Ma CY2006

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
MA 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)
STATE WELL PERMIT#(if applicable)
DWQ or OTHER PERMIT #(if applicable)
WELL USE (Check Applicable Box): Residential Water Supply ❑
DATE DRILLED 9/12/06
TIME COMPLETED 5:00
3. WELL LOCATION:
CITY: FRANKLIN
WILDFLOWER LOT 327
AM ❑ PM NI
COUNTY MACON
(Street Name, Numbers, Community, Subdmsion, Lot No., Parcel, Zip Code)
TOPOGRAPHIC / LAND SETTING:
®Slope ❑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
May be in degrees,
minutes, seconds or
in a decimal format
OWNER'S NAME ULTIMA CAROLINA
STREET ADDRESS 52 BRECKENRDIGE ROAD
WAYNESVILLE NC 28785
City or Town State
( 828 )_ 524-0892
Area code - Phone number
5. WELL DETAILS:
a. TOTAL DEPTH: 750
Zip Code
b. DOES WELL REPLACE EXISTING WELL? YES ❑ NO GE
c. WATER LEVEL Belay Top of Casing: 350 Ff.
(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): 7.5 METHOD OF TEST AIR
338048
f. DISINFECTION: Type HTH
Amount 33IS OUNCES
g. WATER ZONES (depth):
From 435 To 438 From 510 To 513
From 610 To 613 From To
From To From To
6. CASING: Thickness/
From 0 DTot82 Ft Di;3meter V��i� Material
From To Ft. PVI;
From To Ft.
7. GROUT: Depth Material Method
From 0 To 3 Ft. CEMENT TOP
From 3 To 20 Ft. BENTONITE WMPN.raTaNeaE
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
0-77
Formation Description
CLAY
77-435 GRANITE
435-438
438-510
CAVITY
GRANITE
510-513 CAVITY
513-610 GRANITE
610-613 CAVITY
613-750 GRANITE
11. REMARKS:
rrtLtivCU
UIV. Oh WA IEKWHO
FEB 1 2 ZU07
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH
15A NCAC 2C, WELL CONSTRUCTION STANDARDS, AND THATA COPY OF THIS
RECORO.HAS BEEN PROVIDED TO THE WELLAWNER.
SIGNATURE F CERTIFIED WE
4 iv
.4 CONTRACTOR DATE
✓?j� L
INTED 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
337751
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 Cade
( 828 )- 369-9591
Area code- Phone number
2. WELL INFORMATION:
SITE WELL ID #(it applicable)
STATE WELL PERMIT#(if applicable)
DWQ or OTHER PERMIT #(if applicable)
WELL USE (Check Applicable Box): Residential Water Supply O
DATE DRILLED /A ' D I • d G
TIME COMPLETED 3', oc)
AMP PM
3. WELL LO ATION:
C Y: // & „ ' i.. COUNTY IZZIC
(Street Name, Numbers, Com uniq, ubdivision, Lot No., Parcel, Zip Code)
TOPOGRAPHIC / LAND SETTI
❑Slope ❑Valley ❑Flat ❑Ridge ❑Other
(check appropriate box)
LATITUDE _1j. 11
LONGITUDE
Latitude/Iongitude source: ©GPS ❑Topographic map
(location of well must be shown on a USGS topo map and
attached to This form ilnot using GPS)
4. WELL OWNER
OWNER'S NAME
�T ��
LOLl'.V1 �f
May be in degrees,
minutes, seconds or
in a decimal format
(3
City or Town / Stater
(Clog )- 3,57-ibsg
Area code - Phone number
5. WELL DETAILS:
a. TOTAL DEPTH:
jektilt
a AP
Zip C..e
b, DOES WELL REPLACE EXISTING WELL? YES iz
Lo0
c. WATER LEVEL Below Top of Casing: 0
(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 dance with 15A NCAC 2C .0118.
e. YIELD (gpm)' METHOD OF TEST Blow
NO
FT.
f. DISINFECTION: Type H T H Amount 16oz
g. WAT
From
From
From
6. CASING:
ZONES (deptI
To From To
From To
From To
Depth i�ne�t
From To Ft. Di er
From 3 To Ft. 42"
From To Ft.
7. GROUT:
0
Depth
From To
From To Ft.
From To Ft.
20
Thickness/
Weigh) Material
//
Material
Ft. cement & banonite
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
From To Ft.
From To Ft.
From To Ft.
10.
DRILLING LOG
From 1---J6-
0 Clay & sand
11. REMARKS:
Granite
Material
Formation Description
tihUklkitLf
Ucj
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,
nizan-
S NIG ATURE OF CERTIFIED WELL CONTRACTOR DATE
.,I...no' Clot.tr3
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

3. WELL LO
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:
SITE WELL ID #(if applicable)
STATE WELL PERMIT#(if applicable)
DWQ or OTHER PERMIT #(if applicable)
WELL USE (Check ApplicableliqBox): Residential Water Supply Ex
DATE DRILLED ! //1 '' 7� '(.1/�� ''II
TIME COMPLETED 5. QV AM ❑ PM ➢0
ATION: ��nn�� �
CITY I iJ. _ I ! COUNTY LW
reel Name, Numbers, Comm nity, Subd
sion, Lot No
TOPOGRAPHIC / LAND SETTING:
IC Slope DValley ❑Flat ❑Ridge ❑Other
(check appropriate box) p
LATITUDE 355' O ,/
LONGITUDE' a) le
Latitude/longitude source: ©GPS
(location of well must be shown on
attached to this form B not using
4. WELL OWNER
OWNER'S NAME
STREET ADDRESSU
`4 t& )
City or Town r State
�' err�Y�
Area code - Phone number
5. WELL DETAILS:
a. TOTAL DEPTH:
Parcel, Zip Code)
May be in degrees,
minutes, seconds or
in a decimal format
❑ Topographic map
a USGS topo map and
PS)
b. DOES WELL REPLACE EXISTING WELL?YES 0 NO pi .
c. WATER LEVEL Below Top of Casing: PI) 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
337755
f. DISINFECTION: Type H T H
g. WATERZONES(depth)
//
From /iII.J� To /�(//
From
From
6. CASING:
Amount 16oz
From To
From To
To From To
Depth
From 1L.. To
From
From To
7. GROUT:
0
From
From To Ft.
From To Ft.
n'Ft. U D mVer
a�
Ft.______,,
Ft.
Depth
To 20
Material
Thickness/
Weight
JiR
Ft. cement & benonite
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 T Formation Description
0 Clay & sand
11. REMARKS:
Granite
t`z":'LeLTIV�LF
=tipfi;G rAtt,;
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.
ivN/ a7✓Yb--
SIGNATURE OF CERTIFIED WELL CONTRACTOR DATE
,5 hnne / lLk\ 1 r
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
337754
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 #(r applicable)
STATE WELL PERMIT#(if applicable)
DWQ or OTHER PERMIT #(if applicable)
WELL USE (Check Applicable Box): Residential Water Supply Ej
DATE DRILLED 2 1
TIME COMPLETED : J '3t AM ❑ PM Ik
3. WELL LOC,�ITION:
CI s4U COUNTY
(Street Name, umber , 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 �J11''^,(IfI II
OWNER'S NAME �-�-'L
STf2EET ADDRESS
City or Town State
May be in degrees,
minutes, seconds or
in a decimal format
C-221)- 521—yam
Area code - Phone number
6. WELL DETAILS:
a. TOTAL DEPTH:
yob"
Zip Code
3y
b. DOES WELL REPLACE EXISTING WELL? YES El NO �{
e. WATER LEVEL Below Top of Casing: 6 (N FT.
(Use "t" 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): a METHOD OF TEST Blow
f. DISINFECTION: Type H T H Amount 16oz
g. WATER ZONES (depth):
From ,3/36aTo -3.3_4 From To
7 From i(/ 0 To_ ?9 0 From 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
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
From To
From To
From To
Ft.
Ft.
Ft.
Size
Material
10. DRILLING LOG
From To Formation Description
0 Clay & sand
Granite
latter
_MS) %a) y' d2Y
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 0 CERTIFIED WELL CONTRACTOR DATE
rS l...ne t.inS
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 # .3v75/
1. WELL CONTRACTOR:
Well Contractor (Individual) Name
Well COME E fi'A "_
_ 248 crt :: OiR
STREET ADDRE itA.
City or Town State
yes—ayV99
Area code- Phone number
2. WELL INFORMATION:
SITE WELL ID #(if applicable)
Zip Code
STATE WELL PERMIT#(it applicable)
DWQ or OTHER PERMIT #(if applicable)
WELL USE (Check Applicable Box): Residential Water Supply.0�
DATE DRILLED /2--2e—O4
TIME COMPLETED AM ❑ PM ❑
3. WELL LOCATION: 4,61
CITY: _/ ( COUNTY Gt-yl.
1L4/tt-t,,friC.)
(Street Name, Numbers. Fanmuni-ty, Subdivision, Lot No., Parcel, Zip Code)
TOPOGRAPHIC / LAND SETTING:
0 Slope (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: ❑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 nitt/!i8
STREET ADDRESS3 % ,4 9/41'°d
/
City or Town Slate Zip Code
f )-
Area code - Phone number
5. WELL DETAILS: r� ---.
a. TOTAL DEPTH: s? v-U
b. DOES WELL REPLACE EXISTING WELL??/ YES( NO 0
c. WATER LEVEL Below Top of Casing: LID 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.
ac
e. YIELD (gpm): c� b METHOD OF TEST
f. DISINFECTION: Type Amount
g. WA7 ER ZONES (depth):
From To From To
From To From To
From To From To
6. CASING:
Thickness/
Dept r/ Diarrte(ar Weight Material
From_ To Ft. /%�7� ,A „rL
From To FL -�"`�
From_ To Ft.
7. GROUT:
From
From
From
Depth
To
Material
Ft.,{
To Ft.
To Ft.
8. SCREEN:
From
From
From
Method
V �
Depth Diameter Slot Size Material
To Ft. in. in.
To Ft. in. in.
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
REFOCA\15) tNjT?
VNPt r ' �„r^+
JAN 17 2007
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH
ISA NCAC 2C, WELL CONSTRUCTION STANDARDS, AND THAT COPY OF THIS
RECORD HAS BEEN PROVIDED TO THE WELL OWNER.
SIGNATURE OF CERTIFIED WELL 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-la
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:
Well`Contractor (In ividual) ame
Well Conta r"BO ! - rt" WELL t^.rt2
STREET ADDREFSP§QNKLIN, KC L 4
City or Town State
Area code- Phone number
2. WELL INFORMATION:
SITE WELL ID #(if applicable)
Zip Code
STATE WELL PERMIT#(if applicable)
DWQ or OTHER PERMIT #(if applicable)
WELL USE (Check Applicable Box): Residential Water Supply 9—
DATE DRILLED 42-—Oien
TIME COMPLETED AM p PM 0
3. WELL LOCATION:/�
CITY:, trtiI,E_&L
COUNTY / r L3C.Uy�,
(Street Name, umblll era, Common iy 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 ID Topographic map
(location of well must be shown on a USGS topo map and
attached to this form 9 not using GPS)
4. WELL OWNER � elf
,
OWNER'S NAME 4Q�.sL
STREET ADDRESS
City or Town
State Zip Code
( )-
Area code - Phone number
5. WELL DETAILS: ( /
a. TOTAL DEPTH: ,3
b. DOES WELL REPLACE EXISTING WELL? YES ❑ NO ❑
c. WATER LEVEL Below Top of Casing: iy(i 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): r15- METHOD OF TEST /2/..." J
f. DISINFECTION: Type Amount
g. WAT ER ZONES (depth):
From To From
To
From To From
To
To From To
From
6. CASING:
t4, Depth Diami er
From Tohz Ft. 4. /y
From_ To Ft.
From To Ft.
7. GROUT: Depth
337424
Thickness/
Weight Material
f(1/,
Material Method
From 0 To1_0,) Ft.
From_ To Ft.
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 Size
From To Ft.
From_ To Ft
From_ To Ft.
10. DRILLING LOG
From To
30
in.
in.
in.
Material
Material
Formation Description
c/a
ReALWEDuperl
11. REMARKS:
JAN 17 700
1 DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED N ACCORDANCE WrRI
ISA NCAC 2C. WELL CONSTRUCTION STANDARDS, AND THAT COPY OF THIS
RECORD HAS BEEN PROVIDED TO THE WELL OWNER.
&tcaiL.0-- //—d7
SIGNATURE OF CERTIFIED WELL CONTRACTOR DATE
ki' C.-r L
PRIN 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

RESIDENTIAL WELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources- Division of Water Quality
WELL CONTRACTOR CERTIFICATION # , ) d7/
1. WELL CONTRACTOR: /J
Z2/J/L124..2.1 C/iQ,L
Well Contractor (Individual) Name
Well contraathiltZIAORSEWELL248
STREET ADDRES •NINKIRANP� Nf`.) CIRCLE
City or Town State
Area code- Phone number
2. WELL INFORMATION:
SITE WELL ID #(if applicable)
Zip Code
STATE WELL PERMIT#(itapplicable)
DWQ or OTHER PERMIT #(if applicable)
WELL USE (Check Applicable Box): Residential Water Supply Er
DATE DRILLED /ea—, ,C5r
TIME COMPLETED AMID PM❑
3. WELL LO ATION:
CITY:i.?j4�
(Street Nan* Numbers, Community, Subdivision, Lot No., Parcel, Zip Code)
TOPOGRAPHIC / LAND SETTING:
❑Slope oValley ❑Flat CI Ridge ❑Other
(check appropriate box)
LATITUDE 3
COUNTY/ r rrCD /
LONGITUDE_ _
Latitude/longitude source: ❑GPS ❑Topographic map
(location of wet/ must be shown on a USGS topo map and
attached to this form if not using GPS)
4. WELL OWNER
OWNER'S NAME C)
STREET ADDRESS A {.
zzot ; #7r ��73y
ity or Town State Zip Code
May be in degrees,
minutes, seconds or
in a decimal format
Area code - Phone number
5. WELL DETAILS: Ta
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 / 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 lgpm):..../C METHOD OF TEST
337423
f. DISINFECTION: Type Amount
g. WATER ZONES (depth):
From To From To
From To From To
From To From To
6. CASING: // /.Thickness/
From 1./ Doth(p(,. Ft D/
TWeight Material
From To Ft.
From To Ft.
7. GROUT: Depth //�2M�a�t�e�riial Method
From 6 To 2A Ft. aontGzf
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
9. SAND/GRAVEL PACK:
Depth Size Material
From_. To Ft.
From_ To Ft.
From_ To Ft.
10. DRILLING LOG
From To
le/0— d$
Formation Description
RECEIVED
UV, OF WATER ouALVfl
1I. REMARKS:
L"rrz4T Nbf
100 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.
A
SIGNATURE OF CERTIFIED WELL CONTRACTOR///DATE
PRINTEDMEE OF� I ACONSTRUCTING THE WELL
Submit the original to the Division of Water Quality within 30 days. , ,ttn: Information Mgt.,
1617 Mail Service Center - Raleigh, NC 27699-1617 Phone No. [phone] ext 568.
Form GW-la
Rev. 7/05

RESIDENTIAL I IAL 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
Weil Contractor (Individual) Name
I"xlden Brothers Well Drilling, Inc.
t Contractor Company Name
S'R.:cT ADDRESS 73 Holly Hills Vista RD
F3-anly i nR NC 28734
City or Town State Zip Code
( 828 )- 369-9591
Area code- Phone number
2. WELL INFORMATION:
SITE WELL ID *Of applicable)
S" 1 ra WELL PERMIT#(If applicable)
D or OTHER PERMIT #(if applicable)
\+ LL USE (Chec pplicable Box): Residential Water Supply t}i
r.A.'E DRILLED /
TIME COMPLETED AM O PM K
3. WELL LOC TION: {/ /� �ry�
CIT` 403 Clin `O COUNTY lI tLll.(/N
(sant Name, Num rs, Community.-°oeiHaidr, Lot No., Rarest, Zip Code)
TC POGRAPHIC / LAND SETTING:
❑Slope °Valley DFlat °Ridge ❑Other
(check apprdprlate box)
May be in degrees,
I_ ' ,iDE _ minutes, seconds or in a decimal format 1
Lt. I GITUDE
iati'ode/longitude source: °GB ❑Topographic map
flotation of well must be shown on a USGS tope map end
attached to this form Vnot using GPS)
4. WILL OWNER
OWNER'S NAME
T SET ADDRESS
e
own Zip C
5220-2ia ere
Afar code - Phone number
5. WE.L DETAILS: 9 D0
a. TOTAL DEPTH: `/7"
b. LOES WELL REPLACE EXISTING WELL?? YES 0 NO °
RIM V
c. WATER LEVEL Below Top of Casing: FT.
(Use -+' it Above Top of Casing)
d. TOP OF CASING 1S 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. vIELD (gpm): / METHOD OF TEST B101.1
C. DISINFECTION: Type WI H Amount 160Z
g. WATER ZONES (depth): ,
From / 113 To /45 From To
Frcrr. To From To
From
To From To
6. CASING: Thickness/
Depth Di m��er Weight Mat rial
From To Ft
From To Ft. " tJSti
From To Ft.
7. GROUT: Depth Material Method
From 0 To`20 Ft. threat & Letnite =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.
F. om . To Ft,
10. DRILLING LOG
From To
0
11. REMARKS:
Formation Descriptions_'
Clay & sand rr—
Granite
m
100 HEREBY CER11FY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE Wr11
ISA NCAC EC, WELL CONSTRUCTION STANDARDS, ANDTHAT A COPY OF THIS
.RECORD BEEN PROVIDED TO THE WELL OWNER.
� DATE
SIGNATURE OF CERTIFIED WEL NTRAC70R DATE
Russell S. Taylor
PRINTED NAME OF PERSON CONSTRUCTING THE WELL
Sut t t the original to the Division of Water Quality within 30 day 3. Attn: Information Mgt:,
16!'r Mall Service Center— Rai:igh, NC 2768e-1617 Phone No. (919)'r 13-7015 ext 568.
form GW-1a
Rev. 7/05

3. OWNER: L t i '1 d (.�)A—tDgoe
Addresso 5 t C/c•` rzi MA/a S Ec
t3d4tort�preNei-.:-: --- -
�ieiteuI L;_ ;i/- : rat . o°� 873 C4 .
aigarTaoar 5
4Y '"
Ararads Phew wads•
-'
4. DATE DRILLED / / — / —o Co • .
5. TOTAL DEPTH .S-` 7.5 ' -
• "WELL CONSTRUCTION RECORD
- 334641
Nadi Cnianee Depeihm, °Mands Remo >r gnat Groinres Seetice
W W.CONTRACIOR ��,�' ;�� � ' gdiQ4 fIiVI S finMeet rt. = c nnc osi otme .
mem coNTRACTomcomra Y �. . - • . - - - - \
STATE WELL CONSTRUCtIONpzn' - - - --
Itr - .
•
`ewoffiic7-1(-4atl-3 2-4 a
I. WELL USE (Check AppBableHouk:-Rpafde itra.-Nl
Moniloring O Reeovoty a" Hat Pump Waitrhijodiss O
2.1VEL1.LOCATI0It" -
NearestTowa&Et1 /G i T g-
caam
UPubac O Indust's! 0 44riculturalp
Other 17Ifair, LiatUse •
tmmm Nome.Nmee.Cteriotly,edoa,cot*Lairaoae . - . Li1111110101/011d0ONdtmcaEmt
Oltenednioseshrosto
LarstittleliongitddarsoutanDOPS0Topowsphic map
es "17I#I~Qi - DRILLING LOG
Flom To ' pgpuNouDerdPion
n 5l0' P G A•/
«L:+Nr(s �
IB - e- &-'Q- j t L.
6. DOES WELL REPLAN !LUSTING WELLY YES O ��
7. STATIC WATER. LEVEL Below Top Easing O
8. TOP OF CASING ISPT AhOYc -
4opefaeea dartoatud billiglplarferephis$ ,,
mina la aaaraaotria7aA7tCAC7C.Nai --
I0. WATER.Z�ONES(depth): .s'6o
9. nab (i'(—'TEST %OdJf�L¢,
11. DISINFECIION;lype f{#4 Amount-1TA-asShow direction :ad font atlas[
Si
12. CASINO: - - VALES/tom . ttw State Roads or [bwty Roads:Wade the mad
Fromm1 4� Pt e. rwailigt- Ms j. "-numbesandtonunontadnames.
at W21-
Front_ To
- •
Fram . Tp Ft...„,,
13. GROU!`Method
From_t o afl ����,)y, �c �)
From To t-�^�- _•'
.4. SCREEN: Depth I Slot Mi e : -7 WaistFrom To n. is.
From To Ft. in. in.
5. SAND/GRAVEL PACK:
0* Me
From To Ft.
FromTo pt,___
6. REMARKS:
DO HEREhiCERTIFY.
TEATTHISWELWASCONSTRUCT'EQINAO wins isANCAL`2C.Wag. •
CONSTRUCTION STANDARDS, AND TIIATA COPT OF r EII@IPIOVI�TOTE6WALLbWNER
-071� /. -• //--) -
Ma-
IG TURRR-OFPaRSONO< ( EN I'R WELL; . - DATE -
Submit the original to the Division of Water Quality, Groundwater Secdoar I636 Mall Seralte Center-Raletgh,-NC
.27699-1676 Phone No. (9I9) 733•3221, within 30 days - - DW-I REV. 07/200i
monist
RECEIVED
DIV. OF NA ATEP QUALITY .
NOV 1_ 4 2006

N - . ., , • WELL CONSTRUCTION RECORD" -: . - 344042
DepartmentotEnrimmnautaod-NwnaR-DivWonot -
1 Quality:
weu.corrrawcroR(utosrpouAttT (pe Gritn►S IS^Il-n.d.ei. = -''-t • .� c*ul t( to
snit wou.coow, �Rcommune r� rc --- e�ro�sn�Sn4_3cab0
hhl (I1!YSai-,.- K�
oot r*ucrroxrstuihi__, ' -
Ofawuaule1_ J.
:'
I. WELL USE (Chedt Applicable Boe-Residegtal I lic O tndintrld 0 Ati -0
Honoring O Recovery 0' !Teat Pomp Wsica ttUaedan CI Other a IfOti er, List Use .
1-WELL LOCATION: -
'Nearest Town: �.4- /rN/::/ri<) County �,�,�, T�°StaptlndLtmdsetting -
aid E ra. (0e4•I - S u 0 Qy IT /u / ta®a t751opa twiggy .Ottlet
Wf
tsuc[ttemgttaadKgtkm '.g .ta Ik.zPCab) (ebnarppopsibt� a
e/laigihtda ONOONOxdoa
3.0 eitt?.8d. e
Address /I) lv i nt.14•YII/71 -iZ
(abeelar aomstaJ -
GtrurTa a Sim .e- .' yVCode.
(PSo} .SSS- /997Ara cake Pheammober
-
4. DATEDRILLED //�—L to '
S. TOTALDEP7ii:_ o2'yt`__ -
Lad
ideumeladorsetheettan
tt Aongit ids- somcc OP topographic map
• DRILUNO LOG
To - FpgrmdonDemiption
-- •'2,5-' s• fir-c-(re%CjC,t4Jf re_
6. DOES WELL REPLACE ammo wait YES D ND_Qil�
7. STATIC WATER LEVEL Below Top ofCasing /0b -
8. TOP OF CASINO 1$ (tteswitAbwa Top d�
�_ FT. AboveLand Swkce•
'Top geodes am n'M atterhplir[yy4edssa
vans la aaaerdoaa�o,r� 7SA7fC&C3c.otis +a9W L
9. YIELD (gput): ..a2 _METHOD eazza_OFTEST
10. WATER ZONES (depth):
11. DISINFECTION: Aumusi
12. CASING: -
From e.� �W7��� Mom. ,���.t
From__Too�— 6fc r�a.=`ar
From To FL _-
13. GROUT Material From A To Depth
p�L. o �. .)
Front__ �lLgld�
.4. SCREEN: m Diameter . Slot Size : l ial
From Top n.
From 7 o in.
I SAND/GRAVEL PACK:F�m. in. ^--
From Depth
Sim Material -
From To
6. REMARKS:
LOCATION z(£{'CK
Show ;Erection anddishacs In miles from at least
two State Roads orO unty Roads. include the road
•numbersand-ooamronroad names.
RECEVED
DN. QF WATER QUALITY
NOV 1. 4 2006
DO HEREBYCERTIFYTHAr=WELL WAS commas) i -
ONSTRUCTION STANDARDS, AND THATACOPY OF DANL73NR1iDISA EDT TRIL uB
r/'Lliti RD ��iDiRSTbTitB-�fB6LLOWNER
SIB(ATURE•OFPFRSON t7JThUCTR4QTHE wfl.
DATE -
Submit the original to the Division of Water Quality, Groundwater Section,1636 Mall Service Center -Raldgh, NC
a7699-1636 Pion Na (919) 733-33221, within 30 days.
GN-I REV. 07/2001

1 2367
WELL CONSTRUCTION RECORD
3 7
it:
North Carolina - Department of Environment and klaturfl Respurees - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (prilnt)/ 14 i, i& 1]. I L I C � i i t- CERTIFICATION # 3p`t R if
WELL CONTRACTOR COMPANY NAME 1 A.t/ Lit 1 ' ., { ✓f% 'YLPd 1 1 ,�.'t(_ PHONE It {2.)2 �G' ! 'G' 7 / �l
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): ResidenMunicipal/Public 0 Industrial 0 Agricultural 0
Monitoring ❑ Recovery ❑ Heat Pump Water'jection 0 Other 0 If Other, List Use
2. WELL LOCATIO91L i 111
Nearest Town: / County /1 i tl
L,- {. I4&q wit iC /v1 hn
(Street Name, Numbers, chnmunity, Subdivision, Lot No., Zip Code)
3. OWNER:1E ri Ji1 UV1 1 6 ea 1
Address I-j a O"7., ( Qr.'s, t.c y ie f 1' i 1SS J
TW th 3
City crTown State Zip Code
(r o- 'st.to 2)12.4.
4. DATE RILLED I l07 "0 C
5. TOTAL DEPTH: 500 ,/
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO .ra
7. STATIC WATER LEVEL Below Top of Casing: 03_1_0 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS a\ FT. Above Land Surfaces
'Top of rosin terminated at/ar below land surface requires a
variance in accord'e�el'ISA NCAC 2C .611S.
9. YIELD (gpm): E METHOD OF TESTtt f
10. WATER ZONES (depth): Reg()
LOCATION SKETCH
11. DISINFECTION: Type 11I r, i a r Amount Anti) t Show direction and distance in miles from at (east
12. CASING: Wall Mich.= two State Roads or County Roads. Include the road
or Weight/Ft Material numbers and common road names.
From *MMTo Ft 51Ka1 Yti{
From To Ft.
From To Ft
13. GROUT: Depth
FroTo _ Ft.
From To aft Ft
14. SCREEN: Depth Diameter
From To Ft,
Topographic/Land setting
ARidge ❑Slope Malley ❑Flat
(check appropriate boot)
Latitude/longitude of well location / i
iN oS .53.i1t�1nS3'1/1 0.•
(degrees/minutes/seconds)
Latitude/longitude sourc . GPS❑Topographic map
( box)
DEPTH DRILLING LOG
From To Formation Description
g so/1
fZ - co-0 r)ladr tn, 4rE+- c
in.
From To Ft. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
Slot Size Material
in.
in.
16. REMARKS.
I DO HEREBY CERTIFY THA
CONSTRUCTION STAND
SIGNATURE OF PERSON CONS
CE WITH 15A NCAC 2C, WELL
EN PROVIDED TO THE WELL OWNER
/7-cr P- el (
CTING 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

RESIDENTIAL WELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources -Division of Water Quality
WELL CONTRACTOR CERTIFICATION # 3424 ,
f. DISINFECTION: TypeO 7% P Amount .5
g. WATER ZONES (depth):
6,, From ,Q(ZO�LTo From To
From To From To
From To From To
1. WELL CONTRACTOR:
Michael S. McClure
Well Contractor (Individual) Name
Tarheel Water Treatment, Inc.
Well Contractor Company Name
STREET ADDRESS 3672 Georgia Road
Franklin, NC 28734
City or Tam State Zip Code
( 828 )_ 369-0740
Area code- Phone number
2. WELL INFORMATION:
SITE WELL ID #(if applicable)
STATE WELL PERMIT#(if applicable)
DWQ or OTHER PERMIT #(if applicable) ''' 111......���
WELL USE (Check Applicable Box): Residential Water Supp17Fp
DATE DRILLED ///'/J w G
TIME COMPLETED hl 3 c) AM ❑
1. WELL LOCATION:
CITY: EyI' ikl CI ICOUNTY (d' Y�tr 1/T
fl endtrt3ko-nc. 4-kk
(Street Name, Numbers, Community, Subdi ision, Lot No., Parcel, Zp Code)
TOPOGRAPHIC / LAND SETTING:
iSlope DValley ❑Flat ❑Ridge ❑Other
(check appropriate box)
l )f
LATITUDE t3S°Oi / /-oz
LONGITUDEYk)OZe,..7o2159.6
Latitude/longitude source: PS ❑Topographic map
(location of well must be sho on a USGS topo map and
attached to this form if not using GPS)
4. WELL OWNER A1 A
OWNER'S NAME Il tIF�(`X�—� IC�t(v %�
/ ��-
STREET ADDRESS 5 L<SCyui-0.
May be in degrees,
minutes, seconds or
in a decimal format
City or Town State Zip Code
( $a� 3(09-(nZetk1/4-
Area code- Phone number
5. WELL DETAILS:
a. TOTAL DEPTH: 5:30
b. DOES WELL REPLACE EXISTING WELL?qYES ❑ NCO(
c. WATER LEVEL Below Top of Casing: //7 FT_.
(Use "+" if Above TopTof Casing)
d. TOP OF CASING IS Gi FT. Above Land Surface
'Top of casing terminated at/or below land surface may require
a variance in ,accordance with 15A NCAC 2C .0118f
5.•
e. YIELD (gpm): -6 METHOD OF TEST/'Y// {`OLt-
6. CASING:
Depth
Ele/ 2i33
- , of „ fw
Thickness/
Diameter Weight Material
From To FL
From To Ft.
7. GROUT: Depth Material Method
from Te rk
From To FL
From To Ft.
& 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 Formation Demiption
ph-e) —. S O /hi i LA411 511 Aro n
Q\ sl, �1 Qth
11. REMARKS: ) ' ()
to
Qecv..ce m(1 w4 r
1SA HERE WETFYTNSTTHJijWELL W�AAMO IN copy ACCOF ORDANCE WITH
15A CACHERE C, ERE NA aTWAS THATTRUC1EA ACCORDANC
RECORp BE PROV TO-jHE WNER.,
SIGNATURE OF CI:R�TEb'W LL CONTRACTOR DATE
/ �f/rl�ael /v CTIIIFIot&It
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.
DEC 01 2006
Form GW-la
Rev. 7/05

- WEILL CONSTRUCTION RECORD"
Notch&0rtna-Daps-t ofEnvkmrnStmd-NetmeiHewtse/a��-I�Y�tr�lai�mtof. quest- Sectwn
wasomintocnnituamnpwuAW S44tfvlJS / 3isAJ staatajt7�
�c i�Il I -%t we . •Q'1 4�4-3 2-6 0
was �tttnA�tn=�a..�,t,t i�lL A� ;. ...
sun rnlrwiili • Ma IMEN. --?
-(uT .
I. WELL USE (Check AppBab ioo -R I VPublieD .L�tt=ttia10 A tcuita!tp
Matitaing0 Raowsy 0. HaatPM* Wil6rI 13 Ot6ara Ifink,Lptus* _
LL IAGTI
*NcaRnRT' CAI,i t1 - Count). A -Gott-' p{lat[ey .OFlat
; d 018 r1h5' ou.scepptald stor4 .
isue,H.e _C tgsa .1.oteb.Z W4 . - Litiliugelonlrifildedtvo Ioat°t
3. OWNER•
v4
Address /9-0 S'PR/A/�d12iVe..
(ere atoiaarelfo3 - • -
Riosuren_J f a• 30075 "
accerTwa Tylkda.
ante1J- 3h t" - .
Ain cede- Nome somber
4. DATEDRILLBD I� tf'—O 40
5_ TOTALDEPTii aa33 6-s -,
6. DOES WELL REPLACE MISTING WELL? YES El NO<:W--`
IA deikmgila_(deaomoa apoP woP
DRILLING LOG
Flom
• fortmilon Description
Topagripiteikand sating -
10. WATER ZONES (dep4t): -
7_ STATIC WATER LEVEL Below Topoft� Po' Ff:
(Ua`flAtietc Wd
IL TOP OF CASING is Fr. Above Land Swilme'
•Ter etoda*tadaNadalra!1a�_he�evthannMYu■
mtaaae` aneedrowt1a73A 3CA11L
9.YIELD(gp►py): % MRTHODGPTEST 1�f14-.
r Q
It. DISINFECTION: ype /f-I'fF Amount ..3TIJ-sg 5 Show dkecdooanddafanoslnloiktEarn atteasr
12. CASING: - Wail Thickness - two Star: Roads or County Rader. Include the Toad
Depth otwei�ghUll. Moisoal -*numbers and -common Toad names.
From O • To .2 3 Pt h`- art.
;-
Rom
Fom
13. GROUT Depth Ma/mai Mad,od -
From f0oNA--)
Fmm To FT
.4. SCREEN: Depth Dianaer . Slot Size - . Matadi!
From To Ft, in, in.
From. To Ft. in. in.
S. SAND/GRAVEL PACK
Depth Size
From To
From To FL
6_ REMARKS:
DO HERE9Y(ERTIFYTHAtTHIS WEIL WAS CONSTRUCTED INACCORDANCEMTH ISAtiCAC2C. WRIL -
oNSTRUCTION STANDA$o%ANDTHATACDPYOn" RECORD HAS BERNPROV1DffiTOTH&WFILOWNER
d,. _� 6-
SIQdATi1REOFPRRSONCONS1tUC11NOTiflE L . - DATE "
Material
•
• sot?-00-sue
1\�1,'� �Op1
Submit the original to the Dividers of Water Quality, Groundwater Section, 1636 Mall Service Center -Rateegb. NC
fl699-1636 Phone No. [phone], within 30 days. - GW-1 REV. 07/2001
Co
-
»

_WELL CONSTRUCTION RECORD•
. _ -
Ortranthvaler
NoraC olina-DepartmentofEnrir eidwi*alRan
scw -Dkidoao QuaW-
nu. co,rancrononst pam46WAvas tin �•c`•.n.-/ oRts = : itoil�L.A-� •
wei.cootrraw�cor►Went � - _ .. - r>o°t°rtf ..
t_-3 a-b O
srwsa lifaa hale) - _ / " -
L.WELL USE neat AppMable Hmtx-Rai mltleM VPublic U judttstsitl 0 llgtiwMm!I C7
. * Monitoring U Kamer, O" Sat Pump Watt Nation U ONtatt IfOSr, got the "
Z WELL
Ne� ITAoGT "alb
NcL Laa]g•�iediald tag •
O{tt>tley
tf_U RM i w 12YU ki t2? _ abutasmiddei$
(Sumttm.Nimbus. Mr. fiebenMoatat&LapCork) . thataigitild5ufv lIlocatkn
3.0WNER ��' • r
Addy (!J‘(/.�r-
Aam tiwtallo, ..
atybrtawa - Se -f
4.
net cogs- Pin amber
4. DATE DRILLED 1l - ,3 D -O
5. TOTAL DEPTIi: o •n.S • - -
6. DOES WELL REPLACE Immo WELLT YESC NOW-'
�.y,r
FT.
73AMXC3Ki.p/L
S7D�
ifs
..From To ,
n
Above
Land
7. STATIC WATER LEVELBalowT oWuinw ADO Ft:
YA6msTop atQie
3. TOP OF CASING IS / Land Sm�ices
trap eteasmitead•_- ngMa
10. WATER ZONES (den*
I rlaaea amrdres '
9. YIELD(gpax��C�—
I I. DISRIFECI ION Typo Amotmt aTA-S 5
12 CASING: - - WaU7Uidmes -
_ ��
From O . To oW `
Fmm To -
From Tp Ft._- , -
13. GROUP_ Depth Mafat. Medod
From_�ToaPt._-e PIMIA>
Fmm To Ft.
.4. SCREEN: Depth Diameter _ Slot Sire: - Malarial
From To FLJa. in.
From -_-___To Ft.. jm
5_ SAND/GRAVEL PACK: -
Depth Sze Material
From To Ft,
From To Ft
'�opograldtic map
<<R • - DRILLING LOG
anDemiptme
A.
f3L GRRN� te.
1`
rra
Ceo
LOCATION SKETCH
Showdbadoa imddistmeo bnits from at last
two State Roads Or county Rye. Include the mad
-numbest and'amtnon road naves.
•
iytGEW i uA_l?
/ O W R`t EF •.,.
. `113t16
6 REMARKS:
DO HEREBY CERTB=YTHATTHISyam was CO nwcits DI ACCORDANCE WITIIISMlcAC2I WBIL•
ONSTRUCTIOtt SfANDAEDS, ANDTHAT A CM OF RECORD BMA PEOVIDBD1OTHE.WELLOWNER
I I -36--) GO'
SIONA PERSON COt IRUCANGTIIBWEId, - - DALE -
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mall Service Center -Raleigh,'NC
j7699-I 636 Phone No. (9t0I 7333221, within 30 days. • - GW-1 REV. 07n2ooi
144

KESIDENTIAL WELL CON RUCTION RECORD
North Carolina Department of Environment and Natural Resources- Division of Water Quality
WELL CONTRACTOR CERTIFICATION ti
2187
1. WELL CONTRACTOR:
Russell S. Taylor
Well Contractor (Individual) Name.
Hedden Brothers Well Drilling, Inc.
Well. Contractor Company Nei.. *•
STREET ADDRESS 73 Holly Hills Vista RD
Frank] in, NC 28734
City or Town State Zip Cade
828 )- 369-9591
Area code- Phone number
2. WELL INFORMATION:
SITE WELL ID Cif applicable)
STATE WELL PERMIT/NIapplleable)
Dr'Q or OTHER PERMIT O(If applicable)
N ELL USE (Check Applicable Box): Residential Water Supply;
i f:V.f i DRILLED
TIME COMPLETED,
3. WELL LOC TION:
CITYis L1
AM CI
PMIfl
COUNTY /9112C��. C--
(Street Name, Number., Community, Subdivision, Lot No., Paul, Zip Code)
TOPOGRAPHIC / LAND SETTING:
(0 Slope ❑Valley ❑Flat ❑Ridge °Other
(check apprdprie:A box%
I:TITUDE�y�
LONGITUDE o4'
Lat.i'r:de/longitude source: GPS °Topographic map
,iocatlun of well must be s o n on USGS topo map and
attached to this form A' not using GPS)
4.WELL OWNER
OWNER'S NAME
S BET ADDESS
May be in degrees,
minutes, seconds or
in a decimal format
lilted
City of own State
c$0)•_,3Lig-.445j
A'n code - Phone number
5. WELL DETAILS: 0,*s
�m. TOTAL DEPTH: U
b. DOES WELL REPLACE EXISTING WELL? ES N0,L
1.
Zip Code
c. WATER LEVEL Below Top of Casing: -
(Use '+' If Above Top of Casing)
d, TOP OF CASING 18 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): 1i METHOD OF TEST Blow
L DISINFECTION: Type HIT H Amount 1 602
g. WATER ZONES (depth):
From To From To
From To From To
E orn To From To
6. CASING: • Thickness/
Depth D jpmreler Weight Material
From_ To Ft.
From / 7 To,
From To Ft,
7. GROUT: Depth Material Method
From 0 TDR20 Ft, OHiHlt & ba:nits )ait e3
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 Slze Material
From To Ft.
From To Ft.
From To Ft.
10. DRILLING LOG
From To Formation Description
0 r' Clay & sand
11, REMARKS:
Granite
1 D0 HEREBY CERTIFY TNAT TNIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH
1 SA NCAC 2C, WELL CONSTRUCTON STANDARDS, AND THAT A COPY OF TNIS
RECORD � HA�S B�EE�N PPRROj/VVIIIDEEDD-TT/{O TTHHEE "WELL OWNER
H.
SIGNATURE OF CERTIFIED LL CONTRACTOR D 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 Center— Raleigh, NC 27699-1617 Phone No. [phone] ext 568.
Form GW-1 a
Rev. 7/05

RESIDENTIAL WELL CONSMUCTION 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.
Redden Brothers Well
Weil Contractor 0,cmpany frame
Drilling Inc.
STREET ADDRESS 73 Holly Hills Vista RD
Franklin, NC 28734
City or Town State
( 828 )- 369-9591
Aria code. Phone number
2. WELL INFORMATION:
SITE WELL ID e(If applicable)
STATE WELL PERMIT#(Ilappllcablet
Dr1O or OTHER PERMIT e(If applicable)
M HLL USE (Check Applicable Box): Residential Water Supply
�0 rAr :DRILLED /t' /-0,L0
TIME COMPLETED At. DO AM❑ PMk-
Zip Code
COUNTY 1 see"'
� r•
aglic
r'—
(Street Name, Numbers, Community. Sub vision, Lot No., Parcel, Zip Coda)
TOPOGRAPHIC I LAND SETTING:
°Slope °Valley °Flat ❑RIdge °Other
(check appropriate box)
1- 1RUDE ..3�J,f, 4:1(OSIJ
E' LONGITUDm 58J w
Lati'tide/longitude source: OOPS oTopographic map
notation of well must be shown on a USGS topo map and
attached to this form if not using GPS)
e. WELL OWNER
OWNER'S NAME �ip'i� �d�I•
S EFT D RESS 1a4o � '-alik ire('�.Ic
jryY�� 664trI . II State
2zV 'I 1
City or own •
Ltja )- 9410 - (0 1r9A"
Area code - Phone number
May be in degrees,
minutes, seconds or
in a decimal format
5. WELL DETAILS: 500
a. TOTAL DEPTH:
b. DOES WELL REPLACE EXISTING WELL? YES 0 NO
c. WATER LEVEL Below Top of Casing: aZOO 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 acc�'rddaance with 15A NCAC 2C .0118.
e. YIELD Wpm);4v METHOD OF TEST Blow
t. DISINFECTION; Type HIT H Amount 1 60Z
g. WAT - ZONES (depth):q
From To m//� From To
y
From To • W 1 From
From From
8. CASING: Thickness/
Depth Diameter Weight Material
From ,(�q'' To 5 Ft.
From 5D Top Ft
From To Ft.
To
rr�
7. GROUT: Depth Material Method
From 0 Tp220 Ft. Cen3tt & LEU)ite =red
From To Ft.
From To Ft.
8. SCREEN: Depth Diarnater Clot 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
Vara
11. REMARKS:
Formation Description
Clay & sand
Gram to
\rFR
aa-
I D0 HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH
I SA HCAC 20, WELL CONSTRUCTION STANDARDS. AND THAT A COPY DR THIS
RECORYRMS BEEN PROVIDED TO THE WELL 0Vj'NER,
Si NATURE 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 566.
Form GW-la
Rev, 7/05
@r.1
OG
fro
CoD
L^ J

a3&c3
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) V I C, tau.\ M C Ct u i-Lett f IICATION # 34 Dint CID CONTRACTOR COMPANY NAME C L3 r Cr QQ•a!�e, + a7L. -CS
PHONE # ad-bakfi-o"-)y0
STATE WELL CONSTRUCTION PERMIT# _ ASSOCIATED WQ PERMITS
(if applicable)
(if applicable)
1. WELL USE (Check Applicable Box): Residential Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Inje 'on 0 Other 0 If Other, List Use
2. WELL LOCATIGfN• nn
Nearest Town: I'ram it to County / I Moil
,C)ocztV \( PrnnQ
(Street Name, Numbers, Community, Subdivisi 1 No., Tap Code)
3. OWNER: I AiCI t/V'� (1:2 b .Q
Address `.Th I. \07 &ro i
( ��\\�8trxto No.) a93) Li
City or own Srste Zip Code 't
(jai)- 5a4 - c 11 S
Mea code- Phone number/
4. DATE DRILLED f a0 •' 0 (®
5. TOTAL DEPTH: .RL'O r
6. DOES WELL REPLACE EXISTING WELL? YES 01
7. STATIC WATER LEVEL Below Top of Casing: Jo? 0
8. TOP OF CASING IS (Use "+" if Above Top of Cuing)
FT. Above Land Surface.
'Top of casing terminated at/or below land surface requires ■
variance In accordance with ISA NCAC 2C.0118. //n
9. YIELD (gpm): METHOD OF TEST%` FN�
10. WATER ZONE (dS epth): _3[X) L,
11. DISINFECTION: Type 4I Amount
12. CASING: Wall Thickness
From}_ ToD�c, '7 Fa m ei t/FLl I y(atetial
From To Ft.
From To Ft.
13. GROUT: Depth
From 0 To 3 Ft.
From 1 To 'Dr) FL
14. SCREEN: Depth Diameter Slot Size
From To Ft. in. in.
From To Ft. in in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
16. REMARKS:
I DO HEREBY CERTIFY THAT THIS
CONSTRUCTION STAND Agp$ AND
Material
Topo bit/Land setting
❑Ridge (lope ❑Valley ❑Flat
appropriate box)
Latitude/lon 'tude of Tell location
A;351° /3 T 3LUJnh3°,,2.6 ` 40,2"
(degrees/ seconds)
Latitude/Iongitude source GPS❑Topographic map
(check box)
DEPTIL DRILLING LOG
From To Formation Description
0— wit) r��a P /
9 D - ;3240 Vitt ett.rn k9ti (;-)G a �.1/C
CrJ
C(^
Met
c+5
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the roar
numbers and common road names.
ORDANCE WITH 15A NCAC 2C, WELL
HAS BEEN PROVIDED TO THE WELL OWNER
SIGNATURE OF PERSON CITRUCTING THE WELL
/ ? ® "C�
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

1. WELL CONTRACTOR:
Michael S. McClure
Well Contractor (Individual) Name
Tarheel Water Treatment, Inc.
Well Contractor Company Name
STREET ADDRESS 3672 Georgia Road
Franklin, NC 28734
City or Town State Zip Code
82f 8 369-0740
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_ y Q
TIME COMPLETED y : cg— AM El PL,
3. WELL LOCATION: 1
CITY: li— COUNTY
cbae k d%iJn Drl
(Street Name,Numbers, mmunny, Subdivision, Lc No. Parcel, ZpCode)
TOPOGRAPHIC / LAND SETTING:
0 Slope ❑Valley 0 Flat tidge ❑Other
(check appropriatebox)
LATITUDESit'.7F_ yQ,Q k
LONGITUDEM,10&3 I±L22 3'�-- 3
RESIDENTIAL WELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources- Division of Water Quality
WELL CONTRACTOR CERTIFICATION # 3424
May be in degrees,
minutes, seconds or
in a decimal format
Latitude/longitude source: �CrpS ❑Topographic map
(bcation of well must be sho on a USGS topo map and
attached to this form i1 not using GPS)
4. WELL OWNER
OWNER'S NAME
STREET ADDRESS 'W. 0 CC�Y, u342J C f ��.
1 r�(3 t C. A <u
City or T Holt State
Zip Code
Area
aco�- L 1 a71
Arcode - Phone number
5. WELL DETAILS:
a. TOTAL DEPTH:%__�_�Q—
b. DOES WELL REPLACE EXISTING WELL? YES 0 NOa(
c. WATER LEVEL Below Top of Casing:
(Use "+° if Above Top of Casing) �.
d. TOP OF CASING 1S � 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): METHOD OF TEST KO1>✓
Submit the original to the Division of Water Quality within
1617 Mail Service Center— Raleigh, NC 27699-1617 Phone No.
f. DISINFECTION: Type
g. WATER ZONES (depth):
From O To
From To
From To
6. CASING:
Depth
From ,f� o 3
From To
From To
7. GROUT: Dept,
Method
Ft.
Ft.
Amount
From To
From To
From To
Thickness/
Fron_3 To_ Ft�L�e��'
From To.' Ft.
From To Ft. ` [ r
8. SCREEN: Depth Diameter Slot Size Material
From To Ft in.
m in.
Fro
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
nCj4i t1Ai..
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH
15A NCAC 2C, WELL NSTRUC N STANDARDS, AND THAT A COPY OF THIS
RECORD HAS BEE ROVED THE WELL O"'•._s
SIGNATURE OF CERTI IED 2 —�
CONTRACTOR DATE
E
RINTED NAME OF PERSON CONSTRUCTING THE WELL
30 days. Attn: Information Mgt,
[phone] ext568.
Form GW-la
Rev. 7/05

10. WATE$ZONES (depth)
LL1S
*lea cOSe.Tho .sable
4_ DATE DRILLED —Q
S. TOTAL
WALL
CON1'lyR�� cxO/ DE��•Q�:
Norsk -Department Environnsoit
a
-SecdOR_
'WELLCOMTRACrOR
WELL. CONTRAC[ORCOMPANY •lampICj ga
te -
STATE (tpMM_..., _ __--E� .,gJ
-Cf._524_3 2.6 d
-
1. WEU.USE aledc/f ble i- editZ7, u HeCt -maw a
aP
: '• warning o Rosneir E l en 0 Otber11 Caier,List Use - : -
TL WELI.LOCA + '.
-NeuerT
aaA
(e(It E• C: VeIL -a_ •
3. 0
Address
Gayle -Tama ratCLd
Topo kfiind ems -
-DV.
Wer.tN., LLWQ _ a
Miatricleilicelodocrintd1 loca=
6. DOES WELL REPLAC$E }nuti &U -�-
7.
•
STATIC WATER LEVEL Below Top ot
>L TOP OFCASHR}IS Nta"-P'WMweTal Fgraded
wrapeadastimbatel 6 ,tAlameakd3 •
9mina �AUCJiC k wilti_i
hatTROD t3P7
-
11_ DLSINFECygJ y - LOCA7TONSKETCH
12. From _ Aaeoamt =damosiaRa' tirmtatbest
CASID WiHTLi os ' two Ste Roads or fyItind •hcludotheroad
From ©. T •or `a on road names.
From Ttt______Ft„__-
13. GROm 1f�T
FTT�a-i nw•_ "+- "awl
^-vas •
_4. SCREE* Deptb
FroRt__,_To Ja. MatwM ' .
From Tu in•
s_ SANI7/GRAVELPACK:Depth in.
Frorn F Materiel
Fmm_____To a__
f` - DRIWNG LOG
From Tu ' g
-
/4 v 4O
fsrt'8 N `Q.
LfJG A-Pan%--.G
6_ itEmARIC,i
QUAt ITV
9 7 2(00E,
� THAYTHmwau.wAE W
accommtaz .ANDTHATAOOPYW LOWNER
b-D
SIMIATUREO1TERSONCONSTRUMINCITHE _ • DATE _
Submit the original io
the Division
of Water Quality. Groundwater Section I636 Mall Service Ceuta. 424Ielgb; NC
a769941636 PlumeNo, days,
Gy! t REV.07/2001
;•.
try
VD
ere
Vz

RRS/D,OOVT/AL WELL CONS,T$UCTION RECORD
North Carolina Department of Environment and Natural Resources. Division of Water Quality
WELL CONTRACTOR CERTIFICATION H 2187
1. WELL CONTRACTOR:
Russell S. Taylor
Well Contractor (Individual) Name.
Redden Brothers Well Drilling, Inc.
Well Contractor Comsany Name - STREET ADDRESS 73 Holly Hills Vista RD
frank) in. NC 28734
City or Town State
,( 828 ). • 369-9591
Aria code- Phone number
2. WELL INFORMATION: •
SITE WELL ID a(I! apliceble)
STATE WELL PERMITN(II applicable)
[SVC! or OTHER PERMIT a(If applicable)
WELL USE (Check Ap Ilcable Box):.Residential Water Supply 0
(C.AI DRILLED V(P •
y
TIME COMPLETED AMO PM'P.,
Zip Code
3. WELLLO• -TION:
CI
00
COUNTY 1 ! co W
(Street Name, Numbers, Community, Subdivision, Lot No:, Parcel, Zip Code)
TOPOGRAPHIC / LAND SETTING:
cSlope OValtey ❑Flat CRldge O Other
(check apprdprlale box)
1ITUDE ,,, j
LONGITUDE 3343
Lati'tide/longitude source: PS oTopographic map
t'/ocafbn of well must be shown on a USGS topo map and
attached to this form not ui/ng GPS)
4. WELL OWNER
OWNER'S NAME
S kET ADDgESS�
CI y or To Slate-3 21p Code
May be In degrees,
minutes, seconds or
In a decimal formal
_)• 55 -0
Anse code • Phone number
6, WELL DETAILS: d
a, TOTAL DEPTH:
b. DOES WELL REPLACE EXISTING WELL? YES 0
c. WATER LEVEL Below Top of Casing: — - 460 FT.
(Use'+' If Above Top of Casing)
d. TOP OF CASINO 18 2 FT. Above Lend. Surface'
'Top of cuing terminated aVor below land surface may require
a variance In accordance with 15A NCAC 2C .0118.
e,. YIELD (ppm): "F' METHOD OF TEST Blow
•
NOK
f. DISINFECTION: Type
p. WATER ZONES (depth
From
From
From
6. CASING:
From
From
From
Depth
To
Ht`T H Amount 16oz
From 444To
From 70
From
DIP*
Ft Ft: ((�_ 4 L8€
To Ft.
7, GROUT: Depth Material
From 0 To2.20 _ Ft. t. :wL. & ba-rnite wired
From To Ft
From To Ft.
To
.Thickness/
Weight
005
Material
Method
S. SCREEN: Depth Diameter Slot Size Material
From To F7. 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
0
Pi!allint a•
11, REMARKS:
Formation Description
Clay & sand
Granite
RECCIV6D
t.. eu ITV
? a 7f111b
1 DO HERESY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE W nN
ISA NCAC 2C, WELL CONSTRUCTION STANDARDS, AND' NATA COPY OF THIS
RECOROIA( SEEN PROVIDED TO TIE WELL OWNER.
��
SIGNATURE OF CERTIFIED WE CONTRACTOR
Russell- S. Tavl
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 27699.1517 Phone No. [phone] ext 568.
Form GWla
Rev, 7/05

RESIDENTIAL WELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources- Division of Water Quality
WELL CONTRACTOR CERTIFICATION # 2,/-1
1. WELL CONTRACTOR:
cD64,flG 6'44�
Well Contractor (Individual) Name
Well ConticabibrICorSVX6.11
248 CRANE CIRCLE
STREET ADDREESBANKLIN, NC 23734
City or Town
State
(O �� )-
Area code- Phone number
2. WELL INFORMATION:
SITE WELL ID #(if applicable)
Zip Code
STATE WELL PERMIT#(ir applicable)
DWQ or OTHER PERMIT #(if applicable)
WELL USE (Check Applicable Box): Residential Water Supply ❑
DATE DRILLED /4-2 2-6 f�
TIME COMPLETED AMID PM O
3. WELL LOCATION: /,/
CITY: �/%%%/�/'
:' "� v Y� r Parcel, Zip Code
(Street ame, Numbe Community. SubdMsion, Lot No., p )
COUNTY 422,4C4 rJ
TOPOGRAPHIC / LAND SETTING:
❑Slope ❑Valley ❑Flat ❑Ridge 0 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)
May be in degrees,
minutes, seconds or
in a decimal format
4. WELL
OWNER'S NAME /Aa
C �
—r-/j c
S T ADDRESS err? ✓Ll
Ci ✓
City r-Town own State
c—)
Area code - Phone number
Zip Coee
5. WELL DETAILS:
a. TOTAL DEPTH: .-2-475—
b. DOES WELL REPLACE EXISTING WELL? YES El NO 0
c. WATER LEVEL Below Top of Casing: / 0 FT.
(Use "+" if Above Top of Casing)
d. TOP OF CASING IS / 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): METHOD OF TESTiT
f. DISINFECTION: Type Amount
g. WATER ZONES (depth):
From To From To
From To From To
From To From To
6. CASING: Thickness/
Depth n Diametr Weight Material
From v 7 To jFL IL vo
From To Ft.
From To Ft.
7. GROUT: Depth Material Method
Fran_. !� T�Ft. ee�i.� lir Y
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— 2/ c—A�y
7/— 7 r 7/414, fc-
f
11. REMARKS:
DEC 14 20
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.
�DitAw /aaa-e)G
SIGNATURE OF CERTIFIEDIF�r'WELL CONTRACTOR DATE
Were_ AMEO 1
PRItJTED I IAME OF PERSON CONSTRUCTING THEW 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. (919) 733-T015 ext 568.
06
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 # JPD 23
1. WELL CONTRACTOR:
Well
dot CO9-rl c-
ontractor (Individual) Name
Well Contractor Company Name
STREET ADDRESS
City or Town State
( )- V57
Area code- Phone lumber
Zip Code
2. WELL INFORMATION:
SITE W ELL ID #(if applicable)
STATE WELL PERMIT#0i applicable)
DWQ or OTHER PERMIT #(if applicable)
WELL USE (Check ApplicableSupply
-Er--
Box): Residential Water Suppl'
DATE DRILLED //'oz 0�j' L c
TIME COMPLETED AM ❑ PM-9-
3. WELL LOCATION: ��jj����� y�Il
CITY: trA-4kA IJ COUNTYA4C. m
(Street Name, Nu bars, Community, Subdivision, Lot No., Parcel, Zip Code)
TOPOGRAPHIC / LAND SETTING:
D Slope ❑Valley ❑ Flat ❑ Ridge ❑ Other
(check appropriate box)
LATITUDE 3
LONGITUDE
Latitude/longitude source: ❑GPS OTopographic map
(location of well must be shown on a USGS tope map and
attached to this form 'not using GPS)
4. WELL OWNER OWNER'S NAME J//2/ %%,®�L �C A£/j7[D/
STREET ADDRESS O
F✓A-n//" rV
Y!
2-f-727//
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 TOTAL DEPTH: 7J S
b. DOES WELL REPLACE EXISTING WELL? YES ❑ NO ❑
c. WATER LEVEL Below Top of Casing: red FT.
(Use '4" 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 .0118.8.
e. YIELD (gpm): /3— METHOD OF TEST f/-% -
6
f. DISINFECTION: Type Amount
g. WATER ZONES (depth):
From To From To
From To From To
From To From To
CASING: Thickness/
Depth Di �� Weight M��l
From 6/ To Ft.
From_ To Ft.
From To Ft.
7. GROUT: Depth Material Method
From o Top2-6 Ft.fP4,,e[ b/,4vy
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
/�- yr
Ts
11. REMARKS:
\I'
Sf
DEC14 03
Asnevtile R. ylul tar Office
i+t ,rams rrota_Oon
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WM1
I5A NCAC 2C, WELL CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS
RECORD HAS BEEN PROVIDED TO THE WELL OWNER.
IG URE OF CERTIFIED WELL CONTRACTOR DATE
k_t
cfmc
PRINT D NAME OF PERSON CONSTRUCTING THEW 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 # 3v��
1. WELL CONTRACTOR:
D/MeG 61447-
Well Contractor (Individual) Name
well Contractor C.oninaniiquittERS WELL DRILLING,
STREET ADDRESS 248 CRANE CIRCLE
FRANKLIN, NC 2874
City or Town State
(-mallVf�
Area code- Phone number
2. WELL INFORMATION:
SITE WELL ID #(it applicable) -.. -
STATE WELL PERMIT#(it applicable)
DWQ or OTHER PERMIT Cif applicable)
WELL USE (Check Applicable Box): Residential Water Supply,@
DATE DRILLED /11 6
TIME COMPLETED AMP PM
Zip Code
3. WELL LOCATION:
CITY: 67,44/11/ N
COUNTY,7L1C N
(Street Na�YMuir(bers, ommunity, Subdivision, Lot No., Parcel, Zip Code)
TOPOGRAPHIC / LAND SETTING:
OSlope OValley ❑Fiat DRidge ❑Other
(check appropriate box)
LATITUDE 3
LONGITUDE
Latitude/longitude source: ❑GPS ❑Topographic map
(Iocadan of wellmust be shown on a USGS fopo map and
attached to this form d not using GPS)
4. WELL OWNER
OWNER'S NAME (s-Ial rl
STREET ADDRESS 7Sr-2 fo yV ,P€-
Zip Code
May be in degrees,
minutes, seconds or
in a decimal format
ity or Town/ State
rryrLL
Area code - Phone number
5. WELL DETAILS:
a. TOTAL DEPTH: 30.5---
b. DOES WELL REPLACE EXISTING WELL? YES NO
c. WATER LEVEL Below Top of Casing: 7 O 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 inaccordancewith 15A NCAC 2C .0118.
e. YIELD (gpmr fa-.5 3 D METHOD OF TEST di r
f. DISINFECTION: Type Amount
g. WATER ZONES (depth):
From To From To
From To From To
From To From To
6. CASING: Thickness/
Depth p Dieme) Weight Material
From D To 77 Ft. /2 `-t
From To Ft.
From To Ft.
7. GROUT: Depth Material
From 0 T;2_ 4 Ft.(��pp "elnl2T
From_ To Ft.
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. SANDICRAVEL PACK:
Depth
From To
From To
From_ To
10. DRILLING LOG
From To
- 7r
11. REMARKS:
Ft.
Ft.
Ft.
Size Material
Formation Description
e/4p
r
97194',14 PEI
r)! nr INA,TFP (It i61 ITV
9E( ? p ?lin
CFIVF.
UEL 14 [00
1 DO HEREBY CERTIFY THAT 11115 WELL WAS CONSTRUCTED IN ACCORDANCE WITH
ISA NCAC 2C WELL CONSTRUCTION STANDARDS. AND THAT A COPY OF THIS
RECORD IBEEN PROVIDED TO THE WELL OWNER. �9 //
424? Ulm
SIGNATURE OF CERTIFIED WELL CONTRACTOR DATE
er744c
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
Office
an

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
2
Well Contractor (Individual) Name
Hedden Brothers Well Drilling, Inc
Well Contractor Company Name
STREET ADDRESS 73 Holly Hills Vista RD
Franklin,
City or Town State Zip Code
( 828 )_ 369-9591
Area code- Phone number
WELL INFORMATION:
SITE WELL ID #(i1 applicable)
STATE WELL PERMIT#(if applicable)
OWQ or OTHER PERMIT #(If applicable)
WELL USE (Check Applicable Box): Residential Water Supply p
DATE DRILLED D - 3; /0��6,
TIME COMPLETED I'r V AM PM ❑
NC 28734
3. WELL LOCATION:
CIT,M:
COUNTY `/nT ua-)
( treet Name, Numbers, Commun ty, SubE'
TOPOGRAPHIC / LAND SETTING:
❑Slope DValley ❑Flat ❑Ridge
(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
STREET ADDRESS
P-ea)
Nsion, Lot No., Parcel, Zip Code)
❑ Other
May be in degrees,
minutes, seconds or
in a decimal format
City or Town ,I yStal�e
Area code • Phone number
Zip Code
5. WELL DETAILS: i,r(fo a. TOTAL DEPTH: ``��
b. DOES WELL REPLACE EXISTING WELL? YES ❑ NO ,
c. WATER LEVEL Below Top of Casing: FT:
• (Use "+" it 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
333641
f. DISINFECTION: Type H T H Amount 16oz
g. WATER ZONES (de th)
From To From To
From �1 To Jv From To
From ga/h To From To
6. CASING:
Thickness/
From D
Deptlom Digmeter Wei M ri
To QFt. CD
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.
8. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in.
From To Ft. in. in.
From To Ft. In. in.
SAND/GRAVEL PACK:
Depth
From To Ft.
From To Ft. r�T
From To Ft.
Size Material
10. DRILLING LOG
From T4A Formation Description
0 ((• Clay & sand
7d1—
II. R MtADR hri
Granite
RECEIVE a►\,
t )N r,1F wilt? Q�
I15ADO
HEREBY CERTIFY THAT THIS WELL WAS NCAC 2C, WELL CONSTRUCTION STAN ARDS, THAT
COPY ACCY OF THIS RDANCE WITH
RECORD HAS BEEN PROVIDEDTG THE WELL OWNER. -.
SIGNATURE SF//CC�ERTIFIED WELL CONTRACTOR / DATE
�hnne LI nc)r s
PRINTED NAME OF PERSON CONSTRUCTING THE WELL
1617ailwithinty
Mai Service Center Raleigh, NC 2 699.16117 Phone [phone] ext 568lion Mgt.,
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,
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)
DWQ or OTHER PERMIT #(if applicable)
WELL USE (Check Applicable�Box): Residential Water Supply
(u DATE DRILLED ni SAOO ,
TIME COMPLETED i 00 AM ❑ PM,
NC 28734
3. WELL LOC,1ATION:
CITY;
COUNTY 11i.2C 3K3
rvr� r rrvw
(Street Name. Numbers, Community, Subdivision, Lot No., Parcel, Zip Code)
TOPOGRAPHIC / LAND SETTING:
ID Slope ❑Valley ❑Flat ❑Ridge ❑Other
(check appropriat`e//b�ox^))
LATITUDE n/1 vYxL�G/TA��1
LONGITUDE Aj U"r�W
Latitude/longitude source: I}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
OWNERS NAME
ET ADDRESS
May be in degrees,
minutes, seconds or
in a decimal format
ad
,aa%% 63pc ice. fs
City or Town ' state Zip Code
(17a)- 998 7/ 6,2
Area code- Phone number
S. WELL DETAILS: //o(
a. TOTAL DEPTH: 40
b. DOES WELL REPLACE EXISTING WELL? YE� 0 NO,
c. WATER LEVEL Below Top of Casing: /'•+'l`�ESFT.
(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 ac
ordance with 15A NCAC 2C .0118.
e. YIELD (gem): 1___ METHOD OF TEST Blow
f. DISINFECTION: Type H T H
3366-4o
Amount 16oz
g. WATER ZONES (depth):
From 3 11 To 311 From To
From 3 3o To 33 I From To
From 3 LI n To 399 From To
6. CASING:
Depth 7
From ��°.�{,/' To _ I Ft
From / T To 1 Ft
From To Ft
Thickness/
Dialrlgter Weight
41n$
7. GROUT: Depth Material
From 0 To Ft.
20 cement & 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.
Material
Method
pumped
9. SAND/GRAVEL PACK:
Depth
From To Ft.
From To Ft.
Size Material
From To Ft.
10. DRILLING LOG
From T Formation Description
0 5' Clay & sand
Granite
11. REMARKS:
RECFIVF� AllrrX
DIV.orWATER S
BAND
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.
GNATURE7
SS OF CERTIFIED WELL CONTRACTOR l/7/DA 1E
PO:1 o f C �Ly J t"1S
NTED 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 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
State
28734
City or Town Zip Code
( 828 )- 369-9591
Area code- Phone number
2. WELL INFORMATION:
SITE WELL ID #(if applicable)
STATE WELL PERMIT#(it applicable)
DWQ or OTHER PERMIT #Of applicable)
WELL USE (Check rApplicable"J Box):/�Residential Water Supply El
DATE DRILLED la ' I ���//� 9
TIME COMPLETED T r, On AM 0 PMk
COUNTY/Y!'V
(Street Name, Numbers, Community, Subdivision, Lot No., Parcel, Zip Code)
TOPOGRAPHIC / LAND SETTING:
O Slope :Valley ❑Flat El Ridge ❑Other
(check appropriate box) f
LATITUDE 3ilj 94l )d
LONGITUDE 13 A3 0310
Latitude/longitude source: IA GPS ❑ Topographic map
(location of well must be sncwwn on a USGS topo map and
attached to this form if not using GPS)
4. WELL OWNER
OWNER'S NAME
STR ET ADDRESS �t�J�[l
NC���`�
City or Town State Ip Code
($ 3)-3to—A-11f3a
May be in degrees,
minutes, seconds or
in a decimal format
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: 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 .0116.
e. YIELD (gpm): AI) METHOD OF TEST BIoW
.loll'
3466
3
SIt
f. DISINFECTION: Type H T H
g. WATER ZONES (depth):
From
From
From
6. CASING:
Amount 16oz
I 40--) From To
To —TID From To
To From To
Thickness/
Depth ,e) Diameter Weight
From To ) 3 / Ft. to rr
From To /C/Z Ft. to" 'T
From To Ft.
7. GROUT:
0
From
From To Ft.
From To Ft.
Depth
To 20
Material
Ft cement & benonite
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. e• .,
From To Ft.
cL
it
iC
10. DRILLING LOG
From To
0 Yo ' Clay 8 sand
l€{D' DO'
11. REMARKS:
Formation Description
Granite
Rtl,tivcv
tfly- OF vvRIGR Gual1TY
JAN n zuu?
I00 HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH
15A NCAC 2C, WELL CONSTRUCTION STANDARDS, AND THAT A COP'? OF THIS
RECORD HAS BEEN PROVIDED TO THE WELL OWNER.
JJV6& Dion.
SIGNATURE OF CERTIFIED WELL CONTRACTOR DtTE
i(rifr 1911, in%
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

wt.coxsnucriox 333497
Nash -Departs" -
Wtu_t.aotnnsea'atewins cowntacron
_ - y ' e- • . .
I. WEILUSE (Cheek Ap bta8o*- ISM 0 Iadai�l0 A�iW�nd0
Monitoring Recovery 13- HeatPfiVEii'IOwn Man IfOdiat;MSUse _ •
�HariroaaatmttaoRemmele�a-Dlv6ion QarHty�t�dw�xSt
WnmtlDuuj�tAa� aaa:nc /1N1S ian•' ' -?: - c -• _Laif74'
x.-.y�� CaCJlTt01(
cossnn,rtt auiI»j rC j ndn.,rt 1iMz! hi,ait r a s ' * g%SD I!-3 �b
2.1VEi.LLOCATIOIC:.
-Nearest Toms D . -County
(5ueaNa e.mmi cow', ^,�stlh4!..ma - -
1 O . C1J f1 If i
Address 77t 8- $ 7- 0
0tatN t
oqforTamt Sat .f ' zapCeae.
(8'91. 9'33 - aGis-"' _
4_ DATEDunran /a-.j7_0 /P . • .
5. TOTAL DEPTH: . Soo • - -
Aenaoae-Pbmeaaaaer
�.DW
3 . s_ ks) . a
efttRli Wean "
Indttalefionaidesounten3PSDropographiemap
/per --�q • DRILLING LOO
= s'S -'seo• �u a -RANI re
6. DOES WBU.RBPIA(s name wait TES p ; -
7. STATIC WATER LEVEL Beim Topofca*T1 /SA -gr
atfAisaitd lbpata
IL TOP OFCASINGIS. % (G'Y" NewlandFT. S -
lop afeuUafmingldaeirMMgr
vohanta aaah easr1at15A1R'df a •
_
.
9. YIELD (gp10):.__Y__ _METHOD GPTESP tiD2t
10.WATER ZONES (dep� 'F4to' - _
LOCATION SKETCH
I . DISINEECTIOWWTypo fin Amount ..1111-A 5 Show trata/god-dhow hlNAM frantat least
12. CASING: - IVAMadaam - two Stabs Roads orCb
ddWatt mayRtm�:6telttdathe toad
From fl . TToo�•7 a Wei�idlpL "-numbers
Finat_To FL
•
Fmm To
13.OROITC Depth i-tTaMi'at-
Idtshodl
F� `-)
_4. SCREEPk Depth j
_ Dhmtao-s Slaaem
Size = _ /e d
From Tat�_Ft
From To
S_ SANWORAVFLPAtK
From Depth
F1 sire material
To
From To
6 REMFiR &
RECEIVED
DIV QF WATER QUALITY
•IAN942007
DONERE9YCERTIFTMUTT=MU. WAS C wrinisANOAC24Wlff .•
'ONSTRUCTIONSTANDARDS, AND HATACC�OffP��Y0 RECORDtill"! P1IOVIDEUT071�.�YELLOWNER
WELL •_ - DAt& -
Submit the original to the Division of Wades Quality, Groundwater Section, I636 Mali Service Center .ttatetgh, NC
l699-1636 PhooeNa t919) 733J221, tivithla 30 day& - - oW-1 REV. 072001

i • ..-
- - • .WELL CONSTRUCTION
NotdtCam- , & 3.38496
Depstml4oC arkoummtad-Tfp1Resoeucss-Ditidan ". 11061183,8 SeWon
wn.coarawcrolt(mmliawb� -LnntS Am11er:.t, '3: - c iMeAt is a/i4 _
srwreweu�smitr!
wets. ooerxweroabosomy .rc finik,.t 1110_4136ita,yi.:e ,'1-. tQp•1Sa4-3 3.6 U _
•
' --as
ttfap1abIs4 - -. I. WELL USE (Check /461 BBoufle tda l ,al/PuLftea Ida l a A •Q
... Mundmtng0 Ram"'a Haatrant WaotrI imtD Otimra IfO�iar,ListUm
2.lVELLLocATION:. - -
'Naps Tows FR Nia• i /// - County A-COYv • T
1 i��rs tinvet- Co- v-e- .Z�e3 aetr rnt r olmt
�f -
(matl4�R.ei[R,s.�d+iO,.ratim..�ptkdd - ONO IOCariWt
3. OwtIER:, ,Jis t /%•)-41. S e//
Address «o /
ntrarlasub3 -•
GgerTaaa Sat
ttat ,3/a 9-,5s Epee*
dun cede- Ilime saes
4. DATEORILLED I,1-1./ O Fi • -M1' —
S. TOTAL DEPTH: 2S'
6. DOES WELL REPLACE EXIS1'REiWtors TEE aT 4I/'
7. STATIC WATER LEVEL Below Top ofealuir 'Iry
P,.
LalittideficmgitudoimumcDOP'3E7r0110818Phic
(thawirAbwatho tam ire
8.'TOP OFCASING IS Above Land Surber-
TeparendgtrlaaarM 6a7e
YIEIA (g(*
enka Yant
MTTBIOD °FTBST idami 1SA30hC
9. -
10.WATER ZONES (dapfl //h ✓ 36n- -
map
re.�I11 - ` DRRIILI NOI.CG
lffom To ForaationDesc iption
G
I1. DISINFECIIONcrype / a - Amount-27/44,? Show direction aw.ditstws Ems at sat
LOCATION SKETCH
12. CASING. - Weil'lhb9otm - two$4tpRoads arCounty Roeda.Iaaludothe road
From 0 . • c / Deptha • Adidla
_'mambassndonsoad>lsaus
Ftom_To Ff~_' -
•
Fmm Tp
13.OROU'm Depth Me1ao1 d
Fmm�(i_From1a_.-�pw,.amp' p031-0 �
_4. SCREEN: Depth Dyer _ Mot Mas: = Marini
Rem__ Ti. pt..—_ j11; ill.
Fmm To R. In.
5_ SAND/GRAVELPACK - -
From____ Tom Ft`_ Muerst -
Fmm To R.___
FWATER OEN W
ot�. OWWI
14N 9 4 2007
6_ REMARKS_
DO HERE9Y'may menus Wa . WARCDtis'OUlCl7+lD INACCORDANCEmut ISA NGAC2c. WEfL •
ONSIRUCftWV
STA
NDARDS, ANIEUTAAT�At/7OP�Yt$ RT R(ASSBMW PROVIDROTO H8-WBLLOWNER
SIGHATHEROPFRSONCD I TIMWELL - • DATE -
Submit the original to the Division of Water Quality. Groundwater Section, I636 Mall Service Center -Ralelgh,-NC
fl699-1636 Phone Me. (919) 7334211, within 30 days. - GW-I REV. 07/2001

RESIDENTIAL WELL CONSTRUCTION RECORD
f4
cot
crsit
et
North Carolina Department of Environment and Natural Resources- Division of Water Quality
WELL CONTRACTOR CERTIFICATION # ,_' T 0 3
1. WELL CONTRACTOR:
nn
&i t/ Ade--2C'
Well Contractor (Individual) Name
MILLER WELL DRILLING, INC.
Well Contractor Company Name
STREET ADDRESS P. O. BOX 567
HAYESVILLE, N.C. 28904
City or Town State Zip Code
( 828 } 837-2997
Area code- Phone number
2. WELL INFORMATION:
SITE WELL ID #lit applicable)
STATE WELL PERMIT/hit applicable)
DWQ or OTHER PERMIT #(if applicable)
WELL USE (Check Applicable Box): Residential Water Supply
DATE DRILLED //-//- 6
TIME COMPLETED '2 ce AM PMp/
3. WELL LOCATION:
CITY: C/'test
COUNTY 71/4 c C//
e) H-€.r Cris /L
(Street Name, Numbers. Community, Subdi islon, Lot No., Parcel. Zip Code)
TOPOGRAPHIC f LAND SETTING:
['Slope CPI -alley ❑Flat ❑Ridge ❑Other
(check appropriate box)
LATITUDE 3 S ACC 5C 7
LONGITUDE S 3 7 2 43
Latitude/longitude source: 0-CPS ❑Topographic map
(bcation of we# must be shown on a USGS fopo map and
attached to this form IT not using GPS)
4. WELL OWNER /
OWNER'S NAME �'O''d Se" %:t :fttd
STREET ADDRESS St S% o4IFf fee-24 tetidt I
May be in degrees.
minutes, seconds or
in a decimal formal
reple Te ..-- L. ;2S e1
City oi Town Stale Zip Code
( )-
Area code - Phone number
5. WELL DETAILS: ,.
a. TOTAL DEPTH:
b. DOES WELL REPLACE EXISTING WELL? YES 0 NO IT
c. WATER LEVEL Below Top of Casing: ( FT.
(Use'+' tl 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 (gam). S� METHOD OF TEST Tint
Q
OWNER/2-6 `06
MWD
NC ✓
I. DISINFECTION: Type C r %!!
g. WATER ZONES (de lh):
From .J L$ To From
From To From
From To From
6. CASING:
Amount `f c
To
To
To
Thickness)
Depth Diameter Weight Material
From 0 To .5 FL 6.,2,r )4t1( t"'
From To % 5' Ft.
From To FI.
7. GROUT: Depth Material Method
From C To .2 FL /C„T/=`%c
From S To .72`^ Ft. ,_.jd ,a/C/ Y<= "`�.-y
From To Ft.
8. SCREEN: 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 Size Material
From To Ft.
From To Ft.
From To Ft.
10. DRILLING LOG
From To Formation Description
'f --
is-- 7C c?v./
C/4./- G%�^Y✓2^ /
7G YES' E>"u >- 1K-
11. REMARKS:
-"d
d
r
v
r N.
e�a
h(telaw D
L rlv. OF WATER QUALITY
JAN 9 8 2007
1 DO HEREBY CERTFY THAT THIS W Ell WAS CONSTRUCTED IN ACCORDANCE WITH
1SA NCAC 2C. WELL CONSTRUCTION STANDARDS. AND THATA COPY OF THIS
RECORD HAS BEEN PROVIDED TO THE W Ell OWNER.
SIGNATURE OF CERTIFIED WELL CONTRACTOR
CS, /MJ
//
DATE
PRINTED NAME OF PERSON CONSTRUCTING THE WELL
Submit the original to the Division of Water Quality within 30 days. Ann: Information Mgt.,
1617 Mait Servire Canter- Rateioh. NC 27699-1617 Phone No. 19191 733-7015 ext 568.
Form GW-la
n.,.. 'Inc

North Carolina Department of Environment and Natural tlesources• vrvlervn V, ...•.• .,--.,
WELL CONTRACTOR CERTIFICATION N 2187
t, DISINFECTION: Type HIT H Amount 16oz
1. WELL CONTRACTOR:
Russell S. Taylor
Well Contractor (Individual) Name.
Redden Brathets Well Drilling, Inc._
Well. Contractor Company Name
STREET ADDRESS 73 'Ii011y Hiiis-Vista RD
�, rFei_ Tdr DA7Ad
City or Town Stale Zlp Code
( 828 h ZAq_9591
Arse cods- Phone number
2. WELL INFORMATION:
SITE WELL ID Sill applicable)
STATE WELL PERMITN(II applicable)
D'r,'U or OTHER PERMIT Cif applicable)
W 6LL USE (Check Applicable Box): Residential Water Supply Q�
i EMT 1 DRILLED- '� n I t 80OLO r�
TIME COMPLETED I Zi' %i7- AMO PM%
S. WELL LOCATION: - •
CITY:
(Street Na , Numbers, Community, Subdlv.ion, Lot No,. Parcel, Zip Code)
TOPOGRAPHIC I LAND SETTING:
❑Sic I OVBlley CFlat ORIdge 00ther
(cheek epptdP� to box)l ^/
I.
T ITUDE �yL //mo�
LONGITUDEt3 ao W 513
Lati'iide/longitude source: GPS OTopographic map
. Notation of well must be n on a USGS fopo map and
attached to this form 1 not using GPS)
4. WELL OWNER
OWNER'S NAME
STNrfiET ADD-ESS 325
Zip Code
May be in degree.,
minutes, 'sonde or
In a decimal format
Clay or Town State
Aron code • Phone n tuber
5. WELL DETAILS: n �0
a. TOTAL DEPTH: ` U
b. DOES WELL REPLACE EXISTING WELL? YES V NO O
c. WATER LEVEL Below Top of Casing: - 10 _ FT.
(Use •s• If Above Top of Cuing)
d. TOP OF CASINO IS 2 FT. Above Lend: Surface'
'Top of easing terminated svor below lend aunece may require
a variance In accordance with 15A NCAC 2C ,0118,
e.YtELD (9pm): 3D METHOD OF TEST Blow
g. WATERAONES (depth):
From_ r To
From
From
6. CASING:
From
From
From
To
Depth
To
To
To
7, GROUT' Depth
From
From
From
7
To
Thickness/
r Weight'
Material
Ft. C/
Dian/ e4q
Ft•_fi "
F1.
/1.se/po
Material Method
From 0 To':20 Ft. Cetlalt & karznte Pitted
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 FI._in. __ in.
9. SAND/GRAVEL PACK:
Depth
From To__
From To
From To
10. DRILLING LOG
From T
0'
Ft,
Ft.
Ft.
Size Materiel
Formation Description
Clay & sand
Grajlite
wo<ah,
I D0 HEREBY caRTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE VON
15A NCAC 2C, WELL CONSTRUCTION STANDARDS, AND THAT A COPY OF T 115
RECORD S BEEN PR IDED TO THE WELL OWNER.
SIGNATURE OF CERTIFIED ELL CONTRACTOR
Russell S. Taylor
PRINTED NAME OF PERSON CONSTRUCTING THE WELL
A
S o1
Submit
1617 Mall hService iCenter n Raleigh, NC 27699.1 17 QualityPhone No (9 9) 7Information Mgt:,
33 7015 ext 568
E 21
2887
Form GW l a
Rev. 7105
ritL,tivtu
OIV. OF WATER QUALITY
JAN 1 2007

372W
1. WELL CONTRACTOR:
Michael S. McClure
336939
North Carolina Department of Environment and Natural Resources -Division of Water Quality
WELL CONTRACTOR CERTIFICATION # 3424
f. DISINFECTION: Type ihL1 le(1 nOmount
RESIDENTIAL WELL CONSTRUCTION RECORD
Well Contractor (Individual) Name
Tarheel Water Treatment, Inc.
Well Contractor Company Name
STREET ADDRESS 3672 Georgia Road
Franklin, NC 28734
City or Town State Zip Code
( 828 )_ 369-0740
Area code- Phone number
2. WELL INFORMATION:
SITE WELL ID #(if applicable)
STATE WELL PERMITit(if applicable)
DWG) or OTHER PERMIT #(it applicable)
WELL USE (Check Applicable7Box): Residential Water Supply El
DATE DRILLED (-—?Q'CCP
TIME COMPLETED
AM ❑ Prvyap
3. WELL LOCH ION: r� yin
CITY: ✓GZ✓I lt- f 16 COUNTY I f I tQ Clem
Lon% Rao-cL
(Street Nam umbers, Community. SubdiNsion, Lot No., Parcel, Zip Code)
TOPOGRAPHIC / LAND SETTING:
Slope (]Valley ❑Flat ❑Ridge oOther
{� (check appropriate box) ??
LATITUDE 3 q�q2Q9 / iy`J// //
LONGITUD _3 9 ! /) •`D
Latitude/longitude source: X }PS ❑Topographic map
(location of well must be drhoa on a USGS topo map and
attached to this font if not using GPS)
4. WELL OWNER -.pc
OWNER'S NAME Q \\ �w \Q _(�
STREET ADDRESS apa I Vg 't cs1C1+
City or Town State Zip Code
(T1O)_ 331-03
May be in degrees,
minutes, seconds or
in a decimal format
Area code - Phone number
5. WELL DETAILS:
��a. TOTAL DEPTH:
b. DOES WELL REPLACE EXISTING WELL? YE
c. c. WATER LEVEL Belau Top of Casing: r> C/
(Use "+" if Above Top of
Casing)
d. TOP OF CASING IS a / FT. Above Land Surface*
*Top of casing terminated aVor below land surface may require
a variance in accordance with 15A NCAC 2C .0118. /q��
e. YIELD (gpm): 9O METHOD OF TESTA ( ICC)&AI
NO D
FT.
g. WATER ZONES (depth):
From_ )6n To
From To
From
From
From To From
6. CASING:
tt Depth Diameter Weiohht
From / To LOS Ft h i .idS 5j)) iCa
From t-I S To . 3 Ft. (..e>, S
From To Ft.
To
To
To
Thickness/
7. GROUT: Depth Material ��//11Method
From_ To,3 Ft. ,i��ce,��(�cj�t.tt,�ar IPu top
Fran__ Toy-»0 Ft. Ut
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
yp spp/1
�/ar?@aof? mrtt°tt.vn 5r544 lrvnr,
11. REMARKS:
RECEIVED
ulv. OF wAl kK QUALITY
JAN 1 R Zoe?
1 DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH
15A NCAC 2C, WELL CON UCn ANDARDS, AND AT A COPY OF THIS
RECORD H S BEENE�ErPR j D1 WELL OANE'
/Gf2
SIGNATURE OF CERTIFIcD WELL CONTRACTOR DATE
« f4A I -; Clw�
PRINTED NAME OF PERSON CONSTRUCTING THFWELL
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.
FEB 21 Zuul
Form GW-la
Rev. 7/05
c

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 applicable)
STATE WELL PERMIT#(if applicable)
DWQ or OTHER PERMIT #(if applicable)
WELL USE (Check Applicable Box): Residential Water Supply
DATE DRILLED 5/8/06
TIME COMPLETED 5:00 AM CI PM ii
3. WELL LOCATION:
CITY: FRANKLIN COUNTY MACON
WILDFLOWER OFF COON CREEK OFF 441
(Street Name, Numbers, Community, Subdivision, Lot No., Parcel, Zip Code)
TOPOGRAPHIC / LAND SETTING:
❑Slope pValley ID 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 ULTIMA CAROLINA
STREET ADDRESS
52 BRECKENRIDGE ROAD
WAYNESVILLE, NC 28785
City or Town State Zip Code
( 828 )- 454-9450
Area code - Phone number
5. WELL DETAILS:
a. TOTAL DEPTH: 625
b. DOES WELL REPLACE EXISTING WELL? YES p NO
c. WATER LEVEL Below Top of Casing: 260 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
I. DISINFECTION: Type HTH
g. WATER ZONES (depth):
From 105 To 108
Amount 20.13 OUNCES
From 560 To 563
From To From To
From To From To
6. CASING:
Thickness/
Depth pim
88 From 0 To 86 Ft. I1/4Rter Weil>ht
From To Ft.
From To Ft.
7. GROUT: Depth Material
From 0 To 3 Ft. 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
From
From
From
Size
To Ft.
To Ft.
To Ft.
10. DRILLING LOG
From To
0-81
81-105
105-108
108-560
560-563
563-625
11. REMARKS:
Material
Formation Description
CLAY
GRANITE
CAVITY
GRANITE
CAVITY
GRANITE
OIv, OFRECWATF (DUALITY
4 200i
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH
15A NCAC 2C, WELL CONSTRUCTION STANDARDS, AND THAT COPY OF THIS
RECORD HAS BEEN PROVIDED TO THE W LL OWNER.
SIGNATUREr�'OF CERTIFIED WELL ITONTRACTOR DATE
C-lel'1r PRCk744n f%ir1444f Xrr
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

J`FSXDEIVTIAL WELL' CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources -Division of Water Quality
WELL CONTRACTOR CERTIFICATION
1. WELL CONTRACTOR: C-
I
Well ontractcr (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)
STATE WELL PERMIT#(ir applicable)
DWQ or OTHER PERMIT #(d applicable)
WELL USE (Check Applicable Box): Residential Water Supply
DATE DRILLED (9 .mil U
C COMPLETED
3. WELL LOC
CITY:
28779
Zip Code
5qt
(Street Name umbers, Community, Subdt4sl • v ?
Y . Lot No., Par -' "p Cod/1_
TOPOGRAPHIC / LAND SETTING:
❑ ❑Slope aley /IAFlat 0 Ridge 0 Other
(check appropriate box)
LATITUDE —
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
ST ADDR
Cily or own State Zip Code
u-.
Area code - Phone number
5. WELL DETAILS:
a. TOTAL DEPTH:
b. DOES WELL REPLACE EXISTING WELL? YES 0 NOk
c. WATER LEVEL Beim Top of Casing,
(Use -+' if Above Tcp 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 ante with 15ANCAC 2C.0118.
e. YIELD (gpm): a S METHOD OF TEST1
7. GROUT: Depth , Material �/
�f
Fram_�To 3 Ft. ��i1v=y
From 3 To jr-) Ft. /}fin -L.\
From To FL ..
8. SCREEN: Depth Diameter Slot Size
From To Ft in. __ in.
From To Ft. in. in.
From To Ft. in. - in.
I DO HERESY CERTIFY THATTHI$ WELL WAS CONSTRUCTED IN ACCCROANCE WITH
ISA NCAC 2C, WELL CONSTRUCTION STANDARDS AND THATA COPY OF THIS
RECORD HAS BEEN PROVIDED TO THE WELL OWNER
SIGNATURE OF CERTIFIED WELL ONTRACTOR DATE
.1 IJ
PRINTED NAME OF PERSON CONSTRUCT G 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
City or Town
( 828 )- 586-5550
NC
State
28779
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 9/14/06
TIME COMPLETED 5:00 AM 0 PM IE
3. WELL LOCATION:
CITY: FRANKLIN
WILDFLOWER LOT 301
COUNTY MACON
(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 fomr it 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 BRECKENRDIGE ROAD
WAYNESVILLE NC 28785
City or Town State
( 828 )_ 524-0892
Area code - Phone number
5. WELL DETAILS:
a. TOTAL DEPTH: 700
b. DOES WELL REPLACE EXISTING WELL?
Zip Code
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): 7.5 METHOD OF TEST AIR
'4 9
f. DISINFECTION: Type HTH
g. WATER ZONES (depth):
From 225 To 228
From
From To From
Amount 31.5 OUNCES
From To From
6. CASING:
Depth 17 by gter
From 0 To Ft.
From To Ft.
From To Ft.
To
To
To
Thickness/
StSi�Z1
7. GROUT: Depth Material
From 0 To 3 Ft. CEMENT
From 3 To 20 Ft. BENTONITE
From To Ft.
8. SCREEN:
From
From
From
Material
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 Size Material
From To Ft.
From To Ft.
From To Ft.
10. DRILLING LOG
From To Formation Description
0-112 CLAY
112-225 GRANITE
225-228 CAVITY
228-700 GRANITE
11. REMARKS:
I EGE{VED
DIV, OF WATER QUALITY
)-EB F 2 ZOO?
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-oi
SIGNATURE OF CERTIFIED WELL CONTRACTOR DATE
PAA 13 fill it04.
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

cowinacron
N«w c:�e 3
- • -�VBI.L CONSTRUCTION RECORD' _ 3 3 4 6
-Deter � .M)h..d •DirWcr��Qwlity.( mtdeta�Seedat
weu.aatraAcroaoa..nwr c $Iksp l IIM I aflr s Amore flint S24-3 �b 0
screw is
-
fist M - ai
{1f,Eptlorhk) • -
1. WELL USE (Cheek App Boxi-ReddadiaiArk iskiguNPublic I blq talcultentiti
•
Ms 04 Heat Pimp Wi4eilgeelka p Other Q iFotter, List Use
Z WELLLOCATtOhk - - its
Nem:Tortt • ,i *A,J ik.) - ... i . A c • - ) - T-dge •1I ssthig
of /LtcJu �JP73 tf!
Moan womcov.umarliteSo�.rgtR.,Y Caw- - `
3. OWN e , C-ia 4/L.--
Address O 4 3 12. /•
taaeseitaaelt.�._-, _ _,
lit Lla.).•'-�filCA 02 -
alphrra■ ams „et'•'" Aid.
(12id. 37i- 4.64-4
Auaeods Phonea.aber -
4. DATE DMUS Jb � 3 .
S. TOTAL Dp
3
Ladttedefiongiltidet sonmecOCIPSOTopographic map
- - DRILLING .LING LOG
Derip0on
6. DOES Witt EXISTWO With TES EI
7. STATIC WATfl LESTATIC WATER. IMPELBelowTToppoftalre %Do 1r1'
ats
8. TOP OF CASING I$_ Fr. mart Sulfate
-
'Z►pefeedngtaaJndds�ew 6 kadwrtrwrwaiaa ..-
4. YIELD YaYnsaminear -
10. WATER ZONES (depthk ��
tl. DISINFECIYON: Amy -- LOCATION SKETCH
12 CASAdQWallihicbteas +ibtsnosiimike fiomatleast
- acre MIS- Uinta: RedaorCooetyRintk:Includethe mad
F To.. „ arit _
' oamPuommoutoel_
From_ To F _ �'
l3_ GrOm __Te_—Ft`-"_"__
From_ Q_ m nepth
taw - - 4I�
4. s TDEZ�CP\-R DAP
From To Mafatel - OFjiL .�Q�
5. SAND/GRAVEL PACK:
it 00
From Depth - MaWrel
To__
From__To____ ----.
6. REMARKS__ -
•
Twnii=WELL WAS CONS RUCIED"(ACCORDANCEWMISA
A S,A)Dm*T*COPYOF �: ; RECORD ; B 'aC.WB(i.-
1DTtpI.WBiLOWDER
/D— 2 3 15 4
SIONATUREOPERSON CONSTRICTING TER DATE -
Submit the original to the °fettles of Water Quality,Groundwater Section,
.J.7 699--i636 Phone Ne. (919) 7333221, within 30 days.
GW-I REV. 072001
Co
lea
C.)
C)

•
' ..
WELLCONTRAC7081COMPare
STATtwEtbOOlQrtttlCrmtt?lf J+vM!1'+aiEA -
Ono olio -
NahaOtioth1i- Deportment o Eithir ®IY`end iblorel E - •L 77WVYidinate
„ Lprmp�LrfMts Id.,ir ;k. ►•t i. ante -
5ria 42-lliSR4-3 L6 D
1. WELL us __ -�- iarf fr llLJ_LLJ a
• ` Min Ram, o Hat Porno Waabrl as Other ET frolitcListug•
z VEIL LLCA
w1eert+ametheawacm.n..rr rhreOm sr
3. O
Addma . �ZI�S �7T� A n" iy 1 h I2.
D�i'�.tlb= D
,� Zip Cods
a1a- 7q9-PGn'- _ _
Ana code mtdmatar -
4_ DATE DRILLED /¢ •-/ g - z) �o . , -
S TOTAL DEPTH (o O D
6. DOES WELL REPLACE RUSTING WELLY VESO1__a'
7. STATIC WATER LEVEL SelowTopof FO PT:
8. TOP OF CASING IS. J PT. AboveLaodSwathes
atElsOrifAbowillimECuipg)
VflU aeadmawaliLS 7 CWCMIL . _ - - -
t flab
114111101) OF
10. WATER (des /440 ' , - -
•
_ idtaadrg -
ir
reanitlelloughodo often Landon
t i
n Topogapbh:map
rD - DRILLING LCD
To _ Deaaipd
! I. D15MFELTlON: LOCATION S1 T
'�'p __Amount .-2MA Show*region atd.dbhnnMisulks Rom atleast
12. CASINO: - WellThieseno two State .Roads °WarmlyRoads.lncjwlcthctoad
Fmm fl- . /3r ft,rt Ord "-ntonbas end -common road most
Frout__To Ft .
•
13. GROUa1 Den . Mesa Method
FreTD epira%poit,o
_4. SCREEN: Depth yaw . glatSin - _ Waist
From To (n: i14
From To
5. SAND/GRAVEL PACK: -
Depth Size Material
Ram To
From To It
6. REMARIG3;
DO HERERYCERiiFYTLIATIMSwau. WAS COESIEUCTIIDINACCORjtn WlIA 13A 2C. WALL. •
DNSTRUCRONSUIi DAIDS,ANDIRATACOPY CWjL(RECORD ,: WM TOTlOLW1ny0WNER
SIONA PERSON UCLNOTHRWffi1; . DATE .
submit the original to the Division of Water Quaftyl Groundwater Sec„ ou 1636Mal Service Center Phone No. (919)733-322t, width/ 3D days tR NC
- ti9V 1 RHV. 0; 7ROD1

c
•
6. DOES WELL REPLACE WALLZ vas 0 I `
7. STATIC WATER LEVEL HebwTopof ID 0 -
tuie�rS nttap((Cu *
It. TOP OF CASING 18 J PT.ALDeeLmcumSeee
maporedgUnar Unaided beeflld+efl. - in v
ru
Ynsta ■llultl 2C Nli �- � )
9 YIELD(>p* 0 I.DITBODOFTAST_Nalip4Q..
10. WATE&ZONES (depd4 / tf•b !0i
LoglafielonFilude
• `iot
• _ •'' ` 3- 3..
•
.'73'
NewedetwasheessW
aPopopaplda Dap
DRIL ?1G LOG
Decision
73
/ Q.i5 •
-- LOCAllONSI TCH
11. DISINFECTION.Type fen Amount ..3TJJ-A5 Show direedonand. in mites Rom at least
12. CASING WaRllddwms - teoSeto Roads orCounty Roada:l the toad
• Depth
Fmm _LTa _FL ffik�" _ orWt. Wernher,sad'oo smednames.
Frmtt_Ta
Fesn _Tp —
13. GROUT: Depth -
•
- S4
EG00
a©\3N\,
O•NP I0
tdemod
_Tp_ e''„"1''r post`)
-4. SCREEN: Depth I t--_---s sstoma- r made
From..__ Ilk_Ilk_Ft . n. in.
From To FL in. in. -
5. SANDKWAVELPACK -
Dash rtm *inlaid
From To Ft. -
From To Ft
urns COMPACTOR
WELL CONrRACYORCONOWIT
era wa t.onanmenc tt rti asang.�o
OtupoRe - -
North(S%1'ioa-Depo mtofEarrouo taod IXv61m
)UAt 1(AJ Mira ffNIS f.10,a 4 . _3�
s
t� itr. _ f walersestion ` 3 1:
6 1
'IMO=altSa++-3 Lb
t_ �W�E„ILUS.E(Cbs-ch/ .Rei6id8ox)-Reddenialti' A IiPubB�er0 Industrial 13 Agicidtur Q
MixutaSgD Rtmoves EI• Nat Pump Wgeibiee�a0 os If Oiler, Louse - - - .
- 2 wELt. LOCATION -•
Neereu rover - cony AI
A- cat- - !adr pBau t7l ec
CT trim. last rLeestiLa o?¢73y kheac > •
3_ 0
Ad&ess
Ntwe<erBmas
TA)4kL :_A
fflTa u -•' sea
OR} 'n i . 0570
Artace P,aassaaiar
4. DATEDRILLED/ 0 - 3 -6 C.
5. TOTALDEPffi: ITS'
A 1RDS,AIiDTHATACOPYOirll�l p BIRDNPROY�1VTHEW.Tffi=OWNER
T MO,PERSON/{7C ,. iI,►�TERNEU . - DAYS -
Submit the original to the Division of Water Quality, Groundwater Section, 1636mail Service Cotter -RaMgb; NC
.17699-1636 Phone Na [phone], Within 30 days.
b REMARKS: •
DO IIEREiliCESTMATTiISWAILWASCaterAilClpDR( Acazawnsinu oat ICAC24TALL-
-01JSIRUCftOiJST _
. • /b ,2 3 -0
OW-1 REV.072001
0

•
w¢t.t.00NI*AL:11MICO PAIW
STATE was. cateraa twtrnasty
(ifainikas O
• • WELL• CONSl'RUC'1IONfl
Nonhpo lion- Depntrnent of>I IronsRosman-- Di rlAiiityQality:c &Oat -
writ rnertvwctoRlama�ttb rs lints firs f ra;; . = = - " imG►791Ws a�7!!
�tkle�Jt+lA�6JL-nej. -ttC�av-3 2.4. a
I. WELL USE (CiwetAl dHorilteidenfatzYllu eifiublieQ bdititala A " 9
- ` Monitoring 0 Roanry O- Mat Poi, Witte o Other If aim; u*Use :
- 2. WELL LOCATIOlt
emcees lhooes edsee - - _ i -0
4. DATE DRILLED �6 -O . . -1s-1 — t G ' • l-o 2.
5. TOTALDEPTHSeS' _/O� • v`I� •
6. DOES WELLRBPLACBRXISTQW WflT -YES, IdDn
7. STATIC WATER-MinBelowTopoff 4'a f
VittAbrivettp Cuba
s. TOP OF CASING IS FtAy�� •
'iryetembsteraYoloa ��[ !!Mteats . aie. - .
Me.eeL ecawien 7samicas -
9• YIELD(gasl� a .hWTHODeF
10. WATER ZONES (depth): /!.S'J 23
Nearest Tow Fiek/Yie ,�n,Q - T
C.y/� &IDns +� a 3 e / Gnt� plfattay .t7 at
tb"` c�/� vaI•
m'afia -
lst.0 �s>t.t17o.>gif
3. owt J: 7 Q /i c.K.... - . - • . .
Addles !, fS rd 16w� tivnra ii... ,¢.4i Sato T dcmap
FiQil7A�ll(� �% r . DRILUNG LOG
Whams se ' ztPt- • . ; To ' .Fo_tmationDauiptioa
cS2�- (fld6'� o 0l.4
II. DISINFECRON:1 pe WWI:-
f/. Amount 02rks5a wanouoaamt fimnaticast
12. CASING; - Wall Thickens ' two State Roads orCounty Roads:Ialudethe road
F inal_l %1h2, p cSa��r�YitVi t ua 'membasand toad nam
es.
Fq _To Ft. = -
From_
13. atom
Fmm__ 7=t... a � -- \.S .
A. SCREEN: Depth t>T Skit Sim : = Marconi . - ��"
From To From_ To_ ems. in. ¢-\N --c
F1, in. in _ . P
5_ SANDIGRAVEL PACK; - - - �F
Depth size - O\�I< ,�.
Ram To FL Mahoei �C -
Frotn__To Ft.,_
6. REMARKS: -
•
DOBEREBYCERTtrnuATIMSwow wits wigwam@(ACCp wait ISAlamas WBU.-
ONSTRUCfIO�ISIANDAgOB,A(iQTHATACOPY G RECORD �I'(1 O OTEOLIVELLOWNER
-FM =1�•Cf`dsa /6 "old
•
Submit the original io the Division of Water Quality, Groundwater Section I636Mall Service Ceeter-
RalethiNC
.27699-1636 Phone No. [phone], 'within 3@ days t . GW-1 RRY. 072001

WELL - �� ; .. rr ;
REL
• - - _ CONSTRUCTION RECORD '. .
Nonii_e Soa- Department otnivkainicrit and R DirbiailorQ s-: s! a
wsu.corrsrecton ants %�Iter►:t; = _::
vent. ootrrnw<roteoarisr�nv -Mttc jlajlnr.l 11 zs41 : rwc., Sal/ . 3 a -
srrATEvi s�.aotontIICTIottraamtni T :75-
(ir__ inls) - - - -6L. tie1 • - -
1_ WELLUSE (CLoatApi •Bottle-Raidontid V riiw acD .Iodadrbla Q
Monitoring El Re Cr$at PompWietH�i ajoo.D other aHOI$er,LWUse : -
.33.4159
ZIVE[L LOCATWRk !/
.
NET., ::. 4: /� �jin$
!/ lii Gttuu®s Q1faRey .uF7et
Mee Nam tabete.O eway,$.tea retlin.ai CoitmWI ot• .loeetan .
3-0. 1::- hn _SIa--f-erv.- -
Addiess - Rb 'Illi� I) ea; x pk `an ,e..
f�uCaorAaae►e,,l � -=
Chchtnob - A, - '3 . /aortas .
4- Stre Zip 6 66 /- Duda.
Awe eau- thoutawsiter
4. DATE DRILLED / —d
5. TOTAL DEPTH: .350 '
6. DOES WELL REPLACE ERISTDO WBLL1 TES 0 24.0411-e
7. STATIC WATERLEVELBtwTepot ats. 00 Fr _
t11s irtram Ttrdesibia
8. TOP OF CASING 18 f Fr. Above land S -.
-ibpmedgam__te6 beau letheeerwrgdtre . -, -
MusreawArttvIDISA JC.pts..
9. YIELD( METHOD OF
-
10.WATERZONES(dept* 360' - -
1I. DISINFECT 014:. ypa_ ###- Amount 771-A 8110Wd1r c6 nlaw 1tmlkz*omatteest
12. CASING: - - WeRYtidowto - two smoRotaordounyaokban ua:taad
fl . 1G ertlydpiW-L " ''numbers autummtoamadnatntea.
From Pt$.
From _Ta
From__ TP Ft._, _
13. GROUT Depth Mi Sl. Method- _
Ftom—.2Front ,rTa �Fr....CQ�dr-r p� _
_4. SCREEN: Depth Diameter . SeotSua = tdalefd-
Rom
- •L
„outfit -
Ymm To
O 2'
%/n '
titimabieseestass
sourttOOPSOropopaphicSheet bid
map
DRILLING LOG
'r (o • S-4n•
From To R in. m .. . a .
5. SAND/GRAVELPAC(: - `b�
Depth Ma
From_ To Ft.
From_ To R
6. REMARKS:
Fc:tmtlonDescdption
0 1- ay •
Qr ,Lastp
j L#G
Materiel
DO HERE9YiaiijgrraNnlISW&LWAS COINTRUCTRDINA000RDANCHWI'f1j13A 'BtA42f'WBf3.-
DNSThUCTIONSTANDARDS,AND THAT ACOPYOF IMFRECORD HAS MOM P OVIDHOTOTHEMELLOWt 1t
matiATURH'06rPEBSomCONSlRIcTRiO?EHWeu: _ - DAVE - -
submit the original io the Dtvlslon of Water Quality, Groundwater Section, I636 Mall ,entice Center -Ratdgb; NC
27699.1636 Rhone Ns [phone], within 30 days. . 0*-I REV. maim

