Sw CY2006

1. WELL CONTRACTOR:
%A,re ,l am
Well to (Individual) Name
MILLER WELL DRILLING INC.
Well Contractor Company Name
STREET ADDRESSP•O. BOX 567
HAYESVILLE, N.C. 28904
City a Town Slate Zip Cade
1 828 . 837-2997
Area code- Phone number
2. WELL INFORMATION:
SITE WELL ID Ca applicable)
STATE W ELL PERMITN(s applicable)
DWQ or OTHER PERMIT 0(if applicable)
WELL. USE (Check Applicable Box): Residential Water Supply 0
DATE DRILLED / b- D C
TIME COMPLETED // "OC1
--- -- AM pi PM P`
3. WELL LOCATION:
CITY: CterOlLe� COUNTY .S .,Arti Z
(Motel Name, Numbers. Community, Subdivision, Lot No., Parcel, bp Code)
TOPOGRAPHIC f LAND SETTING:
O Slope °Valley ❑Flat [}Ridge ❑Other
(check appropriate box)
LATITUDE S— .Zr: fl r
LONGITUDEL 3Z-
LTlittldellongi(ude source: 0-8T'S °Topographic map
Oration of we/ must be shown, on n USGS fopo map and
effached to this foot, I not using GPS)
4. WELL OWNER // J/
OWNER'S NAME %a'4/7[e 61. ,fy,j, I-4
STREET ADDRESS
City or Town
Area code - Phone number
5. WELL DETAILS:
S. TOTAL DEPTH: S S_ a
Stale
Mny he in degree.,
mindrtee, second* nr
in a decimal format
Zip Code
b. DOES WELL REPLACE EXISTING WELL? YES ❑ NOB'
c. WATER LEVEL Relow Top of Casing: .Z9.0
(Use'+' 0 Above Top of Casing) FT.
d. TOP OF CASING IS / FT. Above Land Surface'
'Top of casing terminated aUor below land surface may require
•
a variance In accordance with 15A NgAC 2C .0118.
e. YIELD (gpm):___j____ METHOD OF TEST
Submit the original to the Division of Water Quality within 30 days. Attn: Information Mgt.,
1617 Mali Service Center- Raleigh, NC 27699-1617 Phone No. [phone] oat 568.
RESIDENTIAL WELL CONSTRUCTION RECOREC
North Carolina Department of Environment and Natural Resources- Division of Waler Quality
SVELL CONTRACTOR CERTIFICAT ON N
OWNER
!4WD
I. DISINFECTION: Type 7lLTFf Amount
g. WATER ZONES (depth):
From __ _ To rid/ From
FromTo
To Fran To
Fran To From
6. CASING:
Depth , Diameter
From C To_�' 7 - FI. 6'',:cr.
From To Ft.
Fran To _ Ft.
7. GROUT:
From
From
From
II. SCREEN:
From
From
From
NC
To
Thickness/
Wei hl Material
atZ/ r"lie
Depth lljealerip
_ To.2a
To FI.
Depth
To
Diameter Slot Size Material
Ft. In. In.
To Ft In. in.
To Ft In. In.
9. SAND/GRAVEL PACK:
Deplh Size Material
From To Ft.
From To Ft. �-'—
From To Ft. ��-
10. DRILLING LOG
From To Formation Description •
C _L. Tay
------5-- D� —
E
--1' Ag_as_200
s ev i e egi nal V
AquiteLPiotection
11. REMARKS:
I DO HEREBY CERTIFY TIlAt THIS WELL WAS CONSTRUCTED N ACCORDANCE WITH
ISA NCAC 2C. W Ell CONSIRUCTON STANDARDS. AND THAT A COPY or THIS
RECORD HAS BEEN PROVIDED TO THE WELL OWNER.
SIGNAT E OF CERTIFIED WELL CONTRACTOR
DATE
elm Qeec6
PRINTED NAME OF PERSON CONSTRUCTING THE WELL
Form GW-1a

1. WELL CONTRACTOR:
eece
Wen Contrdcta (Individual) Name
RESIDENTIAL WELL CONSTRUCTION RECORD
MILLER WELL DRILLING INC.
Well Contractor Company Name
STREET ADDRESS P. O. BOX 567
HAYESVILLE, N.C. 28904
City a Town Stale Zip Code
t B28 } 837-2997
Area code- Phone number
2. WELL INFORMATION:
SITE WELL ID #(ilapplicable)
STATE WELL PERMIT#(ilapplicable)
DWQ or OTHER PERMIT #(if applicable)
WELL USE (Check Applicable Box): Residential Water Supply Q/
DATE DRILLED /UJ'0("°
TIME COMPLETED • dOI
3. WELL LOCATION:
CITY: CAerGrZl2.
)Sheet Name. Numbers, Community, Subdivision, Lot No., Parcel, Zip Code)
TOPOGRAPHIC / LAND SETTING:
( 1ope /]Valley °Flat ❑Ridge °Other
(check appropriate box)
LATITUDE
LONGITUDE„_ L. P%, 7i"
AMO PME-
COUNTY .Swlir
May be in degrees.
minutes, seconds or
in a decimal formal
Latitude/longitude source: ❑GPS ❑Topographic map
(location of wel must be shown on a USGS lope map and
attached to this form lf not using GPS)
4. WELL OWNER OWNERS NAME Thee(/%q///er
STREET ADDRESS C/d T 4 /
City or Town State
Zip Code
Area code)- Phone number
5. WELL DETAILS:
a. TOTAL DEPTH:
b. DOES WELL REPLACE EXISTING WELL? YES 0 NO t3--
c. WATER LEVEL. Below Top of Casing' d
(Use'+' if Above Top of Casing)FT.
d. TOP OF CASING IS / FT. Above Land Surface'
-Top of casing terminated aVo below land surface may require
• a variance In accordance with 15A NCAC 2C .0118.
e. YIELD (gpm): METHOD OF TEST f77,
t4
North Carolina Department of Environment and Natural Resources- Division of Water Quality
WELL CONTRACTOR CERTIFICATION #
OWNER
I. DISINFECTION: Type / 17
Amount
g. WATER ZONES (depth):
From g2 ?O) To 27 / From
Frorn To From
From To From
6. CASING:
From
From
From
Depth
D To_ F(.
To Ft.
—__ To F1.
7. GROUT: Depth
From 6) To 6'
From_ To , W
From To
8. SCREEN: Depth
From To_
From To
From To
9. SAND/GRAVEL PACK:
Depth
From To
From To
From To
10. DRILLING LOG
From To
-RE l/E
t26o6
Asti a eajonal
cti
11. REMARKS:
Diameter
25—
MWD
NC
,io
To
To
To
Thickness/
Weight Material
S1`ee
Material
FL 0i'f(Wj�
Ft. 2?� /e_
Ft.
Method
Diameter Slot Size Material
FI.In. in.
Fl.In. in.
Ft In. In.
FI.
Ft.
Ft.
Size
Material
Formation Description
/ec — C r.: bG
r'l
0
I00 HEREBY CERTWY THAT Tr119 WELL WAS CONSTRUCTED N ACCORDANCE WITH
ISA NCAC 2C. WELL CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS
RECORD HAS BEEN PROVIDED TO THE WELL OWNER.
it —tea... 7 OC 0<
SIGNATURE OF CERTIFIED WELL CONTRACTOR
DATE
%Y e c e
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— Raloigh, NC 27699-1617 Phone No. [phone] ext 568.
Form GW-1a
Rev Ms

^: s
RESIDENTIAL WELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources- Division of Water Quality
TVEI,L CONTRACTOR CERTIFICATION ll
1. WELL�/CONTRACTOR:
fA'ii //eect
Well Contractor (Individual) Narne
MILLER WELL DRILLING, INC.
Well Contractor Company Name
STREET ADDRESS P. 0- D O X 5 G 7
HAYESVILLE, N.C. 28904
City a Town Stale
( 828 )- 837-2997
Area code- Phone numbe,
2. WELL INFORMATION:
SITE WELL ID ern applicable)
Zip Cade
STATE WELL PERMIT/(inapplicable)
DWQ or OTHER PERMIT X(if applicable)
WELL USE (Check Applicable Box): Residenlial Water Supply EY
DATE DRILLED /-4 `— 06
TIME COMPLETED //-.6'61 AM B' PM
3. WELL LOCATION:
CITY: Ctire.-C gee. COUNTY S4J4, 2
(Street Rama, Number,, Community, Subdivision. Lol No.. Parcel, Zip Code)
TOPOGRAPHIC / LAND SETTING:
&Sfoope [Valley ❑Flat ❑Ridge I0Iher
(check eppropriale box)
LATITUDE �T d-- 3.3.00P
LONGITUDE P /,� ,eZz
IMay be in degrees,
oilmen, second, or
in a decimal ronnat
Latitude/Iongiludc source: 'CI'S [Topographic map
(Incnfion of well must he shown on n USGS logo nap and
aflnchpd fo this fora 1 not using GPS)
4. WELL OWNER IAA( /
OWNER'S NAME An Iacr/=( J'TKA/6,,
STREET ADDRESS
City or Town Slate Zip Code
Area code - Phone number
S. WELL DETAILS: �7
a. TOTAL DEPTH:
b. DOES WELL REPLACE EXISTING WELL?
YES
NO BV
e. WATER LEVEL Below Top of Casing FT.
(Use's' if Above Top al Casing)
d. TOP OF CASING IS / FT. Above Land Surface'
'Top o( casing terminated at/or below land surface may require
a variance M accordance With 15A NCAC 2C .0118.
•
e. YIELD Wpm): 0 METHOD OF TEST / r
g
.S_ J
OWNER
MWD
NC
f. DISINFECTION: Type 4'{%/ Amount
g. WATER ZONES (depth):
From flS'� To7i/'
From To
From To
6. CASING:
From 0
‘..r.
From
From To
From To
From To
Thickness)
Depth Diameter Wei uIII Material
To 4.5 F1. 4,25- StgiduL
srfce(
To .76 F1. �•.?-1'
To FI.
7. GROUT: Depth �a,�llerri/ial oo Methcd
FromTo ,� FL/O/'«v+acl / et
Fron 3 To20 Ft. jff'e ife-
Fran To U/A'-
Ft
6. SCREEN: Depth Diameter Slot Size Material
From To FI. In. in.
From To Ft. In. _ M.
From To FT in. _ In.
9. SAND/GRAVEL PACK:
Depth Size Material
From To,
From To
From
10. DRILLING LOG
From To
o �s-
dr- z6o
1I. REMARKS:
Ft.
Ft.
To FI.
Formation Description
t<e.
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED N ACCORDANCE Wml
ISA NCAC 7C, WELL CONSTRUCTION STANDARDS. ANO THAT ACOPY of THIS
RECORD ILAS BEEN PROVIDED TO THE WELL OWNER.
/-/o--DC
SIGNNd� //CERTIFIEDWELLCONTRACTOR DATE
/ie//'y� /Cee cc—..
PRINTED'NAME OF PERSON CONSTRUCTING THE WELL
Gl_—
AT E OF -
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 GIN -la

RESIDENTIAL WELL CONSTRUCTION RECORD
North Carolina Depeltmaa of Environment and Natural Resources-
Division of Water Quality
WELL CONTRACTOR CERTIFICATION # 3 t7 O
1. WELL CONTRACTOR:
OJfa-1;k (h \k€.ps
W A.Cathador (individual) Name /�1
Nv\ Ube \‘ O1 1 l\ rvk%
Weer Contractor Comma Nana
STREET ADDRESS h39 Aide Toni v. (2--ext
62A13 ;1 sot VT( 0-g-n /
City or Torn Stale Lp Code
( tea- 79 - e t/ 6Li
Area code- Phone name
2. WELL INFORMATIOt
SITE WELL ID f(f apurs:SA )
STATE W91 PE MIT/1g ppfuab)
OWQ or OTHER PERMIT f(if applicable)
WELL USE waLtmE(c&ac Appirah .Bat Restlegal Wafer Siwp%,
DATE DRILLED /-- a-- O A
TIME COMPLETED b ' 00
3. WELL TIOtt CITY: (yitran Ca cowry6L-JeAl n
4e1NoR Leite E d-c J-e S
MID PM IQ
(Street Nano. Numbers. CammeYLy-9mdtldon. Loa Parcel, I4 Code) -
TOPOGRAPHIC / LAND SETTING:
❑Slope Ovafey DEW *Riidge OOter
(check appropriate 11ad
LATITUDE ..L fU ` CIS, 'l
Lot/aruE gysa°3J 'r7h./'/
Latitrdeflongitude solace: p&GPS °Topographic amp
(Jacatar ofnalavast be shown on a USGS Iapotaap and
attached Sofors lona loot users
4. WELL OWNER HenryNIR'SNAME l-l(Ecgormes
STREET ADDRESS 4dvtjrc� �... �� re duties
it 7 I'3
-ace)_ 45-t — logo
Area code - Phone number
May be in degree.
sir-n secoodsor
Ina deenel foram
S. WELL DETAILS: ,
a. TOTAL DEPTH: 606
b. DOES WEU.REPLACE EXISTING WELL? YESO NOM
c. WATER LEVEL Below Top d Casing 1�.7 FT.
(Use -*' if Above Tap d Casing)
d. TOP OF CASING I / FT. Above Land Sudan,
"Tap d casing to nirded aaa below lid surface may require
a vadarce Si acadance nth 15A NCAC 2C .0118.
e. YIELD (gnu* a METHODOFTEST G1.I ✓^
ro der fir c
L DISREECTIO1t Type I-/ r/- j Arnow t 9 a Z-
g. WATER
EZONES (dop IG ,
J From I ETo 6 os From To
Fran To From To
Fran To Fran To
6. CASING: 1 ThiclmMI
I
From 0 Driyf/ rarer
� Et I Mai
Fran To Ft
Fran To Ft
7. GROUT: Depth Material
Fran_a_To. a0 Ft [S'-rvlPrd-
Fran To Ft.
From To Ft
McMDd
pa Mein%
9. SCREEN: Depth Diameter Slot Size Material
Fran To Ft in. n
Fran To Ft in. _ i.
Fran To Ft it in.
9. SAND/GRAVEL PACK
Deals
From To Ft.
Fran To Ft
Fnm To Ft.
j-g
Sine Material
10. DRILLING LOG
From To
Fonnalion Dcn.a Bk n
RECEIVFD
MAR 0 8-7E6
Asheville Regienal Offic
AQultet Prutei,t'on
IL REMARKS:
1 an COOFYnaTTre Veal NAS W -6neC1® NIACCORONCE WITH
15A NCAC2C. WELL Wr6IMCIDI STANDARDS, ANDLNTA COPT OFTHS
RECORD HAS BEEN PROVIDED RI 1 E WELL OWNER
cp s1� 1-1)-06
SIGMA OF CERTIFIED WELL CONTRACTOR DATE
0Zr/-/N t'lt6 s
RARE OF PERSON CONSiiTR
PRINTED 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 Roseate- Division / of Water Quality
WELL CONTRACTOR CERTIFICATION # V eD
1. WELL CONTRACTOR:
Doss-(. OA,116e205
Wet \ (kldividua) Nane
lJ re' \fY e-d" c_,ke 1� Uri 11 l n s
Well Contractor Connppa/yName l l ` �, Imo, j� �/�
STREETT�A`DDRESS C� f I YUc-1-01AT1 VZ-»^QJ
t70ibrr�8V11 P SYC [[! q1b 77(
City or Town State hp Cade
( uafil.4179- g-9,5v
Area coda Phale number
2.WELL I FORMATIO1k
SITE WELL ID iP agptua.)
STATE WELL PERMITMirap,NOMa)
DWQ or OTHER PERMMTS(B amicable)
%YELL USE (Check Appirabrb Be* Residential Woks Supply Ik
DATE DRILLED / — c7 — O
TONE COMPLETED /.9% 7 00 MC PMA
3. WEL-L TlOt
CITY: ncCSerk C 1 i--�! cotiav rst,-)c- i 11'\
kp. /! sdz.-}-P c
(Street Name.. timbers. Certentnei.&tthtIon LatNe.. Parcel. $Lode)-
TOPOGRAPHIC I LAND SETTNG:
Oslo* OVatey ['Flat gRidge pother
(aide acacia. ens
LATITUDE S ' c23 /!�Y /
LONGNUDE1 ' / //-7"
f.atituddlongitude source ,OPS ['Topographic map
(kca6al of stet mane shown on a USGS Ioio rap and
attached bit form Indaaip GPS)
OWNER'S NAME kjh IN h0 we
STREET ADDRESS 3:6 e.kp s
L�
II uY� C41-y lv-t QQ-7I 3
( 770 )- eat 7 I FR' I
Area
Arvcde- Phone number
May be in degrees.
mina so* ar
la decimal format
orTann State rip Cade
5. WB1 DETAILS:
a. TOTAL DEPT(t
rS s
b. DOES WELL REPLACE EXISTDC WELL? YES[' ROA
c. WATER LEVEL BelowTop d Casing `700 FT.
(Use Ise if Aborts Tap d Casing)
d. TOP OF CASNG IS / FT. Ahae Land Safscer
'Top d casing lera rated S*r bdom SS surface my mums
a Yarieice h acaccda neat 15A NCAC ZC .0118.
e. YE.D(gpn) rXnMETROD OF TEST G i r
L DISIIFECT(Olt Type f') ri Amount I go -
g. WATER ZONES (depei)
Fmm WO i To /fobs From To
Fran To Fran To
From To Fran To
6. CASING:
Thickness/
FmmQ_ (i(-) Ft Dirref ,Wa-
51 71Depthde
Fran To Ft.
From To Ft
7. GROAT: Depth Mated Melkod
From 0 To ao Ft Gory -era-- ()3Yne1vv�
From To FL f 11
From To Ft
8. SCREENt Depth Diameter Slot S® Material
Fmm To Ft in. le.
Rom To Ft in. _ in.
Fran To FL in. in.
& SAIOGRAVEL PACK:
Depth Size Material
Fmm To FL
Fan To Fir
Fran To P1.
i�
10. DRSLNG LOG
From To Fonnaion Description
CEIVED
08
-n
Asheville Reginnal Office
Aquifer Proteeti
11. REMARKS:
100 HEREBY C6r1EYTNTaa WELL WAS apGlalClED MACCOROAI .E WITH
15"/CAC2C. WELL CONSIRUCTON SINOARDS, NO 1HATA COPY OF INS
RECORD HAS SEEN PROVIDED IO THE WELL OWNER.
rat{y /- 5- 0()
S E OF CERTIFIED WELL CONTRACTOR DATE
S-
PRINTED NAME OF PPERSON CONSTRl1L THE WELL
Submit the original to the Division of Water Quality within 30 days. Attn: hionnatton Mgt,
1617 Mail Service Center — Raleigh, NC 27699.1617 Phone No. [phone] ext 568.
Fam GW-la
Rev. 7/05

RESIDENTIAL WELL CONSTRUCTION RECORD
Noah Carolina Department of Environment and Natural Resources- Division of Water Quality
WELL CONTRACTOR CERTIFICATION # , E.) S U
1. WELL CONTRACTOR.
W e1JJContractor (Ind ual) Name I
t-h Pin rY7 (aJ,' // Ctrs. r9
Well Contractor Company Name
STREET ADDRESS .6341 A J e
R1LL/nsv.we /UG
City or Town State
c Stk - 479- 45
Area code- Phone number
2. WELL INFORMATION:
SITE WELL ID 1t(if-Ypticala•)
72(7/.,-/P7Rcil
Zip Code
STATE WELL PERMRi(dapµable)
DWQ or OTHER PERMIT Mil applicable)
WELL USE (Check Applicable Box): Residential Water Supply 2
DATE DRILLED 1 *-k3 '
t -ci
TIME COMPLETED a 'CO AMO Plut[a
3. WELL LOCATION:
CITY: 13 •S'G f L / irtourfre cS LJraf /7
n/77.yp14 Nrrl;J9 .23' 7!
(Street Name.Nanbe s. CanduNy,.Submdsion. Ld No.. Parcel. Zip Code)- -
TOPOGRAPHIC f LAND SETTING:
°Slope OVaMey OFIM Ell Ridge ❑Other
(check appropriate box)
LATITUDE y3 3 o('TLPG /
LONGITUDE& 3 C 3/.03, (v,/
Latitude/longitude source: as CPS °Topographic map
(bcaabn of wet roust be shown on a USGS bopo map and
attached to this form (not usng GPS)
4. WELL OWNER yF^ 1 1
OWNER'S NAME I ik.-4Z YID[/ i7eaki'ns
STREET ADDRESS 7pNTcolec ! /'
Rry/.Snn c /ry Alt P t7i3
Citf or Town State Zip Code
( SI.2Si . Itssf -cr l5
Area code - Phone number
May be in degas.
minutes, secadsor
m a decimal font
5. WELL DETAILS: a. TOTAL DEPTH: 7k 7
r
b. DOES WELL REPLACE EXISTING WELL? r^�YES ° NO p'
Seim
c. WATER LEVEL BeTop d d
Casing: / n FT.
(Use -+• if Abwe Top ct Casing)
d. TOP OF CASING IS / FT. Above Land Surface•
-Top d casing terminated ally below land surface may require
a vaiance in accordance with 15A NCAC 2C .0118.
e. YIELD (gpm): _ � .. METHOD OF TEST Q f I"
6'
I. DISINFECTION: Type 11 rig
Amount r22' aL
g. WATER ZONES (depth):
From (1 To / aC) From To
From To From To
From To From To
6. CASING: Thickness/
Depth Diameter Weigh pi/c
Material
From 0 To &9 FL C )% cnrai p
From To Ft. T
FL
From To
7. GROUT: Depth Material
From C") To 10 FL (',RyhP>r
From To Ft
From To FL
& SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in.
From To Ft in. _ in.
From To Ft. in. in.
9. SANDIGRAVEL PACK:
Depth Size
From To Ft.
From To FL
From To FL
i
Material
10. DRILLING LOG
From To Formation Descripb3n
RECtIVtD
08 2006
gionat Office
Aquifer Protet,tiuti
11. REMARKS:
100 HEREBY COMFY THAT THIS WELL WAS CO/SIRUCIED N ACCORDANCE wan
15A NCAC 2C. WELL CONSTRUCTION STANDARDS. MD THAT A COPY OF THIS
RECORD HAS BEEN PROVIDED TO THE WELL OWNER
1t/614g is
SIGNATURE OF CE IF1 WELL CONTRACTOR DATE
cN bA /i/ycle
PRINTED NAME PERSON CONSTRUCTING THE WELL
Submit the original to the Division of Water Quality within 30 days. Attn: Information Mgt.,
1617 Mail Service Center -Raleigh, NC 27699-1617 Phone No. [phone] ext 568.
Form GW-la
Rev. 7/05

RESIDENTIAL WELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources- Division of Water Quality
WELL CONTRACTOR CERTIFICAT ON # 6La5 c)
1. WELL CONTRACTOR:yi11e'
W t�(Indi%tuat) Name
r?-irj'ni.YI7 %-if csYi //t nr/
Weil Contractor Company Name
j I o�c
STREET ADDRESS G 347/ e T(.!/1 Ref(
/T ��t1/its v///,ei n/c- 2S71/
City or Tam State zip Code
Crowe }'yyy • $>qj- /
Area code- Phone number
2. WELL INFORMATION:
SITE WELL ID #(8 applicable)
STATE WELL PERMR#(Bapplicable)
DWQ or OTHER PERMIT #(d applicable)
WELL USE (CheckApplicableBox): Residential Water Supply EQ
DATE DRILLED
TIME COMPLETED %Or 30 AM PM1E1
3. WELL LOCATION:
CITY: J3ry$pn r/iry COUNTY Stack i 4,1
c hr1s1n branch 2,1.7/3
(Street Name.Numbea. CommWty.-Subdivision. LatNo., Parcel, Ziip.Cocky
TOPOGRAPHIC ! LAND SETTING:
❑Slope OValey ❑Flat El Ridge ❑Other
(check appropriate box)
LATITUDE il!rArita
LONGITUDE,_ aG 1,a9.. 3 •"/
May he in degrees.
minutes, seconds or
in a decimal format
Latitude/longitude source: M GPS OTopographic map
(location daelmuaf be shown on a USGS topo map and
attached toffee firm Ind usig GPS)
4. WELL OWNER
OWNER'S NAME 11 O.flt7)'S7 j
STREET ADDRESS V;h n in PSMc
rryy can eiry , Ni: ‘Q5?7 i
Citya Town / State Zip Code
Area code - Phone number
5. WELL DETAILS: '
a. TOTAL DEPTH: (c�r)
b. DOES WELL REPLACE EXISTING WELL? YES❑ NOy#
c. WATER LEVEL Below Top d Casing: ithc- FT.
(Uses' it Above Top d Casing)
d. TOP OF CASING IS / _ FT. Above Land Surface•
'Top d casing terminated alor below land surface may require
a variance in accordance with 15A NCAC 2C .0118.
e. YIELD Wpm): CS METHOD OF TEST el_ i/'
322t n0
f. DISINFECTION: Type /7 i/ .
g. WATER ZONES (depth):
From () _To /45 From
From To From
From To From
6. CASING:
Amount /SdZ
To
To
To
Thickness/
Depth Diameter Weight
Fran n To 1 QC Ft Co s/Trat N low
From To FL
From To Ft.
7. GROUT: Depth Material
Fran A To QO FtCE'TrlCni
From To Ft
From To Ft
8. SCREEN: Depth Diameter Slot Size Material
From To
From To Ft in. in.
From To FL in. in.
Ft in. in.
9. SAND/GRAVEL PACK:
Depth
Size Material
From To Ft.
Frain To Ft
From To Ft
10. DRILLING LOG
From To
11. REMARKS:
Formation Description
I DO HEREBY CERTFY THAT THIS WELL WAS CONSTRUCTED N ACCORDANCE Wuu
ISA NCAC 2C, WELL CONSTRUCTOR STANDARDS, AND THAT A COPY OF THIS
RECORD HAS BEEN PROVIDED TO THE WELL OWNER
SIGNATURE F CERTIFIED WELL CONTRACTOR ` DATE
PRINTED NAME OF'PERSON CONSTRUCTING THE WELL
Submit the original to the Division of Water Quality within 30 days. Attn: Information Mgt.,
1617 Mall Service Center— Raleigh, NC 27699-1617 Phone No. [phone] ext 568.
Form GW-la
Rev. 7/05

RESIDENTIAL WELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources- Division of Water Quality
WELL CONTRACTOR CERTIFICATION # :kg()
1. WELL CONTRACTOR:
Well Cmtractmt
6 r,e, h, yn We /I dr;
Wel Contractor Compaq CO Name �7
STREET ADDRESS 311
,4As 744(.1(7 R CA
Rokina ns vs 7/2 472- .26'77/
City or Taws Stab Zip Code
Name
� code-- Phone rumba4,5-4
2 WELL INECRMATIOtt
SITE WELL ID Wif alpF se)
STATE WELL PERMITSWappfoei)
DWO or OTHER PERMIT 1(d appicable)
WELL USE (ChedcAppirable Bark Residential Water Supply
DATE DRILLED /—Jot -el 0
TIME COMPLETED 9rM AM❑ PM®
3. WELL LO�C?ATIOIt
CITY: /.�ryStar ('f'7y COuNTISilk' if* 17
iTtinSen $rart17 Zj7/3
(Str
eet Name. Numbers. Camanly-Sub6vicbq Lae*, P+�. SP Code}
TOPOGRAPHIC l LAND SETTING:
❑Slope OVaaey OFW Wedge OOeru
(TLedr appropriate ba )
LATITUDE 3 Jra . 1j6. / i
LONGRUDE23o 3/r/es.,/.'
Latituddlongitude source: MGPS °Topographic map
Gabon dweiaarstbe shown on a USGS topo neap and
ached to Ns lima Ind usig GPSJ
4. WELL OWNER �
OWNERS NAME fl,C'k S n/ik,°P
STREET ADDRESS 'Cr L, nSr, el bK%Nr
/3 C 1'7yy Iv/ `,2Sr 7 /
m 3
CilytrTaStab Zip Code
Area code - More number
May be in degrees,
mbar, moods=
it adeansi ins
& W91 DETAILS:
a TOTALDEPflt 42c-a
b. DOES WELL REPLACE EXISTING WELL? YES]] NO63
c. WATER LEVEL BelowTop ofCasing FT.
(Use '+• If Above Tap d Casing)
d. TOP OF CASING m / FT. Above Laid Surface'
'Top d calm laminated Wor below lad surface ni q re lfe
a a i nce it accordance rah 15A ?CAC 2C .0118.
e. YIELD (gpm):
METHOD OF TEST en., r
3225
T. osiw cTIOMType /717ff Amount 9 Bz_
g. WATER ZONES (depth):
From (1 To 3.A" Fran To
Fran To Fran To
From To From
6. CASING:
WeiMIT
Fran E1 DepthTo' Ft.. Car j J�r_
To
Thielmear
Fran To Ft
Fran To Ft
7. GROUT: Depot
Medal
Fran , To 26 Ft C' otd641l
From To FL
Ran To
FL
Method
& SCREEtt Depth Diameter Slot Sze Material
Fran To Ft in. in.
Fair To Ft on. _ in.
Flan To Ft Si. in.
A SANOfGRAYti PACK:
Depth Sine lbbria!
Flom To Ft.
From To FL
From To FL
r?r-
10. DRIWNG Lou
From To
Fomia6on Description
EIVC
MAR 08 2005
Asneviiie Hegionai Office
Aguilar Protection
11. REMARKS:
100 ICY CERTIFY MATINS NSTRC1® NACCORMIaNTM
15A IaC 2C. WELL coNsmuCTCN STANDARDS. AIDTRATA COPY CF MS
RECORD WAS BEEN PROV:D701E WELL OWNER.
SIGNATURE OF CI eewat. CONTRACTOR DA
ye, LO
PRINTED NAME OF PERSON CONSTRUCTING THE WELL
Submit the original to the Division of Water Quality within 30 days. Ain: bifonnadon Mgt.,
1617 Mail Service Center —Raleigh, NC 27699-1617 Phone No. [phone] ext 568.
Fab GW-la
Rev. 7105
9

RESIDENTIAL WELL, coNsrRucnoN RECORD
North Carolina Depaitlead of Environment and Natural Resouicn- Division of Water Quality
WELL CONTRACTOR CERTIFICATION # D'Z j L7
1. WELL CONTRACTOR:
0-2-Pi ...L7N
Well CaMmctor Nana �UA
Ora AO yr) 11 Jed Cxr: r/ia T
Wei ContractorConpaty Nate
-�of
STREET ADDRESS L �7 / ijg rLvn R J
RAM) Iels L/.///ef NG r23.77/
City or Toan State Zip Cale
Area aloe- Phone number
2. WELL NTORMATNNt
SITE WELL ID Sid marinate)
STATE WELL PERMTnrryooftre )
DWQ or OTHER PERMIT f(f appicable)
WELL USE (Check Aplirabb BaQ Residenfal Water Supplyg)
DATE DRILLED /►1tl7 —06
IMPUT Twits COMPLETED t,L1r AM❑ PIA MI
3. WELL LOCATIOM
CITY: flry,Sn/l et- 'Ty COUNTYg,JnJii
.) Creee 7/'i
(Street psa..N mbaa. Cmmnti-S wahidon. t otNa. Punk. Z Cole}
TOPOGRAPHIC) LAND SETTING:
OSape OVaiey DFW Stage ()Ogler
(dnd' appopbbn hod
LATITUDE c •x.7' 7^e1 Z oc �•
LONGWme if ,Q6/A,9.c%»
Latitude/longitude sour= ®CPS ()Topographic map
(location of wet mad besham on a USGS Iopo map aid
ached golds farm gaol ashy (iPS)
4. WELL OWNER /
OWNER'S NAME PC)/0 ✓)") /'der
STREET ADDRESS nP.vy) C;f fie k
,Bryson c/'ry Cur fl7/3
CV or Town Sate Zp Cade
l ()_kf 11 7
May be in degas.
Saute, moods or
leotard fa®e
S. WELL DETAUS:
a. TOTAL DEPT* aid
b. DOES WELL REPLACE EXISTING WELL? YES CI NO yJ
c. WATER LEVEL Below Top of Casing / FT.
(Use's? If Abode Top d Casing)
d. TOP OF CASING IS / . FT. Abode laid Surfaces
- - Tap ct casing temiated eta below land striate may require
e variance in accordance at 15A NCAC 2C .0118.
e. YIELD(ppm)c 3a METHOD OF TEST O../f
322597
f. DISINFECTION: Type Hi*
g. WATER ZONES (deptIM
Fran ('} To P.M
From
From
To
To
6. CASING:
From /? �y 1
Fran To
Fran To
From
From
From
Amount ti,6.67—
Ft
FL
Ft.
To
To
To
Thickness/
WeGIII
7. GROUT: Depth Maeda!
ai
Fran 11 To D) Ft Pot 4>frr
Fran To Ft
Fran To Ft
8. SCREEIt Depth Diameter Slat We Material
Fran To Ft in. In.
Fran To m. in. _ at
Fran To Ft in. in.
Method
AdapLajd
A SANINGRAYEL PACK:
Depth Size aerial
From To _ Ft
Fran To Ft
From To FL
T?}�
10. DRILLING LOG
From To Fonna6ak Description
111M112111f91:
1
08
egio
Prot
V
11. REMARKS:
T ODDY CERTFY7n1/T116 WELL WAS ea61R C1® NAGCamMEE WM1
15A /CAC 2C. WE LCONS-M 10N STANDARDS, IVp11ATA COP.( OMB
RECORD HAS BEEN FROMMTOltE WEuaNrmt
)n Wy4e' %-/L/ ..0
SIGNATURE OFC WELL CONTRACTOR DATE
PRMEONAME OF PFJ(SON QCONSTRUCTING Tit WELL
Submit the original to the Division of Water Quality within 30 days. Atli: Information Mgt,
1617 Mall Service Center— Raleigh, NC 27699-1617 Phone No. [phone] ext 568.
Fenn GW-is
Rev. 7415

RESIDENTIAL WELL CONSTRUCTION RECORD
North Carolina Department of Envuonmcnt and Natural Resource- Division of Water Quality
WELL CONTRACTOR CERTIFICATION #
322596
1. WELL CONTRACTOR:
7-2—at �aN
WM Cmtracfa ( Marne
o re--.4ort L✓ev// Yi /iAd
Wel Contractor Company Name �7
STREET ADDRESS W 3 W /� t wY1 /C!'1
R6(1)Li nsvJim) NC a3 771
City or Town Stale tip Cane
« r I/ 7 ei x1'fSzt
Area node- Phone number
2. WELL I FORMATIOtt
SITE WELL ID Slit appiabk)
STATE WELL PIRMITf61,picatee)
OWQ or OTHER PERMIT Mg applicable/
WELL USE (CheckAppiable Go* Residential Water Sup* a
DATEDRILLED /-97-CIF
TIME COMPLETED /%, /9// AM ❑ PMS)
3. WELL LOCATIOtt
CITY: Sryson ry COUNTY .S'LJ(;kl n
De p r-rev k 25%77/
Meet Nan& manners. Cawnuiy-Siidirabq Latin. Pats. Tp Code}
TOPOGRAPHIC l LAND SETTING:
0Slape (Way OFht MRidge Daher
(dredr apaaP.fd
, LATITUDE y 9.7' �//J ;•
LONGrrunE 4L-f. 2613/,R*11
fatiodc/Iongit de source: ®GPS oTopog aphic map
(lunation ofweianal be shawl an a USGS PoPo reap and
attached to Sit Anna not wig GPS)
4. WELL OWNER ('�
OWNER'S NAME atlti )77;Her
STREETA1�
DDRESS Peep r' rfre4k
e'rySln erdry Ale 2.)7
May be in degrees.
mioues seconds at
in decimal format
or Town Slew rip Code
51,2')-1l�'�- (-/Q7
Area ode - Phone number
0. WELL DETAILS: (1
a TOTAL DEPnd. t 0;}
b. DOES WELL REPLACE EXISTING WELL?? YES NO
c. WATER LEVEL BdowTop dW Ca 6,5YEFT.
(Use'+• if Above Top d Casing)
d. TOP OF CASING IS / FT_ Mom Lad Satan'
Top d casing Eswiwred Ate below bad surface nnaymquie
a variance in aemdanceWM 15A NCAC 2C .0116.
e. YIELD (gpm): %5 MEDI0D OF TEST Q % C
f. DISRFECTIOttType %JeT// Amount G e)Z
9. WATER ZONES (depart):
From 0 To %s" From To
From To From To
From To Fran To
6. CASING:
Thickness/
Depth 4wrrelor Weight
Fran n To 5/3 Ft 1 corgi E�I�G
From To Ft
Fran To Ft
7. GROUT: Depth plate ial
Fran 0 To 20 Ft CC'Ynlofr
From To Ft
Fran To Ft
A SCREEN: Depth Diameter Slot Size Material
Fran To Ft in in.
F1mn To Ft Si. _ in.
Fran To Ft in in.
Method
A SAND/GRAVEL PACK:
Depth
From To FL
From To Ft
From To FL
10. DRILLING LOG
Flom To
V
Sze Maael
FormaVon Description
tt
MAR 0-8 2006
Asheville Regional OfftCe
11. REMARKS:
ote
0
I DO MOWCERIFYT a1111B WELL WAS Camiwiciwuu COROAICE WIm
15A CAC 2C. WS.L tbnS1RIx1 IN STAMIARDS. AND 1t WTA COPY OF 1116
RECORD HAS BEEN FROyo®1o1HE WELL owta
SIGNATURE OF CSTIFIE WELL CONTRACTOR DATE
PRINTED NAME OF PHtSON CONSTRUCTING THE WELL
Submit the original to the Division of Water Quality within 30 days. Attn: Infotn ation Mgt.,
1617 Mall Service Center - Raleigh, NC 27699-1617 Phone No. [phone] ext 566.
Form GW-la
Rev. 7/05

RESIDENTIAL WELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources- Division of Water Quality
WELL CONTRACTOR CERTIFICATION # 2045
1. WELL CONTRACTOR:
James B. Brown
Wet Contractor (Individual) Name
Redden Brothers Well Drilling, Inc.
Well Contractor Company Name STREET ADDRESS 73 Holly Hills Vista Rd
Franklin, NC 28734
City or Town State Zip Code
LiZ&J- 369-9591
Area code- Phone number
2. WEL_ INFORMATION:
Sr; `'VELL ID #(It applicable)
S A f WELL PERMIT#(aeppliceble)
'a or OTHER PERMIT #(if applicable)
WE LL USE (Chec Applicable Box): ,R,eesiidential Water Supply 0
L-LA DATE DRILLED / /
TIME COMPLETE 7 '1 AM ❑ PM 62
3. WELL LO T ON:
CITY: COU
TY
Name, Numbers, Community. Subdivision, Lot No., Parcel, Zip Code)
TC L °GRAPHIC I LAND SETTING:
❑:::;ca DVatley DFlat ❑Ridge °Other
(check spprdprlete boxx,),
LA'-ITUDE �� 700I �
LONr+ITUDE9 .EL �� W
Latitude/longitude source: QGPS DTopographic map
(bastion of well must be shown on a USGS topo map and
attached to this form snot using GPS)
4, WELL OWNER
May be in degrees,
minute", seconds or
in decimal formal
OWNER'S NAME
S'PF T ADDRES
' ,/ or Town State
y97 -i$35
Area code • Phone number
6. WELL DETAILS: r
a. TOTAL DEPTH: t 82 E J
10) - E6G
nCWe
CET
b. DOES WELL REPLACE EXISTING WELL? YES D N0
c. WATER LEVEL Below Top of Casing: a5 FT.
(Use •+•' 8 Above Top of Casing)
P OF CASING is 2 FT. Above Land Surface -
*Top of casing terminated atror below land surface may require
a variance in accordanceda/�with 15A NCAC 2C .0118.
e, fC?LD(gpm): 5L METHOD OF TEST Bltxw
6. CASING:
n, rl „B
4; t.0�:
I. DISINFECTION: Type H T H Amount 166z
g. WATER ZONES (depth): ,
From 2O5 To From To
From AD / r Toa_ From To
From To From To
Thickness/
From DepthTo Ft. Diarrrrpp��ete�'r Weight
From m To F1. y/58
From To Ft.
mitsrial
P vG
7. GROUT: Depth Material Method
From 0 To 20 Ft. 03tWL & termite puree
From To Ft
From To Ft.
8, SCREEN: Depth Diameter Slot Size Material
From To Ft. In. In.
From To Ft. In. _ In, _
From To Ft. In. In.
9. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
From To Ft.
10. DRILLING LOG
From To
0 �J Clay & sand
Formation Description
Irani tp
T
1
-J
11. REMARKS:
iQOEQ
� i
100 HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE win'
1 BA NCAC WELL CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS
REC.,•'• BEEN PROVIDED TONE WELL OWNER.
ATURE OF CERTI IED WELL CONTRACTOR DATE
James B. BLtuwn
PRINTED NAME OF PERSON coNs a T1iivE D
Submit the original to the Division of Water Quality within 30 days. Attn: Information Mgt.,
1617 Mall Service Center— Raleigh, NC 27699.1617 Phone No. [phone] eat 568.
FormorcGWle
MAR 08 2,7/05
Asheville Regional Office
Aquifer Protection

RESIDENTIAL WELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources- Division of Water Quality
WELL CONTRACTOR CERTIFICATION # 2045
1. WELL CONTRACTOR:
James B. Brown
Weil Contractor (Individual) Name
Hedden Brothers Well Drilling, Inc.
W > Contractor Company Name
ST':ETADDRESS 73 Holly Hills Vista Rd
cvanklin, NC 28734
City or Town Slate Zip Code
L.1128 )- 369-9591
Arlo' :ode- Phone number
2. WELt. INFORMATION:
SITE. WELL ID Cif applicable)
STATE WELL PERMIT#(ir applicable)
DWG or OTHER PERMIT #(if applicable)
WELL. USE (Check Applicable Box): gqResidential Water Supply 0
O ' "1RILLED , ' /7�te' lM.0
If 1 COMPLETE 11 r O(7 AM 2/ PM ❑
3.'?JELL LOC
Crr
Name�Community, Subdivision, Lot No., Parcel, Zlp Code)
TOPOGRAPHIC / LAND SETTING:
❑Slope [Valley ❑Flat ❑Ridge [Other
(check sparcprlate box)
L`TIDE 15
L
'. CI`UDE
May be in degrees,
minutes, seconds or
in a decimal format
L...ti k de/longitude source: p'OPS [Topographic map
>cation of wag must be shown on a USGS topo map and
attached to this form not using GPS)
4. WE: L OW NER
OWNER'S NAME
ST-, ET ADDRESS
City or i own E�ate ip Code
Area code - Phone number
5. W 1 . DETAILS: O�s
a. ; 11AL DEPTH: D
b. )OES WELL REPLACE EXISTING WELL? Y S 0 NOK
c. WATER LEVEL Below Top of Casing: FT,
(Use le' N Above Top of Casing)
d. TOP OF CASINO is 2 FT. Above Land Surfaces
'Top of casing terminated at/or below land surface may require
a variance in accord ce with 15A NCAC 2C .0118.
e. YIELD (gpm): METHOD OF TEST Blow
1. DISINFECTION: Type H T H Amount 166z
g. WATER ZONES (depth):
From To From To
From To From To
From To From To
6. CASING: ��/�(((( ���� Thickness/
From O DepthToFt. Di�'ter Weight Me(prW�
From To Ft. &'" , / J (t
From To Ft.
7. GROUT: Depth Material . Method
From—Q___ To_jIZ Ft. carer t & tanzite nitcei
From To Ft
From To Ft.
6. SCREEN: Depth Diameter Slot Size Material
From To Ft. in In.
From To Ft. In. In.
From To Ft. In. In,
9. SAND/GRAVEL PACK:
Depth
From To Ft.
From To Ft.
From To Ft.
Size Material
10. DRILLING LOG
From To
11. REMARKS:
Formation Description
Clay & sand
Granite
100 HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE w❑ i
ISA NCAC 2C, WELL CONSTRUCTION STANDARDS. AND THAT COPY OF THIS
RECORtLHAS BEEN PROVIDED TO THE WELL OWNER.
NATORE 0F CERTIFIED WELL CONTRACTOR �a DATE
James B. Brown
PRINTED NAME OF PERSON CONSTRLIrTING THE WELL
Hut' .,>. the original to the Division of Water Duality within 30 days. Attn: Information Mgt? E C E I V Ef-oDrm Gw-la
161 T ?Iail Servleo Center— Raleigh, NC 27699.1617 Phone No. [phone] ext 568. Rev. 7/05
MAR 08 2006
Asheville Regional Office
Aquifer Protection

RESIDENTIAL WELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources- Division of Water Quality
WELL CONTRACTOR CERTIFICATION # 2045
1. WELL CONTRACTOR:
James B, Brown
Well Contractor (Individual) Name
Sadden Brothers Well Drilling, Inc.
W ell Contractor Company Name
STREET ADDRESS 73 Holly Hills Vista Rd
Franklin, NC 28734
City or Town State Zip Code
( 828 1- 369-9591
Area code- Phone number
2. W`.I.L INFORMATION:
$ r ."JELL ID #(If applicable)
S .'P.TE WELL PERMIT#IB applicable)
DIA1C, or OTHER PERMIT #(d applicable)
WELL USE (Check pplicableeBox)M: Residential Water Supply V
DA' i DRILLED ///v�+Y-�
TIME COMPLETED /'�I'J AM PM pY
3. WELL LOC
CITY;
COUNTY__
(&net Name, N bars, Community, Subdivision, Lot No., Parcel, 21p Cods)
Tt TnRAPH1 RAND SETTING:
❑ °Valley ❑Flat ❑Ridge °Other
(check apprdprlals box) t
ATITUDE 5q1 died
LCNGITUDEZ3 4,5 b50
Latitude/longitude source: 036PS °Topographic map
(location of well must be shown on a USGS topo map and
attached to this form N not using GPS)
4, WEL. OWNER
OtYNER'S NAME ,O.b,dS4'e>ys t,^w
• t +'T DDRES - -3
c;ty or - yorT2 N� �8 od/
Te
own 'Stale ,etc epee
Area code - Phone number
5. WEL'. DETAILS: 0nr
a. TOTAL DEPTH:
May be in degrees,
minute!, seconds or
in a decimal format
b. DOES WELL REPLACE EXISTING WELL? YES 0 NO,
e. WATER LEVEL Below Top of Casing: MY) FT.
(Use'*' S Above Top of Casing)
d. TOP OF CASINO 18 2 FT. Above Land Surface
'Top of casing terminated et/or below land surface may require
a variance in accordance with ISA NCAC 2C .0118.
c 5 e. Y'ELD (gpm): Da METHOD OF TEST Blocs
I. DISINFECTION: Type H T H
Amount 168z
g. WATER ZONES (de/pth,):✓�
From
1rTo J(O `7 From To
/ From z' To 45 * From To
From To From To
6. CASING: Thickness/
h Depth Di meter Weight
From ( .1 To Ft. Cc " —�
From .5;1'To y Ft. 6." .,'/89
From To Ft.
Material
✓C
7. GROUT: Depth Material Method
From 0 To 20 FL Ct"nt & tafl)lte ,PADEd
From To Ft.
From To Ft.
8. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. In.
From To Ft, In. In.
From To Ft. In. In.
9. SAND/GRAVEL PACK:
Depth Size
From To Ft.
From To Ft.
From To Ft.
Material
10. DRILLING LOG
From To tr'Q Formation Description
0 eJ✓' Clay & sand
.5:S' 4OZ>' Granite
—t
Ui
I1. RE ARKS:
K[fitr_)_ad9
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH
1SA NCAC 2C, WELL CONSTRUCTION STANDARDS. AND THAT A COPY OF THIS
RECD3D-yAS BEEN PROVIDED TO THE WELL OWNER.
NATURE OF I ERTIFIED WELL CONTRACTOR DATE
James B. Brown
PRINTED NAME OF PERSON CONSTRUCTING THE WELL
Submit the original to the Division of Water Quality within 30 days. Attn: InformatioRee E I V E D
1617 Mali Service Center —Raleigh, NC 27699.1617 Phone No. [phone] ext 568.
MAR 08 2006
Form G1
Rev. 7/0
-1a
Asheville Regional Office
Anu fer Protection

RESIDENTIAL WELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources- Division of Water Quality
WELL CONTRACTOR CERTIFICATION #
1. WLL CONTRACTOR:
James B. Brown
Well Contractor (Individual) Name
Hedden_Brothers Well Drilling, Inc.
Wei Contractor Company Name
STREET ADDRESS 73 Holly Hills Vista Rd
Franklin, NC 28734
City or Town State Zip Code
( a28 )- 369-9591
Area code- Phone number
2. WELL INFORMATION:
$l T'< WELL ID Of applicable)
, i "SE WELL PERMIT0(i1 applicable)
DWQ or OTHER PERMIT R(I( applicable)
WELL USE (Check Applicable Box): Residential Water Supply CBS
DATE DRILLED (Tc' LO 0 O
TIME COMPLETED .'y elf l AM ID PMV
3. WE'.L LOCATION:
C- ,.
COUNTY_
l
(Etrvet Name, Num®ra, Community, SubdiMaton, Lot No., Parcel, Zip Code)
TC"OGRAPHIC / LAND SETTING:
❑Slope 0Valley ❑Flat ❑Ridge DOther
(check appr6prlate box)
LA11 -UDE p,14 j fl Lion)
LONGITUDE ]a� Tlw
Latitude/longitude source: ❑GPS Topographic map
(location of wed must be shown on a USGS tcpo map and
attached to this term M not using GAS)
4. WELL OWNER
May be in degrees,
minutes, seconds or
in a decimal format
O' i "'R'S NAME
S i TADDR SS
�Qin
ly tit.own
•
State
1)
Area code • P one number
5. WELL DETAILS: a. TOTAL DEPTH: 600 ,
Zfp Code
b, DOES WELL REPLACE EXISTING WELL? YES 0 NO»
e. l 4TER LEVEL Below Top or Casing: 3ED FT.
(Use "4" If Above Top of Casing)
d, TOP OF CASING IS 2 FT. Above Lend Surface*
'Top of casing terminated at/or below land surface may require
a variance In accordance with 15A NCAC 2C .0118.
e. YIELD (gpm):
METHOD OF TEST Blew
2045
1, DISINFECTION:Type H T H Amount 166z
g, WATER ZONES (dee�p: ,
,�)p7th
From �� to O From To
FromTo'1 From To
From To � From To
6. CASING: Thickness/
" Depth Diameter W - • M aria
From l) To �, Ft. Ma _
From To Ft.
From To Ft.
7. GROUT: Depth Material . Method
From 0 To 20 Ft. OHjait & baalite =Pad
From To Ft
From To Ft.
8. SCREEN: Depth Diameter Slot Size Material
From To FI. In. In.
From To Ft. In. In.
From To Ft. In. In.
9. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
From To Ft.
10. DRILLING LOG
From To
0
Formation Description
Clay & sand
Granite
1
L.J
11.REMARKS:
F6C,I I,uQ DI
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH
15A NCAC 2C, WELL CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS
RECO' ._. AS BEEN PROVIDED TO THE WELL OWNER.
ATURE 0 C RTIFIED WELL CONTRACTOR DATE
James B. Brown
PRINTED NAME OF PERCnx' rpygTb,,L•T"
Submit the original to the Division of Water Quality within 30 days. Attn: Information .RECEIVED C E 1 V E D
9 Y Y Form GW1
1617 Mall Service Center —Raleigh, NC 27699.1617 Phone No. (919) 773-70t5 eat 568.
MAR 0 8 2006 Rev. 7/05
Asheville Regional Office
Aquifer Protection

4. W,..L.:)WNER
CWHER'S NAME
RESIDENTIAL WELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources- Division of Water Quality
WELL CONTRACTOR CERTIFICATION # 2045
1. WFU, CONTRACTOR:
James B. Brown
Well Contractor (Individual) Name
[-redden Brothers Well Drilling, Inc.
Weil Contractor Company Name
STREET ADDRESS 73 Holly Hills Vista Rd
Franklin, NC 78734
City or Town State Zip Code
La48 )- 369-9591
Ars% cede- Phone number
2. WEI..L INFORMATION:
Stir, WELL ID #(II applicable)
STATE WELL FERMI -NM applicable)
D W L) or OTHER PERMIT Cif applicable)
WELL. USE (Check Applicable Box): Residential Water Suppty ❑
DATE DRILLED J - 3!q' O6o
TIME COMPLETED /a . oO AM O PM 63'
3. WELL LOC
CITY:
COUNTY ail/Lit
(i•net Name, Numbers, Community, Subdivision, Lot o., Parcel, Zlp Code)
TOPOGRAPHIC / LAND SETTING:
❑Slope OValley ❑Flat ❑Ridge ❑Other
(check epprdpriele box)
LATITUDE _
LONGITUDE
Latitude/longitude source: ❑GPS OTopographic map
(location of well must be shown on a USGS topo map and
tacked to this tom, of using GPS)
teritotai
STFAEIADDRESS . Q�t7,l' ZO
A tl �1IZ
(, ivC-- aS'719
City or Town State Zip Code
May be in degrees,
minutes, seconds or
in a decimal format
Area code • Phase number
6. WELL DETAILS:
a. TOTAL DEPTH:
gee
b. DOES WELL REPLACE EXISTING WELL? YES,, NO ❑
e. 1 v .TER LEVEL Below Top of Casing: FT.
(Uses.' 6 Above Top of Casing)
a. 1 OF OF CASINO IS 2 FT. Above Land Surface'
'Top of casing terminated aVor below land surface may require
a variance In accordance wllh 15A NCAC 2C .0118.
e. YIELD (gpm): � METHOD OF TEST Blow
6. CASING:
1. DISINFECTION: Type H T H
oP
CInnr) ra
s
Amount 166z
g. WATER ZONES (depth):
From To From To
From To From To
From To From To
Thickness/
Depth Diameter Weight Material
From _ To Ft44_ r v
FromTo Ft. in,r 78-6D
From To Ft.
7. GROUT: Depth Material . Method
From 0 To 20 Ft. oanEnt & t7ErYllite =Tel
From To Ft.
From To Ft.
8. SCREEN: Depth Diameter Slot Size Material
From To Ft. In. In.
From To Ft. in. In.
From To Ft. In. In.
9. SAND/GRAVEL PACK:
Depth
From To Ft.
From To Ft.
From To Ft.
10. DRILLING LOG
Size Material
Formation Description
Clay & sand
Grani to
-m
11. ReDMARIACS) /thy „,&
CO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH
15A NCAC 2C. WELL CONSTRUCTION STANDARDS. AND THAT COPY OF THIS
RECORD HAS BEEN PROVIDED TO THE WELL OWNER.
SI ATURE CE�TfFIED WELL
OFNTRACTOR� DATE
James B. Brown
PRINTED NAME OF PER
fIEE
Submit the original to the Division of Water Quality within 30 days. Attn: Information Mgt , C E I V E D
1617 Mall Seri/lee Center —Ralei h, NC 27699.1617 Phone No. [phone] ext 568. Roan /05
g ( ) MAR 0 8 2006 Rev. 7/06
Asheville Regional Office
Aquifer Protection

RESIDENTIAL WELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources- Division of Water Quality
WELL CONTRACTOR CERTIFICATION # 2045
1. WELL CONTRACTOR:
James B. Brown
Well Contractor (Individual) Name
Hedden Brothers Well Drilling, Inc.
Well Contractor Company Name
STREET ADDRESS 73 Holly Hills Vista Rd
Franklin, NC 28734
City or Town State Zip Code
( 828 )- 369-9591
Area code- Phone number
2. WELL INFORMATION:
SITE WELL ID #(if applicable)
STATE WELL PERMIT#(Il applicable)
DWQ or OTHER PERMIT #(If applicable)
WELL USE (Check Applicable Box): Residential Water Supply 0
DATE DRILLED,
TIME COMPLETED AMP PMp'
3. WELL LOC I•N:
CITY:
COUNTY&LULst ,
(Street Hai , Num ers, Community, SubdMslon, Lot No., Parcel,. Code)
TOPOGRAPHIC / LAND SETTING:
❑Slope (Valley ❑Flat ❑Ridge °Other
(check appr5�pnate box)
LATITUDE 14,
LONGITUDE a as
Latitude/longitude source: rgt PS ❑Topographic map
(localon of wet 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
ST E ADDR SS '0
ny or Town / StateC ( gig)- 411•S15/
Area code • Phone number
ipCode
ip Code
5. WELL DETAILS: A /Fl� ,
a. TOTAL DEPTH: �(�J
b. DOES WELL REPLACE EXISTING WELL? MO
0 NO 0
e. WATER LEVEL Below Top of Casing: MO FT.
(Use •+' fl Above Top of Casing)
d. TOP OF CASING IS 2 FT. Above Lend Surface'
'Top of casing terminated ai/ar below land surface may require
a variance in accordance�with 15A NCAC 2C .0118.
e. YIELD (gpm): Or L/ METHOD OF TEST B1OW
f. DISINFECTION: Type H T H Amount 166z
g. WATER ZONES (depth):
From0 To==Y• From To
Fram To From To
From To From To
6. CASING: Thickness/
A Depth Dia(�meter Weight Material
From d To /AG Ft. • J �' ,/fi'8 Sim°
From To Ft.
From To Ft.
7. GROUT: Depth Material Method
Frorn 0 To 20 Ft. Gwent & Ratite RIWPed
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
karth
Formation Description
Clay & sand
Grani to
RECEIVED__
MAR 7 21111h
ITO
Gl
Ashevlile i-t gional Office
Aquifor-Protect
1. REMARKS:
I00 HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH
15A NCAC 20. WELL CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS
RECORp.HAS BEEN PROVIDED TO THE WELL OWNER.
IFIED WELL CONTRACTOR DATE
James B. Brown
PRINTED NAME OF PERSON CONSTRUCTING THE WELL
Submit the original to the Division of Water Quality within 30 days. Attn: Information Mgt:,
1617 Mall Service Center— Raleigh, NC 27699-1617 Phone No. [phone] ext 568.
Form GW-la
Rev. 7/05

QSD
RESIDENTIAL WELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources- DivisionGof Water Quality
WELL CONTRACTOR CERTIFICATION X 3 3O b
1. W ONTRACTOR:
Utk'S4-,-r+ thttL5,,e5
W(I.-CQntr or (iaividual) Name
\_/r Uri R! r„N L.JO`, f i I1:n%
Wel CaWactor Company Name I
STREET ADDRESS 6341 I / `1',le raAr, en4
0\tt}nbrm rill, LVC- OCi77/
City or Tam Stale Zip Coda
( /Wit- Li79 e'JSV
Area code- Phone number
2. WELL WORMATIOIt
SITE WELL ID ireeppim6ie)
STATE WELL PERMITfiraPticatat
DWQ or OTHER PERMIT gif appaeable)
WELL USE (Check AplplcdMeBorg Residual Sup
ply
pply
DATE DRILLED C/\ 2 7 -
-raw coMPLETED (-/ ;W AM ❑ PM*
3. WELL LOCATIOtt /�
CITY: $Orrsn.� l i 1-y cou ry
�i bsan 2n61c(
(Street Name. Humbert Camaery lm iyasio . LetNo„ Pater. Zip Coda)
TOPOGRAPHIC 1 LAND SETTING:
OSttje °Valley OFIa IXRidge Oahe
(check spaoptelbap
LATITUDE r° aa1 36%err'
LONGIT1DESZe 6Z '3#!Y'
Tatituddlongitude sauce: KOPS OTopogaphic map
(location al we! be shown on a USGS tape neap and
attached lc %* lam Knot uailg GPS)
4. WELL OWNER
OWNERS NAME Tir ni-
Brkbor, C ;;a y WC_ g*7/3
(4�-6")-736- l fit
Area code - Phone number
May be in degrees,
mimeo, seconds or
sbnYana in a di ra
STREET ADDRESS 7 t ; t; I l"(et,
C' or
Town State Zip Cale
5. WILL DETAILS:
a. TOTAL DEPTIt 7n S
b. DOES WELL REPLACE EXISTING WELL? YES CI ROA
c. WATER LEVEL Below Toper Casty O FT.
(Use+- IAbove Top d Casing)
d. TOP OF CASING r �— FT. Above Laid Sauce-
. Top of casing lownwated SMr hdrw lard sfle may esquire
a variance in acconlance with 15A NCAC 2C .0118.
e YIELD (gpna): 0 rETHOD OF TEST C.A r
f. DISItFECT1olt Type kl rN Amount
g. WATER ZONES (depth):
Fran 1) To Co From
Fran To From
Fran To Fran
6. CAS(NG:
Fran 0 To Depth
Fran To
Fran To
Diameter
Ft6/y
Ft
Ft
To
To
To
QJLISP_V
7. GROUT: Depth Material Ault 0 To avte o Ft [ey- Ault n
From To Ft
Fran To Ft
I. SCREENt
From
Froze
From
Depth
To
To
To
Dianeter Sbt Size Material
Ft in. in.
Ft in. _ in.
Ft in. in.
9. SAICIGRAVEL PACK
Depth Snte Malarial
From To Ft
Fran To Ft
Fran To Ft.
.. iris- - --.
10. DRILING LOG
Fran To Formation Desu4tion
RECEIVED
MAR 2 7 2006
pchevilla Rnoioruil Office
Aquifer rroteetio
11.
I t>
w
v
Hyde() frac+tired
mO iB1EBY CE RwYTNATIMSWE LWASCQGIM CIW mACCOMMICE Wire
ISA CAC 2C. WELL Lbi$7RIICI1011 STANDARDS, AMI1I411TA COPY abbe
RECORD HAS BEEN PRwo® TO 11E WELL ovriER.
yrEid t 1 i4CRAcr 3 7-06
WELL OR DATE
MGM OF CERTIFIED
` S I (NSTAIIC 01G MIMED NAME OF PERSON CO THE WELL
Submit the original to the Division of Water Quality within 30 days. Attn: blformation Mgt,
1617 Mail Service Center— Raleigh, NC 27699-1617 Phone No. [phone] ext 568.
Form GW-le
Rev. 7/05

RESIDENTIAL WELL CONSTRUCTION RECORD A
North Carolina Department of Environment and Natural Resources- Division of Water Quality
WELL CONTRACTOR CERTIFICATION # J �)
1. WELL CONTRACTOR:
t.
W Contractor ( Ind" ual) Name
otra/icvyr2 tJi '7% Aril/L*1
Well Contractor Canpa.y Name ,4 9/',4 STREET Oil ADDRESS L/ p &/n I?1
Rabb+ n€ vrr//6, A/G
City or Taus Stale
to _)-1179- 5`4/5-q
Area code- Phone camber
2. WELL INFORMATION:
SITE WELL ID rho applicable)
STATE WELL PERMR/1dnot cads)
DWQ or OTHER PERMIT Nit applicable)
WELL USE (Check Applicable Bac): Residential Water Supply $
DATE DRILLED n - O 3 - e (<
TIME COMPLETED ' co AM o PM cc
talf
Zip Code
3. WELL LOCATION:
CITY: 13riSon C,'r cour e Sid
rn-IA net Trot P *-7/3
(Street Name. Numbers. Carmmmily. SubditesSi. LatNo.. Parcel Zip -Code) -
TOPOGRAPHIC / LAND SETTING:
❑Slope OVeley ❑Fht ®Ridge ['Other
(check appropriate bo
LATITUDE 3s .,�" % Z` /39 3a
LONGITUDE $} S rt S' 7/1
Latitude/longitude source: @CPS °Topographic map
(location of wet roust be shown on a USGS kipo map and
attached to this (omit not using GPS)
4.WELLOWNER � // ,J
OWNER'S NAME T%YJt/1E1-14/7 a /og //'erne
STREETrADDRESS It -DO %n nG -fiat tc
?
A) / or T/ C. 'Ty ownStale Z , C 3
CArea code - Phone number
May be m degrees,
minutes, seconds or
in a decimal format
5. WELL DETAILS: U /
a. TOTAL DEPTH: / 6-O
b. DOES WELL REPLACE EXISTING WELL? YES 0 NOD
c. WATER LEVEL Below Top of Casing a( Lf�/o FT.
(Use'*- if Above Top d Casing)
d. TOP OF CASING IS / FT. Above Land Surface'
'Top of casing terminated aUor Warr land surface may require
a variance in accordance with ISA NCAC 2C .0118.
e. YIELD (gpm): 3 METHOD OF TEST
T. DISINFECTION: Type /7 %/7 Amount g !f?
g. WATER ZONES (depth):
Fran :7./n To 1/65- From To
From To From To
Fran To From To
6. CASING: Thickness/
Fran (-3To.5D
Depth
7 Ft i peter fi 1 Weight
jD ye,
From To Ft.
Fran To FL
7. GROUT: Depth Material
Method
Frain_/ Too^[,'L FLe-ear 'nY Esarts249
From To Ft.
Fran To Ft.
8. SCREEN:
From
Posh To Ft in. n.
Fran To FL in. in.
Depth Diameter Slot Sire Material
To Ft in. in.
9. SAND/GRAVEL PACK:
Depth Size Material
Fran To Ft.
From To Ft.
From To FL
10. DRIWNG LOG
From To Formation Description
RECEIVED --
MAR 27 2011fi
ICT/ Ilk Regional Office
CD
nt ii err Protectinn
11. REMARKS:
I CO HERESY CEmFY THAT EIS WELL WAS CONSNNCIED N ACCORDANCE WITH
15A NCAC 2C. WELL CONSIRLICDON STANDARDS. AND THAT A COPY OF INS
RECORD HAS SEEN PROVIDED TO THE WR ELL OWNE
ekt
ie
SIGN
AFCERTIFIED WELL CONTRACTOR DATE
PRINTED NAME OF PERSON CONSTRUCTING THE WELL
Submit the original to the Division of Water Quality within 30 days. Attn: Information Mgt.,
1617 Mail Service Center- Raleigh, NC 27699-1617 Phone No. [phone] ext 568.
Form GW-la
Rev. 7105

