0-2t(7
AScOCIATED WQ PERMIT#
(if applicable)
1. WELL USE (('k Applicable Box): Residenti
Monitoring ❑ Recovery ❑ Heat Pump Water Inj
2. WET T LOCA N:
N faCn.
Municipal/Public ❑ Industrial ❑ Agricultural ❑
ion ❑ Other ❑ If Other, List Use
County _)ta.v11
(Street Name, Numbers, Community, Subdivision, lot No., Zip Code)
3. OWNER: S(UN1n1��
Address 1�j \
(Sumer a• Rare No.)
City sc Town (2t)- °4- ua Code
Area code- Phone number /
4. DATE DRILLED number/
c3'n%
5. TOTAL DEPTH: 3fl0
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO
7. STATIC WATER LEVEL Below Top of Casing: I/ 0 PT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS FT. Above Land Surface*
`Top of easing terminated atlor below land surface requires a
variance to aecordanc with 1SA NCAC 2C .0118.
9. YIELD (gpm): n OD F TEST ! `1�
10. WATER ZONES (depth):O
Latitude/longitude source
DEPTH
From To
Topographiclf and setting
❑Ridge ❑Slope alley ❑Flat
(check spprop • box)
Latitude/longitude of well location
N35°in 48.6" 1ooS3°)/ l?)-S'I
(ds6ses/seconds)
Ste; opographic map
DRILLING LOG
Fo.., : tit) Description
- 360 10(1
// + LOCATION SKETCH
11. DISINFECTION: Type(i,lOT 112 e _ Amount I (l. j) Show direction and distance in miles from at least
12. CASING: Wall Thiclmess two Mule' Ma —or unty ads. Include the road
Depth Weight/Ft �at�naI numbers and common road s.
From s a To ERG Ft % 5-Dea �litL }
From To FC ..
r.• 4`�1
CT)
iNL)
r
From To Ft I
13. GROUT: Depth - ,. t (7f L_ Method
From n To F _� __.._: If () t
From.! To �i__Ft Mb- a. p sI/(�*1
14. SCREEN: Depth Diameter Slot Size 1 Materal
From To Ft. in. in.
From To Ft in. in.
15. SAND/GRAVEL PACK
Depth Size Material
From To Ft.
From To Ft.
L
C
r)
N
m
16. REMARKS:
I DO HEREBY CERTIFY
CONSTRUCTION STAND
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

327762
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resouur��es ,- JDiy1"LSion of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) M 1 L 1 1 I `CC 0-- k.( CERTIFICATION N :31.1
Ee_
WELL CONTRACTOR COMPANY NAMAv\ U l .f yee�-'MVc 4ji C PHONE N %�� ;% & 1'(i ? Ili)
STATE WELL CONSTRUCTION PERMIT, ASSOCIATED WQ PERMIT/
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): ResidentiMunicipal/Public ❑ Industrial 0 Agricultural 0
Monitoring 0 Recovery ❑ Heat Pump Water In on 0 Other 0 If Other, List Use
2. WELL LOCATIO `'
Nearest To ) Cl County ; %i
(Street Name, Numbers, Cat, Subdivision, LotNo., try Code)
3. OWNER L—t�CrQ . Ttt S
Address fX �14 L
`�Y(Strtet3RC Na.)
Cc)►�
City or Town State
($(OV} a(v1.9bJ1
Area code Phone number
4. DATE DRILLED 23'O
5. TOTAL DEPTH: &C)
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO4*
7. STATIC WATER LEVEL Below Top of Casing: SOD
(Use''+" if Above Top of Casing)
8. TOP OF CASING IS / FT. Above Land Surface*
Zip Code
Topo hic/Land setting
❑Ridge Slope Malley ❑Flat
(check appropriate box)
Latitude/longitudeofwell location /I
(degraalminaes/aaooda)
Latitude/longitude source: GPS❑Topographic map
box)
DEPTH DRILLING LOG
From Formation Description
Sol i
('nta to
'Top of casing terminated at/or below land warfare requires a
variance in accordance with 15A NCAC 2C A11t A. n
9. YIELD (gpm): HD METHOD OF TEST/4 r' It()
10. WATER ZONES (depth): S70 19147 9
LOCATION SKETCH
Show direction and distance in miles from Wease,,
two State Roads or County Roads. Include
numbers and common road names.
11. DISINFECTION: Type 1n,t nt°
12. CASING:
Depth Diameter
From 1 I To k9 Ft
From To Ft.
From To Ft,
13. GROUT: Depth
From To..3 Ft.
From 3 To a L Ft.
14. SCREEN: Depth Diameter Slot Size
From To Ft. in. - in.
From_ To Ft. in. in.
15. SAND/GRAVEL PACK
Depth
From_ To Ft.
From To Ft.
Amount / a r u ns
Wall Thickness
or Weight/Ft
Sri) 1
Material
Size
Material
w
tv
Cr)
Cr%
16. REMARKS:
I DO HEREBY CERTIFY THAT
CONSTRUCTION STA'! [1ARD
1N ACCORDANCE WITH 15A NCAC 2C, WELL
RECORD HAS BEEN PROVIDED TO THE WELL OWNER
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

RESIDENTIAL WELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources- Division of Water Quality
WELL CONTRACTOR CERTIFICATION # 2597
338020
1. WELL CONTRACTOR:
GLENN MARTIN MATHIS JR.
Well Contractor (Individual) Name
AAA GREENE BROS. WELL DRLG. OF SYLVA, INC
Well Contractor Company Name
STREET ADDRESS 1800 SKYLAND DRIVE
SYLVA NC
City or Town State
( 828 )- 586-5550
Area code- Phone number
2. WELL INFORMATION:
SITE WELL ID #(if applicable) J59930W
STATE WELL PERMIT#(if applicable)
28779
Zip Code
DWQ or OTHER PERMIT #(if applicable) 7602-74-2635
WELL USE (Check Applicable Box): Residential Water Supply ID
DATE DRILLED 9/21/06
TIME COMPLETED 5:00
Am PM®
3. WELL LOCATION:
CITY: DILLSBORO COUNTY JACKSON
SUTTON BRANCH OFF 441
(Street Name, Numbers, Community, Subdivision, Lot No., Parcel, Zip Code)
TOPOGRAPHIC / LAND SETTING:
,ySlope ❑Valley ❑Flat ❑Ridge ❑Other
(check appropriate box)
LATITUDE 3
LONGITUDE
May be in degrees,
minutes, seconds or
in a decimal format
Latitude/longitude source: ❑GPS ❑Topographic map
(location of well must be shown on a USGS topo map and
attached to this form if not using GPS)
4. WELL OWNER
OWNER'S NAME LARRY BATES
STREET ADDRESS P.O. BOX 803
DILLSBORO NC 28725
City or Town State
( 828 )_ 507-0252
Area code - Phone number
5. WELL DETAILS:
a. TOTAL DEPTH: 350
Zip Code
b. DOES WELL REPLACE EXISTING WELL? YES ❑ NO
PD
c. WATER LEVEL Below Top of Casing: 90 FT.
(Use "+" if Above Top of Casing)
d. TOP OF CASING IS 1 FT. Above Land Surface*
*Top of casing terminated at/or below land surface may require
a variance in accordance with 15A NCAC 2C .0118.
e. YIELD (gpm): 4 METHOD OF TEST AIR
f.
9.
DISINFECTION: Type HTH Amount 15.75 OUNCES
WATER ZONES (depth):
From 270 To 273 From To
From To From
To From To
To
From
6. CASING:
Depth D
From 0 To 88 Ft 6#ter
From To Ft.
From To Ft.
Thickness/
Vcei
7. GROUT: Depth Material
From 0 To 3 Ft. CEMENT
From 3 To 20 Ft. BENTONITE
From To Ft.
Mat�rial
Method
TOP
PUMP WITH TRIM PPE
8. SCREEN: Depth Diameter Slot Size
From To Ft. in. in.
From To Ft. in. in,
From To Ft. in. in.
Material
9. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
From To Ft.
10. DRILLING LOG
From To Formation Description
0-83 CLAY/SAND
83-270 GRANITE
270-273 CAVITY
273-350
11. REMARKS:
GRANITE
Fit(in(1f CBi
OFWA1'hotF74 itiura
7€41 P ZUU'
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���" NER
-1 tab Z ,r -f i:7Io7
SIGNATURE OF CERTIFIED WELL CON CTOR DATE
GleleMt II \Actrit-h, MA44 5 Tr.
PRINTED NAME OF PERSON CONSTRUCTING THE WELL
Submit the original to the Division of Water Quality within 30 days. Attn: Information Mgt,
1617 Mail Service Center— Raleigh, NC 27699-1617 Phone No. [phone] ext 568.
Form GW-la
Rev. 7/05

RESIDENTIAL WELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources -Division of Water Quality
WELL CONTRACTOR CERTIFICATION # 2186
38021
1. WELL CONTRACTOR:
J.D. MCCURRY
Well Contractor (Individual) Name
AAA GREENE BROS. WELL DRLG. OF SYLVA, INC
Well Contractor Company Name
STREET ADDRESS 1800 SKYLAND DRIVE
SYLVA
City or Town
( 828 )- 586-5550
NC
State
Area code- Phone number
2. WELL INFORMATION:
SITE WELL ID #(it applicable) J58285W
STATE WELL PERMIT#(it applicable)
28779
Zip Code
DWQ or OTHER PERMIT #(if applicable) 7586-91-6293
WELL USE (Check Applicable Box): Residential Water Supply
DATE DRILLED 12/18/06
TIME COMPLETED 5:00 AM ❑ PM
3. WELL LOCATION:
CITY: TUCKASEEGEE COUNTY JACKSON
BEAR LAKE DR. SUMMITT HOUSE
(Street Name, Numbers, Community, Subdivision, Lot No., Parcel, Zip Code)
TOPOGRAPHIC / LAND SETTING:
DSlope ❑Valley m Flat ❑Ridge ❑Other
(check appropriate box)
LATITUDE 3
LONGITUDE
May be in degrees,
minutes, seconds or
in a decimal format
Latitude/longitude source: ❑GPS ❑Topographic map
(location of well must be shown on a USGS topo map and
attached to this form if not using GPS)
4. WELL OWNER
OWNER'S NAME CENTEX HOMES
STREET ADDRESS MAIN STREET
SYLVA, NC 28779
City or Town State Zip Code
( 828 ). 506-2400
Area code - Phone number
5. WELL DETAILS:
a. TOTAL DEPTH: 1000
b. DOES WELL REPLACE EXISTING WELL? YES 0 NO
c. WATER LEVEL Below Top of Casing: 250 FT
(Use "+" if Above Top of Casing)
d. TOP OF CASING IS 1 FT. Above Land Surface'
'Top of casing terminated at/or below land surface may require
a variance in accordance with 15A NCAC 2C .0118.
e. YIELD (gpm): 2 METHOD OF TEST AIR
f. DISINFECTION: Type HTH
Amount 45 OUNCES
g. WATER ZONES (depth):
From 400 To 403 From To
From To From To
From To From To
6. CASING:
��mt�ee Thickness/
From 0 DToth 67 Ft. 6DD��1/4"ter St ; al
From To Ft.
From To Ft.
7. GROUT: Depth Material
From U To 3 Ft. CEMENT
From 3 To 20 Ft. BENTONITE
From To Ft.
Method
TOP
PUMPWIM ThMPNE
8. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in.
From To Ft. in. in.
From To Ft. in. in.
9. SAND/GRAVEL PACK:
Depth
From To
From To
Ft.
Ft.
From To Ft.
Size Material
10. DRILLING LOG
From To
0-62
62-400
400-403
403-1000
11. REMARKS:
Formation Description
SAND
GRANITE
CAVITY
GRANITE
711, Or ✓ �Kcu
(a(Ire
ELi 1 p 200?
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.
rn r Csnro7-c7
SIGNATURE OF CERTIFIED WELL CONTRACTOR DATE
7D MCA
PRINTED NAME OF PERSON OONSTRUCTING THE WELL
Submit the original to the Division of Water Quality within 30 days. Attn: Information Mgt.,
1617 Mail Service Center — Raleigh, NC 27699-1617 Phone No. [phone] ext 568.
Form GW-la
Rev. 7/05

RESIDENTIAL WELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources -Division of Water Quality
WELL CONTRACTOR CERTIFICATION # 2186
338022
1. WELL CONTRACTOR:
J.D. MCCURRY
Well Contractor (Individual) Name
MA GREENE BROS. WELL DRLG. OF SYLVA, INC
Well Contractor Company Name
STREET ADDRESS 1800 SKYLAND DRIVE
SYLVA NC
City or Town State
( 828 )- 586-5550
Area code- Phone number
2. WELL INFORMATION:
SITE WELL ID #(if applicable) J60581W
STATE WELL PERMIT#(if applicable)
28779
Zip Code
DWQ or OTHER PERMIT #(if applicable) 7568-93-3297
WELL USE (Check Applicable Box): Residential Water Supply 10
DATE DRILLED 9/18/06
TIME COMPLETED 5:00 AM ❑ PM ID
3. WELL LOCATION:
CITY: TUCKASEEGEE COUNTY JACKSON
STAGHORNE ROAD OFFHWY 107
(Street Name, Numbers, Community, Subdivision, Lot No., Parcel, Zip Code)
TOPOGRAPHIC / LAND SETTING:
❑Slope El Valley cFlat ❑Ridge DOther
(check appropriate box)
LATITUDE 3
LONGITUDE
May be in degrees,
minutes, seconds or
in a decimal format
Latitude/longitude source: ❑GPS ❑ Topographic map
(location of well must be shown on a USGS topo map and
attached to this form if not using GPS)
4. WELL OWNER
OWNER'S NAME JIM TRUSTY
STREET ADDRESS 1711 NORTH PINE RIDGE DRIVE
LAPORTE, IN 46350
City or Town State Zip Code
( 219 )- 363-3604
Area code - Phone number
5. WELL DETAILS:
a. TOTAL DEPTH: 350
b. DOES WELL REPLACE EXISTING WELL? YES ❑ NO
c. WATER LEVEL Below Top of Casing: 40 FT.
(Use -+" if Above Top of Casing)
d. TOP OF CASING IS 1 FT. Above Land Surface*
*Top of casing terminated at/or below land surface may require
a variance in accordance with 15A NCAC 2C .0118.
e. YIELD (gpm): 30 METHOD OF TEST AIR
f. DISINFECTION: Type HTH Amount 15.75 OUNCES
g. WATER ZONES (depth):
From 200 To 2023 From 310 To 313
From To From To
From To From To
6. CASING:
From 0 Depth
53 Ft. 61/4gter
From To Ft.
From To Ft.
Thickness/ Nor
S64M PVL: al
7. GROUT: Depth Material
From 0 To 3 Ft.CEMENT
From 3 To 20 Ft. BENTONITE
From To Ft.
Method
TOP
PUMP NTH TRIM PIPE
8. SCREEN: Depth Diameter Slot Size
From To Ft. in. in.
From To Ft. in. in.
From To Ft. in. in.
9. SAND/GRAVEL PACK:
Depth Size
From To Ft.
From To Ft.
From To Ft.
Material
Material
10. DRILLING LOG
From To Formation Description
0-48 CLAY
48-200 GRANITE
200-203 CAVITY
203-310 GRANITE
310-313 CAVITY
313-350 GRANITE
11. REMARKS:
ivEu
Lai V. t )a- tit/H 1 ER IJLIALU I 1
FEI3 1 "4 200?
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.
Cvr
SIGNATURE OF CERTIFIED WELL CONTRACTOR DATE
5N me G-L
PRINTED NAME OF PERSON CO STRUCTING THE WELL
Submit the original to the Division of Water Quality within 30 days. Attn: Information Mgt.,
1617 Mail Service Center — Raleigh, NC 27699-1617 Phone No. [phone] ext 568.
Form GW-la
Rev. 7/05

RESIDENTIAL WELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources- Division of Water Quality
WELL CONTRACTOR CERTIFICATION # 2186
1. WELL CONTRACTOR:
J.D. MCCURRY
Well Contractor (Individual) Name
AAA GREENE BROS. WELL DRLG. OF SYLVA, INC
Well Contractor Company Name
STREET ADDRESS 1800 SKYLAND DRIVE
SYLVA NC
City or Town State
( 828 )- 586-5550
Area code- Phone number
2. WELL INFORMATION:
SITE WELL ID #(if applicable) J61195W
28779
Zip Code
STATE WELL PERMIT#(if applicable)
DWQ or OTHER PERMIT #(if applicable) 7587-03-5186
WELL USE (Check Applicable Box): Residential Water Supply
El
DATE DRILLED 12/12/06
TIME COMPLETED 5:00 AM ❑ PM
3. WELL LOCATION:
CITY: TUCKASEEGEE
281 OF HWY 107
COUNTY JACKSON
(Street Name, Numbers, Community, Subdidsion, Lot No., Parcel, Zip Code)
TOPOGRAPHIC / LAND SETTING:
❑Slope ❑Valley ❑Flat 8)Ridge ❑Other
(check appropriate box)
LATITUDE 3
LONGITUDE
May be in degrees,
minutes, seconds or
in a decimal format
Latitude/longitude source: DGPS ❑Topographic map
(location of well must be shown on a USGS topo map and
attached to this form if not using GPS)
4. WELL OWNER
OWNER'S NAME EDRIA HEFFNER
STREET ADDRESS 317 CEDAR VALLEY ROAD
TUCKASEEGEE, NC 28783
City or Town State
( 828 )_ 293-9242
Area code - Phone number
S. WELL DETAILS:
a. TOTAL DEPTH: 250
Zip Code
b. DOES WELL REPLACE EXISTING WELL? YES O NO
c. WATER LEVEL Below Top of Casing: 30 FT
(Use'+^ if Above Top of Casing)
d. TOP OF CASING IS 1 FT. Above Land Surface'
*Top of casing terminated at/or below land surface may require
a variance in accordance with 15A NCAC 2C .0118.
e. YIELD (gpm): 20 METHOD OF TEST AIR
338023
f. DISINFECTION: Type HTH Amount 11.25 OUNCES
9. WATER ZONES (depth):
From 220 To 223 From
To
From To From
To
From To From To
6. CASING:
Fromm 0 Material
FroPVl
From
Depth
To 23 Ft. bpgter
To Ft.
To Ft.
Thickness/
S�iV�Zt
7. GROUT: Depth Material Method
From 0 To 3 Ft. CEMENT TOP
From 3 To 20 Ft. BENTONITE
From To Ft.
8. SCREEN: Depth Diameter Slot Size
From To Ftin. in.
From To Ft. in.
in.
From To Ft. in.
in.
9. SAND/GRAVEL PACK:
Depth Size Material
From To Ft. ....
From To Ft.
PUMP WITH MN PIPE
Material
From To Ft.
10. DRILLING LOG
From To Formation Description
0-18 CLAY
18-220 GRANITE
220-223 CAVITY
223-250 GRANITE
E 1 i 9 21111:/
11. 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 - rr 1 (r/�ry 2 -,,.7 "0 %
SIGNATURE OF CERTIFIED WELCCONTRACTOR DATE
T'D M4- Cu t-
PRINTED NAME OF PERSON CONSTRUCTING THE WELL
Submit the original to the Division of Water Quality within 30 days. Attn: Information Mgt.,
1617 Mail Service Center— Raleigh, NC 27699-1617 Phone No. [phone] ext 568.
Form GW-la
Rev. 7/05

NONRESIDENTIAL WELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources -Division of Water Quality
WELL CONTRACTOR CERTIFICATION # 2597
1. WELL CONTRACTOR:
GLENN MARTIN MATHIS JR.
Well Contractor (Individual) Name
AAA GREENE BROS. WELL DRLG OF SYLVA, INC.
Well Contractor Company Name
STREET ADDRESS 1800 SKYLAND DRIVE
SYLVA NC 28779
City or Town State
( 828 )_ 586-5550
Area code- Phone number
2. WELL INFORMATION:
SITE WELL ID #(if applicable)
STATE WELL PERMIT#(if applicable)
Zip Code
DWQ or OTHER PERMIT #(if applicable)
WELL USE (Check Applicable Box) Monitoring p Municipal/Public ❑
Industrial/Commercial M Agricultural ❑ Recovery ❑ Injection ❑
Irrigation❑ Other 0 (list use)
DATE DRILLED 10/12/06
TIME COMPLETED 5:00 AM ❑ PM M
3. WELL LOCATION:
CITY: CASHIERS COUNTY JACKSON
NORTON ROAD TO TRILLIUM LINKS
(Street Name, Numbers, Community, Subdivision, Lot No., Parcel, Zip Code)
TOPOGRAPHIC / LAND SETTING:
lope ❑ Valley ❑ Flat 0 Ridge ❑ Other
(check appropriate box)
LATITUDE 3
LONGITUDE
May be in degrees,
minutes, seconds or
in a decimal format
Latitude/longitude source: ❑ CPS ❑ Topographic map
(location of well must be shown on a USGS opo map and
attached to this form if not using GPS)
4. FACILITY- is the name of the business where the well is located.
FACILITY ID #(if applicable)
NAME OF FACILITY TRILLIUM LINKS
STREET ADDRESS 1 TRILLIUM CENTER
CASHIERS NC 28717
City or Town State
CONTACT PERSON PHIL WARD
Zip Code
MAILING ADDRESS 1 TRILLIUM CENTER
CASHIERS NC 28717
City or Town State Zip Code
( 828 )_ 743-9951
Area code - Phone number
5. WELL DETAILS:
a. TOTAL DEPTH: 725
b. DOES WELL REPLACE EXISTING WELL? YES ❑ NO
c. WATER LEVEL Below Top of Casing: 60 FT.
(Use "+" if Above Top of Casing)
338025
d. TOP OF CASING IS 2 FT. Above Land Surface'
*Top of casing terminated at/or belay land surface may require
a variance in accordance with 15A NCAC 2C .0118.
e. YIELD (gpm): 5 METHOD OF TEST AIR
f. DISINFECTION: Type HTH Amount ]2.630UNCE5
g. WATER ZONES (depth):
From 220 To 223 From
To
From To From To
From To From To
6. CASING:
Depth Thickness/ M
From 0 p 53 84iameter Weinht ye
To Ft. :250
From To Ft.
From To Ft.
7. GROUT: Depth Material Method
From 0 To 53 Ft CEMENT Pump
From To Ft.
From To Ft.
8. SCREEN: Depth Diameter Slot Size Material
From To Ft in. _ in.
From To Ft in.
in.
From
To Ft. in. in.
9. SAND/GRAVEL PACK:
Depth
From To Ft.
From To Ft.
From To Ft.
10. DRILLING LOG
From To Formation Description
0-48 SAND
48-220 GRANITE
220-223 CAVITY
223-725 GRANITE
Size Material
11. REMARKS:
RFCFIUFf
r111/ OFWATFROIfALITY
FEB 1 2 2007
100 HERESY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH
15A NCAC 2C, WELL CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS
RE ORD HAS BEEN PROVIDED TO THE W LL0 ER
r YIcJ„ yaazz (/J / a c'g v7
SIGNATURE OF CERTIFIED+4WELL C'l§,NTRACTOR DATE
C t eAM MCA4, —44 j .T
PRINTED NAME OF PERSON CONSTRUCTING THE WELL
Submit the original to the Division of Water Quality within 30 days. Attn: Information Mgt.,
1617 Mail Service Center— Raleigh, NC 27699.1617 Phone No. [phone] ext 568.
Form G W-1 b
Rev. 7/05

NONRESIDENTIAL WELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources- Division of Water Quality
WELL CONTRACTOR CERTIFICATION # 2;$`<) 7 3 3 8 0 2 6
1. WELL CONTRACTOR:
1.1)Evih Mar ry10.f'hi5 3R
Well Contractor (Individual) Name
AAA GREENE BROS. WELL DRLG OF SYLVA, INC.
Well Contractor Company Name
STREET ADDRESS 1800 SKYLAND DRIVE
SYLVA NC 28779
City or Town State Zip Code
586-5550
Area code- Phone number
2. WELL INFORMATION:
SITE WELL ID #(if applicable)
STATE WELL PERMIT#(if applicable)_—�
DWQ or OTHER PERMIT #(if applicable)_
WELL USE (Check Applicable Box) Monitoring ❑ Municipal/public
Industrial/Commercial m Agricultural ❑ Recovery ❑ Injection 0
Irrigation❑ Other ❑ (list use)_
DATE DRILLED 5/16/05
TIME COMPLETED 5_00
3. WELL LOCATION:
CITY: GLENVILLE
FLAT MTN ROAD
(Street Name, Numbers, Community, SubdiNsion, Lot No., Parcel, Zip Corte)
TOPOGRAPHIC / LAND SETTING:
CI Slope ❑Valley ®Flat ❑Ridge ❑ Other
(check appropriate box)
LATITUDE 3
AM ❑ PM
COUNTYJACKSON
Zip Code
Depth
To 57
To Ft
To Ft.
Depth
To 57
To
To
Depth
Thickness/
Diameter W iuhO Material
Ft, 8/A,7SSTEEL
Material
Ft. CEMENT
Ft.
Ft.
Diameter Slot Size Material
Ft. in. in.
Ft. in. in.
Ft. in, in.
Ft.
Ft.
Ft.
Size Material
Method
um
Formation Desceiptibo; ^7
SAND
GRANITE
CAVITY
GRANITE
CAVITY
GRANITE
CAVITY
GRANITE
CAVITY
GRANITE
ThEchillEtr—
d. TOP OF CASING IS 2 FT. Above Land Surface*
`Top of casing terminated at/or below land surface may require
a variance in accordance with 15A NCAC 2C .0118.
e. YIELD (gpm): 200+ METHOD OF TEST AIR
f. DISINFECTION: Type HTH
g.
WATER ZONES (depth):
From 90 To 93
From570 To 573
From
CASING:
From 0
From
From
7. GROUT:
From 0
From
From
8. SCREEN:
From To
From To
From To
9. SAND/GRAVEL PACK:
Depth
From To
From To
From To
10. DRILLING LOG
From To
0-52
52--
9n-Q3
93-26_ 0
260-26 3
263-57p
570-574
Amount
27 OUNCES
From 260 To 263
From 590 To 593
To From To 593
590-593
593-600
11. 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
RFiGO D HArS1 BEEN PLOVIDED TO THE,W�LL OWNER.
SIGNATURE OF CERTIFIED WELL C NTRACTOR Og DA67
TE
GICt\h MfAc"")-1C^ MG iy if 7r
PRINTED NAME OF PERSON CONSTRUCTING THE WELL
Submit the original to the Division of Water Quality within 30 days. Attn: Information Mgt.,
1617 Mail Service Center —Raleigh, NC 27699.1617 Phone No. [phone] ext 568.
May he in degrees,
LONGITUDE minutes, seconds or
— — in a decimal format
Latitude/longitude source: ❑GPS Topographic map
(location of well must be shown on a USGS topo map and
attached to this form if not using GPS)
4. FACILITY_ is the name of the business where the well is located.
FACILITY ID #(if applicable)
NAME OF FACILITY TRILLIUM
STREET ADDRESS 1 TRILLIUM CENTER
CASHIERS NC 28717
City or Town State
Zip Code
CONTACT PERSON PHIL WARD
MAILING ADDRESS 1 TRILLIUM CENTER
CASHIERS NC 28717
City or Town State
8( 28 )_ 743-9951
Area code - Phone number
5. WELL DETAILS:
a. TOTAL DEPTH: 600
b. DOES WELL REPLACE EXISTING WELL.? YES ❑ NO
c. WATER LEVEL Below Top of Casing: 30
(Use'+• if Above Top of Casing) FT.
Form GW-lb
Rev. 7/05

NONRESIDENTIAL WELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources -Division of Water Quality
WELL CONTRACTOR CERTIFICATION # ASY.r
33 3027
1. WELL CONTRACTOR:
.term N%ovhn mYl ils Jp,
Well Contractor (Individual) Name
AAA GREENE BROS. WELL DRLG OF SYLVA, INC.
Well Contractor Company Name
STREET ADDRESS 1800 SKYLAND DRIVE
SYLVA NC 28779
City or Town State Zip Code
82( 8 y 586-5550
Area code- Phone number
2. WELL INFORMATION:
S ITE WELL ID #(if applicable)
STATE WELL PERMIT#(if applicable)
DWQ or OTHER PERMIT #(if applicable)
WELL USE (Check Applicable Box) Monitoring ❑ Municipal/Public ❑
Industrial/Commercial m Agricultural ID Recovery ❑ Injection ❑
Irrigationp Other ❑ (list use)
DATE DRILLED 5/16/05
TIME COMPLETED 5:00
3. WELL LOCATION:
CITY: CASHIERS
AMO PMM
COUNTY JACKSON
NORTON ROAD TO TRILLIUM
(Street Name, Numbers, Community, Subdivision, Lot No., Parcel, Zip Code)
TOPOGRAPHIC / LAND SETTING:
❑Slope ❑Valley mFlat ❑Ridge ❑ Other
(check appropriate box)
LATITUDE 3
LONGITUDE
May be in degrees,
minutes, seconds or
in a decimal format
Latitude/longitude source: ❑GPS ❑Topographic map
(location of well must be shown on a USGS opo map and
attached to this Tom' if not using GPS)
4. FACILITY- is the name of the business where the well is located.
FACILITY ID #(if applicable)
NAME OF FACILITY TRILLIUM
STREET ADDRESS 1 TRILLIUM CENTER
CASHIERS NC 28717
City or Town State
CONTACT PERSON PHIL WARD
Zip Code
MAILING ADDRESS 1 TRILLIUM CENTER
CASHIERS NC 28717
City or Town State
82( 8 1. 743-9951
Area code - Phone number
5. WELL DETAILS:
a. TOTAL DEPTH: 750
Zip Code
b. DOES WELL REPLACE EXISTING WELL? YES ❑ NO
c. WATER LEVEL Below Top of Casing: 40 FT.
(Use °+• if Above Top of Casing)
d. TOP OF CASING 15 2 FT. Above Land Surface*
Top of casing terminated at/or below land surface may require
a variance in accordance with 15A NCAC 2C .0118.
e. YIELD (gpm): 125 METHOD OF TEST AIR
f. DISINFECTION: Type HTH Amount 38.25 DUNCES
g- WATER ZONES (depth):
From 120 To 123 From 280 To 283
From 390 To 393 From
To
From To From To
6. CASING: Thickness/
DepthpQiameter W i ht Material
From e
0 Ft.B
� STEEL
From To Ft
From To Ft.
7. GROUT:
From 0
From
From
8. SCREEN:
From
Depth
To 53
To
To
Material
Ft. CEMENT
Ft.
Ft.
Method
Depth Diameter Slot Size Material
To Ft in. in.
From To Ft. In. _ in.
From To Ft. in.
in.
9. SAND/GRAVEL PACK:
Depth
From To Ft.
From To Ft.
From To Ft.
10. DRILLING LOG
From To
0-48
48-120
120-12`_
123-280
280-283
283-390
190-393
393-750
11. REMARKS:
Size Material
.ui
Formation Description
$AND
GRANITE
CAVITY
GRANITE
CAVITY
GRANITE
CAVITY
GRANITE
RECEIVED
100 HEREBY CERTIFY THAT THIS WELL WAS CONSTRU - INA OIib WITH
15A NCAC 2C, WELL CONSTRUCTION STANDARDS, AND THATA COPY OF THIS
RECOR^HAS BEEN PROVIDED TO EWEy'LOWNER. al ark?
SIGNATURE OF CSCC(EERTTIIFI�IEED��TMWWELLLJyCO�TRACTOR VC DATE
�IP.n N V'vo-1-1 Ma -tms Tr.
PRINTED NAME OF PERSON CONSTRUCTING THE WELL
Submit the original to the Division of Water Quality within 30 days. Attn: Information Mgt.,
1617 Mail Service Center— Raleigh, NC 27699-1617 Phone No. [phone] ext 568.
Form GW-lb
Rev. 7/05

NONRESIDENTIAL WELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources -Division of Water Quality
WELL CONTRACTOR CERTIFICATION # o KVV
1. WELL CONTRACTOR:
()Tenn A lar1m YYlR,gilis JR.
Well Contractor (Individual) Name
AAA GREENE BROS. WELL DRLG OF SYLVA, INC.
Web Contractor Company Name
STREET ADDRESS 1800 SKYLAND DRIVE
SYLVA NC 28779
City or Town State Zip Code
( 828 )- 586-5550
Area code- Phone number
2. WELL INFORMATION:
SITE WELL ID #(if applicable)
STATE WELL PERMIT#(if applicable)
DWQ or OTHER PERMIT #(if applicable)
WELL USE (Check Applicable Box) Monitoring 0 Municipal/Public 0
Industrial/Commercial p Agricultural 0 Recovery ❑ Injection ❑
Irrigation Other 0 (list use)
DATE DRILLED 11/01/05
TIME COMPLETED 5:00 AM 0 PM E
3. WELL LOCATION:
CITY: CASHIERS COUNTY JACKSON
BREEDLOVE ROAD OFF CEDAR CREEK
(Street Name, Numbers, Community. Subdivision, Lot No., Parcel, Zip Code)
TOPOGRAPHIC / LAND SETTING:
❑Slope ❑Valley IDFlat ORidge 0 Other
(check appropriate box)
LATITUDE 3
LONGITUDE
May be in degrees,
minutes, seconds or
in a decimal format
Latitude/longitude source: ❑GPS ❑Topographic map
(location of well must be shown on a USGS opo map and
attached to this form if not using GPS)
4. FACILITY- is the name of the business where the well is located.
FACILITY ID #(if applicable)
NAME OF FACILITY TRILLIUM
STREET ADDRESS 1 TRILLIUM CENTER
CASHIERS NC 28717
City or Town State
CONTACT PERSON PHIL WARD
Zip Code
MAILING ADDRESS 1 TRILLIUM CENTER
CASHIERS NC 28717
City or Town State
( 828 )- 743-9951
Area code - Phone number
5. WELL DETAILS:
a. TOTAL DEPTH: 800
Zip Cade
b. DOES WELL REPLACE EXISTING WELL? YES 0 NO E
c. WATER LEVEL Below Top of Casing: 60
(Use "+" if Above Top of Casing)
FT.
d. TOP OF CASING IS 2 FT. Above Land Surface*
'Top of casing terminated at/or below land surface may require
a variance in accordance with 15A NCAC 2C .0118.
e. YIELD (gpm): 45 METHOD OF TEST AIR
f. DISINFECTION: Type HTH Amount
g. WATER ZONES (depth):
From 200 To 203
From 325
From To From To
36 OUNCES
To 328
From To From To
6. CASING: am Thickness/ f�1 (e
From 0 Depth
Ft fi 1/4'yter W,te�t STEgL
From To Ft.
From To Ft.
7. GROUT: Depth Material Method
From 0 To 53 Ft. CEMENT 00 In P
From To Ft.
From To Ft.
8. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. _ in.
From To Ft. in. in.
From To Ft. in. in.
9. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
From To Ft.
10. DRILLING LOG
From To Formation Description
0-48 SAND
48-200 GRANITE
200-203 CAVITY
203-325 GRANITE
325-328
CAVITY
328-800 GRANITE
11. REMARKS:
RECEIVED
OIV. OF WATER OLAWY
i3 1 d 2007
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH
15A NCAC 2C, WELL CONSTRUCTION STANDARDS. AND THATA COPY OF THIS
RERD HAS BEEN PROVIDED TO THE W ErtL OWNER.
rvy
07
SIGNATURE OF CERTIFIED WELL C(YNTRACTOR ABATE
eAtv, kocckk, me is s„
PRINTED NAME OF PERSON CONSTRUCTING THE WELL
Submit the original to the Division of Water Quality within 30 days. Attn: Information Mgt.,
1617 Mail Service Center— Raleigh, NC 27699-1617 Phone No. [phone] ext 568.
Form GW-1 b
Rev. 7/05

RESIDENTIAL WELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources -Division of Water Quality
WELL CONTRACTOR CERTIFICATION # 3041
V
032
1. WELL CONTRACTOR:
PAUL BRYANT BRUCE
Well Contractor (Individual) Name
AAA GREENE BROS. WELL DRLG. OF SYLVA, INC
Well Contractor Company Name
STREET ADDRESS 1800 SKYLAND DRIVE
SYLVA NC
City or Town State
( 828 )- 586-5550
Area code- Phone number
2. WELL INFORMATION:
SITE WELL ID #(if applicabe) J61513W
28779
Zip Code
STATE WELL PERMIT#(if applicable)
DWQ or OTHER PERMIT #(if applicable) 7623-67-8133
WELL USE (Check Applicable Box): Residential Water Supply
DATE DRILLED 12/6/06
TIME COMPLETED 5:00 AM ❑ PM
3. WELL LOCATION:
CITY: CHEROKEE COUNTY JACKSON
BLACK BEAR FALLS LOT 10 SECTION 1
(Street Name, Numbers, Community, Subdivision, Lot No., Parcel, Zip Code)
TOPOGRAPHIC / LAND SETTING:
pope 0Valley ❑Flat ❑Ridge ID Other
(check appropriate box)
LATITUDE 3
LONGITUDE
Latitude/longitude source: ❑GPS ❑Topographic map
(location of well must be shown on a USGS topo map and
attached to this form if not using GPS)
4. WELL OWNER
OWNER'S NAME ULTIMA CAROLINA
May be in degrees,
minutes, seconds or
in a decimal format
STREET ADDRESS 52 BRENKENRIDGE ROAD
WAYNESVILLE, NC 28785
City or Town State Zip Code
( 828 )- 454-9360
Area code - Phone number
5. WELL DETAILS:
a. TOTAL DEPTH: 850
b. DOES WELL REPLACE EXISTING WELL? YES ❑ NO El
c. WATER LEVEL Below Top of Casing: 60 FT.
(Use "+• if Above Top of Casing)
d. TOP OF CASING IS 1 FT. Above Land Surface*
'Top of casing terminated at/or below land surface may require
a variance in accordance with 15A NCAC 2C .0118.
e. YIELD (gpm): 15 METHOD OF TEST AIR
f. DISINFECTION: Type HTH Amount 30.25 OUNCES
g. WATER ZONES (depth):
From 210 To 213
From 415
To 418
From To From To
From To From To
6. CASING: Dame Thickness/ Mate[la�
From 0 Depth
Ft. 67/4"ter W188t STEtI
From To Ft.
From To Ft.
7. GROUT: Depth Material Method
From U To 3 Ft. CEMENT TOP
From 3 To 20 Ft. BENTONITE o�Mem=.*aIMPer
From To Ft.
8. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in.
From To Ft. in. in.
From To Ft. in. in.
9. SANDIGRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
From To Ft.
10. DRILLING LOG
From To Formation Description
0-90 CLAY . .
90-210 GRANITE
210-213
213-415
415-418
418-850
11. REMARKS:
CAVITY
GRANITE
CAVITY
GRANITE
KEG,
DIV pFWRIkRQUALITY
FEB 1 2 ZOO
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH
15A NCAC 2C. WELL CONSTRUCTION STANDARDS, AND THATA COPY OF THIS
RECORDBEEN PROVIDED T$YfFII WELL OWMSR
SIC, NATURE OF CERTIFIED
2 --go"
ELL CONTRACTOR DATE
PRINTED NAME OF PERSON CONSTRUCTING THE WELL
Submit the original to the Division of Water Quality within 30 days. Attn: Information Mgt.,
1617 Mail Service Center - Raleigh, NC 27699-1617 Phone No. [phone] ext 568.
Form GW-1a
Rev. 7/05

RESIDENTIAL WELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources- Division of Water Quality
WELL CONTRACTOR CERTIFICATION # 3041
1. WELL CONTRACTOR:
PAUL BRYANT BRUCE
Well Contractor (Individual) Name
AAA GREENE BROS. WELL DRLG. OF SYLVA, INC
Well Contractor Company Name
STREET ADDRESS 1800 SKYLAND DRIVE
SYLVA NC
City or Town State
( 828 ). 586-5550
Area code- Phone number
2. WELL INFORMATION:
SITE WELL ID #(if applicable) J60512W
STATE WELL PERMIT#(if applicable)
28779
Zip Code
DWQ or OTHER PERMIT #(if applicable) 7614-50-9666
WELL USE (Check Applicable Box): Residential Water Supply ID
DATE DRILLED 11/14/06
TIME COMPLETED 5:00 AM 0 PM
3. WELL LOCATION:
CITY: CHEROKEE
COUNTY JACKSON
MTN. VIEW ESTATES LOT 7 OFF SUNSET FARMS
(Street Name, Numbers, Community, Subdiysion, Lot No., Parcel, Zip Code)
TOPOGRAPHIC / LAND SETTING:
.Slope DValley ❑Flat ❑Ridge DOther
(check appropriate box)
LATITUDE 3
LONGITUDE
May be in degrees,
minutes, seconds or
in a decimal format
Latitude/longitude source: ❑GPS ❑Topographic map
(location of well must be shown on a USGS topo map and
attached to this (oml if not using GPS)
4. WELL OWNER
OWNER'S NAME AUTOMOTIVE BUSINESS CONSULTANTS
STREET ADDRESS 5353 N. FEDERAL HWY SUITE 2
LAUDERDALE BY THE SEA, FL 33308
City or Town State
( 828 )- 226-2197
Area code - Phone number
5. WELL DETAILS:
a. TOTAL DEPTH: 750
Zip Code
b. DOES WELL REPLACE EXISTING WELL? YES ❑ NO al
c. WATER LEVEL Below Top of Casing: 100 FT.
(Use "+" if Above Top of Casing)
d. TOP OF CASING IS 1 FT. Above Land Surface'
`Top of casing terminated at/or below land surface may require
a variance in accordance with 15A NCAC 2C .0118.
e. YIELD (gpm): 4 METHOD OF TEST AIR
f. DISINFECTION: Type HTH
Amount 33.75 OUNCES
g. WATER ZONES (depth):
From 125 To 128 From To
From To From To
From To From To
6. CASING:
From 0 Depth
29 Ft. s OOlta4ter
From To Ft.
From To Ft.
� Thickness/
S8�hZ1tMalarial
7. GROUT: Depth Material
From 0 To 3 Ft. CEMENT
From 3 To 20 Ft. BENTONITE
From To Ft.
8. SCREEN:
From
From
From
Method
TOP
PUMP WITH TRIM PIPE
Depth Diameter Slot Size Material
To Ft. in. in.
To Ft. in. in.
To Ftin. in.
9. SAND/GRAVEL PACK:
Depth
From
Size Material
To Ft.
From To Ft.
From To Ft.
10. DRILLING LOG
From To
0-24
24-125
125-128
128-750
11. REMARKS:
Formation Description
CLAY
GRANITE
CAVITY
GRANITE
DN. �R �NPTER Q
kel
=E13 I z VW
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 S B EN PROVIDED) THE WELL QWNER.
S NATURE OF CERTIFIED WELL CONTRACTOR DATE
,,/�-1C-2
RINTED NAME OF PERSON CONSTRUCTING THE WELL
Submit the original to the Division of Water Quality within 30 days. Attn: Information Mgt.,
1617 Mail Service Center— Raleigh, NC 27699-1617 Phone No. [phone] ext 568.
Form GW-la
Rev. 7/05
3

RESIDENTIAL WELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources- Division of Water Quality
WELL CONTRACTOR CERTIFICATION # 3041
1. WELL CONTRACTOR:
PAUL BRYANT BRUCE
Well Contractor (Individual) Name
AM GREENE BROS. WELL DRLG. OF SYLVA, INC
Well Contractor Company Name
STREET ADDRESS 1800 SKYLAND DRIVE
SYLVA
City or Town
( 828 )_ 586-5550
NC
State
Area code- Phone number
2. WELL INFORMATION:
SITE WELL ID #(if applicable) J60876W
28779
Zip Code
STATE WELL PERMIT#(if applicable)
DWQ or OTHER PERMIT #(if applicable) 7555-86-0973
WELL USE (Check Applicable Box): Residential Water Supply E
DATE DRILLED 10/23/06
TIME COMPLETED 5:00 AM ❑ PM
3. WELL LOCATION:
CITY: SPEEDWELL COUNTY JACKSON
CEDAR CLIFF FARMS LOT 30
(Street Name, Numbers. Community, Subdivision, Lot No., Parcel, Zip Code)
TOPOGRAPHIC / LAND "SclOpe [Valley ❑Flat ❑Ridge DOther
(check appropriate box)
LATITUDE 3
LONGITUDE
May be in degrees,
minutes, seconds or
in a decimal format
Latitude/longitude source: ❑GPS ❑Topographic map
(location of well must be shown on a USGS topo map and
attached to this form if not using GPS)
4. WELL OWNER
OWNER'S NAME MEL LIVERNOIS
STREET ADDRESS P.O. BOX 1807
CULLOWHEE, NC 28723
City or Town State
( 954 )- 224-6373
Area code - Phone number
5. WELL DETAILS:
a. TOTAL DEPTH: 950
Zip Code
b. DOES WELL REPLACE EXISTING WELL? YES 0 NO 81
c. WATER LEVEL Below Top of Casing: 435 FT
(Use "+" if Above Top of Casing)
d. TOP OF CASING IS 1 FT. Above Land Surface*
*Top of casing terminated at/or below land surface may require
a variance in accordance with 15A NCAC 2C .0118.
e. YIELD (gpm): 60 METHOD OF TEST AIR
f. DISINFECTION: Type HTH
g. WATER ZONES (depth):
From 927 To 930
Amount 42.75 OUNCES
From To
From To From To
From To From To
6. CASING:
From 0 Depth
21 Ft. 61/4"ter
From To Ft.
From To Ft.
Thickness/
NSBii?1 Hateful
7. GROUT: Depth Material
FromFrom 0 To 3 Ft. CEMENT
3 To 20 Ft. BENTONITE
From To Ft.
Method
TOP
PUMP WITH TRIM PPE
8. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in.
From To Ft. in. in.
From To Ft. in. in.
9. SAND/GRAVEL PACK:
Depth
From To
From To
From To
Size Material
Ft.
Ft.
Ft.
10. DRILLING LOG
From To Formation Description
0-16 CLAY
16-927 GRANITE
927-930 CAVITY
930-950 GRANITE
11. REMARKS:
REC_.
DN. OF IMFTER ©IIALIT!
FEU 1 2 ZUUi
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH
I5A NCAC 2C, WELL CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS
RECOIMIAS BEEN PROVIDED Tfl THE WELL OWNER.
........_
D LL CONTRACTOR DATE
SC
PRINTED NAME OF PERS N CONSTRUCT G THE WELL
SIGNATURE QF CERTI
Submit the original to the Division of Water Quality within 30 days. Attn: Information Mgt,
1617 Mail Service Center — Raleigh, NC 27699-1617 Phone No. [phone] ext 568.
Form GW-la
Rev. 7/05

RESIDENTIAL WELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources- Division of Water Quality
WELL CONTRACTOR CERTIFICATION # 2186
1. WELL CONTRACTOR:
J.D. MCCURRY
Well Contractor (Individual) Name
AAA GREENE BROS. WELL DRLG. OF SYLVA, INC
Well Contractor Company Name
STREET ADDRESS 1800 SKYLAND DRIVE
SYLVA
City or Town
( 828 )_ 586-5550
NC
State
Area code- Phone number
2. WELL INFORMATION:
SITE WELL ID #(if applicable) J59322W
28779
Zip Code
STATE WELL PERMIT#(if applicable)
DWQ or OTHER PERMIT #(if applicable) 7548-71-3696
WELL USE (Check Applicable Box): Residential Water Supply
DATE DRILLED 8/8/06
TIME COMPLETED 5:00 AM ❑ PM IXI
3. WELL LOCATION:
CITY: CULLOWHEE COUNTY JACKSON
TILLEY CREEK OFF SPEEDWELL ROAD
(Street Name, Numbers, Community, Subdivision, Lot No., Parcel, Zip Code)
TOPOGRAPHIC / LAND SETTING:
Za/lope ❑Valley ❑Flat ❑Ridge ❑Other
(check appropriate box)
LATITUDE 3
LONGITUDE
May be in degrees,
minutes, seconds or
in a decimal format
Latitude/longitude source: ❑GPS ❑Topographic map
(location of well must be shown on a USGS topo map and
attached to this form if not using GPS)
4. WELL OWNER
OWNER'S NAME AMERICA HOME PLACE-NEWKIRK JOB
STREET ADDRESS P.O. BOX 1030
CULLOWHEE NC 28723
City or Town State
( 828 )_ 349-9880
Area code - Phone number
5. WELL DETAILS:
a. TOTAL DEPTH: 550
Zip Code
b. DOES WELL REPLACE EXISTING WELL? YES ❑ NO
c. WATER LEVEL Below Top of Casing: 200 FT.
(Use "+" if Above Top of Casing)
d. TOP OF CASING IS 1 FT. Above Land Surface*
*Top of casing terminated at/or below land surface may require
a variance in accordance with 15A NCAC 2C .0118.
e. YIELD (gpm): 2 METHOD OF TEST AIR
f. DISINFECTION: Type HTH
g. WATER ZONES (depth):
From 320 To 323 From
From To From
From To From
6. CASING:
Amount 24.75 OUNCES
From 0 DToth 113 Ft. bpgter
From To Ft.
From To Ft.
To
To
To
Thickness/
ISO
7. GROUT: Depth Material
From 0 To 3 Ft. CEMENT
From 3 To 20 Ft. BENTONITE
From To Ft.
8. SCREEN: Depth Diameter Slot Size
From To Ft. in.
From To Ft. in.
From To Ft. in.
9. SAND/GRAVEL PACK:
Depth
From
Size
To Ft.
From To Ft.
From To Ft.
10. DRILLING LOG
From To
0-108
108-320
320-323
323-550
11. REMARKS:
Material
Method
TOP
PUMP WITH TRIM PPE
in.
in.
in.
Material
Material
Formation Description
CLAY
GRANITE
CAVITY
GRANITE
RECEIVED
aiv. of WATER QUAL1 T 1r
FEB 1. tt zoo?
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH
15A NCAC 2C, WELL CONSTRUCTION STANDARDS, AND THATA COPY OF THIS
RECORD HAS BEEN PROVIDED TO THE WELL OWNER.
14t C,._ — O7—o-7
SIGNATURE OF CERTIFIED WELL CONTRACTOR DATE
ISThm` 7
PRINTED NAME OF PERSON CONSTR CTING THE WELL
Submit the original to the Division of Water Quality within 30 days. Attn: Information Mgt.,
1617 Mail Service Center — Raleigh, NC 27699-1617 Phone No. [phone] ext 568.
Form GW-la
Rev. 7/05

RESIDENTIAL WELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources- Division of Water Quality
WELL CONTRACTOR CERTIFICATJ
ION # 'I U Cry
1. WELL CONTRACTOR:
1)n cCa.rr-
Well Contractor (Individual) Name
AAA GREENE BROS. WELL DRLG. OF SYLVA, INC.
Well Contractor Company Name
STREET ADDRESS 1800 SKYLAND DRIVE
SYLVA
NC 28779
City or Town State Zip Code
( 828 )- 586-5550
Area code- Phone number
2. WELL INFORMATION: r[%
SITE WELLID#(it applicable) 76,(e I '� i -392
STATE WELL PERMIT#(if applicable)
DWQ or OTHER PERMIT #(if applicable)
WELL USE (Check Applicable Box): Residential Water Supply ryNif
DATE DRILLED / - 3I - fa
TIME COMPLETED AM ❑ POj
3. WELL LOC TION:
CITY:
COUNTY
(Street Name, Numbers, Community, Subdiy is on, Lot a., Parcel, Zip .
TOPOGRAPHIC / LAND SETTING: G'��
❑Slope ID Valley ❑Flat in Ridge ❑Other
(check appropriate box)
LATITUDE
LONGITUDE
May be in degrees,
minutes, seconds or
in a decimal format
Latitude/longitudesource: ❑GPS ❑ Topographic map
(location of well must be shown on a USGS topo map and
attached to this form if not using GPS)
4. WELL OWNER ^�
OWNER'S NAME IRO
/\OOf _ �E
STREET ADDRESS 'T- 4 q0
City or Ti1'" State
3c`l —/773
Area code - Phone number
5. WELL DETAILS:
a. TOTAL DEPTH: 55o
e 771
Zip Code
b. DOES WELL REPLACE EXISTING WELL? YES ❑ NO*
c. WATER LEVEL Below Top of Casing: 'f / 0 FT,
(Use "+" if Above Top of Casing)
d. TOP OF CASING IS 1
3Sg9 c,63QJ
FT. Above Land Surface*
'Top of casing terminated at/or below land surface may require
a variance in accordance with 15A NCAC 2C .0118.
e. YIELD (gpm): METHOD OF TEST / f%
f. DISINFECTION: Type HTH
g. WATER ZONES (depth), /
From /-70 To /
From To
Amount / a""'-`s
From To
Fran To
From To From To
6. CASING: Thickness/ht
From Depth o�/ / 7 '7Diameter
Ft. % I/..L W,7Qe ?i (Materi
%7G/ aC-
From To Ft.—T7
From To Ft.
7. GROUT: Depth Material
From v To 3 Ft. ( r i" Q
Fran -3 To 7 c/ Ft.
From To Ft. (�--7—t"
6. SCREEN: Depth Diameter Slot Size Materiar' r
From To Ft. in. in.
From - To Ft. in. in.
From To Ft. in. in.
9. SAND/GRAVEL PACK:
Depth
Size
From To Ft.
From To Ft.
From To Ft.
10. DRILLING LOG
From To
11. REMARKS:
Method
Material
Formation Description
:;<LcciVED
Dr! .nr,l r%TER MAIM,
a 17 ZUO7 •
1 DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WRH
15A NCAC 2C, WELL CONSTRUCTION STANDARDS, AND THATA COPY OF THIS
RECORD HAS BEEN PROVIDED TO THE WELL OWNER.
SIGNATURE OF CERTIFIED WE CONTRACTOR DATE
PRINTED NAME OF PERSON CONSTRUCTItI3 THE WELL
Submit the original to the Division of Water Quality within 30 days. Attn: Information Mgt,
1617 Mail Service Center— Raleigh, NC 27699-1617 Phone No. [phone] ext 568.
Form GW-la
Rev. 7/05

RESIDENTIAL WELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources -Division of Water Quality
WELL CONTRACTOR CERTIFICATION # Z/
Wen Contractor (Individua6 Name
AAA GREENE BROS. WELL DRLG. OF SYLVA, INC.
Well Contractor Company Name
STREET ADDRESS 1800 SKYLAND DRIVE
SYLVA NC 28779
City or Tam State Zip Cotle
82( 8 )_ 586-5550
Area code- Phone number
2. WELL INFORMATION: 7 5 42r-5 � di O 4 f� i
SITE WELL ID if a pplicade )CO r��Y,j+ #(
STATE WELL PERMIT/kr applicable)
DWQ or OTHER PERMIT #(Ifapplicable)��_
WELL USE (Check �Alpplicable Box): Residential Water Supply
DATE DRILLED O ` 3 ' 0 c
TIME COMPLETED
3. WELL CATI N:
CITY, 1. COU
(Street Name, Numbers, Cammuni y Subdi lion, Lot ., Parcel, Zi
TOPOGRAPHIC / LAND SETTING:
❑ Slope ❑ Valley filat 0 Ridge 0 Other
(check ppropriate box)
LATITUDE
LONGITUDE_
Latitude/longitudesource: ❑GPS Topographic map
(hcatpn of well must be shown on a USGS topo map and
attached to this fomn ifnot using GPS)
4. WELL OWNER
OWNER'S NAME
STREETADDr?
Brit
City or Tam
Stat Zip Code
Area code- Phone number
5. WELL DETAILS:
a. TOTAL DEPTH: D ()
b. DOES WELL REPLACE EXISTING WELL? YES 0 NO,k
c. WATER LEVEL Belau Top of Casing: -LTD
(Use -+• if Above Top Df Casing)
d. TOP OF CASING IS / FT. Above Land Surface'
`Top of casing terminated at/or belay land surface
may
a variance in accordance with 15A NCAC 2C .011§A� require
•
e. YIELD (gpm): Cam— METHOD OF TEST
May be in degrees,
minutes, seconds or
in a decimal format
333039,
f. DISINFECTION: Type 11TH
Diameter Slot Size
Ft. in. in.
FLin in.
in.
9. SAND/GRAVEL PACK:
Depth
Fran To_
From To
10. DRILLING LOG
From To
II. REMARKS:
I DO HERESY CERTIFY THAT THIS WELL WAS CCNSTRUC1ED W ACCORDANCE WITH
15A NCAC 2C, WELL CONSTRUCTION STANDARDS, AND THATA COPY OF THIS
RECORD HAS BEEN PRWIOED TO THE WELL OWNER.
SIGNATURE OF CERTIFIED wE CONTRACTOR
PRINTED NAME OF PERSON CONSTRUC NG THE WELL
Submit the original to the Division of Water Quality within 30 days. Attn: Information Mgt,
1617 Mail Service Center— Raleigh, NC 27699.1617 Phone No. [phone] ext 568.
Farm G W-1 a
Rev. 7/05

RESIDENTIAL WELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources -Division of Water Quality
WELL CONTRACTOR CERTIFICATION #
Well Contractor(Individ )Name
AAA GREENE BROS. WELL DRLG. OF S
STREET ADDRESS 1800 SKYLAND DRIVE
SYLVA NC
City or Town State
8( 1_ 586-5550
Area code- Phone number
2. WELL INFORMATION:
'-3-5ga6o
SITE WELL ID #(g applicable) 7 5 ✓3y✓y oy_S
STATE WELL PERMIT/Kit applicable)
DWQ or OTHER PERMIT *Of applicable) I
WELL USE (Check rApplicable ?Box): Residential Water Supply t
DATE DRILLED / J �/ - 6 '
3. WELL LOCATION:
CITY: _Cr ' fe h V i dc_ . COUNTY Saj "e�, �
et Name, Nu tiers, Gammen' , ubG�swn, Lot No., Parcel, Zip Code)
TOPOGRAPHIC / LAND SETTING:
❑Slope GValley)QFlat ❑Ridge ❑Other
(check appropriate box)
LATITUDE
LONGITUDE_ _
Latitude/longitude source: ❑GPS ❑Topographic map
(location of well must be shown on a USGS topo map and
attached to this fonn if not using GPS)
4. WELL OWNER F,vreCI
OWNER'S NAMErr.ccc"tlyv -C
STREET ADDRESS
5GrG h
City or own State V�� Zip Cade
Area code- Phone number `�"
5. WELL DETAILS: i
a. TOTAL DEPTH:
b. DOES WELL REPLACE EXISTING WELL.? YES ❑ NO»
c. WATER LEVEL Below Tap of Casing:
(Use -+- if Above Top of Casing)
d. TOP OF CASING IS FT Above Land Surface*
'Top of casing terminal at/or below land surface may require
a variance in accordance with 15A NCAC 2C .0118.
e. YIELD (gpm):_ METHOD OF TEST
May be in degrees,
minutes, seconds or
in a decimal format
f. DISINFECTION: Type HTH
g. WATER ZONES (depth):
From ✓6 To Z.3 y
From To
From Tn
Diameter Slot Size
Ft. in. in.
FL in. in.
in. in.
1 DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH
ISA NCAC 2C, WELL CONSTRUCTION STANDARDS, AND THATA COPY OF THIS
RECORD HAS BEEN PRO�r 1D�ED TO THE WELL OWNER.
,J M. /' r /.
SIGNATURE OF CERTIFIED W L
PRINTED AME OF PE SON CO ST- UCTING- E WELL
Submit the original to the Division of Water Quality within 30 days. Attn: Information Mgt,
1617 Mail Service Center— Raleigh, NC 27699-1617 Phone No. [phone] ext 568.
Form GW-la
Rev. 7/05

RESIDENTIAL WELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources- Division of Water Quality
WELL CONTRACTOR CERTIFICATION # 3041
3 t35
1. WELL CONTRACTOR:
PAUL BRYANT BRUCE
Well Contractor (Individual) Name
AAA GREENE BROS. WELL DRLG. OF SYLVA, INC
Well Contractor Company Name
STREET ADDRESS 1800 SKYLAND DRIVE
SYLVA
City or Town
( 828 )- 586-5550
NC
State
Area code- Phone number
2. WELL INFORMATION:
SITE WELL ID #(inapplicable) J60195W
STATE WELL PERMIT#(itapplicable)
28779
Zip Code
DWQ or OTHER PERMIT #(if applicable) 7555-19-0521
WELL USE (Check Applicable Box): Residential Water Supply El
DATE DRILLED 10/26/06
TIME COMPLETED 5:00 AM E PM
3. WELL LOCATION:
CITY: SPEEDWELL COUNTY JACKSON
TILLEY CREEK ROAD OFF SPEEDWELL
(Street Name, Numbers, Community, Subdivision, Lot No., Parcel, Zip Code)
TOPOGRAPHIC / LAND SETTING:
Slope ER/alley EFlat ❑Ridge DOther
(check appropriate box)
LATITUDE 3
LONGITUDE
May be in degrees,
minutes, seconds or
in a decimal format
Latitude/longitude source: ❑ GPS ❑Topographic map
(location of well must be shown on a USGS topo map and
attached to this (aim if not using GPS)
4. WELL OWNER
OWNER'S NAME RON HENSLEY
STREET ADDRESS P.O. BOX 3330
CASHIERS, NC 28717
City or Town State Zip Code
( 828 )- 399-0028
Area code - Phone number
5. WELL DETAILS:
a. TOTAL DEPTH: 700
b. DOES WELL REPLACE EXISTING WELL? YES ❑ NO
c. WATER LEVEL Below Top of Casing: 700 FT
(Use "+" if Above Top of Casing)
d. TOP OF CASING IS 1 FT. Above Land Surface'
*Top of casing terminated at/or below land surface may require
a variance in accordance with 15A NCAC 2C .0118.
e. YIELD (gpm): 3 METHOD OF TEST AIR
f. DISINFECTION: Type HTH
Amount 31.5 OUNCES
g. WATER ZONES (depth):
From 90 To 93 From 225 To 228
From 525 To 528
From
From To From
6. CASING:
Depth DI ter
From 0 To 45' 6" Ft. b 1/4..
From To Ft.
From To Ft.
7. GROUT: Depth
From D To 3
To
To
Thickness/
Material
Material Method
Ft. CEMENT TOP
From 3 To 20 Ft. BENTONITE eaµ°W1THTHMCPE
Ft.
From To
8. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in.
From To Ft. in. in.
From To Ft. in. In.
9. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
From To Ft.
10. DRILLING LOG
From To Formation Description
0-40' 6" CLAY
40'6"-90 GRANITE
90-93 CAVITY
93-225
225-228
228-525
525-528
528-700
11. REMARKS:
GRANITE
CAVITY
GRANITE
CAVITY
GRANITE
teCEIV
'Ilk/ OF VahTFRo lL.t1Y
2007
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 AS BEEN PROVIDED TO THE WELL OWNER.
s4A-Cr_
R g DATECERTIFIEDAELL
ICyTED NAMPERSON CONSTRUCTING
THE WELL
Submit the original to the Division of Water Quality within 30 days. Attn: Information Mgt.,
1617 Mail Service Center— Raleigh, NC 27699-1617 Phone No. [phone] ext 568.
Form GW-la
Rev. 7/05

RESIDENTIAL WELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources- Division of Water Quality
WELL CONTRACTOR CERTIFICAT ON # 2597
1. WELL CONTRACTOR:
GLENN MARTIN MATHIS JR.
Well Contractor (Individual) Name
AAA GREENE BROS. WELL DRLG. OF SYLVA, INC
Well Contractor Company Name
STREET ADDRESS 1800 SKYLAND DRIVE
SYLVA
City or Town
( 828 )_ 586-5550
NC
State
28779
Zip Code
Area code- Phone number
2. WELL INFORMATION:
SITE WELL ID #(if applicable) J61897W
STATE WELL PERMIT#(if applicable)
DWQ or OTHER PERMIT Cif applicable) 7569-40-0384
WELL USE (Check Applicable Box): Residential Water Supply
DATE DRILLED 11/29/06
TIME COMPLETED 5:00 AM ❑ PM El
3. WELL LOCATION:
CITY: CULLOWHEE COUNTY JACKSON
CANEY FORK OF HWY 107
(Street Name, Numbers, Community, Subdivision, Lot No., Parcel, Zip Code)
TOPOGRAPHIC / LAND SETTING:
>ySlope ❑Valley ❑Flat ['Ridge DOther
(check appropriate box)
LATITUDE 3
LONGITUDE
Latitude/longitude source: ❑GPS ❑Topographic map
(location of well must be shown on a USGS topo map and
attached to this form if not using GPS)
4. WELL OWNER
OWNER'S NAME ED RILEY
May be in degrees,
minutes, seconds or
in a decimal format
STREET ADDRESS 11095 CANADA ROAD
TUCKASEGEE, NC 28783
City or Town State
( 828 )_ 226-3335
Area code - Phone number
5. WELL DETAILS:
a. TOTAL DEPTH: 200
Zip Code
b. DOES WELL REPLACE EXISTING WELL? YES ❑ NO xi
c. WATER LEVEL Below Top of Casing: 100 FT.
(Use "+" if Above Top of Casing)
d. TOP OF CASING IS 1 FT. Above Land Surface'
"Top of casing terminated at/or below land surface may require
a variance in accordance with 15A NCAC 2C .0118.
e. YIELD (gpm): 30 METHOD OF TEST AIR
3S067
f. DISINFECTION: Type HTH
Amount 9 OUNCES
g. WATER ZONES (depth):
From 107 To 110 From To
From. To From To
From To From To
6. CASING:
Depth mprter
From 0 To 48'8„ Ft. 1/4
From To Ft.
From To Ft.
Thickness/
Wrgt
7. GROUT: Depth Material
From 0 To 3 Ft.CEMENT
From 3 To 20 Ft. BENTONITE
From To Ft.
STEEL
Method
TOP
PUMP WITH TRIM PIPE
8. SCREEN: Depth Diameter Slot Size Material
From To Ft in. in.
From To Ft. in. in.
From To Ft. in. in.
9. SAND/GRAVEL PACK:
Depth Size Material -
From To Ft.
From To Ft.
From To Ft.
10. DRILLING LOG
From To
0-43'8"
43'8"-107
107-110
110-200
11. REMARKS:
Formation Description
CLAY
GRANITE
CAVITY
GRANITE
RECEIVED
I_:)l / OF 1101-FP ()HALM,
MO/
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 WELD WNER.
CE Pee �d a/o T�07
SI NATURE OF TIFIED WELL CO RACTOR DATE
G12Nh 111Qrh(r, rY1aLL,ts TI-
PRINTED NAME OF PERSON CONSTRUCTING THE WELL
Submit the original to the Division of Water Quality within 30 days. Attn: Information Mgt.,
1617 Mail Service Center— Raleigh, NC 27699-1617 Phone No. [phone] ext 568.
Form GW-la
Rev. 7/05