• - WELL CONSTRUCT ION RECORD" -335531:
North( oln�-DwaineotKB maotma Resources-lYlYldaa Q y-713 Sectionw w.coreruhtor�pew►itte sO L0911S 31_7tr_► s --111P . Q
va!
wets. carmubgrosooarMW r ;G''"'/,may-Sorb
STATE WQJ.corarauc t rimaitni • aaoc tnD wiltmeara
grealtabls) - -
I. WELL usi: fleck AyilicebbiBotRaideadadeCSeipal/Pubile D .Induil Nat 0 .4
• ` MonitoriSgD Rem" Cl- 3 Pinup Witte bgeopoSD Other tS IfOpleyList UsC
el
3. OWNER; - a Lk f�l : c!� s - -
Address st (o Co. fly,
(�t ttauexaa _
ut.�'`0 7 - l873''k
t . y
6. DOES WEILREPLACE mane wan YESNU.:til'''`
7. STATIC WATER. LEVEL Below Topofcatiins A61f) FT
(WY"
S. TOP OF CASINGLS_ _Fr.AboveLard Surber -
Tpe(earadWtdathrttetsiv rho h avdeian
varinai a�rdaaawN.1SA 2CA11t
9. rap (ggpx�MEMO»OFMST f/11/%j t
10.WATER ZONES (deptItk i2V /9;5—•
2 lYELL LOCATION: -
Tppogtapicithici -
-N Tour iit.>r/C/::tl - t:omtgr/Y1 A- C4)^—; • ' pslopu a�Y f[ay •gam
tsuccallor®e.tasb -itoais. LvtNa.r4�) . - . - . . L't 6id fvt�UlowRoa •
Litlitockdlottgittide , ecOOP opograpide map
rr - •
t DRILLING LOG
Winn - Sara f' '_Zip Cede : - ..,Fiom To : FirmtdionDemiPUoa
Area ade- Phone umber
4. DATE S TOTAL DEP K / V' - L . - _ IA- • / c • ML fi •t O Z4r' i t�—
- • - t.00..ATtt1N SKETCH
II. DISINFECTION. Type WWI- Attu ...TA-i!5 Mow c and islancsiumll.ftmaatleast
12. CASING: - - 'PM Ttdmwea - tea Slaty Roads or County Rodaancludethe mad
DTa_' eem _ �' otwal�rit _ -numbersand`comnonroadnames.
•
Fmttt_Qj•
From Ttl PL _-F
Flom Tp
13. GROUT: Depth Mata61 Method -
From
.4. SCREEN: Depth Oiataecer : StotSiae = _ Materiel
From To Ft. In. in.
From Tor PL . ja in. -
5_ SAND/GRAVEL PACK:
Depth Size
From To Ft
From To Ft
6_ REMARKS:
DO HEREBY RTIFYTHATT ISWEILWASCOSTRUCTEINACCCEIDANCSwlillIS/IINCA vilii•
DESTRUCTION SrANDARDBsAND THAT ACOPY O TH D BEEN PROVIDED TOTHBWELLOWNER
SICNATURB-OFPERSON CONSIRUCTINOTHEWELL - - DATE -
Submit the original to the Division of Water Quality, Groundwater Section! 1636 Mall Service Center -Raleigh,'NC
n699-1636 Phone No. (919) 7333221, within 30 days. . - GEM REV. 07/2001
From_11._ToSpom,
Material
•
: J%—?b-o-'
Cs
0
CND
0

RESIDENTIAL WELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources- Division of Water Quality
WELL CONTRACTOR CERTIFICATION # 3463
1. WELL CONTRACTOR:
GREGORY M. FRENCH
Well Contractor (IndMdual) Name
CHEROKEE WELL DRILLING
Well Contractor Company Name
STREET ADDRESS PO BOX 1007
MURPHY
NC 28906
City or Town State Zip Code
( 828 )- 837-8008
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 El
DATE DRILLED 11/29/06
TIME COMPLETED AM D PM ❑
3. WELL LOCATION:
CITY: NANATHALA
COUNTY MACON
CAMPBELL BRANCH WELL#1
(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: 0 GPS ❑Topographic map
(location of we/must be shown on a USGS topo map and
attached to this foram if not using GPS)
4. WELL OWNER
OWNERS NAME SHELLEY CAMPBELL
STREET ADDRESS 2615 COLGATE
LAKE WORTH FL
33460
City or Town State Zip Code
( 561 )_ 582-2615
Area code - Phone number
6. WELL DETAILS:
a. TOTAL DEPTH: 9°0'
b. DOES WELL REPLACE EXISTING WELL? YES 0 NO ID
c. WATER LEVEL Below Top of Casing: 125 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
335555
f. DISINFECTION: Type CHLORINE
Amount 100 PPM
g. WATER ZONES (depth):
From' To 61301 From To
From 650' To T00' From To
From To From To
6. CASING:
Depth
From 0' To 60'
From To Ft.
From To Ft.
Thickness/
Ft. firer `ssW 1
7. GROUT: Depth Material
From 0 To 20 Ft. CEMENT
From To Ft.
From To Ft.
8. SCREEN: Depth
From To
h1�tt rial
Method
GRAVITY
Diameter Slot Size Material
Ft. in. in.
From To Ft. in. in.
From To Ft. in. In.
9. SAND/GRAVEL PACK:
Depth
From
From
From
To Ft.
To Ft.
To Ft.
10, DRILLING LOG
From To
0' TO 8'
Size Material
Formation Description
RED CLAY
8' TO 53' BROWN DECOMPOSED GRANITE
53' TO 360'
GRAY GRANITE
360' TO 400' GRAY GRANITE/WHITE QUARTZ
400' TO 900'
j
(- fa
11. REMARKS:
GRAY GRANITE
gig
Q CBitttlC9t0fl
Ntfrestrnst
Sa
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE W nH
15A NCAC 2C, WELL CONSTRUCTION STANDARDS, AND THATA CCPY OF THIS
RECORD HAS BEEN PROVIDED TO THE WELL ER.
/,y/�7 4'LdC.r7-1/-/C 11/30/06
SIGNATURJ OF C kTIFTEdW L CONTRACTOR DATE
GP-Ftc c l 61 rR€ I ]ri'H
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
RJAN 02 2007eY.7OS

335556
RESIDENTIAL WELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources- Division of Water
WELL CONTRACTOR CERTIFICATION # 3463
1. WELL CONTRACTOR:
GREGORY M. FRENCH
Well Contractor (Individual) Name
CHEROKEE WELL DRILLING
Well Contractor Company Name
STREET ADDRESS PO BOX 1007
MURPHY NC
28906
City or Town State
( 828 )_ 837-8008
Zip Code
Area code- Phone number
2. WELL INFORMATION:
SITE WELL ID #(if applicable)
STATE WELL PERMIT/tor applicable)
DWQ or OTHER PERMIT #(if applicable)
WELL USE (Check Applicable Box): Residential Water Supply Cx
DATE DRILLED 11/21/06
TIME COMPLETED AM C PM C
3. WELL LOCATION:
CITY: NANTAHALA COUNTY MACON
HIDDEN CREEK ROAD WELL #2
(Street Name, Numbers, Community, Subdivision, Lot No., Faroei, Zip Code)
TOPOGRAPHIC / LAND SETTING:
%Slope °Valley ❑Flat ❑Ridge ID 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 we/ must be shown on a USGS topo map and
attached to this form if not using GPS)
4. WELL OWNER
OWNER'S NAME J.C. AMYGDALITSIS
STREET ADDRESS 1206 NK STREET
LAKE WORTH FL
33460
City or Town State Zip Code
( 828 )_ 321-2780
Area code - Phone number
6. WELL DETAILS:
a. TOTAL DEPTH: 300'
b. DOES WELL REPLACE EXISTING WELL? YES 0 NO
c. WATER LEVEL Below Top of Casing: 75 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
g. WATER ZONES (depth):
From 270' To 271'
f. DISINFECTION: Type CHLORIN C" Amount 100 PPM ei
From To
From To
6. CASING:
Depth
From 0' To'101
From To Ft.
From To Ft.
Diameter
Ft. 6 i
From 'N.=Tfa- rT9,L4
From To
From To
Thickness/
1814$1 PVa grial
7. GROUT: Depth Material Method
From 0 Top Ft. CEMENT GRAVITY
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 Material
10. DRILLING LOG
From To
0' TO 6'
Formation Description
BROWN SLATE
6' TO 10' GRAY GRANITE
10' TO 60'
GRAY GRANITE/WHITE QUARTZ
60' TO 300' GRAY GRANITE/WHITE QUARTZ
11. REMARKS:
vti
Elg
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.
f'� _Gi / 11/27/06
'c- %'cG
SIGNATURE OFF CERTIFIED WELL CONTRACTOR DATE
Ji C-,Ci2-)id 4 F/2 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. .�ia� pp Form GW-1a
0 2 20�lrev. 7/05

• - • .WELL• CONSTRIICaIZONREC IW-
NosthCe�Tolio.-Dep.rt ofBarirommttail
Se aeet-Ear
WRY-7OWWW -,a lSaatoa
wnscorancrost it s /e /111; ►A. = . '_' -'' rsivlrtclTlotlg ! -
wnsoorewcronowwa•P:t +'_IL''i L1/0-1 isjt'+.7:1t.-e _a eRoeRoSa 4-3 0
_
STATE vista. ocwaraucrum radii
1. WELL USE (CbcdcMP > k-> IL dmub>ic 0 j id o AStiwtlaat-C7
•, Monitoring El ReeovayO- Neat PltmpWitte L OS=0 Other17Ifo x,LustUM"
-Z-wai . L& ATlom
N Towm /// CNLftA ' CW
„LL of 11 �iQRidpa OSlo� / taoac.�eys►,� _ a
tsaramom tt®hata.Co.rat0%aabaapla.i,i.tlla.Tr�el - . - titttdltaaxtiwt
3. owl�R J /.�1 s u�. .
Address t7 � a =v c ao P30TglogapMc map
' / to en%I►oaa n
H i Aw t_ AI /C_ raf T Ce / . rEtil a sal DRILLING LOC
GtyorTao ! 1 Dpcuea. .From To • irapna ieriPdan
4. DRILLED !`—/ 7 U 6 1 - --rt. / ' Os • . •L U t— C // Om 3 t-c. -
5. TOTAL DEPTH: . its' - - -.
6. DOES WELL REPLACE miasma} wan Its wO.w—
-
7. STATIC WATER LEVEL Below Topof(>a ;-
-
8. TOP OF CASING IS, / FT. Above Land Smsc s
TepetmLgWa�Ya darkrrraa��
mama In idirlS►'1tlalvc rw0he..
9. YIELD e._._L._RdBTHOD01'r f t`DI//
10. WATER. ZONES (dash): .a .4 S
11. DISINFECTION: Type a -t/•F Amotad ..ZT-S. Shawdimctiwtand from at teasi
12. CASING: - - Weal ___ two State Roads nndyRoadslncludc Ike mad
. Depth
From Q . R ham` a
or Wein nwnbma andoommon road names.
From -___To Ft`_,: .
From Tp Ft
13. GROUT: Depth _„
Moterfai.
Fr _a_.Tr � -00'4>4 L cwc) mac,.: t
To Pt
7 mu
.4. SCREEN_ Depth Minna . &Faze - . Matoatd
From To Fr. In. in.
From To Ft. jn. bit.
5_ SAND/GRAVEL PACK
- FromDepm P `S5m Materiel—
From To Ft.
6_ REMARKS:
DO HEREBYCERTB+YTIATTISS WEIL WA$ CONSTRUCTED-
ONSfRUC 1NACCAC RDANC R Wlmii ISA • 'i% Wage •
DNSTRUCT1ONSfANDARDS.ANDTHATACOPY OF RBODRD BBBNP$OYIDEDTOT1i8WIILLOWNER
Wtif
MONA
!TRIONC TRUCTINGTfBI WELL _ • DATE -
Submit the original to the Division of Water Quafty, Groundwater Sections 1636 Mall Service Center -Raleigh; NC
17699-1636 Phone No."19) 733-3221, Within 30 days. - GW-I REV. 07/2001
-4
V

WELL CONSTRUCTION REc01W :• • ; - _ - 3 3 5 5 g 4
Nord- olim-D a we Rungs ietOn Q Y' ��
arra LrnarRActos m. -tin; 5 jiQerl.d. S0, `„ y-3 24
• !+ram
atrsocutten
STATE � trsoiir/ nt -
1. WELL USE (Ma AjII Box):-Raideato! r uE U .Sall 9
Monies:MO 0 Retovety 0-Veld Paop Waiter Mallon 13 OtherCT taller, er, Lint -
Z'WELL LOCATIO1t . Ts>
-Meanderovra• Fie,A•/od/.a% - Coaoly /Y)A. - ! mos. 0v .o
3 0WNEpj. s/Cii&ti 1]) Ob s
aOS W. WA-C1”- >� Sr,.
lSaeotyiYareNoJ `-- f/
£ CTh» - 2. t3 / t o to
intgrai
(Sam tmtt o .»ua►k.Z cedt) - - GaillotlefloigkiidootNwt
nett**MG ^G
;From oCaY �Piottn!atoanDem'pnm'
a79} -
•
S. TOTALWPM.
PE. OfO ' !3!' 36.E. .—frean_
ite..
g
4 DATE D/—
6. DOES WEI LREPLACB>DOS'TINO WELLY YES 0 NOJfl- �
7. STATIC WATER. LEVEL EelowTopufCam& -7 n FE
We`rBAbtsTepdeeisdf
S. TOP OFCASINOIS�_PT.A6ovs_atdSmdit�
atop .ta W*adaMdalterwla 1petsaheaMekee
.
.nlaatels awaaawewdafISENCILD CaUt
9. YIELD (spit.L_ OF
10.WATERZ0NES(deptl* /(o0) 02to-• t LOCATION SKETCH
11. DISINFECTION; Type _Amount e:Zrfl-S�Show tlitecttixsad.dialaaoahira011 Earn etleast
12. CASING: - - Vitt ildelatem two State Roads or County Rtada. ncludedie road
D etwe;, Fr v '_. numbers and -common road names.
Fmm O . To ! 3 / I•t,_LiZ_5&,,,�'
From To Ft
•
Fmirl_ Tp
13. GROUT: Depth Medved -
From_�_To . _Ft._ -
From_To R.
_4. SCREEN: Depth:Diameter : SlotSm.: Mateial
From Tti __ Ft in in.
From To FL in. in. .
5_ SANDIGRAVELPACIC -
Deptb Size Metals!
From To Ft.
Flom To Ft
6_ REMARKS:
DGHEREHY( RTIFYTEATT ISWELLWA$ TRUCI DpINACOORDANCEwnulSANt.AGttaws.-
oNSTRt1CIi0NSTANDARDS, ANOTHATACOPYOV ifRLCaI•at rpso iOifffi.WELLOWNER
ib-
MIA PERM/4CONSIRUCTIN0TEEWELL . • DATE - -
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mali Service Center -Raleigh;NC
n699-1636 Phone No. (9191733 322!, within 30 days. - - GW-1 REV. 072001
0
1V
0
0

- WELL- CONSTRUCTION RECORD- 335585
- r
Noah&olma-DepartrnentofSnvkaomaoInd 8aountes „Qualitit Yf
WIELLCONTRACTORONDIAtaAltia
WALL CONTRAL7ORMr t ucjJIWC
STATE WELLfawUMUCTION
'MP" accliarali CAM' .
A8f!7so -xt
I. WELL USE (Cheek l Box)-BatdUNml�Mtmic l a Iedu bd A -?
-, >� MonitoringO a tI Heat Pomp WnSI*tl7gothic onCI OtherLotWe _
-z-WEi.L LocAtlOft " - p,Isp�iclLand NeatcuTonm S C? CouEly �i l A [ ax /ORidga []Slope I:Wa Y Mat
met
SKyy 11 �+, a8T3ct rmantra"bwcion
mantra • •thlkesWee.tat t Littpedllomp e •
3_ OWNLER44U-.•Vr)nIC-
m r. ;
t° `l ' ftssCedg 2-
/o} 4Pa_0/ 4 - -
Area ameamsamber
Latitndellougildde opograpbic RAP
/MI " DRILLING LOG
From To s Poim4{ionDemiptien
4. DATE DRILLED /!�-l-6(o • - --
5" TOTAL DEPTH; 700' •-
6. DOES WELLRBPI.ALB RXISTINi WBLL? YES EI NQ_ -
7. STATIC WATER LEVEL BehwrTopofCuaiag /-3ri FTC
sit (User laborsTop sTe
FT. Above Lttud�'
-a
7oa
S. TOP OF CASING IS
-rap dndat Way ndanti sre9Yn
enamels .weraaerdie1SA 2CAUL . •
9. YIELD (gm): � OD I OF TEST I llopEr e
10. WATER. ZONES (depth):TOO ' f(
•
I I. DISINFECI1ON.Type #fffF Ate ..2779-45
12. CASING: - - WnWTt otes
From
fl" To Depth Ft. Wirt r -"Shift
Franc To Ft T
FronL To Ft __„_
13. GRO��UT:A Depth Matmil- Method
Pu at _&Tit_' _
From To Pt.
4. SCREEN: Depth Masnavc Met Mee - Material
From To PL ice. in.
Fro+ Tv Ft _jn. in. -
5_ SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft
t3N SICIITOI
Show d•recU LOCATION
A in miht fiom at least
two StateRoada or County Roada. k clude Bra road
numbers sad -common road names.
{r \)%s>.Thet`
6. REMARKS- - -
DOHERE6YG'6RTIFYTRATT=WELLWAS C IC'LW IN ACCORDANCE WPM immense. FIHt.
ONSTRUCI10NSTANDARDS, ANDTHATACOPY OF RE( D BMPIfOYIDBDTOTHEM=OWNER
SI0MATOREOFPERSON 00NS-M =IN0TtISWEtL " • DA'tE - -
Submit the original to the Division of Water Quality, Groundwater Section, I636 Mall Service Center-Rdelgh,-NC
,27699-I636 Phone No. (PM 7333221, within 30 days. - . GW-1 REV. 07/2001
0
0
0

• • .WELL CONSTRUCTION RECORD- - . 3 3 5 5 8 6
Nonitc t%�-Depofma "uin--..i. 'ta-r-i-:''''. � Reaotoe IrSoa Q '" s0
4-4°
water CON* e�CQa°° °`taN,t .n.c tklb,a (It�a! Us.. ",:_ .�--- -
SrAT° ! — Tin-2 _ - -
.°
o. .
•
I. WELL USE (Cheek re Beet-RaidceiemtheriSdpallPublie0 .moo -p
-( Monitoring0 Remaly Er *at pmipWSklAtIon0 O�rt7 [Ski; _ -
"Z "WELL LOCATIONj: -. TOPti 01-indseltm8 -
NeareatTow m County oRidp OSIcibtr �^. _•
c
nC o .esA-RC. /- aIiiiitudefiongkitdo avail N..)(SteitateWywntiW�}y,__.--t�cIy) bcfn
. l '
ry
-J
3_Gyam.. L.`IQnICsk-S--
Addfem / nil rws-PA-11K
P2.2:de (-) 1i/C/ ,4;f373L
Cuyocrwa Mato : Maude.
( 1¢-31/.a917 .
Arta cad*. niter r
4. DATE DRILLED 11_ X E .
s TOTALDt
Lssbmduida_°pogtaptuc
• (
eer" _ t 1.MO g
Flom To
L, Dmaip°on
.S� C
.. a r6 _ 4 sg
6. DOES WELL REPLACE EICISTMO WELLS TES n rro :or.--'
7. STATIC WATER LEVEL Below Top ofCsinv 'S0 ;
Warr SnoreTop stack)
& TOP OF CASINO IS__FT. AltovnLandSurf s
flop ofmiKtra4>M14h 1 aliatewAeee' ea .
,IELDOIPt'X_/de— ]METH DOFTa4rJJi,/1,*► .
s. YA E (gpmx — /3S .-44FD' - - -
lo. wwTERzaNFS t►x J
11. DISINFECTION: Type /HS:- A° t .•ET11-A5 show eta= andasuca bi ION fiomatteast
Wan Ti s ' teat State Roads or County Roada i°el°de the toad
lz CASING: — " awp aumbersandcofm°onroadnames.
From fl . Co fl. - shirttail J285 gin..
" 0
F Ttt_ n - . - �b675S1
From Tp Ft _ -
13. GROUT: Depth j�M,,N�rii.t�- Method"
Ftom_a—To�-a_aea+n°' palm)
Fnom To .
.4. SCREEN: Depth Diatwter _ Sloth -No - . Material
From it.-- In: in.
From To Ft. in. in. -
5_ SAND/GRAVELPACIf: - _
Depth Sim Material
Front —To Ft V-I ;1 1\t`
From To Et.
._.-
6 REMARKS -
DO HERE8YMain THA` als WEL WAS CONSTRUCIED 1NACCORDANCE WUU tspiracac.
LO-
•ONSTRUCIION STANDARDS, ANDIHATACOPYOF RECORD H SBIER! PIOV1D
NER
Pl1CONSTRUCDNOTtiEWSLt. - • DATE -
Submit the original to the Division of Water Quality, Groundwater Section, t636 Mall Service Center--Raleigh,
NC t
37699-1636 Phone No. [phone], within 30 days

335615
RESIDENTIAL WELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural ResooureeS• Division or Water Quality
WELL CONTRACTOR CERTIFICATION H 2 4- 03
1. WELL CONTRACTOR:
Conti la
erryze et e
Individual
Na
me
(Individual)
MILLER WELL DRILLING, INC.
Well Contractor Company Name
STREET ADDRESS P.O. BOX 567
HAYESVILLE, N.C. 28904
City a Town State Zip Code
( 828 - 837-2997
Area code- Phone number
2. WELL INFORMATION:
SITE WELL ID Lit 'walkable)
STATE WELL PERMITI(Ir applicable)
DWO or OTHER PERMIT il(11 applicable)
WELL USE (Check Applicable Box):: Residential Water Supply
DATE DRILLED /0-CZ— 06
TIME COMPLETED 3 6U AM El PML:I.J
2. WELL LOCATION,
CITY: F/'A/Ikf.4 COUNTY C OLT
(Street Name, Numbers, Community. Subdlvialon, Lot No., Parcel, Zip Code)
TOP GRAPHIC 1 LAND SETTING:
/Valley °Flat ❑Ridge t7Other
(check ppropdale box)
LATITUDE .. 5 /6. Jvt Z
LONGITUDE / 3 3d. f d
Latitude/longitude source: OOPS ❑Topographic map
(bcefbn deer must be shown on a USGS fopo map and
attached to this form I not using GPS)
4. WELL OWNER
OWNER'S NAME ef rl. e e4Az/-
STREET ADDRESS J Co L.H-.t-n On p.. ,A
en .. 3lJsC-
Ciy or town r Stale 1h p Coda
( f31J$)- 3U "514-1-0
Area code • Phone number
May be In degrees,
minutes, seconds or
Inc decimal formal
& WELL DETAILS:
a. TOTAL DEPTH: 3 T I-
b. DOES WELL REPLACE EXISTING WELL? YES 0 NO BS
c. WATER LEVEL Below Top o Casing: 6 0
(Use II Above Top of Casing)
d. TOP OF CASINO IS / Fr. Above Lend Surface'
'Top of eating terminated al/or belay land surface may require
a variance M accordance with 15A NCAC 2C .0116.
•
a. YIELD(gpm): /V METHOD OFTEST /i'r~
FT.
(, DISINFECTION: Type /f l(
g. WATER ZONES (depth):
From Ii".0 To
From To
From To
Amount kit rta
From To
From To
From To
G. CASING: Thickness)
Depth Diameter Wel hl Material
From D To fl kl. �zr' 'zi r°vC.-
From To Fl.
From To FI.
7. GROUT: Depth Material / Method
From 0 To3_ FL i'Tsr Q
From 3 To �29 FL .,r/ten, / - v ie
From To Ft.
6. SCREEN: Depth Diameter Slot Size Material
From To FI. In. In.
From To Ft. In. M.
From To FL In. M.
e.
SANDIGRAVEL PACK:
Depth
From To kl.
From To Pl.
From To Ft.
D•
Size Material 0
Zv
N
10. DRILLING LOG
From To Formation Description
0— 75
2r- )YZ fr,^
11. REMARKS:
ii,'Y`�-
tzcc ED )n�a�
1 DO HEREBY CERTIEY THAT THIS WELL WAS CONSTRUCTED N ACCORDANCE WITH
ISA NCAC TC. WELL CONSTRUCTION STANDARDS. AND THAT A COPT OF TMS
RECORD HAS BEEN PROVIDED TO THE WELL OWNER.
SIGNAT E OFF/CERTIFIED WELL CONTRACTOR DATE
et/ry e_c-
PRINTENAMEOF 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. ,

RESIDENTIAL
0
RESIDENTIAL WELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources- Division of Water Quality
WELL CONTRACTOR CERTIFICATION N 2J`R J
1, WELL ONTRACTOR:
Cm actor
ert)/ /�.tc&
Na
me
(Individual) ame
MILLER WELL DRILLING, INC.
Web Contractor Company Name
STREET ADDRESS P. 0. BOX 567
HAYESVILLE, N.C. 28904
City or Town State Zip Code
( 828 ). 837-2997
Area code- Phone number
2. WELL INFORMATION:
SITE WELL ID I(it applicable)
STATE WELL PERMITN(a applicable)
DWQ or OTHER PERMIT #(if applicable)
WELL USE (Check Applicable Box): Residential Water Supply Lk'
DATE DRILLED /6 'or- eg.
TIME COMPLETED 3,- dz) AM ❑ PM
3. WELL LOCATION:
CITY: ,6afl � Ali COUNTY ci CO/2
r�.� you d
(Street Nam, Numbers. Community, Subdivision, Lot No., Parcel, Zip Code)
TOPOGRAPHIC / LAND SETTING:
G8rope Malley 0Flat ORidge ['Other
(check appropriate box)
LATITUDE ,� S /7> 070
LONGITUDE fri S) J % r e206
Latitude/longitude source: CPS oTopographic map
(location of wet must be shown on a USGS fopo map and
attached to this form 7 not using GPS)
4. WELL OWNER OWNER'S NAME 6rery CeLt en
STREET ADDRESS .5555IVPSL LIne•
barty h AV'Q.
May he in degrees.
minutes, seconds or
in a decimal format
3 ;- lok rim 4 FL 3.36 a
City or Town 1 Stale Zip Code
( 1-
Area code - Phone number
5. WELL DETAILS:
a. TOTAL DEPTH: ✓ it)
b. DOES WELL REPLACE EXISTING WELL? YES 0 NO B�
e. WATER LEVEL Below Top of Casing: Y. U FT.
(Use';- if Above Top of Casing)
d. TOP OF CASING IS / FT. Above Land Surface'
'Top d 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 /71l
OWNER II41-06
MWD
NC
t. DISINFECTION: Type /T %(Z Amount fr:{e-+
g. WATER ZONES (depth):
From /0.5 To From To
From To From To
.Fran To From To
6. CASING: Thickness/
Depth, Diameter Weight Material
Fran U To 6,y FL G #S S$R,2t Pet
From To Ft.
From To Ft.
7. GROUT: Depth Material
From 0 To .3 Ft. OrTZriMG
Fron_3 To .20 FL re_
FromTo Ft.
Method
Are
8. SCREEN: Depth Diameter Slol Size Material
From To FL 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
U—.Ss�
rs' 3 yd
11. REMARKS:
Material A
0
0
0
0
Formation Description
C/7
1 DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WRH
ISA NCAC 2C. WELL CONSTRUCTION STANDARDS. AND TWIT A COPY OF INS
RECORD HAS BEEN PROVIDED TO THE WELL OWNER.
zee— /0 -06- r:'6
SIGNATU�ERTIFIED WELL CONTRACTOR DATE
79)6 4tiny
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. 7105

RESIDENTIAL WELL CONSTRUCTIONRECtReu 1) e
North Carolina Department or Environment and Natural Resources- Division or Water Quality
WELL CONTRACTOR CERTIFICATION 11
1. WELL fi ONTRACTOR:
Y'erte ct-
Individual Nam
Well cat o (Individual) e
MILLER WELL DRILLING, INC.
Well Contractor Company Name
STREET ADDRESSP•0. BOX 5G7
HAYESVILLE, N.C. 28904
City or Town Stale Zip Cale
( 828 )- 837-2997
Area code- Phone number
2. WELL INFORMATION:
SITE WELL ID till applicable)
STATE WELL PERMITR(e applicable)
DWG) of OTHER PERMIT R(0 applicable)
WELL USE (Check Applicable Box): Residential Water Supply (F '
DATE DRILLED /o - 03 - O 6
TIME COMPLETED .3.-00 AM0 PMI —
3. WELL LOCATION:
CITY: 1- iii`/ et COUNTY `Mac 0e2
l3/Ac/c decry //pile&
(Sheol Neme, Numbed, Community, Subdivision, Lot No., Parcel, Zip Code)
TOPOGRAPHIC I LAND SETTING:
OSlope 4eey ❑Flal ORidge ❑Other
(check appropriate box)
LATITUDE ,- -r /;1- 0/ 7
LONGITUDE S 3 Q/-J 0 7
May k in degrees,
minutes, seconds or
in a decimal format
Latitude/longitude source: ❑CPS ❑Topographic map
(bcalbn of we/ must be shown on a USGS lopo map end
attached to this /Orm I Trot ushg GPS)
4. WELL OWNER //��
OWNER'S NAME �+0 CI 6/f0/1
STREET ADDRESS 2511 OUerlakeitVt
Oitank0 F'L 32,806
City or Tam State Zip Code
( 1-
Area code - Phone number
S. WELL DETAILS: A
a. TOTAL DEPTH:
b. DOES WELL REPLACE EXISTING WELL? YES 0
Now
e. WATER LEVEL Below Top ofCasing: tv FT.
(Use'+' 9 Above Top el Casing)
d. TOP OF CASING 13 / FT. Above Lend Surface'
'Top d casing laminated aUor below land surface may require
a variance in accordance with 15A NCAC 2C .011 B.
•
e. YIELD (gpm): -s METHOD OF TEST /Ti
29-03
OWNER
MWD
NC
I. DISINFECTION: type 41761 Amount kits
g. WATER ZONES (depth):
From /BA- To From To
To From To
To From To
Thickness/
Diameter Weight
From //.l To /2/ Ft. d-.Zs" ,/Y?
rt.
From
rran
G. CASING:
h
From () DToI//J
From To
Material
AL
fit e /
7. GROUT: Depth Material Method
Fran 0 To 9 FL Ai%%d ✓Ayfe."
Fran 3 To 4r( Ft fn/W,-Ye- Oq'yyo...s
From to Ft.
8. SCREEN: bepth blameler Sid Size Material
From To rt. In. In.
Ft. In. In.
Ft. In. In.
From To
From To
9. SAND/GRAVEL PACK:
Depth
From
From
From
Size Material
To Ft.
To Ft.
To Ft.
10. DRILLING LOG
From To
D-
1I. REMARKS:
Formation Description
I% .
0
0
i DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED N ACCORDANCE WITH
ISA NCAC 2C, WELL CONSTRUCTION STANDARDS, AND MAT A COPY OF HIS
RECORD HAS BEEN PROVIDED TO THE WELL OWNER.
ePU� /O -oy-0 6i
SIGNATURE OF CERTIFIED WELL CONTRACTOR DATE
Ar7 lee
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] ant 568.
FormcWte
Rev.1$05

RESIDENTIAL wigu. corataucnort RECORD
Node Ceram Department ofEsvioamaa andNmar Ramat
- Division of Water Quality
,�, 7v
WELL CONTRACTOR cEEnnottion s
335399
1. WELL RACTOIt
OrizlW onttr w(�Rvkedq tan1hlc,1i,n
wa Cortadiar r(amCamps, , Name
�U(
STREET ADDRESS 3»I 1-17Cl
r'AbIr4✓1I100 '9g-77/
City aTos Side Irp Cade
( )- Li M- ss-ti 4
Aeea axle- Rues number
2. vas. INFORNATIOM
SITE WELL ID aptapplabIM
STATE WELLPO NITSRapioaei
DM a OTtBr PEWIT NEippieable)
WELL USE (Check Animas SIM Raidaead WattSWAyR
DATE DRILLED /)- a%-n4
TRW COWPLETED /n - rr) AMK RA
3. WELL LOCAnmmt
ant .Pr:-nkI, N coutrrf'7acn:n
I rtI is /
he I� e or. t
184aetNam llombes.00eaot ilaSaribloa Una. Pam* 2Pcoda}.
TOPOGRAPHIC I LAID SETTING:
Man Maley DEM Ledge Oates
"but apF orisio
LoarruDE .s:L / 3 r SE S"
LONGRUDE.Z3! 1'.j7.),r
tada:de/long t de emacc 0,CiPS °Topographic map
(bar d
altdeadbASkWe7not yaksGPS)
4. WELL OWNER
owes mew 114 LUX ki I i Poke,
b ratter ADDRESS nit Ta7 i.a ^ 0-col
!`c.nici, n JvC :El 7,
QV loin Slat Zip Cada
tyl3> yy7-0ets'
Aeeae Cade_ Pieara eeeoa
Mee'6eoAre;
Maim ottombar
ima *Mod fart
S. WELLDETAI.S:
a TOTAL Dena -[ OS
b. DOES WELL REPLACE DOSING WELL? PESO KD,B(
c. WATER LEVEL adoaTap@ Mader J rr S FT.
Warn NaaeTap at Cadre)
d. TOP OF CASING IS / FT -Above Lad Sai®e'
Top damigo leaiaadSbobs kadwdrroey.pie
evariance n a tadamevilt 1MII AC2C AHg,
a. YIELD (wet Wti)gDOFTEST
L DISRFBciloltType /-/T//
g. WATER ZONES MOM
Fan 1 OS To -jO From To
Ram To Fran To
Ram To From To
Mead / -� T
IL CASING: Witham(
Depth Wand
Won 0 to fi0 a Yht �i Ptir
Fmm To R.
Fret To Ft
7. GNOME Depth MAMA Whoa
From n To3h' Ft C'oyr,-.4 0is-n0,.'s
Fmq_To R
Rem To R
IL SCREEN Depth Diner Sbl Sim Material
Ran To FL—M. it
Fop To R_-_a _ R
Ram To Ft4—YL to
!. SANWORAVELPACK:
Depth Sine Ndabl
Femt_To R.
Fmet_To R
Fos To R
/0. Ditties LOG
Rom To
11. REMARKS:
Rimmion Dese ipgon
-.v., r '`")c.
1a0/1MRerC9rIFTa•TIBWaLWRSC01 aAR.pOaeEwm
SROC/CaaME LCIwawOa: MUSIMMawOLAa7aTACOMOF96
S16lMTOREOF _ WBLcorinvcroR DATE
PRISED MANEGE PERSON THEW131
Submit the orighial to the Division of Water Quality within 30 days. Amp: Mfonnaton Mgt,
1617 Meer Service Canter -Raleigh, NC 27689-1617 Phone No. [phone] est Sag.
Fam OW-ta
Rev.7/E

, -,-
' - - WELL. CONSTRUCTION RECORD _ -
- •�335•3$,
Harihaolbs-Depa.L,ofBaviroamdatand- Rama=-Dirblon Qm y-- n
war. eowntacroimino pouAta'weaes rr.t e t [tine 5 f IAr. - - - - timstrthaTtotio me
•
water. corernwaaecoaarutrnai '. $tc JMJL'%rt ilttrig‘;w rw•e raonra Sa'3-3 a•bO
(If_SGble) - - --Ore_pl _} - - - - - -
I. WELL USE (Check a bkflituk->i gql upiaipallPubiic0 -IM SkW CIAgriW@ad -b
- 4"Monitoring 0 Recovery 0-- Seat Pmap Wit* la0 Other C( IfOl tar. LissUh • -
'2.-nit torjernoth
Nearest Tom; i% Tppogt bilea ld setting -
Lame- moo Moog
teiietir.psipabao) -
tsuerlrtmm r�ac iq.�b&-,TaNeapeaae) ufvp4lt
3. OWNER; . 1 Lkirri es . .
Addren (0.1 E1 s. L2ices:4e Da •
tata:tu tba ,:-.-_
iwTies
I?al .AR.; •, 4 760 -
Czip pew.
(fin R:5/-0243
Arn rods Momsomber
4_ DATE DRILLED 1 L-J/1 - A Co • -
•
S. TOTAL DEPTH: 'i S-
6. DOES WELL REPLACE masnme wait. YES0 NU_:QI-/`
7. STATIC WATER LEVEL BalowTopofCafht& (ol) i)T•:
peer
8. TOP OF CASING IS / FT. Above Land Sar
*Ty ofnag twasseabentgaa *..e.iab to .-
whoa wrthe swt¢7sA ICAC3CAWL -
9. limb (g iq9 15 MBTHOD OFTBST j0Oill t/,
I0. WATER ZONES (dap4rx .�.&5 ' - -
1I. DISINFECRON.Tyye WWI- Amount —I TA-14? Show directionaaddialmOa1nmitoe from at least
12. CASINO: - - Wall Thickness - toy Math Roads aCounty Roadr:Indadatheroad
• Deem Ixmw ar Wei, taI.R. I _.-oumbara and'twamon road aemaa.
From fl . To RS FL rei $ e
From_To Ft
From__ Tit___ Ft,..„...„_,,
13. OROUfl Depth
From_Q_To_�FtJ2or. p S
Frma__To R.
.4. SCREEN: Depth lamahr , SlotSiee = s Material
From To______ Ft,-,__ jn- in.
FrothToFL___ --�a, in. -
5_ SANDWORAVEL PACK
Depth thee
From Ft. MaterielFmm To Ft
oPor!l
• 'beearptioon
6. REMARKS:
DOHERESYCaRYwYTHATTEISWELL WMCONSTRUC RD INACCORDANCE MTN ISA 01CAC2C.Vt-
•ONSIRUCTIONSTANDARDS,ANDT T^COPYOFT RBOORD HAS BEEN PROVIDEOTOTHEWIRL OWNER
PERSON OOtJSTRUCTUNOTEE WELL - • DATE - •
Submit the original() the Division of Water Quality, Groundwater Sectton,1636 Malt Service Cadet -Raleigh:NC
2'f699-1636 Phone Na. (919) 7333121, within 30 days. - Gw-1 REV. O712001

n699-1636 Phone Na (919) 7334221, withjn 30 days
• _ WELL- CONSTRUCTION RFCeiw' ::. 3 ? 3 1 Q
NonbCaofttra-Dep ofBnrhoomentand- Reeoutea-Unties of Qa tp= evimds!owSesibm
aw- corentacroa plawmium‘intsam oags !Ants fin /ln a:.L '' '- coiulristeal; Ante _
wELL CONTRA.C7gRCaaPAMr .Sri .52.tt-3 A6 a
STATE WELLf7 f0[CTIONpa pandit
: - -
(irappBwbls) - - (BaPOltiwtde)'
I WEU. USE (Meek ppU DoB Rai- Public Indtutrid 0 Agtiwli mi0
- Monitoring El Recovery CrHat PIMP IllagliddCI of ar Cf WOd ey LiwUsc _
LIVELLLOCATIOtk - - Tmiemmhi
NaTowt L/. - t -
3.OWNER; 1J-&t€ --?,teen -
Address O `e• f u P.Qp /L.S
/=atnki:x ::
ChybrTu a
r1F1..sa-(-
Ana ma>PlmRmmmer
4_ DATE DRILLED
5_ TOTAL DEPTH:
saw mice&
of/7R - -
Mlidp f n;imidr�
Litiitudellaigittlde OMB ImiaBon
teanealudamehetratta
Ladtu.dencenpitideammtcOOPS_ 1�m
erD' t DRILLING Lai
Fran To FetroationDesaiption
- - n •-) LA
,Pn' a 1s' tU4/�22„%t-e-
6.DOES WBLLmacs wane wait YESEINtSW.- '
7_ STATIC WATER LEVEL BelowTopo1CatW
(Uaw'Abate Ten ortSin4)
S. TOP OFCASING IS. / FP Aline Land Swe•
'Tap awing unsu 1d Inkyj
.me.wrea.d swMilSAi!ch rNdiva
9 YIELD (spa* ,q o) WFTEST D//n//p
ID_ WATER ZONES (depgtx J /'+n' y
LOCATION SKETCH
II_ DISINFECTIODL•Typc #-f/t: Amount-aTR-R5 Sow dlre doaauttdistaaoe6imilpeftaaatleast
12. CASING: - - WWBThie tem ' two Slabs Roads orCounty Roads -Include the mad
Finm 0 . To 9) ., $ t -
o& WarBrwa. 1'_.-* umtbets end -common toad names.
From To Ft_,__ -
From_ TQ ,
13_ GROUT.: Depth ldatmGl. 6 d
FromTo_�PL larnerr
From_To Ft.
_4_ SCREEN: Depth hammer , Mot rue = = Materiel
From To Ft, jay In.
From To Ft,.......... -is In, -
5_ SAND/GRAVELPACK
From_____ l� FL rue Material
From_____To FL__
6_ REMARKS:
A ER QUALITY
KW ` 1 2006
DO HEREBYC6RTIPYT ATTEIS WELL wa cotantucam INACCORDANCEWM ISA ilCAC= VillIX -
•. - ,
ONSTRUCTION STANDARDS. AND THAT AOOPYO RECORD BBIdiPROVIDEDTOTHEWBLLOWNER
1 CCAvi // (.0/3 -O
-- SIGNAZU !ERSCNCOIC1RUCrB�TEEWa l; - DATE -
Submit the anginal to the Divislon of Water Qualty, Groundwater Sections 1636 Map Service Center-Ralelg6,-NC
GP! i REV. 07rzo0I
1

•
• .WELL CONSTRUCTIONRECOtD
NotchCwlma-DepartmpdofHarbouea®t litimorreetDivbiaaofWattrQatar! Section
ware =muter= procroiumfrtmarsh R lNonS /r2es:44 = ='- ct fi�GrDwl: ante -
WELL oturrnwctoaoarerutrtuau Gllhrc ll�l n�iI i�GSJI.s = f�flCS2"/.-3 Ab 0
srA1tWILL CONS ea ,wJllp2Thell
fir-" - --
t r_I ball {iT*pliable) • .
335315
I. WELL USE (Check Agi BoxX-R at �saieipallPnb&CI •Indat+kitlQ 4lglitl[7
•' Moaiwring0 Reeovoty aHatFnrapWaaaiL cctlana other II If09iar,Lbtllae _
Z WELLLOCATI01t
• Twin FeAA/it lri2) - County/3/A-crn - •
/d 6• u s ti C-- r HDDSian-) C -2m, as „2fi43 If
tam t+aK/ti_aeXememola8abd+4taalatle.IIPDe) .-
3-OWNER;QvGd•-AI; -
Address cQ57i l /ZnJS re•elLBd •
ORAernaeNe,► --
f� 2y5-51. C' n•47 fG a cI/3
` wbrTa s Sac ..ff' ZipCode.
(Sa.g etre-0 Pa
Arotole- t atarrar
4. DATE DRILLED / /--/ t f •-D to - -
5. TOTAL DEPTH' / 52 ' - •- ,
..From
;'. --,3.
• salting -
(abt
OSdlopapPwptilbaoQ ae Vdw .O$
LiEtudeloigittide often loratIat •
UoincdadasssFrearate
LsEtUdenongittitlesoa fltt'opogaptucmap
,•ram - DRILLING LOG
To ReyrnatioCDmaiption
37' c-4•
/sa' �q•tU�(:-22„ r�-e,
6. DOES WELL REPIA(B ZOOMING WBL.L9 YES El 1.10-; — ' -
7. STATIC WATER LEVEL Below Top ofCubic
/ (1.4010 'Above t1 p tcwW
8. TOP OF CASING IS. / FT. AboveL'dSorbet .
•ry Masks nadaedat er6ter - -
.nh610 nee +.w.waYssw.psC a a - -
9. YIELD (MHTHODOFTEST bi0/fing-.
10. WATER ZONES (deptla) /
I1. DISINFECTION:Type /144-
12. CASING:
• Depth
Fora _Q_io 3 7 F< h
Fmo�To .
Fmm Tp Ft,_�
13. GROUT: Depth MIMS Mood -
From__Too-ay p
.4. SCREEN: Depth Diameter Slut Sae - Material
From To PL Jn; in.
Froth-- ThIt in-
LOCATION SKETCH
Amount ..2TA-A Showdb andditluwalit miles from atleast
Waf1Nelopar - two Sato Roads or CountyRods.-Includc the road
• er Wegghtft. Marl _'lumbers aad-wmmonroad names.
Qat
5_ SAND/GRAVELPACK
From Depth Sim Materiel
From To Ft,-____
NOV
2005
6. REMARKS:
DO HERE9YCESFYINATTHIS WELL WA$CONSIRJCrED INAOOORWJfl vim! I511 'NJc2C. WBIL•
•
ONSIRtJCTIONSfANDARDEANDTHAT A COPY OFTW RECORD BEENPEOVABIOTOTIELT IU,OWNER
l/ -Ty `0(0 -
1 tO0NsmucANOTiiBWELL . - DAM -
Submit the original to the Division of Water Quality, Groundwater Section 1636 Matt Service (eater-Ilaleigb,-NC
.27699-1636 croon No.[phone], within 30 days. - GW-I REV. 072001

• :.,.
- • WELL• CONSTRUCTION RECORD' ,-
onhC opine-Deparmtadof and.NatardResources -DivldonofW�rQwTity'�C)toimdwatarSaeNOn
%Ma.cort7RACroaCDMPANT N4�• C PnfrA .1 IJ�p,IIAp�{I "fi t S.L y-^3 a•b 0
STATx WELL. CIX1i7a1IC1'IMf PIrRIMfr'/ •
Toads) AaaOCfATID : :
{if applicable)
I. WELL USE (Check ApSUSSWe BotItesidentiall u payPubu& O , Industrial 0 ApicultuS U
- ' Monitoring O Recovery O- Heat Pomp WaterNation O Ot er l7 Ifb iter, List Use . • -
N
was eorrrai,crwtttrmtxmu w brrps�llditls /�n�Iflmi r ,:- waif 0tfl4
r - p Tu. _ .KY i
2. "WELL LOCATION: • -
Nean Town fR ' ,14t / ry - 44,±cat- twos many
�• uise ; n .tJ-e•s..- it- &L PCede) 5L
_ tt8eduppo'" baq .
(Soattiune•timixa, r, ,. .lut7o.IIPCak) -
•
1 OWNER- C J i
Address /0 a
t�a:aaatroa - -
In On
�- eat lv . - .
COME Ioce1ion
arc!on 7`12a1 L.
Orin Tau .t'' Ziptbae
(8So} 587- S76 5
•r
4. DATE DRU LED / I 9— O (.P -
—.r0•
S. TOTAL DEPTH: - OO ' •
-
6. DOES WELL REPLACE EXISrI�NG WELL? YES 0 NO it
7. STATIC WATEItLEVEL Below Top otcaiMg -1.0 Ft•:
(User
8. TOP OF CASING IS / FT. Above land SmSxeo -
map washer sa latsd srhdgthadsne toe neat
misses to amadaawltlSAl9CACSCAla
9. YIELD (gpgt): �D _METHOD OFTRST JhflhI •,
10. WATER ZONES (depth): 47D • (7•
,(�
La ddlongididssome«ovpsfTopographicmap
r"] - c DRILLING LOO
From To ' Patwoation Description
,sue,•
L
•
" Si
11. DISINFECTION. Type /f-ti Amend ..2TN•61,> show d'uection and diatetpat Ili mhos from at least
12. CASING: WalTbitas - two State Roads or
County Rotda "[netnda the roes
• Depth Disposer or Weijlittp6 numbers and -common road tames..
From O . To /61) Ft, h" _
From__To
Ft__
From Tp Ft,_„__,_
13. GROUT:
From_ A Too..QZ Pt. eQl Matadi!
OVA--)
From To FL oAv,
.4. SCREEN: Depth fi n. SlotSla Material � - 0
From To Ft. In. in.
5_ SAND/GRAVEL PACK: - . ,
•
Depth Size Material
From To Ft`_
From To Ft
0EC•i2nos
r
6. REMARKS:
•
DO HEREBY CERTIPY THATTHIS WELL WM CONSTRUCTED INAOOORDATICB Wain ISI UCAGZC. *six -
ONSTRUCFION STANDARDS, AND THHATA COPY OF RECORD BEIM PI;OVIDED TO THEM= OWNER
0/1dflL / Amu //: 9'—e ea.
- SIGNATURE -OR PERSON CONSTRUCTING TEE WELL . DATE -
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mall Service Center -Raleigh,-NC
.27699-1636 Phone No. [phone], within 30 days. - GW-i REV. 072001

RESIDENTIAL WELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources Division of Water Quality
WELL CONTRACTOR CERTIFICATION # 3483
1. WELL CONTRACTOR:
GREGORY M. FRENCH
Well Contractor (IndMdual) Name
CHEROKEE WELL DRILLING
Well Contractor Company Name
STREET ADDRESS PO BOX 1007
MURPHY NC 28906
City or Town State Zip Code
82( 8 )- 837-8008
Area code- Phone number
2. WELL INFORMATION:
SITE WELL ID Cif applicable)
STATE WELL PERMIT#(a applicable)
DWQ or OTHER PERMIT #(if applicable)��_
WELL USE (Check Applicable Box): Residential Water Supply I]x
DATE DRILLED 11/20/06
TIME COMPLETED AM PM ❑
3. WELL LOCATION:
CITY: NANTAHALA
COUNTY MACON
310 HIDDEN CREEK RD.
(Street Name, Numbers, Community, Subdivision, Lot No., Parcel, Zip Code)
TOPOGRAPHIC /LAND SETTING:
❑Slope 0 Valley 0 Flat ®Ridge ❑Other
(check appropriate box)
LATITUDE 3 5 12.864N
LONGITUDE 8 3
36.708W
May be in degrees,
minutes, seconds or
in a decimal format
Latitude/longitude source: IS GPS ❑ Topographic map
(location of wel must be shown on a USGS topo map and
attached to this loon if not using GPS)
4. WELL OWNER
OWNER'S NAME J.C. AMYGDALITSIS
STREET ADDRESS 1206 N.K. STREET
TOPTON NC 33460
City or Town State Zip Code
82L f _)- 321-2780
Area code - Phone number -
6. WELL DETAILS:
a. TOTAL DEPTH: 200'
b. DOES WELL REPLACE EXISTING WELL? YES ❑ NO
21
c. WATER LEVEL Below Top of Casing: —
(Use "+" if Above Top of Casing) FT.
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): 0 METHOD OF TEST AIR
33,525t
f. DISINFECTION: Type CHLORINE
g. WATER ZONES (depth):
From To Fror
From To Fror
From Tn
Diameter Slot Size
Ft. in. in.
Ft. in. in.
in. in.
SAND/GRAVEL PACK:
Depth
From Tp
From To_
From Tn
DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH
15A NCAC 2C, WELL CONSTRUL, IAJH STANDARDS, AND THAT A COPY OF THIS
RECORD HAS BEEN PROVIDED TO THE WELL OWNER.
Submit the original to the Division of Water Quality within 30 days. Attn: jlnformauon Mgt,
1617 Mall Service Center— Raleigh, NC 27699-1617 Phone No. [phone]'�ext 568.
DEC 12 2006
Forth GW-1a
Rev. 7/05

3. WELL LOCATION:
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,
City
8f 28 1- 369-9591
Area code- Phone number
2. WELL INFORMATION:
SITE WELL ID #(if applicable)
STATE WELL PERMIT#(it applicable)
DWQ or OTHER PERMIT #(if applicable)
WELL USE (Check Applicable Box): Residential Water Supply In
DATE DRILLED I r
TIME COMPLETED -f'• zri AM ❑ PMit
NC
State
28734
Zip Code
CITE �`�� COUNTY
et Name, Numbers, Community, Subdivision, Lot No., Parcel, Zip Code)
TOPOGRAPHIC / LAND SETTING:
C 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: EIGPS ❑Topographic map
(location of well must be shown on a USGS tope map and
attached to this form if not using GPS)
4. WELL OWNER
OWNER'S NAME
TREET` DI RESS
or Town
)-
Area code - Phone number
Zip Code
5. WELL DETAILS:
a. TOTAL DEPTH:_
b. DOES WELL REPLACE EXISTING WELL? YESNO ❑
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 atlor below land surface may require
a variance in accordance with 15A NCAC 2C .0118.
e. YIELD (gpm): ----I-fL_ METHOD OF TEST Blow
Submit the original to the Division of Water Quality within
1 617 Mail Service Center — Raleigh, NC 27699.1617 Phone No. [phone] ext 5 Information Mgt.,
RESIDENTIAL WELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources- Division of Water Quality
WELL CONTRACTOR CERTIFICATION # 3466
f. DISINFECTION: Type_
g. WATER ZONES (depth):
From—_ To ( G
From& Toj'
From To
6. CASING:
HTH
From
From
From
Depth D eter
From_L To_ Q Ft.
From To Ft
From
To Ft.
7. GROUT:
0
From
From
From
8. SCREEN:
From
From
From
Depth
_ To 20
To Ft.
To Ft.
Depth
To
To
To
9. SAND/GRAVEL PACK:
Depth
From To
From To
From To
10, DRILLING LOG
From T
11. ' EMARKS:
r
Amount 16oz
To
To
To
Thickness/
We, rights 1st
Material
Ft.cement a benonite
Diameter Slot Size
Ft. In. in.
Ft. in. in.
Ft in. in.
Ft.
Ft.
Ft.
Size
Method
pumped
Materal
Formation Description
Clav 8 sand
Granite
t jot
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:
D E
SIGNATURE OF CERTIFIED WELL CONTRACTOR
PRINTED NAME OF PERSON CONSTRUCTING THE WELL
Form GW-1a
Rev. 7/05

1. WELL CONTRACTOR:
Johnny Shane Downs
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 PERMIT#(if applicable)
DWQ or OTHER PERMIT #(if applicable)
WELL USE (Check Applicable Box): Residential Water Supply Dx
DATE DRILLED
TIME COMPLETEDAM 0 PMX
3. WELL LOCATION:
CITY
CO UNTYeSJ
(Street Name, Numbers, Community, Subdivision, Lot Na., Parcel, Zip Code)
TOPOGRAPHIC / LAND SETTING:
❑Slope :Walley ❑Flat ❑Ridge CI Other
(check appropriate box)
LATITUDE ry-
LONGITUDE p3 ..A7
May be in degrees,
minutes, seconds or
in a decimal format
Latitude/longitude source: p 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
STiEET ADDRESS
City or Town State
Area code - Phone number
5. WELL DETAILS:
a. TOTAL DEPTH: r.
b. DOES WELL REPLACE EXISTING WELL? YES D NOfAi
c. WATER LEVEL Below Top of Casing:--s211.LVFT.
(Use 14'-irAbove Top of Casing)
d. TOP OF CASING IS 2 FT. Above Land Surface'
'Top of casing terminated atior below land surface may require
a variance in accordance with 15A NCAC 2C .0118.
e. YIELD (gpm): _ METHOD OF TEST Blow
Zip Code
335110
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_To—+1.LL Fr
CASING: Thickness/
From %� Depth Di eJer Weig r,�„erv,,,
—sL To Ft. /Y�..�i'e;4"i.Lyl—
From To Ft.
From To Ft.
9. SAND/GRAVEL PACK:
Depth
From To_
From To
From T�
Formation Description
Cla & sand
Granite
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.
CERTIFIED WELL CONTRACTOR
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-1a
Rev. 7/05

r
1. WELL. CONTRACTOR:
Johnny Shane Downs
Well Contractor (Individual) Name
Hedden 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 State Zi,
( 828 )_ 369-9591
Area code- Phone number
2. WELL INFORMATION:
SITE WELL ID #(if applicable)
STATE WELL PERMIT#(irapplicable)
DWQ or OTHER PERMIT #Of applicable)
WELL USE (Check
Applicable Box): Residential V�
DATE DRILLED t 1 rQ • n/n
Istreet Name, Numbers, Community, Subdiusion, Lot No., Parcel, Zip Cade)
TOPOGRAPHIC / LAND SETTING:
O Slope ❑Valley ❑Flat ❑Ridge ❑Other
(check appropriate box)
LATITUDE j3, ug_
LONGITUDE 169
Latitude/longitude source: (EGPS ❑ 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
STEET ADDRESS,
May be in degrees,
minutes, seconds or
in a decimal format
Area code - Phone number
5. WELL DETAILS:
a. TOTAL DEPTH:
b. DOES WELL REPLACE EXISTING WELL? YES ❑ NO rX
c. WATER LEVEL Below Top of Casing:
(Use "+' if Above Top of Casing-"�"--T
d. TOP OF CASING IS 2 FT. Above Land Surface`
*Top of casing terminated at/or below and surface may require
a variance in accordance with 15A NCAC 2C .0118.
e. YIELD (gpm): 7 METHOD OF TEST Blow
f. DISINFECTION: Type H T H
9. WATER ZONES (depth):
From_ To Fr
Fromatia_ To Fr.
From-_L To _qj Fri
6. CASING:
Material
Et. cement & benonite
Ft.
Ft.
SAND/GRAVEL PACK:
Depth
From To
From Ta
From Tn
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. _ - ,
t L
aIGNATURE OF CERTIFIED WELL CONTRACTOR
if
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

3466
dtu.1
f. DISINFECTION: Type H T H Amount 16oz
g. WATER ZONES (depth):`
From -I To 3,[TT From To
From From
To
From az T„ /�%{�-1 From To
6. CASING: Thickness/
U Depth Diameter Wei
From To Ft. /D„
From To Ft.
From To Ft.
7, GROUT: Depth Material
-
From D To 20 Ft cement & benonite
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,
Method
pumped
9. SAND/GRAVEL PACK:
Depth Size Material
From To Ft
From To Ft
From To Ft.
10. DRILLING LOG
From T Formation Description
0 / Clay $ sand
Granite
11. RE a RI :
RECEIVED
niv or WATI-R DUALITY
DEC 12 2006
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH
ISA NCAC 2C, WELL CONSTRUCTION STANDARDS, ANO THAT A COPY OF THIS
RE:ORD HAS BEEN PROVIDED TO THE 'WELL OWNER.
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
City or Town State Zip Code
( 828 )_ 369.9591
Area code- Phone number
1. WELL INFORMATION:
SITE WELL ID #(it applicable)
STATE WELL PERMIT#(if applicable)
DWQ or OTHER PERMIT *(if applicable)
WELL USE (Check Applicable Box): Residential Water Supply
El
DATE DRILLED
TIME COMPLETED
3. WELL LO.
CITY:
ATION:
28734
AM ❑ PAX
COUNTY
(Street Name, Numbers, Community, SubdiHsion, Lot No., Parcel, Zip Code)
TOPOGRAPHIC / LAND SETTING:
❑Slope ❑Valley El Flat ❑Ridge ❑Other
(check appropriate box)
LATITUDE 35a� nI'
LONGITUDE fat d6
May be in degrees,
minutes, seconds or
in a decimal format
Latitude/longitude source: alGPS ❑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
STRFxET ADDRESS
twat
Ci or Town State � rZi Code
)-_ 4-04
Area code - Phone number
5. WELL DETAILS:
a. TOTAL DEPTH: tn�h
tJl1
b. DOES WELL REPLACE EXISTING WELL? yY�ES El NOX
WATER LEVEL Below Top of Casing: _ 2IJO FT.
(Use "+" if Above Top of Casing)
d. TOP OF CASING IS 2 FT. Above Land Surface* L \
*Top of casing terminated at/or below land surface may requireMa
a variance in accordance with 15A NCAC 2C .0118. SIGNATURE OF CERTIFIED WELL CONTRACTOR
e. YIELD(gpm): An METHOD OF TEST Blow 5Vtanc UaL..anS
PRINTED NAME OF PERSON CONSTRUCTING THE WELL
7
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/O5

1. WELL CONTRACTOR;
Russell S. Taylor
Well Contractor (Individual) Name.
Redden Brothers Well Diillin Inc.
Well. Contractor Company Namr
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 e(If applicable)
STATE WELL PERMITS/0/ applicable)
RESIDENTIAL WELL CON•SS'gUCT!O, NOR°
North Carolina Department of Environment and Natural Resources. Division or Water Quality
WELL CONTRACTOR CERTIFICATION if 2187
Zip Code
Dw'C.' or OTHER PERMIT eat applicable)
WALL USE (Check Applicable Box): Residential Water Supply
(Ctd f DRILLED / I ' Iy
rre�/' l t�p
TIME COMPLETED J .3o AM PM%
3. WELL LO5A//IQ
TI ON: •
�/j//
CITY: A-11144.1-niM) COUNTY ( .(-iA-.)
��64- Loa f h oo L
Strut Name, Numbers, Communly, SubdiNFlon, Lol No:, Parcel, Zip Code)
TOPOGRAPHIC / LAND SETTING:
CSlor, Whaley ❑Flat aRidge COther
(check epprdprlate box)
L1RUDE a
LONGITUDE13 43 517
Latitude/longitude source: J 'GPS °Topographic map
tlocetbn of well must be deft on a USGS topo map and
attached to this form If not using GPS)
4. WELL OWNER
OWNER'S NAME
Sj kEET ADDRESS _
Y/n 4R93
City
�Lr rlor
Towns T State Zlp Cede
. -7agd
A ea code • Phone number
6. WELL DETAILS:
a, TOTAL DEPTH:
J01
b, DOES WELL REPLACE EXISTING WELL? YES C NO of
c. WATER LEVEL Belau Top of Casing: - - -FT(�'
(Use'+' If Above Top of Casing)
May be In degrees, i
minutea, seconds or
in a decimal Smut
d. TOP OF CASINO 1s 2 FT, Above Land: Surface'
'Top of cuing terminated at/or below land surface may require
a variance In accordance with 16A NCAC 2C ,051 a,
e, YIELD (ppm): 5 l METHOD OF TEST Blow
f. DISINFECTION; Type Ht_, 'T H _ AmountSy_
cr. WATERe ONES (depth):
From .�• To _lot From To
From •7Y To From ' _
To
From . T, //) From To
6. CASINO: Thickness/
ODr thiJ(J Ft. Oyn ter WeIEhL 1uAterpl
To� Ft. n .. l�S�'S S�.cA(i
To Ft
From
From,
From
7. GROUT: Depth
Material Method
From 0 To720 Ft. rant & termite p,rrts3
From To_•_—_ Ft.
From To Ft
S. SCREEN: Depth
From To
From To
From To
9. SAND/GRAVEL PACK:
Depth
From To
From To
From To
10, DRILLING LOG
From To,`,
0
R' /ct'y r
11, REMARKS:
Diameter Slot Size Material
Ft. In, In.
Ft In. In,
Ft, In. In.
FL
Ft.
Ft.
Size Materiel
Formation Description
Clay & sand
Granite
eA 61 c
eA 4
100 HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WIM
16A NCAC 2C, WELL CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS
RECOROK. BEEN PROVIDED TONE WELL OWNER.
S GNATURE OF CERTIFIED WEL CONTRACTOR 14D E
Russell S. Taylo
PRINTED NAME OF PERSON CONSTRUCTING THE WELL
Submit the original to the Division of Water Quality within 30 days. Attn: Ihformation Mgt.,
1617 Mall Service Center- Raleigh, NC 27669.1617 Phone No. (919( 733.7016 eixt 568.
DEC 12 2006
. Form GW1a
Rev. 7/05

W ALL USE (Check A plicable Box): Residential Water Supply
i _��
3. WELL L0
CITY:
DRILLED
RESIDpITIAL WELL CONMUCT!ON RECORD
North Carolina Department of Environment and Natural Resources. Division of Water Quality
WELL CONTRACTOR CERTIFICATION N. __ 2187
s335103'
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, Iv 28734
City or Town State
( 828 )• 369_9591
Area code. Phone number
2. WELL INFORMATION:
SITE WELL ID NW'opticablq
STATE WELL PERMITe(V applicable)
Zip Code
Dv!L.' or OTHER PERMIT W(If applicable)
CAI
TIME COMPLETED AM 0 PMk'
ON
C
LINTY ��x GLf ,1/L/
(Street Name, Numbora, Community, SubdlNelon, Lot No., Parcel, Zip Coda)
TOPOGRAPHIC/LANDSETTING:
Ds:* °Valley ❑Flat °Ridge °Other
(check apprdprlate box)
Lc 7ITUDE ��qal.�LLr�
LONGITUDE 23I1..[
(ati'tide/longitude source: CPS °Topographic map
(locafbn of well must be a n on a USGS repo map and
attached to rhla/prm if not using GPS) .
4. WELL OWNER �/ .
OWNER'S NAME Li
et T DDRESS LLt L?%A.f
City or own S> t. ZipL�ode
(A(P;l&)' •Phonumber
ne
Moy be In da2rees,
minutes, seconds or
In a decimal format
a. WELL DETAILS: 1
a. TOTAL DEPTH:
b, DOES WELL REPLACE EXISTING WELL?
� YES 0 NO
c. WATER LEVEL Below Top of Casing: (C o- -FT.
(Wee'+' If Above Top W Casing)
d, TOP OF CASINO IS 2 FT. Above Land Surface'
Top of cuing terminated at/or below land surface may require
a variance in acco nee with 13A NCAC 2C .011 a,
e, !YIELD Wpm): METHOD OF TEST Blow
L DISINFECTION: Type HIl H _Amountboy_
g. WATER ONES (depth:
From �IYQVQ To
From_.
From
S. CASING:
Depth nDipme)er
From To 013 Ft. (0 '
From r 3 To(Ft. Cr
(big
From___ To FL__. �Y
From
From
From
To
To
To
Thickness/
Weight
riat
7. GROUT: Depth Material Method
From 0 To:.20 Ft. 031Ert & barnite p=fta1
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 FLU In. in.
B, SAND/GRAVEL PACK:
Depth Size Material
From
From,
From
10, DRILLING LOG
From To
0
e.
I
To
To
To
11. REMARKS:
Ft.
Ft.
Ft.
Formation Description
Clay & sand
Granite
annh
DO HERESY CERTIFY THAT TNIS WELL WAS CONSTRUCTED IN ACCORDANCE WRH
15A NCAC 2C, WELL CONETRUCTioN STANDARDS, AND THAT A COPY OF THIS
RECDR BEEN PROVIDED TO THE WELL NER.
SIGNATURE OF CERTIFIED LL CONTRACTOR 11IDA l
Russell S. Taylor
PRINTED NAME OF PERSON-@ONSTRUCTING. NE WELL
Submit the original to the Division of Water Quality within 30 days. Attn: Information nfet:; 1617 Mall Service Center— Raleigh, NC 27899.1817 Phone No, [phone] eat 668. Form GWta
DEC ] 2 2006 Rev, 7/OS

RESIDE, ITIAL 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.
Hedden Brothers Well Drilling, Inc.
WeL.Uuntractor Company Name STREET ADDRESS 73 Holly Hills Vista RD
Franklin, NC 28734
City or Town Stets Zlp Code
( 828 )• 369-9591
Area coder Phone number
2. WELL INFORMATION:
SITE WELL ID Mgr applicable)
STATE WELL PERMITS(r applicable)
YVC." or OTHER PERMIT e(If applicable)
( DI.rWP
ALL USE (Check A liea))bls Box): Residential Water Supply"(
TIME COMPLETED
Di _D� iz
AM ❑ PM if
3. WELL LOC/ETION: •
Y:
R� Q Y Numbers,
tool Neme, Numbers, Community, Subdivision, Lot No:, Pst al, Zip Code)
TOPOGRAPHIC I LAND SETTING:
❑.Steps °Valley ❑Flat ❑Ridge ❑Other
(check opprdprlat, box)
I. 11TUDE 3
COUNTYf/fQ COLD
LONGITUDE
May be in deereee,
minutes, seconds or
In a decimal format
Latitude/longitude source: ❑CPS ❑Topographic map
(bcatbn of well must be shown on a USGS topo map and
attached to this for A' not using PS)
4. WELL OWNER
OWNER'S NAME
5.ET ae D-ESS
Zip Code
A'ea code • Phone number
6, WELL DETAILS:©�y
a. TOTAL DEPTH:
b. DOES WELL REPLACE EXISTING WELL? Y,ES 0 NO 0
e. WATER LEVEL Belau Top of Casing: . l///JJf FT:
(Use's' If Above Top of Casing)
d, TOP OF CASINO 16 2 FT, Above Lend:Surfece'
'Top of casing terminated avor below land surfacemayrequire
a variance In accordjrlce with 15A NOAC 2C ,011E,
e..YIELD (gpm); (fl METHOD OF TEST Blow
f, DISINFECTION: Type Ht'T H Amount 16oz
g. WATER ZONES (depth):
From To _ From To
From To From To
From . To From To
6. CASINO: _ .Thickness/
Weight MateG
From
From
From
To
ClJameter0
Ft l'y
Ft. (p•.
Ft.
7. GROUT: Depth Material Method
From 0 To7.20 FL 03181t & bETIMite purred
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 FI.
From To _ Ft.
10. DRILLING LOG
From To Formation Description
/
0 / UI Clay & sand
70 s /305 I Granite
11, R RKS•
rtIV
4 G LOL
I D0 HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WDH
ISA NCAC 2C, WELL CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS
RECORD SEEN PR 0TH WELL OWN
--
SIGNATURE OF CERTIFIED WELL ONTRACTOR D E
Russell S. Taylor
PRINTED NAME OF PBRsOtfeeNeTRUCTING. THE WELL
Submit the original to the Division of Water Quality within 30 days, Attn: InforliTatlon Mgt.,
1617 Mall Service Center -Raleigh, NC 27699-1617 Phone No, [phone] ext 566,
Form GWla
DEC l 2 20ai5 Rev, 7/05
s? sr
.;1 0

Nardi Ca olina - DevastateofEtwk andNWaaa ffir6im` gaferCiO®dWaierSa
teem coNrwtcrtoaooa.ma *big ftliak .4 (Ii»'Q vsija -new ,• ant _eav-3 ab 0
srwramu.cotarmentert rttf
-
asp6etbie) aaaocLts>m :=
[H•(fa) • .
1. WELLUSE((CheekAp taBoak.ResidmWil�Tr1�0 •>ndowLl1 Agiaadlorelp
- ` Monitoring 0 Raw"' ReitPomp Wmtrllga =0 Other C IfO,er,List Use
2.'1ELL LOCATION
Neatest Town cA'�2/G ; - (may
!)Q^{ [C[- r gDejl 2„ 8,7'3y
tsueet tamemaccennemy,lithaviclie-Parecced .
3.OWNER; i,Pn -- 14U h4, S. •
Address 3trs Z9G n U 1'Ne_ g {
t ayino4
(SG/). 'ts i Qs 4. 9 Elm come
AR ems lhmeemeer
4. DATEDRILLE) //— 0.9c D (0 • -
S. TOTAL DEPTIp 70 0 - ' •
(aaed:sellinga
de gpwpdS)Iocadon
thepostedoneductons
Lalitudellongilidde somo3Ql'opogiaplde map
Er - R LOG G[A
Efts
F �+ tom/ an
6. DOES WELL RBPLACS HXlfll im WSLLt YES 0 Ntlj.1
7. STATIC WATER. LEVEL Dan Top *Mains Lien
8. TOP OFCAS1NGis. % neRAbpdo
wrap ofmingteradattaati6rsekT.ALovaIai
.mewl■.naaaaoeada 1$ leig3 fl - - ! - - en
�r¢
tµx�_ OPTEST himili� .
10. wATER. ZONES (depth): (c 30'
9. YIELD (gp
11. DISINFECTION: ype fM Anronrd ..2T/;-85 Mow di<ecdooand at last
12. CASING; - Well "Mime= two State Rods or Cotmty
From-_ - Depth Dispel -se o r�D p .afaraW _-° ash- toad names.
Inciudetluetosd
Fron1__To
•
IA GROUT: TD*b --
tdphod-
From To '7�7'/�'--.2—• -
.4. SCREEN: Depth _DiameterSlot Mu . Menial
•
From To
From To
S. SAND/GRAVEL PACK
Depth Size
From Toopt`
From To Ft�_
6. REMARKS:
Material
NOV 1 4 2006.
!TY
DD HERaticatTwymemos WELL WA$CONSTRUC111D INACCORDANCB yarn ISANCAC2C. WELL •
DNS1RUCTIONSTANDARDS, ANDTHATACOPY OPRECORD BEIMPROVIDED TOTHILWEILOWNPR
•"/" U� -v -Co
SIGiA7URROPpERSON CONSTRUCT11401116 WELL - DATE -
submit the original to the Division of Water Quality, Groundwater Section, I636Mall Service Center-RddphiNC
.27699-1636 Phone No. (919) 733-322t, within 30 day;
- GYM REY.07lt1101

. . -
.
' • . -;
- : WELL CONSTRUCTION RECORD - :
• I. JP
morel &Oise - Demand ofEakononik and intim' Resources - LiWbia- Quality-7 0Mintiater Salton
0M:441/Tint S aaa-D;;;;;;- ..piaprjaujii tittle .
i.uojtti;ginfai--3 2-10
WELL CONTRACTOR
WELL COKTRAcTOR COMPANY
STATE WELL CONSTRUCTION MSS
fif nortedee) .
Oncliathle) ' •
.3 3 I
n
Raidenfid121/Pablic
WELL USE (Cleat Apitlicable-Box):- CI industrial CI 4Eritataral•
- " Monitoring 0 Recomy a Heat Pomp Water injection 0 Other a Inger, latt Use - -
•.
Nearest Town: FAM-Adi 4/CountY 1
.-44"11141 sallegtting
2. WELL LOCA
VTIOlt
6 474 g• Li? n2S-73 MIRROVRISSOE4
(Se wan. Neethete. Deeteeatfi ilehttielee. He. res add Catitoddloisielde area 10.cation
• • ..
3. OWNER:_,P ak- 14D /Load - k)
Address Pci Sr 4-He I-1/p 0 1-- aa_ Latitvddlonsittide somemi3GPSEITopoglaphie map
taelseediatemodetma
atmg-re
/-----PAA.441,--.): yv e.: cagga V• 1 , ern -
Call:Can SS 7 "... . Zip Date - . From To1.
-
Cal> 3v 9-eqs 0 • -.- ...,- ... • . •
Area cede- Sees ambit 2. -I _
4. DATE DRILLED ---. / 7 "-0 9 . . .2.-
_
76 ' A
5. TOTAL DEPTH; a.5-- • - • --,
6. DOES WEIL REPLACE EXISTING, WELL? YES
7. STATIC WATER.LEVEL Below Top °IQ& r iS.0 —FT:
(Done Warne Top of Coin) . .
L TOP OF CASING IS FT.Above lad Surface*
nee el Ski teeelleldell Mee helip! Intesefeee espitto a , :
Tertian he wards* wilitalOCAC 3C AUL t j • -
9. YIELD (gpm0: .4.5 METHOD DETEST it /04-01-..
10. WATER ZONES (depth) 3 o o • - .
.
DOCA'TION SICETC1(
t 1 . DISINFECTION:.Type %-iii- Amount l. Mg 5 Show (Erection andktenee in miles from at least
J 2, CASING: .VA'SMid:Ross two State Roads or County Roadt-bctude the toad
Dcpthnt. wii :-numbeas Ind -common toad mom
Frore_l_z_To 76" Ft. - ....a.-- - aV ;kr aff O..
From__ To_____ R—__-_
Frota_1-9._____ Ft..,..r„
13. MOUT: Deat Metal-....- /Shod. .‘-
Frem-0.-- To-ta— Ft.fiaeli sp i poyA-,
From_____ To B.
.4. SCREEN: Depth Monter . Shake : a Malesiel
From_ To__ Ft,._____in. _ ht.
From To Ft._113. _ in. -
:L SAND/GRAVEL PACK: - _
Depth Tux Material
From To Ft.________
From To Ft.
lattetto.)
- DRILLING LOG
rwOon Desaiption
7)Fi. /
CA- Air/ s frea--.)
u c--
-
SEP 9 2:3-
0
Ni
0
0
6. REMARKS:
DO HEREBY CERTIFY TEATTHIS WELL WAS OZINSTRIETED Di ACCORDANCE WIDI LCANCAC2C,Yillie •
GNSTRUCTION STANDARDS, ANDTHAT A.COPY OF PADDED mu.ni PROVIDED TO THEVEIL OWNER
- Oen froCk •
siCa!Allattl!PERSONCONSTRUCTINGTHEWELI; _ DATE -
.411i Mil the originalo the Division of Wamr Quality, Groimdwater Section, I6361tdall Saralee Center -12aleigh;
• Sri ?hone teo. (919)7D-3321, within 311 days. GSV-1 REV. 07/2001

- • WELL CONSTRUCTION RECtf.:: .
>r Quay-- n4
North C-dBarltommdmdNetta�l ._
wo.r.corttaaa v trtu _ .1grC iiisjItteA I0101 trGiI gp rove ,'esaite sat1, d.t/-3 2-4 O
STATE nu.cotenimCrt'ott tri
fdappBe wa1 -
L WELL USE (ClericApprabldsox)-Bpaidan6�t7Yl4sawpaUPab6b 0 Weld II A ly
- ' Monitoring II Rum, II- Hat Pomp Willi Injo oa 13 Ott 131fOgier, ListUse -
2 "WEEL=Knott. - selling
NemotTones FRANit i; � - Comily//���} UM-- / IIVaAsy .°flat
.--
it) Sie el D1l�Un �603 5 w4 '' .
(smetNaoe,Ne t SaL6rimealattla.Lvtink) . I; dsOrtttttbafion
3- OWNER: V ; C to 12(k a.40 1� iGtitt�
Add 3soo N•(�• R/ W L1
la toFRereNW /.
/fnn yJW c1• 3361I f
earb tam Ss 2ipCo&
(9Sj4- Rt1/- (osi' _ ;.1
4. DATE DRILLED 'F'y to • -
c TOTAL DEPT.
Cdrwrdainarrtaotds)
Lardoddlongiltddos TopbpdpIde
r ri trTh ( DRILLING LOG
Frain To Description
• 2-D0 • A-L Va.- C- 2.2.-1
6. DOES WELL REPLACE Hnnete vim.? YES II NC -411. -
7. STATIC WATERLEVII.Below Top ofCalm. 350' T: .
(Weer DiannTop d6nirs)
S. TOP OF CASING IS / PT Above Land Smite* -
'Top etcubs tonelnattdWee ba(nka Sfoetgaltba .-.: - - -
mina rucadegvAY7SASICAC3CAUt. /
9. YIELD(gi$ 3 o METHOD OFTBSfhIOR%j c4-.
10. WATER ZONES (depl* ¢' D D (�
LOCATION SKETCH'
I1. DLSWFECCION:Typs H-fff: Amount .aTA-S5stow tlitectioa smtdimintss in mites gem at!east
12. CASING: - Viellickness two State Roods orCounty Raads:Include the toad
Deptht. &W ytL-nombessand-ca om=madmon
From Li . To $t -
Ram To Ft. N
r*t
-o
cm
From Tp Ft.^_
13. GROUT: Depth Mmaid
From r) To _it.�Q,dj - Pi -)
From To
.4. SCREEN: Depth Dian _ Slot Size - . Mina®(
Fram To il•---o. in.
From To FLjn in.
5. SAND/GRAVELPAC:K
Depth Size Mffiail
From To Ft
Front_ To Ft.
6 REMARKS:
•
DO HEREBYcEISFY. HAflHlS maws (XR TRUCIW 1N ALCCRDA4= W=TH ISA)CAC2Cn WBLL -
-ONSTRUCRONSTANDARDS,AIWT ATACOPYOF 1; B8B_NPI/0M STOTBB-WEMOWNER
• '-:P �t -o-Co -
SIGNATURE-OMHE WSW _ - DATE -
submit the original to the Division of Wahl Quality, Groundwater SaHon,1636 Mali Service Cade: -RaIdgb, NC
37699-1636 Phone No. [phone], within 30 days. _ . GW-1 REV. 07t2001

. ' I_•
•-WELL CONSTRUCTION RECA .lF ::
s ._
..
Nova C oftoa-D ofEiwintmtmtmaw-'--'Rtswoas-Drnblon _ r- sa
_ n
WELL CONTRACTOR �'a' 's Tom=
{RtPpl(rahle) •
Orson eraaa - -
1. WELL USE eruct AppsnLldaoax-Baidafm1TYM palfr blie l7 ,lad t 0 48110111,10
- ' Monitoring Raeox4 °' 1 Waaerlaj giaa El Other l Va tic; UAL* _ -
Z-Newest To+t t %J9ks& J c ugly A-ce.'- - " ( . °Flat
HjjCi S_1 S/i Ms' 2 / d ' QL 7r'7 3 (dw wz ' eadcw -
(mw itt.me.ran.Cmaina talk, C.dc wacvP
I 1a awn •
3.OWNER-49- /J ()UTZS-
Add� ci H-0ace Ikb. e� a ds1n i Laduideflongittide someialOPSOTopograpidc 'ap
r,QAit-aL #,'J('J19 ' M'a-a "Zi - - M - . F DRILLING LOG
ann m se "e' - - " . To ' " -17 d Lt Desaiptia
4 DATE DRILLED 8 -2-9 -D' 60 :� �� �Q Ltd L' iseB re_..
5. TOTALDEPTH; 4,-0,5'
6. DOES WELL REPLACE mUSTB>rs WHLL? YESj,7 NO -u
dow-
7. STATIC WATER LEVELBTopatCsmr ' WkT-
(Lb`1" Kane Top410niryl
S. TOP OF CASING IS / PT. Above land Sadhc&
-Tapa =dogtonnaandaaridaland.wiw:NWea
Tatum la ode wsdhllSN CACECJl1i -
9. YIELD (gpOX _.IQ._ 8F
10. WATER. ZONES (dapd0 i 3D ' tr
LirealgliaMai
11. DISINFECI1ON:yypc 11411 Among aTAB 4 Strew auddistmcsinmiles koraat(east
12 CASING: - WeHTigelotess " two State Roads or County Roads.Weds the road
• Dephp�� arWei WPt. -nimbus mnd=conon road names.
Frain . To f S • Q ea
Fmm TR Ft
From TO R
13. GROUT. Depth edam Method l--
From__Q._T4_>��F<..-C°b' 170WC) .' .
From To 'R _
-4. SCREEN: Depth _Disown , slot Mae - : M�easl .
From To ii_�n. in.
Rom To FL —in- in. • -
•
5- SAND/GRAVEL PACK: -
Depth Sine ?Maid
From To Ft
From To R -
6 REMARKS:
DO HFSE9YauciiY7HItfiLL4WSBLWA$COZS[RDCIBDEtAOpOAORgDMS2WSrR15fl4c Z WBtL-
'ONSTRUC[ION STANDARDS, ANDIRATACOPY OF RECORD -'75"BB@iP$OVmBDl'OTi18WEIL.OWNER
SKR:FATURDOFPS ONCONSTRUCTINOT IBWEU: - - DATE -
•
Submit the original to die Division of Water Quaity, Groundwater Section, I636Md1 Service Center-R*Igh. NC
f76994636Those No. (919)733,iE21,within 30days - GW-1REV. mom

fF Y i
WELL- CONSTRUCTION RECORD" -:
$f� true
NonhC%fim- Department dBtgritosod Tf�1)Remmoes-I>itidmofW�ocQa7' , an�
z't
WELL coKtaxcro� Rmt�Paa�t3 f� 6*t°4 c rim t S DJ ie&d, : t C �� Il a b D
WELLCON RAIL:ORCOMP ny cC lift �1 ���N431 _»;
s
Aaaodwstm '
STATE WELL CONSTRUCIION MIST,{ifaldiEl ) . .
I. WELL USE (Chock App5abla Box)-Reeide fisl7Ylda l/PabBe D Indwell 0 AgiwvRm!I-Q
- Monitoring CI Recovery u- Heat Amy wa injet CI Other s Kotler, List Ust _
2.-WELL LOCATI'
newts Tow= t " calmly
P/i% TA - e
mermrntatemeoToomar, I LmI3o.cede
3. OWNER: 1 -A °ma S (''R sk j-n-
Address 3aq S.-W. l a a 57‘.-
(saedsr-asadeltot - .
�C rl.dsvllr _r 3a:6D7 -
Cayor7an Sba Min
(35 3.1- //PS •
Area mdt-r mea -'•.Y
4. DATE DRH.I.BD -.3 D - d G ' -
S TOTAL DEPTA'./
eli.�d setting -
I) DSbpe �lausey . Ll,Ftat
tf-
IsfitufbilonginIde apbic sup
Osat ban)
i r___ - DRILLING LOG
From To - Alma= Descnptton
S. •
_— 5 - / XD - - s 'r e—
.r
6. DOES WELL REPLACE EXISTING WELL? YES CI NO •fie - -
7_ STATIC WATERLEVELBelow Top ofQom' g: '/O FP: -
(User Cabot.* Tap et
8. TOP OF CASING IS _/ Pt. Above Land Surface* d Su'
-top Madan arainbd*Mr baWbada1a 1tnJRsa -
vagina iaa erednirSAIiCAC2C.a11t . - -
9. YIELD (gyro) s ° 4- METHOD UFTRST4h&f 4-.
10.WATERZONES(depffi) 4'OJ 2aj i7o' (1
LoCIMMESKIMEI
11. DIsiNFECUON: Type »#A.#. Amount .lTA-S Show &xis= Sd Ski MIM at least
12. CASING: - - WaU1>utwo Ste(eR��Y orCalmtyR3ncludetberoad
Dt orW Weida -numbers and' es.
road nam
From b - To 7 F7 _S
From To Ft - -
From To Pt
13. GROUT_ Depth Malaa. Method
From ( "'OS— Ft n0 p
From To Ft
.4. SCREEN: Depth Diameter . Slasi= - , Material
Ram To_ Ft. in. in.
From To Ft.--
S. SAND/GRAVELPAGIC: .
Depth Sin
From To FC
From To Ft
6. REMARKS:
DO HEREBYcauffYTHATTiUS WEU. WA$ C><$WRUC1EDRNA000RDANCE WITH ISAI1CAC2C, WELL -
-ONSTRUCfICN STANDARDS, AND THAT COPY OFTHJSRECORD BEEN PROVIDED TOTHB-WELLOWNER
P— 3 D 0 (4
-- SIGNA1URE-OPPERSON CONSTRUCTING TNWffiL _ - DATE -
Submit the original to the Division of Water Quality, Groundwater Section, I636 Mall Service Center -Baidgh: NC
n699-1636 Phone Na [phone], within 30 days. _ - GW-1 REV. 07/2001

• WELL CONSTRUCTION REc6RD- .: `. o u is 4
+�., -
NarthCmaLOa-D eofingkoS=distalR Jj�-D.r}ivid�oa QU+: Slaws-
_
ww.corrm r trA4 Lflflr5 Ind' � r Tiot4 � .
WELL COKraAt?D&COMPAN1Y - _4_, -1: • _.
STATE WELL �-,rrziWtfl
( f. .fl�•�.� "! -
1. WELL USE (C(are Ap lice le-ButxetidanfmltM II Indrottird Agtia aLQ
Monitoring CIRocosay aant Pimp Waw1tcnon Eloear LI wolfs, Ljstls4 - -
-I.'WELLIACATICRL .. /j/]
-NearestTowecfjes L-1 k)' Comfy/ „A -Ca•
(n c. ran C m/t -OJ -.f03 ZI
W S4 • .
Tclt�E
ORid®a ew tgdeallay . Ord
t
_So. (anteabai)
(saeat+.a ct:mrmty lmtPa.Lva d4 - CstitaciallogigitudaOrvalloci=
. Gddress L%SO-ram
Address .� 8 SU A 2.,-021t Pci iatimdd o souromOOPECITopographic asap
ptitiuenataetr0.l. ---_`•
. .(rsetbs)
.2ii-:: 1c 02.&W 1� r DRILLING LOG
t t (on , 9- (o a...? . - F m T35' F YDes°ptioa
megmea• PhilleamMr '? 1 ,/ S • .- -7 3 ' ysB-.vn S 4-0+1 tr
4. DATEDRII3.P-D r"a- 'U _ 73 - .30S' 1 L-U=- a kAN i t�
5. TOTAL DEPrEr_ • ?o S' '
6. DOES WELL REPLACE EXISTING WELL? YESD 1•1045 --
7. STATIC WATER LEVEL Below Top eU y 5' 1•: -
(Daa` nRabmaTopdauisp)
R. TOP OF CASING IS_/PT.AboreLandSodsx' -
"Top damanaa darrbdES4•aaotse+.wtr.. •.-.. .
vnlaa k sinisityabiSAWCAC3Calli _ - - -�t¢, -
9. YIELD (g�ox araoD 9PTR5�%a)/lp Wiper.
10. wATERZONES (daplbX /" O; 2 85- 8 -
Lfectilaaltn
11. DISINFECTION:yypS Amami .STAB mow tHreclion lnages from atleast
Wefllhidmen two Sale Roads or (bmtyRatdsancludc the mad
. _ Depth D orWeislvPt. _m 'mbesand`commonroadnamos.
From O . To 4 3 FL h ` - -
From TR Ft - - -
From Tp Ft. _
13. GROUT: Depth Whoa tdathod-
Fromi_ToFt�Q�y -
Front__To it - - Ci=r p r 3
Water.4. SCREEN: Depth ter , Slot Me - . Material y
From To Ft... --in. - in.
From—To.FC_in. in. . - _ -
5_ SAND/GRAVEL PACK: - -
Depth Sec Mdciai
From To Ft.
From To Ft -
6_ REMARKS
DO HEREBY COSY THETAS you. vim cat nincreD IN ACCORDANCE W1141 ISMICAC2C,Weu_ •
'ONSTRUCTIONSCANDARDS,ANDTHATACOPY�tdO.LlOF��''�q _RECORD HAS MEMM NEMTOT86-WE LOWlER
Yts J1f4i $L rF'i S---Uto
=SIGtyklUREOAPERSONCONS1R11C18i6TIMWM ; - - DAM -
Submit the original to the Division of Water Quality, Groundwater Seetion,1636 Mall Service Center- Raidph; NC
„2.7699-1636 Phone No. [phone], within 30 days. - - Gw-1 REV. 07r100!

•
s;
• -a,c}-
North carotins - Department of Mitotic -tit and Natural Resources - Divbion of W or Quality-- GmStdwater Section
LCONTRACTORWIDt1(IDUA1 (FM*;heti PI Pp s Zl({
etTRAerofcommarmetc .ggrC Jef�)r.! IiM1I�lv4�l (�_'►ne rtoras Sri-Say-3 ab 0
STATE WELL SON PZRafl7a
writ coontacroa - ASSOCIATED
(if applicable) - - "f pflcable) • -
3 5 5
• WELL CONSTRUCTION RECORD - -
1. WELL USE (Check App6tabhi Boxy-R $id nt al dpamUbtic 13 Industrial C - Agri- cultural—
D
Monitoring D Recovery a Heat Pump Water Injection ❑ Other CS If oilier, List Use •
2. -WELL LOCATION: Ted 'et
Ptafr
(Seem Name. Nnaabea. Community, so eu, otHo. rap Cade • I:a6tttdr/lotigitttde &Weil bca4tm
'Nearest Town:
! i 6(r.' DRidge DStope D'Kaltey
CO 4` F /I / C122t7 S •Ca�aLnty '19 4- (en asoarsetrnt4 . ' '
3_ „WNER: f ka .2—/ CO P -e-
Address 8 9 I#/ c no
, (deneeshatautesmonet0
Ltd/tuck/longitude sowt:e:DOPSDTopographic map
i (Sbr,vilemeNo.) — . - KM* bog
,2/4-Aik ^/ 0`�8?3 y .'uEPT l DRILLING LOG
GryerToam Tap Case. . .- .E[om To - Formation Description
c&a23- 4 a/- cif 22 • �G
Area axle- Mat amber .t -I. A. 9/
4. DATE DRILLED 2/- 3 D —O 0 • - 4 / • as 0
5. TOTAL DEPTH; 2s,o .
6. DOES WIIi REPLACE EXISTING WELL? YES D NO DC'e"
7. STATIC WATER LEVEL Below Top of Casing &0 Fr:
(user if Above Top ofCaaios)
R. TOP OF CASING IS __ FT. Above Land Surfaces
rim) ofeasing tormiaasdMkt bemIpdadac,ends a
sar W ea Y amerdaas rr11YI5ATICAC 2C A11t t y
9. YIELD (gpm) 30 METHOD OF TEST 4 mi/inet �
10. WATER TONES (depth) e 2 S'-n' (�
11. DISINFECfION,Type /t%fff- Amount .-2Tn-6S5
12. CASING: - D,a Wan Thickness
From_Q.Too Depth, / R. has orwei�htrpt M:t l _:
lum
From To FL
From Tp FL
13. GROUT: Depth . Matson Method
From_�To_aFL (1�Mtda7 �[i).f�
From To FL_
.4. SCREEN: Depth Diameter - Slot Size - , Material
From To _ FL_jn. in.
From To Ft._in. in.
5. SAND/GRAVEL PACK
Depth Size Material -
From To Ft.
From To FL
LOCATION SKETCH
Show direction and.dislance in miles from at least
two Stato Roads orCounty Roads.Include the road
-numbers and -common road names.
ryt
-n
t'
O'
6. REMARKS:
DO HEREBY CERTIFY THATTHIS WELL WAS CONSTRUCTED INACCORDANCE WITH ISM(CAC2C WELL •
ONSTR(1CTION STANDARDS, AND THAT A COPY OE IT RECORD BEEN PROVIDED TO THE-WBLL OWNER
aw �.. s= 3 .
SIGNATURLWFPERSONcoNS1ROC17NOTHEWELL . - DATE
5 �� irmit the original to the Division of Water Quality, Groundwater Section,1636 Mall Setvlee Center -Raleigh, -NC
„ 25 '9 1116 6 Phone No. (919) 7334321, within 30 days - GW-1 REV. 07/2001
a

lei aUd7
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and NNatuNaturalResources - rDivision of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print`) l' Chel1l-\tat C UAfQ 1 ttWICATIONN # 3 221
WELL CONTRACTOR COMPANY NAME —N�lC\ a\ ��'.i'� �f' - >+ TtRC . PHONE # (V �°9'C 4C)
STATE WELL CONSTRUCTION PERMIT(' ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): ResidentMunicipal/Public 0 Industrial 0 Agricultural 0
Monitoring ❑ Recovery 0 Heat Pump Water Inj on ❑ Other ❑ If Other, List Use
2 WELLLOwn: \/1•
J_C3tddtY )
N st own: `�'ialn [� � t1 county COA \ C Q\tom .
(Street Name, Numbers, Community, Subdiwioo, Tot No, Zip Code)
3. OWNER
Address - QA. j BC cd j C •
(meet cc Rouse S.)
K.:\\ ,( !fills ' . 794%
Chy or Town State Zip Code
09)_ aklo-9nit,
Area code- Phone number ry
4. DATE DRILLED k,
5. TOTAL DEPTH: a'--18 1
6. DOES WELL REPLACE EXISTING WFT.T ? YES ❑ NO
7. STATIC WATER LEVEL Below Top of Casing.212
(Use "+' if Above Top of Casing)
8. TOP OF CASING IS % FT. Above Land Surface*
'Top of casing terminated or below land surface regains a
variance 1n acrordan a with ISA NCAC 2C AIM A9. YIELD (gpm): 60 METHOpRF TEST/1-r tr
10. WATER ZONES (depth): a LV
11. DISINFECTION: Type Jr 1 Amount P t 1
12. CASING:, WallThidmess
F
Front
r To J 7 r W a ight/Ft
numbers and common road names.
.) 3 559
Topographic/Land setting
dge ❑Slope Malley ❑Flat
(check appropriate box)
Latitude/lon ' dir of well locations
/0'39i6 `13 f w g3bo /D.1/ i
(degrees/minutes/seconds)
Latitude/longitude sou ¢deli( S❑Topographic map
YY ( _check box)
DEPTH PRILLING LOG
From To F 'on Description
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the lid
From To Ft rCO g
From To Ft. cy
13. GROUT: Depth Method 0SO
From DepthTo Ft 17 P � J
From Too f� Ft CAI
14. S 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.
Ft.
SEP 2�o.
Mt•
ob •
16. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUN STOF 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 Mali Semi. `Center - Raleigh, NC
27699-1636 Phone No. [phone], within 30 days.
GW-1 REV. 07/2001

WELL CONSTRUCTION RECORD
r5 J 88
North Carolina - Department of Environment andNaturalResources -�C iDivision of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) t ry\ \C rciQL\ 1 t esf. CERTIFICATION #
WELL CONTRACTOR COMPANY NAME l� a LAC
k L -A- (Cla-Ver`it. f\C
STATE WELL CONSTRUCTION PERMIT/ ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
PHONE # a 30-01 I-i V
1. WELL USE (Check Applicable Box): Residentia a Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring ❑ Recovery 0 Heat Pump Wa Inj 'on 0 Other ❑ If Other, List Use
2. WELL LOCATIO _
Nearest Town:
kit) t/ reS KA°
(StreetName, Np�mbers, Community, Subdivision, LotNo., Tip Code)
3. OWNER i)J o..k
Address a14t4t to ref1
County ItYak'.01n
Qv(Sbeetar(l_Route No.) I�
c3
City or Dawn State Zip Code
g2)q).. lin-5 Egce
Area code- Phase
4. DATE DRILLEDC27.0' C
5. TOTAL DEPTH: g of
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO
7. STATIC WATER LEVEL Below Top of Casing: pFT.
(Use "+^ if Above Top of Casing)
8. TOP OF CASING IS / FT. Above Land Surface*
'Top of easing tenanted at/or below land surface requires ■
variance In semrdn wttb ISA NCAC 2C .0118.
9 YIELD (pm): I METHO OF TEST
10. WATER ZONES (depth): / 9i (
11. DISINFECTION: Types 4 1I'-r ✓t e. Amount
12. CASING: Wall Thiclmess
From'-{
From Ft
From Ft.
13. GROUT:
Fro
From
Depth
To T73
To
To
Depth
To_2_ Ft
That_ Ft.
or W ' t/Ft
Ft %. S!)P l
14. SCREEN: Depth Diameter Slot Size
From To Ft in. in.
Fmk__ To Ft in. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
T hic/Land setting
❑Ridge Slope Malley ❑Flat
appropriate box)
Latitude/longitude of well location , )
35* La'a7.5''woS3'a7 y(„7
(degrees Qxmds)
Latitude/longitude source PS❑Topographic map
(data box)
DEPTH DRILLING LOG
F m To Thsnation pescription
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads orColfpt} Roads. Include the road
numbers and common coad names.
Pri
*12
CJl
16. REMARKS: /
I DO HEREBY CERTIFY THAT THIS
CONSTRUCTION STAND
SIGNATURE OF PERSON CONSTRUCTING THE WELL
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Matz Service Center - Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-1 REV. 07/2001

0
• - • wti-. CONSTRUCTION RIC- 0RD"
g,t�,,��
worth catnrnna- Department ufBorirovmr�t andHama Resources-- >;iildon u1f WaaarQmstY'-QtobndgatarSetd'toa
wr CONTitACTOR
" am -at tin t s a ila:.:1 r ;mcrcrtacis (
Et.L AC' CONraf01Wa1pAlaY NA —_ _ _ ineli��ti^4-/ 'TS�-� •'eoa'Li li �4-3 a•6 0
tv
SCAT! WELL cotartnucnott Fri
(ifestheable)
assoctxrio • -
1. WELL USE (Cheek Applablo Ba-________,. Id liC El imiuslrial O Agricultural P
. • Monitoring D Recovery Cl*- Hat Pomp WatirInjecOtm O Other U If Ot$or, List Use .- •
•
2-WELLLOCATIOM- -
"NearvstTown: CZ;
(augE D12UNslo�%11i)
(Sinn Must ataiets. tom, thbdridai, t at t1a.
Cowry 8rn
re Code) .
3. OWNE 2 k r2-AAM- '
Address 30 :b P U nAorn f-I ` ll Ra.
the
J=flwk I Ler X KT 3 (f
'c,«gw rurTaSat �� Zap Coa
C az- 5-1SI- &74'0 - .,-
Amark- pane amber 0 4_ DATE DIULLED r "'-TY Co
5. TOTAL DEPTH; SOS'•
gtaPi019and sating -
ge 0SIo$ CP/alley . Dilat
I t6taddlotigitede Orwell location
•
Laadddlo�ide sw�DOPSOTapogaphIC map
ems. _ DRILLING LOG
. Prom To - Formation Description
��•
Ate ' %,f' Aga afro a•e->
r -Cat s- FrL It L 61 tart
6. DOES WELL REPLACE EXISTING WELL? YESO-
7. STATIC WATER LEVEL Below Top ofCemg '4`n Fr. .
(Iba^N intr. Top oltaios)
8. TOP OF CASING IS I FF. Above Lad SadaoKipafmM nib* arbelnigtarrheeroeoteda-
.aria ss to wadswilli1Sk1ICAC3C .afs. .
9. YIELD (gm): _r- METHOD OF TEST timeix4-,
10. WATER ZONES (dept)'4590 '
LOCATION SKETCH
11. DISINFECrlON,TYPC a Amount 4Tii-B 5 now dcdon'aatruhna M milts from at least
12. CASING: - - Weg'lhidowss two Stale Roads or County Roads:Include Ow mad
Depth ,,, F si er Welts/Pt -numbs s 1S-c mmon road [tames.
Fmm_�? -_To %X t•T._ha -• =-=. -
From To Ft_ - -
From_ To FLU_
13. GROUT' Depth FMatedk . Method
Frout_Q_ To ouch)
From To Ft.
4. SCREEN: Depth Diameter . Slot rat . , Materiel
From To Et th. in.
From To Ft,_�a in.
5. SAND/GRAVELPACK
Depth Size Material
From To Ii
From To FL
^
L:c,w
1
6_ REMARKS_
DO HEREBYca1CTIPYTHATTAIS WEIL WAS CONSTRUCTED IN ACCORDANCE WITH I5AiCAc2C, WELL •
-ONSIRUCIIONSTANDARDS, AND THAT
AACOPY OP RECORD BEEN PROVIDED TOTB&WBnLOWNElt
y
SKRUITUREOFPERSON CO? RUCUNOTHEWEIL - - DATE -
r�
Submit the original to the Division of Water Quality, Groundwater Section. 1636 Mall Service Center-Raldgh, NC
.27699-1636 Moue No. (919)7334221, within 30 days - - GW-1 REV. 072001

REMENTIAL WELL CONST$UCTION 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
'ttriden Brothers Well Drilling, Inc.
Vir< Contrx-:r 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#(I? applicable)
DVVQ or OTHER PERMIT #(If applicable)
V )LL USE (Check pplicable Box): .R�sse�ss2ii�dential Water Supply
/51 %p
31OD AM PM tyy
COUNTY 1( YIQ,GCJk.Ji7�\
Subdivision. No.. Pareei, Zip Code)
C?'a DRILLED
'I COMPLETED
a. WELL LOCATION:
C'TY:
to
(Street Name, N
TOPOGRAPHIC I LAND SETTING:
❑Slope °Valley °Flat ❑Ridge QOther
. (check appldprlate box)
I._1'TUDE Al 1 I0%P4
LONGITUDEISfl 550
Latrude/longitude source: *OPS °Topographic map
tiocatbn of well must be shown on a USGS fopo map and
attached to this form rtnot using GPS)
4. WELL OWNER
OWNER'S NAME
STKEP/T ADDRESS
Zip Code
May be in degrees,
minutes, seconds or
in a decimal formai
city or n State
(�$596 n'
At a code - Phone number
6. Vit LDETAILS: /-OT
e OTAL DEPTH: (.O lL)
dim
a8
Zip Code
b. DOES WELL REPLACE EXISTING WELL?
� ^YES ° NO PC
tLN e. WATER LEVEL Below Top of Casing: - v.- -FT.
(Use'+' II Above Top of Casing)
d. TOP OF CASINO 18 2 FT. Above Lend Surface'
'Top of cuing terminated at/or below land surface may require
a variance In accordance with 15A NCAC 2C .0118.
aS�IELD(gpm): 3 METHOD OF TEST Blow
1. DISINFECTION:Type H"`T H
g. WATER ZONES (depth):
From el�OOQTo Gef7 10
From 50 3 Toyta
From
6. CASING:
Depth D' meter
From O To Ft. ,�
From .17 To FL 0.s a 18a
From To Ft.
From
From
From
3 t g'�Ar l..
Amount 160Z
To
To
To
Thickness/
Weight Material
7. GROUT: Depth Material Method
From 0 To'-20 Ft. Latta- & bEittlite arced
From To Ft.
From To Ft.
8. SCREEN: Depth Diameter Slot Size Material
Frm 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 Ft.
From To Ft.
10. DRILLING LOG
From To
0 eJJt Clay & sand
Formation Description
.55' 600' Grant to
11. REMARKS:
3r_
wt
1 D0 HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WnN
1SA NCAC 2C. WELL CONSTRUCTION STANDARDS, ANDTNAT A COPY OF THIS
RECORQNAS BEEN PROVIDED TO THE WELL OWNER.
SIGNATURE OF CERTIFIED WE 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 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 2187
WELL CONTRACTOR:
Russell S. Taylor
Well Contractor (Individual) Name
Redden Brothers Well Drilling, Inc.
Weil Contractor Company Name
STREET ADDRESS 73 Holly Hills Vista RD
Franklin NC 28734
City or Town State Zip Code
( 'f•,28 )- 369-9591
Area code- Phone number
2. WELL INFORMATION:
SITE WELL ID A(II applicable)
STATE WELL PERMITN(If applicable)
D. Q or OTHER PERMIT N(If applicable)
N ELL USE (Check Applicable Box):N/yResidential Water Supply�l
4A fE DRILLED C7 � I O - ao ,. ^
h::.DOMPLETED d e AM p PMK.
S. WELL LOC - T OM
CITY: i, I � ! /A/ ' COUNTTYYg7J "(LA(-(JV' ,
CtC
(Street N , Numbers, Commum�Sb anLONo. 'reel,
ode)
TOPOGRAPHIC / LAND SETTING:
❑.Stops DValtey ❑Flat ORldge ❑Other
(check appr5prl.te box)
1lTUDE _ID I ro7a
LONGITUDE & 785(3
Lati ude/longitude source: 1,15 CPS ❑Topographic map
tlocefron of well must be shdwn on a USGS fopo map and
',nacho(' to this form If not using GPS)
4 WEOWNER C'le:JER'S NAME dtains
as�
STfi//EE''E_T�ADDRESS TO ?zit Df'l Oslo
May be in degrees,
minutes, seconds or
in a decimal format
frir Al
11
Otty or Town State Zip Code
( 87-$j. 6,0C1) . I atCoq
Area code - Phone number
5. WELL DETAILS: 9�0
a. ^'OTAL DEPTH: `�
b. JES WELL REPLACE EXISTING WELL? DOn
�
�❑ NO
On 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 aVor below land surface may require
a variance In accordance with 15A NCAC 2C .0118.
e. YIELD (ppm): 1 METHOD OF TEST Blow
. tt
1. DISINFECTION: Typo HIT H Amount 16oz
g. WATER ZONES (depth):
From 3`5To 5(0I)From To
M1traa
From 8 D To Cilia From To.
From To
6. CASING: Thickness/
Depth Diameter Weight Material
From
7Q Ft. (//"
From To $a Ft. �e'� .1(i•
From To Ft. _
Fr-m To
7. GROUT: Depth Material ��y Method
From 0 To-.20 Ft. tbiil & AyAAnite anted
From WTo 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 Slze. Material
From To Ft.
From To Ft.
From To Ft.
10. DRILLING LOG
From Togo,
rr
11. REMARKS:
Formation Description
Clay & sand
Grand to
?7
nm
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
RECOR021AS BEEN PROVIDED TO THE WELL OWNER.
JaGdrJf t J
SIGNATURE OF CERTIFIED
Russell S. Taylor
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 GW1a
Rev. 7105

