Mi CY2006

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WELL CONSTRUCTION RECORD `J
North Carolina - Department of Environment and Natural Resourc s - Division of Water Quality - Groundwater Section
p
CERTIFICATION NR6;117A
WELL CONTRACTOR (INDIVIDUAL) NAM
WELL CONTRACTOR COMPANY NAME
y PHONE it 101(.0D3- fE1P14(
STATE WELL CONSTRUCTION PERMIT/4ASSOCIATED WQ PERMIT/4
(if applicable)
(if applicable)
1. WELL USE (Check Applicable Box): Residential ❑ Municipal/Public ❑ Industrial ❑ Agricultural ❑
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use
2. WELL LOCAT1ON-
Nearest`I
Town: �e�,bV1/4Ile, County 1
C.0± R &Ap ( of Dr cos
(Street Name,
(N''umb rs, Community, Subdivision,ispp
LotN,,,o., Zip Code)
�
3. OWNER:Iv��� t +`W ���•()I` C5
Address 50 QV\tP Zy
($nlf� e for Row 8�05 SVla
City or Town State Zip Code
( )-
Topographic/Land setting
Ridge ❑Slope ❑Valley ❑Flat
(check
appropriate box)La/,
N 2 vuOl,dty-• SAD9l location
4V
e.�n (degrees/minutes/seconds)Weieva.7 '2-
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From To Formation Description
Area code- Phone number, !_
4. DATE DRILLED I'� - Vl
5. TOTAL DEPTH: 02.1k.5.-t _ /
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO C�'
7. STATIC WATER LEVEL Below Top of Casing: go FT.
(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 accord3gce h ISA NCAC 2C .0118. }p'7�
9. YIELD (gpm): 7• $ MET QD OF TEST@St 00 )
10. WATER ZONES (depth): S 90 l
11. DISINFECTION: Type & LQJ Amount
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
From 0 To 5 CD Ft.
From To Ft.
From To Ft.
13. GROUT: Depth
From To
From To
14. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in.
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common road names.
rrj
q
O
16. REMARKS:
1 DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH I5A NCAC 2C, WELL
CONSTyTION STANDARD, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE VrELL OWNER
�. RE EYY'G
SIGNATURE OF PERSON CO LL
Submit the original to the Division of Water Qua ty, Grounp.wate Section, 1636 Mail
27699-1636 Phone No. [phone], within 30 days r'tt 1
Asheville Regional Office
Agu'lfer Protection
/IIATe
O5
rvice Center - Raleigh, NC
GW-1 REV. 07/2001

RESIDENTIAL WELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources - Division of Water Quality
WELL CONTRACTOR CERTIFICATION # 2.587
1. WELL CONTRACTOR:
STEVE REECE
Well Contractor (Individual Name)
DEWEY WRIGHTWELL & PUMP CO. INC.
Well Contractor Company Name
STREET ADDRESS P 'l Er='r' l'e"e
BOONE
28807
City or Town State Zip Code
( c1R ) - 'Rd_2fs61
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 I
DATE DRILLED 1/1 5.= i€lit£.
TIME COMPLETED 1? ?n AM ❑ PMCI
3. W ELL LOCATION:
CITY: RCN'J M T N COUNTY MITCHELL
GREASY CREEK OFF HUGHES GAP OFF COVE CR
(Street Name, Numbers, Community, Subdivision, Lot No., Parcel, Zip Code)
TOPOGRAPHIC / LAND SETTING:
9 Slope O Valley 0 Flat 0 Ridge 0 Other
(check appropriate box)
LATITUDE 3
LONGITUDE
Latitude/longitude source: Q 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
2
060007
f. DISINFECTION: Type .4T"-1 Amount
g. WATER ZONES (depth):
From ,un To At& From
From To From
From To From
6. CASING:
Depth Diameter
From n Tono Ft. gr 1 IQ
From n To 0 Ft.
From To Ft.
7.GROUT: Depth Material
From rt To 7.0 Ft.r-r.;,r.)
To
To
To
Thickness/
Weight Material
nr.e mt.r:
From To Ft.
From To Ft.
Method
8.SCREEN: Depth Diameter Slot Size Material
From To Ft. in.
From To Ft. in.
From To Ft. in.
9. SAND/GRAVEL PACK:
Depth
From _To Ft.
From To Ft.
From To Ft.
in.
in.
in.
Size Material
10. DRILLING LOG
From To
0 is
440
440 444
4.44 _A5
Formation Description
DIRT
GRANITE
Q1!ARTZ
GRANITE
4.WELL OWNER
OWNER'S NAME"HAPI F^-. I FriP-Pri
STREET ADDRES I919 QJ!ET!'''-''ram 71
-.i q
City or Town State Zip Code
((704) )- 158-64$7
Area code - Phone number
5.WELL DETAILS:
a. TOTAL DEPTH: 505
b. DOES WELL REPLACE EXISTING WELL? YES 0 NO)0
c. WATER LEVEL Below Top of Casing: 6D FT.
(Use "+" if Above Top of Casing)
d. TOP OF CASING IS 1 FT. Above Land Surface*
" Top of casing terminated at/or below land surface may require
a variance in accordance with 15A NCAC 2C .0118
e. YIELD (gpm): ).5 METHOD OF TEST -An"
RECEIVED
MAR 27 2006
Asheville Regional O Ice
Aquifer Protection
11. REMARKS:
1.5 3Ph41 440 - 4'13 0 GPM
n"PM - 0GPM
n em - n n;Pnq -
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
IPROVIDED
D^T/O THE WELL OWNER.
SIGNATURE OF CERTIFIED WELL CONTRACTOR DATE
-R d i - (7�
STEVE REECE
PRINTED NAME OF PERSON CONSTRUCTING THE WELL
Submit the original to the Division of Water Quality within 30 days. Attn: Information Mgt.,
1617 Mail Service Center - Raleigh, NC 27699-1617 Phone No. [phone] ext 568.
Form GW-1 a
Rev. 7/05

(Street Name. Numbers. Community. Subdivision.Lot No.. Zip Code)
3. OWNER 7INAI/ read (degrees/muwtes(seconds)
(Street or Route No.)
�ar.c.
j3*}Gis°¢tiL,ue
ny or Town Stare Zip Code
ts2 _ 688-"rim
Area code- Phone number
4. DATE DRILLED Oda' O&
5. TOTAL DEPTH: SOS
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO 0
7. STATIC WATER LEVEL Below Top of Casing: 4kb0 FT.
1 (llu"a^ if Above Top ofCarus)
8. TOP OF CASING IS FT. Above Land Surface*
^Top of tasina termianttd auor bNaw land surface regoires a
variance is accordance withISA NCAC 2C .0! 18.
9. YIELD (gpm): (Qm METHOD OF TEST �r it
10. WATER ZONES (depth): C,DO *op. a ¥ O
11. DISINFECTION: Type
12. CASING:
Depth
From Tor__ Ft
From�Se To 32 Ft
From To Ft.
13. GROUT: Depth
From To
To Z 2
From 0
A otent
Wall Thickness
Di CT or Weight/FL Material
67428 /Q&Gv
Material Method
04.949
14. SCREEN: Depth Diameter , Slot Size Material
From To FL in. in.
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Size
From To Ft.
From To Ft.
Material
16. REMARKS:
Et.
FL
1 DO HEREBY CERTIFY T THIS WELL WAS C
CONSTRUCTION STAN t : c; a , AND THA
N.
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) (Y#l/CV OVIC£. CERTIFICATION II 2/W ELL CONTRACTORCOMPANY NAME�C i(r C� WCL (- (,(�LG PHONE Y (OG97Ze
STATE WELL CONSTRUCTION PERMIT* ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential 0 Municipal/Public 0 Industrial 0 Agricultural ❑
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other ❑ If Other, List Use
2. WELL LOCATION:
Nearest Town: Spe€oc f M'i0CCounty Oh lest toe
/7q <eX Rvn/
Topographic/Land setting
❑Ridge ❑Slope ❑Valley ❑Flat
(check appropriate box)
LatitudeMto
n i(ude of well location
34sor, ft/ 3l2N o8Z 0Z'arstd
Address / ce r< y rt 41 POQCon (.3 Latitude/longitude source:❑GPS❑Topographicmap
(check btu)
DRILLING LOG
Formation Description
0: ice it(C.r.Jk.
DEPTH
From To
o- Zf
¢d- Cos tetAA•i-Ite
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.
UCTED IN ACCORDANCE WITH ISA NCAC 2C, WELL
THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
TUR6tF PERSON CONSTRIXTING-THE WELL DATE
Submit the original to the Division of Water Quality, Ground; tter Section; 1636 Mail Sertilfe Center -Raleigh, NC
GW-1 REV. 07/2001
27699-1636 Phone No. [phone], within 30 days.

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural RtsourcesL- Division of Water Quality - Groundwater Section !,
t
W ELL CONTRACTOR (INDIVIDUAL) NAME (print) I) /••r -)1 TIC, I. / '( CERTIFICATION #2 150
WELL CONTRACTOR COMPANY NAME S (, ` t ` :. NAIL 11 437.'. t / , PHONE # ;r 21 Zier451g
STATE WELL. CONSTRUCTION PERMITS/ ASSOCIATED WQ PERMIT*
(ifapplicablc) (ifapplicabk)
1. WELL USE (Check Applicable Box): Residential CY Municipal/Public 0 Industrial 0 Agricultural D
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 1f Other, List Use
2. WELL LOCATION:
Nearest Town:j> r. % i- It-
/7 1 9 Cue areal'
(Street Nam.:. Numbers. Community. Subdivision. trot No., Zip Code)
3. OWNER:T Ls Proud?,
Address 2 Fed 51-
(Sgqect or Rowe No.)
�Ioticrshrlrnggs 0(930
City or Town Suave Zip Code
County NJ. ,1 I
(979)--994-3/7?
Area code- Phone number, j
4. DATE DRILLED I-7- n?C.o,
5. TOTAL DEPTH: z25
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO 0
7. STATIC WATER LEVEL Below Top of Casing: 74 D FT.
(Use Irv- if Above Top ofCatit0)
S. TOP OF CASING IS ' FT. Above Land Surface*
*Top orcasing terminated at/er helm land surface requires a
variance in accordance with ISA NCAC 2C .01 t&
9. YIELD (gpm): / METHOD OF TEST Vic)
t o. WATER ZONES (depth): 1 t Jt M by 2.R')
1 LOCATION SKETCH
11. DISINFECTION: Type CA or% rP Amount R p. Show direction and distance in miles from at least
12. CASING: Wall Thickness two State Roads or County Roads. Include the road
Diameter or Weight/Ft. atcrial nonumbers and commtad names.
FIG / 90 , s czev,'/ re
FL On )fl (NY
Ft.
Topographic/Land setting
❑Ridge ['Slope ❑Valley °Flat
(check appropriate box)
Latitude/longitude of well location
3600. 352N a7t (S.607 k
From 0 To 7?
From7/ To 7'3
From To
13. GROUT: Depth
From a To 1
From To
14. SCREEN: Depth
From To
From To
15. SAND/GRAVEL PACK:
From
From
Depth
To
To Ft.
16. REMARKS:
(degrees/minutes/seconds)
Latitude/longitude sourer:OGPS°Topographic map
(check box)
DEPTH DRILLING LOG
From To Formation.-t�Description
- !n S "TI r
605-405 (.7rctA.;it
Material Metipd ji
rocC
Ft. --rive
Ft ,�U x,✓
Diameter Slot Size Material
FL in. in.
FL in. in.
Size Material
Ft.
(\cnt (raft
Nsne Rd
1 DO HEREBY CERTIFY T4
CONSTRUCTION STAND' !,
HIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
AND THAT Y OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
•
ATURE
F PERSON CONSTRUCTING THE WELL
Submit the original to the D ion of '4o ter Quality, Groundwater
27699-1636 Phone No. [phone], within 30 days.
DATE
tion, M036 Mall Smite Cott-- Raleigh, NC
-I REV.107/2001

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) g40-41 36 9(4 C��' CERTIFICATION #L7
`J5v
SOS$ CS( JQK�{«INi PHONEY1p2$%1y'itSye
WELL CONTRACTOR COMPANY NAME
Trent WELL CONSTRUCTION PERMITS( ASSOCIATED WQ PERMIT#
Iifapplicable) / (if applicable)
I. WELL USE (Check Applicable Box): Residential Iff Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other ❑ If Other, List Use
2. WELL LOCATIO : / r `'I`�'e'C
Nearest Town: County r ?1, r
Lfrt Z oe.0'Lou rt' (�puw Lore
(Street Name. Numbers, Community, Subdivision, Lot No., Zip Codc)
3. OWNER: 'LSA
Address SD $ e e-ler.- e
5 1 (Street or Route No.)
V4LL'.NfNt-
Cily or Town Slate
0tx4 )- 5cea- IItQ
Area code- Phone number
4. DATE DRILLED
5. TOTAL DEPTH:
6. DOES WELL REPLACEtXISTING WELL? YES 0 NO DV-
7. STATIC WATER LEVEL Below Top of Casing: 4n 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 •
variance in accordance with ISA NCAC TC.011&
9. YIELD(gpm): 15— METHOD OF l�/
TEST. 14'/'C
10. WATER ZONES (depth): / Se'pnst tQ 1/0
I L DISINFECTION: Type 6L'kiit/ c
12. CASING:
Depth Diameter
From To Ft.
From ° To 7/ Ft.
From 7/ To 73 F
13. GROUT: Depth
From
sW &is64/2.6et
Zip Code
Amount 9Oa
Wall Thickness
or Weight/Ft. Material
//PJV-c.
Ybju
atonal Method
To Ft.
From 0 To_°Ft. Y-Vfe/ ea 6
14. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in.
From To Ft. in, in.
IS. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
16. REMARKS:
Topogriphic/Land setting
❑Ridge SSlope ❑Valley ❑Flat
(check appropriate box)
Latitude/lon itude fell location
3bo 00.354> 1 02 Est 4T7W
(degrees/minutes/seconds)
Latitude/longitude source:ftleGPS❑Topographic map
(check box)
DRILLING LOG
Formation Description
DEPTH
From To
it 105- Q / R '!
(oS1-2C tit
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the r0ug
numbers and common road names.
elite E� /
Or-
fagt
1
713
--t
0
s
1 DO HEREBY CERTIFY THAT THIS t L CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND COPY OF THIS IDEDTO THE WELL OWNER
SIGY.W#E OF PERSON
Submit the original to the Division of Water Quality,
27699-1636 Phone No. [phone], within 30 days.
NS"GRUCTINGTHE WELL--`--'�--TATE
rohndsvateitectioM 1636 Mail Senice C
nter -Raleigh, NC
iW-I REV. 07/2001