RESIDENTIAL WELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources -
Division of Water Quality
WELL CONTRACTOR CERTIFICATION # d W o
1. WELL CONTRACTOR:
Well Cane (Indrviduan Name
r
�r roJ1an) 1.Je// AP //,n,Q
Well Contractor Company Name
STREET ADDRESS (L 3 Y /-y.IP To tin R ck
R0LI,nsvi'//e Nc 2S77/
City or Tam State Zip Code
( ir2k )- LJ7Q— R'y,S''-t
Area code- Phone number
2. WELL INFORMATION:
SITE WELL ID #(d appricahie)
STATE WELL PERMIT/ftappacaUe)
DWQ or OTHER PERMIT #(8 applicable)
WELL USE (Check Applrcaable Box): Residential Water Supply g
DATE DRILLED a — t'1 O —el
TIME COMPLETED /0 , 30 AM ga PM ❑
3. WELL LOCATION:
CITY: &3PV.Snn C, cowry coTY .S (.Ja tin
an7a/n-Tine p 7)3
fia (Skeet Name.Nums. Ca muhaySubdivisian. LDLN4. parcel, Zip)-
TOPOGRAPHIC / LAND SETTING:
❑Slope ovaley DFlal ®Ridge ❑Other
(check epprwdatebox)
LATITUDE 3 ie fl'.Jr
7 9"
LONGITUDE IL i.-o ;RA- 7"
Latitude/longitude source: MOPS °Topogaphic map
(bcaBDn ofwet must be shown on a USGS bpo map and
attached b this farm snot ush g GPS)
4. WELL OWNER �+
OWNER'S NAME (r(�Frr)N G-r'o SS
STREET ADDRESS 3;rt ya»a 7 !wr' F+
ry.Son C.'t-y A/r. ,QE(7/3
City or Tarn State Zp Code
(4107 )- R-76— 4/969,
Area code - Phone number
May be in degrees.
minutes, seconds or
in a decimal format
5. WELL DETAILS: (� /
a. TOTAL DEPTH: 7oLT
b. DOES WELL REPLACE EXISTING WELL? YES ❑ NO II
c. WATER LEVEL Below Top of Casing: 6270 FT.
(Use -+' if Above Top of Casing)
d. TOP OF CASING IS / . FT. Above Land Surface'
'Tap of casing taninaled at/a below land surface may require
a variance in accada ce with 15A NCAC 2C .0118.
e- YIELD (gpm): / y METHOD OF TEST i / r
f. DISINFECTION: Type /Z T`7 Amountst2a i0 OZ.
g. WATER ZONES (depth):
From500 To qo _ From
To From
To From
From
From
To
To
To
6. CASING: Thickness/
Depth Diameter weigh erial
From (j To nQ FL 6$ .Cnr2I 1/c
From To Ft
From To Ft
7. GROUT: Depth Material Method
From C) To ao FLCPmNnt Anipagg
From To Ft.
From To Ft.
8. SCREEN: Depth Diameter Slot Size Material
From To FL at. n.
From To FL in. it.
Fran To Ft. in. in.
9. SAND/GRAVEL PACK:
Depth Size
From To Ft.
From To Ft
From To Ft
10. DRI W NG LOG
From To
Material
Formation Description
iVED
MAR 27 2006
Asheville Regionai Office
- AcuifeProtection
(J
11. REMARKS:
1 DO HEREBY CERTIFY THAT TWS WELL WAS CONSTRUCTED N ACCORDANCE WITH
15A !CAC 2C. WELL CONSTRUCTOR STANDARDS. AND THAT A COPY OF THIS
RECORD HAS SEEN PROIDED TO THE WELL OWNER.
SIGNATURE OF CE/TIFIED WELL CONTRACTOR DATE
PR EME OFF"D NAME CONSTRUCTING THE WELL
Submit the original to the Division of Water Quality within 30 days. Attn: Information Mgt.,
1617 Mail Service Center —Raleigh, NC 27699-1617 Phone No. [phone] eat 568.
Form GW-la
Rev. 7/05

RESIDENTIAL WELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources- Division of Water Quality
WELL CONTRACTOR CERTIFICAT ON #
1. WELL CONTRACTOR:
Well Gonic (Ir rZal) Name
G-re GYr) Lie//
Well Contractor Company Name
STREET ADDRESS 6347`
R4)13a1151/i%1N Mc
City or Town State
(pkg. )- 479- £3YS4
Area code- Phone numbs
C:I r r //i' b9
de %tA/n &a
aS77I
zip Code
2. WELL INFORMATION:
SITE W ELL ID i/(a applicable)
STATE WELL PERMRX((applicable)
DWQ or OTHER PERMIT tql applicable)
WELL USE (Check( Applicable Bac): ResidentIN lip
ai Water Supp
p( DATE DRILLED -1 - G 6
TIME COMPLETED ,1 , e o AM p PM la
3. WELL LOCATION:
CITY: X3YySOn C,'Ty COUNTY sS wCAI'n
cS% rove aFr7/3
(Street Numbers. CanmundaubcidtIon, LatNo., Parcel, Zip -Code -
TOPOGRAPHIC / LAND SETTING:
❑Slope °Valley ❑Flat ®Ridge °Other
(check appropriatee box) r�
LATITUDE 3 S o! 471
rol3, (o YY
LONGITUDE .1° tip'/6. G "
Latitude/longitude source: g(GPS °Topographic map
(location of we/ must be shown on a USGS topo map and
attached to this Arm Prot usig GPS)
4. WELL OWNER �1 c+
OWR' NESNAME G one �] %/;ck/anet
STREET ADDRESS S K y cove
sort c/'Ty n/c aSt7/
Town' 3'
C- or ToState Zip Code
cRasrr /— y9.33
Area code - ROODS number
May be in degrees,
minutes, seconds or
in a decimal hut
5. WELL DETAILS: C+�
a. TOTAL DEPTH: O 6:6
b. DOES WELL. REPLACE EXISTING WELL? YES❑ NO
c. WATER LEVEL Below Tcp o( Casing: 7n Q FT.
(Use'+• 8 Above Top of Casing)
d. TOP OF CASING IS / FT. Above Land Surface•
*Top d casing terminated aUor below Sid surface may requke
a variance in accordance with 15A NCAC 2C .0118.
e. YIELD (gpm): / METHOD OF TEST a 1'r
1. DISINFECTION: Type /i/7-/>/ Amount C1 Z.
g. WATER ZONES (depth):
From el'OP To 8S5 _ From To
From To From To
Fran To From To
6. CASING: Thickness/
Depth Diameter Weigh f�ttatedal
Fran [1 To 30 Ftre- 'inert NVc
From To FL
Fran To Ft
7. GROUT: Depth
Material
Frain Cl To rip Ft. (come fir
From To FL
From To FL
p , �Methoodd
rg O +Ir
8. SCREEN: Depth Diameter Slot Size Material
From To Ft in. h.
Fran To Ft. in. in.
From To Ft. in. in.
9. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
Fran To Ft.
From To FL
1W-
10. DRIWNG LOG
From To Formation Description
RECtiVEU
MAR 2 7 2005
3
W
AshevillA RPainnal nffine
--AguiferProtection
11. REMARKS:
1 DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED N ACCORDANCE WITH
15A NCAC 2C, WELL CONSTRUCTION STANDARDS. ANDTHAT A COPY OF THIS
RECORD HAS BEEN P/R NI`VVEEDDTTO THE WELL OWNER
SIGNATURE� CER/TIFlED WELL CONTRACTOR ` DATE
PRINTED NAMEOF PERSON CONSTRUCTING THE WELL
Submit the original to the Division of Water Quality within 30 days. Attn: Information Mgt,
1617 Mail Service Center— Raleigh, NC 27699-1617 Phone No. [phone] ext 568.
Fonn GW-la
Rev. 7/05

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SKIS
RECEIVED
Asheville Regional o,fice
Aoulfar Protection

R; .) _
t) 0 _fa
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vaciantecosaangicanont
LIPILLUNIMACialt
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se omisrgeeielprn
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AarAter Protection

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Aouifer Protection

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2 4 4 It
RESIDENTIAL WELL CONSTRUCTION RECORD
Nosh Carolina Department of Environment and Natural Resources- Division of Water Quality
WELL CONTRACTOR CERTIFICATION 11 3�b
1. WELL CQNTRACTOR:
aura 3
Contractor (Individual)
wee Conu
1..4�1 rif\kJ�_
Well Contractor Company Name a Y— �1I
STREET ADDRESS ('A } 2LI Fe7de / CX.4.'n Z.K.A.r
(ZnbhietviIto i'/`C, ae77)
City or Town State Zip Code
(tin- qt`t-<+lXL(
Area code- Phone numbs
2. WELL INFORMATION:
SITE WELL IDf applicable)
STATE WELL PERMIT#(f applicable)
DWQ or OTHER PERMIT cif eppecable)
WELL USE (Check Applicable Bag: Residential Water Supply
DATE DRILLED —r 41'-DEi
TIME COMPLETED 230 Au El PM14
3. WELL LOCATION:
CITY: 4 ry so:\-y
(l n �}
•Ty'��/ rc 'k'r
(Street Name. 'NIDrdMer . Camnuoity.Subdirision. LetNo.. Parcel. rip Code>
TOPOGRAPHIC 1 LAND SETTING:
❑Slope °Vaeey ❑Flat Midge ['Other
(check appropriate bo
LATITUDE Sig r9fj(,a1 d1(
LONGfTUDESSr r 1 ( D. (•Q `r
Latitude/longitude source: *PS °Topographic map
(bca1bn of wellmost be slaws on a USGS topo map and
attached to this ferns I not using GPS)
COUNTY 6 \ C.al n
May be in degrees,
minute; seconds a
in a decimal forme
4. WELL OWNER i 1
OWNER'S NAME / C.4tr'V IJIJ Q(11C CAlti
STREET ADDRESS d- rl/-.5 i P ( c4-19 I�
fy60rC iJ y IVC 9S 7 ( 3
Cify or Town State Zip Code
( )-`Iffy- LI;i7
Area code - Phone number
5. WELL DETAILS:
a. TOTAL DEPTH: 7 OS
b. DOES WELL REPLACE EXISTING WELL? YES NOR
c. WATER LEVEL Below Top of Casing: tc0 r FT.
(Use')." if Above Top of Casing)
d. TOP OF CASING IS % - FT. Above Land Surface*
'Top of casing terminated attar below land surface may require
a variance in accordance with 1SA NCAC 2C .0118.
e. YIELD (gpm): /'Z- METHOD OF TEST C.r i r
f. DISINFECTION: Type %( t1{ Amount 9 717
g. WATER ZONES (depth):
Fran SPS To )n5
Fran To
Fran To
From To
From To
From To
6. CASING: Thickness/
Depth 4. Diameter Weight Material
Fran_CL_To 61 Ft 6.)n/t4 $c2aI Pv-C
Fran To Ft.
From To Ft
7. GROUT: Depth Material
Frorn D To fu Ft. elRmen)-
Fran To Ft.
Fran To FL
Method
8. SCREEN: Depth Diameter Slot Size Material
From To Ft in. in.
From To Ft in. _ in.
From To FL in. in.
9. SANDIGRAVEL PACK:
Depth Size Maleriat
Fran To Ft.
From To FL
From To Ft.
10. DRILLING LOG
From To
Formation Description
0
r: cicnrcl'o'I
11. REMARKS:
100 HEREBY CERTFY THAT MIS WELL WAS CO/STRUCIED N ACCORDANCE WITH
ISA NCAC 2C. WELL CONSTRUCTOR STANDARDS. AND TINT A COPY OF THIS
RECORD HAS BEEN PROVIDED TO THE WELL OWNER
SIGNATURE OF CERTIFIED WELL CONTRACTOR DATE
�1 r` r f �,1 kcci,
PRINTED OFSON 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. 7105

RESIDENTIAL WELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources- Division of Water Quality
WELL CONTRACTOR CERTIFICATION #
4 8 4 6
1. WELL AggNTRACTOR:
G-4-1 (r \k k\cr f C
Well C%tractor (Individual) Name 0
Well Contractor Company Name ?Jr_�
STREET ADDRESS _6%74 N•4TL -jc s`6.QJ
(2CiObiradil`P '< ( 9, -77`I
/� City or Torun State Zip Cade
( Ca6—)- Lin t4,s-t/
Area code- Phone numbs
2. WELL INFORMATION:
SITE WED_ ID kit applicable)
STATE WELL PERMITF(aapplicable)
DWQ or OTHER PERMIT S(8 applicable)
WELL USE (Check Applicable Box): Residential Wafer Supply 154
DATE DRILLED --/cA4-O E+
TIME COMPLETED JC 'L7u AM❑ sink
3. WELL LOCATION:
CITY: goy CP C-117 COUNTY1 �GLI'{i
(Street Name. Numbers.
CLPP Subdiasioa la.. Parcel. Zip .Code)
-
TOPOGRAPHIC / *at
SETTING:
❑Slope ()Valley *at ❑Ridge ❑Other
(check appropriate box) t�
LATITUDE acne / .26.e (t/
LONGITUDE S a g Li / I0- la
Latitude/longitude source: OOPS ()Topographic map
(location o(welmust be shown on a USGS tcpo map and
attached to this form Ind using GPS)
4. WELL OWNER QQQQ f(
OWNER'S NAME 1lI "hip
tire.
STREET ADDRESS PE l I (p etre'.
May be in degrees,
minurq seconds or
in a decimal format
et—\ o,c,ijy (VC$-7i3
City Or TownState Zip Code
c Wirth- rah - a7 3.b
Area code - Phone number
5. WELL DETAILS:
a. TOTAL DEPTH: 3D(5
b. DOES WELL REPLACE EXISTING WELL? YES 0 NOM'
c. WATER LEVEL Below Tap of ?rA�
Casing: `7 .0 FT.
(Use'+- If Above Top of Casing)
d. TOP OF CASING IS 1 FT. Now Land Surface'
'Top d easkg terminated at/or blow land surface may require
a variance in accordance with 15A NCAC 2C .0118.
e. YIELD (gpm): et METHOD OF TEST Gi I ('
1. DISINFECTION: Type Hon
g. WATCE,R ZONES (depth):
From -l.i To (3i7.
From To
Fran To
6. CASING:
Depth Diameter
Fran To /6.1 Ft. A t�ti
Fran To Ft.
From To Ft.
From
From
Amount /U n?
To
To
From To
Thickness/
4/Za Material
PVC
7. GROUT: Depth Material+
From 0 To .9,0 Ft. i(Rm2vT
From To FL
Fran To FL _
8. SCREEN: Depth
From To
Fran To
From To
Method
Port
Diameter Sld Size Material
FL in. in.
Ft. in. in.
Ft. in. in.
9. SAND/GRAVEL PACK:
Depth Size Material
From To Ft
From To FL
From To FL
10. DRIWNG LOG
From To Formation Description
R2CEIV
v're, r311QIOf?E
__.vte
11. REMARKS:
1 DO HEREBY CERTFY THAT nee WELL WAS CONSTRUCIm N ACCORDANCE WITH
15A NCAC 2C, WELL CONSTRUCTION STANDARDS. AND THAT A COPY OF THIS
RECORD HAS BEEN PROVIDED TO THE WELL OWNER.
SIGNAYlRE OF CERTIFIED WELL CONI(RACTOR DATE
PRINTED NAME OF PERSON CONSTRUCT] I HE WELL
Submit the original to the Division of Water Quality within 30 days. Attn: Information Mgt.,
1617 Mall Service Center — Raleigh, NC 27699-1617 Phone No. [phone] ext 568.
Form GW-la
Rev. 7105

RESIDENTIAL WELL CONSTRUCTION RECORD
North Carolina Depsnment of Environment and Natural Resources- Division of
Water Quality
WELL CONTRACTOR CERTIFICATION N
1. CONTRACTOR:
W _ L (hKfNidual)Name �\
A`'
\\J\Cr „Vc A. 9 i\MCs,L
Contractor Company None
STREET ADDRESS (31 H(_ 2 Ti,-1‘ fetid
Vdin,Di✓ yikle L- C
City or Tam State
(s LI71 -
Area ode- Phone number
2. WELL RFORMAT1ON:
SITE WED- IDNR apslicablad
STATE WELL PERMRfa, ' -"-)
DWQ or OTHER PERMIT N(d makable)
WELL USE (Check Apw . h-lLe Bag Residential Water Suppl/A
DATE DRILLED t) --- l 00(i., rt�
TWE COMPLETED c7 AMM)❑ P
S. WELL LOLOCATION
/�CATIO/\r
CRY: 6on C COUNTY �J (..ti c. t
&k\) {hat\ C ( C encAdt
(Street Name. .Hendren. Camay- 4LotNo.. Psoer• 2q Code) -
TOPOGRAPHIC HAND SETTING:
❑Slope OVdeq OFlat k e OONNr
(check appropriate bmd /
LATfn uE _L &f 2t tj 7%j+l
LONGrruDESst act' 3F,-tj It
Latitude/longitude source: AGPS ['Topographic map
(/qualm, dIntl masa. aSrr an a USGS boo map and
eascned b Nis form Ind using GPS)
4. WELL OWNER �/y�
OWNER'S NAME 1 n 11e t; for I,• i Ile ,n (�
STREET ADDRESS LX.., I r'h i li CIQPj�t•i Kit
k3f5.6 r\Ch. me 713
�mrerTam Slab
( ass} 6jk _ (434
Area code - Phone amber
May be in degrees,
minutes. soother
in decal fang
5. WW. DETAILS: -�r
a. TOTAL DEPTWE
b. DOES WELL REPLACE EXISTING WELL? YES CI NOBk
c. WATER LEVEL Bars Top of Cadnw O FT.
(Use"t• if Above Top re Casing)
a1 TOP OF CASING IS j . FT. Abase Lad Surfaces
'rap d casing terminated SAE bob= land surface nNr ragrie
a vdria.ce in aecordanceWM 15A NCAC 2C .0110.
e. YIELD (gpm}_ 0 METHOD OF TEST rA.,
f. DisiNFEcnort Type Hr)-1 Amount
g. WATER ZONES (depth):
Fran !ri To 0 From To
Fran To EMT To
Fran To Fmm To
6. CASING: Thickness/ Depth Durnter u�1
D O S Ft 6-jig _l _PC_Rom From To Ft
Fran To Ft.
o41
7. GROUT: Depth Material
Fran iS To 36 Ft Cat\A.ertd-
Fean To Ft.
Fran To Ft
0
Mrapd
_Rilr+yy
0. SCREEtt Depth Diamla Slot Sim Mataial
Finn To Ft. h in.
From To Ft
Fran To Ft
it
in.
in.
in.
A SAMYGRAVEL PACK:
Depth Sine Mabial
From To FL
Fran To Ft
Fran To R.
10. DRILLING LOG
From To Formation Description
_RiadV J)
Ashevi In Rpgiorni
Aem fe: r1 oLek. .IR)11
11. REMARKS: i r
r ee 1-1 Yft in• ro(GJ-0CNti
r WHEREBY CO FYllt1T716rsal WAS0n1GnNIC1®NA000RO Ja1Mn1
t5A laJC 2C. W SL C W 57RUCIION STANDARDS. ND mAT A COPY OF 7H5
RECORDHAS BEEN PROyt®10111E WELLOWNet
SIiNA 4Tali OF CERTIFIED WEI L CONTRACTOR DATE
c:l( fiLY i
PRINTED NAME OF PERSON CO 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] est 568.
Form GW-la
Rev. 7105

RESIDENTIAL WELL CONSTRUCTION RECORD
North Carolina Department of Envaonmatt and Natural Resources- Division of Water Quality
WELL CONTRACTOR CERTIFICATION # fi{j
1. WELL ONTRACTOR:
)(r1:>1 .11 kiSeeP
Wel (individual) Nana
7✓r� ,°^ k)Q.Al_ `CIr;' t n'
Wd Car tractor Name f"�1,,," ;1��
STREET ADDRESS c�(I � I i7L. °v4'� l v�.�Cl
-114,Stetlle L"Vcni
City or Tarn Sate aCode
(td I- CA1 q
Area carte- Phase number
2. WELL NFORMATIOtt
SITE WELL ID s(daerie:Mb)
STATE WELL PERMfT9(yap0oabte)
DWQ or OTHER PERMIT Kt applicable)
WELL USE (Check Bonk Reddomed Water Sup*ly}4
DATE DRILLED '3- Ci F:
TIME COMPLETED a: PIA El PM�(
3. WELL LOCATION ,, ``
CITY: 13r),gJs', C
Lc CP ir-64— )-o c
(Street Name. .tba,ta . ConamoblcSobdidsinn.i etli. Prot. Z*Code}
TOPOGRAPHIC 1 LAND SETTING:
CiSnpe °VSey °Rat e DOOM
( sample%b&Ga
LATffum �� yj�'. 'I c14
LONGITUDE 3.2' o3 - ?"
Latitude/longitude source: )jGPS °Topographic map
(bcattn orstelmostbe shown on a USGS bpo nap and
attached W Weis Ayer snot flag GPS)
COUNTY CSL•,;G.;
May be in degree.
minces. seconds=
in a amid Nast
4. WELL OYMER
OWNERS NAME
STREET ADDRESS f ortM in Lc C-- t , eS
6r1,6 ve.6,)-y efts (9 7/3
City orTown State Zj Cade
(33c )-6y5--i""s3
Area code - Phone mamba
5. WELL DETAILS: //
a TOTAL DEPTIt f7 D.5
b. DOES WELL REPLACE EXISTING WELL? YES NOM-
c WATER LEVEL Below Top d Cooky aLi,S FT.
(Use's? I Above Top d Casing)
d. TOP OF CASING IS ( FT. Above Laid Surfaces
'Tap d casing dated Arm below bad surface may respire
a variance in aeeadntoewidt 15A !CAC 2C .0118.
e. YIELD (gpm): y METHOD OF TEAT C 1 r
f. DISRFECTIOIt Type H tI-i Amount I h 57
g. WATER!�ZONES (dad,*
From nl (IX r To h n f r
From To
Fran To Fran To
Fran To From To
6. CASING:
Thickness,
Depth Dart Weadgt*d Material
FranQ_To I/ 7 Ft C/q 6iiKa.( p(r£
Fran To Ft
Fran To Ft
7. GROUT: Depth Malone Method
From (1 To An Ft (Qrr vlt4- p 01'n0; re,
From To Ft.
Fran To Ft
0. SCREEN: Depth Client Salt Sine Material
Rom To Ft. in. in.
From To Ft in. _ in.
FromTo Ft.
9. SAIOIGRAVB-PACK:
in.
Depth Size ( Material
Fran To Ft
Fran To Ft.
Fran To FL
rrn-
10. DRILLING LOG
Flan To FortnabanDe9uipdon
RECEIV
ASt1ee.Vlue egiond umce
A ' zfer k'T'J`ertr`il
11. REMARKS:
100HEREBY CERWI T IPS WELL WAS COr61N1C®WACCOea I Wim
15A ICAC2C. Wt31 CONSTRUCTION STANDARDS. MDWAYACOPY OFTHS
RECORD HAS SEEN PnauDmTOTHE WELL OWNER
,4L6,7 -a06
SIGNATISCERTFIED WELL CONTRACTOR DATE
akY, R PRM®NAMEOF THE WELL
Submit the original to the Division of Water Quality within 30 days. Ann: Information Mgt.,
1617 Mali Service Center — Raleigh, NC 27699-1617 Phone No. [phone] ext 568.
Fonn GW-la
Rev. 7/05

RESIDENTIAL wrn.cowsyevrnor RECORD
NmM Ora*Dgehean alEsvimoorot and Naked Rama. Diy"sion ar Rimier Qara9
WEIL CONTRACTOR CERTMCAlwl4 s 3 ac Co
raepedrn a
WdtbRaasa ,1(,
C��--re4 il rw m (d%+// Ary'lI i'17
irrmQammL.f•JS eyMns n
STREET ADORE= 6,3 4-, 'A# % c M �N
R4I ,'Yl s 11.71 Q? 771
'c7*rr a Two 8hso iI. Coda
¢Qs } 1/79- s-j 2/
One md: Pao numb:
2. WELL WORMATIOIt
SITE WEL D i/aweraed
STATE WEIL PBi1MTelt.Ppsenai
DWQa OTHER FEIMMT fl-p-hk)
DATEINS ED 3 - 9-46
TINE canny /O .`DC Aur' PMo
3.a t LOCATION
CITY: 4i ry Ann /. ATV COWRY Suits.:
Pain T%)Nr hrc&.nch QC-7/3
taad Ibrarr-o.Cawnd4.S habloclau4. Rana 21.Cada -
TOPOGRAPHC NANO SETTINGS
CSiae Mika AFWt ow. tam
Rho* "pope ar )
UMBER .L.s�°
Lorr6RutEB..,3° S'it:s/,'
iatimddkmgindesmeec DOPS aTlopoTpphias4
orreasatbosenreena
GtRS631:poaepand
do
{. WELLOYWER
oWNERS MANE Ray/niar'F
STREETMoms
tin n T%Ayr jjrnnrft
ryy<-to r.'•C, Ni 2sr7[.'3
CbtrTam > WS 710Code
sr tontFmi
Nam scab or
kaike aat Asa
cony )- 98-9-20;7
Area coda- Pita nude
IL WELL DETLB:
L TOTAL OEPUt L% 3() '
b.00RSVan REW.ACtcsane WBLT YE80 NOO
c. WATERLEVO.NiosrmGC.r. I.577 FT.
toes`. Dam Top of Cab.
d. ROOF e 1 Ff.PbewiahaShaha"
Top ofmigrarrad aaekbda.rdGuam mgnapes
s wanes: acrade =rah aaA WAG 2c.Mtt
e: Vinous 11 Wb7NODCETw CA' I r
T. ONIFtCaIGrTypo ill 717 Amwd /Q el?
M. WNMRED1Es Wages
ran p To .2$2 Famo___To
Foe To Rom To
L CABNQ INS:s r
T�'o 97 gins
S"Mp a1. u�
Rom To R _
Faun To R
7. GROUT: Moth World
NSW
flelL�_To R
flan To R
Arm To R
L SIN Dap6 WaoMlr Sao WNW
Fm To P1 iL to
L SMWIWRAYRPACM:
Oa & Sea rreY
Fier To Ft
Fhah_ To FI
Fiee1_TO P1.
• OIMUNG LOG
Run To fmnad'un Deaoplbe
•
RECEIVE
Achevilleilegbna
Anuita )grief
T. REMARKS:
1013101SCIERTIFRIONTIGIVIEILVDSCOMMINUGIEDMICOOPIONCEelm
wasaewenm wt,O6ucla/66erLAe06.aeollwn ACOMP o
MUINDIMME InWWahothereLLOMML
enTedt of I TTRW 3 -,29-e0
WELL CONTRACTOR DATE
PRIMED Wear PERSON OONSTRuc biGINEWBL
Submit the original to tit Division of Water Qlallty within 30 days. Ate: Infomution Net,
1617 Mal Selves Cotter— Ra1Nph. NC 27690-1617 Phone No. (P19) 733-7015 est 568.
Fan OW-1.
Roy. 7*5

RESIDENTIAL WELL CONSTRUCTION RECORD
Notib Carolina Departmat of Environment and Natural Resources- Division of Water Quality
WELL CONTRACTOR CERTIFICATION / ,2D 529
1. WELL CONTRACTOR:
:t k( J,
WellCmaada Name
�rrAriiam 4JrI/rlr'�//'ic�c
Wd Contactor Canp®y Nara` STREET ADDRESS Q $'41a
, 7 in R�
fie IA,trsit%/e Nf y77/
City came State Zip Cade
(1/79- 9Nra/
Area code- Panne mama
2. ?SELL INFORMATION:
SITE WELL W SWaapacata)
STATE WELL PERMIT PrappaaW)
DWQ or OTHER PERMIT N(1 eppicatk)
WELL USE (CheckAppicabb Bak RmideW WSt SW*M
DATE DRRLED 3 " /7- dG
TIME COMPLETED 11 :pi) ao PM IM
3. WBL LOCCATIOI&
C TY: ell P pre, n ce,47-COSL
y COUNTY ilo n
e ✓/%atn0L /Ate ES Tap. S .92717
Meet Name. Nanbea. Cammunilp_SubereAsian.Lattip, Pat $ Cade)
TOPOGRAPHIC I LAND SETTING:
°Stile Maley OFW MRidge Daher
(chat apPaPiarea0
LATRUDE tr.
.97.it"
NGI LOTUDE,.& J± 31 r 5-6/7 "
Latitude/longitude sauce: MOPS OTopogapbic map
(bcal on dadIsatbe shown on a USGS tope mop and
attached to Nis brim Mad raig GPS7
0.WELLOWNER n b /,
OWNER'S NAME Rh Br A &I S
STREET ADDRESS -Fri nT ha /a1Se FS�Tes
n0*or onmc,'Ty �C Z� 3
(?AS )- �/�5- /o ?c
Area code - Plane number
May be indegas.
minute; secaadser
Ina drmd bona
S. WELL DETAILS:
a. TOTAL DEPTH: 73CC
b. DOES WELL REPLACE EMSTIIG WELL? YES NO IN
c. WATER LEVEL Below Top d Caaig 33c) FT.
(Use + Vitae Tap at Casing)
d TOP OF CASING M / . FT. Abast Land Sudae
Tap d easigtarri_led arbrbelow had surface may require
a variance in accordance with cew16A NCAC 2C .011e.
e. YIELD Wpm): / Q. METHOD OF TEST r^ai r
T. DISINFECTION: Type !, / 17/ Amount /F- a2
g. WATER ZONES (dep *
Fran _o_To 42S Fran To
Ran To From To
Ran To Fran To
6. CASING: Tlt*n ssl
?L YVG
Depth
Fan_ _To 3_ ` Ft G$-
Fnm To Ft
Fmm To Ft
7. GROUT: Depth n Memel Sidled
u5 Fran 6 To 0 Ft CP Whom -/- }"vp
Far To Ft
Fran To FL
IL SCREEN: Depth Diameter Slat Sias Materiel
Fan To Ft. ht in
Ran To FL _irt _ it
From To Ft in. in.
S. SMOARAVEL PACK
Depth Size Maeda,
Ran To FL
Fmm To R.
Fran To FL
IF Fr
10. SUING LOG
From To Fommoon Desaip(bn
IVFP
gionol Qf rr
;afp:• P rDtecIIGI
11. REMARKS:
0
IcrMEREST enwyVNTn 8wsswAsananwtaDaACCOPDIaCEMTH
t5A *CPC 2C. WELL CmaimlCIOn STANDARDS. MD tnaT A COPY OF 1115
RECORD Ms GEED Fno,m io1EwaLOW a
iJ 1i e 3-17-n4
SIGNATURE OF TOED WELL CONTRACTOR DATE
PRINTED NAME OF PERSON CONSTRUCTS'S THE WELL
Submit the original to the Division of Water Quality within 30 days. Ann: Information Mgt.
1617 Mail Service Center -Raleigh, NC 27699.1617 Phone No. [phone] ext 568.
Faro GWle
Rev. 7/D6

RESIDE VTL4L WELL CONSTRUCTION RECORD
North Camfna Deparhnent ofEnvironment and Natural Resources- Division of Water Quality
WELL CONTRACTOR CERTIFICATION # 2 OU Q
1. WELL CONTRACTOR:
Wed Crr� mtlar Ore adnrq Name o
Wd GamxtraConwany Wree/ Ci r.'!l s it9
STREET ADDRESS (n.:1 i% Jfyi P Z 4Jn RBI
R„bb;nsv,'tle .1/c R7?713
City a Town Stale tip Code
( Sf)- L179- FrgS4
Area code- Phan at
2. WELL RFORMATIOIt
SITE WELL ID I(talpTca"a)
STATE WELL PERMR!(aappdaue)_
DWQ or OTHER PERMIT p(Ti appicahb).
WELL USE (CheekApptiabb Beck Residential Water Sup*$l
DATE DRILLED 3— Ol.y-7)%
TIME COMPLETED In !,ln AMQ PM❑
3_ WELL LOCATidt
CITY: Rr'(,Snrr r, 1—r COUNTY SWra.; n
n-ana %aifr es7a7rs 7/,?
(Sheet Name..Nebae. CoranaStt.k LeLW.. Pavel. Zip Co) -me -
TOPOGRAPHIC / LAND SETTING:..
°Slope °valley °Rat MRI€ U DOOM
(check arempiMebo4
LATITUDE _Li? ,Z3 'O.
LONGITUDE2..02
Latitude/longitude sotaca TOPS ['Topographic map
(bastion ofNS =sibs shams on a USGS tope map and
attached bIbis bnaInot using GPM
4. WELL OWNER OWNERS NAME Chuck-
/e 1/)/
STREET ADDRESS -An T.,.nA Is ke f s i raj'
May be bid:pek
roads or
in adecimd how
DF1/,54n r,'Ty It/et
Get or Tann Stub
(».2& >• 2R' ' arra?
Area code - Phase number
5. WELL DETAILS:
a. TOTAL DEPDt 7a3
r
Zip Code
b. DOES WELL RERACE EXISTING WELL? YES ° NOte
c. WATER LEVEL BeeTep of Cabe; 15O FT.
(Use'V IAbove Tip d Casing)
d. TOP OF CASING M % . FT. Above tad Surface
Top d casing bariated War below Wet suttees may require
alaieDe in acooadNnawih 15A NCAC 2C .0116.
e. YIELD Want I METHOD OF TEST ('A;
Ca •
1. DISnECTW/t Type AlTh` Amount 00CoL
I. WATER ZONES (dais)
From A To (SS From To
Fran To From To
Rom To From To
G. CASING:
TliWnessl
Depth D®nS Weight Malarial
Fran— To /.'07 Ft. snr21 I/C
Fran To Ft.
Fran To FL
7. GROUT: Depth Material Method
Fran n To a Ft Crnt,nr SZW,P47
Fran To FL
Fran To FL
a SCRE(]t Depth
From To
Fun To
Fran To
Diameter Shot Sim Material
FL_9L
FL in. _ it
FL bi. b.
9. SANDGRAVEL PACK
Depth Mae Material
From To FL
From To FL
Fran To FL
19. DRILLING LOG
Rom To
Fomation Desaptbn
air:
LIN
AchRvIlin RP nai
„; P a,ect;
11. REIt1ARICS:
ICCHEREBY CERIFY1INTTMS WBL WAS omsimieim NACCORDANCE Val
15A MCC 2C. WAL Caa1RUC110111 Sa1rNDS. AND TINTACOPTOF IDES
RECORD HAS BEEN PROVD®TUlit WEL OWNER.
Ute7'T^ l-(`s/ P ;i-oh-Oki
SIGNATURE OFrt�E WELL CONTRACTOR DATE
—Tie 'PPyA
PRINTS) NAME OFPERSON CONSTRUCTING THE WELL
Submit the original to the Division of Water Quality within 30 days. Atkin: Mfonnst(on Mgt,
1617 Mali Service Center - Raleigh, NC 27699-1617 Phone No. [phone] ext 568.
Famn GW-1a
Rev. 7/05

rb i1
RESIDENTIAL WELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources- Division of Water Qual ly
WELL CONTRACTOR CERTIFICATION H �7 O
1. WELL. CONTRACTOR:
Fed Cm e_
Well Contractor (Individual) Name
Well Contractor Company Name
CRANE BROTHERS WELL DRILLii 3
STREET ADDRESS
I
FRANKLIN, NC 28734
City or Town State Zip Code
(cr=) )-CI\ b
Area code- Phu) number
2. WELL INFORMATION:
SITE WELL ID Of applicable)
STATE W ELL PERMITR(il applicable)
D W Q or OTHER PERMIT P(if applicable)
WELL USE (Check Applicable Box): Residential Water Supply ❑
DATE DRILLED 0.— 4— d C>
TIME COMPLETED AMO PMfa.
3. WELL LOCATION:
CITY: r%,�U/V! (i--y COUNTYSLthl; J
(Skeet Name, Numbers, Community, Subdivision, Lol No., Parcel, Zip Code)
TOPOGRAPHIC / LAND SETTING:
❑Slope OValley ❑Flat ❑Ridge ❑Other
(check appropriate box)
LATITUDE 3
LONGITUDE
Latitude/longitude source: ❑GI'S ❑Topographic map
(bcalion of wef must be shown on a USGS lopo map and
attached to this form I not using GPS)
4. WELL OWNER OWNER'S NAME (/t.711,A,,�
ID
STREET ADDRESS Flo
May be in degrees,
minutes, seconds or
in a decimal format
%reJ
Yl/1a>'`��A
w ciy nip
Ci or Town State
( )-
Area code - Phone nurnber
5. WELL DETAILS:
a. TOTAL DEPTH:
Zip Code
b. DOES WELL REPLACE EXISTING WELL? YES NOS'
c. WATER LEVEL Below Top of Casing: 6 Q FT.
(Use'+' If Above Top o1 Casing)
d. TOP OF CASING 15 / FT. Above Land Surface'
'Top of casing terminated at/or below land surface may require
a variance in accordance with 15A NCAC 2C .0118.
e. YIELD (gpm): C t—' METHOD OF TEST 7 i i
RECEIVED
MAR 20 2003
Asheville Regional Office
A.uifer Protection
f. DISINFECTION: Type Amount
g. WATER ZONES (depth):
From To
From To
From To
From
From
From
To
To
To
6. CASING: Thickness/
y� Deeth��/ Dia�e)�r Weigh/ Material
Fran 0 To // FL (p7j' /7UL
Fran To F1.
Fran To Ft.
7. GROUT: Depth
From /) Tq,2 u
From To
From To
8. SCREEN: Depth
from To
From To
From To
Material
F1. ile/Weiri (
Ft.
Ft.
Method
Diameter Slot Size Material
F1. in. In.
F1. in. In.
F1. In. in.
9. SAND/GRAVEL PACK:
Depth
From To Ft.
From To Ft.
FL
Frorn To
10. DRILLING LOG
From To
Size
Material
Formation Description
7/
RECEIVE
Asheville RFginnPY t
1I. 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 ZIPS BEEN PROVIDED TO THE WELL OWNER.
ge'22L—e
SIGNAIUNE OF CERTIFIED WELL CONTRACTOR DATE
C r, Ale
PRINTED NAME OF PERSON CONSTRUCTING THE WELL
Submit the original to the Division of Water Quality within 30 days. Attn: Information Mgt.,
1617 Mail Service Center- Raleigh, NC 27699-1617 Phone No. [phone] ext 568.
Form GW-la
Rev. 7/05

RESIDENTIAL WELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources- Division of Water Quality
WELL CONTRACTOR CERTIFICATION # 2045
1. WELL CONTRACTOR:
James B. Brown
Wall Contractor (Individual) Name
-Redden Brothers Well Drilling, Inc.
'.Jell Contractor Company Name
STREETADDRESS 73Holly Hills Vista RD
Franklin, NC 28734
City or Tarn State
(828 )- 369-9591
Area code- Phone number
2. WELL INFORMATION:
SITE WELL ID Cif applicable)
Zip Code
TATE WELL PERMIT#(ir applicable)
DWQ or OTHER PERMIT #(if applicable)
WELL USE (Check Applicable Box): Residential
Residential Water Supply
DATE DRILLED /vim//-��
TIME COMPLETED II X.) AMX PM ❑
3. WELLLO Ta N:
CITY:
COUNTY.
(�1iQ-�,%L.�
(Street ame, Nu 4ers, Community, SubdiNslon, Lot No., Parcel, Zip Code)
TOPOGRAPHIC / LAND SETTING:
❑Slope °Valley ❑Flat ❑Ridge
(check appropriate box)
_4TITUDE
LONGITUDE _
latitude/longitude source: ❑GPS °Topographic map
(location of well must be shown on a USGS topo map and
attached to this fo ; N not using GPS
❑ Other
May be in degrees,
minutes, seconds or
in a decimal format
x. WELL OWNER
OWNER'S NAME
ST T, DDRES
City ororTown _ tale Zip Code
Area code - Phone number
5. WELL DETAILS: . u.) ,
a. TOTAL DEPTH: eau.)
Sl.�C J
b. DOES WELL REPLACE EXISTING WELL? YES °
c. WATER LEVEL Below Top of Casing: 100
(Use -+^ 11 Above Top of Casing)
d. TOP OF CASING IS 2 FT. Above Land Surface'
*Top of casing terminated at/or below land surface may require
a variance In accordance with 15A NCAC 2C .0118.
t YIELD (gpm): a () METHOD OF TEST Blow
NOK
FT,
1. DISINFECTION: Type H T H Amount 160z
g. WATER ZZQNES (depth):
From To /I5 From To
From LLL To From To.
From o From To
6. CASING: - Thickness/
Weight Material
/fire
Depth /— Diameter
From L J To Ft.
ft
ROM A�i-�.�—To Ft.
From To Ft.
7. GROUT: Depth Material Method
From 0 To 20 FGement & benonite
From To Ft.
From To Ft.
8. SCREEN: Depth Diameter Slot Size Material
From To Ft. In, In.
From To Ft. In, In.
From To Ft. In. in.
9. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
From To Ft.
10. DRILLING LOG
From To
Formation Description
Flay & sand
grani t P
RECEiVEE
Asheviih Rogiona
t ;,ieu R
11. REMARKS:��
RtW&rJ cue
I DO HEREBY CERTIFY THATTHIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH
15A NC C, WELL CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS
RE -•-O AS BEEN PROVIDED TO -E WELL OWNER,
NATURE OF CE
/7-06
TIFIED WELL CONTRACTOR DATE
James B. Brown
PRINTED NAME OF PERSON CONSTRUCTING THE WELL
Submit the original to the Division of Water Quality within 30 days. Attn: Information Mgt.,
1617 Mail Service Center— Raleigh, NC 27699.1617 Phone No. [phone] ext 568.
Form GW-la
Rev. 7/05

32461E
• WELL CONSTRUCTION RECORD '•
- , yam;'::
- .. 4., is .• •. - .
North Caforma - Department of Bnrkou nS and island Resources.- DivMon of Wabee Quality-- Grot dwatet Section
WELL coNTRACTOR(RWIKmu cpa4IrtiDI1S Ae/I'e...via . . -r csri?iv1Gkttaiante' -
WELL COMRwCTORCOatPANIf aAJd6aaai`r C $c f - I1 11li5Li Iy���(,,`,'�,'��K e , Pttora scat JD- 14-3 24 O
STATE WELL CONSTRUCROn PnRIDITII -•- ASSOCf= DWQ"PLRMIT♦t - _
(Ifappliable) .
(ir ppliabk) • -
•
1. WELL USE (Chock AppHable Hoak-ResidentialtrMmtkipevPubiic 0 _ lnduattial 0 Agricultural C_7
Monitoring O Rccorcty O' Hest Pump Water Injection O OtherC1 If odic; List Use ' •
2.'WELL LOCATION: :soh City
Tool i L_,6 aJ
mom Nam; Mete. Campaiy,
Sobd'rv(doe,Latta. rap Cote) - Littmddbng -f elliocation -
3. OWNER; ` +Ow P � Su tH e S
Address (t () @ D X i 1 .3 n-
atIO
Cvh µ;RgluedA . i_ &g7gY
Otiat Tows Suer rip Cods.
(Jan- so7- ©4G2 .
Area code. Phone somber - (Q5
E 4. DATE DRILLED a -o -
5. TOTAL DEPTH; vSn 4.-
Topog leind
county Li)
- ty S /� ; ru ' ORidge OSIopa Malley . 1
8 7/-5 . temorwerawsl m) -
—
asonehritosakeetodp
Latituddlongititda sourecOOPSOTopographic map
• (check boa)
Tim - DRILLING LOG
From To - Formation Description
0 L
5/
cf S' 3So' �V e f2CLri,t�
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO:c4Y��
7. STATIC WATER LEVEL Below Top of Ching: / © FT:
(User if Atom Top ofCadet
� FT. Above Land Surface' •
flop of odes towleaud afar �lnd. rk.MOM . ,-
various
la accordant wtthUk 2C .a11L
9. YIELD (gore): METHOD OF TEST Pa/Q10ftr¢.
ID. WATER ZONES (depth): /•?t>' Q - -
LQ
11. DISINFECTION: Type % �'!f: Amonst .3 T -S S dlrectiou and dine a bl mils from at lest
12. CASING: - - Wil17'hidmeu two Sate Roads or County Rosds. Include the road
D�q or Weight/en.
M�,rpt -numbers and-coutmon road names.
From fl.Toul5` ,t'•�
From__To
From Tp Ft�_
13- GROVE_ Depth tAataial Method
From_Q_ To�_ Ft. egia- r�
From To Ft.
4- SCREEN: Depth Diameter . Slot Sir Material
in.
in.
8. TOP OF CASING IS
From To
From To Ft_in.
5- SAND/GRAVEL PACK:
Depth Size
From To Ft
From To FL
Material
6. REMARKS: - -
DO HEREBY CERRTIFYTHAT71 WS WELT. WA$ O WSTRUCIED 1N ACCORDANCE WTTII ISANCACZC. WH Z. -
'ONSTRUCTION STANDARDS, AND THAT COPY WI, �THi3 0RDHAS BH@I PROVIDE) TO THE -WELL OWNER
SIGNATURE -OF PERSON SIC�R&7SIRUCTIp NQTHBWELL . • DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Malt Service Center- Raleigh, NC
„17699-1636 Phone No. [phone], within 30 days. - OW-1 REV. 07/2001

\
I?GSIUIiNI•IAL WELL CONSTRUC'ITUN RECUR!)
North Carolina heparlutenl or Environment mid Natural Resources- Division of Water Qualiiy
WELL. CONTRACTOR CERTIFICATION H .2-10
1. WELL CONTRACTOR:
A'/5.c� C-eet
k
Wee Cor rncla (Nlividtn I( Name
I'IILLEN WELL DIIILLING, INC.
Well Cadracloi Company Name
SI REET ADDRESS F'.O. D0X 5G7
TIAYESVILLE, N.C. 20904
City et Tweet Slate /ip Code
(_020 )- 037-2997
Atom code- Phone nunnhe
2. WELL INFORMATION:
SITE WELL ID ter errrrat•r.l
STATE WELL PERMI1 1pl applicable)
DWO or OWNER FERMI F MO applicable)
WELL USE (Check Applicable Dos): Resklenlial Waite Supply rj
DATE DRILLED / '-/6 OC
71MECOMPLEIED //' CO AMIJ'I'M❑
2. WELL LOCATION:
CITY: C/7'1'212-'e ' COUNTY J eilsi'
-4 {r L cG,/e
'Sheet None, Hu,nbr'e. C„rtenlnni,y, Subdivision. lot No., I`e,dl, hp code)
TOPOGRAPIIIC 1 LAND SETTING:
ElSkre gdafey Orbl 11110011 Cl Other
[check app,isnlals bold
LATITUDE 3_ S All'45-s'f
LONGITUDE 9 ,L if. 3 47
Laliludc/Iongilude solute: RCN'S t_Tnpnginidlic [nap
(minion 01 well mn<I he shown on a USGS fops rnnp and
Mlached MIN, form E rrol lrskrq GF'S)
4. WELL OWNER /
OWNER'S NAME /di kit r U%•,1ley
SIREET ADDRESS //I Col//c //c .'p
Mny le bi deport.
Inlilani N• incondi tM
In a dot final Epinal
City or lowrt Stale Zip Cole
(- ).
Area cafe - Phase nonb l
S. WELL DETAILS: 11 /
B. TOTAL DEPTH:l 1 r'
b. DOES WELL RErLACE EXISTING WELL? YES (3 NO LY
ISM FT.
e. WAT ER LEVELRr.l'w Iry of Casein
(Use's.' 8 Abve Top d Casing)
d. TOP OF CASINO IS % FT. Above Land Smince'
'Top of casing laminated shot below land eurlpce rainy tequlre
■ welance In accordance with 15A NQAC 2C .0118.
a. YIELD Wpm) /2 METHOD OFTEST /9/%
OWNER
MWD
NC
1. DISINFECTION: Type /yri/t
p. WATER ZONES (depth):
From tie To /f/ From To
Amount 'yc F
From
Flom
6. CASING:
Unpth
U In in FI.
To El
To rl
Twin
n+n
Flom
To
to
7. GROUP: Dents
room D To L
now e• maze
r ron to
R. SCREEN:
From
roan
From
Depth
10
To
To
9. SANDIGRAVEL PACK:
Depth
Eton
Flan
non
From
From
Diameter
6- rz5—
To
To
lNcknessl
Weight
•/tE
Mnteilal
5fee/
)8.1l lel Marled
rl 4. /`/rd /lJ, 1 /
ri. ire,..)jab.te- /v«'-4 r!
rt.
Olaneler SkA Size Material
El. In. In.
FI. In,
FI. In. In.
Size Maralal
To rl
To FI.
To FI.
10. DRILLING LOG
Flom To
0 -SS-
yr-/yam
Formation Description
G rr:. 7 . Y e-
—1
11. REMARKS:
Iran NI CFPW Y r11AI MIA WELT W AS C(TNIRUCI70 a ACCOnO*NCE WMM
ISA NCAC 7C. W EI.% CONCIRUCTON SINIOARRS Nu 11wi A COPY Or n11
RECORD HAS BEEN enWIDED 10114E W Ell OWNER.
f i3�1�'.CC- /-/e' tt
SIGNATURE OF CERTIFIED WELL CONTRACTOR UA1E
fit i'Vee,
PRINT eu NAME OF PERSON CONS 1 RUC I IN , I NF W F 11.
r
SlII brill !lie of Ig In al to )lie Division of Water Quality within 30 days. MOP hdonnatlon MOL,
1617 61,It Service Crnlrr - Ratnlgh, NC 27099 1617 phone No. [phone] oat 5611.
Form GWla
tinn05
t

RESIDENTIAL WELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources- Division of Water Quality
WELL CONTRACTOR CERTIFICATION # Sc.) `).? _
1. WELL CONTRACTOR:
n
C `%d4 !1 C
Well Contrac or (Individual) Name
Wen Conslc gDR a.ERS WELL DRILLING, iNe.
STREET ADDRESS248 CRANE CIRC! E
FRANKLIN, NC 28734
City or Town State Zip Code
(FOE/) -.ray 10
Area code- Phone number
2. WELL INFORMATION:
SITE WELL ID #(if applicable)
STATE WELL PERMIT#(! applicable)
DWQ or OTHER PERMIT #(if applicable)
WELL USE (Check Applicable Box): Residential Water Supply ❑
DATE DRILLED /'>�
TIME COMPLETED AM ❑ PM 0
1. WELL LOCATION:
CITY: E Yy,5c3 N C 41 COUNTY i (La
the
(Street Name, Numbers, Community, Subdivision, Lot No., Parcel, Zip Code)
TOPOGRAPHIC / LAND SETTING:
❑Slope ❑Valley ❑Flat ❑Ridge ❑Other
(check appropriate box)
LATITUDE 3
LONGITUDE
Latitude/longitude source: ❑GPS ❑Topographic map
(location of well must be shown on a USGS tope map and
attached to this form IT not using GPS)
May be in degrees,
minutes, seconds or
in a decimal format
4. WELL OWNER ! 1-
OWNER'S NAME r Yy�� -0 tsi-fy s34/,L
STREET ADDRESS
Bry Ar P:I-1 A ` g-Y7
StateCity or Town r
Area code - Phone number
5. WELL DETAILS:
a. TOTAL DEPTH:
S"--
b. DOES WELL REPLACE EXISTING WELL? YES 0 NO ❑
c. WATER LEVEL Below Top of Casing: _2� FT.
(Use "+" if Above Top of Casing)
d. TOP OF CASING 15 1 FT. Above Land Surface'
'Top of casing terminated at/or below land surface may require
a variance in accordance with 15A NCAC 2C .0118.
e. YIELD (gpm): a METHOD OF TEST 4 , Y
2268 7 0
f. DISINFECTION: Type Amount
g. WATER ZONES (depth):
From_. To From To
From To From To
From To From To
6. CASING: Thickness/
Depth Dippmepr Weight Material
From (1 To (id Ft. t/, !!Y p L-;
From To Ft.
From To Ft.
''^^yy
7. GROUT: Depth Material Method
From 0 To a Ft. (74un,I ^, j I it)?
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. DRILL ING LOG
From To
(n3-- rr'O f
11. REMARKS:
Formation Description
ala
C3
P'* °I
y"�C-1
REGE V
ITC'itiiif; Rir'C, U
Aciuqth
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 r HA:i BEEN PROVIDED TO THE WELL OWNER
S /2-0t,
SIG _TUBE OF CERTIFIED WELL CONTRACTOR DATE
,'ck e/.4MJe
PRIN ED NAME OF PERSON CONSTRUCTING THE WELL
Submit the original to the Division of Water Quality within 30 days. Attn: Information Mgt., q CForm Gw-la
1617 Mail Service Center— Raleigh, NC 27699-1617 Phone No. [phone] ext 568. siN 0 6 LOOURev. 7/05

RESIDENTIAL WELL CONSTRUCTION RECORD
North Caroline Department of Environment and Natural Resources- Division of Water Quality
326758
WELL CONTRACTOR CERTIFICAT ON # 2261
1. WELL CONTRACTOR:
CHRISTOPHER L. DICKEY
Well Contractor (Individual) Name
CHEROKEE WELL DRILLING
Well Contractor Company Name
STREET ADDRESS PO BOX 1007
MURPHY
NC 28906
City or Town State Zip Code
( 828 )- 837-8008
Area code- Phone number
2. WELL INFORMATION:
SITE WELL ID Cif applicable)
STATE WELL PERMITC(t applicable)
DWQ or OTHER PERMIT WO applicable)
WELL USE (Check Applicable Box): Residential Water Supply °x
DATE DRILLED 0815l06
TIME COMPLETED AM ❑ PM
3. WELL LOCATION:
CITY: BRYSON CITY COUNTY SWAIN
WESSER CREEK
(Street Name, Numbers, Community, Subdivision. Lot No., Parcel. Zip Code)
TOPOGRAPHIC / LAND SETTING:
8,1Slope °Valley ❑Flat DRidge ❑Otter
(check appropriate box)
LATITUDE 3 5 19.328N
LONGITUDE 8 3 34.343W
Latitude/longitude source: fnGPS ❑Topographic map
(bcetbn of wet must be shown on a USGS topo map end
attached to this form Anot using GPS)
4. WELL OWNER
OWNER'S NAME MAC BROWN
STREET ADDRESS 191 WESSER HEIGHTS DR.
BRYSON CITY NC 26713
City or Town State Zip Code
( 404 ).. 509-6925
Area code - Phone number
Maybe in degree".
minute', second+ or
it a decimal format
5. WELL DETAILS:
a. TOTAL DEPTH: 400
b. DOES WELL REPLACE EXISTING WELL'? YES ° NO L19
C. WATER LEVEL Below Top of Casing: 75 FT.
(Use'+" W Above Top o( Casing)
d. TOP OF CASING IS 1 FT Above Land Surface'
'Top of casing terminated at/or below land surface may require
a variance it accordance with 15A NCAC 2C .0118.
e. YIELD (gam): 7-5 METHOD OF TEST AIR
f. DISINFECTION: Type CHLORINE
g. WATER ZONES (depth):
To 171
From 170'
From 200'
From 379'
To 300.
To 381'
Amount 100 PPM
From To
From To
From To
6. CASING: TThickntess/ N�ata
From 0 DTot81' Ft. arm Via PVC
From To Ft.
From To Ft.
7. GROUT: Depth Materiel Method
From 0 To 20' CEMENT GRAVITY
From To Ft.
From To Ft.
0. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. M.
From To Ft. in. in.
From To Ft. in. In.
9. SAND/GRAVEL PACK:
Depth
From
To Ft.
From To Ft.
Size
Material
From To Ft.
10. DRILLING LOG
From To Formation Description
17 TO 6' RED SLATE
6' TO 38' BROWN SLATE
38' TO 60 RED SLATE
60' TO 63' YELLOW CLAY
63' TO 135' BLACK SLATE
GRAY GRANITE 8 GREENIWHITE QUARTZ
135' TO 155'
155' TO 400'
I1. REMARKS:
BLACK SLATE
O
.e7
—C
0
N nv
BIT SIZE 6.065
a at
—1
I DO HEREBY CERRFYTRAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE W RH
ISA NCAC 2C, WELL GONSTRUCTKIN STANDARDS, AND Ta1TA COPY OF THIS
RECORD HAS BEEN PROVIDED TO THE WELL OWNER.
tWOe
SIGNAiliRE O C D VOELL COdt ACT6 DATE
r
iCT f FlE
�fIFJSToPI(Ek )ICY
PRINTED NAME OF PERSO CONSTRUCTINr7THE WELL
Submit the original to the Division of Water Quality within 30 days. Attn: Information Mgt,
1617 Mall Service Center— Raleigh, NC 27699-1617 Phone No. [phone] ext 568.
Form GW-1a
Rev. 7105
JUN 06 2036

RESIDENTIAL WELLcoNS 1WCnoNRECORD
Natal Combo DeTabolaldEaVWnomtand Rama RofaaobDiivisionatAWN QuakyMn Q
was. CONTRACTOR CERTIPIca 7oN 6 nL r5 -0
6398
1. WELL. COWRACTott
fiYriP
WMI Casketa pnd tsONb
Grrile rn Lto// !X r l /, YJy
raama Web Cpompom Nom
07
STREET ADDRESS 6327/ J/ b rJ.). RBI
Rnbbi`nr itt !Ur 2? 77/
ONrTome Slab ZIP Ca
( Sri& i- 2177 -,6-116-4,
Amaade Phone number
WB1eFORMATIOIt
SITE WELL loe _-- LL3
STATE WELL PERMITIMmeea k
DWQ*ODERP91 Itfl -plo i
DATE mum 17-o�Fl"OCn
TMECOMPI.ET®j/,'tee AMgp PMO
a. wet. LOCATION
art: Pr/Ton l;Ty mutiny S t.l et. n
NOW I ern•- asae.A llawob9MiM.tnt/4.PantbbWry-
TOP'OORAPRICJ(ableSET N&
4IPo OWEN oFba NRibe polar
ad*+Yob
LATPROE S .f.° ,a 3 `a7 vw
LONGITUDElc,,9 32' /q 7'(
LatiOidenoorudes ur= OOPS aT popeWSr+o
(keis daMwetM akee ar a NSR9lopo as s l
asctadbak bwi'nd.e
&W ILMER
owes stow ShI�er: cS uJ Ka
STREET AOOREM-hinTa *In /6ko ES7arris
,Rrysan C: ry NG .2P7/3
a Taal • SW, Zip Cab
(V� 1- -1a 9a
Area cads- Phone surfs
Mnbbdsgoal
WS semis
wad Sae
5.'SELL ♦ ccONIS
a TOTAL roe : 3cSS
b. DOESWSL. REPLACEEXISTING Wf S? VES0 PC
G. WATER LEVEL Oda TapdCsig ACC FT.
(llee"6AtaeT4dCaaig)
d. TOP OFwas Ks J FT.Aearalad&elrr
-Tap etad%bmiaYpahtr66ka(ad ,ra rarrylgia
a mina • aowdmCa S 1SA MAGIC MIL
a ) `a METHOD OF TEST o i r
L Osnmatmatt,. NT/i ism_Q Z_
5- WATER WINES (_*
r ae ISS To .ems Rom To
Fraq_To Flant_To
VTR Frar�_TO
a CASEIN TWINS y�Wi1
TOS
Frml n Dtool_(,(_R, WtA! FAYC
Far To
Flom To Ft.
7. MOUT Depth MOS Method
Far es Te QO aa,rr PIMP
Fran To P1.
Far To Ft
IL SCREEN Depth dexter Sol SW twain
Froe�_To PL Jt h
Fan To Fi,h _ h
S. RATaORAMILPsoe
Depth Sim NNW
Finn
Fali_Ty_R
Rom To_
-^- ------ -- -
nDRAINS Ios
nem To
Faunae De/a jObn
!UN 06 2v05
IL REMARKS:
C
00
3,
1WmmonagnvWMeWWaLIfl ammetawoucceemsaiems
baNCPC2C.IMICOa1mRIDn A1111aTA lam'araee
mO0laaAee®1Rtaa0TOME WELL Met
SIGNATURE [p3T�WEly.COITWbCTOR �-•.9k-d
.y . p
PI1WTED NAME OF -ltbLJN COSTRI OING THERM
Summit the original to the Oivlslan of Water Quality within 30 days. Attn: ildonnatlon Mgt.,
1617 M11 Service Center— Raldgh, NC 27G991617 Phone No. [phone] ext 566.
Fenn Oak
Rar.7w

RESIDENTIAL WELL CONSTRUCTION RECORD
North Carolina Department of Environment aid Natural Resources- Division of Water Quality
WELL CONTRACTOR CERTIFICATION N Q.OSD
1. WLLL CONTRACTOR:
N Wel Contractor Name
rnitrnrn Wei/ r11/ling
Wel Contracto Compaq Name , J
STREET ADDRESS 10, *// I W %// G/n Rd
�c77/
Cade
Re b in nsy L'/e We -
City or Town Slate
(gag- )• t/79- r{Q5'H
Area ado- Phone number
2. WELL INFORMATION:
SITE W E.L O Slaapparm at
STATE WELL PERMIT$(+apvamel
DWQ or OTHER PERMIT 8(i appicatle)
WELL USE (Check Applicable Bonk Red:lead Waea St 0I
DATEDRILLED / -g -Oslo
TIME COMPETED .36 AM CI P11 W)
3. WELL LOCATIOtt
CITY: Rry Ysan C/iT). coUNTY SIAetI n
nNaRe.lLm lr4 .o r-Sas
a Suhd
(Sheet Paeel. $Code -
TOPOGRAPHIC I LAND SETTING:
OSlope OVSBey OF ®Ridge OOtlar
mem appwpdatehoe
LATITUDE 3 Se 3/66.Gt"
LoNcrruoE$if,
Iatit deilong wde sower" 14GPS oTopographic map
(bcation of well must he Mawr an a USGS logo map sad
attached bBuis form Inc( using GPS)
4. WELL OWNER p
owtesNAME nR�ifh d) lalsts
STREET ADDRESS Al rpApet % kP f.STares
Qty.son �-i ry NG sr7/_?
Ott or Ton STaia re Cade
7oy }s7r-9o�1
Area code - Phone amber
May he indorse,
adsaet seconds or
ins decimal format
5. WELL DETAILS:
a. TOTAL DEPTH: 706--
b. DOES WELL REPLACE EXISTING WELL? YES O NO Q'
c. WATER LEVEL Bet nTap d Casing 0 FT.
(Use-+' Abele Tap d Casing)
d. TOP OF CASING IS / FT. Abate Laid Surfaces
'Top el casing laminated War below land surfaoe
a variance in accordance with 1 NCAC 20.0118. require
e. YIELD (g,aa c n METHOD OF TEST et; r
L DISINFECTIOth Typo I
g. WATER ZONES (depth):
From
Fan To From
From To Fran
8. CASING:
Diameter
Fran DepthTo 67 FL 6
Fan To FL
Rom To Ft
326397
Amount
To
To
To
Thames/
Weight
ar)
7. GROUT: Depot Malarial
Fan (1 To 26 FL C-PrIAI HT
Fan To Ft.
From To Ft
8. SCtEtt Depot Diameter Sot See Maeda
Flom To Ft in. in.
Fran To Ft R - in.
Ran To Ft in. in.
9. SAND/GRAVEL PACK:
Depth Size Material
From To Ft
Rom To R.
Fran To FL
Fir
18. DR .LDIG LOG
Rom To Formation Description
0
12.9 0, 7ru.u.Jn5
L
m
rV
11. REMARKS: 1
Wet/ '7o be .lyd.o --ro it re
1 W HEREBY CERIFYTW1TTHIS WELL WAS Cd6TMICiED IN ACCORDANCE WITH
15A /CC2C, WSJ. Wa51RIt1 w STANDARDS. AND TINT ACOPY OFMMS
RECORD HAS BEEN PROVIDED TO TIE WELL owe
SIGNA� ca 1/FiAED WELL CONTRACTOR DATE
rP 'PERSON
PRt:IIDW WE CONSTRUCTING THE WELL
Submit the original to the Division of Water Quality within 30 days. Attn: Information MgL,
1617 Mall Service Center — Raleigh, NC 27699-1617 Phone No. [phone] eat 568.
Form GW-la
Rev. 7/05