RESIDENTIAL WELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources• Division of Water Quality
WELL CONTRACTOR CERTIFICATION H 2187
1. WELL CONTRACTOR:
Russell S. Taylor
Well Contractor (Individual) Name
tedden Brothers Well Drilling. Inc.
Well Contractor Company Name
STREET ADDRESS 73 Holly Hills Vista RD
EranklSn. Nr 28734
City or Town State Zip Code
f 828 )- 369-9591
Area code- Phone number
2. WELL INFORMATION:
SITE WELL ID For applicable)
STATE WELL PERMITM(II applicable)
DWG or OTHER PERMIT M(N applicable)
N LL USE (Check Applicable Box): Residential Water Supply
CA fE DRILLED 8 ill 'CDC,
,.,/� ,
TTill F. COMPLETED 3 .00 AM ❑ PM yK
(ttreet Name, NumbeCommunity, SubdMalon, Lot No., Parcel, Zip Coda)
TOPOGRAPHIC / LAND SETTING:
p.Siope °Valley ❑Flat °Ridge °Other
(check apprd�p�box) rlate
J} L. 1 ITUDE bb3�[ p tan /J
IT L?'..^UDESS a 513W
Lz . ,:de/longitude source: ,, PS oTopographic map
tlocatbn of well must be sho n on a USGS topo map and
attached to this form l not using GPS)
e. WE..L OWNER
OWNER'S NAME
SET ADDRESS Zy0 {� " d 1c?
Fl— 3yZ19
Zip Code
May be in degrees,
minutes, seconds or
in a decimal format
City or Town ' State
I -4.394
A'ae • Phone number
6. WELL DETAILS: 7� T
a. TOTAL DEPTH: ( (�
b. .ES WELL REPLACE EXISTING WELL? YES 0 NO skti
c. '.DATER LEVEL Below Top of Casing: - SOO _ FT.
(Use'+' If Above Top of Casing)
d. TOP OF CASINO 18 2 FT. Above Land Surface'
'Top of cuing terminated st/or below land surface may require
a variance In accordance with ISA NCAC 2C ,0118.
e. YIELD (gpm): � METHOD OF TEST BLOW
f, DISINFECTION: Type H4.T H Amount 1 6oz
g. WATER ZONES (depth):pt
From a83 To iSI OSJ From To
From 613 To615 From To
From lio5S To L!/v 7 From Tc
6. CASING: Thickness/
Depth Diamaler Weight Material
From To Z Ft. iosr
From b1 To SS Ft. (G1'
From To Ft.
7. GROUT: Depth Material Method
From 0 To',20 Ft. CEITEl11:. & LIEIITLite Anted
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
0
0
11. REMARKS:
Formation Description
Clay & sand
Granite
A
rt1 9nr.n.
1
I D0 HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH
1 BA NCAC 2C, WELL CONSTRUCTON STANDARDS. AND THAT A COPY OF 71115
RECORD
may/A�$�BEEN
,PR/OVIVIIDDED TO THE WELL OWNER.
SIG ATURE OF CERTIFIED WELL C NTRACTCBIt 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 Service Center —Raleigh, NC 27699.1617 Phone No. (919) 733-701.5 ext 568.
Form GWla
Rev, 7/05

WELL CONSTRUCTION RECORD
North Catalina - Deportment ofLn buomat' and
WELL cotrmen:t 1amt.slAii NAM
ww CDN1IAcrat COMPANY NAME, i ,' e
Roarma- ,. of Wow Quoity- Groundwater Section
r .. • e - cssrnicA•na.e 2734
1 P/ we// i urar� Paola s fazA F V9-O c)
STATE WELL cotelsucT70NMOWN Aso0c1AUDNQlh
(Ifaanliaable) pfmiolWabi.)
1. WELL USE ((rook Applicable Bat): Rsidmtid D iloddpuIfPublic O badmroird CJ AwicuhmN 0
Mooitotiod 0 Recovery 0 Heat Pump Water boon= 0 Other 0 NMI; Litt Um
2. WELL LOCA
Nana Town: /� �/. Cowry C _
)575 nJ,ve /, � n$3
pr.+tiskNeM►Cswt_ fa Lit Ns. 4Cob)
3. OWNER //9/°�y 6/1/9�// ,r
Address 3•/r% OJ,c r .// Rd
n pnoeN tati e.)
Finn
k( r c
c ,ertne art alp Code
T
� seating
DRS
Oat
Iroltakilengltrado ofwon Ina*
t4aua.r....nat)
1 stsddlatgilido waeoKOfiPS Tapopraphie atop
Din Ws)
From To Famarion Deseaiptiaa
C —.>
As sobs 1hn. sake
4. DATEDRIILBD -U L
5. TOTAL DEPTH. -36 -
6. DOES WELL REPLACE EIOSTINO WELL? YBS C NO 3
7. STATIC WATER LEVEL Mow Top dr..; YD PT, •
8. TOP OF CASINO 1S /I) PT. Above Land b9et
flop Oaks twtitrd rst taw trN she moire t -
ins lr rrtirtt sits HA Watt AIM y-
9. YIELD (era): //, METHOD OF TEST . ; %yr et( -
10. WATER ZONES (depth): .
1 I. DISINFECTION: Type Cr he
12. CASINO:
DITFr
Acorns ACy Sbow di ot(a ad sTummos is miles from at loot
War 7hirhaam two Ste Roods or Comfy Roads Imola& for mad
aatbma sad commm ic road es.
l)C-7/
Frosty____ To Pt
From To Ft
13. GROUT: Doh kWrtL
Froen _,tTo 2-0 Ft.�'D/7Cie7e
Fron_ To Ft.
14. SCREEN: Depth Dram Mee Mao MSS
Prom � To Pt.in 1s
Pmze __To
15. SAND#ORAVBLPACK:
Sae Moroni
Fevot_ To Pt.
Frore_To Pt�_
C'
0)-��d
,
!c1/
„l,'vf
16. REMARKS:
1 DO HEREBY CSRTIFYTEAT TIES NR1L WAS
ACCORDANCE wmr ISA NCAC 2C, WBU.
STANDARDS. ANDTAAT t, OF .. RECORD • BEEN PROVIDED TO THE WELL OWNER
1 _k i
Mat the original to trot Division td% w Quality, Grotadwatr Sfla, U36 Me Sonia CAS -Rai** NC
2700-106 PSa Ns. (01f) 733<1214 witty 30 days (iW-1 REV. 0712001

WELL CONSTRUCTION RECORD
North Carolina - Depsctment of Environment and Romances - Di
WELL CONfZACTOa (IltntVIDOAL)I4WCy-�,"
NTS
WELL COACTOS 10 COMPANY NAf/(.VPP $1 Wei -If Y um72
STATE WELL CONSTRUCTION PERMITS ASSOCIATED WQ I'ifi/MITT
Of aweliable) (if tgtplinblel
9
ti
478
f Water Quality - Orotmdwater Section
P 7 cnrwlcwaows27 `/
PHONE # (b23 �+1` _ SAS CD
I. WELL USE (Mack Applicable Box): Reddmtial OreblmicipaYPublic ❑ Intimmial D Agricultural O
Monitoring O Recovery D Hat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION:
Nearest Town: f !'- /9/1K4`-we County M/9C0e2/
5 47fr 1 Ctttcrt ,( 2 ids
(Burt Maw, NNt m too,, Calamity, &arm. Tat N4 Zip Cods)
3. OWNER AI Vie /kt p
Address 2/ l Super Cr era( /t1
/ Cin/?i/ (�eartd G) .9 -7,J 7
City or Ton Stye Yip Cede
(_•)-
Arseodo- ftae aS
4. DATE DRILLED O6,
5. TOTAL DEPTH- 6 -r
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO Er--
7. STATIC WATER LEVEL Below Top of Casing: he, FT,
(( (Um'w' if Above Top ofCseh�
S. TOP OF CASING 1S / G FT. Above Land Surface'
*Top of Mai ermratd.tlsr bow Tad sews mdrst
nrlaa Is smseiaerldt ISA NCAC2C Alt
9. YIELD (gpm): X METHOD OF TEST T;`test L`d
10. WATER ZONES (depth):
Topogriphi,and seating
9RidgeBlilope OValley OFlat
KW* **peptide box)
Latitude/longitude of Well location
meastematesztamon
Latitude/longitude soarce:DOPSOTapographic map
(dtedc box)
gap.T.rNs; Tm
Formation Description
From To
11. DISINFECTION: Type C C M Amona
12. CASINO: Wall Thickness
Disc or Weight/Pt Mtaerid
From T 4'O FL 9bk'2/ PUG
FranTo Ft
From_ To Ft
13.OROVI:d DtpW Mnmial
F To�PLa/lG/8�Y r" i,r
` I ATIMST07.121
CT
Show direction and distance in miles from at last
two State Roads or Cotmty Roads. Include the road
numbers and common road tames.
From To Ft ! a
14. F=-- Depth Disaaew Slot Slat Mini
To Ft_in. in.
FroD_ To Ft_in. in.15. SAND/GRAVEL PACK:
Depth Size Malarial
Froal To Ft______
Frenl_To Ft.
16. REMARKS•
yi.
u el/ e fie/ fill/
.,„r
•
I DO HEREBY CERTIFY THATTH44 was WAS CONSTRUCTED
CONSTR STANDARDS, At�T1 IT ACOPY THIS
ACCORDANCE WEE ISA NCAc2C, WELL
HAS BEEN PROVIDED TO THE WELL OWNER
GTHE WELL
Sant tbe orightl to tbe Divides of Water Quality, Groundwater Section, (i36 Mall Service Caster -Raleigh, NC
27699.1436PLoue He. [phone], w*kln 30s1a7L 43W-1 REV. 072001

e :z
e1 0
CO7 11y,1,T1pN STANDARDS, AND Tj�1T,A�TiBB
477
WELL CONSTRUCTION RECORD
North Carolina -D,nct nofEtwboaertiod Nevi Raaevuoes-Dalian Water Qudky- Groundwater Suction way cawnucron pravinume '/ %7 L . 0 -3-: aurrmac*TIocr a 2 7 p r
1
wsu, w.auucros coetwAay Nan ✓c.V rP U.�r� / w e/ Witt saes s �n 6 5��%G c
arm WILL oownncnon PR11Qn MSOCIAiip WQ Mterran
(Itesogtebls) ffesdbrb)e)
1. WELL USE (cheek Applied/bibs): lbidntW ET Aoddp.YPublic O LdctnW O A,Seiadcned 0
Maturing 0 Recovery 0 Hest Poop Water 1 rtk u 0 Other 0 If Other, Lit Use
Z r,
t.erlemattemar kbasi ,Iatli.atCNS
3. OWNER; /J 1/404//t es
Addate S72 ."'Moe AV
te fi'/9C4,k-) n Xe. Z$ 95-- 3
ant Ma a.r 32/Ctib
mean* inem sear
4. DATEDRILLED ZZ-06
5. TOTAL DEPTH: Ytt)C
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO D
7. STATIC WATER LEVEL Below Top of Codas SAS ' PT k%
8. TOP OF CASINO IS /8 " Pr.Aban Laod 3wS C
'Tip daubs rdnrt etlr tdea het gabs near
also ae.ea...rr ISA /SCAM Ant
9. YIELD Ups* 5 MRTHOD OF TEST le; eni
10. WATER TONES (deplb):
UreliiZaLSEncli
Show *soda ad disens In miles from et )risk
two State Roads or city Roods. lads& the rood
ambers end commas road
soma. �ti'7j7
Topostipblistand setting
CMS 11.1opOVatley OPW
sm appeodestbad
1a knt&sgitade.fNadi Ina
(Werwm aa•sen.b)
L laddlasgMrd. ro.ea.0(31e90Topagnphie amp
*ea win
Pram To Formetion Dmmcipdaa
11. DISINFECTION: Type CC# Amend AO Or.
12. CASING: agi- fJ Drs�r METheis
Pratt_ To Pt !P i"N 5.0 MSS
ProuL___ To Pt
Prac._To FC
13. GROOT:�{ Dallnafi
Prom_ _To 2. n pt,l ae2crele .0
Rook—. ToPt
14. �� I-��// Deer► Demeere SIR iSian aid
rrom_/_ To Ft. M. L.
From__To FL —it in
15. SAND/ORAVELPACK:
. To
R SMaeMord
Prom /
Pcom_To P1-
IQ REMARKS:
cn m
At
ate[ e
I DO EMIESY C2at1111YTIEAT MS VIOL WAS 02iSTUC1 EN ACCORDANCE WITH ISANCAC 2c, W1EI.L
HAS MIDI PROVIDED TOT= WELL OWNER
S1OI(A11/1111 Of PDX* • • , THE WELL DATE
Sabah theoriginal totbeDtelahaedWaterQuality, Groundwater 8. Sa,16+6x.RSawaC.a..wMigkNC
rams% PisraNs. pep IMAM. mil* 3gHors OW-1 REV. 07/2001

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) Nsme
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
Zip Code
Area code- Phone number
2. WELL INFORMATION:
SITE WELL ID #(if applicable)
JTATE WELL PERMIT#(If applicable)
DWQ or OTHER PERMIT #(If applicable)
WELL USE (Check Applicable Box): Residential Water Supply ID
Ap
DATE DRILLED C I I 0(17
TIME COMPLETED WMMAM ❑ PM &
3. WELL LO TION: I,
'NTY (� W t COUNTY .00
=e —P�
(Street Name, 'umbers. Community bdivision, Lot No., Parcel, Zip Code)
TOPOGRAPHIC / LAND SETTING:
❑Slope °Valley ❑Flat °Ridge ❑Other
(check appropriaterbox)
LATITUDE pp�� 3r��1_n QQ
LONGITUDEg3 go %On'S
:atitude/longitude source: ❑GPS ❑Topographic map
(location of well must be sho n on a USGS tope map and
attached to this form 1( not using GPS)
t WELL OWNER
OWNER'S NAME
May be in degrees,
minutes, seconds or
in a decimal format
ST
ll Ltai G A -RJ1n7
Oily W Town State Zip Code
Area code • Phone number
EET ADDRESS
5. WELL DETAILS: r
a. TOTAL DEPTH: 406
b. DOES WELL REPLACE EXISTING WELL? YES ° NO
A
WATER LEVEL Below Top of Casing: 0.55 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 Blow
6. CASING:
f. DISINFECTION: Type H T H
Amount 160z
g. - WATER ZONES (depth):
From 153 To From To
From 1 jp 3 To 1 From To
From To From To
Thickness/
Depth Diameter Weight
From 49
To Ft._(�_ O
From 3 To r a
From To
7. GROUT:
0
From
From
From
Depth Material
To 20 Fvement & benonite pumped
Material
To Ft.
To Ft.
Method
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
From To Ft.
From To Ft.
From To Ft.
ret
Material
10. DRILLING LOG
From To
11. REMARKS:
Formation Description
clay & sand
grant t-a
T {
"t7 em
1 • w
tT -?
I D0 HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH
iSA NCAC 2C. WELL CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS -
RECOAt1 HAS BEEN PROVIDED TO THE WELL OWNER.
NATURE OF CE
WELL CONTRACTORT 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.,
1517 Mall Service Center- Raleigh, NC 27699-1617 Phone No. [phone] ext 668.
Form G W-1 a
Rev. 7/05

. "
3 9 6 u, A
• • • SYRIA coNsnivenoptitzbenry
ro._ e . .
• _ .
Nonhesseeron-Deparizant oflinviram;mThanditaterd • H'au •-• Quality: eiviadArier Sirdon
wELLCONTRACTOROMMEIDUALMEZ OrEilLarnEllS 111320164,-z7 apolemoig _ te,
ww-corrincroaccarminualtPM- +tugf1IJr tghl11-at i'vuoirtiatst{s2j—" °
STATE vittl.CONSTRUCTION ninths Anw*Asn
. - a. - - -
I. WELL USE (Ora Apicable-Box)-Iteideariare, timicips' EN& nodusitial EI Agrionlioad•P
- ` Monitoring 0 Rearm, El- - Hest hunp Wiwi Injection El Other a If otter, List lbc, - •- - - -
. • : -
1-WELL LOC.A1101t
-1'.1TrovM__,Eddr Ade- / ;./1/ - County14.4-Ca"---• " ' - air rgioictagreysetting. Dint R. a, .arittima„Lacl- 101;re 144 1 I Q 1934; Woe% asistsdiwIro0 -
mow tuawashises.commimdtiake.tatth.Se ' Cailtutlerfiongitudo &1001 WOE 4011 .
... . -
- • .
3. owpa O Li Y c., 14; i I Cr- (TV". i Cr i-I-Alokci- • (dapecinWMWM*010
Addams - a.A11-9 tOt; ve-ta a ILA . IsikutleflongilMitt souramOGPSEIToposmphic MIT
r---, Zia / smi.) 4/C.d. 41-P7L -4 P. . .- M.
. . . "licklttkLING LOG
Carenatorelio4 - ..- - a a , -
Orfor7rom SS , .1 - rip ads - . . Prom To - fOgiudion Description
CR APS- 3b9- a 9 ' ' _- - . -. - :_ - . ,. . - • p .6, 6 • e Lao
_
4. DATE DRILLED 6 - A V ---- e) Co . . 1112 Ail. ' /aer
tam rodo- Thaw amber r--,
to 04 • tax-5- al n to ap at ) t -e-
l. TOTAL DEPTH.* 4,5.c , - 1
6. DOES WELL REPLACE EDGETING WELL? YES El NG: ilif
7. STATIC WATER LEVEL Below Top ottani' g 1-3 0 FT:
Weer 'Aims Top ottosipr) .
R. TOP OF CASING IS FT. Above Land Wart
"Tap of nil% taradsdatatiar beef Imodaiscerespdris a . c
mina= Is amordsom idillinniCAC3C Alt i i, • -
9 YIELD (gputX i 0 METHOD DETEST jelinglilgt
10. WATER ZONES (depth): 1-2 b i . (1-0
WCIONITLELETtli
t 1. DISENFF-CTION:yypc lif-ill- , Amount ca TA 43 5 Show &cam antlaince In miles from at least
12. CASING: Vhfilbickness . Iwo Sista Roads or County Roads:Include the mad
A DtIdk ,, Marcia _or WeijiMpt. *t 'numbers and -common toad namc
Li /0
s.
From . To 0 FL &'"! aii(2t3. .
From ToYLL- • -
FmutTo a--,•,—
13. GROUT: Depth bbteriii
From n Toa MSS
- ' pew.A3 - . - - c-)
a
From__ To 'Ft - •-• i' '" • ' ('0' 6 LLl....a k_o
4. SCREEN: Depth Diameter . SlotSia : s histrial
From To__ Ft_ht.
az?
From To Ft. in. • =-..
5_ SAND/GRAVEL FACK:
Depth Ma Material - -
From To Ft._
From To FL__
•
6. REMARKS:
DO HERESY claw MATTERS WEL WAS CONSTRUMED INACCORDANCE van, v Mix •
I:INSTRUCTION STANDAIMS, ANDTIIAT A COPY OF RECORD BEM PROVWEDTOTHEWBIL OWNER
4111 -
sifit!AnteOF PERSON cotanuentanint vim; . • DATE - 1
Submit the origin' al to the Division of Water Quality, Groundwater Section, 1636 Mail Service Coder -Ibleigb,-NC
•17699-1636 ?boat No. [phone], within 30 days. . GYM REV. 07/2001

North
WELL CONTRACTOR
WELL cottTascrotcornier
STATE WELLCOMEDOWN nnd''H
Cattpptieabte]
- WELL CONSTRUCTION RECORD :: 3 1 3 9 a
- Dep ut meot of Bnrhomneuc and Nolan
d Resources-- Dirt - Hof We6w_Quality-: OrMaitteiter Soda=
tgc1SLvlmjS /4nfinaA,-°- - t 1/ ��4
:ewonicat...524-3 249 0
attplieahle] -
1. WELL USE (Check AppEtable Bmc)-Rea t IPab& 0 Industrial 0 AgSu iutal
� MonittgCI Raay ov0' Hest Pimp Water Injection Other Ifother, List Use
2_ "WELL LOCATION:- T-WLSsalting
NesrestTovro F/4 a,U/cL/ Y.,/J44 (G,�sr✓ �Rt'd Malloy .Clflat
941 S /17 P CI t) e'G-Ret _ • k n 1 (ehadta' aateri bax) -
(Street/km, Cnaamtp�
agyt(den4ettta,rpCede) I4tutMo g?itodacfviCFUb�
av
3- OWNEILY! 'p ►' FA lJ S
Address3 2 L a r e !P L.
(Skelteiamae -
515 Li 01 adz"
CalorTaaa 51aa /-•' Zip Code
(2 g- 39t-Ss92.
Ara man Mem wants .
4. DATE DRILLED ' —/ - - —/)T
5. TOTAL DEPTH: /OF>. S�
6. DOES WELL REPLACE EXISTING WELL? YES.0 N(}:21-`
7_ STATIC WATER LEVEL Below Top ofCask g: / 02 FT.
(User ^ (NALae Ttp dCa+tgv
L TOP OF CASING IS 1 FT. Above Land Surfaces
wry ofeads:taatatad rltet�kaieofiw.Maieea --
edam* is amtdam 75AIICtCZCSUR
R. YIELD METHOD eft Tasty) v.Q-�
10. WATER �ZONES (depth):SYS' 1 �! (I
Le60addlotggodo smuccOOPSETTopographic map
• Meet bra)
"DEPTH - DRILLING LAG
-Fmm To ' FtitotedmeDescription
n ,die.
/i sJ
- `Y' , /L1r75"
Gm % t-Je-
LGCA-TION SKETCH
11. DIS(NFECTION;Type -_ Amount .-2 TAR 5 Show trueetim ttnddiatataat In miles from at least
12. CASING: _ - Well Thickness - too Stabs Roads arCounty Roads.-Iacludathe road
Depth Ft r or Waite Tmmhas and -common toad names.
From__ To
From Tp
13. GROUT_ Death Moot. Method -1
From_-S—Taa
p -
From To 'FL
-4. SCREEN: Depth Diameter . SlutSme - Material • -SEP r nnn5
Fram To Ft.ia in ^ a ;
Ram To FL in. in.
5_ SAND/GRAVEL PACK: _
Depth roe MstnW
From To FL -
From To FL -
6_ REMARKS:
c-�
N
0
•
DO HEREBY CeaTITIFYTHATTIiISWELL WAS LZ communion IN ACCORDANCE win' mine= viluX -
ONSTRUCTIJSCANDARDS,ANDTHATAC0PYOF tHIS RECORD BB@IPIlOVIDEbTOTIOLVIE LOWNFR
071dill y/-1-0
SI(RiATUREOFPERSON C R 37RDCTBicT'i Ewffl - DALE - :
submit the original to the Division of Water Quality, GrotutdmateY Section, I636 Mall Service Center -Raleigh; NC
27699-1636 Puce Na (919733-3221, Within 30 days. - - G5W-I REV. 07/2001
o
r

RESIDENTIAL WELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources- Division of Water Quality
WELL CONTRACTOR CERTIFICAT ON
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)
STATE WELL PERMIT#(if applicable)
DWQ or OTHER PERMIT #(If applicable) r'
WELL USE (Chec Applicable Box): Residential Water Supply7` 14f
DATE DRILLED 24010
-'f1ME COMPLETE S r 00 AM ❑ PMM1
S. WELL LOCATION: �////((������
Y: /1 4a... _ COUNTY ! f"cei
(St % t Name, Numbers, Community, Subdivision, Lot No., Parcel, Zip Code)
TOPOGRAPHIC / LAND SETTING:
DSlope ❑Valley OFlat ORidge pother
(check appropriate box)
. /
TITUDE pp33�5 14968 '4
JNGITUDE y3 gp 155 (03
tatitudeilongitude source: AGPS ❑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
ST'EETADDR SS
„Pity or Town
Area code - Phone number
May be in degrees,
minutes, seconds or
in a decimal format
Zip Code
S WELL DETAILS: ,r r
a. TOTAL DEPTH: 1LJ SILL
b. DOES WELL REPLACE EXISTING WELL? YES50 NOy
c. WATER LEVEL Below Top of Casing: Sop FT.
\
(Use -+° it 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 accgdance with 15A NCAC 2C .0118.
e. YIELD (gpm): METHOD OF TEST Blow
2045
I. DISINFECTION: Type H T H
Amount 160Z
g. WATE�R�ZOy FeS (depth):
From -�,JdTo- From To
From %Q�To From To
From To From To
6. CASING: Thickness/
1-‘ Depth Qd/ • Di mjer Wr;igghtL ten
From (/ To 0 7 Ft. gi h
3
From To Ft.
From To Ft.
7. GROUT:
from 0
Depth Material Method
To 20 Amment & benonite pumped
From To Ft.
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 To Ft.
From To Ft.
Material
in.
in.
in.
•
Size Material
From To Ft.
10. DRILLING LOG
From To
11. REMARKS:
Formation Description
rlay & sand
gran 1-e
c---
c-
I D0 HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH
ISA NCAC 2C, WELL CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS
RECOR• BEEN PROVIDED TO�THE
WELL OWNER.
ar
S MATURE OF C 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 566.
Form GW-la
Rev. 7/05

RESIDENTIAL WELL CONSTRUCTION RECORD
North Carolina Department of Em Vonnfent and Natural Resources- Division of Water Quality
WELL CONTRACTOR CERTIFICATION # 2045
1. WELL CONTRACTOR:
James B. Brown
Well 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 )- 369-9591
Area code- Phone number
2. WELL INFORMATION:
SITE WELL ID #(if applicable)
STATE WELL PERMIT#(if applicable)
Zip Code
OWQ or OTHER PERMIT #(if applicable)
:ELL USE (Chec Applicable Box): Residential Water Supply
DATE DRILLED
TIME COMPLETE . 00
AM PMX
3. WELL LOC TION:
CITTY�jhJ�l�"�' CQUNTY `LK.(le'--'
Lateocrixtos 1
(Street Name, Numbers, Community, SubdiubdiNsion, Lot No., Parcel, Zip Code)
TOPOGRAPHIC / LAND SETTING:
❑Slope ❑Valley OFIat ❑Ridge ❑Other
(check appropriate box)
LATITUDE .i51Lo er1Ou7AJ
.ONGITUDE 8 so I57 13
rtitude/longitude source: �iiPS ❑Topographic map
(location of well must be s/,o�,n on a USGS topo map and
attached to this form y of using GPS)
May be in degrees,
minutes, seconds or
in a decimal format
S. WELL OWNER
OWNER'S NAME
T ET Aa DRESS
City or Town Zip Code
OIJT
Area code - Phone number
5. WELL DETAILS: '/��
a. TOTAL DEPTH: �-(f
b. DOES WELL REPLACE EXISTING WELL? YES D'' `` NO(
c. WATER LEVEL Below Top of Casing: 3 5 V 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
4 9
99
f. DISINFECTION: Type H T H Amount 1 60z
g. WATERZONES(depth):
From )O9 I ' To
From
From To
9. CASING:
Depth
To
From
From
From To Ft.
Ft.
Ft.
From To
From To
From To
Thickness/
Diarnler Weight
. ifMaterial
a �(
7. GROUT: Depth Material Method
From 0 To 20 FGement & 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: N
Depth Size Material
From To Ft.
From To Ft.
From To Ft.
10. DRILLING LOG
From To 7�
0
70' 4Jt'
r-r'
ih,pr
11. REMARKS:
Formation Description
clay & sand
gr-anttP 1-1
Dr.
N
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH
15A NCAC 2C, WELL CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS
RECORQ.H4S BEEN PROVIDED TO THE WELL OWNER
AT RE OF CE 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.,
:17 Mail Service Center— Raleigh, NC 27699.1617 Phone No. [phone] ext 668.
Form GW-la
Rev. 7/05

RESIDENTIAL WELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources- Division of Water Quality
WELL CONTRACTOR CER1 iFICATION # 2045
2
f 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
"ELL INFORMATION:
SITE WELL ID #(i1 applicable)
TATE WELL PERMIT#(if applicable)
DWQ or OTHER PERMIT #(if applicable)
'JELL USE (Check Applicable Box):
Residential Water Supply ❑
DATE DRILLED 7 .615
TIME COMPLETED /Z . DO
C. WELL LOCATION:
CITY:
AM D PM X
COUNTY Mar.
heel Name, Numbers, Community, Subdivision, Lot No., Parcel, Zip Code)
C POGRAPHIC / LAND SETTING:
;]Slope D Valley ❑Flat ❑Ridge DOther
(check appropriate box)
LATITUDE /3 i 644 May be in degrees,
nQ minutes, seconds or
LONGITUDE d 3 41 / / 3163 I in a decimal format
Latitude/longitude source: ,GPS ❑Tcpographic map
(location of well must be shoubn on a USGS topo map and
attached to this form if not using GPS)
"'ELL OWNER
NNER'S NAME
STREET ADDRESS142 O
City or Town State
(22 )- 349.4'74
area code - Phone number
E 9S734
Zip Code
5. WELL DETAILS: y
a. TOTAL DEPTH: 41.76
b. DOES WELL REPLACE EXISTING WELL'? YES NOk
c. WATER LEVEL Below Top of Casing: Sin FT.
(Use "+" if Above Top of Casing)
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): 2 METHOD OF TEST Blow
2
f. DISINFECTION: Type H T H Amount 1 60Z
g. WATER ZONES (depth):j
4A 4t(
.2 From To_From To
From To From To
From To From To
6. CASING: Thickness/
jt Dept Dipmgler Weight Material
From Li To Ft. Le
From'9 3_. To Ft.= i/fl
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 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
C
1i. REMARKS:
Formation Description
clay & sand
granite
A `•J
C
is
CO r:'__!
.21
o
DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH
I5A NCAC 2C. WELL CONSTRUCTION STANDARDS. AND THAT A COPY OF THIS
RECORDS BEEN PROVIDED TO THE WELL OWNER.
7
SI ATURE OF CEFiI-IF D WELL CONTRALTO 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

• WELL CONSTRUCTION RECORD' -:
Nodh Carotitta - Department of Snr4marmt adfwRa1 Rmowces - Division of W Quality-- Groundwater Section
WELL cotTnwctagwitai utwm $(pdaovi3lnnts • J4j'J0,+..t,' _ ` CE4TiiCATlON4•l4'
WELL CONTRAcrORCOMPANY
STATE WELL CONsTtuctlotf PE aderi .. - ASSOCIATED
APPlioags) ' .
((fappltable) .
mitt is a y-3 ab O
1. WELL USE (Check Applicable'Box):-Residauialt ipal/Pubfc 0 Industrial 0 Agricultural 0
Monitoring ❑ Recovery ❑- Hat Pump Water Injection ❑ Other U If other, List Use -
Z IYEI LtLOCATIOfF A Tice l e id setting •
1��1-1+ � fC-1•} ►z a >Y1 o tz �/Yt�A- aGex_g�73 tf (�t�powlr�uoy
t Comma*, tode/!ongt
3. OWNER:U u •e t
Address " �t63 3 )-1.e5 . C;zM,, r Tara
5DUAR -1 mil- 3 4 R $ r!
Coy'orToro State •' /. - tip Code.
nix- as, 1-iS3b - -.
Ara code- Moe ember
4. DATE DRILLED £ �✓ U -0 Co
5. TOTAL DEPTH' , O, S ' •
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO-.
7. STATIC WATER LEVEL Below Top ofCasing: 4'0 FT.
(User ifAMeeTop of Carlos)
8. TOP OF CASING IS __ FT. Above Land Suffice'
'Tep efatlegt.aioandatWoebain(pitar6M maim a .
causes Is amrdaaa'4r-/SATICAC2C.611i.
9. YIELD (spats): ` ' METHOD OF TEST
10. WATER ZONES (depth): % 96
N Town: rt ii/Li</; it) County °Rid °Va y OBlat
saeetttmc, Numbed, ,Sut�6vhk. Ait,Z.Ccde) - Lab - ius&ofwelliocatim
11. DISINFECTION:Type
12. CASING:
From_0 Topic)
From To
From Ty Ft_
13. GROUT_ Depth Material Method -
From_To .ty- F L7(ij4il/
From To Ft. r
Latituddf«gihide graphic map
• (ebadcboo) -
"igna - DRILLING LOG
From To
c"- fos
NSF Amami C2Th-85
Wan Thiehtas
«wt�itupt.
Ian
�:
4. SCREEN: Depth Diameter - Slot Size - . Materiel
From To FL_ in. in.
Front______ To FL in. in.
5- SAND/GRAVELPACK
Depth Sac Material
From To FL -
From To FL
6- REMARKS:
otmaPotn/�Description
LU=e /2Qnrfa"
LOCATION SKETCIj
Show direction outdistance In miles from at least
two State Roads or County Roads. Include the road
-,umbers and common road names.
Co)
rel
tV
DO HEREBY CERTIFY TEEMS WELL WAS CONSTRUCTED IN ACCORDANCE Wl1H ISAI NCAQ2C, Vial. •
-ONSTRUCTIONSTANDARDS, AND THAT ACOPY OFT" RECORD BEEN PROVIDED 'IOTHE-WELL OWNER
&Lk / @(Iysr - 3 0- —0-0
SIGNATURE -OP PERSON O»mRUCTINOTHE W&L - - DA E
Submit the original to the Division of Water Quality, Groundwater Section,1636 Mall Servla Center -Raleigh; NC
„17699-1636 Mate Na (919) 7333321, within 30 days. - . GW-I REV. 072001

RESIDENTIAL WELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources. Division of Water Quality
WELL CONTRACTOR CERTIFICATION N 2187
1. WF' L CONTRACTOR:
ssell S. Taylor
W s Lontraclor (Individual) Name
Holden Brothers Well
W e7 Contractor Ccmparty Nt.T 6
STREET ADDRESS 73 Holly
Franklin. NC 28734
City or Town State
( 828 )• 369-9591
Drilling, Inc,.
Hills Vista RD
Zip Coda
Area code- Phone number
2. WELL INFORMATION:
SITE WELL ID CU applicable)
S " F WELL PERMITS°, applicable)
D •"-;:r OTHER PERMIT N(If applicable
'V 5LL USE (Check Applicable Box):
DRILLED
TIME COMPLETED C PM it_
3. WELL LOgqyyATION; ^ . �
CITY:,71 COUNTY ' IIGL n4.—.)
I 0
me et Name, Numbers, Com ity, Subdivision, Lot No., Parole, Zip Cods)
T."r` . GRAPHIC / LAND SETTING:
°;Wpe °Valley ❑Flat ❑Ridge COthar
(check apprdpdate box)
L, 1,TUDE ,�
LONGITUDE MAU
Latin:de/longitude source: PPS Topographic map
t/ocathn or well must be shown on a LJSGS fopo map and
attached to this ram X not wing GPS)
Residential Water Supply 0
11,
5,ygo
AM
May be in degrees,
minutes, seconds or
in a decimal format
4, WELL OWNER
OWNER'S NAME
ST 'EET ADDRESS
t or Town State Zip Cale
L 9'IL-,771- Jana-
„ :ea code • Phone number
5. WELL DETAILS: / 601
a. TOTAL DEPTH: (f
b. DOES WELL REPLACE EXISTING WELL? YES 0 NO ,
c. WATER LEVEL Below Top of Casing: - 070 -FT.
(Use ••' if Above Top of Casing)
d. "'OP OF CASINO IS 2 - FT. Above Land Surface'
'Top of caning terminated at/or below land surface may require
a variance In accordance with 15A NCAC 2C .0118.
e. YIELD (ppm)• (Do METHOD OF TEST Blow
6. CASING:
.12
f. DISINFECTION: Typo HIT H Amount 16oz
g. WATER(depth):
OZONES
From 1 10 To I akO From To
From To ' From To
From To - - From To
Thickness/
Depth
To Ft.rrryryyy D amejer Weight
—�' ateriai[ From
From" - To Ft, 9 � :go
From To Ft.
7. GROUT: Depth Material
F rem 0 To720 Ft. 03TEl t & i331T11ta Anted
From To Ft.
From To Ft.
8. SCREEN: Depth Diameter Slot SIPA
From To FL In. In.
From To Ft. in. In. _
From To Ft. in. in.
Method
Material
9. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
From To Ft.
10. DRILLING LOG
From To
e
Mtge
11. REMARKS:
Formation Description
Clay & sand
V
O'
I D0 HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE W RN
15A NCAC 2C, WELL CONSTRUCTOR STANDARDS, AND MAT A COPY OF THIS
RECORD HAS BEEN PROVIDED TO NE WELL OWNER.
SIGNATURECERTIFIED JWELL C
Russell S. Taylor
IL/ACTOR DATE
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.
SEP 2 7 2006
Form GWIa
Rev. 7105

RESIDENTIAL WELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources -Division of Water Quality
WELL CONTRACTOR CERTIFICATION # 0 `-[/
1. WELL CO CTOR:
/. J r L (.r a 1-Hru. L-
WeJI Contractor (Ind idual) Name
AAA GREENE BROS. WELL DRLG. OF SYLVA, INC.
Well Contractor Company Name
STREETADDRESS 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)
Zip Code
flprc-,�,
STATE WELL PERMITIQi applicable)
DW Q or OTHER PERMIT #(d applicable)
WELL USE (Check Applicable Box): Residential Water Supply ❑
DATE DRILLED .5 - I Y - G
TIME COMPLETED J AM ❑ PMy.
3. WELL LOCATION: / �'/\
CITY: CLl Vie-1 COUNTY /I�L%Gc71-‘---
LLl; /id j/p e-t :Judd "AY5`
(Street Name, Numbers, Community. Subdidsion, Lot No, Parcel, Zip Code)
tT�OPOGRAPHIC / LAND SETTING:
,tgslope °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
(location of well must be shown on a USGS topo map and
attached to this fom, if not using GPS)
4. WELL OWNER
OWNER'S NAME L-(� f 1 (no -
STREET ADDRESS J
ti-`4 /1
City or flown State
Area code - Phone number
5. WELL DETAILS: /7
a. TOTAL DEPTH: / 7
efl r,Cff£KII,'
k
c_ 73 S—
Zip Code
b. DOES WELL REPLACE EXISTING WELL? YES 0 NO ❑
c. WATER LEVEL Below Top of Casing: 0 FT.
(Use'+' i( Above Top.of Casing) -
d. TOP OF CASING IS / Y-2. FT. Above Land Surface•
-Top of casing terminated at(a below land surface may require
a variance in accordance with 15A NCAC 2C .0118.
e. YIELD (gpm): 6 v .METHOD OF TEST A)
f. DISINFECTION: Type
g. WATER ZONES (depth):
Fro
From CSC To /. 5 d^C From 7� Ll To ��
From 37 0 To cf. From To
From ( 0To (^ (.3 Fran To
6. CASING: Thickness/
Fran DTo % /� FL/ //,'.goial
.0 Z JWeight Mat/-"V C
Fran To FL`�� /J
From To Ft.
Amount ; 7A) ct*cEa
7. GROUT: Depth Material
From To Ft.
Frcm To Ft.
From To Ft.
Method
8. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in. - From To Ft. in. in.
Fran 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
a
1 DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH
15A NCAC 2 ELL CONSTRUCTION DARDS. AND THAT A COPY OF 11115
RECORD S 8 EN PROJIDED TO OHE WELL OWNE
-3o -a
SIGNATURE OF CERTIFIED DATE
r G n / rib C CC --
PRINTED NAME OF P SON CONST UCTING 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.
�n,n
Form GW-la
LI.Ur,J Rev. 7/05

RESIDE! iIAL WELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources -Division of Water Quality
WELL CONTRACTOR CERTIFICATION # 3 0 7 /
1. WE
ONT/RAC7.3R:
Well Contractor (Individu� Name
AAA GREENE BROS:
/2.4. ram.
L DRLG. OF SYLVA, INC.
Well Contractor Company Name
STREET ADDRESS 1800 SKYLAND DRIVE
SYLVA
NC 28779
City or Tavn State Zip Code
( 828 ). 588-5550
Area code- Phone number
2. WELL INFORMATION:- M(,Q,t. G7T`-.)
SITE WELL ID #(it applicable)
STATE WELL PERMIT/Nit applicable)
DWQ or OTHER PERMIT #(If applicable)
WELL USE (Check Applicable Box): Resipeential Water Supply $
DATE DRILLED 3 -r9 3 "L) "" ���/// , `
TIME COMPLETED 5 AM O PMX
1. WELL LOCATION: 11
CITY: CLl LLIs COUNTY jl' C(•7�
U) I4+Iow SULri i4)oJ!3
(Street Name, Numbers, Community, Subdivision, Lot No., Parcel, Zip Code)
TOPOGRAPHIC / LAND SETTING:
❑Skrpe DValley ❑Flat 110idge ❑Other
(check appropriate bm)
LATITUDE
LONGITUDE
Latitude/longitude source: ❑GPS Topographic map
(location of well must be shown on a USGS topo map and
attached to this form Bnot using GPS)
4. WELL OWNER •
OWNER'S NAME U )4-1 (TN ek- (tLVr^Itirk s`
f) STREET ADDRESS 5:2 rgUzett ►m, .- 1.. Jr? L-
L3;-f. n•Psu.11 t (\1C ?761" s
City 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: /Get-)
b. DOES WELL REPLACE EXISTING WELL? YES ❑ NOA
c. WATER LEVEL Below Top of Casing: 7 U FT.
(Use'+• if Above ap of Casing)
/
d. TOP OF CASING IS Z FT. Above Land Surface'
-Top of casing terminated at/ar below land surface may require
a variance in accordance with 15A NCAC 2C .0118/.�
e. YIELD (gpm): / /(i METHOD OF TEST /4I r
2i ? n A w
A ! 4
1. DISINFECTION: Type
g. WATER ZONES (depth):
From S To c1,9 7 From To
From To From To
From To From To
Amount
6. CASING:
Thickness/
Depth Diameter Weight Material
From To Ft.
From To Ft.
From To FL
7. GROUT: Depth Material
From To FL
From To Ft.
From To FL
Method
8. SCREEN: Depth Diameter Slot Size Material
From To FL in. - in.
From To FL 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
2-2 --- /vX-
II. REMARKS:
Formation Description
C3
I-
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCCRDANCE WITH
15A NCAC 2C. LL CONSTRUCTION STANfAFf'S, AND THAT A COPY OF THIS
RECORD N Pgp'NDED TpiAE WE
•
/3A�.
SIGNATURE OF CERTIFIED WELL CONTRACTOR r DA
PRINTED NAM OF PERS N CONSTRUCTING THE WELL
Ok
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.
v_. Y
Forn GW-1a
Rev. 7/05

RESIDEM'IAL WELL CONSTRUCTION RECORD
North Carolina Department ofEEnv ronment and Natural Resources. Division of Water Quality
WELL CONTRACTOR CERTIFICATION # 7 0 /
1. WES,LCONTRACTOR: Ce L L.1 /' NR n I -y-- aici c
Well Contractor (Individu Name
AAA GREENE BROS. ELL 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)
STATE WELL PERMIT#(if applicabe)
DWQ or OTHER PERMIT Of applicable)
WELL USE (Check Applicable Box): Residential Water Supply7�
r '
DATE DRILLED .:2)- % - D }C?
TIME COMPLETED 5 Amp Pptyy
I�
3. WELL LOCATION: C-/ '
CITY: 1 t L^7.�I e'er COUNTY I� y (. ✓��
, y1� t
1+1'e, brs l.o mnit u iio (.
(Street Name, tubers, Community, Subdixsion, Lot No, Parcel, Zip Code)
TOPOGRAPHIC / LAND SETTING:
❑Slope ❑Valley ❑Flat Aidge
(check appropriate box)
LATITUDE
LONGITUDE
❑Other
May be in degrees,
minutes, seconds or
in a decimal fornat
Latitude/longitude source: ❑GPS ❑Topographic map
(location of well must be shown on a USGS topo map and
attached to this tom, if not using GPS)
4. WELL OWNER // � /I
OWNER'S NAME (A f I if) e:-L. etr-nit cc,
STREET ADDRESS 5- 2, SU
rprle id. 4re.=
tA)Ar"nVLl: ll 1V'C QY701 C.
City orlfown State Zip Code
i
Area code - Phone number
5. WELL DETAILS:
a. TOTAL DEPTH: 87.5-0
b. DOES WELL REPLACE EXISTING WELL? YES ❑ NO 4(
c. WATER LEVEL Below Top of Casing: 4 VFT.
(Use'+' if Above Top of Casing)
1
d. TOP OF CASING 1S I % FT. Above Land Surface*
'Top of casing terminated at/or beiow land surface may require
a variance in a(cjfo�rdance with 15A NCAC 2C .0118. /
e. YIELD (gpm): 1 ) METHOD OF TEST
t. DISINFECTION: Type HTH
g. WATER ZONES (depth):
From ./ V OTo / 5 3
From:TOO To S/C)S—
From To
6. CASING: C
From D DepToth
dr/ FL
From To FL
From To FL
From
Flom
n!2e c rIJ
i 1 re .
Amount;)'/
From
Qiarpejer
To
To
To
Thickness/
Weight
40e 2/
Material
V c'(i
7. GROUT: Depth Material Method
From To FL
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
r) _- r//-,
n. -icy
/CC -/ f�
/S'3— 7co��
71 o
3' C' S— _ S') ✓
11. REMARKS:
L
/V L
G
'.O
100 HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH
15A NCAC 2C, WELL CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS
RECORD SPROVIDED T WELLO !E.
SIGNATURE OF CERTIFIED WELL C RACTOR AT
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. Rev.; Rev. 7/05l05
StF 2206 ..

RESIDENTIAL WELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources- Division of Water Quality
WELL CONTRACTOR CERTIFICATION H 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:
SITE WELL ID #(if applicable)
STATE WELL PERMIT#(if applicable)
DWQ or OTHER PERMIT Cif applicable)
WELL USE (Check plicable Box): Residential Water Supply p
DATE DRILLED %/2tJUto
TIME COMPLETED 3 ; OO AM 0 PM p
3. WELL LOCATION:
ITY:
COUNTY I ! UA.f%
(St Community, Subdivision, Lot No., Parcel, Zip Code)
TOPOGRAPHIC / LAND SETTING:
❑Slope OValley CI Flat ❑Ridge ❑Other
(check appropriate box)
LATITUDE _L
LONGITUDE
May be in degrees,
minutes, seconds or
in a decimal format
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)
4. WELL OWNER
OWNERS NAME
STREET ADDRESS
�4)4/ionie fLnle� O, 7
Zip Code
City or Town State
( -11781
Area code - Phone number
5. WELL DETAILS: O�r
a. TOTAL DEPTH: ti
b. DOES WELL REPLACE EXISTING WELL? YES I(1 0 NO
C. WATER LEVEL Belau Top of Casing: 500 FT. `
(Use -+'it 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): t (J METHOD OF TEST Blow
33344.9
f. DISINFECTION: Type H T H
Amount 16oz
g. WATER So
(depth): p
From ) .LSD To From _ To
From I 9 1 To f From To
From To From To
6. CASING:
T Depth Djarrieter
From V To Ft. �(QQ
From S3To Ft. (" Il
From To Ft.
7. GROUT: Depth Material
From D To 20 Ft, cement & benonite
From To Ft.
From To Ft.
8. SCREEN: Depth Diameter Slot Size
From To Ft. in.
From To Ft. in.
From To Ft. in.
Thickness/
Weight at -'al
Method
pumped
in.
in.
in.
Material
9. SANDIGRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
From To Ft.
10. DRILLING LOG
From 5ovr
0 e7
Formation Description
Clay & sand
Granite
DIV. Of- WATER QUAI ITy
11. REMARKS:
OCT 11 2006
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.
5hor t_ tlocsDfls 9-a'1-0(a
SIGNATURE OF CERTIFIED WELL CONTRACTOR DATE
ShcAnt tlat.otn 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

RESIDENTIAL WELL CONSTRICTION 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
Redden Brothers Well Drilling, Inc.
Well. Contractor Company Name
STREET ADDRESS 73 Holly Hills Vista RD
-Snk1in, NC 2R734
City or Town State
828 )• 369-9591
Zip Code
Area code- Phone number
2. WELL INFORMATION:
SITS WELL ID #(It applleable)
STATE WELL PERMIT#Of applicable)
DWQ or OTHER PERMIT Of applicable) L
M _I, USE (Check A licabl Bo Residential Water Supply,+,p
rv' t DRILLED , \
TIM': COMPLETED a AMC PM
1. WELL LOCMION
CITY:
(reptt rlam Numbers, Community, Subdblalon, Lot No., Parcel, Zip Coda)
TOPOGRAPHIC / LAND SETTING:
❑Slope ❑Valley ❑Flat ❑Ridge O Other
(check apprdprlata box
I_"I:TUDE Ila �7
Lr: :ITUDtyttt 7 4 3' 05 /
L. lie/longitude source: GPS ❑Topographic map
,lo.^afbn of well must be st dwn on a USGS fopo map and
erached to this fort if not using GPS)
4. WELL OWNER
O1-,NER'S NAME
STI" 'ET ADDRESS
City or Town tate Zip Code
JTLJ 5'ID -3rfl
A a :Tde • Phone number
6. VYJ.L DETAILS: e
/a, TOTAL DEPTH: ...���+++
b. JOES WELL REPLACE EXISTING WELL? YES 0 NOyi
c. WATER LEVEL Below Top of Casing:- (U- -FT.. `
(Use's' II Above Top of Casing) /
d, TOP OF CASINO 18 2 • FT. Above Lend -Surface -
'Top of casing terminated st/or below lend surface may require
a variance In accord e with ISA NCAC 2C .0118.
e.. YIELD (gpm): /sl METHOD OF TEST Blow
May be in degrees,
minutes, seconds or
in a decimal format
_33514-
333408
1. DISINFECTION: Type WTI H Amount 16oz
g. WATER ZONES (depth):
From
From
From
10
To
To
From To
From To
From To
6. CASINO: Thickness/
Depth ameler Weight Mat rial
From To Ft.
From To FL
From To Ft,
7. GROUT: Depth Material Method
From 0 To-2O Ft. CH=Ent & tem-mite nnrh
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'
r•.
a
11. , REMARKS:�it/
Formation Description
Clay & sand
Granite
RECEIVED
DIV. OF WATER QUALITY
OCT I 1 LUUb
100 HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH
15A NCAC 2C, WELL CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS
RECOR➢SAS BEEN PROVIDED TO THE WELL OWNER.
IGNATURE OF CERTIFIED WCONTRACTOR DATE
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:,
161.'14t1 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 P.esourres• Division of Water Quality
WELL CONTRACTOR CERTIFICATION N 2187
1. WELL CONTRACTOR:
Russell S. Taylor
Well Contractor (Individual) Name
liedden Brothers Well Drilling, Inc.
Web Contractor Company Name
STREET ADDRESS 73 Holly Hills Vista RD
Frank] in, Nr 28734
City or Town State
( 828 )• 369-9591
Area code. Phone number
2. WELL INFORMATION:
SITE WELL ID A(If applicable
STATE WELL PERMITeilf applicable)
DWO or OTHER PERMIT Cif applicable)
Zip Code
DRILLED
T--. COMPLETED � sCK� AMC PMk
3. V .L LOC ON:
CITY: �. 7i/) / s #. CO NTY
fSreel ram•, Numbers, Community, SubdMMeion, Lot No.,
TOPOGRAPHIC i LAND SETTING:
❑Slope :Valley Flat ORIdge ❑Other
(Oink apprcpriste box)
L.1'TUDE jjg
LPI� OITUDEp,1��gAI
Leh'iide/longitude source: ,. GPS
'location of well must be s own on
attached to this form snot using G
4, WELL OWNER
OWNER'S NAM
ST "ET ADORES
Residential Water Supply
' &LL USE (Check Applicable Sox):
'�
arnl, Zlp Code)
May be in degrees,
minute, seconds or
in a decimal former
DTopographic map
a USGS topo map and
PS)
CtyorT•) 5a6
C770�- 340 - gi,&g'
Aral code - Phone number
6. WELL DETAILS:
a. TOTAL DEPTH:
b, .DOES WELL REPLACE EXISTING WELL? YES ❑ NOK
Iv Code
4/400 i
e. WATER LEVEL Below Top of Casing: - 1) - FT,
(Use se' If Above Top of Casing) t'
d. TOP OF CASINO 18 2 PT, Above Lend Surface*
'Top of cuing termlrrated sUor below lend surface may require
a variance in aeeolf7ance with 15A NCAC 2C .0118.
e.. YIELD (gpm): T� METHOD OF TEST Blow
333407
1, DISINFECTION:Typo HIT H =Amount 160z
g. WATER ZONES (de th):
From o From To
From To From To
From To Fiom To
6. CASING:
Dept%
From X Tog r Ft
From 7S 7 To 90 Ft
From To Ft
7. GROUT: Depth
Thickness/
Diameter Weight Material
Material
sao
Method
From 0 To'.20 Ft, c, tkrstL & ksn)ite tarred
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 Size Material
From To Ft.
From To Ft.
From To Ft.
10. DRILLING LOG
From
To88,
g,_
n D t �//l.�-/,
Formation Description
Clay & sand
Granite
DIV.
IIL I I 1 /B0h
11, REAIj,IS,S:ao n_
24,
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED N ACCORDANCE WITH
ISA NCAC 2C, WELL CONSTRUCTION STANDARDS. AND MAT A COPY OF THIS
RECORD BEEN PROVIDED TO THE VVELL OWNER.
SIGNATURE OF CERTIFIED WEjQ.. 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 Mail Service Center— Raleigh, NC 27699.1617 Phone No. [phone] ext 568.
Form GW1a
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. W :'_L CONTRACTOR:
Russell S. Taylor
Well Contractor (Individual) Name
Hedden Brothers Well Drilling, Inc.
Weil. Contractor Company Name _
STREET ADDRESS 73 Holly Hills Vista RD
""Bnklin. 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#(Ir applicable)
DWQ or OTHER PERMIT #(if applicable)
ELL USE (Check Applicable Box): Residential Water Supply it
EAfE DRILLED
TIME COMPLETED t) • C) AM ❑ PM K
3.Yt. .LO ATION: -
C: aJofCO)NTY MOLC.AI-->
k
(Street Name. Numbers.Community. Subdivision, Lot No., Parnei, Zip Code)
TOPOGRAPHIC / LAND SETTING:
❑.S,ope ❑Valley ['Flat DRIdQe ❑Other
(check appropriate box)
L:TITUDE �1�1n //��`,
LONGITUDE8S, c2D 1111ff4
L :de/longitude source: )(CPS OTopographic map
•Safbn of well must be s own on a USGS topo map and
*finched to this form snot using GPS)
4. WELL OWNER
OWNER'S NAME
Tfj,EIT ADDRESS _
IU&b �pn�24 yL 33V/
City or Town Stat Q Zip Code
LI1& 95�-
Area code - Phone number
6. WELL DETAILS: ��
■ . TOTAL DEPTH:
b DOES WELL REPLACE EXISTING WELL?YES ❑ NO k
C. % STEP LEVEL Below Top of Casing: - - CI FT.
(Use'+' 11 Above Top of Casing)
d; TOP OF CASINO 19 2 FT. Above Land Surface'
'Top of casing terminated atior below land surface may require
a variance In accordance with 15A NCAC 2C .0118. d
e ,. YIELD (gpm): Ct - METHOD OF TEST Blow
May be in degrees,
minutes, seconds or
in a decimal format
333400
f. DISINFECTION: Type HIT H Amount 16oz
g. WATER j�NES (depth): •
^
From // To
7 To 5 l From To
From
- From .. To
From To From To
6. CASING: Thickness/
Depth Di m'tpr Weight Material
FromFt
From Ini To Q Ft. 0" tleg
From To FL
7. GROUT: Depth Materiel Method
From 0 To" 20 Ft. 0e181t. & baizLite wired
From To Ft.
From To Fl.
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 Slze Material
From To Ft.
From To Ft.
From To Ft.
10. DRILLING LOG
From T 0
PAW,
11, REMARKS:
Formation Description
Clay & sand
Granite
DIY. O
v
OCT 11 2006
1 D0 HEREBY CERTIFY THAT TITS WELL WAS CONSTRUCTED IN ACCORDANCE WITH
15A NCAC 2C, WELL CONSTRUCTION STANDARDS, AND THAT COPY OF THIS
RECORD S�EO TO7HE WELL OWNER.
SIGNATURE OF CERTIFIED W LL CONTRACTOR DATE
Russell S. Tay1 r
PRINTED NAME OF PERSON CONSTRUCTING THE WELL
Submit the original to the Division of Water Quality within 30 days. Attn: Information Mgt:,
161 Mali Sortie* 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 # 2187
1. WELL CONTRACTOR:
Russell S. 'Taylor
Well Contractor (Individual) Name
•Redden Brothers Well Drilling, Inc.
Well contractor Company Nome
STREET ADDRESS 73 Holly Hills Vista RD
Franklin, NC 28734
City or Town State
(. 8 8 )- 369-9591
Ares code- Phone number
2. WELL INFORMATION:
SITE WELL ID e(If applicable)
STATE WELL PERMITS0r applicable)
DWQ or OTHER PERMIT e(If applicable) aaaa///I
Minable Box): Residential Welter Supply4
•
D 2 �;on AMO PMX_
COUNT/ J.
Zip Code
IA ELL USE (Check
.ru:'F. DRILLED
Trial COMPLETE
3. WELL LOCATION:
CITY:
(Street Name, iumbers, Community, Subdivision, Lot No., Parcel, Zip Coda)
TOPOGRAPHIC I LAND SETTING:
❑Slope [Walley OFlat ❑Ridge ❑Other
(check apprdpdab box) 1_ "IITUDE ..62 'NSA/
LONGITUDE1312 6,520
La5'ude/longitude source: PS ❑Topographic map
t cation of well must be s wn on a USGS topo mep and
:.Meched to this form f not us/no GPS)
May be in degrees,
minutes, seconds or
in a decimal format
4, V I..L OWNER
x:WNER'S NAME
S`FjF;ET ADDRESS
1\.)'tDDR
IT S jiriC g f ,L �tti�E
tate Zip Code
73—,71/
Ain code- Phone number
5. Ye 7,a. DETAILS: r�1
a. '; CTAL DEPTH: 11 ✓ V
b. DOES WELL. REPLACE EXISTING WELL?/YES ❑ NO
c. WATER LEVEL Below Top of Casing' - 7 o2 -FT..
(Use 'I" If Above Top of Casing) d. TOP OF CASINO la 2 Fr. 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): / ..iETHOD OF TEST Blow
'333405
1. DISINFECTION: Type RFT H Amount 16oz
g. WATER ZONES (depth ,
From .q To 3S.5 From To
From To From - To
From To From To
6. CASING: Thickness/
,e, Depth Diaeter Weig,(It M feria/
From LJ To 0'� Ft. l0m" . /hb
From To Ft.
From To Ft.
7. GROUT: Depth Material Method
From 0 To .20 Ft. cetEnt & 17H1 cite armed
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 To0
11. REMARKS:
Formation Description
Clay & sand
Grant to
RFC.EIVED
DIV. OF WATFR OIIAI ITY
OCT 1 1
1 D0 HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WTH
ISA NCAC 20, WELL CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS
RECORD BEEN PROVIDED TO THE WELL OW
SIGNATURE OF CERTIFIED WELL ONTRACTOR 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 Mail Service Center— Raleigh, NC 27699.1617 Phone No. [phone] ext 568.
Form GW1a
Rev. 7/05

11. DISINFECTION: T
12. CASING:
Depth
FFroroma To i/ n R Ft h r/2C SD I 5.11
From To Ft
13. GROUT: Depth _ Method
From To
Frown_ To
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
Type
WELL CONSTRUCTION RECORD 3 3 3 4 2 2
North Carolina - Department of Environment and Natural Resourcess Division of Water Quality - Groundwater Section` 1
WELL CONTRACTOR (INDIVIDUAL) NAME (print) V c \�l^ r \� �L„CI-/4L1'S II —
CERTIFICATION #c3,1 ) I
WELL CONTRACTOR COMPANY NAMETQO'QRh kfic t fec++tv>n't 1)1C- PHONE # (��) 3Le9- Of) ti3
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residentia& Municipal/Public 0 Industrial ❑ Agricultural ❑
Monitoring 0 Recovery ❑ Heat Pump Water Injection ❑ Other 0 If Other, List Use
2. WELL LOCATIO
Nearest Town: net/ I / n Coonty42o(0a
\ad9 W',Ckt[j k-n a rPei kl n
(Street Name, Numbers, Community, Subdivide°, Lot No., Zip Code)
3. OWNER: //1 Cb� fed
_Address �✓t 1- Gf/oll .
(Street or Rdwe No.)
Fc131kNL N uc 31�3`1
City or Town State Zip Code
( ,} — (0a$3
Area coda Phoee somber
4. DATE DRILLED 9 -o (P
5. TOTAL DEPTH: 70 / /
Topographic/Land setting
Midge ❑Slope alley ❑Flat
(cheeksppop • box)
Latitode/longitnde of well location / 1
N'�.Co ' 47,9"u)n23 `era l 3 9
(dq�Pswmds)
Latitude/longitude source: GPS❑Topographic map
box)
DEPTH DRILLING LOG
From To Fir Description
935
SS - 7a/
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO
7. STATIC WATER LEVEL Below Top of Casing: .
(Use'w if Above Top of Casing)
8. TOP OF CASING IS �_ FT. Above Land Surface*
'Top of casing terminated atior below land surface requires ■
variance In aeeordncf ISA NCAC 2C .011&
9. YIELD (gpm): METHOD OF TEST l---
10. WATER ZONES (depth): IV ' 5 5
LOCATION SKETCH
Show direction and distance in miles from at least
Wall Thickness two State Roads or County Roads. Include the road
ifiamete12S or W gtt Material numbers and common road names.
�vrGL pASCs4
°CI
16. REMARKS:
I DO HEREBY CERTIFY THAT THIS
CONSTRUCTION STANDARDS. ANS
DANCE WITH ISANCAC 2C, WELL BEEN PROVIDED TO THE WELL OWNER.
9-2-7—a &
SIa1ATURE OF PERSON CONSTRUCTING THE WELL DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mall Service Center -Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-1 REV. 07/2001

WELL CONSTRUCTION RECORD
At/et/ aa3a
North Carolina - Department of Environment and NaturalNaResources - Division
of1 WaterGcoun watery t ti 1
WELL CONTRACTOR (INDIVIDUAL) NAME (print) KC %.0 \\�-\ S . Cr .1 C IU4Q- Quality - salio�n , ,,//
y� ^" � " n `� CERTIFICATION a `7v/"�; /
WELL CONTRACTOR COMPANY NAME \ OS `UTA\ L5 s s AC Q44 MQM- Tit . PHONE N 04 9' Ong()
STATE WELL CONSTRUCTION PERMIT/ ASSOCIATED WQ PERMTIW
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Resident Municipal/Public ❑ Industrial ❑ Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection ❑ Other 0 If Other, List Use
2. WELL LOCATpN n
N Town: f ll$/%1`I /1 County
(SutaName, Number; Community, SubdividooiLot No., Tip Code)
3. OWNEtiL31 C9 11'4
Address _\ea 9(In,Q, '2\
�\(s"°7ri°.) R CO3Y3
City or Town State tip Code
(gib} 09-9(D$
Area coda Phone number
4. DATE DRILLED /D-OJ -O
5. TOTAL DEPTH: 2 CV
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO
7. STATIC WATER LEVEL Below Top of Casing.
Topo
❑Ridge
hic/Laad setting
ope Malley ❑Flat
appropriate box)
Nt oZ3°M'c. s 3'r
(degrees/minutes/seconds)
Latitude/longiuude source: GPS❑Topographic map
( bean)
DEPTH ARILLLNG LOG
From To Formation r escription
. 300 of
(Use'+" if Above Top of Casing)
8. TOP OF CASING IS I FT. Above Land Surface°
'Top of wing terminated attor below land surface regWrce a
variance le aceordanee wkh ISA NCAC SC At1& n f '
9. YIELD (gpm): 4<i METHOD OF TESTA I'f Par-r�'
10. WATER ZONES (depth): nZ 7C) Q
11. DISINFECTION: TypefP( I es
12. CASING:
Fro TTofro �Ft �.//l
S
Front To Ft.
13. GROUT: Depth Material
From To Ft.
Fr= To Ft
14. SCREEN: Depth Diameter Slot Size Material
From__ To Ft in. in.
From To Ft in. in.
15. SAND/GRAVEL PAC&
Depth Size Material
From To Ft.
From To Ft
j,OCATION SKETCH
I nQ Amount Show direction and distance in miles from at least
Wall Thickness two State Roads or County Roads. Include the road
o W9�b,t/Ft p(atsrial numbers and common road names.
Method
e(G'G*O%
�
ti•
o` 400
16. RRMARXS:
I DO HEREBY CERTIFY THAT THIS t. W •rN a acINA CEWITH I5ANCAC 2C,WELL
CONSTRUCTION STAND s $%� T : • •py e i : , s? EEN 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

27699-1636 Phone No. [phone], within 30 days.
333420 jc/ej pas()
WELL CONSTRUCTION RECORD
North Carolina - Department of Enviromnent and
(NNatu MOW
-(Divisioonn of Water Quality - Groundwater Sec • /A
WELL CONTRACTOR (INDIVIDUAL) NAME (print), "\ ' \� `� ic'y-m \` ,,m ' t C�U et CERTIFICATION
`r� v/
WELL CONTRACTOR COMPANY NAME TQC ` \ )3 •- -Wc 74 C* w IA- PHONE a fid3) Jv9. ow -Iv
STATE WELL CONSTRUCTION PERMITS ASSOCIATED WQ PERMITS
(if applicable)
(if applicable)
1. WELL USE (Check Applicable Box): Resider . Municipai/Public ❑ Industrial ❑ Agricultural ❑
Monitoring ❑ Recovery 0 Heat Pump W Injection 0 Other 0 If Other, List Use
2. WELL LOCATIO��n
Nearest Town: " U ' Count'
Nu 'i"
(Street Name, Nuu—mbbers� unity,/ oq No., Tip Code)
3. OWNER: J )Y%n LC"CZQ
Address Ci (R St(. S PC t ft' S C; r CLv
b \\1 (Street o Route No.) •a X. ?-163
Zip were
(�11- s��s
Area code- Phone number
4. DATE DRILLED lD'lr:::;0
5. TOTAL DEPTH: p-7C,
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO�`
7. STATIC WATER LEVEL Below Top of Casing. at, FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS % FT. Above Land Surface*
'Top of casing terminated or below land surface requires a
variance in accordan 1SA NCAC 2C .0118.
9. YIELD (gpm): METHOD��lOF TEST fM
L-f O
10. WATER ZONES depth): . 'C) G
11. DISINFECTION: Type Ali i'w' -( Amotmt
12. CASING: f Wall Thickness
Fromi-( TDtiFt
o ao7) Ft. J2.� tf i�k�.c (
From /.j To 430 Ft. 6,./.2
From To Ft.
13. GROUT: Depth
From__ To 3
From 3 To. Ft.
14. SCREEN: Depth Diameter Slot Size
From To Ft in. ice.
From To Ft. in. in.
15. SAND/GRAVEL PACK
Depth Size Material
From To Ft.
From
16. REMARKS:
To Ft.
I DO HEREBY CERTIFY TTiATTHIS
CONSTRUCTION STANDARDS,
Topo bic/Land setting
❑Ridge toe ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
1v35°o11'Na.3`f,.tios3°a14 I/5 91(
Latitude/longitude
DEPTH
From
( seconds)
so _ Topographic man
( box)
DRILLING LOG
Fo natignpescription
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.
RECEIV— ,axis/
-TER n
DN OF WP
CCS "I's
15ANCAC 2G WELL
ROVIDED TO THE WELL OWNER
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
Submit the original to the Division of Water Quality, Groundwater Section,1636 Mail Savior - • - -Raleigh, NC
GW-1 REV. 072001

RESIDENTIAL WELL CONSTRUCTION RECORD
North Carolina Department of Emionmrnt and Natural Resources- Division of Water Quality
WELL CONTRACTOR CERTIFICATION B (QC.JL�6
J e el .1_ 1 3
I. WELL coHrncAl TORY,
ei Caaado None
6Maki. m W5// dr,//.
Wee Contractor Campaty Nara ,/ .(]
STREET ADDRESS 63'/ ,4yn4 N 7o t.Jn Ret
Rob ;nsie,1/ /UC 2%77/
City or Town Zip Cade
( apq»)-w7?• gysy
Area code- Pima rumba
2. WELL NFORMATIOtt
SITE WELL ID SFwpfrahy)
STATE WELL PERWTORa paeaae)
DWQ ar OTHER PERMIT 1(i applicable)
WELL 118E (Cheri[ App/iabb Etat Residential Water Supply ElDATE DRILLED 9-6 -66
-max cosine -ran //-O0 AM NJ PM El
3.WELL �TIOIt
CITY: ran k/J i? cotNTvinaa n
/39 r T Ad r
2l7 lap
(Street Name. Rumen /
�arrMr.SutidrkWyiatlb.. Forcer. Cod.}.
TOPOGRAPHIC! LAND SETTING:
Malone OVSey DRat LIFO* Daher
(deck mamma heel
LATITUDE 3 Ste /4 t- /e ••
LONGITUDE af 37`912"
Lat t dv(ongiade source: sGPS ['Topographic map
potato ofeemast be San on a USGS kpo map and
• attached this Ann !not ink g GPM
Mu be indepees,
names, smabQ
inaMond forma
4. WE.LONNER
OWNER'S NAME Char/es /Vc/jle
1�1�tI ADDRESS M r ra4Ar
rnntiCJ.'rt
Cityar Town Byte rip Code
(st2 •)_ 3,; l -3a33
Area cede - Plume number
tL win DETAILS: �7
a. TOTAL DEPrtt 745
h. DOES WELL REPLACE EXISTING WELL? YES ND W
c. WATER LEVEL Maw Tap at Casing 340 FT.
(Use `t' UAbae Tap d Casing)
d. TOP OF CASING IS / -
FT. Above Lard Surface*Top d ig Rem rated aaor be had lad surface may require
avariance in aceadaaeaain 15A NCAC 2C _o11e.
e. YIED(Wmt 4.. METHOD OF TEST CAsr
f. OISWFECiIOtt Type 7-/7
g. WATER ZOIES (dealt*
Fran :40Cr To 7156- From
Fran To From
Fran To From
6. CASING:
Depth
From
Diameter Weight nett
Fran C) T SC_ t'a SAD9( AYiL.
Fran To Ft
To
To
To
Thickness(
7. GROAT: Depth
Material Method
From !S To a(/ Ft CC/nein attnes
From To Ft
Fran To Ft
4 SCREEIt DeFran pth Diameter SIa Size Mama
in. In.
From To Ft in. _ in.
Fran To Ft in. in.
A SAIOKBRAV PACK
Depth Size Maeda
From To Ft
Fror______To Ft
From To Ft
10. DRa11NG LOG
Ram To Fotmation Desaptbn
11. REMARKS:
C.e r.
le R
fifer
m CO MEW CEMIFT1aNTUaS1VEL WAS CONSWrMED NACCORDANCE vmx
1SA Naxx, WBLEONBIRUCIgtS1TIOA DS.AKEDIATACOPm OFla6
RECORD HAS BEEN PROVIDED 701NE WEILOM R.
27LLP N 9-4 n th
SIGNATURE OF WELL CONTRACTOR DATE
teib>E J{yialP
PRIMED 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.
Fenn GW-la
Rev. 7/05

1. WELL CONTRA TOR:
SYLVA City
a Town
g2( 8 )- 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 ontractor (Individual) N
AAA GREENE BROS. WELL DRLG. OF SYLVA, INC.
Well Contractor Company Name
STREET ADDRESS 1800 SKYLAND DRIVE
NC
State
28779
Zip Code
WELL USE (Check Applicable Box): Ijesidentiai Water Supply
DATE DRILLED' / ' (r,
TIME COMPLETE AMID PA
3. WELL LOCsATION:
CITY
( tweet Nam
C
NTYVI
RESIDENTIAL WELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources -Division of Water Quality
WELL CONTRACTOR CERTIFICATION # 3a `i
f. DISINFECTION: Type HTH
g. WATER ZONES (depth):
From /30 To 133 Fran_
From if a,S.--To 1 a a From
From To From
6. CASING:
pepgt ff Di meter
From () To FL
Ran To Ft.
Fran To Ft.
7. GROUT: Depth Material Method
From To_i_ Ft.i l )t.v� -74/7
Fran +, To T.G) Ft. ]7R
Fran To Ft.
8. SCREEN: Depth Diameter Slot Size Material •.
Rem To Ft In. • In.
From To Ft In. _._ In.
Fran To Ft. in. In.
ei l G L ,%Li2 ar, / (
m ers, Community, Su itision, Lot No., Parch. Zip Code)
TOPOGRAPIC / LAND SETTING:
rime °Valley ❑Flat DRidge ❑Other
1 _ (check appropriate box) May be in degrees,
LATITUDE —_ minutes, seconds or
in a decimal format
LONGITUDE_
Latitude/longitude source: DGPS ❑Topographic map
(location of welt must be shown on a USGS topo map and
attached to this form if not using GPS)
4. WELL OWNER tut YL-:--' (J�'_,n/`,
OWNER'S SDDRE 6e 1L0 "LGA /1.
STREET ADDRESS S � j� u��
GUo(ti �Lr� cl.ct€c Y 1 C a ?"7_t —
State Zip Code
CiittyI La Awn
Area code - Phone number
5. WELL DETAILS: �`�AT�
a. TOTAL DEPTH: O u V
b. DOES WELL REPLACE EXISTING WELL? YES 'p_NO
c. WATER LEVEL Below Top of Casing: 3 2 3 FT.
(Use -+- if Above Top of Casing)
d. TOP OF CASING IS {/ FT. Above Land Surface•
'Top of casing terminated ata below land surface may require
a variance in accord.cce with 15A NCAC 2C .0118.
e. YIELD (gem): 7 .t-_METHOD OF TEST / ry
Amount
To,
To
To
Thickness/
Weight
_
Sge1
9. SAND/GRAVEL PACK: Depth Size Material
Fran To Ft.
Fran To Ft.
From To Ft.
10. DRILLING LOG
From To
so
&5 X- s'c-st)
11. REMARKS:
Formation Description
Tr F;
N
CO
0_,
0b •
sv
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH
15A NCAC 2C. WELL CONSTRUCTION STANDARDS. AND THATA COPY OF THIS
RECORD 1SAS BEEN PROVIDED TO94E WELL Ow /
*NATURE O ,: r,IED WELL CONTRACTOR DATE
Pet
PRINTED NAME OF PERSO CONSTRUCT I G 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

ft
RESIDENTIAL WELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resoou �D� ion of Water Quality
WELL CONTRACTOR CERTIFICATION # 33
Well Contractor (Individual)
AAA GREENE BROS. LL DRLG. OF SYLVA. INC.
Well Contractor Company Name
STREET ADDRESS 1800 SKYLAND DRIVE
SYLVA NC 28779
City or Town State
82( 8 )_ 586-5550
Area code- Phone number
2. WELL INFORMATION:
SITE WELL ID R(8 applicable)
ame
Zip Code
STATE WELL PERMITR(8 applicable)
DWQ or OTHER PERMIT R(if applicable)
WELL USE (Check Applicable Boxy Residential Water Supply
DATE DRILLED / 2 t='--`
TIME COMPLETED c AM ❑ PM S
3. WELL LOCJATION:
CITY:
(Street Name.t tubers, Community. Sdbdiwsion, Lot No., ParW, P Cie)
TOPOGRAPHIC / LAND SETTING:
✓��i:510Pe °Valley ❑Flat ❑Ridge ❑Other
(check appropriate box) May be in degrees,
LATITUDE _ minutes, seconds or
in a decimal format
LONGITUDE
Latitude/longitude source: ❑GPS ❑Topographic map
(location of wet must be shown on a USGS topo map and
attached to this form if not using GPS)
4. WELL OWNER 2r /' n ,
OWNER'S NAME
it 4 - , QA%
WSTREET ADDRESS/71 / /J
WET
c.) own
/1..v1�" State
Area code - Phone number
COUNTY
Zip Code
J
5. WELL DETAILS: 7
07)
a. TOTAL DEPTH:
b. DOES WELL REPLACE EXISTING WELL? YES 0 NO L,rj
c. WATER LEVEL Below Top of Casing: a FT.
(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): C,IMETHOD OF TEST
f. DISINFECTION: Type_
g. WATER ZONES (depth):
From 7,o To_7'
From !O To
From
6. CASING:
From v
From
From
From -
From.
To From,
Depth
To
To
To
Fl
Ft.
Ft.
Di mit
t')•�M1 v V l� 1.
� /
a
Amount
To
To
To
Thiclmess/
5pWeight Material
2 z/Se
7. GROUT: Depth Method
Material 2 �
From 0 To_a_ Ft.,
From 2. To 7 t' Ft.
From
To Ft ---in L
8. SCREEN: Depth Diameter Slot Size Material - .
From To _- Ft. in. —_ In.
Frcm To _ FL in. — in.
From To Ft In. _ In.
9. SAND/GRAVEL PACK: Size
Depth
From To Ft.
Ran To Ft.__
From To Ft.__
10. DRILLING LOG
From To
Material
Formation Description
t DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE Wrnl
ISA NCAC 2C. WEL
L CONSTRUCTION
STANDS. AND THAT A COPY OF THIS
RECORD BEEN PROVIDED
S - ATURE OF CERTIFIE A
PRINTED NAME OF PE
LL a ' -t' CTOR DATE
v'ti.G -e
ON CONSTRUCTING THE WELL
in 30 days.
16 Submit Mai Servi a Quality
Center- Raleigh, NC 2 699 16117 Phone hNo (9 9) 733-7Attn: Information Mgt,
ext 568.
Form GW-la
Rev. 7/05

1. WELL CONTRACT°
'/ a icu03
WELL CONTRACTOR CERTIFICATION # 3O
Amount
RESIDENTIAL WELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources -Division of Water Quality
Well�Contractor (Individual) Dime
AAA GREENE BROS. WELL DRLG. OF SYLVA, INC.
Well Contractor Company Name
STREET ADDRESS 1800 SKYLAND DRIVE
NC 28779
SYLVA
City or Town State Zip Code
( 828 )_ 586-5550
Area code- Phone number
2. WELL INFORMATION:
SITE WELL ID#(irapplicable) 4-e-o-r,0
STATE WELL PERMITitot applicable)
DWG) or OTHER PERMIT it(if applicable)
WELL USE (Check Applicable Box): Residential
idential Water Supply LrJ
DATE DRILLED n
TIME COMPLETED .S
f. DISINFECTION: Type HTH
g. W,gTER
-YZONES (depth):_
Fr To a G � From To
From 357To ,-Y/Fran To
From To From - To
6. CASING: Thickness/
Depth `-s Diameter ',Weight Materiel_
From 0 To V ( Ft. `a6 '/ 5Q 24 (J2v(,
Fran To Ft.
From To FL
7. GROUT: Depth
From 0 To
Fromm* _To
From To
�Material y Method
Ft.
Ft.
8. SCREEN: Depth Diameter Slot Size Material
From To Ft. ln. in.
From To Ft. In. In.
Fran To Ft. In. in.
AM 0 PM 9. SAND/GRAVEL PACK:
DePih Size
3. WELL LOC ION: n / From To FL
CITY t COUNTY ��1--' F cm To Ft.
/6' V Ql� 21,,,III�., ��/ ��" V' °rA To Ft.
Na
(Street Name, tyumEeirs, Community. Subdi ision, Lot No., Parcel, Zip Code)
TOPOGRAPHIC / LAND SETTING:
❑Skye °Valley ❑Flat Ridge ❑Other
(check appropriate b�
LATITUDE
LONGITUDE
Latitude/longitude source: ❑GPS °Topographic map
(bcation 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 _—
STR ET ADDRESS
May be in degrees,
minutes, seconds or
in a decimal format
itCjay or
State
l�2
Area code
- Phone number
Zip code
5. WELL DETAILS:
a. TOTAL DEPTH: r
b. DOES WELL REPLACE EXISTING WELL? YES 0
e. WATER LEVEL Below Top of Casing: 7. 0-3
(Use if 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 in accordance with 15A NCAC 2C .011
e. YIELD (gpm): .J G METHOD OF TEST / F
FT.
10. DRILLING LOG
From To
-gas 5 c
�S S{ —(e d7�
11. REMARKS:
Material
Formation Description
1 DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE Wrrn
15A NCAC 2C, WELL CONSTRUCTION STANDARDS, AND THAT A COPY OF INS
RECO AS SEEN PROVIDE [93Q THE WELL 03W ER.
TURF 17t CE TIFIED /ELL CO TRACTOR DATE
(9vi Y rnu c
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.
ForrGW-1 a
Rev. 7/05

1,
, RESIDENTIAL WELL coNSTRucnoN RECORD
North Carolina Department of Environment and Natural Resources -Division of Water Quality
WELL CONTRACTOR CERTIFICATION #
1. WELL CONTRACTOR:
Weil ntractor (Individual) Name
AAA GREENE BROS. WELL DRLG. OF SYLVA, INC.
Well Contractor Company Name
STREET ADDRESS 1800 SKYLAND DRIVE —_
City or Town avow -
Bpl=)_ 586-5550
Area code- Phone number
2. WELL INFORMATION:
SITE WELL ID #(if applicable)��
STATE WELL PERMIT/48 applicable)
DWQ or OTHER PERMIT #(it applicable)
WELL USE (Check Applicable Box): Residential Water Supply 0
DATE DRILLED
TIME COMPLETED
AM 0 PM
CITY: w �c
i 4
(Street Name, Numbers, Community, Subduslon Lot No
TOPOGRAPHIC I LAND SETTING:
D Slope 0Valley ❑Ridge ❑Other
(check opiate lion) M
LONGITUDE hic
Latitude/longitudesource: ❑GPS ❑Topogramap
map d
(location of well must be shown on a USGS top
oattached to this form if not using GPS)
4. WELL OWNER vl
OWNERS NAME
STREET ADD�ESS c/l /, 7G
tor T as , — Stale36�
t� F �
Area code - Phone number
b. DOES WELL REPLACE EXISTING WELL? YEAS ❑
c. WATER LEVEL Below Top of a
(Use' if Above
W Casing)
d. TOP OF CASING IS ET. Above Land Surface
*Top of casing terminated at/or below land surface may require
a variance in accordance With 15A NCAC 2C .0 8.
e. YIELD (gpm): 14 METHOD OF TEST )
f. DISINFECTION: Type 11111
g. WATER ZONES (depth):
From /S
From To
From
33 204S
/ ip Thickness/ ght tit.
Y DI �er s &Qr& M_ .-
FL p `E.
To Ft
To Ft.
Method
Material
7. GROUT: Depth
Fram�T° 33 }-FL
From _ _To -yam !J Ft.
To Ft
9. SANWGRAVEL PACK:
Depth
From To_
Fran To
From
I15AHEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH
2C, WELL CONSTRUCTION STANDARDS. AND THAT A COPY OF THIS
RECORD HAS BEEN PROVIDED TO THE WELL OWNER.
DATE
SIGNATURE OF CERTIFIED WELL TRACTOR �R
PRINT .� NAME OF PERSON CONSTRUCT THE WELL
1617Submit
Mail servi original Center- Raleigh, NC 2 699 1 17 e Division of Water Quality within No. (9 9) 733 7 5 ext 68.Uon Mgt,
Form GW-la
Rev. 7/05

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Na ral Resources - Division of Water Quality - Groundwater Section
1-'4 �,��r�� CERTIFICATION M 3
WELL CONTRACTOR (INDIVIDUAL) NAME (prior)n •J
'.J 0 ,.,.
��77 `-� r
WELL CONTRACTOR COMPANY NAME �.sn s'/�=wAid �G U L/✓7 I/ PHONE s ('Job) %Sr2.- ? 7SZ.
STATE WELL CONSTRUCTION PERMITS/ASSOCIATED WQ P(if applicable)
(if applicable)
I. WELL USE (Check Applicable Box): Residential 2 Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION:
Nearest Town: i /G .•� County ,IY%ea
Cee, f. l 2 k calm. x K,obl, t%b.
(Street N a, Numl(ers, Community, Nubdivisioo, Eot No., Zip Code)
3. OWNER: te.4.-t?
Address 12_7 Ad �Fk ~•
(Street or Route No.)
Secicir r� a/L. 2fr77f
City or Town State Zip Code
Ares code- Phone number
4. DATE DRILLED 1- //- cc.
5. TOTAL DEPTH: 0/(0
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO 1Er-
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 accordance with ISA NCAC 2C .0118.
9. YIELD (gpm): /0 METHOD OF TEST
10. WATER ZONES (depth):
si
11. DISINFECTION: Type HT- N Amount it/ LT
12. CASING: t! • /L6' Wall Thickne
Depth Diameter or Weight/Ft. Material
0 To J-5" Ft. cor
From
From To Ft.
From To Ft.
13. GROUT: Depth Material/
From d To , Ft. pv.--t *e-se
From To Ft. O.
14. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in.
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Size Material
pMethod
/ c-(
From To Ft.
From To Ft.
Topogra and setting
❑Ridge 2Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degreeshninuta/seconds)
Latitude/longitude source:❑GPS❑Topographic map
check box)
DRILLING LOG
Format/ion Description
Lc. e/
Sc cr„� 5 7� ✓-Z-
G ri k-..
DE TH
From T$
d ,,-a
20l- T( '
gd- 77
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common road names.
16. REMARKS:
1 DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH ISA NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
- '--- iz -u
t DATE
S NATURE OF PERSON CONSTRUCTING THE WELL
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Ceenter' R leiV gh, C01
27699-1636 Phone No. [phone], within 30 days.

WELL CONSTRUCTION RECORD
North Catalina - Department ofEn*cnm ntandNaturalResources-Divisionof Quality-7 Groundwater Section
TKiii a ft
WELL CONTRACTOR (DIDIWDUAM ( IoQ chfin1S .Qas t£ ....�,.�,,°o �,,�
wets. CONTRACTOR COMPANY r1A
Ste iC f�elln-.•1 (II:Et1��1v11I�" _P1i01'fRf�FEi. er�—"3 a•b o
STATE WELL CONStRDCf1ON moan - MUM•
-
(Irapplicabta) A»� tea) •
I. WELL USE (Check Applieabia Boxy-RaddenddtrMwuwuc paUPublic a Industrial 0 Agricaltwal U
' Monitoring 0 Rem"ITHeat Pomp Water Nation 0 Other a If Odtm, List Use _ -
` Z V/ELL LOCATION:.' T glapbtc!l end x1tiDg
"NeatestTown: I l: /> LAtib Canty, /� �4 Gm.� OSlopa [Nancy . ,Pbt
!J v/ G K- U • Q _a _ k 7 4- I (dacicappaptreba4 .
Meet None. NombeS. cmmally, &bar'sia4 Lank. re Cade) L'edtod�gitade often location
3. OWN��. �Fa �/ c Infrflon5
AddressE�t.,elf, -Pit . /2da,
(Strwtti-- a89YJ..
/.�; amN CJ Ibi . 6
Arai code Phan amber / `/ �--0--0 Co
' _ �,Y
4. DATE DRILLED / W ' -
5. TOTAL DEPTH; . 30 S'
' rai Code.
(g2- -
Latia!ddlongiuide DOPS0Topographic map
(ea box)
DRILLING LOG
From To ' Fotma)ion Description
'Y5C Litt
6. DOES WELL REPLACE EXISTING WELLY YES 0 NO-
7. STATIC WATER LEVEL Below Top of Caring '? 0 FT:
(User
S. TOP OF CASING IS / FT. Above Land Surface'
,Tap et enAag taaaaad agar we; lnd.atrfa Avails a
mines is uaNaets wakt5AjiCSC IC AIL9. YIELD (gpgix __METHOD OF TEST
10. WATER ZONES (dCPdO /OS'
LOCATION SKETCH
11. DISINFECTION: Type Antotn t Show dimctioa and-diahnaa bi miloa from at least
12. CASING: - Wall Thickness ' tyro Sato Roeder or County Roads. Include the road
• Depth D or Weigftl t. names.
-umbers and -common road es.
From . To 45 Ft. �' Sl2ga a: -
From To FL -
From__ To FL
13. GROUT: Depth Material Method l -
Fmm_b_ToaF4-
From To Ft
.4. SCREEN: Depth Diameter . Blot Sae - • Materiel
From To FL in. In.
From To Ft.—io. in. •
.
5. SAND/GRAVEL PACK
Depth Size
From To Ft
From To Pt
o.
CA •
6. REMARKS:
DO HEREBY CERTIFY THATTHIS WELL WAS CONSTRUCTED IN ACCORDANCE WPIH 15ANCAC2C, WELL -
ONSTRUCTIONSTANDARDS, ANDTHATACOPY OF TM RECORD BEEN PROVIDEDTOME-WELOWNER
Li 7 44 I :—/ g - 0 CO
SIGNATURE -OF PERSON CO(SIRUCTINOtie WE[L. . DATE -
submit the original to the Division of Water Quality, Groundwater Section, 1636 Mali Service Center -Raleigh,"NC
,n699-1636 Phone No. [phone], within 30 days. . eve -I REV. 07/2001
1

a3
0
WELL- CONSTRIICTION REC t6RtD' :: .
DMA" ofW'dtarQuaiity'- Section /�
North Carolina-Dc Department NaturaldwaW0Ni =�
cTORaNDMnuA,W w h . •Gt1y .3 (, 0
w t.t. corrrnw _ rgpii�i .
wELLCON'rnACTOROOtMPANtt _ - t®� omen :_ -
STATE WELLOf " 'ItIWtIRs e '
O
Monitoring
Iiatble Bolt).-Reawenfiall +dtnicipal/Pubiic CI Industrial CI Agricultural CI
WELL USE (I Room!):
Appovery O: Heat ?gulp Water lnjectiou CIOther Q if opia, List U
gtaFticJLand stdtin8 -
Z WELL LOCATION:. /Y1 A � ,' ' idp OSlope Malley .OF�at
Nearest Town: n ihj Cwmtyr-----
1 Welt wiiremlatetga)
Moen Nome Weber; Comaetaity, de, lotNo., VPfie)
3.OWN OYY1
Address
D
ant Town Ante mDSc
c.o�•
4. DATE DRILLED Ana coda. Mae amber to
5. TOTAL DEPTH; S ' •
❑ NOg , __
6. DOES WELL REPLACE EXISTING WELL? YESp of Callum . ,___-- --------
7. STATIC WATERLEVEL Below
Rise" Hamster altesiat
S. TOP OF CASING 1S _..� ---FT. Above Land Surface*
Kep et easing tatiohtalsa anor betw laaaertese nrj*S
.anew la aewrdaaa.t11 /410/C 2C .ells.
9. YIELD (gpm): — �a OD OF TEST
10. WATER ZONES (depth)
•
1I. DISINFEC'aION.Typc--1L-t---� two StateRosdsotCOtmtyROads.lnclu�
12. CASING: Wan tbidotass ',lumbers State
and-common toed names.
A i><P� or Wd Pt
From_ O .s t0—s= Ft h"
Fron To T t
From T9 Ttt
•
13. GROUT: � �jj��M,�,,,,, °��i,,�, poyMeihrid�
Ftom__Q--T0_t-P• - •^" r- f"'^
From To
.4. SCREEN: Depth
From To Ft—m
To Ft fin• ut
From_-___ -
5. SAND/GRAVEL PACK:
Size Material Depth
From To Ft —
From To Ft -
6. REMARKS:
DO THATTNIS WELL WAS CONSTRUCi'8D INACCORDANCSWITH IsANCAC2C, WBU. -
oNnu TIONSTANIFY ANDTH TACOPYOF'1'II{S RECORD HAS BEEN PIROVIDEDTOT E.W(1LLOWNER
ONSTRt)CTION STANDARDS, it t i i
��=o�
t _ DATE
SIGNATURE•OPPERSON CONSTRUCTINGTHE9/EIL •
Submit the original to the Division of Water Quality, Groundwater Section, 1636Md1 Service Center -Raleigh, NO
GW-1 p.Ev.o7ntwl
.27699_I636 Phone No. [phone], within 30 days.
I;aS,Ioagitudo ofvteii location •
(desaresholoatestammas)
LatitudellatgItdde so OOPSOTopo&HPbrc tnap
i b00d T.TNG LOG
From To ' .Forma,
• - T nr•e[97ON SKETCH
Show direction and.distanoo In miles from at least
the road
Diameter _ Slot Sine - r tdateriel •
1

i
7n
0 e2d
cormaacroartrameti.)
�vtaotaist�
COMFAin
¢ta,COa' ��Aa6oC(AtID:=.ua
fan WLLI.c.lsiU1IT1�.-�--•��
paVPahuea :h 0 ?►saadtuT [7
L. WELL USE( a00Cx- I�ection0 0 lfO0ostgNal�o---
"—'
or •
Monitoring Recovery 0 kiaatPnrap
1_ "WELL LOCATt Coun1Y '"
Noma i I
tsarrizonumbel.Camen9p. 0°'i ortio.$code)
Amass
rCalorTan State e
mast
4. D D1t1LLED i - —' fl b -,
.iat ' .
. TOTAL Dru + 87aSTING WELL? YES 0 NO_: i
6. DOES C W REPLACE ofC -
7. srATIcwATirRLavELE°10 Uh er if Moray dudes) _ •
8. TOP OF CASING Above Land Sodom*
reeds
wrung fa st snietmaleaticsc AWL
-Tap erodes urnamtuit suer Win mastics
10. WATER ZONES (fix
ZEInagli
-•-:�_ �
t 1. CIS ON: Showdtec8
hi miles
�at Mast
12. CASING: We1 hkaw+a a Roads
orCounty
names.
road
Fmm_t-°Pt,�arin quF`o� ,-
rt
Froi To Method
GROUT- Depth MYnft
From___b-T°•S - -
DiemetO" , Silage • - Malarial
Ft,. _.__Jn. m.
rr-rrexact sifting
CISlope DveIley'O a
Lii italetlleagitade itTvein i m
husnetholoonsfeemens
LatitudeRon8itada����,,,,op,,,
o,,gr�aap� �to map- • ko on
/man
orl
From To n
Frog^
-4. SCREEN: Depth
Front—_-. To
From TO
5_ SAND(GRAVEL PACK:DePth Size Material
From To Ft —
Fmm
6. REMARKS:
IN ACCORDANCE; ISANCACC. L•
Cann TEIAi'FEESwB[LWASCl14'ffiT y)pgCTOTEffi•�0�
,N nH�UCtip1 STANDARDS,ANDTHATACOP/ ov RECORD • BBIs'IPRO
SIGNATURE-OF!EOM CO tut visa. . DAYE
to the Division of Water Quality, Groundwater Section, 1636 Mall Service Center -Raleigh, NC
��f699-1676 Phone No. (919)'133 33z
OW-1 REV.07/2p01
submit the original 1. within 30 daps

Je;1. ,W0K
011C
WELL CONSTRUCTION RECORD
t of Environment and Natural Resources - Divisioty of Water Quality - Groundwater Section
North Carolina - Department Si S _ CERTIFIC�ATION�#�
WELL CONTRACTOR (INDIVIDUAL) NAME (print l � fA�, l� S� PHONE # lATION # I— `�
T4Cl
WELL CONTRACTOR COMPANY NAME ASSOCIATED WQ PERMITS/STATE WELL CONSTRUCTION PERMTT# if liable
if liable
RApplicable Box): Resider, Municipal/Public 0 Industrial 0 Agricultural O
1. WELL USE ( Check ep 0 Heat Pump Watef Injection 0 Other 0 If Other, List Use
Monitoring 0 ecovef5'
1 T... ..hic/Land setting
2. WELL LOCATI IY lT County— ORidge 4r...ope OValley Ong
Nearest Town: (, . • ppproptisae mac)
N nta`�a 4dep. h4InVie S 7111 ` • i f1
wry. SubdiVisioq No., �p t.uuc,
(Street NamaN ben, seconds)
(uesreePSOTopographic map
box)
3. OWNER: Latimdellongitude so
Address DEM SG
From To For'a'on, scription
t71 n,
(Street or Route No) C1s Ths
Cm, Shoe Zip Code
Mn ado- Prone tnm — O-0-`0
4. DATE DRILLED a
5. TOTAL DEPTH:
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO
7. STATIC WATER LEVEL Below Tp o�Casing:
Above opoi)
8. TOP OF CASING IS 1 FT. Above Land Surfaces
*Top of easing terminateda at/or
below
land surface
ntf c nay
variance g ac): 1v �T OF
9. YIELD (gpm): _1— ��
TEST
10. WATER ZONES (depth):
11. DISINFECTION: T) p'�t hf.( Amount
Wall ThiC
12. CASING: ' Ft piaprbir or Wei t/FL
From r t 1 To
From_____ To Ft•
Froth_ To Ft..
13. GROUT: Depth FromFt
_ To
From D
Diameter Slot Size14. SCRE From_ To
FL in in.
From
To Ft in. in.
15. SAND/GRAVEL PACK:
ACK: h Size
From To Ft.
From To Ft._
16. REMARKS:
I DO HEREBY CER
CONSTRU n
/'.
Method 4.
Or"
Material
i OCATION SKETCH
tew direction and distance in miles from at least
two State Roads or County Roads. Include the nil
numbers and common road names.
CO: g
WAS
,. U sTN•+''r' CE WITH ISA NCAC 2C, WELL
S, , iTHATA aF r"tC S, '-' BEEN PROVIDED TO WELL OWNER
SIGNA • OF PERSON CONSTRUCTING THE WELL DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service CGW i RRSVgh, NC
27699-1636 Phone No. [phone], within 30 days.
1

pie°. a ri
,.:. t a1r)
tY k.i :d `J 13
WELL CONSTRUCTION RECORD t Groundwater Section
Resources - Division of Water Quality -
grmlent of Environment and Natural � CERTIFICATION #
North CaroliRa-Dep A ``rr t(J
WELL CONTRACTOR (INDIVIDUAL) t) NAME noun \ tyf Tf �� &�D1V PHONE # both
Tnr1.
WELL CONTRACTOR COMPANY NAME ASSOCIATED WQ PERMIT# ivable
STATE WELL CONSTRUCTION PE1tM1T# if l
if applicable cultural O
Municipal/Public CIInd � � e Agn
ion CI Other CI If Other, List
Topographic/Land setting
Midge OSlope OValley °Flat
cheek appropriate )
Latitude/longitude f Well loc�tion oZ a
A Nico ) 32 .g i � 5-g
(d n'®ndlseeanda)
Latitude/longitude so GPSOTopographic map
( box)
1. WELL USE (Check Applicable Box): Residen
Monitoring ❑ Recovery C Heat Pump
Wa
2. WELL LOCATr; _ A 1.
��_16�� County.
Nt;pcestT� wit: G(rn1�G P
Community, Subdivision, Lot No Zip Cock)
(Seat Name.N'mbeu,
3. OWNER:
Address
C(`N tip Code
yorTeam State
{`yiCitp' i�•%j^ (O��
Area code- Phone numbs
4. DATE DRILLED_-z,
5. TOTAL DEPTH: y yE NO CI6. DOES WELL REPLACE EXISTING WELL
7. STATIC WATER LEVEL Below
(Use "+? if Above Top of Casing)
TOP CASING 1S _.._ - FT. Above Land Surfacer
8. TOF ., terminated at/or below land surface requires a
y isnCp of In accong d 1SA NCAC 2C .0118.
9°I YIELD (g m) ME fIOD OF TEST A
0 ATE ZONES
O• ONSKET i
10. WATER ZONES (depth): / Show direction and distance in miles from at least
Amount two State Roads or County Roads. Include the road
11. DISINFECTION: Type Wall.fhicmess
12. CASING: or Wei t/Ft �Matm�'al numbers and common road names.
�j1� ,� DoPth'' 11 Fu�2� J�a�S[ - -�-
FromSJ---TOt al--FFt_Lja
Fr<,n, To Ft'
From To Et.
13. GROUT: Depth
Fromuffl--
D
From—. TOE— Ft Slot Size
14. SCREEN: Depth Diameter
Ft in. in.
Fro ^ TO Ft in.
From To
15. SAND/GRAVEL PACK:
Depth
Size
From To.
From To,
yrr rGz-- _
FormatiugDescription
Ft..
Ft,
Material
DEEM
F%
16. REMARKS:
IDOHEREBY .CEaRcT•s•IFY
.. illy J rWAASa•ea .; u dir
i l--
.�
-411"a•;--
iN TRUCT'ING THE a DATE
SIGNA ' O ' ERSON
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center -Raleigh, NC
GW-1 REV. 07/2001
27699-1636 Phone No. [phone], Within 30 days.

Ft..
Ft..
WELL CONSTRUCTION RECORD f Groundwater Section
of Environment and Natural Resources - Division of Water Quality - GrCERTIFICATIONoundwatSe #
NorthCarolina-DePa�IIt .. r � 5 inc ��t1Q rCONE af�a_Ni ��
WELL CONTRACTOR COMPANY NAME NAME (print
qc h911 n-ler Treq-I�fi•
WELL CONTRACTOR COMPANY ASSOCIATED WQ PERMIfM
STATE WELL CONSTRUCTION PERMl'f0 if livable
if linable
1. WELL USE (Check Applicable Box): Residential t Municipal/Public ❑ Industrial ❑ Agricultural ❑
0 Recovery 0 Heat Pump WaterTnjden•on ❑ Other 0 If Other, List Use
Monitoringhic/Land setting
2. WELLIA vn: ❑RiT dge lope Malleyey Mati.,� ( appropriate box)
Nearest T' wn: �' y��e/longitude of well location ! I
(Street Name, Numbers, rotr, '„aion, l.otxa rmcode) N350 �7I CS of b.14$ o ia'
C 0� axons)
Latitude/longitude source: PS❑Topographic map
3. OWNER Iatitude/longi box
Address u� .� t g (fix nan naf�LOG
m QiTo Forme • n Description
F%
Area code Phone number or/ `TD f _
4. DATE DRILLED
5. TOTAL DEPTH: 7 YE 0 NO
6. DOES WELL REPLACE EXISTING WELL
7. STATIC WATER LEVEL Below Top of Casing. of Casing)
(Use '4"' if Above Top
8. TOP OF CASING IS FT. Above Land Surfacer
flop of casing terminated aUor below land surface requires a
variance 1n accord,,rills 1SA NCAC 2C .01111.
9. YIELD (gpm): sue —METHODS TEST
10. WATER ZONES (depth):: �� p
11. DISINFECTION: Type�iti tt�ilas
12. CASING: Depth Diarde�r or Wei L
From i l Tog. Ft.
From_.— To Ft•
Fro++ To Ft..
13. GROUT: Depth
FromL-- To
FTo
14. SCREEN: DepthTmp
From —
Front-- To
15. SAND/GRAVEL LPIC
AC
From To —
From --To
16. REMARKS: �
1, . OORDANCE WITH 15A NCAC 2C, WELL
WELLW'^ •aNSTRUCfED PROVIDED TO THE WELL OWNER
I DO HEREBY CER T j aT, •o HAS BEEN `.
CONSTRU r ON yr%' a+�`,rj
SI ATURE OF ' ON ONSTRUCTING THE WELL D TE
County_3i123-
±
r30 Li
Size
Material
IALATIONS 0
Show direction and distancenmilo. s from Bathe road
t least
two State Roads or County
numbers and common road names.
C
Submit the original to the Division of Water Quality,
Groundwater Section, 1636 Mail Service CGW 1 REeigh,N 07/2001
27699-1636 Phone No. [phone], within 30 days.