*1
Smitist
WELL CONSTRUCTION RECORD
OSP
Nonh Carolina - Department of Emvronment and Natural Resources - Division of Water Quality - Groundwater Section
c /ey �vs�':CE CERTIFICydArT�IIhOON# 2/ a
SF�CE b(tC- Or; Wei PHONE#(DiD-nif -tore
WELL CONTRACTOR (INDIVIDUAL) NAME (print)
WELL CONTRACTOR COMPANY NAME
STATE WELL CONSTRUCTION PERMIT/ ASSOCIATED WQ PtRMITl
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential Q' Mtmicipal/Public 0 Industrial ❑ Aericultwai 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Outer 0 If Other, List Use
2. WELL LOCATION: A
Nearest Town: SQRGe( At✓G
St juvt'U
(Sneer Name. Numbers, Camrumiy. Subdivision. lot No. Zip Code)
m
3. OWNER: Cody "4Le
Address 3 96 Dv[.A-le.4.
County Sir4-1tGLt.
,saes or Route NO 08179
.S,Rc f.0 r0'A>t Al
Ciyor Toro Sex Zip Code
told)- les-2703
Area code- (hone [Dumber
4. DATE DRILLED Si7-a'
5. TOTAL DEPTH: 405 /
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO Q
7. STATIC WATER LEVEL Below Top of Casing 40 FT.
(Use "+- if Above Top of Canog)
8. TOP OF CASING IS { FT. Above Land Surfaces
'Tap of casing ter®4atd at/or below had nrface remits ■
redact h accerdaace wih I NCAC 2C .alIS
9. YIELD (yrrr): _METHOD QF TEST S
10. WATER ZONES (depth): J29,O7
11. DISINFECTION: Type C(eR4)(1t
12. CASING:
From 0
From
From sib
Topograp ic/Land setting
°Ridge Ct16(ope °Valley ❑Flat
(cheek apprupriaic box)
2 °3o. 46� N (7E2°iv 2g6W
(depashaiaans/asaam)
Latitude/Iongitude sotwce:OGPS❑Topographic map
(meek box)
DEPTH DRILLING LOG
From To Formation Description
o-3s Di2f
35- t.os 6%wa,te,ie
LOCATION SKETCH
Amount d 02- Show direction and distance in miles from at least
Wail Thickness two State Roads or County Roads. include the road ,
Depth
Diaeter Wd t/D. • nu4"2rdsers and common road names.
Tea FL 6 VI. 4'0mor
21*
.nn
To FL
13. GROUT: Depth Materiel
From To Ft
From_f_To-_a_Ft. "Pip pit pumeeI.
14. SCREEN: Depth Diameter Slot Size Material
From To Ft in. in,
From To FL in. in.
I5. SAND/GRAVEL PACK:
Depth Size
From To Ft.
From To Ft.
16. REMARKS:
Tor Ft • 1 t_ Method Ir -
err
1 DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WI 14 15A NCAC 2C. WELL
CONSTRUCTION STANDARDS, AND THATA COPY OF THIS RECORD. HAS SEEN PROVIDED TO THE WELL OWNER
Ica
SIG RE OF PERSON CONSTRUCTING THE WELL. DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service enter -Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. 1 i t �GW-1 REV. 07/2001
1
p�
1

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Sect1
\. 1WELL CONTRACTOR (INDIVIDUAL) NAM (print)Ax+t 1_.%� \ CERTIFIC OPat
WELL CONTRACTOR COMPANY NAME T$ P C +�°`a I PHONE #
STATE WELL CONSTRUCTION PERMIT#
(ifa >licabte)
ASSOCIATED WQ PERMI
(if applicable)
326489
WELL USE (Check Applicable Box): Residential hd' Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use,
WELL LOCA •N: / _/,'/,
Ny.1tc, lesvn• f�La4 County / �>'C�lS1�
(Sweet Name, Numbers, Comity, Subdivision, Lot No., Zip Code)
3. OWNER:'P Ut14iD4l(
Address .M.c
(Street or Route No.)
City or Town State Zip Code
( )- q /
4. DATEcode- DRILLED
Area ne1 5I3%6w
5. TOTAL DEPTH:` G' t /
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO GY
7. STATIC WATER LEVEL Below Top of Casing: /6 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 accordant sv th ISA NCAC 2C.0118. /��( l��
9. YIELD (gpm): e� METHOD OF TESII i�d�Xi�j
10. WATER ZONES (depth): tzj 5---
Togo aphic/Land setting
DRidge Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/ n tude w 1location
'3CP°6 .�3 OFSaIt / p//
(degrees/minutes/seconds) elev.�eL Ivy
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From
To Formation Description
11. DISINFECTION: Type hQoItr Amount va—
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
From To (ALP Ft.
From To Ft.
From To Ft.
13. GROUT: Depth Materia
From 0 To 3 Ft. COnd, de
Front, • To / 7-- F
14. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in.
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common road names.
n!�l}r:. �:..
16. REMARKS:
1 DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELD 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-I REV. 07/2001

From
From
13. GROUT:
From
From
I4. SCREEN:
From
II. DISINFECTION: Type ( (g-, Amount 2.2
12. CASING: Wall Thickness
Depth or Weight/Ft. Material
From To. _ Ft.
To Ft.
Diameter
To Ft.
Depth
To F
To= Ft
Materr_ _ a:i ,
Depth Diameter
To Ft. in.
From To Ft. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
Slot Size
in.
in.
Material
WELL CONSTRUCTION RECORD
3 ? 6 A 8 8
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Sectionioq /
WELL CONTRACTOR (INDIVIDUAL) NAME.t. (print) •/y ill01.1J`'L 'tit
CERTIFICAQTIIONN#W?/�! Q
WELL CONTRACTOR COMPANY NAME / i ry+sl/ A iPCh�At� 1(�1{ � J ( PHONE A 'its IE�el`
STATE WELL CONSTRUCTION PERMIT -it r 1 ASSOCIATED WQ PER,
(ifa \licable) (if a. Iicable)
I. WELL USE (Check Applicable Box): Residential c Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCAON: NeIVI.
t?L(
arest Town1'S V
�r t � IC County
40,755—
(Street Name, Nulnbers,roinmultriti, Subdivision, Lot No., Zip Code)
3. OWNER: Sc.)(.LLt%�.
Address
(Street or Koute No.)
tfrcerv;tte, C r?k7-6 j'
City or Town State Zip Code
1 Area code- Phone number �'
4. DATE DRILLED
5. TOTAL DEPTH:
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO 1.}'
7. STATIC WATER LEVEL Below Top of Casing: /00 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS f FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accords nh ISA NCAC 2C.0118. m
9. YIELD (gpm): METHOD OFTESTL7i`lL.
10. WATER ZONES (depth): 1 / 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.
Topogr hic/Land setting
❑Ridge Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude o well lac on
`fo 5V 5
(degrees/minutes/seconds) E(E,(�,
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From To Formation Description
(LIN 06 L:: 3
Sax
16.REMARKS:
1 DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH I5A NCAC 2C, WELL
CONION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL, OW ER
SIGNATURE OF PERSON CONSTRUCTING THE WELL
DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center -Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-1 REV. 07/2001

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
\\'ELL CONTRACTOR (INDIVIDUAL) NAME (print) gafzt t Z S`�) It 2 CERTIFICATION p/o4V
tt'ELL CONTRACTOR COMPANY NAME
STATE WELL CONSTRUCTION PERMIT# ASSOCLATE3WTQ PERMIT/
(ifa,.licabic) (if ,. icable)
329753
1. WELL USE (Check Applicable Box): Residential t; Municipal/Public 0 Industrial 0 Agricultural ❑
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION: it
Nearest Town: .510.44 J a roue - `
(Street Nang:. Numbers. Community. Subdivision's'. tot Now Zip Code)
3. OWNER: Ilh►U iz0 LC1�NS
Address r7 c4e s rxAdt ?tL Hecit
(Shen or Route No.)
S iletu.ocere /U t- 2, $7T7
City or Town State
(31141--q7—/194
Area code- Phone number
4. DATE DRILLED ru e- I
Topograpjtc/Land setting
❑Ridge p ope ❑Valley ❑Flat
(check appropriae box)
Latitude/longitude of well location
(degrees/mimi s/secods)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From To Formation ne .^.r .on.
5. TOTAL DEPTH: -7oS A"'/J
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO (Y /s^ e
7. STATIC WATER LEVEL Below Top of Casing: FT.
(Use u+-ifAboveTop of Casing)
3. TOP OF CASING IS / FT. Above Land Surface*
rt_
gozit r4:,cy
P$ ^ 70 S C',a,/t pa/ l{-{
'Top of canine terminated at/or below land surface requires a
variance in accordance with ISA NCAC 2C Ant9. YIELD (gpm): .V METHOD OF TEST 571thkid
10. WATER ZONES (depth): I/3 G JPMVI
LOCATION SKETCH
1 I. DISINFECTION: Type C T.° L. Amount D c— Show direction and distance in miles from at least
12. CASING: Wall Thiclmes two State Roads or County Roads. Include the rood
Depth Diameter or weight/FL Material numbers and eggnnon road rams.
From To Ft. !J f/
From To Ft �j • � 4-K 1 q
From VI To 35 Ft. t91lJ "7 D .'flf t' y}
13. GROUT: Depth �Material Method
From To Ft / �'I� ._..
Erom_sQ To S EL Zi. ( -�--� =-'
1 i
14. SCREEN! Depth Diameter Slot Six Mat Hal Li "'7
From To Ft. in. in.
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Et.
16. REMARKS:
no
o 'c-
_D c 7
pA 44;irk
—7
226
1 DO HEREBY CERTIFY ��—'tT THIS WELL WAS CONSTRUCTED IN ACCORDANCE N/F T H t )A NCAC ZI:, WELL
CONSTRUCTION STANd}tt[D5, AND THAT A COPY OF THI5RECORD HAS BEEN PROVIDED TO THE WELL OWNER
Id CONSTRUCTING THE WELL
DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center -Raleigh, NC
27699-1636 Phone No. (919) 733-322I, within 30 days GW-1 REV. 07/2001

00) 329705
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section _-
\W ELL COViRACIOR (INDIVIDUAL) NAME (print) 6-A-/,Cy Josf/Ce CERTIFICATION #09/rg)
‘, ELL CONTRACTOR COMPANY NAME TO51 /c6 Wed-- n/Iwaik, PHONES MI & 4411r/8
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMITS
(if applicable) (if applicable)
I. WELL USE (Check Applicable Box): Residential 19r-Municipal/Public 0 Industrial 0 Agricultural ❑
Monitoring ❑ Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION: / /,
Nearest Town: etikertse.Ll a County /0/ CLL
r214 yN6rvi 5Htr De
(Street Na nc. Numbers. Community. Sulddivision. Lot No., Zip Code)
3. OWNER: DOUG 5l CI Les.
Address P. o UQoa' /2
z4»d ISt ctto Rome No.)iknu ,1
City or Town State Zip Code
(tit)- rittirg 9 NR
Area code- Phone number ,�1
0 ? 4. DATE DRILLED Y/ /GN ��
5. TOTAL DEPTH: 46J''
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO gi/
7. STATIC WATER LEVEL Below Top of Casing: /00 FT.
(Use "+' if Above Top of Casing)
S. TOP OF CASING IS / FT. Above Land Surface'
Top of casing terminated at/or below land surface requires a
variance in accordance with ISA NCAC ZC .011&
9. YIELD (gpm): I Z METHOD OF TEST /'r (
10. WATERZONES(depth): /Z % PM. t .1 yos
11. DISINFECTION: Type Ccog/ ate Amount 902D2
12. CASING: 't Wall Thickness
Depth Diameter or Weight/Ft.
From To Ft
From r7 To 70 Ft. G
From %o To 72 Ft.
13. GROUT: Depth
From To Ft.
Material
ciao Ave
r/88 Ca a.f
Material • Method
From EN: Te Ft.ti�_
14. SCREEN: Depth Di t ter Slot Size Ma caul
From To " Ft.
in. in.
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
TopD is/Land setting
DRidge IIRSlope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
35 sea o 4 ©fit 2 ° chi D c✓
(degreesim in�u���sG[s5econds)
Latitudc/iongitude source: I GPPSOTopographic map
(check box)
DEPTH
From To
DRILLING LOG
Fomtation Description
C- Ca S A/ ref¢ /doe*
GT- /-105 (4 eme//`
LOCATION SKETCH
Show direction and distance in miles from at least u
two State Roads or County Roads. Include the ro4-,
numbers and common road names.
£f,ijtjssf, .0
16. REMARKS:
1 DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN A CORDANCE WITH 15A NCAC 2C. WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
SIGNATURE OF PERSON CONSTRUCTING THE WELL
DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
27699-1636 Phone No_ [phone], within 30 days. GW-I REV. 07/2001

North Carolina - Department of Environment and Natural Resources - Division of Water
^r- 6rnzy rclS icy Ar
NY ELL CONTRACTOR COMPANY NAME IA,PLCO
Qua
w ELL CONTRACTOR (INDIVIDUAL) NAME (print)
45) 3 2 S 7 6 4
WELL CONSTRUCTION RECORD
iity - Groundwater Section (��r
CERTIFICATION # (.,J `)
PHONE # [phone]?
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
6f
(ifay, limbic)
I. WELL USE (Check Applicable Box): Residential 67' Municipal/Public 0 Industrial 0 Agricultural ❑
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION: �p
Nearest Town: SP/,r,r.L ` f+ruit County /V%
g %1 4V (✓Tf0 p
(Strut Name_ Numbers, Community, Subdivision. tot No.. Zip Code)
3. OWNER:
Address
pia Oo0i&gdory
ROu GZ4i
,/� (Street or Rowe No.)
ice//�, At ea, 87-77
City or Town Stoic Tap Code
( )- 7695- 9 S3 C
Area code- Pboot nundzr
4. DATE DRILLED S'"i — 06
5. TOTAL DEPTH: / b5
6. DOES WELL REPLACE EXISTING WELL? YES O NO td p D. - (f5
Topographic/Laan4 setting
ORidge OSiope ctQalley ❑Flat
(check appropriate box)
Latit dc/bngitude f well location
3r s ' 7oq AJ ogzadz, 7y54il
(degrees/minutes) )
ude sourer. PSOTo
Latitudc/longit pographic map
(check box)
DRILLING LOG
Fomtation Description
DEPTH
From To
D-?0
7. STATIC WATER LEVEL Below Top of Casing: /%r FT.
/ (Use "+- ifAbote Ton el -Casing)
S. TOP OF CASING IS f FT. Above Land Surface*
'Top of casino terminated at/er below land surface requires a
variance is accordance with ISA NCAC 2C .0118.
9. YIELD (gpm): 30 METHOD OF TES'T'
I
10. WATER ZONES (depth): 31991,44 /
1I. DISINFECTION: Type etorz1Nt Amount qi 02
12. CASING: Wall Thickness
Depth Diameter or Weight/FL Material
From To FL
From 0 TA1D FL
From .2 7 To 21 FL
13. GROUT: Depth MStetia1 Method
From To Ft.
From b To 71 Ft. ili�1,° i
14. SCREEN: Depth Diare(er 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.
tfroatevvi
LOCATION SKETCH
Show direction and distance in miles from at least--_-.
two State Roads or County Roads. Include the rottrd}
nuluba s and common road names.
r-
1 r.f _r
c-n r
tl
16. REMARKS:
1 DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2G WELL
CONSTRUCTION STANDARDS. AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
IGNAT(NRE 9iHPERSON 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. 072001
e