RESIDENTIAL WELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources- Division of Water Quality
WELL CONTRACTOR CERTIFICATION # 2597
1. WELL CONTRACTOR:
GLENN MARTIN MATHIS JR.
Well Contractor (Individual) Name
AAA GREENE BROS. WELL DRLG. OF SYLVA, INC
Well Contractor Company Name
STREET ADDRESS 1800 SKYLAND DRIVE
SYLVA
City or Town
( 828 )- 586-5550
NC
State
Area code- Phone number
2. WELL INFORMATION:
SITE WELL ID #(it applicable) J61501 W
28779
Zip Code
STATE WELL PERMIT#(if applicable)
DWQ or OTHER PERMIT #(if applicable) 7568-17-5660
WELL USE (Check Applicable Box): Residential Water Supply E
DATE DRILLED 12/6/06
TIME COMPLETED 5:00 AM ❑ PM
3. WELL LOCATION:
CITY: CULLOWHEE COUNTY JACKSON
MOODY BRIDGE RO INDIAN MOUND ROAD LOT 8
(Street Name, Numbers, Community, Subdivision, Lot No., Parcel, Zip Code)
TOPOGRAPHIC / LAND SETTING:
Slope DValley DFlat ❑Ridge DOther
(check appropriate box)
LATITUDE 3
LONGITUDE
Latitude/longitude source: ❑GPS ❑Topographic map
(location of well must be shown on a USGS topo map and
attached to this form if not using GPS)
4. WELL OWNER
OWNER'S NAME MARC BRANNIGAN
May be in degrees,
minutes, seconds or
in a decimal format
STREET ADDRESS 64 BALLANTREE DRIVE
CASHIERS, NC 28717
City or Town State Zip Code
( 828 )- 743-4134
Area code - Phone number
5. WELL DETAILS:
a. TOTAL DEPTH: 445
b. DOES WELL REPLACE EXISTING WELL? YES ❑ NO
c. WATER LEVEL Below Top of Casing: 100 FT.
(Use'+" if Above Top of Casing)
d. TOP OF CASING IS 1 FT. Above Land Surface*
'Top of casing terminated at/or below land surface may require
a variance in accordance with 15A NCAC 2C .0118.
e. YIELD (gpm): 15 METHOD OF TEST AIR
33 < I 6 6
f. DISINFECTION: Type HTH
g. WATER ZONES (depth):
From 230 To 233
From To
From To
6. CASING:
Dept3T 6" Diameter
From 0 To Ft. 6 1/4
From To Ft.
From To Ft.
Amount 20.03 OUNCES
From 345
From To
From To
TThickhness/
To 348
7. GROUT: Depth Material
From 0 To 3 Ft. CEMENT
From 3 To 20 Ft. BENTONITE
From To Ft.
Material
Method
TOP
PUMP MTH TRIM PIPE
8. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in.
From To Ft. in. in.
From To Ft. in. in.
9. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
From To Ft.
10. DRILLING LOG
From To Formation Description
0-32' 6" CLAY
32'6"-230 GRANITE
230-233 CAVITY
233-345 GRANITE
345-348 CAVITY
348-445 GRANITE
11. REMARKS:
r 'a C'_.
Rr t ;r I/i( TiptrVCL F1UA)IY
iz )i ° LIJl1/
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 ,LS WELL NER.
- ' al o-il0 7
SIGNATURE OF CERTIFIED WELL CONTRACTOR DATE
lediAn MC 111444-1(5: J{`
PRINTED NAME OF PERSON CONSTRUCTING THE WELL
Submit the original to the Division of Water Quality within 30 days. Attn: Information Mgt.,
1617 Mail Service Center— Raleigh, NC 27699-1617 Phone No. [phone] ext 568.
Form GW-la
Rev. 7/05

RESIDENTIAL WELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources -Division of Water Quality
WELL CONTRACTOR CERTIFICATION # 2597
1. WELL CONTRACTOR:
GLENN MARTIN MATHIS JR.
Well Contractor (Individual) Name
AAA GREENE BROS. WELL DRLG. OF SYLVA, INC
Well Contractor Company Name
STREET ADDRESS 1800 SKYLAND DRIVE
SYLVA NC
28779
City or Town State Zip Code
( 828 )- 586-5550
Area code- Phone number
2. WELL INFORMATION:
SITE WELL ID #(if applicabe) J60392W
STATE WELL PERMIT#(if applicable)
DWQ or OTHER PERMIT #(if applicable) 7563-48-0604
WELL USE (Check Applicable Box): Residential Water Supply
DATE DRILLED 10/2/06
TIME COMPLETED 5:00 AM f7 PM
3. WELL LOCATION:
CITY: CASHIERS
COUNTY JACKSON
FINLEY FOREST OFF NORTON ROAD
(Street Name, Numbers, Community, Subdivision, Lot No., Parcel, Zip Code)
TOPOGRAPHIC / LAND SETTING:
Slope DValley 0 Flat ❑Ridge ❑Other
(check appropriate box)
LATITUDE 3
LONGITUDE
Latitude/longitude source: ❑GPS ❑Topographic map
(location of well must be shown on a USGS topo map and
attached to this form if not using GPS)
4. WELL OWNER
OWNER'S NAME BILL DUNCAN
May be in degrees,
minutes, seconds or
in a decimal format
STREET ADDRESS P.O. BOX 3054
CASHIERS, NC 28717
City or Town State Zip Code
( 828 )_ 7434134
Area code - Phone number
5. WELL DETAILS:
a. TOTAL DEPTH: 475
b. DOES WELL REPLACE EXISTING WELL? YES ❑ NO
c. WATER LEVEL Below Top of Casing: 70 FT.
(Use "+" if Above Top of Casing)
d. TOP OF CASING IS 1 FT. Above Land Surface*
*Top of casing terminated at/or below land surface may require
a variance in accordance with 15A NCAC 2C .0118.
e. YIELD (gpm): 6 METHOD OF TEST AIR
rJ C[ 8 C
jj� 6
ti6 J
f. DISINFECTION: Type HTH
g. WATER ZONES (depth):
From 100 To 103
From 425 To 428
From To
6. CASING:
Depth pipicater
From 0 To 56 Ft. 6 1/4
From To Ft.
From To Ft.
Amount 21.38 OUNCES
From 300 To 303
From To
From To
Thickness/
VSirBSi�21 Material
7. GROUT: Depth Material Method
From 0 To 3 Ft. CEMENT TOP
From 3 To 20 Ft. BENTONITE PUMP mT«TRIM ePE
From To Ft.
8. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in.
From To Ft. in. in.
From To Ft. in. in.
9. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
From To Ft.
10. DRILLING LOG
From To
0-51
Formation Description
CLAY
51-100 GRANITE
100-103
103-300
CAVITY
GRANITE
300-303 CAVITY
303-425 GRANITE
425-428 CAVITY
428-475 GRANITE
11. REMARKS:
RECEIVER
tJElt, OF WVATFR 011ALITy
2UU!
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH
15A NCAC 2C. WELL CONSTRUCTION STANDA S, AND THAT A COPY OF THIS
RE HAS BEEN PROVIDED T THE WELL We
� fi f 7/7
SIGNATURE OF CERTIFIED WELL CO TRACTOR DATE
Qle1 Mat- 4t4 t .1- Jr.
PRINTED NAME OF PERSON CONSTRUCTING THE WELL
Submit the original to the Division of Water Quality within 30 days. Attn: Information Mgt.,
1617 Mail Service Center— Raleigh, NC 27699-1617 Phone No. [phone] ext 568.
Form GW-la
Rev. 7/05

•
RESIDENTIAL WELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources -Division of Water Quality
WELL CONTRACTOR CERTIFICATION # 3041
338052
1. WELL CONTRACTOR:
PAUL BRYANT BRUCE
Well Contractor (Individual) Name
AAA GREENE BROS. WELL. DRLG. OF SYLVA, INC
Well Contractor Company Name
STREET ADDRESS 1800 SKYLAND DRIVE
SYLVA NC
City or Town State
( 828 )- 586-5550
Area code- Phone number
2. WELL INFORMATION:
SITE WELL ID #(if applicable) J61194W
STATE WELL PERMIT#(ifapplicable)
28779
Zip Code
DWQ or OTHER PERMIT #(if applicable) 7623-59-5435
WELL USE (Check Applicable Box): Residential Water Supply
DATE DRILLED 12/7/06
TIME COMPLETED 5:00 AM ❑ PM
3. WELL LOCATION:
CITY: WHITTIER COUNTY JACKSON
CAMP CREEK TO FIREFLY TO LOOP ROAD
(Street Name, Numbers, Community, Subdivision, Lot No., Parcel, Zip Code)
TOPOGRAPHIC / LAND SETTING:
Slope [Valley ❑Flat ❑Ridge ❑Other
(check appropriate box)
LATITUDE 3
LONGITUDE
May be in degrees,
minutes, seconds or
in a decimal format
Latitude/longitude source: ❑GPS ❑Topographic map
(location of well must be shown on a USGS topo map and
attached to this font it not using GPS)
4. WELL OWNER
OWNER'S NAME BOBBY CRAWFORD
STREET ADDRESS 8725 BRYANT ROAD
LAKELAND, FL 33809
City or Town State
( 863 )- 984-1264
Area code - Phone number
5. WELL DETAILS:
a. TOTAL DEPTH: 350
Zip Code
b. DOES WELL REPLACE EXISTING WELL? YES ❑ NO
c. WATER LEVEL Belau Top of Casing: 60 FT.
(Use'+" if Above Top of Casing)
d. TOP OF CASING IS 1 FT. Above Land Surface'
`Top of casing terminated at/or below land surface may require
a variance in accordance with 15A NCAC 2C .0118.
e. YIELD (gpm): 20 METHOD OF TEST AIR
f. DISINFECTION: Type HTH Amount 15.75 OUNCES
g. WATER ZONES (depth):
From 70 To 73 From 280 To 283
From To From To
From To From To
6. CASING: WThickhntess/
From 0 Depth
To 31 Ft.bpgter SlSRZi WOW
From To Ft. F'Vl;
From To Ft.
7. GROUT: Depth Material
From 0 To 3 Et. CEMENT
From 3 To 20 Ft. BENTONITE
From To Ft.
Method
TOP
PUMP WITH TRIM PIPE
8. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in.
From To Ft. in. in.
From To Ft. in. in.
9. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft. .- -)
From To Ft.
10. DRILLING LOG
From To
0-26
26-70
70-73
73-280
Formation Description
CLAY
GRANITE
CAVITY
GRANITE
280-283 CAVITY
283-350 GRANITE
11. REMARKS:
`))•�• t?F tca TFR °CtfiLITY
ES 2 602
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH
15A NCAC W LL CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS
RECOR BEEN PROVIDED TQ THE WELL OWNER.
SIGNATURE OF CERTJEIED WEJ,L CONTRACTOR DATE
nt,l
TED NAM
E PRIN OF PERSONCONSTRUCTING THE WELL
Submit the original to the Division of Water Quality within 30 days. Attn: Information Mgt.,
1617 Mail Service Center— Raleigh, NC 27699-1617 Phone No. [phone] ext 568.
Form GW-1a
Rev. 7/05

RESIDENTIAL WELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources -Division of Water Quality
WELL CONTRACTOR CERTIFICATION # 3041
v38061
1. WELL CONTRACTOR:
PAUL BRYANT BRUCE
Well Contractor (Individual) Name
AAA GREENE BROS. WELL DRLG. OF SYLVA, INC
Well Contractor Company Name
STREET ADDRESS 1800 SKYLAND DRIVE
SYLVA
City or Town
( 828 ). 586-5550
Area code- Phone number
NC
State
2. WELL INFORMATION:
SITE WELL ID #(if applicable) J60884W
28779
Zip Code
STATE WELL PERMIT#(if applicable)
DWQ or OTHER PERMIT #(if applicable) 7672-90-6310
WELL USE (Check Applicable Box): Residential Water Supply
DATE DRILLED 11/03/06
TIME COMPLETED 5:00 AM ❑ PM I I
3. WELL LOCATION:
CITY: BALSAM COUNTY JACKSON
BALSAM MTN. PRESERVE LOT 201
(Street Name, Numbers, Community, Subdivision, Lot No., Parcel, Zip Code)
TOPOGRAPHIC / LAND SETTING:
❑Slope &Valley ❑Flat &Ridge DOther
(check appropriate box)
LATITUDE 3
LONGITUDE
May be in degrees,
minutes, seconds or
in a decimal format
Latitude/longitude source: ❑GPS ❑Topographic map
(location of well must be shown on a USGS topo map and
attached to this foml if not using GPS)
4. WELL OWNER
OWNER'S NAME EWING AND MCCONNAUGHY
STREET ADDRESS 3161 OLD 70 EAST
BLACK MTN, NC 28711
City or Town State
( 828 )_ 669-1133
Area code - Phone number
5. WELL DETAILS:
a. TOTAL DEPTH: B00
Zip Code
b. DOES WELL REPLACE EXISTING WELL? YES & NO xi
c. WATER LEVEL Below Top of Casing: 250 FT.
(Use "+• if Above Top of Casing)
d. TOP OF CASING IS 1 FT. Above Land Surface'
'Top of casing terminated at/or below land surface may require
a variance in accordance with 15A NCAC 2C .0118.
e. YIELD (gpm): 4 METHOD OF TEST AIR
f. DISINFECTION: Type HTH
Amount 36 OUNCES
g. WATER ZONES (depth):
From 220 To 223 From 525 To 528
From 760 To 763 From To
From To From To
6. CASING: yT/hiickhntess/
SD�21
From 0 DToot40 Ft Diameter
From To Ft. /4"
From To Ft.
7. GROUT: Depth Material
From 0 To 3 Ft. CEMENT
From 3 To 20 Ft. BENTONITE
From To Ft.
8. SCREEN:
From
From
From
Matgfial
Method
TOP
PUMP WITH TRIM PIPE
Depth Diameter Slot Size Material
To Ft. in. in.
To Ft. in. in.
To Ft. in. in.
9. SAND/GRAVEL PACK:
Depth
From
From
From
Size Material
To Ft.
To Ft.
To Ft.
10. DRILLING LOG
From To Formation Description
0-35 CLAY
35-220 GRANITE
220-223 CAVITY
223-525 GRANITE
525-528
528-760
760-763
763-800
11. REMARKS:
CAVITY
GRANITE
CAVITY
GRANITE
OVOR TER llAurN
`FEM 9 2 2nn?
I D0 HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH
15A NCAC 2C, WELL CONSTRUCTION STANDARDS, AND THATA COPY OF THIS
RECORD HAS BEEN PROVIDED TO j)1E WELL OWNER.
SIGNATURE OF CERTIFIED��w,ELL CONTRACTOR DATE
%��j�if ✓� /3Lre-c
PRINTED NAME OF PERSON CONSTRUCTING THE WELL
Submit the original to the Division of Water Quality within 30 days. Attn: Information Mgt.,
1617 Mail Service Center — Raleigh, NC 27699-1617 Phone No. [phone] ext 568.
Form GW-la
Rev. 7/05

RESIDENTIAL WELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources- Division of Water Quality
WELL CONTRACTOR CERTIFICATION # 3041
33SC60
1. WELL CONTRACTOR:
PAUL BRYANT BRUCE
Well Contractor (Individual) Name
MA GREENE BROS. WELL DRLG. OF SYLVA, INC
Well Contractor Company Name
STREET ADDRESS
SYLVA
City or Torn
( 828 )_ 586-5550
1800 SKYLAND DRIVE
NC
State
Area code- Phone number
2. WELL INFORMATION:
SITE WELL ID #(if applicable) J59957W
STATE WELL PERMIT#(if applicable)
28779
Zip Code
DWQ or OTHER PERMIT #(If applicable) 7673-58-2164
WELL USE (Check Applicable Box): Residential Water Supply tti
DATE DRILLED 11/03/06
TIME COMPLETED 5:00 AM ❑ PM
3. WELL LOCATION:
CITY: BALSAM COUNTY JACKSON
WOODFIN ROAD
(Street Name, Numbers, Community, Subdi4sion, Lot No., Parcel, Zip Code)
TOPOGRAPHIC / LAND SETTING:
4'Slope OValley ❑Flat El Ridge DOther
(check appropdate box)
LATITUDE 3
LONGITUDE
May be in degrees,
minutes, seconds or
in a decimal format
Latitude/longitude source: ❑ GPS ❑Topographic map
(location of well must be shown on a USGS topo map and
attached to this form it not using GPS)
4. WELL OWNER
OWNER'S NAME JERRY FACTEAU
STREET ADDRESS 715 WOODFIN ROAD
SYLVA NC 28779
City or Town State Zip Code
( 828 )_ 246-4582
Area code - Phone number
5. WELL DETAILS:
a. TOTAL DEPTH: 300
b. DOES WELL REPLACE EXISTING WELL? YES ❑ NO FB
c. WATER LEVEL Below Top of Casing: 60 FT.
(Use "+• if Above Top of Casing)
d. TOP OF CASING IS 1 FT. Above Land Surface*
*Top of casing terminated at/or below land surface may require
a variance in accordance with 15A NCAC 2C .0118.
e. YIELD (gpm): 4
METHOD OF TEST AIR
f. DISINFECTION: Type HTH Amount 13.5 OUNCES
g. WATER ZONES (depth):
From 50 To 53 From 130 To 133
From 260 To 263 From To
From To From To
6. CASING:
From 0 To 33 Ft.
From To Ft.
From To Ft.
ameter Thickness/
Depth g D1/4"IBC ea,
7. GROUT: Depth Material
From 0 To Ft. CEMENT
From 3 To 20 Ft, BENTONITE
From To Ft.
Method
TOP
PUMP WITH TRW PPE
8. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in.
From To Ft. in. in.
From To Ft. in. in.
9. SAND/GRAVEL PACK:
Depth Size Material
From To
Ft.
From To Ft.
From To Ft.
10. DRILLING LOG
From To
0-28
28-50
50-53
53-130
130-133
133-260
260-263
263-300
1I, REMARKS:
Formation Description
CLAY
GRANITE
CAVITY
GRANITE
CAVITY
GRANITE
CAVITY
GRANITE
it�GFli!ELt
fE WATER QUALITY
c Eli .) °t ?OW
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH
15A NCAC 2C, WELL CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS
REC HAS BEEN PROVIDED TO THE WELLPWNER.
SI 'ATURE OF - TIFIED WWL CONTRACTOR DATE
AL/
PRINTED NAME OF PERSON CONSTRUCTING THE WELL
_5J7r.ri'&
Submit the original to the Division of Water Quality within 30 days. Attn: Information Mgt,
1617 Mail Service Center— Raleigh, NC 27699-1617 Phone No. [phone] ext 568.
Form GW-la
Rev. 7/05

RESIDENTIAL WELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources- Division of Water Quality
WELL CONTRACTOR CERTIFICATION # 3041
1. WELL CONTRACTOR:
PAUL BRYANT BRUCE
Well Contractor (Individual) Name
AAA GREENE BROS. WELL DRLG. OF SYLVA, INC
Well Contractor Company Name
STREET ADDRESS 1800 SKYLAND DRIVE
SYLVA
City or Town
( 828 )- 586-5550
Area code- Phone number
NC
State
28779
Zip Code
2. WELL INFORMATION:
SITE WELL ID #(if applicable) J 'c g 1 G siv
STATE WELL PERMITS/(if applicable) ./
DWQ or OTHER PERMIT *Of applicable) 7603- 8'; - "T is
WELL USE (Check Applicable Box): Residential Water Supply
DATE DRILLED 3/27/06
TIME COMPLETED 5:00 AM D PM IE
3. WELL LOCATION:
CITY: BARKERS CREEK COUNTY JACKSON
STEIKOIH HILLS OFF THOMAS VALLEY ROAD
(Street Name, Numbers, Community, Subdiasion, Lot No., Parcel, Zip Code)
TOPOGRAPHIC / LAND SETTING:
t7lope DValley ❑Flat ORidge ❑Other
(check appropriate box)
LATITUDE 3
LONGITUDE
Latitude/ongitudesource: ❑GPS Topographic map
(location of well must be shown on a USGS topo map and
attached to this form it not using GPS)
4. WELL OWNER
OWNER'S NAME ROGER JENNINGS
May be in degrees,
minutes, seconds or
in a decimal format
STREET ADDRESS P.O. BOX 1607
BRYSON CITY NC 28713
City or Town State
( 828 )_ 488-6793
Area code - Phone number
5. WELL DETAILS:
a. TOTAL DEPTH: 150
Zip Code
b. DOES WELL REPLACE EXISTING WELL? YES ❑ NO
c. WATER LEVEL Below Top of Casing: 6 FT.
(Use "+" if Above Top of Casing)
d. TOP OF CASING IS 1 FT. Above Land Surface'
`Top of casing terminated at/or below land surface may require
a variance in accordance with 15A NCAC 2C .0118.
e. YIELD (gpm): 80 METHOD OF TEST AIR
3a s 59
6.
f. DISINFECTION: Type HTH
Amount 6.75 OUNCES
g. WATER ZONES (depth):
From 100 To 103 From 125 To 128
From
From
CASING:
To
To
From To
From To
Thickness/
Depth ipoter
From 0 To 75 Ft. ID Is
From To Ft.
From To Ft.
Ise Riga'
7. GROUT: Depth Material
From 0 To 3 Ft. CEMENT
From 3 To 20 Ft. BENTONITE
From To Ft.
Method
TOP
PUMP WITH TRW PIPE
8. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in.
From To Ft. in. in.
From To Ft. in. in.
9. SAND/GRAVEL PACK:
Depth
From To Ft.
From To Ft.
Size Material
From To Ft.
10. DRILLING LOG
From To Formation Description
0-70 CLAY
70-100 GRANITE
100-103 CAVITY
103-125 GRANITE
125-128 CAVITY
128-150 GRANITE
11. REMARKS:
RECEIVED
DIV. (F WATER QUAD( V
FEB 1't 2007
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH
H
15A NCAC 2C, WELL CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS
RECOR/AS BEEN PROVIDED TO THENEft.
SIGNATURE O�FF CERTIFIED WELL CONTRACTOR DATE
- °A41 h. 4s1e&
PRINTED NAME OF P RSON CONSTRUCTING THE WELL
Submit the original to the Division of Water Quality within 30 days. Attn: Information Mgt.,
1617 Mail Service Center— Raleigh, NC 27699-1617 Phone No. [phone] ext 568.
Form GW-la
Rev. 7/05

RESIDENTIAL WELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources -Division of Water Quality
WELL CONTRACTOR CERTIFICATION # 3041
1. WELL CONTRACTOR:
PAUL BRYANT BRUCE
Well Contractor (Individual) Name
AAA GREENE BROS. WELL DRLG. OF SYLVA, INC
Well Contractor Company Name
STREET ADDRESS 1800 SKYLAND DRIVE
SYLVA NC 28779
City or Town State Zip Code
( 828 )_ 586-5550
Area code- Phone number
2. WELL INFORMATION:
SITE WELL ID #(if applicable) LT ' 1379Cv
STATE WELL PERMIT#(if applicable) 7413-- .5K a/6 y'
DWQ or OTHER PERMIT #(if applicable)
WELL USE (Check Applicable Box): Residential Water Supply
DATE DRILLED 11/7/06
TIME COMPLETED 5:00 AM ❑ PM Ix1
3. WELL LOCATION:
CITY: BALSAM
WOODFIN ROAD
COUNTY JACKSON
(Street Name, Numbers, Community, Subdivision, Lot No., Parcel, Zip Code)
TOPOGRAPHIC / LAND SETTING:
`kSlope ❑Valley ❑Flat ❑Ridge ❑Other
(check appropriate box)
LATITUDE 3
LONGITUDE
Latitude/longitude source: OOPS ❑ Topographic map
(location of well must be shown on a USGS topo map and
attached to this form if not using GPS)
4. WELL OWNER
May be in degrees,
minutes, seconds or
in a decimal format
OWNER'S NAME VERNON CRISP
STREET ADDRESS 717 WOODFIN ROAD
SYLVA NC 28779
City or Town State Zip Code
( 828 )- 246-5980
Area code - Phone number
5. WELL DETAILS:
a. TOTAL DEPTH: 150
b. DOES WELL REPLACE EXISTING WELL? YES ❑ NO
c. WATER LEVEL Below Top of Casing: 40 FT.
(Use "+" if Above Top of Casing)
d. TOP OF CASING IS 1 FT. Above Land Surface'
*Top of casing terminated ator below land surface may require
a variance in accordance with 15A NCAC 2C .0118.
e. YIELD (gpm): 4 METHOD OF TEST AIR
332(.58
f. DISINFECTION: Type HTH
g. WATER ZONES (depth):
From 65 To 68
From
From
6. CASING:
To
To
Depth
From 0 To 34'6"
From To
From To
7. GROUT: Depth
From 0 To 3
From 3 To 20
From To
Ft.
Ft.
Ft.
Amount 6.75 OUNCES
From To
From To
From To
WThickhn1ess/
6plamprter SEVQ27 Matgrlal
Material
Ft.CEMENT
Ft. BENTONITE
Ft.
Method
TOP
PUMP MM TRIM PIPE
8. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in.
From To Ft. in. in.
From To Ft. in. in.
9. SAND/GRAVEL PACK:
Depth
From To
From To
From To
10. DRILLING LOG
From To
0-29' 6"
29'6"-65
65-68
68-150
11. REMARKS:
Ft.
Ft.
Ft.
Size Material
Formation Description
CLAY
GRANITE
CAVITY
GRANITE
RRFCFIVFn
f 11V ('lKlWATFP 01141.11-v
= E 19 ; 2 2 OD /
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH
15A NCAC 2C, WELL CONSTRUCTION STANDARDS. AND THAT A COPY OF THIS
RECORt S BEEN PTO THEOWNER. 2 e}`"7
pATURE OF CERTIFIED VGELL CONTRACTOR DATE
/r%/� &' �ii� ✓L'- �—
PRINTED NAME OF PERSON CONSTRUCTING THE WELL
Submit the original to the Division of Water Quality within 30 days. Attn: Information Mgt.,
1617 Mail Service Center— Raleigh, NC 27699-1617 Phone No. [phone] ext 568.
Form GW-la
Rev. 7/05

RESIDENTIAL WELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources- Division of Water Quality
WELL CONTRACTOR CERTIFICATION # 3041
1. WELL CONTRACTOR:
PAUL BRYANT BRUCE
Well Contractor (Individual) Name
AAA GREENE BROS. WELL DRLG. OF SYLVA, INC
Well Contractor Company Name
STREET ADDRESS 1800 SKYLAND DRIVE
SYLVA NC
City or Town State
( 828 )_ 586-5550
Area code- Phone number
28779
Zip Code
2. WELL INFORMATION:
SITE WELL ID #(if applicable) 754 4 88 W
STATE WELL FERMI -lit -(if applicable)
DWQ or OTHER PERMIT #(if applicable) 7445-- 30-7296
WELL USE (Check Applicable Box): Residential Water Supply
DATE DRILLED 8/30/06
TIME COMPLETED 5:00 AM ❑ PM
3. WELL LOCATION:
CITY: CHEROKEE
COUNTY JACKSON
TEEPEE ROAD TO TEISUE RIAD
(Street Name, Numbers, Community, Subdi ision, Lot No., Parcel, Zip Code)
TOPOGRAPHIC / LAND SETTING:
"lope ❑Valley ❑Flat ❑Ridge CI Other
(check appropriate box)
LATITUDE 3
LONGITUDE
Latitude/longitude source: ❑GPS ❑Topographic map
(location of well must be shown on a USGS topo map and
attached to this form if not using GPS)
4. WELL OWNER
OWNER'S NAME MARCUS GUNTER
May be in degrees,
minutes, seconds or
in a decimal format
STREET ADDRESS 2210 GOLDMINE DRIVE
CUMMING, GA 30040
City or Town State Zip Code
( 770 )_ 889-2859
Area code - Phone number
5. WELL DETAILS:
a. TOTAL DEPTH: 150
b. DOES WELL REPLACE EXISTING WELL? YES D NO
c. WATER LEVEL Below Top of Casing: 20 FT.
(Use "+" if Above Top of Casing)
d. TOP OF CASING IS 1 FT. Above Land Surface*
'Top of casing terminated at/or below land surface may require
a variance in accordance with 15A NCAC 2C .0118.
e. YIELD (gpm): 25 METHOD OF TEST AIR
f. DISINFECTION: Type NTH Amount 6.75 OUNCES
g. WATER ZONES (depth):
From 65 To 68 From 85 To 88
From To From To
From To From To
6. CASING: Thickness/
Depth5 Diameter
From 0 To Ft. 61/4
From To Ft.
From To Ft.
SDRZ�
Material
7. GROUT: Depth Material Method
From U To 3 Ft CEMENT TOP
From 3 To 20 Ft. BENTONITE oUMPWITH TRIM %P.
From To Ft.
8. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in.
From To Ft. in. in.
From To Ft. in. in.
9. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
From To Ft.
10. DRILLING LOG
From To
0-40
Formation Description
CLAY
40-65 GRANITE
65-68 CAVITY
68-85 GRANITE
85-88 CAVITY
88-150 GRANITE
11. REMARKS:
!FEU 1 2 2007
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH
15A NCAC 2C, WELL CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS
RECORD HAS BEEN PROVIDED TO THE WELL OWNER,
G
SIGNATURE OF C TIFIED45ELL CONTRACTOR DATE
PRINTED AME OF PERSON CONSTRUCTING THE WELL
Submit the original to the Division of Water Quality within 30 days. Attn: Information Mgt.,
1617 Mail Service Center— Raleigh, NC 27699-1617 Phone No. [phone] ext568.
Form GW-la
Rev. 7/05

338051
RESIDENTIAL WELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources- Division of Water Quality
WELL CONTRACTOR CERTIFICATION # 3041
1. WELL CONTRACTOR:
PAUL BRYANT BRUCE
Well Contractor (Individual) Name
AAA GREENE BROS. WELL DRLG. OF SYLVA, INC
Well Contractor Company Name
STREET ADDRESS 1800 SKYLAND DRIVE
SYLVA NC
City or Town State
( 828 )_ 586-5550
Area code- Phone number
2. WELL INFORMATION:
SITE WELL ID #(if applicable) J60126W
28779
Zip Code
STATE WELL PERMIT#(if applicable)
DWQ or OTHER PERMIT #(if applicable) 7539-07-3992
WELL USE (Check Applicable Box): Residential Water Supply El
DATE DRILLED 9/26/06
TIME COMPLETED 5:00
3. WELL LOCATION:
CITY: SYLVA
AM ❑ PM El
COUNTY JACKSON
BEECHWOOD-LOT 25 OFF CALVERY CHURCH ROAD
(Street Name, Numbers, Community, Subdivision, Lot No., Parcel, Zip Code)
TOPOGRAPHIC / LAND SETTING:
❑Slope ®Valley ❑Flat ❑Ridge ❑Other
(check appropriate box)
LATITUDE 3
LONGITUDE
Latitude/longitude source: ❑GPS Topographic map
(location of well must be shown on a USGS topo map and
attached to this form if not using GPS)
4. WELL OWNER
OWNER'S NAME JACK DEITZ
May be in degrees,
minutes, seconds or
in a decimal format
STREET ADDRESS 3 SIGNAL RIDGE ROAD
SYLVA, NC
28779
City or Town State
( 826 )_ 631-3644
Area code - Phone number
5. WELL DETAILS:
a. TOTAL DEPTH: 100
Zip Code
b. DOES WELL REPLACE EXISTING WELL? YES D NO pn
c. WATER LEVEL Below Top of Casing: 20 FT.
(Use "+" if Above Top of Casing)
d. TOP OF CASING IS 1 FT. Above Land Surface"
*Top of casing terminated at/or below land surface may require
a variance in accordance with 15A NCAC 2C .0118.
e. YIELD (gpm): 30 METHOD OF TEST AIR
f. DISINFECTION: Type HTH
g. WATER ZONES (depth):
From 40 To 43
Amount 4.5 OUNCES
From
To
From To From To
From To From To
6. CASING:
Dept22 Diam.ter
From 0 To Ft. 6 1/4
From To Ft.
From To Ft.
7. GROUT:
From
From 3
From
Thickness/
S�Si�21
N Veal
Depth Material Method
To 3 Ft. CEMENT TOP
To 20 Ft BENTONITE PUMP WITH TRIM PIPE
To Ft.
8. SCREEN:
From
From
Depth Diameter Slot Size
To Ft. in. in.
To Ft. in. in.
From To Ftin. in.
9. SAND/GRAVEL PACK:
Depth
From
From
From
To Ft.
Size
Material
Material
To Ft.
To Ft.
10. DRILLING LOG
From To
0-17
17-40
40-43
43-100
11. REMARKS:
Formation Description
CLAY
GRANITE
CAVITY
GRANITE
it eettiFn lA►�Tv
W. OF WATER
=EB 1 2 zoo?
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH
15A NCAC 2C, WELL CONSTRUCTION STANDARDS, AND THATA COPY OF THIS
RECORD HAS BEEN PROVIDED TO THE WELL OWNER.
SIGNATURE OF ERTIFIED Eil?t6NIMIFICTOR DATE
PRINTED NAME OF PERSON CONSTRUCTING THE WELL
Submit the original to the Division of Water Quality within 30 days. Attn: Information Mgt.,
1617 Mail Service Center— Raleigh, NC 27699-1617 Phone No. [phone] ext 568.
Form GW-la
Rev. 7/05

RESIDENTIAL WELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources- Division of Water Quality
WELL CONTRACTOR CERTIFICATION # 3041
1. WELL CONTRACTOR:
PAUL BRYANT BRUCE
Well Contractor (Individual) Name
AAA GREENE BROS. WELL DRLG. OF SYLVA, INC
Well Contractor Company Name
STREET ADDRESS 1800 SKYLAND DRIVE
SYLVA NC
City or Town State
( 828 )_ 586-5550
Area code- Phone number
2. WELL INFORMATION:
SITE WELL ID #(i( applicable) J60958W
28779
Zip Code
STATE WELL PERMIT#(if applicable)
DWQ or OTHER PERMIT *Of applicable) 7539-28-7115
WELL USE (Check Applicable Box): Residential Water Supply E
DATE DRILLED 9/27/06
TIME COMPLETED 5:00 AM ❑ PM
3. WELL LOCATION:
CITY: SYLVA
COUNTY JACKSON
BEECHWOOD-LOT 2-B OFF CALVERY CHURCH ROAD
(Street Name, Numbers, Community, Subdivision. Lot No., Parcel, Zip Code)
TOPOGRAPHIC / LAND SETTING:
®Slope ❑Valley ❑Flat ❑Ridge ❑Other
(check appropriate box)
LATITUDE 3
LONGITUDE
Latitude/longitude source: ❑GPS ❑Topographic map
(location of well must be shown on a USGS topo map and
attached to this form if not using GPS)
4. WELL OWNER
OWNER'S NAME CHARLES CONNER
May be in degrees,
minutes, seconds or
in a decimal format
STREET ADDRESS P.O. BOX 21
SYLVA, NC 28779
City or Town State
( 828 )- 331-8416
Area code - Phone number
5. WELL DETAILS:
a. TOTAL DEPTH: 125
Zip Code
b. DOES WELL REPLACE EXISTING WELL? YES ❑ NO 20
c. WATER LEVEL Belau Top of Casing: 20 FT.
(Use "+" if Above Top of Casing)
d. TOP OF CASING IS 1 FT. Above Land Surface'
'Top of casing terminated at/or below land surface may require
a variance in accordance with 15A NCAC 2C .0118.
e. YIELD (gpm): 100 METHOD OF TEST AIR
ve17050
f. DISINFECTION: Type HTH
Amount 5.63OUNees
g. WATER ZONES (depth):
From 100 To 103 From To
From To From To
From To From To
6. CASING:
Thickness/
Depth piampter Wricpt
From 0 To 92 Ft. 6
From To Ft.
From To Ft.
7. GROUT: Depth Material Method
From 0 To 3 Ft. CEMENT TOP
From 3 To 20 Ft. BENTONITE
From To Ft.
PUMP WrtN TRIM PPE
8. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in.
From To Ft. in. in.
From To Ft. in. in.
9. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
From To Ft.
10. DRILLING LOG
From To Formation Description
0-87 CLAY
87-100 GRANITE
100-103 CAVITY
103-125 GRANITE
RtCEIVED
D►IV OF WATER QUALITY
11. REMARKS:
FEB l 2 2007
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 CERTIFIEDIWELL CONTRACTOR DATE
PAL/I )3- Ryyr-c
PRINTED NAME OF PERSON CONSTRUCTING THE WELL
Submit the original to the Division of Water Quality within 30 days. Attn: Information Mgt.,
1617 Mail Service Center — Raleigh, NC 27699-1617 Phone No. [phone] ext 568.
Form G W-1 a
Rev. 7/05

RESIDENTIAL WELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources- Division of Water Quality
WELL CONTRACTOR CERTIFICAT ON # 2597
1. WELL CONTRACTOR:
GLENN MARTIN MATHIS JR.
Well Contractor (Individual) Name
AAA GREENE BROS. WELL DRLG. OF SYLVA, INC
Well Contractor Company Name
STREET ADDRESS 1800 SKYLAND DRIVE
SYLVA NC 28779
City or Town State Zip Code
( 828 )_ 586-5550
Area code- Phone number
2. WELL INFORMATION:
SITE WELL ID #(itapplicable) J60320W
STATE WELL PERMIT#(irapplicable)
DWQ or OTHER PERMIT #(If applicable) 8502-56-7458
WELL USE (Check Applicable Box): Residential Water Supply El
DATE DRILLED 10/25/06
TIME COMPLETED 5:00 AM 0 PM IE
3. WELL LOCATION:
CITY: SAPPHIRE COUNTY JACKSON
TOWER ROAD TO FIVESTONE WELL 1
(Street Name, Numbers, Community, Subdivision, Lot No., Parcel, Zip Code)
TOPOGRAPHIC / LAND SETTING:
]?Slope DValley ❑Flat ❑Ridge ❑Other
(check appropriate box)
LATITUDE 3
LONGITUDE
Latitude/longitude source: OGPS ❑Topographic map
(location of well must be shown on a USGS topo map and
attached to this form if not using GPS)
4. WELL OWNER
OWNER'S NAME FIVESTONE PROPERTIES
May be in degrees,
minutes, seconds or
in a decimal format
STREET ADDRESS 3225 SOUTH MACDILL AVE. SUITE 129-264
TAMPA, FL 33629
City or Town State Zip Code
( 813 )- 624-6270
Area code - Phone number
5. WELL DETAILS:
a. TOTAL DEPTH: 875
b. DOES WELL REPLACE EXISTING WELL? YES ❑ NO fg
c. WATER LEVEL Below Top of Casing: 100 FT.
(Use "+• if Above Top of Casing)
d. TOP OF CASING IS 1 FT. Above Land Surface
*Top of casing terminated at/or below land surface may require
a variance in accordance with 15A NCAC 2C .0118.
e. YIELD (gpm): 4 METHOD OF TEST AIR
338069
f. DISINFECTION: Type HTH
Amount 39.38 OUNCES
g. WATER ZONES (depth):
From 610 To 613 From To
From To From To
From To From To
6. CASING: D�amet Thickness/mM��e�al
From 0 Depth
Ft. 6 1/4" of W188t STEEL
From To Ft.
From To Ft.
7. GROUT: Depth Material Method
From 0 To 3 Ft. CEMENT TOP
From 3 To 20 Ft. BENTONITE
From To Ft.
PUMP NRx TWA PIPE
8. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in.
From To Ft. in. in.
From To Ft. in. in.
9. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
From To Ft.
10. DRILLING LOG
From To Formation Description
0-62 SAND
62-610 GRANITE
610-613 CAVITY
613-875 GRANITE
11. REMARKS:
flttltlVRPL' nU
?(`! (` .rirUR l l
- 04 t 200/
ITV
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 W LOW
6 ✓"�d�+�a J./�tt /o7/o7SIGNATURE OF CERTIFIED WELL CWNTRACTOR DAT
C I e4 1 6' r h4 ma —kir Jr
PRINTED NAME OF PERSON CONSTRUCTING THE WELL
Submit the original to the Division of Water Quality within 30 days. Attn: Information Mgt.,
1617 Mail Service Center — Raleigh, NC 27699-1617 Phone No. [phone] ext 568.
Form GW-la
Rev. 7/05

RESIDENTIAL WELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources- Division of Water Quality
WELL CONTRACTOR CERTIFICAT ON # 2597
1. WELL CONTRACTOR:
GLENN MARTIN MATHIS JR.
Well Contractor (Individual) Name
AAA GREENE BROS. WELL DRLG. OF SYLVA, INC
Well Contractor Company Name
STREET ADDRESS 1800 SKYLAND DRIVE
SYLVA
City or Town
NC
State
28779
Zip Code
( 828 )_ 586-5550
Area code- Phone number
2. WELL INFORMATION:
SITE WELL ID *Of applicable) J61492W
STATE WELL PERMIT#(if applicable)
DWQ or OTHER PERMIT *Of applicable) 8502-65-3791
WELL USE (Check Applicable Box): Residential Water Supply El
DATE DRILLED 11/16/06
TIME COMPLETED 5:00 AM ❑ PM IXJ
3. WELL LOCATION:
CITY: SAPPHIRE COUNTY JACKSON
TOWER ROAD TO FIRESTONE
(Street Name, Numbers, Community, SubdMsion, Lot No., Parcel, Zip Code)
TQPOGRAPHIC / LAND SETTING:
Slope ❑Valley DFlat CRidge DOther
(check appropriate box)
LATITUDE 3
LONGITUDE
Latitude/longitude source: ❑GPS ❑Topographic map
(location of well must be shown on a USGS topo map and
attached to this form if not using GPS)
4. WELL OWNER
OWNER'S NAME FIVESTONE PROPERTIES
May be in degrees,
minutes, seconds or
in a decimal format
STREET ADDRESS 3225 SOUTH MACDILL AVE. SUITE 129-264
TAMPA, FL 33629
City or Town State Zip Code
( 813 )- 624-6270
Area code- Phone number
5. WELL DETAILS:
a. TOTAL DEPTH: 1000
b. DOES WELL REPLACE EXISTING WELL? YES ❑ NO
c. WATER LEVEL Below Top of Casing: 150 FT.
(Use "+° if Above Top of Casing)
d. TOP OF CASING IS 1 FT. Above Land Surface*
*Top of casing terminated at/or below land surface may require
a variance in accordance with 15A NCAC 2C .0118.
e. YIELD (gpm): 1/2 METHOD OF TEST AIR
338068
f. DISINFECTION: Type HTH
Amount 45 OUNCES
g. WATER ZONES (depth):
From 320 To 323 From To
From To From To
From To
6. CASING:
From To
Depth I ter
From 0 To 25 Ft. 1/4..
From To Ft.
From To Ft.
Thickness/
W1t
7. GROUT: Depth Material
From U To 3 Ft.CEMENT
From 3 To 20 Ft. BENTONITE
From To Ft.
Method
TOP
PUMP 'MMIPMPPE
8. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in.
From To Ft. in. in.
From To Ft. in. in.
9. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
From To Ft.
10. DRILLING LOG
From To Formation Descriptioon
0-20 S A!u D
20-320 GRANITE
320-323 CAVITY
323-1000 GRANITE
11. REMARKS:
`ittt1�tL
F Ix/�,� f1/ALI v
200?
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 W OWNER.
& ../✓�r fit it
/TE07 SIGNATURE OF CERTIFIED WELL Cr
TRACTOR
DA
U--)tv 1 r-1lb, I11A 1.,If Tr.
PRINTED NAME OF PERSON CONSTRUCTING THE WELL
Submit the original to the Division of Water Quality within 30 days. Attn: Information Mgt.,
1617 Mail Service Center — Raleigh, NC 27699-1617 Phone No. [phone] ext 568.
Form GW-la
Rev. 7/05

RESIDENTIAL WELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources -Division of Water Quality
WELL CONTRACTOR CERTIFICATION # 2186
3 e1 8 ` 3 7
1. WELL CONTRACTOR:
J.D. MCCURRY
Well Contractor (Individual) Name
AAA GREENE BROS. WELL DRLG. OF SYLVA, INC
Well Contractor Company Name
STREET ADDRESS 1800 SKYLAND DRIVE
SYLVA NC
28779
City or Town State Zip Code
( 828 )- 586-5550
Area code- Phone number
2. WELL INFORMATION:
SITE WELL ID #(it applicable) J59594W
STATE WELL PERMIT#(it applicable)
DWQ or OTHER PERMIT #(if applicable) 7673-79-4546
WELL USE (Check Applicable Box): Residential Water Supply
DATE DRILLED 8/10/06
TIME COMPLETED 5:00 AM ❑ PM le
3. WELL LOCATION:
CITY: SYLVA COUNTY JACKSON
WOODFIN ROAD OFF HWY 23-74
(Street Name, Numbers, Community, Subdivision, Lot No., Parcel, Zip Code)
TOPOGRAPHIC / LAND SETTING:
❑Slope ❑Valley R7 Flat ❑Ridge ❑Other
(check appropriate box)
LATITUDE 3
LONGITUDE
Latitude/longitude source: ❑GPS ❑Topographic map
(location of well must be shown on a USGS topo map and
attached to this form if not using GPS)
4. WELL OWNER
OWNER'S NAME BOB BUCKELEW
May be in degrees,
minutes, seconds or
in a decimal format
STREET ADDRESS 3149 DICKS CREEK ROAD
WHITTIER, NC 28789
City or Town State Zip Code
( 850 )- 324-7776
Area code - Phone number
5. WELL DETAILS:
a. TOTAL DEPTH: 500
b. DOES WELL REPLACE EXISTING WELL? YES 0 NO
c. WATER LEVEL Below Top of Casing: 100 FT.
(Use "+" if Above Top of Casing)
d. TOP OF CASING IS 1 FT. Above Land Surface'
*Top of casing terminated at/or below land surface may require
a variance in accordance with 15A NCAC 2C .0118.
e. YIELD (gpm): 10 METHOD OF TEST AIR
f. DISINFECTION: Type HTH
g. WATER ZONES (depth):
From 330 To 333
Amount 22.5 OUNCES
From 440
To 443
From To From To
From To From To
6. CASING:
Depth8 Diarllgter
From 0 To Ft. 61/4
From To Ft.
From To Ft.
Thickness/1
58�2h1 jal
7. GROUT: Depth Material Method
From 0 To 3 Ft. CEMENT TOP
From 3 To 20 Ft. BENTONITE
From To Ft.
PUMP WITH TRIM PIPE
8. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in.
From To Ft. in. in.
From To Ft. in. in.
9. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
From To Ft.
10. DRILLING LOG
From To Formation Description
0-43 CLAY
43-330 GRANITE
330-333 CAVITY
333-440 GRANITE
440-443 CAVITY
443-500 GRANITE
11. REMARKS:
n n
C
RECEIVED
PAPwars, niIAl
'-•E w lull?
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.
a- 07-07
SIGNATURE OF CERTIFIED WELL CONTRACTOR DATE
SD M= /1
PRINTED NAME OF PERSONrIATRUCTING THE WELL
Submit the original to the Division of Water Quality within 30 days. Attn: Information Mgt.,
1617 Mail Service Center- Raleigh, NC 27699-1617 Phone No. [phone] ext 568.
Form GW-la
Rev. 7/05

RESIDENTIAL WELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources- Division of Water Quahty
WELL CONTRACTOR CERTIFICATION # 2186
1. WELL CONTRACTOR:
J.D. MCCURRY
Well Contractor (Individual) Name
AAA GREENE BROS. WELL DRLG. OF SYLVA, INC
Well Contractor Company Name
STREET ADDRESS 1800 SKYLAND DRIVE
SYLVA NC
City or Town State
( 828 )- 586-5550
Area code- Phone number
2. WELL INFORMATION:
SITE WELL ID #(if applicable) J58445W
28779
Zip Code
STATE WELL PERMIT#(if applicable)
DWI/ or OTHER PERMIT #(if applicable) 7663-31-3332
WELL USE (Check Applicable Box): Residential Water Supply
DATE DRILLED 4/17/06
TIME COMPLETED 5:00 AM ❑ PM IE
3. WELL LOCATION:
CITY: SYLVA COUNTY JACKSON
NORTHFORK ROAD OFF SKYLAND DRIVE
(Street Name, Numbers, Community, SubdiNsion, Lot No., Parcel, Zip Code)
TOPOGRAPHIC / LAND SETTING:
❑Slope ❑Valley ID Flat ❑Ridge ❑Other
(check appropriate box)
LATITUDE 3
LONGITUDE
Latitude/Iongitude source: ❑GPS ❑Topographic map
(location of well must be shown on a USGS topo map and
attached to this fomr it not using GPS)
4. WELL OWNER
OWNER'S NAME EDDIE DYER
May be in degrees,
minutes, seconds or
in a decimal format
STREET ADDRESS 299 NORTH FORK ROAD
SYLVA, NC 28779
City or Town State Zip Code
( 828 )_ 586-5781
Area code - Phone number
5. WELL DETAILS:
a. TOTAL DEPTH: 250
b. DOES WELL REPLACE EXISTING WELL? YES ❑ NO Ei
c. WATER LEVEL Below Top of Casing: 40 FT.
(Use "+" if Above Top of Casing)
d. TOP OF CASING IS 1 FT. Above Land Surface*
*Top of casing terminated atlor below land surface may require
a variance in accordance with 15A NCAC 2C .0118.
e. YIELD (gpm). 7 METHOD OF TEST AIR
a 3b 76
f. DISINFECTION: Type RTH Amount 11.25 OUNCES
g. WATER ZONES (depth):
From 85 To 88 From 190 To 193
From
From
6. CASING:
To
To
From To
From To
Depth0 D! 1,gter
From 0 To Ft. 6
From To Ft.
From To Ft.
Thickness/vnt
VS881 Matfdial
7. GROUT: Depth Material Method
From 0 To 3 Ft. CEMENT TOP
From 3 To 20 Ft. BENTONITE m�e+*�*aw PIPE
From To Ft.
8. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in.
From To Ft. in. in.
From To Ft. in. in.
9. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
From To Ft.
10. DRILLING LOG
From To
0-25
Formation Description
CLAY
25-85 GRANITE
85-88 CAVITY
88-190 GRANITE
190-193 CAVITY
193-250 GRANITE
11. REMARKS:
tttt.klvED
F INATER DUALITY
p 7UU7
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.
'to - re) (
SIGNATURE OF CERTIFIED WL CONTRACTOR DATE
Sfl r Curf
PRINTED NAME OF PERSON CONST,tUCTING THE WELL
Submit the original to the Division of Water Quality within 30 days. Attn: Information Mgt.,
1617 Mail Service Center— Raleigh, NC 27699-1617 Phone No. [phone] ext 568.
Form GW-la
Rev. 7/05

RESIDENTIAL WELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources- Division of Water Quality
WELL CONTRACTOR CERTIFICATION # 2186
1. WELL CONTRACTOR:
J.D. MCCURRY
Well Contractor (Individual) Name
AAA GREENE BROS. WELL DRLG. OF SYLVA, INC
Well Contractor Company Name
STREET ADDRESS 1800 SKYLAND DRIVE
SYLVA
City or Town
( 828 )- 586-5550
Area code- Phone number
NC
State
28779
Zip Code
2. WELL INFORMATION:
SITE WELL ID #(it applicable) J56541W
STATE WELL PERMIT#(ifapplicable)
DWQ or OTHER PERMIT Cif applicable)7640-31-9833
WELL USE (Check Applicable Box): Residential Water Supply E
DATE DRILLED 7/24/06
TIME COMPLETED 5:00 AM ❑ PM
3. WELL LOCATION:
CITY: WEBSTER COUNTY JACKSON
BERRY MTN ROAD OFF OLD SETTLEMENT
(Street Name, Numbers, Community, Subdivision, Lot No., Parcel, Zip Code)
TOPOGRAPHIC / LAND SETTING:
Slope DValley ❑Flat CI Ridge ❑Other
(check appropriate box)
LATITUDE 3
LONGITUDE
Latitude/longitude source: ❑GPS ❑Topographic map
(location of well must be shown on a USGS topo map and
attached to this form if not using GPS)
4. WELL OWNER
OWNER'S NAME MARK SHEFFLER
May be in degrees,
minutes, seconds or
in a decimal format
STREET ADDRESS 253 APPLETON DRIVE
SYLVA, NC 28779
City or Town State Zip Code
( 828 )- 226-4621
Area code - Phone number
5. WELL DETAILS:
a. TOTAL DEPTH: 390
b. DOES WELL REPLACE EXISTING WELL? YES ❑ NO
c. WATER LEVEL Below Top of Casing: 40 FT.
(Use "+" if Above Top of Casing)
d. TOP OF CASING IS 1 FT. Above Land Surface
`Top of casing terminated at/or below land surface may require
a variance in accordance with 15A NCAC 2C .0118.
e. YIELD (gpm): 20 METHOD OF TEST AIR
ES
n
d 5
f. DISINFECTION: Type HTH
g. WATER ZONES (depth):
From 225 To 228
Amount 17.55 OUNCES
From 340 To 343
From To From To
From To From To
6. CASING:
Depth I�0 pter
From 0 To 47 Ft. l/4
From To Ft.
From To Ft.
7. GROUT: Depth
From D To 3
From 3 To 20
From To
Thickness/
I Bcei Material
Material
Ft. CEMENT
Ft. BENTONITE
Ft.
Method
TOP
PUMP WITH AN PIPE
6. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in.
From To Ft. in. in.
From To Ft. in. in.
9. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
From To Ft.
10. DRILLING LOG
From To Formation Description
0-42 CLAY
42-225 GRANITE
225-228
228-340
CAVITY
GRANITE
340-343 CAVITY
343-390 GRANITE
11. REMARKS:
REGEIvEU
ttAl tnk I,)MJAI.,I I Y
'=EI3 t 1'2007
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH
15A NCAC 2C. WELL CONSTRUCTION STANDARDS. AND THAT A COPY OF THIS
RECORD HAS BEEN PROVIDED TO THE WELL OWNER.
3 .0 ` 1''i i l Lam.( 2 ' c 7` 0-7
SIGNATURE OF CERTIFIED WELL CONTRACTOR DATE
SD M`—CC�LL1�Tv�
PRINTED NAME OF PERSON CONSh'RUCTING THE WELL
Submit the original to the Division of Water Quality within 30 days. Attn: Information Mgt,
1617 Mail Service Center— Raleigh, NC 27699-1617 Phone No. [phone] ext 568.
Form GW-la
Rev. 7/05

RESIDENTIAL WELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources- Division of Water Quality
WELL CONTRACTOR CERTIFICATION # 2188
1. WELL CONTRACTOR:
J.D. MCCURRY
Well Contractor (Individual) Name
AAA GREENE BROS. WELL DRLG. OF SYLVA, INC
Well Contractor Company Name
STREET ADDRESS 1800 SKYLAND DRIVE
SYLVA NC 28779
City or Town State Zip Code
( 828 )_ 586-5550
Area code- Phone number
2. WELL INFORMATION:
SITE WELL ID #(if applicable) J58711 W
STATE WELL PERMIT#(if applicable)
DWQ or OTHER PERMIT #Of applicable) 7641-76-4426
WELL USE (Check Applicable Box): Residential Water Supply El
DATE DRILLED 5/23/06
TIME COMPLETED 5:00 AM 0 PM p
3. WELL LOCATION:
CITY: SYLVA
COUNTY JACKSON
COPE CREEK ROAD OF HWY 107
(Street Name, Numbers, Community, Subdivision, Lot No., Parcel, Zip Code)
TOPOGRAPHIC / LAND SETTING:
❑Slope oValley Er Flat ❑Ridge ❑Other
(check appropriate box)
LATITUDE 3
LONGITUDE
Latitude/longitude source: ❑GPS ❑Topographic map
(location of well must be shown on a USGS topo map and
attached to this form it not using GPS)
4. WELL OWNER
OWNER'S NAME BUDDY OWENS
May be in degrees,
minutes, seconds or
in a decimal formal
STREET ADDRESS P.O. BOX 1052
DILLSBORO, NC 28725
City or Town State
( 828 )- 508-8300
Area code - Phone number
5. WELL DETAILS:
a. TOTAL DEPTH: 290
b. DOES WELL REPLACE EXISTING WELL?
Zip Code
YES ❑ NO fP
c. WATER LEVEL Below Top of Casing: 60 FT.
(Use'+' if Above Top of Casing)
d. TOP OF CASING IS 1 FT. Above Land Surface'
'Top of casing terminated at/or below land surface may require
a variance in accordance with 15A NCAC 2C .0118.
e. YIELD (gpm): 5 METHOD OF TEST AIR
338074
f. DISINFECTION: Type HTH
g. WATER ZONES (depth):
From 80 To 83
Amount 13.05 OUNCES
From To
From To From To
From To From To
6. CASING: Thickness/
Depth iaamrttgter1/4' Wricgit
From 0 To 55 Ft.
From To Ft.
From To Ft.
STEtL
7. GROUT: Depth Material Method
From 0 To 3 Ft. CEMENT TOP
From 3 To 20 Ft. BENTONITE
From To Ft.
PUMP WITH MIN PIPE
8. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in.
From To Ft. in. in.
From To Ft. in. in.
9. SANDIGRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
From To Ft.
10. DRILLING LOG
From To Formation Description
0-50 CLAY/SAND
50-80 GRANITE
80-83
83-290
11. REMARKS:
CAVITY
GRANITE
Mi. or tr,//art;
1 ? ?U07
100 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• O - 1'"1is - c 7-c7
SIGNATURE OF CERTIFIED WELL C0NTRACTOR DATE
1J t Y,G CA-4_
PRINTED NAME OF PERSON CONSiA2UCTING THE WELL
Submit the original to the Division of Water Quality within 30 days. Attn: Information Mgt.,
1617 Mail Service Center— Raleigh, NC 27699-1617 Phone No. [phone] ext 568.
Form GW-la
Rev. 7/05

NONRESIDENTIAL WELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources- Division of Water Quality
WELL CONTRACTOR CERTIFICATION # 2186
1. WELL CONTRACTOR:
J.D. MCCURRY
Wet Contractor (Individual) Name
AAA GREENE BROS. WELL DRLG OF SYLVA, INC.
Well Contractor Company Name
STREET ADDRESS 1800 SKYLAND DRIVE
SYLVA NC 28779
City or Town State
( 828 )- 586-5550
Zip Code
Area code- Phone number
2. WELL INFORMATION:
SITE WELL ID #(if applicable)
STATE WELL PERMIT#(if applicable)
DWQ or OTHER PERMIT #(if applicable)
WELL USE (Check Applicable Box) Monitoring ❑ Municipal/Public 0
Industrial/Commercial p Agricultural O Recovery 0 Injection 0
Irrigation Other 0 (list use)
DATE DRILLED 5/2/06
TIME COMPLETED 5:00
3. WELL LOCATION:
CITY: TUCKASEEGEE
BEAR LAKE OFF SHOOK COVE
AMO PM®
COUNTY JACKSON
(Street Name, Numbers, Community, Subdivision, Lot No., Parcel, Zip Code)
TOPOGRAPHIC / LAND SETTING:
Slope OValley ❑Flat ❑Ridge 0 Other
(check appropriate box)
LATITUDE 3
LONGITUDE
May be in degrees,
minutes, seconds or
in a decimal format
Latitude/longitude source: DGPS ❑Topographic map
(location of well must be shown on a USGS opo map and
attached to this form if not using GPS)
4. FACILITY- is the name of the business where the well is located.
FACILITY ID #(if applicable)
NAME OF FACILITY CENTEX HOMES
STREET ADDRESS 559 WEST MAIN STREET
SYLVA NC 28779
City or Town State
CONTACT PERSON BO ALEXANDER
Zip Code
MAILING ADDRESS 559 WEST MAIN STREET
SYLVA NC 28779
City or Town State Zip Code
( 828 )_ 293-3988
Area code - Phone number
5. WELL DETAILS:
a. TOTAL DEPTH: 1000
b. DOES WELL REPLACE EXISTING WELL? YES 0 NO
c. WATER LEVEL Below Top of Casing: 200 FT,
(Use "+" if Above Top of Casing)
6. CASING:
iv 0
73
d. TOP OF CASING IS 2 FT. Above Land Surface*
'Top of casing terminated at/or below land surface may require
a variance in accordance with 15A NCAC 2C .0118.
e. YIELD (gpm): 2qpfYt METHOD OF TEST AIR
f. DISINFECTION: ype HTH Amount 45 OUNCES
g. WATER ZONES (depth):
From 250 To 253 From To
From To From To
From To From To
Thickness/
Depth Diameter W t
From 0 To 63 Ft. 6„
From To Ft.
STEEL
From To Ft.
7. GROUT: Depth Material Method
From 0 To 63 Ft CEMENT
From To Ft.
From To Ft.
8. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in.
From To Ft. in. in.
From To Ft. in. in.
9. SAND/GRAVEL PACK: - -
Depth Size Material
From To Ft.
From To Ft.
From To Ft.
10. DRILLING LOG
From To Formation Description
0-58 SAND
58-250 GRANITE
2F0-253 CAVITY
.253-1000 GRANITE
11. REMARKS:
k' NA FIR O141 I?Y
' D j • 20(1?
I DO HEREBY CERTFY 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 W ELL OWNER.
fifr -O7
SIGGTURE OF CERTIFIED WELL ONTRACTOR DATE
j-Ue,.✓r
PRINTED NAME OF PERSON CONS
WELL
Submit the original to the Division of Water Quality within 30 days. Attn: Information Mgt.,
1617 Mail Service Center- Raleigh, NC 27699-1617 Phone No. [phone] ext 568.
Form GW-1 b
Rev. 7/05

RESIDENTIAL WELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources- Division of Water Quality
WELL CONTRACTOR CERTIFICATION tt 2186
1. WELL CONTRACTOR:
J.D. MCCURRY
Well Contractor (Individual) Name
AAA GREENE BROS. WELL DRLG. OF SYLVA, INC
Well Contractor Company Name
STREET ADDRESS 1800 SKYLAND DRIVE
SYLVA
City or Town
( 828 )- 586-5550
Area code- Phone number
NC
State
28779
Zip Code
2. WELL INFORMATION:
SITE WELL ID tt(if applicable) J59384W
STATE WELL PERMIT#(if applicable)
DWQ or OTHER PERMIT #(if applicable) 7586-91-6291
WELL USE (Check Applicable Box): Residential Water Supply 8
DATE DRILLED 12/27/06
TIME COMPLETED 5:00 AM ❑ PM El
3. WELL LOCATION:
CITY: TUCKASEEGEE
COUNTY JACKSON
BEAR LAKE OFF SHOOK COVE WELL 11
(Street Name, Numbers, Community. SubdiMsion, Lot No., Parcel, Zip Code)
TOPOGRAPHIC / LAND SETTING:
❑Slope CValley EFlat ❑Ridge ❑Other
(check appropriate box)
LATITUDE 3
LONGITUDE
Latitude/longitude source: ❑GPS oTopographic map
(location of well must be shown on a USGS topo map and
attached to this form if not using GPS)
May be in degrees,
minutes, seconds or
in a decimal format
4. WELL OWNER
OWNER'S NAME CENTEX HOMES
STREET ADDRESS P.O. BOX 96
TUCKASEEGEE, NC 28783
City or Town State
( 828 )- 293-7777
Area code - Phone number
5. WELL DETAILS:
a. TOTAL DEPTH: 1000
Zip Code
b. DOES WELL REPLACE EXISTING WELL? YES ❑ NO fig
c. WATER LEVEL Below Top of Casing: 600 FT.
(Use "+" if Above Top of Casing)
d. TOP OF CASING IS 1 FT. Above Land Surface*
'Top of casing terminated at/or below land surface may require
a variance in accordance with 15A NCAC 2C .0118.
e. YIELD (gpm): 1 METHOD OF TEST AIR
338071
f. DISINFECTION: Type HTH
Amount 45 OUNCES
g. WATER ZONES (depth):
From 650 To 653 From To
From To From To
From To From To
6. CASING:
Depth2 Diameter
From 0 To Ft. 6'1/4„
From To Ft.
From To Ft.
yTVhickhMal
SCS)YZI PVI: N
7. GROUT: Depth Material
From D To 3 Ft. CEMENT
From 3 To 20 Ft. BENTONITE
From To Ft.
Method
TOP
PUMP MTH TRIM PPE
8. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in.
From To Ft. in. _ in.
From To Ft. in. in.
9. SAND/GRAVEL PACK:
Depth
Size
From To Ft.
From To Ft.
From To Ft.
Material
10. DRILLING LOG
From To Formation Description
0-17 SAND
17-650 GRANITE
650-653 CAVITY
653-1000 GRANITE
11. REMARKS:
RECEIVED
FEE If1/QTEl2 ri{ IAt_ITY
IT1 i- /_: ?I'll/
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.
(1\�
SIGN]kkTURE OF CERTIFIED WE CONTRACTOR DATE
PRINTED NAME OF PERSON CONS UCTING THE WELL
a—s-U7
Submit the original to the Division of Water Quality within 30 days. Attn: Information Mgt.,
1617 Mail Service Center— Raleigh, NC 27699-1617 Phone No. [phone] ext 568.
Form GW-la
Rev. 7/05

RESIDENTIAL WELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources. Division of Water Quality
WELL CONTRACTOR CERTIFICATION # 2187
1. WELL CONTRACTOR:
Russell S. Taylor
W qP. Contractor (Individual) Name
redden Brothers Well Drilling, Inc.
Wall Contractor Qompiny Name
STREET ADDRESS 73 Holly Hills Vista RD
Franklin. NC 28734
City or Town State Zip Code
! 828 1• 364 9591
Area bode- Phone number
2. WELL INFORMATION:
SITE WELL !Dsillapplicable) Si eta
STATE WELL PERMIT#(If applicable)
D ' Q or OTHER PERMIT NW applicable)
i.. LJSE (Check Applicable Box): Residential Water Supply 0
1U
E DRILLED 3 ' /' L/J
TIMh COMPLETED 5 . 00
3. WELL LO • ATION:
CITY:
(Street Name, N Y be . C rmunity. Subdivision, Lot No., Parcel, Zip Coda)
T'TOGRAPHIC I LAND SETTING:
°3 03 [Walley One °Ridge. ❑Other
(check spprdprlNe box) /J
^ ITUDE .21P J�7/V
LONGITUDE ,j9 5/51J
Lati'ude/longitude source: OOPS °Topographic map
/ocat/on of wail must be shown on a USGS topo map and
enachad to this form II not using GPS)
4, WELL OWNER
OWNER'S NAME
• ST "'ET ADDRESS
AMID PMSd'
May be In deareea,
minutes, seconds or
In a decimal format
iy or Town State
i)• e338-0/7 —'
Area code • Phone number
5. WELL DETAILS: atE�
a. TOTAL DEPTH: DLLJ yyy
b. DOES WELL REPLACE EXISTING WELL?
//�YES ° NOgA
C. WATER LEVEL Below Top of Casing: --� CO 60 FT.
(Use'+' N Above Top of Casing)
d. TOP OF CASINO IS 2 FT. Above Land Surface'
Top of casing terminated at/or below land surface may require
a variance In accordance with 15A NCAC 2C .0118.
e YIELD Wpm): 3- METHOD OF TEST Blow
f, DISINFECTION: Type Hi!'T H Amount 1 6oz
g. WATER NE9 (depth :
From
From
From
To / 0 From To
To ,3d
✓5 From - To
2
0 r From To
8. CASING: Thickness/
,n Depth (o rr Dlajneeter Weight M Ieal
From To Ft. /o
From / To Ft.
From To Ft.
T. GROUT: Depth Materlal Method
From 0 To' 2O Ft. C'3tt37k & betnit a iazws3
From To Ft.
From To Ft.
S. SCREEN: Depth Diameter Slot Size Material
From To Ft. In. In.
From To Ft. In. in.
From To Ft. . In, in.
9. SAND/GRAVEL PACK:
Depth
From
From
From
Size Material
To Ft,
To Ft.
To Ft.
10. DRILLING LOG
From Toe,
0
e.:e 7,'
11, REMARKS:
Formation Description
Clay & sand
Granite
J
1 D0 HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE Wmt
15A NCAC 2C, WELL CONSTRUCTION STANDARDS. AND THAT A COPY Op THIS
RIGOR 9 BEEN PROVIDED TO THE WELL OWNER,
� ✓Q 3'14140
SIGNATURE OF CERTIFIED W CONTRACTOR DA E
Russell S. Tav1
PRINTED NAME OF PERSON COP4flUCTING THE WELL
Submit the original to the Division of Water Quality within 30 t Ftnaineir waen Mgt.,
1617 Mall Service Center— Raleigh, NC 27699.1817 Phone No. [phone] ext 568.
Form GWta
Rev. 7/05
Asheville Regional Office
Aquiter Refection