-2. "WELL LOCATION:
Nearest Tone FAsA4t-i »' ' CotmtyM4
�TLrlhc j,s 'DQ;vie c/3
(saenNuoe.Nmbama. „Subdividoo,LetNw,23pCale)
3. OWNER CI; ..5UM- Fro act
Address t 1 1 II- rettL-q L . /l r1 .
F, AAA di I:EJ . S/ C- F7 3 LI
Cale/Town State ..*". DpCode.
(furl- sad. 74iO
Ares code. na man 4_ DATE DRILLED I 'O �o •
• WELL CONSTRUCTION RECORD'
;.: ,,(tt�,,.
Noah Cs>tolina - Department of Bnvkommtint and ?lateral Raautxa - Division oYWator Qurtlity�-Gronmtiwata Section
war. corTRACTOnprow=DWIWNAYtt bpi alerts)! S Pea : �' CO�1'Rti.A•isONi 'an •C
rrr, 4 SC4a II-3
WELL CONTRACMRCOMPANY� �. }. ._
STATE WELL c N STRUCrICN moan - AssocrsTzQ satiny _�'' .•
rreppl able) ` / •fir ) •
•
1. WELL USE (Check ApplieeeLls Bo*Raidentiel&MmieipaVPub11C ( Industrial C Agriwltur l C7
• Monitoring ❑ Raovay O' iiat Pump Witte InjecOon ❑ Other tl IfOgier, LSa1Use "
•
S. TOTAL DEPTr1• '4'OS . ' •-
6. DOES WELL REPLACE EXISTING WELL.? YES CI NO€ W-
8. TOP OF CASING IS
vai n N aenrdaaavda 151ai e2C MIL j
METHOD OF %I/Dy/
10. WATER ZONES (depth): • r OCA SON SICHTCH
11. DISINFECTION: Type Af>f Amount .ZTP-A S Show direction end.diatanca iti• mhos from at Icast
12. CASING: - Wall Thickness two States Roads cc County Roads.Include the road
Depth Dina or Weight/pt. numbers and`eormnon road names.
From O .Tom FL has $.a *Jot
:
From To Ft .
Fron(_ Tp FLU_
13. GROUT: Depth Maniit tdathod"
Front_( To AD Ft —�Q49a as pcw.A.) .
Front To Ft,
4. SCREEN: Depth Diameter . Slot Size - • Material .
From_ To Ft._in in.
From To Frja in.
5" SAND/GRAVEL PACK: - -
Depth Size Material
7. STATIC WATER LEVEL Below Top of Casing .56 Ff:
(Un'r irAbove Top orcebel
_� FL'. Above Land Surface*
'Ter orntlagtawl atadatkr bel�bwd.tvhangatrba .
9. YIELD (gpitO• �.i_ ` � kept,
�5r'
Tppogthppicli and setting •
Lot h (Slope 'Malley . (Plat
(ohedraPPRW4leb4w)
Latituddbngitude ofinn location
•
Latitude/Washed, souracOPS(TopoWaph(e map
ergEn DRILLING LOG
From To: FcttttationDescription
9n•
�I L 11 A-4Ln7 ¢-�- .
From To Ft
From To
FL
6. REMARKS:
DO HEREBY CERTIFY THATTHIS WELL WAS CONSTRUCTED INACCORDANCE Willi 15ANCAC2C. WELL •
ONSTR(1C IONSTANDARDS,ANDT AATAACOPYOFTMREBEEN PROVIDED OWNER
1CORD
SIGNATURE•OFPERSON CONSIRUCfMOTHBWEtd. . • DATE •
submit the original to the Division or Water Quality, Groundwater Section, 1636 Mall Service Center -Ralelgh,TNC
n699-1636 ?hone No. [phone], within 30 days. . GW-I REV. 07/2001
1

wELL CONTRACTOR COMPANY
STATE WELL CONSTRUCTION►smalIT9 - MacC4-TED W44'ZRMITS .
(ifala) 4irm_1_1e) • .
.. . -
• WELT; CONSTRUCTION RECORD' : _ _
•
- ♦ }
Nora) CaSalina-Deparmad ofEmittmmSand fatwalRes ww-Division fVaatcrQuality-Oroi Section
WELL CONTRACTOR INDVGDUAW'Nlas (pal;;* ;he flflt 5 /rjn II-o„A,t.• '-'. C1137ICATIOPNLAL74. .
Paota scratesca Li-3 24 U
1. WELL USE (ate* Appl niltBoxk-Residential M , ew,ieipaliPublie 0 Kehl CI Agricultural O
Monitoring 0 Recovery 0- Heat Pump Water kinetics ❑ Other CI If Other, List Use _
2. "WELL LOCATION:. 'Nearest Town: Pc); fl /CL i 4/ ' County 1&4cata> .
// ,4SI+eD Rim J$ tP . & T-- .4. tray
(Street Na Number.. Camas*, Beattidaa, Willa. Tho Cods)
3. OWNER a ° P 4%-a
Address .to. 13Oft" /
Pi.L1 1_ t_ _ ;21 % 7
CayerTan &am Zip Coda
data- 3 44.2 - 6P 6 cc 9
Area code- Pbaae sbr ,-
4. DATE DRILLED 7 7-0
5. TOTAL DEPTH: &DO.S '
6. DOES WELL REPLACE EXISTING WELL? y
7. STATIC WATER LEVEL Below Top of Cuing
(User Wallows Top aft
S. TOP OF CASINO IS / PT. Above Land Surface`
'Tap sleuths Wraedaatad War b6eef 1tssad.aarfiw ngWta
.aAoasa la aeeardaass wIlleISATICAC 3C Alta
l Yz- �IO/D
YIELD Wok 9.D OFTEST
0. WATERYANES
1((depth):(depth):DO
ti
Tapogrsptidllimd sating • -
0 Q Nat
IatitudWlwigiarda of w dl Iocadan
bhavershoianstateaam)
Latitude/Iongihide sowcx0OPS0Topogaphic map
• Woe too
e . . DRILLING LOG
From To - I = t'imt Dexriptioa
•0.7 `
s7? /Sb _ w
r / So • l06 d • : �. t: ve_ t /L ot. r r-e--�
f$
0Q N_:V% ''
0 FT:
WCATION SKETCH
11. D!SINFECFION.Typc it-fl.i: Amount .-2 TA -AS Show dimcdo►dIsbncein from at least
12. CASING: - Wall Thickness two State Roads or County Roads.Include the road
Depth w WedgldRi. numbers sad -common road names.
From 0 . To i sa Fk ate' Sag,$.
From.__To Ft •- .
From TVFL___ 0
13. GROUTS_ Depth Aided' Method . - a =
From`.Q_ To Ft.r2 flew,() ' 43
From To FL
.4. SCREEN: Depth Dlazneler Slat Siff Material - 0 i
From To FL _jn. in.
From To Ft�in in.
5. SAND/GRAVELPACK:
Depth Size
From To Ft.
From To Ft.
6. REMARKS:
DO HEREBY CERTIFY THATTHIS WELL WAS 03NSMUCIEDIN ACCORDANCE WITH ISANCAC2C, WELL •
ONSTRUCTION STANDARDS, AND THAT A COPY DPW RECORD HAS BERI PROVIDED TO THEN/ELL 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
fl699-1636 Phone No. [phone], within 30 days. GY%I REV. 07/2001

WELL CONSTRUCTION RECORD OS)
North Carolina - Department of Environment and _Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME ((prrfn�t)) ",/IU 'mS• (Er ,/ Iv„ CERTIFICATION B,!q5��7_
WELL CONTRACTOR COMPANY NAME H T(T ESA. U -C ��G�-L'� 1G t`-k-PHONE 8 an �V- / l SS
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential E Municipal/Public 0 Industrial ❑ Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCA
To
ON:
ty
ERIMW
RR'i!d .
(
N Number,
3. OWNER:
Address
'lion, Lot No.,
It .)
#..FYI. a -*
City or Town
✓i%1 i
Zip Code
Area cods Phone mmtber
4. DATE DRILLED
5. TOTAL DEPTH• - -
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO 1E1/
7. STATIC WATER LEVEL Below Top of Casing: SO FT.
mac "+" if Above Top of Casing)
8. TOP OF CASING IS l FT. Above Land Surface*
'Top of cuing terminated at/or below land surface requires a
variance In accords eecevrkh 15A NCAC 2C .0118.
9. YIELD (gpm): METHOI? OF TEST
10. WATER ZONES (depth): \%C
11. DISINFECTION: Type \itTh Amount
12. CASING: Wall Thickness
From 0 To 5'i' Ft loe it er r•�t y5(
From To Ft �'vl .
From To Ft.
13. GROUT: th eitima
From_To Ft.
From To Ft
14. SCREEN: Depth Diameter Slot Size
From To Ft in. in.
From To Ft in. in.
15. SAND/GRAVEL PACK
Depth Size Material
From To Ft.
From To Ft
(P
Material
,,Topographic/Land setting
Entidge DSlope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH DRILLING LOG
To}l Forma Description
gL
From
0
S-4`
5 `
0
LOCATION SKETCH
Show direction and distance in miles from at least cc
two State Roads or County Roads. Inc de the road
numbers and common road names.
ca
16. REMARKS: IN
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRSCTI ST f_i_RD.S.AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THF�WEI OWNER
SIGNATURE OF PERSON CONSTRUCTING THE WFJ S
(p (o
D TE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mall Service Center - Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-1 REV. 07/2001

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section �Q
WELL CONTRACTOR (INDIVIDUAL) NAME A(prrint)-3\v"k \ S . k ��-MS /� CERTIFICATION # v '�`� _
WELL CONTRACTOR COMPANY NAME 9S Y'l� �S V � r �Q-k u' ` t`'L-'1 PHONE # } J() �� �I S�
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
/
1. WELL USE (Check Applicable Box): Residential H Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water injection 0 Other 0 If Other, List Use
2. WELL LOCATI
stT
(Street N e, Numbers, Community,
3. OWNER: -
Address It 'o c
• !, fstreet a goti&No.)
City
(6}
Area code- Phone number
4. DATE DRILLED
5. TOTAL DEPTH:
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO
7. STATIC WATER LEVEL Below Top of Casing: 45) 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 actordamorith ISA NCAC 2C .01114
9. YIELD (gpm): \ 2 s METHOD pF TEST 9
10. WATER ZONES (depth): \S
11. DISINFECTION: Type
12. CASING:
DP Cork
_ `Topographic/Land setting
CrRidge 0Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/mimrus/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(cheek box)
DRILLING LOG
Forma 'on Description
DEPTH
From To
h
351
LOCATION SKETCR
l F� Amount Show direction and distance in miles from at least
From b To Ft
From To Ft.
From To Ft.
13. From_(:)._
To
GROUT:
T�
Depth( L Ft
From To Ft.
14. SCREEN: Depth Diameter Slot Size
From To Ft. in. in.
From To Ft. in. in.
15. SAND/GRAVEL PACK
Depth Size Material
From To Ft.
From To Ft.
WallThickness two State Roads or County Roads. Delude the road
je•Weight/Ft.Material numbers and common road names.
Material
16. REMARKS:
1 DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2G WELL
CONS R CCTIOr� THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO OWNER
lP 2-ri 1)(0
SIGNATURE OF PERSON CONSTRUCTING THE WELL ATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mall Service Center - Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-1 REV. 07/2001

3. 0WN&R, /S en h 2Y * CUL '—
Address 15a.. yL /Yv i 11 11 art
0,rtarib ettoJ-`_
12oxilt:I �• a-• O`al5'9
CbrorTa.a - star '; ' rrra&
031e} 33O-b(o
Atnaidsarosaeaeer
4. DATE DRILLED L/) "a �I''0 • -
5_ TOTAL DEPTH* / ' -
6. DOES WELLREPLJICB R ISTEC WELL? vase N0421/-r
7_ STATIC WATER. LEVEL HehwrTop ofeerlos. SO
at/
/ Naw serli eroms1%S S
misses la �ea�a�
10. WATERZONES (d(depth):/ PO ' -
11. DISINFECTION, -typo Wilk Amount .3Th-S now dkoe6wBA-et eieS nematIasi
12. CASINO: - - wall - • two Slats Roads orCounty Rad::laolu o0eroad
Drapesarw. pt : _ -manbeaand'aop®onroadtuaes.
From O . 3 F4 '- -
Fmm _To Fc - -
Frotq__Te FL- -
S. TOP OF CASING IS FT. Above land Sia8eoa•
nap eteadegtlaainW tellataikarnalrint
9. WEIS(Spu* itww1I1om6F
z ..
= _V EIL CONSTRUCTION BECTID 33 4 395
tio:1&Olna-D for
wars cou rawctoa
u.0rmtmuw
wecortrawaroac mramv
rat wets a xerneurnatrmitni faafi@
elh7
ar/se -
lints / 112.r::b ' ' " saianc►s * ince
1_ WELL USE (fled&App Iefliox -Raddealnt VPth&fl ,Ier tid0 Agtp aat•4
Monitoring Raxtverya° Heat Pomp wstarlt a 06ercr Ifodier,Lirttae 1 - -
2 -WELL LOCATIOIt , ���
-N Ton L ' ,r
ew k24r3t.avm
DUI AGmv - -
PCiSloiso ansy .CJ6let
dc • (d.t
map
Wio n TR friermarnonDerision
D 4,3 ' t A-
lF3.. 360Lid a-/1,4.v i-t -Q .
13.ORODepth
From —a— lo_� -
From_To -FG
_4. SCREEN: Depth Mama _ Monroe Mania!
Front_ToL FL_,_jn. in.
From__To Ft. in. in. -
5_ SAND/GRAVELPAQC
Depth are Wale)
From To Ft.
Ram To Ft.
RFC, _\1ED
Div. r-lw•i7- QUALITY
Nov 0 6 201)6
6 REMARKS`
DOHERESY MST T0ATmwWE Lwaa» ,Run1NAOCORDANGBWIIRI5A• ' '2L,WEW-
CNSiRtCT(ONSTANDAROS.MelRAOP TAOYc R1 lEEMOYIDlib1OTA6-wmLOWNER
44e. Ib7-0(4-
3I131+ATURDbrERSO CONSIRUCI1NOTi111 Wt$a: - •DATE - :
Submit the original to the Mirka of Water Quality, Groundwater Section 1636 Mali Service Center -Releigh, NC
a76994 636 Phone Pia. [phone], wltb1a 30 days. _ _ OW-1 REV. 072001

RESIDENTIAL WELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources- Division of Water Quality
WELL CONTRACTOR CERTIFICATION # 2a 2h'
1. WELL CONTRACTOR:
Well Contractor (Individual) Name
Ctl Well Contrabtdi rR OT S WELL DRILLING, WC.
1 WANE CIRCLE
STREET ADDRESS FRANKLIN, NC 28734
City or Town State
cayLf926
Area code- Phone number
2. WELL INFORMATION:
SITE WELL ID #(il applicable)
STATE WELL PERMIT#(a applicable)
DWQ or OTHER PERMIT #(if applicable)
WELL USE (Check Applicable Box): Residential Water Supply -
DATE DRILLED e — 0
TIME COMPLETED
Zip Code
3. WELL LOCATION:
CITY: �v-A-Ai CI,•N
�SStylfee
AMO PM
COUNTY Ni,l'+e-0N2
(Street Name, Numbers, Corratr_suggy, Subdivision, Lot No., Parcel, Zip Code)
TOPOGRAPHIC / LAND SETTING:
❑Slope ['Valley ❑Flat DRidge ❑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 2&7 ,(J
STREET ADDRESS 1. 7 /`T/�-T r�/ O�t�' P-c2
wir/ CCg`) 3 y
City or Town State Zip Code
May be in degrees,
minutes, seconds or
in a decimal format
Area code - Phone number
5. WELL DETAILS: S a. TOTAL DEPTH:
b. DOES WELL REPLACE EXISTING WELL? YES NO 0
c. WATER LEVEL Below Top of Casing: /) U FT.
(Use'*- it Above Top of Casing)
d. TOP OF CASING IS / 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): (v METHOD OF TEST >Y! f
Submit the original to the Division of Water Quality within 30 days. Attn: Informatiof
1617 Mail Service Center —Raleigh, NC 27699-1617 Phone No. [phone] ext 568.
f. DISINFECTION: Type
g. WATER ZONES (depth):
From To From
From To From
From To From
Amount
To
To
To
6. CASING: Thickness/
Depth &/ Ft. Di�elgy Weight Ma ial
From 6 To
From To Ft.
From To Ft.
7. GROUT: Depth ^Materia�l jj Method
From b ToD /n� Ft. l.k.l'%'72�V'f—itY'v5
From To Ft.
From To Ft.
8. SCREEN:
From
From
From
Depth Diameter Slot Size
To Ft. in.
To Ft. in.
To Ft. in.
Material
in.
in.
in.
9. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
From_ To Ft.
10. DRILLING LOG
From To
-7-54-5-
11. REMARKS:
Formation Description
pN C WATER
tIpN
0 e LOT,
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED N ACCORDANCE W nH
15A NCAC 2C. WELL CONSTRUCTION STANDARDS. AND THAT A COPY OF THIS
RECORD HAS BEEN PROVIOED TO THE WELL OWNER.
SIGNATURE OF CERTIFIED WELL CONTRACTOR DATE
PRINTED NAME OF PERSON CONSTRUCkI�G SH NIEL6
9 ti t
Mgt.,
FormGW-la
NOV 0 2 209I7/05
0

RESIDENTIAL WELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources- Division of Water Quality
WELL CONTRACTOR CERTIFICATION # 267/
n
1i tj
n
6 iL)
1. WELL CONTRACTOR:
100447, GF4i1 e .
Well Contractor (Individual) Name
Well Contr4RAWEIMOTHERS WELL DRILLING, INC.
248 CRANE CIRCLE
STREET ADDRESS FRANKLIN, NC 28734
City or Town State
Zip Code
(U..)-W-Vp? L
Area code- Phone number
2. WELL INFORMATION:
SITE WELL ID *hit applicable)
STATE WELL PERMIT#(k applicable)
DWQ or OTHER PERMIT Cif applicable)
WELL USE (Check Applicable Box):BResidential Water Supply a"
DATE DRILLED 9-79-0 4.
TIME COMPLETED AM ❑ PM ❑
3. WELL LOCATION: �!'/ �t� ,ram
N[�
CITY:�l iC.(�p COUNTY///v/T0/
Wr
(Street Name, NOmbers, C muniry, Subdivision, Lot No., Parcel, Zip Code)
TOPOGFWPHIC / LAND SETTING:
❑Slope °Valley OFtat 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 X not using GPS)
4. WELL OWNER
OWNER'S NAME W4sk
STREET ADDRESS
May be in degrees,
minutes, seconds or
in a decimal format
City or Town
State
Area code - Phone number
a?3y
Zip Code
5. WELL DETAILS: (�d�
a. TOTAL DEPTH:
b. DOES WELL REPLACE EXISTING WELL? YES ❑ NO ❑
c. WATER LEVEL Below Top of Casing: Ft FT.
(Use "t' 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 (gpnl):3b4 METHOD OF TEST 4,- Y
T. DISINFECTION: Type Amount
g. WATER ZONES (depth):
From To From To
From To From To
From To From To
6. CASING:
Depth ,/
O
From To Ft.
DiameY
From To Ft.
From To Ft.
Thickness/
Weight Material
(WIG
7. GROUT: Depth //�Materiall
From 6 Toz.2_0 Ft. &Al a7
From To Ft.
From To Ft.
Method
pAres.rn7
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
From To Ft.
From To Ft.
From To Ft.
Size
Material
Material
10. DRILLING LOG
From To Formation Description
— to f4 CLit
(y Q�f` r/i�Tr/-
ptv of Nr-
11. REMARKS:
t10�' t� 5 200�
15A NCAC 2C, WELL COI DO HEREBY CERTIFY NHSAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH
CONSTRUCTION STANDARDS, AND TNAT A COPY OF THIS
RECORD HAS BEEN PROVIDED TO THE WELL OWNER.
//-i—d
SIGNATURE OF CERTIFIED WELL CONTRACTOR DATE
,ct 0/1.,
ems{
PRINTED NAME OF PERSDI4.CONSTRI IrTtNfl THE WEI 1
Submit the original to the Division of Water Quality within 30 days. Attn: Informat
1617 Mali Service Center — Raleigh, NC 27699-1617 Phone No. [phone] ext 568.
on Mgt.,
Form GW-la
ev 7/05
NOV 02 2006
Asheviiie Resionel Office •
Am, !if, rei.r.a,.,un#:r;",

RESIDENTIAL WELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources- Division of Water Quality
WELL CONTRACTOR CERTIFICATION #
1. WELL CONTIrjtOR:
Well
ontraclor (Individual) Name
Well Con..___. CRANE CIRCLE
STREET ADDRESgRANKLIN, NC 28734
City or Town State
(7 2 g- )- 6--AY-v924
Zip Code
Area code- Phone number
2. WELL INFORMATION:
SITE WELL ID Cif applicable)
STATE WELL PERMIT#(e applicable)
DWQ or OTHER PERMIT #(if applicable)
WELL USE (Check Applicable Box): Residential Water Supply &
a
DATE DRILLED / O "0 10
TIME COMPLETED AM O PM ❑
3. WELL LOCATION:
CITY: RPrt )L['r /l_ COUNTYin
(11 tburn $'rAnc.1T
(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: OOPS ❑Topographic map
(location of well musf be shown on a USGS topo map and
attached to This form A not using GPS)
4. WELL OWNER y�^�
OWNER'S NAMET.\AJ S Y.�L`i a
STREET ADDRESS /,", 74r 1/441/fr fl /
/76fiti a✓ /dG o2ff�.3y
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:
b. DOES WELL REPLACE EXISTING WELL? lYES ❑ NO O
c. WATER LEVEL Below Top of Casing: ,716 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): jT METHOD OF TEST /yr
33 4
f. DISINFECTION: Type
g. WATER ZONES (death):
From To From
From To From
From To From
Amount
6. CASING:
Dept n laffeter
From 61 h Tor Ft. !y
From To Ft.
From To Ft.
7. GROUT: Depth
From 0 To eta
From To Ft.
From To Ft.
,t _M,-atte_riial
Ft. ectinelt
To
To
To
Thickness/
Weight Material
P `'G
Method
ea/Lily
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.
10. DRILLING LOG
From To n
r
O
Material
Formation Description
(lay
ON• (' O 6 LdflG
11. REMARKS:
1 DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH
RE ORACAS WELL CONSTRPROVIDED
�T AELL OW AND THAT AC�%U�����
RECORD HAS BEEN PROVIDEDT �WELL OWNER
SIGhTA�TUUREE OF CERTIFIED WELL CONTRACTOR DATE
_rra— it
PRINTED NAME OF PERSON CONS RUGT)Nfi TRH
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. 1
NOV 02 26 7/e5q�BI GW-1a
pr.htneillP Regional Office
r� {ulir Protection •

RESIDENTIAL WELL CONSFRUCTtON RECORD
North Carolina Department of Environment and Natural Itsources- Division of Water Quality
WELL CONTRACTOR CERTIFICAT ON t)
1. WELL CONTRACTOR:
ell Contractor (Individual) Name
Well Contractor
CRANE CIRCLE
STREET ADDRESSFRANKLIN, NC 28734
City or Town State
OaS&Y
)4(-c1 en,
Area code- Phone number
2. WELL INFORMATION:
SITE E WELL ID #(if applicable)
STATE WELL PERMIT#(e applicable)
DWQ or OTHER PERMIT #(if applicable)
WELL USE (Check Applicable Box): Residential Water Supply8r
DATE DRILLED pck'QJ
TIME COMPLETED
3. WELL LOCATION:
kJe
CITY: Tl
Zip Code
t t
Cp t1 etre-1
AM0 PM
COUNTY fhfi-e.an
(Street Name, Numbers, Community. Subdivision, Lot No., Parcel, Zip Code)
TOPOGRAPHIC / LAND SETTING:
ID Slope ❑Valley ❑Flat ❑Ridge 0 Other
(check appropriate box)
LATITUDE 3
LONGITUDE
Latitude/longitude source: QGPS ❑Topographic map
(location of weff must be shown on a USGS topo map and
attached to this form L not using GPS)
May be in degrees,
minutes, seconds or
in a decimal format
4. WELL OWNER
OWNER'S NAME 11n�K1 :-f G11 A/
STREET ADDRESS O WhJ4H �—AK.
'Nerww 1. k We u tit 6-7
City or Town State Zip Code
Area code - Phone number
5. WELL DETAILS:
a. TOTAL DEPTH: 3 DS—
b. DOES WELL REPLACE EXISTING WELL? YES 0 NO$
c. WATER LEVEL Below Top of Casing: (00 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): .1 4 METHOD OF TEST _d .)
,0%S%
14
1. DININFECTION: Type
g. WATER ZONES (depth):
From To
Amount
From To
From To _ From _ _ To
From To From To
6. CASING: Thickness/
A Depth p,} Dia er Weight Material
From d To A J Ft. (D y __uy
From _ To Ft.
From To Ft.
7. GROUT:
,�rr)
From !/
From
From
Depth Material 1�ft Method
To ZV FLL��""Itesti/ fO Wf
To FL
To Ft.
8. SCREEN:
From
From
From
Depth
To
To
To
Diameter Slot S
Ft. in.
Ft. in.
Ft. in.
9. SANC;GRAVEL PACK:
Depth
From To
From To
From To
10. DRILLING LOG
From To
O- A'S
11. REMARKS:
Ft.
Ft.
Ft.
e Material
in.
in.
in.
Size Material
Formation Description
RFC:ENED
D V. OF WATER QUALITY
NOV 0 0 2006
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-/-O 6
SIGNATURE OF CERTIFIED WELL CONTRACTOR DATE
�r >=
PRINTED NAME OF PERSON CONSTRUCTING THE WELL
Submit the original to the Division of Water Quality within 30 days. Attn: Information Mgt., R E C E I VFE Pw-ta
1617 Mail Service Center— Raleigh, NC 27699-1617 Phone No. [phone] ext 568. R. 7/05
NOV 02 2006
Ashevilhe Regional Offide

RESIDENTIAL WELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources- Division of Water Quality
WELL CONTRACTOR CERTIFICATION # 367/
334474
1. WEL CONTRACTOR:
ell actor aclor (Individual) Name
Well Co
248 CRANE CIRCLE
STREET ADDRESERANKLIN, NC 2$734
City or Town State
()- 43C211 V92G
Area code- Phone number
2. WELL INFORMATION:
SITE WELL ID #(if applicable)
STATE WELL PERMITfthl applicable)
DWQ or OTHER PERMIT #(if applicable)
WELL USE (Check Applicable Box): Residential Water SupplyQ—
DATEDRILLED —nte,
Zip Code
TIME COMPLETED AM ❑ PMID
3. WELL LOCATION:
,,�/
CITY: rrAil,it/ /
COUNTY I 1 vTv--ten JL)
Re -it 4D2A4- C9 c*
(Street Name, Numbers, Community. Subdivision, Lot No., Parcel, Zip Code)
TOPOGRAPHIC / LAND SETTING:
❑Slope °Valley ❑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 L not using GPS)
May he in degrees,
minutes, seconds or
in a decimal format
4. WELL OWNER
OWNER'S NAME Si QMani—
STREET7iI y } �F �(J /
ADDRESS Nac2 d »Cc e r Jt
r.
City dr Town State Zip Code
Area code - Phone number
5. WELL DETAILS:
a. TOTAL DEPTH:
(0o3
b. DOES WELL REPLACE EXISTING WELL? YES ❑ NO ❑
c. WATER LEVEL Below Top of Casing: 3 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,%r
f. DISINFECTION: Type Amount
g. WATER ZONES (depth):
From To From To
From To From To
Fran To Frorn To
6. CASIfIG:: ty� Dipter
From (/ DTot 7� Ft. to
From To Ft.
From To Ft.
Thickness/
Weight Material
7. GROUT: Depth,,\l Maleria Method
From 0 Torte�rT" FL /
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
,ay
RFCFIVFD
DIV nr WATR flUft }'TY
NO'J (1 2006
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.
Olt eAAVAl )14-121L0
SIGNATURE OF CERTIFIED WELL CONTRACTOR DATE
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
NOV 0 6 2006 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 #
3473
334473
1. WELL CONTRACTOR:
cA2-t/ itaf11 -,
Well Contractor (Individual) Name
well L P 9TW L SIRILLIE4:a, r ...
2 CANE CIRCLE
NKLIK NC 2Si24
STREET ADDR€��
City Of Town State
Area code- Phone number
2. WELL INFORMATION:
SITE WELL ID #(if applicable)
STATE WELL PERMIT#(il applicable)
DWQ or OTHER PERMIT #(6 applicable)
WELL USE (Check Applicable Box): Residential Water Supply-g—
DATE DRILLED I O— Lp't%` (G
TIME COMPLETED AM D PM ❑
3. WELL LOTION:
CITY: 7L 2C COUNTY E-eren..r
Zip Code
Q Parcel, Zi Code
(Street Name, Numbers, Can unity. Subdivision, Lot No., P )
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 f not using GPS)
4. WELL OWNER /n��^ ^
OWNER'S NAME ;(Cwo
/ (1-1-4
STREET ADDRESS vti w• d et/k a� D1-5
r� CY
•ow
�7 Qc0 O %
City Town �r Wlate Zip Code
Area code - Phone number
May be in degrees,
minutes, seconds or
in a decimal format
5. WELL DETAILS:
a. TOTAL DEPTH:
Ybs
b. DOES WELL REPLACE EXISTING WELL? YESCI NO °
c. WATER LEVEL Below Top of Casing: Ye 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): U METHOD OF TEST at/
f. DISINFECTION: Type Amount
g. WATER ZONES (depth):
From To From To
From To From To
From To From To
6. CASING:
6 Depth
From To 141Ft.,
From To Ft.
From To Ft.
Thickness)
Diar{teter Weight Material
7. GROUT: Depth /� ""Mddaa�tee�r�iial
41) Ft{ W/Lsyl
From i% Ti
From To Ft.
From To Ft.
Method
iYL
8. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in.
From To FL 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
e— lob' ()Jr
(4- yfo
11. REMARKS:
61n
RECEIVtD
DIV OF WAl Fu (,NALITY
NOV_ O 8 2006_ _ _ _
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WDH
15A NCAC 2C, WELL CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS
RECORD HAS BEEN PROVIDED TO THE WELL OWNER.
SIN
SI URE OF CERTIFIED WELL CONTRACTOR DATE
PRINTE 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.
NOV 06 2006
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# 3D 7 /
1. WELL CONTRACTOR:
Well Contractor (Individual) Name
CRANE BROTHERS WELL DRILLlt w,
Well Contractor (2di$4ujet-)KL,2`-
FRANKIN, KC, 2S7S4
STREET ADDRESS
City or Town State
t$'4")- Si/ c/47:0
Zip Code
Area code- Phone number
2. WELL INFORMATION:
SITE WELL ID #(if applicable) .. ..
STATE WELL PERMIT#(ir applicable)
DWQ or OTHER PERMIT #(if applicable)
WELL USE (Check Applicable Box): Residential Water Supply.g-
DATE DRILLED IO - a O co
TIME COMPLETED AM D PM
3. WELL LOCATION: '_.l
CITY: h.-Ailifs A'Ir L
Ai COUNTY 4cr1 N
Ltit, ,r Ijurnr44 �xl
S el ame, Numbers.. Community Subdivision, Lot No., Parcel, Zip Code)
TOPOGRAPHIC / LAND SETTING:
❑Slope DValley ❑Fla( ORidge ❑Other
(check appropriate box)
LATITUDE 3
LONGITUDE
Latitude/longitude source: ❑GPS DTopographic map
(location of we# must be shown on a USGS topo map and
attached to this form it not using GPS)
May be in degrees,
minutes, seconds or
in a decimal formal
4. WELL OWNER
OWNER'S NAME '8GM-r (tPIVIIPi%'1
STREET ADDRESS
,gAit-M.--
i� Town
State
Area code - Phone number
5. WELL DETAILS: C
a. TOTAL DEPTH: J
Zip Code ay
b. DOES WELL REPLACE EXISTING WELL? YES ❑ NO ❑
c. WATER LEVEL Below Top of Casing: 'C7 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 (gpm): Z-'0 METHOD OF TEST ,411r-
f. DISINFECTION: Type Amount
g. WATER ZONES (depth):
From To From To
From To From To
From To From To
6. CASINO: Thickness/
Depth Diamg r Weight
From 0 To 6v Ft. (0
From To Ft.
From_ To Ft.
7. GROUT: Depth
From O To pc-0+
From To
From_ To
L. SCREEN: Depth
From To
From
From
To
To
Material
Ft.Iy7/1i.J
Ft.
Ft.
Material
Method
Diameter Slot Size Material
Ft. in. in.
Ft. in. in.
Ft. in. in.
9. SAND/GRAVEL PACK:
Depth
From To
From_ To
From To
10. DRILLING LOG
From To
V
YD- 17/0"--
11. REMARKS:
Ft.
Ft.
Ft.
Size
Material
Formation Description
DIV. OF WA I_N QD ALI
NOV I) 8 2006
100 HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED a1 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
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.
Fonn 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 H c 3O 29
1. WELL CONTRACTOR:
Well Contractor Name
MANE BROTHERS WELL DRILLING, iKC.
Well Contractor ConrpwNE CIRCLE
FRANKLIN, NC 23734
STREET ADDRESS
City or TToom1 State
(1'21)a5,-q22
Zip Code
Area code- Phone number
2. WELL INFORMATION:
SITE WELL ID #(ir applicable)
STATE WELL PERMIT#0f applicable)
DWQ or OTHER PERMIT #(# applicable)
WELL USE (Check Applicable Box): Residential Water Supply e
DATE DRILLED / f\ �So
TIME COMPLETED AM O PM ❑
3. WELL LOCATION:�^�
CITY: r V 'ArKi kJi N
CuActi
COUNTY f/C/-(Gl`"it)
(Street Name. Numbers. Community. Subdivision. Lot No.. Parcel. Zip Code)
TOPOGRAPHIC / LAND SETTING:
ID 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)
May be in degrees,
minutes, seconds or
in a decimal format
4. WELL OWNER OWNER'S NAME B.t IQY_ ld
STREV/�AD.DRESSS�!
c�/' LUr1C :-
Clty or Town
Area code - Phone number
5. WELL DETAILS:
a. TOTAL DEPTH:
47/
State L
Sob —
Zip Code
b. DOES WELL REPLACE EXISTING WELL? YES
NO
c. WATER LEVEL Below Top of Casing: Y31FT.
(Use'+^ if Above Top of Casing)
d. TOP OF CASING IS / 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):. b/4(\ METHOD OF TEST &AL
33446
6.
f. DISINFECTION: Type Amount
g. WATER ZONES (depth):
From To From To
From To From To
From To From To
CASING: Thickness/
11//�� Depth._Diam�iier Weight Material
From l'1 To a FL (n /y AL77,L
From To Ft.
�'"-"
From To Ft.
7. GROUT: Depth
From 0 To "a 6 Ft.
From To Ft.
From To Ft.
Material Method
Cz-Pt,-)1
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
From To Ft.
Size Material
From To Ft.
From To Ft.
10. DRILLING LOG
From To
'}a- oS
11. REMARKS:
Formation Description
RECEIVED
Dlv OF WATFW (DUALITY
t40d Q 8 ?nub
I D0 HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WISH
15A NCAC 2C, WELL CONSTRUCTION STANDARDS, AND THATA COPY OF THIS
RECORD HAS BEEN PROVIDED TO THE WELL OWNER.
SIGN A ORE OF CERTIFIED CONTRACTOR i/✓
TWELLDATEU
.art-Ld l,taao. I Cis
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.
NOV 06 2006
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 # 3091
ILL CONTRACTOR:
))tt> Ci 4 4-n —
Well Contractor (Individual) Name
wen cmtRAIREcERentitinELL DRILLING, till`';.
STREET ADDRESL5248 CRANE
City or Town State
Zip Code
Area code- Phone number
2. WELL INFORMATION:
SITE WELL ID #(ir applicable)
STATE WELL PERMIT#(ir applicable)
DWQ or OTHER PERMIT #(if applicable)
WELL USE (Check
kkyApplicay.-
Applicable Box): Residential Water SuppI
DATE DRILLED /'r)-CDb
TIME COMPLETED AM ❑ PM D
3. WELL LOCATION: CITY: r /,�//--TQ/L!i"�
nF (it.z.c�
COUNTY t y LQ-C+` CMA--
(Street Name, Numbers. Community, Subdidslon, 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 OWNER'S NAME e-,4/; t lL t
STREET ADDRESS
May be in degrees,
minutes, seconds or
in a decimal format
City or Town State
Area cafe - Phone number
5. WELL DETAILS: a. TOTAL DEPTH: 35_ S_
b. DOES WELL REPLACE EXISTING WELL?
Zip Cale
YES ( NO ❑
c. WATER LEVEL Below Top of Casing: h ' 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): / 5 METHOD OF TEST L7�.y)
33446
f. DISINFECTION: Type Amount
g. WATER ZONES (depth):
From To From To
From To From To
From To From To
6. CASING:
Ft CC�r//
From ® Depth,
To /7t2 iarpg)gr
From To Ft.
From To Ft.
Thickness)
Weight Material
7. GROUT: Depth Material
From d Told Ft. P_C'/iu.-f.
From To Ft.
From To Ft.
Method
p�
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.
10. DRILLING LOG
From To
0 — i r,—
Size
Material
Formation Description
Okey
Lia-3 5- 92d
11. REMARKS:
RWPEE co gsrf
°N of Q rclb
TAO
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.
SIGNATUR OF CERTIFIED WELL CONTRACTOR DATE
NNyi
4/"te. Crrf4I2,
PR TEDNAME•OF PERSON CONSTRUCTING THE WELt--
Submit the original to the Division of Watgr Quaflty Within"30 days."Attn: Information Mgt.,
1617 Mail Service Center— Raleigh, NC 27699)1617 Phone No. [phone] ext 568.
„�J

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 Contactor (Individual) Name
Redden 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 #(il applicable)
STATE WELL PERMIT#(il applicable)
DWQ or OTHER PERMIT #Of applicable)
WELL USE (Check Applicable Box): Residential Water Supply EI
DATE DRILLED ID • .0 6 ,l
TIME COMPLETED / / - &. AM cji PM ❑
3. WELL LOC
CI
COUN7Y n.}
N Parcel, ZipCode)
me, Numbe ,Community ub si n, Lot No.,
TOPOGRAPHIC / LAND SETTING:
❑Slope ❑Valley ❑Flat ❑Ridge ❑Other
(check appropriate box)
/
LATITUDE /0%/ i)
LONGITUDE' a
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)
May be in degrees,
minutes, seconds or
in a decimal format
ON:
4. WELL OWNER
OWNER'S NAME
10 SASEET ADDRESS �ir-1✓64j4
til
or Town State Zip Code
)-79a Sat
Area code - Phone number
5. WELL DETAILS: ^ T
a. TOTAL DEPTH: /J(V
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 2 FT. Above Land Surface'
'Top of casing terminated at/or below land surface may require
a variance in accprance with 15A NCAC 2C .0118.
e. YIELD (gpm): ICJII METHOD OF TEST Blow
334484
f. DISINFECTION: Type H T H Amount 16oz
g. WATER Z • NES (d�th
Fran (• / To 0 ♦ From To
From - API" To I� From - To
From Ai I I To JrToTo
6. CASING: Thickness/
From Depth �Q�Ft. Dis3rnelgr Weight
From To ✓/✓ Ft. (CD" (ef/18
From To Ft.
7. GROUT: Depth Material Method
From 0 To
PO Ft cement &benonne pumped
Material
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
' Clay & sand
0
11. REMARKS:
Granite
nf ,70I• g.
JNP �p46
I1 SA ACCORDANCEELL WAS CONSTRUCTED IN NCAC 2C, WELL CONSTRUCTON STANDARDS, AND THAT A COPYOF TIS WITH
RECORD HAS BEEN PROVIDED TO THE WELL OWNER.
44M— Des LOW— ll—t—o42
SIGNATURE OF CERTIFIED WELL CONTRACTOR DATE
Slcrte \1OWf1S
PRINTED NAME OF PERSQN,.CONSTRUCTING. THE.WIFLL.........
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 (Individg=l) Name
Hedden 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 #(if applicable)
STATE WELL PERMIT#(if applicable)
28734
Zip Code
DWQ or OTHER PERMIT #(If applicable)
WELL USE (Check Applicable//D �Box): Residential Water Supply
-(
DATE DRILLED /0 -O b
TIME COMPLETED • Oo AM ❑ PM
3. WELL LOQrATION:
CIT
(Street Name, NAm
COUNTY filla UM-1
rs, Community, Subdivision, Lot No., Parcel, Zip Code)
TOPOGRAPHIC / LAND SETTING:
❑Slope DValley ❑Flat ❑Ridge ❑Other
(check appropriate box)
LATITUDE 35 y
LONGITUDES
Latitude/longitude source: tjGPS ❑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
OWNER'S NAME �!/LAP, ,
ST ET ADDRESS /A / J ./��A -
Town State Zip Code
$813
Area code - Phone number
May be in degrees,
minutes, seconds or
in a decimal format
5. WELL DETAILS:
a TOTAL DEPTH:
b. DOES WELL REPLACE WELL? VEERS 0 NO yp\
c. WATER LEVEL Below Top of Casing: t� 00 FT.
(Use "+" if Above Top of Casing)
d. TOP OF CASING IS 2 FT. Above Land Surface'
*Top of casing terminated at/or below land surface may require
a variance in accordance with 15A NCAC 2C .0118.
e. YIELD (gpm): METHOD OF TEST Blow
6. CASING:
334483
Amount 16oz
f. DISINFECTION: Type H T H
g. WATER ZONES (depth
From To
From To
rnt j-a
From rr11 tt To oi��_. From To
From 41 '/ / To & From To
Thickness/
Depth • Diam ter Weight Material
From /�i
From A To
To Ft. &
FL ti ; / riu
From To Ft.
7. GROUT: Depth Material
From G To 20 Ft. cement & benonite
From To FI.
From To Ft.
8. SCREEN:
From
From
Method
pumped
Depth Diameter Slot Size Material
To Ft. in. in.
To Ft. in. in.
From To Ft in. in.
9. SAND/GRAVEL PACK:
Depth
From
From
From
Size Material
To Ft.
To Ft.
To Ft.
10. DRILLING LOG
From Tg77 Formation Description
Clay & sand
Granite
11. REMARKS:
I D0 HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH
15A NCAC 2C, WELL CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS
RECORD HAS BEEN PROVIDED
TOOTHE WELL OWNER.
SIGN URE OF CERTIFIED WELL CONTRACTOR DATE
Sne cke_ i�CllAir�$
PRINTED NAME OF P-ERSON_CQNSTRUCTING THE WELL ,,,_,.....
Sub
Mail Servicoriginal
e Center Raleigh, NC 2 699- 6117 Quality
Phone within
No (9 9) 733 7016 ext 66tion Mgt.,
8.
1617
Form GW-la
Rev. 7/05

SI
RESIDENTL4L WELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources- Division of Water Quality
WELL CONTRACTOR CERTIFICATION # 3368
1. WELL CONTRACTOR:
WILLIAM BRADLEY LEWIS
Well Contractor (IndMduai) Name
CHEROKEE WELL DRILLING
Well Contractor Company Name
STREET ADDRESS PO BOX 1007
MURPHY
NC 28906
City or Town State Zip Code
( 828 ). 837-8008
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 E
DATE DRILLED 10/04/06
TIME COMPLETED AM ❑ PM ❑
3. WELL LOCATION:
CITY: TOPTON COUNTY MACON
STILLWIND RD.
(Street Name, Numbers, Community, Subdivision, Lot No., Parcel, Zip Code)
TOPOGRAPHIC / LAND SETTING:
❑Slope °Valley CI Flat El Ridge ❑Other
(check appropriate box)
LATITUDE 3 5 15.059N
LONGITUDE 8 3 37.679W
May be in degree,
minutes, seconds or
in a decimal format
Latitude/longitude source: ©GPS ° Topographic map
(location of war must be shown on a USGS topo map and
attached to this fomr !/not using GPS)
4. WELL OWNER
OWNER'S NAME JOEL NEAL
STREET ADDRESS 661 JUNALUSKA RD.
TOPTON
City or Town
( 828 )- 321-4401
Area code - Phone number
5. WELL DETAILS:
a. TOTAL DEPTH: 1000'
NC
State
28781
Zip Code
b. DOES WELL REPLACE EXISTING WELL? YES ° NO
c. WATER LEVEL Below Top of Casing: 400 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 Or METHOD OF TEST AIR
333725
f. DISINFECTION: Type CHLORINE
g. WATER ZONES (depth):
From
From To
From To
6. CASING:
To
Depth
From 0' To 60
From To
From To
7. GROUT: Depth
From 0 To 20
R.
Ft.
R.
Amount 100 PPM
From To
From To
From To
Thickness/
6 ireter Vggi Ii MVteriel
Material Method
R CEMENT GRAVITY
From To Ft.
From To Ft.
8. SCREEN:
From
Depth Diameter Slot Size Material
To R. 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' TO 20'
Size Material
Ft.
Ft.
Ft.
Formation Description
RED SLATE TO BROWN DIRT
20' TO 40' BROWN DIRT TO DARK BLUE GRANITE
40' TO 60' GRANITE
60' TO 1000' DARK BLUE GRANITE
11. REMARKS:
cc"Roo-`
�1v' CC
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.
J. Q
�/V�c'en r �t f( t Lz/ �'Cc 10/09/06
I NATUREOF CERTIFIED WEL,_, NTRACTORe DATE
1 .1Li—tAin ?)RW Lb' f ?= LC) i
PRINTED NAME OF PERSON CONSTRUCTMG 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. 7/05

RESIDENTIAL WELL coNsTRucTION RECORD 3 3 3 7 2 7
North Carolina Department of Environment and Natural Resources- Division of Water Quality
WELL CONTRACTOR CERTIFICATION # 3388
1. WELL CONTRACTOR:
WILLIAM BRADLEY LEWIS
Well Contractor (Individual) Name
CHEROKEE WELL DRILLING
Well Contractor Company Name
STREET ADDRESS PO BOX 1007
MURPHY
NC 28906
City or Town State Zip Code
( 828 ). 837-8008
Area code- Phone number
2. WELL INFORMATION:
SITE W ELL ID tt(if applicable)
STATE WELL PERMITL'(iT applicable)
DWQ or OTHER PERMIT (Rif applicable)
WELL USE (Check Applicable Box): Residential Water Supply D]x
DATE DRILLED 09/29/06
TIME COMPLETED AM ❑ PM ❑
3. WELL LOCATION:
CITY: TOPTON
COUNTY MACON
ALLEN KIRBY ROAD OFF OF OLD SCHOOLHOUSE RD.
(Street Name, Numbers, Community, Subdivision, Lot No., Parcel, Zip Code)
TOPOGRAPHIC / LAND SETTING:
❑Slope ❑Valley DFlat ®Ridge ❑Other
(check appropriate box)
LATITUDE 3 5
LONGITUDE 8 3
12.610N
36.945W
May be in degrees,
minutes, seconds or
in a decimal format
Latitude/longitude solace: IEGPS ❑Topographic map
(location of wel must be shown on a USOS topo map and
attached to this form If not using GPS)
4. WELL OWNER
OWNER'S NAME WARREN BLACK
STREET ADDRESS 115 POSSOM TROT RD.
ANDREWS NC
28901
City or Torun State
Cs_
Area code - Phone number
Zip Code
6. WELL DETAILS:
a. TOTAL DEPTH: 400'
b. DOES WELL REPLACE EXISTING WELL? YES D NO IX
c. WATER LEVEL Below Top of Casing: 75 Ff.
(Use °+' y 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): _ 3 _ METHOD OF TEST AIR
f. DISINFECTION: Type CHLORINE
g. WATER ZONES (depth):
From 100' To 200'
From 200'
To 300'
Amount 100 PPM
From To
From To
From 300' To 400' From
8. CASING:
Depth
To 70' FT . 6118 Diameter
From 0'
From To R.
From To Ft.
To
Thickness/
1816
7. GROUT: Depth Material
From 0 To R. CEMENT
From To R.
From To R.
Method
GRAVITY
8. SCREEN: Depth Diameter Slot Size Material
From To R. 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' TO 20'
20' TO 40'
40' TO 60'
60' TO 70'
70' TO 400'
11. REMARKS:
SZe Material
Ft.
Ft.
Ft.
Formation Description
RED/BROWN SLATE
REDISH BROWN SLATE
BROWN TAN TO BLUE SLATE
BLUE SLATE
BLUE SLATE
JIV mr WATER QUALny
CT 1 8 2006
I DO HEREBY CERTIFY THATTHIS 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.
I4120n 1 /-0/
SIGNATURE OF CERTIFIEDELL
1a,Ni)
O TRACTOR
10/13/06
DATE
UJ\ L.LiAM bR4koL.EI L{�WS`)
PRINTED NAME OF PERSON CONSTRUCTING THE WELL
Submit the original to the Division of Water Quality within 30 days. Alin: information Mgt,
1817 Mall Service Center- Raleigh, NC 27699-1617 Phone No. [phone] ext568.
Form GW-la
Rev. 7/05

333767
!za •%ia CTI x
Na - or rr-s1 47 2.t
5...! tnu_3 Lb 0
Imam casemate.=
stare nu. oatar
wept o�+*O°'a"r '_"
+ n+uah cs
•
ae saeaf tl� : .. tfutar.tid0 9
M• onit(Meek Roans/
0'
�0txy-.a. WaterTele a
Cityirtata Sten - Zfjode
4. DATE DIOLLED - i -- -- ,
s. TOTAL DEPlS: S 7.5. in U li(k_
6. DOES WELLRHPI.ACB muumuus
7. STATIC WATER.LSVELBdowtcp*C 2' 0 Fr.
.NrRAbwaSb►ak
S. TOP OFCASD4G1S FT.AboveladS s
•Topera ben ipandeesuppkisa
,eaaaNaanwiawaddrwllifaC ids)t.
9.MD(gX r—a OD W6 P
It WATER ZONES (depth):) :. - _____ a:SA'I _
1I. CIS lON:yyme A>abopt ..1TA-Ac Show ditaad=aaa a
alaat.Amid Ind
12. CASINO: Weillbidausi tvoS�Ro�orCeuta
Itoodsanobsdo the road
� '•ammd'o�noatadnaa�v.
,m �" • Tc 43 Fl
To —
Freaa•Ta D.
F^_ mbed: - 0
TL-4tei RAGE�ERP_�
- -.P
_
. ,
IieatdrtT V ir canongessiessubsirge
�$73[Nfacorappo` _
- tti7lpt
Lappkilong• UnP
Dar
-4AL/'
Froze TR a-
_4. SCREEN- Depth Dims: Shako , MOMS
From TO In ia. in.
Fro... TR FC____.Jt. in. -
5_ SANDIGRAVELPACK: epth Sze MaterialD
From To PI._
From TO Ft
6_ REMARKS:
DO 1CithWY 8ATTNISV/1 (.WA$ODIBMC[EDRiA00�01�1= ,VilleL-
lS`[Rcicnl111srAtiDA$DB.A1DT[1ATAo PYI
OF RB(IDitD BEEdinOVIDFDTOTHalla OWNER.
•
SlOtlertmEDFPSRsoliCONSMUCTINOT1111 WEIL - - DATE -
Submit the original to the Division of Water QuaUty, Groundwater Section. I636Mali Servtm 'R*It NC
,37699-1636 Phase Na. (919 I, within 30 days.
GW-i REV. 07R001

33.3166
{ -;l atB'n a =diRewueamQuer: Gronadviter Section
o biriatr
sts�
wets -
u-sa
atmCCN[aOD1MPA1Yssaa,
i� - :?i -
gTATtMIEI.I.ODlO7mt
tf • /
t_ WELL USE (APP H00tk-R IZY1d�CI l. 0 p
•' Monitoring CI Re�!r IT Beet Pump Waste 1] OterII Iftdeer,Liat
2. "WELL LOCATION:. - : T '
NearestTowICbatind DIM
Millet'
(SnretNwe.taanlet- — L t tUr •••.
•
3 OWNER; a l l f 1 • t- l—g- gitddo a cScCKIPICPoporiPineamP
Address C a--- ; Kfi
�7D
.P � � 8ja �- tlOn
awrras �pe r . Zip Cods ; Eta To Sic
787- C/9 .a D r� a,
erdr DRILLED
�b� �.lp - � . q,s•' Jai ' ,Q L2_fl.d/, y e
4_ DATE DRILLED ,; OS ' - '
5. TOTAL DEP78:
6. DOES WELL REPLACE EXISTINI} WELL? TES EI N$•_ :
7. STATIC WATER LEVEL Below Top oKCa t -ifO FT:
(Use IilUSwsTopeltedos)
S. TOP OF CASING IS. % PT. Above tadSad'sx'
tip of .taduhdaSbS*4eiarreetn4� a :
9.gyp er.ow+..os ETUOD QW�p )j OW d
0 YAi R.ZONES L2- 93-' / ZrEO ' /. 10. WATER ZONES (depth):
1l. DISUIFECIION;Type H - Amount ..ZTA-At 5 Showa ectlooadd(slamebimltesfimttatlag
�bidosess oss o
. two StatePCauntyRoads.I ude the toad
12. CASiNGA ocWs WPt _ •tmmbmssod`cmtenodtoedmmet
Frota__f_ �' Ft_ .?-
From. - To R
From TO .
13. GROUT.: Depth Method
-
From_—i._TO-an- POY
From Tn l• —
_4. SCREEN: Depth F� Slot b9ae ' ` M
From in.
From To Ft. In. m.
5. SAND/GRAVEL PACK:Depth Sae Wald - -_
From To Ft. -
From To m
6 REMARKS:
po 800 wautiratiwymyrnoswasWASCanTAUC ED IN ACCORDANCII mu imitakeic,
O TO WBim,.11. OWNER
oNSTRUCTIN1SANDARDS,ANDTRATAC�1lOF� R�E�C�ORD BE®'MPROY>
./mdJ 'i�� ...-/ b.,6 -a Co
-- SIQMATURE-OF PERSON CONSTRUCTING TAB WELL . - DATE - -
s-ubmit the original io the Dh3ston of Water Quality, Groundwater Section, i636 Mali Service m 1 I NC
1699-1636 Phone No. [phone], within 30 days -
ktrcsska-

:,...: 3-33765
WELD CONB'1'RUC'1'IO�Q-sec
•
Nwtheddiaz- f !'� Ants x : �1��
WELL CONTRACTOR .._ ...�..�. T -Naas-'3 " °
STATE WELL CONSTRUCTIMIM4In
Eiw
1. WELLUSE (Oak APP '3ox)-3 1:1 ItdosgrL1[ j1WjWRm1_11•0
- ` Mmitorioip Rey OE Hat Pulp Woad/ Welke 0 Others IfOther, PMl _
,• •. *• . •
'Nemo Ton R.
L"WELL L CAT1O*. • _ . - ❑.-
bk� i N A fin
(amtamatom tracamalwaul+t.ida+Lotlb.8pC - 111‘42/bako22 °ffWI1 '
3.011MFR; i I4i i�
Addtes t07 tits i9-N'c�eero..� s,�wy• L Sawto n!''
lAetBa�asMeN0.? _. r • Cdwet �ItT L3
Fl !1 l ov- /3 6: =_GL C.
��"1� To - - -Faaos ionD ion
nincedsaisasamber ;.;
4. DATE DRILLED / 3--o fr • -
S. Tara -mine �A /)D • - y '
6. DOES WEtLREPLACE BX ZWWEIL? Y>
7. STATIC WATER LEVEL BS otto22t Wierialmmellip'Ceiea)
IL TOP OFCASING IS, / PT. Abo e:lad -
sup dada' tom- - =Miles r
.eassta aeterosw�•alar CaCAll><.
9. 'nab (q*--, —.. /1 a S- 10. WATER.ZONES (del j t rx=iT tOat crcrst -
I1. DISINFECTON;TYPC 111-0- Amount —2111-AS Mom dime= loltdb1220212milpnomlahag
12. CASINO: - WdWla r - - two Side Roads or County Roads. ham the toad
• Depth
YY "digit
q ypt �mbassna toad 'amass
er Tn_
Pr —T0 Ft
13.OROUL' Dods Sweat Method -.
From....A Titan_ f-lpMN
From To lit
_4. SCREEN: Depth Diameter _ aatatm - : Alatnmi
From_ To PL jA in.
From_Tom in. -_
5. SANDIORAVELPACK: -
Depth rag Maisie*
From To Ft -
From To Ft-_________--
6. REMARKS: -
iC�ER CLU `CY
pN Of 1 "12
DOtatiroRIIFYTRATiiISWELLWASCIRI$ERRIICIeatACC RD/4E11Y a1SAN
HECADZC,W
'oNsrRucnal+srArmAos.wND'IRAT!►ooeY OF"/T!�R��tTo 3 �-
SKZIA?IBIB•bFjOWNER
R�`PERSON �TUB WELL • DATE -
Submit the original to the Dhlaton of Wabar Quality. Groundwater Section. I636 Mall Service Cater -Raldgb; NC
27699-1636 Phone No.(919)7 1, within 30 days. - GW-I REV. 072o01

-33.3764
' • WELL CONSTRUCTION = D' -: _- .- _ .
Nor h - Depainsawilliwkonaintsndisla d DivLionef kiaQ ': s
olika
nu.contw.cton ba;ps,ILtiftts na:d; = --_: . t i /r 3 a - 0
ot
war.Sums-. P-"SS �lb.4 6 YSiI :Tic* , •r®ota�r s &Y
semwau.otaroucnot[fsoiEts jnnnani, tk •= '
(ram - •
1_ WELL USE (Check . ' " .IttdmOrhlll Agdwmnt-4
r Monitoring O Rem" O• HntPuny Wale Sedan D Other flies; LW Use - - _ -
Z Vf LLLOCA , - TlopogtepiliLi lddada
TkarestT
lm Clet:trr..osuipyairnidia!a;neatest) ' . . Ligpad01710 dsofr�l"- m' -
3. U
/L / Addras,b D X L e Le-pWdh,eslIMP
To Omni:6qm Description
_FA t-Ue14R2nr7-e-
Chit Tom MS /Prapt: 4-4 9 .'4 a 3 .. -
Mee cedes faeaeaeneer
4. DATH DRtum zg a - 6-0 S
5. TOTALDEPTH;a SS•
eYi•
6. DOES WEILREPLACE rent YHSEl 14.4421
7. STATIC WATER. LEVEL BSWTopotta®g: %S F1'
8. TOP OF CAM° IS % Fr AbovsL 1! poet -
(User Vast* efOolei)
Rep stedgtRa- - rbskiltnirm/a- ,-iiue - - -
.Odwenm-'---- 7SalOACsca18. - /-
-
R. YIELD( e_211_METBODevnswr a/WJjxa-. -
i0. WATEBZOMES(dep): /e2.< J i n ' - 6 _ - - -
Wrallagi
I1. DIsINFEcriaN:Type Mit AM ..3TA-A5 ShOW *PAM amtdbillkolthindlessmnatlast
lz CASINO: - Wei Than - - two StateRottds orComity Rottds:ltduds the goad
Dt arWa�mlPt _-ammassd o maoosadmath.
From fl . To U M,.._!Z_ TT .
From To PL .
From TP FL„.....
13_ GROUT: Dash .MMai Method
Frora)
.'ro-_1t p
_4. SCREEN Depth
ShmSha.Maeda' - - - . C \RQVPLC
C`lT
From To.---Ft,—Jo; :R
Frm_ To R. in. 0\V.c,1-10
5- SANDORAV�CK: Sia 9��
From To_ Ft.
From To Ft
6. REMARKS.
DO HUSYC6RTRY't8ATUN WELL WAS CONSTRUCTED RtA000RDANCHVRiit ISANCAC2C,visg.-
ONSIRUCrION STANDARDS, ANDTHATACOPYCWRECORD HAI 11111MP$OVmmED1»THILVIELOWNS.
sl(txTIRED? PERSON CONSmRUCTINOTii8WEL1 . - DATE -
Submit the original to the Division of Water Quality, Groundwater Section. 1636Mall Service Center -Raleigh; NC
j1699-1636 Plume No. (9191737 3221, within 30 days - - GYM REV. 07/200I

�J_ 3 +a
(s�nttr4ar - -.Colin s li.ide..tmH4/aaaoae) emit I a
3. OWNER. t7)a✓: rL / A wt-!cy -
Addess /17 -Slo4N RA- .
onnetelnettrRb-2V� �M3�.:-
Ciwialtwa Sore ft': ' mot
4. DAAteacTE /b,-3-0to • -
5. TOTAL WPM 1.6S '
6. DOES WELL RBPLALSEXISfl MiWEtth 'ni O 2 �'
7. STATIC WAT L ER'S.BdoiTapot 00-" ,-
Meguitabilmorsedmind
Ltm'41 • _ nap
o.
r� - - - DRRI UNO LOG
To ' FolmetionDes
n LQ
-- 2 uiption
�' %0 1. ' p t: k AA' ► t -e--,
�t�erItAao'oTaP{�¢i
3. TOP OFCASING IS / PT.Aboa,Lted Smite
9 YIBLb(piqk_$_D�OU6PTT&4P 11
10. WATER. ZONES (dtpt 4' 70
LOCAntaici
!I. DISINFECIUON:yype, / 'F1' Ammmt ..2TA-S Show diroedeatonldial�abindles fomdleat
I2. CASINO: - W�Tittdas n t®oState Roads or�yRoada:Iacindethe mad
q•Depth
orWii�tll+t onaibastedamoamedtenea
-
Ftom.
13. GROUT Depth l6Mawi- MSS -
Fm1�To, aI Ft 'CQia1 pawl
From To �,
.4. SCREEN: >�A Dbiuier . Slat run- _ Maoist
Fmm To FL.
From. To Ft.._Ju.
5_ SAND/GRAVELPACIC:
Depth roe
From To Ft.
Fmm_ To Ft
6. REMARKS:
DO HEREBTCOCAFYIW.t IS WELLWA$CcBerat C DR AO: AANCSW!U(',Aiw Z<',v/14-
ONSiRUCft(14SfANDARDS,ANOTBATACOPYOF RECORD 118@inOVIDEDT0111 /EILOWIE'R
071 la "h /G
SIQIATORB!EltsoDi�i�mswatl. - DATE - :
Fm
:. r: -333763
•- - _WW:, CONSTRUCTION RECORD -:
•
Nora C inn--Dement"of -a•ndl�- al Dudaatat QaliT7- 43; OtirierSaasyon
war.cartxwctoaptmt+pon�Wtt A iV1591tS •1r2r:;- : +a�.tt
ww.cot<rnacroacotanonr s�JdC �n 4-3 a b 0
.
stattnu. ca .aaa.'t=immifto - •+ �!�+
•
I_ VFW. USE (Ctpel _ !e'Baatk-1 a 1lrN ollPtelfei3 .Idraaid0 Airk:O °
Monitoring CI Reoore y O' HatPlw hialthjealio4C Other a If01$eyList Use
-\NELI.LOCATIObk -lbr
tit.tOmaha�jmQ
C /r Etta w oLK%maw
I 1 e5 /eC n/n A
in.
Moab)
RSA �RQ��}A\;\SV
oN. • °oC,� 11 7.0
•
Submit the original to the Division of Water Quality. Groundwater Section' 1636 Mali Service Center -Ralelgb, NC
n679-1636 Phase No. [phone] within 30 dap. - - GW-I REV. 07/2001

333762
- -WELL• CONSTRUCTION RECORD
-
North Calo%-DepulmtthtofEarhoa dand)Li_1 DivIio�n �'Oto stcrSection
WEc,.CONTRACTOR pareru%tnais j _fi%3«►rl,;i ca>�isiac�►Ttoii sl�7�
wau.cormtacroaooa..p„Deny P4 st t* ri (IMJI VG-li-v`i-x-t,,•r !Tat SaY-3 ab 0
srsnw trlaoitri assorJw a#aa�n - t :' ` -
I. WELL USE (Check gpp6obleBoa)-Reeidm -lO 1 VPublle13 Industrial 0 AgtiwU I.110
• ` Monitoring 0 Recovery CI' *at Pump Wall-414M 0 Offer CI!fol iar, Pat Use
z"WELL LOCATEOIt
3. OWNER: C" a-ity-O w ell S •
Addteas /01 ells 126vg- E..
larttse trod
/=PA�AGLie:yWC1 5ST39L
atiesTaan sire ,J- - Delft
clad- 8344 - 8 / 7 '
4. DRRowsbor , DRILLED /) a -o' (o -
5. TOTAL DEPTH: C(�o FAO • -
•
°Ridge Oft. OV.affey
k
T castimitepdtaehrt) . 7.
LW oogkodautvtonloot=
Ladto.denangittida somemOOPPEOTTopog<aphiarraP
eDEPTH - ( DRRILLING LOG
To Foilnu4oaDaeription
p4/ to Ar
JfL.ri-e G•A.4N s-r t
6. DOES WELL REPLACE EXISTING WEIth YES! N );_E! "
7. STATIC WATER LEVEL BelowTapofCa$ng i3"' - gI
(t4a' W t KAiew Tap dadot
g. TOP OF CASINO IS arG PT: Above Lewd Suttees
..N..a.a a�a�aae� -marl 3caua ` -
9. YIELD h� fj
10. WATER ZONES (depth): 7o' 6FTBST 10�%
LOCA'ITONSKRTC f
11. DISINFECRON;Type #f/f- Amount .1T -A show acetic* wt iaSin from atleast
12. CASINO: Wept two State Roads orCotmtyRoada.sacludetiteroad
� atWdgbtlPe. ••atmnbasandc tmnoatoadaeaws.
From fl . To //b' Ft $t-at r:': .
From__TR__ Ft -
Frotq_T9
13. GROUT: Depth
_
Froa�Q_To_ IL FL p
_ FrootTo I
.4. SCREEN: Depth ▪ D• iaotater . Metro= : • Material
From To FL M. in.
From To Ft. in. in. -
5. SAND/GRAVEL PACK: _
Depth riza Material
From To Ft. -
From To Fr.
6. REMARKS:
DO HERESioutinfTurmaS WHU. WASOotSTRUCII+o INAOOORDANC t WtIH nit inter. WELL -
ONSTRUCTIONSTANDARDS, AND THAT AO3PYW-,REOORD BHBNPROVIDEOTOT7B-WELLOWNER
"Topafamgtnteatrd Wn4adaeGwrgaMa .--
RPtR`-*
p�.° 1�9 .1..1
otI
= 16P—
SI I TUREOFP> COiSTRUCENOTi1HN(F1L - r win - :
-submit the original to the Division of Water Quality, Groundwater Section,1636 Mali Service Center -Raleigh, NC
f7699-1636 Phone No. [phone], within 30 days . OW-1 REV. 072001
o-

3.3761-
- • WELD. CONfTRUCTIONRECOtD -: . -
Notti4do]ma-Depamoadof mid Tubuai Triathlon Quality.- Seta
rikme
w,�ac�amTaa�a�a r nvrs I 'bin-A:41 hcuria" Tiorl:ar14'
WELL *croaewsrANY 4 pirc''a jb l (1 I 1641— - Treys1,',N01 s Y i_Sat!-3 ab 0
STATserru.contnnctaa,namitm JaaJru� -r? "
«dapodeabi1 - - - {Ifs) -
1_ WELL USE (Met Apiff bie Timck-R�danri.t i al/Pub6ei7 Ind t a Ajricuuw p
Monitoring El Rummy 0 Heat Pomp Wmwr* 0 Other 1FOdier,Listuse _
-2_ -WELL LOCATION: -
Al
�NearestTow¢ fifFA/b/:,r �' County MA/.n�> - .
/31eaterDtP. IfldO&t /(I,ies.b��'
t NemeMmoae, Lt t &,�a�!Anin•a cen
3_OWNER ://-•e12ahhs •
-
Address /o.s1 gaterfth raj{rn,r Qa .
twig maw thew ,e cedes
(T20- 57s-- 9.5'e
Meand. Moe star 4. DATEDRUThn 9- . 9-o co
5. TOTAL DEPTH' / 7. S •
_ TQpoDM* Aart
(dndianmpdgawal - ''
I:btiTadallaiW'tada Kyil location
banner aetstmec TopepapidenuP
gram
- DRILLING LOG
- - 0 TO Fer D ton
ty
-- na • / 7S' i/� /r 440 t 1-Q'
6. DOES WELL REPLACE magma Si TES El N_t}_QI—`
7. STATIC WATER LEVEL EelowTop ofDa atl n
(UserUnbars Tvdeada6j
8. TOP OF CASING IS % FtAbove lmdSurfaces
t uw'denawfia�73Ar MAUL -
f-IELb �ai"'•/'METHODOFTTISTDIU
wisp of rake swanned t+ekq mieongdresa
wiaewla 7NtG�iCC -
10. WATER ZONES (depth): ! SD (�
LOCATION SKETCH
Show (Erection atld wore miles Rom at least
two Sato Roads orCounty Rombaneludethe road
-numbers andcommon road mama.
11. DISINFECTION: Type N ti4- . Arnow , 3TJM c
12. CASING: - -DL�eoa Wall 'Midas
From 0 - To :� k("kin Ma j
nuzpa
From To Fti
From_Tn Ft,__„_
13. GROUT Depth Mder:1.
From Q_To�_T F/COLAj
From__ To 7t. r
.4. SCREEN: Depth Diameter . Slat Sim : - Waist
From To
�jin. From To
5_ SAND/GRAVELPAQC: _
Depth Side Material -
From To Ft,,_
From To Ft
a�J oti•P tipp6
6_ REMARKS
DDNERES CERTWFYTMTT ISWEILWAS CONSTRUCTED INACCORDANLEWI HISANCAC2QWSIL.
CNSTRUCTIONSTANDARDS, AND THAT ACOPY OF TS"RECORD DE8NPROVIDED TO7 WEILOWIE
Co-
-- SIU ATVREOFPESONOONSIAICmINDTi EWEu - DAM
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mall Santa Center -Raleigh, NC
n'f 699-1636 Phone No. [phone], witbia 30 days - - OW -I REV. 07/2001
-anti

• •
WB CONSTRUCTION
NmthtSiolma-Deiutmwto[ !od 'DIa.sn Qae - Saedm
'ri165
��_s ab 0
q.�,{,aptt�rRACeOAOOMPAl1Y _-.•_`.- � -
STAiEwas.au as aa(PaaN1Te
t_ WELLt1SE(Check Ap dRor• l�llPablcE _Indandel0 Agnw16tl1'[)
{ifappnsidtt - .
= Monaming0 Recovery t7' $atPlonpWittari n Okra lfO9teylSattlae
2 WELL LOCATIOW _ q'ppp salting -
J, -kL,: /. Coe; AM.4c a tntnay.DIat
O �n C . c 93 c`7t,
Na.d� Iaia,.2ipDadd
' ' snm PSOTopc *Pbu map
taadttay
_tof2J • pan t Throng
o irigaideaDescdption
T'7 3
/7ii' v -SA-ivel s 'O -9--'
/7 5,if8"' 4G b -G ,i-RAAJ
6. DOES WEILREPLACE SXISTBRIWSLLT TBsq-
7. STATIC WATERLEVELBelow Top oit o Int- --
SMflAbatalbpdnuteS _
S. TOP OF CASING IS ` P Abo*eLandS -
!nepdeattKmaA�iau6rbelnhodawiweeqdttaa -
eauaeaLod ae_affi estell METCOF - t1DB// cd-, -
ro.WATIRZONES(depth ca.s' - - - -
'•4 • tanpta.odtetaa0 • '
ts�tire. Lbannayseiernhiay- ONCE Mead=
3. OWN Ai; ✓� • -
Address /a2 2 / n.. 2c+
(�eetaenanettgj -- -- •
fR.4-.44Z ii+ -.A/ e B 7 3 C.
(Fag} *a/- '75•9 9 _..a _
reds Phone eke .z
4. �DATE DPU 1 lb -- a-5 =o Co . • •
-
S TOTAL DEPTH: a•-C'LS ' '
11. DISINFECTION.Type fin -Amount ..37A-ac . cmwd.dWM� MtaIMnomatleast
12. CASING: - - Wane ' tea State Rt�ort ntyRoadstdudethetoad
ntFtb atWe�lmer hr der •-m and- toad>ta�a.
From fl . To /7r : r-
From To Ft -
Fm a. Tp Ft.,,_
13_ GROUT` Depth Mona. ataha-d-i
FreaLQ._Tora1T _� .. - all(/
From To 'Ft. - i��GOS:k••4�P�\�-
_4. SCREEN: Depth Diameter _ BMbiac - = Mutate( - - QF � . - 1503
Front Trt_ F4�_Jo. is = ®\� otuS ��
S. SAND/GRAVELPACK: -
Depth Size Materiel
From To Ft.
Finat_ To FL
6. REMARKS:
DO HEREBYCEKTIFYT M T IS UMW 0311313WCIED INAC ORDANCEPM I.M.hi .'Ac2 , WBLL •
-NSTRUCTIONSTAN /AIDS,AND11uATACOPYCV M ORDHASHIRRIPgOVA�bTOTIEWBLLOWza
SIQiATURROFPERSON�THRWERI _ - DATE -
Submit the original to the Division of Water Quality, Groundwater Section,1636MaU Service tenter -Raleigh; NC
+,'f694-t636 Phone No. [phone], within 30 days. _ - OW -I REV. 07/2001

� .r
3'JO.Ws38
- WELL CONSTRUCTION RECORD
Nortia►im- Department oypmrko�Bodiless] Resomota-T4yWa t Quality.: GICandirliCS SOW=
..Z
WELL CONTRACTOR bd;) ;he VIPII s %wA-- r -tceTION
wru.cotrrwtnAN roncoavtu .ryhrC 'Panned (f2at6jNax' y-'*-t�"S ;�� 4-'3 n o
Jasso
Cif appteabla) . - / - 43f ) ' -
•
t. WEL USE((]wdtApp6ublaBoxxReid-4-O M aww p•V O ,I> ial0 A>piatissai'O
Monitoring(Recovery 0' Heat PompWatrinjection❑ Othert7 ((Ot cr,ListUse - • •
� n Ciikimd suiting -
'Nearest Town: - may/ IACOL• G0 dhi ga EISlope [Nancy-Dlflat
%55' +ee- gd-_0L, lc b ; ad4otal (tbe* WO
Pint NM; Nme-r.onfilia s ,toaHcJk :sae) SK7b3 I:aamduilaogiSofw.dtlocatias .
Z "WELL WCA.TION'
3. OWN 2 IG . D P l't
Address 5--g 4 N. . {o S14- rL t '
(aa.acxea --
?icrr�l�lam�Sae6et :PI.' 3 3 b 6 7
Q- (055• (PtF3?
CnyorTom State .%. Zip Code
Am code Mae number
4. DATE DRILLED �-/ fl - D (O
5. TOTAL DEPTH' 4t 5 5 " •
6. DOES WELL REPLACE EXISTING WELLY YES 0 NO.--04 - -
7. STATIC WATER LEVEL Below Top ofCtmg '7D Ff.
(Uw' W' wAbove Tap ort]elov
S. TOPOFCASINGISL. _/FAboreLandSu
Grp eteasing tradnat 4oiler Wet dlnd.s+rtmaaNat'ea a - verbs* In re�U-isM�ETHgOp� OF j•MyattI
9. YIELD (ZONE _T__ IJ
l0.WA7'ERZONES(deptltE !�D
Latit ddl phphtc map
• (check box)
areffi - _ DRILLING [AG
. From To - Fecmetiaa Description
D 65 rr /.4
.F9• 4755"' Atti2 (LAANTt--
LOCATION SKETCH
11. D[SINEECTION.Typc ff-1/.4- Amount .-2TR-AS Show d= and.dietratce Inmiles from atleast
12. CASING. - - WallT6ieknm two State Roads or County Roads. Include the mad
Depth or Wd�ItlPL -numbers and-o�macs.
acs.
From O . To IX FL
5 area. - -
From To Ft - - -
From Tp F1.
13. GROUT_ Depth Menial. Method - - -
From__ — Tot Ft. (yM,• p� - c
From To Ft.cC
.4. SCREEN: Depth Diameter . Slot See : , Sal _
From To Ft. _in. in. ._.__.,__...._._..___._........ __..,_.._.,_..cri
From To Ft. in.
5. SAND/GRAVEL PACK:
Depth
From To
From To
6. REMARKS:•
rcre
Ft
Ft.
•
DO HEREBY CERIffYTHATTIOS WELL WAS CWITRU(RPD IN ACCORDANCE WITH ISANCAIC2C, WELL -
ONSIRUCTIONSTANDARDS, ANDT(�(1ATAACOPY OFih`SRBLtORD BEIMPROVIDED '1OTHE-WIRL.OW► ER
t i 1O wait : i b -o
- SIGIFURB'OFPERSONODASIRUCrmoTIEWELL . Dan -
•
Submit the original Co the Division of Water Quality, Groundwater- Section, 1636 Mall Service Center- Ra(eteh; NC
X7699-1636 Phone No. (919) 7334321, widths 30 days. - - C'W-I REV. W/2001
N
_
0,.
C^
r

Fejohlip
Me
(fen? OWN
4- 4- QQ O
area ends Pameaeeber
4. DATE DENIM t e// D
- -WELL CONSTRUCTION RECORD
�ts, _ •:� �••,� y:,� ,��,.., -
Nonlr&oama-De laitofBnvkcan cmkt$haalResource-Dividesof P rQuw-Onalmie.AneSeddoa
WELL CoaTnAcrvatum>Kron a7wes (Ao �fitnrlis 110:4; ° , ca TICATIOjantr
33 739
wcucoxrwcroarnrrAlar rums%lcl ��n 4 -3 2-e 0
STATE WELL rmeitra Y / __pan rfi f )
•
I. WELL USE (Chadt Appnabk Ho:*-Raidenfiall r6 - llPoblie 0 Industrial D A_ griculpaal'C7
- ` Monitoring0 Recovery Cr Beat Trump Woot
ton Ot crl Ifotha,List Use
•2.-WELLLOCATTOtt - -
NearexTow Or/ ' - County /4C601-1
4tq/3 ZOope Rd e- 76
(Scranlama Thrmbenamayikkaviska,iorNo.rlrama) .
3. 0 m iv. - i at co-es.
/mo(�o }fl ('a4-12—* Id sake
•
DinitraFttialljnd
OSlope Malley -[][Fret
Ideaepvapehaebec) -
LiiiiMdenoigitude Civet Io"abu
Address -35 -,I/ P,c-c- L aa�{v p Lelitoddlongidide samoG0OPSOTopographie map
o� f r/3 Li „ am - DRILLING LOG
scut From To •ForomtionDescription
- -- n -3' to .
.' I�•"3�s l� 1 arw. Tt-e--
5_ TOTALDEPTT�: . O5' ,
. ' (dockbac)
6. DOES WEI.L REPLACE EXISTING WELL? YES D NO-
7. STATIC WATER LEVEL Below Top of Casks LELIZET.
(M rWAbasTpacsir)
t TOP OF CASING IS FT. Above Laud Surbees
*Tap ands' 4cnYatadattar We; rd.analKat i npYiaa --
nrlaaslaanadaaadlinklICAC3C.$1It- ) _
9. YIELD (gpO: _/ -' METHOD 9FTEST bil &jz ,
10. WATER ZONES (dept4 ,9.n & ' (�
LOCATION SKBTCl(
I L DISINFECITON,Type R-('L Amount .. TR-B S Show aced= and -Mance hiMika 113M et lent
12. CASING: - - Well M lea two Shute Roads or Canty Roads. Include the road
• Dom— t1—__ez_ Solor i ei aup1bas and-oommoa road names.
From fl - To '-i t.f: .
From
From T9
13. GROUT_ Depth Mug &l.
From�_To_i Ft C€z nyt fkWA)
From_ To Tt.
.4_ SCREEN: Depth Dimmer _ Slot Size = - Materiel
From To i1 is ia.
From To Ft. in. in.
5_ SAND/GRAVELPACK:
Depth Sae Materiel
From To Ft -
From To Ft
IJu 2 5.2 :3
0
0
0
6_ REMARKS -
DO HERESY CERTIFY THATTHISWWELLWASCONSTRUCTED AiADDO DANC6WITH15ANCAQ2C,W134.•
ONSIRUCTIONSt•ANDfDS,AND �COPYOF RECORD I3ASBE131PROVE�TOTHB-WEILOWNER
SIGNATUREDFPERSON CONSTRUCTING THE WIC - - DATE - -
Submit the original to me Division of Water Quality, Groundwater Section,1i636 Mail Servtm Cattier -Reldgh, NC
fl699-1636 Pboae tie. [phone], within 30 days. - OW-1 REV. 0712001

,3 tied
WELL CONSTRUCTION RECORD
North Carolina Department of Environment and�Natural Resources/1/
Division of Water Quality
WELL CONTRACTOR (INDIVIDUAL) NA(pliatin Ci1aP_ I J . /(� l i-` lLl�` CERTIFICATION
�Ytl 3ya z]
WELL CONTRACTOR °Airway NAME )' 1hee k 1�4 Xer T/90- 1 P rr --rile _PHONE s (y'q . " tom` 0?WC
STATE WELL CONSTRUCTION mamma ASSOCIATED WQ flanks
Of applicable) (if applicable)
1. WFLI USE (Check Applicable Box): Residential z, Mtmicipal/Public 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump W Injection 0 Other 0 If Other, List Use
2. WELT LOCATIO
Nearest Town: lank\in Cotmty /11\6 { 0'n
/oO Ups A Pot7_ PCe
(Street Name, Numbers, Community, Subdivision. Lot No., Zip Code)
nn
3. OWNER: / 1 `e Thine Pei na-f,GF 7
Address too t);51n1
(Street or Route No.)
City reTown Sbrc Zip Code
( PI} Sal- 1 c3
Area code- Phone number
4. DATE DRILLED_ g-0/—os_
5. TOTAL DEPTH: /Dh /
6. DOES WELL REPLACE EXISTING WELL? YES NO 0
7. STATIC WATER LEVEL Below Top of Casing: / FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS / FT. Above Land Surface*
'Tap al coin terminated atM Waw bald mince requIrts a
mince is nrthea ilia ISA NCAC 2C Lilt /)
9. YIELD (gpm): METHOD OF TEST /1-1 { Pn eror
10. WATER ZONES (depth): o
11. DISINFECTION: Type l/t' n i, ne
12. CASING:
Depth Diameter
From -(_ To % Ft. /,,./`%�
From To Ft.
From To Ft.
13. GROUT: Depth
From 0 To 3 Ft.
From 3 To a() Ft
14. SCREEN: Depth Diameter
From To Ft. in. in.
From To FL is in.
Amount
Wall Thickness
or Weight/Ft. Material
S,DP_a) 2UC_
15. SAND/GRAVEL PACIC:
Depth
To
To
From
From
16. REMARKS:
1 DO HEREBY
CONSTRU
Ft.
Ft.
Size Material
Topographic/Land setting
ORidge,lope OValley OFlat
' (thee appropriate box)
Latitude/longitude of well location
N35s70'164"Wog37,8 1ih,-8"
()
Latitude/longitude source- PSOTopogmphic map
( box)
DRILLING LOG
Formation Description
s1)
f t[lun) ck (rlM igie
DEPTH
From To
0-
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common road names.
AUG 25 2L:
CO
0
IN ACCORDANCE WITH 15A NCAC 2C, WELL
RECORD HAS BEEN PROVIDED TO THE WF)S OWNER
SIGNATURE OFYERSON CONSTRUCTING THE WELL DATE
Submit the otigMal to the Division of Water Quality, Attn: Information Management, 1617 Mail Service Center -
Raleigh, NC 27699-1617, Planet Na. [phone], within 30 days.
GW-1 REV. 09/2004

(
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and N turl1 Resou�ces - Division ofj ater Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME ) Lit Cue 4 5- 42��ft yr CERTIFICATION## C3
/O
WELL CONTRACTOR COMPANY NAME / I.A..)04er. w(°a2ttn7l/ ,20/7C - PHONE # 7(O2'D 7 410
STATE WELL CONSTRUCTION PERMIT* ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residen Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery ❑ Heat Pump W Injection 0 Other 0 If Other, List Use
2. WIT LOCATION
Ni�r�stt Town: t 1 0 County j-aril
C r(}#" S Work, Q,(JP rot 41r3ZS
(Street Name, Numbers, (' munity, Subdivvisin,, Lot No., tip Code)
3. OWNER:�A71l1 Yam✓ w.. 7 "
Address _' a \ AQ VR(_Q
k(Strat or Road No.)
y or zzCtN
(`L.Q )-a.-\�3 Stale Zip Code
Area code- Phone mmbet O o 3 ,D G
4. DATE DRILLED o
5. TOTAL DEPTH: <c%)&
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO,J&
7. STATIC WATER LEVEL Below Top of Casings FT.
(Use "+"ifAbove Top of ing)
8. TOP OF CASING IS 1 FT. Above Land Surface*
'Top of doing terminated atfor below land surface requires a9. YIELD (gpm): METHOD OF TEST
variance be accordance ,pdtb ISA NCAC 2C .011&
10. WATER ZONES ( / 9 a �t/4
1-)
Topo hic/Iand setting
❑Ridgepe Malley ❑Flat
r (chat appropriate box)
/1i35°OR 3 71ottitude of 14/ 83n`-21 '31•S `�
(degredmimmestisawodc)
Latitude/longitude source:❑GPS❑Topographic map
(cheek box)
DEPTH DRILLING LOG
From o , F�S g Description
�Rr
at /her F 7P .
11. DISINFECTION: Type Amount t
12. CASING: Wall Thickness /
fey a UFt Material
From To 4% FLt ,e) eo7J S�(�a i Pig—J
" Depth
From_ To Ft -
From To Ft
13. GROUT: Depth _
From 0 To -3 Ft.
From 3 To tap Ft
14. SCREEN: Depth Diameter Slot Size
From_ To Ft in. in.
From To Ft in. in.
15. SAND/GRAVEL PACK
Depth Size
From To Ft.
From To Ft.
Material
LOCATION SKETCH
Show directioit and distancein miles from at least
two State Roads or County Roads. Include the rrd
numbers and common road names.
" AUG 2 5 2003
16. REMARKS:
I DO HEREBY CERTIFY
CONSTRUCTION ST
WAS •o Li INA
TAS1I'
O t CE WITH I5A NCAC 2C, WELL
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

LJCZD a103
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Reso es - Division of Water Quality - Groundwater Section
.0 WELL CONTRACTOR COMPANY NAME 7, itt?J N.
)
WELL CONTRACTOR (INDIVIDUAL) NAME (print) i Q-�Q
PHONE # %2 -07iii0
STATE WELL CONSTRUCTION PERMIT#
(if applicable)
no
ASSOCIATED WQ PERMIT#
(if applicable)
1. WELL USE (Check Applicable Box): Resident'Municipa1Public ❑ Industrial ❑ Agricultural ❑
Monitoring ❑ Recovery ❑ Heat Pump Wa Injection ❑ Other ❑ If Other, List Use
2. WELL Town: Ol,1LV �1 ` �n a �
NjTown: j — C L Countyl
(Street Name, Number, Community, Subdivisicq Lot No., Zip Code)
3. OWNER.: 4^ EOt.00\
Address0a,aa (3C s (--\-)QoJV
- (S1' `t (Sttcct� C_ '6^ 3H"
ray or Town rate Zip Code
l�aa - 3(Q9-9-1toi
Area code- Phone somber
4. DATE DRILLED '016,
5. TOTAL DEPTH: Ran
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO
7. STATIC WATER. LEVEL Below Top of Casing: `AO FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS / FT. Above Land Surface*
'Top of casing terminated atlor below land surface requires a
variance in accordance with 15A NCAC 2C .0118.
9. YIELD (gpm): / p2 METHQp OF TEST
i
10. WATER ZONES (depth): l
DISINFECTION: Type P�lInr; tl� Amount
CASING:
From � To% l Ft. gyp•/a.5 5bR 1 pig
�31�k SlQe�
t) 3 (i ii U
CERTIFICATION
Topograpbift setting
❑Ridge ❑Sloppe J Valley ❑Flat
(check prim box)
Latitude/longitude tude of well locac Q3 e a 7 t O L
lJ3S°lar5)./ W
(dq�Pcunds)
Latitude/longitude source. GPconds) graphic map
bac)
DEPTH \ DRILLING LOG
From To F r tioq Description
cps -aa.9 �m katit Lrvarwte
Wall Thickness
11.
12.
Depth Diameter or Weight/Ft Material
From To 3(Q Ft62./25
From To Ft.
13. GROUT: Depth Material
iT
From .3 To Ft Etter
From_ To FC n �
14. SCREEN: Depth Diameter Slot Size
From To Ft in. in.
From To Ft in. in.
15. SAND/GRAVEL PACK
Depth Size Material
To Ft.
To Ft.
From
From
Method
Material
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common road names.
AUG 25 L ..J
a
16. REMARKS:
1 DO HEREBY CERTIFY THAT
CONSTRUCTION STANDARDS
15A NCAC 2C, WELL
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

RESIDENTIAL WELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources- Division of Water Qualit
WELL CONTRACTOR CERTIFICATION A 2187
1. WELL CONTRACTOR:
Russell S. Taylor
Well Contractor (Individual) Name
Hedden Brothers Well Drilling, Inc.
- ^•-'�; Contractor Company Name
STREET ADDRESS 73 Holly Hills Vista RD
Franklin,_NC 28734
City or Town Slate Zip Code
( 828 >• 369-9591
Area code- Phone number
2. WELL INFORMATION:
SITE WELL ID #(If aplleable)
STATE WELL PERMIT#0f applicable)
Dtgl or OTHER PERMIT #(if applicable)
N att. USE (Check Applicable Box): Residential Water Supply X
rd.rE DRILLED / '24 •076. 111���
5,00 AMC PM,y�
TIME COMPLETED
1. WELL LOC - ION:
CITY:
/ COUNTY // ette /Yr
-rf! VVe/
ommunl ,
Subdivision, (St tl ame, NumSs, N Lot No., Parcel, Zip Coda)
TOPOGRAPHIC / LAND SETTING:
❑Alope °Valley ❑Flat ❑Ridge ❑Other
(check approprlate box)
L. 11TUDE • .-
LONGITUDE_
Lati'ude/longitude source: OGPS ❑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 NAMt1/4
ST -ET ADDRESS,
May be in degrees,
minutes, seconds or
in a decimal format
Town 1 State
gg.G19,a}
A'aa code - Phone number
1 $
CI
Fe
5. WELL DETAILS: 1 ',
a. TOTAL DEPTH: 00
b. DOES WELL REPLACE EXISTING WELL? YES ❑ NO
c. WATER LEVEL Below Top of Casing: 0- FT,
(Use's' if Above Top of Casing)
d. TOP OF CASING Is 2 FT. Above Lend Surface'
'Top of casing terminated aUor below land aurface may require
a variance In accord ce with 15A NCAC 2C .0115.
e. YIELD (gpm): METHOD OF TEST Blow
f, DISINFECTION: Type HT'T H "—Amount
g. WATER ZONES (depth):
From To
From To
rr To
1 6oz
From To
From • To
From -
6. CASING: Thickness/
A Depth Dim91rsr Weight Material
From FU To Ft. C
From Vl rQ To Ft. rrnr'
From To Ft,
7. GROUT: Depth Material Method
From 0 To-.20 Ft. meat & ba rite lane
From To Ft.
From To Ft.
6. SCREEN:
From
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
From
From
Size
To Ft.
To Ft.
To Ft,
10. DRILLING LOG
From To
Material
Formation Description
Clay & sand
Granite
Ge
rS
na
11. Rj11ARS•
`r/A
1 D0 HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH
ISA NCAC 2C, WELL CONSTRUCTION STANDARDS, AND THAT A COPY OF THI$
RECORD BEEN PROVIDED TO THE WELL OWNER.
J
GNATURE OF CERTIFIED WELL
Russell S. Taylor
NTRA IOR 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 , 3 ,.�-:,,
r•, r 7
of Environment and Natural Resources- Division of Water Qualit3 0 ! 5
North Caroli
na Department
WELL CONTRACTOR CERTIFICATION it 2187
1. WELL CONTRACTOR:
Russell S. Taylor
Well Contractor (Individual) Name
Redden Brothers Well Drilling, Inc.
Well Ccntraoia •'--many Narne --
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 PERMIT/SO applicable)
DWQ or OTHER PERMIT *(if applicable)
N 5LL'USE (Che
ra rE DRILLED
TIME COMPLETE
3. WELL LOCATION•
CITY.
Applicable Box): Residential Water Supply 0
ato Dorn
p to)w AMOMPA S
//
COUNTY 1 s Lsx-U^-'
Parcel, ZipCode
(Sleet Name, Numben. Community. SubtllNalon, Lot No., )
TOPOGRAPHIC / LAND SETTING:
°Slope °Valley ❑Flat ❑Ridge ❑Other
(check appropriate box)
L'IITUDE
LONGITUDE
Lati'ude/longitude source: °GPS °Topographic map
i%ocaf/on of wed must be shown on a USGS topo map and
attached to this form l not using GPS)
4. WELL OWNER
May be in degrees,
minutes, seconds or
in a decimal format
OWNER'S NAME
S3 'ET D RESS
e7 „le L - - - ieotle
(b-m. 9qD-10-y9a'
Area code • Phone number
5. WELL DETAILS:
a. TOTAL DEPTH:
b. DOES WELL REPLACE EXISTING WELL? YES 0 NO 0
c. WATER LEVEL Below Top of Casing: FT.
(Use'+' If Above Top of Casing)
d. TOP OF CASING IS 2 FT. Above Lend Surface'
'Top of cuing terminated at/or below land surface may require
a variance in accord. - ce with 15A NCAC 2C .0118.
e. YIELD (gpm): METHOD OF TEST BlOW
f. DISINFECTION: Type H?.T H Amount 1 6oz
g. WATER ZONES (depth):
From To From To
From To From - To
From From To
6. CASING: Thickness/
Depth. Direr Weight
From To {0 Ft. (Li —��
From kTo la Ft. (s el t/St
From To Ft.
Material
7. GROUT: Depth Material Method
From 0 To"20 Ft. caret & tarnite rimed
From To Ft.
From To Ft.
8. SCREEN: Depth Diameter Slot Size
From •ro 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 Too
Co% moat
Formation Description
Clay & sand
Granite
C
11. R I tier ��
V
rn
N
0
1 DO HER BY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WRH
15A NCAC 2C, WELL CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS
RECORD NA7$,9EEN PROVIDED TO THE WELL OWNER.
gig •Ob
SIGNATURE OCERTIFIE ELL NTRACTOR DATE
Russell S. Taylor vv
PRINTED NAME OF PE •. 9NSTRUCTJWGSHEWELL-.-----
Submit the original to the Division of Water Quality within 30 days. Attn: Intone ton Mgt.,
1677 Mall Service Center- Raleigh, NC 27699-1617 Phone No. [phone] ext 565.
Form GW1d
({p U Rev. 7/05 1

RESIDENTIAL WELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources- Division of Water Qua
WELL CONTRACTOR CERTIFICATION 01 2187
1. WELL CONTRACTOR:
Russell S. Taylor
Well Contractor (Individual) Name
Redden Brothers Well Drilling, Inc.
Woll C Ater:, • ' r many Name
STREET ADDRESS 73 Holly Hills Vista RD
Franklin,_14C 28734
City or Town State Zip Code
( 828 i- 369-9591
Area code- Phone number
2. WELL INFORMATION:
SITE WELL ID #(If applicable)
STATE WELL PERMIT#(e applicable)
DWQ or OTHER PERMIT #(If applicable)
V! all :JSE (Chec Applicable Box): Residential Water Supplytl
f-: rE DRILLED 1111�EEE
TIME COMPLETE • AM O PM gl
3. WELL LOC TION: /�y^/,
CI T' ._ LI)u.•• COUNTY 7/w
IMF
(Strut Name, Numbers. Community, Subd vafon, Lot No., Parcel, Zip Code)
TOPOGRAPHIC I LAND SETTING:
❑Slope DValley ❑Flat DRidge ❑Other
(check appropriate box)
L1'TUDE _.
LONGITUDE
Lati'ude/longitude source: DGPS ❑Topographic map
'location of wed must be shown on a USGS topo map and
attached to this loan #not using GPS)
May be in degrees,
minutes, seconds or
in a decimal format
4. WELL OWNER ,n
OWNER'S NAME `�
ST ADDRESS 3
�Iry or vn Mate
` attic)n1 G
L_17.1- 5*- �9�$
A'aa code - Phone number
5. WELL DETAILS: �/^
a. TOTAL DEPTH: 11 al0 e
Ceriq
Zip Code
b. DOES WELL REPLACE EXISTING WELL? YES 0 NO X
c. WATER LEVEL Below Top of Casing: 570 FT,
(Use'+' if Above Top of Casing)
d. TOP OF CASING is 2 FT. Above Lend Surface'
'Top of casing term!neted aVor below land surface may require
a variance In accordance with 15A NCAC 2C .0118.
e. YIELD (ppm): a METHOD OF TEST Blow
3 3 0 6 5 6
1. DISINFECTION: Type HrT H Amount 1 6oz
g. WATER ZONES (depth):
From 1013 To Joao From To
From To From . To
From Tr. - From---T,_...
6. CASING: Thickness!
a. Depth n Diameter Weigt�tt8
- {Xp M teri
) From LTo rss I a I0"
From To Ft.
From To Ft.
7, GROUT: Depth Material Method
From 0 To-..20 Ft. carat & tsuiite puTrsd
From To Ft.
From To Ft.
8. SCREEN: Depth Diameter Slot S!ze 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,
e
a
11. REMARKS:
Formation Description
Clay & sand
Granite
c D:
Q1 r5'1
o r--;
O
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH
ISA HCAC 2C, WELL CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS
RECORD BEEN PROVIDED TO THE WELL OWNER.
�J L.n g.14.010
SIGNATURE OF CERTIFIED WE CONTRACTOR DATE
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 Mail Service Center —Raleigh, NC 27699-1617 Phone No. [phone] eat 568.
Form GW-la
Rev. 7/05

44)
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
Redden Brothers Well Drilling, Inc.
^•e I Contractor Company !•'•.•-r? -
STREET ADDRESS 73 Hotly Hills Vista RD
City or Town State Zip Code
( 828 )- 369-9591
Area code- Phone number
2. WELL INFORMATION:
SITE WELL ID 0(11 applicable)
STATE WELL PERMIT/Rif applicable)
Dd1Q or OTHER PERMIT I#(If applicable)
V ell- USE (Check Applicable Box): Residential Water Supply
r.A rE DRILLED ii It acelo
TIME COMPLETED 5i00 AM ❑ PM-
3. WELL LO-GATI
CITY: [L`lS',l COUNTY 011Q.i,3100
(Elmo Nemo, Numbs's, Community, SubdrviSion. Lot No., Parcel. Zip Code)
TOPOGRAPHIC / LAND SETTING:
❑Slope ()Valley °Flat DRidge ❑Other
(check apprdprlete box)
L 1ITUDE _L _
LONGITUDE_
Lati'rtde/longitude source: DGPS °Topographic map
%location of well must be shown on a USGS topo map and
attached to this form 1 not using GPS)
May be in degrees,
minutes, seconds or
in a decimal format
4. WELL OWNER
OWNER'S NAME
STREET. ADDRESS
City gtp7 Town((��/n� /h� (ARP --
Area State /��y - Zip Code
(A& code• Phone number
S. WELL DETAILS:
a. TOTAL DEPTH: I MD
b. DOES WELL REPLACE EXISTING WELL? ODD
0 NO )1.._w c. WATER LEVEL Below Top of Casing: I FT.
(Use'+' If Above Top of Casing)
d. TOP OF CASING IS 2 FT. Above Lend Surface'
'Top of easing 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 HAFT H
33:,a:1
Amount 1 6oz
g. WAT2RnZONES (depth: i
..
From y-71(o To From To
From �CO
C 3'To tO1r s From 1 • To
To tr^r. To
E. CASING: Thickness/
Depth^^ as D{ampler Weight Material
From To Ol 1 Ft. 'tD Pl✓� _
From A 2$ To 3a Ft. Co'• /18V a�U
From To Ft.
7. GROUT: Depth Material �.,,...� Method
From_0 To".20 Ft. Ciatult & AL.,.A1Aute RIft1
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
Size Material
From To Ft.
10, DRILLING LOG
From To
330,
0C Jost
11. REMARKS:
Formation Description
Clay & sand
Granite c
G
0
c3 -::i
n- Tii
rn •
1 DO HEREBY CERTIFY THAT TIIIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH
1SA NCAC 2C. WELL CONSTRUCTION STANDARDS. AND THAT A COPY OF 7H15
RECORD BEEN PROVIDED TO THE WELL OWNER.
/ 3t? e R'l NO
SIGNATURE OF CERTIFIED WEL,E 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 Mat.,
1617 Mall Service Center — Raleigh, NC 27699-1617 Phone No. [phone] ext 568.
t i7
Form GW-la
Rev. 7/05

O • 0is 1-J-`f
WELL CONSTRUCTION RECORD"
..`� a `. . . section
Noah Carolina - Department of Pnvironu>ene and tt.an t Resomca - I)ivlslon of. . .Quality-- OR
✓. _ ems- � � !i �.4-3 a_b �
WELL CONTRACTOR COMPANY _
SPATE WELL coturrnlcrlO(t Paler,TRD 1ti EM 1
Of applicable) . 414wPlleable) • • .
1. WELL USE (Check ApplicablWBmt): Resideulial'fMtmicipaUPubllc ❑ Industrial O Agt'culttua4O
•• Monitoring ❑ Recovery O- Heat Pump Water Injection ❑ Other l7 if Odier, List Use
2. WELL LOCATION: .
Nearest Town: 0 cc
S7(' re' e 6-4—)�1 ad3
tStnzt Na /NinaCommrmily', Subdiriuoo, taiga Zip Cade
3. OWNER: ( /G�Lre
Address�-
(SUt.I i RomCN).)
Gila Town Stec .�' Tip Coda
(,o5/)- SG* 7-%40/
Are coda Phone Dumber
4. DATE DRILLED 2 - 0 b
5. TOTAL DEPTHL_ 4 0, S' • -
6. DOES WELL REPLACE EXISTING WELL? YES 1 NO:cQlre
7. STATIC WATER LEVEL Below Top of Casing: /0 0 Fr:
(User if Abort Top of Casing) S. TOP OF CASING IS _ __ FT. Above Land s
'Top of eosin Wml°sfd at/or belay load.sarfaa requires a , :
valise 1s seeordaaa ,uk-ISAT3CAC SC .011E
9. YIELD (gyro): -5- METHOD OFTESTikentit
10. WATER ZONES (depth):'/�S �' ((�I LOCATION SKETCH
11. DISINFECTION,Type_p11 • _ Amount �TR-S 5 Show direction and distance In miles from at least
12. CASING: Wail Thickness tWo State Roads or Couny Roads' Include the road
Day or Wdight/Pt. numbers and -common road names.
From_L_To_52- t eb.R: l . a 113.
From To_ Ft
From To FL
13. GROUP_ Depth Material. Method
From A To — FL A pelt
From To Ft
.4. SCREEN: Depth Diameter . Slot Sim - . Material
From To Ft.__in. in.
From To Ft. —in. in
5_ SAND/GRAVEL PACK - -
Depth Size Metaial
From To Ft
From To Ft.
6. REMARKS:
DO HEREBY CERTIFY THATTHIS WELL WAS CONSTRUCTED IN ACCORDANCE WWI ISANCAC 2C, WEIL •
DNSfRUCfION STANDARDS, ANDIEAT A
COPY
lr" f RECO�BBEN PiIOVID TO TI �WBLL OWNER.
SIGNATUREOFPERSON
//CONSTRUCTING THE WELL . DATE
Submit the original to the Division of Water Quality, Groundwater Section,1636 Mall Service (eater -Raleigh, NC
J7699-1636 Phone No. [phone], within 30 days. _ GW-1 REV. 072001
&Lend setting
'dge OSlope QValloy OFlat
(dnaappmpebtebra)
Liaituciefloligitude of wealllocation
Latitudeilongitdde source:OQPSOTopographic map
• iciwea he:)
DR.IL ING LOG
From To Fortm on Description
- Formation
. /fig.
F3' 4z-e5, /.{ Lt e- r/ZQ4^1 i--'
0
O

- • WE'LL CONSTRUCTION RECF{(??,,I D' > 6
Nortiof Barlronnwot and lateral Resources.- DivWon of Water Quality'- Oro®dwater section
writ Catolma-Depsrl>mt r�,,I'^� ckrucnaa4
war cot awcroawwn uAW t,rm4 c7il_fini 5 /J'+•'i` & 74' 6 d
war-cONTRACfOR COMPANY a (�A .•i .Il�r<ll-u� -+C,�t1'rttowFaitiL --
STATE WRu.I. coNaTRUCRO(1 PitTn A86OWTD W =WM
(ifwPliablo) - ' {if!wllable) • •
1. WELL USE (Check Applicable Box):-RetldeWi.lfMuntcipaFPublc❑ Industrial Agricultural
•
Monitoring ❑ Recovery a Hest Pump Water Injection 0 Other 17 If other, Ltst Use
TJlygapbit•JLand setting •
go OSIope Malloy OBlat
(cruet appropriate WE)
I;atitottdiongitade Of Wen location
, to steeds iauterhecems)
Latituddlongittide anmce:DOPSDTopograpbic map
• • (dadrhat)
Anna - DRILLING LOG
From To -•
Formation Description
.3q'
L -WELL LOCATION: ^n
Nearest Town: (%�Ie /} �tliL L NI County 1 Y ' A-(U'✓
CP 4-!A) /J.fiyIV • ' a&/73y-
(Sues Name. Nnnmbas, Cmaaaoey, Subd'msia. Let No, Sp C j
3. OwNER / YYl e2: �' Lib t ao--
Address 3-5- /Y a 4- L- o0 P
�y (Sant aiaemetio3 99/�
ryg3T� Siam e, 4�Codc T
Pan rF9- 04'4D •
Ann code- Panic number
4. DATE DRILLED 'ea 5 b%
5 TOTAL DEPTH. ,350
(' 3. a-
6. DOES WELL REPLACE EXISTING WELL? YES 1 NO
7. STATIC WATER LEVEL Below Top of Casing
(Use 4" if Above Tap of eosin)
R. TOP OF CASING IS __ILL
FT. Above Land Surface*
irrep of easing temlaard attar Mr laaaaurrfae* MEW' a
,nAaare L aeordaee wltk7SATiCLC:C Auer.
9. YIELD (gpm):(__MSPHODOFTEST11DIUI '+
10. WATER ZONES (depth) 6? to U
I1. DISINFECTION:Type ii-ritI. Amount-ZTA-45
12. CASING: - WallThidmea
{q � Doh w irri t
From�s T0�
From Te_. Ft
From To Ft. _
13. GROUT_ Depth Material Method l
From._-Q-_To a ?) Ft._ C 7t4jl po7�
From To Tut
4. SCREEN: Depth Diameter . Slot Size - • Material
From To Ft.___jtt.
itt
From To Ft ___jet in
5- SAND/GRAVEL PACK
Depth Size Material
From To Ft
Fror* To FL
6. REMARKS:
t
e ,'I a'
L er
LOCATION SKETCH
Show direction anddistance in miles from at least
two State Roads or County Roads. Include the road
numbers and -common road names.
0
DO HEREBY CERTIFY THATTHIS WELL WAS CONSTRUCTED 1N ACCORDANCE WZTh IS/tNCAC2C. 9B12. -
ONS1RUCf1ONSTANDARDS, AND THAT ACOPY OFT RECORD iF 8BEF21PROVIDE[)TOTAB-WELLOWNER
SIGNATURE -OF PERSON CONSTRUCTING THEWELL - DATE
submit the original to the Division of Water Quality, Groundwater Section,1636 Mall Service Oman-- Raleigh, NC
.17699-1636 Phone No. (919) 733-3T21, within 30 days. . GW-1 REV. 07f2001

c9 R
zi 0 - ( J
' • - .
- • WELL CONSTRIICTION RECF{ ltD" .
•
Northaan CTuli- DepaAmatt of Enviroonteot and Nana Resources -Division of Water Quality- Gro Groundwater Section
well. COWTRACr'oa (ntDt1(JDUM twin* v IS fl t S TtON 1 .
WEtd. CorTraAC1.Oa COMPANY Ii 11 11 .�1�t��11_ l e P90Tf 1
STATE WELL. MUTTS UTT/ Assoc:9 in woR - ' ' -
Ofappliabla) .(lfapplicable) • - .
1. WELL USE (Check AppliwbleBoxr-Residentiial7Y MtmicipaVPublic ❑ Industrial Q Agricultural O
Monitoring 0 Recovery a Heat Pump Water Injection 0 Other t? If Other, List Use -
2. WEIL LOCATION:
Neatest TownF/;i3 Nit L i n/' Comty/1A /A-£ a+✓
(fy/ITTha Loti�1
(soot Name. Numbers. Community, Sebdiriaon Lot No. VP Code)
3. OWNER � Chat] '7 DV4-n o t c h
Address %(n VP toytelt_2a Ste•
( tyrameelre.) - 3 a 7 _sr)
Pcrr oRa Gt- 5.).
GryorTmm State • 2;p Cede
13g61- 30 5z .
Ara coda- Puce a wba? a b o
4. DATE DRILLED
5. TOTAL DEPTH_.Th S '•
6. DOES WELL REPLACE /DUSTING WELL? YES 0
7. STATIC WATER LEVEL Below Top of Cellar >'21" FT:
Nan "I" If Above Top *Mashy)8. TOP OF CASING IS FT. Above Land Surfaces
'rep creasing termleated alter Matt badaefaa ngalrea a . .
.artaa .la words ww1SKHCAC2C Atlt
9. YIELD (ww): S __MBTHODOFTEST 0 lozo
10. WATER ZONES (depth): c3O'
•
• T. grapb_ic/I nd selling -
ge ❑Slope QValley °Flat
(check apptep`hic box)
Liiii11140/1ongitode Of well location
onmethaiumorafsecane
Latitudeflongittide source:❑OPSETI'opographic map
• (Scum)
DRILLING LOG
From To - Fotuadoa Description
L Qe
LOCATION sICErcH
I I. DISINFECTION :Type Hf : Amount r2TALA 5 Show direction and distance in miles from at least
12. CASING: - Wall Thidote•9 two State Roads or County Roads. Include the road
�1 Depth or WeiiaMIPt. numbers andtoamon road Hamer.
From__s�To IJ 0 r - i '.em
From To Ft
From._ To
13. GROUT: Depth Material Method
From�_To r FL et207tM FayA_I) .
From To Ft.
.4. SCREEN: Depth Diameter . Slot Sizc :. Material
From To FL_ in. in.
From To Ft,_jn. in
5- SAND/GRAVEL PACK - _
Depth Size Material
From To Ft
From To Ft.
r.
c
-c>
0
o.
6. REMARKS:
DO HEREBY CERTIFYTHATTHIS WEIL WAS CONSTRUCTED IN ACCORDANCE WITH 154NCAC2C, WELL •
DNSTRUCfIONSTANDARDS, AND THAT ACOPY OF 1, RECORD HAS BEEN P)f:OVIDEDTOTHEV/EILOWNER
OM,/ ..-7_G—o-t.
SIGNATURE-OFPERSONCONSTRUCTINGTHEWELL . - DATE
Submit the original to the Division of Water Quality, Groundwater Section,1636 Mali Service Center-Ralelgh,'NC
.27699-1636 Phone No. (919) 7334221, within 30 days. . GW-1 REV. 072001

RESIDENTIA4 nu. corsneccnoN nameii
Neat Caroima Department ofEmsoamcm and Hawni Remoras- Divan It Water Quality
was ctNPTRAcmk CERrfilcAriope s SAD 9
fa fa r�
�110 ( 6
1. WELL tbWTRACTOR
v avhes 1 ; �sr) n
wa+Certractrs (frodo,cuaµ kw*
[A� ) Sn✓t CA) P t ( r r,
wile Car Compas/ Ness
STREET mores al) Ca 4-0 j ,Pn",
T-ntG7ir41/7
City or Tate
y 6 s 90a
State Zip Cale
is E i- 1t37-6941
Asia Pecos naram
1 vas. nnalatniT .t
Siff WELL D SOasweaH
STATE INIRLPTSMislawar
OWO aecre MIME a(Egpata:$c
WELL IRE town Fairmalairat Raatarle War & 4.
TrE.CONFUMID ,r?. r/.�• Amp Pia
S.MU
.Mit flog cr�GI cc
V
CAM. - tallet aft*
talismodlomooe
tATITUOE 2 _
LOIRTTRaoE
censers* 1Morni4
Lr OW „Pout *Raw
►tr be Street.
mimes. Runde en
laa rliod ter
Laimmkarilsio....c T7lPs DTs-asloMomap
t4airalraaasa-aaTasdesUna k omapRed
twatsae/ S o Ieehitlg4PS)
4. *SLSER
*WOOS NAME
SWEET ADDRESS 3
ant TOM some
t_ _}
Nsaatds• Phve ounce
SWELL DETAILS:
a TOTAL ern c 266
p
a. DOIBtSetiSML =ISNIItNSM IL? YES ❑ Mr-
c. WOO LEVEL thy of tieing a50 FT.
(Oar.," E Mma T'i uT OMOS)
d. TOPPI Cafes#. 1 • FT. 1Weetag Seta
Teri anMryisamamsa aMr>tslow lma w4a abr taVua
salllaiiaMssiasaaer15ACAC 2C-.91fA
a Teatipat 0 onamOFTsst Eitrt
E oswFECTwlt TFps,4M Pellets Powse to
g, WATER ZONES (depel.
Fora To Pram To
From To Front To
From To From To
it. cat
Tharsst
r Mita
Hog d DeTo ign/5 � Ft e, O rt / fit c>' &
Front To Ft.
Rem To Ft
T. GROUT: CM*.
Fort 0 TO
Fats 3( Tno2fj
i SCNEfk Depar Omar taupe
Fray To Ft Rt. Is
Fir To Ft - is.
From To Ft o
L SANOIGIRAVEL PACK:
Orr Sir
Far _To Ft
Fmm To FL
Ftan To. R
SUNG LOG
From To
D-(-42
4 2 - aos
11. REMARKS:
3
77S
MOMS
t
c!
Uaat+blon
r7n
3 }5
4OuaMo ramoat nw warm Ns o ssalwasmmnaupwnc
MCC C', atatoaalist6wmaasswww, NOW
MICONDIVO OOON0001110101911441811a.OMms
hn..a on
jamb (A ti (-40BREOF'MU.
c ') IMnn LAt t5hyl
Pa41U Papier pow camawajc ., 11* MIBL

11. DISINFECTION: Type el +t2 Amount
12. CASING: Wall TM
From 41 ToWeight/Ftor .
ial
From T
��
From To
13. GROUT: Depth
From 0 Tom_ F
From 3 To
14. SCREEN: Depth Diameter Slot Size
From To Ft in. is
From To Ft. in. in.
15. SAND/GRAVEL PACK
Depth Size Material
From To Ft.
From To Ft.
D�� Ft A 51�a
o Ft.
Ft.
rico, 0206 7
327761
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and W o es-/p/l�vfsiotp pf Water Quality - Groundwater Section) Li
^�
WELL CONTRACTOR (INDIVIDUAL) NAME (print) /_' (1 , C \ � (V' ` 1. l �/1!lP I CERIIFI TION # 32 I OC
WELL CONTRACTOR COMPANY NAME I G .i r l . 13o- IeJ \ (PO�`y'Y)E/1-f' 34ICYHONE # 072ID
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential Municipal/Public ❑ Industrial ❑ Agricultural ❑
Monitoring ❑ Recovery ❑ Heat Pump Wa Inj ction ❑ Other ❑ If Other, List Use
2. WELL LOCATI
Nearest Town: r County
Saaail
\3q (il(\n r rk
(Street Name, Numbm, Community, Subnndiviam, Lotrlo., Tap Code)
3.' OWNER ' / v
Address C� RUk
tcofl� Street hoc. No.) d%���
( 3N -`^ Ate
Zip Code
City or Town
Area code- Phone member Yj`i `/
4. DATE DRILLED ,5 3 10
5. TOTAL DEPTH: a an
6. DOES WELL REPLACE EXISTING WELL'? YES DNO
7. STATIC WATER LEVEL Below Top of Casing: /
/ (Use "+" if Above Top of Casing)
8. TOP OF CASING IS 1 FT. Above Land Surface'
'Top of casing terminated aVor below land surface requires a
eesrdance 1SA NCAC 2C.0118.
9 YIELD (gpm): aiedl
variance in aIv�yT OD OF TESTA (
10. WATER ZONES (depth):
Topographic/Land setting
❑Ridge lope ❑Valley ❑Flat
( appropriate box)
Latipde/10 of well location
N35 071 3g it 14)os3°.) 5.S //
seconds)
Latitude/longitude source GPS❑Topographic map
DEPTH ack
( DRILLING LOG
From Tp Fo do scription
D I
,5" 7 - ?art <+-n..r k
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common road names. o
0
ter:
rr,,
z
r_
W
0
0
Cr".
c'-
Y"
r
16. REMARKS: ---�
I DO HEREBY CERTIFY THAT THIS
CONSTRUCTION STAND
ORDANCE WITH 15A NCAC 2C, WELL
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 Matz Service Center -Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-1 REV. 07/2001

.328100
• WELL CONSTRUCTION RECORD'
NorthCatolina- Department ofEnviroommtandNaturalResources--DivisionofWaerQuality-'tiroti waterSection
WELL cormacrORtomnnclnuAc.)'NA L (piaovbentrItS I`t"(tnLt. - . COi7nFICAtat f ol%%4e
WCONTRACCOR COMPANY •� _• .
STATE WELL CONSTRUCTION PERMITS AffiOCGTID
Cifapplicable)- -itf!ppllablc) - .
was.was.
sours i
t-ii-5a 44-3 3.b 0
1. WELL USE (Check Applicable Box):-RaidenCnl tYMwacipal/Poblie CI . Industrial 0 Splaltmal Q
Ream" Monitoring Ream"aHat Pump Water Injection O Other Cl If other, List Usc . -
2. -WELL LOCATIQ1.1• T�po�apbWLimd setting -
Nearest Town: rig( ij Adel i`sr- County M Airs d 4/ L�tC"rdge °Slope thaw. OFtat
All ,J4Jy Qa- frj en)Ins1c •FA/Ls Ue p• (chtehaereeFeiambta) -
(Street Nia N�ben. burly, Sabdrit. LotNc. re) Cede) ,38 '/3 Y L111 Cie tuck onkel 10C4on
3.oWNE&JOhn- CYO UI1- -'
Address iL)- 8.dwelt Sr'
(Steep Enteetto.) -_
Gtior Town Slaw .
Vp
Area cods- Phone member
4- DATE DRILLED G - / D - 0
5. TOTAL DEPTH' /464 '
6. DOES WELL REPLACE EXISTING WELL?&1—
, (d Smut dsceendsi
Latittddlutgittide sourca°OPSQTopog/apbic map
• • Nat ben) -
'MTh DRILLING LOG
From T F-nnm6onDe�s/cription
.� A c. /1 I CjQ4-it/)
7. STATIC WATER LEVEL Below Top of Casing D
(User iwAMveTop eiCasitt
8. TOP OF CASING IS / PT. Above Land Surface`
-Tap sr eningterminated War Mtn! leadsartas requires
mina la amrdaoeeep�'LSAT(CAC2C AIIL
9. YIELD .J METHOD OF TEST , t
I0. WATER ZONES(depth):3RD' F'TS''�c
� (�
LOCATION SKETCH
11. DISINFECTION:Typo 11f - Amtnmt ...ETA -AS Show direction ant distil=inmilesfromatleast
12. CASING: - Well Melons two State Roads or County Roads:Include the road
D at "We
- numbers and -common road names.
From 0 . Te 3S F SJRe?
From
From To FL
13. GROUT:. Depth Mataret Method .
From () To FL W( ep,n, 4,7 PO
From To FL
.4. SCREEN: Depth Diameter - Slot Size - Material
From To FL_ia in.
From To FL_in in.
5_ SAND/GRAVEL PACK -
Depth Size
From To Ft.
Front_ To FL
6. REMARKS: - -
DO HEREBY CERTIFY THATTHIS WELL VMS CONSTRUCTED IN ACCORDANCE WITH IM.NCAC2C. WELL •
ONSTRUCTION STANDARDS,,AND THAT A COPY OF RECORD BEM PROVIDEDTO THE-WELLOWNER
SIGNATURE•OFPERSON CCNSIR•IJCTINOTHE WEU. . - 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. - GAF -I REV. 072001
To FL
j
c_
c
N
O
0
0

• .
�
- - . • WELL CONSTRUCTION RECBItD- �- - � r6:.*. 9n N �
NonhCa% lint -Department of Envkannelit and Thtural_emmeaa 1hv61aRof • Quality-7 Oimindwiter Simon
Was cOetTAAr.`I9R (ntolt(lmUA47ws1116 (pea) S Iy�tlTha£ - • '• TtOsl_ .T
WELL cur ncroIcOMfl nrr�e��.;d3i� 1a���1l nQ-�l�O�l�ll- . �'ne , 6e24-3 26 0
1
SLAT[ watt cotemtocrton! - _fraancovap
d {Iftppliable) • .
1. WELL USE (Check ApSSabwBo4-Resid li-•'.11 ipeVPobue0 Industrial0 Agrkulnua1Q
Monitoring Recovery0- Hat Pomp Water hgection❑ Other CJIfOdar,ListUse -
7_ -WELL LOCATION: //
N�tTown: "---7?ANI61-/NCrnmty /Y1A(_m..''
(o't 5 (T U11 k3. CA- Grp rr, n. • c`1 eft y.
(Seen Nose.Numbar.l , Seternisies,LetNt.LpCade)
3. OWNER: J ri, m. _p
Address ke7-5 ////C-b0 N td .
(srredtlK t�
Fie a.uk-t :.: N .c a l93 i
GryhrTaws sloe .,- Zip Code -
(SM.Sin/-a
Area cods Plowsmber -:•':
4. DATE DRILLED 6 4 O40-
5. TOTAL DEPTH- 05 -
6. DOES WELL REPLACE EXISTING WELL? YES 0
liJLii e ng
Didge CISomkW-alley
. QFiat
Ouch appaphthet) -
Catiftlefireisitude eve location
Lati4idddfongihide aowi0OPS0Tcpograpbic map
- DRILLING LOG
To - Fonoation Description
•
•-em• L' 'C- &n..:9e�
From
_ -
7. STATIC WATER LEVEL Below Top ofCasingSO FT:
(User Witham:Top ofcaS
R. TOP OF CASINO IS __ FT. Above Land Surface*
'Top efeadag tenobtetedatlr Mla►had.suSatage6'eea - - - -
ved..ar Is aewdsass wielSA79CAC 2C AUL .
9. YtELb OW*3 0 M$THOD OF TEST /mo - -
►O. WATER. ZONES (depfhx lot' - - -
11. DISINFECTION: Type f i'!F Amount .2 M-A 5 Show d ree6co anti distant* fu MUM from al Least
12. CASINO: - - Wall Thielmew two State Roads a County Roads. Include the road
• Depth Maps .orWa Id9t numbersandtommonroad names.
From_ _ :To 3Ft
From To Ft. - -
From Tp Ft•__
13. GROUT_ Depth Material MMethood,
F m--To
pc» •
.4. SCREEN: Depth D▪ iameter . Slot Size - . Material
From To Pt._jn in.
From To Ft`_io. in. ' - • .
S. SAND/GRAVELPACK:
Depth 3Ze Material
From To Ft. -
From To FL - - -
r_
N
O
00
Crt
6. REMARKS: -
DO HEREBY CERTIFYMATTES W&LL WAS CONSTRUCTED IN ACCORDANCE WEN ISANCAC2C.weu. •
ONS1RUCIIONSTANDARDS, AND THAT A. COPY OF RECORD BEQ4PROVIDED TOTHEWHfLOWNER
SI(r7iA-UREO?PROM C J'RUCnNGIiMWELL DARE -
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mali Service Center -Raleigh, NC
fl699-1636 None No. [phone], within 30 daps. . GW-I REV. 07/2001
•4

WELL" CONsTRUCTIONRE. CP D" : ,.
Aof WaUor .
�oondvtatorsaetion
f3
ofBarlrotmatatand Natural Reomua Drvidon Quality-7
._-• G
WELL COmrnAcronCOMFANY a� w (FA �. T{j�-111i .( I11Q1, _., ��etiC.i-? f_t a! /, � �1-3 a-b 0
ELL
STATE WCONSTRICTION?mita-- "two fxs --- .
CtfappGable) .
1. WELL USE (Check ApPSoble BestiRetridtadial cipaU0 Fabl t • Industrial 0 Agtiwlt194 Q
-' Monitoring Recovery Wn
D' Heat PompeiInjection 0 Other CI Ifo9ax,Lisa Use
mu►ra�u'ib.s
*328388
w>:u.rnKra�croRpnot‘
NmthGio>ma-I>epelmad - • a!7[P
2 'WELL LOCATION, /
'Nearest Town: i/1,4/IAzLi g county .214, <q/v • "
(c 44.0 PtitAt Q o G (StmetName.Nembers,Ceomemityakifivietartet No. ZIP Cede)
itf.
3. owNERG- Mgr J D h C I) ll. i -(' L}
Address (2-ao9 n [-I a n A ll Q'
(Suemeenostwo.) ---
port ChAsibita :Ct. 339n
CalorTrae St.w .t` re Code
(re/1- 193- &?ID
Arse axle- Plane s
4_ DATE DRILLED le- 3-Dfp
5. TOTAL DEPTA:_ 4'/O' - •- ,
6. DOES WELL REPLACE EXISTING WELL? YES � 0• NO_ Q W-
J
7. STATIC WATER. LEVEL Below Top of Odor O FT:
(Iteein If AberraToperalaiat
8. TOP OF CASING IS ___.�_ Ff. Above Land Solace*
•Tap deader wmWadagar ba !bad wrheemitres a
mamas be .eewia ss waY1SATICAC 3C A11a. .
9. YIELD (gp* YL METHOD OP TEST iozfl Lit
10. WATER ZONES (depth): /30' ({
Topograptaind setting -
Sags Alga Macy .OFF
(eltel!nntaptLoeboa) a
taiiMdtdongitude ufwdt location
, (d aa°mde)
Latiseiloagihide scauccOOPSCITepographic map
• Yl - t DRILLING LOG
To Formation Description
. From
i
7/'
19G'TION SKETCH
11. DISINFECTION:,Type WW1- Amy .-2 Th-O, 5 Show threaten and.dtatmce in miles from at least
12. CASING: - - Wan T> an two State Roads or County Roads.' Include the road
Doh or Wd�ttTt. ,gniat, S nombera and`common road names.
From 0 . To 7/ *salt K*
From To Ft - -
From Tp FL.,„....-
13. GROUT: Depth Ddeawt. Method - -
From f To__&12— ► i nEt. eeet Emu_ To To Ft._
-4. SCREEN: Depth Diameter . SIotSSme • : Material .
From To FL_ in. is
From To Ft__in.
5. SAND/GRAVEL PACK - -
Depth Size Material
From _To Ft, -
From To F -
0
rn
6. REMARKS:
DO HEREBY CERTIFYTHATTHIS WILL WAS CONSTRUCTED INACCORDANCE WIIii ISANCAQ2C. W&' •
ONS RUC ION STANDARDS, ANRECORD BEENPROVIDEDTOTHENL OWNER
%—/3
StQiATIIREOFPERSON IRUCIWOTn03 WEid. . - DATE - .
submit the original to the Division of Water Quality, Groundwater Section,1636 Mail Service Center -Raiedgb; NC
17699-1636 Phone No. (919) 7333221, within 30 days. . GW-t REV. 07200!