,RESIDENTIAL WELL cotinsucnoN RECORD
No* Cram Demon and NodRmassar Ditm ofTYda Quaky
WELL CONTRACTORCBRTIFICAnONl QCnCO
1. WELL CONTRACM t
1;
Wel Caota1aa Oodoidoli
rr, hr. m f.JN // Ar,M'rna
WU ContratiorQaeoayNaae
trisan ODRESS (.3L/ l�yrAP. Tien Re-.1
Re 111-?Ins u,'p/e tuc
`Q& 77/
CaraToon ado IpCade
742 r} 1479-ga/(4'4
Arno Beds Pore warm
LWELL K•ORNATq/t
SITE NEM0RO_ PRa
BTATE W ELL PELOarlpaopnehi
MKS OTHER PERMIT WE quicale)
WELL USE (Check Maras Bo* RwidaWWag Sq.*R
DATE DRILLED y- /.S''- a G
Tmummm ATtk %/i O! MIM PMQ
3_ WE.LLOCAT101t
CRY: try s.,n r i Ty COUNTY
,ns /non 227/3
Bnallis e..Nrlaa araaaalaaalahasatala Pica aparo-
TOPOGRAPHIC / LNO m: TTNW
o81:pe Maley OHO UN* Dahor
LATITUDE Si D,5.'S'a.6
LONGITUDE ,o7'31.9"
Isniudetkeestsiemew BOPS 0Topovachiecop
6etdWaar.rwdd.anram.tISOSdrlaAlm as
SAOh alkam/eoitaioGA9J
4 WELLOWt®t
OWNERS NAME &fray Paomrnak
mat ADDRESS Be,n,°s mnin`ro in
Rrryy.Scn G,ty Mc 2Fr71?
War Tom ENS AVOW,
Wu bokocas.
L t_
Area coda- Pbucmaaa
IL WELLDETA/Ut
a TOTAL tent (p[1S
b. 00E5 WELL REPLACE SWIM WW2 NES0 NON
e. Waist LEVEL ElosaapdCubs U tT
(th.`etMara Tep d Cebu)
it TOP OFCPA'S / FT. Maws Laid Saar
'Woof care Mab1dSte bdkwWdsuds few woks
mods nestn damaWwfah IBA MAC at.011A
magic O NED1017061E67 6 i✓'
R CgOFECR01t Typo r,
g. WATER ZOWSt T
TII—C2—
Fun
t CAS Nia
Fod! o Duet
4i S
For _To R
t _Te R
To
Rao To
FeaA_To
Rum To
TNabra!
ssl
7. O7. GOMM oeph btNtafi
Foot O Te a/i Ft rsnu9rer
Fml�_Tq__R
Fia�Ta�_Ft
/r.
i =ERR DNS Ds Mafia ICU
T4_—.P1+--...-_h In
Peaa—Te PT---NL _ a
FAaq___To n. Ya K
E. sASVEL.PACt
Dept Site tlaaY
FianL_Tq_R
Fmq�Tq_R.
Fn�_Ti`�R
1R MSG WO
Ftun TO Ponta' Delnp6ao
rn
0
0
Le ,Sl Nyrk f) T/rn7u rA
A omporramwrowneraeLweroaamucaaarccworazono
ttanuc7aw6LL cansimcmr sNaams.marmakomvarms
ROCOM1wSNeerPRWaE IloI EwELL0V IOL
TURE OF ED WELL CONTRACTOR ATE
PRNi®wuE PEiWONODNSTruicrNOTNEwE3J.
Submit the origl ai to the Division of Water Quality within 30 days. Attu: Infonneeon Mgt,
1617 Mall Service Center- Raleigh, NC 27669-1617 Phone No. [phone] est 663.
Fan'GW-1s
Rex rns

RESIDENTIAL WELL CONSTRUCTION RECORD
North Carolina Departnrnt ofEnvironment and Natural Resource- Division of Water Quality
WELL CONTRACTOR CERTIFICATION # .1q/3 tca
1. WELL CONTRACTOR:
jb tit
Nave
W d Contractor
Gr: L natal L11er/i f� re�lrY
Well Cadraclor Cannery Name I I
STREET ADDRESS &oat/ " "/ d B 7 (.Jrl Red
RQth fin1/45 V11)1161 NC aa'77/
City or Tr State Zip Cade
(Rai )-N77-RWS'/
Area code- Phase number
2. WELL IFORMATIOtt
SITE WEU. ID s(tappieeWa)
STATE WELL PERIdDIR picaae)
DWQ or OTHER PERMIT aid appitable)
WELL. USE (Cheek Applicable Bo¢ Residential Water Supply El
DATE OIaLLED 7— %y—n 6
TIME COMPLETED 4 : 36 AM O PM ea
3. WELL LOCATIOet
crit ity.Yon Citry CouNTvSL✓a.!f
C.y�iANX/1(
(Street Nana .Manta Community-Subtaisien.LtNo. Patei, Zip Caney
TOPOGRAPHIC /LATO SETTING:
Dame DVaiey UFtd Inklge °other
(CIO appmpia*bad
LATRUDE ,i y£a re%�.'().«rI
LONGrtuCESL ° TTS?'OS3"
latiode4ongitude source: mGPS ciTopographic map
gre aeon al wet m must be shown m a USGS Lupo map and
attached begs farm snot using GPM
4. WELL OWNER
OWNERS NAME Die f�, 776.r
Sti(ttI ADDRESS Olin v kcL
Rhysr,n riiTy AIC ra�.� 7I,�
cat oroan • Stae ZpCade
(Sat )-g Q—(4-74,4
Area code - Phone mein
May Ear in dorm.
saes, seconds or
le a tom! forma
S. WELL DETAILS:
a. TOTAL DEFT* ;Inc C
b. DOES WELL REPIACEEXISTING WELL?
YES ❑ NO a,
c. WATER LEVEL BekwTap d Casing 40 FT.
(Uses" IA aft Top at Casing)
d. TOP OF CASBO IS l . FT. Abuse Lad Surface
'Top d casing laminated der bow lad =dace asy aquie
avariaioe M acoordaice Win 1SA NCAC 2C.0116.
e. YIELD Wpm) -(1 METHOO OF TEST 0.i1r
32639E
1. DISINFECf101t Type /7/7-# Nnount rp a2
g. WATER ZONES (depth)
Fran (9C To Q sS From To
Fran To Fran To
Fran To Fern To
6. CASING: dap Thickness!
From n Two S3,Ft.
t J G in W..
Fran To Ft
From To Ft
7. GROUT: Depth maremi Method
From n To.0n Ft rep:Anr Pory),:4
mm FTo Ft (�
Rom To Ft
IL SCREEN: Depth Diameter Slot Size Material
Frent To Ft in. M.
Ran To Ft M. _ in.
From To Ft in. M.
9. SMO CRAVE- PACK:
Depth Size Malarial
Fmm To FL
Frm_To Ft.
Fran To Ft
10. DR9J.ING LOG
From To
Fowl:Won Description
v
UN 0) 6 ra
11. REMARKS:
c
.
a
101HER CERWY11NTaeints wAS Car61NUC1E0 Aa ORONCE WITH
15A WPC 2 . VMS CON61a1C11311=MM06. AND11MTACOPY OF The
RECORD HAS BEEN PRWb®TOTiE WELL OMER.
rr lly,I& N-/4r of
SIGNATURE OF ED WEU. CONTRACTOR DATE
eP-7 maFER4 SON PRINTED TIME CONSTRUCTING THE WELL
Submit the original to the Division of Water Quality within 30 days. Alm: lnfonnation Mgt.,
1617 Mail Service Center — Raleigh, NC 27699-1617 Phone No. [phone] ext 568.
Fam GW-la
Rev. DOS

RESIDENTIAL wFLLCONSTauCTtoN RRCORD
NmtCull Dm/damte&vicrumtaodN*nlRooms- Division ofWater (Aeiiy
WELL corm/croft CERTTn onion 6 Dog()
1. WELL CONIRACTOft
e7e e•
Wei CatontinW
tJg II rL-,'ii rw
wacenrate Panpr7t41t
STREETADDREss 639 Nyde % IA/ n Rd
c), n6liige /VC `2Sf771
City a TOM NSW 2p Cat
(9281• '79- R°/S'l
Ana cod► Moot user
].WW. alaa *uoet
SIMNEL O all.aaS
STATE WELL PENISTEN SWW
DM or OTlflt PREWAR 'n'- a'M
WELL USE Shock Alp6eaYPBoeaj poll .ad WOWSuwr
OATEMILLED L1- 1 3- 0 Co
air en //%30 MAD Plop
t WELL LOCATION
cam flryse, n c;7-y comfysufoJvi
C U)LfffisfG 7/,3
ono toommorom r.c afL.can GOO -
TOPOGRAPHIC f LOOM SETUPS
cap, ovary Onil arago. Does
MT(TIME sIf 20'64.0f�
Larc(RRa:..t,3," 4 nn.7"
tatio dehengmde soar SOPS otapogtaphin map
Ott Iow was m m aUSGSIepoamp aid
obehod6INAI allnduahpGPM
OWNER'S/MAR 2Y/ nlar/ey
slRffr Melee r oJIn S1 a
We,6eiade e.
eiaerr saoaleQ
kotecke boor
.QrySnn city ilk2X7/.?
caforTwin SYaa lip Code
(9/9 )-(00-9?a4
Area code_ Plum number
swEtLDErALSc c+
a. TOIA►.man
b. DOES WELL REINACE awalaSiT.5 .? TESO IMa
e. WATER LEVEL 91hOTcpoCooing 3 00 ' FT.
Warr fAbove Toni OWN)
d. TOP OFCAREWs / Ahem Lad Beaker
a�mimee o ollt1611NCAS R
a TB.D(9 s ME IIODOFTEST O r
is ThtCIWel TYP LL—MM1YNaA tt n
s WATERTOWN (WS
Awl .36t Ta 7SS flan To—.
Rom_To Ftan To
Rom To Ft® To
t CASRW TWINS
fnr. To Ft L.
F1NtL_To Ft
7. GROUT: oeah Wald
Foal 0 To Qn Rf,oni or
Fleq__Tn F1.
Foot To Ft
L SCR®t
Far_
Row_
Foe
Depth OEM* Slosh- Wail
_To Ft._-_ ft. la
ra F ,fit _ _^h.
To Ft.—Yt h.
t snunsrnapiCK:
Oo W Eft Ilene d
Fon To R.
Faly__Tq R.
Fow _To
1t SWUNG LOG
ROM To Ferman Deettiplbn
IL. REMARKS:
0
Vet/ T !;A hiy n
rr
tm18llwrad ..1NT1eaofBL. OCCINI flUaaa . _cXWlM
:r1r7CSVint eate-a -SN10Mbi,AIcfaTAfLPvS S
eaealbW411®1PaOf08)10T11Eb6tobllt
SIGNATUREOF"CLClktfl®twal t.bttTRAcrcR DME
INIEOF CONSTRUCtNG*EWELL
Submit the origlnMto the Dietitian of Water Camay Within 30 days. AVrn illanlatton Mgt,
1617 Ng Sawing Cfalor- Raleigh, NC 27699.1617 Phone No. (911j 733.1015 sxt 361.
Fam0W-1a
RIK 7A6

RESIDENTIAL WELL CONSTRUCTION RECORD
North Caoraa Dg ailmad of Envaommrnt and Natural Resource. Division of Water Quality
WELL. CONTRACTOR CERTIFICATION f otLJ �j d
1. WELL CONTRACTOR:
WellContractort Name
VC) hAsin itJ,o // Ay 17//vl
d Contractor Canpaa Name oCG
STREET ADDRESS uG 9 , ych. a 771 J✓)
/GibeMRI/ A. Air
Chy or Town Stale Zip Code
(St.27}Lf79 gLis-411
Area rode- Raw number
2. WELL I FORMATIOtt
SITE WELL ID WE amicable)
STATE WELL PERM(TS(aappeaae)
DWQ or OTHER PERMIT III amicable)
WELL USE (Cheek Applicable k Residadii Wala Supply 5/
I-C110 DATE DRILLED -3—
THE COMPLETED .2 Ol) AMO PM$
3. WELL LOCATION:
CITY: BP vela n C: Ty co(mrrY rsr,.k}-, n
N13r r,s h l' / ow t a27/3
(Seeet Name. .N Numbers. Cemanatir,Subdivision.LetNa.. Pares. re Code)
TOPOGRAPHIC I LAND SETTING:
OSbpe Maley OF MRidge oOObr
Masa appmprab bw0
LATITHAE sr l4).2 *. 7"
LONGM.ME2WC,3 k"
IatitudeAongit de somca MGPS °Topographic map
(Lemon waoInrsabe shown run a USGS 1oso rap ad
attached b this Arm Ind using CPS)
4. WE.LOWNER
OWNER'S NAME *fan k Sir ; TA
STREET ADDRESS e3rua h l' r'FrK
Base, re c-,Ty lVr .2Fr7/3
RJ
May be indames.
abeam sea:eta
th a dee01 In
orTown Stab rip Code
( 7.2.a.- 63FFl
Area axle - Phone neither
5. WELL DETAILS: 'Ric
a. TOTAL DEPTH: O UU
b. DOESWELL REPLACE EXISTING WELL? YES CI NO 05
c. WATER LEVEL SdowTop d Cathy yCO FT.
(Use ace i Above Top d Casing)
d TOP OF CASNGIS I _ FT. Wage Land Surface*
*Top of casing laminated aUarbebw land sauce may requie
a variance in acccordancew(th 15A NCAC 2C .0118.
e. YIELD Spear .i METHOD OF TEST Gi r
326395
L omnFEcnort Type NTH
g. WATER ZONES (depth):
From 0 To '1 O
From To
Fran To
6. CASING:
Depth Diameter
From O To . 7 r Ft (n
From To Ft
Fran To • Ft
From
Fan
Amount /,P dZ
To
To
From To
Tlicgmsal
Weigh
crira MYC
7. GROUT: Depth Maeda'
ia'
Fan n To r.07) ` R Ca+menT
From To Ft
Fan To Ft
Method
pu�n�
8. SCREEIt Depth Drawbar Slot Ste Material
Fran To R it ilL
Fan To Ft. al _ in.
From To Ft in. in.
A SAND/GRAVEL PACK:
Depth Ste Material
Fiore To R
From To . R
Fan To R
T!
10. DRILLING LOG
From To
Formation Desap)bn
cJ
0
JUN 06[OS
11. REMARKS:
}
ry 0
11r0HEREBY CE IWVIHATTISWEALWAS CONSMUCimWACCORDANCElento
15ANCACat.WELL . tLC1RUCRONSTANDARDS. AND THAT ACOPY OF MIS
RECORD WAS HEErl PnWh®To NE WELL Meet
SIGNATURE OF CEet m WIFD WELL CONTRACTOR RITE
-re -Pk ilyele
PRATED NAME OF PERSON CONSTRUCTING THE WELL
Submit the original to the Division of Water Quality within 30 days. Attu: 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 8
1. WELL CONTRACTOR:
005d-ice Vh �\<erS
Well Contractor (Individual) Name
C W Q11 0 e:l � r�
Well Contractor Company
Name[ �/--
STREET ADDRESS 1‘. gQ /-t ycle ✓ ().rn)`_n
VDbivivII le Lv _ nt7577/
City or Town State Zip Code
(/Colt)-Li71 _CrtjSt/
Area code- Plane number
2. WELL INFORMATION:
SITE WELL ID 8(8applicable)
STATE WELL PERMIT/idapplicable)
DWQ or OTHER PERMIT #(if applicable)
WELL USE (Check Applicable Box): Residential Water Supply Qk
DATE DRILLED �` 027 -D 6
TIME COMPLETED / 00 AM PM*
3. WELL LOCATION:
CITY: 0?1760,rN. _CI 11 COUNTY (5(,,J(AT>,
1.-.oI4er G,lc.(kp..
(Street Name. Numbers. Canmuity..SubdMsion, Lot No.. Parcel. 2q Code) -
TOPOGRAPHIC / LAND SETTING:
❑Slope OValey °Flat %Ridge ❑Other
(cheek a,propdate box)
SD 'se.31'
LATITUDE 3 LONGITUDE 9-3 r erg
May he in degrees,
minutes, seconds or
in a decimal format
Latitude/longitude source: $GPS °Topographic map
(bcatbn of well must be shown on a USGS topo map and
attached to this foie anof using GPS)
4. WELL OWNER /
OWNER'S NAME TO)''A lVQrrJL
STREET ADDRESS J..,otar Cd c.4 YC G.
�ry6Or.0 �V r. 2t7) 3
City a Town fate Z4 Code
1104 r- -dela 3
Area code - Phone number
5. WELL DETAILS: 70
a. TOTAL DEPTH:
b. DOES WELL REPLACE EXISTING WELL? YES NO)l(
c. WATER LEVEL Below Top of Casing: b FT.
(Use "1-* if Above Tap of Casing)
d. TOP OF CASING IS 1 FT. Above Lath Surface•
'Tap of casing terminated at/or below lad surface may require
a variance in accordance with 15A NCAC 2C .0118.
e. YIELD (gpm): (3 METHOD OF TEST OI 4
326394
f. DISINFECTION: Type
9•
Fran 0 To 7bS
Fran To
From To
6. CASING:
WATER ZONES (depth):
Depth
From t� To 37 Ft
From To Ft
From To Ft.
Amount 0
From To
From To
From To
Diameter
6'ki
Thickness/
Weight Material
so It iD.j-
7. GROUT: Depth Material
Frain_p_To ao FtfQMQ'+
Fram To Ft
From To Ft
• Method
(�
8. SCREEN: Depth Diameter Slot Size Material
Fran To Ft. in in.
From To Ft in. _ in.
From To Ft in. in.
9. SANDIGRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
From To Ft
10. DRIWNG LOG
From To Formation Description
O
CO
11. REMARK o
%t7 60 /I-4 yc rc Xrc-rfilite
I DO HERESY CERIFY THAT WS WELL WAS CONSTRUCTED 11 ACCORDANCE WMIH
15A NCAC 2C. WELL CONSTRUCTION STANDARDS. AND THAT A COPY OF THIS
RECORD HAS BEEN PROVIDED TO THE WELL OWNER
SIG E OF CERTIFIED WELL CONTRACTOR DATE
d7069-hr rhiI6475
PRINTED NAME OF PERSON CONSTRUCTING THE WELL
Submit the original to the Division of Water Quality within 30 days. Attn: Information Mgt,
1617 Mail Service Center— Raleigh, NC 27699-1617 Phone No. [phone] ext 568.
Form GW-la
Rev. 7/05

RESIDENTIAL WELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources- Division of Water Quality
WELL CONTRACTOR CERTIFICATION #
1. WE ONTRACTOR:
Well Dick
(Individual) Name I
Well Contracts Company Name
STREET ADDRESS 6 rH ycly LThV'n (C b Ael
RA iriVale r\ C,
City or Tcwn State Zip Code
1?1,2f()-117i — gl-jsv
Area cede- Phone number
2. WELL INFORMATION:
SITE WELL ID (Rif applicable)
STATE WELL PERMIT#( ,plicahle)
DWQ or OTHER PERMIT #(d applicable)
WELL USE (Check Applicable Bak): Residential Water SupplyA
DATE DRILLED / -al) -Q G
TIME COMPLETED at 0 0 AM O PMk))
3. WELL LOCATION:
CITY: IC7TyrS0T‘ CI kL)." COUNTY CS L-i(Ai 11
t, Creek_
N (Street Name. bees. Canmunity,. Subdivision, Lot No., Parcel, Zip Code) -
TOPOGRAPHIC / LAND SETTING:
❑Slaps OValy (Flat ❑Ridge °Otlor
(deeds appropriate box)
LATITUDE 3 3! ix .1 �Id. 7 r/
LONGITUDES af !R /e+ (4331 rr
Latitude/longitude source: ,GPS ['Topographic map
Vocation of Red must be shown on a USGS logo map and
attached to this lam ink using GPS)
May be in degrees,
miane; seconds et
m a decimal Tamar
4. WELL OWNER
OWNER'SNAMNIT E ' U OLP. 1 I Q'rCe
STREET ADDRESS C1oC C reek
Be1,Ct y at7t 3
City or Town State Zip Cade
( fluff )- 736 — 4617i2
Area code - Phone number
5. WELL DETAILS: a 1 30
TOTAL DEPTH:
b. DOES WELL REPLACE EXISTING WELL? YES 0 NO [x
c. WATER LEVEL Below Top d Casing: J Z FT.
(Use if Above Top of Casing)
d. TOP OF CASING IS � FT. Above Laid Surface*
'Top d easing terminated at/or below lad surface may require
a variance in accordance with 15A NCAC 2C .0118.
• e. YIELD (gpm): V METHOD OF TEST 01.1 r
326393
f. DISINFECTION: Type 1-1T1"1
Amount OZ
g. WATER ZONES (depth):
Fran S' t To r3V i From To
Fran To From To
Fran To From To
6. CASING:Depth d gat
Fran (h r/ Ft (�+.( a
From To
Ft.
From To Ft.
Thickness/
Weight
grr
Materiali
7- GROIN: Depth Material Method
From 0 To al) Ft ran...i'
Fran To Ft.
Fran To FL
& SCREEN: Depth Diameter Slot Size Material
From To Ft. in. In.
From To Ft in. _ in.
From To Ft in. in.
A SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
From To Ft.
10. DRILLING LOG
From To Formation Description cO
O
1:22
T'nr
li!:1 (; nnr.:
J [ /y
11. REMARKS:
100 HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED N wrr ienuwn Tint
15A NCAC 2C, WELL CONSTRUCkCN STANDARDS, AND MAT A COPY OF THIS
RECORD HAS BEEN PRODDED TO THE WELL OWNER
SIGNAi E OF CERTIFIED WELL NTRACTOR DATE
co53-1., IM•
1ki
PRINTED NAME OF PERSON CONSTRUCTING 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- Divisionvof Water Quality
Di
WELL CONTRACTOR CERTIFICATION # 33 O { .
1. WELL
W ONTRACTOR:
�s'� e1\sn
s(nNane
COriU v1dWell Contractor Company Na_I
STREET ADDRESS C I N y C�2. V cx n. et6_ %(
(�.r bbc-rs Ue r m gn-r
City or Town State Zip Code
(o®'O )-//
L%71— c6 4g4
Area code- Phone number
2. WELL INFORMATION:
SITE WELL ID LW applicable)
STATE WELL PERMIT/kit applicable)
DWQ or OTHER PERMIT IV applicable)
WELL USE (Check Applicable Box): Residential Water Supply ic
DATE DRILLED U - c%O 6
�t
TIME COMPLETED /f.°On AM PMF4
3. WELL LOCATION:
CITY: f jsy Sn„ Col-y COUNTY cJ1/4.)6..1�Yv
I -I To Liar, ► zoxl
tree) Name. . Camnrra _Suhtlhts' LatNo.
(S a Inn. . Parcel, Zip Code}
TOPOGRAPHIC / LAND SETTING:
OSlope OVaney ❑Flat poidge ❑Other
(cheek appropriate boo)
LATITUDE 3 rSu i .1Set( rr
LONGITUDE
6Z' 3a'bo$u
May be in degea,
minutes, seconds or
in decimal format
Latitude/longitude source: MOPS OTopographic map
(bcation of wel must be shown on a USGS fopo map and
attached to this ram 1not uskg GPS)
4. WELL OWNER +- 1.1
OWNER'S NAME ,{ f1 1` TY% V n LA STREET ADDRESS MIA+a L.t r Re
kgriei<& CT y / a�7/ 3
City or Town State Zip Code
Area code - Phone numbs
5. WELL DETAILS:
a. TOTAL DEPTH:
LinCi
b. DOES WELL REPLACE EXISTING WELL? YES
YYES ❑ NOA
c. WATER LEVEL B"'{ ebw Top of Casing: J FT.
(Use 8 Above Top d Casing)
d. TOP OF CASING IS I - FT. Above Land Surface•
'Top of casing terminated at/or belay land surface may require
a variance in accordance with 15A NCAC 2C .0118.
e. YIELD (gpm): In METHOD OF TEST 01/21 1
326392
t. DISINFECTION: Type e -
Amount 1 6 nZ _
g. WATER ZONES (depth):
From L& I To 405 From To
From To From To
Fran To From To
6. CASING: I�9et Thickness/Fran 0 �Toomr�i LI Ft._4 1/c.`g t aCL_ From To Ft i�
From To Ft
7. GROUT: Depth Material
Ram 0. To bib Ft itC-Tnneltrlil-
From To Ft.
From To Ft
Method
8. SCREEN: Depth Diameter Slat Size Material
From To Ft. in. in.
From To Ft. in. is
From To Ft. in. in.
9. SAND/GRAVEL PACK:
Depth Size Material
From To FL
From To Ft
From To FL
.
10. DRIWNG LOG
From To Formation Descriptbn
11. REMARKS:
Z
O
.,
irut
CO
:1 r n ✓r4)
r-t
0
I00 HEREBY CERTFY THAT TH6 WELL WAS CONSTRUCTED N ACCORDANCE WITH
15A NCAC TO WELL CONS1RUCtial STANDARDS. AND THATA COPY OF TRS
RECORD HAS BEEN PROVIDED TO THE WELL OWNER.
SIGNAperIE OF CERTIFIED> RACTOR DATE
b
PRINTED NAME OF PERSON CONSTRUCTING THE WELL
Submit the original to the Division of Water Quality within 30 days. Attn: Information Mgt.,
1617 Mail Service Center -Raleigh, NC 27699-1617 Phone No. [phone] ext 568.
Form GW-la
Rev. 7/05

RESIDENTIAL WELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources- Division of Water Quality
WELL CONTRACTOR CERTIFICATION #
1. WELL COMRACTOR:
OVOKerS
W a hactor (Individual) (Name rt�
WCco tractor Companyi---�N7a \ke Or(T�-, d
STREET ADDRESS (< :l '/(�%f/-I ycJP 1 ZX- v- Y&c cL
I l AVID 11,5. ��%7I
oily or Tam State Zip Cale
( 45a£0- LI75- cr41611
Area code- Phone number
2. WELL INFORMATION:
SITE WELL ID #(N applicable)
STATE WELL PERMIT#(irapplicable)
DWQ or OTHER PERMIT #(if wearable)
WELL USE (Check Applicable Box): Residential Water Supply (X
DATE DRILLED LI — I cI— 017
TIME COMPLETED 1 d; o n AMJ4 PM 0
3. WELL LOCATION: __ ♦♦
CITY: 6tyson (h.Py couNTY S inky
I^Ick Loc_
(Street Name. Numbers, adly_subdivision, .Let No., Parsed. ZIP Code)
TOPOGRAPHIC I LAND SETTING:
❑ Slope 4aley ❑Fiat ❑Ridge °Other
ttcheck appropriatefnbox)
LATITUDE 3 AZ )1S137-!
33yr
LONGITUDE re' 1 U_2e'f
Latitude/longitude source: fLGPS °Topographic map
(location of we#must be shown on a USGS tope map and
Stashed to Baer form /not usig GPS)
4. WELL OWNER �-
OWNER'S NAME I�L. 32 L (1W1CL3tI , r
STREET ADDRESS 1—(GdC. Lo S
Arylov,laa y ITC an]3
City or Town ' State Zip Code
c tars)- 736 — C5c7, 7
Area code - Phone number
May be m degrees,
minutes, seconds or
in a decimal format
5. WELL DETAILS: / f
a. TOTAL DEPTH:
b. DOES WELL REPLACE EXISTING WELL??, IIYES CI NO j§
c. WATER LEVEL Below Top or Casing L., O FT.
(Use'+• it Above Top d 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.
e. YIELD (gpm): / METHOD OF TEST 01. 1 r
326391
I. DISINFECTION: Type i'(Ti-I Amount ;Co 7
9.
From 'lb / To & OS From To
From To From To
From To Fran To
6. CASING: Thickness/
Fran (7 To_ 1 Ft er I1tt Atm; it
From To Ft.
From To Ft.
WATER ZONES (depth):
7. GROUP: Depth Material
From () To 90f Ft. ( gierazn(- pOrnei d
From To Ft.
From To Ft
Method
8. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in.
From To Ft in. _ in.
From To Ft. in. in.
9. SAND/GRAVEL PACK:
Depth Size Material
From To FL
From To FL
From To Ft.
10. DRIWNG LOG
From To Formation Description
11. REMARKS:
♦J
2- fn
LI
r
cJ
r
1 DD NEREar CERTIFY THAT DE WELL WAS CONSTRUCTED N ACCORDANCE WITH
15A NCAC 2C. WELL CONSTRUCTION STANDARDS. AND THAT A COPY OF THIS
RECORD HAS BEEN PROVIDED TO THE WELL
OWNER. IIIR
SIGNATURE -OF CERTIFIED WELL CONTRACTOR `� -IDAT ��
7)u(Shh (till \6e, s
PRINTED NAME OF PERSON CONSTRUCTING THE WELL
Submit the original to the Division of Water Quality within 30 days. Attn: Information Mgt,
1617 Mail Service Center— Raleigh, NC 27699-1617 Phone No. [phone] ext 568.
Form GW-la
Rev. 7/05

RESIDENTIAL WELL corisTRUCTiON RECORD
North Carolina Department of' Environment and Natural Resources -Division of Water Quality
WELL CONTRACTOR CERTIFICATION # . 2045
1. WELL CONTRACTOR:
James B. Brown
'^'tit Contractor (Individual) Name
Hedden Brothers Well Drilling, Inc.
Well Contractor Company Name
73'Holly'Hills Vista RD
NC 28734
STREET ADDRESS
Franklin.
City or Town State
(828 )- 369-9591
. Zip Cede
Area code- Phone number ,
2. WELL INFORMATION:
SITE WELL ID 'Alf applicable)
STATE WELL FERMI-10(If applicable)
DWQ or OTHER PERMIT Cif applicable)
WELL USE (Check Agplica
DATE DRILLED
TIME COMPLETED
3. WELL LOC/,jION
0
• Residential Water Supply ❑
AMC,(PPMX
COUNTY
_._
(Street Name, N'mhen, Community, SuhdiUslon, Lot No., Parcel, 21p Code)
TOPOGRAPHIC /LAND SETTING:
°Slope °Valley ❑Flat °Ridge ❑Other
(check appropriate box)
LATITUDE
LONGITUDE
May be in degrees,
minutes, seconds or
in a decimal format
Latitude/longitude source, GPS ❑Topographic map
(location of well must be hown on e USGS topo map and
attached to this form tY not using GPS)
A. WELL OWNER
OWNER'S NAME
S,EET ADDRESS
ip Code
Ares code • Phone number
'6. WELL DETAILS: ] /- 6
a. TOTAL DEPTH: / 49
b. DOES.WELL REPLACE EXISTING WELL? YES ° NO,'
c.. WATER LEVEL Below Top. of Casing: /60 ' FT.
• (Use'+" If Above Top of Casing)
d. TOP OP CASINO IS 2 FT. Above Land Surface'
'Top of casing terminated et/or below land surface may require
a variance In accordance with 15A NCAC 2C .0118.
e. YIELD (ppm): r4D METHOD OF TEST Blow
T. DISINFECTION: Type H T H Amount 160z
g. WATER ONES (de pi :r
From ToV1) - From To
From_ To /66 � From To
%'�
From TO g From To
Thickness/
DlaJneter Weight M err
9. CASING:
Depth
From To
Frcm To
From To Ft
Ft
7. GROUT: Depth Material
From 0 - To 20 °Cement & benonite
From To Ft.
From To Ft.
Method
E. SCREEN: Depth Diameter Slot Size Material
From To Ft In. In,
From To Ft In. In.
From To Ft. in. In.
9. SAND/GRAVEL PACK:
Depth
From To Ft.
From To Ft.
From To Ft.
10. DRILLING LOG
From To
11. REMARKS:
Size
Materiel
Formation Description
clay & sand
graniYP'
e
h�etiR-
n. `tI
100 HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH
15A NCAC SC, WELL CONSTRUCTOR STANDARDS, AND THAT A COPY OF THIS
RECORDf1AS BEEN PROVIDED TO THE WELL OWNER.
NATURE OF GE FIED WELL CONTRACTOR DATE
James B. Brown
PRINTED NAME OF PERSON CONSTRUCTING THE WELL
Submit the original to the Division of Water Duality within 30 days. Attn: Information Mgt.,
1617 Mall Service Center —Raleigh, NC 27699.1617 Phone No. [phone] ext688.
Form GW-la
Rev. 7/05

WELL CONTRACTOR CERTIFICATION # 2045
RESIDENTIAL WELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources -Division of Water Quality
272-'F
1. WELL CONTRACTOR:
James. B. Braun
Well Contract& (Individual) Name
Hedden Brothers Well Drilling, Inc.
Well Contractor Company Name
STREET ADDRESS 73 HollyHillsVista RD
Franklin, NC 28734
City or Town State Zip Code
828 )- 369-9591
Area code- Phone number ,
2. WELL INFORMATION:
SITE WELL ID apt eppicahb)
STATE WELLPERMITB(ir appilcable)
DWQ or OTHER PERMIT 4(If applicable)
WELL USE (Check Applicable Box): Residential Water Supply Cl
DATE DRILLED
TIME COMPLETED T (1LD AMX PMC
3. WELL LOCATION:
CITY:
NTY
britdart, Lot No.. Parcel,CZ*lp'—Ca
/ ry
(Strict Na ,Number, Community, Su
de)
TOPOGRAPHIC / LAND SETTING: -
❑Slope °Valley ❑Flat ❑Ridge ❑Other
(check sperm) ste box) ^/
LATITUDE gAs..) 5, `r'
LONGITUDE ( / / u ,
May be in degrees,
minutes, seconds or
in a decimal format
Latitude/longitude source: ❑GPS °Topographic map
(location of well must be shown on a USGS topo map and
attached to this tom, if not using GPS)
4. WELL OWNER
OWNER'S NAME
STREET ADDRESS
City or
Town_g r• States , Zip Code
AArea cage - Phone
l�ll�ll__1ITT//
Area code - Phone numbe
6, WELL DETAILS: /
a. TOTAL DEPTH: ' /
b. DOES WELL REPLACE EXISTING WELL? YES ❑ NO
pJ
a.. WATER LEVEL Below Top of Casing: OW FT.
(Use'+' If Above Top of Casing) d. TOP OF CASINO IS 2 FT. Above Land Surface'
-Top of casing terminated atior below land surface may require
a variance In accordance with 15A NCAC 2C .0118.
e. YIELD (ppm): / • 5 METHOD OF TEST Blow
f. DISINFECTION: Type H T H Amount 160z
9. WATE ZONES (dgpthy
•
From b5* To From To
From /i D' To From To
From To -From. To
9. CASING:
Thickness/
From (� Depth
Ft, Dlamet¢ Wilk, Matprlal_
From ToFt. / / ��(J
From To Ft.
7. GROUT: Depth Material Method
From 0 To 20 xetlent & benonite
From To Ft.
From___ To Ft.
9. 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 Tot-�n
(
11. REMARKS:
Formation Description
clay & sad
Trani to
rV
ON
aN
1 DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH
ISA NCAC 2C. WELL CONSTRUCTION STANDARDS, AND THAT A COPY CF THIS
RFC DRQ HAS BEEN PROVIDED TOO THE WELL OWNER. r1{-z;
NATGRE OF CE IFIED WELL ONTRACTOR DATE
James B. Brown
PRINTED NAME OF PERSON CONSTRUCTING THE WELL
Submit the original to the Division of Water Quality within 30 days, Attn: Information Mgt,
1817 Mali Service Center— Raleigh, NC 27699.1817 Phone No. [phone] ext 668.
Form GW-la
Rev. 7/05

RESIDENTIAL WELL CONSTRUCTION RECORD
- North Carolina Department of Environment and Natural Resources -Division of Water Quality
1. WELL CONTRACTOR:
James B. Brown
Well Cantrector!individual) Name:. -
_Redden Brothers Well Drilling, Inc.
Weil Contractor Company Name
STR 73 Holly'Hills Vista RD
STREET
WELL CONTRACTOR CERTIFICATION # 2045
f. DISINFECTION: Type H T H Amount 160z
g. WATEE0 jr9NES (de�h y
From ``66'' To �From To
(
From Tr b To� From To
From To From To
8. CASING: Thickness/
/) Depth Dbmster Weigh 4 rial
Franklin, NC 28734 From (../ To Ft. LP fits
City or Town State Zip Code From__ To__ Ft.
( 828 )- 369-9591 From To Ft.
Area code- Phone number 7. GROUT: Depth Malarial Method
2. WELL INFORMATION: - From 0 To 20 Fcement & benoniped
SITE WELL ID elif Applicable) From To Ft.
STATE WELL PERMIT#{(if applicable) From To Ft.
DWQ or OTHER PERMIT #(lf applicable)
WELL USE (Check A-pllcable Box): Residential Water Supply ❑
DATE DRILLED
TIME COMPLETED
3. WELL LOCATION:
(Street Nam
AM PM}y
COUNTY (\
/n-
umber, CommunJty, SubdiNSlon, Lot No., Parcel, Zip Code)
TOPOGRAPHIC / LAND SETTING:
C Slope OValley ❑Fiat CRIdge DOther
(check uppmpdate box)
•
LATITUDE �p�� Iere( ??cQSA)
LONGITUDED:l- ZQ 7/w
Latitude/longitude source: %GPS ❑Topographic map
(location of well must be shown on a USGS topo map and
• attached to this town if not using GPS)
May be in degrees,
minutes, seconds or
in a decimal format
4. WELL OWNER
OWNER'S NAME U �.
$T E ADDRESS �r
City Zip de
'70j1
Area code • Phone number
6. WELL DETAILS: ^� r
a. TOTAL DEPTH: n(
b. DOES WELL REPLACE EXISTING WELL? YES C NOA.
e.. WATER LEVEL Below Top of Casing: - J FT.
(Use'+' If Above Top of Casing)
d. TOP OF CASINO IS 2 - FT. Above Lend Surface'
'Top of casing terminated at/or below lend surface may require
a variance In accordance with 1 SA NCAC 2C .0118.
a. YIELD (gpm): 2-10 METHOD OF TEST B1OW
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
Aunt
Formation Description
clay & eand
grin{ FP
L
N
O -
II. REMARKS: tT
100 NEREEY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH
15A NCAC 2C, WELL CONSTRUCTION STANDARDS, AND THAT A COPY OP THIS
RECORD HAS BEEN PROVIDED TO THE WELL OWNER.
GNATURE CF ERTIFIEO WELL CONTRACTOR DATE
James B.-Brown
PRINTED NAME OF PERSON CONSTRUCTING THE WELL
Submit the original to the Division of Water Quality within 30 days. Ann: Information Mgt.,
1817 Mali Service Center- Raleigh, NC 27699.1617 Phone No. [phone] ext 668.
Form GW-la
Rev. 7/05

RESIDENTIAL WELL CONSTRUCTION RECORD
NSith Carolina Department of Environment and Natural Resources•. Division of Water Quality
WELL CONTRACTOR CERTIFICATION # . 2045
1, DISINFECTION: Type H T H Amount 160z
g. WATER ZONES (depth):
From /Sx:S��rTo_1 r From
From, /5t To '/t/�7 Frcm
1. WELL CONTRACTOR:
James B. Brown
Well Cenractctr (Individual) Name
Hedden Brothers Well Drilling, Inc.
Well Contractor Company Name STREET ADDRESS 73.Holly Hills Vista RD
Franklin, NC 28734
City or Town State Zip Code
(828 ). 369-9591
Area code• Phone number ,
2. WELL INFORMATION: •
SITE WELL ID #(If applicable)
STATE WELL PERMIT#(if applicable)
DWQ or OTHER PERMIT eV applicable)
WELL USE (Checks Applicable Box): Residential Water Supply 0
DATE DRILLED OJA' 0� at nk22
TIME /COMPLETED
Q . W0 AM ❑ PPMM �,�/J
a. WEC TLL LOY/ / Y.1' �YIA-Wvti. ON: �r.�air.+�-�—
OUNTY
Ir1et Name umbers, Community, Subdl'slon, Lot No., Parcel. ZIp Code)
TOPOGRAPHIC / LAND SETTING: •
❑Slope °Valley In Flat ❑ Ridge 0 Other
(check appropriate�box)
LATITUDE �35 d: 7LONGITUCE�q� Q J
Latitude/longitude source: PS °Topographic map
(location cl well must be h n one USGS topo map and
attached to this form not using GPS)
4. WELL OWNER
OWNER'S NAME
STR T ADDRESS
lty idd p � --_fiState a g:
TownZlp ode
Area co e • Phone number
.6.WELL DETAILS: t
a. TOTAL DEPTH:
b. DOES WELL REPLACE EXISTING WELL? YES ° NO(
e.: WATER LEVEL Below Top of Casing: CZYD FT.
•
•- (Use'✓ If Above Top of Casing)
d. TOP OR CASINO IS 2 FT. Above Land Surface'
'Tap of casing terminated at/or below land surface may require
a variance In accordance with 15A NCAC 2C .0118.
e. YIELD (gpm): 1 0 METHOD OF TEST Blow
May be in degrees,
minutes, seconds or
in a decimal fotmat
3272
To
To
From To - From To
8. CASING: Thickness/
From
From
From To Ft.
Depth
To
DI m5ter Weight M riot
7. GROUT: Depth Material Method
From 0 To 20 FGement & benonite
From To Ft.
From__ To Ft.
8. SCREEN: Depth Diameter Slot Size Material
From To Ft In. In,
From___ To Ft In. In.
From To Ft. in. in.
9. SAND/GRAVEL PACK:
Depth Size Material.
From To Ft.
From To - Ft.
From To Ft.
10. DRILLING LOG
From To
11. REMARKS:
Formation Description
clay & sand
grin{ t•P
n
- t�
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH
1SA NCAC 2C. WELL CONSTRUCTION STANDAROS, AND THAT A CCPY CF THIS
RECORD HAS BEEN PROVIDED TO THE WELL OWNER.
NATURE C RTIFIED WELL CONTRACTOR DATE
James B. Brown
PRINTED NAME OF PERSON CONSTRUCTING THE WELL
Submit the original to the Division of Water Quality within 30 days, Attn: Information Mgt.,
1617 Mall Service Center — Raleigh, NC 27699.1617 Phone No. [phone] eat 688.
Form GW-1a
Rev. 7/05

RESIDENTIAL WELL CONSTRUCTION RECORD
North Carolina Depart mentof Enduonment and Natural Resources•. Division of Water Quality
WELL CONTRACTOR CERTIFICATION # . 2045
1. WELL CONTRACTOR:
James Be Brown
Well Contractor (Individual) Name
Redden Brothers Well Drilling, Inc.
Well Contractor Company Name -
STREET ADDRESS 73 Holly. Hills Vista RD
Franklin, NC 28734
City or Town State Zlp Code
(828 )- 369-9591
Area code- Phone number 2. WELL INFORMATION:
SITE WELL ID #(il applicable) -
STATE WELL PERMIT#(II applicable)
DWQ or OTHER PERMIT #(If applicable)
WELL USE (Check ApPiicible Box Residden al Water Supply
AM ❑ PM®
DATE DRILLED
TIME COMPLETED
S. WELL LOCATION:
CITY:
COUNT't�/1 r0
(Strict Nun , umber', Community, Subdl.lslon, Lot No., Parcel, Zip Code)
TOPOGRAPHIC / LAND SETTING:
0Slope °Valley °Flat °Ridge °Other
(check apprapd ate box)
LATITUDE ' "
LONGITUDE 10
Latitude/longitude source: GPS °Topographic map
(location of well must be n on a USGS topo map and
attached to this loan /l at using GPS)
4. WELL OWNER
OWNER'S NAME
ST ETADORESS
May be in degrees,
minuses, seconds or
in a decimal format
Zip Code
Area code • Phone num•er
6. WELL DETAILS:
a. TOTAL DEPTH: L, E4
b. DOES WELL REPLACE EXISTING WELL? YES
° NO K.
c.: WATER LEVEL Below Top. of Casing: l J FT.
(Use'+' If Above Top of Casing)
d. TOP OP CASINO IS 2 FT. Above Land Surface'
'Top of casing terminated at/or below land surface may require
a valance In aa�cc�oorfr�dda�nnce with 15A NCAC 2C ,0118.
e. YIELD (gpm):;,.-_L_METHOD OFTEST Blow
1, DISINFECTION; Type H T H Amount 1 602
g. WATER Z Es ppth :
From Toy� y%� From To
From To Frdm To
From To From - TO "-
9. CASING: Thickness/
Depth To �%1 - Diameter Weight MatSCI
Fl. O'n�� PV
Ft. Le- ;rur.
7. GROUT:
0
From
From
From
Ft. __
Depth Material Method
To 20 FGernent & benonite
To Ft.
To Ft.
8. SCREEN: Depth Diameter Slot Size Material
From To FL In. - in.
From To Ft. in. In.
From To Ft. In. In.
9. SAND/GRAVEL PACK:
Depth Size Material .
From To Ft.
From To Ft•
From To Ft.
10. DRILLING LOG
From To
atallbra
11. REMARKS:
Formation Description
clay & sand
gr'Ani t•P
INS
O
100 HEREBY CEATIFY THAT THIS W ELL WAS CCNSTRUCTEO IN ACCORDANCE WITH
ISA NCAC 2C, WELL CONSTRUCTION STANDARDS. AND THAT A COPY CF THIS
RECOAe'MS BEEN PROVIDED TO THE WELL OWNER.
ATU�ROF C RTI ED WELL CONTRACTOR DATE
James B. •Brown
PRINTED NAME OF PERSON CONSTRUCTING THE WELL
Submit the original to the Division of Water Quality within 30 days. Attn: Information Mgt.,
1617 Mali Service Center- Raleigh, NC 27699.1617 Phone No. [phone] ext 688.
Form GW-la
Rev. 7/05

RESIDENTIAL WELL CONSTRUCTION RECORD
North Carolina Department of Environment And Natural Resources -.Division of Water Quality
WELL CONTRACTOR CERTIFICATION # . 2045
1. WELL CONTRACTOR:
James, B. Brown
Well Contractor (IndMdual) Name
Redden Brothers Well Drilling, Inc.
Well Contractor Company Name .
STREET ADDRESS 73 Holly Hills Vista RD
Franklin, NC 28734
City or Town State Zip Code
(828 )- 369-9591
Area code Phone number
2. WELL INFORMATION:.
SITE WELL ID IMF applicable)
STATE WELL PERMITS(Ir applicable)
DWQ or OTHER PERMIT e(If applicable)
WELL USE (Check Applicable Box): �R�essidd/y
_fith
enntial Water Suppl
DATE DRILLED -�
TIME. COMPLETED r ()pV AM ❑ PM(
3. WELL L0 ION: 1�1,,,,
CITY: yUNTYU/lib/M)
_. n..
(S reel Name, Numbers, Community, SubdMNalon. Lot No., Parcel, Zip Code)
TOPOGRAPHIC / LAND SETTING:
O Slope OValiey ❑Flat ❑Ridge
(check eppropri etc box)
LATITUDE j_
LONGITUDE
Latitude/longitude source: OGPS Topographic map
(location of well must be shown on a USGS tope map and
attached to the loan if not using GPS)
4. WELL OWNER
OWNER'S NAME IL
STfjEET ADDRESS
❑Other
May be in degrees,
minutes, seconds or
in a decimal format
nett J 11
ary Town Slate
)- 4IR$
Area code • Phone number
7
44))
Zlp Code7
6. WELL DETAILS:w t
a. TOTAL DEPTH: Rea
b. DOES WELL REPLACE EXISTING WELL? YES NOA
e.: WATER LEVEL Below Top of Casing: FT.
(Use •4" If Above Top of Casing)
•
d. TOP OP CASINO 13 2 - FT. Above Lend Surface'
'Top of casing terminated at/or below land surface may require
a variance In aced ante with 15A NCAC 2C .0118.
e. YIELD (gpm): 4 METHOD OF TEST Blow
1. DISINFECTION: Type H T H Amount 160z
g. WATER ZONES (depth):
From :• To From To
From To From To
From To From - . — To .
8. CASING:
Depth
From_1L To
Frcm
From To
7. GROUT: Depth
From 0 To 20
From To_
From To
Thickness/
Diameter Weight trial___ nz
Material Method
_ Fvement & benonite
Ft.
Ft.
8. SCREEN: Depth Diameter Slot Size Material
From To Ft. In. In.
Frcm To Ft. in. In.
From To Ft in. In.
9. SAND/GRAVEL PACK:
Depth
From
From
From
To FI.
To Ft.
To Ft.
10. DRILLING LOG
From To,
i lr oo1
Size Material.
Formation Description
clay & sand
gr-ani l o
c
11. RE ` ASS» n � may) �.
,CJ(f/�J( (.I�.i
I Co HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH
ISA NCAC EC. WELL CONSTRUCTION STANOARCS, AND THAT A COPY OF THIS
RECORtS7IAS BEEN PROVIDED TO THE WELL OWNER.
s%a*
GNATURE OF E TIFIED WELL CONTRACTOR DATE
James B. Brown
PRINTED NAME OF PERSON CONSTRUCTING THE WELL
Submit the original to the Division of Water Quality within 30 days. Attn: Information Mgt.,
1617 Mall Service Center— Raleigh, NC 27699.1817 Phone No. [phone] ext 588.
Form G W 1 a
Rev. 7/05

RESIDENTIAL WELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural -Resources- Division of Water Quality
WELL CONTRACTOR CERTIFICATION # 2045
1. WELL CONTRACTOR:
James B. Brown
Well Contractor (Individual) Name
Hedden Brothers Well Drilling, Inc.
Well Contractor Company Name
STREET ADDRESS 73 Holly Hills Vista RD
Franklin, NC 28734
City or Town State
(828 )- 369-9591
Zip Code
Area code- Phone number
2. WELL INFORMATION:
SITE WELL ID #(if applicable)
STATE WELL PERMIT#(if applicable)
DWQ or OTHER PERMIT #(if applicable)
WELL USE (Check Applicable Box): jResidential Water Supply tt.
PATE DRILLED 1i .O{ 1 •O1Q
TIME COMPLETED ebJ
Oa
3. WELL LOQ(�T ' ^ ^. N:
CITY: l/ ' IX..IY•Jvl.lnlA4C• K.x.-
AM ❑ PMK
OUNTY\. LOCI;n.
(Street Namumbers,. ommunity, Subdivision. Lot No.el, Zip Code)
TOPOGRAPHIC / LAND SETTING: �v1
❑Slope OValley OFIat IDRidge ❑Other
(check appropriate box)
LATITUDE 3
LONGITUDE
stitude/longitude source: OGPS ❑Topographic map
(location of well must be shown on a USGS topo map and
attached to this fo .• If not using GPS)
May be in degrees,
minutes, seconds or
in a decimal format
4. WELL OWNER rs A,r' • 4
OWNER'S NAME C!//!(Y 4 1 % I /
STREET ADDR SS � -30 zo:t{ j
Nc L 7/
City or Town I State Zip Code
(2,am)- 4q7- 2/ tJ
Area code • Phone number
5. .YELL DETAILS: ���I
a, TOTAL DEPTH:
b. DOES WELL REPLACE EXISTING WELL?? YES ❑ NOet
c. WATER LEVEL Below Top of Casing: aO FT.✓✓��...
(Use "+^ if Above Top of Casing)
d. TOP OF CASING IS 2 FT. Above Land Surface'
'Top of casing terminatell at/or below land surface may require
a variance in accordance with 15A NCAC 2C .0118.
e. YIELD (gpm): COO METHOD OF TEST Blow
J 2 9 r( 4 1
f. DISINFECTION: Type H T H Amount 1 60z
g. WATER ZONES (dept
f I
From.4(0 To 01 From To
From To From To
From To From To
6. CASING: Thickness/
JJJJ���l Depth�,�,�)�,yyyy Di 4er Weight Mat rial
From To FFt. / I
Fromf it To Ft. /nr• / B ,t/n.
From To Ft.
7. GROUT: Depth Material Method
From 0 To 20 FGement & benonite pumped
From To Ft.
From To Ft.
8. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in.
From To Ft. in. In.
From To Ft. in. In.
9. SANDIGRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
From To Ft.
10. DRILLING LOG
From To
/63' 0155'
Formation Description
clay & sand
granite
n.
V7
11. REMARk,' Wait
I CO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH
15A NCAC 2C, WELL CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS
RECORDJIAS BEEN PROVIDED TO THE WELL OWNER.
� lvQ 10
NATURE OF C RTIFIED WELL CONTRACTOR DATE
James B. Brown
PRINTED NAME OF PERSON CONSTRUCTING THE WELL
Submit the original to the Division of Water Quality within 30 days. Attn: Information Mgt.,
17 Mail Service Center -Raleigh, NC 27699-1617 Phone No. [phone] ext568.
Torm G W-1 a
r" U- Rev. 7/05

RESIDENTIAL WELL CONSTRUCTION RECORD 3 2 9 7 4 0
North Carolina Department of Environment and Natural Resources- Division of Water Quality
WELL CONTRACTOR CERTIFICATION # 2045
1. WELL CONTRACTOR:
James B. Brown
Well Contractor (Individual) Name
Redden Brothers Well Drilling, Inc.
Well Contractor Company Name
.STREET ADDRESS 73 Holly Hills Vista RD
Franklin, NC 28734
City or Town . State Zip Code
(828 )- 369-9591
Area code- Phone number
2. WELL INFORMATION:
i TE WELL ID #(it applicable)
'.PATE WELL PERMIT#(if applicable)
DWQ or OTHER PERMIT #(if applicable)
WELL USE (Che k Applicable Box): ResidentialpJ Water Supply
DATE DRILLED to
TIME COMPLETE AM 0 PMX
7. WELL LOIION
-CITY: COUNTY
COUNTY
019,1
(Street Name, Numb emmunity, Subdivision, Lot No., Parcel, Zip Code)
TOPOGRAPHIC / LAND SETTING:
is Slope ❑Valley ❑Flat ID Ridge DOther
(check appropriate box)
LATITUDE 3
LONGITUDE
Latitude/longitude source: ❑GPS. ❑Topographic map
(location of well must be shown on a USGS topo map and
attached to this formif not using GPS)
May be in degrees,
minutes, seconds or
in a decimal format
<. WELL OWNER
OWNER'S NAME
0.
EET ADDRESS 0 111. •
City or Town State
( %z% )- 491- 5.(o 13
Area code • Phone number
U2111-
c %"119
Zip Code
5. WELL DETAILS: 300
a. TOTAL DEPTH:
b. DOES WELL REPLACE EXISTING WELL? YES 0 NOk
c. WATER LEVEL Below Top of Casing: d5 00 FT.
(Use "4" if Above Top of Casing)
d. TOP OF CASING IS - 2 FT. Above Land Surface'
'Top of casing terminated at/or below land surface may require
a variance in accordance with 15A NCAC 2C .0118.
e. YIELD (gpm): /6 METHOD OF TEST Blow
1. DISINFECTION: Type H T H Amount 160z
g. WATER ZON4S (depth):ep�f
From To ar0y� From To
From ZD tTa #J 1 rI From To
qU 1 From Ol7 1 To From To
6. CASING: Thickness/
Ah Depth DirtW Weighj, Wir.i. l
From To
��yFt. r /OaP
From To Ft.
From To Ft.
7. GROUT: Depth Material Method
From 0 To 20 Fvenent & benonite pumped
From To Ft.
From To Ft.
8. SCREEN: Depth Diameter Slat Size Material
From To Ft. in. in.
From To Ft. in. in.
From To Ft. in. in.
9. SAND/GRAVEL PACK:
Depth Size Material
Fropt To Ft.
From To Ft.
From To Ft.
10. DRILLING LOG
From To
o J3Zr in.' aD
Formation Description
clay & cand
(3T-an t t-P
11. REMARKS: ,Q�Q,Q
C4 1
DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH
15A NCAC 2C, WELL CONSTRUCTION STANDARDS. AND THAT A COPY OF THIS
RECOBP HAS BEEN PROVIDED TO THE WELL OWNER.
NATURE OF CERTIFIED WELL CONTRACTOR DATE
James B. Brown
PRINTED NAME OF PERSON CONSTRUCTING THE WELL
Submit the original to the Division of Water Quality within 30 days. Attn: Information Mgt.,
1617 Mail Service Center — Raleigh, NC 27699-1617 Phone No. [phone] ext 568.
Form GW-la
Rev. 7/05

iSD 329739
RESIDENTIAL WELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources- Division of Water Quality
WELL CONTRACTOR CERTIFICATION # 2045
1. WELL CONTRACTOR:
James B. Brown
Nell Contractor (Individual) Name
• Hedden Brothers Well Drilling, Inc.
Well Contractor Company Name
STREET ADDRESS 73 Holly Hills Vista RD
Franklin, NC 28731
City or Town State Zip Code
( 828 )- 369-9591
Area code- Phone number
WELL INFORMATION:
iTE WELL ID #(if applicable)
STATE WELL PERMIT#(if applicable)
")WQ or OTHER PERMIT #pf applicable)
WELL USE (Check Applicable Box): Residential Water Supply']
DATE DRILLED V I I 317 m-5
'TIME COMPLETED 1 .13t. AM ❑ PM
3. WELL L(( �TION::
COUNTY 214)2.Nier
(Street Name, Numbers, ommunity, Subdivision, Lot No., Parcel, Zip Code)
• -TOPOGRAPHIC / LAND SETTING:
i .lope ❑Valley ❑Flat El Ridge ❑Other
(check appropnate box) 1. `
LATITUDE _i 3Q 1. '1tv
LONGITUDE%_+ iy 350-
Latitude/longitude source: liPS ❑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 �� per/
( REET ADDRESS �1.tLt -t3•VLL eV/
May be in degrees,
minutes, seconds or
in a decimal format
NY_ t aaZg1 1
ity or Town r State Zip Code
trivial
Area code- Phone number
5. NELL DETAILS: 4� r
a. TOTAL DEPTH:
b. DOES WELL REPLACE EXISTING WELL? YES ❑ NO
c. WATER LEVEL Below Top of Casing: 50 FT.
(Use'+" if Above Top of Casing)
1. TOP OF CASING is 2 . FT. Above Land Surface'
*Top of casing terminated at/or below land surface may require
a variance in accordance�_or^with 15A NCAC 2C .0118.
/
YIELD (gpm): 6 0+ METHOD OF TEST Blow
From
From '33 a3 al'o / From To
From To From To
6. CASING: Thickness/
Depth G Diaper Wei hI ail
From To 95 Ft. a ee
From To Ft.
From To Ft.
f. DISINFECTION: Type H T H Amount 1 60Z
g. WATER ZONES (depth)
Si& 'To l " From To
7. GROUT: Depth Material Method
From 0 To 20 FGement & benonite pumped
From To Ft.
From To Ft.
8. SCREEN: Depth Diameter Slot Size Material
From To Et. 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
1
11. REMAR
Formation Description
clay & sand
grant 1 e
C'
c_
0
J
rR
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH
t5A NCAC 2C. WELL CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS
RECORD_HAS BEEN PROVIDED TO THE WELL OWNER.
? /.3E
NATURE OF CERTIFIED WELL CONTRACTOR - DATE
James B. Brown
PRINTED NAME OF PERSON CONSTRUCTING THE WELL
Submit the original to the Division of Water Quality within 30 days. Attn: Information Mgt.,
1617 Mail Service Center— Raleigh, NC 27699-1617 Phone No. [phone] ext 568.
Form GW-la
Rev. 7/05

STREET ADDRESS
RESIDENTIAL WELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources- Division of Water Quality J 2
WELL CONTRACTOR CERTIFICATION It ,ib9
1. WEL CONTRACTOR:
Well o
ntraclor (Individual) Name
CRANE RRQTpr re r"ri.l DP.ILUC, a..,.
Well Contractor Compa2yamrgANE CIRCLE
FRANKLIN, NC 28734
City or Town State Zip Code
(SQSf )-.. —�f9zI0
Area code- Phone number
2. WELL INFORMATION:
SITE WELL ID N(ir applicable)
STAT f_ WELL PERMITR(ir applicable)
DWQ or OTHER PERMIT #(if applicable)
WELL USE (Check Applicable Box): Residential Water Supply 0
DATE DRILLED
TIME COMPLETED AM❑ PMD
3. WELL LOCATION:
e,
CITY: ygsopi L./r ;:Ht
h rtt� / /
(Street Name, Numbers. Community, SubdiWsion, Lot No., Parcel. Zip Code)
TOPOGRAPHIC / LAND SETTING:
❑Slope DValley ❑Flat °Ridge DOther
(check appropriate box)
LATITUDE 3
LONGITUDE
Latitude/longitude source: ❑Ol'S °Topographic map
(iocation or well must be shown on a USGS /opo map and
attached to this form rT not using GPS)
COUNTY SWa ( tJ
May be in degrees,
minutes, seconds or
in a decimal format
4. WELL OWNER OWNER'S NAME—.50kA)
STREET ADDRESS Pi 0 poz /ttJ7)_
City 6r Town
Af c- a 7 %/ 3
State Zip Code
Area code - Phone number
5. WELL DETAILS:
a. TOTAL DEPTH:
b. DOES WELL REPLACE EXISTING WELL/ YES
Not-
c. WATER LEVEL Below Top of Casing: ,'7 U FT.
(Use.+' i1 Above Top of Casing)
d. TOP OF CASING IS / FT. Above Land Surface'
'Top of casing terminated at/or below land surface may require
a variance in acccccwdance with 15A NCAC 2C .0118.
e. YIELD (gpm):. s+ METHOD OF TEST At/ y
827
I. DISINFECTION: Type
g. WATER ZONES (depth):
From To
Fran
Fran
6. CASING:
To
To
Depth
From Q To 3j Ft.
From To Ft.
Frei To Ft.
From
From
From
Amount
Diameter
To
To
To
Thickness/
Weight Material�
_yQ
7. GROUT: Depth Material
From 0 To .26 FL PQ_/%tt'Aii-
From To Ft.
From To Ft.
8. SCREEN: Depth
Frcin To
From To
Frcm To
Diameter Slot Size
Ft.
Ft.
F1.
Method
in. in.
• in. in.
in. in.
Material
'
9. SAIID/GRAVEL PACK:
Depth Size Material
Frcin To Fl.
Frcin To Ft.
Frcin To Ft.
10. DRILLING LOG
From To Formation Description
c
s5- 3co 9reqrr/a--e
11. R.EMARKS:
r�
cn
rti
r..
0
JUL 20 20118
I DO HEREBY CERTIFY THAT re15 WELL WAS CONSTRUCTED IN ACCORDANCE WITH
ISA NCAC 2C, WELL CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS
RECORD HAS BEEN PROVIDED TO THE WELL OWNER.
%DA
��
SIGN TURE OF ERTIFIED WELL CONTRACTOR DATE
R14 C a.w_
PRINTED NAME OF PERSON CONSTRUCTING THE WELL
Submit the original to the Division of Water Quality within 30 days. Attn: Information Mgt.,
1617 Mali Service Center — Raleigh, NC 27699-1617 Phone No. [phone] ext 568.
FBrMGW-la
Rev. 7/05

RESIDENTIAL WELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources-c/�Division of Water Quality
WELL CONTRACTOR CERTIFICATION g 30 3
1. WEL CONTRACTO��,RiY:"44..�s''''
(
Well +ariractor (Individual)ame
Well ConkitiiiitNietAVEFahaa
248 CRANE CIRCLE
STREET ADDRES RANKLIN, NC 28734
City or Town Stale
ts)SY—V9710
Zip Code
Area code- Phone number
2. WELL INFORMATION:
SITE WELL ID #(il applicable)
STATE WELL PERMIT*Ot applicable)
DWQ or OTHER PERMIT #(if applicable)
WELL USE (Check Applicable Box): Residential Water Supply0
DATE DRILLED 5 a 6-0 L
TIME COMPLETED AM 0 PM ❑
3. WELL LOCATION:
CITY: 8Yl4S—t...1 r1 COUNTY
4
(Street Name, Numbers, Community. Subdivision, Lot No., Parcel, Zip Code)
TOPOGRAPHIC / LAND SETTING:
❑Slope ❑Valley ❑Flat ❑Ridge ['Other
(check appropiiale box)
LATITUDE 3
LONGITUDE
Latitude/longitude source: ours ❑Topographic map
(Iocation of well must be shown on a USGS topo map and
attached to this form T not using GPS)
May be in degrees,
minutes, seconds or
in a decimal format
4. WELL OWNER ,,,, II
OWNER'S NAME En/AA-k'Tre.1/
STREET ADDRESS no o dot / o
rywnel tJ L T7D
City or Town Stale
Area code - Phone number
5. WELL DETAILS: /
a. TOTAL DEPTH: O 5
Zip Code
b. DOES WELL REPLACE EXISTING WELL? YES 0 NO2-
c. WATER LEVEL Below Top of Casing: / 9.0 FT.
(Use'+' if Above Top of Casing)
d. TOP OF CASING IS I FT. Above Land Surface'
'Top of casing terminated agar below land surface may require
a variance in accordande with 15A NCAC 2C .0118.
e. YIELD (gpm): 3 b METHOD OF TEST .4-719
f. DISINFECTION: Type
g. WATER ZONES (depth):
From To From
From To To
Frorn To To
6. CASING: Thickness/
Depth Di]me)er Weight Material
From 0 To 1 Ft. (0 )Y PUL
From To Ft.
From To Ft.
Amount
To
7. GROUT: Depth
From 6 To 3-0 Ft. C'WI/
From
From
Frorn To Ft.
From To Ft.
8. SCREEN: Depth
From To
From To
From To
9. SAND/GRAVEL PACK:
Depth
From
From
From
Material
Diameter Slot Size
Ft.
FI.
Ft.
in.
in.
In.
To Ft.
To Ft.
To Ft.
Size
Method
in.
in.
in.
Material
Material
10. DRILLING LOG
Front To Formation Description
11. REMARKS:
o
JUL 20 2006
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH
ISA NCAC 2C. WELL CONSTRUCTION STANDARDS. AND THAT A COPY OF THIS
RECORD HAS BEEN PROVIDED TO THE WELL OWNER.
SIGN URE OF CERTIFIED WELL CONTRACTOR DATE
R rck Goa -Aft. -
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.
.F,prm GW1a
v u6 ev. 7/05