RESIDENTIAL. WELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources• Division of Water Quality
WELL CONTRACTOR CERTIFICATION 8 2187
1. WELL CONTRACTOR:
Russell S. Taylor
Well Contractor (Individual) Name
Hedden Brothers Well
W :IL Contractor Company Name
Drilling, Inc.
S'T ;LT ADDRESS 73 Holly Hills Vista RD
Franklin. NC 28734
City a Town State
( 828 )- 369-9591
Arms code- Phone number
2. WELL INFORMATION:
SI T C WELL ID e(if applicable) f �O
STATE WELL PERMIT90e spoilable)
C f " or OTHER PERMIT #(if applica
If ,'_.'1SE (Check A plicable Box):
s:
DRILLED •
T113 _ COMPLETED AM ❑
3. WELL LO TIO11:
CITY: Q
Zip Code
�o-79.9.34
ble)
Residential Water Supply
Al Oft ed
VV
(Street Nemo, Numbers, Community, Subdivision, Lot No., Parcel, Zlp Code)
TOPOGRAPHIC / LAND SETTING:
❑ Zope :Wadley ❑Flat ❑Ridge C3Other
(check epprdprlete box)
L 'TUDE ,,,3—
L, )" !.',.;TUDE
e.•;',alde/longitude source: OGPS °Topographic map
location of well must be shown on a USGS topo map and
attached to this form if not using GPS)
4. WELL OWNER
OWNER'S NAME
ST91ET ADDRESS
ci. AV aX779
Liu
Town�State Zip Code
Liu •AIL/!(aYW-9 78
A. , a node • Phone number
5, WELL DETAILS: 100
^ t, r
a, TOTAL DEPTH: L4)
b. DOES WELL REPLACE EXISTING WELL? YES ❑ NOA
c. WATER LEVEL Below Top of Casing: FT.
(Use •+• H Above Top of Casing) fff
d. TOP OF CASINO IS 2 FT. Above Lend Surface'
'Top of casing terminated al/or below lend surface may require
■ variance In actor ante with 16A NCAC 2C .0118,
e. YIELD (gpm): l� METHOD OF TEST BLOW
Pt._
May be In degrees,
minutes, seconds or
In a decimal format
From
8. CASING:
f, DISINFECTION: Typo H}`.`T H Amount 1 6oz
g. WATER ZONES (depth):
From To From To
From To "From To
To From To
Thickness/
Depth Dlameter Weight Material
From (1_ To Ft
From /. To FL r /�
From To Ft.
7. GROUT: Depth Materiel Method
From 0 To H2O Ft. CR'Ttlt & tamite p1wed
From To Ft.
From To Ft.
8. SCREEN: Depth Dlameter Slot Size Material
From To FI. In. In.
From To FL In. In.
From To FI. In. In.
9. SAND)GRAVEL PACK:
Depth Size Material
From To FI.
From To Ft.
From To Ft.
10. DRILLING LOG
From To
n -=brs
Formation Description
Clay & sand
Granite
J
11, MARKS:
,�JDo/ - E'Z'idnu1
100 HERESY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WIN
ISA NCAC !0. WELL CONSTRUCTION STANDARDS. AND THAT A COPY OF THIS
RECD 9 BEEN PROVIDED
TOi}IS WELL OWNER,
SIGNATURE OF CERTIFIED WE CONTRACTOR
Russell S. Taylor
PRINTED NAME OF PERSON CONSTRUCTING THE WELL
DA
31(71110
Su'> ,tt the original to the Division of Water Quality within 30 days. Attn: Inlormat(on NPiT„
1C, f Mall Service Center— Raleigh, NC 2T899.1617 Phone No, (919) 733-701 sitE ov77 D
Form GWla
Rev. 7105
Asheville Regional Office
-Prat gr:ticrt

RESIDENTIAL WELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources. Division of Water Quality
WELL CONTRACTOR CERTIFICATION #
1. WELL CONTRACTOR:
Russell S. Taylor
Well Contractor (Individual) Name
Hedden Brothers Well Drilling, Inc.
Well Contractor Company Name
S`;f,@ET ADDRESS 73 Holly Hills Vista RD
_:crank T a C 28734
City or Town State Zip Code
( 828 )- 369-9591
Area code- Phone number
2. WELL INFORMATION: /� 41,52
SITE WELL ID#(11 applicable) ry 1/2'&Q-7: - `7
STATE WELL PERMIT #(ir applicable)
DWQ or OTHER PERMIT Cif applicable)
N c_L USE (Check Applicable Box): Residential Water Supply 0
i D.,'E DRILLED .3-1 7�� CKJ
./��2 /y��
T 1.'. COMPLETED T: AM7 "AC
3. P.I. ' i-L LOCAITION:
CI 1 Y:
I C4:Y1 /l: fLt -1 a
(Street Name, Numbers, Community, Subdivision. Lot No.. Parcel, Zip Code)
TOPOGRAPHIC / LAND SETTING:
❑.Sicpe DValley ❑Flat D Ridge D Other
(check appr1d1ppr0rlste box)
I_ ITUDE ,J1 Cy
(.". /:TUDE2.1I 9IB
L.:h'Itde/longitude source: Jii,913S DTopographicmap
i locetbn of welt must be shown on a USGS topo map and
attached to this form Ifnot using GPS)
4. WriL OWNER
�
May be in degrees,
minutes, seconds or
in a decimal format
OyM VER S NAME 1vl.e_P
STKEET ADDRESS 1.j+,,l� 'lU�Gl)�t /nto
.00 �
I �` ,-$79y
n4 / State Zip Code
L_ )- 5-V _ 553
A'sa code - Phone number
5, WELL DETAILS: / _ s
a.''1'OTAL DEPTH: ID
b. DOES WELL REPLACE EXISTING WELL? YES
IDS NO3C
c. WATER LEVEL Below Top of Casing: -c.F /L J FT.
(Use'+' If Above Top of Casing)
d. TOP OF CASING IS 2 FT. Above Land Surface
'Top of casing terminated aUoc below land surface may require
a variance In accordance with 15A NCAC 2C .0118.
gMETHOD OF TEST Blow
2187
1, DISINFECTION:Type Hf`T H Amount 16oz
g. WATERnit-in
(depth):'s
From tS5O �To ifl From To
From F)(Gq To 5'7! From To
From To From To
S. CASING:
Depth
From, ( ) To,
From
From To
Ft
Diameter
Thickness/
Weight
7. GROUT: Depth Material Method
From_Q_To-.20 Ft. omit & knniite pnl'18d
From To Ft.
From To Ft.
8. SCREEN: Depth Diameter Slot Size Material
From To Ft. in, _ In,
From To Ft. In, In.
From To Ft. In. in,
9. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
From To Ft.
10. DRILLING LOG
O From To Formation Description
Clay & sand
11. REMARKS:
Granite
J iCe
100 HERESY OERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH
1SA NCAC 2C, WELL CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS
RECO S SEEN PROVIDED TO THE WELL OWNER.
�3.0
SIGNATURE OF CERTIFIED LL CONTRACTOR DATE
Russell S. Taylor
PRINTED NAME OF PERSON CONSTRUCTING THE WELL
Su:') ,.it the original to the Division of Water Quality within 30 days. Attn: information Mgt.,
161: MI'.II Service Center —Raleigh, NC 27699.1617 Phone No. [phone] ext 568.
Form GW-1a
Rev. 7105

RESIDENTIAL WELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources- Division of Water Qualit
WELL CONTRACTOR CERTIFICATION # 2187
1. WELL CONTRACTOR:
Russell S. Taylor
W eH Contractor (Individual) Name
Hedden Brothers Well
V. ell Contractor Company Name
Drilling/ In
Hills Vista RD
STREET ADDRESS 73 Holly
Franklin, NC 28734
City or Town State Zip Code
( 828 )• 369-9591
Area code- Phone number
2. WELL INFORMATION:
SITE WELL ID Mil implleabs)
STATE WELL PERMIT#(ireppllceble)
DdJQ or OTHER PERMIT e(If applicable)
N cLL tJSE (Check Applicable
Box):'��tt,,Residential Water Supply 0
( rarrE DRILLEO__:4_` ' .•�'� LLLLLL..������
TIME COMPLETED Jr• (.)AM❑_ PM,
3. WELL LO TIOW
o TWn,uNA
( Intl Name, umbva, „emmunlly, Subdivision, Lot No., Parcel, 21p Code)
TOPOGRAPHIC /LAND SETTING:
❑Slope °Valley ❑Flat ❑Ridge ❑Other
(check apprdpdtla box)
I_/ T'TUDE _
L"PeGITUDE
Latitude/longitude source: 00PS °Topographic map
1'Iocatbn of well must be shown on a USGS fopo map and
attached to fhb form Enot using GPS)
4. WELL OWNER . 1
OWNER'S NAME
ST''ET DRESS
In (ia
y o own Stale
C U TY
May be In degrees,
minutes, seconds or
In a decimal format
LS271• 1p5I t97/
Arcs code • Phone nu et
6. WELL DETAILS: 2 �j�
a. TOTAL DEPTH: t
b. DOES WELL REPLACE, EXISTING WELL? YES''°l N0,
c. WATER LEVEL Below Top of Casing: aCJCJ FT.
(Use'+' If Above Top of Cuing)
d. TOP OF CASING IS 2 FT, Above LandSurfaca'
'Top of cuing terminated aVor below land surface may require
a variance In accordance with 16A NCAC 2C .0116,
a e,.YIELD(gpm): METHOD OF TEST BLOW
Zip Code
I. DISINFECTION: Type HIT H Amount 160Z
g. WATER ZONES (depth):
From
From
From
6. CASING:
From
From
From
To
From To
From Ta
From
To
Thickness)
Depth Dlyn%er Weight to ial
To a� Ft. fit
,n
To 3 Ft. 44 "
To Ft.
/l)lf •37
7. GROUT: Depth Material Method
From 0 To .2O FL omit & bEttnite mired
From To Ft.
From To Ft.
e. SCREEN: Depth Diameter Slot Size Material
From To Ft. In, In.
From To Ft. In. In.
From To Ft. . In, in.
9. SAND/GRAVEL PACK:
Depth Size
From
From
From
To Ft.
7o Ft.
To Ft.
10. DRILLING LOG
From To
0 r
11, REMARKS:
Material
Formation Description
Clay & sand
Granite
:\Y
100 HERESY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITN
1 aA NCAC 2C, WELL CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS
RECORD y&S BEEN PROVIDED TO THE WELL OWNER.
���U `7 ''RA —` . T ��
SIGNATURE OF CE TIFIED W CONTRACTOR DATE
Russell S. Tayld
PRINTED NAME OF PERSON CONSTRUCTING THE WELL
Suht7 it the original to the Division of Water Quality within 30 days. Attn: information Mgt',,
161 t Mall Serdcs Center— Raleigh, NC 27899.1617 Phone No. [phone] ext 668, r`m
)
1
Form G�l1 Ti
f 7105 i

RESIDENTIAL, WEL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources• Division of Water Quality
WELL CONTRACTOR CERTIFICATION ft
1. W:;: : CONTRACTOR:
Russell S. Taylor
Wet Contractor (Individual) Name
Hedden Brothers Well Drilling, Inc.
Well Contractor Company Name
STREET ADDRESS 73 Holly Hills Vista RD
Franklin. NC 28734
City or Town State Zip Code
(_828 )• 369-9591
Area code. Phone number
1. WELL INFORMATION:
SITE WELL ID *pi epplieable)
STATE WELL PERMIT#(If spoilable)
DWQ or OTHER PERMIT *(if applicable)
W aLL USE (Check Applicable Bo):): Residentlal Water Supply 0
r,- i; E DRILLED
TIME COMPLETED,
3. WELL LO TIO
Y.
Slw erne, Numbers,
AMC Pik
COUNTY
.Cl�'iLLLT
mmunity, bdbl.ion, Lol No., Parcel, Zip
TOPOGRAPHIC / LAND SETTING:
p.S:ape CValley ❑Flat CRIdge jOther
(check spordptlale box)
IJ'11TUDE
LONGITUDE_ _
Lati'tlde/longitude source: 00PS ❑Topographic map
(locatbn of wed must be shown on a USGS topo map and
attached to th( form snot using GPI)
4.WILL OWNER
OWNER'S NAME
• F. ei _T ADDRESS
May be in degrees,
minutes, seconds or
in a decimal format
5
Qa•'�lly ««Town Mete
Areacde)• _onn CJ
Area code • Phone number
Zip Code
6. WELL DETAILS: ,{ / a
a, TOTAL DEPTH: '*L)
b. DOES WELL REPLACE EXISTING WELL? YES C NO p
c. WATER LEVEL Below Top of Casing:
(Use'+' if Above Top of Casing)
d. TOP OF CASINO is 2 FT. Above Land Surface'
'Top of easing terminated atr« below land surface may require
a variance In accordance with 1SA NCAC 2C .0116.
e. YIELD (gpm): J 1 METHOD OF TEST Blow
2187
t. DISINFECTION: Type H1rT H Amount 160z
g. WATER ZONES (depth):A
From ///7.��1� To�
Fran �E /ri To
From To
From To
From To
From To
6. CASING: Thickness/
n Depth JO/Ft Dlafneter /e a gist
From (/ to. t7II ^C ll
From To Ft.
From To Ft.
T. GROUT: Depth Materiel Method
From 0 Tor.2O FL dRTF'd' & ben:Mite Wired
From To Ft.
From To Ft.
8. SCREEN: Depth Diameter Slot Slza Material
From To Ft. In. In.
From To Ft. In. In.
From To Ft. In. In.
9. SAND/GRAVEL PACK:
Depth Size
From To FI.
From To Ft.
From To Ft.
10. DRILLING LOG
From Totif
pAMILIa r
11. REMARKS:
Material
Formation Description
Clay & sand
Granite
rJ
1
0
100 HERESY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE W nH
1SA NCAC 2C. WELL CONSTRUCTION STANDARDS, AND THAT A COPY OF MIS
RIGOR
�IA�SEEN
PROVIDED TO 7NCE WELL OWNER. �1f
I .A.f.GAGLC/�J� C J N, i 9 'cL
SIGNATURE OF CERTIFIED WE ONTRACTOR DATE
Russell S. Taylo
PRINTED NAME OF PERSOP4CO$STRUCT4NG THE WEI L
Submit the original to the Division of Water Quality within 30 days. Attn: information M¢f:
1617 Mali Servlca Center — Raleigh, NC 27899.1617 Phone No. [phone] ext 168.
Form GW)a
Rev, 7/05

RESIDENTIAL WELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources- Division of Water Quality
WELL CONTRACTOR CERTIFICATION k 2187
1. WEl ), CONTRACTOR:
:ussell S. Taylor
Weil Contractor (Individual) Name
}Iedden Brothers Well Drilling, Inc.
Well. Contractor Company t:b,na
STREET ADDRESS 73 Holly Hills Vista RD
Franklin, NC 28734
City or Town State
L928 )- 369-9591
Area bode- Phone number
2. vials INFORMATION: • 7 �F �,� /
$(TE. WELL ID NW applicable) -5 - `�
STATE WELL PERMITN(ir applicable)
D W Q or OTHER PERMIT N(11 applicable)
N:ELL IJSE (Chec Applicaols Box): Residentlal Water Supply ID
rA fE DRILLED ''/I
TIME COMPLETE T�� AM ID PMA
3. WELL LOCyPT10N; •
CITY: .iVICC)
�A :l1
(Stout Na ,". Numbers. Community, Subdihelon, Lot No., Parcel, Zip Code)
TOPOGRAPHIC / LAND SETTING:
(]Slope ❑Valley O Flat ORldge ❑Other
(check apprdpriete box)!
L;11TUDE i r9l$
LONGITUDE/2
Iatr't:de/longitude source: , GPS oTopographic map
llocetbn of wet must be shown on a USGS topo map and
attached to Mks form if not using GPS)
Zip Code
COUNTY
May be in degrees,
minaret, seconds or
in a decimal format
4.y'-,F i.t. OWNER eI
O. INER'S NAME L" , �1
'
(;T,tEET ADDRESS :1 9 ,5
C11y or Town ' Stale
Area code • Phone number
6, WELL DETAILS; lam'
a.. TOTAL DEPTH:
b. DOES WELL REPLACE EXISTING WELL? YES q NO
c. WATER LEVEL Below Top of Casing: -ri[ FT.
(Use'+' It Above Top of Casing)
d ' LP OF CASING IS 2 FT. Above Land Surface'
.'Top of casing terminated at/or below land surface may require
a variance In accordance with 1SA NCAC 2C .0118.
BOAC)
Zlp Code
e. YIELD (ppm):
METHOD OF TEST Blow.
1, DISINFECTION:Type Hlr'T H Amount 16oz
g. WATER ZONES (depth):
From To From To
From To -From To
From To From To
6, CASING:
�+1 DepthTo FL (( Diq� grter
From l/ /
From__ To_ Ft.
From To_ Ft.
Thickness/
Weiytl6o mat rlal
7. GROUT: Depth Material
r��,.,,��� Method
From 0 To—.20 Ft. cement & AJuL ite wired
From To Ft.
From To Ft.
0. SCREEN: Depth Diameter Slot Size Material
From To Ft. In. In.
From To FL In, in.
From To Ft, In. In.
9. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
From To Ft.
10. DRILLING LOG
F0om To/�9y
/9 io7I
Formation Description
Clay & sand
Granite
O
LJx
11, REM(314%.1ARKS; 1)
100 HERESY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WTI
15A NCAC 2C, WELL CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS
RIGOR AS SEEN PROVIDED TO THE WELL OWNER.
SfGNATURE OF CERTIFIED W CONTRACTOR DATE
Russell S. Taylor
PRINTED NAME OF PELRMN.CQNSTRUCTING THE WELL
Submit the original to the Division of Water Quality within 30 days. Attn: Infation
1617 Mall Service Center— Raleigh, NC 27699-1617 Phone No. [phone] ext 68.
cA
Form GW I
Rev. 7/05
nshe,,e Fiectioti9t Office

RESIDENTIAL WELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources- Division of Water Quality
WELL CONTRACTOR CERTIFICATION 8 2187
1. DISINFECTION: Typo HJ'T H Amount 16oz
1. WELL CONTRACTOR:
Russell S. Taylor
Wen Contractor (Individual) Name
Hx'iden Brothers Well Drilling, Inc
Weil Contractor Company Name STREET ADDRESS 73 Holly Hills Vista RD
City or Town Slate Zip Code
( 828 )- 369-9591
Arse code- Phone number
• 2. WELL INFORMATION:
SITE WELL ID Rif applicable)
STATE WELL PERMITS0f'ppllceble)
DAM or OTHER PERMIT a(If applicable)
Residential Water Supply ❑
USE (Check Applicable Box):
:',,:, rE DRILLED
TIME COMPLETED,
3. WELL LOpATION:
CITY:
tr (4AAL / ij,uuircu
(Scree ems, Num ar¢e, Community, ubdlvlsion, Lot No., Parch, Zip Coda)
TO'OGRAPHIC ( LAND SETTING:
❑Sape ❑Valley ❑Flat ❑Ridge
(check epprdptlals box)
L. ' TUDE
LONGITUDE
OOther
May be In degrees,
minutes, seconds or
In a decimal format
La:- ode/longitude source: OOPS Topographic map
location of well must be shown on a USGS fopo map and
attached to this form N not using GPS)
4. WELL OWNER
OWNER'S NAME
EET 'DDRESS
ay Town TownS ale
pDW,,,(��f/0 :ode. goons numbete
5. LJeLL DETAILS:
a. TOTAL DEPTH:
sVO
Zip Code
b. DOES WELL REPLACE EXISTING WELL? YES NO ❑
a. WATER LEVEL BeIoviTop of Casing: FT.
(Use If Above Top of Cuing)
d. TOP OF CASING IS 2 FT. Above Land Surface'
'Top of using terminated at/or below lend surface may require
a variance In accordance with 15A NCAC 2C .0118.
o.1IELD(gpm): METHOD OF TEST Blow
g. WATER
From
From
From
ONES (de th):
Toj
6, CASING;
From,
From
From
To
From
From,
Frarn
To
To
To
Thickness/
Depth Dirtier Weight IvJuTFFt9�isl
To Ft. Ft. (1L�9� ./0E Weal
To
7. GROUT: Depth
From_a__ To-:20
From To_
From To
S. SCREEN: Depth
From To
From To
From To
Ft.
9. SAND/GRAVEL PACK:
Depth
From To
From To
From To
10. DRILLING LOG
From To
0
11. REMARKS:
Material Method
Ft. Catlett & termite Rutted
Ft.
Ft,
Diameter Slot Size Material
Ft. In. _ In.
Ft. In. __ In.
Ft. In. __ In.
Ft.
Ft.
Ft.
Size
Material
Formation Description
Clay & sand
Gra11i to
100 HEREBY CERTIFY THAT MIS WELL WAS CONSTRUCTED IN ACCORDANCE wmi
15A NCAC 2C. WELL CONSTRUCTION RECORD H►( SEEN PROVIDED TO THE WELL LL OWER.ARDS. AND TMATA COPY OF THIS
J
usicrOD
SIGNAfURE OF CERTIFIED WE CONTRACTOR DATE
Russell S. Taylor
PRINTED NAME OF PERSON CONSTRUCTING THE WELL
LC
the original to the Division of Water Duality within 30 days. Attn: Informatl n Mgt ,k L C
1617 Mali Service Center— Raleigh, NC 27899.1817 Phone No, [phone] ext 668.
aFosPkW-1 a
Rev. 7/05
•
Offs
1..1{ilf.i:
Actle,;'i1ee ryG''(_Iry

RESIDENTIAL WELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources• Division of Water Quality
WELL CONTRACTOR CERTIFICATION Of 2187
1. VJZLL CONTRACTOR:
Russell S. Taylor
Well Contractor (Individual) Name
Redden Brothers Well Drilling, Inc
Well Contractor Company Name
STREET ADDRESS 73 Holly Hills Vista RD
Ftanklini_NC 28734
City or Town State Zip Code
( 828 )- 369-9591
Are, node- Phone number
2. WE INFORMATION:
:' Tj: WELL ID ♦fll epplicebla) P kief9 -.59 -.5211/44-5
STATE WELL PERMITe(II section)
DWQ or OTHER PERMIT a(If applicable)
N ELL :JSE (Check Applicable Box):sResidential Water Supply
i r-•A rE DRILLED -� ' 31,06
6
TIME COMPLETED /0.01'7 AM, PM ❑
8. WELL LOCATION:
/! s
ChhY:
(sueret Neme, Numbers, Community. Subdinslun, Lot No., Parcel, Zip Code)
TOPOGRAPHIC 1 LAND SETTING:
❑.S'Iope °Valley ❑Flat ()Ridge °Other
(check spprdprlslo box)
L 11TUDE
LONGITUDE
La:''Ilde/longitude source: OGPS °Topographic map
/ocetbn of wall must be shown on a USGS tope map and
attached to tills form anof using CPS)
4. Wilt. OWNER
CYvA'2R'S NAME
' LET ADDRESS
May be in degrees,
minutes. seconds or
In a decimal format
City Town 7 -0 Vli
r S,0•
A• ea code • Phone number
8. WELL DETAILS: 4631
a. TOTAL DEPTH:
Zip Code
b. DOES WELL REPLACE EXISTING WELL? YES ° NOA
c. WATER LEVEL Below Top of Casing: - FT.
(Use'+' N Above Top of Casing)
d. TOP OF CASING la 2 FT. Above Land Surface'
'Top of cuing terminated atfor below land surface may require
a variance In accordance with 15A NCAC 2C .0118.
e. YIELD (gpm): / METHOD OF TEST Blow
f. DISINFECTION: Type Hy H Amount 16oz
9. WAT�ERr�ZON€S (d pthlr:/ /
'/L 7 From "'AU To 73 / From To
From To From To
From To From To
6. CASINO: Thickness/
Depth ��^J/ Diameter Weight
From ,.% To (D / Ft. !�r/
From /1 %rToF1. (o"
From To Ft.
h1Aler al
thfi
7. GROUT: Depth Material Method
From 0 To" 20 Ft. Clara t & bErrnite arced
From To Ft.
From To Ft.
8. SCREEN: Depth Diameter Slot Size Material
From To Ft. In. in.
From To Ft. In. In.
From To Ft. In. in.
9. SAND/GRAVEL PACK:
Depth
From To Ft.
Size Material
From To FI.
From To Ft.
10. DRILLING LOG
From To
O
11. REMARKS:
Formation Description
Clay & sand
Granite
100 HERESY CERTrY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE W rm
ISA NCAC 2C, WELL CONSTRUCTION STANDARDS. AND THAT COPY OF TiIS
RECO AS SEEN PROVIDED TO THE WELL OW R.
SIGNATURE OF CERTIFIED WE CONTRACTOR j DlfrE
Russell S. Tavlo
PRINTED NA
Submit the original to the Division of Water Quality within 30 days. A n: Informi{Fornii t.,`
1617 Mall Service Center- Raleigh, NC 27699.1017 Phone No, (919) 733-75 ext 568.
UCI1NG THE W ELL
Fjorm GW1a
Fist 7/05
{

>web
RESIDENTIAL WELL CQNSTRUCTION RECORD ()jilt)
North Carolina Department of Environment and Natural Resources- Division of Water Quality
WELL CONTRACTOR CERTIFICATION N
2187
1. V'ELL CONTRACTOR:
Russell S. Taylor
Well Contractor (Individual) Name
Redden Brothers Well Drilling, Inc.
Well Coi itractor Company Name
STREET ADDRESS 73 Holly Hills Vista RD
tatklin Nr 78734
City or Town State Zip Code
( f;28 )- 369-9591
Area code- Phone number
2. WELL INFORMATION: •
SITS WELL ID0(Ifapplicable) 7ia 3-!>93 .67I'7
STATE WELL PERMIT0(e applicable)
DO/ or OTHER PERMIT Cif applicable)
N FLL :JSE (Check Applicable Box): Residential Water Supply 1"'
o�
: S.•. fE DRILLED 3 O /��
TIME COMPLETED • C.vl/ AM ❑ PMit
3. NiF-L LOCA ION:
C..'. I ,
COUNTY
(Fogel Name, Numbers, Community, - diMelon, Lot No., Parcel, Zip Code)
TOPOGRAPHIC f LAND SETTING:
❑;lope °Valley ❑Fist ❑RIdpe ❑Other
(check apprdprlale box)
Li T'TUDE _3_
LG AGITUDE
L .; ':de/longitude source: °CPS °Topographic map
i!ocafbn of we0must be shown on a USGS topo map end
attached to this tom; M not using GPS)
May be In degrees,
minutes, seconds or
In a decimal format
/. WF.:-L OWNER
OWNER'S NAME
STRET ADDRESS
City orTown State
LILL. Or 30
Aron code • Phone number
Zip Code
•
S. Vti_LL DETAILS: y�L n�,
a. TOTAL DEPTH: LILA
b.. DOES WELL REPLACE EXISTING WELL? YES 0 NO/1(
c HATER LEVEL Below Top of Casing: - FT.
(Use 1+1 If Above Top of Casing)
d. TOP OF CASING la 2 FT. Above Land Surface•
'Top of cuing terminated at/or below lend surface may require
a variance In accord nce with 15A NCAC 2C .0118.
e, YIELD(ppm): METHOD OF TEST Blow
f. DISINFECTION: Typo H"T H Amount 16oz
g. WATER ZONES (depth):
From To From To
From To From To
From To From To
6. CASING: Thickness/
Depth Diameter Welphl
From �) To1 Ft., (to •
From .3/11 To -IV/ Ft. b,, -Ws
From To Ft. _
Meterial
PVc
0
7. GROUT: Depth Materiel Method
From 0 To-.20 Ft. wit & teiznite p.nred
From ToFt.
From To Ft.
8. SCREEN: Depth Diameter Slot Size Material
From__ To FI. in. In.
From To Ft. In. In.
From To Ft. In. In.
9. SAND/GRAVEL PACK:
Depth
From To Ft.
From To Ft.
From To Ft.
10. DRILLING LOG
From To
0
11. REMARKS:
Size
Malarial
Formation Description
Claw & sand
Granite
0
100 HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE Wml
15A NCAC 2C, WELL CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS
.RECORD aSEEN PROVIDED TO THE WELL OWNJ<j1.
J /jyGo
SIGNATURE OF CERTIFIED WEL ONTNTRACTOR D TE
Russell S. Taylnr
PERSO ,QQNSIARJICTIN9 THE WELL-
i ti
Im :tea
PRINTED NAME OF
Submit the original to the Division of Water Quality within 30 days. Attn: Information Mgt,
1611 Mall Service Center- Raleigh, NC 27899.1617 Phone No. (919) 733-701 S aA 568.
Form GW-1a
Rev. 7105

RESIDENTIAL WELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources- Division of Water Quality
WELL CONTRACTOR CERTIFICATION # 2187
1. WEL L CONTRACTOR:
Russell S. Taylor
Well Contractor (Individuap Name
Hedden Brothers Well Drilling, Inc.
Well Contractor Company Name
STREET ADDRESS 73 Holly Hills Vista RD
Franklin, IVC 28734
City or Town State Zip Code
( 828 )- 369-9591
Area code- Phone number
2. WELL INFORMATION:
S!7 r WELL ID *Of applicable) 7140.. g
STATE WELL PERMIT/ft appicable)
D MI or OTHER PERMIT Cif applicable)
`1 t V_'1SE (Check Applicable Box): Residential Water Supply 0
,.rE DRILLED
TIME COMPLETED 1I 15 AMf PM ❑
3. WELL LOC TIO: In, n,G,F
CITY: .a .1 ! COUNTY l�( ipoJt )
(Elmo Name, Numbers. Community, Subdivision, Lot No., Parcel, Zip Code)
TO?°GRAPHIC / LAND SETTING:
❑Slope °Valley ❑Flat ❑Ridge
(check 'portioning box)
L. 1 'TUDE
LONGITUDE }),1 Ud.no 911
Lat'nde/longitude source: GPS °Topographic map
(location or wen must be shown on a USGS topo map and
attached to this form N not using GPS)
4. WELL OWNER
OWNER'S NAME
STREET ADDRESS
❑Other
May be in degrees,
minutes, seconds or
in a decimal format
r PP i1�C �87,113
CI or Town Stole Zip Code
(_$ L- 5'L
A it cute - Phone number
5.''•IELL DETAILS: I
a. TOTAL DEPTH: 375
b. DOES WELL REPLACE EXISTING WELL? YESp NO q1
,1
e. WATER LEVEL Below Top of Casing: J FT.
(Use •+' if Above Top of Casing)
d. TOP OF CASING Is 2 FT. Above Land Surface'
'Top of casing terminated at/or below land surface may require
a variance in accorrdsa;ce with 15A NCAC 2C .0118.
e. !IELD (gpm): (Ls/ METHOD OF TEST Blow
I. DISINFECTION: Type H'T H Amount 160Z
g. WATER ONES (depth):
From ToG2 From To
From Q(o'To From To
From To From To
6. CASING: Thickness/
Depth Dlalneter Weigel Material
From To Ft. /o rr c(r
From To Ft isJZE y22D
From To Ft.
7. GROUT: Depth Material Method
From 0 To" 20 Ft late t & le -mite Tarred
From To Ft.
From To Ft,
8. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in.
From To Ft. In. In,
From To Ft. in. in.
9. SAND/GRAVEL PACK:
Depth Size Material
From To FI.
From To FI.
From To Ft.
10. DRILLING LOG
From T
0
11. REMARKS:
Formation Description
Clay & sand
Granite
I00 HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE Wm1
15A NCAC 2C. WELL CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS
RECORD AS BEEN PROVIDED TO THE WELL OWNER.
SIGN
44,11
ATU E OF( F CERTIFIED WEL ONTRACTOR D TE
Russell S: T yy1of
PRINTED NAME OF'PERSDN GUNS 1 Ht1CTING THE WELL-..
Submit the original to the Division of Water Quality within 30 days. Attn: In •rmatlon Mgt.,
1617 Vall Service Center— Raleigh, NC 27699-1617 Phone No. [phone] ex 568.
Form GW-la
Rev. 710

RESIDENTIAL WELL CONSTRUCTION RECORD �J�, -
North Carolina Department of Environment and Natural Resources- Division of Water Quality
WELL CONTRACTOR CERTIFICATION N 2187
1. WELL CONTRACTOR:
Russell S. Taylor
Well Contractor (Individual) Name
Hedden Brothers Well
Well Contractor Company Name
Drilling, Inc.
STREET ADDRESS 73 Holly Hills Vista RD
'Ganktin NC 78734
City or Town State Zip Code
( 328 )• 369-9591
l•.raa cods- Phone number
2. WELL INFORMATION: '�/ (� �'y
SITE WELL ID *Ol'ppllatela) 'i5 ry / • % tJ (1.9a
STATE WELL P ERMIT#(If applicable)
DW 7 or C T HER PERMIT e(I! aop'Icable'
°'_L USE (Check Applicable Boxy
x):Residential Water Supply O
I I:: '9 DRILLED 3 iY7-61
Tr, E COMPLETED AGO
3. vi Ei.L LOCATION:
a
(Strut Nem., Num
AM ❑ PM
Community, SubdMNPlon, Lot No.. Parcel, Zip Code)
TOPOGRAPHIC / LAND SETTING:
(nIpe °Valley ❑Flat °Ridge ❑Other
(check appropriate box)
I_ 'I ITUDE ,
LONGITUDE
L..I ' 'de/longitude source: DOPS °Topographic map
I :canon of wet MUM be shown on a USGS fcpo map and
'slat/mid to this to not wing GPS)
'
':ALL OWNER
WNER'S NAME
I?MEET ADDRESS
i MTh F 3495%
Zip Coda
May be In degrees,
minutes, seconds or
In a decimal forma
or Town State
g,• ? t .15
number
Area code • Phone number
5. WELL DETAILS:
a. 'TOTAL DEPTH:
50'
b. DOES WELL REPLACE EXISTING WELL?�YES � N0*,
e. WATER LEVEL Belau Top of Cuing: c" LCll1 FT.
(Use'+' 9 Above Top of Casing)
d, TOP OF CASINO IS 2 FT. Above Land Surface'
'Top of cuing terminated aUcr below lend surface may require
• variance In accordance with 1 SA NCAC 2C .0116,
us. YIELD (gpm): .3 METHOD OF TEST Blow
I. DISINFECTION:Type H+T H Amount 16oz
g. WATER ZONES (depth):s
From 11!3" To 115' From To
Fran ir / r From To
From To From To
9. CASING: Thickness/
Depth Di afar WeightM r'sl
From To rJrv�/'1Ft.
Ft. O From To
From To Ft.
7. GROUT: Depth Material Method
From 0 To' 20 Ft. CHtat & kntnite pr ed
From To Ft.
From To Ft.
S. SCREEN: Depth Diameter Slot Size Material
From To Ft. In. In.
From To FI. In. In.
From To FL In. in.
9. SAND/GRAVEL PACK:
Depth
From To FI.
From To Ft.
From To Ft.
Size
Material
10. DRILLING LOG
From To Formation Description
0 Clay & sand
I1. REMARKS:
Granite
100 HERESY CERTIFY THAT THIS WELL WAS CONSTRUCTED N ACCORDANCE Wnlr
ISA NCAC 20. WELL CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS
RECORD HAS SEEN PROVIDED TO THE WELL OW Nf, R.
.tJ1 A o
3J
SIGNATURE OF CERTIFIED WELL ONTRACTOR ' 1 DP+fE
Russell S. Taylor
PRINTED NAME OF PERSON CONSTRUCTING THE WELL
Submit the original to the Division of Water Quality within 30 days. Attn: Informagn,Mgt.,
1617 Mall Service Center— Raleigh, NC 27699.1817 Phone No, [phone] eat 568 ..„,
Foul GW 1 a
Rsv.7/05

RESIDENTIAL WELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources- Division of Water Quality
WELL CONTRACTOR CERTIFICATION # 2187
1. WEL: CONTRACTOR:
Russell S. Taylor
Well Contractor (Individual) Name
I?edden Brothers Well Drilling, Inc.
W all Contractor Company Name
STt".EET ADDRESS 73 Holly Hills Vista RD
'Ianklin NC 28734
City or Town State Zip Cade
( 828 )- 369 9591
Area code- Phone number
2. WELL INFORMATION:
SITE WELL ID Of applicable)
q-ii_sg'
STATE WELL PERMIT#(1f applicable)
DWQ or OTHER PERMIT SW applicable)
N c • '. USE (Check Ap feebl Box): Residential Water Supply
Li DRILLED
TWO, COMPLETED
"T. 5 9_ AM P
3. WLLL LO TION:
CIT ' V - COUNTY C P� t
(Street Na e. Numbers, Commonly. subdlNelo Lot o., Parcel, Zip Coda)
TOPOGRAPHIC 1 LAND SETTING:
❑Slope ❑Valley ❑Flat ❑Ridge ❑Other
(check epprdpriale box)
L. lfl'UDE .�i- �3 IA)
LU'JG)TUDE j„= 00 283J
L 1 le/longitude source: f2PS ❑Topographic map
'location of well must be shown one USGS topo map end
attached to this form Ifnot using GPS) ,
4. W'ULL OWNER ///
OWNER'S NAME ) h 21
1 AM.
ST ET ADDRESS' ;2_y
/ y�S�U .1 /j tt aO ►,� t 1� Code
L Y G gT 477 - i0 7own 4 p Coda
May be In degrees,
minutes, seconds or
in a decimal formal
s s code • Phone number
6.1\ tLL DETAILS:
a. TOTAL DEPTH: t7(
b. DOES WELL REPLACE EXISTING WELL?YES ❑
?
e. WATER LEVEL Below Top of Casing: nl0r - FT.
(Use '+' If Above Top of Casing)
d. TOP OF CASINO IS 2 FT. Above Lend Surface'
'Top of casing terminated at/or below land surface may require
a variance In accordance with 15A NCAC 2C .0118.
METHOD OF TEST Blow
e. YIELD (gpm):
NO ❑
f. DISINFECTION: Type H:r�T H Amount 16oz
g. WATER;ONES(depth):
From IOlf To '70 From To
From /OP To From To
•
From / 67 To / / From To
6. CASING: Thickness)
From
From,
From
Depth 1
To Ft
T To �Ft
To _— Ft
Diameter •
-Weightt;-� Ma rial
r , inn
7. GROUT: Depth Material Method
From_Q_,_To- 2O Ft. C81H1t & Isn,ite P= Dad
From To Ft.
From To Ft.
8. SCREEN: Depth Diameter Slot Size Material
From To Ft. In. in.
From To Ft. In. in.
From To Ft. . In. In.
9. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
From To Ft.
10. DRILLING LOG
From To Formation Description
O odd' Clay & sand
40'1 /SC ' Granite
11. REMARKS:
I D0 HERESY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH
15A NCAC 2C, WELL CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS
RECCgR^�qHAS BEEN PROVIDED T.OvTHE WELL OWNER.
SIGNATURECERTIFIED WEL ONDAT
.teLef)) TRACTOR 412
,1/
Russell S. Taylo
PRINTED NAME OF PE-SQN-CONSTRU.CtTING THE WELL
Suh:TLit the original to the Division of Water Quality within 30 days. Attn: Info ation
16', 7 'tall Service Center —Raleigh, NC 27699.1617 Phone No. [phone] ext 5>�.
t.
Form GW-1
Rev. 7/05

RESIDENTIAL WELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources- Division of Water Quality
WELL CONTRACTOR CERTIFICATION A 2187
1. WELL CONTRACTOR:
Russell S. Taylor
Well Contractor (Individual) Name
Hedden Brothers Well Drilling, Inc.
Well. Contractor Company Name
STREET ADDRESS 73 Holly Hills Vista RD
Frar4lin. NC 28734
City or Town State Zip Cods
•( 828 t- 369-9591
Area code- Phone number 2. WELL INFORMATION: •
SITE WELL ID il(If applicable)
STATE WELL PERMITe(If applicable)
DWG or OTHER PERMIT Cif applicable)
VI• ELL USE (Check Appll able Box): Residential Water Supply ID
I f,AtE DRILLED 7
Go
TIME COMPLETED AM PM :3
3. WELL LOC TION:
CITY:
(S reef dame, umb Community. SubdIM1
T4.?'OGRAPHIC 1 LAND SETTING:
❑T)pe ❑Valley ❑Flat °Ridge C Other
(check apprcprIate box)
11TUDE L _
LONGITUDE
n, Lot No., P rcel, Zip Code)
May be In degrees,
minutes, seeonds or
In a de olmal format
La:ti•ade/longitude source: (DCPS Topographic map
;location of wolf must be shown on a USGS too m Ip and
attached to this loan d not using GPS)
4.WELL OWNER e
C t'NER'S NAME
F .a.ET ADDRESS
7j
or Town
$j• %s - "1-RD
A%ua code • Phone number
6. WELL DETAILS: '7 j�%
a. TOTAL DEPTH: (�
b. DOES WELL REPLACE EXISTING WELL? YES ❑ NO 0
c. WATER LEVEL Below Top of Casing:--4'Ci FT.
(Use'+' If Above Top of Cuing)
d. TOP OF CASINO is 2 FT. Above Land Surface'
'Top of casing terminated at/or below land surface may require
• a variance In accordance with 1SA NCAC 2C ,0116,
e • fiELD (gpm): J METHOD OF TEST Blow
Zip Code
f. DISINFECTION: Typo Hi'T H Amount 1602
9. WATER ZONES (de thy
From ADQv To
From
From To
From
From
From
To
To
To
8, CASING:,s'') �/ // Thickness/
From LZ DToh)70AFt. Dip�reler 9gtD PM)
From To Ft. / ��!/
From To Ft.
7. GROUT: Depth
Material Method
From_Q,__To:2O Ft. cTn.'f & I$Yllite rated
From To Ft.
From To Ft.
8. SCREEN: Depth Diameter Slot Size Material
From To Ft. in In.
From To FI. In. In.
From To Ft. In. In.
9, SAND/GRAVEL PACK:
Depth Size Material
From To FL
From To Ft.
From To FL
10. DRILLING LOG
From T
0
11. REMARKS:
Formation Description
Clay & sand
Granite
r-n
on
I D0 HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WRN
ISA NCAC 2C, WELL CONSTRUCTOR STANDARDS, AND TNAT A COPY OF 71415
RECO S BEEN PROVIDED TO THE WELL OW ER,
L} '19.66
SIGNATURE OF CERTIFIED W CONTRACTOR DATE
Russell S. Taylor
PRINTED NAME OF PERSON CONSTRUCTING THE WELL
Submit the original to the Division of Water Quality within 30 days. Attn: Informatl, n Mgt:
1817 Mall Service Center— Raleigh, NC 27599.11117 Phone No. [phone] ext 568.

RESIDENTIAL WELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources- Division of Water Quality
WELL CONTRACTOR CERTIFICATION N 2187
1. WELL CONTRACTOR:
Russell S. Tavlor
Weil Contractor (Individual) Name
Redden Brothers Well Drilling, Inc.
W ell. Contractor Company Name -
STREET ADDRESS 73 Holly Hills Vista RD
Franklin, NC 28734
• City Or Town State Zip Code
l 828 )- 3699591
Arne code- Phone number
2. WELL INFORMATION: �J '//J Iy(,��2
SITE WELL ID e(I1 applicable) /54 �61 / / ^�
STATE WELL PERMIT/0fapplIcablq
DWQ or OTHER PERMIT a(lf applicable)
N ELL USE (Check Applicable Box): Residential Water Supply 0
!:+AfE DRILLED '067
TIME COMPLETED,
3, WELL LO T10
CITY. COUNTY
04 aF1
(street Ne umbers, Community, Subdivision, Lot No., Pareei, Zip Code)
TOPOGRAPHIC / LAND SETTING:
❑Slope °Valley ❑Flat ORidge O Other
(cheek apprdprlele box)
I-, 1�ITUDE yS4 IS JOS&)
LONGITUDE la also
Lath:de/longitude source: OPS Topographic map
I/ocetbn of well must be sh n on a USGS logo map and
attached to thN form I not using GPS)
4. WELL OWNER
OWNER'S NAME
S�T/NEET ADDRESS
' City a Tawi1 tale Zip Code
4- y94 - 4444
Area code • Phone number
AM ❑ PM,K
May be in degrees,
minutes, seconds or
In a decimal format
S. WELL DETAILS:
a, TOTAL DEPTH:
b. DOES WELL REPLACE EXISTING WELL?PP YES N)'<'6]
o. WATER LEVEL Below Top of Casing: ` / 00 - FT.
(Use '+' If Above Top of Casing)
d..+TOP OF CASINO 18 2 FT. Above Land Surface'
'Top of cuing terminated at/or below land surface may require
a variance In accordance with 15A NCAC 2C .0118.
e, YIELD (gpm): METHOD OF TEST Blow
326334:
f, DISINFECTION: Type HIT H Amount 1 6oz
g. WATER ZONES (depth):
From U To' From To
From
From
From To,
From To
To
To
6. CASING:/ Thickness/
From f / DTeotthFt. Dirt `/ghl„ M ri
FromTo Ft. CO bD�
From To Ft. __
7, GROUT: Depth Material Method
From 0 To' 20 Ft. anent & hernite Aired
From___ To FL
From To Ft.
S. SCREEN: Depth Dlamoter Slot Size, Material
From To Ft. In. In.
From To Ft. In. In.
From To Ft. In. In.
9. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
From To Ft.
10, DRILLING LOG
From To
0
Formation Description
Clay & sand
Granite
RM1
12:1 'v 5 Lb-',J•
11. REMARKS:
73
rn
fTi
rn
tart
100 HERESY CERTIFY THAT nos WELL WAS CONSTRUCTED IN ACCORDANCE WRH
1SA NCAC 2C. WELL CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS
RECOaa HAS SEEN PROVIDED TO THE WELL OJINER.
c�
SIGNATUR OF CERTIFIED W L CONTRACTOR D TE
Russell S. Tavl r
PRINTED NAME OF PERSON CONSTRUCTING THE WELL
Submit the original to the Division of Water Quality within 30 days. Attn: Information Mgt:,
1617 Mall Service Canter— Raleigh, NC 27899-1617 Phone No. (919) 733.701 S ext 568.
Form GW-la
Rev. 7/05

RESIDENTIAL WELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources- Division of Water Quality
WELL CONTRACTOR CERTIFICATION # 2187
326333.
1. WE_. CONTRACTOR:
Russell S. Taylor
W o'I Contractor (Individual) Name
He±Ien Brothers Well Drillings Inc.
Well Contractor Company Name
STREET ADDRESS 73 Holly Hills Vista RD
Franklin._NC 28734
City or Town State Zip Code
(_ Oa)- 369-9591
Area cods- Phone number
2. WELL INFORMATION: SIl'teWELL ID*Of applicable) 1.5 /z©r�
•c -3y.
STATE WELL PERMITS0f applicable)
DW'Q or OTHER PERMIT SW applicable)
N L!_ USE (Check Applicable Box). Residential Water Supply 0
rafE DRILLED
7' hE COMPLETED
3. 'At LO ATION:
( beet Name, Numbers, Community, SubelMelon, Lot No., Parcel, Zlp Code)
TOPOGRAPHIC / LAND SETTING:
(2 Slope [Valley ❑Flat ❑Ridge ❑Other
(check appropriate box)
I_ 1ITUDE _25Z.
�5
LQiiIGITUDE 3,(x`
UV—Me/longitude source: GPS [Topographic map
'location of wail must be ahothl On a USGS topo map and
attached to this form Mnot using GPS)
4. Wf°LL OWNER
OWNER'S NAME
May be In degrees,
minutes, seconds or
In a decimal format
meg
!.10 ET ADDRESS/tpw••n
` .R�JC P.25)A-a03
C orT Stale
athe
Area code • Phone number
6. 4VEI.L DETAILS: r
a,, I TOTAL DEPTH: 000
b., opalWELL REPLACE EXISTING WELL? YES 0 NO fX
NATER LEVEL Belau Top of Casing: - FT.
(Uee'+' If Above Top of Casing)
d. TOP OF CASINO la 2 FT, Above Land Surface'
'Top of casing terminated at/or below lend surface may require
■ variance in accordance with 15A NCAC 2C .0118.
e. YIELD(gpm): 1r 5 METHODOFTEST Blow
Zip Code
1, DISINFECTION: Type HIT H
g. WATER Z�OHES (Elep�/th)2:
Fromi7�-/To iT xJ From
LC
From Ci(l1Z To A95? From
From
To
From
6. CASINO:
/'� Depth Diameter
From U To Ft. 1.0
From To Ft.
From_ TO Ft.
Amount 16oz
To
To
To
Thickness/
W lop8 Vito
7. GROUT: Depth Material
�,� Method
From 0 To 2O Fl, L cai & kystnite rutted
From To Ft.
From To Ft.
$. SCREEN: Depth Diameter Slot Size Material
From To Ft. In in.
From To FL In, In.
From To Ft. In. In.
9. SAND/GRAVEL PACK:
Depth
From
From
From
To FI.
To Ft.
To Ft.
10. DRILLING LOG
From T
0'
Size
Material
Formation Description
Clay & sand
Granite
Q
ti
.iu: i 06 21123
11. REMARKS:
100 HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH
15A NCAC 2C, WELL CONSTRUCTION STANDARDS. AND THAT A COPY OF THIS
RECORECO MAS��EWELL OWNER.
SIGNATURE OF CERTIFIED W CONTRACTOR f DATE
Russell S. Taylor
PRINTED NAME OF PERSON CONSTRUCTING THE WELL
O
Sugmltthe original to the Division of Water Quality within 30 days. Attn: Information Mgt.,
1611 Mall Service Center —Raleigh, NC 27699-1617 Phone No. [phone] ext 668.
Form GW-Is
Rev. 7/05

RESIDENTIAL WELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources. Division of Water Quality
WELL CONTRACTOR CERTIFICATION $ 2187
326
1. WELL CONTRACTOR:
Russell S. Taylor
Well Contractor (Individual) Name
Hedden Brothers Well Drilling, Inc.
Well. Contractor Company Name STREET ADDRESS 73 Holly Hills Vista RD
Franklin. NC 28734
City or Town Slate Zip Code
:-2$_)• 369-9591
A 13 code- Phone number
2. "v" h.LL INFORMATION: ?(l
Si i'E WELL ID ant applicable) 753q - y - / r'715
ST>TE WELL FERMIUMapplicable)
C:re or OTHER PERMIT epf sp-ellcable`
M ELL USE (Check A Applicable Box):
( r , E DRILLED 4•OI '0
Ttla!1 COM PLETED,
3. WELL LOOATIO
C'1"fy;
Resid
octal Water Supply ❑
AMX PMO
COUNTY 44. Asii.L.
1
(Street Name, Numbers, Community, Subdiesion, Lot No., Parcel, Zip Coda)
TOFOGRAPHIC / LAND SETTING:
❑RIrpe °Valley OFlat ORldge ❑Other
(check apprdprlele box)
11TUDE Qq���J II��
LONGITUDE j3 .L3
LaU'ude/longitude source: %OPS ❑Topographic map
'nos flan of well must be o' n on a USGS fopo map and
Michael to fhla form snot wing GPS)
1. '3i OWNER 1 / ,
C:fNER'SNAME .4� t:hr��,
SIRE T ADDRESS 1I.1 / AO!'/.�.511,1
Aare
t iy) Town Stale Zip Code
(22 )• 5f77 7`R
Area code • Phone number
5. \NELL DETAILS: a.i-DTAL DEPTH: " l
mr
b. DOES WELL REPLACE EXISTING WELL? YES ❑ NO
c. WATER LEVEL Below Top of Casing: do - FT.
(Use '+' If Above Top of Cuing)
d, TOP OF CASINO IS 2 Fr. Above Land Surface*
'Top of easing terminated atlor below land surface may require
a variance In accordance with 15A NCAC 2C .0115,
s, YIELD (gpm): 'VD METHOD OF TEST Blow
May be in degrees,
minutes, seconds or
in a decimal format
f, DISINFECTION: Typo HIT H Amount 1602
g. WATER ONES (dept ): ,
From To From To
From To From To
From To From To
6. CASINO:
Depth Dieter Weight M r
From To Ft. LLO
From To Ft. It, MA
From To Ft. __
Thickness/
7. GROUT: Depth Material Method
From 0 To'.2O Ft. carat & kernita Furred
From To Ft.
From To Ft.
8. SCREEN: Depth Diameter Slot Size Material
From To Ft, In. In.
From To Ft. In. In.
From To FL in. In.
9, SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To FI.
From To Ft.
10. DRILLING LOG
11. REMARKS:
Formation Description
Clay & sand
Granite
r
100 HERESY CERTIFY THAT THIS WELL WAS CONSTRUCTED M ACCORDANCE WRN
15A NCAC 20. W ELL CONSTRUCTION STANDARDS. AND THAT A COPY OF TN@
RECO e'I SBEEN PROVI EDTO TIELL OWNER.
SIGNATURE OF CERTIFIED WELL CJTRACTOr D E
Russell S. Taylor
PRINTED NAME OF PERSON CONSTRUCTING THE WELL
Submit the original to the Division of Water Quality within 30 days. Attn: Information Mgt.,
181?' Mall Service Center— Raleigh, NC 27899.1817 Phone No. [phone] ext 668.
JUN 06 2
Form GWl a
Rev. 7/05

RESIDENTIAL WELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources- Division of Water Quality
WELL CONTRACTOR CERTIFICATION l! 2187
32656
1. WELL CONTRACTOR:
Russell S. Taylor
Well Orrtrenire /Individual) Name
Hedden 3rothers Well Drilling, Inc.
Well Contractor Company Name
STREET ADDRESS 73 Holly Hills Vista RD
Franklin, NC 28734
City or Town State Zip Code
( 828 )- 369-9591
Area code- Phone number
2. WELL INFORMATION:
SITE WELL ID Cif applicable) /Ott"` "V- Sit)/ :7.q
STATE WELL PERMIT#(If applicable)
DWQ or OTHER PERMIT #(if applicable)
V1 ELL USE (Check A licable Box): Residential��siJ�Water Supply ❑
C.A fE DRILLED ) /RC,0 [-r
�JJI y�
TIME COMPLETED
CitC.% AM p PM IJp
3. WELL LO ATION: t�`n,�n,.�n^''pn,�ntff�Y,,,,,, �
v
CITY COUNTY U 0/1.422
U
(Street Nate, Numbers, Community, Subdivision, Lot No., Parcel, Zip Code)
TOPOGRAPHIC / LAND SETTING:
❑Slope °Valley ❑Flat ❑Ridge ❑Other
(check appropriate box) "
I_� 'MUM _gjilt �iS51 n[
LOLONGITUDEQ83_07 ��t,t )1
May be in degrees,
minutes, seconds or
in a decimal format
Latihtde/longitude source: OOPS ❑Topographic map
'location of well must be s wn on a USGS fopo map and
attached to this form / not using GPS)
4. WELL OWNER
OWNER'S NAME '((I (�
STK'ET ADDRESS
ity or Town State
C22a)- 5/9 • 17C m-)
Area code • Phone number
5. WELL DETAILS: 11
a. TOTAL DEPTH: (De
Zip Code
b. DOES WELL REPLACE EXISTING WELL? YES 0 NO,k
c. WATER LEVEL Below Top of Casing: 1()0- FT.
(Use'+- If Above Top of Casing)
d. TOP OF CASING IS 2 FT. Above Land Surface'
*Top of casing terminated at/or below land surface may require
a variance in accordance with 15A NCAC 2C .0118.
e. YIELD (gpm):
, 12
METHOD OF TEST Blow
f. DISINFECTION: Type T H Amount 160Z
g. WA'. ER,Z, NES (depth):
From_-„ /1 To Q From To,
From To From To
From To From To
6. CASING: Thickness/
Dept Diameter,
From (i To Ft %
From /Cl' To Ft. sft'
From To Ft.
Weight Mkt}Jai
, C
7. GROUT: Depth Material Method
From 0 To-2O Ft. carat. & t mite p7tFD0d
From To Ft.
From To Ft.
8. SCREEN: Depth Diameter Slot Size Material
From To Ft. In In.
From To Ft. In. In.
From To Ft. in. in.
9. SAND/GRAVEL PACK:
Depth Size Material
From To FL
From To Ft.
From To Ft.
10. DRILLING LOG
From To Formation Description
0 Ab' Clay & sand
.�f0 4U' Granite
OG
C
11. REMARKS:
100 HEREBY CERTIFY THAT TNIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH.
15A NCAC 2C, WELL CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS
RECORpj1AS SEEN PROVIDED TO THE WELL OWNER.
SIGNATURE INED W
Russell S. Taylor
CONTRACTOR
PRINTED NAME OF PERSON CONSTRUCTING THE WELL
Submit the original to the Division of Water Quality within 30 days. Attn: Information Mgt.,
1617 Mall Service Center — Raleigh, NC 27699-1617 Phone No. [phone] ext 568.
Form GW-la
Rev. 7/05
G C'•

.e: NON ON RESIDENTIAL WELL CONSTRUCTION CORD
North Carolina Department of Environment and Natural Resources- Division of Water Quality
WELL CONTRACTOR CERTIFICATION N 2187
329744
1. WELL CONTRACTOR:
Russell S. Taylor
t , 3;I Contractor (Individual) Name
Vaden Brothets'Well Drilling, Inc.
Well Contractor Company Name
STREET ADDRESS 73 Holly Hills Vista RD
FrAnkl i n NC 28734
City or Tom State Zlp Code
L 828 )- 369-9591
Ares code- Phone number
2. WELL INFORMATION:
SITE WELL ID e(U eppll:able)
STATE WELL PERMIT#(II applicable)
DWQ or OTHER PERMIT Cif applicable)
F.'rt.L USE (Check Applicable Box) Monitoring 0 Municipal/Public 0
I. n a'ria1/Commercial ❑ Agricultural 0 Recovery 0 Injection 0
Irrigationo Other [4lst use) 7
DATE DRILLED• 1 ( V,�0-tI
TIME COMPLETED 5, 0 0 AM O PM
3. WELL LO TI• N:
CITY:
Wl
(§treat Name, Numbers, Commune , Subdivision, Lot No., Parcel, 21D Code)
TOPOGRAPHIC / LAND SETTING:
(.'. i•.ops [Valley [Flat ❑Ridge [ Other
(check appropriate box)
ATITUDE ..L
LONGITUDE
May be In degrees,
minutes, seconds or
in a decimal format
Latitude/longitude source: to CPS [Topographic map
(location of well must be shown on a USGS opo map and
attached to this form it not using GPS)
4. FACILITY.ix me name of me Dcein.,s whore me wall is I cn o.
FACILITY ID 0(1/ applicable)
PIAME OF FACILITY
STREET ADDRESS
City or Town
.'L;ONTACT PERSON -/
MAILING ADDRESS r
or Town - ' State
5i?1 l Aci a
Area code - Phone number
S. WELL DETAILS:
a. TOTAL DEPTH: I'PX
Zip Code
a. DOES WELL REPLACE EXISTING WELL? VESX NO [
J. WATER LEVEL Below Top of Casing: ( FT.
(Use '+' If Above Top of Casing) I
d. TOP OF CASING IS 2 FT. Above Lend Surface'
'Top of casing terminated at/or below land surface may require
a variance In accord ce with 15A NCAC 2C .0115.
s. YIELD (gpm): METHOD OF TEST Blow
I. DISINFECTION: ype H T H Amount 1 6oz
g. WATER ZONES (depth):
From To From To
From To From To
From_ To From To
6. CASINO: Thickness/
Depth Dlapp��ejrr WeigJ�� lariat
From � To 5 Ft. 11 v/LYl
From To Ft.
From To Ft.
7. GROUT: Depth Material
From 0 To__ Ft.
From__ To Ft.
From_ To FI.
8. SCREEN: Depth Diameter Slot Size Material
From To Ft. In. In,
From To Ft. In. _ In.
From To Ft. In.
9. SAND/GRAVEL PACK:
Depth
From To Ft.
From To Ft.
Size Material
From To Ft,
10. DRILLING LOG
From To
dart
Formation Description
1"
Vl rr,'r
I DO MEREST CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE W fM
t SA NCAC 2C, WELL CONSTRUCTOR STANDARDS, AND THAT A CDPY OF THIS
REC AS SEEN PROVIDED 704HE WELL OWNE
SIGNATURE OF CE TIFIED WELL NTRACTOR
Russell S. Ta or
PRINTED NAME OF PERSON CONSTRUCTING THE WELL
Submit the original to the Division of Water Quality within 30 days. Attn: Information Mgt.,
1617 Mall Service Center— Raleigh, NC 27693.1617 Phone No. [phone] ext 56B.
Form GW-1b
Rev. 7/05

RESIDENTIAL WELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources- Division of Water Quality
WELL CONTRACTOR CERTIFICATION N 2187
1. WELL CONTRACTOR:
Russell S. Taylor
Well Contractor (Individual) Name
Redden Brothers Well Drilling, Inc.
Well Contractor Company Name - •
STREET ADDRESS 73 Holly Hills Vista RD
Franklin, NC 28734
City or Town State Zip Code
( 828 )- 369-9591
Area code- Phone number
2. WELL INFORMATION:
SITE WELL ID SW applicable) 7555-51-5L,54,
STATE WELL PERMIT#(a appllcabla)
DWQ or OTHER PERMIT CI( applicable)
LLL USE (Chet
kApplicable Box): Residential Water Supply/1
rArE DRILLED LSU.CrLA Ilt ZOO(o
TIME COMPLETED
111 5 %00 AM (3 PM
3. WELL LORATI,O,NI: _l
CITY: _ 1 _(1.VV1kill Y. COUNTY
(Slum Nemo,, Numbers, Community, Subd Talon, Lot No., Percal, Zlp Coda)
TOPOGRAPHIC I LAND SETTING:
❑Slope CValley ❑Flat D Ridge C Other
(check apprdprlale box)
I_•11TUDE
LONGITUDE
Lct,i'ude/longitude source: 0GPS ❑Topographic map
!location of wed must be shown on a USGS fopo map and
efreched to this roam snot using GPS)
4. WELL OWNER ` ,, ,,/ ��LL
OWNER'S NAME 0.2?
STREET ADDRESS
� TO v'>I4^-d �Igr�'{j'��^
Clycr�own 15tate Zip Coos 30
May be in degrees,
minutes, seconds or
in a decimal formal
383-a tP "7
Ansa code • Phone number
S. WELL DETAILS: ��� t
a. TOTAL DEPTH: LOVI^J
b. DOES WELL REPLACE EXISTING WELL?' (tY^EES ^ID NOk
c. WATER LEVEL Below Top of Casing: - "1'00 - FT,
(Use's' if Above Top of Casing)
d. TOP OF CASINO IS 2 FT. Above Land Surface'
'Top of casing terminated at/or below land surface may require
a variance In accordance with 15A NCAC 2C .0118.
s.. YIELD (ppm): 5 METHOD OF TEST Blow
9'138
f. DISINFECTION: Type Hi H Amount 1 6oz
F m 1 ONES (deJgth):_.
From -' To (/ 5
From
From
6. CASING:
Tn
�GG
From To
o 510 From To
From To
Thickness/
Depth From
Di)))me,er
, Weight Material
m• FromTo . To_ Ft.
Ft
From To Ft.
7. GROUT: Depth Material Method
From 0 To72O Ft. caret & Lgznite ru1P33
From To Ft.
From To Ft,
S. SCREEN: Depth Diameter Slot Size Material
From To Ft. In. In.
From To • Ft. In. In.
From To Ft. In. in.
9, SAND/GRAVEL PACK:
Depth Size Material
From To Fl.
From To Ft.
From To Ft.
10. DRILLING LOG
From To Formation Description
0 3.3' Clay & sand
li Obi Granite
11, REMARKS:
1 DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE W ml
1SA HCAO 2C, WELL CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS
REC 5 BEEN PROVIDEDTO7HE WELL OWNER.
NATURE OF CERTIFIED WELL CONTRACTOR DATE
Russell S. Taylor
PRINTED NAME OF PERSON CONSTRUCTING THE WELL
Submit the original to the Division of Water Quality within 30 days. Attn: Information Mgt:,
1617 Mall Service Center —Raleigh, NC 27699-1617 Phone No, [phone] ext 668.
Form GW-la
Rev, 7/05

Lkt.ii.:-C. ::n :vi,iv✓ i:' atu ;:✓
North Carolina Department of Environment and Natural Resources- Division of Water Qualit
WELL CONTRACTOR CERTIFICATION N 2187
1. WELL CONTRACTOR:
Russell S. Taylor
Well Contractor (Individual) Name
Redden Brothers Well Drilling, Inc.
vu:''—soar Company Name
STREET/DDRESM 73 Holly Hills Vista RD
Franklin, NC 28734
City or Town State Zip Code
( 828 )- 369-9591
Area cods- Phone number
2. WELL INFORMATION:
SITE WELL ID #(Ir applicable) 7A /a-b5 JR9$`/
STATE WELL PERMIT#(u applicable)
DWQ or OTHER PERMIT #(if applicable)
N :ILL USE (Check Applicable Box): Residential Water Supply/
rJ.I
fE DRILLED (0e1 r� ss1AAA \
TIME COMPLETED 3eoD AM0
3. WELL LO ATION: _ tI ,�' _
CITY: /L.1(�LL,J,/•1A•71-JYn/ COUNT�i%.�-�)1�-�
n 1 1
S1LRJ0 T:t-
(Slreet Name, Numbers,ra, Community, Subdieston, Lot No., Parcel, Zip Code)
TOPOGRAPHIC / LAND SETTING:
❑Slope CValley ❑Flat ❑Ridge CD Other
(check apprprlate box)
I.;IITUDE
LONGITUDE
Lati'ude/longitude source: oGPS ❑Topographic map
liocatbn of well must be shown on a USGS fopo map and
attached to this form a nor using GPS)
4. WELL OWNER
OWNER'S NAME
STET ADDRESS
May be in degrees,
minutes, seconds ar
in a decimal format
N/L 1 p5
City or Town t state Zip Code
� ,.143-361,g-)
Area code • Phone number
S. WELL DETAILS:
a. TOTAL DEPTH:
b. DOES WELL. REPLACE EXISTING WELL? YES 0 NO )2(..
Inn c, WATER LEVEL Below Top of Casing: - -IFT:
(Use 'elf Above Top of Casing)
d. TOP OF CASING 18 2 FT. Above Land Surfacer
*Top of casing terminated at/or below land surface may require
a variance In accordance with 15A NCAC 2C .0116.
e. YIELD (gpm): 1 D n METHOD OF TEST Blow
1. DISINFECTION: Type H"'T H Amount 16oz
g. WATER'IR,' pZZONES (depth):'( _-_
From e't"TD To, TFrom To
From To From . . To
From To From To
6. CASING: Thickness/
b�ept Dh �s � rater Weight atrial
From v To e+�Ft.
From- To On Ft. S :e••
From To Ft.
7. GROUT: Depth Material
From 0 To ..20 FL reit. & tEltnite tarred
From To Ft
From To Ft.
Method
6. SCREEN: Depth Diameter Slot Size Material
From To Ft. In. In.
From To Ft. In. In.
From To Ft. In. In,
9. SAND/GRAVEL PACK:
Depth .Size Material
From To Fl.
From To Ft.
From To Ft,
10. DRILLING LOG
From . To
0
11. REMARKS:
Formation Description
Clay & sand
Granite
O
N t:P
aD
r
100 HEREBY CERT!? TNAT THIS WELL WAS OOHSTRDOTED N ACCORDANCE W nN
ISA NCAC IC, WELL CONSTRUCTION STANDARDS. AND THAT A COPY OF T 115
RECORD HG$ BEEN PROVIDED TO TXEjy,[:LL OWNER.
&( 4
CO C OR DATF
�
GNATURE OFD WELL
Russell S. Taylor
PRINTED NAME OF PERSON CONSTRUCTING THE WELL
Submit the original to the Division of Water Quality within 30 days. Attn: Information Mgt.,
1617 Mall Service Center - Raleigh, NC 27599.1617 Phone No. [phone] ext 568.
Form GW1a
Rev. 7105