Rfa0"C
. - V O N 'J U U
- - - • WELL• CONSTRUCTION REC@RtD' . .
=� . • -
w Groi�waterSaaion
Nm�hCMolina- Department OiEarkomtegand NdoralRsaomeea-DivbbnofWat�Qoellty' /7(P
WELL CONTRACTDawwDltpDOA14Wre lurs
AMa raa.s JJidel '- - __ cayaiPItC�ATtot+• _-
WELLCONTEACrOa00MPAllY PNOT,iid•tat•/-3 24 0
STATE WEid. CDNBTaIICYIOltnfldii_r,. An0C411110 '-' .
Drappbrable) // -(F l e) - -
1. WELL USE (Check und;b Hmt�-Re ides liYMoakgsaVPubEE O Dial El Agriadturalp
- ` Monitoring CI Recovery a Heat Pomp Water Injection ❑ Other t7Ifother, ListUse - - -
Z-WELL LOCATION:. ^� s>Itogiap• .-.- suet selling--. .
Neatest Town: f 9J Niel i - County / r' A-ca ' O1 p�rapell . QFlat
W R y A W i2 eL o2 9 3 ti (Melt al seedrebm0 -
(sure tjalabe..t:m®iyikbdrsioa.WU.VPcode) L Io�tadaofiellion
3.OWN • a - TRRUW.Afa a( )
Address 3 & ri EH Ch a -rt.,. a La a s LaNuddlmigiWde somceAGPSOfopograpluc map
(e.--aaraorase.) - - --- - - . • (abaci box)
G.enkL.AL'` .uCi ' olB�I3Se ,r)E- DRILLING LOG
Ca erTen arc . rap Code - , -Erma To - FtiDRILaNescription
Min- 35'9- 0 9543 !p L
— - 3 A ' r t .BLU�/C..RAN; t-2-
4.Area
T cede-
RILLED G_ia-d(o
S. TOTALDEPTH; .? n.5- •- ,
6. DOES WELL REPLACE EXISTENG WELL? YES 0 N&JZi— - -
7. STATIC WATER LEVEL Below Top of Casing 4o FT:
(Wee Abate Top arcaioa) R. TOP OF CASING IS / FT. Above Land Swim*
-Tapmea u�mtaadarbeef ladaefaeanidRaa -
embank
9. YIELD (S _a�MIfHOD CIF TEST
/- I/
IO. WATER ZONLan'
ES (depth): (nA 3 /on '
LOCK 1ON SI03fGH
11. DISINFECTION:.Type All- Amount .3TA-13 5 show dirccfon end-diategce Li mhos from at least
12 CASING: - - WallThidmess ' two State Roads or County Roads. Include the road
De(ah D�eta orwdgldlPt numbers end common road names o
Ram fi . To 3 FL W' 3424.
h f � . I r✓
From To Ft. - - -
From Tp Ft._,-_
13. GROUT_ Depth Mete iaf Method
From�_To�_Ft o4ny� POVA---;
c)
From To FL
4. SCREEN: Depth Diameter . Slot Sat - . Material
From T& Ft._in. in.
From To R.--ill. is
5_ SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
6. REMARKS:
DO HEREBY CERTffYTHATTHIS WELL WAS (XIWrRUCrFtD INACCORDANCB WITH 1SANCACIC. WELL •
•ONSTBUCfIONSTANDA*DSSAND THAT ACOPY OF/RIsREC D BEEN PP,OVIDED TO THEWHLLOWNER
S)(ENO'iUREOFPERSONOONSTRUCTINOTiMWELL - - DATE -
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mall Service Center -Raleigh, NC
.11699-1636 Phone No. (919) 7334221, within 30 days. - GW-( REV. 07/2001

. - . - WILL CONSTRUCTION RECORD- `\ .
North&Drum- Department ofHnrhonmece and island Raamees-Dightonof qua r- sadion
WELL CONTRACTOR f, -- ale.I1fJS d,'=.''': . ''-; ►r[o+liAfl4°
WELL CornpAccoRCwnAwr gruolok st-4i „Ca 4-3 A 0
STATE WELL ooe4TRUC ICESPERMtls ..e....ra.:.. - :`--
rd'aaPOeahte) - - / -appuvble)
1. WELL USE (Cheek AppswbW8o*-Ra de tial�blweipaVPublie E oilier,
0 Ar'Iwitmn!-C7
- ' Monitoring 0 Reconq a Heat Prni C Water D tCI If oilier, Lis Use, " - - -
-2, VEIL LOCAT1O1t . _
po setting •
•Neatest Town: CLi - ��VI.4Gm•L/d " �n Malley .DFkt
O I f W ar Slr% % taeac+paid eio -
WiledNara.nevam.aeamaltssabiaiaagget aarIPCold I: oajatdaofwdllow4On
3. ovvt�tt-1)1; le e. A 5 r i /id- S tam
Adates: a 3 P fo . Er Latitodello a wurocOOPSDTopograpldc imp
da
montestray - . (chaddaa)
.�•
!� /1 AAA/:`+l:.vG "a c7 3 9' ; eUM DRILLING LOG
ogler rasa " slut /' ' meows - .From To - Fot�on Deseription
(gat)- 5Thane
5( 73 7 - n (L E1
Atm code. ea bet ;` - Li(t• ,1`, I V Afrdk in n'P ,
4. DATE DRILLED 6- / / -D 4.22' 3 os' G u L R 4 ' f 2
5. TOTAL DEPlHt_ j O S ' • "-,
6. DOES WELL REPLACE EXISTING WELLY YES 13 INO 8-
7. STATIC WATER LEVEL Below Top oft y -6 U W.
(Ua" ilAbaasTop aftl _
8. TOP OF CASINO IS / PT. Above land swfrce* -
a p atauhKurairhaagrWet Ladarta plrba : -
tartans r s. _J_ o al9r1511C4C2CSlL .
9. YIELD (gp t* ' METHOD OFTEST ID/U,C+
ID.WATER ZONES (depdt) // S' d - - -
3 1
•3311'.
�!:
•
t 1. DISRIFECTION.Type /f-/'/. Ammmt .ZT/441 Show &ceoon and - from u least
CASING: - Wd1Thicknest two State Roads orCourtly Roads Include the road e
Depth D orWeifttelt. MiisAlp._ 'ambasand-ctmmtontoadttmta.
From fl . To FL 2= t "" c
From To FL
Fran, Tp Ft,_�_ "-
1T. GROUT: Depth idtlgil. ldathad- IN)From�� Tt Ft earn., pews)
- - o •-
From: Te )
4. SCREEN: Depth Diameter - Slot rue s
Frow . To_ Ft in. in.
From To FL
5_ SAND/GRAVELPACK: -
Depth Sue Material
From To FL -
From To FL
6 REMARKS: .
DO HEREBY CERTirYTHAymis WELL WAS CONSTRUCTED IN ACCORDANCE WZUI 15f NCAC2C, WB(L -
ONSIRUCCIONSTANDARDS, AND THAT ACOPYY(OF _RECORD HAS BEM PROVIDEOT(WOMB-WEILOWNER
SIGNATLWAFPlRL4014CONSSIIRRUCPIIKO'iSWFlI. - - DATE -
mb tent the original to the Division of Water Quality, Groundwater Section, 1636 Mall Santa Caller -Raldgh; NC
;fr 3nPhase Na. (919)7333221,within 30days. - - . GW-1REY.072001

. 331175
. -- _WELL CONSTRUCTION RECCFRD - - 1 •
Nail! Cdolina - Deportment of Eavironnren ".t and Thad Resources-- li;hitM."--S:r Quality:. Oitantivialer Section -
• _ ,:.‘ ,..-.: . .
WELL corn-Rata= . " (pa.o alleli PI i S jalairtinA.;-'7 • 1'2. a•-: cipiirwienciii IL:4We .
wni_ corrroAcroo COMM4Y Matt Abe C .04.004.4 SIM I lid i 1 a -F. in.-• , 'riot:tin/12(.4a 14 -3 2-4 0
STATE WELL CONSTRUCTION FIATID
araspliable) " . ilflordioalde) ' •
• -_-_ _ . . ... . -
I. WELL USE (Check Applicable fica):-RaideattaffrCdscipaVPublle 13 bdustrial 0 Agiculimul a
. .- .".
Monitoring 0 Recovery CV Heat Pump Water Injection 0 Other a If tidier, Lhst Use . • • .
• .. •
2 WELL LOCATION:
60 CI Q. . MNearestTamenCountypc)t-
1 e-eg'
pmact Name.14mobaa:Commooky,Saberagice, loath, rap Code) .
3. OR: vC I / an
WNEi*_) 4
IM.RueakioiPiufe ks0nd =1SIoig -
0SlMny Dbla
eZc7Pti*
Lde7:1talion•
hisneanigatestaingod0
Address -0 • e 0 X c.,9J-: Ladurd. a/laming:le somatOOPSEITopographic map
1- V 4 isn't .1:7149 .515- • . „ • - MatDRILLING Loa
anyhrTavnt St=7 Zip Cotk
. From To - FOrmalion Description
7 ' - -. - - - ,- - - '
Area code- Mee arta im
4. DATE DRILLED
5. TOTAL DEPTH:, At 0.5- ' . -,
6. DOES WELL REPLACE EXISTING WELL? YES 13 NO-R1-------
7. STATIC WATER LEVEL Below Top of Casing A-9 h -ft
(Ua't itAbontop ofemios) .
:C! cloA •9.r s/veLA--
5 ' •
IL TOP OF CASING IS FT. Above Land Surface*
.vrep or aides terodoated atter kin lottantria mke'
eseissee la seseedamee VIICISATICAC2C JUL.
9. YIELD (gm): I s) METHOD OF TEST ibeisfar
10. WATER ZONES (depth): So ' 7.0
‹
LOCATION SKETCH
[1. DISINFF-CTION:.Type AF-/14: Ammmt 111-A 5 show trucoflon muldistalloo In lam from at 'mot
17. CAS1NCr: We Mitts! to State Roads or County Roads. Include the mad
a Depth pipet . Of Weiihrtirt. '-nuorbets and -common toad name
-SPI. hatitat
•
From To R.
FromTOFt._____
13. GROUT: Depth Material . Method
From_b_ Taa - pat.,
From To Ft.
4. SCREEN: Depth Diameter . Slot Sin : t MateriaI
FromTo FL—itt- in
From_ To Ft.____in. in. '
5 SAND/GRAVEL PACK:
Depth Size Material
From To Ft
From_ To Ft.
6. REMARKS:
DO HEREBY CERTIFY TEAS -THIS was WAS CONSMUCIRD IN ACCORDANCE WITH la kW= *Pa •
ONSTRUCTION STANDARDS, AND THAT A COPY' OF RECORD BEEN PROVIDED TO THE-WEIL OWNER
_- 071 . F-/v-0(.0•
SIGNATUREOF PERSON CONSTRUCTING MB WELL Dam -
cubm1t the original to the Division of Water Quality, Groundwater Section, 1636 Mall Serving Center -Rideigh,NC
59 1 1636 Phone No. (9L9) 7334721, within 30 days. GVILI REV. 07/2001 .

- _WELL CONSTRUCTION RE -CORD . • • . 3 3 I 1 7
%
t4ortit,Calala - Depattra, orliarkomriceit and 'Naiad Emma iip;bm.p* (Isar oicesrliar scoop
.
was cONTRACTOR tre;* aCienas
anal COKIMAC:Ma COMPANY arriai 'Scat ‘a. Li —3 2-e• 0
STATE WELL CONSTRUCTION nadirtra • ,
raraapbeabid - - •ErePPEcrhic) • •
• .
WEU. USE (Check Apilicablello:0:-Reside4ilitrCampalfrublie El Industrial UziadtonlU
' Monitoring 0 Recove7 0 Heat Ptunp Water injection 0 Other El If otter, List Ilse - •
AO
LWELLL0C&11OTh.
•Neargsrrown: s A 9 7• COOlay COL-. •
14 cla en. FAILs-rRn-.. (1 c2 ry7.5
(Smetana Matta Ottaramity,WMrka, lat JUMP Cr
3- OWNER: PO R.; e
Mdjtu%bO 1(1,3nd-4-ico_ DR.
V host-rtri9 3 /.‘“).‘;---
CaforTomm to Cade
Act4 -3 8 3 4, ' •• - .,- • -
4. DATE DRILLED - I "t LI= -
Ain code- Thaw :amber •
TOTAL DEPTH: 60 af'
•
ansiplitilLind setting •
ilValley .13Flat
tdvadrarelmidass hal
Catitudefiongitude Oliva location
radtildarnWit4de willect=0PcitriPilic caP
elggrili ' DRILLING LOG
Ezmn To - FOrmation Description
o y
3 9- • ( 4.? 73.74,14- ±19..,P.A y
•
6. DOES WELL REPLACE *MISTING WELL? YES 13 11Q1E-------
7. STATIC WATER LEVEL BelowToy of Onikg 5 "Fr
(Wein Ware Tep ett
S. TOP OF CASING ISJ PT. Above Land Surface*
esid
nap nag teralintri attar Mtn laataarteee reqaker a , ;
lawmen aseadamearlikl5kTICAC2C MIL if a • -
9- YIELD US* —Li—METHOD OFTEST fie -/Roprt,
10. WATER ZONES (dept4 '7 S' • a- /5 -
. - .- uranisnitgi
11. DISINFECIION:yype ft-r/4: Amount earn -A S. ShOW acclion und-adance hr miles from anent
1).. C.ASIN(i: - - WeWthiekness ' two State Roads or Candy P.oadsanelude the road
a • Depth 2 ( i Dines . or WSW" MS pha • :tomb= and -common road names.
From U . To .•_?.L/ Pt_Q./it:a likt .
From TOFti-____: -
•
FromT91____ Ft.-,-.....„.-
13. GROUT: Depth . Matesid MsdS
_......-
From f) To_a_. FL CP,rp ar I ptm&C)
FrontTo Ft .
4. SCREEN: Depth Diameter . Sk4 Size titfateriaA •
Froro in.
From To F1 in. in.
•-; AN 0/GRAVEL PACK:
Depth ate Material
From To
too_To
C=3
C=3
6. ICEMARKS... •
DO HEREBYCERTIFY THATTHIS WELL WAS CONSTIWCHD
ONSTRUCTION STANDARDS, AM THAT A COPY OF
ItECORD
ACCORDANCE vim laic/Laic. WELL -
BEM PROWDEDTO THILY/SIL OWNER
SIGt.IAIIMURN7ERSON IMIRUCTINO WELI; DATE -
• 11 Jam? the original to tie Division of Water Quality, Groundwater Section, 1630 Mall Service Center - Padeigh, NC
1-1 1 'ts AK (90)733-3231, within 30 days. GV/-1 REV. avian

RESIDENTIAL WELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources- Division of Water Quality
WELL CONTRACTOR CERTIFICATION # 2045
.JELL 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)
STATE WELL PERMIT#(if applicable)
DWQ or OTHER PERMIT #(if applicable)
WELL USE (Check Applicable Box): Resid7e�ntial Water Supply El
DATE DRILLED . 21 1,421_ t�
TIME COMPLETE (..000 AM 0 PM 41
7. WELL LOC TION: rn _ I,
CITY: �. COUNTYI Il'V
a
Street NamiNum ers, Cam oily, Subdidsion, Lot No., Parcel, Zip Code)
TOPOGRAPHIC / LAND SETTING:
D Slope ❑Valley ❑Flat ❑Ridge ❑Other
(check appropriate box) A'
LATITUDE gg3
(
LONGITUDE 3 a O (( O
Latitude/longitude source: korPS ❑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 decimal format
r. WELL OWNER /,
OWNER'S NAME l//��
ST EET ADDRESS
�C�it�yyor Town State.
(11L)- 3.(09(D145
Area code - Phone number
5. WELL DETAILS:
a. TOTAL DEPTH:
(0
Zip Code
b. DOES WELL REPLACE EXISTING WELL? YES 0 NOk
-.. WATER LEVEL Below Top of Casing: IICLJ FT.
(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 accordanceda�with 15A NCAC 2C .0118.
e. YIELD (gpm): SCE METHOD OF TEST Blow
n n n r 1 3
f. DISINFECTION: Type H T H Amount 1 60Z
g. WATER ZONES (depth): r
From /3J3 • To 1 35 From To
From ) To f 7 r From To
From To From To
6. CASING:
O
From
From
From
Depth r�
To /d Ft
To Ft.
To Ft.
Thickness/
Diameter Weight M}teri
7. GROUT: Depth
Material Method
From 0 To 20 Foment & benonite pun
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
From To Ft.
From To Ft.
From To Ft.
10. DRILLING LOG
From To
A
11. REMARKS:
Material
Formation Description
clay & sand
granite
4
C --
G7 C_
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH
15A NCAC 2C. WELL CONSTRUCTION STANDARDS. AND THAT A COPY OF THIS
RECORNIAS BEEN PROVIDED TO THE WELL OWNER.
NATURE 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.
Fonn 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
`3 9 3 s‘
J es i 1
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 #(II applicable)
.;'ATE WELL PERMIT#(it applicable)
DWQ or OTHER PERMIT #(if applicable)
WELL USE (Check Applicable/Box):
Residential Water Supply ID
DATE DRILLED J -a "dt)[J
TIME COMPLETED 5' 00 AM 0 PM Xi
3. WELL LO TIIO^ON-:, II,,'' � \\ X.
CITA1': O 1JU2I -1 COUNTYLi/La S °
St e2t Nan , Numbers, Community, Subdidsion, Lot No.. Parcel, Zip Code)
TOPOGRAPHIC / LAND SETTING:
LT Slope ❑Valley ❑Flat O Ridge ❑Other
(check appropriate box)-,
LATITUDE 35)' ic, , J
.ONGITUDE R344 987t3
Latitude/longitude source: 'GPS ❑Topographic map
(location of well must be hewn on a USGS tcoo map and
attached to this form if not using GPS)
4. WELL OWNER
OWNER'S NAME
STRfiET ADDRESS
May be in degrees,
minutes, seconds or
in a decimal format
Town 'State
)- 5l• 3O90
Area code - Phone number
5 WELL DETAILS: ��/-iJl 11 of
a. TOTAL DEPTH:
b. DOES WELL REPLACE EXISTING WELL?
YES 0 NO ❑
c. WATER LEVEL Below Top of Casing: ,/ V FT.
(Use "+" if Above Top of Casing)
TOP OF CASING 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): / 0 METHOD OF TEST Blow
f. DISINFECTION: Type H T H Amount 1 60Z
g. WAT�EyR�ZONES (dep ): ,
From To From To
From 1/ 3 To /f/C From To
From To From To
6. CASING: Thickness/
Depth Diameter Weight Material
From To t. ,i 4/
From �e2 To Ft. eo'x )40
From To Ft.
7. GROUT: Depth Material Method
From 0 To 20 Fgement & 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 Ft. in. in.
9. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
From To Ft.
10. DRILLING LOG
From To
3' 444
Formation Description
C1 ay & sand
grani1-p
J cr
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 AS BEEN PROVIDED TO THE WELL OWNER.
5 ATURE OF RTIFIED WELL CONTRACTOR7A T-
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 COMPLETE
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
rIELL INFORMATION:
61TE WELL ID #(if applicable)
STATE WELL PERMIT#(if applicable)
DWQ or OTHER PERMIT Of applicable)
WELL USE (Check Applicable Box): Residential Water Supply
5.00 AM PM,I
l WELL LO ATION::
r`fT/Y[�:1o,V,�rr'`CtJ �L�i tLeij .r COUNTY �C...Ui'-)
(Street Name, Numbers, Community, Subdivision, Lot No., Parcel, Zip Code)
TOPOGRAPHIC / LAND SETTING:
C Slope :Valley ❑Flat :Ridge ❑Other
(check appropriatebox)
1
LATITUDE fa
/oldd VIP Al
LONGITUDE 112 Li 40150
Latitude/longitude source: XGPS ❑Topographic map
(location of well must be shown on a USGS tope map and
attached to this form ifnot using GPS)
WELL OWNER JNER'S NAME a�twas- ow
it Y
lmvee,iF11TREET ADDRESS 14
341�
City or Town State Zip Code
(4n2)- V51-S3tia-
May be in degrees,
minutes, seconds or
in a decimal format
Area code - Phone number
5. WELL DETAILS: ,
a. TOTAL DEPTH: eau
b. DOES WELL REPLACE EXISTING WELL? YES 0 NO 0
c. WATER LEVEL Below Top of Casing: J 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 accordance�((with 15A NCAC 2C .0118.
a. YIELD (gpm): 40 METHOD OF TEST Blow
c n f O
et ) -k t)
t. gISINFECTION:Type H T H Amount 1 60z
g. WATER ZONES (depth): .
From 1'7l , To From To
From 17g. To From To
From To From To
6. CASING: Thickness/
^ Depth /�) Di�^eter Weight Material
From i'C i To IILj1 Ft. !O .+ �!'
From To Ill Ft. 0 Lai!
_
From To Ft.
GROUT: Depth Material Method
From 0 To 20 Feement & 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 Size Material
From To Ft.
From To Ft.
From To Ft.
10. DRILLING LOG
From To Formation Description
0 ito' clay & sand
110' 4,9eY granite
cCp
II. REMARKS:
0
0
C
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH
15A NCAC 1C. WELL CONSTRUCTION STANDARDS. AND THAT A COPY OF THIS
RECORD}y5 BEEN PROVIDED TO THE WELL OWNER.
7}9�G
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

• . .
WELL CONSTRUCTION RECORD- -:
MathGafoliina-Depa1mentofBnvkoom�aodPd mResources-Ditdsida�QuidRY:Oromdm erSadie%
nit
WELL COR77tACIDR (rva�93 eKN� �,�aj1-A�t� 1701'4� -
wets coKrnweroaoom�ro smite • 41sc flnjkiw1 (M1!A161hl- TW,:# ,'•raced /, 1 t —3 ab 0
STATE vitacotemstuCHan vmitrf - jteenrtcr>m - ,-'' ..
Of senTaltd - - {ifapplldde) ' .
u ' f%
I. WELL. USE (CheekApplcN Box) -Reside l'li liPub6e❑ Industrial AgSulurit1Q
•
Monitoring p Recover ❑- Bat Pump Wao6r bjectiont] OBtar CT If (Mier, List Use • -
•Z-WE]LLOCkTIOtt. -
N TownCounty
0 c
(stet Nmee. lim- .a, Conn, sabjvid04 La tla. 2Ip cold
3 OWNER 0b-e rr j OusT-
Addrss a a-D3 l3t'Lot-e p t- .
tsdeexpraaseib.) : 3 a -. b - -
1/��ksoh4rJIte
afar -Ian sea // . rip Code.
(90`a- 3iS-s59y
men cods Thane amber
4. DATE DRILLED a�/G -O'G
5. TOTAL DEP7$ S-a5•
6. DOES WELLREPLACE EXISTING WELL? YES 0 N0
7. STATIC WATER LEVEL Below Topofl> /.00 F:
(Ohre bmwTap°•
S. TOP OF CASWOIS / PT. Above Land Sure*
'rgdadag1.. - aaGrMrlpelludaoaoamotes a
urines la award.., m-us1icsCfC Wi .
9. YIELD UP* 0MZIUODOPmsr D%D!/Jrt.Q-.
I0.WATER ZONES (dept* r370 J 4 ED' (l
T9 ipl imd setting -
dga Mk* pKallq [Flat
Calinge,agitade oft+ Iecdion •
Latittnidionghride saurealOPSQfopoglaphic map
• '(ebadrtox)
,D$ _ DRILLING LOG
.From To FocmationDescription
0 -10‘r
-- f0• / I-i •
//2• tR:-,
II. DISINFECTION_Typo /1t3'14- Amount .1774-Ac
17. CASING - VisitThiebtees
From fl .Too / 3.7 S�W
Pt
From__To Ft.
From Ty_ F1._
I3. GROUT.: Depth Material
From_&.To_ Ft. earns
Fron>_To i .
.4. SCREEN: Depth Diameter . Slot Sec - Matabi
From To Ft. ----in. is
From To Ft in in -
i. SAND/GRAVEL PACK:
Depth Size Material
Frain To FL -
From To Ft.
;cul%t
t2
LOCATION SKEFCII
Show direction and.dbtana in miles from at feast
two State Roads or County Roads. include the road
'mambas and'oommoaroad coma.
6- REMARKS....
DO HERESY CERTIFYTBATT ISWEILWA$CONSfRUCTEDINA000RDAMEWllaISpNCAC2C,WBIL-
ONS7RUCTION STANDARDS, AND INAT A COPY OFerR1RlOSDaWlitt4 PROVIDED TO T'HLW&L. OWNER
tak
SIGNATUREOPPBIL40NcoNsnwenticT`IiEWEIL . - DATE -
•
astir the original to fie Division of Water Quality, Groundwater Section, I636 Mall Service Center -Raldg NC
d-Jal9-t334Phase Nn(919)733,3221,within 30days. - GW-1 REV. 07/200 I
c-

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
Redden Brothers Well Drilling, Inc.
Well Contractor Company Name -
STREET ADDRESS 73 Holly Hills Vista RD
Franklin, NC 28734
City or Town State Zlp Ccde
(828 )- 364-9591
Area code- Phone number
1. WELL INFORMATION:
SITE WELL ID Or applicable)
.STATE WELL PERMITS1f appllcabl.)
DWQ or OTHER PERMIT Cif applicable)
WELL USE (Check A 'cable Box): Residential Water Supply El
DATE DRILLED / deb 11�'
TIME COMPLETED ' AMC PMkl
1. WELL LOC TION:
COUNTY /% L.i
$ net Name, Numbers, a munity, SubdlNslo of No., Parcel, Zip Cod.)
TOPOGRAPHIC / LAND SETTING:
❑Slope °Valley ❑Flat ❑RIdge °Other
(check appropriate box)) /
LATITUDE pp"" _252 ,f�1J
LONGITUDE&2 . r/ 10
Latitude/longitude source: }y,'GPS ❑Topographic map
(location of well must be shbwn on a USGS topo map and
attached to this form A not using GPS)
4. WELL OWNER /? �f
OWNER'S NAM
May be in degrees,
minutes, seconds or
in a decimal format
ST.��Es�ETT�A,DDR9EYS/S, �., ,t e _ �f o
City or TOW11 •
()-,gyp-0/77)
Area code • Phone number
5. WELL DETAILS: m J'l /
a. TOTAL DEPTH: (/
b. DOES WELL REPLACE EXISTING WELL? YES ° NOO
c. WATER LEVEL Below Top. of Casino: /Op 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 variance In accordancecwith 15A NCAC 2C .0118.
a. YIELD (gpm): (l OI' METHOD OF TEST Blow
Zip Code
f, DISINFECTION: Type H T H Amount 160z
g. WATERZONES(de•t• .. /
From ,9//aTon , From
Fromj4T) r To P= r From
From To From
To
To
To
8. CASING: Thickness/
From Del
pth / /7 Ft. Di�;aler Weight Mpir
From to //7Ft. YY_ 0
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 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
11. REMARKS:
Formation Description.
clay A sand
rani t-0
c r�
100 HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCOROANCE W nH
1SA NCAC 2C, WELL CONSTRUCTON STANDARDS. AND THAT A COPY OF THIS
RECpaAHA$ BEEN PROVIDED TO THE WELL OWNER. {
,R Q/1,
GNATURE 0F 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.
Form GW1a
Rev. 7/05

RESIDENTIAL WELL CONSTRUCTION RECORD
North Carolina Department orEnvuonment and Natural Resources- Division of Water Quality
WELL CONTRACTOR CERTIFICATION # 2045
1. WELL CONTRACTOR:
James B. Brown
', C! 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)
STATE WELL PERMIT#(If applicable)
DWQ or OTHER PERMIT #(If applicable)
WELL USE (Check • -plIca
DATE DRILLED
TIME. COMPLETED
3. WELL LO A ION:
treat
COUNTY,
ble Box): Residential Water Supply 0
AM O PMX
- . II
IF1117
1
( treat Name, Nu ere, Community, SubtlMslon, Lot No., Parcel, Zlp Code)
TOPOGRAPHIC / LAND SETTING: -
❑Slope ❑Valley ❑Flat ORidge 0Other
(check eppropdele box)
LATITUDE
LONGITUDE L 2 71
Latitude/longitude source: PS ❑Topographic map
(location of well must be sho n on a USGS topo map and
attached to thla form /1 not using CPS)
May be in degrees,
minutes, seconds or
in a decimal format
a. OWNER'S NAME WELL OWNER •f 6„_ /
ji,
STR TAD R SS x (��/
STR
l o N� c?g en
(�C4�itySQ)o.1. f g e & R'State Zip Code
Area code • Phone number
6. WELL DETAILS: tt/i a
a. TOTAL DEPTH(!#
b. DOES WELL REPLACE EXISTING WELL?
( YES 0 NO
Ll
c., WATER LEVEL Below Top of Casing: (Jo FT.
(Use'.' If Above Top of Caiing)
d. TOP OF CASINO 13 2 FT. Above Land Surface'
'Top of casing terminated at/or below land surface may require
e variance In accordance with 15A NCAC 2C ,0118.
e. YIELD (gpm): - /J METHOD OF TEST Blow
Flan
From
6. CASING:
1, DISINFECTION: Type H T H Amount 160z
g. WATER ZONES (death
Fmm iS]aW ' To lie
40 From To
4. Frbm - To
Depth,��,'��'///1��,,, - DIyiJer
From To Ft. t�0
From To Ft. -LO ft
From To Ft.
7. GROUT: Depth Material
From 0 To 20 F(',anent & benonite
From To "
Thickness/
Weight M (1,11
/fig
From To Ft.
From To Ft.
Method
8. SCREEN: Depth Diameter Slot Size Materiel
FromTo 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.
ID. DRILLING LOG
From To T ; //
.t7i t 47') r
11. REMARKS:
Size
Material
Formation Description
c'l ay A ganc9
grans to
DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCCROANCE WITH
ISA NCAC 2C, WELL CONSTRUCTON STANDARDS, AND THAT A CCPY OF THIS
RECORAMAS BEEN PROVIDED TO THE WELL OWNER.
NATURE 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.,
1617 Mali Service Center— Raleigh, NC 27699.1817 Phone No. [phone] eat 668.
Form GW=1a
Rev. 7/05

mAr
1
RESIDENTIAL WELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources -Division of Water Quality
WELL CONTRACTOR CERTIFICATION # 2045 r�
1. WELL CONTRACTOR:
James B. Brown
Well Contractor (Individual) Name
Heiden Brothers Well Drilling, Inc.
Well Contractor Company Name
STREET ADDRESS 73 Holly Hills Vista RD
Franklin. NC 28734
City cr Town State Zip Code
(828 )- 369-9591
Area code- Phone number ,
1. WELL INFORMATION:
SITE WELL 10 Sof applicable)
STATE WELLPERMITN(Ir applicable)
DWQ or OTHER PERMIT e(If applicable)
WELL. USE (Check Applicable Box): Residential Water Supply 0 4
DATE DRILLED • o Gt
TIME. COMPLETED Sw (.1iJ AMO PM
a. WELL LOC ION:
IT i [[i�1L� AUNTY
Strap Name, Numbers Community, Subd slop, Lot No., Parcel, Zip Code)
TOPOGRAPHIC / LAND SETTING:
°Slope °Valley ❑FIat ❑Ridge Other (check eppropdele box) )
LATITUDE ��rw90 7i1.<
LONGITUDE 49A)
May be in degrees,
minutes, seconds or
in a decimal format
Latitude/longitude source; 4'GPS (3Topographic map
(location of well must be sho one USGS topo map and
attached to this to " ifnot using GPS)
4. WELL OWNER
OWNER'S NAME
STR AD'R 5S
)- 51,V -.�G,t
Area code • Phone number -
Zip Code
6. WELL DETAILS: .- ptJ,o/
a. TOTAL DEPTH: /
b. DOESWELL REPLACE EXISTING WELL? YES CV NO ❑
c. WATER LEVEL Below Top of Casing: FT.
(Use "+" If Above Top of Casing) f
d. TOP OF CASINO l3 2 FT. Above Lend Surface'
'Top of casing terminated al/or below land surface mey require
a valance In acco4 -noe with 15A NCAC 2C ,0118.
e. YIELD (gpm): /) METHOD OF TEST Blow
• L DISINFECTION: Type H T H Amount 160z
g. WATER ZONES (depth):
From To From To
From To Frbm To
From To From' - - To
6. CASING 1 Thickness/ •
From �/ DTothd / Ft. DIe;,ter JgWeiht, Mal
From__ To Ft. iI ll
From To Ft. _
7. GROUT: Depth Material Method
From 0 To 20 Foment & 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 Size - Mated al
From To Ft.
From To Ft.
From To Ft.
10. DRILLING LOG
11. RE`�
Formation Description
r]ay & sand
rani PO
L to
O
0
100 HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH
ISA NCAC 2C, WELL CONSTRUCTION STANDARDS. AND THAT A COPY OF THIS
RECOa• 3 SEEN PROVIOEO TO ME WELL OWNER.
NATURE OF C R FIED 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 Canter— Raleigh, NC 27899.1617 Phone No. [phone] eat 688.
Form GW-la
Rev. 7/05

$A
RESIDENTIAL WELL CONSTRUC
North Carolina Department of Environment and Natural Resources
U tJ
-Division of Water Quality p)
TION RECORD
M; ;.. c3 r1
y (+
WELL CONTRACTOR CERTIFICATION # 2045
1. WELL CONTRACTOR:
James.B. Brown
Well Contrecht 0+d'.''^al) Name
Heuden &others Well Drilling, Inc.
Well CCntractor Company Name
STREET ADDRESS 73 Holly Hills Vista RD
Franklin, NC 28734
City a Town State Zip Code
( 828 ). 369-9S91
Area code- Phone number 2. WELL INFORMATION:
SITE WELL ID npl applicable)
STATE WELL PERMIT#(If applicable)
DWQ or OTHER PERMIT #(If applicable)
WELL USE (Check Applicable Box): Residential Water Supply 0
DATE DRILLED T/T'Qtnn�''',�
TIME COMPLETED :74 W AM Q PMIC
3. WELL L0 �/f
CITY' 't-�'YL-G0-/n/ � COUNTY //lC�f'.()-w
Judie 16,e-6 y
(Street Name, Numbers, Community, Subdidalon, Lot No., Pirelli, Zip Code)
TOPOGRAPHIC / LAND SETTING:
❑Slope °Valley ❑Flat c Ridge °Other
(check appropriate box)
LATITUDE 220 . i# l
LONGITUDE L Ak vq c3
May be in degrees,
minutes, seconds or
in a decimal format
Latitude/longitude source: PS °Topographic map
(location of well must be sh n on a USGS tope map end
attached to this tom, if not using GPS)
1. WELL OWNER //// / �r
OWNER'S NAMELA k „k�J 6 ik6
STRH6? ADDRC/EJSS ��erl
�i —
City or . Slate ZIp Code
(97f )- .FAO -Opp
Area code • Phone number -
5. WELL DETAILS: 7%`D' /
a. TOTAL DEPTH: ' a '',,LL
b. DOES WELL REPLACE EXISTING WELL?- Y S ° Nyu
c. WATER LEVEL Below Top of Casing: - FT.
(Use'+" If Above Top of Casing)
d. TOP OF CASINO 13 2 FT. Above Land Surface'
'Top of casing terminated aVor below land surface may require
a valance In a cordance with 15A NCAC 2C ,0115.
e, YIELD (gpm): I ' ®./ METHOD OF TEST Blow
f. DISINFECTION: Type H T H Amount 160z
g. WATER ZONES (depth):
From To From To
From To From To
From To From -Tc
e. CASING: Thickness/
Depth Dhyneter Welg�iMaterial
From (1 To ,' I Ft. Cn , / Z.'
9
From__ To Ft.
from To Ft.
7. GROUT: Depth Material Method
From 0 To 20 Fcement & 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 Fl
10. DRILLING LOG
From To
r
11. REMARKS:
Formation Description
clay & sand
rani 1•A
r•s
100 HEREBY CERTIFY THAT THIS WELL WAS CCNSTRUCTED IN ACCORDANCE WITH
t5A NCAC , WELL CONSTRUCTION STANDARDS, AND THAT A COPY OF TMS
RECORD S SEEN PROVIDEDTOTHE WELL OWNER.
NA RE
91EI /DATE
NA RE OF CERTIFIE 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 Mali Service Center— Raleigh, NC 27699.1617 Phone No. [phone] ext 588.
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 •
1. WELL CONTRACTOR:
James B. Brown
Well Contractor (Individual) Name
Hec]den 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 INFORMATICN:
SITE WELL ID Cif applicable)
STATE WELLPERMIT#(it applicable)
DWC or OTHER PERMIT P(I( applicable)
WELL USE (Check Appllcabte Box): Residential Water Supply 0
DATE DRILLED t `C
�^ AM ❑ lY4/GPM K
FZAa11L11►1 COUNTY ka)0
TIME COMPLETED
3. WELL LOCATION:
CITY.
P.t.i_S *ALA gbP
(Street Name, Numbers, Community, SubdINSlon• Lot No., Parcel, Zip Code)
TOPOGRAPHIC / LAND SETTING: •
❑Slope °Valley ❑Flat °Ridge °Other
(check appropd ate box)
LATITUDE if
Oba
LONGITUDE if AV 77 A)
Latitude/longitude source: fitGPS °Topographic map
(location of well must be shown on a USGS tope map and
attached to this form if not using GPS) •
4. WELL OWNER OWNER'S NAME It,^
�t�£Sr
�
STREET ADDRESS T6 tAb
City or Town • date
)-
Area code - Phone number
May be in degrees,
minutes, seconds or
in a decimal format
4.1,
L8739
Zip Code
5, WELL DETAILS:
a. TOTAL DEPTH: 1 CO
lll���
b. DOESWELL REPLACE EXISTING WELL7 YES ❑ NOyg
e.: WATER LEVEL Below Top of Casing: (000 FT. `
(Use )f 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 variance In accordance with 15A NCAC 2C .0118.
it. YIELD (gpm): METHOD OF TEST Blow
f. DISINFECTION: Type H T H Amount 150Z
g. WATER ZONES (depth):,
From I013 To I10 - From To
From V EY To .27,0� From To
From To From - To
5. CASING:
Depth AL(� - DI1 m;tAr
From To
From Ta
From To Ft.
7. GROUT: Depth Material Method
From 0 To 20 Fvement & benorped
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 tonal
9. SAND/GRAVEL PACK:
Depth Size Material.
From To Ft.
From To Ft.
From To Ft.
10. DRILLING LOG
From To b
r 1
11. REMARKS:
Formation Description
clay & sand
grant Po
S
QS
100 HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE W ITN
1SA NCAC 2C, WELL CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS
REC•_5. AS BEEN PROVIDED TO THE WELL OWNER.
NA RE OF C IED W 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 Canter- Raleigh, NC 27699.1817 Phone No. [phone] ext 668.
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 4 . 2045
pi.$) t. t 1j./
V"s
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 Tarn State Zip Code
828 )- 364-9541
Area code Phone number ,
2. WELL INFORMATION:
SITE WELL ID POI applicable)
STATE WELL PERMIT'(ir applicable)
DWQ or OTHER PERMIT Cif applicable)
WELL USE (Check Applicable Box): Residentlal Water Supply El
DATE DRILLED
TIME COMPLETED .�'r C.X) AMO PM7
3. WELL LOC TION:
CITY' - /I J. ►- AS COU
(lee S e, Numbers, Communit bdi\ Ion, Lot No., Parul, Zip
TOPOGRAPHIC /LAND SETTING: •
❑Slope ❑Valley ❑Flat ❑Ridge
(check appropriate
box)
LATITUDE pp�er/-�
LONGITUDEQ� &D
Latitudc/longitude source: PS
(location of well must be sh n on
attached to this form ,ynot using G
4. WELL OWNER '�y^`
OWNER'S NAME 1+'
S Cita �i
EET ADDRESS at 0, n
ra
Sy or Town r St to
(tali)- aI-a44i
Area code' Phone number
6. WELL DETAILS:
a. TOTAL DEPTH:
b. DOES WELL REPLACE EXISTING WELL? YES 0 NOK
c.. WATER LEVEL Below Top of Casing: - `LCJLJ FT,
(Use'+" If Above Top of Casing) .
d. TOP OP CASINO R - _ 2 FT. Above Land Surface'
'Top of casing terminated aVor below land surface may require
a variance In accordance with 15A NCAC 1C .0118.
e. YIELD (ppm): I ` / METHOD OF TEST Blow
❑ Other
May be in degrees,
minutes, seconds or
in a decimal format
DTopographic map
s USGS topo map end
PS)
&
• 3(4-C(0(
Zip Code
From
From
6. CASING:
Dlapt eter
From To Ft. G' d
From �To Ft. r'
From To Ft.
7. GROUT: Depth Material Method
From 0 To 20 pvement & benonite pumps
f. DISINFECTION: Type H T H Amount 1602
g. WATER ZONES (d�)eepptth):
From ToaJ [ut Frpm To
To From To
From To
Thickness,
Weight M rial
J
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 F1. In. i In.
9. SAND/GRAVEL PACK:
Depth Size Material.
From To Ft.
From To FL
From To Ft.
10. DRILLING LOG
From To
11. REMARKS:
Formation Description
riay & sand
grans ha
aer
c
raj
O
OR
3
z
I D0 HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH
ISA NCAC 1C. WELL CONSTRUCTION STANDARDS, AND THAT A CCPY CF THIS
RECS7ap HAS SEEN PROVIDED 0 THE WELL OWNER.
S-/G D(p
GNATURE OF L<E1iTIFIED 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 Mali Service Center— Raleigh, NC 27699.1617 Phone No. [phone] ext 888.
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. in 28734
City cc Town State Zip Code
( 828 )- 369-9591
Area code- Phone number
2. WELL INFORMATION: SITE WELL ID P(If applicable)
STATE WELL FERMI/40f ecoliabie)
DWQ or OTHER PERMIT S(If applicable)
WELL USE (Check Applicable Box): Residential y
�sidential Water Suppl
A
DATE DRILLED I`I \lam{ 3I,-ryJ"
TIME COMPLETED 1 21.1 S AM ❑ PM (t-
3. WELL LOCATION: �` y�,�
It1
CITY: re—AN%K�,I1N1 • COUNTY AC/3A)
51111TN 11]'ktL.l.. 9-0
(Street Neme, Numbers, Community, SubolNsien, Lot No., Parcel, Zlp Code)
TOPOGRAPHIC / LAND SETTING: •
❑Slope ❑Valley ❑Flat °Ridge ❑Other
(check 'ppropriets boa)
LATITUDE aa��je AS09rd
LONGITUDES3 (DOLA
Latitude/longitude source: �p�tPS ❑Topographic map
(lccetion of wee must be stdwn on a USGS topo map and
attached to this form If not using GPS)
4. WELL OWNER
OWNER'S NAME J^t1y� 0 b•
L•
S EET ADDRESS `:0 %.
1RaNISA , 4c.. • A8'73 4
City or Town State Zip Code
( )-5Z4•33/5
Area code - Phone number -
6.WELL DETAILS: 1�t
a. TOTAL DEPTH: //..
b. DOES WELL REPLACE EXISTING WELL? ,�J Ye�E�S❑ NO/1/4
a: WATER LEVEL Below Top•of Casing: ILJFT.
(Use "4" 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): la METHOD OF TEST BLOW
May be in degrees,
minutes, seconds or
in a decimal fojmat
RESIDENTIAL WELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources- Division of Water Quality
WELL CONTRACTOR CERTIFICATION # 2045
I. DISINFECTION: Type H T H Amount 160z
g. WATER ZONES (depth):
From_aTot From To
From 133' To 1551
From To
• From ISO'.To IVZ' Fmm To
6. CASING: Thickness/
Depth.;
Ft Dla}neter Witt Material
From n -
From To Ft. !! —
From To Ft. -
7. GROUT: Depth Material Method
From 0 To 20 p ement & benonite porn
From To Ft. -
From To Ft.
n
p a .
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 f Formation Description
0 ' clay A. and
11.. REMARKS:
C
r
cn
100 HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH
15A NCAC 2C, WELL CONSTRUCTION STANCAROS. AND MAT A COPY OF THIS
RECO+m S SEEN PROVIDED TO THE mu. OWNER. - -
ATURE OF C 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.,
1817 Mali Service Center- Raleigh, NC 27699.1817 Phone No. [phone] ext 688.
Form GW:la
Rev, 7/05

RESIDENTIAL Wilt —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 - - -
STREETADDRESS 73 Holly Hills Vista RD
Franklin, NC 28734
City or Town State Zip Cade
(FOR ). 369-9591
Area code- Phone number
2. WELL INFORMATION:.
SITE WELL !Dag( applicable)
STATE WELLPERMIT#(If applicable)
DWQ or OTHER PERMIT #(If applicable)
WELL USE (Check Applicable Box): Residential Water Supply k_
DATE DRILLED ill 0.41
I Ir o-2LYXa �1rr
TIME COMPLETED r 30 AMC PM,p
3. WELL LOCiTTION: /�/1�/1��/r�.� ��
CITY: L Gi& - COUNTY y x't2�'»u
(Street Name, Numbers, Community, SubdWelon, Lot No., Parcel, Zip Coda)
TOPOGRAPHIC / LAND SETTING:
❑Slope °Valley ❑Flat °Ridge ❑Other
(cheek appropriate box)
LATITUDE 3,
LONGITUDE
Latitude/longitude source: ❑GPS ❑Topographic map
(location of well must be shown on a USGS topo map end
attached to this ram, H not using GPS)
4. WELL OWNER �} I �����
OWNER'S NAME I. // E9i """0 /
STR ET ADDRESS
/.146/PLLA .
City or Town r State Zip Code
()- 31A3-,445
May be in degrees,
minutes, seconds or
in a decimal format
Area code • Phone number
6. WELL DETAILS: 4/0/�
a. TOTAL DEPTH:
b. DOESWELL REPLACE EXISTING WELL?/ YES D NOR
e.. WATER LEVEL Belau Top. of Casing: a43 FT.
(Use'+" If Above Top of Casing)
d. TOP OF CASING IS 2 FT. Above Land Surface'
'Tap of casing terminated at/or below land surface may require
a variance In accordance with 15A NCAC 2C .0118.
e. YIELD (gpm): our METHOD OF TEST Blow
ci 9 w 0 9 r
Ay
f. DISINFECTION: Type H T H Amount 160z
g. WATER ZONES (depth):
From 2-2 1 To From To
From %'5 7 "To /J v r From - To
From - 70- From To -
B. CASING: Thickness/ •
J Dimeler Weight Ma etDoth j
From b Depth
'
From To Ft. _
From To Ft. _
7. GROUT: Depth Material Method
From 0 To 20 FGement & benonite
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
From To Ft.
From To Ft.
From To Ft.
• 10. DRILLING LOG
From To
b` I //its ll r
11. REMARKS:
Size Material.
Formation Description.
clay & sand
Trani 1-0
c
C
C)
rV
4.7 &
i7
100 HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH
15A NCAO]]C, WELL CONSTRUCTION STANDARDS, AND THATA COPY OF THIS
RECORB'rtA3 MEN PROVIDED Tq$HE WELL OWNER,
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] ext 668.
Form GW-la
Rev. 7/05

RESIDENTIAL WELL CONSTRUCTION RECORD
North Carolina Department of Environment end Natural Resources -Division of Water Quality ;y
•
32�?
WELL CONTRACTOR CERTIFICATION tt . 2045
1. WELL CONTRACTOR:
James B. Brown
Ge.'.actor (Individual) Name
Madden 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 POI spplicabre)
STATE WELL PERMITS(I, applicable)
DWCI or OTHER PERMIT 0(If applicable) 111ccc
WELL USE (Check
Appplica'ble Box): nResidential Water Supply?
DATE DRILLED l �l�'Li aiy J �I , e oL? LLL / "
TIME COMPLETED VO 3 .'O AM 0 PM I�
3. WELL LOC�,TION: ,\
CITY.
(Street Name, Number, Cemmun ty, 5 dlUelen, Lot No., Parcel, Zip Code)
TOPOGRAPHIC /LAND SETTING:
❑Slope ❑Valley ❑Flat ❑Ridge OOther
(check appropriate box)
LATITUDE _L
LONGITUDE
Latitude/longitude source: ❑GPS (Topographic map
(location of well must be shown one USGS topc map and
attached to this form if not using GPS)
4. WELL OWNER
OWNER'S NAME
STR ET/ADDRESS
OLNJL.Y.UIL; Ace :7 y
``''��ay__ or Town • ' State
Area code - Phone number - -
May be in degrees,
minutes, seconds or
in a decimal format
Zip Code
6, WELL DETAILS: // /
a. TOTAL DEPTH: /taD ,/
b. DOESWELL REPLACE EXISTING WELL? YES 0 NOd7
� e.: WATER LEVEL Belau Top of Casing: T O 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 vadence In accordance with 15A NCAC 2C ,0118.
e, YIELD (gam): ZOO METHOD OF TEST Blow
os-Li
/. DISINFECTION; Type H T H Amount 160z
g. WATER ZONES (depth): ,
From To - From To
From To Frdm To
From To From - _.. To
8. CASING:A Thickness/
From f 1 DToth� 2 Ft !D
Dlprtteter We e y�ar
From To Ft. —
From To FL -
7. GROUT: Depth Material Method
From 0 To 20 FQement & benoriLturrtped
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 j
5
1
Formation Description
rl ay A saryl
rani FP
11. REMARKS: i aa
100 HERESY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WRN
15A NChApp//!!C, WELL CONSTRUCTION STANOAROS, AND THAT A COPY OF THIS
RECDRdf1AS BEEN PROVIDED TO THE WELL OWNER. ���
GNATURECERTIFIED 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 666.
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
i YELL 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
Zip Code
•;rea code- Phone number
2. WELL INFORMATION:.
SITE WELL ID #(il applicable)
STATE WELL PERMIT#(if applicable)
DWQ or OTHER PERMIT #(if applicable)
WELL USE (Check Applicable Box(): Residential Water Supply Elf7
DATE DRILLED 1 • I O'O((J
TIME COMPLETED .00O
S. WELL LOCATION:
CITY:
J_
,Street Name, Numbers, Community, SubdivisionNo., Parcel, Zip Code)
TOPOGRAPHIC / LAND SETTING:
❑Slope DValley ❑Flat DRidge 0Other
(check appropriate box)
LATITUDE pp��J3S30'� 3II
LONGITUDEpl laL.J
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)
AM ❑PMe K�,�
OUNTY I ((zLCllw
May be in degrees,
minutes, seconds or.
in a decimal format
41. WELL OWNER
OWNER'S NAME
ADDRE.Dtki
F�- Syu3P-i
City or Town State Zip Code
a-
)- UQ lQ
Area code • Phone number
5. WELL DETAILS: 9�d
a. TOTAL DEPTH: U I�
b. DOES WELL REPLACE EXISTING WELL? VES 0 NOk
c. WATER LEVEL Below Top of Casing: WO FT.
(Use -+' if Above Top of Casing)
... TOP OF CASING Is 2 FT. Above Land Surface'
'Top of casing terminated at/or below land surface may require
a variance in accor4ance with 15A NCAC 2C .0118.
e. YIELD (gpm): / METHOD OF TEST Blow
743
f. DISINFECTION: Type H T H Amount 1 60Z
ZONES (depth):
To .71J� From
From
From
To
To
To
6. CASING: Thickness/
Depth o Dipm$er Weight Material
From To Ft LP pp
From Ta Ft. CD v t i88 7n--
From To Ft.
7. GROUT: Depth Material Method
From 0 To 20 FGement & 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 Size Material
From To Ft.
From To Ft.
From To Ft.
10. DRILLING LOG
From To Formation Description
clay & sand
11. REMARKS:
granites
IN)
c n;
rp n
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH
15A NCAC , WELL CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS
RECO:',4f BEEN PROVIDED TO THE WELL OWNER.
7 /D-O(o
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 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
(828 )- 369-9591
Zip Code
Area code- Phone number
2. WELL INFORMATION:
SITE WELL ID #(il applicable)
STATE WELL PERMIT#(if applicable)
DWQ or OTHER PERMIT #(if applicable)
WELL USE (Check Applicable Box): Residential Water Supply
^ATE DRILLED 7' 5 �L.a
IME COMPLETED 5 . al0 AM D PMX
3. WELL LOCATION:
CITY:
COUNTY / / (2.-CO.C--
talk
(Street Name, Number ommunM1� division, Lot No., Parcel, Zip Code)
1 OPOGRAPHIC / LAND SETTING:
.D Slope ❑Valley ❑Flat El Ridge ❑Other
(check appropriate box)
LATITUDE 3�rQ� 31►.1
'_ONGITUDEDZbb� .12 %aa w
Latitude/longitude source: I9 GPS ❑Topographic map
(location of well must be sown on a USGS ropo map and
attached to this form if not using GPS)
WELL OWNER
OWNER'S NAM
STB,EET A9DRES
May be in degrees,
tninutes, seconds or
in a decimal format
r�City or Town r State
9g�) —g73D
Area code • Phone number
. WELL DETAILS:
a. TOTAL DEPTH:
an°
1"
S4SO5
Zip Code
b. DOES WELL REPLACE EXISTING WELL? YES o
c. WATER LEVEL Below Top of Casing: c OD
NOk
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): 67 METHOD OF TEST Blow
329742
f DISINFECTION: Type H T H Amount 1 60z
g. WATER ZONES (depth):
From xx Ara To ed ii - From To
}n� t
From Ara. To i I From To
From To From To
6. CASING:
Depth Di meter
From1J To Ft. 0
From 1I9 To Ft. (, "
From To Ft.
7. GROUT: Depth
Material
From 0 To 20 Fcement & benonite
Thickness/
Weight
/kf
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. SANDIGRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
From To Ft.
10. DRILLING LOG
From To
// or 4d
L1. REMARKS:
Formation Description
clay & sand
gran11-ta
cr.
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH
ISA NCAC . WELL CONSTRUCTION STANDARDS. AND THAT A COPY OF THIS
RECOS BEEN PROVIDED TO THE WELL OWNER.
2NATURE 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.,
1 617 Mail Service Center— Raleigh, NC 27699.1617 Phone No. [phone] ext 568.
Form GW-la
Rev. 7/05

2 0 1 V 4OWNER
RESIDENTIAL WELL CONSTRUCTION RECORD MwD
`" 3
North Carolina Department of Environment mud Natural Resource*. Division or Willer Quality
WELL CONTRAC•I'Olt CEItTIFICA'I' ON N ,
1. WELL CONTRACTOR:
ph fie Reecc-
WeA Conlracla (Individual) Name
MILLER WELL DRILLING, INC.
Well Contractor Company Name
STREET ADDRESS P• O. BOX 567
HAYESVILLE, N.C. 28904
City or Torn Stale Zip Code
( 828 } 837-2997
Area code- Phone number
L WELL INFORMATION:
SITE WELL ID tit eppaceble)
STATE WELL PERMIT/tie applicable)
DWQ or OTHER PERMIT 11(N applicable)
WELL USE (Check Applicable Box): Residential Water Supply [�J
DATE DRILLED -4 e
TIME COMPLETED /I it 0 Z) AM 121"'M LJ
3. WELL LOCATION:
CITY: al uD Ne—
COUNTY AV.,W ice'
I SAW Hama. Numbers. Community. Subdivision. Lot No., Pareel. hip Code)
TOPQGRAPHIC I LAND SETTING:
Bllape 17VafeY tlFlal DRldge ❑Other
(check appropriate box)
LATITUDE , T1 _0_ h TI
LONGITUDE 33 33 Z4 I
Lali(udenongitude source: 00I'S 0Topographic mop
(kxarbn of wet must be shown on n USGS toles map and
attached to this form 'not using GPS)
4. WELL OWNER OWii- r7NER'S NAME V r i7r PRINCe-Lt7twl. D-e,t/
STREET ADDRESS $547 ilia yak Il
rop-foe A/C- ZS7IN
Cit a Tam Stale Zip Code
May le In depea,
minute', secret& or
In • decimal formal
Area code)- Phone number
S. WELL DETAILS: rvTT ,
a t TOTAL DEPTH: t . 5
b. DOES WELL REPLACE EXISTING WELL? YES ❑ NO Er
e. WATER LEVEL B&ow Top el tasing: D FT.
(Use'+' S Above Top d Casing)
d. TOP OF CASING 19 ' FT. Above Land Surface'
'Top of easing terminated aVa below land so lace may require
e variance In accordance with ISA NCAC 2C .0118.
•
e. YIELD (ppm). 120 METHOD OF TEST AvJZ
NC
1. DISINFECTION: Typo /177/
g. WATER ZONES (depth):
From V..5 To 75-
From / -0 To /d 0
Amount /z Cvp
From To
From To
From To From To
6. CASING:
Thickness)
Depth
ht Material
From_0 Toj Fi. G 9y of WR R "STD L
From • To Ft.
From To Ft.
T. GROUT: Depth Material Method
From 0 To J FL fogT//i'vl AA
From 3 To20 Fi. ReA tt 's'{t- 9 R ,
From to FI.
S. SCREEN: Depth biemeler Slot Size Material
From To PI. In. In.
From • To F1. In. In.
Fran To F1. In. In.
9. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
From To Ft.
10. DRILLING LOG
From To
I L ItEA1ARKS:
Formation Description
0
0
1 0O HEREBY CERTIFY THAT TTIIS WELL WAS CONSTRUCTED N ACCORDANCE WITH
ISA NCAC /C. WELL CONSTRUCTION SIANOMDS. AND MAT A COPT CA THIS
RECORD HAS BEEN PR WIDED TO THE WELL OWNER
SIGNATUR OF CERTIFIED WELL CONTRACTOR DATE
Phf'GRCCc c.
PRINTED NAME OF PERSON CONSTRUCTING TIIE WELL
Submit the original to the Division of Water Quality wind 130 days. Attn: Information Mgt.,
•... rip...-. - ,nlni t44 7n1r ...r ere
-FennGWte

WELL CONSTRUCTION RECORD'
t�� s <3�omdwat�Secuon
of E ivIrco eht and Natural Resource Dtvhdon of Water Quality'- �r-T
North want DepaAment _late
4-3 A& 0
WELL cot rsurrostgramtmuAia Wr1a9 vehe V115 ,%Oea., - =. cus7mCATtONa
WELL CONT.ACTOa COMPATIE
STATE WELT. coratauc tots maitrs AssgcpTIDw 1
36.11711
fd-appbable) -(tappldabie) • .
1. WELL USE (Check Appllable Boxy Reitdeutialti pal PubUe ❑ Industrial C] AgriculturalQ
Monitoring o Recovery o- Heat Pump Water Injection U Other C1 If other, List Use
2. WELL LOCATION:
Nearest Town: t� Canty IVI -(Alt-
co (1).T,fA� e�iu2Z - Shope Rd.
tsrrm Name. -mbar. Community. Sulirrioa.l a Ne. Zip Cade)
3. OWNER: Sff(/ L 1 f )t�
Address 'F'- D • 78 DX 3 7 S'' u '
(Saeetar`RameNaJ �t
Otfi) h1.C� o�.gc -
OilerTurn Sure �� zp Code
chit- 3 4 4- 1 a. 3 4(
Aro cot -Pane comber —�o _v�
4. DATE DRILLED
5 TOTAL DEPTH, s 7 5'
ogtapkieAermd setting -
dgc OSlope °Valley C7F�at
(that apprepriatebox)
is6tadellorigitude ofwoll location
•
, ice)
Latitu ienongitdde souroe:DOPSOTopographic map
• tctrdct, s)
,DEPTH - DRILLING LOG
From T(9 - Formation Description
•
S-75 -. L. -�.-ita-,.rt-
V
-G
6. DOES WELL REPLACE EXISTING WELL? YES ❑ N(}:Q✓ e
7. STATIC WATER LEVEL Below Top of Castor 'h" FT:
(twee If Above Top otCub
misses V aeardasa w11111sAFCAla xC2C Ar1j
•
10. WATER ZONES (dept(depth):-s-
11. DISINFECnION:.Type Amount o27A
12. CASING: - - Wall Thickness
8. TOP OF CASING IS FT. Above Land Surface*
-rap of canal Inmleatd et/or hip. Isad.mrbee nerds a
9. YIELD (gpto): MBTHODUFTEST
D' -hear
LOCATION SKETC}i
Show direction anddistance in miles from at least
two State Roads or Calmly Roads. Include the road
numbers and -won road names.
tb // DDu,�p�aa arwp�tdrpL •��
From_To o� ) Ft _4RWK`
From To Ft
From Tp R.„--..,-
It GROUT: Depth Matrral Method -
From_Q._To .*� Fr nun pay A-)
From To FC
4. SCREEN: Depth Diameter . Slot Size : . Material
From_ To FL_ja in.
From To Ft`_ia in.
5- SAND/GRAVEL PACK - ._
Depth size Material
From To Ft -
From To FL
6. REMARKS:
DO HEREBY CERTIFYTHATTHIS WELL WAS CONSTRUCTED IN ACCORDANCE Willi ISANCAC2C. WEIL •
0NS1RUCTION STANDARDS, AND THAT A COPY DPW RECORD HAS BEEN PROVIDED TO TWIN/ELL OWNER
Oen ..1-a o—pC0 -
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 Peon No. [phone], within 30 days. GW-1 REV. 07/2001

•. WELL CONSTRUCTION RECORD
North t:atoliaMiaa-Depatmiait mrsof Environt and Natural Resources - Division of.
was CONTRACTOR (no1{(WUA1..1
WELL CONTRACTOR COMPANY NAMT.Is ll��
STATE WELL COwTRUCUON PLIG[ITI - TID WIrT=RMTra
flfspphable) . . yy // •(if!ppliable) - -
1. WELL USE (Cltedt ApPErable Bax):-RnWenual�MwcipaUPnblic 0 Industrial 0 Agricultural 0
•;hen pin s
Quality-- Gtwmdwator Section
r
scovtricknoiitaate
eaoiia*..—t1-3 b 0
Monitoring ❑ Acton!), O • Scat Pump Water Injection ❑ Other 17 If tidier, List Use 7 •
Z. WELL LOCATION:
Nearest T wn: ILLi d Couaty G07->' .
�g� �Isy Di nt. Tear '23
(Sum Ha Numbers. Coa®Wy, Subdivision, Lath, lap Ode)
3.OWNER L %1N^.1'-5 W-ellc%
Address 9.6.1.3 L• • Se vlc n I- Aqe- g d r
(stmess Rmefo.)
Z n ✓eem eas5"-tS o
GtyorTaas Sam � Tip Coda
(354 vf2-.2387 .
Arts oak- Peon mast
4. DATE DRILLED 7- .2 5-0.
to
5. TOTAL DEPTH; 305
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO :my
7. STATIC WATER LEVEL Below Top ofOutinm 6O FT:
(User if Above Tap of Cadnz)
8. TOP OF CASING IS _._ FT. Above Land Smiecee
writ arming tarmtaatM attar We*, ttadarfaaa ragW4a a . ,
raAaass Is aaardaaw tRhlSATfCC 1C .011L '
9. YIELD (gpra): METHOD OF TEST AMA( .
gtp) io/Lend setting -
dge OSIope Palley .O tat
(abeekappmpda*boa)
i atituddloiigitude of well location
, (dewedmim .whemom)
Latitudeiiongitdde so wcc0OPSOTopogTapbic map
• (dude l ax)
DRILLING LOG
From To FocmationDescription
_-7(0' J, G' `5:,4--*dsjvn `ems
js• 3o ' 44_ue 6-kent--e-
-
10. WATER ZONES (dept)0205'
��`��LOCATION SKETCH
11. DISINFECTION .Type____.___ Amami ..71)-S 5 Show direction and distance In miles from at least
12. CASING: - Wall Thickness two State Roads or County Roads. Include the road
Depth or weiahtRR Mateygl ',lumbers and common road names.
From O . To i-a-T
From To Ft--:
FromTp Ft
13. GROUT- Depth tdateeiat Methodod
From n To �a FL elector- paw'.,
From To Tt
4. SCREEN: Depth Diameter . Slot Size :: Material
From To Ft.
From To Ft`_in. in.
5- SAND/GRAVEL PACK - _
Depth Size Material
From To Ft
From To FL
•
in. in.
6. REMARKS: -
DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC2C, WELL .
ONSTRUCTtON STANDARDS, AND THAT A COPY OF RECORD HAS BEEN PROVIDED TO'IiIE.WELL OWNER
1 t Oaf CQiLi 7— S _ D k
SIGNATURE -OF PERSON CONSTRUCTING THE WELL . DATE -
Submit the original [o the Division of Water QuaUty, Groundwater Section,1636 Mall Service Center -Raleigh, NC
(27699-1636 Phone No. [phone], within 30 days. . GW-I REV. 07/2001

Lrte—i�3
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and NaUarl Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL)
WELL CONTRACTOR COMPANY NAME a �1 el t �Tr4m� PHONE N3 , o74 0
STATE WELL CONSTRUCTION PERFIIT# ASSOCIATED WQ PERMITS
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential Mumicipal/Public ❑ Industrial 0 Agricultural 0
Monitoring ❑ Recovery 0 Heat Pump Wa 'on ❑ Other ❑ If Other, List Use
2. WELL LOCATIO • n
N stT wn: arir // 7 County/ 9ntoe l
,a sf Lhe�� ,end /
(Sheet Name, Numbers, Cao�wity, Subdivision, Lot No., Tip Code)
3. OWNER: JF74A I /1 Sri S
Address ' dN E U, r`t r ktt\\
(Street arRou No.)
Kok\; n eaTibL\
DEPTH
O City
5A - y`Stale Zip code From‘-')
rom To
4. DATERILL DRILLED !n e 51 » uArea code- Phone number / ,-) „ � — ' L'%
5. TOTAL DEPTH: tOO
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO
7. STATIC WATER LEVEL Below Top of Casing: 3 ) FT.
(Use "+" if Above Top of Casa.")
8. TOP OF CASING IS / FT. Above Land Surface*
'Top of easing termloated at/or below land surface requires a
variance In aeeordaa with 1SA NCAC 2C .0I18.
9. YIELD (gpm): METHOD OF TEST,//
10. WATER ZONES depth): / 7/7./
11. DISINFECTION: Type('h7n/, /1 C Amount
12. CASING: Wall Thielmesa
, DepthDiameter or Weight/Ft.
From 7 ( Too � KoW /
From e,4, To 7 7
From To
13. GROUT: Depth
From 0 To g Ft
From 3 To-?C) 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.
Ft. 6//07<
Ft%. /25
Ft.
Topo hic/fand setting
❑Ridge Slope ❑Valley ❑Flat
Meck appropriate box)
Latitpde/lo
71s10 V:� d ' Q K.
©e,ell
Latitude/longitude GPS❑Topographic asap
(check box)
DRILLING LOG
Formatiop Description
Q! I
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common road names.
C
I
cn
K
16. REMARKS:
I DO HEREBY CERTIFY THAT THIS
CONSTRUCTI
WAS CONSTIJJt.1r.° IN ACCORDANCE WITH I5A NCAC 2C, WELL
RECORD HAS BEEN PROVIDED TO THE WELL OWNER
SIGNATURE OF PERSON CONSTRUCTING THE WELL D
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 # 2045
1. WELL CONTRACTOR:
James B. Brown
W&' Contractor (Individual) Name
. Redden Brothers Well Drilling, Inc.
JVell 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:
-ant WELL ID #(If applicable)
rATE WELL PERMIT#(if applicable)
DW4 or OTHER PERMIT Of applicable)
',VEIL USE (Check Applicable Box):r�Residential Water Supply 10DATE DRILLED (0 1 ' OLD TIME COMPLETED 3., co AM 0 PM y yl
Zip Code
3. WELL LO TION:
CITY:
COUNTY 1 1cQCe"
(Street Nem umbers, • -mmun L SubdiN'ion. Lot No., Parcel, Zip Code)
TOPOGRAPHIC / LAND SETTING:
TSlope ❑Valley °Flat ❑Ridge °Other
(check appropriate box)
.ATITUDE j A tie a
LONGITUDES/ 41 79
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 topo map and
attached to this form X not using GPS)
4. WELL OWNER
OWNER'S NAME \LYW�.}'LULJ ,SALItJnJO•� ,
STREET ADDRESS
City or Town - • ' ' State
( flZ )- SA . aaQ
Area code - Phone number
6. WELL DETAILS: �^ 1
a. TOTAL DEPTH:
b. DOES WELL REPLACE EXISTING WELL? ^YES 0 NO
e. WATER LEVEL Below Top of Casing: l vv FT.
(Use -4' if Above Top o1 Casing)
d. TOP OF CASING IS 2 FT. Above Land Surface'
'Top of casing terminated atfor below land surface may require
a variance in accordance with 15A NCAC 2C .0118.
YIELD (gpm): D METHOD OF TEST slow
1. DISINFECTION: Type H T H Amount 1 60z
g. WATER ZONES (de thh)):
, From 153 To 'j5.J From To
From To From To
From To From To
6. CASING:
Dept ./ Dl�meter Weight
From
From To Ft. �P Titre
From To Ft.
Thickness/
Material
7. GROUT: Depth Material Method
From 0 To 20 Fv neat & 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
11. REMARKS:
Formation Description
clay & sand
grRn1 t'o
'lam-
co m=
o r-
1 DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH
15A NCAC 2C, WELL CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS
RECOS BEEN PROVIDED TO THE WELL OWNER.
d ,e
ATURE OF CER'FiFItD 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

• .WELL' CONSTRII
F CTION RECORD" -1 V`" -
_.- _ - - - - - ttGy'_..-__n... /ate.-.l...n+s Section
North C ofina-DepvtmadofBn Want Resources Division
WELL CONTRACTOR(mmlW!W�
WELLcONT AraoltCOMMIT i)tu I- I lIM1I Yal ; „'i-K e , "tramun s k%—fi �4-3 ge 0
STATE WELL CONSTRUCTION FElOtt'1'f_�, ASSOCIATED
fraapliabis) OsSPllrsibia) ' .
ornalennis F�+�''sd' = - r'c tincoviNt. 4P
1. WELL USE (CbedtApn5wl BO4-Raidenti OAur�p1UPoblic0 _IndwpialCI At¢iwltani-Q
Monitoring 0 Recovery 0' fleas Pwnp Water Injection 0 Other CT If Mier, List Use
-2.-WELL LOCATION: .
Nearest TowQ L L i Catmty M , / m2� -
.2 A _Lappt ,- i u le n; r hn.,. K&
(sraatiwttiomtas.crers.igr.lh6 13Ltttta.Lp a F73 y
3.OWNER: J�4v-.el. - 7-2y/UiZ
Address 92) Lu h 4 -'- /'S 4 I t ` S' i- •
(sbei iattetioa ---
F� n-ft t ; Y: � /y/ a Ro
Calor Tom Ste _ Erg Cade
Gish- 3s.2-/S7% .
Area soda- Thmeasica6a
4_ DATE DRILLED to I - D
' TOTAL DEPTIF / /7/2 S /
7
•
T�ogap�trJLmnd g -
L0X`id� 0Slopc 'Many . OFIat
W aetappt iduchaa)
L'adtuddbngituda ofwdll location
Ladtnddloagidide souremaGPSCITopogmphie map
,rj DRILLING LOG
. From To - Formation Description
J� /a /' ('
lv/' //XWS' (T/enA/i f�
6. DOES WELL REPLACE EX15TDW WELLY YES 0 N.Q_ W-
7. STATIC WATER LEVEL Below Top of Casing: D FT:
(Ua" eifAMrettp cWSug)
8. TOP OF CASING IS / FT. Above Land Surfaea
•Tap 'fain tnlWMaltar bSj badaarst s mat , . - -
nrtaatslaaeeerSaaa 1SATICAC3C 917a..
9. YIELD(gp1R): 4 METHOD OF TEST 4,191 pc .
10. WATER. ZONES (depthx rQ 9d1 6' S'o . (J -
LOCATION SKETCR
11. DtS1NFECftON: Type i -t# Amowd .•2T/i-A 5 Show dtrcction anddtatunce in mile from at least
12. CASING: - - wall Thickness tam State Roads or County Roads. Include the road
Depth Derma or WeS8ialFL -ambers auiFcon mon mad names.
From V.. To / 1•t hit
- -
From To Ft -
From Tp FI•__
13. GROIN: Depth Malaria Method .
From_( To -a. �Q pQ)1.t) - -
From To 'it.
.4. SCREEN: Depth Diameter . Sl the= - : Material -
From To PL_io in. .
From To F�_in. in '
5. SAND/GRAVELPACC: -
Depth S Marcia/
From To Ft.
From To Ft. '
6. REMARKS: .
DO HEREBY (ERTIYTHATTHIS WELL WASC I4EGRUCIEDINACCORDANCBWITHISµNCAC2C,WELL•
DESTRUCTION STANDARDS, AND THAT ACOPY OF [1I1SRI D SSA REEtfPEGYIDEDIDTHEWELLOWNER
•
mud,
SI(?IATUREOFPERSON CoterRt1C1DIDTHZWEIL - - DATE -
Submit the original to the Dlriston of Water Quality, Groundwater Section,1636 Mall Service Coder -Raldgh; NC
fl699-1636 Phone Net (919) Tra-'m1, within 30 days. - GW-1 RSV. 07/2001
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...
• WELL CONSTRUCTION RF�tD' `
v -- ..:.=fit"' • = -
.:
North Carolina -Dep mentofBmhommtandNatonlResomoar-Dirbbn _ . LeaUtyT Section
ww.ceerastronprtontiamo'�'� s Ii91iS fin IlOwnrL'- TION �� IP
WELL cotsraAcrontaarAtsr tta"+r 1 p 1 C D__ lL'l �La ��ltr I I ;�s• -f -•, �'rsotak s 4(-3t► -3 ads
STATE WELL CONSTRUCTION flUon_,
Aasocaam - ..
- {if4ppliauie) ..
(irapptmble)
I. WELL USE (ChedcAppfableBus}.-Re,idadMMt &D-Ind�ialEl Agriwitura_lC7
• Monitoring 0 Recovery E- Hat Pomp Water Injection ❑ Other l7 If oilier, List Use =
Z-_WELLLOCATION: '
NearestTowm Fie A-/Y/LL i 4v - Comtr/A% Cot✓ - .
S&ric_e g e•elc 6-U B D. a 8'T e
csetName Numbers. Caosiy',Saleinis oa.LaN4�r�)
3. 0
Address 3
et2h)nal� i)R•.
tsaaLaltaasNaJ - ,
FRAAiltci t :NC- o�1!73tL
Carer ewer " Sole ..At 7 rip Code
6-9- Rss
re Mee amber
`f
4_ DATE DRILLED (- .`,i b %O Cs
5. TOTAL DIIPTW 40S' -
6. DOES WELL REPLACE EXISTING WELL? YES O NO iW-
7. STATIC WATER LEVEL Below Top of� /n FT:
(Us Na tare Top ofCoke°
8. TOP OF CASING IS _/ FT. Above Land Sotfia•
-rep eteedeatraVnbdarar b(wkadaarfannvdres a
.canoes onerdaasswn-i5ATltkC2txtti .
9. YIELD (gpm): if 0 METHOD OF -our I)JLVJjxd-,
10_ WATER ZONES (depth): 90 j 13 D' J / f5 ' (1
LOCATION SKETCH
i{ Amount ..� TA -,A C Show crsea6oa an&IhSna in miles from at last
VIRAL ,: -
Tppogt5pliicJtAnd
°Ridge (]Slope / gDFlat
(eb4asteesebarbea) - -
Ut ddlongiade ofrleB location
IsdodeAongiuido somecOOPSOTopo8TPhic map
sassbao
x)h t DRILLING LOG
E qs To " Famafion Description
tOC) •3: 3 ' e ' 1- /9 V
a s' /ac.7/� is 2/t.v, t'e-.
1 I. DISINFECTION: Type K->` .
12. CASING: -
DePth
From O.
. To Srf
From _To Ft .
From Ty_ FL
13. GROUT: Depth Materiel Method
From_fTo_v Pt eater' p03u )
Wall T a - - too State Roads or tctmty Roads.Include the mad
or Weight/Ft. - '-numbaa and -common mad names.
From To FL
.4. SCREEN_ Depth Diameter - Slot Tao = < Materiel
From- To FL in. in.
From To Ft. in.
5. SAND/GRAVELPACK:
Depth S�
From To FL
From To FL
•
6- REMARKS: - - -
DO HEREBY CERWYTHATTHUS WELL WAS commas) IN AccoRDANC6 WRIT (SANCAc WBLL -
ONSfRUCTIONSTANDARDS, ANDTR}ATT/ACOPY OF REBA( D BE PROM= TOTBBWELLOWNER
• "-/ I 1 �rG(L �/!t'O�Lf. tna '01 r7 D rp
SIGiA1UREOFPERS(N CONSTRUCTING T[IBWEIL _ - DATE - -
•
Submit the original to the Division or Water Quality, Groundwater Section, 1636 Mail Service Center -Raleigh, NC
4 699-1636 Phone No. (919) 7333221, within 30 days. - GW-1 REV. 07/2001
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WELL- CONSTRUCTION RECORD - :
North Catalina - DeparUnent of EnvirotzMent and Natural Resources - Milian of
Quality-- O+oaadwaaer Section
WELL CONTRACTOR (WWIYJDUAL)
WELL CONTRACTOR COMPANY
chill Stunt S %tn 112n d, - C..vlst*T[oNI
.1 ., "rums a2-L%�a1!-3 V-6
,
STATE WEU. SON Main - AaltOCfATED(if applicable) {tapplfable)
1. WELL USE (Chick Apieabls Eo*-Raiea tialtY ieapal/Pob6e D IndustrialD Ifgriculimal-0
Monitoring ❑ RecoveryaHeat Pump WatarN ix:Eon ❑ Mai Ifoffer, List Use
Z LOCATIOlt
salting •
-Nearest Tovmnf�/A//G 2 : i' 7LJYtJ'- pOglopte _
alley
of8miiriz Parr Raj (digit ,;a_Law)Oh7Rt
. '
(SUCCtttISUe.tbakene a r Oo WHO,rp espy 3y atitutikmgitude0?V&1loatioli
3.OWNER: 3a 1-4
Address O /v /J / tE e A-/G 5T•
tuyeaTan - Srate - • 2WCoda
(2a81. 3 542 - /574.1 •
Ara cat. ?benumbs
4. DATE DRILLED G i9-OCa
5. TOTAL DEPTH- 9t S '
6. DOES WELL REPLACE EXISINGWELL? YES NORsy
7. STATIC WATER. LEVELBelow Top ofCalmg: /Sly_,)T:
(User flays Tep dram)
g. TOP OF CASING 1S / FT. Above Land Surface*
frapante estimated atierbe tgdsarfmrapine a
minaN aewdaass ab-i5ABCAC2C.9lta . -
9. YIELD (gyp): / 0 METHOD OF TEST
10. WATER ZONES (dept 9f 00 ' J 6°s '
' LOCATION SKETCH
11. DISINFECIION;Type ij-f!{: Amount ...2 r/h-SS 5 Sbow acedon saddlers= In miles from at least
12. CASING: - - WM TLidows - two Slate Roads or County Roads. -Include the road
Depth • a We3Bht/Pt - '-sabers and common road names.
Latitadd( map
• (dadttas)
rDEUR • DRILLING LOG
Fottmtioa Description
/r/ 4V
s ' ez9' ..s4-/i/o
From To
From__To�_Ft - "$nf -
From Tct Ft
From Ty Ft -
13. GROUT_
From_—Too...eha eQl p03t c)
From_ To •P.
.4. SCREEN: Depth Diameter . Notate - Material
From To Ft __ia. in.
From To Ft, in. in. •
5- SAND/GRAVEL PACK _
Depth Size Mataid
From To Ft
From To Ft
6. REMARKS.
DO HEREBY COMFYTHATTEIS WELL WA$ C Nsmen:a IN ACCORDANCE WIT$1SANCACC., Vita -
ONSIRUCf1ONSTANDARDS,ANDTHAATACOPYOFT RECORD RAS MIEN PROVIDED TOTREWEL,OWNER
- / 4 isr 6 19 •-0 6-
SIQiAlUREOFPERSONCONSI'RUCTWOTiEWELL - DATE -
Submit the original to the Division of Water Quality, Groundwater Section,1636 Mall Swvlee Center -Raleigh, NC
fl6994636 Phone No. [phone], within 30 days. • GW-1 REV. OW2001
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•
. - • WELL CONSTRUCTION RECIELRD • - : ..
74
'
NorhCoiina- Department oiHthwwaamand Natural Resources - Division af :r-Section' • .„,_%4
weu.CONTRACTOR Wm1Wow6wg/L►1n15 J bi l,`: -, aoNL+P •
WELL CONTRACrott MPANY weMIC.ia�n,*c j1aJIn.,� ;,...�`�-..� 'ncfnen( Sao-3 ab 0
STATE WELL coils Kilo, nRMtn jman afla aQi' ►� - ''
fd'eppfiesble) {ifappliahle) • .
I. WELL USE (Check / Bo4-Raidential YPub6e El gt
.Industrial 0 /licultu[a1 O
Monitoring El Rar 0- ecovHeat Pomp Water lnjr onfl Other If bier, List use _
L "WELL LOCATION: -
(suu dNwe.PJab«r.Lbmamiiy,SuldviOns a$u,T,pCaae)
3.OWNER: . J'n Uhn • ` - A0 I1PJU- -
Addmss 13;elwet/ 157 •
ls4ntsrBaeaNs.3 --- --
Ffl vkL : ,r/"fl/CG ' 8rl 3 [f
t:aretTara Mae .. " Zip Cede
(S2.21- 3if 9- 9ui .
MCI code- Phone amber /
4_ DATE DRILLED (., —/4 —0 (A
TopogisptiidLimd Soling -
/�elGdge !]Slope OV.IIcy 0BW
_teh4aatoratehlehual
LiiMaddlhu jtuda ofvll location
•
Iadu!dellcngidide., sourecOGPSOTopographic map
Wyk box)
,ram - DRILLING LOG
From To I:ctmationDescription
_— 35?' j(!'' R-Ll)4(r2jQN)1t.
5. TOTAL DEPTH. / 01013 '
6. DOES WELL REPLAN EXISTING WELL? YES 0 NO.QL----w`
7. STATIC WATER. LEVEL Below Top ofCaiing 0S7) FT:
glare itAbave Top oCilia
8. TOP OF CASING IS / FT. Above Lewd Surfaces
nap edeadgasadaatlador WmbadaScc ngaken n
mina! asfls.ssn� ISATICACJC.011S.. r-
_1L//!)U
9. YIELD (gm* a MS1�RODOPTESP,
10. WATER ZONES (depth):O' v
LOCATION SKETCH
11. DISINFECTION: Type 1141.. - Amount .1TA-A $ Show direction ataidialanca In mile from at leas(
12. CASINO: - - Well Meknes ' two State Roads or County Roads. Include the road
Depth Diaper; or WAR.auunbas and- road names.
From 0 . To 3 a FL h.! $ : -
From To FL
From Tp FLU_
13. GROUT: Depth Memwiet. Method l
From_O_To Ft pna,7 pov^s - -
. - - c_
From To Ft. - a
-4. SCREEN: Depth Diameter - Not Me - , Material. l::._,: ro
From To Ft in. in.
From To Ft in.
5. SAND/GRAVE�LPIC Depth tb S'l e
From To Ft
From To FL
Material
C
Cr.
6. REMARKS:
DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCEFD INACCORDANCE WITH ISANCAC.2C. WBLL -
-ONSfRUCfiONSTANDARDS, ANDTHATACOPY OFIi RECORD BEM PROVIDED TO THEY= OWNER
S1(GTiATUREOFPERSON CONSTRUCTER:1ME WEu. . DATE -
Su bunt the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center -Raleigh; NC
fl699-1636 these Na [phone], within 30 days. . GW-1 REv. mom

- : WELL CONSTRUCTION RECORD : v'
_
North G lint- Depn�tofBuwl.. mtewtand *Mural Resources- Whist of Q�ty-oSndwaterSa�
%TELL CONIRACTOR(INDIt(muAL) (yio.9s t le O tt Vl.
�. _._ _ _ _ 5 - iI Mt
— o
WELL CONTRACTOR COMPANY Nli r""tc iaelln - lI �11±,rc71'trttoi,Y t-5a.+-/•-3 a-b
STATE WELL Corarritucnott eawiirs AESOcfATED
Cd.ppl- ta) yM -(ifappliccble) "
1. WELL USE (Cbeclt Appllwbiti Boater-ResidwtniiYicipsl/PublIc a Industrial 0 Agricultural-Q_
- ` Monitoring ❑ Recovery 0 Heat Pump Water Injection ❑ Other 0If atria, List Ose
2. "WELL LOCATIO
Nearest Town: fled-A/�/kJ - Cotmty /%!�f✓
dens al a,el?•Coems 5
(Sum ti.m4tmmbm.ComaarYh> itiaion.Loala.4Coda/
dgLL • ley
rniapey . q�Iat
t7Rrdgo (theekspFmpdatebos) - ' y� Laii4atdlongit>� of Vet location -
3.OWNER:.,9{'tj - JJ•P 2usc i - (dam
Address .4-Shb/rILA) 9 ,, d.:r Latitu.ddlottilltideaourc OOPSOTopograpbicmap
aam.xal 4.9a' • ; -
(dwelt ca)
F/2 � k // . DRILLING LOG
C`'sa [� _ 3�` ads Ettml Tom F Ltion/Description
Aracede. phosemmbtt - -rt -- /nt,L.' .. / 1 U' _.S,ri-N 1J Yfi�1 /✓ ¢'
4. DATEDRIIZED (,—lG-6 to no- a.s's '- L U e 6-tea r t'e-
S. TOTAL DEPTH: ems• • - -. -
6. DOES WELL REPLACE EXISTING WE(L7 YES 0 NOQ - -
7. STATIC WATER LEVEL BdavTop ofCaomg: 70 FT:
Wier
E. TOP OF CASING IS / FT. Above Land Surface*
irtpdesks troiaah4odor bs irhS.artKetennis • , : wince Is V ea.rd r Serb' ISANCACsc.aid j
9. YIELD (gpgtx a? 0 METHOD OF TEST jI /02/) .¢- . -
10. WATER ZONES (depth) !&s 5 and ' (l . .
I OCATiON SIETCIi
11. DISINFECTION: Tpe % -%1.•f Ammmt ..2TA-A5 Show dtrt cti n and.dietsmx In miles from at least
12. CASING: - - Wall Thickness ' two State Roads or County Roads:belutk the road
- Depth Dr etweltlR •mimbersand-commonroadnames.
From fl .Tot/D PL
From__To Ft......_:
Froze Ty_ FC_ •._
13. GROUT:. o
tkyth Mid
From To - - -
Frrnn To Ft. - - c+
.4. SCREEN: Depth Diameter . Slot Slota re :: Materiel Cw , c
From To
Ft-=
�Jm- in. •
Fr ▪ .`> t-i
Rork__ To Ft _ia is • m • ;
5_ SAND/GRAVEL PACK: - <
Depth Size Materiel - - - o D' ''
From To Ft. - .0
From To Ft,
6_ REMARKS
•
DO HEREBY CERIIFYTEATTHW WELL WAS OUiSfRUCthD ACCORDANCEWITH i3ANCAC2C. WKA , -
ONSIRUCTIO NSTANDARDS,ANDTNATACDPYOFTM- R���ORD BEEN BEPROVIDED TOTER-WEILOWNER
- 'l G=/ 6 - 0 6
SICRIATURB•OFPFRSONCONSIIWCHNOTHE WEI _ DATE -
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mall Service Clutter -Raldgh; NC
%/699-1636 Phone No. (919)133 21, within 30 days. - GW-I REY. 0772001
•

. • .
WEil: CONSTR IICTION RECORD -1
-
North Wolin - Department of Eurkounait and ibhual Resources - Dit;Ision
WELL corrnacron prtmitiouniatAant 449 vb.t ring S 14.5 I it‘A.A.:4-
WELL catern.l7ORCOMPANY tIparIltflflrN
STATE wr.LL coranwcrtor(varattral_..—
rime:SW
1
03=?Iisviiter section
!sr f&tiv-V_Sa 14-3 o
421500fAISD ": • .
:(1r4Pplienbles) -.
- - - •
•
I. WELL USE (Check Apiable-Boze-ResidentialsicipaVPublie 0 industrial 0 41Iticultund 1;1
Monitoring 0 Recovery a Heat Ppm, Woter Injection El Other CI if alio; Lha Use -
2_ -wEu. Locknoik
Nearrbi. 4 ' iii - /14 A ent - • -,4-34MriPtieff-paud oiling -
own: P/Init4 L'
. - OSI00 OValky . Mat
bin aaptcpshte
(SnotThme.14mobers. i'Mas Wk. r‘P Cede) . -
3. °WHEW SD ii fa et./ tiDmv..r A
Address /479/ /3-.01,/
tstreeteittostro.) - -;, A
flAide_i,IJ -:07C-- ' JOC
Color Ton is MD 9de
Area cone- Phone umber
( gge,- qS9 - L7.2 7
4. DATE DRILLED -1 -7
5. TOTAL DEPTH; ist/S-5- •
• -
Climiknoigitude eve! location *
. • -
A/C-• - , tennteskaiumehmoned
Latlitideihmgittido sourecCIOPSOTopopaphic map
tr Ring DRILLING LOG
From To Formation Description
. • 0 & •
1. fitly
_- cs • / , fo 49-J
/ Q., a- fe-4.4/
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO.-
7. STATIC WATER LEVEL Below Top orating H 0 -FT.:
Wes me if Above Top olteeird
8. TOP OF CASING IS FT. Above Lund Surface*
nip of eosin rerMhOill War hefty lostratleco makes*
wham hi amordanerolli15/41CAC3C M111. / I
1 O. WATER ZONES (depth): 4 'go '
9. YIELD (gp* _,2METHOD OF TBsr_AIDillat
J.00ATION SKETCli
11_ DISINFECTION:Type 11-1-11 Amount -2 TAR show trlicarloa awl distance in Data from at Least
12. CASING: Wall Thiekness to Slate Roads or County Roads:Include the road
Depth Dia/oder . or Weijidta. hidadLe-rumbas and -common toad mamas.
From V . Toinpt, , kv s! WV a/RA;
From
From Tp
I 3. GROUT:. Depth ___.chtlaterfal Method
From A To FLF1---eananci-22 PDXASI
From To
.4. SCREEN: Depth Diameter . Slot rat Maeda'
From To Ft. 'n. in.
From To Ft. in. in.
s. SAND/GRAVEL PACK:
Depth Site Mataial
From To Ft,
Fmm To Ft.
6_ REMARKS:
DO HEREBY CERTIFY MATTEIS WELL WAS =arum=atACCORDAMI WITH ISPTICAC_2C, Vila •
ONSTRUCTION StUdDARDS, ANDTHAT ACM OFM113COLDTBEENPROVIDEDIOTHEAVEILOWNER
•
Ski,TURE-OFPERSON CONSTRUCTING THE WELL - DATE -
submit the original to the Division of Water Quality, Groundwater Section, 1636 Mall Service Cotter -Botany-NC
.27699-1636 Phone Plo. (919) 133-3ni, within 30 daysGW-I REY. 07/200 I
C_.
0
0
0
0
0
0 r.