03-s°
RESIDENTIAL WELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources- Division of Water Quality
WELL CONTRACTOR CERTIFICATION # 2n (co
1. WELL CONTRACTOR:
Grr.hctini /Alec// rJr,Y/,i7
Wen Contractor Company Name
STREET ADDRESS Is y /7r1 G T wn RA,
Robbb nsv,rst plc 2277/
City a Town Stale Zip Code
(Sl�9)_ 479- 5f4/61/
Area code- Phone number
2. WELL INFORMATION:
SITE WELL ID AM applicable)
STATE WELL PERMIT/fiappsable)
DWQ or OTHER PERMIT AM appkcade)
WELL USE (Check Applicable Bock Residential Water SuSupply01
DATE DRILLED - 5-- d f/: o
TIME COMPLETED /0 . 30 AM SI PM ❑
3. WELL LOCATION:
CITY: 3 rySe n c i Ty COUNTY s uiet ri
rir//nS,ci CJ %far^ &arket ,2A7/3
(Street Name.Nu nbaa. Canami.ty. SW6aaion, Lotle .. Parcel. $Cods)
TOPOGRAPHIC 1 LAND SETTING:
❑slope OVa/ey °Flat ®Ridge ❑Other
(check appmpriale boa
LATITUDE 3 e) . Orn10.1.'r
LONGITUDE at A S 429
Latitude longitude source: N GPS °Topographic map
donation doe/ roust be shown on a USGS topo map and
attached to this Rona Ind asap GPS)
4. WELL OWNER
OWNER'S NAME J3 J/y an Tsen
STREET ADDRESS C WAS,q
.13r'V$an c;TV fill rSr�/3
War Town f State Zp Code
May be i, degrees,
miane, sweat or
in a drdnal forma
Figs -
Area code - Phone number
5. WELL DETAILS:
a. TOTAL DEPTH: t) 3c
b. DOES WELL REPLACE DUSTING WELL? YES 0 NO
e. WATER LEVEL Below Top at Casing: a100 FT.
(Use'+' g Above Tap d Casing)
d. TOP OF CASING IS / FT. Above Land Solae
'Top d casing laminated athr below land surface ma/ require
a variance ins accordancewith15A NCAC 2C .0118.
e. YIELD (gpnl): Q. l METHOD OF TEST O.I Y'
(i sly
f. DISINFECTION: Type /417i/
g. WATER ZONES (depth):
From 20e To 5-30
From To
Fran To
6. CASING:
Amount /4, A2
Ram To
Ran To
Ran To
Depth D"ler
From r) To�Q(a_ Ft J
Ran To Ft
Fran To Ft.
Thickness/
Weight Material
seat JDVr
7. GROUT: Depth Material
Fran n To 20 FL LehiriT
Fran To FL
Fran To Ft
8. SCREEN: Depth Diameter Slot Sae Material
Fran To FL in. in.
From To Ft in. in.
From To FL in. in.
9. SAND?GRAVEL PACK:
Depth Size
Fran To FL
From To Ft.
From To FL
10. DRIWNG LOG
From To
11. REMARKS:
Material
Formation Description
—71
c
0
Hu% 1 2UQb
1 DO HEREBY CENrfY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WnH
15A MCC 2C. WELL CONSTRUCTION STANDARDS. AND THAT A COPY OF TIC
RECORD HAS BEEN PROVIDED TO THE WELL OWNER
SIGNATURE OF CERTIFIED WELL CONTRACTOR DATE
PRINTED TED NAME SON CONSTRUCTING THE WELL
Submit the original to the Division of Water Quality within 30 days. Attn: information Mgt.,
1617 Mail Service Center - Raleigh, NC 27699-1617 Phone No. [phone] ext 568.
Fonn GW-la
Rev. 7/05

RESIDENTIAL WELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources- Division of Water Quality
WELL CONTRACTOR CERTIFICATION # r Ii Q
1. WELL CONTRACTOR:
Well Contractor (Individ
Grekhc yn Wei/ (4rr'/I/ns
Well Contractor Company Name , /
STREET ADDRESS 3C39 TL/n ReI
Ro bin tinst',We A/C `lsr77/
City or Torn State Zip Cade
9} 1/79- Seetiggi
Area code- Phase number
2. WELL INFORMATION:
SITE WELL ID POI appacabie)
STATE WELL PERMITS( aPtAcatae)
DWQ or OTHER PERMIT SQl applicable)
WELL USE (Check App&cable Box): Residential Water Supply 111
DATE DRILLED 6 — 9 — 0 4
TIME COMPLETED I/;QQ AM 1:11 PIA
3. WELL LOCATION:
C(TY: I3rysan r, Ty COUNTY SLUG. 11 ✓1
fl Fr Glarkq PR7/3
( Numbers. C `a.. oisi... Labia. Parcel, Zhp Code)
TOPOGRAPHIC / LAND SETTING:
❑Slope QVaeay ❑Flat ❑Ridge ❑Other
(died appropriate box
LATITUDE $ at' 2,2'56.6 n
LONGITUDE, last-5
Latitude/longitude source: XGPS oTopographic map
(location of wet oast be shorn on a USGS topo map and
attached to this form d not using GPS)
4. WELL OWNER
OWNER'S NAME Jtnl SF✓)iT: q�
STREET ADDRESS tif)p PGA r /a r r.
)�ryySen GITy iVC ,25E713
Cily'ar Town • Stale Zip Code
( tr2 el- NPt( -(0a79
Area code - Phone amber
May be in degas.
minutes, seconds a
in a decimal fanner
5. WELL DETAILS:
a. TOTAL DEPTH: FIU
b. DOES WELL REPLACE EXISTING WELL?rYES 0 NO IX
c WATER LEVEL BeloaTop d Casing: 5� FT.
(Uses.' 8 Above Top d Casing)
d. TOP OF CASING IS / FT. Above land Surfae
'Top d c s g targeted attar beim land surface may require
a variance Si accordance vath 15A NCAC 2C .0118.
e. YIELD (gpm): Q METHOD OF TEST CAA' r
v
f. DISINFECTION: Type N/ 7/7 Amount c Z
g. WATER ZONES (depth):
Frain :SO To .Yli,jyrJ From To
From To From To
Fran To From To
6. CASING:
Depth D'�+ er
From_ o_To_cf_ FL (.h.
From To Ft. 7
From To Ft.
7. GROUT: Depth
Frun t To O D
From To
From To
8. SCREEN: Depth
From To
Fran To
From To
Thit.baasl
Weight rypaeerial
60r21 /"V!.
Material Method
Ft.rernrnT Pumphity
FL
Ft
Diameter Slot Sae Material
FL in. in.
FL in. in.
Ft. in_ in.
9. SANDIGRAVEL PACK:
Depth Sae Material
From t To Ft.
From To Ft.
Fran To Ft.
10. DRILLING LOG
From To
Formation Description
0
a.-. '.
r .
1
L
0
1366
11. REMARKS:
100 HEREBY CERTVT1HAT DNS WELL WAS CONS1RUCim N ACCORDANCE Wm1
15A CAC 2C. WELL CONSTRllC1ON STANDARDS, AND THAT A COW OF DOS
RECORD HAS BEEN PROVIDED TO THE WELL OWNER
Ab
do TE
SIGNATURE OF CE FLED WELL CONTRACTOR DATE
fr
PRINTED NAME OF �� N 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.
Fain GW-la
Rev. 7/05

71 1. ;y0. 4 i
RESIDENTIAL WELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources- Division of Water Quality
WELL CONTRACTOR CERTIFICATION #
1. WELL CONTRACTOR:
Well Contractor (Ind i(ridual) Name
rflivaluaL m LJe// Olr////'suer
Weil Contractor Company Name
STREET ADDRESS (3171 gitito wn REA
/9pbb/n t'iY/c° /Yr a,1.77/
City a Town State Zip Code
(.� y79 WS'-J
Area cods Phase n
2. WELL INFORMATION:
SITE WELL ID Sfd aWa1e)
STATE WELL PERMITS(V amicable)
DWQ or OTHER PERMIT S(d applicable)
WELL USE (Check AppicabIe Box): Residential Water Supply V
DATE DRILLED (p - /? -O �O
TIME COMPLETED /d a c3O AM III PM ❑
3. WELL LOCATION:
CITY: ,C/ r Y/Sdn C Ty COUNTY icw ti
C,3rQC� s/ nr emended. aS'7133
(Street mmnbed. Cnnmundy..SutdrZiptioe. Taub.. Parcel. )
TOPOGRAPHIC! LAND SETTING:
°Slope WValey DEW °Ridge ❑Other
(check appropriate box)
LATITUDE ,S° Q7r/y,6/r
LONGITUDE' .21'S3.G '
Latitude/longitude source: ®GPS °Topographic map
(location of welmust be shown on a USGS tepo cap and
attached to this Komi Ind using GPS)
4. WELL OWNER •-{-
OWNER'S NAME C bs / /r ito/n6San
STREET ADDRESS Ehr
May be in degrees,
minutes, wads or
in a decimal format
r S /1n P T Alr rp97/3
CTown % SWe Zip Code
(-i- -9S7G
Area code - Phone number
5. WELL DETAILS:
a TOTAL DEPTH: /OS
b. DOES WELL REPLACE EXISTING WELL? YES 0 NO W
c. WATER LEVEL Bdow Top of Casing: 90 FT.
(Use "+" 8 Abate Top d Casing)
d. TOP OF CASING IS / FT. Abate Lard Su,Ia
"Tap d caaig term sled al/or below lad surface nay requie
a variance in accordance wit115A NCAC 2C .0118.
a YIELD (gpn): at) METHOD OF TEST Cr- i r
P.O60
f. DISINFECTION: Type /7 7- Amount
g. WATER ZONES (depth):
From 4iO To /O,i From
From To From
Fran To Fran
6. CASING:
Depth Diameter
From () To £/C1 Ft (e 4
Fran To Ft.
Fran To FL
To
3.n7
To
To
Thickness/
Weight Material
$hrli PVr
7. GROUT: Depth Material
From rj To 2.0 Ft CAni»,i7
Fran To Ft.
From To FL
Method
8. SCREEN: Depth Diameter Slot Size Material
From To FL in. in.
Fran To Ft. in. it.
From To Ft. in. in.
9. SANWGRAVEL PACK:
Depth
From To FL
Fran To Ft.
Sae Material
Fran To Ft.
10. DRI W NG LOG
From To
iq
11. REMARKS:
Formation Description o
P
r—
I
Tv i
O
r
1 O0 HEREBY CERIFY "MATTE WELL WAS CONSTRICTED NACCORDVICE WITH
15A MAC 2C, WELL CONSTRUCTION STANDARDS, AW TINT A COPY OF T16
RECORD HAS BEEN PRONDTD TO THE WELL OWNER
SIureATURE OF CE IFIED WELL CONTRACTOR DATE
yrie
Pl NTED NAME PERSON CONSTRUCTING THE WELL
Submit the original to the Division of Water Quality within 30 days. Attn: Information Mgt,
1617 Mail Service Center — Raleigh, NC 27699-1617 Phone No. [phone] ext 568.
Form GW-la
Rev. 7/05

RESIDENTIAL WELL, CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources- Division of Water Quality
WELL CONTRACTOR CERTIFICATION #
1. WELL CONTRACTOR:
der
Well Contractor (I ual) Nave p
Gra.hrbyn U 'J/ of r,t///n0?
Well Contractor Company Nance , /
STREET ADDRESS re, `1 f7ri/lP 7 t aJYI ack
linAtiinsv,We Arc rAcr77/
City or Town State Zip Code
(9,2 )-4179-g"NSq!
Area code- Phone number
2. WELL INFORMATION:
SITE WELL ID #fd awllcabie)
STATE WELL PERMIT#(tl applicable)
DWQ or OTHER PERMIT 5(d applicable)
WELL USE (CheckResidentialApplicable Bor)ResidenSupplyd Water Supply
f0 $
DATE DRILLED - /S' D (O
TIME COMPLETED S, 30 AM ❑ PM 55
3. WELL LOCATION:
CITY: Sr/ 6D0 L 7)iCOUNTY rSLA/ ct.%rl
4)n7iAna /like €5Ta7P,s Q5.7/3
(Seeet Name. Nantes, Can ntody,Subdlaio . Latino.. Parcel. Zap Code}
TOPOGRAPHIC f LAND SETTING:
❑Slope oVaaey one ®Ridge ❑Other
(check appropriate box)
LATITUDE 3 ,52
LONGITUDE R" rA S... an
Latitude/fongittde sauce: GPS ()Topographic map
(Iocation of we/ must be shown on a USGS Lupo map and
attached to this form 7not rrshg GPS)
d. WELL OWNER J
OWNER'S Fi�` NAME �..r I /->I�, sS
STREET ADDRESS fnnretnc. Ia Ke f.STATP S
A3n4Inn c,'Ty s�Alt. e k7/3
CiWor Town Area code - Phone number
May be in degrees,
minutes, secants or
in a decimal farrrat
5. WELL DETAILS: e�
a. TOTAL DEPTH: 7 1,
b. DOES WELL REPLACE EXISTING WELL?
� YES 0 NO
r7 c. WATER LEVEL Beam Tap of Casing: O FT.
(Use if Above Top d Casing)
d. TOP OF CASING 1S / FT. Above Land Surfae
'Top d casing terminated alloy below lad surface may require
a variance it ace(x�adance with 15A NCAC 2C .0118.
e. YIELD (gpm): rX METHOD OF TEST ra 1 in
ar5"o
f. DISINFECTION: Type if %/7 Amount 17, !7 7
g. WATER ZONES (depth):
From rtC) To SOJ From To
Fran To From To
From To From To
6. CASING:
Depth Diameter
From_O___To //e Ft.
From To FL
From To Ft
Thickness/
Weight Material
Knrai
7. GROUT: Depth Material Method
From_a_ To 0.6 FL 6,0rnpn7-- PUnip r NO
FromFt. . DL To
From To Ft
& SCREEN: Depth Dianeter SIDI Sim Material
From To Ft. in. in.
From To FL in. in.
From To Ft. in. in.
9. SAND/GRAVEL PACK:
Depth Size Material
Fran To Ft.
From To Ft.
From To FL
— — _
10. DRILLING LOG
From To
11. REMARKS:
Formation Description
o-'
u
I OD HERESY CERWY THAT THIS WELL WAS CONSTRUCTED N ACCORDANCE WITH
ISA NCAC 2C. WELL CONSTRUCT/N STANDARDS. AHD THAT A COPY OF THIS
RECORD HAS BEEN PRODDED TO THE WELL OWNER
erta 1E 1b. +Ie
SIGNATURE OF CERTI EQ WELL CONTRACTOR DATE
f
Pyb Ai
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. 7f05
}

RESIDENTIAL WELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources- Division of Water Quality
WELL CONTRACTOR CERTIFICATION ti n(SQ
:.:•r.
Y ^t, V Qi br
1. WELL CONTRACTOR:
Well Contractor (Ind— ual) Name
6rribarn (.Jm'/ a�r //.:7o?
Well Contractor Company Name
STREET ADDRESS (A:3Z ryJO 777 n Rr�.
Relni nsvrl/e MC P771
City or Town State Zip Code
(9i )- W7%— WStel
Area code- Phone number
2. WELL INFORMATION:
SITE WELL ID 0('d apgcable)
STATE WELL PERMIT#(d applicable)
DWQ or OTHER PERMIT 1(d appicable)
WELL USE (Check Applicable Bra): Residential Water Supply El
DATE DRILLED - /fO - rJ (O
TIME COMPLETED 42 . 30 AM 0 PM Et
3. WELL LOCATION:
CITY: R rVsa n (.'Ty cowry SL,Ja Jn
(rren Sov bran)CA 2»7!?
(Street ttne. thambers. CommsSYyS W dvleion. Lenin, Parcel, 2* Code}
TOPOGRAPHIC / LAND SETTING:
❑Slope lQValey ❑FW ❑Ridge ❑Other
(creak 2' apenaxia4bag/
LATITUDE _a_ �° S In; 4 /1
LONGffUDE t af -t.9 S. 9"
Iatituddlongittde source: ■GPS oTopographic map
(location of well must be sham on a USGS tcpo crap and
attached to this form T not usig GPS)
A. WELL OWNER OWNER'S NAME jn f IC' Do /I S
May be in degrees,
minuiq scars or
in a decimal format
STREET ADDRESS gr PoYSPy h res.nrl7
rysn n C T(Mc 25(7/3
City'a Town State Z ,Code
(5'rigSe I- yn'-i93<
Area lode - Phone number
5. WELL DETAILS: ✓
a. TOTAL DEPTH: /SS
b. DOES WELL REPLACE EXISTING WELL? YES 0 NO to
c. WATER LEVEL BetaTop of Casing 30 FT.
(Use's' if Above Top d Casing)
d. TOP OF CASING IS / FT. Above Land Surface*
-Top d casing terminated t r beSlr land surface may recluse
a variance in acFadancewdh 15A NCAC 2C .0118.
e. YIELD (9Pm): /1/0 METHOD OF TEST (X 1, r
1. DISINFECTION: Type A' 7 Amount 7 0 7
g. WATER ZONES (depth):
Fran 30 To /sss
From To From To
From To From
6. CASING:
From
To
Depth Diameter
Fromm To 2D Ft. 64
From To Ft.
From To FL
7. GROUT: Depth
Material
To
Thickness/
Weigh Material
Snra./ N vr.
From n To 20 Ft r•P)??,unr
From To Ft.
From To FL
8. SCREEN: Depth
From To
From To
Fran To
A''�Methodd
d
Diameter Slot Sire Material
Ft. in. in.
Ft. in. in.
Ft. in. in.
9. SAND/GRAVEL PACK:
Depth Size Malarial
Fran To FL
From • To Ft.
From To Ft.
10. DRILLING LOG
From To Formation Description
11. REMARKS:
r
▪ D
J .1
▪ 1
QJC
1 DO HERESY CERTIFY THAT THIS WELL WAS CONSTRUCTED N ACCORDANCE WITH
1SA /CAC 2C. WELL CONS1RUCTWN STANDARDS. AID THAT A COPY OF DRS
RECORD HAS BEEN PROVIDED TO THE WELL OWNER
do-to-N>c >1 R:u 6-/(;-(moo
SIGNATURE OF C IFIED WELL CONTRACTOR DATE
PRINTED
E NAMtE OF SON11/ e
CONSTRUCTING THEW WELL
Submit the original to the Division of Water Quality within 30 days. Attn: Information Mgt.,
1617 Mail Service Center — Raleigh, NC 27699-1617 Phone No. [phone] ext 568.
Form GW-la
Rev. 7/05

RESIDENTIAL WELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources- Division of Water Quality
WELL CONTRACTOR CERTIFICATION # r.IQ J n
1. WELL CONTRACTOR:
y
cart; P
te
Well Contractor mid Name
�re4 Llrl )n l.Je// C�
dl r,Wein,
Contractor Company Name / ..��
STREET ADDRESS .6r'1/ Tilde /ni✓n Rd
/toi2b/tn.SU,7/r /YG 2S-77/
ity or Town State Zip Cede
c5'fl,-Y79-'4's-4'
Area code- Phone number
2. WELL INFORMATION:
SITE WELL ID #(iapplicable)
STATE WELL PERMIT#(ir applicable)
DWQ or OTHER PERMIT #(d applicable)
WELL USE (Check Apo/cable Bm1): Residential Water Supply 91
DATE DRILLED 6-S6-0(6
TIME COMPLETED /t), 30 AM$j PM 0
3. WELL LOCATION: CI /
art: /r >/SO 11 C/ trycoUNLJTY Sou i1
ate./
qCanmkm/, I 0 7/3
Numbers. rtv.SuMFtin L So.. Parcel. Z4-Code}
TOPOGRAPHIC 1 LAND SETTING:
❑Slope OVaaey OFlat alRidge ❑OOha
(check apaaPien bos)
LATITUDE S° >r� 'A0 9 rr
LONGITUDES 3° jX 7 r AS: 6"
Latitude/longitude source: ■CPS ❑Topographic map
(Wation of must be shown on a USGS arpo rrrap and
attached to this form Tnot using GPS)
4. WELL OWNER
OWNER'S NAME T mg Pict k/rnS
STREET ADDRESS 1361 rry PIATCP)
2ry&oi7 C.'r/ h/C `a Fr-7/3
C or Tarn State Zip Code
May be in degrees,
minutes, seconds or
in a decimal format
(5714-)-,57)Fr— a/%
Area code - Phone number
5. WELL DETAILS:
a. TOTAL DEPTH: SDS
b. DOES WELL REPLACE EXISTING WELL? YES 0 NO d
c. WATER LEVEL Bela/ Top d Casing: /06 FT.
(Use'.' 8 Above Top of Casing)
d. TOP OF CASING IS / FT. Above Land Surface'
'Tap d casing riminattd aUor below land surface may require
a variance li accadance with 15A NCAC 2C .0118.
e. YIELD (gpm): METHOD OF TEST et, r
f. DISINFECTION: Type /7 T/7 Amount /3, n2
g. WATER ZONES (depth):
From /Do To 6-as From To
From To From To
From To From To
6. CASING:
Depth D
Fran d To /�,3 FL / f�;
From To Ft
From To Ft
Thickness/ �k++
eidd
Weight
PVC
7. GROUT: Depth Material
-Fran 0 To 20 FL(' PHI E'YIT
From To Ft
From To FL
Lad
8. SCREEN: Depth Diameter Slot Ste Material
Fran To FL in. it.
From To Ft. in. in.
From To FL in. in.
9. SAND/GRAVEL PACK:
Depth Size Material
From To FL
From To Ft.
From To FL
10. DRILLING LOG
From To Formation Description a
11. REMARICS:
l —71
—� -
2005
1 DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED N ACCORDANCE WM4
15A NCNC 2C. WELL CONSTRUCTION STANDARDS. AND THAT A COPY OF THIS
RECORD HAS BEEN PROVIDED TO THE WELL OWNER.
S �TU - CERTIFlEDh WELL CONTRACTOR DATE
PRINTED NAMEOF PtRISON 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 # d 0 ( SD
1. WELL CONTRACTOR:
)P ,4,Je
Well Contractor (Individ Name
,
GArt)7E:tm (Jell A r.//,'n9
Well Contractor Company Name �`
STREET ADDRESS rp. )'7 f/),d e ' -'
R0Lh,n.Sv//%' S-77/
city a Torn State Zip Code
(2.2t)- 1179-
Area code- Phone number
2. WELL INFORMATION:
SITE WELL ID SQl appfaab/e)
STATE WELL PERMITS(' appirable)
DWQ or OTHER PERMIT 5(d apperahPP)
WELL USE (Check Applicable Box)/:
Residential Wale Supply lij
DATE DRILtFD 1p ` o� / —Q W
TIME COMPLETED AM 0 PM 0
3. WELL LOCATION:
CITY: l3r j/Snn R Ci TV COUNTY 5lilrw /t l
TAP 2ha1/Ns Qt,3
(Street Nam Ishmtbea. Canmurvry.Srt&raiaa. LotN4. LpCoda}
TOPOGRAPHIC / LAND SETTING:
°Slope OVaaey ❑Flat 6D Ridge ❑Otlwr
(check approptals bar) LATITUDE _a_Xd eat' I , a D l
LONGITUDE r 26'0/,,?1"
Latitude/longitude source: M GPS °Topographic map
(location of wet must be shown on a USGS tapo map and
attached to this form ,'not usilg GPS)
4. WELL OWNER
OWNERS NAME An s1 L✓s'Tkrudzic,
STREET ADDRESS 77i e2 Po, Iles
2r'y•Son C.Ty 'tic`.25-77.i
City'a Town State Zip Code
42- go7L1
Area code - Phone number
May be m degrees,
minutes. scads or
in a dreamt fame¢
5. WELL DETAILS:
a. TOTAL DEPTH: G O p
b. DOES WELL REPLACE EXISTING WELL? YES 0 NO IM
c. WATER LEVEL Below Top d Casing /Sir FT.
(Use'+' if Above Top of Casing)
d. TOP OF CASING IS / FT. Above tad Surface*
'Top d casing laminated at/or below land surface may require
a variance in accordance with 15A NCAC 2C .0118.
e. YIELD (gpm): Q METHOD OF TEST (fit,. r
f. DISINFECTION: Type /y 7"1 Amount ad . 07
g. WATER ZONES (depth):
From ISO To ( Oo From To
From To From To
From To From To
6. CASING:
Thickness/
Depth Dianeter Weight Material
Fram._To ///e FL CaS0t2t 13 ✓r
From To FL
From To Ft
7. GROUT: Depth Material th Meod
m Fro_ To Q/ Ft GBM#nT f (�Unt/ritlof
From To FL p
From To Ft
8. SCREEN: Depth Dianeter Slot Size
From To Ft.
Fran To Ft
From To FL
Material
n. n.
n. in.
in. in.
9. SAND/GRAVEL PACK:
Depth
From To Ft
From To Ft
Size Material
From To FL
10. DRIWNG LOG
From To
11. REMARKS:
Formation Description
c —: ,i
o C:
-
100 WREST CERWFYTHAT THIS WELL WAS CONSTRUCTED N ACCORDANCE WITH
15A NCAC 2C. WELL CCNSIRUCTEN STANDARDS. ANCT AT A COPY OF TwS
RECORD WAS BEEN PRODDED TO THE WELL OWNER
SIGNATURE OF CEn eFIED WELL CONTRACTOR DATE
r/v M" Z SON
l P
PRINTED NAME OFF SON CONSTRUCTING THEW WELL
Submit the original to the Division of Water Quality within 30 days. Attn: Information Mgt.,
1617 Mail Service Center - Raleigh, NC 27699-1617 Phone No. [phone] ext 568.
Form GW-la
Rev. 7/05

RESIDENTIAL WELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources- Division of Water Quality
WELL CONTRACTOR CERTIFICATION #
1. WELL
CONTRACTOR: C,,,117 d
WdfC�T Inds Nane
STnaA.htLm (ARV/ CAr,'j/,'n
oy-
Well Contractor Company Name ' /
STREET ADDRESS 63 % lYyAe 72 zjn Rot
P101ob?nsV1ljca A/r 9.8.77/
City or Twin State Zip Code
(tt)- V79-�vrs4
Arta code- Phone number
2. WELL INFORMATION:
SITE WELL ID 90f appicanle)
STATE WELL PERMI T9(I appicade)
DWQ or OTHER PERMIT cif ennui -ails)
WELL USE (Check Applicable Ba(): Residential Water Suppy 53
DATE DRILLED Cp " 049
TIME COMPLETED in . 3 D AM ® PM ❑
3. WELL LOCATION:
CITY: J r V Sn n r :Ty COUNTY rS'Uhli n
QcAI/,'y J3ronrh 7/3
(Street Name. Numbers. Cwnmur�tSuhdt on. l.c¢IJo., 2i Code}
TOPOGRAPHIC! LAND SETTING:
❑Slope OYMImp ❑Fla NIRidge ❑Other
(died( apperiatebad
LATITUDE , s Pi' tfr :tin
LONGITUDE 43. 32 an
Latitude/longitudesource: ®GPS °Topographic map
(location of we/ be shaven on a USGS topo map and
attached to this form /not itching GPS)
d. WELL OWNER !
OWNER'S NAME Ina Yrt, 1/74 r hick
STREET ADDRESS OAI I/,'S brand"
ry..sn ry /VP 7/3
City Twm State Zp Code
(Q39 )-(9/- 7772
Area code - Phone number
May be in degrees,
minute, seconds or
h a decimal unmet
5. WELL DETAILS:
a. TOTAL DEPTH: 7n 5-
b. DOES WELL REPLACE EXISTING WELL? YES 0 NO tp
c. WATER LEVEL BsowTop of Casing: .d O FT.
(Use 8 Above Top of Casing)
d. TOP OF CASING IS / FT. Above Land Surface
'Top of casing terminated War below lad surface may requce
a raceme Si accmdatce with 15A NCAC 2C .0116.
e. YIELD (ppm): P. METHOD OF TEST r.i i r
f. DISINFECTION: Type
Amount ./ Fr. n'Z
g. WATER ZONES (depth):
From 3 O 0 To Too From To
From To From To
From To From To
6. CASING: Depth t'/ Thickness/From /) To SO Ft � Tpr9( pVr%
From To Ft
Fran To Ft
7. GROUT: Depth Material McBtod
From_a_To rs Ft Ct°m4nr .Pyn p:
From To Ft �'oC
From To Ft
8. SCREEN: Depth Dianeter Slot Size Material
From To Ft in. in.
From To Ft in. in.
From To Ft in. in.
9. SANDIGRAVEL PACK:
Depth Sire Material
From To Ft
Frorn ' To Ft.
Fran To Ft
10. DRIWNG LOG
From To
1B-
11. REMARKS:
Formation Description
O
rr
a c_
OTh
=-t
LIU
r W HEREBY COMFY THAT THIS WELL WAS WNSII . CIED N ACCORDANCE WITH
15A NCAC 2C. WELL CONSTRUCTION STANDARDS. AND THAT A COPY OFT IS
RECORD HAS BEEN PROVIDED TO WE WELL OWNER.
ce
SIGNATURE ]f
OAF (C"ER ED E CONTRACTOR ` DATE
ydra
PRINTED NAME OF PERSON CONSTRUCTWG THE WELL
Submit the original to the Division of Water Quality within 30 days. Attn: Information Mgt.,
1617 Mall Service Center — Raleigh, NC 27699-1617 Phone No. [phone] ext 568.
Form GW-1a
Rev. 7/05

RESIDENTIAL WELL CONSTRUCTION RECORD
Nonh Carolina Department of Environment and Natural Resources- Division of Water Quality
WELL CONTRACTOR CERTIFICATION #
1. WELL CONTRACTOR:
Well Contractor (l nQvdual) Name
V're Kl a.Yvr 1Z s // 8r.V /, 'not
Well Contracts Company Name
STREET ADDRESS
Re.,'n g,/,1/6
City or Town State
(�2�rW77—eg3-1,
Area code- Phone number
2. WELL INFORMATION:
SITE WELL ID a('d applicable)
STATE WELL PERMITttfs appkeable)
DWQ or OTHER PERMIT s(d appficade)
WELL USE (Check Applicable Box): Residential Water Supply S
DATE DRILLED ( "'al -eV;
TIME COMPLETED // i d 0
3. WELL LOCATION:
CITY:
L CITY: r/si en
<ar O€r3 r!r&tic 7/3
Streer Numbers. Cwmrsrigr-S�ioa.lccNu..
2.Fr77/
Zip Code
AM® PM
COUNTY SL✓asf
Zip Code)-
TOPOGRAPHIC I LAND SETTING:
❑Slope DVSIey ❑Flat Ridge ❑Other
(dadc appropriate bad
LATITUDE 3 sr*a fYvat/ �D
LONGITUDE .? r j 130. 7 ��
Latitude/longitude source: le MS °Topographic map
(location of well must be Mormon a USGS toga map and
attached to this firm 7not usig GPS)
4. WELL OWNER
OWNER'S NAME Y•eel aid %T
STREET ADDRESS (nap Pr 6 Cr Peek
Bryson r,'Ty /VC a1-7A3
Citf a Tom State Zip Code
May be in degrees.
minutes, ands or
in a decimal font
OD/ >_l ` --9q
Area code - Phone mamba
5. WILL DETAILS: �
a. TOTAL DEPTH: �l • Q6--
b. DOES WELL REPLACE EXISTING WELL? YES 0 NOS
c. WATER LEVEL Below Topd Casing: 26r) FT.
(Use '+• ifAbove Top of Casing)
d. TOP OF CASING 1S / FT. Above land Surface*
'Tap d casing terminated S/A below land surface may require
a variance lo acordance alb 15A NCAC 2C .0118.
e. YIELD(gpm): a METHOD OF TEST G rtr
lace,
/. DISINFECTION: Type /7 77 Amount 9 . el> ._
g. WATER ZONES (depth):
Fran 30o To 5'"1roC From To
From To From To
Fran To Fran To
6. CASING:
Thicgressl
Depth Dianeter Weigh Material
Fran_ To Se Ft. (o.!_ ? 4»'9I Pvc.
Fran To Ft
Fran To FL
7. GROUT: Depth Material
Fran A To-161_ FL r Pjr.onY
Frain To Ft
From To Ft.
8. SCREEN: Depth Diameter Slot Size Material
Fran To Ft. in. it.
Fran To Ft. in. in.
From To FL in. in.
9. SAND/GRAVEL PACK:
Depth Size Material
Fran To Ft.
From • To Ft.
From To Ft.
-is---- ___ - - -_
10. DRI W NG LOG
From To
11. REMARICS:
Formation Description
0
2GGC
I DO HEREBY QnnrY TNT TaS WELL WAS CONSTRUCTED It ACCORDANCE WmH
15A *CAC YC. WEU. COIISIRUCTDN STANDARDS. AHD TNT A COPY OF TILE
RECORD HAS BEEN PRODDED TO THE WELL OWNER.
r) e ' eh, % 37-n6
SIGNATURE OF CERTI ED WELL CONTRACTOR DATE
cis
PRINTED NAME OF PERSON CONSTRUCTING THE WELL
Submit the original to the Division of Water Quality within 30 days. Attn: Information Mgt.,
1617 Mail Service Center — Raleigh, NC 27699-1817 Phone No. [phone] ext 568.
Form GW-1a
Rev. 7/05

RESIDENTIAL vow, cor-mucnoN RECORD
Nat air Dept of Enticement rod Natant Rosman- Division of Water Quality
WELL coil nn
AC1ORai ulcAzonv \20 e>
wayikannarottomosok
LJQV. V:\U
WelVadada Gown Nine / J /
STREET ADDRESS (i /%ych r%�z.J�. lCer e�
,krer lie ILL dg7%r/
City orTaw Sys ZP Cede
(.$a.)-Cj7i— Sl6LI
Area code- Psoaeru ear
LWELL DIFORI LTIOIt
SITE WELL D RlaareeatbY}
STATE WELL PERINTATapoierei_
DWQ or oiie PEiOITGTappiahk)
WELL USE WChedcAp'katde Bar Redderrd walerSai
DATE DRILLED —r)4
TINE COMPLETED / Amp PO
3. wHLLOCATuOIt .
CITY: f6L ygOn C 1 b COWRY Nki=.1 rs
VareatNeae______ 916i-.a4IaJb..PaILalaPC006-
TOPOGRAPHIC/LAW SETI1HM
Oahpe Mang DIM MM. oatm
taiduirPoPiewbad
LATITUDE S
Lnwarrum [L1 W 4;71,9
Iatituddloogihdesa.cc KIPS °Topographicmp
pnatmddmastlieahse ae a USGSiepolapa/
aac/ed6ailkern tasiyGPS7
4.WELL OWNER
OWNER'S !ME 7/� �,' L. va= � of Lr�-'- 5
SIRES ADDRESS al.-, , IV2 t (irt r.0
,<Or.C;l /V?' 2f?7 / 3
Mg beledegrees.
flume, steads ar
Maul Arms
et Tom / Stele Zip Cale
(.7fl)-SDt- `i `7r
Area code- Plot .ambler
S. WELL DETAIL&
a. TOTAL DEPTlt
-3o '
b. DOES TABSREPIACE L76STMG WBl7 TESO NOk
. WATER LEVEL BdarTapflair Gn 7 FT
MareCabo)
d. TOP OF CASING 6 I - FT- Above Lied Swint
. Toper mewlswLadrerbaberYdwa_oewymake
aAmine itaemdaaevelbWAICAO 2CAll
e. YIELD lost a METHOD OFTEST \I'
L asaa=Ecno.tType /-N f Pi Amount 77 c?
g. WATER ZONES Ur ,
Foxe 4 o' To () r. n From To
RUM To Fat To
From To Rom To
t CASIO: Threes/
Diameter way t MSS
Rai TTooL`1U'a t'/1 Jfi? 4wwel
Rom To FL
From To a
7. GROUT: Dept IAMBS
Fat () To din Ft- C0m.0.}-
Rue To a
Fes To a
ildhod
a. SCREEk Dept Diameter Slot See
Ran To Ft. In. to -
Root To a it. _ in
Fiore To Ft, in in.
Material
S. EA016RAVERICK:
Dept See Medal
Rom To a
Fort To a
Ts To a
It SLUNG LOG
Flan To
11. REMARKS:
Foramina Dose ipdon
0
r..
w
0
IODNERSOMMIBEFINISINBLWASCOISMSACCOPIONICEVilai
15eILGC1gwBLOaaieIUMMIISeaMI06.601 RTACOPfaFffi
IBOIPOSaS e®1 OVIDED W TNEa1BLpe16t
OFL uu iWBL DATE
tr /chiti•n i1}1.t�S
PNR®WNEOFPERSON THEw131
Submit the original to the L1hAtlon of water Quality within 30 days. Attn: rtioin65on Mgt,
1617 abli Service Center— Raleigh, NC 278994817 Phone No. [phone] end 568.
Fam GW-1a
Rex 7A5

RESIDENTIAL wnLcorentuc'1TOx RECORD
Noah Carolina Deprhamt of Eaviamen t and Natural Reaamur Division of Water Quality
WELL CONTRACTOR cERTTFICATIOx f 3 Tot
I. WELL
Wel
Wd Darraear Domes* 34 1-1/4)01havN eJ
✓t l a2s77t
City orTeen Sate 410xe
(SSfl . Lr75- R-t+sy
Area ads. Peons number
LWELLnnATIOIt
SITE WELL DWirma alai
STATERS PEITIETSPopaslesi
DM or OTHER POW Rifaooioahld
WELL USE (Mack Appian/ &Kt Rridwid WaSSSopping
DATE DULLED S A'D(2,
TtaE cometET® 1 an° MO Plan'
3_WELL I t%&Taat
CITY: \\6<on C c Cota1TY CAS .JGt,r\
,
reName i �G l Louie. pea zk poat-
TOPOGRAPHIC /LAND SETTING
paipe MAW rat ORS Dare
Woodcapplarkila
LATITUDE 3!/c?�c d�d Rs-`a1•o
Dr/
- LotItlRE-ar� ,� 3 ` .3„
Iatioaddlong mote sour= AWE °Topographic rasp
Draft dsell mstie ahora da a USGS bps neap and
Shed b ads fora lad ry GPS)
0. WELL OMER I
OWNEWS WilE IPnrt. l ( rite\€S
=swimmers& tiXiff✓,< C reek- 1?cxcY
£ rMCt 7 217/3
aToam Sots Zlp Code
(�}viA- -r4l3
May be o degas.
miss must ea
Teamed liner
Are code - Pterr amber
SWELL DETAILS:
a. TOTAL DEPTtt —1 05
b. DOES WELL REPLACE comas WELL? YES Q NOJit
cWATER LEVEL DdoaTgtarsier 6 c FT.
(Ue a SAWATopdCages)
d TOP OF CAMS IS / - FT. About Lad Sdsd
Toed cast, [sdalsdW rt°Yod atria sma um*.
a wire n aaaJnrs i 15A I6,AC ZC AWL
e. TIRO twat 7 ■EIIIODOFTEST 011 (
327544
L DHsaaFECITDatTyw H rH Amoral ig,7
g. POWER USES (dephk
From AC To Li o 5j From To
Rom To Fnum To
Ras To Fro To
G. CASING:
Ttclarrsd
Ram n Two Depth
RDiameter
�'Vid % ;stec(
Ron To R
From To • Ft
7. GROUT: Data Wand
Faro n To 2b Ft (Qrrwd-
Frm To R
Rem To R
ladled
povnfJ
S. SOWER Depth Diameter Slot Dze atderid
Flom To R it in.
Ram To R S. - n-
Faaq_To R it in.
i SMOIBRAVB-PACC:
Omar Size aldrid
From • To R
Franc _To FL
Rom To R.
W. mama LOG
Fat To
11. REMARKS:
Foaanefm Desapton
a
cr. �4
IODIfelale03niennersasmatteasc011aCIEDIMEONIONCEIR01
15RICIG2CVELLOr6emCmrW AKILNO MCQffO faS
mp®a eaHManala®W1 EVI LLOae9t
o
SENA OFtE TIF D WELL CONTRACTOR
1 TE
061'+ r Y'\ 1 I l &tQ
WISE OF PERSON t�ottsrtalcl
PRINTED', EWELL
Submit the original to the Division of Water Quallly Within 30 days. An Imbalance Mat,
1617 Mot Service Center —Raleigh, NC 27616.1617 Phone No. [phone] sad 568.
Far GW-1a
Ror.7/05

REsm.ENTIAL WELL CONSTRUCTION RECORD
North Cmolna Dganmml aEnvironment ad Hen Resane6- Division of Weer Quaky
WELL cONTRACTOR CiatrIFICAf +s -? g 6
327545
1. WELL CTOft
�c- l ire no 1
W� i2AVr 1,1 1 rAi ree
WdLootiaofor CotiPmgRoe
STREET ADDRESS ' Erie 7� -4-. (4-41
rhb).si;ii
CAR or Tan Stele rota
( A)- t/71- .1.169
Area code- Rol sorter
2. WELL lFORWATIOlt
SITE WELL D apt apdotld
STATE WelPeawnnapddty
DWQorOTHER FE TS(ifapeTtaNa.
WHLUSE (ChedaA,r' -'- * Radsii WatrSrpplyfl
DATE DRILLED cc -a -nee
TILE car ET® 6 3d /1Np PM p(
3.WELL LOC*_TTIOt
art 't`"' In e4
wa ` r,1a}-sal- -i. latile.Palca ZIP Coda}
TOPOGRAPHIC / LAND SETTING
°Slope [Mew °Rd irk* °olw
(Cheek swags.* 11•4
wimps �� 2ai '31. O `'
LONGIRDESal 31 etR—fr ri
IatimdcJloa d. e sour= SKIPS °Topographic rasp
gram daarmoatbeaiaaa an a USGSlopoamp god
a6r8adblliaAsTado keGPS1
OVINER
`OO OWNERS NAME (Joan G,p� ��[(id-I-
S-MELT�(^�
ADDRESS Cr� n rt ),. f Z rcid
entan. Ct -y tV� '2<— 4.5
ay a Tome Stole rip Code
(ES >-9 633W
Area code - Roo matm
WELLDETAIB en i
a. TOTAL DEPTH
Way teledereeA
miaereso mbor
ark ei•t foss
b. DOES W LREPLACE MEMO WELL? YES() NW
c. WATER LEVH.BdaTapefCasig I aO FT.
((1.." IAbase Tap et Cadet
d. TOP OF CASIG IS / - FT.Ahaas Lad Saint
Toper away lsdrd:SW het ebedsaws, leer
awean=ina ooiooei1MICACffiMIR
e MOW* Li METHOD OF TEST CA.1 r
t tesancnottryp. I -I rH
g. wRBtZO,ES *set
Faun i a0. To ace From To
From To From To
Rom To Ran To
e CAW& Theamesat I�a��
Ras O To ad7'a 4 s55 22J Nv'G
Diameter
Fern To Ft
Finn To Ft
oa
7. GROUT: Depth World
From i j To 940 FL t^enranr
From To FL
Fan To R.
S SCREEtt Depth Oiaoma Slot Sob Material
From To Ft be. M.
Foos To FL he _ n.
From To FL in. in
SMaBRAVaPAQC
Depth Ste lumit
From ' To R.
Fm�_To FL
Roo To FL
1a. oakum LOG
now To Formai=Description
11. REMARKS:
L -.
rThr::
Imaa®r'arwQssaaea.rtaaxraeaae®nAdamooaaeaaea
1SaICIC2C..HLem6WCW SIMIDM.AN170QACOPY OFTm
palaa Ia�a/a6 a P11m1®W 7!Eno
/
SIGFNTUI OF GEMMED WELL CONDUCTOR DATE
Qk fin i2'�1 Lk
PRINTED OF PERSON qDl THE WELL
Submit the original to the Dhrhltolt of Water Duality withhn 30 days. Atli: INoraalion Mgt,
1617 Mai Salvias Cents— Raleigh, NC 276Se-1617 Phone No. [phone] act 568.
Fam GW-1a
Rea 7105

RESIDENTIAL WM.CONLSTRUCTON RECORD
Nmt Cambia Deportment ofEwimtocot and Natant Resource- Din® of Water Quaky
WELL CONTRACTOR C ICf/FnCATIONs
1. WELL CONTRACTOR
F5cpS
Wei Camaaa ondramog tram
d Coneadla Carl
bbi,mvi ►b (rc
Gib, or Tara Stale
(4'9 1- ci 79 - CSLi t/
Arc cods Mane order
2. WSJ_ INFORM/Glatt
SITE WELL D Sp! al afoaYN
rziej
ADDRESS (34 redP
eX77I
TA Code
STATE WELL P@aaTSPaoe-dsa)
DWQ a O11-6t PE3WNOlappiabe
WELL USE (Check Art '—I e* Rmideid WaiarSappllt
DATE ORURO X 1A aY M
-ram COMPLEMD la' OD AC Mal
twat LOCA710lt ..
crrt gy-SOn C a.y COUNTY ).l ('A t 1\
Caere c
16ieetlriil. comealeormiereataltta.Pi. S.3►Rea}
TOPOGRAPHIC!LANDSETW
Cape Maley of w )$i6 Dous
Klock woropkiketos4
LATITUDE _sC Z7 / 3),111
F.Ta a 61 cct 7
Latitudeflongiudemmcc *LIPS DTopogapheemap
Obtain WralamdS skis en a tEGSSwamp aed
SAW rnottangEWS)
WNER
`o WELL
NAM ai9r r S cj k t'ko
STREETMaRt3S 4.4oe L^r 'lc. (21,04
a Tao Code
Lg6ectiers,
Spa secookar
iadSd boat
(,j, r }736"'"Oei0�
Area ende- Plows amber
&WELDETAILS:
a TOTALDEPllt �Dc
b. DOES WELL REPLACE ENSUING WELL? UJ,1Et30 Nom
c. WATER LEVE.BdoaTap d' 'g NF7.
(Me rEAtraeTapdCaeis)
d. TOP OFCASING S / . FT. Abseils! &stew
*Tap dad* boarbdadoar be sIeedalasmgimie
a meieoe is amadmearin ISA!CAC 2C _Olt
a. TWIG bp* aEtlemortma CAI C'
32 550
L DISRIFECTIOltType N77f Amount 131-Z
g. WATER ZONES tdeplhr
Rom 1 D s To U Of Fora To
Foes To Fan To
From To From To
EL CASING:
Dander
Rom O Two e7n' R. 6 t/ e
ROM To Et
From To R.
T''
t _
7. NUT: Dept Idalsid WOW
Ram _P)To '.n Ft (¢rr.8n(r i o np I %
Ram To EL 6
F. To R.
a SCREEt Dept
Fm To
FaA To
Fm To
tYaeemr Skt Ittatarid
FL E. d
Ft in. _ i_
R. it in.
S. SAt06RAVELPACK:
Depth Site WSW
Roe ' To R.
Foam To R
ROM To Ft
* v-
1a ORaLPIG LOG
Ran To
11. REMARKS:
Fotme%t Desrsipion
C
c
q
ILIDIEMSYCEMEMIWOMMELLIMASCONSMIMaEDMACCORDMCEVIEM
ESai_CSa IELLOM6amCIDnSmeONmtNOBaR11COP►OFLaS
RSaaa HAS ®e PADIIMEDIOME NIL OMael
oirc
5.
lE eau OF eWHL CC R CPOR
OF POISON '' l f l /.e
METED TIE WELL
Submit the original to tta DiviMon of Wader Quality within 30 days. Amer: Thomason Mgt.,
1617 Mal Smite Cooler- Raleigh, NC 27699.1617 Phone No. [phone] eat 56&
Fame Ga-la
Rev.7105

sIDENTIAL WELL rnNsnevcnON RECORD
North Caufoa Department of Environment and Natural Resources- Division of Water Quality
WELL CONTRACTOR CERTIFICATION /)�D
1. WELL CONTRACTOR:
W d Cord adore (Fgnv )�Nane
el Wel C a:ha �/y j eAr,'J!,'noq
Palle
STREET ADDRESS :241 .dyne Toa✓n JZa
fiab1b ngv,l/e. /Vr a 77/
Cdy or Town Stale ZIP Gad*
( 1- 4/79- Er' qs 4I
Area code- Phone number
2. WELLWFORr*TIOlt
SITE WELL ID Wdaudelei)
STATE WELL PERMFfl-,. eerie)
DWQ or OTHER PER I&T s(I appiable)
WELL USE (Check Appicaa�vble BaeG RRaSupply ide fig Water Suppla
DATE DRILLEDS-o3-06O
TWacorav Tn31 Ll; AMO PM®
3. WELL LOCATIOIt
CITY: PryAti n .-' 7- COUNTY 5 tt/c, ; >7
r�T�l Glr n J R J f l/ranmhcJrL e297i'1
(Steel Name. ttam6as Caeasoty-98d r...1. tNt. Paeat Bp Cods)
TOPOGRAPHIC 1 LAND SETTING:
°Slope OVa1ey °Flat ®Ridge DOhr
(cheek unmoral. Ms)
LATmUDE y25 1S'o&..3"
LONGRwEt3° 437'416, c"
Latitude/longitude salr= ®CPS °Topographic map
(beacon dwell aunt be shown on a USGS Pope map eel
attached Io this lane Ind wag GFS)
4. WELL MAIER 1J
OWNERS NAME C ),Ue- k
/nn
STREET ADDRESS 5r/r/L✓,',��A R.
Jar an rPry
City/or Taan Shier rip Cods
(2aQ--3G)-OY2d
Area code- Phone nabs
May 6e in degrees,
lea decimal tourer
S Wat. DETAILS:
a TOTAL OEP tt 5%,c`1
b. DOS PADS REPLACE EXISTYG WELL? YES CI NOS
c. WATER LEYB. Below Tap ofCacinw a60 FT.
(Use'+• IAboveTa et Caeag)
d. TOP OF CASING IS 1 FT. Abase land Sudan*
`Tap et— lewilelad anisbelow land sabot may requiee
evalance b acoda oerin 16A NCAC 2C.0116.
e. YIELD(lep er nntiC METHOD DETEST (S. r f
327555
t. DIS0FECTIOIt Type N T H Amount 2 7 a z
g. WATER ZONES (dept )
From To From To
Fran To
Fran To
6. CASING:
From
From
Fran n Two cCO Ft 6 ,
From To Ft.
Fran To Ft.
To
To
Thalami
Wega
A»rfa) Vf
7. GROUT: Depth Material Method
Fmm_tTo P!) Ft / tong &ar PU M/0i at
Faun To Ft
Flan To FL
IL SCREEIt Depth Dinette Slot Son Medal
Fran To Ft M. in.
Fawn To Ft Si. _ n
Fran To Ft in. in. -"
9. SAND/GRAVEL PACIC
Depth Size
Flan To Ft
Fawn To Ft
From To Ft
10. DWLLa4G LOG
From To
Forttla'm Description
O
ITI
CD rn
r
11. REMARKS:
r
I OD I6BY CERTIFY TMTINS WELL WAS WaCIRC®mACW IDAPCE N
ISMICJICS.WELL C46lWICIb11 SWDAan6. AIDIINTA COP/ °FOE
,wn, m S ®I PROADIED10 THE WELL OMER.
clT 7- fly s o`Q(�
SIGNATURE OF Q n4".iEDWELLm WELL CONTRACTOR DATE
PRINTED NAME OF • FP CONSTRUCTING THE WELL
Submit the original to the Division of Water Quality within 30 days. Ann: information Mgt.,
1617 Mall Service Center — Raleigh, NC 27699-1617 Phone No. [phone] ext 568.
Form GW-la
Rev. 765

RESIDENTIAL wL..L CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources- Division of Water Quality
WELL CONTRACTOR CERTIFICATION # Q().Co
1. WELL CONTRACTOR:
Wei Contractor (Individual) Name
�„--ijnnr>a �Je// r�,r,'l(i'ng
Well Contracts Company Name
STREET ADDRESS 63 7 i 4,a 7 wn Rd
fresh',,ins1/,%/P Nc c 771
City or Town Stale Zip Code
(5n )- 1-l7.7- FrwC4/
Area ode- Phone numbs
2 WELL INFORMATION:
SITE WELL ID SW appicable)
STATE WELL PERMITN(dappirase)
DWQ or OTHER PERMIT so applicable)
WELL USE (Check Appicable Bad: Residential Water Supply W
DATE DRILLED 7-/2-04
TIME COMPLETED . : 30 AM 0 PM
3. WELL LOCATION:
CITY: ,CJ rySo rt Ci 7/ COUNTY S L✓O. ,'✓)
rtrce 25'7/3
es (SuName. Cmmazy Latin. Parcel, Zip code}
TOPOGRAPHIC / LAND SETTING:
❑Slope $Vale)' ❑Flat ❑Ridge ❑Other
(dredk apprwriate bad
LATITUDE '� sera .0.5- .T'•
LONGITUDE a_f Ay'39.1 •'
Latitude/longitude source: RIMS $Topographic map
(bcatnn of war must be shown on a USGS tom map and
attached to this lam rnot using GPS)
4. WELL OWNER -� �S
OWNER'SNAME (/O>/ /JUr n5
STREET ADDRESS Xi rk ki.nd r eft &A-
ySnh r/T> NC 0-7/?
CitybrTimm Slate Al Code
May be in degas,
minutes, seconds or
m a decimal format
(7.2k)- 73' -/9t/
Area code - Phone number
5. WELL DETAILS:
a- TOTAL DEPTIt /SS
b. DOES WELL REPLACE EXISTING WELL? YES IDNom
o. WATER LEVEL BelowTw d Caring: .)^Ad FT.
(Use'+• if Above Top d Casing)
d. TOP Of CASING IS / FT. Above Lad Surface-
. 'Tim d casing terser d ata below land surface may require
a vaiaee in acconlance wilh15A NCAC 2C .0118.
e. YIELD (gpm): RD. METHOD OF TEST C..; r
A (a <1
j el
f. DISINFECTION: Type /7/ 7/7 Amount 6. 07
g. WATER ZONES (depth):
Ran 3r1 To /6S From
Fran To From
From To From
6. CASING:
Depth
Fran n To SO
From To
Fran To
Diameter
FL ( 4j
Ft.
FL
To
To
To
Thickness/
Weight Material
Sonr21
7. GROUT: Depth Material 1� Method
From (5To ` o Ft. CCM Pnr PUMpIiW..
Rom To FL
From To FL
8. SCREEN: Depth Diameter Slat Size Material
From To Ft. in.
From To FL in.
From To FL in. m.
9. SAND/GRAVEL PACK:
Depth
From
Rom •
To FL
To Ft.
Ran
Size Material
01
0
0
0
0,
To Ft.
10. DRILLING LOG
From To
1
11. REMARKS:
Formation Description
r
CO
crr
0 C:
100 HERESY CERTFY TUT MIS WELL WAS CONSTRUCTED N ACCORDANCE WITH
ISA ICAC 2C. WELL CONSIRUCDON STANDARDS. NO TUT A COPY OF INS
RECORD HAS SEEN PROVIDED TO THE WELL OWNER.
tt°P.P P 7-/2 -66
S TURE OF C TIFIED WELL CONTRACTOR DATE
de
P are
to NAME OF PERSON CONSTRUCTING THE WELL
Submit the original to the Division of Water Quality within 30 days. Attn: Infomkation Mgt.,
1617 Mall Service Center— Raleigh, NC 27699-1617 Phone No. [phone] ext 568.
Form GW-la
Rev. 7/05

RESIDENTIAL WELL CONSTRUCTION RECORD
pyJ
North Carolina Department of Environment and Natural Resources- Division of Water Quality
WELL CONTRACTOR CERTIFICATION # Qnsd
1. WELL CONTRACTOR:
Weft Contractor (Ind' ual) Name
rolictto 'Jell r,'///ip
Well Contractor Company Name I / I -,
STREET ADDRESS 6 2S /6/a,P. Taunt Rrj
/Crfbb,n.51/i//e A/c os, 77/
City or Town State Zip Code
(9i$ )- L/79-9'SV
Area code- Phone nutMer
2. WELL INFORMATION:
SITE WELL ID #(if applicable)
STATE WELL PERMIT#(( appiimde)
DWQ or OTHER PERMIT #(d applicable)
WELL USE (Check Appfcthle Bat): Residential Water Supply IX
DATE DRILLED 7-20-0G
TIME COMPLETED //.//)()
3. WELL LOCATION:
Cm: Rrysnn C/Ty cowry 5/4A.Ia
Ca mh nSon / .95'i7/?
(Street Name..Numbers. CartumLLy_Subdrasion. Lntab.. Parcel. Zip Code)
TOPOGRAPHIC / LAND SETTING:
❑Slope IgValey ❑Flat [Ridge ❑Other
(check appmpiateqb?o �{1
LATITUDE 3 ,..Cc) (13 '3D.41(
LONGITUDE, 3a a/ / azto
Latitude/longitude source: lc GPS °Topographic map
(bcaSn of MI must be shown on a USGS tope map and
attached to this form Inot usrg GPS)
4. WELL OWNER /
OWNER'S NAME ,4&rclr4-�thn Son
STREET ADDRESS Co]) Va/T nSorl
13rt/,Son City HNC fr7/3
City or Town 1 State Zp Code
( L/OO —3sS9
Area code - Phone number
AM 55 PM ❑
May be in degrees,
mitarer. Scant or
in a decimal imam
5. WELL DETAILS:
a. TOTAL DEPTH: /30
b. DOES WELL REPLACE EXISTING WELL? YES NO)11
c. WATER LEVEL Bebw Top d Cang 30 FT.
(Use'+• If Above Top d Casing)
d. TOP OF CASING IS / FT. Above Land Surfaces
*Top d casing lammed attar belay lard surface nay require
a variance in accordance rah 15A NCAC 2C .0118.
e. YIELD (gpm): 7 METHOD OF TEST air
f. DISINFECTION: Type /77 4 Amount 3 .r/7•
g. WATER ZONES (depth):
From 30 To /30 From To
Fran To From To
Fran To From
6. CASING: Thickness/
Weigh 1{aterial
Snra ]�
To
Depth D"18rtneter
Fm 0 To I7 Ft
From To Ft
From To Ft.
7. GROUT: Depth Material
From n To Do Ft r omen%
From To Ft
From To Ft
Method
8. SCREEN: Depth Diameter Slot Sae Material;
From To Ft in. In.:CI-
Fran To Ft
Fran To Ft in. in. for
..a
9. SAND/GRAVEL PACK: 1,1
r ')
Depth
Sae Material r i
Fran To FL r"' )
Fran • To Ft
From To Ft
10. DRIWNG LOG
From To Formation Descr tion
11. REMARKS:
CD
Fri
I CC HEREBY CERTIFY THAT TIS WELL WAS CONSTRUCTED N ACCflRDA F WITH
15A /CAC EC. WELL CONSTRUCTOR STANDARDS. AND THAT A COPY OF THIS
RECORD HAS BEEN PROVDED TO THE WELL OWNER
Tie) fr 0p 7-24-nG
SIGNATURE OF CERTI ED WELL CONTRACTOR DATE
PRINTED NAME OF PERSON CONSTRUCTING THE WELL
Submit the original to the Division of Water Quality within 30 days. Attn: information Mgt.,
1617 Mall Service Center— Raleigh, NC 27699-1617 Phone No. [phone] ext 568.
Form GW-la
Rev. 7/05

RESIDENTIAL WELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Res
o
urces- Division of Water Quality
WELL CONTRACTOR CERTIFICATION si d 0 SO
1. WELL CONTRACTOR:
Well Conuacta ual Nam
(Intl
Rov,7/c /1/c
Cory or Town Stale
C.2y). 4/79- SrvS'f
Area code- Phone number
2. WELL INFORMATION:
SITE WELL ID *Of anMrable)
STATE WELL PERM(T#O{ appicfle)
) e
Grin.61.M / r,'//,'mg
Well Contractor Company Herne T
STREET ADDRESS 6.;3y ,r 1rdre lttOG,/n R
eld
f %7/
Zip Code
DWQ a OTHER PERMIT Rif applicable)
WELL USE (Check Applicable BDay. Residential Water Supply lA
DATE DRILLED 7 /Ii 6
TIME COMPLETED .0 3a AM 0 PM
1. WELL LOCATION:
CITY. ryfen airy COUNTY sj tact; n
tnf+S rreAsk QS7/.3
(Street Name.Nnnbera. Ca nnumity.Subdwisien. lat.Ne_PanYt 7* Codal
TOPOGRAPHIC ! LAND SETTING:
❑Slope °Valley ❑Fat glRidge °Other
(cheek appropriate boa)
LATITUDE __ se )9, r Y"
LONGffUDE a<-'/.L 7"
tatitudeflongitude source: MGPS oTopographic map
Mooch, of wed must be shown on a USGS fopo map and
attached to this lone Ind useg GPS)
4. WELL OWNER
OWNERS MIME 6ron.p +o t✓lBr'
STREET ADDRESS 7ene°I r^re.ok
2rySan C:Ty 11/i 7/3
Gil or Town State Zip Code
May be in degrees,
minutes, setaeds or
in a decimal format
( %.2 >- 'ISM 9935
Area code - Phone nunber
5. WELL DETAILS:
a. TOTAL DEPTH: 3r7S
b. DOES WELL REPLACE EXISTING WELL? YES NO21
a WATER LEVEL Belay Top or Casing ,30
(Use'+' d AboveTapd Casing)
d. TOP OF CASING 15 / • FT. Above Land Surface*
'Top d Ong terminated Ski below land surface may require
a vaialce n adadance with 15A NCAC 2C .0118.
e. YIELD (apm): /e5 METHOD OF TEST cur
FT.
0646
I. DISINFECTION: Type ,i rg Amount /. . dz
g. WATER ZONES (depth):
From 3e) To 3OS Fran To
Fran To Frain To
Fran To From To
6. CASING:
Depth
Fran n To 9g
From To
From To
nRneter
FL 4-1-
Ft.
Ft.
ThicKnessr
Weight ! 4talcia
snr.S P
7. GROUT: Depth Material
From_ To P.Q Ftf pnienT
Fran To FI.
From To Ft.
Mfl_..
P!/
!L SCREEN: Depth Diameter Slot Slat Materiel
From To Ft. in. in
From To Ft in. _ In.
From _To Ft in. In.
9. SAND/GRAVEL PACK:
Depth Size Material
Fran To Ft
Fran To Ft.
Fran To FL
10. DRILLING LOG
From To
( 9-
11. REMARKS:
Formation Description
n
--1
100 HEREBY CERTIFY MAT MIS WELL WAS CONSTRICTED N ACCORDANCE WITH
15A NCAC2C. WELLCONSTRUC1fN STANDARDS, AND THAT COPY OF e6
RECORD HAS SEEN PROVIDED TO THE WELL OWNER
YM' 1, frAe �t9=ao
SIGNATURE OF RTIFIED WELL CONTRACTOR DATE
PRINTED
P
PTm NAME,, fbr�FPERSON CONSTRUCTING THE WELL
Submlt the original to the Division of Water Quality wtth n 30 days. Attn: Information Mgt.,
1617 Mall Service Center- Raleigh, NC 27699-1617 Phone No. [phone] ext 568.
ram GW-1a
Rev. TMS

RESIDENTIAL WELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources- Division of Water Quality
WELL CONTRACTOR CERTIFICATION # r96.56
1. WELL CONTRACTOR:
m 2/cWCa (Ind Wane
ra h-yrj
Well Contracts Coin
Name
STREET ADDRESS 63y 4Ai� �till? RA
/90.6 j-h5 ile Nc- `�i 9.7 7 /
City or Town State Zip Code
(24A? - y79- -y<sv
Area code- Phone numbs
2 WELL INFORMATION:
SITE WELL ID #fd applicable)
STATE WELL PERMIT/fa appicaae)
DWQ or OTHER PERMIT #(d applicable)
WELL USE (Check Applicable Bak): Residm8al Water Supply NJ
DATE DRILLED 7- /9- nG
TIME COMPLETED a; Ott
3. WELL LOCATION:
CITY: lry$.cn City cowry cS LJa I'rt.
Sars %/cHv sdd 'c 7/3
_S'teetJanroJeh a Meson, Top raw)
TOPOGRAPHIC / LAND SETTING:
❑Slope OValey ['Flat 'Ridge ❑Other
(creak appropriate box
LATITUDE $ y-,° 2c/o2O.6//
LONGITUDE' 3.51 /251.3Zelt
AM ❑ PM®
May be in degrees,
minutes, seconds or
in a decimal format
Latitude/longitude source: GPS oTopographic map
(location of we/ be shown on a USGS hypo map and
attached to this form 'not using GPS)
4. WELL OWNER r�
OWNERS NAME k s, & 0 VC urke
STREET ADDRESS `,nnna /2/49
Flay' on CiTySAC ofC7/3
C Townor Zip
(F6o r aAS- 171R1/0
Area cable - Phone number
5. WELL DETAILS:
a. TOTAL DEPTH: ?Cr<
b. DOES WELL REPLACE EXISTING WELL? YES 0 NO p
c. WATER LEVEL BdowTop of Casing: 0 FT.
(Use'*' 0 Above Tap ct Casing)
d. TOP OF CASING IS / FT. Above Laid Surface
"Top ct casig tem.ated ayes bebw land surface may require
a variance Si accordance wlh 15A NCAC 2C .0118.
e. YIELD (gpm): 0 METHOD OF TEST A i
f. DISINFECTION: Type A
g. WATER ZONES (depth):
From n To 0
From To
From To
6. CASING:
Amount 0
From To
From To
From To
Thickness/
Depth Diameter Weight
Fran_0___ To30 FLCtf4 .9or&t
From To Ft
From To Ft.
Material
Pdc
7. GROUT: Depth Material Method
Fran n To AO Ft. CFNTPnr P�
Fran To Ft
Fran To Ft
8. SCREEN: Depth Diameter Slot Size Material
From To Ft in. in.
From To Ft at in.
From To Ft in. _ in.
9. SAND/GRAVEL PACK:
Depth
From To FL
Fran • To FL
Fran To Ft.
10. DRILLING LOG e�.r___
From To Formation Description
Size
i- J
r_
C % Kim
0
1.
I(,J&i! 7OSbe, /irkd'C/r.7Ur#
1 DO HEREBY CERIFYTHAT THIS WELL WAS cON57W1mED N ACCORDANCE WHIN
15A NCAC 2C, WELL CONSTRIICDON STANDARDS, AND THAT A COPY OF THIS
RECORD HAS BEEN PROVIDED TO THE WELL OWNER
SIGNATURE OF CE3iTIRED WELL CONTRACTOR 7V/DATE
441�
PRINTED NAME 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] eM 568.
Form GW-1a
Rev. 71D5