•
limb Cotes -Dopromtio/t v.'—.:.aNraR..wur-t.t cl Wss, Mel.orw,a..Urs.eta,
Mitt W tbd.t Ow.w-ROOS N.C. WOOL pills. pip Met
WELL CONSTRUCTION RECORD wa•a.00wmAcTae i,1 OR l A ��
WELL CONTRACTORiER1rICATIWIt 1I:
STATE WILL ODNSMIICIt,N MRINT/t
1. WELLUU A.t ry7b�¢n..Idwdj9' WINS, bd..b1ND Apbl•1d❑ V
newsy ❑
n.yLN.dPoopWalorbr..tee❑ Ole NOinr.LIN% r
2 WELL LOOARENt Moor Malt dMlo.tlo-bibw)
Nino Taw ILO. VIe.rsvIIIP O.aIL Nil+mt lJ
Pal 11iniiund Matti. Ovisiorad
� linldmaidtatN.) ORILLNGLOS
t OWNER rnv r r (Lin rfl efl Roo T.
Adbw. I5c; fe b -A I -57C
lac .T.w 1Y.
t.
II.
7.
a
a►TEORURO C 13-LAO i (-+[T\
TOTAL uem S
CTlnwosCOLLECTED YES CI NOCK
DOES W LL REPIXE warm WELL? YEW Q NO[�
STATIC WATER LEVEL Stow Tap of CIMF FT.
(Yw4•tA...TI►.1POW
O. TOP OF CASINO is FT. Abam Land Swam?
O
RE
Ty W seep p Iwsi lit a:
babe b.d.ab.... _t ..._J... bins.
d.../tANaAcla
10. YlaD r Y - .METHODOPTEST I
11. WATER ZONES
12. CHLORINATION- Typo Amood Iod lionotrpnbmodal umteat eile r
13. CASINO:
From t To } FL I
pirriir
Fran To 17
From To FL
1l GROUT:
From _L._ Depth
.b.TNoYw.a LDCATION SSG 1Cli
.A.y..t 111111111 pYswdoe inedbilies boon Mist moles
Palt2 C- R.Swdemop rolwaetpfl)
tit
WSW
p (ne.
From To FL
tS. SCREE*
Dopth
From __To_
From _To_
From. To
1t 811rDGRAVELPACK:
aPh
From To
From
17. nEM.me
Dlaewlw SIM Sm. /Sold
FI_ In,
FL_„_ In. h
FL_h _h
To FL
MSS
i�w�• i CH?
n
-4,4v9 i G
1DONt eVCI MFYn mTHMVSLWAScONt7RUC1EDMACCosts=WITNWWA MAC SC. WELL
communal STANDS AND THAT ACM OFWOE NECONDWIN MOW PROVIDED TOME WEU.OWNER.
FOR OFFICE USE ONLY
awNw
uun
ala�NNNE CP.teI.O1.Ca111 M CINCI1EMYi pat
•ibdwyP./bOiYb..fWde011111r, /end.r.r/.lr■ MNd. 30 duos
OM FILM rant

•.
Nat Craw •Ospwandd lIndanonsnland Sint tlnawaa•anraadWSCAS .OtatardnaorSolon
nal Me sw & On* • SSW N.C. vnaFN0ti F►tona AMj Matt
WELL CONSTRUCTION RECORD nu. ('A wit id k" 'Laflfr
WI1tLCOkmACORCEtTflICAtIONII
STATI *SI. CORNi1RICWON PSlr/Ts:
1. WELL USILLanstingsiormssom fw
RmItler s% .dl4al ❑ SEWS Elol D Asdl*sMorbidly
D
Rowney tJ HMPomp WerWO S Ode law,LilUsc
2 WtsLtDCAW huiviad�'aw'°" 61 lI
NaroMTiwa < <'�
ems rinnuni 3. so To
Owen 1-\ n V l AC n. opiney. or MSS'
1-1 Aba NO sLlKi tDt; 11.. ( �
O/firTS Sole SOe
4. MTEonus) ( 4-1`-t-flG 51(')` 642
5. TOTAL DEPTH -240 C`
0. COMM COLLECTED TEsD P '
7. 00E9 WELL REPLACE 1909111161 WELL? TES CI Noe-
S. STATIC WATER LEVEL Ms Tap al Corry FT.
fie "irlAnn Tun Cosi
0. TOP OFCASINO 19 I FT Phew Land Saioo'
'rep dmen lass l eke ban bud swim nipiwsssrla sAssnw
UassSfUt1CAC76A2Is
10.VELD kip* U METHOD OFTEST (�j
11. WATER ZOfEs OW*JJ
12. CHLORINATION: Typo
13. CASIICt
Pnoad RodMaalspies bnoodadaaotoad bm
pi/ r TawTiMae
Fin I OTo _< Cj R.
% wNrent.
Rom-----. . To R_u 7 —
From To R. —
14.OROUT:
pt
Fran I To R 00 kih t
From To R.
SCRIM
Masrd
Depth O1.nsler Wel alai
From _ To _ R _ Or. h
From __ To ___ R. ki. _ In.
Fran To R_ kt In.
16 sANdORAVEL PACK
aph slap tlalwir
From To R
From To R
17. REAV Is
WC.AM SKETCH
*elthilerdar sal Anne k en sa he We SS
Rea wdrramp norm WWI
£tea f
Cr\
L CK. Rc:
ash F
flucjten -Al
L
C▪ Z•▪ n
- c
t00HERESY CIRTFYTNATTissWELLWAS CONSTRUCTwNACCORDANCE MIN1SA NGACB. M52,
CCNsTRICRONSTANDARDS. AND MAT Aar CAMS RECORD HAS PROy10EOTOME WELL OWNER
FOR OFFICE USE WILT
Galt
atdrranun oFrise Cl0RKt01NOM nwa DUE
0M mswims_omes errWa ceosm ara—weds 30 drys
1115.1 MIS MA

tooth th Carolina • Dperbrte. L of Environment and Nagar Re•otee•a - Otileton al We
1935 Mel Seevlee Crow-WL - Oraedw•ler SectionRaleigh, N.C.N.C27SSL1W61+lane (91>h 73,1-.1p11
WELL CONSTRUCTION RECORD WELL CONTRACTOR. aVinnk nt
WILL CONTRACTOR CERTIFICATION t: C3113
STATE WELL CONSTRUCTION PERMITS.
1.
2.
WELL USE_Lor.rt AFpneabb RWdorpW 69 Murdelpd ❑ Indusblel 0
Recovery a Float Pump Water InIeollon 0 Oscar [j R Other, UM for
WELL LOCAT(QN: (Show Swath of rho location b....)
NeanaTowic lLrnzwN I trio, M1-kfl p
3. OWNER �d j� a', ortt ...aMlotNo.)
ellrCe Q1(9DerRI( ^" r�ir: 14
or Tam Slab Sp bode
4. DATE DRILLED`! k-ALP
5.
6.
7.
6.
Address LQ )
TOTAL DEPTH 1O
CUTTINGS ccLLECTED YES 0 NOE?'
DOES WELL REPLACE EXISTING WELL? YES 0 N09
STATIC WATER LEVEL Below Top of Ca*g FT.
(the •i' a Aben Tent cnt
9. TOP OF CASING IS 1 FT. Above Land Surface•
'Top of vabta Iwedttred aver bolew lend sort«. makes • .came. In se
donee aeet 1SA NCAC 2C MIS (n�
10. YIELD Wpm): METHOD OF TEST ►'1I1�
11. WATER ZONES (depth)*
Apdad4rral 0 Monitoring 0
DRILLING LOG
Fr To
12. CHLORINATION: Type Amount
13. CASING:
Depth .7 n Ineeler
From 1 To a W Flirtyµ
Fron• To FL
From To FL
14. GROUT:
Depth
From To cJn
From To
15. SCREEN:
Depth
From To F1
From _ To __ R.
From To _ FL
16. SANDfGRAVELPACK:
Depth
From To
WY ROSIN.
erW/phleFL WNW
pnSkt(
MatorW Method
Ft. f rin2r*
FL
DIan.l Slot SFS Materiel
lot. kn.
FL
From To Ft.
17. REMARKS:
in lots
kr; in
Size Masai
DEPTH
;mini rf
ti edNtlor i peer b needed use beds of loan
LOCATION SKETCH
(Show dbe llont and dMame ben M Most trio Stets
Roods, or other mop reform pabds)
i DO HERESY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH ISA (CAC 2C. WELL
CONSTRUCTION STANDARDS. AND THAT A COPY OF RECORD,/HAS SE�i PROVIDED TO THE WELL OWNER.
FOR OFFICE USE ONLY Mee l c i' sir' - :- 2 ! `c
Owed No
Sind No.
DOhL►TlS1E'OFPERSON CONSTRUCIM6 THE WELL DATE
Submit edeIndlo DWMsnr WrerD ally. O.NndarwBwaut wNt 30 days
OW-t REV. 12Ae

RESIDENTIAL WELL CONSTRUCTION RECORD
North Carolina Depa tment of Environment and Natural Resources - Division of Water Quality
WELL CONTRACTOR CERTIFICATION # 2878
1.WELL CONTRACTOR:
STEVE PRICE
Well Contractor (Individual Name)
DEWEY WRIGHT WELL & PUMP CO., INC.
Well Contractor Company Name
STREET ADDRESS P O ROX 308
BOONE NC 48B07
City or Town State Zip Code
( R92)- 98L-9851
Area code - Phone number
2.WELL INFORMATION:
SITE WELL ID #fd applicable)
STATE WELL PERMIT #frt applicable)
DWQ or OTHER PERMIT #Otapplicable)
WELL USE (Check Applicable Box): Residential Water Supply D X
DATE DRILLED 5W2006
TIME COMPLETED 110 AM ❑ PM DX
3.WELL LOCATION:
CITY: ROAN MTN. COUNTY MITCHELL
HUGHES GAP/ COVE CREEK OFF 143 OFF 19E.
(Street Name, Numbers, Community, Subdivision, Lot No., Parcel, Zip Code)
TOPOGRAPHIC / LAND SETTING:
❑ Slope Cl Valley 0 Flat 0 Ridge 0 Other
(check appropriate box)
LATITUDE 3 _ 3.106 6'L3
LONGITUDE 0R911 &La
Latitude/longitude source: 0 ICS D 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 Ij/FTT'E M ROI„l RRA.S
STREET ADDRESS 40 DERR RUN RD
c oERVU E State NC Zip Co 2805
(4.8e688-b660
Area Phone
er
5.WELL DETAILS:
a. TOTAL DEPTH: 405
b. DOES WELL REPLACE EXISTING WELL? YES 0 NO OX
May be in degrees,
minutes, seconds or
in a decimal format
c. WATER LEVEL Below Top of Casing: 90 FT
(Use "+" if Above Top of Casing)
d. TOP OF CASING IS 1 FT. Above Land Surface"
Top of casing terminated at/or below land surface may require
a variance in accordance with 15A NCAC 2C .0118
e. YIELD (gpm): 50 METHOD OF TEST Air
060171
f. DISINFECTION: Type 11T)1 Amount 79
g. WATER ZONES (depth):
From 370o 377 From To
From To From To
From • To From To
6.CASING:
Depth
From 0ro106 t,
From__ oro__(Ft.
From To Ft.
7.GROUT: Depth
From____ fo__ 20Ft.
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.
Thickness/
Diameter Weight
8 1/4
10. DRILLING LOG
From To
0 57
ST 370
1713 372
'17? d(15
Material
Cement
Material
1 7
Method
Gravity FINw
Formation Description
DIRT
f RANITE
flUAPT7
r RANITF
Ci
11. REMARKS:
50 GPM 370 - 372 O GPM -
O GPM - O GPM -
0 GPM - 0 GPM -
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH
15A NCAC 2C, WELL CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS
RECORD HAS BEEN PROVIDED TO THE WELL OWNER.
4.9
.�Y�nsalr/ 1:41- -‘" j -J/ ci
SIGNATURE OF CERTIFIED WELL CONTRACTOR DATE
0
IV r-.-.;
0
0
STEVE PRICE
PRINTED NAME OF PERSON CONSTRUCTING THE WELL
r—
y
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 # 2878
1. WELL CONTRACTOR:
STEVE PRICE
Well Contractor (Individual Name)
DEWEY%MtIGHTVELL &PUMP CO., INC.
Well Contractor Company Name
STREET ADDRESS P. 0. BOX 308
BOONE NC 28607
City or Town
( 828) - 284-2651
.Area code - Phone number
2.WELL INFORMATION:
SITE WELL ID #fd applicable)
STATE WELL PERMIT kit applicable)
DWQ or OTHER PERMIT #fd applicable)
WELL USE (Check Applicable Box): Residential Water Supply 0 X
DATE DRILLED 7/8/0008
TIME COMPLETED 11.30 AM OXPM 0
3.WELL LOCATION:
CITY: SPRUCE PINE COUNTY MITCHELL
State Zip Code
TAPPING MTN. RD. OFF 19 E
(Street Name, Numbers, Community, Subdivision, Lot No., Parcel, Zip Code)
TOPOGRAPHIC / LAND SETTING:
0 Slope 0 Valley 0 Flat 0 Ridge 0 Other
(check appropriate box)
LATITUDE 3 _ 36.55028
LONGITUDE 081 02737
Latitude/longitude source: ❑ O(PS 0 Topographic map
(location of well must be shown on a USGS topo map and
attached to this form if not using GPS)
4.WELL OWNER
OWNER'S NAME BILL HUGHES
May be in degrees,
minutes, seconds or
in a decimal format
STREET ADDRESS 41 LYNN DR
SPRUCE PINE NC 78777
City or Town State Zip Code
( (828)- 442-0242
Area code - Phone number
5. WELL DETAILS:
a. TOTAL DEPTH: 205
b. DOES WELL REPLACE EXISTING WELL? YES 0 NO q(
c. WATER LEVEL Below Top of Casing: 10
(Use "+" if Above Top of Casing)
d. TOP OF CASING IS 1 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): 12
METHOD OF TEST Air
From
From
8.SCREEN:
From
From
From
9.SAND/GRAVEL PACK:
Depth
From _To Ft.
From _To Ft.
From To Ft.
10. DRILLING LOG
From To
0 74
f. DISINFECTION: Type NTH
g. WATER ZONES (depth):
From 1RR-o_ 1 __19Pa
From To To
From
From
From To From
6. CASING:
To
sf c c)
0 1.; t. J 0 .1
Amount LP.
1138
Thickness/
Depth Diameter Weight Material
From_Qro 81Ft. 81/R 350 PVC
From__Oro___-OFt.
From To Ft.
7.GROUT: Depth Material Method
From__ Gb 20Ft. Cement Gravity Flow
To Ft.
• To Ft.
Depth Diameter Slot Size Material
To Ft. in. in.
To Ft. in. in.
To Ft. in. in.
74 1613
168 169
169 194
194 1913
19R 205
11. REMARKS:
1 GPM 188 -189 11 GPM 194 c 198
OGPM - OGPM -
OGPM - OGPM -
Size
Material
Formation Description
DIRT SAND MUD
GRANITE
QUARTZ
0
0
GRANITE t� .l'
QUARTZ
GPANITF
I DO HEREBY CER11FY THAT THIS WE11 WAS CONSTRUCTED IN ACCORDANCE WITH
15A NCAC 2C, WELL CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS
RECORD HAS BEEN PROVIDED TO THE WELL OWNER.
SIGNATURE OF CERTIFIED WELL CONTRACTOR DATE
STEVE PRICE
PRINTED NAME OF PERSO
Submit the original to the Division of Water Quality within 30 days. Attn: Information gL,
1617 Mail Service Center - Raleigh, NC 27699-1617 Phone No. [phone] ext 56O.
AUG 25 arnGW-1a
Rev. 7/05