- • . WELL CONSTRUCTION RECORD' : v -
at of Bnviros m it and Natural Resources - Division of Water Quality.- Glvand�pator Section
NorthCafol(na-Dtt 1, �, ..TtON+ot/7(r .
wELL
,ta7+.. twm4Vxrfvtt5 / �lt>�d,':. .tMl.HO �4_3 3b b
WELL CpNTa/tCrOA COMPANY -r. .!•-1;- .
STATE WELL CONSTWUCrtON PLRMtr+ ASSOCfATRD W risers
-
(fappliabla) 4ifapptluble) • .
1. WELL USE (Check Applicable Box):-Resideaiialt MuRteipal/PubUc 0 Industrial 0 Agricultural D
Monitoring 0 Recovery 0- Heat Pump Water Injection ❑ Other t7 if Other, List Use
2. WELL LOCATION: -
Nearest Town: F� Azle i 4 County/VA lion/
(D(' l� /tu-/7!m) �c�•— ,1ET
(Sam Name. Nnmbea, Community, Sabd:viriaa, Lot No.. Vp Cam)
Tppogtapbirlljnd setting . .
[Midge hiallice OKalley . ORtat
(teed app neriatc boa)
Latitudeflongitude of wolf location
3. OWNER: 0 h&n )e t T en- +h a(d t
Address f UAJ-e 57 D %'n t t Th R- Latitudrllongittide source:OOPSOTopographic map
n ! (aant�y��i `RmacNo.) - q (cbadtbmr)
f 1 S h eV; Fl t )1 .- C' cl ��'b i0 r DRILLING LOG
Mitt -Town SW: ' .zip Ccdc ,From To Fa�ma on Description
sae t So Co - ©ot O V
Ara code Phone numbs. ` -- a- F r1. " . L (-r-GD'SV -o n I T R'
4. DATE DRILLED �,- i 9 w to . ' " 2-G ' 3 Sir
5. TOTAL DEPTH: 3 ,FS ` • -
6. DOES WELL REPLACE EXISTING WELL? YES C NQN
7. STATIC WATER LEVEL BelowTop of Casing: a O FT:
(User If Above Top orCadoz)
8. TOP OF CASING 1S FT. Above Land Surface*
'Tap of eattag to lutad atlor bel4t hataarfaea requires ■ - .
mina 4t aaordaaswIditSATICAC 3C .011L
9. YIELD Cepao): Sot M OD OF TEST
10. WATER ZONES (depth): c7 82S JACATIGN SKETCFI
11. DISINFECTION: Type R-%Ji: Amount ..ETA• Al S Show direction anddistance in miles from at least
12. CASING Wall Thicket= two State Roads or County Roads. Include the road,
Dt or wa M�atcna�a1� • numbers and common road names.
From To FL ry
From Tp Ft-- _-
13. GROUT:. Depth Matend ry
Froro____To eV) FL e?7' M�9 C'W`� - - o-.
From To Ft
.4. SCREEN: Depth Diameter - Slot Sit - , Material
From To Ft,__jn. in.
From To Ft,____In. is
5. SAND/GRAVEL PACK:
Depth Size Mntaial
From To Ft
From To Ft
6. REMARKS:
DO HEREBY CERTIFY TRATTHIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15ANCAC2C. WELL •
ONSTRUCTION STANDARDS, AND THAT A COPY OF .TM RE�C�ORD BB&1 PROYIDEDTO THB WELL OWNER
- 'lele� 749: off •
-
SIGNATURE-OFPERSONCONSIRUCTINOTHEWELL - • DATE
Submit the original to the Division of Water QuaUty, Groundwater Section,1636 Mall Service Center -Raleigh, -NC
fl699-I636 Phone No. [phone], within 30 days. . GW-1 RSV. 072001

WELL' CONSTRUCTION RE efle .
Noah Cabal's - Department of Baritonrmut and Hanna Resources - Division of at r Quality- Ciroandy/atm Section
vain. CONTRACTOR tnmRn' nUAL (j Q ;he fi P115 /d+ A- RisrpriCAYWNs •.
WELL CONACrOR COMPANY'�c ide dA A I I a l ✓'1'�l (^u- -.1b:�—.a•r �.PaON 111i
_21 —3abf
STATE WELL CONSTRUCTION PRISM w"ISSIM
A
•
Ufaypliabls) - •(11.WPIIcable)
I. WELL USE (Check Applicable Box):-ResidenlialiY Mvaicipah/Publie ❑ Industrial 0 Agricultural ltural Q
•• Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATI '
Nearest Town: /C County go OSlope Malley . °Flat
J�AU At
(s' e S cl - R on e S ;es e- P.:, E'7 3 y (shock approwtatcboa)
aeon Name, Number; Cemomeity, sot hiaoe. Int No. Lp Coda) - L'atitudeJlongitude of well location
•
3.OWNER.4F2v,, C P; Qnorct..
Address 770 LA-Oteen.4-
(SLN
rcata�acmcNt)
%- -
PA.vk1; ✓ . N. e, 02 g.173 S1
GryeTom rToSum T�CSc
(R�- 3 2)— 0(07 '
Mn cot- Phone numberr/
4. DATE DRILLED " /' �
5. TOTAL DEPTH;_ 3 OA
6. DOES WELL REPLACE EXISTING WELL? YES 0
ER NQ�
7. STATIC WATLEVEL Below Top of 70
(uta `t' if Above Top of Cuing)
8. TOP OF CASING IS �_ FT. Above Land Surface*
?op of wing tirminess atlor belay badaarfia moms
anima y. aasseNk"ISANCIC 3C.011L '
9. YIELD (gpm): 02�_ 'HOD OF TEST 1 iffilb 4
10. WATER ZONES (depth) /40 '
T. - bictLand setting
,lam
Latituddlongittide seunce.OGPSOTopographic mop
• (chock box)
DRILLING LOG
From To . Formation Description
LOCATION SKETCH
11. DISINFECrION.Type Amount .-2TR• 4 5 Show direction enddietaace In mhos from et leasto
12. CASING: - - Wan Thidmw two State Roads or County Roads. Include the roar:
--numbers and common road names.
Depth or Wdgbt/PL
From 0 . To SI2 : �•
From To FL
From Tp FL
13. GROAT_ Depth Material Method
From_To M
FL CQiar� polp
From To FL
4. SCREEN: Depth Diameter . Slot Size - 2 Material
From To F1._ in. in.
From To FL,_ im in.
5. SAND/GRAVEL PACK
Depth Size Material
From To Ft.
From To FL
6. REMARKS:
•
DO HEREBY CERTIFY THATTHIS WELL WAS CONSTRUCTED IN ACCORDANCE writ ISANCAC2C, WELL -
ONSTRUCTDONSTANDARDS, AND THAT ACOPY OF RECORD HAS BBENPROVIDED TOTH&WSILOWNER
SIGNATURE•DF PERSON c0NSTRl1CTIN0 THE WEIL . DATE ..
.submit the ariginal10 the Division of Water Quafty, Groundwater Section, 1636 Mall Service Center -Raleigh, NC
;1699-1636 Phone No. [phone], within 30 days. . . GW-1 REV. 07/2001

RESIDENTIAL WELL CONSTRUCTION RECORD 3 2 9 8 2 9
North Carolina Department of Environment and Natural Resources- Division of Water Quality
WELL CONTRACTOR CERTIFICATION II J07/
1. WELL CONTRACTOR:
W II Contractor (Individual) Name
Well Contractor 41fig#17411W S 1MELL DP.ILLrl1u, uv...
248 CRANE CIRCLE
STREET ADDRESS FRANKLIN, NC 28734
City or Town State
5-ail-Y976
Area code- Phone number
Zip Code
2. WELL INFORMATION:
SITE WELL ID 8(ir applicable)
STATE WELL PERMIT/4H applicable)
DWQ or OTHER PERMIT #(If applicable)
WELL USE (Check Applicable Box): Residential Water Supply k�9—
DATE DRILLED �"ag 0b
TIME COMPLETED AM PM
3. WELL LOCATION:
CITY: r( R��r k.I. /U COUNTY r I I AN
(Sire mi FNunie s. Cortknunily, Subdivision, Lol No., Parcel, Zip Code)
TOPOGRAPHIC / LAND SETTING:
O Slope OValley ❑Flat ORidge ❑Other
(check appropriate box)
LATITUDE 3
LONGITUDE
Latitude/longitude source: ❑GPS ❑To yographic map
(location of well must be shown on a USGS topo map and
attached to this form if not using GPS)
4. WELL OWNER /1 l
OWNER'S NAME C-04)( =1 �II')rlh �Y
STREET ADDRESS ?C 2Ja .-€41,_y ryt to
prnpb
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: 303
b. DOES WELL REPLACE EXISTING WELL? YES ❑ NO D-
c. WATER LEVEL Below Top of Casing: /Q0 FT.
(Use'+- it Above Top of 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): 3o METHOD OF TEST Jj
f. DISINFECTION: Type
g. WATER ZONES (depth):
From To From
From To From
Frar. To From
Amount
6. CASING:
Depth if Diamel}r
From To 7 6, Ft. G /Y
Fri n To Ft.
From To Ft.
7. GROUT: Depth Material
Frcin
Frcin
From
To
To
To
Thickness/
Weigh) Material
A Method
U To aD Ft. 2OJ11s.✓ Qry_�r,'y�
To Ft. /
To Ft.
8. SCREEN: Depth Diameter Slot Size Material
Fran To Ft. in. in.
From To Ft. in. in.
From To Ft. in. in.
9. SAND/GRAVEL PACK:
Depth
From To
Fran
From
Ft.
To Ft.
To Ft.
Size
Material
10. DR.LLING LOG
From To Formation Description
11. REMARKS:
(- ram.: m
c
L v Z00D
100 HEF IEBY CERTIFY THAT THIS WELL WAS CONSTRUCTED N ACCORDANCE WITH
ISA NCAIS 2C, WELL CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS
RECORD HAS BEEN PROVIDED TO THE WELL OWNER.
aid &ac- 24r (-IL
SIGNATU(CERTIFIED WELL CONTRACTOR DATE
F7P'I CV'p-11 c
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 N 3o 7
1. WELL CONTRACTOR:
Cc� Co -Nc
Well Contractor (Individual) Narne
Well Co r ac or Fo2485 ANt CIRCLE
STREET ADDREgGDQ4tNKLIN, NC 28734
City or Town Stale
(lac say-r9po
Area code- Phone number
Zip Code
2. WELL INFORMATION:
SITE WELL ID #(it applicable)
STATE WELL PERMIT#(ir applicable)
DWQ or OTHER PERMIT #(if applicable)
WELL USE (Check Applicable Box): Residential Water Supply2-
DATE DRILLED L/ ! %. O L
TIME COMPLETED AM O PM ❑
3. WELL LOCATION:
CITY: 1-4,h lf3/4Qs couNTY/YI4C.ON
1;yhJm'✓d
(Sheet Nam Numbers. Community, ubdiAsion, Lot No., Parcel, Zip Code)
TOPOGRAPHIC / LAND SETTING:
❑Slope OValley ❑Flat ❑Ridge OOther
(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)
4. WELL OWNER //����� \
OWNER'S NAMELJYFY4 SA//OW ,Z
STREET ADDRESS //CC%O 1 jiild 111) brTL4.
City or Town State Zip Code
( )-
Area code - Phone number
May be in degrees,
minutes, seconds or
in a decimal fonnar
5. WELL DETAILS:
a. TOTAL DEPTH: 103 b
b. DOES WELL REPLACE EXISTING WELL? YES ❑ NO$-
c. WATER LEVEL Below Top of Casing: “l(7 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 accordance with 15A NCAC 2C .0118.
e. YIELD (gpm): / C METHOD OF TESTA/lir
32982
V �,
1. DISINFECTION: Type Amount
g. WATER ZONES (depth):
From To From To
From To From To
From To From To
6. CASING: Thickness/
Depth / ,7 Diarnettel Weight Material
From U To /i' Ft (p % 7A/J G
Fun To Ft.
Frc n To Ft.
7. GROUT: Depth Material Method
From () To a_v Ft. 1/4/-1-- .f aVri A/G
From To Ft. r 7
From To Ft.
8. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in.
From To Ft. in. - in.
Frcm To Ft. in. in.
9. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
Fiom To Ft.
10. DRi.LING LOG
Front To
Formation Description
CD
to 7- 1n30 y' v17
11. REMARKS:
o Ci
JUL 20 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
RECORD HAS BEEN PROVIDED TO THE WELL OWNER.
SIGNATURE OF CERTIFIED WELL 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 Mall Service Center - Raleigh, NC 27699-1617 Phone No. (919) 7.13-7015 ext 568.
�-fbrm ow -la
Rev. 7/05

329820
RESIDENTIAL WELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources- Division of Water Quality
WELL CONTRACTOR CERTIFICATION #
1. WELL CQNTRACTOR:
Well Contractor (Individual) Name
Well Dor0R3}NVBROTNATWELL DP.ILLIE2,
STREET ADDRES 48 CRANE CIRCLE
tttN "2oi.04
Qn `City or Town Stale
Area code- Phone number
2. WELL INFORMATION:
SITE WELL ID Cif applicable)
STATE WELL PERMIT#(il applicable)
DWQ or OTHER PERMIT #(if applicable)
WELL USE (Check Applicable Box): Residential Water Supply 0
DATE DRILLED �elJ So
TIME COMPLETED AM ❑ PM ❑
3. WELL LOCATION:f
CITY: Prietrl/ A Li; COUNTY IA /(A c-3
1-6-11-ty sand
(Street Name, umbers, Community. Subdivision, Lot No., Parcel, Zip Code)
TOPOGRAPHIC / LAND SETTING:
❑Slope DValley ❑Flat ['Ridge ['Other
(check appropriate box)
Zip Cade
LATITUDE 3
LONGITUDE
May be in degrees,
minutes, seconds or
in a decimal format
Latitude/longitude source: ❑GI'S ❑Topographic map
(location of wet/must be shown on a USGS fopo map and
attached to this form 1 not using GPS)
4. WELL OWNER }—
OWNER'S NAME �I tieIA- Tn/J-5' r . �� /n7
ST REET ADDRESSO5 Ly/V.ry d-ci4/L[.e- .L3yAC-
Ie.5 -it/e3
City or Tdvn State Zip ode
Area code - Phone number
5. WELL DETAILS:
a. TOTAL DEPTH:
�30
b. DOES WELL REPLACE EXISTING WELL? YES 0 NO.g—
c. WATER LEVEL Below Top of Casing: /de Fr.
(Use's if Above Top of Casing)
d. TOP OF CASING 1S 1 FT. Above Land Surface'
'Top of casing terminated aUor below land surface may require
a variance in accordande with 15A NCAC 2C .0118.
e. YIELD (gpm): Q- METHOD OF TEST lettrit
f. DISINFECTION: Type Amount
g. WATER ZONES (depth):
From To From To
From To From To
From To From To
6. CASING: Thickness/
From Q OTothr7 FL D/ py Weight Material
Tpj Fran To Ft. j
From To Ft.
7. GROUT: Depth Material
From To _0 Ft. ems..21-
Frorn To Ft.
From To Ft.
Method
8. SCREEN: Depth Diameter Slot Size Material
Frcm To FI. in. in.
From To FI. in. - in.
From To Fl. in. in.
9. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To FL.
From To Ft.
10. DRILLING LOG
From To
a 117
V7- ST-?6
11. REMARKS:
Formation Descripl'lon o
dat
IN)
VI
N
0
rn
JUL > u [OD6
100 HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WTI
15A NCAC 2C, WELL CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS
RECORD HAS BEEN PROVIDED TO THE WELL OWNER.
L 7--/F--4
SIGNATURE OF CERTIFIED WELL 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-la
Rev. 7/05

RESIDENTIAL WELL cons-mucrlon RECORD
North Calolina Department of Environment and Natural Resources- Division of Water Quality
1VELL CONTRACTOR CERTIFICATION II
1. WE ONTRACTOR:
Well onhactor (Individual) Name
CRAW BROTHER: VIP I be° r t•.•
Well Contractor Conrpal yyz�e/.�i.+
�4S I�FM1.N t.
STREET ADDRESS
FRANKLIN, fC2E/34
City or TOM] Stale
) Area tale- Phone number number
2. WELL It (FORMATION:
SITE WELL ID k(il applicable)
Zip Code
STATE WELL PERMITt/gr applicable)
DWQ or OTHER PERMIT e(if applicable)
WELL USE (Check Applicable Box): Residential Water Supply 0
Lit DRILLED rah.- ru L
TIME COMPLETED AMID PM
3. WELL LOCATION: r
CITY: 1 ' R Ai kJ;J N COUNTY aliffe2 A)
r(r(5
(Street Name, Numbers. Community. Subdivision, Lot No., Parcel, Zip Code)
TOPOGRAPHIC / LAND SETTING:
D Slope DValley ❑Flat ❑Ridge El Other
(check appropriale box)
LATITUDE 3
LONGITUDE
May be in degrees.
minutes, seconds or
in a decimal formal
Latitude/longitude source: Et UPS DToI ographic map
(location of well must be shown on a USGS lopo map and
Winched (o This form I not using GPS)
4. WELL OWNER I t-
OWNER'S NAME MLNII 7
STREET ADDRESS
City or 1 n�
/ryes
Slat
58401
Area code - Phone number
5. WELL DETAILS:
a. TOTAL DEPTH(:
p,C/
Zip C e
b. DOES WELL REPLACE EXISTING WELL? YES D NO$
c. WATER LEVEL Below Top of Casing: O FT.
(Use -+' if Above Top of Casing)
d. TOP OF CASING IS / 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): / 5— METHOD OF TEST
337
32981�
T. DISINFECTION: Type
g. WATER ZONES (depth):
From To
From
From
6. CASING:
To
To
From
Amount
From
From
To
To
To
Thickness/
Depth Diame'r Weight Material
Flom 0 To ipP Ft. 6 4- ?VC -
From To Ft.
From To Ft.
7. GROUT: Depth Material Method
From 0 To.� rtra/4 — ,fpp, i
To FI. ���
To FL
From,
From
8. SCREEN: Depth Diameter Slot Size
From To F1. in. In.
From To FI. in. In.
From To Ft. in. in.
9. SAND/GRAVEL PACK:
Depth
From To Ft.
To Ft.
From
From
To Ft.
10. DRILLING LOG
From To
0- �o
(DC— J-"1)5—
Size
Material
Material
Formation Description
deo�
c
II. REMARKS:
JUL 20 2006
I DO HEREBY CERTIFY THAT MIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH
15A NCAC 2C. WELL CONSTRUCTION STANDARDS. AND MAT COPY OF 11115
RECORD HAS BEEN PROVIDED TO TIIE WELL OWNER.
5
7�18� t0
TURE OF CERTIFIED WELL CONTRACTOR DATE
rr(1 eaihej
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 FJI
North Car ulina Department of Environment and Natural )resources- Division of Water Qua ily
WELL CONTRACTOR CERTIFICATION H
.3"e)29
329818
1. WELL CONTRACTOR:
ell onbactor (Individual) Name
Well Contractor Company Name
SIREET ADDRESS
City or 1 own Stale
Area code- Phone number
2. WELL INFORMATION:
SITE WELL ID #(ir applicable)
Zip Code
S TA1E WELL FERMI I #(it applicable)
DWQ or 01I-TER PERMIT #(if applicable)
WELL USE (Check Applicable Box): Residential Water Supply 0
DATE DRILLED V--1/433-- C L
TIME COMPLETED AM D PM ❑
3. WELL LOCATION: /�/�
CITY: Ei.Att)k J. it) COUNTY t/)r7vv�
y j_ sl1
(Street Name. Numbers. Community. Subdnnsiorr, Lot No., Parcel, Zip Code)
TOPOGRAPT IIC / LAND SETTING:
FT Elope ❑Valley ❑Flat El Ridge ❑Other
(check appropriate box)
May be in degrees,
LATITUDE 3 minutes, seconds or
LONGITUDE in a Decimal (Donal
L,n litude/longitude source: ❑OI'S ElTo fographic map
(bcatlon of well must be shown on a USGS fopo map and
attached to This form d not using GPSJ
4. WELL OWNER
OWNER'S NAME
�J�bt2 bsJV
STREETAUDRESS
City or Town Stale
Area code - Phone number
5. WELL DETAILS: a TOT AL DEPTH: 30!
Zip Code
b. DOES WELL REPLACE EXISTING WELL? YES 0 NSJ.g—'
c. WATER LEVEL Below Top of Casing: 50 FT.
(Use -t. if Above Top of Casing)
d. TOP OF CASING IS / FT. Above Land Surface'
'Top or casing terminated at/or below land surface may require
a variance in accordance with 15A NCAC 2C .0110.
e. YIELD Wpm): a 6t ' METHOD OF TESTA r
I. DISINFECTION: Type
g. WATER ZONES (depth):
From To
From To
From To
From
From
From
Amount
To
To
To
6. CASING:
//� Depth DiamgJer
Rom eFLi
From To Ft.
Flom To FI.
Thickness/
Weigh) Materiiaal,
7. GROUT: Depth Malerial Method
From U To__ FL ( *
From To FI.
From To FI.
8. SCREEN: Depth Diameter Slot Size
From . To FI. In. in.
F'om To FI. in.
From To Ft. in.
9. SAND/GRAVEL PACK:
Depth
From To Ft.
From To Ft.
From To Ft.
10. DRILLING LOG
From To
...19
11. REMARKS:
In.
in.
Material
Size Material
Formation Description
air
L -.
c 1Q17,
rt-
JUL 20 Zoos
I DO HEREBY CERTIFY THAT TIES WELL WAS CONSTRUCTED IN ACCORDANCE WITH
15A NCAC 2C. WELL CONSTRUCTION STANDARDS, AND THAT A COPY Or THIS
RECOF.O ((AS BEEN PROVIDED TO THE WELL OWNER.
SIGN/RU OF CERTIFIED WELL 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 Mall Service Center— Raleigh, NC 27699-1617 Phone No. [phone] ext 568.
Form GW-la
Rev. 7/05

329362
• • WELL CONSTRUCTION RECORD • : U ' •
Nof Envkcumth t and Natural Resources - Division of Water Quality-- Croandwater Section
%v tConTReti' on a- t . elin.6 .. AT1ON/ t! •
wP11. C01rraACroR(n�11(IntrAta twi■9S�1b.�.u`CLi�.7=-• .1-:-
WELT-00IRRACfOR COM►ANYIIA.
t r' iatJt• r 11 {1 Vfll^.u-wPHONE scalf3 2:0 0
STATE WCLLCONSTRUC UItt reamtrs AS3047AT1D W mare'
CfappUabla) • . / "(lf iiPPUe�) • -
•1. WELL USE (Check AppUcabWWBox):-Resident'ial�M pal/Public ❑ Wotan] O Agricultural Q
Monitoring O Recovery aHeat Pump Water Injection ❑ Other O If odic;List Use
2. WELL LOCATIO :
Nearest Town: tfib County /3 Orr
Lint s- Lowe it_y £ &wti A''76 3
ante Name, Numbm.Camme.ity, Sob&vitioa. Lot No. rap Cade)
3. OWNER: /)1 lL O A-ss& g .
Address (9 ter—. - ` re ►2 12a G 2.
(sueetstitouaxa) a p�, ,�.
ttinAvlC.,0
a Cede
t,�rCr� ryaT R935 'Tm
Ern cede- Phone aom5er
-
T blt•Jltmd setting -
•dgc OSlopc OValey . [Mat(detappreprhtebox) .
Liiitudenongitade of v(cll location
, (deat.mtmtwwhmom$
Latitudeilongitdde sommap
ap
(abetRILLING LOG
Formation Description
_ e- 2 ;
FT
O Si?
4. DATE DRILLED ?-- / 2 —o (O ' ' 7,s '
5. TOTAL DEPTH:) 5
6. DOES WELL REPLACE EXISTING WELL? YES 13 NO.cw--------
7. STATIC WATER LEVEL Below Top of Outlaw ISD Fr
(Wa'M" if Maw Top of easier) '
8. TOP OF CASING IS _� _ FT. Above Land Surface*
-rap et easing armband Misr beta* leadaarfan nqulS a
9. YIELD (gprp).. 30 METHOD UFTEST be/ '+
virtues to swedesvrW ee ,7StaleriCSC.011S.
10. WATER ZONES (depth): 3 is S -
DISINFECTION• Type Ain/ Amoamt .� T1i• D� 5 Show direction and.distill= In mit a from at least
•
GA`1TON SKETCH
11. two State Roads 0r County Roads. Include the road
or Weight/elkWeight/elkWeight/elknwmbers and -common mad names.
From__To %'J rrh"_$,D,R.� K` `*'
From
12. CASING Wan Thickness To Ft
Frain Tp Ft•
13. GROUT: Depth MaterLt Method -
From�._Tc r30 FL on.ar payA.�
From To Ft.
4. SCREEN: Depth Diameter . Slot Size - = Material
Front_ To Ft --in. in.
From To Ft in. in.
5. SAND/GRAVELPACK
Size
Depth Material
From To Ft.
Fmm_ To Ft.
6. REMARKS:
--
r`
•
DO HEREBY CERTIFY THATTHIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15ANCAC2C, WELL •
ONSTRUCfION STANDARDS, AND THAT ACOPY DEW RECORD S BEEN PF,OVIDED TO THEW&L OWNER
SIGNATURE•OFPERSON CONSTRUCTING THE WELL . DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mall Service Center -Raleigh,'NC
l699-I636 none No. [phone], within 30 days. . GW-1 REV. 072001
C7

. - • . WELL CONSTRUCTION REC,tEIRD'
of Savironm®t and Natural Resources - Division of W ater Quality- G>otmdwater Section
Nosh Catolim-Departma!t �j�,� ��
WELL CONTRACTOR (IXDPt DUAtL) gat) cA in t 5 l y''+"'a'- d' : 11. 4y2� tl 3 gip
WELL Toter aero&COMPANY Nraer' At1r.c eJlAnd iI) 1!�YS-Il-u •*"e 4'rt;owrls (-
SrATE WELL CONSTRUCr10l(rLRNfr/_� - AsspcWrtn �ananas • -.
- ifappliable) • -
Ofggliable) •
I- WELL USE (Check ApplicabWBox):-Re tdeatial icipaVPubile ❑ Industrial 0 A_ gricataRal p
Monitoring 0 Recovery 0" heat Pump Water Injection ❑ Other 0If Other, List Use -
T gtapjgc/Laud selling -
Couoty c age OSlopo Ovillcy .OFlat
,¢a. 8'r3 L:aiituddtotu ofwell iocadon
•
Z.'WELL LOCATION:
I tL ,
erf Ara
Nearest Town:
£oLitL,
(Saar N.ma, Ntnabca Cotmmmity, Subiviooc, LotNo, T+p Coda) •
3- OWNER V O L lie N;
Andras l 2439 Gd f•1: U_ 2�
(So-eata wank)
FPD.NiL)3- Y.4' 02trit Lie
Tip Cods
(; 3409-78a'7 •
Area coda. rboas amber.,
4. DATE DRILLED 7 J i- O L'
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO.co---""e"
7. STATIC WATER LEVEL Below Top ofCaimg: 'X 0 FT:
(Us 'In if Above Top of f)
8- TOP OF CASING 1S _—FT. Above Land Surfaces
5. TOTAL DEPTH:_ , OS' •
•.
-Top or wing tmtetnated aver baker l atisarfaes midst a ,
Tartans t■ aaerdaw whlitsaNCLC 2c aug. j
9. YIELD (gptw): tJ n METHOD OF TEST i02//
10. WATER ZONES (depth) .-) , a 0 •
329381
, 1des emlmieuteJeeoboasl
Latitudeilongitdde source:OGPSOTopograph)c map
(etackboa)
pan LOG
From To " Formation Description
6s
' ebGY
_- ,ri S' 70' /•t/1/D StOL
70 ' 3iis' 7 ai t- % RA1V r
LOCATION SKETCH
11. DISINFECTION: Type Hf Amotmt TR- 4 Show direction anddistance in miler from at least
12- CASINO: - Wall Thickness two State Roads or County Roads. Include the road
nuts and -common road names.
Depth orWeighUPL
From fl • 0 To7 a h" S.zgen
From To Ft
From T9 FL
13. GROUT: Depth -tMethod .,
From_ To F?o1�
From To Ft
.4. SCREEN: Depth Diameter . Slot Siff - ' Naturist
From To PI --in. in.
From To Ft,_ja in.
5. SAND/GRAVEL PACK - _
Depth Size Material
From To Ft
From_ To Ft.
6. REMARKS:
DO HEREBY CERTIFY THATTHIS WELL WAS CONSTRUCTED 1N ACCORDANCE WITH 1SANCAC2C, WELL -
ONSTRUCTIONSTANDARDS, ANDTHATACOPY OFT RECORD SBEENPROVIDEDTOTHEWELLOWNER
7—J-2 '-0 L
SIGNATURE -OF PERSON CONSTRUCTING THE WELL . DATE -
Submit the original - to the Division of Water Quality, Groundwater Section, 1636 Mall Service Center -Raidgh, NC
fl699-1636 ?bone No. [phone], within 30 days. GW-1 REV. 07/2001

• .WELL CONSTRUCTION REC0RD
Noel, Cefolioa- Department of Eavironmeot and Natural Remmces - Divialon of Weser*Quality-- Oroimdwatcr Section
WELLCONTRACTOR(lNDIWin A14'NAHI (pi1U) ;he 11111 S fin fin.r„t. • - . 'CII(W therto 4!_otf err
Weer.corTRweroRCOMPANY=�]°,IW11S I�jk1 i II)Pal tf•113:e�'�•►r ,rsot $ t .52Y-3 a-6 D
STATE WELL CONSTRUC ION trmattrn ASSOCL►Tt1D W
reswucable) • - 4ifappflable) • -
1. WELL USE ((a�ect /lpplicebk'Boxx Reitdwtial�Mmticipzupublic _ Industrial 0 Agricultural 0
Monitoring 0 Recovery 0' Heat Pump Water Wootton 0 Other 0If Other, List Use •
. .
2. -WELL LOCATION:. .. _ ToporigifrAsmd Setting •
"Nearest Town: kl- 47 ' Canty ORidge/.Id57ope milky .OFlat
a j1 5�; L y ,t?& - ST € . (aaekappmwwcboo) .
MSumName, N miKo.Cammty,Sat�ri000,/.allo.,LpCme) Latitade/longitude of well totedon
3. OWNER: FA, 4A'k• vybe- t44 L
Address RDK R-9 - -
FRantdl "`N ) - 8-7 if t4
CirybcTora Stara - TpCode
�
6- Sol- bQ-3SL .
- Ana cede- none maw - •-
4. DATE DRILLED 7—/ D b • . - -
5. TOTAL DEPTH: 9f c' • .
6. DOES WELL REPLACE EXISTING WELL? YES O NQ:W- ' -
7. STATIC WATER LEYEL Below Top ofCaung: ./ /0 FT:
Sheer trainee Top dcair
8. TOP OF CASING 1S 1 FT. Above Land Surface'
'Top of easing tamroatd athrWm! itadavrka ngatria a . wham la Ia aemra..9 whilSATCGIe 2C .4111.
9. YIELD(gpm): to ,0 DOFTEST j)/07/./ .. ,,
10. WATER ZONES (depth):0 (/ .
, (d-a-mionea/ae000th)
Latitudellongittide wntcc0OPS0Topog aphic map
• (ebeeabto
DRILLING LOG
From To ' Formation Description
U 4 l t e- c tea"- r f .
4c ' 7 ft'
LOCATION SKETCH
11. DISINFECTION: Type 1tfi!: Amowd .3 TA-R S Sbow direction and distance in mike from at lease
0
12. CASING: Wan Thickness two State Roads or County Roads. Include the road
Front__To
From Tp
13. GROUT:. . :
From_A Too AD Ft. C
From to 7t
4. SCREEN: Depth Diameter . Slot Size - : Material
From To Ft. in in.
From To Ftin in.
1 SAND/GRAVELPACK:
Depth Size Material
From To Ft
From To Ft.
6. REMARKS: -
DO HEREBY CERTIFY THATTHIS WELL WAS CONS[RUCreD IN ACCORDANCE WITH 15pNCAC2C, WELL -
ONSTRUCTIONSTANDARDS, ANDTHHyA,TAAC-OPYOFT RECORD BBFNPROVIDEDTOTHBWBfLOWNER
- 11 I .f� -1 %• /D D (p
SIGNATi1REUFPERSONCONSTRUCTING THE WELL . • DATE
submit the original to the Division of Water Quality, Groundwater Section, 1636 Mall Service Center -Raleigh, -NC
n699-1636 ?bone No. (919) 733,3221, within 30 days. . - GW-1 REY. 072001

. • WELL CONSTRUCTION RE —CORD • .
of Eavifoomeot and Natural Resources - Division of Watsr Quality'- Oroimdvmter Section
NorthCa>'olina-Departmrnt __ .... -
tipii5 . • �� al t� y-3
.__e: {1w11n-_,l(1)hlt��fll-uw._ymt.ei.laonlic`)•
WELL COMYRACTOR comma-
srwttWELLCOMTRUCrlOtlPMRMTS ASaOCt&TID tram -. '
Ufappliiable) . •(ifsppllable) _ ..
1. WELL USE (Check Applicable Box):-Residenti eltMlimicipaVPubI1c D Industrial 0 Agricultural E3
Monitoring 0 Recovery 0-. Hat Pump Water Injection ❑ Other a If Otfier, List Use
2. WELL LOCATION:
'Nearest Town: f1( nL/LL % A/- (*.runty„iA_co,- '
(, If U) U P 'f-h e CYI'44C 12 a—.4 f'n
(Sum Name. Numba<r, Cmwenky,sebdh14c.. Lot Ho. reP fie)
3.OWNER:
i t2k /So(o2nfSv»
(sheat�+efaamax* 3e�.1
Tunnel/
Address , 3(e 1r1 . (nf, n p a fl- `9 oaG
GryorToon Stets i * rap Code
612- 4437-?y/3
Ana code. Phone somber ., `
4. DATE DRILLED �! 0 —0 6 - -
5- TOTAL DEPTH: c2 75'•
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO<Wr�
7. STATIC WATER LEVEL Below Top of Casing:, D Fr:
(the IfAba° rep of Cunt) .
8. TOP OF CASING IS ___�_ F r. Above Land Surface'
wisp °fcasts' taWuadaU°[e-mail] mined a .: wham la la aemrdaw ad1YLSATfCLC 3C A11L Jj
9- YIELD (gym): 0,0 METHOD OF TEST t %DIUP _ .
10. WATER ZONES (depth): LOCATION TON SKETCH
11. DISINFECTION,Type i-f-/-P: Anmm t . T/j-63 5 Show direction and.diatanoe in miles from at Iasi
12. CASING: - Wall Thickness two State Roads or County Roads. Include the mad
• Depth or WAR.numbers and common road names.
Rom 0 . To�_ fL�_ 5-bR:,$4 t-es .`r'
From Tilt_ Et
From Tp
13. GROUT_ Depth Matensl Method -
From�—To eV) Ft. CQ.f?t4 T • pay ..C.
From To R
.4. SCREEN: Depth Diameter . Slot Size - ° Malaria"l
From To N. in. in.
From To Fl._jn. to
S. SAND/GRAVELPACK: - - -.
Depth Size Material
From To Ft
From To Ft
6. REMARKS
DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WILT( ISANCAC 2C, WELL •
UNSIRUCfIONSTANDARDS, AND THAT ACOPY OFT RECO 3SBEENPROVIDE TO TEEWELL OWNER
glapbiPJand setting
dge 0Slopo *Malley °Flat
Catitnde/longitude ofvigil location
, (depeohnienneuscoands)
Latitude/ongitdde source:OGPSOTopographic map
• (cb ktaa)
P�H DRILLING LOG
From
To - Formation Description
_- o' 0175' I1 C%l /✓2 r
SIGNATURE -OF PERSON CONSTRUCTING THE WELL . • DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mall Service Center - Raleigh, 'NC
2'f 699-1636 Phone No. [phone], within 30 days. GW-I REV. 07/2001
329359
3.60
/cam

• . WELL CONSTRUCTION RECORD • - : 320358
h;.: r.+.t(i6
Nosh Cdolina - Department of Hnyircmneot and Natural Resources - DivWon of W Quality-- Otoimdwator Section
WELLCOrrrRACTOR(nwn u- wtE -(*A1cts� �tp t:q tbe tin I5 An l As `• "'' ci @OCwrrorl. -Ot 74 -
wEta. CONTRACTOR COMPANTNAMIC•la°.JhrC IIei .l IAN11ltfJ1To. yrce,'Psortr(i`alt‹ Sao-3 e,0
STATE WELL CONSTRUCTION PZRM*l'a .. ASSOClATID versiatro r .•
firaopliabte) -Ilfappliable) ' •
I. WELL USE (Check ApPGaute Boxy-RalaeRtiwwamic;paVPnblk D Industrial D Agricultursl.1]
Monitoring O Roomy D Hat Pomp Water Injection ❑ Other tf If other, List Use -
2. WELL LOCATION: - - T bird setting - "
-Ne
arest Town P //C l i �' Camtty / Y CDri� " dge OS1opa Malley . OFIat
��-i Al LU LEr,4 U co--V-j s 7- A- .V (Tay (a6adcap;,aloi ionz)
mime Nme,``Namera.Coaa xy, sobiviske, tottk�.Mzv Cs) - Latitaxkllongitude ofwdt location "
3. OWNER: D R • IJ {'VVP S Iv ,(/ a l i'sripE ( )
Address 6S S• GJ • V ; 5 cc...) 6-1 e n n . Latitude/longitaide sonnx:DOPSDTopogmaphic map
i (Saeatoraauettoa - -' - (cbaetboz)
%— a•kc C i. " t =1. • 3 ,1 D S rD DRILLING LOG
GyurTan Sane ` rapCole - . . From To - , Fomnlion Description
(3810)- 755 — / ?DC) - - om O - Ce7 C 'L
�
A�Phew aa� ry.- _- (o 2', /DO • s i , g
4- DATE DRILLED 7-5 -D & • /00' 70S' L LU-e CLn i te-
5. TOTAL DEPTH: 7 OS
6. DOES WELL REPLACE EXISTING WELL? YES DW-
7. STATIC WATER. LEVEL Below Top of Caging.i00 FT:
(User iWAboeeTop orcadrs)
8. TOP OF CASING IS / FT. Above Land Surface*
'top of eanag fumigated War beam leattawface ogee a
varlaam L amrdaaae tleISANCACSC .a11a. `•
9. YIELD (wit): 01 M[CfEOD OF TESL /1`Ulfi»c
10. WATER ZONES (depth) .3 00 ' (/
LOCATION SKETCH
IL DISINFECTION.Type ittit- Amount 4IAA S Show direction and distance InMika from atleast
12. CASING: - Well Thickness two Stato Roads or County Roads: Include the road
Depth or WdghVFt. M�a *11 __ numbers andcommonroad names.
From O . To OD a axe�•.: -
From To FL - c
From Tq FL_—.—
13. GROUT: Depth T Maknal Method- _
From_(Z To_ Et. Ct smart f)CW✓ ry
From To Fte
<_ - - - o
c-,
.4. SCREEN: Depth Diameter - Slot Size : • Material -
From To Ft_jn, in.
From To Ft. in. in.
5_ SAND/GRAVELPACK i '_.
Depth Size Material
From To Ft.
From To FL
6- REMARKS: -
DO HEREBY CERTIFY WELL WAS CONSTRUCTED IN ACCORDANCE wrni IsjtNCAC2C, WELL •
ONSTRUCT1ONSTANDARDS, ANDTHATACOPY OF TT RECORD HAS BEEN PROVIDEDTOTHE.WEiLOWNER
SIGNATURE -OF PERSONCO RUCT,NGTEB WELL: - DATE -
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mall Service Center -Ratelgb, NC
17699-1636 Phone No. [phone], within 30 days. - OW-1 REV. 07/2001

• . WELL CONSTRUCTION RE
North Caiolina - Department of Pmhonment and Natural Resources Division of
WEL.corrrRAccomgranXwtutW (pt:gcbaimi5 ,
329357
CORD" :
Quaktr Oroamdwator Section
/In;.:.t. `'` r"eryttPlctaoilr 4e -
,'rsoruV i i% S� y-3 �•b 0
weu.convent:rotcoosermrnAM1C . r.0 ickfi ipA Iite-Oloesit
STATE WELL OONsTRucnnott meths AssocpyTID
(if applicable) • . •('dappliable) • .
1. WELL USE (Check ApplicablBBoz):.Reaidential7Y Mtnieipal/PubP ID • Industrial 0 Agricultural 0
Monitoring O Recovery O- Heat Pump Water Injection O Other 0If tidier, List Use . ..
2. WELL LOCATION:. $I8pjllltll 611d g .
Nast Town �jP.9r��GL 9� Camty / r �G�� d e OSlope Malley OFlat
C'1 AEtcs CI-LA-peL Comet, r10311
let
Moen Name. co Nnmbm. mm®•y, %Walsm, ns, ?+p Code) - - LAti (ohadtappe.Webot
tatte/loagitode Orwell location
3. OWNER `1 'e/'1 . Oa t Q. a --
Address &O 55 1e-Ale
"• ci- CL. tart
hJ ;A/C� a e7 t
(Fan- 369. /bQii )
� � •.K •-
PhmeatmLa
(depemlmiooeatM
Latitude longitude source:OOPSOTopographic map
DRILLING LOG
01ybav r7aSeam .'" rtp Cook- . From
Mn code -code-
4. DATE DRILLED '/_. 6 n 6 7e5 •
5. TOTAL DEPTH Soo •
6. DOES WELL REPLACE IDGSTING WELL? YES 0 NO_ .clef
7. STATIC WATER. LEVEL Below Top ofcnsing: .:7 0 "Fit
(thee ifAbove Top of Cohn)
8. TOP OF CASING 1S / FT. Above Land Surface*
'rap of mina tamlaatad atlor Let!* gataar6a rpa4v a
nrlua a a aadaeawYY15ARCAC2C MIS.
9. YIELD (gpin): `f- . METHOD OF TEST t lD//Jrx -,
10. WATER ZONES (depth): /ReD
(1. DISINFECTION.Type Amotmt -.2rli-S
12. CASING: - - Warlhieknonl
Depth D1a tr - or wdghNPL Waist . .
From 0 . To�O Ft._,�6fe
i1 � sit'
From To FL
From Tp FL
T.
13. GROUT.: Depth Mataiii
From i) To . Ft l�nta7'
From_ To 'Ft,
.4. SCREEN: Depth Diameter . Slot Size Material
From To Ft _jo in.
From To FG in. in.
5. SAND/GRAVEL PACK
5.
Size Material - -
From To FL
From To FL
To F;;. don Dacdption
;lo
Sao•
LOCATION SKCH ET
5 Show direction and dialance in mites from at least
two State Roads or County Roads. include the road
"-numbers andcommonroad names.
e/:
Motombiood
6. REMARKS:
DO HEREBY CERTIFY THATTHIS WEIL WAS CONSTRUCM IN ACCORDANCE M N ISANCAC 2C, VimL •
ONSTRUCTION STANDARDS, AND THAT A COPY OF TT RECORD HAS BEEN PROVIDED TO THE -WELL OWNER
011 &At / 7—=6-6 Ca
SIGNATUREOFPERSON CONSTRUCI1NGTIM WEIL - DAYS -
Submit the original to the Division of Water Quality, Groundwater Section,1636 Mall Service Center -Relelgh,-NC
►2%699-1636 Phone No. [phone], within 30 days. . GW-1 REV. 07/2001

•r
• .WELL• CONSTRUCTION RE.CORD" :
QuaIhr ti+mandwater section
le e:cs<isirtrataotts l! .
Department
Nora Catotioa- Depart of Enritoameot and Natural Resources - Mallon of ,
WELL COIrrRACroRWW►KWUAIJlM ti (PLO rdn1 S
WELL corrrRKTORCOMPANY
STATE WELL. CONSTRUCTION motto - assoa(ATaD
fafapplinble) " -frs &able)
329350
rsoia tall'-$C •3Sa• 4-3 3-b 0
•
1. WELL USE (check ApplieabWBo4-Raidcntiall tciwi ipal/Public 0 odic;
0 AgtiwralltuEl
Monitoring ❑ Recovery 0- Hat Pump Watbr brjation ❑ Other I7 If Ot>ta, List Use ' . .
2. `WELL LOCATION:
"Nearest Town: O - Can / v ty' A (./11ti� dy S
9 `t l -5 to e.e t a. R I e ',t gr76 3 (dma awvtwp boa) : Ohtat
(street N.me. Numbers. Cammack:. eebdmtm, lot No..* Code) Iatitu jellot gitode OWE location •
3. OWNER -D A/ - i C i{ . -
Address" 4O CO.
`{2td3c C7+
D WI) ( -r- -1'7 3
czar
Gtye3fotTovaa-Jam '- odc" 7
Am coda Moo a amber
4. DATE DRILLED �- 3 - 6" o
5. TOTAL DEPTH; .SD' •
6. DOES WELL REPLACE EXISTING WELL? YESO No...tra-erir
7. STATIC WATER LEVEL Below Top of Calm' e 0 D Ff:
(User if AboveTop ofCabt8)
8. TOP OF CASING 1S / FT. Above Land Surface'
'rap ofmist armkWda'ar bola Warm tpai'e.•
variant h mordant* Alt /
9. YIELD(gppt): / S METHOD OF TEST 6fflh/li .Q
10. WATER ZONES (depth):330' 6
1 I. DISINFECTION: Type Amount a ni-S 5
12. CASING: - Wall 'Thickness
Depth DDirapeaa
Fmm_0To D sbgen
From To FC
From Tp
13. GROUT: Depth Matanl From A To M-et-hop.t'd l.
From TooFt. L.II-�
.4. SCREEN: Depth Diameter - Slot rut - Materiel
From To Ft it in.
From To Ft. in. in.
S. SAND/GRAVEL PACK .
Depth Size Material
From To Ft.
From To FL
. Oteirmesiosioutmloccoods)
Latitudeflongittidc aowccOOPSOTopographic map
rjfi ' _ DRILLING LOG
Front To " FontionDescription
l) 41&' mt
Wo' 70 /S/9-A>D tt)NO
70 ' 3-.56' L !i e-
LOCATION SKETCH
Show direction and.diatenee In miles from at least
two State Roads or County Roads. Include the road
-numbers and -common road names.
6. REMARKS
DO HEREBY CERTIFYTEATTii)S WELL WAS CONSTRUCTED IN ACCORDANCE WITH ISA NCAC_2C, wmL •
ONSTRUCIIONSTANDARDS, ANOMIE ACOPY OF RECORD HAS BEENPROVIDEDTOTHLW&LOWNER
L c?
ti
SIGNATUREOFPERSON CONSTRUCTINGTHE WRU. - DATE -
Submit the original So the Division of Water Quality, Groundwater Section, 1636 Mall Service Center -Raleigh, NC
n699-1636 Phone No. [phone], within 30 days. - - GW-I REV. 072001

}f1
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and�Na(tural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) ` "`W.. Y' co• 1a�_1 ' \� CERTIFICATION # y� 3g
WELL CONTRACTOR COMPANY NAME 31 �'��- bQ-t PHONE 8 f�G'0)z7-9 is
STATE WELL CONSTRUCTION PERMIT, ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
I. WELL USE (Check Applicable Box): Residential t"Municipal/Public 0 Industrial ❑ Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other ❑ If Other, List Use
2. WELL LOCA aN:
To ••
(Street�TtNEumbers, Como
3. OWNER.c.
r�yQ City or
MP}_
Area code- Phone number
4. DATE DRILLED
5. TOTAL DEPTH: 4'W' /
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO es
7. STATIC WATER LEVEL Below Top of Casing: ` FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS FT. Above Land Surface*
'Top of wing terminated atfor below land surface requires a
variance in accord cewith ISA NCAC 2C .0118. a'
9. YIELD (gpm): METHOD 9F TEST
10. WATER ZONES (depth): 91 S
11. DISINFECTION: Type
12. CASING:
Depth
From 3 To
R Amount
Wall Thickness
piameter or Wunt t at 'al
Ft. (or/4 ` �Q.87�
From To Ft
From To Ft.
13. GROUT: Depdy, , Ma�e�+ Meth
From O To bb Ftes) t
From To Ft.
14. SCREEN: Depth Diameter
From To Ft. in.
From To Ft. in.
15. SAND/GRAVEL PACK
Depth Size Material
From To Ft.
From To Ft
Slot Size Material
in.
in.
Topographic/Land setting
❑Ridge ❑Slope OValley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From To FompgtionDscri on
SO g$' ��SSLLaa..nn
LOCATION SKETCH
Show direction and distance in miles from at le
two State Roads or County Roads. Include the
numbers and common road names.
ad
c_
l
0
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 TI jE WE OWNER
A 1-1)Q7Y0
SIGNATURE OF PERSON CONSTRUCTING THE WELL ' DA
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center -Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-1 REV. 07/2001
0(Q
0
0
tzt
0

1
3.owNER: (U;lI J eh1 bless
Address Ir9-9(o R vet VA_ rt /2.8
d flu- (S4W Cltomellraa ^ 9
to
tfc,2S'1- 3 / 4-.51o.e 40 -. . .•
• • WELL• CONSTRUCTION RE -CORD- - :
Narthcararma-DgotHarhomneo<and l�ec,el-R�eraanea-Dir�id�on Qw11tY--See�4o�n�•y
weLLODNTRACrou euto umutss (1�1�93��sQ�l� "�"+�"� •r ..••�tt t-•4° •
WELL. At ival (t 11�j1Ci�l;xn�.� i 1-it..52.44-3 V-b C
va
werewat nlittitm.
)
•
1. WELL USE (Cheep Ask Baxk-Raidsa"ial ablc D Industrial 0 Agtivmlbualp
Monitoring 0 Recovery 0' Beat ?mop Wage lrgedion 0 Other 0 If Oilier, Lutnse : -
2_"_WELL LOCATION: T sung -
NearestTowm D 11 U y /ii jir-n' �� j apey _Flat
4CI-I .s Cohn , 1 l f�G 3 t -
tSatnName. N_.Community, Sob/Mirka, Lot No. SpCode) r iwJ Ljt cfV&t Wagon
Gty-wTavn Sine - Tgacde
,(�
Latipddlcngiaide somce:DOPSOTopogtaphic map
11- DRILLING LOG
Front To - F Dumb tQn
(Y 1
Arm code- Moe amber -i'
4" DATE DRILLED - - 7� % -
5. TOTAL DEPTW
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO VA
7. STATIC WATER. LEVELBelow Top ofCasing -S :
(tlw'4^taboosTop auks)
8. TOP OF CASING IS / FT. Above Land Surliest*
Kap KeWa<uradaWLaltar Sin hat seamreaies
wino a.mwa a idt-Li NCACZCArta . =
9. YIELD (gpm) / Y.2 METHOD OFTEST LiJ/ Uex4¢.
o. WATER ZONES (depth): 7D (�/
•r
SunruRE•UF?wow cIINSIROCrean B WQL - DATE -
Submit the original to the Division of Witter Quality, Groundwater Section, 1636 Mall Service Center -Raleigh, NC
n699-1636 Phone No. [phone], within 30 days. - GW-I REV. 07/2001
• LOCATION SKSF'CF(
11. DISINFEC7ION,Type fen Amo®t ..2Th.R. S Show trrree6a►and-dista in miles from at (cast
12. CASING: - - Wan7lticinntss two State Roads a County Roads. Include the road
From fl • Depth . To � , Diameter 3 Ft orwaI6t9t -mmsbers and -co road names.
st - ate'' •
From To Ft
From
I3. GROUT: Depth Material. eomoaa
From A To_lFt Cantor pwt.t)
From To Pt.
I
_4. SCREEN_ Depth Olemeoer " Slot Mx : , Material
From To PL jn.
From To Ft`_,in. in.
5_ SAND/GRAVELPACK:
Depth Size Material
From To Ft
From To Ft
6. REMARKS
DO HEREBY cERTIFYTHATTHISWELL wM$ taTRDCIEDINACCORDANCE WI$ISANCAC2C,WELL "
ONSIRUCTKIIISTANDARDS, Ai DTHATACOPY
OF REC �s E»iP$OVIDEOTOTHILWE LOWNPR
-Ostia '�t. •
-a-Co
0
0

WELL• CONSTRUCTION RECORD'
Moab (alumna - Department of EavkoomeK and Nston1 Reron.--s - Mahlon of Quallt3"- Oisnindy.nder Section
-fie • e
(nmllQDrIA,L) °i°
Arnflts �.},�rla�d: " leA arTtOl;;_/L4 -
sraTE WELL CONE UCTiOtf PERMS_
WEu.CONTRACTOR
.���av-3 ab a
wa r.coterweroacoo/wrwa q fMjlne.4 (l 0ys' " itTwee s"ritosmt,
(ifappliaaita • •(Hippo a) • -
1. WELL USE (Cheek ApppabldEoutx-Resident al s ti aveueik Industrial 0 Agricolt uaW
Monitoring Ream" a- Beat Pump Watts Injection ❑ Other U IfOther, List Use
"z"WELL LOCATION: - .-
Nearest Town: fl A-) ItL I i-' - County 41 A cent
•
.7CA/ r2±101T r I-4lc1—Prk_e(f.
(swenwor P—'--.txem.tli,tli ,.A a..Letliw,zrrcam)
ea -
Address 1 S P-
POI L R, fy N-
�• (aa!atarttaaalfo3
GtrarTa.. " S ./ Z% code
dab- 3 24-36//
Area cods Mae Mabee
4. DATE DRILLED . it,3 —0 6 - • -
5. TOTAL n.5 ' .
T lititnd Setting •
G0 ov.Y .°Flat
(die*apntapdatebox) . .
i; tade ufv%u Ioeati0n
Latitudefiongitdde sourccOGPS0Topographienap
1t - ( DRILLING LOG
atioa DescriptionEros T3"7 , FotmC A`/
_- 5,7• (oos• „AL u-e CAR/?," y-L
6. DOES WELL REPLACE EXISTING WELL? YES 0 .14010
7. STATIC WATER. LEVEL Below Top ofCasing: S op- W.
(User Iran Tap afQ+S1
8. TOP OF CASING IS / FT. Above Land Suring*
wisp ofashes tnbasSSMI _ pdaariarunt a .: - -
variance la weeds*walt7SAl3CAC2C.AUL .
9. YIELD(gpmk / 0 METHOD OF TEST 6%OI/iist.Q-+
It WATER ZONES (dl* -SAC (1 - .
WCATlON SKETCH
11.DISINFECrION,Type iff/.•I Amount ..2TR•6l5Show & d ndlatto>cefiimlesfrom etleast
12. CASING: - Wail Thickness - two Sate Roads or Comity Rosm.lnelude the mad
_ Depth orwa�re(. M*J "-numbers and`o road names.
From fl -To S7 Ft h- WAS jag"' -
From To FL -•-
From Tp
13. GROUT: Depth Maaa6l M—ar-hod -
From_ To
From_ To Ft.
.4. SCREEN: Depth Diameter - Slot Vag : = Mathieu
From To Ft. in. in.
Front To Ft jn. in.
5_ SAND/GRAVELPACIQ
- Depth Sat Material
From To Et
From To FL
c
r
m
0
C6
6. REMARKS: -
DO HEREBY CERTIFY THATTHISWELL WAS OWWRUCEEDINACCORDANCE WITHis/NCAC2C,WELL•
ONSTRUCfl N1STANDARDS,ANDIRATACPTOF 3,111if RECORD HAS BE@_ IP*OVIDBDTOTHLWELLOWNPR
ou�.t, ,'.* .... 6 �a 3 d f
SI(STATURE•OFPERSONCONSTRUCTIGTEEWF11.. DATE -
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mall Service Center-Raldgh,'NC
ff699-1636 Phone Ne. (919) 7333221, within 30 days. - - GW-1 REV. 072001
0
rri

WELL CONSTRUCTION RECORD. ,
NortbCdoliva-DeptimentofEavhomeotand NatMdRemacw-Divides of Quality PSection
y ppjcorrrawronpaims @rn9 e l l' ems.' ICATI 4a—n le •
�eidelin ��.1� ��',.-. �.i�'room f�t`J-al- �Cty�33.6O
weu.CONTRACTORCaIn►ANYNA3IK,aa,a {. Y _� ; �. - - .
STATE WELL nivi T/_—s AiOQtw ewut'► "* - .
(8b!aroiRoss$s3 -1,--- - -
in D u r �- I)f ru ; t ssi. . v 4, ' c11 5L3 4'
atrerTen . sun .. '*- ` zip code -
0741- 768- 99v r
Area cede- Phone aamber -
4. DATE DRILLED G - a 6 - U lv
5. TOTAL DEPTH .3U5' ,
6. DOES WELL REPLACE EXISTING WELL? YES 0NQ.
7. STATIC WATER LEVEL &dam Top *Mating 62 0 FT:
(tWeirifAbwsTapof
8. TOP OF CASING IS FT. Above Land Surfaces
weep deaden Madadedatlarham Inettseeteneaneleisa > : -
miaaemaeardaeasadnrlSA7iCAC3C.Ma . //
9 YIELD (gpmk if M$PSOD OF TEST 6f01/icif.Q-.
10.WATER ZONES(depthx �6' ((��
I L DISINFECIION;Type H''f./: Amount a7-A-S S Show direction outdist x in miles from at least
12. CASING: - - WauThidmtas two State Roads or County Roads. Include the road
Depth - or Waidlpt. *I. MIL: and'omnmon road names. E
From fl . To� Ft, tn- � Q E Steel: -
a
From_To Ft._- c —_-
From Tp F1,�_ 1--
13. GROUT.: Depth Matead Method - t _, _.
From_ To ' patio - - - �' a
From_ To -Ft.r..,
_4. SCREEN_ Depth Diameter . SlotSuc - , Material co
From To lt,._in- in -
From To FL ice. in. -
5. SAND/GRAVEL PACK _ - '<
Depth Sin Material
From To Et.
From_ To FL
6. REMARKS,-
EMARKS .
DO HEREBY CERTIFY.
ERT THATHATTHIS WELL WAS CONsntucno IN ACCORDANCE WITH mire/cap. WBIL -
ONSIRUCIlONSTANDARDS( ANDTHATACOPY OF RECORD BEEN _PROVIDED TOTI�WELLOWNER
- la ' -- G.. a -D Co -
- SIGNATURE-0PERSON CONSTRUCTING TIMWELT; . - DATE -
•
.
1. WELL USE (Cheek ApillieablarBaotx-Resida liY1i lle❑ Indwidal0 Agricultural CI
Monitoring ❑ Recovery aHat Pump WaibrInjection ❑ Other C1 If Otter, List Use - - .
Z.-WELL LOCATION:. - tad matting -
Nearest Tome - County Ct>t. CISlope OKdley C]Riat
(Sin:an t.+ .at—. S. r ao.Loala.$rt:ede) 0 67�3 (eeeanyp S1Ina- .
•� }} � uft�l MCa4on
3.OWNEIL_ AJf�tAd--I�IID�� (dam
Address 963 Pax KN6A 12r Ladwddlongibideaoureed3GPSCTopognphiemap
' (eWcW
• DRILLING LOG
Formation Description
--.57' ' 70'•/rA ci Sdan e—
77' . 3o' L-u e- (..24-.v»-f
Submit the orient to the Division of Water Quality, Groundwater Section, 1636 Mall Service Center -Raidgb, NC
27699-1636 Phone Na. [phone], within 30 days. , GW-I REV. 07/2001

. - • .WELL CONSTRUCTION RECORD'
NonbC*.1rolina-DepartmudofEuNwad•sod jihad ctQualit ' Clioimdv.fiderSection o��P
O�ta.s r •
WELL�trraAcrortarmtxma* tv� I��d,�it:a.c"T`°� Can
—s ore a
muu.eormueronCOMEnNrluM '.p c i�(L� �� Il YS��{�_+ .�Ke 'rso►aa� .
STATE WELLcOnSTIWC1CflZgi[rli_„ AflO THD
(if 'portable) cifmolt:obit) • .
I. WELL USE (Clack A EmeN-Re ll lio C Industrial 0 Agricalauat•0
- ' Monitoring ( Recovery O Hatt Pomp Wolte Injection0 Other 0Ifother, List Use
2. "WELL LOCATION:. • g[srp�it d wiling -
"Nean�tTown - Cotms i t lms. Sauey .DRiat
1/474 /--S u LRR oL ,P7i (cbedupin detsbwi) ' -
(somettia t�ams.lr.sa.uotko4oeHareCoe . a gitt$deoftkdlkestion
last en..- cam)
Address . "/ b -5 /-{L) D f l{i /L »iA) Isthude e,0 labPS0t) Topographic map c
eithe
6 i*) - i t - s2.t7b b - DRILLING LOG
agerlc n sae Z% - .Fran Tx:Fotma Description
(�2ff) ,�9-/o i�" /2 ?ff
nee cede. Moth _ , 3 ASs •�.ir-//,2a�n%t'°_
4. DRILLED e � � l �7)1 n : _ . ,, . -
5. TOTAL DEPTH.._. Ste-'
6. DOES WELL REPLACE EXISTING WELLY YES 0 NO it - - -
7. STATIC WATER LEVEL Below Top of Cuing 3.0 FT:
(Mee NAST. Top dthan) _ _•
R_ TOP OF CASING IS ___�_ PT. Above Ind Steam*
weep ads,terWaedeetebekt(leatwrfiee re9 a - -
minesIn sere deaes$J
lSialCAC3C Ma . /�,�',,�
9_ YIELD( ii*_L_METHODOFT t_/7
10_WATER. ZONES (depdO c7 its i<O '
-
LOCATION SKETCH
11. DISINFECTION;Type /[<i-L : Amooat -2TA-S c Show fuentionant &tonal inmilat frOnl at 'tag
12. CASINO: - - WenTiidote= taw Sete Roads or County Roads.Include the mad
_ Depth i M�
a Wenumbers and -common road names.
From 0. TonFt. W! S /21
From To Ft-____.:
From Tp FL_„_
13. GROUT_ Depth Mataiil Method .
From___0_To...a_ QM.b+./ • fOj&C)
From To 7L _
A. SCREEN: Depth fk.—e- _ Marl e = • Niteroi
From To P1, ht. in.
From To Ft. in. in "
5_ SAND/GRAVELPACK:
Depth Size Material
3. OWNER P ; (IAA,
From To FL
From To Ft.
r
r
Ol
0
Cr.
6. REMARKS: - -
DO HEREBY t.tiail'THATTN13 WELL WA$ CONSTRUCTED IN ACCORDANCE WITH 15ANCAC2C, WELL •
DNSfRUCIKOISTANDARDS,ANDTHATA COPY OF RECORD EASBEEN PROVIDED TOTBLWE[LOWNER
SIGZinutsa PERSON CONSTRUCTING -OM WELL .
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Men Service Center-Raldgh,'NC
.2/699-1636 Phone No. [phone], within 30 days. - GW-I REV. 072001

Arn dodo- Mae Yambm
4. DATE DRILLED .5�-- 2L t, ro
5. TOTAL DEPTH: .rG S- •
6. DOES WEI L REPLACE EXISTING WELL? YES El N(1
7. STATIC WATER LEVEL Be1owTop of Cosby J D, T.
(User if Abae Top of Cubs)
8. TOP OF CASING IS / FT. Above Land Space*
-Top denim taradaatedodor bin ba .orf angakeaa . :
various la waIrlaffCLC2C .91*1 j
9. YIELD (gptp): a METHOD OF TES ./1/5Ii%j '+
10. WATER ZONES ( ) / CO li / X73' tf
LOCATION SKETCH
I I. DISINFECTION: Type />r'-/'ff- Arnow .2 TA -A $ Show dinctoa sod.diahnco In Sites from at least
12. CASING: - Wall 'Michas two Slate Roads or County my Roads. Include the road
• Depth •�.�aa orwegbupt. Malt co
mmon and road lames.
From el . To 9/ Et • S•?2R:�• aX. - `E e '
From To Ft.____...:
FromTp Fta_
13. GROUT: Depth Material . Method l.
From 0 To_ '_- FL eayy Bitayit./
From- To Ft. i
.4. SCREEN: Depth Diameter - Slot She - = Material •
From To FLU in.
From To FL in. in.. -
5- SAND/GRAVEL PACK:
Depth Size Material ..
From To FL -
From To FL
• .WELL• CONSTRUCTION RECORD"
' _;.c., it
Nonh Ceiolina - Department of Bavlrunmtat and Haul Resources - Divbion ofW Qwdity-- Groundwater Section
WElLcorTRAcroa ortot'mw►wrAMt tartan'
o r?t_rlflI5 kits jJn«.rl.•-a--
r cnlnrlcATaONl 2/7 le -
vim. CONTRACroRCOMPANY PHons f 1_•Z Li-3 V-b a
STATE WELL constant -not( nothn _ nto ESMTTI
tifapplieablc) •(fappticabte) - -
1. WELL USE (Check Appliwbicacr):-Residential7YMvipaI1Publc ❑ Industrial O Agricultural
• Monitoring 0 Recovery 0' Heat Pump Water Injection ❑ Other 17 If Other, List Use
2.-WELL LOCATION:
•N Town: rit, /,1 Lit County
CXD�y XA / Ed
(Sum Nome. NNor Comoro* Strbarilaar lat W. VIP Cade)
T clLend setting .
ORidge ope Malley °Flat
(chadtapptaalaboa) a
Slude/bngitudeOrwell location '
/y
3.OWNER: !//);/�C- 1-'e1)p 5 , ( )
Address • / 75'2. ff a//e tart f D R. . Latituddlongittide wmce:OGPS°Topographic map
Cl
/o tatteauraouettoJ -- -.-. - ' . (Scthax) -
IisLOr tR.:-C/. 337.1r6 '�- DRILLING LOG
Gryecrp�.t _it.
�t qt sore , - - Zpeade - . From To - Form Lion Description
r?a? �G o ems' e L 4 t
- SA.tt to N e-
a LOt -,€2ni
C—
G',
_r3
6. REMARKS: .
DO HEREBY CERTIFY MATTEIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC2C, WELL -
ONSTRUCTIONSTANDARDS, AND THAT
A.COPY C gsREOORD BBENPROVIDEDTOThWWELLOWNER
SIGNATURE/OPI PERSON O NSTAUC1INO THE WET, - - + DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mall Serviee Center - Raleigh, -NC
.11699-1636 Phone No. (919) 7333E11, within 30 dap. - GW-1 REV. 07/2001
0

- WELL CONSTRUCTION RECORD'
North Carolina - Department of Bavbtn meat and Nailed Resources - Division of Water Quaky"- Orointdwatar Soct*on
wau.corrrawcon prim omut)TiAMa(prnq<l3hn 1S lltjlo,AAJ - r. cM1ncAut N1 0t%7te
wwLLCONTRACTOaCOMPANY NAMCt .h11ri fklineel liMiIA Ima_]Twe ;puma 5a&I-3.-b 0
STATE WELL CONSTRUCTION PHRMIT! ASSOcEATm [Ratlf/ -
(((apprteable)-Gfapplicable) ' .
I. WELL USE (Cited[ Appl;wbleBox):-Raidaetialfl icipaVPubrtc 0 CI -Industrial Agricultural CI
Monitoring O Recovery ❑ Heat Pump Water Injection 0 Other l7 If tither, List Use
2. "WELL LOCATION:. AA -
Neatest Town: PititA eL 1 /✓ County / 1 t 4- t _
51-AD (P1+ CH,41QL r_e-Sat P-6 f &'93
(Sued Hasa Nwaben,Commmty,Sabdeidan,Lot fo,ZipCade)
3. OWNER �: 11 ..0 R PE L
Address go air Ai.EXRNTheR P (1n/
J
(Street.pr"SmcNt) t.etl C l. 3 4c 7 k
G eaten Sao ' Zip Code
(SGL)- 'PA 7- 7-.9.3 . .
Area code- Flme roman
4. DATE DRILLED 0o' o' — D -e-
5. TOTAL DEPTH, .46 6-
6. DOES WELL REPLACE EXISTINO WELL.? YES O NO
7. STATIC WATER LEVEL BelowTopofCasing: 0 Ft
(User iAbove Sap of Colic)
8. TOP OF CASING IS / FT. Above Land Surface'
riot, at eadng arodrn W attar beat Isdarefaa mays a -
vartueaccords witiv'LSAWCAC2C A11L
9. YIELD (gpm):t accordsyartt L METHOD OF TFS s
10. WATERZONES(depth) DO ' (l
ba_CIuetfend setting -
OSIMm OValley °Slat
y
(meek apprapataaetqx)
LBtitndtflongitede of well location
, (dearewim-motedaaonuda)
Latitude iongittide sourecOGPSOTapo(uaphic map
(meek has)
DEPTH ' DRILLING LOG
From
D
11. DISINFECTION: Type N Ili: Amount aT S 5
12. CASING: WallTbiclot s
Depth Dire orW.:ekUR. M.i-•',t.
From_ _To PL` _ _
From To 4'9 PL ti r - . T t - SY re/
From Tp Ft
13. GROUT: Depth ideterial Metbodl
From To Ft. esan. ay� real-A--1
From To FL
4. SCREEN: Depth Diameter . Slot Size - , Material
From To FL ja in.
From To FL ice. in.
-
5. SAND/GRAVEL PACK:
Depth Size Material
From To Ft -
From To Ft.
Formation Description
QLGG von; F-9-
•
LOCATION SKEFCR
Show direction anddistance in miles from at least
two State Roads or County Roads. Include the road
-numbers and`txnanon road names.
6. REMARKS: - -
DO HEREBY (RTIFY THATTHIS WELL WAS CONSTRUCTED IN ACCORDANCE WTTB ISANCAC 2C. WELL -
ONSTRUClIONSTANDARDS, AND THAT A COPY OF RECORD HAS BEEN PROVIDED ID THLWEIL OWNER
SIGNATURE-UFPERSON CONSTRUCTING THE WELL - DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mall Service Center -Raleigh, -NC
fl699-1636 Phone No. [phone], within 30 days. - - OW-1 REV. 072001

WELL CONSTRUCTION RECORD •
•
North Csr'o)ina - Department of Environmsnt and Natotd Resources - Division opiates Quality-- liteindwater Section
cr "
wet. corTa*croa (Omt\IDUAratlAMR fpa) ct ►)n i 5 /4n jhin rt.- - Cif(T1FMvtori 0t%lee
WELL CONTRACTOR COMPANY Scat Sa Y-3 Lb 0
STATE WELL CONSTRUCTION PERMIT/ _ TZO nMTt: -
Ofapplicable)-('d-applicable) • .
1. WELL USE (Check Appticab1e Box):-ResidadielzY ManitpaYPubfic 0 Industrial ❑ Agricultural O
Monitoring 0 Recovery 0- heat Popp Water Injection ❑ Other CT If Oilier, List Use - •
2-WELL LOCATION:
Nearest Town: f ti k i'141-; # County /i}ALe
111 :VI d.4 aApfll ¢e_jr11c Sogp fl73 y<
(Street Nene. Nordberg, Cammoaity, Subdriom, la No, Tap Cede)
3. OWNER: A?hl p/CI Cs` S FL.t[sla a c_
Address .3 Ss # 01 L- L-0o
(Street arRoacNo.) '
c�tiIi WC/- zP7.3-91
GqurTown State ' Tap Cade
5.3C- 34E 9- 094PIXISIC number
4- DATE DRILLED 5 4/ % O b
5. TOTAL DEPTH: '/lam
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO ;ltY
7. STATIC WATER LEVEL Below Top of Casing: 45 FT:
(Usa1riUnbarsTap .res )
/
R. TOP OF CASING IS FT. Above Land Surface*
-Top of casing terminated attar meow Ind.atraae ngtlreao
variant In seeerdanot adar'tS1HCACSC A11i. •
9. YIELD (gpm): _CMETHOD OF TEST AJIDI/ir7I.Q
10. WATER TONES (depth) /7e ' Q
gtapbieJLand setting -
tBRtdge OSlope 0Valley ClFlat
(vb appropriate box) .
Ca6tode/Iongitudeofwell location
, (dccterimim teshea i ds)
Laltudellongit ide source:00PSOTopographic trap
(Mach box)
DEPTfI _ DRILLING LOG
From To — FormatjonDescription
-- �`7' - 446o' 'Sib . �TA, .Qd4-? t.°
LOCATION SKETCH
11. DISINFECTION :Type ff'-/'/I: Amount c3 MLR S Show direction and.diatanco in mites from at last
12. CASING: Wall lbicute s two State Roads or County Roads. Include the road
Depth? ape ee or weipgt. Mulct numbers andtcommon road names.
From 0 . To . Ft, Dr:e- RJR:- -
From To
From Tp Ft.
13. GROUT: Depth Mates l
From�_to �� FL apMl
From To Ft
4. SCREEN: Depth Diameter - Slot Size . Material
From To Ft in. in.
From To Ft. in. in.
5_ SAND/GRAVEL PACK -
Depth Size Material -
From To Ft.
From To Ft.
Meth
pOW
6. REMARKS:
DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE Want ISANCAC2C, WELL -
ONSTRUCTION STANDARDS, AND THAT A COPY OF RECORD BEER PROVIDED TO THE -WELL OWNER
- to' 4,,5' / 9-0 a
SIGNATURE'OF PERSON CONSIRUc11No THE WELL . DATE
Submit the original to the Division of Water Quality, Groundwater Section,1636 Mall Service Center-RaleIgb,-NC
.21699-1636 Phone No. [phone], within 30 days. - GW-1 REV. 07/2001

' • WELL CONSTRUCTION RECORD -
North Cafolh a - Department of BarhoamWl and Natwal Resources - Ditties of wad Quality-Gnoendweter Seetion
WELL coerrawcrORw'wf1(TDu*yltANE(artaovbtfiflsS finllll.nrt, - ' a-r. CL#utCATtOIYl a LUV( .
WELL CONTRACrORCOMPANY 'ruopa siJ•it.S .4-3 2-19 0
SLATE WEIL CONSTRUCTION Pants Ttm ERh1c77
fir applicable) . _ «applicable) . .
•
I. WELL USE (Check Appbeable liox):-Residadialt nucipeUPuble ❑ Industrial 0 Agricultural 0
Monitoring ❑ Recovery 0" Heat Pump Water Injection ❑ Other 17 1f Oilier, List Usc ' . ..
q -9 n
c,.mu0i
Z.-WELL LOCATION: - TwoP1j turd setting
Nearest TOME lC(. hJcounty ORidge Malley .MFIat
i -97/ _ l?J•P v..ei 1-r13 (etnaappap"eb94 .
(Street Naas Neaten. coal, sebRrldoa, to Ha Zip Cade) • Latitode/langitude awn location
3. OWNER: c T c-a-. La%i _ b e IT-, ( )
Address 40 eco Yee/ % e Q rJ S'h 0 r e-s. & ueLatitudellosigiuide somccCIOPSMTopographic map
tsaeatar aametia) Wawa).
/n yj1 ei / • 344 a 3 . e u - DRILLING LOG
ckyerTaan sure _� � - Z Cone From To " Fmirma ionDescdption
4- DATE axle -Arta Moue number LLED % -'D �O "i . • ---� - (-) ' S� ' - S'/3.L 1'.7'71 iv
S. TOTAL DEPTH: 3 Ps' v • �/kS t I,Q G KQ r J
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO ;W- -
7. STATIC WATER LEVEL Below Top ofCosing: O FT:
ghee DtAbove Top efQasmJ
8. TOP OF CASING IS / FT. Above Land Surface* '
'Tap of colas taminYdaWr betewfpdprtaarooms a .
miens to aeatdases tISA1(CAC SC 311t
9. YIELD (gm): / S METHOD OFTEST_Maii,t4-. IC. WATER WATERZONES (depth): aAO' J 027oD' (l
LOCATION SKETCH
11. DISINFECTION:Typc WWI- Amomu ....211143 5 Show direction and distance hi milcs from at least
12. CASING: - Wan Midas' two State Roads or County Roads. Include the road
Depth Dip a oar Wd�6VFt. M p1 numbers and- road names.
From_t�To r1 Ft. h' ant 12.Ytvs. -
From . To Ft -
From TO____ FL_^,_
13. GROUT: . _
From__ Tom Ft. ppyt,(,. o
From To Ft._ I "
.4. SCREEN: Depth Diameter . Slot Size : < Material 0
From To FL —in. in —
From4 To Ft..._ia m CA r,:_
S. SAND/GRAVEL PACK: o
Depth Size :yi7 From To FL .. L , - Q' —
-
From_ To FL _
-
-G
6. REMARKS:
DO HEREBY CERTIFY WELL WAS CONSTRUCTED IN ACCORDANCE WITH I5ANCAC2C, WELL •
INSTRUCTION STANDARDS,ANDTHAT ACOPY OF TM RECORD lithS BEENPROVIDEDTOTHE-WEILOWNER.
' I ' ... E�-.2‘ c SIGNATURE-0 PERSON PIRSON Cotantucma um WELL DATE -
submit the original to the Division of Water Quality, Groundwater Section, 1636 Mao Service Center - Raleigh; NC
.n699-1636 Phone No. (919) 733-i221, within 30 days. . GW-I REV. 07/200!

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR(INDIVIDUAL)NAM*E _(prtut) cgh-gf)P)IS Irf'r)I IVA. rk. •r• CP.RTIPICATION Y rst/Ile
WELL CONTRACTOR COMPANY NAMS"I.t'.l)il($ PA Priori LIMO f.4 -' 'h PJ PRONE/ IC,Sa. 1-/-3 ab 6
STATE WELL CONSTRUCTION PERMIT/ -_________ASSOCIATED WUPPERMITil •
(if applicable) lie applicable) .
1. WELL USE (Check Applicable Box):'Resident(ial' unicipal/Public ❑ Industrial 0 Agricultural 0
Monitoring ❑ Recovery ❑' Heat Pump Water Injection 0 Other 17 If other, List Use •
2. WELL LOCATION: /Yt�q
Nearest Town: / AA/4LLI 4/County 4c.mt '
`I�(tS _ I4.tCWD2y i?»voti 2ri.y&73y
(Street Name, Numbers, Community, Su 'vision, Lot No., Zip Code)
3.OWNER: Cf}R..L /Q,SDPER
Address I a5 i C 1 FF (tics e lfApei- /24
1Q � or ,t
oute No.)
f tA/c> 87 3'+}
City or Town State - Zip Code
gAc0- S a q-- to f L 1
Arta code- Phone number
4. DATE DRILLED o2--• aL 7-0
5. TOTAL DEPTH: if 0 S'
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO.W��
7. STATIC WATER LEVEL Below Top of Casing: 'Ft FT.
(Use "t" if Above Top of Cuing)
8. TOP OF CASING IS / FT. Above Land Surface'
*Top of cuing terminated at/or belgw loadsurface requires a
variance br accordance wltb ISA NCAC 2C MIS. /
9. YIELD (gprn): /.'.1 . METHOD OF TEST /kiUr
10. WATER ZONES (depth): / 3S j / e ' 3 h6 " U
11. DISINFECTION: Type
12. CASING:
Depth
From 0 - To /ol9
From To Ft.
From T9 Ft._
13. GROUT: Depth Material Method
From_( To rY Ft. co.,,., d �7a,tAJ
From To Ft. fI
4. SCREEN: Depth Diameter . Slot Size • • Material
From To Ft. in. in.
From To Ft. in. in.
5. SAND/GRAVEL PACK: -
Depth Size Material
From To Ft.
From To Ft.
pographio/Land setting
Ridge ❑Slope ❑Valley ❑Flat
(check appropriate lox) 4
Latitude/longitude of wall location
•
, (degrees/minutes/seconds)
Latitude/longittide source:❑GPS❑Topographic map
(check box)
DEPTH f)RILI.ING LOG
From Tp S Formation Description
(D
- (p s' i a9' dnR�
144' 4fo5• 6Lue- I
LOCATION SKETCH
Amount a rR-a 5 Show direction and distance in miles from at least
Well Thickness two State Roads or County Roads. Include the road
Di ter or Wcjght/Ft. Mate)' 1 'numbers and common road names.
i Ft. " s a R ev y Q ((::'
1 -Q--
RECEIVED
Asheville Regional Office
- Aquifer Protection
6. REMARKS:
DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH ISA NCAC 2C, WELL
ONSTRUCTION STANDARDS, AND THAT A COPY OF TH S RECORD H BEEN PROVIDED TO THE WELL OWNER
ae
SIGNATURE OF PERSON CONSTRUCTING THE WELL . DATE
submit the original to the Division of Water Quality, Groundwater Section, 1636 Mall Service Center -Raleigh, NC
.31699-1636 Phone No. [phone], within 30 days. GW-I REV. 07/2001

WELL CONSTRUCTION REC
North Carolina - Department of Environment and Natural Resources - Division of
WELL. CONTRACTOR (INDIVIDUAL) NAME (mint) /4-6 •
WELL CONTRACTOR COMPANY NAM
STATE WELL CONSTRUCTION PERM
BMA. Ai
PERMIT.
ORD ator Quality- Groundwater Section -
}�� c h t•71
czI`TfPICATION s oZ /7 le
r 1 �?fynr C Pt J�pear� Wei -\v'cJ l�—u 7�w e ' PRONs a�$�, Sz Y-3 3-6 0
ASSOCIATED W ERMIT# •
(ifapplicable) (if applicable) • .
1. WELL USE (Check Applicable Box): Residential' municipal/Public 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other C7 If Other, List Use
2. `WELL LOCATION:
'd
setting
County T�tpegrapblc/Land
y
Nearest Town: -� �L` ge ❑Slope ❑Valley ❑Flat
(St ,/N mben, Community, Subdivision, tat No.. Zip Code) Latitude/longitude of well location
Z.
3. OWNER: Z %/P? &)7f'Ge p /a r s t L. L' C , (degreeilmh utes/ eeonds) •
Address O.-RD) R Latitude/longitude source:OOPS❑Topographic map
(check box)
Lf(+l IOTAUGA c0pi/39
reel Name u
Dnf (Street or Route No.)
QAa & - 3 0
53
City or Town State Zip Code
(R1zo- 34-0_oante) .
Area code- Phone number
4. DATE DRILLED coi.- a % D CD
5. TOTAL DEPTH: O/l L75'
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO
7. STATIC WATER LEVEL Below Top of Casing: �s'D FT.
/ (User if Above Top of Cuing)
8. TOP OF CASING IS / FT. Above Land Surface*
*Top of cuing terminated at/or belgw land. aurfaee requires a
variance In accordance with ISA NCAC 2C .0111.
9. YIELD (gpm): 4'•O METHOD OFTESTI //Phin
10. WATER ZONES (depth): /OS) / 555 / Qb' (/
•
J,OCATION SKETCI-(
11. DISINFECTION: Type /t -/'fp: Amount 3 TA-p 5 Show direction and distance in miles from at (cast
12. CASING: Wall Thiess two State Roads or County Roads. Include the road
Depth Diapicter or Weight/it. Matey' I ''numbers and common road names.
From 0 . To Rb Ft. F, "` 512R:,$ 7 01"
(check appropriate box) - 4
DEPTH DRILLING LOG
From To - .Formation Description
. S ,t- AQ 5 '/"D h�
-F L. a e. (,- R R q/ s re__.
From To Ft.
From T9 Ft.
13. GROUT: Depth Material
From () To r�� Ft. Co-n 47
From To Ft.
4. SCREEN: Depth Diameter . Slot Size - , Material
From To Ft. in. in.
From To Ft. in. in.
5. SAND/GRAVEL PACK:
Depth Size
From To Ft.
From To Ft.
6. REMARKS:
(� Method
f
- Material
RECEIVED
Asheville Regional Office
Aquifer Protection
DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH I5A NCAC 2C, WELL •
ONSTRUCTION STANDARDS, AND THAT A COPY OF S RECORD H BEEN PROVIDED TO THE WELL OWNER
cvi—a
SIGNATURE -OF PERSON CONSTRUCTING THE WELL . DATE
submit the original to the Division of Water Quality, Groundwater Section, 1636 Mall Service Center- Raleigh, NC
s 7699-1636 Phone No. [phone], within 30 days. GW-I REV. 07/2001

North Carolina - Department of Environment and Natural Resources - Division of
WELL CONTRACTOR (INDIV•IDUAL) NAME (print) /415
WELL CONTRACTOR COMPANY NAM '(I'A 1 I)
STATE WELL CONSTRUCTION PERMITS ASSOCIATED
WELL CONSTRUCTION RECORD
Water Quality- Groundwater Section
c .tn PII$ ijn,�r� s CV T1FICATeIO/NY 0LI74.
S' •trnrs ! Ohri i e(i ' .j i. yrs. J PHONE fitg ....5-2 LI-3 a%
Maim • is
(if applicable) - ' -Cif applicable) • .
I. WELL USE (Check Applicable Box): Resident'ial't---gnicipal/Public ❑ Industrial 0 Agricultural Q
Monitoring C Recovery 0 Heat Pump Water Injection 0 Other 0. If other, List Use
2. WELL LOCATION: /
Nearest Town: fie / /1/A L f /Y County /4 f- ton-)
941 N LUa tcIu g73
(Street Name, Numbers, Community, SubdiWsion, Lot No., Zip Code)
3. OWNER:
Address
•
n /gett
/3..5 Pan ant. a -I
(Street or Route Noj
F'rglut! PO 4T e- a Zr
City or Town state Zip Code
(flag)- 3eF I //
Area code- Phone number
4. DATE DRILLED o2 —02 Se —O %
5. TOTAL DEPTH: o SCV
TOponitftEd setting
°Ridge ope °Valley °Flat
(check appropriate box) a
Latitude/longitude of well location
, (dev,u/minuterheeonda)
Latitude/longitude source:DOPSOTopographic map
(check box)
DEPTH DRILLING LOG
From To - Formation Description
0 as Q ' P / /1
- 44' Q 3'
$ 3 ' a5.1)• jTr L Rg ,i is-9--
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO JZJ—"
7. STATIC WATER LEVEL Below Top of Casing: SO Fr.
(User ifAboveTop of Cuing)
8. TOP OF CASING IS / FT. Above Land Surface'
*Top of easing terminated at/or belgw laadsurface requires 1
variance in accordance with ISA NCAC 2C 'OHS.
9. YIELD (gpm): 1 S METHOD OF TEST 6l07U/7fl-,
10. WATER ZONES (depth): cJ 1') S r (�
11. DISINFECTION: Type
12. CASING:
Depth 3
From 0 . To
From To
From To
LOCATION SKETCH
H� it/: Amount a T Q-I 5 Show direction and distance in miles from at least
WaII Thickness two State Roads or County Roads. Include the road
Diayiter or WeitUFt. Matey' 1 'numbers and common road names.
FL h" 522R:,31, Pr Cilsa
Ft.
FL
13. GROUT: Depth Material
From 1) To aZi Ft. UQyy,,a,,'
From To FL
4. SCREEN: Depth Diameter .
From To Ft. in.
From To Ft. in.
5. SAND/GRAVEL PACK:
Depth Size Material
Meth
POI
Slot Size , Material
in.
in.
From To Ft.
From To Ft.
0
RECEIVED
Asheville Regional Office
_Acuifer Protection
6. REMARKS:
DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED 1N ACCORDANCE WITH 15A NCAC 2C, WELL •
ONSTRUCTION STANDARDS, AND THAT A COPY OF S RECORD HAS BEEN PROVIDED TO THE WELL OWNER
SIGNATURE OF PERSON CONSTRUCTING THE WELL . DATE
s ubmit the original to the Division of Water Quality, Groundwater Section, 1636 Mall Service Center -Raleigh, NC
a 7699-1636 Phone No. [phone], within 30 days. GW-I REV. 07/2001

• . . 1
• .WILLCONSTRUCTION RECORD'
. ,tt a -
North Carolina - Department of Salto:nmc tt and Natural Resources - Division ofWst� - Qroundwater Section
WELL cOPrrRACTOR(INDi1(IDUAL) E (prhg31:Lt)fla S Met JiA.a 1.t, '• `. cEf�TIR[�C.Aatri/N Pl4f
wen. coNTRAcrORcOMPANYNAM .t�lir.S f cI I'/QIII) s jf-it Tice J'PttONE *jet_. SG.t/-3 :Zb a
STATE WELL CONSTRUCTION PERMITS - /tSSOCZATED W ERMtn - ..
(ifappliable) (itappliabic) • .
•
1. WELL USE (Check Applicable -Box): Residential o M' .. icipavPublic n Industrial 0 Agriculture! O
Monitoring O Recovery OHeat Pump Water Injection O Other CJ if Oder, List Use
2. -WELL LOCATION:
NearestTown:n/411ILi V County,MAAn)
449/ s rene// rd.: a 8'f3 y/
(sera Nana:, Numbers, Community, Sabellian, Lot No., Zip Code)
3. OWNER: FIN *t r e esL2worm 6 .?-
Address 3 as if/Pi 1- o i
fRA.bku(s .i/tietb4 8r/3
Citybr Ton State Tip Code
3 4.9- 0'240 '
Area coda Plum *umber •t •�
4. DATE DRILLED lit -D
5. TOTAL DEPTH •4 a s-
dg i1and setting .
QRidga p1816 pe [71(aUey OFlat
(check wraps* boa) .
L11M114dlongitude of wrdl location
((eyaeahnisshe our.)
Latitude/Dongitdde source:OOPSOTopographic map
DEPTH ' DRILLING LOG
From To - Formation Description
c !9
.3s • '7�.?S• -Luc '&ARN: te..
6. DOES WELL REPLACE EXISTING WELL? YES O€cW—
�ND
7. STATIC WATER LEVEL Below Top of Cailn .
(userif Abort Top oft:Was)
as)
8. TOP OF CASING IS / FT. Above Land Surface*
*Top of Gulag Urinatted atlor baker awdaar4a requires a
mimeo la meordasee nth ISANCAC 2C AIIL if - '•
YIELD : /Z MSfHOD OF
10. WATER ZONES (depth): /1) .385
11. DISINFECTION.Type H--ni: Amomd c TfS 5
12. CASING:
From fl- . To .5.5
From To
From Tp Ft._,_
13. GROUT: Depth Mate& Method -
From� To j FL cgs , ar ()twits)
From To FL
4. SCREEN: Depth Diameter . Slot Size : r Material
From To FL —In. in.
From______ To r
5. SAND/GRAVEL PACK:
Depth
From To
From To
9• (gpIn) a TEST W1',
Waf Thl±icn
at S orWeljbtlPt. ^Miteethl
.FL .
Size Material -
FL
FL
• LOCATION SKETCH
Show direction and.dialance In miles from at least
two State.Roadb or County Roads. Include the road
-numbers and common road names.
6. REMARKS: W
DO HEREBY CERTIFY THAT THIS WELL WAS C ONSTRUCIFD IN ACCORDANCE WITH ISA NCAC 2C, WELL •
'INSTRUCTION STANDARDS, AND THAT ACOPY OF RECORD BEENPROVIDEI)TOTHE.WELLOWNER
2� F-6k
final
SIGNATUREUF PERSON CONSTRUCTING THE WELL DATE
•
submit the original to the Division of Water Quality, Groundwater Section,1636 Mall Service Center -Ralelgh, NC
.17699-1636 Phone No. [phone], within 30 days. . OW-1 REV. 072001

• • . 1'
•
•
• . WELL CONSTRUCTION RECORD"
North Cdolina - Deparanent of Environment and Natural Resources - Division of Water Quality'- Groundwater Section
WELL COMfRACTOR(INDINIDUM4NA aE� �(plot r�?GtivilS /J in;P A - - cr. i rCATION# 0t/7[P
nrn wELLcowcroaoommiati ailsraot)Or.0 119JI40ti V)?Ala1tuj-.ut 17new moms s111.1(. Sees/--3 2•6 0
STATE WELL CONSTRUCTION PERMITS - astroc&yin W YPMrr
(it applicable)
• -(ifaopiicabk1 - .
•
1. WELL USE (Check Applcablti Box): Residcnth1W MuNcipaUPub(ic 0 Industrial O Agricultural Q
Monitoring 0 Recovery ❑- Heat Pump Water Injection 0 Other CJ If Other, List Use • •
2. WELL. LOCATION: "
Nearest Town: Pk AAna- ;A/ - Cormty /V1 Aear-, • .
L40u1Sa.C1tspnR.1- Pes sAle• a873y
(Street Nana. Numben, Came nity, Sebdiriuoa. LotN.. Zip Cods)
3. OWNER s ✓ i *
Address ' / Z A• Rd • `
pRiNitiacamit;" Romcno.)
im FT
City 'or Tam State . ' Tap Coda
(Sail" 42./- Al53 .
4. DATE DRILLED 4 —/ 7 -O Co ; Phone number -, , '
5. TOTAL DEPTH ASS' '
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO•_W-
7. STATIC WATER. LEVEL Below Top of Casing: _jT.
(User if Aborts Top of Caring)
g. TOP OF CASING IS / FT. Above Land Surface'
'Top of easingtermiaated atlor Sew leadweraanguie a "
mimeo to aeeerdaaes wiq-1SAT(CAC2C A11i.
9. YIELD (gpw): _�,a_ MEIHOD OF TEST
mimeo
hthates
10. WATER ZONES (depth): r+l QS • I%
• LOCATION SKETCH
11. DISINFECTION. Type tf-f/i- Amount aT1h-135 Show direction anddislancc Itt miles from at tcast
12. CASING: - Wall Thidnteee Iwo State. Roads or County Roads. Include the road
Depth D a a Weii1wiFt numbers and -common road names.
From L . To_.r� Ft. kr" S.jbR:,B'l' n . -
From To FL______:
From. Tp EL
13. GROUT: DepthMateriel. Method
From_Q_._ To e*D FL CO47t0,7 pa i—
From To FL
.4. SCREEN: Depth Diameter . Slot Size : = Materiel
From To FL. --ill: in. � • C13.
Front__To Ft,__ja in
5. SAND/GRAVEL PACK: - _ -
Depth Size Material
From To Ft
From To FL /
6. REMARKS: i
DO HEREBY CERTIFY THAT THIS WEIL WAS CONSTRUCTED IN ACCORDANCE WITH ISANCAC.2Q WELL •
ONS7RUCfIONSTANDARDS, AND THAT ACOPYOFT REW�BEENPROVIDEDTOTHE-WELL OWNER
' -17 -a (p •
- T(togcapbit:/Ltind setting -
ge OSlope OValley at
Latl0Fl
(dmdtayproprhtebau0 - a
httle)oagitude of location
(tg eetimbathieanda)
Latiti�de/longitt(de smm:a:OGPSOTopographic map
• • (Sete boa)
DEPTH ' DRILLING LOG
Frond TA: • Fo on Description
_- r -. ;ss• : BL-(IRG-AAA/i t.4:...
a1
SIGNATURE -OF PERSON CONSTRUCTING THE WELL , • DATE -
submit the original to the Division of Water Quality, Groundwater Section,1636 Mall Service Center -Raie(gii NC
fl699-I636 Phone No. [phone], within 30 days. . GW-I REV. 07/2001

• WELL CONSTRUCTION RECORD - :
North Cafolina - Department of Enrlrotttnat and Natural Resources - DichatM of. Quality-- Groundwater Section
M WELL CONTLTOR(1NDIVInuALI (pct.)cil_n Plr S itlf)iii/ es.rl.''• •'2. cglki1sICAT/ON1 a%7�P .
wELLcoraaACTOa COMPANY NAM -htirC !bowl (114111tyc.Ij;u.1_ rrwe art .Sa1-3 i , 0
STATE WELL CONSTRUCTION PERMITS - AeBOcfATED WIREES1111
(ifapplicsble) ••(IfapNlcablc) • .
•
1. WELL USE (Check Applicable Box):-Reaidcntiel7YMtmlcipaVPublc 0 Industrial 0 Agricultural{]
Monitoring 0 Recovery 0' Heat Pump Water Injection ❑ Other Ci If OO(er, List Use - •
•
2. "WELL LOCATION: 1bic/Land Setting -
'Nearest Town: f/D .bkt i A/ - County /VI AG 01' " dge OSI-opt: Ovalley . OFlat
/%G!/'f SPn,' s edrl,... £tn,) Bo Attefjiia_ ( rapproFfieteboz)
(Street NufC Nomben, Coen uty, Subtrtiloo t, Lot No.. ZIP Cade) Ica pa y L tlttnje/IOrt$itode of well Location
•
3. OWNER: GO Rd/1/ Sl Alb A/'
Address ) 32 4-6CO PRAGE Re+
(SueatetRomeHoa
FRkvkE-; : NG. stir 3r
GtyorTora State . ' • rqs Code
Oast. 3fo9- 34it5 .
Area rode. Phone number
4. DATE DRILLED 'SF' •--•I 3 - it) .6
5. TOTAL DEPTH.
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO
7. STATIC WATER LEVEL Below Top of Casing: /0 0 FT:
(User ifAbove Top of(edag)
8. TOP OF CASING IS / FT. Above Land Surface*
'Tap of cuing terminated atlor belawlend.sorts requires a . ;
MUMS ht aaarda eewith ISAC2C A111.
9. YIELD (gprn): S METHOD OFTESTJ/D)JJ/t f.
10. WATER ZONES (depth): Yo.S (//
11. DISINFECFION:.Type
12. CASING:
Frorn_22_Too CO
, (devoealmlWM+heoands)
Ladtudefongittide souranOOPSOTopographic trap
• (cMck box)
ntEni ' DRILLING LOG
From To Formation Description
1)? -6' e .L icy
_--36, • err,, • ,Faa.r
/vet• d/S6' l/Lae 6-amv;i4—
, -
LOCATION SKETCF(
th%/f: Amount fl7R•R 5 Show direction anddistencs In miles from at least
Wa11 ThIdmen two State Roads or County Roads. Include the road
errf�Well:�.huPt. ers numband common road names. a D h" a `S22
From To Ft -
From Tp F1�_
13. GROUT:•
From_ TTo �.7: Pt�,�Q¢ f)Qy(:
From To FL
.4. SCREEN: Depth Diameter . Slot Size - • Material
From To Ft.__in, in.
From To Ft`in, in,
5. SAND/GRAVEL PACK -
Depth Size Material
From To Ft.
From To Ft
6. REMARKS: -
DO HEREBY CERTIFY THATTHIS WEIL WAR CONSTRUCTED IN ACCORDANCE WITH I5 NCAC2C, WELL
ONSTRUCTIONSTANDARDS, AND THAT ACOPY OF7RE,,nC,ORD BEEN PROVIDED TOTHE.WELLOWNER
t ` je..—/ 3 -040
SIGNATURE -OP PERSON CONSTRUCTING THE WELL . . DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mal( Service Center-Raidgb,-NC
17699-1636 Phone No. [phone], within 30 days. . OW-1 REV. 07/2001

WELL CONSTRUCTION RECORD-
1 NorthCaiolina-Delta:wentofBnvh tandNetonlRemwea-DivWoaof 'tar Quality--OramdwaterSwoon
/
WELL corn-imam(n4DfltiDIML)TMMR(pvi. cb'tn tS /tjnihtAet, -� tcgrwicATION smote -
was CotvTRAcTOR.CoearAttrNeatc).tlrc ejInert HIM I11rsi(;u -rive 'ntaa scat 3aa-3 a•6 O
STATE WELL conflux-rumrawtiITI AanOC/AT!®W ERIal1Y t - -
((applicable) 'Ofapptiwb1e) -
I. WELL USE (Check Appliabk"eox):-Redde'N I12- eimdcipeYPubiie 0 • Industrial CI Agricultural Q
Monitoring ❑ Recovery a Hat Pomp Water Injection ❑ Other CT If Otter, List Use
Z "WELLL0CATI
Narest Town icy M/I" Cat. "
PA1t0.V nu1Ns •d8?3
(Strait Name. Nguema Cmuaaoby, Sub6ridoo, Lot No. Z Calory
Address ewEsk Re•
-
F/ct r.Vesamal�aG
gL;�r/ No2 873 tf
atrmrTow State e - Sp Coda
wn-*a/•3009
Am aide- Phem aeabe -.
4. DATE DRILLED =3 d 0- O 6)5. TOTAL DEPTH;�/i S'
3. 0
Ilkil tmd setting •
/Madge 0Slope Malley . t7Rlat
hasekappapthdabax) - - a
Letit41/bngitude anti loatioa
24621
(ltrotholoottalsocalds-
Latituddlongibide sounee:00PSOTopographic map
• (dockbac)
agn- DRILLING LOG
From T - _Formation Description
r C-
S• yr/ 2_
LAhc
6. DOES WELL REPLACE EXISTING WELL? YES O NOQ;>—`
7. STATIC WATER LEVEL Below Top of Casing 4-'-O FI'.
(therifAbove Top mrcusl
8. TOP OF CASINO IS / FT. Above Laud Sorbet'
'Tap crcasing teradutM attorbsin uaad.amrheoraware. a -: yttriumis seardameeVICISMICACIC 1L -
9. YIELD (gra): MIL METROD OF TEST_ 4JDI//,x.4-.
10. WATER ZONES (depth): DO (i
L95tiTIQUAKEICH
11. DISINFECTION:•Type Jt rR: Amount ..�Ti9-R S Shwa direction and-diatan s hi mike from el last
12. CASING: - Wan Thiamin' two State Roads or County Roads.Include the road
DryW a We rumbas and'tammron toed coma.
From O • To n/ ") Ft Sb flit,
From`_ To FL
From TV_ Ft -
13. GROUT:. Depth Matedil Method
From_ O-- Pc C pouvuil
From To Ft
4_ SCREEN: Depth Diameter - Slot Size : Material
From in.
From To Ft. in. in.
5. SAND/GRAVEL PACK:
Depth Size Material
From To Ft
From To Ft
6_ REMARKS:
DO HEREBY cER1WYTNAi7HIS WELL WAS OONSTRUCfBD IN ACCORDANCE WITH ISA NCAC 2C, WBIL -
DNSTRUCTION STANDARDS, AND THAT ACOPY OF TM RECORD HAS BEEN PROVIDES TO THE. ELL OWNER
- 'tea 1 a 3-3o -o (.
S10NATURB•OF PERSON CONSTRUCTING THE wE I. , - DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mall Saralee Center -Raleigh, -NC
27699-1636 Phone No. [phone], within 30 days. - - GW-1 REV. 072001
774.3.
On
s

2. WELL LOCATION:
Nearest Town: PR II A,I L L i n/ - County /1 A-
(1)uF•E//:5,4 1Cn,Lott/• ,_Alt aAr/
(Sam wax.. Nonben. . SubdvidY, Let Zip Code)
3. OWNER: 11 0 p rT Z ; j �/ P 372
Address // j/e'2i FA T2 4c-e
cs� ✓ aoxel�a
/UPw4'A 3°O c26 3
Griot Town Seta 9 Tap Code
(4?q- as/-337'7 -
Arm code Phut woba
4. DATE DRILLED 3 ^ a S —b
5. TOTAL DEPTH; 1ch5'•
• WELL CONSTRUCTION RECORD' ,
:::: �_,(,a,
Nat Carolina- Dcpcunpk ofBnvhomni*and Naha! Resources - DivWon of WaterQuality--(imtmdwaurrSection
WELL CONTRACI'ORpNDr(IDUAw sgauO:herl PttS An I i-ans,t• a-`.`-•1 '.8::Cilki1P1CAT1• it'aJ7te _
WELL CONTRACTOR clammy/ NAYar c 1<{e 11{ �toal ! ;e�,.-i-K-� `vuot s 1 _fa Y-3 gig 0
STATE WELL cotarrattcrson PXRM1IT 71SD
(lrappltesblc) • - • {ifa pliable) - .
I. WELL USE (Dock ApPNceble: Bca):-Raidmuiet7YMo aIPhlic O • Industrial O Agticultuutal{7
Monitoring 0 Recovery O (ieatt Pump Water Injection O Other a If Other, Lid Use ` • -
TopogTIPWLd setting
midge OSiopa °Valley -oFfat
/ 3 Lj t b
Cal t6wddbigitudc anion location
tom)
Latitudeltotgibide souree:OOPSDTopographic map
•(Om* boa)
Miti - DRILLING LOG
From To - Formation Description
' o 6 a L t� ./2 4Av / t -9-
6. DOES WELL REPLACE EXISTING WELL? YES D NQ_ ta-ee
7. STATIC WATER LEVEL Below Tap ofQainir -.3 O FT:
(User ifAhenTopattain)
8. TOP OP CASINO IS _— FT. Above Land Surfaces
'Top or easing tnotoatsd attar Mtn 4ad.aarIa ngalrm■
variantla auxdeaapr15ATICAC2C Atlt
9 Tab(gpm} °1 MfI jOD OFTEST D%O)Ur'-4=.
10. WATER ZONES (depth):
LOCATION SKFCH
11. DISINFECTION. Type irk- Amount .,i TA- A S Show direction end distance itt miler from et least
12. CASING: - - wall Threat two Slate Roads or County Roads:Include the road
Depth Or%tiightlPt• M. 1'tombola and -common road notes.
From_�To Men LlXC' -
From To PL - From_ To
Tp 1t_,••_
13_ GROUT: Depth MWiil. Method.
Frotn_Q_a lit. Ocarn ar`r• fCY>
A - -
From To Tt.
.4_ SCREEN: Depth Diameter : Slat Sae : = Materiel .
From To Ft,_in, in. r
From To_______t n. ht.
5. SAND/GRAVEL PACK: -
Dept Size Material 1
From To FL
From To R +,> .
6_ REMARKS:
DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE Wuhl ISANCACZC, WBIL -
ONSTRUCIIONSTANDARDS, AND THAT ACOPY OFT RECORDH SBEENPIROVIDEDTOTHEWad.OWNER
3-a�•-o
�(v
SIGNATURE -OP . DATE
dal.
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mall Service Center -Raleigh, -NC
:7699-1636 Phone No. (919) T33a221, within 30 days. - GW-1 REV. 07/1001
-D
crt
0

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and
QQN�atu11r--al__Rl:iiesour*�cflfles - Division of Water Quality - Groundwater Section r
WELL CONTRACTOR (INDIVIDUAL) NAME (prIntjfllt VAC YI'l�Ll lute -
WELL CERTIFICATION
?#jL/:;ThL1
WELL CONTRACTOR COMPANY NAME ay hPE I C'Lktret/ herat�:it'iv TY`\C... PHONE # (�.r2X 4-C74/L7
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential X Municipal/Public ❑ Industrial ❑ Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water ktfection ❑ Other 0 If Other, List Use
2. WELL LOCATI
Nearest. Town tO.-r N1. A County C't�SYI
L'ffIf ) o c c N\`�v1 Lf, .—
ScatNum Subdiviai Lot No.
Code)
Name, ban. /unity. oo, No., Tap
3.OWNER:TOA (i,hSf>91
Address GA1 Rivelf\ *rrt C`Q
& s_ nc (S Ao meNo.) 1
City or Turin „c 9State $atI- tip Code
04W-SC Z15
Area code- Phone number
4. DATE DRILLED �_ )O -0->
5. TOTAL DEPTH: 6,, f? C) /
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO (�
7. STATIC WATER LEVEL Below Top of Casing: /h 0 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS FT. Above Land Surface'
`Top of casing terminated at/or below land surface requires a
variance In accordance with 1SA NCAC 2C .0118. }
9. YIELD (gpm): / METHOD OF TEST / / t ( (i-`4
10. WATER ZONES (depth): 3, (7
11. DISINFECTION: Type r It fn. •1 C Amount c, Ci..43
12. CASING: Wall Thickness
or wer r/Ft.
From To .39 Ft
From To Ft
From To Ft.
GROUT: Depth Material
Fromm To 3 Ft 'e o yfl��f
From c. To.2D Ft AN1.In,1 t it'd
14. SCREEN: Depth Diameter Slot Size
From To Ft in. in.
From To Ft. in. in.
15. SAND/GRAVEL PACK
Depth
To Ft.
From To Ft.
13.Method
Size Material
From To
=LS - ,3Q
_gip - 1y7 (c'OC'
Topo hic/Land setting
❑Ridge Slope ❑Valley ❑Flat
appropriate box)
Latitudes rude of well localip
N 5'OSI Ti >n)c283 /ti aza.a
(degrees/mimes/seconds)
Latitude/longitude source: tl S❑Topograpbic map
box)
DEPTH PULLING DRILLING LOG
Formation Description
5o t ,,�
illea �n� kNot 6-rovAk/
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the roll
numbers and common road names. j{�i
JUN 05 2006
16. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CO TIL CTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS 141DT A CO OF 1 S IjEcE)RD'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

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
>rea code- Phone number
t 4t ELL INFORMATION:
SITE WELL ID #(if applicable)
STATE WELL PERMIT#(if applicable)
,DWQ or OTHER PERMIT Of applicable)
WELL USE (Checkflplicable Box): Residential Water Supply
DATE DRILLED ,y ^
TIME COMPLETED T 3 �(' . AM ❑ Ptv_
WELL LOCATION:
CITY:I COUNTY ONYX _
(Street Name, Num
s, Community, SubdiNsion, Lot No., Parcel, Zip Code)
TOPOGRAPHIC /LAND SETTING:
,2 Slope °Valley ❑Flat ❑Ridge ❑Other
(check appropriate box)
erp LATITUDE p` L8 "--/yyQ�
LONGITUDE y,3 44 5.3iL
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)
May be in degrees,
minutes, seconds or
in a decimal format
WELL OWNER
OWNER'S NAME g e I ,
STREEeT ADDRESS Si ��0_ r/A V. it '
City or Town �Statt Zip Cdde�
( f38)- Sal- 1 83 g
Area code - Phone number.
5. WELL DETAILS: /
a. TOTAL DEPTH:
t2. 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 atlor below land surface may require
a variance in accordance with 15A NCAC 2C .0118.
m): e. YIELD (gp15 METHOD OF TEST Blow
f. DISINFECTION: Type H T H Amount 1 60Z
g. WATER ZONES (depth):
From Ld1 of To From To
From To sue'/ From To
From 01,5 `I' To From To
6. CASING: Thickness/
Depth Dia eter Weipryj M erial
From l7 To ) / Ft. 4'r a iiM)
From To Ft.
From To Ft.
7. GROUT: Depth Material
From 0 To 20 Fcement & benonite
From To Et.
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
11. REMARKS:
Formation Description
rl ay & sand
J"'T171
1
—
C h
1 D0 HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH
15A NCAC 2C, WELL CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS
RECOpaysAS BEEN PROVIDED TO THE WELL OWNER.
Q J �'G -5LV of
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., a' �d�oorm GW-ta
1617 Mail Service Center— Raleigh, NC 27699.1617 Phone No. [phone] ext 568. JUN 0 5 2QI .v. 7/05