North Carolina Department of Environment and Natural Resources- Division of Water Quality
WELL CONTRACTOR CERTIFICATION H 2187
IC a n 4
1. WELL CONTRACTOR:
Russell S. Taylor
Well Contractor (Individual) Name
Redden Brothers Well Drilling, Inc.
W e lt°, orsctor Company Name STREET ADDRESS 73 Holly Hills Vista RD
Franklin —NC 28734
City or Town State Zip Cede
( 828 ). 369-9591
Area code- Phone number
2. WELL INFORMATION:
SITE WELL ID #(If applicable) 7.56,o - yi - kW'
STATE WELL PERMIT#(II apogee/she)
DWQ or OTHER PERMIT *Of applicable)
cLL USE (Check Applicable Box): Residential Residential Water Supply
Gl. rE DRILLED (543 1.R0``
TIME COMPLETED f : 06 AMO PMk
3. WELL LOC ?ION:
CITY: COUNTY
(Street Name, Numbers, Community, Subdivision, Lot No., Parcel, Zip Code)
TOPOGRAPHIC! LAND SETTING:
CI Slope ❑Valley ❑Flat CI Ridge 0Other
(check epptdprlate box)
L.1ITUDE .J._
LONGITUDE
Lati'ude/longitude source: oGPS ❑Topographic map
I/ccat%on of well must be shown an a USGS topic map and
attached to this corm N not using GPS)
May be in degrees,
minuleS, seconds or
in a decimal format
4. WELL OWNER
OWNER'S NAME
ST T ADDRESS
City or Town Etate Zlp Code
Aida code • Phone number
5. WELL DETAILS: ar
. TOTAL DEPTH: l!/• v
b. DOES WELL REPLACE EXISTING WELL? YES ❑ NO
c. WATER LEVEL Below Top of Casing: .Wl/ FT,
(Use '+' It Above Top of Casing)
d. TOP OF CASINO 18 2 FT, Above Land Surface'
'Top of casing terminated atlor below land surface may require
a variance in accordance with 15A NCAC 2C .0118.
e, YIELD (gpm): / METHOD OF TEST Blow
f. DISINFECTION: Type HFT H Amount 1 6oz
g. WATER Z NES (depth):
From &TO To•97c , From To
From To From - - To -
From To From To -
6. CASING:
Thickness/
Depth _. Dijmejgr -Weight MAte,rial
From To
From 4To
From To Ft.
7. GROUT: Depth Material Method
From_ To�'.20 Ft. t-ntcasL & hatnite Rnpad
From To Ft.
From To Ft.
8. SCREEN: Depth Diameter Slot Size Material
From To FI, In. In.
From To Ft. in. in.
From To Ft. In. In.
9. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
From To Ft.
•
•
10. DRILLING LOG
From 79 Formation Description
0'-- Clay & sand
Granite
11. R7�a . 7' 3
100 HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH
ISA NCA{0��0, WELL CONSTRUCTION STANDARDS. AND THAT A CCPY OF THIS
RECO BEEN PR OE TO Tf$ WELL OWNER.
jalp
SIGNATURE OF CERTIFIED WEL4'CONTRACTOR JDAdEu
Russell S. Taylo
PRINTED NAME OF PERSON CONSTRUCTING THE WELL
Submit the original to the Division of Water Quality within 30 days. Attn: Information Mgt„
1617 Mall Service Center— Raleigh, NC 27699-1617 Phone No. [phone] ext 568.
Form GW-1 a
Rev. 7/05

iiL,.)11;far 4:I i AI:. _i! ...,.;5,:...
North Carolina Department of Environment and Natural Resources- Division of Water Qualit;
WELL CONTRACTOR CERTIFICATION 4
2187
1. WELL CONTRACTOR:
Russell S. Taylor
Well Contractor (Individual) Name
•Redden Brothers Well Drilling, Inc.
Well Contractor °:;r.mpany Name
STREET ACDRESS 73 Holly Hills Vista RD
Franklin NC 28734
City or Town State Zip Cods
( 828 )- 369-9591
Aria coda- Phone number
2. WELL INFORMATION:
SITE WELL ID 4(11applicable) 85Qo?-38 •5kb(0,3--
STATE WELL PERMITNpr applicable)
DWQ or OTHER PERMIT *(If applicable)
M ELL USE (Check Applicable Box): Residential Water Supply
r A rE DRILLED
TIME COMPLETED eg:CYD AMO PMititi.
3. WELL LQCATION: •
CITCOUNTY
(Street Name, Numbers, Community, subdivision, Lot No., Parcel, Zip Code)
TOPOGRAPHIC / LAND SETTING:
❑Slope C Valley ❑Flat C Ridge ID Other
• (check appropriate box)
I: 11TUDE J- _
LONGITUDE
Latitude/longitude source: cGPS ❑Topographic map
I./citation of wed must be shown on a USGS logo map and
attached to this fom, d not using GPS)
May be in degrees,
minutes, seconds or
in decimal formal
4. WELL OWNER
OWNER'S NAME
STR6iET ADDRESS
City t ibwn U / State
(jo )- 54 • aif3
A'aa code - Phone number
5. WELL DETAILS: W
' co,
a. TOTAL DEPTH:. (/�
b. DOES WELL REPLACE EXISTING WELL? YES C NOX
c, WATER LEVEL Below Top of Casing: - /W FT.
(Use Nis If Above Top of Casing)
d. TOP OF CASINO IS 2 FT, Above Lend Surface'
'Top of casing terminated aVor below land surface may require
a variance In accordance with 15A NCAC 2C .0118.
e. YIELD (gpm): _-,5— METHOD OF TEST B1OW
f, DISINFECTION: Type H?'T H Amount 16oz
g. WATER ZONES (depth):e
88 ' 'Y To 0 From To
To 899 From _ To
To
From
From
From
From To
6. CASING: /� Thickness/
From l J DTo , 5 Ft, Diameter rif rate- M rlal
From To Ft. __�
From To Ft.
7. GROUT: Depth Material ,,,�� Method
From 0 Tc �.2O Ft. CHi1Ent & bayrnlite anted
From To Ft.
From To Ft.
8. SCREEN: Depth Diameter Slot Slze Material
From Tc Ft. In. in.
From To Ft. in. In.
From To Ft. In. in,
9. SAND/GRAVEL PACK:
Depth Slze Material
From To Ft.
From To Ft.
From To Ft.
10, DRILLING LOG
From , To Formation Description
O o� 3 Clay & sand
A3'
Granite
nT
Q
0
Cr,
1L, j2EMARDK�S ftw , /oaoeft/695.
1 D0 HERESY CERTIFY THAT THIS WELL WAS OONSTRUCTED IN ACCORDANCE WRN
t SA NCAC 20, WELL CONSTRUCTION STANDARDS. AND MAT A COPY OF THIS
RECOR BEEN PROVIDED THE WELL OWNER.
SIGNATURE OF CERTIFIED CONTRACTOR OAT
Russell S. Taylor
PRINTED NAME OF PERSON CONSTRUCTING THE WELL
Submit the original to the Division of Water Quality within 30 days. Attn: Information Mgt.,
1617 Mall Service Center— Raleigh, NC 27699-1617 Phone No. [phone] ext 568.
Form GWla
Rev, 7105

North Carolina Department of Environment and Natural Resources• Division of Water Quality
WELL CONTRACTOR CERTIFICATION # 2187
1. WELL CONTRACTOR:
Russell S. Taylor
Well Contractor (Individual) Name
Redden Brothers Well Drilling, Inc.
W+I) fin -tractor Company Name
STREET ADDRESS 7? rx,1.1y Hills Vista RD
F'raiklin. NC 28734
City or Town State Zip Code
( 828 )- 369-9591
Area code- Phone number
2. WELL INFORMATION: t' ' p Q
SITE WELL ID e(I1 applicable) %17 - / -615l
STATE WELL PERMIT#(If applicable)
?:YQ cr PE :MIT !(If applicable' L
cLL USE (Check Applicable Box)'. Residential Water Supply p(1
(� r,A rE DRILLED
TIME COMPLETED
3. WELL LOAATION:
CITY: (7)'�`"�',�„",'h IJQ. COUNTY
`� iKt U aak ai
19,Ao06
i} :on AM
PM,
(Streit Name, Numbers, community, Suediesion, Lot No., Parcel Zip Code)
TOPOGRAPHIC / LAND SETTING:
❑Slope DValley DFlat ❑Ridge ❑Other
(check appr6priate box)
I_ 1ITUDE J1_
LONGITUDE
Lati'nde/longitude source: DGPS DTopographic map
it cation of well must be shown on USGS tepo map and
attached to this form if not using GPS)
e. WELL OWNER tO
OWNER'S NAME
ST "ET AD RESS
city or Town 0 date Zip �5783 t
S.
May be in degrees,
minutes, seconds or
in a decimal format
Area code - Phone number
5. W ELL DETAILS: �� '
a. TOTAL DEPTH:
b. DOES WELL REPLACE EXISTING WELL? YES 0 NOJ
e. WATER LEVEL Below Top of Casing: - 100 FT:
(Use 'N' If Above Top of Casing)
d. TOP OF CASING Is 2 FT. Above Land Surface'
'Top of casing terminated at/or below lend surface may require
a variance In accordance with 15A NCAC 2C .0115.
e. YIELD (ppm):, AO METHOD OF TEST Blow
f, DISINFECTION: Type HIT H Amount 1 6oz
g, WATE ZONES (depth), '/ ,
From To From aye ToAjo
_
From / . To O From To
From_,1i1 To /O From To'
6. CASING: Thickness/
Depth Diamp}er Weight Trial
From 0 To Ft. lj,,"" �g p—�
From %S To
From To Ft.
7. GROUT: Depth Material Method
From 0 ToT20 Ft. Laura. & laniite R7tr'ed
From To Ft.
From To Ft.
e. SCREEN: Depth Diameter Slot Size Material
From To Ft. In. In.
From To Ft. In. In,
From To Ft. in. in.
9. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
From To Ft.
10. DRILLING LOG
From , To
0
11, REMARKS:
Formation Description
Clay & sand
- f1
w
100 HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED N ACCORDANCE W rTH
I SA NCAC 2C, WELL CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS
RECOSBEEN PRO TO WELL OWNE
R.
SIGNATURE OF CERTIFIED W CONTRACTOR 'DAT
Russell S. Tayl --
PRINTED NAME OF PERSON CONSTRUCTING THE WELL
Submit the original to the Division of Water Quality within 30 days. Attn: Information Mgt:,
1617 Mali Service Canter— Raleigh, NC 27699.1617 Phone No, [phone] ext 568.
Form GW-1a
Rev. 7/05

RESIDENTIAL WELL CdNSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources- Division of Water Quality
WELL CONTRACTOR CERTIFICATION # 2187
22,7
1. WELL CONTRACTOR:
Russell S. Taylor
Wet Contractor (Individual) Name
Redden Brothers Well Drilling, Inc.
;Yell Contractor Company Name
STREET ADDRESS 73 Holly Hills Vista RD
Franklin. NC 28734
City or Town - State Zip Code
( 828 )- 369-9591
Area code- Phone number
2. WELL INFORMATION:
SITE WELL ID #(II applicable) 7.57• 30g
STATE WELL PERMIT#(If applicable)
DWG] or OTHER PERMIT #(if applicable)
N _LL:JSE (Check Applicable Box):
rArE DRILLED
TIME COMPLETED
3. WELL LO ATION:
CITY:
Residential Water Supply 0
AM O PMK
1 L1 /10 COUNTY
/ &al h t
Street ame, Numbers. Community. Subdid.ion. Lot No., Parcel, Zip Code)
TOPOGRAPHIC I LAND SETTING:
Slope OValley Cl Flat ❑Ridge ❑Other
(check apprcprlate box)
TITUDE _�'6=JG
LONGITUDE_i2r5�
May be in degrees,
minutes, seconds or
in a decimal format
LatPude/longitude source: CPS ❑Topographic map
'location of well must be wn on a USGS repo map and
attached to this form it not using GPS)
4. WELL OWNER
OWNER'S NAME
STRET ADORE
4 . , "AMA
2 1 �1 2nDJ1i4
/�. L s d
I
i I
City or Town State
L •, m• q/R7
Area code • Phone number
5, 'YELL DETAILS:
a. TOTAL DEPTH: / ho/
Zip Code
b. DOES WELL REPLACE EXISTING WELL? �YE7FT
S�d7 NO CIc. WATER LEVEL Below Top of Casing: W .
(Use '+" If Above Top of Casing ^
d. TOP OF CASING Is 2 FT. Above Lend Surface'
*Top of casing terminated aVor below land surface may require
a variance In accordance with 15A NCAC 2C .0118.
e. YIELD (gpm): __ METHOD OF TEST Blow
f. DISINFECTION: Type HfT H Amount 16oz
g. WATER ZONES (depth):
From
From
From
ToJ From
To (156 From' To
From
To
6. CASING:
n Depth Die4sr
From t) To Ft.
f'/
From To Ft.
From To Ft.
To
To
Thickness/
Weight M_ate�rial
7. GROUT: Depth Material Method
From 0 To-20 Ft. claret & tatnite tarred
From To Ft
From To Ft.
8. SCREEN: Depth Diameter Slot Size Material
From To FI. in. In.
From To Ft. in. In.
From To Ft. in. in.
9. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
From To Ft.
10. DRILLING LOG
From To
0
11. REMARKS:
Formation Description
Clay & sand
Granite
1
fl
Cg
671
100 HERESY CERTIFY THAT THIS WELL WAS CONSTRUCTED I ACCORDANCE W rot
1 SA NCAC 2C, WELL CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS
RECORD S�EOTO THE WELL OWNER
.
SIGNATURE OF CERTIFIED WE CONTRACTOR
Russell S. Taylor
PRINTED NAME OF PERSON CONSTRUCTING THE WELL
Submit the original to the Division of Water Quality within 30 days. Attn: Information Mgt.,
1617 Mall Service Center— Raleigh, NC 27699-1617 Phone No, [phone] ext 568.
Form GWta
Rev. 7/05

„1 NON RESIDENTIAL WELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources- Division of Water Quality
WELL CONTRACTOR CERTIFICATION # 2187
I. CONTRACTOR:
Russell S. Taylor
Well Contractor (Individual) Name
;redden Brothers -Well Drilling, -Inc.
'.V;it contractor Company Name
STREET ADDRESS 73 Holly Hills Vista RD
Frank1 in wr 2R734
City cr Town Stale Zlp Code
328 )- 369-9591
„aa code- Phone number
L PWEIL INFORMATION:
SATE WELL ID #(II applicable)
1.i1 ATE WELL PERMIT#(If applicable)
OWQ or OTHER PERMIT #(if applicable)
we...L USE (Check Applicable Box) Monitoring 0 Municipal/Public 0
IndustriaVCommerclal [' Agricultural 0 Recovery 0 Injection 0
Irrigation0 Other 0(llst use)
rTA.TE DRILLED
TIME COMPLETED
3. WELL LOCATIQN:
'ITT:
AM PM*
NTT_
Seal Name. N(,mbers, Community, SubdlNeion, Lot No., Parcel, Zip Code)
TOPOGRAPHIC / LAND SETTING:
❑Slope ['Valley ❑Flat ['Ridge 0 Other
(check appropriate box)
LATITUDEjzaQ'
I_DNGITUOtags
On
May be in degrees,
minutes, seconds or
in a decimal format
Latitude/longitude source: CPS ['Topographic map'
(location of well must be s ow n a USGS opo map and
attached to this form Ifnot using GPS)
• DILITY-le the name el the busm...,.N.r. Is. Well h Iccned,
.'AGILITY ID #(II applicable)
IAME OF FACILITY
STREET ADDRESS
City or Town „ State Zi• Cade
CONTACT. PERSON
MAALVIG ApORES
��. t/l.lg./nll/1�
City or Town - SCate Zlp Code
$zR1.7 �j 47
Area code • Phone num sr
.-FELL DETAILS: �/
a. TOTAL DEPTH: /VLIJI
b, DOES WELL REPLACE EXISTING WELL? YES
c. WATER LEVEL Blow Top of Casing:
(Use'+' If Above Top o1 Casing)
d. TOP OF CASING IS 2 FT. Above Land Surface'
'Top of easing terminated at/or below land surface may require
variance In accordance with 15A NCAC 2C .0118.
e. YIELD (gpm): J. METHOD OF TEST B1041
f. DISINFECTION: Type N T $ Amount 1 6oz
g, WATERZONES(depth):
Fromf- 1/7 TOJAC From To
From 7� From To
From
To d From To
6. CASING:
Depth/- t r Dia
From DTo in Ft.
From To Ft.
From To Ft.
Thickness/
/n�
t l
7. GROUT: Depth Material Method
From C 6 To GL3 Fi_
From To Ft. �iL'i J,1, / y
From Tc Ft.
8. SCREEN: Depth Diameter Slot Size Material
From To Ft. In. _ In.
From_ To Ft. In In.
From_ To Ft. In. _ in.
9. SAND/GRAVEL PACK:
Depth Size Malarial
From To Et.
From To Ft.
From To Ft.
10.. DRILLING LOG
11, REMARKS:
4Fo nation Description
P/1 ,I eQ.aEO---
ON
I DO HEREBY CERTIFY THAT THIS WELL WAS CON5TRUCTEO M ACCORDANCE Wall
15A NCAC 2C, WELL CONSTRUCTION STANDARDS, AND 'NAT A COPY OF THIS
RECO AS SEEN PROVIDED TO THE WELL ER.
��W
SIGNATURE OF CERTIFIED CONTRACT00.
Russell S. aylor
PRINTED NAME OF PERSON CONSTRUCTING THE WELL
Submit the original to the Division of Water Quality within 30 days. Attn: Information Mgt.,
1817 Mall Service Center — Raleigh, NC 27639.1617 Phone No. [phone] ext 568,
Form GW-1b
Rev. 7/05

North Carolina Department of Environment and Natural Resources- Division of Water Quality
WELL CONTRACTOR CERTIFICATION H 2187
r
1. WELL CONTRACTOR:
Russell S. Taylor
Well Contractor (Individual) Name
Hedden Brothers Well Drilling, Inc.
Well Contractor Company Name
STREET ADDRESS 73 Holly Hills Vista RD
Franklin, NC 28734
City or Town State Zip Code
( 828 )- 369-9591
Area code- Phone number 2. WELL INFORMATION:
SITE WELL ID #(II applicable) 75w T:.t//
STATE WELL PERMIT#(il applicable)
DWQ or OTHER PERMIT #(If applicable)
M ELL USE (Check Applicable Box): Residential Water Supply O
CLfE DRILLED 15 r ID -No 1/
TIME COMPLETED T. (X.. AM ❑ PM
3. WELL LOCATION:
CITY:
- m
COUNTY
(Strew Numbers, Community, Subdh sicn, Lot No., Parcel, Zlp Code)
TOPOGRAPHIC / LAND SETTING:
❑Slope ❑Valley CI Flat ❑Ridge ❑Other
(check apprdpriate box)
L_' 11TUDE _h
LONGITUDE
Latitude/longitude source: 0GPS ❑Topographic map
ilocatkn of wee must be shown on a USGS repo map and
attached to this form M not using GPS)
May be in degrees,
minutes, seconds or
in a decimal formal
4. WELL OWNER
OW
NER
NAMEI(..d
STAEET ADDRESS /
City or Town State
70,- 3fl. a81L
Area code • Phone number
rcLt.t.
5. WELL DETAILS:
a. TOTAL DEPTH: �( )
Zip Code
b. DOES WELL REPLACE EXISTING WELL? YES 0 NOA
c. WATER LEVEL Below Top of Casing: - /00 FT,
(Use'+' if Above Top of Casing)
d. TOP OF CASINO is 2 FT. Above Lend Surface'
'Top of casing terminated at/or below and surface may require
a variance In accordance with 15A NCAC 2C .0118.
a. YIELD (gpm): An METHOD OF TEST Blow
f. DISINFECTION: Type HT H Amount 16oz
g. WATER ZONES (depth):
From. E(OR To /n
From ��j `.•�� oFrom • To
Frone '�LTo_ itC From To
6. CASING:
From
Di4metpr
J FL !D
From To ,9 Ft. (n •,
From To Ft.
From 14/Tc /Z3 /
Thickness/
Weight M lanai
7. GROUT: Depth Material
,�,� Method
From 0 To -.20 Ft. caret& Ly,Ca cite panned
From To Ft.
From To Ft.
8. SCREEN: Depth Diameter Slot Size Material
From To Ft, in. in.
From To Ft. In. in.
From To FL In. In.
9. SAND/GRAVEL PACK:
Depth Size Maierial
From To Ft. _
From To Ft.
From . To Ft.
10, DRILLING LOG
From To Formation Description
0 s Clay & sand
Granite
11. REM RKS:
.6 v.:54;2-,
I CO HERESY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE '41
ISA NCAC 2C. W ELL CONSTRUCTION STANDARDS. AND THATA CCPY CF THIS
RECORD 1Aj BEEN PROVIDED TO THE WELL OWNER.1,0
dd� a -
SIGNATURE OFCERTIFIED WEL CTRACIOR AiE
Russell S. Taylo
PRINTED NAME OF PERSON CONSTRUCTING THE WELL
Submit the original to the Division of Water Quality within 30 days. Attn: Information Mgt.,
1617 Mall Service Center- Raleigh, NC 27699.1617 Phone No. [phone] ext 568.
Form GWla
Rev. 7/05
•-.

North Carolina Department of Environment and Natural Resources- Division of Water Quality
WELL CONTRACTOR CERTIFICATION II 2187
n
a
1. WELL CONTRACTOR:
Russell S. Taylor
Well Contractor (Individual) Name
hedden Brothers Well Drilling, Inc.
Well Contractor Company Name
STREET ADDRESS 73 Holly Hills Vista RD
Franklin. NC 28734
City or Town State Zip Code
( 828 )• 369-9591
Area code- Phone number
2. WELL INFORMATION: ij^�%� �1yn,
SITE WELL ID #(1l applicable) 7510 (✓ I( 1
STATE WELL PERMIT#(II applicable)
D"WQ or OTHER PERMIT #(If applicable)
V ELL USE (Check Applicable Box): Residential Water SupplyyX
CJ. rE DRILLED cQ(a Ofco(O
TIME COMPLETED I DO AMX PM❑
3. WELL LO TION
CIT
Y
chi: COUNTY Zi•C.-.kJJ..I )1‘+
•
(Street Name, Numbers, Community, SubdMafalloJ{n,Lot Na., Parcei, Zlp Code)
TOPOGRAPHIC 1 LAND SETTING:
❑slope ['Valley ❑Flat CRidge CI Other
(check apprdpriate box)
V1iTUDE _
LONGITUDE
Lat.?ode/longitude source: ❑GPS °Topographic map
'location of well must be shown on a USGS topo map and
sttached to this form I not using GPS)
4, WELL OWNER A.E/Fl.YJ7 OWNER'S NAME �I i n b7
STjET ADDRESS 15 /C'��lI1jCTL,1 l Alt t1
itatt
City d Town) �St'te C'A Zip Code
'
(71a. l069 7
Area code • Phone number
May be in degrees,
minutes, seconds or
in a decimal format
S. WELL DETAILS: n
a. TOTAL DEPTH: �-l1
co
b. DOES WELL REPLACE EXISTING WELL? YESS❑ NO
c. WATER LEVEL Below Top of Casing: - (ROD - FT,
(Use'+' If Above Top of Casing)
d, 70P OF CASING Is 2 FT, Above Land Surface*
'Top of casing terminated suor below land surface may require
a variance In accordance with 15A NCAC 2C .0118.
e. YIELD Wpm): I METHOD OF TEST Blow
f. DISINFECTION: Type HIT H Amount 16oz
g. WAT R ZONES (dePth): r
From at
To .7 ' From To
aFrom r To ' 'I 1 From - To
'-'-ern - To From To
6. CASING: - Thickness)From
7\ Depth Diameter Weight Matenai
V %� "
From70 To /O es Ft. 0'� 'Mb
From To Ft.
7. GROUT: Depth Material Method
From 0 To—.20 Ft. Caret t &)J3TZLite PJT &1
From To Ft.
From To Ft.
8. SCREEN: Depth Diameter - Slot Size Material
From To Ft. in. in.
From To Ft. In. in.
From To Ft. In. In.
e. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
From To Ft.
10. DRILLING LOG
From To Formation Description
0 - ' Clay & sand
11. REMARKS:
Granite
100 MERE BY CERTIFY THAT THIS WELL WAS CONSTRUCTED INAOCORDANC ITH
ISA NCAC EC. WELL CONSTRUCTION STANDARDS, AND THAT COPY OF THIS
RECOR 5 BEEN PROV TTHE
WELL OWNER.
KTH
SIGNATURE CERTIFIED WELL ONTOR T(k
Russell S. Taylor
PRINTED NAME OF PERSON CONSTRUCTING THE WELL
Submit the original to the Division of Water Quality within 30 days. A -I: Information Mgt.,
1617 Mali Service Center —Raleigh, NC.27699.1617 Phone No. (919) 733-7 5 ext 568.
Form GW1a
Rev. 7105

North Carolina Department of Environment and NattiraI Resources- Division of Water Quality
WELL CONTRACTOR CERTIFICATION 0 2187
1. WELL CONTRACTOR:.
Russell S. Taylor
Well Contractor (Individual) Name
Hedden Brothers Well Drilling, Inc.
W 111. Con;rw for Company Name
STREET ADDRESS 73 Holly Hills_. Vista RD
Franklin, NC 28734
City or Town State - Zip Cede
( 828 )- 369-9591
Area code- Phone number
2. WELL INFORMATION: �-/ ) 240 p� �l
SITE WELL ID #(If applicable) r,5 7 " -d nQ��
STATE WELL PERMIT#01 applicable)
DWG cr OTHER PERMIT #(If applicable)
N aLL USE (Check Applicable Box):)��Residential Water Supply
r.h rE DRILLED � -1 1 - J0`JJ A'
TIME COMPLETED I . I c5 AM ❑�1 PM»
W
1. ClI Y: LOCATION: J,, \ COUNTY ( �/fr .t/04-%
(Street Name, umber., Community, Subdivision, Lot No., Parcel, Zip Code)
TOPOGRAPHIC / LAND SETTING:
❑Slope °Valley ❑Flat ❑RIdge ❑Other
(check apprcprlate hoc)
1_, l ITUDE ,S
QQ' L/ 3�1V
LONGITUDEk 8ti,o
May be in degrees,
minutes, seconds or
in a decimal format
Lati't:de/longitude source: GPS oTopographic map
'location of well must be s own on a USGS tope map and
attached to (hla form 'not using GPS)
4. WELL OWNER
OWNER'S NAME
iSjtHEET ADDRESS eJ
_tOnmfn,
fl w
Aka/meting-it
City or Town State
�qn—vi414
A code • Phone number
5. WELL DETAILS:
a. TOTAL DEPTH:
700'
73L1
Zip Code
b. DOES WELL REPLACE EXISTING WELL? YES 0 NOK
c. WATER LEVEL Below Top of Casing: A W FT.
(Use'+' If Above Top of Casing)
d. TOP OF CASINO 13 2 FT. Above Land Surface*
'Top of casing terminated at/or below land surface may require
a variance In accordance with 15A NCAC 2C .0118.
e, YIELD (gpm): LG4J METHOD OF TEST Blow
f. DISINFECTION: Type HIT H Amount 1 6oz
g. WATER ZONES (depth):
r
From___, To_51From To
From
From To
From To
From To
6. CASING: Thickness/
Depth Diameter Weight seal
From O To Ft /a'r _,,
From To Ft.
From To Ft. _
7. GROUT: Depth Material Method
From 0 To220 Ft. caret & tr3wit•e wiped
From To Ft
From To FI.
8. SCREEN: Depth Diameter Slot Size Material
From To Ft. In. In.
From To Ft. In. in.
From To Ft. in. in.
9. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
From To Ft.
10. DRILLING LOG
From T
0
11, REMARKS:
Formation Description
Clay & sand
Granite
—e
CO
nY 2
o
100 HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED M ACCORDANCE wrrH
ISA NCA C. WELL CONSTRUCTION STANDARDS. AND THAT A COPY OF THIS
RICO BEEN PROVIDED TO TIE WELL OWNE$.
SIGNATURE OF CERTIFIED WELONTRACTOR 1 Df TE
Russell S. Taylor
PRINTED NAME OF PERSON CONSTRUCTING THE WELL
Submit the original to the Division of Water Quality within 30 days. Attn: Information Mgt.,
1617 Mall Service Canter — Raleigh, NC 27699-1617 Phone No, [phone] ext 568,
Form GWla
Rev. 7/05

WWI
nn n9, l'
WELL CONTRACTOR CERTIFICATION H 2187 a !di ee
North Carolina Department of Environment. and Natural -Resources. Division of Water Quality
1. WELL CONTRACTOR:
Russell S. Taylor
Well Contractor (Individual) Name
Redden Brothers Well Drilling, Inc.
Well. Contractor Company Name - -
STREET ADDRESS 73. Holly Hills Vista RD
Franklin, NC 28734
City or Town State Zip Code
( 828 )- 369-9591
Aria code- Phone number
2. WELL. INFORMATION:
SITE WELL ID Mill applicable)
STATE WELL PERMIT#(lI applicable)
DWQ or OTHER PERMIT e(I( applicable)
N ±LL :JSE (Check Applicable Box): Residential Water Supply
r,l rE DRILLED
tZODS0
TIME COMPLETED ) I '. bid AM
0. WELL LOCATION:
CIT
.COUNTY
(Sir et Name. Numbers, Community, SubdI Iaion, Lot No., Parcel Zip Code)
TOPOGRAPHIC / LAND SETTING:
❑Slope ❑Valley ❑Flat DRidge DI Other
(check apprdprlate box)
1.1ITUDE J_
LONGITUDE
Lati'ttde/longitude source: aGPS ❑Topographic map
it cation of well must be shown on a USGS tcpo map and
attached to this form If not Laing GPS)
4. WELL OWNER
May be in degrees,
minutes, seconds or
in a decimal format
OWNERS NAME
57 EET ADDRESS
City or TownC.
Slat bioaLt-LArN!
Aa4-61543.
Area code • Phone number
S. WELL DETAILS:
a. TOTAL DEPTH: 5()
b. DOES WELL REPLACE EXISTING WELL? YES ❑ NO,QS
c. WATER LEVEL Below Top of Casing: - — J0 FT,
(Use's' If Above Top of Casing)
P. TOP OF CASINO IS 2 FT. Above Land Surface'
'Top of casing terminated aVor below land surface may require
a variance In accordance with 15A NCAC 2C .0118.
e. YIELD (gpm): 50 METHOD OF TEST slow
2 c04q
48,723
Zip Code
1, DISINFECTION: Type H>f`T H Amount 1 6oz
g. WATERZONES(depth) •
From Lad To MD From—( QTo e l
From `�5eTo J37' From _ To
Fromd� q�CC� From To
6. CASING: Thickness/.
From 0 To 72
Depti �s . FL (t DI ter Weight Mitgrial
/YG
From_'1'To 71' Ft._(` ./88 'a0
From To Ft.
7. GROUT: Depth Material Method
From 0 Tc"2O Ft. caret & L r7it'e 011PEl3
From To Ft.
From To Ft,
S. SCREEN: Depth Diameter Slot Size Material
From To Ft. In. in.
From To Ft. In. In,
From To Ft. In. in.
9. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
From To Ft.
10. DRILLING LOG
From To
760
11. REMARKS:
Formation Description
Clay & sand
Granite
to
K
ti
en
100 HEREBY OER11FY THAT THIS WELL WAS CONSTRUCTED PI ACCORDANCE WITH
1SA NCA , WELL CONSTRUCTION STANDARDS, AND THAT A COPT OF m115
RECo-A'- BEEN PROVIDED TO THE WELL OWNER.
n A
FIED WEL ONTRACTOR A E
SIGNATURE OF CERTI
Russell S. Taylor
PRINTED NAME OF PERSON CONSTRUCTING THE WELL
Submit the original to the Division of Water Quality within 30 days. Attn: Information Mgt.,
1617 Mall Service Center —Raleigh, NC 27699-1617 Phone No. [phone] eat 568.
Form G W l a
Rev. 7/05

334100
North Carolina Department of Environment gnu r.ann., --•--•-•• - •
•
WELL CONTRACTOR CERTIFICATION N. 2187
1. WELL CONTRACTOR:
Russell S. To for
well Contractor (Individual) Name.
Haden Bresthers Well Drilling; Inc.
Well. Contractor Company Name
STREET ADDRESS 73 B 2011Y-- 1� Visi:.d RD
City or Town Slate Zip Code
c a29 )• zoo 9591
Aria code. Phone number
2. WELL INFORMATION:. 75n/ -�� . 0/ 3�
SITE WELL ID 0(I1 aPVIICable) /
STATE WELL PERMIT'°, applicable)
DV'C or OTHER PERMIT 0(I! applicable)
Wr.U_ USE (Check Applicable Box); Residential Weller SupplyK
f:d.l-'. DRILLED_
TIME COMPLETED,
3. WELL LOTIONI
CITY:
(Sinai Name, Number, Community, SubdlN Lot No:, Parcel, Zlp Dodo)
TOPOGRAPHIC / LAND SETTING:
❑.SiCfia °Valley ❑Flat °Ridge O Other
(crack apprdprlala box) May be In degrees,
I 11TUDE J_ _ minutes, seconds or
In decimal format
LONGITUDE __ ._ •
Cati'iide/longitude source: ❑OPS °Topographic map
pocafbn of well must be shown on a USGS repo map and
attached to this form Ifnot uak' GPS)
4. WELL OWNER
OWNER'S NAME
STREET AD RESS
or Town State Zip Code
Aroa code • Phone number
6.WELL DETAILS:
- j��/�� f
a. TOTAL DEPTH:,�LY0fl_L_
b. DOES WELL REPLACE EXISTING WELL? Y 5 $ NO ❑
FT.
c. WATER LEVEL BlflAbovve Top of Cuing)
d. TOP OF CASINO IS Z _ FT, Above Land Surfaces
!Top of cuing terminated at/or below lend sere may require
e. �• ■ variance In aeon -ante with 15A NCAC 2C .0118,
YIELD (gars): 4 METHOD OF TEST Blow
1. DISINFECTION: Type HFT H Amount 16oz
g, WATER ZONES (depth);
From To _ From,
From 70 - Frm,
From To From
5. CASING: • From TOI-
Deplh II L ''
-Fl.
• From To Ft:
From To Ft.
Materiel Method
7. GROUT: Depth
From_IL_ To:2DL.Ft a31E t &barni
F rom To Ft,
From To Ft.
To
To_
To
Thickness)
per Wei•.•. h rpj
S. SCREEN:
From
From_
From
Depth
To,
To,
To.
9. SAND/GRAVEL PACK:
Depth
From To
From To
From To
Dlameter Slot Size
Ft. In. In,
Ft. In. in.
Ft. . In.
Fl.
Ft,
Ft.
Size Material
Material
10, DRILLING LOG Formation Description
From T �r Clav & sand
0 rP —
—Rate—
cm-7:73rvwcrorere
OCT 3 a 9onF
i D0 HERESY CERT1/Y THAT THIS WILL WAS CONSTRUCTED IH ACCORDANCE WriH
16A NCAC IC, WELL CONSTRUCTON STANDARDS, AND THAT A COPY OF mIS
RECORD H SEEN PROVIDED TO THE WELL OWNE
GJ o o�
SIGNATURE OF CERTIFIED WELL NTRACTOR D TE
Russell S Taylor
PRINTED NAME OF PERSON CONSTRUCTING. THE WELL
Submit te
n 30 days. Attn:
11517 Ma IhSara. laCanter- Raleigh, NC 2 699-1 17 Quality Phone NInformation Mgt.,
o. (9 9) 735 7015 ext 568.
Form GW.1a
Rev. 7/05

LONGITUDE
- +HD
1. WELL CONTRACTOR:
Russell S Taylor
we Contractor (Individual) Name.
Redden Brothers Well Drillin
Well. Contractor Company Name
• STREET ADORES. 7373 HD._- ol]. � 1s Vi S`_a RR�%%
City or Town Stets Zip Code
North Carolina Department of Environment and Natural Resources• L AWSwn IA TY.,., •-•••,
WELL CONTRACTOR CERTIFICATION fl 2187
t, DISINFECTION: Type HI`T H Amount 16oz.� 3
g. WATER ZONES (de 1�:
From
LL To13[2 From To
From, fJyLQ.L_ To From_
To rrorn_
rl:
8. CASING:
zaG 9591
Areacode-Phone number
2. WELL INFORMATION: n�IAL _��3nI�
SITE WELL ID our appllcabla)
STATE WELL PERMITeill applicable)
Di'C' or CTHER PERMIT Cif applicable)--/ —
W'=L1_ USE (Check Applicable Box); Residential Water Supply pl
Cat I. DRILLED
TIME COMPLETED
S. WELL LOCr{.TAON:
CIT`
(Sant Name, Numbers, Community. Subdhltien, Lot Noe Rarest, he Coda)
TOPOGRAPHIC / LAND SETTING:❑RCI Other
❑Siena (Valley Flat _�—
(check apprdpnab boox))Q ��
I_, 11TUDE _la_LILL_
Inc.
LOW
Lati'lide/longitude source; I GPS ❑Topographic map
(locators of well must be shown one USGS fopo map end
attached to this form 'not using GPS
May be In decrees,
minutes, seconds or
Ins decimal format
4, WELL OWNER
OWNER'S NAME
ST. kET ADDRESS
(( OOddCity or Town I tat Z
Area code) Phone number
6.WELL DETAILS:. t
a. TOTAL DEPTH:
b, DOES WELL REPLACE EXISTING WELL? YES ❑ N0 w
��/a - -FT:
c. WATER LEVEL Below Top of Casing:
(Use '+' if Above Top of Cuing)
d. TOP OF CASINO 18 2 __ FT, Above Land: Surface'
'Top of cuing terminated aVor below land surface may require
• a variance In accordance with 15A NCAC 2C .0118, B10W
a. YIELD (gpm): ....._— METHOD OF TEST
p
ode
From
From
From
Depth
To
To
Diiam$er
Ft. CO
Fl.
To
Thickness/
Weigh: Mat -far
7, GROUT: Depth Material Method
From._a__To".20 Ft. orlatt & b31:111 �
Flom To_Ft. ---
From To__. Fl,
8, SCREEN: Depth Diameter Slol Size
From To___Ft, In.
From To Ft. In. In.
From To Ft. . In.
9. SANDIGRAVEL PACK:
Depth
From To
FromTo•_
From To•__,
10. DRILLING LOG
From To
0
11. REMARKS:
FL,
Ft.
Ft.
dC89
Size
Material
In.
Material
Formation Description
Clav & sand
100 HERESY CERTIFY THAT 11115 WELL W A5 CONSTRUCTED IN ACCORDANCE WITH
16A NCAC 2C, WELL CONSTRUCTION STANDARDS. AND THAT A COPY OF T1115
RICO SPROVIDED O THE WELL NER
el
SIGNATURE OF CERTIFIED W L CONTRACTOR. DA E
Russell S. Ta ldr
PRINTED NAME OF PERSON CONSTRUCTING. THE WELL
Submit the original to the Division of Water Quality within 30 days. Attn: Information Mgt:,
1817 Mall Service Center— Raleigh, NC 27699.1817 Phone No. [phone] ext 668r
1,11 rr rr.r•
1 {yIJF c, tout)
Form GW/a
_.-Rev.7/05

North Carolina Department of Environment and Natural 1Lesourccs• -
WELL CONTRACTOR CERTIFICATION N 2187
f. DISINFECTION. Type Hd`T fl—Amount _ u 3 4 C 9 8
1. WELL CONTRACTOR)
Russell S Tavlor
W ell Contractor (Individual) Name.
Redden Brothers Well D=illin , In
Well. Contractor Company Name
;'-:EETADDRESS 73 Boll. Hills Vista RD
serf or Tawn State Zip Code
z69 9aa1 —
Are a► Phone number
2. WELL INFORMATION:
SITE WELL ID CV applicable)
STATE WELL P ERMITepr appliesbla)
or OTHER PERMIT NO applicable) _..----
air '&LL USE (Check Applicable Box1: Residential Water Supply
en,.�Q •n�n
j CM ? DRILLED
TIME COMPLETED
S. WELL LO ATIO
YI
Name,
N NLS1►�.m
(8tnet Name, Number, Community, Su d Neon, lot No:, Peeel, Zlp Coda).
TOPOGRAPHIC I LAND SETTING: ❑Elope ❑Valley VIM ❑Ridge ❑Olhe
(check apprdprlete box)
L_'1ITUDE �—
LONGITUDE,,,_ ._ a hit map
Lati'ddellongitudesource: ❑CPS ❑Topogr p
flotation of wed musl be shown on a USGS repo map end
attached to this form if not Wing OPS)
•
4,.WELL OWNER
OWNER'S NAME
SJ tiET ADDRESS
CI or Town
Area e • Phone number
May be In degrees,
minutes, seconds or
In a decimal format
e. WELL DETAILS: /I
a. TOTAL DEPTH:--�
b. DOES WELL REPLACE EXISTING WELL? YES 0 NOL-
�j /�/�
o, WATER LEVEL Below Top of CeUn9•`�1[sL--
FT:
(Use's.' II Above Top of Casing)
d, TOP OP CASINO IS 2 _ FT. Above Land Surface*
'Top of easing terminated aVor below land surteee may require
a variance In accordance with 15A NCAC 2C ,0118, BLOW
e.—
YIELD (ppm):4METHOD OF TEST
g, WATER ZONES (depth)'.
From TO _ From,
From To From,
From To From
3. CASING{
From
From
From
To
To
To
Thickness/
D' meter Weight
Ft.
l Methodia
7. GROUT: Depth Material
From_Q—_To�—FI.S�=�—
From To Fl.
From To Ft
S, SCREEN: Depth
From To
From To
From To
9. SAND/GRAVEL PACK:
Depth
From,
From,
From
To,
To,
To
10. DRILLING LOG
From To
• jeegir%G
11, REMARKS:
Diameter Siol Size
Ft. in.
Ft. In.
Ft,_In.
In.
In,
in.
Size Materiel
Material
Formation Description
Cl & sand
crap i to _
100 MEREST CERTIFY THAT TrILS
NCAC 2C, WELL CONSTRUCTION LSTANDA CONSTRUCTED ANi D TIATA COPT N ACCORDANCE W� OF mIS
RICO S TEIN PROVIDED TO E WELL/ HER.
b
SIGNATURE OF CERTIFIED W = L CONTRACTOR. DASTE
Russell S. Ta 1=r
PRINTED NAME OF PERSON CONSTRUCTING. THE WELL
Submit 11617 Mall Service Cent•rh Raleigh, NC 27699-1 17 r Quality within No. (9 9) 737 701 S ezt 56811on Mgt:,
Form GWl a
Rev, T105

RESIDENTIAL WELL col vs_T_gucTtoN RFcoRO_
North Carolina Department of Environment and Natural Resources- Division of Water Quality
WELL CONTRACTOR CERTIFICATION N 2187
1. WELL CONTRACTOR:
Russell S Ta 1or
Well Contractor (Individual) Name
HeLiden brothers Well Drlling, Inc.
Well Contractor Company Name
STREET ADDRESS 73 1io11
City or Town State Zip Code
uo a591
Area a Phone number
2. WELL INFORMATION: 4fe� -L1.1 5�0.'S
SITE WELL ID Cif applicable)
ST6'. WELL PERM:T1101 applIcabb)�.._--- DING or OTHER PERMIT e(If applicable)
N- SLL USE (Check Applicable Box); Residential Water Supply
31(
r,.\ re DRILLED
TIME COMPLETED,
3. WELL LOC - TION:
CITY:
Hills Vista RD
AM PM&
COUNTY
I a me.m*,
(h'teNumbers, Commonly, Subdivision, Lot No., Parcel, Zip Code)
TOPOGRAPHIC I LAND SETTING:
❑SIT,e °Valley OFIat ❑Ridge °Other
(check appropriate box)
—
LONGITUDE_ — .—
Lati'ude/longitude source: °GPS °Topographic map
Ilocafbn of well must be shown on a USGS tope map and
attached to this form Knot using GPS)
e. WELL OWNER
OWNER'S NAME
5' Ir`'iET ADDRESS
May be In degrees,
minutes, seconds or
in a decimal format
,y or Town State Zip Code
Area cafe - .Phone number.
5, WELL DETAILS: cor
e. TOTAL DEPTH:.—
b. DOES WELL REPLACE EXISTING WELL? YESof Casing: °° NO t
FT.
c. WATER (EVEL Below Use +' If Above Top p of Caning)
d. TOP OF CASING IS 2 FT. Above Land Surface'
'Top of casing terminated aVor below lend surface may require
a variance In acc rdance with 15A NCAC 2C .0118. B1
e. YIELD (gpm): _ METHOD OF TEST
334 697
f. DISINFECTION: Typa III .T 11 Amount 160Z
g, WATER hZZONES (depth):
roin
1 V To _!.. �From T°
F
��_To From T°
From ---" "
From j�a'�_Tol{I,.. Ffom TO
Thickness/
6. CASING: Depth D'ameter Weigh/ Material
ua=
FL �
FromToj�-�
FromTO
From To._Fl.
Method
7. GROUT: Depth Material�� ,,,,..��
From_.Q__.To"-24_. Ft. carat & X1"� 4!
From To Ft.
From To_ Ft.
Depth
To
To
To
100 HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE Wmt
AC 2C. WELL CONSTRUCTION STANDARDS, AND a BEEN PROVIDED TOME WELL OWNER.TMATACOPY OF THIS
RIGOR
0
SIGNATURE OF CERTIFIED WEL CONTRACTOR D TE
Russell S. Ta for
PRINTED NAME OF PERSON CONSTRUCTING THE WELL
Submit the original to the Division of Water Quality within 30 days. Attn: Information Mgt:,
1617 Mall Service Center —Raleigh, NC 27699.1617 Phone No. [phone] ext568.
Form GW-1 a
Rev.1105

RESIDENTIAL WELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources• Division of Water Quality
WELL CONTRACTOR CERTIFICATION #
1. W±.L CONTRACTOR:
R.assell S. Taylor
W ell Contractor (Individual) Name
Hedden Brothers Well Drilling, Inc.
Cont2Cof Company'`'["^
STREET ADDRESS 73 Holly Hills Vista RD
City or Town
State
Zip Code
( 828 )• 369-9591
Area code- Phone number
2. WELL INFORMATION:
SITE WELL ID CH applicable) 75,'7- R.7 / / 90
SITE WELL PERM:TO(i appllcabie)
DWQ or OTHER PERMIT *Of applicable)
V CILL USE (Check Applicable Box): Residential Water Supply lz
fE DRILLED `' N TIME COMPLETED 7 ' LA) AM 01 PM,,,...,,,///
qp,
TIC /
3. Wr;'-L LOC
( - C COUNTY
C / - r7
Wet Name, Number., Comm iy, subdivision. Lot No., rui, Zip Code)
TOPOGRAPHIC / LAND SETTING:
❑Slope OValley ❑Flat ❑Ridge [Other
(check apprdpria!e Fox)
I_ TITUDE i5f1 02' A3
LONGITUDE65(9.1
Lati'ude/longitude source: ()(GPS oTopographic map
, ocation of well must be shown one USGS fopo map and
attached to this /part If not using GPS)
4. WELL OWNER
C ' FR'S NAME✓ �rIL)/Ylf .G7
;:T ADDRESS ? o 14 -'
May be in degrees,
minutes, seconds or
in a decimal format
City or Town State
L)- L07—a7'7 i
Area code - Phone number
5. WELL DETAILS: 3�,
a. TOTAL DEPTH:
Zip Code
b. DOES WELL REPLACE EXISTING WELL?? YES 0 N0X
c 1 ?TER LEVEL Below Top of Casing: /CO - FT.
(Uae •+' I1 Above Top of Casing)
d. TOP OF CASINO IS 2 FT. Above Lend Surface'
*Top of casing terminated at/or below lend surface may require
a variance in accordance with 15A NCAC 2C .0118.
e. YIELD (gpm): 110:- METHOD OFTEST Blow
2187
f. DISINFECTION:Type Hf'T A
g. WAT R ZONES (depth):
oe
From
From
From To
To rUIJfO
To &..
91+ tot
,10f E1
Amount 1 6oz
From To
From To
To
6. CASING: Thickness/
Depth Diameter WeitS�h aerial
From O To Ft, /O ; /l7�
From To Ft.
From To Ft.
7. GROUT: Depth Material�Method
From 0 To720 Ft. o3narit & hernite Tamed
From To Ft.
From To Ft.
8. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. M.
From To Ft. In. In.
From To Ft. In. in,
9.
SAND/GRAVEL PACK:
Depth
From To Ft.
From To Ft.
From To Ft.
Size Material
10. DRILLING LOG.
From Tote- Formation Description
0 Clay & sand
95; .10Z)Granite
11. REMARKS:
rn
100 HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED N ACCORDANCE WITH
16A NCAC 2C, WELL CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS
RECORD $A$ BEEN PROVIDED TO THE WELL OWNER,
SIGNATURE OF CERTIFIED WELLICONTRAC T OR DATE
Russell S. Taylor
PRINTED NAME OF PERSON CONSTRUCTING THE WELL
Submit the original to the Division of Water Quality within 30 days. Attn: Information Mgt:,
1617 Mall Service Center- Raleigh, NC 27699-1617 Phone No, [phone] ext 568.
Form GW-la
Rev. 7/05

RESIDENTIAL WELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources- Division of Water Quality
WELL CONTRACTOR CERTIFICATION $ 2187
•
1. WELI, CONTRACTOR:
.Russell S. Taylor
Well Contractor (individual) Name
Hedden Brothers Well Drilling, Inc.
Well. Contractor Company Name
• STREET ADDRESS 73 Holly Hills Vista RD
Franklin, NC' 28734
City or Town State Zip Code
L i2@_)- 369-9591
Ar+a code- Phone number
2. WELL INFORMATION:
SITE WELL ID 0(11 appllcabls) 74 50 - o54(45
STATE WELL PERMIT#QI ■pplicable)
DWQ or OTHER PERMIT kW applicable)
Vr ELL USE (Check Applicable Box): Residential Water Supply
GATE DRILLED TIME COMPLETED '4%on AMZ PM
3. WELL LOC TION:
COUNTY
set Name, Number, Community. Subdivision. Lot No., Parcel, Zip Code)
TOPOGRAPHIC/LAND SETTING:
❑Slope (Valley ❑Flat ORidge °Other
(check apprdpr1ale box)
L '. ITUDE a'sa 14c,K
LONGITUDE %3,19 4'y' 1 LAD
Lati'ude/longitude source: QpGPS ❑Topographic map
:location or well must bit than on a USGS topo map and
attached to this form C not using GPS)
4, WP_L OWNER
O.W'r'ER'S NAME
5TI..:ET ADDRESS
May be in degrees,
minutes, seconds or
in a decimal format
pCryawn State
ill. (031 • 04a4
Area code - Phone number
agl75'
hip Code
6. WELL DETAILS: 4601
a. TOTAL DEPTH:
b. DOES WELL. REPLACE EXISTING WELL? YES ❑ N0,
c. WATER LEVEL Below Top of Cuing: — / 00- FT.
(Use'+' If Above Top of Casing)
d. )OP OF CASING 18 2 FT. Above Lend Surface'
'Top of casing terminated at/or below land surface may require
a variance In accordance with 15A NCAC 2C .0118.
e,. YIELD Wpm): 50 METHOD OF TEST - Blow
333403
f. DSINFECTION:Typo HUT H Amount 160z
g, WATER ZONES (depth):
From 113 To 115 From To
From aa3Toaa5 From To•
From 403 To 405From To
6. CASING:
Depth a
From To
From 5To11
From To
Ft. 1 eI
Thickness/
Diameter Weight Material
Ft. G ,185 _Irak
Ft.
7. GROUT: Depth Materiel �,i Method
From_Q_ To'.2O Ft. anent & ba-.rnLte WRY
From To Ft.
From To Ft.
8. SCREEN: Depth Diameter Slot Size Material
FromTo Ft in. In.
From To Ft. In. in.
From To Ft. . in. In.
9. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
From To Ft.
10. DRILLING LOG
From To Formation Description
p 0'1 Clay & sand
/0 71 '.'S0' Gram fa
11. REMARKS:
REL EIVtO
DIV. yr WAI ER QUALM
OCT I T 2006
I D0 HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED N ACCORDANCE WITH
16A NCAC I0, WELL CONSTRUCTION STANDARDS. AND THAT A COPY OF THIS
RECORD HAS SEEN PROVIDED TWINE WELL OWNER.
SIGNATURE OF CERTIFIED WELL CONTRACTOR DATE
•
Russell S. Taylor
PRINTED NAME OF PERSON CONSTRUCTING THE WELL
Submit the original to the Division of Water Quality within 30 days. Attn: Information Mgt:,
1617 Mall Service Center- Raleigh, NC 27699-1617 Phone No, [phone] eat 568.
Form GWIa
Rev. 7/05

RESIDENTIAL WELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources- Division of Water Quality
WELL CONTRACTOR CERTIFICATION $
1. W V_L CONTRACTOR:
Russell S. Taylor
W el. Contractor (Individual) Name
Redden Brothers.Well Drillings Inc.
Weli Conraclor Company Name
STREET ADDRESS 73 Holly Hills Vista RD
Franklin Nf 28734
City or Town State Zip Code
( 828)- 369-9591
Area code Phone number
2. W °'.L INFORMATION:
SIT:_ WELL ID #(ifapplicable) 751e& -34 • 439R
3•* .TE WELL PERMIT#(II applicable)
DM) or OTHER PERMIT #(If applicable)
N ELL USE (Check Applicable Box): Residential Water Supply
C.AYE DRILLED 10 ' 'O(o
TIME COMPLETED 4.DO A ° PM,&
3. WELL LO TIONW
C;1T Y.
COUNTY
(Street Nome, Numbers, Community, SubSM#n, Lot No.. Parcel, hip Code)
TOPOGRAPHIC I LAND SETTING:
Slope °Valley ❑Flat ❑Ridge ❑Other
(check appropriate box)
Li l ITUDE IL
LONGITUDE' .L@
Lati'ude/longitude source:OPS °Topographic map
(locatbn of wall must be sliorM on a USGS topo map and
attached to this form If not using GPS)
4, WELL OWNER
O'?. 'FR'S NAME Ky , •
SADDRESS - --
`/I G � a$e1l►
City or Town State Zip Code
( 7C}')• 3(04• tO'LU I
Area code- Phone number
May be in degrees,
minutes, seconds or
in a decimal format
5.WELL DETAILS: �OO'
a. TOTAL DEPTH:
b. DOES WELL REPLACE EXISTING( WELL? YES ❑ NO4
e v, ATER LEVEL Below Top of Casing: -1.560 -FT.
(Use'+' If Above Top of Casing)
d. TOP OF CASING 18 2 Fr. Above Land Surface'
'Top of casing terminated at/or below land surface may require
a variance in accordance with 15A NCAC 2C .0118.
e. YIELD (gpm): 3 . METHOD OF TEST Blow
2187
333402
I. DISINFECTION: Type HrT H Amount 1 6oz
g. WATER ZO,NES (dde�ptth))':f
From 1LfGR I To 1 t From To
From To From To
From To From To
6. CASING: Thickness/
Depth Diameter Weight M_atCarial�
From To jQ�� Ft.j� Pam' From b To 75 3 Ft , •'Mr
From To__Ft.
7. GROUT: Depth Material Method
From 0 To'2Q Ft. Cement & beir ite =red
From To Ft.
From To Ft,
8. SCREEN: Depth Diameter Slot Size Material
From To Ft. In, In.
From To Ft. In. In.
From To Ft. In. In.
9. SAND/GRAVEL PACK:
Depth Size Material
From To__ Ft.
From To Ft.
From To Ft.
10. DRILLING LOG
From To
0
•
a
Formation Description
Clay & sand
>i�- r) •' Granite
11. REMARKS:
RECEIVED
DIV OF WATFR Ql IAI ITY
OCT I 1 2006
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE W n11
16A NCAC 2C, WELL CONSTRUCTION STANDARDS. AND THAT A COPY OF 1111S
RECORD HAS BEEN PROVIDED TO THE WELL OWNER.
SIGNATURE OF CERTIFIED WELL CONTRACTOR DATE
Russell S. Taylor
PRINTED NAME OF PERSON CONSTRUCTING THE WELL
Submit the original to the Dielslon of Water Quality within 30 days. Attn: Information Mgt:,
1617 Mall Service Center— Raleigh, NC 27699.1617 Phone No, (919)1'33-7015 ext 568.
Form GW1a
Rev. 7/05

1. WE' CONTRACTOR:
Russell S. Taylor
Well Contractor (Individual) Name
Eden Brothers Well Drilling, Inc.
Well Contractor Company Name
STREET ADDRESS 73 Holly Hills Vista RD
Fraytk1 i n, NC 28734
City or Town State Zip Code
Lfilfl i' 369 .S591
Are - cede- Phone number
2. WELL. INFORMATION: r{ ^ Q�7 ^p�/
£ ITE WELL ID A(If applicable) 15c 7- D / - IO{L!T'
STATE WELL PERMIT'°, ipplicable)
DWQ or OTHER PERMIT #(if applicable)
M iLL USE (Check pplicabie Box): Residential Water Supply 0
r'A fE DRILLEDI d /oA00 -
T1:1 E COMPLETED '3 . a0 AM O
3.Wt I. LOC 10
(5f-iat Name, Numbers, O
COUNTY
r !IJIl, II !Yk '}p1,1
a unity. Subdivision, LNo., Parcel, Zip toll
PMkt
TOPOGRAPHIC / LAND SETTING:
❑Sldpe OValley ❑Flat ❑Ridge pother
(check apprdprlate box)
I:'11TUDE j1
LONGITUDE jg
Latitude/longitude source: OPE oTopographic map
iIocatun of well must be shown 'oft a USGS topo map and
attached to this to 6 not using GPS)
4. WELL OWNER M
OWNER'S NAME : &11 I (A `Le
STREET ADDRESS -
41 0)7. ei e$7r
City or Town - / State Ip Code
( 497 477a-,
Area code- Phone number
May be in degrees,
minutes, seconds or
in a decimal format
5. WELL DETAILS:
a. TOTAL DEPTH: '700
b.-DOES WELL REPLACE EXISTING WELL? YES
/^❑� NO•
c. WATER LEVEL Below Top of Casing: - & tW -FT.
(Use'+' 6 Above Top of Casing)
d. TOP OF CASINO 18 2 - FT. Above Land Sur1ace'
'Top of casing terminated at/or below land surface may require
a variance In accordance with 15A NCAC 2C .0118.
e.. YIELD (gpm): % METHOD OF TEST Blow
RESIDENTIAL WELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources- Division of Water Quality
WELL CONTRACTOR CERTIFICATION #
f. DISINFECTION: Type WT H Amount 160Z
2187
.'333401
g. WATER ZONES (de th):
From (1•5 To ,9; J From To
From To From , To
From To From To
6, CASING:
Depth D'samsler
From AO To Ft. /0 .,
From ih0 To Ft. /# • . /»5
From To Ft.
7. GROUT: Depth Material
From 0 To220 Ft. Ct3iult & termite lamed
From To Ft.
From To Ft.
8, SCREEN: Depth Diameter Slot Size Material
From To Ft. In In.
From To Ft. In, In.
From To Ft. In. In.
Thickness/
Weight Material
9. SAND/GRAVEL PACK:
Depth
From
From
From
To Ft.
To Ft.
To Ft.
Size Material
Method
1
10. DRILLING LOG
From To Formation Description
0 -�Clay & sand
11. REMARKS:
Granite
RECEIVED
RIV OF WATFR OI1AI ITY
1 200
1 DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH
15A NCAC 20, WELL CONSTRUCTON STANDARDS. AND THAT A COPY OF MIS
RECORD BEEN
5 BEEN PROVIDED!DEEDTO TTNE WELL�OWWNNE�R..
IGNATUREfAide
CERTIFIED WEL ONTR tTOR DATE
Russell S. Taylor
PRINTED NAME OF PERSON CONSTRUCTING THE WELL
Submit the original to the Division of Water Quality within 30 days. Attn: Information Mgt:,
1617 Mall Service Center-Ralelgh,NC 27699-1617 Phone No, [phone] eat 568.
Form G W-1 a
Rev. 7105

RESIDENTIAL WELL CoNS'[RUCT1ON RECORD
North Carolina Department of Environment and Natural Resources- Division of Water Quality
WELL CONTRACTOR CERTIFICATION N 2187
332119
1. WELL CONTRACTOR:
"ussell S. Taylor
W 9 T.cntractor (Individual) Name
dden Brothers Well D4-4114ng, Inc..
t'Jcli COntractof Company Name ._
STREET ADDRESS 73 Holly Hills Vista RD
;Yank?In Nr 28734
City or Town State Zip Code
828 H 369-9591
Area code- Phone number
2. W.:" L INFORMATION:
Si IE WELL ID Cif applicable)
75(n7.9j • I (o7,
STATE WELL PERMIT/10f applicable)
O4 Q.-or OTHER PERMIT e(If applicable)
N &LL :1SE (Check Applicable Box): Residential Water Supply
f A f E DRILLED 4,115 (w 9 A6032
TIME COMPLETED .7SS oo AM O PM
3. WELL LQCATION:
,(_itraeatCOUNTY
rru : O� aR I mt. e-
ame. Num en, Community. Subdivision, Lot No., Parcel, Zip Code)
CIT.f:V
(rnreet
T 7' .)GRAPHIC / LAND SETTING:
❑'il;we °Valley ❑Flat ❑Ridge °Other
(check appr(3priate box)
1_, 11TUDE p.i�� ^L' A VI A)
LONGITUDE 73 �1 55a (�
Lari'ude/longitude source: AGPS °Topographic map
' %location o/ well must be shown on a USGS fopo map and
attached to this fofm Snot using GPS)
May be in degrees,
minutes, seconds or
ins decimal format
4. WELL OWNER q-v
C' 'iR'S NAME U/ s UQ/II '
S . .'IT�/AADL7s,DRRE-SSSS�/^'�' u� l
L Town �L /J /stag r ip s 7-3C
( L. sso7-9g7Z)
Area code . Phone number
6. WELL DETAILS: ��//���
a. TOTAL DEPTH: ACID
b. DOES WELL REPLACE EXISTING WELL??� YESYE^0 P40
c. WATER LEVEL Below Top of Casing: ).50 - FT.
(Use'+' II Above Top of Casing)
d. TOP OF CASINO IS 2 FT. Above Land Surface'
'Top of cuing terminated aVor below land surface may require
a variance In accordance with 15A NCAC 2C .0118.
e ` IELD (gpm): 45 METHOD OF TEST Blow
I DISINFECTION: Type HMI' H Amount 1 6oz
g. WATER ZONES (depth):
From I5O To RD0 From To
From
From - To
From To From To
6. CASING: Thickness/
Depth Diapmeter Weig *sit)
From O To.S9 Ft. 1D" .I_
From To Ft.
From To Ft.
7. GROUT: Depth Material Method
From 0 To720 Ft. c i iL & tenonite Attu
From To Ft.
From To Ft.
8, SCREEN: Depth Diameter Slot Size Material
From To Ft. In. In.
From To Ft. In. In.
From To Ft. In. in.
9. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
From To Ft.
10, DRILLING LOG
From To
0
Imo` �I r
11. REMARKS:
Formation Description
Cla & sand
Granite
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE wrTH
ISA NCAC 2C, WELL CONSTRUCTION STANDARDS. AND THAT A COPY OF TilS
RECOR BEEN PROVIDED TO THE WELL OWNER.
SIGNATURE NTRACTOR DATE
Russell S. Taylor
PRINTED NAME OF PERSON CONSTRUCTING THE WELL
Submit the original to the Division of Water Quality within 30 days. Attn: Information Mgt.,
1617 Mali Service Center- Raleigh, NC 27699-1617 Phone No. [phone] east 568.
Form GWla
Rev. 7/05
n--, -.., ..�...,
Qt 4 ' L:..