RESIDENTIAL WELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources - Division of Water Quality
WELL CONTRACTOR CERTIFICATION it 2878
YELL CONTRACTOR:
STEVE PRICE
Yell Contractor (Individual Name)
DEWEY WRIGHT WELL & PUMP CO., INC.
/ell Contractor Company Name
TREET ADDRESS P O RAX 10R
BOONE NC
City or Town State
Phone umber
1
ELL INFORMATION:
TE WELL ID #pt applicable)
ATE WELL PERMIT tit applicable)
VC or OTHER PERMIT *tut applicable)
ELL USE (Check Applicable Box): Residential Water Supply ❑)(
.TE DRILLED ? {0/2006
dE COMPLETED 1 i0
ELL LOCATION:
v: ROAN MTN. COUNTY MITCHELL
CHRISTMAS WAY OFF OLD ROM MTh. RD. OF
eet Name, Numbers, Community, Subdivision, Lot No., Parcel, Zip Code)
)OGRAPHIC / LAND SETTING:
;lope ❑ Valley O Flat O Ridge U Other
(check appropriate box)
-ITUDE 3
28607
Zip Code
JGITUDE
ode/longitude source: ❑ RPS ❑ Topographic map
(location of well must be shown on a USGS topo map and
attached to this form if not using GPS)
L OWNER
JER'S NAME MICH� fC� ICK ND
EET ADDRESS P O ROX 572
City or owner- State
1)- 888-3370
code - Phone number
L DETAILS:
DTAL DEPTH: 505
OES WELL REPLACE EXISTING WELL? YES ❑ NO
ATER LEVEL Below Top of Casing: 80
(Use "+" if Above Top of Casing)
)P 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
ELD (gpm): 15 METHOD OF TEST Air
AM PM LIX
May be in degrees,
minutes, seconds or
in a decimal format
Zip Co
FT.
g. WATER ZONES (depth):
From__, j 0 1•�g
From__ 470To 472
From To
6.CASING:
Depth
From__BTo_,pt.
From--.BTo_t.
From To Ft.
7.GROUT: Depth
From__- -o__ 0Ft.
From To Ft.
From To Ft.
3 2482
060406
f. DISINFECTION: Type HTH Amount
88
From 27Tb 273
From To
From To
Thickness/
Diameter Weight Material
61/8 ,350- PVC
Material �M�ethod
—Cement-- �.tTF!Orm—
8.SCREEN: Depth Diameter Slot Size Material
From To Ft. in.
From To Ft. in.
From To Ft. in.
9.SAND/GRAVEL PACK
Depth
From _To Ft.
From _To Ft.
From _To Ft.
10. DRILLING LOG
From To
0 34
34 125
1Z 126
126 272
272 273
273 470
470 472
'72 505
11. REMARKS:
in.
in.
in.
Size Material
Formation Description
DIRT BOULDER
BLACK GRANITE
GRANITE
BLP.CK GRANITE
QUARTZ crmnrrE,
14 25 GPM 470 - 472 0 GPM -
O GPM - O GPM -
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH
15A NCAC 2C, WELL CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS
RECORD HAS BEEN PROVIDED TO THE WELL OWNER.
i �S
9__r(
ATUHE OF FI WELL CONTRACTOR DATE
PRINTED NS AM OFF PPERSPRION CONSTRUCTING THE WELL
omit the original to the Division of Water Quality within 30 days. Attn: Information Mgt,
17 Mail Service Center - Raleigh, NC 27699-1617 Phone No. [phone] ext 568.
Form GW-la
Rev. 7/05

WELL CONSTRUCTION RECORD
a 2 i. :) ^,
ei ra b
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Sectionin�
WELL CONTRACTOR (INDIVIDUAL) NAME (print)_ t(iint)� Go c Y Jus #, te.- CERTIFICATION #d 150
\\'ELL CONTRACTOR COMPANY NAME J 05-Tine . Lie ll /r 1 '. /), (5 PHONE # R2) 124- 6 411
STATE WELL. CONSTRUCTION PERMIT# ASSOCIATED WQ PERNIITI
(if applicable) (ifapplicable)
—/
I. WELL USE (Check Applicable Box): Residential Ud' Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery ❑ Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION:
Nearest Town: r.,re one Coun
/ /7 C- -akta t ✓La
(Sucet Name, Numbers, Community,
Subdivision, Lot No., Zip Code)
3. OWNER: I� -e.-�' 1A,$i FQ.vI.#t
Address P. 0 /.,� Cry / 007
(Street or Route No.)
A-r2 Q 75 2,
d+'1 iov
ny or Town State Zip Code
( ) (fo $2' ?2 s'i
Area code- Phone number
4. DATE DRILLED 7-10 -o (,
5. TOTAL DEPTH: I (L
6. DOES WELL REPLACE EXISTING WELL? YES 'NO 0
7. STATIC WATER LEVEL Below Top of Casing: 2.o FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS 1 FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordance with l5A NCAC 2C .011I,
9. YIELD (gpm): Ito METHOD OF TEST A ; r
10. WATERZONES(depth): leetp_ try 1It0
I I. DISINFECTION: Type tlnr.',ne
12. CASING:
From 7)
From a 9
From '(9(
13. GROUT:
From Q
From To
14. SCREEN: Depth
From To
From To
15. SAND/GRAVEL PACK
Toth 9? Ft. Co itr
�stcter
To in Ft. 6.14
To_5C) FL _
Depth Material
To J0 Ft. 4r E
Ft
Diameter
Ft. in.
Ft. in.
From
From
Depth
To Ft.
To Ft.
16. REMARKS:
Size
Slot Size
in.
in.
Amount f( 07
Wall Thickness
or Weight/Ft. _ 4p!ecrtal
Sv Alec
loft C,p1V
Method
Pv,�p�!
Material
Topo phic/Land setting
❑Ridge ¢lope ❑Valley ❑Flat
(Check appropriate box)
Latitude/longitude of well location
39' 50.362oht OW/ 06.898W
(degrees/minute seconds)
Latitude/longitude source: PS❑Topographic map
(check box)
DEPTH DRILLING LOG
From To Formation Description
n - zf S p, r f
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.
DIV. OF WATERI DUALITY
OCT O & 2006
.4
tort(
1 DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C. WELL
CONSTRUCTION STANDARD AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
SIGNATURE OF PERSON CONSTRtdBTee- Etv€ D
Submit the original to the Division of Water Quality, Groundwater Section,J6,}6 NLaii Service
27699-1636 Phone No. [phone], within 30 days. OCT 17 L(JLo
Asheville Regional Office
Arc uifer Protection
DATE
enter - Raleigh, NC
GW-1 REV. 07/2001

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural^Resources ,-{.Division of Water Quality - Groundwater Section
tVELL CONTRACTOR (INDIVIDUAL) NAME (print) [ C• c Y c.f L'S t�. CC CERTIFICATIONi 2JYC {,
xvE LL CONTRACTOR COM PANS' NAME . S ust ce- Lye./I // f. IL hti PHONE 16'<iS) Y - `5yo
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential E3/ Municipal/Public 0 Industrial 0 Agricultural ❑
Monitoring 0 Recovery 0 Beat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION:
Nearest Town:
P? t- e- County /fukr>S-eln-6-,
1I-1 rJ ark P,.l Ptf1/44
(Street Nate. Numbers, Community. Subdivision, Lot No.. Zip Code)
3. OWNER Ova. OtLNij N t
nddress■S tew w 117 Seismas
t~,
L '(Siml ar Route No.11
frn9
City or Town State Zip Code
)-7ot-trititi
Area code- Phone num
4. DATE DRILLEDy—q— O4
5. TOTAL DEPTH• 6 8r
eF c1n a
Topogra_phiciLand setting
❑Ridge BSlope ❑Valley ❑Flat
(check appropriate box)
Latitudeilongitude of well location
35 .5SC MG9N cz2° 07.457 W
(degrees/minus/�seconds)
Latitude/longitude source:97GPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From To Fomation Description
a� Xs ales}-rzocic
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO Ir
7. STATIC WATER LEVEL Below Top of Casing: FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS / FT. Above Land Surface*
*Top of casing terminated at/or below land surface moires a
variance in accordance with ISA NCAC 2C .0118.
9. YIELD (gpm): METHOD OF TEST
10. WATER ZONES (depth):
11. DISINFECTION: Type Canoe Amount " s7
12. CASING: Wall Thickness
Depth) Di ter
From 0 To 7 O Ft_
From 'lb To / 3 Ft. in si,/y
From To Ft.
13. GROUT: Depth Material
From U To dC) FL ,1 ( /
or Weight/Ft. Material
110
.l�j( e'xlV
From To Ft.
14. SCREEN: Depth Diameter
From To Ft. in.
From To FL in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To FL
Method
ti oyScd
Slot Size Material
in.
in.
16. REMARKS:
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common road names
DIV. OF WATER QUALITY
OCT 0,6 2006
d Y Vt
V 2 L(p-A Ear -e 5c41i
11-1
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
1,44,4 SIGNATURE OF PERSON C
�-Co-06n
Submit the original to the Division of Water Quality, C oundwargetiti h! 163g'IrUI Senicc
27699-1636 Phone No. [phone], within 30 days.
OCT
1 ' 'c . J
DATE
enter - Raleigh, NC
GW-1 REV. 07/2001
Asheville Regional Office
Aquifer Protection

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural
'Resources-
/Division of Water Quality - Groundwater Section r.y�
tt ELL CONTRACTOR (INDIVIDUAL) NAME (print) '--j[�'%-t..� J Uf' rW,/�T CERTIFICATION �'a�vy�
\VEL t. CONTRACTOR COMPANY NAME 3(IS 7 ;e-�E Wet, Or,LL-t t PHONE 8 7L� -rs*g
STATE WELL CONSTRUCTION PERMIT* ASSOCIATED WQ PERMIT#
(if licablej (if applicable)
I. WELL USE (Check Applicable Box): Residential Yd" Municipai/Pubiic 0 industrial 0 Agricultutai u
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION:�L 41
Nearest Town: —/ "-_ 11 Nt County kirle ie
J3/I R7�e PCA C4 ►2-L
(Saco Name. Numbers. Courntmiity, Subdivision. Lot No.. Zip Code)
3. OWNER: 5 RDZ /c. ld(it7+
Address 12 V S CV I Se)
(Street or Rowe No.)
;41.r_51..rb.44 N a • flr7 Jf9
City or Town sate Zip Code
( )- 'S= Sy 38
Area code- Phone number
4. DATE DRILLED 7~/f' (17
5. TOTAL DEPTH: ':> .6.<
6. DOES WELL REPLACE EXISTING WELL? YES Q NO II
7. STATIC WATER LEVEL Below Top of Casing: gb FT.
(Us. `a- if Above Top of Caen%)
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 .AI18.
9. YIELD (gpm): /5 METHOD OF TEST A / R
10. WATER ZONES (depth):
11. DISINFECTION: Type( V'e Amount OZ.
12. CASING: Wall Thickness
Dept Di4nrcter or Weight/Ft. Material
From To 3 Ft. G 110 ,PV[.
From To �2-0
From to 3 To b5 Ft. -L2d— 14 VC
13. GROUT: Depth Material Method
From To Ft.
From a To le Ft. Z cC I.tvf
14. SCREEN: Depth Diameter/ Slot Size atenal
From To Ft. in. in.
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
I6. REMARKS:
1 DO HEREBY CE St T
CONSTRUCTION
Topographic/Landg
DRidge OSlope alley OFIat
(check appropnate box)
Latitude/longitude of well location
{-Of 07 c zct ioZ 9/ 61
(dcgredmin�wq/seconds)
Latitude/longitude source:OGPSOTopographic map
(cheek box)
DEPTH DRILLING LOG
From To Formation Description
io Drat'
�e ��tvt/ E raz
e -5-e rcccli.
5`O -.al s qicasec
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. include the road
numbers and common road na
Tte
to
lU
RECEIVED
DIV. OF WATER QUALITY
OCT 0 6 2006
CgAt(.4t
'?o' 216 -A
THAT T
DARDS
ELL WAS CONST
IN ACCORDANCE WITH I5A NCAC 2C. WELL
IAT A CO' n CORD HAS BEEN PROVIDED TO THE WELL OWNER
1
RE OF PERSON C. RE WELL
Submit the original to the Division of Water Quality, Groundwa
27699-1636 Phone No. [phone], within 30 days.
DATE
r Sectiritt
C 1 t e U G4Yr1
aleigh, NC
V. 07/2001
OCT 17 21.T5
Asheville Regional Office
Aquifer Protection

4. DATE DRILLED at—.3
5. TOTAL DEPTH a S
6. CUTTINGS COLLECTED YES El NO�
7. DOES WELL REPLACE EXISTING WELL? YES 0 NO� �,cf.EljEul7 .LTV
8. STATIC WATER LEVEL Below Top of Casing: FT. �‘,' OF 'JJr'�T E
9. TOP OF CASING IS --�� (Use •'• a Above Top of Casing)
FT. Above 'Top of casing terminated aver below land surface requires a variannd ce accor-
dance with 15A NCAC 2C.gg,,11e
10. YIELD (gpm): S METHOD OF TEST I CA
North Carolina • Department of Environment and Natural Resources • Division of Water Quality • Groundwater Section
1636 Mail Service Center - Raleigh, N.C. 27699.1636•Phone [phone]
WELL CONSTRUCTION RECORD WELL CONTRACTOR: C1-00 f A )(I {,'—
WELL CONTRACTOR CERTIFICATION &sOI (3
STATE WELL CONSTRUCTION PERMITe:
334246
1. WELL USE (cheek Appiicahia Box): Residentiail2r Municipal ❑ Industrial 0 Agricultural 0 Monitoring ❑
Recovery ❑ Heat Pump Water Injection Q Other If Other, List Use:
2. WELL LOC N: (Sh w sketch of the location below) 11 nn
Nearest Town: ef'A)1 (1.P . County: II n Q A X..
(Road Nae and Numbers. Conmuni or Sutxon and Lot
3. OWNER mQc`t 1 O� kvWDRILLING LOG
From
Address , .a ! T? a ��
City or Town
7Jp Code
G4
11. WATER ZONES (depth):
12. CHLORINATION: Type
13. CASING:
Amount
If additional space is needed use back of Corm
LOCATION SKETCH
Depth)
% Duyneter
1 a Weight/FL terial (Show direction and distance from at least two State
From
Ft /. 1 From To Roads, or other map reference points)
Ft ,
From To Ft
14. GROUT
Depth Material Method
From 4 T —Ft. CQr'ry rvj-
From To Ft
15. SCREEN:
Wall Thickness
Depth Diameter Slot Size Material
From To Ft _ in. in.
From To Ft. in In.
From To _ Ft. in. in
16. SAND/GRAVEL PACK:
Depth Size Material
From To Ft
From To Ft
17. REMARKS:
I DO HEREBY CERTIFY THATTHIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPOF THIS RECORD _HAS SEEN PROVIDED TO THE WELL OWNER.
u rxL v>/ 9-23-64
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
Submit original to Division of Water Duality. Groundwater Section within 30 days
FOR OFFICE USE ONLY
Quad No:
Serial No.
GW-t REV. 12/99