RESIDENTIAL WELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources- Division of Water Quality
WELL CONTRACTOR CERTIFICATION d 2045
1. WELL CONTRACTOR:
James B. Brown
Nell 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
: WELL INFORMATION:
SITE WELL ID Cif applicable)
STATE WELL PERMIT#(il applicable)
OWQ or OTHER PERMIT Cif applicable)
WELL USE (Check
Ap9gIllcable Box): Residential Water Supply ❑
DATE DRILLED 0
TIME COMPLETED
3. WELL LOCATION:
C�Y
,"67 AM ❑ P
COUNTY 11 �"`^' —
( tr et Name, Numbers, Community, SubdiNalon, Lot No., Parcel, Zip Code)
TOPOGRAPHIC / LAND SETTING:
•Slope ❑Valley ❑Flat DRidge ❑Other
(check appropdate box)
LATITUDE 1j
LONGITUDE
Latitude/longitude source: ❑ GPS 0Topographic 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
May be in degrees,
minutes, seconds or
in a decimal format
Ity or Town S e
- 3u9—00107
Area code - Phone number
Zip Code
6. WELL DETAILS: 2�
a. TOTAL DEPTH: a.it.Jl.l
b. DOES WELL REPLACE EXISTING WELL? /Y�E/S NOO
e. WATER LEVEL Below Top of Casing: at/"' FT,
(Use "+" if Above Top of Casing)
d. TOP OF CASING IS 2 FT. Above Land Surface*
'Top of casing terminated atior below land surface may require
a variance in ardance with 15A NCAC 2C .0118,
e. YIELD (gpm): U METHOD OF TEST Blow
f. DISINFECTION: Type H T H Amount 1 60z
g. WATER ZONES (depth):
dd..GG ,
From To / 5,(0 From To
From 1 To ,27'3 Y From To
From To From To
6. CASING: {{ Thickness/
From O DToth 41a Ft. Diafeter Wghh rt ria]
From To Ft. (p fl `.w
From To Ft.
7. GROUT: Depth Material Method
From 0 To 20 Fcement & benoniterriped
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
gr nifP
-c
0'
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;:J:AS BEEN PROVIDED TOT1fE WELL OWNER.
NATURE OF CERTI IED 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.,
1 617 Mail Service Center — Raleigh, NC 27699-1617 Phone No. [phone] ext 568.
Form GW-la
Rev. 7/05
JUN 05.2005

RESIDENTIAL WELL CONSTRUCTION RECORD
North Carolina Department ofEnvvonment end 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 )- 169-9591
Area Code- Phone number
2. WELL INFORMATION: •
SITE WELL ID BR applicable)
STATE WELLPERMIT#(If applicable)
DWQ or OTHER PERMIT Cif applicable)
WELL USE (Check Applicable/ Box), Residential Water Supply
DATE DRILLED eiq 'O9
10
TIME COMPLETED 5 - AM ❑ PM)(
3. WELL LOC TION::, n
CITYn la VD II.IC-U/ry . COUNTY ��/A (Inc)
fneili
(Street Name, Nurnberg, Community, Subdivision, Lot No., Parcel, Zlp Cods)
TOPOGRAPHIC I LAND SETTING:
❑Slope °Valley ❑Flat ❑Ridge °Other
(check appropriate box)
LATITUDE ..2a7'4 /v
LONGITUDE 83j/ 070
Latitude/longitude source: kPS °Topographic map
(location of well must be shown on a USGS topo map and
attached to this lawn N not using GPS)
4. WELL OWNER .- A_,�
OWNER'S NAME -v'i t.".KJ �vy/J)
STADDRESS _
�C�ity, �or Tavh . •
) State Zip Code
L oZ o)- 488 R533
Ares code • Phone number
6, WELL DETAILS:
a. TOTAL DEPTH: ,!
b. DOESWELL REPLACE EXISTING WELLT YES O Nt1O
c., WATER LEVEL Below Top of Casing: 360 FT.
(Use'+" If Above Top of Casing)
d. TOP OF CASINO li - 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
May be in degrees,
minutes, seconds or
in a decimal format
tvLi
0
1, DIBINFEGTION: Type H T H Amount
g. WATER ZONES (depth :
/ 1
From
From
From
9. CASING:
From
From
From
160z
To Jf1) From To
To .aa From To
To From To
�rryy Thickness/
DTot eti Ft. D1721er WeIgttl, tsrl(�
To Ft.
To Ft.
7. GROUT: Depth Material Method
From 0 TO 20 F(',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 FL In. • In.
9. SAND/GRAVEL PACK:
Depth
From To Ft.
From To Ft.
From To Ft.
Size Materiel.
10. DRILLING LOG
From To n Formation Description
() g ' rimy G canr3
Req ' -yU4 I Irani to '
11, REMARKS:
I D0 HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH
ISA NCAC 2C, WELL CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS
NEC A5 BEEN PROVIDED TO THE WELL OWNER.
NATURE OF C R FIED 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 27699.1817 Phone No. (919) 733.701E eat 888.'
JUN 05 2006
Form GW-ta
Rev. 7/05

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 )• 36Q-9591
Area code- Phone number
1. WELL INFORMATION:.
SITE WELL ID Cu appllcable)
STATE WELLPERMIT#(if applicable)
DWQ or OTHER PERMIT e(If applicable)
WELL USE (Check Ap Ilcable Box: Residential Water Super
DATE DRILLED
TIME COMPLETED r AM -PM ❑
3. WELL LOC ,TION:
CITY:
(Street Name, Numbers, Community, SubdliAalon, Lot No., Parcel, Zip Code)
TOPOGRAPHIC / LAND SETTING:
°Slope ❑Valley ❑Flat °Ridge °Other
COUNTY fila(DU
(check appropriate bo )
LATITUDE-{qy,15,)
vio
LONGITUDE 3.d 1i314.)
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 tom /fnot using CPS)
4. WELL OWNER
OWNER'S NAME
ST EET ADDRESS /(i/ dI
�tA�le iJL 0?8'73y'
ay or Torn • r State • Zlp Code
( 228' )' 5a4 -70 74
Area code Phone number
6. WELL DETAILS: _ ^ /
a, TOTAL DEPTH: 4 CX•J _
b. DOES WELL REPLACE EXISTING WELL? VEERS p NOX_
c.: WATER LEVEL Below Top. of Casing: c2lo0 FT.
(Use'+^ If Above Top of Ceeing)
d. TOP OP CASINO Is - 2 FT, Above Lend Surface'
'Top of casing terminated et/or below land surface may require
a valance In accordance with 15A NCAC 2C .0118.
e. YIELD (ppm): Of 0 METHOD OF TEST E1OW
RESIDENTIAL WELL CONSTRUCTION RECORD
North Carolina Department of Environment end Natural Resources -.Division of Water Quality
WELL CONTRACTOR CERTIFICATION # 2045
f. DISINFECTION: Type H T H Amount 160z
p. WATER ZONES (depth):
From To From To
From Jag I To v From To
From • To
Thickness/
Depth DleplettAr Weight MAtnI I
t. 77A�•.
CCDD
From To
6. CASING:
From To J-F�
From To t. /n0 ,.iov carp
From To Ft.
7. GROUT: Depth Material Method
From 0 To 20 FGement & 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,
e. 9AND/GRAVEL PACK:
Depth Size Materiel .
From To Ft.
From To Ft.
From To Ft.
10. DRILLING LOG
From To
11. REMARKS:
Formation Description
r'l ay A 4Anri
granite
a
s
100 HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH
ISA L�' C. WELL CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS
R-.H•1.1•E; AS BEEN PROVIDED TO THE WELL OWNER.
NATURE OF CER'T1 I€D WELL CONTRACTOR
S0:
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 666.
JUN 03 2011,3
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 4 ,36 7/
1. WELL CONTRACTOR:
` )nn! e l / ctA c
Well Contractor (Individual) Name
CRANE 8RQTKPS ;oil i izs,g , ^
Well Contractor Gompappgar, c,IVF CIRCLE
FRANKLIN, NC 28734
STREET ADDRESS
City or Town State
X9-7)-59v-((917k
Area code- Phone number
2. WELL INFORMATION:
Zip Code
SITE WELL ID #(ir applicable)
STATE WELL PERMIT#(if applicable)
DWQ or OTHER PERMIT#(if applicable)
WELL USE (Check Applicable Box): Residential Water Supply ❑
DATE DRILLED , 3'3/— 0 iv
TIME COMPLETED AM ❑ PM p
3. WELL LOC IIOON:
y A CITY: Ti ; J. /l/ COUNTYkneed
(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 IFY`
May be in degrees,
minutes, seconds or
in a decimal format
STREET ADDRESS
ohh b e Me C3y
City or Town State Zip Code
Area code - Phone number
5. WELL DETAILS: �,�r
a. TOTAL DEPTH: 3 t) ' Z)
b. DOES WELL REPLACE EXISTING WELL? YES ❑ NO 0
c. WATER LEVEL Below Top of Casing: /a0 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./1]
e. YIELD (gpm): 1�% METHOD OF TEST/7! /
3 2 6 S r ha
11
1. DISINFECTION: Type
g. WATER ZONES (depth):
From To From
From To From
From To From
Amount
6. CASING:
Depth Diaynett�r
From To (eV Ft. (e y!('
From To Ft.
From To Ft.
7. GROUT: Depth
Material
From � TcQ 0 Ft. e.Q/)14-ij7
To
To
To
Thickness/
Weight Material
From To
From To
8. SCREEN:
From
From
From
Depth
To
To
To
SAND/GRAVEL PACK:
Depth
From
Ft.
Ft.
Diameter Slot Size
Ft.
Ft.
Ft.
Method
in. in.
in. in.
in. in.
Size
To Ft.
From To Ft.
From_ To Ft.
10. DRILLING LOG
From To
11. REMARKS:
Material
Material
Formation Description
C
;+e.
N C L D
PrIS
t EC
ailon yl
T-
1 DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED N ACCORDANCE WITH
ISA NCAC 2C, WELL CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS
RECOHO HAS BEEN PROVIDED TO THE WELL OWNER.
A,ELL, 54a—o
SIGNATURE OF CERTIFIED WELL CONTRACTOR DATE
.✓lfi/t Cfit ric.
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 #_ 69y
1. WELL CONTRACTOR:
d £nnc
Well Contractor (Individual) Name
Well corkAtglEcanightet,Mal DRILLIFS, ira.
248 CRANE CIRCLE
STREET ADDRESCSRANKLIN NC 2R744
City or Town State
c/9 912
Zip Code
Area code- Phone number
2. WELL INFORMATION:
SITE WELL ID #(if applicable)
STATE WELL PERMIT#(ir applicable)
DWQ or OTHER PERMIT #(if applicable)
WELL USE (Check Applicable Box):/I Residential Water Supply p
DATE DRILLED 3-3c-t'7
TIME COMPLETED AM PMO
3. WELL LO TION:
CITY Aniic/ fly COUNTY ACJt�%
Po AA)
(Street Name, Numbers,CEommu 6Y: Subtlivision, Lot No., Parcel, Zip Code)
TOPOGRAPHIC / LAND SETTING:
['Slope ['Valley ❑Flat DRidge ❑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 6 not using GPS)
4. WELL OWNER
May be in degrees,
minutes, seconds or
in a decimal format
OWNER'S NAME
Rvbb; € i e
STREET ADDRESS
7 ki,lk)
City or Town
ti L 0_S(
State Zip Cale
Area code - Phone number
5. WELL DETAILS:
a. TOTAL DEPTH: s-d t7
b. DOES WELL REPLACE EXISTING WELL? YES [' NO ❑
c. WATER LEVEL Below Top of Casing: (lb 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): v METHOD OF TEST At, \
f. DISINFECTION: Type
g. WATER ZONES (depth):
From To From
Amount
From To From
From To From
6. CASING:
,hy Depth�U Ft. bDiamg r
From v To . �y
From To Ft.
From To Ft.
7. GROUT: Depth Material
From C) To -O Ft 01MAC-7
From To
From To
Ft.
FI.
326875
To
To
To
Thickness/
Weight Material
P1)`
Method
�,1[v rAlrf'
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
To Ft.
To Ft.
To Ft.
10. DRILL'NG LOG
From To
b - 5'
11. REMARKS:
Size
Material
Formation Description O
+i
▪ -<rn
J � j
rV v S'I
Cil06
n
r
I DO HEREBY CERTIFY THAT THIS W' '♦NA606N-TR�- �n���?;1T h1r.
15A NCAC 2C, WELL CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS
RECORD HAS BEEN PROVIDED TO THE WELL OWNER.
,/Le4/ l/zQr c 62 () 6
SIGNATURE OF CERTIFIED WELL CONTRACTOR DATE
-ter/ 01A-Ale-
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 # r % 23
1. DISINFECTION: Type Amount
g. WATER ZONES (depth):
1. WELL CONTRACTOR:
k CA -A /I/e -
Well Contractor (Individual) Name
Well ContrcitatioAKIWEL LUIt ,
248 CRANE CIRCLE
STREET ADDRESSFRANKLIN, NC 28734
City or Town State
T0-1()- � Y- V 976
Zip Code
Area code- Phone number
2. WELL INFORMATION:
SITE WELL ID #(it applicable)
STATE WELL PERMIT#(if applicable)
DWQ or OTHER PERMIT #(if applicable)
WELL USE (Check Applicable
Box): //Residential Water Supply ❑
DATE DRILLED J 27 4, 6
TIME COMPLETED AM ❑ PM ❑
3. WELL LOCATION: yy���r
CITY: FV�Yttlfr/ n/ COUNTY7meArt)
Py4
(Street Name, Number Communi32 Subdivia ion. 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 ifnot using GPS)
4. WELL OWNER I��
OWNER'S NAME �`J bbt`e 1/tLC t�{
✓.t.!l/
STREET ADDRESS
w Nc. ag),-3 y
City or Town State Zip Code
Area code - Phone number
May be in degrees,
minutes, seconds or
in a decimal format
5. WELL DETAILS: r�
a. TOTAL DEPTH: 7 °5
b. DOES WELL REPLACE EXISTING WELL? YES p NO p
c. WATER LEVEL Below Top of Casing: ) / 5 FT.
(Use "+' it 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): I r) METHOD OF TEST >A r r
3268
4
From To From To
Fran To From To
From To From To
6. CASING:77n g)
Fran �J DToth6 / Ft. D7nyer
From To Ft.
Fran. To Ft.
7. GROUT: Depth
Thickness/
Weight Material
G✓G
/J Material Method
From [% To, Ftf 1%LQ"
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.
9. SAND/GRAVEL PACK:
Depth Size
From To Ft.
From To Ft.
Material
Material
From To Ft.
10. DRILLING LOG
From To Formation Description
127- /o`y
11. REMARKS:
Cify
—R
v
ca
D
I DO HEREBY CERTIFY THAT THIS WELL WAD CONSIMUCIE6ANACCdRDA110E WITH
1SA NCAC 2 2, WELL CONSTRUCTION STANDARDS. AND THAT A COPY OF THIS
RECORD HAS BEEN PROVIDED TO THE WELL OWNER.
tit (%tl/ !i AR-0
SIG TUBE OF CERTIFIED WELL CONTRACTOR DATE
PRINTE C7C✓� H/1
PRINTS 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
i7T

RESIDENTIAL WELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources- Division of Water Quality
WELL CONTRACTOR CERTIFICATION # lam-) I
1. WELL CONTRACTOR:
1
mice_ CrMle
Well Contractor (Individual) Name
Well ContrFAror Corr f fWELL DRILLING, NC.
STREET ADDRESS 248 CRANE CIRCLE
FRANKLIN, NC 28734
City or Town State
( ValC)-5r2Y ' V 7
Zip Code
Area code- Phone number
2. WELL INFORMATION:
SITE WELL ID #(if applicable)
STATE WELL PERMIT#(d applicable)
DWQ or OTHER PERMIT #(if applicable)
WELL USE (Check Applicable Box): Residential Water Supply 0
DATE DRILLED 7 -=23—via
TIME COMPLETED AM ❑ PM ❑
3. WELL LOCATION:
CITY: Fit AA,/k/._a COUNTY%Yt1CJ11.)
k6isit 036— Haw)
(Street Name, Numbers, Community, Subdivision, Lot No., Parcel, Zip Code)
TOPOGRAPHIC / LAND SETTING:
❑Slope 0Valley [Mat ❑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 n �t
OWNER'S NAME fL D,I2 e fh ea y
STREET ADDRESS
FiirPYJki,Ai
May be in degrees,
minutes, seconds or
in a decimal format
N C_
City or Town State
Area code - Phone number
5. WELL DETAILS:
a. TOTAL DEPTH: (, (a5
Zip Code
b. DOES WELL REPLACE EXISTING WELL? YES p NO 0
c. WATER LEVEL Below Top of Casing: /3 D FT.
(Use'+- if Above Top of Casing)
d. TOP OF CASING IS / 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): a. J METHOD OF TEST A: Y'
3 4 6
f. DISINFECTION: Type
g. WATER ZONES (depth):
From
From
From
6. CASING: �Jj`
From . U
To
To
To
From
From
From
Amount
Depth Di mpxl�r
To y Ft. /6 y
From To Ft.
From To Ft.
7. GROUT: Depth
From 6 Tc,Qj)
To
To
To
Thickness/
Weight Material
Material(
Ft. &Mea--L
From To Ft.
From To Ft.
Method
pit ltriky
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
v- 06s
ie
�''j
7i
',UN 6 2085 —
11. REMARKS:
11—'Ee fr—tom'
n H 7s :)'e He>.a r'e'.i I O l'_ .
o cc..-ro:
-..-;!
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED el ACCORDANCE WITH
15A NCAC 2C, WELL CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS
RECORD HAS BEEN PROVIDED TO THE WELL OWNER.
1f/ - 5 /a -'to
SIGNATURE OF CERTIFIED WELL CONTRACTOR DATE
T J1I1[P ('1fA"L—
PRINT D 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 CONB'CRUCTION RECORD
North Carolina Department of Environment and Natural Resources- Division of Water Quality h
WELL CONTRACTOR CERTIFICATION # �li / 3
1. WELL CONTRACTOR:
e life
Well Contractor (Individual) Name
C.r4/UJc &CI LIZ%' `.r)jiri/, A4 Svc,_
Well contractor comps" t# pWELLDRILLING,i C.
t ttANK. MOLE
STREET ADDRESS , kUM Ne103,4
City or Town State Zip Code
S/ 9710
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 ❑
t
DATE DRILLED / - /Op - Oip
TIME COMPLETED AM ❑ PM C
3. WELL LOCATION:' /�
CITY: �" f F /I1 kit. 4/ COUNTY Mile ci 1"
l �Aln�-f ('jtcek
(Street Name, Numbers, Community, Subdidslon, Lot No., Parcel, Zip Code)
TOPOGRAPHIC / LAND SETTING:
❑Slope [Valley ❑Flat DRidge ❑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
OWNER'S NAME
May be in degrees,
minutes, seconds or
in a decimal format
/IIVLL
STREET ADDRESS 22%i1// ,2
City or Town State Zip Code
Area code - Phone number
5. WELL DETAILS: rS _
a. TOTAL DEPTH: Y S
b. DOES WELL REPLACE EXISTING WELL? YES [ NO [
c. WATER LEVEL Below Top of Casing: / V FT,
(Use'+' if Above Top of Casing)
d. TOP OF CASING 1S / 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):3e-'Tl% METHOD OF TEST 4/ Y-
f. DIE.NFECTION: Type Amount
g. WATER ZONES (depth):
From To From To
From To From To
From To From To
6. CASING:
Thickness/
Depth {{��,y Diameter Weight Material
(G
From D To / Ft. & /y
From To Ft.
From_ To Ft.
7. GROUT: Depth Material
From 0 To Z.-i) Ft.(7.1Hz4/4
From To Ft.
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. SANCIGRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
From To Ft.
10. DRILLING LOG
From To Formation Description
JUN v G 2UJ6
11. REMARKS:
0
r
N D
o "-
(
I W HEREB r CERTIFY THAT THIS WELL WAS CONSTRUCTED N ACCORDANCE W Im
15A NCAC 2:., WELL CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS
RECORD HP S BEEN PROVIDED TO THE WELL OWNER.
SIG ATURE OF CERTIFIED WELL CONTRACTOR DATE
)c/� de.- •• •• ••
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
72

RESIDENTIAL WELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources- Division of Water Quality
WELL CONTRACTOR CERTIFICATION # St)/
1. WELL CONTRACTOR:
Pi 4Vje CrA-Af°
Well Contractor (Individual) Name
wen contQRAN6o-[4tItRf9yl gewELL DRILLING,
STREET ADDRESS 248 CRANE CIRCLE
FRANKLIN, NC 28734
City or Town State
Area code- Phone number
2. WELL INFORMATION:
SITE WELL ID #tif applicable)
STATE WELL PERMIT#(il applicable)
DWQ or OTHER PERMIT #(if applicable)
WELL USE (Check Applicable Box): Residential Water Supply ❑
DATE DRILLED 3- G.-0L.
TIME COMPLETED AM D PM ❑
3. WELL LOCATION:" k
CITY: trvek J r (li COUNTY/'MC 4 flee
Zip Code
iR ,vt I/keel i '— a lJ
(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 it not using GPS)
4. WELL OWNER
OWNER'S NAME
May be in degrees,
minutes, seconds or
in a decimal format
_J mni nit ✓iC hle
STREET ADDRESS /(OD,-,2 7 6-
:Vonv/VA), 6-,i, _?11)L 3-
City or Town State Zip Code
Area code - Phone number
5. WELL DETAILS:
a. TOTAL DEPTH:
rectr
b. DOES WELL REPLACE EXISTING WELL? YES ❑ NO ❑
c. WATER LEVEL Below Top of Casing: /S2.) 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,/ /%
3 l 6 Q 7 i
f. DISINFECTION: Type Amount
g. WATER ZONES (depth):
From To From
From To From
From To From
6. CASING:
/t Depth/ �-) Diamee�typr
From V To (,p / Ft. z JC...
From To Ft.
From To Ft.
To
To
To
Thickness/
Weight Material
7. GROUT: Depth Material Method
From 6 ! /1'41e41L /YS(i �;4
From_ To Ft. / `T7
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.
SANG/GRAVEL PACK:
Depth
From To
From To
From To
10. DRILLING LOG
From To
G7
JUN 0 6 2006
11. REMARKS:
Ft.
Ft.
Ft.
Size
Material
Formation Description
lea
O
rit
r1,J
—'-n
J rvf'7
r
—1
-E
ffflrc:
1 DO HEREBY CERTIFY THAT 111I5 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.
SIG ATURE OF CERTIFIED WELL CONTRACTOR DATE
i/1f, c
P TIED NAME OF PRS E ON
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-ta
Rev. 7/05

rl
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Divissipn of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) at 1CVOC I iI//14 3--�,/� CERTIFICATIONsATa �`7, di
WELL CONTRACTOR COMPANY NAME )0‘../tir1 —Veda khrn XrHONEv_ilrl'O7'/0
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMITS/
(if applicable) - (if applicable)
.,6812
1. WELL USE (Check Applicable Box): ResidentiaJ4 Municipal/Public ❑ Industrial 0 Agricultural ❑
Monitoring 0 Recovery 0 Heat Pump Water Injection ❑ Other ❑ If Other, List Use
2. WELL LOCATION:
Nearest Tojwn
5-fNATVl C+
(Street Name, Numbers, Community, Subdivision, Lot No., Tip Code)
3. OWNER:
Address - 134 ('(
(Street. Route No.)
County " ICen
0\A)- `�' * S\tJ\ tip Cade
Ansa code- Phone numlxs
4. DATE $ `/)-O C'
5. TOTAL DEPTH: 1—/(70
6. DOES WELL REPLACE EXISTING WELL? NO
7. STATIC WATER LEVEL Below Top of Casing:
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS 0,C FT. Above Land Surface*
'Top of casing terminated actor below land surface requires a
variance fa accordance 'nth ISA NCAC 2C .0118.
9. YIELD (gpm): / 7 METHOD OF TEST e
10. WATER ZONES (depth): %5� / a /i o �i 3 4,06
11. DISINFECTION: Type Amount
12. CASING:
Wall Thickness
Depth Diameter or Weight/Ft Material
From To 92 Ft 6 • t z co 1 QW d
From To Ft
From To Ft.
13. GROUT: Depth
From_ To , 3 Ft.
From 3 To a t7 Fi.
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.
Topographic/Land setting
❑Ridge lope Malley ❑Flat
(check appropriate box)
Latitude/longitude of well location
03S'°aS' 7.3" Uc/i3°o2'J 0./i
(degrees/minutes/seconds)
Latitude/longitude source• GPS❑Topographic map
( box)
DEPTH DRILLING LOG
From To FormatiDescription
QQ- 9'O $oi
Yf) - 4-Kr) l�cvd
LOCATION SKETCH
Show direction and distance in miles from at Least
two State Roads or County Roads. Include the roadr
numbers and common road names.
JUN
16. REMARKS:
I DO HEREBY CERTIFY THA
CONSTRUCTION STAND
DANCE WITH 15A NCAC 2C, WELL
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

326811
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural
atural Resourceesn- � Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) //j11 1 rlyke 1 1 Y \ 1ZlM1(# )' �pA CERTIFICATIONTI�SAAR 41.
WELL CONTRACTOR COMPANY NAME tee\ gate Irer,PA4- t\L PHONE 2C��f-�7e%D
STATE WELL CONSTRUCTION PERMTT# ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential Municipal/Public 0 Industrial 0 Agricultural ❑
Monitoring 0 Recovery 0 Heat Pump Water jection 0 Other ❑ If Other, List Use
2. WELL LOCATI9ON:
Nearest Town: I- ca..itiC l t v l County I Vl('p r 1F7�1
MtMOSck I _R \nk );1 G,Yt(+t\Nxis Sir
(Street Name, Number, Community, Subdivision, LctNo., Zip Code)
3. OWNER: pw crtJA1
v1 t'✓i
Address 0 ('r1>( `)
(Street or Rome No.)
City or T State
Area code- Phone number o
4. DATE DRILLED £'% y2 D' D t4
5 TOTAL DEPTH i� tP�<� /
Zip Code
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO
7. STATIC WATER LEVEL Below Top of Casing: e.)
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS I FT. Above Land Surface'
`Top of casing terminated stior below land surface requires a
variance In accordance with ISA NCAC 2C .0118.
9. YIELD (gpm): METHOD OF Tttv }
10. WATER ZONES (depth): /70 / )i'-li�+�
11. DISINFECTION: Type ' ' Amount }1 S
12. CASING: Wall Thickness
Depth Diameter or Wei t/FL terial
To I Ft �.1 � 5n2 rapt
T hic/Land setting
❑Ridge lope ❑Valley ❑Flat t�
\CO' 3,T, y- (check appropriate box)
lQ
0
Latitude/lon�,�e of well location sn 1
N 3S`oR'i.3.'f " wo 8.3 D2S' 35 14
(dmk�)
Latitude/longitude source. GPS❑Topographic map
O
DEPTH
From To
5- s H1
From I"� �n
From To Ft.
From To Ft.
13. GROUT: Depth, Material
From A
From SCRE Toy_ Ft. Rita
. To 9 C) Ft
Diameter Slot
14. Depth Size Material
From To FL in. in.
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
PRILLING LOG
F tion Description
r i vwYl E :ail (wan)
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road2
numbers and common road names.
J
0
0
Q
16. REMARKS:
1 DO HEREBY CERTIFY THAT THIS
CONSTRUCTION STAND
UCTED IN At ORDANCE WITH 15A NCAC 2C, WELL
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

RESIDENTIAL WELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources- Division of Water Quality
WELL CONTRACTOR CERTIFICAT ON #�f)/
f DISINFECTION: Type
1. WELL CONTRACTOR:
» C' (it-
Well Contractor (Individual) Narne
CRANE BROTHERS WELL DPIi LI
Well Contractor ConWPORANE CIRCLE
FRANKLIN, NC 28734
STREET ADDRESS
City or Town State
( d7.? )- Cc2V-Cf �l7 to
Zip Code
Area code- Phone number
2. WELL INFORMATION:
SITE WELL ID #(it applicable)
STATE WELL PERMIT#(if applicable)
DWQ or OTHER PERMIT #(if applicable)
WELL USE (Check Applicable Box): Residential Water Supply ❑
DATE DRILLED L/.J V- D (e
TIME COMPLETED AM ❑ PM❑
3. WELL LOC I,O,N: f i
CITY: br/i ry ki it) COUNTY mAU %U)
0P/:>a) l'rLc.k f\ i; ad.
(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 l���l
OWNER'S NAME. lit P f c1�i�'Sf\A.)
STREET ADDRESS f€Io O1f;0 (Iv, r4
n/uty Ak- a8��3V
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: 3oS
b. DOES WELL REPLACE EXISTING WELL? YES 0 NO 0
c. WATER LEVEL Below Top of Casing: d" ' 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): `� J METHOD OF TES.G; V. _ _
326880
g. WATER ZONES (depth):
From To From
From To From
From To From To
Amount
To
To
6. CASING: Thickness/
Depth Diamelt Weight Material
From To'(j Ft. G%y 7 /C.
From To Ft.
From To Ft.
7. GROUF: Depth Material
From, 6 Tor) Lj Ft. Ce#1J,±
From To Ft.
From To Ft.
Method
li
8. SCRE RN: 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
Leo
3
i,$
LOU
11. REMARKS:
yrthy
;
:-G
e ertir:;i a +
I D0 HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IR ACCORDANCE WITH
1SA NCAC 2C, WELL CONSTRUCTISIN SSANDARDLAND11NAT,A COPY OF
RECOR HAS BEEN PROVIDED TO THE WELL OWNER.
SIGNATURE OF CERT IED WELL 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.
ram GW4a
Rev. 7/05

RESIDENTIAL WELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources- Division of Water Quality
WELL CONTRACTOR CERTIFICATION # J7 7
1. WELL CONTRACTOR:
&a.. (1✓g *_-
Well Contractor (Individual) Name
Well Contractor omp m`e;,�'�„ 'CI. '
2 e�rcAIIL CERCLE
STREET ADDRESSFRANKLIN, NC 28734
City or Town�1// State Zip Code
()- SO 7 -�f 7b
Area code- Phone number
2. WELL INFORMATION:
SITE WELL ID #(if applicable)
STATE WELL PERMIT#tif applicable)
DWQ or OTHER PERMIT #(if applicable)
WELL USE (Check Applicable Box): Residential Water Supply (
DATE DRILLED J— l 9 — o La
TIME COMPLETED
3. WELL LOCATION: y.
CITY: YA ± /i)1 COUNTY 1 r�}'
m et) A)
AM ❑ FM❑
(T.>G5 P7 c Al 314,4
(Street Name, Numbers, Community. Subdivision. Lot No., Parcel, Zip Code)
TOPOGRAPHIC / LAND SETTING:
p Slope (Valley ID Flat ['Ridge ❑Other
(check appropriate box)
LATITUDE 3
LONGITUDE
Latitude/longitude source: ❑GPS ❑Topographic map
(location of wet must be shown on a USGS topo map and
attached to this form t not using GPS)
4. WELL OWNER n y, J
OWNER'S NAME V_l' t. -ii�I .C" S_/ -c.
STREET ADDRESS / 9 CL.12.,Lii! J11471/tA
IA9t/.Al ivC
May be in degrees,
minutes, seconds or
in a decimal format
City or Town State c- Zip C de y
( )-
Area code - Phone number
5. WELL DETAILS:
a. TOTAL DEPTH: 3U cJ
6. 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): rQ—t% METHOD OF TEST Jr/ if
a 6 U �
3879
eT�r
f. DISINFECTION: Type Amount
g. WATER ZONES (depth):
From To _ From To
From To From To
From To From To
6. CASING: Thickness/
From & DTolh V2 Ft. D e�ly 7Weigh) Material
From To Ft. 7 /��J—`
From To Ft.
7. GROUT:
�Depth Material Method
From (/}} To ) Ft. C,.t' 10 -/,y �
From To Ft.
From To Ft.
8. SCREEN: Depth
From To
From To
From To
Diameter Slot Size Material
Ft. in. in.
Ft. in. in.
Ft. In. in.
9. SAND/GRAVEL PACK:
Depth
From To
From
From
To
To
10. DRILLING LOG
From To
Ft.
Ft.
Ft.
Size Material
Formation Description
ra-
tr
't "T
m et€Tfi
art)
J rn-
-, cI"9
I DO HEREBY CERTIFY THAT THIS LL WAS Bblirt61CIEdN.ACCQRDffCE WITH
15A NCAC 2C. WELL CONSTRUC • • STANDARDS: ANFTTNAI.ACOP.Y.OF.THIS _
RECORD HAS BEEN PROVIDED TO THE WELL OWNER.-'
SIG ATURE OF CERTIFIED WELL CONTRACTOR DATE
ric?d CvvNittt
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 # _2c 7
1. WELL CO TRACTOR:
r cd (1-01-Nc
Well Contractor (Individual) Name
CRANE t Wf.,;p`" ,, I;'F? L DRILI IN1; 27:"
Well Contractor Comparppj aLpe,;.NE CIRCLE
FRANKLIN, NC 28734
STREET ADDRESS
!City or Town State
c x , 5DI-`/77c
Area code- Phone number
Zip Code
2. WELL INFORMATION:
SITE WELL ID #(i( applicable)
STATE WELL PERMIT/hit applicable)
DWQ or OTHER PERMIT #(if applicable)
WELL USE (Check Applicable Box): Residential Water Supply ❑
DATE DRILLED., ?—$ — 6 Co
TIME COMPLETED AM O PM O
3. WELL LOCATION: I 1/yt
CITY: rui/0//A 1 COUNTY MAbOAJ
)URr tv_ inhit
(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: DGPS ['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 »AC'e QArk.ty
STREET ADDRESS gad() 7 if R6j tri.
May be in degrees,
minutes, seconds or
in a decimal format
City or Town State Zip Code
( )-
Area code - Phone number
5. WELL DETAILS: �� 5/
a. TOTAL DEPTH:
b. DOES WELL REPLACE EXISTING WELL? YES 0 NO 0
c. WATER LEVEL Below Top of Casing' FT.
(Use "+' if Above Top of Casing)
d. TOT` 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. YIELO (gpm): 3O-f- METHOD OF TEST del/ r
aETC.iTh
! 0 G
f. DISINFECTION: Type Amount
g. WATER ZONES (depth):
From To From
Fran_. To From
From To From
6. CASING:
Depth //' Ft. (0 Dippm�evt r
1/
From
From To Ft.
From To Ft.
To
To
To
Thickness/
Weigh) Material
L/C—..,
7. GROL T: Depth Material
From --,, 0 Toc //�v Ft. /df'h¢s. /1
From To Ft.
From To Ft.
TLMethod 1
/ V
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
Size Material
Ft.
Ft.
From To Ft.
10. DRILLING LOG
From To
1Jo 2006
11. REMARKS:
Formation Description
i-/4r
Ly�i
o-
g-c
O
7—t
0
cr`
1C;
/ h UeIiewtalv!unl
I DO HEREBY CERTIFY THAT THIS WEL WAS CONSTRUCTED N ACCORDANCE war
15A NCAC 2C. WELL CONSTRUCTION STANDARDS, AND THAT COPY OF THIS
RECORD HAS BEEN PROVIDED TO THE WELL OWNER.
02—cam -O2-C%4
SIGNATURE OF CERTIFIED WELL CONTRACTOR DATE
/ r&e_
PRINTED NAME OF PERSON CONSTRUCTING THE 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-la
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:
Pre�l C r/rftt-c-
Well Contractor (Individual) Name
CRANE BROTHERS WELL DRILLING, aa,C.
Well Contractor ComPgalel®ItetNE CIRCLE
FRANKLIN, NC 28734
STREET ADDRESS
City or Town State
Area code- Phone num er
Zip Code
2. WELL INFORMATION:
SITE WELL ID #(if applicable)
STATE WELL PERMIT#(if applicable)
DWQ or OTHER PERMIT #(il applicable)
WELL USE (Check VW'
Box): Residential Water Supply
(
DATE DRILLED W' 0
TIME COMPLETED AM D PM ❑
3. WELL LOCATION: T'Y
CITY: OCAn1�'/,"N
COUNTY' 1 I la, D/V(
C.t/fU)t+' 1 I\ -a,
(Street Name, Numbers, Community, Subdivision, Lot No., Parcel, Zip Code)
TOPOGRAPHIC / LAND SETTING:
❑Slope °Valley ❑Rat ❑Ridge ❑Other
(check appropriate box)
LATITUDE 3
LONGITUDE
Latitude/longitude source: OGPS ❑Topographic map
(location of wet must be shown on a USGS topo map and
attached to this form t not using GPS)
4. WELL OWNER 11 �y
OWNER'S NAME c\l4NI�f1 �I7r i/Gy
STREET ADDRESS/2) M/jd%rf / j u,. iv
OrIi ,n C-A JR-CC
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: .11;
J
b. DOES WELL REPLACE EXISTING WELL? YES ° NO °
c. WATER LEVEL Below Top of Casing: 7 FT.
(Use "+' if Above Top of Casing)
d. TOP OF CASING IS / FT. Above Land Surface'
'Top of casing terming ed atior below land surface may require
a variance in accordance with 15A NCAC 2C .0118.
e. YIELD (gpm): a- / METHOD OF TEST ./1// r
a 67y
sl Cr 6877
f. DISINFECTION: Type Amount
g. WATER ZONES (depth):
From To From To
From To From To
From To From To
6. CASING: Thickness/
Depth> Diameett r Weight Material
From 6 To /,Ft. �A%� J
From To Ft, t/
From To Ft.
7. GROUT: Depth-'t Material
From C; TD /✓�- r) Fti64fr%//
From ToFt.
From To Ft.
Method
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 Formation Description
0- L2y Croy
//-25-5—
11. REMARKS:
¶The4/3I!L' RDCIICn: i (1`Fir n
ACLIEISr nrn,c-t'r°.,
1 DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED INACCDRDANCEWUUW "
15A NCAC 2C, WELL CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS
RECORD HAS BEEN PROVIDED TO THE WELL OWNER.
SIT7T> U OF CERTIFIED WELL CONTRACTOR DATE
v:ed C r 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 # 2261
1. WELL CONTRACTOR:
CHRISTOPHER L. DICKEY
Wet Contractor (IndMduap Name
CHEROKEE WELL DRILLING
Well Contractor Company Name
STREET ADDRESS PO BOX 1007
MURPHY
NC 28906
City or Town State Zip Code
( 828 )- 837-8008
Area code- Phone number
2. WELL INFORMATION:
SITE WELL ID *Cif applicable)
STATE WELL PERMIT#Iw applicable)
DWQ or OTHER PERMIT #(if applicable)
WELL USE (Check Applicable Box): Residential Water Supply L]
DATE DRILLED 05/12/06
TIME COMPLETED AM ❑ PM ❑
3. WELL LOCATION:
CITY: BRYSON CITY COUNTY MACON
SILVERMINE
(Street Name, Numbers, Community, Subdivision, Lot No, Parcel, Zip Code)
TOPOGRAPHIC / LAND SETTING:
Slope °Valley ❑Fbt °Ridge ❑Other
(check aPPropriate box)
LATITUDE 3
LONGITUDE
Latitude/longitude source: ❑GPS ❑Topographic map
(location of wel must be shown one USGS topo map end
attached to tilki room I not using GPS)
4. WELL OWNER
OWNER'S NAME DARLA KEMP
May be in degrees,
minutes, second. or
bra decimal format
STREET ADDRESS 4985 GUNNERS PASS
ROSWELL GA
30075
City or Town State Zip Code
( 404 509-6925
Area code - Phone number
6. WELL DETAILS:
a. TOTAL DEPTH: 40 O
b. DOES WELL REPLACE EXISTING WELL? YES 0 NO gi
c. WATER LEVEL Below Top of Casing: 75 FT.
(Use'+' W 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): METHOD OF TEST AIR
326759
1. DISINFECTION: Type CHLORINE Amount 100 PPM
g. WATER ZONES (depth):
From 280' To 285' From To
Rom MgTo 400' From To
From To Frorq To
6. CASINO:
From 0' Depth
Ft. 6N 7/8
From To Ft.
From To Ft.
Thickness/
y
S8K71tpoC
T. GROUT: Depth Material Method
From 0 To 20 Ft CEMENT GRAVITY
From To Ft
From To Ft
8. SCREEN: Depth Diameter Slot Size Material
From To Ft. In. in.
From To Ft. in. n.
From To Ft. In. n.
9. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
Frorn To Ft.
From To FL
10. DRILLING LOG
From To
0' TO 35'
Formation Description
RED & BROWN SLATE
35' TO 400' GRAY SLATE
11. REMARKS:
O
0
BIT SIZE 6.061
b
-t
-:1
I DO HERESY CERTIFY THAT THIS WELL WAS CONSTRUCTED INACCORDANCE Wntf
15A NCAC 2G, WELL CONSTRUCTION STANDARDS, MD 'NATA CWIOF THIS
RECORD HAS BEEN PROVIDED TO THE WELLONNER
t007,
IGNATURE F CERTIFIED WELL CONT CTOR DATE.
05/17106
-\R15TOP FR I . i�lf 10E' I
PRINTED NAME OF PERSON CONSTRUCTING HE WELL
Submit the original to the Division of Water Quality within 30 days. Attn: Information Mgt., Form GW 1•
1817 Mail Service Center- Raleigh, NC 27699-1617 Phone No. [phone] ext 568. J uw 06 L 7I05

WELL CONSTRUCTION RZcORD' :
NoshCafolina-DepartmentofEnvimnmehhtand Natural Resources - Division of Quality -Groundwater Section
wELL CONTRACTOR (DiDPCWUAL)r1N
WELL CONTRACTOR COMPANY llLL
STATE WELL CONSTRUCTIONPERMti% - ASSOCWIliD W�tTERMPrt
GIapplicable) ' 4ifapplicable) •
I. WELL USE ((Brecht Applicable Boxk-RaidenhalTY m m cipdUPublic 0 Industrial 0 Agriwitaral Q
` Monitoring O Recovery a'' heat Pump Water Injection ICI Other Cf If other, List Use . • _ _
32:60.0. y
ow.° ci)f rf tat 5 /jtn n.� Jl,'- cigrntcAstortis_d17 [P -
;Pttoint4fli-sSa4-3 Al, O
2. "WELL LOCATION: '/
Nearest Town: fRAN/a —;4' - County/ A .
(o 4 E Ui4LA/ tit Cta gz?_ ZoMoor ei tap. 873 tj
(Sweet Name, Numbers, Comnu mky, S vd'rvidoe, let 14e., Zip Cade)
3. OWNER:-RRrg V - A N.t_ tt—A
Address 3SS 2 t ((J Fe/ern-a A»,...j Of- •
wirlaltrIomatrW -a
•
Gtyu_T Stele !- ' T.q. Code
(&/3)- /g3-01.-70
a Armale- Phone number4. DATEDRILLHD S�/7-o
5. TOTAL DEPTH jtD.c'
6. DOES WELL REPLACE EXISTING WELL? YES El NO;
?It �,ht. f,:/ts Li.
3. 5V /
. , Topogtapbj setting -
ORidge p816 allcY .0RIat
(cheek appmeatate boa) .
L'atitaldlongitude of well location
(deameehaiaates emada)
Latituddlongittide somccUOPSCITopographic map
OW*hoa)
erg=- _DRILLING LOG
From To F Lion Description
•B qcf'
' -LSD• .?OS•
7. STATIC WATER LEVEL Below Top of Casing: _ / J7 o FT:
(User ifMbove Top of Cuing)
8. TOP OF CASINO IS / FT. Above Land Surface*
wrap etmutat taminnd at
helm bad.evka. require a
variance laamerdaaee telae'15ANCAC2C .9115.
9. YIELD (gpm):.1 S METHOD OF TEST_ 6%Dliuti
10. WATER ZONES (depth): / 00 ' (l
�L
�}w>fmvtJ
it &Lin of rr/'tc.
t/ rice.
LOCATION SKETCH
11. DISINFECTION:1 ype Amount .2TA-S 5 Show direction and diatance In miles from at last
12. CASING: WallNdotess two State Roads or County Roads. Include the road
Depth/Di�exa , or We%gbt/Pt. :members and -common road names.
From fl . To/TD �S�„ , -
From To Ft - -
From Tp Ft
13. GROUT: Depth Ms $J Method .
From_a_To_ Ft. eadndy1 pov ) .
From To Ft
.4. SCREEN: Depth Diameter
From To FL -,__in.
From To Ft. _in.
5. SAND/GRAVEL PACK
Depth Size
From To Ft
From To Ft
Sint Size - • Material
in.
in.
Material
JUN 06 2008 -
6. REMARKS: -
DO HEREBY CERTIFY THATTHIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH ISA NCAC2C, WELL. •
ONSTRUCTION STANDARDS, AND THAT A
COPY RECORDIWDE14rPROVIDEDTOTHE.V/ELLOWNER
Q44 (mil-+•
-<7-0 6
SIGNATURE -OF PERSON CONSTRUCTING THE WELL - - DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mali Service Center- Raleigh, NC
17699-1636 Phone No. [phone], within 30 days. _ OW -I REV. 07/2001
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WELL• CONSTRIICTION RLCORI' :
Nonh Cafotina- Depsnmcnt of Envitotu S Indiana) Resources. -
Division of W Quality". tio-unittliter.
Section
%NELLCOTRA ronctrDUCIDUAW (priagcb .tiP11S /,}n II r:. . '~. =77RtCATION/Iot/-7`e
wat. cow -Becton meaner tamitP94eirt OjIneert HMI iI1(cjl7u ywe-J PRONsa Sao-3 Ai 0
STATE WELL CONSTRUCTIONPEWALT, OCYATSn W
(ifappiieablc) •(iifappliwble) • .
t. WELL USE (Check ApppcebWBox):-ResidentfslW Muukipal/Public O Industrial O Agricultural Q
Monitoring ❑ Recovery 0' Heat Pp,Water Injection ❑ Other Cf If Odic List Use - •
2. "WELL LOCATION: .
Nearest Town: Ft,* NI4 j4/-
(sum Name, NCoransvay,suterian,Let N6,Zip Cede) _61eon VL'ntitudWtongitudeo(w.elllocation
3. OWNER: R/4Iy/ %/✓ i C I•FT '
Address �3 R'A. r 'Ati in • tt ct . Latitudelongit ide source:DOPSOTopographic map
Shsasit(oeterta ..--
Ga sun '' ' Tip Dods - . . From (ckFee•aDkaR)LLtNG LOGK�NNPSaJ .GA. .3aj5za
Mo)•• tr,.22 -3385
A.:CZcode. Phone number —
•
4. DATE DRILLED -s-// /s to A
S. TOTAL DEPTH: (n SA'
6. DOES WELL REPLACE EXISTING WELL? YES 0 Nt_&t —
7. STATIC WATER LEVEL Below Top of Casing 90 FT;
(User lfAbon Topofvatg)
S. TOP OF CASINO IS / PT. Above Land Surface*
'Top or asks taamlaatd *We betew badnrfs= multi, •-
nrlanes 4 aeeerdaaae wak'LSANCZCIC A11L
9. YIELD (gpro): _e, METHOD OF TEST JJDIU/
10. WATER ZONES (depth): / / D'
LOCATION SKETCH
11. DISINFECTION.Type f-/11- Amount .3 T1)-A 5 Show di vedoa and.diatence in miles from at least
12. CASING: Well Thickness two State Roads or Camay Roads.Include the road
Depth bta�da or Wa tlyt numbers and —common road names.
From_Q_To- Ft`>tZ`_ •
From To Ft
From T9 Ft
I3. GROUT: Depth .
From_A To ga Ft e 7 pequi.)
From To Ft,
.4. SCREEN: Depth Diameter . Slot Sin - • Material
From To Ft.__in, in.
From To He In. in.
5: SAND/GRAVEL PACK: _
Depth Size Material
From To Ft
From To FL
6. REMARKS: .
DO HEREBY CERTIFY THATTEIS WEU. WAS CONSTRUCTED IN ACCORDANCE WITH ISANCAC2C. WELL •
.:
gtapbir/Lind setting -
(. - ..dgc OSIopt tIVallay . °Fiat
G (cbecaapptapLac bra) . a
(so' (QSbe
on Description
JIJN Q 6 2035
ONSTRUCTIONSTANDARDS, AND THAT ACOPY wags RECORD HAS BEEN PROVIDED TOTHEN/ELLOWNER
SIGNATURE -DP PERSON CO- NSTRUCIINOTHE WELL- . - DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mall Service Center - Raleigh, NC
17 699-1636 Phone No. [phone], within 30 days. _ GW-1 REV. 072001
sr.
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• WELL CONSTRUCTION RECORD: -: 3 2 6 6 6 E
HonLCaane- Department ofEnvhoRmeatand Nadal Resources -Drvbionor Quality'-fim®dwater Section
WELL CONTRACTOR ONDAtIDUMa S(pneq'AL1)vttS / lan&r -.. 2 . 4:"CtlilRlCATlOND of/71 .
WELL CONTRACTOR COMPANY NAME .tbtir.4 0011442,1 WIti l Iltl) la 4 Vw e , .MIOia St)-&i_Sa 4-3 a b O
STATE WELL CONSTRUCTION PERMITS .. *ssow:tiO wSn atrn . ' -
(rapplicable) •.. • -(iimmliablc) • .
1. WELL USE fleck AppUwble'Boxr-Remdenttat7—Malicwt(cipBUPubl c 0 Industrial 0 Agricultural 0
- , Monitoring 0 Recovery 0' . Heat Pomp Water. Injection 0 Other 0 Ifodicu, List Use •
-2. -WELL LOCATION:. Tctpog[ap I- -.. • setting -
Flat
/2 I' he Cmdu.... to L. Al_ ASy �Re °Ridge ( o � _ "i
,Bust Nude Numbers, Community, sab&vaion, tat No. re Code) c2 fey IA4twellongitudc orvRn TOpdon
3. OWNERj J' /'Yb kit? O /)2 le-
.
Address 375 7.1 AAIL'-
(Saeats/Rouiallo.)
Ana code- Phase somber
•
4. DATE DRILLED S. --// —D (o 125.
5. TOTAL DEPTH: '& _ _C' - • `
6. DOES WELL REPLACE EXISTING WELL? YES 0 N. iW-
7. STATIC WATER LEVEL Below Top ofCallow FT:
(Uss W' If AboveTop of Casing)
8. TOP OF CASING IS FT. Above Land Surface*
'Top or sailers termt rated tutor b� l(mdagoha : r as raa -
mime Is awrdaaa wkh 1SATICstC2C Alli
9. YIELD am): 'ern METHOD OFTEST�102///si .
10. WATER ZONES (depth): o O2S' Q - LOCATION SKETCH
I I. DISINFECTION:•Type N-/'9• Amount ea TA -a S show direcdoa and distance In miler from at least
12. CASING: - WaUThi±csa two State Roads orCotmty Roads; Include the mad
• Depth D•• . or WeIjht Pt numbers and common road names.
From_____01_:To_a 1 Min. ay .
From To Ft
(dereerhatotorhesenes)
Latitude/Iongitt de soarccDOPSDTopograpbic trap
(eeteaba)
DIEM DRILLING LOG
From To " Formation Description
n 06,4 (/- Pv"
_- (or,' 10..4• spNDSfm-i--
,3„c•S' L L/ t /'t Q2 n r +--ts
From Tp
F1.
13. GROUT: Depth Material �! Mdho-d'i
From n Toa. FG po4r a, - ' po)t ) _
From To FL
4. SCREEN: Depth Diameter , Slot Size : = Material
From_ To Ft —ill. in.
From_ To Ft`_in. in.
S. SAND/GRAVEL PACK: .
Depth Size Material
From To Ft.
From To Ft.
�.t lo, 0 Fi [D5P3
Jiv
6_ REMARKS:
•
DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE Wt1$ I5ANCAC 2C, WELL. " -
ONSTRUCTIONSTANDARDS,AND THAT ACOPY OF 7 RI// RD BEP.NPROVIDEDTOTHE-WELLOWNER
SIGNATURE -OF PERSON CONS1RUCI1NO TEE WEIL - - DATE
Su bmit the original to the Division of Water Quality, Groundwater Section,1636 Malt Service Center -Raleigh, NC
.17699-1636 Phone No. [phone], within 30 days. - OW -I REY. 07/2001

• ...
• WELL CONSTRUCTION RECORD" -: 12 6 6 5 9
,t .
Nonh Cafohina - Department of Bnvirowneint and Natural Resources - Division of Water Quality--Oro®dwater Section
%vet.CONTRACTORtwnITIDUAatawkrt(pdhI S fflIS jjtila .L - ` tC [CAIONR_ot/ilp -
WELL CONTRACTORCOMPANY NAMt4 f)fl S tll�f w�- Il � i :�s:,d ��t+=Puotat sfliif, .Sa. 4-3 3 b 0
STATE WELL CONSTRUCTION PERMITS .. ASSOCIATED W MATO -
(irapplieable) • {(f agtlwble) ' -
I. WELL USE (Check Applicable Box): Residentia(7r(rtuniapsUPublIc ID - Industrial CI Agrical:mai �7
Monitoring O Recovery ITHeat Pump Water Injection O Other L1 If Oilier, List Use ' - '
2. WELL LOCATION:
T d setting
Nearest Town: GL County (a OR(dgeapI alley Ohfat
4 LO .( ,. I I s iL 2 e �tw.. in tit (check appropriate lax)
(Street Name. Norters, Community Settrittm. Lot tta. Zip Code) - - I:atitudefoagitude ofwell location '
3. OWNER dltb era Ayr/ 9-Sun-)
Address VA Al Dille D2•
Meetelleemtto.)
F.e,�rl/u1; t/ .;A/� a tva (y
CayerTaws Stets Tap Cade
(Sd- 3A9- (pro D
Ain code- Minn amber
4- DATE DRILLED c� 1 t;;-'D ,%
5. TOTAL DEPTH: ei ^IS'
6. DOES WELL REPLACE EXISTING WELL? YES O NO_
7. STATIC WATER LEVEL Below Top of Cashir 5
(User if Above Top oftasiag)
8. TOP OF CASING I3 4/FT. Above Land Surface*
'Top of eatlag terminated attar bed teadtarfies minket a
variant in aseerdamswRYISATJC/AC3C Alta.
9. YIELD(gpta): /S METHOD OF TEST hl
0. WATER ZONES (depth): G3' 75' AS''
•
1 I. DISINFECTION:.Type H-/'/.f: Amount .. %A•S S
12. CASING:Wall Thickness Thickn
Depth Diameta or Weijittlyt.
From�_Too EL Sag:
From_To Ft
From To
13. GROUT. Depth Mama Method_
FromA �� _ To pOy
From To Ft.?M�
.4. SCREEN: Depth Diameter , Slot Size = = Material
From To FLjo in.
From To FLjn. in. -
5- SAND/GRAVEL PACK '
Depth Size Material -
From To
i J J
Fr•
•
From To
•
, (depecindosterheeentle
Ladtuddlongittide aource:CIOPSOTopographic map
otteenoto
ant - DRILLING LOG
To • Formation Description
.42 to' rp-LI
S3' s w/J) S -rm-U
a7I5 {4 4v4- Galt, rt<—
From
S3'
LGCA'TION SKETCH
Show direction anddistance in nitea from at least
two Sat Roads or County Roads lncludo the road
'monikers and -common road names.
JUN 0 6 NG513
6. REMARKS: .
DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15/MNCAC 2C, WEIL •
ONSTRUCRONSTANDARDS, AND THAT ACOPY OPT RECORD BEPNPROVIDEDTOTHB-WELL OWNER
SIGNATURE -OF PERSON CONS7RUC17NGTIE WELL - • DATE -
submit the original to the Division of Water Quality, Groundwater Section, 1636 Mali Service Center -Raletgh,-NC
;7699-1636 Phone No. [phone], within 30 days. . OW-1 REV. 07/2001

• WELL- CONSTRUCTION RECORD
torch Catoihta- Department of&nvbtlt and
tEt r_ CONTRACTOR (lNDl' lDUA1A
TELL CONTRACTOR COMPANY
rATe weLOr ONtBMttlltt�� . iifapolasIde) • -
_ WELL USE (Chock AppEcablei Boxx-Reaidattiet pauPubuc D Industrial O Agricultural0
Monitoring ❑ Rccovcq O' Heat Pump W>ttimWagoa O Other [7 IfOdier, LatUse :
Resources -DittLionofWaterQuality--tioimdwaterSection
ref
netts ��alln.t.dr.
;;
'note sc Q 3 Al, 0
326658
_-wti.L1.nrAnn*
-Nearest Town: Le%�'N/GL;Al Cowttyif1 Lox> " •
'eV / i✓ .44r P 2 t elj Rd .- fl# % y
(saatanne.Nambm.Cma wdyadirbiaa4ot *,/*Code) _•
I. OWNER: /
/' h a/2.l rs P; n it 5 /711%—'
Address ///-/ M o c Re R.d`
i l7t a gn V
PR/A/I/k•
CtyorTown Stem r Rip Code
gafb- 34 9- en,
Ain rade. Phone awaber
I. DATE DRILLED 0-.1t'•-•1)
i_ TOTAL DEPTH: .3 Sb
i. DOES WELL REPLACE EXISTING WELLY YES0 NO.:I?>/—"-
t- STATIC WATER LEVEL Below Top of Callas SO
laAbmeTapol
t. TOP OF CASINO IS _/FT. AbmaLatd Surface*
rrep oreadaa terminated attar L l tarc6arMo6eaa .: ..
oartaac 1* a raordaaaewilfl5 /11CACSC.011i .
1. YIELD (gpm): a) _5 _METHOD GPTEST /O///pft
D_ wATERZONES (depth): r5 00 a ice •
• LOCATION SKETCH
1. DISINFECTION:Type %fF Amount .2Tfl5 Show direction and .dims=inmiles from athag
Z. CASING: - waUTlddmen two State Roads or Cotmty Roads. Include the road
Diameter a WeijhVPL 'members and-cortcmon road names.
From O . To f FL 11i st.
From To Ft
From Tp
3_ GROUT.: Depth Meath- Method
From n _ To via Ft,_�Qgn yt�' po)vA.)
From To tt
4_ SCREEN: Depth
_,44E•
Latidddloagitd de muroCt7OPSOTOpograPhic map
• - telemeoa)
per{ - PULLING LOG
. From To - Formation Description
z erfe.
Cott•
a.1ld
T- oneimd meting '
CIRIdge itagloPe L0Vauay . QF1at
(ebaduememboba0 - , 4
Lad IlmigihtdeOfv&Ilocatioa •
r
Diameter - Slot Size : , Material
From To PY,___jn. in.
From To Ft._in. in
S. SAND/GRAVEL PACK
Depth Size Material
From To FL
From To FL
/o r
6_ REMARKS: _
DO HEREBY CERTIFY THAT THIS WELL WM COISTRUCIBD INACCORDANCE WITH 15ANCAC2C %YIP, -
ONSTRUCfIONSTANDARDS, AND THAT ACOPYOFn RECORD BB@IM(OMS)IOTHBWELLOWNER
5-�-:06 -
SIGNATURE-bFPERSON c m ucni OTHEWEIL - - DATE
ubmit the original to the Division of Water Quality, Groundwater Section, 1636 Mall Service Center -Raleigh; NC
1699-1636 Phone No. [phone], within 30 days. - . GW-t REV. 07/2001
•
- 0

• WELL CONSTRUCTION RECORD : 3 2 6 6 5 e
Nosh Wolin* - Department of linviroomdnt and Natural Resources - Division of3Vatvr Quality'- Groundwater Section
ELL wCONTRACTOR(INDIXIDUMa t(pelat)etc719115 JJnilrLaA. - •- CrR'tIFICATI(Th 2/74' .
WELL CONTRACTOR COMPANY NAMtt:' tnirc 1{ejIf)4„4 WA, 11 pi y.Fe nroi a �24--3 2-6 0
STATE WELL CONSTRUCTION PYm *rw wgaOCrrsrzn - r '
•(u+FP11cable) ,
(if applicable) •
-
1. WELL USE (Check AppBeeble-Boxk-ltesidentialfmdcipal/PublicCI , Industrial 0 Agricultural-Q
y ❑ Monitoring ❑ Rccova- Heat Pump Water Injection ❑ Other CIIfOdiey Lust Use • - -
-Z `WELL LOCATION:. d setting -
Nearest Town: ' : - k L ; n/ - county, w+."> • " °Ri ge Pro -pc galley . Ohlat
et-4 I A/ i ,4 e 6 i T L F 9 3 5 ohnkappopt.ortwr) - a
C (Street Name. Number..ammunity.Sabdiriden.totNa..rpCode) LgtituddlongitudeofWell location -
3. OWNER: %" - . I-1 i 4 sLA'
Address 074S M fi le r F t f-A v Q• Latituddlongittale f PSCITopographic map
PLO't i s sa,v` -j- .ri 11) -Co 3 0 3 3 D r i . c DRILLING LOG
carirtowa stag ' Tip Cow - - - From To - • _Formation Description
aLS. 93o- 4a3a1 ' - - - • O-.4:a
Arca code Phaoe ember �',,¢, ,,e�y.� '^ .
4. DATE DRILLED —S.— Q (� - . . F ice G=.f ' r to
5. TOTAL DEPTH; 4 SS'' ' ,
6. DOES WELL REPLACE EXISTING WELL? YES O N0-:0-
7. STATIC WATER. LEVEL Below Top ofCsing: re. FT.
/ (Ua'r ifAbowTop eressing)
8. TOP OF CASINO IS / FT. Above Land Serface*
'rap of easing teraloaad attar het w Ipdaarfiee requires a .
nrlum In ;(archon wublsANCAC 2C AUL -
9. YIELD (gpi$):„ELL_ METHOD OF TEST LIJOY- j-w4-. -
10. WATER ZONES (depth): / fa; / /.s' (1 - -
11. D!SINFECTION:.Type half: Amount .. TA- Art 5
12. CASING: - - Wall Thickness
Depth Dix or Weight/Pt
From0.To 96 Ft $
From -___--To Ft. -
From_ To FL
13. GROUP_ Depth MatedM. Method.
From To - a. FL (gyp ter `/- POjf�
From To . Ft.
.4. SCREEN: Depth Diameter . Slot Size : = Material
From To FL__jn in.
From To Ft. in. in.
S. SAND/GRAVEL PACK _
Depth Size Material
From To Ft.
From To FL
LOCATION SKETCR
Show direction and distance Itt mile; from at least
two State Roads or County Roads:Include the road
:numbers and -common road names.
J U N 0 e it
6- REMARKS: -
DO HEREBY CERTIFY THATTHIS WELL WAS CONSTRUCTED IN ACCORDANCE STET ISIANCAC 2C, WELL -
•ONSIRUCTIONSTANDARDS. AND THAT ACOPY OF RECORD BEEN PPtOVIDEOTOTHEY/ELL OWNER
s S_ o
SIGNATURE -OF PERSON CONSTRUCTINOMBWELL - - DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mali Service Center -Raletgh,-NC
.17699-1636 Phone No. [phone], within 30 days. - - GW-1 REV. 07/2001
a

RESIDENTIAL WELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources- Division of Water Quality
WELL CONTRACTOR CERTIFICATION A 2187
3-26517.-
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 #(if applicable)
STATE WELL PERMIT#(a applicable)
DWQ or OTHER PERMIT #(If applicable)
• N ELL USE (Check Applicable Box): Residential//'Water Supply ID
rd,rE DRILLED ‘/W
TIME COMPLETED AM ❑ PM4
Trnu. / �J �J�,,y
1/ J COUNTY ,Lfi'/L-'
3. WELL LOCA
(Street Name, Numbers, Community. Subdivision, Lot No., Parcel, Zip Code)
TOPOGRAPHIC / LAND SETTING:
❑Slope °Valley ❑Flat ❑Ridge ❑Other
(check appropriate box)
L 11TUDE
LONGITUDE
May be in degrees,
minutes, seconds or
in a decimal format
Cati`ude/longitude source: ❑GPS °Topographic map
tlocation of wet must be shown on a USGS topo map and
attached to this form snot using GPS)
4. WELL OWNER
OWNER'S NAME
SIR cT ADDRESS/��r� .ram a
cit
� 2zC�ity �or Townn 'Sttaatte9
Area code - Phone number
5. WELL DETAILS:
��'>
a. TOTAL DEPTH: na/
b. DOES WELL REPLACE EXISTING WELL? YES 0 NO
?
e. WATER LEVEL Below Top of Casing: • J n� 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): ,5 METHOD OF TEST Blow
I. DISINFECTION: Type H T H Amount 16oz
g. WATER ZONES (depth):
From
From
From
6. CASING:
Depth s� Dies a}pr Weight
From � To !X Ft.
From o.� To 3/D) Ft. U
From To FI.
From To
From To
From To
7. GROUT: Depth Material
Thickness/
Method
From 0 To`20 Ft. ()went & termite Fumed
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
11. REMARKS:
Formation Description
Clay & sand
Granite
m22.
O
1 DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED m ACCORDANCE WIM
/5A NCAC 2C, WELL CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS
RECORD BEEN PROVIDED TO THE WELL OWNER.
S7ppo
SIGNATURE OF CERTIFIED WELL ONTRACTOR t:
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.
JUii 06 2Q33
Form GW-la
Rev. 7/05

/} L 3 Midge Pc OValley QFlat
(Suit Nam; Number,.c_nity.Svbiniao,,.t IW..4 ode) • Lotitudellongidtdeofwell location
3. OWN
Address
f&emuaina fit2 a 17le y
($ -9- oa tiocTown Soda 4 -z;°`°d`.
Are. eade- Phone ,umber ` ro
4. DATE DRILLED tJ
5. TOTAL DEPTH: %SD ' '
, (dezneduiNaalawenda)
Latitudeilongittide souroa:OOPSOTopographic map
(ebedr boa)
l DRILLING LOG
From To - Ft unation Description
0 _._ a 4a , C L,.
.
01.' Co. 66' LU
6. DOES WELL REPLACE EXISTING WELL? YES C NQ01--a`
7_ STATIC WATER LEVEL Below Top °TCad(ng: ht
(user unions TopofGrin)
8. TOP OF CASING IS FT. Above Land Surface*
-rap of easing news enabler bdy yadmrfieerpofresa
nrtaea4 aeeoroata IiCAC
9. v „
Io_ WATER ZONES (depth): ai.�iS • "'(/X^
nCH
11. DISINFECTION _Type >tftf:- Amowit ...3 T -�i 5 Show direction�and distance ON Ip lcs from at least
12. CASING: WallThidotess two State Roads or County Roads. Include the road
• r or Weishr/Ft numbers and-conmaon road names.
From fl_ . To 92 Ft .b
•t: Wit•.:
North Carolina - Department offnviroopwot and Natural Reaancea - Division of W
j Quality.- roimdwaoer Section
WELL CONTRACTOR (nmrti'WUAL)'NAajlg�(pr et) :hell Pt t S /7^IJfL.A.A, . ` ' -4-' clii�lsrlC�e'SON s 117le
tv'ELL CONTMCTOROOMPAWYNADt$ .pt)TR ldnlined IItel1\y4J!'u -j'x'C.a 'noon stint SG. a/-3 al,O
STATE WELLCONSTRUCTION Math! - TEn W4i111NIT! .- - -
•
(irapplioable)• 'inapplicable) • . .
326246
,
• WELL CONSTRUCTION RECORD' -:
•
1. WELL USE (Check Appliabht-Box):-Residetttialed�iritatmidpavpubtic 0 Industrial a Agricultural
' Monitoring ❑ Recovery O- Heat Pump Water hijectinn ❑ Other CI If other, List Use
•
2. "WELL LOCATIOlI: /
•
Nearest Town: R ANK -- - C M Art tp`/ - - Top°��d setting
f .r- CR ee Ra - Feel} iI e>v a$9 / KM* appropriate hoe) _
rrWrlSA 2C A11t4
YIELD (pm): METHOD OF TEST_ J%U//i
From To Ft_____
From To Ft.
13_ GROUT: Depth Material. Method
From_(To eel,y7,'t n�
From To I
4. SCREEN: Depth Diameter . Slot Size : < Material
From To_ FL _in. is
From To Ft. in in. -
5. SAND/GRAVEL PACK:
Depth Size Material
From To Ft
From To Ft.
6. REMARKS:
.°SUN 06 2`a
DO HEREBY CERTIFY THAT THIS WBU. WAS CONSTRUCTED IN ACCORDANCE WIU$ ISANCAC.2C. WIEL -
ONSTRUCTION STANDA*DS, AND THAT A COPY MIMS RECORD BEEN PROVIDED TO THE WELL OWNER
SIGNATURE -OF PERSON CONS -ERUCTING THE WELL . DATE -
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mali Service Center -Raleigh; NC
n699-1636 Phone No. (919) 733-322I, within 30 days. - OW-1 REV. 0721101
03

• . WELL• CONSTRUCTION RECORD"
Nonh Stohna - Departtnent of Environment and Natural Resources - Division of Water Quality-- Oroimdwater Section
WELL coNTRACTOR(WDIVIDUAta'NAME (vrta) c%fint S fin /Ia.AA d.'• • - -'.' cz1n restnitis .01174'
WELL CONTRACTOR COMPANY NAMIC'.ilt)r4 Ptkepi ION II i 277. "rttoini icraV, Sec. 4-3 a•b a
STATE WELL CONSTRUCTION PERMITS _ SS - 'AOATED , - -
(it -applicable)- cif npp W ERa• .
pplitwble)
I. WELL USE (Check Applicable -Box): Residential rr ManicipalPubiic O • Industrial 0 Agricultural
Monitoring 0 Recovery °` Hat Pump Water Injection 0 Other a If Other, List Use •
2. WELL LOCATION:
Nearest Town: f 4*.Yk/a✓ ' County /41 it
91,4/ S• Cam' 2arnt`01.ka• £17sly
(Street Name, Nwaben Commuwty, Subdivision, Lot Non Zip Code)
3.OWNER: /y� ,4R7-iPkl p%0e.S
Address a. 5' F441.01041.. W ,¢ Lek_
OXNAta`s 0A�1�) 93035
(2O, - firs-s73/ •
CtybrTown / State ' • rip Code
Arta cede- Phone number
4. DATE DRILLED S - 3 .-0 4.
5. TOTAL DEPTH: tS&s "
• 0 e•
_—.11A• Qs•
Topograppiic/Lend setting -
°Ridge 0Slopeey °FIat
(dwdtappttgdiare box) . a
Latitotie/longittde of well location
, (hag neahoisutaheee da)
Latitddlongittide source:°OPSCITopogmphic map
Ohmic but)
1211PIEI DRILLING LOG
From To ' FFoonnadon/Desccription
Art 9C ,Pail; t-e•-
326245
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO.
7. STATIC WATER LEVEL Below Top of Casing: FT:
8. TOP OF CASING IS / we a WAbora Top Mks
FT. Above Land Surface
?op ofesslag tormlaateed ararp.aaw hadeerfee requIns a
variant Le aaardaaa-ISANCZC 2C AIIL - '
9. YIELD (gpm): A METHOD OF TEST a
10. WATER ZONES (depth): /Q/I •
jft nr/O f. .
t 1. DISINFECTION.Type #4/1; Amount .4 TIM 5 Show direction and distance in miles from at least
12. CASING: - Wall 'Thickness taro Stara Roads a
• Depthon tudyroad Roads: Include the mad
�°� or Weight/Ft, .'numbers sod common mad mania.
From 0 . ToJb_a s.?Zg:, y a .-
From To FL
From Ty_ FL
13. GROUT.: Depth Muuid
'
Method .
From To as Ft. ► 4 4,../n&�
From To I
4. SCREEN: Depth Diameter . Slot Size • • Material
From______ To FL in. in.
From To Ft. in. in.
5- SAND/GRAVEL PACK:
Depth Size Material
From To Ft,
From To Ft.
JUN O6 2U:
6. REMARKS:
DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED INACCORDANCE WITH 13jt NCAC 2C, WELL •
ONSTRUCFION STAND ASDS. AND THATA COPY OF TH(g RECp�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
17699-1636 Phone No, [phone], within 30 days.
GW-I REV.072001

RESIDENTIAL WELL COIN STRUCTION 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) Nine
Redden Brothers Well Drilling, Inc. -
Well Contractor Company Name •
STREET ADDRESS 73 Holy• Hills Vista RD Franklin, NC 28734
City or Town State
( 828 )- 364-9591
Zip Code
Area code- Phone number . 2. WELL INFORMATION:.
SITE WELL ID lilt applicable)
STATE WELLPERMITB(it applicable)
DWQ or OTHER PERMIT e(If applicable)
WELL USE (Check Applicable Box): Residential Water Supply 0
DATE DRILLED I94
TIME. COMPLETED
3. WELL LOCATION:
CITY:
1 AO
�7 �0
AM ❑��PMMAf/1
CO, NTY
( act Name, on, Commu SubdlJalon, m No., Parch, Zip Cad.)
TOPOGRAPHIC / LAND SET ING:
O Slope OValley ❑Flat ORldge OOther
(check appropriate box)
LATITUDE
LONGITUDE
May be in degrees,
minutes, seconds or
in a decimal format
Latitude/longitude source:GPS ❑Topographic map
(location cl well mustbe s o n on a USGS topo map and
attached to this /a - If not using GPS)
WELL OWNER
`.OWNERS NAME I/AIrieni
STET pC]DRESS , l
City or Town. • tate
( 77si)• / -- V7 Zip Code
Ares code • Phone number -
5, WELL DETAILS: M
a, TOTAL DEPTH: I/t /V
b. DOES WELL REPLACE EXISTING WELL? JYEES NO O
c.: WATER LEVEL Below Top .ofCasing: -r-QLl J FT.
- - - (Use 'it." 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 valence in accordance with 15A NCAC 2C .0118.
e. YIELD (gpm): t.�METHOD OFTEST Blow
as �7 '' r op
1. DISINFECTION; Type H T H Amount 160z
P. WATER ZONES (depth
From To From To
From Io From To
From 1�TQL ..From - To
6. CASING: Thickness/
Depth Diameter
Ft. to " Weight M to fai
From To Ft. ��:r
From To r %� ` o ('
From To Ft.
7. GROUT: Depth Material Method
From 0 To 20 Fpement & benonite
From To Ft.
From To Ft.
9, SCREEN: Depth Diameter Slot Size Material
From To Ft. In. i 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
Fro
yr
11. REMARKS:
Formation Description
clay & sand
grant to
1
C.3
O
C7•1 •
100 HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH
ISA NCAC IC. WELL CONSTRUCTEN STANDARDS. AND THAT A COPY OF THIS
RE SORp HAS BEEN PRCVID TO THE WELL OWNER.
GNATURE 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] eat 568.
Form 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
W e l Contractor (Individual) Name
Hedden Brothers Well Drilling, Inc.
Well Contractor Company Name
STREET ADDRESS 73 Holly Hills Vista Rd
Pranklin, NC 28714
City or Town State Zip Code
( 828 )- 369-9591
Ares code- Phone number
2. Wit :. INFORMATION:
r ELL ID 111I applicable)
6 AI S. W ELL PERMITS(II applicable)
DWI] or OTHER PERMIT Cif applicable)
WEL L USE (Check Applii Gable Bo/{): Residential Water Supply CI
DATE DRILLED I &2 ttA� n� /
TIME COMPLETED .3 • OK01 AM O PM ('jam
3. WELL LOC - TION:
rY: 1
COU
Ty ((/
tau
( 1 , Nema, Numb n, Community. Subdon, Lot No., Parcel, Zip Code)
Tc. •I ) 3RAPHIC / LAND SETTING:
- °Valley ❑Flat 0 Ridge °Other
(check epprdprlate box)
LATITUDE ,3 _
LONGITUDE_ _
Latitude/longitude source: oGPS °Topographic map
j bcatlon or wet must be shown on a USGS fopo map and
attached to this roan I not using CPS)
4. W':.L OWNER
0 L L.R'S NAME
S i `.. ET ADDRESS
P
PA/Lk a,n NC',
�f i"pr o Town �� // State Zip Code
71P7
L 2fl )- for qgg
May be In degrees,
minutes, seconds or
in a decimal format
Area cede - Phone number
5. WELL DETAILS: L4/ll f
a. TOTAL DEPTH: t
b. DOES WELL REPLACE EXISTING WELL? A�YESS 0 NO) ,
c. WATER LEVEL Below Top of Casing: `tom/ FT,
(Use'+' 0 Above Top of Casing)
OP OF CASINO IS 2 FT. Above Land Surface'
'Top of casing terminated at/or below land surface may require
s variance In accordance with 15A NCAC 2C .0115.
a. FIELD(ppm): L_.7tb METHOD OF TEST Blcw
1. DISINFECTION: Type H T H Amount 166z
g. WATEONES (de th):
From —,Lf�f,.�j-Tot From To
From To From To
From To From To
6. CASING: Thickness/
Depth /41 Diameter Weight Mat Ia
From To ( Ft. 1, 7
From To_rj FLU " _n 2
From To Ft.
7. GROUT: Depth Material Method
From 0 To 20 Ft. L halt & termite turned
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
11. REMARKS:
Formation Description
Clay & sand
Granite
..,
i.)
I D0 HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN AC00ROANCE win
ISA NC 2C. WELL CONSTRUCTION STANDARDS. AND THAT A COPY OF THIS
RE gC HAS BEEN PROVIDE iHTO THE WELL OWNER.
GNATURE 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 da C
s. AttI ryorl sit t, D
1617 Mall Service Center— Raleigh, NC 27699-1617 Phone No. (919) r 33-701 V
FEB 0 7 2006
Form GWle
Rev. 7/05
Asheville Regional Office
Aquifer Protection

RESIDENTIAL WELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources- Division of Water Quality
WELL CONTRACTOR CERTIFICATION #
1. W LL CONTRACTOR:
James B. Brown
Well Contractor (Individual) Name
Hedden Brothers Well Drilling, Inc.
Well Contractor Company Name
STREET ADDRESS 73 Holly Hills Vista Rd
tranklin, NC 28734
City or Town State Zip Code
( d28 )- 369-9591
Arca code- Phone number
2. WLL L. INFORMATION:
SITE WELL ID #(If applicable)
ST,CE WELL PERMIT#(II applicable)
DWQ or OTHER PERMIT #(tt applicable)
WELL USE (Check Applicable Box): Residential Water Supply ID
DATS DRILLED TIME COMPLETEDAM ❑ PM LDJ
3. W ; .L LOCATION:
Ci,
Creel Name.
C UN Diaqa TYv
onlry. Subdivls on, Lot No., Parcel, Zip Code)
TOPOGRAPHIC / (AND SETTING:
❑S'ope °Valley ['Flat ❑Ridge ❑Other
(check apprdprlale box)
LATITUDE J_ _
LONGITUDE
Ls i ude/longitude source: ❑ OPS oTopographic map
( r=cafbn o/ wed must be shown on a USGS fopo map and
attached to this form I not using GPS)
4. 1N.^L.L OWNER t% -
OI tr1ER'S NAME
STEET ADQRES§
May be in degrees,
minutes, seconds or
in a decimal format
City or Town ' State
WZg). 6.4 -__00g
Area code - Phone number
5. WELL DETAILS: cQO a. TOTAL DEPTH:
Zip C
b. DOES WELL REPLACE EXISTING WELL? YES YES 0 NO f ,
e. WATER LEVEL Below Top of Casing: - Ad FT,
(Use'+' 6 Above Top of Casing)
{. TOP OF CASINO Is 2 FT. Above Land Surface'
'Top of casing terminated et/or below land surface may require
a variance In accordance with 15A NCAC 2C .0118.
e, YIELD(gpm): METHODOFTEST Blow
2045
1. DISINFECTION: Type H T H Amount 1 66z
g. WATER ZONES (depth):
From � To L' From To
From i7i To /90 From To
From _ To From To
6. CASING: Thickness/
Depth Di meter We t dica ria
From �P
To Ft. "
From To Ft.
From To Ft.
7. GROUT: Depth Material - Method
From 0 To 20 Ft. parent & ternite pnPef1
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
lair
11. REMARKS:
Formation Description
Clay & sand
Granite
c,3
100 HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WM1
16A NCAC IC, WELL CONSTRUCTION STANDARDS. AND THAT COPY OF THIS
RE BEEN PROVIDED TO�ER.
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. A
1617 Mall Service Center —Raleigh, NC 27699-1617 Phone No. (919) 733.7
r formation Mgt.,
15ext56
RECEIVED
FEB 07 2006
Asheville Regional rug --
Form GW-la
Rev, 7/05

WELL CONSTRUCTION RECORD"
Nordrolina - Department of Enw vironeiht and Natural Resources - Division of Water Quality-- uali Groundwater Section
WELLCONTRACrOR(INDIV•IDUAL)NAM**Y e(prtat) Cheri?' S fini /L+�ri.. - '-- �Tjm(CA•ION-i o1/7(
WELL CONTRACTOR COMPANY NAMIT rg 1dt1Invy-t 10 1yeij nt'1L Tice i'pttort $ ,,.,j a4-3 V.b
STATE WELL CONSTRUCTION PER/tarsi - ASSOC[ATED WQJIY LRM171F -
(irapplicabk) •(ifapplicable) • .
1. WELL USE (Check Applicable Box):-ResidentiaTtrV lunicipal/Public 0 Industrial 0 Agricultural • 0
• Monitoring 0 Recovery ❑` Heat Pump Water Injection ❑ Other CT If Otlier, List Use -
'2. "WELL LOCATION:. L
Nearest Town: r,?A,vK L ; �/ County /l/1 A eav� . T. pilit 1Land setting -
ge ❑Slope [Walley ❑Flat
01 A v k S C? H A P l; L co v z o"l g93 9 Obedt appropriate boa) .
(Street Name. Numbers, Commuaiy, Subdivides, Lot No., Zip Code) • Latitutie/Iongitude of well location
3. OWNER:�(�U'{ h et la,A
Address c 2 / l,() rck y> A-'N `s7-•
(Syew or Rowe o.)
FRRA/P )n% i1L 8/39
City at Town State Tip Code
(gain- r33
Area code- Phone number
4. DATE DRILLED / —/ en —0 60
5. TOTAL DEPTH: a DO `
-it
, (dertr)miautea/eaconda)
Latitude/longitude source:❑GPS❑Topographic map
(cheek boa)
DEPTH ' DRILLING LOG
From To ' Formation Description
qs,
q ' a t e.) •
L u-
1.
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO _I/Y_
7. STATIC WATER LEVEL Below Top of Casing: 1.5O FT.
/ (User Unbars Top of Casing)
8. TOP OF CASING 1S / FT. Above Land Surfaces
'Top or using tenanted at/or bel2w ittndaurbt regolres a variance it accordant with ISANCAC 2C .ails, crt
9. YIELD (gpm): o2 5".METHOD OFTESTI /0l/)ar
10. WATER ZONES (depth): 02 (00') k`0 • (/ . . o
LOCATION SKETCH
11. DISINFECTION :Type il ffl Amount a T/>LM $ Show direction and distance In miles from at least
12. CASING: - Wall Thickness two State Roads or Cou
nty Roads. Include the road
Depth, Ft Diameter or Weighupt. Mi�p 1 ''numbers and common road names,
,y From 0 . To 5.12R.,,7. K
From To FL__
From Tp Ft. _. . .
13. GROUT: Depth �1� Material Method
From n To r7[l t 04 e7'7 nay
From To f
.4. SCREEN: Depth Diaineter . Slot Size - > Material
From To Ft. in. in.
From To FL in. in.
5. SAND/GRAVEL PACK: _
Depth Size Material -
From To FL
From To FL
6. REMARKS:
RECEIVED
FEB 07 2006
Asheville Regional Office
Aquifer Protection
DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WI'11( 15p NCAC 2C, WELL
ONSTRUCTION STANDARDS, AND THAT A COPY OF S RECORD HAS BEEN PROVIDED TO THE WELL OWNER
SIGNATURE OF PERSON CONSTRUCTING THE WELL , DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mall Service Center -Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. . OW-1 RBV. 07/2001

• .WELL CONSTRUCTION RECORD'
N onh Carolina - Department of Environment and Natural Resources - Division of Water Quality- Groundwater Section 1 7
WELL CONTRACTOR (INDIY,tDUAL)NAME (putt) ;heft FI I s f 4t, I1 (1.A At • • a CZ1�TIFICCATIIOON Pam! r 4o .
WELL CONTRACTOR COMPANY NAME .1rnTS 1�linrd IiMIlalvi)iru Ke 4 PHONL adan_..�a.y—a Lb
STATE WELL CONSTRUCTION PERMITM ASSOCIATED W EMITS • .
(if applicable) ' .(if applicable)
I. WELL USE (Check Applicable Box): Residential' micipal/Public ❑ Industrial ❑ Agricultural Q
Monitoring 0 Recovery ❑' Heat Pump Water Injection 0 Other E7 If other, List Use -
2. "WELL LOCATION:
Nearest Town: f5e/AitICL;.ilk County Al_
f t S, /Y) P Crnneli i s- ,:2k'g&
(Street Name, Nuumben, Community, Subdivision, Lot No., Ztp Code)
3. OWNER A A Al I ec L j
Address .2 ?..3 2 anMNall f�-I
(Street or Rowe No.)
1=rEcam,ei,4J AIL 1139
City or Town State - Zip Code
LEW- S 2V 1 .
Ara code- Phone number
4. DATE DRILLED C - L`I
5. TOTAL DEPTH: On '
>3epCgtaphicfLand setting .
alkidge ❑Slope ❑Valley ❑Flat
(ehook appropriate box) . a
Lat(tude/1ongitude of well location
•
(degroeiminutahxbnds)
Latitude/longitude source:❑OPS❑Topographic map
(check box)
DEPTH ' DRILLING LOG
From To ' Formation Description
r Aie.4 Lf / yy
Gf nh` )ALC'•e, (L2A-Ni+¢_
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO
7. STATIC WATER. LEVEL Below Top of Casing: / n FT:
(Use "t" if Above Top of Casing)
8. TOP OF CASING 1S / FT. Above Land Surfaces
'Top of casing terminated atlor bel2w Iwa surface requires a
variance la accordaau,£ttb 1SANCAC 3C .0111L /
9. YIELD (gpm): METHOD OF TEST_ h /0//ThL(f-,
10. WATER ZONES (depth): .-7e>' (1
11. DISINFECTION: Type il-1-14.
12. CASING:
Depth Diameter
From 0 . To FL h'
From To FL
From TO Fl.
13. GROUT:
From n
LOCATION SKETCH
Amount a'J-A-�i 5 Show direction and distance in miles from at least
Wall Thickness two State Roads or County Roads, Include the road
Of WCIJMIPL Ma numbers and -common road names.
5-t R•
_
Depth Material
To e-W) Ft. e p vyt sr /
From To FL
SCREEN: Depth Diameter
From To FL in.
From To Ft. in
S. SAND/GRAVEL PACK
Depth Size Material
From To Ft
From To Ft.
Method
f
oluo
Slot Size • Material
_ in.
in.
6. REMARKS:
DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
ONSTRUCTION STANDARDS, AND THAT A COPY OF TiS RECORD BEEN PROVIDED TO THE WELL OWNER
sle
SIGNATURE bF PERSON CONSTRUCTING THE WELL . DATE
Submit the original to the Division of Water Quality, Groundwater SeIgl orrr eel Center- IeIgh, NC
27699-1636 Phone No. [phone], within 30 days. - C li C I GW-I V. 07/2001
I
0
Zrat
zt
lV
0
a
0
FEB 0 / 2006
I Asheville Reolonal t'Nfiro

• . WELT., CONSTRUCTION RECORD
Nonh Carolina - Department of Enviromntint and Natural Resources - Division of Water Quality"- Groundwater Section
7 1 •' 171�
wELL CONTRACTOR MIDIY•IDUAL NAM}[E,,(primp the n Vl t S Fin F /1.A rV - C[!i(TTPtCAT""tO/�N
WELL CONTRACTOR COMPANY NAM1C:h 4hr S Oil IlovRa I )jai i yet) j cu- Tn e l'PUON[ Oat Sao-3 a
agOC(ATED W
(it applicable) •(ifapplicable) • .
STATE WELL CONSTRUCTION PERMIT/ 1
•
1. WELL USE (Check Applicable Box): Residential' unicipal/Public 0 Industrial 0 Agricultural[)
Monitoring 0 Recovery ❑' Heat Pump Water Injection 0 Other C1 If Other, List Use
•
2. "WELL LOCATION:
Nearest Town: •
itopogripiliciLand setting '
County dge ❑Slope ❑Valley ❑Flat
cc 1 N Q it/2 K. (cheek appropriate boa)
(Sued Name, Numbcn, Community, Subdivision, Loot No., Tip Code) L'etitudatioagitude of Well location
3. OWNER A) l o e Ie ' o A S ! 'I p Nal pI-4 (' E (degrees/minutea/racbnde)
Address 335 Al! P t L. L O c) P Latitude/ ongittide source:❑GPSOTopographic map
(Street a Route No3t,�
f�eNkLiA/ w. e cf (93/
City 'or Town State .. tip Cade
(Ra_ 349- 0440
DEPTH'
From To "
AM code- Phone number
4. DATE DRILLED � — 9 ()je
5. TOTAL DEPTH: 7/0'
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO :ma-
7. STATIC WATER LEVEL Below Top of Casing: ISD FT
(their if Above Top of Cuing)
8. TOP OF CASING IS / FT. Above Land Surface'
'Top or using termlaated at/or below Iwd rurfass requires a
variaaee ill accordance wltb-ISANCAC 2C .0111. /
9. YIELD (pm): YO METHOD OFTEST_hiO7J)/
10. WATER ZONES (depth): S 440 ' rn RD
11. DISINFECTION: Type E% l' : Amount ,e3 TA -a 5
12. CASING: •WallThirknes
Depth, Divider orWe'tiib/FL tMail
From 0 . To ti Ft. hS.bR:St pF.
From To Ft.
From
Tp Ft.
13. GROUT: Depth^ Material Method,
From n To eQ7) Ft. earl, dr7 F)av-O
From To B.
I
4 SCREEN: Depth Diameter Slot Size , Material
From To FL in. in.
From To Ft. in. in.
5. SAND/GRAVEL PACK:
Depth
From To
From To
6. REMARKS:
•
Size Material
Ft.
Ft.
DRILLING LOG
Forms ton Description
9 /" 0 I& ve
`7no '3"LUG RAN"tt2.
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.
RECEIVED •
FEB 0 7 2006
Asheville Regional Office
AquiferPnAtictivn
DO HEREBY CERTIFY THAT THIS WELL VMS CONSTRUCTED 1N ACCORDANCB WITH 15A NCAC 2C, WELL •
'ONSTRUCTION STANDARDS, AND THAT A COPY OF TH{S RECORD HISS BEEN PROVIDED TO THE.WELL OWNER
DATE
SIGNATURE -OF PERSON CONSTRUCTING THE WELL
submit the original to the Division of Water Quality, Groundwater Section,1636 Mall Service Center -Raleigh, NC
.27699-I636 Phone No. [phone], within 30 days. . OW -I REV. 07/2001

WELL CONSTRUCTION RECORD :
North Carolina - Department of Environment and Natural Resources - Division11of Water Quality- Groundwater Sect • ion / -
WELLCONTRACfOR(INDIVIDUAL)NAM*L_ (print) cht nil 1 S / 11 Q„n^,.• . MSFTwwI�C+�A,T,,I,O/Na! /14c
WELL CONTRACTOR COMPANY NAM/:'I 'MT S 1 1114a,4 iilei l 1Y.11nt Tice .' PHONE/ ttSa 4-3 geo o
STATE WELL CONSTRUCTION PERMIT'S ASSOCht,TRD WIPPERMITS .. •
(if applicable) . ' •(if applicable)
1. WELL USE (Check Applicable Box): Residential 'L;?" Municipal/Public 0 industrial 0 Agricultural Q
Monitoring 0 Recovery ❑` Heat Pump Water Injection 0 Other cr If other, List Use
2. -WELL LOCATION:
Nearest Town: FR Avlic L7 /1/ County MA- Lzbc'
114IZlc5 fii/*pa) COM'.. R by Lei-„l _
(Street Name, Numbers, Conuouuity, Subdivision, Lot No., Zip
3. OWNER: eR / cog,, e- Vt3Nt Iconft
Address IY '(YU Q y t/ AIC
(Street or Route No.)
FQ 4A, tz (-) fi.0 3 ,
City or Taw State - Zip Code
60.1O- <S.;tf-- (n(,3S .
Ara code- Phone number
4. DATE DRILLED /—1b(n
5. TOTAL DEPTH: a2 75'
6. DOES WELL REPLAN EXISTING WELL? YES O NO
7. STATIC WATER LEVEL Below Top of Cuing: se) FT;
(Use'Y" if Above Top of Cuing)
8. TOP OF CASING 1S / FT. Above Land Surface'
-Top of cuing terminated atior below Isad.lurfaa nqulru a /
9. YIELD (gpm): METHOD OF TEST A107,/nc4--,
10. WATER ZONES (depth): 5.2 (/
LOCATION SKETCH
11. DISINFECTION: Type Amount , 3 TA-13 S. Show direction and distance in miles from at least
12. CASING: Wail Thickness two State Roads or County Roads. Include the road
Depth Diameter or Wejilttlpt MatepJ� 'numbers and common road names.
From 0 . To P-t- Ft h" 3.bR:,$1 aX,•
From To Ft _
From Tq Ft._
13. GROUT: Depth Material
From n To ra'Z° Ft. �yyy(q, '
From To
Sz
Topogtapbi _ setting •
❑ Ridge po ❑Valley ❑Fiat
:k appropriate buz)
lAttitu4e/longitude of well location
•
, (dcgra&minuterHecbnds)
Latitude/Iongittide source:❑GPSOTopographic map
(cheek box)
DEPTH, ' DRILLING LOG
From To '
r^ (n5L,
fey 2-41-•
Formation Description
sa a�
R//le-
vantage la accordance via -lSANCAC 2C AI IL
FL
4. SCREEN: Depth Diameter .
From To Ft. in.
From To Ft. in.
5. SAND/GRAVEL PACK
Depth Size
From To Ft.
From To Ft.
6. REMARKS:
Meth
po .
Slot Size Material RECEIVED
in.
,
FEB 07 2006
Asheville Regional Office
Aquifer Protection
Material
ZINd UZNvr90
O
DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WPTH 1SA NCAC 2C, WELL •
ONSTRUCTION STANDARDS, AND THAT A COPY OF S RECORD HAS BEEN PROVIDED TO THE.WELL OWNER
14
SIGNATURE•OF PERSON CONSTRUCTING THE WELL . DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mall Service Center -Raleigh, NC
j1699-1636 Phone No. [phone], within 30 days. . , GW-I REV. 07/2001

•
• . WELL CONSTRUCTION RECORD'
North Caiolina - Depar4uent of Environment and Natural Resourcess-- Division of Water Quality-- Oroimdwatcr Section / -
WELLCONTRACTOR(mDrV,IDUAWNA I (Phut c al F 15 Al/ In`A'L..`• • . CLI♦ IFICATtorio 114. .
wELLcoPITRACTORCOMPANY NAMIE 4fr.0 }l0JI0,,rt (l)elil,f.1lpe �'n-e-'Ptloeua gti Sao-3 �•bO
••
STATE WELL CONSTRUCTION PERMITS .ASSOCrATa W&ERMITii
(if applicable)-(it•aoplitable) • .
1. WELL USE (Check Applicable Box):-Residential7Y(rim(cipa1publlc 0 Industrial 0 Agricultural O
Monitoring D Recovery 0' . Heat Pump Water Injection 0 Other C1 If Otlier, List Use - '
2.'WELL LOCATION:.
Nearest Town:F0/kkt; County M An"'
cJRA/ Mose CREEK. ,0 8r13(f
(Street Name. Nataben, Comaamky, Sabioidoa, Lot No.. TAP Code) .
3. OWNER: L00 f e.. �CvCEa
Address 3 Co is HA CH -L. A N D S Rat.
(Shaat naeet)
PRJ*N MLJiiT N4 • a 8173 Li-
05ry'orTows State rap Code
cma�-'ai - j463 -
Area code- Phone somber
4. DATE DRILLED 2 "e,t "6 (O
5. TOTAL DEPTH: a as •
grappirlLtind setting -
dge OSlopc OValloy ORIat
ohs* appropriteboa) .
L'ptituddbligitnde of well location
, (deareeshaiouw/sseondq
Latitudellongihide sonrce:OOPSOTopographic map
(ebeea box) -
DEPTH - DRILLING LOG
From To Formation Description
•
6. DOES WELL REPLACE EXISTING WELL? YES 0
7. STATIC WATER LEVEL Below Top of Calling 3
(UseAbove Top of Cubs
8. TOP OF CASING IS /
IPT. Above Land Surface*
'Top of easing tnm4Ned aUor baljw ymdaartme requires a •
mordant
mimeo la ordauee wnh'ISA7(CLC 2CMIL
9. YIELD (gptp): �d OD OETEST
-1 'im t,
M. WATER ZONES (depths O ' , /3 0 • `�`�`
LOCATION SKETCH
11. DISINFECTION: Type ff flf: Amount .3 T#J• S S Show direction anddistenw In mils,: from at least
12. CASING: Wail Tbidowa two State Roads or
Include the road
Might..Might.. • or WeigliuPL numbers and commit names
From fl . To_ 3bR:f S � ` •
From To Ft -
From Tp 13. GROUT:
Depth
From_() To e 73 FL CQnMpA,�
From To Ft.
n•e.
.4. SCREEN: Depth Diameter . Slot Sim : • Material
From To P1-____in, in.
From To Ft, _in in.
5. SAND/GRAVEL PACK:
Depth Size Material
From To FL
From To R.
RECEIVED
MAR 0 8 2006
Asheville Regional Office
Aquifer Protection
6. REMARKS:
DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH ISAMAC 2C. WELL •
-ONSTRUCTION STANDARDS, AND THAT A COPY mugs R&bRD HAs BEEN PROVIDED TO THE ELL 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
a7699-1636 Phone No. (919) 7333221, within 30 days. OW -I REV. 07/2001
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WELL CONSTRUCTION RECORD " : r5 2 2
. r(
North Caiolina - Department of Earinttaswt and Natural Resources • Division of YVater
Quality-• Qrointdwater Section
WELL CONTRACTOR (INDIEIDUAL)•NAfl (prbo cbe ii P1 l s A I
wets. CONTRACTOR COMPANY NAME" '�A I I a-1
STATE WELL CONSTRUCTION PlrRptj7'/ - asocanp
(if applicable) .. {ifapplivsble) • .
�. hY)fS I f!w{ IjPAI Trwe 'ruornc t/--3 3•b
)ERMrra ' - �• '
1. WELL USE (Check Applicable Box):-ResidentielTYMtn icipauPubuc 0 Industrial 0 Agricultural.0
• Monitoring 0 Recovery 0" Heat Pump Water Injection 0 Other CI If Odher, List Use "
2 "WELL LOCATION: -
NearestTowtn: X/rNICL,/✓ c�O°��°°�4-
C I E}i21CS f.A Pe G�Min. '(17.t.f�': e
(Street Name, Numbers, Cammnmby, Subdlvi4ea,, Lot No., Zip Coda)
3.OWNER: IC, y l� ie4LOh)2ri
Address `I), 0. R D X .� .' h
Stets pintoes.)
FRnfkL;4!;_Nee- Q ✓ 79- L
Cirya Town Slam " Zip Code
(eta ace % —R—P-/ 3
Ara rode- Phone camber
4. DATE DRILLED 02 — / — 0 De''
5. TOTAL DEPTH: o%.S 0' •
6. DOES WELL REPLACE EXISTING WELL? YES 0 NI?
7. STATIC WATER LEVEL Below Top ofCas(ng: ra n -FT:
(Ua'rifAbove Top oaq ui*
8. TOP OF CASINO IS / FT. Above Lund Surface*
'Tap of cuing tarmbatad Mir beWr(lpad.ar4a requiresa
wartime aeardaawih ISATjc,tC2C After. JJ .
9. YIELD(gpm): a(') METHOD OFTEST_./)IDNJ
10. WATER ZONES (depth): I I S `.) / 90 J Z?I)if
LOCATION SKgTCH
11. DISINFECTION: Type f rAi: Amoud ,3 T/ -a. 5 Show direction end.diswiae In milm from at (east
12. CASING: - Wall Thickness two State Roads or County Roads. Include the road
fl" . Depth
orwaghunt 'numbers and common mad names.
teYl.. " . bidLtind setting .
�� g� 3 d lops fl alley . OFlat
(dantappmyri.trbox) .
• Latitude/longitude ofwell location
From
From To FL
From Tp Ft
13. GROUT: Method .,
From I) ToTFL eenuty.7 p
From To FL I
4. SCREEN: Depth Diameter . Slot Size - . Material
From To Ft. in. in.
From To Pt`_ in.
5. SAND/GRAVEL PACK
Depth Size
From To R.
From To
, (degeeshmtautea/aomdr)
Lsdtude/ongittide source:OGPSOT'opographic map
DEPTf- (ehedtbox)
DRILLING LOG
From To - ,Formation Description
P) 3r� yy",� ��
-- R t{-' CC C{-' -S'/4- N 1% S• tzr"..S�
6,9-' .sfc RL U'e c-QA-N i
6. REMARKS:
tn.
Material
RECEIVED
MAR 0 8 2006 '
Asheville Regional Office
Aquifer Protection
DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH ISA NCAC 2C, WELL
ONSTRUCTION STANDARDS, AND THAT A COPY OF RECORD BEEN PROVIDED TO THE.WEDL OWNER
SIONATURBOFPERSON CONSTRUCnNOTHE WELL . • DATE -
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mali Service Center -Raleigh, NC
.27699-1636 Phone No. [phone], within 30 days.GW-I RSV. 07/2001
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- .WELL CONSTRUCTION REC
North Carolina - DepaMlgd of Envlmmneat and Natural Resources Division or
1?•��ft S
:PuoriR i ILSa ti-3 24 0
WELL CONTRACTOR(INDfIIDUAL1IAME(pied rf)t tP11
wets CONTRACTOR COMPANY NAMat',(trC ldal l�fl�-.i �i)
ORD
t"aterQuality- Grotmdwatcr Section •
�"
1 A •t, ` ctcgrivicnTioSi ottne
STATE WELL CONSTRUC ION PERMiTs ASSOCM1ED wtl•Pmisers
(if applicable) - ;-(ifappltable) ' .
1. WELL USE (Check Applicable'Box): Resideatiai etmdcipaUPubuc O Industrial 0 Apiculture! • p
Monitoring 0 Recovery 0' heat Pump Watei Injection 0 Other Cf If Oilier, List Use
2. "WELL LOCATIO�l:
Nearest Town: "-WitHILL; Al' comny,Vl ante)
C lsets a RAPE I- 0ti a
(Street Name. Numbers, Comm * Subdivide; to Ho., rip Cede)
3. OWNER Gil 0.. t G4 /Ye' a. R a. ea.
Address O. So X / 7 4 3
(Strssl Roj)
oviet
4t RIKIAsa! . N-C• at cfi
$_2j-n�3r49- 3Yf39- •ripc'de
•
cede- Phone amber
4. DATE DRILLED / —J 4 -0 L
5. TOTAL DEPTH: 30S'
T�pvgtsph c/Land setting -
LBiCdge OSiope Malley OFlat
?T3 (eh.aawrcpdatehrd .
Luwtaaenongihtda of w,II location
, (deyeahoiau shecondo
Ladtuddlongibide source:OGPSDTopographic map
(See hoe) -
D . DRILLING LOG
From To ' Formation Description
_- cs• g17• >
F' • 3.0.5 • ,Q L. U E, G. 12ant i t -e.
6. DOES WELL REPLAN EXISTING WELL? YES�� NO Cr-'
7. STATIC WATER LEVEL Below Top of Casing r- ..
/ (User if Ahore Top of Ca4oa)
8. TOP OF CASING IS FT. Above Land Surface*
'Top of easing terminated atha•helar tendaaatia riven ■ _-
mina H ssadaaa rW'ISATfCkC SC MIL
9. YIELD (gprm):�'�t�ODOFTEST /j% ett. -.
10. WATER ZONES (depth): a I'S • Q
LOCATION SKETCH
11. DISINFECTION.Type l flf: Amount .2 TA-B S Show direction and.distance in miles from at least
12. CASING: - Wall Maness two State Roads or County Roods. Include the road
• DcPt or weight) t. numbers and -common road names.
From . O To S 75L R-�• Maim*
-
From To Fi.- -•
From Tp Ft
13. GROUT Depth Material Method .
From n Toe' Ft Cterns,7 f »ice
From To H.
.4. SCREEN: Depth Diameter . Slot Size : • Material
From To FL. —in. in.
From To FL ___in. in.
5- SAND/GRAVEL PACK:
Depth Size Material
From To Ft
From To Ft,----
6. REMARKS:
DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE Wff11 ISA NCAC 2C, WELL -
RECEIVED
MAR 0 8 2006
Asheville Regional Office
- Aquifer Protection
ONSTRUCTION STANDARDS, ANDTHAT A COPY op s RECORD BEEN PROVIDED TOTHEN/ELL OWNER
/ —19 --6. 40.
SIGNATURE -OF PERSON CONSTRUCTING THE WELL DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center -Raleigh, NC
427699-1636 Phone No. [phone], within 30 days. . OW-1 REV. 07/2001
rrt
cri
co
J
0
s

, (dePealmkatabeobnds)
Latitude/longitude source:OGPSOTopographic map
Meek Ma)
DEPTH ' DRILLING LOG
From To - Formation Description
0 Lek, • r L 61. t.
1.?s' 3os- inure, GR/q.trit-e
(Uua^N if Above Top of Casing)
OF CASING IS / P '. Above Land Surface*
of eat' mintb.nor bdgw I$aasarfaw requires _-
alnASINGeewthISAIICAC3CA11L /
(gpm): / f ,MBTHODOFTEST_,hi0)//pc4-, -
1 ER ZONES (depth): / SS 5 �(e,5 • Q
! FECTION: - LOCATION SKETCH
Tree .44-f%F: Amotmt , Th-S $ Show direction and distance In miles from at (east
1 CASING: wall Thickness two State Roads or County Roads. Include the road
fl• ePd13 5 er WeiishUlt. Ma • 1 "-number and -common road names.
To �5/2R:2i PTO;
T9 FL
I UT: Depth Melnik] Method .
To t ?; FL &Q47t G� op.. .i
To Ft.
risen unison
-,
• . WELL CONSTRUCTION RECORD -
North Cdoline - Department of Envt nun tt and Natural Resources.- Divlslon of Water Quality --Groundwater Section
WELL CONTRACTOR (1NDIYJDUALWAMEz(pAaq ch-P_n P11 S I,�n /1 n„n rt..'' � 1CAT o/S i -a/7 to
WELL corm roa COMPANY NAMS'tX. r AnIfne i II1EII ys -�(�-' ne i•PHONE f+ -t .�Sa'C 4-'3 a�.H 0
STATE WELL CONSTRUCTION PERM`'—" - w -
(ifappliabla) -
•
1. WELL USE (Check Applicable Box): Residatnisl7Ylrltaiolpal/PubUc O industrial O Agricultural O
•
Monitoring 0 Recovery Cr Heat Pump Water Injection 0 Other Cf If Other, List Use
2. -WELL LOCATION:
Nearest Town /GL:
dfN min) county
(Sued Name. Numbea. Community, Subdivision, Lot No.. Tap Cade)
3. OWNER: (7e n hL. /Yl c jm (e t/
Address R 0 o rs - 0: T r {�
(Stunt Romexo.)
Fin/Jai j e/� P73 9 .
Mini Stitt . rip Code
LQ .369— 4/3rf
Arta code- Phone number
4. DATE DRII I FD .- —/ 5 —O Co
5. TOTAL DEPTH: ? OS
6. DOES WELL REPLACE EXISTING WELL? YES O N0.2J..
7. STATIC WATER LEVEL Below Top ofC.asing: S 0 - FT;
8. TOP
9. YIELD
0.WAT
1. DISIN
2. CASI
From
From
From
3.GRO
From
From
4. SCREEN: Depth Diameter . Slot Size : = Material
From__ To FL in. in.
From To PL _In in,
5. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.___
From To FL____
6. REMARKS:
-(Tttpplicabl,J
. Topograp Lind setting -
ORid a LBSI
g ope 17Vatley . OFlel
LstiturI etude Of well location
le let 'r' . SAA/cl Y
RECEIVED
MAR 0 8 2006
Asheville RegionatOffice
Aquifer Protection
DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH ISANCAC2C, WBIL •
ONSTRUCTIONSTANDARDS, ANDTHATACOPY OF noS RECORD HAS BEEN PROVIDEDTIOTHB.WELLOWNER
SIGNATURE -OF PERSON CONS7RUC17N0 THE WREL . DATE
-71
0
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mali Service Center. Raleigh, NC
:7699-1636 Phone No. [phone], within 30 days. OW-1 REV. 07k001