RESIDE1VTIAL WELL CON.syr CTWN RECORD
North Carolina Department of Environment and Natural Resources. Division of Water Quality
WELL CONTRACTOR CERTIFICATION W. 2187
1. WELL CONTRACTOR:
Russell S. Taylor
Well Contractor (Individual) Name.
Redden Brothers Well Drilling, Inc,
Well. Contractor Company Name - STREET ADDRESS 73'Holly Hills Vista RD
Franklin, Nf' 28734
City or Town Stele - Zip Code
( 828 )• 369-9591
Area code. Phone number
2. WELL INFORMATION: G; �� 'I /- /)
SITE WELL ID OW applicable) �.L(Q'7• ' 17 r 7l[rr9)J
STATE WELL PERMIT:0r applicable)
DviOO or OTHER PERMIT e(If applicable)
W ALL USE (Check Applicable Box); //R�esidential Water Supply
j C�At DRILLED IC) •at19 q')t0
TIME COMPLETED S •6(:)- AM O PME]
3. WELL LQQATION:
CITY:
(Street Name, Num�e a, Community, Subdivision, Lot N ;, Parcel, Zip Code)
TOPOGRAPHIC I LAND SETTING:
❑Slope °Valley °Flat ORldpe °Other
(check apprdpest* box)
I.1ITUDE y1T.y3�
LONGITUDE .j2J
Lati'tide/longitude source: PS ❑Topographic map
Notation of well must be shown on a USGS fopo map and
attached to rh/s form anor using GPS)
4,WELL OWNER DQ
OWNER'S NAME ? /')j'4 d /
S kEET ADDRESS 14l Aft
ajank ,ct 3?tre*
Cly Or Ton r State Zip Code
-
Area code • Phone number
6. WELL DETAILS:
a. TOTAL DEPTH: 9 nt r
b. DOES WELL REPLACE EXISTING WELL? Y S ° NOK
c. WATER LEVEL Belau Top of Casing: FT,
(Use '+' If Above Top of Cuing)
d. TOP OF CASING is 2 FT, Above Land: Surface
Top of casing terminated at/or below land aurfads may require
a variance In accorder ^e with 15A NCAC 2C ,0116,
e..YIELD (ppm):�METHOD OFTEST __. Blow
Maybe In doyen,
minutes, monde or
in a decimal format
099
L DISINFECTION: Typea Amount_16
g, WATER ZONES (depth):
From To
From To
From To
6. CASING:
From
From
From
To
To.
To_
Dth Thickness/
epp _. giampler Weight
To S().FI: ^ f(fi
To Ft.
From
From
From
7, GROUT: Depth Material Method
From 0 To-2O Ft, =Ent & kat rite pzcej
From To ___ Ft
From To__ FI. O. SCREEN: Depth Diameter Slot Size Material
From To___ Ft. In, _ In.
From Tom Ft In.
From To__— Ft. ,•,�_In,
0. SAND/GRAVEL PACK;
Depth Size Materiel
From
From
From
10, DRILLING LOG
From To
il°3 �
To
To
To
Ft.
Ft.
Ft.
In.
In.
Formation Description
Clay & sand
vr'
Jo 5
11 E RKS:
100 HERESY CE me) THAT THIS WELL WAS CONSTRUCTED IN ACCOADANce WITH
15A NCAC 2C, WELL CONS TRUOnON STANDARDS, AND THAT A COPY OF THIS
RICORDD SEEN PROVIDED TO THE WELL OWNER.
SIGNATURE OF CERTIFIED WE CONTRACTOR1110
DATE
Russell S. Tavior
PRINTED NAME OF PERSON CONSTRUCTING. THE WELL
Submit the original to the Division of Water Quality within 30 days, Attn: Inform tlon M(pt ,
1617 Mall Service Center- Raleigh, NC 27699.1617 Phone No, [phone] ext 668i _,.
farm GW1a
Rev, 7/05 I
DEC 12 2006

RESIDENTIAL WELL CONS) yCTION RECORD
North. Carolina Department of Environment and Natural Resources. Division of Water Quality
WELL CONTRACTOR CERTIFICATION A
1. WELL CONTRACTOR:
Russell S. Taylor
Well Contractor (Individual) Name.
Heiden Brothers Well Drilling, Inc,
Well Contractor CompanyName
STREET ADDRESS 73 Holly Hills Vista RD
Franklin, NC 28734
City or Town State Zip Code
ti• 369 9591
. Area code. Phone number
2. WELL INFORMATION;
SITE WELL ID e(ll eppllcabe) 7 = & 3- %7
STATE WELL PERMIT Of applicable)
DOC: or OTHER PERMIT e(If applicable)
WELL USE (Check Applicable Box): Residential Water Supply0
(OAr?DRILLED I''Up LL
TIME COMPLETED :Col" AM 0 PM Up
3• WELLLO5ritTION: •rr'- I �/�I ,, 'A.\
CIT , t t Q�/JItY.[�, COUNTY l k7 (At elin•3
nla-4-\ :# �
(Street Name, Numbers, ammonite, Sub NUon, Lot No , Parcel, Zlp Code)
TOPOGRAPHIC ILAND SETTING:
p.Slope OVelley ❑Flat ORIdge C0ther
(cheek epprelpriut box)
I.'TITUDE .JJ'_J
LONGITUDE 23
Lati'(ide/longitude source: �GPS ❑Topographic map
i'ocatbn of well must be shobn on a USGS repo mep and
snitched to d le torm b not u,Mg GPS)
4.WELL OWNER n' /
OWNER'S NAME UAJ7d
S at"leDDDRESS 1
,\—'v0d{h-y�orTow(
State
zeL)- ��
Area code • Phone number
5. WELL DETAILS:
a. TOTAL DEPTH: '7,
May be In degrees, I
minutes, seconds or
In a decimal format
Z!p Code
b. DOES WELL REPLACE EXISTING WELL? YES c) NI
IYQ
c. WATER LEVEL Below Top of Casing:: - vdn.. 'FT.
(Use v' If Above Top of casing)
d, TOP OF CASINO IS 2 FT. Above Land: Surface'
'Top of cuing terminated aVor below lend aurfede may require
a variance In accordance with 15A NCAC 2C .011 a.
e. ,YIELD (gpm): •, METHOD OF TEST BLOW
2187
.. 3
1. DISINFECTION: Type Hr_ T 14 _, Amount,_j6Qy_
g. WATER ZONES (depth):
35
From 5 To 3 FroFromm ' To
FroFromTo To
Frcr CCC���- 1 5 To From - To
8. CASING; .Thickness/
r) Depth DI flat Wei AAa1•r
From 1. I To 1 Ft. _ , / I Q✓%!
From____ To Ft:
From Tom. Ft.
7. GROUT: Depth Material Method
From 0 , To320 Ft It & tstnTinted
T led
From ToFt.
From To Ft.
S. SCREEN:
From
From
From
Depth
To_
To_
To
5. SAND/GRAVEL PACK:
Depth
From To
From To
From To
10. DRILLING LOG
From To
0
11, REMARKS:
Diameter Slot Sire
Ft. In. In.
Ft In. __ In.
Ft. __In. _ In.
Size Material
Ft.
Ft.
Ft.
Material
Formation Description
Clay & sand
Grandt-e -
I00 HEREBY CERTIFY THAT THIS W ELL WAS CONSTRUCTED IN ACCORDANCE MN
16A NCAC 20, WELL CONSTRUOTN2N STANDARDS, AND THAT A COPY OF TNIS
RECOROJt, s BEEN PROI D� THE WELL (jyJHER.
SIGNATURE OF CERTIFIED LL CONTRACTOR 'I DA E
Russell S. Taylor
PRINTED NAME OF PERSON CONSTRUCTING. THE WELL
Submit the original to the Division of Water Quality within 30 days. Attn: information Mgt.,
1617 Mall Service Canter- Raleigh, NC 27699.1617 Phone No. [phone] wit 668.
DEC 12 2606
FormOW1a
Rev,/05

RESIDENTIAL WELL CON IBUCTfpN RECORD
North Carolina Department of Environment and Natural Resources. Division of Water Quality
WELL CONTRACTOR CERTIFICATION A
1. WELL CONTRACTOR:
Russell S. Taylor
Well Contractor (Individual) Name.
Redden Brother's Well Drilling, Inc,
Weft Contractor Company Name.
STREET ADDRESS 73 Holly Hills Vista RD
Franklin, NC 28734
City or Town State Zip Code
Lea). 369-9591
Area code- Phone number 2. WELL INFORMATION: !� I
SITE WELL ID SO applicable) I 0''f r r%t•I •
STATE WELL PERMITS/Of applicable)
Dvi'C' or OTHER PERMIT e(If applicable)
M ELL USE (Check Applicable Box); Residential Water Supply
C»Af ? DRILLED 1 /' 3•%
TIME COMPLETED �Z
- ` : 6U
3. WELL LOOATLON; •
CITY:
AM °
COUNTY
Pal
(SHeet Name, Numb a, Community, Subdlvalon, Lot No., Parcel, Zip Code)
TOPOGRAPHIC / LAND SETTING:
°.Slone °Valley °Flat ❑Ridge OOther
(chock apprdpnat, box)
ITUDE p_3,5z 1^3� .1 (DJ
LONGITUDE 9�.Sib 275-tO
PM❑
May be In degree.,
minutes, secont/sof
In a decimal format
La/hide/longitude source: i(OPS °Topographic map
(locafbn of well must be sVV n on a USGS fopo map and
enacted to this form a not using GPS)
4. WELL OWNER
OWNER'S NAME
STti'ET ADDRESS
City or Town r State
)_ ,2qu- Oita
Arse code Phone number
6. WELL DETAILS:
a. TOTAL DEPTH: I l7J
b. DOES WELL REPLACE EXISTING WELL? ES !Ct NO 0
c. WATER LEVEL Below Top or Casing: t • FT.
(Use'+' if Above Top of Casing)
d, TOP OF CASINO le 2 FT. Above Land Surface'
'Top of casing terminated at/or below land surface may require
a variance In sec rdanea with 15A NCAC 2C .0118,
e, YIELD (gpm): METHOD OF TEST Blow
53100 CO
Zip Code
Submit the original to the Division of Water Quality within 30 days. Ann: InformailailIgj -`
1617 Mall Service Center -Raleigh, NC 27599.1617 Phone No. [phone] ext 566
2187
L DISINFECTION: Type HI)°T H Amount
0. WATER ZONES (depth):
From_ To _ From
From To - From
From To • From
S. CASINO:
Depth
From To
From
From
To
To
To
To_
.Thickness/
Weight
7. GROUT: Depth Material
From 0 To. Ft. carslt & Larnite
From ToFL _
From To__ Ft.
8. SCREEN: Depth Diameter Slot Size Material
From To__ Ft. in, In.
From To FI.._In. In,
From To Ft. In. In.
anal
Method
arced
9. SAND/GRAVEL PACK:
Depth
From To
From To
From To
Ft.
Ft.
Ft.,
Size
Material
10. DRILLING LOG
From To Formation Description
0 ' Clay & sand
3ai /off- lif r�anit•e
1y4
100 HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED N ACCORDANCE W11H
ISA NCAC 2C, WELL. CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS
.RECORD yA9 BEEN PROVgW T)THE WELL OWNER,
AA a
SIGNATURE OF CERTIFIED WE CONTRACTOR D E
Russell S. Tavlor
PRINTED NAME OF PERSON CONSTRUCTING. THE WELL
. FormGWta
Retsina
DEC 12 2006

North Carolina Department of Environment and Naturaf Resources- Division of Water Quality
WELL CONTRACTOR CERTIFICATION t< 2187
F ,' A,
9.9
V
1. WELL CONTRACTOR:
Russell S. Taylor
Well Contractor (Individual) Name
••bedden Brothers Well Drilling, Inc.
Well Contractor Company Name
STREET ADDRESS 73 Holly Hills Vista RD
Franklin, NC 28734
City or Town State Zip Code
( 828 )- 369-9591
Area coda- Phone number
2. WELL INFORMATION: Gpp��rr.r/
SITE WELL ID #(V applicable) 156C 50 ` tiDO /
STATE WELL PERMIT#(If applicable)
DWVQ or OTHER PERMIT 0(ir applicable)
M aLL USE (Check Ap licgable Box): Residential Water Supply C
r,ArE DRILLED--����({,�'' V'
/� • L,A
TIME COMPLETED / M,J PM
❑
3. WELL LOCATIO
CIT,
C11LV4LT
(Stl M Name, Numbers, community, Subdivision, Lot No., Parcel, Zip Code)
TOPOGRAPHIC l LAND SETTING:
❑.Slope ❑Valley ❑Flat ❑Ridge ❑Other
(check apprdprlate box)
1 71TUDE _L _
LONGITUDE_
Lat':de/longitude source: OOPS ❑Topographic map
ilocetbn of well must be shown on a USGS topo mop and
attached to this roam Itnot using GPS)
4. WELL OWNER
OWNER'S NAME
STR" TADDRESS
May be in degrees,
minutes, seconds or
in adecimal format
City or Town S ate Zip Code
( 77a. at}q•AR7n
Area code - Phone number
3. WELL DETAILS: /
a. TOTAL DEPTH:
apa
b. DOES WELL REPLACE EXISTING WELL? YES ❑ NO k
c. WATER LEVEL Below Top of Casing: 900 FT.
(Use'+• N Above Top of Casing)
d. TOP OF CASING 1a 2 FT. Above Land Surface'
'Top of casing terminated at/or below land eurfate may require
a variance In accordance with 1SA NCAC 2C .0118.
e.. YIELD (gpm): cot METHOD OF TEST Blow
f. DISINFECTION: Type T H Amount 16oz
g, WATER ZONES (depth):
7alz
From To
From
From
S. CASING.
Fron, To
From To
From To
Thickness/
Depth Diameter Weight M ejial
From To Fi _ —fir
From To Ft. r1'O
From To Ft. _
7. GROUT: Depth Material Method
From—Q_Tc7.2O Ft. C91Hit & het -mite pitted
From To Ft.
From To Ft.
8. SCREEN: Depth Diameter Slot Size Material
From To Ft. In. In.
From To Ft. In. in.
From To FL . in. in,
9. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
From To Ft.
10. DRILLING LOG
From To
0
Formation Description
Clay & sand
a 1 ' /IXXJ Granite
L
11. REI
1
100 HERESY CERTIFY THAT THIS WELL WAS CONSTRUCTED N ACCORDANCE WITH
1SA NCAC 2C, WELL CONSTRUCTION STANDARDS, AND THAT A COPY OF 1NI9
AEC HAS SEEN PROVIDED TO THE WELL OWNER.
SIGNATURE OF CERTIFIEVNELL CONTRACTOR D TE
Russell S. Taylor
PRINTED NAME OF PERSON CONSTRUCTING THE WELL
z
Submit the original to the Division of Water Quality within 30 days. Attn: Information Mgt:,
1617 Man Service Center— Raleigh, NC 27699.1617 Phone No. [phone] ext 568.
Form GW-la
Rev, 7/05

4. WE:.L OWNER
OWNER'S NAME STET ADDRESS r v ( 3I D Ip-s
{lia° NC t J8 i/ 7
—Ip CC_e
RESIDENTIAL WELL CONSTRUOTION RECORD
North Carolina Department of Environment and Natural Resources• Division of Water Quality
WELL CONTRACTOR CERTIFICATION # 2187
1. WELL CONTRACTOR:
Russell S. Taylor
W.I' Contractor (Individual) Name
::.den Brothers Well Drilling, Inc.
Vie;/ Contractor Company Name
STREET ADDRESS 73 Holly Hills Vista RD
Franklin, Nr 28734
City or Town State Zip Code
( 828 r 369-9591
Area code- Phone number
2. WELL INFORMATION:
SITE WELL ID #(If applicable)
STA"E WELL PERMIT#Qf applicable)
D 4 . or OTHER PERMIT #(if applicable)
V, s :1SE (Check A►piicable Box): Residential Water Supply,
'•;EDRILLED O' 'TOLD
TIME COMPLETED 5 • CC) AM D PM :4,
3. WELL LOQA ION:
CITY:
(Streit Name, Numbers, Corr+ily. Subdivision. Lot No., Parcel, Zip Code)
OGRAPHIC / LAND SETTING:
❑ ,+ a OValley O Flat ❑Ridge ❑Other
(check apprdpdate box)
1_ TITUDE
LONGITUDE
)at."ude/longitude source: ❑GPS ❑Topographic map
`'cation of well must be shown on a USGS fopo map and
attached to this form #not ustng//GAS)
,, ,,a /�-
AU , 111YSI1C�Yt
May be in degrees,
minutes, seconds or
in a decimal format
y or Town ' State
8z& Jo(- 1041
A • : :de • Phone number
5. .huL DETAILS: I O
a. TOTAL DEPTH:
b. DOES WELL REPLACE EXISTING WELL? ///YES O NCX
c. WATER LEVEL Below Top of Casing: (/J FT.
(Use'+' It Above Top of Casing) /
d. TOP OF CASINO le 2 FT. Above Land Surfaces
'Top of casing terminated aVor below land surface may require
a variance in accordfIce with 15A NCAC 2C .0118.
e. ` tELD (gpm): ^W( METHOD OF TEST Blow
s-0 AN++ C'a
t 0I i J?
t. DISINFECTION: Type H+'T H Amount 1 602
g. WATER ZONES (depth):
From To From To
From To From I To
From To From To
6. CASING: Thickness/
Depth Diameter Weight Material
From To Ft.
From To Ft.
From To Ft.
7. GROUT: Depth Material Method
From 0 To".20 Ft. CHia t & barnite wired
From To Ft.
From To Ft.
6. SCREEN: Depth Diameter Slot Size Material
From To Ft. In. In. _
From To Ft. In. In.
From To FI. in. in.
S. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
From To Ft.
10. DRILLING LOG
From To Formation Description
0 Clay & sand
11. ::fC=1( :
niCvn
Granite
0
0
c
0
100 HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH
ISA NCAC 2C, WELL CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS
RECORD HQS BEEN PROVIDED TO THE WELL OWNER.
.(RE01Y 1tJs Dt
L
SIGNATURE OF CERTI ED �Jj/4LCCONTRACTOR DATE
Russell-S.Tarl r -
PRINTED NAME OF PERSON CONSTRUCTING THE WELL
Submit the original to the Division of Water Quality within 30 days. Attn: nformation Mgt.,
1617 Mall Service Center- Raleigh, NC 27699-1617 Phone No. (91S) 733-7015 eat 568. ?
Form GW-la
Rev. 70

RESIDENTIAL WELL CONSTRUCTION RECORD
North Carolina Department of Environment and Nature; Resources- Division of Water Quality
WELL CONTRACTOR CERTIFICATION # 2187
1. WELL CONTRACTOR:
Russell S. Taylor
WPr Contractor (Individual) Name
lien Brothers Well Drilling, Inc.
: Contractor Company Name
STREET ADDRESS 73 Holly Hills Vista RD
Franklin, NC 28734
City or Town State Zip Code
( 828 )- 369-9591
Area code- Phone number
2. WELL INFORMATION:
S T: WELL ID Mir applicable)
S : b WELL PERMIT#(If applicable)
DAC or OTHER PERMIT Cif applicable)
M B4 USE (CheckA livable Box) Residential Water Supply 0
ram DRILLED '• I•Ola•
TIMK COMPLETED 5; OO AM ❑ PM '1
3. WELL LOCATION:,
CITY: •I U„X�idl',L1,i�•�,�1�1 ^ COUNT
(Slrset Name, Numbers. r(trfiu , SubdiNaion, Lot No., Parcel, Zip Code)
TObOGRAPHIC / LAN SETTING:
❑•. r'. °Valley °Flat ❑RIdge °Other
(check appropriate box)
T'JDE _3_
LONGITUDE
L ee:Ida/longitude source: ❑GPS ❑Topographic map
,location of well must be showr on a USGS fopo map and
attached to this form M not uslno GPS)
May be in degrees,
minutes, seconds or
in a decimal format
4, WELL OWNER
OWNER'S NAME L1
5 1 E,ET ADDRESS O It 13 i'3
IOSO t-000 C a8717
r or Town / State Zip Coto,
c77-112- R47-1e55(o
A:t. 1 :ode - Phone number
6. WELL DETAILS: Q / s
a. 1 OTAL DEPTH: / v
b. DOES WELL REPLACE EXISTING WELL? YES// ❑ NOgp
c, WATER LEVEL Below Top of Caging: 3Vs FT,`
(Use'+' If Above Top of Casing)
d. TOP OF CASING IS 2 FT. Above Lend Surface'
'Top of casing terminated at/or below land surface may require
a variance In accordance with 15A NCAC 2C .0118.
e ;:'_D (ppm): 070 METHOD OF TEST Blow
n
;.1� . 52
f. DISINFECTION: Type HT H Amount 16o2
g. WATER ZONES (depth):
From 7Z3 To' �4 From To
From 0 , To 'l�,Vy3�/ x From To
From. 4Zr To s From To
6. CASING:
Thickness/
Depth Di meter Weight Mat ri
From l 1 To I Ft. �a" . Int
From To Ft.
From To Ft.
7. GROUT: Depth Material Method
From 0 ToT20 Ft. wreiL & tstnite armed
From To Ft.
From To Ft.
8. SCREEN: Depth Diameter Slot Size Material
From To Ft. In. In.
From To Ft. In. In.
From To Ft. in. In.
9. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
From • To Ft.
10. DRILLING LOG
From To
O 1
r
11. REMARKS:
Formation Description
Clay & sand
Granite
sox
L—
r�
Cn r'1:
0
m
I D0 HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED N ACCORDANCE WtH
15A NCAC 2C, WELL CONSTRUCI1ON STANDARDS, AND THAT A COPY OF THIS
RECORD HAS BEEN PROVIDED TO THE WELL OWNER.
SIGNATURE OF CERTIFIED WE CONTRACTOR DATE
Russell (�
PRINTED NAME O PERSON CONSTRUCTING THE WELL
Suamlt the original to the Division of Water Quality within 30 days. Attn: Information Mgt.,
1617 Mali Service Center — Raleigh, NC 27699-1617 Phone No, [phone] ext 568. .1-
1.E i 2 i i L,
Form GWla
Rev. 7/05

;. NONRESIDENTIAL WELLCONST
UCTION RECORD
North Carolina Department of Environment and Natural Resources- Division of Water Quality
WELL CONTRACTOR CERTIFICATION k 2187
1. WELL CONTRACTOR:
Russell S. Taylor
r r: Contractor (Individual) Name
:j.`)3en Brothers Well Drilling, Inc.
Well Contractor Company Name
STREET ADDRESS 73 Holly Hills Vista RD
F rank1 i Tl Nr 28734
City or Town State Zip Code
( 828 )• 369-9591
Area code- Phone number
2. WELL INFORMATION:
: 1TE WELL ID #(If applicable)
'ATE WELL PERMIT#(il applicable)
LTti!'O or OTHER PERMIT #(il applicable)
E:'.L USE (Check Applicable Box) Monitoring ° Municipal/Publ d 0
InULLtrieUCommerclal ° Agricultural 0 Recovery 0 Injection 0
irrigation° Other 0 (list
�1 use)
)
LUTE DRILLED j -A 'QL
TIME COMPLETED J!is 00 AM ❑ PMx1
3. WELL LOCATION: -� -
CITY: I.f nI V aki- COUNTY JACL,5 U )
Lot K3oJ
(Street Name. Numbers, Community, Subdlvslon, Lot No., Parcel, Zip Code)
'OPOGRAPHIC / LAND SETTING:
C 3 ope °Valley ❑Flat °Ridge 0 Other
(check appropriate box)
LATITUDE _a_
LONGITUDE
May be in degrees,
minutes, seconds or
in a decimal format
Latitude/longitude source: (oGPS ❑Topographic map
(location of wan must be shown on a USGS topo map and
attached to this form not using GPS)
4. C ACILITY• Is the name el the business wMn the well Is located.
AGILITY ID cif applicable)
ME OF FACILITY
r7EET ADDRESS
City or Town State Zip Code
CONTACT PERSON-CyVA'V1A�yL�.L+
. i LING ADDRESS 4 �5 A&)/CK- Cotter
Ik ri.-rq e FF 30050
City or Town State Zip Code
t/in 1- 5S9-9o?9at
Area code - Phone number
5. WELL DETAILS: ^ n
a. TOTAL DEPTH: IO1v
V
a DOES WELL REPLACE EXISTING WELL? YETIS 0 NOO
WATER LEVEL Below Top•of Casing: /ob FT.
(Use 'e' B Above Top of Casing)
33C?a1
d. TOP OF CASING IS 2 FT. Above Land Surface'
'Top of casing terminated at/or below land surface may require
a variance In accordance with 15A NCAC 2C .0118.
A YIELD (ppm): '7 .: METHOD OF TEST Blow
f. DISINFECTION: Type H T H Amount 1 6oz
g. WATER ZONES (depptth)q:
From Tom o� I From To
From ToG2L From To
From To From_To
6. CASING Thickness/
Depth rt Djareter Wei IC
n To ni/7f Ft. ((OO
From To Ft.
From To Ft.
Material�( Method
From To 5a Ftfft 4gri
From To Ft. //l.KOM�in.
7. GROUT: Depth
From To Ft.
11. SCREEN: Depth Diameter Slot Size Material
From To Ft. In. _ In.
From To Ft. In. _ In,
From To Ft. In. _ In.
9. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
From To Ft.
10. DRILLING LOG
From To
n 5o'
Formation Description
r-e
In —
m - -
11. REMILRKS: 1
i2i arno c6J5sr?De
1 DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED N ACCORDANCE well
1SA NCAC 2C, WELL CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS
RECgj10'yA5 SEEN PROVIDEgjO THE WELIpWNER.
>cv1 p.,t9
SIGNATURE OF CERTIFIED )LL CONTRA-T0R D E
Russell S.�___ ylor
PRINTED NAME OF PERSOI CONSTRUCTING THE WELL
Submit the original to the Division of Water Quality within 30 days. Attn: Information Mgt„
1617 Mall Serviee Center— Raleigh, NC 27699.1617 Phone No. [phone] ext 568.
Form GW-1b
.Rw..7/05

RESIDENTIAL WELL CONSTRUCTION RECORD _
North Carolina Department of Environment and Natural Resources- Division of Water Quality
WELL CONTRACTOR CERTIFICATION R 2187
1. W . CONTRACTOR:
Russell S. Taylor
Well Contractor (Individual) Name
he&3en Brothers Well Drilling, Inc.
Wei t actor Col:nnhany:(ame
STREET ADDRESS 73 Holly Hills Vista RD
_Jtanklin, NC 28734
. City or Town State Zip Code
L 828 ). 369-9591
Area code- Phone number
2. WELL INFORMATION: A� Q
SITE WELL ID #(If applicable) 15a'J 31 ' 1 19 o
STATE WELL PERMITS(Ilepplicable
DWO or OTHER PERMIT C(if applicable)
N 5LL USE (Check Applicable Box). )RResidential Water Supply
r-APE DRILLED O IA �'.�^0/�e(49
TIME COMPLETED T r• W AM Q PMI(
3. WELL LOCATION:
COUNTY Y
rut Name. Numbers. Community. &bdreeion,'_ot No,. Parcel, Zlp Code)
TOPOGRAPHIC / LAND SETTING:
❑Slope °Valley ❑Flat °Ridge °Other
(check epprdpriatr box)
1_,',ITUDE _ga
LONGITUDE /3 Si
Lz.'ude/longitude source: GPS ❑Topographic map
:eon of well must be sho n on a USGS topo map and
.leached to this {qrm not using GPS)
4. Y'tLL OWNER
0-NIER'S NAM
STk-SET ADDRESS
May be in decrees,
minutes, seconds or
in a decimal format
ty or Town State Zip Code
(_gl). 497- a772
Area code • Phone number
6. WELL DETAILS: /] r
a. TOTAL DEPTH: `1
b. DOES WELL REPLACE EXISTING WELL? Y°S 0 NOK
e. &TER LEVEL Below Top of Casing:93
FT.
(Use •I.' If Above Top of Casing)
4. 'OP OF CASING IS 2 FT. Above Lend Surfacer
'Top of cuing terminated aUor below land surface may require
a variance In actor nca with 15A NCAC 2C .0118.
e. YIELD (gpm): METHOD OF TEST Blow
f. DISINFECTION: Typo HrT H Amount 16oz
g. WATER ZONES (depth):
From To From To
From To Prom -To
From To
From Tc
6. CASING: Thickness/
Depth oh Di else Walla M eri
From 0 To AU Ft. e t aka
From To Ft.
From To Ft.
7. GROUT: Depth Material Method
Frcm� To-.20 Ft. Laura. & tatnite 1:LITGEd
From To Ft.
From To Ft.
8. SCREEN: Depth Diameter Slot Slze Material
From To Et. in. In.
From To Ft. In. In.
From To Ft. . in. In.
9. SAND/GRAVEL PACK:
Depth Slze Material
From To Ft.
From To Ft.
From To Ft.
10. DRILLING LOG
From To
0
Formation Description
Cla & sand
-I -
GI
4>'
6
SE0 2CUJ
a'
T
11. REMARKS:
Set arlAY C2 54
a
1 DO HERESY CERTIFY THAT TNIS WELL WAS CONSTRUCTED IN ACCORDANCE WIN
15A NCAC 2C, WELL CONSTRUCTION STANDARDS, ANDTHAT A COPY OF TIME
RECORD
55 SEEN PROVIDED TO Tilt WELL OWNEERRR.
SIGNATURE OF CERTIFIED WELL CNTRACTOR DATE
Russell S. Taylor (J
PRINTED NAME OF PERSON CONSTRUCTING THE WELL
Submit the original to the Division of Water Quality within 30 days. Attn: Information Mgt.,
1617 Mall Service Canter -Raleigh, NC 27699-1617 Phone No. [phone] ext 568.
Form GWla
Rev. 7/05

RESIDENTIAL WELL CON,SUCTION RECORD
North Carolina Department of Environment and Natural Resources. Division of Water Quality
WELL CONTRACTOR CERTIFICATION 0 2187
1. WELL CONTRACTOR:
Russell S. Taylor
Well Contractor (Individual) Name.
Redden Brothers Well Drilling, Inc.
Well Contractor Company Name
STREET ADDRESS 73 Holly Hills Vista RD
Franklin, wr 28734
City or Town State Zip Code
( 828 )• 369-9591
Area code- Phone number
2. WELL INFORMATION:
SITE WELL ID Hill applicable) 155? 54. _,..9(na9
STATE WELL PERMIT#(If applicable)
Dv/0 or OTHER PERMIT e(If applicable)
V ALL USE (Check A ppllIcable Box): �SReesidential Water Supply
ri DRILLED //Jt :0I'
TIME COMPLETED 3 (AJ AM ❑ PM)ir
3. WELL LOCATION: •
CIT
(Street Name, Numbers, Community, Subdivision, Lot No., Parcel, Zlp Code)
TOPOGRAPHIC / LAND SETTING:
❑.Slope ❑Valley ❑Flat ❑Ridge COther
(check apprdprlate box)
�910d
I111TUDE j_P_
LONGITUDE 3
May be In decrees,
minutes, seconds or
In decimal format
Lat.i'tide/longitude source: PS ❑Topographic map
'location of well must be hown on a USGS topo map and
attached to this for ff nor ua/np GPS) 4. WELL OWNER
OWNER'S NAM
�T bET sAD +ESS
P�y tlJ�nc iLJ1Lr' /� ti
_Dirt.? Town - State/'
( 6104). P°Tfthone &do
Area code =b
6. WELL DETAILS: 70 0
a. TOTAL DEPTH:
y
Zip Cede
b. DOES WELL REPLACE EXISTING WELL? YES ❑ NOK
c. WATER LEVEL Below Top of Casing: - G - -FT..
(Use'+' If Above Top of Casing)
d, TOP OF CASINO IS 2 FT. Above Land Surface'
'Top of cuing terminated at/or below land surreal; may require
a variance In actor ance with 15A NCAC 2C ,0118.
e, YIELD (gpm): METHOD OF TEST Blow
f. DISINFECTION: Type H1"T H Amount 16oz
g, WATER Z0, ES (depth);
From To
From
From TO lO 65.
From To
From To
From To
6. CASING: Thickness/
From f% DTolh di Dirtier
DirtierM p j a`ra
From To Af__ Ft: ((PP f—f_3
From To Ft.
7. GROUT: Depth Material .Method
From 0 , To'-20 Ft. caret & ba mite anted
From To Ft.
From To Ft.
e, SCREEN: Depth Diameter Slot Size Material
From To Ft in. In.
From To FI. In. In.
From To Ftin. in.
9. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
From To Ft.
10, DRILLING LOG
From To
0
Lal
11. REMARKS:
Formation Description
Clay & sand
Granite
RECEIVED
100 HEREBY GERM THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITS
I SA NCAC 20, WELL CONSTRUCTION STANDARCS, AND THAT A COPY OF THIS
RIGOR S SEEN PROVIDE TO THE WELL OWNER•
W� 1�%�
SIGNATURE OF CERTIFIED WE CONTRACTOR DAT
Russell S. Taylor
PRINTED NAME OF PERSON CONSTRUCTING. THE WELL
Submit the original to the Division of Water Quality within 30 days. Attn: Information Mgt.,
1617 Mall Service Center— Raleigh, NC 27699.1617 Phone No. [phone] ext 568.
Form GWla
Rev, 7/05
eNt
Ord
Girt
Ckt

North Carolina Department of bnvlronmens Diu ix Emu - -•• -•- • -•
WELL CONTRACTOR CERTIFICATIONS. 2187
1. WELL CONTRACTOR:
Russell S. Taylor
Well Contractor (Individual) Name.
HExlden Brothers Well Drilling,
W 6JDontractor Company Name
�'REETADDRESS 7'. ,-"_ Hills Vista RD
Franklin. NC 28134
City or Town State Zip Code
( 828 )• 369-9591
Area code. Phone number
2. WELL INFORMATION: SITE WELL ID k(If applicable) 1 -96 - / 9iv5
STATE WELL PERMIThOt applicable)
DOC: or OTHER PERMIT k(Ir applicable)
414ALL USE (Check Applicable Box):/�
Residential Water Supply to
rsAr I DRILLED •_'
TIME COMPLETED
3. WELL LOCATION:'
CITY.
AM ❑
COUNTY
A b
(Street Nomi Number , Community, SubdlNdon, Lot No:, Parcel, Zip Code)
PM1,.
TOPOGRAPHIC / LAND SETTING:
❑Slope (Valley ❑Flat (Ridge (Other
(check apprdprlete box
i- l ITUDE _tt7y�
LONGITUDE a
Lati'tide/longitude source:! GPS ❑Topographic map
ilocaflon of well must be Shown on a USGS topo map end
attached to deaf if not using GPS
4. WELL OWNER
OWNER'S NAME of
May be In degree',
minutes, seconds or
In a decimal format
STHbETA--gqjjD� 3�R;; ESS
tan)? /
DIy °
L�
a
State
Area bode • Phone number
5. WELL DETAILS: 2
a. TOTAL DEPTH: C)
b. DOES WELL REPLACE EXISTING WELL? YrS�
ES❑ NO
c, WATER LEVEL Below Top of Casing: - CAC/" _ FT.
(Use +' if Above Top of Casing)
d. TOP OF CASINO 18 2 . FT. Above Lend: Surface'
'Top of ©Ding terminated aVor below land surface may require
a variance In accordance with 1SA NCAC 2C ,0118,
p Code
e, YIELD (gprn): 10 METHOD OF TEST Blow
L DISINFECTION: Type W'T H Amount 16oz
g. WATE- ONES (depth)):
From_ is
To / 50_ From . To
From YFa� Toir From To
From .H.I H'To i ie From To
S. CASING:. Thickness/
Depth ' -`.e tar Weight M;tteril
FromTo //✓ Ft�
• FromTo ///f Ft. 6"
From_ To__ Ft.
7. GROUT: Depth Material - Method
From 0 To72O Ft. C Tstt & k ltte Tamed
From To Ft.
From To Ft.
8, SCREEN: Depth
From To
From_ To,
From To
9. SANDiGRAVEL PACK:
Depth
From To
From To
From To
Diameter Slot Size Material
Ft.__In. In.
Ft In. __ In.
Ft. In. ___ In.
Size Material
Ft.
Ft.
Ft.
10, DRILLING LOG
From T• Formation Description
Clay &sand
Grani to
11. REMARKS:
1 DO HERESY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANC Wm!
16A NCAC 30, WELL o0N3TRU0TON STANDARDS, AND THAT A COPY OF 711I5
RECDRD HAS PROVIDED TV EWELL OWNER.
•
SIGNATURE OF CERTIFIED WE CONTRACTOR, I DarE
Russell S. Taylor
PRINTED NAME OF PERSON CONSTRUCTING. THE WELL
Submit
16 7 Mall hmice Center — Raleigh, NC 27699.1617 e oriinal to the Division of Water all Phone withinty lion Mgt:,
No,(919) 733 T015 ext 568
FEB 21 2007
Form GW-ta
Rev, 7105
DIV. OF WATERQDUALITY
JAN 1 0 2007
F4
law
Inc.

1. WELL CONTRACTOR:
Johnny Shane Downs
Well Contractor (Individual) Name
Hedden Brothers Well Drilling, Inc
Well Contractor Company Name
STREET ADDRESS 73 Holly Hills Vista RD
Franklin, NC 28734
City or Town Stale Zip Code
( 828 )- 369-9591
Area code- Phone number
2. WELL INFORMATION: r@�
SITE WELL ID#(it applicable) _?&Sg 5 ti58
STATE WELL PERMIT#(if applicable)
DWQ or OTHER PERMIT #(if applicable)
WELL USE (Check Applicable Box): Residential Water Supply
DATE DRILLED
TIME COMPLETED AM D PMK
3. WELL LO—ATION:
CITY:
(St/eet Name, Numbers, Commurmy, Subdivision, Lot No., Parcel, Zip Code)
TOPOGRAPHIC / LAND SETTING:
❑Slope DValley ❑Flat ❑Ridge ❑Other
(check appropriate box)
LATITUDE
LONGITUDE dp ,3
Latitude/longitude source: ©GPS O Topographic map
(location of well must be shown on a USGS topo map and
attached to this form ifnot using GPS)
4. WELL OWNER
OWNER'S NAME
SLEET ADDRESS
-bgAn NC
(x 0 )- goq
Area code - Phone number
City or Town prg
May be in degrees,
minutes, seconds or
in a decimal format
rQ r745
Zip Code
5. WELL DETAILS:
a. TOTAL DEPTH: le O©
b. DOES WELL REPLACE EXISTING WELL? YES ❑ N0 Gd
•
c. WATER LEVEL Below Top of Casing: l
(Use'+'it Above Top of Casing) d. TOP OF CASING IS 2 FT. Above Land Surface'
*Top of casing terminated allor below land surface may require
a variance in accordance with 15A NCAC 2C .0118.
e. YIELD (gpm): / f9 METHOD OF TEST Blow
RESIDENTIAL WELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources- Division of Water Quality
WELL CONTRACTOR CERTIFICATION # 3466
f. DISINFECTION: Type H T H
g. WATER ZONES (depth):
From
From
From To
6. CASING:
Depth
From_ To
From
From To r Ft
7. GROUT: Depth
From
From
From
From
From
From To
Thickness/
Ft.
Di meter Weight
//q �7��- -
Ft.—yL l/CIZI
Amount 16oz
0 Material
To 20 Ft. cement &benonite
_ To Ft.
To Ft.
To
To
Material
Method
pumped
8. SCREEN: Depth Diameter Slot Size
From To Ft.in.
in.
From
To Ft. in. in.
From To Ft in.
9. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
From To Ft.
10. DRILLING LOG
From
0
11. REMARKS:
Formation Description
Clay & sand
Granite
FAir ftF
9�C !1
Material
DEC 12 2006
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH
ISA NCAC 2C. WELL CONSTRUCTION STANDARDS. AND THAT A COPY OF THIS
RECORDHASBEEN PROVIDED ;J THE WELL OWNER.
SIGNATURE O F CERTIFIED WELL CONTRACTOR
DTE nnc bin/ Onc
PRINTED NAME OF PERSON CONSTRUCTING THE WELL
Submit the original to the Division of Water Quality within 30 days. Attn: Information Mgt.,
1617 Mail Service Center— Raleigh, NC 27699-1617 Phone No. [phone] ext 568.
Form GW-la
Rev. 7/05

STREET ADDRESS
Franklin,
RESIDENTIAL WELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources -Division of Water Quality
WELL CONTRACTOR CERTIFICATION # 3466
336642
1. WELL CONTRACTOR:
Johnny Shane Downs
Well Contractor (Individual) Name
Hedden Brothers Well Drilling, Inc
Well Contractor Company Name
73 Holly Hills Vista RD
NC 28734
City or Town State Zip Code
(828 ). 369-9591
Area code- Phone number
2. WELL INFORMATION: �J
SITE WELL ID #(if applicable) l 5b —qt. 0217
STATE WELL PERMIT#(if applicable)
DWQ or OTHER PERMIT #(if applicable)
WELL USE (Check /Appplicab2le Box):- Residential Water Supply EI
`Oi DATE DRILLED /3 0/
TIME COMPLETED d . ©0 AM ❑ PMg
3. WELL L ATION:
CITY: (.LX�(1 Lll"YLi COUNTY
(Street Name, Numbers, Community, Subdiision, Lot No., Parcel, Zip Code)
TOPOGRAPHIC / LAND SETTING:
❑Slope ❑Valley ❑Flat ❑Ridge ❑Other
(check appropriate box)
LATITUDE 3
LONGITUDE
Latitude/longitude source: m GPS ❑Topographic map
(location of well must be shown on a USGS topo map and
attached to this form if not using GPS)
4. WELL OWNER I'
OWNER'S NAME
TREET ADDREsk
May be in degrees,
minutes, seconds or
in a decimal format
(
/tie
or Town State
Area code • Phone number
a$Ma 3
Zip Code
S. WELL DETAILS: 0 t
a. TOTAL DEPTH:
b. DOES WELL REPLACE EXISTING WELL?
JYES ❑ NO
/�1{F]
c. WATER LEVEL Below Top of Casing- Cd Lid FT:
(Use "+" if Above Top of Casing)'
d. TOP OF CASING IS 2 FT. Above Land Surface*
`Top of casing terminated at1or below land surface may require
a variance in acc
ff��ord
d/-a
-�nce with 15A NCAC 2C .0118.
e. YIELD (gem): 50 METHOD OF TEST Blow
f. DISINFECTION: Type H T H Amount 16oz
g. WATER ZONES (depth):
From To I From To
From To From To
From /92To From To
6. CASING: Thickness/
Depth Dipmeter We%iqqI� terlal
From O To / f U Ft. Din
r/
From To Ft.
From To Ft.
7. GROUT: Depth Material
cement & benonite
From U To 2 Ft.
Method
pumped
From To Ft.
From To Ft.
8. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in.
From To Ft. in. in.
From To Ft. in. in.
9. SANDIGRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
From To Ft.
10. DRILLING LOG
From To Formation Description
0 / Clay & sand
I
11. REMARKS:
Granite
FtwevEguamf
w CIF*15'
Joi
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE W RH
ISA NCAC 2C, WELL CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS
RECORD HAS BEEN PROVIDED TO THE WELL OWNER„
02
SIGNA]TTUURE OFCrIZAJ ERTIFIED WELL CONTRACTOR E
\AGrY ODr.711s
PRINTED NAME OF PERSON CONSTRUCTING THE WELL
Submit the original to the Division of Water Quality within 30 days. Attn: Information Mgt.,
1617 Mail Service Center— Raleigh, NC 27699-1617 Phone No. [phone] ext 568.
Form G W-1 a
Rev. 7/05

RESIDENTIAL WELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources- Division of Water Quality
WELL CONTRACTOR CERTIFICATION #
1. WELL CONTRACTOR:
Johnny Shane Downs
Well Contractor (Individual) Name
Hedden Brothers Well Drilling, Inc
Well Contractor Company Name
STREET ADDRESS 73 Holly Hills Vista RD
Franklin, NC
28734
City or Town State
Zip Code
( 828 ). 369-9591
Area code- Phone number
2. WELL INFORMATION:
SITE WELL ID #(if applicable) 75(97-03 -691ity
STATE WELL PERMIT#(if applicable)
DWQ or OTHER PERMIT #(if applicable)
WELL USE (Check A plicable Box): Residential Water Supply Ox
DATE DRILLED_
TIME COMPLETED AM Cl PM
3. WELL LOCATION:
73
COUNTY 'L_ 5Dt-
(Street Name, Numbers, Community, Subdidsion, Lo No., Parcel, Zip Code)
TOPOGRAPHIC / LAND SETTING:
❑Slope [Valley ❑Fiat ❑Ridge ❑Other
(check appropriate box)
LATITUDE 39 15
L OCIN
LONGITUDE0 j gaat)
Latitude/longitude source: )& PS ❑Topographic map
(location of well must be shown on a USGS topo map and
attached to this form if not using GPS)
4. WELL OWNER
May be in degrees,
minutes, seconds or
in a decimal format
OWNER'S NAME
STREET Ae DRESS
own tate
/031-9v��
Area code • Phone number
5. WELL DETAILS:
a. TOTAL DEPTH:
b. DOES WELL REPLACE EXISTING WELL?
Zip Code
c. WATER LEVEL Below Top of Casing: FT.
(Use "+" if Above Top of Casing)
d. TOP OF CASING IS 2 FT. Above Land Surface`
*Top of casing terminated at/or below land surface may require
a variance in accordance with 15A NCAC 2C .0118.
e. YIELD (gpm):
METHOD OF TEST Blow
6. CASING:
3466
333647
f. DISINFECTION: Type H T H Amount 16oz
g. WATER ONES (dep
From •/y To 14 From To
From Ll� To 0From To
From L' To /✓C 0 From To
Thickness/
From DToth 75 Ft Diameter ��ght terial
From To i Ft.� j�'
From To Ft.
7. GROUT: Depth Material
From D To 20 Ft. cement & benonite
From To Ft.
From To Ft.
Method
pumped
8. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in.
From To Ft. in. in.
From
To _ Ft. in. in.
9. SAND/GRAVEL PACK:
Depth
From
From
From
Size Material
ry
To Ft. -
To Ft.
To Ft.
10. DRILLING LOG
From T
0
11. REMARKS:
Formation Description
Clay & sand
Granite
a
RFCFIVFIl
ll\/. P7F IRIATFR nuAl IT/
,JA.N- 6 5 Z007
I D0 HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH
1 SA NCAC 2C, WELL CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS
RECORD HAS BEEN PROVIDED TO THE WELL OWNER. -
SIGNATURE OF CERTIFIED WELL CONTRACTOR
,5iwne `YJ rah-1
PRINTED NAME OF PERSON CONSTRUCTING THE WELL
Submit the original to the Division of Water Quality within 30 days. Attn: Information Mgt.,
1617 Mail Service Center- Raleigh, NC 27699-1617 Phone No. [phone] ext 568.
Form G W-1 a
Rev. 7/05

RESIDENTIAL WELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources- Division of Water Quality
WELL CONTRACTOR CERTIFICATION # 3466
1. WELL CONTRACTOR:
Johnny Shane Downs
Well Contractor (Individual) Name
Hedden Brothers Well Drilling, Inc
Well Contractor Company Name
STREET ADDRESS 73 Holly Hills Vista RD
Franklin,
NC
State
28734
City or Town Zip Code
( 828 )- 369-9591
Area code- Phone number
2. WELL INFORMATION: /� /�
SITE WELL ID #(ir applicable) rift/DIN 63,511,293V
STATE WELL PERMIT#(i( applicable)
DWQ or OTHER PERMIT #(if applicable)
WELL USE (Check Applicable Box): Residential Water Supply px
DATE DRILLED J I ' Z 1 ' d'
TIME COMPLETED 5 , a AM ID PM l_
3. WELL LOCATION:
CIT
(Street Name,umbers, Community, SubdiHsion, Lot No., Parcel, Zip Code)
TOPOGRAPHIC / LAND SETTING:
o Slope EDValley ❑Flat ID Ridge pother
(check appropriate box)
LATITUDE 3
LONGITUDE
Latitude/longitude source: ® GPS ❑Topographic map
(location of well must be shown on a USGS topo map and
attached to this form if not using GPS)
4. WELL OWNER I//y/��.}{''--`jy` p�A
OWNER'S NAME itt�n +/�iLd�-ppe�ly,y///LL'� !! ,,,�
EET ADDRESS I3Ji 4 L"M. PJIVF WCJ
May be in degrees,
minutes, seconds or
in a decimal format
fit n rro, Fl•-• 3 zz1
City or Town State Zip Code
(gg)- 7 - Si bb
Area code - Phone n�umbner1 p,, /,
WELL DETAILS:
5. a. TOTAL DEPTH: J/ IUI.L&O Fein 4 o/l so' n
b. DOES WELL REPLACE EXISTING WELL? PESO❑ NO V_
•
c. WATER LEVEL Below Top of Casing: •• FT.
(Use "+" if Above Top of Casing)
d. TOP OF CASING IS 2 FT. Above Land Surface"
*Top of casing terminated at/or below land surface may require
a variance in accor ance with 15A NCAC 2C .0118.
e. YIELD (gpm): METHOD OF TEST Blow
33664C
t. DISINFECTION: Type H T H
g. WATER ZONES (depth):
Amount 16oz
From To From To
From To From To
From To From To
6. CASING: Thickness/
Depth Diameter
From To Ft.
From To Ft.
From To Ft.
Weight Material
7. GROUT: Depth Material
20 cement & benonite
From 0 To Ft.
From To Ft.
From To Ft.
Method
pumped
8. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in.
From To Ft. in. in.
From To Ft. in. in.
9. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
To Ft.
To Ft.
From
From
10. DRILLING LOG
From To Formation Description
0 Clay & sand
Granite
RICCI IED
ow, or WATER QUA L' i T
„ AN yr F7n11 —
Olt0
I1r j ^fl aJIXX.II �0yJ,..4SiicLzY 100' 44770
9
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... ,
u ,0
SIGNATURE 0 CERTIFIED WELL CONTRACTOR
Sf+PnNtljtw
PRINTED NAME OF PERSON CONSTRUCTING THE WELL
Submit the original to the Division of Water Quality within 30 days. Attn: Information Mgt.,
1617 Mail Service Center— Raleigh, NC 27699-1617 Phone No. [phone] ext 568.
Form GW-la
Rev, 7/05

STREET ADDRESS
Franklin,
RESIDENTIAL WELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources -Division of Water Quality
WELL CONTRACTOR CERTIFICATION # 3466
1. WELL CONTRACTOR:
Johnny Shane Downs
Well Contractor (Individual) Name
Hedden Brothers Well Drilling, Inc
Well Contractor Company Name
73 Holly Hills Vista RD
NC 28734
City or Town State Zip Code
( 828 )- 369-9591
Area code- Phone number
2. WELL INFORMATION: /� /� /7
SITE WELL ID #(i( applicable) 7 ((ICY./� { - 9CP3 9
STATE WELL PERMIT#(it applicable) DWQ or OTHER PERMIT #(If applicable)
WELL USE (Check Applicable Box):I-Residential Water Supply O
DATE DRILLED I v' a U (
TIME COMPLETED 3 / 30 AM ❑ PMX
3. WELL LO ATI N:
CIJ�: Q
(Street Name, mbers, Community, Subdivision, Lot No., Parcel, Zip Code)
TOPOGRAPHIC / LAND SETTING:
❑Slope ❑Valley ❑Flat ❑Ridge 0 Other
(check appropriate box)
LATITUDE iZ33 p0I LI 0
LONGITUDE13I LURID
Latitude/longitude source: GPS ❑Topographic map
(location of well must be s o on a USGS topo map and
attached to this form if not using GPS)
4. WELL OWNER (�/rp, ao1.
OWNER'S NAME '`-"" tit
May be in degrees,
minutes, seconds or
in a decimal format
rl S ET ADDRESS I3b Y ' MCtazsr
r ro, FL 34z.z1
C'ty or Town
(1)- 7d9-5/ On
Area code - Phone number
State Zip Code
5. WELL DETAILS: I
a. TOTAL DEPTH: ) ODD'
b. DOES WELL REPLACE EXISTING WELL? YFrSXI NO 0
c. WATER LEVEL Below Top of Casing: W FT. -
(Use "+" if Above Top of Casing)
d. TOP OF CASING IS 2 FT. Above Land Surface'
*Top of casing terminated at/or below land surface may require
a variance in acco ance with 15A NCAC 2C .0118.
e. YIELD (gpm): _ __ METHOD OF TEST Blow
s1 t ?e
U i;
4S
f. DISINFECTION: Type H T H Amount 16oz
g. WATER ZONES (depth):
From To From
From To From
From To From
6. CASING:
To
To
To
Thickness/
Depth D' meter Weight Ma From
From Q To Ft. to 0 red
From To Ft. f n rr r l 8h
From To Ft.
7. GROUT: Depth Material
From 0 To 20 Ft. cement benonite
From To Ft.
From To Ft.
Method
pumped
8. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in.
From To Ft. in. in.
From To Ft. in. in.
9. SAND/GRAVEL PACK:
Depth Size Material t�
From To Ft. z0
From To Ft. tc
From To Ft.
10. DRILLING LOG
From o Formation Description
0 0 Clay & sand
Uri / 6 Granite
ry
c,w
car
REGEKATOFIAMITQUALr
NED
IAN (I 5 2nm
].i-oREMnMAARK9to /SO/ z/O6; t837'
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 CERTIFIED WELL CONTRACTOR I DA E
PRINTED NAME OF PERSON CONSTRUCTING THE WELL
Submit the original to the Division of Water Quality within 30 days. Attn: Information Mgt.,
1617 Mail Service Center— Raleigh, NC 27699-1617 Phone No. [phone] ext 568.
Form GW-la
Rev. 7/05

RESIDENTIAL WELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources- Division of Water Quality
WELL CONTRACTOR CERTIFICATION # 3466
1. WELL CONTRACTOR:
Johnny Shane Downs
Well Contractor (Individual) Name
Hedden Brothers Well Drilling, Inc
Well Contractor Company Name
STREET ADDRESS 73 Holly Hills Vista RD
Franklin, NC 28734
City or Town State Zip Code
( 828 )- 369-9591
Area code- Phone number
2. WELL INFORMATION: r7 / g.� 2 /�����+
SITE WELL ID kit applicable) Ii$30 13' 90.45
STATE WELL PERMIT#(if applicable)
DWQ or OTHER PERMIT #(if applicable)
WELL USE (Check Applicable Box�:
DATE DRILLED
TIME COMPLETED
3. WELL LATIO :
CITY.
Residential Water Supply px
AM ❑ PMK
COUNTY
umbers, Community, Subdivision, Lot No., Parcel, Zip Code)
TOPOGRAPHIC / LAND SETTING:
❑Slope cValley ❑Flat ❑Ridge ❑Other
(check appropriatebox)
LATITUDE /C/JA./
LONGITUDE 15' 144 tJ
Latitude/longitude source: GPS ❑Topographic map
(location of well must be s own on a USGS tops map and
attached to this form if not using GPS)
May be in degrees,
minutes, seconds or
in a decimal format
4. WELL OWNER
OWNER'S NAME i
STREET ADDRESS
4
Q,op a828��
City or Town 4tate Zip Code
Area code - Phone number
5. WELL DETAILS:
a. TOTAL DEPTH: f'
b. DOES WELL REPLACE EXISTING WELL? YESS�❑ NO fX
c WATER LEVEL Below Top of Casing: ADD FT.. _
-- - (Use "4." if Above Top of Casing)
d. TOP OF CASING IS 2 FT. Above Land Surface*
*Top of casing terminated at/or below land surface may require
a variance in accordance with 15A NCAC 2C .0118.
e. YIELD (gpm): J METHOD OF TEST Blow
.300
336644
f. DISINFECTION: Type H T H Amount 16oz
g. WATER ZONES (depth):
From ,.-,2 ✓tJ To of From To
From To From To
From To From To
6. CASINGy:� Thickness/
From t I DToth 5 Ft. C�IarReter W�ighj, ter I
From To i" Ft. CO /�f�j
From To Ft.
7. GROUT: Depth Material Method
From 0 To 20 Ft. cement 8 benonite pumped
From To Ft.
From To Ft.
8. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in.
From To Ft. in. in.
From To Ft. in. in.
9. SAND/GRAVEL PACK:
Depth
From To
Size
Ft.
From To Ft. From To Ft.
my
Material
10. DRILLING LOG
FromFormation Description
Clay & sand
Granite
11. REMARKS:
ECEIVt
s'N r)F vugl QUALITY
JAN 0 5 200?
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.
Ali, Uttar- 1 ?. �o7
SIGNATURE OF CERTIFIED WELL CONTRACTOR D-A E
5 .n,e t;.7its
PRINTED NAME OF PERSON CONSTRUCTING THE WELL
Submit the original to the Division of Water Quality within 30 days. Attn: Information Mgt.,
1617 Mail Service Center— Raleigh, NC 27699.1617 Phone No. [phone] ext 566.
Form G W-1 a
Rev. 7/05

RESIDENTIAL. WELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources- Division of Water Quality
WELL CONTRACTOR CERTIFICATION # 3466
1. WELL CONTRACTOR:
Johnny Shane Downs
Well Contractor (Individual) Name
Hedden Brothers Well Drilling, Inc
Well Contractor Company Name
STREET ADDRESS 73 Holly Hills Vista RD
Franklin, NC
28734
City or Town State Zip Code
( 828 ). 369-9591
Area code- Phone number
2. WELL INFORMATION: rr�� / ,�l /,,
SITE WELL ID #(i( applicable) 7301 q -& T -/-y 6.a 9
STATE WELL PERMIT#(if applicable)
DWQ or OTHER PERMIT #(if applicable)
WELL USE (Check Applicable Box): Residential Water Supply O
DATE DRILLED /,2 -/na a
TIME COMPLETED c , OG AM El PMK
3. WELL LO • TIO
CIT
COUNTY
(Street Name, Nu 1 re, Immunity, SubdiNsion, Lot No , Parcel, Zip Code)
TOPOGRAPHIC / LAND SETTING:
❑Slope ❑Valley ❑Flat ❑Ridge ❑Other
(check appropriaterbox)r� ,•,1,
LATITUDE 3� 1.8 5 i1v
LONGITUDE IBA/ 06L)
Latitude/longitude source: ©GPS ❑Topographic map
(location of well must be shown on a USGS topo map and
attached to this form if not using GPS)
4. WELL OWNER
OWNER'S NAME
STR ET ADDRESS
City or own r State
May be in degrees,
minutes, seconds or
in a decimal format
Area code • Phone number
5. WELL DETAILS:
a. TOTAL DEPTH:
700'
179
Zip Code
b. DOES WELL REPLACE EXISTING WELL? YES ❑ NOV
c. WATER LEVEL Below Top of Casing: FT.
(Use "+"-if Above Top of Casing)
d. TOP OF CASING IS 2 FT. Above Land Surface*
*Top of casing terminated at/or below land surface may require
a variance in acc dance with 15A NCAC 2C .0118.
e. YIELD (gpm): METHOD OF TEST Blow
From
6. CASING:
f. DISINFECTION: Type H T H Amount 16oz
g. WATER ZONES (depth):
From To '1 From To
From 76 r To Ill' r From To
To From To
Thickness/
Depth , Diameter Weight
From To ) Ft. rt
From To 1(7. Ft. (e" lI»>i
From To Ft.
7. GROUT: Depth
Material
From D To 20 Ft. cement & benonite
From To Ft.
From To Ft.
Material
Method
pumped
8. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in.
From To Ft. in. In.
From To Ft. in. in.
9. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
From To Ft.
10. DRILLING LOG
From To Formation Description
0 /�j Clay & sand
115' 92
11. REMARKS:
Granite
RFC.FI Pr
OR/. OF WLTpP QUALITY
JAN 0 6 2007
I D0 HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH
ISA NCAC 20, WELL CONSTRUCTION STANDARDS. AND THAT A COPY OF THIS
RECORD HAS BEEN PROVIDED TOTE WELL OWNER.
nua
SIGNATUR F CERTIFIED WELL CONTRACTOR
5 lw.ne 1 ]b i..211
PRINTED NAME OF PERSON CONSTRUCTING THE WELL
Submit the original to the Division of Water Quality within 30 days. Attn: Information Mgt.,
1617 Mail Service Center- Raleigh, NC 27699-1617 Phone No. [phone] ext 568.
Form GW-1a
Rev. 7/05

RESIDENTIAL WELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources- Division of Water Quality
WELL CONTRACTOR CERTIFICATION
1. WELL CONTRACTOR:
James 8. Brown
Well Contractor (Individual) Name
Hedden Brothers Well Drilling, Inc,
Well Contractor Company Name
STREET ADDRESS 73 Holly Hills Vista RD
Franklin, NC
28734
City or Town State
( 828 ). 369-9591
Area code- Phone number
Zip Code
2. WELL INFORMATION:
SITE WELL ID #(if applicable) 1100 /-7g -8c Ia
STATE WELL PERMIT#(if applicable)
DWQ or OTHER PERMIT #(if applicable)
WELL USE (Check A%ecable Box): Residential Water Supply 3
DATE DRILLED
TIME COMPLETED +-F . LJr I AM O PM t
3. WELL LO TION: �7T��.,.,
CITY: •_� , / COUNTY -&" JJ fv
(5 reef Nam i mbCommunity, Subdivision,Lot No., Parcel, Zip Code)
TOPOGRAPHIC / LAND SETTING:
❑Slope (Valley ❑Flat ❑Ridge ❑Other
(check appropriate box)
LATITUDE _151
LONGITUDE
May be in degrees,
minutes, seconds or
in a decimal format
Latitude/longitude source: )(CPS (Topographic map
(location of well must be s own on a USGS topo map and
attached to this form if not using GPS)
4. WELL OWNER
OWNER'S NAME Ili
ST ET ADDRESS
tap
ilk s429/3
City o own ate Zip Code
Area code- Phone number
5. WELL DETAILS:
a. TOTAL DEPTH:
b. DOES WELL REPLACE EXISTING WELL? -YES Q NOX
c. WATER LEVEL Below Top of Casing: la) FT.
(Use'«^ if Above Top of Casing)
d. TOP OF CASING IS 2 FT. Above Land Surface`
'Top of casing terminated at/or below land surface may require
a variance in accordance with 15A NCAC 2C .0118.
e. YIELD (gpm): 4,510 METHOD OF TEST Blow
2045
t
558
f. DISINFECTION: Type H T H
g. WATER ZONES (depth):
From
From
From
8. CASING:
Depth, DI mp)er
From `1 To Ft
From To
From To Ft.
Amount 16oz
From To
From To
From To
Thickness/
Weight Materi
Ime
7. GROUT: Depth Material
From 0 To 20 Ff. cement a benonite
From To Ft.
From To Ft.
Method
pumped
8. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. In.
From To Ft. in. in.
From To Ft. in. In.
9. SAND/GRAVEL PACK:
Depth
Size Material
From To Ft.
From To Ft.
From To Ft.
10, DRILLING LOG
From To ,
Al w
11. REMARKS:
Formation Description
Clay & sand
granite
r.>
nc-Crt‘ fii6E�1:�i
' ,V's).(1��' (}.
/11
I D0 HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH
- 15A NCAC 2C, WELL CONSTRUCT/LA STANDARDS, AND THAT A COPY OF THIS
RECOOa11AS BEEN PROVIDED
10 THE WELL OWNER.
ATURE OF CERTIFIED WELL CONTRACTO DATE
,wmCS -12. VictA)N
PRINTED NAME OF PERSON CONSTRUCTING THE WELL
Submit the original to the Division of Water Quality within 30 days: Attn: Information Mgt.,
1617 Mail Service Center— Raleigh, NC 27699.1617 Phone No. [phone] ext 568.
Form GW-1a

RESIDENTIAL WELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources- Division of Water Quality
WELL CONTRACTOR CERTIFICATION # 2045
1. WELL CONTRACTOR:
James B. Brown
Well Contractor (Individual) Name
Hedden Brothers Well Drilling, Inc,
Well Contractor Company Name
STREET ADDRESS 73 Holly Hills Vista RD
Franklin, NC
28734
City or Town State
( 828 ). 369-9591
Area code- Phone number
2. WELL INFORMATION:
SITE WELL ID #(if applicable)
STATE WELL PERMIT#(if applicable)
DWQ or OTHER PERMIT #(If applicable)
Zip Code
WELL USE (Check Applicable Box): esidentiai Water Supply O
DATE DRILLED
TIME COMPLETED rr AM PM4I
3. WELL LOCATION;•
CITY: vj Taw T '4— CO,iNTY
(�-_
(Street Name, Numbers, Community, SubdhAsion, Lot No., Parcel, Zip Code)
TOPOGRAPHIC / LAND SETTING:
❑Slope [Valley ❑Flat CI Ridge ❑Other
(check appropriate box)
LATITUDE 3
LONGITUDE
Latitude/longitude source: ❑GPS ❑Topographic map
(location of well must be shown on a USGS topo map and
attached to this form if not using GPS) ^
4. WELL OWNER gh „/_i/
OWNER'S NAME //���� Nl I'1/�ItYll
TF>.EET,ADDRESS D C[.(pJ cligi
ketv
gt-
City or Town / State Zip Code
)• 4 :i1r/l
Area code - Phone number
May be in degrees,
minutes, seconds or
in a decimal format
5. WELL DETAILS: I / _ yl I
a. TOTAL DEPTH: U) �f
b. DOES WELL REPLACE EXISTING WELL? YES [ NO Icil
c. WATER LEVEL Below Top of CpWog: - FT.
(Use "+" if Above Top of Casing)
d. TOP OF CASING IS 2 FT. Above Land Surface'
'Top of casing terminated at/or below land surface may require
a variance In accordance with 15A NCAC 2C .0118.
e. YIELD (gpm): METHOD OF TEST BIOW
f. DISINFECTION: Type H T H Amount 16oz
g. WATE ONES (depth):
From To
� From To
From To From To
To From To
From
6. CASING:
Depth
From To Ft
From To Ft.
From To Ft.
7. GROUT: Depth
D6meter
n
Thickness/
jig 0
Material Method
From 0 To 20 Ft, cement & benonite pumped
From To Ft.
From To Ft.
8. SCREEN: Depth Diameter Slot Size Material
From To Ft. In. In.
From To Ft. In. in.
From To Ft. In. In.
8. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
From To Ft.
10, DRILLING LOG
From
0 � Clay & sand
11. REMARKS:
Formation Description
granite
RFCENED
rlty OF waif" OUALTe
I DO HEREBY CERTIFY THAT THIS WELL WAS r`ONSTRUCTED IN ACCORDANCE WITH
15A NCAC 2C, WELL CONSTRUCTION. STANDArLS, AND THAT ACOPY OF THIS -
REC :{?HAS BEEN PROVIDED TO THE WELL OWNERAg
GNATURE a CERTIFIED WELL CONTRA
TOR
DATE
,$mCS b. 'UWO
PRINTED NAME OF PERSON CONSTRUCTING THE WELL
Submit the original to the Division of Water Quality within 30 days. Attn: information Mgt, - Form GWla
1617 Mail Service Center— Raleigh, NC 27699.1617 Phone No. [phone] ext 568. Rev. 7/05
: 2l 2 '7
es
ce
CL