1. WELL CONTRACTOR:
David Braswell
Well Contractor (Individual) Name
Braswell Welldnlling_
Web Contractor Company Name
STREET ADDRESS PO Box 70
Newland NC
City or Town State Zip Zip Code
(828)-733-2602
Area code- Phone number
2. WELL INFORMATION:
SITE WELL ID #(if applicable)
STATE WELL PERMIT#(8 applicable)
DWQ or OTHER PERMIT #(if applicable)
WELL USE (Check Applicable Box): Residential Water Supply _
DATE DRILLED_11/2/06
TIME COMPLETED1:00_
3. WELL LOCATION:
CITY: Bakersville
4819 Hwy 226N Red Hill
(Street Name. Numbers, Community, Subdivision, Lot No., Parcel, Zp Code)
TOPOGRAPHIC / LAND SETTING:
_ Slope _Valley _Flat, Ridge _ Other
(check appropriate box)
LATITUDE _3 _
LONGITUDE
AM_ PM/0
COUNTY Mitchell
May be in degrees,
minutes, seconds or
in a decimal format
Latitude/longitude source: _GPS _ Topographic map
(location or well must be shown on a USGS topo map and
attached to this form if not using GPS)
4. WELL OWNER
OWNER'S NAME Faye Siegel
STREET ADDRESS 4619
4619 Hwy 226 N
City or Town State Zip Code
Area Area code - phone number
5. WELL DETAILS:
a. TOTAL DEPTH:260
b. DOES WELL REPLACE EXISTING WELL? YES
NO _
c. WATER LEVEL Below Top of Casing: _20FT
(Use'+• if Above Top of Casing)
d. TOP OF CASING IS 1 FT. Above Land Surface*
*Top of casing terminated at/or below land surface may require
a variance in accordance with 15A NCAC 2C .0118.
e. YIELD (gpm): _3 METHOD OF TEST Blow Down
RESIDENTIAL WELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources- Division of Water Quality
WELL CONTRACTOR CERTIFICATION # 2133
L DISINFECTION: Type_HTH
9. WATER ZONES (depth):
From 12 To 13
From To
From To
Amount_9 oz
From 70 To_73
From To
From To
6. CASING: Thickness/
Depth Diameter Weight Material
From_ 1 To_20 Ft. 6 .188
From To Ft _. _9al_
From To Ft.
7. GROUT: Depth
From_0 _ To20
From To
From To
Ft.
Ft.
Ft.
. SCREEN: Depth Diameter
From To Ft
From _ To _ Ft.
From To Ft
9. SAND/GRAVEL PACK:
Depth Size Material
From To
From To
From To
10. DRILLING LOG
From To
0_-12
12-13
13-70
70-73
73-260
11. REMARKS:
Ft
Ft
Ft.
Material
Slot Size
in.
n.
Material
in.
in.
in.
Formation Description
Granite
Creves
Granite
_Brown Shale Granite and White Quartz
335833
Method
N*.\313.-N'�
I00 HERESY CERiFV THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH
15A NCAC 2C. WELL CONSTRUCTION STANDARDS. AND THAT A C
RECORD HAS BEEN PROVIDED TO THE WELL OW7HER �Y THIS
SIGN r.�E OF CER IED yVVE L CONTRACTO
d d ), Acc-42 L.- L
PRINTED NAME OF PERSON CONSTRUCTING THE WELL
Submit the original to the Division of Water Quality within 30 days. Attn: Information Mgt.,
1617 Mail Service Center— Raleigh, NC 27699-1617
Phone No. [phone] ext 568.
0
(\3
r
Form GW-la
Rev. 7/05

RESIDENTIAL WELL CONSTRUCTION RECO:2D
North Carolina Depamnent of Environment and Natural Resources.- Division of R'aa Qua)ity
WELL CONTRACTOR CERTIFICATION # o[ l36
1. WELL CONTRACTOR:
'Z Q.cc: a 'YAe-G-a1, 'Sa-%Aevec5
We Contractor (Individual) Name
e.-\1142 ' S4s..i''yyg-CS '�.TOr.
Well Cthtracta Company Nape
STREET ADDRESS \`\%8 S
Ho4 5?c;t14SC oL8' I AK.
City or Town sue -Zip Code
l� } ca(Os-aoaa
Area code- Phone number
2. WELL INFORMATION:
SITE WELL ID allif raficabk0
STATE WELL PERMITS(: applicable)
DWQ or OTHER PERMIT R(N appfxable)
WELL USE (Check Applwble Box): Residential Water Supply 01
DATE DRILLED 9 P ?-4
TIME COMPLETED ) , b o AM O
3. WELL LOCATION: • // //
CITY: 4G,4.-s (1/1A COt1NTY /1%t. i`Ue//
Aria/leaal
{Sheet Name, Number. Cann uMy. Subdivision, Lel No.. Parcel, Zip Code) ..
TOPOGRAPHIC / LAND SETTING:
lope DValley ❑Flat ORidge ❑Ober
(cheek appropriate bard
fATTTUDE 3
PMV
LONGITUDE
May be in degrees,
minutes, seconds or
in a decimal format
Latitude/longitude source: COPS ['Topographic map
(location of vetmust be shown on a USGS typo map and
etrer.heJ to this form fnot owns GPS)
4. WELL OWNER
OWNER'S NAME "1:' m. QHs,{ cracsae" a
STREET ADDRESS 53 1..Tl+C Ie.S*YT Roo.
taX1\LCCS Vi Ile Ajo ar105
City or Town State .Tip Code
<Sa% ), 1'1te1- 3(e$a5
Area code - Phone number
S. WELL DETAILS: r e5,5
a TOTAL DEPTH: J
b. DOES WELL REPLACE EXISTING WELL? YES 0 NOV
c. WATER LEVEL BelowT y d Casing SD FT.
(Use "+' WAbove Top of Casing)
d. TOP OF CASING IS \ . FT. Abaue Land Surface
'Top or casing terminated at/or below land surface may require
a variance in accadam a with 15A NCAC 2C _0118.
e. YIELD (gpm): METHOD OF TEST P.:•es
u
335291
t. DISINFECTION: Type4n.115 Amount��
g. WATER ZONES (depth):
from To From To
From To From To
From To From To
6. CASING: - Thitlmess/
epth , Dampier Weight
From }�_DTo 6 8 FI. _
From To R.
From To Ft.
7. GROUT: Depth
�l Material
pLMNllb
From 0 To © FI. centosT'�-. YY ire
From To Ft.
From To R.
8. SCREEN: Depth Da nester Slot Size ! Material
From To Ft. in h, i
From To FL m.. in. '
From To R. in it
9- SAND/GRAVEL PACK:
Depth Size Material
From To FL
From To FL
From To Ft
10. DRIWNG LOG
From
1
To� 8, Formation
OCE
46r
<E,c tT"'fR
11. REMARICS:
I DO HEREBY CERTFY THAT THIS WELL V 'AS CONSTRLV 1ED M ACCORD V ICE W Res
ISA NCAC 2C, WELL CONS1RVC1VN IMANSARDS. Mt'THATA COPY OF INS
RECORD HAS BEEN PROVIDED TO THE Ill ELL OWNER.
SIGNATURE OF CERTIFIED WELL
TRACTOR DATE
el2cc c." HtC.lto,. 643ihrtri5
PRINTED NAME OF PERSON X'NSTRUCTING TFTE WELL
Submit the original to the Division of Water Quality within 30 days. Attn: information MIL,
1617 Mail Service Center —Raleigh, NC 27699-1617 Phone No. [phone] ext 568.
Faro GW-la
Rev. 7N5

STATE
RESIDENTIAL w
North Carolina De ELL CONSTRUCTION RECORD
Department of Environment and Natural Resources -
Division of Water Quality
WELL CONTRACTOR CERTIFICATION #
, %•
vveu�ontractor Company-yName
STREET ADDRESS
May be in degrees,
LONGITUDE f L minutes, seconds or
%c/ in a decimal format
Latitude/longitude source: i t;pS ❑Topographic map
(/ocation of wed must be shown on a USGS topo map and
attached to this form d not userg GPS)
4. WELL OWNER
OWNER'S NAME
ST�EET ADDRESS eIC ..._. /, r•. _ _ �"
City or Town t r
Ar,}� State Zip Corte
e Phone
2. WELL INFORMATION:
SITE WELL ID J{(if applicable)
STATE WELL PERMIT/IOrapplicable)
DWQ or OTHER PERMIT X(if applicable)_
WELL USE (Check Applicable Box
): ResiDATE DRILLED Cj _ 7 'J=tlential Water Supply [�
TIME COMPLETED 2 ',JJ
3. WELL LOCATION: AM
CITY: ,iJ. ce v, .
COUNTY i/ .,/,e —
(Street Name, Numbers, Community, Subdivision, Lot No., TOPOGRAPHIC / LAND Parcel, Zip Code)
OPOGRAPHIC
I? ope 0 ValleySETTING:
CI CI Ridge ❑Other
(check appropriate box)
LATITUDE 3 /-
rztrL
City or Town Stale
)
Area COde, Pho 6 94 _
number
5. WELL DETAILS:
a. TOTAL DEPTH: ?or
b. DOES WELL REPLACE EXISTING WELLY YES ❑ NO c. WATER LEVEL Below Top of Casing: �� p
(Use "+• if Above Top of Casing)
d. TOP OF CASING IS
'Top of casing terminated at/or Above ceLay require
a variance in a below land surface may r
accordance with 15A NCAC 2C . Y squire
e. YIELD (gpm): 16 OT TS.
---� METHOD OF TEST '
within 3
Submit the original to the Division of Water Qualityi9
1617 Mail Service Center- Raleigh, NC 27699-1617
Pho
3a143
f, DISINFECTION: Type CAbr.;
g. WATER ZONES (depth). Amount
From
/ 9 To
T From To
From /� To From To
From �'
6. CASING: T°
I DO HEREBY CERTIFY THAT 7111,S WELL WAS CONS
1SA NCAC 2C, WELL CONSTRUCTION STANDARDS
RECOR CONSTRUCTED WgCCORDANCE WDH
�AS BEEN PROV''IDE''D TO THE WELL OWNER.
D ETA COPY OF THIS
SIGNATURE OF CERTIFIED WELL CONT A RACTOR 17±Q�
.4 DATE
RINTED NAME OF PERSON CONSTRUCTING THE WELL
0 days" Attn: Information Mgt.,
Oe No. [phone] ext 568.
Form GW-fa
Rev. 7/05