• , ,•'
- . WELL CONSTRUCTION RECORD -
North Catolina - Department ofEnviroanaot and Natural Division ofWaterQuality-- Otoiutdwater Section �"
M
WELL CONTRACTOR (WDtV,tDUAL) (pin Egchf rt'llS / Jlnasrt. - r CEi4TtP(�C,(7�70/t(iot/%•C
WELL CONTRACTOR COMPANY NA$ rAfta PQ,'bo rt Intl I SI 4I �1t .(_ yK'P J •!HOt a jj' 'a LI-3 2-6 a
STATE WELL CONSTRUCTION PERMIT/ • ASSOCIATED WIPfilitell -
(ifapplicable) _ - •(irapp&able) • .
1. WELL. USE (Check Applicable Box):.Residen al�Y[rl mieipal/Public 0 Industrial CI Agriculture! 0
Monitoring 0 Recovery ❑' Heat Pomp Water Injection 0 Other Ef If Other, List Use • -
•
2. WELL LOCATION:. Topogrspbic/L,and setting -
Nearest Town: P/Q`tA/r(C. ii d - County M Alex, - - Las 0Slope °Valley °Flat
t$Q E P//;JAy I&•1- lie. t„tees Pa."Se/ty.c (dteckappoptiate box .
(Street Na Numbers. Canm'mitt',Sabdivl.ioo,tolNo,TWCode)ag.7-3 y L`atitmldiongitudaofwdllocation -
3. OWNER:ne re/2eC4. ena-M -
Address 3')// N. 55fly AV e • Latitude/Ion!hide °GPSOT h-
tsamsanasewo.) •
RDdyy/i/ned F/. 330a-/ DEPTH
Ctt}QrTam State "' -Tip Cade - .From To -
t9s�H S9f4. 96�9 . __ e�/,.
Area code- Ph011e number 4. DATE DRILLED O2 — /� h G Lf rn D S •
5. TOTAL DEPTH: (o O S'
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO_ & k-
7. STATIC WATER LEVEL Below Top of Casing: (F n -FT:
(Use W ifAbove Top of Cubs)
S. TOP OF CASING IS � FT. Above Land Surface*
'Top of whit tarmlaat.d at/or bet6w iaataarfwo midst, a ..--
rattan
la aeaed000e w(th I5A1fCLC 3C A11L.
9. YIELD (gpm)): / 3 . METHOD OF TESTJYJ/nJ) x4 ,
10. WATER ZONES (depth): `f 90 ' J 9 /GI' (j
(degraedmicutaleecands)
gl ' source: opog ap hi map
(Sok box)
DRILLING LOG
Formation Description
P Ly
• 9 6y
7 31.
. Ali? (,.'P/fC//t=
LOCATION SKETCH
11. DISINFECTION: Type /1-t'lt Amount .� T -4 5 Show direction and distance in miles from at least
12. CASING: n- Wallor Thickness two State Roads or County Roads. Include the road
Fronti� • peltt ! (J FDisPerler WeighUFL numbers and -common road names.
To" saR-,al
From To Ft
Front Tq FL___„_
13. GROUT: Depth Material
From_l To Q Ft C1.'-
From To Ft
.4. SCREEN: Depth Diameter . Slot Size = • Material
From To Ft, in. in.
From To FL In. in.
5_ SAND/GRAVEL PACK: .
Depth Size Mater- - ial
From To Ft,
From To Ft
6. REMARKS:
RECEIVED
MAR 08 2006
Asheville Regional Office
Aquifer Protection
DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE MTH ISfNCAC2C,WEILL
DNSTRUCTION STANDARDS, AND THAT A COPY ornqs RECORD H&S BEEN PROVIDED TO TH&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
a17699-1636 Phone No. [phone], within 30 days. . OW-1REV. 07/2001

• WELL CONSTRUCTION RECORD' -
• Nortl,.Caiolina - Department of Environment and Natural Resources -
Division of Water Quality- Choundwater Section
WELL CONTRACTOR ONDIVIDUAL)TIAME IpAa» c7)tfi In15 I i . 1)fbe d- '` cgIiIIPlCATt011 s 'an (!
WELL CONTRACTOR COMPANY NAMSbler•
r.S Pa flle(I1)'flj-u, I. y_we, 'no.
sTrat -24 -3 ab 6
STATE WELL CONSTRUCTION PERMITS - -
inapplicable) ASBOCLATEDW ERI • . "`?
. •(ifapplteabie)
I. WELL USE (Chock AppliwbltsBox):-Residential w M micipauPublic O industrial 0 Agricultural
Monitoring ❑ Recovery O" Heat Pump Water Injection ❑ Other cf If Other, List Use
M : t� eQ. " - , Negneshostiliccando
5 3 (0 7 ab a.� et. k) fry 11 R . LatitudeAong)tta& sour cOGPSOTopographic map
(saeetjta.teNo.) (cheek box)
Fat-?14 ?mfr. • i✓ (• 3 9-7 r'7 DEPTH '
Gip orTaloa State Zip Code - . From To -
Sq• AD. p :s•
4- DATE DRILLED eV
5. TOTAL DEPTH: 3OS' ,
6. DOES WELL REPLACE EXISTING WELL? YES O
7. STATIC WATER. LEVEL Below Top of Casing: t X 0 '-FT;
(User if Above Top'Dittman )
8. TOP OF CASING IS / FT. Above Land Surface*
*Tap of a slag termlestad War baltw lautloarfarte requires a
radian N sesordaaes wRY13ATICAC 2C Ala
2. "WELL LOCATION: . Topota/L rind setting Nearest Town: PRANlet; A/ " county A -Got •
" B -
�P E E L / i J,¢ y ,Qd ' {iyl L nr./i - - go —"o$ Malloy . OFiat
(Seven Harae. Numbers. Comm*S6risim, La No., Tap Code) -`//�"//jf Latitldt/1 w� , . e2 y3, f tmgitude titwe ll location
3. OWNER
Address
Area code- Pbone number &S. Sds•
9. YIELD (gpm): Q MBTTHOD OF TEST AjiOgi 7f4..,
• / (/
10
. WATER ZONES (depth): .SD'J ',fib
11. DISINFECTION. Type /1-1-14, Amount oZ TA ; 5 Show direction and.dislana in miles from at least
12. CASING: - Wall Thielmess ' two State Roads or County Roads. Include the road
Ft,a Weiight/Ft �"-numbers and common mad tames.
m—�Tc 3 S S,22R•,�- -
To Ft •
From Tp Ft_�
(3. GROUT: Depth Material Method
From_A To .0a Ft eani.„7 pewit"
From To Ft.
.4. SCREEN: Depth Diameter . Slot Size - , Material
DRILLING LOG
Formation Description
i3LUe Lr 2/-vTt'. ..
Fro
From
•
LOCATION SKETCH
Front_To FL in. in. . RECEIVED
From To Ft._____ta in. .. ;
5. SAND/GRAVEL PACK: ,
Depth Size Material MAR 08 2006
From To Ft.
From To Ft. Asheville Regional Office
6. REMARKS: Aquifer Protection
DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCrFD IN ACCORDANCE WtITI ISA NCAC 2C, WELL .
ONSIRUCTIONSTANDARDS, ANDTHATACOPY OF nqsS RECORD HAs BEENP$OVWEDTOTHEN/ELL OWNER
SIGNATURE -OF PERSON CONSTRUCTING THE WELL - • DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mall Service Center-Ralelgb,-NC
.17699-1 636 Phone No. [phone], within 30 days. _ - OW-i REV. 07/2001
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• . WELL CONSTRUCTION RECORD'
North Carotins - Department of Environment and Natural PiResources - Division of Water Quality'- (3roimdwater Section
wets. CONrRActon(INDIY,IDUAWTtAata (pine rt./V. rI 15 / I111„A Ai *;• `_ CE1't7PICATIONa_� ��--rr
�r!te
wets. CONTRACTOR COMPANY NAINIE1 r.c fejlgrd lilaIIlya; iI:u -rent i'rsorslint Sat/-3 ab a
STATE WELL CONSTRUCTION PHRtttre - ASSOCIATED W mirdnS
(If applicable) • . -Ofappliablc) • .
I. WELL USE (Check Applicable' Eox)-Residentiati tmiaipaYPubuca Industrial 0 Agricultural CI
Monitoring CI Recovcry CI' Heat ?tulip Water itpcction ❑ Other CI If Oilier, List Use
2. "WELL LOCATION: Topogt>gthic/Lend •setting -
:: County /1 lai fSI ' OVali fFlat
Nearest Town:
oJC A fL 7-244 a L (check aapropdate box)
(Snrea Name. Rumbas, Community, Sobdividan, lot Nov raapcade) _ a 73 y L'atihalenongitude Ofwell location
3. OWNER enpi.4"e f sywe.
Address Pl)• BOY a 0 37
(SttntoiltaueNo.)
FRA• ett.:at, NC ti I 549
, (deanee mtnumdae )
Latituddlongittide saourcc:C70PSfTopogtaphic map
(check boa)
DEURCity or Tetra sate DRILLING LOG
cig - a 7 / » / 9 % 9 ' From To• Fo tioa Description
4. DATE DRILLED of % ..- D Iv =Ain code- Phone number �0 �. ` ..5:S • �t!'
5. TOTAL DEPTH: 4'SS' •,
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO_ —'
7. STATIC WATER LEVEL Below Top ofCasiing: j D a FT:
(User NAboreToop of Cubs)
8. TOP OF CASING IS / FT. Above Land Surface*
-
'rap of using awninstedodor belarrleod.urtsn rpalroa .
varlaaala esordaoeewmr'tSANCAC7CA1I$. /•
0. WATER ONES d G METHOD O TEST 6lDU]/r
t I. DISINFECTION: LOCATION SKETCH(
Type H•-rJN, Amount of T -S 5 Show direction and. distance in miles from at least
12. CASING: - WaU 'Endows: two State Roads or County Roads. Include the road
Dt•.�1a or Weight/t. Ma "-numbers andcommonroad names.
From 0 . To 1 Ft - S.Txgn a '' .
From To FL_
From Tp FL
13. GROUT_ Depth - . Materiul Malwd.
From_O_To ,4t7 FtF3�,(,O
From To Ft.
.4. SCREEN: Depth Diameter _ Slot Size: • Material •
From To FL
in. in.
From To Ft`_in. in.
5. SAND/GRAVEL PACK:
Depth Size Material
From To FL
From To Ft
6. REMARKS:
• - •
DO HEREBY CERTIFY THAT THIS WELL. WAS CONSTRUCTED IN ACCORDANCE WITH ISA NCAC 2C, WELL
ONSTR(1CTION STANDARDS, ANDT AAT✓A► COPY OFT S RECORD BEEN PROVIDED TO MEI WELL OWNER
ear IIF.(� "l� o?-7--0
RECEIVED,
MAR 08 2006
Asheville Regional Office
A • uifer F
SIGNATURE -OF PERSON CONSTRUCTINO 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. our-i REV. 07/2001
-71
ri
0
0

•
- . WELL CONSTRUCTION RECORD -
North Carolina - Department of Environment and Natural Resources - Division of ate: Quality-- Groundwater Section
WELL CONTRACTOR (1NDlY•1DUAL)ws un.q hGfivit 5 /jn/171.n d. ` ' •`" c 'ny1CAT1ONi .a/7(P
WELL comlucroa COMPANY IAattria°.1i41r.S jdejlf(,,,1 Eifel ia-lY.li;1t �(_'�weJ'PNoiIR s SaY--3'60
Q�(P 1
STATE WELL. CONSTRUCTION PHRp CONSTRUCTION - �OCIATED W iRaf11Y ' -
(if applicable) lit applicable) • . - -
1. WELL USE (Check Applicable Hox):-Residential (YMmiicipalPublc 0 Industrial Cl Agricultural
Monitoring O Recovery O- Hat Puny Water injection O Other 17 If Oilier, List Use
2. -WELL LOCATION:
Nearest Town: Le County, A tan
4'4 W 4/aienel •
(Street Name, Numbers, Community, Subtavidoo, La No. Zip Cadet
3. OWNER: / ro t 14 i C JCS (h %pip 1 Qe c
Address as N P 4- 1- l; a e r
(Strea.KaoteeNo.) .
fRANkL;_A/ N.C. a2 fl 9
ciry Or Town Stale - - Tip Code
Q .S()- Sa. if) 490
Am rode- Phone amber4. DATE DRILLED ( - —a&
5. TOTAL DEPTH. 0 S ' - •
.. Topo - ogaphjrltaad setting •
ORidgo ape Ovaley OFlat
(Meek appropriate boa) .
Latihtde/lortgitude of well location
, (tiepradmtausnhevmtda)
Latttudellongittide sourecOOPSOTopographic map
(cMgtboa) -
DECfH.. DRILLING LOG
From To Formation Description
O -9'l0 '
„56'QS� G
6. DOES WELL REPLACE EXISTING WELL? YES ONO IA/'
7. STATIC WATER LEVEL Below Top of Casing % 0 FT:
(User if Above Top °MCaaias)
8. TOP OF CASING IS / FT. Above Land Surface*
'Top of eating tevmbated aUor Rehm aaaaarfMe raqulrta . -
vartap4amordamewdtY75ATjCACICA11a. //
9. YIELD (wpm): *0 METHOD OF TEST_•/ 1/020Per
10. WATER TONES (depth): /; S' , •V. '71'
11. DISINFECTION.Type it-ni. Amount c2TR-S
12. CASING: - - Wall Thickness
Depth
From ii . to /b G
From To Ft
From Tp FL
13. GROUT_ Depth Materiel
From_QTo rid Ft. earlsap,7
_
From
m Weishi[R. M4'-4-3
To Ft.
.4. SCREEN: Depth Diameter . Slot Size - , Material
From To Ft min, in.
From To Ft, in. in.
5 SAND/GRAVEL PACK
Depth Size Material
From To Ft.
From To FL
LOCATION SKETC}(
5 Show direction and diatancc in miles from at least
two State Roads or County Roads: Include the mad
--numbers and -came on road names.
Method ,
6. REMARKS:
•
RECEIVED .
MAR 0 8 2006
Asheville Regional Office
Aquifer Pro 'on
DO HEREBY CERTIFY THAT THIS WELL WAS CONSTR�UCTED IN ACCORDANCE WWI ISANCAc2C, WELL
•
INSTRUCTION STANDARDS, AND THAT ^ COPY OF 1_ RECORD HAS BEEN PROVIDED TO THEN/ELL OWNER
. [ r Wd� /'• PB�fX.Qiypiie-+ a -I, (/
SIGNATURE OF PERSON CONSTRUCTING THE WELL . DATE
Submit the original to the Division of Water Quailty, Groundwater Section, 1636 Mali Service Center_ Raleigh, NC
„27699-1636 Phone No. [phone], within 30 days. - GW-I REV. 07/2001

• . WELL CONSTRUCTION RECORD " :
.h. ` 4
North Carolina - Department of Environment and Natural Resources - Division of Water • ) � Quality.'- Giroimoiwator Section
WELL CONTRACTOR (INDlyIDUAL)NAaaE (prlat) c�.! ?this 5 I�n f I i rt, •`. -` - ' 77tr[CAT(Ot(/ /i [�
WELL CONTRACTOR COMPANY NAM1 C IA Illell ._ . �13( 1�I vrl �, .1iI-le'j'•n:t•4eFUOitsitAltSe_.sa4-3Aba
STATE WELL. CONSTRUCTION elxative - ASSOCGTED ziMrr - -
(irappliable) cif applicable) •
1. WELL USE (Check Applicable Bout): Residential rrMu ticipal/Public ❑ Industrial O Ag is ulhu.aat CI
Monitoring CI Amor, Q' . Hat Pump Water Injection Q Other CI If Other, List Use ' .
2. "WELL LOCATION: .
Nearest Town:/ /fifr%L; 4/County A 4- (ix) _ $iC(Land setting '
- 9- C.-lrido 1 n.•e- I?rt_ 1/73 `t . ( wx) 0F4
(Street Nano. Rumbas. Community, L-
at'. SabrriaJia_4 Lett No., Zip Cade) atihu()tJbugitude Of well location
3. OWNER:,_,P a VI e l l -e i JW? ii — , (d miauterheo6ttdr)
Address CO 5 0 /9 P JV g •A t S" , ta(itudeAongitpde source:QOPSE To tic ma
(SaaraiitowsNO� PograP P
0 Co e e r-/. .3 9-7/ (chaehbox)
City or Town State .. - 'Tap Code
(�- ludo-�99C '
5. TOTAL DEPTH: AF-Ar - • (o
6. DOES WELL REPLACE EXISTING WELL? YES Q NO QJ/-
7. STATIC WATER LEVEL Below Top of Casing LOOPY:
Arca code- Pbaoe number
4. DATE DRILLED -. 0-6 ,
8. TOP OF CASING IS (Use*" abmeTop of Casing)
FT. Above Land Surface*
'Top or ragtag terminated War balmm ynd.sarGp re po s a
aartua 4 ainerdairsadailSATIC.AC 2C AUL
9. YIELD (gpgt): 72 METHOD OF TEST %D)U 7is
10. WATER ZONES (depth): eh) ' (/
DEPTH DRILLING LOG
m To f', Ftitmatiom Description
tr; r
�O.C' 2 li r
•
0N SKETCH
11. DISINFECTION: Type /4-$ff- Amowt .2 TA•B $ Show direction and in miles from at least
12. CASING: Wall Theban two State Roads or County Reads. Include the road
From _TDeptho C (' F( Diameter . or Weight/Ft numbers and common road names.
From To Ft,_,_
From Tp FL__,^
13. GROUT_ Depth Matmiel Method
From_
om—FromfTo To tD Ft ( aPAJ . . -
.rn
4. SCREEN: Depth Diameter . Slot Sim - • Material —IFrom To FL,_ jn: in.
From To FtRECEIVED � ____ n. is c,
5. SAND/GRAVEL PACK .
Delnit
From ToFt. Size Material MAR 0 8 2006
Asheville Regional Office
A' uiterProtection
DO HEREBY CERTIFY THAT THIS WELL WAS CON
'ONSTRUCT ION STANDARDS, AND CONSTRUCTED IN RECORD HAS
BANCB PWITHROVIDED
ISAED O TH 2C, WELL .
THAT A COPY OF S HBgN Pi(Oy1Dg6.I.O.IHH�W$[.L OWNER
SIGNAT URE OF PERSON CONSTRUCTING THE WELL, . DATE
t
From To Ft.__
6. REMARKS:
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mall Service Center -Raleigh, -NC
.77699-1636 Phone No. [phone], within 30 days. . OW-1 R V. 07/2001
``2 2

Arta code- Moe aea eer
4. DATE DRILLED od -/ 6 D -2
5. TOTAL DEPTH: 3 OS' L/J -e TRAIL -ft-Q-
6. DOES WELL REPLACE EXISTING WELL? YES O NO WY-
7. STATIC WATER LEVEL Below Top of Casing:
Warr it Above Top ofVaaied)
8. TOP OF CASING IS / FT, Above Land Surface*
*Tap of cadaa taro noted aUer balaw gatsar6arequire a
variance in ueerdanee whir"1SA?ICLC 2C Atha. /�
9. YIELD (gprn): a n METHOD OFTEST_./1Jl/P8pflt,
10. WATER ZONES (depth): 9n 5 A 7/)'
• .WELL CONSTRUCTION REC;,
Nord, Catolina - Department of Environment and Natural Resources - Division Of Wain Quality-- Orodndwater Socton
WELL CONTRACTOR (NDn(WDUAWNAMZ(Pt1al) The Pi PI I j.]tjfn«;:t,`-_• '=•° . ;T c;mons and
WELL CONTRACTOR COMPANY NAME S fn I11el I htl 1�f wrl AY-ll-u j-K� Panora itk%Sa4-3 air 0
STATE WELL. CONSTRUCTION PSRMhT
(irappliable) ASao -(lt pp Ewa1Ti
• Or.Pplicahle)
1. WELL USE (CheckApplicaWdBox):-Resideutialynunteipal/Public 0 Industrial 0 Agricultural a
Monitoring 0 Recovery 0 • • Beat Pump Water Injection 0 Other CI If otter, List Use -
Z.-WELL LOCATION: BaPlc/L end setting
•
Nearest To L Coun /V f}(D 'dge °Slope OValey OFlat
A/ �' CC D 13S f3 R : w2 a g q �.� (cheek approprbte bq4
(�N.me.Nties. ty,Subdi, Subdivide; of ,llocauon
3. OWNER: GY e 20 e(25 - ( iouttsf )
Address 9Q-/! e 5W GUcc ga LatitudPAongitude souNx:OOPS°Topographic map
(srreµerRoweNoJ (eke* has)
fefrAIILLI-IfJ Ain; , R'T (f DEPTH ' DRILLING LOG
(sail or Town Sure .. - rip Code .. From To ' FormatlonDescription
'� `,, LOCATION SKET41(
11. DISINFECTION:
TYPe Amount a T/1,-S 5 Show direction end distinct in miles from et least
12. CASINO: Wall Thickness two State Roads or County Roads. include the road
Dept Dia� et or Welln(Pt, numbers andcommonroad names.
From__Q_To 1,9 Ft. he SbR_,p. .
From To Ft.__._:.
From Tp FL_�
13. GROUT.
From_ To Depth
Ft. sett POWS)
From To
.4. SCREEN: Depth Diameter . Slot size : = Material .
Ft. __in: in
From To RECEIVED
From To Ft. __in, in. i
5. SAND/GRAVEL PACK
Depth Size Material - MAR 08 2006
From To FL -
From To Ft.
Asheville Regional Office
REMARKS: A e offer Protection
6.
DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH ISA NCAC2C, WELL •
ONSTR()CrIONSTANDARDS, AND THAT ACOPY OF TIT RECORD HAS BEEN P1;OVIDEDTOTHE:WELL OWNER
SIGNATURE -OF PERSON CONSTRUCTINGTHE 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. 07/200I

RESIDENTIAL WELL CDNSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources- Division of Water Quality
WELL CONTRACTOR CERTIFICATION $ 2187
1. W!LL CONTRACTOR:
.assell S. Taylor
W«il Contractor (Individual) Name
,'3_ ten Brothers Well Drilling, Inc.
Weh 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 agl applicable)
S'En': WELL FERMITN°, applicable)
D ,t<<] or OTHER PERMIT Cif applicable)
:dLL LJSE (Chec pplicable Box): Residential Water Supply 0
r:h f E LED—, /�Lr� t
T10.iE COMPLETE // �J � ZQO� o AM ❑ PM lty
3. WEL L LOCA ION:
CITY: k
OUNTY OINN'v ,
Over Name, IJOmberg, Community. Subdivision, Lol No., Parcel, 21p Code).
TOPOGRAPHIC / LAND SETTING:
O ;lope ❑Valley ❑Flat ❑Ridge ❑Other
(check epprdprlete box)
L/IITUDE .,g AUN
LOi'ILTITUDE an.5
May be In degrees,
minutes, seconds or
In a decimal format
Lati•ude/longitude source: cp.CtS ❑Topographic map
Ibcatbn of well must be shown on a USGS topo map and
attached to this form snot using GPS)
4. WELL OWNER
OWNER'S NAME
S7 kEET ADDRESS
•; orLTown /(ySttteel
,`, lee
'ore: .oi
Phone number
//Uy/
3
Ip Code
5. WELL DETAILS: t �1 r
a. TOTAL DEPTH: 00
b. DOES WELL REPLACE EXISTING WELL? YES 0 Wit
c. WATER LEVEL Below Top of Casing. .--.... FT.
(Use "+' If Above Top of Casing)
d.y TOP OF CASINO is 2 FT, Above Land Surface`
'Top of casing terminated aVor below land surface may require
a variance In acco dance with 15A NCAC 2C .0118.
e..YIELD (gpm): t% METHOD OF TEST Blow
I. DISINFECTION: Typo HIT H Amount 160Z
g. WATER ZONES (d pt ):
From 931`To 7 7 r From To
From To From To
From To From - To
8. CASINO; Thickness/
Depth ra Dia Weight tly�ji31
From p J'*'cLCLxT. Ft
rte.
From Q'To Ftsee qui
From To Ft.
7. GROUT: Depth Material Method
From 0 To?20 Ft. CE'r-T't' & hawite rutted
From To Ft.
From To Ft.
e, 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:
Depth Size Material
From To Ft.
From To Ft.
From To FI.
10. DRILLING LOG
From To n
4v1 /,Q1'
11, REMARKS:
Formation Description
Clay & sand
Granite
Tl
L1
D0 HERESY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH
ISA NCAC 2C, WELL CONSTRUCTION STANDARDS, AND THAT A COPY OFF THIS
RECO AS SEEN PROVIDED TO THE WELL• NER. hh
/ V
SIGNATURE OF CERTIFIE W-+E CONTRACTOR E
Russell S. Taylor
PRINTED NAME OF PERSON CONSTRUCTING THE WELL
Submit the original to the Division of Water Quality within 30 days. Attn: 1'ET4Y,E D
1617 Mall Sarvlcs Center —Raleigh, NC 27699-1617 Phone No. [phone] ex
MAR 0 8 2006.
Form GWta
Rev. 7/05
Asheville Regional Office
Anuifer Protection

3. WELL LO
CITYi
,: NON ON 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
iiedden Brothers Well Drilling, Inc,
Well Contractor Company Name
STREET ADDRESS 73 Holly Hills Vista RD
Pranklin, NC 28734
City or Town State Zlp Code
828 )• 369-9591
Area code- Phone number
2. WELL INFORMATION:
SITE WELL ID #(ir applicable)
STATE WELL PERMITeof applicable)
DWQ or OTHER PERMIT #(If applicable)
WELL USE (Check Applicable Box) Monitoring 0 Municipal/Public 0
Industrial/Commercial 0 Agricultural 0 Recovery 0 Injection 0
Irrigation° Other 0 (list use)
DATE DRILLED
TIME COMPLETED - 3 : 00 AM n PM ro/
TIO,,. � //���
COUNTY i%"(/,ua
(Street Name, Numbers, Community. Subdivision, Lot No., Parcel, Zip Code)
TOPOGRAPHIC / LAND SETTING:
❑Slope °Valley ❑Flat ❑Ridge in Other
(check appropriate box)
LATITUDE_alibi 143 A)
LONGITUDE Pig Al A' 5i.c)
Latitude/longitude source: o PS ❑Topographic map
(location of wel/ must be shown on a USGS opo map end
attached to this form If not using GPS)
4. FACILITY -le the name el IN business where the well Is located.
FACILITY ID #(If applicable)
NAME OF FACILITY All
May be in degrees,
minutes, seconds or
in a decimal format
STRT ADDRESS /D _ , , _
6 ,A(�C� r ?_
City orrrown ,��!It� a,, nShta�tee ,, � Zip Code
CONTACT PERSON 0
MAILING ADDRESS d
City or Town State
c5a(c /( 5
Area code • Phone number
5. WELL DETAILS: a. TOTAL DEPTH; Rno'
b. DOES WELL REPLACE EXISTING WELL? YES ° NOX
e. WATER LEVEL. Below Top of Casing: ?JOD FT.
(Use sir' If Above Top of Casing)
Zip Code
SO
tso
I ;
(
d. TOP OF CASING IS 2 FT. Above Land Surface'
'Top of casing terminated at/or below land surface may require
a variance In accordanceanwith 15A NCAC 2C .0118.
e. YIELD (gpm): o`^' METHOD OF TEST B1ow
f, DISINFECTION: Type H T H Amount 16oz
WAT
R
9 FromE &fTo(d 11 / From To
From__To From To
From To From To
6. CASING: Thickness/
From D DTothtip( Ft. Dire*
From To Ft. t3
From To Ft.
Weights M eria)
7. GROUT: Depth
K Material Method
From (� To a JoQ Ft.htl( nr%.I gyfru,1+-4 4 noc
From To Ft.
From To FI.
8. SCREEN: Depth Diameter
From
From,
From
To Ft.
To Ft.
To Ft,
9. SAND/GRAVEL PACK:
Depth
From To Ft.
From To Ft.
From To Ft.
10. DRILLING LOG
Slot Size Material
In. _ In.
In,
In. In.
Size Material
From To Formation Description
11. REMARKS:
r1
1
O'
100 HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTEO IN ACCORDANCE WITH
ISA NCAC 2C, WELL CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS
RECS BEEN pppyl ED T THE WELL NER.
SIGNATURE OF CERTIFIED W CONTRACTOR
Russell S. aylor
PRINTED NAME OF PERSON CONSTRUCTING THE WELL
Submit the original to the Division of Water Quality within 30 days. Alri: i',i�lirma�tfatlon �Mph.
1817 Mall Service Center -Raleigh, NC 27899.1617 Phone No. (919) 733.701R'¢�r•E I Y D
MAR 0 8 2006
Form GW1b
Rev. 7/05
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 #
1. WEL... L.L CONTRACTOR:
James B. Brown
we Contractor (Individual) Name
Hedden Brothers Well Drilling, Inc.
Well Contractor Company Name
STREET ADDRESS 73 Holly Hills Vista Rd
Frank] jn, NC 28734
City or Town State Zip Code
L$.3_i- 369-9591
A-et.:ads Phone number
2. WELL INFORMATION:
si;'E WELL ID #(If applicable)
STATE WELL PERMITS/Of applicable)
DWQ or OTHER PERMIT #(if applicable)
WEL.. USE (Chet Applicable Box): Residential Water Supply 0
DATE DRILLED
TI'ic COMPLETED' 1 •OS7 AM ❑ PM[g]/
NTY filawcf
.
Street Name, '� mews, Community, SubdMaion, Lot No., Parcel, Zip Code)
T0i'0GRAPHIC / LAND SETTING:
❑Sic a ❑Valley ❑Flat ❑Ridge OOther
(check appr6priale box)
LATITUDE ..;s� ,An �9 l
LONGITUDEi A 1SA i)
Latitude/longitude source: is oTopographic map
tIocafbn of wet must be shown on a USGS tapo map and
attached to this form 5' not using GPS)
4.1R i . )WNER
May be in degrees,
minutes, seconds or
in a decimal format
0' r .cR'S NAME
Y it,EET ADDRESS
l!Y)4 b l iC, 7�y
City or own Stela Ip Code
LWJ. 4- OVA
Area code - P one number
5. WEL. DETAILS: „ rt,., r
a. OTAL DEPTH: �)
b ICS WELL REPLACE EXISTING WELL? YES 0 NO ft
c. Y /ATER LEVEL Below Top of Casing: 4:200 FT,
(Use'+' S Above Top of Casing)
d. 1 :P OF CASINO 18 2 FT. Above Land Surface'
'Top of casing terminated abor below land surface may require
a variance In accordance with 15A NCAC 2C .0118.
e. YIELD (ppm): 5 METHOD OF TEST Blow
From
From
6. CASING:
2095
1. DISINFECTION: Type
g. WATER ZONES (depth)
From ) 33To 2 From To
From To
From To
Thickness/
Depth A • Diameter Weight A1atelial
From To ��"I' Ft.� YUf;
From To 11 % Ft. /d''?�y�s
From To Ft.
H T H Amount 168z
0_d601
7. GROUT: Depth Material . Method
From 0 To 20 Ft. oarEnt & banhite i_1iteed
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 FL
10. DRILLING LOG
From To. Formation Description
0 / LJ ' Clav & sand
11. REMARKS:
Granite
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED N ACCORDANCE WITH
15A NCAC 2C, WELL CONSTRUCTION STANDARDS. AND THAT A COPY OF THIS
RECOR• AS BEEN PROVIDED TO THE WELL OWNER.
ru l —/6 D
RE OF CERTIFIED WELL CONTRACTOR DATE
James B. Brown
PRINTED NAME OF PERSON 6eNCTRJCTINe TIC WE
Submit the original to the Division of Water Quality within 30 days. Attn: Information Mgt., RECEIVED
1617 >sII Service Center— Raleigh, NC 27699-1617 Phone No. [phone] ext 568. Form ,(taw. 7/05/05
MAR 0 8 200
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. WE L CONTRACTOR:
• James B. Brown
W_'I Contractor (Individual) Name
Hedden Brothers Well Drilling, Inc.
W e!! 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 #(Itappllcabla)
S' A Tit.. WELL PERMIT#(II applicable)
DIG :r OTHER PERMIT #(if applicable)
7ti iLL USE (Check Applicable Box): Residential Water Supply 0
DA it DRILLED OS 'I'
TIME COMPLETED 5•406 AMO PA/f�j`
3. WELL LOCATION: �yJ
CITY: Fgam IGL1 A) COUNTY (//ac(,x.
j'{TATLo�x (rrc_ 49
( t '•t Name, Numbers, Community, Subdivision, Lot No., Puce, Zip Cods)
T,+. L.3RAPHIC/LAND SETTING:
0 °Valley ❑Flat ORidge OOther
(check epprdprlate box)
LATITUDE,
L01'CITUDE
May be in degrees,
minutes, seconds or
in a decimal format
Latitrde/longitude source: OGPS °Topographic map
(location of well must be shown one USGS topo map and
attached to Shin corm If not using GPS)
1, WELL OWNER a
OWNER'S NAME Ar '' • ,�• ��7
STREET ADDRESS /a05 D]J yS�r2PJ .�4'
Judaea'
r y or Town State Zip Code
AZIt)- 30-0'/if
?..a code - Phone number
5. WELL DETAILS: ^
a. TOTAL DEPTH: of
110
b. DOES WELL REPLACE EXISTING WELL? YES 0 NOA
c. WATER LEVEL Below Top of Casing: /0c/ FT.
(Use's' S Above Top of Casing)
d. TOP OF CASINO IS 2 FT. Above Land Surface
'Top of casing terminated svor below land surface may require
a variance In accordancerdpwith 15A NCAC 2C .0118.
e. YIELD(gpm): CA(5 METHOD OF TEST Blau
f. DISINFECTION: Type H T H
g. WATER ZONES (depth):
From in To (80' From To
From 01031 To .266 From To
From To From To
6. CASING:
Amount 1 66z
Depth �f Diameter
From (.1 To 8a Ft.
From To Ft.
From To Ft.
Thickness/
We• jBb Ma er4
7. GROUT: Depth Material Method
From () To 20 Ft. clamant & 1m-1:nits 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 Formation Description
Clay & sand
8t)'
sD' 440.
Granite
RECEIVED
MAR 27 2006
A$havillR Regional Uttice
M� far Protection
11. REMARKS: ,/ -,�,�I
l di 4t)an Cub®
100 HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED N ACCORDANCE WON
15A NCAC 2C, WELL CONSTRUCTION STANDARDS. AND THAT A COPY OF THIS
RECOHAS BEEN PROVIDED TO THE WELL OWNER.
CJC
GNATURE 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 Hall Service Center —Raleigh, NC 27699-1617 Phone No. [phone] ext 568.
Form GW-la
Rev. 7/06

L
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.
v tell Contractor Company Name
STREET ADDRESS 73 Holly Hills Vista Rd
.ranklin, NC 28734
City or Town State
L328 )- 369-9591
Arco code. Phone number
2. WELL INFORMATION:
SITE WELL ID #(if applicable)
Zip Code
S. ATE WELL PERMIT#(If applicable)
"."N'Ll or OTHER PERMIT #(if applicable)
WELL USE (Check Applicable Box): Residential Water Supply IDDC,-C DRILLED An/, 1('
TIME COMPLETED , 1 AM ❑ PM GIK
3. WELL LOCAXIO,N::
CITY:
COUNTYLePv
,rn&O ,(1�y411,
(Stree e, umbers, Community. Subdivision, Lot No., Parcel, Zip Code)
TOPOGRAPHIC / LAND SETTING:
❑ iloos ❑Valley ❑Flat ❑Ridge ❑Other
(check appr5pdate box)
l •AiITUDE ._j 5/ Ai. t
LGNGITUDE j ,, / 6 i 1
May be in degrees,
minutes, seconds or
in a decimal format
Lai:tude/longitude source:Gdt`,PS ❑Topographic map
(location of well must be shown on a USGS topo map and
attached to this form 1 not using GPS)
4. WELL OWNER
GUi NER'S NAME
S:lU T ADDRE
ITy or Town - State ZipCode
jz$)-00S-9/9/ &x.,t4
Area code - Phone number
5. WEL..L DETAILS:
a. TOTAL DEPTH:
b. DOES WELL REPLACE EXISTING WELL? YES 0 NO 0
c. WATER LEVEL Below Top of Casing: /09 FT.
(Use "+' if Above Top of Casing)
d. TOP OF CASING IS 2 FT. Above Land Surface*
'Top of casing terminated attor below land surface may require
a variance in accordance with 15A NCAC 2C .0118.
e. ` IELD (gpm): fSCJf METHOD OF TEST Blow
f. DISINFECTION: Type H T H Amount
g. WATER NES (depth): ,
From To ,570 From To
From To From To
From To From To
6. CASING:
1 66z
Depth • Diameter
From .2 To 1rA Ft. (.0
From Jot To
From To Ft.
7. GROUT: Depth
Thickness/
Weight kAatu,ial
itaa
Material Method
From 0 To 20 Ft. ofIEDt & bEnnite pirrs3
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.
S. SAND/GRAVEL PACK:
Depth
From
To Ft.
From To Ft.
From To Ft.
Size
Material
10. DRILLING LOG
From To - Formation Description
' Clay & sand
Granite
IV
ED
7
gional Office
qui er rotection
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
RECORD - - BEEN PROVIDED TO THE WELL OWNER.
i �e aTy`/ A� 6-[16
ATURE OF C 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 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 # 2045
1. WELL CONTRACTOR:
James B. Brown
Well Contractor (Individual) Name
'ioaaen Brothers Well Drilling, Inc.
W a c. onlractor Company Name
S'i I:£ET ADDRESS 73 holly Hills Vista Rd
�:anklinr NC 28734
City or Town State Zip Code
('.L)- 369-9591
Area code- Phone number
2. WELL INFORMATION:
SITE WELL ID #(If applicable)
ST.NTE WELL PERMIT#(II applicable)
DWG➢ or OTHER PERMIT #(5 applicable)
IA i . JSE (Check Applicable Box): Residential Water Supply V
r„ ! _ E,RILLED
TIME COMPLETED
3. WELL LOCAT ON:
L�,{� COUNTY
AM V PM ❑
(Streal Name, Numbers, Community, SubdiNslon, Lot No., Parcel, Zip Code)
TOPOGRAPHIC I LAND SETTING:
❑ .I ^e °Valley ❑Flat ❑Ridge
(check appr6pdate box)
L. ‘, ITUDE �JQ$
LGNL:ITUDE 513
Latitude/longitude source: p'GPS °Topographic map
rdcatlon of wet must be shown on a USGS topo map and
attached to this form /not using GPS)
4. WELL OWNER
OWNER'S NAME
STREET ADDRESS
May be in degrees,
minutes, seconds or
in a decimal format
°Other
City or Towtate I
J L - 1;y1,2
Ar3 7. de - Phone nu bar
5. W ?LL DETAILS: d ""in r
a TOTAL DEPTH:
b. DOES WELL REPLACE EXISTING WELL,?/ YES 0 N0k
e. WATER LEVEL Below Top of Cuing: ADD FT,
(Use v' N Above Top of Casing)
d. TOP OF CASINO 18 2 FT. Above Lend Surfaces*
*Top of casing terminated at/or below land surface may require
a variance in accordance with 15A NCAC 2C .0118.
e. ` fLD(gpm): METHOD OF TEST Blcxa
1. DISINFECTION: Type H T H Amount 1 66z
9. WAT ONES G (de th):
From ToFrom To
From /15 To a/ From To
From c96/' Tor)(..)i3' From To
6. CASING:
Thickness/
Deptllyen . Di nAter Welpht lariat
From To /vo—,Ft. co ' I/
From .2 'To 76 Ft. /a" dB!
From To Ft.
7. GROUT: Depth
Material . Method
From 0 To 20 FL LULHlt & t7enal.te armed
From To Ft
From To Ft.
8. SCREEN: Depth Diameter Slot Sin 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 Formation Description
' 73' Clay & sand
1'
Granite
RFCEIVLIU
MAR 21 20Q6
Astlevllle Regional -Office
0
Aquifer erotectinn
11. REMARKS:
Vr
100 HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH
15A NCA 2C, WELL CONSTRUCTION STANDARDS. AND THAT A COPY OF THIS
REC9R9'kAS SEEN PROVID D TO THE WELL OWNER.
sessi
IGNATURE OF'CERTIFIED WELL CONTRACTOR DATE
James B. Brown
PRINTED NAME OF PERSON CONSTRUCTING THE WELL
Su'.mtlt the original to the Division of Water Quality within 30 days. Attn: Information Mgt.,
1619'4.11 Service Center -Raleigh, NC 27699.1617 Phone No. [phone] eat 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 #(if applicable) STATE WELL PERMIT#01applicable)
•`WQ or OTHER PERMIT #(if applicable)
WELL USE (Check Applicable Box): Residential Water Supply f7
DATE DRILLED
TIME COMPLETED 3 00 AM ❑ PM4
3. 0LATIONn:
CITY: COUNTY nfi�Z�%
O^L��A
C. / ,f % wy`C✓
(Street Name, Numbers, Comm nity, Subdivision, Lot No., Parcel, Zip Code)
TOPOGRAPHIC / LAND SETTING:
El Slope El Valley CI Flat Ridge ❑ Other WA/ '4/(05
(check appropriate box)
,TITUDE _
LONGITUDE 15 21 54
May be in degrees,
minutes, seconds or
in a decimal formal
Latitude/longitude source: Bi GAPS ❑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
ST ET ADDRESS s3.,3"o ' / wocTi lei/
City a Town 2 StateG 3 Zipa` 0
( Wig )- tiQ4 8Y 8
Area code - Phone number
rnD
5. WELL DETAILS:
a. TOTAL DEPTH: 3U
b. DOES WELL REPLACE EXISTING WELL? YES �oO( N
c. WATER LEVEL Below Top of Casing: 1 CV 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.
i
e. YIELD (gpm): O(_../ METHOD OF TEST Blow
f. DISINFECTION: Type H T H Amount 160z
g. WATER ZONES (depth):t/)a
From / To / I From To
From )) I' f To //3 r From To
From a65r To 40 76 From To
6. CASING:
Thickness/
Depth Dia eter Weight aterial
From To Ft.
From 7 To FLTe '" f /814 36749
From To Ft.
7. GROUT: Depth Material Method
From 0 To 20 Fpement & benonite pumped
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
From To Ft.
From To Ft.
From To Ft.
10. DRILLING LOG
From To _
�ril�r
Materiel
Formation Description
clay & aand
grani f-a
RECEIVED
MAR 27 2003
Aahavilfe Regiunal Office
Aquifer Protection
11. REMARKS:
L7
Li
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH
15A NCAC 2C, WELL CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS
RECOOQ HAS BEEN PROVIDED TO THE WELL OWNER.
RTIFIED 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.,
1617 Mail Service Center - Raleigh, NC 27699.1617 Phone No. [phone] ext 568.
Form GW-la
Rev. 7/05

.WELL CONSTRUCTION RE -CORD
North Carolina - Department of EnvironnWia andNatural Resources - Division of WatW Quality'
Resources- Groundwater Section
waLcOwrfRACTOR(m1DIV,IDUAL) E tratmq tilt flfl1S .t rl.'• • - CiDrIC+,ATItii1 f� _ 19 •
WELL cox- actot COMPANY NAMr'_�.p0.tc 1�e11�.{j;,R; 'j-"we 'tritons i<s +2li-'3 a•b a
STATE WELL CONSTRUCTINN Pxinttre ASSOCtAT® W4Wan
(if applicable) -• .
•(ifaepliable) .
1. WELL USE (Check ApplicableBox):-Reaidential'ZYMtmiapaUPublic ID Industrial O Agricultural I7
Monitoring O Recovery O Hat Pump Water Injection ❑ Other aIf Other, List Use •
2. WELL LOCATION:
Nearest Town: 0 OD County An 4 ( 11 /U
If 4-! S LI) a.t t at i e t) tier e1 8r7 lo'►
lsucct Nrme. Numbers, Community, sabBxulaa. tot No. ZIP Code)
3. OWNER JOCLn n • Po-Ch ✓ 0.
Address 7 /af-Ai _ tit- W •
(Smeetyf,No.tmme
Leh, ) a t,.a 1. 33 971
aty ix a3 3 9_ (oa7,2— •Sq Cade
Ann coda Phone amber - ')
4. DATE DRILLED 7 —0 &p -
5. TOTAL DEPTH: I 0. S
opogap�it�L and Setting -
Ridge OSIope galley .Opal
Windt saptapbubox) .
I:Siitode/latgitede of well location
(deareedraionerheseads)
Latitudellatgittide source:OOPSOTopogmphic map
. - (ea.eabea)
DEPTH ' DRILLING LOG
From To - Formation Description
•-
55' '70 S ' -B'-U trRAN%-r .
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO QI �f
7. STATIC WATER LEVEL Below Top of Casing:.0 0 FT:
water Waage* Top of Coshes)
8. TOP OF CASING IS / FT. Above Land Surface*
-Top of easing teradaatsd atlr Wows hsd.sosiaw nquirie a . ;
vsrWn 1. mmentaass wS61SANCLC 3C MIS. J.
9. YIELD (gpm): YD. METHOD OF TEST_,/)/11M4' Q•.
10. WATER ZONES (depth): % 0 '
11. DISINFECTION: yype
12. CASING:
Depth
o Frorn�[_ TS
From To
From Tp
13. GROUT: Depth
From A To AD
From To Ft.
I O(..ATION SKETCH
H i fF: Arnotmt TN•S S Show direction and. distance In mules from at least
Wall Tbidmess two State Roads or County Roads: include the road
. or Weirdu.Flt. Material ''numbers and-eommion road names.
r4_L`L� f i. :Steel -
FL _
a
Mrieriii Method
Ft _ FOWL,
4. SCREEN: Depth Diameter . Slot Sim : • Material
From_ To Ftin. in.
From___—__ To Ft._ in. in.
5. SAND/GRAVEL PACK: - _
Depth Size Material
From To Ft. -
Front To FL
6. REMARKS:
RECEIVED
MAR 2 7 2006
Asheville Regional Office
A a uifer Protection
DO HEREBY CERTIFY THAT TIES WELL WAS CONSTRUCTED IN ACCORDANCE WITH ISA NCAC2C, WELL -
ONSTRUCTIONSTANDARDS, AND THAT ACOPY OF S RECORD BEE?! PROVIDED TOTIEi.WELLOWNER
q —J7-04
SIGNATURE -OF PERSON CONSTRUCTING THE 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. . OW -I REV. 07/2001

• WELL CONSTRUCTION RECOiD' :
",(1 . R
North Cato►ina - Department of Bnviront ent and Natural Resources.- Division: ofWaata Quality'- Ground
WELL CONTRACTOR (IND[VIDUAy�A�yiE �(prdat) Chet? P11 S /`tn i in,A4,'• '^ CEifiusi
WELL conTRACroa COMPANY NAMICIX.Ib')r C IIA IIA*zrtt IIF211 itv111;u one i'ruortEi
STATE WELL CONSTRUCTION PIRM*T/ Assoa T® WQ iciterr - •-'.' .•
Brow sable) {ifspplicable) • .
I. WELL USE (Check Applicable Boo-Residential7YMu ticipaUPubiic ❑ Industrial CI Agriwttu
Monitoring ❑ Recovery aHat PumpO Water Injection ❑ Other if Otlier, List Use •
WELL LOCATION:. opoglapldidLand s
Nearest Town O jib County A C /1 •dge OS1o0e OVan
4-4"IS W &it(LI 1 e o I?A e1 f'763 . We
(Street Name. Numbest. Community, Sundae; Lot Ha, zip Code) - Lgtitude/I014itude newel
3.OWNER Joanh Patti:- va.--
Address 3 i. / 7 /.2frA5 5t- LW.) •
Arts code- Phone slumber
4" DATE DRILLED ea -/ 7 —0 6
5. TOTAL DEPTH: '7 O. ' •.
6. DOES WELL REPLACE RXISfING WELL? YES 0 NO W-
7. STATIC WATER LEVEL Below Top ofCaaing: 0 FT:
(Uas V'KAben Top of Casing)
8. TOP OF CASING IS _/ FT. Above Land Surface*
''Top of cuts; taralaaW at/or bda Ipd.svrfaa motel s
nrlaan la aeardans •dtW1SA7(CAC 2C AMIL.
9. YIELD (gpm): % METHOD OF TEST &1D/.1ix
10. WATER ZONES (depth): 7 0 ' (f
LICAMON
11. DISINFECTION:•Type l-/`H Amount .2TARS Show direction and.disbluce Into
12. CASINO: - Wall Thickness two State Roads or County Roads
Depth _ of WelabWname t. Melerba --numbers and`cotnmon road
From O . To S. 5-F t ij -tee/ -
From To Ft._
From To
, (dgaerhotmoesheeS
Latitudelongitdde sourcaOOPS(
(SaarDr"RwteNb. (deem
Leh; ,� {. 335z� » . >�
MYR Soft zq,Cade From To ' Form
tat- 3 9- (v a7 a_ • - . b Ss ' (
-- 47 170 S ' ,B'L
13. GROUT. Depth Mstedil
From_1 To_,c1/2_ FL 0..am
From To 'FL
.4. SCREEN: Depth Diameter . Slot Size
From_ To
From_ To Ft_ia in. •
v,•'
Material
in.
S. SAND/GRAVEL PACK
Depth Size Material
From To FL
From_ To Ft
• RECEIVED
MAR 27 2006
Asheville Regional Office
Aquifer Protection
6. REMARKS: -
DO HEREBY CERTIFY THATTHISWELLWAS CONSTRUCTED 1NACCORDANCE WITH ISANCAC2C,
ONSTRUCI•IONSTANDAItDS,AND THAT ACOPY OF RECORD lio,S BEEN PROVIDED TOTHwWI
SIGNA URE-OF PERSON CONSTRUCTING THE WELL DATE
Submit the original to the DivWon of Water Quality, Groundwater Section, 1636 Mali Service Center.
17699-1636 Phone No. [phone], within 30 days. . GW-I

WELL CONSTRUCTION RECORD -
North Carolina - Department of Environment and Natural Resources Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIV•IDUAL)NAMy�E� �(prtat) cb.e 11 hI 5 >('r" j in r% ri. ''' "• c8Ik2'IFrcATlolt r'0117 le
WELL CONTRACTOR COMPANY NAM6••Il°f)}•)rC Soiinsci-t libel t v1.1 l-14 �/((. T-K AJ PHONE 1a ,7 aL/-3 a-b el
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQpERMITY ,•
(if applicable) • -(ifcpplicabie)
I . WELL USE (Check Applicable Box): Residentiial' unicipal/Public 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery ❑' Heat Pump Water Injection 0 Other O. If Other, List Use • '
2. WELL LOCATION: Alearest Town: PR/Y/l//GL / N County ,41 A L2V'-'
�fSr/ S, Led Erred /Ed. tf
(Street Name. Numbers, Community, Subdivision, t.ot Noo..,, Zip Code)
3. OWNER: Ri Gk f� ._ W e»& c9'Deb; iv
Address P 0. )3 o x gat)
(Street or Route No.)
Cflhien-s Nc 4g7/7
City or Town State Zip Code
(far)- 7et-3• /os 9 •
Arca code- Phone number
4. DATE DRILLED 04 —a %"0 6,
5. TOTAL DEPTH: SOP) '
TopograpNaand setting
❑Ridge aBrope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
•
, (degr.&minutes/aeconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DRILLING LOG
Formation Description
DEPTH •
From To •
o So ' • n_
- 5-4;' '79' D�
79' Sao- BLue G-2»Nrt2_
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO
7. STATIC WATER LEVEL Below Top of Casing: D FT.
/ (User if Above Top of Casing)
/
8. TOP OF CASING IS Ff. Above Land Surface'
*Top of casing terminated at/or beta! l nd.surfaee requires a
variance In accordance with 1SA NCAC 2C .0118. / /
9. YIELD (gpm): (p METHOD OFTEST _.ihntinti ,
10. WATER ZONES (depth): a 902 '547S'
I1. DISINFECTION:Type NW-,: Amount .ETA- A5
12. CASING: Wall Thickness
Depth Dia} ter or We /Ft. Maley' 1
From 0 To_�FI. F7` S�(�$� %�Y
From To FL
From To Ft._,•__
13. GROUT: Depth Material Method
From n To ria Ft. (,yr am'patt�1/
From To Ft.
4. SCREEN: Depth Diameter . Slot Size . , Material
From To Ft. in. in.
From To Ft. in. in.
5. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
).00ATION SKETCH
Show direction and distance in miles front at least
two State Roads or County Roads. Include the road
numbers and common road names.
RECEIVED
MAR 27 2006
Asheville Regional Office
Aquifer Protection
6. REMARKS:
DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED 1N ACCORDANCE WITH 15A NCAC 2C, WELL
ONSTRUCTION STANDARDS, AND THAT A COPY OF TH S RECORD HfS BEEN PROVIDED TO THE WELL OWNER
.10
SIGNATURE OF PERSON CONSTRUCTING THE 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

2. "WELL LOCATION:
Nearest Town: %..P 4 N/C L i Al County /4
2 ». I eV RA_ dE1'3 ti
(Street Nat. Number. Commmi ty, svbdirimn, Lot No.. DP )
3. OWNER: C-b.S fl' h) S no i i-*
Address 900 $a)) Rr -
FR4NIGL(i7 n NC. ,z2 $
Chita Town Sane ' rap Code
(Pram- .5a - In 53 `f -
Ana ado- Paine mbar
4. DATE DRILLED a •' a / -'d Go
5 TOTAL DEPTH• 02.55
6. DOES WELL REPLACE
EXISTING WELL? YESJJ NO cl -
7. STATIC WATER LEVEL Below Top of Casing: 6 FC:
(Uss r it Man Top of Casks)
8. TOP OF CASINO IS —FT. Above Land Suttee*
'Top of eating terminated atlor bola Isaaaarfiee moires a
radian le emerdame with 1SANCLC2C.01IS. /.
9. YIELD (spat): METHOD OP TEST_n /Mil
10. WATER ZONES (depth): /. Cf)
11. D(SINFECTION:Type lkkf Amountt
12. CASING:
From__L_,.Toq/ /
From To
From Ty
GROUT.:
13. Depth
From_(_To Aa-
From To
.4. SCREEN: Depth
- ..
. • WELL CONSTRUCTION RECOIL!). :
Noah Cafolina - Department of EnYlromoent and Natural Resources.- Division of Quality-7tY'- - Qroimd ea Section
•a►Ttoi(r�(!
WELL CONTRACTORW4DntW1IA,L)1%. (PrbQ c f'(PII S -dam - •
]prC f_ Mil v4. TuYItoiS r a &3 Lb 0
WELL CONTRACTOR COMPANY NAME'. r .t)1) It�I�_ U ��� nA J'_ . nww&inipArn..
STATE WELL CONSTRUCTION SWOTS—, .--,•
"
��-Of a,�lieable
(if appllcabla)'
1. WELL USE ((Bieck AppUcabla Box)rltaideatia1 1 icipavPublic ❑ Indust:1A 0 Agriwitural-O
• • Monitoring [ Recovery [' Heat Pump Water Injection [ Other U If Other, List Use
Tapo8T8pl itli,and setting .
[Ridge [Slope [Nancy . [Fiat
(aback swamis bo:)
i siitudeAwigitude of well location
(depeeshai-Wadaowdr)
Latitude/ongitiide sourcc[OPS[Topographic map
(ebadtboz)
MYTH ' DRILLING LOG
From To ' Formation Description
Ay-
4-Ai ns/an
13 Lire PA-NI-1
•
"1TON SK>�'I'CF(
.VTR S Show duettistL and -distance in miles from at least
Wan 'Diktat's two State Roads or County Roads. Include the road
or Weight/ft.
Ft._ -:Material' Method
-
R.
PQ
Diameter . Slot Size - = Material
From To Ft.__ -in. in.
From— To Ft._jn. in..
5. SAND/GRAVEL PACK:
Depth Size Metals)
From To FL -
From To FL
numbers and -common road names.
RECEIVED -
MAR 2 7 2006
Asheville Regional Office
Aquifer Protection
6. REMARKS: '
DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCEED IN ACCORDANCE WIT) I5A NCAC 2C, vita .
ONSTRUCTION STANDARDS. AND THHATynA COPY
OF TIT
T _R�E�CORD A7`,►S BEEN PROVIDED TO THEY/ELL OWNER
a 1 fL /46".. t�lctT "' �� j -o '
SIGNATURE•OF PERSON CONSTRUCCIN0 THE WELL . DATE
Submit the original to the Division of Water QuaUty, Groundwater Section, 1636 Mall Service Center -Raleigh, NC
37699-1636 Phone No. [phone], within 30 days. - OW-1 REV. 07/2001

WELL CONSTRUCTION RECORD `` % ,` 5 0 9
North Carolina Department of Environment ands�Natural
Resources-ODivision of Water Quality
WELL CONTRACTOR (INDIVIDUAL) NAME unint)JVj1I C-,\AJ (Ace ,� Lf' I� CERTIFICATION tit JL/�LJ
WELL CONTRACTOR COMPANY NAME (A( hee l VJOIP.i irpckit't e - Ttnc. PHONE # ` "(o 9' ONO
STATE WELL CONSTRUCTION PERMEIn ASSOCIATED WQ PERMTF#
Of applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential Municipal/Public ❑ Industrial ❑ Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection ❑ Other 0 If Other, List Use
2. WELL LOCATIO ,/J/�
Nearest Town: C �( County T (fin
H;r kt-m.t� Viol\ c��, c
(Street Name, 1tijmban. Community, Subdivision, Lot No., Zip Code)
3. OWNER: O y• C°
Address F[<Inktin 54feat bS *c%
(Street or Route No.)
t;\\Q&C GC; 3 , 531
City or Town State Zip Code
(1t14- can-o%`i5
Area code- Phone number
4. DATE DRILLED 5-09 - n (C
5. TOTAL DEPTH: iR
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO
7. STATIC WATER LEVEL Below Top of Casing: 30 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS j FT. Above Land Surface'
*Top of amain ternatea at%or Wow bad lax requires a
variance in ateardaset with 15ANCAC2C MIL ,r�
9. YIELD (gpm): / 7 OD OF TEST 4j r 434
10. WATER ZONES (depth): .20 / Ho n
11. DISINFECTION: Type (' It\nr i w. Amount
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
From i To ,j y Ft..-/a5 55D0.2l 10VC
From To Ft
From To Ft.
13. GROUT: Depth Material
From D To 3 Ft�
From ,'3 To 2/) FL r'PI t i ' p1
14. SCREEN: Depth Diameter Slot Sin �aal
From To Ft. in. in.
From To Ft. in. in.
15. SAND/GRAVEL PACK
Depth Size Material
From To Ft.
From To Ft.
Toii rehic/Landsetting
❑Ridge P lope ❑Valley Mat
ch k appropriate box)
Latitude/lonaitude of well location r r�
l(i.35 t/& 63-.3 • iVo63':Pi 56.4-
( )
Latitude/1ongitude Topographic map
( box)
DEPTH DRILLING LOG
From To Formation Description
diem ha cycr,,,i e_
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common road names.
16. REMARKS:
I DO CERTIFY THAT THIS WELL WAS
CONS RUCCTS AN�A DSS ACC F THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
DATE
Submit the original to the Division of Water Quality, Attn: Information Management, 1617 Mail Service Center -
Paieigh, NC 27699-1617, ?bone No. [phone], within 30 days.
GW- I REV. 09/2004

11. DISINFECTION: Type (hln(t steel Amount ass
12. CASING: Wall Thiclm
Matsal
From 11 Tooj&. t Ft_ 5C)Qot l V11ii
From To Ft.
From To Ft.
13. GROUT: Depth on j
From_ To Fttee.men
From 3 To an 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.
16. REMARKS:
45 0
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural _Rfesourcces - Division of Water Quality - Groundwater Section )
WELL CONTRACTOR (INDIVIDUAL) NAME (print)/Y 11c\l(.e\ . J. `v l= IL—�-TiP,i CERTIFICATION#- 3L7�d'4
WELL CONTRACTOR COMPANY NAME 1 A.I }\PP. , yl doer ?eCd(fletl .lf IC a PHONE # (O'7A' .1, 9-6 40
STATE WELL CONSTRUCTION PERMIT#_ ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential.( Municipal/Public ❑ Industrial ❑ Agricultural ❑
Monitoring ❑ Recovery ❑ Heat Pump Water In on ❑ Other ❑ If Other, List Use
2. WELL LOCATIO
Nearest Town: / County Man) n
(beset Name, Numbers, Community, Subdivision, Lot No., Tap Code)
3. OWNER: 11/DML( 5)
Addrep U 4 •ctI—nn fin Ott
Fre L'n, ues or Route No.)
City or Town State rip Code
Area code- Phone number n�
4. DATE DRILLED dD
5. TOTAL DEPTH: / .R 0
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NOl
7. STATIC WATER LEVEL Below Top of Casing:.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS i FT. Above Land Surface*
'Top of casing terminated at/or below land surface requires a
variance In accordance with 15A NCAC 2C .0118.
9. YIELD (gpm): 30 f— METHOD OF TEST
10. WATER ZONES (depth): / 620
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common road manes.
Topographic/Land setting
itAge ❑Slope ❑Valley ❑Flat
(check appropriate box)
titude/longitude of well location e1
035°Me65.011ti)O.K3t'aara -3
(degrea/m3 seconds)
Latitude/longitude source. GPS❑Topographic map
( box)
DRILLING LOG
Formatio Description
Died tLx,vt apt. C-•-/e•n14C
DEPTH
From To
Asheville,Rer; °: r Ctfice
__.�J
I DO HEREBY CERTIFY THA
CONSTRUCTIO
T
WAS CONSTRU IN ACCORDANCE WITH ISA NCAC 2C, WELL
CORD HAS BEEN PROVIDED TO THE WELL OWNER
Ofa
GNATURE OF PERSON CONSTRUCTING THE WELL DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-1 REV. 07/2001

• .WELL CONSTRUCTION RECORD" `lv
324516
North Ca(olind - Deparhnent of Emlmamdut and Natural Resources - Dfvlsio t of ater Quality-- Om®dwaier Section �-J / _
wetsCoNTRACrOR (tNDtt(WUAta L (print c1. ri PI1 S ' n.11-0M Ai -"• ` - Cs:ISR[CAT10N #_ r `' .
WELLCONTRACTOR COMPANY NAM .1)I)r.S idkjI ,j IIJP.Oysjjpt.t "rite s 'rums tin( SaY-3 oAb 0
STATE WELL CONSTRUCTION PERMIT# - _AililDCIATSD WiPrziouri -. �'� •,' -•
_
(ifappliable)-Oftpplicable) • .
I. WELL USE (Check ApplicablWBox):-Residtntial7YMunicipal/Publ(c❑ Industrial Agriculanra4O
Monitoring O Recovery 0- Heat Pump Water -Injection ❑ Other C7 If Other, List Use -
-
T biP/Land setting
Nearest Town: r4'Ltf P L. i A/ - Couaty,�M /1(.A A/' " L ❑SSIone Malley Whit
Co EIl;,� Cza- FFpn,(nu�CA1.-t-5 (cheek appropriate boa) %
(Strew Name. Noreen, Cammt6ay, SubAi tea, Lot No., ZP Code) a 8'73 l Latitu4c/Iongituda of AO location
3. OWNER: SCIy /f' .. Le; h 2 '
Address (o Coo n t Ry ` RA •
e
FA f)Nl< N 1 A C, 0` 8-'7 3 5L
City.or TaroSoo* . . Tip Code .
(Mi- 4.2 /%3Q
Area code. Phone amber
4. DATE MULLED 3 RI—b-0Co
5. TOTAL DEPTH- ca .55 '
6. DOES WELL REPLACE EXISTING WELL? YES ❑
7. STATIC WATER LEVEL Below Top ofCading: SS FI;
- •1
(User if Above Top of Casing)
8. TOP OF CASING IS / FT. Above Land Surface*
'rep of easing terminated near blow gadaadKe ngdres a
Tertian ln avordaneawith '15ANGZC 2C MIS. /
9. YIELD (gpm): 30 METHOD OF TEST,_,/) %DJU
10. WATER ZONES (depth): / 355 1 M-
11. DISINFECTION: Type
12. CASING:
Depth _r.
From_ i_. Too (Q 1 Ft
From To FL
From
From
•
Nepealmiouuahaoondv)
Latitudellongittide source:❑OPSOTopographic map
• @aea bats)
' DRILLING LOG
From To - FwrmationDescription
3 ct' •• e
_—.i4, (Di. .5A�r%DistnAt _
fait Zs5' I�LU—E_ RANIT4-
•
LOCATION SKETCH
Amount .� %A•4 5 Show direcdon ant distance in miles from at least
Wall Thickness two State Roads or County Roads:Include the road
or We(ght/Ft numbers and`coumron road names.
5. bR:.a( a -
From T9 Ft
13. GROUT: Depth Material Method
From_ a_ To L'�
To TL I
4. SCREEN: Depth Diameter .
From To Ft`_in
To Ft`_ia
5. SAND/GRAVEL PACK:
Depth Size Material
From To FL
From To FL
Slot Site : = Material
in.
_ in.
6. REMARKS:
DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
ONSTRUCTION STANDARDS, AND THAT A COPY OF TRECOBEPN PROVIDED TO TEE WELL OWNER
' �:• 3=ao-off
SIGNATURE-bF PERSON CONSTRUCTING THE WELL: . - DATE
•Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mall Service Center -Raleigh, NC
,I'/699-1636 Phone Pio. [phone], within 30 days. Gy,i-( REV. 07/2001

• WELL CONSTRUCTION RECORD - - : lJ`^ '• .. 4 • 5 f r
North Catolina - Department of Pmironment and Natural Resources - Division
1of Watt Quality- Omdadwater • Section
WELL CONTRACTORUND/{7DUAL)NAMyE� �tprIsQS�fl PISS /4tii-n,:ar<..�• - • - r CLi�71PICCATIOltt _Lte
WELL CONTRACTOR COMPANYtVAMs'1 A° r.t g1l4awi (112ijl1v:iI;u ��t(J-7-we J'PROraasnf _.Say-3 a-b 0
STATE WELL. CONSTRUCTION PERMITS - ASSOCIATED• w titan/ ..� . • . _ .
(if applicable) • -Of applicable) • .
•
1. WELL USE (Check ApplicabkBox):-Reaidential*4iimicipaFPubfc 0 • Industrial !7 Agricultural
Monitoring O Recovery ❑ Heat Pump Water Injection O Other C( If other, List Use
•
2. "WELL LOCATION:
Nearest Town:? flleti1 CotmtyMAuld
(ptj P. Al ALNvT CJ2t•e/4- 2i-+
(Slat Name. Numbers, Cemmms= ity, Subdivideof No., Zip Cade)
3. OWNER: L ct /A)G1t i iiaLw ;.
Address R' WA-B UT r ReeK /.'J!
(Saaetl Nos
jF/9j4?Vk:rl A . A/ G r2 l
Gtyor Town _pea - Zip Code
t2
Y)- . 3 (o 9- Sr 9 3 j�
Arra cede. Phone somber
4- DATE DRILLED 3 - b
5. TOTAL DEPTH• .SSD
6. DOES WELL REPLACE EXISTING WELL? YES O No
W —
7. STATIC WATER LEVEL Below Top of Wimp '`' 0 Fr:
T grapolcil,and setting - -
go 0S1o0o OVaUey . °Flat
(daxtapperISboa) - a
LatittxjeflotigiWdo anion location
•
, (dha miautd+aadr)
Lat(tode/longittide source:OGPSOTopographic map
(Meet my) -
12121R' DRILLING LOG
From To - Formation Description
(1-L_A'- -
'%3(Ue- IL2ntt
(User if Above Top orGering)
8. TOP OF CASINO IS / FT. Above Land Surface*
'Top of cuing teralaateel actor burr laadaarfaa multi* a
mimes M eeaedaeawlmrlSANCk 2C MIS.
9. YIELD (gpm): - ?n METHOD OF TEST Abillp7�
10. WATER ZONES (depth): 3 a
LOCATION SKETCH[
11. DISINFECTION:.Type__t_ Amount -2 TE)• A Show direction anddistance in miles from at least
12. CASING: Wail Thidoless two State Roads or County Roads. Include the road
• Depth Drer or wetghtyt numbers and'common road names.
From 0 . To Ft ki 5.1aR:=8l a, •
From To
From Tp
13. GROUT: Deptb - tdeteriei
From To t D
From To Ft.�
4. SCREEN: Depth Diameter -
From To Ft`_in
From To Ft, in
5. SAND/GRAVEL PACK:
Depth Size
To Ft
To Ft
From
From
Method
C,lt.00
Slot Size Material
in.
in.
Material
Ashevifk Rep ,f <i Office
6. REMARKS:
DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED EiACCORDANCE WftH ISANCAC2C, WELL
•ONSTRUCf10NSTANDARDS,ANDTHATACOPY OFT RpcO11D ASH BBENPROVIDED TOTHE.WBLLOWNER
�UCS +•• 3—a/—o fo .
SIGNATURE -OF PERSON 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. - OW -I REV. 07/2001

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality• Groundwater Section
WELL CONTRACTOR (INDIVIDUAL)NAME Congo eD-tlj VI s /tbel n ri. • 'A CE1tIFICAT10NY of/7lta
WELLCONTRACTl>OR COMPANY NAMtgflrc 010110.4.4 Wel ydj_,—% Ynt_pHONB# .Sa 4-3 a.6 6
STATE WELL CONSTRUCTION PERMITY ASSSOCtATED W ZRM1TY
(if applicable) {if applicable)
•
1. WELL USE (Check Applicable Box): Residential' unicipal/Public 0 Industrial O Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other Cf If Other, List Use
2. "WELL A 1 LOCATIwO : An
Nearest Ton: F�AA/v/G t .4/ County A-
C Og_j K/i/oa Cbmn,• ntk'r73cy
(Sued Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: �YT J 0l� �C'
Address 3 >°£S /y 1Y1 , n C (r -1 e-
(S outa Na-f
PjAN)CLI Afor Rd873 L/
ity or Town State Zip Code
fidXl- ,36,9— 94<K-D
Area code- Phone number
4. DATE DRILLED c3 — I % —D CP
5. TOTAL DEPTH: 4DS
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO U1
7. STATIC WATER LEVEL Below Top of Casing: j p f's F•1':
(Use "+" if Above Top of Casing)
/
8. TOP OF CASING IS FT. Above Land Surface'
*Top of cuing terminated ether belay( leadsurfau requires a
variance la accordance with ISA NCAC 3C.0118.
9. YIELD (gpm): 0 METHODyOF TEST „�j�DI/���L�.-,
10. WATER ZONES (depth): alto S5 3 8S • (�/
ograpilic/Land setting
dge 0Slope Malley ❑Flat
(check appropriate box)
Latitude/longitude of Well location
•
(degreer)minutWseconds)
Latitude/longitude source:❑GPSOTopographic map
(check box)
DEPTH DRILLING LOG
To Formation Description
LA v
0g .`i ,4r/vd.c
Et 9 . A L. U L C ya..-, r t C.
From
n
•
3215,c
LOCATION SKETCHi I. DISINFECTION: Type
HIP. P: Amount a TA A 5 Show direction and distance in miles from at least
12. CASING: Wall Thickness two State Roads or County Roads. Include the road
Depth Diapiter or Weight/Ft. Matey' 1 ' numbers and common road names.
From O.
. To_ 3_Ft th` S-j)R.St, a .
From To FL
From T9 FL__,,._
13. GROUT: Depth M
Deaterial Method
From_ To r*D Ft. CQyyt4r7< ppyt,(,
From To Ft.
4. SCREEN: Depth Diameter . Slot Size
From To Ft. in. in.
From To Ftin. in.
5. SAND/GRAVEL PACK:
Depth Size
From To Ft.
From To Ft.
Material
Material
•AsheviP der;.,>, ,i Office.
6. REMARKS:
DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH ISA NCAC 2C, WELL
ONSTRUCTION STANDARDS, AND THAT A COPY OF S RECORD BEEN PROVIDED TO THE WELL OWNER
fhl t / ,7--/7 —D•(
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
submit the original to the Division of Water Quality, Groundwater Section, 1636 Mall Service Center- Raleigh, NC
,9'7699-1636 Phone No. [phone], within 30 days. GW-I REV. 07/2001
r- )
0

• . WELL CONSTRUCTION RECOIUF
•
3244511
NOnb Carolina- Department of F.nvltomna�t and Natural Resources - Division of Water Quality'. f3soimdwata Section
mELL CONTRACTORONDIXIDUAta?(AMS (prte) v?kt iPIIS �, �in:�a.• ' - CUI W1CATmo/s ot% 11P .
wad. coNTRACrORCOMPANY NAMt) fl t)r.4 a JUlr,l WON I lYs.(I ; t4 it t' J "p110I tint t/-3 3.b 0
STATE WELL CONSTRUCTION PSR T/ - ASSOCL►TmW missal
Propagable) • •in -applicable) • .
I. WELL USE (CheckAppliabltiBox):-Resideattal7YMtadcipaUPubllc O Industrial U AgricnittualD
Monitoring ❑ Recovery aHat Pimp Water injection O Other CT if other, List Use -
2.-WELL LOCATION:.
"Nearest Town: Pe »til/ L . 4 - County / } 1 f�Gy�' ' T tdf t1IId Stalling -
OSIope OValley OFlat
(saner None. _ (died aPprepri.tebax) . ..
eoevaaain: Sebdir,wm, Loa t(o, zip Code) • i:niitttde/longitude Orwell location
t/':� ie� _ ivca-14 R _ 73y
3. OWNER: igt) /7t yv'L
Address /001-9 fei v�-le- E.
(S sso;No.)
F z�,vvLrd /vato C73 V'
r
qry y a_ State
el acme
Ara code- Tama amber
4. DATE DRILLED 3 -/6 -U 1,
5. TOTAL DEPTH• .Z <5'S '
6. DOES WELL REPLACE EXISTING WELL? YES O NOS W-
7. STATIC WATER LEVEL Below Top of Caring:
.t
•
(User llamas Top o(caaIu
8. TOP OF CASING 1S / FT. Above Land Surfaces
'Top or codas toradugd aUor lake toad.aarfw* maim a "
variance la aeasrdaaea wRa'ISATICAC 2C.01111.
9. YIELb (gpm): j12_METHOD OF TEST
10. WATER ZONES (depth): _,243 O'_
, (depewia iamahxad.)
Latitude/ongittide somco:OGPSOTopographic map
• (dmdcbox)
EOM ' DRILLING LOG
From To ' "Formation Description
0 fp. ' 01 (9�
_- (o.a' "79' , S/�zvDStpm-0--,
79' ;i.A- • 8 L-U G-R/gfvi r e-•
LOCATION SKETCH
11. DISINFECTION: Typo /f-Pft Anwunt .•2 Th•A S Show direction and distance in Slra from at least
12. CASING: - Wall Thickness ' two State Roads or County Roads; Include the road
st Depth or WdghtlPt. '-bombers and -common road names.
Frottt_SLTo 7 % D;epist sz �.,3 -: .
From To FL____-, k�'` - •
From Tq Ft - .
13. GROUT: Depth Mataiii Method .
Frorirn To AD Ft C+Qyr ar� fDo c) - - NJ
Front To Ft .n
4. SCREEN: Depth Diameter - Slot Sin - = Material
From To Ft.__in, in.
From To Ft. _in in.
S. SAND/GRAVEL PACK: '
Depth Size Material - -
From To Ft
From To Ft Ash li«
h
6. REMARKS: fj� "._ _}'-,
nice
DO HEREBY CERTIFY TAATTEIS WEU. WAS CONSTRUCTED IN ACCORDANCE WITH IS/iNCAC_2C, WELL -
ONSTRUCTtONSTANDARDS, AND THAT ACOPY OFII*
RECORD BEEN PROVIDED TOTHEN/ELL OWNmR
- / 1 I del% -/a 3-✓G - o'
SIONATURB-OF PERSON CONSTRUCTING THE WELL; - DATE
Submit the original to the Division of Water Quality, Groundwater Section,1636 Mall Service Center -Raleigh, NC
,21699-1636 Phone No. [phone], within 30 days. OW -I REV. 07/2001
0

�b <'4508
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural\ Reso es--/Diivision of Water Quality - Groundwater Section /J rf
WELL CONTRACTOR (INDIVIDUAL) NAME (print)
1 c\ 1 u er- LIT CERTIFICATION #7 3 ` ?`
WELL CONTRACTOR COMPANY NAME1/1 ✓ 'ed 1A1� WL:1'-L%ete-n- d_.itC r PHONE # (X.22 Se9'67 qa
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residentiz)O�Municipal/Public 0 Industrial 0 Agricultural ❑
Monitoring ❑ Recovery ❑ Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATIOpt
Nearest Town: ,-1'CIA4 \tV1 County alQCPi�
5c\c eer
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: K. C - tic to 9 e.6
Address '144,1 VS&'n C4 A+'or P
Pc\\Street or RaseNo.)
YA can i= L 334 (9
City or Town State
(.ia1 )_ a(0a-03(2
Zip Code
Arca code- Phone ,comber /
4. DATE DRILLED 3 06
5. TOTAL DEPTH: 34-m f
6. DOES WELL REPLACE EXISTING WELL? YES 0 NOX
7. STATIC WATER LEVEL Below Top of Casing: a)O
(Use"+" if Above Top of Casing)
8. TOP OF CASING IS / FT. Above Land Surface*
'Top of wing terminated atror below land surface requires a
vadaoa in aces 1SA NCAC 2C Alm
9. YIELD (gpm): to METH D,O ]'EST
10. WATER ZONES (depth): J
11. DISINFECTION: Typeeiti,vitie- Amount
12. CASING: �f Wall Thickness
From T D o hi d �i or Ft dal
1 ,St (91 Weight/Ft L
From . To Ft.
From To Ft.
13. GROUT: Depth
From To Ft
From To Ft.
14. SCREEN: Depth Diameter Slot Sir
From To Ft in. in.
From To Ft. in in.
15. SAND/GRAVEL PACK
Depth Size Material
From To Ft.
Material
Method
From To Ft.
16. REMARKS:
I DO HEREBY CERTIFY
CONSTRUCTION
SIGNATURE OF PERSON CONSTR
Topographic/Land setting
Age ❑Slope ❑Valley ❑Flat
(check appropriate box)
Latitudellongitude of welllocation
¥J " l5' (a �' 3 o%3 ato' Spa 3,.
(de lc i seconds)
Latituderongitude source: GP5❑Topographic map
( box)
DEPTH DRILLING LOG
From T Formation Description
) // I I
< '
LOCATION SKETCR
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common road names.
Asheville Per
15A NCAC 2C, WELL
OVIDED TO THE WELL OWNER
c.±� 6 ,
G 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 tural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) j ''-t L r.,34V0L . -- CERTIFICATION H ()O
WELL CONTRACTOR COMPANY NAME -c+- Ott«t1 /1,/GLL a-.;",-) PHONE ii (')c/4 n'l--. 37 j-
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
324465
1. WELL USE (Check Applicable Box): Residential N Municipal/Public ❑ Industrial 0 Agricultural 0
Monitoring 0 Recovery ❑ Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION -
Nearest Town: c jC
28li1/
County /77ACei
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER:
Address
Achy &tcb�(4—
1'/o �
(Street or Route No.)
6l7® t/c )S76.
City or Town State Zip Code
(SZf- 36(9-63i1
Area code- Phone number
4. DATE DRILLED /U--7-0>
5. TOTAL DEPTH:
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO 1,-
7. STATIC WATER LEVEL Below Top of Casing: % S FT.
m (Use "+" if Above Top of Casing)
8. TOP OF CASING IS / V FT. Above Land Surface*
*Top of casing terminated at/or below Land surface requires a
variance in accordance with 15A NCAC 2C .0118. /J
9. YIELD (gpm): 7 METHOD OF TEST jfry
10. WATER ZONES (depth): /2-r 2/ S'
11. DISINFECTION: Type /•f he
12. CASING:
Depth Diameter
From 0 To TG Ft. t•/L6'
From To Ft.
From To Ft.
13. GROUT: Depth Material
From () To .)o Ft. p,r-t6 J
From To Ft.
Amount It( cp
Wall Thickne
or Weight/Ft. Material
SP,2/
Method
p
14. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in.
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
16. REMARKS:
pographic/Land setting
edge ❑Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutcs/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From To Formation Description
- �o ricr
7/—V4 rem cde L�
fl -.ai7 (p-co. r a�
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common road names.
1 DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AJ>J THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
SIGNATCJ OF PERSON CONSTRUCg 81EVNIE D DATE
Submit the original to the Division of Water Quality, Gro indwater Section, 1636 Mail Service Center - Raleigh, NC
GW-1 REV. 07/2001
27699-1636 Phone No. [phone], within 30 days.
a,..t
L
Asheville Regional Office
Aquifer Protection

n
A
v
RESIDENTIAL WELL CONSTRUCTION RECORD
RECEIVED
MAR 20 2006
North Carolina Department of Environment and Natural Resources- Division of Water Quality
WELL CONTRACTOR CERTIFICATION # :34/W
1. WELlCONTRACTOR:
r2.ck CY 1q?LI�
Well Contractor (Individual) Name
Well Contractor Comp oy8arueKANE CIRCLE
STREET ADORESIRANKLIN, NC 2tH734
City or Town State
Area code- Phone number
2. WELL INFORMATION:
SITE WELL ID #(if applicable)
Zip Code
STATE WELL PERMIT#pl applicable)
DWQ or OTHER PERMIT #(if applicable)
WELL USE (Check Applicable Box): Residential Water Supply ❑
DATE DRILLED rc— / n/ - ® L(7
TIME COMPLETED AM ID PMD
3. WELL LOCATION:
CITY: f YAA; k/i /t% COUNTY //&cl/v
I� SY:44S
(Street Na Num era, C unity, Subdivision, Lot No., Parcel, Zip Code)
TOPOGRAPHIC / LAND SETTING:
❑Slope DValley ❑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 we# :rust be shown on a USGS topo map and
attached to this fore snot using GPS)
4. WELL OWNER
OWNERS NAME jrl(y/nteinev.
STREET ADDRESS (�7 c/WIanOk Dy1 u" _
rnI.AJk/, /v /LJ/` ( csye i 3
City or Town State Zip Code
Area code - Phone nurnber
5. WELL DETAILS: /,, -
a. TOTAL DEPTH: (lDej
b. DOES WELL REPLACE EXISTING WELL? YES 0 NO P—
c. WATER LEVEL Below Top of Casing: a.. 0 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): / 0 0 METHOD OF TEST / y-
0
Asheville Regional Office
f. DISINFECTION: Type A p Icunr e
etten
g. WATER ZONES (depth):
From To From To
From To From To
From To From To
6. CASING: Thickness/
Weight }�'any� r Material
From Depth D
`, ToFt. to/Y �7v Ci
From To Ft.
From To Ft.
7. GROUT: Depth
MC'n Material / Method
From To.Z U Ft. 6P/,!pelt' rat
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.
Fran To Ft.
10. DRILLING LOG
From To Formation Description
O
II. REMARK.:
I DO HEREBY CERTIF._,.. ,-- 4-,.cAri'_„i.
ISA NCAC 2C, WELL CONSTRUCTION STANDARDS. A
RECORD I IAS BEEN PROVIDED TO THE WELL OWNER.
�BFLCORDANC WITH
/%/./,1 � Sys 0!c,
SIGN T 112E OF CERTIFIED WELL CONTRACTOR DATE
ecl ertlXit
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 Q
WELL CONTRACTOR CERTIFICATION 8
1. WELLNTRACTOR:
7e / C'/-wt
Well Contractor (Individual) Name
Well Contractor Company Name
CRANE BROTHERS WELL MLLES, EC.
STREET ADDRESS 24R r.RANF CRC' F
FRANKLIN, NC 26734
City or Town State
Area cafe- Phone number
2. WELL INFORMATION:
SITE WELL ID M(ir applicable)
Zip Code
STATE WELL PERMITA(itapplicable)
DWQ or OTHER PERMIT N(if applicable)
WELL USE (Check Applicable Box): Residential Water Supply p
DATE DRILLED 5' 2 - O,
TIME COMPLETED AMP PM9-
3. WELL LOCAT ON:
CITY: /A/iijtY A) COUNTY 4-C /I/
f\wk 'L)- /c- f of.
(Street Name, Numbers, Community, Subdivision, Lot No., Parcel, Zip Code)
TOPOGRAPHIC / LAND SETTING:
❑Slope °Valley CI Fiat ❑Ridge ID Other
(check appropriate box)
LATITUDE 3
LONGITUDE
Latitude/longitude source: ❑GPS oTopographic map
(location of wef must be shown on a USGS topo map and
attached to this ram i not using GPS)
4. WELL OWNER
OWNER'S NAME C.
May be in degrees,
minuses, seconds or
in a decimal formal
ST,,R�E TADORES
fiTawn /
a City Town
c4
(/L)
Stale
1/27- iv
"Zion 00 fat_
Zip Code
Area code - Phone number
5. WELL DETAILS:
a. TOTAL DEPTH:
97e)
b. DOES WELL REPLACE EXISTING WELL? YES❑ NOF3—
c. WATER LEVEL Below Top of Casing: /440 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 ISA NCAC 2C .0118.
e. YIELD (gpm): s'3LY* METHOD OF TEST; r
ncl.,cIvcv
MAR 20 2006
iiAsheville Regional Office
A.uifer Protection
1. DISINFECTION: Type Amount
g. WATER ZONES (depth):
From To From To
From To From To
From To From To
6. CASING: Thickness/
A Depth eDiameter Weight Material
From Cl To/02/ FL 6.'i>";-- iL',—.
From To Ft.
From To Ft.
7. GROUT: Depth Material Method
Frorn To2G �r FI. ( eWQ"
From To Ft.
From To FI.
8. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. In.
from_ To FL In. in.
From To FI. 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 dt 9 �j92 eht. Zee
/,Zt- ' i d
RECEIVE
I
Ashev!Ile He/Tonai '!ce
ACiuitQr Fkcteci _
II. REMARKS:
100 HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED N ACCORDANCE WITH
15A NCAC 2C, WELL CONSTRUCTION STANDARDS. AND THAT A COPY OF THIS
RECORD HPS BEEN PROVIDED TO THE WELL OWNER.
31.E-3
SIGNATURE OF CERTIFIED WELL 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 Mali Service Center- Raleigh, NC 27699-1617 Phone No. [phone] ext 568.
Form GW-la
Rev. 7/05

FA00.
a n; 11. '. f e_R
RESIDENTIA WELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources- Division of Water Qu
WELL CONTRACTOR CERTIFICATION N JO
1. We CONTRACTOR:
8
ick C/4�C
II Contractor (Individual) Name
etrAfilie LgintilJ)e// r,/LN9, '2iuc,
Well Contractor Company Name
STREET ADDRESS (9(%p aml
F*,wk/ ,) NC- DY)3 V
City or Town State Zip Code
( code-. Phone number
Area numbs
2. WELL INFORMATION:
SITE WELL ID #01 applicable)
STATE WELL PERMIT#(ilapplicable)
DWQ or OTHER PERMIT #(if applicable)
WELL USE (Check Applicable Box): Residential Water Supply®—
DATE DRILLED l /lama' C1 C
TIME COMPLETED AM D PM la""
3. WELL LOCATION:7^-'n^ �n1,^, �".�I
CITY: /-i�/If N COUNTY ,//vtiftiYV
(Street Name. Numbed, Cotaunity, Subdivision. Lot No., Parcel, Zip Code)
TOPOGRAPHIC / LAND SETTING:
❑Slope DValley ❑Flat ❑Ridge ❑Other
(check appropriate box)
LATITUDE 3
LONGITUDE
latitude/longitude source: POPS ❑Topographic map
(location of well must be shown on a USGS /opo map and
attached to this form I not using GPS)
4. WELL OWNER
OWNER'S NAME h)
May be in degrees,
minuses, seconds or
in a decimal format
STREET ADDRESS
r fig D5i7 3�
City or Town
D
S
( )-
Area code - Phone number
State
5. WELL DETAILS:
a. TOTAL DEPTH: 405-6
Zip Code
b. DOES WELL REPLACE EXISTING WELL? YES 0 War
WATER LEVEL Below Top of Casing: r v L) FT.
(Use's' 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 .01/118.
e. YIELD (gpm): d METHOD OF TEST
RECEIVED
MAR 20 2006
lily
Asheville Regional Office
Aquifer Protection
1. DISINFECTION: Type Amount
g. WATER TONES (depth):
From__ _ To From To
From To From To
From To From To
6. CASING: Thickness/
6 Depth / 2 Dia et", Weight Material
Fran To/r�/ht.��j sO ice_
From To Ft. -713
From To FI.
7. GROUT: Depth
Material Method
Frans 0 TO G! Ft. (1)'9z ja10/ 0e'41
From To FL
Fran 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
Fran To
From
From
To
To
10. DRILLING LOG
From To
1V
hed:Ilc '1anio
11. REMARKS:
FI.
Ft.
Ft.
Size Material
Formation Description
E'<
^7
PO
I D0 HEREBY CERTIFY THAT T1115 WELL WAS CONSTRUCTED N ACCORDANCE WITH
15A NCAC 2C. WELL CONSTRUCTION STANDARDS. AND THAT A COPY OF THIS
REC . HAS BEEN PROVIDED TO THE WELL OWNER.
`RTIFIED �r/_�aE
Sle URE OF CERTIFIED WELL CONTRACTOR DATE
&-,� ry,e
PRIN ED 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-Ia
Rev. 7/05

STREET ADDRESS
RESIDENTIAL WELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources- Division of Water Quality
WELL CONTRACTOR CERTIFICATION 11 3 /en
1. WELL CONTRACTOR:
(,J -iIrn 4) tied
Wel tractor (Individual) Name
Well Contractor Company Name
Ao• aloe g clo
L✓/ /; )G
City flown Stale
Zip Code
(70& } ?(-1-?yt2
Area code- Phone number
2. WELL INFORMATION:
SITE WELL ID got applicable)
STATE WELL PERMIT#(r applicable)
DWQ or OTHER PERMIT #(if applicable)
WELL USE (Check Applicable Box): Residential Water Supply @-
DATEDRILLED 3` /
TIME COMPLETED 3. 60 AM ❑ PM t
3. WELL / ,
LOCATION:L
CITY: / //).%6— k `�
c/cet✓ Cra-t />-d 1s74-1/
COUNTYGer:h
(Street Name, Numbers, Community, Subdivision, Lot No., Parcel, Zip Code)
TOPOGRAPHIC / LAND SETTING:
❑Slope Qtalley ❑Flat ❑Ridge Gather
(check appropriate box)
LATITUDE J._
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 snot using GPS) rr
d, WELL OWNER //7 pa ',G4V
OWNER'S NAME✓� r`a'p'r1y�V j�,.lc y,
STREET ADDRESS P'CA f'oc 140.1-
1H1kLc,,€1 1J, L• dg7 q!
Citf or Town State Zip Code
Area code - Phone number
5. WELL DETAILS: a. TOTAL DEPTH: 3 7
b. DOES WELL REPLACE EXISTING WELL? YES ❑ NO [9'
c. WATER LEVEL Below Top of Casing: a'FT.
(Use'+' if Above Top
of Casing)
d. TOP OF CASING IS l / u 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): 30 METHOD OF TEST
324462
f. DISINFECTION: Type /'
g. WATER ZONES (depth):
From 296 To a^9s--
/f
From
From To From
From To From
Amount 2/U evjO
To
To
To
6. CASING: Thickness)
Depth r Diameter Weight Material
From 0 To 7/ Ft. LVic SPr2( pVC-
From To Ft.
Fran To Ft.
7. GROUT: Depth r Material
From 0 To ea0 Ft. PO r -Ct
From
From
To Ft.
To Ft.
Method
t
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
From
To
To
10. DRILLING LOG
From To
0- /0
)I — �b
6 1-I1'
72 - ?o7
11. REMARKS:
Size Material
Ft.
Ft.
Ft.
Formation Description
.6 /46i- Sa/ 1
crcr, k- s-hz ot1.--
u/
A g
C
33
-'l (D
to fl
—lS
a3A13J3a
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 HAS BEEN PROVIDED TO THE WELL OWNER.
IGNATURE E CERTIFIED WELL CONTRACTOR DATE
l' , ' c a
0.
PRINTED NAME OF PERSO
CONSTRUCTING THE WELL
Submit the original to the Division of Water Quality within 30 days. Attn: Information Mgt.,
1617 Mall Servlee Center —Raleigh, NC 27699-1617 Phone No. [phone] ext 568.
Form GW-la
Rev. 7/05

•
• . WELL CONSTRUCTION RECORD'
North Caa/olim - DeparDnent of Environment and Natural Resources - Division of Quality-- Qruundwater Section
WELL CONTRACTOR UNDIK►D(pdQ UAL)NAME Tbe fl PI I S fit I i n... Air '• ' '' r cTlli{T[ncxn1 rs a j�r-7f i`/
C .
wELLCONCTOR COMPANY NAM1-0)"airC 1'l�wr; IIMll1iy4.4' ni 'rive J TaONLS f $t Sa V-3 ab 0
STATE WELL CONSTRUCTION PERpttaaTRA- ASBOCIATzD W RRMI'17 " - -
(i(spptkable) . • (-faopllcabte) ' .
//
1. WELL USE (Check AppUcable Box):-RRidenGal7YMunicipe1/Pubiic 0 Industrial 0 Agricatlttua)0
Monitoring O Recovery 0 Heat Pimp Watts Injection 0 Other l7 If Other, List Use
2.-WELL LOCATION: - AA
Nearest Town: P JCL' County-,/l/l4 Cl'h�
/1/ / () r kg37 •
(Sum Na Numbers. Ca mtmky, Sal�vislooe, La Ho, Code)
3. OWNER: / 1D 4 0 4ro
Zap. 9/'7- /SL7/
Area code u Phone mber
4. DATE DRILLED D —/ -S `L') Le'5. TOTAL DEPTH: /p' 5'
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO.:0----"
7. STATIC WATER LEVEL BelowTop ofCasitg 01 540 FT:
•
T o biC/Ltind setting -
i go OSlopo Malley OFlat
(cheek appropriate boa) -
Ls6bxje/iongitode Orwell location •
, (deanedmiauw/rwont)
Address °75li /Y) oel-O- L. 4 i t? /2c (. �I/ tLatitudellongitude rot¢tx:OOPSOTopographic map
(SmeetorRe efoJ Oho* box
�L /}) �. a>� S DRILLING LOG
anticlinal clews State ' -. rep Code From To ' Formation Description
.
S 41rn fit sire
LLUL rRANire.
J (User if Above Top OCRing)
S. TOP OF CASING IS / PT. Above Land Surface*
`Top of easing tvmiaated War Wei Ilmdaadaee requires a
nincs In anerdaime wlti'ISANCAC 2C MIL - -
9. YIELD (gptn): / - METHOD OF TEST POW/�GQ-,
10. WATERZONES(depth): 0250' 3 Sim'
II. DISINFECTION: Type
12. CASING:- Depth
From___ .
From, To
From Tp
13. GROUT: Depth
From A To . D itans.pewit
From To Ft.
4. SCREEN: Depth Diameter . Slot Size : • Material •
From To Ft._irt is
From To Ft_ia in.
5. SAND/GRAVEL PACK
Depth Material
From To
Hill Amount -2TkA5
Ft•
Wall Thidmaa
or Weiinht/PL
LOCATION SKETCI(
Show direction and"distan a in miles from at least
two States Roads or County Roads.' Include the road
-numbers and`common road names.
.bfly
FL
. Matsui- Medved
Size
From To FL
6. REMARKS:
RECE VED
. Aehevilie Regio,'3)a? Office
Al;t.fe Proteciti .'1
DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 154NCAC2C, WALL -
ONSTRUCTIONSTANDARDS, ANDTHATACOPY OFT, S RECORD HAS 8AANP10VA)EDTOTHEN/ELL 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
17699-1636 Phone No. [phone], within 30 days• . GW-I REV. 07/2001

• • .
•
• . WELL CONSTRUCTION RECORD •
North Ceto(ina - Department of Environment and Natuni Resources - Division of Water Quality--Qroimdwater Section r�
+�» /i%Ln rl. ` CL U1CAT16Ni fP .
WELL CONTRACTOR (INDI{(WUAL)NA►6 (Prue, c f1%L S I .
'sums .524-3 a-b a
WELL CONTRACTOR COMPANY
STATE WELL CONSTRUCTIONPERMITI - _ Assoc(ATED w{rPLRMFII •
(if applicable) •
-(itappllable) • .
1. WELL USE (Check Applicable Bai):-Rcs1dential7YMauicipal/Public 0 • Industrial 0 Agricultural 0
Monitoring 0 Recovery 0- Heat Pump Water Injection CI Other Cl. If Otiusr, List Use • • '
.2. "WELL LOCATIQJ• - / (� T • . ••
end setting -
N Town: rllr bf t' 4' County /Y! 4 Ca' ' . .l dgl ' a�0 opo 9lind seey g .
/Y • pi R i kit Cad. led- /a ZA L. G-`� ' R t,1 at
$ (eu.ataP ap d.rbox)
(Street Na Member;Commmby, stlbdiviwoq Let Zip) afill y/. L'adhrde/longittida Orwell location
3. OWNER: W.M. C`ARLrow
Address qm• Rex a00,
(StreataramaeltoJ
C L Ay /71JJ b7 3o 5 2
or owu zlde
po4C)-ryfll . �6 p Co
Area code Phooe number -
4. DATE DRILLED - - / 3 -o Co
5. TOTAL DEPTH. Star''
-�14-©n•
6. DOES WELL REPLACE EXISTING WELL? YES 0 NOE W-
7. STATIC WATER. LEVEL Below Top of allay '70 Fr.
(User if Above Top of Caine)
8. TOP OF CASINO IS FT. Above Land Surface*
'Top of aisles terminated aver be lead.aorfam nqutres a
variance In aeardaaq ,wttb 15AHCAC 2C.911a. 9. YIELD (gpto): i' METHOD OF TEST ,Sig 1 �GQ_.
10. WATER ZONES (depth): Ss's, Q
, (degmeim auiahaci der)
Latittde/longittide source:OOPSCITopographic map
Obi* tea)
MUM- DRILLING LOG
Froo To ' Fotmatiot Description
e e
. 1.0CAT1ON SKETCH
11. DISINFECTION:Type /f-f is Amount .2TA,AS Show dlrectiop and diste ce la miln front at least
12. CASING: Wall Madmen two State Roads or County Roads. Include the road
Depth Diapr Let or weight/ft.numbers and n road names.
From O . To Depth„
FL kiat SZIR:S � •
From To Ft
From Tp Ftv_T
13. GROUT: Depth Materil Method
From_,_ To rya Pt r pow°
From To FL
4. SCREEN: Depth Diameter . Slot Size : • Material -.--
From To Ft.__in, in.
From To FL _in in.
5. SAND/GRAVEL PACK:
Depth Size Material
From To Ft
From To FL _
6- REMARKS:
RECEIVED
- Asheville Regicf8r Office
DO HEREBY CERTIFY THATTHIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15ANCAG 2C, WEIL
ONSTRUCTIONSTANDARDS, AND THAT
�-/ A
ACOPY OF/ $RECORD BEEN PROVIDED TOTHE.WELLOWNER
J! Ia 3 43 -o r) •
SIGNATURE -OF PERSON CONSTRUCTINGTHE WELL . - DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mall SerAce Center -Raleigh, NC
J7699-1636 Phone No. (919) 7333721, within 30 days. OW-1 REV. 07/2001
N
J
0

RESIDENTIAL WELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources- Division of Water Quality
WELL CONTRACTOR CERTIFICATION #
1. WELL CONTRACTOR: t. DISINFECTION: Type H T H Amount 160z
James B. Brown 9• WATER ZONES (deppth)):r r
O O
Well Contractor (Individual) Name From J To ) 90 From To
Hedden Brothers Well Drilling, Inc. From :?Cl3(To 2,06' From To
Well Contractor Company Name From To From To
2045
4550
STREET ADDRESS 73-H011y Hills Vista RD
Franklin. NC 28734
City or Town State Zip Code
(828 )- 369-9591
Area code- Phone number
WELL INFORMATION:
TE WELL ID #(It applicable)
STATE WELL PERMIT#(if applicable)
DWQ or OTHER PERMIT #(if applicable)
WELL USE (Check Applicable Box):ox�)�Residential Water Supply
DATE DRILLED . iS'ULP
TIME COMPLETED IA O AM ❑ PM&
3. WELL LOCCCAtTION: �, %� l /f� �'
CITY: IJ "J//�/K.iK/J�(/H 1 COUNTY 1 Y 1Q eft)
t;Lt
(Street Name, mbers, Community, Subdivision, Lot No., Parcel, Zip Code)
TOPOGRAPHIC / LAND SETTING:
C7 Slope °Valley °Flat ❑Ridge DOther
(check" appropriate box)
LATITUDE oo��y�'_15 .5g
LONGITUDE23O g
Latitude/longitude source: GPS °Topographic map
Ossetian of well must be s on a USGS topo map and
attached to this tom 11 not using GPS)
May be in degrees,
minutes, seconds or
in a decimal format
I. WELL OWNER
OWNER'S NAME
ET ADDRESS
A AA-0 lf) l NC,
ity or Town State
jai^irrd
Area code - Phone number
Zip Code
6. WELL DETAILS: '1 /
a. TOTAL DEPTH: C2
b. DOES WELL REPLACE EXISTING WELL? /rYES 0 NOaC
WATER LEVEL Below Top of Casing: I D() 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 Wpm): METHOD OF TEST Blow
6. CASING:
Thickness/
Dept
Diner Weight M r�I
From To Ft. C-•
From ` To Ft. 40 " , /88
From To Ft.
7. GROUT: Depth Material Method
From 0 To 20 FGement & 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
r
Formation Description
clay & sand
grani fp
RECEIV
O
ACVWe,,: Pr -,Tee ion
11. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH
ISA NCACQq,y*Q WELL CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS
RECORLTHA6 BEEN PROVIDED TOTHWELL OWNER.
291-0
ATURE OF CERD 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.
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 #(if applicable)
STATE WELL PERMIT#(il applicable)
DW Q or OTHER PERMIT Cif applicable)
WELL USE (Checkk Applicable Box): Residential Water Supply
id
DATE DRILLED 7 /(C(/U-�15, r eth>
TIME COMPLETED ID.,r1© AM 4 PM ❑
3. WELL LOCATION:
� %r/l���
CITY: %At "li�'.GoLJ COUNTY ! / Itit^-,fnJn- 1
.(StreetNems, Numbers, Community, Subdivision, Lot No., Parcel, Zip Code)
TOPOGRAPHIC / LAND SETTING:
OSlope OValley ❑Flat ❑Ridge OOther
(check appropriate box)
LATITUDE AS______
LONGITUDE a3 A(Zw
Latitude/longitude source: GPS ❑Topographic map
(location of well must be th‘own on a USGS topo map and
attached to this form it not using GPS)
May be in degrees,
minutes, seconds or
in a decimal format
WELL OWNER
OWNER'S NAME
51''flRFFEJJ,T, AOD ESS
�1
to
n1R73y
City Cr Town / State Zip Code
5?U• 3t 2/
Area code - Phone number
6. WELL DETAILS:
a. TOTAL DEPTH: �W
b. DOES WELL REPLACE EXISTING WELL? YES
O NO O
e. WATER LEVEL Below Top of Casing: VLl FT.
(Use "+" if Above Top of Casing)
e 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): I Qt Ii' METHOD OF TEST Blow
)
f. DISINFECTION: Typo H T H Amount 160z
g. WATER ZONES (depth): f
From1/4'To From To From j7® ,To % From To
From ) 7 g To From To
6. CASING: Thickness/
Depth Dlpmgter Weight Ma ria
From To 1 f� Ft. LLOI
From
To %� FL (P 'in";,/��%
From To Ft.
7. GROUT: Depth Material Method
From 0 To 20 FGement & 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 i,``l Formation Description
I � /�� ' c] ay & sand
+
IL� r , OVt grans fP.
54
G4
Ashevii!e Hergio
%{'P WC.' Pr J.
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
RECORb'FItaS BEEN PROVIDED TO THE WELL OWNER.
NATURE 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.,
1317 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 Environment and Natural Resources- Division of Water Quality
WELL CONTRACTOR CERTIFICATION # 2045
I 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 ar Town State
( 828 )- 369-9591
Area code- Phone number.
2. WELL INFORMATION:
SITE WELL ID Of applicable)
Zip Code
STATE WELL PERMIT#(if applicable)
DWQ or OTHER PERMIT Cif applicable)
WELL USE DATE DRILLED (Check a� Ie Box): 3e/P Residential /Water Supply fi3�
TIME COMPLETED77777D •' r(�:11 /5 )r�) AM Do PM»
3. WELL LOCATION:
CITY:
COUNTY (LQar&
• (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: DGPS °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 decimal format
"/ELL OWNER
.OWNER'S NAME
STRE TADDREES� ns
City or Town r State Zip Code
i y9- °CO/
Area code • Phone number
6. WELL DETAILS: �D©
a. TOTAL DEPTH:
b. DOES WELL REPLACE EXISTING WELL? YES It NO
c. WATER LEVEL Below Top of Casing: CR60 \ FT,
(Use'+' If Above Top of Casing)
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): Ig METHOD OF TEST Blow
324548
1. DISINFECTION: Type H T H Amount 1 60z
g. WATER ONES (depth): ,
From Tots,, From
From_A ii/ r To - From
From To From
6. CASING:
Depth Dap,:
To Ft. CB
From To Ft.
From To Ft.
7. GROUT: Depth
From 0
To
To
To
Thickness/
WeightE M terl
Material Method
To 20 rcement & 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 To Ft.
From To Ft.
From To Ft.
10. DRILLING LOG
From To
twinTI
Size
Material
Formation Description
cla
y & and
rani t-a
O
lof7al
11. R ARKS:
to ilitat
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 5 BEEN PROVIDED TO HE WELL OWNER.
3-/. tZ
WELL CONTRACTOR DATE
James B. Bran
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 588.
Form GIN -la
Rev. 7/05