RESIDENTIAL WELL CONSTRUCTION RECORD
North Carolina Dcpanment of Environment and Natural Resources- Division of Water Quality
WELL CONTRACTOR CERTIFICATION # 2045
i. WELL CONTRACTOR:
James B. Brown
Well Contractor (Individual) Name
Hedden Brothers Well Drilling, Inc.
Well Contractor Company Name
C.TREET ADDRESS 73 Holly Hills Vista RD
Franklin, NC 28734
City or Town State Zip Code
(828 )- 369-9591
Area code- Phone number
2. WELL INFORMATION:
SITE WELL ID #(if applicable)
STATE WELL PERMIT#(ifapplicablel
DWQ or OTHER PERMIT #(if applicable)
WELL USE (Check Applicable Box): Residential Water Supply
TE DRILLEDTE
IME COMPLETED AM ❑ PM filt
3. WELL LOCATION:
��/I��� �/1._ �
CITY: (J)t&1.1LQ.X_ COUNTY.,)aL /
�u �.
; Suee Name, Numbers, Community, SubdMsion. Lot No.. Parc Ip Code)
TOPOGRAPHIC / LAND SETTING:
_!Slope ❑Valley ❑Flat ❑Ridge Eother
(check appropn ate box)
,LTITUDE �.3p5 7
LONGITUDE p1 !7air
' atitude/longitude source: XGPS ❑Topographic map
(location of well must be shown on a USGS topo map and
attached to this form A not using GPS)
?. WELL OWNER t
L.WNER'S NAME
fyr
ST T ADDRFSS F0x.
at hie eQ8719
City or Town State Zip Code
g24 )- jig?' 63I(0
May be in degrees,
minutes, seconds or
in a decimal format
Area code - Phone number
S '/ LL DETAILS:
. TOTAL DEPTH:
ktcot
b. DOES WELL REPLACE EXISTING WELL? YES 0 NO
c. WATER LEVEL Be:ow Top of Casing: / 0 0 FT.
(Use "+" if Above Top of Casing)
d. TOP OF CASING IS 2 FT. Above Land Surface'
'Top of casing terminated at/or below land surface may require
a variance in accordance with 15A NCAC 2C .0118.
e. YIELD (gpm): 30 METHOD OF TEST Blow
331316
f. DISINFECTION: Type H 2' H Amount 1 60Z
g. WATERI�ZONES (depth):
From A tp5 Togel 7 From To
pQ
From AC0, To 30From To
From 335 °To 337‘ From To
6. CASING: Thickness/
Depth1� Di eter Weight Mat rial
From To r7 Ft. �Ok C
From To Depth,/
Ft. (e")
From To Ft.
7. GROUT: Depth Material Method
From 0 To 20 F£ement & benonite
From To Ft.
From To Ft.
8. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in.
From To Ft. in. in.
From To Ft. in. in.
9. SAND/GRAVEL PACK:
Depth Size Material
Prom To Ft.
From To Ft.
From To Ft.
10. DRILLING LOG
From To
60,
60, 400
Formation Description
clay & sand
grani t-e
O
p
r
SED ,„r..
I 1. i7 �,.L1
11. REMARKS:
c-)
N =1
rV
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH
15A NCAC 2C, WELL CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS
R=CORQW,I BEEN PROVIDED TO THE WELL OWNER.
ATURE OF CERTIFIED WELL CONTRACTOR DATE
James B. Brown
PRINTED NAME OF PERSON CONSTRUCTING THE WELL
aubmit the original to the Division of Water Quality within 30 days. Attn: Information Mgt.,
1617 Mail Service Center— Raleigh, NC 27699-1617 Phone No. [phone] ext 568.
Form GW-la
- Rev. 7/05

_WELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources Division of Water
;WELL CONERACCOR(LNDIVIDUAL) NAME (print) KJ) J[4 l CERTIFlCATIONM e
j SELLCONT
N �RACCOR CO,�tPA.\YhAbIE MA GREE EBROS: WELL DRLGAF SYLVA.INC PHONE MJ 1828 586-5550
STATE - ASSOCIATED WQ PEICCUT%ajlieable)
.:--:I(if applicable)
' ..
1 WELL USE (Check Applicable Box) Residential LI Municipal/Public 0 Industrial ❑ Agricultural 0
Monitoring 0 Recovery0 -Heat Pump Water injection ❑ Other ❑ If Other, List Use
_(Soeet_Na
3. OWNER:
vs. Community. Loth rp Code
Address... 4, -L'Yel
!
City or Town Stare - Zip de
($23-)- S% St) -Q3 c U F.L__:�
.Area code- Phone number - -'
4- DATE DRILLED *OM �'
5. TOTALDEPTH:22'S
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO ISK
7. STATIC WATER LEVEL Below Top of Cosine: 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
raiance in accordance with 15A NCAC 2C -al18.
9. YIELD (epm): _ METHOD OF TEST I {J
10. WATER -ZONES (depth)- L CD
7-576
Topoderaphie/Land setting
• ❑Ridge lope ❑Valley ❑Flat` J y
• check appropriate box)
atitiide/longtrude }of weII loCOoh is
_'..(degreesiminutcilneeonds) '
Lktitud&longitude souFce ❑GPS❑Topographic map
(chink boz)
-'DEPTH r:';;.:;DRILLING LOG
From • :- `.:To ;"Formation Des riptioh'
/7
1 7 - /ov
/o /— 4z-a
7a —r37.
a.7V LOCATION SKETCH
I 1 DISINFECTION: Type {-(- j r( Amount
-!� -SnCi: It/nil 7)i rise / Show direction and distance in miles from at lent
,6vo State Roads or County Roads. include the road
- .'
Depth - Di meter - or WeighbFc. - N terra numbers aria common road Haines.
From 0 To ltFt. (O 1.L- ;VP al
0 . . 4__ .
From To FL ! I(`//hJ
From U To Ft. - ,(�,G�y�-
13. GROUT: Depth Material Icthod o
From "0 To 3 Ft-ttSizc
�(�,�
From To 20 Ft. .
GO
14. SCREEN: Depth Material r
From •.. To - Ft in. - - in.
From To Ft. in. - -in.
15. SAND/GRAVEL PACK:
-. From To -'Ft.
From To 'Ft.
16. REMARKS:
y . --.1 1
iU RUC_ f ING NE Ws._L iA'.::
Submit the original to the Division of Wpter Quality, Attn: Information Management, 1617 Mail Senice Center -
Raleigh, NC 27699-1617, Phone No: (9I9) 733-7015, within 30 days. - -
GW-1 REV.09/2004
ti
I DO HEREBY CERTIFY THAT THIS WELL WASCONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C WELL
CONSTRUCTION STAND , AN1THAT A COPY F THIS RECOO HAS BEEN PROVIDED TO THE WELL OWNER

WELL CONSTRUCTION RECORD
Noah Carolina Department of Eavuo��Natual Resour� n of Water Quality
WELL CONTRACTOR (LYDIWDVAL)NAU� (print) - - CERTIflCATIONY
;WELL CONTRACTOR COMPA]Y !IAMB AAA GREENE BROS. WELL ORLG.OF SYLVA, INC PHU\E , f 828) 586-Sa50
ESTATE WELLiCONSTRUCTION PER%TITY ASSOCIATED WQ PER\QTY
^-•+u(ifapplicablei C- - _..- 1-(if applicable) ="':".-
I. -WELL
USE (Check Applicable Box). Residential (d Municipal/Public 0 Industrial 0 - Agricultural 0
_ Monitoring 0 'Recovery ❑ :Heat Pump Water Injection 0 Other 0 If Other, List Lis:
�1 (Seeetor Rim7eN) f� q
VALYa it ntf / : /
(_02a} r'57 L. `L o `7
An:a codc- Phone Dumbernnn ��/ ///
4.-DATE DRILLED C// /5 tip
5. TOTAL DEPTH: /
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO IS
7. STATIC WATER LEVEL Below Top of Casing: ,`,k' FT.
(Use '+-if Above Top o[Lasing)
8. TOP OF CASING IS i FT. Above Land Surface'
Top of easing terminated arlor below land surface requires a
variance in accordance v., 1_21_11A NCAC 2C .0118.
9. YIELD (gpm): %5 METHOD OF EST I /J
10. WATER ZONES (depth): /02. •
LOCATION SKETCH
1 L DISINFECTION: Type I -I- i H Amount / - Show direction and distance in miles from at least
1? c StYG:. Wall ) Arc:, 1 4vo State Roads or County Roads. include the road
Depth �iaimeter . or Weight/FLMaterial" numbers anu con -coon road names.
From O To Z.4 Ft
From To Ft.
From To Ft.
13. GROUT: Depth - Material a fethod
From D To 3 Ft.
From To W Ft. 4^ date }7 GJ 4'LN+?-1 .
14. SCREEN: Depth Diameter Slot Size Material �e.t\9-w
From To - -Ft. in. in. -
si
From To Ft. in. - in.
•
Topooraphi4and setting L} ,
❑Ridgelope ;.t❑Valley ❑Flat
-. - (check appropriate box)
atitude/longttude of well location
_
.4;
- x:.(degrecsfaunuwshceonds)
Latituddlopgitt desource:DGPS❑Topographic ma
5!:(cheek box) ..
='•DEPTH "r-=DRILLNGLOG-s:
To Formation Description -
15. SAND/GRAVEL PACK:
-. From ;: To :-Ft.
From - To `Ft. - - -
16. REMARKS:
I DO HEREBY CERTIFY T T THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STAh ND THAT A C9P F THIS RECORD S BEEN PROVIDED TO THE WELL OWNER
F'EPSON CC}S
Submit the original to the Division of Water Quality, Attn: Information Management, 1617 Mali Service Center -
-`Raleigh, NC 27699-1617, Phone No: [phone], within 30 days. - -
GW-1 REV.0912004

`YELL CONSTRUCTION RECORD
wrth Carolina Depar anent -of Enviro ent and Natural Resources Division of Water Quality . gg
WELLCOK[RACfOR (LYDIVIDCAL)NA3�(prtot) L' CERTIFICATIONS
•
is c . ' 828 586-5550 "_
W'ELL CON72�CCOR C0.titPA-�Y N.4�tE A4A GR�ENE BROS. WELL ORLG.OF SYLVA INC PHa�� � f )
STATE WELL COAS'fRUG7[ON _ ASSOCIATED WQ PERI4TB
-`�:=(if applicable).
l WELL USE (Check Applicable Box): Residential] IM(unicipal/Public 0 Industrial 0 Agricultural 0
• •- h(onitoring 0 Recovery O -Heat Pump Waier Injection 0 Other D If Other, List Use
Topographic/Land setting
dge OSlope ; OValley t..OFlat
." (check appropriate box)
atitiideflongitude Ofwell location
City or T;
Area code -Phone number
4. DATE DRILLED
5.. TOTAL DEPTH:
6. DOES WELL RE ACE EXISTING WELL? YES 0 NO C
7. STATIC WATER LEVEL Below Top of Casing: �» 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 15A NCAC IC .0118. 9. YIELD (epm): METHOD OF TEST 1
10. WATER BONES (depth): LOCATION SKETCH
•
I 1 DISINFECTION: Type -1- I 4 Amount if �.� Show direction and distance m miles from at least
I7 CASINO: - t" ?II Thickness ��hao State Roads or County Roads. Include the road
Depth i ter - or Weight/Ft. Martina numbers and con no road names.
From D To Ft. SOtQ 4
From To , Ft.
From To Ft.
13. GROUT: Depth - —Material - tethod
From v -D To 3
t
(ifapplicable) ---
..,_:'(degrees/minutes/seconds)
Latttudellongitude source:OGPSOTopographte map
(check box)'=;..
%- DEPTH _ DRILLING LOG
From To -' Formation Descnpttoir
g3—Gre)
From To ZD
-14. SCREEN: Depth
From - ` To -Ft. i
From To Ft. in. - in.
15. SAND/GRAVEL PACK -
Depth:. .'Size' Material -
From - .. To .: tFt..
From To - -Ft. - -
FL,�,_ .,. _LL
..
Diameter - Slot Size -.:Material
n. ir..
-::16. REMARKS:
11
-_1 DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTIONST D RDS,AND TATA B• 'FTHIS RECo1HAS BEENPROVIDED"TOTHE WELL OWNER
C U-.
Iv\:. t._ ;,n O: FEGSUr: �"GnS i�RUCI Ri .r: �., . HE 1�: 'Li
Submit the original to the Division of Water Quality, Attn: Information Management, 1617 Mail Service Center -
Raleigh, NC 27699-1617, - Phone No. [phone], within 30 days. -
GW-1 REV. 09/2004

'Top of casia: terminated aUor below land surface require a
variance in accordance with 15A NCAC 2C .0118.
9. YIELD (¢pm): , M OF TEST I iJ
. 10. WATER ZONES depth): ,'� (� 8 LOCATION SKETCH
11. DISINFECTION: Type ' /+ 1 Y( Amount Show direction and distance in miles from at least
• - 12 OAS NG_ - - V-,!I Th_kr.nts 7 �1)-i o Star Roads or County Roads. include the road -
. Dia(nft r liVF or We t.: Afatuj i. r.u: to rs and common road names
Y
Depth
From 0 To
From To
From To Ft.
3. GROUT:
britevial a lethod - aj•� i 2
Depth Diametcr - Slot Size hlatrrial . - -
ZYELL CONSTRUCTION RECO
orth CaroliDa De rtment of Envuoament and Natural Resottrccs Divuton of Water
WEL CONTRACTOR (LYD[VIDUAL)lP�h �>� t' arl�� T A'" ,�CERTtFICATION I Sri
rr
{5'ELLC0.\TRAI'[OR COSIPA.\Y NAME 'AAA GREENE BROS: WELLDRLG.OF SYLVA INC: •?:-•-PROtYE �f [phone]
STATE WELL coNsrattcrION PERNrrri A55OCGTED WQ PERMITI
= tr.4ifap`plieable) �'s .. .. . (if applicable)'
l WELL USE (Check Apphcable Box) Residential Munn tpal/Public ❑ Indusmal ❑ Agiicultural 0 2
Monitoring 0 'Recovery ❑ 'Heat Pump Water Injection O - Other 0 If Other, List Us: -
2 WELL LOCAT N " Y _
NearestTowna CountyL\ A
(SccetNaTC Numbers, Community Subd stoo. Ltho.: Zip Cole)•,•
:3 OWNER:
Addies��^
CityrTown - 5ete r r Code
(828)-Qa.1`O —.ty/
Are: code- Pboae number y
4. DATE DRILLED
5. TOTAL DEPTH:
6. DOES WELL REPL E EXISTING WELL? YES D NO t
7. STATIC WATER LEVEL Below Tcn of Casino: • 7 - FT.
. . (Use `*' if Abov< Top of Casing)
8. TOP OF CASING IS / - FT. Above Land Surface
,Tapoo aphzcfLand setting
Ridge" ❑Slope '::OValley C]Fla(
. (check appropriate box)
Latitude/lon� tuck of well location
fidegre dminuteslseeonds)
•
atitude longitude source;( JGPSDTopographrc ma
(check box) -}:::
DEPTH DRILLI G LOG
!-'From .-.-To Formation Des- riptioil
S I.0—
�S7.03 — n
H2O
Ft. byoO2Z V(f P
Fc.
Depth
l
From" 7 F
From
14. -SCREEN:
From • To - d
o - t. 6: 01 ' . t W �'V p
From -To Ft. in. . - -in.
15. SAND/GRAVEL PACK:
Material -'.
From To - 'Ft. • - `
.16. REMARKS:
I DO HEREBY CERTIF THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE W1TH ISA NCAC 2C WELL
CONSTRUCTION SIC'DARDS, AND THAy OPY OF HIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
r-V:NSti_ t, ELL• -
Submit the original to the Division of Water Quality, Attu: Information Management, 1617 Mail Senice Center -
Raleigh, NC 27699-1617, Phone No: [phone], t+ithio 30 days. - . - -- Gt,V-1 REV. 09.'2004

\\TELL CONSTRUCTION RECO
a•-• EL CONTRACTOR (LNDIVIDUAL) NA_NEE (p r1210
tar,s , faat.
_
7.• - (if t
tip8ocaotes
NA:
Ass
icre'grftsan
North Caroltna Departinlent of Edirironinint and Natural Resources of Water Quilitje
' ER I =
„,..„"CrSTATE WELL cONSTRUcTIONPEIL
tt-r-,2:--n:Ctret.t.: CZ'
1 USt. (Checic Aitplieable.Box):Residential 0 ::IvlunicipaVPUblic 0 i:-:IndUitrint 0.1:;:zek'grinulnal -Tht.
Moaitorutg0 Recovery 0 C31-teit Pump Water Injection 0 ' Other 0 If Oihei,LisiUe.;
' -:••
it AM. (iREENE BROS:WELL•DRLG.OF.SYLVA. min [phone]
412. -4,p7
own]) yirQ pnormi •••Ft.N&91,..1W.-y‘ly.17.1rInt.e--;-‘+-•=c
....... , . si4e 0
N own • •
r•-•::-.7Coun oRi
'3/ • - "Leen . • .(checkipOiepriatebox) • ..• • ,
umbers.:Communi WA -vision. otNo...-21p ) •-•:±1st,:c;t4C:: . Of
. • • •
3. OWNER:
Addiiss
(Scott or Root
Coy or T)n- Sc lZip Code
( 828 )-
Area code -Phone cumber (c,
4. DATE DRILLEDn.
5. TOTAL DEFTH:__
6. DOES WELL REP,
7. STATIC WATER I
8 TOP OF CASNG I
cTop of casing terrnin:
ariance in szcorclin5;
9 YIELD (gpm):
10. WATER ZONES (de
11 DISINFECTION: Ty
- 12 1.14' SING'
Depth.,
From 0 To
From To
From To
13. GROUT: Depth
From .0 To
From :"R To 74
14. SCREEN: Depth
From To CL. In.
From To Ft. in.
15. SAND/GRAVEL PACK:
' : r (degreeshnicurgsfsecoilds)swy
LitinfajlonaiMdi souice:0012SOToPacrraphininai
z Iche5k box) 1
DEPTH :,.:DRILLING LOG
From .-;To Forrnation DeciicioiV
••••
2--
- 4ei 7
7 -
\?-7
Th7/9
,
in.
Nfaterial .
-From To •• tFt. •
From To Ft.
. •
PA:*--'11', •
LOCATION SKETCH . .
ection and distance in miles from at least -• . .. ' ;
Roads or County Roads. Include the road ..
.tici co tamo:: ru ;I mos.
fi „_
_ .
1 DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C,yhrELL
CONSTRUCTIO 'ST AND THAT PY OF THIS cpito HAS BEEN PROVIDED TO THE WELL:OWN l'ER11
SKI \ iC ESUCC\5l(UCU
t •
Submit the original to the Division of Wpter Qualit), Attn: Information Management, 1617 Mail Senice CenteCIN.,-
GW-1 REVR1120P Raleigh, NC 27699-1617,. Phone No. [phone], within 30 days.
t I

WELL CONSTRUCTION RECORii)
7 5 op Gt-e2,;.-
WELL CONTRACTOR COMPANY NAME AAA GREENE BROS. WELL DRLG.OF SYLVA, INC.
North Carolina Department of Enviro—nmenv and Natural Resources - Division of Water Quality
WELL CONTRACTOR (LYDIYIDL'AL) NAME (print) 1-.� !tv/-"' CERTIFICATION c-)(1(..
PHONE # [phone]
STATE WELL CONSTRUCTION PERM TO
(if applicable)
ASSOCIATED WQ PERMITS
(if applicable)
I. WELL USE (Check Applicable Box): Residential MunicipaVPublic ❑ Industrial O Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection ❑ Other 0 If Other, List Use
2. WELL LOCATI
Nearest Towp: -. ,La�tJ Couptg
(Scat Name
A• Topographic/Land setting
lope OValley ❑Flat
fr�n—fli ieX�� �yj r/�(/•G(i yv La.", / L (check appropriate box)
crs.Communiry,Subdivisio,L, ot�Si 7Yp Code) Ladtalelongitude of well location
3. 0 WNE1tC
Address Ce& 0-r az—
(Scar or Route
5e34(
• -`).. °a° Tow, - "a - ?` d3
-A:ea code- Phone nurnbcr
4. DATE DRILLED c"/a �o &
5. TOTAL DEPTH:
6. DOES WELL REPLACEXISTING WELL? YES 0 NQck
7. STATIC WATER LEVEL Below Top of Casing: ?UY FT.
(Use'-*" if Above Top of Casing)
8. TOP OF CASING IS ' FT. Above Land Surface'
'Top of easing terminated ao'or below land surface requires a
variance in accordance with A NCAC 2C .0118.
9. YIELD(gpm): / MET,EIOROFTEST I/J
10. WATER ZONES (depth): 9-`j O '
11. DISINFECTION: Type
12. CASING:
Depth
0 To• 7T
To
To
13. GROUT: Depth
From ("% To
From
From
From
From
Tom
14. SCREEN: Depth
- From To
From To
15. SAND/GRAVEL PACK:
Depth
From To Ft.
From To Ft.
f'"1�— Amount 2
Wall Thickness
Diame er or WeighdFt. is
Llolff So2)J
Ft.
Ft.
Ft
Ft.
Ft.
Ft.
Material
Diameter.
in.
in.
Size
s
of Size M
in.
in.
Material
(degrees/minutes/seconds)
Latirude/lon_eitude source:OGPSDTopoeraphic map
(cheek box) .
DEPTH DRILLING LOG
From • To Formation Description
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.
nnfr,
rceri
tT
1
16. REMARKS:
1 DO HEREBY CERTTFYZF[AT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTIO.' A S, AND T A COPY HIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
-( —b
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
Submit the original to the Division of Water Quality, Attn: Information Management, 1617 Mail Senice Center -
Raleigh, NC 27699-1617, Phone No. [phone], within 30 days.
GW-I REV. 09/2004

7 4
c&tritAcroa (LNDWIDUALWA-
- • * ebvNtl'ANY NANIE
'-art
app)
et.p,t-ISTATE WELL CON,STRUP1 lzcable
r•:::•-r1c2±.-±;
1. l'.WELT.; CONSTRUCTION RECORD
North Carolina Department of En7;51.metZ7d Natural R sources -DiVision of Water Quality
= : —..t.:4CERTIFICATIONY
ME (print
• s a.••-;-'.;•:.:Z.:'":21•gr.r•,•,..c••••••• .
• •
..:7-: 2 ..,-.: ----- --- - a ti 1 - . - -
.:;wELLUSEIChcOcAiiiiticable Box): Rest en a IvIunicipaltRublic 0 - Industnal : gncu t.,: 4..
ririg 0 .Recciery: 0 7l:Hiat Pump Water Monito njection 0 Other 0 If Other, List Use `' " e 4-
_ . .
2.-iiyaitztobis, ki.::::::1;-_:4ii:(c.-.-;:•:-f-::::c.i,„'„ f----;,..:7 .-.• a1/2 'Ir` - - 'T ; - > i- d • --J-
faits/
Ne.areit oufity 7 • ' 47 - . c P • • -
- - ORidge itplevalley • ,
dir e oca on
• -' •-•:• y•-5•1:1,„:',..r,•:472:."..r.rypir.r,,:?:,--;-,y,j.
13. GROUT:
Depth Material
From S To ze) Ft
14. SCREEN: Depth Diameter Slot Sat •Material irt..--Cor L-J
•From To Ft in. in.
• From To Ft in in.
15. SAND/GRAVEL PACK:
• ,-71.c.."1ornirri;
• ;.:?„.:4r0c LiNiyivion, bi
•• . “Strc tb:
3. OWNER:-
AddresS.
(Street or 12 o.)
- .
( 82B )- 6, t..1
City I
4. DATE DRILLED 45, - 5- 040
•5. TOTAL DEPTH: ..._ CV
6. DOES WELL REPLACE EXISTNO WELL? YES
7. STATIC WATER LEVEL Below Top of Casine:
• - ., (1./seN7it'Alamiclop o Casing)
8. TOP OF CASING IS / Fr. Above Land Surface'
*Top of casing terminated actor below land surface requIres 3
variance in accordance w415.8. NCAC 2C .0118. A
9. YIELD (pm): C.1 METHOD OF TEST H ki
10. WATER 'ZONES (depth): 7 5— - /as 5--
•
• LOCATION SKETCH
11. DISINTECTION: Type /--/- 1 H Amount / 3, ,e.,_ Show direction and distance in miles from at least
I') rASNC,: V ',I' Thickr,:cv ')-to State Roil& or County Roads. include the road • -
Depth Diameter or Vicighat. Nia•- Lembers and csiiiritori ii..mi names. i
• From El. To , cS Ft.,_424‘
.
11 ti .• • - .
grce nimu steon
From To Ft.
From To Ft.
From To fethod SEP .1 9 2005
•0 -.3
sol,ice;ocpsoTiiipc.lgrapk4Cc!ixp. •
''C'4!:"•••OEFTH DR!LLTNG LOG
Flom :TO :• Forrnation DeSiriptiait
60
7%-r • -.
• Material
To `Ft.
%Pt'refrVI-a
ryi
I DO HEREBY CERT1FYTHAT THIS WELL WASCONSTRUCTED INACCORDANCE WITH 1$A NCAC 2C, WELL ::••••
• CONSTRU 4S btfARD D THAT A CO OF THIS RECOD HAS BEENPkOVIDED TO THE WELLOW•iitic ,
. 37j: -
5c; CONS I rUCTiNCj tit Vi ELL
Submit the original to the Division or Wpiter Quality, Attn: Information Management, 1617 Mali Senice Center -
Raleigh, NC 27699-1617, Phone So. [phone], within 30 days.
: OW-1 REV. 09.2004

RESIDENTIAL WELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources -Division of Water Quality .
WELL CONTRACTOR CERTIFICATION # 2045
1. WELL CONTRACTOR:
James B. Brown
V^II Contractor (IndMduatt Name
Redden Brothers Well
Well Contractor Company Name
STREET ADDRESS 73 Holly Hills Vista RD
Franklin. NC 28734
City or Town State Zip Code
(828 )- 369-9591
Area code- Phone number
2. WELL INFORMATION:
SITE WELL ID #(if applicable)
STATE WELL PERMIT#(if applicable)
".NCI or OTHER PERMIT #(if applicable)
pplicable Box): Residential Water Supply<
AM ❑ PMF
COUNTY %I)314_)
TELL USE (Check
DATE DRILLED
TIME COMPLETED
0. WELL LOC,T!N.
TY:
Street N me, Nu - Comm
Drilling, Inc.
A6.,07P
ty, 511fiditision, Lot No.,,,
&oat Zip Code)
OPOGRAPHIC / LAND SETTING
Slope ❑Valley ❑Flat ❑Ridge
(check appropriate box)
LATITUDEp�
.ONGITUDE p.,;y-i,55
Latitude/longitude source: I�GPS 0Topographic map
(location of well must be shown on a USGS topo map and
attached to this form If not using GPS)
4. WELL OWNER y1
OWNER'S NAME 7/
❑Other
May be in degrees,
minutes, seconds or
in a decimal format
tif—
STT,2EET ADORES
City or Tom State Lip Code
51PU- 750'C)549
ea code - Phone number
b. WELL DETAILS:
a. TOTAL DEPTH:
b. DOES WELL REPLACE EXISTING WELL?J� YES IDNOA
c. WATER LEVEL Below Top of Casing:-.5LIJA' FT.
(Use -+• 11 Above Top of Casing)
d. TOP OF CASING IS 2 FT. Above Land Surface*
'Top of casing terminated at/or below land surface may require
a variance in acre ance with 15A NCAC 2C .0118.
e. YIELD (gpm): METHOD OF TEST Blow
r± A
ti xi
600
f. DISINFECTION: Type H T H Amount 160z
g. WATE QNES (depth);
From To la- From
From_I� To ) (n2 r From
From
W To Fyn From
6. CASING:
Depth
From (i_ To
From
From To
'ro
To
To
Thickness/
D151..me�r Weight Material
Ft aiLL 00 rIRS
Ft.
7. GROUT: Depth Material
From 0 To 20 FGenent & benonite
From To Ft
From To Ft.
Method
8. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. In.
From To Ft. in. in.
From To Ft. in. in.
9. SAND/GRAVEL PACK:
Depth Size
From To Ft.
From To Ft.
From To Ft.
Material
10. DRILLING LOG
Formation Description
clay & sand
grani
�.t �
rP u 2C
. _ acLIS
11. REMARKS:
gaua as
0'0
CT'
1 DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH
ISA NCAC 2C, WELL CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS
RECORD HAS BEEN PROVIDED TO THE WELL OWNER.
j26?v(
ATURE OF CRTfIFIED WELL CONTRACTOR DATE
James B. Brown
PRINTED NAME OF PERSON CONSTRUCTING THE WELL
Submit the original to the Division of Water Quality within 30 days. Attn: Information Mgt.,
1617 Mali Service Center— Raleigh, NC 27699.1617 Phone No. [phone] ext 566.
Form GW-la
Rev. 7/05

r
star,
:
RESIDENTIAL WELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources- Division of Water Quality
WELL CONTRACTOR CERTIFICATION # 2045
c o rt.,' (1 r
t1 O F u
1. WELL CONTRACTOR:
James Be Brown
Well Contractor (Individual) Name
Hedden Brothers Well Drilling, Inc.
Well Contractor Company Name
STREET ADDRESS 73 Holly Hills Vista RD
Franklin. NC 28734
City or Town State Zip Code
(828 )- 369-9591
Area code- Phone number
2. WELL INFORMATION:
SITE WELL ID #(i/ applicable)
STATE WELL PERMIT#(if applicable)
DWQ or OTHER PERMIT #(if applicable)
WELL USE (Check Applicable Box): Residential Water Supply 0
DATE DRILLED
TIME COMPLETE
O. WELL LOC TIO
CITY: '
a9 aoab
S'"oo AM PM�
COUNTY VKAX.11AV
(Street Name, Numbers, Community, Subditision, Lot No., Parcel, Zip Code)
TOPOGRAPHIC / LAND SETTING:
']Slope °Valley ❑Flat ❑Ridge °Other
(check appropriate box)
LATITUDE
LONGITUDE
Latitude/longitude source: ❑GPS ❑Topographic map
(location of well must be shown on e USGS topo map and
attached to this form it not using GPS)
WELL OWNER
'.VNER'S NAME}'y�
sr T ADORE S r'V B 1�
City or Town State ip Code
'4T7'do56
Area code • Phone number
May be in degrees,
minutes, seconds or
in a decimal format
5. WELL DETAILS: )
a. TOTAL DEPTH: 1000
b. DOES WELL REPLACE EXISTING WELL? YES 0 NO,41
c. WATER LEVEL Below Top of Casing: ({J FT.
(Use "+' if Above Top of Casing)
el. TOP OF CASING IS 2 FT. Above Land Surface'
*Top of casing terminated at)or below land surface may require
a variance in accord. -ce with 15A NCAC 2C .0118.
e. YIELD (pm): �� METHOD OF TEST Blow
f. DISINFECTION: Type H T H Amount 1602
g. WATER ZONES (depth):
From 0 To From To _
From To From To
From To From To
6. CASING: Thickness/
Depth Di meter Weight
From L[]J.p To Ft. to
From "/ To Ft. "D„
From To Ft.
7. GROUT: Depth Material
From 0 To 20 FCenent & benonite
From To Ft.
From To Ft.
Material
Method
8. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in.
From To Ft. in. In.
From To Ft. in. In.
9. SAND/GRAVEL PACK: 91
Depth Size Material
From To Ft.
From To Ft.
From To Ft.
10. DRILLING LOG
From To
0 ..
ADr
zo
Formation Description
clay & sand
grnn1 tP
cn
"Cl
1
61
11. REMARKS:
/DO' S"dAILP
Lau
1 DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH
15A NCAC 2C, WELL CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS
RECOAS BEEN PROVIDED TO THE WELL OWNER
fErF
S /ATURE OF CER IFIED WELLL CONTRACTOR DATE
James B. Brown
PRINTED NAME OF PERSON CONSTRUCTING THE WELL
Submit the original to the Division of Water Quality within 30 days. Attn: Information Mgt,
1617 Mall Service Center— Raleigh, NC 27699.1617 Phone No. [phone] ext 668.
Form G W-1 a
Rev. 7/05

RESIDENTIAL WELL CONSTRUCTION RECORD
North Carolina Department of FFvioamen and Neural Resources- Division of Water Quality
WELL CONTRACTOR CERTIFICATION 8 a ) KD
1. WELL CONTRACTOR:
4IN
waerac� (Ynivi&S) Nana
�rn.hnm LJell cl.r.1/�
Wd Canta:ta Corrrp®7 Nano
STREET ADDRESS (a 3 y gyrio TaiJn R
Re) k & ns vi %/B /VO a?r 77/
City or Toga Slate Tip Code
(fir&£r> 4/79-7,-'/s4/
Area code- Phase rumba
2. WELL IFORMATIOIt
SITE WELL ID flgQicehk)
STATE WUI. PEIN psepidAe)
DWI or OTTER PERMIT 4(Ii appira L.)
WELL USE (OtAppiicable Baia ResdudS WS Supply.
DATE DRILLED 3-n6,
THE COMPLETED Ll; 30 AM 0 PM IR
3. WELL LOCATION
CaTY: Br ySon r cry COUNTY S bin hi
_nnrana lake F5trPs `1$-7/3
(Steer tMrrre-Numbsc Co m rib. Sbeeeee. ISa. Pace. fl Coda)- -
TOPOGRAPIUC I LAND SETTING:
°Some ovaley °Rs NM* °Oliva
(deck aPPrapbrtoN �1
LATRi1DE _L ir' D �'29 Er"
LONGITUDE a! 13' .34 s,.
Latituddlmgimde sour= ISGPS °Topographic map
(6ea5m & Noel must be shown on a USGS lope snap and
aasdsd b MieIona Inot using GPS)
4. WELL OWNER OWNERS (� NAME ! / elt Airs,n ,n
STREET ADORESS na la ke FS7n i as
arysnxi C i'Ty - N/C S- 7/3
Cie$ a Tana Stale rip Code
(gait)-U-SR- /o9b
Area code - Picas rifler
May In &gees.
maes.sacmdsa
lea deans, feces
4 WELL DETAILS: a. TOTAL DEPI* LitG
O
b. DOES WELL REPLACE COSTING WELL? YES NO la
c. WATER LEVEL. Reis Top et Cathy .cO FT.
(Usev' if Above Top d Casing)
el_ TOP OF CASING S / FT. Abase Lard Surber
'Tap d casiplwrmaletl meat hind aldaCamay impair
a vaince is amnia= with 15A NCAC 20.0114
e. YIELD toper _ri NEMECOFTEST a e r
rt
5 J `) LA
L. OISRFECfOIt Type lla TIT Amount / 9. AZ
g. WATER ZONES (depth)
Fran SO To Ll inn
From
From
0. CASING:
To
To
Depth
Fran ti To Ina Ft
Fan To Ft
From To Ft
From
From
Fran
To
To
To
Thickness/Weight OAKS
Sarl NVG
7. GROUT: Depth Naked
From 6 To a° FL CernPnr
than To Ft
Fran To Ft
WNW
pr rn11.
A SCREE& Depth Dianser Sot Size Materin
Foxe To Ft. it in.
Firm To Ft IL in.
From To Ft _ Si. in.
IL SAIMIGRAVEL PACK:
Depth Sae Mated
From _ To R
thorn To F<
Fan To R
10. DRWJNG LOG
From To Fomasion Desap6R
rn
N
'S1
2:3
11. REMARKS:
CJ` t
tT1
DO WHEW GERM 1itRTaSVIOL WAS oaBWCIED ACCamNCEwren
MAMAC 2C. WELL COMMUCTION SWMDALDS. NtTHAT A COPY CFTC
rEearmrlS eE N PROVIDED TO1EWELL GOMM
Jill.thILDHEN
SIG�.N,JA{T�URE OF /,�%`/ CONTRACTOR 2�
PRNIID tiOF Pl p NAbE tbpISTRUCTNGTHEwE11
Submit the original to the Division of Water Quality within 30 days. Attn: Monnation Mgt.,
1617 MITI Service Center — Raleigh, NC 27699-1617 Phone No. [phone] bit 568.
Fum GW-la
Rev.7A5

RESIDENTIAL WELL CONSTRUCTION RECORD
North Carolina Department of Enticement and Natural RrsourCtS- Division of Water Quality
WELL CONTRACTOR CERTIFICATION I
1. WELL CONTRACTO,R:/
c�Ppt ,4lyrl P
Wei
u9 CwdreContactor(YlavdaW tare
/ ryyy
Girt 6Q - llt// dPi t'y�
l !�
Wea Contractor Company
Name/
STREET ADDRESS 67:3 AOP 7 Wn 1(rt
l9nh6 /insv,Wr /✓C 25-77/
City a�Town Slate Zip Code
(e r�sr) -f 7c7— 5-11 54
Area code- Phone number
2. WELL INW WIATIOtt
SITE WELL ID i(d amicable)
STATE WELL PERMITS, male/
DWQ ar OTHER PERMIT Kt appicabn)
WELL USE (Chad( Appir b(e Boit Rasidestral Watt Supply®
DATE DRILLED S'—vLS—n
r
TIME COMPLETED / , 30 AMCI PM
3. WELL LOCATW$t
CITY: Bryson r, r1 COUNTY gl JeL�n
c.,me.I eQ.2 �/
It
Mama Name Murthma. Camnunaa..Searedo4 Lane- P+W Lp.Coati-
TOPOGRAPHIC /LAND SETTING:
OSlope NValey OFW ORilge Ooeer
(check apparel, tad
5f
LATITUDE 3 N
LONGITUDE a32 . 3'31 4"
tatitudeAougiit de sots= ■GPS °Topographic map
(location dset must be shoran on a USGS Nopa map and
attache( b Otis fatal not using GPS)
4. WELL OWNER
OWNERS NAME c 3- %Al,, mC1 &nn
May be it degas.
mime; seconds er
ova dial Twee
S/Rttt ADDRESS CG,%G r
�3rv,n C,'ry iIIC 25-7/3
a Total Sere Ip Eaaaaee
ea rode- Phone anew
5. WELL DETARS:
a. TOTAL DFPTTt 1 cf)
b. DOES WELL REPLACE E1aSTOC WELL? YES❑ NOS
c. WATER LEVEL Below Top d Casig (n FT.
(Use + if Atom Tap d Casing)
d TOP OF CASING IS / FT. Above Land Sw e
Top d casing tamed agar below lad surface nay rewire
a Valera aceadancewih 15AIICAC 2C .0116.
e. YIELD {spar 0 NETHODOFTEST (—A_ r
anso
6.) r r ^,
`aa
f. COUN ECT1Ott Type 11 7—iT Amount co. Z
g. WATER ZONES (dealh):
Fran 60 To %Sfrt From To
iron To Fran To
From To From To
6. CASING:
y Diameter
Fitinu To 4o SI Ft
Faun To Ft.
From To Ft
Thidmess/
Weigh
Sna1 vc
7. GROUT: Depth Material SMelhod
Fams'�To 20 Ft GEmpnT t
Fan To Ft
From To FL
B. SCROat Depth Dant Slot Sea Material
Fran To FL in. it
Finn To Ft Si. _ it
From To Ft it in.
A SAND/GRAVELPACK:
Dept Size Material
From To FL
Flom To Ft
F ra To FL
i
10. DRILLING LOG
From To Fomtation Description
SEP 1 (-) /I
11. REMARKS:
'O
1
m/earCERTIFYTHOTHISWELLEMSCONSOICIEDNACCORDNCE
Sant
MA WAG 2.%Maln SWmaaaa.NDTthTACCP OFTNB
RECORD HAS BEEN A.OYME0io1E WELL OWNER.
SIG 4M1$ EE OF WELL CONTRACTOR DATE
j P 4:r hI
PRINTED NAME OF CONSTRUCTNG THE WELL
Submit the original to the Division of Water Quality within 30 days. Attn: Information Mgt,
1617 Mall Service Center —Raleigh, NC 27699-1617 Phone No. [phone] ext 566.
Form GW-la
Rev. 7105

RESIDENTIAL WELL CONSIRUCITON RECORD
North Cambia Department or 'Environment and Naaaal Resounds -
Division of Water Quality
WELL CONTRACPOR CELTTIFLCAITON # 66
•t fl r'- 4
1. WELL CONTRACTOR:
ti tact
W Catwada 1'Nene
_62rnk°,m W // rdr/7/4
Wet Contra . Canaan! Mare
/ n
STfREET ADDRESS 6 (3 7 hly� N / T vWh Jam,
Neat ,in5v.%/F /1Vc 77/
City or Town Seat r9 Code
2. WELL itFCIWTIOlt
SITE WELL ID a ,Pii:lle)
STATE WELL PERMIT*,apprab q
DWQ or OTHER PERMIT 6(a appkab)e)
1NELL USE (ChedcAPP4'1-6a[k Raideraat Was Supply"
DATE DRILLED G ^ a 3 -O(o
TIME COMPLETED 7/, (/(1 Mt• PM ID
3. WELL LOCATOR
crrY:.437,Cnn Cttiy cotMY �j GJA i rl
CC)k //l' // 7/,i
(Street rin8 &VComarq.94Arfebn.titllo- Pared. ZbCvae)- -
TOPOGRAPFIC I LAND SEITFNG.
DSnpe [VS OFW Unite oOcer
(deck appiorioloscud
LATITUDE .S., d aE'sa,:vt
L.ONGrI IDEZ o 30'o9. 711
Latitude/longitude sauce: ■OPS ()Topographic map
OXBOW alma =OW siwsa on aUSGS lapa tap end
dish&b his lam lnot using GPSi
4. WS.L OWNER el
owners raw Ai us 77 1 .s' KP r
slier soonEss Sky ro ve
n Gi'Ty )VG
May he o deres,
:targnmaarw
Ina Am bra
#L3,47P3r79 -6175
7/3
rip Code
S. WELL DETAtS:
a. TOTAL DEPrtt y/t
b. DOES WEL REPLACE OUSTING WELL? YES in NO■
c. WATER LEVEL Below Top el caiu¢ Too FT.
(Ustre iAbaft Top d Caving
d. TOP OF CASING IS / FT. Above Lad Sihoe
Top d casing tw®ded S baba Sod allot, may require
a vain* in aomdawew7b 15A NCAC 2C A116
e. YIELD Watt Y METHOD OF TEST air
ot-
t DISINFECTIOet Type /7 %% Amount 9. n Z
g. WATER ZONES (depth)
From 700 To 90s From To
Fran To Fran To
Ran To From To
6. CASING:
Depth Darter
Fmgf-_To S/ Ft 6
Fun To Ft
Fran To Ft.
Thickness/
$pr4Weight
I W
7. GROUT: Depth Malaria
Fran n To.O Ft Ceznonr
Fran To Ft.
Fan To R
A�� Method
9. SCREIt Depth Diameter Slat Sae Materiel
Fran To Ft In. In.
Rom To Ft in. _ in.
Fran To Ft M. in.
9. SAND/GRAVEL PACK
Depth Sae WSW
Fen To R
Frog To Ft
Ran To Ft
10. DTMLNG L.OG
Rom To
11. REMARKS:
FomraSm DesaptiNt
CJI
e-
1OOIaWNY tHmFT nwnnwaLwASCONSM C®aaCCOROMPICEaam
tSAI CK7C. WELLCa6IrmC'TIOw SatSNmS. NDTNTA COPY OFT6
RECOMMYS lPmala®OTEWELL t711110.
T
SIGNATURE OF
5 -ia-
CONTRACTOR DATE
Tr f/y�a
PRINTED NAME OF PERSON CONSTRUCTING THE WELL
Submit the original to the Division of Water Quality within 30 days. AHn: information Mgt.,
1617 Mall Serrks Center — Raleigh, NC 27699-1617 Phone No. [phone] sxt 568.
Form GW-la
Rev. 7A5

RESIDENTIAL WELL CONSTRUCTION RECORD
North CaraTm Departmca ofEovimmat and Natural Resources- Div'aia; of Water Quality
WELL CONTRACTOR CERTIF1CAIION I O([7SO 1.6'/ /,
0N/ FEC1ION Type 7 r? Amount CI oQZ
g. WATER ZONES (depth):
From ? To a0.0 From To
Fran To From To
Fmm To From To
1. WELL CONTRACTOR:
webolati
e
Name
62r.Aha m (AJH// dri7/,4
Wd Contractor Compare
STREET ADDRESS 6-3W 4$,J s /// &&I
,kQblgl%1$(/tWe' /Ye- 9, 77/
Cdy or Torn Sam id Code
(gag-). 4,9- F[q5'/
Area code- Phase amber
2. WELLIFORMATIOIt
SITE WELL ID )
STATE WELL PERMIT'S a,.S..S .)
DWQ or OTHER PERMIT applicable)
WELL -USE (CheckApplicableBad¢ Realigned Water Supply
DATE DRILLED /6-n6
THE COMPLETED I/13a AM PM■
3. WELL LOCATIOIt
are: far/Son retry couw v rS Lila i r7
Mast nc i C nchw..S. ees Se/ Latin_ PP� t7 �.)-
TOPOGRAPHIC I LAND SETTING:
°slope *vdey OFW Wedge Meer
— appmpridahmO
LATITUDE A_ SI° etc t3zLSn
LONGITUDE .a3 ° 30 ' 4 S to I I
Latitude/longitude sour= SUPS °Topographic map
(beaten atrial must be slow; on a USES&ipo asapab
eawiedb It"e bmlaat osdtg 6PS)
4. WELL OWiet
antes NAME 3d, nDV'? hip
STRUT ADDRESS 6rty l cy b rcAn h
,Qn/son c/`ry 4'? r7/3
CWWTown Slade Zip Cade
(kak - ST 7 -75--
Area code- Phase number
May be in degas.
Mena. seconds ar
in decimal bees
5. WBL DETAILS: a TOTAL DEPTTt D.A,C
b. DOHS WELL REPLACE DOSTNG OWELL? YES') NO•
c a WATER LEVEL BdamTap at G FT.
(Uses.' IAlma Tap d Casing)
d. TOP OF CASING IS / FT. Above Lad Surfaces
'Tap d casing deeded S bias Ind surface ray' require
a variance in acaada....S 15ANCAC 2C.011&
a YIELDbpa): T YELNOD OF TEST G.rr
0 n n - ct 9
et O e) c) o
& CASING:
Tactless/
Depth wegld
Fecm_a_To 3, Ft , hr2I i/G
F1ao To Ft.
From To Ft
7. GROUT: Depth Material !1 MOW
Flan ' n 0 To 0 Ft rein Fin N n7- Vm pstf7
Fran To Ft K
From To Ft
& SCREEtt Depth Diameter Slot Size
Ran To Ft M. in.
Fran To Ft it _ it
Fran To Ft it. in.
A SMDIGRAva PACK:
Depth Size Maui/
Fran To Ft
From To FL
From To R
10. DRILLING LOG
Ftam To Formation Description
SEP S_ 1 Ll:(:il
11. REMARKS:
N
Ur
T
rs
rnr
!WHEREBY WYTI T6W91WAS EMC® rAefAfmaICEWNIX
15A1110•4rC. WELL CONSTRUCDON MAIMARDS. AID TWA COPYCFTIS
RECORD HAS BEEN PROJDED1)TE WELLOM6t
e
SIGNATURE OF WELL CONTRACTOR DATE
N
fl NAITE OF
Submit the original to the Division of Water Quality within 30 days. Awn: rdonnatlon Mgt,
1617 Mali Senior Center- Raleigh, NC 27699-1617 Phone No. [phone] ext 568.
Fam GW-la
Rev_7/65

RESIDENTL4L WELL CONSTRUCTION RECORD
Noah Camara Depm4aan oEaviuoma t and Neural Resources- Division of Water Quality
WELL CONTRACTOR CERTIFICATION I Q r.CO
1. WELL CONTRACTOR:
7- P
Wei Contractor Name
.6r0Lhn. nl (Jell ri r/ //,'
et Contractor Campos Name STREET
/ T I
STREET! ADDRESS in3q /7`yAP [DWn l?�A
�pAi),il.SV,//e' /VC 25.77/
City or Torn State 24 Cede
(craecn- y77- Sr %5'/
Amen aldR Plmone maoher
2. WBI IFORMATIOIt
SITE WELL ID Id applicahla
STATE WELL PERIIRI(lappitatiM
DWQ or OTHER PERMIT S(I aptlkable)
WELL USE (Chad Appieade Monk Rand-LJ War add/ IR
DATE DRILLED Ff XS =o4'
TINE COUPLETS) 2. m MAD PM■
3. WELL LOCATIOIt
CITY: ✓arySon r/Ty COUNTY S/A1n1i77
1,3sIn cS Jflnu/1%ar% S7/3
(SeeetName..Numbem. Camemay.S'hS too teLNe. iaer. 2*Cot)- -
TOPOGRAPFIC I LAID SETTING:
❑Slope Wang EMS oRidge pater
(Mack enumerate box)
LATITUDE a. 1° 7. / Ir
LoNGRTAE1 3° A713/, Q 4
Latialdkllonginde source: SOPS °Topographic map
(beafts dwe/ must be slam on a USGS Napo rasp end
eddied Sothis new l rd tsig G
I. WELL OWNER
owners NAME dim , e roon/7nL %S
&inttrADDRESS Ad,"es hive nrt./rr
RMyythTam !irk/ � �/3
Side c$ra1 ).7,36-72o6
Area code- Phone mamba
May be ik degree.
alarm moods or
Sadea' fort
S. WIIL DETAILS:
a. TOTAL OEPTIt 756-
b. DOES WILL REPLACE EXISTING WELL? YES ❑ No■
c. WATER LEVEL Below Tap d Cava () FT.
(Use + I Above Top d Casing)
d_ TOP OF CASING IS / FT. Above lad Surface'
Tap d tasty I marled dor tabs Ind surface cry require
awrS=in amdrwrih 15A NC AC 2C.O11&
e. YIELD (War 0 METHOD OF TEST G.ir
o 3 l 5 3 4
L DISINFECTIOft Type O Arnaud C)
g. WATER ZONES (daps*
Rom 0 To d From To
Form To Fran To
Fran To Fran To
6. CASING:
Thickness/
Depth Diameter Weight Materd
From 0 To /n 3 Ft
From To Ft
Fran To FL
7. GROUT: Depth Framf2__ppTo at0
Fore To
Rem To
Wind t1 Method
Ft Ctirrnnr P�7m,0hN0
Ft T XX
FL
& SGifftt Depth Disaster Stt Sim Material
Fr® To Ft in in.
Rao To Ft_ Si. _ it
From To Ft it in.
A SMOmNRAVE. PACK
Depth
From To Ft
Wee Naiad
Ram To Ft
From To R
i?p
1& DRILLING LOU
Rom To
Fomrion Dtsaploa
-u
c.TM
0
era
t� uu
II.
tt e-F; T.Be. hyd.,-r>r.,T're
IOotEa ncERIFTNrATTMSMELWASOONSIMC1® ISCC 1ma10E WITH
ISAIOC 2C.WBLCONSTRUCTOR swctND$. NUfMTA:.- CFTC
RECORD IS 6®tPRON]®TOTIEWWBL OaaR.
o
SIGNATlME OF '
DATE
Submit the original to the Division of Water Quality within 30 days. Anm IMomrtbn Mgt,
1617 Mail Service Center— Raleigh, NC 27699-1617 Phone No. [phone] ext 568.
Farm GW-la
Rev. 7/05

RESIDENTIAL WELL CONSTRUCTION RECORD
Nowt Carolina Deprmion of Eavionmaa and *aural Resources- Division of Water Quality
oG
WELL CONTRACTOR CERTIFICATION g O 60
1. WELL CONTRACTOR:
m4 iy nIe
wd Contractor (Yn6anbityl Nana
r %been L1J // 01r.74re
Well Contractor Carom Nome
STREET ADDRESS In3Y JP %OWn ler4
R1,6h;nsv;//te /1VC 9S-771
City at Town Stye Z4 Cade
(S5)-L/77-?US'/
Area tads Phone mamba
2. WBINFORMATIOIt
SITE WELL IDetapie )
STATE WW. PHiMIrlpappreaaa)
OWO or OTHER PERMIT SW appirabk)
WELL USE (ChedcAppfrable B
olt Reddened Wafer Supply 6Q
DATE DRILLED
TWE COMPLETED //.36 AN RI PM
3. WELL LOCATIOIt
CITY: K'rv50/1 CJ Ty cowry Sl.✓rs,.r n
Wal * Rd 7/3
(Sheet Plaine.lYettas CaneuotY-98fddon. LM*.. Paned. $ Cade) -
TOPOGRAPHIC ) LAND SETTING:
OSlope Maley OFW (!Ridge OOIer
(deck apprap ielebpo
LATITUDE aS. rL+in(rlJ 72"
LDworruvE23° 39'67.y"
Latitude/longitude source: ■CaPS OTopograpbic soap
Oran dadmust be shown on a USGS kpa soap and
a®sdted blab kra 7not using GPS)
4. WELL OWNER tl�-�-
OWNERS N, lAME er r y' 2� p
SItesi ADDRESS WoSr,t 'Cl
d3bn cl"ry 4/c Q?7/3
Oly or Tom Saeie 2p Cole
c Q?)-7'77-6O.cG
Area code - Phone amber
May be in depees.
manes sacaedsor
lea data foist
A WELL DETAILS: C-[�
a TOTAL DEPTIt
b. DOES WELL REPLACE EXISTING WELL? YES O NO IN
c. WATER LEVEL. BebeTop reCasing Aro FT.
(User' If Abase Top d Casing)
d. TOP OF CASING / FT. Abate Lad Surface
'Top d tatao doybd agar beta Nod surface ay minis
a variancet ataoAwoevat 15A NCAC 2C .ol10.
a. YIELD (pp11 NEMO OF TEST a it
6'. r r rt
tl rj l l t
t DISINFECTION: Type H nil Amamt i c' n>
g. WATER ZONES (d $t)
From ISb To 5:63 From To
From To From To
From To Rom To
6. CASING: D�ne� Thickness!
NIS
From n Tob741 FL G.Is' Sn t ✓l
Flan To fl. oC
Frain To Ft.
7. GROUT: Deplir1� Material Method
Fmm�_To� a Cotrkonr
Faun To Ft ��L
From To FL
A SCREt Depth Diameter Slat Sim Material
Faun To Ft_ ic in
From To Ft it _ a
Flom To Ft in. in.
A SAM/GRAVE PACK
Depth Mite Wort
Frun To Ft
From To R
Fame To R
i•A
10. DRBLING LOG
From To Fomafon Destapfcn
cci—<0
11. REMARKS:
rf1
'e A
T.
cJI
ILL
MD a,nJ1MTTaa WHt WAS WaG1aOIED aAOemnNCE Vint
15A110CtC. WBLCOIIriltCOON SDNONtD& AMEIHMA COPYW lIr
RECORDHAS Si PnOYCEDTOTIE Wort Owia
trp: Fr�9-d
SIGNATURE OF WELL CONTRACTOR DATE
,ore
pizak
NAME PERSON CONSTRUCTING TIE WELL
Submit the original to the Division of Water Quality within 30 days. Atha: information Mgt,
1617 Mall Service Center— Raleigh, NC 27666-1617 Phone No. [phone] text 566.
Form GW-la
Rev. 7A35

RESmimr.r AL WEI.I. CONSTRUCTION RECORD
North Caofoa Department of Environment and Natant Resources- Division of Waco Quality
WELL CONTRACTOR CERTIFICATIONS aoc.rO
R n n
d i j v 3 O
1. WELL CONTRACTOR:
wd Contactor e
6?L'If:J1C2 m /.t IP/! ri r:'/I.'ng
Wd Contractor Campers
S E T ADDRESS (n 3 7 ,rk Wlw /IZ Rd
/TphLir)SVi%IP VC 9.Ce77!
Cayce Tear Shoe Zip Code
L '')-Lfy9-Fg5-1,
Area code- Phone anew
7-WELL RFOIWTIONt
SITE WELL ID Sfaa1¢cahw)
STATE WELL P'ERMf.,appint re
DWG a OTtER PERMIT a(iappleable)
WO.L USE (Cheek Parka BResidential Weber Sep* El
DATE DRILLED 3-OG
TIME COMPLETED /;O0 AMID MN
3. WELL LOCATIOIt
CITY: Bry(Sa/) Ci 7y COUNTY Slain
anlane.. Aka ts7 77-s `2xi13
($12a t u e_Nurabas. CommunilLaubdideime.leas..PaulZp.Cely-
TOPOGRAPHIC t LAND SETTING:
OSope Wham. OFnc ■R* oOlw
(check appropristaba)
LATITUDE ,_1.t°.?��'31. 3(0,,�[ 3
totai1DE 2°+LJ1 AC/�T"
Latit dd ongiude same= ■GPS OTopogaphic tap
4L. S malma=s beshownsiraUSGStyomapand
embeds RraAnn Inot wig GPS)
May ten deems,
maea neater
Ira dread Nowt
4. WELL OWNER ]� 11
OWNERS NAME TA rm /l.i/nkeenlalerd�r
STREET AOOFtESsri fine. lake 1f.S7aT F
fire�Son City A/4 »-7/ 3
*War Town • Sale Z, Code
(%as)-(,g7-ntel
Area axle - Phone hues
S. WELL DETAILS:
a TOTAL DEPTIt 7S C
b. DOES Wt3L.REPLACE Damao WELL?
YES o NO
e. WATER LEVEL 6abwTapdCacig 64 FT.
Wan' • Abaft Teo et Caning) d. TOP OF CASIO IS / - FT. Above Laid Swine
. 'Top at easigteeoakd aka beimW taboo trai Rabe
a vaimeen aeadmeevir 15ANCAC 1C .01111
e. YIELD(gpar y METHOD OFTEST Q i'r'
L DISINFECITOM Type ifiTIY Amount 30. oZ
g. WATER ZONES (depth):
Fran 2'0 To 7eCC Fran To
From
Fran To Fran
To From To
To
6 CASING: Thickness/
Depth Weight
Fran n To /09 FL Shen P VC
Fan To Ft�'�l�
From To Ft.
7. GROUT: Depth Marano' Method
Fran n To DR Ft. Corti enr
From To Ft
From To Ft
8. SCREEM Depth Diameter Sat Sim Material
From To Ft al in.
From To Ft a _ in.
Fran To Ft a in.
9. SAMORIRAVB.PACK:
Depth -Size Mrrerel
Fran To R.
Fran To F3.
Tram To FL
Y?)•
16 DRILLING LOG - From To Formate Description
11. REAIARXS:
4-p
u
ImIBC .WS.L GIMc1 LLVIAS aaoac®*ArmmwCE WITH
1SA WAG= WELL W161a1 ilt AICNb mi. A11MTA COPY MINS
i PROVIDED TO11E HAS BEEN PROYea61OWNER.
s� p
TUBE OF WELL CONTRACTOR DATE
te
WaIT®N E COtSI'RUCTNG
THE WELL
Submit the orighial to the Division of Water W aNty within 30 days. Attn: Information Mgt.,
1617 Man Service Center — Raleigh, NC 27699-1617 Phone No. [phone] est 568.
Form GW-la
Rev. 7/05

RESIDENTML WELL CONSTRUCTION RECORD
Noah Carolina Department of Environment and Ntacal-Re�sourca-Diviiskm of Water Quality
WELL CONTRACTOR CERTIFICATION # (l0S_U
1. WELL CTOTt
�a �C�
Wet Cantor Ware
c5 cJ m (s /el/ of re W./ ix57
Weil Contractor Connally Name
sTREET ADDRESS (,-34, $d e 7:114In Rri
i7r> jin.sv.%/ei A/c 2fr77/
Of Town Stait r9 Code
{ rQ$t1 2/79'-R445'1/
As® Dods- Prose itt
2. WELL NPOIRilATNOtt
SITE WELL ID /(i aopicable)
STATE WELL PERMIT/pappioae)
lNNli er an -ER PERT ea nopi - J )
wai. USE (Check AppacableBa¢ Reaidafi Wain SippN
DATEDWLLW 1 606
TaE COMPLETED .1 ;3C) AM PM DI
3. WELL LOCATIOIt
err,: rySn n c. 7,.co(xiry sWa;r
2nj nF,C m�.un _ j�/,3
(Street Name. .Nu Numbers. C �,.-Sl_ldF_ia_..i aim.. Parcel, Coda}
�2 g -
TOPOGRAPHIC 1 NAND SETTING:
•Stops Maim oriel Midge Dolma
iced appiapia e9
LATITUDE .,C3'/60, y n
LDNGrruc E . a° .�.7'tfl - '
Latitude/longitude sag= oGPS oTopog aphic map
(bcehon d wd must be shown an a USGS lcpo map and
_RadialloWs form I nal Drip GPS)
&bybidegas,
souse secondsv
iratea mot
♦. WELL OWtee /
oweers NAME/97�r��
,�ar�e, S7 /cJnnncj
ti
Sh1�th ADORESS 47eC )Ypnirnr:n
l )rV TO C./Ty /i,r D?7/`j
� or Tom Sabo
(srlrr } Z/Pf -.Q9.6d
Area code- Phase nista
s. WELL DETAILS:
a. TOTAL DEPIrk
b. DOES WELL MENACE OUSTING Wa.L7 YES ❑ NDp
c. WATER LEVEL BdowTcp d Casing 0 Et
(Use'• IAbove Tap d Casing)
d TOP OF CASING IS / . FT. Above lad Surfaces
- 'Top d ashy tsaoied aWbake Mid srbanram rases
avaielcab accordant* Vath 15A CAC 2C J110.
a YIELD Wpm* 6 rEnNooGFTES7 GJ e
J•a
t. OISRWTCi101t Type r) Amount 0
g. WATER ZONES(dere*
Fnanf_To P5 Fran To
Frain To Fran To
Fran To Fran To
6. CASING: Thickness/
Depth , a?: :. _ Weigle
Fran_a__
QTo WIa / Snr2( 'Vr
Fran To Ft
Fran To FL
0
7. GROUT: Depth WWII (5 Method
Fmn(_To aG FL [Pj'i7 Pre -Pum,D Qq
Fran To Ft OC
Fran To Ft
8. SCREB:Jt Depth Diameter Slot Size Material
From To Ft it in.
Fom To R_ In. _ in.
Fan To Ft M. in.
A SOURAVEL PACK:
Depth Sine Material
Fran To Ft
From To FL
From To Ft.
10. DRWJNG LOG
Fran To Fomta&on Dmupto,
SEP 19 2OCZ
t +
Il. REMARKS:,5,4,,_,L•r„„
Cr%•
100113EBY aELLYcnwsmKaa)eACCOONCEWmh
SSA IOC S, WELL tOd 1Dtty OARDSMe1NTA COPY MINS
RECaOHAS IIEBi Ra/O®TOTIEWELLOWI6L
SIGNATURE WELL CONTRACTOR DATE
PRNT®r trF Pa6(7N CONSTRUCTING THE W01
Submit the orighlal to the Division of Water Quality within 30 days. AWE Infonnatron Mgt.,
1617 Mall Sendai Ctnttr— Raleigh, NC 27699.1617 Phone No. [phone] ext 568.
Farm GW-la
Rev. 7105

- RESIDENTIAL WELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources -Division of Water Quality
WELL CONTRACTOR CERTIFICATION # 2045
1. WELL CONTRACTOR:
James B. Brown
Well Contractor (Individual) Name
Redden Brothers Well Drilling, Inc.
Well Contractor Company Name
STREET ADDRESS 73 Holly Hills Vista RD
Franklin, NC 28734
City or Town State Zip Code
t 828 )- 369-9591
Area code- Phone number
2 WELL INFORMATION:
SITE WELL ID #(it applicable)
STATE WELL PERMIT#(if applicable)
OWQ or OTHER PERMIT #('d applicable)
YELL USE (Check Applicable Box): Residential Water Supply .1
-ATE DRILLED E - ��cc11��
TIME COMPLETED 5 - GV AM 0 PM 0
3. WELL LOQArION:
COUNTY_
I tree/ ame. Num rs, Community, Subdivision, Lot No., Parcel, Zip Code)
TOPOGRAPHIC / LAND SETTING:
❑Slope :Valley DFIat ❑Ridge ❑Other
(check appropriate box)
LATITUDE 3
LONGITUDE
..:itude/longitude source: ❑CPS ❑Topographic map
(location of well must be snnwn on a USGS frpo map and
attached to this form if not using GPS)
4. WELL OWNER •//
NAME/OOO-^�Wp/NNEER''S,��
l �Y6[ A� DDRE �`-
May be in degrees,
minutes, seconds or
in a decimal format
Q��ity �or Town �Sta�
L T /AS )- `f97-
Area code - Phone number
..:.;ELL DETAILS: 7�
a. TOTAL DEPTH: 50D
b. DOES WELL REPLACE EXISTING WELL? YES.09 NO 0
c. WATER LEVEL Below Top of Casing: 111^^^ FT.
(Use "+" if Above Top of Casing)
d. TOP OF CASING IS 2 FT. Above Land Surface'
"Top of casing terminated aVor below land surface may require
a variance in accordance with 15A NCAC 2C .0118.
e. YIELD (gpm): ((/ METHOD OF TEST Blow
f. DISINFECTION: Type H T H Amount 160Z
g. WATER ZONES (depth):
OG From 3S'To L i° . From To
From To From To
From To From To
6. CASING: Thickness/
Depth Diamelexr Weight M. -al
From V To Ft._, CP
From /Jig To Ft._&_L'e 1L8Q -- - -
From To Ft.
7. GROUT: Depth Material Method
From 0 To 20 FGement & benonite pumped
From To Ft.
From To Ft.
8. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in.
From To Ft_in. in.
From To Ft. in. in.
9. SAND/GRAVEL PACK: 9
Depth Size Material
From To Ft.
From To Ft.
From To Ft.
10. DRILLING LOG
From To Formation Description
1) 3Di clay & sand
50' 5D0' granite
11. REMARKS:
1.1
Q
n
C— -
GD
rV
62
c C
I D0 HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH
15A NCAC 2C. WELL CONSTRUCTION STANDARDS. AND THAT A COPY OF THIS
RE HAS BEEN PROVIDED THE WELL OWNER.
NATURE OF CERTIFIED WELL CONTRACTOR DATE
James B. Brown
PRINTED NAME OF PERSON CONSTRUCTING THE WELL
submit the original to the Division of Water Quality within 30 days. Attn: Information Mgt.,
17 Mail Service Center— Raleigh, NC 27699-1617 Phone No. [phone] ext 668.
Form GW-1 a
Rev. 7/05

RESIDENTIAL WELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources- Division of Water Quality
«'ELL CONTRACTOR CERTIFICATION # 2045
1. WELL CONTRACTOR:
James B. Brown
Well Contractor (Individual) Name
Hedden Brothers Well Drilling, Inc.
Wet Contractor Company Name
STREET ADDRESS 73 Holly Hills Vista RD
Franklin, NC 28734
City or Town State Zip Code
828 )- 369 9591
'krea code- Phone number
2 WELL INFORMATION:
SITE WELL ID #(if applicable;
STATE WELL PERMIT#(if anp1cable)
DWQ or OTHER PERMIT #(if applicable)
WELL USE (Che k Applicable Box): Residential Water Supply ❑
DATE DRILLED TIME COMPLETE 5 i AM ❑ PM1d,
3 'A'ELL L*- ATION:
CITY:
(Stree ame, Numbers, Community, Subdidsion, Lot No., Parcel, Zip Code)
TOPOGRAPHIC / LAND SETTING:
ESlope D Valley ❑Flat ❑Ridge ]Other
(check appropriate box)
LATITUDE 3
I ONGITUDE
-titude/longitude source: GPS ❑Topographic map
(location of well must be shown on a USGS tcpo map and
attached to his form if not using GPS)
May be in degrees,
minutes, seconds or
in a decimal format
4 ./ELL OWNER
OWNER'S NAM
>TREET ADDRESS
cenk NC as-u 3
City or own S r Zip Code
yICN aai$
Area code - Phone number
5. WELL DETAILS:V I
a. TOTAL DEPTH:
• DOES WELL REPLACE EXISTING WELL? YES 0 NO'A
c. WATER LEVEL Below Top of Casing: 50 FT.
(Use `+" if Above Top of Casing)
d. TOP OF CASING IS 2 FT. Above Land Surface -
'Top of casing terminated at/or below land surface may require
a variance in accordance with 15A NCAC 2C .0118.
e. YIELD (gpm): METHOD OF TEST Blow
From
From
6, CASING:
3E3I311
f. DISINFECTION: Type H T H Amount 1 60Z
g. WATER ZONES (de�ptt.h�::t�
From 104 To IXVW From To
To From To
To From To
Depth /QQ Diipmeter
From To (O11 Ft. 10
FromTo—A—
o (1. Ft. CO N
From To Ft.
7. GROUT:
From 0
Thickness/
Weight
Material
(14110
Depth Material Method
To 20 F€e-nt & benonite pumped
From To Ft.
From To Ft.
8. SCREEN:
From
Depth Diameter Slot Size Material
To Ft. in. in.
From To Ft, in. in.
From To Ft. in. in.
9. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
From To Ft.
10. DRILLING LOG
From To
YO'a
11. REMARKS:
Formation Description
clay & sand
granites
0
nnnn
1
r--
Grr
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH
15A NCAC 2C. WELL CONSTRUCTION STANDARDS. AND THAT A COPY OF THIS
RECOAS BEEN PROVIDED TO THE WELL OWNER.
ATURE OF C - IF I D WELL CONTRACTOR DATE
James B. Brown
PRINTED NAME OF PERSON CONSTRUCTING THE WELL
t.Ibmit the original to the Division of Water Quality within 30 days. Attn: Information Mgt,
.. " Mail Service Center- Raleigh, NC 27699.1617 Phone No. [phone] ext 568.
Form GW-la
Rev. 7/05

RESIDENTIAL WELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources• Division of Water Quality
WELL CONTRACTOR CERTIFICATION # 2045
1. WELL CONTRACTOR:
James B. Brown
Well Contractor (Individual) Name
Hedden Brothers Well Drilling, Inc.
Well Contractor Company Name
STREET ADDRESS 73 Holly Hills Vista RD
Franklin, NC 28734
City or Town State
(828 )- 369-9591
Zip Code
Area code- Phone number
2. WELL INFORMATION:
SITE WELL ID #(if applicable)
STATE WELL PERMIT#(if applicable)
DWQ or OTHER PERMIT #(if applicable) ���///
WELL USE (Ch k Applicable Box): Residential Water Supply Up
r_r.TE DRILLED, /
-ME COMPLETE 3 r co AM ❑ PM
3. WELL LO ATION:
CITY�:r 4y. 'itt ter. COUNTYSlIX.L(,N.-
1
Greet Name, N�rnbers, Community, Subditision, Lot No., Parcel, Zip Code)
TOPOGRAPHIC / LAND SETTING:
QSlope ❑Valley OFIat ❑Ridge DOther
(check appropriate ' Alt( box) I
..ATITUDE 35 Z�Ai}
LONGITUDEI3 a_5 03(.3
Latitude/longitude source: XGPS OTopographic map
(location of well must be shown on a USGS topo map and
attached to this form A not using GPS)
d. WELL OWNER
May be in degrees,
minutes, seconds or
in a decimal format
OWNER'S NAME �� ' /
ST TADDRESS O
77�7Y�t_Y•,l�/� en
Y2 nas779
/C�ity a own p1� State Zip Code
Area code - Phone number
LNELL DETAILS: 11 O
a. TOTAL DEPTH: lO
b. DOES WELL REPLACE EXISTING WELL? YES 0 NO yk.
c. WATER LEVEL Below Top of Casing: /V FT.
(Use •+• if Above Top of Casing)
d. TOP OF CASING IS 2 FT. Above Land Surface*
•Top of casing terminated at/or below land surface may require
a variance in acc
_orrddance with 15A NCAC 2C .0118.
2. YIELD (gpm): (XD+ METHOD OF TEST Blow
6
J l J U 8
f. DISINFECTION: Type H T H Amount 1 602
g. WATER�]ZONES (depth :,
From IR To From To
From To From To
From To From To
6. CASING: Thickness/
Depth r7/_ Digme)er Wei ri
From O To BS Ft. LP . 1 001
From To Ft.
From To Ft.
7. GROUT: Depth Material Method
From 0 To 20 FGednent & benonite pumpedFrom 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
Ffom To Ft.
From To Ft.
From To Ft.
10. DRILLING LOG
From To
Aiwa
Formation Description
clay & saran
°ranite c-
IV
SE; .b u c
11. REMARKS:
cr.
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH
ISA NCAC 2C, WELL CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS
RECOR• BEEN PROVIDED TO THE WELL OWNER.
7-016-0(0
TIFIED WELL CONTRACTOR DATE
James B. Brown
PRINTED NAME OF PERSON CONSTRUCTING THE WELL
Submit the original to the Division of Water Quality within 30 days. Attn: Information Mgt,
i 617 Mail Service Center- Raleigh, NC 27699-1617 Phone No. [phone] ext 568.
Form G W-1 a
Rev. 7/05

RESIDENTIAL WELL CONSTRUCTION RECORD
'3 n r .
North Carolina Department of Environment and Natural Resources- Division of Water Quality J 0 4
WELL CONTRACTOR CERTIFICATION #
1. WE CO CTOR:
l h (^/a.it,l-
Wet Contractor jt'ndb iduaf) Name
AAA GREENS BROS. WELL DRLG. OF SYLVA, INC.
Well Contractor Company Name
STREET ADDRESS 1800 SKYLAND DRIVE
SYLVA
NC 28779
City or Thom State
( 828 } 586-5550
Zip Code
Area code- Phone number
2. WELL INFORMATION:
SITE WELL ID #fdappLcade) d! �.(-I M1 O
STATE WELL PERMITS/Or applicable)
DWQ or OTHER PERMIT #(if applicable)
WELL USE (Check Applicable Box): /Residential Water Supply 0
DATE DRILLED 3_ ( — L) ti
TIME COMPLETED / AMP PMA,
3. WELL LOy.,CATION: /1
CITY: '
kA .s0i/iyc/G7 couNTY (�u)�/It
3 v (t4%1IL 4-i✓v'
(Street Name, Numbers, Community, Sobrition, Lot No., Parcel, Zip Code)
TOPOGRAPHIC / LAND SETTING:
pope ❑Valley ❑Flat ❑Ridge El Other
(check appropriate bar)
LATITUDE
LONGITUDE
May be in degrees,
minutes, seconds or
in a decimal format
Latitude/longitude source: ❑GPS ❑Topographic map
(location of well must be shown on a USGS topo map and
attached to this fonm #not using GPS)
4. WELL OWNER
OWNER'S NAME
0t-hctC1/4' Pr 5141
ADDRESS 7�L) I'1GY I �lt
l Town S e ', S,771 C; `4-..4 N C
City 7 Zip Code
((112 } �k6g— I1R.
Arearcode - Phone number
5. WELL DETAILS: C7,
a, TOTAL DEPTH:
b. DOES WELL REPLACE EXISTING WELL? YES 0 NO CX
c. WATER LEVEL Below Top of Casing: 100 Fr.
(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 .0118n.
e. YIELD (gpm): /^ _ METHOD OF TEST , 4) ✓-
30yi
f. DISINFECTION: Type HTH
g. WATER ZONES (depth):
v
Fmm:�(�.o Tor
Amon/ O1""'
From To
From To From To
From To From To
6. CASING:
Thickness/
,� Depth, Dii ler Weight terial
Fran i TO % C% FL A"_ r/i 5D1L1/ V i 2
From To Ft.
From To Ft.
7. GROUT: Depth Material
Fran To Ft.
Fran To Ft.
From To FL
Method
8. SCREEN: Depth Diameter Slot Size Material
From To FL in. in.
Fran To Ft. in. in.
From To Ft. in. in.
9. SAND/GRAVEL PACK:
Depth Size Material
From To FL
To Ft.
To Ft.
Fran
From
10. DRILLING LOG
From To Formation Description
/ice
<� — .3
3v - Z c- P
74 Z.—
�LZ — 7D7>
11. REMARKS:
-i
C
:
i
1 DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WRVI
15A NCAC 2C. WELL CONS1RUC1ION STANDARDS. AND THAT COPY OF Thy
RECORD WAS BEEN PROVIDED TOji1E WELL OWNER.
SIGNATURE OF CERTI IED WELL CO R DFE
(/✓/ii1 �li '/
PRINTED NAME OF PE SON CONSTRUCTING THE WELL
Submit the original to the Division of Water Quality within 30 days. Attn: Information Mgt, Form Gw-la
1617 Mail Service Center— Raleigh, NC 27699-1617 Phone No. [phone] ext 568. Rev. 7/05
SEP 2.n 200 ..