RESIDENTIAL WELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources - Division of Water Quality
WELL CONTRACTOR CERTIFICATION # 2878
1. WELL CONTRACTOR:
STEVE PRICE
Well Contractor (Individual Name)
DEWEY WRIGHT WELL & PUMP CO., INC.
Well Contractor Company Name
STREET ADDRESS P. 0. BOX 308
BOONE NC 28807
City or Town State Zip Code
( 828) - 284-2851
Area code - Phone number
2.WELL INFORMATION:
SITE WELL ID #lif applicable)
STATE WELL PERMIT #(it applicable)
DWG) or OTHER PERMIT #(a applicable)
WELL USE (Check Applicable Box): Residential Water Supply 0 X
DATE DRILLED 9/5/2008
TIME COMPLETED 6:00 AM ❑ PM OX
3. WELL LOCATION:
CITY: SPRUCE PINE COUNTY MITCHELL
RABBIT HOP RD. OFF PENLAND RD. OFF 19E
(Street Name, Numbers, Community, Subdivision, Lot No., Parcel, Zip Code)
TOPOGRAPHIC / LAND SETTING:
❑ Slope 0 Valley 0 Flat 0 Ridge 0 Other
(check appropriate box)
LATITUDE 3 35.55021
May be in degrees,
minutes, seconds or
LONGITUDE 082.08683
in a decimal format
Latitude/longitude source: 0 MPS 0 Topographic
(location of well must be shown on a USGS
attached to this form if not using GPS)
4.WELL OWNER
OWNER'S NAME CYNTHIA GRACE
map
topo map and
STREET ADDRESS 1987 RABBIT HOP PO. .
SPRUCE PINE NC 28777
City or Town State Zip Code
( (828)_ 487-2323
Area code - Phone number
5.WELL DETAILS:
a. TOTAL DEPTH: 805
b. DOES WELL REPLACE EXISTING WELL? YES 0 NO CI(
c. WATER LEVEL Below Top of Casing: 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): 0 METHOD OF TEST Air
33
tot P' 4
�t).
060488-2
f. DISINFECTION: Type HTH Amount
g. WATER ZONES (depth):
From DRYTo HOLE From To
From To From To
From To From To
6.CASING: Thickness/
Depth Diameter Weight Material
From 0To S4Ft. 81/8 .350 PVC_i
FromTo OFt.
From To Ft.
7.GROUT: Depth Material Method
From Oro 20Ft Cement Gravity Flow
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 28 DIRT
28 605 BLACK GRANITE
tvED
2006
140V 16
11. REMARKS:
0 GPM DRY - HOLE 0 GPM -
OGPM - OGPM -
O GPM - O GPM -
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
4THE WELL OWNER.
./' 1`_/92/ '%< N'Lr -a" l//7//
-'i7(D
SIGNATURE OF CERTIFIED WELL CONTRACTOR DATE
STEVE PRICE
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 # 2878
1.WELL CONTRACTOR:
STEVE PRICE
Well Contractor (Individual Name)
DEWEY WRIGHT WELL & PUMP CO., INC.
Well Contractor Company Name
STREET ADDRESS P. O. BOX 308
BOONE NC 28807
City or Town State Zip Code
( 828)- 284-2851
Area code - Phone number
2.WELL INFORMATION:
SITE WELL ID #(if applicable)
STATE WELL PERMIT #(iapplicable)
DWQ or OTHER PERMIT #(if applicable)
WELL USE (Check Applicable Box): Residential Water Supply U X
DATE DRILLED g/l/2008
TIME COMPLETED 2.061 AM ❑ PM D)(
3. WELL LOCATION:
CITY: SPRUCE PINE COUNTY MITCHELL
RABBIT HOP RD. OFF PENLAND RD. OFF 19E
(Street Name, Numbers, Community, Subdivision, Lot No., Parcel, Zip Copal
TOPOGRAPHIC / LAND SETTING: P
❑ Slope 0 Valley 0 Flat O Ridge 0 Other
(check appropriate box)
LATITUDE 3 38.55021
May be in degrees,
minutes, seconds or
LONGITUDE OSt .08883
in a decimal format
Latitude/longitude source: 0 (KpS 0 Topographic
(location of well must be shown on a USGS
attached to this form if not using GPS)
4.WELL OWNER
OWNER'S NAME CYNTHIA GRACE
map
topo map and
STREET ADDRESS 1987 RABBITT HOP RD.
SPRUCE PINE NC 2R7T7
City or Town State Zip Code
( (828)- 785-9552
Area code - Phone number
5.WELL DETAILS:
a. TOTAL DEPTH: 805
b. DOES WELL REPLACE EXISTING WELL? YES 0 NO q(
c. WATER LEVEL Below Top of Casing: 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): 0 METHOD OF TEST Air
0 2 A 11 r 47,1
080488-1
f. DISINFECTION: Type I4TH Amount
g. WATER ZONES (depth):
From DRYfo HOI F From To
From To From To
From To From To
6.CASING: Thickness/
Depth Diameter Weight Material
From 0To 41Ft. 6118 .350 PVC
From trot.
From To Ft.
7.GROUT: Depth �aMaterial Method
From_�ro20Ft. Cement Gravity Flow
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 35 DIRT
35 305 GRANITE
R.E.CE�R QUAUI
OF WA
to
200%
WI V , 6
11. REMARKS:
OGPM DRY - HOLE OGPM -
O GPM - O GPM -
0GPM - OGPM -
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH
15A NCAC 2C, WELL CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS
RECORD HAS BEEN PROVIDED TO THE WELL OWNER.
SIGNATURE OF CERTIFIED WELL CONTRACTOR DATE
STEVE PRICF
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# 2878
1. WELL CONTRACTOR:
STEVE PRICE
Well Contractor (Individual Name)
DEVEY WRIGHT WELL & PUMP CO., INC.
Well Contractor Company Name
STREET ADDRESS P 0 BOX 308
BOONE NC 28807 •
City or Town State Zip Code
( 828) - 204-2851
Area code - Phone number
2.WELL INFORMATION:
SITE WELL ID #(d applicable)
STATE WELL PERMIT *of applicable)
DWG or OTHER PERMIT #It applicable)
WELL USE (Check Applicable Box): Residential Water Supply 0 X
DATE DRILLED 9080006
TIME COMPLETED 11'00 AM ❑ PM DX
3. WELL LOCATION:
CITY: SPRUCE PINE COUNTY MITCHELL
RABBIT HOP RD. OFF PENLAND RD. OFF 19E
(Street Name, Numbers, Community, Subdivision, Lot No., Parcel, Zip Code)
TOPOGRAPHIC / LAND SETTINGt
❑ Slope 0 Valley 0 Flat 0 Ridge 0 Other
(check appropriate box)
LATITUDE 3 lq 5'0?1
May be in degrees,
minutes, seconds or
LONGITUDE on OR883
in a decimal format
Latitude/longitude source: ❑ 1(PS 0 Topographic
(location of well must be shown on a USGS
attached to this form if not using GPS)
4.WELL OWNER
OWNER'S NAME CYNTHIA GRACE
map
topo map and
STREET ADDRESS 1987 RABBIT HOP RD. ,
SPRUCE PINE NC 28777
• City or Town State Zip Code
( (8281_ 487-2323
Area code - Phone number
5.WELL DETAILS:
a. TOTAL DEPTH: 405
b. DOES WELL REPLACE EXISTING WELL? YES 0 NO Q(
c. WATER LEVEL Below Top of Casing: 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): 0 METHOD OF TEST Air
r,. r.;
alc/ G tj
060488-3
f. DISINFECTION: Type flTij Amount
g. WATER ZONES (depth):
From DR S+fo HOI F From To
From To From To
From To From To
6.CASING: Thickness/
Depth Diameter Weight Material
From_0To 2tO�t. 81/R 150 PVC
From0TooFt
From To Ft.
7.GROUT: Depth Material Method
From Go ?0Ft. Cement Gravity Firm
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.
\1
10. DRILLING LOG
From To Formation Description c.
0 20 DIRT
?O M15 PANITF
viz
RE- QUI\LtTY
16 .61)
NOv
11. REMARKS:
OGPM DRY - HOLE OGPM -
O GPM - O GPM -
O GPM - O GPM -
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.
XV /2 / //-» /2Le
A E OF CERTI IED LL ONON"G� , / DATE
STEVE PRICE
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 # 2878
1.WELL CONTRACTOR:
STEVE PRICE
Well Contractor (Individual Name)
DEVUEY WRIGHT WELL & PUMP CO., INC.
Well Contractor Company Name
STREET ADDRESS
BOONE
P. 0. Box 308
NC 28807
City or Town State Zip Code
( 828)- 284-2851
Area code - Phone number
2.WELL INFORMATION:
SITE WELL ID #(if applicable)
STATE WELL PERMIT #fif applicable)
DWQ or OTHER PERMIT #(it applicable)
WELL USE (Check Applicable Box): Residential Water Supply 0 X
DATE DRILLED 9/14/2008
TIME COMPLETED 4:30 AM ❑ PM OX
3. WELL LOCATION:
CITY: SPRUCE PINE COUNTY MITCHELL
CLEOE SILVERS RD. OFF 80 SOUTH OFF MINE
(Street Name, Numbers, Community, Subdivision, Lot No., Parcel, Zip Code)
TOPOGRAPHIC / LAND SETTING:
❑ Slope 0 Valley 0 Flat 0 Ridge 0 Other
(check appropriate box)
LATITUDE 3 38.59188
LONGITUDE 081.11200
May be in degrees,
minutes, seconds or
in a decimal format
Latitude/longitude source: 0 KPS 0 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 HERBERT E DAVIS
STREET ADDRESS 24 CLEVE SILVERS RD. ,
BAKERSVILLE NC 28705
City or Town State Zip Code
( (828)_ 888-9151
Area code - Phone number
5.WELL DETAILS:
a. TOTAL DEPTH: 405
b. DOES WELL REPLACE EXISTING WELL? YES 0 NO ®(
c. WATER LEVEL Below Top of Casing: 100
(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
FT.
e. YIELD (gpm): 3 METHOD OF TEST Al?
33I.76P.
rW
080432
f. DISINFECTION: Type HTH Amount 64
g. WATER ZONES (depth):
From 335ro 337 From To
From To From To
From To From To
6.CASING: Thickness/
Depth Diameter Weight Material
From °To 121Ft. 81/8 .350 PVC
From OTo OFt.
From To Ft.
7.GROUT: Depth Material Method
From Oro 20Ft. Cement Gravity Flow
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
0 115 DIRT
115 335 GRANITE
335 337 QUARTZ
337 405 GRANITE
ED
IV,
PEOF
WNTER oUALIT�'
DN.OF
1 6 0006
NOV
11. REMARKS:
3 GPM 335 - 337 O GPM -
O GPM - O GPM -
OGPM - OGPM -
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.
/, ,744. i /,/-/(/'(1(2
SIGNATURE OF CERTIFIED WELL CONTRACTOR DATE
STEVE PRICE
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 # 2878
1.WELL CONTRACTOR:
STEVE PRICE
Well Contractor (Individual Name)
DEWEY WRIGHT WELL & PUMP CO., INC.
Well Contractor Company Name
STREET ADDRESS P. O. BOX 308
BOONE NC 28607
City or Town State Zip Code
( 828) - 264-2651
Area code - Phone number
2.WELL INFORMATION:
SITE WELL ID #lif applicable)
STATE WELL PERMIT #(d applicable)
DWQ or OTHER PERMIT #(d applicable)
WELL USE (Check Applicable Box): Residential Water Supply 0 X
DATE DRILLED 9/18/2006
TIME COMPLETED 4.00 AM ❑ PM UX
3.WELL LOCATION:
CITY: SPRUCE PINE COUNTY MITCHELL
MINE CREEK RD. OFF 226 OFF 19E
(Street Name, Numbers, Community, Subdivision, Lot No., Parcel, Zip Code)
TOPOGRAPHIC / LAND SETTING:
❑ Slope 0 Valley 0 Flat 0 Ridge 0 Other
(check appropriate box)
LATITUDE 3 36.59399
May be in degrees.
minutes, seconds or
LONGITUDE 081.09685
in a decimal format
Latitude/longitude source: ❑ a12S ❑ Topographic
(location of well must be shown on a USGS
attached to this form if not using GPS)
4.WELL OWNER
OWNER'S NAME DANNY L THOMAS
map
topo map and
STREET ADDRESS 429 MINE CREEK RD. ,
BAKERSVILLE NC 28705
City or Town State Zip Code
( (828)_ 888-2922
Area code - Phone number
5.WELL DETAILS:
a. TOTAL DEPTH: 105
b. DOES WELL REPLACE EXISTING WELL? YES 0 NO LX
c. WATER LEVEL Below Top of Casing: 10 FT.
(Use "+" if Above Top of Casing)
d. TOP OF CASING IS 1 FT. Above Land Surface*
Top of casing terminated at/or below land surface may require
a variance in accordance with 15A NCAC 2C .0118
e. YIELD (gpm): 15 METHOD OF TEST Air
33'767
060596
f. DISINFECTION: Type HTH Amount 20
g. WATER ZONES (depth):
From MO 81 From To
From To From To
From To From To
6.CASING: Thickness/
Depth Diameter Weight Material
From OTo SAt. 61/4 .188 GALV
From OTo OFt.
From To Ft.
7.GROUT: Depth Material Method
From Ofo 2OFt. Cement Gravity Flow
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 53 DIRT BOULDER
53 BD GRANITE
BO 31 QUARTZ
B1 105 GRANITE
p\V.
05
NQv A 7
11. REMARKS:
15GPM 80-81 OGPM -
OGPM - OGPM -
O GPM - 0 GPM -
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. /� //�
/ 4J i
SIGNATURE OF CERTIFIED WELL CONTRACTOR DATE
STEVE PRICE
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