• RESIDENTIAL WELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources- Division of Water Quality
WELL CONTRACTOR CERTIFICATION #
2045
1. WELL CONTRACTOR:
James B. Brown
Well Contractor (Individual) Name
Redden Brothers Well Drilling, Inc,
Well Contractor Company Name
STREET ADDRESS 73 Holly Hills Vista RD
Franklin, NC 28734
City or Town State Zip Code
( 828 )_ 369-9591
Area code- Phone number
2. WELL INFORMATION: / `'
SITE WELL ID SO, applicable) l y (D b 1 -05' .I zi5
STATE WELL PERMIT#(it applicable)
DWQ or OTHER PERMIT #(id applicable)
WELL USE (Check Applicable �Box):Residential Water Supply 3
DATE DRILLED /Of ' I —/ ep(J
l6�
iOD AM ❑ PML
3.
Q COUNTY
ROI n t .
(Street ▪ Nar• p)Num•ars, Community, SSubdivision, Lot No., Parcel, Zip Code)
TOPOGRAPHIC / LAND SETTING:
❑Slope DValley ❑Flat ❑Ridge ❑Other
(check'' appropriate box) ^ /
LATITUDE q_S2I / V
LONGITUDE 26 69
May be in degrees,
minutes, seconds or
in a decimal format
Latitude/longitude source: XGPS ❑Topographic map
(location of well must be sifo.wn on a USGS topo map and
attached to this form if not using GPS)
4. WELL OWNER
OWNER'S NAME
STREET ADDRESS p O &t / /✓O'
Cam ,
City or Town ' 4tatye
( R ). silo VVDDU
Area code - Phone number
5. WELL DETAILS:
a. TOTAL DEPTH:
b. DOES WELL REPLACE EXISTING WELL? YES 0 NOX
c. WA: ;UR LEVEL Below Top of Casing: /
• (Use'.' if Above Top of Casing)
d. TOP OF CASING IS 2 FT. Above Land Surface`
'Top of casing terminated at/or below land surface may require
a variance in accordance with 15A NCAC 2C .0116.
e. YIELD (gpm): 50 iL METHOD OF TEST Blow
god
gyy77
Zip Code
/6.0 FT.
f. DISINFECTION: Type H T
g. WATER ZONES (depth):
Fromm 0 To 515 From To
From To From To
From To From To
6. CASING: dig g Thickness/
From DepthTo00 Ft
From To Ft.
From To Ft.
H Amount 16oz
Diameter Weiyflt ,r 5nal
7. GROUT: Depth Material
From 0 To 20 Ft cement & benonite
From To Ft.
From To Ft.
Method
pumped
6. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. In.
From To Ft. In In,
From To FL In. In.
9. SAND/GRAVEL PACK:
Depth
From To Ft.
From To Ft.
Size Material
From To Ft.
10. DRILLING LOG
From T Formation Description
0 Clay &sand
granite
11. REMARKS:
.rlWATER (JUALI flr
I,_, �, a ?ODE,
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH
15A NCAC £L. BELL CONSTRUCTION STANDARDS, AND THAT A CUES ;HIS
RECOR•,. SEEN PROVIDED Tj17HE WELL OWNER.
is—/9—o4
SIATURE eF CERTIFIED WELL CONTRACTOR DATE
,Smcm 3. Bizazo
PRINTED NAME OF PERSON CONSTRUCTING THE WELL
Submit the original to the Division of Water Quality within 30 days. Attn: Information Mgt.,
1617 Mall Service Center— Raleigh, NC 27699-1617 Phone No. [phone] ext 566.
Form GW-la
OR v. 7/05
CV

RESIDENTIAL WELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources- Division of Water Quality
WELL CONTRACTOR CERTIFICATION # 2045
3 3 I 306
1. WELL CONTRACTOR:
James B. Brown
Well Contractor (Individual) Name
Hedden Brothers Well Drilling, Inc.
Well Contractor Company Name
BEET ADDRESS 73 Holly Hills Vista RD
Franklin, NC 28734
City or Town State Zip Code
(828 )- 369-9591
.area code- Phone number
2.'N ELL INFORMATION:
SITE WELL ID #0( applicable)
STATE WELL PERMIT#lit applicable)
DWQ or OTHER PERMIT #(if applicable)
WELL USE (Check nApplicable
( Box): ResidentialsiN.dWater Supply
DATE DRILLED I b) �O6so
r!ME COMPLETED 3 0D AM ❑ PMK
. . FLL LOCATION.:, /� ,,
CITY: \i Lttt'.t1AL/ QJ.4 — COUNTY
AR
(Street Name, Numbers, Community. SubdiMsion, Lot No., Parcel, Zip Code)
'OPOGRAPHIC / LAND SETTING:
_Slope ❑Valley DFlat ERidge ❑Other
(check appropriate box) -/
LATITUDE 35 19 _9 /#
NGITUDEa 05 335 cJ
May be in degrees,
minutes, seconds or
in a (decimal format
L.3'.itude/longitude source: %@PS ❑Topographic map
(location of well must be shown or; d US SS tcpo map and
attached to this form A no: using Gi 3)
4. WELL OWNER
WNER'S NAME
9Ti2EET ADDRESS
/' �C Qq��
City or Town V State Zip Code
'2z2)- al -5453
Area code - Phone number
r WELL DETAILS:.
TOTAL DEPTH:
DOES WELL REPLACE EXISTING WELL'' YES ❑ NOX
c. WATER LEVEL Below Top of Casing: I DO FT.
(Use "+" if Above Top of Casing)
d. TOP OF CASING IS 2 FT. Above Land Surface*
'Top of casing terminated at/or below land surface may require
a variance in /accordance with 15A NCAC 2C .0118.
e. YIELD(gpm): toot METHOD OF TEST Blow
f. DISINFECTION: Type H T H Amount 1 60Z
g. WATER ZONES (depth):
From a IS To From To
From m3 • To From To
From 74{F1r To 760' From To
6. CASING:^ � Thickness/
From l J Depth
Mort Ft. Dia)ne�er We11g11L M_ to ria1
From To Ft. !� YfiS .41131)
%eD
From To Ft.
7. GROUT: Depth Material Method
From 0 To 20 FGement & benonilfLumped
From To Ft.
From To Ft.
8. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in.
From To Ft. in. in.
From To Ft. in. in.
9. SAND/GRAVEL PACK: 1
Depth Size Material
Frpm To Ft.
From To Ft.
From To Ft.
10. DRILLING LOG
From To Formation Description
rl ay & sand
grand to
11. REMARKS:
n� i
H Lt:ul
r-
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-L' BEEN PROVIDED TO THE WELL OWNER.
r Oab
A URE OF CE IED WELL CONTRACTOR DATE
James B. Brown
PRINTED NAME OF PERSON CONSTRUCTING THE WELL
' :irnit the original to the Division of Water Quality within 30 days. Attn: Information Mgt.,
: 17 Mail Service Center - Raleigh, NC 27699-1617 Phone No. [phone] ext 568.
Form GW-la
Rev. 7/05

irtn
City or la7-)r State
( )- 4m- ioQ
Area code • Phone number
RESIDENTIAL WELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources- Division of Water Quality
WELL CONTRACTOR CERTIFICATION # 2095
99 , 19n
J 01 JU;
1. WELL CONTRACTOR:
James B. Brown
Well Contractor (Individual) Name
Hedden Brothers Well Drilling, Inc.
Well Contractor Company Name
STREET ADDRESS 73 Holly Hills Vista RD
Franklin, NC 28734
City or Town State Zip Code
828 )- 369-9591
Area code- Phone number
2. WELL INFORMATION:
SITE WELL ID #(if applicable) 1(,55 Si • 3153 •
STATE WELL PERMIT#(if applicable)
DWQ or OTHER PERMIT #Of applicable)
WELL USE(Che4Applicable
�Bpox):�Residential Water Supply ❑
'ATE COMPLETE
v'-'�
I�IME COMPLETE 3 r , O0 AM ❑ PM [k,
3. WELL LOCATION:
CITY:
COUNT
(S Feet Name, Numbers, Co mu ty, Subdivision, Lo No„ Parcel, Zip Code)
TOPOGRAPHIC / LAND SETTING:
❑Slope oValley ❑Flat 0Ridge pother
(check appropriate box)
LATITUDE 3
_ONGITUDE
';'titude/ ongitude source: ❑GPS pTopographic map
(location of well must be shown on a USGS (cpo map and
attached to this form if not using GPS)
WELL OWNER I\
OWNER'S NAME _
S42EET ADDRESSO ?b 2Dk-(o51
�c enlg a
May be in degrees,
minutes, seconds or
in a decimal format
Zip Code
ELL DETAILS: a. TOTAL DEPTH: [Abb.
b. DOES WELL REPLACE EXISTING WELL? YES
0 NOSK
c. WATER LEVEL Below Top of Casing: 3 lJ FT.
(Use'+° if Above Top of Casing)
1. TOP OF CASING IS 2 FT. Above Land Surface'
"Top of casing terminated at/or below land surface may require
a variance in accordance with 15A NCAC 2C .0118.
e. YIELD (gpm): CAV METHOD OF TEST Blow
f. DISINFECTION: Type H T H Amount 160z
g. WATERf'ZONES (depth).
Y From I o To L{/!t From To
From 4'I_tfo (0 From To
From To
From To
6. CASING: Thickness/
Dept Diameter Weight Material
From 0 To . , Ft. (ev
From abet)To 1• Ft.__Ur_ riBl&
From To Ft.
7. GROUT: Depth Material Method
From 0 To 20 Fcement & benonite p
From To Ft.
From To Ft.
8. SCREEN: Depth Diameter Slat Size Material
From To Ft. in. in.
From To Ft. in. in.
From To Ft. in. in.
9. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
From To Ft.
10. DRILLING LOG
From To D�
'1 r
*1r UOtr
11. REMARKS:
Formation Description
r]ay & sand
granite,
O
c
c
r0
r n cm
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 AS BEEN PROVIDED TO THE WELL OWNER.
�jnTE
ATURE OF TIFIED WELL CONTRACTOR DATE
James B. Brown
PRINTED NAME OF PERSON CONSTRUCTING THE WELL
Submit the original to the Division of Water Quality within 30 days. Attn: Information Mgt,
"17 Mail Service Center— Raleigh, NC 27699-1617 Phone No. [phone] ext 568.
Form GW-1a
Rev. 7/05

RESIDENTIAL WELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources- Division of Water Quality
WELL CONTRACTOR CERTIFICATION # 2045
33304
1. WELL CONTRACTOR:
James B. Brown
Well Contractor (Individual) Name
Hedden Brothers Well Drilling, Inc.
Well Contractor Company Name
STREET ADDRESS 73 Holly Hills Vista RD
Franklin, NC 28734
City or Town State Zip Code
828 )- 369-9591
.Area code- Phone number
2. WELL INFORMATION:
SITE WELL ID #(if applicable) 714,2 - 902 - 07M 8
STATE WELL PERMIT#(if applicable)
DWQ or OTHER PERMIT #(if applicable)
WELL USE (Che k Applicable Box)
Residential Water Supply ❑
DATE DRILLED d O1
TIME COMPLETE
le°, OO AM ❑ PM
3. WELL CATION:
CITY. COUNT
Lino eme,
(Street Name, Numbers, Community, Subdivision, Lot No., Parcel, Zip Code)
`OPOGRAPHIC / LAND SETTING:
]Slope ID Valley ❑Flat ❑Ridge ❑Other
(check appropriate box)b�11��f1_1
LATITUDE _ysA3 A3.,/
LONGITUDE .13 93
Latitude/longitude source: IGPS ❑Topographic map
(location of well must be s own on a USGS topo map and
attached to this form if not using GPS)
OWNER'S NAME /ONbD
tAELL OWNER
aRE ADDRESSQ
C r la -an N11Cpgnf�tbOState
�
( AZ )- 508-J
May be in degrees,
minutes, seconds or
in a decimal format
Area code - Phone number
Zip Code
WELL DETAILS:
TOTAL DEPTH: 340
b. DOES WELL REPLACE EXISTING WELL? YES ID NO5i
WATER LEVEL Below Top of Casing: ado FT.
(Use "+° if Above Top of Casing)
d. TOP OF CASING IS 2 FT. Above Land Surfacer
"Top of casing terminated at/or below land surface may require
a variance in accordance with 15A NCAC 2C .0118.
e. YIELD (gpm): W METHOD OF TEST Blow
f. DISINFECTION: Type H T H Amount 1 60Z
g. WATER ZONES (depth)::
From j.O{pg To IS From To.
From ASS ToA9O From To
From To From To
6. CASING: Thickness/
Depthe� nn Di meter Weipl}� Ma ri
From Q To (OV Ft. " .1 MO
From To Ft.
From To Ft.
7. GROUT: Depth
Material Method
From 0 To 20 FGement & benoaLtieumped
From To Ft.
From To Ft.
8. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in.
From To Ft. in. in.
From To Ft. in. in.
9. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
From To Ft.
10. DRILLING LOG
From To
Formation Description
clay & sand
granite
0
w-r q Arty,^
. REMARKS:
G-]
n3
CO T. _
)
c
I CO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH
15A NCAC 2C, WELL CONSTRUCTION STANDARDS. AND THAT A COPY OF THIS
RECORgx).S BEEN PROVIDED TO THE WELL OWNER.
ED WELL CONTRACTOR DATE
James B. Brown
PRINTED NAME OF PERSON CONSTRUCTING THE WELL
Submit the original to the Division of Water Quality within 30 days. Attn: Information Mgt,
1617 Mail Service Center— Raleigh, NC 27699-1617 Phone No. [phone] ext 568.
Form GW-la
Rev. 7/05

RESIDENTIAL WELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources -Division of Water Quality
WELL CONTRACTOR CERTIFICATION # 2095
R O a
1. WELL CONTRACTOR:
James B. Brown
Well Contractor (Individual) Name
Hedden Brothers Well Drilling, Inc.
Well Contractor Company Name
CTREET ADDRESS 73 Holly Hills Vista RD
Franklin, NC 28734
City or Town State Zip Code
( 828 )- 369-9591
Area code- Phone number
2. WELL INFORMATION:
SITE WELL ID #(if applicable)
STATE WELL PERMIT#(if applicable)
:-WQ or OTHER PERMIT #(if applicable)
WELL USE (Check Applicable Box): Residential Water Supply
]ATE DRILLED q 1�
TIME COMPLETED
C. WELL LOCATION:
CITY:
PM O
OUNTY
(Street Name, Numbers, Community, Subdiision, Lot No., Parcel, Zip Code)
TOPOGRAPHIC / LAND SETTING:
O Slope OValley ID Flat ❑Ridge OOther
(check appropriate box)
TITUDE 3641 imi
..;NGITUDEj 14 %
Latitude/longitude source: GPS ❑Topographic map
(location of well must be s own on a USGS topo map and
attached to this form if not using GPS)
May be in degrees,
minutes, seconds or
in a decimal format
b. WELL OWNER t
OWNER'S NAME Ii
STRF T ADDRESS ^ DDRESSTO it `
I MC a 7
Ciity or Town StateZip Code
giS)- 497�J'116 1
Area code - Phone number
'NELL DETAILS:
a. TOTAL DEPTH: co'
b. DOES WELL REPLACE EXISTING WELL? YES`O NO
c. WATER LEVEL Below Top of Casing: 860I FT.
(Use "+" if Above Top of Casing)
d. TOP OF CASING IS 2 FT. Above Land Surface'
*Top of casing tenninatea at/or below land surface may require
a variance in accordance with 15A NCAC 2C .0118.
tea
e. YIELD (gpm):
METHOD OF TEST Blow
f. DISINFECTION: Type H T H Amount 160z
g. WATER ZONES (depth):
From ass To Z40 From To.
From To . From To
From To From To
6. CASING: Thickness/
Depth Dipm�jer Weight Mat rial
From 0 To I Ft. tt,0o
From ICO Tom_ Ft.t t 18$
From To Ft.
7. GROUT: Depth Material Method
From 0 To 20 apernent & benonite p
From To Ft.
From To Ft.
8. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in.
From To Ft. in. in.
From To Ftin. in.
9. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
From To Ft.
10. DRILLING LOG
From Tor Formation Description
0 `0' ' clay & sand
/0J' OD' granite
0
2Z
11. REMARKS:
r-a 0 .
r —.
ti
DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH
15A NCAC 2C, WELL CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS
RECO-.. S BEEN PROVIDED TO THE WELL OWNER.
ATURE OF R IFIED WELL CONTRACTOR DATE
James B. Brown
PRINTED NAME OF PERSON CONSTRUCTING THE WELL
omit the original to the Division of Water Quality within 30 days. Attn: Information Mgt,
. ,17 Mail Service Center— Raleigh, NC 27699-1617 Phone No. [phone] ext 566.
Form GW-la
Rev. 7/05

RESIDENTIAL WELL CONSTRUCTION RECORD
North Carolina Department of Envfonnlent and Natural Resources- Division of Water Quality
WELL CONTRACTOR CERTIFICATION #
1 `..ELL CONTRACTOR:
James B . Brown
'.r/ell Contractor (Individual) Name ...---....
Hedden Brothers Well Drilling, Inc.
'Aid Contractor Company Name
STREET ADDRESS 73' Holly Hills Vista RD
Franklin, NC 28734
City or Town State Zip Code
(828 )- 369-9591
Area code- Phone number
NELL INFORMATION: �7 4 Grp /y�
frE WELL ID (kit applicable) 110JO-RI 0:/0(0
ATE WELL PERMIT#(it applicable)
DWQ or OTHER PERMIT #(if applicable)
WELL USE (Check
Applicable Box): Residential Water Supply ❑
GATE DRILLED I II.G9 / e//i4,
TIME COMPLETED 5 • 00 AM ❑ PM
3. WELL LO��,4T�IIO�N": �lnq`\ ^-' nano
CITY: 0.1CY.Y COUNTY, V nano
Lwun wn w r`ri. fi
(Street Name, Numb s, (immunity, Subdivision, Lot No., Parcel, Zip Code)
:TOPOGRAPHIC / LAND SETTING:
❑Slope OValley ❑Flat ❑Ridge ❑Other
(check appropriate box)
LATITUDE iy�flo 4aIPN
LONGITUDEI 15 187 IAD
Latitude/longitude source: .CPS ❑Topographic map
(location of well must be shown on a USGS topo map and
attached to this form if not using GPS)
May be in degrees,
minutes, seconds or
in a uecimet format
4. WELL OWNER
OWNER'S NAME
ET ADDRESS
(y
City ® Tox'n/,.,' Stater
la )- iloo-c09aa
Area code - Phone number
3oal
Zip Code
5. WELL DETAILS: �/ ^ t
a. TOTAL DEPTH: (i1()
b. DOES WELL REPLACE EXISTING WELL? YE//S��❑ NO k
WATER LEVEL Below Top of Casing: Lobo FT.
(Use'+' If Above Top of Casing)
d. TOP OF CASING 15 2 FT. Above Land Surface'
'Top of casing terminated at/or below land surface may require
a variance In accordance with 15A NCAC 2C .0118.
e. YIELD (pm): 6 METHOD OF TEST Blow
2045
f. DISINFECTION: Type H T H
From
From S50T
6. CASING:
Amount 160z
From To
From To
From
To
Thickness/
Dept Di meter Weight Material
p To Ft. O Y�
From 99 To Ft. 10,• z/8B
From To Ft.
7. GROUT: Depth Material Method
From 0 To 20 FFement & benonite pumped
From To Ft.
From To Ft.
8. SCREEN: - Depth Diameter Slot Size Material
From To Ft. in. in.
From To Ft. in. In.
From To Ft. in. In.
9. SAND/GRAVEL PACK:
Depth
From To Ft.
From To Ft.
ft
Size Material
From To Ft.
10. DRILLING LOG
From To
r
/wt 60,
Formation Description
clay & sand
granite
rn Z
ry C 1;
CrF�ti Luc
11. REMARKS:
Cn
g
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH
ISA NCAC 2C, WELL CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS
RECOR •„ AS BEEN PROVIDED TO THE WELL OWNER.
12--r2
ATURE OF CER IFIED WELL CONTRACTORDATE
James B. Brown
PRINTED NAME OF PERSON CONSTRUCTING THE WELL
Submit the original to the Division of Water Quality within 30 days. Attn: Information Mgt.,
1617 Mall Service Center — Raleigh, NC 27699.1617 Phone No. [phone] ext 568.
Form G W-1 a
Rev. 7/05

RESIDENTIAL WELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources -Division of Water Quality
WELL CONTRACTOR CERTIFICATION # 2045
1. WELL CONTRACTOR:
James B. Brown
Well Contractor (Individual) Name
Redden Brothers Well Drilling, Inc.
Well Contractor Company Name
STREET ADDRESS 73 Holly Hills Vista RD
Franklin, NC 28734
City or Town State
28 )• 369-9591
Zip Code
>:ea code- Phone number
2. WELL INFORMATION:
SITE WELL ID #(it applicable)
STATE WELL PERMIT#(if applicable)
DWQ or OTHER PERMIT #(if applicable)
WELL USE (Chet pplicable Box): Residential Water Supply O
',ATE DRILLED �qy�
IME COMPLETED • W AM ❑ PM K.
WELL LO ATION:
CITY: COUNTY
( treet Name. Numbers, Community, Subditision, Lot No., Parcel, Zip Code)
TOPOGRAPHIC / LAND SETTING:
❑Slope 0. Valley c Flat 0 Ridge ❑Other
(check appropriate box)
LATITUDE _43V 15 3J
q
LONGITUDE Cr3.5 46 Era (4)
tatitude/longitude source: f}t1PS ❑Topographic map
(location of well must be shown on a USGS tepo map and
attached to this form s no: using GPS)
DELL OWNER
OWNER'S NAME
S'yyRE�E/T1 vyAD��DRR�En�SS
))
City or Town U ' State
May be in degrees,
minutes, seconds or
in a decimal format
( L1Zn )- Aq3-5 .1
Area code • Phone number
"'ELL DETAILS:
- 11162 bAsi .�p�
ors/GJ
Zip Code
. TOTAL DEPTH: ____LIDnotEtag.
b. DOES WELL REPLACE EXISTING WELL?X' PEES ❑ NO
e. WATER LEVEL Below Top of Casing: SFT,
(Use "+" if Above Top of Casing)
d. TOP OF CASING IS 2 FT. Above Land Surface
*Top of casing terminated aVor below land surface may require
a variance in accordance with 15A NCAC 2C .0116.
e. YIELD (gpm): t 2 METHOD OF TEST Blow
f. DISINFECTION: Type H T H Amount 1 60Z
g. WATER ZONES (de.th)
From To /b Froni To
From To iI From To
From To From To
6. CASING•rt Thickness/
Diameter Weight Material
pth
From Ft
From To Ft.
From To Ft.
7. GROUT: Depth Material Method
From 0 To 20 FGe20ent & benonite
From To_ Ft.
From To Ft.
8. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. In.
From To Ft. in, in.
From To Ft. in. In.
9. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
Frdm To Ft.
10. DRILLING LOG
From ti T
Formation Description
clay & sand
grAni to*
rn
i1. REMARKS: , (y
LLF 3TT E e
0
en
I D0 HEREBY CERTIFY THAT THIS W LL WAS CONSTRUCTED IN ACCORDANCE WITH
15A NCAC 2C. WELL CONSTRUCTION STANDARDS, AND THAT A COPY OF TH6
RECORaHA5 BEEN PROVIDED JD THE WELL OWNER.
�0O
IFIED WELL CONTRACT ' DATE
James B. Brown
PRINTED NAME OF PERSON CONSTRUCTING THE WELL
Submit the original to the Division of Water Quality within 30 days. Attn: Information Mgt.,
4 617 Mail Service Center — Raleigh, NC 27699-1617 Phone No. [phone] ext 568.
Form GW-la
Rev. 7/05

RESIDENTIAL WELL CONSTRUCTION RECORD
North. Carolina'Department of Environment and Natural Resources- Division of Water Quality
WELL CONTRACTOR CERTIFICATION # 2045
1. WELL CONTRACTOR:
James B. Brown
Well Contractor (individual) Name Hedden Brothers Well Drilling, Inc.
Well Contractor Company Name
STREET ADDRESS 73 Holly Hills Vista RD
Franklin, NC 28734
City or Tarn State Zip Code
: 828 )• 369-9591
Area code- Phone number
2.. WELL INFORMATION: aQ
SITE WELL ID Nil applicable) n I(O05 34-31 /lc
STATE WELL PERMIT#(ir applicable)
OW Q or OTHER PERMIT Cif applicable)
WELL USE (Chet Applicable Box): Residential Water Supply
DATE LE � EDyl(er�;�[,(�stJ
TIME COMOMPLETEDi 3 r AM 0 PMk
3. WELL L• CAT I•N:
/
:
CI y; _�Q COUNT •
_ !1
l7 ilt& '' 8
/ l
Street Na 2, umbers, Community, ubdidsion, Lot No., Parcel, Zip Code)
TOPOGRAPHIC / LAND SETTING:
❑Slope °Valley °Flat ❑Ridge °Other
(check appropriate box)
LATITUDE _g�E
LONGITUDE ,pzyall 4Y5
Latitude/longitude source: NGPS ❑Topographic map
(location of well must be sho n on a USGS topo map and
attached to this form if not using GPS)
May be in degrees,
minutes, seconds or
in a decimal format
WELL OWNER
OWNER'S NAME
:,TRe T ADDRESS �YI/I.fR"1 751
NC- cid1/9
City a a Town - State Zip Code
1 hryL0 )- Ogg-39aa
Area code - Phone number
5. WELL DETAILS: ��
a. TOTAL DEPTH:
b. DOES WELL REPLACE EXISTING WELL? YES ��❑ NO A
•,. WATER LEVEL Below Top of Casing: 4CC) FT.
(Use+' R Above Top of Casing)
d. TOP OF CASING IS 2 FT. Above Land Surface'
'Top of casing terminated at/or below land surface may require
a variance In accordance with 15A NCAC 2C .0118:
e. YIELD (gpm): ft7 METHOD OF TEST Blow
1. DISINFECTION: Type H T H Amount 1 60z
From To
From To
From To
6. CASING: Thickness/
Depth / �^1 Diameter Weight Material
From D To )V10. FL_[Q= ,a
From To Ft.
From To Ft.
7. GROUT: Depth Material Method
From 0 To 20 FGement & benonitemped
from To Ft.
From To Ft.
8. SCREEN: Depth Diameter Slot Size Material
From To Ft. in, In.
From To Ft. in. In.
From To Ft. in. In,
9. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft
From To Ft.
10. DRILLING LOG
From To Formation Description
�1 /tob clay & sand
/(oo 660 ' granites
I Rrhocs, 155 ' e5 178'
0
N 0
—121 {
I , m
rn
1 DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH
ISA NCAC 2C, WELL CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS
REODRpf9AS BEEN PROVIDED TO THE WELL OWNER.
7270c,
NATURE OF CERTIFIED WELL CONTRACTOR DATE
James B. Brown
PRINTED NAME OF PERSON CONSTRUCTING THE WELL
Submit the original to the Division of Water Quality within 30 days. Attn: Information Mgt.,
1617 Mall Service Center— Raleigh, NC 27699.1617 Phone No. [phone] ext 868.
Form GW-la
Rev. 7/05

RESIDENTIAL WELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources -Division of Water Quality
WELL CONTRACTOR CERTIFICATION # 2045
1. WELL CONTRACTOR:
James B. Brown
i Contractor (Individual) Name
Hedden Brothers Well Drilling, Inc:
Well Contractor Company Name
STREET ADDRESS 73 Holly Hills Vista RD
Franklin, NC 28734
City or Town State Zip Code
( 828 )- 369-9591
Area code- Phone number
TELL INFORMATION:
SITE WELL ID#(f applicable) 1(#41,2 -14 -933(-4
STATE WELL PERMIT#01 applicable)
DWQ or OTHER PERMIT #(if applicable)
.VELL USE (Check Applicable Box): Residential Water Supply
DATE DRILLED 8.I4 'Ott
TIME COMPLETED
:W AM❑ PM cit
3. WELL LOCATION: //,,11,, --
CITY: Q.- COUNTYU(lil )/IOTV
BM.neh Pd 11
. treat Nalb, Numbers, Community. Subdivision. Lot No., Parcel, Zip Code)
UPOGRAPHIC / LAND SETTING:
❑Slope °Valley ❑Flat °Ridge ❑Other (check appropriate box) - /
LATITUDE SAY
.�/1'J�i1V
i ONGITUDEt3, a Ail (4)
Latitude/longitude source: g.GPS ❑Topographic map
(location of well must be shown on a USGS topo map and
attached to this form if not using GPS)
, "ELL OWNER
` 'AMER'S NAME
ST ET ADDRESS'16I
4 NC
C ty or ' State
May be in degrees,
minutes, seconds or
in a decimal format
(U )- 581a-9417g
Area code - Phone number
eganch
Zip Code
6. WELL DETAILS: LD��
a. TOTAL DEPTH:
b. DOES WELL REPLACE EXISTING WELL? YES 0 NOK
c. WATER LEVEL Below Top of Casing: 400 - FT.
(Use -+' if Above Top of Casing)
TOP OF CASING 15 2 FT. Above Land Surface'
'Top of casing terminated at/or below land surface may require
a variance In accordance with 15A NCAC 2C .0118.
e. YIELD (gpm): METHOD OF TEST Blow
t
r 001 493
f. DISINFECTION: Type H T H Amount 1 60Z
g. WATER ZONES (depth): ,
From . 434 - To 4% From To
From 50 (' To g03" From To
From To From To
6. CASING: Thickness/
a Depth Diameter Weight Material
From .. To Fiji --
From (3(p To Ft 1D"• gib ALE
From To Ft.
7. GROUT: Depth Material Method
From 0 To 20 Feement & benonite
From To Ft.
From To Ft.
8. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in.
From To R. in. in.
From To Ft. in in.
9. SAND/GRAVEL PACK: it
Depth Size Material
From To Ft.
From To Ft.
From To Ft.
10. DRILLING LOG
From To
Pp' Wm'
11. REMARKS:
Formation Description
day & sand
rani tp
—V ;in
Crs
A
Hi
1 DO HEREBY CERT1FYTHAT THIS WELL W AS CONSTRUCTED IN ACCORDANCE WITH
15A NCAC 2C. WELL CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS
RECORD HAS BEEN PROVIDED TO THE WELL OWNER,
SI ='"ATURE OF CEF IFIED WELL CONTRACTOR DATE
James B. Brown
PRINTED NAME OF PERSON CONSTRUCTING THE WELL
Submit the original to the Division of Water Quality within 30 days. Attn: Information Mgt.,
1617 Mali Service Center— Raleigh, NC 27699-1617 Phone No. [phone] ext 668.
Form GW-ta
Rev. 7/05

RESIDENTIAL WELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources- Division of Water Quality ai 3 t x
WELL CONTRACTOR CERTIFICATION #— 2045 2 2
1. WELL CONTRACTOR:
• James B, Brown
Well Contractor (Individual) Name
Hedden Brothers Well Drillin Inc:
Well Contractor Company Name
STREET ADDRESS 73 Roll y Hills Vista RD
Franklin N 2 7 4
City or Town ' State Zip Code
Area code- Phone number
2. WELL INFORMATION:
SITE WELL ID #(if applicable)(/,3"%�-
STATE WELL PERMIT#(if applicable)--�
DWG) or OTHER PERMIT #(if applicable)
• WELL USE (Check Applicable Box): Residential Water Supply
DATE DRILLED V ' o
TIME COMPLETED��j AM p PM"(
3. WELL LOCATI • Nr
CITY: ri
COUNTY
(Street Name, Num •era, ommunity, Subdivision, Lot No., Parcel, Zlp Code)
TOPOGRAPHIC / LAND SETTING:
CSlope ❑Valley ❑Flat ❑Ridge 0Other
(Check
r� to box)
LATITUDE
LONGITUDE •13�--
May be in degrees,
minutes, seconds or
in a decimal format
Latitude/longitude source: },IQrGPS ❑Topographic map
(location of well must be shovLn on a USGS topo map and
attached to this form if not using GPS)
9, WELL OWNER
OWNER'S NAME•
ST T ADDRESS
City r Town
� / 0
to
.Area code one number
5, WELL DETAILS:
a. TOTAL DEPTH:_•
b. DOES WELL REPLACE EXISTING WELL? YES ❑ N0K.
c. WATER LEVEL Below Top of Casing: Sf2
(Use "+" if Above Top of Casing) —FT.
d. TOP OF CASINO IS 2
FT. Above Land Surface'
'Top of casing terminated aVor below -land -surface may require
a variance In accordance with 15A NCAC 2C .0118.
e: YIELD (gpm): METHOD OF TEST Blow
Zip Code
Material
F/ Go
f. DISINFECTION: Type
/R�(ij� --�_ Amount 160z.
F• WAT'NE5 (depth
From To From
From To
To From To
From, To From
To
6. CASING:
Depth Weight Thickness/
From From To--�'/,/y Dlefr Weight
L FtTo.
From To[L FtF—�_ i/pa
7. GROUT: Depth Material
From 0 To 20 Method
F'cement & benonite
From_ To Ft.
From To
F(.
8, SCREEN: Depth Diameter Slot Size Material
From To
Ft. in, In.
From, To Ft, in.
FromTo In.
Ft. In, In
9. SAND/GRAVEL PACK:
Depth Size Material
To Ft
From To Ft
From To Ft •--
10: DRILLING LOG
From To Formation Description
e r
r`1 av R sa r7
r*rani 1-a
11. 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
RECO S BEEN PROVIDED TO THE WELL OWNER.
James B Bzcum
PRINTED tD NAME OF PERSON CONSTRUCTING THE WELL
Salbmit.the original .to the Division of Water Quality within 30 days. Attn: Information Mgt.,
1617 Mail Service Center.. Raleigh, NC 27699.1617 Phone No. [phone] ext 568.
DEC 12 2006
Form GW-1a
Rev, 7/05

1. WELL CONTRACTOR:
James B Brown
Well Contractor (Individual) Name
Heddesl-brothers Well Drillin Inc.
Well Contractor Company Name
STREET ADDRESS 73Holly Hills Vista RD
FYanklin N 287aa
City or Town State Zip Code
( 828
Area code- Phone number
2. WELL INFORMATION:
SITE WELL ID#(Ilapplicable) 7504.A1-(•a00
STATE WELL PERMIT#(it applicable)
DWQ or OTHER PERMIT #(if applicable)
WELL USE (Check Ap 'icable Box): Residential Water Supply
DATE DRILLED '14.O1a
TIME COMPLETE
3,WELL LOCATION:
CITY: �1 - COUNTY I {'A 7?. z
D `3 OD AM ❑ PM �i
(Street Name, Numbers, C nity, Subditision, Lot NO.., Parcel, Zip Code)
TOPOGRAPHIC / LAND SETTING:
O Slope °Valley ❑Flat ❑Ridge ❑Other
(check app`r�opriat�e b/ox�e�`' box)
LATITUDE �J lS
LONGITUDE Li 04 7(21 a
Latitude/longitude source: y*GPS ❑Topographic map
(location of well must be shown on a USGS topo map and
attached to this form if not using GPS)
4. WELL OWNER n•
OWNER'S NAME
REETADDRESS
May be in degrees,
minutes, seconds or
in a decimal format
Clly or Town State Zip
-_$13)._ 89ing ,'T • Zip Code
Area code • Phone number
5, WELL DETAILS:
a. TOTAL DEPTH: 400 e
b, DOES WELL REPLACE EXISTING WELL? YES ❑ NO
c. WATER LEVEL Below Top of Casing: h
(Use °+° If Above Top of Casing) FT.
d. TOP OF CASING IS 2 FT, Above Land Surface'
`Top of casfnp-terminated at/or below land surface may require
a variance in accordance with 15A NCAC 2C .0115,
a. YIELD (gpm):_ METHOD OF TEST B1°W
RESIDENTIAL WELL CONSTRUCTION RE ORD
North Carolina Department of Envronment and Natural Resources- Division of Water Quality
WELL CONTRACTOR CERTIFICATION 14 _2045
335123
f. DISINFECTION: Type T H Amount 160z
g. WATER ZONES (depth):
From_ To V From
From_ a r Tu To,
--..�.Y.+� From To
FromTo From To
6, CASING:
Depth
From To
From
From
7, GROUT:
0
From
From,
From
- 6. SCREEN:
From
From
From
Thickness/
Diameter Weight
FL_(`
FL ° •/g�
To Ft.
Material
Depth Material Method
To 20 FQement & benonite p
To Ft
To Ft
Depth
_ To_
To
To
Diameter Slot Size
Ft. in.
Ft. In.
Ft. In,
9. SAND/GRAVEL PACK:
Depth
From To Ft,
From To Ft.
From To Ft.
10: DRILLING LOG
From To Formation Description
clay X s nr3
nr-ni 1•a
Size
In.
In,
in
Material
11. REMARKS:
Material
— 2CRec4R-DuNtret---
I D0 HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH
ISA NCAC 2C, WELL CONSTRUCTION STANDARDS. AND THAT A COPY OF THIS
RE �� HAS BEEN PROVIDED TO THE WELL OWNER.
NATURE 0 C' 'i IFIED WELL CONTRACTO7/ DATE C
James B Bra•:^
PRINTED NAME OF PERSON CONSTRUCTING THE WELL
1617 Mali Service Canter -Raleigh,
699 1617 Phone No, [phone] ext 568.
DEC 12 2006
NC 27
Spbmit the original to the Division of Water Quality within 30 days. Attn: Information Mgt.,
Form GW-la
Rev, 7/05

1. WELL CONTRACTOR:
James B. Brown
Well Contractor (Individual) Name
Hedden Brothers Well Drilling, Inc,
Well Contractor Company Name
STREET ADDRESS 73 Holly Hills Vista RD
Franklin, NC
City or Town Stale
( 828 )- 369-9591
Area code- Phone number
2. WELL INFORMATION:
SITE WELL ID #(If applicable)
STATE WELL PERMIT#(if applicable)
OWQ or OTHER PERMIT *Of applicable)
RESIDENTIAL WELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources- Division of Water Quality
WELL CONTRACTOR CERTIFICATION # 2045
WELL USE (Check Applicable Box):
DATE DRILLED
TIME COMPLETED
3. WELL LOT,ION:
Vs:
28734
Zip Code
Residential Water Supply p
AM PMK
COUNTY
(Street Na S Numbers, Community, SubdR4sion, Lot No., Parcel, Zip Code)
TOPOGRAPHIC / LAND SETTING:
❑Slope °Valley ❑Flat ❑Ridge ❑Other
(check approphate box)
LATITUDE ,
213
LONGITUDE „lip
Latitude/longitude source: I GPS
U Topographic (location of well must be s r on a USGS 7 po map and
° attached to this form if not using GPS)
4. WELL OWNER
OWNER'S NAME
ET ADDRES
May be in degrees,
minutes, seconds or
in a decimal format
r )r own . State Zip Code
0
Area code - Phone number
5. WELL DETAILS:
--. a, TOTAL DEPTH:
DOES WELL REPLACE EXISTING WELL? YES 0 NOX
c. WATER LEVEL Below Top of Casing:
(Use "+" if Above Top of Casing) FT.
d. TOP OF CASING IS 2 FT. Above Land Surface`
-Top of casing terminated al/or below land surface may require
a variance in accordance with 15A NCAC 2C .0118.
e. YIELD (gpm):_ METHOD OF TEST Blow
f. DISINFECTION: Type H
g. WATFrR ZONES (deptly:
SAND/GRAVEL PACK:
Depth
From To
From To
From
°tit424
Diameter Slot Size
Ft. In In.
Ft. In. in.
Ft. in. In,
100 HERESY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH
15A NCAC 2C, WELL CONSTRUCEON STANDARDS, AND THAT A COPY OF THs
RECORDHASSEEN PROVIDED TC THE WELL OWNER.
NATUR- o� /TE
E CERTIFIED WELL CONTRACTOR DATE
pacan
PRINTED NAME OF PERSON CONSTRUCTING THE WELL
Submit the original to the Division of Water Quality within 30 days. Attn: Information Mgt.,
1617 Mail Service Center— Raleigh, NC 27699.1617 Phone No. [phone] err 5AR
Form Gw.i

WELL CONTRACTOR CERTIFICATION #
1, WELL CONTRACTOR:
James B. Brown
Well Contractor (Individual) Name
Redden Brothers Well Drilling, Inc,
Well Contractor Company Name
STREET ADDRESS
73 Holly Hills Vista RD
Franklin, NC
City or Town State
( 828 )- 369-9591
Area code- Phone number
2. WELL INFORMATION:
SITE WELL ID #(itappllcable)
28734
Zip Code
Rd4 -q9 -31005
STATE WELL PERMIT#(If applicable)
DWQ or OTHER PERMIT Cif applicable)
DATE WELL USILLED (Check A pplicable Box): Residential Water Supply 0
R
TIME COMPLETED lhN/
(Street Name, Number Community, Subdivision, Lot N ,) Par Eel, Zip
TOPOGRAPHIC / LAND SETTING:
❑Slope ❑Valley ❑Flat ❑Ridge ❑Other
(check appropriate box)
LATITUDE 3I
LONGITUDE
3.00
AMC PMW
May be in degrees,
minutes, seconds or
in a decimal format
Latitude/longitude source: GPS ❑Topographic map
(location of well must be sho n on a USGS topo map and
attached to this form if not using GPS)
4. WELL OWNER
OWNER'S NAME ,{AO—)r
STREET, y ..42/ v (;)}.
!J DDRESS / � Q �j
City 1 T own l [DLSta 0 Zip C de
Area code - Phone number
5. WELL DETAILS:
a. TOTAL DEPTH;
b, DOES WELL REPLACE EXISTING WELL? YES ❑ NO%
c, WATER LEVEL Below Top of Cas,ig: aoa FT.
(Use -a^ if Above Top of Casing)
d, TOP OF CASING IS 2 FT. Above Land Surface'
'Top of casing terminated at/or below land surface may require
a variance in accordance with 15A NCAC 2C .0118.
e. YIELD (gpm): '7 METHOD OF TEST Blow
From
From
From To
7. GROUT: Depth Material
From To 20 Ft.cement & benonae
From To Ft.
From To Ft.
RESIDENTIAL WELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources- Division of Water Quality
2045
n r ,e J t ti N C J
f. DISINFECTION: Type H T H
g. WATER ZONES (depth
From To From To
From rnciu In rn n r From To
From To From To
6, CASING: Thickness/
Di myter Weight
Amount 16oz
Method
pumped
8. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. In.
From To Ft. in. In.
From To Ft. in. _____ In. _ R
9. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
From To Ft.
10, DRILLING LOG
Fro
0
11. REMARKS:
Formation Description
Clay 8 sand
granite
Y� SER
VIP`.
10
vtc"'
I D0 HEREBY CERTIFY THAT THIS WELL WAS CONZTRUCTED IN ACCORDANCE WITH
15A NDAC 2C, WELL CONSTRUCTION STANDARDS, ;,,;D THAT A COPY OF THIS
RECORD HAS BEEN PROVIDED TO THE WELL OWNL'
NATURE OF CCE IFIED WELL CONTRACTOR DATE
JAmcs 3 -Buxom.)
PRINTED NAME OF PERSON CONSTRUCTING THE WELL
Submit the original to the Division of Water Quality within 30 days. Attn: Information Mgt,
1617 Mail Service Center— Raleigh, NC 27699.1617 Phone No. [phone] ext 568,
Form GW-la

(tm(1 £26 t gee
IQ . `' (J c a21a�
City or Town State Zip Code
aq3-q83,
Area code • Phone number
6. WELL DETAILS: _ —I
b. DOES WELL REPLACE EXISTING WELL? YES
7t❑f� NOk_
/
c. WATER LEVEL Below Top of Casing: `ib° FT.
(Use'+^ if Above Top of Casing)
d. TOP OF CASING IS 2 ' FT. Above Land Surface•
'Top of casing terminated at/or below land surface may require
a variance in accordance with 15A NCAC 2C .0118.
YIELD (gpm): METHOD OF TEST Blow
a. TOTAL DEPTH:
RESIDENTIAL WELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources- Division of Water Quality
WELL CONTRACTOR CERTIFICATION # . 2045
1. WELL CONTRACTOR:
James B. Brown
Well Contractor (intividualLName
Hedden Brothers Well Drilling, Inc.
Well Contractor Company Name
STREET ADDRESS 73 Holly Hills Vista RD
Franklin, NC 28734
City or Town State Zip Code
(828 )- 369-9891
Area code- Phone number
2 WELL INFORMATION:
917E WELL ID #01 applicable)
STATE WELL PERMIT#(if applicable)
DWQ or OTHER PERMIT #(if applicable)
WELL USE (Checky
Applicable Box): Residential Water Suppl
9
DATE DRILLED •T '6
TIME COMPLETED 3.O D AM ❑ PM [K.
3. WELL LO TION
C COl1N?V.
at Name, Number, Community, Subdivision, Lot No., Parcel, Zip Code)
TOPOGRAPHIC / LAND SETTING:
I Slope OValley °Flat ❑Ridge ❑Other
(check appropriate box)
LATITUDE _y/J 4Ic'
LONGITUDE t;] .LL O d KJ
Latitude/longitude source: GPS ❑Topographic map
(location of well must be shown on a USGS topo map and
attached to this form 9 not using CPS)
4. WELL OWNER
OWNER'S NAME
May be in degrees,
minutes, seconds or
in a decimal format
ST IET ADDRESS
333394
t. DISINFECTION: Type H T H
g. WATER ZONES (depth):
From i t 3 To t-1.5
From To
From To
From
From
From
Amount 1 60z
6. CASING:
A Depth DI Ster
From / J To 73 Ft. o
From To Ft.
From To FL
To
To
To
Thickness/
Weigh{,di M erial
1 SS�51
7. GROUT: Depth Material Method
From 0 To 20 FEement & benonite
From To Ft.
From To Ft.
8. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in.
From To Ft. in. in.
From To Ft. in. in.
9. SAND/GRAVEL PACK:
Depth
From
Size Material
To Ft.
From To Ft.
From To F}.
10. DRILLING LOG
From To
.-.ffnn / r
11. REMARKS:
Formation Description
clay & Sand
Otani to
_ RECEIVE
nIV OFWATER QUALITY
ucr 1 1 200C
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH
15A NCAC 2C, WELL CONSTRUCTION STANDARDS. AND THAT A COPY OF THIS
RECOR• BEEN PROVIDED TO THE WELL OWNER.
� . 42" 52-12-4
ATURE OF CER IFIED WELL CONTRACTOR DATE
James B. Brown
PRINTED NAME OF PERSON CONSTRUCTING THE WELL
Submit the original to the Division of Water Quality within 30 days. Attn: Information Mgt,
1617 Mail Service Center — Raleigh, NC 27699.1617 Phone No. [phone] ext 568.
Form GW-la
Rev. 7/05

RESIDENTIAL WELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources- Division of Water Quality
WELL CONTRACTOR CERTIFICATION # 2045
1. WELL CONTRACTOR:
James B. Brown
_', \vesLContractor (Individual) Name
Heiden Brothers Well Drilling, Inc. -
Well Contractor Company Name
STREET ADDRESS 73 Holly Hills Vista RD
Franklin, NC 28734
City or Town State Zip Code
(828 )- 369-9591
Area code- Phone number
2. WELL INFORMATION:
SITE WELL ID #(I( applicable)
STATE WELL PERMIT#(It applicable)
lW Q or OTHER PERMIT #Of applicable)
' ELL USE (Check Ap icable Box): Residential Water Supply
•
DATE DRILLED '
TIME COMPLETED AM 0 PMM
3. WELL LOCATIQN:_
CTY: M t1r
( tree Numbers; Communil bdid a on, Lot No, Parcel, Zip Code)
TOPOGRAPHIC /LAND SETTING:
rl Slope DValley ❑Flat ORidge oOther
(check appropriate box)
LATITUDE pip�t$,p 2LOOt'A' "`
LONGITUDE Og � Me
Latitude/longitude source: it DTopographic map
(location of well must be s o n on a USGS topo map and
attached to this form ifnot using GPS)
4. WELL OWNER
OWNER'S NAME
S RE T ADDRESS /Da�
rJi,N
City or Town Stale
gab; (v3/-97
ea code - Phone number
COUNTY
May be in degrees,
minutes, seconds or
in a decimal format
t. WELL DETAILS: /—
a. TOTAL DEPTH: �� /
b. DOES WELL REPLACE EXISTING WELL? YES 0 NO(Zl
c. WATER LEVEL Below Top of Casing: 0 FT.
(Use -+" if Above Top of Casing)
d. TOP OF CASING IS 2 FT. Above Land Surface'
'Top of casing terminated at/or below land surface may require
a variance in accordance with 15A NCAC 2C .0118.
e. YIELD (gpm): es/• METHOD OF TEST Blow
333393
t. DISINFECTION: Type H T H Amount 160z
g. WATER ZONES (depth):
_from To� ,^T From To
From To From To
From To From To
6. CASING:
Thickness/
De th 1 Dia etpr Wei��ii1 Mi�ajjeena�l
From f'1 To hp FL ,' r its
s �l177
From To Ft.
From To Ft.
7. GROUT: Depth Material Method
From 0 To 20 FGement & benomflnped
From To Ft.
From To Ft.
8. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. In.
From To Ft. in. in.
From To Ft. in. in.
9. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
From To Ft.
10. DRILLING LOG
From To a,
11. REMARKS:
Formation Description
clay & sand_
(ranil-p
RECEIVEU
DIV. OF WATER QUALITY
OCT 11 2006
I OD HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH
15A NCAC 2C, WELL CONSTRUCTION STANDARDS. AND THAT A COPY OF THIS
RECORA44AS BEEN PROVIDED TO THE WELL OWNER.
ATURE OF CED WELL CONTRACTOR DATE
James B. Brown
PRINTED NAME OF PERSON CONSTRUCTING THE WELL
Submit the originalto the Division of Water Quality within 30 days. Attn: Information Mgt.,
1617 Mail Service Center— Raleigh, NC 27699-1617 Phone No. [phone] ext 568.
Form GW-la
Rev. 7/05

RESIDENTIAL WELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources- Division of Water Quality
WELL CONTRACTOR CERTIFICATION # . 2045
1. WELL CONTRACTOR:
James B. Brown
,:•II Contractor (IndMdual) Name —- - -- -
Hedden Brothers Well Drilling, Inc.
Well Contractor Company Name
STREET ADDRESS 73 Holly Hills Vista RD
Franklin NC 28734
City or Town State
(828 )- 364-9591
Area code- Phone number
2. WELL INFORMATION: //� //��Ofng /j /�
SITE WELL ID #(if applicable) 7(O-a3 . / 55 5
STATE WELL PERMIT#(If applicable)
DWQ or OTHER PERMIT #(If applicable)
WELL USE (Check Ap licable Box): Residential Water Supply ik
DATE DRILLED• /V
TIME COMPLETED AM ❑
3. WELL LQCATION:
CITY:
PM ❑
Zlp Code
COUNTY,
(Street Name, Numbers, Community, 5ubdiNalon, Lot No., Parcel, Zip Code)
bPOGRAPHIC / LAND SETTING:
Slope ❑Valley ❑Flat ORidge DOther
(check appropriate box) A
LATITUDE gq5�GL7 a71� ^A�J
LONGITUDE 11 �0q W
Latitude/longitude source: KGPS ❑Topographic map
(location of well must be shown on a USGS topo map and
attached to this form If not using GPS)
a.. WELL OWNER
STREET
DAME p
STREET AD RESS "�� •�„l1Uh�/ R A
City or Town
5R27 ZipCode
9
May be in degrees,
minutes, seconds or
in a decimal format
Area code • Phone number
5. WELL DETAILS: (JJO
a. TOTAL DEPTH: rrr���
b. DOES WELL REPLACE EXISTING WELL? YES IDNOX
c. WATER LEVEL Below Top of Casing: /0 0 FT.
(Use N Above Top of Casing)
d. TOP OF CASING IS 2 FT. Above Land Surface
'Top of casing terminated at/or below land surface may require
e variance In accordancewith 15A NCAC 2C .0118.
a. YIELD (gam): /el / + METHOD OF TEST BLOW
333333
f. DISINFECTION: Type H T H Amount 1 60z
g. WATER ZONES (depth):
From ,.. i. re
To . From To
From i ie To From To
From To From To
6. CASING:
Depth D)'art)eter
From To �0.) Ft. ( o
From O To t4 Ft.�o
From To Ft.
7. GROUT: Depth
o.
Thickness/
Weight Mel
ISRiL
Material Method
From 0 To 20 FGement & benonite
From To Ft.
From To Ft.
8. SCREEN: Depth Diameter Slot Size
From To Ft. In. In.
From To Ft. in. In.
From To Ft. in. in.
Material
8. SAND/GRAVEL PACK:
Depth Size
From To Ft.
From To Ft.
From To Ft.
10. DRILLING LOG
From To
fi
far
11. REMARKS:
Material
Formation Description
clay & sand
granites
DiM. or WATER QUALITY
OCT 11 2006
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH
ISA NCACZC, WELL CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS
RECO BEEN PROVIDED TO THE
WEELLLOWNE�R.
A
re
S NATURE OF 12f IED WELL ONTRACTO
James B. Brown
PRINTED NAME OF PERSON CONSTRUCTING THE WELL
1617Submit the Mali Servicginal to the Division of Water e a Center- Raleigh, NC 27699 16117 Quality within eNo. 9 9) 733.7015 exit 68.Uon Mgt,
Form GW-la
Rev. 7/05

LATITUDE _p372 ¢11Qn
LONGITUDE QL !do
latitude/longitude source: XGPS ❑Topographic map
(location of well must be shown on a USGS topo map and
attached to thi form B not using GPS)
S.. WELL OWNER
OWNER'S NAME
STREET ADDRESS
RESIDENTIAL IAL WELL CONSTRUCTION RECORD
North Carolina Department of Envoomnentand Natural Resources -Division of Water Quality
WELL CONTRACTOR CERTIFICATION # 2045
1. :'ELL CONTRACTOR:
James B. Brown
Well Contractor (Individual) Name
Redden Brothers Weir Drilling, Inc.
Well Contractor Company Name
STREET ADDRESS 73 Holly Hills Vista RD
Franklin, NC 28734
City or Town State
828 )- 369-9591
Area code- Phone number
2. WELL INFORMATION:
SITE WELL ID #(if applicable)
Zlp Code
'i/00`l •79-5/
STATE WELL PERMIT#(if applicable)
DWQ or OTHER PERMIT #(if applicable)
WELL USE (Check AIica/b�le Box): Residential Water Supply tar
DATE DRILLED 1 ? O -0
TIME COMPLETED —7 . l Jl) AM 0 PM tjt
3: WELL LOC TI N:
CITY:
AUfilb
(Street Name, Num• rs, Community, Subdivision. Lot No., Parcel, Zip Code)
C
LINTY
TOPOGRAPHIC / LAND SETTING:
❑Slope °Valley ❑Flat ❑Ridge ❑Other
(check appropriate box)
t/%
May be in degrees,
minutes, seconds or
in a decimal format
)-
Area code - Phone number
State
Q��
97- &AI&
6. WELL DETAILS: 300
"
a. TOTAL DEPTH:
Zip ode
b. DOES WELL REPLACE EXISTING WELL? YES ° NOKI
fl. WATER LEVEL Below Top of Casing: a 0O FT.
(Use "+" If Above Top of Casing)
d. TOP OF CASING IS 2 FT. Above Land Surface'
'Top of casing terminated at/or below land surface may require
a variance In accordance with 15A NCAC 2C .0116.
Blow
e. YIELD (gpm): U METHOD OF TEST
333391
t. DISINFECTION: Type H rl' H Amount 1 60z
g. WATER ZONES (depth):
From
From
From
6. CASING:
From
From
From
Depth
To
FL ((#
Djawter
Ft.1Q=
Ft.
From To
From -- To
From To
Thickness/ e
Weight Mat
rial
4�
7. GROUT: Depth Material Method
From 0 To 20 FQL=ment & benonitemed
From To Ft.
From To Ft,
6. SCREEN: Depth Diameter Slot Size Material
From To Ft. In. in.
From To Ft. in. In.
From To Ft. In. In.
9. SAND/GRAVEL PACK: 9
Depth Size Material
From To Ft.
From To Ft.
From To Ft.
10. DRILLING LOG
From To Formation FormationDescription
' cla�r& and
/0 / r 260 r arani to
REctivED
nlV OF WA3 ER QUMLT Y
OCT 11 2006
11. R 640CS: kka.
100 HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH
ISA NCAC 2C. WELL CONSTRUCTION STANDARDS. AND THAT A COPY OF THIS
RECORO.!)AS BEEN PRONDED TO THE WELL OWNER.
512e-06
ATURE OF C RTIFIED WELL CONTRACTOR DATE
James B. Brown
PRINTED NAME OF PERSON CONSTRUCTING THE WELL
Submit the original to the Division of Water Quality within 30 days. Attn: Information Mgt.,
1617 Mall Service Center— Raleigh, NC 27899.1617 Phone No. [phone] ext 668.
Form GW-la
Rev. 7/05

RESIDENTIAL WELL CONSTRUCTION RECORD
North Carolina Department of EnJuonntent and Natural Resources -Division of Water Quality
WELL CONTRACTOR CERTIFICATION # . 2045 -
1. WELL CONTRACTOR:
James B. Brown
Well Contractor (IndMdual) Name
Redden Brothers Well Drilling, Inc.
Well Contractor Company Name
STREET ADDRESS 73 Holly Hills Vista RD
Franklin. NC 28734
City or Town State Zip Code
(828 )• 369-9591
Area code- Phone number
2. WELL INFORMATION:
117E WELL ID #(it applicable) 7'60-g5- g135
STATE WELL PERMIT#(Ir applicable)
DWG or OTHER PERMIT Cif applicable)
WELL USE (Check Applicable Box): Residential Water Supply 0
DATE DRILLED % AO'06
TIME COMPLETED f 2 . OD AM 0 PM X
3: WELL LO ION: n
CITY: OUN ,/2
loa
(Street Name, Numbers, community, Subdh ision, Lot No., Pares , Zip Code)
TOPOGRAPHIC / LAND SETTING:
❑Slope °Valley ❑Flat ❑Ridge ❑Other
(check" appropriate iate box)
LATITUDE A a
LONGITUDE 7.3 120
Latitude/longitude source: GPS ❑Topographic map
(location of well must be shown on a USGS topo map and
attached to this form if not using GPS)
1. WELL OWNER
WNER'S NAME
STREET ADORES
May be in degrees,
minutes, seconds or
in a decimal format
Id
JAPAAPS
CM' or Town State-r�/63 Zip Code
la- 497
Area code - Phone number
6. WELL DETAILS: �r
a. TOTAL DEPTH: 'le
b. DOES WELL REPLACE EXISTING WELL'? yyYEESS��❑ NO
��
c. WATER LEVEL Below Top of Casing: �JSC.IJ FT.
(Use °+' If Above Top of Casing)
d. TOP OF CASING IS 2 FT. Above Lend Surface -
'Top of casing terminated at/or below land surface may require
a variance In accordance with 15A NCAC 2C .0118.
e. YIELD (pm): 5 • METHOD OF TEST Blow
333390
f. DISINFECTION: Type H T H Amount 1 60z
g. WATER ZONES (depth):
From 3) ) To From To
From 3140 To From From To
From To From To
6. CASING:
Thickness/
Depth a Di}aameter Weigh(., M eria
From n To ItoA Ft. (0" woo
_N'
From To Ft.
From To Ft.
7. GROUT: Depth Material Method
From 0 To 20 Ffranent & benonite pumped
From To Ft.
From To Ft.
8. SCREEN: Depth Diameter Slot Size Material
From To Ft. In. in.
From To Ft. in. In.
From To Ft. In. In.
9. SANDIGRAVEL PACK: n
Depth Size Material
From To Ft.
From To Ft.
From To Ft.
10. DRILLING LOG
From To
Formation Description
rlay & sand
gran i1P
RECEIVED DN. Or WATER QUA! ITV
11. Rabei KS� _ , A
uCT 1 1
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH
15A NCAC WELL CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS
RECOr. -- BEEN PROVIDED TO 5 WELL OWNER.
?;.-2 0-6 C,
ATUR OF CERiRrfED ELL CONTRACTOR DATE
James B. Brown
PRINTED NAME OF PERSON CONSTRUCTING THE WELL
1617Submit the original to Mall Service Center — the Raalleigh, NC 2 699 1 17vision of Water QualityPhone
o a No (9 9) 733-7015 extn668.gon Mgt.,
30 days. Attn:
Form GW-la
Rev. 7/05

RESIDENTIAL WELL CONSTRUCTION RECORD
North Carolina Depaitment of Environment and Natural Resources- Division of Water Quality
WELL CONTRACTOR CERTIFICATION # 2045
1. WELL. CONTRACTOR:
James B. Brown
Well Contractor (Inglodual) Name
Redden Brothers Well Drilling, -Inc.
Well Contractor Company Name •
STREET ADDRESS 73 Holly -Hills Vista RD
Franklin. NC 28734
City or Town State Zip Code
(828 ). 369-9541
Area code- Phone number ,
3. WELL INFORMATION:. �j �J y
SITE WELL ID Cif applicable) iL/LieiO -W - 71:Z1
STATE WELLPERMIT#(If applicable)
DWQ or OTHER PERMIT #(If applicable)
WELL USE (Check Applicable Box):
yResidential Water Supply ❑
DATE DRILLED Se r�^!��(,,1W
TIME. COMPLETED /•V(->'
3, WELL L0
CITY:
TION:
AMC PM/t
(Street Name, Nu ben, Community, SubdhNalon, Lot No., Parcel, Zip Coda)
TOPOGRAPHIC / LAND SETTING: .
°Slope °Valley ❑Flat °Ridge ❑Other
(check appropriate box)
LATITUDE itQ3 ot4
LONGITUDE 33al -to
Latitude/longitude source: $GPS °Topographic map
(location of well must be s own on USGS (cpo map end
attached to this form if not using GPS) 4. WELL OWNER n
OWNER'S NAME �kid
May be in degrees,
minutes, seconds or
in a decimal forjnat
ST•REET ADDRESS
City or Town State
()-33rri`141if9
Area code • Phone number
6. WELL DETAILS:
�7
a. TOTAL DEPTH:
Zlp Code
b. DOES WELL REPLACE EXISTING WELL? YEESS�0 NOA
t11
e,:WATER LEVEL Below Top of Casing: „7FT.
(Use "+' If Above Top of Casing) ,
d. TOP OF CASINO IS 2 FT. Above Land Surface'
'Top of casing terminated aVor below land surface may require
a variance In ace rdanoe with 15A NCAC 2C .0118.
e. YIELD (gprn): METHOD OF TEST BloW
I. DISINFECTION; Type H T H Amount 160z
g. WATER ZONES (depth): r
From /y.'7 To 1���J 7- Frgm 'To_
To
From to r7f l?�r From
From To.1" From- -To
5. CASING:
Thickness/
Depth• _ Dip,. Weight Materlal
From !f ToFt.
From rTo 63Ft. /A•
From To Ft.
7. GROUT: Depth Material
From 0 To 20 Fce meet & bencIattiolyped
From To Ft.
From To Ft.
.10
Method
8. SCREEN: Depth Diameter Slot Size Material
From To Ft. In. In.
From To Ft In. In.
From To Ft In. • In.
9. SAND/GRAVEL PACK:
Depth Size Material.
From To Ft.
From To Ft.
From To Ft.
10. DRILLING LOG
From To
11. REMARKS:
Formation Description
rlay & sand
grans to
aV
01
100 HEREBY CERTIFY THAT THIS WELL WAS CCNSTRUCTEO IN ACCORDANCE WITH 15A NCAC 2C, WELL CONSTRUCTION STANDARCS, AND THAT A CCPY OF TH15
RECORP41A3 BEEN PROVIDED TO THE WELL OWNER.
GNAT RE 0 RTIFIED WELL CONTRACTOR DATE
James B.-Brown
PRINTED NAME OF PERSON CONSTRUCTING THE WELL
Submit the original to the Division of Water Quality within 30 days. Attn: Information Mgt.,
1817 Mall Service Canter- Raleigh, NC 27699.1617 Phone No. [phone] set 868.
Form GWla
Rev. 7/05

RESIDENTIAL WELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources -Division of Water Quality ,3 2 a
WELL CONTRACTOR CERTIFICATION #
2045
1. WELL CONTRACTOR:
James Be Brown
Well Contractor (Individual) Name
Redden Brothers WellDrilling, Inc.
Well Contractor Campany Name .
STREET ADDRESS 73 Holly Hills Vista RD
Franklin, NC 28734
City or Town State Zip Code
('828 )- 369-9591
Area code- Phone number
1. WELL INFORMATION: e 2j / p
SITE WELL ID IR applicable) 1469••g/.J5
.STATE WELL PERMIT/Air applicable)
DWQ or OTHER PERMIT e(If applicable)
WELL USE (Check Applicable •Borra; Residential Water Supply ❑
DATE DRILLED 4 .Ae; �•.�0
TIME. COMPLETED r� (X� AM PM
3. WELL LOCATIO
CITY.
(51?et Nome, Numbers ommunIty,'SubdlNslon, Lot No., Parcel. Zip Code)
TOPOGRAPHIC / LAND SETTING: •
❑Slope °Valley OFIat ❑Ridge ❑Other
(check appropriate box))
LATITUDE _Lz `y?ON
py I
LONGITUDE2 (A9ZLJ.
May be in degrees,
minutes, seconds or
• in a decimal format
Latitude/longitude source: GPS ['Topographic map
(location of well must be s o n on a USGS topo map and
attached to this form if not using GPS)
4. WELL OWNER
OWNER'S NAME
STREET ADD
,tlriv ) 1 r
Ity or Town - State
( 9Z8 )- fl9 7.9IL q
Zip Code
Area code • Phone number - -
6. WELL DETAILS: .7 l'
a. TOTAL DEPTH: Ci ("
b. DOES WELL REPLACE EXISTING WELL?
YES 0� NOK
e.: WATER LEVEL Below Top, of Casing: 000 FT.
(Use's" If Above Top of Casing)
d. TOP OP CASING Is 2 FT, Above Land Surface'
*Top of casing terminated 5Vor below land surface may require
a variance In accordance with 15A NCAC 2C ,0118. .6 e. YIELD (gpm): METHOD OF TEST 81°W
f. DISINFECTION: Type H T H
g. WATER ZONES (depth):
Prom _ r To eg10Y From To
From 5 IT0---.21 From To
From To - - • From • To
6. CASING: Thickness/ •
Amount 1602
Depth qq a�o,.qq
From O To Ft.
From • To Ft.
From To Ft..
Direr Welph{�i 1�1 erial
(i
7. GROUT: Depth Material Method
From 0 To 20 FCement & benonite puntpE
From To Ft.
From To Ft.
8. SCREEN: Depth Diameter Slot Size Material
From To Ft, In. In.
From To Ft. In. In,
From To Ft. In. In.
9. SAND/GRAVEL PACK:
Depth Size Materiel.
From To FI.
From To Ft.
From To Ft.
10. DRILLING LOG
From Tg,r_0r
Formation Description
clay & sand
grant -a'
t
n•
11. __Lb Y ' L��
�
I DO HEREBY CERTIFY THAT THIS WELL WAS CCNSTRUCTEO IN ACCCROANCE WITH
t5A NCAC 2C. WELL CONSTRUCTION STANOARCS, AND THAT A CCPY OF MIS
RECORS BEEN PROVIDED • THE WELL OWNER.
NATURE 0
ERTIF EO WELL CONTRACTOR DATE
James B. Brown
PRINTED NAME OF PERSON CONSTRUCTING THE WELL
Submit the original to the Division of Water Quality within 30 days, Attn: Information Mgt,
1817 Mail Servk6 Center- Raielgh, NC 27699.1617 Phone No. [phone] eat 688.
Form GW-la
Rev. 7/05