1. WELL CONTRACTOR:
James B. Brown
Well Contractor (Individual) Name -
Hedden Brothers Well Drilling, Inc.
Well Contractor Company Name
TREET ADDRESS 73 Holly Hills Vista RD
Franklin, NC 28734
City or Town State Zip Code
828 )- 369-9591
Area code- Phone number
2. LJELL INFORMATION:
SITE WELL ID *Of applicable)
STATE WELL PERMIT#(If applicable)
DWQ or OTHER PERMIT #(if applicable)
WELL USE (Checlppplicable Box):
ResidentialWater Supply
DATE DRILLED.. 5 A�'Do
i AE COMPLETED 5..06 AM ❑ PM (,*
NELL LOQ.At,ION:
CITY:
ry w.v
(Street Nam , Numbers, Community, SubdiNsion, Lot No., Parcel, Zip Code)
TOPOGRAPHIC / LAND SETTING:
❑Slope OValley ❑Flat ❑Ridge ❑Other
(check appropriate box)
+.ATITUDE 2r1r
,7NGITUDE �D
Latitude/longitude source: t(..GPS ❑Topographic map
(location of well must be shown on a USGS topo map and
attached to this form If not using GPS)
4. WELL OWNER
)WNER'S NAME
STREET Ai
May be in degrees,
minutes, seconds or
in a decimal format
City or Tow
). (497 `1
Area code - Phone number
Zip Code
6 WELL DETAILS: '
t TOTAL DEPTH:
b. DOES WELL REPLACE EXISTING WELL? YES 0 NOYi
—{
c. WATER LEVEL Below Top of Casing: t WI FT.
(Use "+' If Above Top of Casing)
d. TOP OF CASING IS 2 FT. Above Land Surface*
'Top of casing terminated at/or below land surface may require
a variance In accordance with 15A NCAC 2C .0118.
e. YIELD (gem): I . METHOD OF TEST
Blow
RESIDENTIAL WELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources -Division of Water Quality
WELL CONTRACTOR CERTIFICATION # 2045
f. DISINFECTION: Type H T H Amount 160z
g. WATER ZONES (depth):,
From •iC
From
From
6. CASING:
•333400
To_9_, From To
To i'S0 From To
To From To
Thickness/
Depth giamfter Weight Material
From To Ft. la� �,,,,aq �j '�
From To Ft._ya— a_L__
From To - Ft.
Ir
7. GROUT: Depth Material Method
From To 20 Fpement & benonite
From To Ft.
From To Ft.
9. 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: 011
Depth Size Material
From To . Ft.
From To Ft.
From To Ft.
10. DRILLING LOG
From To•,,
�1, `15&
11. REMARKS:
Formation Description
clay & sand
KELEIVED
Dlb. Ur VVAI ER QUALITY
OCT 1 1 200G
1 DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH
15A NCAC 2C, WELL CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS
REC flAS BEEN PROVIDED 9 THE WELL OWNER.
NATURE OF TIFIED WELL CONTRACTOR DATE
James B. Brown
PRINTED NAME OF PERSON CONSTRUCTING THE WELL
.limit the original to the Division of Water Quality within 30 days. Attn: Information Mgt.,
617 Mall Service Center— Raleigh, NC 27699-1617 Phone No. [phone] eat 668.
Form GW-la
Rev. 7/05

RESIDENTIAL WELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources- Division of Water Quality
WELL CONTRACTOR CERTIFICATION # . 2045_
' 33399
1. WELL CONTRACTOR:
James Be Brown
Wet Contractor (Individual) Name
Hedden Brothers Well Drilling, Inc.
Well Contractor Company Name •-- - --
STREET ADDRESS 73 Holly Hills Vista RD
Franklin. NC 28734
City or Town ' State Zip Code
( 828 )- 369-9591
Area code- Phone number
2. WELL INFORMATION: - -
SITE WELL ID eat applicable) -
STATE WELL PERMIT#(il applicable)
DWQ or OTHER PERMIT #(If applicable)
WELL USE (Check ApplicableleBox): Residential Water Supply
DATE DRILLED On zs aj AO 6
TIME COMPLETED 4,0D AM ❑ PM X
3.WELLLORA IIOON:^/
CI(T:S�'jJ�1'��,,,R,,--^ COUNTY
CJILRl, Numb
ra, Community,
(Street Name, Numbers, Community, Subdivision, Let No., Parcel, Zip Code)
TOPOGRAPHIC / LAND SETTING:
D Slope OValley bFlat DRidge ❑Other
(check appropriate box)
LATITUDE _ap� assA
LONGITUDE13 _1a5 4 R5c—)
Latitude/longitude source: 59PS ❑Topographic map
(location of well must be shown on a USGS topo map and
attached to this Pone if not using GPS)
May be in degrees,
minutes, seconds or
in a decimal format
4. WELL OWNER
OWNER'S NAME /
5T(2fi//EET ADDRESS
City or Town State
/2g)- 497-4/4q .
Area code - Phone number
•
Zlp Code
5. WELL DETAILS: 35�0 a
a. TOTAL DEPTH: T
b. DOES WELL REPLACE EXISTING WELL? YES
0 ND*
c. WATER LEVEL Below Top of Casing: O( OD FT.
(Use'+' if Above Top of Casing) ,
d. TOP OF CASINO is 2 FT. Above Land Surface'
'Top of casing terminated at/or below land surface may require
a variance In accordance with 15A NCAC 2C .0118.
METHOD OF TEST Blow
e: YIELD (gpm):
1. DISINFECTION: Type H '1' H
Amount 160z
g. WATER ZONES (depth):
From 1I 3 To 11511 From To
From _0• To �i bac From
From To From
6. CASING:
Depthn
From 0 To Al Ft.
From To Ft.
From To Ft.
Diam(Deter
n
To
Thickness/
W;Ahi ateral
7, GROUT: Depth Material Method
From 0 To 20 FGement & Uenonite
From To FL
From To Ft.
B. SCREEN: Depth Diameter Slot Size Material
From To Ft. In. In.
From To Ft. in. In.
From To Ft. In. in.
9. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To - Ft.
From To Ft.
10. DRILLING LOG
From To
11. REMARKS:
Formation Description
clay & and
grand-p
RtCEiVtD
DIV. OF VVAI ER QUAI ITV
OCT 1 1 2006
DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH
15A NCAC 2C, WELL CONSTRUCTION STANDARDS, ANO THAT A COPY OF THIS
RECOIiE'AAS SEEN PROVIDED TO THE WELL OWNER,
NATURE OF CE TIFIED WELL CONTRACTOR DATE
James B. Brown
PRINTED NAME OF PERSON CONSTRUCTING THE WELL
Submit the originalto the Division of Water Quality within 30 days. Attn: Information Mgt.,
1617 Mail Service Center- Raleigh, NC 27699.1617 Phone No. [phone] ext 568.
Form GW-la
Rev. 7/05

RESIDENTIAL WELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources- Division of Water Quality
WELL CONTRACTOR CERTIFICATION 4 . 2045
1. WELL CONTRACTOR:
James B, Brown
I Well Contractor (Individual) Name
Hedden Brothers Well Drilling, Inc
Well Contractor CompanyName
STREET ADDRESS 73 Holly Hills Vista RD
Franklin, NC 28734
City or Town ' State Zip Code
(828 )- 369-9591
Area code- Phone number
2. WELL INFORMATION:
SITE WELL ID #(II applicable)
STATE WELL PERMIT*01 applicable)
DWQ or OTHER PERMIT *(if applicable)
WELL USE (Check Applicable Box): Residential Water Supply k
DATE DRILLED 4.61q •//Q�1f/?4� 1'
TIME COMPLETED .•.tA/ AM ❑ PM m
3. WELL LOCATION: /��
CITY: ,(ottr�_,oa.__ COUNT
(Street Name, Numbers, Cot y, SuEdaion, Lot Na:, Parcel, Zip Code)
TOPOGRAPHIC / LAND SETTING:
D Slope CValley O Flat ❑Ridge pother
(check appropriate box) ��
ri�C LATITUDE Q�r+t.-J I I
LONGITUDE ,per _15 a4 LO
Latitude/longitude source: I, iPS ❑Topographic map
(location of well must be shown on a USGS fopo map and
attached to this form /1 not using GPS)
4. WELL OWNER
OWNER'S NAME
STPIEET ADORES
Oan�lot,
City or Town State
,47R)-(9�- 835'
Area code - Phone number
May be in degrees,
minutes, seconds or
in a decimal format
Zip Code
5, WELL DETAILS: neR5 t
a. TOTAL DEPTH: a 1'
b. DOES WELL REPLACE EXISTING WELL? YEAS 0 NO 6i
c. WATER LEVEL Below Top of Casing: ../�.� FT. \
(Use'+' If Above Top of Casing)
d. TOP OF CASINO is 2 FT. Above Land Surface'
'Topof casing terminated at/or below land surface may require
a variance In accordance with 15A NCAC 2C .0118.
e. YIELD (gpm): AD_ METHOD OF TEST Blow
f. DISINFECTION: Type H T H
g. WATER ZONES (depth):
Amount 160z
From To 1 ��I From To
From Tc�4p�O7� From To
- From From To
Thickness/
From O DepthToIO7 et, Diq�e)er ill yhJ, ter' I
/ From To Ft.
From To Ft.
6. CASING:
7. GROUT: Depth Material Method
From 0 To 20 Fgement & benonite
From To Ft.
From To Ft.
8. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. In.
From To Ft. In, In.
From To Ft. In. in.
9. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
From To Ft.
10, DRILLING LOG
From To�^�. Formation Description
CJ r clay & sand
0°5 r a r grani t-P
RECEIVED
niv nF WATER QUALITY
oci 1 L mn06
11. RE EICS:
1 DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH
ISA NCAC 20, WELL CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS
RECOA5 SEEN PRDVIDED TO THE WELL OWNER.
NATURE OF CRTIFIED WELL CONTRACTOR DATE
James B. Brown
PRINTED NAME OF PERSON CONSTRUCTING THE WELL
Submit the original to the Division of Water Quality within 30 days. Attn: Information Mgt,
1617 Mail Service Center— Raleigh, NC 27699-1617 Phone No. [phone] ext 568.
Form G W-1 a
Rev. 7/05

RESIDENTIAL WELL CONSTRUCTION. RECORD
North Carolina Department of Environment and Natural Resources- Division of Water Quality
WELL CONTRACTOR CERTIFICATION # 2045
33flS7
1. WELL CONTRACTOR:
James B. Brown
Well Contractor (Indiddual) Name
Hedden Brothers Well Drilling, Inc.
--Well Contractor Company Name STREET ADDRESS 73Holly Hills Vista RD
Franklin, NC 28734
City or Town ' State Zip Code
( 828 )- 369-9591
Area code- Phone number
2. WELL INFORMATION:
SITE WELL ID #(lt applicable)
STATE WELL PERMIT#(it applicable)
DWQ or OTHER PERMIT #(if applicable) [�
WELL USE (Check Applicable Bx): Residential Water Supply
DATE DRILLED /�
TIME COMPLETED 1 ES. 0D AM O PM,&
OUNTY_�
3. WELL LQCSTION:
C
(Street N-j -1, �•eri Community, Subdiision, Lot No., Parcel, Zlp Code)
TOPOGRAPHIC / LAND SETTING:
°Slope °Valley °Flat ❑Ridge ❑Other
(check appropriate box)`5a
LATITUDE pJ2. 'yo ]- '4
LONGITUDE /
Z rrI 3 W
Latitude/longitude source: PS ❑Topographic map
(location of well must be shown on a USGS topo map and
attached to this fonq it not using GPS;
4. WELL OWNER
OWNER'S NAM
ST.85kET ADDRESS
NC ll
Zip Code
May be in degrees,
minutes, seconds or
in a decimal format
City or Town State
417- f /([5 •
-,Area code • Phone number
5. WELL DETAILS:Wr
a. TOTAL DEPTH: OK
b. DOES WELL REPLACE EXISTING WELL? YES 0
Nf-
c. WATER LEVEL Below Top of Casing: /rl 1 FT.
(Use'+' if Above Top of Casing)
d. TOP OF CASINO IS 2 FT. Above Land Surface'
'Too of casing terminated at/or below land surface may require
a variance In accordance with 15A NCAC 2C .0118.
e.. YIELD (gpm): ) 6 METHOD OF TEST Blow
f. DISINFECTION: Type H T H Amount 1 60Z
g. WATER ZONES (depth):
From__ To IQ From To
From To 13n From To
From To 150' From -Ta
6. CASING: Thickness/
n Depth11 -- 9lanieter Weight �pteri i
From L/ To tQ1 Ft. LDS 1IB6 �SIDEi
From To Ft.
From To Ft.
7. GROUT: Depth Material Method
From 0 To 20 Felt & benonite purr
From To Ft
From To Ft.
6. SCREEN: Depth Diameter Slot Size Material
From___ To FL in. in.
From To Ft. In. In,
From To Ft. In. In.
9. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
From To Ft.
10. DRI).LING LOG
From To ,(
11, REMARKS:
Formation Description
clay & sand
granite
kFCEIVED
II • ..
OCT 712c;
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH
1EA NCAC 2C, WELL CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS
RECOrt6KAS SEEN PROVIDED TO THE WELL OWNER.
NATURE OF C RTIFIED WELL CONTRACTOR DATE
James B. Brown
PRINTED NAME OF PERSON CONSTRUCTING THE WELL
Submit the original to the Division of Water Quality within 30 days. Attn: Information Mgt.,
1617 Mail Service Center- Raleigh, NC 27699-1617 Phone No. [phone] ext 568.
Form GW-la
Rev. 7/05

RESIDENTIAL WELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources- Division of Water Quality
WELL CONTRACTOR CERTIFICATION # . 2045
1. WELL CONTRACTOR:
James B. Brown
Well Contractor (Individual) Name
Redden Brothers Well Drilling, Inc.
Well Contractor Company Name - --
STREET ADDRESS 73 Holly Hills Vista RD
Franklin, NC 28734
City or Town State Zip Code
( 828 )• 359-9591
Area code- Phone number
2. WELL INFORMATION:
SITE WELL ID #(II applicable)
STATE WELL PERMIT#(if applicable)
DWQ or OTHER PERMIT Of applicable)
WELL USE (Check Applicable Box):
DATE DRILLED
TIME COMPLETED
3. WELL LO AJION: 1L
CITY: lr{`0 CQU
1/
(Street Na m rs, C mmunity, SobdAlsion, Lot No'., Parcel, Zip Code)
Residential Water Supply
AM ID PM^^
iTY- I44;:
TOPOGRAPHIC / LAND SETTING:
°Slope °Valley °Flat ❑Ridge ❑Other
(check appropriate box)
LATITUDE _,10
LONGITUDE 23
Latitude/longitude source: *PS °Topographic map
(location of well must be shown on a USGS topo map and
attached to this form Snot using GPS)
4. WELL OWNER
OWNER'S NAME
STjjc` T ADDR SS
,y/ C/•Cw-C,-
C•I{f or Town
May be in degrees.
minutes, seconds or
in a decimal format
its
St e
RZ� )- 497 - /3
Ares code • Phone number -
5. WELL DETAILS: 1 ,'ry
a. TOTAL DEPTH:
b. DOES WELL REPLACE EXISTING WELL? YES °
c. WATER LEVEL Below Top of Casing: op
(Use •+° if Above Top of Casing)
Zip Code
NO °
FT.
d. TOP OF CASING IS 2 FT. Above Land Surface'
`Top of casing terminated aVor below land surface may require
e variance In accordance with 15A NCAC 2C .0118.
e. YIELD (gpm): METHOD OF TEST Blow
333396
f. DISINFECTION: Type H T H
Amount 160z
g. WATER ZONES (depth):,
From/O/3 To /0.57 From To
From I/ 3 'To / (.61, From To
From /32. r To /as_ - From To ---
6. CASING:
A Depth Dlappl�eter
From U To Ft. (0
From To Ft.
From To Ft.
7. GROUT: Depth
Thickness)
W�Igltl, M erial
/ iY�177ff
Material Method
From 0 To 20 Fcenent & benonite pumped
From To Ft.
From To Ft.
8, SCREEN: Depth Diameter Slot Size Material
From To Ft. In. in.
From - To Ft.In in.
From To Ft. In In.
9. SAND/GRAVEL PACK:
Depth
From To
From To
From To
ID, DRILLING LOG
From To
0
•
19.111124
Size Material
Ft.
Ft.
Ft.
Formation Description
clay & sand
granites
HIV. Of WATER u�uALITY
11. ARKS:
aw
UC J 1 1 2006
I CO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH
16A NCAC 2C, WELL CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS
RECOO-• 5 BEEN PROVIDED TO THE WELL OWNER.
�.•e •moo-
SATURE OF CERTIFIED WELL CONTRACTOR DATE
r James B. Brown
PRINTED NAME OF PERSON CONSTRUCTING THE WELL
Submit the original to the Division of Water Quality within 30 days. Attn: Information Mgt,
1617 Mail Service Center— Raleigh, NC 27699.1617 Phone No. [phone] ext 568.
Form GW-la
Rev. 7/05

RESIDENTIAL WELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources -Division of Water Quality
WELL CONTRACTOR CERTIFICATION # 2045
f. DISINFECTION: Type H T H Amount 1 60z
g. WATER ZONES (depth)
From taI3 To OgI5 From To
From_3D( To CY From To
From To From To
6. CASING: Thickness/
Depth C ulster Weight
From To /�'/�� Ft
From i ME
From To Ft.
7. GROUT: Depth Material
From To 20 j anent & benonite
From To Ft.
From___ To Ft.
8. SCREEN: Depth Diameter Slot Size Material
From To Ftin. in.
From To Ft in. In.
From To Ft in. In.
8. SAND/GRAVEL PACK: et
Depth Size Material
From To Ft.
From To Ft.
From To Ft.
333395
1. WELL CONTRACTOR:
James B. Brown
Well Contractor (Individual) Name — - - -
Hedden Brothers Well Drilling, Inc.
Well Contractor Company Name
STREET ADDRESS 73 Holly Hills Vista RD
Franklin, NC 28734
City or Town State Zip Code
•28 )- 369 9591
ea code- Phone number
2. WELL INFORMATION:
SITE WELL ID #(if applicable)
STATE WELL PERMIT#(It applicable)
OWQ or OTHER PERMIT #(If applicable)
NELL USE (Check AA plicable Box): Residential Water Supply IQ
DATE DRILLED —, IS•6�L0
:ME COMPLETED s AM 0 PM�(
$6flti�y_—
a. WELL LO ATION:
CITCOUNTY
vyva
(Street Neme, mben, Community, Subditision, Lot No., Parcel, Zip Code)
TOPOGRAPHIC / LAND SETTING:
❑Slope ❑Valley ❑Flat 0 Ridge O Other
(check appropriate Abox)
LATITUDE ��
LONGITUDES' sa,5
Latitude/longitude source: XGPS ❑Topographic map
(location of well must be shown on a USGS fopo map and
attached to this form it not using GP
. •'ALL OWNER 7I
OWNER'S NAME ♦1 **� r_�./,. ,� I.11s. -I
ST ET ADDRESS
I...�l.iL Zip Code
13
Ity•4own Fa.
Ares c•.e - Phone number
b. WELL DETAILS: / W s
a. TOTAL DEPTH: [O
b. DOES WELL REPLACE EXISTING WELL? YES 0 NOX
c. WATER LEVEL Below Top of Casing: s,�.LX) FT.
(Use •+' If Above Top of Casing)
d. TOP OF CASING 15 2 FT. Above Land Surface'
'Top of casing terminated atlor below land surface may require
a variance In accordance with 15A NCAC 2C .0118.
e. YIELD (gpm): 3 METHOD OF TEST Blow
May be in degrees,
minutes, seconds or
in a decimal format
10. DRILLING LOG
From To
I
,♦
Gfallitt♦
11. REMARKS:
Formation Description
cl ay & sand
grani 1-p
Method
REr.FIVED
HIV. OF WATER QUALI I Y.
T 1 1 2006
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH
E HI D OT THE OWNER. TMATACOPY OF THIS
RAS BEEN PROVIDE
1 /7—OG
NATURE OF CERTIFIED WELL CONTRACTOR DATE
James B. Brown
PRINTED NAME OF PERSON CONSTRUCTING THE WELL
Submk the original to the Division of Water Quality within 30 days. Attn: Information Mgt.,
1617 Mall Service Center- Raleigh, NC 27699.1617 Phone No. [phone] eat 668.
Form GW-la
Rev. 7/05

RESIDENTIAL wax. CONSTROCnON RECORD
North Carolina Department ofEnvironment and Natural Resources- Division d Water Quality
WELL CONTRACTOR CERTIFICATION # h1(J CC.)
33'0 I
1. WELL CONTRACTOR:
r(MdaN:
WCdMactoram f
1YPr. lnnkn? 11Jtc// (,r,/ir
Wd Contractor CnmpaityNorm
STET ADDRESS
is(r) k)O sins Vi//N II/G
Cory ortown Stele % 7 /
Zip Coda
LYE- ti799- ge4i54
Area code- Phone number
2. WHL aFORMATIOtt
SITE WELL ID in applicable)
STATE WELL PESAIIT V_-ted
DWQ or OTHER PERIAR 1T(if 'pple)
WELL USE (Oiedc Appicalie lks* Residential Water Supply.
DATE DRILLED
TWECOUPLETm //;//a maul PMD
3. WELL LOCATIOtt
cRrVson Ci`Ty COUNTYcSWa..al(
„ri /crkp esro-s
(Sheet Ibrat. Punta Community, Smmtion. L. Pane. ZIP .Coast -
TOPOGRAPHIC !LAND SETTING:
°Slope Maley OFW 1(IR)dge Daher
(duck ePptoPri�ead
antsvi
LONGDUOE a° :4a'sq i
Latitude/longitude sass: stOPS °Topographic map
(beatim ofwdmust be shown on a USGS dapo map and
attached /ra fare lea using GPS)
4. WELL OWNER '/
OWNERSIILME lY nn HoQG7�j�u.[o
STREET ADDRESS el nTa.net /ijC° ✓rs7a7 s
Jan/Sari C/7y ABC e2S/7/3
CCi f Town r Sate rip Cods
IMay be itdepees,
a bate% aiaaadnor I
it aheavt fan
(140 ). R766067
Area code. Phone number
5. WELL DETAILS:
a. TOTAL DEPTIt L/ irt2
b. DOES WELL REPLACE EXISTING WELL? YES❑ NO
c. WATER LEVEL Below Top ofCasilg: 2cO FT.
(Use'+• if Abode Top d Casing)
d. TOP GE CASING IS / FT. Above Land Surfaces
Top dcasig tamiiwted aka bows id surface morainal)
a variance it accordance with ISA NCAC 2C .0116.
a YIELD ((peak as- METHOD OF TEST Cr- /r
f. DISIPWECTIO►t Type A 7"/7 Mourn 9 62..
g. WATER ZONES (depar)_
Fran ate) To f%9.0 From To
Fran To From To
From To Fmm To
6. CASING: Thicknea.VMain
ere1
Fran 0 Two 7A Ft of crtra 1 Nt_4.
From To Ft
From To Ft
7. GROUT: Depth PARS]
From n To (2o Ft CEThQYIT
Fran To Ft
Fran To FL
a SCREEft Depth
Fran To
From To
From To
Method
spae
Diameter Slot Size Mahal
Ft is Si.
Ft in. _ in.
Ft it in.
9. SAND/GRAVEL PACK:
Depth Size ihterid
From To Ft
From To Ft.
From To Ft
10. DRILLING LOG - ... .
From To Fomia6on Description
r•
II.
1
1
RECEIVED
OCT 1 2
Asheville Regional Office
Rguifer
Imein .watvnurnsvWSTAND WAS .
ISA NCAC AS WBLG PROVIDED
OM,/YO11MT11 COPY OF7w8
RECORD HAS BEEN vadlom TO ore svrat. caexet
llycl
SIGNATURE OF CERTIFIED WELL ��
17-471- '`Y�p CONTRACTOR DATE
PRINTEDNAME P w CONSTRUCTING THE WELL
Submit the original to the Division of Water Quality within 30 days. Attn: h fonnafon Mgt,
1617 Mail Service Center - Raleigh, NC 27699-1617 Phone No. [phone] ext 568.
Font GW-la
Rev. 7l05

City or Tor Stale
( )• v)9 - p cs-'
Area coda- Phone Amber
2. WELL INFORMATION
SITE WELL ID SW amicable)
RESIDENTIAL WILL coxsreucnox RECORD
North Carina Depahnart of Envitonmait and Natural Resaucet Division of Water Quality
WELL. CONTRACTOR CERTIFICATION # Ln.CC
1. WELL CONTRACTOR:
;%4±( e
Name
We
l Contractor
(r' i'aha m Lis O
w
A Contractor Oarepary na 1me
STREET ADDRESS 6.3 i Ate /.,» 1qd
RAI)Ins v,%/e Arc ,Q577i
Zip Coda
STATE WELL PERt6TlpappeuJte)
DWQ a OTHER PERMIT NV applicable)
WELL USE (Check
,s ,Eau.. Satj Residential Water Supply 55
DATE DRILLED 7 - 27 -O 6
TIME COMPLETED /Q f 30
3. WELL LOCATIOIt
CITY. fr y,nn C: i Tr COUNTY 2Wo r i)
MA RA
per R•' rs e /3r#nAle RA _91-713
(Street subehassan sat rro
P.caL
..
ZpCode)-
TOPOGRAPt9C r LAND SElTSIG:
OSbpe OVafey I3Fbt "Mite oola
(check appropriateboa)
LATITUDE. Yc `�(} '63, rf/�
to icnuoEa3i P7 '11:3 , 9"
IMay be in degas. I
Rams, :coeds or
lea decimal format
Latitude/longitude source: OOPS otopographic map
(kca6mr of salnaf be show an a USGS kp° map and
elb the db Mit bmInot ushg GPSJ
4. WELL OWNER
OWNER'S NAME Shalt /, lt wall y)
STREET ADDRESS A Irer:AA, RcoX Ron Roe
y..Son C,'T'y weO?7/.1 CCff
ay or Torn • Site Zip Cab
(77tQ )- 7/3-J772
Area code - Phone number
5. WELL DETAILS:
a. TOTAL DEPTIt 9GS
b. DOES WELL REPLACE EXISTING WELL? VESO No!
c. WATER LEVEL BdalTop ((Casing ;3S0 FT.
(the ^♦•'Abate Top d Casing)
d. TOP OF CASING IS / -
FT. Abe.* Lend Surface'
. Top d madoWim farriadad drat blard wtace may require
e variance in aaiadaroenth 15A NCAC 2C .0116.
e. YIELD (spray / METHOD OFTEST ar
33311'7
t DISINFECTION Typegrid/ Amount /peen
9. WATER ZONES (dope*
From t?i5-0 To 90.0 From To
Fan To From To
Fran To Fran To
6. CASING:
Thidaessi
Deper 0091n... WNW
Fran C� To 4/$( Ft ..1 Ca/
Fr
an To Ft
Fran To Ft
7. GROUT: Depth Material
Fan () To 20 Ft Crnn#nr
Fran To Ft
Fan To Ft
I SCREEN Depth Diameter Slot Sze Material
Fran To Ft. M. In.
Rom To FL n. in
From To Ft in in.
8. SMOKIRAVEL PACK
Depth Siaa MISS!
Fan To FL
Fan To Ft.
Fan To R.
7a"
ter
74 DRILLING LOG
From To FomMgm Description
11. REMARKS:
jel
-RECEIVE©
o
OCT
Asheville Regional Office
A utter Protection
1001a31E8r1fxmrnurnes WEIL WAS COr6amcrID INACCORDNtf War
trek CAC 2G WELL COMRUCTEIN SdONm$, AND NATACOPT°Filth
RECORD In BEEN PROVIDED TO tore WQL OWNER
TORE OF WELL CONTRACTOR PATE
catl
CA�STRUCTNGTHEWELL
Submit the original to the Division of Water Quality within 30 days. Attn: Information Mgt.,
1617 Mali Service Center — Raleigh, NC 27699-1617 Phone No. [phone] ext 568.
Form GW-la
Rev. 7/a5

RESIDENTIAL WELL CONSTRUCTION RECORD
North Camara Department orEavironment and Natural Resources- Division or Water Quality
WELL CONTRACTOR CERTIFICATION # o(D ..52)
33311s;
10E11 val. TRACTOR:
1• Wel Candorast.aij Name
Groho n WW el/ G1 1-.74`n9
Wd Ca na Comply Kane
STREET ADDRESS fay AA Zahn Rci
RoeIi;n5ii.//N /Yc 2%-77/
City or Town Stab Tap Code
(92g- 79- & e/ S 4%
Area code Phone number
2. WELL NFORMATIOIt
SITE WELL m Mamorcebaa)
STATE WELL PERMITfEapp-ubie)
DWQ or OTHER PERINT f(f appiaehle)
WELL USE (CheckAppkabls Bo*
DATE DRILLED 7 - 2/ - O 6
TIME COMPLETED
3. WELL LOCATlOtt
CITY: a ySnn r.,`7y
(SOU» R.__ FAQ Sbasiae
teeltN Name. TOPOGRAPHIC / LAND SETTNG:
OSlape Walley DRat ORidge OOFer
Residential WaterSappya
(abed( spate bad
LATITUDE
LONGITUDE .3 ,97,v7 c”
Latitude/longitude source: ■OPS OTopographic map
(Salim dmall must be shesu on a USGS kpon * and
attached bfi Arminot eerily GP_)
d. wELLOWtER
OWNERS NAME cir 14 r *Aar
sORR
tEEr ADEss :Nax Run R:, e APN/1rUQ 14,
g-.-ry Sn/T C,'T/ A/c 2v,7/?
/War Town Stele Op Code
i77Q ).(T07. i73/
Area code- Phone number
6. WELL DETAILS:
a. TOTALDEPT* s*-oS
b. DOES WELL REPLACE OUSTING WELL?"" YES ❑ ND s
c. WATER LEVEL. BdowTap it Casing ale FT.
(Use ^•' if Above Tap at Casing)
d. TOP OF CASING IS / . FT. Ahae Land Surface
Taper cuing laminated riot below lad surface maw*.
a valence in ecoadanoe with 15A NCAC 2C .0118.
e. YIED (9pm) .. METHOD OF TEST A it
AM O PMtg
COUNTY SW),,�/!
5?
tome.. Parcel, $ Cod*
May he in dealer.
Olarm.sraob or I
badadeal few
T. DISIFECTWtt Type /717- Mount / {inz
g. WATERZO/ES (depths
Ran Zlel To 'OS Fran To
Fmm To Fran To
Ran To Fran To
6. CASING:
Diameter
Fran vl DepthToo Pc Ft e
Fran To Ft
Fran To Ft
Thidmess/
waem d
t'nr2/ /�VG
7. GROUT: Da *Aerial
Fnrn0To AO Ft cenNnr
Fran To Ft
From To Ft
IL SCREE* Depth Diameter SIR She Metahl
Fran To Ft M. in.
Frain To PL it _ in.
Fmm To FL_SL in.
A SANDIGRAVEL PACK:
Depth Size Malarial
From To R.
Frain To R
Fmm To R.
Method
10. DRILLING LOG
From To Formron Desmatplion
CI
—4
r
II. REMARKS:
Asheville Reginnai Office
A uifer Prntortina,
MID HEREBY COMFY TNTTNS witarl1SCONSia1CIEDRIPCCamMILE Vann
ReZORD HAS BEER PROVIDED TO DIE WELL MUT1a1T11COPTOPTraS
SIGl n0-k ® q-3i-a6
WELL CONTRACTOR DATE
a-r-4t %A
PRINTED NAME PERSON CONSTRUCTNG THE WELL
Submit the original to the Division of Water Quality within 30 days. Athl: Information Mgt,
1617 Map Service Center - Raleigh, NC 27699-1617 Phone No. [phone] ext 558.
Form GW-la
Rev. 7/06

RESIDENTLIL WELL CONSTRUCTION RECORD
North Carolina Departrnent of Environment and Natural Resources. Dials' of Water Quality
WELL CONTRACTOR CERTIFICATION / Q 6.56
1. WELL CONTRACTOR:
;)P ctb
wet contractor Kane
G A,rn G✓ell rib, ///n9
Wet Contractor Cmrpaey Nano STREET ADDRESS I C l . /7(Ylip 7JL,Jn Rd
P46brsav/,wN ifrc » 77/
City or Torn State tp Code
(9 -)- 1/79 F(tt6'4(
Area coda- Paine number
7. WELL INFORMATIONt
SUEWELLIDINar Table)
STATE WELL PERMITIRapptinble)
DWQ or OTHER PERMIT Rif appioaye)
WEtLUBE (ChedcAP le:eb 8a* Residential Water Suppy®
DATE DRILLED 9-/.qt/ -OG,
TWE COMPLETED / oC . 30 AND PM •
3. WBL LOCATIOIt
CITY: erysnn CiTyCOUNTY sLJoa'h
CoLLasvq
(Street Name. Numbers. Cmm undo-at.ItIeq LatNo.. Parcel, Zp de)-
TOPOGRAPHIC / LAND SETTING:
OSlape Overby OFW MTBrbe Daher
(check aanePiaeba9
LATITUDE .16 0.6'a9.6"
LONGITIAEg 3_6 trice /l%.
Latitude/longitude scwcc idGPS ()Topographic mar
(beefod of memos, be sham on a USGS Iponw and
aardwdb Ida dorm loot using GAS)
4. WELL OWNER I I
OWNERS'U E Qt v/!L S6n ekY
STREET ADDRESS !' /, BUS la /?
ryrsan City A/C
City Town Slate tp Code
( 9/ 3 ). (ne) / 7760
Area code - Phone number
May ba&pee% I
misrtes,moods or
lea decimal feat
s was. DETAILS:
a. TOTAL DEPTIt
vas
b. DOES WELL REPLACE EXISTING WELL? YES NO■
c. WATT31 LEVB. ear€, teasing a60 FT.
(Use WI NAbwe Tap d Casing)
d. TOP OF CASSIG* / -
FT. Ahem Land Surfaces
. Tap d casing lamented ate below lad surface rap mlgbe
e variance in acoardmaewith 15A NCAC 2C .0110.
e. YIELD(gpenk 36 I/Filial OFrEsr ck r
L OISI FECTIOIt Type Nr. fi Amount (, . r; Z.
o. WATER ZONES (deplhk
From TOG To WO From To
From To Fran To
Fran To From To
0. CASING:
Depth From l) To P..6 FL (p 50 1 Material
Flan To Ft
From To Ft
7. GROUT: Depth Material What
From C1 To an Ft rPrrlonr A
wriplAg
From To Ft.
Fran To Ft
0. SCREEN:
Fran
From
From
Depth
To
To
To
A SANINGRAYEL PACK:
Depth
Fran
Fran
From
Diameter Slot Size
Ft 7n.
FL it _
Ft in. in.
mane
Size Material
To FL
To FL
To R
10. DRILLING LOG
From To
11. REM
Fomlltim Descrpton
O
OCT
11DIUNDYfBr1FYT atM Me WELL SRN
SWAG EC. WELL COIISTRUCMON MANDARDS. RECORD HAS SEEN PROVIDED 10 TIE NDTINTIICUP'/OFTim
it
Asheville Regional Offic0
A r lifer Protection
T y M-E14
WELL CONTRACTOR DATE
PRIMED NAME PERSON CONSTRUCTING TIE WELL
Submit the original to the Division of Water Quality within 30 days. Attn: Infonnaton Mgt.,
1617 Mail Service Center — Raleigh, NC 27699-1617 Phone No. [phone] ext 568.
Faro GW-la
Rev. 7105

RESIDENTIAL WELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources- Division of Water Quality
WELL CONTRACTOR CERTIFICATION #
1. WELL CONTRACTOR:
Teo de
Wd Contactor Name
rrlh.atj"7 tie/irk/WI ;i
Wd Coarsens Corp, Naive , / D'
STREET ADDRESSf6311 AlyA o 7d tin RA
R IT,elsw,//p A/c c9.�77/
City or Tam State $Cole
(9c2 )- 479 — 2-z/,S4
Area ode- Mew number
7_ WELL IFFORMATIONt
SITE WELL m *St WPM)
STATE WELL PERMwTIAappaohle)
DWQ or OTHER PERMT Rif appfeahis)
WELL USE (Check Anoka' SoQ Residential Water Swag
DATE DRILLEV. 9—%�:j� O Co
-rasa-rasa cwptnET_,_ p
.� 00AM PM OW
3. WELL LO(C�ATIOlet
CITY: L) ry San CI Ty COUNTY c5ibicl n
+.CQrenAJe min n 7/,z
(sheet Name..Nunaas. Canmmws_b n.Look.. Parcel. ZO.code)
TOPOGRAPHIC! LAND SETTING:
MSiMe DVSEy OFlat Dredge 001s
(check apn`eabbod
LATITUDE s y2N'67. 11 "
LONGITUDES' :ice `.,�-teh.4"
Latit de/Iongit de somacr pCMS OTopogaaphic map
(bae&Wl dydmust be shown an a USGSbpo map end
alladiedb IS ken rnot us* g GPM
4. WELL OWNER {
OWNERS NAME Ma, r /C hi IS hoer?
STREETT ADDRESS &n°°nrk/lo Ref
T CiliaTa l of State tip
Code
(5(43)-45-0-7702
Area code - Phone number
0. WELL DETAILS:
a. TOTALDEPTft aCS
h. DOES WELL REPLACE DUSTING WELL? YES ❑ ND M
c. WATER LEVEL Blow Top d Casing 'ceO Fr.
(Use +- iAboy Top d Cm'ag)
d TOP OF CASING M / . FT. Above lad &Mace•
Tap or casing rerouted ale below land niece nay m pde
a variance in accordymew ith 15A !CAC 2C .0110.
e . YIELD(gptat 6 MEDICO OF TEST air
IMay 46degrees,
minutes, weedsm I
:a deal fora
cd
L DISRFECiia)l Typo /7 %riri Amount /. a
g. WATER ZONES (depth):
Fran To Q,SS From To
From To Frain To
Fran To From To
6. CASING:
w
Fran r To ?S Ft
ROM To Ft r
From To Ft
Thiparnsy
Weight
a t �
5nr�/ NVr.
7. GLUT: Dept Materiel
From ri To 20 Ft PNrr,E%nT
Fran To FL
From To FL
0. SCREEt Depth Diameter Slot Slav Material
Aces To Ft. a. in,
From To R. in. _ in.
From To Ft in. in.
9. SANOGRAVEL PACK:
Depth Sloe Myatt'
Fro To Ft
From To Fl.
Fran To Ft.
10. DRILLING LOG
Haan To
Formation Description
11. REMARKS
OCT
Aehavilla Re ional Offlre
At fer O...s..,,.a...�
MAIOC 2C. WELL COrSMUCmgp STANDARDS. IOARDS. AS .•••'
RECORD IMS BEEN PROVOEDTOTNE WELL WRIER
/eW6ycIe 9lS=oho
SIGNATURE OF CjB'7E/TyL WELL CONTRACTOR DATE
laNAME CONSTRUCThC THE WB L
Submit the original to the Division of Water Quality within 30 days. Arc information Mgt,
1617 Mail Service Center — Raleigh, NC 27699-1617 Phone No. [phone] ext 568.
Farm GW-la
Rev. 7/E

RESIDENTIAL WELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resource �D�ion of Water Quality
WELL CONTRACTOR CERTIFICATION #
1. WELL CONTRACTOR:
Well Contrac cc (Individual)
AAA GREENE BROS. LL DRLG. OF SYLVA, INC.
Well Contractor Company Name
STREET ADDRESS 1800 SKYLAND DRIVE
NC 28779
SYLVA Stale Zip Code
City or Tam
Oa_ )_ 506-5550
Area code- Phone number
2- WELL INFORMATION:
SITE WELL ID #(if applicable) o� w
STATE WELL PERMIT#(ir applicable)
DWQ or OTHER PERMIT #(if applicable)---�
WELL USE (Check Applicable Box) Resler tii l Water Supply
DATE DRILLED AM ❑ PM [
(Street Name, Numbers, Community, Subdivision, Lot No., Parcel, Zip Code)
TOPOGRAPHIC 1 LAND SETTING:
❑Slope CIValiey ❑Flat ❑Ridge ❑Otha�----
(check appropriate box)
LATITUDE —
LONGITUDE __ a hic
Latitude/longitude source: OGPS °Topogr p map
(location of welt must be shown on a USGS topo map and
attached to this form I not using GPS)
4, WELL OWNER
OWNER'S NAME
„-$7REET ADDRESS
c.{ll1Yv fate ZiP COode
ity Tam ) Iri � -
May be in degrees,
minutes, seconds or
in a decimal format
F(
9 %' h
Area code - Phone number
5. WELL DETAILS:
a, TOTAL DEPTH:
b. DOES WELL REPLACE EXISTING WELL? YES ❑ NOS
c, WATER UBdabTop ot Casing:
(Use
Use se's"rf Above Top of Casing)
d. TOP OF CASING IS411 FT, Above Land Surface'
'Top of casing terminated attor below land surface may require
a variance in accordance with 15A NCAC 2C .0118
e. YIELD (gpm): METHOD OF TEST_ —
1. DISINFECTION: Type PEN
g. WATER ZONES (depth):
From To
Depth ToyZ Ft.
_To,i_ Ft,
To Ft,
SCREEN:
From
From
From
SAND/GRAVEL PACK:
Depth
From To
FromT0—
From T� —
TED IN
ANCE
15A HEREBY CERTIFY NCAC 2C. WELL CONSTRUCTION STANDARDS. AND WELL WAS OTHAT A COPY OF THIS WITH
RECO$D%IAS BEEN PR O)DED TOME W OWNER
w
116 Submit Ma I Service Center h Raleigh, NC 2 699-1 17 Quality once No (9 9) 733-7Attn: extn568lion Mgt,
Form GW-la
Rev. 7105

1. WEL,LCcONTRACTO
Well Contractar (Individual)
AAA GREENE BROS. WEL DRLG. OF SYLVA, INC.
Well Contractor Company Name
STREET ADDRESS 1800 SKYLAND DRIVE
NC 28779
State
SYLVA
City
82t_r 586-5550
Area code- Phone number
RESIDENTIAL WELL CONSTRUCTION RECORD ,
North Carolina Department of Environment and Natural Resources-Divisioq oWater Quality
WELL CONTRACTOR CERTIFICATION #�!/
� f. DISINFECTION: Type
g. WATER ZONES (depth):From
NFrom
From To ...2 Front
From
-
Zip Code
2. WELL INFORMATION: r
SITE WELL ID #(H applicable)
STATE WELL PERMIT#(8 applicable)
DWQ or OTHER PERMIT #(If applicable)
WELL USE (Check Applicable Box): Residential Water Sunny
DATE DRILLED
TIME COMPLETED
3. WELL L•. ATION:
CITY:
AM ❑ PM
COUNTY
as �j -
(Street Name, Numb rs, Comma Subdusion, Lot No., 'arch, p i
TOPOGRAPHIC / LAND SETTING: /
°Slope °Valley ❑Flat ridge ❑Other_�—
(cherk appropriate May be jn degre
LATITUDE _ mm�rtes, second
m a decimal for
LONGITUDE_ _
Latitude longitude source: ❑GPS ❑Topographic map
(Iocation 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
ET ADDRESS
b
Stale Zip Code
City Town b" f / 2 /
Area code - Phone number 7J
5. WELL DETAILS: 7
a. TOTAL DEPTH:
b. DOES WELL REPLACE EXISTING WELL? YES 0 NO ❑
C/l FT.
c. WATER LEVEL Belau Top of Casing: �--
(Use'+' if Above Top of Casing)
J FT. Above Land Surface'
d. TOP p CASINGngIS
`Top of casing terminated aVar below land surface may require
a variance in accord- with 15A NCAC 2C .0118.
METHOD OF TEST
From LaZ To JJ 1L
6. CASING:er
From
Depth /FL CJa t .
From Lam- To'.I.fG/L Ft.
From To Ft.
Material
7. GROUT: Depth
From To Ft.�I^_.^_— �-
From__, .To -Ft.
From. To FLU—_
8. SCREEN: Depth Diameter Slot Size
Ft. in. in. _
From To in. _
FromTo Ft. in.
From To
Ft. in. in. _
e. YIELD (gpm).
9. SAND/GRAVEL PACK:
Depth
Frcm T
From To
From To
V C
0. DRILLING LOG
From To
11. REMARKS:
Size
Ft.__
Ft.__
Ft.
Material
Amount
oy n r R R
es<5 -'l90i.:
$
To
To
To
Thickness/
W pp J
Method
as •
P
Material
Formation Description
CO
i5AC2ELLCOTUiANRANDACFI
WITH
1M1CAC WCONSTRUCTION STDADS, ANCTEDT ACCORDANCE
S
RECORD HAS N PROVIDED TO THE WELL OWNER.
SIGNAT RE OF IED WELL CONTRACTOR
DATE
le- seJI I
PRINTED NAME OF PER S N CON TRUCTING THE WELL
•
1617Submit ity
in 30 days.
Mail Seroriinal to te Division of Water vicge Centerh Raleigh, NC 2 699 16117 al Phone hNo (9 9) 733-7Attn: ext 568. Mgt,
Form GW-la
Rev. 7/05

4. WELL OWNER
OWNER'S NAM
STREET ADDRESS
1. WF�LL CONTRA5TOR:
/Tj�J /7
Q W'l
Well Contractor (
AAA GREENE B
ual) Name
WELL DRLG. OF SYLVA, INC.
Well Contractor Company Name
STREET ADDRESS 1800 SVE
SYLVA NC
City a Tam Stale
82! 8 1_ 586-5550
Area code- Phone number
2. WELL INFORMATION:
1�nn i�
SITE WELL ID #(B applicable)
STATE WELL PERMIT#(if applicable)
DWQ or OTHER PERMIT #(if applicable)
WELL USE (Check Applicable Box): Reesidential Water Supply
DATE DRILLED_ �--V
TIME COMPLETED— AM 0 PM/Oki
ATION:
28779
Zip Code
� t
COUNTY (-Oat ('
eel Name Numbers, Co rmunity, Sub6W
TOPOGRAPHIC / LAND SETTING:
lope °Valley ❑Flat °Ridge ❑Other
(check appropriate box)
LATITUDE
LONGITUDE_ _
May be in degrees,
minutes, seconds or
in a decimal format
Latitudeflongitude source: 0 GPS 0 Topographic map
(location of well must be shown on a USGS topo map and
attached to this loin, if not using GPS)
e
City- _ S = e,o Zip Code
City • van
Area code - Phone number
5. WELL DETAILS:
a. TOTAL DEPTH:_ C
b. DOES WELL REPLACE EXISTING WELL? YES ❑LK NO I
c. WATER LEVEL Below Top of Casing: _L—FT.
(Use'+• if Above Top of Casing)
d. TOP OF CASING IS FT. Above Land Surface
'Top of casing terminated at/or below land surface may require
a variance in accord with 15A NCAC 2C .0118. -�
e. YIELD (gpm): � METHOD OF TEST
_RESIDENTIAL WELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources- Division of Water Quality
WELL CONTRACTOR CERTIFICATION #
f. DISINFECTION: Type 14TH
g, WATER ZONES (d
FromA,tt. Ton From.
From To Fes'
From To From,
332000
Amount
To
To
To
Thiclmessl
6. CASING: �n ,gn
From Q -DepthD'aTeter ToFt. Weight
tYi_
From To Fl. ---
Fran To Ft
7. GROUT: Depth Material Method � ^
From _L._ To ��z..!, Ft
From,._Tol____ Ft.,
Fran To FL
B. SCREEN: Depth Diameter in.Slot Size in.
Mated1'
Fran To Ft.
From To Ft in. — in.
From To Ftin. — in.
9. SAND/GRAVEL PACK:
Depth
From To
FrailTo
FromTo-
10. DRILLING LOG
From To
11. REMARKS:
Formation Description
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH
15A NCAC 2 WELL CONSTRUCTION STANDARDS. AND RECORD BEEN PROVIDED) THE WELL O'' ER. T�TACOPY OF THL`
Submit
1617 Mai Servi a Center— the RaDivision
leigh, NC 2 699 1 17 QualityPnewithin
No. 9 9) 733-7Attn: Information Mgt,
ext 68.
OR DATE
tq (it
NG THE WELL
Form GW-1a
Rev. 7/05

RES/DL/1/2"AL WELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources -Div i� of Water Quality
WELL CONTRACTOR CERTIFICATION #
f. DISINFECTION: Type
g. WATER ZONES (depth):Q
From ONTo / r
From To,
Wen Conga Company Name
STREET ADDRESS 1800 SKI
City Tm State
82t 8 } 586-5550
Area code- Phone number
2. WELL INFORMATION:
SITE WELL ID #01 applicable)
STATE WELL PERMIT#(H applicable)
DWQ or OTHER PERMIT Of applicable)
WELL USE (Check Applicable Box): Residential Water Supply I$
DATE DRILLED.,Cr
PML
TIME COMPLETED AM 0
3. WELL LOCATION: /1 /
�i�trre 4evl L-LLCOUNTY t)G I Yl-
Numbers, C munity, Subdldsion,
(StreehN2 e,
TOPOGRAPHIC / LAND SETTING:
°Slope CVailey ❑Flat 4Ridge ❑Other,
(check appropriate box)
,A
p Code)/
LONGITUDE,_ --
Latitude/longitude source: ❑GPS ❑Topographicma p
(location of well must be shown on a USGS topo map and
attached to this form if not using GPS)
4. WELL OWNER eV`(YI
OWNER'S NAME
S7�ET ADDRESS
5. WELL DETAILS: �S - J�
a. TOTAL DEPTH:
b. DOES WELL REPLACE EXISTING WELL? YES ❑ NO f
pc
c. WATER LEVEL Below Top of Casing: Fr.
(Use '+"d Above Tap of Casing)
d. TOP OF CASING IS FT. Above Land Surface'
'Top of casing terminated at/or below land surface may require
a variance in accordance with 1 SA NCAC 2C .0118.
�e.. YIELD (gem): 2a.- METHOD OF TEST_.J2--
7. GROUT: Depth_
Frarn _ T Ft
From —To —FL
8.
Diameter Slot Size Material . SCREEN: Depth FL in. in. —_
I DO HEREBY CERTIFY TED IN ACCCRDANCE
15A NCAC 2C, WELLO 5 UCTION STANDARDS, AND THAT WITH
THAT A COPY OF THIS
THE WE NER
RECORD NPRO
N //,,6
SIGNATURE OF CERTIFIED WELL CONTRA TOR DATE
thin 30 days. Attm
16 Submit Ma I the
ge Center h Raleigh, gh, NC 2 699-1ision of Water8 7 Quality one No. (9 9) 733-7 5 Information
568.Uon Mgt,
Farm GW-la
Rev. 7105

RESIDENTIAL WELL CONSTRUCTION RECO
RD
North Carolina Department of Environment and Natural Resources -Division of Water Quality
WELL CONTRACTOR CERTIFICATION # n I
1. WELLf40NTR/ TOR:
Well Contractor (IndividijS) Name
AAA GREENE BROS. WELL DRLG. OF SYLVA, INC.
Well Contractor Company Name
STREET ADDRESS 1800 SKYLAND DRIVE
NC 28779
State
SYLVA Zip Cade
City a Tam
821 8 )_ 586-5550
AreaEcode-NPhone number A, ,, ,, JJ .
2. WELL INFORMATION: �r ��+-r�
SITE WELL ID #(9 applicable)
STATE WELL PERMIT(Rif applicable)
DWQ or OTHER PERMIT #(if applicable)
WELL USE (Check Applicable Box): Residential Water Supply ❑
DATE DRILLED
TIME COMPLETED AM PMA -
3. WELL LOCATI • :
CITY: ♦ tut ` COUNTY , ...'
(Street Name, Numbers, Community, Sub •r 'sion, Lot No., Parcel, Zip Code)
TOPOGRAPHIC / LAND SETTING:
❑Slope DValiey ❑Flat ORidge ❑Other
(check appropriate box)
LATITUDE — — —
LONGITUDE ___ _ --
Latitude/longitude source: oGPS °Topographic map
(location of wen must be shown on a USGS topo map and
attached to this foml A not using GPS)
4. WELL OWNER h-i"r✓r`
OWNER'S NAME
STREET ADDRESS
May be in degrees,
minutes, seconds or
in a decimal format
5. WELL DETAILS: C
a. TOTAL DEPTH:—
b. DOES WELL REPLACE EXISTING WELL? YES 0 NO ()"
c. WATER LEVEL Belau Top of Casing:
3 CO Fr.
(Use'+' if Above Top of Casing)
d. TOP OF CASING IS ' FT. Above Land Surface
'Top of casing terminated at/or beta+ land surface may require
a variance in accordance with 15A NCAC 2C .0118.n�
e. YIELD Wpm):
METHOD OF TEST I"f b r
f. DISINFECTION: Type HTH
g. WATER ZONES (depth):
From 'V To Z2r�
Frond, =To 6, rZ
From To
6. CASING:
8. SCREEN: Depth
From To
FromTo
From To
9. SANDIGRAVEL PACK:
Depth
From To
Fran To
From To__.
10. DRILLING LOG
From To
11. REMARKS:
at n:< 40 o
eA,JA
Amount s�
2�n.r rs
Ft.
Ft. in.
Ft. in.
Size
Ft.
Ft__
Ft.
Formation Description
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH
RE BEEN WELL CONSTRUCTON STANDARDS, DTHAT A COPY OF THIS
BEEN RW19EUTl11HE WELL OWNER
SIGNATURE OF CERTIFIED WELL CONTRACTOR DATE
�rl wruL�
PRINTED NAME OF PERSON ONSTRUCTING 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

Salt
WELL COUC170N RECORD
North Caren Deportment of Favioamem and Nomad Resources- Dirmi of Water Quality
WELL CONTRACTOR CERTIFICATION# ram Sal)
STREET ADDRESS (�a�C��
Oily oTasn rip Code
Area as Rsonentimacr
iWELL IFOWIATNNt
SITE Vial. ®fOraeo eiset
STATE WEL PERMITIEr____e
UWQa°TIERPERMIT A aPpa�lel
WELL USE (Check AppaaWleBo* tteddewiet Water Soppy a
DATE DRI1Eo 43 /
THE COMPLETED. AMO PMSI
S. WELL LDCATat
CITY: T Cownv'SM
„n/'�i_ _-i_
Ira TOPOGRAPIIClLAND SEMNGS tsana.P tie ZPCua.}
DSge DVSep OFLt oats DOOia
t4adcappapwraaL
LATRIIm SS Ste rr
LONGIrulM.2_ o35L12a2.1
latiluddiongitude SOW= MOPS °Topographic
map
Na tiondadaaffiboshownataUSW/worn*ad
ala¢tedbask kraal not many GPM
4. WELL. OPENER
OWNER'S NAIE
STREET ADDRESS
n
Tan Side Zip Cab
aas 29r7- i7rn
Area code_ member
6. WELL DErAI &
a. TOTAL DEPT1t_5Q��
h- DoEs PELL REPLACE EXISmm,s DIEIL? VESD NO
a WATER LEVEL BeloeTop oCal ag _FT.
NaawWane Top dCan%)
d TOP OF CASING I6_Ff. Above Surface
`Tap of cadre Mara a enagtegme-
saucen aacand•rmengh 15ANCAC ffi alit
a. Yiati-_a_ smnaooFTEst ai'r
_771
L OISINFECTIOlt Type
9• WATER 20#133 Merit
Finn To
Ram To Fmm
S. CASINO:
Fran
From
Amoawt J9.07
To
To
To
Tliclas of
Fmr_LL' Totta,c R /° ` S '
ld
Ram To R
ACM To R
7 GROUT: Deer elebrd From
Top' „�- Whorl
^ c_Fl..rnonr
To R.
Rom To R.
S. Depth Dialer Sal She �
Ram To—n.
R. to. it
Ran To Ft
aSANOIGRAVELPACK:
Depth
From To
ROM To
From To
Sae Maeda
R
Ft.
to anima LOG
Flom To Foliation Deemiplion
1L REttAEKS:
ICONEREINCEIMPrdenTleBINELLIVASCONSIMUCTECIOUCCOROMICE
a MISANcAOB� nS AACOPr YmN
PRWO®WLIEME;w.9nn9t
TURE OFs% e - %�t i� aWEIL CONTRACTOR
PRIMED NAME OF PFR6�IIt pp „weps THE WELL
Submft the original to the Division of Water Quality within 30 days. Attn: tolonnatlon Mgt,
1617 Mail Service Center— Raleigh, NC 27699-1617 Phono No. [phone] ext 568.
Fam OW -la
Rev. 7Ip6
33427