City or Town
RESIDENTIAL WELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources - Division of Water Quality
WELL CONTRACTOR CERTIFICATION # 2878
1. WELL CONTRACTOR:
STEVE PRICE
Well Contractor (Individual Name)
DEWEY WRIGHT WELL & PUMP CO., INC.
Well Contractor Company Name
STREET ADDRESS P. O. BOX 308
BOONE
NC 28607
City or Town State Zip Code
( 828) - 264-2651
Area code - Phone number
2.WELL INFORMATION:
SITE WELL ID #(if applicable)
STATE WELL PERMIT #(f applicable)
DWQ or OTHER PERMIT #In applicable)
WELL USE (Check Applicable Box): Residential Water Supply U X
DATE DRILLED 9/6/2006
TIME COMPLETED 3.00 AM ❑ PM UX
3.WELL LOCATION:
CITY: SPRUCE PINE COUNTY MITCHELL
ROBERT PHILLIPS RD.
(Street Name, Numbers, Community, Subdivision, Lot No., Parcel, Zip Code)
TOPOGRAPHIC / LAND SETTING:
❑ Slope U Valley U Rat U Ridge Cl Other
(check appropriate box)
LATITUDE 3 36.58092
LONGITUDE 081.08721
Latitude/longitude source: 0 XPs ❑ 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 CHRIS WARREN
STREET ADDRESS 3132 HWY 226 S
BAKERSVILLF NC 2R705
State Zip Code
( (828►- 888-1369
Area code - Phone number
5.WELL DETAILS:
a. TOTAL DEPTH: 305
b. DOES WELL REPLACE EXISTING WELL? YES 0 NO LK
c. WATER LEVEL Below Top of Casing: 20 FT.
(Use "+" if Above Top of Casing)
d. TOP OF CASING IS 1 FT. Above Land Surface*
Top of casing terminated at/or below land surface may require
a variance in accordance with 15A NCAC 2C .0118
e. YIELD (gpm): 15 METHOD OF TEST Air
fl, /rl n,
060509
f. DISINFECTION: Type HTH Amount 57
g. WATER ZONES (depth):
From 250ro 251 From 26Ib 283
From To From To
From To From To
6.CASING: Thickness/
Depth Diameter Weight Material
From OTo Vit. 81?t 350 PVC
From OTo_irt.
From To Ft.
7.GROUT: Depth Material Method
From _Do ?OFt Cement Gravity Flew
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 29 DIRT
29 250 GRANITE
250 2 s1 GRANITE
251 281 GRANITE
231 2E3 QUART]
2R7 VS GRANIITTEE,.c.i,Arn
r- UAi-ITY
R
p1v of i athAi ' a
11. REMARKS:
1 GPM 250 - 251 14 GPM 281 - 283
O GPM - O GPM -
O GPM - O GPM -
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH
15A NCAC 2C, WELL CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS
RECORD HAS BEEN PROVIDED TO THE WELL OWNER.
SIGNATURE OF CERTIFIED WELL CONTRACTOR DATE
STEVE PRICF
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 # 2878
1.WELL CONTRACTOR:
STEVE PRICE
Well Contractor (Individual Name)
DEWEY WRIGHT WELL & PUMP CO., INC.
Well Contractor Company Name
STREET ADDRESS P. O. BOX 308
BOONE NC 28607
City or Town State Zip Code
( 828)- 284-2851
Area code - Phone number
2.WELL INFORMATION:
SITE WELL ID #(it applicable)
STATE WELL PERMIT #(ff applicable)
DWQ or OTHER PERMIT #(ir applicable)
WELL USE (Check Applicable Box): Residential Water Supply 0 X
DATE DRILLED 9/12/2006
TIME COMPLETED 11:00 AM :WPM ❑
3. WELL LOCATION:
CITY: SPRUCE PINE COUNTY MITCHELL
TED BYRD RD. OFF CANE CREEK OFF BAKERS\
(Street Name, Numbers, Community, Subdivision, Lot No., Parcel, Zip Code)
TOPOGRAPHIC / LAND SETTING:
0 Slope 0 Valley 0 Flat 0 Ridge 0 Other
(check appropriate box)
LATITUDE 3 36.16534
May be in degrees,
minutes, seconds or
LONGITUDE 081.31702
in a decimal format
Latitude/longitude source: 0 XPS 0 Topographic
(location of well must be shown on a USGS
attached to this form if not using GPS)
4.WELL OWNER
OWNER'S NAME DON SEATZ
map
topo map and
STREET ADDRESS 284 TED BYRD RD..
BAKERSVILLE NC 28705
City or Town State Zip Code
( (828)_ 688-3793
Area code - Phone number
5.WELL DETAILS:
a. TOTAL DEPTH: 305
b. DOES WELL REPLACE EXISTING WELL? YES 0 NO CK
c. WATER LEVEL Below Top of Casing: 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): 0 METHOD OF TEST Air
3 41
080453
f. DISINFECTION: Type HTH Amount 84
g. WATER ZONES (depth):
From DRYfo HOLE From To
From To From To
From To From To
6.CASING: Thickness/
Depth Diameter Weight Material
From OToOIFt. 6 VS .350 PVC
From 0To OFt.
From To Ft.
7.GROU10 Depth Material Method
From Oro 20Ft. Cement Gravity Flow
From To Ft.
From To Ft.
8.SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in
From To Ft. in in.
From To Ft. in. in.
9.SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
From To Ft.
10. DRILLING LOG
From To Formation Description
0 58 DIRT
59 305 BLACK GRANITE
RtGE-cn QU0-lTY
ON Q� \NpiER
6 904b
��V
11. REMARKS:
0 GPM DRY - HOLE 0 GPM -
O GPM - O GPM -
O GPM - O GPM -
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.
,. /2 / / /e/ ,6
SI NATURE OF CERTIFIED WELL CONTRACTOR DATE
STEVE PRICE
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 # 2878
1.WELL CONTRACTOR:
STEVE PRICE
Well Contractor (Individual Name)
DEWEY WRIGHT WELL & PUMP CO., INC.
Well Contractor Company Name
STREET ADDRESS P. O. BOX 308
BOONE NC 28607
City or Town State Zip Code
( 828) - 264-2651
Area code - Phone number
2.WELL INFORMATION:
SITE WELL ID #(d applicable)
STATE WELL PERMIT #(if applicable)
DWQ or OTHER PERMIT #fd applicable)
WELL USE (Check Applicable Box): Residential Water Supply D X
DATE DRILLED 8/22/2006
TIME COMPLETED 4:00 AM ❑ PM DX
3. WELL LOCATION:
CITY: ROM MTN. COUNTY MITCHELL
BATTLE BRANCH RD. OFF BEANS CREEK OFF 2
(Street Name, Numbers, Community, Subdivision, Lot No., Parcel, Zip Code)
TOPOGRAPHIC / LAND SETTING:
❑ Slope D Valley D Flat 0 Ridge 0 Other
(check appropriate box)
LATITUDE 3 36 04585
May be in degrees,
minutes, seconds or
LONGITUDE 081.14113
in a decimal format
Latitude/longitude source: ❑ iXPS D Topographic
(location of well must be shown on a USGS
attached to this form if not using GPS)
4.WELL OWNER
OWNER'S NAME ANDRE JACQUES
map
topo map and
STREET ADDRESS 905 BATHE BRANCH RD..
BAKERSVILLE NC 28705
City or Town State Zip Code
( (828)_ 688-9199
Area code - Phone number
5.WELL DETAILS:
a. TOTAL DEPTH: 165
b. DOES WELL REPLACE EXISTING WELL? YES 0 NO EX
c. WATER LEVEL Below Top of Casing: 40 FT.
(Use "+" if Above Top of Casing)
d. TOP OF CASING IS 1 FT. Above Land Surface`
' Top of casing terminated at/or below land surface may require
a variance in accordance with 15A NCAC 2C
.0118
e. YIELD (gpm): 2 METHOD OF TEST Air
334762
060400
f. DISINFECTION: Type HTH Amount 28
g. WATER ZONES (depth):
From 150ro 151 From To
From To From To
From To From To
6.CASING: Thickness/
Depth Diameter Weight Material
From 0To 61/8 .350 PVC
_4BFt.
From 0To_ OFt.
From To Ft.
7.GROUT: Depth Material Method
From Oro 20Ft. Cement Gravity now
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 47 DIRT
42 150 GRANITE
150 151 QUARTZ
451 165 GRANITE
vr?
Recj aver
O\v0R
OF vriP
1 �pp6
\\ON
11. REMARKS:
2GPM 150-151 OGPM -
OGPM - OGPM -
OGPM - OGPM -
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.
all ,%_ tp / / %y-v&
SIGNATURE OF CERTIFIED WELL CONTRACTOR DATE
STEVE PRICE
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 # 2878
060680
1. WELL CONTRACTOR:
STEVE PRICE
Well Contractor (Individual Name)
DEWEY WRIGHT WELL & PUMP CO., INC.
Well Contractor Company Name
STREET ADDRESS P 0 BOX 308
BOONE
City or Town
(___ 828) - 981-9851
NC
State
28807
Zip Code
Area code - Phone number
2.WELL INFORMATION:
SITE WELL ID #(it applicable)
STATE WELL PERMIT #(it applicable)
DWQ or OTHER PERMIT If (if applicable)
WELL USE (Check Applicable Box): Residential Water Supply 0 X
11f21/2008
DATE DRILLED
TIME COMPLETED 3:00 AM ❑ PM DX
3. WELL LOCATION:
CITY: DRILI DFFPFR COUNTY MITCHFII
CARVERS KNOB RD. OFF CHESTNUT GROVE R
(Street Name, Numbers, Community, Subdivision, Lot No., Parcel, Zip Code)
TOPOGRAPHIC / LAND SETTING:
O Slope 0 Valley ,0 Flat D Ridge D Other
(check appropriate box)
LATITUDE 3
LONGITUDE
Latitude/longitude source: ❑ 1XPS ❑ 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 .Iron 114 VRFEI AND
STREET ADDRESS 707 I ITTLF CRFFK RQ
May be in degrees,
minutes, seconds or
in a decimal format
ty or town' ""'"State
99r,-787a
Area code - Phone number
5.WELL DETAILS:
a. TOTAL DEPTH: 705
b. DOES WELL REPLACE EXISTING WELL? YES ❑ NO OX
c. WATER LEVEL Below Top of Casing: FT.
(Use "+" if Above Top of Casing)
d. TOP OF CASING IS I FT. Above Land Surface'
Top of casing terminated at/or below land surface may require
a variance in accordance with 15A NCAC 2C .0118
Zippo e
e. YIELD (gpm): 0,25 METHOD OF TEST
�#T
f. DISINFECTION: Type
HTH
g. WATER ZONES (depth):
From nntrnnwnTo
From To
From To
6. CASING:
Amount
From To
From To
From To
Thickness/
Depth Diameter Weight Material
From To Ft.
From_._ OTo fit.
From To Ft.
7. GROUT: Depth Material Method
From To Ft. Comer, Gnutty Flyv
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
200
0 0
Formation Description
OLD WELL
DP'LL DEEPER
FEE ela
r3F W
gtC 1 4
11. REMARKS:
ailfn G -sue
0f+PM - 0GPM -
OGPM - OGPM
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH
15A NCAC 2C, WELL CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS
RECORD HAS BEEN PROVIDED TO THE WELL OWNER.
i/i;�%Sr ijt6ta
SIGNATURE OF CERTIFIED WELL CONTRACTOR DATE
PRINTEdNQIv(f'O�SbN 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 # 2878
1.WELL CONTRACTOR:
STEVE PRICE
Well Contractor (Individual Name)
DEWEY WRIGHT WELL & PUMP CO., INC.
Well Contractor Company Name
STREET ADDRESS P. O. BOX 308
BOONE NC 28607
City or Town State Zip Code
( 828) - 264-2651
Area code - Phone number
2.WELL INFORMATION:
SITE WELL ID #(N applicable)
STATE WELL PERMIT Of applicable)
DWQ or OTHER PERMIT #(f applicable)
WELL USE (Check Applicable Box): Residential Water Supply O X
DATE DRILLED 10/31/2008
TIME COMPLETED 2:00 AM ❑ PM OX
3. W ELL LOCATION:
CITY: SPRUCE PINE COUNTY MITCHELL
DALL.AS YOUNG RD. OFF GREEN YOUNG CEME
(Street Name, Numbers, Community, Subdivision, Lot No., Parcel, Zip Code)
TOPOGRAPHIC / LAND SETTING:
❑ Slope O Valley D Flat 0 Ridge O Other
(check appropriate box)
LATITUDE 3 38.01574
May be in degrees,
minutes, seconds or
LONGITUDE 081.07718
in a decimalfonnat
Latitude/longitude source: ❑ OS ❑ Topographic
(location of well must be shown on a USGS
attached to this form if not using GPS)
4.WELL OWNER
OWNER'S NAME LARRY J GANTZ
map
topo map and
STREET ADDRESS 5405 POLK CITY RD. ,
HAINES CITY FL 33844
City or Town State Zip Code
( (883)_ 422-5411
Area code- Phone number
5.WELL DETAILS:
a. TOTAL DEPTH' 305
b. DOES WELL REPLACE EXISTING WELL? YES 0 NO OI(
c. WATER LEVEL Below Top of Casing 40 FT.
(Use "+" if Above Top of Casing)
d. TOP OF CASING IS 1 FT. Above Land Surface'
Top of casing terminated at/or below land surface may require
a variance in accordance with 15A NCAC 2C .0118
e. YIELD (gpm): 10 METHOD OF TEST Air
f. DISINFECTION: Type HTH Amount 54
g. WATER ZONES (depth):
From 20W0 210 From 270) 271
From 29Iro 290 From To - I
From To From To 1
6.CASING: Thickness/ f
Depth Diameter Weight Material
From 0To 90=t. 81/8 .350 PVC
From OTo Qt.
From To Ft.
7.GROUT: Depth Material Method
From Oro 20Ft. Cement Gravity Flow
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 B4 DIRT
B4 209 GRANITE
209 210 GRANITE
210 270 GRANITE
270 271 QUARTZ
271 289 GRANITE
289 290 GRANITE QUARTZ
290 305 GRANITE
RECEIVED
Q`n
DIY, OF WEB
UEC l 4 2006
11. REMARKS:
1 GPM 209 - 210 1 GPM 270 - 271
8 GPM 289 - 290 O GPM -
O GPM - O GPM -
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH
15A NCAC 2C, WELL CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS
RECOR AS BEEN PROVIDED TO THEE WELL OWNER.
SIGNATURE OF CERTIFIED WELL CONTRACTOR DATE
STEVE PRICE
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

76s' QRv5hy Csfix ad
`Road Name and Numbers Communitx, or Subdivision and Lot No.)
3 OWNER .Q/ tC &of•r
"dress 74et 1{AuVuAY CrEch Ra
SP'i-vc& (f/,w& o_) fl7„
r;ity or Town State Zio Code
DATE DRILLFD /a-2/ -0 L
r,FPTH L 9
INGs COLLECTED YES n NON
f�r�rLt: WELL REPLACE EXISTING WELL? YES y NoviTA, C WATER LEVEL Below Top of Casing: FT.
(Use "+'• if above Top of Casing)
rfR OF CASING IS /St FT Above Land Surface"
`x.asIeg terminated at/or below land surface requires a variance in ar_cor-
1a^rr .Nor SA NCAC 2C 0118
"FIIL1 (GPM) 1zf METHOD OF TEST -v-/A `
WATER ZONES (depth)
North Carolina Department of Environment and Natural Resources -Division of Water Quality -Groundwater Section
1636 Mall Service Center - Ralelgh,N.C. 27699-1636-Phone [phone]
WELL CONSTRUCTION RECORD WELL CONTRACTOR' / 01P41vi
WELL CONTRACTOR CERTIFICATION # : "SIP
STATE WELL CONSTRUCTION PERMIT # :
336520
USE (Check Applicable Box): Residential[] Municipal n Industrial Agricultural Monitorinc
LI
-1ecevery J Heat Pump Water Injection Other pi If Other. List Use:
OCATION: (Show sketch of the location below) /y�
vearest town S' l f /) County / r 7L'S�'
DRILLING LOG DEPTH
From To Formation Description
HLCPINATION: Type Hrfw Amount / "' ' if additional space is needed use hack of form
• ARING Wall Thickness
�` Depth Diameter or Weight/Ft Material •
`� o �r FtG ›. Gi /T$Ti LOCATION SKETCH
To q (Showdirection and distance from atleast two State
`'^m To =t Roads, or other map reference points)
la. ;RC1tIT
'E. SCREEN
Depth Material Method
o Ft
To Ft
Depth Diameter SlotSize Material
to Ft In in
To Ft in in
In Ft in in
'f. SAND/GRAVEL PACK
Depth Size Material
om
om
REMARKS.
To
To
Ft
Ft
RECEIVED
6 IV. OF WATER QUALITY
JAN 0 4 ?ON
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
FOR OFFICE USE ONLY
7uad No.
Serial No
f S67-/ At'it e - x/ •- D L
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
Submit original to Division of Water Quality, Groundwater Section within 30 days
GW-1 REV 12/9C•

CZ
NNW Crabs • NSA of E ee nmnt and SUS Meows - OIMdn M WAS Ooiy • OaunOmobr DINIon
ME s-r... e% VISMEISPhonsplp7nsa1
WELL CONSTRUCTION RECORD WELL'
CONTRACTOR C liQ() IlkTV
TELL CONTRACTOR CERTIFIOATDN F•3
STATE al. COIIRINIC110N FENINITet
1. WEIL Witreestrapponiettsumfodhrild lMwdl a0 ISSAS❑ ApINiMdMNEwigo
Par C Hod Poop Wear L; D or sr 9pIOE1or,IMWm
1
gwTam delo sae
4. DATE DRILLED L
E. TOTAL DEPTH
E. armee COIIECTED YES Q ^O621
7. DOES waL REPLACEEIosTE+o weal
Q NU�
YES
S. STATIC WATER LEVEL Sober Top d Calor FT.
An Top el ONER.
O. TOP OF CASING IS I FFT. Abele Lod Sorlator rI ksMMadsnpYw morlinsoMmom
S n NITASSCLIIIMI
10. YIELD (ppne: if 0 METHOD OF TEST
11. WATER ZONES (dope*
12. CHLORINATION: Typo Amount
13. CASINO:
ma Taros
I Osow/ Vl n� ppp l "Sat
From l Te FL
From To R.
From To FL
14. GROUT:
Frerrr Te / F1. l Y
ttrh
From To FL
1S. SOWER
Doper DMmmolsr Sol IS MMuld
Rom To Fl In. In.
Fran To F1. In.. in.
Fran To _ R. Inc r1.
10. SANDIERAVELPACK:
Doper Sloe MdwY
Ram To R.
From To FL
RISSARICN
sdllydspa b nosed un boaoilier
LOCATION nlO4
{Nrrdldon d dMrw ban Nowllesla
Rose, w aAvmsp nbiow pobb)
RECEIVED
DIV. OF WATER QUALITY
, AN tiI 5 ZOO?
100HERESY CERTIFY THAT THIS WELL WAS CONSTRUCTED MACCORDANCE WITH 1M N=C TC.WEU.
CONSTRUCTER STANDARDS. AND THATAC THSRECORD SEM MOWED TOME WELL OW.a
FOR OFFICE USE ONLY �/�%1-)s-at
Ors Ns Tun onlasOme ISmUQIn6TItns MT!
MIISIIIWATINOMONettiVarDWIls Owe SINS Mien 30days
eT 4 M. tare