RESIDENTIAL WELL -CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources - Division of Water Quality
WELL CONTRACTOR CERTIFICATION # . 2045
+4ApHf-A,
ei .', e r .
1. WELL CONTRACTOR:
James B. Brown
Well Contractor (Individual) Name .
Hedde:n. Brothers Well Drilling, Inc.
Well Contractor Company Name
•
STREET ADDRESS 73 Holly Hills Vista RD
Franklin, NC 28734
City or Town State Zip Code
(828 )• 369-9591
Area code- Phone number
2. WELL INFORMATION:. ry sit
SITE WELL ID egl applicable) 7I/OGf 1 •, ✓�/ /�i
STATE WELL FERMI-fe(ir applicable)
DWG or OTHER PERMIT #(If applicable) WELL USE (Check App!cable Box): Residential Water Supply ❑
DATE DRILLED
TIME COMPLETED AM PM*.
3. WELL LOCATIO //``
V(Slnet el Name, Numbers, Community, Subdlualon, Lot Na., Parcel, Zlp Code)
TOPOGRAPHIC / LAND SETTING:
°Slope °Valley °Flat ❑Ridge ❑Other
(check spprapd eta box)
LATITUDE g
LONGITUDE& Jfi
Latitude/longitude source: GPS (DTopographic map
(location of well must be s o n on a USGS topo map and
attached to thls to If not using GPS)
4. WELL OWNER (J/ /10-4710-)I_
OWNER'S NAME L ! O
May be in degrees,
minutes, seconds or
in a decimal format
City or own . ` State
( Sts . &a =541 J
Area code • Phone number
5. WELL DETAILS: /�, r
a. TOTAL DEPTH: 5.01J I ('
b. DOES WELL REPLACE EXISTING WELL? YES 0 NO Bp
c.. WATER LEVEL Below Top. of Casing: OSCCi FT.
(Use'+" If Above Top of Cuing)
d. TOP OP CASINO IS 2 FT, Above Land Surface'
'Top of casing terminated auor below land surface may require
a valence In accordance with 15A NCAC 2C .0118.
e. YIELD (gpm): orD METHOD OF TEST Blow
STRETADDRESS
S4570
Zip Code
f. DISINFECTION; Type H T H Amount 1 60z
g. WATER ZONES (depth):,
!
From ��'aTo 2 1 . From
`
Framer i o From To
From To
Thickness/
From Depth Dlgmeter Weight It
I
m TcFt. �}Q
Ta Ft. (�" /� �`ie . �%
FroFrom m_ To Ft.
7. GROUT: Depth Material Method
From 0 To 20 FGement & benonite
8. CASING:
From To Ft.
From To Ft.
To
8. SCREEN: Depth Diameter Slot Size Material
From To Ft. In. In.
From To Ft. In. in.
From To Ft. In. In.
9. SAND/GRAVEL PACK:
Depth Size Material.
Frcm To FI.
From To Ft.
From To Ft.
10. DRILLING LOG
From To
11. REMARKS:
Formation Description
clay & cand
rani to
1 o0 HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCCROANCE WITH
ISA NCAC 7C, WELL CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS
RECS.'7 AS BEEN PROVIDED TO THE WELL OWNER.
-61
NATURE OF C IFI 0 WELL CONTRACTOR DATE
James B. Brown
PRINTED NAME OF PERSON CONSTRUCTING THE WELL
Submit the original to the Division of Water Quality within 30 days. Attn: Information Mgt.,
1817 Mall Service Center- Raleigh, NC 21699.1617 Phone No. [phone] ext 668.
Form GW-la
Rev. 7/05
DPo

RESIDENTIAL WELL CONSTRUCTION RECORD
North Carolina Department of Envronment and Natural Resources- Division of Water Quality
WELL CONTRACTOR CERTIFICATION t1 . 2045
1. WELL CONTRACTOR:
James B. Brown
Well Contractor (IndNideal) Name
Hedden Brothers Well Drilling, Inc.
Well Contractor Company Name
^TREET ADDRESS 73 Holly Hills Vista RD
Franklin, NC 28734
City or Town State Zip Code
B2B )- 369-9591
Area code- Phone number
2. WELL INFORMATION:
SITE WELL ID #(if applicable) 7531 '&?• 7a a 5
STATE WELL PERMIT#01 applicable)
DWQ or OTHER PERMIT #(If applicable)
WELL USE (Check Applicable Box):) Residential Water Supply 54
DATE DRILLED L 15 •�0l0
�
":W EAE COMPLETED 5 ••
/ !_L LOON:
I
AM ❑
CITY: t2 COUNTY
PMM
( treat Name, Number, Community, SubdiNeion, Lot No., Parcel, Zip Code)
TOPOGRAPHIC f LAND SETTING:
Ej Slope °Valley 0 Flat °Ridge °Other
(check appropriate box)
LATITUDE
-';NGITUDE_ _
Latitude/longitude source; DGPS 0Topographic map
(location of well must be shown on a USGS lop map and
attached to this form If not using GPS)
4. WELL OWNER
OWNER'S NAME 1 rW4A-4J " 'mil Eut.L{ -
May be in degrees,
minutes, seconds or
in a decimal format
STREET ADDRESS
MC
City Qoroown State
Lilt 5077158
Area code- Phone number
5. WELL. DETAILS: /�� I
a, TOTAL DEPTH: "r(/V
b: DOES WELL REPLACE EXISTING WELL?? ^Y�ESS 0 NO4
3ll
c. WATER LEVEL Below Top of Casing: V FT.
(Use'+" If Above Top of Casing) d. TOP OF CASINO IS 2 FT. Above Land Surface
*Top of casing terminated aVOr below land surface may require
a variance In aceg0(dance with 15A NCAC 2C .0118.
e. YIELD (gpm): METHOD OF TEST Blow
IS
•
f. DISINFECTION: Type H T H Amount 1 60z
g. WATER ZONES (depth):
�f
• From 1a3�1• To From To
From 19a�1 r To l From To
From To From To
6. CASING: Thickness/
Dept' 0 ¢ Dlagneler Weight M e'el
From To_ .(h." Ft. la
From_ 3 To_ 44! J RS
From To Ft.
7. GROUT: Depth Material Method
From 0 To 20 Fcement & benonite
From To Ft.
From To Ft.
8. SCREEN: Depth Diameter Slot Size Material
From To Ft. ' In. In.
From To Ft. In In.
From To Ft. in. In.
9. SAND/GRAVEL PACK:
Depth Size Material.
From To Ft.
From To Ft.
From• To Ft.
10. DRILLING LOG
From To
11. REMARKS:
Formation Description
play & aanri
(rani1
co
o c—
V
I DD HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH
15A NCAC 2C, WELL CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS
RECOR •„ 5 BEEN PROVIDED TO THE WELL OWNER.
S� ATURE OF CE FIED WELL CONTRACTOR DATE
James B. Brown
PRINTED NAME OF PERSON CONSTRUCTING THE WELL
,t,5mit the original to the Division of Water Quality within 30 days. Attn: Information Mgt.,
t iT Mail Service Center —Raleigh, NC 27699.1617 Phone No. [phone] ext 568.
Form G W-1 a
Rev. 7/05

RESIDENTJAL WELL CONSTRUCTION RECORD
North Carolina Department of Envfonment and Natural Resources- Division of Water Quality
WELL CONTRACTOR CERTIFICATION # . 2045
1, WELL CONTRACTOR:
James B. Brown
We.: Contractor (Individual) Name
Redden Brothers 44811 Drilling, Inc.
W :'Contractor Company Name
STREET ADDRESS 73 Holly Hills Vista RD
Franklin, NC 28734
City or Town State Zip Code
(828 )• 364-9591
Area code- Phone number ,
2. WELL INFORMATION:
SITE WELL ID Cif applicable)
STATE WELL PERMIT#(11 applicable)
DWQ or OTHER PERMIT 1(11 applicable)
WELL U9E (Check Applicable Box): Residential Water Supply ❑
DATE DRILLED 141Qa. 2 eD UIe
TIME COMPLETED 1 3'. OS AM ❑ PM
3. WELL LOON:
CIT1Y.:'� �v� COUNTY ll�C'.�-S/JAe•+
ac
(Street Name, Numbers, Community, SubdkAelon, Lot No., Parcel, Zip Code)
TOPOGRAPHIC / LAND SETTING: •
❑Slope (Valley ❑Flat ORldge Other
(check eppropnate box)
LATITUDE _,
LONGITUDE
Latitude/longitude source: DGPS 0Topographic map
(location of well must be shown on a USGS topo map and
attached to this form if not using GPS)
1. WELL OWNER U0I [`'�' • 1
OWNER'S NAME l.J �^t' "��'1Yhij \"�1
STREET ADDRESS 76 Zell
w7
May be in degrees,
minutes, seconds or
in a decimal format
V NC a.%1tI
own 9 State Zip Code
{1 City
I 9,29). 502-13 4 i
Area code • Phone number
6. WELL DETAILS: �1 s
a. TOTAL DEPTH: t D6
b. DOES WELL REPLACE EXISTING WELL?, YES ❑ NO ❑
e.: WATER LEVEL Below Top,of Casing: Le FT.
• (Use'+' 11 Above Top of Casing)
d. TOP OP CASINO IS 2 FT. Above Land Surface'
'Tap of casing terminated sVor below lend surface may require
a variance in accordance with 1SA NCAC 2C ,0118. .
t
e. YIELD (gpm): 1 z METHOD OF TEST 131°W
1. DISINFECTION: Type H T H Amount 1 60z
g. WATEucemES (deyp�th):
From /0 To VD From To
From To From To
From - To From To
e. CASINO: Thickness/
Depth Dlalnelm Weight Mye ial
From To �.JJTT�,�nyy�.ee Ft. !!Oo
From To (.1 FL_ 186
From To Ft.
7. GROUT: Depth Material Method
From 0 To 20 FGem6nnt & benonite e'
From To Ft.
From To Ft.
d, SCREEN: Depth Diameter Slot Size Material
From To Ft. In. In.
From To Ft. In, In.
From To Ft in In.
9. SAND/GRAVEL PACK:
Depth
From To Ft.
From To Ft.
From To Ft,
Size Material
10. DRILLING LOG
From To
11. REMARKS:
Formation Description
clAy & Rand
grani f•P
x-,
i
rm
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH
ISA NCAC 2C, WELL CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS
REC s AS BEEN PROVIDED TO THE WELL OWNER.
ATURE OF CEAITFIED WELL CONTRACTOR DATE
James B. Brown
PRINTED NAME OF PERSON CONSTRUCTING THE WELL
Submit the original to the Division of Water Quality within 30 days. Attn: Information Mgt.,
1617 Mall Service Center— Raleigh, NC 27699.1617 Phone No. [phone] extb88.
Form GW-la
Rev. 7/05

RESIDENTIAL WELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources- Division of Water Quality
WELL CONTRACTOR CERTIFICATION # . 2045
1. WELL CONTRACTOR:
James B. Brown
Well Contractor (Individual) Name
'Redden Brothers Well Drilling, Inc.
Well Contractor Company Name
''TREET ADDRESS 73 Holly Hills Vista RD
Franklin, NC 28734
City or Town State Zip Code
(828 )- 369-9591
Area code- Phone number
2. WELL INFORMATION: �L
SITE WELL ID#(Ir applicable) 7AO3.93-�Iq�
0O
STATE WELL PERMIT#(If applicable)
'DWQ or OTHER PERMIT Cif applicable)
:LL USE (Check Applicable Box): Residential Water Supply
;ATE DRILLED IO .144 ' 0(0
":ME COMPLETED 4%. 2.0 AM 0 PMk
3. WELL LQ
SIT
ATION:
4—
COUNTY (1)04.012.02,01-7
(Street Nafi,JNumbers, Community. Subdivision. Lot No., Parcel, Zip Code)
TOPOGRAPHIC / LAND SETTING:
D Slope OValley ❑Flat ❑Ridge DOther
(check appropriate box)
LATITUDE . et:t 53i
NGITUDE 13 2 9 80
..litude/longitude source: [ iPS OTopographic map
(location of well must be shown on a USGS tope map and
attached to this form Snot using GPS)
4. WELL OWNER
OWNER'S NAME LTV J ltiti/LI1s
S, REET ADDRESS
May be in degrees,
minutes, seconds or
in a decimal format
Clt6 or Town / J' State
tit )- '-jfl. 6a5
• Area code - Phone number
6. WELL DETAILS: A�
a. TOTAL DEPTH: (%
b. DOES WELL REPLACE EXISTING WELL? YES 0 NO&
YE
c. WATER LEVEL Below Top of Casing: FT.
(Use '4." if Above Top of Casing)
d. TOP OF CASING 13 2 FT. Above Land Surface'
'Top of casing terminated at/or below land surface may require
a variance In accordance with 15A NCAC 2C .0118.
e. YIELD (gpm): 3'G METHOD OF TEST Blow
•
f. DISINFECTION: Type H T H Amount 160Z
g. WATER ZONES (depth):th7
From 53 7To 551 ' From To From To From To
From To From To
6. CASING: Thickness/
Depth DIap1eW Weight Material
From To Ft. ((gyp �
From 'To Ft• LC�
From To Ft.
7. GROUT: Depth Material
From 0 To 20 p event & benonite
From To Fl.
From To Ft:
Method
8. SCREEN: Depth Diameter Slot Size Material
From To Ft. In. In,
From To Ft. In. In.
From To Ft in. In.
9. SAND/GRAVEL PACK:
Depth Size Material.
From To Ft.
From To Ft.
From
To Ft.
10. DRILLING LOG
From To LL
11. REMARKS:
Formation Description
r)ay & sand
grantfp
G
Tv
E
0
r-
100 HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH
I5A NCAC 2C. WELL CONSTRUCTION STANDARDS. AND THAT A COPY OF THIS
RECOR. -AS BEEN PROVIDED TO THE WELL OWNER.
eW DATE
406
5 >' ATURE OF CERT IED WELL CONTRACTOR' DATE
James B. Brawn
PRINTED NAME OF PERSON CONSTRUCTING THE WELL
:- '2mit the original to the Division of Water Quality within 30 days. Attn: Information Mgt.,
t1 ' Mail Service Center— Raleigh, NC 27699.1617 Phone No. [phone] ext 668.
Form GW-1a
Rev. 7/05

RESIDENTIAL WELL CONSTRUCTION RECORD
North Carolina Department of Envi onment and Natural Resources- Division of Water Quality
WELL CONTRACTOR CERTIFICATION # .• 2045
t. WELL CONTRACTOR:
James B. Brown
Wel! Contractor (individual) Name
Redden Brothers Well Drilling, Inc.
Wail CtttraEtor Company Name -- -
STREET ADDRESS 73 Holly Hills Vista RD
Franklin. NC 28734
City or Town State Zip Code
828 )- 369-9591
Area code- Phone number
2. WELL INFORMATION: ��t1 p C��t
SITE WELL ID #(ir applicable) 1•y (0 9 I 5 I - O7vnf
STATE WELLPERMIT#(ir applicable)
:,:WQ or OTHER PERMIT *(if applicable)
WELL USE (Check Applicable Box): Residential Water Supply
DATE DRILLED lc / 06 TIME COMPLETED 5 : oO AM ❑ PMk
3. WELL LOATION:
CITY:
(Street Name, Numbers, Community, Subdi4IIon, Lot No., Parcel, Zip Code)
TOPOGRAPHIC / LAND SETTING •
:
°Slope °Valley ❑Flat ORidge °Other
' (check eppropdate box)
LATITUDE J1_
LONGITUDE
Latitude/longitude source: ❑GPS ❑Topographic map
(location of well must be shown on a USGS topo map and
attached to this form snot using GPS)
4. WELL OWNER
OWNER'S NAME
STET 4pDRESS IV . `C
-.._eg77
Zip Codeb
May be in degrees,
minutes, seconds or
in a decimal format
City or tjwh•
(2 Z� )- 55L-fq 45
Area code • Phone number
6. WELL DETAILS: lily vO-
a. TOTAL DEPTH:
b. DOES WELL REPLACE EXISTING WELL? YES ❑ NO$
e.: WATER LEVEL Below Top of Casing: 500 FT.
(Use'•° If Above Top of Casing)
d. TOP OP CASINO Is 2 FT. Above Land Surface'
'Top of casing terminated at/or below lend surface may require
a variance In accordance with 15A NCAC 2C .0118.
e. YIELD (gpm): CJj METHOD OF TEST Blow
State
1. DISINFECTION: Type H T H Amount 160z
g. WATER ZONES (depth)
-e-llpth)
From 73To.J� From To
From 5'U4 ' r To From To
From To Fronts_ To .
8. CASING: Thickness/
Depth dd Dlgmeleer Weight feria:
From To 5 I Ft. l " I?S
From To Ft.
From To Ft. _
7. GROUT: Depth Material Method
From 0 To 20 pvement & benonite •• �
From To Ft.
From To Ft.
8. SCREEN: Dbpiii Dlameler Slot Size Material
From To Ft. In. In.
From To Ft. in. In.
From To Ft. In. In.
9. SAND/GRAVEL PACK:
Depth Size - Material
From To Ft.
From To FL
From To Ft.
10. DRILLING LOG
11. REMARKS:
Formation Description
(-lay & sand
rani 1-0
0
r_
n
0 Cr
1 DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH
ISA NCAC t WELL CONSTRUCTION STANDARDS. AND THAT A COPY OF THIS
RECOR BEEN PROVIDED TO THE WELL OWNER.
H!'SIG6IATUkE OF CER 0 WELLCONTRACTO DATE
James B. Brown
PRINTED NAME OF PERSON CONSTRUCTING THE WELL
Submit the original to the Division of Water Quality within 30 days. Attn: Information Mgt.,
1617 Mall Saralee Cantor- Raleigh, NC 27699.1617 Phone No. [phone] ext 666.
Form GWla
Rev. 7/05

RESIDENTIAL WELL CONSTRUCTION RECORD •
North Carolina Department of Environment and Natural Resources- Divisionof Water Quality
WELL CONTRACTOR CERTIFICATION # . 2045
1. WELL CONTRACTOR:
James B. Brown
Well Contractor (Individual) Name
Redden Brothers Well Drilling, Inc:
Well Contractor Company Name _.
STREET ADDRESS 73'Holly Hills Vista RD
Franklin. NC 28734
City or Town State Zip Code
(828 )- 369-9591
Area code- Phone number ,
2. WELL INFORMATION: r7/ _
SITE WELL ID t#(it applicable) r(D0-1 i-`' Li
STATE WELLPERMITM(II applicably
DWQ or OTHER PERMIT 0(If applicable)
WELL USE (Check
DATE DRILLED
TIME. COMPLETED
3. WELL LOCATION:
CITY:
plicabie Box): Residential Water Supply ❑
�' Piti iiL "ALA 1 �i
(Street N me, Number., Community, Subdh4.lo , La No., Parcel. Zip Code)
TOPOGRAPHIC / LAND SETTING: •
°Slope °Valley ❑Flat ❑Ridge ❑Other
(check appropriate box)
LATITUDE
LONGITUDE
May be in degrees,
minutes, seconds or
in a decimal format
Latitude/longitude source: ❑GPS ❑Topographic map
(Iccat/cn of well must be shown on a USGS topo map and
attached to th/s form /t not using GPS)
t. WELL OWNER •
1
OWNER'S NAME O 44 11114 ()GU QLQK.J
$II,T'AREEETT AADDDD-R2ESS1 l' 6-Srt
City or Town 1. 51 te,tD Zi7 Code
(s $)_aA e
Area code • Phone number
5, WELL DETAILS: / �t
a. TOTAL DEPTH: tQ
b. DOES WELL REPLACE EXISTING WELL? YES ❑ NOk
a. WATER LEVEL Below Top of Casing: ' FT,
(Use'+" If Above Top of Casing)
d. TOP OF CAa1N0 IS - 2 - FT. Above Land Surface'
'Top of casing terminated at/or below land surface may require
a variance In accordance with 15A NCAC 2C .0118.
e. YIELD (gpm): METHOD OF TEST Blow
f. DISINFECTION: Type H T H Amount 160E
g. WATER Z NES (depth): r
Fror.,_LI To - From To
From r T o From To
From To ' From To
8. CASING: Thickness/
0Dept DlapFletCr Weight Material
From To Ft. CD ' 3Ji—
From 73 To Ft._ _ _
From To Ft.
7. GROUT: Depth Material Method
From 0 To 20 Fcement & benoniteed
From To_ Ft.
From To Ft.
8. SCREEN: Depth Diameter Slot Size Material
From To Ft. In. In.
From To Ft. in. In.
From To Ft. In. In.
9. SAND/GRAVEL PACK:
Depth Size - Material.
From To Ft,
From - To Ft.
From To Ft.
10. DRILLING LOG
From To
11. REMARKS:
Formation Description
rlay & sand
grant trz
7
100 HERESY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH
ISA N .0 2C, WELL. CONSTRUCTION STANOARCS. AND THAT A COPY OF THIS
AS SEEN PROVIDED TR.
NATURE OF CERTIFIED WELL CONTRACTOR DATE
James B. Brown
PRINTED NAME OF PERSON CONSTRUCTING THE WELL
Submit the original to the Division of Water Quality within 30 days. Attn: Information Mgt.,
1617 Mall Service Center- Raleigh, NC 27699.1817 Phone No. [phone] eat 688.
Form GW-la
Rev. 7/05

• RESIDENTIAL WELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources- Division of Water Quality
WELL CONTRACTOR CERTIFICATION #
2045
a AS
fl CI
1. WELL CONTRACTOR:
James B. Brown
Well Contractor (Individual) Name
Redden Brothers Well Drilling, Inc.
Well Contractor Company Name -
STREETADDRESS. 73 Holly Hills Vista RD
Franklin, NC 28734
City or Town State
( 828 )- 369-9991
ZIp Code
Area code- Phone number
2. WELL INFORMATION: ey' ^ rye
SITE WELL ID #(ir applicable) ICCLf 0-07)-10 ,O9
STATE WELL PERMIT#(e applicable)
DWQ or OTHER PERMIT #(if applicable)
WELL USE (Check Applicable Box): Residential Water Supply
DATE DRILLED 5. Ate .0
TIME COMPLETED ti •O AM
3. WELL LQCATION:
COUNTY,
PrA
(Streit Name, Numbers, Comm Its,
ubdiNSlon, Lot Na., Parcel, Zlp Code)
TOPOGRAPHIC/LAND SETTING: •
O Slope ❑Valley ❑Flat CI Ridge ❑Other
(check appropriate box)
LATITUDE _3_
LONGITUDE
May be in degrees,
minutes, seconds or
in a decimal format
Latitude/longitude source: ❑GPS ❑ Topographic map
(location of well must be shown on a USGS topo map end
attached to this form a not using GPS)
4. WELL OWNER
OWNER'S NAME
rEET ADO SS
JArL
City or Town • isletsZip Code
(? 0 3)- Aid 3 -010-1
Area code • Phone number
6. WELL DETAILS:(
a. TOTAL DEPTH:
b. DOES WELL REPLACE EXISTING WELL? YES
c., WATER LEVEL Below Top. of Casing: 1 FT.
(Use'✓ If Above Top of Casing)
d. TOP OF CASINO is - 2 _ FT, Above Land Surface'.
'Top of casing terminated at/or below land surface may require
a variance In accordance with 15A NCAC 2C .0118.
e. YIELD (gpm): ia--e METHOD OF TEST Blow
abocinc
f. DISINFECTION: Type H T H Amount 160z
g. WATER ZQNfS (depth): a
From �'To) From
From L To From
c�- To
From To
6. CASING: From DTohy�t N
(mil FL Diameter WIZe yWCLP
aw*
From To Ft. ( Zt
From To Ft.
_To
From
7, GROUT: Depth Material
From 0 To 20 Foement & benonite
From To Ft.
Thickness/ •
From To Ft.
Method
6. SCREEN: Depth Diameter Slot Size Material
From To Ft. In. in.
From To Ft. in. In.
From To FL In. In.
9. SAND/GRAVEL PACK:
Depth Size Material.
From To FI.
From To Ft.
From To Ft.
10. DRILLING LOG
11. REMARKS:
Formation Description
clay & sand
grant t'o
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH
1SA NCAC 2C, WELL CONSTRUCTOR STANCARCS, AND THAT COPY OF THIS
HBEEN CVICEDT�ER.
NATURE CF CERTIFIED WELL CONTRACTOR DATE
James B. Brown
PRINTED NAME OF PERSON CONSTRUCTING THE WELL
Submit the original to the Division of Water Quality within 30 days. Attn: Information Mgt,
1617 Mall Service Center- Raleigh, NC 27699.1817 Phone No. [phone] ext 688.
Fenn GWta
Rev. 7/05

RESIDENTIAL WELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources -Division of Water Quality
WELL CONTRACTOR CERTIFICATION # • 2045
1. WELL CONTRACTOR:
James B. Brown
lr' 1 :".:infractor (Individual) Name
:redden Brothers Well Drilling, Inc.
Well Contractor Company Name
STREET ADDRESS 73 Holly Hills Vista RD
Franklin, NC 28734
City or Town State Zip Code
(828 )- 369-9591
Area code- Phone number
2. WELL INFORMATION:
SITE WELL ID Cif applicable) 763/3.-/3-31,1
STATE WELL PERMITS(If applicable)
DWQ or OTHER PERMIT bllf applicable)
WELL USE (Check Appliicqca��bttle Box):/ Residential Water Supply (2DATE DRILLED .�-Ofcf' rA'
ar oo AMC PM9(
TIME COMPLETED
3. WELL LOTTION:
CITY:
I
�A COUNTY
44711) a
(Strut Name, Numbers VUCommunity, SubdhAslon, Lot No., Parcel, Zip Code)
TOPOGRAPHIC / LAND SETTING: •
❑Slope °Valley ❑Flat ❑RIdge ❑Other
(check appropriate box)
LATITUDE _3_
LONGITUDE
May be in degrees,
minutes, seconds or
in a decimal formal
Latitude/longitude source: ° GPS °Topographic map
(location of well must be shown one USGS topo map and
attached to this form Knot using GPS) •
4. WELL OWNER /n�
OWNER'S NAME : � P�
ST ET ADDRESS n d?Li-LI (04l_e
roc ainito
City or Twin • ' State Zip Code
(VA). )- 674s' 93L9
Area code • Phone number
6. WELL. DETAILS:
a. TOTAL DEPTH: aitAJ
b. DOES WELL REPLACE EXISTING WELL? YES ❑ NO1
a. WATER LEVEL Belau Top. of Casing: - clOn FT.
(Use's" If Above Top of Casing)
d. TOP OP CASINO IS 2 - FT. Above Land Surface' -
*Top of casing terminated aVor below land surface may require
a variance In accordance with 15A NCAC 2C .0118.
a. YIELD (gpm): 1 , - METHOD OF TEST Blow
1. DISINFECTION: Type H T H Amount 160z
g. WATER ZONES (depth :1
From C * To - From - To
Frcr To c J7' From To
From ,. 70 To,& 74 From To
8. CASING: Thickness! •
Depth Dlamejer Weight M;le,rlal
From _�7T To Ft. W ;gyp f, L
From-75 7 To Ft. 7. " 5ta1Li
From To Ft. _
7. GROUT: Depth Material Method
From 0 To 20 mement & benonite
From To Ft.
From To Ft.
S. SCREEN: Depth Diameter Slot Size Material
From To Ft. In. in.
From To Ft in In.
From To Ft. In. In.
9. SAND/GRAVEL PACK:
Depth Size Material.
From To Ft.
From To Ft.
Frcm To Ft.
10 DRILLING LOG
From To
11. REMARKS:
Formation Description
rlay & card
grant tP
fl
Crs
100 HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCCRDANCE WITH ISA NCAC SC. WELL CONSTRUCTION STANOARCS, AND THAT A COPY CF THIS
RECOEa'IAS BEEN PROVIDED TO THE WELL OWNER.
ti n- iescm, ` DATED(,
AT RE OF CET ED WELL CONTRACTOR DATE
James B. Brown
PRINTED NAME OF PERSON CONSTRUCTING THE WELL
Submit the original to the Division of Water Quality within 30 days. Attn: Information Mgt.,
1617 Mall Service Center- Raleigh, NC 27699.1617 Phone No. [phone] eat 688.
Form GW-1a
Rev. 7/05

RESIDENTIAL WELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources - Division of Water Quality
WELL CONTRACTOR CERTIFICATION # 2045
/.rf
_.
1. WELL CONTRACTOR:
James B. Brown
Well Contractor (In'Ldd',al) Name
Hedden Brothers Well Drilling, Inc. --
Well Contractor Company Name
STREET ADDRESS 73' Holly. Hills Vista RD •
Franklin, -NC 28734
City or Town State Zip Code
(828 )- 369-9591
Area code- Phone number
2. WELL INFORMATION:. 2
SITE WELL ID #pr applicabtel "TiO13 - I 6
STATE WELLPERMIT#(if applicable)
DWQ or OTHER PERMIT #(if applicable)
WELL USE (Check Applicable Box): Residential Water SuppiY 0
F
DATE DRILLED . )' H co
TIME COMPLETED 3 o AM 0 PMM
3, WELL LOCATION:]�I,/r�1^ ^
CITY: l RU/t _ COUNTY Lj.0 kMii i
stediMAID Numbers,
�u +
(Strut Name, Numbers, Community, bdiNslon, Lot No., Parcel, Zip Code)
TOPOGRAPHIC / LAND SETTING: -
❑Slope °Valley ❑Flat 0 Ridge 0 Other
(check uppropd ate box)
LATITUDE r25
LONGITUDE a7
May be in degrees,
minutes, seconds or
in a decimal format
Latitude/longitude source: ,(GPS °Topographic map
(location of well must be swn on a USGS tope map and
attached to th/s form it not using GPS)
4. WELL OWNER I'
OWNER'S NAME V
STREET ADDRESS
State Zip Code
7-307.5
Area code • Phone number
5. WELL DETAILS:
a. TOTAL DEPTH:
b. DOES WELL REPLACE EXISTING WELL? YESYE0 NO
c.: WATER LEVEL Below Top of Casing' - Ste FT.
(Use'+" If Above Top of Casing)
d. TOP OP CASINO IS - 2 - - FT. Above Land Surface'
'Top of casing terminated at/or below land surface may require
a valance In ec rdance with 15A NCAC 2C .0118,
a. YIELD (gpm): I METHOD OF TEST Blow
f. DISINFECTION: Type H T H Amount 160z
g. WATER ZONES (depth):
From To /f From To
From
fo� From - To
From To -._'FromTo
6. CASING:
From Depth r,y'� Dlpmeter
To Ft.
From � To FL ? .r
P "
From To Ft.
7. GROUT: Depth Matilda(Method
From 0 To 20 FGgnent & benonite
Frain To Ft.
From To Ft.
8, SCREEN: Depth Diameter Slot Size Material
From To Ft. In. In.
From To Ft. In. In.
From To Ft. In. In,
Thickness/
Weight MAlerlal
9. SAND/GRAVEL PACK:
Depth
From To Ft.
From - To Ft.
From To Ft.
10. DRILLING LOG
From To
nfiewp
11. REMARKS:
Size Matenal
Formation Description
rl ay R sand
granita•
L
a
Ol
VS
100 HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH
ISA NC . WELL CONSTRUCTION STANDARDS. AND THAT A COPY OF THIS
RE C•..tEI:G BEEN PROVICEO T0, E WELL OWNER.
ATURE
ED WELL CONTRACTOR DATE
James B. Bruin
PRINTED NAME OF PERSON CONSTRUCTING THE WELL
Submit the original to the Division of Water Quality within 30 days. Attn: Information Mgt.,
1617 Mall Service Center —Raleigh, NC 27699.1617 Phone No. [phone] ext568.
Form GWla
Rev. 7/05

RESIDENTIAL WELL CONSTRUCTI
North Carolina Department of Environment and Natural Resources- Division of Water Quality
WELL CONTRACTOR CERTIFICATION # 2045
1. WELL CONTRACTOR:
James B. Brown
Well Contractor (Individual) Name
Hedden Brothers Well Drilling, Inc.
Well Contractor Company Name
STREET ADDRESS 73 Holly Hills Vista RD
Franklin, NC 28734
City or Town State Zip Code
(828 )- 369-9591
Area code- Phone number
2. WELL. INFORMATION: n/ /��(
SITE WELL ID #(il applicable) /l0 76
STATE WELL PERMIT#lit applicable)
DWQ or OTHER PERMIT #(if applicable)
WELL USE (Check pplicable Box): Residential Water Supplt)fl
(01.53,281
DATE DRILLED AJ00( I /
TIMECOMPLETED I1 .l.)6/ AM ® PM ❑
3. WELL LO TION:
CITY
I ) • • �12,1 ed,
(Stree Name, Numbers, Community, Subdivision, Lot No., Parcel. Zip Code)
TOPOGRAPHIC / LAND SETTING:
O Slope DValley ❑Flat ❑Ridge ❑Other
(check appropriate box)
LATITUDE
LONGITUDE
Latitude/longitude source: OGPS 0Topographic map
(location of well must be shown on a USGS topo map and
attached to this to 1 it not using GPS)
4.:VELL OWNER
OWNER'S NAME
COUNTY
May be in degrees,
minutes, seconds or
in a decimal format
ST: ET • DDRESS
Zip Code
Area code - Phone number
5. WELL DETAILS: �O� a. TOTAL DEPTH:
b. DOES WELL REPLACE EXISTING WELL? YES 0 NOA
c. WATER LEVEL Below Top of Casing: SO FT.
(Use if Above Top of Casing)
d. TOP OF CASING IS 2 FT. Above Land Surface -
'Top of casing terminated at/or below land surface may require
a variance In �T
accordance
�with 15A NCAC 2C .01113.
e. YIELD (gpm): / METHOD OF TEST Blow
320737
f. DISINFECTION: Type H T H
Amount 160z
g. WATER ZONES (denth):
jatFrom- //O To / O From To
From /JJ r To From To
From /••77/7 To / From To
6. CASING:
D Depth ♦ s Di9mevjer
From To I Ft. 6fr
From F.9 To 91 Ft. TO " /'R
From To Ft.
Thickness/
Weight Material
C-
7. GROUT: Depth Material Method
From 0 To 20 opement & benolIitiumped
From To Ft.
From To Ft.
6. SCREEN: Depth Diameter Slot Size
From To Ft. in.
From To Ft. in.
From To Ft. in.
Material
In.
in.
in.
9. SAND/GRAVEL PACK:
Depth Size Matedal
From To Ft.
From To Ft.
From To Ft.
10. DRILLING LOG
From To
11. REMARKS:
Formation Description
clay & and
granite
DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH
ISA NCAC 2C, WELL CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS
RECOgp.1/AS BEEN PROVIDED TO THE WELL OWNER.
NATURE OF CERTIFIED WELL CONTRACTOR DATE
James B. Brown
PRINTED NAME OF PERSON CONSTRUCTING THE WELL
Submit the original to the Division of Water Quality within 30 days. Attn: Information Mgt.,
1617 Mail Service Center— Raleigh, NC 27699-1617 Phone No. [phone] ext 568.
Form GW-la
Rev. 7/05

DATE DRILLED
TIME COMPLETED
9. WELL LOC4TIO
CITY:
IV
RESIDENTIAL WELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources- Division of Water Quality
WELL CONTRACTOR CERTIFICATION # 2045
1. WELL CONTRACTOR:
James B. Brown
Well Contractor (Individual) Name
Hedden Brothers Well Drilling, Inc.
Well Contractor Company Name
STREET ADDRESS
73 Holly Hills Vista RD
Franklin, NC 28734
City or Town State Zip Code
(828 )- 369-9591
Area code- Phone number
2. WELL INFORMATION:
SITE WELL ID #(If applicable) 7h51-b0
STATE WELL PERMIT#(ir applicable)
DWQ or OTHER PERMIT #(if applicable)
WELL USE (Check Applicable Box): Residential Water Supply ❑
b(o
AM ❑ PM'
COUNTY
(Street Name, Numbers, Community, Subd ion, Lot No.. Parcel, Zip Code)
TOPOGRAPHIC / LAND SETTING:
❑Slope [Walley ❑Fla/ CI Ridge ❑Other
(check appropriate box)
LATITUDE
LONGITUDE
May bein degrees,
minutes, seconds or
in a decimal format
Latitude/longitude source: ❑GPS ❑Topographic map
(location of well must be shown on a USGS topo map and
attached to this form if not using GPS)
4. WELL OWNER
OWNER'S NAME
STREETADDRESS K_ t9 ZO
• City or Town ate Zip Code
( )-Z93.3gsq
Area code - Phone number
5. WELL DETAILS:
a. TOTAL DEPTH:
b. DOES WELL REPLACE EXISTING WELL? YES 0 NO Kp
c. WATER LEVEL Below Top of Casing: 1 bt) FT.
(Use'+" if Above Top of Casing)
d. TOP OF CASING IS 2 FT. Above Land Surface'
*Top of casing terminated at/or below land surface may require
a variance in accydance with 15A NCAC 2C .0118.
e. YIELD (gpm): HU METHOD OF TEST Blow
el
�S r` 1 2 v 0 tic)J
f. DISINFECTION: Type H T H Amount 160z
g. WATER ES (depth): f
From L, To/24/ 1 From To
From To From To
From To From To
6. CASING:
From
From
From To
Depth a Di�mFjer
To Ft. ((OO
Ft 0"
Ft.
Thickness/
Weight M
7. GROUT: Depth Material Method
From 0 To 20 Fcement & benonite
From To Ft.
From To Ft.
8. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in.
From To Ft. in. in.
From To Ft. in. in.
9. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
From To Ft.
10. DRILLING LOG
From Tofl� r
D- I �.fi V r
I
11. REMARKS:
Formation Description
clay & sand
grani t-e
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH
15A NCAC 2C, WELL CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS
RECOO AS BEEN PROVIDED TO THE WELL OWNER,
to -
NATURE OF ttFIED WELL CONTRACTOR DATE Y
James B. Brown
PRINTED NAME OF PERSON CONSTRUCTING THE WELL
Suomit the original to the Division of Water Quality within 30 days. Attn: Information Mgt.,
1417 Mail Service Center— Raleigh, NC 27699-1617 Phone No. [phone] ext 568.
Form GW-la
Rev. 7/05

RESIDENTIAL WELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources- Division of Water Quality
WELL CONTRACTOR CERTIFICATION # 2045
1. WELL CONTRACTOR:
James B. Brown
Well Contractor (Individual) Name
Hedden Brothers Well Drilling, Inc.
Well Contractor Company Name
STREET ADDRESS 73 Holly Hills Vista RD
Franklin, NC 28734
City or Town State Zip Code
(828 ). 369-4591
Area code- Phone number
2. WELL INFORMATION:
SITE WELL ID #(if applicable)
STATE WELL PERMIT#(if applicable)
DWQ or OTHER PERMIT #(if applicable)
WELL USE (Check Applicable Box): Residential Water Supply 0
DATE DRILLED
TIME COMPLETED 'ai,?am ❑ PM.t
3. WELL LOCATION:
CITY:
COUNTY
m� r�8 8°
reel Name, Numbers, Comm y, Subdiwalon, Lot No., Parcel, Zip Code)
TOPOGRAPHIC / LAND SETTING:
❑Slope QValley 0 Flat ❑Ridge DOther
(check appropriate box)
LATITUDE
LONGITUDE
Latitude/longitude source: ❑GPS ❑Topographic map
(location of well must be shown on a USGS topes map and
attached to this ram, if not using GPS)
4. WELL OWNER 1
OWNER'S NAME l
May be in degrees,
minutes, seconds or
in a decimal format
ST,cZfi
City
ET ADDR SS
QMIJ nDL( 0/M25
r Town / Statee
)- i%-O/J�"�'I'
Area code - Phone number
Zip Code
5. WELL DETAILS:. ��.�'
a. TOTAL DEPTH: )
b. DOES WELL REPLACE EXISTING WELL? VEES; NO CLc.yy
e. WATER LEVEL Below Top of Casing:. 0 FT.
(Use "t" If Above Top of Casing)
d. TOP OF CASING IS 2 FT. Above Land Surface*
*Top of casing terminated at/or below land surface may require
a variance In accordance with 15A NCAC 2C .0118.
e. YIELD (gpm): /n METHOD OF TEST Blow
From
6. CASING:
From
From
From
7. GROUT:
From 0
f. DISINFECTION: Type H T H Amount 160z
g. WATER ZONES (depth):
From W.IETo fifdo• From To
From To From To
To From To
Thickness(
Dept
To
Diameter Weight M terial
Ft. CO
Ft. Io' , /88 rr�)
Ft.
Depth Material Method
To 20 FGement & benonite
From To Ft.
From To Ft,
8. SCREEN:
From
From
Depth Diameter Slot Size Material
To Ft. In. In,
To Ft. in. In.
From To Ft. in. in.
9. SAND/GRAVEL PACK:
Depth Size Material.
From To Ft.
From To Ft.
From To Ft.
10. DRILLING LOG
From To
11. REMARKS:
Formation Description
Clay & sand
gnn11 o
t.
OOP
s
G
m'
a
I D0 HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH
15A NCAC 2C, WELL CONSTRUCTION STANDARDS, AND. THAT A COPY OF THIS
RECOBDHAS BEEN PROVIDED TO THE WELL OWNER.
eerp--� c219=0, ,
GNATURE OF ERTIFIED WELL CONTRACTOR DATE
James B. Brown
PRINTED NAME OF PERSON CONSTRUCTING THE WELL
Submit the original to the Division of Water Quality within 30 days. Attn: Information Mgt.,
1617 Mail Service Center— Raleigh, NC 27699.1617 Phone No. [phone] ext 568.
Form GWla
Jt IN 05 2Q06 Rev. 7/05

RESIDENTIAL WELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources- Division of Water Quality
WELL CONTRACTOR CERTIFICATION # 2045
Amount 160z
1. WELL CONTRACTOR:
James B. Brown
Well Contractor (Individual) Name
Hedden Brothers Well Drilling, Inc.
Well Contractor Company Name
STREET ADDRESS 73 Holly Hills Vista RD
Franklin, NC 28734
City or Town State Zip Code
( 828 )- 369-9591
Area code- Phone number ,
2. WELL INFORMATION'
SITE WELL ID #(I( applicable) /LD/ I - / 4- 034--.)
STATE WELL PERMIT#(If applicable)
DWQ or OTHER PERMIT *(If applicable)
WELL USE (Check Applicable Box): Residential Water Supply
DATE DRILLED a ..4 f O`+/,
`I'
TIME COMPLETED • 00 AM 0
3. WELL LOCAT�IO��N:•}�-��-.•
CITY. !.i/-Zfl.Guu[. OUNTY
diniOn 66 OhhoW �a l
(Street Name, Num ra, Community, Subdikislore Logo., Parcel, Zip Code)
TOPOGRAPHIC /LAND SETTING:
❑Slope :Valley ❑Flat ❑Ridge ❑Other
(check eppropdale box)
LATITUDE �S �i�
LONGITUDE23 L5
Latitude/longitude source: ,d'GPS ❑Topographic map
(locatbn of well must be shown on a USGS tope map end
attached to this rem, 11 not using GPS)
PMl,
May be in degrees,
minutes, seconds or
in a decimal format
t. NELL OWNER
OWNER'S NAME
STj2E T pip ES$ _ /U (h 1 �i
City or T State
Area code • Phone number
6. WELL DETAILS: /0T
a. TOTAL DEPTH: 'TL/C/
b. DOES WELL REPLACE EXISTING WELL? YEAS Li NOA
c.; WATER LEVEL Below Top of Casing: 2Vv FT.
(Use"+" If Above Top of Casing)
Saiena-
t
llipCode
d. TOP OF CASINO IS 2
FT. Above Land Surface•
*Top of casing terminated at/or below land surface may require
a variance In actor nce witti 15A NCAC 2C .0116.
e. YIELD (gpm): METHOD OF TEST Blow
t. DISINFECTION: Type H T H
g. WATER ZONES (depth):ep/�
From To /%a7C - From To
From 3/c✓r To 3/7' From To
From To From To
6. CASING: Thickness/
From DToth� f &Ft. Gabel,
From To_,[2 Ft._(O
From To Ft.
7. GROUT: Depth Material Method
From 0 TO 20 Fcement & benoniped
From To Ft.
From To Ft.
8. SCREEN: Depth Diameter Slot Size Material
From To Ft. In. In.
From To Ft. In. In,
From To Ft. In. In.
9. SAND/GRAVEL PACK:
Depth Size Material.
From To FL
From To Ft.
From To Ft.
Weight Mi1teJ�al
Q ectiv
10. DRILLING LOG
Frn m r Tof l Formation Description
relay & aand
/ / O grata to
11. REMARKS:
O
Cs
1 DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH
1SA NCAC 2C, WELL CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS
RECOR t AS BEEN PROVIDED TO THE WELL OWNER,
NATURE OF CERTIFIED WELL CONTRACTOR DATE
James B Brown
PRINTED NAME OF PERSON. CONSTRUCTING THE WELL
Submit the original to the Division of Water Quality within 30 days. Attn: Information Mgt
1617 Mall Service Center- Raleigh, NC 27699.1617 Phone No. [phone] ext 668.
UN 05 UG
Form GW-la
Rev. 7/05

RESIDENTIAL WELL CONSTRUCTION RECORD
North Carolina Department of Environment end Natural Resources -Division of Water Quality
WELL CONTRACTOR CERTIFICATION #
2045
1. WELL CONTRACTOR:
James B. Brown
Well Contractor (Individual) Name
Hedden Brothers Well Drilling, Inc.
Well Contractor Company Name
STREET ADDRESS 73Holly Hills Vista RD
Franklin, NC 28734
City or Town State Zip Code
(828 )• 169-9591
Area code- Phone number
2. WELL INFORMATION:.
SITE WELL ID 4(I( applicable)
STATE WELL PERMIT#(If applicable)
DWQ or OTHER PERMIT #QI epplicabie)
WELL USE (Check Applicable Box). Residential Water Supply ❑
DATE DRILLED 3 1'nNO
TIME COMPLETED „RI 15 AM ❑ PM
3. WELL LOCCCON• iA >6w
CITY: y� Ala— • COUNTY
d°e,
(Strut Name umbers, Communit 6ubdidelon, Lot No., Parcil, Zip Code)
TOPOGRAPHIC / LAND SETTING:
CI Slope °Valley ❑Flat ❑Ridge °Other
(check appropriate box) . t
jiZe
LONGITUDE Wg
Latitude/longitude source: GPS Topographic map
(location or well must b. h one USGS topo map and
attached to th/s to 4not using GPS)
4. WELL OWNER
OWNER'S NAME
$TR , T ; DDRESS
Tarn • State Zip Code
5 - CYo�5
Area code - Phone number
May be in degrees,
minutes, seconds ar
in a decimal format
6. WELL DETAILS: ,-7
a. TOTAL DEPTH: ISO
b. DOES.WELL REPLACE EXISTING WELL? Y S o N0
c. WATER LEVEL Below Top,of Casing: ` QSJ FT.
(Use"+' If Above Top of Caking)
2 FT. Above Land Surface'
'Top of casing terminated at/or below land surface may require
e variance In acco nee wan 15A NCAC 2C .0118,
e, YIELD (gpm): METHOD OF TEST Blow
d. TOP OF CASINO IS
/ 2
1, DISINFECTION; Type H T H
p. WATER ZONES (depth
Fru?,,:1%J57 To 157 From To
irom 7b /' To 76,5' From To
From To From To
6. CASING: J, Thickness/ •
From Depth
h Let" Ft. D roster W/Ipjta.' M6(CIJa1.
From__ ToFt. _!?3 Kit
From To Ft. __
Amount 160z
7. GROUT: Depth Material Method
From 0 To 20 FGement & benonite pt.[tlpt
From To Ft
From To Ft.
8. SCREEN: Depth Diameter Slot Size Material
From To Ft. In, In.
From To__ Ft. In. In.
From__ To__ Ft. In. In.
9. SAND/GRAVEL PACK:
Depth
From To Ft.
From To Ft.
From To Ft.
Size Materiel.
10, DRILLING LOG
From To
11. REMARKS:
Formation Description
r1Ry & sand
grin1 ♦'P
CO
r1
I D0 HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH
1SA NCAC 2C, WELL CONSTRUCTION STANDARDS, AND THAT COPY Or THIS
RECORD HAS BEEN PROVIDED TOME WELL OWNER. q
SIVGNATURE OF EERftIFI'D WELL CONTRACTOR DA'i
James B. Brown
PRINTED NAME OF PERSON CONSTRUCTING THE WELL
Submit the original to the Division of Water Quality within 30 days. Attn: Information Mgt.,
1617 Mall Servie6Center- Raleigh, NC 27699.1617 phone No. [phone] ext 668.
JUN 05 2UU3
Form GW-1a
Rev. 7/05

RESIDENTIAL WELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources•. Division of Water Quality
WELL CONTRACTOR CERTIFICATION #
1. WELL CONTRACTOR:
James B, Brown
Well Contractor (Individual) Name
Hedd6nn Brothers Well Drilling, Inc.
Well Contractor Company Name
STREET ADDRESS 73 Holly Hills Vista RD
Franklin, NC 28734
City or Town State Zip Code
(828 )• 369-9591
Area code- Phone number
2.WELL INFORMATION: q//�r�jj 2Q
SITE WELL ID #pt applicable) 7(l8Q
STATE WELLPERMITN(II applicable)
DWQ or OTHER PERMIT Cif applicable)
WELL USE (Check Applicable Box): Residential Water Supply
DATE DRILLED 7 -Z Z ' 040
TIME. COMPLETED .4 da
3. WELL LOCA
CITY:
ION:
1Q
e p /4 ("rite -
(Street ame, Numbers, Community, Subdhlllon, Lol No
Parcel, Zip Code)
TOPOGRAPHIC / LAND SETTING: •
❑Slope °Valley ❑Flat ORldge °Other
(check eppropdate bcxx)'
LATITUDE � 9�A
LONGITUDE Mai /P!T`I
Latitude/longitude source: GPS °Topographic map
(location of well must be sho on a USGS topo map and
• attached to this form Irnot using GPS) •
4. WELL OWNER
OWNER'S NAME
STET ADDRESS
May be In degrees,
minutes, seconds or
in a decimal format
State
Area code • Phone number
Zip Code
'6, WELL DETAILS: ,
a. TOTAL DEPTH: LI b. DOESWELL REPLACE EXISTING WELL?.. YES D NO»
c.: WATER LEVEL Below Top -of Casing: d FT.
(Use'+" If Above Top of Casing)
d. TOP OF CASINO IS 2 FT. Above Land Surfaces
'Top of casing terminated aVor below land surface may require
a variance In acccorrdance with 15A NCAC 2C .0118.
e. YIELD (gpm): O METHOD OF TEST Blow
2045
I. DISINFECTION; Type Ii T H Amount 160z
g. WATER ZONES (depth):
From
To )bF FTo
From r TO )90r Fromrom To
From To From _ " To
6. CASING: ;Jr Thickness/
From 10 DToth-' 7 l/ Ft.
DIf r Weight gel
From 57 To 57 Ft. �r = =.
From To Ft.
7. GROUT: Depth Material Method
From 0 To 20 FGsnent 6 benonite
From To Ft.
From To Ft.
6. SCREEN: Depth Diameter Slot Size Material
From__ To Ft. In. - In.
From To Ft. In. In,
From To Ft. in. In.
9. SAND/GRAVEL PACK:
Depth
From To
From To
From To
10. DRILLING LOG
From To •
11. REMARKS:
Ft.
Ft:
Ft.
Size - Material.
Formation Description
clay R sand
rgrnni fa
t
c:
I D0 HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH
ISA NCAC C, WELL CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS
RECO E BEEN PROVIDED TO THE WELL OWNER,
°NATURE OF CERTIFIED WELL CONTRACTOR ATE
James B. Brown
PRINTED NAME OF PERSON CONSTRUCTING THE WELL
Submit the original to the Division of Water Quality within 30 days. Attn: Information Mgt.,
1617 Mali Service Center- Raleigh, NC 27699.1817 Phone No. [phone] ext 668.
Form GW1a
Rev. 7/06
JUN 05 /ail

RESIDENTIAL WELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources, Division of Water Quality
WELL CONTRACTOR CERTIFICATION # . 2045
L DISINFECTION: Type H T H Amount 160z
p, WATER(r
ZONES�(depth):
From_,. C,Z.�]To / r From To
From ,31N. Too From To
From IJ� l i T L' From To
1. WELL CONTRACTOR:
James B. Brown
Well Contractor (Individual) Name
Hedden Brothers Well Drilling, Inc.
Well Contractor Company Name
STREET ADDRESS 73 Holly -Hills Vista RD
Franklin. NC 28734
City or Town State
( 828 ). 169-9591
Area code- Phone number
2. WELL INFORMATION:.
Zlp Code
SITE WELL ID #(II eppllcabl
STATE WELL PERMIT#(I( applicable)
DWQ or OTHER PERMIT #(If applicable) A
WELLUSE(CheckkAloplIcableBox: Residential Water Supply'ILT
DATE DRILLED T e I Oif7�
TIME. COMPLETED // • L Z AMat PM °
3. WELL LOCAT)ONj v ,ka�
COUNTY
(S6eet Name, Numbers, C minutely, Subdldslon, Lin No., Parcel, Zip Cade)
TOPOGRAPHIC /LAND SETTING:
°Slope °Valley ❑Flat Rid pa °Other
(check appropriate box)
b�N
LATITUDE Jn�52'/�
LONGITUDE934 (Jk)
Latitude/longitude source: GPS °Topographic map
(location of well must be sh on a USGS tops map end
attached to this form Ifnot using GPS)
4. WELL OWNER / ^/
OWNER'S NAME //u"/VI
May be In degrees,
minutes, seconds or
in a decimal formal
STR(ZET ADDRESS (-29'
/Va Ne- ))?779
City Town • State Zip Code
(112
Area code • Phone number
6. WELL DETAILS: 21i)
a, TOTAL DEPTH: 971/
b. DOES WELL REPLACE EXISTING WELL? YES
NO k
e.: WATER LEVEL Below Top of Casing: e5C) FT,
(Use'+° If Above Top of Casino)
d. TOP OP CA$INO IS 2 FT. Above Land Surface
*Top of casing terminated et/or below land surface may require
a variance In accordance with 15A NCAC 1C ,0118.
e. YIELD (gpm): 016 METHOD OF TEST BLOW
9. CASING:
Depth
To Ft.
5q To Fi._.
From
From
From To Ft.
Thickness/ '
Dlajnete r Md reWeight al
1111�� , /e 8 %ice'
7. GROUT: Depth Material Method
From 0 To 20 p emetlt & benorumped
From To Ft
From To Ft.
8. SCREEN: Depth Diameter Slot Size Material
From To Ft. In. In.
From•_ To__ Ft. In. In,
From To Ft. In. In.
9. SAND/GRAVEL PACK:
Depth Size Material.
From To
From To
From To
10.rrDRILLING LOG
From To
t r
11. REMARKS:
Ft.
Ft.
Ft.
Formation Description
clay A cand
Trani 1-fa
3P
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH
i5A NCAC 2C, WELL CONSTRUCTION STANDARDS, AND THAT A COPY OF TM15
RECO S BEEN PROVIDED TO THE WELL OWNER.
El� v « _04
NATURE OF C T ED ELL CONTRACTOR DATE
James B. Brown
PRINTED NAME OF PERSON CONSTRUCTING THE WELL
Submit the original to the Division of Water Quality within 30 days. Attn: Information Mgt,,
1617 Mall Service Center- Raleigh, NC 27699.1617 Phone No. [phone] ext 568.
Form GW;1a
Rev, 1/05

RESIDENTIAL WELL CONSTRUCTION RECORD
North Carolina Department of Env ronmcnt and Natural Resources- Division of Water Quality
WELL CONTRACTOR CERTIFICATION # 2045
1. WELL CONTRACTOR:
James B, Brown
Well Contractor (Individual) Name
Hedden Brothers Well Drilling, Inc.
Well Contractor Company Name
STREET ADDRESS 73 Holly Hilts Vista RD
Franklin', NC 28734
City or Town State
(828 )- 369-9991
Zip Code
Area code- Phone number
2. WELL INFORMATION:
SITE WELL ID #(II appllcablel
STATE WELL PERMIT#(if applicable)
DWQ or OTHER PERMIT :Of applicable)
WELL USE (Check Applicable Box)'
.ATE DRILLED
TIME COMPLETED
Z. WELL LO ATIO
CITY: M. MIA
�SUh4Y111ta0
(Street Name, Numbers, Community, Subdivision, Lot No., Parcel, Zip Code)
TOPOGRAPHIC / LAND SETTING:
❑Slope ❑Valley ❑Flat ❑Ridge ❑Other
(check appr�opiate box)
;.ATITUDE •,L•,'',1 77 i
LONGITUDES3 et 6320
atitude/longitude source: 381%9PS ❑Topographic map
(location of well must be shown on a USGS topo map and
' attached to this form if not using GPS)
.:. WELL OWNER
OWNER'S NAME
Residential Water Supply ❑
AM El PM%
COUNTY
May be in degrees,
minutes, seconds or
in a decimal format
ST}s2F„ET ADDR
SS
City or Town ' State
( )-
Area code • Phone number
Zip Code
y/ELL DETAILS: / rn
a. TOTAL DEPTH: D
b. DOES WELL REPLACE EXISTING WELL? YES (' NO ❑
c. WATER LEVEL Below Tap of Casing: aid FT.
(Use "+" if Above Top of Casing)
d. TOP OF CASINO IS 2 FT. Above Land Surface'
'Top of casing terminated at/or below land surface may require
a variance In accoor[4aa�nce with 15A NCAC 2C .0118.
e. YIELD (gpm): '(L_ METHOD OF TEST Blow
f. DISINFECTION: Type H T H
g. WATER ONES (depth):]
From
To, ,6'
//3To //5' From
Amount 160z
!
From To y> y
From
To
To
6. CASING: Thickness/
Depth /� c DIy�ngter IV M riot
From (! To f Xt. (O r / r n.
From To Ft.
From To Ft.
7. GROUT: Depth Material Method
From 0 To 20 Fcement & benonitePed
From To Ft.
From To Ft.
8. SCREEN: Depth Diameter Slot Size Material
From To Ft. In. In.
From To Ft. in. In.
From To Ft. In. In.
9. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
From To Ft.
10. DRILLING LOG
From To
11. REMARKS:
Formation Description
clay & sand
grans t-P
DC
-
O
Va
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH
15A NCAC 2C, WELL CONSTRUCTION STANDARDS, ANC THAT A COPY OF THIS
REC AS BEEN PROVIDED TO WELL OWNER.
1746
NATURE OF CERTIFIED WELL CONTRACTOR DATE
James B. Brown
PRINTED NAME OF PERSON CONSTRUCTING THE WELL
Submit the original to the Division of Water Quality within 30 days. Attn: Information Mgt.,
1617 Mail Service Center— Raleigh, NC 27699-1617 Phone No. [phone] ext 668.
Form GW-la
Rev. 7/05
JUN 05 2CJ3

RESIDENTIAL WELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources -Division of Water Quality
WELL CONTRACTOR CERTIFICATION # 2045
1. WELL CONTRACTOR:
James B. Brown
Well. Contractor (Individual) Name
Hedden Brothers Well Drilling, Inc.
Well Contractor Company Name
STREET ADDRESS 73 Holly Hills Vista RD
Franklin, NC 28734
City or Town State Zip Code
(828 )- 369-9591
Area code- Phone number
2. WELL INFORMATION:
SITE WELL ID #(ir applicable)
STATE WELL PERMIT#(if applicable)
DWQ or OTHER PERMIT #(if applicable)
WELL USE (Check ApplicablUok Residential Water Supply
GATE DRILLED .✓ 27
i WE COMPLETED , 2 ; / 5 AM ❑ PMII
.. WELL LOCATION:
TION:
CITY:111 th COUNTY
�Lirat, !.l'A;hAr 2
(Street Name, Numbers, Community. subdiwslod' Lot
TOPOGRAPHIC / LAND SETTING:
❑Slope OValley 0 Flat O Ridge 0 Other
(check appropriate box)
ATITUDE e.2,3��/
.LDNGITUDE $311
Latitude/longitude source: bfGPS ❑Topographic map
(location of well must be s own on a USGS topo map and
attached to this form if not using GPS)
d. WELL OWNER
OWNER'S NAME
STR _ T ADORE
arcel, Zip Code)
May be in degrees,
minutes, seconds or
in a decimal format
City or Town
()-
Area code- Phone number
Zip Co.e
NELL DETAILS: ; —ADO r
?. TOTAL DEPTH: ,!(f(-J
b. DOES WELL REPLACE EXISTING WELL? YES ❑ NOL
c. WATER LEVEL Below Top of Casing: 50 FT.
(Use "+" if Above Top of Casing)
d. TOP OF CASING IS 2 FT. Above Land Surface'
'Top of casing terminated at/or below land surface may require
a variance In accordance with 15A NCAC 2C .0118.
e. YIELD (gpm): 15 METHOD OF TEST Blow
f. DISINFECTION: Type H T H Amount 1 60Z
g. WATER ZONESCC.�(depth): r
From 67.6ct To /D /QO From To
From To From To
From To From To
8. CASING:
From OToth�C Ft
From To 7 Ft
From To Ft
Djampter
Thickness/
Weight ;Val
,it t3 " d7W
7. GROUT: Depth Material Method
From 0 To 20 FGement & IDenonite
From To Ft.
From To Ft.
8. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. In.
From To Ft. In. In.
From To Ft. in. in.
9. SANDIGRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
From To Ft.
10. DRILLING LOG
From Too
o1
II. REMARKS:
Formation Description
clay & sand
(rani t'P
a
u
T
I D0 HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH
15A NCAC 2C, WELL CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS
RECO6D p1AS BEEN PROVIDED TO THE WELL OWNER.
2 27-l24
iNATURE OF CERTIFIED WELL CONTRACTOR DATE
James B. Brown
PRINTED NAME OF PERSON CONSTRUCTING THE WELL
ubmit the original to the Division of Water Quality within 30 days. Attn: Information Mgt.,
16t7 Mail Service Center— Raleigh, NC 27699.1617 Phone No. [phone] ext 568.
JUN 05 2ee7u
Form GW-la
Rev. 7/05

STREET ADDRESS
RESIDENTIAL WELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources- Division of Water Quality
WELL CONTRACTOR CERTIFICAT ON d 2045
WELL CONTRACTOR:
James B. Brown
Well Contractor (Individual) Name
Hedden Brothers Well Drilling, Inc.
Well Contractor Company Name
73 Holly Hills Vista RD
Franklin, NC 28734
City or Town State Zip Code
828 )- 369-9591
r.rea code- Phone number
2. As ELL INFORMATION: // !�� ) / �.7)/
517E WELL ID #(if applicable) 7l4 0—•— 77.2(CO
STATE WELL PERMITS/(if applicable)
DWQ or OTHER PERMIT #(if applicable)
WELL USE (Check Applicable Box): Residential Water Supply
DATE DRILLED J✓'' ✓� ,, ``
TIME COMPLETED "7'. (/) V AM 0 PM,
3: WELL LOC' TIO :
("treat Name, Numbers, Community, SubdiAslon, Lot No., Parcel, Zip Code)
TOPOGRAPHIC /LAND SETTING:
❑Slope DValley ❑Flat ❑Ridge DOther
(check appropriate�rhot,.
I.ATITUDE &t 6.5t'"� ^�
LONGITUDE DR, r7w,
Latitude/longitude source: kiiPS Topographic map
(location of well must be shown on a USGS lopo map and
attached to this form it not using GPS)
.JELL OWNER (7
OWNER'S NAME(
EET ADD
City orroow S o / Site
J21)- 3
Area code - Phone number
5. WELL DETAILS: `ee
a. TOTAL DEPTH: Lw
b. DOES WELL REPLACE EXISTING WELL? YES 0 NO
c. WATER LEVEL Below Top of Casing:
(Use if Above Top of Casing)
d. TOP OF CASING IS 2 FT. Above Land Surface
`Top of casing terminated at/or below land surface may require
a variance In accordance with 15A NCAC 2C .0118.
e. YIELD (gpm): /p METHOD OF TEST Blow
May be in degrees,
minutes, seconds or
in a decimal format
C1
Zip Code
f. DISINFECTION: Type H T H
g. WAT R ZONES (depth): ,
From J To %4?
From
From Tp
Amount 160z
From_ dj 7/ To AZ1
From To
From To
6. CASING:
Depth/J� Darr
To jj Ft. CCffii
From To Ft.
From To Ft.
7. GROUT: Depth Material Method
From 0 To 20 FGement & benonite plliRp
From To Ft.
From To Ft.
8. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in.
From To Ft. In. In.
From To Ft. In. in.
Thickness/
Wejgbf+. _M terl
9. SAND/GRAVEL PACK:
Depth
From To Ft.
From To Ft.
Size Material
From To Ft.
10. DRILLING LOG
From To
11. REMARKS:
Formation Description
r•l ay & sand
granite
100 HEREBY CERTIFY THAT THIS WELL. WAS CONSTRUCTED IN ACCORDANCE WITH
ISA NCAC 2C, WELL CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS
RECORg31A5 BEEN PROVIDED TOME WELL OWNER.
ATURE OF CERTI ED WELL CONTRACTOR DATE
James B. Brown
PRINTED NAME OF PERSON CONSTRUCTING THE WELL
Submit the original to the Division of Water Quality within 30 days. Attn: Information Mgt.,
1617 Mail Service Center — Raleigh, NC 27699-1617 Phone No. [phone] ext 568.
Form GW-1a
Rev. 7/05
JUN 05 2006

RESIDENTIAL WELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources- Division of Water Quality
WELL CONTRACTOR CERTIFICATION # 2095
. WELL CONTRACTOR:
James B. Brown
Well Contractor (Individual) Name
Hedden Brothers Well Drilling, Inc.
Well Contractor Company Name
STREET ADDRESS 73Holly Hills Vista RD
Zip Code
(828 )- 369-9591
Area code- Phone number
2. WELL INFORMATION: 7!�]Q %�(J
uITE WELL ID#(Ifapplicable) .y (7 5/ " V V—so773
STATE WELL PERMIT#(if applicable)
DWQ or OTHER PERMIT #(i1 applicable)
WELL USE (Check Applicable Box): Residential Water Supply
t.AO ❑
DATE DRILLED 4. II
TIME COMPLETED ‘.3.55 AM ❑ PMta
1. WELL LO ATION: /�
;ITV:
COUNTY
(Street Name, Numbers, Community, Subdivision, Lot No., Parcel, Zip Code)
"OPOGRAPHIC / LAND SETTING:
°Slope °Valley ❑Flat ❑Ridge °Other
(check appropriate boxx))
LATITUDE , �j Q /27QAt
LONGITUDEU JSQ /1
Latitude/longitude source: PS °Topographic map
(location of well must be o n on a USGS topo map and
attached to this form if not using GPS)
4. WELL OWNER
May be in degrees,
minutes, seconds or
in a decimal format
OWNER'S NAME
STREET ADDRESS
her No,
City or Town / State
)- acA- 325
Area code - Phone number
5. WELL DETAILS:
a. TOTAL DEPTH:
b. DOES WELL REPLACE EXISTING WELL? YES 0 N
JLZESMO
c. WATER LEVEL Below Top of Casing: J FT.
(Use "+" If Above Top of Casing)
d. TOP OF CASING IS 2 FT. Above Land Surface'
'Top of casing terminated al/or below land surface may require
a variance in accordance with 15A NCAC 2C .0118.
e. YIELD (gpm): /tQ METHOD OF TEST Blow
Jc9
Zip Code
1. DISINFECTION: Type H T H Amount 160Z
g. WATFR ZONES (depth):
'To //per From To
From To
From To
From •< j
From 3,.3orTo
From To
6. CASING: Thickness/
/'� Depth Dla etyr Weight trial
From
(/ To Ft.—Cf
From,
To Ft. !a
From To Ft.
7. GROUT: Depth Material Method
From 0 To 20 Fpement & benonite pumped
From To Ft.
From To Ft.
8. SCREEN: Depth Diameter Slot Size Material
From To Ft. In. In.
From To Ft. In. In.
From To Ft. In. In.
9. SANDIGRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
From To FI.
10. DRILLING LOG
From To
r a
11. REMARKS:
Formation Description
r•1 ay & sand
gran11-e
100 HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH
15A NCAC 20, WELL CONSTRUCTION STANDARDS. AND THAT A COPY OF THIS
RECOR HAS BEEN PROVIDED TO THE WELL OWNER,
;�- '
NATURE OF CERTIFIED WELL CONTRACTOR DATE
James B. Brown
PRINTED NAME OF PERSON. CONSTRUCTING THE WELL... .. _.
Submit the original to the Division of Water Quality within 30 days. Attn: Information Mgt, Form GW-la
1617 Mail Service Center— Raleigh, NC 27699.1617 Phone No. [phone] ext 668. A� I f(��Rev. 7/05
JUN r)5 LUtiii