RESIDE1V2Z4L WEL[. CONSPROCTION RECORD
North Can lia Department ((Emanational and Natural Resauca- Divot of Water Quality
WELL CONTRACPORCERTIFICATION!
Wet Contractor gnaw Name
STREET ADDRESS 6 SDI ✓ lcte.
fi ,b; )1ll. Nt as77/
City arTaon Sena Bp Code
( (gip u75- sfv5Li
Agra coda. Phone number
2. WELL I9ATION:
SITE Wanner evprmabw
STATE WELLPEIaI{#appfopd,
DWQorOTHER PERMIT I(t ,
WELL USE (Chock MPIcaldaBa* ftetidodid Water Supply fk
DATE maim / 1la3-og
ToecompLErno S' Oo AM❑ P11(
3. Mat LOCATION:
CITY: Y .6 ANC i). co(INrr �'
lDuJcr G.Lrk�
Meet Name Itanime,Caommelo taus. Groot Go caw
TOPOGRAPHIC NLAaD SETTnIM
OSlope OMB ORM SOD OOtlar
tamramanabbbaN
Emma se 93'63.3"
LDNGITUDE$ 32. 31 ' 10.7"
Pormfba wmK6esbaunat UU6G3 Spa map arid
Winched toils Irmalno(roit„
4. WAlOWNER
OWtaRs NAME T (V Q
lbw tetedames,
wino; accoods
badecimal h amt
s Net, ADDRFss !,
City orTann Side to Cab
(7/Ct)- aln-`1Ssan
Area code - Phone number
LINOS DETAIL&
a. TOTAL cant
b. DOES WHLREPLACE EXISTING MBA.? VESO ND@(
ON(
c. WATER LEVEL Below Top otCasbq 2_FT
(UM*"v taboos Top ct Casing)
d. TOP OF CASING IS .Above Land Sabot
sap m capi1g teaseled Mar hips Mel outface may galas
a minion' ecor6mceawih ISANCAC 2C .01i4
•. YIELD bat O IEFNODOFT(ST c&
3 3 4/
L OISINFECTIOttTypo Nf H Animist _CI__
9. WATER zotes (depIlt):
Fran 0 To F7 From To
From To Rain
RUM To From
4 CASING:
Fran 0Two .Ste FL
From To FL
Ra4__To Ft.
7 GROUT: Depot Wand
ROM 0 _ _Ft rnO
Ron To FL
Rom To FL
i. SCREW& Deport
Hull! To
RCM To
Fiat To
9. SANDIGRAYEL PACK
Depth
Run
Rain
Hors
To
To
TNebresat
RS* Ideal
sp al
Method
r� l
Diameter Slot Sap Wert
FL it in.
Sim
To FL
To Ft
To 1.
fa-- .
14 onjLWG too
From To
11. REM ARBs:
Form men DeaopOem
aGnrp1E,, "
t.-7 an.)
i)IV
Th 4yJ C„S
rI v.Tal711WINamaLapl8Car6aaCe�alaaCpRDAmCt?tent
RBCa1011e6m®1Pap/ WTNEML AbTFMTACOPPOF7IB
' �OR �TI
l
Submk the original to the Division of Water Quality within 30 days. Ann: infonnm(Ion Mgt-,
1617 Mail Service Center— Raleigh, NC 27699-1617 Phone No. [phone] ext 566,
PRINTED NAME OF PERSON uttrarrttm-rove T}E wet
Faun GW-la
Rev. ,ADS

RESIDENTIAL WELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources- Division of Water Quality
WELL CONTRACTOR CERTIFICATION #
1.
ELL CONTRACTOR:
Well Contractor (Individual) Name
Well ConTraclotiECBBROTR S N!CLL DRILLING, 6kC.
FILMY WIN CIRCLE
STREET ADDRESERANKLIN, NC 28734
City or Town State Zip Code
1-bic
Area code- Phone number
2. WELL INFORMATION:
SITE WELL ID POI applicable)
STATE WELL PERMIT#(ir applicable)
DWQ or OTHER PERMIT #(if applicable)
WELL USE (Check Applicablel.@ Box): Residential Water Suppty—
DATE DRILLED 9 'oC to- Q to
TIME COMPLETED AM ❑ PM O
3. WELL L CATION:
�, ry p
CITY: s"JN COUNTY`F#-J N
(Street Name, Numbers, Community, Subdivision, Lot No., Parcel, Zip Code)
TOPOGRAPHIC / LAND SETTING:
❑Slope OValley OFlat ❑Ridge ❑Other
(check appropriate box)
LATITUDE 3
LONGITUDE
Latitude/longitude source: ❑GPS ❑Topographic map
(location of weff must be shown on a USGS fopo map and
attached to this form if not using GPS)
May be in degrees,
minutes, seconds or
in a decimal format
4. WELL OWNER / U _
OWNER'S NAME I'y4r / ,, ser bit
STREET ADDRESS L1 k13 5; GO_ '- 7
Cs�alwa,6112-- r/ Sacco 7
City or Town State Zip Code
Area code - Phone number
5. WELL DETAILS: IV-
`-
a. TOTAL DEPTH:
b. DOES WELL REPLACE EXISTING WELL? YES 0 NO 0
c. WATER LEVEL Below Top of Casing: / FT.
(Use'+' i1 Above Top of Casing)
d. TOP OF CASING IS / FT. Above Land Surface'
'Top of casing terminated at/or below land surface may require
a variance in accordance with 15A NCAC 2C .0116..
e. YIELD (gpm): LC, METHOD OF TEST
334438
T. DISINFECTION: Type
g. WATER ZONES (depth):
From To
From
From
6. CASING:
To
To
Amount
From To
From To
From To
Thickness/
'r� Depth Diarr� ter Weight Material
From (5 To Oo., FL (o 1y `TlC.-
From To Ft.
From To Ft.
7. GROUT: Depth
�l Material
From 0 To D-6 Ft.PG/idG;.-Z
From To Ft.
From To Ft.
8. SCREEN:
From
From
From
Depth Diameter Slot Size
To Ft.
To Ft.
To Ft.
Method
in. in.
in. in.
in. in.
Material
9. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
From To Ft.
10. DRILLING LOG
From To
Ira- ,
11. REMARKS:
nN t,F
Formation Description
.!
fir /aJ
RyCC�ENED AL1TY
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED N ACCORDANCE WITH
15A NCAC 2C, WELL CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS
RECORD HAS BEEN PROVIDED TO THE WELL OWNER.
fti !/1.e-v.ei jJ4—cL
SIGNATURE OF CERTIFIED WELL CONTRACTOR DATE
PRINTED NAME OF PERSON CONSTRUCTING THE WELL
D
Submit the original to the Division of Water Quality within 30 days. Attn: Informat on Mgt.,E E 1 E
GW-la
1617 Mail Service Center - Raleigh, NC 27699-1617 Phone No. [phone] ext 568. Rea. /05
9 Rev. 7/OS
NOV 02 2006
Ashevt3', C•e •

RESIDENTLAL WELL CONSTRUCTION RECORD
North Carolina Department of Eeviormtmt and Nasal Resaoca,- Division or Water Quality
WELL CONTRACTOR CERTIFICATION I a °se
1. WELL CONTRACTOR:
Z-�fa e
WellContractorName
6jnaba »1 t.JNI/ cir/'ll,'r
Well Contactor Camay Name , /
STREET ADDRESS 63 S/ h`y!AP 7 tan /` 4
RQhbi'ris
City or Toen Stale
(Sr2 fv 1. 479- S459
rap Cala
Area coda Phone number
2. WELL VVFORMATWIt
SITE WELL IDEp/atp—)
STATE WELL PERMITepappLeade)
DWQ or OTHER PERMIT /(r amicable)
WELL USE (Check Applicable nark RsdaNsl Water supply if
caw DPo.L® .)
Y/o —66
ram corPLET® a 00 AM O RAM
3. WELL LOCATOR
Corr: k3 ryso n C "Ty coum fj Wet ttn
oA.sT CAlc.rfa Ydtrsi/7
(Street Name. Numbers. C emlat lo.. Para*, $COOa)-
TOPOGRAPIaC / LAND SETTING:
❑Slope OVdey ❑RA ■Ridge ❑Other
(check preys bo:4
LATITUDE 3 f5' it t 7"
LONOrruoE,g 4d ,1613.`,�.n//
sour= ■CH'S oTopographicmap
Median ofwarned be ahwwr on e USGS lope seep and
attached to Nis form Inal using GAS)
4. WB1 OWNER OWNER'S NAME RoYI isiraTka task:
STREET ADDRESS Si $7 CJct rka
lc��*TownSo n eiTy h/� Cadee/3
(tit 1.31f2--4n7y
Area aide - Phan amber
May be itrtgee.
sabmtesomeedset
in triad Gam
5. WSJ- DETAILS: �
a. TOTAL DEFDit 0 cs
b. DOES WELL REPLACE DOSING WELL? YES O NOa
c. WATER LEVEL Edw. Top d Casing 0 FT.
(Use'+• IAbdeTap d (wing)
d. TOP OF CASING IS 1 . FT_ Above Lad Surfacer
'Top d casing ten i eted odor blow tad surface may require
a variance In =adencewith ISA NCAC 2C.0110.
e. YIELD WC A NERCO OF TEST 0a.1 r
335413
f. msaEEC)OTt Type 6 Amount a
g. WATER ZONES (doper):
Fran n To 0 Fran To
From To From To
Fran To From To
6. CASNG:
DepthpiRS W Thi lmessl
etht
Fmnr �Ft/
Fran To Ft
�
From To Ft
T. GROUT: Depth Material
Form n To 9,9 Ft Cenwnr
Fran To R
From To R
0. SCRUM Depth
Fran To
Ran To
Farm To
NVC
is
Method
...panvilne
Darwler Slot Slme Materiel
Ft F. in.
Ft it. _ in.
Ft Si. in.
9. SAND/GRAVE PACK
Depth She Meta01
From To R
From To
Form To R
'rig'
10. DRILLING WO
Form To Formation Description
n P( (1
OEG Ii 4 200t
11. REMARKS:
We// T 1 e JIydn JrcTir to
10016®yCERiwnwr116wEtl WAS CONSTRUCTED W ACCON:INCEwinl
.SA NCPC 2C, WELL CONSTRU anN STMCARDS. NO TIATA COP! OF Tin
RECORD HAS BEEN PRIMED TONE WELL OwIBL
3,4t-,
yy
SIGNATURE OF WELL CONTRACTOR DATE
PRIMED NAME OYPERSON GONSIRUCTWG TIE WELL
Submit the original to the Division of Water Quality within 30 days. Attn: Information Mgt,
1617 Mail Service Canter — Raleigh, NC 27699.1617 Phone No. [phone] ext 568.
Farm GW-la
Rey. 7105

RESIDENTIAL WELL CONSTRUCTION RECORD
North Carolina De ertnx a of Enviaunact and Natural Resources- Divis urces- ion of Watt' Quality
WELL CONTRACTOR CERTIFICATION # o(0 SO
1. WELL CONRACTO :
Te e
en cmaada Wane
aryl{u3.m t.JN// 4 r
Wel Contractor Conga/ry Name rO STREET ADDRESS 31 I/ydp Tatum Ra
Gbh; r)Svi%/C nit 9S-77/
City or Tam Stele Zip Code
( 213. 4 79- S tl6 4/
Area coda. Phone number
2 WELL K-0RMATIOtt
SITE WELL IDa0/1011 ohN)
STATE WELL PERMIT#saaabie)
DWQ or OTHER PERL[T S(d appicable)
was. I$E (ClredikAppirable Bark Reddened Wain Supply.
DATE DRILLED % / - / 3 - O to
TIME COMPLETED 3;&0 AMO PathI I
3. WEILLOCATICet
are: Ary.tnn Gi Ty town, rS tAti n
Er,sr G.lark4 a&7/3
Nase.Nambers. 9redlkWglotN0.. Patel. cone
(Street
cep )-
TOPOGRAPHIC / LAND SETTING:
°Slope °Veber OFIat Wedge OOhe
(deck apprraplaehor0
LATITUDE _a_3° 13. //, $"
totarumEs3± a4'9 V'
LatitudeAangiimde sources ■GPS °Topographic map
(beacon afsee mad be Mown on a USGS lopomap and
Minded bids face Ind using GPS,
4 WELL OWNER
OWNERS NAME Pa n W/ Ir4 wSk,
net tADDRESS _c. ST nit le kq
6RryysOn ci'Ty /L c 25,r7/3
Citybr Tam Stele re Cale
( SrDIsr ). 3 4a - £/A 74/
Ares code- Phone rumba
May be o epees.
Dieen amoeba
in adecioal force
5. WM . DETAILS:
a. TOTAL DEPTIt tin c'
b. DOES WELL. REPLACE EXISTING WELL? YES ° NO gr
e. WATER LEVEL Below Top et Casing 76 FT.
(Use ‘I" II Above Top of Casing)
d. TOP OF CASNG IS / . FT. Above Land Sutam
'Top of casing lemi afed allybelow lard surface maw mpie
a valence in aeoadNgewM 15A NCAC 2C .0110.
e. YIELD (Wink o1 METHOD OF TEST C5. t r
335404
1. OISMFECTIOM Type liTY>/ Amount /C. A7
g. WATEtZOMES (deed*
Rom 7Q Te Fran To
Fan To From To
Fran To From To
0. CASING:
D�a Thickness/
ss/
DeptWeight Kin
Fnm�_too 11/ FtC, All lt.
From To R
From To FL
7. GROUT: Depth Mafais Method
Fern h To 90 Ft, CAm&hr P— .'v
Fran To R
Fran To R
& SCREEN: Depth Diameter Slot Size Material
Fran To FL In. Si.
Ruin To R in _ M.
Fran To FL it in.
9. SANOIGRAVR. PACK:
Doper Size 1Wa®I
Fan To R
Fan To R
Fan To R.
fA-
10. SUING LOG
Fmm To revelation Description
11. REMARKS:
RFCEtvE�
-) f WATEK QUA
ciEE 9 ��uh
IODIEREBv ISE'MAT naWELL VAS CONS1RUC1® 'MCCOWN= tam
15A ICC IC. WELL CONSTRUCTOR STANDARDS., AM 1H TA COPY OF THIS
RECORD HAS SEEN PROVIEDTOIIE WELL OWNER.
SIGNATURE OF Ct3tTIF1ED WELL CONTRACTOR DATE
Tie n AP
PRATED NAME OF PERSON CONSTRUCTING STRUCTNG THE WELL
Submit the original to the Division of Water Quality within 30 days. Atm: Information Mgt,
1617 Map Service Center —Raleigh, NC 27699-1617 Phone No. [phone] ext 566.
Fan GW-la
Rev. 7/05

RESIDENTIAL WELL CONSTRUCTION RECORD
North Catalina Department of Environment and Natural Resources- Division of Water Quality
WELL CONTRACTOR CERTIFICATION # 2 a ..co
1. WELL CONTRACTOR:
reP-P Sit
WeI ContractorName
(7rallek)1/ (.rlP// (71.r n//tq'Iq
Wdw CNada Company Nano ' / 0�
STREET ADDRESS ln3 / A ,-i P Town RA
ICahbins ui//N /VG
2 t77 /
City or Town Stab Zip Code
(r2� . in -gyC#
Ara coda- Plan number
2. WELLRFORMATIOtt
SITE WELL ID 501appa _Ue)
STATE WEU. PERMITINappaanb)
DWQ or OTHER PERMIT f(V applicable)
WELL USE (ChekAppfotle Sera): Residential Waber Supply IS
oATE DRILLED ED //— /4 -O
TWECOMPLETED S: 30 AMO PM®
3. WELL LOCATIOIt
CITY: %3rySan Ci7-y cowry SI.Jcr..i h
Eryr rJn.rkc1 R&7i?
(Street Name. Numbers. Ca mu SutdtWm. Int.N... Pawl. $.Code). -
TOPOGR; PHIC (LAND SETTING:
°Slope Maley OF MRMIle QOthw
(them apaepnat. bard
LATITUDE '_,° a "/11.7 t;
LONGtruoEL 3° .QG" .i. G`r
Latin de/long:ta is SOU= LOPS °Topographic map
(baton dzedeastbesham on a USGS IcPo map and
anac adblra bnminot Wag GPS)
s. WELL OWNER
OWNER'S NAME /Qt r? wI T/fo tusk I
STREET
ADDRESS fa.[ T G.f Ai" ka
% Cay4 TiaaGeT' SW C 1EpC Code
May be b dames,
Inoue; secoodsor
Ira trim* Wean
t %2fr - Wn17'f
Area code- Phone n rubs
5. WELL DETAILS:
a. TOTAL DEPflt 6 Oar
b. DOES WELL REPLACE DUSTING WELL? YES NO■
c. WATER LEVEL. Retie Top of Cuing 0 FT.
(Use- Above Top d Casing)
d. TOP OFCASING IS / _ FT. Abate Land Solace'
Top of casing braided Sheba lad surface nag mgtie
e nuance in accordance ugh 15A NCAC 2C .0116.
a. YIELD (gees* n METHOD OF TEST G.. n�1"
335405
t DISINFECTIOtt Type () Amount 0
g. WATER ZONES (depth*
From 0 To 0 From To
Fran To Fran To
Fan To Fran To
6. CASING:
rater Ft Coe� S�l i�✓Gal
Fran To Ft `
Fran To Ft
7. GROUT: Depth Material Method
Fanf_Tot_ Ft rsv,pnni- Nrim04y6
Fan To Ft for
Rea To Ft
& SCREEN& Depth Diameter Slot Size Material
Fo
ra
To Ft In. a
Fran To Ft is _ in.
Fran To FL S. _ an.
A SNOOGRAVEL PACK:
Depth Size Materiel
Fan To Ft
Fan To FL
From To FL
to. OR51.1tic LOG
Flom To Fomalcn Dominion
11. REMARKS:
t t isik aAPI
r„\t. 0 WF
)FL 047"6
1.Jell 7; Be YyJo r c re
IWMIST CBwFVRMTTNawerLWAS Wrrlaa1flflu CaanCEmn
MA naC 7C. WELL CONSMUCTnI STMMAPna. AND 1nMTACOP? SEMIS
RECOUP HAS 1e1394 PROYEW TOTHE WELL OWTER
Ye e
s�NATUR€ of WELL CONTRACTOR DATE
Pfta) ' PnsoN t1AHIE OF CONSTRUCTING THE WELL
Submit the original to the Division of Water Quality within 30 days. Attu: infonnatton Mgt.,
1617 Mall Service Center —Raleigh, NC 27699-1617 Phone No. [phone] ext 568.
Fanm GW-la
Rev. 7A5

RESIDENTIAL nu. cora- mutnon RECORD
North Carols Department ofEnvironment and Hamel Resource- Division of Water Quality
WELL comnescros CERTIFICATION 0.5-6
1. WELL oNTRACTfe 1
t5F -P
tla��e
Wei Cm
trmEor 11
roJnct_rn tde/l r
Wed Collector Pawn
ST/R�EET ADDRESS %r3�/ W AAP
City oTam Stab
f*2? 1- lin-
At® code- Phoeamba
aS-77/
rip Code
2WEHLIWORNATC t
SITE WEU. 1) *IT -4
STATE WELL PERNMWorridesa/
DWQ or OTHER PEMMT fiappicable)
*amuse (Meek ned oil.. Redtlanid Walr M
DATE Om.LW //'-1,5r-%Cn
TIME COMPLETED ) Ot (.15 AMO PM®
S. WELL LOCN : nATO
CITY: /J r>/Sin n C/gTy COUNTY <R(A CC.In
fI /(��/n� r Ci�//'AM {1 r5 Z3
I�str�dM..lab•6as.Go••aariFBraWYilRMe..paort Carlo
TOPOGRAPHIC I LAND SETTING
Dave Maley OFW RRr* obis
Obstappeebiekabal
tATflWE . .if alr/l..s,,
LONsR1mE2 36 Q5''Sa. 7"
Latiwd /Iongi desoaac Win °Topographicbgr
pbcsion d tw1 meths *star a USGS logo amp and
atiebsdlolielmaiadmig GPM
t WELL OWNER
owners UMW ,9ICk /7{ ea5
STREETAOCRESS ti irer cis r %t'd_
/3 rr se n ciry Ali .2Sr7/.?
War Taal SW Bp Cods
f?eh/ Wt '-'1739
Area code- Phone comber
PA, be indepea,
Waft moods a
inadated faa r
5. WELDETAI&
a. TOTAL DEPTlt II o o
b. DOES NELLREPLIICE EXISTING WELL? YES ° Nog
c WATER LEVEL BdoaTopdcadag O FT:
glee ^ef Nee Top d Caiq)
d. TOP OF CASING* / . FT. Above Laid Sorbet
Top dconic - iatedatehaMrled ruin ang made
a mince in aoeadanesoil ISAWAG 2C At1&
. YIBD Wag 0 METHOD
L OMawTIOlt Type fl
g. WATER ZONES [dep6Y
Amount O
406
From 0 To 0 Rant To
Rom To Fran To
Fro. To From To
& GUM TN nasl
Fran ei To_51 Ft nC f 5 .21 /Mt
Ran To Ft 7
Fee To Ft
7. GROUT: De go WSW DAMS
Ran r7 To aO Ft C#op,Prr Pumpink9
Rom To Pt
From To FL
& SCR®t Depth Dander SIN Sias Weil
Ran To Ft in_ it
FRS To R, is _ in.
Ftaw______T __FL__h in.
0. Sa1aBRAYB. PACK:
Depth Sits M edd
Fraq_To Ft
FaeL__To FL
From To FL
10. ortin 1G LOG
Fm To Fanisim D®optlon
AL REMARKS:
yttCCIVEn t t 1
�tv nrWATER ri°P1.
as u 4 2006
tOD11BEWCEIRW aRaMtlmaLMAEOpMMaCIEDMAOaaCerp!Mm
IMICACnGMELLOMM CMatSakOMD$MD9AACONIOFlrt
keoowtsS e®/FRorM®W11Mta61.01SMR
rrtcn SIGNATURE OF y/� WELL CONTRACTOR DATE
PNIB)WIMEOFPER80NCa1CInt;TitEtwt3L
Submit the original to the Division of Water Quality within 30 days. Anse: information Mgt,
1817 Mali Setvlce Center —Raleigh, NC 27689-1617 Phone No. [phone] es t 568.
Fano aW-ls
Rev. 71D6

RESIDENTIAL witu. CONSTRUCTION RECORD
NathCaon=Depwuaeotof Environment and Natural Rosau Division ofWater Quality
WELL constecronCERTIFICATION ?Vic(,
1. WELL CCHTRACTO(t:
041n 1711`I IfiepS
y anractor ( duaq Nano
(—)iTh ekc..;ail t)fik"^c
Wel Cadraelor None
STREET ADDRESS (3 Y N7cCe rt ", Rc.
0.0\01) 9.0
City orTarn Stale TpCode
L171 — C51-15L(
Area etude- Phone amber
SWELL IFOWiAT101t
SITE WELL O eNappiwttel
STATE WHLPERATrpappaatei
DIM or OTHER PERMIT Wi appiraNe)
WELL USE (CleedtAppfaNtBat ReadaW WaterSoply(
DATEDIILLEO / l - 30-06
T'WE COMPLETED / 'Oc3 em AM FMIk
3. WELL LOCATmat
CITY.. (,i - I- I e'r COUNTY . > e c ki r�
C reuc R�;r4cL
Meet sarw..smmaa vgYama.9e3+tm. tewo_ pate* $ Came}
TOPOGRAPHIC t LAND SETTING:
Gape Matey ORd ONIdjs EKGs
Wattapprapiaetwrp
LATITUDE _ S r; ,7 rgc , 5 � (
income St at n 5.yr,
May be to degas.
rae;aaetmia
leadmt•1 Omar
Latimddkregiode source XGPS OTopogtaphic amp
(bcaeaa dadmastbs shawl one USGStopegI and
atdmdiattar act ming BPS)
&WELL OWNER r pq j� ` OWNER'S NAME / e / reca, Ain/C,q�)
*itu ADDRESS erty.'�1�, Crieedo Rccsi
1-v b,r Thr i
City orToon rip oftde
Area code - Pope number
S WELL DETAIL&
ale TOTAL DERR
b. DOES WELL REPLACE ExtSTI(G Wen YESO NO R
e. WATER LEVELBdowTapeCadeg / 60 FL
(Uoa a IAhaeTap at Casing)
d. TOP OF CASRW LS / FT.Aho s Lined Sorbet
Taper maig aawmiwtd meta Wow bald mateoe ary tapirs
avariance in acosileeit 15ANCAC2C .Dili
e. YE3Dbptj /n METHOD OF TEST ON. r
335406
L osowEcnoa Typo I -I T H Amount / rl r a
S WATER ZOWB*par
Fran / ' To Ram
Rom To From
Rom To Ram
t CASING:
Diar
Fans 0 To L-I I Ft. A t
Depth ,
Ram To Ft
Ram To Ft
To
To
To
Thiebe®d
leapt t Materiel
T.61OUT: Deem Mead 1aWlod
Ram C., To 94 Ft i e h. -4- - r
Feell _To Ft, �•,, ` ,�
Rom To FL
S. SCR®t Dept Diameter Ski Ste Mt
Ran To FL in. a.
Firm To Ft M. M.
Fear To FL._—_-0L in.
L SA NOWIFIAYELPACK:
Dept Sze iiamii
Foam To Ft
FaeL_To R
Rem To R.
1a animas LOG
Ran To Fotmdmn Deaopfen
11. REMARKS:
tcu" its g1/4)
or SNP.
OEC
IOa.BB►ClaW elMWae6LlmeWISIICIEDm CCAIMANCEVele
ISm IIGCS.INEMCaiWlCmalEma DAROS.NaRYOACa•tWIGS
a60aemIeB!®nROYa®W 711Emga.OMER.
SIGNATURE OFC sYcO l 1— NTRACTOR DATE a"
PeUfED lY1MEOFif..- ati THE wELL
Submit the original to the Division of Water Quality within 30 days. Awe: Intonna(lon Mgt.
1617 Mail Service Center — Raleigh, NC Z7699.1617 Phone No. [phone] ext 568.
ram GW-la
Rev.7AS

3. WELL LO
CI
1. WELL CONTRACTOR:
James B Brown
1 Well Contractor (Individual) Name
Redden Brothers Well Drillin Inc,
Well Contractor Company Name
STREET ADDRESS 73Holly Hills Vista RD
Franklin NC 287ta
City or Town State Zip Code
1 828 )- 369_9591
Area code- Phone number
2. WELL INFORMATION:
SITE WELL ID *Of applicable)
STATE WELL PERMIT#(If applicable)
DWQ or OTHER PERMIT Cif applicable)
• WELL USE (Check Applicable Box): Residential Water Supply [�
DATE DRILLED J • . (� p
TIME COMPLETED �5 Dc7 AM O PM9(
(S reel ame, Numbers, Community, Suhdivsion, Lot No„ Parcel, Zip Code)
TOPOGRAPHIC / LAND SETTING:
°Slope °Valley ❑Flat ❑Ridge °Other
(check appropriate box) —�—
LATITUDE� 1�6
LONGITUDE 834
Latitude/longitude source: & 3PS °Topographic map
(location of well must be s o on a USGS topo map and
attached to this rm Anot using GPS)
4, WELL OWNER
OWNER'S NAME
�TRET ADDRESS
May be in degrees,
minutes, seconds or
in a decimal format
City or Town State Zip Code
'- )• u
Area co e •Phone number
5, WELL DETAILS:
a. TOTAL DEPTH:
b. DOES WELL REPLACE EXISTING WEL ? YES ❑ NOIL
c. WATER LEVEL Below Top of Casing:
(Use "+" If Above Top of Casing) FT.
d. TOP OF CASING IS 2 FT, Above Land Surface'
Top of casing terminated ator below land Surfaoe may require
a variance In ac ordance with 15A NCAC 2C .0118.
e, YIELD (gpm):-- METHOD OF TEST Blow
RESIDENTIAL WELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources- Division of Water Quality
WELL CONTRACTOR CERTIFICATION # _2045
9 119
f. DISINFECTION: Type__ H T H Amount 160z
g. WATER ZONES (depth:
From To i From•
From_ To From_
From-_ //2 To [i From_
6. CASING:
De th Thickness/
To
From Diameter We h
O ♦ u l Ft. (0 „ ter' I
From To Ft
From To Ft
7. GROUT: Depth Material
from 0 Ton Method
Fcerrent & benonite
From To Ft.
From To Ft
8. SCREEN: Depth Diameter Slot Size Material
From To__ FI,in. In.
From . To__ Ft. In. in.
From To Ft In.
in,
9. SAND/GRAVEL PACK:
Depth Size Material
From To Ft,
From To Ft.
From To Ft.
10, DRILLING LOG
From To.
11. REMARKS:
Formation Description
C1,R7 R sand
rrrani+p
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH
ISA NCAC 2C, WELL CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS
RECOgp HAS SEEN PROVIDED TO THE WELL OWNER
ERTIFIED WELL CONTRACT R DATE
PRINTED NAME OF PERSON CONSTRUCTING THE WELL
Slrbmit the orlghral.to the Division of Water Quality within 30 days, Attn: Information Mgt.,
18817 Mail Service Center -Raleigh, NC 27699.1617 Phone No. [phone] ext 568.
DEC 12 2006
Form GW1a
Rev. 7/05

1. WELL CONTRACTOR:
James B Brown
Well Contractor (Individual) Name
Redden Brothers Well Drillin Inca
Well Contractor Company Name
STREET ADDRESS 73 Holly Hills Vista RD
Franklin NC 287aa
City or Town State Zip Code
Area code- Phone number
2. WELL INFORMATION:
SITE WELL ID #(II applicable)
STATE WELL PERMIT#(I? applicable)
DWQ or OTHER PERMIT #(if applicable;
WELL USE (Check Applicablepn/Box): Residential Water Supply
DRILLED /V - (O'Q6,
TIME COMPLETED v , 00
3. WELL LOCATION
T
Id
( reet Name umbers, Community,
i TOPOGRAPHIC/LAND SETTING:
°Slope °Valley ❑Flat ❑Ridge ❑Other
(check appropriate box)
LATITUDE
LONGITUDE 2,3da
Latitude/longitude source: GPS ❑Topographic map
(location of well must be s own on a USGS topo map and
attached to this form )(not using GPS)
4. WELL OWNER
OWNER'S NAME
STREET ADDRESS
AM ❑ PMA
Tr(
rraa.r,/
division, Lot No;, Parcel, Ip Code)
May be in degrees,
minutes, seconds or
in a decimal format
City or Town State Zip Code
aR>4ai9a,Q
Area code - Phone number
5. WELL DETAILS:
a. TOTAL DEPTH: q ,ems ox r
b. DOES WELL REPLACE 1EXI�STING WELL? 7nY�ES 0 N0)K
c. WATER LEVEL Below Top of Casing: tR0D FT.
(Use "+" if Above Top of Casing)
d. TOP OF CASING IS 2 FT. Above Land Surface'
'Top of casing terminated aVbr below land surface may require
a variance In accordance with 15A NCAC 2C .0118.
e. YIELD (gpm): `5 METHOD OF TEST Blow
• RESIDENTIAL WELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources -
Division of Water Quality
WELL CONTRACTOR CERTIFICATION # — 2045
335120
f. DISINFECTION: Type H T H Amount 160z
g. WATER ZONES (depth):
From__ To /6 (-I From To
ifk From To
From
To
Thickness/
Dr Weight M t ial
a AA
From To
From / 3 3 To
6. CASING:
From
From
From
Depth
To
To
Ft
7, GROUT: Depth Material
From 0 Method
To 20 ?cement & benonite p
From__ To FL
From To FI.
8, SCREEN: Depth Diameter Slot Size
From To Ft. In.Material
in.
From
—__ To Ft, In, In,
From To___ Ft. In.
__ in.
9. SAND/GRAVEL PACK:
Depth Size Material
From To FL
From To Ft,
From To Ft._.
10: DRILLING LOG
From To
11. REMARKS:
Formation Description
play R sand
- 4rani tom_
1 DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH
15A NCAWELL CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS
RECJRD y(S BEEN PROVIDED TO THE WELL OWNER,
ATURE OF'CERTIFIED WELL CONTRACTOR OAT
James B Brow
PRINTED NAME OF PERSON CONSTRUCTING THE WELL
Submit the original to the Division of Water Quality within 30 days. Attn: Information Mgt.,
1817 Ma)18ervice Center- Raleigh, NC 27699.1817 Phone No. [phone] ext 568.
DEC 12 2006
Form G W-1 a
Rev, 7/05

1. WELL CONTRACTOR;
James B, Brown
Well Contractor (Individual) Name
Redden Brothers Well Drillin Inc:
Well Contractor Company Name
STREET ADDRESS 73H011V Hills Vista RD
Franklin NG 287�a
City or Town State Zip Code
( 828 )-����9591
Area code- Phone number
2. WELL INFORMATION:
SITE WELL 10 #(If applicable)
STATE WELL PERMIT#(ir applicable)
DWQ or OTHER PERMIT #(if applicable;__
WELL USE (Check Applicable Box): Residential Water Supply4
DATE DRILLED/n -r/-•_ /C
TIME COMPLETED _W _ AM PM ..
J. WELL LOCATI•N; CITY: L-��- i� COUNTY -IL
d
(SlretJame, Numbers, Community, 5 ditiaioIof No:, Parcel, Zip Code)
TOPOGRAPHIC / LAND SETTING:
(Slope (Valley CI Flat ❑Ridge ❑Other
(check apprqop�riate box)
LATITUDE 25
LONGITUDE a nea
May be in degrees,
minutes, seconds or
in a decimal format
Latitude/longitude source: Cl GPS ❑Topographic map
(location of well must be shown on a USGS topo map and
attached to this form of using GPS)
4. WELL OWNER '
OWNER'S NAME
STREET •OGRESS
Cy or own State
)- �4737,c0 •
Area code - Phone number
5. WELL DETAILS:
a. TOTAL DEPTH:
Zip Code
b. DOES WELL REPLACE EXISTING WELL? YES ( NOy4
aWATER LEVEL Below Top of Casing:. FT, \
(Use "+" if Above Top of Casing)
d. TOP OF CASING 15 2 FT, Above Land Surfacer
'Top ofcasing terminated at/or below land surface may Teoulre
a variance In accord nce with 15A NCAC 2C .0118.
e. YIELD (gpm): METHOD OF TEST Blow
RESIDENTIAL WELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources- Division of Water Quality
WELL CONTRACTOR CERTIFICATION # . 2045
1 1 of t'. t3,L2
f. DISINFECTION: Type H T H Amounta_
g. WATER ZONES (depth):
From To From
From To
To - From To
From To - From To
6. CASING: Thickness/
From U' ...Depth
7 Ft p eter �tf,,l�,•a, Ma alai
From To Ft. 6—----8
From To Ft.
7. GROUT: Depth Material
From 0 To 20 Ft',enent &
From_ To Ft.
From_ To FL
8. SCREEN: Depth Diameter Slot Size Material
From____ To Ft. In. In.
From ___ To Ft. In.
In.
From-__ To Ft. In. In.
9. SAND/GRAVEL PACK:
Depth Size Material
From
From,
From
11); DRILLING LOG
From To
11. REMARKS:
To Ft.
To Ft.
To Ft.
Method
benonite p
Formation Description
clay R c--d
nr-n i 1-A
I D0 HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH
ISA NCAAyy{{C, WELL CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS
REC06161NS BEEN PROVIDE TO THE WELL OWNER.
/d//€Q
SI (ATURE OF C IFIED WELL CONTRACTOR -DATE
v James
PRINTED NAME OF PERSON CONSTRUCTING THE WELL
Submit the original to the Division of Water Quality within 30 days. Attn: Information Mgt.,
1617 Mall S'ervice Center- Raleigh, NC 27699.1617 Phone No. [phone] ext 568.
DEC 12 2006
Form GW-la
Rev. 7/05

1. WELL CONTRACTOR:
James B Brown
J Well Contractor (Individual) Name
RESIDENTIAL WELL CONSTRU TION RE ORD
North Carolina Department of Environment and Natural Resources- Division of Water Quality
WELL CONTRACTOR CERTIFICATION # 2045
Redden Brothers Well Drillin Inc.
Well Contractor Company Name
STREET ADDRESS 73 Holly Hills Vista RD
Franklin. NC 287aa
City or Town State Zip Code
Area code- Phone number
2. WELL INFORMATION:
SITE WELL ID #(ll applicable)
STATE WELL PERMIT#(I/ applicable)
DWQ or OTHER PERMIT #(if applicable] WELL USE (Check Applicable Box):rResidential Water Supply �f
DATE DRILLED )O.9'Op^�
TIME COMPLETED 3 r.00 AM ❑ PM/K
3. WELL LLIA ION:
ei
CITY: OO COUNTY-
(SlreBl Name, Nuli16lri, Community, Subdivision, Lot No„ Parcel, Zip Code)
TOPOGRAPHIC /LAND SETTING:
ci Slope :Valley ❑Flat ❑Ridge ❑Other
(check appropriate box)
LATITUDE J121
LONGITUDE83 i 87
Latitude/longitude source: MOPS ❑Topographic map
(location of well must be s awn on a USGS topo map and
attached to this form if not using GPS)
e. WELL OWNER
May be in degrees,
minutes, seconds or
in a decimal format
OWNER'S NAME
STREET ADDRESS
City or Town ate
SZS )- gR7. 601 •
Area code • Phone number
Zip Code
5. WELL DETAILS: (too 1
a. TOTAL DEPTH.
b. DOES WELL REPLACE EXISTING WELL? YES O NO/E
c. WATER LEVEL Below Top of Casing:—3,210_Fr.
(Use "+" If Above Top of Casing)
d. TOP OF CASING IS 2 " FT, Above Land Surface'
'Top of casing terminated at/or below land surface may require
a variance In acc rdance with 15A NCAC 2C .0118.
e, YIELD (gpm): p� METHOD OF TEST Blow
�" rv.14
cr
f. DISINFECTION: Type_nit_ T H Amount 16Q
g. WATER ZONES depth
):
,
From O Too
prom , I33. To S15
From To
6. CASING:
Dept
From_, To
From I9 To
From
From To
From To
From To
Thickness/
Ft. '
Damelter Weight Mal
To Ft. T
7. GROUT: Depth
From 0 To 20
From___ To
From To
8. SCREEN: Depth
From To
From __ To_
From To_
9. SAND/GRAVEL PACK:
Depth
From To
From To
From To
10. DRILLING LOG
From To
/40 1
11..�F�$,ARKS:
1 D0 HEREBY CERTIF
16A NCAC 2C, WELL
RECOR. AS BEEN
Material Method
FGement & benonite
Ft.
FI.
• • —•
Diameter Slot Size Material...
Ft. In. •__. In. ,
Ft In. __. In.
Ft. In. _ in. -
Ft.
Ft.
Ft.
Size Material
Formation Description
clay & SRnr7
gran i f-a
c»v, t ifUeTFR
Y THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS
PROVIDED TO THE WELL OWNER.
/p-54-61{
OF C RTIFIED WELL CONTRACTOR DATE
a!R ss A As�,Ty
PRINTED NAME OF PERSON CONSTRUCTING THE WELL
SI
ATURE
Submit the original to the Division of Water Quality within 30 days. Attn: Information Mgt.,
1617 Mail Service Center.. Raleigh, NC 27699.1617 Phone No, [phone] ext 568.
Form GW-la
Rev. 7/05

RESIDENTIAL WELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources- Division of Water Quality
WELL CONTRACTOR CERTIFICATION # 2045
1. WELL CONTRACTOR:
James B. Brown
Well Contractor (Individual) Name
Redden Brothers Well Drilling, Inc.
Well Contractor Company Name
STREET ADDRESS 73 Holly Hills Vista RD
Franklin, NC 28734
City or Town • State
828 )- 369-9591
Area code- Phone number
2. WELL INFORMATION:
SITE WELL ID *Of applicable)
STATE WELL PERMIT#(i/applicable)
DWQ or OTHER PERMIT #(if applicable)
• WELL USE (Check Applicable Box): Residential Water Supply t�'y
DATE DRILLED I • 5 • Q( J�
TIME COMPLETED
Zip Code
3. WELL LOO ATION:
CI Y: (.JUL,,ot u- COUNT
cam.
( Creel Name, Numbers, Community, SubdiNaion, Lot No., Parcel, Zip Cade)
TOPOGRAPHIC /LAND SETTING:
OSlope OValley DFlat ❑RIdge DOther
(check appropriate box)
LATITUDE al..ILCO
LONGITUDE 1315 .0411
Latitude/longitude source: XGPS ❑Topographic map
(location of well must be s o on a USGS topo map and
attached to this form Anot using GPS)
4, WELL OWNER n1
OWNER'S NAME 1 V / Q
STREET ADDRESS I$'-�
5 •• 00 AM ❑ PM,
May be in degrees,
minutes, seconds or
in a decimal format
33a45
f. DISINFECTION: Type H T H Amount 160z
g. WATER ZONES (depth):
From 365 To 367 From To
From To From
To
From To From
To
6. CASING: Thickness/
Depth DIAmf)er Weight Materlal
From X/� To �7 Ft. ((p q/ds
From Y l' To l00 FL_ - -
From To__ Ft.
7. GROUT: Depth Materlal Method
From 0 TD 20 FGement & benonite
From To Ft.
From To FL
8, SCREEN: Depth Diameter Slot Size Material'
From To FL In. In.
From To Ft. In. in.
From To Ft. In _ In.
^t18!
9. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
From To Ft.
1 I e 'd ,«:f •
steivniAmt
VV�ar C.
City or 7 - Slate 4 A.0 48 5 /
Area code- Phone number
5. WELL DETAILS: I I,
a. TOTAL DEPTH: 111O0 s
b. DOES WELL REPLACE EXISTING WELL? YES ❑ NOI
c. WATER LEVEL Below Top of Casing: /t;J FT.
• (Use "+" If Above Top of Casing)
d. TOP OF CASING -IS 2 FT. Above Land Surface"
'Top of casing -terminated at/or below land surface may require
a variance In accordance with 15A NCAC 2C .0118.
e. YIELDQ Blow U
(gpm):
METHOD OF TEST
PRINTED NAME OF PERSON CONSTRUCTING THE WELL
10. DRILLING LOG
From To
I1. REMARKS:
_ "_
Formation Description
rIeiy' & saad
gram FP
RCCENFD
t.1V_ Or WNATFR OUALm
If (a 1 700E
100 HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH
16A NCAC 2C, WELL CONSTRUCTION STANDARDS, AND THATA COPY OF THIS
RECO HAS BEEN PROVIDED TO THE WELL OWNER.
NATURE OF CERTt�L CONTRACTDRO'. DATE
James B. Brown
Submit the originalto the Division of Water Quality within 30 days. Attn: Information Mgt.,
1617 Mail Service Center- Raleigh, NC 27899.1617 Phone No. [phone] ext 568.
Form G W-1 a
Rev. 7/05

RESIDENTIAL WELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources- Division of Water Quality
WELL CONTRACTOR CERTIFICATION # .
1. WELL CONTRACTOR:
James B. Brown
I Well Contractor (Individual) Name
From To From To
Redden Brothers Well Drilling, Inc. Fro,n- To Weil Contractor Company Name From To
From To From To
STREET ADDRESS 73 Holly Hills Vista RD 6. CASING:
Depth Thickness/
Franklin. NC 28734 Diameter Walla M erlal
City or Town StateFrom n To tit Ft. /e
Zip Code From To Ft.
(_$.2.$_)- 369-9591 From To Ft. Area code- Phone number
2. WELL INFORMATION:
SITE WELL ID #(It applicable)
2045
STATE WELL PERMIT#(il applicable)_
DWG or OTHER PERMIT #(if applicable;
• WELL USE (CheckApplicableBox): Residential Water Supply rx
DATE DRILLED lj'A5•Q(0 �L! TIME COMPLETED hoe oe AMC PM IE .
3. WELL LO/C,1pTAJ,ON:
, /
CITY: •1 .pI�JW�( D.p. - COUNTY
(Street Name, Numbers, Community, Subdivision, Lot No., Parcel, Zip Code)
TOPOGRAPHIC / LAND SETTING:
O Slope ❑Valley DFlat ❑Ridge ❑Other
(check appropriate box)
LATITUDE y3_
LONGITUDE
May be in degrees,
minutes, seconds or
in a decimal format
Latitude/longitude source: oGPS ❑Topographic map
(location of well must be shown on a USGS tcpo map and
attached to this form if not using GPS)
4, WELL OWNER
OWNER'S NAME
STET ADDRESS �c _ �'�^'^v •r
City oifown Zip Code
($Lg)- 1 — /$36
.Area code • Phone number
R7/A
5. WELL DETAILS: 11•
a. TOTAL DEPTH; IOOO
b. DOES WELL REPLACE EXISTING WELL? Y S❑ NO,(
c. WATER LEVEL Below Top of Casing: FT.
(Use •+" If Above Top of Casing)
d.. TOP OF CASING IS '2 FT. Above Land Surface'
Top of casing terminated at/or below land surface may require
e variance in acco ance with 15A NCAC 2C .0118.
a; YIELD (gpm):
METHOD OF TEST Blow
f. DISINFECTION: Type H T H Amount 160z
g. WATER ZONES (depth):
7. GROUT:
From 0
Depth
To 20
From To
From To Ft.
Material Method
Fcement & benonite p
Ft
8. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. ___ In.
From To Ft. in. in,
From To Ft. in. �• In.
9. SAND/GRAVEL PACK:
Depth Size Material
From To Ft
From To Ft
From To Ft
10. DRILLING LOG
From T•�D Formation Description
e
clay & and
rani Fs
11. REgM&tKS:
kEGENEDtIAt 11 y
wp\/ t'?FN�TCft9
ilGk 1f I ZOUt
I D0 HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH
ISA NCAC 2C, WELL CONSTRUCTION STANDARDS AND THAT A COPY OF THIS
REC•�• HAS BEEN PROVIDED TO THE WELL OWNER.
_ I E
GVATURE • CERTIFIED WELL CONTRACTOR DATE
PRINTED NAME OF PERSON CONS RUCTING THE WELL
Submit the originalto the Division of Water Quality within 30 days. Attn: Information Mgt.,.
1617 Mail Service Center- Raleigh, NC 27699.1617 Phone No, [phone] ext 568.
Form
GW-la
DEC to 7
� �O6

RESIDENTIAL WELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources- Division of Water Quality
WELL CONTRACTOR CERTIFICATION # . 2045
1. WELL CONTRACTOR:
James B. Brown
Well Contractor (Individual) Name
Hedden Brothers Well Drillin Inc,
Well Contractor Company Name
STREET ADDRESS 73.H011V Hills Vista RD
Franklin NC 2B7aa
City or Town • State Zip Code
Area code. Phone number
2. WELL INFORMATION:
SITE WELL ID #(It applicable)
STATE WELL PERMIT#(if applicable)-�
DWQ or OTHER PERMIT #(if applicable)• __
WELL USE (Check Applicable Box): Residential Water Supply ❑
DATE DRILLED LD' 19 • c
TIME COMPLETED
•6C) AM El PM&
CITY' , COUNTY
4ansisd
lair el Nam , Numbers, Community, Subdleslon, Lot No., Parcel, Zip Code)
TOPOGRAPHIC / LAND SETTING:
❑Slope ❑Valley ❑Flat ❑Ridge ❑Other
(check appropriate box)
LATITUDE.5 b4=
LONGITUDIS
May be in degrees,
minutes, seconds or
in a decimal format
Latitude/longitude source: ,S/� `'PS Topographic map
(location of well must be shorn on a USGS topo map and
attached to this form 11 not using GPS)
4. WELL OWNER
OWNER'S NAME
STAEFTaADDRESS ' (ryj I r 1N4 Pik
f�y
Cityitor Town pState Zip Code
)- 73t.0 a7,/ 0 77 •
Area code • Phone number
5. WELL DETAILS:
a. TOTAL DEPTH:_
b. DOES WELL REPLACE EXISTING WELL?� Y�E`S..❑� NO,L
c. WATER LEVEL Beiow Top of Casing:SET,
FT, `•
(Use •+° If Above Top of Casing)
d, TOP OF CASING IS 2 FT. Above Land Surface'
— 'Top of cas!ng terminated at/or beinw land surface may require
a variance In accordance with 15A NCAC 2C .0118.
a. YIELD (gpm): __(2( METHOD OF TEST Blow
f. DISINFECTION: Type H T H Amount a
g. WATER ZONES (depth):
From-$ To,_ From To
From- 3JD To 31.1" . From To ._
From To From To
6. CASING:
De lhThickness/
From To2z Ft, _linter Wi • u§a M terial
From To Ft.
From To Ft.
7. GROUT: Depth Material Method
From 0 To 20 FGeinent & benonite p
From To Ft
From To FL
6. SCREEN: Depth Diameter Slot Size Material
From To Ft. In. _ In.
From To Ft. In, in. 1 __
From ToFt. In. In, I
9. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From ToFt.
From To Ft.
10. DRILLING LOG
From% %1D r
11. REMARKS:
Formation Description
clay R a
1 DO HEREaY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE IT
15A NCAC 2C, WELL CONSTRUCTION STANDARDS, AND THATA COPY OF THIS
RECOR S SEEN PROVIDED TO THE WELL OWNER.
ATURE OF CER IFIED WELL CONTRACTOR ���
Ames R Brown
PRINTED NAME OF PERSON CONSTRUCTING THE WELL
Submit the original, to the Division of Water Quality within 30 days, Attn: Information Mgt.,
1617 Mail Service Center.. Raleigh, NC 27699.1617 Phone No. [phone] ext 568.
16
Form G W-1 a
Rev. 7/05
•

RESIDENTIAL WELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources- Division of Water Quality
WELL CONTRACTOR CERTIFICATION # 2045
1. WELL CONTRACTOR:
James B. Brown
Well Contractor (Individual) Name
Hedden Brothers Well Drilling, Inc,
Well Contractor Company Name
STREET ADDRESS 73 Holly Hills Vista RD
Franklin, NC
City or Town State
(828 ). 369-9591
Area code- Phone number
2. WELL INFORMATION:
SITE WELL ID #(ir applicable)
28734
Zip Code
STATE WELL PERMIT#(if applicable)
DWQ or OTHER PERMIT #(if applicable)
WELL USE (Check Applicable Box): Residential Water Supply
DATE DRILLED j7ay Ito COJ)b
TIME COMPLETED - /4. ! 2Z AM 0 PMX
3. WELL LOCATION:.
CY --"�/�"^ COUNTY
(( e� I�Q
(Street Name. Numbers, Community, 1belniislon, Lot No., Parcel, Zip Code)
TOPOGRAPHIC / LAND SETTING:
❑Slope OValley ❑Flat ❑Ridge DOther
(check appropriate bo
LATITUDE _ma /J ,^ _
LONGITUDE do la7
May be in degrees,
minutes, seconds or
in a decimal format
Latitude/longitude source: GPS ❑Topographic map
(location of well must be shown on a USGS topo map and
attached to this lam if not using GPS)
4. WELL OWNER
OWNER'S NAME
STREET ADDR SS
or T n State
City )_ 'Y97 a9t665.
Area code • Phone number
Zip Code
5. WELL DETAILS: /A7 h
a. TOTAL DEPTH: -- / VQU y
b. DOES WELL REPLACE EXISTING WELL? AYES - NO 0
c. WATER LEVEL Below Top of Casing:
(Use "+" if Above Top of Casing)
d. TOP OF CASING IS 2 FT. Above Land Surface*
`Top of casing terminated at/or below land surface may require
a variance in actor ante with 15A NCAC 2C .0118.
e. YIELD (gam): METHOD OF TEST Blow
f. DISINFECTION: Type H
T H
Amount 16cz
g. WATER ZONES (depth):
From To From
To
From To - From
To
From To From To
8, CASING:
From DToth 5 Ft. Yo r Diapmeter
From To
From To__ Ft.
Thickness/
Weight
7. GROUT: Depth Material
From D To 20 Ft cement & benonite
From To___ Ft.
From To Ft.
Material
Method
pumped
8. SCREEN: Depth Diameter Slot Size Material
From To Ft. In. _ in.
From To Ft In. _ in.
From To Ft. In. _ In.
9. SAND/GRAVEL PACK:
Depth Size Material Cnj
From To Ft.
From To Ft, IV.
From To FL
O
rn
10, DRILLING LOG
From To Formation Description
0 Clay & sand
3 '' / %J granite
11. REMA K§:
2r''cr{:t\lEt? .Ty
zUUF
100 HERESY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH
15A NCAC 20, WELL CONSTRUCTION STANDARDS, AND THAT A COPY OF
RECO AS SEEN PROVIDED TO THE WELL OWNER.
/f /6t
Sr ATURE OF TIFIED WELL CONTRACTOFE DATE
/ �wmcs 3. 't zcwtl
PRINTED NAME OF PERSON CONSTRUCTING THE WELL
Submit the original to the Division of Water Quality within 30 days, Attn: Information Mgt.,
1617Mail Service Center - Raleigh. NC27t9.daw

RESIDENTIAL WELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources- Division of Water Quality
WELL CONTRACTOR CERTIFICATION # 2045
1, WELL CONTRACTOR:
James B.. Brown
Well Contractor (Individual) Name
Hedden Brothers Well Drilling, Inc,
Well Contractor Company Name
STREET ADDRESS 73 Holly Hills Vista RD
Franklin, NC
28734
City or Town State Zip Code
828 ). 369-9591
Area code- Phone number 2. WELL INFORMATION:
SITE WELL ID #(If applicable)
STATE WELL PERMIT#(if applicable)
DWQ or OTHER PERMIT #(If applicable)
WELL USE (Chec
DATE DRILLED
TIME COMPLETED
3. WELL LOCATION:
CITY:
it-ch
placable Box): Residential Water Supply I]p
AM PMk
COUNTY,)Usti.
(Street Name, Numbers, Community, Subdivision, Lot No., Parcel, Zip Code)
TOPOGRAPHIC / LAND SETTING:
❑Slope OValley ❑Flat ❑Ridge Other
(check appropriate box) /
LATITUDE pa v 1/37'^Y
LONGITUDE g/4 RtVt'1)
Latitude/longitude source: k_PS ❑ 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
STREET ADDRESS
City or Town State
y97-25'63
Area code • Phone number
6. WELL DETAILS: ,
a. TOTAL DEPTH: J6ZTD
77/ A
Na ig Zip Code
b. DOES WELL REPLACE EXISTING WELL? YE9 NOti
WATER LEVEL Below Top of Casing:. FT.
• (Use '4" If Above Top of Casing)
d. TOP OF CASING IS 2 FT. Above Land Surface'
'Top of casing terminated at/or below land surface may require
a variance In accordance with 15A NCAC 2C .0118.
e. YIELD (gpm): 1 METHOD OF TEST BIOW
f. DISINFECTION: Type H T H Amount 1602
g. WATER ZONES (depth): -:
From To From
From To From
From To From
To
To
To
6. CASING: Thickness/
DepthDiameter Weight M e I
From d To 4- Z Ft. "
From To Ft.
From To Ft.
7. GROUT: Depth Material Method
From 0 To 20 Ft. cement 8 bencnite pumped
From To Ft.
From To Ft.
S. SCREEN: Depth Diameter Slot Size Material
From To Ft. In. in.
From To Ft. In. in.
From To Ft. in, In.
9. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
From To Ft.
10. DRILLING LOG
From To, Formation Description
0 `fa' Clay & sand
fp ' 'fl
granite
KECENED
QiV, of WATER QUAUTY
I)Fr' 9,, 7 7U06
11. )1(1�KS:zaes
th
I D0 HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH
iSA NCAC 2C, WELL CONSTRUCTIION STANDARDS, AND THAI.:. JOPY of THIS
RECOHD'F.LS BEEN PROVIDED TO THE WELL OWNER.
ATURE OF CERTIFIED WELL CONTRACTOR DATE
,$mcs 3. eeaowa
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.
RAE GW-1a
'- RES. 7/05

RESIDENTIAL WELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources -Division of Water Quality
WELL CONTRACTOR CERTIFICATION # 2045
f. DISINFECTION: Type H T H
1. WELL CONTRACTOR:
James B. Brown
Well Contractor (Individual) Name
Hedden Brothers Well Drilling, Inc,
Well Contractor Company Name
STREET ADDRESS 73 Holly Hills Vista RD
Franklin, NC
28734
City cc Town State Zip Code
( 828 )_ 369-9591
Area code- Phone number
2. WELL INFORMATION:
SITE WELL ID rt(if applicable)
STATE WELL PERMIT#(if applicable)
DWQ or OTHER PERMIT #(if applicable)
WELL USE (Check Applicable Box): Residential Water Supply O
DATE DRILLED /A'll'"f
TIME COMPLETED 3:0
3. WELL LTnION
CITY: k
AMC) (Ng.
COUNTY
L/f.bertv
(Streett Name, Numbers, Commuommun ty, Subdivision, Lot No., Parcel, Zip Code)
TOPOGRAPHIC / LAND SETTING:
D Slope ❑Valley ❑Flat ❑Ridge ID Other
(check appropriate box)
LATITUDE .Qj' 995i✓
LONGITUDE 0�1420 6l19520
Latitude/longitude source: $GPS ❑Topographic map
(location of well must be shown on a USGS topo map and
attached to this I it not using GPS)
4. WELL OWNER L /n! m
OWNER'S NA I .4M ql( 61,���
S ET ADDRESS 4156 /!Zoe ���
„92019
City or Town / State Zip Code
( )-zI97-719gi
Area code - Phone number
May be in degrees,
minutes, seconds or
in a decimal format
5. WELL DETAILS:
a. TOTAL DEPTH:
Z9001 11
b. DOES WELL REPLACE EXISTING WELL? YES 0 NOyI
c. WATER LEVEL.3elow Top of Casing: s FT.
(Use "r" if Above Top of Casing)
d. TOP OF CASING IS 2 FT. Above Land Surface*
'Top of casing terminated at/or below land surface may require
a variance in accordance with 15A NCAC 2C .0118.
e. YIELD (gpm): 5 METHOD OF TEST Blow
From
From
6. CASING:
Amount 16oz
g. WATER ZONES (depth):
0 From L To I 60 From To
To From To
To From To
Thickness/
Weight
Depth Diameter
From� L/To Ft. Ic
From To FL (ntrtr t 18%
From To Ft.
7. GROUT: Depth
From 0 To 20
From To
From To
Material
Ft.cement a benanite
Ft.
Ft
Material
Method
pumped
8. SCREEN: Depth Diameter Slot Size Material
From To Ft. In. in.
From To Ft. in. In.
From To Ft. In. In.
9. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
From To Ft.
10. DRILLING LOG
From To
0
.501 %Q
11. REMARKS:
Formation Description
Clay 6: sand
granite
RECFNEn
n„®t fl` ot1AIRN,
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH
15A NCAC 20 WELL CONST, cuCTION STANDARDS, AND THAT A COPY OF THIS
RECOR BEEN PROVIDED TO THE WELL OWNER.
SIe)-ATU- E OEISTIFIED WELL CONTRACTOR DATE
Jwmcez 3• "SRou'4
PRINTED NAME OF PERSON CONSTRUCTING THE WELL
Submit the original to the Division of Water Quality within 30 days. Attn: Information Mgt.,
1617 Mail Service Center— Raleigh, NC 27699-1617 Phone No. [phone] ext 566.
,pprmGW-1a
Rev. 7/05

RESIDENTIAL WELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources- Division of Water Quality
WELL CONTRACTOR CERTIFICATION #
1, WELL CONTRACTOR:
James B. Brown
Well Contractor (Individual) Name
Hedden Brothers Well Drilling, Inc,
Well Contractor Company Name
STREET ADDRESS 73 Holly Hills Vista RD
Franklin, NC
28734
City or Town State Zip Code
(828 )- 369-9591
Area code- Phone number
2. WELL INFORMATION:
SITE WELL ID #(it applicable)
STATE WELL PERMIT#(it applicable)
DW Q or OTHER PERMIT #(if applicable)
WELL USE (CheckppIIcable Box): Residential Water Supply
DATE DRILLED TIME COMPLETE AM ❑ PfX,
3. WELL LL/ppp/C///qJJ��'TI^ON:�r
CITY: I..J COUNTY
rs, -
( reel Na e, Numbers, Community, SubtllNsion, Lot No., Parcel, Zip Code)
TOPOGRAPHIC / LAND SETTING:
❑Slope DValley ❑Flat ❑Ridge ❑Other
(check appropriate box)
LATITUDE 3
LONGITUDE
Latitude/longitude source: ❑ GPS oTopographic map
(location of well must be shown on a USGS topo map and
attached to this rm if not using GPS)
May be in degrees,
minutes, seconds or
in a decimal format
4. WELL OWNER
OWNER'S NAME
$7 EET AD RESS
d I
Area code - Phone number
5. WELL DETAILS: /x D
a. TOTAL DEPTH: /
b. DOES WELL REPLACE EXISTING WELLS YES 0 NOK
c. WATER LEVEL Below Top C_Casing: ION ET...
(Use "+" if Above Top of Casing)
d. TOP OF CASING le 2 FT. Above Land Surface`
*Top of casing terminated at/or below land surface may require
a variance in accordance with 15A NCAC 2C .0118.
e. YIELD (gpm): O`er METHOD OF TEST Blow
p Code
2045
1. DISINFECTION: Type H T H Amount l6oz
g. WATEF; 2Ql NES (poet!(h)
From (0 To '-� From To
From To From To
From To From To
6, CASING: Thickness/
DeptDiameter Weight N leIial
From To 1nu Ft. !io
From Ft.,40..!1
From To Ft.
7. GROUT: Depth Material
From 0 To 20 Ft. cement & benonite
From To Ft
From To Ft.
Method
pumped
9. SCREEN: Depth Diameter Slot Size Material
From To Ft. In. In.
From To Ft. In, in.
From To Ft. in. In.
9. SANDIGRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
From To Ft.
10. DRILLING LOG
From Tp_/
C11��
/P l /d71U
Formation Description
Clay & sand
granite
IVED
c:A'frCflr tR.QUAL;iY
?7?OM
11. RlMARKS;.�,�,rn
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH
15A NCAC 2C, WELL CONSTRUCTION S i3ONOORDS, AND THAT A COPY OF THIS.
RECO'y' S BEEN PROVIDED TO THE WELL OWNER.
ATURE OF CERTIFIEDRACTOfi L DATE
,$mcs
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] ext568.
Form GW-la
Rev. 7/05
,7

RESIDENTIAL WELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources- Division of Water Quality
WELL CONTRACTOR CERTIFICATION # 2045
f. DISINFECTION: Type H T H Amount 16oz
1. WELL CONTRACTOR:
James B. Brown
Well Contractor (Individual) Name
Redden Brothers Well Drilling, Inc,
Well Contractor Company Name
STREET ADDRESS 73 Holly Hills Vista RD
Franklin,
NC
City or Town State
828 )_ 369-9591
28734
Zip Code
Area code- Phone number
2. WELL INFORMATION:
SITE WELL ID #(If applicable)
STATE WELL PERMIT#(it applicable)
DWQ or OTHER PERMIT #(if applicable)
WELL USE (Check Applicable Box): Residential Water Supply O
DATE DRILLED r 0,66
TIME COMPLETED AM ❑ PHA.
3. WELL LOON: /� \
CITYsl �!iX%l.Ff' �_ COUNTY )
(Street are. Numbers, Community, Subdk4sion. Lot No., Parcel, Zip Code)
TOPOGRAPHIC / LAND SETTING:
❑Slope ❑Valley ❑Flat ❑Ridge Other
(check appropriate box)
LATITUDE 3
LONGITUDE
Latitude/longitude source: ❑GPS ❑Topographic map
(location of well must be shown on a USGS topo map and
attached to this form if not using GPS)
4. WELL OWNER
OWNER'S NAME
STET ADDRESS
May be in degrees,
minutes, seconds or
in a decimal format
City a Town r Sta Zip Code
(g2 )-1i%7-/O)v
Area code - Phone number
5. WELL DETAILS: /,ADO
a. TOTAL DEPTH: (0
b. DOES WELL REPLACE EXISTING WELL? YES ❑ NO
c. WATER LEVEL Below Top of Casing:... rw FT
(Use'+" If Above Top of Casing)
d. TOP OF CASING IS 2 FT. Above Land Surface
*Top of casing terminated at/or below land surface may require
a variance in accordance with 15A NCAC 2C .0118.
e. YIELD (gpm): )01nMETHOD OF TEST Blow
g. WATER ZONES (depth):
From 3Q1 To 2)0 From To
From To From To
From To From To
6. CASING: Thickness/
Depth Ff S+•, Dlameeter %eigpSS { a ial
From b Tow /l ((0 PPCCY�
From To FI.
From To Ft.
7. GROUT:
From
From
From
8. SCREEN:
From
From
From
Depth Material
0 To 20 Ft. cement a benonite
To Ft.
To Ft.
Method
pumped
Depth Diameter Slot Size Material
To Ft. In. In.
To Ft. In. in.
To Ft. In. In,
9. SAND/GRAVEL PACK:
Depth
From To Ft.
From To Ft.
Size Material
From To Ft.
10. DRILLING LOG
From To Formation Description
0 L. Clay & sand
granite
RECEIVED Rr •OUN -
RH fi 7 LUUb
11. R MA KSi` )0A,
100 HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH
15A NCAC 2C,MILL CONSTRUCTION STANDARDS, AND THP'i A COPY OF THIS
RECOOB'FjAS BEEN PROVIDED TO THE WELL OWNER,
NATURE OF C TIFIED WELL CONTRACTOR DATE
,$mcm 3. "U2.owt.1
PRINTED NAME OF PERSON CONSTRUCTING THE WELL
Submit the original to the Division of Water Quality within 30 days. Attn: Information Mgt.,
1617 Mail Service Center— Raleigh, NC 27699-1617 Phone No. [phone] eat 568.
Form GW-la
.. Rey=7/05
LJ