IFOR MICE use ONLY
awNE
WOW
Franr To FL
From To . FL
14. GROUT: 5V
pis
Front To Ft. ettfittll bblrgd 36 vhr From To FL DIV,,OFu.EUATERQIAIii
is. SCRODS (1,��W .,,�,�
Depth Dlrnsler Sol SIM h MOMS Uy \� !` t iN 0 E 2007
From To FI
From To Ft. Yr. ___ In.
From _To_R
It 8ANDIIWWELPACK i
DroFrom th StroFt blaloAll i- 411Q7-14
From To R I.-,
IT. NOMARIOk Hp,"
1t. CAI
•
fare�ofIlmoomermland IlSSR=aaas.-Oe�wralWalorCMS •Graud�..l.r Smarm
NMI" 14.0. ERNS•1S1114Mano ma use
WELL CONSTRUCTION RECORD weu.00NMAOT011, OJ-an Win'
consacrat can A i i 3
*TATO WELL CONSTRUCTION PERIM
1. WELL uaa.LOraabSpr.r. t...a.ra.nENCI aado4yD bloat Afl&wdD bbadorbrsD
may p Neal Pump Wale b jaown p Orr= p EOErsr. LM Us¢
z NiresTLwt - ft 671�t 1r of M•
Wni 1 lea.ioe imonsr wilt(r IC.Al
flard and omnarry,orarb-LLandlLot My oR..,-ritti(pp f]tIM
r. Oar R1 ) ft r�1 V Pan To ----_
«Taro
4. wasonu.E° I1-I3-o(o ADM, ��Gi.TJL
s. Tara wpm 3>Y
r. curries COu rF_D yes
T. Does wow. REPLACE oars wa
a STATIC WATER LEVEL OslowTop aICoast FT
S. TOP OFCAsINeti I �9•m omTm.fouly
FT. Above Lacy Sudan°
mop Masks Iuaormsdardam ular learMl.wMud walesrope=avats lase
10. YIELD ): ai
Wpm): bEiF100 OF TEST P. (C'
11. WATER ZONES (doprO
12. CHLORINATION: Typo Anaud
raddllmalspa Yr __ uaobaskMroan
my a s, �GTIOIs S1 ItII
From. 1 to FL Lt mourlsra► aat Oslowwa.Sd on siva Star osrromIMolfsrb
1 J7l) C. amok ante imp manna sobs)
1 UO HERESY CERTIFY THAT Tills WELL WAS OONi1RUCTED N ACCORD/MCI WITH 1M MAC a WELL
CONSTRUCTION STANDIADs.AND MAT ACOPY OFTIP RECORD HAS SEMPHONON) TODIE WE .OW►ER.
adituumeoFromponosernuarear
/Memairds.OMMaMMrr l+ rwMil Oo wet OATS
OW4 oat ran
Ern )

•
North Carolina . Department or Environment and Natural Resources • Division of Water Quality - Groundwater Section
1636 Mail Service Center - Raleigh, N.C. 27699.1636-Phone [phone]
WELL CONSTRUCTION RECORD WELL CONTRACTOR. l ,J.&.C.t tx P -+W 4
WELL CONTRACTOR CERTIFICATION 0: c9
STATE WELL CONSTRUCTION PERMIT#:
dr \T
1. WELL USE (Check Applicable awn: Residential �(/
Recoveryb` Industrial ❑ Agricultural ❑ Monitoring (�J
❑ Heat Pump Water Injection 0Other � 1f Otherr,,List Use:
2. WELL LOCATIp : (Show Sketch of this location below)
Nearest Town: i � 1/ 1 .) \QCA Q )') County
(Road Name and �!jumpers, cirmiuNty. or Su and tot No.)
M. OWNER Y uArA
Lei
Le
Address1041 �~ ni Oridg./1
(43
Gay or Slate zip Code
4. DATE DRILLED
5. TOTAL DEPTH —1714121)
O
6. CUTTINGS COLLECTED YES ❑ N��
7. DOES WELL REPLACE EXISTING WELL? `!ES Ej 1421
8. STATIC WATER LEVEL Below Top of Casing: FT.
9. TOP OF CASING IS (Use 14, a Above Top of Cisirp)
FT Above Land Surface
'Top of casing terminated at/or below land surface requires a variance In accor-
dance with 15A NCAC 2C .pttp
10. YIELD (gpm): 1 ON METHOD OF TEST j ICI
11. WATER ZONES (depth):
12. CHLORINATION: Type Amount
13. CASING:
FromD
_eptTo
From To
FromTo.
14. GROUT:
Deptbn
From To
From To
15. SCREEN:
Ft
Ft.
Ft.
Wag TNaurss
Diameter ot Weight/FL ,.Mite
Ft.IV t I
Ft
Size
From Ft
From To Ft
17. REMARKS:
Depth Diameter Slot Size
From To Ft In in
From To Ft In In
From To Ft. in in
16. SAND/GRAVEL PACK:
Depth
To
Method
Material
Material
DRILLING LOG DEPTH
1-C 1
l kit - Iete
To Formation Dowd Pon
It additional space is needed use back of form
LOCATION SKETCH
(Show direction and distance from at least two State
Roads, or other map reference points)
�j�1lg�tm�S Rr arilr
OJV. OFWATER (DUALITY
.(AN (I 2007
gum Vct-E-
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY t THIS RECORD HAS SEEN PROVIDED TO THE WELL OWNER.
/7 2 //VaG
FOR OFFICE USE ONLY
Quad No:
Serial No.
SIGNATURE OF PERSON CONSTRUCTING THE WEU. DATE
Submil ofighyi to Division of Water Quality, Groundwater Sedum within 30 days
GW•1 REV. 12/99

RESIDENTIAL WELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources - Division of Water Quality
WELL CONTRACTOR CERTIFICATION # 2878
337869
060547-1
1.WELL CONTRACTOR:
STEVE PRICE
Well Contractor (Individual Name)
DEWEY WRIGHT WELL & PUMP CO.. INC.
Well Contractor Company Name
STREET ADDRESS P 0 ROX 10R
BOONE
City or Town
( R2R) - 28L-2951
Area code - Phone number
2.WELL INFORMATION:
NC
State
SITE WELL ID #(if applicable)
STATE WELL PERMIT #(if applicable)
DWG or OTHER PERMIT #(a applicable)
28807
Zip Code
WELL USE (Check Applicable Box): Residential Water Supply 0 X
DATE DRILLED 9/14//2Q8
TIME COMPLETED 5:00 AM 0 PM OX
3. WELL LOCATION:
CITY: SPRUCE PINE COUNTY MITCHELL
LITTLE MTN. OFF GREEN COVE RD. OFF CANE
(Street Name, Numbers, Community, Subdivision, Lot No., Parcel, Zip Code)
TOPOGRAPHIC / LAND SETTING:
❑ Slope 0 Valley 0 Flat 0 Ridge 0 Other
(check appropriate box)
LATITUDE 3 313 00881
LONGITUDE 081O50;3
Latitude/ongitude source: ❑ sPS ❑ 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
May be in degrees,
minutes, seconds or
in a decimal format
STREET ADDRESS ?7687 rATAMA'A11 fl
r
CI o own State
Zip Comae`
( (R03)- r47-8OR9
Area code - Phone number
5.WELL DETAILS:
a. TOTAL DEPTH: 705
b. DOES WELL REPLACE EXISTING WELL? YES ❑ NO 01(
c. WATER LEVEL Below Top of Casing: 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): 0 METHOD OF TEST
lair
f. DISINFECTION: Type Iffl4 Amount
g. WATER ZONES (depth):
From DRAT° RCAF From To
From To From To
From To From To
6.CASING: Thickness/
Depth Diameter Weight Material
From___�To__41Ft.
From___oTo__OFt.
From To Ft.
7.GROUT: Depth Material
From Qo_ 0Ft. CaP1tf11
From To Ft.
-0 1/8 —.350- PVC
From To Ft.
Method
Gravity Flav
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
0
ei5
To
u5
Formation Description
RIOT
.F"ANITG
RECEIVED_owITY
JAN 2 9 7007
11. REMARKS:
0 GPM DRY •-11QI F II GPM
OGPM - OGPM -
O GPM - O GPM -
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH
15A NCAC 2C, WELL CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS
RECORD HAS BEEN PROVIDED TO THE WELL OWNER.
SIGNATURE OF CERTIFIED WELL CONTRACTOR ItHDATE
PRINTED NAM Opp I
F PE Ffi '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-la
Rev. 7/05

WELL CONSTRUCTION RECORD
Nona Carolina - Department of -Environment and Natural Resources - Division flirter Quality - Grotmdwater Section �—/
WELL CO\ reacron (INDIVIDUAL) W VIDUAL) NAME OrM0 C7 141li GG CERTIFICATIONS S 7) *- `a
WELL car -macron CO8IPANY NAME XUSfr C5 -Et ii rrZEit4-1 PHONES (47Z€ Vr-4iS 4f9
STATE WELL. CONSTRUCTION PERMITS ASSOCIATED WQ PERMITS
(if licLble) (iflimble)
1. WELL USE (Check Applicable Box)= Residential WI MunicipaURlbiie O Iadas(riai 0 Agricultural 0
Monitoring ❑ Recovery CI Heat Pump Water Injection 0 Other 0 ItOtter, List Use
337531
2. WELL LOCATION: ' /�
Nearest Town: 5�((XI Pr nit County 1r4((i.tQ.
Kai 'WCtl/C Of 5024:9
(Sued Name. Numbers. Community, Subdivision. IatNt. ry Co4t)
3.OWNER: CLe*4wt01U5
Address '1o.o rlobee+ 12U4 r IZ D/.
tsaeew or Rom Nat)
5,c11.4re Ale Z$qz,/
City otTwa Same rryCst
l- cis al -gl31
Area rode. Phone number
4. DATE DRILLED Q.C+ 4 0 ro
5. TOTAL DEPTH: 405
6. DOES WELL REPLACE EXISTING WELL.? YES 0 NO U
7, STATIC WATER LEVEL Below TopotCasing: (ao FT.
(t 4ITAb.eTapoftanim)
8. TOP OF CASING IS 1 FT. AboveLand Surface*
flap efeadastermswhir belay bad surface ratan a
variance A accormn with ISA NCAC 2C.6I1&
9. YIELD (glen): `12 METHOD OF TEST ifl:t itpHeiLl
10_ WATER ZONES (depth) Nogg.+. (r j 380
11. DISINFECTION: Type iu.(.L'1vV Fs-e- Amount 9 d2
12- CASINO: Wan T_do__
Depth t>ramcL . or Weight/FL Mauna
From_ To
From 0 To iL a !a i4 40
From . To FL.
13. GROUT: Depth Materiel
From To Ft
From 0 To 2 6 FL 1l ya l
14. SCREEN: Depth Diameter
From To Ft is in
From To FL in. is
15. SAND/GRAVEL PACK
Depth Size Material
From To FL
From To Er
Topographic/Land setting
ORidge Elfsktpe Malley OFIat
(sheet appopian box)
Latrtudellonytil de of well location
25 "Sul . f c. Al QI2 62, 4'97W
(depecthninutesisecould
LatitudeJkorgitudesoamtet0GPSCITopographicmap
(slat boat)
DEPTH DRILLING LOG
From To Formation Description
�+- 25 A -#
Zc- ?OS Ca✓ldna,. ✓e_
LOCATION SKETCH,
Show direction and distance in miles rrom at least
two State Roads or County Roads. )ndade the road
mambas and common road names.
4elfr‘t let
Method
PtivisPit
Slot Size Material
(Ai itLaJF
SECEIVED
DIV. OF WATER QUALITY
JAN 2 6 2007
16. REMARKS:
I DO HEREBY CERTIFY THAT
CONSTRUCTION ST
WELL WAS CONSTRUCTED IN ACCORDANCE WITH I5A NCAC 2C, WELL
THATA COPY OFTEit$gEcoltD HAS BEEN PROVIDED TO THE WILL OWNER
ATURE
CONSTRUCTING THE WELL DATE
Submit the original to the Division of Water Quality, Groundwater Secant 1636 MI!) Service Cater -Raleigh, NC
27699-1656?hone No.[phone],within 30days. GW-I REV. 07/2001

RESIDENTIAL WELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources- Division of Water Quality
WELL CONTRACTOR CERTIFICATION # ;?(1
1. WELL CONTRACT
G-i'r ()St.( tC--
Well Contract (Individual) Name
Welrtontractor Company Name {-
STREET ADDRESS 5W 45 0 S tzwy 7
plil A f or Ai EteC--
City or Town
(�L`s )— 7Vf-45vb
Area code- Phone number
2. WELL INFORMATION:
zeS7s2
Zip Code
SITE WELL ID #(if applicable)
STATE WELL PERMIT#fdapplicable) 2( 5G
DWQ or OTHER PERMIT#(f applicable)
WELL USE (Check Applicable Box): Residential Water Supply p/
DATE DRILLED /0 ••4Y-0
TIME COMPLETED I I.:00 AM f PM ❑
3. WELL LOCATION:
CITY: ,5 4 K e,'5t; L t-e
33 &tax 1.044 z-
(Street Name. Numbers. Commonly, Subdivision. Lot No., Parcel, Zip Code)
TOPOGRAPHIC/ LAND SETTING:
R75lope ['Valley ❑FIN DRidge ❑Other
(cheek appropriate box) ,� Q
LATITUDE _31,,A 362 r\%
LONGITUDE 11 .4.2/24-14
Latitude/longitude source: Esters ❑Topographic map
(location of well must be shown on a USGS topo map and
attached to this form not using GPS)
O. WELL OWNER // /7�
OWNER'S NAME I�fIJIA+)^-O £ L(r Stave I \ ycLpt(
STREET ADDRESS I�l I "Willi L' ,4 T
COUNTY i 1o•KL,e.(.
May be in degrees.
minutes, Seconds or
in a decimal format
(ja51PRGn PrAd" Rh r5
City or Town State Zip Code
(352 )_ 26'7- `7651
Area code - Phone number
5. WELL DETAILS:
a. TOTAL DEPTH: Z Z 5
b. DOES WELL REPLACE EXISTING WELL? YES 0 NO Vd
c. WATER LEVEL Below Top c( Casing: 40 FT.
(Use '+' if Above Top of Casing)
d. TOP OF CASING IS ( FT, Above Land Surface-
. 'Top of casing terminated #/or below land surface may require
a variance in accordance with 15A NCAC 2C .0118.
e. YIELD (gpm):
3 METHOD OF TEST Al f
vC'iw
o e 1 l
f. DISINFECTION: Type C' CCrZ f tit Amount b C3 2- 77
g. WATER ZONES (depth): /`
From To From
From ND To / I From
From To From
6. CASING:
From
From
Depth Diameter
To Ft.
0 To 31 Ft.
From 31 To 33 Ft.
To
To
To
Thickness/
Weight Material
7. GROUT: Depth Material Method
From To Ft. s
%
From 0 To L Ft C nEr
From To F1.
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 Materiel
From To Ft.
From To Ft
From To Ft.
10. DRILLING LOG
From To
0- ZC
Formation Description
RF(:FIUFfl
C)H/ riF IniATFP f?! lA! ITV
11. REMARKS:
IAN 2 6 2007
I DO HEREBY CERTIFY THAT DOS WELL WAS CONSTRUCTED N ACCORDANCE WITH
ISA NCAC2C, WELL CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS
RECORD i3As BEEN PROVIDED 7O THE WELL OWNER.
SI
PRINTED ME
CONTRACTOR DATE
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