RESIDENTIAL WELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources -Division of Water Quality
WELL CONTRACTOR CERTIFICATION # 2095
1. WELL CONTRACTOR:
James B. Brown
Well Contractor (Individual) Name
Redden Brothers Well Drilling, Inc.
Well Contractor Company Name
STREET ADDRESS 73' Holly Hills Vista RD
Franklin. NC 28734
City or Town State Zip Code
( 828 )- 369-9591
Area code- Phone number.
2. WELL INFORMATION:
SITE WELL ID #(If applicable)
STATE WELL PERMITS/(If applicable)
DWQ or OTHER PERMIT Cif applicable)
WELL USE (Check Appll°able
Box): Residential Water Supply 0
DATE DRILLED
TIME COMPLETED A PM 0
3. WELL LOCATION' r
CITY: yBIZ COUNTY-
nI
(Street tuna, Numbers, Community, Subdidalon, Lot No., Parcel, Zip Code)
TOPOGRAPHIC /LAND SETTING:
L7 Slope °Valley ❑Flat °Ridge ❑Other
(check appropriate box)
LATITUDE
LONGITUDE
Latitude/longitude source: GPS °Topographic map
(location of well must be shown on a USGS topo map and
attached to this rom, if not using GPS)
r 4. WELL OWNER
May be in degrees,
minutes, seconds or
in a decimal format
OWNER'S NAME
ST i E ADDRES
City gr Town 4ta - Zip Code
Area code • Phone number
6. WELL DETAILS: l U-/s
a. TOTAL DEPTH:
lzr
b. DOES WELL REPLACE EXISTING WELL? YES ° NO
c. WATER LEVEL Below Top of Casing: e. tJ FT.
(Use "4," If Above Top of Casing)
TOP OF CASINO IS 2 FT. Above Lend Surface*
'Top of casing terminated at/or below land surface may require
a valance In accordance with 15A NCAC 2C .0118.
e. YIELD (gpm): .40 METHOD OF TEST 131°W
I. DISINFECTION: Type H T H Amount 160z
g. WATER�?ZONES (de-pth):, A
From '=J To `/�t/.•)
From PAP To /Y'�r
From To
From To
From To
From To
6. CASING: Thickness/
From 0 Depth
Dlgmeter We�h� *apt
From To Ft. LLOO t�� ��!//
From To Ft. ___
7. GROUT: Depth Material Method
From 0 To 20 FQenent & benonite
From To Ft.
From To - Ft.
8. SCREEN: Depth Diameter Slot Size Material
From To Ft. In. In.
From To Ft. In. In.
From To Ft. In. In.
9. SAND/GRAVEL PACK:
Depth Size Materiel.
From To Ft.
From To Ft.
From To___ Ft.
10. DRILLING LOG
From To
11. MARKS/•`y
Formation Description
clay & cand
gran -if -to
—c
1
I D0 HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH
1 SA NCAC 2C. WELL CONSTRUCTION STANDARDS. AND THAT A COPY OF THIS •
RE
HAS BEEN PROVIDED TO THE WELL OWNER.
/= GNATURE OF CERTIFIED WELL CONTRACTOR DATE
James B. Brown
PRINTED NAME OF PERSON CONSTRUCTING THE WELL
•
Si bmit the original to the Division of Water Quality within 30 days. Attn: Information Mgt,
1 617 Mall Service Center- Raleigh, NC 27699-1617 Phone No. [phone] ext 668.
Form G W-1 a
Rev, 7/05
.11JN 35 Lubo

RESIDENTIAL WELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources- Division of Water Qua
WELL CONTRACTOR CERTIFICATION # 2045
1. WELL CONTRACTOR:
James B. Brown
Well Contractor (Individual) Name
Hedden Brothers Well Drilling, Inc.
'Well Contractor Company Name
STREET ADDRESS 73 HollyHillsVista RD
Franklin, NC 28734
City or Town State Zip Code
(828 )- 369-9591
Area code- Phone number
2. WELL INFORMATION:
SITE WELL ID #0( applicable) f4.Q3 -D5 - toga`
STATE WELL PERMIT#(if applicable)
DWQ or OTHER PERMIT Cif applicable) f���//
WELL USE (Check Applicable Box): Residential Water Supply OQ
DATE DRILLED /
TIME COMPLETED
3. WELL LOp ATION:
CITY: Q.-
/✓J,l5 AMPM
(Street Name, Numbers, ComV ity, Subdivaion, Lot No., Parcel, Zip Code)
TOPOGRAPHIC / LAND SETTING:
D Slope °Valley El Flat ❑Ridge ❑Other
(check appropriate box)
LATITUDE
LONGITUDE
Latitude/longitude source: ❑GPS ❑Topographic map
(location of well must be shown on a USGS topo map and
attached to this form if not using GPS)
4. WELL OWNER
May be in degrees,
minutes, seconds or
in a decimal format
OWNER'S NAME.v�n cs,
STREET ADDRESS LIi&P l5 /LL�KUY,,! /}.P.igG7t0 �
City or Town State Zip Code
(ill )- l�D/- 7,176
Area code - Phone number
: NELL DETAILS: a. TOTAL DEPTH: O2t/q7
.00 '
b. DOES WELL REPLACE EXISTING WELL? YES ❑ NOX
c. WATER LEVEL Belau Top of Casing: FT,
(Use "+' if Above Top of Casing)
d. TOP OF CASING 13 2 FT. Above Land Surface*
'Top of casing terminated at/or below land surface may require
a variance In accordance with 15A NCAC 2C .0118.
2. YIELD (gpm): /4METHOD OF TEST Blow
324543
f. DISINFECTION: Type H T H Amount 160z
g. WATER•ZONES (de )th):
From 3 r To j , From {/ 5 Co //! t
From / 0 l . To /07 r From To
From /0.5co JO 7' From To
6. CASING:
Depth O Diareter
From if To Q Ft. ti /r
From To Ft.
From To Ft.
7. GROUT: Depth
From 0 To 20 FGement & benonite
From To Ft.
From To Ft.
Thickness/
ViVeA Material-
/ T1
Material Method
8. SCREEN: Depth Diameter Slot Size
From To Ft. In. in.
From To Ft. In. In.
From To Ft. In. In.
9.
Material
SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
From To Ft.
10. DRILLING LOG
From To
PP C. L. i`
11. REMARKS:
Formation Description
01 ay & Sand
gr n t t-o
CO
1 DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH
I5A NCAC 2C, WELL CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS
RECORIPrjAS BEEN PROVIDED TOME WELL OWNER.
dO4
ATURE OF CERTIFIED WELL CONTRACTOR DATE
James B. Brown
PRINTED NAME OF PERSON CONSTRUCTING THE WELL
Submit the original to the Division of Water Quality within 30 days. Attn: Information Mgt.,
1317 Mail Service Center— Raleigh, NC 27699-1617 Phone No. [phone] ext 568.
Farm GW-1a
Rev, 7/05

RESIDENTIAL WELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources- Division of Water Quality
WELL CONTRACTOR CERTIFICATION # 2045
4546
1. WELL CONTRACTOR:
James B. Brown
Well Contractor (Individual) Name
Hedden Brothers Well Drilling, Inc.
Well Contractor Company Name
STREET ADDRESS 73 HollyHillsVista RD
Franklin. NC 28734
City or Town State Zip Code
(828 )- 369-9591
Area code- Phone number
2. WELL INFORMATION: (� �' �y
SITE WELL ID #0tapplicable) / b 7J ' ' J'iO�l�
STATE WELL PERMIT#(ilapplicable)
OWQ or OTHER PERMIT #(if applicable)
WELL USE (Check Applicable Box): Residential Water Supply 0
DATE DRILLED 3 —ito • ©l0
TIME COMPLETED &I $ 5 AM 0 PM pd
3. WELL LOCNION:: [ +�.
CITY: f iLJ%,C(){aJ../I.C.L_ L� COUNTY
(Street Name, ic
en, Community, SubdiNaion, Lot No., Parcel, Zip Code)
TOPOGRAPHIC / LAND SETTING:
[Slope [Valley ❑Flat ❑Ridge °Other
(check appropriate �byorx))
LATITUDE „ J.j 0JA)
f�
LONGITUDE
T
Latitude/longitude source: tiPS °Topographic map
(location of well must be shown on a USGS topo map and
attached to this Rrm if not using GPS)
May be in degrees,
minutes, seconds or
in a decimal format
A. WELL OWNER ; , 1
OWNER'S NAME �(j
STRF T ADDftES,S
APl�
City or Town State
Litt 7f3 .5&99
Area code - Phone number
6. WELL DETAILS: r t a. TOTAL DEPTH:
ae 7/7
Zip Code
b. DOES WELL REPLACE EXISTING WELL? YES 0 NOk_
c. WATER LEVEL Below Top of Casing: 4.5 FT.
(Use "+" if Above Top of Casing)
d. TOP OF CASING IS 2 FT. Above Land Surface'
'Top of casing terminated at/or below land surface may require
a variance In accc[9rdance with 15A NCAC 2C .0118.
e. YIELD (gpm): T 0 METHOD OF TEST Blow
f. DISINFECTION: Type H T H
g. WATER ZONES (Olepth):
From 80 To z From
From ToFrom
From To 1 1 6 From
6. CASING:
Amount 160z
Depth rrrr1111777��1 Diameter
From To FL
Fran To FL 6?
From To Ft.
7. GROUT: Depth
To
To
To
Thickness/
WeightM erial
y /iM
Malarial Method
From 0 To 20 FGetnent & benonite
From To Ft.
From To Ft.
8. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in,
From To Ft. In, In.
From
To Ft. in. In,
9. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
From To FL
10. DRILLING LOG
From To
r
Ir
RECEIV
Formation Description
clay & sand
9-rani
r
CO
CT
Snewllle Regi(n:3
11. REMARKS:
I D0 HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH
15A NCAC 2C, WELL CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS
REC•'• AS BEEN PROVIDED TO THE WELL OWNER.
A U
F C RTIFIED WELL CONTRACTOR DATE
James B. Brown
PRINTED NAME OF PERSON CONSTRUCTING THE WELL
Submit the original to the Division of Water Quality within 30 days. Attn: Information Mgt,
1617 Mail Service Center— Raleigh, NC 27699.1617 Phone No. [phone] ext668.
Form GW-la
Rev. 7/05

RESIDENTIAL WELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources- Division of Water Quality
WELL CONTRACTOR CERTIFICATION # . 2045
1. WELL CONTRACTOR:
James B. Brown
Well Contractor (Individual) Name
Hedden Brothers Well Drilling, Inc.
Well Contractor Company Name
STREET ADDRESS 73 Holly' Hills Vista RD
Franklin, NC 28734
City or Town State Zip Code
(828 )- 369-9591
Area code- Phone number
2. WELL INFORMATION: ry .y
SITE WELL ID #(If applicable) /fz/cQc /! . 74i5
STATE WELL PERMIT#(if applicable)
DWQ or OTHER PERMIT Cif applicable)
WELL USE (Check Applicable Box): Residential Water Supply 0
DATE DRILLED 3 .074 02C€�
TIME COMPLETED AM ❑ PMfr
3. WELL LOCATION: '`
CITY: COUNTY
ittftt
(Stleet Name, b rd s, Community, SubdiNalon, Lot No., Parcel, Zip Code)
TOPOGRAPHIC / LAND SETTING:
2Slope °Valley ❑Flat ❑Ridge °Other
(check appropriate box)
. \TITUDE Q� _1543
J P3;NGITUDE 14
Latitude/longitude source: °GPS ❑Topographic map
(location of well must be shown on a USGS topo map and
attached to this form if not using GPS)
4. WELL OWNER `^
OWNER'S NAME i � )t2 ( !Lk ,L�®At7i/4J
Jo
STR EEET ADDRESS 3n3 fs
City or Town / l ZlPioder
,jz$)- J49y.f5q/a-
May be in degrees,
minutes. seconds or
in a decimal formal
Area code - Phone number
WELL DETAILS:"v )
a. TOTAL DEPTH:
b. DOES WELL REPLACE EXISTING WELL?��YYESX NO °
/'2G c. WATER LEVEL Below Top of Casing: l FT,
(Use'+' If Above Top of Casing)
d. TOP OF CASING IS 2 FT. Above Land Surface'
'Top of casing terminated at/or below land surface may require
a valance In accordance with 15A NCAC 2C .0118.
e. YIELD (gpm): /42 METHOD OF TEST Blau
$ 4545
f. DISINFECTION: Type H T H Amount 1 602
g. WATER ZONES (depth):
From Asa() To From To
r
From lc/ / To From To
From To From To
6. CASING:n
From l / DToth / _1 ,Ft DI�tneter
From To U7 Ft. t�
From To Ft.
Thickness/
Wept„ c,teM rial
C'f3
7. GROUT: Depth Material Method
From 0 To 20 Ffrernent & benonite
From To Ft.
From To Ft.
S. SCREEN: Depth Diameter Slot Size Material
From To Ft. In. in.
From To Ft. in. In.
From To Ft. In. In,
9. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft,
From To Ft.
10. DRILLING LOG
From To
Formation Description
clay & sand
granite
fECEFV
O
Ashev!i!e tieClien•
11. REMARKS:
I00 HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH
15A NCAC 2C, WELL CONSTRUCTION STANDARD$, AND THAT A COPY OF THIS
RECQR014AS BEEN PROVIDED TO THE WELL OWNER,
RTIFIE
3za�oc
NATURE OF C CONTRACTOR DATE
James B. Brown
PRINTED NAME OF PERSON CONSTRUCTING THE WELL
pbmit the original to the Division of Water Quality within 30 days. Attn: Information Mgt.,
:617 Mail Service Center— Raleigh, NC 27699-1617 Phone No. [phone] ext 568.
Form GW-la
Rev, 7/05

RESIDENTIAL WELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources- Division of Water Quality
WELL CONTRACTOR CERTIFICATION # 2045
1, WELL CONTRACTOR:
James B. Brown
Well Contractor (Individual) Name
Hedden Brothers Well Drilling, Inc.
Well Contractor Company Name
STREET ADDRESS 73 Holly Hills Vista RD
Franklin, NC 28734
City or Town State Zip Code
(828 )- 369-9591
Area code- Phone number
2. WELL INFORMATION:
SITE WELL ID Cif applicable) 1531-77.495y
STATE WELL PERMIT#(If applicable)
DWQ or OTHER PERMIT Cif applicable) �/
p
WELL USE (Check Applicable Box): Residential Water Supply ry
DATE DRILLED 3 ' I d -
r
TIME COMPLETED 63 AM ❑ PM
WELL LOCATION:
CITY'
lJ) LI LCp. WVQ/N.
COUNTY l Xd�' i
Street Name, Numbers, Community, Subdiasion, L
No., Parcel, Zip Code)
TOPOGRAPHIC / LAND SETTING:
0 Slope oValley ❑Flat ❑Ridge ❑Other
(check appropriate box)
LATITUDE 0p. Q Oaf 36,A
v! LONGITUDE y,L / 00 t..LJ
Latitude/longitude source: GPS ❑Topographic map
(location of well must be sho n on a USGS topo map and
attached to this form if not using GPS)
.:.?JELL OWNER
WNER'S NAME
STREET ADDRESS
N( 'JR779
City 'own 1 fate Zip Code
gam- egg, -tAia5
Area code - Phone number
May be in degrees,
minutes, seconds or
in a decimal format
6. WELL DETAILS:
a. TOTAL DEPTH: SOO
,
b. DOES WELL REPLACE EXISTING WELL? YES 0 NO k
c. WATER LEVEL Below Top of Casing: too FT.
(Use'+" if Above Top of Casing)
d. TOP OF CASINO IS 2 FT. Above Land Surface'
'Top of casing terminated at/or below land surface may require
a variance in ac/coo dance with 15A NCAC 2C .0118.
e. YIELD (gpm): "7t1 METHOD OF TEST Blow
f. DISINFECTION: Type H T H
g. WATER 7„ONES (de. /
From 1 /�j To _/ flU From To
From �(i `f'I) To
/ From To
From To From To
6. CASING: Thickness/
/ Depth Dlymyter Weight Material
From /}} To Ft. to c1
From JG�j To. _Ft. 0" /R/J
From To Ft.
324544
7. GROUT: Depth Material Method
From 0 To 20 F1',ement & benonite
From To Ft
From To Ft.
8. SCREEN: Depth Diameter Slot Size Material
From To Ft. In. In.
From To Ft. In, In.
From To Ft. In. In.
9. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
From To Ft.
10. DRILLING LOG
From To
11. REMARKS:
Formation Description
Clay & Rand
granite
I DO HEREBY CERTFV THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH
ISA NCAC 2C, WELL CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS
RECORCTAS BEEN PROVIDED TO THE WELL OWNER
ATURE OF ERTIFIED WELL CONTRACTOR DATE
James B. Brown
PRINTED NAME OF PERSON CONSTRUCTING THE WELL
Submit the original to the Division of Water Quality within 30 days. Attn: Information Mgt.,
1617 Mail Service Center —Raleigh, NC 27699.1617 Phone No. [phone] ext 668.
Form GW-la
Rev. 7/05

RESIDENTIAL WELL CONSTRUCTION RECORD
c)9-5)
North Carolina Department of Environment and Natural Resources- Division of Water Quality
WELL CONTRACTOR CERTIFICATION # 2045
1. WELL CONTRACTOR:
James B. Brown
Web Contractor (Individual) Name
Hedden_Brothers Well Drilling, Inc.
Well Contractor Company Name
STREET ADDRESS 73 Holly Hills Vista Rd
ksanklin, NC 211734
City or Town Stale Zip Code
LULL). 369-9591
Aran coda Phone number
2. WELL INFORMATION: /fin '�!cycl
SrcWELL IDO(Irapplicable) IC�4-9-,L6S
STATE WELL PERMIT#(II applicable)
DWC.I or OTHER PERMIT Hof applicable)
WELL USE (Check Applicable Box):
Residential Water Supply 0
DA(E DRILLED i /h' 0qqCPnn
TIME COMPLETED r7f �nf dl AM ❑ PM{C J
3. W_% LOC TION:
C Tjh�
OUNTY
(£beat Name, Numbers, Community, SubdlMalon, Lot No., Parcel, Zip Code)
TOPOGRAPHIC / LAND SETTING:
❑Slope ❑Valley ❑Flat ORidge OOther
(check apprdprlate box) LATITUDE g?j,,j ,a,__jj A/
Lc 1 GITUDEQ,j7J T/
ie/longitude source: D PS 0Topographic map
(location of well must be drown on a USGS topo map and
attached to this form root using GPS)
e. WL9, I. OWNER
OWNER'S NAME
ADDRESS
May be in degrees,
minutes, seconds or
in a decimal format
S�S).a4Z-1or own 7'yg te
(
Ares code - Phone number
Zip Code
5. WELL DETAILS:
a. TOTAL DEPTH:
b. 1 )F.S WELL REPLACE EXISTING WELL? YES, NO U
c. Y/ATER LEVEL Belau Top of Casing: 8F.0 FT.
(Use'+' S Above Top of Casing)
d. TOP OF CASINO 18 2 FT. Above Land Surface'
'Top of casing terminated sVor below land surface may require
a variance in accordance with 15A NCAC 2C .0118.
e. IIELD Wpm): (e METHOD OF TEST Blow
1. DISINFECTION: Type H T H
. WATERES (d From
ES
From To � .From To
From To From To
From To From To
6. CASING: ��^^ Thickness/
From Depth
Ft. Di/o _ r Weight MBtarjal
From A 0 To Ft. % F'YC:
From To Ft.
Amount 168z
7. GROUT: Depth Material Method
From 0 To 20 Ft. cement & barite Piped
From To Ft
From To
Ft.
8. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. In.
From To Ft. In. In.
From To Ft. In. In.
9. SAND/GRAVEL PACK:
Depth Size Material
From
To Ft.
From To Ft.
From To Ft.
10. DRILLING LOG
From To Formation Description
Clay & sand
11. REMARKS:
Granite
1
0'
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED N ACCORDANCE WITH
15A NCAC 2C. WELL CONSTRUCTION STANDARDS. AND THAT A COPY OF THIS
RECOg6HAS BEEN PROVIDED TO THE WELL OWNER. /fit
ATURE 4L2 CERTIFIED CONTRACTOR , 2 DATEO
James B. Brown
PRINTED NAME OF PERSON Pal -am inyyr TLIG
Sub .dt the or(ginal to the Division of Water quality w(th(n 30 days. Attn: Information Mgt ,RECEIVE D
161 "oil Service Center - Raleigh, NC 27699-1617 Phone No. [phone] ext 568. ! Form GW-la
Re
MAR 0 8 2006v. 1/05
e
Asheville Regional Office
Aquifer Protection

RESIDENTIAL WELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources- Division of Water Quality
WELL CONTRACTOR CERTIFICATION # 2045
1. WELL CONTRACTOR:
James B. Brown
W I ' itntractor (Individual) Name
_&'widen Brothers Well Drilling Tnc.
V:.:.I Contractor Company Name
STREET ADDRESS 73 Holly Hills Vista Rd
Franklin, NC' 28734
City or Town State Zip Code
( 828 )- 369-9591
Area code- Phone number
2. WI' ..L INFORMATION: ,,..// p
$.f ' V ELL ID $(If applicable) /!O.D- 33 '58 9
E', TS WELL PERMITS/Of applicable)
D‘W.I or OTHER PERMIT Cif applicable)
WELL USE (Check Applicable Box):Residential Water Supply ❑
DATE DRILLED I ' I3 -Q,,r/�7'
TIME COMPLETED a ,, CO AM ❑ PMK
3. WELL LO - TION:
CIT
(Street Name,
meets, Community, Subdivision, Lot No., Parcel, Zip Code)
Ti.r -Y3RAPHIC/LAND SETTING:
❑ sl .. ❑Valley ❑Flat ❑Ridge ❑Other
(check epprdprlate box)
°,r ITUDE
LONGITUDE ma L aide/longitude source: 0.6PS ❑Topographic map
j.bcadon of web must be shown on a USGS topo map and
attached to this form b not using GPS)
4. WELL OWNER
Cr,VER'S NAME
ADDRESS
May be in degrees,
minutes, seconds or
in a decimal format
Town State
9/CR- 9L/.5
Area code - Phone number
Zip Code
6. WELL DETAILS: J J06
y
a. TOTAL DEPTH:
b. DOES WELL REPLACE EXISTING WELL? �YESS 0 WOK
e. WATER LEVEL Below Top of Casing: I(O FT,
(Use's- 8 Above Top of Casing)
d. TOP OF CASING IS 2 FT. Above Lend Surface'
'Top of casing terminated aVor below land surface may require
a variance in accordance with 15A NCAC 2C .0110.
/ vn-�
e• '.LD (gpm): METHOD OF TEST Blow
T. DISINFECTION: Type H T H Amount 166z
g. WATER ZONES (depth):
From Tot From To
From 'Tc 3531 From To
From To From To
6. CASING:
Depth Diameter
From To Ft. 4.
From r To�' Z,Ft. /a"
From To Ft.
Thickness/
Weight
h4at�ial
//E8 rYrY
7. GROUT: Depth Material Method
From 0 To 20 Ft. taiptt & teniite rutrei
From To Ft
From To Ft.
8. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in.
From To FL In. In.
From To Ft. In. in.
9. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
From To - Ft.
10. DRILLING LOG
From To ,�
GY r
:t r r
11. REMARKS:
Formation Description
Clay & sand
Grani to
O
LN
100 HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE Wrn4
15A NCAC 2C. WELL CONSTRUCTION STANDARDS. AND THAT COPY OF THIS
RE jaRg HAS BEEN PROVIDED TO THE WELL OWNER.
-- ,
sursta
NATURE OPCERTID WCONTRACTOR — /DA E
James B. Brown
PRINTED NAME OF PERSON
Submit the original to the Division of Water Quality within 30 days. Attn: Information Mgt C E 1 V E D
Form GW-Na
1617 Mali Service Cantor —Raleigh, NC 27699.1617 Phone No. [phone] ext 568. Rev. 7/05
MAR 0 8 2006
Asheville Regional Office
Aquifer Protection

RESIDENTIAL WELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources- Division of Water Quality
WELL CONTRACTOR CERTIFICATION # 2045
1. WELL CONTRACTOR:
James B. Brown
Well Contractor (Individual) Name
Hedden Brothers Well Drilling, Inc.
Well Contractor Company Name
STREET ADDRESS 73 Holly Hills Vista RD
Franklin, NC 28734
City or Town Stale
( 828 )- 369-9591
Area code- Phone number
2. WELL INFORMATION: �y
SITE WELL ID #(if applicable) / 4, /rQ - ya a 3e
STATE WELL PERMIT#(ifapplicable)
DWQ or OTHER PERMIT #(if applicable)
WELL USE (Check Applicable Box):. Residential Water Supply ❑
DATE DRILLED
TIME COMPLETED
Zip Code
AM IR PM ❑
: i 'ELL LOCATIO :
CITY:� IJ,--4i COUNTY
/ I t7YLC1/ hat
(Street Name, Numbers, Community, Subdivision, Lot No., Parcel, Zip Code)
TOPOGRAPHIC / LAND SETTING:
El Slope ❑Valley 0Flat :Midge ❑Other
(check appropriate box)
LATITUDE .i5 al
LONGITUDEZ aq
May be in degrees,
minutes, seconds or
in a decimal format
..atitude/longitude source: QfTPS 0Topographic map
(location of well must be shown on a USGS topo map and
attached to this form if not using GPS)
WELL OWNER
OWNER'S NAME
STREE AD ESS 6
City or Town Slate
(8V&3)- /o31- 7'26
Area code - Phone number
Zip Code
S. WELL DETAILS:
a. TOTAL DEPTH:
b. DOES WELL REPLACE EXISTING WELL? YES 0 NOH
c. WATER LEVEL Below Top of Casing: /f) FT.
(Use'+• if Above Top of Casing)
d. TOP OF CASING 15 2 FT. Above Land Surface'
'Top of casing terminated at/or below land surface may require
a variance in accordance with 15A NCAC 2C .0118.
e. YIELD (gpm): 41) METHOD OF TEST Blow
cf
f. DISINFECTION: Type H T H Amount 160z
g. WATER ZONES (depth):
From_2342 to a; jg From To
From To From To
From To From To
6. CASING: Thickness/
'1 Depth Diameter Weig M terial
�/ To �C%, Ft. 67 "/
From
From To Ft.
From To Ft.
7. GROUT: Depth Material Method
From 0 To 20 n ement & benoill.te
From To Ft.
From To Ft.
8. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in.
From To Ftin. in.
From To Ft. in. in.
9. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
From To Ft.
10. DRILLING LOG
From To
foQ'
20 3/y).
Formation Description
clay & sand
(grant t-P
RECEI
27
O
Asheville-fiegional Office
gutter Protection
11. 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.
ATURE OF CERTIFIED WELL CONTRACTOR
DATEr
James B. Brown
PRINTED NAME OF PERSON CONSTRUCTING THE WELL
submit the original to the Division of Water Quality within 30 days. Attn: Information Mgt.,
• '"7 Mail Service Center —Raleigh, NC 27699-1617 Phone No. [phone] ext568.
Form GW-la
Rev. 7/05

1
RESIDENTIAL WELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources -Division of Water Quality
WELL CONTRACTOR CERTIFICATION # 2045
WELL CONTRACTOR:
James B. Brown
Well Contractor (Individual) Name
Hedden Brothers Well Drilling, Inc.
Well Contractor Company Name
STREET ADDRESS 73 HollyHillsVista RD
828 )- 369-9591
Area code- Phone number
2. WELL INFORMATION:
SITE WELL ID #(if applicable)
Zip Code
71 0- 6-2 - oaf:?
STATE WELL PERMIT#(if applicable)
DWQ or OTHER PERMIT #(if applicable)
WELL USE (Check Applicable Box): Residential Water Supply ❑
!.ATE DRILLED 3 .3 -0
TIME COMPLETED ! r
WELL LOfiATION;
CITY:
(Street Name,
kuttev
AM ❑ PM t('
TY
mbers, Community, Subdivision, Lot No., Parcel, Zip Code)
TOPOGRAPHIC / LAND SETTING:
;]Slope DValley ❑Flat ❑Ridge ❑Other
(check appropriate box)
LATITUDE _h
LONGITUDE
May be in degrees,
minutes, seconds or
in a decimal format
ititude/longitude source: uGPS oTopographic map
(location of well must be shown on a USGS topo map and
attached to this form if not using GPS)
4. WELL OWNER
OWNER'S NAME
r
STREET ADDRES
'2ip Code
City
City or Town 'State
704
Area code - Phone number
*YELL DETAILS:
a. TOTAL DEPTH:
r
1620
b. DOES WELL REPLACE EXISTING WELL? YES 0 NOy
c. WATER LEVEL Below Top of Casing: FT.
(Use "+" if Above Top of Casing)
d. TOP OF CASING IS 2 FT. Above Land Surface
'Top of casing terminated at/or below land surface may require
a variance in accordance with 15A NCAC 2C .0118.
e. YIELD (gpm):
53t
METHOD OF TEST Blow
f. DISINFECTION: Type H T H
NES (depth):
Amount 160z
From
From
From
To
To
To
6. CASING: Thickness/
pi Depth Q Di meter Weigy, trial
From C./To O Ft CO? 1‘ y /37� iak
From To Ft.
From To Ft.
7. GROUT: Depth
From 0 To 20 FGement & benonite
From To Ft.
From To Ft.
Material Method
8. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in.
From To Ft. in. in.
From To Ft. in. In.
9. SAND/GRAVEL PACK:
Depth
From
From
From
Size
To Ft.
To Ft.
To Ft.
10. DRILLING LOG
From To
Material
Formation Description
clay & sand
grant 1-fa
RECEIVED
MAR 27 2066
Asheville Reyion
0
0
Aquifer Protection
1l. REMARKS:
1 DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE W ❑H
15A NCAC 2C, WELL CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS
RECORy4J4A5 BEEN PROVIDED TO THE WELL OWNER.
3—OCR
NATURE OF CERTIFIED WELL CONTRACTOR DATE
James B. Brown
PRINTED NAME OF PERSON CONSTRUCTING THE WELL
Submit the original to the Division of Water Quality within 30 days. Attn: Information Mgt.,
1617 Mail Service Center— Raleigh, NC 27699.1617 Phone No. [phone] ext 568.
Form GW-la
Rev. 7/05

RESIDENTIAL WELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources- Division of Water Quality
WELL CONTRACTOR CERTIFICATION # 2045
1. WELL CONTRACTOR:
James B. Brown
Well Contractor (Individual) N<.me
Redden Brothers Well Drilling, Inc.
Well Contractor Company Name
STREET ADDRESS 73 Holly Hills Vista Rd
Franklin, NC 28734
City or Town State
( 828 )- 369-9591
Area code- Phone number
2. WELL INFORMATION:
SITE WELL ID #(Il applicable) / 1 /J ` 15 -43O 9
STATE WELL PERMIT#(it applicable)
Zip Code
DWQ or OTHER PERMIT #(If applicable)
WELL USE (Check Applicable Box): Residential Water Supply f
DATE DRILLED 1/5-0 I4O
d
TIME COMPLETED A )© AM ❑ PM Q /
3. WELL LOC TIO CITY: COUNTY
LJj{' t COUNTY
mho)"
iuv ry r/^ /
(Sir t Name, Nudiher dommunIy, Subdivision, Lot N9 jParcal, Zip Code)
TOPOGRAPHIC / LAND SETTING: uu
°Slope °Valley ❑Flat ❑Ridge ❑Other
(check apprdpnate box)
LATITUDE ,5:i;
LONGITUDEaL').4op ;
May be in degrees,
minutes, seconds or
in a decimal format
Latitude/longitude source: ° GPS ❑Topographic map
(location of well must be shown on a USGS torso map and
attached to this form 1 nol using GPS)
4. WELL OWNER
OWNER'S NAME
STET ADD
4/ de.i / 1(.
✓ffmw i/�,i1I
City or Town State • i P Code
( 8�y� 2K T- 0rJ -,3a5
Area code - Phone number
5. WELL DETAILS: JnJ�,
a. TOTAL DEPTH: i00
b. DOES WELL REPLACE EXISTING WELL? YES 0 NOa
c. WATER LEVEL Below Top of Casing: I.5DO Fr.
(Use '4.' S Above Top of Casing)
d. TOP OF CASINO IS 2 FT. Above Land Surface'
'Top of casing terminated aUor below land surface may require
a variance in accordance with 15A NCAC 2C .0118.
e. YIELD (gpm): METHOD OF TEST Blow
t. DISINFECTION: Type H T H
g. WATER 'Oh(ES (depth): ,
From J59 To , 355 From To
. From 'Y(O IS -To 3 70 r From To
From To From To
6. CASING: Thickness/
From b.
Dept Di t i
etpr Weight al
p�
CL To Ft.
From To Ft. /i " ,Megy(yyQ
From To Ft.
7. GROUT: Depth
Amount 166z
Material • Method
From 0 To 20 Ft. tatt t. & t trite RitPBd
From To Ft.
From To Ft.
8. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. In.
From To Ft. In. In.
From To Ftin. in.
9. SAND/GRAVEL PACK:
Depth
From To Ft.
From To Ft.
From To Ft.
10. DRILLING LOG
From To
1 �<4
11. REMARKS:
Size
Material
Formation Description
Clay & sand
Granite
0
u
I D0 HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH
15A NCAC 2C, WELL CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS
RECOAS BEEN PROVIDED TO THE WELL OWNER.
aro/
NATURE OF
<' S—oW
ERTIFIED WELL CONTRACTOR DATE
James B. Brown
PRINTED NAME OF PERSON CONSTRUCTING THE WELL
Submit the original to the Division of Water Quality within 30 days. Attn. Info
1617 Mall Service Center— Raleigh, NC 27699.1617 Phone No. [phone] ext
68. RECEIVEDR 5
FEB 07 2006
Asheville Regional Office
a

RESIDENTIAL WELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources- Division of Water Quality
WELL CONTRACTOR CERTIFICATION # 2045
1. WELL CONTRACTOR:
James B. Brown
Welt Contractor (Individual) Name
Hedden Brothers Well Drilling Inc.
Wei! Contractor Company Name
STREET ADDRESS 73 Holly Hills Vista Rd
Franklin, NC 28734
City or Town State
( 828 )- 369-9591
Area code- Phone number
2. We'.', NFORMATION:
: '.tea ID #(It applicable)
Zip Code
1519 -5 81M7
:T 7. WELL PERMIT#(Il appilcable)
DWQ or OTHER PERMIT #(If applicable)
USE (Check Applicable Box): Residential Water Supply 0
DATE DRILLED TIME COMPLETED L(J . l..C/ AM CI PM /
3. W ? I. LOCAT
C. +.
eme, Nu - era, C. mun , Subdivision, Lot No., Parcel, Zip Code)
TOPOGRAPHIC/LAND ETTING:
❑S:'pe °Valley °Flat °Ridge °Other
(check eppr6p�riate box)
LATITUDE _6^J
LONGITUDE
ia
May be In degrees,
minutes, seconds or
in a decimal format
Lat:''.lde/longitude source: °GPS ❑Topographic map
(location of wed must be shown on a USGS topo map and
attached to this form /not using GPS)
4. W 11_L OWNER
OAER'S NAME
-✓ -ET ADDRESS
{
ty or Town State
- a74- 94094
Area code - Phone number
6. WELL DETAILS: goo /
a. TOTAL DEPTH: yU
0/ZA
33R7i)
Zip Code
b. DOES WELL REPLACE EXISTING WELL? YES ° NOK_
c.:±„TER LEVEL Below Top of Casing: FT.
(Use'+' 6 Above Top of Casing)
o. TUP OF CASING IS 2 FT, Above Land Surface*
Top of casing terminated at/or below land surface may require
a variance in accordance with 15A NCAC 2C .0118.
e. YIELD (gpm): _di_ METHOD OF TEST Blow
1. DISINFECTION: Type H T H
Amount 168z
g. WATER ZONES (depth):`/
From To T4 .From To
From To From To
From To From To
6. CASING: Thickness/
Depth Dimeter Weight
From To 3Ft. tosi
From To &' Ft. as+'
From To Ft.
7. GROUT: Depth
Mal. pit
'mg
Material • Method
From 0 To 20 Ftc r13tt & termite RITL81
From To Ft.
From To FI.
8. SCREEN: Depth Diameter Slot Size Material
From To Ft. In. In.
From To Ft. In. In.
From To Ft. In. In.
9. SAND/GRAVEL PACK:
Depth
From
From
From
Size
To Ft.
To Ft.
To Ft.
Material
10. DRILLING LOG
From To 4 j Formation Description
`Y Clay & sand
Tr `16 r Granite
11. REMARKS:
t.)
1 DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED N ACCORDANCE WITH
15A NCAC 2C, WELL CONSTRUCTION STANDARDS. AND THATA COPY OF THIS
RECODj4AS BEEN PROVIDED TO THE WELL OWNER.
2-79
GNATl7tiE OP'-CI=RTIF1� E�NTRACTORI `DATE
James B. Brown
PRINTED NAME OF PERSON CONSTRUCTING THE WELL
Submit the original to the Division of Water Quality within 30 days. Attn: formation M,t.
1617 Mall Service Center— Raleigh, NC 27699.1617 Phone No. (919) 733-701' ext 568.
RECEIVED
FEB 07 2006
Asheville Reainnni flMHAE
GW-la
Rev17/05

RESIDENTIAL WELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources- Division of Water Quality
WELL CONTRACTOR CERTIFICATION # 3466
f. DISINFECTION: Type H T H Amount 16oz
1. WELL CONTRACTOR:
Johnny Shane Downs
Wel! Contractor (Individual) Name
Hedden Brothers Well Drilling, Inc
Well Contractor Company Name
STREET ADDRESS 73 Holly Hills Vista RD
Franklin,
NC 28734
City or Town State Zip Code
( 828 )_ 369-9591
Area code- Phone number
2. WELL INFORMATION:
SITE WELL ID #(it applicable)
750/ R-n$ 03 0
STATE WELL PERMIT#(if applicable)
DWQ or OTHER PERMIT #(if applicable)
WELL USE (Check Applicable Box): Residential Water Supply
DATE DRILLED IC)' r .d(p
5
TIME COMPLETED t O AM 0 PM
3. WELL LO TION:
COUNT
`` 0
(Street Na e, Numbers, Community, Subdivision, Lot No., Parcel, Zip Code)
TOPOGRAPHIC / LAND SETTING:
❑Slope OValley ❑Flat ❑Ridge ❑Other
(check appropriate box
LATITUDE 1,6
3y� 11
d LONGITUDE u _J_(
Latitude/longitude source: ©GPS oTopographic map
(location of well must be shown on a USGS topo map and
attached to this form it not using GPS)
4. WELL OWNER
OWNER'S NAME
STREET ADDRESS
May be in degrees,
minutes, seconds or
in a decimal format
'ownState
s cap -3 3/
Area code - Phone number
5. WELL DETAILS:
a. TOTAL DEPTH:
knO
b. DOES WELL REPLACEXISTING WELL? � /YES IDNOK
c. WATER LEVEL Below Top of Casing: Ai(�L FT.
(Use "+" if Above Top of Casing)
d. TOP OF CASING IS 2 FT. Above Land Surface'
`Top of casing terminated at/or below land surface may require
a variance in accordance with 15A NCAC 2C .0118.
e. YIELD (gem): 00 METHOD OF TEST Blow
Zip Code
From
From
6. CASING:
From
From
From To Ft.
g. WATER ONES (depth):
From ! r)_ To
Z!�
From to. --
From To_
From To
Thickness/
Dlamptter Weight Ma 'al
Ft. tn,• &'
Depth
To
7. GROUT: Depth Material
0 To Y0 Ft cement&benonite
From
From To Ft.
From To Ft.
8. SCREEN: Depth Diameter
From To Ft. in
From To Ft. in
From To Ft. in
9. SAND/GRAVEL PACK:
Depth
From To Ft.
From To Ft.
Method
pumped
Slot Size Material
in.
_ in.
in.
Size Material
From To Ft.
10. DRILLING LOG
From ic�p Formation Description
0
LLIIJJ Clay & sand
Granite
11. REMARKS:
IWELL WAS CONSTRUCTED IN ACCORDANCE wfni
5A NCAC 2C, WELL CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS
15A
RECORD HAS BEEN PROVIDED TO THE WELL OWNER.
ZIWC f)0/4m4- I1-1-Ofo
SIGNATURE OF ERTIFIED WELL CONTRACTOR DATE
"JI-,4nc t3tiln'
PRINTED NAME OF PE,RSQtL CONSTRUCTING THE WELL
Submit the original to the Division of Water Quality within 30 days. Attn: Inforination Mgt.,
1617 Mail Service Center— Raleigh, NC 27699.1617 Phone No. [phone] ext 568.
Form GW-;1a
Rev. 7/05 ,

STREET ADDRESS
Franklin,
RESIDENTIAL WELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources -Division of Water Quality
WELL CONTRACTOR CERTIFICATION (# 3466
1. WELL CONTRACTOR:
Johnny Shane Downs
Well Contractor (Individual) Name...
Hedden Brothers Well Drilling, Inc
Well Contractor Company Name
73 Holly Hills Vista RD
NC 28734
City or Town State Zip Code
828 )- 369-9591
Area code- Phone number
2. WELL INFORMATION:
SITE WELL ID #(it applicable)
STATE WELL PERMIT#(if applicable) —
DWQ or OTHER PERMIT #Of applicable)
WELL USE (Chec/k? pplicable Box): Residential Water Supply El
DATE DRILLED (lc / AOC ,y
TIME COMPLETED 3 "OD AM ❑ PM
3. WELL LOp4.TION:
i
CI reef N e, „ujl/Q C ^ion, Lot No
UNTY
`1Lj,(j/;r���✓ 6N
Street N me, Numbers, Or ommunitY. ubdideion, Lot No., Parcel, Zip Code)
TOPOGRAPHIC / LAND SETTING:
❑Slope ❑Valley ❑Flat ❑Ridge Other
(check appropriate box)
LATITUDE 3
LONGITUDE
Latitude longitude source: pGPS ❑Topographic map
(location of well must be shown on a USGS topo map and
attached to this foryn if not using GPS)
May be in degrees,
minutes, seconds or
in a decimal format
4. WELL OWNER
OWNER'S NAM
STREET ADDRESS
City or Town r State
(_221)- 4, & - 7a7(p
Area code- Phone number
Zip Code
5. WELL DETAILS:
a. TOTAL DEPTH:
b. DOES WELL REPLACE EXISTING WELL? YES ❑ NO 0
c. WATER LEVEL Below Top of Casing: FT.
(Use "+• if Above Top of Casing)
d. TOP OF CASING is 2 FT. Above Land Surface
"Top of casing terminated at/or below land surface may require
a variance in accordance with 15A NCAC 2C .0118.
e. YIELD (gpm): METHOD OF TEST Blow
6. CASING:
334481
t. DISINFECTION: Type H T H Amount 16oz
g. WATER ZONES (depth):
From To Prom. To
From To From To
From To From To
Thickness/
Weight Material
Depth Diameter
From To Ft.
From To Ft.
From To Ft.
7. GROUT: Depth Material Method
From
0 To 20 Ft cement & benonite pumped
From To Ft.
From To Ft.
Depth Diameter Slot Size Material
To Ft. in. — in.
To Ft. in. _ in.
To Ft. in. in.
8. SCREEN:
From
From
From
9. SANDIGRAVEL PACK:
Depth
From
From
From
To Ft.
To Ft.
To Ft.
Size Material
10. DRILLING LOG
From To
0
Formation Description
Clay & sand
Granite
cm
1 D0 HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH
1 SA NCAC 20, WELL CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS
RECORD HAS BEEN PROVIDED TO THE WELL OWNER.
M 4.4 DOwYty— 11,1'-00
SIGNATURE OF CERTIFIED WELL CONTRACTOR DATE
F tonne (\ow .%
PRINTED NAME OF PERSON CONSTRUCTING THE WELL
Submit the original to the Division of Water Quality within 30 days. Attn: Information Mgt,
1617 Mail Service Center— Raleigh, NC 27699-1617 Phone No. [phone] ext 566. .. _..
Form GW-la
Rev. 7/05

RESIDENTIAL WELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources -Division of Water Quality
WELL CONTRACTOR CERTIFICATION # 3466
1. WELL CONTRACTOR:
Johnny Shane Downs
Well Contra'Dot (individual) Name
Hedden Brothers Well Drilling, Inc
STREET ADDRESS
Well Contractor Company Name
73 Holly Hills Vista RD
Franklin,
City or Town State Zip Code
( 828 )- 369-9591
Area code- Phone number
2. WELL INFORMATION: I��� Ql may
7�
SITE WELL ID#(inapplicable) / V - -/
/CO /
NC 28734
STATE WELL PERMIT#(Ifapplicab'e)
DWQ or OTHER PERMIT #(if applicable)
WELL USE (Check ApplicablejBox):oxResidential Water Supply ia
DATE DRILLED /VJ�4��// ��vT��(1�1!
TIME COMPLETED , W AM 0 PM*
3. WELL LOC 10 :
CITE L A. Nan COUNTY.,
//1,
reet Name, Numbers, Community, Subdiv,smn, Lot No., Parcel, Zip Code)
TOPOGRAPHIC / LAND SETTING:
❑Slope ['Valley ❑Flat ❑Ridge ❑Other
(check appropriate box)
LATITUDE �r�/'t1
A)
LONGITUDE d Q 49 KJ
Latitude/longitude source: L GPS ❑Topographic map
(location of well must be shown on a USGS topo map and
attached to this form If not using GPS)
4. WELL OWNER
OWNER'S NAME
STREET D ESS
T uAt.
City or Town State
( )- Ph -6
Area code - Phone number
May be in degrees,
minutes, seconds or
in a decimal format
5. WELL DETAILS:
a. TOTAL DEPTH:
b. DOES WELL REPLACE EXISTING WELL? YES 0 NO
c. WATER LEVEL Below Top of Casing: di FT.
(Use "*" if Above Top of Casing)
d. TOP OF CASING IS 2 FT. Above Land Surface'
'Top of casing terminated at/or below land surface may require
a variance in accordance with 15A NCAC 2C .0118.
e. YIELD (gpm): /aJ1 METHOD OF TEST Blow
by
334480
f. DISINFECTION: Type H T H Amount 16oz
g. /JWATER ZONES (dep
From_. �I 7 u!� Ffom-c..
From gS4/ To From To
From To From To
6. CASING: Thickness/
From LLDD
D DTpoth/ 2 (Q Ft De WW M vial
From To Ft.
From To Ft.
7. GROUT: Depth Material Method
From 0 To 20 Ft. cementBDenanae pumped
From To Ft.
From To Ft.
8. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. _ in.
From To Ft. in. _ in.
From To Ft. in. in.
9. SAND/GRAVEL PACK: Depth Size Material
From To Ft.
From To Ft.
From To Ft.
10. DRILLING LOG
From To Formation Description
D � 4 Clay & sand
11. REMARKS:
Granite
!An \I
n\I %
t*C)
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH
15A NCAC 2C, WELL RECORD
/DHHAS
S BEEN PROVIDED TOO HE WELN L OWNER,
THAT A COPY OF HIS
SIGNATURE OF CERTIFIED CONTRACTOR DATE
?ha np 1 oo W r'1C
PRINTED NAME OF PERSON'CCONSTRUCTING. THE WELL
Submit the original to the Division of Water Quality within 30 days. Attn: Information Mgt., —
1617 Mail Service Center — Raleigh, NC 27699-1617 Phone No. [phone] ext 568. NOV 2 8
LOns
Form GW-1a
Rev. 7105

WELL CONTRACTOR CERTIFICATION #
1. WELL CONTRACTOR:
Johnny Shane Downs
Wel! Contractor (Individual) Name
Hedden Brothers Well Drilling, Inc
Well Contractor Company Name
STREET ADDRESS 73 Holly Hills Vista RD
Franklin, NC 28734
City or Town State
( 828 )- 369-9591
Area code- Phone number
Zip Code
2. WELL INFORMATION: ry / a e�
SITE WELL ID #(ir applicable) 1(S22 • IL • Li 14
STATE WELL PERMIT#(if applicable)
DWQ or OTHER PERMIT #(if applicable)
WELL USE (Check Applicable Box):
DATE DRILLED
TIME COMPLETED
3. WELL LO Afc TION:
CITX: �?4/�V VQ
Residential Water Supply
ov(0
AM ❑ PM&
(Street Name, Num
rs, Commum Subdivision, Lot No., Parcel, Zip Code)
TOPOGRAPHIC / LAND SETTING:
❑Slope DValley ❑Flat ❑Ridge ❑Other
(check appropriate box)
LATITUDE _a 1 ( J
LONGITUDE f 3 f2 T
May be in degrees,
minutes, seconds or
in a decimal format
Latitude/longitude source: GPS ❑Topographic map
(location of well must be s own on a USGS topo map and
attached to this form if not using GPS)
4. WELL OWNER
OWNER'S NAME
EET ADDRESS
&'fie, D- Rabe-..
e� 4c n49
(} City Qor Town tate
(Qb.gt- 7q, • 0598
Area code - Phone number
5. WELL DETAILS: VVo
a. TOTAL DEPTH:
Zip Code
b. DOES WELL REPLACE EXISTING WELL? YES 0 NO1
c. WATER LEVEL Below Top of Casing: 400 FT.
(Use "+• if Above Top of Casing)
d. TOP OF CASING IS 2 FT. Above Land Surface'
-Top of casing terminated at/or below land surface may require
a variance in accordance with 15A NCAC 2C .0116.
e. YIELD (gpm): 020. METHOD OF TEST Blow
RESIDENTIAL WELL CONSTRUCTION RECORD •
North Carolina Department of Environment and Natural Resources- Division of Water Quality 3 3 3 4 0 4
3466
f. DISINFECTION: Type H T H Amount 16oz
g. WATER ZONES/(depth):
From I,AL• To___at From To
From To From - To
From To From To
6. CASING: Thickness/
Depth Dim'e"ter Weight Material
From 0 To II(eFt. u- P1(Gri
From To Ft.
From To Ft.
7. GROUT: Depth Material Method
From D To 20 Ft. cement abenonite pumped
From To Ft.
From To Ft.
8. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in.
From To Ft. in. in.
From To Ft. in. in.
9. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
From To Ft:
10. DRILLING LOG
From T Formation Description
Gray sand
Granite
11. REMARKS:
DIV. OFWq EIR ODla
l LITy
OCT I i 2006
I D0 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 CERTIFIED WELL CONTRACTOR DATE
5 tncnc 1laL..anS
PRINTED NAME OF PERSON CONSTRUCTING THE WELL
Submit the original to the Division of Water Quality within 30 days. Attn: Information Mgt,
1617 Mail Service Center— Raleigh, NC 27699-1617 Phone No. [phone] ext 568.
Form GW-la
Rev. 7/05

1. WELL CONTRACTOR:
Johnny S:.ane Downs
Well Contractor (Individual) Name
Haddon, Brothers Well Drilling, Inc
RESIDENTIAL WELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources- Division of Water Quality
WELL CONTRACTOR CERTIFICATION # 3466
STREET ADDRESS 73 Holly Hills Vista RD
Franklin, NC
City or Town p code
State Zip Code
Lai. 369-9591
Area code- Phone number
2. WELL INFORMATION:
SITE WELL ID #(il applicable) •�4f ��l/n
STATE WELL PERMIT#(it applicable)
DWQ or OTHER PERMIT *(if applicable)
WELL USE (Check Appticable Box): Residential Water Supply
DATE DRILLED_ I_�{ A0
TIME COMPLETED_ 5 �j0 AM 0
3. WELL LOCATION:
CITY: ril nn.,l rnn-n 1\A_L _
(Street Name, Numbers, Co unity, Subdivision, Lot Na., parcel, Zi
TOPOGRAPHIC / LAND SETTING:
❑Slope ❑Valley ❑Flat ❑Ridge ❑Other
(check appropriate box)
LATITUDE 35 4,33 _S'-�
LONGITUDE . U40
Latitude/longitude source: p GPS ❑Topographic map
(location of well must be shown on a USGS topo map and
attached to this form it not using GPS)
a. WELL OWNER
OWNER'S NAME /YI 7A(. 7VOl//AAA. A_ -.I ILA
City or Town
State Zip Cade
Area code • Phone number
5. WELL DETAILS:
a. TOTAL DEPTH:_
b. DOES WELL REPLACE EXISTING WELL? YES ❑ NO ❑
a. WATER LEVEL Below Top of Casing:
(Use "+" if Above Top of Casing)
d. TOP OF CASING IS 2
FT. Above Land Surface`
*Top of casing terminated at/or below land surface may require
a variance in accordance with 15A NCAC 2C .0118.
e. YIELD (gpm): j_ METHOD OF TEST Blow
May be in degrees,
minutes, seconds or
in a decimal format
f. DISINFECTION: Type
g. WATER ZONES (depth):
From__ f To I3 3
From To
From To
6. CASING:
Depth
From a ToSt Ft.
Fromy_ TD__ Ft.
From To Ft.
7. GROUT:
0
From
From
From
Depth
To 20
To
To
8. SCREEN:. Depth
From To_
From To
From To
9. SAND/GRAVEL PACK:
Depth
From To
From To
From To
10. DRILLING LOG
From T
ys
11. REMARKS:
HTH
From
From
From
Diameter
ff
'3°165
Amount 160z
To,
To
To
Thickness/
Weight
Material
Ft. cement 3 benonite
Ft._�_
Ft.
Material
Method
pumped
Diameter Slot Size Material
Ft. in. in.
Ft. In. In.
Ft in. in.
Size
Ft.
Ft.
Ft.
Material
Formation Description
Clay & sand
Granite
DEC 12 200
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH
n"AC 2C, WELL CONSTRUCTION STANDARDS, AND TH..T;, COPY OF THIS
RECC `D HAS BEEN PROVIDED TO THE WELL OWNER.
SIGNATURE OF CERTIFIED WELL CONTRACTOR D E
PRINTED NAME OF PERSON CONSTRUCTING THE WELL
Submit the original to the Division of Water Quality within 30 days. Attn: Information Mgt.,
1617 Mail Service Center— Raleigh, NC 27699.1617 Phone No. [phone] ext 565.
Form GW-1a
Rev. 7/05

RESIDENTIAL WELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources- Division of Water Quality
WELL CONTRACTOR CERTIFICATION # 2187
1. WELL CONTRACTOR:
Russell S. Taylor
Well Contractor (Individual) Name
Hedden Brothers Well Drilling, Inc.
Well. Contractor Company Name
STREET ADDRESS 73 lolly Hills Vista RD
F'iav1)LLUI._NC 28734
City or Town State Zip Code
! 828 )- 369 9591
Area code- Phone number
2. A. INFORMATION: r/ 2'
StTEiiNFOR ATIONlic•N•) 553'33-3 0-
F (ATE WELL PERMIT#(l applicable)
DWQ or OTHER PERMIT Cif applicable)
BLL USE (Check Applicable Box): Residential Water Supply ❑
t, A / re DRILLED ' 7 ' 66 TIME COMPLETED 2 ; 00 AM ❑ PMU1
1. WELL LOC TION:
CI` Y.
COUNTY
(Street Nam*, Numbers. Communl , Subdivision, Lot No., Parcel, Zip Co-.
TOPOGRAPHIC / LAND SETTING:
❑.Slope °Valley ❑Flat ❑Ridge ❑other
(check spprcpriats box)
I_ 1 ITUDE S
LONGITUDE
Lati'ude/longitude source: °GPS °Topographic map
(location of well must be shown on a USGS topo map and
attached to this form Bnot us arg GPS)
May be In degrees,
minutes, seconds or
in a decimal format
4. WELL OWNER
C r :JER'S NAME
5 r
qF.T AA DRESS
Il / U12
Town N State/AL/taa
Ll(Jl.. •. 501Q- oil
Area code - Phone number
City
S. WELL DETAILS:
a. TOTAL DEPTH:
Zip Cods
b. DOES WELL REPLACE EXISTING WELL? YES 0 NOg,
e. WATER LEVEL Below Top of Casing: - -- / /5 FT.
(Use '+' 6 Above Top of Casing)
d. TOP OF CASING IS 2 FT. Above Land Surface'
*Top of easing terminated at/or below land surface may require
a variance In accordance with 15A NCAC 2C .0118.
e. YIELD (gpm): /5 METHOD OF TEST Blow
t. DISINFECTION: Type Hf`T H Amount 16oz
g. WATER ZONES (depth):
From y To
From
From
6. CASING:
To
To
Depth
From To Ft. (p"
From
From To Ft.
7. GROUT: Depth Material
From To
From To
From To
Thickness/
Diameter Weight M=-err al
rtiu
tiff/
Method
From () To'20 Ft. CT-,F. 4, & kauiite nmrei
From To Ft.
From To Ft.
8. SCREEN: Depth Diameter Slot Size Material
From To Ft. In. In.
From To Ft. In. In.
From To Ft. . in. In.
9. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
From To Ft.
10. DRILLING LOG
From To
0
Lt
11. REMARKS:
Formation Description
Clay & sand
Granite
ru
W
ul
100 HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH
15A NCAC 2C. WELL CONSTRUCTION STANDARDS. AND THATA COPY OF THIS
RECOR AS BEEN PROVIDED TO THE WELL OWNER. 5
•
SIGNATURE OF ERTIF cL CONTRACTOR 1 DAOTE
Russell S. Taylor
PRINTED NAME OF PERSON CONSTRUCTING THE WELL
Submit the original to the Division of Water Quality within 30 days. Ann
1617 Mall Service Center— Raleigh, NC 27699-1617 Phone No, (919) 733.701
ext
Into56 .. �rRE!GE1VED
FEB 0 7 2006
Asheville Regional Office
Aquifer Protection
For • GW-la
Rev 7/05

RESIDENTIAL WELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources- Division of Water Quality
WELL CONTRACTOR CERTIFICATION 0 2187
Ntle
1. WELL CONTRACTOR:
Russell S. Taylor
Well Contractor (Individual) Name
13 :'den Brothers Well Drilling, Inc
Contractor Company Name STREET ADDRESS 73 Holly Hills Vista RD
Franklin, NC 28734
City or Town State Zip Code
L;17.8 H 369-9591
Artie code- Phone number
2. WELL INFORMATION: p Q
WTI WELL ID dill smokable) 1 50
0 - DO .fY?821
S 'R WELL PERMITCW applicable)
i/Q, or OTHER PERMIT e(11 applicable)
VI :'LJ. USE (Check Applicable Box): Residential Water Supply p
I C.A I E DRILLED
TIIh t. COMPLETED
d. WELL LOCATION:
CITY:
TTT••• n i
AM p PM3.
COUNTY
.! k,o,o e
(Street Nerve, Nu
re, Community. Subdivision, Lot No., Parcel, Zip Code)
TOPOGRAPHIC'( LAND SETTING:
p Slope (Valley DFlat ❑Ridge (other
(check upprd�pQrtate boa)
I_ `.11'JDE_(s//3
LONGITUDE12_a/q 05
Latitude/longitude source: ErtPS (Topographic map
(location of well must be shown on a USGS top* map and
attached to this form snot using GPS)
4. WELL OWNER
OWNER'S NAME
S'_`tEET .:DD-ES
May be In degrees,
minutes, seconds or
in a decimal format
ty or own �' to Zip Code
LZ�
weu code • Phone number
5. WELL DETAILS: ^^ e
a. TOTAL DEPTH: P3(50 I '
b. DOES WELL REPLACE EXISTING WELL? YES ❑ �r NO
c. WATER LEVEL Below Top of Casing: lOD FT.
(Use'+' 11 Above Top of Casing)
d. TOP OF CASING IS 2 _ FT. Above Lend Surfece•
lop of casing terminated aVor below land surface may require
. variance In ac/gorda_nce with 1SA NCAG 2C .0115,
e.,.'YIELD (gpm): /5 METHOD OF TEST slow
f. DISINFECTION: Typo H 'T H Amount 16oz
g, WATERRZONES (depth):
` 5 From 11 TO to From To
From /he1o'To /88r From To
From rR f To A /O 1 From To
8. CASING:
Depth
From To
From
From
To
Dlsyneter
Ft. w
Ft_dett
Ft.
Thickness/
Weight M oriel
y lt9$
7. GROUT: Depth Material Method
From 0 Ter.20 FL 091133t & )=Hu tte A red
From To FL
From To Ft.
6. SCREEN: Depth Diameter Slot Size Material
From To Ft. In. In.
From To Ft. In. In.
From To Ft. . In, In,
9. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
From To FI.
10. DRILLING LOG
From T0
_ write
11. REMARKS:
Formation Description
Clay & sand
Grantte
100 HERESY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH
15A NCAC 2C, WELL CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS
RECO NA�VIDED TO THE
,wyWELL OWNER.
SIGNATURE OF CERTIFIED W IL CONTRACTOR
Russell S. Taylor
PRINTED NAME OF PERSON CONSTRUCTING THE WELL
Submit the original to the Division of Water Quality within 30 d
1617 Mall Service Canter —Raleigh, NC 27899-1617 Phone No. (91
733.70e13 EtCt 1 V E D
Form GW 1 a
Ray. 7/05
MAR 2 7 2006
Asheville Regional Office
A. uifer Protection

RESIDENTIAL, WELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources- Division of Water Quality
WELL CONTRACTOR CERTIFICATION # 2187
1. WELL CONTRACTOR:
Russell S. Taylor
W •{. Contractor (Individual) Name
Hedden Brothers Well Drillina2 Inc.
,'II Contractor Company Name
STREET ADDRESS 73 Holly Hills Vista RD
Franklin, N 28734
City or Town State Zip Code
( 8281• 369-9591
Area code- Phone number 2. WEB-L INFORMATION: ' ' n 2 "
Si ,re WELL ID M it applicable) 7`�}tp7- 03 a813
STATE WELL PERMITehr applicable)
DWQ or OTHER PERMIT Cif applicable)
N :cLL IJSE (Check Applicable Box): Residential Water Supply ❑
re DRILLED l ' 13 . V C0
TIME COMPLETED .5. 15
AM
3. WELL LOCATION:
,.,
CITY: J1 o1COUNTY
ma'
(Suet Name, Numbers, CommunlubdiNFlan, Lot No„ Parcel, Zip Code)
TO-OGRAPHIC / LAND SETTING: t ,
°Slope °Valley CI Flat °Ridge ❑Other t �,U
(Oink apprdpriatebox)
L.' '11TUDE it
dp &SA/
LONGITUDEM iL{�
Iati'ude/longitude source: 6,6PS ❑Topographic map
'location of well must be shown on a USGS topo map and
attached to this form r1 not va/ng GP$)
1. WELL OWNER
CWNER'SNAME Yyr ea/Y.0416
• S'."Ic1EET ADDRESS f O BIG '`7 �
Qjrlu .r AlC (gild
City or Town /State Zip Code
(L)• all - AM& •
Area code • Phone number
May be in degrees,
minutes, seconds or
In a decimal format
'74
6, WELL DETAILS: ryk,,
a. TOTAL DEPTH: OU)
b. DOES WELL REPLACE EXISTING WELL? YES 0 N0K
c. WATER LEVEL Belau Top of Casing: . -- 0- - -FT.
(Use'+' If Above Top of Casing)
el, TOP OF CASINO le 2 FT, Above Land Surface'
'Top of casing terminated aVor below lend surface may require
■ variance In accord co with 16A NCAC 2C .0118,
e. YIELD(gpm):__ METHOD OF TEST Blow
f, DISINFECTION: Type H'T H Amount 16oz
g. WATER ZONES (depth):
From To From To
From To • From To
From To From
6. CASING:
j� Depth DI���nnna}er
From To Ft. (/'
From To Ft. s _
From To___ Ft.
Thickness)
Weight Mat��al
7. GROUT: Depth Material Method
From 0 To72O Ft rsaTc t & ba-uiite wired
From To FI.
From To Ft,
8. SCREEN: Depth Diameter Slot Size Material
From To Ft. in, In.
From To Ft. In. In.
From To Ft. . In, In.
9, SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
From To__ Ft.
10. DRILLING LOG
From To Formation Description
0 Clay & sand
MINIMS
11. REMARKS:
Granite
_J
I00 HERESY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE Wn/l
16A NCAC 2C, WELL CONSTRUCTOR STANDARDS, AND THAT A COPY OF THIS
RECORD S SEEN PROVIDED TO THE WELL OWNER,
SIGNATURE OF CERTIFIED W CONTRACTOR D E
Russell S. Taylor
PRINTED NAME OF PERSON CONSTRUCTING THE WELL
Submit the original to the Division of Water Quality within 30 days. Attn. • n g
1617 Mall Service Center— Raleigh, NC 27899.1617 Phone No, (919) "'RE 0 EE3V E D
MAR 0 8 2006
Asheville Regional Office
Aeuifer Protection
Form GWla
Rev. 7/05

WELL CONSTRUCTION RECORD 335390
North Carolina - Department of Environment and N tural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) hi A✓ Wthb CERTIFICATION #p249q
WELL CONTRACTOR COMPANY NAME 1fCene. � s welt °Lfn U%I]p PHONE # Gan 6VD7j/9D
STATE WELL CONSTRUCTION PERMIT# ND 2 - ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential 19" Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection ❑ Other 0 If Other, List Use
2. WELL LOCATIO I
Nearest Town: f VGLL County..lap/4s0/"
(Street Name,
3. OWNER:
Address
4
5
7
Numbers, Community, Subdivision, Lot No., Zip Code)
Uss heibaSt-.
(Strecycir Route No.)
a)at/naive tUc LB7R6
City or own State Zip Code
(BLS)- HSy- oo 8
Area code- Phone number
DATE DRILLED w 14 -d 6
TOTAL DEPTH:
yyS'
DOES WELL REPLACE Fvlrrin U \u):1 l ., YES r,_7 NC)
STATIC WATER LEVEL Below Top of Casing: 10 FT.
(Use "+" if Above Top of Casing)
S. TOP OF CASING IS / FT. Above Land Surface'
*Top of casing terminated at/or below land surface requires a
variance in accordance with ISA NCAC 2C .0118.
`
9. YIELD (gpm): 7/ METHOD OF TEST rgetif S
I . WATER ZONES (depth): 2 6 S
11. DISINFECTION: Type
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft.
From 0 To (pL/ Ft. (rrt
From To Ft.
From To Ft.
�L '125'
`1 %21 Amount
Material
Pv c
13. GROUT: Depth Material Method
From 0 To 2-0 Ft. CtreAk To�
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 0Valley C�]Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:DGPS0Topographic map
(check box)
DEPTH DRILLING LOG
From
b
b5' Tote
Hy5' Formation Description
p - 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.
JAN 02 2001
RECENED
OkV. .
16. REMARKS:
1 DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONST )C ION STANDARDS,�AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
cM ea- a� C/.ttarr.) /27S-o ct
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