RESIDENTIAL WELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources- Division of Water Quality
WELL CONTRACTOR CERTIFICATION # 2045
1. WELL CONTRACTOR:
James B. Brown
Well Contractor (Individual) Name
Hedden Brothers Well Drilling, Inc,
Well Contractor Company Name
STREET ADDRESS 73 Holly Hills Vista RD
Franklin,
NC 28734
City or Town State
828 )- 389-9591
Zip Code
Area code- Phone number
2. WELL INFORMATION:
SITE WELL ID Sint applicable)
STATE WELL PERMIT#(if applicable)
DWQ or OTHER PERMIT #(If applicable)
WELL USE (Check Applicable Box): Residential Water Supply O
DATE DRILLED /Oi "I"0
TIME COMPLETED 3 (](/ AM ❑ PM,k
3. WELL LO
CIT
ATION:
CS7UNTY,
(Street Name. Numbers, Community, SubdhNsion, Lot No., Parcel. Zip Code)
TOPOGRAPHIC / LAND SETTING:
❑Slope °Valley OFlat ❑Ridge ❑Other
(check appropriate box) -1
LATITUDE �..3,E� �7iy� n7g21N
LONGITUDE 6i 1)0
Latitude/longitude source: tMGPS ❑Topographic map
(location of well must be s own on a USGS topo map and
attached to this form it not using GPS)
May be in degrees,
minutes, seconds or
in a decimal format
4. WELL OWNER
OWNER'S NAME
STR6,ET ADORES
City or n
Qit
Area
co )- D
Area code - Phone number
(D3
dam
♦
1/3
Lip Code
5. WELL DETAILS: / f
a. TOTAL DEPTH: CC
b. DOES WELL REPLACE EXISTING WELL?S YES
0 NOk
c. WATER LEVELBelow Top of Casing:' e. Z ?. FT.
(Use "+" if Above Top of Casing)
d. TOP OF CASING IS 2 FT. Above Land Surface*
*Top of casing terminated al/or below land surface may require
a variance in accordance with 15A NCAC 2C .0118.
e. YIELD (gpm): 3 METHOD OF TEST BIOW
f. DISINFECTION: Type H T H Amount 16oz
g. WATER ZONES (depth):
From P7
�j (T To /`2a From To
From-Q, nv To ll�5{' From To
From To From To
6. CASING:
Depth
From To
From To
From To
0 Ft. D arr)eyler
Ft. (((ti
Ft.
Thickness/
Weight Mat
M
7. GROUT: Depth Material
From D To 20 Ft. cement 8,benanile
From To Ft.
From To Ft.
Method
pumped
8. SCREEN: Depth . Diameter Slot Size Material
From To Ft. In. In.
From To Ft. In. in.
From To Ft. In. In.
8. SAND/GRAVEL PACK: —n
Depth Size Material I-ry
From To Ft. tL0
From To Ft. ism
From To Ft. 1--'
n.r
r..
10. DRILLING LOG c-i
From To Formation Description
0 (/' Clay & sand
I
granite
C
ow or WAT6 _G1UAuiv
')CC 2 7 ZOOS
11, RACK S
iveze
I DD HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH
15A NCAC 2C, WELL CONSTRUCTION STANDARDS, AND THAT A COPY OP THIS
RECOBDf/4S BEEN PROVIDED TO THE WELL OWNER.
ATURE OF CEMTFIED WELL CONTRACTOR DATE
SAMCM b.
PRINTED NAME OF PERSON CONSTRUCTING THE WELL
Submit the original to the Division of Water Quality within 30 days, Attn: Information Mgt.,
1617 Mall Service Center —Raleigh, NC 27699-1617 Phone No. [phone] eat 568.
Form GW-la
Rev. 7/05
cez
Cl�
CfT

WELL USE (CheclW
DATE DRILLED
TIME COMPLETED
7.WTLLq,CgTInON:
RESIDENTIAL WELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources- Division of Water Quality
WELL CONTRACTOR CERTIFICATION # 2045
1. WELL CONTRACTOR:
James B. Brown
Well Contractor (Individual) Name
Hedden Brothers Well Drilling, Inc,
Well Contractor Company Name
STREET ADDRESS 73 Holly Hills Vista RD
Franklin, NC
28734
City or Town State Zip Code
( 828 )- 369-9591
Area code- Phone number
2. WELL INFORMATION:
SITE WELL ID #(If applicable)
STATE WELL PERMIT#(if applicable)
DWQ or OTHER PERMIT *Of applicable)
plicable Box): Residential Water Supply
IN 9/A0b6
f0; JD AM& PM
COUNT
(Street Name umbers, Community, Subdivision, Lot No., Parcel, Zip Code)
TOPOGRAPHIC / LAND SETTING:
❑Slope °Valley CI Flat ❑Ridge DOther
• (check appropdate box)
LATITUDE -�
LONGITUDE
Latitude/longitude source: ❑GPS Topographic map
(location of well must be shown on a USGS topo map and
attached to this form not using GPS)
May be in degrees,
minutes, seconds or
in a decimal format
4. WELL OWNER
OWNER'S NAME
TF EET ADDRESS
CIN of Tow(n�/�� �(�/�Stattee
Zip Code
Area code - Phone number
5. WELL DETAILS: .9cl�,.C�L�
a. TOTAL DEPTH: / T�
b. DOES WELL REPLACE EXISTING WELL? YES 0 N04
c: WATER LEVEL Below 'fop of Casing: �R) FT.
(Use "+" if Above Top of Casing)
d. TOP OF CASING IS 2 FT. Above Land Surface'
`Top of casing terminated at/or below land surface may require
a variance in accordance with 15A NCAC 2C .0118.
e. YIELD (gam): L14/T METHOD OF TEST Blow
f. DISINFECTION: Type H T H Amount 16oz
g. WAT R ZONES (d��ee11pAl�1h)�)�11 JJ�-
From I / To From To
From I To a From To
From qqn To (MD From To
6. CASING:
Depth / I DI meter
From b To I -I O Ft. (001
From To Ft.
From To Ft.
Thickness/
Welia Mpte34l
7. GROUT: Depth Material Method
From 0 To 20 Ft. cement & bononite pumped
From To Ft.
From To Ft.
8. SCREEN: Depth Diameter Slot Size Material
From To Ft. In. In.
From To Ft. In. In.
From To Ft. In. In,
8. SAND/GRAVEL PACK:
Depth
From To
Ft.
From To Ft.
Size
Material
From To Ft.
10. DRILLING LOG
From
0
11. Ne,RK_ „ i0
Formation Description
Clay & sand
granite
REfEIVFf
otkr WATFRfatIAI
3CC 2 7 2006
I D0 HEREBY CERTIFY THAT THIS W ELI. WAS CONSTRUCTED IN ACCORDANCE WITH
t'_A NOA 2C. WELL CONSTRUCTION ATANDARDS, AND THAT A COPY OF THIS
REC0RIAS BEEN PROVIDJD TO THE WELL OWNER.
GNATURE F ERTIFIED WELL CONTRACTOR DATE
.jwmc5 WO
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-ta
Rev. 7/05
etsI
eats
GNI
CC'
C^C

RESIDENTIAL WELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources- Division of Water Quality
WELL CONTRACTOR CERTIFICATION # 2045
1. WELL CONTRACTOR:
James B. Brown
Well Contractor (Individual) Name
Hedden Brothers Well Drilling, Inc,
Well Contractor Company Name
STREET ADDRESS 73 Holly Hills Vista RD
Franklin, NC
28734
City or Town State
828 )- 369-9591
Zip Code
Area code- Phone number
2. WELL INFORMATION:
SITE WELL ID #(if applicable)
STATE WELL PERMITS/(if applicable)
DWQ or OTHER PERMIT Of applicable)
WELL USE (Chet pplicable Box): Residential Water Supply tz
DATE DRILLED iJtci a,yA70d(0
TIME COMPLETED /pt " aD AM 0 PMA
3. WELL LO TION:
CITY: dL1Y1— COUNTY
treet NameNumbers, Community, 6ubdiNslon, Lot No., Parcel, Zip Code)
TOPOGRAPHIC / LAND SETTING:
❑Slope ❑Valley ❑Flat ORidge ❑Other
(check appropriate box)
LATITUDE 35aZZ a 2
LONGITUDE E A 053
Latitude/longitude source: xGPS ❑Topographic map
(location of well must be shown on a USGS topo map and
attached to this fo- A not using GPS)
4. WELL OWNER
OWNER'S NAME _ f
ST1aEFaK ADDRESS '. •
flat@, MC
City.gr )- 9 7 4gate / Zip Code
Area code•
11Phhoone number ((//!!�J__33
May be in degrees,
minutes, seconds or
in a decimal format
5. WELL DETAILS: Cf' `
a. TOTAL DEPTH:
b. DOES WELL REPLACE EXISTING WELL? YES 0 N0IK
c. ,DATER LEVEL Below Top of Casing: Soa FT.
(Use "+" If Above Top of Casing)
d. TOP OF CASING is 2 FT. Above Land Surface'
'Top of casing terminated at/or below land surface may require
a variance in accorda ce with 15A NCAC 2C .0118,
e. YIELD (gpm): METHOD OF TEST Blow
f, DISINFECTION: Type H T H Amount 16oz
g. WATER ZONES (depth):
From ' 7D To / 71) From To
From To From To
From To From To
6. CASING: Thickness/
/1 Depth Di m�ter Weight
From To I'F_ Ft. a
From-�L-11F.-r7-To IJr�Ft. 0 fat (UPS
From To Ft.
Material
7. GROUT: Depth Material Method
From D To 20 Ft. cement S.benonits pumped
From To Ft.
From To Ft.
8. SCREEN: Depth Diameter Slot Size Material
From To Ft. In. in.
From To Ft. in. in.
From To Ft. In. In,
9. SAND/GRAVEL PACK:
Depth Size Material
From To Ft. -T-i
From To Ft. rn
w
From To Ft.
10. DRILLING LOG
From T` Clay Formation Description c�
0`¢ &sand
granite
RECEIVED
EN C1F1AMETF17ofIAIITV
11. REMARKS:
edge/ kine
Ir.k B f CUuu
I D0 HEREPY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE, WITH
ISA NCAS LC. WELL CONSTRUCTION STANDARDS. AND THAT A COPY OF THIS
RECOjiq HAS BEEN PROVIDED THE WELL OWNER.
/4r7
NATURE OF I;€RTIFIED WELL CONTRACTOR DATE
`ArnCS �1 . �t2ownl
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
a WELL CONTRACTOR CERTIFICATION # 0 J/6
1. WELL CONN`TFR`AC,T1TO/Ry:
W Contractor (tom) Name
u-raft&-st Well ('irvlla`nfy
Well Contractor Company Name
STREET ADDRESS (n3 LI ft yAP "Vun R t
ReiD6 jets v; Me Nc 2_7771
City or Tarn State Zip Code
( i179- ? He?
Area code- Phan number
2. WELL INFORMATION:
SITE WELL ID t(dapprrable)
STATE WELL PERMR!(aappioNe)
DWQ or OTHER PERMIT 1(e applicable)
WELL USE (CheckAppFrable Bar)_ Residential Water Supply M
DATE DRILLED /a - 7 - 06
TIME COMPLETED ; /3 el AM o PM %
3. WELL LOCATIOtt
CITY: 1'3 ry,So n G t ITr.COUNTY S bin t f
4'0 a n ii, R r. B Art � v71 I
(Sheet Name.. Numbers. Parcel. Zip Cade).
TOPOGRAPHIC / LAND SETTING:
❑Slope ova•ey QFlat ■Ridge oolha
(dw appropriate bad
LATITUDE 3 r1a ,o $35:
LONGrruDE 1L 3 ° f 9' 119. 3 / /
Latitude/longitude sauce: • GPS °Topographic map
(location aweltmtsf be shown on a USGS topo mop and
attached to this *innrnal daft GPS)
d. WELL OWIER
OWNERS NAME OFon/s Lc) n// A C1
STREET ADDRESS -F nenY nor 7c. / N Pro p
f\ryys#'gn r / Ty /TIC VVV,D.-7 /3
Citylir Town Slate Zip Code
efraArea wde- Phone3��69�
May be m degrees,
minutes, seconds or
Ma decimal in a
s. wai. DETAILS: a. TOTAL DEPTH: Q 3en
b. DOES WELL REPLACE EXISTING WELL? YES ° NO •
e. WATER LEVEL Reba Top at Casty / Ff.
(Use •+• if Abase Top of Casing)
d. TOP OF CASING IS 1 FT. Above Land Surface*
'Top of casing terminated at/or beast lad surface may require
a variance tr accordance yak 15A NCAC 2C .0118.
e. YIELD Wpm). 3O METHOD OF TEST �}..i r
f. DISINFECTION: Type # 7/ / Amount 44 n7
g. WATER ZONES (depth):
Fran To From To
From To From To
From To From To
6. CASING: Thicgwss/
Depth Diameter Weight
Ram n To,rj3 Ft C, 41 Zhr2( Prat
From To Ft.
Fran To Ft.
7. GROUT: Depth Material Method
From A Toa.O Ftc0rn6nl . 9
From To Ft.
From To FL
8. SCREEN: Depth DAanser Slat Size Material
Fran To Ft. in. in.
Fran To Ft in. _ in.
From To Ft. in. in.
9. SAND/GRAVEL PACK
Depth Sae Material ---
Fran To Ft. r-1
From To Ft
�...
Fran To Ft. ^^
10. DRILLING LOG
c.,
From To Formation Description —.r
11. REMARKS:
Rick—
D!V.OFWATEr, QUALITv
JAN (1 b ZUU7
/00 HEREBY t231WY1HAT11113 WELL WAS CONSTRU 1® NACCMmAnCE Wmr
15A NCAC 2C. WELL CaCTRUCI N STAtmABVS. AID TNT A COPY OF WM
RECORD HAS BEEN PRO /MD TO INE WELL OW NEW
SIGNATURE Eli CONTRACTOR DATE
.376
J o4 Dli �o PRVRED NAME OF NSTRUCTNG 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 8 ? Q 55
1. WELL CONTRACTOR:
c j� del) e
Wel Contactor <'"dName
y«3CG41"if
h-J L6')/
Conhactor Company Name
STREET ADDRESS OJ9 /y /ll^li)/ fr^ Robio n6Vi`/1# A/c 9?77/
City or Town Stale ZIP Code
itS/)- 479- @LISq
Area code- Phone number
2. WELL INFORMATION:
SITE WELL ID 401 appfzable)
STATE WELL PERMITS(' datable)
DWQ or OTHER PERMIT 1(d applicable)
WELL USE (Check Applicable gal): Residential Water Suppi W
DATE DRILLED / �-al- (-Lc,
COMPLETED '7 3 0 AM ❑ PM
NI
3. WELL LOCATIOtt
CITY: /3 i- y& n7� ��C'''7)7 COUNTY .5 Wsin s'7n
�o n Nit nt .s. saaYion. Callo.. Parcel. Cam).
(Street Name. -
TOPOGRAPHIC I LAND SETTING:
°Slope Maley °Flat atRidge °Other
(creak appropiale
hood
LATITUDE £o vw /33r 9)r
LONGrnroE2_r '35.`t/I
Latitude/longitude same: aGPS DTopographic map
(location dxel must be shown on a USGS tope map and
attached to this farm Ind ushg GPS)
4. WELL OWNER
OWNER'S NAME
STREET ADDRESS
May be in degrees.
mutes. seconds at
m adekmal Exam
City Town 'site
(4C2Sl- T\C-0S7S
Area code - Phone number
5. WILL DETAILS: 9.�,5 a. TOTAL DEFTit
b. DOES WELL REPLACE EXISTING WELL? YES ❑ NO
c. WATER LEVEL Below Top d Casing: t! OO FT.
(Use'+' if Above Top d Casing)
d. TOP OF CASING 19 / FT. Above Land Surface'
'Tap of casing temimaled aver be land surface may require
a variance in accordance vldh ISA NCAC 2C .0118.
e. YIELD (gpm): 7 METHOD OF TEST CA. I)^
L DISINFECTION: Type / ' TA Amount /2 , a z.
g. WATER ZONES (depth):
From di el To ya`i
Fran To
From To
6. CASING:
From To
From To
From To
Thickness/
Diarnetrt Weird
Fran,�_Dro�,`-�'a FL 6.4i Sor91 VC
From To Ft.
From To Ft
7. GROUT: Depth Material �1 Method
From f) To .0/7 Ft Cein.nT
From To Ft
From To FL
8. SCREEN:
Fran
Fran
From
Depth Diameter Slot Size Material
To Ft. In. in.
To Ft bL - in.
To Ft. in. in.
9. SAND/GRAVEL PACK:
Depth
From
From
To FL
To Ft.
From To FL
Size Material
10. DRILLING LOG
From To
11. REMARKS:
Fomration Description
RCCEIVED
LAV. OF WATCR QUALITY
JAN
WO ICY CEFCTFY TNT DRS WELL WAS CQcimciw NAx:CORnna WON
15A RCAC2C. INELLCONSERUCTION STANDARDS. AND DRS A COPY OF MIS
RECORD HAS BEEN
PROVIDED
TOO THE WELL OWNER
S EoRE OF CERTWIED WELL CONTRACTOR 1a DAT,E-0i+
PRINTED NAME 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.
Font GW-la
Rev. 7/05

RESIDENTIAL WELL CONSTRUCTION RECORD
Noah Carolina Department of Environment and Natural Resources- Division of Water Quality
WELL CONTRACTORal CERTIFICATION # 06-6
1. WELL CONTRACTOR:
e�A de
WA Cuuragar (Indlvid Name
[rro.ko'Yn (jJ&// Anti
Well Contractor Company Name 1
S EETADDRESS ���'7 lT)� yelp Twn Re
NOinbigrisVrnl/N 'VC f2Sr771
City orToem Star Lip Code
itam1174-FiIACH
Area code- Plane number
2. WELL INFORMATIOIk
SITE WELL ID Aft applraile)
STATE WELL PERMITS(' ennoble)
DWQ or OTHER PERMIT gig applicable)
WELL USE (Check ApepT&able Back Residences! Water Supply O
DATE DRILLED la—/Fr'6�
TIME COMPLETED / Ail AM El PM
3. WELL LOCATIOtk
Y: J3ryrtv1» Ct.TyCOUNTY A
a n Tr Yt f P /"re
(Street Name. Numbers. •. -•'. .Lot
TOPOGRAPHIC f LAND SETTING:
❑Stye °Valley °Flat $Ridge °other
(trick appropriate boa)
LATITUDE 3"
LONGITUDE2_ -3°
LNJC� i n
Rama
e2�73
Pael. Zq )-
May be in degrees,
minutes, seconds°,
ma dead gnaw
Latitude/longitude source: it GPS ()Topographic map
(location of seanwst be shown on a USGS two mop and
attached bet lomalnot using GPS)
4. WELL OWNER
OWNER'S NAME J
STREET ADDRESS n r L) e%
, V
ity Town saute Zip
+ la »i'/A
N ter
r'/ Ty 1VC `1
(9%l).__he d!p-�)Q
Area code- Pna
5. WELL DETAILS:
a. TOTAL DEPTtk !t ri s
b. DOES WELL REPLACE EXISTING WELL? YES 0 NO M
c. WATER LEVEL Bars Top el Cuing 0 FT.
(Use'F• if Mae Top at Casing)
d. TOP OF CASING $ / Fr. Above Lard Surface'
'Tap of casing tanilafed aver below Tad saface may require
a variance in acardancewlh 15A NCAC 2C .0118.
e. YIELD (gpm): O METHOD OF TEST C.i
f. DISINFECTION: Type !?
g. WATER ZONES (depth);
From n Tom_
Fran To
From To
6. CASING:
Amount t5
Ram To
From To
Fran To
Fran�_.To�„MO FtW
Fran To Ft.
From To Ft.
7. GROUT: Depth
Material
Fr«n�_To n FL C-em@Y)T
From To FL
From To FL
Thdaiessf
Sort Weight Material Lit
Method
8. SCREEtt Depth Diameter Slot Size Material
Fran To FL in. in
Fran To Ft in. - iL
From To Ft. in. in.
9. SAtmtGRAva PACK:
Depth Size Material
From To Ft.
From To FL
From To FL
'T9-
10. DRILLING LOG
From To Fomsaton Desorption
RECEIVLO
ubt OF WATER QUALITY
JAN 0 k • 7(10
Il.
REirls• Ter Ze J/7d ro rq`.mnerl
1 DO NAY CERIFYThAT T HS WELL WAS CO161a1C1m w ACCCrtona WITH
MA MAC 2C. WELL CONSTRUCTION STANDARDS. AND THAT A COPT OF MS
RECORD HAS BEEN PROVIDED TO ME WELL OWNER.
3P #yele >2�
SIGNATURE OF CERTIFIED WELL CONTRACTOR DATE
PRIRED NAME OF AlPERSON 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. 7f05

RESIDENTIAL WELL CONSTRUCTION RECORD
Noah Carolina Department of Environment and Natural Resources- Division of Water Quality
WELL CONTRACTOR CERTIFICATION # a2O5O
1. WELL CONTRACCTTOR j�CJI�
WdContracta (hflvidua) Nane erred-10Lp/ hell et io i I/ii9
Wel Contractor Company Name
STREET ADDRESS 14;3 9 ,si,, A P 72-41r/ R�
Rni4iinSV/lP Ne `l-77/
City or Town State Zip Code
Areacode-
)-Wit
inm baFr ys" Li
2. WELL INFORMATION:
SITE WELL ID MI applicable)
STATE WELL FERMIUM applicable)
DWQ or OTHER PERMIT f(d applicable)
WELL USE (Check Amicable Barg Residential Wafer Supply a)
DATE Daum /a- 7-06
TIME COMPLETED O a 3o MAO PMl&
3. WELL LO{CATICIt
CITY:/3rv.Snn� ei O
11! COUNTYS % 'Y)
7
((StreetNa Name. Nznbas. Lmma�_1+.a W. Parted. Zip C3)
TOPOGRAPHIC / LAND SETTING:
OSlope OVaet ()Flat ',Ridge pother
(check appropriate burg
LATITUDE 3 d_d 3.71S7,9 /!
LoNGITwEt 30 a)'/O.7"
Latitude/Iongitde source: nGPS °Topographic map
(location of wet mad be strewn on a USGS tope map and
attached to this knnInat using GPS)
4. WELLOWNER -'T , J
OWNER'S NAME TA Me
May be in dogma,
mimic; moods.:madecimaI front
STREET ADDRESS el n'Ta rO
f rvsrl f otry We
Ciy+a Tonal State
yv(a.n
/a kro Prep
ft7/3
rN Cob
( 7/4 )- `.L/n - /iQ-9,0
Area code - Phone comber
5. WELL DETMLS:
a. TOTALDEPTtt /60 s I
6. DOES WELL REPLACE EXISTING WELL? YES ° NO la
c. WATER LEVEL Below Top oCasing n FT.
(Use'+• if Abate Tap d Casing)
d. TOP OF CASING W 1 - FT. Above Land Surface'
Tap d casing rem need agar be lad surface may regale
a valiance in aecadawewWh 15A NCAC 2C .0118.
e. YIELDIgpm) 0 MEMO OFTEST at'r
6. CASING:
CAS
Cra
L DISINFECTION: Type 0 Amount A
g. WATER ZONES (depth):
Fmm_CI___To C) From To
From To Fran To
Fran To From To
ThcWmss/
Diareter
Fran_O_TToo Sy Ft (e Weight
From To Ft
From To • Ft.
7. GROUT: Depth '
rig
From n To ;)d Ft ('.PrrIPn7
Fran To Ft
From To Ft
& SCREEN: Depth Diameter Slut Size Material
From To Ft. M. in.
Fran To Ft. in. _ in.
From To Ft in. _ in.
9- SAIfGRAVEL PACK:
Depth Size Manna
From To FL
From To Ft.
Fran To FL
10. DRILIJNG LOG
From To
Formalbn Description
RECE1VtU
lF WATER fjt)AL1T t
JAW 0 6 Mt
r
11. REMARKS:
l t/r0 1 / -r Lei /7lydh5-fr. •nr-1
MO IEWBY(9fTFVT1a1TT16 WE. WAS CX061RUCTED IN ACCORDANCE wrm
15A NCAC 2C. WELL CON511W1Qa STANDARDS. AND IHATA COPY °FINS
RECORD HAS BEEN PROVVEDTOTIE WELL OWNER
9c /2-7-44
SIGNATURE OF CE�nFl WELL CONTRACTOR DATE
il
PRIITEDNAIAEOF
CONSTRUCTING
TILE 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 # O((JS0
1. WELL CONTRACTOR:
cr yelea
Well Contractor (bOviduQ Name
-a firkin W 991 ci r, r/l. ncy
Cad actor Company Name y
STREET ADDRESS a k� Si /7ytta /abin Rei
Ro ijoins ll/C ? 77/
City or Torn Stab Zip Cab
(di2t» 479-911/5'11
Area at Phone number
2. WELL INFORMATION:
SITE WELL ID 4(d applI le)
STATE WELL PERMIT:Repeaoae)
DWQ or OTHER PERMIT 1(y applicable)
WELL USE (Check Applicable Bork Residential Water Supply pl
DATEDRIaED 4-o6
3
TIME COMPLETED , 3a Ma ° PM M
3. WELL LOCATIOIt
CITY:
1.nrl
AN
(Sheet None, Numbers.
``'' COu�%NTY n6 Won
unto, Parcel. Zp Code) -
TOPOGRAPHIC / LAND SEFnNG:
❑Slope °Vaaay OF4t S)lbdge °Other
(check appropriate bad
LATITUDE _ of 3 /!
LONGITurea 34 31'I/.O'1
Latitude/longitude sauce: gGPS °Topographic map
(baalion of wellmust be shown en a USGS tope crop and.
ached bo NNa lam Mot using GPS)
4. WEU_OWIER -^/� 10 1 n
ET
OWNER'S NAMEiIV&ma
STREET ADDRESS" fa t?ianCs /Akco Prop
�rysnn CI' Ty )vC 7/3
Citjor Town State rep Code
(7 G4 )- 9 /O -'/ »-2ri
Area code - Phone number
May beta degas,
minutq seconds or
in adecimal format
5. WELL DETAILS:
a. TOTAL DEPTit Inc /
b. DOES WELL REPLACE EXISTING WELL? YES ° NOS)
c. WATER LEVEL. Bel wTop et Cacbrg 0 FT.
(User if Above Top of Casing)
d. TOP OF CASING IS J FT. Above Land Surface*
'Top of casing terminated agar belays land safaoe may require
a variance in accordance valh 15A NCAC 2C .0118.
e. YIELD(gpm)_ n METHOD OF TEST 0.4
M
f. DlSINFECTIOIt Type 0 Amount G
g. WATER ZONES (deparx
Fran n To C)
From To
From To From To
From To Frorn To
6. CASING: Thickness/
From Cl Two Sr] FL 6, apt per ( NYf.
From To Ft
From To FL
7. GROUT: Depth
Material
From 0 ToQn Ftretro rl7'
From To Ft
From To Ft
Method
pub
& SrRFFN: Depth Diameter Slat Size Material
Fun To Ft 'IL ten.
From To Ft Si. _ in.
From To Ft in. in:
A sANDTGRAVEL PACK:
Depth Sob Material
From To FL
From To FL
From To Ft.
10. DRILLING LOG
Fran To
i•
Formation Description
REGtIVED
CIIN i )F WATEK 0041.3fv
lAU f4 5 7f1f1i
n D �
r.�i'� � y cIctrc.<rBa
turn HEREBY CE 1FYTHATIIIS WELL WAS Ca6Iw1C1® IACCORDANCE VYIIH
15A NCAC 2C. WELL CaaIRUCIION STANDARDS. APO IHATA COPY OF 1I S
RECORD HAS BEEN PROVIDED101HE WELL OWNER
4smile 4'906
S Tl1RE OF C ��ED WELL CONTRACTOR DATE
0;01-
PRINTED A PERSONC 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 # -5 3 'b
NTRACTOR:
/
! h.(1k6f.y,<
waN�mn+daC tcNlan1 Qri1I,h5
we.DDens (-Jai
crampe,y Name
STREET ADDRESS 43q Hycie ocd
en\nb'9‘Sr7 71
Gay or Town State Zip Code
( YrAVI-4175-e5'6zi
Area cods flaw mare
2. WELL ,FORMATION:
SITE WELL ID *it-n crele)
STATE WELL PERMITS(:,. •J.)
DWQ or OTHER PERMIT fl applicable)
WEN. USE (Check Appiabla Boa* Reddened Water Supply("
DATE DRILLED l �.—ar-06 -``
TAME COMPLETED 'ant AM ❑ PM/"`
3. WELL LOCATIONt
CITY: 6568r\ G i-y COUNTY c5(40‘;w
CD • r mine.. Rdt
MSheet Name. Cameaon&SatIm,.tatNE., Parc6( ZIP Code).
TOPOGRAPHIC I LAND SETTING:
OSlkpe OVali OFiat OI'Fdge Daher
(dad[ eppmpdrhnbad
LATITUDE 3 $' b a71i e(• b r
LONGIRDE135 90t ,A7-9 ji
Latitude/longitude source: *PS OTOpogtaphic map
(kct, d %ef mrmlbe shoran on a USGS two map and
attached to this Iona Inof using GPS)
4. WELL OWNER
OWNER'S NAME -4- N '} o r i'i-y ryte5
brwtt ADDRESS Crrr in-, nei CAA 0
Ar e Cl+� 77 N'C a s 7I>>>»3
Cify a Tonn Sate Zip Code
May be in degas,
mimes, secs dsor
is adRol foram
( 70ti)- (5'71 i631
Area code - Phone number
5. WELL. DETAILS:
a. TOTAL OEFnt
b. DOES WELL REPLACE EXISTING WELL? YES ❑ NOg
c. WATER LEVEL Below Top dCasieg i') FT.
(Use-+• iAbove Top d Casing)
d. TOP OF CASING IS 1 -
FT. Above Lad Surfaces
'Top d craft lemi ated a*or bebnlad =face may require
a variance in accordance rah 15A NCAC 2C .0118.
e. YIELD(gpm) fl MEMO OF TEST O)1 r_
Ca
ZAS
c�a
lerai
f. DISINFECTIO t Type 1-1 t 1-) Amount C7
g. WATERZONES (deal*
From D To 0 From To
Fran To Fran To
Fran To Fran To
6. CASING:
TItk nsaf
Depth Diameter Weight Material
Ft 6 'Yri S114rZI Pvt.
From To Ft
Fran To Ft.
7. GROUT: Depth Maeda Method
From 0 To a30 Ft re,rv-,a-d-- n , )-nti rt�
Fan To Ft 1
From To FL
8. SCREEN: Depth Diameter Slot Sim Materiel
From To Ft in. in. _
Fran To Ft it _ in.
From To FL it in.
A SAND/GRAVEL PACK:
Depth Size Magid
Fan To FL
From To Ft.
From To Ft
T9
1A DRILLING LOG
From To Fomlatbn Desapliosi
RECEIVED
IAN00
11. REMARKS:
40 ICE- 1-Tyr i© A
100HEREBY CFxIFYTINTLB WELL VWt4Cm stiruc W moccor ONICE Vam
1Sk WPC 2C. WHL Cam1n1Ca0N STANDARDS. lapTINTACOPY CEDE
RECORD HAS BEM PROVDEDTOTH= WELL OWNER.
SIGNATURE OF CERTIFIED WELL CONTRACTOR DATE
PRWTW NAME OF PERSON CONSTRl1CiIiG THE WELL
Submit the original to the Division of Water Quality within 30 days. Attu: Information Mgt,
1617 Mali Service Center— Raleigh, NC 27699-1617 Phone No. [phone] ext 568.
Form GW-la
Rev. 7105

RESIDENTIAL WELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources- Division of Water Quality
WELL CONTRACTOR CERTIFICATION f
ONTRACTOR:
Wel Calla:tor (Individual) Name 9
�Cc L'
d Contractor Canpaay Name
STREET ADDRESS 6 c ]LI �1 �,!.(P /Olar' ICQr-¢'i
��j a_^raw � ilI, Alt_�Cown Statew7a7/
( )-Y— frgSY
Area code. Phase number
2. WELL INFORMATIOIt
SITE WELL ID liftappaeaNe)
STATE WELL PERMRfRappicamel
DWG or OTHER PERMIT f(d applicable)
WELL USE (Check Applicable Oa): Reciderial Water snvpNfr
DATE DRILLED I — L4 — 0 6
TIME COMPLETED Q AIM❑ PMJ
1. WELL LOCATIOtt
CITY: try rsav\ C 1.It COUNTY C 1 Gi ✓�
643.1 r (Z ,ci
(Street Name. Numbers. CanmunisSuhdnision. tattto.. Parcel. Z.q-Came)- _
TOPOGRAPHIC / LAND SETTING:
❑Slope °Val ry AIrlat ORidge OOtha
(check appmpdab box re
LATITUDE ..3
LC' 27/Me/
LONcnuDe 3 ° 9,4 ` H S
Latitude/bngitude source: 4GPS °Topographic map
oration dnet must be shown on a USGS Mepo map and
attached the lam Ind usig GPS)
A WELL OWNER �%
OWNER'S NAME t )reir['. r7A
£C), ey
STREET ADDRESS )airk areA(l
glYCaai'I l
TState ZfpC e( ,5( )- 73(.- T3 -a7
Area code- Phase number
May be in degrees
minutes seoadsor
ina decimal heat
S. WELL DETAILS: �� /
a. TOTAL DEPTH:
b. DOES WELL REPIACE DUSTING WELL? YES ° NO IS
e. WATER LEVEL Below Top at Casing 40 FT.
(use-+' IAbs a Top d Casing)
d. TOP OF CASING IS / FT. Abort Surface e Laid Surfa
_ 'Tap at casing n. iwTbelow.
*or blad surface now tome
e variance in accordance wdh 15A NCAC 2C .0118.
a. YIELD (goo* PC.) METHOD OF TEST CCt_I r
f. DISINFECTION: Type fin Amount / e 7
g. WATER ZONES (depth):
Front tin To 310
From To
Fran To From To
Fran To Fran To
6. CASING: Tay
Depth
, Diameter Weight Material
FFromfl 79 Ft 612aal PvC
From To Ft
Fran To Ft
7. GROUT: Depth Marcia Method
Fran d To_9_ Ft rOrn9 rd" CAV
From V
n To FL E9
From To Ft
& grin -Ft Depth Diameter Slat She Material
Fran To FL In. it.
From To FL h1 - in.
From To Ft. In in.
9. SAIO GRAVEL PACK:
Depth
From
From
F�_
Ste
To Ft.
To FL
To Ft
Material
10. DRILLING LOG
From To Formation Description
11. REMARKS:
RECEIVED —
I DO!HEREBYCERTIFYTNTTC1 WE LWAS W EDNACORD/ WM1
NCAC DC. WELL CONSIRUCION STANDARDS PNWRIATA COPY OF la15
RECORD
HAS SEEN PROVOEDWORE WW1 OWNER
SIGNATIr OF CERTIFIED WELL C TOR DATE
c!�t�id-,Y, I ItC�
PRINTED NAME OF PERSON WELL
tab
c;Ya
eldb
•
Submft 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 # 2597
338024
1. WELL CONTRACTOR:
GLENN MARTIN MATHIS JR.
Well Contractor (Individual) Name
AAA GREENE BROS. WELL DRLG. OF SYLVA, INC
Well Contractor Company Name
STREET ADDRESS 1800 SKYLAND DRIVE
SYLVA NC
City or Town State
( 828 )_ 586-5550
Area cafe- Phone number
2. WELL INFORMATION:
SITE WELL ID #(if applicable)
STATE WELL PERMIT#(if applicable)
28779
Zip Code
DWQ or OTHER PERMIT #(if applicable)
WELL USE (Check Applicable Box): Residential Water Supply Ea
DATE DRILLED 6/8/06
TIME COMPLETED 5:00 AM ❑ PM l
3. WELL LOCATION:
CITY: BRYSON CITY COUNTY SWAIN
BUCKNER BRANCH OFF HWY 19
(Street Name, Numbers, Community, Subdivision, Lot No., Parcel, Zip Code)
TOPOGRAPHIC / LAND SETTING:
❑Slope ❑Valley ❑Flat BRidge ❑Other
(check appropriate box)
LATITUDE 3
LONGITUDE
May be in degrees,
minutes, seconds or
in a decimal format
Latitude/longitude source: ❑GPS ❑Topographic map
(location of well must be shown on a USGS topo map and
attached to this form if not using GPS)
4. WELL OWNER
OWNER'S NAME WILLIAM HYDE
STREET ADDRESS 2825 NEUSHORE DRIVE
WINSTON SALEM NC 27127
City or Town State Zip Code
( 336 )_ 749-3825
Area code - Phone number
5. WELL DETAILS:
a. TOTAL DEPTH: 500' DRILLED 225' DEEPER
b. DOES WELL REPLACE EXISTING WELL? YES ❑ NO
c. WATER LEVEL Below Top of Casing: 200 FT.
(Use "+" if Above Top of Casing)
d. TOP OF CASING IS 1 FT. Above Land Surface*
'Top of casing terminated at/or below land surface may require
a variance in accordance with 15A NCAC 2C .0118.
e. YIELD (gpm): 3 METHOD OF TEST AIR
f. DISINFECTION: Type HTH
Amount 22.5 OUNCES
g. WATER ZONES (depth):
From 305 To 308 From To
From To From To
From To From To
6. CASING:
Depth Diameter
From ? To Ft.
From To Ft.
From To Ft.
Thickness/
Weight Material
7. GROUT: Depth Material
From To Ft.
From To Ft.
From To Ft.
8. SCREEN: Depth
From To
From To
From To
9. SAND/GRAVEL PACK:
Depth
From
From
From
Method
Diameter Slot Size Material
Ft. in. in.
Ft. in. in.
Ft. in. in.
Size Material
To Ft.
To Ft.
To Ft.
10. DRILLING LOG
From To
275-305 GRANITE
Formation Description
305-308 CAVITY
308-500 GRANITE
itealVED
t.Ilgl, OF WATcR OILIAUT'1
240
11. REMARKS:
DRILLED DEEPER 275' ORGINIALLY + 225' ADDITIONAL= TOTAL 500' DEEP
NO OTHER INFORMATION
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH
15A NCAC 2C, WELL CONSTRUCTION STANDARDS. AND THATA COPY OF THIS
RECORDHASBEEN PROVIDED TO THE WELL W NER.
AetlX • f l04 N s D g a 7
SIGNATURE OF CERTIFIED WELL CONTRACTOR DATE
G4ektll rn � IN \c 4k5- T1�
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

4. WELL OWNER ir
OWNER'S NAMik. Cyitl
S REET ADDRESS
RESIDENTIAL WELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources -Division of Water Quality
WELL CONTRACTOR CERTIFICATION # G/
Well Contractor (Individual) Name y r
AAA GREENE BROS. WELL DRLG. OF SYLVA, INC.
Well Contractor Company Name
STREET ADDRESS' 1800 SKYLAND DRIVE
SYLVA NC
City or Town 28779
State Zip Code
82( 8 )_ 586-5550
Area cede- Phone number
2. WELL INFORMATION:
SITE WELL ID #(if appliwde)��
STATE WELL PERMIT#(IN applicable)
DWQ or OTHER PERMIT #(if applicable)
WELL USE (Check Applicable Box): Res tied Water Supply
El
DATE DRILLED (" EY" Q
TIME COMPLETED
—�� AM ❑ PM*.
WELL L TION:
OUNTY.�
(Street Name, Numbers, Con, y icy, Su diNsi
TOPOGRAPHIC / LAND SETTING:
❑Elope ❑Valley at ❑Ridge 0 Other
(check a replete boat
LATITUDE
LONGITUDE — — •.W,u�, aconI
in a decimal foi
Latitude/longitude source:
❑GPS Topographic dp
(attache of thimust be shown on a USGS topo map and
attached to this l�r i/not using GPS)
City . Town
ate Zip Code
Area code - Phone
5. WELL DETAILS:ter,
a. TOTAL DEPTH:
b. DOES WELL REPLACE EXISTING WELL? YES ❑ NO'
c. WATER LEVEL Below Top of Casing: /60 _FT. (Use '+• if Above T of Casing)
d. Top OF CASING IS �FT. Above Land Surface'
`Top of casing terminated at/or below land surface may require
a variance in accordance with 15A NCAC 2C .0118.
e. YIELD (gpm): L-.. METHOD OF TEST / //'
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.
f. DISINFECTION: Type Will
g. WWWATER ZONES (d thZ=
To�S
From To
u
Diameter Slot Size
Ft in. in.
Ft.in. in.
in. in.
040
u. REMARKS: RECEIVED
co OF vitATER MAW)!
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WRH
15A NCAC 2C, WELL CONSTRUCTION STANDARDS, AND THATA COPY OF THIS
RECORD HAS BEEN PROVIDED TO THE WELL OWNER.
SIGNATURE OF CERTIFIED W L CONTRACTOR
PRINTED NAME OF PERSON CONSTRU ING THE WELL
Form GW-la
Rev. 7/05

RESIDENTIAL WELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources -Division of Water Quality
WELL CONTRACTOR CERTIFICATION # 3041
3
1. WELL CONTRACTOR:
PAUL BRYANT BRUCE
Well Contractor (Individual) Name
AAA GREENE BROS. WELL DRLG. OF SYLVA, INC
Well Contractor Company Name
STREET ADDRESS 1800 SKYLAND DRIVE
SYLVA
City or Town
( 828 )- 586-5550
Area code- Phone number
2. WELL INFORMATION:
SITE WELL ID #(if applicable)
NC
State
28779
Zip Code
STATE WELL PERMIT#(if applicable)
DWQ or OTHER PERMIT #(if applicable)
WELL USE (Check Applicable Box): Residential Water Supply
DATE DRILLED 12/13/06
TIME COMPLETED 5:00 AM ❑ PM
3. WELL LOCATION:
CITY: BRYSON CITY COUNTY SWAIN
BUCKNER BRANCH TO BLACK FOREST
(Street Name, Numbers, Community, Subdivision, Lot No., Parcel, Zip Code)
TOPOGRAPHIC / LAND SETTING:
❑Slope DValley DFIat lD Ridge ❑Other
(check appropriate box)
LATITUDE 3
LONGITUDE
May be in degrees,
minutes, seconds or
in a decimal format
Latitude/longitudesource: ❑GPS ❑Topographic map
(location of well must be shown on a USGS topo map and
attached to this fomr if not using GPS)
4. WELL OWNER
OWNER'S NAME REGAN HALL
STREET ADDRESS 14679 SOUTHCOUNTRYWOOD DRIVE
GULFPORT, MISSISSIPPI 39503
City or Town State Zip Code
( 228 )- 669-0063
Area code - Phone number
5. WELL DETAILS:
a. TOTAL DEPTH: 550
b. DOES WELL REPLACE EXISTING WELL? YES ❑ NO in
c. WATER LEVEL Below Top of Casing: SD FT.
(Use "+" if Above Top of Casing)
d. TOP OF CASING IS 1 FT. Above Land Surface*
*Top of casing terminated at/or below land surface may require
a variance in accordance with 15A NCAC 2C .0118.
e. YIELD (gpm): 4.5 METHOD OF TEST AIR
f. DISINFECTION: Type HTH Amount 24.T5OUNCES
g. WATER ZONES (depth):
From 160 To 163 From 260
To 263
From To From To
From To From To
6. CASING:
Thickness/
From 0DepTot8515" Ft bpl ,gter S�i�hZ1 �4'al
From To Ft.
From To Ft.
7. GROUT: Depth Material
From 0 To 3 Ft. CEMENT
From 3 To 20 Ft. BENTONITE
From To Ft.
8. SCREEN: Depth Diameter. Slot Size
From To Ft. in. in.
From To Ft. in. in.
From To Ft. in. in.
9. SAND/GRAVEL PACK:
Depth Size
From To Ft.
From To Ft.
From To Ft.
Method
TOP
PUMP %VIM TRIM PIPE
Material
Material
10. DRILLING LOG
From To Formation Description
0-80'5" CLAY
80'5"-160 GRANITE
160-163 CAVITY
163-260 GRANITE
260-263 CAVITY
263-550 GRANITE
11. REMARKS:
I EED
V r3F Wf FR 01IAI (TY
'F E13 A 2 200?
Gam,+ C
PRINTED NAME OF PERSON CONSTRLICTING THE WELL
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH
15A NCAC 2C, WELL CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS
RECOHAS BEEN PROVIDED TO T, EE�r�
WELL OWNER:*
SIGNATURE OF CERTIFIED r ELL CONTRACTOR DATE
A -kJ l?
Submit the original to the Division of Water Quality within 30 days. Attn: Information Mgt.,
1617 Mail Service Center— Raleigh, NC 27699.1617 Phone No. [phone] ext 568.
Form GW-la
Rev. 7/05

RESIDENTIAL WELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources- Division of Water Quality
WELL CONTRACTOR CERTIFICATION # 3041
Uv 64
` �t
1. WELL CONTRACTOR:
PAUL BRYANT BRUCE
Well Contractor (Individual) Name
AAA GREENE BROS. WELL DRLG. OF SYLVA, INC
Well Contractor Company Name
STREET ADDRESS 1800 SKYLAND DRIVE
SYLVA
City or Town
( 828 )- 586-5550
Area code- Phone number
NC
State
2. WELL INFORMATION:
SITE WELL ID #(if applicable)
28779
Zip Code
STATE WELL PERMIT#(if applicable)
DWQ or OTHER PERMIT #(it applicable)
WELL USE (Check Applicable Box): Residential Water Supply Ea
DATE DRILLED 11/9/06
TIME COMPLETED 5:00 AM ❑ PM
3. WELL LOCATION:
CITY: BRYSON CITY
ELA OFF SKYVIEW ROAD
COUNTY SWAIN
(Street Name, Numbers, Community, Subdivision, Lot No., Parcel, Zip Code)
TOPOGRAPHIC / LAND SETTING:
kSlope ❑Valley Li Flat ❑Ridge ❑Other
(check appropriate box)
LATITUDE 3
LONGITUDE
May be in degrees,
minutes, seconds or
in a decimal format
Latitude/longitude source: ❑GPS ❑Topographic map
(location of well must be shown on a USGS topo map and
attached to this fomr if not using GPS)
4. WELL OWNER
OWNER'S NAME JOHN PIERCE
STREET ADDRESS P.O. BOX 1790
BRYSON CITY NC 28713
City or Town State
( 828 )- 341-5556
Area code - Phone number
5. WELL DETAILS:
a. TOTAL DEPTH: 200
Zip Code
b. DOES WELL REPLACE EXISTING WELL? YES 0 NO
c. WATER LEVEL Below Top of Casing: 40 FT.
(Use "+` if Above Top of Casing)
d. TOP OF CASING IS 1 FT. Above Land Surface"
'Top of casing terminated at/or below land surface may require
a variance in accordance with 15A NCAC 2C .0118.
e. YIELD (gpm): 10 METHOD OF TEST AIR
f. DISINFECTION: Type HTH Amount 9 OUNCES
g. WATER ZONES (depth):
From 150 To 153 From 160 To 163
From To From To
From To From To
6. CASING:
From 0 DToot57 Ft. Drgter
From To Ft.
From To Ft.
Thickness/
SB4Pi
7. GROUT: Depth Material
From 0 To 3 Ft. CEMENT
From 3 To 20 Ft. BENTONITE
From To Ft.
AAaterial
Method
TOP
PUMP WITH LPoM PIPE
8. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in.
From To Ft. in. in.
From To Ft. in. in.
9. SAND/GRAVEL PACK:
Depth Size
From To Ft.
From To Ft.
From To Ft.
Material
10. DRILLING LOG
From To Formation Description
0-52 CLAY
52-150 GRANITE
150-153 CAVITY
153-160 GRANITE
160-163 CAVITY
163-200 GRANITE
11. REMARKS:
F
D0 HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE
15A NCAC C, WELL CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS
RECOf ij,S BEEN PROVIDED 7p5HE WELL 0 A'pER
SIGNATURE OF CERTIFIE
P, ,� ut
PRINTED NAM OF PERSON CONSTRUCTING THE WELL
Z.- %
WELL CONTRACTOR DATE
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
LIT?

RESIDENTIAL WELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources- Division of Water Quality
WELL CONTRACTOR CERTIFICATION # 3041
0
1. WELL CONTRACTOR:
PAUL BRYANT BRUCE
Well Contractor (Individual) Name
AAA GREENE BROS. WELL DRLG. OF SYLVA, INC
Well Contractor Company Name
STREET ADDRESS 1800 SKYLAND DRIVE
SYLVA NC
28779
City or Town State
( 828 )_ 586-5550
Area code- Phone number
2. WELL INFORMATION:
SITE WELL ID #(if applicable)
STATE WELL PERMIT#(if applicable)
Zip Code
DWQ or OTHER PERMIT #(if applicable)
WELL USE (Check Applicable Box): Residential Water Supply
DATE DRILLED 12/20/06
TIME COMPLETED 5:00 AM ❑ PM El
3. WELL LOCATION:
CITY: BRYSON CITY COUNTY SWAIN
BLACK FOREST OFF BUCKNER BRANCH
(Street Name, Numbers, Community, Subdivision, Lot No., Parcel, Zip Code)
TOPOGRAPHIC / LAND SETTING:
❑Slope DValley ❑Flat ERidge ❑Other
(check appropriate box)
LATITUDE 3
LONGITUDE
May be in degrees,
minutes, seconds or
in a decimal format
Latitude/longitude source: ❑GPS ❑Topographic map
(location of well must be shown on a USGS topo map and
attached to this form Snot using GPS)
4. WELL OWNER
OWNER'S NAME MITCH ELKINS
STREET ADDRESS 3130 BLACKBOTTOM DRIVE
DECATUR, GA 30019
City or Town State Zip Code
( 678 )_ 773-5312
Area code - Phone number
5. WELL DETAILS:
a. TOTAL DEPTH: 700
b. DOES WELL REPLACE EXISTING WELL? YES ❑ NO
c. WATER LEVEL Below Top of Casing: 200
FT.
(Use "+" if Above Top of Casing)
d. TOP OF CASING IS 1 FT. Above Land Surface
*Top of casing terminated at/or below land surface may require
a variance in accordance with 15A NCAC 2C .0118.
e. YIELD (gpm): 6 METHOD OF TEST AIR
f. DISINFECTION: Type HTH
Amount 31.5 OUNCES
g. WATER ZONES (depth):
From 625 To 628 From 650 To 653
From To From To
From To From To
6. CASING:
From 0 DTot20 Ft. DlAnmeter
From To Ft. 6 7�4
From To Ft.
Thickness/hf
50W21 Ries
7. GROUT: Depth Material Method
From 0 To 3 Ft. CEMENT TOP
From 3 To 20 Ft. BENTONITE RIMP WITH TRIM PIPE
From To Ft.
8. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in.
From To Ft. in. in.
From To Ft. in. in.
9. SAND/GRAVEL PACK:
Depth Size Material
From To Ft. _
From To Ft.
From To Ft.
10. DRILLING LOG
From To
0-15
Formation Description
CLAY
15-625 GRANITE
625-628 CAVITY
628-650 GRANITE
650-653
653-700
11. REMARKS:
CAVITY
GRANITE
1 DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH
15A N C 2C, WELL CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS
REC `SBEEN PRTO THE WEL NER.
/'0J
SI ATURE OF CERT FIED WE CONTRACTOR DATE
96// )- id'✓&'.t
PRINTED NAME 0 PERSON CONSTRUCTING ONSTRUCTING 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
63

RESIDENTIAL WELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources -Division of Water Quality
WELL CONTRACTOR CERTIFICATION # 3041
338053
1. WELL CONTRACTOR:
PAUL BRYANT BRUCE
Well Contractor (Individual) Name
AAA GREENE BROS. WELL DRLG. OF SYLVA, INC
Well Contractor Company Name
STREET ADDRESS 1800 SKYLAND DRIVE
SYLVA NC 28779
City or Town State Zip Code
( 828 )- 586-5550
Area code- Phone number
2. WELL INFORMATION:
SITE WELL ID #(if applicable)
STATE WELL PERMIT(t(if applicable)
DWQ or OTHER PERMIT #(if applicable)
WELL USE (Check Applicable Box): Residential Water Supply tE
DATE DRILLED 6/14/06
TIME COMPLETED 5:00 AM ❑ PM RI
3. WELL LOCATION:
CITY: BRYSON CITY COUNTY SWAIN
LAND CREEK LOG CABINS OFF FRANKLIN GROVE ROAD
(Street Name, Numbers, Community, Subdivision, Lot No., Parcel, Zip Code)
TOPOGRAPHIC / LAND SETTING:
Al Slope °Valley ❑Flat ❑Ridge ❑Other
(check appropriate box)
LATITUDE 3
LONGITUDE
May be in degrees,
minutes, seconds or
in a decimal fomtat
Latitude/longitude source: ❑GPS oTopographic map
(location of well must he shown an a USGS topo map and
attached to this form if not using GPS)
4. WELL OWNER
OWNER'S NAME ROBIN FRONRATH
STREET ADDRESS 3336 BALLTOWN ROAD
BRYSON CITY NC 28713
City or Town State Zip Code
( 828 )- 736-2319
Area code - Phone number
5. WELL DETAILS:
a. TOTAL DEPTH: 200
b. DOES WELL REPLACE EXISTING WELL? YES 0 NO fg
c. WATER LEVEL Below Top of Casing: 50 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 9 OUNCES
g. WATER ZONES (depth):
From 50 To 53 From To
From To From To
From To From To
6. CASING: Thickness/
From 0 Depth
Ft. Dlatneter V ���3 Nlatenal
From To Ft. 6'1 �4 Vega!
From To Ft.
7. GROUT: Depth Material Method
From 0 To 3 Ft. CEMENT TOP
From 3 To 20 Ft. BENTONITE PUMPwrtn TRIM PIPE
From To Ft.
8. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in.
From To Ft. in. in.
From To Ft. in. in.
9. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
From To Ft.
10. DRILLING LOG
From To Formation Description
0-23 CLAY
23-50 GRANITE
50-53 CAVITY
53-200 GRANITE
RELEIVEu
11. REMARKS: E71V. (�F WATER QUALITY
li i° 20117
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 O NER.
vj 71 2._ -
SIGNATURE OF CERTIFIED WELL CONTRACTOR DATE
Ali )? e 404: tf
PRINTED NAME OF PERSON CONSTRUCTING THE WELL
Submit the original to the Division of Water Quality within 30 days. Attn: Information Mgt.,
1617 Mail Service Center —Raleigh, NC 27699-1617 Phone No. [phone] ext 568.
Form GW-la
Rev. 7/05

RESIDENTIAL WELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources- Division of Water Quality
WELL CONTRACTOR CERTIFICATION # 3041
1. WELL CONTRACTOR:
PAUL BRYANT BRUCE
Well Contractor (Individual) Name
AAA GREENE BROS. WELL DRLG. OF SYLVA, INC
Well Contractor Company Name
STREET ADDRESS 1800 SKYLAND DRIVE
SYLVA
City or Town
( 828 )_ 586-5550
NC
State
28779
Zip Code
Area code- Phone number
2. WELL INFORMATION:
SITE WELL ID #(if applicable)
STATE WELL PERMIT#(if applicable)
DWQ or OTHER PERMIT *Of applicable)
WELL USE (Check Applicable Box): Residential Water Supply Ei
DATE DRILLED 8/28/06
TIME COMPLETED 5:00 AM ❑ PM
3. WELL LOCATION:
CITY: BRYSON CITY COUNTY SWAIN
BLACK BEAR OFF MAIN STREEET
(Street Name, Numbers, Community, SubdMsion, Lot No., Parcel, Zip Code)
TOPOGRAPHIC / LAND SETTING:
INSlope ❑Valley ❑Flat ❑Ridge ❑Other
(check appropriate box)
LATITUDE 3
LONGITUDE
Latitude/longitude source: ❑GPS ❑Topographic map
(location of well must be shown on a USGS topo map and
attached to this form if not using GPS)
4. WELL OWNER
OWNER'S NAME ROLLIN SMITH
May be in degrees,
minutes, seconds or
in a decimal format
STREET ADDRESS P.O. BOX 880
BRYSON CITY NC 28713
City or Town State Zip Code
( 828 )_ 736-2174
Area code - Phone number
5. WELL DETAILS:
a. TOTAL DEPTH: 410
b. DOES WELL REPLACE EXISTING WELL? YES ❑ NO
c. WATER LEVEL Below Top of Casing: 40 FT.
(Use "+" if Above Top of Casing)
d. TOP OF CASING IS 1 FT. Above Land Surface*
*Top of casing terminated at/or below land surface may require
a variance in accordance with 15A NCAC 2C .0118.
e. YIELD (gpm): 17.5 METHOD OF TEST AIR
33 052
f. DISINFECTION: Type HTH
g. WATER ZONES (depth):
From 65 To 68
Amount 18.45 OUNCES
From 360 To 363
From To From To
From To From To
6. CASING:
Depth
From 0 To 21
From To
From To
Ft. 6
Ft.
Ft.
Thickness/
181491 Matefial
7. GROUT: Depth Material Method
From 0 To 3 Ft.CEMENT TOP
From 3 To 20 Ft. BENTONITE PUMP wnx TRIM PIPE
From To Ft.
8. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in.
From To Ft. in. in.
From To Ft. in. in.
9. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
From To Ft.
10. DRILLING LOG
From To Formation Description
0-16 CLAY
16-65 GRANITE
65-68
68-360
CAVITY
GRANITE
360-363 CAVITY
363-410 GRANITE
11. REMARKS:
RECEIVED
DIV,1OFWATER QU
AL.ITY
':EB g 2 200?
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH
15A NCAC 2C. WELL CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS
RECORD HAS BEEN PROVIDED TO THE WELL OWNER.
SIGNATURE OF CER IFIED WELL CONTRA OR DATE
P INTED NAME OF PERSON CONSTRUCTING THE WELL
Submit the original to the Division of Water Quality within 30 days. Attn: Information Mgt.,
1617 Mail Service Center- Raleigh, NC 27699-1617 Phone No. [phone] ext 568.
Form GW-la
Rev. 7/05

RESIDENTIAL WELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources- Division of Water Quality
WELL CONTRACTOR CERTIFICATION # 2186
1. WELL CONTRACTOR:
J.D. MCCURRY
Well Contractor (Individual) Name
AAA GREENE BROS. WELL DRLG. OF SYLVA, INC
Well Contractor Company Name
STREET ADDRESS 1800 SKYLAND DRIVE
SYLVA NC
City or Town State
( 828 ). 586-5550
Area code- Phone number
2. WELL INFORMATION:
SITE WELL ID #(if applicable)
28779
Zip Code
STATE WELL PERMITS/(if applicable)
DWQ or OTHER PERMIT #(if applicable)
WELL USE (Check Applicable Box): Residential Water Supply
DATE DRILLED 9/12/06
TIME COMPLETED 5:00 AM ❑ PM
ELI
3. WELL LOCATION:
CITY: BRYSON CITY COUNTY SWAIN
BERRY BRANCH OFF MAIN STREET
(Street Name, Numbers, Community, Subdivision, Lot No., Parcel, Zip Code)
TOPOGRAPHIC / LAND SETTING:
,Slope DValley ❑Flat ❑Ridge ❑Other
(check appropriate box)
LATITUDE 3
LONGITUDE
May be in degrees,
minutes, seconds or
in a decimal format
latitude/longitude source: ❑GPS ❑Topographic map
(location of well must be shown on a USGS topo map and
attached to this form if not using GPS)
4. WELL OWNER
OWNER'S NAME ROLLIN SMITH
STREET ADDRESS P.O. BOX 880
BRYSON CITY, NC 28713
City or Town State
( 828 )- 736-2174
Area code - Phone number
5. WELL DETAILS:
a. TOTAL DEPTH: 800
Zip Code
b. DOES WELL REPLACE EXISTING WELL? YES ❑ NO
zi
c. WATER LEVEL Below Top of Casing: 250 FT
(Use "+- if Above Top of Casing)
d. TOP OF CASING IS 1 FT. Above Land Surface*
*Top of casing terminated at/or below land surface may require
a variance in accordance with 15A NCAC 2C .0118.
e. YIELD (gpm): 3 METHOD OF TEST AIR
f. DISINFECTION: Type HTH
g. WATER ZONES (depth):
From 250 To 253
Amount 36 OUNCES
From 690 To 693
From To From
To
From To From To
6. CASING:
From 0
From
Depth
To 120 Ft.#ter
To Ft.
From To Ft.
IBCV1y�
IBC Weal
7. GROUT: Depth Material Method
From 0 To 3 Ft. CEMENT TOP
From 3 To 20 Ft. BENTONITE wwvnrx TRPMpI_E
From To Ft.
8. SCREEN: Depth Diameter Slot Size
From To Ft. in. in.
From To Ft. in. in.
From To Ft. in. in,
9. SAND/GRAVEL PACK:
Depth
From
From
From
Size
To Ft.
To Ft.
To Ft.
10. DRILLING LOG
From To
0-115
115-250
250-253
Material
Material
Formation Description
CLAY
GRANITE
CAVITY
253-690 GRANITE
690-693 CAVITY
693-800 GRANITE
11. REMARKS:
1�)V.OF ATCRODALITY
FEU 1 2 ZOO/
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH
15A NCAC 2C, WELL CONSTRUCTION STANDARDS, AND THATA COPY OF THIS
RECORD HAS BEEN PROVIDED TO THE WELL OWNER.
- M C,,,,rr'-M� 9-.07-07
SIGNATURE OF CERTIFIED WEL& CONTRACTOR DATE
ME -at
PRINTED NAME OF PERSON CONS RUCTING THE WELL
Submit the original to the Division of Water Quality within 30 days. Attn: Information Mgt.,
1617 Mail Service Center - Raleigh, NC 27699-1617 Phone No. [phone] ext 568.
Form GW-la
Rev. 7/05

RESIDENTIAL WELL CONSTRUCTION RECORD
North Cumbria Uctnnrncnt of I nvinnnnmd and Rotund Resources- Division or\Valor Quality
WELL CONTRACTOR CERTIFICATIONft 3368
1. WELL CONTRACTOR:
WILLIAM BRADLEY LEWIS
Wen Contractor (Individual) Name
CHEROKEE WELL DRILLING
Well Contractor Company Name
STREET ADDRESS PO BOX 1007
MURPHY NC
28906
City or Tovn State Zip Code
(2828 )- 837-8008
Area code- Phone number
2. WELL INFORMATION:
SITE WELL ID #(if applicable)
STATE WELL PERMIT#(if applicable)
DWQ or OTHER PERMIT Cif applicable)
WELL USE (Check Applicable Box): Residential Water Supply 17
DATE DRILLED 03/13/06
TIME COMPLETED
3. WELL LOCATION:
CITY: BRYSON CITY
AM p PMD
COUNTY MACON
SILVERMINE/GRANT ESTATES LOT #43
(Street Name, Numbers, Community. Subdivision, Lot No., Parcel, Zip Code)
TOPOGRAPHIC / LAND SETTING:
DSlope Malley ❑Flat ®Ridge DOther
(check appropriate box)
LATITUDE 3 5
LONGITUDE 8 3
18.060N
36.472W
May be in degrees,
minutes, seconds or
in a decimal formal
Latitude/longitude source: f9G1'S ❑Topographic map
(location of we) must be shown on a USGS repo map end
attached to this form if not using GPS)
4. WELL OWNER
OWNER'S NAME CINDY RIOS
STREET ADDRESS 115 WEST 41h AVE.
TALLAHASSEE FL
32303
City or Town State Zip Code
( 850 )- 425-2897
Area code - Phone number
5. WELL DETAILS:
a. TOTAL DEPTH: 605'
b. DOES WELL REPLACE EXISTING WELL? YES D NO 13
c. WATER LEVEL Below Top of Casing: 250 FT.
(Use "+" if Above Top of Casing)
d. TOP OF CASING IS 1 FT. Above Land Surface'
'Top of casing terminated at/or below land surface may require
a variance in accordance with 15A NCAC 2C .0118.
e. YIELD (gpm): 2 METHOD OF TEST AIR
324474
f. DISINFECTION: Type CHLORINE
Amount 100 PPM
g. WATER ZONES (depth):
From To From To
From To From To
From To From To
6. CASING: TVhickhn1ess/
From 0' Depth 40, Ft. 6 l,4meter VS18�21 Material
From To Ft. FVC
From To Ft.
7. GROUT: Depth Material
Frorn 0 To 20' Ft CEMENT
From -To Ft.
From To Ft.
Method
GRAVITY
8. SCREEN: Depth Diameter Slot Size Material
From To Ftin. in.
From To Ft. in. in.
From To Ft. In. in.
9. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
From To Ft.
10. DRILLING LOG
From To Formaton Description
0' TO 20' BLACK TAN DIRT/BLUE SLATE
20' TO 40' BLUE SLATE
40' TO 605'
11. REMARKS:
BLUE SLATE
CEIVFD
Asheville Regional Office
Aauifer Protection
1 DOIIEREBY CER WY it TA r THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH
15A NCAC 2C, WELL CONSTRUCTION SIANDARDS. AND T11AT A COPY OF THIS
RECORD HAS BEEN PROVIDED 10 THE WELL OWNER.
AA
SIGNATURE OF CERTIFIE
L�1.lJ
CONTRACTOR DATE
03/20/06
LUtLI.)NL 6Qt. 4 ms5
PRINTED NAME OF PERSON CONSTRUCTING THE WELL
Submit the original to the Division of Water Quality within 30 days. Attn: Information Mgt,
1617 Mali Service Center — Raleigh, NC 27699-1817 Phone No. [phone] ext 568.
Form GW-la
Rev. 7/05